CONNECTMED INTERNATIONAL: Form 990EZ, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CONNECTMED INTERNATIONAL (EIN 27-0804773)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-07
- IRS object ID
- 201323119349201362
- Schema version
- 2012v2.1
- 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 | 2013-11-07T16:07:48-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203676004 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CPWR LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5057 KELLER SPRINGS RD SUITE 425 | AddressLine1 |
| City | ADDISON | City |
| State | TX | State |
| ZIP Code | 75001 | 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 | 270804773 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONNECTMED INTERNATIONAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CONN | NameControl |
| Phone | 6198005349 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1435 EOLUS AVE | AddressLine1 |
| City | ENCINITAS | City |
| State | CA | State |
| ZIP Code | 92024 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMANDA GOSMAN MD | Name |
| Title | PRESIDENT AND CEO | Title |
| Phone | 6198005349 | Phone |
| Date Signed | 2013-11-07 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RONALD E COLBURN | Name |
| PTIN | P00021126 | PTIN |
| Phone | 9729914566 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Cash | X | MethodOfAccountingCash |
| Web Site | WWW.CONNECTMED.ORG | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 137467 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 69070 | ContributionsGiftsGrantsEtc |
| Investment Income | 140 | InvestmentIncome |
| Fundraising Gross Income | 68257 | FundraisingGrossIncome |
| Special Events Direct Expenses | 21672 | SpecialEventsDirectExpenses |
| Special Events Net Income Loss | 46585 | SpecialEventsNetIncomeLoss |
| Total Revenue | 115795 | TotalRevenue |
| Other Expenses Total | 12837 | OtherExpensesTotal |
| Total Expenses | 12837 | TotalExpenses |
| Excess Or Deficit For Year | 102958 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 91759 | NetAssetsOrFundBalancesBOY |
| Other Changes In Net Assets | 0 | OtherChangesInNetAssets |
| Net Assets Or Fund Balances EOY | 194717 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85148 | BOY |
| EOY | 177171 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6611 | BOY |
| EOY | 48321 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91759 | BOY |
| EOY | 225492 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 30775 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91759 | BOY |
| EOY | 194717 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Primary Exempt Purpose | THE MISSION OF THIS ORGANIZATION IS TO PROMOTE SUSTAINABLE MULTIDISCIPLINARY HEALTH CARE AND EDUCATION TO PATIENTS AND HEALTH CARE PROVIDERS IN UNDERSERVED AREAS AROUND THE WORLD THROUGH A COMBINATION OF DIRECT MEDICAL CARE AND THE ESTABLISHMENT OF AN INTERACTIVE TELEMEDICINE NETWORK BETWEEN INTERNATIONAL SITES | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment (4 entries)
| Description Program Service AccomDescriptionProgramServiceAccom | Grants And AllocationsGrantsAndAllocations | Program Service ExpensesProgramServiceExpenses |
|---|---|---|
| FEB 18, 2012 -- TRAVEL TO HOSPITAL INFANTIL DE LAS CALIFORNIAS IN TIJUANA, MEXICO AND PERFORMED CRANIOFACIAL RECONSTRUCTIVE SURGERIES ON 6 PATIENTS. TWO SURGEONS ON THIS TRIP. ALSO CONNECTED VIA TELECONFERENCE WITH 25 PARTICPATING STUDENTS AT UNIVERSITY OF CALIFORNIA SAN DIEGO TELEMEDICINE CENTER. ESTIMATED VALUE OF VOLUNTEER TIME FOR SERVICES PERFORMED IS $130,000 | 0 | 0 |
