﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile" returnVersion="2023v5.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2024-11-12T09:18:16-06:00</ReturnTs>
    <TaxPeriodEndDt>2023-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>410746749</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>CLIFTONLARSONALLEN LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>5901 PRIESTLY DR SUITE 204</AddressLine1Txt>
        <CityNm>CARLSBAD</CityNm>
        <StateAbbreviationCd>CA</StateAbbreviationCd>
        <ZIPCd>92008</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>870765789</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>SAN DIEGO SHOULDER INSTITUTE</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>SAND</BusinessNameControlTxt>
      <PhoneNum>7609402066</PhoneNum>
      <USAddress>
        <AddressLine1Txt>5901 PRIESTLY DRIVE SUITE 204</AddressLine1Txt>
        <CityNm>CARLSBAD</CityNm>
        <StateAbbreviationCd>CA</StateAbbreviationCd>
        <ZIPCd>92008</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>JAMES ESCH MD</PersonNm>
      <PersonTitleTxt>PRESIDENT &amp; CEO</PersonTitleTxt>
      <PhoneNum>7609402066</PhoneNum>
      <SignatureDt>2024-11-08</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>1</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>DAVID B FORMAN CPA</PreparerPersonNm>
      <PTIN>P00436299</PTIN>
      <PhoneNum>7607292343</PhoneNum>
      <PreparationDt>2024-11-08</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2024-10-15 13:58:12Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="5">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <PrincipalOfficerNm>JAMES ESCH MD</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>1770 TROY LN</AddressLine1Txt>
        <CityNm>OCEANSIDE</CityNm>
        <StateAbbreviationCd>CA</StateAbbreviationCd>
        <ZIPCd>92054</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>1074396</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>HTTPS://SDSI-SHOULDER.COM/</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>2006</FormationYr>
      <LegalDomicileStateCd>CA</LegalDomicileStateCd>
      <ActivityOrMissionDesc>THE MISSION OF SAN DIEGO SHOULDER INSTITUTE IS TO PROMOTE THE DEVELOPMENT AND DISSEMINATION OF EDUCATION RELATED TO SHOULDER DISORDERS TO PHYSICIANS AND ALLIED HEALTH CLINICIANS.EDUCATION RELATED TO SHOULDER DISORDERS TO PHYSICIANS AND ALLIED HEALTH CLINICIANS.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>7</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>0</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>10</TotalEmployeeCnt>
      <TotalVolunteersCnt>0</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>342000</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>248250</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>868215</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>814765</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>7754</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>11381</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>0</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>0</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>1217969</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>1074396</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>206081</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>113517</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>972472</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>1035183</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>1178553</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>1148700</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>39416</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-74304</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>509825</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>512933</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>0</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>53600</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>509825</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>459333</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <MissionDesc>THE MISSION OF SAN DIEGO SHOULDER INSTITUTE IS TO PROMOTE THE DEVELOPMENT AND DISSEMINATION OF EDUCATION RELATED TO SHOULDER DISORDERS TO PHYSICIANS AND ALLIED HEALTH CLINICIANS.</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>940015</ExpenseAmt>
      <Desc>THE MISSION OF SAN DIEGO SHOULDER INSTITUTE (SDSI) IS TO PROMOTE THE DEVELOPMENT AND DISSEMINATION OF EDUCATION RELATED TO SHOULDER DISORDERS TO PHYSICIANS AND ALLIED HEALTH CLINICIANS. GOALS:1.TO OFFER SUPERIOR LEARNING OPPORTUNITIES BY APPROVING ANNUAL CONTINUING MEDICAL EDUCATIONAL OFFERINGS.2.TO PARTICIPATE IN THE ADVANCEMENT OF SHOULDER CARE BY ACTIVE INVOLVEMENT IN INTERNATIONAL TEACHING, RESEARCH, AND EDUCATIONAL COLLABORATION.3.TO PROVIDE ONGOING EDUCATIONAL SUPPORT AND EXPERTISE VIA ESTABLISHMENT AND MAINTENANCE OF AN INTERACTIVE WEBSITE.SDSI HAS ACHIEVED THIS MISSION BY OFFERING A QUALITY EDUCATIONAL FORUM FOR 27 YEARS. COURSE STATISTICS VALIDATE SDSI IS IMPACTING NATIONAL AND INTERNATIONAL PHYSICIAN COMPETENCE AND PERFORMANCE.</Desc>
      <TotalProgramServiceExpensesAmt>940015</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc1039100001">1</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1234500001">1</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>0</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>0</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>0</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc1040000001">0</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc1040000001">0</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc1040000001">0</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc1040000001">0</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>0</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc1040000001">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc1040000001">0</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc1040000001">0</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc1040000001">0</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc1040000001">0</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc1040000001">0</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>0</SchoolOperatingInd>
