2018-08-07T14:51:04-05:00 2018-03-31 410746749 CLIFTONLARSONALLEN LLP 201 N FRANKLIN ST SUITE 2500 TAMPA FL 33602 990 2017-04-01 541032555 AMERICAN ASSOCIATION FOR PHYSICIAN LEADERSHIP INC AMER 8132872000 400 N ASHLEY DR NO 400 TAMPA FL 33602 MICHELLE MARTIN CPA CHIEF FINANCIAL OFFICER 8132872000 2018-07-30 1 LAUREN BALLARD P01451787 8133842700 2018-07-30 2017 2022-09-23 18:48:47Z PETER ANGOOD MD 400 N ASHLEY DR NO 400 TAMPA FL 33602 11104100 0 X WWW.PHYSICIANLEADERS.ORG X 1974 FL TO ENSURE PHYSICIANS CONTINUALLY GROW AS INDIVIDUALS AND BECOME SUCCESSFUL HEALTHCARE LEADERS. 13 12 55 16 12000 0 1014 493 9156564 9230250 282625 290640 43542 12106 9483745 9533489 0 0 0 0 3881902 3807779 0 0 0 6612984 6691414 10494886 10499193 -1011141 -965704 7271643 6553277 4909078 5190665 2362565 1362612 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 8020874 7249037 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. 467677 1719287 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. 676738 267926 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. 9165289 1 0 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 1 0 0 0 0 0 1 1 1 0 0 1 99 0 55 1 1 1 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHELLE MARTIN 8132872000 400 N ASHLEY DR TAMPA FL 33602 ALAN MARCO CHAIR AS OF 04/2017 1.00 0.10 X X 0 0 0 NAPOLEON KNIGHT CHAIR THROUGH 04/2017 1.00 0.10 X X 0 0 0 JACK SMITH DIRECTOR 1.00 0.00 X 0 0 0 ANTHONY SLONIM DIRECTOR 1.00 0.00 X 0 0 0 WILLIAM CASPERSON DIRECTOR 1.00 0.10 X 0 0 0 DANIEL LACE DIRECTOR 1.00 0.10 X 0 0 0 JD POLK DIRECTOR 1.00 0.00 X 0 0 0 BRET BURTON DIRECTOR 1.00 0.00 X 0 0 0 JAMES GREGORY JOLISSAINT DIRECTOR 1.00 0.00 X 0 0 0 LAURA CLAPPER DIRECTOR 1.00 0.00 X 0 0 0 ALBERT TZEEL DIRECTOR 1.00 0.00 X 0 0 0 HOWARD SHAW DIRECTOR 1.00 0.00 X 0 0 0 MARK LESTER DIRECTOR 1.00 0.00 X 0 0 0 BYRON SCOTT DIRECTOR 1.00 0.00 X 0 0 0 LISA LAURENT DIRECTOR 1.00 0.00 X 0 0 0 THOMAS HIGGINS DIRECTOR 1.00 0.00 X 0 0 0 PETER B ANGOOD MD CHIEF EXECUTIVE OFFICER 40.00 5.00 X X 520000 0 17805 MICHELLE MARTIN CPA CHIEF FINANCIAL OFFICER 40.00 5.00 X 210000 0 10820 RICHARD SITES CHIEF LEARNING OFFICER 40.00 5.00 X 173819 0 22337 HANS ZETTERSTROM CHIEF OPERATING OFFICER 40.00 5.00 X 79925 0 6606 DAWN MCKNIGHT DIRECTOR OF BUSSINES DEVELOPMENT 40.00 0.00 X 126112 0 12239 1109856 0 69807 4 0 1 0 HYALINE LLC 206 S MODDY AVE UNIT 1 TAMPA FL 33609 IT DEVELOPMENT CONSULTING SERVICES 332720 REFLECTIONS PSYCHOLOGICAL SVCS 2709 HAMMAN WAY AURORA IL 60502 FACULTIY SERVICES 223100 PROTECH ASSOCIATES INC 5457 TWIN KNOLLS RD STE 400 COLUMBIA MD 21045 IT MANAGED SERVICES 198682 LIVINGHR INC 1810 W KENNEDY BLVD TAMPA FL 33606 HR CONSULTING SERVICES 151221 MADE INC PO BOX 153 HAMBURG NY 14075 IT MANAGEMENT AND DEVELOPMENT CONSULTING 124050 7 493 493 EDUCATION PROGRAMS 900099 7000210 7000210 MEMBERSHIP DUES 900099 1719287 1719287 PUBLICATIONS AND INFORMATION SERV 900099 267926 267926 SPONSORSHIP INCOME 900099 242827 242827 9230250 98129 98129 1763122 1562268 8343 200854 -8343 192511 192511 ADVERTISING INCOME 900099 12000 12000 MISCELLANEOUS INCOME 900099 106 106 12106 9533489 9230250 12000 290746 1023449 603835 419614 2308011 2076453 231558 23448 16175 7273 218057 196437 21620 234814 197344 37470 31492 22195 9297 61767 36674 25093 29747 29747 412306 262807 149499 