2015-11-16T15:20:48-06:00 2014-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-01-01 956419205 SANSUM CLINIC SANS 8056817700 PO BOX 1200 SANTA BARBARA CA 931021200 CHAD HINE VP/CFO 8056817700 2015-11-16 1 RENIE BURBANK P00159653 4159561500 2014 2016-03-07 17:11:31Z CHAD HINE PO BOX 1200 SANTA BARBARA CA 931021200 239645649 0 X WWW.SANSUMCLINIC.ORG X 1921 CA TO PROVIDE MEDICAL SERVICES TO THE GENERAL PUBLIC. 19 19 1168 30 0 0 4442047 5734775 215485111 228519744 136632 -10783 3472808 4145284 223536598 238389020 0 0 0 0 65635092 65670105 0 0 409983 155374968 167834516 221010060 233504621 2526538 4884399 99878212 116256326 61716575 73063120 38161637 43193206 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 192913914 228519744 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. 192913914 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 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 485 0 1 1168 1 0 0 0 0 0 0 0 0 0 0 X 19 19 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X CHAD HINE 8056817700 PO BOX 1200 SANTA BARBARA CA 931021200 VICKI HAZARD CHAIRPERSON 1.00 X X 0 0 0 ED ROSENBLATT VICE CHAIRPERSON 1.00 X X 0 0 0 JANET GARUFIS VICE CHAIRPERSON 1.00 X X 0 0 0 MICHAEL BERNSTEIN MD TRUSTEE 1.00 X 10000 0 0 KENNETH COATES TRUSTEE 1.00 X 0 0 0 CHRIS CORPUZ TRUSTEE 1.00 X 0 0 0 ROGER 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 RONALD 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 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 VINCE JENSEN PRESIDENT/COO 40.00 X 439521 0 21629 CHAD HINE VICE PRESIDENT/CFO 40.00 X 271022 0 21629 KURT RANSOHOFF MD CEO/CHIEF MEDICAL OFFICER 40.00 X 272576 0 0 JENNIFER THOMAS VICE PRESIDENT, BILLING SERVICES 40.00 X 221534 0 15140 SEAN JOHNSON DIR ELEC HEALTH RECORDS 40.00 X 236318 0 21629 CHRISTINE MCNAMARA VP PROF SERVICES 40.00 X 212501 0 5204 MARJORIE NEWMAN MED DIR ASST 40.00 X 203841 0 0 TIMOTHY JOHNSON SR DOSIMETRIST 40.00 X 169164 0 11134 2036477 0 96365 62 0 1 0 SANSUM SANTA BARBARA MEDICAL CLINIC INC PO BOX 1200 SANTA BARBARA CA 93102 PROFESSIONAL SERVICES 63875000 PACIFIC DIAGNOSTIC LABORATORIES PO BOX 8180 GOLETA CA 93118 LABORATORY SERVICES 3606928 SANTA BARBARA RADIOLOGY MEDICAL GROUP 320 W PUEBLO ST SANTA BARBARA CA 93101 RADIOLOGY SERVICES 3330417 JACKSON MEDICAL GROUP 517 WEST JUNIPERO SANTA BARBARA CA 93105 PROFESSIONAL SERVICES 3158511 SANTA BARBARA HEMATOLOGY ONCOLOGY 540 W PUEBLO ST SANTA BARBARA CA 93105 ONCOLOGY SERVICES 2036935 140 5734775 1116850 5734775 MEDICAL SRVC REVENUE 621110 228519744 228519744 228519744 14813 14813 601956 236379 365577 365577 365577 994654 1020250 -25596 -25596 -25596 MISCELLANEOUS INCOME 624100 3779707 3779707 3779707 238389020 228519744 0 4134501 X 1036376 10000 1026376 49169369 39777083 9196386 195900 11880630 9455642 2385670 39318 3583730 2841898 727226 14606 1778830 1778830 159996 159996 89746634 71169081 18459222 118331 816285 647314 163793 5178 5133233 4070654 1035322 27257 2822982 2238625 584357 7685511 6094610 1590901 98827 78370 16586 3871 195573 155089 35895 4589 1168412 926551 241861 7295902 5785650 1509319 933 1709497 1083562 625935 MEDICAL SUPPLIES 27182637 27182637 PHARMACEUTICAL SUPPLIES 19003125 19003125 REPAIRS/MAINTENANCE 3037072 2394023 643049 233504621 192913914 40180724 409983 14044192 17468729 7562724 2190165 15862680 15971050 3546000 3833386 2114639 3297591 1755232 1988739 130146955 76862398 38740313 53284557 4120947 4954631 422721 422721 11708764 12844757 99878212 116256326 26193417 24498530 22482375 38133333 4336184 2505477 8704599 7925780 61716575 73063120 X 32830234 36485570 4508187 5730085 823216 977551 38161637 43193206 99878212 116256326 4884399 147170 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4598622 147165 154335 4900122 3502880 520508 575234 4598622 3191729 23957 287194 3502880 3256051 13799 -78121 3191729 2933851 33680 288520 3256051 0.49000 0.12000 0.39000 0 0 6033858 6033858 49382859 22373972 27008887 71191782 54488426 16703356 3538456 3538456 53284557 BOND CONSTRUCTION AND RESERVE FUNDS 6885105 BOND ISSUANCE COSTS, NET OF AMORTIZATION 364280 DEFERRED COMPENSATION PLAN ASSETS 4427780 OTHER ASSETS 199592 INSURANCE RECEIVABLE 778000 ACQUISITION COSTS 190000 12844757 DEFERRED COMPENSATION PLAN LIABILITIES 4427780 MEDICAL MALPRACTICE LIABILITY 3498000 7925780 X 238152486 147170 147170 238005316 383704 383704 238389020 233120917 0 233120917 383704 383704 233504621 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, 2014 OR 2013. THE CLINIC IS NO LONGER SUBJECT TO THE U.S. FEDERAL EXAMINATIONS BY THE INTERNAL REVENUE SERVICE FOR THE TAX YEARS ENDED ON OR BEFORE 2010 AND STATE EXAMINATIONS BY THE CALIFORNIA TAX BOARD FOR THE YEARS ENDED ON OR BEFORE 2009. PART XI, LINE 4B - OTHER ADJUSTMENTS: GROSS RENTAL INCOME RECLASSED FROM EXPENSE SECTION 601,956. RENTAL EXPENSES NETTED WITH RENTAL INCOME -236,379. RECLASSIFICATION OF LOSS ON SALE OF INVESTMENT TO EXPENSES 18,127. PART XII, LINE 4B - OTHER ADJUSTMENTS: GROSS RENTAL INCOME RECLASSIFIED TO REVENUES 601,956. RENTAL EXPENSES RECLASSIFIED TO STATEMENT OF REVENUE -236,379. RECLASSIFICATION OF LOSS ON SALE OF INVESTMENT TO EXPENSES 18,127. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 VINCE JENSEN PRESIDENT/COO 439521 0 0 0 0 0 0 0 21629 0 461150 0 0 0 CHAD HINE VICE PRESIDENT/CFO 271022 0 0 0 0 0 0 0 21629 0 292651 0 0 0 KURT RANSOHOFF MD CEO/CHIEF MEDICAL OFFICER 272576 0 0 0 0 0 0 0 0 0 272576 0 0 0 JENNIFER THOMAS VICE PRESIDENT, BILLING SERVICES 221534 0 0 0 0 0 0 0 15140 0 236674 0 0 0 SEAN JOHNSON DIR ELEC HEALTH RECORDS 236318 0 0 0 0 0 0 0 21629 0 257947 0 0 0 CHRISTINE MCNAMARA VP PROF SERVICES 212501 0 0 0 0 0 0 0 5204 0 217705 0 0 0 MARJORIE NEWMAN MED DIR ASST 203841 0 0 0 0 0 0 0 0 0 203841 0 0 0 TIMOTHY JOHNSON SR DOSIMETRIST 169164 0 0 0 0 0 0 0 11134 0 180298 0 0 0 PART I, LINE 1A PAYMENT FOR MONTHLY DUES FOR MEMBERSHIP AT THE LA CUMBRE COUNTRY CLUB WAS PAID ON BEHALF OF KURT RANSOHOFF. THE AMOUNT WAS INCLUDED IN HIS FORM W-2. X 3 1116850 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 11 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 ARE FILED. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION PERIODICALLY. NO CHANGES TO EXECUTIVE COMPENSATION ARE IMPLEMENTED THAT ARE NOT BUDGETED FOR AND THAT 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 OTHER NON-EMPLOYEE SERVICES: PROGRAM SERVICE EXPENSES 71,169,081. MANAGEMENT AND GENERAL EXPENSES 18,459,222. FUNDRAISING EXPENSES 118,331. TOTAL EXPENSES 89,746,634. 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT - THE BOARD OF TRUSTEES HAS DELEGATED FIDUCIARY RESPONSIBILITY OF THE OVERSIGHT OF THE AUDIT TO THE AUDIT COMMITTEE. THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR.