2024-03-13T10:56:10-05:00 2023-04-30 410746749 CLIFTONLARSONALLEN LLP 801 CHERRY STREET SUITE 1400 FORT WORTH TX 76102 990 2022-05-01 363071272 FEDERATION OF STATE MEDICAL BOARDS RESEARCH & EDUCATION FOUNDATION FEDE 8178684000 400 FULLER WISER ROAD EULESS TX 76039 HUMAYUN J CHAUDHRY SECRETARY 8178684000 2024-03-06 1 HUMAYUN CHAUDHRY 999009999 0 ROSALINDA MARIKAR CPA P01684134 8178775000 2024-03-06 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z FSMB FOUNDATION JANELLE A RHYNE MD 400 FULLER WISER ROAD EULESS TX 76039 519517 0 X WWW.FSMB.ORG/FOUNDATION X 1980 IL TO SUPPORT AND PROMOTE RESEARCH AND EDUCATION INITIATIVES THAT STRENGTHEN THE SAFETY AND QUALITY OF HEALTH CARE THROUGH EFFECTIVE MEDICAL REGULATION 11 7 0 0 0 0 31867 36300 0 0 37580 70037 0 0 69447 106337 25000 65000 0 0 0 0 0 0 0 30280 86773 55280 151773 14167 -45436 4557436 4294423 7461 20897 4549975 4273526 TO SUPPORT AND PROMOTE RESEARCH AND EDUCATION INITIATIVES THAT STRENGTHEN THE SAFETY AND QUALITY OF HEALTH CARE THROUGH EFFECTIVE MEDICAL REGULATION. 0 0 130689 65000 THE FOUNDATION AWARDED FUNDING TO STATE MEDICAL BOARDS AND OTHER ORGANIZATIONS THAT ARE CONDUCTING RESEARCH, DEVELOPING EDUCATIONAL MATERIALS AND INCREASING AWARENESS ABOUT TOPICS OF IMPORTANCE TO MEDICAL REGULATORS. THE LATEST EXAMPLES OF FOUNDATION GRANTS INCLUDE A GRANT TO THE ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION (ACCME). THE FOUNDATION PROVIDED $25,000 TO ACCME FOR THEIR PROJECT AIMED AT COORDINATING AND HARMONIZING THE MANDATORY OPIOID AND PAIN MANAGEMENT EDUCATION REQUIREMENTS ACROSS STATE MEDICAL BOARDS. ANOTHER GRANT WAS GIVEN TO THE NORTH CAROLINA MEDICAL BOARD. THE FOUNDATION PROVIDED A $20,000 GRANT TO THE NC MEDICAL BOARD FOR THEIR STUDY ON PHYSICIAN ASSISTANT DISCIPLINE. 130689 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 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 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X TODD PHILLIPS CFO 8178684000 SAME AS ORG EULESS TX 76039 HUMAYUN J CHAUDHRY DO SECRETARY 3.00 37.00 X X 0 698653 119264 JANELLE A RHYNE MD PRESIDENT 10.00 X X 0 0 0 RALPH C LOOMIS MD TREASURER 10.00 X X 0 0 0 PATRICIA A KING MD PHD VICE PRESIDENT 10.00 X X 0 0 0 CHERYL WALKER-MCGILL MD MBA DIRECTOR 2.00 18.00 X 0 32500 0 KATHLEEN HALEY JD DIRECTOR 2.00 X 0 0 0 ARTHUR S HENGERER MD DIRECTOR 2.00 X 0 0 0 CLAUDETTE DALTON MD DIRECTOR 2.00 X 0 0 0 SARVAM TERKONDA MD DIRECTOR 2.00 18.00 X 0 81866 0 JEFFREY D CARTER MD DIRECTOR 2.00 18.00 X 0 34366 0 STEPHANIE LOUCKA JD DIRECTOR 2.00 X 0 0 0 KENNETH B SIMONS MD DIRECTOR 2.00 18.00 X 0 84160 0 KATIE L TEMPLETON JD DIRECTOR 2.00 18.00 X 0 4003 0 0 935548 119264 0 0 1 0 0 36300 36300 52743 52743 430474 413180 17294 17294 17294 106337 0 0 70037 65000 65000 21084 21084 3071 3071 28038 28038 34580 34580 151773 130689 21084 0 5600 14556 53389 45531 640 1400 2600378 2437612 1881152 1764224 16277 31100 4557436 4294423 7461 20897 7461 20897 X 4549975 4273526 4549975 4273526 4557436 4294423 -45436 -231013 0 X 0 1 X 1 0 X X 1 THE FEDERATION OF STATE MEDICAL BOARDS OF THE UNITED STATES 751092490 10 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, SECTION A, LINE 3B: THE ORGANIZATION CONFIRMS ANNUALLY THAT THE SUPPORTED 501(C)(6) ORGANIZATION SATISFIES THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2). THIS CONFIRMATION LAST TOOK PLACE IN 2022. PART IV, SECTION A, LINE 3C: THE SUPPORTED ORGANIZATION AND THE FILING ORGANIZATION SHARE MANAGEMENT, SUPPORT PROVIDED TO THE SUPPORTED ORGANIZATION IS BASED ON THE REIMBURSEMENT FOR EXPENDITURES THAT RELATE TO THE SECTION 170(C)(2)(B) PURPOSES. 3333181 -81288 58900 3192993 3512170 -178989 3333181 2563456 1050170 100000 1456 3512170 2561788 4226 2558 2563456 2467504 256711 154500 7927 2561788 1.00000 0 0 0 MERCATOR FUND (DE) LP 1764224 C 1764224 X PART V, LINE 4: THE ENDOWMENT SHALL BE USED SOLELY TO SUPPORT THE FSMB FOUNDATION'S MISSION TO UNDERTAKE EDUCATIONAL AND SCIENTIFIC RESEARCH PROJECTS DESIGNED TO EXPAND PUBLIC AND MEDICAL PROFESSIONAL AWARENESS AND KNOWLEDGE OF CHALLENGES IMPACTING HEALTH CARE AND HEALTH CARE REGULATION IN ORDER TO CREATE STRONGER AND MORE EFFECTIVE MEDICAL LICENSURE AND REGULATION. PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM THE PAYMENT OF INCOME TAXES ON THEIR EXEMPT ACTIVITIES UNDER SECTION 501(C)(3) OF THE IRC, AND ARE CLASSIFIED AS ORGANIZATIONS THAT ARE NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(3) OF THE CODE. THE FEDERATION FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAD NO IMPACT ON THE FEDERATION'S CONSOLIDATED FINANCIAL STATEMENTS. FSMB AND THE FOUNDATION FILE AS TAX-EXEMPT ORGANIZATIONS. 1 ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION (ACCME) 401 N MICHIGAN AVE SUITE 1850 CHICAGO IL 60611 470941683 501(C)(3) 25000 0 A PROJECT AIMED AT COORDINATING AND HARMONIZING THE MANDATORY OPIOID AND PAIN MANAGEMENT EDUCATION REQUIREMENTS ACROSS STATE MEDICAL BOARDS. NEW JERSEY STATE BOARD OF MEDICAL EXAMINERS PO BOX 183 TRENTON NJ 086250183 216000928 STATE OF NEW JERSEY 10000 0 TO IMPLEMENT THE INTERSTATE MEDICAL LICENSURE COMPACT IN THEIR JURISDICTION. FEDERATION OF STATE PHYSICIAN HEALTH PROGRAMS (FSPHP) 668 MAIN STREET SUITE 8 295 WILMINGTON MA 01887 541561851 501(C)(3) 10000 0 SUPPORT A NATIONAL SURVEY OF PHYSICIAN HEALTH PROGRAMS ACROSS THE US AND CANADA ON THE SCOPE OF EDUCATIONAL AND SUPPORT SERVICES OFFERED. NORTH CAROLINA MEDICAL BOARD 3127 SMOKETREE CT RALEIGH NC 27604 566002153 NC MEDICAL BOARD 20000 0 SUPPORT A PROJECT TITLED PHYSICIAN ASSISTANT DISCIPLINARY STUDY. 4 PART I, LINE 2: THE FOUNDATION SENDS A NOTICE OF GRANT FUNDS DISBURSEMENT TO GRANT RECIPIENTS, STIPULATING WITHIN 6 MONTHS OF RECEIPT OF FUNDING, YOU AGREE TO PROVIDE THE FOUNDATION WITH A WRITTEN REPORT SUMMARIZING THE STATUS OF THE PROJECT. THIS REPORT SHOULD INCLUDE A DESCRIPTION OF PROGRESS MADE TOWARD ACHIEVING THE PURPOSES OF THE GRANT AND INCLUDE AN ACCOUNTING OF THE USES OR EXPENDITURE OF FUNDS. WITHIN 60 DAYS OF PROJECT COMPLETION, YOU ALSO AGREE TO PROVIDE A WRITTEN REPORT THAT INCLUDES A NARRATIVE OF WHAT WAS ACCOMPLISHED BY THE GRANT SUCH AS THE RESULTS, BENEFITS AND IMPACT OF THE FUNDING, AS WELL AS AN INDICATION AS TO WHETHER THE FUNDING WAS 100% OF THE PROJECT COST. 0 1 0 0 0 0 0 0 0 HUMAYUN J CHAUDHRY DO SECRETARY 0 653684 0 30893 0 14076 0 97827 0 21437 0 817917 0 0 PART I, LINE 4B DR. HUMAYUN J. CHAUDHRY, DO - 457(F) PLAN EMPLOYER CONTRIBUTIONS $52,077. TODD PHILLIPS - 457(F) PLAN EMPLOYER CONTRIBUTIONS $8,354. THERE WERE NO DISTRIBUTIONS IN FY2023. SCHEDULE J, PART I, LINE 3: FOR THE PURPOSE OF DETERMINING COMPENSATION, THE REPORTING ORGANIZATION DOES NOT COMPENSATE ANY OFFICERS/DIRECTORS. THEY RELIED ON A RELATED ORGANIZATION, THE FEDERATION OF STATE MEDICAL BOARDS OF THE UNITED STATES, TO ESTABLISH THE COMPENSATION OF THE OFFICERS/DIRECTORS. THE FEDERATION OF STATE MEDICAL BOARDS OF THE UNITED STATES USED THE FOLLOWING PRACTICES TO ESTABLISH COMPENSATION FOR THE OFFICERS/DIRECTORS: COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7A THE FOUNDATION BOARD SHALL CONSIST OF UP TO FIFTEEN (15) DIRECTORS (THE"DIRECTORS"), MINIMUM OF THREE (3) OF WHOM SHALL BE ELECTED FOR THREE (3) YEAR TERMS FROM AMONG THE FELLOWS OR HONORARY FELLOWS OF THE FSMB; ONE (1) OF WHOM SHALL BE THE CHIEF EXECUTIVE OFFICER OF THE FEDERATION OF STATE MEDICAL BOARDS (THE "FSMB"), ONE (1) OF WHOM SHALL BE THE CURRENT CHAIR OF THE FSMB BOARD OF DIRECTORS, AND UP TO TWO (2) OF WHOM MAY BE PERSONS ELECTED FROM THE PUBLIC AT LARGE. AT NO TIME SHALL THE FOUNDATION BOARD CONSIST OF LESS THAN FORTY PERCENT (40%) OF DIRECTORS WHO HAVE BEEN ELECTED BY THE FSMB BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE TREASURER, THEN A COPY OF THE FORM 990 IS PROVIDED TO AND REVIEWED BY THE BOARD OF DIRECTORS BEFORE THE FORM 990 IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION'S CONFLICT OF INTEREST POLICY AND ITS CERTIFICATION IS DISTRIBUTED TO AND REVIEWED ANNUALLY BY DIRECTORS, OFFICERS, COMMITTEE MEMBERS AND EXECUTIVE MANAGERS, EACH OF WHOM HAS A CONTINUING RESPONSIBILITY TO EVALUATE THEIR TRANSACTIONS, OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS OF INTEREST, AND TO MAKE SUCH DISCLOSURES AS DESCRIBED IN THE POLICY. THE FOUNDATION BOARD SHALL ANNUALLY REVIEW THE CONFLICT OF INTEREST CERTIFICATIONS. THE DISCLOSURES CONTAINED THEREIN SHALL BE DEEMED APPROVED BY THE BOARD UNLESS AN OBJECTION IS MADE BY ONE OR MORE DIRECTORS. SUCH APPROVAL OR OBJECTION IS DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. WHENEVER ANY INDIVIDUAL SUBJECT TO THIS POLICY BELIEVES HE OR SHE MAY HAVE A CONFLICT OF INTEREST, HE OR SHE SHALL PROMPTLY NOTIFY THE BOARD PRESIDENT OR APPROPRIATE COMMITTEE CHAIR OF SUCH CONFLICT. WHEN ANY CONFLICT OF INTEREST IS RELEVANT TO A MATTER THAT COMES UNDER CONSIDERATION OR REQUIRES ACTION BY THE FOUNDATION BOARD OR A COMMITTEE, THE DIRECTOR/OFFICER/COMMITTEE MEMBER SHALL CALL IT TO THE ATTENTION OF THE BOARD PRESIDENT OR APPROPRIATE COMMITTEE CHAIR. AFTER BEING PERMITTED TO MAKE A PRESENTATION TO THE BOARD OR COMMITTEE, THE INTERESTED PARTY SHALL RECUSE HIMSELF OR HERSELF FOR THE DISCUSSION OF, AND THE VOTE ON, THE MATTER. THE INTERESTED PARTY SHALL BE COUNTED FOR PURPOSES OF A QUORUM BUT SHALL LEAVE THE MEETING BEFORE DECISIONS ARE MADE ON MATTERS IN WHICH HE/SHE HAS SUCH AN INTEREST. THE MINUTES OF THE MEETING OF THE BOARD OR COMMITTEE DOCUMENT ANY CONFLICT OF INTEREST THAT WAS DISCLOSED AND THAT THE INTERESTED PARTY WAS NOT PRESENT DURING DISCUSSION OR DECISION ON THE MATTER AND DID NOT VOTE. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FEDERATION OF STATE MEDICAL BOARDS OF THE UNITED STATES 400 FULLER WISER ROAD EULESS TX 76039 751092490 PROMOTING EXCELLENCE IN MEDICAL PRACTICE, LICENSURE, AND REGULATION NE 501(C)(6) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 NA