2021-11-15T12:14:13-06:00 2020-12-31 341884125 CBIZ MHM LLC 4722 N 24TH ST STE 300 PHOENIX AZ 85016 990 2020-01-01 208106540 DISTRICT MEDICAL GROUP INC DIST 6024705000 2929 EAST THOMAS ROAD PHOENIX AZ 85016 CRAIG JONES CHIEF FINANCIAL OFFICER 6024705000 2021-11-15 1 CRAIG JONES 999009999 AMY A O'LOUGHLIN P00869687 6022646835 2021-11-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DMG DR KOTE CHUNDU 2929 EAST THOMAS ROAD PHOENIX AZ 85016 212516404 0 X WWW.DMGAZ.ORG X 2006 AZ OPERATE A FACULTY PRACTICE PLAN FOR THE BENEFIT OF THE MARICOPA COUNTY SPECIAL HEALTHCARE DISTRICT, DBA VALLEYWISE HEALTH, WHICH WAS CREATED TO PROVIDE MEDICAL EDUCATION PROGRAMS, EMERGENCY AND OTHER SERVICES TO THE MEDICALLY UNDERSERVED. 9 5 945 0 0 0 500 3356037 183062598 206692086 277913 2150512 123440 317769 183464451 212516404 410178 716045 0 0 134987164 145076689 0 0 0 43981839 56265479 179379181 202058213 4085270 10458191 57691089 74717554 18770316 25338590 38920773 49378964 X WE ARE DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF INDIVIDUALS IN ARIZONA THROUGH AN INTEGRATED MEDICAL GROUP PRACTICE BASED ON A BALANCED PROGRAM OF PATIENT CARE, EDUCATION, RESEARCH AND COMMUNITY SERVICE. 0 0 159976307 716045 184011885 ESTABLISHED IN 1993, BY 2010 OUR 350+ PROVIDER MULTI-SPECIALTY GROUP PRACTICE EVOLVED INTO DISTRCT MEDICAL GROUP, INC. (DMG), A PHYSICIAN-CENTRIC, PHYSICIAN-LED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION; THE SECOND LARGEST IN ARIZONA AND ONE OF THE LARGEST MEDICAL OFFICES IN THE PHOENIX AREA. OUR MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF INDIVIDUALS IN THE PHOENIX AREA AND THE ENTIRE STATE OF ARIZONA THROUGH THIS INTEGRATED GROUP PRACTICE, FOCUSING ON PATIENT CARE, EDUCATION, RESEARCH, AND COMMUNITY SERVICE. WE STRIVE TO ENSURE THAT OUR PATIENTS HAVE EQUAL ACCESS TO THE HIGHEST QUALITY, SAFEST CARE IN THE MOST APPROPRIATE SETTINGS, REGARDLESS OF A PATIENT'S SERVICES ABILITY TO PAY. WE SEEK TO CREATE AND SUPPORT NEW PROGRAMS AND SERVICES THAT REFLECT THE NEEDS OF ALL PATIENTS, ACROSS ALL SPECTRUMS OF LIFE FROM BIRTH TO THE ELDERLY, INCLUDING THE MOST VULNERABLE, THE POOR AND THE UNDERSERVED. THE HEART OF OUR MISSION IS PROVIDING EXCEPTIONAL AND COMPASSIONATE MEDICAL CARE WITH NO RESTRICTIONS TO OUR ENTIRE COMMUNITY. DMG WITH ITS AFFILIATES COMPRISE 70 CLINICAL SITES, APPROXIMATELY 600 PHYSICANS, 200 NON-PHYSICIAN PROVIDERS, AND OVER 120 ANCILLARY CLINIC STAFF. IN 2020, AMIDST THE LINGERING COVID-19 PANDEMIC, DMG SERVED PATIENT VOLUMES OF OVER 16,000 AS INPATIENT, OVER 465,000 AS OUTPATIENT, AND MORE THAN 88,000 EMERGENCY VISITS. DURING 2020 DMG'S DIRECT ECONOMIC OUTPUT, INCLUDING THE SERVICE ECONOMY, IS ESTIMATED AT OVER $170 MILLION. THE INDIRECT ECONOMIC BENEFIT TO THE COMMUNITY IS SIGNIFICANTLY MORE.DISTRICT MEDICAL