2017-10-11T08:56:31-05:00 2016-09-30 050353162 PICCERELLI GILSTEIN & CO LLP 144 WESTMINSTER STREET PROVIDENCE RI 029032282 990 2015-10-01 050486254 UNIVERSITY EMERGENCY MEDICINE FOUNDATION UNIV 4015191602 593 EDDY STREET NO 2ND FL PROVIDENCE RI 02903 BRIAN ZINK PRESIDENT 4015191602 2017-08-31 1 SHARON KENNEDY P00218909 4018310200 2015 2017-02-10 21:41:12Z X BRIAN ZINK 593 EDDY STREET NO 2ND FL PROVIDENCE RI 02903 53310234 0 X WWW.UEMF.ORG X 1995 RI EXCEPTIONAL EMERGENCY MEDICAL CARE, EDUCATION, RESEARCH, AND SERVICE TO THE PEOPLE OF RHODE ISLAND AND BEYOND. 10 2 355 0 0 0 0 49004 51689572 53068329 140635 143897 0 0 51830207 53261230 130500 192405 0 0 47455868 49211448 0 0 0 4280496 4660089 51866864 54063942 -36657 -802712 13323759 13312564 5588285 4926456 7735474 8386108 X TO PROVIDE EXCEPTIONAL EMERGENCY MEDICAL CARE, EDUCATION, RESEARCH, AND SERVICE TO THE PEOPLE OF RHODE ISLAND AND BEYOND. 0 0 51325574 192405 53068329 THE UNIVERSITY EMERGENCY MEDICINE FOUNDATION PROVIDES EMERGENCY MEDICAL SERVICES, CONDUCTS MEDICAL RESEARCH, AND EDUCATES MEDICAL RESIDENTS, FELLOWS, MEDICAL STUDENTS AND OTHERS. THE FOUNDATION PROVIDES THESE SERVICES THROUGH AFFILIATIONS WITH RHODE ISLAND HOSPITAL (RIH), HASBRO CHILDREN'S HOSPITAL (HASBRO), THE MIRIAM HOSPITAL (TMH), AND NEWPORT HOSPITAL. UNIVERSITY EMERGENCY MEDICINE FOUNDATION (UEMF) IS THE ACADEMIC EMERGENCY MEDICINE PHYSICIAN PRACTICE PLAN OF THE DEPARTMENT OF EMERGENCY MEDICINE AT THE ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY, LIFESPAN'S RHODE ISLAND HOSPITAL, AND THE MIRIAM HOSPITAL. WITH MORE THAN 100 FULL TIME PHYSICIANS AND 34 MID-LEVEL PROVIDERS, UEMF PROVIDES EMERGENCY DEPARTMENT STAFFING FOR RHODE ISLAND HOSPITAL, THE REGION'S ONLY LEVEL 1 TRAUMA CENTER, HASBRO CHILDREN'S HOSPITAL, THE STATE'S ONLY CHILDREN'S SPECIALITY HOSPITAL, THE MIRIAM HOSPITAL, WHICH IS A LEADING COMMUNITY TEACHING HOSPITAL, AND NEWPORT HOSPITAL. ALL UEMF MEMBER PHYSICIANS ARE BOARD CERTIFIED IN EMERGENCY MEDICINE OR PEDIATRIC EMERGENCY MEDICINE. DURING FISCAL YEAR 2016, UEMF PROVIDED EMERGENCY MEDICAL CARE TO 259,099 PATIENTS. IN ADDITION, 111 RESIDENTS AND FELLOWS RECEIVED TEACHING, 4,049 INDIVIDUALS RECEIVED TRAINING IN A SIMULATION CENTER, AND 57 RESIDENTS AND 73 MEDICAL STUDENTS FROM OTHER DEPARTMENTS ROTATED THROUGH THE EMERGENCY DEPARTMENT TO RECEIVE EDUCATION SERVICES. 51325574 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 25 0 355 1 0 0 0 0 0 0 0 0 0 0 X 10 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 X KEITH NEAL 4015191602 125 WHIPPLE STREET 3RD FLOOR PROVIDENCE RI 02908 BRAIN ZINK CHAIRMAN 40.00 X X 609901 0 66114 ANTHONY NAPOLI TREASURER 40.00 X X 344537 0 61217 JAMES MONTI SECRETARY 40.00 X X 336252 0 62156 FRANK OVERLY PEDI EM MEMBER AT LARGE 40.00 X 284708 0 66200 CATHERINE CUMMINGS DIRECTOR 40.00 X 294441 0 62895 ACHYUT MIHIR KAMAT DIRECTOR 40.00 X 315109 0 63178 GARY BUBLY PHYSICIAN 40.00 X 360445 0 64617 JAMIESON COHN PHYSICIAN 40.00 X 276226 0 60901 JOHN MURPHY DIRECTOR, EX-OFFICIO 1.00 X 0 0 0 GLENN TUNG DIRECTOR, EX-OFFICIO 1.00 X 0 0 0 GREGORY JAY PHYSICIAN 40.00 X 398147 0 64158 FRANCIS SULLIVAN PHYSICIAN 