2020-11-05T09:50:58-06:00 2019-12-31 463330935 AVENSON HAMANN CPAS LLP 1779 WELLS BRANCH PKWY 110B-292 AUSTIN TX 78728 990 2019-01-01 200914085 THE PHYSICIANS FOUNDATION INC PHYS 6173990417 401 W 15TH STREET NO 100 AUSTIN TX 78701 JOHN DORMAN COO 6173990417 2020-11-04 1 CATHERINE AVENSON P01259734 5126939131 45.18.124.65 2020-11-05 09:50:54 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 357970AC9E1D7E23FF1AD2A84AA029E57A57FC34 2019 2021-01-29 14:40:06Z JOHN DORMAN 401 W 15TH STREET NO 100 AUSTIN TX 78701 23136894 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 2 0 0 0 0 0 0 0 8161753 3888942 0 0 8161753 3888942 3072581 3008992 0 0 258000 457329 0 0 0 3989604 3414503 7320185 6880824 841568 -2991882 106371957 118723740 2526819 2195365 103845138 116528375 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 2709370 1235992 PHYSICIAN LEADERSHIP - GRANTS AND PROGRAMS TO EQUIP PHYSICIANS WITH THE CORE MANAGEMENT AND LEADERSHIP SKILLS NEEDED AS THEY INCREASINGLY FACE ADMINISTRATIVE AND REGULATORY BURDENS. 1649513 850000 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. 970602 710626 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. 350160 212374 DISASTER RELIEF - GRANTS TO HELP PHYSICIAN PRACTICES REBUILD AFTER DISASTERS SO THEY CAN GET BACK TO TREATING PATIENTS AS QUICKLY AS POSSIBLE. 350160 212374 5679645 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 30 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 15 0 0 1 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 16000 0 0 SUNNY RAMCHANDANI MD MEMBER 5.00 X 0 0 0 SUBHI ALI MD MEMBER 5.00 X 12000 0 0 SANDRA JOHNSON MEMBER 5.00 X 12000 0 0 RUSSELL LIBBY MD MEMBER 5.00 X 0 0 0 RIP HOLLISTER MD MEMBER 5.00 X 12000 0 0 RALPH NOBO MD MEMBER 5.00 X 12000 0 0 PHIL SCHUH MEMBER 5.00 40.00 X 0 398109 0 PAUL HARRINGTON MEMBER 5.00 40.00 X 12000 0 0 PALMER JONES MEMBER 5.00 X 12000 0 0 LOU GOODMAN MEMBER 5.00 40.00 X 3000 736383 107720 JOSEPH VALENTI MD MEMBER 5.00 X 12000 0 0 JENNIFER HANSCOM MEMBER 5.00 40.00 X 12000 270142 22061 GERALD MCKENNA MD MEMBER 5.00 X 12000 0 0 DUSTIN CORCORAN MEMBER 5.00 40.00 X 6000 950248 73762 DON ALEXANDER MEMBER 5.00 X 12000 0 0 ALEX MALTER MD MEMBER 5.00 X 12000 0 0 ROBERT SELIGSON TREASURER 15.00 40.00 X X 14000 405801 0 LARRY DOWNS SECRETARY 5.00 40.00 X X 14000 228505 0 LAWRENCE BRAUD MD VICE PRESIDENT 5.00 X X 14000 0 0 ALAN PLUMMER MD VICE PRESIDENT 10.00 X X 7000 0 0 MARCH SEABROOK MEMBER 5.00 5.00 X 12000 8000 0 JOY MAXEY MEMBER 5.00 X 0 0 0 WALKER RAY MEMBER 5.00 X 24844 0 0 JOHN DORMAN COO 5.00 40.00 X 100000 438248 68673 TIM NORBECK CEO 40.00 X 300000 0 0 642844 3435436 272216 1 0 1 0 GMA FOUNDATIONS 2 LIBERTY SQUARE SUITE 500 BOSTON MA 02109 GRANT MANAGEMENT 429243 JPA HEALTH COMMUNICATIONS 111 CONNECTICUT AVE SUITE 600 WASHINGTON DC 20036 COMMUNICATIONS 415782 PROJECT HOPE HEALTH AFFAIRS 7500 OLD GEORGETOWN RD SUITE 600 BETHESDA MD 20814 HEALTH POLICY RESEARCH 200000 GLOBAL DEVELOPMENT INCUBATOR 1401 K ST NW SUITE 900 WASHINGTON DC 20005 MANAGEMENT 174685 4 3120305 3120305 20016589 19247952 768637 768637 768637 3888942 0 0 3888942 X 3008992 3008992 442844 324784 118060 14485 9100 5385 200000 125600 74400 119237 119237 110000 110000 248311 248311 829932 614405 215527 11013 11013 120968 48387 72581 331497 235363 96134 181812 129087 52725 22703 22703 PROFESSIONAL CONSULTING 1482420 1432420 50000 LEADERSHIP DEVELOPMENT 145512 145512 SPONSORSHIPS 55000 55000 DUES AND SUBSCRIPTIONS 5103 5103 -449005 -449005 6880824 5679645 1201179 0 932485 1200965 3910658 3749541 86628 675708 183963 38459865 47262055 62393241 66240588 106371957 118723740 108761 457550 2418058 1737815 2526819 2195365 X 103845138 116528375 103845138 116528375 106371957 118723740 -2991882 15675119 0 X 0 1 X 1 0 X X X 79 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 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 BAYLOR SCOTT & WHITE HEALTHCARE FOUNDATION 273513154 7 0 0 0 AMERICAN ACADEMY OF DERMATOLOGY 410793046 10 0 0 0 AMERICAN ACADEMY OF PEDIATRICS 362275597 10 0 0 0 BENJAMIN RUSH INSTITUTE 461848302 7 0 0 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 COLORADO MEDICAL SOCIETY FOUNDATION 841390157 10 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 0 0 DANIEL HANLEY CENTER FOR HEALTH LEADERSHIP 204271488 7 0 0 0 FAMILY HEALTH CENTER OF WORCESTER 042485308 7 0 0 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 INSTITUTE FOR MEDICAL QUALITY 943240330 10 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 MINNEAPOLIS MEDICAL RESEARCH FOUNDATION (HENNEPIN HEALTHCARE RESEARCH) 411677920 7 0 0 0 MICHIGAN STATE MEDICAL SOCIETY FOUNDATION 386069432 7 0 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 0 0 MEDICAL ASSOCIATION OF GEORGIA FOUNDATION 586066431 7 0 0 0 MAINE QUALITY COUNTS 204935972 7 0 0 0 LOUISIANA STATE MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 237029259 7 0 0 0 JOAN & SANFORD I WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY NYPH-WEILL CO 131623978 2 0 0 0 SOUTH DAKOTA STATE MEDICAL ASSOCIATION FOUNDATION 466012680 5 0 0 0 ASSOCIATION OF WOMEN SURGEONS FOUNDATION 364029232 10 0 0 0 REGENTS OF THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO 946036493 7 0 0 0 PALM BEACH COUNTY MEDICAL SOCIETY SERVICES 651048299 7 0 0 0 WESTERN CAROLINA MEDICAL SOCIETY FOUNDATION INC 455586998 10 0 0 0 KANSAS MEDICAL FOUNDATION 481194663 7 0 0 0 UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL 566001393 2 0 0 0 UNITED PHYSICIANS AND SURGEONS OF AMERICA 471819061 7 0 0 0 WISCONSIN MEDICAL SOCIETY FOUNDATION 396045649 7 0 0 0 THE BOWLER-BARTLETT FOUNDATION 237425858 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 UNIVERSITY MEDICINE FOUNDATION (BROWN MEDICINE) 050450410 4 0 50000 0 OHIO MEDICAL EDUCATION FOUNDATION 310907287 10 0 76890 0 SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION 570168534 10 0 87374 0 MAYO CLINIC 416011702 10 0 100000 0 PHYSICIANS FOR A HEALTHY CALIFORNIA 946062822 7 0 100000 0 FOUNDATION FOR HEALTHY FLORIDIANS 462259497 7 0 0 0 TWIN CITIES MEDICAL SOCIETY FOUNDATION 510178010 10 0 109102 0 AMERICAN MEDICAL ASSOCIATION 360727175 10 0 109481 0 NORTH CAROLINA MEDICAL SOCIETY FOUNDATION 566088142 7 0 130000 0 INSTITUTE OF MEDICINE AND PUBLIC OF NEW JERSEY 200678012 7 0 130000 0 TENNESSEE MEDICAL EDUCATION FUND INC (TN MEDICAL ASSOCIATION STUDENT EDUCA 626049920 7 0 150000 0 TEXAS MEDICAL ASSOCIATION SPECIAL FUNDS FOUNDATION 742749879 7 0 250000 0 WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 836004846 7 0 150000 0 VERMONT MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 200183445 10 0 150000 0 FUTURE ALASKA MEDICAL LEADERS INC 831874375 7 0 150000 0 MONTANA MEDICAL ASSOCIATION FOUNDATION 463696068 10 0 150000 0 NEBRASKA MEDICAL FOUNDATION 476036827 7 0 175000 0 WSMA FOUNDATION FOR HEALTH CARE IMPROVEMENT 916074463 7 0 191145 0 DOCS FOR PATIENT CARE FOUNDATION 464752703 10 0 250000 0 KANSAS HEALTH INFORMATION NETWORK 274437508 7 0 500000 0 79 3008992 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 2019 THE FOUNDATION MADE NEW GRANTS TO 3 ORGANIZATIONS THAT WERE NOT LISTED ON THE 2018 FORM 990: FUTURE ALASKA MEDICAL LEADERS INC., AMERICAN MEDICAL ASSOCIATION, AND KANSAS HEALTH INFORMATION NETWORK. SOME OF THE SUPPORTED ORGANIZATIONS DID NOT RECEIVE SUPPORT DURING 2019, BUT THEY ARE ALL LISTED ON SCHEDULE A, PART VI OF THE 2019 FORM 990. 