2013-01-11T12:56:02-06:00 2012-06-30 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2011-07-01 352134193 INDIANA UNIVERSITY HEALTH PROTON THERAPY CENTER LLC INDI 8123495074 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 JOHN R KERSTIENS CPA 8123495028 2013-01-10 1 AMBER KOCHER CPA P01286298 3176334705 2011 2016-02-25 16:41:14Z MIDWEST PROTON RADIOTHERAPY INSTITUTE LLC DR PETER JOHNSTONE 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 18773121 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 5 65 0 0 0 22792 105982 17511463 18660957 4731 3202 6121 2980 17545107 18773121 290 28500 0 0 4516326 4877556 0 0 0 13104248 14394487 17620864 19300543 -75757 -527422 27598376 24909929 18677833 16516808 8920543 8393121 TO LEVERAGE OUR UNIQUE TECHNOLOGY TO IMPROVE OUR PATIENTS' HEALTH, AND PROMOTE INNOVATION IN EDUCATION AND RESEARCH. 0 0 17903730 28500 18660957 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 $402,474 FOR THE YEAR ENDED JUNE 30, 2012. 17903730 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7 0 1 65 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 JOHN KERSTIENS CPA 8123495074 2425 N MILO B SAMPSON LN BLOOMINGTON IN 47408 DR PETER JOHNSTONE 16.00 X 0 0 0 JENNIFER M ALVEY 1.00 X 0 0 0 TOM MARTIN 1.00 X 0 0 0 DOUGLAS PRIEST 1.00 X 0 0 0 JIM TERWILLIGER 1.00 X 0 0 0 RICHARD S HELSPER 40.00 X X 122580 0 12180 MARVIN PEMBER 0.00 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 136946 0 19634 KARIN CAMPBELL 40.00 X 79781 0 19634 CHRIS ALLGOWER 40.00 X 136490 0 36958 MARK WOLANSKI 40.00 X 136461 0 32419 LI ZHAO 40.00 X 105108 0 24173 LENILSON COUTINHO 40.00 X 107565 0 16693 LEIA FANELLI 40.00 X 103027 0 18270 927958 0 179961 7 0 1 0 UNIVERSITY RADIATION ONCOLOGY ASSOC 535 BARNHILL DRIVE INDIANAPOLIS IN 46202 PHYSICIAN AND PHYSICISTS 2145838 BLOOMINGTON ANESTHESIOLOGISTS PO BOX 2121 DEPT 1438 MEMPHIS TN 38159 ANESTHESIOLOGISTS 386312 SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DEPT 0733 DALLAS TX 75312 MEDICAL EQUIPMENT SOLUTIONS/SERVICE 199505 ELEKTA 13723 CORPORATE LAKE DR MARYLAND HEIGHTS MO 63043 COMPUTERIZED MEDICAL SYSTEM SERVICES 152193 SLINGSHOT SEO 8900 KEYSTONE CROSSING STE 100 INDIANAPOLIS IN 46240 SEARCH ENGINE OPTIMIZATION 121929 5 105982 17025 105982 PATIENT SERVICE REVENU 621110 18660957 18660957 18660957 3202 3202 OTHER INCOME 541900 2980 2980 2980 18773121 18660957 0 6182 28500 28500 366905 311869 55036 3354960 3354960 359796 305827 53969 509136 432766 76370 286759 243745 43014 53105 53105 45990 45990 5079387 5079387 40000 40000 491507 423653 67854 1691786 1353429 338357 43070 43070 14795 14795 297367 297367 2171675 1845924 325751 40972 40972 PROTON BEAM EXPENSE 4223000 4223000 BAD DEBT 139310 139310 DUES & SUBSCRIPTIONS 18206 18206 44317 44317 19300543 17903730 1396813 0 100 75 1864714 1850642 2374916 1613545 76810 40140 21796964 7421904 15731836 14375060 7550000 6950000 0 80467 27598376 24909929 1040115 924353 966794 598253 16670924 14994202 18677833 16516808 X 8920543 8312654 80467 8920543 8393121 27598376 24909929 -527422 0 X X 0 1 0 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 INTERNAL REVENUE 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 SIMILARILY RECOGNIZED BY A STATE AS A HOSPITAL IS REQUIRED TO COMPLETE THIS 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 85000 4533 80467 1.00000 0 0 14772495 4130450 10642045 4159073 2259732 1899341 2865396 1031722 1833674 14375060 DUE TO INDIANA UNIVERSITY 14994202 14994202 18773121 19300543 -527422 -527422 18773121 0 18773121 0 18773121 19300543 0 19300543 0 19300543 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION HAS TEMPORARILY RESTRICTED NET ASSETS AVAILABLE FOR THE PURPOSE OF PURCHASING EQUIPMENT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012 AND 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. 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. 1 JILL'S HOUSE INC 751 E TAMARACK TRAIL BLOOMINGTON IN 47408 352139920 501(C)(3) 28500 PATIENT SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SUPPORT PROVIDED TO 501(C)(3) PUBLIC CHARITY FOR PATIENT SUPPORT. THE ORGANIZATION DOES NOT MONITOR THE USE OF THESE FUNDS BY THE PUBLIC CHARITY LISTED. 0 0 0 0 0 0 0 0 0 JOHN KERSTIENS 136946 0 0 0 0 0 13999 0 5635 0 156580 0 0 0 CHRIS ALLGOWER 136490 0 0 0 0 0 32140 0 4818 0 173448 0 0 0 MARK WOLANSKI 136461 0 0 0 0 0 31725 0 694 0 168880 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 THEMSELVES 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.