PATIENT SAFETY MOVEMENT FOUNDATION: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- PATIENT SAFETY MOVEMENT FOUNDATION (EIN 46-2730379)
- Tax period
- 2018-04-01 to 2019-03-31
- Filed
- 2020-02-14
- IRS object ID
- 202030459349301528
- Schema version
- 2018v3.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-02-14T12:57:51-06:00 | ReturnTs |
| Tax Period End | 2019-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MICHAEL BERRY CPA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5045 | AddressLine1Txt |
| City | CULVER CITY | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90230 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462730379 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PATIENT SAFETY MOVEMENT FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PATI | BusinessNameControlTxt |
| Phone | 8772360279 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15776 LAGUNA CANYON ROAD | AddressLine1Txt |
| City | IRVINE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92618 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICAH YOUNG | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 8772360279 | PhoneNum |
| Signature | 2020-02-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL BERRY | PreparerPersonNm |
| PTIN | P00179412 | PTIN |
| Phone | 3107454027 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 23.241.196.243 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-02-14 | IPDt |
| IP Tm | 12:56:35 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | F0D1D7F3213C11ECE9BDE5D4E232E99CC46FDEA6 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-09-22 18:59:49Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID MAYER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15776 LAGUNA CANYON ROAD | AddressLine1Txt |
| City | IRVINE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92618 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,714,056 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://PATIENTSAFETYMOVEMENT.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2013 | FormationYr |
| Legal Domicile State | DE | LegalDomicileStateCd |
| Activity Or Mission | THE PATIENT SAFETY MOVEMENT FOUNDATION (PSMF) IS COMMITTED TO WORKING WITH (CON SCH O) HOSPITALS, MEDICAL TECHNOLOGY COMPANIES, AND PATIENT ADVOCATES TO UNIFY THE HEALTHCARE ECOSYSTEM AND ELIMINATE THE MORE THAN 200,000 PREVENTABLE HOSPITAL DEATHS THAT OCCUR EVERY YEAR IN THE UNITED STATES AND 4.8 MILLION GLOBALLY BY 2020. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 12 | TotalEmployeeCnt |
| Total Volunteers | 181 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,993,870 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,545,707 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $124,762 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $163,310 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,008 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | -$5,533 | CYOtherRevenueAmt |
| PY Total Revenue | $4,118,632 | PYTotalRevenueAmt |
| CY Total Revenue | $2,705,492 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $85,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $25,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $315,668 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $460,491 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $16,725 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $18,433 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $111,454 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,382,226 | PYOtherExpensesAmt |
| CY Other Expenses | $2,829,161 | CYOtherExpensesAmt |
| PY Total Expenses | $2,799,619 | PYTotalExpensesAmt |
