2021-05-06T08:53:35-05:00 2020-06-30 351178661 BLUE & CO LLC 9200 WORTHINGTON RD STE 200 WESTERVILLE OH 43082 990 2019-07-01 311447726 OHIO STATE UNIVERSITY PHYSICIANS INC OHIO 6147847800 700 ACKERMAN RD STE 505 NO 5000 COLUMBUS OH 43202 L ARICK FORREST MD PRESIDENT 6149473700 2021-04-23 1 BRIDGETTE MUGGE P00671418 6148852583 2021-04-23 2019 2022-09-23 18:48:47Z L ARICK FORREST MD 700 ACKERMAN RD STE 505 NO 5000 COLUMBUS OH 43202 607550706 0 X WWW.OSUPHYSICIANS.COM X 2002 OH OHIO STATE UNIVERSITY PHYSICIANS ALONG WITH THE OHIO STATE UNIVERSITY COLLEGE OF MEDICINE RENDER CLINICAL SERVICES IN CONNECTION WITH THEIR TEACHING DUTIES AND PROVIDE MEDICAL CARE TO ALL THOSE WHO SEEK SUCH SERVICES. THE PHYSICIANS SUPPORT ACADEMIC ENRICHMENT TO THE EDUCATIONAL AND RESEARCH PROGRAMS OF THE OHIO STATE UNIVERSITY COLLEGE OF MEDICINE AS WELL AS CHARITY CARE TO SUPPORT THE CLINICAL MISSION OF OSU INCLUDING PROVIDING CARE TO INDIVIDUALS THAT MAY NOT BE ABLE TO AFFORD CARE. ADDITIONALLY THEY SUPPORT PATIENTS THAT ARE A PART OF THE MEDICARE / MEDICAID PROGRAMS BY ACCEPTING PAYMENTS FOR SERVICES THAT ARE LESS THAN COST. 30 1 1452 0 0 0 0 0 569122597 603989617 2178248 934050 2011166 1892666 573312011 606816333 10787260 7917409 0 0 428497234 483038853 0 0 0 106101328 107667062 545385822 598623324 27926189 8193009 245703137 280155333 48337740 74494188 197365397 205661145 X THE EXEMPT PURPOSE OF THE ORGANIZATION IS TO ENHANCE, IMPROVE AND SUPPORT THE EDUCATIONAL, RESEARCH, AND CLINICAL PROGRAMS OF THE OHIO STATE UNIVERSITY COLLEGE OF MEDICINE, THE PHYSICIANS WHO RENDER CLINICAL AND RESEARCH SERVICES IN CONNECTION WITH THEIR TEACHING DUTIES AND TO PROVIDE MEDICAL CARE TO ALL THOSE WHO SEEK SUCH SERVICES. PROGRAMS PROVIDE HEALTH CARE AND TEACHING TO THE CENTRAL OHIO AREA AND MULTIPLE CLINICAL LOCATIONS. OTHER SERVICES INCLUDE BILLING AND COLLECTIONS FOR RELATED ENTITIES AND DEPARTMENTS. CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS CHARITY CARE IN ACCORDANCE WITH FEDERAL GUIDELINES, THE OHIO STATE UNIVERSITY HEALTH SYSTEM AND OHIO STATE UNIVERSITY PHYSICIANS, AND AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE WRITTEN OFF. 0 0 129868842 7917409 17195698 ACADEMIC ENRICHMENT TO SUPPORT THE EDUCATIONAL AND RESEARCH PROGRAMS OF THE OHIO STATE UNIVERSITY COLLEGE OF MEDICINE. 312932569 136027730 SUPPORT PATIENTS THAT ARE A PART OF THE MEDICARE /MEDICAID PROGRAMS BY ACCEPTING PAYMENTS FOR SERVICES THAT ARE LESS THAN COST. 8457591 CHARITY CARE TO SUPPORT THE CLINICAL MISSION OF OSU INCLUDING PROVIDING CARE TO INDIVIDUALS THAT MAY NOT BE ABLE TO AFFORD CARE. 71607419 450834327 ALL OTHER PROGRAM SERVICES INCLUDE CLINICAL CARE FOR PATIENTS TYPICAL OF AN ACADEMIC PHYSICIAN OFFICE PRACTICE. 