NEW YORK SPINE AND BRAIN SURGERY UNIVERSITY FACULTY PRACTICE CORP: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NEW YORK SPINE AND BRAIN SURGERY UNIVERSITY FACULTY PRACTICE CORP (EIN 11-2645930)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-06
IRS object ID
201221279349300607
Schema version
2010v3.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-06T21:20:02-04:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 MONUMENT CIRCLE SUITE 2600AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46204ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN112645930EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1New York Spine and Brain SurgeryBusinessNameLine1
Business Name Line2University Faculty Practice CorporationBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlNEWYNameControl
Phone6314442055Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1554AddressLine1
CityStony BrookCity
StateNYState
ZIP Code11790ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRaphael DavisName
TitlePresidentTitle
Date Signed2012-04-26DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone3176817000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRaphael Davis MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 1554AddressLine1
CityStony BrookCity
StateNYState
ZIP Code11790ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13336121GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Siten/aWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1983YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionProvide clinical instruction to and supervision of medical school students, interns and residents and, incident thereto, rendering professional services.ActivityOrMissionDescription
Nbr Voting Members Governing Body3NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees10TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12339913ProgramServiceRevenuePriorYear
Program Service Revenue CY13320487ProgramServiceRevenueCY
Investment Income Prior Year13587InvestmentIncomePriorYear
Investment Income Current Year15634InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year12353500TotalRevenuePriorYear
Total Revenue Current Year13336121TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4396772SalariesEtcPriorYear
Salaries Etc Current Year4456937SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year7713847OtherExpensePriorYear
Other Expenses Current Year8814246OtherExpensesCurrentYear
Total Expenses Prior Year12110619TotalExpensesPriorYear
Total Expenses Current Year13271183TotalExpensesCurrentYear
Revenues Less Expenses Prior Year242881RevenuesLessExpensesPriorYear
Revenues Less Expenses CY64938RevenuesLessExpensesCY
Total Assets BOY886603TotalAssetsBOY
Total Assets EOY951542TotalAssetsEOY
Total Liabilities BOY886603TotalLiabilitiesBOY
Total Liabilities EOY951542TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY0NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY0NetAssetsOrFundBalancesEOY
Mission DescriptionProvide clinical instruction to and supervision of medical school students, interns and residents and, incident thereto, rendering professional services.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense11344244Expense
Revenue13320487Revenue
DescriptionThe organization provides services in the field of Neurological Surgery to patients and provides clinical instruction to and supervision of School of Medicine students and Hospital Residents.Description
Total Program Service Expense11344244TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
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Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees10NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members3NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCLINICAL PRACTICE MGMT PLANNamePerson
Telephone Number6314442055TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1554AddressLine1
CityStony BrookCity
StateNYState
ZIP Code11790ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Raphael Davis
PRESIDENT AND DIRECTOR50.0XX87352621008057086
Frederick Gutman
SECRETARY AND DIRECTOR50.0XX29048911509653403
Michael Egnor
DIRECTOR50.0X31288520935758838
Henry Woo
Neurological Surgeon50.080597317516157509X
Robert Galler
Neurological Surgeon50.06248309798448193X
David Fiorella
Neurological Surgeon50.05389447613746361X
Arthur Rosiello
Neurological Surgeon50.02363908683248173X
George Tyson
Neurological Surgeon50.09972619771048376X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3782763TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1168357TotalReportableCompFrmRltdOrgs
Total Other Compensation417939TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Business Code621111BusinessCode
Total Revenue Column13320487TotalRevenueColumn
Related Or Exempt Function Income13320487RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue13320487TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column15634TotalRevenueColumn
Exclusion$15,634ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

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Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

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Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

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Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
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Total Revenue TotalRevenue

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Total Revenue Column13336121TotalRevenueColumn
Related Or Exempt Function Income13320487RelatedOrExemptFunctionIncome
Exclusion$15,634ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

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Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

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Total0Total

Foreign Grants ForeignGrants

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Total0Total

Benefits To Members BenefitsToMembers

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Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1578780Total
Program Services1499841ProgramServices
Management And General78939ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2559572Total
Program Services2559572ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total180174Total
Program Services180174ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total23559Total
Program Services23559ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total114852Total
Program Services114852ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total8800000Total
Program Services6952000ProgramServices
Management And General1848000ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

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Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1900Total
Program Services1900ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total8919Total
Program Services8919ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total1760Total
Program Services1760ProgramServices

