2020-05-19T14:53:45-05:00 2019-09-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2018-10-01 943084159 NORTHERN CALIFORNIA INSTITUTE FOR RESEARCH AND EDUCATION INC NORT 4157506954 4150 CLEMENT STREET 151NC SAN FRANCISCO CA 941211545 REBECCA A ROSALES CEO/EXECUTIVE DIRECTOR 4157506954 2020-05-15 1 MICHAEL LUMSDEN P01262236 4159561500 2020-05-15 76.14.38.113 2020-05-15 16:08:50 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 00C4359F54289D19625D58AABAD73364CEA05A5F 2018 2020-09-23 17:36:50Z REBECCA A ROSALES 4150 CLEMENT STREET 151NC SAN FRANCISCO CA 941211545 48385846 0 X WWW.NCIRE.ORG X 1988 CA MEDICAL RESEARCH TO FIND NEW AND IMPROVED WAYS TO COMBAT DISEASE AND IMPAIRMENTS OF MAN. 18 5 312 0 0 0 43800228 42745781 3366889 5584653 25228 42732 20406 2528 47212751 48375694 0 0 0 0 16803355 16724003 0 0 0 29396071 30007825 46199426 46731828 1013325 1643866 11327406 14819377 7822131 9670236 3505275 5149141 X TO IMPROVE THE HEALTH AND WELL-BEING OF VETERANS AND THE GENERAL PUBLIC BY SUPPORTING A WORLD-CLASS BIOMEDICAL RESEARCH PROGRAM CONDUCTED BY UCSF FACULTY AT THE SAN FRANCISCO VA MEDICAL CENTER. 0 0 38174167 5584653 THE NORTHERN CALIFORNIA INSTITUTE FOR RESEARCH AND EDUCATION, INC. ("NCIRE") IS A RESEARCH INSTITUTE AFFILIATED WITH THE U.S. DEPARTMENT OF VETERANS AFFAIRS ("VA") IN SAN FRANCISCO, CALIFORNIA AND THE UNIVERSITY OF CALIFORNIA AT SAN FRANCISCO. NCIRE WORKS WITH SPONSORS AND THE U.S. DEPARTMENT OF VETERANS AFFAIRS IN ADMINISTERING CONTRIBUTIONS FOR CONDUCTING RESEARCH TO FIND NEW AND IMPROVED WAYS TO COMBAT HUMAN DISEASE AND TO HELP PEOPLE WITH DISABILITIES. THE RESEARCH ADMINISTERED BY NCIRE IS VA-APPROVED RESEARCH, CONDUCTED AT VA FACILITIES. NCIRE WAS ESTABLISHED UNDER TITLE 38, SUBCHAPTER IV, SUBSECTIONS 7361-7366 AND IS SUBJECT TO DEPARTMENT OF VETERANS AFFAIRS HANDBOOK 1200 17. UNDER TITLE 38, SUSBSECTION 7 363, NCIRE'S BOARD OF DIRECTORS CURRENTLY INCLUDES THREE MEMBERS WHO SERVE BY VIRTUE OF THEIR STATUTORY POSITIONS WITHIN THE SAN FRANCISCO VA MEDICAL CENTER. THEY ARE THE MEDICAL CENTER DIRECTOR, THE CHIEF OF STAFF, AND THE ASSOCIATE CHIEF OF STAFF FOR RESEARCH. 38174167 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 66 0 1 312 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 5 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X JOANNA ZHAO 4152214810 4150 CLEMENT STREET 151NC SAN FRANCISCO CA 941211545 X RAYMOND A SWANSON MD CHAIR 8.00 40.00 X X 0 153708 0 THEODORA MAURO MD VICE CHAIR 1.00 40.00 X X 0 149018 0 NEAL H COHEN MD MPH MS DIRECTOR 1.00 0.00 X 0 0 0 HAROLD COLLARD MD DIRECTOR EFFECTIVE 1/2019 1.00 0.00 X 0 0 0 LT COLONEL STEVE COUNTOURIOTIS DIRECTOR 1.00 0.00 X 0 0 0 BONNIE S GRAHAM MBA DIRECTOR 1.00 40.00 X 0 188402 0 JENNIFER GRANDIS MD DIRECTOR THROUGH 12/2018 1.00 0.00 X 0 0 0 CARL GRUNFELD MD PHD DIRECTOR 1.00 40.00 X 0 153843 0 MICHAEL D HOPE MD DIRECTOR EFFECTIVE 1/2019 1.00 40.00 X 0 