INTERNATIONAL PERFUSION ASSOCIATION: Form 990EZ, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- INTERNATIONAL PERFUSION ASSOCIATION (EIN 65-0763136)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-26
- IRS object ID
- 201213009349200511
- Schema version
- 2011v1.2
- 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 | 2012-10-26T10:33:52-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | 2011-01-01 | 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 | 2012-10-19 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CRAIG R FOLK | Name |
| Phone | 2394819696 | Phone |
| Date Prepared | 2012-10-19 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
| Web Site | N/A | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 33365 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 33360 | ContributionsGiftsGrantsEtc |
| Investment Income | 5 | InvestmentIncome |
| Total Revenue | 33365 | TotalRevenue |
| Grants And Similar Amounts Paid | 25460 | GrantsAndSimilarAmountsPaid |
| Fees And Oth Pymt To Ind Contractors | 220 | FeesAndOthPymtToIndContractors |
| Printing Publications Postage | 534 | PrintingPublicationsPostage |
| Other Expenses Total | 7910 | OtherExpensesTotal |
| Total Expenses | 34124 | TotalExpenses |
| Excess Or Deficit For Year | -759 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 53562 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 52803 | NetAssetsOrFundBalancesEOY |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53562 | BOY |
| EOY | 52803 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53562 | BOY |
| EOY | 52803 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53562 | BOY |
| EOY | 52803 | 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 IN THE D0MINICAN REPUBLIC. | DescriptionProgramServiceAccom |
| Grants And Allocations | 25460 | GrantsAndAllocations |
| Includes Foreign Grants | X | IncludesForeignGrants |
| Program Service Expenses | 33570 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 33570 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation |
|---|---|---|---|---|---|---|
| IRIS CHACON CCP | ||||||
| 8141 NW 186TH ST | REDDICK | FL | 32686 | PRES, DIR | 0.50 | 0 |
| PETER ZUCK | ||||||
| 15266 BRIAR CREST CIRCLE | FORT MYERS | FL | 33912 | VP, DIR | 0.50 | 0 |
| BRYAN V LICH | ||||||
| 500 KEENAN AVE | FORT MYERS | FL | 33919 | S-T, BD CHR | 1.00 | 0 |
| SAM DOMINICO CCP | ||||||
| 5413 WILLIAMS PLACE CT | WINSTONSALEM | NC | 27106 | DIR | 0.50 | 0 |
| ROBERT PASCOTTO MD | ||||||
| 6910 OLD WHISKEY CREEK DRIVE | FORT MYERS | FL | 33901 | 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 |
| 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 | 53906 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 120733 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 76351 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 29835 | CurrentTaxYearMinus1Year |
| Current Tax Year | 33360 | CurrentTaxYear |
| Total | 314185 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 53906 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 120733 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 76351 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 29835 | CurrentTaxYearMinus1Year |
| Current Tax Year | 33360 | CurrentTaxYear |
| Total | 314185 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 1000 | CurrentTaxYearMinus2Years |
| Total | 1000 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 1000 | CurrentTaxYearMinus2Years |
| Total | 1000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 313185 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 23 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 13 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5 | CurrentTaxYear |
| Total | 56 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 23 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 13 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5 | CurrentTaxYear |
| Total | 56 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 53915 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 120756 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 76364 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 29841 | CurrentTaxYearMinus1Year |
| Current Tax Year | 33365 | CurrentTaxYear |
| Total | 314241 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99660 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99640 | 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 (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| GRANTS AND SIMILAR AMTS PAID TO ORGANIZATIONS | FORM 990-EZ, PART I, LINE 10 | HOSPITAL REGIONAL UNIVERSITARIO SANTIAGO, DOMINICAN REPUBLIC PERFUSION SUPPL DR 0 25,460 0 |
| OTHER EXPENSES | FORM 990-EZ, PART I, LINE 16 | EXPENSES AWARDS 250 TRAVEL 7,660 TOTAL 7,910 |
| 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 IN THE D0MINICAN REPUBLIC. |
Compensation Explanation CompensationExplanation
Compensation Compensation (5 entries)
| IRIS CHACON CCP |
| PETER ZUCK |
| BRYAN V LICH |
| SAM DOMINICO CCP |
| ROBERT PASCOTTO MD |
Comments