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PENSION ADMIN FEES10211021
ALL OTHER EXPENSES646646

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13271183Total
Program Services11344244ProgramServices
Management And General1926939ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY886603BOY
EOY951542EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY886603BOY
EOY951542EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY886603BOY
EOY951542EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY886603BOY
EOY951542EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY886603BOY
EOY951542EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses64938ReconcilationRevenueExpenses
Reconcilation Other Changes-64938ReconcilationOtherChanges
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6773291CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8927000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10704203CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12339913CurrentTaxYearMinus1Year
Current Tax Year13320487CurrentTaxYear
Total52064894Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6773291CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8927000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10704203CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12339913CurrentTaxYearMinus1Year
Current Tax Year13320487CurrentTaxYear
Total52064894Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1115132CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2210905CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1814105CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2310121CurrentTaxYearMinus1Year
Current Tax Year2497451CurrentTaxYear
Total9947714Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1115132CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2210905CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1814105CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2310121CurrentTaxYearMinus1Year
Current Tax Year2497451CurrentTaxYear
Total9947714Total
FieldValueIRS element (for citing)
Public Support Total50942117180PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15106CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15840CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11318CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13587CurrentTaxYearMinus1Year
Current Tax Year15634CurrentTaxYear
Total71485Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15106CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15840CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11318CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13587CurrentTaxYearMinus1Year
Current Tax Year15634CurrentTaxYear
Total71485Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6788397CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8942840CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10715521CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12353500CurrentTaxYearMinus1Year
Current Tax Year13336121CurrentTaxYear
Total52136379Total
FieldValueIRS element (for citing)
First5 Years509XFirst5Years509

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation SurveyXCompensationSurvey
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Raphael Davis
706712210080150000016814000188553823189238124831100
Frederick Gutman
286919115096003570000323182108532280713618100
Michael Egnor
2969442093570015941000207143812433359924748100
Henry Woo
60240317516120000003570000357272178284170019694300
Robert Galler
556260979846500003570000316551653865648511452200
David Fiorella
46871076137666640357000032501138605714458999700
Arthur Rosiello
23286986832003521000293461882726573610565900
George Tyson
99726197710000000119673640911169323411900

