INTERNATIONAL PERFUSION ASSOCIATION: Form 990EZ, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- INTERNATIONAL PERFUSION ASSOCIATION (EIN 65-0763136)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-06
- IRS object ID
- 201313109349200116
- Schema version
- 2012v2.3
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-06T10:03:19-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLER HELMS & FOLK PA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6326 WHISKEY CREEK DRIVE SUITE A | AddressLine1 |
| City | FORT MYERS | City |
| State | FL | State |
| ZIP Code | 33919 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 650763136 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL PERFUSION ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | INTE | NameControl |
| Phone | 2392439171 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17080 SAFETY STREET UNIT 109 | AddressLine1 |
| City | FORT MYERS | City |
| State | FL | State |
| ZIP Code | 33908 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRYAN V LICH | Name |
| Title | SEC/TREASURER | Title |
| Phone | 2392439171 | Phone |
| Date Signed | 2013-10-26 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CRAIG R FOLK | Name |
| Phone | 2394819696 | Phone |
| Date Prepared | 2013-10-26 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Cash | X | MethodOfAccountingCash |
| Web Site | WWW.PERFUSION.COM | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 81557 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 81549 | ContributionsGiftsGrantsEtc |
| Investment Income | 8 | InvestmentIncome |
| Total Revenue | 81557 | TotalRevenue |
| Grants And Similar Amounts Paid | 7824 | GrantsAndSimilarAmountsPaid |
| Fees And Oth Pymt To Ind Contractors | 7213 | FeesAndOthPymtToIndContractors |
| Printing Publications Postage | 1425 | PrintingPublicationsPostage |
| Other Expenses Total | 10021 | OtherExpensesTotal |
| Total Expenses | 26483 | TotalExpenses |
| Excess Or Deficit For Year | 55074 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 52803 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 107877 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52803 | BOY |
| EOY | 107777 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 100 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52803 | BOY |
| EOY | 107877 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52803 | BOY |
| EOY | 107877 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Primary Exempt Purpose | SURGICAL EQUIPMENT,SUPPLIES AND INFORMATION | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service Accom | OBTAINED DONATIONS OF HEART SURGERY MEDICAL EQUIPMENT AND SUPPLIES AND PROVIDED THEM FREE OF CHARGE TO A HUMANITARIAN PROGRAM WHICH DOES FREE HEART SURGERY FOR INDIGENT PATIENTS AT A PUBLIC HOSPTAL IN SANTIAGO, DOMINICAN REPUBLIC. | DescriptionProgramServiceAccom |
| Grants And Allocations | 7824 | GrantsAndAllocations |
| Includes Foreign Grants | X | IncludesForeignGrants |
| Program Service Expenses | 22520 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 22520 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (5 entries)
| TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation |
|---|---|---|
| IRIS CHACON CCP | ||
| PRES, DIR | 0.50 | 0 |
| PETER ZUCK | ||
| VP, DIR | 0.50 | 0 |
| BRYAN V LICH | ||
| S-T, BD CHR | 1.00 | 0 |
| SAM DOMINICO CCP | ||
| DIR | 0.50 | 0 |
| ROBERT PASCOTTO MD | ||
| DIR | 0.50 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | false | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | false | OrganizationHadUBI |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Organization Dissolved Etc | false | OrganizationDissolvedEtc |
| Did Org File Form1120 POL This Year | false | DidOrgFileForm1120POLThisYear |
| Made Loans To From Officers | false | MadeLoansToFromOfficers |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTrans |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | VICTOR J LICH JR ATTORNEY | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17080 SAFETY STREET UNIT 109 | AddressLine1 |
| City | FORT MYERS | City |
| State | FL | State |
| ZIP Code | 33908 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2392439171 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccount |
| Foreign Office | false | ForeignOffice |
| Maintain Any Donor Advised Funds | false | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | false | DoesOrgHaveHospital |
| Tanning Services Provided | false | TanningServicesProvided |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction With Control Entity | false | TransactionWithControlEntity |
| Engage Political Cmpgn Activities | false | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | false | EngageInLobbyingActivities |
| Operating School | false | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | false | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | true | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 120733 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 76351 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 29835 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 33360 | CurrentTaxYearMinus1Year |
| Current Tax Year | 81549 | CurrentTaxYear |
| Total | 341828 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 120733 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 76351 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 29835 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 33360 | CurrentTaxYearMinus1Year |
| Current Tax Year | 81549 | CurrentTaxYear |
| Total | 341828 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 1000 | CurrentTaxYearMinus3Years |
| Current Tax Year | 100 | CurrentTaxYear |
| Total | 1100 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 1000 | CurrentTaxYearMinus3Years |
| Current Tax Year | 100 | CurrentTaxYear |
| Total | 1100 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 340728 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 23 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 13 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5 | CurrentTaxYearMinus1Year |
| Current Tax Year | 8 | CurrentTaxYear |
| Total | 55 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 23 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 13 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5 | CurrentTaxYearMinus1Year |
| Current Tax Year | 8 | CurrentTaxYear |
| Total | 55 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 120756 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 76364 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 29841 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 33365 | CurrentTaxYearMinus1Year |
| Current Tax Year | 81557 | CurrentTaxYear |
| Total | 341883 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99660 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99660 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00000 | InvestmentIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| GRANTS AND SIMILAR AMTS PAID TO ORGANIZATIONS | FORM 990-EZ, PART I, LINE 10 | JOSE MARIA CABRAL Y BAEZ HOSPTAL SANTIAGO, DOMINICAN REPUBLIC PERFUSION SUPPL DR 0 7,824 0 |
| OTHER EXPENSES | FORM 990-EZ, PART I, LINE 16 | EXPENSES TRAVEL 10,021 TOTAL 10,021 |
| OTHER ASSETS | FORM 990-EZ, PART II, LINE 24 | UNDEPOSITED FUNDS 0 100 TOTAL 0 100 |
| FIRST ACCOMPLISHMENT | FORM 990-EZ, PART III, LINE 28 | OBTAINED DONATIONS OF HEART SURGERY MEDICAL EQUIPMENT AND SUPPLIES AND PROVIDED THEM FREE OF CHARGE TO A HUMANITARIAN PROGRAM WHICH DOES FREE HEART SURGERY FOR INDIGENT PATIENTS AT A PUBLIC HOSPTAL IN SANTIAGO, DOMINICAN REPUBLIC. |
Compensation Explanation CompensationExplanation
Compensation Compensation (5 entries)
| IRIS CHACON CCP |
| PETER ZUCK |
| BRYAN V LICH |
| SAM DOMINICO CCP |
| ROBERT PASCOTTO MD |
Comments