Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
STONY BROOK ANAESTHESIOLOGY UFPC |
112553515 | 10 | No | 0 | 0 | |
| (B)
STONY BROOK CHILDREN'S SERVICE UFPC |
112571524 | 10 | No | 0 | 0 | |
| (C)
STONY BROOK DERMATOLOGY ASSOCIATES UFPC |
113011790 | 10 | No | 0 | 0 | |
| (D)
STONY BROOK EMERGENCY PHYSICIANS UFPC |
113066770 | 10 | No | 0 | 0 | |
| (E)
STONY BROOK FAMILY AND PREVENTIVE MEDICINE UFPC |
112552321 | 10 | No | 0 | 0 | |
| (F)
STONY BROOK INTERNISTS UFPC |
112558775 | 10 | No | 0 | 0 | |
| (G)
NEUROLOGY ASSOCIATES OF STONY BROOK UFPC |
112587430 | 10 | No | 0 | 0 | |
| (H)
NEW YORK SPINE AND BRAIN SURGERY UFPC |
112645930 | 10 | No | 0 | 0 | |
| (I)
UNIVERSITY ASSOCIATES IN OBST & GYNECOLOGY UFPC |
112569522 | 10 | No | 0 | 0 | |
| (J)
STONY BROOK OPHTHALMOLOGY UFPC |
112658697 | 10 | No | 0 | 0 | |
| (K)
STONY BROOK ORTHOPAEDIC ASSOCIATES UFPC |
112593061 | 10 | No | 0 | 0 | |
| (L)
STONY BROOK PATHOLOGISTS UFPC |
112647243 | 10 | No | 0 | 0 | |
| (M)
STONY BROOK PSYCHIATRIC ASSOCIATES UFPC |
112590096 | 10 | No | 0 | 0 | |
| (N)
STONY BROOK RADIATION ONCOLOGY UFPC |
112664726 | 10 | No | 0 | 0 | |
| (O)
STONY BROOK RADIOLOGY UFPC |
112548304 | 10 | No | 0 | 0 | |
| (P)
STONY BROOK SURGICAL ASSOCIATES UFPC |
112552333 | 10 | No | 0 | 0 | |
| (Q)
STONY BROOK UROLOGY UFPC |
112644371 | 10 | No | 0 | 0 | |
|
Total 17
|
0 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Part IV, Section A, line 1: | Per SB Clinical Practice Management Plan, Inc.'s ("CPMP") Certificate of Incorporation, one of the purposes of CPMP's formation is "to foster, support, promote and provide assistance for medical, educational and scientific research and for other similar and related programs at the medical school of the state university of New York at Stony Brook." All CPMP's supported organizations, University Faculty Practice Corporations("UFPC") listed on Sch A Attachment 1, are Section 509(a)(2) organizations. CPMP names them by class or purpose in its Certificate of Incorporation. |
| Part IV, Section A, lINE 5a: | (i) the names and EIN numbers of the supported organizations added: CPMP added eighteen supported organizations during the year. Please see Schedule A Attachment 1 for their names and EINs. (ii) the reasons for each such action: In this amended return, CPMP chose to describe itself as a Section 509(a)(3) Type I supporting organization, instead of a Section 509(a)(2) organization. CPMP meets an organizational test, an operational test, and a relationship test and is classified as Type I supporting organization. - CPMP meets the organizational test, as all of its supported organizations, the UFPCs, are Section 509(a)(2) organizations, and CPMP names them by class or purpose in its Certificate of Incorporation. - CPMP meets the criteria of the operational test as CPMP engages solely in activities that support or benefit the UFPCs. CPMP is responsible for the accounting, administrative and billing for the UFPCs and is an integral part of the UFPC operations. - CPMP meets the relationship test by its supported organization(s) (the UFPCs) having the power to regularly appoint and elect the directors/trustees of the organization. The CPMP board of directors consists of individuals appointed by the UFPCs; each UFPC appoints one individual director. Therefore, the UFPCs collectively would be deemed to operate, supervise and control CPMP. As a Section 509(a)(3) Type I supporting organization, CPMP added eighteen supported organizations during the year. (iii) the authority under the organization's organization document authorizing such action: Per CPMP's Certificate of Incorporation, one of the purposes of CPMP's formation is "to foster, support, promote and provide assistance for medical, educational and scientific research and for other similar and related programs at the medical school of the state university of New York at Stony Brook." A type I supporting organization can add or substitute particular supported organizations within the class or classes designated in its articles. (iv)how the action was accomplished: CPMP's management agreed to describe CPMP as a Section 509(a)(3) Type I supporting organization and add eighteen supported organizations. |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, LINE 11B | AN ELECTRONIC VERSION OF FORM 990 WAS PROVIDED TO THE OFFICERS AND DIRECTORS PRIOR TO FILING. MANAGEMENT PERFORMS A REVIEW OF FORM 990 PRIOR TO FILING, ADDRESSING ANY QUESTIONS MADE BY THE GOVERNING BODY. |
| FORM 990, PART VI, LINE 12C | SB CLINICAL PRACTICE MANAGEMENT PLAN, INC. HAS ADOPTED THE SAME CONFLICT OF INTEREST POLICY AS ITS MEMBER UFPCS. THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT SB CLINICAL PRACTICE MANAGEMENT PLAN, INC.'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE ORGANIZATION OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OF COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. COMPLIANCE WITH THIS POLICY IS MONITORED THROUGH INTERNAL PAYMENT POLICIES AND ANNUAL REPRESENTATIONS. THE REVIEWS, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: A. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. B. WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENT FOR GOODS AND SERVICES, FURTHER EDUCATIONAL PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. A VOTING MEMBER OF THE GOVERNING BOARD WHO HAS A COMPENSATION CONFLICT IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. IF THERE ARE VIOLATIONS TO THE POLICY, THE COMMITTEE OR GOVERNING BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. |
| FORM 990, PART VI, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC. |
| Form 990, Part XI, Line 9 | ALLOCATION TO CLINICAL PRACTICE RESERVE = $-14,483,804 DISPOSAL OF ASSETS = $- 88,920 LINE 9 TOTAL CHANGE IN NET ASSETS = $-14,572,724 |
| AMENDED RETURN: | (i) reasons to amend the return: In the original filed return, SB Clinical Practice Management Plan, Inc. ("CPMP") described itself as a Section 509(a)(2) organization and completed Schedule A, Part III. However, CPMP does not qualify as a publicly supported organization under Section 509(a)(2) for Fiscal year 2019 and Fiscal Year 2020. After the Management's discussion, CPMP qualifies as a Section 509(a)(3) type I supporting organization. Please see Schedule A, Part VI. (ii) items amended: In this amended return, CPMP checked Schedule A, Part I, Boxes 12 and 12a, completed Part I, line 12g and Part IV Section A and Section B, and listed the UFPCs as the supported organizations in Schedule A attachment 1. CPMP unchecked Schedule A, Part I, Boxes 10, and left Part III blank. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER OPERATING TOTAL FEES:15824820 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SCHOOL OF MEDICINE CHARGE TOTAL FEES:28385703 |
| Software ID: | |
| Software Version: |