2020-07-13T11:51:59-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-07-01 201304472 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIV 4193837100 4510 DORR STREET TOLEDO OH 43615 HAITHAM M ELSAMALOTY CFO 4193837100 2020-07-06 1 KAREN GRIES P00078514 6123764500 2020-06-29 67.137.57.251 2020-07-06 14:10:58 ED P FDDE6E59ECAC1E5ABC0702B1D23036C1C3115FC1 D29B5C5D9B46E7FA09E7F5D6BC1CF6730C7D69CE 2018 2020-09-22 18:59:49Z KRISTOPHER BRICKMAN MD 4510 DORR STREET TOLEDO OH 43615 117839165 0 X N/A X 2004 OH TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY. 27 0 577 5 0 0 361160 5442 97651296 106400223 -7206 -48114 3565297 8325712 101570547 114683263 620650 8602487 0 0 85263071 89581018 0 0 0 18455520 14419066 104339241 112602571 -2768694 2080692 73700437 73719816 23783758 21650490 49916679 52069326 TO IMPROVE THE HUMAN CONDITION THROUGH EXCELLENCE IN PATIENT CARE AND MEDICAL DISCOVERY 0 0 106358395 8602487 106400223 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.CAPTIVE INSURANCE- WRITING OR FUNDING MEDICAL MALPRACTICE INSURANCE AND REINSURANCE FOR UNIVERSITY OF TOLEDO AND UNIVERSITY OF TOLEDO PHYSICIANS. 106358395 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 45 0 577 1 0 0 0 0 0 0 0 0 0 0 0 0 X 27 0 0 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 OH X MINDY WARD 4193837100 4510 DORR STREET TOLEDO OH 43615 X COOPER CHRISTOPHER MD PRESIDENT, UTMAC 20.00 20.00 X X 227000 492472 101577 BRICKMAN KRISTOPHER MD PRESIDENT, UTP; SECRETARY, 20.00 20.00 X X 543819 175025 73654 DWORKIN LANCE MD VICE PRESIDENT, UTP 20.00 20.00 X X 291077 413674 79885 ELSAMALOTY HAITHAM MD TREASURER, UTP 20.00 20.00 X X 530285 107800 85369 HEJEEBU SRINI DO SECRETARY, UTP 20.00 20.00 X X 271954 84722 63876 PYLES BRYAN T TREASURER, UTMAC 20.00 20.00 X X 0 248550 33390 HENDERSON PATRICIA L ASST SECRETARY, UTMAC 1.00 0.00 X X 0 0 0 BRUNICARDI FRANCIS MD TRUSTEE, UTP 20.00 20.00 X 360000 411536 106945 CASABIANCA ANDREW MD TRUSTEE, UTP 20.00 20.00 X 293182 217021 99157 CHEN CHANGHU MD TRUSTEE, UTP 20.00 20.00 X 538506 186461 102067 EBRAHEIM NABIL MD TRUSTEE, UTP 20.00 20.00 X 1396226 241031 127539 MRAK ROBERT MD TRUSTEE, UTP 20.00 20.00 X 254998 198379 92842 MUKUNDAN DEEPA MD TRUSTEE, UTP 20.00 20.00 X 73545 126119 30345 SINDHWANI PUNEET MD TRUSTEE, UTP 20.00 20.00 X 412038 197513 74575 VAN HOOK JAMES MD TRUSTEE, UTP 20.00 20.00 X 347351 300486 82884 SPEER LINDA MD TRUSTEE, UTP 20.00 20.00 X 126496 191626 72067 TIETJEN GRETCHEN MD TRUSTEE, UTP 20.00 20.00 X 261827 209913 71149 SKIE MARTIN MD TRUSTEE, UTP 20.00 20.00 X 761088 103159 80055 SCHROEDER JASON MD TRUSTEE, UTP 20.00 20.00 X 620274 46525 71038 BOOTH ROBERT MD TRUSTEE, UTP 20.00 20.00 X 194737 117530 75690 GRIDER STEPHEN MD TRUSTEE, UTP 20.00 20.00 X 315165 101861 62922 MOLONEY BRYAN MD TRUSTEE, UTP 20.00 20.00 X 339462 188014 93787 KHOURI SAMER MD TRUSTEE, UTP 20.00 20.00 X 312540 105857 63428 KAW DINKAR MD TRUSTEE, UTP 20.00 20.00 X 306106 77894 79519 BARBEE DANIEL MANAGER, UTMAC 1.00 40.00 X 0 326137 61587 ELLIS MICHAEL