40.00 X 378623 0 48840 DANIEL SAVITT PHYSICIAN 40.00 X 358364 0 60591 BRIAN CLYNE PHYSICIAN 40.00 X 357356 0 61843 MICHAEL MELLO PHYSICIAN 40.00 X 354078 0 63778 MATTHEW KOPP FORMER DIRECTOR 40.00 X 285957 0 63711 MICHELLE DANIEL FORMER PHYSICIAN 40.00 X 195801 0 30445 5149945 0 900644 133 1 1 0 0 49004 49004 49004 PATIENT SERVICES 621400 46404919 46404919 RESEARCH GRANTS 621400 3378914 3378914 TEACHING AND ADMIN REV 621400 3025515 3025515 OTHER INCOME 621400 258981 258981 53068329 144788 144788 48113 49004 -891 -891 -891 53261230 53068329 0 143897 X 192405 192405 5823106 5741682 81424 34609686 33212691 1396995 3923412 3731122 192290 2983944 2689253 294691 1871300 1745551 125749 21025 21025 44165 44165 25000 25000 123033 107703 15330 103575 66900 36675 52404 17314 35090 215455 152345 63110 186 186 7344 2210 5134 115147 59602 55545 136314 90009 46305 MALPRACTICE INSURANCE 1415969 1415969 EDUCATIONAL PROGRAM EXP 653631 647631 6000 OUTSIDE SERVICES 607416 343594 263822 EXPENSES ASSOCIATED WIT 551622 551622 587803 557971 29832 54063942 51325574 2738368 0 1000593 3214585 523130 834308 274475 299720 1049765 499055 460404 550710 3361606 4901438 7703551 3511803 13323759 13312564 5588285 4926456 5588285 4926456 X 7735474 8386108 7735474 8386108 13323759 13312564 -802712 355184 1098162 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 25000 0 0 25000 0 PART II-B, LINE 1: OUTSIDE CONSULTING RELATED TO LOBBYING ACTIVITES. 112617 53824 58793 914719 445231 469488 22429 22429 550710 MONEY MARKET 3511803 C 3511803 X 53567410 355184 355184 53212226 49004 49004 53261230 54014938 0 54014938 49004 49004 54063942 PART X, LINE 2: THE FOUNDATION IS A SUPPORTING ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 509(A)(3) OF THE INTERNAL REVENUE CODE. THE FOUNDATION 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 FOUNDATION 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 FOUNDATION IS NOT CURRENTLY SUBJECT TO AUDITS FOR ANY TAX PERIODS. PART XI, LINE 4B - OTHER ADJUSTMENTS: SHARES OF PUBLICLY TRADED STOCK RECEIVED 49,004. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION MADE TO RHODE ISLAND HOSPITAL 49,004. 0 BROWN UNIVERSITY OFFICE OF BIOMEDICAL ADVANCEMENT PO BOX G-ADV PROVIDENCE RI 02912 050258937 501(C)(3) 60000 SUPPORT FOR THE CONSTRUCTION OF THE NEW BROWN MEDICAL SCHOOL BUILDING THE MIRIAM HOPSITAL FOUNDATION LIFESPAN DEVELOPMENT OFFICE PO BOX H PROVIDENCE RI 02901 050377502 501(C)(3) 55000 $5,000 - SILVER SPONSOR OF THE 2016 GALA $50,000 - ADVANCING EMERGENCY AND CARDIAC CARE: TMH CAMPAIGN FOR EXCELLENCE RHODE ISLAND HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 050258954 501(C)(3) 49004 TO FUND RESEARCH ACTIVITIES OF DR. ADAM CHODOBSKI AND DR. JOANNA SZMYDYNGER- CHODOBSKA. 