2020-11-09T11:10:27-06:00 2019-12-31 161468002 CHIAMPOU TRAVIS BESAW & KERSHNER LLP 45 BRYANT WOODS NORTH AMHERST NY 14228 990 2019-01-01 161485974 UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC UNIV 7168818050 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 SARAH BERGA MD PRESIDENT 7168818050 2020-10-22 1 CHRISTINA HEIM P01360063 7166302400 2020-10-22 72.45.217.66 2020-10-22 08:33:19 ED P 812E703A05D2EECE1009E379DA4D9F674AC58BAB 8DEC77A2E6F9B96EEFED664B5C8CEC873DB43804 2019 2021-01-29 14:40:06Z SARAH BERGA MD 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 4815076 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 1 0 0 6209 0 4943802 4586525 3059 6894 185658 221657 5138728 4815076 0 0 0 0 3448163 3377637 0 0 0 1758098 1358496 5206261 4736133 -67533 78943 1777223 1637586 997333 760666 779890 876920 TO PROVIDE THE HIGHEST QUALITY CARE TO WOMEN OF WESTERN NEW YORK IN THE SPECIALTY AREAS OF GENERAL AND HIGH RISK OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY. 0 0 3851263 4808182 THE CORPORATION PROVIDED VARIOUS MEDICAL SERVICES TO THE FEMALE 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. 3851263 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 VANESSA BARNABEI MD PHD PRESIDENT 40.00 X X 147041 289111 49994 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 40.00 X X 188687 54701 10413 TOVA ABLOVE MD TREASURER/SECRETARY 40.00 X X 195392 56817 21921 LISA JANE JACOBSON MD DIRECTOR 40.00 X 108540 85517 1170 PAUL OGBURN MD DIRECTOR 40.00 X 550000 106849 2800 JOHN GARBAY CFO & COO 40.00 X 132250 0 1319 JOSEPH DENAGY DO PHYSICIAN 40.00 X 180015 50258 11316 MANDEEP BRAR MD PHYSICIAN 40.00 X 381213 72063 26209 SHAVETA MALIK MD FORMER SECRETARY (TERM 7/31/19) 40.00 X 142905 30150 1743 2026043 745466 126885 9 1 1 0 0 CONTRACT REVENUE 624100 2421181 2421181 GRADUATE MEDICAL EDUCA 624100 1190737 1190737 FEES FOR SERVICES 624100 953396 953396 HITECH INCENTIVE FUNDS 624100 17000 17000 MEDICAID SUPPLEMENT 624100 4211 4211 4586525 6894 6894 MISCELLANEOUS INCOME 900099 221657 221657 221657 4815076 4808182 0 6894 1464815 1129922 334893 1570343 1380451 189892 25365 20799 4566 137388 94776 42612 179726 145956 33770 35443 35443 56568 56568 12347 12347 19365 19365 151724 109241 42483 184949 105421 79528 22098 22098 15628 8752 6876 38160 21370 16790 36758 16174 20584 MALPRACTICE INSURANCE 332257 332257 CAO'S FUND 121955 121955 CLINICAL SUPPLIES AND F 119879 119879 RESIDENTS EXPENSE 98877 98877 112488 103970 8518 4736133 3851263 884870 0 299014 203100 31427 31662 717845 668270 82549 96439 731771 431800 328821 299971 96680 117257 220887 220887 1777223 1637586 308529 175692 8791 0 680013 584974 997333 760666 X 0 0 0 0 779890 876920 779890 876920 1777223 1637586 78943 18087 0 X X 0 1 X 1 0 X 81328 6209 0 87537 4837669 5316382 5343642 4943802 4586525 25028020 4837669 5316382 5424970 4950011 4586525 25115557 0 25105 37452 162584 136798 110003 471942 25105 37452 162584 136798 110003 471942 24643615 10785 8055 2405 3059 6894 31198 10785 8055 2405 3059 6894 31198 293580 285419 330005 185658 221657 1316319 5142034 5609856 5757380 5138728 4815076 26463074 0.93120 0.94080 0.00120 0.00130 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. 313449 29263 284186 418322 402537 15785 299971 OTHER INVESTMENTS - M&T 117257 F 117257 MALPRACTICE CAPITAL CONTRIBUTIONS 220887 220887 NOTE PAYABLE UB ASSOCIATES, INC. 348549 MALPRACTICE INSURANCE ASSESSMENT 168928 CHIEF ADMINISTRATIVE OFFICER'S FUND PAYABLE 67497 584974 4833163 18087 18087 4815076 0 4815076 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 VANESSA BARNABEI MD PHD PRESIDENT 147041 272311 0 0 0 16800 1625 24960 0 23409 148666 337480 0 0 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 188687 54701 0 0 0 0 2132 0 0 8281 190819 62982 0 0 TOVA ABLOVE MD TREASURER/SECRETARY 195392 54039 0 0 0 2778 2126 0 0 19795 197518 76612 0 0 LISA JANE JACOBSON MD DIRECTOR 108540 81669 0 0 0 3848 1170 0 0 0 109710 85517 0 0 PAUL OGBURN MD DIRECTOR 550000 106849 0 0 0 0 2800 0 0 0 552800 106849 0 0 JOSEPH DENAGY DO PHYSICIAN 180015 48447 0 0 0 1811 2007 0 0 9309 182022 59567 0 0 MANDEEP BRAR MD PHYSICIAN 381213 47063 0 0 0 25000 2800 0 0 23409 384013 95472 0 0 SHAVETA MALIK MD FORMER SECRETARY (TERM 7/31/19) 142905 30150 0 0 0 0 1743 0 0 0 144648 30150 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 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 121955 MARKET VALUE STATE OF NEW YORK E 67497 MARKET VALUE