2016-05-16T14:16:28-05:00 2015-06-30 341145015 WILLIAM VAUGHAN COMPANY 145 CHESTERFIELD LANE MAUMEE OH 435373836 990 2014-07-01 201304472 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIV 4193837100 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 HAITHAM M ELSAMALOTY MD TREASURER 4193837100 2016-05-16 1 JACK C HAGMEYER P00051646 4198911040 2016-05-16 2014 2016-08-17 19:52:53Z KRISTOPHER BRICKMAN MD 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 86488725 0 X N/A X 2004 OH PROMOTE, ENHANCE, SUPPLEMENT AND ASSIST IN THE PERFORMANCE OF THE MEDICAL AND HEALTH EDUCATION PROGRAMS AND SERVICES OF THE UNIVERSITY OF TOLEDO. 25 0 544 0 0 0 0 0 87950560 80189752 -590 2983021 2431435 3293199 90381405 86465972 2182469 2591443 0 0 63418885 64726883 0 0 0 19403946 16699405 85005300 84017731 5376105 2448241 30577886 31916318 10264899 9155090 20312987 22761228 PROMOTE, ENHANCE, SUPPLEMENT AND ASSIST IN THE PERFORMANCE OF THE MEDICAL AND HEALTH EDUCATION PROGRAMS AND SERVICES OF THE UNIVERSITY OF TOLEDO. 0 0 79475435 2591443 83482951 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. 79475435 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 43 0 1 544 1 0 0 0 0 0 0 0 0 X 25 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 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 171730 112910 58092 BRICKMAN MD KRISTOPHER PRESIDENT 20.00 20.00 X X 394615 193700 98116 CASABIANCA MD ANDREW B TRUSTEE 20.00 20.00 X 248850 171279 91278 CHANGHU CHEN MD TRUSTEE 20.00 20.00 X 470000 181648 95316 COOPER MD CHRISTOPHER J CHAIRMAN & DEAN 20.00 20.00 X X 233538 376960 141355 EBRAHEIM MD NABIL TRUSTEE 20.00 20.00 X 1546821 222139 105742 ELSAMALOTY MD HAITHAM M TREASURER 20.00 20.00 X X 296547 86765 72536 FARRELL MD STEVEN J TRUSTEE 20.00 20.00 X 209492 114301 64150 SPEER MD LINDA M TRUSTEE 20.00 20.00 X 116897 181779 67476 LYNN MD CHRISTOPHER K TRUSTEE 20.00 20.00 X 82617 124530 50711 MRAK MD ROBERT TRUSTEE 20.00 20.00 X 210000 183770 88541 NAZZAL MD MUNIER MS VICE PRESIDENT 20.00 20.00 X X 724496 169432 92384 SELMAN MD STEVEN H TRUSTEE 20.00 20.00 X 290491 208769 102337 SKIE MD MARTIN TRUSTEE 20.00 20.00 X 510170 100359 74730 TAMBURRINO MD MARIJO TRUSTEE 20.00 20.00 X 15000 205552 54597 TIETJEN MD GRETCHEN E TRUSTEE 20.00 20.00 X 151431 199790 73595 ZELENOCK MD GERALD B SECRETARY 20.00 20.00 X X 301923 210166 94585 ROLAND SKEEL MD TRUSTEE 20.00 20.00 X 158436 165458 69208 LANCE TALMAGE MD TRUSTEE 20.00 20.00 X 12981 106118 32915 JACOB E BIESZCZAD MD TRUSTEE 20.00 20.00 X 226360 40366 54237 THOMAS SODEMAN MD TRUSTEE 20.00 20.00 X 188392 169693 81581 DINKAR KAW MD TRUSTEE 20.00 20.00 X 410692 86857 69120 SRINI HEJEEBU DO TRUSTEE 20.00 20.00 X 211743 96074 69214 JIHAD T ABBAS MD PHYSICIAN 20.00 20.00 X 733646 82685 70260 HOSSEIN ELGAFY MD PHYSICIAN 20.00 20.00 X 718722 65499 