2019-05-14T14:54:38-05:00 2018-06-30 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2017-07-01 203889761 UPSTATE COMMUNITY MEDICAL PC UPST 3156349272 4900 BROAD ROAD NO 1507 SYRACUSE NY 13215 MATTHEW GLIDDEN MD DIRECTOR 3154925140 2019-05-10 1 ANGELA M FRANCO P00589741 3154463600 2019-05-10 24.39.85.114 2019-05-10 14:11:36 ED P 7E9C33F7C5CD1DA8693DD78F29AF2560BCFF7C5D FD62137317EE26C9F26E40FD83CAC65FE1294EC8 2017 2019-02-21 02:37:17Z MATTHEW GLIDDEN MD 750 EAST ADAMS STREET SYRACUSE NY 13215 19015746 0 X WWW.UPSTATE.EDU/COMMUNITY/UCM/ X 2005 NY THE ROLE OF UPSTATE COMMUNITY MEDICAL, P.C. (UCM) IS TO PROVIDE A COMPREHENSIVE SOURCE FOR ACUTE MEDICAL CARE AND RELATED SERVICES TO ADVANCE THE MISSION OF UPSTATE MEDICAL UNIVERSITY OF NEW YORK. UCM WAS FORMED FOR THE CHARITABLE PURPOSE OF SERVING THE HEALTH CARE NEEDS OF THE COMMUNITY SERVICED BY THE HOSPITAL AND ADVANCING THE CHARITABLE PURPOSE OF THE UNIVERSITY. 1 0 115 0 3420 2420 0 0 17004406 18980209 2967 2487 33535 33050 17040908 19015746 0 0 0 0 7961378 9803156 0 0 0 9296281 9505172 17257659 19308328 -216751 -292582 5959673 4103036 7536043 6026276 -1576370 -1923240 X THE ROLE OF UPSTATE COMMUNITY MEDICAL, P.C. IS TO PROVIDE A COMPREHENSIVE SOURCE FOR ACUTE MEDICAL CARE AND RELATED SERVICES TO UNINSURED AND UNDERINSURED INDIVIDUALS IN THE COMMUNITY. 0 0 4541726 4473542 HOSPITALIST SERVICE - PROVIDED ACUTE MEDICAL CARE FOR THE PATIENTS OF UPSTATE UNIVERSITY HOSPITAL COMMUNITY CAMPUS. 1672459 1641355 SURGICAL PHYSICIANS' ASSISTANT SERVICE - PROVIDED SKILLED MEDICAL SERVICES FOR PHYSICIANS PERFORMING SURGICAL PROCEDURES AT THE UPSTATE UNIVERSITY HOSPITAL COMMUNITY CAMPUS. 2129041 2030739 OBGYN HOSPITALIST SERVICE - PROVIDED OB/GYN HEALTHCARE SERVICES TO THE UPSTATE UNIVERSITY HOSPITAL COMMUNITY CAMPUS. 10193058 10864203 OTHER PROGRAM SERVICES 10193058 10864203 18536284 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 15 0 1 115 1 1 1 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X ROBERT J CALNON 3154721488 1001 W FAYETTE STREET SYRACUSE NY 13204 X MATTHEW GLIDDEN OFFICER 40.00 X X 0 0 0 MARY ELLEN GRECO MD PHYSICIAN 40.00 X 279191 0 10800 KRISTINE M KEENEY MD PHYSICIAN 40.00 X 260000 0 10400 ALFREDO LOPEZ MD PHYSICIAN 40.00 X 225000 0 9000 KENNETH K RHEE PHYSICIAN 40.00 X 259615 0 10385 HOWARD M WEINSTEIN PHYSICIAN 40.00 X 235000 0 0 1258806 0 40585 36 0 1 0 DEPARTMENT OF MEDICINE MEDICAL SERVICE 550 E GENESEE ST SUITE 201 SYRACUSE NY 13202 PROFESSIONAL MEDICAL SERVICES 3774326 CHAG ANESTHESIA GROUP 5000 BRITTONFIELD PARKWAY EAST SYRACUSE NY 13057 PROFESSIONAL MEDICAL SERVICES 2872912 SYRACUSE ORTHOPEDIC SPECIALIST 5824 WIDEWATERS PARKWAY EAST SYRACUSE NY 13057 PROFESSIONAL MEDICAL SERVICES 665975 PRACTICE RESOURCES LLC 1001 W FAYETTE ST SYRACUSE NY 13204 ADMINISTRATIVE AND BILLING SERVICES 512810 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PROFESSIONAL MEDICAL SERVICES 144261 6 PROFESSIONAL SERVICE AGREEMENT - 621110 