2016-01-29T14:38:13-06:00 2015-09-30 050353162 PICCERELLI GILSTEIN & CO LLP 144 WESTMINSTER STREET PROVIDENCE RI 029032282 990 2014-10-01 050389803 UNIVERSITY SURGICAL ASSOCIATES INC UNIV 4014446290 PO BOX 16149 RUMFORD RI 02916 WILLIAM CIOFFI MD PRESIDENT 4014446290 2016-01-20 1 SHARON KENNEDY P00218909 4018310200 2014 2016-04-25 22:37:26Z WILLIAM CIOFFI MD PO BOX 16149 RUMFORD RI 02916 56061599 0 X WWW.USASURG.ORG X 1980 RI UNIVERSITY SURGICAL ASSOCIATES, INC. IS A NONPROFIT CORPORATION FOUNDED TO PROVIDE DIAGNOSIS AND TREATMENT OF DISORDERS FOR PATIENTS OF RHODE ISLAND HOSPITAL AND OTHERS REQUIRING SURGERY; TO CONDUCT RESEARCH IN THE FIELD OF SURGERY AND TO TEACH PHYSICIANS, MEDICAL STUDENTS AND OTHER HEALTH CARE PERSONNEL IN THE FIELD OF SURGERY. 7 7 219 0 0 0 7890 970 35249908 36405084 2055460 2793538 45021 68264 37358279 39267856 198000 190500 0 0 29605131 31121832 0 0 142110 6346426 6303451 36149557 37615783 1208722 1652073 28992193 31512744 5014573 5883048 23977620 25629696 X UNIVERSITY SURGICAL ASSOCIATES, INC. IS A NONPROFIT CORPORATION FOUNDED TO PROVIDE DIAGNOSIS AND TREATMENT OF DISORDERS FOR PATIENTS OF RHODE ISLAND HOSPITAL AND OTHERS REQUIRING SURGERY; TO CONDUCT RESEARCH IN THE FIELD OF SURGERY AND TO TEACH PHYSICIANS, MEDICAL STUDENTS AND OTHER HEALTH CARE PERSONNEL IN THE FIELD OF SURGERY. 0 0 28465176 190500 36379149 PROVIDES DIAGNOSIS AND TREATMENT OF DISORDERS AND SURGERY FOR PATIENTS AS WELL AS RESEARCH IN SURGERY AND RELATED FIELDS AND PROVIDES INSTRUCTION IN SURGERY AND RELATED FIELDS. 28465176 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 51 0 1 219 1 1 1 0 0 0 0 0 0 0 X 7 7 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X HELEN REID 4014446290 75 NEWMAN AVENUE RUMFORD RI 02916 JEFFREY SLAIBY MD TRUSTEE 40.00 X 384227 0 66560 DAVID HARRINGTON MD TRUSTEE 40.00 X 396572 0 23159 G DEAN ROYE MD TRUSTEE 40.00 X 384640 0 57911 ARLET KURKCHUBASHCE MD TRUSTEE 40.00 X 399650 0 55638 WILLIAM CIOFFI MD PRESIDENT 40.00 X 459048 0 40691 EDWARD MARCACCIO MD VICE PRESIDENT 40.00 X 701026 0 66065 STEPHEN MIGLIORI MD TREASURER/SECRETARY 40.00 X 414859 0 48966 THOMAS F TRACY JR MD PHYSICIAN 40.00 X 506730 0 64505 THOMAS NG MD PHYSICIAN 40.00 X 468425 0 44782 CHARLES ADAMS PHYSICIAN 40.00 X 442157 0 61432 GUY NICASTRI MD PHYSICIAN 40.00 X 410015 0 64611 4967349 0 594320 11 1 1 0 NEW ENGLAND MEDICAL BILLING INC 75 NEWMAN AVE SUITE 100 RUMFORD RI 02916 BILLING SERVICES 908082 RHODE ISLAND HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 RESEARCH SALARY SUPPORT 476703 NEWPORT HOSPITALITY INC 221 3RD STREET NEWPORT RI 02840 CONFERENCE LOCATION 103383 3 970 970 PATIENT FEES 621110 18633134 18633134 CONTRACT REVENUE - RI HOSPITAL 621110 7416655 7416655 OTHER INCOME - SURGERY 621110 4554621 4554621 CONTRACTUAL REVENUE - MIRIAM HOSP 621110 3408460 3408460 OTHER CONTRACT REVENUE 621110 1143548 1143548 1248666 1248666 36405084 942061 942061 107120 38856 68264 68264 68264 18606364 16728952 25935 1877412 -25935 1851477 -25935 1877412 39267856 36379149 0 2887737 190500 190500 3587504 1614377 1937252 35875 21183008 16324564 4780405 78039 2489232 1915215 564807 9210 2598139 1999008 589518 9613 1263949 972482 286790 4677 45465 45465 51690 51690 97970 97970 1391883 1292786 99097 1854030 1530331 323699 32965 29668 3297 