2019-11-14T14:43:20-06:00 2017-12-31 341884125 CBIZ MHM LLC 4722 N 24TH ST STE 300 PHOENIX AZ 85016 990 2017-01-01 208106540 DISTRICT MEDICAL GROUP INC DIST 6024705000 2929 EAST THOMAS ROAD PHOENIX AZ 85016 CRAIG JONES CHIEF FINANCIAL OFFICER 6024705000 2019-11-12 1 AMY A O'LOUGHLIN P00869687 6022646835 2019-11-12 12.221.96.220 2019-11-12 19:55:13 MS P 00D8EAD6C853267EA0FAEACDA358CF90F321AF39 1212D86953DF9911D4E957E54162B84DD93DFAA7 2017 2020-03-31 21:24:44Z DMG KOTE CHUNDU MD 2929 EAST THOMAS ROAD PHOENIX AZ 85016 158038692 0 X WWW.DMGAZ.ORG X 2006 AZ OPERATE A FACULTY PRACTICE PLAN FOR THE BENEFIT OF THE MARICOPA COUNTY SPECIAL HEALTHCARE DISTRICT, WHICH WAS CREATED TO PROVIDE MEDICAL EDUCATION PROGRAMS, EMERGENCY AND OTHER SERVICES TO THE MEDICALLY UNDERSERVED. 9 5 882 0 0 0 2200 0 151470123 157889910 -158521 31093 118010 117689 151431812 158038692 101275 77509 0 0 113758473 118817364 0 0 0 37066019 38859864 150925767 157754737 506045 283955 43795986 44578370 10205934 10704363 33590052 33874007 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 120759260 77509 139884521 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 THAT 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 SPECTRUS 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, 220 NON-PHYSICIAN PROVIDERS, AND OVER 80 ANCILLARY CLINIC STAFF. IN 2017, DMG SERVED OVER 19,000 INPATIENTS, 400,000 OUTPATIENTS, AND 97,000 EMERGENCY/WALK-IN CLINIC VISITS. DURING 2017 DMG'S DIRECT ECONOMIC OUTPUT, INCLUDING THE SERVICE ECONOMY, IS ESTIMATED AT OVER $146 MILLION. THE INDIRECT ECONOMIC BENEFIT TO THE COMMUNITY IS SIGNIFICANTLY MORE.DISTRICT MEDICAL GROUP STAFFS THE MARICOPA INTEGRATED HEALTH SYSTEM, WHICH INCLUDES A 325 BED ACUTE CARE HOSPITAL, A 219 BED INPATIENT PSYCHIATRIC HOSPITAL, TWELVE 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 800 PATIENTS/YEAR AND SERVING MORE THAN 8,700 PATIENTS/YEAR IN AN OUTPATIENT SETTING; THE VERIFIED AMERICAN COLLEGE OF SURGEONS LEVEL 1 TRAUMA CENTER, AND LEVEL 2 PEDIATRIC TRAUMA CENTER; AND THE ARIZONA CHILDREN'S CENTER, A NACHRI-CERTIFIED CHILDREN'S HOSPITAL, CARING FOR WELL OVER 25,000 PATIENTS/YEAR 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 ARE THE REFUGEE WOMEN'S HEALTH CLINIC, THE FIRST OF ITS KIND IN ARIZONA, PROVIDING CULTURALLY-GROUNDED HEALTHCARE TO THE GROWING REFUGEE AND IMMIGRANT COMMUNITY, AND MARIPOSA: WINGS TO SAFETY, WHOSE FOCUS IS ON VICTIMS AND FAMILIES AFFECTED BY DOMESTIC VIOLENCE AND SEXUAL ABUSE.THROUGH AFFILIATION WITH MARICOPA INTEGRATED HEALTH SYSTEM (MIHS) AND THE UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE, 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, 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 CLOSE TO 100 ACTIVE RESEARCH PROJECTS, INCLUDING INDUSTRY-SPONSORED AND NIH GRANTS.