2011-07-12T10:10:47-05:00 2010-09-30 Piccerelli Gilstein & Co LLP 144 Westminster Street Providence RI 029032282 990 2009-10-01 050389803 UNIVERSITY SURGICAL ASSOCIATES INC (FORMERLY RIH SURGERY FOUNDATION INC UNIV 4014446290 593 EDDY STREET APC 451 PROVIDENCE RI 02903 WILLIAM CIOFFI md 4014446290 2011-06-09 1 John M Mathias 4018310200 2009 2016-02-24 21:20:13Z william cioffi MD 593 EDDY STREET APC 451 PROVIDENCE RI 02903 38465428 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 7 163 0 230688 0 12704 3262 29664765 29940993 -552082 747421 83315 74924 29208702 30766600 189300 87250 0 23937932 24563547 0 184081 5963863 5826193 30091095 30476990 -882393 289610 22225613 22278080 3693335 3456191 18532278 18821889 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 24055337 87250 29940993 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 24055337 1 0 0 0 0 0 0 0 1 1 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 1 22 0 163 1 1 1 0 0 0 0 0 0 0 0 7 7 1 0 1 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 386970 0 63147 DAVID HARRINGTON MD 40.00 X 376050 0 73663 THOMAS SHAHINIAN MD 40.00 X 416033 0 70013 WILLIAM CIOFFI MD 40.00 X 409655 0 83500 EDWARD MARCACCIO MD 40.00 X 691159 0 77861 THOMAS F TRACY JR MD 40.00 X 507860 0 75085 STEPHEN MIGLIORI MD 40.00 X 410236 0 59714 VICTOR PRICOLO MD 40.00 X 575464 0 60803 OREST ZAKLYNSKY MD 40.00 X 549695 0 73318 THOMAS NG MD 40.00 X 454694 0 74112 G Dean RoyE MD 40.00 X 419121 0 76703 CHARLES ADAMS 40.00 X 404156 0 75450 5601093 0 863369 47 0 1 0 new england medical 75 Newman Ave Rumford RI 02916 billing service 856063 NAVIX DIAGNOSTIX INC 100 myles standish blvd taunton MA 02870 VASCULAR TESTING SERVICES 186075 2 3262 3262 Patient Fees 621110 19734706 19699647 35059 Fees from RI Hospital 621110 5864159 5864159 Fees from Miriam Hospi 621110 858530 858530 OTHER REVENUE 621110 819249 819249 Fees from Newport Hosp 621110 682766 682766 1981583 1785954 195629 29940993 579052 579052 102000 27076 74924 74924 74924 7840121 7665086 6666 175035 -6666 168369 -6666 175035 30766600 29703639 230688 829011 87250 87250 3833638 1797976 1946338 89324 16384737 13597263 2727774 59700 1816123 1418211 385926 11986 1629101 1286341 334616 8144 899948 702769 191239 5940 15862 15862 44509 44509 124728 124728 527455 484672 42783 1675935 1592138 83797 43055 43055 4626 4626 156151 151748 4403 1790471 1422163 359484 8824 Office Expense and Post 431361 409793 21568 0 Outside Services 360335 360335 0 0 Support Services 352982 282386 70596 0 Miscellaneous 116934 116934 0 0 DUES AND SUBSCRIPTIONS 99084 97102 1982 0 82705 75847 6695 163 30476990 24055337 6237572 184081 2858023 1153155 544468 795352 85932 38118 2060453 1221249 622846 839204 13962508 15792422 2597143 3152179 1554693 507650 22225613 22278080 34493 47464 78197 204300 3580645 3204427 3693335 3456191 X 1286196 2238011 17093371 16428213 152711 155665 18532278 18821889 22225613 22278080 X 0 1 1 X 0 X X 0 0 0 RHODE ISLAND HOSPITAL 050258954 3 1 1 1 0 1 0 152711 6142 3188 155665 171221 -13362 5148 152711 0.00000 1.00000 0.00000 0 0 12000 12000 374829 172572 202257 229598 134419 95179 1444026 914258 529768 839204 Deferred Compensation Agreement 3152179 C 3152179 Deferred Compensation 3152179 Due to Other Funds 52248 3204427 30766600 30476990 289610 0 289610 30773267 6666 6666 30766601 0 30766601 30483656 6666 6666 30476990 0 30476990 Part V, Line 4: Description of Intended Use of Endowment Funds: 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: 6666. Part XIII, Line 2d - Other Adjustments: LOSS ON SALE OF INVESTMENTS: 6666. 1 HASBRO CHILDREN'S HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 581563444 501 (c) 3 10000 CHILDREN HOSPITALHOSPITAL GALA/ MEDICAL AMERICAN CANCER SOCIETY 931 jefferson blvd warwick RI 02886 131788491 501 (c) 3 5000 CANCER RESEARCH RIH FOUNDATION 593 EDDY STREET PROVIDENCE RI 02903 050258954 501 (c) 3 5000 CAMPAIGN FOR THE NEXT GENERATION AND FOURTH INSTALLMENT FOR PRIOR CAMPAIGN PLEDGE the miriam hospital 164 summit ave proviDENCE RI 02906 050258905 501 (c) 3 35000 MEDICAL HOPE FUNDS FOR CANCER RESEARCH 226 BELLEVUE AVENUE STE 6 NEWPort RI 02840 205799367 501 (c) 3 7500 CANCER RESEARCH NEWPORT HOSPITAL FOUNDATION 11 FRIENDSHIP STREET NEWPORT RI 02840 222535533 501 (c) 3 5000 MEDICAL THE TOMORROW FUND 593 EDDY STREET PROVIDENCE RI 02903 050450569 501 (c) 3 10000 PROVIDES SUPPORT TO CHILDREN WITH CANCER AND THEIR FAMILIES Other Information: Part IV: 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 358931 0 5000 0 23039 0 44654 0 18493 0 450117 0 281250 0 DAVID HARRINGTON MD 336979 0 5000 0 34071 0 56011 0 17652 0 449713 0 273375 0 THOMAS SHAHINIAN MD 374178 0 5000 0 36855 0 51260 0 18753 0 486046 0 300000 0 WILLIAM CIOFFI MD 386720 0 5000 0 17935 0 65829 0 17671 0 493155 0 257000 0 EDWARD MARCACCIO MD 592551 0 5000 0 93608 0 59139 0 18722 0 769020 0 450000 0 THOMAS F TRACY JR MD 462623 0 5000 0 40237 0 54613 0 20472 0 582945 0 375000 0 STEPHEN MIGLIORI MD 363494 0 5000 0 41742 0 55178 0 4536 0 469950 0 296250 0 VICTOR PRICOLO MD 542092 0 5000 0 28372 0 41831 0 18972 0 636267 0 431250 0 OREST ZAKLYNSKY MD 503692 0 5000 0 41003 0 54630 0 18688 0 623013 0 397500 0 THOMAS NG MD 415796 0 5000 0 33898 0 54404 0 19708 0 528806 0 338500 0 G Dean RoyE MD 380174 0 5000 0 33947 0 56977 0 19726 0 495824 0 304750 0 CHARLES ADAMS 364930 0 5000 0 34226 0 55939 0 19511 0 479606 0 296000 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 4 THE BY-LAWS WERE CHANGED DURING THE FISCAL YEAR 9/30/2010. THE AMENDED BY-LAWS ARE ATTACHED FOR YOUR REVIW. 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. FORM 990 PAGE 12, PART XI, QUESTION 2C AUDIT COMMITTEE THE AUDIT COMMITTEE MEMBERS CONSIST OF DEAN ROYE, THOMAS F. TRACY, JEFFREY M. SLAIBY AND ARLET KURKCHUBASCHE. FORM 990 PART VI GOVERNING BODY AND MANAGEMENT CHANGE IN BY-LAWS THE BY-LAWS WERE AMENDED AT THE OCTOBER 5, 2009 FOUNDATION MEETING. THE REVISIONS RELATED TO MEMBERSHIP LANGUAGE. THE BY-LAWS NOW STATE THAT THAT EVERYONE WHO JOINS USA WILL COME IN AS A NON-VOTING EMPLOYEE FOR TWO YEARS. DR. CIOFFI HAS THE DISCRETION TO OFFER MEMBERSHIP INTO THE FOUNDATION AND WAIVE THE TWO YEAR PERIOD. USA Pawtucket Properties LLC (Disregarded entity) 15 hazel street pawtucket RI 02860 261855890 RENTAL PROPERTY RI 74924 72716