2022-09-21T09:11:44-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 1301 WEST 22ND STREET SUITE 1100 OAK BROOK IL 60523 990 2021-01-01 510287258 THE ANESTHESIA PATIENT SAFETY FOUNDATION ANES 8478255586 1061 AMERICAN LANE SCHAUMBURG IL 601734973 DANIEL J COLE MD PRESIDENT 8478255586 2022-09-15 1 DANIEL COLE MD 999009999 JAMES R THOMAS P00095586 6305738600 2022-09-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DANIEL J COLE MD 1061 AMERICAN LANE SCHAUMBURG IL 601734973 3191454 0 X WWW.APSF.ORG X 1985 DE THE APSF'S MISSION IS TO IMPROVE THE SAFETY OF PATIENTS DURING ANESTHESIA CARE BY: IDENTIFYING SAFETY INITIATIVES AND CREATING RECOMMENDATIONS TO IMPLEMENT DIRECTLY AND WITH PARTNER ORGANIZATIONS, BEING A LEADING VOICE FOR ANESTHESIA PATIENT SAFETY WORLDWIDE, AND SUPPORTING AND ADVANCING ANESTHESIA PATIENT SAFETY CULTURE, KNOWLEDGE, AND LEARNING. 20 20 0 125 0 0 1521974 1433646 0 0 2884717 956051 6522 76305 4413213 2466002 304233 655342 0 0 227117 240931 0 0 316163 1162382 1369472 1693732 2265745 2719481 200257 14104656 16092814 302368 287981 13802288 15804833 X THE APSF'S MISSION IS TO IMPROVE THE SAFETY OF PATIENTS DURING ANESTHESIA CARE BY: IDENTIFYING SAFETY INITIATIVES AND CREATING RECOMMENDATIONS TO IMPLEMENT DIRECTLY AND WITH PARTNER ORGANIZATIONS, BEING A LEADING VOICE FOR ANESTHESIA PATIENT SAFETY WORLDWIDE, AND SUPPORTING AND ADVANCING ANESTHESIA PATIENT SAFETY CULTURE, KNOWLEDGE, AND LEARNING. 0 0 1631391 655342 76305 THE SPECIFIC PURPOSES OF THE FOUNDATION ARE TO FOSTER INVESTIGATIONS THAT WILL PROVIDE A BETTER UNDERSTANDING OF PREVENTABLE ANESTHETIC INJURIES, TO ENCOURAGE PROGRAMS THAT WILL REDUCE THE NUMBER OF ANESTHETIC INJURIES, AND TO PROMOTE NATIONAL AND INTERNATIONAL COMMUNICATION OF INFORMATION AND IDEAS ABOUT THE CAUSES AND PREVENTION OF ANESTHETIC INJURIES. THE APSF IS MADE UP OF INDIVIDUALS AND CORPORATIONS INVOLVED IN ALL ASPECTS OF ANESTHESIA, AND IS A MAJOR SOURCE OF GRANTS FOR RESEARCH. THE FOUNDATION'S NEWSLETTER IS PUBLISHED THREE TIMES A YEAR AND IS DISTRIBUTED WITHOUT CHARGE TO ANESTHESOLOGSTS, NURSE ANESTHETISTS, ANESTHESIOLOGIST ASSISTANTS, AND TO THOUSANDS OF HOSPITAL ADMINISTRATORS AND GOVERNMENT OFFICIALS IN THE US, CANADA, AND OTHER VARIOUS COUNTRIES. THE APSF HAS ALSO INITIATED AND SPONSORED MANY OTHER ACTIVITIES IN FULFILLMENT OF ITS MISSION, INCLUDING SUPPORTING MEETINGS ON ANESTHESIA SAFETY AND FACILITATING DEVELOPMENT OF SIMULATORS FOR TRAINING ANESTHESIOLOGISTS IN CRISIS MANAGEMENT AS WELL AS OTHER ANESTHESIA MANAGEMENT PROBLEMS. 