GROUP STAFFS THE VALLEYWISE HEALTH SYSTEM, WHICH INCLUDES A 325 BED ACUTE CARE HOSPITAL, THREE INPATIENT PSYCHIATRIC HOSPITALS TOTALING MORE THAN 340 BEDS, ELEVEN FAMILY HEALTH CENTERS THROUGHOUT THE VALLEY AND A LARGE DIAGNOSTIC CENTER. DMG ALSO STAFFS THE INTERNATIONALLY RENOWNED ARIZONA BURN CENTER, THE 2ND LARGEST IN THE US, ADMITTING OVER 900 PATIENTS/YEAR AND SERVING MORE THAN 5,000 PATIENTS/YEAR IN AN OUTPATIENT SETTING; THE VERIFIED AMERICAN COLLEGE OF SURGEONS LEVEL I TRAUMA CENTER, AND LEVEL 2 PEDIATRIC TRAUMA CENTER; AND THE ARIZONA CHILDREN'S CENTER, A NACHRI-CERTIFIED CHILDREN'S HOSPITAL, CARING FOR CHILDREN BETWEEN THE PEDIATRIC EMERGENCY DEPARTMENT, PEDIATRIC INTENSIVE CARE UNIT, THE NEONATAL INTENSIVE CARE UNIT, AND THE PEDIATRIC INPATIENT AREAS, WITH A DEDICATED AREA FOR PEDIATRIC PROCEDURAL SEDATIONS. AMONG OTHER INNOVATIVE PROGRAMS THAT DMG PROVIDES IS THE REFUGEE WOMEN'S HEALTH CLINIC, THE FIRST OF ITS KIND IN ARIZONA, PROVIDING CULTURALLY-GROUNDED HEALTHCARE TO THE GROWING REFUGEE AND IMMIGRANT COMMUNITY.THROUGH AFFILIATION WITH VALLEYWISE HEALTH SYSTEM, THE UNIVERSITY OF ARIZONA - COLLEGE OF MEDICINE, AND THE CREIGHTON UNIVERSITY ARIZONA HEALTH EDUCATION ALLIANCE, WE ARE A RECOGNIZED LEADER IN PROVIDING HIGH QUALITY, INNOVATIVE MEDICAL CARE DELIVERED IN A FISCALLY RESPONSIBLE AND COST EFFECTIVE MANNER. AS THE LARGEST TEACHING FACULTY IN PHOENIX, WE ANNUALLY TRAIN OVER 230 RESIDENTS AND FELLOWS, ANOTHER 60 IN AFFILIATED PROGRAMS, AND SUPERVISE CLOSE TO 500 MEDICAL STUDENT ROTATIONS. A MAJORITY OF DMG PHYSICIANS HOLD FACULTY POSITIONS WITH THE UNIVERSITY OF ARIZONA - COLLEGE OF MEDICINE AND/OR CREIGHTON UNIVERSITY, GIVING AND ATTENDING CLINICAL LECTURES AND OTHER ACADEMIC EVENTS, AND ACTIVELY TEACHING AND SUPPORTING SCHOLARSHIP AND RESEARCH ACTIVITIES. IN RECENT YEARS WE HAVE BEEN INVOLVED IN A SIGNIFICANT NUMBER OF ACTIVE RESEARCH PROJECTS, INCLUDING INDUSTRY-SPONSORED AND NIH GRANTS. EXAMPLES OF OUR INVOLVEMENT INCLUDE: - FOOD IS MEDICINE PILOT STUDY: A PROSPECTIVE ANALYSIS OF THE IMPACT OF THE IMPLEMENTATION OF A PUBLIC HEALTHCARE SYSTEM FOOD PHARMACY - SOCIAL NETWORK AND DIABETES MANAGEMENT AMONG LATINO IMMIGRANTS WITH DIABETES - COVID-19 VARIANTS AND MORBIDITY AND MORTALITY - PERINATAL OUTCOMES AND PSYCHOSOCIAL HEALTH DURING COVID-19 PANDEMIC - A PROSPECTIVE MULTICENTER RANDOMIZED CONTROLLED CLINICAL STUDY TO INVESTIGATE THE SAFETY AND EFFECTIVENESS OF THE RECELL SYSTEM COMBINED WITH MESHED AUTOGRAFT FOR REDUCTION OF DONOR SKIN HARVESTING IN SOFT TISSUE RECONSTRUCTION - A PROSPECTIVE, MULTICENTER, RANDOMIZED CONTROLLED CLINICAL STUDY TO INVESTIGATE THE SAFETY AND EFFECTIVENESS OF RES (REGENERATIVE EPIDERMAL SUSPENSION) PREPARED WITH THE RECELL DEVICE COMPARED TO STANDARD OF CARE DRESSINGS FOR TREATMENT OF PARTIAL-THICKNESS