2014-05-14T10:50:30-05:00 2013-06-30 274080201 CBIZ MHM LLC 5100 POPLAR AVENUE THIRTIETH FLOOR MEMPHIS TN 38137 990 2012-07-01 621162462 UT MEDICAL GROUP INC UTME 9018668015 1407 UNION AVENUE NO 700 MEMPHIS TN 381043641 ANDREW BOTSCHNER 9018668015 2014-05-13 1 MARK E GROCHAU P00235252 9016855575 2012 2015-11-30 17:44:51Z ANDREW BOTSCHNER 1407 UNION AVESUITE 700 MEMPHIS TN 381043641 129033485 0 X WWW.UTMEDICALGROUP.COM X 1983 TN DELIVERY OF HEALTH CARE BY THE FACULTY PHYSICIANS OF THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER COLLEGE OF MEDICINE. 16 5 1179 0 4864047 -1391613 0 0 120014237 123402168 13671 23297 6861484 5606242 126889392 129031707 0 0 0 0 87324130 92698404 0 0 0 36625001 61640163 123949131 154338567 2940261 -25306860 67087792 60771025 30594973 49662508 36492819 11108517 X THE MISSION OF UT MEDICAL GROUP, INC. IS TO DELIVER HIGH QUALITY HEALTH AND MEDICAL SERVICES THROUGH: - LEADING EDGE CLINICAL PRACTICE IN AN ACADEMIC SETTING, - EXCELLENCE IN SERVICE AND SATISFACTION, AND - AVAILABILITY, ACCESSIBILITY, AND CONVENIENCE FOR THE PATIENTIN SUPPORT OF THE COLLEGE OF MEDICINE OF THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER. 0 0 130263458 122724112 UT MEDICAL GROUP, INC. (THE GROUP) IS A NONPROFIT EDUCATIONAL, RESEARCH AND CHARITABLE ORGANIZATION INCORPORATED IN THE STATE OF TENNESSEE WHOSE ACTIVITIES ENCOMPASS THE DELIVERY OF HEALTH CARE BY THE FACULTY OF THE COLLEGE OF MEDICINE OF THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER (UTHSC). THE GROUP OPERATES UNDER AN AFFILIATION AGREEMENT WITH UTHSC AND PROVIDES COMPREHENSIVE, HIGH QUALITY, MULTI-SPECIALTY HEALTH CARE TO ALL PATIENTS WHILE FULFILLING THE ACADEMIC, TEACHING AND RESEARCH RESPONSIBILITIES OF THE PROFESSIONAL EMPLOYEES (FACULTY PHYSICIANS).THE GROUP BEGAN THE YEAR WITH EIGHTEEN CLINICAL DEPARTMENTS AND CERTAIN ANCILLARY AND ADMINISTRATIVE DEPARTMENTS. THE CLINICAL DEPARTMENTS INCLUDED ADULT CARDIOVASCULAR INSTITUTE, ANESTHESIOLOGY, EMERGENCY MEDICINE, FAMILY MEDICINE, INTERVENTIONAL RADIOLOGY, MEDICINE, NEONATOLOGY, NEUROLOGY, OBSTETRICS AND GYNECOLOGY, OPHTHALMOLOGY, OTOLARYNGOLOGY, PLASTIC SURGERY, PRIMARY CARE, PSYCHIATRY, RADIOLOGY, SURGERY, SOLID ORGAN TRANSPLANT INSTITUTE, AND UROLOGY. DURING THE YEAR ENDED JUNE 30, 2013, A NEW DEPARTMENT OF DERMATOLOGY WAS ESTABLISHED TO ENHANCE BOTH THE SCOPE OF PATIENT SERVICES OFFERED AND THE ACADEMIC PROGRAM. THE RANGE OF SERVICES PROVIDED BY THE CLINICAL DEPARTMENTS INCLUDES PRIMARY CARE, SPECIALTY CONSULTATIONS, SUBSPECIALTY PROCEDURES AND DIAGNOSTIC EVALUATIONS, SURGICAL PROCEDURES (INCLUDING A TRANSPLANT PROGRAM) AND EMERGENCY CARE. HEALTH CARE SERVICES ARE DELIVERED IN NUMEROUS HOSPITAL AND CLINIC SETTINGS, INCLUDING INPATIENT AND OUTPATIENT CARE AT THE REGIONAL