2019-07-17T14:51:11-05:00 2018-06-30 410746749 CLIFTONLARSONALLEN LLP ONE SEAGATE SUITE 2650 TOLEDO OH 436041558 990 2017-07-01 201304472 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIV 4193837124 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 HAITHAM M ELSAMALOTY CFO 4193837124 2019-04-15 1 KAREN GRIES P00078514 4192443711 2019-07-17 67.137.57.251 2019-07-17 09:47:37 CD P BBA58EB6E7F87D04A815B4FA9AD717FA41A89180 D96076016A1D85786C0DD27C05D232F375DC2AFE 2017 2019-02-21 02:37:17Z KRISTOPHER BRICKMAN MD 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 101669385 0 X N/A X 2004 OH TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY. 31 0 593 5 0 0 26358701 361160 104197742 97651296 -7476 -7206 2559053 3565297 133108020 101570547 200977 620650 0 0 78284722 85263071 0 0 0 25338324 18455520 103824023 104339241 29283997 -2768694 73317685 73700437 20602583 23783758 52715102 49916679 TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY 0 0 93983771 620650 94526670 FACULTY PRACTICE PLAN FOR THE UNIVERSITY OF TOLEDO TO PROVIDE HEALTH CARE SERVICES AS AN INTEGRAL COMPONENT OF THE ACADEMIC AND RESEARCH MISSION OF THE UNIVERSITY. 3331163 0 3124626 CAPTIVE INSURANCE- WRITING OR FUNDING MEDICAL MALPRACTICE INSURANCE AND REINSURANCE FOR UNIVERSITY OF TOLEDO AND UNIVERSITY OF TOLEDO PHYSICIANS. 97314934 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 46 0 593 1 0 0 0 0 0 0 0 0 0 0 X 31 0 0 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 OH X KANDY JUSTICE 4193837124 3355 GLENDALE AVE THIRD FLOOR TOLEDO OH 43614 X COOPER CHRISTOPHER MD PRESIDENT, UTMAC 20.00 20.00 X X 229534 477670 106913 BRICKMAN KRISTOPHER MD PRESIDENT, UTP; SECRETARY, UTMAC 20.00 20.00 X X 407276 173890 77982 DWORKIN LANCE MD VICE PRESIDENT, UTP 20.00 20.00 X X 265000 410000 102575 ELSAMALOTY HAITHAM MD TREASURER, UTP 20.00 20.00 X X 385745 148975 74557 HEJEEBU SRINI DO SECRETARY, UTP 20.00 20.00 X X 242582 86577 67236 PYLES BRYAN T TREASURER, UTMAC 20.00 20.00 X X 0 219299 77551 HENDERSON PATRICIA L ASST SECRETARY, UTMAC 1.00 0.00 X X 0 0 0 BRUNICARDI FRANCIS MD TRUSTEE, UTP 20.00 20.00 X 413923 410000 114945 CASABIANCA ANDREW MD TRUSTEE, UTP 20.00 20.00 X 174797 218112 79139 CHEN CHANGHU MD TRUSTEE, UTP 20.00 20.00 X 495285 191017 87198 EBRAHEIM NABIL MD TRUSTEE, UTP 20.00 20.00 X 1450474 233597 89602 MRAK ROBERT MD TRUSTEE, UTP 20.00 20.00 X 236756 193250 73375 MUKUNDAN DEEPA MD TRUSTEE, UTP 20.00 20.00 X 99252 100391 28943 SINDHWANI PUNEET MD TRUSTEE, UTP 20.00 20.00 X 392337 200335 84898 VAN HOOK JAMES MD TRUSTEE, UTP 20.00 20.00 X 251586 225000 75377 SINGH TANVIR MD TRUSTEE, UTP 20.00 20.00 X 341362 142884 76902 SPEER LINDA MD TRUSTEE, UTP 20.00 20.00 X 117696 214850 61797 TIETJEN GRETCHEN MD TRUSTEE, UTP 20.00 20.00 X 249150 204838 82340 WROBLEWSKI MARY BETH MD TRUSTEE, UTP 20.00 20.00 X 46036 115016 39959 SKIE MARTIN MD TRUSTEE, UTP 20.00 20.00 X 509690 105647 71673 SCHROEDER JASON MD TRUSTEE, UTP 20.00 20.00 X 609974 41565 62717 LACH JOSEPH MD TRUSTEE, UTP 20.00 20.00 X 130994 26530 39761 ATALLAHM JOSEPH MD TRUSTEE, UTP 20.00 20.00 X 807806 133698 75266 BOOTH ROBERT MD TRUSTEE, UTP 20.00 20.00 X 182437 118803 52781 GRIDER STEPHEN MD TRUSTEE, UTP 20.00 20.00 X 227771 95509 65904 MOLONEY BRYAN MD TRUSTEE, UTP 20.00 20.00 X 330000 183848 82604 KHOURI SAMER MD TRUSTEE, UTP 20.00 20.00 X 289991 107209 71845 KAW DINKAR MD TRUSTEE, UTP 20.00 20.00 X 337630 77097 62054 BARBEE DANIEL MANAGER, UTMAC 0.00 40.00 X 0 325335 48270 ELLIS MICHAEL MD MANAGER, UTMAC 0.00 40.00 X 155295 118303 40119 ALEXANDER GORDAN CHIEF PHYSICIAN EXECUTIVE 40.00 0.00 X 0 0 0 BISHOP KATHY CFO 40.00 0.00 X 116037 0 21279 LAWERA GARY COO 40.00 0.00 X 337229 0 40500 ZAIDI SAYED FAZAL ABBAS MD PHYSICIAN 20.00 20.00 X 842657 95509 99333 JUMAA MOUHAMMAD MD PHYSICIAN 20.00 20.00 X 796495 95509 83641 ELGAFY HOSSEIN MD PHYSICIAN 20.00 20.00 X 675502 74403 77630 NAZZAL MUNIER MD PHYSICIAN 20.00 20.00 X 621545 178172 135164 GEHLING DANIEL PHYSICIAN 20.00 20.00 X 617409 31836 64817 BIESZCZAD JACOB MD TRUSTEE, UTP 20.00 20.00 X 348769 43150 66551 BLUMER PHD MD JEFFREY TRUSTEE, UTP 20.00 20.00 X 42692 63988 16446 FARRELL MD STEVEN J TRUSTEE, UTP 20.00 20.00 X 208405 118919 55702 SKEEL ROLAND T MD TRUSTEE, UTP 20.00 20.00 X 165000 86807 47911 SODEMAN THOMAS C MD TRUSTEE, UTP 20.00 20.00 X 203865 152675 68058 TALMAGE LANCE MD TRUSTEE, UTP 20.00 20.00 X 25308 101408 28390 TAMBURRINO MD MARIJO TRUSTEE, UTP 20.00 20.00 X 8077 185394 18089 14389369 6527015 2897794 193 1 1 0 TRG HEALTHCARE LLC 1835 MARKET ST SUITE 555 PHILADELPHIA PA 19103 INTERIM MANAGEMENT/CEO SERVICES 975164 BARONE BROTHERS LLC 4841 MONROE ST SUITE 101 TOLEDO OH 43623 RENT 386670 DFG WATERVILLE RETAIL LLC 10100 WATERVILLE ST WHITEHOUSE OH 43571 RENT 198497 FUSION HEALTHCARE STAFFING 870 EAST 9400 SOUTH SUITE 200 SANDY UT 84094 HEALTHCARE STAFFING 185061 EASTMAN & SMITH LTD ONE SEAGATE 24TH FLOOR TOLEDO OH 43699 LEGAL SERVICES 148070 6 361160 361160 PATIENT SERVICE 621110 94526670 94526670 UTMAC INVESTMENT INCOME 621110 1795447 1795447 UTMAC INSURANCE PREMIUMS 621110 1329179 1329179 97651296 91632 91632 98838 -98838 -98838 -98838 MISCELLANEOUS 999999 3565297 3565297 3565297 101570547 97651296 0 3558091 620650 620650 7386719 7386719 64238995 60691430 3547565 7968015 7622490 345525 3974041 1666603 2307438 1695301 1457959 237342 131739 131739 194013 194013 7656498 7656498 134112 134112 475685 461414 14271 152485 152485 1135639 1010719 124920 1129080 1129080 447310 447310 776196 776196 UTMAC EXPENSES 3331163 3331163 CLINIC COSTS 1712100 1712100 PHARMACEUTICALS 673033 673033 EQUIPMENT RENTAL & REPA 374618 187309 187309 131849 65925 65924 104339241 97314934 7024307 0 17960290 10060146 10445992 14236294 15062809 1925919 77862 50005 27156 245739 2230579 1194534 1079553 1036045 0 34632340 27751 27751 39908779 213691 73317685 73700437 2450928 13426386 451453 18151655 9905919 20602583 23783758 X 52715102 49916679 52715102 49916679 73317685 73700437 -2768694 -29729 0 X 0 1 X 1 0 X X 1 UNIVERSITY OF TOLEDO 346401483 5 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 X SCHEDULE A, PAGE 5, LINE 1C THE ORGANIZATION SERVES AS THE FACULTY PRACTICE PLAN FOR THE UNIVERSITY OF TOLEDO TO PROVIDE HEALTH CARE SERVICES AS AN INTEGRAL COMPONENT OF THE ACADEMIC AND RESEARCH MISSION OF THE UNIVERSITY. SCHEDULE A, PAGE 5, SECTION D LINE 3 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY, INC. (UTP) HAS ONLY ONE CLASS OF MEMBER, AND ONLY ONE MEMBER, THE UNIVERSITY OF TOLEDO. THE SOLE MEMBER, UNIVERSITY OF TOLEDO HAS A SIGNIFICANT VOICE IN THE ACTIVITIES AND OPERATIONS OF UTP. ACT ON ITS BEHALF AS THE SOLE MEMBER OF THE ORGANIZATION. THE SOLE MEMBER OF UTP HAS THE POWER TO NOMINATE, ELECT AND REMOVE THE BOARD OF DIRECTORS OF THE CORPORATION; APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION AND CODE OF REGULATIONS OF THE CORPORATION; AND EXERCISE SUCH OTHER POWERS AS ARE NECESSARY, APPROPRIATE, AND CONSISTENT WITH LAW AND WITH THE ARTICLES OF INCORPORATION AND THE CODE OF REGULATIONS OF THE CORPORATION. THE FOLLOWING ACTIONS REQUIRE PRIOR APPROVAL OF THE SOLE MEMBER: (A) ANY CHANGE IN THE PURPOSE OR MISSION OF THE CORPORATION; (B) ANY CHANGE IN THE CODE OF REGULATIONS OR ARTICLES OF INCORPORATION OF THE CORPORATION; (C) ANY MERGER OR CONSOLIDATION OF THE CORPORATION WITH AN UNRELATED ENTITY; (D) THE PROPOSED SALE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; (E) ANY BORROWING OF FUNDS BY THE CORPORATION (EXCLUDING TRADE PAYABLES OR OTHER ORDINARY COURSE INDEBTEDNESS) IN EXCESS OF ITS GENERAL OPERATING LINE OF CREDIT IN AN AMOUNT TO BE ESTABLISHED ON AN ANNUAL BASIS BY APPROVAL OF THE BOARD OR ANY LOAN OF FUNDS BY THE CORPORATION; (F) ANY MATERIAL CHANGES IN THE CORPORATION'S PROFESSIONAL LIABILITY INSURANCE COVERAGE, INCLUDING CHANGES IN THE PARTIES PROVIDING SUCH COVERAGE; AND (G) THE DISSOLUTION OR LIQUIDATION OF THE CORPORATION. 2230579 1194534 1036045 1036045 LOSSES AND LOSS ADJUSTMENT EXPENSES - UTMAC 9681272 LOSSES AND CLAIMS HANDLING FEES PAYABLE - UTMAC 224647 9905919 95876905 -29729 -206537 -236266 96113171 5457376 5457376 101570547 98675336 0 98675336 5663905 5663905 104339241 PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UTMAC -206,537. PART XI, LINE 4B - OTHER ADJUSTMENTS: UTMAC INCOME 3,124,626. CLINIC COSTS 1,712,100. DONATIONS TO UTF 397,539. DISTRIBUTIONS TO UT/UTMAC 223,111. PART XII, LINE 4B - OTHER ADJUSTMENTS: CLINIC COSTS 1,712,100. DONATIONS TO UTF 397,539. DISTRIBUTIONS TO UT/UTMAC 223,111. UTMAC EXPENSES 3,331,163. ROUNDING -8. 