2019-08-15T16:46:32-05:00 2018-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2017-10-01 383474766 UNIVERSITY PHYSICIAN GROUP UNIV 2485815930 1560 E MAPLE NO 400 TROY MI 48083 DIANA GOODE CFO/VP OF FINANCE 2485815930 2019-08-15 1 REBEKUH ELEY P01247672 3126343400 66.98.98.131 2019-08-15 15:57:14 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2A28FA2E2A09A40AF4F0A751499BE74D16D20E85 2017 2019-02-21 02:37:17Z JACK SOBEL MD 1560 E MAPLE NO 400 TROY MI 48083 160275518 0 X WWW.WSUPGDOCS.ORG X 1999 MI TO FURNISH MEDICAL CARE AND RELATED SERVICES IN AN ACADEMIC HEALTH CARE SETTING THROUGH EMPLOYED LICENSED PHYSICIANS HOLDING FACULTY APPOINTMENTS IN CLINICAL DEPARTMENTS AT THE WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE AND THROUGH OTHER APPROPRIATELY LICENSED PHYSICIANS AND HEALTH PROFESSIONALS. 14 8 1282 67 0 162412 0 38325 178468715 147892298 131500 92670 14864263 12252225 193464478 160275518 0 0 0 0 126719610 111924637 0 0 0 66472561 56716515 193192171 168641152 272307 -8365634 132564251 67695283 92132642 46364484 40431609 21330799 X SEE SCHEDULE OTO FURNISH MEDICAL CARE AND RELATED SERVICES IN AN ACADEMIC HEALTH CARE SETTING THROUGH EMPLOYED LICENSED PHYSICIANS HOLDING FACULTY APPOINTMENTS IN CLINICAL DEPARTMENTS AT THE WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE AND THROUGH OTHER APPROPRIATELY LICENSED PHYSICIANS AND HEALTH PROFESSIONALS. 0 0 105239653 108661421 PROVIDE MEDICAL SERVICES AND EDUCATIONAL OPPORTUNITIES FOR NUMEROUS DEPARTMENTS AT LOCAL AREA HOSPITALS AND FOR WAYNE STATE UNIVERSITY FACULTY, FELLOWS AND RESIDENTS. 41048401 51483102 COORDINATE PROFESSIONAL AND ADMINISTRATIVE SERVICES PROVIDED TO HOSPITALS AND OTHER HEALTH CARE INSTITUTIONS AND PATIENTS; SPONSOR & CONDUCT ACTIVITIES SUPPORTING THE ACADEMIC PROGRAMS OF THE SCHOOL OF MEDICINE (UNDER-GRADUATE AND GRADUATE TEACHING PROGRAMS, RECRUITING HIGH QUALITY FACULTY MEMBERS, AND PROVIDING PUBLIC ACCESS TO ADVANCED HEALTH CARE SERVICES.) 1520311 ESTABLISH AND CONDUCT REGULATORY COMPLIANCE PROGRAMS COVERING ALL DEPARTMENTS OF THE CORPORATION APPLICABLE TO HEALTH CARE SERVICES FURNISHED TO TEACHING PATIENTS AND TO OTHERS. 147808365 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 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 1 1 1 1 0 0 1 178 0 1 1282 1 1 1 0 0 0 0 0 0 0 0 0 X 14 8 1 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 1 1 X DIANA GOODE 2485815930 1560 E MAPLE STE 400 TROY MI 48083 JACK SOBEL MD CHAIRPERSON 48.00 1.00 X X 343708 0 1362 LIZABETH ARDISANA VICE CHAIR 1.00 0.00 X X 0 0 0 WAEL SAKR MD TREASURER 48.00 1.00 X X 350003 0 3880 MARK JUZYCH MD SECRETARY 