2013-05-13T16:48:07-05:00 2012-06-30 860683059 BEACHFLEISCHMAN PC PO BOX 64130 TUCSON AZ 857284130 990 2011-07-01 990343363 CADUCEUS INDEMNITY INSURANCE CORPORATION LTD CADU 5206942700 745 FORT STREET HONOLULU HI 96813 MISTY D HANSEN 5206942700 2013-05-08 1 KAREN K MCCLOSKEY CPA P00099644 5203214600 2011 2016-02-24 21:20:13Z FARSHAD M SHIRAZI 1501 N CAMPBELL AVENUE TUCSON AZ 85724 17710242 0 X WWW.UAHEALTH.COM X 1999 HI PURE CAPTIVE INSURANCE COMPANY WHOLLY-OWNED BY THE UNIVERSITY OF ARIZONA PHYSICIANS. 6 3 0 3 0 0 0 0 5544095 5230191 3551969 2041834 0 0 9096064 7272025 0 0 0 0 1500 0 0 0 0 5244170 6846313 5245670 6846313 3850394 425712 55163584 65003556 18352265 27515675 36811319 37487881 CADUCEUS INDEMNITY INSURANCE COPORATION, LTD. IS A WHOLLY-OWNED SUBSIDIARY OF THE UNIVERSITY OF ARIZONA PHYSICIANS AND WAS CREATED AS A PURE CAPTIVE INSURANCE COMPANY. 0 0 6322115 5230191 INSURES THE UNIVERSITY OF ARIZONA PHYSICIANS ON A CLAIMS-MADE BASIS FOR MEDICAL PROFESSIONAL LIABILITY, MANAGED CARE PROFESSIONAL LIABILITY, AND DEFENSE COSTS. 6322115 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 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 0 1 0 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 3 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 X DONELLA FONES 5206942700 1501 N CAMPBELL AVENUE TUCSON AZ 85724 KEVIN J BURNS 1.00 X X 0 1880456 26542 ROBERT GOSHAY 1.00 X X 0 0 0 MISTY D HANSEN 1.00 X X 0 595126 91107 SCOT STERENBERG 1.00 X X 0 0 0 FARSHAD M SHIRAZI 1.00 X X 0 341877 71296 BRUCE M COULL 1.00 X 0 378828 69668 LAURA EBERLY 1.00 X 0 0 0 0 3196287 258613 0 0 1 0 ROPES & GRAY LLP 700 12TH STREET NW SUITE 900 WASHINGTON DC 200053948 LEGAL SERVICE 110610 1 DIRECT WRITTEN PREMIUM 525190 5230191 5230191 5230191 1517649 1517649 10962402 10438217 524185 524185 524185 7272025 5230191 0 2041834 63127 63127 194329 194329 27500 27500 151847 151847 87395 87395 LOSS RESERVE EXPENSE 6307635 6307635 UNDERWRITING EXPENSE 14480 14480 6846313 6322115 524198 0 4989946 4085284 14563 161349 49947177 55829763 211898 4927160 55163584 65003556 73265 136817 18279000 27378858 18352265 27515675 X 2500000 2500000 0 0 34311319 34987881 36811319 37487881 55163584 65003556 X 425712 250850 X 0 1 1 X 0 X X X 0 0 0 UNIVERSITY PHYSICIANS HEALTHCARE 942958258 3 1 1 1 6846313 1 6846313 0 DUE FROM THE UNIVERSITY OF ARIZONA PHYSICIANS HEALTHCARE 4927160 4927160 DUE TO THE UNIVERSITY OF ARIZONA PHYSICIANS HEALTHCARE 36197 UNEARNED PREMIUM 4913661 RESERVE FOR LOSSES 22429000 27378858 7272025 6846313 425712 250850 250850 676562 7522875 250850 250850 7272025 0 7272025 6846313 0 6846313 0 6846313 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: TAXES: THE COMPANY QUALIFIES FOR TAX-EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES IN THE ACCOMPANYING STATEMENTS OF OPERATIONS. HOWEVER, FOR THE STATE OF HAWAII, A 0.25 PERCENT GROSS PREMIUM TAX IS ASSESSED IN LIEU OF STATE INCOME AND GENERAL EXCISE TAXES. THE COMPANY HAS ADOPTED THE PROVISIONS OF THE INCOME TAXES TOPIC IN THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION. THE INCOME TAXES TOPIC CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE TOPIC AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT STANDARD FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF AN INCOME TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE COMPANY HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT THE ADOPTION OF THIS TOPIC DID NOT AFFECT THE FINANCIAL STATEMENT PRESENTATION. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE AND LOCAL TAX AUTHORITIES FOR YEARS ENDED JUNE 30, 2008, AND BEFORE. 1 1 0 0 0 0 0 0 0 KEVIN J BURNS 0 310302 0 286209 0 1283945 0 7055 0 19487 0 1906998 0 0 MISTY D HANSEN 0 395981 0 196796 0 2349 0 75461 0 15646 0 686233 0 0 FARSHAD M SHIRAZI 0 223677 0 116900 0 1300 0 52806 0 18490 0 413173 0 0 BRUCE M COULL 0 374447 0 0 0 4381 0 50254 0 19414 0 448496 0 0 PART I, LINES 4A-B KEVIN J. BURNS RECEIVED $1,281,641 IN SEVERANCE PAYMENTS IN ACCORDANCE WITH THE EMPLOYMENT CONTRACT. THE FOLLOWING PEOPLE PARTICIPATED IN OR RECEIVED PAYMENTS FROM A NON-QUALIFIED RETIREMENT PLAN: KEVIN J. BURNS $286,209 AND MISTY D. HANSEN $52,050. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE ORGANIZATION DOES NOT COMPENSATE THE PRESIDENT, BUT RATHER RELIES ON ITS RELATED ORGANIZATION THE UNIVERSITY OF ARIZONA HEALTH NETWORK, WHICH USED THE FOLLOWING TO ESTABLISH COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OF DIRECTORS OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 3 THE CORPORATION EMPLOYS MARSH MANAGEMENT SERVICES TO MANAGE DAILY OPERATIONS. FORM 990, PART VI, SECTION A, LINE 6 THE UNIVERSITY OF ARIZONA PHYSICIANS IS A THE SOLE MEMBER OF CADUCEUS INDEMNITY INSURANCE CORPORATION, LTD. FORM 990, PART VI, SECTION A, LINE 7A THE UNIVERSITY OF ARIZONA PHYSICIANS, AS SOLE MEMBER OF CADUCEUS INDEMNITY INSURANCE CORPORATION, MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS PROVIDE FOR SPECIFIC MATTERS THAT ARE RESERVED FOR APPROVAL FROM THE MEMBER. MAJOR ACTIVITIES ARE ALSO SUBJECT TO REVIEW BY THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. ANY REPORTED CONFLICT OF INTEREST IS REVIEWED BY GENERAL COUNSEL, PRESIDENT AND THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 250,850. ARIZONA BOARD OF REGENTS 2020 N CENTRAL AVENUE PHOENIX AZ 85004 866004791 GOVERNING BOARD OF ARIZONA'S PUBLIC UNIVERSITIES AZ N/A 0 THE UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE 888 N EUCLID TUCSON AZ 85719 742652689 PUBLIC UNIVERSITY AZ ARIZONA BOARD OF REGENTS 0 THE UNIVERSITY OF ARIZONA HEALTH NETWORK INC 1501 N CAMPBELL AVENUE TUCSON AZ 85724 272936985 ENHANCE RELATIONSHIP BETWEEN UAMCC AND UAP AZ 501(C)(3) LINE 11B, II ARIZONA BOARD OF REGENTS 0 UNIVERSITY MEDICAL CENTER CORPORATION 1501 N CAMPBELL AVENUE TUCSON AZ 85724 860492210 HEALTHCARE AZ 501(C)(3) LINE 3 THE UNIVERSITY OF ARIZONA HEALTH NETWORK 0 UNIVERSITY PHYSICIANS HEALTHCARE 2701 E ELVIRA ROAD TUCSON AZ 85756 942958258 HEALTHCARE AZ 501(C)(3) LINE 3 THE UNIVERSITY OF ARIZONA HEALTH NETWORK 0 UNIVERSITY MEDICAL CENTER FOUNDATION 1501 N CAMPBELL AVENUE TUCSON AZ 85724 860572438 FUNDRAISING AZ 501(C)(3) LINE 11A, I UNIVERSITY MEDICAL CENTER CORPORATION 0 UNIVERSITY PHYSICIANS HEALTHCARE FOUNDATION 2701 E ELVIRA ROAD TUCSON AZ 85756 202826747 FUNDRAISING AZ 501(C)(3) LINE 11A, I UNIVERSITY PHYSICIANS HEALTHCARE 0 DEVICE PRESERVATION INC 1501 N CAMPBELL AVENUE TUCSON AZ 85724 860687598 SUPPORT AZ 501(C)(3) LINE 11A, I UNIVERSITY MEDICAL CENTER CORPORATION 0 UM LEASING LLC 4291 N CAMPBELL AVENUE TUCSON AZ 85724 203400643 LEASING AZ N/A UMCC INSURANCE FUNDING LIMITED PO BOX 1051 GEORGETOWN GRAND CAYMAN KY1-1102 CJ 980116943 CAPTIVE INSURANCE CJ N/A C THE UNIVERSITY OF ARIZONA HEALTH PLANS - UNIVERSITY HEALTHCARE INC 2701 E ELVIRA ROAD TUCSON AZ 85756 454370907 HEALTH INSURANCE AZ N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1