2012-05-15T14:28:01-05:00 2011-06-30 KERBER ECK & BRAECKEL LLP 1000 MYERS BUILDING SPRINGFIELD IL 62701 990 2010-07-01 364143823 SIU PHYSICIANS & SURGEONS INC SIUP 2175458850 PO BOX 19639 SPRINGFIELD IL 62794 WENDY COX-LARGENT 2175458850 2012-05-15 1 JASON D JONES 2177890960 2012-05-15 2010 2016-02-24 21:20:13Z SIU HEALTHCARE WENDY COX-LARGENT PO BOX 19639 SPRINGFIELD IL 627949639 106299657 0 X WWW.SIUMED.EDU/PHYSURG/ X 1997 IL ASSIST SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE'S MEDICAL EDUCATION ACTIVITIES THROUGH PROVIDING PATIENT CARE. 11 4 301 0 0 0 0 0 85308702 105989374 148154 154897 0 0 85456856 106144271 0 0 0 0 31277684 31813578 0 0 0 50283371 58027586 81561055 89841164 3895801 16303107 27080375 45596220 7541320 9760834 19539055 35835386 TO BE A LEADER IN QUALITY HEALTH CARE TO ALL PEOPLE OF CENTRAL AND SOUTHERN ILLINOIS IN SUPPORT OF THE MISSION OF THE SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE. 0 0 89253804 105989374 HEALTH CARE DELIVERY: PHYSICIANS AND OTHER HEALTHCARE PROVIDERS OF SIU PHYSICIANS AND SURGEONS, INC. ASSISTED IN THE TRAINING OF 291 UNDERGRADUATE MEDICAL STUDENTS AND 293 MEDICAL RESIDENTS AND FELLOWS WHILE PROVIDING MEDICAL SERVICES IN THE COMMUNITIES WE SERVE. (364,519 PATIENT VISITS) 89253804 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 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 33 0 1 301 1 0 0 0 0 0 0 0 0 0 0 X 11 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X X SOUTHERN ILLINOIS UNIVERSITY SCHOOL 2175455791 327 W CALHOUN SPRINGFIELD IL 62794 CAROL POSEGATE 2.00 X 0 0 0 J KEVIN DORSEY MD PHD 10.00 X 0 388553 63592 ARTHUR BUNN 2.00 X 0 0 0 JOHN BRADLEY MD 50.00 X X X 61930 295563 40615 SERGIO PECORI 2.00 X 0 0 0 DAVID STEWARD MD 70.00 X X 24876 0 29041 GARY DUNNINGTON MD 70.00 X 113152 532175 54333 MICHAEL NEUMEISTER MD 70.00 X 585083 191989 99176 LUCINDA BUESCHER 70.00 X 110170 89806 19386 ALAN DECKARD 50.00 X 51827 158207 22805 KATHY MAHAFFEY 60.00 X 0 133266 27997 WENDY COX-LARGENT 60.00 X 0 155256 28950 JERRY KRUSE 70.00 X 67653 0 53274 RICARDO LORET DE MOLA 70.00 X 177731 509849 98308 RUSSELL YANG 70.00 X 243491 603518 66403 KHALED SALEH 70.00 X 171011 596391 85628 REUBEN BUENO 70.00 X 624163 66066 56002 STEPHEN HAZELRIGG 70.00 X 356363 302349 73649 MARK PUCZNSKI MD 70.00 X 0 322907 55678 STEPHEN SOLTYS MD 70.00 X 33798 231310 35045 JONATHAN GOLDFARB MD 70.00 X 173965 133644 81767 PATRICK MCKENNA MD 70.00 X 264427 234317 80371 ROBERT BUZZELL MD 70.00 X 305330 150879 34952 OSARETIN IDUSUYI 70.00 X 351475 56544 37739 NICOLE SOMMER 70.00 X 397127 45093 46673 HYUNG KIM 70.00 X 0 0 0 ELVIN ZOOK MD 50.00 X 149840 22986 702 DAVID RESCH MD 50.00 X 26655 210626 24615 DAVID TKACH 70.00 X 155758 134302 84409 4445825 5565596 1301110 15 1 1 0 SPRINGFIELD CLINIC 1025 SOUTH 7TH STREET SPRINGFIELD IL 62703 ON CALL COVERAGE 623050 ON TIME TRANSCRIPTION DEPT 4933 CAROL STREAM IL 60122 MEDICAL TRANSCRIPTION 283276 HEALTHLINK PO BOX 66971-N ST LOUIS MO 63166 PROVIDER ADMINISTRATION 240000 MEMORIAL MEDICAL CENTER 701 NORTH FIRST