BETA

CENTINELA MEDICAL STAFF INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
CENTINELA MEDICAL STAFF INC (EIN 45-0557148)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-11-15
IRS object ID
202303199349310855
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)
Return2023-11-15T11:45:54-06:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN843731713PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DEJENE & ASSOCIATES INCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11025 W 190TH ST STE 120AddressLine1Txt
CityGARDENACityNm
State AbbreviationCAStateAbbreviationCd
ZIP90248ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN450557148EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CENTINELA MEDICAL STAFF INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCENTBusinessNameControlTxt
Phone3106801492PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1555 E HARDY STREETAddressLine1Txt
CityINGLEWOODCityNm
State AbbreviationCAStateAbbreviationCd
ZIP90301ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonFIROOZ PAK MDPersonNm
Person TitleCHIEF OF STAFFPersonTitleTxt
Phone3106801492PhoneNum
Signature2023-11-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstFIROOZPersonFirstNm
Person LastPAK MDPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL F JUDGEPreparerPersonNm
PTINP00532571PTIN
Phone3103217388PhoneNum
Preparation2023-11-13PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerFIROOZ PAK MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1555 E HARDY STREETAddressLine1Txt
CityINGLEWOODCityNm
State AbbreviationCAStateAbbreviationCd
ZIP90301ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$152,894GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.CENTINELAMED.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2007FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionPROMOTION OF HEALTH AND MEDICAL CARE.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$161,188PYContributionsGrantsAmt
CY Contributions Grants$152,894CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$15,232PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue-$11,228PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$165,192PYTotalRevenueAmt
CY Total Revenue$152,894CYTotalRevenueAmt
PY Grants And Similar Paid$5,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$5,500CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$55,000PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$65,000CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$40,018PYOtherExpensesAmt
CY Other Expenses$24,168CYOtherExpensesAmt
PY Total Expenses$100,018PYTotalExpensesAmt
CY Total Expenses$94,668CYTotalExpensesAmt
PY Revenues Less Expenses$65,174PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$58,226CYRevenuesLessExpensesAmt
Total Assets BOY$286,779TotalAssetsBOYAmt
Total Assets EOY$345,005TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$286,779NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$345,005NetAssetsOrFundBalancesEOYAmt
MissionPROMOTION OF HEALTH AND MEDICAL CAREMissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$20,605ExpenseAmt
DescPROVIDED RECOGNITION AWARDS AND OTHER ITEMS TO SUPPLEMENT EXEMPT PURPOSE THOUGH EMPLOYEE/STAFF PERSONNEL RECOGNITION.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$5,500ExpenseAmt
DescPROVIDED GRANTS TO CHARITABLE ORGANIZATIONS WHICH PROMOTE CAUSES CONSISTENT WITH THE EXEMPT PURPOSE OF THIS ORGANIZATION.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,650ExpenseAmt
DescPROVIDED FUNDS FOR THE EDUCATION AND ADDITIONAL CREDENTIALING OF THE HOSPITAL MEDICAL STAFF.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$27,755TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FIROOZ PAK MDBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3106801492PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1555 E HARDY STREETAddressLine1Txt
CityINGLEWOODCityNm
State AbbreviationCAStateAbbreviationCd
ZIP90301ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (5 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
ALI MORSHEDI-MEIBODI MD
IMMMEDIATE PAST COS5.00Yes (X)$0$0$0
FIROOZ PAK MD
CHIEF OF STAFF20.00Yes (X)$0$65,000$0
CRAIG GOMBERG MD
CHIEF OF STAFF, ELECT5.00Yes (X)$0$0$0
JAY MELTON MD
SECRETARY5.00Yes (X)$0$0$0
BASIL YOUNES DO
TREASURER5.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$65,000TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$152,894AllOtherContributionsAmt
Total Contributions$152,894TotalContributionsAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$152,894TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,500TotalAmt
Program Services$5,500ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$65,000TotalAmt
Management And General$65,000ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$10,955TotalAmt
Program Services$10,955ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,035TotalAmt
Management And General$1,035ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
STAFF RECOGNITION & AWA$9,650$9,650
EDUCATION & CREDENTIALI$1,650$1,650
PHOTOGRAPHY$875$875
BANK CHARGE$3$3

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$94,668TotalAmt
Program Services$27,755ProgramServicesAmt
Management And General$66,913ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$286,779BOYAmt
EOY$345,005EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$286,779BOYAmt
EOY$345,005EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$286,779BOYAmt
EOY$345,005EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$286,779BOYAmt
EOY$345,005EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$286,779BOYAmt
EOY$345,005EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$58,226ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 7AMEMBER ELECTION FOR ADDITIONAL MEMBERS A VACANCY IN THE BOARD OF DIRECTORS MAY BE FILLED BY A MAJORITY OF THE REMAINING DIRECTORS, OR IF THE NUMBER OF DIRECTORS THEN IN OFFICE IS LESS THAN A QUORUM, BY (1) THE UNANIMOUS WRITTEN CONSENT OF THE DIRECTORS THEN IN OFFICE, (2) THE AFFIRMATIVE VOTE OF A MAJORITY OF THE DIRECTORS THEN IN OFFICE AT A MEETING HELD PURSUANT TO NOTICE OR WAIVERS OF NOTICE COMPLYING WITH SECTION 5211 OF CALIFORNIA NONPROFIT CORPORATION LAW, OR (3) A SOLE REMAINING DIRECTOR.
FORM 990, PART VI, SECTION B, LINE 11BGOVERNING DOCUMENTS, ECT, AVAILABLE TO PUBLIC THE BOARD OF DIRECTORS REVIEWED THE 2022 FORM 990 BEFORE AUTHORIZING ITS FILING.
FORM 990, PART VI, SECTION C, LINE 19THE BOARD OF DIRECTORS HAVE ENSURED THE COPIES OF THE GOVERNING DOCUMENTS HAVE BEEN MADE AVAILABLE AT THE ORGANIZATION'S PLACE OF BUSINESS UPON WRITTEN OR VERBAL REQUEST OF THE PUBLIC.

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.