310694 0 HUBERT KIM MD PHD DIRECTOR 1.00 40.00 X 0 390806 0 SHIRA MAGUEN PHD DIRECTOR 1.00 40.00 X 0 127097 0 JOHN R MCQUAID PHD DIRECTOR 1.00 40.00 X 0 169776 0 KENNETH R MCQUAID MD DIRECTOR 1.00 40.00 X 0 357217 0 DAVID MORGAN PHD DIRECTOR EFFECTIVE 1/2019 1.00 0.00 X 0 0 0 BRUCE OVBIAGELE MD MSC MAS MBA DIRECTOR 1.00 40.00 X 0 0 0 STEPHEN PEARY JD LLM DIRECTOR 1.00 0.00 X 0 0 0 CARMEN PERALTA MD MAS DIRECTOR THROUGH 12/2018 1.00 0.00 X 0 110351 0 RINA SHAH MD DIRECTOR THROUGH 12/2018 1.00 40.00 X 0 137956 0 MICHAEL SHLIPAK MD MPH DIRECTOR 1.00 40.00 X 0 133250 0 LOUISE C WALTER MD DIRECTOR 1.00 15.00 X 0 129978 0 KRISTINE YAFFE MD DIRECTOR EFFECTIVE 1/2019 1.00 40.00 X 0 143000 0 KEITH R YAMAMOTO PHD DIRECTOR THROUGH 12/2018 1.00 0.00 X 0 0 0 REBECCA A ROSALES CEO/EXECUTIVE DIREECTOR 40.00 0.00 X 232929 0 2348 JOANNA ZHAO CONTROLLER, SECRETARY & TREASURER 40.00 0.00 X 156260 0 40901 DIANA SACREY LABORATORY MANAGER 40.00 0.00 X 136590 0 39510 ZIN KAY CHAN DIRECTOR OF INFORMATION SYSTEMS 40.00 0.00 X 132090 0 20663 BRIAN ROACH PROGRAM ANALYST IV 40.00 0.00 X 126625 0 27287 KATHLEEN STANLEY ADMINISTRATIVE NURSE III 40.00 0.00 X 126714 0 30248 DEREK FLENNIKEN CIND IT MANAGER 40.00 0.00 X 123027 0 34256 STEPHEN MORANGE FORMER CFO (THROUGH 5/2018) 0.00 0.00 X 145704 0 15912 1179939 2655096 211125 15 1 1 0 0 42277871 467910 42745781 CLINICAL RESEARCH REVENUE 541700 2794251 2794251 PERSONNEL REIMBURSEMENTS - SFVA 541700 2753262 2753262 SERVICE REVENUE 541700 37140 37140 5584653 52884 52884 10152 -10152 -10152 -10152 OTHER REVENUE 900099 2528 2528 2528 48375694 5584653 0 45260 X 506543 506543 12630234 9579964 3050270 777926 335017 442909 1776627 948775 827852 1032673 558276 474397 55785 500 55285 83650 83650 6436503 4878894 1557609 248908 44598 204310 212412 30660 181752 345398 99472 245926 343454 169847 173607 66686 5634 61052 232053 161445 70608 70089 70089 SUBCONTRACTS 19063666 19063666 OUTSIDE RESEARCH 1153368 994055 159313 LAB SUPPLIES 995632 881406 114226 UBI TAX EXPENSE 9516 9516 690705 421958 268747 46731828 38174167 8557661 0 463375 2278735 3651453 3724118 5143740 7005829 733761 467105 118325 129471 4860355 4047365 718603 812990 498149 401129 11327406 14819377 4270427 7333416 3551704 2336820 7822131 9670236 X 2360345 3925781 1144930 1223360 3505275 5149141 11327406 14819377 1643866 0 X 0 1 X 1 1 1 X SAN FRANCISCO VETERANS AFFAIRS MEDICAL CENTER SAN FRANCISCO CA RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 999680 829890 169790 3834450 3195277 639173 26225 22198 4027 812990 X 48385846 0 48385846 -10152 -10152 48375694 46741980 10152 10152 46731828 0 46731828 PART X, LINE 2: NCIRE IS A NONPROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND STATE INCOME TAX UNDER CALIFORNIA REVENUE AND TAXATION CODE SECTION 23701D. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO NCIRE'S TAX-EXEMPT PURPOSE MAY BE SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. NCIRE QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER IRC SECTION 170(B)(1)(A)(III) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(1). AS OF SEPTEMBER 30, 2019 AND 2018, NCIRE HAD NO UNRECOGNIZED TAX BENEFITS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON EQUIPMENT DISPOSAL -10,152. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON EQUIPMENT DISPOSAL 10,152. X X X 1 0 0 0 0 0 0 0 0 RAYMOND A SWANSON MD CHAIR 0 153708 0 0 0 0 0 0 0 0 0 153708 0 0 BONNIE S GRAHAM MBA DIRECTOR 0 188402 0 0 0 0 0 0 0 0 0 188402 0 0 CARL GRUNFELD MD PHD DIRECTOR 0 153843 0 0 0 0 0 0 0 0 0 153843 0 0 MICHAEL D HOPE MD DIRECTOR EFFECTIVE 1/2019 0 310694 0 0 0 0 0 0 0 0 0 310694 0 0 HUBERT KIM MD PHD DIRECTOR 0 390806 0 0 0 0 0 0 0 0 0 390806 0 0 JOHN R MCQUAID PHD DIRECTOR 0 169776 0 0 0 0 0 0 0 0 0 169776 0 0 KENNETH R MCQUAID MD DIRECTOR 0 357217 0 0 0 0 0 0 0 0 0 357217 0 0 REBECCA A ROSALES CEO/EXECUTIVE DIREECTOR 232929 0 0 0 0 0 0 0 2348 0 235277 0 0 0 JOANNA ZHAO CONTROLLER, SECRETARY & TREASURER 156260 0 0 0 0 0 12090 0 28811 0 197161 0 0 0 DIANA SACREY LABORATORY MANAGER 136590 0 0 0 0 0 10758 0 28752 0 176100 0 0 0 ZIN KAY CHAN DIRECTOR OF INFORMATION SYSTEMS 132090 0 0 0 0 0 9982 0 10681 0 152753 0 0 0 BRIAN ROACH PROGRAM ANALYST IV 126625 0 0 0 0 0 9403 0 17884 0 153912 0 0 0 KATHLEEN STANLEY ADMINISTRATIVE NURSE III 126714 0 0 0 0 0 9701 0 20547 0 156962 0 0 0 DEREK FLENNIKEN CIND IT MANAGER 123027 0 0 0 0 0 9415 0 24841 0 157283 0 0 0 STEPHEN MORANGE FORMER CFO (THROUGH 5/2018) 87279 0 0 0 58425 0 7955 0 7957 0 161616 0 0 0 PART I, LINE 4A STEVEN MORANGE, WHO SERVED AS CHIEF FINANCIAL OFFICER THROUGH MAY 19, 2018, RECEIVED A SEVERANCE OF $37,452, WHICH HAS BEEN REPORTED WITHIN "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS DURING THE 9/30/2019 TAX YEAR. THE SIGNIFICANT CHANGES (ASIDE FROM VARIOUS WORDING AND FORMAT UPDATES) FROM THESE AMENDMENTS INCLUDE ADDING THE CHAIR OF THE BOARD, SECRETARY, AND TREASURER AS OFFICERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION DOES NOT HAVE "MEMBERS" BY DEFINITION OF THE BYLAWS; HOWEVER, THE FORM 990 INSTRUCTIONS ALSO DEFINE A "MEMBER" AS ANY PERSON (INCLUDING A CORPORATION OR OTHER LEGAL ENTITY) WHO, PURSUANT TO A PROVISION OF THE ORGANIZATION'S GOVERNING DOCUMENTS, HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE (INCLUDING ELECTING MEMBERS OF THE GOVERNING BODY) OR RECEIVE A SHARE OF THE ORGANIZATION'S NET ASSETS UPON DISSOLUTION. ACCORDINGLY, NCIRE HAS ONE SOLE MEMBER: THE SAN FRANCISCO VETERANS AFFAIRS MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTOR OF THE SAN FRANCISCO VETERANS AFFAIRS MEDICAL CENTER HOLDS THE AUTHORITY TO APPOINT MEMBERS OF THE BOARD (FOLLOWING NOMINATION BY THE BOARD NOMINATING COMMITTEE), REMOVE A NON-STATUTORY BOARD MEMBER, APPOINT SUCCESSOR BOARD MEMBERS IN THE EVENT OF A VACANCY, AND APPOINT THE