2018-05-14T11:01:37-05:00 2017-06-30 341145015 WILLIAM VAUGHAN COMPANY 145 CHESTERFIELD LANE MAUMEE OH 435373836 990 2016-07-01 201304472 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIV 4193837100 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 HAITHAM M ELSAMALOTY MD TREASURER 4193837100 2018-05-11 1 JACK C HAGMEYER P00051646 4198911040 2018-05-10 2016 2022-09-23 18:48:47Z KRISTOPHER BRICKMAN MD 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 133128621 0 X N/A X 2004 OH TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY. 22 0 573 0 0 0 0 26358701 86539675 104197742 -18362 -7476 3083820 2559053 89605133 133108020 177081 200977 0 0 69662444 78284722 0 0 0 19095731 25338324 88935256 103824023 669877 29283997 35449523 73317685 12018418 20602583 23431105 52715102 X TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY. 0 0 98283141 200977 106756795 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. SEE SCHEDULE O 98283141 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 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 1 0 1 36 0 1 573 1 0 0 0 0 0 0 0 0 0 0 X 22 0 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 OH X X GARY G LAWERA 4193837100 3355 GLENDALE AVE THIRD FLOOR TOLEDO OH 43614 BOOTH JR MD ROBERT L TRUSTEE 20.00 20.00 X 185809 117445 66603 BRICKMAN MD KRISTOPHER PRESIDENT 20.00 20.00 X X 415544 172002 102463 CASABIANCA MD ANDREW B TRUSTEE 20.00 20.00 X 261156 213610 108473 CHANGHU CHEN MD TRUSTEE 20.00 20.00 X 493462 188943 106585 COOPER MD CHRISTOPHER J CHAIRMAN & DEAN 20.00 20.00 X X 228911 440600 165961 EBRAHEIM MD NABIL TRUSTEE 20.00 20.00 X 1557707 231061 116492 ELSAMALOTY MD HAITHAM M TREASURER 20.00 20.00 X X 360532 103150 85400 SPEER MD LINDA M TRUSTEE 20.00 20.00 X 118103 210216 87846 SRINI K HEJEEBU DO SECRETARY 20.00 20.00 X X 189459 101182 71979 MRAK MD ROBERT TRUSTEE 20.00 20.00 X 240673 191151 100279 SKIE MD MARTIN VICE PRESIDENT 20.00 20.00 X X 493071 104390 82760 DINKAR KAW MD TRUSTEE 20.00 20.00 X 387785 82830 72052 TIETJEN MD GRETCHEN E TRUSTEE 20.00 20.00 X 232290 207613 106458 JACOB BIESZCZAD MD TRUSTEE 20.00 20.00 X 344173 43440 63937 BRYAN PYLES EXECUTIVE DIRECTOR 0.00 40.00 X X 0 219299 77551 BLUMER PHD MD JEFFREY TRUSTEE 20.00 2.00 X 205985 172709 92914 FARRELL MDSTEVEN J TRUSTEE 20.00 20.00 X 180373 117628 65837 LYNN MDCHRISTOPHER K TRUSTEE 20.00 20.00 X 42038 132288 38960 ROLAND T SKEEL MD TRUSTEE 20.00 20.00 X 155000 160578 75838 THOMAS C SODEMAN MD TRUSTEE 20.00 20.00 X 146889 164526 82324 LANCE TALMAGE MD TRUSTEE 20.00 20.00 X 25557 180093 64618 TAMBURRINO MDMARIJO TRUSTEE 20.00 20.00 X 15549 213808 62144 MOUHAMMAD JUMAA MD PHYSICIAN 20.00 20.00 X 663008 94471 79866 DAVID SOHN MD PHYSICIAN 20.00 20.00 X 685714 57897 69027 SYED FAZAL ABBAS ZAIDI MD PHYSICIAN 20.00 20.00 X 690069 94471 79867 MUNIER MS NAZZAL MD PHYSICIAN 20.00 