SANSUM CLINIC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- SANSUM CLINIC (EIN 95-6419205)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201223199349302822
- 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 | 2012-11-14T11:00:46-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910189318 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SECOND STREET 9TH FLOOR | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 956419205 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANSUM CLINIC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SANS | NameControl |
| Phone | 8056817700 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1200 | AddressLine1 |
| City | SANTA BARBARA | City |
| State | CA | State |
| ZIP Code | 931021200 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHAD HINE | Name |
| Title | VP,CFO | Title |
| Phone | 8056817700 | Phone |
| Date Signed | 2012-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RENIE BURBANK | Name |
| PTIN | P00159653 | PTIN |
| Phone | 4159561500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHAD HINE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1200 | AddressLine1 |
| City | SANTA BARBARA | City |
| State | CA | State |
| ZIP Code | 931021200 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 177654615 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SANSUMCLINIC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1921 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE MEDICAL SERVICES TO THE GENERAL PUBLIC. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 20 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 19 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1083 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1920570 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2169704 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 167248916 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 173022902 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 231381 | InvestmentIncomePriorYear |
| Investment Income Current Year | 221475 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1884543 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1701966 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 171285410 | TotalRevenuePriorYear |
| Total Revenue Current Year | 177116047 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 48027363 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 50887227 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 266130 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 118427296 | OtherExpensePriorYear |
| Other Expenses Current Year | 122865722 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 166454659 | TotalExpensesPriorYear |
| Total Expenses Current Year | 173752949 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4830751 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3363098 | RevenuesLessExpensesCY |
| Total Assets BOY | 82071771 | TotalAssetsBOY |
| Total Assets EOY | 86024320 | TotalAssetsEOY |
| Total Liabilities BOY | 55576392 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 56461831 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26495379 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 29562489 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 159575890 | Expense |
| Revenue | 173022902 | Revenue |
| Description | SEE SCHEDULE O | Description |
| Total Program Service Expense | 159575890 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 416 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1083 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 20 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 19 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAD HINE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8056817700 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1200 | AddressLine1 |
| City | SANTA BARBARA | City |
| State | CA | State |
| ZIP Code | 931021200 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (28 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| KURT RANSOHOFF MD | |||||||
| PRESIDENT/CEO,MED DIR | 40.00 | X | X | 145172 | 0 | 0 | |
| MICHAEL BERNSTEIN MD | |||||||
| TRUSTEE | 1.00 | X | 10000 | 0 | 0 | ||
| VICKI HAZARD | |||||||
| CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| ED ROSENBLATT | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| LARS BRUUN-ANDERSEN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| KEN COATES | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| CHRIS CORPUZ | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| CHARLIE COX | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ROGER CRATON | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JANET GARUFIS | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PAUL HARTLOFF | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ROGER HORTON | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| CHUCK KAYE | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| VICKY MACGREGOR | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JULIE MCGOVERN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JAMES MCNAMARA MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DAVID RAPHAEL MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL STEIN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JOSEPH TUMBLER | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| BETH VOS | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PAUL JACONETTE | |||||||
