STRATEGY STUDIO / PUBLIC DATA EXPLORER

STONY BROOK CLINICAL PRACTICE MGMT PLAN REALTY CORPORATION: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
STONY BROOK CLINICAL PRACTICE MGMT PLAN REALTY CORPORATION (EIN 11-3285712)
Tax period
2021-07-01 to 2022-06-30
Filed
2023-05-12
IRS object ID
202311329349302231
Schema version
2021v4.2
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)
Return2023-05-12T08:49:43-05:00ReturnTs
Tax Period End2022-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1ONE MANHATTAN WESTAddressLine1Txt
CityNEW YORKCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10001ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN113285712EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STONY BROOK CLINICAL PRACTICEBusinessNameLine1Txt
Business Name Line2Management Plan Realty CorporationBusinessNameLine2Txt
FieldValueIRS element (for citing)
In Care Of% SB CLINICAL PRAC MGMT PLAN IInCareOfNm
Business Name ControlSTONBusinessNameControlTxt
Phone6314442055PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1554AddressLine1Txt
CityStony BrookCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11790ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonWAYNE WALTZERPersonNm
Person TitleVICE CHAIRPERSONPersonTitleTxt
Phone6314442055PhoneNum
Signature2023-05-08SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstWAYNEPersonFirstNm
Person LastWALTZERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
PTINP01962945PTIN
Phone2127734931PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRaphael Davis MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1554AddressLine1Txt
CityStony BrookCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11790ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$173,233GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website Addressn/aWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1995FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionAcquire, hold, and collect income on property and remint the entire amount, after the payment of expenses, to Stony Brook Clinical Practice Management Plan.ActivityOrMissionDesc
Voting Members Governing Body2VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$179,269PYProgramServiceRevenueAmt
CY Program Service Revenue$173,233CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$179,269PYTotalRevenueAmt
CY Total Revenue$173,233CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$201,020PYOtherExpensesAmt
CY Other Expenses$263,684CYOtherExpensesAmt
PY Total Expenses$201,020PYTotalExpensesAmt
CY Total Expenses$263,684CYTotalExpensesAmt
PY Revenues Less Expenses-$21,751PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$90,451CYRevenuesLessExpensesAmt
Total Assets BOY$929,491TotalAssetsBOYAmt
Total Assets EOY$833,598TotalAssetsEOYAmt
Total Liabilities BOY$23,603TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,161TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$905,888NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$815,437NetAssetsOrFundBalancesEOYAmt
MissionACQUIRE, HOLD, AND COLLECT INCOME ON PROPERTY AND REMIT THE ENTIRE AMOUNT, AFTER THE PAYMENT OF EXPENSES, TO STONY BROOK CLINICAL PRACTICE MANAGEMENT PLAN.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$0ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescThe organization acquires, holds and collects income on property and remits the entire amount, after the payment of expenses, to Stony Brook Clinical Practice Management Plan.Desc
Total Program Service Expenses$0TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members2GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSB CLINICAL PRAC MGMT PLAN IPersonNm
Phone6314442055PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1554AddressLine1Txt
CityStony BrookCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11790ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
RAPHAEL DAVIS
TREASURER/President1.049.0Yes (X)Yes (X)$0$1,437,093$96,015
MARGARET MCGOVERN
FMR DIR(TERM 5/1/2018)0.010.0$0$1,096,208$125,581Yes (X)
Tong Gan
SECRETARY1.049.0Yes (X)Yes (X)$0$908,691$80,359
Todd Griffin till 61522
PRESIDENT1.049.0Yes (X)Yes (X)$0$715,664$92,875
KENNETH SHROYER
SECRETARY (TERM 3/20/19)0.010.0$0$633,930$101,984Yes (X)
Mark Talamini
Former President(Term 4/5/21)0.010.0$0$261,570$731Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,053,156TotReportableCompRltdOrgAmt
Total Other Compensation$497,545TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

FieldValueIRS element (for citing)
PersonNONEPersonNm
FieldValueIRS element (for citing)
Contractor AddressContractorAddress
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescRENTAL REVENUEDesc
Business531120BusinessCd
Total Revenue Column$173,233TotalRevenueColumnAmt
Related Or Exempt Func Income$173,233RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$173,233TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$173,233TotalRevenueColumnAmt
Related Or Exempt Func Income$173,233RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$70,251TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,013TotalAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$5,173TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$48,414TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$14,392TotalAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmt
REPAIR AND MAINTENANCE$124,341
CORPORATION TAX$100