20.00 X 697969 176237 103845 THOMAS SCHWANN MD PHYSICIAN 20.00 20.00 X 520215 229757 118438 9537041 4421395 2348517 198 0 1 0 0 26358701 26358701 PATIENT SERVICE 621110 91235151 91235151 UTMAC INSURANCE PREMIUMS 621110 11425027 11425027 UTMAC INVESTMENT INCOME 621110 1474918 1474918 DIALYSIS CENTER AND ACO 621110 62646 62646 104197742 13125 20601 -7476 -7476 -7476 MISCELLANEOUS 900099 2286506 2286506 MEANINGFUL USE REVENUE 900099 272547 272547 2559053 133108020 106756795 0 -7476 200977 200977 6896600 6896600 61171469 57887480 3283989 6826352 6583551 242801 1780583 740268 1040315 1609718 1391074 218644 165255 165255 50315 50315 6504864 6504864 702737 678469 24268 865523 774558 90965 1146257 1146257 228914 228914 2194186 2194186 UTMAC LOSSES AND LOSS A 8495132 8495132 MCO CLINICAL COST AND D 2081123 2081123 PHARMACEUTICALS AND LAB 868623 868623 MISCELLANEOUS 703818 351717 352101 1331577 1094093 237484 103824023 98283141 5540882 0 21926715 17960290 12272512 14236294 100207 77862 86844 27156 2152280 1072727 830494 1079553 27751 27751 205000 39908779 35449523 73317685 3301760 2450928 8716658 18151655 12018418 20602583 X 23431105 52715102 23431105 52715102 35449523 73317685 29283997 0 X X 0 1 X 1 0 X X 1 UNIVERSITY OF TOLEDO 346401483 5 1 26358701 0 1 26358701 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 X SCHEDULE A, PAGE 5, LINE 1C 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2152280 1072727 1079553 1079553 UTMAC ASSETS 39703779 GOODWILL 205000 39908779 ACCRUED EXPENSES 8562261 ACCRUED PENSION 411645 UTMAC LIABILITIES 9177749 18151655 1 UNIVERSITY OF TOLEDO FOUNDATION 2801 W BANCROFT ST TOLEDO OH 43606 346555110 501(C)(3) 200577 FMV SUPPORT FOR THE UNIVERSITY OF TOLEDO FOUNDATION 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 0 0 0 0 0 0 0 0 BOOTH JR MD ROBERT L TRUSTEE 161254 117445 24555 0 0 0 27871 15815 0 22917 213680 156177 0 0 BRICKMAN MD KRISTOPHER PRESIDENT 372855 172002 42689 0 0 0 39750 23162 0 39551 455294 234715 0 0 CASABIANCA MD ANDREW B TRUSTEE 246375 213610 14781 0 0 0 39174 28092 0 41207 300330 282909 0 0 CHANGHU CHEN MD TRUSTEE 493462 188943 0 0 0 0 39750 25444 0 41391 533212 255778 0 0 COOPER MD CHRISTOPHER J CHAIRMAN & DEAN 228911 440600 0 0 0 0 34335 56602 0 75024 263246 572226 0 0 EBRAHEIM MD NABIL TRUSTEE 42919 231061 1514788 0 0 0 39750 31115 0 45627 1597457 307803 0 0 ELSAMALOTY MD HAITHAM M TREASURER 19265 103150 341267 0 0 0 39750 13891 2400 29359 402682 146400 0 0 SPEER MD LINDA M TRUSTEE 118103 210216 0 0 0 0 17714 28392 0 41740 135817 280348 0 0 SRINI K HEJEEBU DO SECRETARY 36487 101182 152972 0 0 0 28644 13478 1500 28357 219603 143017 0 0 MRAK MD ROBERT TRUSTEE 210000 191151 30673 0 0 0 36101 25741 0 38437 276774 255329 0 0 SKIE MD MARTIN VICE PRESIDENT 8042 104390 485029 0 0 0 39750 14057 0 28953 532821 147400 0 0 DINKAR KAW MD TRUSTEE 63653 82830 324132 0 0 0 39750 11044 0 21258 427535 115132 0 0 TIETJEN MD GRETCHEN E TRUSTEE 153803 207613 78487 0 0 0 34842 27285 0 44331 267132 279229 0 0 JACOB BIESZCZAD MD TRUSTEE 23025 43440 321148 0 0 0 39750 5843 0 18344 383923 67627 0 0 BRYAN PYLES EXECUTIVE DIRECTOR 0 219299 0 0 0 0 0 30702 0 46849 0 296850 0 0 BLUMER PHD MD JEFFREY TRUSTEE 205985 172709 0 0 0 0 30898 23087 0 38929 236883 234725 0 0 FARRELL MDSTEVEN J TRUSTEE 793 117628 179580 0 0 0 27056 15840 0 22941 207429 156409 0 0 LYNN MDCHRISTOPHER K TRUSTEE 14228 132288 27810 0 0 0 6306 12869 0 19785 48344 164942 0 0 ROLAND T SKEEL MD TRUSTEE 155000 160578 0 0 0 0 23250 21466 0 31122 178250 213166 0 0 THOMAS C SODEMAN MD TRUSTEE 146009 164526 880 0 0 0 22033 22009 0 38282 168922 224817 0 0 LANCE TALMAGE MD TRUSTEE 25557 180093 0 0 0 0 3832 24252 0 36534 29389 240879 0 0 TAMBURRINO MDMARIJO TRUSTEE 15549 213808 0 0 0 0 2332 28792 0 31020 17881 273620 0 0 MOUHAMMAD JUMAA MD PHYSICIAN 460000 94471 203008 0 0 0 39750 12722 0 27394 702758 134587 0 0 DAVID SOHN MD PHYSICIAN 11886 57897 673828 0 0 0 39750 7797 0 21480 725464 87174 0 0 SYED FAZAL ABBAS ZAIDI MD PHYSICIAN 460000 94471 230069 0 0 0 39750 12722 0 27395 729819 134588 0 0 MUNIER MS NAZZAL MD PHYSICIAN 19305 176237 678664 0 0 0 39750 23733 0 40362 737719 240332 0 0 THOMAS SCHWANN MD PHYSICIAN 485456 229757 34759 0 0 0 39750 30924 0 47764 559965 308445 0 0 NORTHWEST OHIO EMERGENCY SERVICES ENTITY MORE THAN 35% OWNED BY KRISTOPHER BRICKMAN, M.D.,PRESIDENT 190357 BILLING AND MANAGEMENT SERVICES 0 FORM 990, PART VIII, LINE 2C: THE AMOUNT FROM PAGE 9, PART VIII, LINE 2C, $1,474,918, IS MADE UP OF VARIOUS INVESTMENTS FROM UTMAC. UTMAC IS A PURE CAPTIVE DOMICILED IN THE STATE OF VERMONT. IT'S A WHOLLY OWNED SUBSIDIARY AND THEREFORE DISREGARDED FOR TAX PURPOSES. THE NET INVESTMENT INCOME IS MADE UP OF: DIVIDEND INCOME OF $135,894, INTEREST INCOME OF $258,815, INVESTMENT EXPENSES OF $18,557, REALIZED GAINS ON SALES OF SECURITIES OF $150,822, REALIZED LOSSES ON SALES OF SECURITIES OF $74,415, AND A CHANGE IN UNREALIZED GAINS AND LOSSES OF $1,022,359. FORM 990, PART VI, SECTION A, LINE 6 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 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 CHANGE 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 DISTRIBUTED TO BOARD OF DIRECTORS FOR REVIEW BEFORE SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE CONFLICTS OF INTERESTS, WHICH IS SPECIFIED IN EACH EMPLOYMENT CONTRACT, INCLUDING NON-COMPETE REQUIREMENT. FORM 990, PART VI, SECTION B, LINE 15 USE COMPARABILITY DATA. REVIEWED BY CHAIRMAN AND COMPENSATION COMMITTEE OF THE BOARD. PROCESS IS THE SAME FOR OTHER OFFICERS AND EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS IN WHICH THE COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM PRIOR YEAR. 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