71607419 450834327 522866421 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 91 0 1 1452 1 0 0 0 0 0 0 0 0 0 0 0 0 X 30 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 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UNDER A NOW DISREGARDED LEGAL ENTITY NAME, OSUP OBTAINED ITS DETERMINATION LETTER ON OCTOBER 21, 1996, IN WHICH THE INTERNAL REVENUE SERVICE STATED THAT THE ORGANIZATION WAS IN COMPLIANCE WITH APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. OSUP MANAGEMENT AND LEGAL COUNSEL BELIEVE THAT THE ORGANIZATION IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. OSUP HAS DETERMINED NO PROVISION FOR INCOME TAXES IS NECESSARY NOR HAS BEEN INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. ANY UNRELATED BUSINESS INCOME IS TAXABLE. 0 THE OHIO STATE UNIVERSITY 1960 KENNY ROAD COLUMBUS OH 432101016 316025986 115 7917409 ACADEMIC ENRICHMENT 1 PART I, LINE 2: GRANTS MADE BY THE ORGANIZATION ARE EXCLUSIVELY GIVEN TO THE VARIOUS MEDICAL DEPARTMENTS AT THE OHIO STATE UNIVERSITY, A RELATED SECTION 115 ORGANIZATION. X X X 0 0 0 0 0 0 0 0 0 GOERLITZ RYAN CFO 0 256484 0 34710 0 480 0 30026 0 22681 0 344381 0 0 LEE CHERYL VICE PRESIDENT 0 654601 0 139968 0 552 0 83086 0 23065 0 901272 0 0 PAWLIK TIMOTHY SECRETARY/TREASURER 0 829377 0 164000 0 552 0 82681 0 29539 0 1106149 0 0 ANGELOS MARK BOARD MEMBER 0 456201 0 107947 0 3105 0 80843 0 16343 0 664439 0 0 CATERINO JEFF BOARD MEMBER 0 331077 0 28470 0 780 0 53744 0 28656 0 442727 0 0 CHAKRAVARTI ARNAB BOARD MEMBER 0 726612 0 203580 0 2382 0 53232 0 29705 0 1015511 0 0 DUNGAN KATHLEEN BOARD MEMBER 0 195170 0 0 0 1110 0 25442 0 24294 0 246016 0 0 FRANKEL WENDY BOARD MEMBER 0 467410 0 129154 0 3770 0 73315 0 27260 0 700909 0 0 GLASSMAN ANDREW BOARD MEMBER 0 718663 0 169020 0 1640 0 88215 0 15989 0 993527 0 0 HARTER RONALD BOARD MEMBER 0 551622 0 99343 0 4422 0 76190 0 25241 0 756818 0 0 KOLETAR SUSAN BOARD MEMBER 0 295015 0 35006 0 3129 0 42405 0 8325 0 383880 0 0 LANDON MARK BOARD MEMBER 0 587723 0 150626 0 1955 0 84428 0 22987 0 847719 0 0 LONSER RUSSELL BOARD MEMBER 0 939896 0 214232 0 552 0 96513 0 22729 0 1273922 0 0 MALLAMPALLI RAMA BOARD MEMBER 0 577491 0 92859 0 1367 0 61684 0 25065 0 758466 0 0 MYSIW W JERRY BOARD MEMBER 0 371182 0 72846 0 1981 0 57450 0 28330 0 531789 0 0 NEEDLEMAN BRADLEY BOARD MEMBER 0 547449 0 75300 0 828 0 85893 0 29876 0 739346 0 0 OHR MATTHEW BOARD MEMBER 0 678435 0 141810 0 480 0 81973 0 24629 0 927327 0 0 PAPADAKIS MICHAEL BOARD MEMBER 0 602154 0 134200 0 2217 0 76337 0 23581 0 838489 0 0 POWERS CIARAN BOARD MEMBER 0 705078 0 6 0 615 0 74087 0 26731 0 806517 0 0 ROCCO JAMES BOARD MEMBER 0 662491 0 172769 0 1031 0 83086 0 33560 0 952937 0 0 WHITE RICHARD BOARD MEMBER 0 642571 0 107874 0 1059 0 99200 0 15710 0 866414 0 0 OLAYIWOLA JACQUELINE NWANDO BOARD MEMBER 0 115772 0 100000 0 14016 0 30450 0 5684 0 265922 0 0 PHAN KINH LUAN BOARD MEMBER 0 197441 0 0 0 15445 0 28000 0 9120 0 250006 0 0 SEGAL BENJAMIN BOARD MEMBER 0 243861 0 0 0 20477 0 34300 0 3243 0 301881 0 0 THOMAS ANDREW BOARD MEMBER / CMO 0 616419 0 130556 0 607 0 64506 0 29715 0 841803 0 0 KENT K CRAIG BOARD MEMBER/DEAN,COM 0 847538 0 232377 0 3015 0 90544 0 15968 0 1189442 0 0 MCQUAID DAVID CEO, HEALTH SYSTEM 0 923835 0 345950 0 5231 0 111539 0 26339 0 1412894 0 0 FARRAR WILLIAM CEO, THE JAMES 0 789227 0 211177 0 2580 0 72607 0 17885 0 1093476 0 0 LARMORE MARK CFO, MEDICAL CENTER 0 843159 0 324104 0 7936 0 101907 0 18356 0 1295462 0 0 PAZ HAROLD CHANCELLOR 0 780229 0 50000 0 26742 0 70369 0 10622 0 937962 0 0 FORREST L ARICK PRESIDENT 0 663251 0 154480 0 2407 0 81028 0 17201 0 918367 0 0 SHARP KYLE EXECUTIVE DIRECTOR 0 335917 0 87576 0 1712 0 58100 0 19898 0 503203 0 0 ELDER JAMES BRADLEY PHYSICIAN 0 545243 0 502089 0 255 0 88049 0 22651 0 1158287 0 0 FARHADI FRANCIS H PHYSICIAN 0 590814 0 358649 0 655 0 80154 0 22681 0 1052953 0 0 POLLOCK RAPHAEL ETOMAR PHYSICIAN 0 824114 0 226686 0 7780 0 99200 0 6384 0 1164164 0 0 TANDON AMIT PHYSICIAN 0 593268 0 407338 0 865 0 66647 0 24868 0 1092986 0 0 WASHBURN WILLIAM KENNETH PHYSICIAN 0 783047 0 186747 0 5006 0 82681 0 24793 0 1082274 0 0 CHANDAWARKAR RAJIV BOARD MEMBER 1/1/19-6/30/19 0 544715 0 82119 0 1237 0 83086 0 18130 0 729287 0 0 RYAN EILEEN BOARD MEMBER 1/1/19-6/30/19 0 296997 0 178478 0 1379 0 57272 0 14893 0 549019 0 0 SCHARRE DOUGLAS BOARD MEMBER 1/1/19-6/30/19 0 365539 0 68439 0 2246 0 63630 0 21965 0 521819 0 0 WELKER MARY JO BOARD MEMBER 1/1/19-6/30/19 0 410954 0 82611 0 3033 0 48970 0 16550 0 562118 0 0 A COUNTY OF FRANKLIN OHIO 316400067 2013-05-01 15381000 REFINANCE ORIGINAL FINANCE BUILDING PROJECTS AND INFORMATION SYSTEMS 0 0 0 A 570855 15381000 86000 15381000 2013 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT AND CHIEF FINANCIAL OFFICER. THE GOVERNING BODY DISCUSSES THE DOCUMENT AT THE FINANCE COMMITTEE OF THE BOARD AS IT IS ULTIMATELY FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS, OFFICERS AND STAFF