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$263,684TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$194,269BOYAmt
EOY$148,301EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$47,475BOYAmt
EOY$45,964EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,578,345LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$939,012LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$687,747BOYAmt
EOY$639,333EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$929,491BOYAmt
EOY$833,598EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$23,603BOYAmt
EOY$18,161EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$23,603BOYAmt
EOY$18,161EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$905,888BOYAmt
EOY$815,437EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$905,888BOYAmt
EOY$815,437EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$929,491BOYAmt
EOY$833,598EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$90,451ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$470,000OtherCostOrOtherBasisAmt
Book Value$470,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$803,866OtherCostOrOtherBasisAmt
Depreciation$710,993DepreciationAmt
Book Value$92,873BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$304,479OtherCostOrOtherBasisAmt
Depreciation$228,019DepreciationAmt
Book Value$76,460BookValueAmt
FieldValueIRS element (for citing)
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp
Total Book Value Land Buildings$639,333TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt
Total Liability$0TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2FormAndLineReferenceDesc
ExplanationThe Plan adopted the provisions pertaining to uncertain tax provisions of FASB ASC Topic 740, Income Taxes, and has determined that there are no material uncertain tax provisions that require recognition or disclosure in the financial statements.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Todd Griffin till 61522
PRESIDENT$0$563,054$0$150,000$0$2,610$0$70,670$0$22,205$0$808,539$0$0
Tong Gan
SECRETARY$0$719,294$0$186,787$0$2,610$0$57,338$0$23,021$0$989,050$0$0
RAPHAEL DAVIS
TREASURER/President$0$1,307,523$0$125,659$0$3,911$0$72,993$0$23,022$0$1,533,108$0$0
MARGARET MCGOVERN
FMR DIR(TERM 5/1/2018)$0$844,751$0$248,847$0$2,610$0$82,473$0$43,108$0$1,221,789$0$0
KENNETH SHROYER
SECRETARY (TERM 3/20/19)$0$547,026$0$84,294$0$2,610$0$74,530$0$27,454$0$735,914$0$0
Mark Talamini
Former President(Term 4/5/21)$0$255,000$0$5,700$0$870$0$0$0$731$0$262,301$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, QUESTION 6The corporation has a single member. The member of the corporation shall take part in discussions of any subject that may properly come before it and shall have such other additional rights and privilege and be subject to such other duties and restrictions as set forth in the not-for-profit corporation law of the State of New York and in the Bylaws.
FORM 990, PART VI, QUESTION 7AAccording to the Bylaws, the Member shall have the sole right to elect all members of the Board of Directors. Directors shall be elected by the affirmative vote of the Member at the annual meeting. The number of Directors of the corporation shall be fixed by the Member at each annual meeting or at any meeting called for that purpose, provided that no decrease shall shorten the term of any incumbent Director, and provided that any change in number of Directors shall require the affirmative vote of the Member.
FORM 990, PART VI, QUESTION 7BPer the Bylaws, the Member shall have the sole power to dismiss the corporation's investment adviser, if any, following reasonable notice and terminate its interest in the corporation by selling or exchanging its interests in the corporation to any organization described in Section 501(c)(25) of the code so long as the sale or exchange does not increase the number of beneficiaries of the corporation above 35.
FORM 990, PART VI, QUESTION 11BAn electronic version of Form 990 was provided to the officers and directors prior to filing. Management performs a review of Form 990 prior to filing, addressing any questions made by the governing body.
