2022-11-15T10:43:06-06:00 2021-12-31 161468002 CHIAMPOU TRAVIS BESAW & KERSHNER LLP 45 BRYANT WOODS NORTH AMHERST NY 14228 990 2021-01-01 161485974 UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC UNIV 7168818050 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 SARAH BERGA MD PRESIDENT 7168818050 2022-11-14 1 SARAH BERGA MD 999009999 EUGENE G KERSHNER P00601324 7166302400 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z SARAH BERGA MD 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 6042493 0 X WWW.UBMD.COM X 1995 NY THE CORPORATION IS FORMED FOR THE PURPOSE OF SUPPORTING THE EDUCATIONAL PURPOSE OF THE JACOBS SCHOOL OF MEDICINE AT THE STATE UNIVERSITY OF NEW YORK AT BUFFALO BY PROVIDING CLINICAL INSTRUCTION AND SUPERVISION TO STUDENTS, INTERNS AND RESIDENTS AND RENDERING PROFESSIONAL SERVICES AND FURTHER TO PRACTICE THE PROFESSION OF MEDICINE. 13 1 51 0 0 0 23565 0 5165457 5797706 1876 38287 388084 167685 5578982 6003678 0 0 0 0 4036406 4709538 0 0 0 1323440 1496845 5359846 6206383 219136 -202705 1815315 1734224 705141 844118 1110174 890106 TO PROVIDE THE HIGHEST QUALITY CARE TO THE POPULATION OF WESTERN NEW YORK IN THE SPECIALTY AREAS OF GENERAL AND HIGH RISK OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY. 0 0 5056076 5965391 THE CORPORATION PROVIDED VARIOUS MEDICAL SERVICES TO THE POPULATION OF WESTERN NEW YORK SEEKING MEDICAL ATTENTION IN THE AREAS OF OBSTETRICS AND GYNECOLOGY. THE CORPORATION ALSO SUPPORTS THE EDUCATIONAL PURPOSE OF THE JACOBS SCHOOL OF MEDICINE AT THE STATE UNIVERSITY OF NEW YORK AT BUFFALO BY PROVIDING CLINICAL INSTRUCTION AND SUPERVISION OF STUDENTS,INTERNS AND RESIDENTS. 5056076 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 1 8 0 51 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 1 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 0 NY X X JOHN GARBAY KELLY BADURA 7168818050 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 14203 SARAH BERGA MD PRESIDENT 40.00 X X 272023 0 2732 TOVA ABLOVE MD VICE PRESIDENT 40.00 X X 174324 0 1755 SUZANNE GRIFFITH MD TREASURER/SECRETARY 40.00 X X 197974 0 1980 FAYE JUSTICIA-LINDE DO PHYSICIAN 40.00 X 172240 0 1722 LISA JANE JACOBSON MD DIRECTOR 40.00 X 107042 0 1070 RACHELLE ST ONGE MD PHYSICIAN 40.00 X 179741 0 1797 VANESSA BARNEBEI MD PHYSICIAN 40.00 X 47543 0 488 ELANA TAL MD PHYSICIAN 40.00 X 52100 0 521 JOHN GARBAY CFO & COO 40.00 X 128318 0 1377 MANDEEP BRAR MD PHYSICIAN 40.00 X 252921 0 2529 PAUL OGBURN MD DIRECTOR 40.00 X 520450 0 2900 HENRY REYES MD PHYSICIAN 40.00 X 512768 0 2900 STACEY AKERS MD PHYSICIAN 40.00 X 250167 0 2502 2867611 0 24273 11 0 1 0 0 CONTRACT REVENUE 624100 3334193 3334193 FEES FOR SERVICES 624100 1249481 1249481 GRADUATE MEDICAL EDUCA 624100 1213439 1213439 MEDICAID SUPPLEMENT 624100 593 593 5797706 2102 2102 75000 38815 36185 36185 36185 MISCELLANEOUS INCOME 900099 167685 167685 167685 6003678 6001576 0 2102 2867611 2424638 442973 1365137 1053976 311161 32905 26982 5923 210877 160493 50384 233008 188413 44595 31607 31607 53281 53281 13183 13183 22028 22028 157041 113070 43971 223035 127130 95905 22379 22379 12621 7068 5553 42555 23831 18724 360830 335025 25805 CAO'S FUND 194072 194072 CLINICAL SUPPLIES AND F 192344 192344 RESIDENTS EXPENSE 70203 70203 CONTRACTUAL SERVICES 45758 45758 55908 48666 7242 6206383 5056076 1150307 0 673852 378211 31410 31026 433215 665628 55603 67568 793444 501970 266535 291474 133813 79430 220887 220887 1815315 1734224 297103 478875 408038 365243 705141 844118 X 1110174 890106 1110174 890106 1815315 1734224 -202705 -17363 0 X X 0 1 X 1 0 X 81328 6209 23565 0 111102 5343642 4943802 4586525 5165457 5797706 25837132 5424970 4950011 4586525 5189022 5797706 25948234 0 162584 136798 110003 91586 125495 626466 162584 136798 110003 91586 125495 626466 25321768 2405 3059 6894 3762 2102 18222 2405 3059 6894 3762 2102 18222 330005 185658 221657 44739 167685 949744 5757380 5138728 4815076 5237523 5967493 26916200 0.94080 0.93860 0.00070 0.00090 X SCHEDULE A, PART III LINE 12: MISCELLANEOUS INCOME INCLUDES INCOME FROM OTHER HEALTHCARE RELATED ORGANIZATIONS, INSURANCE SETTLEMENTS, SUPPORT INCOME, AND SALARY REIMBURSEMENTS THAT ARE RELATED TO THE PRIMARY PURPOSE OF THE ORGANIZATION. 307628 64141 243487 485816 437829 47987 291474 MALPRACTICE CAPITAL CONTRIBUTIONS 220887 220887 NOTE PAYABLE UB ASSOCIATES, INC. 209966 MALPRACTICE INSURANCE ASSESSMENT 56294 CHIEF ADMINISTRATIVE OFFICER'S FUND PAYABLE 51956 LONG TERM DEBT 47027 365243 5986315 -17363 -17363 6003678 0 6003678 6206383 0 6206383 0 6206383 X 0 0 0 0 0 0 0 0 0 PAUL OGBURN MD DIRECTOR 520450 0 0 0 0 0 2900 0 0 0 523350 0 0 0 HENRY REYES MD PHYSICIAN 512768 0 0 0 0 0 2900 0 0 0 515668 0 0 0 SARAH BERGA MD PRESIDENT 272023 0 0 0 0 0 2732 0 0 0 274755 0 0 0 MANDEEP BRAR MD PHYSICIAN 252921 0 0 0 0 0 2529 0 0 0 255450 0 0 0 STACEY AKERS MD PHYSICIAN 250167 0 0 0 0 0 2502 0 0 0 252669 0 0 0 SUZANNE GRIFFITH MD TREASURER/SECRETARY 197974 0 0 0 0 0 1980 0 0 0 199954 0 0 0 RACHELLE ST ONGE MD PHYSICIAN 179741 0 0 0 0 0 1797 0 0 0 181538 0 0 0 TOVA ABLOVE MD VICE PRESIDENT 174324 0 0 0 0 0 1755 0 0 0 176079 0 0 0 FAYE JUSTICIA-LINDE DO PHYSICIAN 172240 0 0 0 0 0 1722 0 0 0 173962 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES CERTAIN MANAGEMENT FUNCTIONS TO A RELATED PARTY, UB ASSOCIATES, INC., IN EXCHANGE FOR A FEE. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS MEMBERS THAT MAY ELECT OTHER MEMBERS TO THE GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS MADE BY THE BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF MEMBERSHIP AND/OR THE STATE UNIVERSITY OF NEW YORK (SUNY) AT BUFFALO. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS GIVEN TO EACH BOARD MEMBER FOR REVIEW BEFORE THE 990 WAS FILED. THIS WAS DONE VIA BOARD MEETING AND/OR EMAIL. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES DISCLOSURE OF ANY CONFLICTS OF INTEREST ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 PHYSICIAN COMPENSATION IS GOVERNED BY ARTICLE XVI OF THE STATE UNIVERSITY OF NEW YORK. NON-PHYSICIAN COMPENSATION IS DETERMINED USING MARKET RATES FOR SIMILAR ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES FROM THE PRIOR YEAR. UNIVERSITY AT BUFFALO ASSOCIATES INC UB DOWNTOWN GATEWAY BUILDING 77 GOO BUFFALO NY 14203 161559460 PROVIDE ADMIN SUPPORT TO SUNY BUFFALO MEDICAL SCHOOL PRACTICE PLAN NY 501(C)(3) LINE 10 N/A 0 STATE OF NEW YORK ONE COMMERCE PLAZA 99 WASHINGTON AV ALBANY NY 12231 146013200 GOVERNMENT NY 501(C)(1) N/A 0 UNIVERSITY AT BUFFALO FAMILY MEDICINE INC 77 GOODELL STREET BUFFALO NY 14203 161280696 PROVIDES MEDICAL SERVICES NY 501(C)(3) LINE 10 N/A 0 UNIVERSITY AT BUFFALO FOUNDATION INC PO BOX 900 BUFFALO NY 14226 160865182 PROVIDE ADMIN SUPPORT FOR AND PROMOTE THE ACTIVITIES OF THE UNIVERSITY NY 501(C)(3) LINE 10 N/A 0 UNIVERSITY AT BUFFALO PEDIATRIC ASSOCIATES INC 239 BRYANT STREET BUFFALO NY 14222 161238821 PROVIDES MEDICAL SERVICES NY 501(C)(3) LINE 10 N/A 0 ACADEMIC MEDICINE SERVICES INC 77 GOODELL STREET SUITE 240 BUFFALO NY 14203 161455134 PROVIDES OFFICE SPACE VIA A SUBLEASE NY 501(C)(3) LINE 10 N/A 0 UNIVERSITY AT BUFFALO SURGERY INC 462 GRIDER STREET BUFFALO NY 14203 800033443 PROVIDES BILLING SERVICES NY 501(C)(3) LINE 10 N/A 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 STATE OF NEW YORK P 194072 MARKET VALUE STATE OF NEW YORK E 51956 MARKET VALUE