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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PENNSYLVANIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION
Employer identification number
23-2340801
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
If the organization did not check a 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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
1,467,957
1,979,336
2,598,199
3,442,513
2,824,657
12,312,662
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......
113,508
109,491
83,415
122,090
79,956
508,460
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.
1,581,465
2,088,827
2,681,614
3,564,603
2,904,613
12,821,122
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
12,821,122
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
1,581,465
2,088,827
2,681,614
3,564,603
2,904,613
12,821,122
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
16,999
12,167
-780
11,688
127
40,201
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
16,999
12,167
-780
11,688
127
40,201
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
735
1,759
2,494
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.)..
1,598,464
2,100,994
2,680,834
3,577,026
2,906,499
12,863,817
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.670 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.630 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PENNSYLVANIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION
Employer identification number
23-2340801
Return Reference
Explanation
FORM 990 - ORGANIZATION'S MISSION
THE PENNSYLVANIA ACADEMY OF FAMILY PHYSICIANS AND ITS FOUNDATION WILL SUPPORT ITS MEMBERS THROUGH ADVOCACY AND EDUCATION TO ENSURE A PATIENT-CENTERED, PHYSICIAN-COORDINATED MEDICAL HOME AND QUALITY HEALTH CARE FOR EVERY PENNSYLVANIAN.
FORM 990, PAGE 2, PART III, LINE 4A
CES HELPS PHYSICIANS MAINTAIN THE SKILLS THEY NEED TO PROVIDE QUALITY CARE THROUGH SEMINARS, DEMONSTRATIONS, HANDS-ON WORKSHOPS AND SCIENTIFIC EXHIBITS. SERVE AS THE STATE COORDINATING OFFICE FOR "TAR WARS" EDUCATION PROGRAM. TARGETED AT FIFTH GRADE STUDENTS, THE PROGRAM IS DESIGNED TO DISCOURAGE TOBACCO USE AT A YOUNG AGE BY INCREASING AWARENESS OF THE EFFECTS OF TOBACCO USE ON THEIR BODIES. IT IS A FREE ONE HOUR PROGRAM, PRESENTED BY VOLUNTEERS TO STUDENTS AT ANY OF THE 501 SCHOOL DISTRICTS IN PENNSYLVANIA, FOCUSING ON THE SHORT-TERM EFFECTS OF TOBACCO USE, REASONS PEOPLE USE TOBACCO & THE IMAGES TOBACCO COMPANIES USE TO MARKET TOBACCO TO THE PUBLIC. IN THE CURRENT SCHOOL YEAR, THE PROGRAM REACHED APPROXIMATELY 15,000 STUDENTS IN PA SCHOOLS. IPIP IS A PHYSICIAN-BASED, CHRONIC CARE FOCUSED QUALITY IMPROVEMENT PROGRAM FEATURING PRACTICE COACHING, COLLABORATIVE LEARNING, PATIENT REGISTRY SUPPORT AND MONTHLY PERFORMANCE MEASUREMENT AND BENCHMARKING. NATIONALLY, IPIP IS A PROGRAM OF THE AMERICAN BOARD OF MEDICAL SPECIALTIES(ABMS)RESEARCH & EDUCATION FOUNDATION AND FUNDED BY THE ROBERT WOOD JOHSON FOUNDATION. PENNSYLVANIA IS JUST ONE OF SEVEN STATES TO HAVE RECEIVED ABMS SUPPORT TO CREATE A STATE-BASED IPIP PROGRAM. THE PA IPIP PROGRAM STARTED IN 2007 AND IS LED BY BY THE PAFP ALONG WITH THE PA CHAPTERS OF THE AMERICAN COLLEGE OF PHYSICIANS & THE AMERICAN ACADEMY OF PEDIATRICS. TOGETHER THE THREE ORGANIZATIONS FORM THE PA PRIMARY CARE COALITION AND REPRESENT MORE THAN 10,000 FAMILY PHYSICIANS, INTERNISTS AND PEDIATRICIANS. IN PENNSYLVANIA, IPIP WORKS IN CONJUNCTION WITH THE PA CHRONIC CARE INITIATIVE, A PROGRAM OF THE GOVERNOR'S OFFICE OF HEALTH CARE REFORM, THE GOAL OF THIS INITIATIVE IS TO ASSIST PRACTICES IN IMPLEMENTING THE "CHRONIC CARE MODEL" INITIALLY FOR ADULT DIABETES AND PEDIATRIC ASTHMA PATIENTS AND TO BECOME PATIENT-CENTERED MEDICAL HOMES.
FORM 990, PAGE 2, PART III, LINE 4B
PRESENTED, RESEARCH DAY ALSO PROVIDES PARTICIPANTS WITH THE OPPORTUNITY TO LEARN NEW PRESENTATION TECHNIQUES, NEW RESEARCH METHODOLOGIES, AND TO GAIN CONTINUING MEDICAL EDUCATION CREDITS
FORM 990, PAGE 2, PART III, LINE 4C
PRACTICE. THE FAMILY PRACTICE EDUCATIONAL FUND(FPEF)WAS CREATED IN 1991 TO SUPPORT MEDICAL SCHOOL ACTIVITIES FOR STUDENTS INTERESTED IN PURSUING A CAREER IN FAMLY PRACTICE. MEDICAL SCHOOL GRADUATES, LOCAL COMPONENT CHAPTERS OF PAFP, AND MEMBERS OF PAFP/AAFP DONATE THE FUNDS FOR THIS PROGRAM. FPEF CRITERIA REQUIRE FUNDS BE USED ONLY TO SUPPORT GROUP ACTIVITIES SUCH AS EDUCATIONAL MEETINGS, SPEAKER FEES ETC AND NOT FOR INDIVIDUAL ACTIVITIES.
FORM 990, PAGE 6, PART VI, LINE 11B
REVIEWED BY FINANCE DIRECTOR AND/OR FINANCE COMMISSION
FORM 990, PAGE 6, PART VI, LINE 12C
ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND FILE ANNUAL CONFLICT OF INTEREST DISCLOSURE FORMS WITH THE ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 19
THE ORGANIZATION MAKES ALL REQUIRED DOCUMENTATION, INCLUDING ITS FORM 990, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY, AVAILABLE UPON REQUEST FROM THEIR ADMINISTRATIVE OFFICE TO ALL DONORS, PERSPECTIVE DONORS AND THE GENERAL PUBLIC IF SO REQUESTED.
FORM 990, PART IX, LINE 11G
MEDICAL COACHES/CONSULTANTS 1,145,592 0 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.