MAG INSTITUTE FOR EXCELLENCE IN MEDICINE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MAG INSTITUTE FOR EXCELLENCE IN MEDICINE INC (EIN 30-0211350)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-07
- IRS object ID
- 201243129349301014
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-07T07:57:42-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 580692043 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAULDIN & JENKINS LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 GALLERIA PARKWAY SE SUITE 1700 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 303395946 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300211350 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHYSICIAN'S INSTITUTE FOR EXCELLENCE | BusinessNameLine1 |
| Business Name Line2 | IN MEDICINE INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PHYS | NameControl |
| Phone | 6783039290 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1849 THE EXCHANGE NO 200 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 303392027 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DONALD J PALISANO | Name |
| Title | TREASURER | Title |
| Phone | 6783039290 | Phone |
| Date Signed | 2012-11-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFF T FUCITO | Name |
| PTIN | P00120748 | PTIN |
| Phone | 7709558600 | Phone |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DONALD J PALMISANO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1849 THE EXCHANGE NO 200 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 303392027 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 908546 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | HTTP://WWW.PHYSICIANSINSTITUTE.ORG/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2003 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE PATIENT SAFETY AND ACHIEVE CLINICAL IMPROVEMENTS FOR GEORGIA PHYSICIANS AND THEIR PATIENTS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1564181 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 812102 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 69520 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 91179 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 9581 | InvestmentIncomePriorYear |
| Investment Income Current Year | 5265 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1643282 | TotalRevenuePriorYear |
| Total Revenue Current Year | 908546 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 493769 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 418516 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 267631 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 310266 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 798077 | OtherExpensePriorYear |
| Other Expenses Current Year | 508441 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1559477 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1237223 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 83805 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -328677 | RevenuesLessExpensesCY |
| Total Assets BOY | 1491385 | TotalAssetsBOY |
| Total Assets EOY | 992974 | TotalAssetsEOY |
| Total Liabilities BOY | 142506 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 319371 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1348879 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 673603 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO IMPROVE PATIENT SAFETY AND ACHIEVE CLINICAL IMPROVEMENTS FORGEORGIA PHYSICIANS AND THEIR PATIENTS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 870762 | Expense |
| Grants | 418516 | Grants |
| Revenue | 91179 | Revenue |
| Description | CEASE SMOKING TODAY - INDIAN HEALTH COMMUNITIESAS A PART OF A NATIONAL COLLABORATIVE SUPPORTED BY AN INDEPENDENT EDUCATIONAL GRANT FROM PFIZER, THE PHYSICIANS' INSTITUTE UTILIZED A TRAIN-THE-TRAINER APPROACH TO MOTIVATIONAL INTERVIEWING/PATIENT COMMUNICATIONS TO FOCUS ON SMOKING CESSATION IN MEDICAL COMMUNITIES. THE PHYSICIANS' INSTITUTE PROVIDED SUPPORT AND COORDINATION FOR A TWO 2-DAY INTENSIVE MOTIVATIONAL INTERVIEWING WORKSHOPS IN ARIZONA FOR THE INDIAN HEALTH COMMUNITY IN COLLABORATION WITH UNIVERSITY OF ARIZONA HEALTHCARE PARTNERSHIP. | Description |
| Total Program Service Expense | 870762 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 9 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 3 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALLY-ANNE ALLPASS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6783039290 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1849 THE EXCHANGE SE SUITE 200 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 30339 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| WALKER L RAY MD | |||||||