| CY Total Expenses | $3,333,085 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,319,013 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$627,593 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,087,755 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,313,186 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $225,162 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $78,186 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,862,593 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,235,000 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE PATIENT SAFETY MOVEMENT IS CONNECTING PEOPLE, IDEAS AND TECHNOLOGY TO CONFRONT THE LARGE SCALE PROBLEM OF MORE THAN 200,000 PREVENTABLE PATIENT DEATHS IN U.S. HOSPITALS AND 4,800,000 WORLDWIDE, EACH YEAR BY PROVIDING ACTIONABLE IDEAS AND INNOVATIONS THAT CAN (CON SCH O) TRANSFORM THE PROCESS OF CARE, DRAMATICALLY IMPROVE PATIENT SAFETY AND HELP ELIMINATE PATIENT PREVENTABLE DEATHS. WE ARE DOING THIS ONE SOLUTION, ONE COMMITMENT, ONE HOSPITAL, ONE ACT OF KINDNESS AND LOVE, AND ONE PATIENT AT A TIME. THE PSMF IS HELPING TO BREAK DOWN SILOS THAT EXIST BETWEEN HOSPITALS, HEALTHCARE TECHNOLOGY COMPANIES, PATIENT ADVOCATES, PATIENTS, THE GOVERNMENT AND ALL THE STAKEHOLDERS AFFECTED IN HEALTHCARE - ALL OF US. TOGETHER WE ARE PUSHING TOWARDS ZERO PREVENTABLE DEATHS BY 2020. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,905,034 | ExpenseAmt |
| Grant | $25,000 | GrantAmt |
| Revenue | $163,310 | RevenueAmt |
| Desc | ZERO PREVENTABLE DEATHS BY 2020 INITIATIVETO IMPACT THE PREVENTABLE DEATHS OCCURRING IN HOSPITALS ACROSS THE WORLD BY SUPPORTING EDUCATION, PROVIDING TOOLS, GENERATING AWARENESS ACROSS COMMUNITIES, AND ENCOURAGING PUBLIC COMMITMENTS FROM STAKEHOLDERS ACROSS THE WORLD TO IMPLEMENT ACTIONABLE SOLUTIONS. BUILDING ON LAST YEAR'S SUCCESS, PSMF GENERATED NEW HOSPITAL COMMITMENTS, HEALTHCARE TECHNOLOGY PLEDGES AND SOLUTIONS TO HELP REDUCE PREVENTABLE PATIENT DEATHS IN HOSPITALS BY 2020. PSMF CONTINUED TO EDUCATE AND BRING AWARENESS TO THE INITIATIVE DURING EVENTS AND MEETINGS THROUGHOUT THE YEAR (CON SCH O).ACCOMPLISHMENTS: SINCE INCEPTION OF THE PSMF MORE THAN 4,710 HOSPITALS AND HEALTHCARE ORGANIZATIONS HAVE PUBLICLY COMMITTED TO IMPLEMENT SAFETY SOLUTIONS THAT WILL SAVE LIVES THIS LAST YEAR WE ADDED 112 HOSPITALS TO OUR MOVEMENT. THESE COMMITMENTS REPRESENT EFFORTS THAT SAVED NEARLY 90,000 LIVES IN 2018 ALONE WITH A CUMULATIVE 273,077 LIVES SAVED SINCE INCEPTION. SIMILARLY, OVER 89 HEALTHCARE TECHNOLOGY COMPANIES HAVE NOW SIGNED THE OPEN DATA PLEDGE (6 ADDED THIS LAST YEAR) STATING THAT THEY WOULD NOT PROACTIVELY BLOCK CONNECTIONS FROM OTHER TECHNOLOGIES OR CHARGE FOR INFORMATION EXCHANGE WITH THE PURPOSE OF ALLOWING ACCESS TO THEIR PRODUCTS' OUTPUT DATA FOR THE IMPROVEMENT OF PATIENT SAFETY.THIS YEAR TWO NEW ACTIONABLE PATIENT SAFETY SOLUTIONS (APSS), WERE DISCUSSED ADDRESSING: -APSS #17: PATIENT SAFETY CURRICULUM FOR SCHOOLS -APSS #18: POST-OPERATIVE DELIRIUM IN OLDER ADULTSTHESE APSS ARE AVAILABLE FOR VIEWING AND DOWNLOAD: HTTP://PATIENTSAFETYMOVEMENT.ORG/APSS/PSMF ALSO PRODUCED FIVE SHORT-FORM DOCUMENTARIES DURING THE LAST YEAR, HIGHLIGHTING PREVENTABLE MEDICAL ERRORS AND HOW THEY IMPACT PATIENTS AND FAMILIES AS WELL AS FOUR DOCUMENTARIES HIGHLIGHTING HOW PROVIDERS CAN IMPLEMENT SOLUTIONS TO ENSURE THAT PREVIOUS TRAGEDIES DO NOT HAPPEN AGAIN. SINCE 2012, THE FOUNDATION HAS PRODUCED 29 FILMS SHARING THESE TRAGIC EVENTS WITH THE PUBLIC. THESE SHORT FILMS ARE FREELY AVAILABLE AT: YOUTUBE.COM/C/PATIENTSAFETYMOVEMENT.THE PSMF HAS ORGANIZED AND ACTIVATED A TOTAL OF 18 CLINICAL WORKGROUPS COVERING 34 SOLUTIONS AND TWO SPECIAL INTEREST WORKGROUPS (METRICS INTEGRITY AND TECHNOLOGY VETTING). SINCE LAST YEAR, TWO NEW WORKGROUPS WERE ACTIVATED COVERING THREE NEW TOPICS. PATIENT SAFETY CURRICULUM FOR SCHOOLS BECAME APSS #17 AND POST-OPERATIVE DELIRIUM IN OLDER ADULTS BECAME APSS #18. THE THIRD WAS A SUBAPSS UNDER MEDICATION SAFETY, RELATED TO DRUG SHORTAGES (APSS #3F). ALL 18 WORKGROUPS MEET VIRTUALLY THROUGHOUT THE YEAR TO UPDATE AND REVISE OF ALL 34 SOLUTIONS. IN ADDITIONAL WE ACTIVATED ONE NEW SPECIAL INTEREST WORKGROUP ADDRESSING HOW TO ADDRESS THE INCLUSION OF TECHNOLOGY WITHIN ALL OF OUR APSS TO ENSURE THE TECHNOLOGY IS BACKED BY SOLID EVIDENCE BEFORE BEING ADDED. THESE MULTI-DISCIPLINARY WORKGROUPS ARE MADE UP OF VOLUNTEER SUBJECT MATTER EXPERTS AND KEY OPINION LEADERS AS WELL AS INDUSTRY LEADERS AND PATIENT/FAMILY ADVOCATES. THE WORKGROUPS CONVENE VIRTUALLY TO ENSURE THAT THE PSMF APSS REMAIN CLINICALLY VALID AND THE WORKGROUPS WILL FUNCTION IN PERPETUITY.PSMF CONTINUED ITS THOUGHT LEADERSHIP ACTIVITIES THROUGH EARNED MEDIA PLACEMENT IN KEY MARKETS, SOCIAL MEDIA ACTIVITY, AND SPEAKING ENGAGEMENTS BEFORE LEADING HOSPITALS AND ORGANIZATIONS THROUGHOUT THE U.S., WITH THE GOAL OF SOLICITING MORE COMMITMENTS TO ACTION. | Desc |
