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UNIVERSITY SURGICAL ASSOCIATES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
UNIVERSITY SURGICAL ASSOCIATES INC (EIN 05-0389803)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-02-10
IRS object ID
201440419349300849
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-02-10T11:45:26-06:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN050353162EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PICCERELLI GILSTEIN & CO LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1144 WESTMINSTER STREETAddressLine1
CityPROVIDENCECity
StateRIState
ZIP Code029032282ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN050389803EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNIVERSITY SURGICAL ASSOCIATES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlUNIVNameControl
Phone4014446290Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1593 EDDY STREET APC 451AddressLine1
CityPROVIDENCECity
StateRIState
ZIP Code02903ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWILLIAM CIOFFI MDName
TitlePRESIDENTTitle
Phone4014446290Phone
Date Signed2014-01-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOHN M MATHIASName
PTINP00008458PTIN
Phone4018310200Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonWILLIAM CIOFFI MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1593 EDDY STREET APC 451AddressLine1
CityPROVIDENCECity
StateRIState
ZIP Code02903ZIPCode
FieldValueIRS element (for citing)
Gross Receipts47413927GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.USASURG.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1980YearFormation
State Legal DomicileRIStateLegalDomicile
Activity Or Mission DescriptionUNIVERSITY 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees187TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income-23373NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year18850ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year31627497ProgramServiceRevenuePriorYear
Program Service Revenue CY32733486ProgramServiceRevenueCY
Investment Income Prior Year860990InvestmentIncomePriorYear
Investment Income Current Year2120787InvestmentIncomeCurrentYear
Other Revenue Prior Year77199OtherRevenuePriorYear
Other Revenue Current Year71211OtherRevenueCurrentYear
Total Revenue Prior Year32584536TotalRevenuePriorYear
Total Revenue Current Year34925484TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year255700GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY276750GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year24994891SalariesEtcPriorYear
Salaries Etc Current Year26437741SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year151185TotalFundrsngExpCurrentYear
Other Expense Prior Year5942637OtherExpensePriorYear
Other Expenses Current Year6197963OtherExpensesCurrentYear
Total Expenses Prior Year31193228TotalExpensesPriorYear
Total Expenses Current Year32912454TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1391308RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2013030RevenuesLessExpensesCY
Total Assets BOY24703282TotalAssetsBOY
Total Assets EOY27334560TotalAssetsEOY
Total Liabilities BOY3947414TotalLiabilitiesBOY
Total Liabilities EOY4565662TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY20755868NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY22768898NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionUNIVERSITY 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense25546329Expense
Grants276750Grants
Revenue32747707Revenue
DescriptionPROVIDES 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.Description
Total Program Service Expense25546329TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109633NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees187NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HELEN REIDBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4014446290TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line175 NEWMAN AVENUEAddressLine1
CityRUMFORDCity
StateRIState
ZIP Code02916ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JEFFREY SLAIBY MD
TRUSTEE40.00X383727043224
G DEAN ROYE MD
TRUSTEE40.00X362648052051
ARLET KURKCHUBASHCE MD
TRUSTEE40.00X306597052177
WILLIAM CIOFFI MD
PRESIDENT40.00455547035778X
EDWARD MARCACCIO MD
VICE PRESIDENT40.00691266058318X
THOMAS F TRACY JR MD
TREASURER40.00498604058870X
STEPHEN MIGLIORI MD
SECRETARY40.00415546043864X
DAVID HARRINGTON MD
PHYSICIAN40.00360685017224X
VICTOR PRICOLO MD
PHYSICIAN40.00432403035299X
OREST ZAKLYNSKY MD
PHYSICIAN40.00658064059541X
THOMAS NG MD
PHYSICIAN40.00439051056008X
CHARLES ADAMS
PHYSICIAN40.00408081053450X
ELIZABETH ALTENHEIN MD
PHYSICIAN40.00371248020231X
PAUL MORRISSEY MD
PHYSICIAN40.00357251058342X
FieldValueIRS element (for citing)
Total Reportable Comp From Org6140718TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation644377TotalOtherCompensation
Number Individuals GT100 K14NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1NEW ENGLAND MEDICAL BILLING INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line175 NEWMAN AVE SUITE 100AddressLine1
CityRUMFORDCity
StateRIState
ZIP Code02916ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesBILLING SERVICESDescriptionOfServices
Compensation820795Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT FEES6211101690049216900492
CONTRACT REVENUE - RI HOSPITAL62111087478888747888
CONTRACTUAL REVENUE - MIRIAM HOSP62111030212233021223
OTHER INCOME - SURGERY62111017216251721625
OTHER CONTRACT REVENUE621110846037846037

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column1496221TotalRevenueColumn
Related Or Exempt Function Income1496221RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue32733486TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column878602TotalRevenueColumn
Exclusion$878,602ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real102000Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real30789Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real71211Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column71211TotalRevenueColumn
Exclusion$71,211ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities13699839Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities12456045Securities
Other1609Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1243794Securities
Other-1609Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1242185TotalRevenueColumn
Related Or Exempt Function Income-1609RelatedOrExemptFunctionIncome
Exclusion$1,243,794ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column34925484TotalRevenueColumn
Related Or Exempt Function Income32747707RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,193,607ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total276750Total
Program Services276750ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3551009Total
Program Services2045026ProgramServices
Management And General1473314ManagementAndGeneral
Fundraising32669Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total17434926Total
Program Services13826745ProgramServices
Management And General3526624ManagementAndGeneral
Fundraising81557Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2174885Total
Program Services1640484ProgramServices
Management And General522605ManagementAndGeneral
Fundraising11796Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2216212Total
Program Services1676121ProgramServices
Management And General528123ManagementAndGeneral
Fundraising11968Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1060709Total
Program Services802214ProgramServices
Management And General252767ManagementAndGeneral
Fundraising5728Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total31424Total
Management And General31424ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total47889Total
Management And General47889ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total129898Total
Program Services129898ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total42596Total
Program Services42596ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1142423Total
Program Services1064556ProgramServices
Management And General77867ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1714489Total
Program Services1414693ProgramServices
Management And General299796ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total25862Total
Program Services25345ProgramServices
Management And General517ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total5371Total
Program Services5371ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total193122Total
Program Services187610ProgramServices
Management And General5512ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1297500Total
Program Services931188ProgramServices
Management And General358845ManagementAndGeneral
Fundraising7467Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
OUTSIDE SERVICES10040101004010
SUPPORT SERVICES43917635134187835
DUES AND SUBSCRIPTIONS91086892641822
LICENSES AND PERMITS2564425644

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total7473Total
Program Services7473ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total32912454Total
Program Services25546329ProgramServices
Management And General7214940ManagementAndGeneral
Fundraising151185Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1244491BOY
EOY945952EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1413734BOY
EOY480343EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY43829BOY
EOY90628EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2388752LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1555277LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY695473BOY
EOY833475EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17053802BOY
EOY20070642EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3777743BOY
EOY4273616EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY474210BOY
EOY639904EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY24703282BOY
EOY27334560EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY19824BOY
EOY28152EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY118847BOY
EOY211228EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3808743BOY
EOY4326282EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3947414BOY
EOY4565662EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3294403BOY
EOY3638704EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY17286172BOY
EOY18938082EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY175293BOY
EOY192112EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20755868BOY
EOY22768898EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY24703282BOY
EOY27334560EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2013030ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1RHODE ISLAND HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
EIN050258954EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance175293BeginningOfYearBalance
Contributions249Contributions
Investment Earnings Or Losses18320InvestmentEarningsOrLosses
Other Expenditures1750OtherExpenditures
End Of Year Balance192112EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance152515BeginningOfYearBalance
Contributions17500Contributions
Investment Earnings Or Losses6679InvestmentEarningsOrLosses
Other Expenditures1316OtherExpenditures
Administrative Expenses85AdministrativeExpenses
End Of Year Balance175293EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance155665BeginningOfYearBalance
Investment Earnings Or Losses5180InvestmentEarningsOrLosses
Other Expenditures5632OtherExpenditures
Administrative Expenses2698AdministrativeExpenses
End Of Year Balance152515EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance152711BeginningOfYearBalance
Investment Earnings Or Losses6142InvestmentEarningsOrLosses
Other Expenditures3188OtherExpenditures
End Of Year Balance155665EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance171221BeginningOfYearBalance
Investment Earnings Or Losses-13362InvestmentEarningsOrLosses
Other Expenditures5148OtherExpenditures
End Of Year Balance152711EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis12000OtherCostOrOtherBasis
Book Value12000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis374829OtherCostOrOtherBasis
Depreciation214918Depreciation
Book Value159911BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis268435OtherCostOrOtherBasis
Depreciation185756Depreciation
Book Value82679BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1733488OtherCostOrOtherBasis
Depreciation1154603Depreciation
Book Value578885BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings833475TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionDEFERRED COMPENSATION AGREEMENTDescription
Book Value4273616BookValue
Method Of ValuationCMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities4273616TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DEFERRED COMPENSATION$4,273,616
DUE TO OTHER FUNDS$52,666
FieldValueIRS element (for citing)
Total Of Amounts4326282TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt34927093TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal34927093RevenueSubtotal
Other Revenues Not Included-1609OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-1609RevenueNotRptdOnFinStmt
Total Revenue Per Form99034925484TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt32914063TotExpensesEtcAuditedFinclStmt
Other Expenses Included1609OtherExpensesIncluded
Expenses Not Rptd F9901609ExpensesNotRptdF990
Expenses Subtotal32912454ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99032912454TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: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.
