2022-05-12T16:39:25-05:00 2021-06-30 ERNST & YOUNG US LLP ONE MANHATTAN WEST NEW YORK NY 10001 990 2020-07-01 461787308 SB Clinical Practice Management Plan Inc % SB CLINICAL PRAC MGMT PLAN I SBCL 6314442055 PO BOX 1554 STONY BROOK NY 11790 Todd Griffin MD PRESIDENT & DIRECTOR 6314442055 2022-05-10 true Todd Griffin MD XXX-XX-XXXX LAURA MAYO P01962945 2127734931 3 2020 2022-09-23 18:48:47Z TODD GRIFFIN MD PO BOX 1554 STONY BROOK NY 11790 269216276 false X N/A X 2013 NY RESPONSIBLE FOR THE COLLECTION AND DISBURSEMENT OF MEMBERS' CLINICAL PRACTICE INCOME. 17 0 0 0 0 0 0 0 214536126 269132528 75795 61123 0 0 214611921 269193651 0 0 0 0 112394390 111968327 0 0 0 120671201 134489055 233065591 246457382 -18453670 22736269 114712208 140139431 114712208 140139431 0 0 A CLINICAL PRACTICE MANAGEMENT PLAN FOR THE MANAGEMENT OF THE CLINICAL PRACTICE OF FACULTY MEMBERS AT THE MEDICAL SCHOOL AT THE STATE UNIVERSITY OF NEW YORK AT STONY BROOK. false false 240858965 0 269132528 COLLECTION AND DISBURSEMENT OF MEMBERS' CLINICAL PRACTICE INCOME. 240858965 true false false false false false false false false false true false false true true false false true false false true false false false false false false false false true false false false false false false false false false false false false false true true true false false true 48 0 true 0 false true CJ false false false false false false false false false false X 17 0 false false false false false false false true true false false true true true true true true false false false NY X SB CLINICAL PRAC MGMT PLAN I 6314442055 PO BOX 1554 STONY BROOK NY 11790 RAPHAEL DAVIS MD SECRETARY 1.0 49.0 X X 0 1372472 87525 MARK TALAMINI MD CHAIRPERSON (THRU 4/5/21) 1.0 49.0 X X 0 1114634 61516 EVAN JONES MD-MPH DIRECTOR 1.0 49.0 X 0 1078432 74710 APOSTOLOS TASSIOPOULOS DIRECTOR 1.0 49.0 X 0 984886 66370 MARGARET M MCGOVERN MD PHD FORMER DIRECTOR (thru 5/1/18) 1.0 49.0 X 0 908900 103348 WAYNE WALTZER MD DIRECTOR 1.0 49.0 X 0 918700 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CARLOS DE LOS SANTOS FMR DIRECTOR (thru 1/13/20) 1.0 49.0 X 0 113859 0 ALAN TURNER Director 1.0 49.0 X 0 109261 0 0 16177161 1584696 0 true true false J BOISEN CONSULTING LLC 12223 HERSHEY BEACH GALVESTON TX 77554 CONSULTING SERVICES 162141 Allen Norin 140 RIVERSIDE DRIVE APT 6D NEW YORK NY 10024 MEDICAL SERVICES 121763 2 0 MANAGEMENT FEES 900099 267275688 267275688 RENTAL 531120 1856840 1856840 269132528 0 0 0 0 0 0 83748 22625 61123 61123 61123 0 0 0 0 0 0 0 0 0 0 269193651 269132528 61123 0 0 0 0 0 0 83143176 78986017 4157159 0 28825151 27383893 1441258 0 0 414770 414770 331853 331853 0 0 12365 12365 48403019 48403019 439025 439025 2041463 2041463 5524600 5524600 0 13362351 13362351 75700 75700 0 0 1815381 1815381 0 4427341 4427341 27525093 27525093 MEDICAL EXPENSES 14133291 14133291 CLINICAL PRACTICE RESEARCH 9652585 9652585 DUES AND LICENSE FEES 1816516 1816516 REPAIRS AND MAINTENANCE 4513702 4513702 246457382 240858965 5598417 0 10904697 4651604 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13380 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false 0 0 STONY BROOK PSYCHIATRIC ASSOCIATES UFPC 112590096 10 false 0 0 STONY BROOK RADIATION ONCOLOGY UFPC 112664726 10 false 0 0 STONY BROOK RADIOLOGY UFPC 112548304 10 false 0 0 STONY BROOK SURGICAL ASSOCIATES UFPC 112552333 10 false 0 0 STONY BROOK UROLOGY UFPC 112644371 10 false 0 0 17 0 false false false false false false false false false false false false false false false true false Part IV, Section A, line 1: Per SB Clinical Practice Management Plan, Inc.'s ("CPMP") Certificate of Incorporation, one of the purposes of CPMP's formation is "to foster, support, promote and provide assistance for medical, educational and scientific research and for other similar and related programs at the medical school of the state university of New York at Stony Brook." All CPMP's supported organizations, University Faculty Practice Corporations("UFPC") listed on Sch A Attachment 1, are Section 509(a)(2) organizations. CPMP names them by class or purpose in its Certificate of Incorporation. 41965552 12344994 29620558 13376883 12445860 931023 12628025 10045466 2582559 33134140 ADVANCES TO UFPCS 93127211 ADVANCES - HOSPITAL 68771 INVEST IN NICOLLS INDEMNITY 4500000 97695982 0 CLINICAL PRACTICE RESERVE 114294325 CAPITAL LEASE 17027141 131321466 Central America and the Caribbean Investments Captive Insurance 4500000 4500000 4500000 true false true false false false X false false false false false false false false false TONG J GAN VICE CHAIRPERSON 0 715438 0 50745 0 2828 0 39083 0 15953 0 824047 0 0 EVAN JONES MD-MPH DIRECTOR 0 615547 0 460275 0 2610 0 58461 0 16249 0 1153142 0 0 MARK C HENRY MD DIRECTOR 0 543260 0 62670 0 2828 0 65371 0 19242 0 693371 0 0 IRIS A GRANEK MD DIRECTOR 0 336343 0 50000 0 2828 0 48810 0 15916 0 453897 0 0 VINCENT W YANG MD PHD DIRECTOR 0 658522 0 57563 0 2828 0 54557 0 15916 0 789386 0 0 MARC HALTERMAN MD DIRECTOR 0 147772 0 0 0 435 0 10897 0 14114 0 173218 0 0 RAPHAEL DAVIS MD SECRETARY 0 1304615 0 65029 0 2828 0 70659 0 16866 0 1459997 0 0 TODD GRIFFIN MD CHAIRPERSON 0 554289 0 50000 0 2828 0 62930 0 15137 0 685184 0 0 ROBERT HONKANEN MD DIRECTOR 0 653890 0 77541 0 2865 0 49284 0 15126 0 798706 0 0 LAWRENCE HURST DIRECTOR 0 812298 0 68605 0 2828 0 76455 0 19991 0 980177 0 0 KENNETH R SHROYER MD PHD DIRECTOR 0 534352 0 63422 0 2828 0 66295 0 17992 0 684889 0 0 CAROLYN MILANA MD DIRECTOR 0 491683 0 50000 0 2696 0 57919 0 16221 0 618519 0 0 RAMIN V PARSEY MD PHD DIRECTOR 0 672234 0 60000 0 2880 0 30480 0 15281 0 780875 0 0 ELAINE GOULD DIRECTOR 0 576796 0 20364 0 2333 0 52856 0 16307 0 668656 0 0 SAMUEL RYU DIRECTOR 0 707480 0 70250 0 2828 0 62729 0 16053 0 859340 0 0 APOSTOLOS TASSIOPOULOS DIRECTOR 0 856558 0 125500 0 2828 0 51056 0 15314 0 1051256 0 0 WAYNE WALTZER MD DIRECTOR 0 798622 0 117250 0 2828 0 73136 0 16203 0 1008039 0 0 DENNIS CHOI MD PHD FORMER DIRECTOR (thru 6/30/19) 0 420946 0 9872 0 3055 0 31627 0 17377 0 482877 0 0 PATRICK SIBONY MD FORMER DIRECTOR (thru 3/28/18) 0 287246 0 48166 0 2941 0 48012 0 16015 0 402380 0 0 MARGARET M MCGOVERN MD PHD FORMER DIRECTOR (thru 5/1/18) 0 794948 0 111124 0 2828 0 72682 0 30666 0 1012248 0 0 CARLOS DE LOS SANTOS FMR DIRECTOR (thru 1/13/20) 0 113859 0 0 0 0 0 0 0 0 0 113859 0 0 MARK TALAMINI MD CHAIRPERSON (THRU 4/5/21) 0 1061806 0 50000 0 2828 0 45600 0 15916 0 1176150 0 0 PATRICIA COYLE MD DIRECTOR (thru 9/1/20) 0 376617 0 90393 0 2828 0 62953 0 19736 0 552527 0 0 MARK E SCHWEITZER MD FORMER DIRECTOR (thru 4/28/20) 0 213080 0 0 0 1523 0 0 0 15253 0 229856 0 0 FORM 990, PART VI, LINE 11B AN ELECTRONIC VERSION OF FORM 990 WAS PROVIDED TO THE OFFICERS AND DIRECTORS PRIOR TO FILING. MANAGEMENT PERFORMS A REVIEW OF FORM 990 PRIOR TO FILING, ADDRESSING ANY QUESTIONS MADE BY THE GOVERNING BODY. FORM 990, PART VI, LINE 12C SB CLINICAL PRACTICE MANAGEMENT PLAN, INC. HAS ADOPTED THE SAME CONFLICT OF INTEREST POLICY AS ITS MEMBER UFPCS. THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT SB CLINICAL PRACTICE MANAGEMENT PLAN, INC.'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE ORGANIZATION OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OF COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. COMPLIANCE WITH THIS POLICY IS MONITORED THROUGH INTERNAL PAYMENT POLICIES AND ANNUAL REPRESENTATIONS. THE REVIEWS, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: A. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. B. WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENT FOR GOODS AND SERVICES, FURTHER EDUCATIONAL PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. A VOTING MEMBER OF THE GOVERNING BOARD WHO HAS A COMPENSATION CONFLICT IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. IF THERE ARE VIOLATIONS TO THE POLICY, THE COMMITTEE OR GOVERNING BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. Form 990, Part XI, Line 9 ALLOCATION TO CLINICAL PRACTICE RESERVE = -$22,757,928 LINE 9 TOTAL CHANGE IN NET ASSETS = -$22,757,928 FORM 990 PART IX LINE 11G DESCRIPTION:SCHOOL OF MEDICINE CHARGE TOTAL FEES:33272699 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER OPERATING TOTAL FEES:15130320 NEW YORK STATE 1 COMMERCE PLZ 99 WASHINGTON ALBANY NY 12231 146013200 GOVERNMENT NY 501(C)(1) N/A NA false STONY BROOK ANAESTHESIOLOGY UFPC PO BOX 1554 STONY BROOK NY 11790 112553515 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK DERMATOLOGY ASSOCIATES UFPC PO BOX 1554 STONY BROOK NY 11790 113011790 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK CLIN PRACT MGMT REALTY CORP PO BOX 1554 STONY BROOK NY 11790 113285712 RLTY HOLDING NY 501(C)(25) N/A CPMP true STONY BROOK SURGICAL HOLDING CORP PO BOX 1554 STONY BROOK NY 11790 116434538 RLTY HOLDING NY 501(C)(25) N/A CPMP true STONY BROOK EMERGENCY PHYSICIANS UFPC PO BOX 1554 STONY BROOK NY 11790 113066770 HEALTHCARE NY 501(C)(3) 10 NYS false SB Family and Preventive Medicine UFPC PO BOX 1554 STONY BROOK NY 11790 112552321 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK INTERNISTS UFPC PO BOX 1554 STONY BROOK NY 11790 112558775 HEALTHCARE NY 501(C)(3) 10 NYS false NEW YORK SPINE AND BRAIN SURGERY UFPC PO BOX 1554 STONY BROOK NY 11790 112645930 HEALTHCARE NY 501(C)(3) 10 NYS false NEUROLOGY ASSOC OF STONY BROOK UFPC PO BOX 1554 STONY BROOK NY 11790 112587430 HEALTHCARE NY 501(C)(3) 10 NYS false UNIV ASSOC IN OBST & GYNECOLOGY UFPC PO BOX 1554 SOTNY BROOK NY 11790 112569522 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK PATHOLOGISTS UFPC PO BOX 1554 STONY BROOK NY 11790 112647243 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK OPHTHALMOLOGY UFPC PO BOX 1554 STONY BROOK NY 11790 112658697 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK ORTHOPAEDIC ASSOCIATES UFPC PO BOX 1554 STONY BROOK NY 11790 112593061 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK CHILDREN'S SERVICE UFPC PO BOX 1554 STONY BROOK NY 11790 112571524 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK PSYCHIATRIC ASSOCIATES UFPC PO BOX 1554 STONY BROOK NY 11790 112590096 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK RADIATION ONCOLOGY UFPC PO BOX 1554 STONY BROOK NY 11790 112664726 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK SURGICAL ASSOCIATES UFPC PO BOX 1554 STONY BROOK NY 11790 112552333 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK UROLOGY UFPC PO BOX 1554 STONY BROOK NY 11790 112644371 HEALTHCARE NY 501(C)(3) 10 NYS false STONY BROOK RADIOLOGY PO BOX 1554 STONY BROOK NY 11790 112548304 HEALTHCARE NY 501(C)(3) 10 NYS false SB HLTHCARE IPA LLC PO BOX 1554 STONY BROOK NY 11790 113499101 HEALTHCARE NY SB CPMP RELATED 0 0 false 0 true 1.00000 Nicolls Indemnity Solutions SPC 27 HOSPITAL RD CAYMAN CORP CTR GRAND CAYMAN CJ KY1-9008 981378568 SELF-INSURANCE CJ CPMP C-CORP 15480449 83221885 1.00000 true false false false false false false false false false false true true false false false false true false Stony Brook Surgical Holding Corporation L 313384 Stony Brook CPMP Realty Corporation M 21751