MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization: MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL (EIN 34-1663333)
Tax period: 2019-01-01 to 2019-12-31
Filed: 2020-08-19
IRS object ID: 202022329349301337
Schema version: 2019v5.1
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 D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2020-08-19T17:19:33-04:00	ReturnTs
Tax Period End	2019-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Sauppe 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	2019-01-01	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	2020-08-12	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Janice Sauppe	PreparerPersonNm
PTIN	P00014757	PTIN
Phone	6085342122	PhoneNum
Preparation	2020-08-19	PreparationDt
Self Employed	Yes (X)	SelfEmployedInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	156.146.50.134	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2020-08-19	IPDt
IP Tm	17:20:27	IPTm
Federal Original Submission Id	3450262020232psq0bih	FederalOriginalSubmissionId
Federal Original Submission Id	2020-08-19	FederalOriginalSubmissionIdDt
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	82BC287C1A18061EA0CEC8D102BE6C3BB08AAE76	AtSubmissionCreationDeviceId
At Submission Filing Device Id	82BC287C1A18061EA0CEC8D102BE6C3BB08AAE76	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2019	TaxYr
Build TS	2020-09-23 17:36:50Z	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	$410,185	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	145	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$167,105	PYContributionsGrantsAmt
CY Contributions Grants	$151,381	CYContributionsGrantsAmt
CY Program Service Revenue	$0	CYProgramServiceRevenueAmt
PY Investment Income	$32,811	PYInvestmentIncomeAmt
CY Investment Income	$26,809	CYInvestmentIncomeAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$199,916	PYTotalRevenueAmt
CY Total Revenue	$178,190	CYTotalRevenueAmt
PY Grants And Similar Paid	$8,047	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$3,169	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$21,892	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$21,216	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$134,000	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$159,000	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$43,058	PYOtherExpensesAmt
CY Other Expenses	$41,887	CYOtherExpensesAmt
PY Total Expenses	$206,997	PYTotalExpensesAmt
CY Total Expenses	$225,272	CYTotalExpensesAmt
PY Revenues Less Expenses	-$7,081	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$47,082	CYRevenuesLessExpensesAmt
Total Assets BOY	$657,115	TotalAssetsBOYAmt
Total Assets EOY	$674,299	TotalAssetsEOYAmt
Total Liabilities EOY	$0	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$657,115	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$674,299	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	$51,155	ExpenseAmt
Desc	Ongoing medical training and conferencing for hospital medical staff	Desc
Total Program Service Expenses	$51,155	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	9	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	false	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 (11 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
Robert Stern
Immediate Past President	10.00	0.00	Yes (X)	Yes (X)	$29,167	$0	$0
Gregory Bloxdorf
Vice President	5.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Mehrun Elyaderani
SecretaryTreasurer	5.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
John Coletta
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
Richard Below
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
Christopher Reese
Dept Chair	5.00	0.00	Yes (X)		$11,000	$0	$0
Hazem Nouraldin
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
Irwin Mandell
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
Michelle Belardo
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0
Stephen Evans
President	10.00	0.00	Yes (X)	Yes (X)	$46,833	$0	$0
Melanie Stempowski
Dept Chair	5.00	0.00	Yes (X)		$12,000	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$159,000	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	$84,381	MembershipDuesAmt
Related Organizations	$67,000	RelatedOrganizationsAmt
Total Contributions	$151,381	TotalContributionsAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$18,360	TotalRevenueColumnAmt
Related Or Exempt Func Income	$18,360	RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$240,444	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$231,995	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$8,449	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$8,449	TotalRevenueColumnAmt
Related Or Exempt Func Income	$8,449	RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$178,190	TotalRevenueColumnAmt
Related Or Exempt Func Income	$26,809	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$3,169	TotalAmt
Program Services	$3,169	ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$21,216	TotalAmt
Program Services	$21,216	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$159,000	TotalAmt
Management And General	$159,000	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$550	TotalAmt
Management And General	$550	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$5,456	TotalAmt
Management And General	$5,456	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$388	TotalAmt
Management And General	$388	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$26,770	TotalAmt
Program Services	$26,770	ProgramServicesAmt

Other Expenses OtherExpensesGrp

Field	Value	IRS element (for citing)
Desc	Gifts	Desc
Total	$8,723	TotalAmt
Management And General	$8,723	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$225,272	TotalAmt
Program Services	$51,155	ProgramServicesAmt
Management And General	$174,117	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$82,819	BOYAmt
EOY	$89,780	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$474,682	BOYAmt
EOY	$564,464	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$99,614	BOYAmt
EOY	$20,055	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$657,115	BOYAmt
EOY	$674,299	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	$657,115	BOYAmt
EOY	$674,299	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$657,115	BOYAmt
EOY	$674,299	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$657,115	BOYAmt
EOY	$674,299	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	-$47,082	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$64,266	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 D IRS990ScheduleD

Other Assets Org OtherAssetsOrgGrp

Field	Value	IRS element (for citing)
Desc	Wells Fargo Bank CD	Desc
Book Value	$20,055	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$20,055	TotalBookValueOtherAssetsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 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
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.