MEDICAL STAFF OF BLAKE MEDICAL CENTER INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF BLAKE MEDICAL CENTER INC (EIN 83-2065303)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-05-12
IRS object ID
202221329349304137
Schema version
2021v4.0
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)
Return2022-05-12T13:17:31-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

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 Begin2021-01-01TaxPeriodBeginDt

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
Phone9417465266PhoneNum

US Address USAddress

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

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGURUSWAMY RAMAMURTHYPersonNm
Person TitleSECRETARY/TREASURERPersonTitleTxt
Signature2022-05-10SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstGURUSWAMYPersonFirstNm
Person LastRAMAMURTHYPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKEVIN A HASSALL CPAPreparerPersonNm
PTINP01057408PTIN
Phone9417390920PhoneNum
Preparation2022-05-10PreparationDt
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGURUSWAMY RAMAMURTHYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12020 59TH ST WAddressLine1Txt
CityBRADENTONCityNm
State AbbreviationFLStateAbbreviationCd
ZIP34209ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$318,718GrossReceiptsAmt
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 Body264VotingMembersGoverningBodyCnt
Voting Members Independent264VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$200,550PYContributionsGrantsAmt
CY Contributions Grants$159,600CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income-$6,906PYInvestmentIncomeAmt
CY Investment Income$24,344CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$193,644PYTotalRevenueAmt
CY Total Revenue$183,944CYTotalRevenueAmt
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$98,888PYOtherExpensesAmt
CY Other Expenses$117,925CYOtherExpensesAmt
PY Total Expenses$98,888PYTotalExpensesAmt
CY Total Expenses$117,925CYTotalExpensesAmt
PY Revenues Less Expenses$94,756PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$66,019CYRevenuesLessExpensesAmt
Total Assets BOY$592,182TotalAssetsBOYAmt
Total Assets EOY$717,003TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$592,182NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$717,003NetAssetsOrFundBalancesEOYAmt
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$55,700ExpenseAmt
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
FieldValueIRS element (for citing)
Total Program Service Expenses$58,700TotalProgramServiceExpensesAmt
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 Document23IRPDocumentCnt
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 Members264GoverningBodyVotingMembersCnt
Independent Voting Member264IndependentVotingMemberCnt
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)
PersonGURUSWAMY RAMAMURTHYPersonNm
Phone9417465266PhoneNum

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
IFTEKHAR BAIG
MEDICINE CHA1.00Yes (X)$0$0$0
RALPH BARKER
TRAUMA DIREC1.00Yes (X)$0$0$0
PHILIP BLAUSTEIN
VICE CHIEF O1.00Yes (X)$0$0$0
JAMES DEMAIO
CHIEF OF STA1.00Yes (X)$0$0$0
SCOTT KOSFELD
MEMBER AT LA1.00Yes (X)$0$0$0
GURUSWAMY RAMAMURTHY
SECRETARY/TR2.00Yes (X)$0$0$0
SCOTT SELPH
MEMBER AT LA1.00Yes (X)$0$0$0
MICHAEL VAN VLIET
SURGERY CHAI1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Membership Dues$159,600MembershipDuesAmt
Total Contributions$159,600TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,374TotalRevenueColumnAmt
Exclusion$5,374ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$153,733SecuritiesAmt
Other$11OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$134,774SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$18,959SecuritiesAmt
Other$11OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,970TotalRevenueColumnAmt
Related Or Exempt Func Income$18,959RelatedOrExemptFuncIncomeAmt
Exclusion$11ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$183,944TotalRevenueColumnAmt
Related Or Exempt Func Income$18,959RelatedOrExemptFuncIncomeAmt
Exclusion$5,385ExclusionAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$5,899TotalAmt
Management And General$5,899ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$48,960TotalAmt
Management And General$48,960ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$4,080TotalAmt
Management And General$4,080ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
STIPENDS$55,700$55,700
SPONSORSHIPS$3,000$3,000
CORPORATE ANNUAL FEE$236$236
BANK CHARGES$50$50

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$117,925TotalAmt
Program Services$58,700ProgramServicesAmt
Management And General$59,225ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$120,683BOYAmt
EOY$68,261EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$471,499BOYAmt
EOY$648,742EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$592,182BOYAmt
EOY$717,003EOYAmt

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$592,182BOYAmt
EOY$717,003EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$592,182BOYAmt
EOY$717,003EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$592,182BOYAmt
EOY$717,003EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$66,019ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$58,802NetUnrlzdGainsLossesInvstAmt
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 (5 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 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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