48.00 1.00 X X 540890 0 1504 DAVID ROSENBERG MD BOARD MEMBER 48.00 1.00 X 339199 0 3633 SANDEEP MITTAL MD BOARD MEMBER 48.00 1.00 X 754963 0 7334 DONALD WEAVER MD BOARD MEMBER 48.00 1.00 X 182167 0 1287 LAWRENCE HORN MD BOARD MEMBER (UNTIL 7/18) 48.00 1.00 X 42054 0 0 GEROLD BEPLER MD BOARD MEMBER 1.00 1.00 X 0 0 0 MAHA FREIJ BOARD MEMBER 1.00 0.00 X 0 0 0 SCOTT THORNTON BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL GEHEB BOARD MEMBER 1.00 0.00 X 0 0 0 CARLA WALKER-MILLER BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD BROWN BOARD MEMBER 1.00 0.00 X 0 0 0 SAFWAN BADR MD BOARD MEMBER 1.00 1.00 X 0 0 0 LISA KEANE PRESIDENT (UNTIL 2/18) 48.00 0.00 X 489890 0 13829 CHARLES SHANLEY MD PRESIDENT (AS OF 3/18) 48.00 0.00 X 0 0 0 JEFFERY KOHLITZ VP OF FINANCE/CFO (UNTIL 8/18) 48.00 0.00 X 194581 0 18928 DIANA GOODE CFO/VP OF FINANCE (AS OF 8/18) 48.00 0.00 X 0 0 0 KAREN TURNER COO (AS OF 4/18) 48.00 0.00 X 0 0 0 SAYF FATHY GENERAL COUNSEL 48.00 0.00 X 178230 0 16933 LUAY HADDAD PHYSICIAN 48.00 0.00 X 1123980 0 27192 JOHN WEBBER PHYSICIAN 48.00 0.00 X 674868 0 21577 ANU PATEL PHYSICIAN 48.00 0.00 X 611729 0 36180 JOFFER HAKIM PHYSICIAN 48.00 0.00 X 586822 0 47586 MURALI GUTHIKONDA PHYSICIAN 48.00 0.00 X 563581 0 1412 6976665 0 202637 288 0 1 0 CULBERT HEALTHCARE SOLUTIONS INC 800 W CUMMINGS PARK WOBURN MA 01801 PROFESSIONAL STAFFING 1692437 HEALTH CARE ADMINISTRATIVE PO BOX 1511 MEDIA PA 19063 CONTRACTED PATIENT BILLING SERVICES 1234178 HENRY FORD 1 FORD PLACE 5E DETROIT MI 48202 CONTRACTED ANESTHESIOLOGIST 478029 DATAFILE TECHNOLOGIES LLC PO BOX 419130 KANSAS CITY MO 64141 CLINICAL E-FILING SERVICES 406428 ANESTHESIA BUSINESS CONSULTANTS 4489 CRANBROOK TRAIL ORCHARD LAKE MI 48323 MEDICAL SERVICES 374958 22 38325 38325 PATIENT REVENUES 900099 109399099 109399099 ADMIN & CLINICAL SVCS 900099 23672795 23672795 TEACHING SERVICES 900099 13720743 13720743 RENTAL INCOME 900099 1099661 1099661 147892298 17168 17168 75502 0 75502 75502 75502 12252225 12252225 12252225 160275518 160144523 0 92670 94136716 88284217 5852499 2391652 1913322 478330 10123038 8098430 2024608 5273231 4218585 1054646 317227 317227 358526 358526 15466253 15249623 216630 180202 180202 1880804 506660 1374144 12090757 9573574 2517183 231565 54358 177207 491683 491683 2259 2259 1364288 1364288 6024487 539630 5484857 PRACTICE EXPENSE 11572043 11572043 FUND FOR MEDICAL RESEAR 5941952 5941952 LICENSES, DUES, AND SUB 794469 794469 168641152 147808365 20832787 0 52216103 21480337 47613461 28631272 1035694 1015267 27646199 25616853 3299124 2029346 13333057 4137349 15066812 10401712 132564251 67695283 77160779 34363845 