2013-02-22T11:49:23-06:00 2012-06-30 341145015 WILLIAM VAUGHAN COMPANY 145 CHESTERFIELD LANE MAUMEE OH 435373836 990 2011-07-01 201304472 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIV 4193837100 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 HAITHAM M ELSAMALOTY MD 4193837100 2013-02-18 1 JACK C HAGMEYER P00051646 4198911040 2011 2016-03-07 17:11:31Z KRISTOPHER BRICKMAN MD 3355 GLENDALE AVENUE 3RD FLOOR TOLEDO OH 43614 78826466 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. 24 0 451 0 0 0 0 0 73877488 77828434 97 83 315190 997949 74192775 78826466 0 5100 0 0 50816896 53116112 0 0 0 22906076 22280973 73722972 75402185 469803 3424281 20112525 20699738 12623990 9786922 7488535 10912816 PROMOTE, ENHANCE, SUPPLEMENT AND ASSIST IN THE PERFORMANCE OF THE MEDICAL AND HEALTH EDUCATION PROGRAMS AND SERVICES OF THE UNIVERSITY OF TOLEDO. 0 0 70652182 5100 78826383 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. 70652182 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 0 0 0 0 0 1 1 0 0 0 0 1 47 0 1 451 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 TAMMY SCARBOROUGH 4193837100 3355 GLENDALE AVE THIRD FLOOR TOLEDO OH 43614 BLUMER PHD MD JEFFREY 40.00 X 220000 193908 65781 BOOTH JR MD ROBERT L 40.00 X 151119 110072 42099 BRICKMAN MDKRISTOPHER 40.00 X X 305955 167763 63413 CASABIANCA MD ANDREW B 40.00 X 233330 138646 57586 EBRAHEIM MD NABIL 40.00 X 1746450 215928 73156 ELMER MD LAWRENCE W 40.00 X 52475 102212 32342 ELSAMALOTY MD HAITHAM M 40.00 X X 319918 75169 52300 FARRELL MD STEVEN J 40.00 X 6362 107235 49005 FRENCH MD LINDA M 40.00 X X 115350 179687 45778 GOLD MD JEFFREY P 40.00 X X 166100 463256 92887 HAMMERSLEY MD JEFFREY R 40.00 X 150001 112805 41494 KIMMEL MD SANFORD R 40.00 X 77004 137569 34868 LYNN MD CHRISTOPHER K 40.00 X X 57756 119960 27561 MANAHAN MD KELLY 40.00 X 422725 79717 47910 MARCO MD ALAN P 40.00 X 192669 182555 59635 MRAK MD ROBERT 40.00 X 210000 181533 59466 NAZZAL MD MUNIER MS 40.00 X 485317 125410 57483 SELMAN MD STEVEN H 40.00 X 290000 206000 68766 SHAPIRO MD JOSEPH I 40.00 X X 171923 223175 60208 SKIE MD MARTIN 40.00 X 558756 94423 55545 TAMBURRINO MD MARIJO 40.00 X 15000 184609 28095 TIETJEN MD GRETCHEN E 40.00 X 152750 193971 50410 WOLDENBERG MD LEE S 40.00 X X 340341 153375 62780 ZELENOCK MD GERALD B 40.00 X X 290000 206834 70313 ELGAFY MD HOSSEIN 40.00 X 491349 58883 48170 SCHWANN MD THOMAS 40.00 X 407500 161941 62742 ABBAS MD JIHAD T 40.00 X 498197 75120 50402 COOPER MD CHRISTOPHER J 40.00 X 271536 306751 82830 MUSTAPHA MD ABDUL AZIM 40.00 X 507347 71011 49867 8907230 4629518 1592892 140 0 1 0 WALID MAHMOUD MD 546 TROON RD HOLLAND OH 43528 EMERGENCY ROOM COVERAGE 330566 1 PATIENT SERVICE 621110 77671853 77671853 DIALYSIS CENTER 621110 156581 156581 77828434 83 83 REFUND OF INTEREST ON 900099 534330 534330 MISCELLANEOUS 900099 463619 463619 997949 78826466 78826383 0 83 5100 5100 9752373 9752373 37104922 33962920 3142002 4201510 3929266 272244 774186 295070 479116 1283121 1040825 242296 154033 154033 77273 77273 1158619 1158619 1829702 1758410 71292 487636 396671 90965 962031 962031 117669 117669 2681996 2681996 PHARMACEUTICALS AND LAB 6829647 6829647 BAD DEBT EXPENSE 4466914 4466914 MCO CLINICAL COST AND D 1960737 1960737 MISCELLANEOUS 580034 205219 374815 974682 974682 75402185 70652182 4750003 0 4812688 9129029 13933137 10215453 81620 80618 167648 139139 946477 472407 396009 474070 488847 455429 232576 206000 20112525 20699738 5144733 2649388 7479257 7137534 12623990 9786922 X 7488535 10912816 7488535 10912816 20112525 20699738 3424281 0 X X 0 1 1 X 0 X X 0 0 0 UNIVERSITY OF TOLEDO 340967014 6 1 1 1 5100 1 5100 946477 472407 474070 474070 ACCRUED EXPENSES 6713420 ACCRUED PENSION 424114 7137534 1 UNIVERSITY OF TOLEDO 3000 ARLINGTON AVE TOLEDO OH 43614 340967014 501(C)(3) 5100 FMV SUPPORT FOR THE UNIVERSITY OF TOLEDO