Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
THE PHYSICIANS FOUNDATION INC
C/O WILLIAM MAHON
Employer identification number
20-0914085
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) AMERICAN COLLEGE OF RADIOLOGY FOUNDATION
1891 PRESTON WHITE DRIVE
RESTON,VA20191 		36-6125578 501(C)(3) 75,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(2) KENTUCKY FOUNDATION FOR MEDICAL CARE INC
4965 US HIGHWAY 42 SUITE 2000
LOUISVILLE,KY40222 		23-7181728 501(C)(3) 74,590       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(3) MEDICAL EDUCATIONAL AND SCIENTIFIC FOUNDATION OF NEW YORK
865 MERRICK AVENUE
WESTBURY,NY11590 		11-2780360 501(C)(3) 69,015       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(4) MISSISSIPPI STATE MEDICAL ASSOCIATION FOUNDATION
PO BOX 2548
RIDGLAND,MS391582548 		57-0906060 501(C)(3) 75,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(5) PHYSICIAN HEALTH SERVICES
860 WINTER STREET
WALTHAM,MA024511411 		22-3234975 501(C)(3) 50,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(6) UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
55 NORTH LAKE AVENUE
WORCESTER,MA01655 		04-3167352 501(C)(3) 75,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(7) UTAH MEDICAL ASSOCIATION FOUNDATION
310 E 4500 SOUTH
SALT LAKE CITY,UT84107 		87-6122299 501(C)(3) 75,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(8) WASHINGTON STATE MEDICAL ASSOCIATION FOUNDATION FOR HEALTH CARE IMPROVEMENT
2001 SIXTH AVENUE NO 2700
SEATTLE,WA98121 		91-6074463 501(C)(3) 75,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(9) WISCONSIN MEDICAL SOCIETY FOUNDATION
PO BOX 1109
MADISON,WI53701 		39-6045649 501(C)(3) 72,300       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(10) THE DANIEL HANLEY CENTER FOR HEALTH LEADERSHIP
217 COMMERCIAL STREET SUITE 201
PORTLAND,ME04101 		20-4271488 501(C)(3) 75,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(11) CONNECTICUT STATE MEDICAL SOCIETY PHEF
127 WASHINGTON AVE EAST BLDG 3RD FL
NORTH HAVEN,CT06473 		06-1425205 501(C)(3) 58,833       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(12) BRANDEIS UNIVERSITY
PO BOX 9110 SUITE MS 110
WALTHAM,MA024549110 		04-2103552 501(C)(3) 102,660       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(13) COLORADO ACADEMY OF FAMILY PHYSICIANS
2224 S FRASER ST
AURORA,CO80014 		84-1150631 501(C)(3) 50,000       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(14) THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
153A COUNTRY CLUB ROAD
CHAPEL HILL,NC27514 		56-6001393 501(C)(3) 504,078       TO ASSIST THE EXEMPT ORGANIZATION IN PROVIDING AND PROMOTING HIGH QUALITY MEDICAL CARE.
(15) AMERICAN ASSOCIATION OF MEDICAL SOCIETY EXECUTIVES
555 EAST WELLS STREET SUITE 1100
MILWAUKEE,WI53202 		36-2915937 501(C)(3) 5,000       SPONSORSHIP AWARD
(16) FOUNDATION OF THE AMERICAN ASSOCIATION OF MEDICAL SOCIETY
555 EAST WELLS STREET SUITE 1100
MILWAUKEE,WI53202 		36-3790660 501(C)(3) 10,000       SPONSORSHIP AWARD
(17) WISCONSIN MEDICAL SOCIETY FOUNDATION INC
330 E LAKESIDE STREET
MADISON,WI53701 		39-6045649 501(C)(3) 10,000       SPONSORSHIP AWARD
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
17
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014
Page 2

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
non-cash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of non-cash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
PART I, LINE 2: THE GRANT COMMITTEE MEETS QUARTERLY TO DISCUSS RECOMMENDED PHYSICIAN LEADERSHIP PROPOSALS AND APPROVAL OF GRANTS THAT RELATE TO THE FOUNDATIONS MISSION.
SCHEDULE I, PART I, LINE 2: TO ENSURE THAT ITS ASSETS ARE USED FOR CHARITABLE PURPOSES, THE FOUNDATION MAKES GRANTS ONLY TO 501(C)(3) ORGANIZATIONS AND ONLY FOR PROJECTS THAT ARE APPROVED AFTER A RIGOROUS APPLICATION PROCESS. GRANTS ARE MADE SUBJECT TO A WRITTEN AGREEMENT REQUIRING PERIODIC AND FINAL FINANCIAL AND NARRATIVE REPORTS AND PROVIDING THAT THE FOUNDATION MAY WITHHOLD FUTURE PAYMENTS AND DEMAND CORRECTION OF MISUSE OF FUNDS SHOULD THE FOUNDATION DETERMINE FUNDS HAVE NOT BEEN USED FOR APPROVED PURPOSES.
Schedule I (Form 990) 2014



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