2012-03-05T08:27:01-06:00 2011-06-30 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2010-07-01 352134193 INDIANA UNIVERSITY HEALTH PROTON THERAPY CENTER LLC INDI 8123495074 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 JOHN R KERSTIENS 8123495028 2012-03-05 1 KEISHA CORSO CPA 3176334705 2010 2016-02-24 21:20:13Z MIDWEST PROTON RADIOTHERAPY INSTITUT JOHN R KERSTIENS CPA 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 17545107 0 X WWW.IUHEALTHPROTONTHERAPY.ORG X LLC - LIMITED LIABILITY COMPANY 2001 IN MEDICAL CLINIC THAT USES UNIQUE PROTON BEAM TECHNOLOGY TO TREAT CANCER VICTIMS. 5 4 67 3 0 0 1626408 22792 16462551 17511463 9368 4731 2115 6121 18100442 17545107 8112 290 0 0 4980223 4516326 0 0 0 13516484 13104248 18504819 17620864 -404377 -75757 29841210 27598376 20844910 18677833 8996300 8920543 TO LEVERAGE OUR UNIQUE TECHNOLOGY TO IMPROVE OUR PATIENTS' HEALTH, AND PROMOTE INNOVATION IN EDUCATION AND RESEARCH. 0 0 16111900 290 17511463 IU HEALTH PROTON THERAPY CENTER USES PROTON BEAM ENERGY TO TREAT CANCER VICTIMS. OUR PATIENTS ARE SELECTED BASED ON TYPE OF CANCER, EFFICIENCY OF TREATMENT AND WITHOUT REGARD TO THE PATIENTS' ABILITY TO PAY. UNINSURED CARE WAS APPROXIMATELY $650,782 FOR THE YEAR ENDED JUNE 30, 2011. 16111900 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 0 1 67 1 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 0 0 1 0 IN X JOHN KERSTIENS CPA 8123495074 2425 N MILO B SAMPSON LN BLOOMINGTON IN 47408 DR PETER JOHNSTONE 16.00 X X 0 0 0 RICHARD S HELSPER 16.00 X X 36240 0 3606 TOM MARTIN 1.00 X 0 0 0 MARVIN PEMBER 1.00 X 0 0 0 DOUGLAS PRIEST 1.00 X 0 0 0 ISADORE RIVAS 1.00 X 0 0 0 WILLIAM STEPHAN 1.00 X 0 0 0 JOHN KERSTIENS 40.00 X 142041 0 19038 KARIN CAMPBELL 40.00 X 77462 0 22221 DR ALLAN THORNTON 40.00 X 320852 0 35387 CHRIS ALLGOWER 40.00 X 128482 0 33093 MARK WOLANSKI 40.00 X 130446 0 31872 REGINALD V SIMONEAUX 40.00 X 91163 0 21523 LI ZHAO 40.00 X 101670 0 11607 937193 0 156824 5 0 1 0 UNIVERSITY RADIATION ONCOLOGY ASSOC 535 BARNHILL DRIVE INDIANAPOLIS IN 46202 PHYSICIAN AND PHYSICISTS 2122507 BLOOMINGTON ANESTHESIOLOGISTS PO BOX 2121 DEPT 1438 MEMPHIS TN 38159 ANESTHEIOLOGISTS 243625 SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DEPT 0733 DALLAS TX 75312 MEDICAL EQUIPMENT SOLUTIONS/SERVICE 220460 ELEKTA 13723 CORPORATE LAKE DR MARYLAND HEIGHTS MO 63043 COMPUTERIZED MEDICAL SYSTEM SERVICES 144000 BAKER & DANIELS 600 EAST 96TH STREET STE 600 INDIANAPOLIS IN 46240 LEGAL SERVICES 138618 7 22792 19860 22792 PATIENT SERVICE REVENU 621110 17511463 17511463 17511463 4731 4731 6121 6121 6121 17545107 17511463 0 10852 290 290 325317 276519 48798 3134780 3134780 330248 280711 49537 472087 401274 70813 253894 215810 38084 101688 101688 50493 50493 4050041 4050041 22818 22818 440988 370430 70558 1510227 1208182 302045 72631 72631 11677 11677 441803 441803 2082177 1769850 312327 34383 34383 PROTON BEAM EXPENSE 4100007 4100007 BAD DEBT 56652 56652 DUES & SUBSCRIPTIONS 47356 47356 RECRUITING 35198 35198 46109 46109 17620864 16111900 1508964 0 100 100 2638865 1864714 2512929 2374916 1387 76810 21582064 5850228 16537929 15731836 8150000 7550000 29841210 27598376 1346964 1040115 1327184 966794 18170762 16670924 20844910 18677833 X 8996300 8920543 8996300 8920543 29841210 27598376 -75757 0 X X 0 1 1 X 0 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART I, LINE 3, HOSPITAL: IU HEALTH PROTON THERAPY CENTER HAS BEEN DETERMINED BY THE IRS TO BE A PUBLIC CHARITY UNDER IRS CODE SECTION 170(B)(1)(A)(III). PER SCHEDULE H INSTRUCTIONS ONLY ORGANIZATIONS THAT OPERATE AT LEAST ONE FACILITY THAT IS, OR IS REQUIRED TO BE, LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL IS REQUIRED TO COMPLETE THE SCHEDULE. IU HEALTH PROTON THERAPY IS A CANCER TREATMENT CENTER AND IS NOT LICENSED AS A HOSPITAL FOR THE STATE OF INDIANA. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14772495 3211953 11560542 5234215 2638275 2595940 1575354 1575354 15731836 DUE TO INDIANA UNIVERSITY 16670924 16670924 17545107 17620864 -75757 0 -75757 17545107 0 17545107 0 17545107 17620864 0 17620864 0 17620864 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 SUPERSEDED BY FASB CODIFICATION: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY IUHPTC AND RECOGNIZE A TAX LIABILITY IF IUHPTC HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY IUHPTC, AND HAS CONCLUDED THAT AS OF JUNE 30, 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. IUHPTC IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 0 0 0 0 0 0 JOHN KERSTIENS 142041 0 0 0 0 0 13591 0 5447 0 161079 0 0 0 DR ALLAN THORNTON 320852 0 0 0 0 0 33507 0 1880 0 356239 0 0 0 CHRIS ALLGOWER 128482 0 0 0 0 0 31250 0 1843 0 161575 0 0 0 MARK WOLANSKI 130446 0 0 0 0 0 31195 0 677 0 162318 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A DOMESTIC LIMITED LIABILITY COMPANY WITH TWO CORPORATE MEMBERS AND A BOARD OF MANAGERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBERS INDIANA UNIVERSITY RESEARCH AND TECHNOLOGY CORPORATION AND INDIANA UNIVERSITY HEALTH, INC. EACH SELECT TWO BOARD MANAGERS AND UNANIMOUSLY VOTE ON ONE "ELECTED" MANAGER TO THE GOVERNING BOARD OF MANAGERS. FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S CFO AND BY THE CORPORATE MEMBERS' TAX DEPARTMENTS. THE GOVERNING BODY REVIEWS AND APPROVES THE FORM 990 AND THE FINAL FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, ARE PROVIDED ELECTRONICALLY TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE IS ENFORCED BY THE DIRECTOR OF HUMAN RESOURCES/ ADMINISTRATION AND DIRECTOR'S TEAM. THE SCOPE OF THIS POLICY INCLUDES ALL MEMBERS OF THE ORGANIZATION'S BOARD OF MANAGERS, ALL EMPLOYEES, AND ALL CONTRACTED PROFESSIONALS. THE POLICY IS IN PLACE TO PREVENT ANY POTENTIAL CONFLICTS OF PERSONAL PROFIT OR GAIN, DIRECTLY OR INDIRECTLY, BY REASON OF HIS OR HER PARTICIPATION WITH OR EMPLOYMENT BY THE ORGANIZATION. IN ADDITION COVERED PERSONS ARE TO REFRAIN FROM OBTAINING ANY LIST OF THE ORGANIZATION'S PATIENTS, REFERRING PHYSICIANS AND VENDORS FOR PERSONAL OR PRIVATE SOLICITATION PURPOSES. A SELF DISCLOSURE FROM COVERED PERSONS TO THE ORGANIZATION'S LEADERSHIP IS REQUIRED ON ANY POTENTIAL INTEREST WITH VENDORS, PATIENTS OR OTHER MATTERS. ANY POTENTIAL CONFLICTS DISCLOSED ARE REVIEWED AND RESEARCHED BY COMPLIANCE PERSONNEL AND BROUGHT TO THE BOARD OF MANAGERS FOR REVIEW. THE COVERED PERSONS ARE TO RECUSE FROM PARTICIPATING IN ANY DELIBERATION OR DECISION ON SUCH TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15B THE CEO (TOP MANAGEMENT OFFICIAL) OF THE ORGANIZATION HAS BEEN SELECTED BY THE ORGANIZATION'S CORPORATE MEMBERS TO SERVE AS BOARD MEMBER AND MANAGEMENT OFFICIAL FOR THE ORGANIZATION. THIS OFFICER DOES NOT RECEIVE COMPENSATION FROM THE ORGANIZATION AND THEREFORE COMPENSATION DETERMINATION IS NOT REQUIRED BY THE ORGANIZATION. THE PROCESS FOR DETERMINING THE COMPENSATION OF THE COO AND ALL OTHER ORGANIZATION'S OFFICERS AND KEY EMPLOYEES INCLUDED A REVIEW AND APPROVAL BY THE GOVERNING BODY. COMPARISON WITH MEMBER INSTITUTIONS AND LOCAL PROVIDERS WAS MADE DURING THE REVIEW OF THE COMPENSATION. THE DELIBERATION AND DECISION MADE ON THE COMPENSATION WAS CONTEMPORANEOUSLY SUBSTANTIATED IN THE MINUTES OF THE BOARD OF MANAGERS. IN ADDITION A WRITTEN COMPENSATION AGREEMENT OUTLINES ALL COMPENSATION ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC. REQUESTS CAN BE MADE BY PHONE OR MAIL. OVERSIGHT OF THE AUDIT FORM 990, PART XII, LINE 2C THE BOARD OF MANAGERS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. FORM 990, PAGE 1, HEADING B, NAME CHANGE: INDIANA UNIVERSITY HEALTH PROTON THERAPY CENTER, LLC CHANGED ITS NAME DURING THE TAX YEAR AND THE NAME CHANGE HAS BEEN FILED AND UPDATED WITH THE INTERNAL REVENUE SERVICE AND INDIANA SECRETARY OF STATE. IU HEALTH PROTON THERAPY CENTER WILL CONTINUE DOING BUSINESS UNDER THE ASSUMED BUSINESS NAME OF MIDWEST PROTON RADIOTHERAPY INSTITUTE, LLC. NO OTHER CHANGES HAVE BEEN MADE TO IU HEALTH PROTON THERAPY CENTER'S GOVERNING DOCUMENTS.