MD MANAGER, UTMAC 20.00 20.00 X 126140 233925 52266 MCCULLUMSMITH CHERYL MD TRUSTEE, UTP 20.00 20.00 X 135962 165795 48850 JUSTICE KAMELA CFO 40.00 0.00 X 52357 0 8985 ZAIDI SAYED FAZAL ABBAS MD PHYSICIAN 20.00 20.00 X 858097 94340 75935 JUMAA MOUHAMMAD MD PHYSICIAN 20.00 20.00 X 788088 94316 58935 ELGAFY HOSSEIN MD PHYSICIAN 20.00 20.00 X 669358 72202 55916 RAMINENI SATHEESH MD PHYSICIAN 20.00 20.00 X 713439 20348 57378 GEHLING DANIEL PHYSICIAN 20.00 20.00 X 750625 26179 71809 SINGH TANVIR MD TRUSTEE, UTP 20.00 20.00 X 474366 140445 75866 WROBLEWSKI MARY BETH MD TRUSTEE, UTP 20.00 20.00 X 53957 113128 33781 BIESZCZAD JACOB MD TRUSTEE, UTP 20.00 20.00 X 94970 10089 23882 FARRELL MD STEVEN J TRUSTEE, UTP 20.00 20.00 X 211230 116907 101816 SKEEL ROLAND T MD TRUSTEE, UTP 20.00 20.00 X 175000 67415 63866 SODEMAN THOMAS C MD TRUSTEE, UTP 20.00 20.00 X 162919 148805 88917 TALMAGE LANCE MD TRUSTEE, UTP 20.00 20.00 X 25000 86340 18658 LAWERA GARY COO 40.00 0.00 X 377525 0 43250 14446709 6259539 2765457 196 1 1 0 FUSION HEALTHCARE STAFFING 870 EAST 9400 SOUTH SUITE 200 SANDY UT 84094 HEALTHCARE STAFFING 605360 CLIFTONLARSONALLEN LLP 220 S 6TH ST SUITE 300 MINNEAPOLIS MN 55402 AUDIT AND FINANCIAL SERVICES 540452 TRG HEALTHCARE LLC 1835 MARKET ST SUITE 555 PHILADELPHIA PA 19103 INTERIM MANAGEMENT/CEO SERVICES 446898 BARONE BROTHERS LLC 4841 MONROE ST SUITE 101 TOLEDO OH 43623 RENT 432476 MOSS ADAMS LLP 999 THIRD AVE SUITE 2800 SEATTLE WA 98104 CONSULTING 234206 5 5442 5442 PATIENT SERVICE 621110 101854397 101854397 UTMAC INSURANCE PREMIUMS 621110 2431845 2431845 UTMAC INVESTMENT INCOME 621110 2113981 2113981 106400223 157788 157788 2950000 2938878 217024 11122 -217024 -205902 -205902 MISCELLANEOUS 999999 8325712 8325712 8325712 114683263 106400223 0 8277598 8602487 8602487 10429964 10429964 66175014 62389312 3785702 8129484 7769102 360382 2708606 1131317 1577289 2137950 1838637 299313 201057 201057 347541 347541 7707350 7707350 82099 82099 640610 621392 19218 196589 196589 1584645 1410334 174311 905429 905429 268911 268911 1383474 1383474 PHARMACEUTICALS 567441 567441 PROFESSIONAL DUES AND L 505454 505454 28466 505 27961 112602571 106358395 6244176 0 10060146 5046426 10445992 19765828 15062809 15852419 1925919 0 50005 67617 245739 328654 2151442 1239486 1036045 911956 34632340 31746916 27751 0 213691 0 73700437 73719816 13426386 12631576 451453 479497 9905919 8539417 23783758 21650490 X 49916679 52069326 49916679 52069326 73700437 73719816 2080692 71955 0 X 0 1 X 1 0 X X 1 UNIVERSITY OF TOLEDO 346401483 5 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 X SCHEDULE A, PAGE 5, LINE 1C THE ORGANIZATION SERVES AS THE 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. SCHEDULE A, PAGE 5, SECTION D LINE 3 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY, INC. (UTP) HAS ONLY ONE CLASS OF MEMBER, AND ONLY ONE MEMBER, THE UNIVERSITY OF TOLEDO. THE SOLE MEMBER, UNIVERSITY OF TOLEDO HAS A SIGNIFICANT VOICE IN THE ACTIVITIES AND OPERATIONS OF UTP. ACT ON ITS BEHALF AS THE SOLE MEMBER OF THE ORGANIZATION. THE SOLE MEMBER OF UTP 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 CHANGES 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13655 13655 2137787 1239486 898301 911956 LOSSES AND LOSS ADJUSTMENT EXPENSES - UTMAC 8535746 LOSSES AND CLAIMS HANDLING FEES PAYABLE - UTMAC 3671 8539417 106180192 71955 4573287 4645242 101534950 13148313 13148313 114683263 104027540 0 104027540 8575031 8575031 112602571 PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON UTMAC 4,573,287. PART XI, LINE 4B - OTHER ADJUSTMENTS: UTMAC INCOME 4,545,826. DONATIONS TO UTF 103,000. DISTRIBUTIONS TO UT/UTMAC 6,500,000. UT MISSION SUPPORT 1,999,487. PART XII, LINE 4B - OTHER ADJUSTMENTS: DONATIONS TO UTF 103,000. DISTRIBUTIONS TO UT/UTMAC 6,500,000. UTMAC EXPENSES -27,457. UT MISSION SUPPORT 1,999,487. ROUNDING 1. 1 UNIVERSITY OF TOLEDO FOUNDATION 4510 DORR ST MS 820 TOLEDO OH 43615 346555110 501(C)(3) 100000 N/A N/A SUPPORT FOR THE UNIVERSITY OF TOLEDO FOUNDATION UNIVERSITY OF TOLEDO 2801 W BANCROFT ST TOLEDO OH 43614 346401483 SECTION 115 8499487 N/A N/A SUPPORT FOR THE UNIVERSITY OF TOLEDO 2 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 0 1 X 1 0 0 1 0 0 0 1 0 COOPER CHRISTOPHER MD PRESIDENT, UTMAC 227000 492472 0 0 0 0 34200 55895 7341 4141 268541 552508 0 0 BRICKMAN KRISTOPHER MD PRESIDENT, UTP; SECRETARY, 431221 175025 112598 0 0 0 46073 24638 0 2943 589892 202606 0 0 DWORKIN LANCE MD VICE PRESIDENT, UTP 291077 413674 0 0 0 0 37500 37387 1000 3998 329577 455059 0 0 ELSAMALOTY HAITHAM MD TREASURER, UTP 70000 107800 460285 0 0 0 41250 40063 0 4056 571535 151919 0 0 HEJEEBU SRINI DO SECRETARY, UTP 36466 84722 235488 0 0 0 41123 18736 0 4017 313077 107475 0 0 PYLES BRYAN T TREASURER, UTMAC 0 248550 0 0 0 0 0 29135 0 4255 0 281940 0 0 BRUNICARDI FRANCIS MD TRUSTEE, UTP 360000 411536 0 0 0 0 41250 61385 0 4310 401250 477231 0 0 CASABIANCA ANDREW MD TRUSTEE, UTP 229723 217021 63459 0 0 0 41250 55011 0 2896 334432 274928 0 0 CHEN CHANGHU MD TRUSTEE, UTP 525944 186461 12562 0 0 0 41250 51703 0 9114 579756 247278 0 0 EBRAHEIM NABIL MD TRUSTEE, UTP 34099 241031 1362127 0 0 0 41250 82304 0 3985 1437476 327320 0 0 MRAK ROBERT MD TRUSTEE, UTP 210000 198379 44998 0 0 0 38250 51810 0 2782 293248 252971 0 0 MUKUNDAN DEEPA MD TRUSTEE, UTP 73500 126119 45 0 0 0 11257 17490 1500 98 86302 143707 0 0 SINDHWANI PUNEET MD TRUSTEE, UTP 412038 197513 0 0 0 0 41250 28264 0 5061 453288 230838 0 0 VAN HOOK JAMES MD TRUSTEE, UTP 347351 300486 0 0 0 0 41250 37310 0 4324 388601 342120 0 0 SPEER LINDA MD TRUSTEE, UTP 126496 191626 0 0 0 0 19651 51218 0 1198 146147 244042 0 0 TIETJEN GRETCHEN MD TRUSTEE, UTP 153000 209913 108827 0 0 0 39274 29204 0 2671 301101 241788 0 0 SKIE MARTIN MD TRUSTEE, UTP 0 103159 761088 0 0 0 41250 32851 0 5954 802338 141964 0 0 SCHROEDER JASON MD TRUSTEE, UTP 620274 46525 0 0 0 0 41250 25478 0 4310 661524 76313 0 0 BOOTH ROBERT MD TRUSTEE, UTP 162244 117530 32493 0 0 0 29211 41378 0 5101 223948 164009 0 0 GRIDER STEPHEN MD TRUSTEE, UTP 291652 101861 23513 0 0 0 41250 