2021-11-15T10:16:55-06:00 2020-12-31 910189318 MOSS ADAMS LLP 21700 OXNARD ST STE 300 LOS ANGELES CA 91367 990 2020-01-01 956419205 SANSUM CLINIC SANS 8056817700 PO BOX 1200 SANTA BARBARA CA 931021200 ALEX BAUER CFO 8056817700 2021-11-12 1 ALEX BAUER 999009999 LAUREN A HAVERLOCK P00545829 8185771900 2021-11-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ALEX BAUER PO BOX 1200 SANTA BARBARA CA 931021200 337068766 0 X WWW.SANSUMCLINIC.ORG X 1921 CA TO PROVIDE MEDICAL SERVICES TO THE GENERAL PUBLIC. 18 17 1508 50 0 0 5067702 12624492 330117350 317525946 3769219 69755 5120023 6690318 344074294 336910511 0 0 0 0 87143250 88117245 0 0 468561 248419651 250297685 335562901 338414930 8511393 -1504419 152573559 153773832 90548801 91916818 62024758 61857014 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 260148521 322601261 SEE 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 MEDI-CAL) 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 TO SOCIO-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 THE LARGEST LOCAL FLU IMMUNIZATION CLINICS ANNUALLY FOR FREE OR FOR A NOMINAL DONATION.- PROVIDING FREE EYE EXAMINATIONS THROUGH 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. 260148521 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 1 0 0 0 0 1 0 0 0 0 1 0 0 0 1 291 0 1 1508 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ALEXANDER BAUER 8056817500 PO BOX 1200 SANTA BARBARA CA 931021200 CHAD HINE COO AND VICE PRESIDENT 40.00 X 467310 0 40774 KURT RANSOHOFF CEO, MEDICAL DIRECTOR 40.00 X 431247 0 0 ALEX BAUER CFO AND VICE PRESIDENT 40.00 X 377173 0 5600 MARJORIE NEWMAN MEDICAL DIRECTOR 40.00 X 307092 0 14000 MATTHEW KUNKEL VICE PRESIDENT - ONCOLOGY 40.00 X 278311 0 32374 SEAN JOHNSON VICE PRESIDENT APPLICATIONS AND ANALYTICS 40.00 X 259414 0 38083 KAREN HANDY VICE PRESIDENT - OPERATIONS 40.00 X 263272 0 12148 LOUIS GIAMBELUCA DIRECTOR EHR 40.00 X 198494 0 32827 JANET A GARUFIS CHAIR 1.00 X X 0 0 0 VICKI HAZARD VICE CHAIRMAN 1.00 X X 0 0 0 STEPHEN JONES VICE CHAIRMAN 1.00 X X 0 0 0 ED ROSENBLATT TRUSTEE (THRU 01/10/20) 1.00 X 0 0 0 ELIZABETH VOS TRUSTEE (THRU 01/10/20) 1.00 X 0 0 0 JULIE MCGOVERN TRUSTEE (THRU 01/10/20) 1.00 X 0 0 0 JAMES MCNAMARA MD TRUSTEE 1.00 X 0 0 0 GEORGE RUSZNAK TRUSTEE 1.00 X 0 0 0 ART MEROVICK TRUSTEE 1.00 X 0 0 0 RON LATIMER MD TRUSTEE 1.00 X 0 0 0 STEVE MCHUGH TRUSTEE 1.00 X 0 0 0 TOM KENNY TRUSTEE 1.00 X 0 0 0 BRET E DAVIS MD TRUSTEE 1.00 X 0 0 0 DAVID A RAPHAEL MD TRUSTEE 1.00 X 0 0 0 MICHAEL BERNSTEIN MD TRUSTEE 1.00 X 10385 0 0 CHRISTINE GARVEY TRUSTEE 1.00 X 0 0 0 MARTY MCDERMUT TRUSTEE 1.00 X 0 0 0 ARNOLD R SCHAFFER TRUSTEE 1.00 X 0 0 0 GEORGE SHORT TRUSTEE 1.00 X 0 0 0 WILLIAM MEEKER TRUSTEE 1.00 X 0 0 0 VAL MONTGOMERY TRUSTEE 1.00 X 0 0 0 2592698 0 175806 131 0 1 0 SANSUM SANTA BARBARA MEDICAL CLINIC INC PO BOX 1200 SANTA BARBARA CA 93102 PROFESSIONAL SERVICES 74089354 SANTA BARBARA RADIOLOGY MEDICAL GROUP 320 W PUEBLO STREET SANTA BARBARA CA 93101 RADIOLOGY SERVICES 3456347 SANTA BARBARA HEMATOLOGY 317 W PUEBLO STREET SANTA BARBARA CA 93105 ONCOLOGY SERVICES 2835790 JACKSON MEDICAL GROUP 517 WEST JUNIPERO SANTA BARBARA CA 93105 PROFESSIONAL SERVICES 2815431 PACIFIC DIAGNOSTIC LAB PO BOX 8180 GOLETA CA 93118 LABORATORY SERVICES 2007630 175 6236129 6388363 2255093 12624492 OTHER MEDICAL SERVICES 621110 313830768 313830768 PROGRAM RELATED INVESTMENT - ACO 621110 2808840 2808840 COTTAGE HOSPITALISTS SERVICES 621110 886338 886338 317525946 88115 88115 516188 139895 376293 376293 376293 18360 -18360 -18360 -18360 MISCELLANEOUS INCOME 900099 3679270 3679270 ADMINISTRATIVE