| VP/CAO | 40.00 | X | 318017 | 0 | 20128 | ||
| CHAD HINE | |||||||
| VP/CFO | 40.00 | X | 303896 | 0 | 19108 | ||
| CHRISTINE MCNAMARA | |||||||
| VP PPSERV/SECRETARY | 40.00 | X | 193315 | 0 | 9733 | ||
| JENNIFER THOMAS | |||||||
| VP BILLING SRVCS | 40.00 | 234688 | 0 | 25952 | X | ||
| TOM COLBERT | |||||||
| VP CIO | 40.00 | 171141 | 0 | 10965 | X | ||
| MARJORIE NEWMAN | |||||||
| MED DIR AST | 40.00 | 172032 | 0 | 8402 | X | ||
| SEAN JOHNSON | |||||||
| DIR ELEC HEALTH RECORDS | 40.00 | 183916 | 0 | 0 | X | ||
| LOUIS GIAMBELUCA | |||||||
| MANAGER EPIC APPLICATIONS | 40.00 | 137773 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1869950 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 94288 | TotalOtherCompensation |
| Number Individuals GT100 K | 31 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SANSUM SANTA BARBARA MEDICAL CLINIC INC | |||||
| PO BOX 1200 | SANTA BARBARA | CA | 93102 | PROFESSIONAL SERVICES | 49972000 |
| PACIFIC DIAGNOSTIC LABORATORIES | |||||
| PO BOX 8180 | GOLETA | CA | 93118 | LABORATORY SERVICES | 3974118 |
| JACKSON MEDICAL GROUP | |||||
| 517 WEST JUNIPERO | SANTA BARBARA | CA | 93105 | PROFESSIONAL SERVICES | 3257953 |
| SANTA BARBARA RADIOLOGY MEDICAL GROUP | |||||
| 320 W PUEBLO | SANTA BARBARA | CA | 93101 | RADIOLOGY SERVICES | 2713863 |
| ANESTHESIA MEDICAL GROUP | |||||
| 514 W PUEBLO | SANTA BARBARA | CA | 93105 | PROFESSIONAL SERVICES | 1655901 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 118 | NumberOfContractorsGT100K |
| Fundraising Events | 263400 | FundraisingEvents |
| All Other Contributions | 1906304 | AllOtherContributions |
| Total Contributions | 2169704 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICAL SRVC REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 173022902 | TotalRevenueColumn |
| Related Or Exempt Function Income | 173022902 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 173022902 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 221475 | TotalRevenueColumn |
| Exclusion | $221,475 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 635096 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 404515 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 230581 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 230581 | TotalRevenueColumn |
| Exclusion | $230,581 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 30000 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 263400 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 134053 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -104053 | TotalRevenueColumn |
| Exclusion | -$104,053 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS | 624100 | 1469830 | $1,469,830 |
| INCOME FROM K-1S | 900099 | 105608 | $105,608 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1575438 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 177116047 | TotalRevenueColumn |
| Related Or Exempt Function Income | 173022902 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,923,441 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 993261 | Total |
| Management And General | 993261 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38596475 | Total |
| Program Services | 32297364 | ProgramServices |
| Management And General | 6129119 | ManagementAndGeneral |
| Fundraising | 169992 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 873759 | Total |
| Program Services | 695856 | ProgramServices |
| Management And General | 177903 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7554047 | Total |
| Program Services | 6257448 | ProgramServices |
| Management And General | 1267807 | ManagementAndGeneral |
| Fundraising | 28792 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2869685 | Total |
| Program Services | 2335350 | ProgramServices |
| Management And General | 521682 | ManagementAndGeneral |
| Fundraising | 12653 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 182405 | Total |
| Program Services | 148441 | ProgramServices |
| Management And General | 33964 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 128650 | Total |
| Program Services | 104695 | ProgramServices |
| Management And General | 23955 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 77614628 | Total |
| Program Services | 76719890 | ProgramServices |
| Management And General | 885076 | ManagementAndGeneral |
| Fundraising | 9662 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 543678 | Total |
| Program Services | 442445 | ProgramServices |
| Management And General | 63364 | ManagementAndGeneral |
| Fundraising | 37869 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4831864 | Total |
| Program Services | 4041263 | ProgramServices |
| Management And General | 783439 | ManagementAndGeneral |
| Fundraising | 7162 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1721706 | Total |
| Program Services | 1401124 | ProgramServices |
| Management And General | 320582 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5067637 | Total |
| Program Services | 4124043 | ProgramServices |
| Management And General | 943594 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58890 | Total |
| Program Services | 47925 | ProgramServices |
| Management And General | 10965 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 181322 | Total |
| Program Services | 147560 | ProgramServices |
