2011-02-01T12:15:38-06:00 2010-06-30 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2009-07-01 591680273 Florida Clinical Practice Association Inc FLOR 3522657951 PO Box 100205 Gainesville FL 326100205 William W Tharp CPA 3522657951 2011-02-01 1 Terry Haefner 7274427110 2009 2016-02-24 21:20:13Z Edward R Block MD PO Box 100205 Gainesville FL 326100205 379117556 0 X N/A X 1976 FL See Supplementary Schedule Schedule OThe Florida Clinical Practice Association, Inc. was formed primarily for the purpose of enhancing the quality of medicine education and research at the University of Florida. 23 0 0 0 0 0 34425000 35425000 293321824 318963939 1179060 1053926 15000 0 328940884 355442865 225009743 239512712 0 0 0 0 98182231 106210215 323191974 345722927 5748910 9719938 109598407 122936237 9985766 13336560 99612641 109599677 The Florida Clinical Practice Association, Inc. was formed primarily for the purpose of enhancing the quality of medicine education and research at the University of Florida. 0 0 332448540 239512712 318963939 The FCPA facilitates the provision of education and research related clinical practice settings and opportunities, through which University of Florida faculty members provide health and medical treatment to patients as an integral part of their academic activities and their employment as faculty. Such faculty practice activities are designed to assure clinical practice opportunities and experiences that are essential in the training of students and postgraduate health professionals and that will enhance skills and knowledge of faculty members who must teach and train medical and other health professional students. Other faculty practice activities include research and other educational programs. 332448540 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 113 0 1 0 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 X Katherine Peck 3522657951 1329 SW 16th Street Room 4250 Gainesville FL 32608 X Patrick J Antonelli M 0.20 X 0 501970 55993 Tetsuo Ashizawa 1.00 X 0 245000 37060 Kevin E Behrns MD 0.30 X 0 561960 44265 Edward R Block MD 0.20 X X 0 498796 54367 Richard Bucciarelli MD 0.10 X 0 423415 55829 Michael Clare-Salzler 0.10 X 0 411497 56686 R Whit Curry Jr MD 0.10 X X 0 291644 47776 Francesca K Enneking M 0.20 X 0 467775 42415 William A Friedman MD 0.10 X X 0 744343 54791 Peter F Gearen MD 0.10 X 0 529544 55311 Mark S Gold MD 0.10 X 0 477448 55870 Michael Good MD 0.50 X X 0 564776 55301 David S Guzick MD 0.10 X 0 522044 33226 David W Kays MD 0.10 X 0 385548 55530 Anthony A Mancuso MD 0.10 X X 0 531828 57296 Paul Okunieff MD 0.10 X 0 92299 4064 Marco Pahor MD 0.10 X 0 460286 43253 John E Poppell 0.10 X 0 256379 40898 William W Tharp CPA 0.40 X X 0 286705 51857 Joseph A Tyndall MD 0.10 X 0 335024 43296 Johannes W Vieweg MD 0.10 X X 0 450438 50233 Stan R Williams MD 0.30 X 0 447277 59458 William Driebe MD 0.50 X 0 61338 19313 Robert J Amdur MD 0.00 X 0 471030 55886 Douglas J Barrett MD 0.00 X 0 579499 56411 Daniel J Driscoll MD 0.00 X 0 192746 34213 Fonda D Eyler PhD 0.00 X 0 158567 39038 Nikolaus Gravenstein M 0.00 X 0 425465 55328 Bruce C Kone MD 0.00 X 0 474921 32336 Nancy P Mendenhall MD 0.00 X 0 582280 43610 Bayard D Miller MD 0.00 X 0 193387 35346 Richard E Neiberger M 0.00 X 0 169529 32468 David Paulus MD 0.00 X 0 337194 50798 Rebecca Pauly MD 0.00 X 0 239573 27490 I Keith Stone 0.00 X 0 323039 47218 Craig C Tisher MD 0.00 X 0 242467 38777 Edward Valenstein MD 0.00 X 0 285765 44010 0 14222796 1667017 0 1 1 0 Shands Hospital PO Box 100304 Gainesville FL 326100304 Rent & Oper. Supp. 53145568 National Anesthesia Services Inc 31040 Lasher Road Beverly Hills MI 48025 CRNA Contract Labor 3497523 University of Florida PO Box 113200 Gainesville FL 326113200 Contract Labor 2504257 Medquist Inc PO Box 10832 Newark NJ 071930832 Transcription Serv. 2134432 Epic Systems Corporation PO Box 883147 Milwaukee WI 532880314 Elect. Med. Records 1636023 55 35425000 35425000 Program Service Revenu 621110 220667496 220667496 Medicare/Medicaid Paym 621110 97077887 97077887 Other Program service 621110 1218556 1218556 318963939 1053926 1053926 23674691 23674691 0 0 355442865 318963939 0 1053926 239512712 239512712 164293 164293 90811 90811 58138247 49577993 8560254 223148 223148 3379870 2902680 477190 1064710 1064710 2420 2420 3087498 2995145 92353 160979 145807 15172 76669 68504 8165 6432 6432 2866621 1290956 1575665 121776 121776 Bad Debts 26672079 26672079 Educational/Medical Sup 4350401 4351154 -753 Repairs & Maintenance 1799587 1735535 64052 Malpractice