SOCIETY FOR THE PRESERVATION OF PHYSICIAN ASSISTANT HISTORY INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: SOCIETY FOR THE PRESERVATION OF PHYSICIAN ASSISTANT HISTORY INC (EIN 03-0429253)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-09-05
IRS object ID: 201702489349300125
Schema version: 2016v3.0
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-09-05T12:27:53-05:00	ReturnTs
Tax Period End	2016-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	580692043	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	MAULDIN & JENKINS LLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	200 GALLERIA PKWY SE STE 1700	AddressLine1Txt
City	ATLANTA	CityNm
State Abbreviation	GA	StateAbbreviationCd
ZIP	303395946	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	030429253	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SOCIETY FOR THE PRESERVATION OF	BusinessNameLine1Txt
Business Name Line2	PHYSICIAN ASSISTANT HISTORY INC	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	SOCI	BusinessNameControlTxt
Phone	6784178100	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	12000 FINDLEY ROAD NO 100	AddressLine1Txt
City	JOHNS CREEK	CityNm
State Abbreviation	GA	StateAbbreviationCd
ZIP	30097	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	KAREN MULITALOMPASPA-C	PersonNm
Person Title	PRESIDENT	PersonTitleTxt
Phone	8015857588	PhoneNum
Signature	2017-08-28	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MARY JO ALEXANDER	PreparerPersonNm
PTIN	P00002534	PTIN
Phone	7709558600	PhoneNum
Preparation	2017-08-24	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	50.192.51.169	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2017-08-28	IPDt
IP Tm	10:58:31	IPTm
IP Timezone	ED	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	22709AFA47563364B621B0C461921DEB0EE6EC74	AtSubmissionCreationDeviceId
At Submission Filing Device Id	55811D467FC98571772255EE5EA31765EFEB9429	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	KAREN MULITALOMPASPA-C	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	12000 FINDLEY ROAD NO 100	AddressLine1Txt
City	JOHNS CREEK	CityNm
State Abbreviation	GA	StateAbbreviationCd
ZIP	30097	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$415,582	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.PAHX.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	2002	FormationYr
Legal Domicile State	NC	LegalDomicileStateCd
Activity Or Mission	PAHX IS DEDICATED TO PRESERVING THE HISTORY AND LEGACY OF THE PA PROFESSION THROUGH THE IDENTIFICATION AND COLLECTION OF APPROPRIATE PAPERS, MANUSCRIPTS, MAGAZINE AND NEWSPAPER CLIPPINGS, ORAL HISTORIES, AUDIO & VIDEOS AND PHOTOGRAPHS. PAHX ARCHIVES THESE MATERIALS AND MAKES THEM AVAILABLE ON THE PAHX WEBSITE (WWW.PAHX.ORG) FOR EVERYONE TO ACCESS.	ActivityOrMissionDesc
Voting Members Governing Body	10	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	0	TotalEmployeeCnt
Total Volunteers	9	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$236,358	PYContributionsGrantsAmt
CY Contributions Grants	$415,582	CYContributionsGrantsAmt
PY Program Service Revenue	$0	PYProgramServiceRevenueAmt
CY Program Service Revenue	$0	CYProgramServiceRevenueAmt
PY Investment Income	$0	PYInvestmentIncomeAmt
CY Investment Income	$0	CYInvestmentIncomeAmt
PY Other Revenue	$0	PYOtherRevenueAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$236,358	PYTotalRevenueAmt
CY Total Revenue	$415,582	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$119,001	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$168,666	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$92,714	PYOtherExpensesAmt
CY Other Expenses	$211,653	CYOtherExpensesAmt
PY Total Expenses	$211,715	PYTotalExpensesAmt
CY Total Expenses	$380,319	CYTotalExpensesAmt
PY Revenues Less Expenses	$24,643	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$35,263	CYRevenuesLessExpensesAmt
Total Assets BOY	$77,820	TotalAssetsBOYAmt
Total Assets EOY	$167,394	TotalAssetsEOYAmt
Total Liabilities BOY	$19,005	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$73,316	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$58,815	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$94,078	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	TO SHARE THE HISTORY OF THE DEVELOPMENT OF THE PA PROFESSION AND ILLUSTRATE HOW PAS CONTINUE TO MAKE A DIFFERENCE IN OUR SOCIETY.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$155,501	ExpenseAmt