| Total Program Service Expenses | $2,905,034 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | 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 | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | Yes (1) | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (1) | 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 |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 18 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 12 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | 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 | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | DE | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARNETT & COMPANY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9492163458 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30212 TOMAS SUITE 200 | AddressLine1Txt |
| City | RANCHO SANTA MARGARITA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92688 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 |
|---|---|---|---|---|---|---|---|
| JOE E KIANI | |||||||
| CHAIRMAN, DIRECTOR | 2.50 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MICHAEL AE RAMSAY MD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID MAYER MD | |||||||
| SEE SCH O | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHARLES MICELI | |||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| ROBIN BETTS | |||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| JIM MESSINA | |||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | ||
| STEVEN BARKER MD PHD | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| ALICIA COLE | |||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | ||
| OMAR ISHRAK | |||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | ||
| JANNICKE MELLIN-OLSEN MD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMI MINNIER | |||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | ||
| PETER PRONOVOST START SEPT 2018 | |||||||
| DIRECTOR | 0.10 | Yes (X) | $0 | $0 | $0 | ||
| MIKE DURKIN START MAY 2018 | |||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ARIANA LONGLEY | |||||||
| SEE SCH O | 40.00 | Yes (X) | $108,855 | $0 | $8,034 | ||
| DAVID VAN RAMSHORST LEFT MAY 2018 | |||||||
| ASST SECRETARY & TREASURER | 3.00 | 0.75 | Yes (X) | $0 | $0 | $0 | |
| MICAH YOUNG | |||||||
| TREASURER | 0.25 | 0.10 | Yes (X) | $0 | $0 | $0 | |
| TOM MCCLENAHAN LEFT MAY 2018 | |||||||
| SECRETARY | 0.50 | 0.05 | Yes (X) | $0 | $0 | $0 | |
| RACHEL RAYNES START MAY 2018 | |||||||
| SECRETARY | 0.40 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $108,855 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $8,034 | 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 |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| STUNGUN PRODUCTIONS INC | |||||
| 1793 LAFAYETTE STREET 100 | SANTA CLARA | CA | 95050 | EVENT PRODUCTION | $605,443 |
| LYON & ASSOCIATES | |||||
| 3366 N TORREY PINES COURT 110 | LA JOLLA | CA | 92037 | VIDEO PRODUCTION | $300,651 |
| CREATIVE CIRCLE LLC | |||||
| PO BOX 74008799 | CHICAGO | IL | 606748799 | PUBLICITY | $153,520 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $29,923 | FundraisingAmt |
| All Other Contributions | $2,515,784 | AllOtherContributionsAmt |
| Total Contributions | $2,545,707 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CONFERENCE | Desc |
| Business | 611600 | BusinessCd |
| Total Revenue Column | $163,310 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $163,310 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $163,310 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,008 | TotalRevenueColumnAmt |
| Exclusion | $2,008 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $3,031 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $29,923 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $8,564 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,533 | TotalRevenueColumnAmt |
| Exclusion | -$5,533 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,705,492 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $163,310 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$3,525 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,000 | TotalAmt |
| Program Services | $25,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,079 | TotalAmt |
| Program Services | $85,455 | ProgramServicesAmt |
| Management And General | $30,520 | ManagementAndGeneralAmt |
