2015-02-12T13:23:02-06:00 2014-06-30 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2013-07-01 352134193 INDIANA UNIVERSITY HEALTH PROTON THERAPY CENTER LLC INDI 8123495074 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 DR PETER NALIN PRESIDENT & CEO 8128562548 2015-02-10 1 AMBER KOCHER CPA P01286298 3176334705 2013 2016-03-07 17:11:31Z MIDWEST PROTON RADIOTHERAPY INSTITUTE LLC DR PETER NALIN 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 29620754 0 X WWW.IUHEALTHPROTONTHERAPY.ORG X LLC - LIMITED LIABILITY COMPANY 2001 IN CANCER TREATMENT CENTER THAT UTILIZES UNIQUE PROTON BEAM TECHNOLOGY TO TREAT CANCER PATIENTS. 5 5 73 0 0 0 1736112 13957935 16221548 15651910 3090 3105 3134 7804 17963884 29620754 8873 0 0 0 5124374 4694522 0 0 0 15166827 12755942 20300074 17450464 -2336190 12170290 22671251 20447565 16614320 2220344 6056931 18227221 X TO LEVERAGE OUR UNIQUE TECHNOLOGY TO IMPROVE OUR PATIENTS' HEALTH AND PROMOTE INNOVATION IN EDUCATION AND RESEARCH. 0 1 16193565 15651910 IU HEALTH PROTON THERAPY CENTER (THE CENTER) USES PROTON BEAM ENERGY TO TREAT CANCER PATIENTS. 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 $355,433 FOR THE YEAR ENDED JUNE 30, 2014. 16193565 1 1 0 0 0 0 0 0 0 1 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 1 0 0 0 0 0 0 0 0 1 6 0 1 73 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 IN X JOAN HAGEN 8128562548 2425 N MILO B SAMPSON LN BLOOMINGTON IN 47408 DR PETER NALIN CEO/PRESIDENT & BOARD MEMB 16.00 X X 0 0 0 HOLLY GOE BOARD MEMBER 1.00 X 0 0 0 JOAN HAGEN BOARD MEMBER 1.00 X 0 0 0 ERIN LEWIS BOARD MEMBER 1.00 X 0 0 0 TOM MARTIN BOARD MEMBER 1.00 X 0 0 0 TONY ARMSTRONG CORPORATE OFFICER 1.00 X 0 0 0 JOHN KERSTIENS COO/CFO 40.00 X 198430 0 23692 KARIN CAMPBELL DIRECTOR, HR/ADMINISTRATIO 40.00 X 91600 0 21766 AMANDA BURNHAM DIRECTOR, MARKETING AND DE 40.00 X 77274 0 16431 MARK WOLANSKI DIRECTOR, MEDICAL PHYSICS 40.00 X 153430 0 35159 CHRIS ALLGOWER SENIOR MEDICAL PHYSICIST 40.00 X 143196 0 41159 LENILSON COUTINHO MEDICAL PHYSICIST 40.00 X 109174 0 19007 LEIA FANELLI MEDICAL PHYSICIST 40.00 X 106660 0 21424 ARCHANA GAUTAM MEDICAL PHYSICIST 40.00 X 112370 0 28221 TERESA OLDHAM RADIATION ONCOLOGIST 40.00 X 307893 0 28217 1300027 0 235076 7 0 1 0 UNIVERSITY RADIATION ONCOLOGY ASSOC 535 BARNHILL DRIVE INDIANAPOLIS IN 46202 PHYSICIAN AND PHYSICISTS 1298649 SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DEPT 0733 DALLAS TX 75312 MEDICAL EQUIPMENT SOLUTIONS/SERVICE 200000 VARIAN MEDICAL SYSTEMS 8900 KEYSTONE CROSSING STE 100 INDIANAPOLIS IN 46240 COMPUTERIZED MEDICAL SYSTEM SERVICES 199842 BLOOMINGTON ANESTHESIOLOGISTS PO BOX 2121 DEPT 1438 MEMPHIS TN 38159 ANESTHESIOLOGISTS 162750 4 13957935 574758 13957935 PATIENT SERVICE REVENUE 621110 15651910 15651910 15651910 3105 3105 7804 7804 7804 29620754 15651910 0 10909 X 309195 262816 46379 