2018-11-15T13:15:10-06:00 2017-12-31 463330935 AVENSON HAMANN CPAS LLP 1779 WELLS BRANCH PKWY 110B-292 AUSTIN TX 78728 990 2017-01-01 200914085 THE PHYSICIANS FOUNDATION INC PHYS 6173990417 401 W 15TH STREET NO 100 AUSTIN TX 78701 GARY PRICE PRESIDENT 6173990417 2018-11-14 1 CATHERINE AVENSON P01259734 5126939131 71.42.144.60 2018-11-15 13:15:07 CS P 7FBB1FF3FA313FF48503ED9694125008F8DDFE26 7FBB1FF3FA313FF48503ED9694125008F8DDFE26 2017 2019-02-21 02:37:17Z JOHN DORMAN 401 W 15TH STREET NO 100 AUSTIN TX 78701 35924085 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 16 0 0 0 0 0 0 0 0 5445716 4793923 34350 0 5480066 4793923 5037341 5829978 0 0 212000 219500 0 0 0 3242893 3297446 8492234 9346924 -3012168 -4553001 113536965 119293065 3072302 3285200 110464663 116007865 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 7485275 5829978 GRANTMAKING: AWARDED GRANTS TO DEVELOP LEADERSHIP SKILLS IN PHYSICIANS, TO PILOT LEADERSHIP PROGRAMS AT THE RESIDENCY LEVEL, AND TO EMPOWER PHYSICIANS TO DELIVER HIGH QUALITY CARE TO PATIENTS. 30000 CONDUCTED A PHYSICIAN SURVEY TO OBTAIN A DETAILED UNDERSTANDING OF PHYSICIANS' PROFESSIONAL MORALE, PRACTICE PATTERNS, CAREER PLANS, AND PERSPECTIVES IN ORDER TO BETTER SERVE THE GENERAL PUBLIC. 130802 LEADERSHIP: HOSTED THE ANNUAL KARL M. ALTENBURGER LEADERSHIP ACADEMY AND PROVIDED PHYSICIAN LEADERS WITH THE SKILLS AND INFORMATION THEY NEED TO ENHANCE THEIR LEADERSHIP ABILITIES AND BUILD THE CAPACITY OF STATE MEDICAL ASSOCIATIONS. PARTICIPATING PHYSICIANS RECEIVED CATEGORY 1 CREDITS. 269580 RESEARCH: INITIATED A PATIENT SURVEY TO OBTAIN A MORE DETAILED UNDERSTANDING OF HOW THE AFFORDABLE CARE ACT, AS WELL AS OTHER ASPECTS OF HEALTHCARE AND HEALTHCARE REFORM IMPACT PATIENTS' PERCEPTIONS.SUPPORTED RESEARCH AND PUBLICATION ON HEALTH CARE COST AS RELATED TO HEALTH CARE REFORMS.OTHER PROGRAM SERVICES CONDUCTED IN CONNECTION WITH THE FOUNDATION'S STATED CHARITABLE PURPOSE WHICH IS TO PROMOTE HIGH QUALITY HEALTHCARE. 269580 7915657 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 26 0 0 0 0 0 0 0 0 0 0 0 0 X 23 16 0 1 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 RAY WALKER MD CHAIRMAN 20.00 X X 14000 0 0 TODD ATWATER MEMBER 5.00 X 7500 0 0 SUNNY RAMCHANDANI MD MEMBER 5.00 X 0 0 0 SUBHI ALI MD MEMBER 5.00 X 10000 0 0 SANDRA JOHNSON MEMBER 5.00 X 10000 0 0 RUSSELL LIBBY MD MEMBER 5.00 X 10000 0 0 RIP HOLLISTER MD MEMBER 5.00 X 10000 0 0 RALPH NOBO MD MEMBER 5.00 X 10000 0 0 PHIL SCHUH MEMBER 5.00 40.00 X 0 325000 0 PAUL HARRINGTON MEMBER 5.00 40.00 X 10000 130000 13000 PALMER JONES MEMBER 5.00 X 10000 0 0 LOU GOODMAN MEMBER 5.00 40.00 X 10000 896560 142987 JOSEPH VALENTI MD MEMBER 5.00 X 10000 0 0 JENNIFER HANSCOM MEMBER 5.00 40.00 X 10000 214173 18708 GERALD MCKENNA MD MEMBER 5.00 X 10000 0 0 GARY PRICE MD MEMBER 5.00 X 10000 0 0 DUSTIN CORCORAN MEMBER 5.00 40.00 X 10000 679887 65357 DON ALEXANDER MEMBER 5.00 X 10000 0 0 ALEX MALTER MD MEMBER 5.00 X 10000 0 0 ROBERT SELIGSON TREASURER 15.00 40.00 X X 12000 413569 0 LARRY DOWNS SECRETARY 5.00 40.00 X X 12000 222818 0 LAWRENCE BRAUD MD VICE PRESIDENT 5.00 X X 12000 0 0 ALAN PLUMMER MD VICE PRESIDENT 10.00 X X 12000 0 0 MARCH SEABROOK MEMBER 5.00 5.00 X 0 6000 0 JOHN DORMAN COO 5.00 40.00 X 0 477513 66310 TIM NORBECK CEO 5.00 40.00 X 0 0 0 219500 3365520 306362 0 0 1 0 GMA FOUNDATIONS 2 LIBERTY SQUARE SUITE 500 BOSTON MA 02109 GRANT MANAGEMENT 473173 COOPERKATZ 205 LEXINGTON AVE 5TH FLOOR NEW YORK NY 10016 COMMUNICATIONS 374099 NORBECK ASSOCIATES LLC 22451 GLENVIEW LANE BONITA SPRINGS FL 34135 EXECUTIVE MANAGEMENT 300000 COO INFORMATICS LLC 9900 SPECTRUM DR AUSTIN TX 78717 EXECUTIVE MANAGEMENT 125000 ALSTON AND BIRD ONE ATLANTIC CENTER 1201 W PEACHTR ATLANTA GA 30309 LEGAL SERVICES 116384 5 2470662 2470662 33453423 31130162 2323261 2323261 2323261 4793923 0 0 4793923 5829978 5829978 219500 167910 51590 400000 138750 261250 170901 170901 116030 116030 350626 350626 820318 578722 241596 7110 7110 141686 42506 99180 322627 251649 70978 166237 129665 36572 19340 19340 SPONSORSHIPS 511244 511244 PROFESSIONAL CONSULTING 299580 299580 LEADERSHIP DEVELOPMENT 130802 130802 DUES AND SUBSCRIPTIONS 6094 6094 -165149 -165149 9346924 7915657 1431267 0 2729133 3251313 149781 64514 59135090 110658051 56842148 113536965 119293065 110822 177223 2961480 3107977 3072302 3285200 X 110464663 116007865 110464663 116007865 113536965 119293065 -4553001 10096203 0 X 0 1 X 1 0 X X X 87 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 MEDICAL ASSOCIATION OF GEORGIA 580605267 10 1 0 0 MEDICAL SOCIETY OF NEW JERSEY 210601684 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 TEXAS MEDICAL ASSOCIATION 741078510 10 1 0 0 VERMONT MEDICAL SOCIETY 030164911 10 1 0 0 WASHINGTON STATE MEDICAL ASSOCIATION 910462170 10 1 0 0 ACCMA COMMUNITY HEALTH FOUNDATION 461703508 7 0 0 0 AMERICAN ACADEMY OF DERMATOLOGY 410793046 10 0 0 0 AMERICAN ACADEMY OF PEDIATRICS 362275597 10 0 0 0 AMERICAN MEDICAL ASSOCIATION FOUNDATION 366080517 7 0 76446 0 AMERICARES FOUNDATION INC 061008595 7 0 100000 0 BENJAMIN RUSH INSTITUTE 461848302 7 0 40000 0 BOARD OF TRUSTEES OF THE LELAND STANFORD JR UNIVERSITY 941156365 2 0 225000 0 CALIFORNIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION 941149565 7 0 0 0 CENTER FOR A HEALTHY MARYLAND 521110642 7 0 150000 0 COLORADO MEDICAL SOCIETY FOUNDATION 841390157 10 0 0 0 COMMUNITY SERVICE EDUCATION AND RESEARCH FUND 237003581 7 0 134171 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 DELAWARE MEDICAL EDUCATION FOUNDATION 510343625 7 0 0 0 DOCS FOR PATIENT CARE FOUNDATION 464752703 10 0 262488 0 EQUALHEALTH INC (PHYSICIANS FOR HAITI) 273645742 7 0 0 0 FAMILY HEALTH CENTER OF WORCESTER 042485308 7 0 150000 0 