      <ForeignOfficeInd>0</ForeignOfficeInd>
      <ForeignActivitiesInd>0</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>0</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>0</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>0</FundraisingActivitiesInd>
      <GamingActivitiesInd>0</GamingActivitiesInd>
      <OperateHospitalInd>0</OperateHospitalInd>
      <GrantsToOrganizationsInd>0</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd>0</ScheduleJRequiredInd>
      <TaxExemptBondsInd>0</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>0</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>0</PYExcessBenefitTransInd>
      <LoanOutstandingInd>0</LoanOutstandingInd>
      <GrantToRelatedPersonInd>0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>0</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>0</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>0</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>0</DeductibleArtContributionInd>
      <TerminateOperationsInd>0</TerminateOperationsInd>
      <PartialLiquidationInd>0</PartialLiquidationInd>
      <DisregardedEntityInd>0</DisregardedEntityInd>
      <RelatedEntityInd>0</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>0</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>0</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>0</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>10</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>1</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>0</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>0</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>0</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>0</Form8282PropertyDisposedOfInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>0</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>0</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>7</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>0</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>0</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>0</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>0</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>0</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>0</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>1</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>1</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>1</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>1</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>1</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>1</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>0</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>0</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>CA</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>LESLIE LEBITSKI</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>9516956800</PhoneNum>
        <USAddress>
          <AddressLine1Txt>PO BOX 890850</AddressLine1Txt>
          <CityNm>TEMECULA</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>92589</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <NoListedPersonsCompensatedInd>X</NoListedPersonsCompensatedInd>
      <Form990PartVIISectionAGrp>
        <PersonNm>PATRICK DENARD MD</PersonNm>
        <TitleTxt>MEMBER AT LARGE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GREGORY M ALBERTON MD</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK GETELMAN MD</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MATTHEW PROVENCHER MD</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JONATHAN TICKER MD</PersonNm>
        <TitleTxt>MEMBER AT LARGE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JON JP WARNER MD</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JAMES C ESCH MD</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <AverageHoursPerWeekRt>6.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>0</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>0</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>0</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>0</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <CntrctRcvdGreaterThan100KCnt>0</CntrctRcvdGreaterThan100KCnt>
      <AllOtherContributionsAmt>248250</AllOtherContributionsAmt>
      <TotalContributionsAmt>248250</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>REGISTRATION AND RELAT</Desc>
        <BusinessCd>611430</BusinessCd>
        <TotalRevenueColumnAmt>757865</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>757865</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>ENDURED COURSES</Desc>
        <BusinessCd>323100</BusinessCd>
        <TotalRevenueColumnAmt>56900</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>56900</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>814765</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>11381</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>11381</RelatedOrExemptFuncIncomeAmt>
      </InvestmentIncomeGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>1074396</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>826146</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>104918</TotalAmt>
        <ManagementAndGeneralAmt>104918</ManagementAndGeneralAmt>
      </CompDisqualPersonsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>8599</TotalAmt>
        <ManagementAndGeneralAmt>8599</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>6856</TotalAmt>
        <ManagementAndGeneralAmt>6856</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <AdvertisingGrp>
        <TotalAmt>25981</TotalAmt>
        <ProgramServicesAmt>25981</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>14381</TotalAmt>
        <ManagementAndGeneralAmt>14381</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>321</TotalAmt>
        <ProgramServicesAmt>321</ProgramServicesAmt>
      </InformationTechnologyGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>110953</TotalAmt>
        <ProgramServicesAmt>110953</ProgramServicesAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>932</TotalAmt>
        <ProgramServicesAmt>932</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>6852</TotalAmt>
        <ManagementAndGeneralAmt>6852</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>FACULTY EXPENSES</Desc>