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 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; COMMUNITY OUTREACH EVENTS HIGHLIGHTING PRENATAL SCREENINGS, REHABILITATION, HOSPICE, SENIOR CARE, TRANSPORTATION AND CARE COORDINATION; BACK-TO-SCHOOL AND HOLIDAY CLINICS FOR CHILDREN AND STUDENTS; CHILDHOOD AND ADOLESCENT OBESITY CLINICS; AND 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, RELIEF EFFORTS IN THIS COUNTRY AND ABROAD, AND 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. 17686705 18140085 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 SERVING THE OUTLYING COMMUNITIES. THE CRS MULTI-SPECIALTY INTERDISCIPLINARY CLINIC (MSIC) WAS DESIGNED TO PRESENT THE UNIQUE ABILITY TO 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.DMG ALSO OPERATES THE DESERT HORIZONS INTEGRATIVE MEDICINE CLINIC, SPECIALIZING IN BEHAVIORAL HEALTH ASSESSMENT AND TREATMENT OF CHILDREN AND ADULTS. 138445965 1 0 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 1 307 0 1 882 1 0 0 0 0 0 0 0 0 0 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 PHYLLIS BIEDESS COMMUNITY BOARD MEMBER, VI 0.50 X X 10429 0 0 JAMES MAROVICH COMMUNITY BOARD MEMBER 0.50 X 12429 0 0 WILLIAM PUTNAM COMMUNITY BOARD MEMBER 0.50 X 10429 0 0 ALAN RAWLS COMMUNITY BOARD MEMBER 0.50 X 10429 0 0 TED WILLIAMS COMMUNITY BOARD MEMBER 0.50 X 10429 0 0 DR DAN HOBOHM BD. CHAIR, PATH CHAIR, VP 65.00 X X 442768 0 39077 DR KOTE CHUNDU BD. MEMBER, PRESIDENT & CE 65.00 X X 1308933 0 82256 DR DAVID WISINGER BD. MEMBER, CMO, INT. MEDI 65.00 X X 433508 0 85265 DR DEAN COONROD BD. MEMBER, SECRETARY, OBG 60.00 X X 394054 0 86219 CRAIG JONES CFO, TREASURER 50.00 X 271566 0 61923 DR WILLIAM JOHNSON ANES. CHAIR, PERIOPERATIVE 60.00 X 470498 0 84174 DR CAROL OLSON PSYCHIATRY CHAIR 60.00 X 407488 0 83231 DR ERIC KATZ EMERGENCY MEDICINE CHAIR 60.00 X 398231 0 66369 DR ABRAHAM KURUVILLA AMBULATORY CHAIR 60.00 X 276412 0 54471 DR DANIEL CARUSO SURGERY CHAIR 60.00 X 267474 0 74012 DR IMAN FEIZ-ERFAN DIRECTOR OF NEUROSURGERY 70.00 X 1454396 0 60011 DR NAFTALY ATTIAS CHAIR ORTHOPEDICS 60.00 X 695030 0 71628 DR ELI SWANSON ORTHOPEDIC SURGEON 60.00 X 594709 0 43263 DR PAUL ZIDEL CHIEF OF HAND SURGERY 60.00 X 523298 0 67504 DR KENG-YU CHUANG MED DIRECTOR GASTOENTEROLOGY 60.00 X 519938 0 66397 DR DANIEL GRIDLEY FORMER KEY EE, RADIOLOGY CHAIR 60.00 X 554197 0 65780 DR PRABODH HEMMADY FORMER KEY EE, PEDIATRICS CHAIR 60.00 X 359826 0 84381 DR JOSEPH STAPCZYNSKI FORMER KEY EE, FORMER EMER 50.00 X 240310 0 51914 9666781 0 1227875 308 1 1 0 PHOENIX CHILDRENS HOSPITAL 1919 E THOMAS ROAD PHOENIX AZ 85016 PHYSICIAN SERVICES 892798 MAYO CLINIC PO BOX 4006 ROCHESTER MN 559034006 PHYSICIAN SERVICES 683998 COMPHEALTH PO BOX 972651 DALLAS TX 753972625 PHYSICIAN SERVICES 620488 GE HEALTHCARE 15724 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 TECHNOLOGY SERVICES 552522 SONORAN ORTHO TRAUMA SURGEONS PLLC PO BOX 29425 BIN 920067 PHOENIX AZ 85038 PHYSICIAN SERVICES 540505 38 PATIENT SERVICES 621110 157889910 157889910 157889910 31093 17007 14086 OTHER INCOME 900099 117689 117689 117689 158038692 158024606 0 14086 77509 77509 