2025-11-11T14:54:57-06:00 2024-12-31 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2024-01-01 822152009 PHYSICIANS LEADERSHIP ACADEMY PHYS 6142407410 1390 DUBLIN ROAD COLUMBUS OH 432151009 TRACY L DAVIDSON CEO 6142407410 2025-11-10 1 1 AMY CIMINELLO P00796388 6148493000 2025-11-10 2024 2025-03-06 01:10:19Z TRACY L DAVIDSON 1390 DUBLIN ROAD COLUMBUS OH 432151009 440115 0 X WWW.PHYSICIANSLEADERSHIPACADEMY.ORG X 2017 OH TO SUPPORT PHYSICIANS THROUGH MINDFUL LEADERSHIP TRAINING. 11 11 0 11 0 0 303175 316347 130333 120362 0 0 0 3406 433508 440115 0 0 0 0 0 0 0 0 0 434739 443445 434739 443445 -1231 -3330 218562 200435 118076 103279 100486 97156 THE PURPOSE OF THE PHYSICIANS LEADERSHIP ACADEMY IS TO PROVIDE MINDFUL LEADERSHIP TRAINING TO IMPROVE THE LIVES OF PHYSICIANS, THEIR PATIENTS, AND THE COMMUNITY. 0 0 349185 123768 THE PHYSICIANS LEADERSHIP ACADEMY (PLA) RECONNECTS PRACTICING PHYSICIANS WITH THEIR ORIGINAL PURPOSE AND IN DOING SO CREATES AUTHENTIC LEADERSHIP. THE PLA FOCUSES ON THREE PRIMARY AREAS: EMOTIONAL INTELLIGENCE, SOCIAL INTELLIGENCE AND COGNITIVE CAPACITY. 349185 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X LAURIE HAWKINS 6142407410 1390 DUBLIN ROAD COLUMBUS OH 432151009 JASON MELLILO MD PRESIDENT 1.00 0.00 X X 0 0 0 DAWN PRALL MD VICE PRESIDENT 1.00 0.00 X X 0 0 0 MARIA COURSER MD SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 JEFFREY BELL MD TRUSTEE 1.00 0.00 X 3881 0 0 MARC L PARNES MD TRUSTEE 1.00 4.00 X 8500 0 0 DOUGLAS FINNIE MD TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM SCHNACKEL MD TRUSTEE 1.00 0.00 X 0 0 0 CHRISTINA CHAN MD TRUSTEE 1.00 0.00 X 0 0 0 ELIZABETH LOTTES DO TRUSTEE 1.00 0.00 X 0 0 0 RUTH MULLOWNEY-AGRA MD TRUSTEE 1.00 0.00 X 0 0 0 JODY GEROME ZUCHOWSKI MD TRUSTEE 1.00 0.00 X 0 0 0 DIANE BROGAN-HABASH PHD TRUSTEE- PART YEAR 1.00 0.00 X 0 0 0 ROBERT E FALCONE MD CEO- PART YEAR 2.00 38.00 X 0 303604 1365 TRACY L DAVIDSON CEO 2.00 38.00 X 0 38963 138 LAURIE HAWKINS CFO/COO 2.00 38.00 X 0 163136 43855 12381 505703 45358 0 0 1 0 0 302000 14347 316347 TUITION 611430 120362 120362 120362 ALUMNI CELEBRATION 900099 3406 3406 3406 440115 123768 0 0 X 21 21 16053 16053 83182 82816 366 5032 4414 618 19117 6658 12459 106298 106036 262 397 397 SALARY ALLOCATION/REIMB 212024 149261 62763 TAXES & LICENSES 1181 1181 AUTO ALLOWANCE 140 140 443445 349185 94260 0 205941 189831 2750 5600 8779 4309 1191 496 1092 695 218562 200435 13442 17932 80667 68000 23967 17347 118076 103279 X 0 0 0 0 100486 97156 100486 97156 218562 200435 -3330 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1191 496 695 695 REIMBURSEMENT TO AFFILIATES 17347 17347 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 SCHEDULE E, PART I, LINE 3 THE POLICY IS DISCLOSED ON THE APPLICATION PAGE OF THE PLA WEBSITE. SCHEDULE E, PART I, LINE 4 LINE 4B: ALL STUDENTS ENROLLED AT PLA PAY THE SAME AMOUNT OF TUITION. LINE 4C: AT THIS TIME PLA DOES NOT UTILIZE BROCHURES OR CATALOGUES. LINE 4D: AT THIS TIME PLA HAS NOT SOLICITED CONTRIBUTIONS. SUPPORT IS PROVIDED BY A RELATED ORGANIZATION, COLUMBUS MEDICAL ASSOCIATION FOUNDATION. 