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Supplemental Compensation InformationSchedule J, Part I, Line 7Employees are reimbursed for business expenses that relate to the practice of medicine. The total amount reimbursable in a given fiscal year is determined by the respective Chairperson. All reimbursements are subject to approval by the Chairperson or their designee. For an expense to be eligible for reimbursement, it must be allowable "in accordance with generally accepted accounting principles and allowable to a practitioner as a deductible cost or expense under current federal Internal Revenue Service guidelines." Documentation of expenses follows IRS guidelines. Expenses are not processed unless they have complete documentation. Expenditures that are over $5,000, unprecedented, or unusual, will require prior approval from the Purchasing and Asset Management Committee.
First Class/Business Class travelSchedule J, Part I, 1aBusiness class travel was provided to Neurological Surgeon Robert Galler, MD, who was reimbursed for the cost of airfares to an international mission and a west coast meeting. The amount reimbursed was not treated as taxable compensation. This benefit is subject to the guidelines for nonfixed payments. Employees are reimbursed for business expenses that relate to the practice of medicine. The total amount reimbursable in a given fiscal year is determined by the respective Chairperson. All reimbursements are subject to approval by the Chairperson or their designee. For an expense to be eligible for reimbursement, it must be allowable "in accordance with generally accepted accounting principles and allowable to a practitioner as a deductible cost or expense under current federal Internal Revenue Service guidelines." Documentation of expenses follows IRS guidelines. Expenses are not processed unless they have complete documentation. Expenditures that are over $5,000, unprecedented, or unusual, require prior approval from the Purchasing and Asset Management Committee. First class/business class airfare is considered unusual and therefore must be approved by the Purchasing and Asset Management Committee.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Describe the Process used by Management &/or Governing Body to Review 990Form 990, Part VI, Question 11BAN ELECTRONIC VERSION OF FORM 990 WAS PROVIDED TO THE OFFICERS AND DIRECTORS PRIOR TO FILING. MANAGEMENT PERFOMS A REVIEW FOR FORM 990 PRIOR TO FILING, ADDRESSING ANY QUESTIONS MADE BY THE GOVERNING BODY.
Description of Process to Monitor Transactions for Conflicts of InterestForm 990, Part VI, Question 12cTHE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT THE UFPC'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE UFPC OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OF COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. COMPLIANCE WITH THIS POLICY IS MONITORED THROUGH INTERNAL PAYMENT POLICIES AND ANNUAL REPRESENTATIONS. THE REVIEWS, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: A. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. B. WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE UFPC'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENT FOR GOODS AND SERVICES, FURTHER EDUCATIONAL PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. A VOTING MEMBER OF THE GOVERNING BOARD WHO HAS A COMPENSATION CONFLICT IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. IF THERE ARE VIOLATIONS TO THE POLICY, THE COMMITTEE OR GOVERNING BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
Offices & Positions for Which Process was Used, & Year Process was BegunForm 990, Part VI, Question 15a and bBEGAN AT INCEPTION: EACH PHYSICIAN IS A MEMBER OF THE SCHOOL OF MEDICINE'S FACULTY AND A NEW YORK STATE EMPLOYEE PROVIDING SERVICES AT THE UNIVERSITY, AND REPORTS TO THE CHAIRMAN OF HIS/HER DEPARTMENT AND THE DEAN OF THE SCHOOL OF MEDICINE, WHO IN TURN REPORTS TO THE PRESIDENT OF THE UNIVERSITY. THE DEAN OF THE SCHOOL OF MEDICINE IS RESPONSIBLE FOR HIRING AND TERMINATING EACH PHYSICIAN, DETERMINING EACH PHYSICIAN'S COMPENSATION (WHICH IS SUBJECT TO THE LIMITATIONS IN ARTICLE XVI AS DESCRIBED BELOW), AND ALSO APPOINTS THE CHAIRPERSON OF THE SCHOOL OF MEDICINE'S Department of Neurological Surgery, (I) WHO IS ONE OF THE DIRECTORS; AND (II) WHO IN TURN SELECTS ITS OTHER TWO DIRECTORS. CONSEQUENTLY, THE