2021-05-16T21:40:46-05:00 2020-06-30 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2019-07-01 203889761 UPSTATE COMMUNITY MEDICAL PC UPST 3156349272 4900 BROAD ROAD NO 1507 SYRACUSE NY 13215 AMY TUCKER DIRECTOR 3154925140 2021-05-14 1 ANGELA M FRANCO P00589741 3154463600 2021-05-14 2019 2022-09-23 18:48:47Z AMY TUCKER 750 EAST ADAMS STREET SYRACUSE NY 13215 26432052 0 X WWW.UPSTATE.EDU/COMMUNITY/UCM/ X 2005 NY THE ROLE OF UPSTATE COMMUNITY MEDICAL, P.C. (UCM) IS TO PROVIDE A COMPREHENSIVE SOURCE FOR ACUTE MEDICAL CARE AND RELATED SERVICES TO ADVANCE THE MISSION OF UPSTATE MEDICAL UNIVERSITY OF NEW YORK. UCM WAS FORMED FOR THE CHARITABLE PURPOSE OF SERVING THE HEALTH CARE NEEDS OF THE COMMUNITY SERVICED BY THE HOSPITAL AND ADVANCING THE CHARITABLE PURPOSE OF THE UNIVERSITY. 1 0 155 0 0 0 0 250594 22138125 25668422 673 0 913847 513036 23052645 26432052 0 0 0 0 11447922 12740018 0 0 0 12036445 14126688 23484367 26866706 -431722 -434654 3951980 5506214 6306942 8295830 -2354962 -2789616 X THE ROLE OF UPSTATE COMMUNITY MEDICAL, P.C. IS TO PROVIDE A COMPREHENSIVE SOURCE FOR ACUTE MEDICAL CARE AND RELATED SERVICES TO UNINSURED AND UNDERINSURED INDIVIDUALS IN THE COMMUNITY. 0 0 4577273 4557971 HOSPITALIST SERVICE - PROVIDED ACUTE MEDICAL CARE FOR THE PATIENTS OF UPSTATE UNIVERSITY HOSPITAL COMMUNITY CAMPUS. 5248716 5248716 ANESTHESIA SERVICE - PROVIDED ANESTHESIA SERVICES FOR THE PATIENTS OF UPSTATE UNIVERSITY HOSPITAL COMMUNITY CAMPUS. 3033254 2803091 AMBULATORY OBGYN SERVICE- PROVIDED OBGYN HEALTHCARE SERVICES FOR THE PATIENTS OF UPSTATE COMMUNITY MEDICAL, P.C. 12811504 13571680 OTHER PROGRAM SERVICES 12811504 13571680 25670747 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 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 16 0 1 155 1 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X ROBERT J CALNON 3154721488 1001 W FAYETTE STREET SYRACUSE NY 13204 AMY TUCKER MD OFFICER 2.00 40.00 X X 0 381611 36633 MATTHEW GLIDDEN OFFICER 2.00 40.00 X X 13236 277460 37171 MARY ELLEN GRECO MD PHYSICIAN 40.00 X 260234 0 24038 ANTHONY M STIRPE PHYSICIAN ASSISTANT 40.00 X 293315 0 16655 KENNETH K RHEE PHYSICIAN 40.00 X 339715 0 24838 HOWARD M WEINSTEIN PHYSICIAN 40.00 X 333206 0 0 MICHAEL L MCGRATTAN MD PHYSICIAN 40.00 X 290096 0 18038 1529802 659071 157373 5 0 1 0 CHAG ANESTHESIA GROUP 5000 BRITTONFIELD PARKWAY EAST SYRACUSE NY 13057 PROFESSIONAL MEDICAL SERVICES 3732836 DEPARTMENT OF MEDICINE MEDICAL SERVICE 550 E GENESEE ST SUITE 201 SYRACUSE NY 13202 PROFESSIONAL MEDICAL SERVICES 3082544 GOLDFISH LOCUM TENENS 6865 WINDCREST DR STE 300 PLANO TX 75024 PROFESSIONAL MEDICAL SERVICES 667786 PRACTICE RESOURCES LLC 1001 W FAYETTE ST SYRACUSE NY 13204 ADMINISTRATIVE AND BILLING SERVICES 641211 SYRACUSE ORTHOPEDIC SPECIALIST 5824 WIDEWATERS PARKWAY EAST SYRACUSE NY 13057 PROFESSIONAL MEDICAL SERVICES 445143 11 250594 250594 PROFESSIONAL SERVICE AGREEMENT - 621110 18761854 18761854 PROFESSIONAL SERVICES 621110 6906568 6906568 25668422 MISCELLANEOUS INCOME 900099 512901 512901 135 135 513036 26432052 26181458 0 0 13236 13236 10882872 10637663 245209 333592 333592 784730 764190 20540 725588 706596 18992 156000 156000 12609 1516 11093 32021 32021 155316 797 154519 30404 30404 255790 254178 1612 338747 323315 15432 249 249 91548 91548 10453 10453 818774 744358 74416 PURCHASED SERVICES 11532332 11115523 416809 BILLING FEES 477600 477600 BAD DEBT EXPENSE 177721 177721 PERMITS, LICENSES, DUES 29926 29025 901 7198 2423 4775 26866706 25670747 1195959 0 2496964 1715383 375627 309221 176497 44656 94395 94395 10453 0 892439 3436954 3951980 5506214 1028590 1264828 5278352 7031002 6306942 8295830 X 10 10 90 90 -2355062 -2789716 -2354962 -2789616 3951980 5506214 -434654 0 X X 0 1 X 1 0 X 250594 250594 13271243 17004406 18980209 22138125 25668422 97062405 13271243 17004406 18980209 22138125 25919016 97312999 0 0 0 97312999 3090 2967 2487 673 0 9217 3090 2967 2487 673 9217 112394 33535 33050 913847 513036 1605862 13386727 17040908 19015746 23052645 26432052 98928078 0.98370 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 94395 94395 0 0 DUE FROM UNIVERSITY HOSPITAL 3308710 OTHER RECEIVABLES 128244 3436954 DUE TO RELATED PARTIES 7031002 7031002 X 26254331 0 26254331 177721 177721 26432052 26688985 0 26688985 177721 177721 26866706 PART X, LINE 2: THE FINANCIAL STATEMENTS DO NOT GIVE CONSIDERATION FOR FEDERAL AND STATE INCOME TAXES AS THE CORPORATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). AS OF JUNE 30, 2020 AND 2019, THE CORPORATION DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2017 THROUGH 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 177,721. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 177,721. X 0 0 0 0 0 0 0 0 0 AMY TUCKER MD OFFICER 0 381611 0 0 0 0 0 18166 0 18467 0 418244 0 0 MATTHEW GLIDDEN OFFICER 13236 277460 0 0 0 0 0 18704 0 18467 13236 314631 0 0 MARY ELLEN GRECO MD PHYSICIAN 260000 0 0 0 234 0 10400 0 13638 0 284272 0 0 0 ANTHONY M STIRPE PHYSICIAN ASSISTANT 293132 0 0 0 183 0 11200 0 5455 0 309970 0 0 0 KENNETH K RHEE PHYSICIAN 339000 0 0 0 715 0 11200 0 13638 0 364553 0 0 0 HOWARD M WEINSTEIN PHYSICIAN 331114 0 0 0 2092 0 0 0 0 0 333206 0 0 0 MICHAEL L MCGRATTAN MD PHYSICIAN 290000 0 0 0 96 0 11200 0 6838 0 308134 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS DISTRIBUTED FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE COMPANY BYLAWS REFLECT THAT THE BOARD ENFORCES A POLICY THAT REQUIRES ALL DIRECTORS, OFFICERS, AND OTHER PERSONS IN A POSITION TO INFLUENCE CORPORATE DECISIONS TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AND THE PROCESS THAT SHALL BE FOLLOWED WHEN A DISCLOSURE IS MADE. ENHANCEMENTS TO THE POLICY ARE IN THE PROCESS OF BEING MADE. FORM 990, PART VI, SECTION B, LINE 15 SALARY AND BONUS OR INCENTIVE COMPENSATION IS DETERMINED BASED ON A REVIEW OF RELEVANT MARKET DATA. PERIODIC REVIEWS ARE CONDUCTED AS APPROPRIATE FOR REASONABLENESS, VALUATION, PERFORMANCE, AND COMPLIANCE WITH CONTRACTUAL REQUIREMENTS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE IS RESPONSIBLE FOR OVERSEEING THE SELECTION OF THE INDEPENDENT ACCOUNTANT. SUNY UPSTATE UNIVERSITY HOSPITAL 750 E ADAMS STREET SYRACUSE NY 13210 161469571 PATIENT CARE NY 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 SUNY UPSTATE UNIVERSITY HOSPITAL L 18761855 PROFESSIONAL SERVICES AGREEMENT SUNY UPSTATE UNIVERSITY HOSPITAL M 430045 ADMIN SERVICES AGREEMENT