2019-11-14T19:10:37-06:00 2018-12-31 463330935 AVENSON HAMANN CPAS LLP 1779 WELLS BRANCH PKWY 110B-292 AUSTIN TX 78728 990 2018-01-01 200914085 THE PHYSICIANS FOUNDATION INC PHYS 6173990417 401 W 15TH STREET NO 100 AUSTIN TX 78701 ROBERT SELIGSON TREASURER 6173990417 2019-11-14 1 CATHERINE AVENSON P01259734 5126939131 47.220.181.233 2019-11-14 19:10:33 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7FBB1FF3FA313FF48503ED9694125008F8DDFE26 2018 2020-03-31 21:24:44Z JOHN DORMAN 401 W 15TH STREET NO 100 AUSTIN TX 78701 31561099 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. 23 15 0 0 0 0 0 0 0 0 4793923 8161753 0 0 4793923 8161753 5829978 3072581 0 0 219500 258000 0 0 0 3297446 3989604 9346924 7320185 -4553001 841568 119293065 106371957 3285200 2526819 116007865 103845138 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 3523453 1657950 PHYSICIAN LEADERSHIP - GRANTS AND PROGRAMS TO EQUIP PHYSICIANS WITH THE CORE MANAGEMENT AND LEADERSHIP SKILLS NEEDED AS THEY INCREASINGLY FACE ADMINISTRATIVE AND REGULATORY BURDENS. 1322705 1015075 DISASTER RELIEF - GRANTS TO HELP PHYSICIAN PRACTICES REBUILD AFTER DISASTERS SO THEY CAN GET BACK TO TREATING PATIENTS AS QUICKLY AS POSSIBLE. 546707 399556 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. 719561 OTHER ACTIVITIES TO PROMOTE HIGH QUALITY MEDICAL CARE. 719561 6112426 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 1 0 0 0 0 0 1 0 0 0 1 29 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 23 15 0 1 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 RAY WALKER MD CHAIRMAN 20.00 X X 14000 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 12000 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 334750 37000 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 12000 765717 148167 JOSEPH VALENTI MD MEMBER 5.00 X 12000 0 0 JENNIFER HANSCOM MEMBER 5.00 40.00 X 12000 215048 19553 GERALD MCKENNA MD MEMBER 5.00 X 12000 0 0 GARY PRICE MD MEMBER 5.00 X 14000 0 0 DUSTIN CORCORAN MEMBER 5.00 40.00 X 12000 919472 71649 DON ALEXANDER MEMBER 5.00 X 12000 0 0 ALEX MALTER MD MEMBER 5.00 X 9000 0 0 ROBERT SELIGSON TREASURER 15.00 40.00 X X 14000 402507 0 LARRY DOWNS SECRETARY 5.00 40.00 X X 14000 222818 0 LAWRENCE BRAUD MD VICE PRESIDENT 5.00 X X 14000 0 0 ALAN PLUMMER MD VICE PRESIDENT 10.00 X X 14000 0 0 MARCH SEABROOK MEMBER 5.00 5.00 X 9000 19000 0 JOHN DORMAN COO 5.00 40.00 X 0 453472 67490 TIM NORBECK MGMT CO CEO 40.00 X 0 0 0 258000 3332784 343859 0 0 1 0 WEIL MEDICAL COLLEGE OF CORNELL 575 LEXINGTON AVE 9TH FLOOR NEW YORK NY 10022 PROGRAM PROJECT 1500000 GMA FOUNDATIONS 2 LIBERTY SQUARE SUITE 500 BOSTON MA 02109 GRANT MANAGEMENT 468415 COOPERKATZ 205 LEXINGTON AVE 5TH FLOOR NEW YORK NY 10016 COMMUNICATIONS 344141 MERRITT HAWKINS & ASSOCIATES PO BOX 281943 ATLANTA GA 30384 SURVEY 300000 NORBECK ASSOCIATES LLC 22451 GLENVIEW LANE BONITA SPRINGS FL 34135 EXECUTIVE MANAGEMENT 300000 5 3082875 3082875 28478224 23399346 5078878 5078878 5078878 8161753 0 0 8161753 X 3072581 3072581 258000 196080 61920 400000 275000 125000 161727 161727 110550 110550 264661 264661 861326 581542 279784 10947 10947 