DIRECTORS MUST ACT IN A MANNER WHICH WILL NOT JEOPARDIZE THEIR EMPLOYMENT WITH THE MEDICAL SCHOOL AND THE UNIVERSITY IN ORDER TO REMAIN ON THE BOARD. AS A RESULT, NEW YORK STATE, THROUGH THE SUNY SYSTEM, THE UNIVERSITY, THE MEDICAL SCHOOL, AND CPMP (AS EXPLAINED BELOW) EXERCISES SUBSTANTIAL CONTROL OVER OPERATIONS, WHICH ARE ALSO SUBJECT TO ORIGINATING DOCUMENTS (I.E., CERTIFICATE OF REINCORPORATION AND BYLAWS), WHICH STATE THE PURPOSE AS FURTHERING THE UNIVERSITY'S EDUCATIONAL MISSION. ALL PHYSICIANS ENTER INTO EMPLOYMENT ARRANGEMENTS WITH THE UFPC. AS A RESULT, EACH PHYSICIAN RECEIVES COMPENSATION AND BENEFITS FROM THE UFPC AND THE STATE OF NEW YORK (BECAUSE SUCH PHYSICIAN IS ALSO A UNIVERSITY EMPLOYEE). THE DEAN OF THE SCHOOL OF MEDICINE DETERMINES EACH PHYSICIAN'S COMPENSATION, IN CONSULTATION WITH SUCH PHYSICIAN'S DEPARTMENTAL CHAIRPERSON. DOCUMENTATION REGARDING SUCH COMPENSATION DETERMINATION IS MAINTAINED BY THE DEAN'S OFFICE. EACH PHYSICIAN IS COMPENSATED BASED ON TRADITIONAL FACTORS SUCH AS TRAINING, EXPERIENCE, QUALIFICATIONS, AND GENERAL MARKET CONDITIONS. SUBJECT TO THE LIMITATIONS DESCRIBED BELOW, EMPLOYMENT AGREEMENTS WITH PHYSICIANS TYPICALLY ALLOW AN INDIVIDUAL PHYSICIAN TO RECEIVE NON-FIXED COMPENSATION, BASED ON AMOUNTS COLLECTED WHICH ARE ATTRIBUTABLE TO SUCH PHYSICIAN'S DIRECT PATIENT CARE SERVICES. THE ORGANIZATION GENERALLY DETERMINES A PHYSICIAN'S COMPENSATION TO EQUAL AN AMOUNT BETWEEN THE 50TH AND 75TH PERCENTILE OF COMPARABLE PHYSICIAN COMPENSATION, AS REPORTED IN THE ASSOCIATION OF AMERICAN MEDICAL COLLEGE'S (THE "AAMC'S") COMPENSATION DATA REFERENCE MATERIALS. EACH PHYSICIAN IS ALSO SUBJECT TO ARTICLE XVI, WHICH AT ALL TIMES GOVERNS SUCH PHYSICIAN'S COMPENSATION. UNDER THE TERMS OF ARTICLE XVI, THE MAXIMUM AMOUNT OF COMPENSATION PAYABLE TO ANY PHYSICIAN (INCLUDING COMPENSATION FROM ALL OTHER SOURCE EXCLUSIVE OF FRINGE BENEFITS) IS NOT TO EXCEED 250% OF THAT INDIVIDUAL'S MAXIMUM STATE BASIC ANNUAL SALARY FOR HIS/HER ACADEMIC RANK (THE "250% RULE"). IN SPECIAL CIRCUMSTANCES RELATING TO RECRUITMENT, THE UNIVERSITY PRESIDENT (OR HIS/HER DESIGNEE) MAY AUTHORIZE AN PHYSICIAN TO RECEIVE GREATER THAN 250% OF THE MAXIMUM STATE BASIC ANNUAL SALARY FOR SUCH PHYSICIAN'S RANK, PROVIDED THAT SUCH COMPENSATION IS IN THE BEST INTEREST OF THE UNIVERSITY AND THE HOSPITAL. SUCH ADDITIONAL COMPENSATION SHALL NOT EXTEND BEYOND A TWO YEAR PERIOD. ALSO, WITH THE APPROVAL OF THE CHANCELLOR OF THE SUNY SYSTEM (OR HIS/HER DESIGNEE) THE MAXIMUM ALLOWABLE COMPENSATION PAYABLE TO A PHYSICIAN MAY EXCEED 275% OF SUCH INDIVIDUAL'S MAXIMUM STATE BASIC ANNUAL SALARY (E.G., IN THE CASE OF PHYSICIANS PROVIDING SERVICES IN DIFFICULT TO RETAIN SPECIALTIES). IN MAKING RECOMMENDATIONS WITH RESPECT TO SUCH EXCEPTIONS TO THE "250% RULE", THE PRESIDENT OF THE UNIVERSITY CONSIDERS THE COMPETITION FOR PHYSICIANS IN A PARTICULAR SPECIALTY AS INDICATED BY THE AAMC'S COMPENSATION DATA, AND OTHER REVENUE GENERATED BY THE PHYSICIAN'S CLINICAL ACTIVITIES. SUCH EXCEPTIONS, PURSUANT TO THE TERMS OF ARTICLE XVI, SHALL NOT EXCEED 5% OF THE TOTAL NUMBER OF PHYSICIANS ON A SYSTEM-WIDE BASIS. ALSO, SUBJECT TO THE TERMS OF ARTICLE XVI, A PORTION OF EACH PHYSICIAN'S COMPENSATION MAY BE USED TO PURCHASE A RETIREMENT BENEFIT FOR THE BENEFIT OF PHYSICIANS.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen PublicForm 990, Part VI, Question 19ALL GOVERNING DOCUMENTS WILL NOT BE DISCLOSED OUTSIDE OF THE ORGANIZATION. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ALSO WILL NOT BE DISCLOSED OUTSIDE OF THE ORGANIZATION.
HOURS DEVOTED TO RELATED ORGANIZATIONFORM 990, PART VIITHE MISSION OF THE REPORTING ORGANIZATION IS TO SUPPORT THE EDUCATIONAL MISSION OF THE STATE UNIVERSITY OF NEW YORK SCHOOL OF MEDICINE AT STONY BROOK (THE "MEDICAL SCHOOL") BY PROVIDING CLINICAL INSTRUCTION TO AND SUPERVISION OF MEDICAL SCHOOL STUDENTS, INTERNS AND RESIDENTS AND, INCIDENT THERETO, RENDERING PROFESSIONAL SERVICES. EACH PHYSICIAN IS AN EMPLOYEE OF THE REPORTING ORGANIZATION AND A NEW YORK STATE EMPLOYEE PROVIDING SERVICES AS A MEMBER OF THE THE MEDICAL SCHOOL'S FACULTY. HOURS WORKED BY THE PHYSICIANS LISTED IN PART VII RELATE TO THE ENTIRE MISSION OF THE REPORTING ORGANIZATION WHICH INCLUDES SUPPORTING THE MISSION OF THE MEDICAL SCHOOL.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5CASH TRANSFER FROM CLINICAL PRACTICE MANAGEMENT PLAN = $64,938

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (22 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
New York State
One Commerce Plaza 99 Washington AAlbanyNY12231146013200GovernmentNY501 C 1N/ANA
Stony Brook Dermatology Associates UFPC
PO Box 1554Stony BrookNY11790113011790HealthcareNY501 C 39NYS
Stony Brook Emergency Physicians UFPC
PO Box 1554Stony BrookNY11790113066770HealthcareNY501 C 39NYS
Stony Brook Family Medical Group UFPC
PO Box 1554Stony BrookNY11790112552321HealthcareNY501 C 39NYS
Stony Brook Internists UFPC
PO Box 1554Stony BrookNY11790112558775HealthcareNY501 C 39NYS
Neurology Assoc of Stony Brook UFPC
PO Box 1554Stony BrookNY11790112587430HealthcareNY501 C 39NYS
Univ Assoc in Obst & Gynecology UFPC
PO Box 1554Stony BrookNY11790112569522HealthcareNY501 C 39NYS
Stony Brook Pathologists UFPC
PO Box 1554Stony BrookNY11790112647243HealthcareNY501 C 39NYS
Stony Brook Preventive Med Srvc UFPC
PO Box 1554Stony BrookNY11790112822992HealthcareNY501 C 39NYS
Stony Brook Ophthalmology UFPC
PO Box 1554Stony BrookNY11790112658697HealthcareNY501 C 39NYS
Stony Brook Orthopaedic Associates UFPC
PO Box 1554Stony BrookNY11790112593061HealthcareNY501 C 39NYS
Stony Brook Children's Service UFPC
PO Box 1554Stony BrookNY11790112571524HealthcareNY501 C 39NYS
Stony Brook Psychiatric Associates UFPC
PO Box 1554Stony BrookNY11790112590096HealthcareNY501 C 39NYS
Stony Brook Radiation Oncology UFPC
PO Box 1554Stony BrookNY11790112664726HealthcareNY501 C 39NYS
Stony Brook Radiology UFPC
PO Box 1554Stony BrookNY11790112548304HealthcareNY501 C 39NYS
Stony Brook Surgical Associates UFPC
PO Box 1554Stony BrookNY11790112552333HealthcareNY501 C 39NYS
Stony Brook Urology UFPC
PO Box 1554Stony BrookNY11790112644371HealthcareNY501 C 39NYS
Stony Brook Anaesthesiology UFPC
PO Box 1554Stony BrookNY11790112553515HealthcareNY501 C 39NYS
Stony Brook Clin Pract Mgmt Realty Corp
PO Box 1554Stony BrookNY11790113285712Rlty HoldingNY501 C 25N/ANYS
Stony Brook Surgical Holding Corp
PO Box 1554Stony BrookNY11790116434538Rlty HoldingNY501 C 25N/ANYS
Stony Brook University Physicians UFPC
PO Box 1554Stony BrookNY11790113559055Support SvcsNY501 C 39NYS
Clinical Practice Management Plan
PO Box 1554Stony BrookNY11790Mgmt ActivityNY501 C 3N/ANA

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Stony Brook Healthcare IPA LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 1554AddressLine1
CityStony BrookCity
StateNYState
ZIP Code11790ZIPCode
FieldValueIRS element (for citing)
EIN113499101EIN
Primary ActivityhealthcarePrimaryActivity
Legal Domicile StateNYLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CPMPBusinessNameLine1
FieldValueIRS element (for citing)
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
Suffolk Psychiatric Services PC
PO Box 1554Stony BrookNY11790113115689managed Hlth svcNYCPMPC CORP
Stony Brook Physicians PC
PO Box 1554Stony BrookNY11790201611829medical svcsNYCPMPC CORP
Healthcare Management Services Inc
PO Box 1554Stony BrookNY11790113247917medical svcsNYCPMPC CORP
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
State of New York
k2630812
Clinical Practice Management Plan
l8800000
Clinical Practice Management Plan
l64938

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