2017-11-14T18:18:59-06:00 2016-12-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2016-01-01 956419205 Sansum Clinic SANS 8056817700 PO Box 1200 SANTA BARBARA CA 931021200 Alex Bauer CFO 8056817700 2017-11-14 1 Renie Burbank P00159653 4159561500 12.129.7.100 2017-11-14 13:08:47 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 41F3D51277C721D7E64869098416E4BAA04E310D 2016 2021-01-29 14:40:06Z Alex Bauer PO Box 1200 SANTA BARBARA CA 931021200 287575432 0 X www.sansumclinic.org X 1921 CA To provide medical services to the general public. 20 18 1324 50 0 0 7328148 6812315 254781524 276037127 -5542 21065 4574471 4457573 266678601 287328080 2512100 1863382 0 0 72768666 78945645 0 0 510261 188851860 203328554 264132626 284137581 2545975 3190499 122161654 122055972 76563995 72858123 45597659 49197849 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 251369805 1863382 276821665 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. 251369805 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 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 458 0 1 1324 1 0 0 0 0 0 0 0 0 0 0 X 20 18 1 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 1.00 X 12500 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 281896 0 0 Chad Hine COO AND VICE PRESIDENT 40.00 X 433855 0 36830 Alex Bauer CFO AND VICE PRESIDENT 40.00 X 289742 0 35729 Kashmiri Chopra MEDICAL RADIATION PHYSICIST 40.00 X 403584 0 0 John Rice SENIOR MEDICAL DOSIMETRIST 40.00 X 332549 0 32654 Sean Johnson DIR ELEC HEALTH RECORDS 40.00 X 280657 0 35581 Jonathan Andrews ASSOCIATE VICE PRESIDENT 40.00 X 252440 0 29752 Marjorie Newman MED DIR ASSISTant 40.00 X 251234 0 12203 2538457 0 182749 85 0 1 0 Sansum Santa Barbara Medical Clinic Inc PO Box 1200 Santa Barbara CA 93102 Professional Services 68828141 Michaelsen Construction CO 14 W Valerio St B Santa Barbara CA 93101 Professional Services 4834371 Santa Barbara Radiology Medical Group 320 W Pueblo St Santa Barbara CA 93101 Radiology Services 3612752 Jackson Medical Group 517 West Junipero Santa Barbara CA 93105 Professional Services 3284547 Pacific Diagnostic Lab PO Box 8180 Santa Barbara CA 93118 Laboratory Services 2987977 148 6812315 682502 6812315 Other MEDICAL SRVC REV 621110 276037127 276037127 276037127 1065 1065 448565 247352 201213 201213 201213 20000 0 20000 20000 20000 MISCELLANEOUS INCOME 900099 1051296 1051296 Administrative fees 900099 978957 978957 ACO/Chronic Care Program 900099 784538 784538 1441569 1441569 4256360 287328080 276821665 0 3694100 X 1863382 1863382 1078052 1078052 58857205 48161911 10454031 241263 1139709 1044181 95528 13705988 12528978 1127599 49411 4164691 3789184 359022 16485 386680 386680 149662 149662 105354173 95854964 9310975 188234 1407059 1280192 126867 5443844 4953002 475974 14868 3668822 3338024 330798 9108352 8264799 843553 144483 131456 13027 214249 194931 19318 1043701 949596 94105 8912686 8109078 803608 1930040 1756019 174021 PHARMACEUTICAL SUPPLIES 32366320 29448026 2918294 MEDICAL SUPPLIES 29681122 26501862 3179260 REPAIRS/MAINTENANCE 3517361 3200220 317141 284137581 251369805 32257515 510261 19877211 17185806 1858218 2542642 19725602 17150640 3417258 4133474 3941124 4263278 2146058 2565984 137743582 79567158 54220694 58176424 4803569 6881789 422721 591236 11749199 8564699 122161654 122055972 27396484 29818974 36640741 32769053 12526770 10270096 76563995 72858123 X 39065697 43411404 5237143 4485726 1294819 1300719 45597659 49197849 122161654 122055972 3190499 409691 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6409208 672567 409690 7491465 4900122 1655849 -141524 5245 6409208 4598622 147165 154335 4900122 3502880 520508 575234 4598622 3191729 23957 287194 3502880 0.23000 0.17000 0.60000 0 0 6033858 6033858 59917284 26286433 33630851 68738466 53280725 15457741 3053974 3053974 58176424 Bond Construction and Reserve Funds 2007905 DEFERRED COMPENSATION PLAN ASSETS 6065365 OTHER ASSETS 198429 INSURANCE RECEIVABLE 183000 ACQUISITION COSTS 110000 8564699 Deferred Compensation Plan Liabilities 6065365 MEDICAL MALPRACTICE LIABILITY 3125000 ACCRUED CENCAL DEFerred REVenue 1079731 10270096 X 287536558 409691 409691 287126867 201213 201213 287328080 283936368 0 283936368 201213 201213 284137581 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 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 as of December 31, 2016 or 2015. Part XI, Line 4b - Other Adjustments: Gross Rental Income reclassed from Expense Section 448,565. Rental Expenses Netted with Rental INcome -247,352. Part XII, Line 4b - Other Adjustments: Gross Rental Income reclassified to Revenues 448,565. Rental Expenses reclassified to Statement of Revenue -247,352. 1 CANCER FOUNDATION OF SANTA BARBARA 601 W JUNIPERO SANTA BARBARA CA 93101 952158727 501(C)(3) 1850732 General Support COTTAGE HOSPITAL FOUNDATION PO BOX 689 SANTA BARBARA CA 93102 951644629 501(C)(3) 6000 General Support 2 Part I, Line 2: GRANT requests are reviewed and APPROVED BY THE BOARD OF TRUSTEES. Once approved, tHE FUNDING IS MONITORED BY SANSUM CLINIC FINANCE DEPARTMENT. X 1 1 X X X 0 0 0 0 0 0 0 0 0 Kurt Ransohoff CEO, MEDICAL DIRECTOR 281896 0 0 0 0 0 0 0 0 0 281896 0 0 0 Chad Hine COO AND VICE PRESIDENT 433855 0 0 0 0 0 7950 0 28880 0 470685 0 0 0 Alex Bauer CFO AND VICE PRESIDENT 257485 0 32257 0 0 0 0 0 35729 0 325471 0 0 0 Kashmiri Chopra MEDICAL RADIATION PHYSICIST 403584 0 0 0 0 0 0 0 0 0 403584 0 0 0 John Rice SENIOR MEDICAL DOSIMETRIST 332549 0 0 0 0 0 0 0 32654 0 365203 0 0 0 Sean Johnson DIR ELEC HEALTH RECORDS 280657 0 0 0 0 0 6187 0 29394 0 316238 0 0 0 Jonathan Andrews ASSOCIATE VICE PRESIDENT 252440 0 0 0 0 0 1002 0 28750 0 282192 0 0 0 Marjorie Newman MED DIR ASSISTant 251234 0 0 0 0 0 12203 0 0 0 263437 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. Christine McNamara Spouse of James McNamara, Trustee 113385 Services rendered as VP PROF SERVICES 0 X 6 682502 Sales Price of Shares 0 0 1 0 Form 990, Part VI, Section A, line 2 CHRISTINE MCNAMARA, VICE PRESIDENT OF PROFESSIONAL SERVICES, AND DR. JAMES MCNAMARA, MEMBER OF THE BOARD OF TRUSTEES, HAVE A FAMILY RELATIONSHIP. 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 95,854,964. Management and general expenses 9,310,975. Fundraising expenses 188,234. Total expenses 105,354,173.