BURNS IN INFANTS, CHILDREN AND ADOLESCENTS (AGED 1-16 YEARS) - POINT OF CARE OR HIGH-THROUGHPUT BIOLOGICAL ASSAYS FOR DETERMINING ABSORBED IONIZING RADIATION DOSE (BIODOSIMETRY) AFTER RADIOLOGICAL AND NUCLEAR EVENT - COLLECTION PROTOCOL FOR THE CLINICAL VALIDATION OF BD SARS-COV-2/FLU FOR BD MAX SYSTEM AND THE BD RESPIRATORY ASSAY FOR BD MAX SYSTEM - EVALUATION OF THE CLINICAL PERFORMANCE OF THE PAXGENE BLOOD CCFDNA TUBE IN COMPARISON TO THE BD VACUTAINER K2EDTA TUBE USING THE THERASCREEN PIK3CA RGQ PCR KIT - SYSTEMIC TREATMENT OF STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS: A PILOT STUDY IN ADVANCE OF A PHASE III CLINICAL TRIAL - A RANDOMIZED TRIAL OF ENTERAL GLUTAMINE TO MINIMIZE THERMAL INJURY (RE-ENERGIZE) - A RETROSPECTIVE CHARACTERIZATION OF HEALTH DISPARITIES RELATED TO VIRAL INFECTIONS USING HIGHLY-MULIPLEXED SEROLOGY - A PHASE 2, PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PARALLEL-GROUP, WITHIN-SUBJECT VEHICLE CONTROLLED MULTICENTER STUDY OF THE EFFICACY AND SAFETY OF GRANEXIN GEL TO IMPROVE BURN WOUND HEALING - A PHASE 3, MULTICENTER, OPEN-LABEL EXTENSION STUDY TO EVALUATE THE LONG-TERM EFFICACY AND SAFETY OF MIRIKIZUMAB IN PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS LUCENT 3.DMG BELIEVES THAT CREATING AN INSTITUTIONAL CULTURE OF SCHOLARSHIP AND PROMOTING CLINICAL RESEARCH IMPROVES THE HEALTH AND WELL-BEING OF ALL OUR PATIENTS AND THEIR COMMUNITIES. DMG PHYSICIANS ARE FREQUENT CONTRIBUTORS TO NATIONAL PEER-REVIEWED PUBLICATIONS AND PRESENTERS AT NATIONAL MEDICAL CONFERENCES AND WORKSHOPS, HOLDING ACTIVE LEADERSHIP POSITIONS IN STATE, NATIONAL, AND INTERNATIONAL MEDICAL SOCIETIES. DMG PROVIDERS AND EMPLOYEES FURNISH SIGNIFICANT ASSISTANCE AND PERSONAL RESOURCES TO THE COMMUNITY AS WELL AS OUTLYING AREAS THROUGH SCREENINGS, IMMUNIZATIONS, AND INFORMATION/ACCESS TO INTEGRATED SERVICES AT HEALTH FAIRS; THROUGH COMMUNITY OUTREACH EVENTS HIGHLIGHTING PRENATAL SCREENINGS, REHABILITATION, HOSPICE, SENIOR CARE, TRANSPORTATION AND CARE COORDINATION; THROUGH BACK-TO-SCHOOL AND HOLIDAY CLINICS FOR CHILDREN AND STUDENTS; THROUGH CHILDHOOD AND ADOLESCENT OBESITY CLINICS; AND THROUGH SEMINARS PROMOTING EXERCISE AND NUTRITION IN OUR PARTNERSHIPS WITH LOCAL SCHOOLS. DMG PHYSICIANS VOLUNTEER THEIR TIME SEEING PATIENTS AT THE ARIZONA STATE HEALTH DEPARTMENT, THE CRISIS NURSERY, ST. VINCENT DE PAUL, THE RED CROSS AND SCORES OF NONPROFIT AGENCIES, CENTERS AND CLINICS ACROSS THE COUNTY AND THE STATE. AWARENESS AND SENSITIVITY TO THE HISTORICAL, CULTURAL AND TRADITIONAL MORES OF THE LARGE HISPANIC AND VARIED NATIVE AMERICAN POPULATIONS ACROSS ARIZONA IS A HALLMARK OF DMG'S LONGSTANDING COMMITMENT TO MAKING HEALTHCARE SERVICES AND INFORMATION ACCESSIBLE AND EFFECTIVE FOR EVERYONE, BENEFITING THE ENTIRE COMMUNITY. NATIONALLY AND