9304 9304 204321 198473 5848 1001045 801284 195065 4696 OUTSIDE SERVICES 751794 751794 SUPPORT SERVICES 620479 496383 124096 MISCELLANEOUS 137717 137717 DUES AND SUBSCRIPTIONS 73392 71924 1468 31396 31396 37615783 28465176 9008497 142110 1355350 1175375 999711 1220915 117515 131514 2398191 1639399 722264 758792 20412338 22046084 4844594 5618923 0 27524 540421 533617 28992193 31512744 35050 41280 134929 218513 4844594 5623255 5014573 5883048 X 3363897 3706011 20401744 21689938 211979 233747 23977620 25629696 28992193 31512744 X 1652073 3 X X 0 1 X 1 0 X X 1 RHODE ISLAND HOSPITAL 050258954 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 X 0 0 0 211979 211979 192112 22023 1918 238 211979 175293 249 18320 1750 192112 152515 17500 6679 1316 85 175293 155665 5180 5632 2698 152515 1.00000 0 0 12000 12000 374829 243149 131680 267769 183380 84389 1743593 1212870 530723 758792 INVESTMENTS - MUTUAL FUNDS 5618923 C 5618923 DEFERRED COMPENSATION 5618923 DUE TO OTHER FUNDS 3997 DUE TO UCSA 335 5623255 X 39293791 0 39293791 -25935 -25935 39267856 37641718 25935 25935 37615783 0 37615783 PART V, LINE 4: W.R. THOMPSON LECTURESHIP ENDOWMENT IS USED TO ACCOUNT FOR FUNDS SET ASIDE TO ESTABLISH THE WR THOMPSON LECTURESHIP IN ESOPHAGASTRIC SURGERY. THE INTEREST EARNED ON THE CORPUS MAY BE USED FOR AN ANNUAL LECTURESHIP. THE PRINCIPAL MAY NOT BE INVADED; AS A RESULT, THIS FUND IS CONSIDERED AN ENDOWMENT FUND. PART X, LINE 2: THE ORGANIZATION INTERNALLY MONITORS ITS TAX POSITIONS TO DETERMINE WHETHER ANY ARE UNCERTAIN. A TAX POSITION IS TAKEN IF IT IS DETERMINED THAT THE POSITION WILL "MORE-LIKELY-THAN-NOT" BE SUSTAINED UPON EXAMINATION BY A TAXING AUTHORITY. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2015, THERE WERE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE THE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE FINANCIAL STATEMENTS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2011. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSET -25,935. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSET 25,935. 1 HASBRO CHILDREN'S HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 581563444 501 (C) 3 5000 CHILDREN HOSPITALHOSPITAL GALA/ MEDICAL THE MIRIAM HOSPITAL 164 SUMMIT AVE PROVIDENCE RI 02906 050258905 501 (C) 3 6000 MEDICAL THE TOMORROW FUND 593 EDDY STREET PROVIDENCE RI 02903 050450569 501 (C) 3 0 CANCER RESEARCH NEWPORT HOSPITAL FOUNDATION 11 FRIENDSHIP STREET NEWPORT RI 02840 222535533 501 (C) 3 5000 MEDICAL RHODE ISLAND HOSPITAL FOUNDATION PO BOX H PROVIDENCE RI 02901 050258954 501 (C) 3 105000 MEDICAL BROWN UNIVERSITY BOX G-ADV PROVIDENCE RI 02912 050258809 501 (C) 3 50000 EDUCATION AMERICAN CANCER SOCIETY 931 JEFFERSON BLVD WARWICK RI 02886 131788491 501 (C) 3 5000 CANCER RESEARCH THE IZZY FOUNDATION PO BOX 2326 PROVIDENCE RI 02906 453459440 501 (C) 3 5000 SERVICE PROVIDER AND RESOURCE CENTER SCHEDULE I, PART I, LINE 2 OUR ORGANIZATION IS FREQUENTLY APPROACHED BY OTHER 501(C)3 ORGANIZATIONS FOR SUPPORT OF VARIOUS PROGRAMS WHICH ARE IN LINE WITH OUR MISSION. WE MAINTAIN A FILE OF SUCH SOLICITATIONS ALONG WITH THE ACKNOWLEDGEMENTS OF THEIR RECEIPT OF OUR CONTRIBUTIONS AS WELL AS THEIR CANCELLED CHECKS X X 0 0 0 0 0 0 0 0 0 JEFFREY SLAIBY MD TRUSTEE 384227 0 0 0 0 0 40500 0 26060 0 450787 0 0 0 DAVID HARRINGTON