2022-05-12T15:17:47-05:00 2021-06-30 593204548 JAMES MOORE & CO PL 2477 TIM GAMBLE PLACE SUITE 200 TALLAHASSEE FL 323084386 990 2020-07-01 571234883 FLORIDA MEDICAL PRACTICE PLAN INC FLOR 8506452827 1115 W CALL ST TALLAHASSEE FL 323043556 JOHN FOGARTY MD PRESIDENT 8502247144 2022-05-12 1 JOHN FOGARTY MD 999009999 KEVIN WARREN P00642409 8503866184 2022-05-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JOHN FOGARTY MD 1115 W CALL ST TALLAHASSEE FL 323043556 9443720 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. 13 0 0 0 0 0 0 0 7486569 8675873 139113 767847 0 0 7625682 9443720 239473 218268 0 0 6124366 7348769 0 0 0 1609488 1746882 7973327 9313919 -347645 129801 6439041 6356277 3306300 3093735 3132741 3262542 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 9213935 218268 8675873 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. 9213935 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 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 13 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 0 1 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 439819 44212 DANIEL VAN DURME MD VICE PRESIDENT 1.00 40.00 X X 0 327948 46307 JONATHAN APPELBAUM MD TREASURER 1.00 40.00 X X 0 322473 43909 ALMA LITTLES MD SECRETARY 1.00 40.00 X X 0 327964 43922 PAUL KATZ MD DIRECTOR 1.00 40.00 X 0 318192 43901 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 1.00 40.00 X 0 310762 35480 RICHARD NOWAKOWSKI PHD DIRECTOR 1.00 40.00 X 0 272937 34084 JAMES ZEDAKER MPAS PA-C DFAAPA DIRECTOR 1.00 40.00 X 0 222821 36423 JOAN MEEK MD MS DIRECTOR 1.00 40.00 X 0 262317 32470 LESLIE BEITSCH MD JD DIRECTOR 1.00 40.00 X 0 296566 65904 KYLE CLARK MBA DIRECTOR 0.50 40.00 X 0 431318 45985 SALLIE MCRORIE PHD DIRECTOR 0.50 40.00 X 0 476750 47398 HEATHER FLYNN PHD DIRECTOR 1.00 40.00 X 0 237848 29221 0 4247715 549216 0 0 1 0 MARY TERRY MEEK 3244 ARBOR HILL WAY TALLAHASSEE FL 32309 CFMSD 189370 1 CLINICAL REVENUE 624100 8287099 8287099 MEDICAID REVENUE 624100 388774 388774 8675873 767847 767847 9443720 8675873 0 767847 218268 218268 5775801 5775801 438536 438536 824674 824674 309758 309758 22200 22200 313639 313639 2359 2359 75425 75425 60953 60953 88510 88510 14770 14770 639414 639414 PROGRAM DEVELOPMENT 300805 300805 MEDICAL SUPPLIES 202514 202514 BANKING FEES 22778 22778 MEDICAL SERVICES 3515 3515 9313919 9213935 99984 0 14578 20957 1454837 354970 464715 743674 47510 40934 129100 33641 110229 95459 1746905 2246788 2600267 2853495 6439041 6356277 171725 79894 125864 115004 3008711 2898837 3306300 3093735 X 0 0 0 0 3132741 3262542 3132741 3262542 6439041 6356277 129801 0 X X 0 1 X 1 0 X X X 1 FLORIDA STATE UNIVERSITY 591961248 2 1 7348769 0 1 7348769 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 129100 33641 95459 95459 FSU FOUNDATION 1156457 F FLORIDA SPECIAL PURPOSE INVESTMENT ACCOUNT (VIA UNIVERSITY) 1697038 F 2853495 FLORIDA STATE UNIVERSITY AUXILIARY 1243867 DEPARTMENTAL DISTRIBUTION 1654970 2898837 X 9443720 0 9443720 0 9443720 9313919 0 9313919 0 9313919 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. CENTRAL AMERICA AND THE CARIBBEAN - NICARAGUA 0 0 PROGRAM SERVICE MEDICAL MISSION FACULTY TRIPS 7503 0 0 0 0 0 0 7503 0 7503 0 0 0 0 0 0 PART III ACCOUNTING METHOD: 0 FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE 1115 WEST CALL STREET TALLAHASSEE FL 32306 591961248 501(C)(3) 218268 DEPARTMENTAL DISTRBUTION SUPPORT 1 0 0 0 0 0 0 0 0 0 0 JOHN FOGARTY MD PRESIDENT 0 438619 0 1200 0 0 0 25585 0 18627 0 484031 0 0 DANIEL VAN DURME MD VICE PRESIDENT 0 316748 0 1200 0 10000 0 27680 0 18627 0 374255 0 0 JONATHAN APPELBAUM MD TREASURER 0 321273 0 1200 0 0 0 25282 0 18627 0 366382 0 0 ALMA LITTLES MD SECRETARY 0 326764 0 1200 0 0 0 25295 0 18627 0 371886 0 0 PAUL KATZ MD DIRECTOR 0 316992 0 1200 0 0 0 25274 0 18627 0 362093 0 0 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 0 309562 0 1200 0 0 0 25245 0 10235 0 346242 0 0 RICHARD NOWAKOWSKI PHD DIRECTOR 0 271737 0 1200 0 0 0 23849 0 10235 0 307021 0 0 JAMES ZEDAKER MPAS PA-C DFAAPA DIRECTOR 0 187828 0 1200 0 33793 0 17796 0 18627 0 259244 0 0 JOAN MEEK MD MS DIRECTOR 0 248680 0 1200 0 12437 0 23812 0 8658 0 294787 0 0 LESLIE BEITSCH MD JD DIRECTOR 0 295366 0 1200 0 0 0 47277 0 18627 0 362470 0 0 KYLE CLARK MBA DIRECTOR 0 388868 0 26250 0 16200 0 25407 0 20578 0 477303 0 0 SALLIE MCRORIE PHD DIRECTOR 0 439550 0 31200 0 6000 0 38070 0 9328 0 524148 0 0 HEATHER FLYNN PHD DIRECTOR 0 236648 0 1200 0 0 0 20563 0 8658 0 267069 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 A, LINE 2 SALLIE MCRORIE, PH.D. AND KYLE CLARK, MBA SERVE TOGETHER ON THE FOLLOWING ORGANIZATION BOARDS: FAMU-FSU COLLEGE OF ENGINEERING JOINT MANAGEMENT COUNCIL AND THE FSU RESEARCH FOUNDATION, INC. 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 7348769 CASH