INTERNATIONALLY, DMG'S PHYSICIANS HAVE BEEN ON THE SCENE WHEREVER MEDICAL HELP IS NEEDED, BRINGING THEIR CLINICAL EXPERTISE TO COMBAT HOSPITALS IN WAR-TORN AREAS, TO RELIEF EFFORTS IN THIS COUNTRY AND ABROAD, AND IN DAY TO DAY MEDICAL CRISES AND EMERGENCIES IN THE U.S. AND MANY COUNTRIES IN AFRICA AND ASIA. WORKING WITH DOCTORS WITHOUT BORDERS, THE RED CROSS, OTHER RELIEF AGENCIES, AND EVEN ON THEIR OWN, DMG'S PHYSICIANS HAVE MADE A DIFFERENCE AND BEEN GRATEFULLY RECOGNIZED FOR THEIR EFFORTS AND CONTRIBUTIONS, TO THE EXTENT OF RECEIVING THE "CITIZEN SERVICE ABOVE SELF" AWARD FROM THE CONGRESSIONAL MEDAL OF HONOR FOUNDATION. DMG CONTRIBUTES REGULARLY THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, CASH AND IN-KIND CONTRIBUTIONS, AND COMMUNITY BENEFITING ACTIVITIES. 22497564 22680201 THE CHILDREN'S REHABILITATIVE SERVICES (CRS) PROGRAM STARTED IN 1929 TO PROVIDE MEDICAL SERVICES TO CHILDREN WHO HAVE SOME OF THE MOST SERIOUS HEALTH CONDITIONS AND WHO ARE ENROLLED IN THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (MEDICAID). THE PROGRAM IN TOTAL SERVES OVER 24,000 MEMBERS STATEWIDE WITH THE DMG LOCATION SERVING APPROXIMATELY 16,000 CHILDREN, INCLUDING TELEMEDICINE VISITS AND FIELD CLINICS SERVING THE OUTLYING COMMUNITIES.THE CRS MULTI-SPECIALTY INTERDISCIPLINARY CLINIC (MSIC) WAS DESIGNED TO UNIQUELY MEET THE HEALTH CARE REQUIREMENTS OF SPECIAL NEEDS CHILDREN BY OFFERING NEARLY ALL SPECIALTY, PRIMARY CARE, AND BEHAVIORAL HEALTH SERVICES IN A SINGLE LOCATION. THE DMG CRS CLINIC PROVIDES A FULL SPECTRUM OF PEDIATRIC SPECIALTY CARE WHERE PHYSICIANS, THERAPISTS, NUTRITIONISTS, CHILD LIFE SPECIALISTS, SOCIAL WORKERS AND A HOST OF OTHERS CAN ALL WORK TOGETHER PROVIDING VITAL MEDICAL CARE, BEHAVIORAL HEALTH CARE AND SUPPORT SERVICES UNDER ONE ROOF AND ON ONE FLOOR IN A SPACE SPECIFICALLY DESIGNED FOR THIS PURPOSE. THROUGH THE USE OF A SINGLE ELECTRONIC MEDICAL RECORD, THE DMG CRS CLINIC IMPROVES EFFICIENCY AND COMMUNICATION BETWEEN THE HEALTH CARE PROVIDERS, WITH THE GOAL OF IMPROVING CARE WHILE BETTER MANAGING COSTS. 182473871 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 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 0 1 0 0 0 1 272 0 1 945 1 0 0 0 0 0 0 0 0 0 0 1 0 X 9 5 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CRAIG JONES 6024705000 2929 E THOMAS ROAD PHOENIX AZ 85016 DR IMAN FEIZ-ERFAN DIRECTOR OF NEUROSURGERY 70.00 X 1574328 0 67494 DR KOTE CHUNDU BD. MEMBER, PRESIDENT & CEO 65.00 0.30 X X 1336475 0 83319 DR NAFTALY ATTIAS FORMER KEY EE/ORTHOPEDICS CHAIR 60.00 X 649027 0 76517 DR WADDAH HAJJA GENERAL INTERNAL MEDICINE PHYSICIAN 60.00 X 631867 0 51241 DR DAN HOBOHM BD. CHAIR, PATH CHAIR, VP OF QUALITY 65.00 X X 630060 0 27326 DR DANIEL GRIDLEY FORMER KEY EE/RADIOLOGY CHAIR 60.00 X 580634 0 70684 DR SYDNEY VAIL