3 3 1 X X X X 0 0 0 0 0 0 0 0 0 BRAIN ZINK CHAIRMAN 606289 0 0 0 3612 0 35000 0 31114 0 676015 0 0 0 ANTHONY NAPOLI TREASURER 344321 0 0 0 216 0 35000 0 26217 0 405754 0 0 0 JAMES MONTI SECRETARY 334992 0 0 0 1260 0 35000 0 27156 0 398408 0 0 0 FRANK OVERLY PEDI EM MEMBER AT LARGE 283448 0 0 0 1260 0 35000 0 31200 0 350908 0 0 0 CATHERINE CUMMINGS DIRECTOR 292509 0 0 0 1932 0 35000 0 27895 0 357336 0 0 0 ACHYUT MIHIR KAMAT DIRECTOR 314269 0 0 0 840 0 35000 0 28178 0 378287 0 0 0 GARY BUBLY PHYSICIAN 356833 0 0 0 3612 0 35000 0 29617 0 425062 0 0 0 JAMIESON COHN PHYSICIAN 275470 0 0 0 756 0 35000 0 25901 0 337127 0 0 0 GREGORY JAY PHYSICIAN 396215 0 0 0 1932 0 35000 0 29158 0 462305 0 0 0 FRANCIS SULLIVAN PHYSICIAN 367955 0 0 0 10668 0 35000 0 13840 0 427463 0 0 0 DANIEL SAVITT PHYSICIAN 357332 0 0 0 1032 0 35000 0 25591 0 418955 0 0 0 BRIAN CLYNE PHYSICIAN 356096 0 0 0 1260 0 35000 0 26843 0 419199 0 0 0 MICHAEL MELLO PHYSICIAN 350466 0 0 0 3612 0 35000 0 28778 0 417856 0 0 0 MATTHEW KOPP FORMER DIRECTOR 284697 0 0 0 1260 0 35000 0 28711 0 349668 0 0 0 MICHELLE DANIEL FORMER PHYSICIAN 195311 0 0 0 490 0 12794 0 17651 0 226246 0 0 0 X 1 49004 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE FOLLOWING PHYSICIANS ARE ELIGIBLE TO JOIN THE FOUNDATION AS MEMBERS, THOSE WHO: ARE MEMBERS OF THE STAFF ASSOCIATION OF RHODE ISLAND HOSPITAL (RIH) AND THE MIRIAM HOSPITAL (TMH), AND HOLD PROFESSIONAL STAFF APPOINTMENTS WITHIN THE DEPARTMENT OF EMERGENCY MEDICINE AT RIH OR THE DIVISION OF EMERGENCY MEDICINE AT TMH, AND EITHER HOLD A FACULTY APPOINTMENT IN THE BROWN UNIVERSITY MEDICAL SCHOOL (BROWN) OR HAVE BEEN EMPLOYEES BY THE FOUNDATION FOR LESS THAN ONE YEAR AND HAVE AGREED TO APPLY FOR A BROWN FACULTY APPOINTMENT, AND ARE APPROVED BY THE RIH CHIEF OF THE DEPARTMENT OF EMERGENCY MEDICINE AND THE FOUNDATION'S BOARD OF DIRECTORS, AND WILL BE EMPLOYED BY THE FOUNDATION TO CONDUCT THEIR PRACTICE OF MEDICINE EXCLUSIVELY ON BEHALF OF THE FOUNDATION, UNLESS OTHERWISE RECOMMENDED BY THE PRESIDENT AND APPROVED BY THE BOARD, AND WILL BE BOARD CERTIFIED OR BOARD ELIGIBLE IN EMERGENCY MEDICINE OR PEDIATRIC EMERGENCY MEDICINE, UNLESS OTHERWISE RECOMMENDED BY THE PRESIDENT AND APPROVED BY THE BOARD. EACH SUCH ELIGIBLE PHYSICIAN WHO HAS IN EFFECT AN EMPLOYMENT AGREEMENT WITH THE FOUNDATION SHALL BE A MEMBER OF THE FOUNDATION AS LONG AS THE EMPLOYMENT AGREEMENT IS IN A FORM APPROVED BY THE BOARD AND THE CHIEF OF EMERGENCY MEDICINE (RIH). FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL BE COMPRISED OF: THE CHIEF OF EMERGENCY MEDICINE, EX OFFICIO, WITH VOTING RIGHTS; THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF LIFESPAN CORPORATION, A RI NON-PROFIT CORPORATION, WHICH IS THE SOLE MEMBER OF RHODE ISLAND HOSPITAL, THE MIRIAM HOPSITAL, AND OTHER NON-PROFIT HEALTH CARE PROVIDERS, OR HIS/HER DESIGNEE, EX OFFICIO, WITH VOTING RIGHTS; THE DEAN OF MEDICINE OF BROWN UNIVERSITY MEDICAL SCHOOL OR HIS/HER DESIGNEE, EX OFFICIO, WITH VOTING RIGHTS; UP TO 8 MEMBERS ELECTED BY THE MEMBERS AT AN ANNUAL MEETING OR ANY SPECIAL MEETING HELD IN LIEU THEREOF BASED ON NOMINATIONS MADE BY THE NOMINATING COMMITTEE (EACH AN AT- LARGE DIRECTOR); AND UP TO 2 INDIVIDUALS ELECTED BY THE BOARD WHO ARE NOT EMPLOYED BY THE ORGANIZATION AND ARE NOT NECESSARILY PHYSICIANS, BASED ON NOMINATIONS FOR THE NOMINATING COMMITTEE (EACH AN "OUTSIDE DIRECTOR"). EACH MEMBER SHALL BE ENTITLED TO ONE VOTE AT ANNUAL AND SPECIAL MEETINGS OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THERE WILL BE