2023-05-15T14:32:19-05:00 2022-06-30 593204548 JAMES MOORE & CO PL 2477 TIM GAMBLE PLACE SUITE 200 TALLAHASSEE FL 323084386 990 2021-07-01 571234883 FLORIDA MEDICAL PRACTICE PLAN INC FLOR 8506452827 1115 W CALL ST TALLAHASSEE FL 323043556 ALMA LITTLES MD CEO 8502247144 2023-05-11 1 ALMA LITTLES MD 999009999 KEVIN WARREN P00642409 8503866184 2023-05-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ALMA LITTLES MD 1115 W CALL ST TALLAHASSEE FL 323043556 8676982 0 X WWW.MED.FSU.EDU/FMPP X 2006 FL THE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS. 12 0 0 0 0 0 0 0 8675873 8676982 767847 0 0 0 9443720 8676982 218268 361106 0 0 7348769 7402107 0 0 0 1746882 2052692 9313919 9815905 129801 -1138923 6356277 5825533 3093735 3886301 3262542 1939232 X THE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS. 0 0 9658467 361106 8676982 PERFORMED PROFESSIONAL SERVICES IN SUPPORT OF: 1) AN AFFILIATION AGREEMENT WITH A HOSPITAL FOR GRADUATE MEDICAL EDUCATION PROGRAMS, AND 2) AGREEMENTS WITH HEALTH DEPARTMENTS, CLINICS, AND OTHER FOR PATIENT CARE. 9658467 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 15 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAWN SNYDER 8506445024 1115 WEST CALL STREET TALLAHASSEE FL 32306 JOHN FOGARTY MD PRESIDENT 2.00 40.00 X X 0 436041 46078 DANIEL VAN DURME MD VICE PRESIDENT 1.00 40.00 X X 0 326778 47662 RICHARD NOWAKOWSKI PHD TREASURER 1.00 40.00 X X 0 270455 34818 ALMA LITTLES MD SECRETARY 1.00 40.00 X X 0 325017 45645 JAMES CLARK PHD DIRECTOR AS OF 1/3/2022 0.50 40.00 X 0 0 0 KYLE CLARK MBA DIRECTOR 1.00 40.00 X 0 419337 47810 PAUL KATZ MD DIRECTOR 0.25 40.00 X 0 320809 45612 JONATHAN S APPELBAUM MD DIRECTOR 1.00 40.00 X 0 319870 45625 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 1.00 40.00 X 0 309195 36563 HEATHER FLYNN PHD DIRECTOR 2.00 40.00 X 0 269013 32764 JAMES ZEDAKER MPAS PA-C DFAAPA DIRECTOR UNTIL 1/14/2022 1.00 40.00 X 0 253888 42552 JOAN MEEK MD MS DIRECTOR UNTIL 2/19/2022 1.00 40.00 X 0 267815 33137 BENJAMIN SMITH DMSC PA-C DFAAPA DIRECTOR AS OF 1/14/2022 1.00 40.00 X 0 0 0 WILLIAM C BOYER DHSC MS CHSE DIRECTOR AS OF 5/2/2022 1.00 40.00 X 0 0 0 SALLIE MCRORIE PHD DIRECTOR UNTIL 1/2/2022 0.50 40.00 X 0 442981 48087 0 3961199 506353 0 0 1 0 MARY TERRY MEEK 3244 ARBOR HILL WAY TALLAHASSEE FL 32309 CFMSD 199874 ATHENA HEALTH INC 311 ARSENAL STREET WATERWORN MA 04272 MEDICAL RECORDS & BILLING SOFTWARE 112628 2 CLINICAL REVENUE 624100 8401710 8401710 MEDICAID REVENUE 624100 275272 275272 8676982 8676982 8676982 0 0 361106 361106 5799844 5799844 474763 474763 815740 815740 311760 311760 22500 22500 268581 268581 35838 35838 70966 70966 99575 99575 76498 76498 14770 14770 713891 713891 PROGRAM DEVELOPMENT 486985 486985 MEDICAL SUPPLIES 234954 234954 BANKING FEES 28134 28134 9815905 9658467 157438 0 20957 19331 354970 543650 743674 1680656 40934 58666 129100 48412 95459 80688 2246788 2000632 2853495 1441910 6356277 5825533 79894 191487 115004 114378 2898837 3580436 3093735 3886301 X 0 0 0 0 3262542 1939232 3262542 1939232 6356277 5825533 -1138923 -184387 0 X X 0 1 X 1 0 X X X 1 FLORIDA STATE UNIVERSITY 591961248 2 1 7402107 0 1 7402107 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 