2016-11-11T15:39:34-06:00 2015-12-31 161468002 CHIAMPOU TRAVIS BESAW & KERSHNER LLP 45 BRYANT WOODS NORTH AMHERST NY 14228 990 2015-01-01 161485974 UNIVERSITY GYNECOLOGISTS & OBSTETRICIANS INC UNIV 7168818050 219 BRYANT STREET BUFFALO NY 14222 VANESSA BARNABEI CHAIRMAN 7168818050 2016-11-10 1 DAVID A URBAN P00630018 7166302400 2015 2017-02-10 21:41:12Z VANESSA BARNABEI 239 BRYANT STREET BUFFALO NY 14222 5142034 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 34 0 0 0 0 0 5190147 4837669 10514 10785 60125 293580 5260786 5142034 0 0 0 0 3717981 3796807 0 0 0 1645662 1626960 5363643 5423767 -102857 -281733 2024510 1699750 820699 783880 1203811 915870 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 4544821 5131249 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. 4544821 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 34 1 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 7168593478 WCHOB 219 BRYANT ST BUFFALO NY 14222 VANESSA BARNABEI MD PHD PRESIDENT 40.00 X X 217960 287919 57358 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 40.00 X X 164855 49575 25113 TOVA ABLOVE MD TREASURER 40.00 X X 222948 45567 39024 ANGELLE BREBNOR SECRETARY 40.00 X X 178997 46035 25794 TAECHIN YU MD DIRECTOR 40.00 X 252993 50828 43501 CHRISTIAN DOLENSEK DO DIRECTOR 40.00 X 187310 41615 33706 JOHN GARBAY CFO & COO 40.00 X 121991 0 9759 JEFFREY JOHNSON MD PHYSICIAN 40.00 X 407500 53965 56010 MANDEEP BRAR MD PHYSICIAN 40.00 X 211240 63781 44834 SHAVETA MALIK PHYSICIAN 40.00 X 178997 36716 36822 PAI-JONG TSAI PHYSICIAN 40.00 X 126282 0 10103 2271073 676001 382024 11 0 1 0 0 GRADUATE MEDICAL EDUCA 624100 1931669 1931669 CONTRACT REVENUE 624100 1557767 1557767 FEES FOR SERVICES 624100 1078265 1078265 SALARY SUPPORT 624100 217951 217951 HITECH INCENTIVE FUNDS 624100 51415 51415 602 602 4837669 10785 10785 OTHER INCOME 900099 200000 200000 MISCELLANEOUS INCOME 900099 93580 93580 293580 5142034 5131249 0 10785 1347054 1212349 134705 1889425 1599399 290026 257956 203785 54171 237621 187721 49900 64751 51153 13598 4150 4150 48282 48282 18213 6639 11574 37460 37460 150810 126139 24671 27779 27779 8341 2836 5505 139559 133977 5582 34527 34527 MALPRACTICE INSURANCE 369901 369901 OFFICE AND BILLING 242435 181826 60609 CAO'S FUND 117480 117480 CONTRACTUAL SERVICES 112922 112922 315101 290935 24166 5423767 4544821 878946 0 331124 154158 32380 32125 225411 338207 126485 133332 691708 516804 324052 174904 487138 491458 497920 375566 2024510 1699750 266554 300906 299321 333704 254824 149270 820699 783880 X 0 0 0 0 1203811 915870 1203811 915870 2024510 1699750 -281733 -6208 0 X X 0 1 X 1 0 X 3144709 4016219 4437466 5190147 4837669 21626210 3144709 4016219 4437466 5190147 4837669 21626210 0 68502 67374 42196 25105 203177 68502 67374 42196 25105 203177 21423033 21741 14731 9745 10514 10785 67516 21741 14731 9745 10514 10785 67516 9767 8727 90567 60125 293580 462766 3176217 4039677 4537778 5260786 5142034 22156492 0.96690 0.98070 0.00300 0.00400 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. 185498 121784 63714 504260 393769 110491 1950 1251 699 174904 OTHER INVESTMENTS - M&T 491458 F 491458 MALPRACTICE CAPITAL CONTRIBUTIONS 220887 SECURITY DEPOSIT 5145 ELECTRONIC HEALTHCARE SYSTEM ACCESS 149534 375566 DUE TO UB ASSOCIATES, INC. 149270 149270 5135826 -6208 -6208 5142034 0 5142034 5423767 0 5423767 0 5423767 X 0 0 0 0 0 0 0 0 0 VANESSA BARNABEI MD PHD PRESIDENT 217960 254019 0 0 0 33900 17437 21200 0 18721 235397 327840 0 0 FAYE JUSTICIA-LINDE MD VICE PRESIDENT 164855 48050 0 0 0 1525 13188 4067 0 7858 178043 61500 0 0 TOVA ABLOVE MD TREASURER 222948 43822 0 0 0 1745 17836 3988 0 17200 240784 66755 0 0 ANGELLE BREBNOR SECRETARY 178997 44381 0 0 0 1654 14320 3781 0 7693 193317 57509 0 0 TAECHIN YU MD DIRECTOR 252993 50828 0 0 0 0 20239 6062 0 17200 273232 74090 0 0 CHRISTIAN DOLENSEK DO DIRECTOR 187310 39996 0 0 0 1619 14985 0 0 18721 202295 60336 0 0 JEFFREY JOHNSON MD PHYSICIAN 407500 51913 0 0 0 2052 32600 4689 0 18721 440100 77375 0 0 MANDEEP BRAR MD PHYSICIAN 211240 39781 0 0 0 24000 16899 9214 0 18721 228139 91716 0 0 SHAVETA MALIK PHYSICIAN 178997 35062 0 0 0 1654 14320 3781 0 18721 193317 59218 0 0 MILAN YIM-YU SPOUSE OF TAECHIN YU, MD 45385 OFFICE RENT (6161 TRANSIT ROAD) 0 MARY ABU-SITTA SPOUSE OF MOEEN ABU-SITTA, MD 10441 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 11 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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