Desc	SEE SCHEDULE OTHE PA HISTORY SOCIETY MAINTAINS A COLLECTION OF ARCHIVAL DOCUMENTS, REFERENCE MATERIALS, AUDIO & VIDEO CLIPS, AND MUSEUM ITEMS FROM THEDEVELOPMENT OF THE PA PROFESSION. THE SOCIETY SHARES THESE MATERIALS, VIA ITS ILLUSTRATED WEBSITE, AND DEVELOPS ADDITIONAL EDUCATIONALRESOURCES USED TO TEACH THE HISTORY OF PA PROFESSION. EDUCATIONAL MATERIALS INCLUDE A PUBLISHED THE PHYSICIAN ASSISTANT AN ILLUSTRATEDHISTORY BOOK, A PRODUCED DVD ABOUT THE CREATION OF THE NATIONAL PA ORGANIZATIONS TITLED, THE WAY WE WERE, A CONVERSATION WITH THE PAPROFESSION'S EARLY LEADERS, A DEVELOPED EDUCATIONAL TOOLKIT WITH LEARNING MODULES AND INSTRUCTORS GUIDE FOR PA FACULTY TO ASSIST THEMWITH TEACHING THE HISTORY OF THE PROFESSION. EACH YEAR THE SOCIETY CREATES ADDITIONAL EDUCATIONAL MATERIALS FROM ITS GROWING COLLECTION.	Desc
Total Program Service Expenses	$155,501	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	0	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	1	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	0	EmployeeCnt
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	10	GoverningBodyVotingMembersCnt
Independent Voting Member	9	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	NC	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SONIA RATLIFF VP FINANCE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6784178109	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	12000 FINDLEY ROAD SUITE 100	AddressLine1Txt
City	JOHNS CREEK	CityNm
State Abbreviation	GA	StateAbbreviationCd
ZIP	30097	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt
DAWN MORTON-RIAS EDDPA-C
CEO/EX-OFFICIO TRUSTEE	2.00	40.00	Yes (X)	Yes (X)	$0	$374,405	$32,161
ALFRED M SADLER JR MD
PAST PRESIDENT	2.00		Yes (X)		$0	$0	$0
KAREN MULITALO MPAS PA-C
PRESIDENT	2.00		Yes (X)	Yes (X)	$0	$0	$0
MARILYN FITZGERALD HONORARY PA
TRUSTEE	2.00		Yes (X)		$0	$0	$0
DEBORAH GERBERT MS PA-C
TRUSTEE	2.00		Yes (X)		$0	$0	$0
MARYANN RAMOS MPH PA
SECRETARY/TREASURER	2.00		Yes (X)	Yes (X)	$0	$0	$0
ROBERT WOTTEN PA-C DFAAPA
TRUSTEE	2.00		Yes (X)		$0	$0	$0
JOHN J DAVIS PA-C
TRUSTEE	2.00		Yes (X)		$0	$0	$0
HENRY HANK HEARD MPAS PA-C DHSC
TRUSTEE	2.00		Yes (X)		$0	$0	$0
STEVE WILSON PA-C
TRUSTEE	2.00		Yes (X)		$0	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$0	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$374,405	TotReportableCompRltdOrgAmt
Total Other Compensation	$32,161	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	0	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Related Organizations	$310,233	RelatedOrganizationsAmt
All Other Contributions	$105,349	AllOtherContributionsAmt
Total Contributions	$415,582	TotalContributionsAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$415,582	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$123,316	TotalAmt
Program Services	$47,466	ProgramServicesAmt
Management And General	$75,850	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$33,018	TotalAmt
Program Services	$12,709	ProgramServicesAmt
Management And General	$20,309	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$12,332	TotalAmt
Program Services	$4,747	ProgramServicesAmt
Management And General	$7,585	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$2,135	TotalAmt
Management And General	$2,135	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$3,100	TotalAmt
Management And General	$3,100	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$31,950	TotalAmt
Program Services	$16,541	ProgramServicesAmt
Management And General	$15,409	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$3,138	TotalAmt
Management And General	$3,138	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,183	TotalAmt
Management And General	$3,183	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$36,125	TotalAmt
Management And General	$36,125	ManagementAndGeneralAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$3,000	TotalAmt
Management And General	$3,000	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$10,800	TotalAmt
Management And General	$10,800	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$46,979	TotalAmt
Program Services	$9,680	ProgramServicesAmt
Management And General	$37,299	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,401	TotalAmt
Management And General	$1,401	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$2,288	TotalAmt
Management And General	$2,288	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
PUBLIC RELATIONS	$64,358	$64,358
CREDIT CARD PROCESSING	$1,391		$1,391
MISCELLANEOUS EXPENSE	$1,187		$1,187
TRAINING	$618		$618