| Management And General | 33762 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1410780 | Total |
| Program Services | 1148093 | ProgramServices |
| Management And General | 262687 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4352493 | Total |
| Program Services | 3542059 | ProgramServices |
| Management And General | 810434 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1328851 | Total |
| Program Services | 1081419 | ProgramServices |
| Management And General | 247432 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 14201997 | 14201997 | |
| PHARMACEUTICAL SUPPLIES | 7832770 | 7832770 | |
| REPAIRS/MAINTENANCE | 2143920 | 1744722 | 399198 |
| PROV. FOR UNCOLLECTIBLE | 1249602 | 1249602 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14529 | Total |
| Program Services | 11824 | ProgramServices |
| Management And General | 2705 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 173752949 | Total |
| Program Services | 159575890 | ProgramServices |
| Management And General | 13910929 | ManagementAndGeneral |
| Fundraising | 266130 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128997 | BOY |
| EOY | 8210280 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23817386 | BOY |
| EOY | 12109844 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10657278 | BOY |
| EOY | 9346085 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2000000 | BOY |
| EOY | 2817077 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1483708 | BOY |
| EOY | 1676876 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 774059 | BOY |
| EOY | 1242836 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 98083655 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 60683900 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31017780 | BOY |
| EOY | 37399755 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3047301 | BOY |
| EOY | 2880357 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 474919 | BOY |
| EOY | 432130 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8670343 | BOY |
| EOY | 9909080 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82071771 | BOY |
| EOY | 86024320 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20171416 | BOY |
| EOY | 19154118 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25862430 | BOY |
| EOY | 24785745 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4486366 | BOY |
| EOY | 6489814 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5056180 | BOY |
| EOY | 6032154 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55576392 | BOY |
| EOY | 56461831 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22510247 | BOY |
| EOY | 25818949 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3199695 | BOY |
| EOY | 2944304 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 785437 | BOY |
| EOY | 799236 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26495379 | BOY |
| EOY | 29562489 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82071771 | BOY |
| EOY | 86024320 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3363098 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -295988 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3256051 | BeginningOfYearBalance |
| Contributions | 13799 | Contributions |
| Investment Earnings Or Losses | -78121 | InvestmentEarningsOrLosses |
| End Of Year Balance | 3191729 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2933851 | BeginningOfYearBalance |
| Contributions | 33680 | Contributions |
| Investment Earnings Or Losses | 288520 | InvestmentEarningsOrLosses |
| End Of Year Balance | 3256051 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2292447 | BeginningOfYearBalance |
| Contributions | 255486 | Contributions |
| Investment Earnings Or Losses | 385918 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2933851 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1952796 | BeginningOfYearBalance |
| Contributions | 839584 | Contributions |
| Investment Earnings Or Losses | -499933 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2292447 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.75000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.25000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6033858 | OtherCostOrOtherBasis |
| Book Value | 6033858 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 33109764 | OtherCostOrOtherBasis |
| Depreciation | 17955945 | Depreciation |
| Book Value | 15153819 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 53732539 | OtherCostOrOtherBasis |
| Depreciation | 42727955 | Depreciation |
| Book Value | 11004584 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5207494 | OtherCostOrOtherBasis |
| Book Value | 5207494 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 37399755 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BOND CONSTRUCTION AND RESERVE FUNDS | 4077881 |
| BOND ISSUANCE COSTS, NET OF AMORTIZATION | 1199710 |
| DEFERRED COMPENSATION PLAN ASSETS | 2144151 |
| OTHER ASSETS | 461338 |
| INSURANCE RECEIVABLE | 2026000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 9909080 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION PLAN LIABILITIES | $2,144,154 |
| MEDICAL MALPRACTICE LIABILITY | $3,888,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6032154 | TotalOfAmounts |
| Total Revenue | 177116047 | TotalRevenue |
| Total Expenses | 173752949 | TotalExpenses |
| Excess Or Deficit For Year | 3363098 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -306537 | NetUnrealizedGLOnInvestments |
| Other | $10,549 | OtherAmount |
| Total Adjustments | -295988 | TotalAdjustments |
| Excess Or Deficit Per FS | 3067110 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 176723531 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -306537 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -306537 | RevenueNotRptdF990 |
| Revenue Subtotal | 177030068 | RevenueSubtotal |
| Other Revenues Not Included | 85979 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 85979 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 177116047 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 173656421 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 173656421 | ExpensesSubtotal |
| Other Expenses Not Included | 96528 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 96528 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 173752949 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE INTENDED USE OF ENDOWMENT FUNDS ARE RELATED TO THE PURPOSE FOR WHICH THEY WERE GIVEN. THERE ARE RESTRICTED FUNDS SET UP FOR DIGITAL MAMMOGRAPHY, CYSTIC FIBROSIS, PHYSICIAN HOUSING, TECHNOLOGY IMPROVEMENTS, AND COLONOSCOPIES FOR NEIGHBORHOOD CLINIC PATIENTS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | 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, 2011 OR 2010. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME 10,549. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | GROSS RENTAL INCOME RECLASSIED FROM EXPENSE SECTION 635,096. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME -10,549. RENTAL EXPENSES NETTED WITH RENTAL INCOME -404,515. FUNDRAISING EXPENSES RECLASSIFIED TO REVENUES -134,053. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | GROSS RENTAL INCOME RECLASSIFIED TO REVENUES 635,096. RENTAL EXPENSES RECLASSIFIED TO REVENUES -404,515. FUNDRAISING EXPENSES RECLASSIFIED TO REVENUES -134,053. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | 90TH ANNIVERSARY | NameOfEvent1 |
| Gross Receipts Event1 | 293400 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 263400 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 30000 | GrossRevenueEvent1 |
| Entertainment Event1 | 134053 | EntertainmentEvent1 |
| Gross Receipts Total | 293400 | GrossReceiptsTotal |
| Charitable Contributions Total | 263400 | CharitableContributionsTotal |
| Gross Revenue Total Events | 30000 | GrossRevenueTotalEvents |
| Entertainment Total Events | 134053 | EntertainmentTotalEvents |
| Direct Expense Summary Events | 134053 | DirectExpenseSummaryEvents |
| Net Income Summary | -104053 | NetIncomeSummary |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAUL JACONETTE | |||||||||||||
| 225096 | 0 | 0 | 0 | 92921 | 0 | 9685 | 0 | 10443 | 0 | 338145 | 0 | 0 | 0 |
| CHAD HINE | |||||||||||||
| 303896 | 0 | 0 | 0 | 0 | 0 | 3443 | 0 | 15665 | 0 | 323004 | 0 | 0 | 0 |
| CHRISTINE MCNAMARA | |||||||||||||
| 193315 | 0 | 0 | 0 | 0 | 0 | 9733 | 0 | 0 | 0 | 203048 | 0 | 0 | 0 |
| JENNIFER THOMAS | |||||||||||||
| 234688 | 0 | 0 | 0 | 0 | 0 | 10287 | 0 | 15665 | 0 | 260640 | 0 | 0 | 0 |
| TOM COLBERT | |||||||||||||
| 171141 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 10965 | 0 | 182106 | 0 | 0 | 0 |
| MARJORIE NEWMAN | |||||||||||||
| 172032 | 0 | 0 | 0 | 0 | 0 | 8402 | 0 | 0 | 0 | 180434 | 0 | 0 | 0 |
| SEAN JOHNSON | |||||||||||||
| 183916 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 183916 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | KURT RANSOHOFF AND PAUL JACONETTE RECEIVED MONTHLY CLUB DUES TOTALING $4,008 PER YEAR FOR EACH INDIVIDUAL. THESE AMOUNTS HAVE BEEN INCLUDED IN 2011 W-2 WAGES. |
| PART I, LINE 4A | IN 2011, PAUL JACONETTE RECEIVED A SEVERANCE IN THE AMOUNT OF $92,921, WHICH WAS INCLUDED IN HIS 2011 W-2 WAGES. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. ALSO, MICHAEL STEIN, MEMBER OF THE BOARD OF TRUSTEES, HAS A BROTHER THAT WORKS FOR SANSUM CLINIC. | |
| 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 EXECUTIVE COMMITTEE AND THE CHIEF FINANCIAL OFFICER; UPON APPROVAL BY THE EXECUTIVE 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 IRS. ONCE FINAL APPROVAL IS GIVEN, THE 990 TAX RETURN IS SUBMITTED TO THE IRS. | |
| 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 XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -306,537. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME 10,549. TOTAL TO FORM 990, PART XI, LINE 5: -295,988. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 990, PART XII, LINE 2C | 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. | AUDIT COMMITTEE AND OVERSIGHT |
| FORM 990, PART III, LINE 4A | IN 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. | EXEMPT PURPOSE ACHIEVEMENTS |
| 990, PART VI, LINE 16B | DUE DILIGENCE WAS PERFORMED BY LEGAL COUNSEL AT THE TIME OF THE INITIAL INVESTMENT. THE FACILITY, WHICH IS MANAGED BY THE PARTNERSHIP, IS USED BY SANSUM CLINIC FOR OUTPATIENT SURGERY PROCEDURES. SANSUM CLINICS ENGAGE LEGAL COUNSEL FOR ANY CHANGES RELATING TO PARTNERSHIP ACTIVITIES TO ENSURE PROCEDURES ARE FOLLOWED TO SAFEGUARD THEIR EXEMPT STATUS. EFFECTIVE NOVEMBER 2011, SANSUM CLINIC SOLD THEIR INVESTMENT INTEREST IN SANTA BARBARA SURGERY CENTER, LP. | INVESTMENT IN OR PARTICIPATION IN A JOINT VENTURE OR SIMILAR ARRANGEMENT: |
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