14843 0 6829 356415 123533 0 0 MOLONEY BRYAN MD TRUSTEE, UTP 338462 188014 1000 0 0 0 41250 45641 0 6896 380712 240551 0 0 KHOURI SAMER MD TRUSTEE, UTP 312540 105857 0 0 0 0 41250 15517 0 6661 353790 128035 0 0 KAW DINKAR MD TRUSTEE, UTP 62777 77894 243329 0 0 0 41250 35487 0 2782 347356 116163 0 0 BARBEE DANIEL MANAGER, UTMAC 0 326137 0 0 0 0 0 57451 0 4136 0 387724 0 0 ELLIS MICHAEL MD MANAGER, UTMAC 126140 233925 0 0 0 0 18921 32739 0 606 145061 267270 0 0 MCCULLUMSMITH CHERYL MD TRUSTEE, UTP 100962 165795 35000 0 0 0 20394 23800 0 4656 156356 194251 0 0 ZAIDI SAYED FAZAL ABBAS MD PHYSICIAN 530000 94340 328097 0 0 0 41250 30630 0 4055 899347 129025 0 0 JUMAA MOUHAMMAD MD PHYSICIAN 530000 94316 258088 0 0 0 41250 13630 0 4055 829338 112001 0 0 ELGAFY HOSSEIN MD PHYSICIAN 0 72202 669358 0 0 0 41250 10557 0 4109 710608 86868 0 0 RAMINENI SATHEESH MD PHYSICIAN 0 20348 713439 0 0 0 41250 4473 0 11655 754689 36476 0 0 GEHLING DANIEL PHYSICIAN 746785 26179 3840 0 0 0 41250 22014 0 8545 791875 56738 0 0 SINGH TANVIR MD TRUSTEE, UTP 23077 140445 451289 0 0 0 43948 27862 0 4056 518314 172363 0 0 WROBLEWSKI MARY BETH MD TRUSTEE, UTP 40000 113128 13957 0 0 0 8094 21480 0 4207 62051 138815 0 0 BIESZCZAD JACOB MD TRUSTEE, UTP 5679 10089 89291 0 0 0 14201 7124 0 2557 109171 19770 0 0 FARRELL MD STEVEN J TRUSTEE, UTP 0 116907 211230 0 0 0 31685 65867 0 4264 242915 187038 0 0 SKEEL ROLAND T MD TRUSTEE, UTP 155000 67415 20000 0 0 0 23250 37945 0 2671 198250 108031 0 0 SODEMAN THOMAS C MD TRUSTEE, UTP 154900 148805 8019 0 0 0 24438 60276 0 4203 187357 213284 0 0 TALMAGE LANCE MD TRUSTEE, UTP 25000 86340 0 0 0 0 3750 12237 0 2671 28750 101248 0 0 LAWERA GARY COO 290525 0 87000 0 0 0 41250 0 2000 0 420775 0 0 0 PART I, LINE 1A CERTAIN INDIVIDUALS IN PART VII DO HAVE HEALTH OR SOCIAL CLUB DUES PAID BY UTP. PART I, LINE 1B UTP DOES NOT HAVE A POLICY REGARDING THE PAYMENT OR REIMBURSEMENT OF THE EXPENSES DESCRIBED ON LINE 1A. PAYMENT OR REIMBURSEMENT IS BASED UPON THE BUSINESS PURPOSE OF SUCH REQUEST AND APPROVED BY APPROPRIATE INDIVIDUAL(S) WITHIN UTP. PART I, LINE 4A GARY LAWERA - $128,750 PART I, LINE 5 MANY PHYSICIANS ON STAFF DO RECEIVE COMPENSATION COMPUTED ON SERVICES RENDERED/COLLECTIONS RECEIVED. FOR THIS COMPENSATION, ESTABLISHED FORMULAS AND COMPUTATIONS ARE UTILIZED TO DETERMINE THE COMPENSATION. PART I, LINE 7 MANY PHYSICIANS ON STAFF DO RECEIVE NON-FIXED PAYMENTS BASED ON ACHIEVING VARIOUS MEASURABLES AND GOALS WITHIN THEIR PRACTICE. NORTHWEST EMERGENCY SERVICES ENTITY MORE THAN 35% OWNED BY KRISTOPHER BRICKMAN, M.D., PRESIDENT 168809 BILLING AND MANAGEMENT SERVICES 0 FORM 990, PART VI, SECTION A, LINE 3 UTMAC, LLC DELEGATES AUTHORITY TO STRATEGIC RISK SOLUTIONS WHICH SERVES AS THE CAPTIVE MANAGER. STRATEGIC RISK SOLUTIONS RECEIVED $53,000 AS COMPENSATION FOR CAPTIVE MANAGEMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY, INC. (UTP) HAS ONLY ONE CLASS OF MEMBER, 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 CHANGES 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 