Insurance 1557755 1557755 Dues & Subscriptions 1130575 696852 433723 1316344 715800 600544 345722927 332448540 13274387 0 14346 14665 19385605 29324210 36285338 41319737 4806963 2486878 25400110 16357125 6112444 9042985 31237606 30294325 11756105 10453437 109598407 122936237 7934297 11090511 69696 1397 1981773 2244652 9985766 13336560 X 99612641 109599677 0 0 0 0 99612641 109599677 109598407 122936237 X 0 1 1 X 0 X X X 0 0 0 University of Florida 596002052 2 1 332139881 1 332139881 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2858433 1615561 1242872 22451817 14741564 7710253 89860 89860 9042985 Accrued Interest 267854 Deferred Facilities Entitlement 10111033 Other Assets 74550 10453437 Estimated Liability for Refund 2213950 Long Term Debt 30702 2244652 355442865 345722927 9719938 267098 267098 9987036 329031452 267098 267098 328764354 6432 26672079 26678511 355442865 80972865 0 80972865 6432 264743630 264750062 345722927 Part XII, Line 4b - Other Adjustments: Bad Debts Netted Against Book Income $ 26,672,079 Part XIII, Line 4b - Other Adjustments: Bad Debts Netted Against Book Income $ 26,672,079 Grants and Allocations $238,071,551 Total $264,743,630 1 University of Florida PO Box 113200 Gainesville FL 32611 596002052 115 239204053 General support. University of Florida Student Government PO Box 118505 Gainesville FL 32611 596002052 115 19760 Medical student financial assistance (travel) and senior banquet support Stop Childrens Cancer 2622 NW 43 St Suite B3 Gainesville FL 32606 592624901 501(c)(3) 17000 Organization funds research grants and professorship in Pediatrics which benefits UF COM. University of Florida Foundation PO Box 14425 Gainesville FL 32604 590974739 501(c)(3) 206304 Organizational mission is to raise and invest funds to assist with the clinical, educational and research missions. American Heart Association 1101 Northchase Pkwy Suite 1 Marietta GA 30067 135613797 501(c)(3) 17500 Organization mission is preventing cardiovascular diseases and strokes Sebastian Ferrero Foundation 12921 SW1rd Suite 107-424 Jonesville FL 32669 261200788 501(c)(3) 15000 Organizational funds promotion of patient safety and a Children's Hospital in Gainesville FL 4 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The largest grants or assistance were made to the University of Florida. The Florida Clinical Practice Association was established by the State of Florida legislation as a support organization of the University of Florida. The Florida Clinical Practice Association is required to transfer funds to the University of Florida to fulfill its mission as a support organization of the University of Florida. Once the funds are transferred to the University of Florida, the University ensures that the funds are used to fulfill the mission of the University of Florida. Other grants are made to non-profit organizations that support the health care and education mission of the Florida Clincial Practice Association. 1 0 0 0 0 0 0 0 0 Patrick J Antonelli MD 0 441759 0 40121 0 20090 0 38495 0 17498 0 557963 0 0 Tetsuo Ashizawa 0 239833 0 0 0 5167 0 25089 0 11971 0 282060 0 0 Kevin E Behrns MD 0 551712 0 2377 0 7871 0 25564 0 18701 0 606225 0 0 Edward R Block MD 0 437708 0 50000 0 11088 0 36789 0 17578 0 553163 0 0 Richard Bucciarelli MD 0 412750 0 184 0 10481 0 37936 0 17893 0 479244 0 0 Michael Clare-Salzler 0 371713 0 24748 0 15036 0 39098 0 17588 0 468183 0 0 R Whit Curry Jr MD 0 282895 0 0 0 8749 0 29871 0 17905 0 339420 0 0 Francesca K Enneking MD 0 461566 0 0 0 6209 0 38188 0 4227 0 510190 0 0 William A Friedman MD 0 729197 0 0 0 15146 0 37293 0 17498 0 799134 0 0 Peter F Gearen MD 0 514650 0 0 0 14894 0 37813 0 17498 0 584855 0 0 Mark S Gold MD 0 438629 0 13207 0 25612 0 38032 0 17838 0 533318 0 0 Michael Good MD 0 542620 0 0 0 22156 0 37753 0 17548 0 620077 0 0 David S Guzick MD 0 340035 0 0 0 182009 0 25554 0 7672 0 555270 0 0 David W Kays MD 0 366679 0 5572 0 13297 0 38032 0 17498 0 441078 0 0 Anthony A Mancuso MD 0 496557 0 6089 0 29182 0 39798 0 17498 0 589124 0 0 Marco Pahor MD 0 436533 0 16956 0 6797 0 25689 0 17564 0 503539 0 0 John E Poppell 0 241716 0 0 0 14663 0 26790 0 14108 0 297277 0 0 William W Tharp CPA 0 277992 0 0 0 8713 0 29164 0 22693 0 338562 0 0 Joseph A Tyndall MD 0 329012 0 0 0 6012 0 25798 0 17498 0 378320 0 0 Johannes W Vieweg MD 0 443114 0 1070 0 6254 0 29466 0 20767 0 500671 0 0 Stan R Williams MD 0 417772 0 4544 0 24961 0 41960 0 17498 0 506735 0 0 Robert J Amdur MD 0 447148 0 17178 0 6704 0 38388 0 17498 0 526916 0 0 Douglas J