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MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL (EIN 34-1663333)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-05-27
IRS object ID
202201479349300705
Schema version
2021v4.2
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

FieldValueIRS element (for citing)
Return2022-05-27T09:30:41-04:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Saupp Tax Service LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1P O Box 245AddressLine1Txt
CityTrempealeauCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54661ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN341663333EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Medical Staff of St John Westshore HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMEDIBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1Txt
CityWestlakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44145ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonStephen EvansPersonNm
Person TitlePresidentPersonTitleTxt
Phone4408275536PhoneNum
Signature2022-05-11SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstStephenPersonFirstNm
Person LastEvansPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJanice SauppePreparerPersonNm
PTINP00014757PTIN
Phone6085342122PhoneNum
Preparation2022-05-27PreparationDt
Self EmployedYes (X)SelfEmployedInd

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer0TrustedCustomerCd
OOB Security Verification00OOBSecurityVerificationCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerStephen EvansPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1Txt
CityWestlakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44145ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$514,251GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization AssocYes (X)TypeOfOrganizationAssocInd
Formation1981FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionContinuing Medical Education to keep doctors up to date on medical issuesActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers87TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$199,196PYContributionsGrantsAmt
CY Contributions Grants$185,894CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$15,773PYInvestmentIncomeAmt
CY Investment Income$77,887CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$214,969PYTotalRevenueAmt
CY Total Revenue$263,781CYTotalRevenueAmt
PY Grants And Similar Paid$4,355PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$5,110CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$13,499PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$13,911CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$134,000PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$130,500CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$15,167PYOtherExpensesAmt
CY Other Expenses$45,540CYOtherExpensesAmt
PY Total Expenses$167,021PYTotalExpensesAmt
CY Total Expenses$195,061CYTotalExpensesAmt
PY Revenues Less Expenses$47,948PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$68,720CYRevenuesLessExpensesAmt
Total Assets BOY$772,457TotalAssetsBOYAmt
Total Assets EOY$815,139TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$772,457NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$815,139NetAssetsOrFundBalancesEOYAmt
MissionContinuing Medical Education to keep doctors up to date on medical issuesMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$32,102ExpenseAmt
DescOngoing medical training and conferencing for hospital medical staffDesc
Total Program Service Expenses$32,102TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document14IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsYes (true)ChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonStephen EvansPersonNm
Phone4408275536PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1Txt
CityWestlakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44145ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
Stephen Evans
President10.000.00Yes (X)Yes (X)$50,000$0$0
Christopher Reese
Dept Chair5.000.00Yes (X)$12,000$0$0
Hazem Nouraldin
Dept Chair5.000.00Yes (X)$12,000$0$0
Irwin Mandell
Dept Chair5.000.00Yes (X)$12,000$0$0
John Coletta
Dept Chair5.000.00Yes (X)$12,000$0$0
Melanie Stempowski
Dept Chair5.000.00Yes (X)$10,000$0$0
Kristin Klosterman
Dept Chair5.000.00Yes (X)$10,000$0$0
Richard Below
Dept Chair5.000.00Yes (X)$8,000$0$0
Gregory Bloxdorf
Vice President5.000.00Yes (X)Yes (X)$3,000$0$0
Andrew Filiatraut
SecretaryTreasurer5.000.00Yes (X)Yes (X)$1,500$0$0
Robert Stern
Immediate Past President10.000.00Yes (X)Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$130,500TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Membership Dues$130,741MembershipDuesAmt
Related Organizations$54,833RelatedOrganizationsAmt
All Other Contributions$320AllOtherContributionsAmt
Total Contributions$185,894TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,028TotalRevenueColumnAmt
Related Or Exempt Func Income$26,028RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$302,329SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$250,470SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$51,859SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$51,859TotalRevenueColumnAmt
Related Or Exempt Func Income$51,859RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$263,781TotalRevenueColumnAmt
Related Or Exempt Func Income$77,887RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,110TotalAmt
Program Services$5,110ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$13,911TotalAmt
Program Services$13,911ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$130,500TotalAmt
Management And General$130,500ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$580TotalAmt
Management And General$580ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$6,728TotalAmt
Management And General$6,728ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$26TotalAmt
Management And General$26ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$13,081TotalAmt
Program Services$13,081ProgramServicesAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmt
Gifts$18,325$18,325
Honorariums$6,800$6,800

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$195,061TotalAmt
Program Services$32,102ProgramServicesAmt
Management And General$162,959ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$151,932BOYAmt
EOY$149,676EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$620,525BOYAmt
EOY$665,463EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$772,457BOYAmt
EOY$815,139EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$772,457BOYAmt
EOY$815,139EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$772,457BOYAmt
EOY$815,139EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$772,457BOYAmt
EOY$815,139EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$68,720ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$26,038NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (17 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdIRC SectionIRCSectionDescCash GrantCashGrantAmtRecipient EINRecipientEINAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCd
ALS Association Northern Ohio Chapt
6155 Rockside Rd 403IndependenceOH44131501c3$250
Ohio Physicians Health Program
5900 Roche Dr Ste 440ColumbusOH43229501c3$500341817218
Epilepsy Association
2831 Prospect AveClevelandOH44115501c3$250
Humane Society of Erie County
1911 Superior StSanduskyOH44870501c3$250
Alzheimers Association
23215 Commerce ParkBeachwoodOH44122501c3$250
American Parkinson Disease Foundati
135 Parkinson AveStaten IslandNY10305501c3$250
The Emergency Assistance Center
9199 Olde 8 Road Suite CNorthfieldOH44067501c3$250
Doctors Without Borders
P O Box 5030HagerstownMD21741501c3$500
Circle Area Humane Society
P O Box 784CirclevilleOH43113501c3$250
Menorah Park
27100 Cedar RdBeachwoodOH44122$250
Ideastream WCLV
P O Box 74141ClevelandOH44194501c3$250
The Akanksha Education Fund
$500P O Box 2038New YorkONTARIOCAM4R1K8
Friends of Dartmouth Rowing
6066 Development OfficeHanoverNH03755$250
Our Lady of the Elms
1375 W Exchange StreetAkronOH44313$250
The Little Guild of Saint Francis
285 Sharon-Goshen TurnpikeWest CornwallCT06796$250
SJMC Auxiliary
29000 Center Ridge RdWestlakeOH44145$410
St John Westshore
29000 Center Ridge RdWestlakeOH44145$200

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Officer directors etc family relationship Part VI line 2Officers, 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 4Bylaws were voted on and revised during 2021. Revision is attached as pdf file.
Member election for additional members Part VI line 7aAll officers and department chairs are elected by the general membership by paper ballot
Governing body decisions Part VI line 7bAll governing decisions are voted upon by the membership and must have a majority approval to pass.
Form 990 governing body review Part VI line 11A 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 19These documents are available upon request
General explanation attachmentMonitoring of donations - receipts are kept and all disbursements approved in advance for any donations made.