14791748 11951150 180115 49489 92132642 46364484 X 40431609 21330799 40431609 21330799 132564251 67695283 X -8365634 -10735176 X 0 0 0 X 37825 37825 189185088 197546386 218624088 193332978 160145023 958833563 189185088 197546386 218624088 193332978 160182848 958871388 0 0 0 958871388 7896 117583 127583 131500 17168 401730 7896 117583 127583 131500 17168 401730 189192984 197663969 218751671 193464478 160200016 959273118 0.99960 0.99960 0.00040 0.00040 X 3249876 2517746 732130 24396323 23099107 1297216 2029346 OHS/UPG VENTURES 1797624 C OAKLAND PHYSICIAN SURGERY CENTER 2319475 C OAKWOOD ACO 20250 C 4137349 INSURANCE RECOVERIES 10401712 10401712 CAPITAL LEASE OBLIGATIONS 49489 49489 X X X X 0 1 0 1 0 0 1 1 0 JACK SOBEL MD CHAIRPERSON 340000 0 0 0 3708 0 0 0 1362 0 345070 0 0 0 WAEL SAKR MD TREASURER 350003 0 0 0 0 0 0 0 3880 0 353883 0 0 0 MARK JUZYCH MD SECRETARY 539858 0 0 0 1032 0 0 0 1504 0 542394 0 0 0 DAVID ROSENBERG MD BOARD MEMBER 339199 0 0 0 0 0 0 0 3633 0 342832 0 0 0 SANDEEP MITTAL MD BOARD MEMBER 754633 0 0 0 330 0 5830 0 1504 0 762297 0 0 0 DONALD WEAVER MD BOARD MEMBER 179881 0 0 0 2286 0 0 0 1287 0 183454 0 0 0 LISA KEANE PRESIDENT (UNTIL 2/18) 439407 0 50000 0 483 0 5666 0 8163 0 503719 0 0 0 JEFFERY KOHLITZ VP OF FINANCE/CFO (UNTIL 8/18) 184618 0 8775 0 1188 0 9770 0 9158 0 213509 0 0 0 SAYF FATHY GENERAL COUNSEL 178054 0 0 0 176 0 8960 0 7973 0 195163 0 0 0 LUAY HADDAD PHYSICIAN 1123463 0 0 0 517 0 0 0 27192 0 1151172 0 0 0 JOHN WEBBER PHYSICIAN 674351 0 0 0 517 0 20073 0 1504 0 696445 0 0 0 ANU PATEL PHYSICIAN 611580 0 0 0 149 0 7435 0 28745 0 647909 0 0 0 JOFFER HAKIM PHYSICIAN 586374 0 0 0 448 0 17832 0 29754 0 634408 0 0 0 MURALI GUTHIKONDA PHYSICIAN 561295 0 0 0 2286 0 0 0 1412 0 564993 0 0 0 PART I, LINE 3 THE POSITIONS ARE HIRED AS PART OF A COLLABORATIVE PROCESS WITH WAYNE STATE UNIVERSITY AND THE HIRING PROCESS INCLUDES FORMAL OFFER LETTER APPROVED BY THE WSU BOARD OF GOVERNORS AS WELL AS THE UPG BOARD. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2017: JACK SOBEL $17,500 ANU PATEL $18,000 PART I, LINE 5 THE ORGANIZATION MAKES PAYMENT TO SOME PHYSICIANS (WHO ARE ALSO BOARD MEMBERS) FOR DIRECT COMPENSATION THAT ARE BASED ON REVENUES AS PART OF INCENTIVE BASED COMPENSATION. PART I, LINE 6 MEMBERS OF THE MANAGEMENT EXECUTIVE TEAM WERE PAID BONUSES BASED ON ORGANIZATION RESULTS PART I, LINE 7 SAYF FATHY - MANAGEMENT INCENTIVE PROGRAM ($10,000) MARK JUZYCH, SANDEEP MITTAL, LUAY HADAD, JOHN WEBBER, ANU PATEL, MURALI GUTHIKONDA - DEPARTMENT COMPENSATION PROGRAM (VARIABLE COMPENSATION) FORM 990, PART VI, SECTION A, LINE 2 OFFICERS HAVE BUSINESS RELATIONSHIPS WITHIN THEIR RESPECTED MEDICAL FIELDS. BUSINESS TRANSACTIONS INVOLVING INTEREST PERSONS: ALMOST ALL OF THE DIRECTORS AND OFFICERS OF THE ORGANIZATION ALSO SERVE AS OFFICERS, DIRECTORS, AND/OR KEY EMPLOYEES OF UNIVERSITY PHYSICIAN GROUP AND/OR WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE. FORM 990, PART VI, SECTION A, LINE 4 IN APRIL, 2018, THE BYLAWS WERE REVISED TO INCLUDE THE ADDITION OF THE COO POSITION AS A CORPORATE OFFICER ROLE AND CORRESPONDING REVISIONS TO INCLUDE THE COO ON VARIOUS BOARD COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CHIEF FINANCIAL OFFICER REVIEWS A DRAFT OF THE 990 AND THEN REVIEWS THE FINAL COPY OF THE RETURN BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C VERBAL COMMUNICATION TOOK PLACE IN WHICH OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES WERE MADE AWARE OF THE POLICY AND GIVEN THE OPPORTUNITY TO EXPLAIN INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST. UPG DID NOT HAVE A FORMALLY ASSIGNED CHIEF COMPLIANCE OFFICE IN FISCAL 2018. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, LINE 15A HIRING PROCESS FOR TOP OFFICIALS: THE POSITIONS ARE HIRED AS PART OF A COLLABORATIVE PROCESS WITH WAYNE STATE UNIVERSITY AND THE HIRING PROCESS INCLUDES FORMAL OFFER LETTERS/CONTRACTS APPROVED BY THE WSU BOARD OF GOVERNORS AS WELL AS THE UPG BOARD. FORM 990, PART VI, LINE 15B COMPENSATION PROCESS FOR CORPORATE OFFICERS: COMPENSATION IS DETERMINED AS PART OF A COLLABORATIVE PROCESS WITH WAYNE STATE UNIVERSITY AND THE HIRING PROCESS INCLUDES FORMAL OFFER LETTER APPROVED BY THE WSU BOARD OF GOVERNORS AS WELL AS THE UPG BOARD. FORM 990, PART VI, SECTION C, LINE 19 A COPY OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THE SAME PERIOD OF TIME AS SET FORTH IN PUBLIC DISCLOSURE 6104(D). FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO MAPLE SURGERY CENTER -1,541,281. OTHER RECONCILING ITEMS -9,193,895. UNIVERSITY ANESTHESIA SERVICES LLC 1560 E MAPLE STE 400 TROY MI 48083 455505859 ANESTHESIA MI 6156595 -5127 UPG FUND FOR MEDICAL RESEARCH & EDUCATION 1560 E MAPLE STE 400 TROY MI 48083 382319524 MEDICAL MI 501(C)(3) LINE 12C, III-FI N/A 0 OPSC DBA MAPLE SURGERY CENTER 1560 E MAPLE STE 400 TROY MI 48083 454916090 MEDICAL MI UPG RELATED 3710035 0 1 0.80410 UNIVERSITY PHYSICIANS SERVICES 1560 E MAPLE STE 400 TROY MI 48083 383386347 MEDICAL MI UPG C 1 OHSUPG VENTURES 1560 E MAPLE STE 400 TROY MI 48083 205072681 MEDICAL MI UPG C -143364 2576148 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 OPSC DBA MAPLE SURGERY CENTER R 1541281 CASH AMOUNT PART III, COLUMN (A): OPSC DBA MAPLE SURGERY CENTER CEASED OPERATIONS ON 11/17/17.