2020-08-17T08:41:13-05:00 2019-09-30 050409384 KAHN LITWIN RENZA & CO LTD 951 NORTH MAIN STREET PROVIDENCE RI 02904 990 2018-10-01 050389803 UNIVERSITY SURGICAL ASSOCIATES INC UNIV 4014539623 75 NEWMAN AVENUE PO BOX 16149 RUMFORD RI 02916 WILLIAM CIOFFI MD PRESIDENT 4014539623 2020-08-14 1 SANDY ROSS P01399337 4012742001 2020-08-11 71.117.160.66 2020-08-14 11:34:29 ED P 2F85E008C48DD5A141159495B2D1781CA3E157FD D52BEBB77B7FBC4D68F7A8619DEF4FC42F71D885 2018 2020-09-22 18:59:49Z WILLIAM CIOFFI MD 75 NEWMAN AVENUE PO BOX 16149 RUMFORD RI 02916 46584382 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. 8 0 240 0 201405 -8377 31500 0 37271702 38707775 2948751 1153993 -58924 4433 40193029 39866201 96000 62200 0 0 32588999 34155140 0 0 0 5871353 6903092 38556352 41120432 1636677 -1254231 36804984 47208911 9519886 17231546 27285098 29977365 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 34032916 62200 38508154 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. 34032916 1 0 0 0 0 0 0 0 0 1 1 0 0 1 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 0 1 0 0 0 1 50 0 240 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 2 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 RI X AMY HICKEY 4014539623 75 NEWMAN AVENUE RUMFORD RI 02916 WILLIAM CIOFFI MD PRESIDENT 40.00 X X 490002 0 60641 STEPHEN MIGLIORI MD VICE PRESIDENT 40.00 X X 409000 0 43196 ARIET KURKCHUBASHCE MD TREASURER/SECRETARY (UP TO 10/18) 40.00 X X 356392 0 52806 THOMAS NG MD TREASURER/SECRETARY (AS OF 10/18) 40.00 X X 423128 0 59833 CHARLES ADAMS MD TRUSTEE 40.00 X 542772 0 65375 DAVID CLOUTIER MD TRUSTEE 40.00 X 408558 0 64990 DAVID HARRINGTON MD TRUSTEE 40.00 X 443628 0 61520 STEPHANIE LUECKEL MD TRUSTEE 40.00 X 280302 0 66335 JEFFREY SLAIBY MD TRUSTEE 40.00 X 401728 0 65571 BRADFORD GRAY MD PHYSICIAN 40.00 X 397629 0 62388 FRANCOIS LUKS MD PHYSICIAN 40.00 X 395422 0 61970 PETER MAZZAGLIA MD PHYSICIAN 40.00 X 474042 0 50544 PAUL MORRISSEY MD PHYSICIAN 40.00 X 412922 0 61689 JAMES VALENTE MD PHYSICIAN 40.00 X 380000 0 44268 5815525 0 821126 76 0 1 0 NEW ENGLAND MEDICAL BILLING INC 75 NEWMAN AVENUE SUITE 100 RUMFORD RI 02916 MEDICAL BILLING SERVICES 1358280 1 MEDICAL SERVICES 621110 20706184 20706184 CONTRACT REVENUE 621110 12909588 12909588 TEACHING AND ADMINISTRATION 621110 4087150 4087150 OTHER CONTRACT REVENUE 621110 734325 537353 196972 RESEARCH GRANTS 621110 270528 270528 38707775 552986 552986 7319188 6715532 2649 603656 -2649 601007 -2649 603656 INCOME FROM INVESTMENT, EQUITY 900099 4433 4433 4433 39866201 38508154 201405 1156642 62200 62200 4366605 3766876 599729 22842420 19705140 3137280 2743589 2353202 390387 2761737 2405912 355825 1440789 652677 788112 23549 23549 54556 54556 126233 126233 1849659 766673 1082986 82545 82545 687713 580777 106936 168593 138583 30010 1434012 1168868 265144 53507 53507 35290 35290 11307 11307 168511 