8 ORGANIZATIONS THAT WERE LISTED AS SUPPORTED ORGANIZATIONS ON THE 2018 FORM 990, SCHEDULE A ARE NO LONGER SUPPORTED ORGANIZATIONS AND WERE REMOVED FROM THE 2019 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 9039522 F METROPOLITAN WST INTM BD I 8990658 F S&P 500 INDEX FUND 12665836 F ISHARES SP SMALLCAP 600 INDEX 6946889 F FPA CRESCENT FD INSTL 6888229 F ISHARES S&P MIDCAP 400 INDEX 7613076 F PIMCO INCOME INST 7575954 F BLACKROCK GLOBAL ALLOCATION I 6520424 F 66240588 X 19315750 15675119 15675119 3640631 248311 248311 3888942 6632513 0 6632513 248311 248311 6880824 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, 2019, 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) 250000 TO SUPPORT THE DIRECT PRIMARY CARE CONFERENCE SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION PO BOX 11188 COLUMBIA SC 29211 570168534 501(C)(3) 87374 TO SUPPORT PHYSICIAN DISASTER RELIEF EFFORTS AFTER HURRICANES FLORENCE AND MICHAEL NORTH CAROLINA MEDICAL SOCIETY FOUNDATION PO BOX 27167 RALEIGH NC 27611 566088142 501(C)(3) 130000 TO ADDRESS BURNOUT AMONG NORTH CAROLINA'S PHYSICIANS BY PROVIDING TRAINING AND SUPPORT FOR IMPLEMENTING PRACTICE-LEVEL CHANGES PHYSICIANS FOR A HEALTHY CALIFORNIA 1201 J STREET SUITE 200 SACRAMENTO CA 95814 946062822 501(C)(3) 100000 TO DEVELOP PROGRAMS TO REDUCE STRESS AND INCREASE WELLNESS OF ETHNIC MINORITY WOMEN PHYSICIANS TEXAS MEDICAL ASSOCIATION SPECIAL FUNDS FOUNDATION 401 WEST 15TH STREET AUSTIN TX 78701 742749879 501(C)(3) 250000 TO SUPPORT LEADERSHIP DEVELOPMENT OF BOTH EARLY CAREER AND ESTABLISHED PHYSICIANS AND SUPPORT THE PLANNING AND IMPLEMENTATION OF THE TELEHEATLH INITIATIVE AMERICAN MEDICAL ASSOCIATION 330 N WABASH AVE STE 39300 CHICAGO IL 60611 360727175 501(C)(6) 109481 TO ADDRESS PHYSICIAN BURNOUT AND IDENTIFY INTERVENTIONS TO IMPROVE DELIVERY OF CARE AT THE PRACTICE AND SYSTEM LEVEL FUTURE ALASKA MEDICAL LEADERS INC 4107 LAUREL ST ANCHORAGE AK 99508 831874375 501(C)(3) 150000 TO SUPPORT DEVELOPMENT AND IMPLEMENTATION OF A PHYSICIAN LEADERSHIP DEVELOPMENT PROGRAM INSTITUTE OF MEDICINE AND PUBLIC HEALTH OF NEW JERSEY 2 PRINCESS ROAD LAWRENCEVILLE NJ 08648 200678012 501(C)(3) 130000 TO ADDRESS BURNOUT AMONG NEW JERSEY'S PHYSICIANS BY PROVIDING TRAINING AND SUPPORT FOR IMPLEMENTING PRACTICE-LEVEL CHANGES KANSAS HEALTH INFORMATION NETWORK 623 SW 10TH AVENUE TOPEKA KS 66612 274437508 501(C)(3) 500000 TO SUPPORT PHYSICIANS ACROSS SEVEN STATES WITH IMPLEMENTATION AND ADOPTION OF AN EMR INTEROPERABILITY PLATFORM MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 501(C)(3) 100000 TO DEVELOP AND IMPLEMENT A COACHING INTERVENTION STUDY TO ADDRESS BURNOUT FOR MID-CAREER PHYSICIANS MONTANA MEDICAL ASSOCIATION FOUNDATION 2021 11TH AVENUE STE 1 HELENA MT 59601 463696068 501(C)(3) 150000 TO SUPPORT THE PHYSICIAN LEADERSHIP PROGRAM AND ALUMNI COMPONENT IN PARTNERSHIP WITH FUTURESYNC INTERNATIONAL NEBRASKA MEDICAL FOUNDATION 233 S 13TH STREET SUITE 1200 LINCOLN NE 68508 476036827 501(C)(3) 175000 TO IMPLEMENT A COHORT-BASED PHYSICIAN LEADERSHIP PROGRAM OHIO MEDICAL EDUCATION FOUNDATION 5115 PARKCENTER AVENUE SUITE 200 DUBLIN OH 43017 310907287 501(C)(3) 76890 TO DEVELOP THE HEALTH SYSTEM PHYSICIAN POLICY AND ADVOCACY INSTITUTE AIMED TO CREATE PHYSICIAN LEADERS TENNESSEE MEDICAL EDUCATION FUND 701 BRADFORD AVE NASHVILLE TN 37204 626049920 501(C)(3) 150000 TO EXPAND THE CURRENT PHYSICIAN LEADERSHIP PROGRAM TWIN CITIES MEDICAL SOCIETY FOUNDATION 1300 GODWARD STREET STE 2000 MINNEAPOLIS MN 55413 510178010 501(C)(3) 109102 TO REPLICATE THE NETWORK MODEL USED TO SUPPORT PHYSICIAN-LED SOLUTIONS TO PUBLIC HEALTH ISSUES UNIVERSITY MEDICINE FOUNDATION 593 EDDY STREET JANE BROWN 035 PROVIDENCE RI 02903 050450140 501(C)(3) 50000 TO EXPAND THE LEADERSHIP ACADEMY TO FOCUS ON PHYSICIANS' RELATIONSHIPS WITH HOSPITALS VERMONT MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION PO BOX 1457 MONTPELIER VT 05601 200183445 501(C)(3) 150000 TO SUPPORT THE PHYSICIAN LEADERSHIP PROGRAM WSMA FOUNDATION FOR HEALTH CARE IMPROVEMENT 2001 SIXTH AVENUE SUITE 2700 SEATTLE WA 98121 916074463 501(C)(3) 191145 TO SUPPORT THE THREE-DAY, IN PERSON, DYAD LEADERSHIP COURSE AND SUPPORT ADVANCE CARE PLANNING FOR ROUTINE PATIENT CARE WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 122 E 17TH STREET CHEYENNE WY 82001 836004846 501(C)(3) 150000 TO OFFER A PHYSICIAN LEADERSHIP PROGRAM 19 1 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 PHIL SCHUH MEMBER 0 371586 0 0 0 26523 0 0 0 0 0 398109 0 0 LOU GOODMAN MEMBER 3000 588707 0 0 0 147676 0 56000 0 51720 3000 844103 0 0 JENNIFER HANSCOM MEMBER 12000 240396 0 22746 0 7000 0 10828 0 11233 12000 292203 0 0 DUSTIN CORCORAN MEMBER 6000 525000 0 400000 0 25248 0 25200 0 48562 6000 1024010 0 0 ROBERT SELIGSON TREASURER 14000 387001 0 0 0 18800 0 0 0 0 14000 405801 0 0 LARRY DOWNS SECRETARY 14000 220196 0 0 0 8309 0 0 0 0 14000 228505 0 0 JOHN DORMAN COO 100000 373116 0 17000 0 48132 0 56000 0 12673 100000 506921 0 0 TIM NORBECK CEO 300000 0 0 0 0 0 0 0 0 0 300000 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN AUGUST 2019 TO REMOVE THE REQUIREMENT FOR A BOARD MEMBER TO BE APPOINTED BY AETNA. AETNA NOTIFIED THE PHYSICIANS FOUNDATION IN 2019 THAT THEY WOULD NOT CONTINUE THEIR ROLE ON THE BOARD AS AGREED IN 2003. 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 PAYMENTS IN LIEU OF BOARD STIPENDS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 30,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,000. GRANT MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 275,621. MANAGEMENT AND GENERAL EXPENSES 124,128. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 399,749. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 325,310. MANAGEMENT AND GENERAL EXPENSES 57,408. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 382,718. CONSULTING: PROGRAM SERVICE EXPENSES 13,474. MANAGEMENT AND GENERAL EXPENSES 3,991. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,465. 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 CALIFORNIA MEDICAL ASSOCIATION P 2225 FMV MEDICAL SOCIETY OF NEW JERSEY P 9545 FMV MEDICAL SOCIETY OF THE STATE OF NY P 5764 FMV MEDICAL SOCIETY OF THE STATE OF NY R 6000 FMV TEXAS MEDICAL ASSOCIATION P 22975 FMV TEXAS MEDICAL ASSOCIATION M 100000 CONTRACTED AMOUNT WASHINGTON STATE MEDICAL ASSOCIATION P 5856 FMV MEDICAL SOCIETY OF NORTHERN VIRGINIA R 12000 FMV