2022-11-01T18:35:13-05:00 2021-12-31 463330935 AVENSON HAMANN CPAS LLP 7421 BURNET ROAD 522 AUSTIN TX 78757 990 2021-01-01 200914085 THE PHYSICIANS FOUNDATION INC PHYS 6173990417 401 W 15TH STREET 100 AUSTIN TX 78701 JOHN DORMAN COO 6173990417 2022-10-31 1 JOHN DORMAN 999009999 CATHERINE AVENSON P01259734 5126939131 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JOHN DORMAN 401 W 15TH STREET 100 AUSTIN TX 78701 24013454 0 X WWW.PHYSICIANSFOUNDATION.ORG X 2003 FL THE FOUNDATION'S PURPOSE IS TO ADVANCE THE WORK OF PRACTICING PHYSICIANS AND TO IMPROVE THE QUALITY OF HEALTH CARE FOR ALL AMERICANS. 21 16 2 0 0 0 0 10000 0 0 4549667 7615645 5000 0 4554667 7625645 2181085 2155816 0 0 645307 704126 0 0 0 2990028 2986723 5816420 5846665 -1261753 1778980 124010488 135038479 1862141 2185768 122148347 132852711 X TO SUPPORT, BENEFIT OR CARRY OUT THE CHARITABLE PURPOSES OF PUBLICLY SUPPORTED ORGANIZATIONS WHOSE PURPOSES INCLUDE PROMOTING HIGH QUALITY MEDICAL CARE, INCLUDING, WITHOUT LIMITATION, ASSISTING PHYSICIANS AND THE PUBLIC TO IMPROVE THE QUALITY OF CARE RECEIVED BY PATIENTS IN THE EVOLVING HEALTHCARE ENVIRONMENT, IN A MANNER THAT CONSTITUTES CHARITABLE, SCIENTIFIC, OR EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. 0 0 2732201 1192968 PHYSICIAN LEADERSHIP - GRANTS AND PROGRAMS TO EQUIP PHYSICIANS WITH THE CORE MANAGEMENT AND LEADERSHIP SKILLS NEEDED AS THEY INCREASINGLY FACE ADMINISTRATIVE AND REGULATORY BURDENS. 913477 199588 GENERAL HEALTH INITIATIVES - INCLUDE SOCIAL DETERMINANTS, DIRECT PRIMARY CARE EDUCATION, AND THE DEVELOPMENT OF TOOLS AND RESOURCES TO HELP PHYSICIAN PRACTICES IMPLEMENT TELEMEDICINE AND TECHNOLOGY. 1182613 763260 WELLNESS - GRANTS AND PROGRAMS TO SUPPORT SYSTEMIC CHANGE AND INNOVATIVE RESEARCH THAT REDUCES PHYSICIAN BURNOUT WHICH CAN HAVE DEVASTATING EFFECTS ON PHYSICIANS' QUALITY OF LIFE, AS WELL AS ON COST OF, ACCESS TO, AND QUALITY OF CARE. 4828291 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 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 27 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 16 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JOHN DORMAN 6173990417 401 W 15TH STREET SUITE 100 AUSTIN TX 78701 GARY PRICE MD CHAIRMAN 20.00 X X 51167 0 0 SUBHI ALI MD TREASURER 5.00 X X 15500 0 0 SANDRA JOHNSON MEMBER 5.00 X 14000 0 0 RUSSELL LIBBY MD MEMBER 5.00 X 2000 0 0 RIP HOLLISTER MD MEMBER 5.00 X 13500 0 0 RALPH NOBO MD MEMBER 5.00 X 14000 0 0 PHIL SCHUH MEMBER 5.00 40.00 X 10500 337032 0 PAUL HARRINGTON MEMBER 5.00 X 13500 0 0 PALMER JONES MEMBER 5.00 X 14000 0 0 JOSEPH VALENTI MD MEMBER 5.00 X 14000 0 0 JENNIFER HANSCOM MEMBER 5.00 40.00 X 14000 333304 20858 GERALD MCKENNA MD MEMBER 5.00 X 10500 0 0 DUSTIN CORCORAN MEMBER 5.00 40.00 X 9500 1062000 90130 DON ALEXANDER MEMBER 5.00 X 14000 0 0 ALEX MALTER MD MEMBER 5.00 X 14000 0 0 ROBERT SELIGSON CEO 40.00 15.00 X X 300000 0 0 LARRY DOWNS SECRETARY 5.00 40.00 X X 16000 210196 0 LAWRENCE BRAUD MD VICE PRESIDENT 5.00 X X 16000 0 0 MARCH SEABROOK MEMBER 5.00 5.00 X 11000 0 0 JOY MAXEY MEMBER 5.00 X 0 0 0 MICHAEL DARROUZET MEMBER 5.00 40.00 X 0 599554 41170 HURSHELL BAGGETT MEMBER 5.00 40.00 X 14000 317177 17530 JERRY VAN METER MEMBER 5.00 X 0 0 0 JOHN DORMAN COO 5.00 40.00 X 100000 450462 70190 681167 3309725 239878 1 0 1 0 WEIL MEDICAL COLLEGE OF CORNELL UNIVERSI 575 LEXINGTON AVE 9TH FLOOR NEW YORK NY 10022 ACADEMIC RESEARCH 851062 JPA HEALTH COMMUNICATIONS 111 CONNECTICUT AVE SUITE 600 WASHINGTON DC 20036 COMMUNICATIONS 457470 GMA FOUNDATIONS 2 LIBERTY SQUARE SUITE 500 BOSTON MA 02109 GRANT MANAGEMENT 392040 THE HEALTH INITIATIVE 255 FRANKLIN ST SUITE 350 BOSTON MA 02110 IMPACT RESEARCH 226202 4 10000 10000 1878817 1878817 22124637 16387809 5736828 5736828 5736828 7625645 0 0 7615645 X 2155816 2155816 681167 490875 190292 22959 16071 6888 34444 34444 110031 110031 258139 258139 772897 535121 237776 5521 5521 144264 92329 51935 148147 111110 37037 86707 65030 21677 22934 22934 PROFESSIONAL CONSULTING 1411410 1378651 32759 SPONSORSHIPS 22000 22000 DUES AND SUBSCRIPTIONS 2579 2579 MISCELLANEOUS -32350 -38712 6362 5846665 4828291 1018374 0 1472455 924870 8481322 4414894 10906 186318 436201 50204995 69223769 63665398 60027839 124010488 135038479 124985 18666 1737156 2167102 1862141 2185768 X 122148347 132852711 122148347 132852711 124010488 135038479 1778980 8925384 0 X 0 1 X 1 0 X X X 64 ALASKA STATE MEDICAL ASSOCIATION 926002176 10 1 0 0 CALIFORNIA MEDICAL ASSOCIATION 940359340 10 1 0 0 CONNECTICUT STATE MEDICAL SOCIETY 060665164 10 1 0 0 DENTON COUNTY MEDICAL SOCIETY 751676014 10 1 0 0 EL PASO COUNTY MEDICAL SOCIETY 741238007 10 1 0 0 FLORIDA MEDICAL ASSOCIATION 590559672 10 1 0 0 LOUISIANA STATE MEDICAL SOCIETY 720386637 10 1 0 0 ACCMA COMMUNITY HEALTH FOUNDATION 461703508 7 0 150000 0 MEDICAL ASSOCIATION OF GEORGIA 580605267 10 1 0 0 MEDICAL SOCIETY OF NEW YORK 131030760 10 1 0 0 MEDICAL SOCIETY OF NORTHERN VIRGINA 540739279 10 1 0 0 NEBRASKA MEDICAL ASSOCIATION 470372108 10 1 0 0 NEW HAMPSHIRE MEDICAL SOCIETY 020223176 10 1 0 0 NORTH CAROLINA MEDICAL ASSOCIATION 560320130 10 1 0 0 SOUTH CAROLINA MEDICAL ASSOCIATION 570248750 10 1 0 0 TENNESSEE MEDICAL ASSOCIATION 620382010 10 1 0 0 MEDICAL SOCIETY OF NEW JERSEY 210601684 10 1 0 0 AMERICAN ACADEMY OF PEDIATRICS 362275597 10 0 0 0 BOARD OF TRUSTEES OF THE LELAND STANFORD JR UNIVERSITY 941156365 2 0 149998 0 CENTER FOR A HEALTHY MARYLAND 521110642 7 0 0 0 COMMUNITY SERVICE EDUCATION AND RESEARCH FUND 237003581 7 0 144320 0 CONNECTICUT STATE MEDICAL SOCIETY PHYSICIAN HEALTH & EDUCATION FUND 061425205 7 0 0 0 DANIEL HANLEY CENTER FOR