2017-11-14T14:23:10-06:00 2016-12-31 161468002 CHIAMPOU TRAVIS BESAW & KERSHNER LLP 45 BRYANT WOODS NORTH AMHERST NY 14228 990 2016-01-01 161485974 UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC UNIV 7168818050 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 VANESSA BARNABEI CHAIRMAN 7168818050 2017-11-01 1 CHRISTINA BARONE P01360063 7166302400 2017-11-01 72.45.217.66 2017-11-01 17:01:08 ED P 4576ECEAE366F3AE1AE44E5EBE13BE5F39CFA2D3 BB6FE852E5E4C0BF12F7E927ACED4A9D467AE7D0 2016 2017-02-10 21:41:12Z X VANESSA BARNABEI 1001 MAIN ST FL 5 CONVENTUS BUFFALO NY 142031009 5609856 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. 16 0 35 0 0 0 0 0 4837669 5316382 10785 8055 293580 285419 5142034 5609856 0 0 0 0 3796807 4279217 0 0 0 1626960 1786926 5423767 6066143 -281733 -456287 1699750 1440503 783880 960034 915870 480469 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 5080116 5601801 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. 5080116 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 1 1 0 0 0 0 0 0 1 0 0 0 1 9 0 1 35 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 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 77 GOODELL ST BUFFALO NY 14203 VANESSA BARNABEI MD PHD PRESIDENT 40.00 X X 217960 296585 58778 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 40.00 X X 157899 52478 24113 TOVA ABLOVE MD TREASURER 40.00 X X 73571 52642 28554 ANGELLE BREBNOR MD SECRETARY 40.00 X X 178997 47203 26346 TAECHIN YU MD DIRECTOR 40.00 X 366233 53500 47454 MOOEN ABU-SITTA MD DIRECTOR (START 7/1/16) 40.00 X 193687 51247 43581 JOHN GARBAY CFO & COO 40.00 X 128677 0 23738 JEFFREY JOHNSON MD PHYSICIAN 40.00 X 228651 0 19324 MANDEEP BRAR MD PHYSICIAN 40.00 X 221695 66800 48023 SHAVETA MALIK MD PHYSICIAN 40.00 X 178997 38082 38261 PAI-JONG TSAI MD PHYSICIAN 40.00 X 226152 42975 21589 PAUL OGBURN MD PHYSICIAN 40.00 X 300616 45644 18333 CHRISTIAN DOLENSEK DO DIRECTOR (TERMED 7/1/16) 40.00 X 93393 0 8548 2566528 747156 406642 12 1 1 0 0 CONTRACT REVENUE 624100 2059816 2059816 GRADUATE MEDICAL EDUCA 624100 1861404 1861404 FEES FOR SERVICES 624100 1381194 1381194 HITECH INCENTIVE FUNDS 624100 7840 7840 MEDICAID SUPPLEMENT 624100 6128 6128 5316382 8055 8055 MISCELLANEOUS INCOME 900099 140837 140837 OTHER INCOME 900099 100000 100000 EMR REFUND 900099 44582 44582 285419 5609856 5601801 0 8055 1410417 1269375 141042 2250549 1910990 339559 276490 218427 58063 270007 213305 56702 71754 56686 15068 580 580 37493 37493 19338 8967 10371 36469 36469 224420 199749 24671 29632 29632 7981 2714 5267 118736 113987 4749 45748 45748 MALPRACTICE INSURANCE 383503 383503 OFFICE AND BILLING 267064 200298 66766 CAO'S FUND 149595 149595 CONTRACTUAL SERVICES 126902 126902 339465 309112 30353 6066143 5080116 986027 0 154158 66639 32125 31778 338207 269879 133332 92303 1063706 599395 174904 464311 491458 245581 375566 270012 1699750 1440503 300906 498129 333704 52941 149270 408964 783880 960034 X 0 0 0 0 915870 480469 915870 480469 1699750 1440503 -456287 20886 0 X X 0 1 X 1 0 X 4016219 4437466 5190147 4837669 5316382 23797883 4016219 4437466 5190147 4837669 5316382 23797883 0 68502 67374 42196 25105 37452 240629 68502 67374 42196 25105 37452 240629 23557254 14731 9745 10514 10785 8055 53830 14731 9745 10514 10785 8055 53830 8727 90567 60125 293580 285419 738418 4039677 4537778 5260786 5142034 5609856 24590131 0.95800 0.96690 0.00220 0.00300 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. 593641 154398 439243 468115 443356 24759 1950 1641 309 464311 OTHER INVESTMENTS - M&T 245581 F 245581 MALPRACTICE CAPITAL CONTRIBUTIONS 220887 SECURITY DEPOSIT 5145 ELECTRONIC HEALTHCARE SYSTEM ACCESS 43980 270012 DUE TO UB ASSOCIATES, INC. 43716 NOTE PAYABLE UB ASSOCIATES, INC. 365248 408964 5630742 20886 20886 5609856 0 5609856 6066143 0 6066143 0 6066143 X 0 0 0 0 0 0 0 0 0 VANESSA BARNABEI MD PHD PRESIDENT 217960 256689 0 0 0 39896 17437 21200 0 20141 235397 337926 0 0 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 157899 50868 0 0 0 1610 12448 4293 0 7372 170347 64143 0 0 TOVA ABLOVE MD TREASURER 73571 50640 0 0 0 2002 5631 4577 0 18346 79202 75565 0 0 ANGELLE BREBNOR MD SECRETARY 178997 45505 0 0 0 1698 14320 3880 0 8146 193317 59229 0 0 TAECHIN YU MD DIRECTOR 366233 53500 0 0 0 0 22721 6387 0 18346 388954 78233 0 0 MOOEN ABU-SITTA MD DIRECTOR (START 7/1/16) 193687 51247 0 0 0 0 15495 7945 0 20141 209182 79333 0 0 JOHN GARBAY CFO & COO 128677 0 0 0 0 0 10284 0 13454 0 152415 0 0 0 JEFFREY JOHNSON MD PHYSICIAN 228651 0 0 0 0 0 19324 0 0 0 247975 0 0 0 MANDEEP BRAR MD PHYSICIAN 221695 42800 0 0 0 24000 18350 9532 0 20141 240045 96473 0 0 SHAVETA MALIK MD PHYSICIAN 178997 36419 0 0 0 1663 14320 3800 0 20141 193317 62023 0 0 PAI-JONG TSAI MD PHYSICIAN 226152 41471 0 0 0 1504 18151 3438 0 0 244303 46413 0 0 PAUL OGBURN MD PHYSICIAN 300616 45644 0 0 0 0 18333 0 0 0 318949 45644 0 0 CHRISTIAN DOLENSEK DO DIRECTOR (TERMED 7/1/16) 93393 0 0 0 0 0 8548 0 0 0 101941 0 0 0 MILAN YIM-YU SPOUSE OF TAECHIN YU, MD 45129 OFFICE RENT (6161 TRANSIT ROAD) 0 MARY ABU-SITTA SPOUSE OF MOEEN ABU-SITTA, MD 29954 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: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. 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