2017-02-13T12:27:11-06:00 2016-09-30 050353162 PICCERELLI GILSTEIN & CO LLP 144 WESTMINSTER STREET PROVIDENCE RI 029032282 990 2015-10-01 050389803 UNIVERSITY SURGICAL ASSOCIATES INC UNIV 4014539623 PO BOX 16149 RUMFORD RI 02916 WILLIAM CIOFFI MD PRESIDENT 4014446290 2017-02-11 1 SHARON KENNEDY P00218909 4018310200 2015 2021-01-29 14:40:06Z WILLIAM CIOFFI MD PO BOX 16149 RUMFORD RI 02916 49535446 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 0 234 0 0 0 970 0 36405084 36737503 2793538 450902 68264 -13762 39267856 37174643 190500 76210 0 0 31121832 31315592 0 0 126742 6303451 6227918 37615783 37619720 1652073 -445077 31512744 33344928 5883048 8160309 25629696 25184619 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 29005737 76210 36737503 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. 29005737 1 0 0 0 0 0 0 0 0 1 1 1 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 1 0 0 0 0 1 50 0 1 234 1 1 1 0 0 0 0 0 0 0 X 8 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X AMY HICKEY 4014539623 75 NEWMAN AVE PO BOX 16149 RUMFORD RI 02916 CIOFFI MD WILLIAM PRESIDENT 40.00 X X 512069 0 67610 MIGLIORI MD STEPHEN VICE PRESIDENT 40.00 X X 413948 0 45192 KURKCHUBASHCE MD ARLET TREASURER/SECRETARY 40.00 X X 351211 0 47891 SLAIBY MD JEFFREY TRUSTEE 40.00 X 397205 0 69865 HARRINGTON MD DAVID TRUSTEE 40.00 X 425291 0 68496 NG MD THOMAS TRUSTEE 40.00 X 465655 0 58540 ROYE MD G DEAN TRUSTEE 40.00 X 385408 0 64900 ADAMS MD CHARLES TRUSTEE 40.00 X 479337 0 70695 NICASTRI MD GUY PHYSICIAN 40.00 X 416248 0 67981 CLOUTIER MD DAVID PHYSICIAN 40.00 X 394381 0 72087 LUKS MD FRANCOIS PHYSICIAN 40.00 X 363036 0 65709 MORRISSEY MD PAUL PHYSICIAN 40.00 X 386388 0 67158 VREES MD MATTHEW PHYSICIAN 40.00 X 363284 0 43591 MARCACCIO MD EDWARD PHYSICIAN/ FORMER OFFICER 40.00 X 701026 0 65968 6054487 0 875683 70 1 1 0 NEW ENGLAND MEDICAL BILLNG INC 75 NEWMAN AVE SUITE 100 RUMFORD RI 02916 MEDICAL BILLING SERVICES 961932 CITY PERSONNEL INC 226 BROADWAY PROVIDENCE RI 02903 TEMPORARY EMPLOYEE SERVICE 136834 2 PATIENT FEES 621110 19550400 19550400 CONTRACT REVENUE - RI HOSPITAL 621110 7003864 7003864 OTHER INCOME - SURGERY 621110 5119164 5119164 CONTRACTUAL REVENUE - MIRIAM HOSP 621110 3044010 3044010 OTHER CONTRACT REVENUE 621110 808172 808172 1211893 1211893 36737503 754755 754755 24720 38482 -13762 -13762 -13762 12018468 12322321 -303853 -303853 -303853 37174643 36737503 0 437140 76210 76210 4606698 2929049 1646512 31137 20178889 15601175 4510341 67373 2711694 2087968 614209 9517 2553120 1965435 578566 9119 1265191 973438 287072 4681 52307 52307 33436 33436 96919 96919 1223483 1138998 84485 2069331 1706363 362968 29963 29963 7833 7833 197649 192002 5647 1051141 840221 206005 4915 OUTSIDE SERVICES 628585 628585 SUPPORT SERVICES 521880 417504 104376 INVESTMENT AND BANK FEE 137218 137218 LICENSES AND PERMITS 78817 78817 99356 98039 1317 37619720 29005737 8487241 126742 1175375 1631687 1220915 2402278 131514 157080 2415730 1841763 758792 573967 22046084 20094052 5618923 6500788 27524 32017 533617 1953059 31512744 33344928 41280 37433 218513 154035 5623255 7968841 5883048 8160309 X 3706011 3624690 21689938 21325986 233747 233943 25629696 25184619 31512744 33344928 -445077 0 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 0 0 0 233747 106 5073 4983 233943 211979 25028 2524 736 233747 192112 22023 1918 238 211979 175293 249 18320 1750 192112 152515 17500 6679 1316 85 175293 1.00000 0 0 12000 12000 374829 257264 117565 275427 197178 78249 1753474 1387321 366153 573967 INVESTMENTS - MUTUAL FUNDS 6500788 C 6500788 DEPOSITS 39134 GOODWILL - NET 148003 ADVANCE TO NEMB 297964 DUE FROM OTHER FUNDS 1467958 1953059 DEFERRED COMPENSATION 6500788 DUE TO OTHER FUNDS 1467958 DUE TO UCSA 95 7968841 X 37492258 317615 317615 37174643 0 37174643 37937335 317615 317615 37619720 0 37619720 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: THE ORGANIZATION 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 THE ORGANIZATION, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2016, 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. THE ORGANIZATION IS NOT CURRENTLY SUBJECT TO AUDITS FOR ANY TAX PERIODS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL LOSS 13,762. LOSS ON SALE OF INVESTMENTS 303,853. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL LOSS 13,762. LOSS ON SALE OF INVESTMENTS 303,853. 1 THE MIRIAM HOSPITAL PO BOX H PROVIDENCE RI 02901 050258905 501 (C) 3 5000 GALA SPONSORSHIP- SILVER SPONSOR AMERICAN CANCER SOCIETY 931 JEFFERSON BLVD STE 3004 WARWICK RI 02886 131788491 501 (C) 3 5000 MAKING STRIDES KICK OFF BREAKFAST AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY 100 SW 75TH ST SUITE 201 GAINESVILLE FL 32607 521203109 501 (C) 3 5000 WALK FOR OBESITY SPONSORSHIP RI HOSPITAL FOUNDATION BOX H PROVIDENCE RI 02901 050258954 501 (C) 3 15700 HASBRO GOLF TOURNAMENT, HASBRO BALL AND PURSUIT OF EXCELLENCE DINNER THE IZZY FOUNDATION INC PO BOX 2326 PROVIDENCE RI 02906 453459440 501 (C) 3 5000 GALA SPONSORSHIP THE PHOENIX SOCIETY INC 1835 RW BERENDS DRIVE SW GRAND RAPIDS MI 49519 232062352 501 (C) 3 5500 DONATION-WORLD BURN CONGRESS THE TOMORROW FUND RIH DEVELOPMENT OFFICE PO BOX H PROVIDENCE RI 02901 050450569 501 (C) 3 5000 FANTASY BALL-BRONZE UNIVERSITY CARDIOVASCULAR SURGICAL ASSOCIATES INC PO BOX 16149 RUMFORD RI 02916 263750378 501 (C) 3 10000 DONATIONDONATION 8 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 503775 0 0 0 8294 0 42555 0 25055 0 579679 0 0 0 MIGLIORI MD STEPHEN VICE PRESIDENT 409772 0 0 0 4176 0 41284 0 3908 0 459140 0 0 0 KURKCHUBASHCE MD ARLET TREASURER/SECRETARY 346609 0 0 0 4602 0 33711 0 14180 0 399102 0 0 0 SLAIBY MD JEFFREY TRUSTEE 391878 0 0 0 5327 0 41790 0 28075 0 467070 0 0 0 HARRINGTON MD DAVID TRUSTEE 421878 0 0 0 3413 0 41421 0 27075 0 493787 0 0 0 NG MD THOMAS TRUSTEE 461908 0 0 0 3747 0 41192 0 17348 0 524195 0 0 0 ROYE MD G DEAN TRUSTEE 383128 0 0 0 2280 0 40825 0 24075 0 450308 0 0 0 ADAMS MD CHARLES TRUSTEE 476378 0 0 0 2959 0 41120 0 29575 0 550032 0 0 0 NICASTRI MD GUY PHYSICIAN 412239 0 0 0 4009 0 41484 0 26497 0 484229 0 0 0 CLOUTIER MD DAVID PHYSICIAN 392128 0 0 0 2253 0 41302 0 30785 0 466468 0 0 0 LUKS MD FRANCOIS PHYSICIAN 358128 0 0 0 4908 0 41372 0 24337 0 428745 0 0 0 MORRISSEY MD PAUL PHYSICIAN 383128 0 0 0 3260 0 41953 0 25205 0 453546 0 0 0 VREES MD MATTHEW PHYSICIAN 360000 0 0 0 3284 0 41372 0 2219 0 406875 0 0 0 MARCACCIO MD EDWARD PHYSICIAN/ FORMER OFFICER 696928 0 0 0 4098 0 40693 0 25275 0 766994 0 0 0 NEW ENGLAND MEDICAL BILLING THE PRESIDENT OF THE FOUNDATION, WILLIAM CIOFFI, MD, SITS ON THE BOARD. 961932 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 323962 WAGES: THERESA A GRAVES, MD IS EMPLOYED BY UNIVERSITY SURGICAL ASSOCIATES, INC. 0 FORM 990, PART VI, SECTION A, LINE 6 PER THE ARTICLES OF INCORPORATION, THE CORPORATION SHALL BE A MEMBERSHIP CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A PER THE ARTICLES OF INCORPORATION, THE MEMBERSHIP SHALL CONSIST INITIALLY OF THE MEMBERS NAMED IN THE BY-LAWS TO BE ADOPTED BY THE INCORPORATORS AND OF SUCH ADDITIONAL MEMBERS AS MAY THEREAFTER BE ELECTED TO MEMBERSHIP FROM TIME TO TIME UPON SUCH TERMS AND CONDITIONS AS THE BY-LAWS SHALL SET FORTH. FORM 990, PART VI, SECTION A, LINE 7B PER THE ARTICLES OF INCORPORATION, THE AFFAIRS AND BUSINESS OF THE CORPORATION SHALL BE MANAGED BY A BOARD OF TRUSTEES. THE TRUSTEES AND OFFICERS OF THE CORPORATION, TERMS OF OFFICE, METHOD OF SELECTION, RESPECTIVE DUTIES, AND ALL THINGS PERTAINING THERETO, SHALL BE AS DEFINED AND ESTABLISHED BY THE BY-LAWS. FORM 990, PART VI, SECTION B, LINE 11 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 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND 990 OF THE ORGANIZATION ARE MADE AVAILABLE TO THE PUBLIC ON GUIDESTAR.ORG. THE CONFLICT OF INTEREST POLICY WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 1: THE ORGANIZATION MAINTAINS ITS BOOKS ON THE MODIFIED CASH METHOD OF ACCOUNTING. FORM 990, PART XII, LINE 2C: COMMITTEE'S OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. USA PAWTUCKET PROPERTIES LLC (DISREGARDED ENTITY) 15 HAZEL STREET PAWTUCKET RI 02860 261855890 RENTAL PROPERTY RI -13762 471134 UNIVERSITY SURGICAL ASSOCIATES INC