2021-11-10T19:00:22-06:00 2020-12-31 463330935 AVENSON HAMANN CPAS LLP 1779 WELLS BRANCH PKWY 110B-292 AUSTIN TX 78728 990 2020-01-01 200914085 THE PHYSICIANS FOUNDATION INC PHYS 6173990417 401 W 15TH STREET NO 100 AUSTIN TX 78701 JOHN DORMAN COO 6173990417 2021-11-10 1 JOHN DORMAN 999009999 CATHERINE AVENSON P01259734 5126939131 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JOHN DORMAN 401 W 15TH STREET NO 100 AUSTIN TX 78701 36352700 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 15 3 0 0 0 0 0 0 0 3888942 4549667 0 5000 3888942 4554667 3008992 2181085 0 0 457329 645307 0 0 0 3414503 2990028 6880824 5816420 -2991882 -1261753 118723740 124010488 2195365 1862141 116528375 122148347 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 2282763 984114 PHYSICIAN LEADERSHIP - GRANTS AND PROGRAMS TO EQUIP PHYSICIANS WITH THE CORE MANAGEMENT AND LEADERSHIP SKILLS NEEDED AS THEY INCREASINGLY FACE ADMINISTRATIVE AND REGULATORY BURDENS. 1477641 400000 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. 1076854 796971 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. 4837258 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 22 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 15 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 20000 0 0 SUBHI ALI MD MEMBER 5.00 X 16000 0 0 SANDRA JOHNSON MEMBER 5.00 X 15000 0 0 RUSSELL LIBBY MD MEMBER 5.00 X 3000 0 0 RIP HOLLISTER MD MEMBER 5.00 X 15000 0 0 RALPH NOBO MD MEMBER 5.00 X 15000 0 0 PHIL SCHUH MEMBER 5.00 40.00 X 0 363971 0 PAUL HARRINGTON MEMBER 5.00 X 15000 0 0 PALMER JONES MEMBER 5.00 X 15000 0 0 JOSEPH VALENTI MD MEMBER 5.00 X 15000 0 0 JENNIFER HANSCOM MEMBER 5.00 40.00 X 15000 289707 22607 GERALD MCKENNA MD MEMBER 5.00 X 12000 0 0 DUSTIN CORCORAN MEMBER 5.00 40.00 X 9000 931194 76669 DON ALEXANDER MEMBER 5.00 X 15000 0 0 ALEX MALTER MD MEMBER 5.00 X 15000 0 0 ROBERT SELIGSON CEO AS OF MAY'20 40.00 15.00 X X 173000 380648 20233 LARRY DOWNS SECRETARY 5.00 40.00 X X 17500 212604 0 LAWRENCE BRAUD MD VICE PRESIDENT 5.00 X X 17500 0 0 MARCH SEABROOK MEMBER 5.00 5.00 X 15000 0 0 JOY MAXEY MEMBER 5.00 X 0 0 0 MICHAEL DARROUZET MEMBER 5.00 40.00 X 0 596545 26571 HURSHELL BAGGETT MEMBER 5.00 40.00 X 0 256837 20233 JOHN DORMAN COO 5.00 40.00 X 100000 462324 69673 TIM NORBECK CEO UNTIL MAY'20 40.00 X 100000 0 0 618000 3493830 235986 1 0 1 0 WEIL MEDICAL COLLEGE OF CORNELL UNIVERSI 575 LEXINGTON AVE 9TH FLOOR NEW YORK NY 10022 ACADEMIC RESEARCH 1297875 GMA FOUNDATIONS 2 LIBERTY SQUARE SUITE 500 BOSTON MA 02109 GRANT MANAGEMENT 415398 JPA HEALTH COMMUNICATIONS 111 CONNECTICUT AVE SUITE 600 WASHINGTON DC 20036 COMMUNICATIONS 392746 MERRITT HAWKINS & ASSOCIATES 8840 CYPRESS WATERS BLVD SUITE 300 COPPELL TX 75019 PHYSICIAN SURVEY 375000 THE HEALTH INITIATIVE 255 FRANKLIN ST SUITE 350 BOSTON MA 02110 IMPACT RESEARCH 148483 5 2268167 2268167 34079533 31798033 2281500 2281500 2281500 OTHER REVENUE 900099 5000 5000 5000 4554667 0 0 4554667 X 2181085 2181085 618000 432600 