2020-11-13T15:24:15-06:00 2019-12-31 390919055 RITZ HOLMAN LLP 330 E KILBOURN AVE MILWAUKEE WI 53202 990 2019-01-01 362902642 AMERICAN COLLEGE OF MOHS SURGERY INC AMER 4143471103 555 E WELLS STREET SUITE 1100 MILWAUKEE WI 53202 CLARK C OTLEY MD FACMS SECRETARY/TREAS 4143471103 2020-11-13 1 KATY L SOMMER P00273273 4142711451 2020-11-11 38.71.64.105 2020-11-13 15:20:19 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 04326551E785102FA6E4817A0E2435091CF4426A 2019 2021-01-29 14:40:06Z ELIZABETH BILLINGSLEY MD 555 E WELLS ST STE 1100 MILWAUKEE WI 53202 3088422 0 X WWW.MOHSCOLLEGE.ORG X 1967 WI THE COLLEGE PROMOTES AND ADVANCES THE HIGHEST STANDARDS OF PATIENT CARE WITH RESPECT TO MOHS SURGERY AND CUTANEOUS ONCOLOGY THROUGH FELLOWSHIP TRAINING, RESEARCH, EDUCATION AND PUBLIC ADVOCACY. 13 13 0 20 1750 21 1206297 541910 2280561 2409608 68843 77781 75431 58123 3631132 3087422 14000 14410 0 0 7500 15000 0 0 114302 2383117 2620250 2404617 2649660 1226515 437762 5687478 6863812 933980 1393861 4753498 5469951 X THE COLLEGE PROMOTES AND ADVANCES THE HIGHEST STANDARDS OF PATIENT CARE WITH RESPECT TO MOHS SURGERY AND CUTANEOUS ONCOLOGY THROUGH FELLOWSHIP TRAINING, RESEARCH, EDUCATION AND PUBLIC ADVOCACY. 0 0 1092569 1058689 THE ANNUAL MEETING BRINGS TOGETHER OVER 1000 PARTICIPANTS TO EDUCATE THEM ON THE LATEST ADVANCES IN THE TREATMENT OF SKIN CANCER, DISCUSS RECENT RESEARCH FINDINGS IN THE AREA OF MOHS MICROGRAPHIC SURGERY AND CUTANEOUS ONCOLOGY, AND EXPLAIN NEW TECHNIQUES IN RECONSTRUCTION. PARTICIPANTS ARE ABLE TO ATTEND VARIOUS EDUCATIONAL SESSIONS, RESEARCH ABSTRACT PRESENTATIONS AND LISTEN TO GUEST SPEAKERS. CONTINUING MEDICAL EDUCATION CREDITS ARE ALSO AVAILABLE FOR QUALIFYING PARTICIPANTS 362830 MOHSAIQ IS THE NATIONAL DATA REGISTRY OF THE ACMS. THE REGISTRY PROVIDES MEANINGFUL DATA ABOUT PATIENTS AND PHYSICIAN PERFORMATION IN ORDER TO IMPROVE OUTCOMES AND MAXIMIZE RESULTS UNDER NEW PAYMENT MODELS. 25558 51311 ACMS PROMOTES, EDUCATES AND REACHES OUT TO PATIENTS THROUGH VARIOUS FORMS OF PUBLIC RELATIONS. THIS INCLUDES PATIENT EDUCATION PAMPHLETS AND A MOHS SURGERY PATIENT EDUCATION WEBSITE TO HELP PATIENTS BECOME MORE INFORMED OF SKIN CANCER AND MOHS SURGERY. 608502 14410 OTHER PROGRAM SERVICES 608502 14410 2089459 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 13 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X EXECUTIVE DIRECTOR INC 4142766445 555 E WELLS ST STE 1100 MILWAUKEE WI 53202 THOMAS STASKO MD FACMS DIRECTOR 1.00 X 0 0 0 CHRISTOPHER J MILLER MD FAC DIRECTOR 1.00 X 0 0 0 BARRY LESHIN MD FACMS IMMED PAST PRES 3.00 X X 0 0 0 JEREMY S BORDEAUX MD MPH DIRECTOR 1.00 X 0 0 0 SARAH TUTTLETON ARRON MD PHD DIRECTOR 1.00 X 0 0 0 GLENN D GOLMAN MD FACMS VICE PRESIDENT 3.00 X X 0 0 0 CHRISTIAN LEE BAUM MS MD FA DIRECTOR 1.00 X 0 0 0 IAN A MAHER MD FACMS DIRECTOR 1.00 X 0 0 0 NATHANIEL J JELLINEX MD FACMS DIRECTOR 1.00 X 0 0 0 ELIZABETH BILLINGSLEY MD FACMS PRESIDENT 5.00 X X 0 0 0 CLARK C OTLEY MD FACMS SECRATARY/TREASURER 5.00 X X 0 0 0 DANIEL B EISEN MD FACMS DIRECTOR 1.00 X 0 0 0 EVA A HURST MD FACMS DIRECTOR 1.00 X 0 0 0 MICHEL A MCDONALD MD FACMS DIRECTOR 1.00 X 0 0 0 EDUARDO M VIDAL MD DIRECTOR 1.00 X 0 0 0 JERRY D BREWER MD MS FACMS DIRECTOR 1.00 X 0 0 0 THOMAS S BANDER MD DIRECTOR 1.00 X 0 0 0 SCOTT A BUCKTA COLLINS MD FACMS DIRECTOR 1.00 X 0 0 0 HOWARD W ROGERS MD PHD FACMS DIRECTOR 1.00 X 15000 0 0 ALLISON T VIDIMOS MD RPH FACMS PAST PRESIDENT 1.00 X X 0 0 0 15000 0 0 0 0 0 0 EXECUTIVE DIRECTOR INC 555 E WELLS ST STE 1100 MILWAUKEE WI 53202 MANAGEMENT 851762 HART HEALTH STRATEGIES 3823 FORDHAM RD WASHINGTON DC 20016 CONSULTING 156000 2 541910 541910 MEMBERSHIP DUES AND AS 541700 1301185 1301185 ANNUAL MEETING 541700 1064644 1062894 1750 JOB BOARD 541700 24209 24209 NEWSLETTER 541700 16787 16787 SITE INSPECTION 541700 1583 1583 1200 1200 2409608 77781 77781 53773 1000 52773 52773 MISCELLANEOUS 900099 5350 5350 5350 3087422 2465981 1750 77781 14410 14410 15000 15000 851762 603788 166199 81775 5849 5849 5800 5800 13881 13881 174982 174982 2359 2359 114098 59353 54745 4053 13 4040 64606 34666 29940 858406 847737 10669 80598 80598 13153 5630 7523 NATIONAL REGISTRY 256462 256462 DUES & SUBSCRIPTIONS 42669 31290 11379 PRODUCT EXPENSE 38676 38676 PUBLICATIONS 34693 25213 9480 58203 18556 7120 32527 2649660 2089459 445899 114302 533534 1317364 2246899 2272075 485155 169050 233792 577283 45035 147002 182866 182420 1211 446 1921434 2239190 164278 105555 56140 35847 5687478 6863812 86324 88501 847656 1305360 933980 1393861 X 3604741 3875234 1148757 1594717 4753498 5469951 5687478 6863812 437762 278691 0 X 0 1 X 1 0 X 978690 1024900 1131014 2262597 1843095 7240296 866783 864089 983093 1162872 1062894 4939731 1845473 1888989 2114107 3425469 2905989 12180027 52500 60000 76500 621868 125000 935868 0 52500 60000 76500 621868 125000 935868 11244159 34086 46407 46524 68843 77781 273641 2800 5500 5900 9000 1750 24950 36886 51907 52424 77843 79531 298591 9402 64839 67505 60629 49129 251504 1891761 2005735 2234036 3563941 3034649 12730122 0.88330 0.88570 0.02350 0.02020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 20156 0 1 3750 23906 0 PART II-B, LINE 1: ACMS MEMBERS PARTICIPATGED IN THE ALLIANCE OF SPECIALTY MEDICINE (COALITION) FLY-IN. THIS WAS AN OPPORTUNITY FOR VOLUNTEER PHYSICIANS TO ENGAGE IN CONVERSATIONS WITH LEGISLATORS ABOUT ISSUES PERTAINING TO THE PRACTICE OF SPECIALTY MEDICINE. THE FLY-IN TOOK PLACE JULY 2019 IN WASHINGTON, DC IN THE OFFICES OF LEGISLATORS REPRESENTING THE VARIOUS DISTRICTS/STATES OF THE PARTICIPANTS. ACMS ALSO PARTICIPATED IN A FLY-IN HELD BY THE COALITION THEY ARE MEMBERS OF. DESCRIPTION FOR I: $3,750 (PORTION OF COALITION DUES PAYMENT) GOES TOWARDS THE COALITION'S LOBBYING ACTIVITIES. 