FOUNDATION FOR HEALTHY FLORIDIANS 462259497 7 0 650000 0 FOUNDATION OF THE AMERICAN ASSOCIATION OF MEDICAL SOCIETY EXECUTIVES 362915937 10 0 0 0 HAWAII MEDICAL FOUNDATION 237063698 7 0 0 0 HEALTH LEADS 450484533 7 0 340000 0 INDIANA MEDICAL FOUNDATION 237001672 7 0 0 0 INSTITUTE FOR MEDICAL QUALITY 943240330 10 0 0 0 INSTITUTE OF MEDICINE AND PUBLIC & NEW JERSEY 200678012 7 0 150000 0 JOAN & SANFORD I WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY NYPH-WEILL CO 131623978 2 0 0 0 KANSAS MEDICAL FOUNDATION 481194663 7 0 0 0 KENTUCKY FOUNDATION FOR MEDICAL CARE 237181728 7 0 0 0 LOUISIANA STATE MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 237029259 7 0 146000 0 MAINE QUALITY COUNTS 204935972 7 0 149996 0 MAYO CLINIC 416011702 10 0 100000 0 MEDICAL ASSOCIATION OF GEORGIA FOUNDATION 586066431 7 0 150000 0 MEDICAL EDUCATION AND SCIENTIFIC FOUNDATION OF NY 112780360 7 0 150000 0 MEDICAL SOCIETY OF VIRGINIA FOUNDATION 521394768 7 0 150000 0 METRO OMAHA MEDICAL SOCIETY FOUNDATION 470814363 10 0 149620 0 MICHIGAN STATE MEDICAL SOCIETY FOUNDATION 386069432 7 0 150000 0 MINNEAPOLIS MEDICAL RESEARCH FOUNDATION (HENNEPIN HEALTHCARE RESEARCH) 411677920 7 0 99922 0 MISSISSIPPI STATE MEDICAL ASSOCIATION FOUNDATION 570906060 10 0 0 0 MONTANA MEDICAL ASSOCIATION FOUNDATION 463696068 10 0 0 0 MOUNT SINAI MEDICAL CENTER 136271888 7 0 148397 0 NEBRASKA MEDICAL FOUNDATION 476036827 7 0 150000 0 NORTH CAROLINA MEDICAL SOCIETY FOUNDATION 566088142 7 0 0 0 OHIO MEDICAL EDUCATION FOUNDATION 310907287 10 0 80000 0 PALM BEACH COUNTY MEDICAL SOCIETY SERVICES 651048299 7 0 0 0 PHYSICIANS BENEVOLENT FUND 746050660 7 0 500000 0 REGENTS OF THE UNIVERSITY OF CALIFRONIA SAN FRANCISCO 946036493 7 0 150000 0 SOUTH CAROLINA MEDICAL ASSOCIATION FOUNDATION 570168534 10 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 150000 0 TEXAS MEDICAL ASSOCIATION SPECIAL FUNDS FOUNDATION 742749879 7 0 150000 0 THE BOWLER-BARTLETT FOUNDATION 237425858 7 0 150000 0 THE GENERAL HOSPITAL (MASSACHUSETTS GENERAL HOSPITAL) 042697983 3 0 100000 0 TRAVIS COUNTY MEDICAL SOCIETY FOUNDATION 741720086 7 0 150000 0 TWIN CITIES MEDICAL SOCIETY FOUNDATION 510178010 10 0 0 0 UNITED PHYSICIANS AND SURGEONS OF AMERICA 471819061 7 0 0 0 UNIVERSITY MEDICINE FOUNDATION (BROWN MEDICINE) 050450410 4 0 0 0 UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL 043167352 2 0 0 0 UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL 566001393 2 0 0 0 UTAH MEDICAL ASSOCIATION FOUNDATION 876122299 10 0 0 0 VERMONT MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 200183445 10 0 150000 0 WESTERN CAROLINA MEDICAL SOCIETY FOUNDATION INC 455586998 10 0 127938 0 WISCONSIN MEDICAL SOCIETY FOUNDATION 396045649 7 0 150000 0 WSMA FOUNDATION FOR HEALTH CARE IMPROVEMENT 916074463 7 0 0 0 WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 836004846 7 0 150000 