2022-08-12T12:53:18-05:00 2022-03-31 410746749 CLIFTONLARSONALLEN LLP 2523 US HIGHWAY 27 S SEBRING FL 338704926 990 2021-04-01 541032555 AMERICAN ASSOCIATION FOR PHYSICIAN LEADERSHIP INC AMER 8132872000 400 N ASHLEY DR 400 TAMPA FL 33602 MICHELLE MARTIN CHIEF FINANCIAL OFFICER 8132872000 2022-08-09 1 MICHELLE MARTIN 999009999 KRISTINA HIMROD CPA P01544190 8633851577 2022-08-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z PETER ANGOOD MD 400 N ASHLEY DR 400 TAMPA FL 33602 8651260 0 X WWW.PHYSICIANLEADERS.ORG X 1974 FL TO ENSURE PHYSICIANS CONTINUALLY GROW AS INDIVIDUALS AND BECOME SUCCESSFUL HEALTHCARE LEADERS. 15 14 29 17 21594 0 0 1506892 7246547 6827318 -53821 -33640 84620 254199 7277346 8554769 0 0 0 0 3000605 3616192 0 0 0 4034652 3941089 7035257 7557281 242089 997488 5806967 6075015 7101098 6371658 -1294131 -296643 X TO HELP ENSURE THAT PHYSICIANS CONTINUALLY GROW AS INDIVIDUALS AND BECOME SUCCESSFUL HEALTHCARE LEADERS, THE ASSOCIATION DEVELOPS AND PROVIDES THE NECESSARY LEADERSHIP PROGRAMS, PRODUCTS AND SERVICES TO IMPROVE HEALTHCARE. 0 0 3188806 5019555 EDUCATION - EDUCATING PHYSICIANS IN LEADERSHIP SKILLS FOCUSING ON PATIENT CARE, FISCAL HEALTH, EMPLOYEE WELL-BEING AND COMMUNITY INVOLVEMENT; TRAIN PHYSICIANS TO BE HIGHLY CAPABLE MANAGERS AND EXCEPTIONAL PHYSICIANS; OFFER LIVE COURSES, COMPUTER-BASED AND INHOUSE TRAINING. 1073109 403613 PUBLICATIONS AND INFORMATION SERVICES - PRINTING AND PRODUCTION OF TEXTBOOKS, PUBLICATIONS, AND NEWSLETTERS. PUBLICATIONS INCLUDE BI MONTHLY JOURNAL AND PUBLICATIONS FOR PURCHASE WHICH FOCUS ON MANAGERIAL AND LEADERSHIP TOPICS, ETHICS, AND MEDICAL RESOURCES. 524400 1382306 MEMBERSHIP - MAINTAINING MEMBER DIRECTORY AND RECRUITING; PROVIDE ONLINE COMMUNITIES WHERE MEMBERS EXCHANGE SOLUTIONS TO PROBLEMS AND DISCUSS NEW IDEAS. PROVIDE CAREER COUNSELING, ONLINE TOOL KITS, COMPENSATION SURVEYS & OTHER RESOURCES. 250 SPONSORSHIPS 250 4786315 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 136 0 1 29 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X MICHELLE MARTIN 8132872000 400 N ASHLEY DR 400 TAMPA FL 33602 PETER ANGOOD MD CHIEF EXECUTIVE OFFICER 40.00 5.00 X X 627976 0 13550 ASH GOKLI CHAIR 1.00 0.10 X X 0 0 0 STEPHANIE DUGGAN VICE CHAIR 1.00 0.00 X X 0 0 0 MARK LESTER PAST CHAIR 1.00 0.10 X 0 0 0 ANNE VANGARSSE DIRECTOR 1.00 0.00 X 0 0 0 BRUCE LEVY DIRECTOR 1.00 0.00 X 0 0 0 COLLEEN INOUYE DIRECTOR 1.00 0.00 X 0 0 0 DANIEL LACE CCMM BOARD CHAIR DIRECTOR 1.00 0.10 X 0 0 0 GREGG DAVIS DIRECTOR 1.00 0.00 X 0 0 0 JULIE LOSEPH DIRECTOR 1.00 0.00 X 0 0 0 LINDA LAWRENCE DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL CANADY DIRECTOR 1.00 0.00 X 0 3000 0 RANDALL BICKLE DIRECTOR 1.00 0.00 X 0 0 0 TERESA MALCOLM DIRECTOR 1.00 0.00 X 0 0 0 ZULMA BERRIOS DIRECTOR 1.00 0.00 X 0 0 0 MICHELLE