185400 27307 19115 8192 23654 23654 110000 110000 252769 252769 861877 631351 230526 1552 1552 75353 24866 50487 97887 68521 29366 71620 50134 21486 24940 24940 PROFESSIONAL CONSULTING 1613475 1581475 32000 SPONSORSHIPS 36200 36200 DUES AND SUBSCRIPTIONS 4344 4344 MISCELLANEOUS -183643 -188089 4446 5816420 4837258 979162 0 1200965 1472455 3749541 8481322 86628 183963 186318 47262055 50204995 66240588 63665398 118723740 124010488 457550 124985 1737815 1737156 2195365 1862141 X 116528375 122148347 116528375 122148347 118723740 124010488 -1261753 6881725 0 X 0 1 X 1 0 X X X 63 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 HAWAII MEDICAL ASSOCIATION 990067306 10 1 0 0 LOUISIANA STATE MEDICAL SOCIETY 720386637 10 1 0 0 ACCMA COMMUNITY HEALTH FOUNDATION 461703508 7 0 0 0 MEDICAL ASSOCIATION OF GEORGIA 580605267 10 1 0 0 MEDICAL SOCIETY OF NEW YORK 131030760 10 1 150000 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 BAYLOR SCOTT & WHITE HEALTHCARE FOUNDATION 273513154 7 0 0 0 AMERICAN ACADEMY OF PEDIATRICS 362275597 10 0 376971 0 BOARD OF TRUSTEES OF THE LELAND STANFORD JR UNIVERSITY 941156365 2 0 0 0 CALIFORNIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION 941149565 7 0 0 0 CENTER FOR A HEALTHY MARYLAND 521110642 7 0 0 0 COMMUNITY SERVICE EDUCATION AND RESEARCH FUND 237003581 7 0 0 0 CONNECTICUT STATE MEDICAL SOCIETY PHYSICIAN HEALTH & EDUCATION FUND 061425205 7 0 150000 0 DANIEL HANLEY CENTER FOR HEALTH LEADERSHIP 204271488 7 0 75000 0 FOUNDATION OF THE AMERICAN ASSOCIATION OF MEDICAL SOCIETY EXECUTIVES 362915937 10 0 0 0 HAWAII MEDICAL FOUNDATION 237063698 7 0 0 0 INDIANA MEDICAL FOUNDATION 237001672 7 0 0 0 TEXAS MEDICAL ASSOCIATION 741078510 10 1 0 0 WASHINGTON STATE MEDICAL ASSOCIATION 910462170 10 1 0 0 VERMONT MEDICAL SOCIETY 030164911 10 1 0 0 MOUNT SINAI MEDICAL CENTER 136271888 7 0 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 230000 0 MEDICAL ASSOCIATION OF GEORGIA FOUNDATION 586066431 7 0 0 0 ASSOCIATION OF WOMEN SURGEONS FOUNDATION 364029232 10 0 0 0 PALM BEACH COUNTY MEDICAL SOCIETY SERVICES 651048299 7 0 148800 0 KANSAS MEDICAL FOUNDATION 481194663 7 0 0 0 WISCONSIN MEDICAL SOCIETY FOUNDATION 396045649 7 0 0 0 TRAVIS COUNTY MEDICAL SOCIETY FOUNDATION 741720086 7 0 0 0 THE GENERAL HOSPITAL (MASSACHUSETTS GENERAL HOSPITAL) 042697983 3 0 0 0 OHIO MEDICAL EDUCATION FOUNDATION 310907287 10 0 80000 0 SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION 570168534 10 0 80000 0 MAYO CLINIC 416011702 10 0 0 0 PHYSICIANS FOR A HEALTHY CALIFORNIA 946062822 7 0 0 0 FOUNDATION FOR HEALTHY FLORIDIANS 462259497 7 0 0 0 TWIN CITIES MEDICAL SOCIETY FOUNDATION 510178010 10 0 10314 0 AMERICAN MEDICAL ASSOCIATION 360727175 10 0 0 0 NORTH CAROLINA MEDICAL SOCIETY FOUNDATION 566088142 7 0 150000 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 250000 0 WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 836004846 7 0 0 0 VERMONT MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 200183445 10 