11B THE ORGANIZATION'S FORM 990 IS PREPARED BY AN OUTSIDE PUBLIC ACCOUNTING FIRM BASED ON INFORMATION PROVIDED BY MANAGEMENT. ONCE A DRAFT RETURN IS AVAILABLE, IT IS PROVIDED TO MANAGEMENT FOR THEIR REVIEW. ANY CHANGES NOTED BY MANAGEMENT ARE INCORPORATED INTO THE RETURN BEFORE THE DOCUMENT IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C UTP DOES HAVE A CONFLICT OF INTEREST POLICY THAT IT FOLLOWS WHEN ADDRESSING POTENTIAL CONFLICTS. ALL OFFICERS, DIRECTORS, OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE CONFLICTS OF INTERESTS WHICH MAY ARISE. SHOULD AN INDIVIDUAL HAVE A CONFLICT OF INTEREST, THE INDIVIDUAL IDENTIFIED WITH THE CONFLICT MAY NOT VOTE ON SUCH ISSUE BEFORE GOVERNANCE. UNIVERSITY OF TOLEDO PHYSICIANS, LLC. AND UTP PATHOLOGY SERVICES, LLC FOLLOWS THE SAME CONFLICT OF INTEREST POLICY THAT WAS ADOPTED BY UTP LLC. UNIVERSITY OF TOLEDO MEDICAL ASSURANCE COMPANY, LLC HAS A SIMILAR CONFLICT OF INTEREST POLICY THAT IS FOLLOWED BY ALL UTMAC MANAGERS. THE POLICY REQUIRES SIMILAR DISCLOSURES AS NOTED ABOVE. FORM 990, PART VI, SECTION B, LINE 15 WHEN DETERMINING COMPENSATION FOR THE PRESIDENT/CEO OF THE VARIOUS ENTITIES, GOVERNANCE UTILIZES COMPARABILITY DATA. COMPENSATION LEVELS ARE REVIEWED BY CHAIRMAN AND COMPENSATION COMMITTEE OF THE BOARD. THIS PROCESS IS THE UTILIZED FOR ALL OFFICERS AND EMPLOYEES PLUS APPLIES TO ALL ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII - BOARD OF DIRECTOR LISTING FOR THE PURPOSE OF THE PART VII REPORTING, THE TRUSTEES OF UNIVERSITY OF TOLEDO PHSICIANS CLINICAL FACULTY, INC. (UTP) SERVE AS GOVERNANCE FOR UNIVERSITY OF TOLEDO PHSICIANS, LLC AND UTP PATHOLOGY SERVICES, LLC. THE SOLE MEMBER OF EACH OF THE LLCS IS UTP. UNIVERSITY OF TOLEDO MEDICAL ASSURANCE COMPANY, LLC (UTMAC) GOVERNANCE IS DESIGNATED IN PART VII OF THE FORM 990. UTP IS ALSO THE SOLE MEMBER OF UTMAC. PART VI LINE 13 - WRITTEN WHISLTLEBLOWER POLICY NEITHER UTP NOR UTMAC HAS YET ADOPTED A WRITTEN WHISTLEBLOWER POLICY. UNIVERSITY OF TOLEDO PHYSICIANS LLC 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 341127097 DISREGARDED ENTITY FORMED TO CARRY OUT PURPOSES OF MEMBER OH 110180109 37398395 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 0 0 100 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC UNIVERSITY OF TOLEDO MEDICAL ASSURANCE COMPANY LLC 159 BANK ST 4TH FLOOR BURLINGTON VT 05401 DISREGARDED ENTITY FORMED TO CARRY OUT PURPOSES OF MEMBER VT 4545826 36302042 100 UNIVERSITY OF TOLEDO PHYSICIANS CLINICAL FACULTY INC TOLEDO AREA MEDICAL FOUNDATION 3355 GLENDALE AVE 3RD FLOOR TOLEDO OH 43614 341308939 FINANCIAL SUPPORT TO UNIV. OF TOLEDO PHYSICIANS CLINICAL FACULTY OH 501(C) LINE 12C, III-FI N/A 0 UNIVERSITY OF TOLEDO 2801 W BANCROFT MS 319 TOLEDO OH 43606 346401483 A PUBLIC INSTITUTION OF HIGHER EDUCATION OH SECTION 115 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 0 0 0.05000 NORTHWEST OHIO ACO LLC 4235 SECOR ROAD TOLEDO OH 43614 455444018 ACCOUNTABLE CARE ORGANIZATION OH N/A RELATED 0 0 0.40000 0 0 1 0 0 1 0 0 0 0 1 1 1 1 1 1 1 0 0