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  5. UB ORAL & MAXILLOFACIAL SURGERY, INC.

UB ORAL & MAXILLOFACIAL SURGERY, INC.

Company Details

Name: UB ORAL & MAXILLOFACIAL SURGERY, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION (UNIVERSITY FACULTY PRACTICE CORPORATION)
Status: Active
Date of registration: 07 Apr 2010 (15 years ago)
Entity Number: 3933710
ZIP code: 14214
County: Erie
Place of Formation: New York
Address: DEPT. OF ORAL & MAXILLOFACIAL, SURGERY, 112 SQUIRE HALL, BUFFALO, NY, United States, 14214

Contact Details

Phone +1 716-829-6637

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UB ORAL & MAXILLOFACIAL SURGERY INC 401K PLAN 2023 300634052 2024-08-23 UB ORAL & MAXILLOFACIAL SURGERY, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168296004
Plan sponsor’s address 3435 MAIN STREET, 112-C SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2024-08-23
Name of individual signing JOANNA KESSEL
UB ORAL & MAXILLOFACIAL SURGERY INC 401K PLAN 2022 300634052 2023-06-28 UB ORAL & MAXILLOFACIAL SURGERY, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168496004
Plan sponsor’s address 3435 MAIN STREET, 112-C SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2023-06-28
Name of individual signing DIANE ELSTON
UB ORAL & MAXILLOFACIAL SURGERY INC 401K PLAN 2021 300634052 2022-07-12 UB ORAL & MAXILLOFACIAL SURGERY, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168496004
Plan sponsor’s address 3435 MAIN STREET, 112-C SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2022-07-12
Name of individual signing DIANE ELSTON
UB ORAL & MAXILLOFACIAL SURGERY INC 401K PLAN 2020 300634052 2021-05-05 UB ORAL & MAXILLOFACIAL SURGERY, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168496004
Plan sponsor’s address 3435 MAIN STREET, 112-C SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2021-05-05
Name of individual signing DIANE ELSTON
UB ORAL & MAXILLOFACIAL SURGERY, INC. 401(K) PLAN 2019 300634052 2020-06-22 UB ORAL & MAXILLOFACIAL SURGERY 15
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168296004
Plan sponsor’s address 3435 MAIN ST 112G SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2020-06-22
Name of individual signing TSHANAHAN3177
UB ORAL & MAXILLOFACIAL SURGERY, INC. 401(K) PLAN 2019 300634052 2020-06-30 UB ORAL & MAXILLOFACIAL SURGERY 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168296004
Plan sponsor’s address 3435 MAIN ST 112G SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2020-06-30
Name of individual signing TRICIA SHANAHAN
UB ORAL & MAXILLOFACIAL SURGERY, INC. 401(K) PLAN 2018 300634052 2019-06-03 UB ORAL & MAXILLOFACIAL SURGERY 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168296004
Plan sponsor’s address 3435 MAIN ST 112G SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2019-06-03
Name of individual signing TRICIA SHANAHAN
UB ORAL & MAXILLOFACIAL SURGERY, INC. 401(K) PLAN 2017 300634052 2018-07-11 UB ORAL & MAXILLOFACIAL SURGERY 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168296004
Plan sponsor’s address 3435 MAIN ST 112G SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2018-07-11
Name of individual signing TRICIA SHANAHAN
UB ORAL & MAXILLOFACIAL SURGERY, INC. 401(K) PLAN 2016 300634052 2017-07-14 UB ORAL & MAXILLOFACIAL SURGERY 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168296004
Plan sponsor’s address 3435 MAIN ST 112G SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2017-07-14
Name of individual signing TRICIA SHANAHAN
UB ORAL & MAXILLOFACIAL SURGERY, INC. 401(K) PLAN 2015 300634052 2016-07-14 UB ORAL & MAXILLOFACIAL SURGERY 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 7168296004
Plan sponsor’s address 3435 MAIN ST 112G SQUIRE HALL, BUFFALO, NY, 14214

Signature of
Role Plan administrator
Date 2016-07-14
Name of individual signing TRICIA SHANAHAN

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent DEPT. OF ORAL & MAXILLOFACIAL, SURGERY, 112 SQUIRE HALL, BUFFALO, NY, United States, 14214

Filings

Filing Number Date Filed Type Effective Date
100407000074 2010-04-07 CERTIFICATE OF INCORPORATION 2010-04-07

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
30-0634052 Corporation Unconditional Exemption 112 SQUIRE HALL, BUFFALO, NY, 14214-0000 2011-06
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that normally receives no more than one-third of its support from gross investment income and unrelated business income and at the same time more than one-third of its support from contributions, fees, and gross receipts related to exempt purposes 509(a)(2)
Tax Period 2023-12
Asset 500,000 to 999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 582025
Income Amount 2386593
Form 990 Revenue Amount 2386593
National Taxonomy of Exempt Entities Education: Single Organization Support
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Form 990-N (e-Postcard)
Organization Name UB ORAL & MAXILLOFACIAL SURGERY INC
EIN 30-0634052
Tax Year 2010
Beginning of tax period 2010-01-01
End of tax period 2010-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address State Univ of NY at Buffalo, Squire Hall Room 112, Buffalo, NY, 14214, US
Principal Officer's Name Richard E Hall
Principal Officer's Address State Univ of NY at Buffalo, Squire Hall Room 112, Buffalo, NY, 14214, US

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name UB ORAL AND MAXILLOFACIAL SURGERY INC
EIN 30-0634052
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name UB ORAL AND MAXILLOFACIAL SURGERY INC
EIN 30-0634052
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name UB ORAL AND MAXILLOFACIAL SURGERY INC
EIN 30-0634052
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name UB ORAL AND MAXILLOFACIAL SURGERY INC
EIN 30-0634052
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name UB ORAL AND MAXILLOFACIAL SURGERY INC
EIN 30-0634052
Tax Period 201612
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8488858302 2021-01-29 0296 PPS 3435 Main St, Buffalo, NY, 14214-3001
Loan Status Date 2022-07-12
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 180800
Loan Approval Amount (current) 180800
Undisbursed Amount 0
Franchise Name -
Lender Location ID 46027
Servicing Lender Name Evans Bank, National Association
Servicing Lender Address 8599 Erie Rd, ANGOLA, NY, 14006
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Buffalo, ERIE, NY, 14214-3001
Project Congressional District NY-26
Number of Employees 12
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 46027
Originating Lender Name Evans Bank, National Association
Originating Lender Address ANGOLA, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 183202.41
Forgiveness Paid Date 2022-06-03

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Date of last update: 27 Mar 2025

Sources: New York Secretary of State

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