182866 182420 446 446 X 3353232 278691 278691 3074541 13881 -1000 12881 3087422 2636779 0 2636779 13881 -1000 12881 2649660 PART X, LINE 2: THE ORGANIZATION AND THE AFFILIATE ARE EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE CLASSIFIED AS OTHER THAN PRIVATE FOUNDATIONS. HOWEVER, INCOME FROM CERTAIN ACTIVITIES (PRIMARILY ADVERTISING INCOME) NOT DIRECTLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. AS OF DECEMBER 31, 2019, THE ORGANIZATION HAD RECORDED A LIABILITY OF $4 FOR UNRELATED BUSINESS INCOME TAX AND PENALTIES. THE TOTAL UNRELATED BUSINESS INCOME TAX EXPENSE RECORDED FOR YEAR ENDED DECEMBER 31, 2019, WAS $4. MANAGEMENT HAS REVIEWED ALL TAX POSITIONS RECOGNIZED IN PREVIOUSLY FILED TAX RETURNS IN THE U.S. FEDERAL AND STATE JURISDICTIONS AND THOSE EXPECTED TO BE TAKEN IN FUTURE TAX RETURNS. AS OF DECEMBER 31, 2019, THE ORGANIZATION HAD NO AMOUNTS RELATED TO UNRECOGNIZED INCOME TAX BENEFITS AND NO AMOUNTS RELATED TO ACCRUED INTEREST AND PENALTIES. THE ORGANIZATION DOES NOT ANTICIPATE ANY SIGNIFICANT CHANGES TO UNRECOGNIZED INCOME TAX BENEFITS OVER THE NEXT YEAR. THE ORGANIZATION IS CURRENTLY NOT UNDER AUDIT BY ANY FEDERAL OR STATE TAXING AUTHORITY. PART XI, LINE 4B - OTHER ADJUSTMENTS: COGS -1,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: COGS -1,000. 1 AMER SOCIETY FOR MOHS HISTOTECHNOLOGY 555 E WELLS ST STE 1100 MILWAUKEE WI 53202 361967102 501(C)(3) 14000 FMV OPERATIONS AND ANNUAL MEETING FMV PART I, LINE 2: ACMS AWARDS A GRANT TO ASMH FOR USE AT THEIR COMBINED ANNUAL MEETING AND GENERAL OPERATIONS. THE GRANT IS REVIEWED BY THE BOARD EACH YEAR AND THEN AWARDED UPON APPROVAL. FORM 990, PART VI, SECTION A, LINE 3 LINE 3 EXPLANATION - ACMS IS IN CONTRACT WITH EXECUTIVE DIRECTOR, INC., AN ASSOCIATION MANAGEMENT COMPANY. FORM 990, PART VI, SECTION A, LINE 6 LINE 6 EXPLANATION - THE MEMBERSHIP OF ACMS INCLUDES FOUR CATEGORIES OF MEMBERS: FELLOWS, ASSOCIATES, LIFE AND INTERNATIONAL AFFILIATE. FORM 990, PART VI, SECTION A, LINE 7A LINE 7A EXPLANATION - ELECTION OF DIRECTORS AND OFFICERS IS CONDUCTED PRIOR TO EACH ANNUAL MEETING OF THE MEMBERS OF THE COLLEGE IN ACCORDANCE WITH THE PROCEDURES DESCRIBED IN THE BYLAWS. AT LEAST NINETY (90) DAYS PRIOR TO THE MEETING, A MAIL OR ELECTRONIC BALLOT OF THE NOMINEES IS SENT TO ALL MEMBERS IN GOOD STANDING. FORM 990, PART VI, SECTION A, LINE 7B LINE 