AN ANNUAL MEETING OF THE MEMBERS HELD IN THE MONTH OF DECEMBER EACH YEAR. THERE MAY ALSO BE SPECIAL MEETINGS OF THE MEMBERS, WHICH CAN BE CALLED BY THE PRESIDENT, BY THE BOARD, OR BY 2/3 VOTE OF THE MEMBERS ENTITLED TO VOTE. THERE ARE REQUIREMENTS FOR PROVIDING NOTICE OF THE MEETINGS TO THE MEMBERS. EACH MEMBER SHALL BE ENTITLED TO ONE VOTE. VACANCIES IN THE BOARD OR IN ANY CORPORATE OFFICE MAY BE FILLED BY ELECTION BY THE REMAINING DIRECTORS AT ANY REGULAR OR SPECIAL MEETING, BUT IF A VACANCY EXISTS AT THE TIME OF ANY MEMBERS MEETING, IT SHALL BE FILLED BY ELECTION AT SAID MEETING. AN AT-LARGE DIRECTOR MAY BE REMOVED FROM OFFICE WITH OR WITHOUT CAUSE AT ANY ANNUAL, REGULAR, OR SPECIAL MEETING OF MEMBERS BY VOTE OF AT LEAST 2/3 OF THE MEMBERS ENTITLED TO VOTE IN THE ELECTION OF SUCH DIRECTORS AND PRESENT IN PERSON OR BY PROXY AT A MEETING IN WHICH A QUORUM (MAJORITY) IS PRESENT, OR FOR CAUSE BY A VOTE OF A MAJORITY OF THE DIRECTORS THEN IN OFFICE AND PRESENT AT A MEETING IN WHICH A QUORUM IS PRESENT; PROVIDED, HOWEVER THAT A DIRECTOR MAY BE REMOVED FOR CAUSE ONLY AFTER REASONABLE NOTICE AND OPPORTUNITY TO BE HEARD BEFORE THE BODY PROPOSING TO REMOVE HIM/HER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE EXTERNAL AUDITORS AND REVIEWED BY MANAGEMENT AND THE AUDIT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS PROVIDED TO ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES. THESE PEOPLE ARE ASKED TO REVIEW THE POLICY AND SIGN A STATEMENT INDICATING THAT THEY UNDERSTAND THE POLICY, HAVE REPORTED ALL POTENTIAL CONFLICTS DURING THE PAST YEAR IN ACCORDANCE WITH THE POLICY AND WILL REPORT ALL POTENTIAL CONFLICTS DURING THE COMING YEAR. ALL POTENTIAL CONFLICTS ARE EVALUATED BY THE BOARD TO DETERMINE IF A CONFLICT ACUTALLY EXISTS (AN ATTORNEY IS PRESENT AT EACH BOARD MEETING). IN THOSE INSTANCES WHERE THE POTENTIAL TRANSACTION IS A CONFLICT, THE BOARD EXAMINES THE TRANSACTION AND A VOTE IS TAKEN (WITH THOSE INVOLVED RECUSING THEMSELVES) AS TO WHETHER THE ORGANIZATION WILL ENTER INTO THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT COMPENSATION COMMITTEE CONDUCTS A PERFORMANCE REVIEW AND EVALUATION OF ALL MEMBER COMPENSATION, INCLUDING THE PRESIDENT. THIS PROCESS INVOLVES THE EVALUATION OF THE INDIVIDUAL AND A REVIEW OF COMPENSATION OF COMPARABLE POSITIONS OBTAINED FROM PUBLISHED SURVEYS OF INDUSTRY DATA. THE COMMITTEE'S DELIBERATION AND DECISION IS NOTED IN THE MINUTES OF THE MEETING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS (ARTICLES OF INCORPORATION AND BY-LAWS, INCLUDING ITS CONFLICT OF INTEREST POLICY) AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE ORGANIZATION WILL MAIL COPIES UPON REQUEST OR PROVIDE COPIES TO THOSE WHO COME TO THE ADMINISTRATIVE OFFICE DURING NORMAL BUSINESS HOURS. THE ORGANIZATION CHARGES FOR THE COPIES IN ACCORDANCE WITH IRS REGULATIONS. FORM 990, PART IX, LINE 24C COLUMN C AN AMENDED RETURN IS BEING FILED TO CORRECT THE AMOUNT OF TOTAL GENERAL AND ADMINISTRATIVE OUTSIDE SERVICES THAT WERE OVERSTATED BY $50,000 DUE TO A CLERICAL ERROR ON LINE 24B OF FORM 990 PAGE 10 AND THE RELATED EXPENSE LINES ON THE FORM 990.