MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL (EIN 34-1663333)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-05-11
IRS object ID: 201201329349301110
Schema version: 2011v1.2
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
Form 990
Schedule B
Schedule D
Schedule I
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-05-11T15:19:28-00:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Sauppe Tax Service LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	32650 Greenwood Dr	AddressLine1
City	Avon Lake	City
State	OH	State
ZIP Code	44012	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	341663333	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Medical Staff of St John Westshore Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	MEDI	NameControl
Phone	4408275536	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	29000 Center Ridge Rd	AddressLine1
City	Westlake	City
State	OH	State
ZIP Code	441455294	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Adnan Mourany	Name
Title	President	Title
Date Signed	2012-05-08	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Janice Sauppe EA ATP	Name
Phone	4409333178	Phone
Date Prepared	2012-05-11	DatePrepared
Self Employed	X	SelfEmployed

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Adnan Mourany MD	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	29000 Center Ridge Rd	AddressLine1
City	Westlake	City
State	OH	State
ZIP Code	441455293	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	249372	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c	X	Organization501c
Year Formation	1981	YearFormation
State Legal Domicile	OH	StateLegalDomicile
Activity Or Mission Description	Continuing Medical Education to keep doctors up to date on medical issues	ActivityOrMissionDescription
Nbr Voting Members Governing Body	17	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	17	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	210	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	199733	ContributionsGrantsPriorYear
Contributions Grants Current Year	201050	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	10813	InvestmentIncomePriorYear
Investment Income Current Year	2413	InvestmentIncomeCurrentYear
Other Revenue Prior Year	31497	OtherRevenuePriorYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	242043	TotalRevenuePriorYear
Total Revenue Current Year	203463	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	15500	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	16770	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	19991	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	22991	BenefitsPaidToMembersCY
Salaries Etc Prior Year	134000	SalariesEtcPriorYear
Salaries Etc Current Year	134000	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	24736	OtherExpensePriorYear
Other Expenses Current Year	43083	OtherExpensesCurrentYear
Total Expenses Prior Year	194227	TotalExpensesPriorYear
Total Expenses Current Year	216844	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	47816	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-13381	RevenuesLessExpensesCY
Total Assets BOY	533610	TotalAssetsBOY
Total Assets EOY	520229	TotalAssetsEOY
Total Liabilities EOY	0	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	533610	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	520229	NetAssetsOrFundBalancesEOY
Mission Description	Continuing Medical Education to keep doctors up to date on medical issues	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	45862	Expense
Description	Ongoing medical training and conferencing for hospital medical staff	Description
Total Program Service Expense	45862	TotalProgramServiceExpense
Described In501 C3	false	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	false	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	true	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	9	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	0	NumberOfEmployees
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Funds To Pay Premiums	false	FundsToPayPremiums
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	17	NbrVotingGoverningBodyMembers
Number Independent Voting Members	17	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	true	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	false	ConflictOfInterestPolicy
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	Adnan Mourany MD	NamePerson
Telephone Number	4408358500	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	29000 Center Ridge Rd	AddressLine1
City	Westlake	City
State	OH	State
ZIP Code	441455293	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Individual Trustee Or DirectorIndividualTrusteeOrDirector
Amelia Llerena MD
Immed Past President	005.00	X	4167	0	0
David Tolentine DO
Vice President	005.00	X	0	0	0
Roberta Persaud MD
Secretary/Treasurer	005.00	X	0	0	0
Adnan Mournay MD
President	010.00	X	46833	0	0	X
James H Myers
Dept Chair	005.00		12000	0	0	X
Naim Z Farhat & Associates Inc
Dept. Chair	005.00		12000	0	0	X
Kornelia Solymos-Bratton MD
Dept Chair	005.00		12000	0	0	X
Edwina Simmons MD
Dept Chair	005.00		12000	0	0	X
Manuel Martinez MD
Dept Chair	005.00		12000	0	0	X
Matthew Kacir MD
Dept Chair	005.00		12000	0	0	X
Karen Machen
Dept Chair	005.00		0	0	0	X
Robert Kanstan MD
Dept Chair	005.00		0	0	0	X
Attilla Kiss MD
Dept Chair	005.00		0	0	0	X
Jeremy Hoban MD
Dept Chair	005.00		0	0	0	X
Robert Stern MD
Imm Past President	005.00	X	11000	0	0
Gregory Bloxforf DO
Member at Large	005.00	X	0	0	0
Charles Duncan MD
Member at Large	005.00	X	0	0	0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	134000	TotalReportableCompFromOrg
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Membership Dues	134050	MembershipDues
Related Organizations	67000	RelatedOrganizations
Total Contributions	201050	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	3322	TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	45000	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	45909	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	-909	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-909	TotalRevenueColumn

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	203463	TotalRevenueColumn

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	15270	Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	1500	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	22991	Total
Program Services	22991	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	134000	Total

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	0	Total

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	0	Total

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	0	Total

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	450	Total

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Fees For Services Prof Fundraising		FeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	312	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	0	Total

Advertising Advertising

Field	Value	IRS element (for citing)
Total	0	Total

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	504	Total

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	11340	Total

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	0	Total

Travel Travel

Field	Value	IRS element (for citing)
Total	0	Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	22871	Total
Program Services	22871	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	0	Total

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	0	Total

Insurance Insurance

Field	Value	IRS element (for citing)
Total	0	Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescription	TotalTotal
Gifts to volunteers	3237
Unrealized loss in investments	4369

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	0	Total

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	216844	Total
Program Services	45862	ProgramServices

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	168852	BOY
EOY	206207	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	226043	BOY
EOY	222210	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	138715	BOY
EOY	91812	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	533610	BOY
EOY	520229	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	533610	BOY
EOY	520229	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	533610	BOY
EOY	520229	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	533610	BOY
EOY	520229	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-13381	ReconcilationRevenueExpenses
Method Of Accounting Cash	X	MethodOfAccountingCash
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited
Audit Committee	false	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Included On FS	false	IncludedOnFS

Other Assets OtherAssets (6 entries)

DescriptionDescription	Book ValueBookValue
MidFirst Bank CD	20567
MidFirst Bank CD	25709
Barclays Bank CD
Barclays Bank CD	20238
Barclays Bank CD
Barclays Bank CD	25298

Field	Value	IRS element (for citing)
Total Book Value Other Assets	91812	TotalBookValueOtherAssets
Total Revenue	203463	TotalRevenue
Total Expenses	216844	TotalExpenses
Excess Or Deficit For Year	-13381	ExcessOrDeficitForYear
Excess Or Deficit Per FS	-13381	ExcessOrDeficitPerFS

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (16 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant
ALS Association
2500 E 22nd St Suite 102	Cleveland	OH	44115	341595148	501c3	100
American Cancer Society
10501 Euclid Ave	Cleveland	OH	44106	340726080	501c3	200
Arthritis Foundation
P O Box 96280	Washington	DC	200777491	581341679	501c3	200
Community West Foundation
20545 Center Ridge Rd Ste 448	Rocky River	OH	44116	341456398	501c3	100
Harvest for Hunger
15500 South Waterloo Rd	Cleveland	OH	44110	341292848	501c3	3000
Hospice of Western Reserve
300 E 185th St	Cleveland	OH	44119	341256377	501c3	200
John Kanzius Research Foundation
130 West 8th St	Erie	PA	16501	261790100	501c3	200
Koster Children's Fund
355 Dover Center Rd	Bay Village	OH	44140		501c3	1000
SJMC Giving Tree
29000 Center Ridge Rd	Westlake	OH	44145		501c3	135
Mercy Cancer Center
41201 Schaden Road	Elyria	OH	44035	341504558	501c3	200
Pancreatic Cancer Action Network
1500 Rosecrans Ave Suite 200	Manhattan Beach	CA	90266	330841281	501c3	200
SJMC Hope Fund
29000 Center Ridge Rd	Westlake	OH	44145		501c3	500
Memorial Fund for Philip Masterson
801 Crocker Rd	Westlake	OH	44145		501c3	200
Westlake Fire Local 1814
3200 Crocker Road	Westlake	OH	44145			500
Ohio Physicians Health Program
5900 Roche Dr Suite 440	Columbus	OH	43229	341817218	501c3	500
St John Medical Center
29000 Center Ridge Rd	Westlake	OH	44145		501c3	8034

Field	Value	IRS element (for citing)
Total Nbr Of Other Organizations	16	TotalNbrOfOtherOrganizations

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Form 990 Part VI	2	Officers, trustees, etc. may consult and work together on patient care but there is no family or direct business relationship.
Form 990 Part VI	4	A copy of the revised by-laws is attached via a pdf file.
		Form 990 Part VI Section A Line 2 Officers, trustees, etc. may consult and work together on patient care but there is no family or direct business relationship. Form 990 Part VI Section A Line 4 A copy of the revised by-laws is attached via a pdf file.