2011-11-15T11:43:24-06:00 2010-12-31 MOSS ADAMS LLP ONE CALIFORNIA STREET 4TH FLOOR SAN FRANCISCO CA 94111 990 2010-01-01 956419205 SANSUM CLINIC SANS 8056817700 PO BOX 1200 SANTA BARBARA CA 931021200 CHAD HINE 8056817700 2011-11-10 1 RENIE BURBANK 4159561500 2010 2016-03-07 17:11:31Z CHAD HINE PO BOX 1200 SANTA BARBARA CA 93102 171655807 0 X WWW.SANSUMCLINIC.ORG X 1921 CA TO PROVIDE MEDICAL SERVICES TO THE GENERAL PUBLIC. 22 19 1037 10 37810 36810 1285809 1920570 162863850 167248916 170149 231381 1920313 1884543 166240121 171285410 0 0 0 0 47390504 48027363 0 0 330638 116605029 118427296 163995533 166454659 2244588 4830751 71280307 80892771 49836971 54397392 21443336 26495379 X 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. 0 0 150840181 167248916 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. 150840181 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 358 0 1037 1 1 1 0 0 0 0 0 0 0 0 0 0 X 22 19 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X CHAD HINE 8056817700 470 S PATTERSON AVENUE SANTA BARBARA CA 93111 KURT RANSOHOFF MD 40.00 X X 100000 0 0 PAUL JACONETTE 40.00 X X 271063 0 10389 MICHAEL BERNSTEIN MD 1.00 X 10000 0 0 VICKI HAZARD 1.00 X X 0 0 0 ED ROSENBLATT 1.00 X X 0 0 0 DAN BRENNAN MD 1.00 X 0 0 0 LARS BRUUN-ANDERSEN 1.00 X 0 0 0 KEN COATES 1.00 X 0 0 0 CHRIS CORPUZ 1.00 X 0 0 0 CHARLIE COX 1.00 X 0 0 0 ROGER CRATON 1.00 X 0 0 0 CHRIS DONNER MD 1.00 X 0 0 0 JANET GARUFIS 1.00 X 0 0 0 PAUL HARTLOFF 1.00 X 0 0 0 ROGER HORTON 1.00 X 0 0 0 CHUCK KAYE 1.00 X 0 0 0 ALEX KOPER MD 1.00 X 0 0 0 VICKY MACGREGOR 1.00 X 0 0 0 JULIE MCGOVERN 1.00 X 0 0 0 JAMES MCNAMARA MD 1.00 X 0 0 0 MICHAEL STEIN 1.00 X 0 0 0 BETH VOS 1.00 X 0 0 0 CHAD HINE 40.00 X 286342 0 6669 JENNIFER THOMAS 40.00 X 218582 0 28063 CHRISTINE MCNAMARA 40.00 X 175592 0 19348 TOM COLBERT 40.00 X 155145 0 299 MARJORIE NEWMAN 40.00 X 162240 0 4142 JULIE MARTIN 40.00 X 141641 0 3943 1520605 0 72853 22 0 1 0 SANSUM SANTA BARBARA MEDICAL CLINIC INC PO BOX 1200 SANTA BARBARA CA 93102 PHYSICIAN SERVICES 49972000 PACIFIC DIAGNOSTIC LAB FILE 50933 LOS ANGELES CA 90074 LABORATORY SERVICES 3441246 JACKSON MEDICAL GROUP 517 WEST JUNIPERO SANTA BARBARA CA 93105 PHYSICIAN SERVICES 3271294 SANTA BARBARA RADIOLOGY MEDICAL GROUP 320 W PUEBLO ST SANTA BARBARA CA 93101 RADIOLOGY SERVICES 2760812 MEDQUIST PO BOX 10832 NEWARK NJ 07193 TRANSCRIPTION SVCS 1969558 97 1920570 1920570 MEDICAL SRVC REVENUE 621110 167248916 167248916 167248916 231131 231131 668672 370397 298275 298275 298275 250 250 250 250 MISCELLANEOUS 624100 1472134 1472134 INCOME FROM K-1S 900099 114134 37810 76324 1586268 171285410 167248916 37810 2078114 684463 684463 37340389 30621997 6542122 176270 7304511 5904986 1371742 27783 2698000 2172989 511776 13235 335160 303377 31783 180613 163485 17128 124426 124426 569129 515158 53971 8595277 7697293 806412 91572 6140776 5558445 582331 92340 83583 8757 1594377 1594377 4436994 4015632 420698 664 MEDICAL SRVC CONTRACTS 67471425 67471425 MEDICAL SUPPLIES 17587583 15919749 1667834 OTHER PROFESSIONAL SVCS 7188053 6487297 679642 21114 PROV. FOR UNCOLLECTIBLE 2145755 2145755 REPAIRS/MAINTENANCE 1965388 1779010 186378 166454659 150840181 15283840 330638 516318 128997 17095281 23817386 11363023 10657278 1723834 2000000 1323397 1483708 644177 774059 94061155 63043375 27797580 31017780 2485775 3047301 668889 474919 7662033 7491343 71280307 80892771 17934043 20171416 26894115 25862430 1244765 4486366 3764048 3877180 49836971 54397392 X 18109081 22510247 2577998 3199695 756257 785437 21443336 26495379 71280307 80892771 X 4830751 221292 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2933851 33680 288520 3256051 2292447 255486 385918 2933851 1952796 839584 -499933 2292447 0.74000 0.26000 0 0 6033858 6033858 32745346 17718281 15027065 53268659 45325094 7943565 2013292 2013292 31017780 BOND CONSTRUCTION AND RESERVE FUNDS 3888654 BOND ISSUANCE COSTS, NET OF AMORTIZATION 1314739 DEFERRED COMPENSATION PLAN ASSETS 2041180 OTHER ASSETS 246770 7491343 DEFERRED COMPENSATION PLAN LIABILITIES 2041180 MEDICAL MALPRACTICE LIABILITY 1836000 3877180 171285410 166454659 4830751 264686 -43394 221292 5052043 171208427 264686 264686 170943741 341669 341669 171285410 166156384 0 166156384 298275 298275 166454659 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, COLONOSCOPIES FOR NEIGHBORHOOD CLINIC PATIENTS, ENDOCRINOLOGY REMODEL AND ONCOLOGY REMODEL PROJECTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CLINIC ADOPTED THE PROVISIONS OF FASB ACCOUNTING STANDARDS CODIFICATION (ASC) 740-10, INCOME TAXES, RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS ON JANUARY 1, 2009, WHICH HAD NO FINANCIAL STATEMENT IMPACT TO THE CLINIC. 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. PART XI, LINE 8 - OTHER ADJUSTMENTS: BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME -43,394. PART XII, LINE 4B - OTHER ADJUSTMENTS: GROSS RENTAL INCOME RECLASSIED FROM EXPENSE SECTION 668,672. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME 43,394. RENTAL EXPENSES NETTED WITH RENTAL INCOME -370,397. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GROSS RENTAL INCOME RECLASSIFIED TO REVENUES 668,672. RENTAL EXPENSES RECLASSIFIED TO REVENUES -370,397. X 0 1 X X X X 0 1 0 1 0 1 0 0 0 PAUL JACONETTE 269514 0 0 0 1549 0 5712 0 4677 0 281452 0 0 0 CHAD HINE 286006 0 0 0 336 0 0 0 6669 0 293011 0 0 0 JENNIFER THOMAS 218210 0 0 0 372 0 18673 0 9390 0 246645 0 0 0 CHRISTINE MCNAMARA 173137 0 0 0 2455 0 14848 0 4500 0 194940 0 0 0 TOM COLBERT 152690 0 0 0 2455 0 299 0 0 0 155444 0 0 0 MARJORIE NEWMAN 161682 0 0 0 558 0 4142 0 0 0 166382 0 0 0 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 2010 W-2 WAGES. PART I, LINE 1B SANSUM CLINIC DOES NOT HAVE A WRITTEN EXPENSE REIMBURSEMENT POLICY, HOWEVER, ALL EMPLOYEE REIMBURSEMENTS ARE APPROVED BY A MEMBER OF MANAGEMENT. PART I, LINE 4B IN 2010, JENNIFER THOMAS HAD CONTRIBUTIONS TO THE NON-QUALIFIED RETIREMENT PLAN OF 13,000, AND CHRIS MCNAMARA HAD CONTRIBUTIONS TO THE PLAN OF 10,400. THESE AMOUNTS WERE INCLUDED IN THE INDIVIDUALS FORMS W-2. PART I, LINE 5 SEE RESPONSE TO QUESTION 6A BELOW PART I, LINE 6 COMPENSATION WAS ACCRUED FOR EXECUTIVE TEAM AND THE PAYOUT WAS BASED ON REACHING CERTAIN FINANCIAL TARGETS. MEETING OPERATING PROFIT TARGETS IS THE FIRST MEASURE. ONCE THESE ARE MET THEN THERE ARE OTHER METRICS SUCH AS PATIENT SATISFACTION, QUALITY OF CARE, EHR IMPLEMENTATION, PROVIDER ACCESS, FTE PER PROVIDER, REVENUES AND A/R DAYS GOALS AND TARGETS TO BE MET. THE WEIGHTING OF THE METRICS VARY ANY WHERE FROM 7.5% TO 25% TOTALLING A 100%. 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 264,686. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME -43,394. TOTAL TO FORM 990, PART XI, LINE 5: 221,292. AUDIT COMMITTEE AND OVERSIGHT 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. INVESTMENT IN OR PARTICIPATION IN A JOINT VENTURE OR SIMILAR ARRANGEMENT: 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 CLINICS 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.