2017-08-15T10:58:14-05:00 2016-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2015-10-01 383474766 UNIVERSITY PHYSICIAN GROUP UNIV 2485815668 1560 E MAPLE NO 400 TROY MI 48083 JEFFERY P KOHLITZ VP OF FINANCE/CFO 2485815930 2017-08-14 1 WAYNE HARDER P00294296 3126343400 2015 2021-01-29 14:40:06Z JACK SOBEL MD 1560 E MAPLE NO 400 TROY MI 48083 218751671 0 X WWW.WSUPGDOCS.ORG X 1999 MI SEE SCHEDULE O 14 6 1645 67 0 0 0 0 195839027 211293437 98679 101208 1707359 7330651 197645065 218725296 0 0 0 0 141348794 130672567 0 0 0 66600329 89056404 207949123 219728971 -10304058 -1003675 68418727 108791541 17876197 67183768 50542530 41607773 X SEE SCHEDULE O 0 0 131243932 154611358 PROVIDE MEDICAL SERVICES AND EDUCATIONAL OPPORTUNITIES FOR NUMEROUS DEPARTMENTS AT LOCAL AREA HOSPITALS AND FOR WAYNE STATE UNIVERSITY FACULTY, FELLOWS AND RESIDENTS. 50208582 63986355 COORDINATE PROFESSIONAL AND ADMINISTRATIVE SERVICES PROVIDED TO HOSPITALS AND OTHER HEALTH CARE INSTITUTIONS AND PATIENTS; SPONSOR & CONDUCT ACTIVITIES SUPPORTING THE ACEDEMIC 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.) 149717 0 ESTABLISH AND CONDUCT REGULATORY COMPLIANCE PROGRAMS COVERING ALL DEPARTMENTS OF THE CORPORATION APPLICABLE TO HEALTH CARE SERVICES FURNISHED TO TEACHING PATIENTS AND TO OTHERS. 181602231 1 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 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 1 251 0 1 1645 1 0 0 0 0 0 0 0 0 0 0 X 14 6 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 1 1 X X JEFFERY KOHLITZ 2485815930 1560 E MAPLE STE 400 TROY MI 48083 JACK SOBEL MD CHAIRPERSON 40.00 0.00 X X 357281 0 30116 LIZABEH ARDISANA VICE CHAIR 1.00 0.00 X X 0 0 0 WAEL SAKR MD SECRETARY 40.00 0.00 X X 371210 0 30110 BASIM DUBAYBO MD TREASURER 40.00 0.00 X X 277552 0 30309 LAWRENCE HORN MD CLINICAL CHAIR-BOARD MEMBER 40.00 0.00 X 96075 0 0 DAVID ROSENBERG MD CLINICAL CHAIR-BOARD MEMBER 40.00 0.00 X 406444 0 32557 DONALD WEAVER MD CLINICAL CHAIR-BOARD MEMBER 40.00 0.00 X 241841 0 27248 MICHAEL CHER MD CLINICAL CHAIR-BOARD MEMBER 40.00 0.00 X 140659 0 15764 GEROLD BEPLER MD CLINICAL CHAIR-BOARD MEMBER 40.00 0.00 X 0 0 0 CARLA WALKER-MILLER COMMUNITY BOARD MEMBER 1.00 0.00 X 0 0 0 MAHA FREIJ COMMUNITY BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL BUSUITO MD COMMUNITY BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD BROWN DO COMMUNITY BOARD MBR(AS OF 10/01/15) 1.00 0.00 X 0 0 0 SCOTT THORNTON COMMUNITY BOARD MEMBER 1.00 0.00 X 0 0 0 MARK JURZYCH MD CLNCL CHR-BOARD MBR(UNTIL 01/04/16) 40.00 0.00 X 794702 0 30396 LISA KEANE PRESIDENT (AS OF 01/04/16) 40.00 0.00 X 0 0 0 SAFWAN BADR MD CMO (AS OF 10/1/2015) 40.00 0.00 X 308967 0 30252 JEFFERY KOHLITZ VP FINANCE (AS OF 08/22/16) 40.00 0.00 X 0 0 0 DIANE K STILLER CFO/COO (UNTIL 05/31/16) 40.00 0.00 X 232343 0 41860 KENNETH P LEE CPA EXEC DIR/TREASURER (UNTIL 01/03/16) 1.00 0.00 X 268447 0 49895 OMAR KHAN MD CEO (UNTIL 01/04/16) 40.00 0.00 X 434861 0 27196 LUAY HADDAD PHYSICIAN 40.00 0.00 X 947530 0 48773 ASHEESH TEWARI PHYSICIAN 40.00 0.00 X 923849 0 27280 JOHN WEBBER PHYSICIAN 40.00 0.00 X 637696 0 30309 JOFFER HAKIM PHYSICIAN 40.00 0.00 X 603499 0 53527 HAZEM ELTAHAWY PHYSICIAN 40.00 0.00 X 612559 0 30309 JOHN FLACK MD MPH FORMER SECRETARY 1.00 0.00 X 123601 0 13953 7779116 0 549854 341 1 1 0 HENRY FORD HEALTH SYSTEM 