2015-11-16T12:19:47-06:00 2014-12-31 161468002 CHIAMPOU TRAVIS BESAW & KERSHNER LLP 45 BRYANT WOODS NORTH AMHERST NY 14228 990 2014-01-01 800033443 UNIVERSITY AT BUFFALO SURGEONS INC UNIV 7168292859 462 GRIDER STREET BUFFALO NY 14215 WILLIAM FLYNN JR MD PRESIDENT 7168292859 2015-11-10 1 DAVID A URBAN P00630018 7166302400 2014 2016-04-25 22:37:26Z WILLIAM FLYNN JR MD 462 GRIDER STREET BUFFALO NY 14215 13270486 0 X WWW.UBMD.COM X 1988 NY UNIVERSITY AT BUFFALO SURGEONS, INC., IS A LARGE TEAM OF SURGEONS DEDICATED TO THE IMPROVEMENT OF THE HEALTH OF OUR PATIENTS, CUTTING EDGE RESEARCH, AND THE PROFESSIONAL DEVELOPMENT OF OUR STUDENTS AND RESIDENTS. WE ARE COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE TO OUR PATIENTS REQUIRING A SPECIALIST IN GENERAL, VASCULAR AND ENDOVASCULAR, COLORECTAL, MULTI-ORGAN TRANSPLANT, ADVANCED LAPAROSCOPIC, BARIATRIC AND PEDIATRIC SURGERY, AS WELL AS CRITICAL CARE AND BURN MANAGEMENT. 4 0 92 0 0 0 0 0 14824556 13205646 13940 15563 92170 49277 14930666 13270486 0 0 0 0 10951625 10301344 0 0 0 2686692 2530243 13638317 12831587 1292349 438899 7908029 8762565 1942308 2333501 5965721 6429064 X UNIVERSITY AT BUFFALO SURGEONS, INC., IS A LARGE TEAM OF SURGEONS DEDICATED TO THE IMPROVEMENT OF THE HEALTH OF OUR PATIENTS, CUTTING EDGE RESEARCH, AND THE PROFESSIONAL DEVELOPMENT OF OUR STUDENTS AND RESIDENTS. WE ARE COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE TO OUR PATIENTS REQUIRING A SPECIALIST IN GENERAL, VASCULAR AND ENDOVASCULAR, COLORECTAL, MULTI-ORGAN TRANSPLANT, ADVANCED LAPAROSCOPIC, BARIATRIC AND PEDIATRIC SURGERY, AS WELL AS CRITICAL CARE AND BURN MANAGEMENT. 0 0 11141760 13254923 THE CORPORATION PROVIDED MANY VARIED MEDICAL SERVICES TO THE POPULATION OF WESTERN NEW YORK SEEKING MEDICAL ATTENTION FROM SURGEONS. 11141760 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 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 13 0 92 1 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 0 1 1 0 NY X X JAMES MILLS 7168983875 462 GRIDER STREET BUFFALO NY 14215 JEFFREY BREWER MD DIRECTOR 40.00 X 469905 36828 21669 RAPHAEL BLOCHLE MD COMPLIANCE OFFICER 40.00 X X 441716 41228 73669 WILLIAM FLYNN MD INTERIM PRESIDENT/DIRECTOR 40.00 X 354589 101675 85475 MACIEJ DRYJSKI MD DIRECTOR 40.00 X 342741 62018 78681 LINDA HARRIS MD TEMPORARY DIRECTOR/SECRETARY 40.00 X X 267068 54108 78374 CHARLES WILES MD VICE PRESIDENT 40.00 X 238290 65035 23574 WEIDUN ALAN GUO MD TREASURER 40.00 X 326009 45892 75099 JAMES MILLS CHIEF FINANCIAL OFFICER 40.00 X 147909 0 0 JAMES LUKAN MD SURGEON 40.00 X 641082 45488 73416 MARK LAFTAVI MD SURGEON 40.00 X 324918 50851 77230 ALAN POSNER MD SURGEON 40.00 X 303827 132885 88290 SUNIL PATEL MD SURGEON 40.00 X 299913 47157 11285 GREGORY CHERR MD SURGEON 40.00 X 278333 81939 44009 PHILIP GLICK MD FORMER OFFICER 40.00 X 36698 146975 36501 4472998 912079 767272 19 1 1 0 0 FEES FROM SERVICE 624100 6833705 6833705 CONTRACT REVENUE 624100 3656095 3656095 GRADUATE MEDICAL EDUCATION REVENU 624100 2221690 2221690 SALARY SUPPORT 624100 381802 381802 MEDICAID SUPPLEMENT 624100 65314 65314 47040 47040 13205646 15563 15563 MISCELLANEOUS REVENUE 624100 49277 49277 49277 13270486 13254923 0 15563 2624925 2114731 510194 5825408 5241019 584389 977386 781909 195477 417180 323273 93907 456445 375627 80818 29107 29107 480 384 96 32906 26325 6581 137121 109697 27424 5160 4128 1032 414404 331523 82881 477784 430006 47778 118484 