MEDICAL CENTER AT MEMPHIS (THE MED), LE BONHEUR CHILDREN'S HOSPITAL, MEMPHIS VA MEDICAL CENTER, METHODIST UNIVERSITY HOSPITAL, ST. JUDE CHILDREN'S RESEARCH HOSPITAL, ST. FRANCIS HOSPITAL, BAPTIST MEMORIAL HOSPITALS, AND OTHER LOCAL COMMUNITY HOSPITALS. THE GROUP'S FACULTY PHYSICIANS PROVIDE HEALTH CARE SERVICES TO PATIENTS OF THE CENTERS OF EXCELLENCE AT THE MED. THE CENTERS OF EXCELLENCE INCLUDE THE TRAUMA CENTER, BURN CENTER, WOUND CARE CENTER, HIGH RISK OBSTETRICS CENTER, NEWBORN CENTER, ADULT SPECIAL CARE, AND SICKLE CELL CENTER.DURING THE YEAR ENDED JUNE 30, 2013, THE GROUP HAD 697,000 PATIENT ENCOUNTERS IN INPATIENT, OUTPATIENT, AND CLINICAL SETTINGS. THE TRANSPLANT INSTITUTE SURGEONS PERFORMED 227 TRANSPLANTS DURING THE YEAR, INCLUDING TRANSPLANTS OF 112 LIVERS, 103 KIDNEYS, AND 12 PANCREASES. GROUP PHYSICIANS HAD 46,000 TRAUMA PATIENT ENCOUNTERS AT THE MED'S LEVEL ONE TRAUMA CENTER. GROUP PHYSICIANS WERE INVOLVED IN THE DELIVERIES OF OVER 4,000 BABIES AND COVERED OVER 34,000 SICK BABY DAYS IN THE MED'S NEWBORN CENTER AND AT LE BONHEUR CHILDREN'S HOSPITAL IN ADDITION TO 6,600 DAYS IN THE MED'S WELL BABY NURSERY. THE MEDICAL SERVICES PROVIDED BY THE GROUP ARE AVAILABLE TO THE COMMUNITY AS A WHOLE WITHOUT REGARD TO ABILITY TO PAY. MEDICARE, MEDICAID, AND TENNCARE PATIENTS ARE ACCEPTED. THE GROUP HAS AN AGREEMENT WITH THE MED, WHICH IS THE PUBLIC SAFETY NET HOSPITAL OF SHELBY COUNTY, TENNESSEE, THAT PROVIDES FOR THE DELIVERY OF PROFESSIONAL SERVICES TO INDIGENT PATIENTS, BOTH INPATIENT AND OUTPATIENT. IN ADDITION TO PATIENTS FROM SHELBY COUNTY, THE FACULTY PHYSICIANS AND OTHER PROFESSIONAL EMPLOYEES OF THE GROUP PROVIDE HEALTH CARE SERVICES TO OUT-OF-STATE RESIDENTS AND RESIDENTS OF FOREIGN COUNTRIES WHO HAVE LIMITED INCOMES. DURING THE YEAR OVER APPROXIMATELY 50 PERCENT OF THE GROUP'S SERVICES WERE PROVIDED TO PATIENTS WITH TENNCARE, MEDICAID OR NO INSURANCE COVERAGE. ANOTHER 25 PERCENT WERE PROVIDED TO MEDICARE PATIENTS. THE PROFESSIONAL EMPLOYEES OF THE GROUP ARE DEDICATED TO THE MEDICAL TRAINING AND EDUCATION OF HEALTH PROFESSIONALS IN CONJUNCTION WITH THE UTHSC COLLEGE OF MEDICINE. ALTHOUGH EDUCATIONAL ACTIVITIES ARE FUNDED PRIMARILY THROUGH THE UTHSC COLLEGE OF MEDICINE, THE GROUP MAKES SIGNIFICANT CONTRIBUTIONS TO THIS EFFORT WITH BOTH PERSONNEL AND FINANCIAL RESOURCES. DURING THE YEAR FACULTY PHYSICIANS WERE INVOLVED IN THE EDUCATION OF PRIMARILY THE THIRD AND FOURTH YEAR MEDICAL STUDENTS (300 OF THE 600 MEDICAL STUDENTS), 213 PRIMARY CARE INTERNS AND RESIDENTS, AND 271 NON-PRIMARY CARE RESIDENTS AND FELLOWS. ALSO IN CONJUNCTION WITH THE UTHSC COLLEGE OF MEDICINE, THE PROFESSIONAL EMPLOYEES OF THE GROUP ENGAGE IN PROGRAMS OF MEDICAL RESEARCH AND EDUCATION THAT PROMOTE THE LONG-TERM HEALTH AND WELFARE OF PATIENTS AND THE GENERAL PUBLIC. THE RESEARCH PROGRAMS FOCUS ON PREVENTION AND TREATMENT OF ILLNESSES AS WELL AS EFFECTS OF DRUGS AND MEDICATIONS ON A VARIETY OF DISEASES AND MEDICAL CONDITIONS. WHILE SERVING AS THE FACULTY PRACTICE PLAN OF THE UTHSC COLLEGE OF MEDICINE, THE LONG-TERM COMMITMENT OF THE GROUP IS TO CONTINUE TO PROVIDE MEDICAL SERVICES TO ANY AND ALL PATIENTS AND TO PROMOTE GOOD HEALTH THROUGH RESEARCH AND EDUCATION. 130263458 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 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 113 0 1 1179 1 1 1 0 0 0 0 0 0 0 0 0 X 16 5 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X X GEORGE J SANDERS 9018668015 1407 UNION AVENUE SUITE 720 MEMPHIS TN 381043641 ROBERT B CANADA MD 28.00 12.00 X 235660 109603 28099 TIMOTHY C FABIAN MD 22.00 18.00 X 236944 386203 60726 EDITH KELLY-GREEN 3.00 X 18500 0 0 DAVID MANESS DO 8.00 32.00 X 27790 290790 53870 HERMAN MORRIS JR 1.00 X 8000 0 0 F ELIZABETH PRITCHARD MD 24.00 16.00 X 163331 218207 34228 RONALD D REDDIN 3.00 X 31500 0 0 GUY REED III MD 10.00 30.00 X 99877 430223 35311 SRIDHAR SHANKAR MD 32.00 8.00 X 449212 11725 24372 CLAUDETTE SHEPHARD MD 18.00 22.00 X 108509 177364 32702 JAMES LACEY 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STERN, MD WAS RECRUITED TO UT MEDICAL GROUP, INC. AND THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER (UTHSC)IN 2011 TO BECOME THE NEW EXECUTIVE DEAN OF THE UTHSC COLLEGE OF MEDICINE AND CHAIRMAN OF THE BOARD OF UT MEDICAL GROUP INC. AS PART OF HIS COMPENSATION PACKAGE AND WITH THE APPROVAL OF THE CHANCELLOR OF UTHSC AND THE EXECUTIVE LEADERSHIP OF UT MEDICAL GROUP INC., DR. STERN RECEIVED A $30,000 RECRUITMENT INCENTIVE THAT IS TREATED AS A LOAN UNDER A SIGNED, FULLY EXECUTED MEMORANDUM OF OBLIGATION, WHICH CONTAINS CONDITIONS UNDER WHICH THE AMOUNT WILL BE FORGIVEN (AS A 3-YEAR RETENTION INCENTIVE) AND REPAYMENT TERMS IN THE EVENT THE CONDITIONS ARE NOT MET.PYONGSOO D. YOON, MD WAS RECRUITED TO UT MEDICAL GROUP INC. AND THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER (UTHSC)IN 2011 TO BECOME THE SURGICAL DIRECTOR OF THE ADULT CARDIOVASCULAR INSTITUTE. AS PART OF HIS COMPENSATION PACKAGE AND WITH THE APPROVAL OF THE CHANCELLOR OF UTHSC AND THE EXECUTIVE LEADERSHIP OF UT MEDICAL GROUP INC., DR. YOON RECEIVED A $125,000 RECRUITMENT INCENTIVE THAT IS TREATED AS A LOAN UNDER A SIGNED FULLY EXECUTED MEMORANDUM OF OBLIGATION, WHICH CONTAINS CONDITIONS UNDER WHICH THE AMOUNT WILL BE FORGIVEN (AS A 4-YEAR RETENTION INCENTIVE) AND REPAYMENT TERMS IN THE EVENT THE CONDITIONS ARE NOT MET. FORM 990, PART VI, SECTION A, LINE 4 ON DECEMBER 17, 2013, THE UT MEDICAL GROUP, INC. (UTMG) BOARD OF DIRECTORS APPROVED REVISIONS TO THE CORPORATE BYLAWS. THE MAJOR REVISIONS WERE ASSOCIATED WITH THE NUMBER AND COMPOSITION OF THE BOARD OF DIRECTORS, SEVERAL OF THE BOARD-LEVEL COMMITTEES, AND DESIGNATED STAFF OFFICERS TO BETTER ALIGN UTMG BYLAWS WITH THOSE OF OTHER NONPROFIT ORGANIZATIONS. THE NEW BYLAWS INCREASE THE PERCENTAGE OF INDEPENDENT DIRECTORS AND ADD A CHIEF COMPLIANCE OFFICER AND INTERNAL AUDITOR AS DESIGNATED STAFF OFFICERS. FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO ARTICLE II, SECTION 1 OF THE BYLAWS: THOSE PHYSICIANS WHO ARE DULY LICENSED TO PRACTICE MEDICINE IN THE STATE OF TENNESSEE AND THOSE CLINICAL PSYCHOLOGISTS WHO ARE DULY LICENSED IN THE STATE OF TENNESSEE, WHO HAVE BEEN APPOINTED TO FACULTY OF THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER (UTHSC),COLLEGE OF MEDICINE, WHO ARE FULL TIME EMPLOYEES PURSUANT TO WRITTEN EMPLOYMENT AGREEMENTS WITH THE GROUP AND WHO HAVE OBTAINED AND MAINTAIN CREDENTIALED STATUS AS A PRACTITIONER OF THE GROUP IN ACCORDANCE WITH THE POLICIES OF THE BOARD OF DIRECTORS AND THE GROUP'S PROVIDER CREDENTIALING AND ENROLLMENT DEPARTMENT, SHALL BE MEMBERS OF THE GROUP. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE BYLAWS: THE MEMBERS OF THE GROUP ANNUALLY SHALL ELECT THE MEMBER DIRECTORS WHO WILL SERVE ON THE BOARD OF DIRECTORS AT AN ELECTION HELD IN ACCORDANCE WITH SECTION 3.3 OF ARTICLE III OF THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B ACCORDING TO THE BYLAWS: THE MEMBERS SHALL ALSO HAVE THE RIGHT TO APPROVE OR DISAPPROVE THE DECISION OF THE BOARD OF DIRECTORS TO MERGE, LIQUIDATE, DISSOLVE OR TERMINATE THE GROUP, BY A VOTE OF TWO THIRDS (2/3) OF THE MEMBERS PRESENT OR REPRESENTED AT SUCH MEETING. THE MEMBERS SHALL ALSO HAVE THE RIGHT TO VOTE UPON SUCH MATTERS AS MAY BE PRESENTED TO THEM FROM TIME TO TIME BY THE BOARD OF DIRECTORS OR UPON SUCH MATTERS AS MAY BE PRESENTED BY A MAJORITY OF THE MEMBERS PRESENT OR REPRESENTED AT ANY ANNUAL OR SPECIAL MEETING OF THE MEMBERS; PROVIDED, HOWEVER, THAT ANY SUCH MATTERS ARE NOT VESTED EXCLUSIVELY, DIRECTLY OR INDIRECTLY, WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 UTMG'S BOARD OF DIRECTORS HAS DELEGATED THE 990 REVIEW PROCESS TO THE AUDIT AND COMPLIANCE COMMITTEE, WHICH IS A COMMITTEE OF THE BOARD. THIS COMMITTEE REVIEWS UTMG'S 990 & 990-T AND APPROVES THE RETURNS BEFORE THEY ARE SIGNED BY THE CHIEF EXECUTIVE OFFICER AND SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE OFFICERS AND DIRECTORS OF UT MEDICAL GROUP, INC. (UTMG) RECEIVE UTMG'S CONFLICT OF INTEREST POLICY AND A FORM TO COMPLETE AND SIGN ACKNOWLEDGING THAT THEY HAVE READ, UNDERSTAND, AND AGREE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. IN THE EVENT A POTENTIAL CONFLICT OF INTEREST WITH ANY OFFICER OR DIRECTOR ARISES, THE PROCESS FOR DISCLOSING THE ACTUAL OR