0 CALIFORNIA MEDICAL ASSOCIATION FOUNDATION 946062822 7 0 0 0 FOUNDATION OF THE PENNSYLVANIA MEDICAL ASSOCIATION 231511600 7 0 0 0 ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY 050258809 2 0 0 0 PHYSICIANS' INSTITUTE 300211350 10 0 0 0 87 5829978 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 DETERMINED AT INCEPTION IN 2006 THAT EACH OF ITS NAMED SUPPORTED ORGANIZATIONS ARE DEEMED TO BE DESCRIBED IN SECTION 509(A)(2) BECAUSE ITS MEMBERSHIP DUES CONSTITUTED MORE THAN ONE THIRD OF THEIR SUPPORT, AND THAT NO MORE THAN ONE THIRD OF THEIR SUPPORT CAME FROM GROSS INVESTMENT INCOME AND NET UNRELATED BUSINESS TAXABLE INCOME. THE FOUNDATION CONFIRMS ANNUALLY THAT ITS SUPPORTED ORGANIZATIONS MEET THE REQUIREMENTS OF SECTION 509(A)(2). 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 AND ONLY FOR PROJECTS THAT 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 THAT ARE INCLUDED IN THE CLASS OF ORGANIZATIONS DESIGNATED IN THE GOVERNING DOCUMENTS BY CLASS OR PURPOSE. IN 2017 THE FOUNDATION MADE NEW GRANTS TO 21 ORGANIZATIONS THAT WERE NOT LISTED ON THE 2016 FORM 990. NO PAYMENTS WERE MADE IN 2017 TO 33 ORGANIZATIONS THAT WERE LISTED ON THE 2016 FORM 990 BECAUSE THE GRANT PERIOD ENDED IN 2016. NAMES AND EINS ARE AVAILABLE ON SCHEDULE A, PART VI OF THE 2016 AND 2017 FORMS 990. 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 BENFITTINGN 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 13378656 F METROPOLITAN WST INTM BD I 10365149 F S&P 500 INDEX FUND 10103114 F ISHARES SP SMALLCAP 600 INDEX 9281567 F FPA CRESCENT FD INSTL 6915742 F ISHARES S&P MIDCAP 400 INDEX 6797920 F 56842148 X 14890126 10096203 10096203 4793923 0 4793923 9346924 0 9346924 0 9346924 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, 2017, THE FOUNDATION DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS RESULTING FROM ITS TAX POSITIONS. 1 BENJAMIN RUSH INSTITUTE PO BOX 3113 HALF MOON BAY CA 94019 461848302 501(C)(3) 40000 TO PROVIDE SCHOLARSHIPS TO MEDICAL STUDENTS TO ATTEND AT MEDICAL SOCIETY AND PROFESSIONAL ASSOC CONFERENCES TO LEARN ABOUT HEALTH POLICY AND NETWORK WITH PRACTICING PHYSICIANS. AMERICAN MEDICAL ASSOCIATION FOUNDATION 330 N WABASH AVE CHICAGO IL 60611 366080517 501(C)(3) 76446 TO SUPPORT THE JOY IN MEDICINE MULTI-STAKEHOLDER MEETING TO BRING TOGETHER PHYSICIANS, HEALTH SYSTEM LEADERS, POLICY MAKERS, PAYERS, SPECIALTY SOCIETIES, PATIENT AND FAMILY REPRESENTATIVES, AND QUALITY AND SAFETY ORGANIZATIONS TO CREATE A STRATEGIC MULTI-PRONGED PLAN TO ADDRESS PHYSICIAN WELL-BEING OHIO MEDICAL EDUCATION FOUNDATION 5115 PARKCENTER AVENUE SUITE 200 DUBLIN OH 43017 310907287 501(C)(3) 80000 TO DEVELOP THE HEALTH SYSTEM PHYSICIAN POLICY AND ADVOCACY INSTITUTE AIMED TO CREATE SOPHISTICATED, KNOWLEDGEABLE AND ACTIVE PHYSICIAN LEADERS MINNEAPOLIS MEDICAL RESEARCH FOUNDATION (HENNEPIN HEALTHCARE RESEARCH) 