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UNIVERSITY SURGICAL ASSOCIATES INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
UNIVERSITY SURGICAL ASSOCIATES INC (EIN 05-0389803)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-03-15
IRS object ID
201230799349300513
Schema version
2010v3.4
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)
Timestamp2012-03-15T11:21:07-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-10-01TaxPeriodBeginDate

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 Signed2012-03-02DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOHN M MATHIASName
Phone4018310200Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts41284817GrossReceipts
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 Employees166TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income-2413NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3262ContributionsGrantsPriorYear
Contributions Grants Current Year1390ContributionsGrantsCurrentYear
Program Service Revenue Prior Year29940993ProgramServiceRevenuePriorYear
Program Service Revenue CY29925867ProgramServiceRevenueCY
Investment Income Prior Year747421InvestmentIncomePriorYear
Investment Income Current Year735632InvestmentIncomeCurrentYear
Other Revenue Prior Year74924OtherRevenuePriorYear
Other Revenue Current Year69818OtherRevenueCurrentYear
Total Revenue Prior Year30766600TotalRevenuePriorYear
Total Revenue Current Year30732707TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year87250GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY297750GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year24563547SalariesEtcPriorYear
Salaries Etc Current Year23879215SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year148880TotalFundrsngExpCurrentYear
Other Expense Prior Year5826193OtherExpensePriorYear
Other Expenses Current Year5960675OtherExpensesCurrentYear
Total Expenses Prior Year30476990TotalExpensesPriorYear
Total Expenses Current Year30137640TotalExpensesCurrentYear
Revenues Less Expenses Prior Year289610RevenuesLessExpensesPriorYear
Revenues Less Expenses CY595067RevenuesLessExpensesCY
Total Assets BOY22278080TotalAssetsBOY
Total Assets EOY22907029TotalAssetsEOY
Total Liabilities BOY3456191TotalLiabilitiesBOY
Total Liabilities EOY3542470TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18821889NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY19364559NetAssetsOrFundBalancesEOY
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
Expense22846724Expense
Grants297750Grants
Revenue29924982Revenue
DescriptionPROVIDES 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 FIELDSDescription
Total Program Service Expense22846724TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Stmt1IndependentAuditFinancialStmt
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
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109625NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees166NumberOfEmployees
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 (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JEFFREY SLAIBY MD
TRUSTEE40.00X394988064821
DAVID HARRINGTON MD
TRUSTEE40.00X379184078778
THOMAS SHAHINIAN MD
TRUSTEE40.00X360929065382
WILLIAM CIOFFI MD
PRESIDENT40.00459967068969X
EDWARD MARCACCIO MD
VICE PRESIDENT40.00826934088043X
THOMAS F TRACY JR MD
TREASURER40.00500939074907X
STEPHEN MIGLIORI MD
SECRETARY40.00417956062657X
VICTOR PRICOLO MD
PHYSICIAN40.00545843065330X
OREST ZAKLYNSKY MD
PHYSICIAN40.00539591074795X
THOMAS NG MD
PHYSICIAN40.00446537074390X
G DEAN ROYE MD
PHYSICIAN40.00384135073961X
CHARLES ADAMS
PHYSICIAN40.00412736077104X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5669739TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation869137TotalOtherCompensation
Number Individuals GT100 K52NumberIndividualsGT100K
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 Line1NAVIX DIAGNOSTIX INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 347203AddressLine1
CityPITTSBURGHCity
StatePAState
ZIP Code15251ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesVASCULAR TESTING SERVICESDescriptionOfServices
Compensation250656Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions1390AllOtherContributions
Total Contributions1390TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT FEES6211101875065018750650
FEES FROM RI HOSPITAL62111072477597247759
FEES FROM MIRIAM HOSPI62111011009781100978
OTHER INCOME - SURGERY621110866919866919
OTHER REVENUE621110617728617728