HEALTH LEADERSHIP 204271488 7 0 0 0 FOUNDATION OF THE AMERICAN ASSOCIATION OF MEDICAL SOCIETY EXECUTIVES 362915937 10 0 0 0 INDIANA MEDICAL FOUNDATION 237001672 7 0 150000 0 TEXAS MEDICAL ASSOCIATION 741078510 10 1 0 0 WASHINGTON STATE MEDICAL ASSOCIATION 910462170 10 1 0 0 METRO OMAHA MEDICAL SOCIETY FOUNDATION 470814363 10 0 0 0 MEDICAL SOCIETY OF VIRGINIA FOUNDATION 521394768 7 0 0 0 MEDICAL EDUCATION AND SCIENTIFIC FOUNDATION OF NY 112780360 7 0 50000 0 MEDICAL ASSOCIATION OF GEORGIA FOUNDATION 586066431 7 0 150000 0 ASSOCIATION OF WOMEN SURGEONS FOUNDATION 364029232 10 0 0 0 PALM BEACH COUNTY MEDICAL SOCIETY SERVICES 651048299 7 0 0 0 KANSAS MEDICAL FOUNDATION 481194663 7 0 0 0 TRAVIS COUNTY MEDICAL SOCIETY FOUNDATION 741720086 7 0 0 0 OHIO MEDICAL EDUCATION FOUNDATION 310907287 10 0 150000 0 SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION 570168534 10 0 0 0 MAYO CLINIC 416011702 10 0 0 0 PHYSICIANS FOR A HEALTHY CALIFORNIA 946062822 7 0 150000 0 FOUNDATION FOR HEALTHY FLORIDIANS 462259497 7 0 150000 0 TWIN CITIES MEDICAL SOCIETY FOUNDATION 510178010 10 0 142968 0 AMERICAN MEDICAL ASSOCIATION 360727175 10 0 0 0 NORTH CAROLINA MEDICAL SOCIETY FOUNDATION 566088142 7 0 0 0 INSTITUTE OF MEDICINE AND PUBLIC OF NEW JERSEY 200678012 7 0 0 0 TENNESSEE MEDICAL EDUCATION FUND INC (TN MEDICAL ASSOCIATION STUDENT EDUCA 626049920 7 0 0 0 TEXAS MEDICAL ASSOCIATION SPECIAL FUNDS FOUNDATION 742749879 7 0 0 0 WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 836004846 7 0 150000 0 MONTANA MEDICAL ASSOCIATION FOUNDATION 463696068 10 0 50000 0 NEBRASKA MEDICAL FOUNDATION 476036827 7 0 150000 0 WSMA FOUNDATION FOR HEALTH CARE IMPROVEMENT 916074463 7 0 0 0 DOCS FOR PATIENT CARE FOUNDATION 464752703 10 0 0 0 PAGNY HEALTH AND RESEARCH FOUNDATION INC 811318522 7 0 0 0 MAINE MEDICAL EDUCATION TRUST 010443926 7 0 0 0 BROWN UNIVERSITY OF PROVIDENCE 050258809 2 0 0 0 ACADEMY OF MEDICINE EDUCATION FOUNDATION 320006201 7 0 24988 0 DR LORNA BREEN HEROES' FOUNDATION 851509081 7 0 75000 0 IOWA MEDICAL SOCIETY FOUNDATION 426078626 7 0 49600 0 MASSACHUSETTS MEDICAL SOCIETY AND ALLIANCE CHARITABLE FOUNDATION 223199624 7 0 25000 0 MISSISSIPPI STATE MEDICAL ASSOCIATION FOUNDATION 570906060 10 0 150000 0 THE RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL 316056230 7 0 93942 0 FUTURE ALASKA MEDICAL LEADERS 831874375 7 0 0 0 LOUISIANA STATE MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 237029259 10 0 0 0 VERMONT MEDICAL SOCIETY 030164911 10 1 0 0 HAWAII MEDICAL ASSOCIATION 990067306 10 1 0 0 64 2155816 0 0 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 PART IV, SECTION A, LINE 1: SUPPORTED ORGANIZATIONS ARE DESIGNATED IN THE GOVERNING DOCUMENTS BY CLASS OR PURPOSE: "TO SUPPORT, BENEFIT OR CARRY OUT THE CHARITABLE PURPOSES OF PUBLICLY SUPPORTED ORGANIZATIONS WHOSE PURPOSES INCLUDE PROMOTING HIGH QUALITY MEDICAL CARE, INCLUDING, WITHOUT LIMITATION, ASSISTING PHYSICIANS AND THE PUBLIC TO IMPROVE THE QUALITY OF CARE RECEIVED BY PATIENTS IN THE EVOLVING HEALTHCARE ENVIRONMENT, IN A MANNER THAT CONSTITUTES CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE CODE." PART IV, SECTION A, LINE 2: THE FOUNDATION CONFIRMS ANNUALLY THAT EACH OF ITS SUPPORTED ORGANIZATIONS QUALIFY AS PUBLICLY SUPPORTED ORGANIZATIONS. ALL 501(C)(6) SUPPORTED ORGANIZATIONS ARE DEEMED TO BE DESCRIBED IN SECTION 509(A)(2) BECAUSE MEMBERSHIP DUES CONSTITUTED MORE THAN ONE THIRD OF THEIR SUPPORT, AND NO MORE THAN ONE THIRD OF THEIR SUPPORT CAME FROM GROSS INVESTMENT INCOME AND NET UNRELATED BUSINESS TAXABLE INCOME. PART IV, SECTION A, LINE 3B: THE FOUNDATION MAINTAINS A COPY OF THE DETERMINATION LETTER FOR EACH SUPPORTED ORGANIZATION THAT QUALIFIES UNDER SECTION 501(C)(6) ALONG WITH AN ANNUALLY-UPDATED SCHEDULE DEMONSTRATING THE ORGANIZATION'S COMPLIANCE WITH THE SECTION 509(A)(2) PUBLIC SUPPORT TEST. PART IV, SECTION A, LINE 3C: TO ENSURE THAT ITS ASSETS ARE USED FOR CHARITABLE PURPOSES, THE FOUNDATION MAKES GRANTS ONLY TO 501(C)(3) ORGANIZATIONS OR 501(C)(6) ORGANIZATIONS THAT ARE DEEMED TO BE DESCRIBED IN SECTION 509(A)(2). FUNDED PROJECTS ARE APPROVED AFTER A RIGOROUS APPLICATION PROCESS. GRANTS ARE MADE SUBJECT TO A WRITTEN AGREEMENT REQUIRING PERIODIC AND FINAL FINANCIAL AND NARRATIVE REPORTS AND PROVIDING THAT THE FOUNDATION MAY WITHHOLD FUTURE PAYMENTS AND DEMAND CORRECTION OF MISUSE OF FUNDS SHOULD THE FOUNDATION DETERMINE FUNDS HAVE NOT BEEN USED FOR APPROVED PURPOSES. PART IV, SECTION A, LINE 5A: AS DESCRIBED IN PART IV, NUMBER 3C, THE FOUNDATION MAKES GRANTS TO 501(C)(3) ORGANIZATIONS AND 501(C)(6) ORGANIZATIONS THAT ARE DEEMED TO BE DESCRIBED IN SECTION 509(A)(2) THAT ARE INCLUDED IN THE CLASS OF ORGANIZATIONS DESIGNATED IN THE GOVERNING DOCUMENTS BY CLASS OR PURPOSE. IN 2021 THE FOUNDATION MADE NEW GRANTS TO 6 ORGANIZATIONS THAT WERE NOT LISTED ON THE 2020 FORM 990: ACADEMY OF MEDICINE EDUCATION FOUNDATION, MASSACHUSETTS MEDICAL SOCIETY AND ALLIANCE CHARITABLE FOUNDATION, IOWA MEDICAL SOCIETY FOUNDATION, MISSISSIPPI STATE MEDICAL ASSOCIATION FOUNDATION, THE REEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL, AND DR. LORNA BREEN HEROES' FOUNDATION. SOME OF THE SUPPORTED ORGANIZATIONS DID NOT RECEIVE SUPPORT DURING 2021, BUT THEY ARE ALL LISTED ON SCHEDULE A, PART VI OF THE 2021 FORM 990. 7 ORGANIZATIONS THAT WERE LISTED AS SUPPORTED ORGANIZATIONS ON THE 2020 FORM 990, SCHEDULE A ARE NO LONGER SUPPORTED ORGANIZATIONS AND WERE REMOVED FROM THE 2021 LIST. PART IV, SECTION B, LINE 2: IN ADDITION TO MAKING GRANTS TO 501(C)(3) ORGANIZATIONS OPERATED, SUPERVISED OR CONTROLLED BY SUPPORTED ORGANIZATIONS NAMED IN THE ORGANIZING DOCUMENTS, THE FOUNDATION ALSO GIVES GRANTS TO 501(C)(6) ORGANIZATIONS TO CARRY OUT THE FOUNDATION'S CHARITABLE PURPOSES. SEE REV. RUL. 76-401, 1976-C.B. 175, WHICH PROVIDES THAT THE GENERAL REQUIREMENTS OF SECTIONS 1.509(A)-4(C), (D) AND (E) OF THE REGULATIONS ARE INAPPLICABLE TO SUPPORTED SECTION 501(C)(6) ORGANIZATIONS FOR PURPOSES OF SATISFYING BOTH THE ORGANIZATIONAL AND OPERATIONAL TESTS OF SECTION 509(A)(3)(A) OF THE INTERNAL REVENUE CODE. THE FOUNDATION MAKES GRANTS TO PUBLICLY SUPPORTED ORGANIZATIONS THAT DO NOT CONTROL THE FOUNDATION, BUT BY BENEFITTING THEM, THE FOUNDATION CARRIES OUT THE PURPOSE OF THE CONTROLLING SIGNATORY ENTITIES, AS PERMITTED UNDER SECTION 1.509(A)-4(G)(1)(II) OF THE REGULATIONS. 0 ISHARES CORE S&P SMALL CAP E 12455825 F ISHARES CORE S&P 500 ETF 21366290 F ISHARES S&P MIDCAP 400 INDEX 10778554 F ISHARES TR RUS 1000 GRW ETF 8584023 F ISHARES RUSSELL 1000 VALUE ETF 6843147 F 60027839 X 16292890 8925384 8925384 7367506 258139 258139 7625645 5588526 0 5588526 258139 258139 5846665 PART X, LINE 2: THE FOUNDATION ACCOUNTS FOR UNCERTAINTY OF INCOME TAXES BASED ON A "MORE-LIKELY-THAN-NOT" THRESHOLD FOR THE RECOGNITION AND DE-RECOGNITION OF TAX POSITIONS, WHICH INCLUDES THE ACCOUNTING FOR INTEREST AND PENALTIES. AT DECEMBER 31, 2021 AND 2020, THE FOUNDATION DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS RESULTING FROM ITS TAX POSITIONS. 1 THE OSMA FOUNDATION 5115 PARKCENTER AVENUE SUITE 200 DUBLIN OH 43017 310907287 501(C)(3) 150000 0 TO ADDRESS BURNOUT AMONG THE STATE'S PHYSICIANS BY PROVIDING TRAINING AND SUPPORT FOR IMPLEMENTING PRACTICE-LEVEL CHANGES TWIN CITIES MEDICAL SOCIETY FOUNDATION 1300 GODWARD STREET STE 2000 MINNEAPOLIS MN 55413 510178010 501(C)(3) 142968 0 TO SUPPORT EXPANSION OF THE CURRENT COHORT OF THE PUBLIC HEALTH LEADERSHIP PROGRAM MEDICAL EDUCATION AND SCIENTIFIC FOUNDATION OF NY 865 MERRICK AVE WESTBURY NY 11590 112780360 501(C)(3) 50000 0 TO SUPPORT A LEADERSHIP PROGRAM TARGETING WOMEN PHYSICIANS; TO ADDRESS BURNOUT AMONG THE STATE'S PHYSICIANS BY PROVIDING TRAINING AND SUPPORT FOR IMPLEMENTING PRACTICE-LEVEL CHANGES ACADEMY OF MEDICINE EDUCATION FOUNDATION 6111 OAK TREE BLVD SUITE 150 INDEPENDENCE OH 44131 320006201 501(C)(3) 24988 0 TO SUPPORT TELEHEALTH ACCMA COMMUNITY HEALTH FOUNDATION 6230 CLAREMONT AVE 3RD FLOOR OAKLAND CA 94618 461703508 501(C)(3) 150000 0 TO DEVELOP AND DELIVER LEADERSHIP PROGRAM BOARD OF TRUSTEES OF THE LELAND STANFORD JR UNIVERSITY 1520 PAGE MILL ROAD PALO ALTO CA 94304 941156365 501(C)(3) 149998 0 TO DEVELOP AND IMPLEMENT A PROGRAM TO DRIVE PHYSICIAN ENGAGEMENT FOR A CULTURE OF WELLNESS COMMUNITY SERVICE EDUCATION AND RESEARCH FUND 5380 ELVAS AVE SUITE 104 SACRAMENTO CA 95819 237003581 501(C)(3) 144320 0 TO ESTABLISH THE JOY OF MEDICINE PROGRAM TO IMPROVE PHYSICIAN WELL-BEING DR LORNA BREEN HEROES' FOUNDATION 1867 WINSTON RD CHARLOTTESVILLE VA 22903 851509081 501(C)(3) 75000 0 TO PROMOTE A WELLNESS PROGRAM FOUNDATION FOR HEALTHY FLORIDIANS 1430 PIEDMONT DRIVE EAST TALLAHASSEE FL 32308 462259497 501(C)(3) 150000 0 TO DEVELOP EDUCATIONAL CONTENT AND PROMOTE INNOVATIVE PHYSICIAN-LED MODELS INDIANA MEDICAL FOUNDATION 23 CANAL WALK INDIANAPOLIS IN 46202 237001672 501(C)(3) 150000 0 TO SUPPORT THE LAUNCH OF A PHYSICIAN LEADERSHIP PROGRAM IOWA MEDICAL SOCIETY FOUNDATION 515 LOCUST ST SUITE 400 DES MOINES IA 50309 426078626 501(C)(3) 49600 0 TO SUPPORT TELEHEALTH IN RURAL AMERICA MASSACHUSETTS MEDICAL SOCIETY AND ALLIANCE CHARITABLE FOUNDATION 860 WINTER STREET WALTHAM MA 02451 223199624 501(C)(3) 25000 0 TO SUPPORT TELEHEALTH MEDICAL ASSOCIATION OF GEORGIA FOUNDATION 1849 THE EXCHANGE SE 200 ATLANTA GA 30339 586066431 501(C)(3) 150000 0 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM MISSISSIPPI STATE MEDICAL ASSOCIATION FOUNDATION 408 WEST PARKWAY PLACE RIDGELAND MS 39157 570906060 501(C)(3) 150000 0 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM MONTANA MEDICAL ASSOCIATION FOUNDATION 2021 11TH AVENUE STE 1 HELENA MT 59601 463696068 501(C)(3) 50000 0 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM NEBRASKA MEDICAL FOUNDATION 233 S 13TH STREET SUITE 1200 LINCOLN NE 68508 476036827 501(C)(3) 150000 0 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM PHYSICIANS FOR A HEALTHY CALIFORNIA 1201 J STREET SUITE 200 SACRAMENTO CA 95814 946062822 501(C)(3) 150000 0 TO DEVELOP PROGRAMS TO INCREASE WELLNESS OF ETHNIC MINORITY WOMAN PHYSICIANS THE RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL 700 CHILDRENS DRIVE COLUMBUS OH 43205 316056230 501(C)(3) 93942 0 TO SUPPORT A WELLLNESS PROGRAM WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 122 E 17TH STREET CHEYENNE WY 82001 836004846 501(C)(3) 150000 0 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM 19 PART I, LINE 2: TO ENSURE THAT ITS ASSETS ARE USED FOR CHARITABLE PURPOSES, THE FOUNDATION MAKES GRANTS ONLY TO 501(C)(3) ORGANIZATIONS AND 501(C)(6) ORGANIZATIONS THAT ARE DEEMED TO BE DESCRIBED IN SECTION 509(A)(2). FUNDED PROJECTS ARE APPROVED ONLY AFTER A RIGOROUS APPLICATION PROCESS. THE GRANT COMMITTEE MEETS QUARTERLY TO DISCUSS RECOMMENDED PHYSICIAN LEADERSHIP PROPOSALS AND APPROVAL OF GRANTS THAT RELATE TO THE FOUNDATION'S MISSION. FINAL RECOMMENDATIONS ARE APPROVED BY THE FULL BOARD. GRANTS ARE MADE SUBJECT TO A WRITTEN AGREEMENT REQUIRING PERIODIC AND FINAL FINANCIAL AND NARRATIVE REPORTS AND PROVIDING THAT THE FOUNDATION MAY WITHHOLD FUTURE PAYMENTS AND DEMAND CORRECTION OF MISUSE OF FUNDS SHOULD THE FOUNDATION DETERMINE THAT FUNDS HAVE NOT BEEN USED FOR APPROVED PURPOSES. X X 0 0 0 0 0 0 0 0 0 DUSTIN