Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ASSOCIATION OF DERMATOLOGY ADMINISTRATORS AND MANAGERS
Employer identification number
36-4021025
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
194,751
239,261
229,929
183,198
205,360
1,052,499
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
238,416
366,109
236,366
248,556
186,010
1,275,457
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
433,167
605,370
466,295
431,754
391,370
2,327,956
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
2,327,956
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
433,167
605,370
466,295
431,754
391,370
2,327,956
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
8,206
9,251
9,787
5,191
3,407
35,842
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
8,206
9,251
9,787
5,191
3,407
35,842
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
441,373
614,621
476,082
436,945
394,777
2,363,798
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
98.480 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
98.320 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
1.520 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
1.550 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ASSOCIATION OF DERMATOLOGY ADMINISTRATORS AND MANAGERS
Employer identification number
36-4021025
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
UNDER THE TERMS OF THE ASSOCIATION MANAGEMENT AGREEMENT BETWEEN ADA/M AND STRATEGIC HEALTH CARE COMPANY (SHC) (A CLOSELY HELD CORPORATION IN WHICH THE EXECUTIVE DIRECTOR OF ADA/M IS A PARTNER), EXECUTIVE MANAGEMENT AND ADMINISTRATION, MEETING AND EXHIBIT MANAGEMENT, MEMBERSHIP AND COMPUTERIZED FILE MAINTENANCE, SOCIETY HEADQUARTERS OFFICE MANAGEMENT AND ADMINISTRATIVE SERVICES, FINANCIAL MANAGEMENT SERVICES, NEWSLETTER MANAGEMENT AND PRODUCTION AND MANAGEMENT OF THE ORGANIZATION'S PUBLIC RELATIONS PROGRAMS WERE PROVIDED TO ADA/M BY SHC.
FORM 990, PART VI, SECTION A, LINE 6
MEMBERSHIP IN THE ASSOCIATION SHALL BE OPEN TO PERSONS, DERMATOLOGY OFFICES AND PRACTICES AND COMPANIES WHO ARE INVOLVED IN, OR THAT HAVE A SPECIFIC INTEREST IN, THE FIELD OF DERMATOLOGY. THERE SHALL BE SIX (6) CLASSES OF MEMBERS (CHARTER, ACTIVE, AFFILIATE, HONORARY, CORPORATE AND PRACTICE) AS FOLLOWS: A. CHARTER MEMBERS: INDIVIDUALS ACCEPTED TO MEMBERSHIP ON OR BEFORE DECEMBER 3L, 1994. CHARTER MEMBERS WILL NOT CHANGE MEMBERSHIP CATEGORY ONCE ACCEPTED IN THE ASSOCIATION. CHARTER MEMBERS MAY VOTE AND HOLD OFFICE AND ARE REQUIRED TO PAY DUES AS DETERMINED BY THE BOARD. B. ACTIVE MEMBERS: INDIVIDUALS WHO ARE ACTIVELY ENGAGED IN DERMATOLOGY AND WERE ACCEPTED TO MEMBERSHIP ON OR AFTER JANUARY 1, 1995. ACTIVE MEMBERS MAY VOTE AND HOLD OFFICE AND ARE REQUIRED TO PAY DUES AS DETERMINED BY THE BOARD. ACTIVE MEMBERS WHO CEASE BEING ACTIVELY ENGAGED IN DERMATOLOGY MAY CHOOSE TO REMAIN IN THE ASSOCIATION AS AFFILIATE MEMBERS. C. AFFILIATE MEMBERS: INDIVIDUALS WHO HAVE A SPECIFIC INTEREST IN THE FIELD OF DERMATOLOGY, BUT MAY NOT BE SERVING IN THE CAPACITY OF AN ADMINISTRATOR OR MANAGER OF A DERMATOLOGICAL PRACTICE. AFFILIATE MEMBERS MAY VOTE AND HOLD OFFICE AND ARE REQUIRED TO PAY DUES AS DETERMINED BY THE BOARD. IF AN