Civic Intelligence

Utah Surgical Interventional and Medical Simulation Center Inc

990 • Fiscal year 2016 • EIN 47-5262046

Jan 01, 2016 to Dec 31, 2016 • Filed on Nov 15, 2017

645 E 2800 NNorth Ogden, UT 84414

(801) 699-7656

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

98th percentile

2.99x

Higher debt load relative to assets than 98% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Liabilities / Revenue

92nd percentile

0.43x

Higher debt load relative to revenue than 92% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Net Margin

6th percentile

-79%

Higher net margin than 6% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Top Officer Pay

97th percentile

$75,000

Higher top officer pay than 97% of similar nonprofits.

Top officer pay equals 50.0% of source-year revenue.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Asset Growth

3rd percentile

-85%

Faster asset growth than 3% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Revenue Growth

8th percentile

-57%

Faster revenue growth than 8% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Assets

Down

$21,743

Down $119,366 (-85%) from 2015

Net Assets

Down

-$43,257

Down $118,200 (-158%) from 2015

Liabilities

Down

$65,000

Down $1,166 (-1.8%) from 2015

Revenue

Down

$150,023

Down $199,994 (-57%) from 2015

Expenses

Up

$268,223

Up $16,073 (+6.4%) from 2015

Net Income

Down

-$118,200

Down $216,067 (-221%) from 2015

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$150K$100K$50K$0-$50KAssets 2015: $141,109Liabilities 2015: $66,166Net Assets 2015: $74,9432015Assets 2016: $21,743Liabilities 2016: $65,000Net Assets 2016: -$43,2572016

Highlighted filing

2016

Assets$21,743
Liabilities$65,000
Net Assets-$43,257

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$400K$200K$0-$200KRevenue 2015: $350,017Expenses 2015: $252,150Net Income 2015: $97,8672015Revenue 2016: $150,023Expenses 2016: $268,223Net Income 2016: -$118,2002016

Highlighted filing

2016

Revenue$150,023
Expenses$268,223
Net Income-$118,200
Jump To
Filing Snapshot
Filing Period
Jan 1, 2016 to Dec 31, 2016
Signed
Nov 15, 2017
Return Version
2016v3.0
Gross Receipts
$150,023
Mission and Program Overview

Mission

(1) providing a high-tech learning and simulation environment designed to facilitate the education of physicians and medical professionals regarding new and innovative surgical techniques, (2) operating an interactive anatomy and medical technology exhibit designed to educate school-aged children in the areas of science, technology, engineering and mathematics within the various medical fields, and (3) providing charitable grants of monetary support to medical schools, foundations and other tax-exempt organizations that will directly improve the human condition through advancements and education in medical fields.

Balance Sheet Detail
LineBeginningEndChange
Assets
Prepaid Expenses and Deferred Charges$25,000$21,763▼ $3,237
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Cash and Non-Interest-Bearing Accounts$116,109$-20▼ $116,129
Rtn Earn Endowment Incm Other Fnds$74,943$-43,257▼ $118,200
Total Assets$141,109$21,743▼ $119,366
Liabilities
Unsecured Notes Loans Payable$66,166$65,000▼ $1,166
Total Liabilities$66,166$65,000▼ $1,166
Net Assets / Fund Balance
Total Net Assets Fund Balance$74,943$-43,257▼ $118,200
Total Liabilities and Net Assets / Fund Balance$141,109$21,743▼ $119,366
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseTotal
Matt WhiteCEOFT$75,000$75,000
Garry BeltonCOOFT$65,000$65,000
Charles BeckSenior StrategistPT$25,000$25,000
Natalie WhiteExecutive AssistantPT$16,750$16,750
Jb HenriksenCFOPT$11,330$11,330
Chris BeltonCMOPT$7,331$7,331
Jim UrryCIOPT$5,500$5,500
Steve NuessleLab DirectorPT$5,500$5,500
Rick WebsterDirector EducationPT$3,000$3,000
Revenue and Support

Revenue Composition

Contributions and Grants
$150,000
Program Service Revenue
$0
Investment Income
$23
Other Revenue
$0
All Other Contributions
$150,000
Change in Net Assets
$-118,200
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Salaries, Compensation, and Employee Benefits$223,161
Other Expenses$45,062
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Current Officers, Directors, Trustees, and Key Employees-$223,161-$223,161
Occupancy-$15,210-$15,210
Fees for Services Accounting-$11,344-$11,344
Office Expenses-$1,967-$1,967
All Other Expenses-$1,847-$1,847
Other Expenses-$1,787-$1,787
Insurance-$1,494-$1,494
Travel-$1,452-$1,452
Information Technology-$963-$963
Advertising-$109-$109
Total Functional Expenses$0$268,223$0$268,223
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section B, Line 11B

We create and maintain financial reports on a timely basis that accurately portray our financial status and activities and provide them to all of our trustees. Our internal financial statements identify and explain any material variation between actual and budgeted revenues and expenses. These efforts bolster a thorough review of form 990 by each trustee, with a corresponding unanimous vote for adoption, reflected in the minutes of the board of trustees.

