2011-11-11T13:57:44-06:00 2011-06-30 EIDE BAILLY LLP 3999 PENNSYLVANIA AVE SUITE 100 DUBUQUE IA 52002 990 2010-07-01 421058745 NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION INC NORT 3192722525 2055 KIMBALL AVENUE WATERLOO IA 50702 ANTHONY A DAY 3192722525 2011-11-11 1 CARMEN KRANTZ 5635561790 2010 2016-02-24 21:20:13Z ANTHONY A DAY 2055 KIMBALL AVENUE WATERLOO IA 50702 6955205 0 X WWW.FAMILYPRACTICERESIDENCY.ORG X 1975 IA TO PREPARE QUALIFIED PHYSICIANS IN THE SPECIALTY OF FAMILY PRACTICE 12 11 91 158 0 0 3444595 3228811 3467330 3714337 8259 9637 1320 2420 6921504 6955205 0 0 0 0 4742483 4953258 0 0 0 2385136 2206701 7127619 7159959 -206115 -204754 3993605 3948468 1071602 1231219 2922003 2717249 X THE MISSION OF THE NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION IS TO PREPARE EXCELLENT FAMILY MEDICINE PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS THROUGH EVIDENCE-BASED MEDICAL EDUCATION IN THE SPECIALTY OF FAMILY MEDICINE, AND TO COORDINATE UNDERGRADUATE AND CONTINUING MEDICAL EDUCATION BY MODELING AND TRAINING, COMPASSIONATE, COMPREHENSIVE AND CONTINUING PATIENT CARE WITH BEST PRACTICE RESULTS. 0 0 5778197 3714337 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.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, 2011 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. 5778197 1 1 0 0 0 0 0 0 1 1 0 0 0 0 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 16 0 1 91 1 0 0 0 0 0 0 0 0 0 0 X 12 11 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X GREG NELSON 3192722525 2055 KIMBALL AVENUE WATERLOO IA 50702 ANTHONY A DAY MD 55.00 X X 254737 0 28658 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 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 MICHAEL SLAVIN 1.00 X 0 0 0 SARA POLING 1.00 X 0 0 0 GREG NELSON 45.00 X 0 0 0 GARY MILNER 60.00 X 139483 0 10827 ROBERT FRIEDMAN MD 45.00 X 251724 0 23903 JAMES POOCK MD 45.00 X 220723 0 25908 MICHELLE GRAHAM MD 45.00 X 108611 0 3650 JOHN SUTHERLAND MD 30.00 X 163783 0 28693 SUZANNE MUNNS MD 45.00 X 114866 0 6904 1253927 0 128543 7 0 1 0 0 282836 2945975 3228811 CLINIC REVENUE 621110 3261797 3261797 PHARMACY RESEARCH AND 900099 282741 282741 SUPPORTING REVENUE 900099 63920 63920 QUALITY PERFORMANCE IN 900099 57190 57190 PHARMACY RESIDENCY REI 900099 48689 48689 3714337 1760 1760 2420 2420 2420 2420 7877 7877 7877 7877 6955205 3714337 0 12057 443343 443343 3793952 3709885 84067 108037 108037 349513 323247 26266 258413 226580 31833 1885 1885 13701 13701 306727 259497 47230 78808 78808 392214 300567 91647 162134 37381 124753 130569 130569 56653 8400 48253 34900 34900 190913 190913 126578 126578 RESEARCH 282741 282741 BAD DEBT EXPENSE 225868 225868 REFUND OF EDUC SUPPORT 200287 200287 2723 93 2630 7159959 5778197 1381762 0 826036 907546 1382979 1154471 360303 362772 48285 27591 67589 89034 3191240 2214269 966961 976971 270494 424164 70958 5919 3993605 3948468 815532 884892 256070 346327 1071602 1231219 X 1593326 1630150 1328677 1087099 2922003 2717249 3993605 3948468 -204754 0 X 0 1 1 X 0 X 3216297 3368129 3409270 3444556 3228811 16667063 2916865 3197065 3350536 3467330 3714337 16646133 6133162 6565194 6759806 6911886 6943148 33313196 0 0 0 33313196 12161 5517 1929 1622 4180 25409 12161 5517 1929 1622 4180 25409 6145323 6570711 6761735 6913508 6947328 33338605 0.99920 0.99900 0.00080 0.00100 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 107243 306 5850 71550 535 41314 0.00000 0.85670 0.14330 1 0 1314809 779516 535293 1876431 1434753 441678 976971 6955205 7159959 -204754 0 -204754 7188905 241577 241577 6947328 7877 7877 6955205 6993084 241577 -7877 233700 6759384 400575 400575 7159959 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 990 200,288. REFUND OF EDUCATION SUPPORT INCLUDED IN EXPENSES PER 990 200,287. X X X 0 0 0 0 0 1 0 1 0 ANTHONY A DAY MD 244210 0 10527 0 0 0 12071 0 16587 0 283395 0 0 0 GARY MILNER 133374 0 6109 0 0 0 8128 0 2700 0 150311 0 0 0 ROBERT FRIEDMAN MD 241884 0 9840 0 0 0 12007 0 11896 0 275627 0 0 0 JAMES POOCK MD 190513 0 9516 0 20694 0 10270 0 15638 0 246631 0 0 0 JOHN SUTHERLAND MD 154642 0 9141 0 0 0 11613 0 17080 0 192476 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. PART I, LINE 7 WELLMARK PROVIDED AN INCENTIVE PAYOUT IF PREDETERMINED TARGETS WERE MET. ALL EMPLOYEES PRESENT FOR HALF A YEAR RECEIVED A BONUS EQUAL TO 1.25% OF THEIR ANNUAL BASE WAGE. ANTHONY DAY, MD $ 950 GARY MILNER 350 ROBERT FRIEDMAN, MD 700 JAMES POOCK, MD 700 MICHELLE GRAHAM, MD 700 JOHN SUTHERLAND, MD 2,200 DR JAMES POOCK STUDENT LOAN ADVANCE AS PART OF A RECRUITMENT AGREEMENT X 106000 27591 0 1 1 27591 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, SARA POLING, KYLE CHRISTIASON, MD, AND RAJA AKBAR, MD HAVE A BUSINESS RELATIONSHIP. MARK FELDKAMP, DO, PAUL FRANKE, JACK DUSENBERY, KIM NEUMANN, MD, 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 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 2011. 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.