7B EXPLANATION - ON ANY MATTER TO BE VOTED UPON AT ANY ANNUAL MEETING OF MEMBERS, EACH MEMBER (FELLOW, ASSOCIATE AND LIFE) IN GOOD STANDING SHALL BE ENTITLED TO VOTE. THERE SHALL BE NO VOTING BY PROXY OR CUMULATIVE VOTING AT THE ANNUAL MEETING OF MEMBERS. THE ACT OF A MAJORITY OF THE MEMBERS PRESENT AND VOTING AT THE ANNUAL MEETING AT WHICH A QUORUM IS PRESENT SHALL BE THE ACT OF THE MEMBERSHIP OF THE COLLEGE, EXCEPT WHERE OTHERWISE PROVIDED BY LAW OR THE BYLAWS, INCLUDING ELECTION OF DIRECTORS. QUORUM SHALL CONSIST OF FIVE PERCENT (5%) OF THE TOTAL VOTING MEMBERSHIP IN GOOD STANDING, BUT NOT LESS THAN FIFTY (50) MEMBERS WITH VOTING RIGHTS. FORM 990, PART VI, SECTION B, LINE 11B LINE 11B EXPLANATION - UPON COMPLETION OF THE PREPARED FORM 990 AND ALL APPLICABLE SCHEDULES, IT IS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. THE ORIGINAL FORM IS SIGNED BY THE APPROPRIATE OFFICER AND THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ACMS REQUIRES DISCLOSURE OF CERTAIN INFORMATION FROM LEADERS (OFFICERS, BOARD MEMBERS, COMMITTEE CHAIRS/ MEMBERS, TASK FORCE CHAIRS, AND SENIOR STAFF), FACULTY, PARTICIPANTS AT BUSINESS/COMMITTEE MEETINGS, AND AUTHORS OF MANUSCRIPTS SUBMITTED FOR POSSIBLE PUBLICATION. ANY POSSIBLE CONFLICTS OF INTEREST DISCLOSED ARE REVIEWED BY THE EXECUTIVE DIRECTOR AND ARE BROUGHT FORWARD TO THE ETHICS COMMITTEE AND BOARD OF DIRECTORS FOR FURTHER INVESTIGATION, REVIEW AND DETERMINATION OF THE APPROPRIATE DISCIPLINARY ACTIONS. ACTIONS THAT MAY BE IMPOSED INCLUDE ABSTENTION FROM DISCUSSING OR VOTING ON THE MATTER OF CONFLICT AND DISCIPLINARY ACTIONS IF REQUIRED AND/OR RESIGNATION FROM POSITION OR DIVESTITURE OF INTEREST WHICH GIVES RISE TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 ACMS IS MANAGED BY EXECUTIVE DIRECTOR INCORPORATED, A FOR-PROFIT MANAGEMENT COMPANY. ACMS HAS NO OFFICIAL EMPLOYEES, BECAUSE ALL STAFF ASSIGNED TO ACMS ARE EMPLOYEES OF THE MANAGEMENT COMPANY. ACMS ALSO DOES NOT COMPENSATE DIRECTORS OR OTHER TOP OFFICIALS AND DOES NOT HAVE ANYONE WHO FITS THE DEFINITION OF A KEY EMPLOYEE. FORM 990, PART VI, SECTION C, LINE 19 ACMS MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FORM 990/990-T AND APPLICABLE SCHEDULES AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. ALL SUCH REQUESTS SHOULD BE IN WRITING TO THE ACMS OFFICE. MEMBERS OF THE BOARD RECEIVING AN INQUIRY MUST ADVISE STAFF OF THE REQUEST WITHIN A REASONABLE TIME AFTER INQUIRY IS RECEIVED. SITE INSPECTION & SLIDE REVIEW BOARD LLC 555 E WELLS ST SUITE 110 MILWAUKEE WI 53202 362902642 CONDUCT SLIDE/LAB REVIEW ACTIVITIES FOR TRAINING WI 1583 86370 AMERICAN COLLEGE OF MOHS SURGERY INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0