0 0 0 0 0 0 0 0 0 ROBERT E FALCONE MD CEO- PART YEAR 0 303604 0 0 0 0 0 0 0 1365 0 304969 0 0 LAURIE HAWKINS CFO/COO 0 163136 0 0 0 0 0 10983 0 32872 0 206991 0 0 PART I, LINE 3: THE ORGANIZATION'S CEO IS COMPENSATED BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION, THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION, PERFORMS THE COMPENSATION REVIEW THROUGH THE CEO EVALUATION COMMITTEE AND USES AN EMPLOYMENT CONTRACT WITH BOARD APPROVAL. FORM 990, PART VI, SECTION A, LINE 6 COLUMBUS MEDICAL ASSOCIATION IS THE ORGANIZATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS AND APPROVE CHANGES IN THE BY-LAWS AND CODE OF REGULATIONS. IN ADDITION THE SOLE MEMBER HAS THE AUTHORITY TO APPROVE DECISIONS SUCH AS DISSOLVING THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS PROVIDED TO THE BOARD MEMBERS FOR THEIR REVIEW BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY SENDS A DISCLOSURE FORM TO ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES REQUIRING THEM TO DISCLOSE ANY CONFLICTS OF INTEREST AT THAT TIME AND AT ANY TIME THE MATTER BECOMES A BOARD ACTION. THOSE CONFLICTS ARE THEN ADDRESSED BY THE BOARD. VOTING AND PARTICIPATION RESTRICTIONS ARE IMPOSED ON THOSE WITH ANY CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PERFORMS COMPENSATION REVIEWS. THE CEO REVIEW IS HANDLED BY THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION BOARD AND THE CEO EVALUATION COMMITTEE. THE FORMER CEO HAD AN EMPLOYMENT CONTRACT AND IT WAS LAST UPDATED IN 2023. THE CURRENT CEO WAS HIRED IN NOVEMBER 2024 AND THEIR CONTRACT WAS ESTABLISHED AT THAT TIME. THE CEO REVIEWS THE COMPENSATION FOR ALL STAFF. THE CEO ESTABLISHES COMPENSATION BASED ON INFLATION RATES, AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS AND STUDIES AND APPROVAL BY THE JOINT FINANCE COMMITTEE AND THE BOARD. THE OUTSIDE REVIEW IS CONDUCTED EVERY THREE YEARS AND THE LAST ONE WAS IN 2024. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTANT - SEMINAR GUEST FACILITY: PROGRAM SERVICE EXPENSES 51,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,500. CONSULTANT - MEDITATION: PROGRAM SERVICE EXPENSES 12,360. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,360. CONSULTANT - COACHING: PROGRAM SERVICE EXPENSES 18,956. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,956. OTHER SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 366. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 366. FORM 990, PART XII, LINE 2C THE TREASURERS OF THE FILING ORGANIZATION AND ITS RELATED ENTITIES ARE MEMBERS OF THE JOINT FINANCE COMMITTEE. THIS COMMITTEE MAKES DECISIONS CONCERNING THE SELECTION OF THE INDEPENDENT AUDITORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. COLUMBUS MEDICAL ASSOCIATION 1390 DUBLIN ROAD COLUMBUS OH 43215 314411074 ADVANCING COMMUNITY HEALTH THROUGH ADVOCACY, EDUCATION AND SERVICE OH 501(C)(6) N/A 0 COLUMBUS MEDICAL ASSOCIATION FOUNDATION 1390 DUBLIN ROAD COLUMBUS OH 43215 310679012 SUPPORT INITIATIVES THAT IMPROVE THE HEALTH OF CENTRAL OHIO RESIDENTS OH 501(C)(3) LINE 12B, II COLUMBUS MEDICAL ASSOCIATION 1 COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED 1390 DUBLIN ROAD COLUMBUS OH 43215 200385860 FUND PHILANTHROPIC INTERESTS OH 501(C)(3) LINE 7 COLUMBUS MEDICAL ASSOCIATION FOUNDATION 1 COTS 1390 DUBLIN ROAD COLUMBUS OH 43215 311592734 REDUCING INJURIES AND SAVING LIVES BY IMPROVING EMERGENCY SERVICES OH 501(C)(3) LINE 7 COLUMBUS MEDICAL ASSOCIATION 1 PHYSICIANS CARE CONNECTION 1390 DUBLIN ROAD COLUMBUS OH 43215 311373719 OPTIMIZING THE HEALTH OF THE MOST VULNERABLE IN CENTRAL OHIO OH 501(C)(3) LINE 3 COLUMBUS MEDICAL ASSOCIATION 1 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 COLUMBUS MEDICAL ASSOCIATION FOUNDATION C 302000 GRANT