2799 W GRAND BLVD DETROIT MI 48202 MEDICAL SERVICES 8754012 UNIVERSITY PEDIATRICIANS 7457 E CAD BLVD SUITE 200 CLARKSTON MI 48348 MEDICAL SERVICES 8437970 ST JOHN EMERGENCY PHYSICIANS PC 17717 MASONIC BLVD FRASER MI 48026 MEDICAL SERVICES 4070742 MEDICAL CENTER EMERGENCY SERVICES 39300 W TWELVE MILE ROAD SUITE 10 FARMINGTON MI 483312989 MEDICAL SERVICES 3300427 ANESTHESIA SERVICES PC PO BOX 1009 JACKSON MI 49204 MEDICAL SERVICES 2521494 25 PATIENT REVENUES 900099 154611358 154611358 ADMIN & CLINICAL SVCS SUPPORT 900099 55908665 55908665 RENTAL INCOME 900099 773414 773414 211293437 127583 127583 26375 -26375 -26375 -26375 7330651 7330651 7330651 218725296 218597713 0 127583 1840903 1840903 109958806 100031926 9926880 3546964 3094755 452209 8935010 7077500 1857510 6390884 5202959 1187925 325386 30670 294716 21381114 17185365 4195749 3052987 1857953 1195034 204335 148948 55387 11667876 7149520 4518356 103007 67497 35510 375559 341728 33831 70257 70257 3070193 1183395 1886798 6538957 262953 6276004 PRACTICE EXPENSE 12061757 12054847 6910 FUND FOR MEDICAL RESEAR 11188521 11045709 142812 BAD DEBT 10760866 10760866 INTERCOMPANY 4146377 4146377 4109212 2264737 1844475 219728971 181602231 38126740 0 3301647 32374658 42365487 44581989 1655841 1416138 28373774 22949719 7315445 5424055 13332307 13333057 448000 0 0 11661644 68418727 108791541 14258189 12177530 3315649 54837144 302359 169094 17876197 67183768 X 50542530 41607773 50542530 41607773 68418727 108791541 X -1003675 -6391803 -1539279 X 0 1 X 1 0 X 193423807 194932690 189185088 197546386 218624088 993712059 193423807 194932690 189185088 197546386 218624088 993712059 0 0 0 993712059 8035 9182 7896 117583 127583 270279 8035 9182 7896 117583 127583 270279 193431842 194941872 189192984 197663969 218751671 993982338 0.99970 0.99980 0.00030 X 0 1 0 0 0 0 1 49500 0 0 49500 0 PART II-B, LINE 1: THE LOBBYING EFFORT IS TO CREATE A CONTINUED AWARENESS WITH LAWMAKERS OF THE ONGOING NEED TO SUSTAIN THE MEDICAID ENHANCEMENT PAYMENT PROGRAM. THE GOAL OF THE PROGRAM IS TO OFFER ACCESS TO HIGH QUALITY MEDICAL CARE FOR THOSE MEDICAID PATIENTS SEEN BY THE PHYSICIANS AND OTHER HEALTH CARE PROVIDERS OF UNIVERSITY PHYSICIAN GROUP. THIS PROGRAM PROVIDES ADDITIONAL PAYMENTS TO PHYSICIANS, ABOVE THE PUBLISHED MEDICAID FEE SCREENS, AS AN INCENTIVE TO SEE MEDICAID PATIENTS AND THE OTHER UNDER-SERVED MEMBERS OF THE COMMUNITY. 3200816 1810333 1390483 25172958 21139386 4033572 5424055 UNIVERSITY PHYSICIAN SVCS 10735175 C OHS/UPG VENTURES 1797624 C OAKLAND PHYSICIAN SURGERY CENTER 780008 C OAKWOOD ACO 20250 C 13333057 RELATED PARTY 2630000 INSURANCE RECOVERIES 9031644 11661644 CAPITAL LEASE OBLIGATIONS 169094 169094 X PART X, LINE 2: IN A DETERMINATION LETTER DATED MARCH 22, 2001, THE INTERNAL REVENUE SERVICE HELD THAT THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE CODE. THE ORGANIZATION IS SUBJECT TO TAX ON ANY UNRELATED BUSINESS INCOME. THE ORGANIZATION AND ITS SUBSIDIARIES FILE INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND VARIOUS STATE AND LOCAL JURISDICTIONS. FEDERAL, STATE AND LOCAL TAX RETURNS GENERALLY REMAIN OPEN FOR EXAMINATION BY THE VARIOUS TAXING AUTHORITIES FOR A PERIOD OF THREE TO FOUR YEARS. 