2024-05-15T08:40:48-05:00 2023-06-30 593204548 JAMES MOORE & CO PL 2477 TIM GAMBLE PLACE SUITE 200 TALLAHASSEE FL 323084386 990 2022-07-01 571234883 FLORIDA MEDICAL PRACTICE PLAN INC FLOR 8506452827 1115 W CALL ST TALLAHASSEE FL 323043556 ALMA LITTLES MD PRESIDENT 8502247144 2024-05-14 1 ALMA LITTLES MD 999009999 1 KEVIN WARREN P00642409 8503866184 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ALMA LITTLES MD 1115 W CALL ST TALLAHASSEE FL 323043556 11703538 0 X WWW.MED.FSU.EDU/FMPP X 2006 FL THE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS. 10 0 157 0 0 0 0 0 8676982 10571217 0 351187 0 0 8676982 10922404 361106 402343 0 0 7402107 9530952 0 0 0 2052692 2230535 9815905 12163830 -1138923 -1241426 5825533 4906814 3886301 4209008 1939232 697806 X THE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS. 0 0 12009416 402343 10571217 PERFORMED PROFESSIONAL SERVICES IN SUPPORT OF: 1) AN AFFILIATION AGREEMENT WITH A HOSPITAL FOR GRADUATE MEDICAL EDUCATION PROGRAMS, AND 2) AGREEMENTS WITH HEALTH DEPARTMENTS, CLINICS, AND OTHER FOR PATIENT CARE. 12009416 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 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 X 8 0 1 157 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAWN SNYDER 8506445024 1115 WEST CALL STREET TALLAHASSEE FL 32306 JOHN FOGARTY MD PRESIDENT UNTIL 2/28/2023 2.00 40.00 X X 0 428050 47464 DANIEL VAN DURME MD VICE PRESIDENT UNTIL 5/30/2023 1.00 40.00 X X 0 320741 49165 RICHARD NOWAKOWSKI PHD TREASURER 1.00 40.00 X X 0 269059 36423 ALMA LITTLES MD INTERIM PRESIDENT/SECRETARY UNTIL 3/1/2023 1.00 40.00 X X 0 321533 47403 JAMES CLARK PHD DIRECTOR 0.50 40.00 X 0 500745 61657 KYLE CLARK MBA DIRECTOR 1.00 40.00 X 0 451267 51048 PAUL KATZ MD DIRECTOR UNTIL 2/28/2023 0.25 40.00 X 0 313452 47323 JONATHAN S APPELBAUM MD DIRECTOR 1.00 40.00 X 0 318069 47727 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 1.00 40.00 X 0 303388 36856 HEATHER FLYNN PHD DIRECTOR 2.00 40.00 X 0 291395 36594 BENJAMIN SMITH DMSC PA-C DFAAPA DIRECTOR 1.00 40.00 X 0 184547 37360 WILLIAM C BOYER DHSC MS CHSE DIRECTOR 1.00 40.00 X 0 192490 23127 LISA GRANVILLE MD DIRECTOR AS OF 3/1/2023 1.00 40.00 X 0 0 0 0 3894736 522147 0 0 1 0 BANK OF AMERICA PO BOX 982238 EL PASO TX 79998 SERVICES FEES 960413 MARY TERRY MEEK 3244 ARBOR HILL WAY TALLAHASSEE FL 32309 CFMSD 181200 ATHENA HEALTH INC 311 ARSENAL STREET WATERWORN MA 04272 MEDICAL RECORDS & BILLING SOFTWARE 111180 3 CLINICAL REVENUE 624100 10369538 10369538 MEDICAID REVENUE 624100 201679 201679 10571217 1132321 781134 351187 351187 351187 10922404 10571217 0 351187 402343 402343 7389355 7389355 631869 631869 1095992 1095992 413736 413736 25484 25484 393666 393666 3777 3777 91052 91052 27821 27821 49873 49873 15870 15870 726826 726826 PROGRAM DEVELOPMENT 675569 675569 MEDICAL SUPPLIES 186496 186496 BANKING FEES 34101 34101 12163830 12009416 154414 0 19331 2710 543650 936541 1680656 1247108 58666 62990 139855 64283 80688 75572 2000632 2272305 1441910 309588 5825533 4906814 191487 113184 114378 147104 3580436 3948720 3886301 4209008 X 0 0 0 0 1939232 697806 1939232 697806 5825533 4906814 -1241426 0 X 0 1 X 1 0 X X X 1 FLORIDA STATE UNIVERSITY 591961248 2 1 12009416 0 1 12009416 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FORM 990, SCHEDULE A, PART I, LINE 12G: THE AMOUNT REPORTED ON LINE 12G, COLUMN V REPRESENTS AMOUNTS PAID TO OR ON BEHALF OF THE SUPPORTED ORGANIZATION FLORIDA STATE UNIVERSITY AND ITS AFFILIATES OR CHARITABLE BENEFIT CLASS. 139855 64283 75572 75572 FSU FOUNDATION 308641 F FLORIDA SPECIAL PURPOSE INVESTMENT 947 F 309588 FLORIDA STATE UNIVERSITY AUXILIARY 1787158 DEPARTMENTAL DISTRIBUTION 2161562 3948720 X 10922404 0 10922404 0 10922404 12163830 0 12163830 0 12163830 PART X, LINE 2: FMPP IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FMPP IS CONSIDERED A TYPE I SUPPORTING ORGANIZATION OF THE FLORIDA STATE UNIVERSITY UNDER SECTION 509(A)(3) OF THE INTERNAL REVENUE CODE. IT IS THE POLICY OF MANAGEMENT TO EVALUATE ITS TAX POSITIONS ON AN ONGOING BASIS AND TO DISCLOSE ANY SUCH POSITIONS IT BELIEVES WOULD HAVE A MATERIAL IMPACT ON THE FINANCIAL STATEMENTS AND RELATED NOTES. MANAGEMENT ALSO BELIEVES THAT NO SUCH REQUIRED DISCLOSURES CURRENTLY EXIST. FMPP FILES INFORMATIONAL RETURNS IN THE U.S. FEDERAL JURISDICTION. FMPP'S INCOME TAX RETURNS FOR THE PAST THREE YEARS ARE SUBJECT TO EXAMINATION BY TAXING AUTHORITIES AND MAY CHANGE UPON EXAMINATION. 