Tristate Patient Safety Foundation: Form 990EZ, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- Tristate Patient Safety Foundation (EIN 20-0735895)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201243209349201849
- 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 | 2012-11-15T10:10:36-08:00 | 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 | Scinto Graziano LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1797 | AddressLine1 |
| City | Grass Valley | City |
| State | CA | State |
| ZIP Code | 95945 | 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 | 200735895 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tristate Patient Safety Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | TRIS | NameControl |
| Phone | 9163576723 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1024 Iron Point Road | AddressLine1 |
| City | Folsom | City |
| State | CA | State |
| ZIP Code | 95630 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Dianne Vass-Watson | Name |
| Title | Executive Direc | Title |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | George Graziano | Name |
| Phone | 5302733200 | Phone |
| Self Employed | X | SelfEmployed |
| 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) |
|---|---|---|
| Terminated Return | X | TerminatedReturn |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Schedule B Not Required | X | ScheduleBNotRequired |
| Web Site | www.tristatepsf.org | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts Less Than25000 | X | GrossReceiptsLessThan25000 |
| Gross Receipts | 4 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Investment Income | 4 | InvestmentIncome |
| Cost Other Basis And Sales Expenses | 0 | CostOtherBasisAndSalesExpenses |
| Fundraising Gross Income | 0 | FundraisingGrossIncome |
| Special Events Direct Expenses | 0 | SpecialEventsDirectExpenses |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
| Total Revenue | 4 | TotalRevenue |
| Other Expenses Total | 7942 | OtherExpensesTotal |
| Total Expenses | 7942 | TotalExpenses |
| Excess Or Deficit For Year | -7938 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 9347 | NetAssetsOrFundBalancesBOY |
| Other Changes In Net Assets | -1409 | OtherChangesInNetAssets |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11388 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 639 | BOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12027 | BOY |
| EOY | 0 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2680 | BOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9347 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | To promote patient safety in the practice of medicine throughout the Tri State region of Ohio, Kentucky and Indiana. | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service Accom | Organization was able to wind up its affairs and provide its remaining net assets to a qualified 501(c)(3) with a similar mission. | DescriptionProgramServiceAccom |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation |
|---|---|---|---|---|---|---|
| Dianne Vass-Watson | ||||||
| 1024 Iron Point Road | Folsom | CA | 95630 | Executive Direc | 0 | 0 |
| William Michael McCullough MD | ||||||
| 1024 Iron Point Road | Folsom | CA | 95630 | Chairman | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | false | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | false | OrganizationHadUBI |
| Organization Filed990 T | false | OrganizationFiled990T |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Organization Dissolved Etc | true | OrganizationDissolvedEtc |
| Did Org File Form1120 POL This Year | false | DidOrgFileForm1120POLThisYear |
| Made Loans To From Officers | false | MadeLoansToFromOfficers |
| Initiation Fees And Capital Contri | 0 | InitiationFeesAndCapitalContri |
| Gross Receipts For Public Use | 0 | GrossReceiptsForPublicUse |
| 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 | Dianne Vass | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1024 Iron Point Road | AddressLine1 |
| City | Folsom | City |
| State | CA | State |
| ZIP Code | 95630 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9163576723 | 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 |
| Form720 Filed | false | Form720Filed |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction With Control Entity | false | TransactionWithControlEntity |
| Engage Political Cmpgn Activities | false | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | false | EngageInLobbyingActivities |
| Operating School | false | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | false | TrnsfrsExemptNonCharRelatedOrg |
| Related Org Section527 Org | false | RelatedOrgSection527Org |
| 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 Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 32250 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 13500 | CurrentTaxYearMinus3Years |
| Total | 45750 | Total |
Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 32250 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 13500 | CurrentTaxYearMinus3Years |
| Total | 45750 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 0 | AmountsSubstContributorsTotal |
| Public Support Total170 | 45750 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 80 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 46 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 47 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 23 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4 | CurrentTaxYear |
| Total | 200 | Total |
Net UBI NetUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 45950 | TotalSupport |
| Public Support Pertcentage170 | 0.99560 | PublicSupportPertcentage170 |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule N IRS990ScheduleN
Liquidation Table LiquidationTable
Liquidation Detail LiquidationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Asset | Cash | DescriptionOfAsset |
| Date Of Distribution | 2011-02-02 | DateOfDistribution |
| FMV Of Asset | 1409 | FMVOfAsset |
| Method Of FMV Determination | Book value | MethodOfFMVDetermination |
| EIN | 270057395 | EIN |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1024 Iron Point Road | AddressLine1 |
| City | Folsom | City |
| State | CA | State |
| ZIP Code | 95630 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(c)3 | IRCSection |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | false | DirectorOfSuccessor |
| Employee Of Successor | false | EmployeeOfSuccessor |
| Owner Of Successor | false | OwnerOfSuccessor |
| Receive Compensation | false | ReceiveCompensation |
| Assets Distributed | true | AssetsDistributed |
| Required To Notify AG | false | RequiredToNotifyAG |
| AG Notified | false | AGNotified |
| Liabilities Paid | true | LiabilitiesPaid |
| Bonds Outstanding | false | BondsOutstanding |
| Bond Liabilities Discharged | false | BondLiabilitiesDischarged |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990-EZ, Part II, Line 26.1001 | Total Liabilities.1001 | Accounts Payable and Accrued Expenses - Beginning $2680 Accounts Payable and Accrued Expenses - Ending $0 |
| Form 990-EZ, Part II, Line 24.1011 | Other Assets.1011 | Prepaid Expenses and Deferred Charges - Beginning $639 Prepaid Expenses and Deferred Charges - Ending $0 |
| Form 990-EZ, Part I, Line 20.1 | Other Changes In Net Assets Or Fund Balances - Other Decreases.1 | Final Year Distributions to Qualified charities $1409 |
| Form 990-EZ, Part I, Line 16.6 | Other Expenses.6 | Business Licenses & Fees $50 |
| Form 990-EZ, Part I, Line 16.5 | Other Expenses.5 | IT Services $73 |
| Form 990-EZ, Part I, Line 16.4 | Other Expenses.4 | Accounting $500 |
| Form 990-EZ, Part I, Line 16.3 | Other Expenses.3 | Audit $500 |
| Form 990-EZ, Part I, Line 16.2 | Other Expenses.2 | Consulting Services $2500 |
| Form 990-EZ, Part I, Line 16.1 | Other Expenses.1 | Legal $4319 |