2018-11-14T15:37:09-06:00 2017-12-31 910189318 MOSS ADAMS LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2017-01-01 956419205 SANSUM CLINIC SANS 8056817700 PO BOX 1200 SANTA BARBARA CA 931021200 ALEX BAUER CFO 8056817700 2018-11-13 1 LAUREN A HAVERLOCK P00545829 3104770450 2018-11-13 12.129.7.100 2018-11-13 20:59:33 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7D0D6C7A6A5655B0595BBDB8C4257A6B648F0CEB 2017 2019-02-21 02:37:17Z ALEX BAUER PO BOX 1200 SANTA BARBARA CA 931021200 304121746 0 X WWW.SANSUMCLINIC.ORG X 1921 CA TO PROVIDE MEDICAL SERVICES TO THE GENERAL PUBLIC. 19 18 1364 50 0 0 6812315 9833215 276037127 289885446 21065 -35859 4457573 4251189 287328080 303933991 1863382 11875 0 0 78945645 86203869 0 0 513022 203328554 216165583 284137581 302381327 3190499 1552664 122055972 144898884 72858123 93108727 49197849 51790157 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 266834576 11875 290344639 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 FREE SPORTS PHYSICALS TO YOUTH WHO COULD NOT OTHERWISE AFFORD THEM.- 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. 266834576 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 1 0 0 0 0 0 0 0 1 388 0 1 1364 1 0 0 0 0 0 0 0 0 0 0 X 19 18 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 JANET A GARUFIS CHAIRPERSON 1.00 X X 0 0 0 VICKI HAZARD VICE CHAIRMAN 1.00 X X 0 0 0 ED ROSENBLATT VICE CHAIRMAN 1.00 X X 0 0 0 MICHAEL BERNSTEIN MD TRUSTEE/PHYSICIAN 1.00 X 11000 0 0 KENNETH COATES TRUSTEE 1.00 X 0 0 0 CHRIS CORPUZ TRUSTEE 1.00 X 0 0 0 ROGER P CRATON TRUSTEE 1.00 X 0 0 0 BRET E DAVIS MD TRUSTEE 1.00 X 0 0 0 PAUL HARTLOFF TRUSTEE 1.00 X 0 0 0 CHUCK KAYE TRUSTEE 1.00 X 0 0 0 TOM KENNY TRUSTEE 1.00 X 0 0 0 RON LATIMER MD TRUSTEE 1.00 X 0 0 0 JULIE MCGOVERN TRUSTEE 1.00 X 0 0 0 STEVE MCHUGH TRUSTEE 1.00 X 0 0 0 JAMES MCNAMARA MD TRUSTEE 1.00 X 0 0 0 ART MEROVICK TRUSTEE 1.00 X 0 0 0 DAVID A RAPHAEL MD TRUSTEE 1.00 X 0 0 0 GEORGE RUSZNAK TRUSTEE 1.00 X 0 0 0 ELIZABETH VOS TRUSTEE 1.00 X 0 0 0 KURT RANSOHOFF CEO, MEDICAL DIRECTOR 40.00 X 316210 0 0 CHAD HINE COO AND VICE PRESIDENT 40.00 X 443805 0 33141 ALEX BAUER CFO AND VICE PRESIDENT 40.00 X 322621 0 25041 SEAN JOHNSON DIR ELEC HEALTH RECORDS 40.00 X 279554 0 32632 MATTHEW KUNKEL VICE PRESIDENT - ONCOLOGY 40.00 X 272842 0 25041 KAREN HANDY VICE PRESIDENT - OPERATIONS 40.00 X 252368 0 12945 JONATHAN ANDREWS VICE PRESIDENT - CSS 40.00 X 231242 0 29666 TOM COLBERT VICE PRESIDENT - IT 40.00 X 175392 0 26299 KASHMIRI CHOPRA THRU 92917 MEDICAL RADIATION PHYSICIS 40.00 X 311626 0 0 JAMES MARTIN MEDICAL RADIATION PHYSICIST 40.00 X 406830 0 0 LOUIS GIAMBELUCA APPLICATIONS MANAGER 40.00 X 188428 0 27840 TIMOTHY JOHNSON MEDICAL DOSIMETRIST 40.00 X 177889 0 21839 SUSAN KENNEDY VICE PRESIDENT - HR 40.00 X 173588 0 16436 3563395 0 250880 109 0 1 0 SANSUM SANTA BARBARA MEDICAL CLINIC INC PO BOX 1200 SANTA BARBARA CA 93102 PROFESSIONAL SERVICES 72906000 SANTA BARBARA RADIOLOGY MEDICAL GROUP 320 W PUEBLO STREET SANTA BARBARA CA 93101 RADIOLOGY SERVICES 3939407 PACIFIC DIAGNOSTIC LAB PO BOX 8180 GOLETA CA 93118 LABORATORY SERVICES 3503803 JACKSON MEDICAL GROUP 517 WEST JUNIPERO SANTA BARBARA CA 93105 PROFESSIONAL SERVICES 2589733 ANESTHESIA MEDICAL GROUP 514 WEST PUEBLO SECOND FL SANTA BARBARA CA 93105 MEDICAL SERVICES 1443021 152 9833215 224287 9833215 OTHER MEDICAL SRVC REV 621110 289885446 289885446 289885446 30393 30393 446448 121503 324945 324945 324945 66252 -66252 -66252 -66252 MISCELLANEOUS INCOME 900099 1082643 1082643 ADMINISTRATIVE FEES 900099 956415 956415 CLINICAL STUDIES 900099 909932 909932 977254 459193 518061 