2013-02-05T14:20:19-06:00 2012-06-30 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2011-07-01 237328642 UNIVERSITY PEDIATRIC ASSOCIATES INC UNIV 3172741201 550 NORTH MERIDIAN STREET NO 228 INDIANAPOLIS IN 46202 DR D WADE CLAPP 3172741201 2013-01-31 1 DON BOEZEMAN P01000722 3175802000 2013-01-31 2011 2016-02-25 16:41:14Z DR D WADE CLAPP 550 N MERIDIAN ST SUITE 228 INDIANAPOLIS IN 46202 99312341 0 X N/A X 1973 IN THE ORGANIZATION'S PRIMARY EXEMPT PURPOSE IS TO ENGAGE ACTIVELY AND CONTINUOUSLY IN MEDICAL RESEARCH AND TO PROVIDE MEDICAL EDUCATION AND MEDICAL RESEARCH IN CONJUNCTION WITH SERVING AS AN AUXILIARY TO THE OPERATION OF THE DEPARTMENT OF PEDIATRICS OF INDIANA UNIVERSITY SCHOOL OF MEDICINE AND ITS HOSPITALS. 15 15 0 0 0 0 1749541 2422306 66551342 69539580 1521728 1820089 0 366062 69822611 74148037 32878804 33804332 0 0 6566605 8933596 0 0 0 33817676 39344512 73263085 82082440 -3440474 -7934403 37882732 30459111 0 0 37882732 30459111 X THE ORGANIZATION'S PRIMARY EXEMPT PURPOSE IS TO ENGAGE ACTIVELY AND CONTINUOUSLY IN MEDICAL RESEARCH AND TO PROVIDE MEDICAL EDUCATION AND MEDICAL RESEARCH IN CONJUNCTION WITH SERVING AS AN AUXILIARY TO THE OPERATION OF THE DEPARTMENT OF PEDIATRICS OF INDIANA UNIVERSITY SCHOOL OF MEDICINE AND ITS HOSPITALS. 0 0 33031755 33031755 VARIOUS CONTRIBUTIONS TO INDIANA UNIVERSITY FOUNDATION AND INDIANA UNIVERSITY SCHOOL OF MEDICINE 772577 772577 CHARITABLE CONTRIBUTIONS TO VARIOUS MEDICAL INSTITUTIONS 186719 THE ORGANIZATION PROVIDES ADMINISTRATIVE AND COLLECTION SERVICES FOR INDIANA UNIVERSITY FACULTY AND PHYSICIANS 32728084 PHYSICIAN CONTRACTS FOR RESEARCH, EDUCATION, AND PATIENT CARE 32728084 66719135 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 1 1 IN X HELEN BRODY ADMINISTRATIVE DIRECTO 3172741211 550 NORTH MERIDIAN STREET INDIANAPOLIS IN 46204 DR RANDALL L CALDWELL 40.00 X X 209981 0 0 DR D WADE CLAPP 40.00 X X 140415 0 0 DR HOWARD EIGEN 40.00 X 325000 0 0 DR ROBERT J FALLON 40.00 X 158975 0 6500 DR SHARON P ANDREOLI 40.00 X 98104 0 0 DR ERICA A EUGSTER 40.00 X 136394 0 4920 DR DAVID A INGRAM JR 40.00 X X 263314 0 8083 DR EUGENIA P MOLLESTION 40.00 X 218000 0 4920 DR JOHN C CHRISTENSON 40.00 X 159395 0 8000 DR STEPHEN M DOWNS 40.00 X 137681 0 9000 DR STEPHANIE DAVIS 40.00 X 147375 0 0 DR ABIGAIL F KLEMSZ 40.00 X 261474 0 9000 DR VAUGHN I RICKERT 40.00 X 114964 0 8000 DR JAMES A LEMONS 40.00 X 189917 0 0 DR ALEXANDRE T ROTTA 40.00 X 448400 0 9000 DR MARK RIGBY 40.00 X 406300 0 0 DR SHEKHAR RAJ 40.00 X 391479 0 10000 DR DAVID HERTZ 40.00 X 313526 0 6360 4120694 0 83783 17 0 1 0 0 2422306 2422306 PATIENT SERVICES 621110 69539580 69539580 69539580 803349 803349 26181044 25164304 1016740 1016740 1016740 ROC SURGERY CENTER K-1 621400 366062 366062 366062 74148037 69905642 0 1820089 33804332 33804332 7363513 7363513 1570083 1570083 45983 45983 174237 174237 1053861 186719 867142 404627 404627 1229399 1229399 376225 376225 PHYSICIAN CONTRACTS 32728084 32728084 OUTSIDE SERVICE EXPENSE 1169568 1169568 MALPRACTICE INSURANCE 1136795 1136795 MISCELLANEOUS 853498 853498 172235 172235 82082440 66719135 15363305 0 5888671 5896014 390000 0 3107300 605303 707199 2501997 30784005 21967769 112857 93331 37882732 30459111 0 0 X 37882732 30459111 37882732 30459111 37882732 30459111 X -7934403 510782 X X 0 1 1 X 1 1 X 1108741 1396376 1749541 2422306 6676964 1108741 1396376 1749541 2422306 6676964 6676964 1823690 1160495 946270 924962 803349 5658766 12335730 319864600 0.54130 0.46700 X 2787154 542938 2244216 320146 62365 257781 2501997 74148037 82082440 -7934403 -1813427 2324209 510782 -7423621 74658819 -1813426 2324208 510782 74148037 0 74148037 82062914 -19526 -19526 82082440 0 82082440 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: UPA IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. IN ADDITION, UPA HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEARS ENDED JUNE 30, 2012 AND 2011. UPA FILES U.S. FEDERAL AND STATE OF INDIANA INFORMATION RETURNS. UPA IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE OF INDIANA TAX EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS BEFORE 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: INCOME FROM INVESTMENTS 2,324,209. PART XII, LINE 2D - OTHER ADJUSTMENTS: INCOME FROM INVESTMENT 2,324,208. PART XIII, LINE 2D - OTHER ADJUSTMENTS: LOSS FROM JOINT VENTURE -19,526. 