701 PARK AVE PP7700 MINNEAPOLIS MN 55415 411677920 501(C)(3) 99922 TO CREATE A MENTORING PROGRAM FOCUSED ON PROMOTING PROFESSIONAL FULFILLMENT AND REDUCING BURNOUT AMONG PHYSICIANS IN THE DEPARTMENT OF MEDICINE AMERICARES FOUNDATION INC 88 HAMILTON AVE STAMFORD CT 06902 061008595 501(C)(3) 100000 PUERTO RICO HURRICANE RELIEF MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 501(C)(3) 100000 TO DEVELOP AND IMPLEMENT A COACHING INTERVENTION STUDY FOR MID-CAREER PHYSICIANS TO ADDRESS PHYSICIAN BURNOUT THE GENERAL HOSPITAL (MASSACHUSETTS GENERAL HOSPITAL) 55 FRUIT STREET BOSTON MA 02114 042697983 501(C)(3) 100000 TO STUDY THE IMPACT OF A LONGITUDINAL RELATIONSHIP BETWEEN A RESIDENT OR FACULTY MEMBER AND A FACULTY COACH TRAINED IN POSITIVE PSYCHOLOGY COACHING WESTERN CAROLINA MEDICAL SOCIETY FOUNDATION INC 304 SUMMIT ST ASHEVILLE NC 28803 455586998 501(C)(3) 127938 TO OFFER A MULTI-FACETED PROGRAM TO ADDRESS PHYSICIAN BURNOUT, INCLUDING COACHING, COUNSELING, RETREATS, AND OTHER RESOURCES COMMUNITY SERVICE EDUCATION AND RESEARCH FUND 5380 ELVAS AVE SUITE 104 SACRAMENTO CA 95819 237003581 501(C)(3) 134171 TO ESTABLISH THE JOY OF MEDICINE PROGRAM TO IMPROVE PHYSICIAN WELL-BEING LOUISIANA STATE MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION 6767 PERKINS ROAD NO 100 BATON ROUGE LA 70808 237029259 501(C)(3) 146000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM PROVIDE YOUNG PHYSICIANS WITH EXPERIENCE AND TRAINING IN THE CORE APTITUDES TO EXCEL IN LEADERSHIP POSITIONS OUTSIDE THE PRACTICE OF MEDICINE MOUNT SINAI MEDICAL CENTER 1 GUSTAVE L LEVY PLACE NEW YORK NY 10029 136271888 501(C)(3) 148397 TO IMPLEMENT AN EVIDENCE-BASED, PHYSICIAN-LED INITIATIVE TO ADDRESS PHYSICIAN BURNOUT METRO OMAHA MEDICAL SOCIETY FOUNDATION 7906 DAVENPORT ST OMAHA NE 68114 470814363 501(C)(3) 149620 TO CREATE A COMPREHENSIVE PHYSICIAN WELLNESS PROGRAM TO HELP IDENTIFY BURNOUT AND PROMOTE RESILIENCY MAINE QUALITY COUNTS PO BOX 16 MANCHESTER ME 04351 204935972 501(C)(3) 149996 TO EXPAND THE LEADERSHIP ON THE FRONT LINES PROGRAM FOCUSING ON HELPING PHYSICIANS ENHANCE THEIR LEADERSHIP SKILLS TO BE ON THE FRONTLINES OF ADDRESS EMERGING PUBLIC HEALTH CRISES BOARD OF TRUSTEES OF THE LELAND STANFORD JR UNIVERSITY 1520 PAGE MILL ROAD PALO ALTO CA 94304 941156365 501(C)(3) 225000 TO DEVELOP AND IMPLEMENT A PROGRAM TO DRIVE PHYSICIAN ENGAGEMENT TO CREATE AN ORGANIZATIONAL CULTURE OF WELLNESS CENTER FOR A HEALTHY MARYLAND 1211 CATHEDRAL ST BALTIMORE MD 21201 521110642 501(C)(3) 150000 TO SUPPPORT THE CREATION AND IMPLEMENTATION OF A CERTIFICATE PROGRAM IN PHYSICIAN LEADERSHIP FAMILY HEALTH CENTER OF WORCESTER 26 QUEEN ST WORCESTER MA 01610 042485308 501(C)(3) 150000 TO DEVELOP AND IMPLEMENT A 3-PART PHYSICIAN WELLNESS PROGRAM INSTITUTE OF MEDICINE AND PUBLIC & NEW JERSEY 2 PRINCESS ROAD LAWRENCEVILLE NJ 08648 200678012 