MEDICAL CENTER PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 X X 1 0 0 0 0 0 0 0 0 BLUMER PHD MD JEFFREY 220000 193908 0 0 0 0 33000 27147 0 5634 253000 226689 0 0 BOOTH JR MD ROBERT L 146119 110072 5000 0 0 0 22668 15410 0 4021 173787 129503 0 0 BRICKMAN MDKRISTOPHER 305955 167763 0 0 0 0 36750 23487 0 3176 342705 194426 0 0 CASABIANCA MD ANDREW B 233330 138646 0 0 0 0 35000 19410 0 3176 268330 161232 0 0 EBRAHEIM MD NABIL 32340 215928 1714110 0 0 0 36750 30230 0 6176 1783200 252334 0 0 ELMER MD LAWRENCE W 0 102212 52475 0 0 0 8231 14310 2400 7401 63106 123923 0 0 ELSAMALOTY MD HAITHAM M 18800 75169 301118 0 0 0 36750 10524 1200 3826 357868 89519 0 0 FARRELL MD STEVEN J 0 107235 6362 0 0 0 30361 15013 0 3631 36723 125879 0 0 FRENCH MD LINDA M 115000 179687 350 0 0 0 17302 25156 0 3320 132652 208163 0 0 GOLD MD JEFFREY P 166100 463256 0 0 0 0 24915 64856 0 3116 191015 531228 0 0 HAMMERSLEY MD JEFFREY R 47945 112805 102056 0 0 0 22500 15793 0 3201 172501 131799 0 0 KIMMEL MD SANFORD R 68675 137569 8329 0 0 0 11551 19260 0 4057 88555 160886 0 0 LYNN MD CHRISTOPHER K 25665 119960 32091 0 0 0 8663 16794 0 2104 66419 138858 0 0 MANAHAN MD KELLY 422725 79717 0 0 0 0 36750 11160 0 0 459475 90877 0 0 MARCO MD ALAN P 192669 182555 0 0 0 0 28901 25558 0 5176 221570 213289 0 0 MRAK MD ROBERT 210000 181533 0 0 0 0 31500 25415 0 2551 241500 209499 0 0 NAZZAL MD MUNIER MS 0 125410 485317 0 0 0 36750 17557 0 3176 522067 146143 0 0 SELMAN MD STEVEN H 290000 206000 0 0 0 0 36750 28840 0 3176 326750 238016 0 0 SHAPIRO MD JOSEPH I 161923 223175 10000 0 0 0 25788 31244 0 3176 197711 257595 0 0 SKIE MD MARTIN 0 94423 558756 0 0 0 36750 13219 0 5576 595506 113218 0 0 TAMBURRINO MD MARIJO 15000 184609 0 0 0 0 2250 25845 0 0 17250 210454 0 0 TIETJEN MD GRETCHEN E 147115 193971 5635 0 0 0 22912 27156 0 342 175662 221469 0 0 WOLDENBERG MD LEE S 41577 153375 298764 0 0 0 36750 21473 1500 3057 378591 177905 0 0 ZELENOCK MD GERALD B 290000 206834 0 0 0 0 36750 28957 0 4606 326750 240397 0 0 ELGAFY MD HOSSEIN 0 58883 491349 0 0 0 36750 8244 0 3176 528099 70303 0 0 SCHWANN MD THOMAS 407500 161941 0 0 0 0 36750 22672 0 3320 444250 187933 0 0 ABBAS MD JIHAD T 0 75120 498197 0 0 0 36750 10517 0 3135 534947 88772 0 0 COOPER MD CHRISTOPHER J 179037 306751 92499 0 0 0 36750 42945 0 3135 308286 352831 0 0 MUSTAPHA MD ABDUL AZIM 0 71011 507347 0 0 0 36750 9941 0 3176 544097 84128 0 0 PART I, LINE 4A GERARD L OTTEN RECEIVED $59,458 FROM UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY, INC. FOR SERVERANCE. FORM 990, PART VI, SECTION A, LINE 4 FORMER MEMBERS WERE TWO CLASSES: UNIVERSITY OF TOLEDO (UT) MEMBERS (PRESIDENT AND 2 MEMBERS OF THE BOARD OF TRUSTEES OF UT) AND FACULTY MEMBERS (PHYSICIANS WHO HAVE FACULTY APPOINTMENTS IN THE UT COLLEGE OF MEDICINE AND EMPLOYMENT WITH UTP, LLC (LLC).) THE ORGANIZATION HAS MOVED TO A SINGLE MEMBER MODEL WITH UT AS THE SOLE MEMBER. THE PRESIDENT OF UT, EXEC. VP FOR HEALTH AFFAIRS, AND 3 MEMBERS OF THE BOARD OF TRUSTEES OF UT HAVE BEEN AUTHORIZED TO ACT ON BEHALF OF THE SOLE MEMBER, UT. THE SOLE MEMBER MUST NOW SEEK INPUT ON ANY MATERIAL CHANGE TO THE ARTICLES OF INCORPORATION OR THE CODE OF REGULATIONS FROM THE CLINICAL FACULTY MEMBERS OF THE UT COLLEGE OF MEDICINE WHO ARE EMPLOYEES OF THE LLC, TO BE TAKEN IN TO CONSIDERATION SUBJECT TO THE MISSION AND CHARITABLE PURPOSES OF THE CORPORATION. FACULTY MEMBERS ARE NO LONGER VOTING MEMBERS FOR SECTION 2.3 RESERVED POWERS 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 77029994 20039309 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 1639891 0 100 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 340967014 A PUBLIC INSTITUTION OF HIGHER EDUCATION OH 501(C)(3) LINE 6 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 156581 427679 0 0 0.19000 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0