2023-10-05T18:04:01-05:00 2022-12-31 910189318 MOSS ADAMS LLP 21700 OXNARD ST STE 300 WOODLAND HILLS CA 91367 990 2022-01-01 956419205 SANSUM CLINIC SANS 8056817700 PO BOX 1200 SANTA BARBARA CA 931021200 ALEX BAUER CFO 8056817700 2023-10-02 1 ALEX BAUER 999009999 0 LAUREN A HAVERLOCK P00545829 8185771900 2023-10-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ALEX BAUER PO BOX 1200 SANTA BARBARA CA 931021200 358093102 0 X WWW.SANSUMCLINIC.ORG X 1921 CA TO PROVIDE MEDICAL SERVICES TO THE GENERAL PUBLIC. 16 16 1668 50 0 0 21127536 9404731 337959239 341714073 160110 213199 6690391 6596915 365937276 357928918 0 0 0 0 99222945 105265865 0 0 462949 258534061 267048392 357757006 372314257 8180270 -14385339 164070911 205934220 92713387 151006889 71357524 54927331 X THE CLINIC PROVIDES MEDICAL SERVICES TO THE GENERAL PUBLIC, INCLUDING CHARITY CARE TO PATIENTS WHO ARE UNABLE TO PAY AND THOSE UNDER MEDICARE AND MEDI-CAL PROGRAMS AT LESS THAN STANDARD CHARGES. OTHER HEALTH SERVICES IN THE COMMUNITY ARE ALSO PROVIDED, SUCH AS WELLNESS PROGRAMS, EDUCATIONAL SERVICE, SPEAKING ENGAGEMENTS AND INTERNSHIP PROGRAMS. 0 0 305732188 341714073 SEE SCHEDULE OSEE SCHEDULE OIN FURTHERANCE OF ITS CHARITABLE PURPOSE, THE CLINIC PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED CHARGE TO RESIDENTS OF THE COMMUNITY, PRIMARILY THROUGH: (A) SERVICES PROVIDED AT NO CHARGE TO THE UNINSURED; (B) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICAL) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES; AND (C) THE SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE UNABLE DUE TOSOCIO-ECONOMIC FACTORS. ADDITIONAL ACTIVITIES UNDERTAKEN TO BENEFIT THE COMMUNITY AND TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE TO EVERY PATIENT IN AN ENVIRONMENT THAT FOSTERS CARING AND COMPASSION AND PROMOTES EDUCATION AND RESEARCH INCLUDE THE FOLLOWING:- PROVIDING FREE EYE EXAMINATIONSTHROUGH SEE INTERNATIONAL TO CHILDREN WHO COULD NOT OTHERWISE AFFORD THEM.- PROVIDING MORE THAN 300 HEALTH EDUCATION CLASSES (E.G. ASTHMA, BACK AND NECK CARE, CHOLESTEROL, DIABETES, HEALTHY AGING, JOINT REPLACEMENT, STRESS, WEIGHT MANAGEMENT FOR CHILDREN AND ADULTS) THAT ARE OFFERED EACH YEAR. THE CLASSES ARE OPEN TO THE COMMUNITY, ARE OFFERED FOR FREE OR AT A NOMINAL FEE AND ARE AVAILABLE THROUGHOUT THE COUNTY.- LEADING CAMP WHEEZ AND PROVIDING PHYSICIANS AND SUPPORT STAFF FOR THIS WEEKLONG SUMMER CAMP FOR CHILDREN LIVING WITH ASTHMA.- COLLABORATING WITH SANTA BARBARA NEIGHBORHOOD CLINICS TO PROVIDE DIAGNOSTIC CARE AND SPECIALTY MEDICAL SERVICES TO RESIDENTS WHO COULD OTHERWISE NOT AFFORD THESE TESTS.- PROVIDING RELIABLE HEALTH AND RESOURCE INFORMATION FREE OF CHARGE TO ANY COMMUNITY MEMBER, PATIENTS AND NON-PATIENTS ALIKE, THROUGH OUR HEALTH RESOURCE CENTER.- PARTICIPATING IN A VARIETY OF RESEARCH PROJECT WITH PARTNERS SUCH AS UCLA, THE RAND CORPORATION AND SEVERAL PHARMACEUTICAL COMPANIES.- PARTICIPATING IN OVER A DOZEN ANNUAL HEALTH FAIRS AND FREE HEALTH SCREENING EVENTS. 305732188 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 223 0 1 1668 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X ALEXANDER BAUER 8056817500 PO BOX 1200 SANTA BARBARA CA 931021200 ARNOLD R SCHAFFER CHAIR OF BOARD OF TRUSTEES 1.00 X X 0 0 0 CHRISTINE GARVEY VICE CHAIRMAN BOT 1.00 X X 0 0 0 STEPHEN JONES VICE CHAIRMAN BOT 1.00 X X 0 0 0 BRET E DAVIS MD PHYSICIAN TRUSTEE 1.00 X 0 0 0 DAVID A RAPHAEL MD PHYSICIAN TRUSTEE 1.00 X 0 0 0 MICHAEL BERNSTEIN MD PHYSICIAN TRUSTEE 1.00 X 0 0 0 ART MEROVICK TRUSTEE 1.00 X 0 0 0 GEORGE RUSZNAK TRUSTEE 1.00 X 0 0 0 GEORGE SHORT TRUSTEE 1.00 X 0 0 0 JAMES MCNAMARA MD TRUSTEE 1.00 X 0 0 0 JANET A GARUFIS TRUSTEE 1.00 X 0 0 0 MARTY MCDERMUT TRUSTEE 1.00 X 0 0 0 RON LATIMER MD TRUSTEE 1.00 X 0 0 0 STEVE MCHUGH TRUSTEE THROUGH 4/2022 1.00 X 0 0 0 VAL MONTGOMERY TRUSTEE 1.00 X 0 0 0 VICKI HAZARD TRUSTEE 1.00 X 0 0 0 WILLIAM MEEKER TRUSTEE 1.00 X 0 0 0 KURT RANSOHOFF CEO, MEDICAL DIRECTOR 40.00 X 435565 0 0 CHAD HINE COO,VICE PRESIDENT AND SEC 40.00 X 503327 0 39592 ALEX BAUER CFO AND VICE PRESIDENT 40.00 X 376105 0 8332 MATTHEW BAUMANN VICE PRESIDENT 40.00 X 353615 0 24342 MARJORIE NEWMAN MEDICAL DIRECTOR 40.00 X 353984 0 15250 SEAN JOHNSON VICE PRESIDENT APPLICATION 40.00 X 308809 0 39592 KAREN HANDY VICE PRESIDENT - OPERATIONS 40.00 X 322713 0 14444 DANIEL WEIGEL VICE PRESIDENT - HUMAN RESOURCES 40.00 X 277559 0 21274 TRACY KERN VICE PRESIDENT,FINANCE, CONTROLLER 40.00 X 269798 0 11501 3201475 0 174327 184 0 1 0 SANSUM SANTA BARBARA MEDICAL CLINIC INC PO BOX 1200 SANTA BARBARA CA 93102 PROFESSIONAL SERVICES 80729921 SANTA BARBARA RADIOLOGY MEDICAL GROUP 320 W PUEBLO STREET SANTA BARBARA CA 93101 RADIOLOGY SERVICES 3851029 RADIATION CENTER MEDICAL GROUP 300 W PUEBLO STREET SANTA BARBARA CA 93105 PROFESSIONAL SERVICES 3249263 JACKSON MEDICAL GROUP 517 W JUNIPERO STREET SANTA BARBARA CA 93105 PROFESSIONAL SERVICES 2895822 PARKER BROWN INC 21116 VAN OWEN STREET CANOGA PARK CA 91303 PROFESSIONAL SERVICES 2614787 87 9404731 2060507 9404731 OTHER MEDICAL SERVICES 621110 340032709 340032709 COTTAGE HOSPITALISTS SERVICES 621110 1681364 1681364 341714073 213199 213199 574995 164184 410811 410811 410811 MISCELLANEOUS INCOME 561499 4376172 4376172 ADMINISTRATIVE FEES 561000 908341 908341 CLINICAL STUDIES 561499 731421 731421 170170 170170 6186104 357928918 341714073 0 6810114 X 1740879 1740879 81007200 61497807 19369696 139697 1596140 1264781 328486 2873 14927239 11828344 3072026 26869 5994407 4749968 1233649 10790 789118 789118 166669 166669 121233237 96065217 24949800 218220 675728 