SURGERY CHAIR 60.00 X 565391 0 67843 DR ELI SWANSON ORTHOPEDICS VICE CHAIR, ORTHOPEDIC SURGEON 60.00 X 555848 0 43866 DR JOHN TIDWELL ORTHOPEDIC TRAUMA SURGEON 60.00 X 559568 0 31741 DR WILLIAM JOHNSON FORMER KEY EE/ANES. CHAIR, PERIO DIR 60.00 X 476175 0 74453 DR KHALED FAREED UROLOGY SURGEON 60.00 X 532900 0 17630 DR DAVID WISINGER BD. MEMBER, CMO, INT. MEDICINE CHAIR 65.00 X X 469697 0 74392 DR DEAN COONROD BD. MEMBER, SECRETARY, OBGYN CHAIR 60.00 X X 406574 0 88771 DR CAROL OLSON PSYCHIATRY CHAIR 60.00 X 391558 0 90636 DR PRABODH HEMMADY FORMER KEY EE/PEDIATRICS CHAIR 60.00 X 386183 0 88728 DR DANY QUAN EMERGENCY MEDICINE CHAIR 60.00 X 315698 0 35276 CRAIG JONES CFO, TREASURER 50.00 X 251302 0 62491 JAMES MAROVICH COMMUNITY BOARD MEMBER 0.50 X 12131 0 0 TOM MANOS COMMUNITY BOARD MEMBER 0.50 X 11790 0 0 PHYLLIS BIEDESS COMMUNITY BOARD MEMBER, VICE PRESIDENT 0.50 0.10 X X 10631 0 0 ALAN RAWLS COMMUNITY BOARD MEMBER 0.50 X 10631 0 0 WILLIAM PUTNAM COMMUNITY BOARD MEMBER 0.50 X 7155 0 0 10365623 0 1052408 376 1 1 0 R1 RCM INC PO BOX 734735 CHICAGO IL 606734735 BILLING SERVICES 1616811 VVC HOLDING CORP PO BOX 840952 DALLAS TX 752840952 TECHNOLOGY & BILLING SERVICES 890676 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 303845547 TEMPORARY PHYSICIAN SERVICES 814611 ISHIFT 7014 E CAMELBACK ROAD PHOENIX AZ 85251 TECHNOLOGY SERVICES 673849 MAYO CLINIC PO BOX 4006 ROCHESTER MN 559034006 PHYSICIAN SERVICES 444333 32 3356037 3356037 PATIENT SERVICES 621110 206692086 206692086 206692086 2076001 2076001 74511 0 74511 74511 74511 OTHER INCOME 900099 317769 317769 317769 212516404 206692086 0 2468281 716045 716045 4949147 3002401 1946746 115692585 109505856 6186729 8829818 8326947 502871 9359327 8792585 566742 6245812 5831778 414034 395952 395952 240083 240083 95850 95850 25000 25000 11794606 8371734 3422872 2166228 2149655 16573 17092 1912 15180 1403343 426056 977287 3629136 3428471 200665 BAD DEBT 28322831 28322831 MAINTENANCE CONTRACTS 2797297 117988 2679309 DUES & FEES 632922 565054 67868 RESIDENT PROGRAM EXPENS 446449 446449 4298690 2468109 1830581 202058213 182473871 19584342 0 18803087 35074082 7371971 6131845 19106806 20993194 39625 46636 1191242 1391087 17678054 10383028 7153555 7295026 2208151 2538991 475000 475000 699080 509144 642572 262549 57691089 74717554 14643170 21196174 607286 90879 3519860 4051537 18770316 25338590 X 38920773 49378964 38920773 49378964 57691089 74717554 10458191 0 X X 0 1 X 1 0 X 2200 1000 500 3356037 3359737 151470123 157889910 167801841 183062598 206692086 866916558 151472323 157889910 167802841 183063098 210048123 870276295 0 0 0 870276295 22850 31093 110612 277913 2076001 2518469 22850 31093 110612 277913 2076001 2518469 590226 154057 130018 123440 317769 1315510 152085399 158075060 168043471 183464451 212441893 874110274 0.99560 0.99740 0.00290 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2016 AMOUNT: $ 590,226. 