81571 JOSEPH ATALLAH MD PHYSICIAN 20.00 20.00 X 721030 125007 81010 SYED FAZAL ABBAS ZAIDI MD PHYSICIAN 20.00 20.00 X 664891 90824 72301 DAVID SOHN MD PHYSICIAN 20.00 20.00 X 673385 55540 63337 GOLD MDJEFFREY P FORMER CHAIRMAN & DEAN 20.00 20.00 X 19280 288587 27570 10934176 4613342 2290967 170 1 1 0 0 PATIENT SERVICE 621110 80228196 80228196 DIALYSIS CENTER AND ACO 621110 -38444 -38444 80189752 3000000 3000000 5774 22753 -16979 -16979 -16979 MISCELLANEOUS 900099 2448624 2448624 MEANINGFUL USE REVENUE 900099 844575 844575 3293199 86465972 83482951 0 2983021 2591443 2591443 8149072 8149072 48629303 45482162 3147141 5500279 5241704 258575 942254 456818 485436 1505975 1262019 243956 204324 204324 47373 47373 3566255 3566255 1230599 1197458 33141 783054 692089 90965 1255222 1255222 189616 189616 2698426 2698426 PHARMACEUTICALS AND LAB 3445626 3445626 MCO CLINICAL COST AND D 1666825 1666825 MISCELLANEOUS 596970 361261 235709 PROFESSIONAL DUES AND S 494263 494263 520852 520852 84017731 79475435 4542296 0 17175726 18370263 11861467 12245318 46428 175477 91025 66454 1478802 730381 614112 748421 583128 104385 206000 206000 30577886 31916318 2938893 2104885 7326006 7050205 10264899 9155090 X 20312987 22761228 20312987 22761228 30577886 31916318 2448241 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. 1478802 730381 748421 748421 ACCRUED EXPENSES 6777289 ACCRUED PENSION 272916 7050205 1 UNIVERSITY OF TOLEDO FOUNDATION 2801 W BANCROFT ST TOLEDO OH 43606 346555110 501(C)(3) 2591443 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 154150 112910 17580 0 0 0 25759 12947 0 19386 197489 145243 0 0 BRICKMAN MD KRISTOPHER PRESIDENT 351589 193700 43026 0 0 0 39000 22161 0 36955 433615 252816 0 0 CASABIANCA MD ANDREW B TRUSTEE 211370 171279 37480 0 0 0 37328 19799 0 34151 286178 225229 0 0 CHANGHU CHEN MD TRUSTEE 470000 181648 0 0 0 0 39000 20898 0 35418 509000 237964 0 0 COOPER MD CHRISTOPHER J CHAIRMAN & DEAN 233538 376960 0 0 0 0 35031 43378 0 62946 268569 483284 0 0 EBRAHEIM MD NABIL TRUSTEE 33386 222139 1513435 0 0 0 39000 25471 0 41271 1585821 288881 0 0 ELSAMALOTY MD HAITHAM M TREASURER 18800 86765 277747 0 0 0 39000 10018 1200 22318 336747 119101 0 0 FARRELL MD STEVEN J TRUSTEE 0 114301 209492 0 0 0 31424 13145 0 19581 240916 147027 0 0 SPEER MD LINDA M TRUSTEE 116097 181779 800 0 0 0 17535 20913 0 29028 134432 231720 0 0 LYNN MD CHRISTOPHER K TRUSTEE 25665 124530 56952 0 0 0 12393 14220 0 24098 95010 162848 0 0 MRAK MD ROBERT TRUSTEE 210000 183770 0 0 0 0 31500 21142 0 35899 241500 240811 0 0 NAZZAL MD MUNIER MS VICE PRESIDENT 0 169432 724496 0 0 0 39000 19492 0 33892 763496 222816 0 0 SELMAN MD STEVEN H TRUSTEE 290491 208769 0 0 0 0 39000 23938 0 39399 329491 272106 0 0 SKIE MD MARTIN TRUSTEE 3546 100359 506624 0 0 0 39000 11508 0 24222 549170 136089 