POSSIBLE CONFLICT, DETERMINING IF ONE EXISTS, AND ADDRESSING A CONFLICT IS INCLUDED IN THE CONFLICT OF INTEREST POLICY AND IS FOLLOWED. FORM 990, PART VI, SECTION B, LINE 15 ACCORDING TO THE UT MEDICAL GROUP, INC. (UTMG) BYLAWS, THE COMPENSATION COMMITTEE OF THE UTMG BOARD OF DIRECTORS IS RESPONSIBLE FOR "APPROVING THE COMPENSATION OF THE EXECUTIVE STAFF AND APPLICABLE DIRECTORS OF THE GROUP. THE COMPENSATION COMMITTEE SHALL AT THE DIRECTION OF THE BOARD OF DIRECTORS REVIEW THE SYSTEM OF COMPENSATION OF THE GROUP'S MEMBERS AND OTHER PROFESSIONAL EMPLOYEES." THE COMPENSATION COMMITTEE IS COMPOSED OF THREE (3) VOTING MEMBERS, ALL OF WHOM ARE INDEPENDENT, OUTSIDE DIRECTORS, AND THREE (3) NONVOTING MEMBERS, INCLUDING THE CHAIRMAN OF THE BOARD AND TWO OTHER DIRECTORS. DURING THE REPORTING PERIOD THE COMPENSATION COMMITTEE MET AS OFTEN AS NEEDED AND, UTILIZING COMPENSATION MARKET SURVEY DATA, REVIEWED AND APPROVED SALARIES OF THE CHIEF EXECUTIVE OFFICER, OTHER EXECUTIVE OFFICERS, AND KEY EMPLOYEES. ACTIONS OF THE COMMITTEE WERE DOCUMENTED CONTEMPORANEOUSLY. FORM 990, PART VI, SECTION C, LINE 19 FORMS 1023, 990, AND 990-T ARE MADE AVAILABLE UPON REQUEST. PAPER COPIES OF THE SPECIFIC DOCUMENTS ARE FORWARDED TO THE REQUESTING INDIVIDUALS. FORMS 990 AND 990-T ARE ALSO AVAILABLE ON GUIDESTAR.ORG. THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. PAPER COPIES OF THE SPECIFIC DOCUMENTS ARE FORWARDED TO THE REQUESTING INDIVIDUALS. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THOSE ENTITIES WITH A BUSINESS NEED. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: UTMG NEPHROLOGY ADJUSTMENTS -222,593. UTMG DERMATOPATHOLOGY LLC 145,081. MSPS K-1 70. PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR UNIVERSITY PRACTICE MANAGEMENT 1407 UNION AVENUE SUITE 700 MEMPHIS TN 38104 273733656 PROVIDE BILLING & ADMIN SERVICES TO OTHER ACADEMIC MEDICAL PRACTICES TN 4864047 UTMG VASCULAR ACCESS PHYSICIANS LLC 1407 UNION AVENUE SUITE 700 MEMPHIS TN 38104 460928187 VASCULAR ACCESS CENTER TN 1699699 UTHSC COLLEGE OF MEDICINE 910 MADISON MEMPHIS TN 38163 626001636 TN 170(C) 0 INTERVENTIONAL ASSOCIATES OF MEMPHIS PC 1407 UNION AVENUE SUITE 700 MEMPHIS TN 381043641 201082435 TN 501 (C)(3) LINE 1 0 UTMG NEPHROLOGY LLC 1407 UNION AVENUE MEMPHIS TN 38104 271561248 RENAL DIALYSIS CENTER TN RELATED 307143 600833 0 0 0.70000 UTMG DERMATOPATHOLOGY LLC 1407 UNION AVENUE MEMPHIS TN 38104 461168283 DERMATOLOGICAL PATHOLOGY LABORATORY TN RELATED -985121 23394 0 0 0.67330 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 UNIVERSITY OF TN K 130011 UNIVERSITY OF TN P 6071790 UNIVERSITY OF TN - COLLEGE OF MEDICINE EDUCATION FUND SUPPORT R 1879893 UNIVERSITY OF TN Q 781602 UTMG DERMATOPATHOLOGY LLC A 615 UTMG DERMATOPATHOLOGY LLC D 80160