501(C)(3) 150000 TO SUPPORT IMPLEMENTATION OF A LEADERSHIP ACADEMY THAT ALLOWS PARTICIPANTS TO BUILD LEADERSHIP SKILLS WHILE VIEWING HEALTHCARE ISSUES FROM ALL PERSPECTIVES MEDICAL ASSOCIATION OF GEORGIA FOUNDATION 1849 THE EXCHANGE SE 200 ATLANTA GA 30339 586066431 501(C)(3) 150000 TO SUPPORT THE YEAR LONG PHYSICIAN LEADERSHIP PROGRAM TEACHING ADVOCACY, COMMUNICATION, AND CONFLICT RESOLUTION SKILLS MEDICAL EDUCATION AND SCIENTIFIC FOUNDATION OF NY 865 MERRICK AVE WESTBURY NY 11590 112780360 501(C)(3) 150000 TO SUPPORT A LEADERSHIP PROGRAM TARGETING MEDICAL STUDENTS, RESIDENTS AND YOUNG PHYSICIANS MEDICAL SOCIETY OF VIRGINIA FOUNDATION 2924 EMERYWOOD PKWY SUITE 300 RICHMOND VA 23294 521394768 501(C)(3) 150000 TO SUPPORT A PHYSICIAN LED INTERPROFESSIONAL CLINICAL TEAM LEADERSHIP PROGRAM MICHIGAN STATE MEDICAL SOCIETY FOUNDATION 120 W SAGINAW EAST LANSING MI 48823 386069432 501(C)(3) 150000 TO ENHANCE THE PHYSICIAN EXECUTIVE DEVELOPMENT EDUCATION PROGRAM, INCLUDING THE DEVELOPMENT OF AN ONLINE RESOURCE LIBRARY NEBRASKA MEDICAL FOUNDATION 233 S 13TH STREET SUITE 1200 LINCOLN NE 68508 476036827 501(C)(3) 150000 TO IMPLEMENT A COHORT-BASED PHYSICIAN LEADERSHIP PROGRAM TO IMPROVE LEADERSHIP COMPETENCIES INCLUDING LEADING TEAMS AND MANAGING ORGANIZATIONS. TENNESSEE MEDICAL EDUCATION FUND INC 701 BRADFORD AVE NASHVILLE TN 37204 626049920 501(C)(3) 150000 TO EXPAND THE CURRENT PHYSICIAN LEADERSHIP PROGRAM FOCUSING ON PHYSICIAN-LED ASSOCIATION MANAGEMENT, FOUNDATIONAL LEADERSHIP TRAINING, AND PHYSICIAN-LED CARE TEAMS TEXAS MEDICAL ASSOCIATION SPECIAL FUNDS FOUNDATION 401 WEST 15TH STREET AUSTIN TX 78701 742749879 501(C)(3) 150000 TO SUPPORT THE LEADERSHIP COLLEGE SKILL BUILDING PROGRAM AND THE ENHANCED ONLINE LEARNING PORTAL JOHN P BOWLER MD MEMORIAL LIBRARY 7 NORTH STATE DTREET CONCORD NH 03301 237425858 501(C)(3) 150000 TO CREATE A PHYSICIAN LEADERSHIP PROGRAM THAT INCLUDES SKILL BUILDING, NETWORKING AMONG PHYSICIANS, AND PROVIDES CONTINUING PROFESSIONAL DEVELOPMENT OPPORTUNITIES TRAVIS COUNTY MEDICAL SOCIETY FOUNDATION 4300 N LAMAR BLVD AUSTIN TX 78756 741720086 501(C)(3) 150000 TO DEVELOP A TOOLKIT AND TRAINING PROGRAM ON HOW MEDICAL ASSOCIATIONS/SOCIETIES CAN START A PHYSICIAN WELLNESS PROGRAM (PWP) WHICH PROVIDES BOTH PREVENTIVE AND INTERVENTIONAL SUPPORT SERVICES TO REDUCE PHYSICIAN BURNOUT VERMONT MEDICAL SOCIETY EDUCATION AND RESEARCH FOUNDATION PO BOX 1457 MONTPELIER VT 05601 200183445 501(C)(3) 150000 TO SUPPORT VERMONT'S PHYSICIAN LEADERSHIP PROGRAM DESIGNED TO DEVELOP THE LEADERSHIP SKILLS NEEDED TO NAVIGATE VERMONT'S POLITICAL ENVIRONMENT AND HEALTH CARE POLICY ARENA WISCONSIN MEDICAL SOCIETY FOUNDATION 330 EAST LAKESIDE ST MADISON WI 53715 396045649 501(C)(3) 150000 TO SUPPORT A PHYSICIAN LEADERSHIP PROGRAM THAT BRINGS PHYSICIAN LEADERS FROM WISCONSIN TOGETHER IN PEER COHORTS TO LEARN A SYSTEMS