STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL (EIN 34-1663333)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-05-15
IRS object ID
201711359349300046
Schema version
2016v3.0
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

FieldValueIRS element (for citing)
Return2017-05-15T08:57:20-04:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN311505872PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Sauppe Tax Service LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line132650 Greenwood DrAddressLine1Txt
CityAvon LakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44012ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN341663333EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Medical Staff of St John Westshore HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMEDIBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1Txt
CityWestlakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44145ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRobert SternPersonNm
Person TitlePresidentPersonTitleTxt
Phone4408275536PhoneNum
Signature2017-05-05SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJanice SauppePreparerPersonNm
PTINP00014757PTIN
Phone4409333178PhoneNum
Preparation2017-05-15PreparationDt
Self EmployedYes (X)SelfEmployedInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address75.118.190.215IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-05-15IPDt
IP Tm08:58:35IPTm
Federal Original Submission Id34502620171351nsisp4FederalOriginalSubmissionId
Federal Original Submission Id2017-05-15FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id5094A727497E75AE7B4E03A96847C67D0537A4DFAtSubmissionCreationDeviceId
At Submission Filing Device Id5094A727497E75AE7B4E03A96847C67D0537A4DFAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts$631,182GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization AssocYes (X)TypeOfOrganizationAssocInd
Formation1981FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionContinuing Medical Education to keep doctors up to date on medical issuesActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers139TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$194,508PYContributionsGrantsAmt
CY Contributions Grants$200,850CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$36,411PYInvestmentIncomeAmt
CY Investment Income$67,389CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$230,919PYTotalRevenueAmt
CY Total Revenue$268,239CYTotalRevenueAmt
PY Grants And Similar Paid$13,334PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$5,835CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$19,730PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$21,356CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$134,000PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$145,167CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$16,370PYOtherExpensesAmt
CY Other Expenses$31,727CYOtherExpensesAmt
PY Total Expenses$183,434PYTotalExpensesAmt
CY Total Expenses$204,085CYTotalExpensesAmt
PY Revenues Less Expenses$47,485PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$64,154CYRevenuesLessExpensesAmt
Total Assets BOY$650,204TotalAssetsBOYAmt
Total Assets EOY$687,763TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$650,204NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$687,763NetAssetsOrFundBalancesEOYAmt
MissionContinuing Medical Education to keep doctors up to date on medical issuesMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$46,010ExpenseAmt
DescOngoing medical training and conferencing for hospital medical staffDesc
Total Program Service Expenses$46,010TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document10IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsYes (true)ChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonRobert Stern MDPersonNm
Phone4408275536PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1Txt
CityWestlakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44145ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
Robert Stern
President10.000.00Yes (X)Yes (X)$54,167$0$0
Dilip Narichania
Vice President5.000.00Yes (X)Yes (X)$0$0$0
Gregory Bloxdorf
Secretary Treasurer5.000.00Yes (X)Yes (X)$0$0$0
James H Myers
Dept Chair5.000.00Yes (X)$13,000$0$0
Jeffrey Christian
Dept Chair5.000.00Yes (X)$13,000$0$0
Matthew Kacir
Dept Chair5.000.00Yes (X)$13,000$0$0
John Coletta
Dept Chair5.000.00Yes (X)$1,000$0$0
Adnan Mournay
Immediate Past President5.000.00Yes (X)$0$0$0
Mehrun Elyaderani
Dept Chair5.000.00Yes (X)$13,000$0$0
John Wolf
Dept Chair5.000.00Yes (X)$1,000$0$0
Stephen Evans
Dept Chair5.000.00Yes (X)$13,000$0$0
Atul Hulyalkar
Dept Chair5.000.00Yes (X)$12,000$0$0
Nel Solymos
Dept Chair5.000.00Yes (X)$12,000$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$145,167TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Membership Dues$133,850MembershipDuesAmt
Related Organizations$67,000RelatedOrganizationsAmt
Total Contributions$200,850TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,401TotalRevenueColumnAmt
Related Or Exempt Func Income$8,401RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$421,931SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$362,943SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$58,988SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$58,988TotalRevenueColumnAmt
Related Or Exempt Func Income$58,988RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$268,239TotalRevenueColumnAmt
Related Or Exempt Func Income$67,389RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,835TotalAmt
Program Services$5,835ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$21,356TotalAmt
Program Services$21,356ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$145,167TotalAmt
Management And General$145,167ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$515TotalAmt
Management And General$515ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$704TotalAmt
Management And General$704ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,339TotalAmt
Management And General$1,339ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$18,819TotalAmt
Program Services$18,819ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescGifts to VolunteersDesc
Total$10,350TotalAmt
Management And General$10,350ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$204,085TotalAmt
Program Services$46,010ProgramServicesAmt
Management And General$158,075ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$172,599BOYAmt
EOY$150,147EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$362,943BOYAmt
EOY$422,597EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$114,662BOYAmt
EOY$115,019EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$650,204BOYAmt
EOY$687,763EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$650,204BOYAmt
EOY$687,763EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$650,204BOYAmt
EOY$687,763EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$650,204BOYAmt
EOY$687,763EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$64,154ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$26,595NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Other Assets Org OtherAssetsOrgGrp (5 entries)

DescDescBook ValueBookValueAmt
Ally Bank CD$24,702
Goldman Sachs CD$20,119
Ally Bank CD$20,037
Barclays Bank CD$25,039
Barclays Bank CD$25,122
FieldValueIRS element (for citing)
Total Book Value Other Assets$115,019TotalBookValueOtherAssetsAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdIRC SectionIRCSectionDescCash GrantCashGrantAmtRecipient EINRecipientEIN
St John Medical Center
29000 Center Ridge RdWestlakeOH44145501c3$1,985
Delaware Valley Ornithological Club
1314 Lenore RdJenkintownPA19046501c3$250237058391
Hospice of Western Reserve
300 E 185th StClevelandOH44114501c3$50341256377
McDougall Research Found for MS
P O Box 14039Santa RosaCA95402501c3$250820573876
Out Run Ovarian Cancer
P O Box 40332Bay VillageOH44140501c3$200
Westshore Ostepathic Foundation
29101 Health Campus Dr Ste 150WestlakeOH44145501c3$1,500341207772
R B I Club Scholarship Fund
8091 Humphrey Hill DrPainesvilleOH44077501c3$250
St Augustine Church
2486 West 14th StClevelandOH44113501c3$50208957171
St Emeric Church
1860 West 22nd StClevelandOH44113501c3$50
Veterans Inc
69 Grove StWorcesterMA01605501c3$250
Celebrate Westlake
36097 Westminster AveWestlakeOH44145501c3$500341703289
Ohio Physicians Health Program
5900 Roche Dr Ste 440ColumbusOH43229501c3$500341817218
FieldValueIRS element (for citing)
Total501c3 Org12Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceMonitoring procedures (Part I, line 2)FormAndLineReferenceDesc
ExplanationReceipts are kept for all donations madeExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Officer directors etc family relationship Part VI line 2Officers, trustees, etc. may consult and work together on patient care but there is no family or direct business relationships
Organizational document changes Part VI line 4The by-laws were not changed but the rules and regulations addendum to the by-laws were revised in 2015. Revised version is attached as pdf
Member election for additional members Part VI line 7aAll officers and department chairs are elected by the general membership by paper ballot
Governing body decisions Part VI line 7bAll governing decisions are voted upon by the membership and must have a majority approval to pass.
Form 990 governing body review Part VI line 11A 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 19These documents are available upon request