STREET SPRINGFIELD IL 62781 REFERENCE LAB AND ANSWERING SERVICE 202848 ORTHOPEDIC CENTER OF ILLINOIS LTD 1301 S KOKE MILL RD SPRINGFIELD IL 62707 ON CALL COVERAGE 200000 9 MEDICAL FEES 621110 103376149 103376149 TRAUMA/ON CALL FEES 621110 2613225 2613225 105989374 155278 155278 155005 155386 -381 -381 -381 106144271 105989374 0 154897 1233801 1063718 170083 29045488 29045488 1534289 1534289 16443 16443 29500 29500 2551025 2551025 13795 13795 7424336 7424336 909309 909309 37626 37626 28573 28573 2049 2049 311473 311473 373982 373982 UNIVERSITY OVERHEAD 38300063 38300063 ACADEMIC DEVELOPMENT 8010670 8010670 MISCELLANEOUS 18742 18742 89841164 89253804 587360 0 3076642 4726561 14513480 28613554 9838 116553 2919190 1891400 1241574 1027790 8238841 11111762 27080375 45596220 4734228 4829704 2807092 4931130 7541320 9760834 X 18297480 34807596 1241575 1027790 0 0 19539055 35835386 27080375 45596220 X 16303107 -6776 X 0 1 1 X 0 X X X 0 0 0 BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY 376005961 6 1 1 1 46310733 1 46310733 2905413 1877623 1027790 13777 13777 0 1027790 DEPOSITS WITH SOUTHERN ILLINOIS UNIVERSITY 11103176 ACCRUED INTEREST RECEIVABLE 8586 11111762 DUE TO SOUTHERN ILLINOIS UNIVERSITY 4931130 4931130 106144271 89841164 16303107 -6776 -6776 16296331 106137495 -6776 -6776 106144271 0 106144271 89841164 0 89841164 0 89841164 SIU PHYSICIANS AND SURGEONS OWES SOUTHERN ILLINOIS UNIVERSITY FOR SERVICES PERFORMED ON OUR BEHALF. THESE SERVICES INCLUDE STAFF, SUPPLIES, AND FACILITIES EXPENSES. X X X X 0 0 0 0 0 0 0 0 0 J KEVIN DORSEY MD PHD 0 388553 0 0 0 0 0 63592 0 0 0 452145 0 429000 JOHN BRADLEY MD 61930 295563 0 0 0 0 15258 24003 1354 0 78542 319566 139512 252495 GARY DUNNINGTON MD 113152 532175 0 0 0 0 11234 41599 1500 0 125886 573774 126749 570674 MICHAEL NEUMEISTER MD 585083 191989 0 0 0 0 49000 48676 1500 0 635583 240665 645950 239087 LUCINDA BUESCHER 110170 89806 0 0 0 0 11016 7507 863 0 122049 97313 0 0 ALAN DECKARD 51827 158207 0 0 0 0 9326 12844 635 0 61788 171051 54172 123971 KATHY MAHAFFEY 0 133266 0 0 0 0 0 27997 0 0 0 161263 0 0 WENDY COX-LARGENT 0 155256 0 0 0 0 0 28950 0 0 0 184206 0 156464 RICARDO LORET DE MOLA 177731 509849 0 0 0 0 44208 52600 1500 0 223439 562449 191701 0 RUSSELL YANG 243491 603518 0 0 0 0 45303 19600 1500 0 290294 623118 222514 601870 KHALED SALEH 171011 596391 0 0 0 0 42528 41600 1500 0 215039 637991 0 0 REUBEN BUENO 624163 66066 0 0 0 0 49000 5502 1500 0 674663 71568 544572 82945 STEPHEN HAZELRIGG 356363 302349 0 0 0 0 32152 39997 1500 0 390015 342346 484372 267737 MARK PUCZNSKI MD 0 322907 0 0 0 0 0 54459 1219 0 1219 377366 1462 361698 STEPHEN SOLTYS MD 33798 231310 0 0 0 0 3379 30692 974 0 38151 262002 30058 262053 JONATHAN GOLDFARB MD 173965 133644 0 0 0 0 26087 54243 1437 0 201489 187887 252588 138955 PATRICK MCKENNA MD 264427 234317 0 0 0 0 37774 41097 1500 0 303701 275414 306922 274342 ROBERT BUZZELL MD 305330 150879 0 0 0 0 21067 12385 1500 0 327897 163264 474684 93481 OSARETIN IDUSUYI 351475 56544 0 0 0 0 31401 4838 1500 0 384376 61382 482062 