MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization: MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL (EIN 34-1663333)
Tax period: 2022-01-01 to 2022-12-31
Filed: 2023-05-22
IRS object ID: 202311429349300891
Schema version: 2022v5.0
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
Form 990
Schedule B
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2023-05-22T17:36:05-04:00	ReturnTs
Tax Period End	2022-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Saupp Tax Service LLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	P O Box 245	AddressLine1Txt
City	Trempealeau	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54661	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2022-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	341663333	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Medical Staff of St John Westshore Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	MEDI	BusinessNameControlTxt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	29000 Center Ridge Rd	AddressLine1Txt
City	Westlake	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44145	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Stephen Evans	PersonNm
Person Title	President	PersonTitleTxt
Phone	4408275536	PhoneNum
Signature	2023-05-08	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Stephen	PersonFirstNm
Person Last	Evans	PersonLastNm

Field	Value	IRS element (for citing)
SSN	XXX-XX-XXXX	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Janice Sauppe	PreparerPersonNm
PTIN	P00014757	PTIN
Phone	6085342122	PhoneNum
Preparation	2023-05-22	PreparationDt
Self Employed	Yes (X)	SelfEmployedInd

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	0	TrustedCustomerCd
OOB Security Verification	00	OOBSecurityVerificationCd
Authentication Assurance Level	AAL2	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2022	TaxYr
Build TS	2023-04-26 12:10:37Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Stephen Evans	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	29000 Center Ridge Rd	AddressLine1Txt
City	Westlake	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44145	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$285,704	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c	Yes (X)	Organization501cInd
Website Address	N/A	WebsiteAddressTxt
Type Of Organization Assoc	Yes (X)	TypeOfOrganizationAssocInd
Formation	1981	FormationYr
Legal Domicile State	OH	LegalDomicileStateCd
Activity Or Mission	Continuing Medical Education to keep doctors up to date on medical issues	ActivityOrMissionDesc
Voting Members Governing Body	9	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	0	TotalEmployeeCnt
Total Volunteers	57	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$185,894	PYContributionsGrantsAmt
CY Contributions Grants	$49,271	CYContributionsGrantsAmt
CY Program Service Revenue	$0	CYProgramServiceRevenueAmt
PY Investment Income	$77,887	PYInvestmentIncomeAmt
CY Investment Income	$15,489	CYInvestmentIncomeAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$263,781	PYTotalRevenueAmt
CY Total Revenue	$64,760	CYTotalRevenueAmt
PY Grants And Similar Paid	$5,110	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$4,572	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$13,911	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$18,682	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$130,500	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$116,000	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$45,540	PYOtherExpensesAmt
CY Other Expenses	$24,972	CYOtherExpensesAmt
PY Total Expenses	$195,061	PYTotalExpensesAmt
CY Total Expenses	$164,226	CYTotalExpensesAmt
PY Revenues Less Expenses	$68,720	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$99,466	CYRevenuesLessExpensesAmt
Total Assets BOY	$815,139	TotalAssetsBOYAmt
Total Assets EOY	$658,585	TotalAssetsEOYAmt
Total Liabilities EOY	$0	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$815,139	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$658,585	NetAssetsOrFundBalancesEOYAmt
Mission	Continuing Medical Education to keep doctors up to date on medical issues	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$37,478	ExpenseAmt
Desc	Ongoing medical training and conferencing for hospital medical staff	Desc
Total Program Service Expenses	$37,478	TotalProgramServiceExpensesAmt
Described In Section501c3	false	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Donor Rstr Or Quasi Endowments	false	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	false	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	false	ReportOtherLiabilitiesInd
Include FIN48 Footnote	false	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	false	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	false	OperateHospitalInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	false	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	false	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	false	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	8	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	0	EmployeeCnt
Unrelated Bus Incm Over Limit	false	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	false	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	false	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	9	GoverningBodyVotingMembersCnt
Independent Voting Member	9	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	Yes (true)	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	false	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	false	ConflictOfInterestPolicyInd
Whistleblower Policy	false	WhistleblowerPolicyInd
Document Retention Policy	false	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	Stephen Evans	PersonNm
Phone	4408275536	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	29000 Center Ridge Rd	AddressLine1Txt
City	Westlake	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44145	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt
Stephen Evans
President	10.00	0.00	Yes (X)	Yes (X)	$50,000	$0	$0
Christopher Reese
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
M Hazem Nouraldin
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
John Coletta
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
Gregory Bloxdorf
Vice President	5.00	0.00	Yes (X)	Yes (X)	$12,000	$0	$0
Mehrun Elyaderani
Dept Chair	5.00	0.00	Yes (X)		$11,000	$0	$0
Andrew Filiatraut
SecretaryTreasurer	5.00	0.00	Yes (X)	Yes (X)	$6,000	$0	$0
Irwin Mandell
Dept Chair	5.00	0.00	Yes (X)		$1,000	$0	$0
Robert Stern
Immediate Past President	10.00	0.00	Yes (X)	Yes (X)	$0	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$116,000	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$0	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	0	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	false	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd
Membership Dues	$8,438	MembershipDuesAmt
Related Organizations	$40,833	RelatedOrganizationsAmt
Total Contributions	$49,271	TotalContributionsAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$20,262	TotalRevenueColumnAmt
Related Or Exempt Func Income	$20,262	RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$216,171	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$220,944	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	-$4,773	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$4,773	TotalRevenueColumnAmt
Related Or Exempt Func Income	-$4,773	RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$64,760	TotalRevenueColumnAmt
Related Or Exempt Func Income	$15,489	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$4,572	TotalAmt
Program Services	$4,572	ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$18,682	TotalAmt
Program Services	$18,682	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$116,000	TotalAmt
Management And General	$116,000	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$595	TotalAmt
Management And General	$595	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$6,050	TotalAmt
Management And General	$6,050	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$300	TotalAmt
Management And General	$300	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$14,224	TotalAmt
Program Services	$14,224	ProgramServicesAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDesc	TotalTotalAmt	Management And GeneralManagementAndGeneralAmt
Gifts	$2,803	$2,803
Honorariums	$1,000	$1,000

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$164,226	TotalAmt
Program Services	$37,478	ProgramServicesAmt
Management And General	$126,748	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$149,676	BOYAmt
EOY	$35,654	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$665,463	BOYAmt
EOY	$622,931	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$815,139	BOYAmt
EOY	$658,585	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$815,139	BOYAmt
EOY	$658,585	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$815,139	BOYAmt
EOY	$658,585	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$815,139	BOYAmt
EOY	$658,585	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	-$99,466	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$57,088	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	false	FSAuditedInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

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)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Officer directors etc family relationship Part VI line 2	Officers, trustees, etc. may consult and work together on patient care but there is no family or direct business relationships
Organizational document changes Part VI line 4	Bylaws were voted on and revised during 2021. Revision is attached as pdf file.
Member election for additional members Part VI line 7a	All officers and department chairs are elected by the general membership by paper ballot
Governing body decisions Part VI line 7b	All governing decisions are voted upon by the membership and must have a majority approval to pass.
Form 990 governing body review Part VI line 11	A complete copy of the 990 is available for review by all members of the governing body before the return is filed.
Governing documents etc available to public Part VI line 19	These documents are available upon request
General explanation attachment	Monitoring of donations - receipts are kept and all disbursements approved in advance for any donations made.