AFFILIATE MEMBER BECOMES ACTIVELY ENGAGED IN DERMATOLOGY THEY MAY REQUEST ELEVATION TO ACTIVE MEMBER STATUS. D. HONORARY MEMBERS: INDIVIDUALS RECOGNIZED FOR THEIR OUTSTANDING CONTRIBUTIONS TO THE FIELD OF DERMATOLOGY ADMINISTRATION OR MANAGEMENT. A RECOMMENDATION FROM A MEMBER OF THE BOARD, ACCOMPANIED BY THE CANDIDATE'S QUALIFICATIONS, SHALL BE SENT TO THE ASSOCIATION SECRETARY NOT LESS THAN SIXTY (60) DAYS PRIOR TO AN ANNUAL MEETING. HONORARY MEMBER STATUS IS GRANTED WHEN APPROVED BY A MAJORITY VOTE OF THE BOARD. HONORARY MEMBERS ARE NOT REQUIRED TO PAY DUES AND MAY NOT VOTE OR HOLD OFFICE. E. CORPORATE MEMBERS: A CORPORATE MEMBER IS A COMPANY OR FIRM WITH A SPECIFIC INTEREST IN THE FIELD OF DERMATOLOGY. CORPORATE MEMBERS ARE REQUIRED TO PAY DUES BASED ON MEMBERSHIP CATEGORY AS DETERMINED BY THE BOARD. A CORPORATE MEMBER MAY NOT VOTE OR HOLD OFFICE. F. PRACTICE MEMBERS: A PRACTICE MEMBER IS A PRIVATE, GROUP OR ACADEMIC DERMATOLOGY RELATED OFFICE OR PRACTICE THAT DESIRES TO DESIGNATE THREE OR MORE EMPLOYEES AS REPRESENTATIVES OF THE PRACTICE FOR PARTICIPATION IN THE ASSOCIATION. PRACTICE MEMBERS ARE REQUIRED TO PAY DUES AS DETERMINED BY THE BOARD BASED ON THE NUMBER OF EMPLOYEE REPRESENTATIVES DESIGNATED BY THE PRACTICE FROM TIME TO TIME. DESIGNATED EMPLOYEE REPRESENTATIVES MAY VOTE AND HOLD OFFICE. PRIVILEGES A MEMBER OF THIS ASSOCIATION, WHOSE DUES ARE PAID IN FULL AND IS NOT UNDER SUSPENSION, SHALL BE CONSIDERED A MEMBER IN GOOD STANDING.
FORM 990, PART VI, SECTION A, LINE 7A
ONLY CHARTER, ACTIVE AND AFFILIATE MEMBERS AND DESIGNATED EMPLOYEE REPRESENTATIVES OF PRACTICE MEMBERS IN GOOD STANDING SHALL BE ENTITLED TO VOTE, HOLD OFFICE, ACT AS DELEGATES OR SERVE ON THE BOARD OR A COMMITTEE. MEMBERSHIP IS NOT TRANSFERABLE.
FORM 990, PART VI, SECTION A, LINE 7B
VOTING MEMBERS MAY VOTE ON ANY ISSUES THAT THE BOARD PLACES BEFORE THEM FOR VOTE.
FORM 990, PART VI, SECTION A, LINE 8B
THERE ARE NO OTHER COMMITTEES AUTHORIZED TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11
THE 990 IS PREPARED BY A 3RD PARTY ACCOUNTING FIRM. A COPY OF THE 990 IS THEN GIVEN TO MANAGEMENT FOR REVIEW. A FINAL COPY IS THEN GIVEN TO EACH MEMBER OF THE BOARD FOR THEIR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD OF DIRECTORS IN CONCERT WITH THE EXECUTIVE DIRECTOR MAINTAINS COMPLIANCE WITH THE WRITTEN CONFLICT OF INTEREST POLICY. UNDER THE WRITTEN CONFLICT OF INTEREST POLICY, DURING ANY PRESENTATION OR DISCUSSION AT AN EDUCATIONAL SESSION, THE DIRECTOR WILL ASK EACH SPEAKER/COMMERCIAL ENDORSER/CONSULTANT PARTICIPATING IN THE DISCUSSION OF A PARTICULAR ISSUE TO INTRODUCE HIMSELF OR HERSELF BY NAME AND PROFESSIONAL POSITION AND TO IDENTIFY ANY ASPECT OF THE SPEAKER/COMMERCIAL ENDORSER/CONSULTANT'S PERSONAL OR PROFESSIONAL CIRCUMSTANCES WHICH MIGHT REASONABLY BE EXPECTED TO AFFECT THE SPEAKER/COMMERCIAL ENDORSER/CONSULTANT'S VIEWS ON THE SUBJECT UNDER DISCUSSION/ ANY INDIVIDUAL WHO REFUSES TO PROVIDE SUCH INFORMATION WILL BE DENIED THE OPPORTUNITY TO SPEAK.
THE ORGANIZATION HAS NO EMPLOYEES. THEREFORE, THERE IS NO PROCESS FOR DETERMINING SALARIES.
FORM 990, PART VI, SECTION C, LINE 19
THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.