2019-08-05T08:44:29-05:00 2018-09-30 050353162 PICCERELLI GILSTEIN & CO LLP 144 WESTMINSTER STREET PROVIDENCE RI 029032282 990 2017-10-01 050389803 UNIVERSITY SURGICAL ASSOCIATES INC UNIV 4014539623 PO BOX 16149 RUMFORD RI 02916 WILLIAM CIOFFI MD PRESIDENT 4014446290 2019-07-29 1 SHARON KENNEDY P00218909 4018310200 70.183.170.60 2019-07-29 13:34:56 ED P A2C1D4D9D0B537EBAB5B7A9E07E6322D20E780D7 15808008B75BF586CA86DED9AD94DF4081F2BEFF 2017 2019-02-21 02:37:17Z WILLIAM CIOFFI MD PO BOX 16149 RUMFORD RI 02916 47219679 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 130721 -71011 1525 31500 35873920 37271702 2168360 2948751 -69550 -58924 37974255 40193029 52310 96000 0 0 31898752 32588999 0 0 112468 5546969 5871353 37498031 38556352 476224 1636677 33658311 36804984 8003428 9519886 25654883 27285098 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 35019271 96000 37081965 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. 35019271 1 1 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 0 1 0 0 0 1 40 0 1 240 1 1 1 0 0 0 0 0 0 0 0 0 X 8 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 RI X X AMY HICKEY 4014539623 75 NEWMAN AVE PO BOX 16149 RUMFORD RI 02916 CIOFFI MD WILLIAM PRESIDENT 40.00 X X 503348 0 59830 MIGLIORI MD STEPHEN VICE PRESIDENT 40.00 X X 409601 0 65149 KURKCHUBASHCE MD ARLET TREASURER/SECRETARY 40.00 X X 361314 0 52674 ADAMS MD CHARLES TRUSTEE 40.00 X 543804 0 65770 CLOUTIER MD DAVID TRUSTEE 40.00 X 414872 0 64895 HARRINGTON MD DAVID TRUSTEE 40.00 X 441117 0 61038 NG MD THOMAS TRUSTEE 40.00 X 434175 0 60188 SLAIBY MD JEFFREY TRUSTEE 40.00 X 401109 0 64673 GRAY MD BRADFORD PHYSICIAN 40.00 X 405918 0 63602 LUKS MD FRANCOIS PHYSICIAN 40.00 X 393346 0 59782 MAZZAGLIA MD PETER PHYSICIAN 40.00 X 477141 0 49116 MORRISSEY MD PAUL PHYSICIAN 40.00 X 406549 0 64752 VALENTE MD JAMES PHYSICIAN 40.00 X 391585 0 43036 ROYE MD G DEAN - FORMER TRUSTEE 40.00 X 280412 0 45526 5864291 0 820031 72 1 1 0 NEW ENGLAND MEDICAL BILLING INC 75 NEWMAN AVE SUITE 100 RUMFORD RI 02916 MEDICAL BILLING SERVICES 1172713 1 31500 31500 PATIENT FEES 621110 19491503 19491503 CONTRACT REVENUE - RI HOSPITAL 621110 7742069 7742069 OTHER INCOME - SURGERY 621110 4545167 4545167 CONTRACTUAL REVENUE - MIRIAM HOSP 621110 3255914 3255914 OTHER CONTRACT REVENUE 621110 927715 747715 180000 1309334 1299689 9645 37271702 1021004 1021004 8954397 7026558 92 1927839 -92 1927747 -92 1927839 INCOME FROM INVESTMENT IN PASSTHR 900099 -58924 -58924 -58924 40193029 37081965 130721 2948843 96000 96000 3912476 3600948 282184 29344 22558338 20659844 1827644 70850 2416781 2097766 314181 4834 2335936 2027592 303672 4672 1365468 1185226 177511 2731 15151 15151 52140 52140 131606 131606 113541 113541 944029 900105 43924 117073 87805 29268 2099694 1730072 369622 37912 37912 38189 38189 185175 185175 167779 163028 4751 1007353 1004474 2842 37 OUTSIDE SERVICES 692750 692750 LICENSES AND PERMITS 97246 97246 DUES AND SUBSCRIPTIONS 86142 84419 1723 MISCELLANEOUS 85573 85573 38556352 35019271 3424613 112468 2741594 1008191 598090 852098 63618 44303 2319042 1568229 443967 750813 21470387 24515403 7280515 8246808 66414 91345 993726 1296023 33658311 36804984 49027 46858 86185 256170 7868216 9216858 8003428 9519886 X 2824689 2384634 22580286 24625665 249908 274799 25654883 27285098 33658311 36804984 X 1636677 -6462 X 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 USA 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 USA TO SERVE AS THE SURGERY DEPARTMENT, THE LIFESPAN GROUP OF HOSPITALS WOULD HAVE TO HIRE SURGEONS TO PERFORM THESE SERVICES. 