Many times, these offshore outsourcing activities may occur without the organization for which the data is processed ever knowing it actually occurs. Consider a 2009 case when a Pakistani data entry clerk attempted to extort money from the University of California at San Francisco's (UCSF) Medical Center. In this particular case, the Center outsourced the processing of its medical transcripts (physician notes) to a U.S.-based company that outsourced the records to yet another company in the United States. The second outsourcing company, in turn, sent the records to Pakistan for processing.