MARTIN TREASURER/CHIEF FINANCIAL 40.00 5.00 X 311654 0 7818 HANS ZETTERSTROM SECRETARY/CHIEF STRATEGIC 40.00 5.00 X 275625 0 14287 ANTHONY TALBOT SECRETARY/CHIEF OPERATIONS OFFICER 40.00 5.00 X 275920 0 21016 BRIAN FENDING CHIEF INFORMATION TECHNOLO 40.00 0.00 X 229125 0 42320 DANIEL SIROIS LEAD SOFTWARE ARCHITECH 40.00 0.00 X 177379 0 43946 NANCY COLLINS SVP, CONTENT PROCUREMENT & DISTRIBUTION 40.00 0.00 X 124889 0 47844 JESSICA CHASE SR. DIRECTOR, PROGRAM DELIVERY EXPERIENCE 40.00 0.00 X 115250 0 18662 SIAOMING WONG SR. NATIONAL ACCOUNT MANAGER 40.00 0.00 X 116683 0 17574 2254501 3000 227017 9 0 1 0 ADP INC PO BOX 842875 BOSTON MA 02284 PAYROLL & BENEFITS 273995 REFLECTIONS PSYCHOLOGICAL SERVICES 2709 HAMMAN WAY AURORA IL 60502 CONTRACTED FACULTY SERVICES 171822 BANK OF AMERICA 100 NORTH TRYON STREET CHARLOTTE NC 28255 CREDIT CARD PROCESSING FEES 162752 KEVIN E O'CONNOR AND ASSOC LTD 3531 RFD OAK HILL LANE LONG GROVE IL 60047 CONTRACTED FACULTY SERVICES 115186 VIVAYOS 67-3 NORWICH SALEM ROAD LYME CT 06371 CREATIVE MARKETING CONSULTING SERVICES 114959 6 1506892 1506892 EDUCATION PROGRAMS 900099 5019555 5019555 MEMBERSHIP DUES 900099 1382306 1382306 PUBLICATIONS AND INFOR 511120 425207 403613 21594 SPONSORSHIP INCOME 900099 250 250 6827318 223 223 224439 62628 161811 161811 161811 33863 -33863 -33863 -33863 403B FORFEITURES 900099 92388 92388 92388 8554769 6805724 21594 220559 1762308 775415 986893 1461889 659219 802670 36961 16319 20642 160355 70788 89567 194679 85869 108810 7867 6261 1606 28769 22896 5873 900 900 592675 447322 145353 228025 199536 28489 465947 229374 236573 229935 13027 216908 2829 1136 1693 81382 24718 56664 5429 5429 681871 667086 14785 68271 37629 30642 EDUCATION PROGRAM 1097220 1096676 544 PUBLICATION EXPENSES 412378 412378 RECRUITMENT EXPENSES 15196 6703 8493 MEMBERSHIP EXPENSES 7367 7367 15028 6596 8432 7557281 4786315 2770966 0 1921785 2609081 1761190 1760513 205945 161625 15712 16300 470158 372764 1075042 761330 490685 313712 941492 841020 5806967 6075015 729563 836558 2367824 2940388 150000 1494580 2359131 2594712 7101098 6371658 X -1294131 -296643 -1294131 -296643 5806967 6075015 997488 0 X 0 1 X 1 0 X 493 1506892 1507385 9236250 9906146 9261469 7212497 6805724 42422086 9236743 9906146 9261469 7212497 8312616 43929471 0 0 0 43929471 98129 82151 58182 32092 224662 495216 98129 82151 58182 32092 224662 495216 106 57873 92388 150367 9334978 9988297 9319651 7302462 8629666 44575054 0.98550 0.99120 0.01110 0.00710 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2017 AMOUNT: $ 106. 2020 AMOUNT: $ 57,873. 2021 AMOUNT: $ 92,388. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 84314 72116 12198 206928 186636 20292 783800 502578 281222 313712 SOFTWARE DEVELOPMENT COSTS 799108 BOOK PUBLICATION COSTS 26087 DEFERRED SUBLEASE BENEFIT 15825 841020 INCENTIVE FROM LESSOR 32766 DUE TO RELATED PARTY 2561946 2594712 X PART X, LINE 2: THE ORGANIZATION HAS IMPLEMENTED THE ACCOUNTING GUIDANCE FOR UNCERTAINTY IN INCOME TAXES AND MANAGEMENT BELIEVES THAT THERE ARE NO UNCERTAIN TAX POSITIONS FOR WHICH EITHER RECOGNITION OR DISCLOSURE IS REQUIRED IN THE FINANCIAL STATEMENTS. X X X X X 0 0 0 0 0 0 0 0 0 PETER ANGOOD MD CHIEF EXECUTIVE OFFICER 482476 0 145500 0 0 0 2500 0 11050 0 641526 0 0 0 MICHELLE MARTIN TREASURER/CHIEF FINANCIAL 249154 0 62500 0 0 0 0 0 7818 0 319472 0 0 0 ANTHONY TALBOT SECRETARY/CHIEF OPERATIONS OFFICER 219670 0 56250 0 0 0 2500 0 18516 0 296936 0 0 0 HANS ZETTERSTROM SECRETARY/CHIEF STRATEGIC 219375 0 56250 0 0 0 2500 0 11787 0 289912 0 0 0 BRIAN FENDING CHIEF INFORMATION TECHNOLO 179125 0 50000 0 0 0 2500 0 39820 0 271445 0 0 0 DANIEL SIROIS LEAD SOFTWARE ARCHITECH 165979 0 11400 0 0 0 2500 0 41446 0 221325 0 0 0 NANCY COLLINS SVP, CONTENT PROCUREMENT & DISTRIBUT 115514 0 9375 0 0 0 0 0 47844 0 172733 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A COMPOSITION OF THE EXECUTIVE COMMITTEE OF THE ASSOCIATION CONSISTS OF THE PRESIDENT/CEO, BOARD CHAIRPERSON AND THREE ADDITIONAL BOARD MEMBERS. A. ROLE. THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWER OF THE BOARD BETWEEN THE MEETINGS OF THE BOARD. B. ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE MUST BE RATIFIED BY THE FULL BOARD AT ITS NEXT MEETING. C. MEETINGS. THE EXECUTIVE COMMITTEE SHALL MEET AT THEIR DISCRETION BETWEEN MEETINGS OF THE ENTIRE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE ASSOCIATION SHALL HAVE SIX (6) CLASSES OF MEMBERS AS DESCRIBED BELOW. A. PHYSICIAN MEMBERS: MEDICAL DOCTOR (MD) OR DOCTOR OF OSTEOPATHY (DO) WHO MEETS THE FOLLOWING CRITERIA: - HAS GRADUATED FROM A MEDICAL SCHOOL IN THE UNITED STATES OR CANADA, ACCREDITED BY THE LIAISON COMMITTEE ON MEDICAL EDUCATION (LCME), OR GRADUATED FROM AN OSTEOPATHIC COLLEGE OF MEDICINE ACCREDITED BY THE AMERICAN OSTEOPATHIC ASSOCIATION (AOA), OR GRADUATED FROM A RECOGNIZED INTERNATIONAL EQUIVALENT SCHOOL. - HAS HELD A FULL UNRESTRICTED MEDICAL LICENSE THAT WAS NOT REVOKED. - ARE ENGAGED IN LEADERSHIP OR ADMINISTRATIVE RESPONSIBILITIES IN A HEALTH CARE OR HEALTH CARE RELATED ORGANIZATION, SERVICE OR PROGRAM, OR ARE INTERESTED IN PHYSICIAN LEADERSHIP OR MEDICAL MANAGEMENT. B. INTERNATIONAL MEMBERS: MDS OR DOS WORKING OUTSIDE THE UNITED STATES. C. PUBLIC SERVICE/MILITARY MEMBERS: MDS OR DOS WORKING IN THE PUBLIC HEALTHCARE SECTOR OR ACTIVE MILITARY. D. RISING LEADER MEMBERS: MDS OR DOS IN THEIR 1ST TO 5TH YEAR IN FULL TIME PRACTICE AS AN ATTENDING PHYSICIAN. E. STUDENT, RESIDENT, FELLOW MEMBERS: STUDENTS ENROLLED IN MEDICAL SCHOOL, RESIDENT IN 1ST 4TH YEAR OR FELLOWS IN 1ST 3RD YEAR. F. PROFESSIONAL AFFILIATE MEMBERS: NON-MD OR DO CLINICIANS, SUCH AS PA, NP, AND RN, WITH AN INTEREST IN LEADERSHIP. THIS CLASS OF MEMBERSHIP IS OPEN TO CLINICAL HEALTHCARE PROFESSIONS AS DESIGNATED AND APPROVED BY THE ASSOCIATON BOARD. BENEFITS ARE THE SAME AS TRADITIONAL MEMBERS (INCLUDING DISCOUNTS ON COURSES), EXCEPT THAT THEY CAN NOT SERVE ON THE BOARD, BECOME AN OFFICER, OR BECOME A CPE. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS SHALL BE A CPE AND/OR FELLOWS OR DISTINGUISHED FELLOWS OF THE CORPORATION AND SHALL BE ELECTED BY THE MEMBERS OF THE CORPORATION UNDER PROCEDURES ESTABLISHED AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE ORGANIZATION'S FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO THE FILING OF THE FORM. FORM 990, PART VI, SECTION B, LINE 12C PRIOR TO BOARD OR COMMITTEE ACTION ON A CONTRACT OR TRANSACTION INVOLVING A CONFLICT OF INTEREST, A DIRECTOR OR COMMITTEE MEMBER HAVING A CONFLICT OF INTEREST AND WHO IS IN ATTENDANCE AT THE MEETING SHALL DISCLOSE ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE REFLECTED IN THE MINUTES OF THE MEETING. IF BOARD MEMBERS ARE AWARE THAT STAFF OR OTHER VOLUNTEERS HAVE A CONFLICT OF INTEREST, RELEVANT FACTS SHOULD BE DISCLOSED BY THE BOARD MEMBER OR BY THE INTERESTED PERSON HIM/HERSELF IF INVITED TO THE BOARD MEETING AS A GUEST FOR PURPOSES OF DISCLOSURE. A DIRECTOR OR COMMITTEE MEMBER WHO PLANS NOT TO ATTEND A MEETING AT WHICH HE OR SHE HAS REASON TO BELIEVE THAT THE BOARD OR COMMITTEE WILL ACT ON A MATTER IN WHICH THE PERSON HAS A CONFLICT OF INTEREST SHALL DISCLOSE TO THE CHAIR OF THE MEETING ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST. THE CHAIR SHALL REPORT THE DISCLOSURE AT THE MEETING AND THE DISCLOSURE SHALL BE REFLECTED IN THE MINUTES OF THE MEETING. A PERSON WHO HAS A CONFLICT OF INTEREST SHALL NOT PARTICIPATE IN OR BE PERMITTED TO HEAR THE BOARD'S OR COMMITTEE'S DISCUSSION OF THE MATTER EXCEPT TO DISCLOSE MATERIAL FACTS AND TO RESPOND TO QUESTIONS. SUCH PERSON SHALL NOT ATTEMPT TO EXERT HIS OR HER PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, EITHER AT OR OUTSIDE THE MEETING. A PERSON WHO HAS A CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT OR TRANSACTION THAT WILL BE VOTED ON AT A MEETING SHALL NOT BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM FOR PURPOSES OF THE VOTE. THE PERSON HAVING A CONFLICT OF INTEREST MAY NOT VOTE ON THE CONTRACT OR TRANSACTION AND SHALL NOT BE PRESENT IN THE MEETING ROOM WHEN THE VOTE IS TAKEN, UNLESS THE VOTE IS BY SECRET BALLOT. SUCH PERSON'S INELIGIBILITY TO VOTE SHALL BE REFLECTED IN THE MINUTES OF THE MEETING. FOR PURPOSES OF THIS PARAGRAPH, A MEMBER OF THE BOARD OF DIRECTORS OF THE ASSOCIATION HAS A CONFLICT OF INTEREST WHEN HE OR SHE STANDS FOR ELECTION AS AN OFFICER OR FOR RE-ELECTION AS A MEMBER OF THE BOARD OF DIRECTORS. INTERESTED PERSONS WHO ARE NOT MEMBERS OF THE BOARD OF DIRECTORS OF THE ASSOCIATION, OR WHO HAVE A CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT OR TRANSACTION THAT IS NOT THE SUBJECT OF BOARD OR COMMITTEE ACTION, SHALL DISCLOSE TO THEIR SUPERVISOR, OR THE CHIEF EXECUTIVE OFFICER, OR THE CHIEF EXECUTIVE OFFICER'S DESIGNEE, ANY CONFLICT OF INTEREST THAT SUCH INTERESTED PERSON HAS WITH RESPECT TO A CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL BE MADE AS SOON AS THE CONFLICT OF INTEREST IS KNOWN TO THE INTERESTED PERSON. THE INTERESTED PERSON SHALL REFRAIN FROM ANY ACTION THAT MAY AFFECT THE ASSOCIATION'S PARTICIPATION IN SUCH CONTRACT OR TRANSACTION. IN THE EVENT IT IS NOT ENTIRELY CLEAR THAT A CONFLICT OF INTEREST EXISTS, THE INDIVIDUAL WITH THE POTENTIAL CONFLICT SHALL DISCLOSE THE CIRCUMSTANCES TO HIS OR HER SUPERVISOR OR THE CHIEF EXECUTIVE OFFICER, OR THE CHIEF EXECUTIVE OFFICER'S DESIGNEE, WHO SHALL DETERMINE WHETHER FULL BOARD DISCUSSION IS WARRANTED OR WHETHER THERE EXISTS A CONFLICT OF INTEREST THAT IS SUBJECT TO THIS POLICY. ANNUALLY EACH DIRECTOR, OFFICER, EMPLOYEE AND VOLUNTEER SHALL COMPLETE A DISCLOSURE FORM IDENTIFYING ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES IN WHICH S/HE IS INVOLVED THAT HE OR SHE BELIEVES COULD CONTRIBUTE TO A CONFLICT OF INTEREST. SUCH RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES MIGHT INCLUDE SERVICE AS A DIRECTOR OF OR CONSULTANT TO ANOTHER NONPROFIT ORGANIZATION, OR OWNERSHIP OF A BUSINESS THAT MIGHT PROVIDE GOODS OR SERVICES TO THE ASSOCIATION. ANY SUCH INFORMATION REGARDING THE BUSINESS INTERESTS OF A DIRECTOR, OFFICER, EMPLOYEE OR VOLUNTEER, OR A FAMILY MEMBER THEREOF, SHALL BE TREATED AS CONFIDENTIAL AND SHALL GENERALLY BE MADE AVAILABLE ONLY TO THE PRESIDENT OF THE BOARD OF DIRECTORS, THE CHIEF EXECUTIVE OFFICER, AND ANY COMMITTEE APPOINTED TO ADDRESS CONFLICTS OF INTEREST, EXCEPT TO THE EXTENT ADDITIONAL DISCLOSURE IS NECESSARY IN CONNECTION WITH THE IMPLEMENTATION OF THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE COMPENSATION OF THE CHIEF EMPLOYED EXECUTIVE IS REVIEWED AND APPROVED BY THE ASSOCIATION'S BOARD OF DIRECTORS OR EXECUTIVE COMMITTEE, PROVIDED THAT PERSONS WITH CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN THIS REVIEW AND APPROVAL. COMPENSATION IS REVIEWED AND APPROVED USING DATA NO GREATER THAN THREE YEARS OLD AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST CERTIFYING COMMISSION IN MEDICAL MANAGEMENT INC 400 N ASHLEY DR SUITE 400 TAMPA FL 33602 311487805 IMPROVING THE HEALTH CARE DELIVERY SYSTEM FL 501(C)(6) AMERICAN ASSOCIATION FOR PHYSICIAN LEADERSHIP INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 CERTIFYING COMMISSION IN MEDICAL MANAGEMENT O 109800 CASH