| Fundraising | $6,104 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,297 | TotalAmt |
| Program Services | $188,190 | ProgramServicesAmt |
| Management And General | $38,474 | ManagementAndGeneralAmt |
| Fundraising | $30,633 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,611 | TotalAmt |
| Program Services | $36,816 | ProgramServicesAmt |
| Management And General | $8,767 | ManagementAndGeneralAmt |
| Fundraising | $3,028 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,504 | TotalAmt |
| Program Services | $23,439 | ProgramServicesAmt |
| Management And General | $6,258 | ManagementAndGeneralAmt |
| Fundraising | $2,807 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,407 | TotalAmt |
| Management And General | $9,407 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,350 | TotalAmt |
| Management And General | $35,350 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,433 | TotalAmt |
| Fundraising | $18,433 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,185 | TotalAmt |
| Program Services | $60,599 | ProgramServicesAmt |
| Management And General | $13,245 | ManagementAndGeneralAmt |
| Fundraising | $50,341 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,410 | TotalAmt |
| Management And General | $65,410 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $382,688 | TotalAmt |
| Program Services | $363,228 | ProgramServicesAmt |
| Management And General | $19,460 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,351 | TotalAmt |
| Program Services | $98,351 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,843 | TotalAmt |
| Management And General | $33,843 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,013 | TotalAmt |
| Management And General | $2,013 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PRODUCTION | $1,078,981 | $1,078,981 |
| VENUE | $333,662 | $333,662 |
| PUBLICITY | $277,575 | $277,575 |
| INCENTIVES RE PROGRESS | $200,000 | $200,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,696 | TotalAmt |
| Program Services | $118,738 | ProgramServicesAmt |
| Management And General | $53,850 | ManagementAndGeneralAmt |
| Fundraising | $108 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,333,085 | TotalAmt |
| Program Services | $2,905,034 | ProgramServicesAmt |
| Management And General | $316,597 | ManagementAndGeneralAmt |
| Fundraising | $111,454 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,852,112 | BOYAmt |
| EOY | $157,375 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $34,008 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,000,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $106,100 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,825 | BOYAmt |
| EOY | $46,997 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $119,207 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $44,401 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,718 | BOYAmt |
| EOY | $74,806 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,087,755 | BOYAmt |
| EOY | $1,313,186 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,162 | BOYAmt |
| EOY | $78,186 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,162 | BOYAmt |
| EOY | $78,186 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,862,593 | BOYAmt |
| EOY | $1,235,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,862,593 | BOYAmt |
| EOY | $1,235,000 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,087,755 | BOYAmt |
| EOY | $1,313,186 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$627,593 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,818,974 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,128,240 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,327,724 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,993,870 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,545,707 | CurrentTaxYearAmt |
| Total | $13,814,515 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,818,974 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,128,240 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,327,724 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,993,870 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,545,707 | CurrentTaxYearAmt |
| Total | $13,814,515 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $4,478,110 | SubstantialContributorsTotAmt |
| Public Support Total170 | $9,336,405 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $2,008 | CurrentTaxYearAmt |
| Total | $2,008 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $13,816,523 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $501,147 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.67570 | PublicSupportCY170Pct |
| Public Support PY170 | 0.52300 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $119,207 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,401 | DepreciationAmt |
| Book Value | $74,806 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $74,806 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $3,050,773 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $336,717 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $8,564 | OtherRevenueAmt |
| Revenue Not Reported | $345,281 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,705,492 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,705,492 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,678,366 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $336,717 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $8,564 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $345,281 | ExpensesNotReportedAmt |
| Expenses Subtotal | $3,333,085 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $3,333,085 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE FOUNDATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("IRC") EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. THE FOUNDATION IS RECOGNIZED BY THE FRANCHISE TAX BOARD AS HAVING TAX EXEMPT STATUS UNDER SECTION 23701(D) OF THE CALIFORNIA REVENUE AND TAXATION CODE. THE FOUNDATION HAD NO UNRECOGNIZED TAX BENEFITS OR LIABILITIES AS OF MARCH 31, 2019 AND 2018. FOR PURPOSES OF THE ABOVE TAX PROVISION FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS, PATIENT SAFETY MOVEMENT FOUNDATION (PSMF) IS REFERRED TO AS "THE FOUNDATION." |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | EXPENSES FROM FUNDRAISER NETTED ON FORM 990 8,564. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | EXPENSES FROM FUNDRAISER NETTED ON FORM 990 8,564. |
Schedule F IRS990ScheduleF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | SOUTH ASIA | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 0 | EmployeeCnt |
| Type Of Activities Conducted | GRANTMAKING | TypeOfActivitiesConductedTxt |
| Specific Services Provided | GRANTMAKING | SpecificServicesProvidedTxt |
| Region Total Expenditures | $25,000 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continuation Total Office | 0 | ContinuationTotalOfficeCnt |
| Continuation Total Employee | 0 | ContinuationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $25,000 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $25,000 | TotalSpentAmt |
Grants To Org Outside US GrantsToOrgOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | SOUTH ASIA | RegionTxt |
| Purpose Of Grant | FUND THE PURCHASE, EQUIPPING, STAFFING OF AN AMBULANCE TO SERVE INJURED ANIMALS IN INDIA. | PurposeOfGrantTxt |
| Cash Grant | $25,000 | CashGrantAmt |
| Manner Of Cash Disbursement | WIRE TRANSFER | MannerOfCashDisbursementTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THIS IS A ONE TIME GRANT TO SUPPORT THE PROCUREMENT, EQUIPPING AND STAFFING OF AN AMBULANCE. THE GRANTEE WILL REPORT BACK TO PSMF UPON COMPLETION OF THE PURCHASE, EQUIPPING AND STAFFING. | ExplanationTxt |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEN TO PAPER GRANT CONSULTING INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 35540 CHANTILLY COURT | AddressLine1Txt |
| City | WINCHESTER | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92596 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | CONSULTING AND GRANT WRITING | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $18,433 | RetainedByContractorAmt |
| Net To Organization | -$18,433 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $18,433 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$18,433 | TotalNetToOrganizationAmt |
| Licensed States | CA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | SOCCER TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $32,954 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $29,923 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $3,031 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $8,564 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $32,954 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $29,923 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $3,031 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $8,564 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $8,564 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$5,533 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART V, LINE 2(A): | ALL PAYROLL AND RELATED EMPLOYER COSTS FOR PSMF'S EMPLOYEES ARE PROCESSED THROUGH A THIRD PARTY PROFESSIONAL EMPLOYER ORGANIZATION (PEO) AND PAID/REIMBURSED BY PSMF. |
| FORM 990, PART VI, SECTION A, LINE 2 | DIRECTOR JOE KIANI IS AN OFFICER AND DIRECTOR OF MASIMO CORPORATION; TREASURER MICAH YOUNG IS AN OFFICER OF MASIMO CORPORATION; SECRETARY TOM MCCLENAHAN (WHO SERVED UNTIL MAY 2018) IS EMPLOYED BY MASIMO CORPORATION; ASSISTANT SECRETARY AND TREASURER DAVID VAN RAMSHORST (WHO SERVED UNTIL MAY 2018) IS EMPLOYED BY MASIMO CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 WAS REVIEWED BY PSMF MANAGEMENT AND REPRESENTATIVES, INCLUDING ITS CHIEF OPERATING OFFICER, TREASURER, AND CERTAIN ACCOUNTING & TAX PERSONNEL OF MASIMO CORPORATION, AS WELL AS THE MEMBERS OF ITS BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ON AN ANNUAL BASIS, ALL BOARD MEMBERS AND OFFICERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY STATMENT STATING THEY HAVE READ THE CONFLICT OF INTEREST POLICY AND HAVE DISCLOSED ALL KNOWN CONFLICTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | ARIANA LONGLEY'S (WHO SERVED AT DIFFERENT TIMES OF THE YEAR AS EXECUTIVE DIRECTOR AND VICE PRESIDENT) COMPENSATION WAS DETERMINED BASED ON NEGOTIATIONS SHE HAD WITH THE BOARD CHAIR BEFORE SHE BECAME AN OFFICER. |
| FORM 990, PART VI, SECTION C, LINE 19 | PSMF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| PART VII, SECTION A | DAVID MAYER SERVED AS A DIRECTOR FOR THE FULL YEAR. IN JANUARY, 2019, HE ALSO BECAME THE CEO. ARIANA LONGLEY SERVED AS VICE PRESIDENT FROM APRIL-AUGUST 2018; SERVED AS EXECUTIVE DIRECTOR FROM SEPTEMBER- DECEMBER 2018; SERVED AS CHIEF OPERATING OFFICER STARTING JANUARY 2019 THROUGH THE END OF YEAR. SHE ALSO SERVED AS ASSISTANT TREASURER SINCE MAY 2018. |
| FORM 990, PART IX, LINE 11G | DESIGN AND EDITING: PROGRAM SERVICE EXPENSES 51,960. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,960. PAYROLL: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 13,245. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,245. FUNDRAISING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 6,691. TOTAL EXPENSES 6,691. RECRUITING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 43,650. TOTAL EXPENSES 43,650. PROGRAM-OTHER: PROGRAM SERVICE EXPENSES 8,639. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,639. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| THE MASIMO FOUNDATION FOR ETHICS INNOVATION AND COMPETITION IN HEALTHCARE | |||||||||
| 52 DISCOVERY | IRVINE | CA | 92618 | 010956020 | GRANT MAKING | DE | 501(C)(3) | N/A | 0 |
| PATIENT SAFETY MOVEMENT COALITION INCORPORATED | |||||||||
| 52 DISCOVERY | IRVINE | CA | 92618 | 463194443 | ADVOCACY | DE | 501(C)(4) | N/A | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MASIMO CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 52 DISCOVERY | AddressLine1Txt |
| City | IRVINE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92618 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330368882 | EIN |
| Primary Activities | NON-INVASIVE MEDICAL DEVICES | PrimaryActivitiesTxt |
| Legal Domicile State | DE | LegalDomicileStateCd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MASIMO CORPORATION | ||
| C | $105,550 | CASH |
| MASIMO CORPORATION | ||
| C | $176,108 | SEE PART VII |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCH R, PARTS II AND III | THE ORGANIZATIONS THAT HAVE BEEN LISTED IN PARTS II AND III HAVE COMMON DIRECTORS AND OFFICERS WITH PSMF EVEN THOUGH THEY DO NOT MEET THE DEFINITION OF "RELATED PARTY" PER THE FORM 990 INSTRUCTIONS. |
| SCH R, PART V, LINE 2 | MASIMO CORPORATION PROVIDED DONATED SPACE AND SERVICES AT AN ESTIMATED COST TO MASIMO CORPORATION OF $176,000. SUCH AMOUNT IS PART OF THE AMOUNT REFLECTED ON SCH D, PART XI, LINE 2(B). |