MEDICAL STAFF OF BLAKE MEDICAL CENTER INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF BLAKE MEDICAL CENTER INC (EIN 83-2065303)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-05-12
IRS object ID
202121329349301537
Schema version
2020v4.0
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)
Return2021-05-12T09:14:17-05:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

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 Begin2020-01-01TaxPeriodBeginDt

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)
PersonJOHN LOURIEPersonNm
Person TitleSECRETARY/TREASURERPersonTitleTxt
Signature2021-04-29SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJOHNPersonFirstNm
Person LastLOURIEPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKEVIN A HASSALL CPAPreparerPersonNm
PTINP01057408PTIN
Phone9417390920PhoneNum
Preparation2021-04-29PreparationDt
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOHN LOURIEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12020 59TH ST WAddressLine1Txt
CityBRADENTONCityNm
State AbbreviationFLStateAbbreviationCd
ZIP34209ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$396,467GrossReceiptsAmt
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 Body622VotingMembersGoverningBodyCnt
Voting Members Independent622VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$179,877PYContributionsGrantsAmt
CY Contributions Grants$200,550CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$578PYInvestmentIncomeAmt
CY Investment Income-$6,906CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$180,455PYTotalRevenueAmt
CY Total Revenue$193,644CYTotalRevenueAmt
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$69,194PYOtherExpensesAmt
CY Other Expenses$98,888CYOtherExpensesAmt
PY Total Expenses$69,194PYTotalExpensesAmt
CY Total Expenses$98,888CYTotalExpensesAmt
PY Revenues Less Expenses$111,261PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$94,756CYRevenuesLessExpensesAmt
Total Assets BOY$454,933TotalAssetsBOYAmt
Total Assets EOY$592,182TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$454,933NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$592,182NetAssetsOrFundBalancesEOYAmt
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 SrvcYes (true)SignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$2,500ExpenseAmt
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$48,400ExpenseAmt
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

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$10,000ExpenseAmt
DescTHE ORGANIZATION CONTRIBUTED TO THE FLORIDA MEDICAL ASSOCIATION'S POLITICAL ACTION COMMITTEE DURING THE YEAR TO SUPPORT LEGISLATIVE EFFORTS THAT THE FLORIDA MEDICAL ASSOCIATION IS INVOLVED IN ON BEHALF OF ALL FLORIDA PHYSICIANS TO BRING ABOUT FAVORABLE CHANGES IN THE PRACTICE OF MEDICINE IN FLORIDA.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$60,900TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyYes (true)PoliticalCampaignActyInd
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 Document19IRPDocumentCnt
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 Members622GoverningBodyVotingMembersCnt
Independent Voting Member622IndependentVotingMemberCnt
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)
PersonJOHN LOURIEPersonNm
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 WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RALPH BARKER
TRAUMA DIREC1.000.00Yes (X)$0$0$0
SCOTT CLULOW
VICE-CHIEF O1.000.00Yes (X)$0$0$0
JAMES DEMAIO
CHIEF OF STA1.000.00Yes (X)$0$0$0
RICARDO GONZALES
CHIEF OF SUR1.000.00Yes (X)$0$0$0
SCOTT KOSFELD
MEMBER AT LA1.000.00Yes (X)$0$0$0
JOHN LOURIE
SECRETARY/TR2.000.00Yes (X)$0$0$0
GURUSWAMY RAMMAMURTHY
CHIEF OF MED1.000.00Yes (X)$0$0$0
LUIS URRUTIA
MEMBER AT LA1.000.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Membership Dues$200,550MembershipDuesAmt
Total Contributions$200,550TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,568TotalRevenueColumnAmt
Exclusion$4,568ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$191,337SecuritiesAmt
Other$12OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$202,823SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$11,486SecuritiesAmt
Other$12OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$11,474TotalRevenueColumnAmt
Related Or Exempt Func Income-$11,486RelatedOrExemptFuncIncomeAmt
Exclusion$12ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$193,644TotalRevenueColumnAmt
Related Or Exempt Func Income-$11,486RelatedOrExemptFuncIncomeAmt
Exclusion$4,580ExclusionAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$7,078TotalAmt
Management And General$7,078ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$23,554TotalAmt
Management And General$23,554ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,235TotalAmt
Management And General$7,235ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$10,000TotalAmt
Program Services$10,000ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
STIPENDS$48,400$48,400
SPONSORSHIPS$2,500$2,500
CORPORATE ANNUAL FEE$61$61
BANK CHARGES$60$60

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$98,888TotalAmt
Program Services$60,900ProgramServicesAmt
Management And General$37,988ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$216,397BOYAmt
EOY$120,683EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$238,536BOYAmt
EOY$471,499EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$454,933BOYAmt
EOY$592,182EOYAmt

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$454,933BOYAmt
EOY$592,182EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$454,933BOYAmt
EOY$592,182EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$454,933BOYAmt
EOY$592,182EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$94,756ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$42,493NetUnrlzdGainsLossesInvstAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Political Expenditures$10,000PoliticalExpendituresAmt
Internal Funds Contributed$10,000InternalFundsContributedAmt
Total Exempt Function Expend$10,000TotalExemptFunctionExpendAmt
Form1120 POL FiledfalseForm1120POLFiledInd

Section527 Political Org Section527PoliticalOrgGrp

Organization Business Name OrganizationBusinessName

FieldValueIRS element (for citing)
Business Name Line1POLITICAL ACTION COMMITTEEBusinessNameLine1Txt
Business Name Line2FLORIDA MEDICAL ASSOCIATIONBusinessNameLine2Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11430 PIEDMONT DRIVE EASTAddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32308ZIPCd
FieldValueIRS element (for citing)
EIN590559672EIN
Paid Internal Funds$10,000PaidInternalFundsAmt
FieldValueIRS element (for citing)
Substantially All Dues NondedfalseSubstantiallyAllDuesNondedInd
Only In House LobbyingfalseOnlyInHouseLobbyingInd
Agree Carryover Prior YearfalseAgreeCarryoverPriorYearInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART I-A, LINE 1FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION MADE A CONTRIBUTION TO THE FLORIDA MEDICAL ASSOCIATION'S POLITICAL ACTION COMMITTEE DURING THE YEAR.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 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 2, PART III, LINE 2THE ORGANIZATION CONTRIBUTED TO THE POLITICAL ACTION COMMITTEE OF THE FLORIDA MEDICAL ASSOCIATION.
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.

Comments

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