STRATEGY STUDIO / PUBLIC DATA EXPLORER

MEDICAL STAFF OF CALIFORNIA PACIFIC MEDICAL CENTER: Form 990, tax year 2024

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF CALIFORNIA PACIFIC MEDICAL CENTER (EIN 33-1223596)
Tax period
2024-01-01 to 2024-12-31
Filed
2025-11-12
IRS object ID
202523169349303072
Schema version
2024v5.2
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)
Return2025-11-12T10:04:35-06:00ReturnTs
Tax Period End2024-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN873710909PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HICKOK WATERMANBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12110 S BASCOM AVE STE 103AddressLine1Txt
CityCAMPBELLCityNm
State AbbreviationCAStateAbbreviationCd
ZIP950083299ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2024-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN331223596EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MEDICAL STAFF OF CALIFORNIABusinessNameLine1Txt
Business Name Line2PACIFIC MEDICAL CENTERBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlMEDIBusinessNameControlTxt
Phone5713340462PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13701 SACRAMENTO STREET 172AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94118ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonIAN JAFFEE MDPersonNm
Person TitleTREASURERPersonTitleTxt
Phone5713340462PhoneNum
Signature2025-11-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonERIC S HICKOKPreparerPersonNm
PTINP02469672PTIN
Phone4082658400PhoneNum
Preparation2025-11-12PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2024TaxYr
Build TS2025-03-06 01:10:19ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTOM PEITZ MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13701 SACRAMENTO STREET 172AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94118ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,261,697GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization AssocYes (X)TypeOfOrganizationAssocInd
Formation2012FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionOVERSIGHT OF THE QUALITY OF CARE PROVIDED BY MEMBERS, ACCOMPLISHED THROUGH CREDENTIALING OF APPLICANTS AND MEMBERS, PEER REVIEW OF CARE, AND REPRESENTING THE INTERESTS OF MEMBERS IN RELATIONS WITH HOSPITAL ADMINISTRATION AND BOARD.ActivityOrMissionDesc
Voting Members Governing Body18VotingMembersGoverningBodyCnt
Voting Members Independent18VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$666,063PYContributionsGrantsAmt
CY Contributions Grants$843,080CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$12,034PYInvestmentIncomeAmt
CY Investment Income$38,384CYInvestmentIncomeAmt
PY Other Revenue-$27,495PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$650,602PYTotalRevenueAmt
CY Total Revenue$881,464CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$458,880PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$474,905CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$256,040PYOtherExpensesAmt
CY Other Expenses$322,043CYOtherExpensesAmt
PY Total Expenses$714,920PYTotalExpensesAmt
CY Total Expenses$796,948CYTotalExpensesAmt
PY Revenues Less Expenses-$64,318PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$84,516CYRevenuesLessExpensesAmt
Total Assets BOY$1,593,806TotalAssetsBOYAmt
Total Assets EOY$1,850,831TotalAssetsEOYAmt
Total Liabilities BOY$69,619TotalLiabilitiesBOYAmt
Total Liabilities EOY$99,030TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,524,187NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,751,801NetAssetsOrFundBalancesEOYAmt
MissionOVERSIGHT OF THE QUALITY OF CARE PROVIDED BY MEMBERS, ACCOMPLISHED THROUGH CREDENTIALING OF APPLICANTS AND MEMBERS, PEER REVIEW OF CARE, AND REPRESENTING THE INTERESTS OF MEMBERS IN RELATIONS WITH HOSPITAL ADMINISTRATION AND BOARD.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
DescPROMOTE AND MAINTAIN HIGH QUALITY PATIENT CARE THAT IS COMMENSURATE WITH AVAILABLE RESOURCES FOR ALL PATIENTS TREATED IN ANY FACILITIES OR SERVICES OF THE HOSPITAL, WHILE SERVING AS THE PATIENT ADVOCATE AT ALL LEVELS OF CARE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
DescMAINTAIN AND IMPROVE THE QUALITY OF CARE RENDERED AND PROVIDE OVERSIGHT OF CARE, TREATMENT, AND SERVICES PROVIDED BY ALL PRACTITIONERS AUTHORIZED TO PRACTICE IN THE HOSPITAL THROUGH AN APPROPRIATE DELINEATION OF CLINICAL PRIVELEGES AND THROUGH UNIFORM AND ONGOING REVIEW AND EVALUATION OF EACH PRACTITIONER'S PERFORMANCE IN THE HOSPITAL.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
DescPROVIDE AN EDUCATIONAL SETTING TO MAINTAIN SCIENTIFIC STANDARDS, FURTHER MEDICAL EDUCATION AND CLINICAL INVESTIGATION, AND LEAD TO CONTINUOUS ADVANCEMENT IN PROFESSIONAL KNOWLEDGE AND SKILL.Desc
FieldValueIRS element (for citing)
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy TaxYes (1)SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members18GoverningBodyVotingMembersCnt
Independent Voting Member18IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HEATHER SMITHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4082658400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12110 S BASCOM AVE STE 103AddressLine1Txt
CityCAMPBELLCityNm
State AbbreviationCAStateAbbreviationCd
ZIP95008ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
TOM PEITZ MD
CHIEF OF STAFF15.00Yes (X)Yes (X)$125,000$0$0
CLAUDIA MUELLER MD
VICE CHIEF OF STAFF1.20Yes (X)Yes (X)$8,333$0$0
MARIE LA PENTA MCHENRY MD
VICE CHIEF OF STAFF5.80Yes (X)Yes (X)$41,667$0$0
IAN JAFFE MD
TREASURER5.00Yes (X)Yes (X)$25,000$0$0
STEFANI WEDL MD
SECRETARY5.00Yes (X)Yes (X)$25,000$0$0
JENNIFER GUY MD
DIRECTOR2.00Yes (X)$24,000$0$0
BRIAN MICHAEL PARRETT MD
DIRECTOR2.00Yes (X)$23,400$0$0
YILE DING MD
CME COMMITTEE CHAIR5.00Yes (X)$14,400$0$0
VINAYAK JHA MD
DIRECTOR2.00Yes (X)$5,700$0$0
LEWIS Z LENG MD
DIRECTOR2.00Yes (X)$23,400$0$0
HIDEKI PAUL CHIN MD
DIRECTOR2.00Yes (X)$23,400$0$0
MEGAN E FAUGHNAN MD
DIRECTOR2.00Yes (X)$6,000$0$0
JENNIFER GUY MD
PHYSICAL WELLNESS COMMITTE5.00Yes (X)$5,826$0$0
CLAUDIA MUELLER MD
DIRECTOR2.00Yes (X)$2,100$0$0
FABIOLA COBARRUBIAS MD
DIRECTOR2.00Yes (X)$3,300$0$0
MIMI LIN MD
DIRECTOR2.00Yes (X)$6,300$0$0
RITIK CHANDRA MD
DIRECTOR2.00Yes (X)$6,600$0$0
ABIGAIL PEASE MD
DIRECTOR2.00Yes (X)$23,400$0$0
ADITI MANDPE MD
DIRECTOR2.00Yes (X)$19,080$0$0
IAN JAFFE MD
DIRECTOR2.00Yes (X)$23,400$0$0
IRA SHARLIP MD
DIRECTOR2.00Yes (X)$16,200$0$0
SACHA NIEMI MD
DIRECTOR2.00Yes (X)$23,400$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$474,906TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Government Grants$505,700GovernmentGrantsAmt
All Other Contributions$337,380AllOtherContributionsAmt
Total Contributions$843,080TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$38,074TotalRevenueColumnAmt
Exclusion$38,074ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$380,543SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$380,233SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$310SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$310TotalRevenueColumnAmt
Exclusion$310ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$881,464TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$38,384ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$474,905TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$14,680TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,153TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$19,177TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmt
MEDICAL STAFF SERVICES:$98,910
MEDICAL STAFF EVENT: GO$69,999
MEDICAL STAFF EVENT: HO$54,078
PAY SIMPLE AND MERCHANT$13,786

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$48,260TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$796,948TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$163,751BOYAmt
EOY$249,450EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$10,274BOYAmt
EOY$191,865EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,419,781BOYAmt
EOY$1,409,516EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,593,806BOYAmt
EOY$1,850,831EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$69,619BOYAmt
EOY$99,030EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$69,619BOYAmt
EOY$99,030EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,524,187BOYAmt
EOY$1,751,801EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,524,187BOYAmt
EOY$1,751,801EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,593,806BOYAmt
EOY$1,850,831EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$84,516ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$143,098NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Political Expenditures$0PoliticalExpendituresAmt
Volunteer Hours0VolunteerHoursCnt
Substantially All Dues Nonded0SubstantiallyAllDuesNondedInd
Only In House LobbyingYes (1)OnlyInHouseLobbyingInd
Agree Carryover Prior Year0AgreeCarryoverPriorYearInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6MEMBERS CONSIST OF ALL LICENSED PHYSICIANS HOLDING EITHER M.D. OR D.O. DEGREES, DENTISTS, AND PODIATRISTS WHO ARE PRIVILEGED TO ADMIT, TREAT, OR CONSULT ON PATIENTS IN CALIFORNIA PACIFIC MEDICAL CENTER HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7AALL ACTIVE STAFF MEMBERS HAVE THE PREROGATIVE TO VOTE ON MATTERS PRESENTED AT GENERAL AND SPECIAL MEETINGS OF THE MEDICAL STAFF, INCLUDING ELECTION OF OFFICERS AND MEMBERS AT LARGE. PODIATRISTS AND DENTISTS SHALL NOT VOTE ON ANY OF THOSE MATTERS BEYOND THE SCOPE OF THEIR LICENSURE.
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE 990 IS PROVIDED TO THE TREASURER OF THE ORGANIZATION FOR REVIEW AND SIGNATURE, PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 15BOFFICER STIPENDS ARE DETERMINED BY THE BOARD COMPENSATION COMMITTEE IN ITS ANNUAL MEETING.
FORM 990, PART VI, SECTION C, LINE 19AVAILABLE UPON REQUEST.