2013-05-03T10:53:09-05:00 2012-09-30 050353162 PICCERELLI GILSTEIN & CO LLP 144 WESTMINSTER STREET PROVIDENCE RI 029032282 990 2011-10-01 050389803 UNIVERSITY SURGICAL ASSOCIATES INC UNIV 4014446290 593 EDDY STREET APC 451 PROVIDENCE RI 02903 WILLIAM CIOFFI MD 4014446290 2013-04-30 1 JOHN M MATHIAS P00008458 4018310200 2011 2016-03-07 17:11:31Z WILLIAM CIOFFI MD 593 EDDY STREET APC 451 PROVIDENCE RI 02903 44425888 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 7 156 0 0 -75316 1390 18850 29925867 31627497 735632 860990 69818 77199 30732707 32584536 297750 255700 0 0 23879215 24994891 0 0 149271 5960675 5942637 30137640 31193228 595067 1391308 22907029 24703282 3542470 3947414 19364559 20755868 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 23843436 255700 31627828 PROVIDES DIADNOSIS 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 23843436 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 1 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 0 1 33 0 1 156 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 62245 DAVID HARRINGTON MD 40.00 X 362054 0 25268 THOMAS SHAHINIAN MD 40.00 X 189084 0 21782 G DEAN ROYE MD 40.00 X 370878 0 55108 ARLET KURKCHUBASHCE MD 40.00 X 300624 0 49408 WILLIAM CIOFFI MD 40.00 X 451743 0 42105 EDWARD MARCACCIO MD 40.00 X 689314 0 55880 THOMAS F TRACY JR MD 40.00 X 492938 0 61491 STEPHEN MIGLIORI MD 40.00 X 393913 0 42954 VICTOR PRICOLO MD 40.00 X 532194 0 45348 OREST ZAKLYNSKY MD 40.00 X 524250 0 61947 THOMAS NG MD 40.00 X 437656 0 55674 CHARLES ADAMS 40.00 X 408601 0 46694 ELIZABETH ALTENHEIN MD 40.00 X 377688 0 61876 5914664 0 687780 26 0 1 0 NEW ENGLAND MEDICAL BILLING INC 75 NEWMAN AVE SUITE 100 RUMFORD RI 02916 BILLING SERVICES 838554 NAVIX DIAGNOSTIX INC PO BOX 347203 PITTSBURGH PA 15251 VASCULAR TESTING SERVICES 285868 COVIDIEN VASCULAR AND MEDICAL SUPPLIES PO BOX 120823 DALLAS TX 75312 MEDICAL SUPPLIES 146936 THE STANDARD PO BOX 5676 PORTLAND OR 97228 LONG-TERM DISABILITY INSURANCE 132221 4 18850 18850 PATIENT FEES 621110 18879031 18879031 FEES FROM RI HOSPITAL 621110 8006951 8006951 FEES FROM MIRIAM HOSPI 621110 1929091 1929091 OTHER INCOME - SURGERY 621110 1020218 1020218 FEES FROM WOMEN AND IN 621110 571668 571668 1220538 1220538 31627497 665999 665999 110500 33301 77199 77199 77199 12002711 331 11808051 0 194660 331 194991 331 194660 32584536 31627828 0 937858 255700 255700 3413807 1536213 1843456 34138 16677620 13128823 3470892 77905 1993232 1556941 423214 13077 1926382 1521071 395679 9632 983850 768289 209068 6493 37666 37666 43350 43350 129123 129123 31425 31425 1067190 993004 74186 1585900 1310174 275726 55221 55221 2439 2439 165608 160922 4686 1638312 1302729 327557 8026 OUTSIDE SERVICES 564504 564504 SUPPORT SERVICES 466469 373175 93294 DUES AND SUBSCRIPTIONS 87334 85587 1747 LICENSES AND PERMITS 43356 43356 24740 24740 31193228 23843436 7200521 149271 959632 1244491 898339 1413734 33002 43829 2151774 1456301 720902 695473 16543805 17053802 3326520 3777743 424829 474210 22907029 24703282 41591 19824 149358 118847 3351521 3808743 3542470 3947414 X 2257756 3294403 16954288 17286172 152515 175293 19364559 20755868 22907029 24703282 X 1391308 1 X X 0 1 1 X 0 X X 0 0 0 RHODE ISLAND HOSPITAL 050258954 3 1 1 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 152515 17500 6679 1316 85 175293 155665 5180 5632 2698 152515 152711 6142 3188 155665 171221 -13362 5148 152711 0 0 12000 12000 374829 200803 174026 247465 165921 81544 1517480 1089577 427903 695473 DEFERRED COMPENSATION AGREEMENT 3777743 C 3777743 DEFERRED COMPENSATION 3777743 DUE TO OTHER FUNDS 31000 3808743 32584536 31193228 1391308 1 1 1391309 32584205 -331 -331 32584536 0 32584536 31192897 -331 -331 31193228 0 31193228 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. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: DR. SHOAIB SHEIKH SURGICAL FUND WAS ESTABLISHED TO AWARD A RESIDENT OF RHODE ISLAND HOSPITAL AND BROWN UNIVERSITY SURGICAL PROGRAM WHO PUBLISHES THE BEST SURGICAL PAPER ACCEPTED TO A NATIONAL SURGICAL SOCIETY. THE ENDOWMENT WILL ALSO FUND EXPENSES FOR AN INTERNATIONAL BURN TRIP WITH THE SURGICAL FACULTY OF UNIVERSITY SURGICAL ASSOCIATES. PART XI, LINE 8 - OTHER ADJUSTMENTS: ROUNDING 1. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF ASSETS -331. PART XIII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON SALE OF INVESTMENTS -331. 1 HASBRO CHILDREN'S HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 581563444 501 (C) 3 5000 CHILDREN HOSPITALHOSPITAL GALA/ MEDICAL AMERICAN CANCER SOCIETY 931 JEFFERSON BLVD WARWICK RI 02886 131788491 501 (C) 3 5000 CANCER RESEARCH THE MIRIAM HOSPITAL 164 SUMMIT AVE PROVIDENCE RI 02906 050258905 501 (C) 3 65400 MEDICAL THE TOMORROW FUND 593 EDDY STREET PROVIDENCE RI 02903 050450569 501 (C) 3 5000 CANCER RESEARCH NEWPORT HOSPITAL FOUNDATION 11 FRIENDSHIP STREET NEWPORT RI 02840 222535533 501 (C) 3 5000 MEDICAL RIH FOUNDATION PO BOX H PROVIDENCE RI 02901 050258954 501 (C) 3 110000 MEDICAL THE CRANSTON ARC 111 COMSTOCK PKWY PO BOX 20130 CRANSTON RI 02920 056015153 501 (C) 3 5000 MEDICAL BROWN UNIVERSITY BOX G-ADV PROVIDENCE RI 02912 050258809 501 (C) 3 50000 EDUCATION 6 OUR ORGANIZATION IS FREQUENTLY APPROACHED BY OTHER 501(C)3 ORGANIZATIONS FOR SUPPORT OF VARIOUS PROGRAMS WHICH ARE IN LINE 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 38500 0 23745 0 445972 0 0 0 DAVID HARRINGTON MD 338054 0 0 0 24000 0 0 0 25268 0 387322 0 0 0 THOMAS SHAHINIAN MD 189084 0 0 0 0 0 0 0 21782 0 210866 0 0 0 G DEAN ROYE MD 359216 0 0 0 11662 0 33000 0 22108 0 425986 0 0 0 ARLET KURKCHUBASHCE MD 300624 0 0 0 0 0 38500 0 10908 0 350032 0 0 0 WILLIAM CIOFFI MD 451743 0 0 0 0 0 16500 0 25605 0 493848 0 0 0 EDWARD MARCACCIO MD 689314 0 0 0 0 0 33000 0 22880 0 745194 0 0 0 THOMAS F TRACY JR MD 492938 0 0 0 0 0 38500 0 22991 0 554429 0 0 0 STEPHEN MIGLIORI MD 393913 0 0 0 0 0 38500 0 4454 0 436867 0 0 0 VICTOR PRICOLO MD 532194 0 0 0 0 0 22000 0 23348 0 577542 0 35297 0 OREST ZAKLYNSKY MD 524250 0 0 0 0 0 38500 0 23447 0 586197 0 0 0 THOMAS NG MD 437656 0 0 0 0 0 33000 0 22674 0 493330 0 0 0 CHARLES ADAMS 363851 0 0 0 44750 0 24750 0 21944 0 455295 0 0 0 ELIZABETH ALTENHEIN MD 377688 0 0 0 0 0 38500 0 23376 0 439564 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. FORM 990, PART VI, SECTION B, LINE 12C THE 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 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 WOULD BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: ROUNDING 1. TOTAL TO FORM 990, PART XI, LINE 5: 1. THE ORGANIZATION HAS AN AUDIT COMMITTEE. THE ORGANIZATION HAS HAD THIS COMMITTEE IN THE PRIOR YEAR AND NO CHANGES HAVE BEEN MADE. 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