| MAY 12, 2012 -- TRAVEL TO HOSPITAL INFANTIL DE LAS CALIFORNIAS IN TIJUANA, MEXICO AND PERFORMED CRANIOFACIAL RECONSTRUCTIVE SURGERIES ON TWO PATIENTS. TWO SURGEONS ON THIS TRIP. ALSO CONNECTED VIA TELECONFERENCE WITH 25 PARTICPATING STUDENTS AT UNIVERSITY OF CALIFORNIA SAN DIEGO TELEMEDICINE CENTER. ESTIMATED VALUE OF VOLUNTEER TIME FOR SERVICES PERFORMED IS $60,000. | 0 | 0 |
| DEC 08, 2012 -- TRAVEL TO HOSPITAL INFANTIL DE LAS CALIFORNIAS IN TIJUANA, MEXICO AND PERFORMED CRANIOFACIAL RECONSTRUCTIVE SURGERIES ON 4 PATIENTS. TWO SURGEONS ON THIS TRIP. ALSO CONNECTED VIA TELECONFERENCE WITH 25 PARTICPATING STUDENTS AT UNIVERSITY OF CALIFORNIA SAN DIEGO TELEMEDICINE CENTER. ESTIMATED VALUE OF VOLUNTEER TIME FOR SERVICES PERFORMED IS $120,000. | 0 | 0 |
| PLANNING TRIP TO MALAWI IN FEB 2012 TO ESTABLISH UNDERSTANDING WITH FOREIGN GOVERNMENT AND CHARITY HOSPITAL FOR PLANNED FEB 2013 TRIP WITH FULL VOLUNTEER TEAM ( 20+ MEMBERS) | 0 | 4098 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 4098 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (11 entries)
| TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|
| SHERRY L COLBURN | ||||
| EXECUTIVE DIRECTOR | 15.00 | 0 | 0 | 0 |
| AMANDA GOSMAN MD | ||||
| PRESIDENT AND CEO / BOARD | 20.00 | 0 | 0 | 0 |
| RITA ABBATI | ||||
| VICE PRESIDENT/BOARD MEMBE | 5.00 | 0 | 0 | 0 |
| ELIZABETH STEVENS | ||||
| SECRETARY/BOARD MEMBER | 5.00 | 0 | 0 | 0 |
| RONALD COLBURN CPA | ||||
| TREASURER/BOARD MEMBER | 2.00 | 0 | 0 | 0 |
| ALICIA SIGLER MD | ||||
| BOARD MEMBER | 2.00 | 0 | 0 | 0 |
| ZIA AGHA MD | ||||
| BOARD MEMBER | 2.00 | 0 | 0 | 0 |
| ROHIT KHOSLA MD | ||||
| BOARD MEMBER | 2.00 | 0 | 0 | 0 |
| SHANKAR SITAPATI | ||||
| BOARD MEMBER | 2.00 | 0 | 0 | 0 |
| EVELYN SNYDER RN | ||||
| BOARD MEMBER | 2.00 | 0 | 0 | 0 |
| ROBERT HALL | ||||
| BOARD MEMBER | 2.00 | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | 0 | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | 0 | OrganizationHadUBI |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtc |
| Direct Indirect Political Expend | 0 | DirectIndirectPoliticalExpend |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficers |
| Tax Imposed Under IRC4911 | 0 | TaxImposedUnderIRC4911 |
| Tax Imposed Under IRC4912 | 0 | TaxImposedUnderIRC4912 |
| Tax Imposed Under IRC4955 | 0 | TaxImposedUnderIRC4955 |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTrans |
| Amount Of Tax Imposed On Org Mgr | 0 | AmountOfTaxImposedOnOrgMgr |
| Amount Of Tax Reimbursed By Org | 0 | AmountOfTaxReimbursedByOrg |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SHERRY L COLBURN | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 UTE LANE | AddressLine1 |
| City | ESTES PARK | City |
| State | CO | State |
| ZIP Code | 80517 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9705861793 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Foreign Office | 0 | ForeignOffice |
| Maintain Any Donor Advised Funds | 0 | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | 0 | DoesOrgHaveHospital |
| Tanning Services Provided | 0 | TanningServicesProvided |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Engage Political Cmpgn Activities | 0 | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | 0 | EngageInLobbyingActivities |
| Operating School | 0 | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | 0 | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | 1 | 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 Minus2 Years | 8610 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 65449 | CurrentTaxYearMinus1Year |
| Current Tax Year | 57286 | CurrentTaxYear |
| Total | 131345 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 8610 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 65449 | CurrentTaxYearMinus1Year |
| Current Tax Year | 57286 | CurrentTaxYear |
| Total | 131345 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 131345 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 140 | CurrentTaxYear |
| Total | 140 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 140 | CurrentTaxYear |
| Total | 140 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 8610 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 65449 | CurrentTaxYearMinus1Year |
| Current Tax Year | 57426 | CurrentTaxYear |
| Total | 131485 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | X | First5Years509 |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: INITIAL FILING YEAR IN 2010 WAS FOR A PERIOD OF LESS THAN TWELVE MONTHS | GeneralExplanation |
| General Explanation | SCHEDULE A, PART IV, LIST OF UNUSUAL GRANTS: CASH GRANT FOR MALAWI AFRICA CLINIC DATE: 03/23/12 AMOUNT: 10000. CASH GRANT FOR MALAWI AFRICA CLINIC DATE: 04/18/12 AMOUNT: 5000. CASH GRANT FOR GENERAL OPERATONS DATE: 12/01/12 AMOUNT: 25000. CASH GRANT FOR GENERAL OPERATONS DATE: 01/25/12 AMOUNT: 5000. CASH GRANT FOR GENERAL OPERATONS DATE: 01/01/12 AMOUNT: 5000. | GeneralExplanation |
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 G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 0 | AgreementRefFundraising |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | DINNER AND RAFFLE PALO ALTO CA | NameOfEvent1 |
| Gross Receipts Event1 | 41077 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 41077 | GrossRevenueEvent1 |
| Name Of Event2 | DINNER AND RAFFLE SAN DIEGO CAL | NameOfEvent2 |
| Gross Receipts Event2 | 46080 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 18900 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 27180 | GrossRevenueEvent2 |
| Food And Beverage Event2 | 5301 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 1250 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 1848 | OtherDirectExpensesEvent2 |
| Food And Beverage Other Events | 9691 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 440 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 3142 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 87157 | GrossReceiptsTotal |
| Charitable Contributions Total | 18900 | CharitableContributionsTotal |
| Gross Revenue Total Events | 68257 | GrossRevenueTotalEvents |
| Food And Beverage Total Events | 14992 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 1690 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 4990 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 21672 | DirectExpenseSummaryEvents |
| Net Income Summary | 46585 | NetIncomeSummary |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER INVESTMENT INCOME | FORM 990-EZ, PART I, LINE 4 | INTEREST 140.. |
| OTHER EXPENSES | FORM 990-EZ, PART I, LINE 16 | DESCRIPTION: OFFICE AND ADMINISTRATIVE. AMOUNT: 2,563. DESCRIPTION: INFORMATION TECHNOLOGY HOSTING . AMOUNT: 290. DESCRIPTION: PROGRAM SERVICE TRAVEL. AMOUNT: 6,420. DESCRIPTION: MEDICAL SUPPLIES. AMOUNT: 140. DESCRIPTION: PROMOTION. AMOUNT: 273. DESCRIPTION: PATIENT THERAPY. AMOUNT: 807. DESCRIPTION: BOARD MEETINGS. AMOUNT: 165. DESCRIPTION: STATE REGISTRATION FEES. AMOUNT: 10. DESCRIPTION: CREDIT CARD FEES AND BANK SERVICE FEES. AMOUNT: 2,169. TOTAL TO FORM 990-EZ, LINE 16: 12,837. |
| OTHER ASSETS | FORM 990-EZ, PART II, LINE 24 | DESCRIPTION: PREPAID TRIP COSTS FOR 2013 PROGRAM SERVICE TRIP. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 24,461. DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 6,611. END OF YEAR AMOUNT: 23,860. |
| OTHER LIABILITIES | FORM 990-EZ, PART II, LINE 26 | DESCRIPTION: DEFERRED PROGRAM SERVICES TRIP FEE CONTRIBUTIONS. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 30,775. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. | Declaration |
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