PART XI, LINE 4B - OTHER ADJUSTMENTS:LOSS ON DISPOSAL OF ASSET -1,609.
PART XII, LINE 2D - OTHER ADJUSTMENTS:LOSS ON DISPOSAL OF ASSET 1,609.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
HASBRO CHILDREN'S HOSPITAL
593 EDDY STREETPROVIDENCERI02903581563444501 (C) 35000CHILDREN HOSPITALHOSPITAL GALA/ MEDICAL
THE PHOENIX SOCIETY
1835 RW BERENDS DR SWGRAND RAPIDSMI49519232062352501 (C) 330000MEDICAL
THE MIRIAM HOSPITAL
164 SUMMIT AVEPROVIDENCERI02906050258905501 (C) 335000MEDICAL
THE TOMORROW FUND
593 EDDY STREETPROVIDENCERI02903050450569501 (C) 310000CANCER RESEARCH
NEWPORT HOSPITAL FOUNDATION
11 FRIENDSHIP STREETNEWPORTRI02840222535533501 (C) 35000MEDICAL
RHODE ISLAND HOSPITAL FOUNDATION
PO BOX HPROVIDENCERI02901050258954501 (C) 3115000MEDICAL
BROWN UNIVERSITY
BOX G-ADVPROVIDENCERI02912050258809501 (C) 350000EDUCATION
IZZY FOUNDATION
PO BOX 2326PROVIDENCERI02906453459440501 (C) 311250GENERAL DONATIONS
AMERICAN CANCER SOCIETY
931 JEFFERSON BLVDWARWICKRI02886131788491501 (C) 35000CANCER RESEARCH

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
ExplanationOUR 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 CHECKSExplanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JEFFREY SLAIBY MD
TRUSTEE38372700000225000207240426951000
G DEAN ROYE MD
TRUSTEE36264800000340000180510414699000
ARLET KURKCHUBASHCE MD
TRUSTEE30659700000395000126770358774000
WILLIAM CIOFFI MD
PRESIDENT45554700000170000187780491325000
EDWARD MARCACCIO MD
VICE PRESIDENT69126600000395000188180749584000
THOMAS F TRACY JR MD
TREASURER49860400000395000193700557474000
STEPHEN MIGLIORI MD
SECRETARY4155460000039500043640459410000
DAVID HARRINGTON MD
PHYSICIAN3606850000000172240377909000
VICTOR PRICOLO MD
PHYSICIAN43240300000168750184240467702000
OREST ZAKLYNSKY MD
PHYSICIAN65806400000395000200410717605000
THOMAS NG MD
PHYSICIAN43905100000340000220080495059000
CHARLES ADAMS
PHYSICIAN40808100000340000194500461531000
ELIZABETH ALTENHEIN MD
PHYSICIAN3712480000000202310391479000
PAUL MORRISSEY MD
PHYSICIAN35725100000395000188420415593000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
WILLIAM CIOFFI MD
BOARD PRESIDENTWILLIAM CIOFFI, MD IS ON THE BOARD OF NEW ENGLAND MEDICAL BILLING, WHICH IS A VENDOR OF UNIVERSITY SURGICAL ASSOCIATES.0
THERESA A GRAVES MD
MARRIED TO WILLIAM CIOFFI, MD, PRESIDENTTHERESA A GRAVES, MD IS EMPLOYED BY UNIVERSITY SURGICAL ASSOCIATES, INC.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 2FAMILY RELATIONSHIP: THERESA GRAVES, MD AND WILLIAM CIOFFI, MD
FORM 990, PART VI, SECTION A, LINE 6PER THE ARTICLES OF INCORPORATION, THE CORPORATION SHALL BE A MEMBERSHIP CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7APER 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 7BPER 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 11FORM 990 IS REVIEWED BY THE PRESIDENT OF THE BOARD AND THE ORGANIZATION'S ADMINISTRATIVE DIRECTOR WHO SUBSEQUENTLY COMMUNICATE TO THE ENTIRE BOARD OF TRUSTEES THAT THEY APPROVED THE FORM 990 FOR FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS DISTRIBUTED AND EXPLAINED TO THE PRESIDENT AND 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 15THE 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 19THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND 990 OF THE ORGANIZATION ARE MADE AVAILABLE TO THE PUBLIC ON GUIDESTAR.ORG. THE CONFLICT OF INTEREST POLICY WOULD BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1USA PAWTUCKET PROPERTIES LLC (DISREGARDED ENTITY)BusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line115 HAZEL STREETAddressLine1
CityPAWTUCKETCity
StateRIState
ZIP Code02860ZIPCode
FieldValueIRS element (for citing)
EIN261855890EIN
Primary ActivitiesRENTAL PROPERTYPrimaryActivities
Legal Domicile StateRILegalDomicileState
Total Income102000TotalIncome
EOY Assets1025033EOYAssets