2019-11-15T14:41:20-06:00 2018-12-31 951777440 GREEN HASSON & JANKS LLP 10990 WILSHIRE BLVD 16TH FLOOR LOS ANGELES CA 900243929 990 2018-01-01 475552178 PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION PACI 3105827450 2125 ARIZONA AVE SANTA MONICA CA 90404 DANIEL F KELLY MD CEO 3105827450 2019-11-13 1 LIZBETH G NEVAREZ P01399868 3108731600 38.186.35.254 2019-11-13 17:24:30 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E5821BB28F8D661E245324DF3223955FF902DF5B 2018 2020-03-31 21:24:44Z DANIEL F KELLY MD 2125 ARIZONA AVE SANTA MONICA CA 90404 3030620 0 X WWW.PACIFICNEUROSCIENCEINSTITUTE.ORG X 2015 CA TO FUNDAMENTALLY ADVANCE NEUROSCIENCE CLINICAL CARE THROUGH NOVEL TREATMENT APPROACHES THAT OPTIMIZE BRAIN HEALTH AND QUALITY OF LIFE, TO TRAIN THE NEXT GENERATION OF NEUROSCIENTISTS AND CLINICIANS, AND TO EDUCATE PATIENTS AND THE COMMUNITY AT LARGE ON VITAL NEUROSCIENCE ISSUES. 7 3 5 7 0 0 1266986 3003853 0 26685 74 82 0 0 1267060 3030620 96000 240000 0 0 59876 502307 0 0 112987 1097454 2301692 1253330 3043999 13730 -13379 576177 5515222 128968 236481 447209 5278741 X TO FUNDAMENTALLY ADVANCE NEUROSCIENCE CLINICAL CARE THROUGH NOVEL TREATMENT APPROACHES THAT OPTIMIZE BRAIN HEALTH AND QUALITY OF LIFE, TO TRAIN THE NEXT GENERATION OF NEUROSCIENTISTS AND CLINICIANS, AND TO EDUCATE PATIENTS AND THE COMMUNITY AT LARGE ON VITAL NEUROSCIENCE ISSUES. 0 0 2677901 240000 26685 SUPPORT OF THE EDUCATION AND COLLABORATION OF NEUROSCIENTISTS AND CLINICIANS REGARDING TECHNIQUES FOR THE OPTIMIZATION OF BRAIN HEALTH.EDUCATING AND INFORMING THE PUBLIC ABOUT NEW DEVELOPMENTS IN NEUROSCIENCE RESEARCH, TREATMENTS AND CLINICAL TRIALS.PRODUCTION OF EDUCATIONAL VIDEOS AND IMAGES TO ADVANCE AND EDUCATE THE PUBLIC AND CLINICIANS REGARDING NEW AND IMPROVED NEUROSCIENCE TECHNIQUES. 2677901 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 19 0 1 5 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 0 0 0 0 0 CA X HOWARD R KRAUSS MD 3105827450 2125 ARIZONA AVENUE SANTA MONICA CA 90404 DANIEL F KELLY MD PRESIDENT & CEO 10.00 2.00 X X 0 0 0 CHESTER F GRIFFITHS MD CHAIRPERSON 8.00 2.00 X X 0 0 0 HOWARD R KRAUSS MD CFO 3.00 1.00 X X 0 0 0 SANTOSH KESARI MD SECRETARY 4.00 1.00 X X 0 0 0 DONNA TUTTLE BOARD MEMBER 1.00 1.00 X 0 0 0 CAROLE SCHWARTZ BOARD MEMBER 1.00 1.00 X 0 0 0 JAE GOODMAN BOARD MEMBER 1.00 1.00 X 0 0 0 KARTER WHITE ADMINSTRATIVE DIRECTOR 40.00 0.00 X 112083 0 0 112083 0 0 1 0 0 0 PACIFIC NEUROSCIENCE INSTITUTE MEDICAL G 2125 ARIZONA AVENUE SANTA MONICA CA 90404 RESEARCH & ADMINSTRATIVE SERVICES 1758325 1 3003853 3003853 PROGRAM EVENT INCOME 900099 26685 26685 26685 82 82 3030620 26685 0 82 240000 240000 112083 74494 17530 20059 268121 178202 41935 47984 92773 61660 14510 16603 29330 19392 4635 5303 124415 124415 18509 18509 42086 34206 7669 211 2738 1820 428 490 20026 18842 701 483 77186 76182 495 509 43600 40045 1658 1897 1744 1369 215 160 10429 8743 1093 593 88709 59106 13806 15797 372 372 RESEARCH EXPENSE 1804440 1804440 DUES AND SUBSCRIPTIONS 26073 23197 1421 1455 COMMUNITY OUTREACH AND 22445 19943 1169 1333 MEDICAL RECORDS AND SUP 8789 8789 10131 7471 2550 110 3043999 2677901 253111 112987 110473 97458 20 0 109741 235713 0 10899 16400 498 0 15902 355943 217670 0 4937580 576177 5515222 68968 236481 60000 0 128968 236481 X 447209 341161 0 4937580 447209 5278741 576177 5515222 X -13379 -50509 4895420 X X 0 1 X 1 0 X 749455 1266968 3003853 5020276 749455 1266968 3003853 5020276 5020276 55 74 82 211 5020487 26658 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16400 498 15902 15902 BENEFICIAL INTEREST IN ASSETS HELD BY SJHCF 4937580 4937580 7926040 4895420 4895420 3030620 0 3030620 3043999 0 3043999 0 3043999 PART XI, LINE 2D - OTHER ADJUSTMENTS: BENEFICIAL INTEREST IN ASSETS HELD BY SJHCF 1 JOHN WAYNE CANCER INSTITUTE 2200 SANTA MONICA BLVD SANTA MONICA CA 90404 954291515 501(C)(3) 240000 RESEARCH SUPPORT 1 PART I, LINE 2: PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION MONITORS THE USE OF THE GRANTS THROUGH ONGOING COMMUNICATION WITH THE GRANTEE ORGANIZATION. PACIFIC NEUROSCIENCE INSTITUTE MEDICAL GROUP INC OWNED BY 4 OFFICERS OF THE FOUNDATION 1758325 THE ORGANIZATION CONTRACTED WITH PNIMG, INC. TO PROVIDE RESEARCH AND ADMINISTRATIVE SERVICES TO THE ORGANIZATION. 0 FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS AND DIRECTORS OF THE ORGANIZATION ARE ALSO: I) MEMBERS AND MANAGERS IN PACIFIC NEUROSCIENCE INSTITUTE, LLC; AND II) SHAREHOLDERS, OFFICERS AND DIRECTORS IN A PROFESSIONAL MEDICAL CORPORATION (PACIFIC NEUROSCIENCE INSTITUTE MEDICAL GROUP, INC.). FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS PACIFIC NEUROSCIENCE INSTITUTE, LLC AND SAINT JOHN'S HEALTH CENTER FOUNDATION FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE GOVERNING BODY OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS HAVE THE AUTHORITY TO APPROVE THE GOVERNING BODY'S DECISION TO FILL A VACANCY ON THE GOVERNING BODY IF SUCH VACANCY WAS CREATED BY REMOVAL OF A DIRECTOR, AND TO APPROVE THE AMENDMENT OF THE BY-LAWS. FORM 990, PART VI, SECTION A, LINE 8B THIS QUESTION IS NOT APPLICABLE SINCE THE ORGANIZATION HAS NO COMMITTEES FORMED. FORM 990, PART VI, SECTION B, LINE 11B AN ELECTRONIC COPY OF THE FORM 990 AND ITS SUPPORTING SCHEDULES WERE DISTRIBUTED TO THE ORGANIZATION'S GOVERNING BODY FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S GOVERNING BODY PERIODICALLY REVIEWS ACTIVITIES IN WHICH IT AND MEMBERS OF ITS GOVERNING BODY ARE PARTICIPATING TO ENSURE THAT ANY AND ALL ARRANGEMENTS (AND ESPECIALLY THOSE WHICH MAY APPEAR TO POSE A CONFLICT OF INTEREST) ARE PROPERLY DOCUMENTED AND REFLECT REASONABLE AND SUPPORTABLE ECONOMIC COMPONENTS SO AS TO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFITS OR EXCESS BENEFIT TRANSACTIONS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY AFFILIATE 4,895,420. FORM 990, PART XII, LINE 2C: PROCESS HAS NOT CHANGED FROM PRIOR YEAR. SAINT JOHN'S HEALTH CENTER FOUNDATION 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 956100079 NON-PROFIT/FUNDRAISING CA 501(C)(3) LINE 7 0 PACIFIC NEUROSCIENCE INSTITUTE LLC 11645 WILSHIRE BLVD 6TH FL LOS ANGELES CA 90064 472490586 MANAGEMENT/INVESTMENT CA N/A N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0