149099 19412 1373777 1360272 13505 SURGICAL SUPPLIES 405363 405363 ACADEMIC ASSESSMENT 388469 388469 LICENSES 40008 40008 41120432 34032916 7087516 0 1008191 665527 852098 3795618 44303 62188 1926302 1458458 750813 467844 24515403 38142667 8246808 91345 117108 1296023 3957959 36804984 47208911 46858 1914340 150000 256170 299716 9216858 14867490 9519886 17231546 X 2384634 29640981 24625665 17550 274799 318834 27285098 29977365 36804984 47208911 X -1254231 -195221 4141719 X 0 1 X 1 0 X 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 1 1 SECTION E, LINE 2A UNIVERSITY SURGICAL ASSOCIATES SERVES AS THE SURGERY DEPARTMENT FOR THE LIFESPAN GROUP OF HOSPITALS AND THEREFORE, ENABLES THE HOSPITALS TO OFFER A SURGICAL RESIDENCY PROGRAM. SECTION E, LINE 2B BUT FOR THE AVAILABILITY OF UNIVERSITY SURGICAL ASSOCIATES TO SERVE AS THE SURGERY DEPARTMENT, THE LIFESPAN GROUP OF HOSPITALS WOULD HAVE TO HIRE SURGEONS TO PERFORM THESE DUTIES. 274799 6527 -37508 318834 249908 27060 177 1992 274799 233943 452 18482 2969 249908 233747 106 5073 4983 233943 211979 25028 2524 736 233747 0.43130 0.56870 0 0 438550 195455 243095 1487752 1263003 224749 467844 RIGHT OF USE ASSETS 3728850 DEPOSITS 12569 INVESTMENT - EQUITY METHOD 190525 INVESTMENT RESEARCH FOUNDATION 26015 3957959 DEFERRED COMPENSATION LIABILITY 11235847 OPERATING LEASE LIABILITIES 3331927 FINANCING LEASE LIABILITIES 299716 14867490 X 39544747 -195221 -195221 39739968 126233 126233 39866201 40994199 0 40994199 126233 126233 41120432 PART V, LINE 4: W. R. THOMPSON LECTURESHIP ENDOWMENT IS USED TO ACCOUNT FOR FUNDS SET ASIDE TO ESTABLISH THE W. R. THOMPSON LECTURESHIP IN ESOPHAGASTRIC SURGERY. THE INTEREST EARNED ON THE CORPUS MAY BE USED FOR ANNUAL LECTURESHIP. THE PRINCIPAL MAY NOT BE INVADED; AS A RESULT, THIS FUND IS CONSIDERED AN ENDOWMENT FUND. DR. SHOAIB SHEIKH SURGICAL ENDOWMENT WAS ESTABLISHED TO FUND THE DR. SHOAIB SHEIKH SURGICAL AWARD. THE INTEREST EARNED ON THE CORPUS MAY BE USED FOR AN ANNUAL AWARD TO A RESIDENT, INCLUDING A MONETARY SUM AND FUNDING OF EXPENSES TO GO ON A ONE OR TWO WEEK INTERNATIONAL BURN TRIP WITH THE SURGICAL FACULTY, AT THE DISCRETION OF THE PRESIDENT OF UNIVERSITY SURGICAL ASSOCIATES. THE PRINCIPAL MAY NOT BE INVADED; AS A RESULT, THIS FUND IS CONSIDERED AN ENDOWMENT FUND. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MANAGEMENT BELIEVES THAT THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS TAX-EXEMPT STATUS AT BOTH THE STATE AND FEDERAL LEVEL. THE ORGANIZATION HAS BEEN CLASSIFIED AS AN ORGANIZATON THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(3). THE ORGANIZATION ANNUALLY FILES IRS FORM 990 - RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, REPORTING VARIOUS INFORMATION THAT THE IRS USES TO MONITOR THE ACTIVITIES OF TAX-EXEMPT ENTITIES. THESE TAX RETURNS ARE SUBJECT TO REVIEW BY THE TAXING AUTHORITIES, AND THE FEDERAL INCOME TAX RETURNS ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. THE ORGANIZATION CURRENTLY HAS NO TAX EXAMINATIONS IN PROGRESS. 