2014-02-10T11:45:26-06:00 2013-09-30 050353162 PICCERELLI GILSTEIN & CO LLP 144 WESTMINSTER STREET PROVIDENCE RI 029032282 990 2012-10-01 050389803 UNIVERSITY SURGICAL ASSOCIATES INC UNIV 4014446290 593 EDDY STREET APC 451 PROVIDENCE RI 02903 WILLIAM CIOFFI MD 4014446290 2014-01-31 1 JOHN M MATHIAS P00008458 4018310200 2012 2015-11-30 17:44:51Z WILLIAM CIOFFI MD 593 EDDY STREET APC 451 PROVIDENCE RI 02903 47413927 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. 7 7 187 0 0 -23373 18850 0 31627497 32733486 860990 2120787 77199 71211 32584536 34925484 255700 276750 0 0 24994891 26437741 0 0 151185 5942637 6197963 31193228 32912454 1391308 2013030 24703282 27334560 3947414 4565662 20755868 22768898 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 25546329 276750 32747707 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. 25546329 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 0 0 0 0 1 33 0 187 1 1 1 0 0 0 0 0 0 0 X 7 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X HELEN REID 4014446290 75 NEWMAN AVENUE RUMFORD RI 02916 JEFFREY SLAIBY MD 40.00 X 383727 0 43224 G DEAN ROYE MD 40.00 X 362648 0 52051 ARLET KURKCHUBASHCE MD 40.00 X 306597 0 52177 WILLIAM CIOFFI MD 40.00 X 455547 0 35778 EDWARD MARCACCIO MD 40.00 X 691266 0 58318 THOMAS F TRACY JR MD 40.00 X 498604 0 58870 STEPHEN MIGLIORI MD 40.00 X 415546 0 43864 DAVID HARRINGTON MD 40.00 X 360685 0 17224 VICTOR PRICOLO MD 40.00 X 432403 0 35299 OREST ZAKLYNSKY MD 40.00 X 658064 0 59541 THOMAS NG MD 40.00 X 439051 0 56008 CHARLES ADAMS 40.00 X 408081 0 53450 ELIZABETH ALTENHEIN MD 40.00 X 371248 0 20231 PAUL MORRISSEY MD 40.00 X 357251 0 58342 6140718 0 644377 14 0 1 0 NEW ENGLAND MEDICAL BILLING INC 75 NEWMAN AVE SUITE 100 RUMFORD RI 02916 BILLING SERVICES 820795 1 PATIENT FEES 621110 16900492 16900492 CONTRACT REVENUE - RI HOSPITAL 621110 8747888 8747888 CONTRACTUAL REVENUE - MIRIAM HOSP 621110 3021223 3021223 OTHER INCOME - SURGERY 621110 1721625 1721625 OTHER CONTRACT REVENUE 621110 846037 846037 1496221 1496221 32733486 878602 878602 102000 30789 71211 71211 71211 13699839 12456045 1609 1243794 -1609 1242185 -1609 1243794 34925484 32747707 0 2193607 276750 276750 3551009 2045026 1473314 32669 17434926 13826745 3526624 81557 2174885 1640484 522605 11796 2216212 1676121 528123 11968 1060709 802214 252767 5728 31424 31424 47889 47889 129898 129898 42596 42596 1142423 1064556 77867 1714489 1414693 299796 25862 25345 517 5371 5371 193122 187610 5512 1297500 931188 358845 7467 OUTSIDE SERVICES 1004010 1004010 SUPPORT SERVICES 439176 351341 87835 DUES AND SUBSCRIPTIONS 91086 89264 1822 LICENSES AND PERMITS 25644 25644 7473 7473 32912454 25546329 7214940 151185 1244491 945952 1413734 480343 43829 90628 2388752 1555277 695473 833475 17053802 20070642 3777743 4273616 474210 639904 24703282 27334560 19824 28152 118847 211228 3808743 4326282 3947414 4565662 X 3294403 3638704 17286172 18938082 175293 192112 20755868 22768898 24703282 27334560 X 2013030 0 X 0 1 X 1 0 X X 0 0 0 RHODE ISLAND HOSPITAL 050258954 3 1 1 1 0 1 0 175293 249 18320 1750 192112 152515 17500 6679 1316 85 175293 155665 5180 5632 2698 152515 152711 6142 3188 155665 171221 -13362 5148 152711 0 0 12000 12000 374829 214918 159911 268435 185756 82679 1733488 1154603 578885 833475 DEFERRED COMPENSATION AGREEMENT 4273616 C 4273616 DEFERRED COMPENSATION 4273616 DUE TO OTHER FUNDS 52666 4326282 34927093 0 34927093 -1609 -1609 34925484 32914063 1609 1609 32912454 0 32912454 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. 1 HASBRO CHILDREN'S HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 581563444 501 (C) 3 5000 CHILDREN HOSPITALHOSPITAL GALA/ MEDICAL THE PHOENIX SOCIETY 1835 RW BERENDS DR SW GRAND RAPIDS MI 49519 232062352 501 (C) 3 30000 MEDICAL THE MIRIAM HOSPITAL 164 SUMMIT AVE PROVIDENCE RI 02906 050258905 501 (C) 3 35000 MEDICAL THE TOMORROW FUND 593 EDDY STREET PROVIDENCE RI 02903 050450569 501 (C) 3 10000 CANCER RESEARCH NEWPORT HOSPITAL FOUNDATION 11 FRIENDSHIP STREET NEWPORT RI 02840 222535533 501 (C) 3 5000 MEDICAL RHODE ISLAND HOSPITAL FOUNDATION PO BOX H PROVIDENCE RI 02901 050258954 501 (C) 3 115000 MEDICAL BROWN UNIVERSITY BOX G-ADV PROVIDENCE RI 02912 050258809 501 (C) 3 50000 EDUCATION IZZY FOUNDATION PO BOX 2326 PROVIDENCE RI 02906 453459440 501 (C) 3 11250 GENERAL DONATIONS AMERICAN CANCER SOCIETY 931 JEFFERSON BLVD WARWICK RI 02886 131788491 501 (C) 3 5000 CANCER RESEARCH 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 JEFFREY SLAIBY MD 383727 0 0 0 0 0 22500 0 20724 0 426951 0 0 0 G DEAN ROYE MD 362648 0 0 0 0 0 34000 0 18051 0 414699 0 0 0 ARLET KURKCHUBASHCE MD 306597 0 0 0 0 0 39500 0 12677 0 358774 0 0 0 WILLIAM CIOFFI MD 455547 0 0 0 0 0 17000 0 18778 0 491325 0 0 0 EDWARD MARCACCIO MD 691266 0 0 0 0 0 39500 0 18818 0 749584 0 0 0 THOMAS F TRACY JR MD 498604 0 0 0 0 0 39500 0 19370 0 557474 0 0 0 STEPHEN MIGLIORI MD 415546 0 0 0 0 0 39500 0 4364 0 459410 0 0 0 DAVID HARRINGTON MD 360685 0 0 0 0 0 0 0 17224 0 377909 0 0 0 VICTOR PRICOLO MD 432403 0 0 0 0 0 16875 0 18424 0 467702 0 0 0 OREST ZAKLYNSKY MD 658064 0 0 0 0 0 39500 0 20041 0 717605 0 0 0 THOMAS NG MD 439051 0 0 0 0 0 34000 0 22008 0 495059 0 0 0 CHARLES ADAMS 408081 0 0 0 0 0 34000 0 19450 0 461531 0 0 0 ELIZABETH ALTENHEIN MD 371248 0 0 0 0 0 0 0 20231 0 391479 0 0 0 PAUL MORRISSEY MD 357251 0 0 0 0 0 39500 0 18842 0 415593 0 0 0 WILLIAM CIOFFI MD BOARD PRESIDENT WILLIAM 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, PRESIDENT THERESA A GRAVES, MD IS EMPLOYED BY UNIVERSITY SURGICAL ASSOCIATES, INC. 0 FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIP: THERESA GRAVES, MD AND WILLIAM CIOFFI, MD 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 THE ORGANIZATION'S ADMINISTRATIVE DIRECTOR WHO SUBSEQUENTLY COMMUNICATE TO THE ENTIRE BOARD OF TRUSTEES THAT THEY APPROVED THE FORM 990 FOR FILING. 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