CHAIR OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B NO AMENDMENT TO THE BYLAWS SHALL BE EFFECTIVE UNTIL APPROVED BY THE DIRECTOR OF THE SAN FRANCISCO VETERANS AFFAIRS MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING WITH THE ASSISTANCE OF THE ORGANIZATION'S FINANCE AND ACCOUNTING STAFF. THE FINAL DRAFT OF THE 990 IS REVIEWED BY THE CONTROLLER AND THE EXECUTIVE DIRECTOR. A COMPLETE COPY OF THE FORM 990 IS DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL NCIRE DIRECTORS, OFFICERS, AND ANY EMPLOYEES WITH DECISION MAKING AUTHORITY ("KEY EMPLOYEES") SUBMIT A CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE AND AFFIRMATION OF COMPLIANCE ANNUALLY BY JANUARY 31ST TO THE EXECUTIVE DIRECTOR. ANY QUESTIONNAIRE WITH A DISCLOSURE WILL BE PROVIDED TO THE BOARD TO REVIEW. THE BOARD THEN DECIDES WHETHER ANY DISCLOSURES REPRESENT ACTUAL, PERCEIVED, OR POTENTIAL CONFLICTS OF INTEREST. WHENEVER THERE IS REASON TO BELIEVE THAT A POTENTIAL CONFLICT EXISTS BETWEEN THE INTERESTS OF NCIRE AND ANY BOARD MEMBER, OFFICER, OR EMPLOYEE, THE INTERESTED PARTY WILL HAVE AN OPPORTUNITY TO PROVIDE FACTUAL INFORMATION ABOUT THE PROPOSED CONFLICT AND/OR MATTER THAT PROVOKED THE POTENTIAL CONFLICT. THE INTERESTED PARTY DOES NOT PARTICIPATE IN ANY WAY, OR IS PRESENT DURING, THE DELIBERATIONS AND DECISION-MAKING VOTE OF NCIRE WITH RESPECT TO SUCH MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE COMPENSATION OF THE EXECUTIVE DIRECTOR AND OTHER TOP MANAGEMENT OFFICIALS IS AS FOLLOWS: TWO CUSTOM SURVEYS WERE USED AND MARKET DATA WAS GATHERED AND ANALYZED BY THE HUMAN RESOURCE DEPARTMENT. RESULTS WERE REVIEWED BY THE AUDIT AND RISK MANAGEMENT COMMITTEE OF THE BOARD AND WERE USED TO FORMALLY REVIEW AND CONFIRM THAT COMPENSATION IS APPROPRIATE. THE PROCESS WAS LAST DONE IN 2019 AND WAS CONTEMPORANEOUSLY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC VIA THE COMPANY WEBSITE. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A: FORM 990, PART VII, SECTION A ONLY REPORTS REPORTABLE COMPENSATION PAID BY A RELATED ORGANIZATION TO THE ORGANIZATION'S DIRECTORS, AS THE AMOUNT OF DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS WAS NOT AVAILABLE AT THE TIME OF FILING. FORM 990, PART IX, LINE 11G CONSULTANTS/OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 67,393. MANAGEMENT AND GENERAL EXPENSES 48,829. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116,222. JPA PAYROLL/FEES: PROGRAM SERVICE EXPENSES 4,811,501. MANAGEMENT AND GENERAL EXPENSES 1,464,722. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,276,223. TEMPORARY EMPLOYEE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 44,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,058. SAN FRANCISCO VETERANS AFFAIRS MEDICAL CENTER 4150 CLEMENT STREET SAN FRANCISCO CA 94121 941160824 HEALTH CARE BENEFITS AND SERVICES CA N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0