2017 AMOUNT: $ 154,057. 2018 AMOUNT: $ 130,018. 2019 AMOUNT: $ 123,440. 2020 AMOUNT: $ 317,769. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25000 25000 202033214 202058214 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 25000 25000 250000 250000 250000 250000 1000000 1500000 25000 25000 PART II-A, LINE 2 DMG MADE ITS FIRST SECTION 501(H) ELECTION FOR THE TAX YEAR ENDING DECEMBER 31, 2014. 350000 350000 3970258 1047021 2923237 3247603 2109513 1138090 9839784 7148031 2691753 270409 78463 191946 7295026 DEFERRED RENT 503713 SUSPENSE - UNIDENTIFIED RECEIPTS 989576 ESCHEAT LIABILITY 19257 457(B) LIABILITY 2538991 4051537 X PART X, LINE 2: DISTRICT QUALIFIES AS A TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("IRC"). IN ADDITION, DISTRICT QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170 OF THE IRC AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. INCOME DETERMINED TO BE UNRELATED BUSINESS TAXABLE INCOME WOULD BE TAXABLE. THE COMPANY EVALUATES THEIR UNCERTAIN TAX POSITION, IF ANY, ON A CONTINUAL BASIS THROUGH REVIEW OF THEIR POLICIES AND PROCEDURES, REVIEW OF THEIR REGULAR TAX FILINGS, AND DISCUSSIONS WITH OUTSIDE EXPERTS. AT DECEMBER 31, 2020, THE COMPANY DID NOT HAVE ANY UNCERTAIN TAX POSITIONS. 1 MARICOPAVALLEYWISE HEALTH FOUNDATION 2901 E CAMELBACK ROAD SUITE 202 PHOENIX AZ 85016 860777567 501(C)(3) 35000 VARIOUS PROGRAMS / GENERAL SUPPORT UA FOUNDATION 1111 N CHERRY AVE PO BOX 210109 PHOENIX AZ 85721 866050388 501(C)(3) 20000 EDUCATIONAL PROGRAMS MARICOPA COUNTY SPECIAL HEALTHCARE DISTRICT 2601 E ROOSEVELT ST PHOENIX AZ 85006 860830701 GOVERNMENT 481050 GENERAL SUPPORT CREIGHTON UNIVERSITY ARIZONA HEALTH EDUCATION ALLIANCE 4001 N 3RD STREET SUITE 290 PHOENIX AZ 85012 831300808 501(C)(3) 177144 OPERATING SUPPORT 4 PART I, LINE 2: DMG GENERALLY GIVES GRANTS TO WELL ESTABLISHED ORGANIZATIONS THAT IT IS FAMILIAR WITH AND WHICH ARE INVOLVED IN ACTIVITIES CLOSELY ALIGNED TO DMG'S MISSION. ACCORDINGLY, THE COMPANY DOES NOT FEEL POST GRANT MONITORING TO BE PRACTICAL OR NECESSARY FOR THESE TYPES OF GRANTS. X X X X X X 0 0 0 0 0 0 0 1 0 DR IMAN FEIZ-ERFAN DIRECTOR OF NEUROSURGERY 1024518 0 0 0 549810 0 34200 0 33294 0 1641822 0 0 0 DR KOTE CHUNDU BD. MEMBER, PRESIDENT & CEO 1007911 0 325000 0 3564 0 57000 0 26319 0 1419794 0 0 0 DR NAFTALY ATTIAS FORMER KEY EE/ORTHOPEDICS CHAIR 614253 0 23570 0 11204 0 34200 0 42317 0 725544 0 0 0 DR WADDAH HAJJA GENERAL INTERNAL MEDICINE PHYSICIAN 190656 0 6270 0 434941 0 34200 0 17041 0 683108 0 0 0 DR DAN HOBOHM BD. CHAIR, PATH CHAIR, VP OF QUALITY 422437 0 10000 0 197623 0 17100 0 10226 0 657386 0 0 0 DR DANIEL GRIDLEY FORMER KEY EE/RADIOLOGY CHAIR 487811 0 10000 0 82823 0 34200 