2016-05-09T15:14:58-05:00 2015-12-31 580692043 MAULDIN & JENKINS LLC 200 GALLERIA PKWY SE STE 1700 ATLANTA GA 303395946 990 2015-01-01 030429253 SOCIETY FOR THE PRESERVATION OF PHYSICIAN ASSISTANT HISTORY INC SOCI 6784178100 12000 FINDLEY ROAD NO 160 JOHNS CREEK GA 30097 KAREN MULITALO MPAS PA-C PRESIDENT 8015857588 2016-05-06 1 MARY JO ALEXANDER P00002534 7709558600 2016-05-06 2015 2016-09-27 15:27:22Z KAREN MULITALOMPASPA-C 12000 FINDLEY ROAD NO 160 JOHNS CREEK GA 30097 236358 0 X WWW.PAHX.ORG X 2002 NC SEE SCHEDULE OTO PRESERVE AND SHARE THE HISTORY OF THE DEVELOPMENT OF THE PHYSICIAN ASSISTANT PROFESSION AND TO SUPPORT THE WORK OF THE NCCPA TO PRESERVE THE HISTORY OF THE PHYSICIAN ASSISTANT PROFESSION THROUGH EDUCATION, PRESERVATION OF THE ARCHIVES AND OTHER INITIATIVES AS A BENEFIT TO THE PUBLIC. 11 10 0 12 0 0 267910 236358 0 0 0 0 0 0 267910 236358 0 0 0 0 90394 119001 0 0 0 169498 92714 259892 211715 8018 24643 39075 77820 4903 19005 34172 58815 X SEE SCHEDULE OTO PRESERVE AND SHARE THE HISTORY OF THE DEVELOPMENT OF THE PHYSICIAN ASSISTANT PROFESSION AND TO SUPPORT THE WORK OF THE NCCPA TO PRESERVE THE HISTORY OF THE PHYSICIAN ASSISTANT PROFESSION THROUGH EDUCATION, PRESERVATION OF THE ARCHIVES AND OTHER INITIATIVES AS A BENEFIT TO THE PUBLIC. 0 0 64729 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. 64729 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 0 0 0 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X SONIA RATLIFF VP FINANCE 6784178109 12000 FINDLEY ROAD SUITE 100 JOHNS CREEK GA 30097 DAWN MORTON-RIAS EDDPA-C EX-OFFICIO TRUSTEE 2.00 50.00 X X 0 334234 21332 ALFRED M SADLER JR MD PRESIDENT 8.00 X X 0 0 0 GLORIA STEWART EDD PA PRESIDENT-ELECT 8.00 X X 0 0 0 KAREN MULITALO MPAS PA-C SECRETARY/TREASURER 2.00 X X 0 0 0 MARILYN FITZGERALD HONORARY PA TRUSTEE 2.00 X 0 0 0 DEBORAH GERBERT MS PA-C TRUSTEE 2.00 X 0 0 0 FJ 'GINO' GIANOLA MAPA TRUSTEE 2.00 X 0 0 0 THOMAS E PIEMME MD TRUSTEE 2.00 X 0 0 0 RAISA POLACEK MPAS PA-C TRUSTEE 2.00 X 0 0 0 MARYANN RAMOS MPH PA TRUSTEE 2.00 X 0 0 0 MARY WARNER MMSC PA-C TRUSTEE 2.00 X 0 0 0 ROBERT WOTTEN PA-C DFAAPA TRUSTEE 2.00 X 0 0 0 0 334234 21332 0 0 1 0 0 175000 61358 236358 236358 0 0 0 X 85929 24841 61088 33072 9591 23481 7200 7200 27487 13200 14287 8695 5566 3129 2115 2115 2400 2400 40574 11531 29043 571 571 1988 1988 CREDIT CARD PROCESSING 806 806 MISCELLANEOUS EXPENSE 381 381 SUBSCRIPTION EXPENSE 310 310 TRAINING 172 172 15 15 211715 64729 146986 0 32540 71685 5500 2000 170 144 4995 1004 865 3991 39075 77820 1748 4903 17257 4903 19005 X 33036 50579 1136 8236 34172 58815 39075 77820 24643 0 X X 0 1 X 1 0 X X 1 NATL COMM ON CERT OF PHYS ASSISTANT 581218672 9 1 0 0 1 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 REQUIRED TO RECEIVE PHYSICIAN CERTIFICATION CONSEQUENTLY, NCCPA, A 501(C)(6) ORGANIZATION, WILL CONTINUE TO PASS THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2) INDEFINITELY (98.7% IN FYE 2015) 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 (98.7% IN FYE 2015) SHOULD THERE EVER BE A SIGNIFICANT CHANGE IN PROGRAM FUNCTIONS, THE FOUNDATION 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 2016 TO NCCPA AT THE BOARD MEETING IN NOVEMBER 2015. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3327 680 2647 1668 324 1344 3991 RELATED PARTY PAYABLE - NCCPA 17257 17257 X 236358 0 236358 0 236358 211715 0 211715 0 211715 PART X, LINE 2: 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 THE INCOME TAX RETURNS FOR THE PAST THREE YEARS ARE SUBJECT TO EXAMINATION BY TAX AUTHORITIES, AND MAY CHANGE UPON EXAMINATION. 0 0 0 0 0 0 0 0 0 DAWN MORTON-RIAS EDDPA-C EX-OFFICIO TRUSTEE 0 256634 0 47600 0 30000 0 20966 0 366 0 355566 0 0 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 11 THE CHIEF FINANCIAL OFFICER REVIEWED THE FORM 990 PRIOR TO ITS FILING. THE FORM 990 WAS SUPPLIED TO THE BOARD OF DIRECTORS VIA EMAIL WITH RETURN RECEIPT REQUESTED TO ENSURE EACH MEMBER HAD RECEIVED THEIR COPY. EACH BOARD MEMBER 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 DIRECTORS REVIEW AND SIGN A STATEMENT OF FIDUCIARY OBLIGATIONS, INCLUDING CONFLICT OF INTEREST ISSUES, ON AN ANNUAL BASIS BOARD MEMBERS RECUSE THEMSELVES FROM DISCUSSIONS OR VOTES ON ISSUES ON WHICH THEY HAVE A 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 FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 13,200. MANAGEMENT AND GENERAL EXPENSES 14,287. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,487. FORM 990, PART XII, LINE 2C THE ORGANIZATION ISSUED A REQUEST FOR PROPOSALS FOR A FINANCIAL AUDIT AND SELECTED A FIRM. THE PROCESS FOR OVERSIGHT OF FINANCIAL STATEMENTS HAS NOT CHANGED. 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) LINE 11A, I NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS INC 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS INC P 119045 PERSONNEL RELATED COST NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS INC C 175000 AMOUNT CONTRIBUTED