1 FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE 1115 WEST CALL STREET TALLAHASSEE FL 32306 591961248 501(C)(3) 386463 0 DEPARTMENTAL DISTRBUTION SUPPORT FLORIDA STATE UNIVERSITY FOUNDATION INC 325 W COLLEGE AVENUE TALLAHASSEE FL 32301 596152180 501(C)(3) 15880 0 DEPARTMENTAL DISTRBUTION SUPPORT 2 0 PART I, LINE 2: THE FUNDS AWARDED TO THE SUPPORTED ORGANIZATION AND ITS AFFILIATES ARE MONITORED BY ALL INVOLVED ORGANIZATIONS THROUGH THE OVERLAPPING OF BOARDS AND EMPLOYEES TO ENSURE THAT FUNDS ARE SPENT IN LINE WITH THE MISSION OF ALL ORGANIZATIONS AND THEIR CHARITABLE CLASSES. 0 0 0 0 0 0 0 0 0 JAMES CLARK PHD DIRECTOR 0 479078 0 21322 0 345 0 39804 0 21853 0 562402 0 0 KYLE CLARK MBA DIRECTOR 0 396245 0 46322 0 8700 0 29232 0 21816 0 502315 0 0 JOHN FOGARTY MD PRESIDENT UNTIL 2/28/2023 0 427800 0 0 0 250 0 27608 0 19856 0 475514 0 0 DANIEL VAN DURME MD VICE PRESIDENT UNTIL 5/30/2023 0 309648 0 1093 0 10000 0 29309 0 19856 0 369906 0 0 ALMA LITTLES MD INTERIM PRESIDENT/SECRETARY UNTIL 3/ 0 319533 0 0 0 2000 0 27547 0 19856 0 368936 0 0 JONATHAN S APPELBAUM MD DIRECTOR 0 318069 0 0 0 0 0 27871 0 19856 0 365796 0 0 PAUL KATZ MD DIRECTOR UNTIL 2/28/2023 0 310492 0 2960 0 0 0 27467 0 19856 0 360775 0 0 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 0 302386 0 1002 0 0 0 27514 0 9342 0 340244 0 0 HEATHER FLYNN PHD DIRECTOR 0 291395 0 0 0 0 0 27390 0 9204 0 327989 0 0 RICHARD NOWAKOWSKI PHD TREASURER 0 269059 0 0 0 0 0 25574 0 10849 0 305482 0 0 BENJAMIN SMITH DMSC PA-C DFAAPA DIRECTOR 0 125735 0 0 0 58812 0 17504 0 19856 0 221907 0 0 WILLIAM C BOYER DHSC MS CHSE DIRECTOR 0 180490 0 0 0 12000 0 16994 0 6133 0 215617 0 0 PART I, LINE 3 COMPENSATION FOR THE ORGANIZATION'S OFFICERS/FACULTY ARE DETERMINED BY THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE AND APPROVED BY FSU'S HUMAN RESOURCE DEPARTMENT (A RELATED ORGANIZATION). THE COMPENSATION IS ESTABLISHED BASED ON BENCHMARKS WITHIN THE INDUSTRY. IN ADDITION, FSU UTILIZES A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACTS AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE TO ESTABLISH COMPENSATION. FORM 990, PART V, LINES 2A AND 2B THE NUMBER OF EMPLOYEES REPORTED ON PART V, LINE 2A REPRESENTS THE NUMBER OF EMPLOYEES OF THE FILING ORGANIZATION DURING TAX YEAR 2022. DUE TO THE USE OF THE SUPPORTED ORGANIZATION, FLORIDA STATE UNIVERSITY (FSU) AS A COMMON PAYMASTER, THE EMPLOYEES WERE REPORTED ON FSU'S FORM W-3. SIMILARLY THE SALARY EXPENSES WERE ALL REPORTED ON FSU'S FORM 941, EMPLOYER'S QUARTERLY FEDERAL TAX RETURN. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FINAL FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS THROUGH ELECTRONIC MAIL PRIOR TO SUBMITTAL TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, IS COVERED UNDER THE POLICY. ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST MUST BE DISCLOSED TO THE DIRECTORS, AND THE DIRECTORS WILL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF A MEMBER FAILS TO DISCLOSE A CONFLICT OF INTEREST IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE ORGANIZATION'S TOP OFFICIAL, OFFICERS, AND KEY EMPLOYEES IS DETERMINED BY FAIR MARKET VALUE, SALARY SURVEYS AND A SALARY RANGE PROVIDED BY FLORIDA STATE UNIVERSITY, THE SUPPORTED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FLORIDA STATE UNIVERSITY A2201 UNIVERSITY CENTER TALLAHASSEE FL 32306 591961248 UNIVERSITY FL 115(1) N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 FLORIDA STATE UNIVERSITY O 9530952 CASH VALUE FLORIDA STATE UNIVERSITY B 386463 CASH VALUE