| PRESIDENT | 0.00 | X | X | 0 | 0 | 0 | |
| JOHN S ANTALIS MD | |||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||
| WILLIAM A BORNSTEIN MD | |||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||
| JACK M CHAPMAN MD | |||||||
| SECRETARY | 0.00 | X | X | 0 | 0 | 0 | |
| HOWARD MAZIAR MD | |||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||
| JACQUELINE FINCHER MD | |||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||
| JAMES R MORROW MD | |||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||
| ALAN L PLUMMER MD | |||||||
| VICE PRESIDENT | 0.00 | X | X | 0 | 0 | 0 | |
| RICHARD S SIMMONS MD | |||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||
| DAVID A COOK EX-0FFICIO | |||||||
| TREASURER | 1.00 | X | 0 | 32719 | 25168 | ||
| DONALD J PLAMISANO JR EX-OFFICIO | |||||||
| TREASURER | 1.00 | X | 0 | 206953 | 33716 | ||
| ROBERT ADDLETON | |||||||
| EXECUTIVE VICE PRESIDENT | 40.00 | 121389 | 0 | 16847 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 121389 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 239672 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 75731 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| All Other Contributions | 812102 | AllOtherContributions |
| Total Contributions | 812102 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | FEES & REGISTRATIONS | Description |
| Business Code | 611430 | BusinessCode |
| Total Revenue Column | 91179 | TotalRevenueColumn |
| Related Or Exempt Function Income | 91179 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 91179 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5265 | TotalRevenueColumn |
| Exclusion | $5,265 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 908546 | TotalRevenueColumn |
| Related Or Exempt Function Income | 91179 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $5,265 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 418516 | Total |
| Program Services | 418516 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 262905 | Total |
| Management And General | 262905 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14785 | Total |
| Management And General | 14785 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14504 | Total |
| Management And General | 14504 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18072 | Total |
| Management And General | 18072 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8500 | Total |
| Management And General | 8500 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 282591 | Total |
| Program Services | 279727 | ProgramServices |
| Management And General | 2864 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9765 | Total |
| Program Services | 2322 | ProgramServices |
| Management And General | 7443 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17202 | Total |
| Program Services | 17202 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34264 | Total |
| Program Services | 33036 | ProgramServices |
| Management And General | 1228 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29534 | Total |
| Program Services | 28282 | ProgramServices |
| Management And General | 1252 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1541 | Total |
| Management And General | 1541 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| OTHER EXPENSE/CREDIT CA | 65771 | 65319 | 452 |
| OCCUPANCY & SALARY REIM | 25000 | 25000 | |
| PROGRAM MANAGEMENT | 20858 | 20858 | |
| AUDIO VISUAL | 5500 | 5500 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7915 | Total |
| Management And General | 7915 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1237223 | Total |
| Program Services | 870762 | ProgramServices |
| Management And General | 366461 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1281094 | BOY |
| EOY | 793502 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 210000 | BOY |
| EOY | 199472 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 291 | BOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1491385 | BOY |
| EOY | 992974 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18772 | BOY |
| EOY | 72760 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46920 | BOY |
| EOY | 165534 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76814 | BOY |
| EOY | 81077 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 142506 | BOY |
| EOY | 319371 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69843 | BOY |
| EOY | 123437 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1279036 | BOY |
| EOY | 550166 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1348879 | BOY |
| EOY | 673603 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1491385 | BOY |
| EOY | 992974 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -328677 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -346599 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEDICAL ASSOCIATION OF GEORGIA INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 580605267 | EIN |
| Type Of Organization | 501(C)(6) | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $0 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED ENTITIES | Description |
| Amount | $81,077 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 81077 | TotalOfAmounts |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| UNIVERSITY OF ARIZONA PARTNERSHIP | |||||||
| 2030 E SPEEDWAY STE 120 | TUCSON | AZ | 85719 | 742652689 | 501(C)(3) | 5000 | INDIAN HEALTH PROJECT |
| NORTHWEST COMMUITY HOSPITAL FOUNDATION | |||||||
| 3060 SALT CREEK LANE | ARLINGTON HEIGHTS | IL | 60005 | 363125193 | 501(C)(3) | 5175 | CHRONIC PAIN PROJECT |
| ST ANTHONY HOSPITAL | |||||||
| 1000 LEE STREET | OKLAHOMA CITY | OK | 73102 | 730657693 | 7500 | TOBACCO CESSATION PROJECT | |
| SALEM VA MEDICAL CENTER | |||||||
| 1970 ROANOKE BLVD | SALEM | VA | 24153 | 541622309 | 7500 | TOBACCO CESSATION PROJECT | |
| CME ENTERPRISE | |||||||
| 630 W CARMEL DRIVE SUITE 260 | CARMEL | IN | 46032 | 201380466 | 13082 | TOBACCO CESSATION CONTENT CONTRACT | |
| AMERICAN SOC TRANSPLANTATION | |||||||
| 15000 COMMERCE PARKWAY SUITE C | MOUNT LAUREL | NJ | 08054 | 421182936 | 501(C)(3) | 21810 | KIDNEY NEEDS ASSESSMENT PROJECT |
| INTERSTATE POSTGRADUATE MEDICAL | |||||||
| PO BOX 5474 | MADISON | WI | 53705 | 390368317 | 501(C)(3) | 6750 | KIDNEY NEEDS ASSESSMENT PROJECT |
| AMERICAN SOC TRANSPLANTATION | |||||||
| 15000 COMMERCE PARKWAY SUITE C | MOUNT LAUREL | NJ | 08054 | 421182936 | 501(C)(3) | 7270 | KIDNEY NEEDS ASSESSMENT PROJECT |
| AMERICAN UROLOGICAL ASSOCIATION | |||||||
| 1000 CORPORATE BOULEVARD | LINTHICUM | MD | 21090 | 430691437 | 501(C)(3) | 19675 | KIDNEY NEEDS ASSESSMENT PROJECT |
| HEALTHCARE PERFORMANCE | |||||||
| 2321 STOCKTON DRIVE | FLEMING ISLAND | FL | 32003 | 562357759 | 38113 | KIDNEY NEEDS ASSESSMENT PROJECT | |
| UNIVERSITY OF ARIZONA PARTNERSHIP | |||||||
| 2030 E SPEEDWAY STE 120 | TUCSON | AZ | 85719 | 742652689 | 501(C)(3) | 180000 | INDIAN HEALTH PROJECT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 6 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 4 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DONALD J PLAMISANO JR EX-OFFICIO | NamePerson |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 177830 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 700 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 28423 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 12948 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 20768 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 240669 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 7 | ReturnReference |
| Explanation | PERFORMANCE BONUSES FROM THE ORGANIZATION: ROBERT ADDLETON 22,107 ADELE COHEN 19,416 PERFORMANCE BONUSES FROM RELATED ORGANIZATION: DAVID COOK 15,000 DONALD PALMISANO 700 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 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 12C | THE 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 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART XI, LINE 5: | PRIOR PERIOD ADJUSTMENTS: -273,329. REFUND OF GRANT REVENUES -73,270. TOTAL TO FORM 990, PART XI, LINE 5: -346,599. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII LINE 2C | THERE HAVE BEEN NO CHANGES TO THE AUDITOR SELECTION PROCESS, NOR OVERSIGHT OF THE FINANCIAL STATEMENTS. | |
| FORM 990 PART V LINE 2A | THE ORGANIZATION HAS THREE 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/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEDICAL ASSOCIATION OF GEORGIA | |||||||||||
| 1849 THE EXCHANGE SE STE 200 | ATLANTA | GA | 30339 | 580605267 | PROMOTE ART AND SCIENCE OF MEDICINE | GA | 501(C)(6) | N/A | 0 | ||
| MEDICAL ASSOCIATION OF GEORGIA FOUNDATION | |||||||||||
| 1849 THE EXCHANGE SE STE 200 | ATLANTA | GA | 30339 | 586066431 | SUPPPORT MAG | GA | 501(C)(3) | 0 | LINE 11A, I | MEDICAL ASSOCIATION OF GEORGIA | |
| GEORGIA MEDICAL POLITICAL ACTION COMMITTEE | |||||||||||
| 1849 THE EXCHANGE SE STE 200 | ATLANTA | GA | 30339 | 580939391 | PROMOTE MEDICAL PROFESSION | GA | 527 | 0 | MEDICAL ASSOCIATION OF GEORGIA | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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