FEES 900099 1378221 1378221 CLINICAL STUDIES 900099 912053 912053 344481 344481 6314025 336910511 317870427 0 6415592 X 1322104 1322104 67404059 51488043 15650102 265914 1389832 1088516 301316 13130669 10283940 2800301 46428 4870581 3814639 1037280 18662 1097806 1097806 201018 201018 108099323 84663390 23302414 133519 1626781 1274095 352686 6967671 5457080 1506553 4038 4294525 3363472 931053 8985006 7006727 1978279 94891 74319 20572 105735 82812 22923 1930791 1930791 8395146 6575078 1820068 773431 605751 167680 MEDICAL SUPPLIES 60891389 47690136 13201253 PHARMACEUTICAL SUPPLIES 41652329 32622104 9030225 REPAIRS/MAINTENANCE 5181843 4058419 1123424 338414930 260148521 77797848 468561 19968602 20848596 2405994 2365540 29483024 30931226 600000 600000 6258750 5420286 5368350 4729571 1688620 1382254 175542658 110363760 67098243 65178898 9017938 10335826 633560 633560 10050478 11348075 152573559 153773832 39898848 43179705 37829717 34619280 12820236 14117833 90548801 91916818 X 57307065 57946014 4717693 3911000 62024758 61857014 152573559 153773832 -1504419 1336675 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10103261 26547 1330349 11460157 8595676 83699 1423886 10103261 8983804 84452 -472580 8595676 7491465 333333 1159006 8983804 6409208 672567 409690 7491465 0.88222 0.11778 0.00000 0 0 5289659 5289659 27740518 14535012 13205506 30751605 18300542 12451063 106124463 75020165 31104298 5636413 2508041 3128372 65178898 DEFERRED COMPENSATION PLAN ASSETS 10775226 OTHER ASSETS 172242 INSURANCE RECEIVABLE 400607 11348075 DEFERRED COMPENSATION PLAN LIABILITIES 10775226 MEDICAL MALPRACTICE LIABILITY 3342607 14117833 X 338387082 1336676 1336676 337050406 -139895 -139895 336910511 338554826 0 338554826 -139895 -139895 338414931 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, 2020 OR 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH RENTAL INCOME -139,895. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO STATEMENT OF REVENUE -139,895. X 1 1 X X 0 0 0 0 0 0 0 0 0 CHAD HINE COO AND VICE PRESIDENT 467310 0 0 0 0 0 14000 0 26774 0 508084 0 0 0 KURT RANSOHOFF CEO, MEDICAL DIRECTOR 425951 0 0 0 5296 0 0 0 0 0 431247 0 0 0 ALEX BAUER CFO AND VICE PRESIDENT 377173 0 0 0 0 0 5600 0 0 0 382773 0 0 0 MARJORIE NEWMAN MEDICAL DIRECTOR 307092 0 0 0 0 0 14000 0 0 0 321092 0 0 0 MATTHEW KUNKEL VICE PRESIDENT - ONCOLOGY 278311 0 0 0 0 0 5600 0 26774 0 310685 0 0 0 SEAN JOHNSON VICE PRESIDENT APPLICATIONS AND ANAL 259414 0 0 0 0 0 11309 0 26774 0 297497 0 0 0 KAREN HANDY VICE PRESIDENT - OPERATIONS 263272 0 0 0 0 0 4911 0 7237 0 275420 0 0 0 LOUIS GIAMBELUCA DIRECTOR EHR 198494 0 0 0 0 0 6053 0 26774 0 231321 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. ALEX BAUER CFO HOME LOAN X 300000 300000 0 1 1 MATTHEW KUNKEL VP OF ONCOLOGY HOME LOAN X 300000 300000 0 1 1 600000 X 14 2255093 SALES PRICE OF SHARES 0 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 EXECUTIVE 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 EXECUTIVE COMMITTEE PRIOR TO IMPLEMENTATION. FORM 990, PART VI, SECTION C, LINE 19 IT IS THE POLICY OF SANSUM CLINIC TO PROVIDE DOCUMENTATION UPON WRITTEN REQUEST BY MAIL TO THE CORPORATE LOCATION. FORM 990, PART IX, LINE 11G OUTSIDE PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 84,663,390. MANAGEMENT AND GENERAL EXPENSES 23,302,414. FUNDRAISING EXPENSES 133,519. TOTAL EXPENSES 108,099,323. COASTAL ONE HEALTH PARTNERS LLC 400 WEST PUEBLO STREET SANTA BARBARA CA 93105 821663329 HEALTH CARE CA SANSUM CLINIC RELATED -1699236 242718 0 1 0.50000 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1