2023-11-14T14:12:24-06:00 2022-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-01-01 942422439 PACIFIC VISION FOUNDATION PACI 4153931225 711 VAN NESS AVENUE 260 SAN FRANCISCO CA 94102 JAMES CHANG CFO 4153931225 2023-11-14 1 JAMES CHANG 999009999 0 MICHAEL LUMSDEN P01262236 4159561500 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z VIVEKA RYDELL-ANDERSON 711 VAN NESS AVENUE 260 SAN FRANCISCO CA 94102 2611265 0 X WWW.PACIFICVISIONFOUNDATION.ORG X 1977 CA PVF IS DEDICATED TO EXCELLENT EYE CARE FOR ALL REGARDLESS OF ABILITY TO PAY. 22 19 35 21 -2220620 0 2132280 703305 0 0 152571 134746 -962111 -2101146 1322740 -1263095 495628 96836 0 0 840043 1242905 34534 70000 320838 526729 1397830 1896934 2807571 -574194 -4070666 47950109 45332852 23393126 23599567 24556983 21733285 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 618067 96836 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. 618067 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 1 0 0 1 6 0 1 35 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 22 19 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X JAMES CHANG 4153931225 711 VAN NESS AVENUE 260 SAN FRANCISCO CA 94102 FRANCINE MILTENBERGER CHAIR 2.00 X X 0 0 0 DAVID D O'NEILL VICE CHAIR 2.00 X X 0 0 0 SUZANNE DAGGERT TREASURER 2.00 X X 0 0 0 MARTIN ROHER SECRETARY 2.00 X X 0 0 0 BRUCE SPIVEY CHAIR EMERITUS 2.00 X 0 0 0 USHA ARUNACHALAMA PHD MBA DIRECTOR 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 WAYNE E FUNG MD DIRECTOR 2.00 X 0 0 0 BERND KUTZSCHER 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 SETH M SCHALET MBA 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 ROBERT TOMASELLO DIRECTOR 2.00 X 0 0 0 ROBERT G WEBSTER JR MD DIRECTOR 2.00 X 0 0 0 LENARD WEISS 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 CEO START 5/2022 40.00 X 178500 0 14355 JAMES CHANG CFO START 1/2022 40.00 X 184206 0 4410 ROSEMARY JORDAN CEO THROUGH 5/2022 40.00 X 111498 0 13041 DIANE FERNALD INTERIM CFO THROUGH 1/2022 40.00 X 0 0 0 VERONICA JEONG NURSING DIRECTOR 40.00 X 144107 0 4343 KATE STEFAN SR. DIRECTOR OF FINANCE TRANSFORMATION 40.00 X 124019 0 11596 774730 0 47745 5 0 1 0 NEXT LEVEL STRATEGIES 1155-C ARNOLD DRIVE MARTINEZ CA 94553 PAYROLL AND HR SERVICES 159877 ERICA FAYRE DBA FAYRE CONSULTING 1224 WOODLAND AVENUE MANKATO MN 56001 MARKETING SERVICES 110175 2 703305 703305 134746 134746 3224965 3874360 -649395 -649395 -574039 -75356 MANAGEMENT FEES 561499 194830 194830 UBI FROM PARTNERSHIPS 621110 -1646581 -1646581 -1451751 -1263095 0 -2220620 254220 X 96836 96836 538410 32400 506010 552941 84203 357407 111331 32493 8475 19634 4384 47916 12379 29134 6403 71145 13222 51084 6839 130665 130665 282544 282544 70000 70000 10165 10165 365120 851 252579 111690 62385 60168 2217 95916 94980 936 43831 42273 1558 10215 10215 12714 12714 EYE INSTITUTE CHARITY C 251635 251635 OTHER PROGRAM 118066 118066 TAXES & LICENSES 9094 9094 5480 5480 2807571 618067 1868666 320838 1191299 663309 15237 15322 2702183 1890261 360734 187002 722319 697646 60968 63865 36434039 8107224 29195913 28326815 9079650 8765850 2670000 2670000 1951806 2052782 47950109 45332852 906608 1460503 22299605 21952151 186913 186913 23393126 23599567 X 9074942 6629725 15482041 15103560 24556983 21733285 47950109 45332852 X -4070666 -399613 1646581 X 0 1 X 1 0 X 2217142 2722683 7413303 2132280 703305 15188713 2217142 2722683 7413303 2132280 703305 15188713 5618569 9570144 1488367 1863066 1388301 888888 508971 6137593 75000 153458 208500 194830 631788 21958094 0.43580 0.40630 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6660551 80000 -310589 165882 6264080 6332062 469312 140823 6660551 1826055 4506007 6332062 1826055 1826055 1826055 1826055 0.00000 1.00000 0.00000 0 0 6000000 6000000 25599364 3361976 22237388 4531689 4531689 0 218712 213559 5153 84274 84274 28326815 INVESTMENT IN PACIFIC VISION SURGERY CENTER LLC (PVSC) 2670000 C 2670000 SECURITY DEPOSITS 186913 186913 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. X X X X X 1 ASPEN BAKER 290 VERNON STREET OAKLAND CA 94610 DEVELOPMENT CONSULTANT 0 0 70000 -70000 70000 -70000 CA 1 VOLUNTEER FACULTY MEMBERS 14 93925 EYE RESIDENCIES 13 2911 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 CEO START 5/2022 178500 0 0 0 0 0 5355 0 9000 0 192855 0 0 0 JAMES CHANG CFO START 1/2022 184206 0 0 0 0 0 4410 0 0 0 188616 0 0 0 KEVIN DENNY MD BOARD MEMBER 126881 LEASED OFFICE SPACE 0 LEE K SCHWARTZ MD INC 35% CONTROLLED ENTITY OF BOARD MEMBER LEE K. SCHARTZ, MD 202981 LEASED OFFICE SPACE 0 RONA SILKISS MD FACS BOARD MEMBER 54300 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 A, LINE 3 DURING 2022, THE ORGANIZATION DELEGATED INTERIM CFO DUTIES TO DIANE FERNALD, A CONSULTANT WITH FUTURECAST FINANCE LLC. TOTAL COMPENSATION PAID TO FUTURECAST FINANCE LLC IN EXCHANGE FOR THESE SERVICES TOTALED $52,206 DURING THE 2022 TAX YEAR. 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 PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 237,308. FUNDRAISING EXPENSES 111,250. TOTAL EXPENSES 348,558. PAYROLL SERVICE FEES: PROGRAM SERVICE EXPENSES 851. MANAGEMENT AND GENERAL EXPENSES 3,288. FUNDRAISING EXPENSES 440. TOTAL EXPENSES 4,579. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,983. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,983. FORM 990, PART XI, LINE 9: UBI FROM PASSTHROUGHS NOT RECORDED ON FINANCIAL STATEMENTS 1,646,581. SFOC LLC 711 VAN NESS AVENUE SUITE 260 SAN FRANCISCO CA 94102 452209678 REAL ESTATE RENTAL CA 3336643 32786733 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 UNRELATED -1646581 1849619 0 -1646581 0 0.89000 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 PACIFIC VISION SURGERY CENTER LLC L 149830 BOOK VALUE PACIFIC VISION SURGERY CENTER LLC M 251635 BOOK VALUE SCHEDULE R, PART V, LINE 2: TRANSACTION M FOR FOR $251,635 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.