535447 139065 1216 5542365 4391769 1140620 9976 5550428 4398159 1142278 9991 10435015 8234621 2181315 19079 24510 19422 5044 44 327230 259297 67344 589 2094323 2094323 8338717 6607599 1716108 15010 1467991 1467991 PHARMACEUTICAL SUPPLIES 47996292 47996292 ONCOLOGY SUPPLIES 40423440 40423440 MEDICAL SUPPLIES 12208306 12208306 SETTLEMENT 5000000 5000000 4775023 3783728 982700 8595 372314257 305732188 66119120 462949 26275660 20771614 3276349 5453131 75079 26377 33313697 41039742 5266250 4926180 5942562 4912509 1590005 3163098 160424480 96099095 62576926 64325385 11650574 9553533 750334 750334 13353475 51012317 164070911 205934220 44392964 39794782 16472895 39179682 31847528 72032425 92713387 151006889 X 67725496 50481598 3632028 4445733 71357524 54927331 164070911 205934220 -14385339 -2044854 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12756519 83667 -2066475 10773711 11460157 6250 1290112 12756519 10103261 26547 1330349 11460157 8595676 83699 1423886 10103261 8983804 84452 -472580 8595676 0.86630 0.13370 0.00000 0 0 5289659 5289659 29592386 15879362 13713024 25757643 14715607 11042036 91578583 63623923 27954660 8206209 1880203 6326006 64325385 DEFERRED COMPENSATION PLAN ASSETS 9760240 OTHER ASSETS 193452 INSURANCE RECEIVABLE 2498749 ROU ASSET 38559876 51012317 DEFERRED COMPENSATION PLAN LIABILITIES 9760240 MEDICAL MALPRACTICE LIABILITY 5440749 OPERATING LEASE LIABILITY - CURRENT 5420704 OPERATING LEASE LIABILITY - NONCURRENT 33649792 FINANCE LEASE OBLIGATIONS - CURRENT 1674494 FINANCE LEASE OBLIGATIONS - NONCURRENT 16086446 72032425 X 356048248 -2044854 -2044854 358093102 -164184 -164184 357928918 372478441 0 372478441 -164184 -164184 372314257 PART V, LINE 4: THE CLINIC'S ENDOWMENT INCLUDES DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS. PART X, LINE 2: THE CLINIC IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE AND SIMILAR PROVISIONS OF THE CALIFORNIA REVENUE AND TAXATION CODE. IN ADDITION, THE CLINIC QUALIFIED FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. UNRELATED BUSINESS INCOME TAX, IF ANY, IS INSIGNIFICANT. THE CLINIC RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THERE WERE NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2022 OR 2021. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH RENTAL INCOME -164,184. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO STATEMENT OF REVENUE -164,184. X 1 1 X X 0 0 0 0 0 0 0 0 0 CHAD HINE COO,VICE PRESIDENT AND SEC 503327 0 0 0 0 0 15250 0 24342 0 542919 0 0 0 KURT RANSOHOFF CEO, MEDICAL DIRECTOR 430465 0 0 0 5100 0 0 0 0 0 435565 0 0 0 ALEX BAUER CFO AND VICE PRESIDENT 376105 0 0 0 0 0 8332 0 0 0 384437 0 0 0 MATTHEW BAUMANN VICE PRESIDENT 302940 0 50675 0 0 0 0 0 24342 0 377957 0 0 0 MARJORIE NEWMAN MEDICAL DIRECTOR 353984 0 0 0 