Tristate Patient Safety Foundation: Form 990EZ, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- Tristate Patient Safety Foundation (EIN 20-0735895)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201133199349203743
- Schema version
- 2010v3.2
- 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 | 2011-11-15T16:43:34-08:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | 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 | 2010-01-01 | 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 | Diane Vass-Watson | Name |
| Title | Executive Director | Title |
| Date Signed | 2011-11-11 | DateSigned |
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 | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Schedule B Not Required | X | ScheduleBNotRequired |
| Web Site | www.tristatepsf.org | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 23 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Investment Income | 23 | InvestmentIncome |
| Cost Other Basis And Sales Expenses | 0 | CostOtherBasisAndSalesExpenses |
| Fundraising Gross Income | 0 | FundraisingGrossIncome |
| Special Events Direct Expenses | 0 | SpecialEventsDirectExpenses |
| Special Events Net Income Loss | 0 | SpecialEventsNetIncomeLoss |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
| Total Revenue | 23 | TotalRevenue |
| Grants And Similar Amounts Paid | 32000 | GrantsAndSimilarAmountsPaid |
| Other Expenses Total | 3685 | OtherExpensesTotal |
| Total Expenses | 35685 | TotalExpenses |
| Excess Or Deficit For Year | -35662 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 45009 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9347 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45066 | BOY |
| EOY | 11388 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2653 | BOY |
| EOY | 639 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47719 | BOY |
| EOY | 12027 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2710 | BOY |
| EOY | 2680 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45009 | BOY |
| EOY | 9347 | 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 | Developed educational web-based training program for shoulder dystocia in conjunction with on-site simulation and team training to reduce risk and improve outcomes during childbirth. | DescriptionProgramServiceAccom |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (4 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 |
| Robert Smith MD | ||||||
| 1024 Iron Point Road | Folsom | CA | 95630 | Director | 0 | 0 |
| Warren Metherd MD | ||||||
| 1024 Iron Point Road | Folsom | CA | 95630 | Director | 0 | 0 |
| William Michael McCullough MD | ||||||
| 1024 Iron Point Road | Folsom | CA | 95630 | Sec/Treasurer | 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 Dissolved Etc | false | 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 | 46375 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 32250 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 13500 | CurrentTaxYearMinus2Years |
| Total | 92125 | 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 | 46375 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 32250 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 13500 | CurrentTaxYearMinus2Years |
| Total | 92125 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 0 | AmountsSubstContributorsTotal |
| Public Support Total170 | 92125 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 38 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 80 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 46 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 47 | CurrentTaxYearMinus1Year |
| Total | 211 | 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 | 92336 | TotalSupport |
| First5 Years170 | X | First5Years170 |
| Public Support Pertcentage170 | 0.00000 | PublicSupportPertcentage170 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990-EZ, Part II, Line 26.1001 | Total Liabilities.1001 | Accounts Payable and Accrued Expenses - Beginning $2710 Accounts Payable and Accrued Expenses - Ending $2680 |
| Form 990-EZ, Part II, Line 24.1011 | Other Assets.1011 | Prepaid Expenses and Deferred Charges - Beginning $636 Prepaid Expenses and Deferred Charges - Ending $639 |
| Form 990-EZ, Part II, Line 24.1002 | Other Assets.1002 | Furniture and Fixtures - Beginning $2017 Furniture and Fixtures - Ending $0 |
| Form 990-EZ, Part I, Line 16.5 | Other Expenses.5 | Business License $50 |
| Form 990-EZ, Part I, Line 16.4 | Other Expenses.4 | Miscellaneous $241 |
| Form 990-EZ, Part I, Line 16.3 | Other Expenses.3 | Legal $278 |
| Form 990-EZ, Part I, Line 16.2 | Other Expenses.2 | Audit $650 |
| Form 990-EZ, Part I, Line 16.1 | Other Expenses.1 | Liability Insurance $2190 |
| Form 990-EZ, Part I, Line 16.1009 | Other Expenses.1009 | Depreciation $276 |
| Form 990-EZ, Part I, Line 10.1 | Grants and Similar Amounts Paid In Excess of $5,000.1 | | Donee's Name: Emergency Medicine Patient Safety Found. | Donee's Address: 1024 Iron Point Road Folsom, CA 95630 | Relationship of Donee: Supported Organization | Cash Amount Given: $32000 |