2024-11-15T09:22:09-06:00 2023-12-31 160929175 DOPKINS & COMPANY LLP 200 INTERNATIONAL DR BUFFALO NY 142215794 990 2023-01-01 300634052 UB ORAL & MAXILLOFACIAL SURGERY INC UBOR 7168292772 112 SQUIRE HALL BUFFALO NY 14214 DR MICHAEL MARKIEWICZ VICE PRESIDENT/TREASURER 7168292772 2024-11-01 1 0 MICHAEL ORLOWSKI P00956557 7166348800 2024-11-01 2023 2024-10-15 13:58:12Z DR MICHAEL R MARKIEWICZ SUNY BFLO SCHOOL OF DENTAL MEDSQUIRE HALL BUFFALO NY 14214 2386593 0 X N/A X 2010 NY THE ORGANIZATION IS ORGANIZED EXCLUSIVELY FOR THE PURPOSE OF SUPPORTING THE EDUCATIONAL MISSION OF THE SCHOOL OF DENTAL MEDICINE OF THE STATE UNIVERSITY OF NEW YORK AT BUFFALO BY PARTICIPATING IN THE PLAN FOR THE MANAGEMENT OF CLINICAL PRACTICE INCOME APPLICABLE TO THE SCHOOL OF DENTAL MEDICINE OF THE STATE UNIVERSITY OF NEW YORK AT BUFFALO AND INCIDENTAL THERETO, BY PROVIDING CLINICAL INSTRUCTION AND SUPERVISION OF STUDENTS, INTERNS AND RESIDENTS AND RENDERING THE PROFESSIONAL DENTAL SERVICES. 3 0 26 0 0 0 0 0 1986592 2386593 0 0 0 0 1986592 2386593 0 0 0 0 914884 1403182 0 0 0 993345 943534 1908229 2346716 78363 39877 542568 582025 420 0 542148 582025 X THE ORGANIZATION IS ORGANIZED EXCLUSIVELY FOR THE PURPOSE OF SUPPORTING THE EDUCATIONAL MISSION OF THE SCHOOL OF DENTAL MEDICINE OF THE STATE UNIVERSITY OF NEW YORK AT BUFFALO BY PARTICPATING IN THE PLAN FOR THE MANAGEMENT OF CLINICAL PRACTICE INCOME APPLICABLE TO THE SCHOOL OF DENTAL MEDICINE OF THE STATE UNIVERSITY OF NEW YORK AT BUFFALO AND INCIDENTAL THERETO, BY PROVIDING CLINICAL INSTRUCTION AND SUPERVISION OF STUDENTS, INTERNS AND RESIDENTS AND RENDERING THE PROFESSIONAL DENTAL SERVICES. 0 0 2211406 2386593 THE ORGANIZATION IS A UNIVERSITY FACULTY PRACTICE CORPORATION ORGANIZED UNDER SECTION 1412 OF THE NOT-FOR-PROFIT CORPOARTION LAW OF THE STATE OF NEW YORK. THIS LAW AUTHORIZES LICENSED DENTISTS WHO ARE MEMBERS OF THE FACULTY OF AN ACCREDITED DENTAL SCHOOL IN THE STATE OF NEW YORK TO ORGANIZE A UNIVERSITY FACULTY PRACTICE CORPORATION FOR THE PURPOSE OF SUPPORTING THE EDUCATIONAL MISSION OF SUCH DENTAL SCHOOL BY PROVIDING CLINICAL INSTRUCTION AND SUPERVISION OF STUDENTS OF THE SCHOOL, INTERNS, AND RESIDENTS AND, INCIDENT THERETO, RENDERING PROFESSIONAL SERVICES. 2211406 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 12 0 26 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 NY X THE ORGANIZATION 7168292772 112 SQUIRE HALL BUFFALO NY 14214 RICHARD E HALL DDSMPHDFACS PRESIDENT 18.00 X 144210 0 0 ROBERT L CRONYN MDDDS SECRETARY 18.00 X 158083 0 0 MICHAEL R MARKIEWICZ VICE PRESIDENT/TREASURER 18.00 X 319980 0 0 622273 0 0 3 0 1 0 0 PATIENT REVENUE 541900 1765575 1765575 ECMC STIPEND 541900 340192 340192 OTHER REVENUE 541900 280826 280826 2386593 2386593 2386593 0 0 X 1246761 1246761 4232 4232 69449 69449 82740 82740 84533 84533 4754 4754 46023 46023 72077 72077 5595 5595 53595 53595 1107 1107 17528 17528 LAB FEES AND CLINIC SUP 160170 160170 ON-CALL SESSIONS 117822 117822 DEAN'S FUND 72698 72698 MALPRACTICE INSURANCE 70933 70933 236699 236699 2346716 2211406 135310 0 542568 582025 255937 255937 0 0 542568 582025 420 0 420 0 X 0 0 0 0 542148 582025 542148 582025 542568 582025 39877 0 X 0 0 0 X 1514610 1338270 1949017 1986592 2386593 9175082 1514610 1338270 1949017 1986592 2386593 9175082 0 0 0 9175082 1514610 1338270 1949017 1986592 2386593 9175082 1.00000 1.00000 0.00000 X 255937 255937 0 0 X 0 0 0 0 0 0 0 0 0 MICHAEL R MARKIEWICZ VICE PRESIDENT/TREASURER 319980 0 0 0 0 0 0 0 0 0 319980 0 0 0 ROBERT L CRONYN MDDDS SECRETARY 158083 0 0 0 0 0 0 0 0 0 158083 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PRESENTED TO MEMBERS OF THE BOARD OF UB ORAL & MAXILLOFACIAL SURGERY, INC. FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PURSUANT TO THE ORGANIZATION'S CONFLICT OF INTEREST POLICY PROCEDURES HAVE BEEN ADOPTED FOR ADDRESSING THE CONFLICT OF INTEREST OF ANY DIRECTOR, OFFICER, ADMINISTRATOR, OR MEMBER OF A COMMITTEE. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST 1. AN INTERSTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OF DIRECTORS OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. 2. THE CHAIRPERSON OF THE BOARD OF DIRECTORS OR THE COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. 3. AFTER EXCERCISING DUE DILIGENCE, THE BOARD OF DIRECTORS OR THE COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 4. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OF DIRECTORS OR THE COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. VIOLATION OF THE CONFLICT OF INTEREST POLICY 1. IF THE BOARD OF DIRECTORS OR THE COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. 2. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE BOARD OF DIRECTORS OR THE COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. EACH DIRECTOR, OFFICER, MEMBER OF A COMMITTEE WITH POWERS DELEGATED BY THE BOARD OF DIRECTORS AND ADMINISTRATOR SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: 1. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY 2. HAS READ AND UNDERSTANDS THE POLICY AND 3. HAS AGREED TO COMPLY WITH THE POLICY FORM 990, PART VI, SECTION B, LINE 15 NONE OF THE OFFICERS OR DIRECTORS ARE COMPENSATED FOR THEIR SERVICES. COMPENSATION FOR FACULTY MEMBERS EMPLOYED BY THE ORGANIZATION IS REGULATED BY THE FACULTY PRACTICE PLAN, WHICH ESTABLISHES LIMITATIONS ON THE TOTAL AMOUNT OF COMPENSATION A FACULTY MEMBER CAN EARN FROM ALL SOURCES IN A GIVEN YEAR, INCLUDING INCOME FROM THE CLINICAL PRACTICE. THE MAXIMUM COMPENSATION MAY NOT EXCEED 250% OF THE APPROVED STATE BASIC ANNUAL SALARY FOR A PERSON'S FACULTY RANK. EACH OFFICER AND DIRECTOR OF THE ORGANIZATION IS REQUIRED TO BE A FACULTY MEMBER OF THE SUNY BUFFALO DENTAL SCHOOL AND AN EMPLOYEE OF THE CORPORATION. EACH EMPLOYEE WILL, AMONG OTHER THINGS, ENGAGE IN THE CLINICAL PRACTICE. SALARY WILL DEPEND, IN PART, UPON THE EMPLOYEE'S CLINICL PRACTICE AND COLLECTIONS FROM CLINICAL PRACTICE. EACH YEAR THE DEAN OF THE SCHOOL OF DENTAL MEDICINE, IN CONSULTATION WITH THE DEPARTMENT CHAIR, WILL PREPARE AND DISTRIBUTE TO EACH FACULTY MEMBER/EMPLOYEE A WRITTEN STATEMENT THAT SETS FORTH THE PERSON'S MAXIMUM ALLOWABLE COMPENSATION FOR THAT YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON ITS OWN WEBSITE OR ANOTHER'S WEBSITE. COPIES CAN BE PROVIDED UPON REQUEST BY PHONE, IN WRITING OR VIA-EMAIL. A COPY OF THE ORGANIZATIONS FORM 990 CAN BE FOUND THROUGH THE WEBSITE WWW.GUIDESTAR.ORG. FORM 990, PART IX, LINE 24E MISCELLANEOUS EXPENSES: PROGRAM SERVICE EXPENSES 52,673. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 52,673. OUTSIDE SERVICES - MEDICAL: PROGRAM SERVICE EXPENSES 47,698. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,698. PATIENT REFUNDS: PROGRAM SERVICE EXPENSES 39,371. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,371. DUES AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 38,925. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,925. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 32,816. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,816. TELEPHONE: PROGRAM SERVICE EXPENSES 11,648. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,648. CREDIT CARD FEES: PROGRAM SERVICE EXPENSES 6,124. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,124. BANK CHARGES: PROGRAM SERVICE EXPENSES 4,898. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,898. TRAY STERILIZATION: PROGRAM SERVICE EXPENSES 1,434. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,434. CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 1,005. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,005. POSTAGE: PROGRAM SERVICE EXPENSES 107. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 107.