1 UNIVERSITY OF TOLEDO FOUNDATION 4510 DORR ST MS 820 TOLEDO OH 43615 346555110 501(C)(3) 126992 FMV SUPPORT FOR THE UNIVERSITY OF TOLEDO FOUNDATION UNIVERSITY OF TOLEDO 2801 W BANCROFT ST TOLEDO OH 43614 346401483 SECTION 115 493658 FMV SUPPORT FOR THE UNIVERSITY OF TOLEDO 1 PART I, LINE 2: THE ORGANIZATION MONITORS THE USE OF GRANT FUNDS IN THE UNITED STATES BY ONLY DONATING TO THE RELATED ORGANIZATIONS LISTED UNDER SCHEDULE R. X 0 1 X 0 0 0 1 0 0 0 1 0 COOPER CHRISTOPHER MD PRESIDENT, UTMAC 229534 477670 0 0 0 0 34430 56085 0 16398 263964 550153 0 0 BRICKMAN KRISTOPHER MD PRESIDENT, UTP; SECRETARY, UTMAC 384653 173890 22623 0 0 0 40500 24345 0 13137 447776 211372 0 0 DWORKIN LANCE MD VICE PRESIDENT, UTP 250000 410000 15000 0 0 0 39750 57400 0 5425 304750 472825 0 0 ELSAMALOTY HAITHAM MD TREASURER, UTP 20633 148975 365112 0 0 0 40500 15259 2400 16398 428645 180632 0 0 HEJEEBU SRINI DO SECRETARY, UTP 36080 86577 206502 0 0 0 36897 12074 1900 16365 281379 115016 0 0 PYLES BRYAN T TREASURER, UTMAC 0 219299 0 0 0 0 0 30702 0 46849 0 296850 0 0 BRUNICARDI FRANCIS MD TRUSTEE, UTP 363923 410000 50000 0 0 0 40500 57400 0 17045 454423 484445 0 0 CASABIANCA ANDREW MD TRUSTEE, UTP 174797 218112 0 0 0 0 38146 30186 0 10807 212943 259105 0 0 CHEN CHANGHU MD TRUSTEE, UTP 495285 191017 0 0 0 0 40500 26742 0 19956 535785 237715 0 0 EBRAHEIM NABIL MD TRUSTEE, UTP 43097 233597 1407377 0 0 0 40500 32704 0 16398 1490974 282699 0 0 MRAK ROBERT MD TRUSTEE, UTP 210555 193250 26201 0 0 0 35513 27055 0 10807 272269 231112 0 0 MUKUNDAN DEEPA MD TRUSTEE, UTP 77469 100391 21783 0 0 0 14888 14055 0 0 114140 114446 0 0 SINDHWANI PUNEET MD TRUSTEE, UTP 392337 200335 0 0 0 0 40500 28000 0 16398 432837 244733 0 0 VAN HOOK JAMES MD TRUSTEE, UTP 251586 225000 0 0 0 0 40500 0 34877 0 326963 225000 0 0 SINGH TANVIR MD TRUSTEE, UTP 549 142884 340813 0 0 0 40500 20004 0 16398 381862 179286 0 0 SPEER LINDA MD TRUSTEE, UTP 117696 214850 0 0 0 0 17654 30079 0 14064 135350 258993 0 0 TIETJEN GRETCHEN MD TRUSTEE, UTP 153000 204838 96150 0 0 0 37372 28677 0 16291 286522 249806 0 0 WROBLEWSKI MARY BETH MD TRUSTEE, UTP 44766 115016 1270 0 0 0 6978 16102 481 16398 53495 147516 0 0 SKIE MARTIN MD TRUSTEE, UTP 5001 105647 504689 0 0 0 40500 14775 0 16398 550190 136820 0 0 SCHROEDER JASON MD TRUSTEE, UTP 609974 41565 0 0 0 0 40500 5819 0 16398 650474 63782 0 0 LACH JOSEPH MD TRUSTEE, UTP 87231 26530 43763 0 0 0 19649 3714 0 16398 150643 46642 0 0 ATALLAHM JOSEPH MD TRUSTEE, UTP 666 133698 807140 0 0 0 40500 18368 0 16398 848306 168464 0 0 BOOTH ROBERT MD TRUSTEE, UTP 161199 118803 21238 0 0 0 27366 