1 0 0 1 0 1 0 0 0 JACK SOBEL MD CHAIRPERSON 353264 0 0 0 4017 0 29150 0 966 0 387397 0 0 0 WAEL SAKR MD SECRETARY 350000 0 21210 0 0 0 29150 0 960 0 401320 0 0 0 BASIM DUBAYBO MD TREASURER 276778 0 0 0 774 0 29150 0 1159 0 307861 0 0 0 DAVID ROSENBERG MD CLINICAL CHAIR-BOARD MEMBER 331444 0 75000 0 0 0 29150 0 3407 0 439001 0 0 0 DONALD WEAVER MD CLINICAL CHAIR-BOARD MEMBER 162055 0 77500 0 2286 0 26351 0 897 0 269089 0 0 0 MICHAEL CHER MD CLINICAL CHAIR-BOARD MEMBER 44536 0 95842 0 281 0 15442 0 322 0 156423 0 0 0 MARK JURZYCH MD CLNCL CHR-BOARD MBR(UNTIL 01/04/16) 792457 0 0 0 2245 0 29150 0 1246 0 825098 0 0 0 SAFWAN BADR MD CMO (AS OF 10/1/2015) 301190 0 7196 0 581 0 29150 0 1102 0 339219 0 0 0 DIANE K STILLER CFO/COO (UNTIL 05/31/16) 221155 0 10000 0 1188 0 25808 0 16052 0 274203 0 0 0 KENNETH P LEE CPA EXEC DIR/TREASURER (UNTIL 01/03/16) 266161 0 0 0 2286 0 29150 0 20745 0 318342 0 0 0 OMAR KHAN MD CEO (UNTIL 01/04/16) 399717 0 35144 0 0 0 26431 0 765 0 462057 0 0 0 LUAY HADDAD PHYSICIAN 345619 0 601147 0 764 0 29150 0 19623 0 996303 0 0 0 ASHEESH TEWARI PHYSICIAN 923849 0 0 0 0 0 26500 0 780 0 951129 0 0 0 JOHN WEBBER PHYSICIAN 499118 0 137750 0 828 0 29150 0 1159 0 668005 0 0 0 JOFFER HAKIM PHYSICIAN 584507 0 18337 0 655 0 29150 0 24377 0 657026 0 0 0 HAZEM ELTAHAWY PHYSICIAN 612379 0 0 0 180 0 29150 0 1159 0 642868 0 0 0 JOHN FLACK MD MPH FORMER SECRETARY 48139 0 0 0 75462 0 13545 0 408 0 137554 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 4A PURSUANT TO THE TERMS OF A SEVERANCE AGREEMENT BETWEEN UNIVERSITY PHYSICAN GROUP AND JOHN FLACK, THE ORGANIZATION PAID JOHN FLACK $75,000 OF SEVERANCE IN CALENDAR YEAR 2015 THAT WAS TREATED AS TAXABLE. PART I, LINE 5 THE ORGANIZATION MAKES PAYMENTS 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 THE ORGANIZATION MAKES PAYMENTS TO SOME PHYSICIANS (WHO ARE ALSO BOARD MEMBERS) FOR DIRECT COMPENSATION THAT ARE BASED ON EARNINGS AS PART OF INCENTIVE-BASED COMPENSATION. FORM 990, PART I, LINE 1 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. FORM 990, PART III, LINE 1 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. FORM 990, PART VI, SECTION A, LINE 4 DURING FISCAL YEAR 2016 THE ORGANIZATION AMENDED ITS BYLAWS TO SHIFT ITS FOCUS FROM A COMMUNITY FOCUSED BOARD TO A CHAIR FOCUSED BOARD. THE BOARD CHAIR IS NOW THE DEAN OF THE WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE INSTEAD OF A COMMUNITY MEMBER. DUE TO THE SHIFT IN FOCUS, THE ENTIRE COMMITTEE AND SUBCOMMITTE STRUCTURE WAS REVAMPED AS WELL. FORM 990, PART VI, SECTION B, LINE 11 ORGANIZATION'S PROCESS TO REVIEW FORM 990: THE ORGANIZATION'S CFO REVIEWS A DRAFT OF THE 990 AND REVIEWS THE FINAL COPY OF THE RETURN BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE UPG FINANCE DEPARTMENT SENT OUT EMAIL NOTIFICATIONS TO THE PRACTICE ADMINISTRATORS WITH INSTRUCTIONS TO THEIR RESPECTIVE DEPARTMENT CHAIRS ASKING THEM TO RESPOND FOR ANY POTENTIAL CONFLICTS OF INTEREST WITH UPG. UPG DID NOT HAVE A FORMALLY ASSIGNED CHIEF COMPLIANCE OFFICER IN FISCAL 2016, HOWEVER, ANY DISCLOSURES WERE REVIEWED BY THE CFO TO DETERMINE WHETHER THERE ARE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. 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 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION: NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO MAPLE SURGERY CENTER -1,257,634. NET ASSET TRANSFER -281,645. 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