TY 2011 Form 990EZ

Form990-EZ
Click to see attachment

Department of the Treasury
Internal Revenue Service

Short Form
Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)

Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions).
All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form.

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-1150

2011

Open to Public
Inspection

Check if applicable:

Address change

Name change

Initial return

Terminated

Amended return

Application pending

C Name of organization
MENORAH MEDICAL CENTER - MEDICAL
STAFF DUES FUND

Number and street (or P. O. box, if mail is not delivered to street address)5721 W 119TH ST
Room/suite

City or town, state or country, and ZIP + 4 OVERLAND PARK, KS66209

D Employer identification number

71-0941618

E Telephone number

(913) 498-6623

F Group Exemption
Number. . bullet

K Check

if the organization is not a section 509(a)(3) supporting organization or a section 527 organization and its gross receipts are normally not more than $50,000. A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.

Part IRevenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.)Check if the organization used Schedule O to respond to any question in this Part I...........
	1	Contributions, gifts, grants, and similar amounts received...............	1
2	Program service revenue including government fees and contracts ............	2
3	Membership dues and assessments......................	3	153,253
4	Investment income...........................	4	130
5a	Gross amount from sale of assets other than inventory........	5a
b	Less: cost or other basis and sales expenses...........	5b
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......	5c
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000) .	6a
b	Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the
	sum of such gross income and contributions exceeds $15,000)	6b
c	Less: direct expenses from gaming and fundraising events.......	6c
d	Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c)	6d
7a	Gross sales of inventory, less returns and allowances........	7a
b	Less: cost of goods sold.................	7b
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........	7c
8	Other revenue (describe in Schedule O) .....................	8
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8.................	9	153,383
	10	Grants and similar amounts paid (list in Schedule O) .................	10	27,450
11	Benefits paid to or for members........................	11
12	Salaries, other compensation, and employee benefits................	12	48,600
13	Professional fees and other payments to independent contractors............	13	1,820
14	Occupancy, rent, utilities, and maintenance...................	14
15	Printing, publications, postage, and shipping...................	15
16	Other expenses (describe in Schedule O) ....................	16	65,905
17	Total expenses. Add lines 10 through 16 ....................	17	143,775
	18	Excess or (deficit) for the year (Subtract line 17 from line 9)............	18	9,608
19	Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
	end-of-year figure reported on prior year’s return)................	19	420,945
20	Other changes in net assets or fund balances (explain in Schedule O) ..........	20
21	Net assets or fund balances at end of year. Combine lines 18 through 20.........	21	430,553

Part IRevenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.)Check if the organization used Schedule O to respond to any question in this Part I...........

Contributions, gifts, grants, and similar amounts received...............

Program service revenue including government fees and contracts ............

Membership dues and assessments......................

153,253

Investment income...........................

130

Gross amount from sale of assets other than inventory........

Less: cost or other basis and sales expenses...........

Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......

Gaming and fundraising events

Gross income from gaming (attach Schedule G if greater than $15,000) .

Gross income from fundraising events (not including $ of contributions
from fundraising events reported on line 1) (attach Schedule G if the

sum of such gross income and contributions exceeds $15,000)

Less: direct expenses from gaming and fundraising events.......

Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c)

Gross sales of inventory, less returns and allowances........

Less: cost of goods sold.................

Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........

Other revenue (describe in Schedule O) .....................

Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8.................

153,383

Grants and similar amounts paid (list in Schedule O) .................

27,450

Benefits paid to or for members........................

Salaries, other compensation, and employee benefits................

48,600

Professional fees and other payments to independent contractors............

1,820

Occupancy, rent, utilities, and maintenance...................

Printing, publications, postage, and shipping...................

Other expenses (describe in Schedule O) ....................

65,905

Total expenses. Add lines 10 through 16 ....................

143,775

Excess or (deficit) for the year (Subtract line 17 from line 9)............

9,608

Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with

end-of-year figure reported on prior year’s return)................

420,945

Other changes in net assets or fund balances (explain in Schedule O) ..........

Net assets or fund balances at end of year. Combine lines 18 through 20......... Bullet

430,553

Part IIIStatement of Program Service Accomplishments (see the instructions for Part III.) Check if the organization used Schedule O to respond to any question in this Part III .	Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose? TO ENABLE MEMBERS TO FULFILL THEIR PROFESSIONAL EDUCATION
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 PROVIDING EDUCATIONAL SEMINARS TO ENABLE THE APPROXIMATELY 600 MEMBERS TO CONTINUE THEIR PROFESSIONAL EDUCATION. (Grants $ ) If this amount includes foreign grants, check here ...		28a
29 (Grants $ ) If this amount includes foreign grants, check here ...		29a
30 (Grants $ ) If this amount includes foreign grants, check here ...		30a
31 Other program services (describe in Schedule O) .................. (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a)..............	32