        <TotalAmt>573286</TotalAmt>
        <ProgramServicesAmt>573286</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LAB EXPENSES</Desc>
        <TotalAmt>201746</TotalAmt>
        <ProgramServicesAmt>201746</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BANK CHARGES</Desc>
        <TotalAmt>34828</TotalAmt>
        <ManagementAndGeneralAmt>34828</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EDUCATION</Desc>
        <TotalAmt>32251</TotalAmt>
        <ManagementAndGeneralAmt>32251</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>26796</TotalAmt>
        <ProgramServicesAmt>26796</ProgramServicesAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>1148700</TotalAmt>
        <ProgramServicesAmt>940015</ProgramServicesAmt>
        <ManagementAndGeneralAmt>208685</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>151839</BOYAmt>
        <EOYAmt>76101</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>11425</BOYAmt>
        <EOYAmt>101350</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>14008</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>12444</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>2496</BOYAmt>
        <EOYAmt>1564</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>344065</BOYAmt>
        <EOYAmt>333918</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <TotalAssetsGrp>
        <BOYAmt>509825</BOYAmt>
        <EOYAmt>512933</EOYAmt>
      </TotalAssetsGrp>
      <DeferredRevenueGrp>
        <EOYAmt>53600</EOYAmt>
      </DeferredRevenueGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>53600</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>509825</BOYAmt>
        <EOYAmt>459333</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>509825</BOYAmt>
        <EOYAmt>459333</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>509825</BOYAmt>
        <EOYAmt>512933</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-74304</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>23812</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingCashInd>X</MethodOfAccountingCashInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>0</FSAuditedInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>458867</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>56274</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>292693</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>342000</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>248250</CurrentTaxYearAmt>
        <TotalAmt>1398084</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>1500224</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>47950</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>234150</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>868215</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>814765</CurrentTaxYearAmt>
        <TotalAmt>3465304</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>1959091</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>104224</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>526843</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1210215</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1063015</CurrentTaxYearAmt>
        <TotalAmt>4863388</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <CurrentTaxYearMinus4YearsAmt>356167</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>245000</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>300000</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>127250</CurrentTaxYearAmt>
        <TotalAmt>1028417</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <CurrentTaxYearMinus4YearsAmt>356167</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>245000</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>300000</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>127250</CurrentTaxYearAmt>
        <TotalAmt>1028417</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>3834971</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus2YearsAmt>4128</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5333</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>11381</CurrentTaxYearAmt>
        <TotalAmt>20842</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus2YearsAmt>4128</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5333</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>11381</CurrentTaxYearAmt>
        <TotalAmt>20842</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>1959091</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>104224</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>530971</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1215548</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1074396</CurrentTaxYearAmt>
        <TotalAmt>4884230</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.78520</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.76910</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00430</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00160</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>14008</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>12444</DepreciationAmt>
        <BookValueAmt>1564</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>1564</TotalBookValueLandBuildingsAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GOVERNING BODY CONTEMPORANEOUSLY DOCUMENTS THE MEETINGS HELD AND/OR WRITTEN ACTIONS UNDERTAKEN DURING THE YEAR BY THE ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>UPON REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES WERE CONTINUALLY REQUIRED TO DISCLOSE INTERESTS THAT COULD RESULT IN A CONFLICT OF INTEREST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>UPON REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC</FormAndLineReferenceDesc>
        <ExplanationTxt>JAMES C. ESCH, M.D. - 1770 TROY LN., OCEANSIDE, CA 92054. PATRICK DENARD, M.D. - 80 PLACER HILL DRIVE, JACKSONVILLE, OR 97530. GREGORY M. ALBERTON, M.D. - 2929 HEALTH CENTER DRIVE, SAN DIEGO, CA 92123. MARK GETELMAN, M.D. - 6815 NOBLE AVENUE, VAN NUYS, CA 91405. MATTHEW PROVENCHER, M.D. - 34800 BOB WILSON DRIVE, SAN DIEGO, CA 92134. JONATHAN TICKER, M.D. - 1728 SUNRISE HWY, MERRICK, NY 11566. JON J.P. WARNER, M.D. - 471 WELLESLEY STREET, WESTON, MA 02493.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>