0 36484 0 651318 0 0 0 DR SYDNEY VAIL SURGERY CHAIR 540769 0 10000 0 14622 0 34200 0 33643 0 633234 0 0 0 DR ELI SWANSON ORTHOPEDICS VICE CHAIR, ORTHOPEDIC S 470251 0 14736 0 70861 0 34200 0 9666 0 599714 0 0 0 DR JOHN TIDWELL ORTHOPEDIC TRAUMA SURGEON 470419 0 3053 0 86096 0 22098 0 9643 0 591309 0 0 0 DR WILLIAM JOHNSON FORMER KEY EE/ANES. CHAIR, PERIO DIR 427981 0 10000 0 38194 0 57000 0 17453 0 550628 0 0 0 DR KHALED FAREED UROLOGY SURGEON 418631 0 27777 0 86492 0 0 0 17630 0 550530 0 0 0 DR DAVID WISINGER BD. MEMBER, CMO, INT. MEDICINE CHAIR 394350 0 19500 0 55847 0 57000 0 17392 0 544089 0 0 0 DR DEAN COONROD BD. MEMBER, SECRETARY, OBGYN CHAIR 392358 0 10000 0 4216 0 57000 0 31771 0 495345 0 0 0 DR CAROL OLSON PSYCHIATRY CHAIR 350664 0 10000 0 30894 0 57000 0 33636 0 482194 0 0 0 DR PRABODH HEMMADY FORMER KEY EE/PEDIATRICS CHAIR 343664 0 10000 0 32519 0 57000 0 31728 0 474911 0 0 0 DR DANY QUAN EMERGENCY MEDICINE CHAIR 166017 0 5000 0 144681 0 34200 0 1076 0 350974 0 0 0 CRAIG JONES CFO, TREASURER 249576 0 0 0 1726 0 31311 0 31180 0 313793 0 0 0 PART I, LINE 3 DMG MAINTAINS A COMPENSATION PLAN APPROVED BY THE BOARD OF DIRECTORS, AND OVERSEEN BY THE COMPENSATION COMMITTEE. THE VOTING RIGHTS OF THE COMPENSATION COMMITTEE, IN REGARDS TO COMPENSATION OF DMG EMPLOYEES, ARE VESTED ENTIRELY IN THE COMMUNITY DIRECTORS (NON-EMPLOYEE DIRECTORS). THERE IS A WRITTEN POLICY GOVERNING THE PERSONNEL ACTION COMMITTEE, WHICH OVERSEES THE DAY TO DAY ADMINISTRATION OF THE COMPENSATION PLAN. THERE IS ALSO A WRITTEN POLICY FOR PROVIDERS WHO EARN COMPENSATION IN EXCESS OF BASE SALARY. PART I, LINE 7 THE MAJORITY OF BONUS AND INCENTIVE COMPENSATION IS BASED ON EMPLOYEE CONTRACTS AND APPROVED WRITTEN COMPENSATION PLANS. ANNUALLY THE COMPANY CONSIDERS WHETHER A COMPANY-WIDE BONUS FOR ALL EMPLOYEES IS POSSIBLE BASED ON OVERALL COMPANY FINANCIAL PERFORMANCE FOR THE YEAR. THIS AMOUNT IS APPROVED BY THE COMPENSATION COMMITTEE AND AMOUNTS ARE DETERMINED BY THE TYPE OF EMPLOYEE AND THE FULL-TIME EQUIVALENT STATUS WITHIN THE COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE 4 PHYSICIAN DIRECTORS OF THE BOARD ARE ELECTED BY THE BOARD, WHICH CONSISTS OF A MAJORITY OF COMMUNITY BOARD MEMBERS, AFTER BEING NOMINATED BY THE DIVISION CHAIRS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE DRAFT IS SENT TO EACH OF THE BOARD MEMBERS. INPUT FROM THE BOARD MEMBERS IS INCORPORATED INTO THE DRAFT, WHICH IS THEN REVIEWED BY THE CFO AND THE CONTROLLER. AN OUTSIDE ACCOUNTING FIRM IS CONSULTED ROUTINELY. THE UPDATED DRAFT IS SENT TO THE BOARD MEMBERS AND THEN SIGNED AND FORWARDED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY AND PROCEDURE IS REVIEWED WITH THE BOARD ANNUALLY, AND THE CONFLICT OF INTEREST DISCLOSURE STATEMENT IS COMPLETED ANNUALLY, AND RETAINED BY THE CHIEF