OF OHIO STATE UNIVERSITY PHYSICIANS, INC. ("OSUP") DEAL WITH A VARIETY OF ISSUES INVOLVING OSUP'S CLINICAL SERVICES AND RELATED BUSINESS ACTIVITIES. OSUP IS WELL SERVED BY THE FACT THAT MANY OF ITS EMPLOYEES WHO ARE INVOLVED IN POLICY DEVELOPMENT AND IMPLEMENTATION, OR OTHERWISE MAY HAVE A ROLE IN BUSINESS OR CLINICAL DECISION-MAKING FOR OSUP, HAVE DIVERSE INTERESTS AND ARE INVOLVED IN A NUMBER OF PROFESSIONAL AND BUSINESS ACTIVITIES OUTSIDE THE ORGANIZATION. THIS INTEREST AND INVOLVEMENT ENHANCE THE EXPERTISE, WHICH THESE INDIVIDUALS BRING TO THE VARIOUS ROLES THEY FILL IN REPRESENTING OSUP. ON OCCASION, SITUATIONS MAY EXIST IN WHICH AN INDIVIDUAL SERVING OSUP IN AN ELECTED OR APPOINTED POSITION OR AS AN EMPLOYEE, HAS SOME OUTSIDE INTEREST IN AN ENTITY DOING BUSINESS WITH OSUP OR COMPETING WITH OSUP WHICH WOULD CONSTITUTE A CONFLICT OF INTEREST OR WHICH COULD BE PERCEIVED AS CONSTITUTING A CONFLICT OF INTEREST. GENERALLY, A CONFLICT OF INTEREST COULD BE SAID TO EXIST WHEN INDIVIDUALS HAVE MATERIAL INTERESTS OUTSIDE OSUP WHICH COULD INFLUENCE THEM OR COULD BE PERCEIVED AS INFLUENCING THEM TO ACT CONTRARY TO THE INTERESTS OF OSUP AND FOR THEIR OWN PERSONAL BENEFIT. THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT BOTH THE INDIVIDUAL EMPLOYEE AND OSUP, AS A CORPORATION, WHEN OSUP IS CONTEMPLATING ENTERING INTO A BUSINESS TRANSACTION OR OTHER ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF A MEMBER OF THE BOARD OF DIRECTORS, AN OFFICER, OR A MEMBER OF THE STAFF OF OSUP. THIS POLICY APPLIES TO THE MEMBERS OF THE BOARD OF DIRECTORS, TRUSTEES, EMPLOYED PHYSICIANS, INDEPENDENT CONTRACTORS AND STAFF OF OSUP (EACH, AN "ASSOCIATE"). IT IS EACH ASSOCIATE'S OBLIGATION TO DISCLOSE ANY ACTUAL OR PERCEIVED CONFLICT OF INTEREST ON A WRITTEN DISCLOSURE STATEMENT ATTACHED TO THIS POLICY. IF ASSOCIATES ARE UNSURE AS TO WHETHER THEIR ACTIVITIES ARE A CONFLICT OF INTEREST, THEY ARE ADVISED TO ERR ON THE SIDE OF CAUTION AND DISCLOSE THE POTENTIAL FOR SUCH. IF THE INDIVIDUAL IS UNWILLING TO DISCLOSE THE DETAILS GIVING RISE TO THE CONFLICT OF INTEREST, HE OR SHE SHOULD DISCLOSE THE FACT OF THE CONFLICT AND WITHDRAW FROM THE SITUATION CONCERNED. ASSOCIATES REVIEW THE OSUP CONFLICT OF INTEREST POLICY AND COMPLETE THE ATTACHED "CONFLICT OF INTEREST DISCLOSURE STATEMENT" FOR OSUP. THIS PROCESS IS COMPLETED, INITIALLY UPON EMPLOYMENT AND ANNUALLY, AND ALSO WHEN A POTENTIAL CONFLICT OF INTEREST SITUATION ARISES. NOTIFICATION OF A POTENTIAL -ACTUAL OR PERCEIVED- CONFLICT OF INTEREST INVOLVING AN OSUP ASSOCIATE OR ANOTHER