(a) Name and title	(b) Average hours per week devoted to position	(c)Reportable compensation (Forms W-2/1099-MISC) (if not paid, enter -0-)
DENISE MILLER MD 5721 W 119TH ST OVERLAND PARK,KS66209	PRESIDENT0.25	17,250
IAN BELSON DO 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,050
GARY BERGER DO 5721 W 119TH ST OVERLAND PARK,KS66209	SECRETARY/TR0.25	5,500
JENNIFER BROWN MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,500
LAURIE FISHER MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,350
RICHARD CHARETTE MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,350
VALERIE DEARDORFF MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,650
HERBERT HODES MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,500
HARISH PONNURU MD 5721 W 119TH ST OVERLAND PARK,KS66209	VICE PRESIDE0.25	8,750
MANDY SANDER-PRATHER MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,350
DAVID BOCK MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,050
DAVID BOUDA MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	600
WILLIAM CHASE MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,500
FRANCISCO PENA MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	1,200
RICHARD PRICE MD 5721 W 119TH ST OVERLAND PARK,KS66209	PAST PRESIDE0.25	1,500
THOMAS ALLEN MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	0
CYNTHIA ECKERT MD 5721 W 119TH ST OVERLAND PARK,KS66209	DIRECTOR0.25	600

Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefittransaction during the year or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I. ......

40b

Part VI

Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b and 52. Check if the organization used Schedule O to respond to any question in this Part VI ...........

Yes

Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ....

49a

Did the organization make any transfers to an exempt non-charitable related organization?......

49a

If "Yes," was the related organization a section 527 organization?................

49b

Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."

(a) Name and title of each employee paid more than $100,000	(b) Average hours per week devoted to position	(c) Reportable compensation (Forms W-2/1099-MISC)	(d) Health benefits, contributions to employee benefit plans, and deferred compensation	(e) Estimated amount of other compensation

Total number of other employees paid over $100,000 ................. bullet

Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."

(a) Name and address of each independent contractor paid more than $100,000	(b) Type of service	(c) Compensation

Identifier	Return Reference	Explanation
GRANTS AND SIMILAR AMTS PAID TO ORGANIZATIONS	FORM 990-EZ, PART I, LINE 10	KANSAS CITY HOSPICE & PALLIATIVE CA 9221 WARD PARKWAY KANSAS CITY, MO 64114 10,000 0 0 HEALTH PARTNERSHIP CLINIC OF JO CO 7171 W 95TH ST OVERLAND PARK, KS 66212 15,000 0 0
OTHER EXPENSES	FORM 990-EZ, PART I, LINE 16	EXPENSES CONFERENCES & MEETINGS 38,528 OFFICE EXPENSES 903 CONTINUING MEDICAL EDUCAT 4,375 DUES & MEMBERSHIPS 2,149 LIBRARY/ARTICLES 329 PHYSICIAN LOUNGE 10,030 STAFF MEETINGS 2,504 SUBSCRIPTIONS 231 TAXES & LICENSES 40 WORKSHOPS & SEMINARS 4,771 MISCELLANEOUS 2,045 TOTAL 65,905

Identifier

Return Reference

Explanation

GRANTS AND SIMILAR AMTS PAID TO ORGANIZATIONS

FORM 990-EZ, PART I, LINE 10

KANSAS CITY HOSPICE & PALLIATIVE CA 9221 WARD PARKWAY KANSAS CITY, MO 64114 10,000 0 0 HEALTH PARTNERSHIP CLINIC OF JO CO 7171 W 95TH ST OVERLAND PARK, KS 66212 15,000 0 0

OTHER EXPENSES

FORM 990-EZ, PART I, LINE 16

EXPENSES CONFERENCES & MEETINGS 38,528 OFFICE EXPENSES 903 CONTINUING MEDICAL EDUCAT 4,375 DUES & MEMBERSHIPS 2,149 LIBRARY/ARTICLES 329 PHYSICIAN LOUNGE 10,030 STAFF MEETINGS 2,504 SUBSCRIPTIONS 231 TAXES & LICENSES 40 WORKSHOPS & SEMINARS 4,771 MISCELLANEOUS 2,045 TOTAL 65,905

Person Name	Explanation
DENISE MILLER MD
IAN BELSON DO
GARY BERGER DO
JENNIFER BROWN MD
LAURIE FISHER MD
RICHARD CHARETTE MD
VALERIE DEARDORFF MD
HERBERT HODES MD
HARISH PONNURU MD
MANDY SANDERPRATHER MD
DAVID BOCK MD
DAVID BOUDA MD
WILLIAM CHASE MD
FRANCISCO PENA MD
RICHARD PRICE MD
THOMAS ALLEN MD
CYNTHIA ECKERT MD

Person Name

Explanation

DENISE MILLER MD

IAN BELSON DO

GARY BERGER DO

JENNIFER BROWN MD

LAURIE FISHER MD

RICHARD CHARETTE MD

VALERIE DEARDORFF MD

HERBERT HODES MD

HARISH PONNURU MD

MANDY SANDERPRATHER MD

DAVID BOCK MD

DAVID BOUDA MD

WILLIAM CHASE MD

FRANCISCO PENA MD

RICHARD PRICE MD

THOMAS ALLEN MD

CYNTHIA ECKERT MD

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