16623 0 8792 209803 144218 0 0 GRIDER STEPHEN MD TRUSTEE, UTP 223820 95509 3951 0 0 0 36135 13371 0 16398 263906 125278 0 0 MOLONEY BRYAN MD TRUSTEE, UTP 330000 183848 0 0 0 0 40500 25739 0 16365 370500 225952 0 0 KHOURI SAMER MD TRUSTEE, UTP 289991 107209 0 0 0 0 40500 14947 0 16398 330491 138554 0 0 KAW DINKAR MD TRUSTEE, UTP 64035 77097 273595 0 0 0 40500 10747 0 10807 378130 98651 0 0 BARBEE DANIEL MANAGER, UTMAC 0 325335 0 0 0 0 0 31872 0 16398 0 373605 0 0 ELLIS MICHAEL MD MANAGER, UTMAC 155295 118303 0 0 0 0 23294 16516 0 309 178589 135128 0 0 LAWERA GARY COO 292729 0 44500 0 0 0 40500 0 0 0 377729 0 0 0 ZAIDI SAYED FAZAL ABBAS MD PHYSICIAN 492308 95509 350349 0 0 0 40500 42435 0 16398 883157 154342 0 0 JUMAA MOUHAMMAD MD PHYSICIAN 492308 95509 304187 0 0 0 40500 26743 0 16398 836995 138650 0 0 ELGAFY HOSSEIN MD PHYSICIAN 7839 74403 667663 0 0 0 40500 20732 0 16398 716002 111533 0 0 NAZZAL MUNIER MD PHYSICIAN 3354 178172 618191 0 0 0 40500 78266 0 16398 662045 272836 0 0 GEHLING DANIEL PHYSICIAN 4880 31836 612529 0 0 0 40500 4457 0 19860 657909 56153 0 0 BIESZCZAD JACOB MD TRUSTEE, UTP 21610 43150 327159 0 0 0 40500 6041 0 20010 389269 69201 0 0 BLUMER PHD MD JEFFREY TRUSTEE, UTP 42692 63988 0 0 0 0 6404 5754 0 4288 49096 74030 0 0 FARRELL MD STEVEN J TRUSTEE, UTP 896 118919 207509 0 0 0 31261 16649 0 7792 239666 143360 0 0 SKEEL ROLAND T MD TRUSTEE, UTP 155000 86807 10000 0 0 0 24750 12153 0 11008 189750 109968 0 0 SODEMAN THOMAS C MD TRUSTEE, UTP 150362 152675 53503 0 0 0 30580 21080 0 16398 234445 190153 0 0 TALMAGE LANCE MD TRUSTEE, UTP 25308 101408 0 0 0 0 3796 13787 0 10807 29104 126002 0 0 TAMBURRINO MD MARIJO TRUSTEE, UTP 8077 185394 0 0 0 0 1212 16877 0 0 9289 202271 0 0 PART I, LINE 1A CERTAIN INDIVIDUALS IN PART VII DO HAVE HEALTH OR SOCIAL CLUB DUES PAID BY UTP. PART I, LINE 1B UTP DOES NOT HAVE A POLICY REGARDING THE PAYMENT OR REIMBURSEMENT OF THE EXPENSES DESCRIBED ON LINE 1A. PAYMENT OR REIMBURSEMENT IS BASED UPON THE BUSINESS PURPOSE OF SUCH REQUEST AND APPROVED BY APPROPRIATE INDIVIDUAL(S) WITHIN UTP. PART I, LINE 5 MANY PHYSICIANS ON STAFF DO RECEIVE COMPENSATION COMPUTED ON SERVICES RENDERED/COLLECTIONS RECEIVED. FOR THIS COMPENSATION, ESTABLISHED FORMULAS AND COMPUTATIONS ARE UTILIZED TO DETERMINE THE COMPENSATION. PART I, LINE 7 MANY PHYSICIANS ON STAFF DO RECEIVE NON-FIXED PAYMENTS BASED ON ACHIEVING VARIOUS MEASURABLES AND GOALS WITHIN THEIR PRACTICE. NORTHWEST EMERGENCY SERVICES ENTITY MORE THAN 35% OWNED BY KRISTOPHER BRICKMAN, M.D., PRESIDENT 209491 BILLING AND MANAGEMENT SERVICES 0 FORM 990, PART VI, SECTION A, LINE 3 UTMAC, LLC DELEGATES AUTHORITY TO STRATEGIC RISK SOLUTIONS WHICH SERVES AS THE CAPTIVE MANAGER. STRATEGIC RISK SOLUTIONS RECEIVED $53,000 AS COMPENSATION FOR CAPTIVE MANAGEMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY, INC. (UTP) HAS ONLY ONE CLASS OF MEMBER, AND ONLY ONE MEMBER, THE UNIVERSITY OF TOLEDO, EXERCISING ALL MEMBER RIGHTS. THE REPRESENTATIVES OF THE UNIVERSITY OF TOLEDO ACT ON ITS BEHALF AS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS ONLY ONE CLASS OF MEMBERS, AND ONLY ONE MEMBER, THE UNIVERSITY OF TOLEDO, EXERCISING ALL MEMBER RIGHTS. THE REPRESENTATIVES OF THE UNIVERSITY OF TOLEDO ACT ON ITS BEHALF AS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION HAS ONE MEMBER, THE UNIVERSITY OF TOLEDO, WHICH EXERCISES ALL MEMBER RIGHTS THROUGH THE ACTIONS OF ITS AUTHORIZED REPRESENTATIVES. THE SOLE MEMBER HAS THE POWER TO NOMINATE, ELECT AND REMOVE THE BOARD OF DIRECTORS OF THE CORPORATION; APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION AND CODE OF REGULATIONS OF THE CORPORATION; AND EXERCISE SUCH OTHER POWERS AS ARE NECESSARY, APPROPRIATE, AND CONSISTENT WITH LAW AND WITH THE ARTICLES OF INCORPORATION AND THE CODE OF REGULATIONS OF THE CORPORATION. THE FOLLOWING ACTIONS REQUIRE PRIOR APPROVAL OF THE SOLE MEMBER: (A) ANY CHANGE IN THE PURPOSE OR MISSION OF THE CORPORATION; (B) ANY CHANGE IN THE CODE OF REGULATIONS OR ARTICLES OF INCORPORATION OF THE CORPORATION; (C) ANY MERGER OR CONSOLIDATION OF THE CORPORATION WITH AN UNRELATED ENTITY; (D) THE PROPOSED SALE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; (E) ANY BORROWING OF FUNDS BY THE CORPORATION (EXCLUDING TRADE PAYABLES OR OTHER ORDINARY COURSE INDEBTEDNESS) IN EXCESS OF ITS GENERAL OPERATING LINE OF CREDIT IN AN AMOUNT TO BE ESTABLISHED ON AN ANNUAL BASIS BY APPROVAL OF THE BOARD OR ANY LOAN OF FUNDS BY THE CORPORATION; (F) ANY MATERIAL CHANGES IN THE CORPORATION'S PROFESSIONAL LIABILITY INSURANCE COVERAGE, INCLUDING CHANGES IN THE PARTIES PROVIDING SUCH COVERAGE; AND (G) THE DISSOLUTION OR LIQUIDATION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S FORM 990 IS PREPARED BY AN OUTSIDE PUBLIC ACCOUNTING FIRM BASED ON INFORMATION PROVIDED BY MANAGEMENT. ONCE A DRAFT RETURN IS AVAILABLE, IT IS PROVIDED TO MANAGEMENT FOR THEIR REVIEW. ANY CHANGES NOTED BY MANAGEMENT ARE INCORPORATED INTO THE RETURN BEFORE THE DOCUMENT IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C UTP DOES HAVE A CONFLICT OF INTEREST POLICY THAT IT FOLLOWS WHEN ADDRESSING POTENTIAL CONFLICTS. ALL OFFICERS, DIRECTORS, OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE CONFLICTS OF INTERESTS WHICH MAY ARISE. SHOULD AN INDIVIDUAL HAVE A CONFLICT OF INTEREST, THE INDIVIDUAL IDENTIFIED WITH THE CONFLICT MAY NOT VOTE ON SUCH ISSUE BEFORE GOVERNANCE. UNIVERSITY OF TOLEDO PHYSICIANS, LLC. AND UTP PATHOLOGY SERVICES, LLC FOLLOWS THE SAME CONFLICT OF INTEREST POLICY THAT WAS ADOPTED BY UTP LLC. UNIVERSITY OF TOLEDO MEDICAL ASSURANCE