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$380,319	TotalAmt
Program Services	$155,501	ProgramServicesAmt
Management And General	$224,818	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$71,685	BOYAmt
EOY	$160,059	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,000	BOYAmt
EOY	$1,000	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$144	BOYAmt
EOY	$123	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$8,617	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$2,405	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$3,991	BOYAmt
EOY	$6,212	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$77,820	BOYAmt
EOY	$167,394	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$1,748	BOYAmt
EOY	$49,605	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$17,257	BOYAmt
EOY	$23,711	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$19,005	BOYAmt
EOY	$73,316	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$50,579	BOYAmt
EOY	$77,390	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$8,236	BOYAmt
EOY	$16,688	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$58,815	BOYAmt
EOY	$94,078	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$77,820	BOYAmt
EOY	$167,394	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$35,263	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Supporting Organization509a3	Yes (X)	SupportingOrganization509a3Ind
Supporting Org Type1	Yes (X)	SupportingOrgType1Ind
Supported Organizations	1	SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	NATL COMM ON CERT OF PHYS ASSISTANT	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
EIN	581218672	EIN
Organization Type	10	OrganizationTypeCd
Governing Document Listed	Yes (1)	GoverningDocumentListedInd
Support	$0	SupportAmt
Other Support	$0	OtherSupportAmt

