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MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL (EIN 34-1663333)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-06-02
IRS object ID
201401539349300000
Schema version
2013v3.1
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

FieldValueIRS element (for citing)
Return2014-06-02T07:02:02-04:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Sauppe Tax Service LLCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line132650 Greenwood DrAddressLine1
CityAvon LakeCity
StateOHState
ZIP Code44012ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN341663333EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Medical Staff of St John Westshore HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlMEDIBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1
CityWestlakeCity
StateOHState
ZIP Code44145ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAdnan Mournay MDPersonNm
Person TitlePresidentPersonTitleTxt
Phone4408275536PhoneNum
Signature2014-05-22SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJanice SauppePreparerPersonNm
PTINP00014757PTIN
Phone4409333178PhoneNum
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts$272,417GrossReceiptsAmt
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 Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers122TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$181,367PYContributionsGrantsAmt
CY Contributions Grants$186,800CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$10,152PYInvestmentIncomeAmt
CY Investment Income$13,537CYInvestmentIncomeAmt
PY Other Revenue$20,101PYOtherRevenueAmt
CY Other Revenue$72,080CYOtherRevenueAmt
PY Total Revenue$211,620PYTotalRevenueAmt
CY Total Revenue$272,417CYTotalRevenueAmt
PY Grants And Similar Paid$16,489PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$12,664CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$18,930PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$20,642CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$134,000PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$134,000CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$40,206PYOtherExpensesAmt
CY Other Expenses$37,452CYOtherExpensesAmt
PY Total Expenses$209,625PYTotalExpensesAmt
CY Total Expenses$204,758CYTotalExpensesAmt
PY Revenues Less Expenses$1,995PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$67,659CYRevenuesLessExpensesAmt
Total Assets BOY$522,224TotalAssetsBOYAmt
Total Assets EOY$589,883TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$522,224NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$589,883NetAssetsOrFundBalancesEOYAmt
MissionContinuing Medical Education to keep doctors up to date on medical issuesMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$65,000ExpenseAmt
DescOngoing medical training and conferencing for hospital medical staffDesc
Total Program Service Expenses$65,000TotalProgramServiceExpensesAmt
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 Document8IRPDocumentCnt
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 Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
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)
PersonAdnan Mournay MDPersonNm
Phone4408358500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1
CityWestlakeCity
StateOHState
ZIP Code44145ZIPCode

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
Adnan Mournay MD
President10.000.00Yes (X)Yes (X)$50,000$0$0
David Tolentino
Vice President5.000.00Yes (X)Yes (X)$0$0$0
Sagarika Nayak MD
Secretary Treasurer5.000.00Yes (X)Yes (X)$0$0$0
James H Myers
Dept Chair5.000.00Yes (X)$12,000$0$0
Kornelia Solymos-Bratton
Dept Chair5.000.00Yes (X)$12,000$0$0
Edwina Simmons MD
Dept Chair5.000.00Yes (X)$12,000$0$0
Manuel Martinez MD
Dept Chair5.000.00Yes (X)$12,000$0$0
Matthew Kacir
Dept Chair5.000.00Yes (X)$12,000$0$0
John Coletta
Dept Chair5.000.00Yes (X)$12,000$0$0
Robert Stern MC
Dept Chair5.000.00Yes (X)$12,000$0$0
Amelia Llerena MD
Immediate Past President5.000.00Yes (X)$0$0$0
Gregory Bloxforf DO
Member At Large5.000.00Yes (X)$0$0$0
Charles Duncan MD
Member At Large5.000.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$134,000TotalReportableCompFromOrgAmt
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$119,800MembershipDuesAmt
Related Organizations$67,000RelatedOrganizationsAmt
Total Contributions$186,800TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,537TotalRevenueColumnAmt
Related Or Exempt Func Income$13,537RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescUnrealized Gain InvestDesc
Business900001BusinessCd
Total Revenue Column$72,080TotalRevenueColumnAmt
Related Or Exempt Func Income$72,080RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$72,080OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$272,417TotalRevenueColumnAmt
Related Or Exempt Func Income$85,617RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$12,664TotalAmt
Program Services$12,664ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$20,642TotalAmt
Program Services$20,642ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$134,000TotalAmt
Management And General$134,000ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$475TotalAmt
Management And General$475ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$300TotalAmt
Management And General$300ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,890TotalAmt
Management And General$1,890ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$31,694TotalAmt
Program Services$31,694ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescGifts to VolunteersDesc
Total$3,093TotalAmt
Management And General$3,093ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$204,758TotalAmt
Program Services$65,000ProgramServicesAmt
Management And General$139,758ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$129,615BOYAmt
EOY$114,033EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$251,284BOYAmt
EOY$335,688EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$141,325BOYAmt
EOY$140,162EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$522,224BOYAmt
EOY$589,883EOYAmt

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$522,224BOYAmt
EOY$589,883EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$522,224BOYAmt
EOY$589,883EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$522,224BOYAmt
EOY$589,883EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$67,659ReconcilationRevenueExpnssAmt
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$24,942
Ally Bank CD$19,983
Ally Bank CD$25,137
GE Capital CD$50,057
Goldman Sachs CD$20,043
FieldValueIRS element (for citing)
Total Book Value Other Assets$140,162TotalBookValueOtherAssetsAmt

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (12 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeIRC SectionIRCSectionDescCash GrantCashGrantAmtRecipient EINRecipientEIN
St John Medical Center
29000 Center Ridge RdWestlakeOH44145501c3$2,850
United Way Foundation
1331 Euclid AveClevelandOH44115501c3$614131635294
Harvest for Hunger
15500 South Waterloo RdClevelandOH44110501c3$3,200
Kornelia E Solymos Scholarship Fund
14806 Detroit AveLakewoodOH44107501c3$200
Ohio Physicians Health Program
5900 Roche Dr Ste 440ColumbusOH43229501c3$500341817218
PASO Typhoon Disaster Relief Fund
1975 W Ridgewood DrClevelandOH44134501c3$2,000
St Edward Foundation
3131 Smith RdAkronOH44312501c3$200
St George Orthodox Church
3204 Ridgewood RdAkronOH44333501c3$1,000
St Judes Childrens Research Ctr
262 Danny Thomas PlaceMemphisTN38105501c3$200620646012
The Brothers of the Sacred Heart
685 Steere Farm RoadPascoagRI02859501c3$200
US Fund for Unicef
125 Maiden LaneNew YorkNY10038501c3$200131760110
Westshore Ostepathic Foundation
29101 Health Campus Dr Ste 150WestlakeOH44145501c3$1,500341207772

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 4Bylaws revised in 2013. Revised copy 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