13684989 13684989 PROFESSIONAL SERVICES 621110 5295220 5295220 18980209 2487 2487 DISALLOWED FRINGE BENEFITS 900099 3420 3420 29630 29630 33050 19015746 19009839 3420 2487 8375979 8375979 272234 272234 587301 587301 567642 567642 138000 138000 9677 9677 22130 22130 148335 148335 79555 79555 331513 331513 214731 214731 3056 3056 87278 87278 13937 13937 456964 456964 PURCHASED SERVICES 7571136 7141091 430045 BILLING FEES 341999 341999 BAD DEBT EXPENSE 45815 45815 PERMITS, LICENSES, DUES 35572 35572 5474 5474 19308328 18536284 772044 0 2360935 716497 409726 274938 60318 75912 38291 46644 94395 70004 38329 24391 3052074 2964654 5959673 4103036 4806301 885839 2729742 5140437 7536043 6026276 X 100 10 0 90 -1576470 -1923340 -1576370 -1923240 5959673 4103036 -292582 -54288 0 X X 0 1 X 1 0 X 5881986 13271243 17004406 18980209 55137844 5881986 13271243 17004406 18980209 55137844 0 0 0 55137844 1454 3090 2967 2487 9998 1454 3090 2967 2487 9998 112394 33535 33050 178979 5883440 13386727 17040908 19015746 55326821 X 94395 70004 24391 24391 DUE FROM UNIVERSITY HOSPITAL 2964654 2964654 DUE TO RELATED PARTIES 5140437 5140437 X 19012326 0 19012326 3420 3420 19015746 19308328 0 19308328 0 19308328 PART X, LINE 2: THE FINANCIAL STATEMENTS DO NOT GIVE CONSIDERATION FOR FEDERAL AND STATE INCOME TAXES AS THE CORPORATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). AS OF JUNE 30, 2018 AND 2017, THE CORPORATION DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2015 THROUGH 2018. PART XI, LINE 4B - OTHER ADJUSTMENTS: DISALLOWED FRINGE BENEFITS 3,420. X X X X X 0 0 0 0 0 0 0 0 0 MARY ELLEN GRECO MD PHYSICIAN 279191 0 0 0 0 0 0 0 10800 0 289991 0 0 0 KRISTINE M KEENEY MD PHYSICIAN 260000 0 0 0 0 0 0 0 10400 0 270400 0 0 0 ALFREDO LOPEZ MD PHYSICIAN 225000 0 0 0 0 0 0 0 9000 0 234000 0 0 0 KENNETH K RHEE PHYSICIAN 259615 0 0 0 0 0 0 0 10385 0 270000 0 0 0 HOWARD M WEINSTEIN PHYSICIAN 235000 0 0 0 0 0 0 0 0 0 235000 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS DISTRIBUTED FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER AND MEMBER OF A COMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS READ, UNDERSTANDS, AND HAS COMPLIED WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 BASE SALARY USING COMPARISON DATA AND BONUS OR INCENTIVE COMPENSATION IS BASED ON WRVU ESTABLISHED BY THE FEDERAL GOVERNMENT, TIME, SKILL, AND TRAINING. PERIODIC REVIEWS SHALL BE CONDUCTED REGARDING COMPENSATION AND BENEFIT ARRANGMENTS FOR REASONABLENESS AND CONFORMITY OF CONTRACTS FOR REASONABLE PAYMENT. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTE IS RESPONSIBLE FOR OVERSEEING THE SELECTION OF THE INDEPENDENT ACCOUNTANT. SUNY UPSTATE UNIVERSITY HOSPITAL 750 E ADAMS STREET SYRACUSE NY 13210 161469571 PATIENT CARE NY 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 SUNY UPSTATE UNIVERSITY HOSPITAL L 13465346 PROFESSIONAL SERVICES AGREEMENT SUNY UPSTATE UNIVERSITY HOSPITAL M 430045 ADMIN SERVICES AGREEMENT