1631391 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 31 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 20 20 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X LISA STEININGER 8472689220 1061 AMERICAN LANE SCHAUMBURG IL 601734973 LYNN REEDE DNP MBA CRNA FNAP DIRECTOR-AT-LARGE 1.00 X 0 0 0 BRIAN THOMAS JD DIRECTOR 1.00 X 0 0 0 DELLA M LIN MS MD FASA DIRECTOR 1.00 X 1200 0 0 DRU RIDDLE PHD DNP CRNA DIRECTOR 2.00 X 800 0 0 ELIZABETH REBELLO MD FASA CPPS DIRECTOR 1.00 X 800 0 0 JEFFREY M FELDMAN MD MSE DIRECTOR 2.00 X 2900 0 0 JOHN W BEARD MD DIRECTOR 1.00 X 800 0 0 JOSHUA LEA DNP MBA CRNA DIRECTOR 1.00 X 1200 0 0 MARJORIE P STIEGLER MD DIRECTOR 5.00 X 40000 0 0 MAY C M PIAN-SMITH MD MS DIRECTOR 1.00 X 0 0 0 PATTY MULLEN REILLY CRNA DIRECTOR 1.00 X 0 0 0 SEEMA KUMBHAT MD DIRECTOR 1.00 X 0 0 0 SHANE ANGUS CAA DIRECTOR 1.00 X 800 0 0 STEVEN K HOWARD MD DIRECTOR 1.00 X 0 2700 0 DANIEL J COLE MD PRESIDENT 25.00 X 0 600 0 MEGHAN LANE-FALL MD VICE PRESIDENT 2.00 X 0 450 0 STEVEN B GREENBERG MD FCCP FCCM SECRETARY 10.00 X 26200 0 0 DOUGLAS BARTLETT TREASURER 1.00 X 0 0 0 MARK A WARNER MD PAST PRESIDENT 0.00 X 0 0 0 ALICE ROMIE PHARMD DIRECTOR 0.00 X 0 0 0 LINDA GROAH MSN RN CNOR NEA-BC DIRECTOR 1.00 X 0 0 0 MARIA VAN PELT CRNA PHD DIRECTOR 1.00 X 0 0 0 74700 3750 0 0 0 0 0 ROYAL PALMS 5200 E CAMELBACK RD PHOENIX AZ 85018 APSF SEPTEMBER STOELTING CONFERENCE 237372 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 EXECUTIVE OFFICE SUPPORT AND WEBSITE HON 180000 EDENS WORKS 409 23RD AVE SW ROCHESTER MN 55902 WESBSITE HOSTING AND CONSULTING SERVICES 176818 LANGUAGE LINE TRANSLATION SOLUTIONS PO BOX 202560 DALLAS TX 75320 TRANSLATION OF NEWSLETTERS 118308 MOSER STRATEGY GROUP 640 WELSH PARTRIDGE CIRCLE BALTIMORE NC 28715 FUNDRAISING SERVICES 115817 5 340000 1093646 1433646 163758 163758 1517745 725452 792293 792293 792293 MISCELLANEOUS INCOME 900099 76305 76305 76305 2466002 76305 0 956051 X 655342 655342 74700 35856 27639 11205 166231 80475 61361 24395 16000 16000 25 16 1 8 12769 8172 383 4214 81134 81134 643153 413756 17411 211986 2158 1381 65 712 20998 20998 172842 110619 5185 57038 7864 7864 204036 150831 50505 2700 202207 151445 46857 3905 CREDIT CARD FEES 3786 3786 SPEAKER FEES 2500 2500 2265745 1631391 318191 316163 504691 341101 1351554 2833872 34230 84664 109648 82542 12104533 12750635 14104656 16092814 37819 38710 225000 75000 120000 39549 54271 302368 287981 X 13624794 15509467 177494 295366 13802288 15804833 14104656 16092814 200257 1802288 0 X X 0 1 X 1 0 X 1058817 1338849 1293067 1521974 1433646 6646353 1058817 1338849 1293067 1521974 1433646 6646353 1963186 4683167 180633 202604 214443 172620 163758 934058 107 348 1991 6522 1305 10273 7590684 0.61700 0.60470 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 107. 2018 AMOUNT: $ 348. 