0 0 0 MONTANA MEDICAL ASSOCIATION FOUNDATION 463696068 10 0 0 0 NEBRASKA MEDICAL FOUNDATION 476036827 7 0 0 0 WSMA FOUNDATION FOR HEALTH CARE IMPROVEMENT 916074463 7 0 0 0 DOCS FOR PATIENT CARE FOUNDATION 464752703 10 0 150000 0 PAGNY HEALTH AND RESEARCH FOUNDATION INC 811318522 7 0 150000 0 MAINE MEDICAL EDUCATION TRUST 010443926 7 0 80000 0 BROWN UNIVERSITY OF PROVIDENCE 050258809 2 0 100000 0 63 2181085 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 2020 THE FOUNDATION MADE NEW GRANTS TO 3 ORGANIZATIONS THAT WERE NOT LISTED ON THE 2019 FORM 990: PAGNY HEALTH AND RESEARCH FOUNDATION, MAINE MEDICAL EDUCATION TRUST, AND BROWN UNIVERSITY OF PROVIDENCE. SOME OF THE SUPPORTED ORGANIZATIONS DID NOT RECEIVE SUPPORT DURING 2020, BUT THEY ARE ALL LISTED ON SCHEDULE A, PART VI OF THE 2020 FORM 990. 19 ORGANIZATIONS THAT WERE LISTED AS SUPPORTED ORGANIZATIONS ON THE 2019 FORM 990, SCHEDULE A ARE NO LONGER SUPPORTED ORGANIZATIONS AND WERE REMOVED FROM THE 2020 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 VANGUARD TOTAL BD MKT IDX INST 9744243 F METROPOLITAN WST INTM BD I 9687699 F S&P 500 INDEX FUND 18975964 F ISHARES SP SMALLCAP 600 INDEX 9840652 F ISHARES S&P MIDCAP 400 INDEX 8643217 F ISHARES TR RUS 1000 GRW ETF 6773623 F 63665398 X 11183623 6881725 6881725 4301898 252769 252769 4554667 5563651 0 5563651 252769 252769 5816420 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, 2020, THE FOUNDATION DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS RESULTING FROM ITS TAX POSITIONS. 1 DOCS FOR PATIENT CARE FOUNDATION 1210 NORTH MAPLE ROAD ANN ARBOR MI 48103 464752703 501(C)(3) 150000 TO SUPPORT A SMALL GROUP MENTORING PROGRAM CULMINATING IN THE DIRECT PRIMARY CARE CONFERENCE SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION PO BOX 11188 COLUMBIA SC 29211 570168534 501(C)(3) 80000 TO ADDRESS BURNOUT AMONG THE STATE'S PHYSICIANS BY PROVIDING TRAINING AND SUPPORT FOR IMPLEMENTING PRACTICE-LEVEL CHANGES NORTH CAROLINA MEDICAL SOCIETY FOUNDATION PO BOX 27167 RALEIGH NC 27611 566088142 501(C)(3) 150000 TO SUPPORT THE THREE MAIN LEADERSHIP DEVELOPMENT PROGRAM OFFERINGS WITHIN THE KANOF INSTITUTE FOR PHYSICIAN LEADERSHIP TEXAS MEDICAL ASSOCIATION SPECIAL FUNDS FOUNDATION 401 WEST 15TH STREET AUSTIN TX 78701 742749879 501(C)(3) 250000 TO SUPPORT A COLLABORATION BETWEEN MEDICAL SOCIETIES TO DEVELOP AND SHARE RESOURCES AND EXPERTISE ON TELEHEALTH IMPLEMENTATION OHIO MEDICAL EDUCATION FOUNDATION 5115 PARKCENTER AVENUE SUITE 200 DUBLIN OH 43017 310907287 501(C)(3) 80000 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) 10314 TO SUPPORT EXPANSION OF THE CURRENT COHORT OF THE PUBLIC HEALTH LEADERSHIP PROGRAM DANIEL HANLEY CENTER FOR HEALTH LEADERSHIP 217 COMMERCIAL STREET STE 406 NORTH HAVEN CT 06473 204271488 501(C)(3) 75000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM GEARED TOWARDS RURAL PHYSICIANS PALM BEACH COUNTY MEDICAL SOCIETY SERVICES 3540 FOREST HILL BLVD 101 WEST PALM BEACH FL 33406 651048299 501(C)(3) 148800 TO ENHANCE THE PHYSICIAN LEADERSHIP ACADEMY COLLABORATION BETWEEN THREE COUNTY MEDICAL SOCIETIES CONNECTICUT STATE MEDICAL SOCIETY PHYSICIAN HEALTH AND EDUCATION FUND 127 WASHINGTON AVE EAST BLDG 3RD FLOOR NORTH HAVEN CT 06473 061425205 501(C)(3) 150000 TO SUPPORT THE DEVELOPMENT OF YOUNG PHYSICIAN LEADERS MEDICAL EDUCATION AND SCIENTIFIC FOUNDATION OF NY 865 MERRICK AVE WESTBURY NY 11590 112780360 501(C)(3) 230000 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 MEDICAL SOCIETY OF VIRGINIA FOUNDATION 2924 EMERYWOOD PKWY SUITE 300 RICHMOND VA 23294 521394768 501(C)(3) 150000 TO EXPAND AND ENHANCE THE PHYSICIAN LEADERSHIP INSTITUTE PAGNY HEALTH AND RESEARCH FOUNDATION INC 55 W 125TH STREET SUITE 1001 NEW YORK NY 10027 811318522 501(C)(3) 150000 TO SUPPORT THE NEW COACHING SKILLS DEVELOPMENT PROGRAM AS PART OF THE LEADERSHIP DEVELOPMENT PIPELINE MAINE MEDICAL EDUCATION TRUST PO BOX 190 MANCHESTER ME 04351 010443926 501(C)(3) 80000 TO ADDRESS BURNOUT AMONG THE STATE'S PHYSICIANS BY PROVIDING TRAINING AND SUPPORT FOR IMPLEMENTING PRACTICE-LEVEL CHANGES BROWN UNIVERSITY OF PROVIDENCE CONTROLLERS OFFICE BOX 3 PROVIDENCE RI 02912 050258809 501(C)(3) 100000 TO SUPPORT THE IMPLEMENTATION OF THE SECOND PATIENT PRACTITIONER AND COMPUTER CONFERENCE AMERICAN ACADEMY OF PEDIATRICS 141 NORTHWEST POINT BLVD ELK GROVE IL 60007 362275597 501(C)(3) 376971 TO EXPAND THE WELLNESS THROUGH EQUITY AND LEADERSHIP (WEL 2.0) TRAINING FOR EARLY AND MID CAREER WOMEN PHYSICIANS 15 0 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 9000 551250 0 350000 0 29944 0 25650 0 51019 9000 1007863 0 0 JOHN DORMAN COO 100000 382664 0 35727 0 43933 0 57000 0 12673 100000 531997 0 0 MICHAEL DARROUZET MEMBER 0 540000 0 43900 0 12645 0 14850 0 11721 0 623116 0 0 ROBERT SELIGSON CEO AS OF MAY'20 173000 380648 0 0 0 0 0 0 0 20233 173000 400881 0 0 PHIL SCHUH MEMBER 0 349802 0 0 0 14169 0 0 0 0 0 363971 0 0 JENNIFER HANSCOM MEMBER 15000 256912 0 25795 0 7000 0 11400 0 11207 15000 312314 0 0 HURSHELL BAGGETT MEMBER 0 231837 0 25000 0 0 0 0 0 20233 0 277070 0 0 LARRY DOWNS SECRETARY 17500 204196 0 0 0 8408 0 0 0 0 17500 212604 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 239,850. MANAGEMENT AND GENERAL EXPENSES 159,900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 399,750. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 357,421. MANAGEMENT AND GENERAL EXPENSES 56,706. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 414,127. CONSULTING: PROGRAM SERVICE EXPENSES 34,080. MANAGEMENT AND GENERAL EXPENSES 13,920. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,000. 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 5189 FMV MEDICAL SOCIETY OF THE STATE OF NY P 2426 FMV TEXAS MEDICAL ASSOCIATION P 11572 FMV TEXAS MEDICAL ASSOCIATION M 100000 CONTRACTED AMOUNT WASHINGTON STATE MEDICAL ASSOCIATION P 3371 FMV MEDICAL SOCIETY OF NV R 12000 FMV MEDICAL SOCIETY OF THE STATE OF NY R 15000 FMV TEXAS MEDICAL ASSOCIATION R 6000 FMV