FORM 990, PART VI, QUESTION 12CThe purpose of the conflict of interest policy is to protect the organization'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 organization 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 organization'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.
FORM 990, PART VI, QUESTION 19NO DOCUMENTS AVAILABLE TO THE PUBLIC.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (20 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
New York State
1 Commerce Plz 99 Washington AveAlbanyNY12231146013200GovernmentNY501(C)(1)N/ANAfalse
Stony Brook Urology UFPC
PO Box 1554Stony BrookNY11790112644371HealthcareNY501(C)(3)10NYSfalse
Stony Brook Anaesthesiology UFPC
PO Box 1554Stony BrookNY11790112553515HealthcareNY501(C)(3)10NYSfalse
Stony Brook Dermatology Associates UFPC
PO Box 1554Stony BrookNY11790113011790HealthcareNY501(C)(3)10NYSfalse
Stony Brook Surgical Holding Corp
PO Box 1554Stony BrookNY11790116434538Rlty HoldingNY501(C)(25)N/ACPMPYes (true)
SB Clinical Practice Management Plan Inc
PO Box 1554Stony BrookNY11790461787308Mgmt ActivityNY501(C)(3)10NAfalse
Stony Brook Emergency Physicians UFPC
PO Box 1554Stony BrookNY11790113066770HealthcareNY501(C)(3)10NYSfalse
SB Family and Preventive Medicine UFPC
PO Box 1554Stony BrookNY11790112552321HealthcareNY501(C)(3)10NYSfalse
Stony Brook Internists UFPC
PO Box 1554Stony BrookNY11790112558775HealthcareNY501(C)(3)10NYSfalse
New York Spine and Brain Surgery UFPC
PO Box 1554Stony BrookNY11790112645930HealthcareNY501(C)(3)10NYSfalse
Neurology Assoc of Stony Brook UFPC
PO Box 1554Stony BrookNY11790112587430HealthcareNY501(C)(3)10NYSfalse
Univ Assoc in Obst & Gynecology UFPC
PO Box 1554Stony BrookNY11790112569522HealthcareNY501(C)(3)10NYSfalse
Stony Brook Pathologists UFPC
PO Box 1554Stony BrookNY11790112647243HealthcareNY501(C)(3)10NYSfalse
Stony Brook Ophthalmology UFPC
PO Box 1554Stony BrookNY11790112658697HealthcareNY501(C)(3)10NYSfalse
Stony Brook Orthopaedic Associates UFPC
PO Box 1554Stony BrookNY11790112593061HealthcareNY501(C)(3)10NYSfalse
Stony Brook Children's Service UFPC
PO Box 1554Stony BrookNY11790112571524HealthcareNY501(C)(3)10NYSfalse
Stony Brook Psychiatric Associates UFPC
PO Box 1554Stony BrookNY11790112590096HealthcareNY501(C)(3)10NYSfalse
Stony Brook Radiation Oncology UFPC
PO Box 1554Stony BrookNY11790112664726HealthcareNY501(C)(3)10NYSfalse
Stony Brook Radiology UFPC
PO Box 1554Stony BrookNY11790112548304HealthcareNY501(C)(3)10NYSfalse
Stony Brook Surgical Associates UFPC
PO Box 1554Stony BrookNY11790112552333HealthcareNY501(C)(3)10NYSfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1SB HLTHCARE IPA LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1554AddressLine1Txt
CitySTNY BRKCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11790ZIPCd
FieldValueIRS element (for citing)
EIN113499101EIN
Primary ActivitieshealthcarePrimaryActivitiesTxt
Legal Domicile StateNYLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CPMPBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRelatedPredominantIncomeTypeTxt
Share Of Total Income$0ShareOfTotalIncomeAmt
Share Of EOY Assets$0ShareOfEOYAssetsAmt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
UBI Code V$0UBICodeVAmt
Ownership0.00000OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Nicolls Indemnity Solutions SPCBusinessNameLine1Txt

Foreign Address ForeignAddress

FieldValueIRS element (for citing)
Address Line127 HOSPITAL RD CAYMAN CORP CTRAddressLine1Txt
CityGRAND CAYMANCityNm
CountryCJCountryCd
Foreign PostalKY1-9008ForeignPostalCd
FieldValueIRS element (for citing)
EIN981378568EIN
Primary ActivitiesSELF-INSURANCEPrimaryActivitiesTxt
Legal Domicile Foreign CountryCJLegalDomicileForeignCountryCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CPMPBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Share Of Total Income$0ShareOfTotalIncomeAmt
Share Of EOY Assets$0ShareOfEOYAssetsAmt
Ownership0.00000OwnershipPct
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1rental revenueBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeJTransactionTypeTxt
Involved$173,233InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt