MEDICAL STAFF OF BLAKE MEDICAL CENTER INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF BLAKE MEDICAL CENTER INC (EIN 83-2065303)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-06-12
IRS object ID
202331639349300513
Schema version
2022v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-06-12T09:28:44-04:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN300014946PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1REHFELDT GROUP CPASBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line13201 26TH ST WESTAddressLine1Txt
CityBRADENTONCityNm
State AbbreviationFLStateAbbreviationCd
ZIP34205ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN832065303EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE MEDICAL STAFF OF BLAKE MEDICALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMEDIBusinessNameControlTxt
Phone9417926611PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12020 59TH ST WAddressLine1Txt
CityBRADENTONCityNm
State AbbreviationFLStateAbbreviationCd
ZIP34209ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSCOTT SELPHPersonNm
Person TitleTREASURERPersonTitleTxt
Phone9417926611PhoneNum
Signature2023-05-19SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstSCOTTPersonFirstNm
Person LastSELPHPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (true)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonREBECCA HODGE CPAPreparerPersonNm
PTINP00001682PTIN
Phone9417390920PhoneNum
Preparation2023-06-12PreparationDt
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSCOTT SELPHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12020 59TH ST WAddressLine1Txt
CityBRADENTONCityNm
State AbbreviationFLStateAbbreviationCd
ZIP34209ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$500,391GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2018FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionTO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF THE PEOPLE IN THE COMMUNITY SERVED BY THE ENTITY. TO PROMOTE THE INTEREST OF THE MEDICAL STAFF OF BLAKE MEDICAL CENTER THROUGH THE ADVANCEMENT OF IDEAS AND EDUCATION OF ITS MEMBERS TO PROMOTE THE DELIVERY OF EFFECTIVE MEDICAL CARE. TO ESTABLISH, DEVELOP, SPONSOR, PROMOTE AND/OR CONDUCT EDUCATION PROGRAMS, SCIENTIFIC RESEARCH, MEDICAL FACILITIES AND MANAGEMENT SERVICES.ActivityOrMissionDesc
Voting Members Governing Body281VotingMembersGoverningBodyCnt
Voting Members Independent281VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$159,600PYContributionsGrantsAmt
CY Contributions Grants$314,421CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$24,344PYInvestmentIncomeAmt
CY Investment Income-$3,813CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$183,944PYTotalRevenueAmt
CY Total Revenue$310,608CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$117,925PYOtherExpensesAmt
CY Other Expenses$108,901CYOtherExpensesAmt
PY Total Expenses$117,925PYTotalExpensesAmt
CY Total Expenses$108,901CYTotalExpensesAmt
PY Revenues Less Expenses$66,019PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$201,707CYRevenuesLessExpensesAmt
Total Assets BOY$717,003TotalAssetsBOYAmt
Total Assets EOY$832,211TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$717,003NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$832,211NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF THE PEOPLE IN THE COMMUNITY SERVED BY THE ENTITY. TO PROMOTE THE INTEREST OF THE MEDICAL STAFF OF BLAKE MEDICAL CENTER THROUGH THE ADVANCEMENT OF IDEAS AND EDUCATION OF ITS MEMBERS TO PROMOTE THE DELIVERY OF EFFECTIVE MEDICAL CARE. TO ESTABLISH, DEVELOP, SPONSOR, PROMOTE AND/OR CONDUCT EDUCATION PROGRAMS, SCIENTIFIC RESEARCH, MEDICAL FACILITIES AND MANAGEMENT SERVICES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$3,000ExpenseAmt
DescTHE ORGANIZATION SUPPORTED A LOCAL CHARITY TO PROVIDE A BREAKFAST WITH SANTA SPONSORSHIP FOR THE CHILDREN OF BLAKE HOSPITAL EMPLOYEES.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$35,860ExpenseAmt
DescTHE ORGANIZATION PROVIDED STIPENDS FOR VARIOUS MEDICAL STAFF TO SIT ON VARIOUS MEDICAL COMMITTEES OF BLAKE MEDICAL CENTER. THOSE COMMITTEES WERE THE MEDICAL REVIEW COMMITTEE, CREDENTIALS COMMITTEE, AND THE MEDICAL EXECUTIVE COMMITTEE.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$5,000ExpenseAmt
DescTHE ORGANIZATION CONTRIBUTED TO THE MANATEE MEDICAL SOCIETY FOUNDATION. THE FOUNDATION EXTENDS SUPPORT TO MANATEE COUNTY PHYSICIANS AND PROMOTES HIGH-QUALITY HEALTH CARE FOR THE PEOPLE OF MANATEE COUNTY.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$20,000ExpenseAmt
DescTHE ORGANIZATION CONTRIBUTED TO THE MY BREAST FRIENDS 941 NONPROFIT ORGANIZATION. THE ORGANIZATION SUPPORTS BREAST CANCER PATIENTS.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$20,000TotalOtherProgSrvcExpenseAmt
Total Program Service Expenses$63,860TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxYes (true)SubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document20IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members281GoverningBodyVotingMembersCnt
Independent Voting Member281IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSCOTT SELPHPersonNm
Phone9417926611PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12020 59TH ST WAddressLine1Txt
CityBRADENTONCityNm
State AbbreviationFLStateAbbreviationCd
ZIP34209ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JOSEPH ALESNIK
MEMBER AT LA1.00Yes (X)$0$0$0
AWAIS BAIG
MEDICINE CHA1.00Yes (X)$0$0$0
RALPH BARKER
TRAUMA DIRECYes (X)$0$0$0
PHILIP BLAUSTEIN
VICE CHIEF O1.00Yes (X)$0$0$0
DAVID CASHEN
SURGERY CHAI1.00Yes (X)$0$0$0
ARUNA NARASIUMAN
MEMBER AT LA1.00Yes (X)$0$0$0
GURUSWAMY RAMAMURTHY
CHIEF OF STA1.00Yes (X)$0$0$0
SCOTT SELPH
TREASURER2.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Membership Dues$314,421MembershipDuesAmt
Total Contributions$314,421TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,006TotalRevenueColumnAmt
Exclusion$8,006ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$177,931SecuritiesAmt
Other$33OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$189,783SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$11,852SecuritiesAmt
Other$33OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$11,819TotalRevenueColumnAmt
Related Or Exempt Func Income-$11,852RelatedOrExemptFuncIncomeAmt
Exclusion$33ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$310,608TotalRevenueColumnAmt
Related Or Exempt Func Income-$11,852RelatedOrExemptFuncIncomeAmt
Exclusion$8,039ExclusionAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$7,253TotalAmt
Management And General$7,253ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$32,674TotalAmt
Management And General$32,674ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$4,620TotalAmt
Management And General$4,620ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
STIPENDS$35,860$35,860
CONTRIBUTION$20,000$20,000
SPONSORSHIP$5,000$5,000
SPONSORSHIPS$3,000$3,000

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$494TotalAmt
Management And General$494ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$108,901TotalAmt
Program Services$63,860ProgramServicesAmt
Management And General$45,041ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$68,261BOYAmt
EOY$281,035EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$648,742BOYAmt
EOY$551,176EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$717,003BOYAmt
EOY$832,211EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$717,003BOYAmt
EOY$832,211EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$717,003BOYAmt
EOY$832,211EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$717,003BOYAmt
EOY$832,211EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$201,707ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$86,499NetUnrlzdGainsLossesInvstAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Substantially All Dues NondedfalseSubstantiallyAllDuesNondedInd
Only In House LobbyingYes (true)OnlyInHouseLobbyingInd
Agree Carryover Prior YearfalseAgreeCarryoverPriorYearInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSIONTO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF THE PEOPLE IN THE COMMUNITY SERVED BY THE ENTITY. TO PROMOTE THE INTEREST OF THE MEDICAL STAFF OF BLAKE MEDICAL CENTER THROUGH THE ADVANCEMENT OF IDEAS AND EDUCATION OF ITS MEMBERS TO PROMOTE THE DELIVERY OF EFFECTIVE MEDICAL CARE. TO ESTABLISH, DEVELOP, SPONSOR, PROMOTE AND/OR CONDUCT EDUCATION PROGRAMS, SCIENTIFIC RESEARCH, MEDICAL FACILITIES AND MANAGEMENT SERVICES.
FORM 990, PAGE 2, PART III, LINE 4DTHE ORGANIZATION CONTRIBUTED TO THE MY BREAST FRIENDS 941 NONPROFIT ORGANIZATION. THE ORGANIZATION SUPPORTS BREAST CANCER PATIENTS.
FORM 990, PAGE 6, PART VI, LINE 6THE ORGANIZATION IS A MEMBERSHIP ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 11BTHE ORGANIZATION DOES NOT HAVE A PROCESS TO REVIEW THE FORM 990 NOR DOES IT PLAN TO CONDUCT A REVIEW.
FORM 990, PAGE 6, PART VI, LINE 12COFFICERS ATTEST IN WRITING ANNUALLY THAT THEY HAVE NO CONFLICTS OF INTEREST.
FORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST ONLY.

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