Field	Value	IRS element (for citing)
Supported Organizations Total	1	SupportedOrganizationsTotalCnt
Support Sum	$0	SupportSumAmt
Other Support Sum	$0	OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

Field	Value	IRS element (for citing)
Listed By Name Governing Doc	Yes (1)	ListedByNameGoverningDocInd
Suprt Org No IRS Determination	0	SuprtOrgNoIRSDeterminationInd
Supported Org Section C456	Yes (1)	SupportedOrgSectionC456Ind
Supported Org Qualified	Yes (1)	SupportedOrgQualifiedInd
Suprt Exclusively Sec170c2 B	Yes (1)	SuprtExclusivelySec170c2BInd
Supported Org Not Organized US	0	SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org	0	OrganizationChangeSuprtOrgInd
Support Non Supported Org	0	SupportNonSupportedOrgInd
Payment Substantial Contribtr	0	PaymentSubstantialContribtrInd
Loan Disqualified Person	0	LoanDisqualifiedPersonInd
Controlled Disqualified Prsn	0	ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int	0	DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int	0	DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules	0	ExcessBusinessHoldingsRulesInd
Contribution Controller	0	ContributionControllerInd
Contribution Family	0	ContributionFamilyInd
Contribution35 Controlled	0	Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

Field	Value	IRS element (for citing)
Power Appoint Majority Dir Trst	Yes (1)	PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org	0	OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART IV, LINE 3B	THE SUPPORTED ORGANIZATION, THE NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS INC (NCCPA), RECEIVES THE MAJORITY OF ITS SUPPORT FROM EXEMPT ACTIVITY FUNCTIONS WHICH ARE DERIVED DIRECTLY FROM THE ADMINISTRATION OF EXAMS AND RECERTIFICATION REQUIRED TO BE CERTIFIED AS A PHYSICIAN ASSISTANT. CONSEQUENTLY, NCCPA, A 501(C)(6) ORGANIZATION, WILL CONTINUE TO PASS THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2) INDEFINITELY (97.7% IN FYE 2016) SHOULD THERE EVER BE A SIGNIFICANT CHANGE IN PROGRAM FUNCTIONS, THE SOCIETY WILL BE NOTIFIED IMMEDIATELY.
SCHEDULE A SECTION A PART IV LINE 2	THE SUPPORTED ORGANIZATION, THE NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS INC (NCCPA), RECEIVES THE MAJORITY OF ITS SUPPORT FROM EXEMPT ACTIVITY FUNCTIONS WHICH ARE DERIVED DIRECTLY FROM THE ADMINISTRATION OF EXAMS REQUIRED TO RECEIVE PHYSICIAN ASSISTANT CERTIFICATION. CONSEQUENTLY, NCCPA, A 501(C)(6) ORGANIZATION, WILL CONTINUE TO PASS THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2) INDEFINITELY (97.7% IN FYE 2016) SHOULD THERE EVER BE A SIGNIFICANT CHANGE IN PROGRAM FUNCTIONS, THE SOCIETY WILL BE NOTIFIED IMMEDIATELY. THE SUPPORTING AND SUPPORTED ORGANIZATIONS HAVE COMMON MANAGEMENT.
PART IV, LINE 3C	THE EXPENSES SHOWN GOING TO THE SUPPORTED ORGANIZATION (NCCPA) ARE IN FACT EXPENSES SPENT BY THE SOCIETY TO SUPPORT ITS PROGRAM INITIATIVES WHICH ARE ORIGINALLY DIRECTED TO THE SOCIETY BY NCCPA. THE SOCIETY OPERATES ITS OWN PROGRAMS AND HAS THE CONTROL OVER WHERE THE FUNDS ARE DIRECTED, WHICH ARE FOR CHARITABLE AND EDUCATIONAL PURPOSES UNDER SECTION 170(C)(2)(B. THE SOCIETY PROVIDES WRITTEN REPORTS ABOUT ITS PROGRAM ACTIVITIES TO NCCPA ON A QUARTERLY BASIS. THE NCCPA BOARD OF DIRECTORS ALSO PROVIDES DIRECTION FOR THE SOCIETY'S FUTURE PROGRAM ACTIVITIES, AND THE SOCIETY WILL PRESENT ITS STRATEGIC INITIATIVES FOR 2018 TO NCCPA AT THE BOARD MEETING IN NOVEMBER 2017.

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

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)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,689	OtherCostOrOtherBasisAmt
Depreciation	$1,110	DepreciationAmt
Book Value	$3,579	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,928	OtherCostOrOtherBasisAmt
Depreciation	$1,295	DepreciationAmt
Book Value	$2,633	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$6,212	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

Field	Value	IRS element (for citing)
Desc	RELATED PARTY PAYABLE - NCCPA	Desc
Amt	$23,711	Amt

Field	Value	IRS element (for citing)
Total Liability	$23,711	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$415,582	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$415,582	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$415,582	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$380,319	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$380,319	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$380,319	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART X, LINE 2:	FormAndLineReferenceDesc
Explanation	THE COMMISSION IS EXEMPT FROM INCOME TAXATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(6), AND THE FOUNDATION AND THE PA HISTORY SOCIETY ARE EXEMPT UNDER SECTION 501(C)(3). MANAGEMENT OF THE ORGANIZATION CONSIDERS THE LIKELIHOOD OF CHANGES BY TAXING AUTHORITIES IN ITS FILED INCOME TAX RETURNS AND RECOGNIZES A LIABILITY FOR OR DISCLOSES POTENTIAL SIGNIFICANT CHANGES THAT MANAGEMENT BELIEVES ARE MORE LIKELY THAN NOT TO OCCUR, INCLUDING CHANGES TO THE ENTITY'S STATUS AS A NOT-FOR-PROFIT ENTITY. MANAGEMENT BELIEVES THE ENTITIES WITHIN THE ORGANIZATION MET THE REQUIREMENTS TO MAINTAIN THEIR TAX-EXEMPT STATUS AND HAVE NO INCOME SUBJECT TO UNRELATED BUSINESS INCOME TAX; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THESE FINANCIAL STATEMENTS.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

Field	Value	IRS element (for citing)
Person	DAWN MORTON-RIAS EDDPA-C	PersonNm
Title	CEO/EX-OFFICIO TRUSTEE	TitleTxt
Base Compensation Filing Org	$0	BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs	$288,723	CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization	$0	BonusFilingOrganizationAmount
Bonus Related Organizations	$55,682	BonusRelatedOrganizationsAmt
Other Compensation Filing Org	$0	OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs	$30,000	OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org	$0	DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs	$31,800	DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org	$0	NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs	$361	NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org	$0	TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs	$406,566	TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org	$0	CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs	$0	CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6	NCCPA (THE CORPORATE MEMBER) IS THE SOLE MEMBER OF THE SOCIETY FOR THE PRESERVATION OF PHYSICIAN ASSISTANT HISTORY, INC AS THE SOLE MEMBER, THE NCCPA BOARD OF DIRECTORS ELECTS THE MEMBERS OF THE SOCIETY'S BOARD OF DIRECTORS
FORM 990, PART VI, SECTION A, LINE 7A	PAHX BOARD PROVIDES RECOMMENDATIONS OF NEW TRUSTEES TO THE NCCPA BOARD OF DIRECTORS FOR APPROVAL.
FORM 990, PART VI, SECTION B, LINE 11B	THE CHIEF FINANCIAL OFFICER REVIEWED THE FORM 990 PRIOR TO ITS FILING. THE 990 WAS SUPPLIED TO THE BOARD OF TRUSTEES VIA EMAIL WITH RETURN RECIEPT TO ENSURE EACH MEMBER HAD RECEIVED THEIR COPY. EACH TRUSTEE IS REQUIRED TO REVIEW THE FORM 990 AND VOTE TO APPROVE FOR FILING.
FORM 990, PART VI, SECTION B, LINE 12C	MEMBERS OF THE BOARD OF TRUSTEES REVIEW AND SIGN A STATEMENT OF FIDUCIARY OBLIGATIONS, INCLUDING CONFLICT OF INTEREST ISSUES, ON AN ANNUAL BASIS. TRUSTEES RECUSE THEMSELVES FROM DISCUSSIONS OR VOTES ON ISSUES ON WHICH THEY HAVE A POTENTIAL CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15	THE NCCPA DETERMINES PAY BASED ON COMPENSATION STUDIES
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AT THE SOCIETY FOR THE PRESERVATION OF PHYSICIAN ASSISTANT HISTORY, INC. ALL FINANCIAL AND GOVERNERING DOCUMENTS ARE STORED ON THE NCCPA-PAHX INTRANET SO THAT THE PAHX MANAGING DIRECTOR AND/OR THE NCCPA-PAHX FINANCE TEAM CAN ACCESS THEM.
FORM 990, PART XII, LINE 2C	THE PROCESS FOR OVERSIGHT OF FINANCIAL STATEMENTS HAS NOT CHANGED.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
12000 FINDLEY ROAD SUITE 100	JOHNS CREEK	GA	30097	581218672	CERTIFICATION OF PHYSICIAN ASSISTANTS	GA	501(C)(6)	N/A	0
NCCPA HEALTH FOUNDATION INC
12000 FINDLEY ROAD SUITE 100	JOHNS CREEK	GA	30097	204318466	SUPPORTING ORGANIZATION	IL	501(C)(3)		0	LINE 12A, I	NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS INC

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd