UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC (EIN 16-1485974)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-11
- IRS object ID
- 202133159349306548
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-11T15:17:17-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161468002 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHIAMPOU TRAVIS BESAW & KERSHNER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 45 BRYANT WOODS NORTH | AddressLine1Txt |
| City | AMHERST | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14228 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161485974 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNIVERSITY GYNECOLOGISTS & | BusinessNameLine1Txt |
| Business Name Line2 | OBSTETRICIANS INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UNIV | BusinessNameControlTxt |
| Phone | 7168818050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 MAIN ST FL 5 CONVENTUS | AddressLine1Txt |
| City | BUFFALO | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 142031009 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SARAH BERGA MD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 7168818050 | PhoneNum |
| Signature | 2021-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SARAH | PersonFirstNm |
| Person Last | BERGA MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | EUGENE G KERSHNER | PreparerPersonNm |
| PTIN | P00601324 | PTIN |
| Phone | 7166302400 | PhoneNum |
| Preparation | 2021-11-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SARAH BERGA MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 MAIN ST FL 5 CONVENTUS | AddressLine1Txt |
| City | BUFFALO | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 142031009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,584,803 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UBMD.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 36 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $23,565 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,586,525 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,165,457 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,894 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,876 | CYInvestmentIncomeAmt |
| PY Other Revenue | $221,657 | PYOtherRevenueAmt |
| CY Other Revenue | $388,084 | CYOtherRevenueAmt |
| PY Total Revenue | $4,815,076 | PYTotalRevenueAmt |
| CY Total Revenue | $5,578,982 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,377,637 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,036,406 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,358,496 | PYOtherExpensesAmt |
| CY Other Expenses | $1,323,440 | CYOtherExpensesAmt |
| PY Total Expenses | $4,736,133 | PYTotalExpensesAmt |
| CY Total Expenses | $5,359,846 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $78,943 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $219,136 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,637,586 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,815,315 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $760,666 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $705,141 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $876,920 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,110,174 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,377,679 | ExpenseAmt |
| Revenue | $5,551,655 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $4,377,679 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 36 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN GARBAY KELLY BADURA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7168818050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 MAIN ST FL 5 CONVENTUS | AddressLine1Txt |
| City | BUFFALO | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14203 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| SARAH BERGA MD | |||||||
| PRESIDENT | 40.00 | Yes (X) | Yes (X) | $160,417 | $0 | $1,604 | |
| TOVA ABLOVE MD | |||||||
| VICE PRESIDENT | 40.00 | Yes (X) | Yes (X) | $178,077 | $0 | $1,781 | |
| SUZANNE GRIFFITH MD | |||||||
| TREASURER/SECRETARY | 40.00 | Yes (X) | Yes (X) | $199,210 | $0 | $1,992 | |
| FAYE JUSTICIA-LINDE DO | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $172,640 | $0 | $1,726 | ||
| LISA JANE JACOBSON MD | |||||||
| DIRECTOR | 40.00 | Yes (X) | $109,805 | $0 | $1,098 | ||
| JOHN GARBAY | |||||||
| CFO & COO | 40.00 | Yes (X) | $130,925 | $0 | $1,364 | ||
| MANDEEP BRAR MD | |||||||
| PHYSICIAN | 40.00 | $321,860 | $0 | $2,975 | Yes (X) | ||
| PAUL OGBURN MD | |||||||
| DIRECTOR | 40.00 | $550,000 | $0 | $2,800 | Yes (X) | ||
| HENRY REYES MD | |||||||
| PHYSICIAN | 40.00 | $473,131 | $0 | $2,850 | Yes (X) | ||
| RACHELLE ST ONGE MD | |||||||
| PHYSICIAN | 40.00 | $180,206 | $0 | $1,802 | Yes (X) | ||
| JOSEPH DENAGY MD | |||||||
| PHYSICIAN | 40.00 | $146,686 | $0 | $1,467 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,622,957 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $21,459 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $23,565 | GovernmentGrantsAmt |
| Total Contributions | $23,565 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CONTRACT REVENUE | 624100 | $2,971,928 | $2,971,928 |
| GRADUATE MEDICAL EDUCA | 624100 | $1,192,218 | $1,192,218 |
| FEES FOR SERVICES | 624100 | $998,200 | $998,200 |
| MEDICAID SUPPLEMENT | 624100 | $3,111 | $3,111 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,165,457 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,762 | TotalRevenueColumnAmt |
