2019-11-14T09:04:51-06:00 2018-12-31 161468002 CHIAMPOU TRAVIS BESAW & KERSHNER LLP 45 BRYANT WOODS NORTH AMHERST NY 14228 990 2018-01-01 161485974 UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC UNIV 7168818050 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 VANESSA BARNABEI MD PHD CHAIRMAN 7168818050 2019-11-12 1 CHRISTINA HEIM P01360063 7166302400 2019-11-12 72.45.217.66 2019-11-12 16:07:56 ES P 9EF7FE056D34465340A7603B3F96AF2A54496CDE 3CAB4B20C9077208CE704FCC9099C88110051BC5 2018 2020-03-31 21:24:44Z VANESSA BARNABEI MD PHD 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 5138728 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. 6 0 36 0 0 0 81328 6209 5343642 4943802 2664 3059 330005 185658 5757639 5138728 0 0 0 0 3855614 3448163 0 0 0 1541684 1758098 5397298 5206261 360341 -67533 1694033 1777223 841840 997333 852193 779890 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 4269167 5129460 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. 4269167 1 1 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 1 0 0 0 0 0 0 1 0 0 0 1 8 0 1 36 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 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 171519 305696 49548 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 40.00 X X 193033 55135 10402 TOVA ABLOVE MD TREASURER 40.00 X X 179858 52787 21479 SHAVETA MALIK MD SECRETARY 40.00 X X 236320 45493 25529 LISA JANE JACOBSON MD DIRECTOR 40.00 X 106555 86137 1073 PAUL OGBURN MD DIRECTOR 40.00 X 550000 104854 2750 JOHN GARBAY CFO & COO 40.00 X 125339 0 16241 JOSEPH DENAGY DO PHYSICIAN 40.00 X 187279 49299 11134 MANDEEP BRAR MD PHYSICIAN 40.00 X 315791 68715 26071 MOOEN ABU-SITTA MD PHYSICIAN 40.00 X 146930 53930 24932 ANGELLE BREBNOR MD PHYSICIAN 40.00 X 121521 0 1342 TAECHIN YU MD PHYSICIAN 40.00 X 191879 0 1919 2526024 822046 192420 12 1 1 0 0 6209 6209 CONTRACT REVENUE 624100 1900259 1900259 GRADUATE MEDICAL EDUCA 624100 1837870 1837870 FEES FOR SERVICES 624100 1205673 1205673 4943802 3059 3059 MISCELLANEOUS INCOME 900099 185658 185658 185658 5138728 5129460 0 3059 1562624 1333162 229462 1554441 1222735 331706 27279 22369 4910 123729 81661 42068 180090 145012 35078 46066 46066 53091 53091 15035 15035 19219 19219 163687 117855 45832 190048 108327 81721 21539 21539 19888 11137 8751 35770 20031 15739 34009 14964 19045 MALPRACTICE INSURANCE 650584 650584 CAO'S FUND 133140 133140 RESIDENTS EXPENSE 131861 131861 CLINICAL SUPPLIES AND F 128584 128584 115577 106987 8590 5206261 4269167 937094 0 312339 299014 31354 31427 496648 717845 175222 82549 722461 393640 358382 328821 99201 96680 220887 220887 1694033 1777223 360416 328553 0 8791 481424 659989 841840 997333 X 0 0 0 0 852193 779890 852193 779890 1694033 1777223 -67533 -4770 0 X X 0 1 X 1 0 X 81328 6209 87537 5190147 4837669 5316382 5343642 4943802 25631642 5190147 4837669 5316382 5424970 4950011 25719179 0 42196 25105 37452 162584 136798 404135 42196 25105 37452 162584 136798 404135 25315044 10514 10785 8055 2405 3059 34818 10514 10785 8055 2405 3059 34818 60125 293580 285419 330005 185658 1154787 5260786 5142034 5609856 5757380 5138728 26908784 0.94080 0.94540 0.00130 0.00160 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 313449 12184 301265 409012 381456 27556 328821 OTHER INVESTMENTS - M&T 96680 F 96680 MALPRACTICE CAPITAL CONTRIBUTIONS 220887 220887 NOTE PAYABLE UB ASSOCIATES, INC. 413750 MALPRACTICE INSURANCE ASSESSMENT 246239 659989 5133958 -4770 -4770 5138728 0 5138728 5206261 0 5206261 0 5206261 X 0 0 0 0 0 0 0 0 0 VANESSA BARNABEI MD PHD PRESIDENT 171519 264696 0 0 0 41000 1727 24500 0 23321 173246 353517 0 0 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 193033 53440 0 0 0 1695 1854 0 0 8548 194887 63683 0 0 TOVA ABLOVE MD TREASURER 179858 50074 0 0 0 2713 1787 0 0 19692 181645 72479 0 0 SHAVETA MALIK MD SECRETARY 236320 43697 0 0 0 1796 2208 0 0 23321 238528 68814 0 0 LISA JANE JACOBSON MD DIRECTOR 106555 82261 0 0 0 3876 1073 0 0 0 107628 86137 0 0 PAUL OGBURN MD DIRECTOR 550000 104854 0 0 0 0 2750 0 0 0 552750 104854 0 0 JOSEPH DENAGY DO PHYSICIAN 187279 47521 0 0 0 1778 1819 0 0 9315 189098 58614 0 0 MANDEEP BRAR MD PHYSICIAN 315791 44215 0 0 0 24500 2750 0 0 23321 318541 92036 0 0 MOOEN ABU-SITTA MD PHYSICIAN 146930 53930 0 0 0 0 1611 0 0 23321 148541 77251 0 0 ANGELLE BREBNOR MD PHYSICIAN 121521 0 0 0 0 0 1342 0 0 0 122863 0 0 0 TAECHIN YU MD PHYSICIAN 191879 0 0 0 0 0 1919 0 0 0 193798 0 0 0 MARY ABU-SITTA SPOUSE OF MOEEN ABU-SITTA, MD (FORMER BOARD MEMBER) 32810 OFFICE RENT (755 WEHRLE DRIVE) 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 133140 MARKET VALUE STATE OF NEW YORK E 20024 MARKET VALUE