2015-05-15T10:05:52-05:00 2014-06-30 341145015 WILLIAM VAUGHAN COMPANY 145 CHESTERFIELD LANE MAUMEE OH 435373836 990 2013-07-01 201304472 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIV 4193837100 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 HAITHAM M ELSAMALOTY MD TREASURER 4193837100 2015-05-15 1 JACK C HAGMEYER P00051646 4198911040 2015-05-15 2013 2016-04-25 22:37:26Z KRISTOPHER BRICKMAN MD 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 90381995 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 0 508 0 0 0 0 0 78608413 87950560 -3576 -590 2581520 2431435 81186357 90381405 36450 2182469 0 0 59402184 63418885 0 0 0 17723657 19403946 77162291 85005300 4024066 5376105 24131341 30577886 9194459 10264899 14936882 20312987 PROMOTE, ENHANCE, SUPPLEMENT AND ASSIST IN THE PERFORMANCE OF THE MEDICAL AND HEALTH EDUCATION PROGRAMS AND SERVICES OF THE UNIVERSITY OF TOLEDO. 0 0 80496769 2182469 90381995 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. 80496769 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 44 0 1 508 1 0 0 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 195000 87949 BOOTH JR MD ROBERT L TRUSTEE 20.00 20.00 X 161943 111886 54062 BRICKMAN MD KRISTOPHER PRESIDENT 20.00 20.00 X X 381723 179435 92563 CASABIANCA MD ANDREW B TRUSTEE 20.00 20.00 X 258650 140532 82704 CHANGHU CHEN MD TRUSTEE 20.00 20.00 X 460961 173077 87913 COOPER MD CHRISTOPHER J TRUSTEE 20.00 20.00 X 248834 342516 131080 EBRAHEIM MD NABIL TRUSTEE 20.00 20.00 X 1713742 220124 102170 ELMER MD LAWRENCE W TRUSTEE 20.00 20.00 X 57296 106291 44719 ELSAMALOTY MD HAITHAM M TREASURER 20.00 20.00 X X 364257 78660 68917 FARRELL MD STEVEN J TRUSTEE 20.00 20.00 X 231120 114301 65250 SPEER MD LINDA M TRUSTEE 20.00 20.00 X 117834 180116 69330 GOLD MD JEFFREY P CHAIRMAN 20.00 20.00 X 166100 563057 119540 HAMMERSLEY MD JEFFREY R TRUSTEE 20.00 20.00 X 227612 111463 68657 KIMMEL MD SANFORD R TRUSTEE 20.00 20.00 X 87442 140089 54026 LYNN MD CHRISTOPHER K VICE PRESIDENT 20.00 20.00 X X 70601 118963 45892 MANAHAN MD KELLY TRUSTEE 20.00 20.00 X 393831 96904 61965 MARCO MD ALAN P TRUSTEE 20.00 20.00 X 173328 145756 67492 MRAK MD ROBERT TRUSTEE 20.00 20.00 X 210891 182103 86605 NAZZAL MD MUNIER MS TRUSTEE 20.00 20.00 X 603490 167896 89718 SELMAN MD STEVEN H TRUSTEE 20.00 20.00 X 292834 206876 98930 SKIE MD MARTIN TRUSTEE 20.00 20.00 X 527376 99449 72652 TAMBURRINO MD MARIJO TRUSTEE 20.00 20.00 X 15891 203688 52209 TIETJEN MD GRETCHEN E TRUSTEE 20.00 20.00 X 152834 199706 71769 WOLDENBERG MD LEE S TRUSTEE 20.00 20.00 X 230156 100505 64687 ZELENOCK MD GERALD B SECRETARY 20.00 20.00 X X 290891 208260 91995 JIHAD T ABBAS MD PHYSICIAN 20.00 20.00 X 605346 81770 68486 HOSSEIN ELGAFY MD PHYSICIAN 20.00 20.00 X 660298 64905 73288 AZEDINE MEDHKOUR MD PHYSICIAN 20.00 20.00 X 554814 173501 91796 JOSEPH ATALLAH MD PHYSICIAN 20.00 20.00 X 632997 116995 76908 DAVID SOHN MD PHYSICIAN 20.00 20.00 X 709143 52530 61276 10822235 4876354 2304548 163 0 1 0 0 PATIENT SERVICE 621110 82668419 82668419 DIALYSIS CENTER AND ACO 621110 5282141 5282141 87950560 590 -590 -590 -590 MEANINGFUL USE REVENUE 900099 1265000 1265000 MISCELLANEOUS 900099 1166435 1166435 2431435 90381405 90381995 0 -590 2182469 2182469 8400643 8400643 47370648 44218754 3151894 5277274 5016705 260569 807921 391093 416828 1562399 1313765 248634 108632 108632 51373 51373 1581927 1581927 1631643 1599835 31808 695929 604964 90965 1178116 1178116 172783 172783 2531820 2531820 PHARMACEUTICALS AND LAB 7871801 7871801 MCO CLINICAL COST AND D 1664023 1664023 MISCELLANEOUS 540734 284274 256460 MEANINGFUL USE PAYMENT 500000 500000 875165 875165 85005300 80496769 4508531 0 11474786 17175726 11196255 11861467 86343 46428 55712 91025 1342992 728880 465418 614112 646827 583128 206000 206000 24131341 30577886 1784887 2938893 7409572 7326006 