| Exclusion | $3,762 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,935 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,821 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$1,886 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,886 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$1,886 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| FORGIVENESS OF DEBT | 900099 | $343,345 | $343,345 |
| MISCELLANEOUS INCOME | 900099 | $44,739 | $44,739 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $388,084 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,578,982 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,551,655 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,762 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $951,074 | TotalAmt |
| Program Services | $814,688 | ProgramServicesAmt |
| Management And General | $136,386 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,704,227 | TotalAmt |
| Program Services | $2,236,301 | ProgramServicesAmt |
| Management And General | $467,926 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,772 | TotalAmt |
| Program Services | $25,233 | ProgramServicesAmt |
| Management And General | $5,539 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,505 | TotalAmt |
| Program Services | $113,174 | ProgramServicesAmt |
| Management And General | $44,331 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,828 | TotalAmt |
| Program Services | $159,307 | ProgramServicesAmt |
| Management And General | $33,521 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,335 | TotalAmt |
| Management And General | $36,335 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,598 | TotalAmt |
| Management And General | $55,598 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,115 | TotalAmt |
| Management And General | $26,115 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,436 | TotalAmt |
| Program Services | $18,436 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,378 | TotalAmt |
| Program Services | $98,912 | ProgramServicesAmt |
| Management And General | $38,466 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,437 | TotalAmt |
| Program Services | $119,949 | ProgramServicesAmt |
| Management And General | $90,488 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,481 | TotalAmt |
| Program Services | $13,481 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,963 | TotalAmt |
| Program Services | $7,259 | ProgramServicesAmt |
| Management And General | $5,704 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,550 | TotalAmt |
| Program Services | $17,668 | ProgramServicesAmt |
| Management And General | $13,882 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,262 | TotalAmt |
| Program Services | $15,515 | ProgramServicesAmt |
| Management And General | $19,747 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MALPRACTICE INSURANCE | $316,355 | $316,355 |
| CLINICAL SUPPLIES AND F | $135,950 | $135,950 |
| CAO'S FUND | $120,508 | $120,508 |
| RESIDENTS EXPENSE | $74,015 | $74,015 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,057 | TotalAmt |
| Program Services | $90,928 | ProgramServicesAmt |
| Management And General | $8,129 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,359,846 | TotalAmt |
| Program Services | $4,377,679 | ProgramServicesAmt |
| Management And General | $982,167 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $203,100 | BOYAmt |
| EOY | $673,852 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,662 | BOYAmt |
| EOY | $31,410 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $668,270 | BOYAmt |
| EOY | $433,215 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,439 | BOYAmt |
| EOY | $55,603 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $725,950 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $459,415 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $299,971 | BOYAmt |
| EOY | $266,535 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,257 | BOYAmt |
| EOY | $133,813 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $220,887 | BOYAmt |
| EOY | $220,887 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,637,586 | BOYAmt |
| EOY | $1,815,315 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $175,692 | BOYAmt |
| EOY | $297,103 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $584,974 | BOYAmt |
| EOY | $408,038 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $760,666 | BOYAmt |
| EOY | $705,141 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $876,920 | BOYAmt |
| EOY | $1,110,174 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $876,920 | BOYAmt |
| EOY | $1,110,174 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,637,586 | BOYAmt |
| EOY | $1,815,315 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $219,136 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $14,118 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $81,328 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,209 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $23,565 | CurrentTaxYearAmt |
| Total | $111,102 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,316,382 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,343,642 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,943,802 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,586,525 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,165,457 | CurrentTaxYearAmt |
| Total | $25,355,808 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,316,382 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,424,970 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,950,011 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,586,525 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,189,022 | CurrentTaxYearAmt |
| Total | $25,466,910 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $37,452 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $162,584 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $136,798 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $110,003 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $91,586 | CurrentTaxYearAmt |
| Total | $538,423 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $37,452 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $162,584 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $136,798 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $110,003 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $91,586 | CurrentTaxYearAmt |
| Total | $538,423 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $24,928,487 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,055 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,405 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,059 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,894 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,762 | CurrentTaxYearAmt |
| Total | $24,175 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,055 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,405 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,059 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,894 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,762 | CurrentTaxYearAmt |
| Total | $24,175 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $285,419 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $330,005 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $185,658 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $221,657 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $44,739 | CurrentTaxYearAmt |
| Total | $1,067,478 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,609,856 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,757,380 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,138,728 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,815,076 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,237,523 | CurrentTaxYearAmt |
| Total | $26,558,563 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.93860 | PublicSupportCY509Pct |
| Public Support PY509 | 0.93120 | PublicSupportPY509Pct |
| Investment Income CY | 0.00090 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00120 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III LINE 12: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $307,628 | OtherCostOrOtherBasisAmt |
| Depreciation | $46,341 | DepreciationAmt |
| Book Value | $261,287 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $418,322 | OtherCostOrOtherBasisAmt |
| Depreciation | $413,074 | DepreciationAmt |
| Book Value | $5,248 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $266,535 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INVESTMENTS - M&T | Desc |
| Book Value | $133,813 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $133,813 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MALPRACTICE CAPITAL CONTRIBUTIONS | Desc |
| Book Value | $220,887 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $220,887 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| NOTE PAYABLE UB ASSOCIATES, INC. | $280,684 |
| MALPRACTICE INSURANCE ASSESSMENT | $112,611 |
| CHIEF ADMINISTRATIVE OFFICER'S FUND PAYABLE | $14,743 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $408,038 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $5,593,100 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $14,118 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $14,118 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,578,982 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $5,578,982 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $5,359,846 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $5,359,846 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $5,359,846 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAUL OGBURN MD | ||||||||||||||
| DIRECTOR | $550,000 | $0 | $0 | $0 | $0 | $0 | $2,800 | $0 | $0 | $0 | $552,800 | $0 | $0 | $0 |
| HENRY REYES MD | ||||||||||||||
| PHYSICIAN | $473,131 | $0 | $0 | $0 | $0 | $0 | $2,850 | $0 | $0 | $0 | $475,981 | $0 | $0 | $0 |
| MANDEEP BRAR MD | ||||||||||||||
| PHYSICIAN | $321,860 | $0 | $0 | $0 | $0 | $0 | $2,975 | $0 | $0 | $0 | $324,835 | $0 | $0 | $0 |
| SUZANNE GRIFFITH MD | ||||||||||||||
| TREASURER/SECRETARY | $199,210 | $0 | $0 | $0 | $0 | $0 | $1,992 | $0 | $0 | $0 | $201,202 | $0 | $0 | $0 |
| RACHELLE ST ONGE MD | ||||||||||||||
| PHYSICIAN | $180,206 | $0 | $0 | $0 | $0 | $0 | $1,802 | $0 | $0 | $0 | $182,008 | $0 | $0 | $0 |
| TOVA ABLOVE MD | ||||||||||||||
| VICE PRESIDENT | $178,077 | $0 | $0 | $0 | $0 | $0 | $1,781 | $0 | $0 | $0 | $179,858 | $0 | $0 | $0 |
| FAYE JUSTICIA-LINDE DO | ||||||||||||||
| PHYSICIAN | $172,640 | $0 | $0 | $0 | $0 | $0 | $1,726 | $0 | $0 | $0 | $174,366 | $0 | $0 | $0 |
| SARAH BERGA MD | ||||||||||||||
| PRESIDENT | $160,417 | $0 | $0 | $0 | $0 | $0 | $1,604 | $0 | $0 | $0 | $162,021 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| STATE OF NEW YORK | ||
| P | $120,508 | MARKET VALUE |
| STATE OF NEW YORK | ||
| E | $14,743 | MARKET VALUE |
Comments