3355123 3355123 342082 290770 51312 436657 371158 65499 251465 213745 37720 40234 40234 48822 48822 2813865 2813865 23844 23844 367765 348890 18875 1757411 1405929 351482 30670 30670 8197 8197 233564 233564 2261121 1921953 339168 46977 46977 PROTON BEAM EXPENSE 5040405 5040405 DUES & SUBSCRIPTIONS 38228 38228 RECRUITING 3992 3992 40847 40847 17450464 16193565 1256899 0 75 75 1899757 1766869 1549113 1761850 136714 57664 21921474 10810367 12709977 11111107 6350000 5750000 25615 0 22671251 20447565 578204 571364 681444 451934 15354672 1197046 16614320 2220344 X 6031316 18227221 25615 0 6056931 18227221 22671251 20447565 12170290 0 X X 0 1 X 1 0 X SCHEDULE A PART I LINE 3 THE IRS HAS DETERMINED THAT IU HEALTH PROTON THERAPY CENTER IS A PUBLIC CHARITY UNDER INTERNAL REVENUE CODE SECTION 107(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 ARE REQUIRED TO COMPLETE THIS SCHEDULE. IU HEALTH PROTON THERAPY CENTER IS A CANCER TREATMENT CENTER AND IS NOT LICENSED AS A HOSPITAL BY THE STATE OF INDIANA. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25615 25615 80467 54852 25615 85000 4533 80467 1.00000 0 0 14772495 5967444 8805051 5766687 3557706 2208981 1382292 1285217 97075 11111107 RELATED PARTY PAYABLES 1197046 1197046 X 29620754 0 29620754 0 29620754 17450464 0 17450464 0 17450464 PART V, LINE 4: THE ORGANIZATION HAS TEMPORARILY RESTRICTED NET ASSETS AVAILABLE FOR THE PURPOSE OF PURCHASING EQUIPMENT. PART X, LINE 2: IUHPTC IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, AS SUCH, IS NOT REQUIRED TO PAY FEDERAL OR STATE INCOME TAXES ON EXCESS REVENUES RELATED TO THEIR TAX-EXEMPT ACTIVITIES. 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, 2014, 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. IUHPTC IS GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, IUHPTC IS REQUIRED TO FILE FEDERAL FORM 990 - RETURN OF ORGANIZATION FROM INCOME TAX, WHICH IS AN INFORMATIONAL RETURN ONLY. 0 0 0 0 0 0 0 0 0 JOHN KERSTIENS COO/CFO 198430 0 0 0 0 0 16500 0 7192 0 222122 0 0 0 MARK WOLANSKI DIRECTOR, MEDICAL PHYSICS 153430 0 0 0 0 0 34413 0 746 0 188589 0 0 0 CHRIS ALLGOWER SENIOR MEDICAL PHYSICIST 143196 0 0 0 0 0 33966 0 7193 0 184355 0 0 0 TERESA OLDHAM RADIATION ONCOLOGIST 307893 0 0 0 0 0 25500 0 2717 0 336110 0 0 0 X IN-KIND CONTR 1 560224 FMV 0 0 0 PART I, COLUMN (B): FORGIVENESS OF CONSTRUCITON LOAN PAYMENTS FOR FISCAL YEAR 2014 ON ACCOUNTS PAYABLE TO INDIANA UNIVERSITY. FORM 990, PART III, LINE 3 SUBSEQUENT TO JUNE 30, 2014 THE GOVERNING BODY APPROVED TO DISSOLVE THE ORGANIZATION AND ITS PROGRAM SERVICES. THE ORGANIZATION WILL BEGIN TO CEASE CONDUCTING ITS PROGRAM SERVICES FOR THE 2014 TAX YEAR. 