1 AMERICAN CANCER SOCIETY 931 JEFFERSON BLVD STE 3004 WARWICK RI 02886 131788491 PUBLIC CHARITY 5000 SUPPORT FOR MAKING STRIDES AGAINST BREAST CANCER WALK RHODE ISLAND HOSPITAL FOUNDATION BOX H PROVIDENCE RI 02901 050258954 PUBLIC CHARITY 43000 SUPPORT FOR HASBRO CHILDREN'S HOSPITAL HEROES BALL, HASBRO CHILDREN'S HOSPITAL GOLF INVITATIONAL, AND RHODE ISLAND HOSPITAL FOUNDATION. THE TOMORROW FUND - RHODE ISLAND HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 050450569 PUBLIC CHARITY 5000 BRONZE LEVEL SPONSORSHIP OF CHARITY BALL 3 0 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 WILLIAM CIOFFI MD PRESIDENT 481121 0 0 0 8881 0 39640 0 21001 0 550643 0 0 0 STEPHEN MIGLIORI MD VICE PRESIDENT 405027 0 0 0 3973 0 39699 0 3497 0 452196 0 0 0 ARIET KURKCHUBASHCE MD TREASURER/SECRETARY (UP TO 10/18) 351687 0 0 0 4705 0 39736 0 13070 0 409198 0 0 0 THOMAS NG MD TREASURER/SECRETARY (AS OF 10/18) 420717 0 0 0 2411 0 39688 0 20145 0 482961 0 0 0 CHARLES ADAMS MD TRUSTEE 538851 0 0 0 3921 0 39751 0 25624 0 608147 0 0 0 DAVID CLOUTIER MD TRUSTEE 405801 0 0 0 2757 0 39696 0 25294 0 473548 0 0 0 DAVID HARRINGTON MD TRUSTEE 437985 0 0 0 5643 0 39818 0 21702 0 505148 0 0 0 STEPHANIE LUECKEL MD TRUSTEE 279676 0 0 0 626 0 40223 0 26112 0 346637 0 0 0 JEFFREY SLAIBY MD TRUSTEE 396247 0 0 0 5481 0 40426 0 25145 0 467299 0 0 0 BRADFORD GRAY MD PHYSICIAN 391251 0 0 0 6378 0 39707 0 22681 0 460017 0 0 0 FRANCOIS LUKS MD PHYSICIAN 388189 0 0 0 7233 0 40577 0 21393 0 457392 0 0 0 PETER MAZZAGLIA MD PHYSICIAN 469898 0 0 0 4144 0 39652 0 10892 0 524586 0 0 0 PAUL MORRISSEY MD PHYSICIAN 407596 0 0 0 5326 0 39696 0 21993 0 474611 0 0 0 JAMES VALENTE MD PHYSICIAN 373415 0 0 0 6585 0 39721 0 4547 0 424268 0 0 0 NEW ENGLAND MEDICAL BILLING INC WILLIAM CIOFFI, MD, PRESIDENT OF THE ORGANIZATION, SITS ON THE BOARD 1414769 BILLING FEES: THE ORGANIZATION OWNS 40.54% OF NEW ENGLAND MEDICAL BILLING (NEMB), WHICH IS AN INDEPENDENT CONTRACTOR OF THE ORGANIZATION. 0 THERESA A GRAVES MD EMPLOYEE IS MARRIED TO WILLIAM CIOFFI, MD, PRESIDENT OF THE ORGANIZATION 345000 COMPENSATION: THERESA A. GRAVES, MD, IS EMPLOYED BY UNIVERSITY SURGICAL ASSOCIATES, INC. 0 FORM 990, PART VI, SECTION B, LINE 11B THE 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 FORM 990 OF THE ORGANIZATION IS MADE AVAILABLE UPON REQUEST AND TO THE PUBLIC ON GUIDESTAR. THE CONFLICT OF INTEREST POLICY WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: ADJUSTMENT TO CHANGE ACCOUNTING BASIS TO U.S. GAAP 4,141,719. RHODE ISLAND HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 050258954 HOSPITAL COMMITTED TO ITS MISSION OF DELIVERING HEALTH WITH CARE. RI 501(C)(3) LINE 3 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0