CORCORAN MEMBER 9500 775000 0 275000 0 12000 0 26100 0 64030 9500 1152130 0 0 MICHAEL DARROUZET MEMBER 0 540000 0 27000 0 32554 0 29000 0 12170 0 640724 0 0 JOHN DORMAN COO 100000 382664 0 19133 0 48665 0 58000 0 12190 100000 520652 0 0 JENNIFER HANSCOM MEMBER 14000 302956 0 23348 0 7000 0 8700 0 12158 14000 354162 0 0 HURSHELL BAGGETT MEMBER 14000 282822 0 34355 0 0 0 0 0 17530 14000 334707 0 0 PHIL SCHUH MEMBER 10500 337032 0 0 0 0 0 0 0 0 10500 337032 0 0 ROBERT SELIGSON CEO 300000 0 0 0 0 0 0 0 0 0 300000 0 0 0 LARRY DOWNS SECRETARY 16000 204196 0 0 0 6000 0 0 0 0 16000 210196 0 0 FORM 990, PART VI, SECTION A, LINE 7A THE MEDICAL ASSOCIATIONS AND SOCIETIES NAMED IN THE FOUNDATION'S BYLAWS HAVE THE POWER TO APPOINT MEMBERS OF THE BOARD OF DIRECTORS AND MAY REMOVE THEIR RESPECTIVE APPOINTEES. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE FORM 990 IS REVIEWED BY THE COO AND DISTRIBUTED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST NO LESS FREQUENTLY THAN ANNUALLY. THE BOARD OF DIRECTORS REVIEWS THE DISCLOSURES AND ENSURES ALL TRANSACTIONS ARE FAIR TO THE FOUNDATION. IF THE POLICY IS VIOLATED, THE BOARD OF DIRECTORS MAY VOID THE CONTRACT OR TRANSACTION AND RECOVER DAMAGES OR MODIFY THE PRICE AND TERMS TO MATCH WHAT THE FOUNDATION WOULD RECEIVE IN AN ARM'S-LENGTH NEGOTIATION. FORM 990, PART VI, SECTION B, LINE 15A IN 2015, THE BOARD OF DIRECTORS CONTRACTED WITH AN INDEPENDENT COMPENSATION CONSULTANT TO ENSURE THAT AMOUNTS PAID TO DIRECTORS, CEO, AND COO ARE NOT EXCESSIVE. FORM 990, PART VI, SECTION C, LINE 19 ALL REQUIRED DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G GRANT MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 198,745. MANAGEMENT AND GENERAL EXPENSES 149,930. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 348,675. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 306,000. MANAGEMENT AND GENERAL EXPENSES 77,722. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 383,722. CONSULTING: PROGRAM SERVICE EXPENSES 30,376. MANAGEMENT AND GENERAL EXPENSES 10,124. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,500. ALASKA STATE MEDICAL ASSOCIATION 4107 LAUREL ST ANCHORAGE AK 99508 926002176 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS AK 501(C)(6) 0 CALIFORNIA MEDICAL ASSOCIATION 1201 J STREET SUITE 200 SACREMENTO CA 95814 940359340 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS CA 501(C)(6) 0 CONNECTICUT STATE MEDICAL SOCIETY 127 WASHINGTON AVE EAST 3RD FLOOR NORTH HAVEN CT 06473 060665164 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS CT 501(C)(6) 0 DENTON COUNTY MEDICAL SOCIETY 3537 S INTERSTATE 35 ESTE 302 DENTON TX 76210 751676014 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS TX 501(C)(6) 0 EL PASO COUNTY MEDICAL SOCIETY 730 CITADEL DR EAST SUITE 206 COLORADO SPRINGS CO 80909 741238007 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS CO 501(C)(6) 0 FLORIDA MEDICAL ASSOCIATION 1430 PIEDMONT DR E TALLAHASSEE FL 32308 590559672 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS FL 501(C)(6) 0 HAWAII MEDICAL ASSOCIATION 1360 S BERETANIA ST 200 HONOLULU HI 96814 990067306 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS HI 501(C)(6) 0 LOUISIANA STATE MEDICAL SOCIETY 6767 PERKINS ROAD SUITE 100 BATON ROUGE LA 70808 720386637 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS LA 501(C)(6) 0 MEDICAL ASSOCIATION OF GEORGIA 1849 THE EXCHANGE SUITE 200 ATLANTA GA 30339 580605267 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS GA 501(C)(6) 0 MEDICAL SOCIETY OF NEW JERSEY TWO PRINCESS ROAD LAWRENCEVILLE NJ 08648 210601684 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS NJ 501(C)(6) 0 MEDICAL SOCIETY OF NEW YORK 865 MERRICK AVE SUITE 200 WESTBURY NY 11590 131030760 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS NY 501(C)(6) 0 MEDICAL SOCIETY OF NORTHERN VIRGINA 4604 JONES BRANCH DR SUITE 3150 MCLEAN VA 22102 540739279 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS VA 501(C)(6) 0 NEBRASKA MEDICAL ASSOCIATION 233 S 13TH STREET SUITE 1200 LINCOLN NE 68508 470372108 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS NE 501(C)(6) 0 NEW HAMPSHIRE MEDICAL SOCIETY 7 NORTH STATE DTREET CONCORD NH 03301 020223176 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS NH 501(C)(6) 0 NORTH CAROLINA MEDICAL ASSOCIATION PO BOX 27167 RALEIGH NC 27611 560320130 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS NC 501(C)(6) 0 SOUTH CAROLINA MEDICAL ASSOCIATION 132 WESTPARK BLVD COLUMBIA SC 29210 570248750 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS SC 501(C)(6) 0 TENNESSEE MEDICAL ASSOCIATION 701 BRADFORD AVENUE NASHVILLE TN 37204 620382010 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS TN 501(C)(6) 0 TEXAS MEDICAL ASSOCIATION 401 WEST 15TH STREET SUITE 100 AUSTIN TX 78701 741078510 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS TX 501(C)(6) 0 VERMONT MEDICAL SOCIETY PO BOX 1457 MONTPELIER VT 05601 030164911 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS VT 501(C)(6) 0 WASHINGTON STATE MEDICAL ASSOCIATION 2001 SIXTH AVE SUITE 2700 SEATTLE WA 98121 910462170 PROFESSIONAL SOCIETY REPRESENTING PHYSICIANS WA 501(C)(6) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 MEDICAL SOCIETY OF NEW JERSEY P 3935 FMV MEDICAL SOCIETY OF THE STATE OF NY P 2327 FMV TEXAS MEDICAL ASSOCIATION P 23322 FMV TEXAS MEDICAL ASSOCIATION M 100000 CONTRACTED AMOUNT WASHINGTON STATE MEDICAL ASSOCIATION P 1912 FMV MEDICAL SOCIETY OF NV R 12000 FMV MEDICAL SOCIETY OF THE STATE OF NY R 3500 FMV TEXAS MEDICAL ASSOCIATION R 11000 FMV CALIFORNIA MEDICAL ASSOCIATION P 3277 FMV