APPROACH TO LEADERSHIP WYOMING MEDICAL SOCIETY SCHOLARSHIP FUND 122 E 17TH STREET CHEYENNE WY 82001 836004846 501(C)(3) 150000 TO OFFER A PHYSICIAN LEADERSHIP PROGRAM THAT PROVIDES INDIVIDUAL COACHING, PERSONAL SKILL IMPROVEMENT, AND A BETTER UNDERSTANDING OF HEALTHCARE IN THE STATE REGENTS OF THE UNIVERSITY OF CALIFRONIA SAN FRANCISCO 1855 FOLSOM STREET BOX 0812 SAN FRANCISCO CA 94143 946036493 501(C)(3) 150000 TO IMPLEMENT THE MINDFUL MENTAL TRAINING PROGRAM TO SUPPORT PHYSICIAN WELLBEING AND RESILIENCE DOCS FOR PATIENT CARE FOUNDATION 1210 NORTH MAPLE ROAD ANN ARBOR MI 48103 464752703 501(C)(3) 262488 TO SUPPORT THE DIRECT PRIMARY CARE CONFERENCE HEALTH LEADS 24 SCHOOL STREET 6TH FLOOR BOSTON MA 02108 450484533 501(C)(3) 340000 TO ELEVATE PHYSICIAN LEADERS TO ADDRESS POVERTY AND SOCIAL DETERMINANTS OF HEALTH THROUGH RESEARCH AS WELL AS RESOURCE DEVELOPMENT AND DISSEMINATION PHYSICIANS BENEVOLENT FUND 401 W 15TH STREET SUITE 100 AUSTIN TX 78701 746050660 501(C)(3) 500000 HURRICANE DISASTER RELIEF SUPPORT 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) 150000 TO SUPPORT THE LEADERSHIP ACADEMY SKILL BUILDING PROGRAM 34 PART I, LINE 2: TO ENSURE THAT ITS ASSETS ARE USED FOR CHARITABLE PURPOSES, THE FOUNDATION MAKES GRANTS ONLY TO 501(C)(3) ORGANIZATIONS OR GOVERNMENT AGENCIES AND ONLY FOR PROJECTS THAT ARE APPROVED 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 325000 0 0 0 0 0 0 0 0 0 325000 0 0 PAUL HARRINGTON MEMBER 10000 130000 0 0 0 0 0 13000 0 0 10000 143000 0 0 LOU GOODMAN MEMBER 10000 550004 0 194422 0 152134 0 113700 0 29287 10000 1039547 0 0 JENNIFER HANSCOM MEMBER 10000 179894 0 27279 0 7000 0 8567 0 10141 10000 232881 0 0 DUSTIN CORCORAN MEMBER 10000 441000 0 205000 0 33887 0 24300 0 41057 10000 745244 0 0 ROBERT SELIGSON TREASURER 12000 362718 0 0 0 50851 0 0 0 0 12000 413569 0 0 LARRY DOWNS SECRETARY 12000 214248 0 0 0 8570 0 0 0 0 12000 222818 0 0 JOHN DORMAN COO 0 341744 0 69384 0 66385 0 54000 0 12310 0 543823 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 TYPOMDCOM LLC OWNED BY FORMER COO BILL MAHON 60000 PROVIDES CONSULTING SERVICES 0 COO INFORMATICS LLC OWNED BY COO JOHN DORMAN 125000 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 7A THE FOUNDATION'S SUPPORTED ORGANIZATIONS HAVE THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS. 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. 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 THE SOUTH CAROLINA MEDICAL ASSOCIATION P 638 FMV CALIFORNIA MEDICAL ASSOCIATION P 5238 FMV CALIFORNIA MEDICAL ASSOCIATION M 346609 CONTRACTED AMOUNT MEDICAL SOCIETY OF NEW JERSEY P 8719 FMV MEDICAL SOCIETY OF THE STATE OF NY P 7642 FMV MEDICAL SOCIETY OF THE STATE OF NY R 7500 FMV TEXAS MEDICAL ASSOCIATION P 41704 FMV TEXAS MEDICAL ASSOCIATION M 100000 CONTRACTED AMOUNT WASHINGTON STATE MEDICAL ASSOCIATION P 8039 FMV