2020-10-22T18:54:45-05:00 2019-06-30 ERNST & YOUNG US LLP 2005 MARKET STREET SUITE 700 PHILADELPHIA PA 19103 990 2018-07-01 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 2020-10-20 true JAMES L ZIESCHE P01264584 2154485336 173.68.23.158 26308520201965000621 2020-07-14 P 047C777BBD395ADD529156C75D94AFF56594489C 047C777BBD395ADD529156C75D94AFF56594489C 2018 2021-01-29 14:40:06Z X Todd Griffin MD PO BOX 1554 STONY BROOK NY 11790 248829856 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 219204716 248756898 50358 68593 0 0 219255074 248825491 0 0 0 0 97960133 105503320 0 0 0 114394510 128831734 212354643 234335054 6900431 14490437 115620845 135820922 115620845 135820922 0 0 A CLINICAL PRACTICE MANAGEMENT PLAN FOR THE MANAGEMENT OF THE CLINICAL PRACTICE OF FACULTY MEMBERS AT THE 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X 0 608324 83761 IRIS A GRANEK MD DIRECTOR 1.0 49.0 X 0 363371 61697 VINCENT W YANG MD PHD DIRECTOR 1.0 49.0 X 0 756122 75833 PATRICIA COYLE MD DIRECTOR 1.0 49.0 X 0 361600 67429 TODD GRIFFIN MD DIRECTOR 1.0 49.0 X 0 626053 79062 ROBERT HONKANEN MD DIRECTOR 1.0 49.0 X 0 688083 61860 KENNETH R SHROYER MD PHD DIRECTOR 1.0 49.0 X 0 680672 94488 CAROLYN MILANA MD DIRECTOR 1.0 49.0 X 0 389748 64027 RAMIN V PARSEY MD PHD DIRECTOR 1.0 49.0 X 0 846518 59101 MARK E SCHWEITZER MD DIRECTOR 1.0 49.0 X 0 903913 53714 SAMUEL RYU DIRECTOR 1.0 49.0 X 0 765746 77572 WAYNE WALTZER MD DIRECTOR 1.0 49.0 X 0 1013349 91104 DENNIS CHOI MD PHD DIRECTOR (THRU 6/30/19) 1.0 49.0 X X 0 598078 54304 CARLOS DE LOS SANTOS DIRECTOR 1.0 49.0 X 0 113859 45769 MARGARET M MCGOVERN MD PHD CHAIRPERSON (THRU 5/1/2018) 0.0 50.0 X 0 876856 96933 PATRICK SIBONY MD DIRECTOR (THRU 3/28/2018) 0.0 50.0 X 0 444199 75353 0 14684856 1405871 0 true true false J BOISEN CONSULTING LLC 12223 HERSHEY BEACH GALVESTON TX 77554 CONSULTING SERVICES 370484 1 0 MANAGEMENT FEES 900099 247980927 247980927 RENTAL 531120 775971 775971 248756898 0 0 0 0 0 0 72958 4365 68593 68593 68593 0 248825491 248756898 68593 0 0 0 0 0 0 77746846 73859504 3887342 0 27756474 26368650 1387824 0 0 1141818 1141818 216375 216375 0 0 11695 11695 44210523 44210523 998454 998454 4318174 4318174 5438078 5438078 0 11735607 11735607 2033433 2033433 0 0 1276814 1276814 0 4699942 4699942 24792097 24792097 MEDICAL EXPENSES 14159411 14159411 CLINICAL PRACTICE RESEARCH 9254201 9254201 DUES AND LICENSE FEES 2057402 2057402 REPAIRS AND MAINTENANCE 2487710 2487710 234335054 229059888 5275166 0 7185157 15494262 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2346474 0 58081980 25715403 31916243 32366577 4349450 4488635 0 0 0 0 0 0 69823521 83471448 115620845 135820922 3917182 7347056 0 0 0 0 0 0 0 0 0 0 0 0 0 0 111703663 128473866 115620845 135820922 X 0 0 0 0 0 0 0 0 115620845 135820922 X 14490437 82287 -14572724 X false true X true X X 17 STONY BROOK ANAESTHESIOLOGY UFPC 112553515 10 false 0 0 STONY BROOK CHILDREN'S SERVICE UFPC 112571524 10 false 0 0 STONY BROOK DERMATOLOGY ASSOCIATES UFPC 113011790 10 false 0 0 STONY BROOK EMERGENCY PHYSICIANS UFPC 113066770 10 false 0 0 STONY BROOK FAMILY AND PREVENTIVE MEDICINE UFPC 112552321 10 false 0 0 STONY BROOK INTERNISTS UFPC 112558775 10 false 0 0 NEUROLOGY ASSOCIATES OF STONY BROOK UFPC 112587430 10 false 0 0 NEW YORK SPINE AND BRAIN SURGERY UFPC 112645930 10 false 0 0 UNIVERSITY ASSOCIATES IN OBST & GYNECOLOGY UFPC 112569522 10 false 0 0 STONY BROOK OPHTHALMOLOGY UFPC 112658697 10 false 0 0 STONY BROOK ORTHOPAEDIC ASSOCIATES UFPC 112593061 10 false 0 0 STONY BROOK PATHOLOGISTS UFPC 112647243 10 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 0 0.00000 false false false false true true 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. Part IV, Section A, lINE 5a: (i) the names and EIN numbers of the supported organizations added: CPMP added eighteen supported organizations during the year. Please see Schedule A Attachment 1 for their names and EINs. (ii) the reasons for each such action: In this amended return, CPMP chose to describe itself as a Section 509(a)(3) Type I supporting organization, instead of a Section 509(a)(2) organization. CPMP meets an organizational test, an operational test, and a relationship test and is classified as Type I supporting organization. - CPMP meets the organizational test, as all of its supported organizations, the UFPCs, are Section 509(a)(2) organizations, and CPMP names them by class or purpose in its Certificate of Incorporation. - CPMP meets the criteria of the operational test as CPMP engages solely in activities that support or benefit the UFPCs. CPMP is responsible for the accounting, administrative and billing for the UFPCs and is an integral part of the UFPC operations. - CPMP meets the relationship test by its supported organization(s) (the UFPCs) having the power to regularly appoint and elect the directors/trustees of the organization. The CPMP board of directors consists of individuals appointed by the UFPCs; each UFPC appoints one individual director. Therefore, the UFPCs collectively would be deemed to operate, supervise and control CPMP. As a Section 509(a)(3) Type I supporting organization, CPMP added eighteen supported organizations during the year. (iii) the authority under the organization's organization document authorizing such action: Per CPMP's 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." A type I supporting organization can add or substitute particular supported organizations within the class or classes designated in its articles. (iv)how the action was accomplished: CPMP's management agreed to describe CPMP as a Section 509(a)(3) Type I supporting organization and add eighteen supported organizations. 34934268 7809439 27124829 12133607 8939245 3194362 11014105 8966719 2047386 32366577 ADVANCES TO UFPCS 78537177 ADVANCES - HOSPITAL 434271 ADVANCES - NICOLLS INDEMNITY 4500000 83471448 0 CLINICAL PRACTICE RESERVE 109188983 CAPITAL LEASE 19284883 128473866 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 MARK TALAMINI MD CHAIRPERSON 0 955699 0 200000 0 2393 0 38500 0 15868 0 1212460 0 0 TONG J GAN VICE CHAIRPERSON 0 665917 0 134946 0 2393 0 37831 0 15005 0 856092 0 0 RAPHAEL DAVIS MD SECRETARY 0 1276640 0 182578 0 4383 0 68429 0 16080 0 1548110 0 0 EVAN JONES MD-MPH DIRECTOR 0 606532 0 614491 0 2393 0 56242 0 15909 0 1295567 0 0 MARK C HENRY MD DIRECTOR 0 540048 0 65883 0 2393 0 65273 0 18488 0 692085 0 0 IRIS A GRANEK MD DIRECTOR 0 318478 0 42500 0 2393 0 46023 0 15674 0 425068 0 0 VINCENT W YANG MD PHD DIRECTOR 0 623729 0 130000 0 2393 0 60159 0 15674 0 831955 0 0 PATRICIA COYLE MD DIRECTOR 0 329113 0 30094 0 2393 0 49667 0 17762 0 429029 0 0 TODD GRIFFIN MD DIRECTOR 0 548660 0 75000 0 2393 0 64048 0 15014 0 705115 0 0 ROBERT HONKANEN MD DIRECTOR 0 645804 0 39886 0 2393 0 46846 0 15014 0 749943 0 0 KENNETH R SHROYER MD PHD DIRECTOR 0 525992 0 152287 0 2393 0 76089 0 18399 0 775160 0 0 CAROLYN MILANA MD DIRECTOR 0 353563 0 33650 0 2535 0 47792 0 16235 0 453775 0 0 RAMIN V PARSEY MD PHD DIRECTOR 0 652125 0 192000 0 2393 0 43920 0 15181 0 905619 0 0 MARK E SCHWEITZER MD DIRECTOR 0 751520 0 150000 0 2393 0 37577 0 16137 0 957627 0 0 SAMUEL RYU DIRECTOR 0 673592 0 89761 0 2393 0 62667 0 14905 0 843318 0 0 WAYNE WALTZER MD DIRECTOR 0 733430 0 277526 0 2393 0 75018 0 16086 0 1104453 0 0 MARGARET M MCGOVERN MD PHD CHAIRPERSON (THRU 5/1/2018) 0 730489 0 143705 0 2662 0 76428 0 20505 0 973789 0 0 DENNIS CHOI MD PHD DIRECTOR (THRU 6/30/19) 0 520685 0 75000 0 2393 0 37202 0 17102 0 652382 0 0 PATRICK SIBONY MD DIRECTOR (THRU 3/28/2018) 0 441806 0 0 0 2393 0 59500 0 15853 0 519552 0 0 CARLOS DE LOS SANTOS DIRECTOR 0 113859 0 0 0 0 0 0 0 45769 0 159628 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 = $-14,483,804 DISPOSAL OF ASSETS = $- 88,920 LINE 9 TOTAL CHANGE IN NET ASSETS = $-14,572,724 AMENDED RETURN: (i) reasons to amend the return: In the original filed return, SB Clinical Practice Management Plan, Inc. ("CPMP") described itself as a Section 509(a)(2) organization and completed Schedule A, Part III. However, CPMP does not qualify as a publicly supported organization under Section 509(a)(2) for Fiscal year 2019 and Fiscal Year 2020. After the Management's discussion, CPMP qualifies as a Section 509(a)(3) type I supporting organization. Please see Schedule A, Part VI. (ii) items amended: In this amended return, CPMP checked Schedule A, Part I, Boxes 12 and 12a, completed Part I, line 12g and Part IV Section A and Section B, and listed the UFPCs as the supported organizations in Schedule A attachment 1. CPMP unchecked Schedule A, Part I, Boxes 10, and left Part III blank. FORM 990 PART IX LINE 11G DESCRIPTION:OTHER OPERATING TOTAL FEES:15824820 FORM 990 PART IX LINE 11G DESCRIPTION:SCHOOL OF MEDICINE CHARGE TOTAL FEES:28385703 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 7196714 37897728 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 339479 Stony Brook CPMP Realty Corporation M 68420