MEDICAL STAFF OF CALIFORNIA PACIFIC MEDICAL CENTER: Form 990, tax year 2021
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- Organization
- MEDICAL STAFF OF CALIFORNIA PACIFIC MEDICAL CENTER (EIN 33-1223596)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-16
- IRS object ID
- 202221369349314837
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T19:13:36-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 680456197 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WASSERMAN KLEINFELD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 415 A STREET | AddressLine1Txt |
| City | PETALUMA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94952 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 331223596 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEDICAL STAFF OF CALIFORNIA | BusinessNameLine1Txt |
| Business Name Line2 | PACIFIC MEDICAL CENTER | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEDI | BusinessNameControlTxt |
| Phone | 5713340462 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3701 SACRAMENTO STREET 172 | AddressLine1Txt |
| City | SAN FRANCISCO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94118 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARIE L MCHENRY MD | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 5713340462 | PhoneNum |
| Signature | 2022-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MARIE | PersonFirstNm |
| Person Last | MCHENRY MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOAN GLENDENING CPA | PreparerPersonNm |
| PTIN | P01240145 | PTIN |
| Phone | 7077781320 | PhoneNum |
| Preparation | 2022-05-10 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ODED HERBSMAN MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3701 SACRAMENTO STREET 172 | AddressLine1Txt |
| City | SAN FRANCISCO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94118 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $886,835 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Assoc | Yes (X) | TypeOfOrganizationAssocInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | OVERSIGHT OF THE QUALITY OF CARE PROVIDED BY MEMBERS, ACCOMPLISHED THROUGH CREDENTIALING OF APPLICANTS AND MEMBERS, PEER REVIEW OF CARE, AND REPRESENTING THE INTERESTS OF MEMBERS IN RELATIONS WITH HOSPITAL ADMINISTRATION AND BOARD. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $481,943 | PYContributionsGrantsAmt |
| CY Contributions Grants | $458,970 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $54,145 | PYInvestmentIncomeAmt |
| CY Investment Income | $103,068 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $3,819 | CYOtherRevenueAmt |
| PY Total Revenue | $536,088 | PYTotalRevenueAmt |
| CY Total Revenue | $565,857 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $302,640 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $284,740 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $111,809 | PYOtherExpensesAmt |
| CY Other Expenses | $161,853 | CYOtherExpensesAmt |
| PY Total Expenses | $414,449 | PYTotalExpensesAmt |
| CY Total Expenses | $446,593 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $121,639 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $119,264 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,564,757 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,664,364 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $80,148 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $73,812 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,484,609 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,590,552 | NetAssetsOrFundBalancesEOYAmt |
| Mission | OVERSIGHT OF THE QUALITY OF CARE PROVIDED BY MEMBERS, ACCOMPLISHED THROUGH CREDENTIALING OF APPLICANTS AND MEMBERS, PEER REVIEW OF CARE, AND REPRESENTING THE INTERESTS OF MEMBERS IN RELATIONS WITH HOSPITAL ADMINISTRATION AND BOARD. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Desc | PROMOTE AND MAINTAIN HIGH QUALITY PATIENT CARE THAT IS COMMENSURATE WITH AVAILABLE RESOURCES FOR ALL PATIENTS TREATED IN ANY FACILITIES OR SERVICES OF THE HOSPITAL, WHILE SERVING AS THE PATIENT ADVOCATE AT ALL LEVELS OF CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MAINTAIN AND IMPROVE THE QUALITY OF CARE RENDERED AND PROVIDE OVERSIGHT OF CARE, TREATMENT, AND SERVICES PROVIDED BY ALL PRACTITIONERS AUTHORIZED TO PRACTICE IN THE HOSPITAL THROUGH AN APPROPRIATE DELINEATION OF CLINICAL PRIVELEGES AND THROUGH UNIFORM AND ONGOING REVIEW AND EVALUATION OF EACH PRACTITIONER'S PERFORMANCE IN THE HOSPITAL. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROVIDE AN EDUCATIONAL SETTING TO MAINTAIN SCIENTIFIC STANDARDS, FURTHER MEDICAL EDUCATION AND CLINICAL INVESTIGATION, AND LEAD TO CONTINUOUS ADVANCEMENT IN PROFESSIONAL KNOWLEDGE AND SKILL. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | Yes (1) | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 24 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOAN GLENDENING CPA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7077781320 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 415A STREET | AddressLine1Txt |
| City | PETALUMA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94952 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| ROBERT J MARGOLIN MD | ||||||
| CHIEF OF STAFF | 15.00 | Yes (X) | Yes (X) | $125,000 | $0 | $0 |
| ODED HERBSMAN MD | ||||||
| VICE CHIEF OF STAFF | 7.00 | Yes (X) | Yes (X) | $50,000 | $0 | $0 |
| THOMAS PEITZ MD | ||||||
| TREASURER | 5.00 | Yes (X) | Yes (X) | $25,000 | $0 | $0 |
| NOBL BARAZANGI MD | ||||||
| SECRETARY | 5.00 | Yes (X) | Yes (X) | $25,000 | $0 | $0 |
| BRIAN T ANDREWS MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $5,700 | $0 | $0 | |
| STEVEN REIDBORD MD | ||||||
| CME COMMITTEE CHAIR | 5.00 | Yes (X) | $6,240 | $0 | $0 | |
| ROBERT KLETT MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $6,300 | $0 | $0 | |
| ARAVIND MANI MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $6,000 | $0 | $0 | |
| RYAN DOUGHERTY MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $5,100 | $0 | $0 | |
| STEFANI WEDL MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $6,300 | $0 | $0 | |
| GUY LUBLINER MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $5,400 | $0 | $0 | |
| APARAJITA SOHONI MD | ||||||
| PHYSICAL WELLNESS COMMITTE | 5.00 | Yes (X) | $7,000 | $0 | $0 | |
| WENDY ZACHARY MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $5,700 | $0 | $0 | |
| MARIE LA PENTA MCHENRY MD | ||||||
| DIRECTOR | 2.00 | Yes (X) | $6,000 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $284,740 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Membership Dues | $346,470 | MembershipDuesAmt |
| All Other Contributions | $112,500 | AllOtherContributionsAmt |
| Total Contributions | $458,970 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,973 | TotalRevenueColumnAmt |
| Exclusion | $20,973 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $364,892 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $282,797 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $82,095 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $82,095 | TotalRevenueColumnAmt |
| Exclusion | $82,095 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $42,000 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $38,181 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,819 | TotalRevenueColumnAmt |
| Exclusion | $3,819 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $565,857 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $106,887 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $284,740 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,570 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,108 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt |
|---|---|
| REAPPT FEES | $57,560 |
| PHYSICIAN EVENTS/MEETIN | $35,166 |
| GIFTS/FLOWERS | $28,900 |
| INVESTMENT EXPENSES AND | $7,480 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,069 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446,593 | TotalAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,537 | BOYAmt |
| EOY | $187,785 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,783 | BOYAmt |
| EOY | $10,553 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,887 | BOYAmt |
| EOY | $21,150 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,171 | BOYAmt |
| EOY | $1,000 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,137,379 | BOYAmt |
| EOY | $1,443,876 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,564,757 | BOYAmt |
| EOY | $1,664,364 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,076 | BOYAmt |
| EOY | $73,812 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,148 | BOYAmt |
| EOY | $73,812 | 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 | $1,484,609 | BOYAmt |
| EOY | $1,590,552 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,484,609 | BOYAmt |
| EOY | $1,590,552 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,564,757 | BOYAmt |
| EOY | $1,664,364 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $119,264 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$13,321 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Political Expenditures | $0 | PoliticalExpendituresAmt |
| Volunteer Hours | 0 | VolunteerHoursCnt |
| Substantially All Dues Nonded | 0 | SubstantiallyAllDuesNondedInd |
| Only In House Lobbying | Yes (1) | OnlyInHouseLobbyingInd |
| Agree Carryover Prior Year | 0 | AgreeCarryoverPriorYearInd |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $42,000 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $42,000 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $34,633 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $3,548 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $42,000 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $42,000 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $34,633 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,548 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $38,181 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $3,819 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS CONSIST OF ALL LICENSED PHYSICIANS HOLDING EITHER M.D. OR D.O. DEGREES, DENTISTS, AND PODIATRISTS WHO ARE PRIVILEGED TO ADMIT, TREAT, OR CONSULT ON PATIENTS IN CALIFORNIA PACIFIC MEDICAL CENTER HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | ALL ACTIVE STAFF MEMBERS HAVE THE PREROGATIVE TO VOTE ON MATTERS PRESENTED AT GENERAL AND SPECIAL MEETINGS OF THE MEDICAL STAFF, INCLUDING ELECTION OF OFFICERS AND MEMBERS AT LARGE. PODIATRISTS AND DENTISTS SHALL NOT VOTE ON ANY OF THOSE MATTERS BEYOND THE SCOPE OF THEIR LICENSURE. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE 990 IS PROVIDED TO THE TREASURER OF THE ORGANIZATION FOR REVIEW AND SIGNATURE, PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 15B | OFFICER STIPENDS ARE DETERMINED BY THE BOARD COMPENSATION COMMITTEE IN ITS ANNUAL MEETING. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST. |