FLORIDA MEDICAL PRACTICE PLAN INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
FLORIDA MEDICAL PRACTICE PLAN INC (EIN 57-1234883)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-15
IRS object ID
201801359349302495
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-15T10:16:51-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN593204548PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1JAMES MOORE & CO PLBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12477 TIM GAMBLE PLACE SUITE 200AddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP323084386ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN571234883EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FLORIDA MEDICAL PRACTICE PLAN INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFLORBusinessNameControlTxt
Phone8506452827PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11115 W CALL STAddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP323064300ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonOFFICERPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone8502247144PhoneNum
Signature2018-05-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKEVIN WARRENPreparerPersonNm
PTINP00642409PTIN
Phone8503866184PhoneNum
Preparation2018-05-14PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOHN FOGARTY MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11115 W CALL STAddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP323064300ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,581,551GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MED.FSU.EDU/FMPPWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2006FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionTHE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$8,844,365PYProgramServiceRevenueAmt
CY Program Service Revenue$4,449,315CYProgramServiceRevenueAmt
PY Investment Income$21,180PYInvestmentIncomeAmt
CY Investment Income$132,236CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$8,865,545PYTotalRevenueAmt
CY Total Revenue$4,581,551CYTotalRevenueAmt
PY Grants And Similar Paid$265,872PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$236,150CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,117,781PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,472,744CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,723,137PYOtherExpensesAmt
CY Other Expenses$686,221CYOtherExpensesAmt
PY Total Expenses$8,106,790PYTotalExpensesAmt
CY Total Expenses$3,395,115CYTotalExpensesAmt
PY Revenues Less Expenses$758,755PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,186,436CYRevenuesLessExpensesAmt
Total Assets BOY$4,234,474TotalAssetsBOYAmt
Total Assets EOY$5,373,318TotalAssetsEOYAmt
Total Liabilities BOY$1,892,473TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,844,881TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,342,001NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,528,437NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$3,354,153ExpenseAmt
Grant$236,150GrantAmt
Revenue$4,449,315RevenueAmt
DescPERFORMED PROFESSIONAL SERVICES IN SUPPORT OF: 1) AN AFFILIATION AGREEMENT WITH A HOSPITAL FOR GRADUATE MEDICAL EDUCATION PROGRAMS, AND 2) AGREEMENTS WITH HEALTH DEPARTMENTS, CLINICS, AND OTHER FOR PATIENT CARE.Desc
Total Program Service Expenses$3,354,153TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign ActivitiesYes (1)ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document16IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DAWN SNYDERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8506452827PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11115 WEST CALL STREETAddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32306ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
DANIEL VAN DURME MD
VICE PRESIDENT1.0040.00Yes (X)Yes (X)$0$289,799$38,420
ALMA LITTLES MD
SECRETARY1.0040.00Yes (X)Yes (X)$0$288,177$36,870
JOHN FOGARTY MD
PRESIDENT2.0040.00Yes (X)Yes (X)$0$407,321$36,614
RICHARD NOWAKOWSKI PHD
TREASURER1.0040.00Yes (X)Yes (X)$0$251,201$28,885
RICARDO GONZALEZ-ROTHI MD
DIRECTOR1.0040.00Yes (X)$0$269,975$21,263
LESLIE BEITSCH MD JD
DIRECTOR1.0040.00Yes (X)$0$270,957$35,619
KYLE CLARK MBA
DIRECTOR0.5040.00Yes (X)$0$340,890$38,881
SALLIE MCRORIE PHD
DIRECTOR0.5040.00Yes (X)$0$371,261$36,741
JONATHAN APPELBAUM MD
DIRECTOR1.0040.00Yes (X)$0$251,800$35,491
PAUL KATZ MD
DIRECTOR1.0040.00Yes (X)$0$294,595$36,339
KENNETH BRUMMEL-SMITH MD
FORMER DIRECTOR0.0040.00$0$246,875$35,277Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$3,282,851TotReportableCompRltdOrgAmt
Total Other Compensation$380,400TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CLINICAL REVENUE624100$4,398,912$4,398,912
MEDICAID REVENUE624100$50,403$50,403
FieldValueIRS element (for citing)
Total Program Service Revenue$4,449,315TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$132,236TotalRevenueColumnAmt
Exclusion$132,236ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,581,551TotalRevenueColumnAmt
Related Or Exempt Func Income$4,449,315RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$132,236ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$236,150TotalAmt
Program Services$236,150ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,910,507TotalAmt
Program Services$1,910,507ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$128,116TotalAmt
Program Services$128,116ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$347,454TotalAmt
Program Services$347,454ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$86,667TotalAmt
Program Services$86,667ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$17,500TotalAmt
Management And General$17,500ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$54,753TotalAmt
Program Services$54,753ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$4,978TotalAmt
Management And General$4,978ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$18,484TotalAmt
Management And General$18,484ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$47,946TotalAmt
Program Services$47,946ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$50,900TotalAmt
Program Services$50,900ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$266,676TotalAmt
Program Services$266,676ProgramServicesAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
PROGRAM DEVELOPMENT$202,136$202,136
BANKING FEES$16,338$16,338
MEDICAL SUPPLIES$6,510$6,510

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,395,115TotalAmt
Program Services$3,354,153ProgramServicesAmt
Management And General$40,962ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,034,408BOYAmt
EOY$563,853EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$407,208BOYAmt
EOY$381,331EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$36,570BOYAmt
EOY$52,708EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,019,476BOYAmt
EOY$1,075,209EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,736,812BOYAmt
EOY$3,300,217EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,234,474BOYAmt
EOY$5,373,318EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$36,268BOYAmt
EOY$35,604EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$4,800BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,851,405BOYAmt
EOY$1,809,277EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,892,473BOYAmt
EOY$1,844,881EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$2,342,001BOYAmt
EOY$3,528,437EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,342,001BOYAmt
EOY$3,528,437EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,234,474BOYAmt
EOY$5,373,318EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,186,436ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1FLORIDA STATE UNIVERSITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN591961248EIN
Organization Type2OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$2,472,744SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$2,472,744SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
FSU FOUNDATION$794,284F
FLORIDA SPECIAL PURPOSE INVESTMENT ACCOUNT (VIA UNIVERSITY)$2,505,933F
FieldValueIRS element (for citing)
Total Book Value Securities$3,300,217TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
FLORIDA STATE UNIVERSITY AUXILIARY$640,122
DEPARTMENTAL DISTRIBUTION$1,169,155
FieldValueIRS element (for citing)
Total Liability$1,809,277TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$4,581,551TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$4,581,551RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$4,581,551TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$3,395,115TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$3,395,115ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$3,395,115TotalExpensesPerForm990Amt

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp (4 entries)

RegionRegionTxtOfficesOfficesCntEmployeeEmployeeCntType Of Activities ConductedTypeOfActivitiesConductedTxtSpecific Services ProvidedSpecificServicesProvidedTxtRegion Total ExpendituresRegionTotalExpendituresAmt
EAST ASIA AND THE PACIFIC00PROGRAM SERVICE.FACULTY TRIP TO COLLABORATE AND SPEAK AT 2016 JAPANESE SOCIETY OF PERSONALITY PSYCHOLOGY.$2,668
CENTRAL AMERICA AND THE CARIBBEAN00PROGRAM SERVICEMEDICAL MISSION FACULTY TRIPS.$6,993
NORTH AMERICA00PROGRAM SERVICE.FACULTY TRIP TO ATTEND SENIORS QUALITY LEAP INITIATIVE CONFERENCE.$976
SOUTH ASIA00PROGRAM SERVICE.FACULTY TRIP TO COORDINATE AND PARTICIPATE IN INDIAN AGING CONGRESS.$4,756
FieldValueIRS element (for citing)
Subtotal Offices0SubtotalOfficesCnt
Subtotal Employees0SubtotalEmployeesCnt
Continutation Total Office0ContinutationTotalOfficeCnt
Continutation Total Employee0ContinutationTotalEmployeeCnt
Total Office0TotalOfficeCnt
Total Employee0TotalEmployeeCnt
Subtotal Spent$15,393SubtotalSpentAmt
Continuation Spent$0ContinuationSpentAmt
Total Spent$15,393TotalSpentAmt
Transfer To Foreign Corp0TransferToForeignCorpInd
Interest In Foreign Trust0InterestInForeignTrustInd
Foreign Corp Ownership0ForeignCorpOwnershipInd
Passive Foreign Investmest Co0PassiveForeignInvestmestCoInd
Foreign Partnership0ForeignPartnershipInd
Boycott Countries0BoycottCountriesInd

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINEBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11115 WEST CALL STREETAddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32306ZIPCd
FieldValueIRS element (for citing)
Recipient EIN591961248RecipientEIN
IRC Section115(1)IRCSectionDesc
Cash Grant$236,150CashGrantAmt
Purpose Of GrantDEPARTMENTAL DISTRBUTION SUPPORTPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DANIEL VAN DURME MD
VICE PRESIDENT$0$289,799$0$0$0$0$0$23,093$0$15,327$0$328,219$0$0
ALMA LITTLES MD
SECRETARY$0$288,177$0$0$0$0$0$21,543$0$15,327$0$325,047$0$0
JOHN FOGARTY MD
PRESIDENT$0$407,321$0$0$0$0$0$21,287$0$15,327$0$443,935$0$0
RICHARD NOWAKOWSKI PHD
TREASURER$0$251,201$0$0$0$0$0$20,217$0$8,668$0$280,086$0$0
RICARDO GONZALEZ-ROTHI MD
DIRECTOR$0$269,975$0$0$0$0$0$16,502$0$4,761$0$291,238$0$0
LESLIE BEITSCH MD JD
DIRECTOR$0$270,957$0$0$0$0$0$20,292$0$15,327$0$306,576$0$0
KYLE CLARK MBA
DIRECTOR$0$332,190$0$0$0$8,700$0$21,455$0$17,426$0$379,771$0$0
SALLIE MCRORIE PHD
DIRECTOR$0$364,761$0$0$0$6,500$0$28,833$0$7,908$0$408,002$0$0
JONATHAN APPELBAUM MD
DIRECTOR$0$234,750$0$0$0$17,050$0$20,164$0$15,327$0$287,291$0$0
PAUL KATZ MD
DIRECTOR$0$294,595$0$0$0$0$0$21,012$0$15,327$0$330,934$0$0
KENNETH BRUMMEL-SMITH MD
FORMER DIRECTOR$0$246,875$0$0$0$0$0$19,950$0$15,327$0$282,152$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationCOMPENSATION FOR THE ORGANIZATION'S OFFICERS/FACULTY ARE DETERMINED BY THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE AND APPROVED BY FSU'S HUMAN RESOURCE DEPARTMENT (A RELATED ORGANIZATION). THE COMPENSATION IS ESTABLISHED BASED ON BENCHMARKS WITHIN THE INDUSTRY. IN ADDITION, FSU UTILIZES A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACTS AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE TO ESTABLISH COMPENSATION.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2SALLIE MCRORIE, PH.D. AND KYLE CLARK, MBA ARE ON THE BOARD OF THE FOLLOWING ORGANIZATIONS TOGETHER: FAMU-FSU COLLEGE OF ENGINEERING JOINT MANAGEMENT COUNCIL, FSU INTERNATIONAL PROGRAMS ASSOCIATION, INC. AND THE FSU RESEARCH FOUNDATION, INC.
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE FINAL FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS THROUGH ELECTRONIC MAIL PRIOR TO SUBMITTAL TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12CANY DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, IS COVERED UNDER THE POLICY. ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST MUST BE DISCLOSED TO THE DIRECTORS, AND THE DIRECTORS WILL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF A MEMBER FAILS TO DISCLOSE A CONFLICT OF INTEREST IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION FOR THE ORGANIZATION'S TOP OFFICIAL, OFFICERS, AND KEY EMPLOYEES IS DETERMINED BY FAIR MARKET VALUE, SALARY SURVEYS AND A SALARY RANGE PROVIDED BY FLORIDA STATE UNIVERSITY, THE SUPPORTED ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990 PART XII, LINE 2CTHE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1FLORIDA STATE UNIVERSITYBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1A2201 UNIVERSITY CENTERAddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32306ZIPCd
FieldValueIRS element (for citing)
EIN591961248EIN
Primary ActivitiesUNIVERSITYPrimaryActivitiesTxt
Legal Domicile StateFLLegalDomicileStateCd
Exempt Code Section115ExemptCodeSectionTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1FLORIDA STATE UNIVERSITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeOTransactionTypeTxt
Involved$2,472,744InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt

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