0 0 15250 0 0 0 369234 0 0 0 SEAN JOHNSON VICE PRESIDENT APPLICATION 308809 0 0 0 0 0 15250 0 24342 0 348401 0 0 0 KAREN HANDY VICE PRESIDENT - OPERATIONS 322713 0 0 0 0 0 7772 0 6672 0 337157 0 0 0 DANIEL WEIGEL VICE PRESIDENT - HUMAN RESOURCES 277559 0 0 0 0 0 5584 0 15690 0 298833 0 0 0 TRACY KERN VICE PRESIDENT,FINANCE, CONTROLLER 269798 0 0 0 0 0 4829 0 6672 0 281299 0 0 0 PART I, LINE 1A KURT RANSOHOFF MD/CEO SUBMITS AN EXPENSE REPORT THAT DOCUMENTS PERSONAL USE WHICH IS INCLUDED IN HIS W-2 COMPENSATION. X 9 2060507 SALES PRICE OF SHARES 0 1 0 PART I, COLUMN (B): THE NUMBERS REPORTED IN PART I, COLUMN (B) REPRESENT THE NUMBER OF DONORS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF TRUSTEES HAS DELEGATED THE FIDUCIARY RESPONSIBILITY OF THE REVIEW AND APPROVAL PROCESS OF THE 990 TAX RETURN TO THE FINANCE COMMITTEE AND THE CHIEF FINANCIAL OFFICER; UPON APPROVAL BY THE FINANCE COMMITTEE THE 990 TAX RETURN GOES TO THE BOARD OF TRUSTEES FOR FINAL APPROVAL. THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS ELECTRONICALLY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. ONCE FINAL APPROVAL IS GIVEN, THE 990 TAX RETURN IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF SANSUM CLINIC TO MAIL OUT, ON AN ANNUAL BASIS, A CONFLICT OF INTEREST STATEMENT TO THE BOARD OF TRUSTEES FOR COMPLETION. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND ALL RESPONSES FILED. PER POLICY ALL BOARD OF TRUSTEES MEMBERS HAVE A DUTY TO DISCLOSE POTENTIAL CONFLICT OF INTERESTS. A PROCESS IS IN PLACE TO EVALUATE AND DETERMINE IF POSSIBLE CONFLICT OF INTEREST EXISTS. PROCEDURES ARE IN PLACE TO ADDRESS CONFLICT OF INTEREST BY RECUSING THE MEMBER FROM PARTICIPATING IN THE BOARD OF TRUSTEES DELIBERATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE HUMAN CAPITAL MANAGEMENT COMMITTEE OF THE BOARD OF TRUSTEES PERIODICALLY REVIEWS EXECUTIVE COMPENSATION. INDUSTRY BASED COMPENSATION SURVEYS BY MGMA AND AMGA ARE USED TO DETERMINE EXECUTIVE COMPENSATION. IN ADDITION, SALARY SURVEYS ARE PROVIDED BY THE EXECUTIVE SEARCH FIRM WHEN POSITIONS ARE BEING RECRUITED FOR. NO CHANGES TO EXECUTIVE COMPENSATION ARE IMPLEMENTED THAT ARE NOT BUDGETED FOR AND ARE NOT CONSISTENT WITH THE AVERAGE RATE OF PAY INCREASES FOR OTHER COMPANY EMPLOYEES. ANY EXCEPTIONS TO THIS ARE APPROVED, IN ADVANCE, BY THE HUMAN CAPITAL MANAGEMENT COMMITTEE PRIOR TO IMPLEMENTATION. FORM 990, PART VI, SECTION C, LINE 19 IT IS THE POLICY OF SANSUM CLINIC TO PROVIDE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS UPON WRITTEN REQUEST BY MAIL TO THE CORPORATE LOCATION. FORM 990, PART IX, LINE 11G OUTSIDE PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 96,065,217. MANAGEMENT AND GENERAL EXPENSES 24,949,800. FUNDRAISING EXPENSES 218,220. TOTAL EXPENSES 121,233,237.