2016-05-16T11:11:13-05:00 2015-06-30 593204548 JAMES MOORE & CO PL 2477 TIM GAMBLE PLACE SUITE 200 TALLAHASSEE FL 323084386 990 2014-07-01 571234883 FLORIDA MEDICAL PRACTICE PLAN INC FLOR 8506452827 1115 WEST CALL STREET TALLAHASSEE FL 32604 OFFICER PRESIDENT 8502247144 2016-05-16 1 KEVIN WARREN P00642409 8503866184 2016-05-12 2014 2016-08-17 19:52:53Z JOHN FOGARTY MD 1115 WEST CALL STREET TALLAHASSEE FL 32604 12439719 0 X WWW.MED.FSU.EDU/FMPP X 2006 FL THE 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. 9 0 0 0 0 0 0 0 12052714 12416967 4390 22752 8062 0 12065166 12439719 78759 291739 0 0 10290514 9777482 0 0 0 2018157 1659618 12387430 11728839 -322264 710880 3701473 4622522 1680382 3132832 2021091 1489690 X THE 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. 0 0 11681044 291739 12416967 PERFORMED 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. 11681044 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 1 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 16 0 1 0 0 0 0 0 0 0 0 0 0 0 X 9 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAWN SNYDER 8506452827 1115 WEST CALL STREET TALLAHASSEE FL 32306 DANIEL VAN DURME MD VICE PRESIDENT 1.00 40.00 X X 0 267394 34549 ALMA LITTLES MD SECRETARY/TREASURER 1.00 40.00 X X 0 271054 34349 JOHN FOGARTY MD PRESIDENT 2.00 40.00 X X 0 393583 34613 RICHARD NOWAKOWSKI PHD DIRECTOR 1.00 40.00 X 0 240770 26938 RICARDO GONZALEZ-ROTHI MD DIRECTOR 1.00 40.00 X 0 292600 35456 LESLIE BEITSCH MD JD DIRECTOR 1.00 40.00 X 0 259703 33830 KYLE CLARK MBA DIRECTOR 0.50 40.00 X 0 319286 40502 SALLIE MCRORIE PHD DIRECTOR 0.50 40.00 X 0 276899 27944 KENNETH BRUMMEL-SMITH MD DIRECTOR 1.00 40.00 X 0 261361 32853 GARNETT STOKES PHD DIRECTOR 0.50 40.00 X 0 422467 23457 PAUL KATZ DIRECTOR 1.00 40.00 X 0 0 0 0 3005117 324491 0 0 1 0 0 CLINICAL REVENUE 624100 12235336 12235336 MEDICAID REVENUE 624100 181631 181631 12416967 22752 22752 12439719 12416967 0 22752 291739 291739 8446132 8446132 456071 456071 507202 507202 368077 368077 29000 29000 116780 116780 18795 18795 40155 40155 21350 21350 1076772 1076772 MEDICAL SUPPLIES 197990 197990 PROGRAM DEVELOPMENT 141059 141059 MEDICAL SERVICES 11925 11925 BANKING FEES 5792 5792 11728839 11681044 47795 0 2146051 1254680 1295610 1449472 59502 41846 162298 131644 0 994880 0 750000 38012 3701473 4622522 90520 146487 1589862 2986345 1680382 3132832 X 0 0 0 0 2021091 1489690 2021091 1489690 3701473 4622522 710880 4367 -1246648 0 X X 0 1 X 1 0 X X X 1 FLORIDA STATE UNIVERSITY 591961248 2 1 9777482 0 1 9777482 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 FSU FOUNDATION 750000 F 750000 FLORIDA STATE UNIVERSITY AUXILIARY 1775681 DEPARTMENTAL DISTRIBUTION 1210664 2986345 12444086 4367 4367 12439719 0 12439719 11728839 0 11728839 0 11728839 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICE MEDICAL MISSION TRIP 12320 0 0 0 0 0 0 12320 0 12320 0 0 0 0 0 0 0 FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE 1115 WEST CALL STREET TALLAHASSEE FL 32306 591961248 501(C)(3) 291739 DEPARTMENTAL DISTRBUTION SUPPORT 1 0 0 0 0 0 0 0 0 0 DANIEL VAN DURME MD VICE PRESIDENT 0 263594 0 199 0 3601 0 19556 0 14993 0 301943 0 0 ALMA LITTLES MD SECRETARY/TREASURER 0 270855 0 199 0 0 0 19356 0 14993 0 305403 0 0 JOHN FOGARTY MD PRESIDENT 0 393384 0 199 0 0 0 19620 0 14993 0 428196 0 0 RICHARD NOWAKOWSKI PHD DIRECTOR 0 240571 0 199 0 0 0 18439 0 8499 0 267708 0 0 RICARDO GONZALEZ-ROTHI MD DIRECTOR 0 292401 0 199 0 0 0 21135 0 14321 0 328056 0 0 LESLIE BEITSCH MD JD DIRECTOR 0 259504 0 199 0 0 0 18837 0 14993 0 293533 0 0 KYLE CLARK MBA DIRECTOR 0 310466 0 0 0 8820 0 23433 0 17069 0 359788 0 0 SALLIE MCRORIE PHD DIRECTOR 0 225975 0 199 0 50725 0 20899 0 7045 0 304843 0 0 KENNETH BRUMMEL-SMITH MD DIRECTOR 0 258562 0 199 0 2600 0 19352 0 13501 0 294214 0 0 GARNETT STOKES PHD DIRECTOR 0 343708 0 199 0 78560 0 23264 0 193 0 445924 0 0 PART I, LINE 3 COMPENSATION 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. FORM 990, PART VI, SECTION A, LINE 2 ALMA B. LITTLES, M.D. AND JOHN P. FOGARTY, M.D. ARE ON THE AMA COUNCIL TOGETHER. ALMA B. LITTLES, M.D, AND DANIEL J. VAN DURME, M.D. ARE ON THE FAFP BOARD TOGETHER. FORM 990, PART VI, SECTION B, LINE 11 A 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 12C ANY 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 15 COMPENSATION 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 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FLORIDA STATE UNIVERSITY A2201 UNIVERSITY CENTER TALLAHASSEE FL 32306 591961248 UNIVERSITY FL 115 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 FLORIDA STATE UNIVERSITY O 9777482 CASH