MAG INSTITUTE FOR EXCELLENCE IN MEDICINE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MAG INSTITUTE FOR EXCELLENCE IN MEDICINE INC (EIN 30-0211350)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-11
IRS object ID
201343169349302204
Schema version
2012v2.1
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)
Timestamp2013-11-11T12:00:13-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN580692043EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MAULDIN & JENKINS LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 GALLERIA PKWY SE STE 1700AddressLine1
CityATLANTACity
StateGAState
ZIP Code303395946ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN300211350EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PHYSICIAN'S INSTITUTE FOR EXCELLENCEBusinessNameLine1
Business Name Line2IN MEDICINE INCBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlPHYSNameControl
Phone6783039290Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11849 THE EXCHANGE NO 200AddressLine1
CityATLANTACity
StateGAState
ZIP Code303392027ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDONALD J PALMISANO JRName
TitleTREASURERTitle
Phone6783039290Phone
Date Signed2013-11-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJEFF T FUCITOName
PTINP00120748PTIN
Phone7709558600Phone
Date Prepared2013-11-08DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDONALD J PALMISANO JRNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11849 THE EXCHANGE NO 200AddressLine1
CityATLANTACity
StateGAState
ZIP Code303392027ZIPCode
FieldValueIRS element (for citing)
Gross Receipts724356GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteHTTP://WWW.PHYSICIANSINSTITUTE.ORG/WebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2003YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTO IMPROVE PATIENT SAFETY AND ACHIEVE CLINICAL IMPROVEMENTS FOR GEORGIA PHYSICIANS AND THEIR PATIENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees2TotalNbrEmployees
Total Nbr Volunteers8TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year812102ContributionsGrantsPriorYear
Contributions Grants Current Year563478ContributionsGrantsCurrentYear
Program Service Revenue Prior Year91179ProgramServiceRevenuePriorYear
Program Service Revenue CY145805ProgramServiceRevenueCY
Investment Income Prior Year5265InvestmentIncomePriorYear
Investment Income Current Year1485InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year13588OtherRevenueCurrentYear
Total Revenue Prior Year908546TotalRevenuePriorYear
Total Revenue Current Year724356TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year418516GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY291852GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year310266SalariesEtcPriorYear
Salaries Etc Current Year252125SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year508441OtherExpensePriorYear
Other Expenses Current Year381964OtherExpensesCurrentYear
Total Expenses Prior Year1237223TotalExpensesPriorYear
Total Expenses Current Year925941TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-328677RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-201585RevenuesLessExpensesCY
Total Assets BOY992974TotalAssetsBOY
Total Assets EOY603703TotalAssetsEOY
Total Liabilities BOY319371TotalLiabilitiesBOY
Total Liabilities EOY203158TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY673603NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY400545NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO IMPROVE PATIENT SAFETY AND ACHIEVE CLINICAL IMPROVEMENTS FORGEORGIA PHYSICIANS AND THEIR PATIENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense243625Expense
Grants123297Grants
Revenue3000Revenue
DescriptionPARTNERSHIP FOR ADULT VACCINATION AND EDUCATION (PAVE)AS A PART OF NATIONAL COLLABORATIVE, PAVE RECEIVED AN EDUCATIONAL GRANT FROM GLAXOSMITHKLINE TO INCREASE THE NUMBER OF ELIGIBLE PERSONS WHO RECEIVE ALL OF THE ADULT VACCINES CURRENTLY RECOMMENDED BY THE US CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP). THE PHYSICIANS' INSTITUTE IS SUPPORTING EIGHT ORGANIZATIONS TO OFFER CME ACTIVITIES AND TO RECRUIT PHYSICIANS TO PARTICIPATE IN THE PERFORMANCE IMPROVEMENT COMPONENT OF THE PROJECT. AN ARRAY OF RESOURCES ARE PROVIDED TO PARTICIPANTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense172105Expense
Grants114108Grants
DescriptionIMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION - BLOCK GRANTSAS PART OF A NATIONAL COLLABORATIVE, THE ATRIAL FIBRILLATION INITIATIVE RECEIVED AN EDUCATIONAL GRANT FROM THE BRISTOL-MYERS SQUIBB/PFIZER PARTNERSHIP. THE MISSION OF THE EVOLUTION OF ANTICOAGULATION MANAGEMENT (TEAM) INITIATIVE IS TO REDUCE STROKE, PULMONARY EMBOLISM, AND OTHER COMPLICATIONS ASSOCIATED WITH THROMBUS FORMATION THROUGH EFFECTIVE CONTINUING EDUCATION THAT RESULTS IN OPTIMAL ANTICOAGULATION MANAGEMENT TARGETING PRIMARY CARE PHYSICIANS AND THEIR TEAMS. AS PART OF THIS NATIONAL INITIATIVE, THE PHYSICIANS' INSTITUTE IS SUPPORTING AND MANAGING 46 EDUCATIONAL ACTIVITIES THROUGH 14 GRANTEES IN 10 STATESDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense79698Expense
Grants19342Grants
Revenue10000Revenue
DescriptionHEALTH INFORMATION TECHNOLOGY - MEANINGFUL USETHE PHYSICIANS' INSTITUTE WAS AWARDED A GRANT FROM THE PHYSICIANS' FOUNDATION TO USE A PERFORMANCE IMPROVEMENT (PI) APPROACH TO ASSIST PHYSICIAN PRACTICES IN THE ADOPTION OF ELECTRONIC MEDICAL RECORDS AND TO QUALIFY FOR MEANINGFUL USE (FINANCIAL INCENTIVES FOR DEMONSTRATING THE DELIVERY OF QUALITY CARE) AS DESCRIBED IN THE HITECH ACT. THE PHYSICIANS' INSTITUTE USED A MIX OF EDUCATIONAL ACTIVITIES TO SUPPORT EIGHT GEORGIA PHYSICIAN PRACTICES THROUGH THE PROVISION OF TOOLS, RESOURCES, AND CONSULTING SERVICES IN THE CONTEXT OF AN EDUCATIONAL PROCESS THAT AWARDS CME CREDIT. THE PHYSICIANS' INSTITUTE CONTINUED WITH EDUCATIONAL ACTIVITIES FOR BOTH MAG AND GAFP RELATED TO ACHIEVING MEANINGFUL USE STAGE 2 FOR GEORGIA PHYSICIANS AND THEIR TEAMS. ADDITIONAL WEB-BASED RESOURCES WERE MADE AVAILABLE TO PROVIDERS.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense141310Expense
Grants35105Grants
Revenue132805Revenue
DescriptionALL OTHER GRANT PROGRAMS AND ACTIVITIESDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp141310TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt35105TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev132805TotalOfOtherProgramServiceRev
Total Program Service Expense636738TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org1TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109610NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees2NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SALLY-ANNE JACOBSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6783039290TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11849 THE EXCHANGE SE SUITE 200AddressLine1
CityATLANTACity
StateGAState
ZIP Code30339ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedHighest Compensated EmployeeHighestCompensatedEmployee
WALKER L RAY MD
PRESIDENT0.50XX000
JOHN S ANTALIS MD
DIRECTOR0.50X00012.50
WILLIAM A BORNSTEIN MD
DIRECTOR0.50X000
JACK M CHAPMAN MD
SECRETARY0.50XX000
HOWARD MAZIAR MD
DIRECTOR0.50X000
JAMES R MORROW MD
DIRECTOR0.50X000
ALAN L PLUMMER MD
VICE PRESIDENT0.50XX000
RICHARD S SIMMONS MD
DIRECTOR0.50X000
DONALD J PALMISANO JR EX-OFFICIO
TREASURER0.50X02224002879648.00
ROBERT ADDLETON
EXECUTIVE VICE PRESIDENT37.50112000012666X
FieldValueIRS element (for citing)
Total Reportable Comp From Org112000TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs222400TotalReportableCompFrmRltdOrgs
Total Other Compensation41462TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions563478AllOtherContributions
Total Contributions563478TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionFEES & REGISTRATIONSDescription
Business Code611430BusinessCode
Total Revenue Column145805TotalRevenueColumn
Related Or Exempt Function Income145805RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue145805TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1485TotalRevenueColumn
Exclusion$1,485ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionREFUNDED SUBGRANTSDescription
Business Code900099BusinessCode
Total Revenue Column13588TotalRevenueColumn
Exclusion$13,588ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue13588TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column724356TotalRevenueColumn
Related Or Exempt Function Income145805RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$15,073ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total291852Total
Program Services291852ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total206331Total
Management And General206331ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total12000Total
Management And General12000ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total18585Total
Management And General18585ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total15209Total
Management And General15209ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total190325Total
Program Services187982ProgramServices
Management And General2343ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4642Total
Program Services1502ProgramServices
Management And General3140ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2701Total
Program Services2701ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total20048Total
Program Services19744ProgramServices
Management And General304ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total14727Total
Program Services14396ProgramServices
Management And General331ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1541Total
Management And General1541ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
OTHER EXPENSE/CREDIT CA6938768471916
PROGRAM MANAGEMENT3646036460
OCCUPANCY & SALARY REIM2500025000
ACCREDITATION FEES16900136003300

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total233Total
Program Services30ProgramServices
Management And General203ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total925941Total
Program Services636738ProgramServices
Management And General289203ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY793502BOY
EOY580453EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY199472BOY
EOY23250EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY992974BOY
EOY603703EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY72760BOY
EOY29461EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY165534BOY
EOY36667EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY81077BOY
EOY137030EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY319371BOY
EOY203158EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY123437BOY
EOY137615EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY550166BOY
EOY262930EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY673603BOY
EOY400545EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY992974BOY
EOY603703EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-201585ReconcilationRevenueExpenses
Reconcilation Other Changes-71473ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEDICAL ASSOCIATION OF GEORGIA INCBusinessNameLine1
FieldValueIRS element (for citing)
EIN580605267EIN
Type Of Organization501(C)(6)TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$6,000Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts6000SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO RELATED ENTITIESDescription
Amount$137,030Amount
FieldValueIRS element (for citing)
Total Of Amounts137030TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationTHERE ARE NO UNCERTAIN TAX LIABILITIES REPORTED ON THE CONSOLIDATED AUDITED FINANCIALS UNDER FIN 48(ASC 740-10).Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (22 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
AMERICAN COLLEGE OF PHYSICIANS
PO BOX 1487FLOWERY BRANCHGA3054252128937314550PARTNERSHIP FOR ADULT VACCINATION AND EDUCATION.
ANNE WHITE MD PC
909 NORTH FIFTH AVEROMEGA301655825448395542TO SUPPORT ATTENDANCE AT MEETINGS
BUMC WEBB ROBERTS CENTER
3500 GASTON AVEDALLASTX752467518374549000IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
DES MOINES UNIVERSITY
3200 GRAND AVEDES MOINESIA503124207303478910IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
GA ACADEMY OF FAMILY PHYSICIAN
3760 LAVISTA RDTUCKERGA3008458604415831800IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
GALEN PUBLISHING DBA ASIM
166 W MAIN STSOMERVILLENJ0887622372020220250IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
HEALTHCARE PERFORMANCE CONSULT
2321 STOCKTON DRIVEFLEMING ISLANDFL330025623577599690OUTCOME INTERVIEWS
INTERSTATE POSTGRADUATE MEDICAL
PO BOX 5474MADISONWI537053903683178493KIDNEY TRANSPLANT NA PROJECT
KENTUCKY HEART FOUNDATION
2201 LEXINGTON AVEASHLANDKY4110126079199724000IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
MEDICAL ASSOCIATION OF GEORGIA
1849 THE EXCHANGE SEATLANTAGA303392607919976000TO SUPPORT ACHIEVING MEANINGFUL USE FOR HOD
MEMORIAL HERMANN HOSPITAL SYSTEM
909 FORSTWOOD SUITE 22058HOUSTONTX770245806052679000LETTER OF AGREEMENT
MISSISSIPPI ACADEMY OF FAMILY
133 EXECUITVE DRMADISONMS3911074115259715000PAVE AGREEMENT
MISSISSIPPI OSTEOPATHIC MEDICAL
P O BOX 16890JACKSONMS3923664075704028500IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
NE GA HEALTH SYSTEM
2150 LIMESTONE PKWY SUITE 115GAINSVILLEGA305015816940988910IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
ROCKFORD HEALTH SYSTEM
2350 N ROCKTON AVEROCKFORDIL611033621678479000IMPROVING THE PRIMARY CARE TREATMENT OF ATRIAL FIBRILLATION.
ST ANTHONY HOSPITAL FOUNDATION
826 NW 11STOKLAHOMA CITYOK731067361043008550LETTER OF AGREEMENT
ST FRANCIS MEDICAL CENTER FOUNDATION
3630 E IMPERIAL HWYLYNWOODCA900339531907738194LETTER OF AGREEMENT
THE UNIVERSITY OF MONTANA
32 CAMPUS DRMISSOULAMT5981281600171311213MONTANA ADULT VACCINATION RATE IMPROVEMENT CONSORTIUM.
UNIVERSITY OF ARIZONA HEALTHCARE
2030 E SPEEDWAY BLVDTUCSONAZ8571974265268920000FINAL RECONCILIATION
VISTA HEALTH SYSTEM
1324 N SHERIDAN RDWAUKEGANIL6008520397852115000LETTER OF AGREEMENT
WHITE MEMORIAL MEDICAL CENTER
1720 CESAR E CHAVEZ AVELACA900334537602019000LETTER OF AGREEMENT
YANKTON RURAL AREA HEALTH EDUCAION
1000 W 4TH STYANKTONSD5707846600036411250LETTER OF AGREEMENT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants12TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations10TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: FOR EACH GRANT THERE IS AN RFP THAT STATES THE REQUIREMENTS AND RESPONSIBILITIES FOR THAT SPECIFIC GRANT. A REVIEW TEAM USES SELECTION CRITERIA TO REVIEW THE GRANT APPLICATIONS. ADDITIONAL INFORMATION MAY BE REQUESTED. THERE ARE SPENDING GUIDELINES FOR GRANT FUNDS. ALL UNSPENT FUNDS MUST BE RETURNED. ONCE A GRANT IS AWARDED, AN AGREEMENT MUST BE SIGNED BY THE GRANTEE. A GRANT PROJECT MANAGER CONTACTS GRANTEES ON A MONTHLY BASIS TO ENSURE THAT THEY ARE COMPLYING AND MAKING PROGRESS. IN THE END, A STRUCTURED FINAL REPORT MUST BE SUBMITTED AND A FINANCIAL RECONCILIATION REPORT. 75% OF THE GRANT IS PAID UPFRONT. RECONCILIATION DETERMINES AMOUNT DUE AT THE END. FINAL REPORT MUST BE APPROVED BEFORE A FINAL CHECK IS ISSUED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonDONALD J PALMISANO JR EX-OFFICIONamePerson
TitleTREASURERTitle
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs222400CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs28796NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs251196TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE DIRECTOR OF OPERATIONS AND THE TREASURER REVIEW THE RETURN. ONCE THEY APPROVE THE RETURN, IT IS SIGNED AND MAILED BY THE EXECUTIVE DIRECTOR. IN ADDITION, THE BOARD REVIEWS THE RETURNS BEFORE THEY ARE FILED.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT COVERS ODTKE. BOARD MEMBERS ARE GIVEN THE POLICY WHEN APPOINTED. ONCE THE POLICY IS UNDERSTOOD, IT IS SIGNED BY THE BOARD MEMBERS. DURING BOARD MEETINGS, LEGAL COUNSEL ASKS IF THERE ARE ANY CONFLICTS OF INTEREST. IF ONE ARISES, THE BOARD MEMBER MAY BE ASKED TOLEAVE THE MEETING AND ABSTAIN FROM VOTING.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11GPAYROLL SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 843. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 843. CONSULTANTS: PROGRAM SERVICE EXPENSES 187,982. MANAGEMENT AND GENERAL EXPENSES 1,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 189,482.OTHER FEES
FORM 990, PART XI, LINE 9:EXPENSE REFUND OF GRANTS -71,473.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII LINE 2CTHERE HAVE BEEN NO CHANGES TO THE AUDITOR SELECTION PROCESS, NOR OVERSIGHT OF THE FINANCIAL STATEMENTS.
FORM 990 PART V LINE 2ATHE ORGANIZATION HAS TWO EMPLOYEES WHOSE PAYROLL IS HANDLED BY AN EMPLOYEE LEASING COMPANY. THE ORGANIZATION DOES NOT PROCESS ANY PAYROLL.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
MEDICAL ASSOCIATION OF GEORGIA
1849 THE EXCHANGE SE STE 200ATLANTAGA30339580605267PROMOTE ART AND SCIENCE OF MEDICINEGA501(C)(6)N/A0
MEDICAL ASSOCIATION OF GEORGIA FOUNDATION
1849 THE EXCHANGE SE STE 200ATLANTAGA30339586066431SUPPPORT MAGGA501(C)(3)0LINE 11A, IMEDICAL ASSOCIATION OF GEORGIA
GEORGIA MEDICAL POLITICAL ACTION COMMITTEE
1849 THE EXCHANGE SE STE 200ATLANTAGA30339580939391PROMOTE MEDICAL PROFESSIONGA5270MEDICAL ASSOCIATION OF GEORGIA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
MEDICAL ASSOCIATION OF GA
O246637ACTUAL COST INCURRED
MEDICAL ASSOCIATION OF GA
P306033ACTUAL COST INCURRED

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