118484 10 10 58903 53013 5890 70585 56468 14117 MALPRACTICE INSURANCE 398592 398592 CAO'S FUND 378509 378509 CONTRACTUAL SERVICES 178002 169102 8900 BOOKS, DUES AND SUBSCRI 98018 98018 132178 130942 1236 12831587 11141760 1689827 0 4980868 5756362 841349 771844 863666 1081311 74037 150627 1054840 923798 163933 131042 298560 329847 685616 541532 7908029 8762565 1446334 1985297 495974 348204 1942308 2333501 X 0 0 0 0 5965721 6429064 5965721 6429064 7908029 8762565 438899 24444 0 X 0 1 X 0 0 X 15428378 14082377 13506397 14824556 13205646 71047354 15428378 14082377 13506397 14824556 13205646 71047354 0 1791287 1836681 1809452 2616130 1346746 9400296 1791287 1836681 1809452 2616130 1346746 9400296 61647058 25604 20300 14647 13940 15563 90054 25604 20300 14647 13940 15563 90054 116033 2246990 2453708 92170 49277 4958178 15570015 16349667 15974752 14930666 13270486 76095586 0.81010 0.83050 0.00120 0.00140 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS 1054840 923798 131042 131042 MALPRACTICE CAPITAL CONTRIBUTIONS 185827 INVESTMENT IN PARTNERSHIP 3801 DEPOSITS 3700 ELECTRONIC HEALTHCARE SYSTEM ACCESS 348204 541532 13294930 24444 24444 13270486 0 13270486 12831587 0 12831587 0 12831587 X 0 0 0 1 0 1 0 0 0 JEFFREY BREWER MD DIRECTOR 469905 35442 0 0 0 1386 0 3695 0 17974 469905 58497 0 0 RAPHAEL BLOCHLE MD COMPLIANCE OFFICER 441716 22342 0 0 0 18886 52000 3695 0 17974 493716 62897 0 0 WILLIAM FLYNN MD INTERIM PRESIDENT/DIRECTOR 354589 101675 0 0 0 0 52000 15501 0 17974 406589 135150 0 0 MACIEJ DRYJSKI MD DIRECTOR 342741 44518 0 0 0 17500 52000 8707 0 17974 394741 88699 0 0 LINDA HARRIS MD TEMPORARY DIRECTOR/SECRETARY 267068 54108 0 0 0 0 52000 8069 0 18305 319068 80482 0 0 CHARLES WILES MD VICE PRESIDENT 238290 62935 0 0 0 2100 0 5600 0 17974 238290 88609 0 0 WEIDUN ALAN GUO MD TREASURER 326009 15843 0 0 0 30049 52000 5125 0 17974 378009 68991 0 0 JAMES LUKAN MD SURGEON 641082 44677 0 0 0 811 52000 3111 0 18305 693082 66904 0 0 MARK LAFTAVI MD SURGEON 324918 33351 0 0 0 17500 52000 7256 0 17974 376918 76081 0 0 ALAN POSNER MD SURGEON 303827 132885 0 0 0 0 52000 17985 0 18305 355827 169175 0 0 SUNIL PATEL MD SURGEON 299913 28201 0 0 0 18956 0 3884 0 7401 299913 58442 0 0 GREGORY CHERR MD SURGEON 278333 81939 0 0 0 0 14342 11362 0 18305 292675 111606 0 0 PHILIP GLICK MD FORMER OFFICER 36698 100975 0 0 0 46000 7340 21760 0 7401 44038 176136 0 0 PART I, LINE 5 SOME OFFICERS, DIRECTORS, KEY EMPLOYEES, OR FIVE HIGHEST PAID EMPLOYEES ARE PHYSICIANS WHOSE INCOME IS PARTIALLY DEPENDENT UPON SERVICES PROVIDED AND THEREFORE DEPENDENT ON THE REVENUE THAT IS DERIVED BY THE ORGANIZATION FROM THESE SERVICES. PART I, LINE 6 SOME OFFICERS, DIRECTORS, KEY EMPLOYEES, OR FIVE HIGHEST PAID EMPLOYEES ARE PHYSICIANS WHOSE INCOME IS PARTIALLY DEPENDENT UPON SERVICES PROVIDED AND THEREFORE DEPENDENT ON THE REVENUE THAT IS DERIVED BY THE ORGANIZATION FROM THESE SERVICES. 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 B, LINE 11 A COPY OF THE FORM 990 WAS GIVEN TO EACH BOARD MEMBER FOR REVIEW BEFORE THE 990 WAS FILED. THE WAS DONE VIA BOARD MEETING AND EMAIL. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO SIGN AN FPMP EMPLOYMENT AGREEMENT THAT PROHIBITS ANY CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS GOVERNED BY ARTICLE XVI OF THE STATE UNIVERSITY OF NEW YORK. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 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