1161 856 305 270902 253047 17855 583717 349806 233911 259689 211854 47835 72195 60103 12092 157178 103168 54010 1108 925 183 620460 602494 17966 37144 30875 6269 EDUCATION PROGRAM 3598472 3598472 PUBLICATION EXPENSES 427775 427775 RECRUITMENT EXPENSES 38274 34677 3597 MEMBERSHIP EXPENSES 20406 20406 67621 58911 8710 10499193 9165289 1333904 0 1223132 444036 112873 385605 398260 354375 670 30965 25772 369957 269068 1076375 899227 351346 177148 4032613 3764692 375 275 752122 1131636 7271643 6553277 1074058 1174012 2396501 2290150 24076 16244 1414443 1710259 4909078 5190665 X 2362565 1362612 2362565 1362612 7271643 6553277 -965704 -34249 0 X 0 1 X 1 0 X 5000 1014 493 6507 9569213 10045005 12423126 9156564 9236250 50430158 9569213 10045005 12428126 9157578 9236743 50436665 0 0 0 50436665 83454 139206 122157 48304 98129 491250 13700 10951 24651 83454 152906 133108 48304 98129 515901 46341 7747 4585 18817 106 77596 9699008 10205658 12565819 9224699 9334978 51030162 0.98840 0.98870 0.01010 0.00970 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2013 AMOUNT: $ 46,341. 2014 AMOUNT: $ 7,747. 2015 AMOUNT: $ 4,585. 2016 AMOUNT: $ 18,817. 2017 AMOUNT: $ 106. 47928 28812 19116 279264 215134 64130 749183 655281 93902 177148 SOFTWARE DEVELOPMENT COSTS 1131636 1131636 INCENTIVE FROM LESSOR 80487 DUE TO RELATED PARTY 1629772 1710259 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 0 0 0 0 0 1 0 0 0 PETER B ANGOOD MD CHIEF EXECUTIVE OFFICER 435000 0 85000 0 0 0 2500 0 15305 0 537805 0 0 0 MICHELLE MARTIN CPA CHIEF FINANCIAL OFFICER 190000 0 20000 0 0 0 0 0 10820 0 220820 0 0 0 RICHARD SITES CHIEF LEARNING OFFICER 168819 0 5000 0 0 0 2500 0 19837 0 196156 0 0 0 PART I, LINE 6 THE CEO WAS ELIGIBLE FOR BONUS BASED ON NON-FINANCIAL PERFORMANCE (MEMBERSHIP GROWTH, NEW CONTENT DELIVERY, NEW PRODUCT DEVELOPMENT, ETC.) BUT ONLY IF THE MINIMUM SURPLUS THRESHOLD WAS REACHED. HYALINE LLC HANS ZETTERSTROM FORMER OFFICER 423888 IT DEVELOPMENT CONSULTING SERVICES 0 FORM 990, PART VI, SECTION A, LINE 1 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 NINE (9) CLASSES OF MEMBERS AS DESCRIBED BELOW. A. PHYSICIAN MEMBERS: MDS, DOS, PODIATRIC PHYSICIANS AND DENTISTS WHO MEET THE QUALIFICATIONS FOR MEMBERSHIP IN SECTION 2. THERE ARE 4 CLASSES OF MEMBERSHIP IN THIS CATEGORY - "MEMBERS", "DIPLOMATES", "FELLOWS", AND "DISTINGUISHED FELLOWS". B. SPECIAL CATEGORIES OF MEMBERSHIP. THERE ARE TWO (2) SPECIAL CATEGORIES OF MEMBERSHIP "HONORARY MEMBERS", AND "HONORARY FELLOWS". C. AFFILIATE MEMBERS: 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. AFFILIATE MEMBERS CAN SERVE ON COMMITTEES AND TASK FORCES AND BE EX-OFFICIO MEMBERS OF THE BOARD. D. HEALTHCARE LEADERS: THIS CLASS OF MEMBERSHIP IS OPEN TO NON-CLINICIAN HEALTHCARE LEADERS AND MANAGERS INCLUDING HOSPITAL EXECUTIVES, PRACTICE MANAGERS, PHARMACEUTICAL COMPANY EXECS - ANYONE WHO WORKS WITH PHYSICIAN EXECUTIVES TO DELIVER HEALTHCARE SERVICES OR PRODUCTS. BENEFITS ARE THE SAME AS AFFILIATE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS SHALL BE 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 15 THE COMPENSATION OF THE CHIEF EMPLOYED EXECUTIVE, OTHER OFFICERS, AND KEY EMPLOYEES 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) 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 68210 CASH