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 ORGANIZATION'S CORPORATE MEMBERS, INDIANA UNIVERSITY RESEARCH AND TECHNOLOGY CORPORATION AND INDIANA UNIVERSITY HEALTH, INC., EACH APPOINT TWO INDIVIDUAL BOARD MANAGERS TO SERVE ON THE GOVERNING BOARD OF MANAGERS. TOGETHER THE FOUR APPOINTED INDIVIDUALS ELECT ONE ADDITIONAL UNRELATED INDIVIDUAL TO SERVE ON THE GOVERNING BOARD OF MANAGERS. FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS FOR REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S COO/CFO AND EACH CORPORATE MEMBERS' TAX DEPARTMENTS. THE ORGANIZATION'S GOVERNING BODY REVIEWS AND APPROVES THE FORM 990. PRIOR TO FILING EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY IS PROVIDED AN ELECTRONIC COPY OF THE FINAL FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY, THE PURPOSE OF WHICH IS, TO PREVENT ANY POTENTIAL FOR PERSONAL PROFIT OR GAIN, EITHER DIRECTLY OR INDIRECTLY, BY REASON OF AN INDIVIDUAL?S ASSOCIATION WITH OR EMPLOYMENT BY THE ORGANIZATION. THE SCOPE OF THE POLICY INCLUDES ALL MEMBERS OF THE ORGANIZATION?S BOARD OF MANAGERS, OFFICERS, EMPLOYEES, AND INDEPENDENT CONTRACTORS. THE POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED FOR COMPLIANCE BY THE OFFICE OF THE DIRECTOR OF HUMAN RESOURCES/ADMINISTRATION. A COVERED INDIVIDUAL IS REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST TO THE ORGANIZATION'S LEADERSHIP AND REFRAIN FROM OBTAINING ANY LIST OF THE ORGANIZATION'S PATIENTS, REFERRING PHYSICIANS, AND VENDORS FOR ANY PERSONAL OR PRIVATE USE. ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED BY THE ORGANIZATION'S COMPLIANCE PERSONNEL AND BOARD OF MANAGERS. IF THE DISCLOSURE IS MADE BY A COVERED INDIVIDUAL SERVING ON THE BOARD OF MANAGERS, SUCH INDIVIDUAL IS REQUIRED TO RECUSE THEMSELVES FROM PARTICIPATION IN THE GOVERNING BODY'S REVIEW REGARDING SUCH DISCLOSURE. 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 TOP MANAGEMENT OFFICIAL FOR THE ORGANIZATION. THE CEO DOES NOT RECEIVE COMPENSATION FROM THE ORGANIZATION AND THEREFORE, NO COMPENSATION DETERMINATION PROCESS IS USED FOR THE CEO BY THE ORGANIZATION. THE PROCESS ESTABLISHED FOR DETERMINING THE COMPENSATION OF THE COO AND ALL OTHER ORGANIZATION'S OFFICERS AND KEY EMPLOYEES INCLUDES OBTAINING COMPARABLE COMPENSATION DATA FROM ITS CORPORATE MEMBERS AND LOCAL PROVIDERS AND USING WRITTEN EMPLOYMENT CONTRACTS DOCUMENTING APPLICABLE COMPENSATION ARRANGEMENTS. ALL COMPENSATION ARRANGEMENTS ARE SUBJECT TO THE REVIEW AND APPROVAL OF THE ORGANIZATION'S GOVERNING BODY WITH ANY DELIBERATION BEING CONTEMPORANEOUSLY DOCUMENTED IN THE MINUTES OF THE BOARD OF MANAGERS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC. SUCH REQUESTS CAN BE MADE EITHER BY PHONE OR MAIL. FORM 990, PART IX, LINE 11G PURCHASED PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 2,813,865. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,813,865. FORM 990, PART XII, LINE 2C, OVERSIGHT OF THE AUDIT: THE BOARD OF MANAGERS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR.