2024-11-15T13:07:26-06:00 2023-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2023-01-01 942422439 PACIFIC VISION FOUNDATION PACI 4153931225 711 VAN NESS AVENUE 260 SAN FRANCISCO CA 94102 JAMES CHANG CFO 4153931225 2024-11-15 1 0 MICHAEL LUMSDEN P01262236 4159561500 2024-11-15 2023 2024-10-15 13:58:12Z VIVEKA RYDELL-ANDERSON 711 VAN NESS AVENUE 260 SAN FRANCISCO CA 94102 5342109 0 X WWW.PACIFICVISIONFOUNDATION.ORG X 1977 CA PVF IS DEDICATED TO EXCELLENT EYE CARE FOR ALL REGARDLESS OF ABILITY TO PAY. 19 17 28 20 -322417 0 703305 1403148 0 0 134746 298410 -2101146 -215503 -1263095 1486055 96836 166663 0 0 1242905 1172379 70000 0 280741 1397830 794831 2807571 2133873 -4070666 -647818 45332852 44996012 23599567 23657874 21733285 21338138 EXCELLENT EYE CARE FOR ALL REGARDLESS OF ABILITY TO PAY. PACIFIC VISION FOUNDATION IS DEDICATED TO IMPROVING HEALTH EQUITY IN EYE HEALTH AND VISION IN COLLABORATION WITH A COMMUNITY OF PHYSICIANS AND OTHER PARTNERS PROVIDING CARE AND TRAINING. 0 0 421113 166663 0 PVF'S MISSION IS TO SUPPORT THE HIGHEST QUALITY OF EYECARE FOR ALL MEMBERS OF OUR COMMUNITY, REGARDLESS OF ABILITY TO PAY. WE WORK TO ACCOMPLISH OUR MISSION THROUGH DEVELOPMENT AND SUPPORT OF THE PACIFIC VISION EYE INSTITUTE. IN PARTICULAR, PVF SUPPORTS THE CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) OPHTHALMOLOGY RESIDENCY PROGRAM, AND THE RETINA FELLOWSHIP PROGRAM WHOSE RESIDENTS, FELLOWS, AND FACULTY PROVIDE EYE CARE TO LOW INCOME AND UNINSURED PATIENTS. PVF ALSO SUBSIDIZES EYE SURGERIES FOR LOW-INCOME PATIENTS AT THE PACIFIC VISION SURGERY CENTER WHICH OPENED IN 2020. 421113 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 15 0 1 28 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 19 17 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X JAMES CHANG 4153931225 711 VAN NESS AVENUE 260 SAN FRANCISCO CA 94102 FRANCINE MILTENBERGER CHAIR THROUGH 5/2023 2.00 X X 0 0 0 ROBERT TOMASELLO CHAIR START 5/2023 2.00 X X 0 0 0 DAVID D O'NEILL VICE CHAIR THROUGH 12/2023 2.00 X X 0 0 0 LENARD WEISS VICE CHAIR & SECRETARY START 12/2023 2.00 X X 0 0 0 SUZANNE DAGGERT TREASURER 2.00 X X 0 0 0 BRUCE SPIVEY CHAIR EMERITUS 2.00 X 0 0 0 USHA ARUNACHALAMA PHD MBA DIRECTOR THROUGH 3/2023 2.00 X 0 0 0 DAVID C CUNEO CPA DIRECTOR 2.00 X 0 0 0 KEVIN DENNY MD DIRECTOR 2.00 X 32400 0 0 ANNE FUNG MD DIRECTOR 2.00 X 0 0 0 WAYNE E FUNG MD DIRECTOR 2.00 X 0 0 0 BERND KUTZSCHER MD DIRECTOR 2.00 X 0 0 0 RICHARD LEE MD DIRECTOR 2.00 X 0 0 0 ROBERT A NELSON MD MBA DIRECTOR 2.00 X 0 0 0 JOHN POSEY DIRECTOR 2.00 X 0 0 0 KRISTA RAMONAS MD DIRECTOR 2.00 X 0 0 0 LEE K SCHWARTZ MD DIRECTOR 2.00 X 0 0 0 RONA SILKISS MD FACS DIRECTOR 2.00 X 0 0 0 ERIC W SPIVEY DIRECTOR 2.00 X 0 0 0 DALE WALKER DIRECTOR THROUGH 7/2023 2.00 X 0 0 0 ROBERT G WEBSTER JR MD DIRECTOR 2.00 X 0 0 0 VERNON G WONG MD DIRECTOR 2.00 X 0 0 0 STEVEN R YOUNG BCO DIRECTOR 2.00 X 0 0 0 VIVEKA RYDELL-ANDERSON JD MSC CHIEF EXECUTIVE OFFICER 40.00 X 300000 0 24864 JAMES CHANG CHIEF FINANCIAL OFFICER 40.00 X 217681 0 6570 STEPHANIE TWERDAHL DEVELOPMENT DIRECTOR 40.00 X 138788 0 14159 688869 0 45593 3 0 1 0 0 1403148 1403148 298410 298410 3445551 3856054 -410503 -410503 -322417 -88086 MANAGEMENT FEES 561499 195000 195000 195000 1486055 0 -322417 405324 X 166663 166663 581516 581516 428591 18679 186848 223064 12636 12636 68994 68994 80642 63694 16948 65234 65234 82741 82741 10222 10222 244446 244446 26402 10223 16179 38823 38823 47765 15411 32354 1030 1030 3630 3630 16068 16068 CHARITY CARE 190070 190070 MISC FUNDRAISING EXP 40729 40729 DUES & SUBSCRIPTIONS 7604 7604 20067 20067 2133873 421113 1432019 280741 663309 1045699 15322 15521 1890261 1485106 187002 233046 697646 696875 63865 150215 36461844 9140800 28326815 27321044 8765850 7540507 2670000 2670000 2052782 3837999 45332852 44996012 1460503 1882716 21952151 21589645 186913 185513 23599567 23657874 X 6629725 5824192 15103560 15513946 21733285 21338138 45332852 44996012 -647818 252671 0 X 0 1 X 1 0 X 2722683 7413303 2132280 703305 1403148 14374719 2722683 7413303 2132280 703305 1403148 14374719 5294920 9079799 1863066 1388301 888888 508971 1037756 5686982 75000 153458 208500 194830 195000 826788 20888489 0.43470 0.43580 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2019 AMOUNT: $ 75,000. 2020 AMOUNT: $ 153,458. 2021 AMOUNT: $ 208,500. 2022 AMOUNT: $ 194,830. 2023 AMOUNT: $ 195,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6264080 51200 419886 342618 6392548 6660551 80000 -310589 165882 6264080 6332062 469312 140823 6660551 1826055 4506007 6332062 1826055 1826055 0.00000 1.00000 0.00000 0 0 6000000 6000000 30131054 8923612 21207442 218711 217188 1523 112079 112079 27321044 INVESTMENT IN PACIFIC VISION SURGERY CENTER LLC (PVSC) 2670000 C 2670000 DUE FROM PVSC 2643518 DEFERRED RENT RECEIVABLE 1040187 LEASE COMMISSIONS 154294 3837999 SECURITY DEPOSITS 185513 185513 X PART V, LINE 4: ENDOWMENT FUNDS ARE INTENDED TO SUPPORT THE ORGANIZATION'S ACTIVITIES IN PROVIDING EXCELLENT EYE CARE FOR ALL, REGARDLESS OF ABILITY TO PAY, INCLUDING TRAINING EYE PHYSICIANS/SURGEONS AND GRANTMAKING. PART X, LINE 2: MANAGEMENT EVALUATED THE FOUNDATION'S TAX POSITIONS AND CONCLUDED THAT THE FOUNDATION HAD MAINTAINED ITS TAX EXEMPT STATUS AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE CONSOLIDATED FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 VOLUNTEER FACULTY MEMBERS 17 110425 EYE RESIDENCIES 13 17164 CHAIR 1 32400 VISITING PROFESSOR STIPEND 9 6674 PART I, LINE 2: PAYMENTS ARE MADE TO SUPPORT GRANTEES' WORK WITHIN THE FIELD OF OPHTHALMOLOGY. PROCEDURES TO MONITOR PROPER USE OF GRANT FUNDS INCLUDE THE COLLECTING OF EXPENSE REPORTS, BOARD APPROVAL OF STIPENDS, AND REVIEW BY THE GRANTS COMMITTEE FOR RESEARCH GRANTS. X X 0 0 0 0 0 0 0 0 0 VIVEKA RYDELL-ANDERSON JD MSC CHIEF EXECUTIVE OFFICER 300000 0 0 0 0 0 9000 0 15864 0 324864 0 0 0 JAMES CHANG CHIEF FINANCIAL OFFICER 217681 0 0 0 0 0 6530 0 40 0 224251 0 0 0 STEPHANIE TWERDAHL DEVELOPMENT DIRECTOR 138788 0 0 0 0 0 4164 0 9995 0 152947 0 0 0 KEVIN DENNY MD BOARD MEMBER 142289 LEASED OFFICE SPACE 0 RONA SILKISS MD FACS BOARD MEMBER 61122 LEASED OFFICE SPACE 0 FORM 990, PART VI, SECTION A, LINE 2 BRUCE SPIVEY AND ERIC SPIVEY HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT TAX ACCOUNTANT, IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE DEPARTMENT. A DRAFT IS REVIEWED BY THE CFO; ADJUSTMENTS ARE MADE, AS NECESSARY. A COMPLETE COPY OF THE FORM 990 IS THEN PROVIDED TO THE GOVERNING BODY FOR REVIEW AND COMMENT PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS, KEY EMPLOYEES, OR MEMBER OF A COMMITTEE COVERED BY THE CONFLICT OF INTEREST POLICY. SHOULD A POTENTIAL CONFLICT OF INTEREST ARISE, DETERMINATIONS ARE MADE BY EITHER CEO (FOR EMPLOYEES) OR MEMBERS OF THE BOARD (IN THE CASE OF A CONFLICT OF INTEREST INVOLVING THE CEO). IN EITHER CASE, CONFLICTED INDIVIDUALS ARE NOT ALLOWED TO PARTICIPATE ON THE DELIBERATION OR VOTE INVOLVING THE POTENTIAL TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES COMPENSATION FOR THE CEO AND AND OTHER SENIOR MANAGEMENT OFFICIALS BASED ON A REVIEW OF SALARY SURVEYS FOR SIMILARLY SITUATED INDIVIDUALS IN SIMILAR ORGANIZATIONS, TAKING INTO ACCOUNT COST-OF-LIVING GEOGRAPHIC LOCATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST IN THE CONTROLLER'S OFFICE. FORM 990, PART IX, LINE 11G ARTWORK/ILLUSTRATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 192. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192. PAYROLL SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 8,346. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,346. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 7,277. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,277. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 228,631. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 228,631. SFOC LLC 711 VAN NESS AVENUE SUITE 260 SAN FRANCISCO CA 94102 452209678 REAL ESTATE RENTAL CA 3463707 29350119 PACIFIC VISION FOUNDATION PACIFIC VISION SURGERY CENTER LLC 711 VAN NESS AVENUE SUITE 260 SAN FRANCISCO CA 94102 833286106 VISION SURGERY CENTER CA PACIFIC VISION FOUNDATION RELATED -902084 11613650 0 0 0.89000 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 PACIFIC VISION SURGERY CENTER LLC D 2643518 BOOK VALUE PACIFIC VISION SURGERY CENTER LLC L 150000 BOOK VALUE PACIFIC VISION SURGERY CENTER LLC R 190070 BOOK VALUE SCHEDULE R, PART V, LINE 2: TRANSACTION R FOR FOR $190,070 REPRESENTS THE COST OF CHARITY CARE EXPENSES COVERED BY PACIFIC VISION FOUNDATION FOR LOW-INCOME INDIVIDUALS TO RECEIVE NECESSARY EYE SURGERIES AT PACIFIC VISION SURGERY CENTER, LLC.