2020-02-14T12:57:51-06:00 2019-03-31 MICHAEL BERRY CPA PO BOX 5045 CULVER CITY CA 90230 990 2018-04-01 462730379 PATIENT SAFETY MOVEMENT FOUNDATION PATI 8772360279 15776 LAGUNA CANYON ROAD IRVINE CA 92618 MICAH YOUNG TREASURER 8772360279 2020-02-14 1 MICHAEL BERRY P00179412 3107454027 X 23.241.196.243 2020-02-14 12:56:35 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F0D1D7F3213C11ECE9BDE5D4E232E99CC46FDEA6 2018 2020-09-22 18:59:49Z DAVID MAYER 15776 LAGUNA CANYON ROAD IRVINE CA 92618 2714056 0 X HTTP://PATIENTSAFETYMOVEMENT.ORG/ X 2013 DE 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. 13 13 12 181 0 0 3993870 2545707 124762 163310 0 2008 0 -5533 4118632 2705492 85000 25000 0 0 315668 460491 16725 18433 111454 2382226 2829161 2799619 3333085 1319013 -627593 2087755 1313186 225162 78186 1862593 1235000 X 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. 0 0 2905034 25000 163310 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. 2905034 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 18 0 1 12 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA DE X BARNETT & COMPANY 9492163458 30212 TOMAS SUITE 200 RANCHO SANTA MARGARITA CA 92688 X JOE E KIANI CHAIRMAN, DIRECTOR 2.50 0.50 X X 0 0 0 MICHAEL AE RAMSAY MD DIRECTOR 1.00 X 0 0 0 DAVID MAYER MD SEE SCH O 1.00 X X 0 0 0 CHARLES MICELI DIRECTOR 0.50 X 0 0 0 ROBIN BETTS DIRECTOR 0.50 X 0 0 0 JIM MESSINA DIRECTOR 0.25 X 0 0 0 STEVEN BARKER MD PHD DIRECTOR 3.00 X 0 0 0 ALICIA COLE DIRECTOR 0.25 X 0 0 0 OMAR ISHRAK DIRECTOR 0.25 X 0 0 0 JANNICKE MELLIN-OLSEN MD DIRECTOR 1.00 X 0 0 0 TAMI MINNIER DIRECTOR 0.25 X 0 0 0 PETER PRONOVOST START SEPT 2018 DIRECTOR 0.10 X 0 0 0 MIKE DURKIN START MAY 2018 DIRECTOR 0.00 X 0 0 0 ARIANA LONGLEY SEE SCH O 40.00 X 108855 0 8034 DAVID VAN RAMSHORST LEFT MAY 2018 ASST SECRETARY & TREASURER 3.00 0.75 X 0 0 0 MICAH YOUNG TREASURER 0.25 0.10 X 0 0 0 TOM MCCLENAHAN LEFT MAY 2018 SECRETARY 0.50 0.05 X 0 0 0 RACHEL RAYNES START MAY 2018 SECRETARY 0.40 X 0 0 0 108855 0 8034 1 0 0 0 STUNGUN PRODUCTIONS INC 1793 LAFAYETTE STREET 100 SANTA CLARA CA 95050 EVENT PRODUCTION 605443 LYON & ASSOCIATES 3366 N TORREY PINES COURT 110 LA JOLLA CA 92037 VIDEO PRODUCTION 300651 CREATIVE CIRCLE LLC PO BOX 74008799 CHICAGO IL 606748799 PUBLICITY 153520 3 29923 2515784 2545707 CONFERENCE 611600 163310 163310 163310 2008 2008 3031 29923 8564 -5533 -5533 2705492 163310 0 -3525 X 25000 25000 122079 85455 30520 6104 257297 188190 38474 30633 48611 36816 8767 3028 32504 23439 6258 2807 9407 9407 35350 35350 18433 18433 124185 60599 13245 50341 15000 15000 65410 65410 382688 363228 19460 98351 98351 33843 33843 2013 2013 PRODUCTION 1078981 1078981 VENUE 333662 333662 PUBLICITY 277575 277575 INCENTIVES RE PROGRESS 200000 200000 172696 118738 53850 108 3333085 2905034 316597 111454 1852112 157375 34008 1000000 106100 51825 46997 119207 44401 77718 74806 2087755 1313186 225162 78186 225162 78186 X 1862593 1235000 1862593 1235000 2087755 1313186 -627593 0 X 0 1 X 1 0 X 1818974 3128240 2327724 3993870 2545707 13814515 1818974 3128240 2327724 3993870 2545707 13814515 4478110 9336405 2008 2008 13816523 501147 0.67570 0.52300 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 119207 44401 74806 74806 X 3050773 336717 8564 345281 2705492 0 2705492 3678366 336717 8564 345281 3333085 0 3333085 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. 1 SOUTH ASIA 0 0 GRANTMAKING GRANTMAKING 25000 0 0 0 0 0 0 25000 0 25000 SOUTH ASIA FUND THE PURCHASE, EQUIPPING, STAFFING OF AN AMBULANCE TO SERVE INJURED ANIMALS IN INDIA. 25000 WIRE TRANSFER 1 0 0 0 0 0 0 PART I, LINE 2: 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. X X X 1 PEN TO PAPER GRANT CONSULTING INC 35540 CHANTILLY COURT WINCHESTER CA 92596 CONSULTING AND GRANT WRITING 0 0 18433 -18433 18433 -18433 CA SOCCER TOURNAMENT 32954 29923 3031 8564 32954 29923 3031 8564 8564 -5533 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. 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 MASIMO CORPORATION 52 DISCOVERY IRVINE CA 92618 330368882 NON-INVASIVE MEDICAL DEVICES DE C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 MASIMO CORPORATION C 105550 CASH MASIMO CORPORATION C 176108 SEE PART VII 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).