5442076 3663252 1778824 91544332 82991626 8552706 8342738 7675412 667326 8254434 6451730 1802704 5233784 4540916 692868 383302 383302 192720 51526 141194 60100 60100 12118929 11343892 775037 510 510 1161126 463728 697398 2486657 224900 2261757 2033666 1832150 201516 59726 32737 26989 34978 3013 31965 99499 30397 69102 1206874 483930 722944 3454255 3298821 155434 BAD DEBT 11148116 11148116 PROVIDER EDUCATION 1128265 1128265 RESIDENT PROGRAM EXPENS 874497 874497 DUES & FEES 593667 494268 99399 1822977 1634770 188207 157754737 138445965 19308772 0 17882478 14945421 0 8129469 11958158 9974412 14545 0 522710 757963 13925 13925 944689 916778 13958838 6579649 7560151 7379189 475000 475000 4424330 1986213 43795986 44578370 4873239 5801415 3069006 2398934 2263689 2504014 10205934 10704363 X 33590052 33874007 33590052 33874007 43795986 44578370 283955 0 X 0 1 X 1 0 X 1645 252 15 2200 0 4112 156473501 157563465 154027584 151470123 157889910 777424583 156475146 157563717 154027599 151472323 157889910 777428695 0 0 0 777428695 6218 7264 65608 22850 31093 133033 6218 7264 65608 22850 31093 133033 1292472 855460 581152 590226 154057 3473367 157773836 158426441 154674359 152085399 158075060 781035095 0.99540 0.99460 0.00020 0.00020 X SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: MISC. NON-OPERATING INCOME 2013 AMOUNT: $ 139,070. 2014 AMOUNT: $ 49,603. 2015 AMOUNT: $ 43,271. 2016 AMOUNT: $ 51,976. 2017 AMOUNT: $ 30,683. UA INTEGRATED HEALTH CLINIC START-UP/OPERATIONS SUBSIDY 2013 AMOUNT: $ 1,153,402. 2014 AMOUNT: $ 805,857. 2015 AMOUNT: $ 345,975. 2016 AMOUNT: $ 461,378. 2017 AMOUNT: $ 0. EHR INCENTIVES 2015 AMOUNT: $ 191,906. 2016 AMOUNT: $ 76,872. 2017 AMOUNT: $ 123,374. 1000000 1000000 1000000 1000000 4000000 6000000 260000 260000 250000 250000 250000 250000 1000000 1500000 PART II-A, LINE 2 DMG MADE ITS FIRST SECTION 501(H) ELECTION FOR THE TAX YEAR ENDING DECEMBER 31, 2014. DMG DID NOT INCUR ANY LOBBYING EXPENSES IN 2017. 350000 350000 3501873 585278 2916595 2706372 1318274 1388098 3706515 2859743 846772 3694078 1816354 1877724 7379189 DEFERRED RENT - CURRENT 8949 DEFERRED RENT - LONG TERM 414666 SUSPENSE - UNIDENTIFIED RECEIPTS 507792 GCR COLLECTION LIABILITY 2780 ESCHEAT LIABILITY 57290 457(B) LIABILITY 1512537 2504014 X PART X, LINE 2: FROM FOOTNOTE 1 OF THE AUDITED FINANCIAL STATEMENTS: THE COMPANY EVALUATES THEIR UNCERTAIN TAX POSITIONS, 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, 2017 AND 2016, THE COMPANY DID NOT HAVE ANY UNCERTAIN TAX POSITIONS. 0 MARICOPA HEALTH FOUNDATION 2901 E CAMELBACK ROAD SUITE 100 PHOENIX AZ 85016 860777567 41550 GENERAL SUPPORT MARCH OF DIMES - ARIZONA CHAPTER 3550 N CENTRAL AVE SUITE 610 PHOENIX AZ 85012 131846366 5000 GENERAL SUPPORT UA FOUNDATION 1111 N CHERRY AVE PO BOX 210109 PHOENIX AZ 85721 866050388 18500 EDUCATIONAL PROGRAMS CITY OF HOPE 1500 E DUARTE RD DUARTE CA 91010 953435919 5000 GENERAL SUPPORT 4 PART 1, LINE 2: DMG GENERALLY GIVES GRANTS TO WELL ESTABLISHED ORGANIZATIONS THAT IT IS FAMILIAR WITH AND WHICH ARE INVOLVED IN ACTIVITIES CLOSELY RELATED TO DMG'S MISSION. 