Barrett MD 0 566121 0 0 0 13378 0 38116 0 18295 0 635910 0 0 Daniel J Driscoll MD 0 174385 0 6289 0 12072 0 18295 0 15918 0 226959 0 0 Fonda D Eyler PhD 0 142883 0 5248 0 10436 0 15729 0 23309 0 197605 0 0 Nikolaus Gravenstein MD 0 388860 0 10000 0 26605 0 37830 0 17498 0 480793 0 0 Bruce C Kone MD 0 179011 0 0 0 295910 0 22777 0 9559 0 507257 0 0 Nancy P Mendenhall MD 0 500553 0 25000 0 56727 0 39466 0 4144 0 625890 0 0 Bayard D Miller MD 0 185201 0 2500 0 5686 0 19356 0 15990 0 228733 0 0 Richard E Neiberger MD 0 160239 0 0 0 9290 0 16724 0 15744 0 201997 0 0 David Paulus MD 0 319117 0 2500 0 15577 0 33300 0 17498 0 387992 0 0 Rebecca Pauly MD 0 229696 0 3000 0 6877 0 24049 0 3441 0 267063 0 0 I Keith Stone 0 287616 0 7544 0 27879 0 29984 0 17234 0 370257 0 0 Craig C Tisher MD 0 237038 0 0 0 5429 0 24773 0 14004 0 281244 0 0 Edward Valenstein MD 0 265109 0 6756 0 13900 0 26661 0 17349 0 329775 0 0 Part I, Line 4a Dr. Bruce Kone-Separation Agreement included various payments for vacation and sick leave cash outs totalling $208,500. Form 990, Part VI, Section A, line 6 The following are the members of Florida Clinical Practice Assocation as stated in the articles of incorporation: All clinical practitioners who serve full-time on the faculty of the University of Florida College of Medicine, the Dean of the College of Medicine, the Senior Vice President for Health Affairs of the University of Florida, the Executive Vice President of the corporation, if one has been selected by the Board of Directors, and each Chair of a clinical department of the College of Medicine shall be members. Form 990, Part VI, Section B, line 11 The Florida Clinical Practice Association's audit committee reviewed the form 990 before it is filed with the Internal Revenue Service. Form 990, Part VI, Section C, line 19 Florida Clinical Practice Association will make it's governing documents and financial statements available to the public upon request. Form 990, Part VI Section B Line 12 Florida Clinical Practice Association does not have a conflict of interest policy, because the organization does not have actual employees. All Board Members which are all employees of the University of Florida follow The University of Florida's conflict of interest policy. The University of Florida is a related organization for which the Florida Clinical Practice Association is a support organization. The faculty members of the University of Florida are required to file the "Outside Activities" form if they intend to perform services or obtain funds from organizations outside the University. In addition, the College of Medicine of the University of Florida has a conflict of interest policy that specifically focuses on potential conflict of interests between College of Medicine faculty and medical/pharmaceutical companies. The College of Medicine has an "Industry Academic Relations" committee that oversees implementation of the College's Conflict of Interest policy. The College recently hired a full time staff person to staff the Industry Academic Relations committee and develop procedures for overseeing conflicts of interest. Form 990, Part VI Section B Line 13 The Florida Clinical Practice Association does not have a written whistleblower policy, but its related organization the University of Florida does. All Board Members are University of Florida employees and adhere to this policy for Florida Clinical Practice Association's business activities. Form 990, Part VI Section B Line 14 The Florida Clinical Practice Association does not have a written document retention and destruction policy, but its related organization the University of Florida does. All Board Members are University of Florida employees and adhere to this policy for Florida Clinical Practice Association's documents. Form 990, Part VI Section B Line 15 The Florida Clinical Practice Association does not provide compensation to the organization's CEO, Executive Director, or top management official. In addition, the FCPA does not provide compensation to the organizations other officers nor key employees. The University of Florida provides compensation to these individuals in their role as University employees. The compensation is determined, reviewed, and approved following the University's procedures which require review and approval by University officials that are not in the College of Medicine. University of Florida PO Box 113200 Gainesville FL 32611 596002052 Education FL 115 N/A N/A 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 0 1 0