COMPLIANCE OFFICER. ANY POTENTIAL CONFLICTS OF INTEREST IDENTIFIED FROM THE DISCLOSURE STATEMENTS ARE REVIEWED BY THE EXECUTIVE COMMITTEE AND THE ORGANIZATION'S LEGAL COUNSEL, IF NEEDED, AND UNRESOLVED POTENTIAL CONFLICTS ARE NOTED SO THAT ACTUAL CONFLICTS OF INTEREST ARE AVOIDED. FORM 990, PART VI, SECTION B, LINE 15 WITH GUIDANCE FROM AN OUTSIDE (INDEPENDENT) COMPENSATION CONSULTANT, THE EXECUTIVE COMMITTEE REVIEWS AND MAKES RECOMMENDATIONS TO THE BOARD ON THE COMPENSATION OF THE CEO. SAID COMPENSATION IS DETERMINED BASED ON SURVEY DATA AND COMPARISON FROM THE CEO COMPENSATION REPORTED BY SIMIALR ORGANIZATIONS ON THEIR IRS FORM 990. A MAJORITY OF THE MEMBERSHIP OF BOTH THE EXECUTIVE COMMITTEE AND THE BOARD CONSISTS OF COMMUNITY BOARD MEMBERS (THEY ARE INDEPENDENT, AND NOT EMPLOYED BY DMG). SUCH DISCUSSIONS AND ACTIONS ARE REFLECTED IN THE MINUTES OF DULY CONSTITUED MEETINGS OF THE COMMITTEE AND THE BOARD. THE COMPENSATION OF THE OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED BASED ON SURVEY DATA PRODUCED BY MGMA, A NATIONALLY RECOGNIZED MEDICAL GROUP MANAGEMENT ASSOCIATION. FORM 990, PART VI, SECTION C, LINE 19 DMG MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC THROUGH WRITTEN REQUESTS RECEIVED AT THE CORPORATE OFFICE. THE REQUEST IS TO BE REVIEWED BY THE APPROPRIATE CORPORATE OFFICER, WHO WILL OVERSEE THE FULFILLING OF THE REQUEST. 990 PART XII, LINE 2C: THE AUDIT COMMITTEE'S PROCESS OF APPROVING THE INDEPENDENT AUDITOR AND REVIEWING THE RESULTS OF THE ANNUAL AUDIT REMAINS THE SAME AS IN PREVIOUS YEARS. DMG INSURANCE COMPANY INC 2929 E THOMAS RD PHOENIX AZ 85016 261262665 PURE CAPTIVE INSURER AZ 501(C)(3) LINE 12A, I DISTRICT MEDICAL GROUP INC 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 DMG INSURANCE COMPANY INC L 126329 ESTIMATE DMG INSURANCE COMPANY INC R 3630050 CASH DMG INSURANCE COMPANY INC F 2000000 CASH PART V, LINE 2(1) THE AMOUNT PRESENTED REPRESENTS AN ESTIMATED COST OF PERSONNEL TIME PROVIDED BY EMPLOYEES OF THE PARENT TO THE SUBSIDIARY. THE AMOUNT WAS BASED ON AN ESTIMATED OF ANNUAL HOURS PARENT EMPLOYEES DEDICATED TO MANAGING THE SUBSIDIARY. THE PARENT ABSORBED THESE COSTS, WHICH ARE INCLUDED IN PART IX OF FORM 990, AND WAS NOT REIMBUSED BY THE SUBSIDIARY. PART V, LINE 2(2) THIS AMOUNT REPRESENTS TOTAL PREMIUMS PAID TO THE SUBSIDIARY FOR PROFESSIONAL LIABILITY AND GENERAL LIABILITY INSURANCE COVERAGE. PORTIONS OF THIS AMOUNT ARE INCLUDED ON FORM 990, PART IX, LINE 23 - INSURANCE EXPENSE AND FORM 990, PART X, LINE 9 - PREPAID EXPENSES AND DEFERRED CHARGES. SCHEDULE R, LINE 1(L): PERSONNEL OF THE PARENT PERFORM ADMINISTRATIVE FUNCTIONS FOR THE SUBSIDIARY. THESE FUNCTIONS INCLUDE CASE MANAGEMENT, ACCOUNTING AND OVERALL ORGANIZATION MANAGEMENT. THE PARENT IS NOT REIMBURSED BY THE SUBSIDIARY FOR THESE COSTS.