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column1341833TotalRevenueColumn
Related Or Exempt Function Income1341833RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue29925867TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column645255TotalRevenueColumn
Exclusion$645,255ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real102000Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real32182Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real69818Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column69818TotalRevenueColumn
Exclusion$69,818ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities10610305Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities10519043Securities
Other885Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities91262Securities
Other-885Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column90377TotalRevenueColumn
Related Or Exempt Function Income-885RelatedOrExemptFunctionIncome
Exclusion$91,262ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column30732707TotalRevenueColumn
Related Or Exempt Function Income29924982RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$806,335ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total297750Total
Program Services297750ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3583501Total
Program Services1612575ProgramServices
Management And General1935091ManagementAndGeneral
Fundraising35835Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15572386Total
Program Services12203933ProgramServices
Management And General3291347ManagementAndGeneral
Fundraising77106Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2014912Total
Program Services1573617ProgramServices
Management And General428029ManagementAndGeneral
Fundraising13266Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1806913Total
Program Services1426738ProgramServices
Management And General371140ManagementAndGeneral
Fundraising9035Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total901503Total
Program Services703984ProgramServices
Management And General191569ManagementAndGeneral
Fundraising5950Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total53611Total
Management And General53611ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total63825Total
Management And General63825ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total113913Total
Program Services113913ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total160386Total
Program Services160386ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total918313Total
Program Services854221ProgramServices
Management And General64092ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1828232Total
Program Services1508656ProgramServices
Management And General319576ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total40084Total
Program Services40084ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total3537Total
Program Services3537ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total156269Total
Program Services151863ProgramServices
Management And General4406ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1571372Total
Program Services1249744ProgramServices
Management And General313940ManagementAndGeneral
Fundraising7688Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
SUPPORT SERVICES517990414392103598
OUTSIDE SERVICES428243428243
DUES AND SUBSCRIPTIONS905838877118120
LICENSES AND PERMITS1431714317

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total30137640Total
Program Services22846724ProgramServices
Management And General7142036ManagementAndGeneral
Fundraising148880Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1153155BOY
EOY959632EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY795352BOY
EOY898339EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY38118BOY
EOY33002EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2069946LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1349044LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY839204BOY
EOY720902EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY15792422BOY
EOY16543805EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3152179BOY
EOY3326520EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY507650BOY
EOY424829EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY22278080BOY
EOY22907029EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY47464BOY
EOY41591EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY204300BOY
EOY149358EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3204427BOY
EOY3351521EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3456191BOY
EOY3542470EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2238011BOY
EOY2257756EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY16428213BOY
EOY16954288EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY155665BOY
EOY152515EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18821889BOY
EOY19364559EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22278080BOY
EOY22907029EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses595067ReconcilationRevenueExpenses
Reconcilation Other Changes-52397ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 Balance155665BeginningOfYearBalance
Investment Earnings Or Losses5180InvestmentEarningsOrLosses
Other Expenditures5632OtherExpenditures
Administrative Expenses2698AdministrativeExpenses
End Of Year Balance152515EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance171221BeginningOfYearBalance
Investment Earnings Or Losses-13362InvestmentEarningsOrLosses
Other Expenditures5148OtherExpenditures
End Of Year Balance152711EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
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
Depreciation186688Depreciation
Book Value188141BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis234437OtherCostOrOtherBasis
Depreciation148302Depreciation
Book Value86135BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1448680OtherCostOrOtherBasis
Depreciation1014054Depreciation
Book Value434626BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings720902TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionDEFERRED COMPENSATION AGREEMENTDescription
Book Value3326520BookValue
Method Of ValuationCMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities3326520TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DEFERRED COMPENSATION$3,326,521
DUE TO OTHER FUNDS$25,000
FieldValueIRS element (for citing)
Total Of Amounts3351521TotalOfAmounts
Total Revenue30732707TotalRevenue
Total Expenses30137640TotalExpenses
Excess Or Deficit For Year595067ExcessOrDeficitForYear
Prior Period Adjustments-52397PriorPeriodAdjustments
Total Adjustments-52397TotalAdjustments
Excess Or Deficit Per FS542670ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt30733592TotRevenueEtcAuditedFinclStmt
Other Revenues885OtherRevenues
Revenue Not Rptd F990885RevenueNotRptdF990
Revenue Subtotal30732707RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99030732707TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt30138524TotExpensesEtcAuditedFinclStmt
Other Expenses Included885OtherExpensesIncluded
Expenses Not Rptd F990885ExpensesNotRptdF990
Expenses Subtotal30137639ExpensesSubtotal
Other Expenses Not Included1OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1ExpensesNotRptdOnFinStmt
Total Expenses Per Form99030137640TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 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 XII, LINE 2D - OTHER ADJUSTMENTS:LOSS ON DISPOSAL OF ASSETS 885.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:LOSS ON SALE OF INVESTMENTS 885.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:ROUNDING 1.

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
AMERICAN CANCER SOCIETY
931 JEFFERSON BLVDWARWICKRI02886131788491501 (C) 35000CANCER RESEARCH
THE MIRIAM HOSPITAL
164 SUMMIT AVEPROVIDENCERI02906050258905501 (C) 35000MEDICAL
HOPE FUNDS FOR CANCER RESEARCH
226 BELLEVUE AVENUE STE 6NEWPORTRI02840205799367501 (C) 310000CANCER RESEARCH
NEWPORT HOSPITAL FOUNDATION
11 FRIENDSHIP STREETNEWPORTRI02840222535533501 (C) 35000MEDICAL
RIH FOUNDATION
PO BOX HPROVIDENCERI02901050258954501 (C) 35000MEDICAL
BOYS AND GIRLS CLUB OF PITTSFIELD
16 MELVILLE STPITTSFIELDMA01201042103925501 (C) 35000EDUCATION
BROWN UNIVERSITY
BOX G-ADVPROVIDENCERI02912050258809501 (C) 350000EDUCATION
RIH FOUNDATION
PO BOX HPROVIDENCERI02901050258954501 (C) 3200000MEDICAL
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants15TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierOTHER INFORMATION:Identifier
Return ReferencePART IV:ReturnReference
ExplanationOUR 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.Explanation

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 (12 entries)

Base 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
3949880000043781021040045980900299121
DAVID HARRINGTON MD
35418400025000055247023531045796200269071
THOMAS SHAHINIAN MD
3609290000045383019999042631100309382
WILLIAM CIOFFI MD
4599670000049091019878052893600344549
EDWARD MARCACCIO MD
8269340000068654019389091497700525534
THOMAS F TRACY JR MD
5009390000054877020030057584600377575
STEPHEN MIGLIORI MD
417956000005544407213048061300320415
VICTOR PRICOLO MD
5458430000043282022048061117300412195
OREST ZAKLYNSKY MD
5395910000054546020249061438600408444
THOMAS NG MD
4465370000055016019374052092700335812
G DEAN ROYE MD
36997400014161053236020725045809600279505
CHARLES ADAMS
37173600041000055206021898048984000280399

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
WILLIAM CIOFFI MD
BOARD PRESIDENT0WILLIAM 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, PRESIDENT0THERESA A GRAVES, MD IS EMPLOYED BY UNIVERSITY SURGICAL ASSOCIATES, INC.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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.
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 12C
THE ORGANIZATION MAINTAINS SALARY RANGES FOR ALL EMPLOYEES WHICH IS UPDATED AND APPROVED BY THE BOARD OF TRUSTEES ANNUALLY.FORM 990, PART VI, SECTION B, LINE 15
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.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:PRIOR PERIOD ADJUSTMENTS: -52,397.FORM 990, PART XI, LINE 5:
THE AUDIT COMMITTEE CONSISTS OF DEAN ROYE, THOMAS TRACY, JEFFREY M. SLAIBY AND ARLET KURKCHUBASCHE.FORM 990, PART XII, LINE 2C

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 Income69818TotalIncome
EOY Assets96650EOYAssets