85287 22564 62723 284881 216510 68371 155002 117802 37200 21623 21623 PROFESSIONAL CONSULTING 1442617 1442617 LEADERSHIP DEVELOPMENT 132921 132921 SPONSORSHIPS 87665 87665 DUES AND SUBSCRIPTIONS 3253 3253 -32856 -32856 7320185 6112426 1207759 0 323798 932485 2927515 3910658 64514 675708 59135090 38459865 56842148 62393241 119293065 106371957 177223 108761 3107977 2418058 3285200 2526819 X 116007865 103845138 116007865 103845138 119293065 106371957 841568 -13004295 0 X 0 1 X 1 0 X X X 85 ALASKA STATE MEDICAL ASSOCIATION 926002176 10 1 0 0 REGENTS OF THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO 946036493 7 0 0 0 PALM BEACH COUNTY MEDICAL SOCIETY SERVICES 651048299 7 0 148800 0 OHIO MEDICAL EDUCATION FOUNDATION 310907287 10 0 0 0 NORTH CAROLINA MEDICAL SOCIETY FOUNDATION 566088142 7 0 650000 0 NEBRASKA MEDICAL FOUNDATION 476036827 7 0 0 0 MOUNT SINAI MEDICAL CENTER 136271888 7 0 0 0 MONTANA MEDICAL ASSOCIATION FOUNDATION 463696068 10 0 0 0 SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION 570168534 10 0 15075 0 MISSISSIPPI STATE MEDICAL ASSOCIATION FOUNDATION 570906060 10 0 0 0 MICHIGAN STATE MEDICAL SOCIETY FOUNDATION 386069432 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 149300 0 MEDICAL ASSOCIATION OF GEORGIA FOUNDATION 586066431 7 0 0 0 MAYO CLINIC 416011702 10 0 0 0 MAINE QUALITY COUNTS 204935972 7 0 0 0 LOUISIANA STATE MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 237029259 7 0 0 0 MINNEAPOLIS MEDICAL RESEARCH FOUNDATION (HENNEPIN HEALTHCARE RESEARCH) 411677920 7 0 0 0 SOUTH DAKOTA STATE MEDICAL ASSOCIATION FOUNDATION 466012680 5 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 ASSOCIATION OF WOMEN SURGEONS FOUNDATION 364029232 10 0 99556 0 CALIFORNIA MEDICAL ASSOCIATION FOUNDATION 946062822 7 0 0 0 WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 836004846 7 0 0 0 WSMA FOUNDATION FOR HEALTH CARE IMPROVEMENT 916074463 7 0 0 0 WISCONSIN MEDICAL SOCIETY FOUNDATION 396045649 7 0 0 0 WESTERN CAROLINA MEDICAL SOCIETY FOUNDATION INC 455586998 10 0 0 0 VERMONT MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 200183445 10 0 0 0 UTAH MEDICAL ASSOCIATION FOUNDATION 876122299 10 0 75000 0 UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL 566001393 2 0 0 0 UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL 043167352 2 0 0 0 UNIVERSITY MEDICINE FOUNDATION (BROWN MEDICINE) 050450410 4 0 0 0 UNITED PHYSICIANS AND SURGEONS OF AMERICA 471819061 7 0 0 0 TWIN CITIES MEDICAL SOCIETY FOUNDATION 510178010 10 0 0 0 TRAVIS COUNTY MEDICAL SOCIETY FOUNDATION 741720086 7 0 0 0 THE GENERAL HOSPITAL (MASSACHUSETTS GENERAL HOSPITAL) 042697983 3 0 0 0 THE BOWLER-BARTLETT FOUNDATION 237425858 7 0 0 0 KENTUCKY FOUNDATION FOR MEDICAL CARE 237181728 7 0 0 0 KANSAS MEDICAL FOUNDATION 481194663 7 0 0 0 JOAN & SANFORD I WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY NYPH-WEILL CO 131623978 2 0 0 0 INSTITUTE OF MEDICINE AND PUBLIC & NEW JERSEY 200678012 7 0 0 0 WASHINGTON STATE MEDICAL ASSOCIATION 910462170 10 1 0 0 VERMONT MEDICAL SOCIETY 030164911 10 1 0 0 TEXAS MEDICAL ASSOCIATION 741078510 10 1 0 0 TENNESSEE MEDICAL