Form 990, Part VI, Section B, Line 12C

The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy.

Form 990, Part VI, Section C, Line 19

Available within 30 days, upon written request

Filing and Contact Details

Filer

Filer Name
Utah Surgical Interventional and
EIN
47-5262046
Phone
8016997656
Address
645 E 2800 N, NORTH OGDEN, UT 84414

Signing Officer

Name
Jb Henriksen
Title
CFO/treasurer
Phone
8016997656
Signed
2017-11-15
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Matthew White
Formed
2015
Legal Domicile
Ut
Voting Board Members
5
Independent Board Members
1
Employees
0
Volunteers
0

Preparer

Firm
Tanner LLC
Address
36 S STATE STREET SUITE 600, SALT LAKE CITY, UT 84111
Preparer
Marc a Metcalf
Phone
8015327444
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0WE CREATE AND MAINTAIN FINANCIAL REPORTS ON A TIMELY BASIS THAT ACCURATELY PORTRAY OUR FINANCIAL STATUS AND ACTIVITIES AND PROVIDE THEM TO ALL OF OUR TRUSTEES. OUR INTERNAL FINANCIAL STATEMENTS IDENTIFY AND EXPLAIN ANY MATERIAL VARIATION BETWEEN ACTUAL AND BUDGETED REVENUES AND EXPENSES. THESE EFFORTS BOLSTER A THOROUGH REVIEW OF FORM 990 BY EACH TRUSTEE, WITH A CORRESPONDING UNANIMOUS VOTE FOR ADOPTION, REFLECTED IN THE MINUTES OF THE BOARD OF TRUSTEES.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2AVAILABLE WITHIN 30 DAYS, UPON WRITTEN REQUEST
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION C, LINE 19
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IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd00
IRS990/TotalAssetsBOYAmt0141109
IRS990/TotalAssetsEOYAmt021743
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IRS990/TotalContributionsAmt0150000
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IRS990/TotalGrossUBIAmt00
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IRS990/TotalLiabilitiesEOYAmt065000
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IRS990/TotalOtherCompensationAmt00
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IRS990/TotalRevenueGrp/ExclusionAmt023
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt00
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt0150023
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt00
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt0141109
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt021743
IRS990/TotReportableCompRltdOrgAmt00
IRS990/TravelGrp/ManagementAndGeneralAmt01452
IRS990/TravelGrp/TotalAmt01452
IRS990/TrnsfrExmptNonChrtblRltdOrgInd00
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UnsecuredNotesLoansPayableGrp/BOYAmt066166
IRS990/UnsecuredNotesLoansPayableGrp/EOYAmt065000
IRS990/UponRequestInd0X
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IRS990/USAddress/CityNm0NORTH OGDEN
IRS990/USAddress/StateAbbreviationCd0UT
IRS990/USAddress/ZIPCd084414
IRS990/VotingMembersGoverningBodyCnt05
IRS990/VotingMembersIndependentCnt01
IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd00
ReturnHeader/BuildTS02017-02-10 21:41:12Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0JB HENRIKSEN
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0CFO/TREASURER
ReturnHeader/BusinessOfficerGrp/PhoneNum08016997656
ReturnHeader/BusinessOfficerGrp/SignatureDt02017-11-15
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0UTAH SURGICAL INTERVENTIONAL AND
ReturnHeader/Filer/BusinessName/BusinessNameLine2Txt0MEDICAL SIMULATION CENTER INC
ReturnHeader/Filer/BusinessNameControlTxt0UTAH
ReturnHeader/Filer/EIN0475262046
ReturnHeader/Filer/PhoneNum08016997656
ReturnHeader/Filer/USAddress/AddressLine1Txt0645 E 2800 N
ReturnHeader/Filer/USAddress/CityNm0NORTH OGDEN
ReturnHeader/Filer/USAddress/StateAbbreviationCd0UT
ReturnHeader/Filer/USAddress/ZIPCd084414
ReturnHeader/FilingSecurityInformation/AtSubmissionCreationDeviceId0C8006F72E7D0BAB2BBCCCEFAC0601D3397ECDD6C
ReturnHeader/FilingSecurityInformation/AtSubmissionFilingDeviceId0A048973EBE51817971A011BC8A53D60B5A560BA5
ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd0P
ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt0162.218.219.130
ReturnHeader/FilingSecurityInformation/IPDt02017-11-15
ReturnHeader/FilingSecurityInformation/IPTimezoneCd0MS
ReturnHeader/FilingSecurityInformation/IPTm015:59:09
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0202253063
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0TANNER LLC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt036 S STATE STREET SUITE 600
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0SALT LAKE CITY
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0UT
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd084111
ReturnHeader/PreparerPersonGrp/PhoneNum08015327444
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0MARC A METCALF
ReturnHeader/ReturnTs02017-11-15T18:04:46-06:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02016-01-01
ReturnHeader/TaxPeriodEndDt02016-12-31
ReturnHeader/TaxYr02016

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