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 151431 199790 0 0 0 0 22715 22909 0 27971 174146 250670 0 0 ZELENOCK MD GERALD B SECRETARY 301923 210166 0 0 0 0 39000 24179 0 31406 340923 265751 0 0 ROLAND SKEEL MD TRUSTEE 130616 165458 27820 0 0 0 23765 18975 0 26468 182201 210901 0 0 LANCE TALMAGE MD TRUSTEE 12981 106118 0 0 0 0 1947 12481 0 18487 14928 137086 0 0 JACOB E BIESZCZAD MD TRUSTEE 114154 40366 112206 0 0 0 33954 4644 0 15639 260314 60649 0 0 THOMAS SODEMAN MD TRUSTEE 145193 169693 43199 0 0 0 28259 19429 0 33893 216651 223015 0 0 DINKAR KAW MD TRUSTEE 59767 86857 350925 0 0 0 39000 9896 0 20224 449692 116977 0 0 SRINI HEJEEBU DO TRUSTEE 33966 96074 177777 0 0 0 32136 11040 2500 23538 246379 130652 0 0 JIHAD T ABBAS MD PHYSICIAN 0 82685 733646 0 0 0 39000 9513 0 21747 772646 113945 0 0 HOSSEIN ELGAFY MD PHYSICIAN 4734 65499 713988 0 0 0 39000 14060 0 28511 757722 108070 0 0 JOSEPH ATALLAH MD PHYSICIAN 0 125007 721030 0 0 0 39000 14337 0 27673 760030 167017 0 0 SYED FAZAL ABBAS ZAIDI MD PHYSICIAN 420769 90824 244122 0 0 0 39000 10414 0 22887 703891 124125 0 0 DAVID SOHN MD PHYSICIAN 4415 55540 668970 0 0 0 39000 6390 0 17947 712385 79877 0 0 GOLD MDJEFFREY P FORMER CHAIRMAN & DEAN 19280 288587 0 0 0 0 2875 23000 0 1695 22155 313282 0 0 NORTHWEST OHIO EMERGENCY SERVICES ENTITY MORE THAN 35% OWNED BY KRISTOPHER BRICKMAN, M.D.,PRESIDENT 168905 BILLING AND MANAGEMENT SERVICES 0 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 COMPARIBILITY 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. UNIVERSITY OF TOLEDO PHYSICIANS LLC 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 341127097 DISREGARDED ENTITY FORMED TO CARRY OUT PURPOSES OF MEMBER OH 83438020 31606933 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 3083375 100 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC NORTHWEST OHIO MEDICINE INC 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 020624653 DISREGARDED ENTITY FORMED TO CARRY OUT PURPOSES OF MEMBER OH 0 205000 100 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC TOLEDO AREA MEDICAL FOUNDATION 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 341308939 PROVIDE FINANCIAL SUPPORT TO UNIV. OF TOLEDO PHYSICIANS CLINICAL FACULTY INC OH 501(C)(3) LINE 11C, 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 G A M RENAL LTD DIALYSIS PARTNERS OF NORTHWEST OHIO 30100 TELEGRAPH ROAD SUITE 200 BINGHAM FARMS MI 48025 341877956 DIALYSIS MI N/A RELATED 70149 40665 0 0 0.19000 NORTHWEST OHIO ACO LLC 4235 SECOR ROAD TOLEDO OH 43614 455444018 ACCOUNTABLE CARE ORGANIZATION OH N/A RELATED -108593 35970 0 0 0.40000 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 UNIVERSITY OF TOLEDO K 104269 COST UNIVERSITY OF TOLEDO N 104269 COST UNIVERSITY OF TOLEDO O 15652012 COST UNIVERSITY OF TOLEDO P 7152753 COST UNIVERSITY OF TOLEDO Q 15652012 COST