61244 NICOLE SOMMER 397127 45093 0 0 0 0 41383 3790 1500 0 440010 48883 510522 48981 ELVIN ZOOK MD 149840 22986 0 0 0 0 0 0 702 0 150542 22986 98036 21936 DAVID RESCH MD 26655 210626 0 0 0 0 6664 17069 882 0 34201 227695 42770 217964 DAVID TKACH 155758 134302 0 0 0 0 38940 44255 1214 0 195912 178557 157915 195082 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS AS DESCRIBED IN THE ORGANIZATIONAL BYLAWS. THESE BYLAWS LAY OUT THE SPECIFIC REQUIREMENT FOR MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A FOUR DIRECTORS ARE ELECTED BY THE MEMBERSHIP REPRESENTING EACH OF THE MAJOR PRIMARY CARE OR SPECIALTY DEPARTMENTS AND 1 MEMBER-AT-LARGE. A NOMINATING COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS WHO SOLICITS NOMINATIONS FROM THE MEMBERSHIP. THE MEMBERS THEN VOTE IN ONE OF HE CATEGORIES FOR A DIRECTOR. EACH DIRECTOR IS ELECTED TO A THREE YEAR TERM AND CAN SERVE NO MORE THAN TWO CONSECUTIVE TERMS. FORM 990, PART VI, SECTION A, LINE 7B THE ONLY DECISION OF THE GOVERNING BOARD THAT IS SUBJECT TO THE MEMBERSHIP IS A CHANGE IN THE BYLAWS. A BYLAWS CHANGE REQUIRES A SIMPLE MAJORITY OF THE VOTING MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS INITIALLY REVIEWED BY THE CHIEF FINANCIAL OFFICER. A COPY IS PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW AND RECOMMENDATION TO THE BOARD FOR APPROVAL. ANY QUESTIONS OR CHANGES ARE ADDRESSED BY THE CFO. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED ANNUALLY TO THE CORPORATE COMPLIANCE OFFICER WHO REVIEWS FOR POTENTIAL CONFLICTS. AT BOARD OF DIRECTORS MEETINGS, THE DIRECTORS ARE ASKED AT EACH MEETING OF ANY POTENTIAL CONFLICTS RELATED TO THE MEETING AGENDA. POTENTIAL CONFLICTS ARE DISCUSSED AND WHEN THEY EXIST, BOARD MEMBERS EITHER RECUSE THEMSELVES FROM DISCUSSION,VOTING, OR THE MEETING AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 EXTERNAL COMPENSATION DATA IS USED FOR ALL DIRECTORS AND OFFICERS. DATA TYPICALLY USED WOULD INCLUDE NATIONAL TRADE ASSOCIATION DATA SUCH AS MGMA OR AAMC. COMPENSATION CAPS ARE SET FROM MEDIUM TO NO GREATER THAN THE 90 PERCENTILE. ONCE AN EMPLOYEE EXCEEDS THE ABSOLUTE COMPENSATION CAP, NO ADDITIONAL INCOME CAN BE EARNED. THE COMPENSATION COMMITTEE, WHICH CONSISTS OF INDEPENDENT VOTING MEMBERS OF THE BOARD OF DIRECTORS, REVIEWS THE RECOMMENDATIONS AND MAKE CHANGES OR APPROVE. THIS PROCESS OCCURS ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 SIU PHYSICIANS AND SURGEONS MAKES ITS MOST RECENT BOARD MEEETING MINUTES, BYLAWS AND CONFLICT OF INTEREST POLICY AVAILABLE ON ITS PUBLIC WEBSITE. EACH BOARD MEETING STARTS WITH A REQUEST FOR DISCLOSURE OF CONFLICTS OF INTEREST FOR THE MEETING AGENDA. FINANCIAL STATEMENTS ARE POSTED ON ANOTHER WEBSITE, GUIDESTAR. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -6,776. SOUTHERN ILLINOIS UNIVERSITY PO BOX 19607 327 W CALHOUN SPRINGFIELD IL 627949607 376005961 HIGHER EDUCATION IL 170(B)(1)(A)(V) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 SOUTHERN ILLINOIS UNIVERSITY O 38300063 CASH SOUTHERN ILLINOIS UNIVERSITY Q 8010670 CASH