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 DAN HOBOHM BD. CHAIR, PATH CHAIR, VP 381574 0 13748 0 47446 0 16200 0 22877 0 481845 0 0 0 DR KOTE CHUNDU BD. MEMBER, PRESIDENT & CE 1086496 0 218873 0 3564 0 54000 0 28256 0 1391189 0 0 0 DR DAVID WISINGER BD. MEMBER, CMO, INT. MEDI 354802 0 12709 0 65997 0 54000 0 31265 0 518773 0 0 0 DR DEAN COONROD BD. MEMBER, SECRETARY, OBG 376174 0 13757 0 4123 0 54000 0 32219 0 480273 0 0 0 CRAIG JONES CFO, TREASURER 256794 0 13150 0 1622 0 32400 0 29523 0 333489 0 0 0 DR WILLIAM JOHNSON ANES. CHAIR, PERIOPERATIVE 408474 0 11000 0 51024 0 54000 0 30174 0 554672 0 0 0 DR CAROL OLSON PSYCHIATRY CHAIR 332541 0 11000 0 63947 0 54000 0 29231 0 490719 0 0 0 DR ERIC KATZ EMERGENCY MEDICINE CHAIR 337508 0 13150 0 47573 0 32400 0 33969 0 464600 0 0 0 DR ABRAHAM KURUVILLA AMBULATORY CHAIR 256810 0 11000 0 8602 0 32400 0 22071 0 330883 0 0 0 DR DANIEL CARUSO SURGERY CHAIR 250198 0 10000 0 7276 0 54000 0 20012 0 341486 0 0 0 DR IMAN FEIZ-ERFAN DIRECTOR OF NEUROSURGERY 1024036 0 3400 0 426960 0 32400 0 27611 0 1514407 0 0 0 DR NAFTALY ATTIAS CHAIR ORTHOPEDICS 587096 0 25296 0 82638 0 32400 0 39228 0 766658 0 0 0 DR ELI SWANSON ORTHOPEDIC SURGEON 474027 0 56498 0 64184 0 29700 0 13563 0 637972 0 0 0 DR PAUL ZIDEL CHIEF OF HAND SURGERY 501165 0 2900 0 19233 0 32400 0 35104 0 590802 0 0 0 DR KENG-YU CHUANG MED DIRECTOR GASTOENTEROLOGY 365604 0 106049 0 48285 0 30023 0 36374 0 586335 0 0 0 DR DANIEL GRIDLEY FORMER KEY EE, RADIOLOGY CHAIR 471293 0 18539 0 64365 0 32400 0 33380 0 619977 0 0 0 DR PRABODH HEMMADY FORMER KEY EE, PEDIATRICS CHAIR 328526 0 13052 0 18248 0 54000 0 30381 0 444207 0 0 0 DR JOSEPH STAPCZYNSKI FORMER KEY EE, FORMER EMER 225965 0 2190 0 12155 0 29840 0 22074 0 292224 0 0 0 PART 1, 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 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 1, 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 STATUS WITHIN THE COMPANY. PART II, B (III): OTHER REPORTABLE COMPENSATION - THIS INCLUDES ADDITIONAL PAY FOR SERVICES PERFORMED OUTSIDE AND/OR IN ADDITION TO THEIR BASE CONTRACTUAL REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 7A THE 4 PHYSICIAN DIRECTORS OF THE BOARD ARE ELECTED BY THE BOARD, 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 EVERY FEW YEARS AS WELL. 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 A SURVEY AND COMPARISON FROM THE CEO COMPENSATION REPORTED BY SIMILAR 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 AND THE AAMC, BOTH OF WHICH ARE NATIONALLY RECOGNIZED MEDICAL GROUP MANAGEMENT ASSOCIATIONS. 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. 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 0 0 0 0 0 0 1 0 0 0 0 0 1 0 DMG INSURANCE COMPANY INC L 260482 ESTIMATE DMG INSURANCE COMPANY INC R 3144990 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.