2019 AMOUNT: $ 1,991. 2020 AMOUNT: $ 6,522. 2021 AMOUNT: $ 1,305. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO ASA 54271 54271 X 4187156 1802288 1802288 2384868 81134 81134 2466002 2184611 0 2184611 81134 81134 2265745 PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM INCOME TAX UNDER PROVISIONS OF INTERNAL REVENUE CODE SECTION 501(C)(3). ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE FOUNDATION AND RECOGNIZE A TAX LIABILITY IF THE FOUNDATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE FOUNDATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 1 NORTHWESTERN UNIVERSITY 750 NORTH LAKE SHORE DRIVE 7TH FLOOR CHICAGO IL 60611 501(C)(3) 149592 0 APSF RESEARCH AWARD - DR. PALOMA TOLEDO SUNNYBROOK RESEARCH INSTITUTE S130 2075 BAYVIEW AVE TORONTO ONTARIO CA M4N3M5 501(C)(3) 150000 0 APSF/ASA PRESIDENT RESEARCH AWARD - DR. STEPHEN CHOI BRIGHAM AND WOMEN'S HOSPITAL 399 REVOLUTION DR STE 740 SOMERVILLE MA 21145 501(C)(3) 154998 0 APSF/MEDTRONIC RESEARCH AWARD ($149,998) AND APSF ELLISON C. PIERCE MD MERIT AWARD ($5,000) - DR. VESELA KOVACHEVA NORTHSHORE UNIVERSITY HEALTHSYSTEM FOUNDATION 1033 UNIVERSITY PLACE 450 EVANSTON IL 60201 362167060 501(C)(3) 50000 0 DOCTORS COMPANY FOUNDATION GRANT AWARD HEALTH AND HOSPITAL HARLEM HOSPITAL CENTER HARLEM KP BUILDING 7TH FL 506 LENOX AVE NEW YORK NY 10037 132655001 501(C)(3) 50000 0 DOCTORS COMPANY FOUNDATION GRANT AWARD UNIVERSITY OF COLORADO 12801 E 17TH AVE 4TH FL MAILSTOP 8130 AURORA CO 80045 846000555 501(C)(3) 50000 0 DOCTORS COMPANY FOUNDATION GRANT AWARD INSTITUTE FOR SAFE MEDICATION PRACTICES 200 LAKESIDE DR STE 200 HORSHAM PA 19044 501(C)(3) 50000 0 SPONSORSHIP OF ISMP NATIONAL MEDICATION SAFETY SUMMIT FOR PERIOPERATIVE SETTINGS 7 0 PART I, LINE 2: THE GRANTS FUNDED BY THE SCIENTIFIC EVALUATION COMMITTEE (SEC) UNDERGO A RIGOROUS REVIEW PROCESS. THE APPLICATIONS HAVE TO DESCRIBE IN DETAIL THE LINE-ITEMIZED BUDGET, WHICH IS REVIEWED BY SEC MEMBERS ON AT LEAST THREE DIFFERENT OCCASIONS. FOR MANY OF THE APPLICATIONS, CHANGES AND/OR CORRECTIONS TO THE BUDGET ARE REQUESTED BY THE MEMBERS OF THE SEC, SUCH THAT THE FINAL GRANT, IF APPROVED, DETAILS SPECIFICALLY HOW THE GRANT MONEY WILL BE USED. A COPY OF THE APPLICATION, INCLUDING THE BUDGET, IS ALSO SENT TO THE OFFICE OF SPONSORED RESEARCH AT THE APPLICANT'S INSTITUTION, AND THE INSTITUTIONAL GRANTS AND CONTRACTS OFFICER IS THEN SENT THE GRANT MONEY FOR DISTRIBUTION TO THE APPLICANT. IN ADDITION, THE APPLICANT'S DEPARTMENTAL CHAIR HAS TO WRITE A LETTER OF SUPPORT ON BEHALF OF THE APPLICANT, AND THE CHAIR CONFIRMS THAT THE APPLICANT WILL PERFORM THE STUDY AS PROPOSED, AND THAT ANY MONEY NOT USED AT THE END OF THE FUNDED PERIOD WILL BE RETURNED TO THE APSF. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION UTILIZES THE MANAGEMENT OF AMERICAN SOCIETY OF ANESTHESIOLOGISTS,INC (ASA) TO PROVIDE CERTAIN PROGRAM AND ADMINISTRATIVE SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO PREPARE THE ORGANIZATION'S FORM 990. MANAGEMENT REVIEWS THE COMPLETED FORM 990 AND PROVIDES A COPY TO EACH MEMBER OF THE GOVERNING BODY PRIOR TO FILING. THE GOVERNING BODY IS GIVEN A CHANCE TO COMMENT AND/OR ASK QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES EVERY BOARD AND COMMITTEE MEMBER TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ON AN ANNUAL BASIS. A CONFLICT OF INTEREST MAY NOT DISQUALIFY THE MEMBER FROM SERVING, BUT MAY NECESSITATE DISCLOSURE OF THE CONFLICT OR APPARENT CONFLICT SO THAT THE WORDS OR DEEDS OF THE APSF MEMBER CAN BE EVALUATED BY OTHERS. FORM 990, PART VI, SECTION B, LINE 15 MANAGEMENT DUTIES NORMALLY PERFORMED BY CEO,EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL ARE PERFORMED BY BOARD MEMBERS. BOARD MEMBER STIPENDS ARE DETERMINED ANNUALLY BY THE EXECUTIVE COMMITTEE WHILE APPROVING THE BUDGET. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE THROUGH APPLICABLE GOVERNMENTAL AGENCIES. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 413,756. MANAGEMENT AND GENERAL EXPENSES 17,411. FUNDRAISING EXPENSES 211,986. TOTAL EXPENSES 643,153. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT CPA FIRM. AMERICAN SOCIETY OF ANESTHESIOLOGISTS 1061 AMERICAN LANE SCHAUMBURG IL 60173 362181944 ADVANCE THE SPECIALTY OF ANESTHESIA NY 501(C)(6) 0 WOOD LIBRARY-MUSEUM OF ANESTHESIOLOGY 1061 AMERICAN LANE SCHAUMBURG IL 60173 363573324 COLLECTION OF ANESTHESIA LITERATURE IL 501(C)(3) LINE 12A, I AMERICAN SOCIETY OF ANESTHESIOLOGISTS 1 FOUNDATION FOR ANESTHESIA EDUCATION AND RESEARCH 1061 AMERICAN LANE SCHAUMBURG IL 60173 521494164 ANESTHESIA CARE EDUCATION AND RESEARCH DE 501(C)(3) LINE 7 AMERICAN SOCIETY OF ANESTHESIOLOGISTS 1 ANESTHESIA QUALITY INSTITUTE 1061 AMERICAN LANE SCHAUMBURG IL 60173 263848288 ADVANCES IN QUALITY OF CARE MEASUREMENT AND DELIVERY IN ANESTHESIA DC 501(C)(3) LINE 12A, I AMERICAN SOCIETY OF ANESTHESIOLOGISTS 1 ASA CHARITABLE FOUNDATION 1061 AMERICAN LANE SCHAUMBURG IL 60173 454946512 IMPROVE HEALTH AND MEDICAL CARE IN UNDER-SERVICED COMMUNITIES IL 501(C)(3) LINE 12A, I AMERICAN SOCIETY OF ANESTHESIOLOGISTS 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 AMERICAN SOCIETY OF ANESTHESIOLOGISTS C 340000 FMV AMERICAN SOCIETY OF ANESTHESIOLOGISTS P 148321 FMV FOUNDATION FOR ANESTHESIA EDUCATION AND RESEARCH R 150000 FMV AMERICAN SOCIETY OF ANESTHESIOLOGISTS Q 21304 FMV