ASSOCIATE KNOWN TO THE OSUP ASSOCIATE SHOULD BE REPORTED TO THE INDIVIDUAL'S DIRECT SUPERVISOR. ALL DISCLOSURE STATEMENTS SHOULD INCLUDE THE COMPANY/INDIVIDUALS INVOLVED, THE NATURE AND EXTENT OF WORK/RELATIONSHIP AND AN EXPLANATION OF THE POTENTIAL CONFLICT. OCCASIONALLY, INFORMATION BEING DISCLOSED COULD BE SENSITIVE IN NATURE AND SHOULD BE HANDLED WITH TACT AND A REASONABLE EFFORT MADE TO KEEP IT CONFIDENTIAL. THIRD PARTIES MAY RAISE CONCERN OF POSSIBLE CONFLICTS OF INTEREST, IF THERE ARE REASONABLE AND SUBSTANTIAL GROUNDS FOR SUCH A CONFLICT TO EXIST. THE SERIOUS NATURE OF THIRD PARTY DISCLOSURES MUST BE EMPHASIZED TO AVOID FRIVOLOUS OR MISCHIEVOUS ALLEGATIONS. THE NOTIFICATION SHOULD BE TAKEN TO THE PERSON WITH RESPONSIBILITY FOR THE ISSUE OR AREA (USUALLY THE DIRECT SUPERVISOR). ASSOCIATES WHO REFUSE TO TAKE THE NECESSARY STEPS TO RESOLVE THE CONFLICT IN ACCORDANCE WITH THIS POLICY MAY BE SUBJECT TO DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. DEPENDING ON THE SEVERITY OF CONFLICT, LEGAL ACTION MAY BE NECESSARY. THE RESPONSE TO A DISCLOSURE OF A CONFLICT OF INTEREST SHOULD BE APPROPRIATE TO THE CIRCUMSTANCES. NOT ALL RELATIONSHIPS DESCRIBED IN A DISCLOSURE STATEMENT CONSTITUTE AN ACTUAL CONFLICT OF INTEREST. ADDITIONALLY, THE EXISTENCE OF A CONFLICT OR A POTENTIAL CONFLICT DOES NOT NECESSARILY IMPLY THAT THE ACTIVITY OR RELATIONSHIP SHOULD CEASE. THE DIRECTOR OF COMPLIANCE AND RISK MANAGMENT AND THE GOVERNANCE AND ETHICS COMMITTEE OF THE OSUP BOARD MONITOR OUR COMPLIANCE PROGRAM. THE PRESIDENT OF THE BOARD OF OSUP CHAIRS THE GOVERNANCE AND ETHICS COMMITTEE. THESE COMMITTEE'S ARE RESPONSIBLE FOR REVIEWING ANY POTENTIAL CONFLICT TO DETERMINE IF ONE EXISTS. IF A CONFLICT OF INTEREST IS FOUND TO EXIST, THE ACTION OR DECISION BEING AFFECTED SHOULD BE REVIEWED AND THE DECISION DOCUMENTED IN WRITING BY THE PRACTICE ADMINISTRATOR/COO IN COLLABORATION WITH THE OSUP HUMAN RESOURCES DEPARTMENT. ALL DOCUMENTATION SHOULD BE MAINTAINED IN THE ASSOCIATE'S PERSONNEL FILE AND DEPARTMENT FILE. IF THE INDIVIDUAL CONCERNED DOES NOT AGREE WITH THE DECISION HE OR SHE MAY APPEAL THE DECISION TO THE NEXT LEVEL OF MANAGEMENT AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 ALL SALARIED POSITIONS WITHIN OSUP ARE REVIEWED ANNUALLY WITH BENCHMARK DATA FROM THE ASSOCIATION OF ACADEMIC MEDICAL CENTER'S DATA TO INSURE REASONABLENESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE THROUGH ITS LEGAL COUNSEL FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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