129100 48412 80688 80688 FSU FOUNDATION 1171745 F FLORIDA SPECIAL PURPOSE INVESTMENT 270165 F 1441910 FLORIDA STATE UNIVERSITY AUXILIARY 1680373 DEPARTMENTAL DISTRIBUTION 1900063 3580436 X 8492595 -184387 -184387 8676982 0 8676982 9815905 0 9815905 0 9815905 PART X, LINE 2: IT IS THE POLICY OF MANAGEMENT TO EVALUATE ITS TAX POSITIONS ON AN ONGOING BASIS AND TO DISCLOSE ANY SUCH POSITIONS IT BELIEVES WOULD HAVE A MATERIAL IMPACT ON THE FINANCIAL STATEMENTS AND RELATED NOTES. MANAGEMENT ALSO BELIEVES THAT NO SUCH REQUIRED DISCLOSURES CURRENTLY EXIST. 0 FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE 1115 WEST CALL STREET TALLAHASSEE FL 32306 591961248 501(C)(3) 361106 0 DEPARTMENTAL DISTRBUTION SUPPORT 1 0 0 0 0 0 0 0 0 0 0 SALLIE MCRORIE PHD DIRECTOR UNTIL 1/2/2022 0 424186 0 12795 0 6000 0 38212 0 9875 0 491068 0 0 JOHN FOGARTY MD PRESIDENT 0 423213 0 12828 0 0 0 26222 0 19856 0 482119 0 0 KYLE CLARK MBA DIRECTOR 0 374292 0 26345 0 18700 0 26003 0 21807 0 467147 0 0 DANIEL VAN DURME MD VICE PRESIDENT 0 305780 0 9311 0 11687 0 27806 0 19856 0 374440 0 0 ALMA LITTLES MD SECRETARY 0 315416 0 9601 0 0 0 25789 0 19856 0 370662 0 0 PAUL KATZ MD DIRECTOR 0 307207 0 9358 0 4244 0 25756 0 19856 0 366421 0 0 JONATHAN S APPELBAUM MD DIRECTOR 0 310414 0 9456 0 0 0 25769 0 19856 0 365495 0 0 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 0 298934 0 9045 0 1216 0 25714 0 10849 0 345758 0 0 RICHARD NOWAKOWSKI PHD TREASURER 0 262429 0 8026 0 0 0 23969 0 10849 0 305273 0 0 HEATHER FLYNN PHD DIRECTOR 0 246903 0 8700 0 13410 0 23560 0 9204 0 301777 0 0 JOAN MEEK MD MS DIRECTOR UNTIL 2/19/2022 0 248185 0 7653 0 11977 0 23933 0 9204 0 300952 0 0 JAMES ZEDAKER MPAS PA-C DFAAPA DIRECTOR UNTIL 1/14/2022 0 188318 0 5800 0 59770 0 22696 0 19856 0 296440 0 0 PART I, LINE 3 COMPENSATION FOR THE ORGANIZATION'S OFFICERS/FACULTY ARE DETERMINED BY THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE AND APPROVED BY FSU'S HUMAN RESOURCE DEPARTMENT (A RELATED ORGANIZATION). THE COMPENSATION IS ESTABLISHED BASED ON BENCHMARKS WITHIN THE INDUSTRY. IN ADDITION, FSU UTILIZES A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACTS AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE TO ESTABLISH COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FINAL FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS THROUGH ELECTRONIC MAIL PRIOR TO SUBMITTAL TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, IS COVERED UNDER THE POLICY. ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST MUST BE DISCLOSED TO THE DIRECTORS, AND THE DIRECTORS WILL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF A MEMBER FAILS TO DISCLOSE A CONFLICT OF INTEREST IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE ORGANIZATION'S TOP OFFICIAL, OFFICERS, AND KEY EMPLOYEES IS DETERMINED BY FAIR MARKET VALUE, SALARY SURVEYS AND A SALARY RANGE PROVIDED BY FLORIDA STATE UNIVERSITY, THE SUPPORTED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FLORIDA STATE UNIVERSITY A2201 UNIVERSITY CENTER TALLAHASSEE FL 32306 591961248 UNIVERSITY FL 115(1) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 FLORIDA STATE UNIVERSITY O 7402107 CASH