Upstate Medical University
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1 Upstate Medical University
2 05/15/ :21 PM Page: 3 ExhibitY FORMB OSC Ute Only: Cate Code: State CODlUltant Services Contndor's Annual EmploymeDt Report Report Period: Aprill. to Mareh 31. Sc:ope of Contraet (ChooR one that belt fiti): Analysis 0 Evaluation 0 Research 0 Training 0 Data Processing 0 Com~ Programming 0 Other IT consulting 0 Engineering 0 Architect Services 0 Surveying 0 Environmental Services 0 Health Services E' Mental Health Services 0 Accounting 0 Auditing 0 Paralegal 0 Legal 0 Other Consulting 0 Employment Category ~...".1 Number of Employees Number of Hours Worked Amount Payable Under ~ I.J I Total this page Grand Total Use additional pages if necessary) Page of
3 Exhibit x FORMA OSC Use Only: Category Code: Date Contract Approved: - Contractor's Planned Employment From Contract Start Date Through The End Of The Contract Term 3.3 dil0 'J..' State Agency Name: SUNY Upstate Medical University Agency Code: ~,-..,.. Contractor Name: (, f'':ls~ r",."tn;.)~~ffl"i\!1-ii.' Contract Nurnber: ("S03l;/7 Contract Start Date: : t.c.'" I(~:' / J rcontract End Date: ~!'2,ll'i Number of Number of hours to Amount Payable Employment Category Employees be worked Under IMI~Itlv! H'l..JI~,LSul)ia ~ -~ 3g ~OO j~/.y2-g,37f).do /11/). ", z, v- \. c..j Total this page ~ "1-- 38'1!:J-{)O IJ Z-fiZ8. )'70,00 Grand Total c. '2r- 38",500 J J C; j 7(7, t,'10 (Use additional pages, if necessary) Page of
4 05/15/ :21 PM Page: 3.3 ~ 0 ~II Exhibit Y FORMB OSCUHODIy': C Code: State COD.wiant Servic:eI COlltractor'. Annual EmploymeJIt Report ReportPeriod: AprilI, to March31. Contracting State Agency Name =SUNY Upstate Medical University Agency Code: ContractNumber: c- 5o'3lt~o. CooInct Term: IJ IP'l.~~"l. Contractor Name: IUl l.l 1'_ Contractor Address: :cj1&1~e~ci?~~le &a~r,» Description of ~ Being Provided '. (j..~ v:j UJ,UCa.e Pl.{9nY'r\.U Q(V)" C,q4J - \CU Scope of Contract (CbOOleone tot best fit.): Analysis 0 Evaluation 0 Research 0 Training 0 Data Processing D comerer Programming 0 Other IT consulting 0 Engineering 0 Architect Services Surveying 0 Environmental Services 0 Health Services ltp Mental Health Services 0 A,ccounting 0 Auditing 0 Parale~D Legal 0 Other Consulting 0 Employment Category Number of Number of Hours Amount Payable Employees Worked Under 'Cl!iJ11J!ff.1rfJ f) h{ )(Li.'j fi./yjam. ( :J 402. d.!l ax t.j26.~/j j - /t"ta Total this page Grand Total :2 [In}....?--"5.)if 4KI).115 Use additional pagc5 if necessary) Page of
5 FORMB osc U'eOnly: Category Code: _ -Contractor'sAnilua -EmployltlenfReport- Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name:SUNY Upstate Agency Code: 2. WI' 0 Oontraot Number: Co 4>tnO G>SS"'". 1~~.O~\\ Contract Term: 7/1 /10 to ~ /50/ IS Contractor Name: Press Ganey Associates, Inc. Contractor Address: 404 Columbia Place, South Bend, IN Description of Services Being Provided: Heatthcare Improvement Solullons Scope of contract (Choose one that best fits): Analysis 0 Evaluation 0 Research 0 Training 0 Data ProcessIng 0 computer ProgrammIng 0 Other IT consulting 0 EngineerIng 0 Architect Services (J Surveying 0 EnvIronmental servlces 0 H~alth Services 0 Mental Health ServIces 0 Accounting 0 Auditing 0 Paralegal tj Legal 0 Other Consulting 181 Employmont Category Number of Employees Number of Hou(s Worked (Cust Sarv Rap 2 88 $ (Data Entry Koyers) $ (>1.00 (Mali clerkand Mall) $ (Sales Rep) 1 22 $ (611I1n9. CosiClerk) 4 1 $ ~ (Social Science and Related Worker) 4 9 $ Please note, we. do not operate our business In a manner where hours and costs are specuically allocated per Jierson on an account basis. The Information provided Is based upon best lntormatlon available. Total this page $61, Grand Total Name of person who prepar Preparer's Srgnalure:,_ -_y~.:::.:z:...e:~~q.. 'fltle: Dlreotor, Business S Date Pre ared; 05/05/2014 Use additional pages If necessary) Page of _
6 May :04 From-M/E Eniineerini PC T-014 P.002/002 F-674 FORMB osc Use Only: Categof'Y_Code: Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name: University at Buffalo Agency Code: Contract Number: T }3).()~{) L Contract Term: 5/25/2010 to 6/30/2013 Contractor Name: M/E Engineering, P.C. Contractor Address: 150 N. Chestnut Street, Rochester, NY Description of Services Being Provided: Mechanical and Electrical Engineering Scope of Contract (Choose one that best fits): Analysis D Evaluation 0 Research 0 Training D Data Processing 0 Computer Programming 0 Other IT consulting 0 Engineering l8l Architect Services D Surveying 0 Environmental Services 0 Health Services D Mental Health Services 0 Accounting D Auditing D Paralegal D LegalD Other Consulting 0 Employment Category Number of Employees Number of Hours Worked $0.00 Total this page 2 13 $0.00 Grand Total 2 13 $0.00 Name of person who pr~ed this rep0'brachel C. Patterson Preparer's Signature: cwl C... aitj/l..q,(fy\,) Title: Accounting Representative Phone #: (585) Date Pre ared: 5/14/2014 Use additional pages If necessary) Page 1 of 1
7 May :49 From-M/E EOiineerini PC T-017 P.003/003 F-677 FORMB C8C Use Only; catecorv Code: Contractor':S Annual Employment Report Report Period: April 1, 2013 to March Contracting State Agency Name: SUNY-Upstate Medical University Contract Number: T Contract Term: 10/01/2010 to 6/ Contractor Name: M/E Engineering, P.C. Contractor Address: 150 North Chestnut Street, Rochester, NY Description of Services Being Provided: Mechanical and Electrical Engineering Service Agency Code: '3 ~ 1,0 ~\\ Scope of Contract (Choose Analysis 0 Evaluation D one that best fits)~ Research 0 Training D Data Processing D Computer Programming D Other IT consulting 0 Engineering rgj Architect Services D Surveying 0 Environmental Services 0 Health Services D Mental Health Services 0 Accounting 0 Auditing 0 Paralegal 0 LegalD Other Consulting 0 Employment Category Number of Employees Number of Hours Worked $0.00 Total this page 1 4 $ 0.00 Grand Total 1 4 $0.00 Name of person who p~\ed!isrkporti. Rachel C. Patterson Preparer's Signature: -41L0l~ L-. -!-JC.l:rol\.LXS)'\.J. Title: Accounting Represeiltative Phone #: Date Pre ared: 5/14/2014 Use additional pages if necessary) Page 1 of 1
8 FORM B OSC Use Only: Category Code: Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name: SUNY-Upstate Medical University Agency Code: Contract Number: T ;2. I / Contract Term: 12/10/2010 to 1 1 0'\ Contractor Name: Cannon Design Contractor Address: 2170 Whitehaven Rd., Grand Island, NY Description of Services Being Provided: Architectural & Engineering Scope of Contract (Choose one that best fits): Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting D Engineering D Architect Services IZI Surveying D Environmental Services D Health Services D Mental Health Services D Accounting D Auditing D Paralegal D Legal D Other Consulting D Employment Category Number of Employees Number of Hours Worked Architects, Except UN $29, Cost Estimators 2 17 $3, Electrical Engineers $69, Materials Engineer 1 4 $ Technical Writer 1 1 $ Total this page $103, Grand Total $103, Name of person who pre am Babcock Preparer's Signature:_-->.o::~'=="'~~~~-==- _ Title: Sr. Project Accountant Phone #: Date Pre ared: 4/18/2014 Use additional pages if necessary) Page 1 of 1
9 May :49 From-WE Eniineerini PC T-OI7 P.002/003 F-677 FORMB osc Use Ooly: Catecorv Coda: Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name: SUNY.Upstate Medical University Agency Code: Contract Number: T Contract Term: 03/02/2012 to 11/02/2013 Contractor Name: M/E Engineering, P.C. Contractor Address: 150 North Chestnut Street, Rochester, NY Description of Services Being Provided: Mechanical and Electrical Engineering Service Scope of Contract (Choose one that best fits): Analysis 0 Evaluation 0 Research D Training D Data Processing 0 Computer Programming D Other IT consulting D Engineering 181 Architect Services 0 Surveying 0 Environmental Services 0 Health Services 0 Mental Health Services 0 Accounting D Auditing 0 Paralegal 0 Legal 0 Other Consulting 0 Employment Category Number of Employees Number of I,ou(s Worked $4, I Total this page 1 22 $4, Grand Total 1 22 $4, Name of person who P!ared this re~1 C. Patterson Preparer's Signature: ~C1.C ltl L:±a::1:J1!) I\ON Title: Accountinq Represe~tative Phone #: Date Pre ared: 5/14/2014 Use additional pages if necessary) Page 1 of 1
10 , FORM B OSC Use Only: Category Code: Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name: SUNY-Upstate Medical University Agency Code: Contract Number: T Contract Term: 10109/2012 to 1 1 Contractor Name: Cannon Design Contractor Address: 2170 Whitehaven Rd., Grand Island, NY Description of Services Being Provided: Architectural & Engineering Scope of Contract (Choose one that best fits): Analysis 0 Evaluation 0 Research 0 Training 0 Data Processing 0 Computer Programming 0 Other IT consulting 0 Engineering 0 Architect Services fsi Surveying 0 Environmental Services 0 Health Services 0 Mental Health Services 0 Accounting 0 Auditing 0 Paralegal D Legal D Other Consulting D Employment Category Number of Employees Number of Hours Worked Architects, Except UN 10 1,476 $116, Architectural Drafters $22, Cost Estimators 4 42 $3, Drafters, All Other 1 35 $2, Electrical Drafters 3 54 $4, Electrical Engineers $22, Environ. Engineers 1 2 $ Environ. Technicians $32, Environ. Scientists $33, Fire Prevent Engineers $21, Interior Designers 1 2 $ Materials Engineers 1 3 $ Mechanical Drafters 1 9 $ Total this page 48 3,302 $261, Grand Total 51 3,568 $282, Name of per~on who p~r~ MPJ/rtjAdam Babcock Preparer's Slgnature:-'~I,;;;::i~J ==~r-+.:-9~---'- Title: Sr. Project Accountant Phone #: Date Pre ared: 4/25/2014 Use additional pages if necessary) Page 1 of 2 _
11 .. FORM B OSC Use Only: Category Code: Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name: SUNY-Upstate Medical University Agency Code: Contract Number: T Contract Term: 10/09/2012 to / / Contractor Name: Cannon Design Contractor Address: 2170 Whitehaven Rd., Grand Island, NY Description of Services Being Provided: Architectural & Engineering Scope of Contract (Choose one that best fits): Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting D Engineering D Architect Services ~ Surveying D Environmental Services D Health Services D Mental Health Services D Accounting D Auditing D Paralegal D Legal D Other Consulting D Employment Category Number of Employees Number of Hours Worked Mechanical Engineers $16, Technical Writers 1 63 $4, Total this page $21, Grand Total 51 3,568 $282, Name of per~on who ~!~ Adam Babcock Preparer's Slgnature:...,~~~~::=;;10==;~;c..,~...,..-F'-+- _ Title: Sr. Project Accountant Phone #: Date Pre ared: 4/25/2014 Use additional pages if necessary) Page 2 of 2
12 FORMS OSC Use Only: Category Code: Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name: SUNY Upstate Medical University Agency Code: Contract Number: T Contract Term: 1/7/2013 to 6/30/2015 Contractor Name: Fisher Associates, P.E., L.S., L.A., P.C. Contractor Address: 135 Calkins Road, Rochester, NY Description of Services Being Provided: Campus Site Improvements at Upstate Medical University Scope of Contract (Choose one that best fits): Analysis 0 Evaluation 0 Research 0 Training 0 Data Processing 0 Computer Programming 0 Other IT Consulting 0 Engineering 0 Architect Services ~ Surveying 0 Environmental Services 0 Health Services 0 Mental Health Services 0 Accounting 0 Auditing 0 Paralegal 0 Legal 0 Other Consulting 0 Employment Category Number of Employees Number of Hours Worked Landscape Architects $29, Civil Engineers $9, Civil Engineering Technicians $1, Graphic Designers $23, Architects, Except Landscape and Na\ $4, Architectural Drafters $5, Architectural & Engineering Managers $13, Surveying & Mapping Technicians $1, Surveying Technicians $1, Date Prepared: 4/28/2014 Total this page $91, Grand Total $91, Name of person who prepared this report: Pcllt, Fisher, p..l..-/, l Preparer's Signature: l", Cu..,LL.J -tt5 ~ Title: CEO Phone #: (585) (Use additional pages if necessary) Page 1 of 1
13 Apr PM Te r al-le dic a, Inc /1 FORMS OSC Use Only: R.portlllg Cod.: CataaCN Code: State Consultant ServIces Report Period: April to March Contracting State Agency Name: efftoe-<:lhhe-stats'"c01tfpjrollsr Contract Number: PO T13 lj yy'l '-- Contract Term: /2013 to ongoing Contractor Name: TeraMedica Contractor Address: Innovation Drive, Milwaukee, WI 5:3226 Description of Services Being Provided: Philips Xcelera Data Migration Agency Code: ~o~ II SCOpG of Contract (Choose one that best fits): Analysis 0 Evaluation 0 Research 0 Training 0 Data Processing 0 Computer Progl1lmmlng X Other IT consultfng 0 Engineering 0 Architect Services 0 Surveying 0 Environmental Services 0 Health Services 0 Mental Health Servlce$ 0 Accounting 0 Auditing 0 Paralegal 0 Legal 0 Other ConsLlltlng 0 EmplOYTnlintC"tegory Number of Employeea Number of Houra Worked Amount-paylilife Vrider thecontrad $ $ $ ~. ;,. Total this page Grnnd Total $25000 Use additional pages if necessary) Page 1 of 1
14 FORMB OSC Use Only: Category Code: State Consultant Services Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name -5 UN\} ---U (>3)IJ-1E'Y'f f::p/~gency Code: Contract Number: I 33;:tO. ~J / Contract Term: 8/1/2013 to 7/31/2015 Contractor Name: Nordic Consulting Partners Contractor Address: 740 Regent St Suite 400 Madison, WI Description of Services Being Provided: Epic EMR Implementation and support services Scope of Contract (Choose one that best fits): Analysis 0 Evaluation 0 Research 0 Training 0 Data Processing 0 Computer Programming 0 Other IT consulting ~ Engineering 0 Architect Services 0 Surveying 0 Environmental Services 0 Health Services 0 Mental Health Services 0 Accounting 0 Auditing 0 Paralegal 0 Legal 0 Other Consulting 0 Employment Category Number of Number of Hours Amount Payable Employees Worked Under Computer and Information Systems Managers 16 9, $1,589,681 Total this page 16 9, $1,589,681 Grand Total 16 9, $1,589,681 Name of per:-0n who prepa~r this r~rt: Amy Rettler Preparer's Slgnature: ~~~... _p.!::.=~ _ I Title: Director of Client Relations Phone #: Date Pre ared: 5/14/2014 Use additional pages if necessary) Page 1 of 1
15 Apr PM Te r a+te dlr a, Inc / FORMB oae U Only: Reporting Code; State Consultant Services ReDort Period: April 1,2013 to March 31, 2014 CaiellON Code: AgencyCode: ' -3~ 0 ~ \ \ Contracting State Agency Name: Office-of th,e State Comptroller Contract Number; PO T13 \.) \(V\..l. Contract Term: 04/01/2014 to ongoing Contractor Name: TeraMedica, Inc. Contractor Address: Innovation Drive, Milwaukee, WI Description of Services Being Provided: Community General Hospital Data Mignation (lncludes pre-fetch) Scope of Contract (ChoOIUt one that best fits): Analysis 0 Evaluation 0 Research 0 Training 0 Data Processing 0 Computer Programming X Other IT consulting 0 Engineering 0 Architect Services 0 Surveying 0 Environmental Services 0 Health Services 0 Mental Health Services 0 Accounting 0 Auditing 0 Paralegal 0 Legal 0 Other Consulting 0 Employmsnt Category Number of EmpJayHlJo Number of Houl8 WorKed 16~ $4, $ ~, ift, Total this paas Grand Total $ Name of person who pr p'srvd. his r Preparer's 5Ignatur6:,----6-~~~u.:..;~~.JJ.tJ.~~= Title: Project Manage Date Pre ared: 4117/14 Use additional pages If necessary) Page 1 of 1 -'._- _.._--_...,-----
16 FORMB osc Use Only: Category Code: Report Period: April 1, 2013 to March 31, 2014 Contracting State Agency Name: Office of the State Comptroller Contract Number: PO T13 Contract Term: /2013 to ongoing Contractor Name: TeraMedica Contractor Address: Innovation Drive, Milwaukee, WI Description of Services Being Provided: Philips Xcelera Data Migration Agency Code: ~IJ Scope of Contract (Choose one that best fits): Analysis 0 Evaluation 0 Research 0 Training D. Data Processing 0 Computer Programming X Other IT consulting 0 Engineering 0 Architect Services 0 Surveying 0 Environmental Services 0 Health Services 0 Mental Health Services 0 Accounting 0 Auditing 0 Paralegal 0 Legal 0 Other Consulting 0 Employment Category Number of Employees Number of Hours Worked Amount Payable Under the Contrad $ $19, $ Total this page Grand Total $25,000 Use additional pages if necessary) Page 1 of 1
17 FORMB OSC Use Only: Category Code: Report Period: April to March 31, 2014 Contracting State Agency Name: Office of the State Comptroller Contract Number: PO T13 Contract Term: 04/01/2014 to ongoing Agency Code: \ 33~C ~\ Contractor Name: TeraMedica, Inc. Contractor Address: Innovation Drive, Milwaukee, WI Description of Services Being Provided: Community General Hospital Data Migration (includes pre-fetch) Scope of Contract (Choose one that best fits): -Analysis D Evaluation0 Research 0 Training 0 Data Processing 0 Computer ProgrammingX Other IT consulting 0 Engineering0 Architect Services D Surveying D EnvironmentalServices D Health Services D Mental Health Services D Accounting D Auditing D Paralegal 0 LegalD Other Consulting D Employment Category Number of Employees Number of Hours Worked Amount Payable Under $4, $29, Total this page Grand Total $34,500 Name of person who pr pared Preparer's Signature:-+p..4-Lo:I..l.<I~I<:.L...Io~~",",",,~~~=- _ Title: Project Manage Phone #: Date Pre ared: 4/17/14 Use additional pages if necessary) Page 1 of
18 Appendix H FORMS OSC Use Only: Category Code: Report Period: April 1, to March 31, Contracting State Agency Name: Korn Ferry Int'I Agency Code: Contract Number: Contract Term: I I to I I - TBD with signed contract Contractor Name: John Ferry 265 Franklin Street, 17th Fir. Boston, MA Contractor Address: Recruitment Services Description of Services Being Provided: Scope of Contract (Choose one that best fits): Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting D Engineering D Architect Services D Surveying D Environmental Services D Health Services D Mental Health Services D Accounting D Auditing D Paralegal D Legal D Other Consulting ~ Employment Category Number of Employees Number of Hours Worked Recruitment Services 4 TBD $ Total this page 0 0 $ 0.00 Grand Total $112, Name of person who prepared this report: Pre parer's Signature:---->:J=o'"'"'h"-'n:...:F'-'e=r...:..ryJ-l,'-'M..:..:..=:D'----::~~=_= ==:_=_7--- Title: Senior Client Partner Phone #: I I Use additional pages if necessary) Page 1 of 1
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