ASSOCIATION 620382010 10 1 0 0 SOUTH CAROLINA MEDICAL ASSOCIATION 570248750 10 1 0 0 NORTH CAROLINA MEDICAL ASSOCIATION 560320130 10 1 0 0 NEW HAMPSHIRE MEDICAL SOCIETY 020223176 10 1 0 0 NEBRASKA MEDICAL ASSOCIATION 470372108 10 1 0 0 MEDICAL SOCIETY OF NORTHERN VIRGINA 540739279 10 1 0 0 MEDICAL SOCIETY OF NEW YORK 131030760 10 1 0 0 MEDICAL SOCIETY OF NEW JERSEY 210601684 10 1 0 0 MEDICAL ASSOCIATION OF GEORGIA 580605267 10 1 0 0 LOUISIANA STATE MEDICAL SOCIETY 720386637 10 1 0 0 HAWAII MEDICAL ASSOCIATION 990067306 10 1 0 0 FLORIDA MEDICAL ASSOCIATION 590559672 10 1 0 0 EL PASO COUNTY MEDICAL SOCIETY 741238007 10 1 0 0 DENTON COUNTY MEDICAL SOCIETY 751676014 10 1 0 0 CONNECTICUT STATE MEDICAL SOCIETY 060665164 10 1 0 0 CALIFORNIA MEDICAL ASSOCIATION 940359340 10 1 0 0 ACCMA COMMUNITY HEALTH FOUNDATION 461703508 7 0 150000 0 BAYLOR SCOTT & WHITE HEALTHCARE FOUNDATION 273513154 7 0 150000 0 AMERICAN ACADEMY OF DERMATOLOGY 410793046 10 0 0 0 AMERICAN MEDICAL ASSOCIATION FOUNDATION 366080517 7 0 0 0 INSTITUTE FOR MEDICAL QUALITY 943240330 10 0 150000 0 INDIANA MEDICAL FOUNDATION 237001672 7 0 150000 0 HEALTH LEADS 450484533 7 0 0 0 HAWAII MEDICAL FOUNDATION 237063698 7 0 0 0 FOUNDATION OF THE AMERICAN ASSOCIATION OF MEDICAL SOCIETY EXECUTIVES 362915937 10 0 0 0 FOUNDATION FOR HEALTHY FLORIDIANS 462259497 7 0 505000 0 FAMILY HEALTH CENTER OF WORCESTER 042485308 7 0 0 0 EQUALHEALTH INC (PHYSICIANS FOR HAITI) 273645742 7 0 0 0 DOCS FOR PATIENT CARE FOUNDATION 464752703 10 0 250000 0 DELAWARE MEDICAL EDUCATION FOUNDATION 510343625 7 0 0 0 DANIEL HANLEY CENTER FOR HEALTH LEADERSHIP 204271488 7 0 0 0 CONNECTICUT STATE MEDICAL SOCIETY PHYSICIAN HEALTH & EDUCATION FUND 061425205 7 0 150000 0 COMMUNITY SERVICE EDUCATION AND RESEARCH FUND 237003581 7 0 0 0 COLORADO MEDICAL SOCIETY FOUNDATION 841390157 10 0 0 0 CENTER FOR A HEALTHY MARYLAND 521110642 7 0 0 0 CALIFORNIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION 941149565 7 0 129850 0 BOARD OF TRUSTEES OF THE LELAND STANFORD JR UNIVERSITY 941156365 2 0 0 0 BENJAMIN RUSH INSTITUTE 461848302 7 0 0 0 AMERICAN ACADEMY OF PEDIATRICS 362275597 10 0 150000 0 PHYSICIANS FOR A HEALTHY CALIFORNIA 946062822 7 0 150000 0 85 3072581 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 2018 THE FOUNDATION MADE NEW GRANTS TO 3 ORGANIZATIONS THAT WERE NOT LISTED ON THE 2017 FORM 990: ASSOCIATION OF WOMEN SURGEONS FOUNDATION, BAYLOR SCOTT & WHITE HEALTHCARE FOUNDATION, AND PHYSICIANS FOR A HEALTHY CALIFORNIA. SOME OF THE SUPPORTED ORGANIZATIONS DID NOT RECEIVE SUPPORT DURING 2018, BUT THEY ARE ALL LISTED ON SCHEDULE A, PART VI OF THE 2018 FORM 990. 5 ORGANIZATIONS THAT WERE LISTED AS SUPPORTED ORGANIZATIONS ON THE 2017 FORM 990, SCHEDULE A ARE NO LONGER SUPPORTED ORGANIZATIONS AND WERE REMOVED FROM THE 2018 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 8311708 F METROPOLITAN WST INTM BD I 8419331 F S&P 500 INDEX FUND 9638927 F ISHARES SP SMALLCAP 600 INDEX 5656512 F FPA CRESCENT FD INSTL 5923762 F ISHARES S&P MIDCAP 400 INDEX 6038108 F PIMCO INCOME INST 7010742 F BLACKROCK GLOBAL ALLOCATION I 5741004 F WELLS FARGO ABSOLT RET I 5653147 F 62393241 X -5107203 -13004295 -13004295 7897092 264661 264661 8161753 7055524 0 7055524 264661 264661 7320185 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, 2018, THE FOUNDATION DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS RESULTING FROM ITS TAX POSITIONS. 