0 249908 27060 177 1992 274799 233943 452 18482 2969 249908 233747 106 5073 4983 233943 211979 25028 2524 736 233747 192112 22023 1918 238 211979 1.00000 0 0 493081 227645 265436 1825961 1340584 485377 750813 INVESTMENTS - MUTUAL FUNDS 8246808 C 8246808 DEFERRED COMPENSATION 8246808 DUE TO OTHER FUNDS 970050 9216858 X 40186659 92 92 40186567 6462 6462 40193029 38556444 92 92 38556352 0 38556352 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. 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 USA. THE PRINCIPAL MAY NOT BE INVADED; AS A RESULT, THIS FUND IS CONSIDERED AN ENDOWMENT FUND. PART X, LINE 2: USA 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 USA AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2018, 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. USA IS NOT CURRENTLY SUBJECT TO AUDITS FOR ANY TAX PERIODS. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF ASSETS 92. PART XI, LINE 4B - OTHER ADJUSTMENTS: ADJUSTMENT FOR NON-DEDUCTIBLE EXPENSES FROM PASSTHROUGH ENTITY 6,462. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF ASSETS 92. 1 AMERICAN CANCER SOCIETY 931 JEFFERSON BLVD STE 3004 WARWICK RI 02886 131788491 501 (C) 3 5500 MAKING STRIDES AGAINST BREAST CANCER WALK RI HOSPITAL FOUNDATION BOX H PROVIDENCE RI 02901 050258954 501 (C) 3 71000 $50,000 - EVERY CHILD EVERY DAY CAMPAIGN - HASBORO CHILDREN'S HOSP $5,000 - AUBIN CENTER CHILD PROTECTION PROGRAM$5,000 - PURSUIT OF EXCELLENCE DINNER(2018)$5,000 - HASBRO CHILDREN'S HEROES BALL$5,000 - HASBRO CHILDREN'S HOSPITAL GOLF INVITATIONAL$1,000 - HASBRO INVITATIONAL FUND 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 CIOFFI MD WILLIAM PRESIDENT 493773 0 0 0 9575 0 39652 0 20178 0 563178 0 0 0 MIGLIORI MD STEPHEN VICE PRESIDENT 405628 0 0 0 3973 0 39853 0 25296 0 474750 0 0 0 KURKCHUBASHCE MD ARLET TREASURER/SECRETARY 356609 0 0 0 4705 0 39871 0 12803 0 413988 0 0 0 ADAMS MD CHARLES TRUSTEE 540795 0 0 0 3009 0 40105 0 25665 0 609574 0 0 0 CLOUTIER MD DAVID TRUSTEE 412097 0 0 0 2775 0 39702 0 25193 0 479767 0 0 0 HARRINGTON MD DAVID TRUSTEE 435628 0 0 0 5489 0 40214 0 20824 0 502155 0 0 0 NG MD THOMAS TRUSTEE 431628 0 0 0 2547 0 38713 0 21475 0 494363 0 0 0 SLAIBY MD JEFFREY TRUSTEE 395628 0 0 0 5481 0 39857 0 24816 0 465782 0 0 0 GRAY MD BRADFORD PHYSICIAN 401340 0 0 0 4578 0 39857 0 23745 0 469520 0 0 0 LUKS MD FRANCOIS PHYSICIAN 388128 0 0 0 5218 0 39860 0 19922 0 453128 0 0 0 MAZZAGLIA MD PETER PHYSICIAN 472859 0 0 0 4282 0 38713 0 10403 0 526257 0 0 0 MORRISSEY MD PAUL PHYSICIAN 401378 0 0 0 5171 0 40299 0 24453 0 471301 0 0 0 VALENTE MD JAMES PHYSICIAN 385000 0 0 0 6585 0 39864 0 3172 0 434621 0 0 0 ROYE MD G DEAN - FORMER TRUSTEE 279124 0 0 0 1288 0 30757 0 14769 0 325938 0 0 0 NEW ENGLAND MEDICAL BILLING THE PRESIDENT OF THE FOUNDATION, WILLIAM CIOFFI, MD, SITS ON THE BOARD. 1309148 BILLING FEES: THE FOUNDATION OWNS 40.54% OF NEW ENGLAND MEDICAL BILLING (NEMB). NEMB IS AN INDEPENDENT CONTRACTOR OF THE FOUNDATION. 0 THERESA A GRAVES MD EMPLOYEE IS MARRIED TO DR. WILLIAM CIOFFI, PRESIDENT OF UNIVERSITY SURGICAL 345000 COMPENSATION: THERESA A GRAVES, MD IS EMPLOYED BY UNIVERSITY SURGICAL ASSOCIATES, INC. 0 FORM 990, PART VI, SECTION B, LINE 11B 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.ORG. THE CONFLICT OF INTEREST POLICY WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: ADJUSTMENT FOR NON-DEDUCTIBLE EXPENSES FROM PASSTHROUGH ENTITY -6,462. FORM 990, PART XII, LINE 2C: COMMITTEE'S OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0