2017-05-15T14:32:55-05:00 2016-06-30 341145015 WILLIAM VAUGHAN COMPANY 145 CHESTERFIELD LANE MAUMEE OH 435373836 990 2015-07-01 201304472 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIV 4193837100 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 HAITHAM M ELSAMALOTY MD TREASURER 4193837100 2017-05-15 1 JACK C HAGMEYER P00051646 4198911040 2017-05-05 2015 2021-01-29 14:40:06Z KRISTOPHER BRICKMAN MD 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 89634972 0 X N/A X 2004 OH TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY. 24 0 544 0 0 0 0 0 80189752 86539675 2983021 -18362 3293199 3083820 86465972 89605133 2591443 177081 0 0 64726883 69662444 0 0 0 16699405 19095731 84017731 88935256 2448241 669877 31916318 35449523 9155090 12018418 22761228 23431105 TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY. 0 0 84389628 177081 89623495 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. 84389628 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 34 0 1 544 1 0 0 0 0 0 0 0 0 0 0 X 24 0 0 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 OH X X KATHY BISHOP 4193837100 3355 GLENDALE AVE THIRD FLOOR TOLEDO OH 43614 BLUMER PHD MD JEFFREY TRUSTEE 20.00 20.00 X 220000 196785 93102 BOOTH JR MD ROBERT L TRUSTEE 20.00 20.00 X 178968 112910 59178 BRICKMAN MD KRISTOPHER PRESIDENT 20.00 20.00 X X 417156 193700 98866 CASABIANCA MD ANDREW B TRUSTEE 20.00 20.00 X 252025 171279 91754 CHANGHU CHEN MD TRUSTEE 20.00 20.00 X 470073 181648 96066 COOPER MD CHRISTOPHER J CHAIRMAN & DEAN 20.00 20.00 X X 213575 376960 138167 EBRAHEIM MD NABIL TRUSTEE 20.00 20.00 X 1405024 222139 106492 ELSAMALOTY MD HAITHAM M TREASURER 20.00 20.00 X X 361744 86765 74486 FARRELL MD STEVEN J TRUSTEE 20.00 20.00 X 200641 114301 62822 SPEER MD LINDA M TRUSTEE 20.00 20.00 X 120258 181779 67867 SRINI K HEJEEBU DO SECRETARY 20.00 20.00 X X 232032 96074 71683 MRAK MD ROBERT TRUSTEE 20.00 20.00 X 212100 183770 88856 SKIE MD MARTIN VICE PRESIDENT 20.00 20.00 X X 467163 100359 75480 SAMAY JAIN MD TRUSTEE 20.00 20.00 X 285000 30875 57643 DINKAR KAW MD TRUSTEE 20.00 20.00 X 328795 86857 69870 TAMBURRINO MD MARIJO TRUSTEE 20.00 20.00 X 15000 205552 54597 TIETJEN MD GRETCHEN E TRUSTEE 20.00 20.00 X 163300 199790 75375 JACOB BIESZCZAD MD TRUSTEE 20.00 20.00 X 344860 40366 60033 SAMER KHOURI MD TRUSTEE 20.00 20.00 X 254933 83786 69426 JASON SCHROEDER MD TRUSTEE 20.00 20.00 X 571137 35320 58916 THOMAS SCHWANN MD TRUSTEE 20.00 20.00 X 475000 199314 94167 ROLAND T SKEEL MD TRUSTEE 20.00 20.00 X 176184 165458 71741 THOMAS C SODEMAN MD TRUSTEE 20.00 20.00 X 172997 169693 79271 LANCE TALMAGE MD TRUSTEE 20.00 20.00 X 25000 106118 34718 MOUHAMMAD JUMAA MD PHYSICIAN 20.00 20.00 X 621032 90824 73051 HOSSEIN ELGAFY MD PHYSICIAN 20.00 20.00 X 574969 65499 82321 JOSEPH ATALLAH MD PHYSICIAN 20.00 20.00 X 728059 125007 81760 SYED FAZAL ABBAS ZAIDI MD PHYSICIAN 20.00 20.00 X 662681 90824 33301 MUNIER MS NAZZAL MD PHYSICIAN 20.00 20.00 X 460596 169432 93134 10610302 4083184 2214143 227 0 1 0 0 PATIENT SERVICE 621110 86594465 86594465 DIALYSIS CENTER AND ACO 621110 -54790 -54790 86539675 11477 29839 -18362 -18362 -18362 MISCELLANEOUS 900099 2537350 2537350 MEANINGFUL USE REVENUE 900099 546470 546470 3083820 89605133 89623495 0 -18362 177081 177081 8330111 8330111 52266991 49416652 2850339 6278487 6047513 230974 1261562 456118 805444 1525293 1310258 215035 66350 66350 49115 49115 5394227 5394227 1352849 1327288 25561 845460 754495 90965 1035906 1035906 203586 203586 2660595 2660595 PHARMACEUTICALS AND LAB 4253288 4253288 MCO CLINICAL COST AND D 1659600 1659600 MISCELLANEOUS 635633 357438 278195 PROFESSIONAL DUES AND S 471248 471248 467874 467874 88935256 84389628 4545628 0 18370263 21926715 12245318 12272512 175477 100207 66454 86844 1689232 858738 748421 830494 104385 27751 206000 205000 31916318 35449523 2104885 3301760 7050205 8716658 9155090 12018418 X 22761228 23431105 22761228 23431105 31916318 35449523 669877 0 X 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 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. 1689232 858738 830494 830494 ACCRUED EXPENSES 8375961 ACCRUED PENSION 340697 8716658 1 UNIVERSITY OF TOLEDO FOUNDATION 2801 W BANCROFT ST TOLEDO OH 43606 346555110 501(C)(3) 177081 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 BLUMER PHD MD JEFFREY TRUSTEE 220000 196785 0 0 0 0 33000 22564 0 37538 253000 256887 0 0 BOOTH JR MD ROBERT L TRUSTEE 159039 112910 19929 0 0 0 26845 12947 0 19386 205813 145243 0 0 BRICKMAN MD KRISTOPHER PRESIDENT 372609 193700 44547 0 0 0 39750 22161 0 36955 456906 252816 0 0 CASABIANCA MD ANDREW B TRUSTEE 234053 171279 17972 0 0 0 37804 19799 0 34151 289829 225229 0 0 CHANGHU CHEN MD TRUSTEE 470073 181648 0 0 0 0 39750 20898 0 35418 509823 237964 0 0 COOPER MD CHRISTOPHER J CHAIRMAN & DEAN 213575 376960 0 0 0 0 31843 43378 0 62946 245418 483284 0 0 EBRAHEIM MD NABIL TRUSTEE 44957 222139 1360067 0 0 0 39750 25471 0 41271 1444774 288881 0 0 ELSAMALOTY MD HAITHAM M TREASURER 17600 86765 344144 0 0 0 39750 10018 2400 22318 403894 119101 0 0 FARRELL MD STEVEN J TRUSTEE 0 114301 200641 0 0 0 30096 13145 0 19581 230737 147027 0 0 SPEER MD LINDA M TRUSTEE 118058 181779 2200 0 0 0 17925 20913 0 29029 138183 231721 0 0 SRINI K HEJEEBU DO SECRETARY 34466 96074 197566 0 0 0 35105 11040 2000 23538 269137 130652 0 0 MRAK MD ROBERT TRUSTEE 210000 183770 2100 0 0 0 31815 21142 0 35899 243915 240811 0 0 SKIE MD MARTIN VICE PRESIDENT 7222 100359 459941 0 0 0 39750 11508 0 24222 506913 136089 0 0 SAMAY JAIN MD TRUSTEE 285000 30875 0 0 0 0 39750 3483 0 14410 324750 48768 0 0 DINKAR KAW MD TRUSTEE 59512 86857 269283 0 0 0 39750 9896 0 20224 368545 116977 0 0 TAMBURRINO MD MARIJO TRUSTEE 15000 205552 0 0 0 0 2250 23570 0 28777 17250 257899 0 0 TIETJEN MD GRETCHEN E TRUSTEE 153000 199790 10300 0 0 0 24495 22909 0 27971 187795 250670 0 0 JACOB BIESZCZAD MD TRUSTEE 21287 40366 323573 0 0 0 39750 4644 0 15639 384610 60649 0 0 SAMER KHOURI MD TRUSTEE 254933 83786 0 0 0 0 38069 9540 0 21817 293002 115143 0 0 JASON SCHROEDER MD TRUSTEE 571137 35320 0 0 0 0 39750 4050 0 15116 610887 54486 0 0 THOMAS SCHWANN MD TRUSTEE 475000 199314 0 0 0 0 39750 20025 0 34392 514750 253731 0 0 ROLAND T SKEEL MD TRUSTEE 176184 165458 0 0 0 0 26298 18975 0 26468 202482 210901 0 0 THOMAS C SODEMAN MD TRUSTEE 146069 169693 26928 0 0 0 25949 19429 0 33893 198946 223015 0 0 LANCE TALMAGE MD TRUSTEE 25000 106118 0 0 0 0 3750 12481 0 18487 28750 137086 0 0 MOUHAMMAD JUMAA MD PHYSICIAN 460000 90824 161032 0 0 0 39750 10414 0 22887 660782 124125 0 0 HOSSEIN ELGAFY MD PHYSICIAN 10220 65499 564749 0 0 0 39750 14060 0 28511 614719 108070 0 0 JOSEPH ATALLAH MD PHYSICIAN 0 125007 728059 0 0 0 39750 14337 0 27673 767809 167017 0 0 SYED FAZAL ABBAS ZAIDI MD PHYSICIAN 460000 90824 202681 0 0 0 0 10414 0 22887 662681 124125 0 0 MUNIER MS NAZZAL MD PHYSICIAN 0 169432 460596 0 0 0 39750 19492 0 33892 500346 222816 0 0 NORTHWEST OHIO EMERGENCY SERVICES ENTITY MORE THAN 35% OWNED BY KRISTOPHER BRICKMAN, M.D.,PRESIDENT 185511 BILLING AND MANAGEMENT SERVICES 0 FORM 990, PART VI, SECTION A, LINE 4 SINCE THE FILING OF THE PREVIOUS FORM 990, THE ORGANIZATION CHANGED ITS MISSION STATEMENT. 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 11 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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