COMPANY, LLC HAS A SIMILAR CONFLICT OF INTEREST POLICY THAT IS FOLLOWED BY ALL UTMAC MANAGERS. THE POLICY REQUIRES SIMILAR DISCLOSURES AS NOTED ABOVE. FORM 990, PART VI, SECTION B, LINE 15 WHEN DETERMINING COMPENSATION FOR THE PRESIDENT/CEO OF THE VARIOUS ENTITIES, GOVERNANCE UTILIZES COMPARABILITY DATA. COMPENSATION LEVELS ARE REVIEWED BY CHAIRMAN AND COMPENSATION COMMITTEE OF THE BOARD. THIS PROCESS IS THE UTILIZED FOR ALL OFFICERS AND EMPLOYEES PLUS APPLIES TO ALL ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII - BOARD OF DIRECTOR LISTING FOR THE PURPOSE OF THE PART VII REPORTING, THE TRUSTEES OF UNIVERSITY OF TOLEDO PHSICIANS CLINICAL FACULTY, INC. (UTP) SERVE AS GOVERNANCE FOR UNIVERSITY OF TOLEDO PHSICIANS, LLC AND UTP PATHOLOGY SERVICES, LLC. THE SOLE MEMBER OF EACH OF THE LLCS IS UTP. UNIVERSITY OF TOLEDO MEDICAL ASSURANCE COMPANY, LLC (UTMAC) GOVERNANCE IS DESIGNATED IN PART VII OF THE FORM 990. UTP IS ALSO THE SOLE MEMBER OF UTMAC. PART VII, COMPENSATION INFORMATION THE INTERIM CEO OF THE ORGANIZATION IS CONTRACTED THROUGH A SERVICE CONTRACT WITH TRG HEALTHCARE LLC. HE IS NOT AN EMPLOYEE OF UTP. REMUNERATION PAID TO TRG HEALTHCARE LLC IS REPORTED IN PART VII SECTION B. PART VI LINE 13 - WRITTEN WHISLTLEBLOWER POLICY NEITHER UTP NOR UTMAC HAS YET ADOPTED A WRITTEN WHISTLEBLOWER POLICY. PART VI LINE 14 - DOCUMENT RETENTION AND DESTRUCTION POLICY UTMAC HAS NOT YET ADOPTED A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. UNIVERSITY OF TOLEDO PHYSICIANS LLC 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 341127097 DISREGARDED ENTITY FORMED TO CARRY OUT PURPOSES OF MEMBER OH 95811306 23604844 100 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UTP PATHOLOGY SERVICES LLC 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 264032238 DISREGARDED ENTITY FORMED TO CARRY OUT PURPOSES OF MEMBER OH 2280661 0 100 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIVERSITY OF TOLEDO MEDICAL ASSURANCE COMPANY LLC 159 BANK ST 4TH FLOOR BURLINGTON VT 05401 DISREGARDED ENTITY FORMED TO CARRY OUT PURPOSES OF MEMBER VT 3124626 39595383 100 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC TOLEDO AREA MEDICAL FOUNDATION 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 341308939 FINANCIAL SUPPORT TO UNIV. OF TOLEDO PHYSICIANS CLINICAL FACULTY OH 501(C) LINE 12C, III-FI N/A 0 UNIVERSITY OF TOLEDO 2801 W BANCROFT MS 319 TOLEDO OH 43606 346401483 A PUBLIC INSTITUTION OF HIGHER EDUCATION OH SECTION 115 N/A 0 REGIONAL CENTER FOR SLEEP MEDICINE OF TOLEDO LLC 3450 W CENTRAL AVE STE 118 TOLEDO OH 43606 264665939 SLEEP CENTER OH N/A RELATED 27750 0 0 0.05000 NORTHWEST OHIO ACO LLC 4235 SECOR ROAD TOLEDO OH 43614 455444018 ACCOUNTABLE CARE ORGANIZATION OH N/A RELATED 0 0 0.40000 0 0 1 0 0 1 0 0 0 0 1 1 1 1 1 1 1 0 0