9194459 10264899 X 14936882 20312987 14936882 20312987 24131341 30577886 5376105 0 X X 0 1 X 1 0 X X X 0 0 0 UNIVERSITY OF TOLEDO 346401483 SECTION 115 1 1 1 400 1 400 1342992 728880 614112 614112 ACCRUED EXPENSES 6844382 ACCRUED PENSION 481624 7326006 1 UNIVERSITY OF TOLEDO FOUNDATION 2801 W BANCROFT ST TOLEDO OH 43606 346555110 501(C)(3) 2182069 FMV SUPPORT FOR THE UNIVERSITY OF TOLEDO FOUNDATION 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 0 0 0 0 0 0 0 0 BLUMER PHD MD JEFFREY TRUSTEE 220000 195000 0 0 0 0 33000 20400 0 34549 253000 249949 0 0 BOOTH JR MD ROBERT L TRUSTEE 151943 111886 10000 0 0 0 24291 11705 0 18066 186234 141657 0 0 BRICKMAN MD KRISTOPHER PRESIDENT 332041 179435 49682 0 0 0 38250 18841 0 35472 419973 233748 0 0 CASABIANCA MD ANDREW B TRUSTEE 215790 140532 42860 0 0 0 38250 14704 0 29750 296900 184986 0 0 CHANGHU CHEN MD TRUSTEE 460961 173077 0 0 0 0 38250 18208 0 31455 499211 222740 0 0 COOPER MD CHRISTOPHER J TRUSTEE 248834 342516 0 0 0 0 37325 35796 0 57959 286159 436271 0 0 EBRAHEIM MD NABIL TRUSTEE 36895 220124 1676847 0 0 0 38250 23028 0 40892 1751992 284044 0 0 ELMER MD LAWRENCE W TRUSTEE 334 106291 56962 0 0 0 8969 11120 2500 22130 68765 139541 0 0 ELSAMALOTY MD HAITHAM M TREASURER 19691 78660 344566 0 0 0 38250 8259 1200 21208 403707 108127 0 0 FARRELL MD STEVEN J TRUSTEE 2834 114301 228286 0 0 0 34668 12002 0 18580 265788 144883 0 0 SPEER MD LINDA M TRUSTEE 117834 180116 0 0 0 0 17675 18912 0 32743 135509 231771 0 0 GOLD MD JEFFREY P CHAIRMAN 166100 563057 0 0 0 0 24915 49576 0 45049 191015 657682 0 0 HAMMERSLEY MD JEFFREY R TRUSTEE 52636 111463 174976 0 0 0 34142 11661 0 22854 261754 145978 0 0 KIMMEL MD SANFORD R TRUSTEE 86958 140089 484 0 0 0 13116 14658 0 26252 100558 180999 0 0 LYNN MD CHRISTOPHER K VICE PRESIDENT 28499 118963 42102 0 0 0 10590 12258 0 23044 81191 154265 0 0 MANAHAN MD KELLY TRUSTEE 393831 96904 0 0 0 0 38250 10148 0 13567 432081 120619 0 0 MARCO MD ALAN P TRUSTEE 131438 145756 41890 0 0 0 24648 14801 0 28043 197976 188600 0 0 MRAK MD ROBERT TRUSTEE 210891 182103 0 0 0 0 31634 19121 0 35850 242525 237074 0 0 NAZZAL MD MUNIER MS TRUSTEE 2834 167896 600656 0 0 0 38250 17629 0 33839 641740 219364 0 0 SELMAN MD STEVEN H TRUSTEE 292834 206876 0 0 0 0 38250 21642 0 39038 331084 267556 0 0 SKIE MD MARTIN TRUSTEE 5377 99449 521999 0 0 0 38250 10404 0 23998 565626 133851 0 0 TAMBURRINO MD MARIJO TRUSTEE 15891 203688 0 0 0 0 2384 21309 0 28516 18275 253513 0 0 TIETJEN MD GRETCHEN E TRUSTEE 152834 199706 0 0 0 0 22925 20885 0 27959 175759 248550 0 0 WOLDENBERG MD LEE S TRUSTEE 20891 100505 209265 0 0 0 34523 10504 0 19660 264679 130669 0 0 ZELENOCK MD GERALD B SECRETARY 290891 208260 0 0 0 0 38250 21867 0 31878 329141 262005 0 0 JIHAD T ABBAS MD PHYSICIAN 2834 81770 602512 0 0 0 38250 8587 0 21649 643596 112006 0 0 HOSSEIN ELGAFY MD PHYSICIAN 6889 64905 653409 0 0 0 38250 6790 0 28248 698548 99943 0 0 AZEDINE MEDHKOUR MD PHYSICIAN 454887 173501 99927 0 0 0 38250 18153 0 35393 593064 227047 0 0 JOSEPH ATALLAH MD PHYSICIAN 4419 116995 628578 0 0 0 38250 12204 0 26454 671247 155653 0 0 DAVID SOHN MD PHYSICIAN 5587 52530 703556 0 0 0 38250 5516 0 17510 747393 75556 0 0 NORTHWEST OHIO EMERGENCY SERVICES ENTITY MORE THAN 35% OWNED BY KRISTOPHER BRICKMAN, M.D.,PRESIDENT 181873 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 81710957 29789758 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 3220714 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 5450324 540515 0 0 0.19000 NORTHWEST OHIO ACO LLC 4235 SECOR ROAD TOLEDO OH 43614 455444018 ACCOUNTABLE CARE ORGANIZATION OH N/A RELATED -168183 14863 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 151355 COST UNIVERSITY OF TOLEDO N 151355 COST UNIVERSITY OF TOLEDO O 14621197 COST UNIVERSITY OF TOLEDO P 6427165 COST UNIVERSITY OF TOLEDO Q 14621197 COST