2021-11-11T15:17:17-06:00 2020-12-31 161468002 CHIAMPOU TRAVIS BESAW & KERSHNER LLP 45 BRYANT WOODS NORTH AMHERST NY 14228 990 2020-01-01 161485974 UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC UNIV 7168818050 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 SARAH BERGA MD PRESIDENT 7168818050 2021-11-09 1 SARAH BERGA MD 999009999 EUGENE G KERSHNER P00601324 7166302400 2021-11-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SARAH BERGA MD 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 5584803 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. 5 0 36 0 0 0 0 23565 4586525 5165457 6894 1876 221657 388084 4815076 5578982 0 0 0 0 3377637 4036406 0 0 0 1358496 1323440 4736133 5359846 78943 219136 1637586 1815315 760666 705141 876920 1110174 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 4377679 5551655 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. 4377679 1 0 0 0 0 0 0 0 0 0 1 1 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 7 0 1 36 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 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 160417 0 1604 TOVA ABLOVE MD VICE PRESIDENT 40.00 X X 178077 0 1781 SUZANNE GRIFFITH MD TREASURER/SECRETARY 40.00 X X 199210 0 1992 FAYE JUSTICIA-LINDE DO PHYSICIAN 40.00 X 172640 0 1726 LISA JANE JACOBSON MD DIRECTOR 40.00 X 109805 0 1098 JOHN GARBAY CFO & COO 40.00 X 130925 0 1364 MANDEEP BRAR MD PHYSICIAN 40.00 X 321860 0 2975 PAUL OGBURN MD DIRECTOR 40.00 X 550000 0 2800 HENRY REYES MD PHYSICIAN 40.00 X 473131 0 2850 RACHELLE ST ONGE MD PHYSICIAN 40.00 X 180206 0 1802 JOSEPH DENAGY MD PHYSICIAN 40.00 X 146686 0 1467 2622957 0 21459 11 0 1 0 0 23565 23565 CONTRACT REVENUE 624100 2971928 2971928 GRADUATE MEDICAL EDUCA 624100 1192218 1192218 FEES FOR SERVICES 624100 998200 998200 MEDICAID SUPPLEMENT 624100 3111 3111 5165457 3762 3762 3935 5821 -1886 -1886 -1886 FORGIVENESS OF DEBT 900099 343345 343345 MISCELLANEOUS INCOME 900099 44739 44739 388084 5578982 5551655 0 3762 951074 814688 136386 2704227 2236301 467926 30772 25233 5539 157505 113174 44331 192828 159307 33521 36335 36335 55598 55598 26115 26115 18436 18436 137378 98912 38466 210437 119949 90488 13481 13481 12963 7259 5704 31550 17668 13882 35262 15515 19747 MALPRACTICE INSURANCE 316355 316355 CLINICAL SUPPLIES AND F 135950 135950 CAO'S FUND 120508 120508 RESIDENTS EXPENSE 74015 74015 99057 90928 8129 5359846 4377679 982167 0 203100 673852 31662 31410 668270 433215 96439 55603 725950 459415 299971 266535 117257 133813 220887 220887 1637586 1815315 175692 297103 584974 408038 760666 705141 X 876920 1110174 876920 1110174 1637586 1815315 219136 14118 0 X X 0 1 X 1 0 X 81328 6209 23565 111102 5316382 5343642 4943802 4586525 5165457 25355808 5316382 5424970 4950011 4586525 5189022 25466910 0 37452 162584 136798 110003 91586 538423 37452 162584 136798 110003 91586 538423 24928487 8055 2405 3059 6894 3762 24175 8055 2405 3059 6894 3762 24175 285419 330005 185658 221657 44739 1067478 5609856 5757380 5138728 4815076 5237523 26558563 0.93860 0.93120 0.00090 0.00120 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 46341 261287 418322 413074 5248 266535 OTHER INVESTMENTS - M&T 133813 F 133813 MALPRACTICE CAPITAL CONTRIBUTIONS 220887 220887 NOTE PAYABLE UB ASSOCIATES, INC. 280684 MALPRACTICE INSURANCE ASSESSMENT 112611 CHIEF ADMINISTRATIVE OFFICER'S FUND PAYABLE 14743 408038 5593100 14118 14118 5578982 0 5578982 5359846 0 5359846 0 5359846 X 0 0 0 0 0 0 0 0 0 PAUL OGBURN MD DIRECTOR 550000 0 0 0 0 0 2800 0 0 0 552800 0 0 0 HENRY REYES MD PHYSICIAN 473131 0 0 0 0 0 2850 0 0 0 475981 0 0 0 MANDEEP BRAR MD PHYSICIAN 321860 0 0 0 0 0 2975 0 0 0 324835 0 0 0 SUZANNE GRIFFITH MD TREASURER/SECRETARY 199210 0 0 0 0 0 1992 0 0 0 201202 0 0 0 RACHELLE ST ONGE MD PHYSICIAN 180206 0 0 0 0 0 1802 0 0 0 182008 0 0 0 TOVA ABLOVE MD VICE PRESIDENT 178077 0 0 0 0 0 1781 0 0 0 179858 0 0 0 FAYE JUSTICIA-LINDE DO PHYSICIAN 172640 0 0 0 0 0 1726 0 0 0 174366 0 0 0 SARAH BERGA MD PRESIDENT 160417 0 0 0 0 0 1604 0 0 0 162021 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 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 120508 MARKET VALUE STATE OF NEW YORK E 14743 MARKET VALUE