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ObjectId: 201911339349307066 - Submission: 2019-05-13
TIN: 11-2664726
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
STONY BROOK RADIATION ONCOLOGY
University Faculty Practice Corporation
Employer identification number
11-2664726
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
New York State
1 Commerce Plz 99 Washington Ave
Albany
,
NY
12231
14-6013200
Government
NY
501(C)(1)
N/A
NA
No
(2)
Stony Brook Anaesthesiology UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2553515
Healthcare
NY
501(C)(3)
10
NYS
No
(3)
Stony Brook Dermatology Associates UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-3011790
Healthcare
NY
501(C)(3)
10
NYS
No
(4)
Stony Brook Clin Pract Mgmt Realty Corp
PO Box 1554
Stony Brook
,
NY
11790
11-3285712
Rlty Holding
NY
501(C)(25)
N/A
CPMP
No
(5)
Stony Brook Surgical Holding Corp
PO Box 1554
Stony Brook
,
NY
11790
11-6434538
Rlty Holding
NY
501(C)(25)
N/A
CPMP
No
(6)
SB Clinical Practice Management Plan Inc
PO Box 1554
Stony Brook
,
NY
11790
46-1787308
MGMT ACTIVITY
NY
501(C)(3)
10
NA
No
(7)
Stony Brook Emergency Physicians UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-3066770
Healthcare
NY
501(C)(3)
10
NYS
No
(8)
SB Family and Preventive Medicine UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2552321
Healthcare
NY
501(C)(3)
10
NYS
No
(9)
Stony Brook Internists UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2558775
Healthcare
NY
501(C)(3)
10
NYS
No
(10)
New York Spine and Brain Surgery UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2645930
Healthcare
NY
501(C)(3)
10
NYS
No
(11)
Neurology Assoc of Stony Brook UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2587430
Healthcare
NY
501(C)(3)
10
NYS
No
(12)
Univ Assoc in Obst & Gynecology UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2569522
Healthcare
NY
501(C)(3)
10
NYS
No
(13)
Stony Brook Pathologists UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2647243
Healthcare
NY
501(C)(3)
10
NYS
No
(14)
Stony Brook Ophthalmology UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2658697
Healthcare
NY
501(C)(3)
10
NYS
No
(15)
Stony Brook Orthopaedic Associates UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2593061
Healthcare
NY
501(C)(3)
10
NYS
No
(16)
Stony Brook Children's Service UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2571524
Healthcare
NY
501(C)(3)
10
NYS
No
(17)
Stony Brook Psychiatric Associates UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2590096
Healthcare
NY
501(C)(3)
10
NYS
No
(18)
Stony Brook Radiology UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2548304
Healthcare
NY
501(C)(3)
10
NYS
No
(19)
Stony Brook Surgical Associates UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2552333
Healthcare
NY
501(C)(3)
10
NYS
No
(20)
Stony Brook Urology UFPC
PO Box 1554
Stony Brook
,
NY
11790
11-2644371
Healthcare
NY
501(C)(3)
10
NYS
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2017
Page 2
Schedule R (Form 990) 2017
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
SB HLTHCARE IPA LLC
PO Box 1554
STNY BRK
,
NY
11790
11-3499101
healthcare
NY
CPMP
RELATED
0
0
No
0
No
0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
NICOLLS INDEMNITY SOLUTIONS SP
27 HOSPITAL RD
CAYMAN CORP CT
KYI-900
CJ
SELF-INSURANCE
CJ
NA
C CORP
0
0
0 %
No
Schedule R (Form 990) 2017
Page 3
Schedule R (Form 990) 2017
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
State of New York
L
26,953
FMV
Schedule R (Form 990) 2017
Page 4
Schedule R (Form 990) 2017
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2017
Page 5
Schedule R (Form 990) 2017
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2017
Additional Data
Software ID:
Software Version: