2012-12-12T13:36:30-06:00 2012-06-30 450250958 EIDE BAILLY LLP 3999 PENNSYLVANIA AVE SUITE 100 DUBUQUE IA 52002 990 2011-07-01 421058745 NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION INC NORT 3192722525 2055 KIMBALL AVENUE WATERLOO IA 50702 ANTHONY A DAY 3192722525 2012-12-05 1 CARMEN KRANTZ P00031958 5635561790 2012-12-05 2011 2016-02-24 21:20:13Z ANTHONY A DAY 2055 KIMBALL AVENUE WATERLOO IA 50702 7252622 0 X WWW.FAMILYPRACTICERESIDENCY.ORG X 1975 IA DEVELOPING FAMILY MEDICINE PHYSICIANS THROUGH MODELING AND TEACHING 10 9 94 158 0 0 3228811 3462921 3714337 3777963 9637 9098 2420 2640 6955205 7252622 0 0 0 0 4953258 5098629 0 0 0 2206701 2347113 7159959 7445742 -204754 -193120 3948468 4736155 1231219 2212025 2717249 2524130 X DEVELOPING EXCELLENT FAMILY MEDICINE PHYSICIANS BY MODELING AND TEACHING COMPASSIONATE AND COMPREHENSIVE PATIENT CARE DELIVERED WITH THE HIGHEST QUALITY. 0 0 6040391 3777963 THE NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION WAS FOUNDED IN 1975 TO DEVELOP A FAMILY MEDICINE TRAINING PROGRAM. THE FAMILY MEDICINE RESIDENCY PROGRAM IS THE BRANCH OF THE FOUNDATION WHICH PROVIDES PHYSICIANS WITH THREE YEARS OF ADDITIONAL TRAINING IN THE SPECIALTY OF FAMILY MEDICINE. DURING THEIR TRAINING, RESIDENT PHYSICIANS PROVIDE COMPREHENSIVE HEALTH CARE UNDER THE SUPERVISION OF BOARD CERTIFIED FAMILY MEDICINE PHYSICIANS. UPON GRADUATION, THESE PHYSICIANS PROVIDE A POTENTIAL SOURCE OF FAMILY PHYSICIANS SETTLING TO PRACTICE IN THE COMMUNITY.RESIDENT TRAINING TAKES PLACE IN THE HOSPITAL SETTING, IN PRIVATE PHYSICIAN OFFICES AND IN THE NORTHEAST IOWA FAMILY PRACTICE CENTER. DURING THEIR THREE-YEAR TRAINING PROGRAM, THE PHYSICIANS RECEIVE TRAINING IN INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, SURGERY, PEDIATRICS, EMERGENCY MEDICINE, FAMILY MEDICINE, COMMUNITY MEDICINE, PSYCHIATRY AND BEHAVIORAL SCIENCE, ORTHOPEDICS, OTORHINOLARYNGOLOGY, OPHTHALMOLOGY AND DERMATOLOGY. IN ADDITION, THEY MAY USE ELECTIVE TIME TO CONCENTRATE ON SPECIALTIES AND SUB-SPECIALTIES OF THEIR CHOICE. RESIDENT PHYSICIANS PROVIDE COMPREHENSIVE MEDICAL CARE TO A GROUP OF UP TO 250 PATIENT FAMILIES AT THE NORTHEAST IOWA FAMILY PRACTICE CENTER. RESIDENTS MAY CONSULT WITH FACULTY PHYSICIANS DURING PATIENT VISITS. PATIENTS REQUIRING CARE IN THE HOSPITAL ARE SEEN BY BOTH RESIDENT AND FACULTY PHYSICIANS.AREA PHYSICIANS ARE COMMITTED TO THE NORTHEAST IOWA FAMILY MEDICINE RESIDENCY PROGRAM. NEARLY ALL PRIVATE PHYSICIANS IN THE AREA VOLUNTEER TO TEACH THE SKILLS AND PROCEDURES RESIDENT PHYSICIANS WILL NEED IN PRIVATE PRACTICE. PHYSICIANS SELECTED TO BE RESIDENTS IN THE NORTHEAST IOWA FAMILY MEDICINE RESIDENCY PROGRAM ARE ALL GRADUATES OF ACCREDITED MEDICAL SCHOOLS. THE WATERLOO PROGRAM RECRUITS MEDICAL SCHOOL GRADUATES OF THE HIGHEST CALIBER, TAKING INTO CONSIDERATION PERSONAL CHARACTERISTICS, APTITUDE AND ACADEMIC ACHIEVEMENTS.GRADUATES OF THE NORTHEAST IOWA FAMILY MEDICINE RESIDENCY PROGRAM ARE ELIGIBLE TO SIT FOR THE CERTIFICATION EXAMINATION IN THE SPECIALTY OF FAMILY MEDICINE. THIS EXAMINATION IS ADMINISTERED BY THE AMERICAN BOARD OF FAMILY MEDICINE, WHICH IS THE SPECIALTY BOARD THAT CERTIFIES FAMILY PHYSICIANS. DURING THE ACADEMIC YEAR 2011-12, SIX RESIDENTS GRADUATED AND WILL TAKE THE EXAMINATION FOR CERTIFICATION.THE RESIDENCY PROGRAM IS ACCREDITED BY THE ACCREDITATION COUNCIL OF GRADUATE MEDICAL EDUCATION (ACGME), WHICH IS COMPOSED OF REPRESENTATIVES OF FIVE NATIONAL ASSOCIATIONS INTERESTED IN MEDICAL EDUCATION. THESE ASSOCIATIONS ARE THE AMERICAN BOARD OF MEDICAL SPECIALTIES, AMERICAN HOSPITAL ASSOCIATION, AMERICAN MEDICAL ASSOCIATION, ASSOCIATION OF AMERICAN MEDICAL COLLEGES AND THE COUNCIL OF MEDICAL SPECIALTY SOCIETIES. THE ACGME ACCREDITS RESIDENCY PROGRAMS THROUGH THEIR RESIDENCY REVIEW COMMITTEES WITH EACH SPECIALTY HAVING ITS OWN COMMITTEE.EDUCATIONAL ACTIVITIES OF THE FOUNDATION INCLUDE THE FAMILY MEDICINE RESIDENCY PROGRAM, UNDERGRADUATE MEDICAL EDUCATION, CONTINUING MEDICAL EDUCATION, AND MEDICAL RESEARCH. THE FOUNDATION IS SPONSORED BY ALLEN MEMORIAL HOSPITAL AND COVENANT MEDICAL CENTER.DURING FISCAL YEAR ENDED JUNE 30, 2012 NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION TRAINED 18 RESIDENT PHYSICIANS IN THE SPECIALTY OF FAMILY MEDICINE AND ONE PHARMACY RESIDENT IN TRADITIONAL AND CLINICAL PHARMACY SERVICES. PROVIDED CLINICAL EXPERIENCE IN FAMILY MEDICINE FOR 42 MEDICAL STUDENTS, 16 PHARMACY STUDENTS, THREE PODIATRY STUDENTS, AND SIX PHYSICIAN ASSISTANT STUDENTS. 6040391 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 15 0 1 94 1 0 0 0 0 0 0 0 0 0 0 X 10 9 1 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X GREG NELSON 3192722525 2055 KIMBALL AVENUE WATERLOO IA 50702 KYLE CHRISTIASON MD 1.00 X X 0 0 0 PAUL FRANKE 1.00 X X 0 0 0 JACK DUSENBERY 1.00 X X 0 0 0 JOHN KNOX 1.00 X X 0 0 0 TOM TIBBITTS 1.00 X X 0 0 0 RUSSELL ADAMS MD 1.00 X 0 0 0 MARK FELDKAMP DO 1.00 X 0 0 0 RAJA AKBAR MD 1.00 X 0 0 0 DAVE HAPPEL 1.00 X 0 0 0 KIM NEUMANN MD 1.00 X 0 0 0 ANGELA TOWNSEND MD 1.00 X 0 0 0 ROGER TRACY 1.00 X 0 0 0 ANTHONY A DAY MD 55.00 X X 264743 0 26435 GREG NELSON 45.00 X 93527 0 750 ROBERT FRIEDMAN MD 45.00 X 257858 0 25918 JAMES POOCK MD 45.00 X 225086 0 27504 JOHN SUTHERLAND MD 30.00 X 173915 0 23485 SUZANNE MUNNS MD 45.00 X 187818 0 12885 1202947 0 116977 5 0 1 0 COMPUTER SENSE INC 421 OLIVE STREET CEDAR FALLS IA 50613 COMPUTER SERVICES 213764 1 274122 3188799 3462921 CLINIC REVENUE 621110 3282499 3282499 SUPPORTING REVENUE 900099 298636 298636 PHARMACY RESEARCH AND 900099 88116 88116 QUALITY PERFORMANCE IN 900099 60163 60163 PHARMACY RESIDENCY REI 900099 48549 48549 3777963 1221 1221 2640 0 2640 2640 2640 7877 0 7877 7877 7877 7252622 3777963 0 11738 421822 421822 3915761 3787908 127853 112630 109185 3445 377508 350989 26519 270908 230812 40096 2095 2095 12950 12950 363070 326154 36916 82071 82071 277861 156116 121745 183618 40217 143401 315520 315520 62298 7575 54723 11693 11693 199524 199524 123141 123141 MEDICAL SUPPLIES 234325 234325 BAD DEBT EXPENSE 196881 196881 SUCCESS SHARING INCENTI 141033 141033 REFUND OF EDUC SUPPORT 141033 141033 7445742 6040391 1405351 0 907546 696711 1154471 944062 362772 428854 27591 6898 41849 89034 88648 3385673 2413794 976971 971879 424164 1271159 5919 6095 0 280000 3948468 4736155 884892 788725 346327 251276 0 1172024 1231219 2212025 X 1630150 1678608 1087099 845522 2717249 2524130 3948468 4736155 X -193120 1 X 0 1 1 X 0 X 3368129 3409270 3444556 3228811 3462921 16913687 3197065 3350536 3467330 3714337 3777963 17507231 6565194 6759806 6911886 6943148 7240884 34420918 0 0 0 34420918 5517 1929 1622 4180 3861 17109 5517 1929 1622 4180 3861 17109 6570711 6761735 6913508 6947328 7244745 34438027 0.99950 0.99920 0.00050 0.00080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 41314 256 168 1246 576 39916 107243 306 5850 71550 535 41314 0.84730 0.15270 1 0 1377492 846062 531430 2008181 1567732 440449 971879 ESTIMATED INSURANCE RECOVERIES RECEIVABLE 280000 280000 FICA REFUND DUE TO MEMBERS AND RESIDENTS 892024 ESTIMATED CLAIMS LIABILITY 280000 1172024 7252622 7445742 -193120 1 1 -193119 7244745 0 7244745 7877 7877 7252622 7155799 -7877 -7877 7163676 282066 282066 7445742 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION IS A BENEFICIARY OF A FUND ESTABLISHED AT A COMMUNITY FOUNDATION KNOWN AS THE CHARLES A. WATERBURY, JR., M.D. MEMORIAL FUND. THE COMMUNITY FOUNDATION MAINTAINS THIS FUND AS AN INDEPENDENT TRUSTEE. THIS FUND IS INTENDED FOR "CURRENT PRIORITY NEEDS" OF THE FOUNDATION SUCH AS EQUIPMENT FOR EDUCATIONAL RESOURCES, NEW PROGRAM DEVELOPMENT, RESIDENT RECRUITMENT COSTS, AND ADMINISTRATIVE AND OPERATIONAL EXPENSES. AN ENDOWMENT FUND KNOWN AS THE CHARLES A. WATERBURY, JR., M.D. ENDOWMENT FUND HAS ALSO BEEN ESTABLISHED AT THE COMMUNITY FOUNDATION. THE COMMUNITY FOUNDATION MANAGES THE FUND WITH THE LONG-TERM OBJECTIVES OF SAFEGUARDING PRINCIPAL, INCREASING THE PRINCIPAL'S GROWTH SUFFICIENTLY TO OFFSET ANY DECREASE IN PURCHASING POWER DUE TO INFLATION, AND GENERATING INCOME FOR DISTRIBUTION TO THE FOUNDATION. THE COMMUNITY FOUNDATION HAS VARIANCE POWER, WHICH ALLOWS THEM TO MODIFY THE DONOR'S STIPULATIONS UNDER CERTAIN CIRCUMSTANCES AS THEY MONITOR THE CHANGING NEEDS OF THE COMMUNITY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE FOUNDATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XII, LINE 4B - OTHER ADJUSTMENTS: DEFERRED GAIN ON FORMER BUILDING INCLUDED IN REVENUE PER FORM 990 7,877. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DEFERRED GAIN ON FORMER BUILDING INCLUDED IN EXPENSES FOR FINANCIAL STMTS -7,877. PART XIII, LINE 4B - OTHER ADJUSTMENTS: SUCCESS SHARING PAYOUT INCLUDED IN EXPENSES PER 990 141,033. REFUND OF EDUCATION SUPPORT INCLUDED IN EXPENSES PER 990 141,033. X X X 0 0 0 0 0 1 0 0 0 ANTHONY A DAY MD 252095 0 12648 0 0 0 11866 0 14569 0 291178 0 0 0 ROBERT FRIEDMAN MD 245319 0 12539 0 0 0 11863 0 14055 0 283776 0 0 0 JAMES POOCK MD 194200 0 10192 0 20694 0 11729 0 15775 0 252590 0 0 0 JOHN SUTHERLAND MD 164994 0 8921 0 0 0 11784 0 11701 0 197400 0 0 0 SUZANNE MUNNS MD 179007 0 8811 0 0 0 0 0 12885 0 200703 0 0 0 PART I, LINE 6 A SUCCESS SHARING POLICY HAS BEEN APPROVED BY THE BOARD OF DIRECTORS WHICH ALLOWS ALL EMPLOYEES, INCLUDING THOSE LISTED IN PART VII, TO BE ELIGIBLE FOR ADDITIONAL FINANCIAL COMPENSATION BASED UPON THE FINANCIAL SUCCESS (NET EARNINGS) OF THE ORGANIZATION AND OTHER QUALITY MEASURES. DR JAMES POOCK STUDENT LOAN ADVANCE AS PART OF A RECRUITMENT AGREEMENT X 106000 6898 0 1 1 6898 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF OFFICERS ELECTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS AUTHORITY TO EXERCISE ALL POWERS OF THE BOARD OF DIRECTORS BETWEEN REGULARLY SCHEDULED BOARD MEETINGS. FORM 990, PART VI, SECTION A, LINE 2 DAVE HAPPEL, RUSSELL ADAMS, MD, JOHN KNOX, KYLE CHRISTIASON, MD, AND RAJA AKBAR, MD HAVE A BUSINESS RELATIONSHIP. MARK FELDKAMP, DO, PAUL FRANKE, JACK DUSENBERY, AND ANGELA TOWNSEND, MD HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION ARE ALLEN MEMORIAL HOSPITAL CORPORATION AND COVENANT HEALTH SYSTEM. NEW MEMBERS MAY BE ADMITTED ONLY WITH THE UNANIMOUS CONSENT OF THE PRESENT MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE TWO MEMBERS, ALLEN MEMORIAL HOSPITAL CORPORATION AND COVENANT HEALTH SYSTEM, APPOINT THE BOARD OF DIRECTORS OF NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION INC. THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF EACH OF THE MEMBERS ARE AUTOMATICALLY, BY VIRTUE OF THEIR OFFICE, DIRECTORS OF THIS CORPORATION. THE EXECUTIVE DIRECTOR OF THE NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION, INC. SERVES ON THE BOARD. A REPRESENTATIVE OF THE UNIVERSITY OF IOWA COLLEGE OF MEDICINE SERVES ON THE BOARD AS APPOINTED BY THE DEAN OF THE COLLEGE. EACH MEMBER APPOINTS TO THE BOARD OF DIRECTORS TWO PERSONS WHO ARE MEMBERS OF THE MEDICAL STAFF OF THE APPOINTING MEMBER, AND TWO PERSONS WHO ARE ALSO DIRECTORS OF THE APPOINTING MEMBER, OR AN AFFILIATED ORGANIZATION OF SUCH APPOINTING MEMBER. FORM 990, PART VI, SECTION A, LINE 8B THE EXECUTIVE COMMITTEE DID NOT MEET DURING FISCAL YEAR 2012. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS MADE AVAILABLE TO THE GOVERNING BODY. THE EXECUTIVE DIRECTOR AND ADMINISTRATOR REVIEW THE 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND OFFICERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE STATEMENTS ARE REVIEWED BY THE ADMINISTRATOR OF THE ORGANIZATION. ANY POTENTIAL CONFLICT IS BROUGHT TO THE BOARD'S ATTENTION FOR DISCUSSION. IN THE EVENT OF A POTENTIAL CONFLICT, THE MEMBER WILL DISCLOSE THE POTENTIAL CONFLICT AND EITHER ABSTAIN FROM INVOLVEMENT OR DISCUSSION OF THE ISSUE LEADING TO THE CONFLICT OR RESIGN. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY ADJUSTMENT RECOMMENDATIONS BASED ON AN ANNUAL INDIVIDUAL PERFORMANCE EVALUATION AND REVIEW OF MEDICAL GROUP COMPENSATION SURVEYS PUBLISHED BY MGMA, AMGA, AND UNIVERSITY OF IOWA COMPENSATION SURVEY OF IOWA MEDICAL RESIDENCY PROGRAMS INCLUDING SIZE OF GROUPS, OWNERSHIP, PRODUCTIVITY, AND GEOGRAPHIC AREA. THE EXECUTIVE DIRECTOR DETERMINES THE ADMINISTRATOR'S COMPENSATION BASED ON THE ABOVE PROCESS. THE ORGANIZATION DOCUMENTS AND PROVIDES SUBSTANTIATION FOR THEIR COMPENSATION PROCESS. THE PROCESS FOR DETERMINING COMPENSATION FOR THE EXECUTIVE DIRECTOR AND ADMINISTRATOR WAS COMPLETED IN FISCAL YEAR 2012. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: 1.