MD TRUSTEE 396572 0 0 0 0 0 0 0 23159 0 419731 0 0 0 G DEAN ROYE MD TRUSTEE 384640 0 0 0 0 0 35000 0 22911 0 442551 0 0 0 ARLET KURKCHUBASHCE MD TRUSTEE 399650 0 0 0 0 0 40500 0 15138 0 455288 0 0 0 WILLIAM CIOFFI MD PRESIDENT 459048 0 0 0 0 0 17500 0 23191 0 499739 0 0 0 EDWARD MARCACCIO MD VICE PRESIDENT 701026 0 0 0 0 0 40500 0 25565 0 767091 0 0 0 STEPHEN MIGLIORI MD TREASURER/SECRETARY 414859 0 0 0 0 0 40500 0 8466 0 463825 0 0 0 THOMAS F TRACY JR MD PHYSICIAN 506730 0 0 0 0 0 40500 0 24005 0 571235 0 0 0 THOMAS NG MD PHYSICIAN 468425 0 0 0 0 0 35000 0 9782 0 513207 0 0 0 CHARLES ADAMS PHYSICIAN 442157 0 0 0 0 0 35000 0 26432 0 503589 0 0 0 GUY NICASTRI MD PHYSICIAN 410015 0 0 0 0 0 40500 0 24111 0 474626 0 0 0 NEW ENGLAND MEDICAL BILLING (28C) 37.9% OWNED ENTITY 908082 BILLING FEES: THE FOUNDATION OWNS 37.97% OF NEW ENGLAND MEDICAL BILLING (NEMB), WHILE NEMB IS AN INDEPENDENT CONTRACTOR OF THE FOUNDATION. ADDITIONALLY, THE PRESIDENT OF THE FOUNDATION, WILLIAM CIOFFI, MD, SITS ON THE BOARD OF NEMB. 0 THERESA A GRAVES MD 28B EMPLOYEE IS MARRIED TO DR. WILLIAM CIOFFI, PRESIDENT 317098 WAGES: THERESA A GRAVES, MD IS EMPLOYED BY UNIVERSITY SURGICAL ASSOCIATES, INC. AND MARRIED TO DR. WILLIAM CIOFFI, PRESIDENT 0 FORM 990, PART VI, SECTION A, LINE 4 THE BY-LAWS WERE UPDATED ON SEPTEMBER 25, 2015 TO INCREASE THE MAXIMUM MEMBERSHIP OF THE BOARD OF TRUSTEES TO 11 MEMBERS. FORM 990, PART VI, SECTION A, LINE 6 PER THE ARTICLES OF INCORPORATION, THE CORPORATION SHALL BE A MEMBERSHIP CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A PER THE ARTICLES OF INCORPORATION, THE MEMBERSHIP SHALL CONSIST INITIALLY OF THE MEMBERS NAMED IN THE BY-LAWS TO BE ADOPTED BY THE INCORPORATORS AND OF SUCH ADDITIONAL MEMBERS AS MAY THEREAFTER BE ELECTED TO MEMBERSHIP FROM TIME TO TIME UPON SUCH TERMS AND CONDITIONS AS THE BY-LAWS SHALL SET FORTH. FORM 990, PART VI, SECTION A, LINE 7B PER THE ARTICLES OF INCORPORATION, THE AFFAIRS AND BUSINESS OF THE CORPORATION SHALL BE MANAGED BY A BOARD OF TRUSTEES. THE TRUSTEES AND OFFICERS OF THE CORPORATION, TERMS OF OFFICE, METHOD OF SELECTION, RESPECTIVE DUTIES, AND ALL THINGS PERTAINING THERETO, SHALL BE AS DEFINED AND ESTABLISHED BY THE BY-LAWS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE PRESIDENT OF THE BOARD AND PRESENTED TO THE TRUSTEES FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY AND DISCUSSED WITH THE PRESIDENT, MEMBERS OF THE BOARD OF TRUSTEES AND SENIOR MANAGEMENT. THE DOCUMENTATION INCLUDES A DETAILED EXPLANATION OF THE POLICY AND THE ACTIONS TO BE TAKEN IF A CONFLICT SHOULD ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION MAINTAINS SALARY RANGES FOR ALL EMPLOYEES WHICH IS UPDATED AND APPROVED BY THE BOARD OF TRUSTEES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND 990 OF THE ORGANIZATION ARE MADE AVAILABLE TO THE PUBLIC ON GUIDESTAR.ORG. THE CONFLICT OF INTEREST POLICY WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: ROUNDING 3. FORM 990, PART XII, LINE 1: THE ORGANIZATION MAINTAINS ITS BOOKS ON THE MODIFIED CASH METHOD OF ACCOUNTING. FORM 990, PART XII, LINE 2C: COMMITTEE'S OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. USA PAWTUCKET PROPERTIES LLC (DISREGARDED ENTITY) 15 HAZEL STREET PAWTUCKET RI 02860 261855890 RENTAL PROPERTY RI -65821 484894