1 INDIANA UNIV FOUNDATION S STATE ROAD 46 BLOOMINGTON IN 47401 356018940 501(C)(3) 33031755 TO PROVIDE MEDICAL EDUCATION AND MEDICAL RESEARCH IN CONJUNCTION WITH SERVING AS AN AUXILIARY TO THE OPERATION OF THE DEPARTMENT OF PEDIATRICS OF INDIANA UNIVERSITY SCHOOL OF MEDICINE AND ITS HOSPITALS. VARIOUS MEDICAL PROGRAMS S STATE ROAD 46 BLOOMINGTON IN 47401 772577 TO PROVIDE MEDICAL EDUCATION AND MEDICAL RESEARCH IN CONJUNCTION WITH SERVING AS AN AUXILIARY TO THE OPERATION OF THE DEPARTMENT OF PEDIATRICS OF INDIANA UNIVERSITY SCHOOL OF MEDICINE AND ITS HOSPITALS. 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TERESA HUTCHISON RECEIVES REQUESTS FROM PEDIATRIC DEPARTMENTS TO SET UP PURCHASE ORDERS FOR PHYSICIANS UPA SALARIES ON FEDERAL AND NON-FEDERAL GRANTS. TERESA HUTCHISON THEN REQUESTS PURCHASE ORDERS WITH APPROVAL GOING THROUGH THE REQUESTING DEPARTMENT. ONCE APPROVAL OF THE PURCHASE ORDER IS RECEIVED, TERESA BILLS BASED ON THE IU SALARY PERCENTAGE CHARGED TO THE ACCOUNT. THE REQUESTING DEPARTMENT MONITORS THE OVERALL SPENDING OF THE GRANT ACCOUNTS. THE BILLING OF THE SALARY BY TERESA CANNOT EXCEED THE AMOUNT OF THE INITIAL PURCHASE ORDER. 1 X X 0 0 0 0 0 0 0 0 0 DR RANDALL L CALDWELL 209981 0 0 0 0 0 0 0 0 0 209981 0 0 0 DR HOWARD EIGEN 325000 0 0 0 0 0 0 0 0 0 325000 0 0 0 DR ROBERT J FALLON 158975 0 0 0 0 0 6500 0 0 0 165475 0 0 0 DR DAVID A INGRAM JR 263314 0 0 0 0 0 8083 0 0 0 271397 0 0 0 DR EUGENIA P MOLLESTION 218000 0 0 0 0 0 4920 0 0 0 222920 0 0 0 DR JOHN C CHRISTENSON 159395 0 0 0 0 0 8000 0 0 0 167395 0 0 0 DR ABIGAIL F KLEMSZ 261474 0 0 0 0 0 9000 0 0 0 270474 0 0 0 DR JAMES A LEMONS 189917 0 0 0 0 0 0 0 0 0 189917 0 0 0 DR ALEXANDRE T ROTTA 448400 0 0 0 0 0 9000 0 0 0 457400 0 0 0 DR MARK RIGBY 406300 0 0 0 0 0 0 0 0 0 406300 0 0 0 DR SHEKHAR RAJ 391479 0 0 0 0 0 10000 0 0 0 401479 0 0 0 DR DAVID HERTZ 313526 0 0 0 0 0 6360 0 0 0 319886 0 0 0 SUPPLEMENTAL INFORMATION PART III COMPENSATION RELATES TO MEDICAL SERVICES PROVIDED, NOT AS COMPENSATION FOR SERVING ON THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 FORM 990, WHICH IS PREPARED BY A CPA FIRM, IS REVIEWED IN DETAIL BY THE ORGANIZATION'S BUSINESS MANAGER, ADMINISTRATOR AND OTHER ACCOUNTING PERSONNEL. IN ADDITION, FORM 990 IS PRESENTED TO THE BOARD OF DIRECTOR'S FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C UPA BOARD REVIEWS AND MONITORS ALL COMPLIANCE IN ACCORDANCE WITH UPA'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A UPA BOARD WILL VOTE AND DETERMINE THE COMPENSATION BASED ON EXTERNAL AND INTERNAL FACTORS. FORM 990, PART VI, SECTION C, LINE 18 AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,813,427. INCOME FROM INVESTMENTS 2,324,209. TOTAL TO FORM 990, PART XI, LINE 5: 510,782. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR. PICU INVESTMENTS LLC 575 WEST DR ROOM XE 010 INDIANAPOLIS IN 46209 201530701 INVESTMENT HOLDINGS IN INVESTMENT 1652502 0 0 NICU INVESTMENTS LLC 575 WEST DR ROOM XE 010 INDIANAPOLIS IN 46209 201530584 INVESTMENT HOLDINGS IN INVESTMENT 826268 0 0 ROC SURGERY LLC 340 WEST 10TH STREET INDIANAPOLIS IN 46202 271497960 AMBULATORY SURGERY CENTER PERFORMING ONLY OUTPATIENT PROCEDURES IN RELATED 366062 225000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0