3926244 303933991 290344639 0 3756137 X 11875 11875 2489800 2489800 61880455 51771058 9864162 245235 1241974 1160551 81423 16025021 13168376 2806849 49796 4566619 3690774 858692 17153 214016 214016 148000 148000 100285505 91549038 8552134 184333 1616973 1476109 140864 5712004 5214397 484747 12860 3705368 3382571 322797 10755576 9846902 905962 2712 162837 148651 14186 244251 222973 21278 1990425 1817027 173398 9250833 8444938 804962 933 1652497 1508538 143959 MEDICAL SUPPLIES 40992502 37421401 3571101 PHARMACEUTICAL SUPPLIES 35783127 32665846 3117281 REPAIRS/MAINTENANCE 3651669 3333551 318118 302381327 266834576 35033729 513022 17185806 19848493 2542642 1430576 17150640 19362857 600000 4133474 3729574 4263278 4588563 2565984 1519060 165687650 88779613 58176424 76908037 6881789 8069462 591236 633560 8564699 8208702 122055972 144898884 29818974 37811502 32769053 44411302 10270096 10885923 72858123 93108727 X 43411404 46080753 4485726 4398485 1300719 1310919 49197849 51790157 122055972 144898884 1552664 1143606 -103962 0 X 0 1 X 1 0 X 7491465 343533 1148806 8983804 6409208 672567 409690 7491465 4900122 1655849 -141524 5245 6409202 4598622 147165 154335 4900122 3502880 520508 575234 4598622 0.36000 0.15000 0.49000 0 0 6033858 6033858 34254623 15305957 18948666 28563355 13297071 15266284 86940126 58560281 28379845 9895688 1616304 8279384 76908037 DEFERRED COMPENSATION PLAN ASSETS 7723923 OTHER ASSETS 194779 INSURANCE RECEIVABLE 220000 ACQUISITION COSTS 70000 8208702 DEFERRED COMPENSATION PLAN LIABILITIES 7723923 MEDICAL MALPRACTICE LIABILITY 3162000 10885923 X 304752652 1143606 1143606 303609046 324945 324945 303933991 302056382 0 302056382 324945 324945 302381327 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, 2017 OR 2016. PART XI, LINE 4B - OTHER ADJUSTMENTS: GROSS RENTAL INCOME RECLASSED FROM EXPENSE SECTION 446,448. RENTAL EXPENSES NETTED WITH RENTAL INCOME -121,503. PART XII, LINE 4B - OTHER ADJUSTMENTS: GROSS RENTAL INCOME RECLASSIFIED TO REVENUES 446,448. RENTAL EXPENSES RECLASSIFIED TO STATEMENT OF REVENUE -121,503. X 1 1 X X X 0 0 0 0 0 0 0 1 0 KURT RANSOHOFF CEO, MEDICAL DIRECTOR 287973 0 25000 0 3237 0 0 0 0 0 316210 0 0 0 CHAD HINE COO AND VICE PRESIDENT 443805 0 0 0 0 0 8100 0 25041 0 476946 0 0 0 ALEX BAUER CFO AND VICE PRESIDENT 322621 0 0 0 0 0 0 0 25041 0 347662 0 0 0 SEAN JOHNSON DIR ELEC HEALTH RECORDS 254992 0 24562 0 0 0 7834 0 24798 0 312186 0 0 0 MATTHEW KUNKEL VICE PRESIDENT - ONCOLOGY 272842 0 0 0 0 0 0 0 25041 0 297883 0 0 0 KAREN HANDY VICE PRESIDENT - OPERATIONS 252368 0 0 0 0 0 0 0 12945 0 265313 0 0 0 JONATHAN ANDREWS VICE PRESIDENT - CSS 231242 0 0 0 0 0 4625 0 25041 0 260908 0 0 0 TOM COLBERT VICE PRESIDENT - IT 175392 0 0 0 0 0 8770 0 17529 0 201691 0 0 0 KASHMIRI CHOPRA THRU 92917 MEDICAL RADIATION PHYSICIS 311626 0 0 0 0 0 0 0 0 0 311626 0 0 0 JAMES MARTIN MEDICAL RADIATION PHYSICIST 406830 0 0 0 0 0 0 0 0 0 406830 0 0 0 LOUIS GIAMBELUCA APPLICATIONS MANAGER 188428 0 0 0 0 0 2799 0 25041 0 216268 0 0 0 TIMOTHY JOHNSON MEDICAL DOSIMETRIST 177889 0 0 0 0 0 8894 0 12945 0 199728 0 0 0 SUSAN KENNEDY VICE PRESIDENT - HR 173588 0 0 0 0 0 8006 0 8430 0 190024 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. PART I, LINE 7 KURT RANSOHOFF AND SEAN JOHNSON RECEIVED BONUSES, REPORTED ON PART II, THAT WERE DISCRETIONARY. 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 6 224287 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 ANNUALLY 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 91,549,038. MANAGEMENT AND GENERAL EXPENSES 8,552,134. FUNDRAISING EXPENSES 184,333. TOTAL EXPENSES 100,285,505.