PEDIATRIC SPINE FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PEDIATRIC SPINE FOUNDATION (EIN 20-3169071)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-10-05
IRS object ID
201332789349300303
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

FieldValueIRS element (for citing)
Timestamp2013-10-05T18:23:08-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1TEUSCHER RUF & WALPOLE LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line111650 S STATE ST STE 200AddressLine1
CityDRAPERCity
StateUTState
ZIP Code840207150ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN203169071EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHEST WALL AND SPINE DEFORMITYBusinessNameLine1
Business Name Line2RESEARCH FOUNDATIONBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlCHESNameControl
Phone8016625637Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1072AddressLine1
CityLAYTONCity
StateUTState
ZIP Code84041ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN T SMITHName
TitlePRESIDENTTitle
Phone8016625637Phone
Date Signed2013-09-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRYAN J THOMPSON CPAName
Phone8016191400Phone
Date Prepared2013-10-05DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN T SMITHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1100 N MARIO CAPECCHI DRAddressLine1
CitySALT LAKE CITYCity
StateUTState
ZIP Code84113ZIPCode
FieldValueIRS element (for citing)
Gross Receipts904921GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHESTANDSPINE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2005YearFormation
State Legal DomicileUTStateLegalDomicile
Activity Or Mission DescriptionPROVIDE STRUCTURE AND FUNDING TO CONDUCT PROSPECTIVE AND RETROSPECTIVE STUDIES BY SURGEONS AND RESEARCHERS STUDYING COMPLEX CHEST WALL AND SPINE DEFORMITIES IN THE GROWING CHILD.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year705070ContributionsGrantsPriorYear
Contributions Grants Current Year904369ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year397InvestmentIncomePriorYear
Investment Income Current Year552InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year705467TotalRevenuePriorYear
Total Revenue Current Year904921TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year238362GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY153664GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year60000SalariesEtcPriorYear
Salaries Etc Current Year50000SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year299909OtherExpensePriorYear
Other Expenses Current Year315997OtherExpensesCurrentYear
Total Expenses Prior Year598271TotalExpensesPriorYear
Total Expenses Current Year519661TotalExpensesCurrentYear
Revenues Less Expenses Prior Year107196RevenuesLessExpensesPriorYear
Revenues Less Expenses CY385260RevenuesLessExpensesCY
Total Assets BOY479955TotalAssetsBOY
Total Assets EOY865164TotalAssetsEOY
Total Liabilities BOY51TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY479904NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY865164NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDE STRUCTURE AND FUNDING TO CONDUCT PROSPECTIVE AND RETROSPECTIVE STUDIES BY SURGEONS AND RESEARCHERS STUDYING COMPLEX CHEST WALL AND SPINE DEFORMITIES IN THE GROWING CHILD.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense519661Expense
Grants153664Grants
Revenue904921Revenue
DescriptionTHE CHEST WALL AND SPINE DEFORMITY RESEARCH FOUNDATION LEADS A COMMUNITY OF INDIVIDUALS DEDICATED TO IMPROVING THE QUALITY OF CARE AND THE OUTCOME OF TREATMENT FOR PATIENTS AND FAMILIES DEALING WITH CHEST WALL AND SPINE DEFORMITIES. THE GROUP HAS HAD OVER 60 ARTICLES PUBLISHED IN MAJOR MEDICAL JOURNALS AND HAS PRESENTED OVER 180 STUDIES AT EXPERT MEETINGS. DURING 2012, THE FOUNDATION CONTINUED ITS SUPPORT OF A PROSPECTIVE, MULTI-CENTER STUDY EVALUATING THE USE OF RIB DISTRACTION DEVICES TO TREAT CHILDREN WITH PROGRESSIVE SCOLIOSIS WITHOUT RIB ABNORMALITIES. IT ALSO SUPPORTED A SUBGROUP FOCUSING ON WHAT HAPPENS AT THE END OF GROWTH SURGERY, THIS SUBGROUP RESULTED IN A KEY PRESENTATION AT A MAJOR INTERNATIONAL SOCIETY MEETING.Description
Total Program Service Expense519661TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredfalseScheduleORequired
Number Forms Transmitted With10967NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSARAH MUMFORDNamePerson
Telephone Number8016625637TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1072AddressLine1
CityLAYTONCity
StateUTState
ZIP Code84113ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
RANDAL BETZ MD
SECRETARY1.00XX2000000
JOHN T SMITH
PRESIDENT1.00XX2000000
MICHAEL G VITALE MD MPH
TREASURER1.00XX1000000
JACK M FLYNN MD
VICE-PRESIDE1.00XX000
FieldValueIRS element (for citing)
Total Reportable Comp From Org50000TotalReportableCompFromOrg
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
All Other Contributions904369AllOtherContributions
Total Contributions904369TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column552TotalRevenueColumn
Related Or Exempt Function Income552RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column904921TotalRevenueColumn
Related Or Exempt Function Income552RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total153664Total
Program Services153664ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total50000Total
Program Services50000ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total51Total
Program Services51ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total95Total
Program Services95ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total151432Total
Program Services151432ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2936Total
Program Services2936ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total5619Total
Program Services5619ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total49093Total
Program Services49093ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total750Total
Program Services750ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
REGISTRY EXPENSES9218392183
STUDY-RELATED1166611666
MISCELLANEOUS759759
DUES AND SUBSCRIPTIONS705705

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total708Total
Program Services708ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total519661Total
Program Services519661ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY479056BOY
EOY850462EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
EOY13803EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis899LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY899BOY
EOY899EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY479955BOY
EOY865164EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY51BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY51BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY479904BOY
EOY865164EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY479904BOY
EOY865164EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY479955BOY
EOY865164EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses385260ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years183792CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years218019CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years877811CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year705070CurrentTaxYearMinus1Year
Current Tax Year904369CurrentTaxYear
Total2889061Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years183792CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years218019CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years877811CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year705070CurrentTaxYearMinus1Year
Current Tax Year904369CurrentTaxYear
Total2889061Total
FieldValueIRS element (for citing)
Public Support Total5092889061PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years691CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years277CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years563CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year397CurrentTaxYearMinus1Year
Current Tax Year552CurrentTaxYear
Total2480Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years691CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years277CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years563CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year397CurrentTaxYearMinus1Year
Current Tax Year552CurrentTaxYear
Total2480Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years184483CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years218296CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years878374CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year705467CurrentTaxYearMinus1Year
Current Tax Year904921CurrentTaxYear
Total2891541Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99910PublicSupportPercentage509
Prior Year Support Percentage0.99790PriorYearSupportPercentage
Investment Income Percentage0.00000InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis899InvestmentCostOrOtherBasis
Book Value899BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings899TotalOfBookValueLandBuildings

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedfalseRecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
TRUSTEES OF COLUMBIA U
211 LOW LIBRARY 535 WEST 116NEW YORKNY1002724000EQUIPOISE
SHRINERS HOSPITAL CHIL
VIRGINIA STREETSALT LAKE CITYUT8410336112RESEARCH COORDINATOR
UNIVERSITY OF UTAH
540 ARAPEEN DRIVE SUITE 250SALT LAKE CITYUT8410887302RESEARCH COORDINATOR
UNIVERSITY OF MINNESOTA
200 OAK STREETMINNEAPOLISMN554556250RESEARCH
FieldValueIRS element (for citing)
Total Nbr Of Other Organizations4TotalNbrOfOtherOrganizations

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BNO REVIEW WAS OR WILL BE CONDUCTED.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC
OTHER FEES FOR SERVICESFORM 990, PART IX, LINE 11GOTHER FEES 151,432 0 0

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