1 MEDICAL EDUCATION AND SCIENTIFIC FOUNDATION OF NY 865 MERRICK AVE WESTBURY NY 11590 112780360 501(C)(3) 149300 TO SUPPORT A LEADERSHIP PROGRAM TARGETING MEDICAL STUDENTS, RESIDENTS AND YOUNG PHYSICIANS 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 FOUNDATION FOR HEALTHY FLORIDIANS 1430 PIEDMONT DRIVE EAST TALLAHASSEE FL 32308 462259497 501(C)(3) 500000 HURRICANE DISASTER RELIEF SUPPORT FOUNDATION FOR HEALTHY FLORIDIANS 1430 PIEDMONT DRIVE EAST TALLAHASSEE FL 32308 462259497 501(C)(3) 5000 TO DEVELOP EDUCATIONAL CONTENT AND PROMOTING AWARENESS OF PHYSICIAN-LED MODELS OF CARE SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION PO BOX 11188 COLUMBIA SC 29211 570168534 501(C)(3) 15075 HURRICANE DISASTER RELIEF SUPPORT NORTH CAROLINA MEDICAL SOCIETY FOUNDATION PO BOX 27167 RALEIGH NC 27611 566088142 501(C)(3) 500000 HURRICANE DISASTER RELIEF SUPPORT UTAH MEDICAL ASSOCIATION FOUNDATION 310 E 4500 SOUTH 500 SALT LAKE CITY UT 84107 876122299 501(C)(3) 75000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM CALIFORNIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION 1520 PACIFIC AVENUE SAN FRANCISCO CA 94109 941149565 501(C)(3) 129850 TO SUPPORT THE CREATION OF A READY TO LEAD PROGRAM PALM BEACH COUNTY MEDICAL SOCIETY SERVICES 3540 FOREST HILL BLVD 101 WEST PALM BEACH FL 33406 651048299 501(C)(3) 148800 TO DEVELOP A PHYSICIAN LEADERSHIP PROGRAM ADDRESSING DIVERSITY ACCMA COMMUNITY HEALTH FOUNDATION 6230 CLAREMONT AVE 3RD FLOOR OAKLAND CA 94618 461703508 501(C)(3) 150000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM AMERICAN ACADEMY OF PEDIATRICS 141 NORTHWEST POINT BLVD ELK GROVE IL 60007 362275597 501(C)(3) 150000 TO SUPPORT A YOUNG PHYSICIAN LEADERSHIP ALLIANCE WITH AN INTERNSHIP PROGRAM CONNECTICUT STATE MEDICAL SOCIETY PHYSICIAN HEALTH & 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 INDIANA MEDICAL FOUNDATION 23 CANAL WALK INDIANAPOLIS IN 46202 237001672 501(C)(3) 150000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM INSTITUTE FOR MEDICAL QUALITY 180 HOWARD STREET STE 210 SAN FRANCISCO CA 94105 943240330 501(C)(3) 150000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM NORTH CAROLINA MEDICAL SOCIETY FOUNDATION PO BOX 27167 RALEIGH NC 27611 566088142 501(C)(3) 150000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM ASSOCIATION OF WOMEN SURGEONS FOUNDATION 225 W WHACKER DR SUITE 650 CHICAGO IL 60606 364029232 501(C)(3) 99556 TO ADDRESS BURNOUT IN WOMEN SURGERY RESIDENTS BAYLOR SCOTT & WHITE HEALTHCARE FOUNDATION 204 S 31ST STREET TEMPLE TX 76508 273513154 501(C)(3) 150000 TO FIGHT BURNOUT IN WOMEN PHYSICIANS USING LEADERSHIP DEVELOPMENT PHYSICIANS FOR A HEALTHY CALIFORNIA 1201 J STREET SUITE 200 SACRAMENTO CA 95814 946062822 501(C)(3) 150000 TO DEVELOP PROGRAMS TO REDUCE STRESS AND INCREASE WELLNESS OF ETHNIC MINORITY WOMEN PHYSICIANS 18 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 334750 0 0 0 0 0 0 0 37000 0 371750 0 0 LOU GOODMAN MEMBER 12000 614255 0 0 0 151462 0 117170 0 30997 12000 913884 0 0 JENNIFER HANSCOM MEMBER 12000 184920 0 23128 0 7000 0 8616 0 10937 12000 234601 0 0 DUSTIN CORCORAN MEMBER 12000 500000 0 400000 0 19472 0 24750 0 46899 12000 991121 0 0 ROBERT SELIGSON TREASURER 14000 402507 0 0 0 0 0 0 0 0 14000 402507 0 0 LARRY DOWNS SECRETARY 14000 214248 0 0 0 8570 0 0 0 0 14000 222818 0 0 JOHN DORMAN COO 0 362249 0 31923 0 59300 0 55000 0 12490 0 520962 0 0 NORBECK ASSOCIATES LLC OWNED BY CEO TIM NORBECK 300000 PROVIDES CEO-LEVEL MANAGEMENT SERVICES; TRANSACTIONS ARE AT ARMS-LENGHT AND FAIR VALUE 0 COO INFORMATICS LLC OWNED BY COO JOHN DORMAN 100000 PROVIDES COO-LEVEL MANAGEMENT SERVICES 0 FORM 990, PART VI, SECTION A, LINE 3 THE FOUNDATION HAS CONTRACTS WITH INDEPENDENT CONTRACTORS WHO PROVIDE SERVICES AS CHIEF EXECUTIVE OFFICER (CEO) AND CHIEF OPERATING OFFICER (COO). THE COMPENSATION PAID TO THESE INDIVIDUALS HAS BEEN DISCLOSED ON PAGE 8, PART VII, SECTION B. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION WERE AMENDED IN 2018 TO AMEND THE CHARITABLE PURPOSES OF THE FOUNDATION TO BE ORGANIZED AND OPERATED TO SUPPORT, BENEFIT OR CARRY OUT THE CHARITABLE PURPOSES OF THE 20 PUBLICLY SUPPORTED MEDICAL SOCIETIES AND ASSOCIATIONS NAMED THEREIN, THE PURPOSES OF WHICH INCLUDE "PROMOTING HIGH QUALITY MEDICAL HEALTH CARE, INCLUDING, WITHOUT LIMITATION, ASSISTING PHYSICIANS AND THE PUBLIC TO IMPROVE THE QUALITY OF HEALTH CARE RECEIVED BY PATIENTS IN AN EVOLVING HEALTH CARE ENVIRONMENT AND TO ENHANCE THE DELIVERY OF MEDICAL CARE TO DISADVANTAGED MEMBERS OF THE PUBLIC IN A MANNER THAT CONSTITUTES CHARITABLE, SCIENTIFIC OR EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTIONS 501(C)(3) AND 170(C)(2)(B) OF THE CODE." OTHER AMENDMENTS INCLUDED REVISING THE ARTICLE RELATED TO THE BOARD OF DIRECTORS TO REFER SUCH PROVISIONS TO THE BYLAWS. THE BYLAWS WERE ALSO AMENDED IN 2018 TO MAKE CONFORMING CHANGES RELATED TO THE CHARITABLE PURPOSES AND THE BOARD OF DIRECTORS AS AMENDED BY THE ARTICLES OF INCORPORATION. 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 AND TO THE LLC'S PROVIDING CEO AND COO SERVICES TO THE FOUNDATION 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 13,680. MANAGEMENT AND GENERAL EXPENSES 4,320. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,000. GRANT MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 292,061. MANAGEMENT AND GENERAL EXPENSES 157,264. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 449,325. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 275,801. MANAGEMENT AND GENERAL EXPENSES 118,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 394,001. 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 7693 FMV MEDICAL SOCIETY OF NEW JERSEY P 5593 FMV MEDICAL SOCIETY OF THE STATE OF NY P 8012 FMV MEDICAL SOCIETY OF THE STATE OF NY R 12000 FMV TEXAS MEDICAL ASSOCIATION P 38124 FMV TEXAS MEDICAL ASSOCIATION M 100000 CONTRACTED AMOUNT WASHINGTON STATE MEDICAL ASSOCIATION P 10145 FMV