• Structure of the Academy
• Purpose of County Chapters
• County Chapter Roles in CAFP Governance
• Volunteer Involvement and Leadership
• Recruiting New Members
• Chapter Activities
• Income and Taxes
• Assessing Your Chapter
• CAFP Resources for Chapters

STRUCTURE OF THE ACADEMY
The American Academy of Family Physicians (AAFP) is divided into national, state and county levels. The California Academy of Family Physicians (CAFP) is the largest state chapter of the American Academy. The key to fulfilling our goals as an organization is effective communication among the levels:

• American Academy of Family Physicians
• California Academy of Family Physicians
• CAFP County Chapters

The general membership is the ultimate authority of CAFP; members exercise authority through representatives who are elected by county chapter members to serve on the Board of Directors and Congress of Delegates. The governance structure of the Academy includes:

Elected Offices

County Chapter Officers: Read about the purpose and activities of county chapters below.

Congress of Delegates: The Congress consists of Delegates and Alternates who are selected by their county chapters. The number of delegates per chapter is proportional to the number of Active members in each chapter.

Board of Directors: The Board consists of Directors who represent 10 districts in California (the districts are formed by groupings of the 36 county chapters and have roughly equal number of members), two at-large Directors elected by the Congress of Delegates (one is designated as a rural seat and the other as a new physician), selected officers, California's Delegates to the AAFP, one student member, one resident member and the CAFP Foundation President.

Executive Committee: The Executive Committee consists of seven officers elected by either the Congress or the Board of Directors and includes the President, President-Elect, Immediate Past President, Secretary/Treasurer, Speaker and Vice Speaker and the President of the Foundation. The Executive Vice President serves as an ex-officio member of the committee.

President: The President is elected annually by the Congress of Delegates. She/he serves as Chair of the Board of Directors and Executive Committee.

Appointed Offices

Committees: Committees carry on the "nuts and bolts" of CAFP's activities. They develop programs and/or recommendations approved by the Board to serve the membership. Their responsibilities range from planning the Annual Scientific Assembly to monitoring, responding to, and developing legislation that will advance the specialty of family medicine. Log onto http://www.familydocs.org/about-the-cafp/leadership/committees.php for information about CAFP Committees and their charges.

CAFP encourages county chapter officers to submit the names of promising members who may be willing to serve on CAFP committees. Please submit potential committee candidates to Mariah Brooks at (415) 345-8667 ext. 221 or email mbrooks@familydocs.org.

PURPOSE OF COUNTY CHAPTERS
The main purpose of a county chapter is to bring members together at a local level. The county chapter also acts as a training ground for physicians who go on to serve as leaders in the state and national Academies, as well as the county and state medical societies.

Some recommended chapter activities are:

• Advocate for local hospital activities and policies that reflect well on family medicine
• Provide or assist other groups in providing postgraduate programs for family physicians
• Encourage qualified members to serve as leaders in the county medical society and/or as delegates/alternates to the state medical society House of Delegates
• Recruit new family physician members
• Help in the development and improvement of local family medicine residency programs
• Bring local family physicians together to discuss issues of mutual concern or interest
• Recruit medical students into family medicine
• Elect and send Delegates and Alternates to the CAFP Congress of Delegates
• Survey members and non-members to assess whether or not the chapter is meeting the needs of local family physicians
• Identify potential district directors and committee members
• Undertake community service activities that demonstrate family physicians' commitment to their communities and patients.

Your local efforts directly affect the future of family medicine. If you would like assistance in improving your chapter relations, contact Jessica Kuo, CAFP Chapter Affairs Coordinator, at (415) 345-8667 ext. 234 or e-mail jkuo@familydocs.org.

COUNTY CHAPTER ROLE IN CAFP GOVERNANCE

Local chapters are the starting point for development of CAFP leadership. Because CAFP governance is based on grassroots participation, the chapter role in providing representatives to the CAFP Board, Congress, and Committees is crucial. Without sufficient representation, the CAFP's ability to serve and advocate for California's family physicians would be greatly diminished.

District Directors to the CAFP Board

CAFP is made up of 36 county chapters. These chapters are grouped into 10 districts based on roughly equal membership numbers and are represented on the Board by district.

County chapters should contact their District Directors with concerns they would like addressed by the CAFP Board. Likewise, District Directors should regularly communicate with chapters to ensure chapter concerns are represented on the Board. Access the http://www.familydocs.org/about-the-cafp/leadership/board-of-directors.php for a current list of District Directors.

District Directors are elected by their constituencies to serve up to two three-year terms. CAFP Bylaws state that a district director shall be elected by a plurality vote of members within their districts. Chapters may contact the CAFP to assist with election procedures whenever necessary. See the CAFP Resource Manual for more information about conducting district director elections.

Delegates and Alternates to the CAFP Congress

Each year, county chapters are asked to name Delegates and Alternates to represent their members during the annual Congress of Delegates meeting, the policymaking meeting of CAFP. The number of Active county members in the county chapter determines the number of Delegates a chapter will have. The Congress elects officers of CAFP and determines organization policy by adopting resolutions. It is also the forum in which county chapter concerns can influence the direction of the state organization. In September of each year, county chapters are notified of the number of Delegates and Alternates to be appointed or elected. A call for resolutions to the Congress is issued in September as well.

CAFP and AAFP Committee Appointments

Much of the work of both CAFP and AAFP is done at the committee level. Generally, committees carry out the action on policies and programs determined by the Congress and Board, but they also generate policies and programs for consideration by both bodies. Local chapters are encouraged to involve their leaders and members in committee activities at both state and national levels. At CAFP, committee members are appointed throughout the year by the Executive Committee. County chapters are encouraged to suggest nominees through their district directors or directly to CAFP. Nominees for AAFP commission members must be nominated by the CAFP Board, usually in September. Generally, it is recommended that an individual serve on a CAFP committee before applying for nomination to an AAFP commission. For more information on involving members in a CAFP committee, contact Mariah Brooks at (415) 345-8667 ext. 221 or email at mbrooks@familydocs.org.

VOLUNTEER INVOLVEMENT AND LEADERSHIP

Chapters thrive on solid leadership and active volunteers. However, in the current socio-economic medical environment, chapters (and organized medicine in general) face several challenges when attempting to attract and retain physician volunteers and leaders:

• increasing demands on physician time;
• decreased affinity with professional organizations as more physicians become employees;
• decreased income to contribute to professional association dues; and
• generational differences that may redefine priorities and ways of doing work.

Continued volunteer involvement and fresh leadership sustain a chapter. Chapter leaders are the source for state and national Academy leadership; therefore, a dynamic leadership program at the chapter level is necessary to sustain the Academy as a whole.

Suggestions for Attracting and Retaining Leaders

• Have a clear membership recruitment and retention plan that is adhered to by the chapter officers.
• Foster new leadership involvement by reaching out to younger physicians. Once you have recruited younger physicians, allow them to contribute in significant ways immediately.
• Allow new leaders to advance to higher levels of leadership quickly. This will afford your chapter the opportunity for multi-generational input into chapter priorities and activities, and sustain the interest and dedication of new leaders.
• Tailor volunteer activities to the busy person-some physicians may want to contribute but may only be able to work on small, one-time projects. Creating smaller, short-term tasks is also an easy way for chapter officers to delegate work.
• Be sure to recognize the efforts of volunteers and leaders-be aware that different generations respond to different types of recognition.

CAFP can assist in strategy development in this area. The results of a recent survey of new family physicians have implications for the type of activities and programming of local chapters. New family physicians stated they wanted contact with their colleagues and chapter activities are a great way to fulfill those needs.

Chapter Elections

Each chapter's bylaws specify the number of officers and method of election. Regardless of when the election is held, terms of District Directors begin with the Board of Directors meeting immediately following the Annual Scientific Assembly. Ideally, the chapters should elect directors prior to the annual meeting so they may attend that ASA as guests and begin their terms as voting members of the Board at the meeting immediately following the annual meeting.

RECRUITING NEW MEMBERS

One of the most important roles for a county chapter is to stimulate membership in the Academy. Watch for new family physicians in your area. Ask them to attend county chapter meetings, introduce them to colleagues in hospital or clinic corridors, and suggest they join CAFP. Further suggestions to consider include: peer-to-peer contacts and "pitching" CAFP at hospital medical staff meetings, department meetings, and in physicians' lounges. A personal call to a member is four times more effective in recruitment and retention than a letter from the AAFP or CAFP. CAFP will furnish you with recruitment materials and a list of recently dropped memberships in your chapter when asking for your assistance with retention or recruitment efforts. In addition, staff and CAFP leaders can make presentations at your chapter meetings to discuss the many benefits of Academy membership, update you on Academy activities, or assist your chapter with a recruitment plan.

CHAPTER ACTIVITIES

Chapter activities should meet the needs of local family physicians across generational and practice-type lines. Chapters should assess the environment every one or two years to ensure that the activities and direction of the chapter are in line with the local family medicine community's needs. CAFP can help with brief, online surveys for this purpose. Your chapter will thrive if it is on track with members' needs, and recruiting and retaining new members and leaders will keep it vital.

Examples of Local Chapter Activities/Programs

• CME events
• Community service projects (i.e., health fairs, vaccinations, community clean-up, homeless shelter, etc.)
• Physician leadership training
• Addressing local privileging issues
• Legislative visits/contacts
• Identifying legislative key contacts
• Promoting the CAFP and AAFP political advocacy committees
• Recruitment of participants in CAFP's New Directions in Diabetes Care project
• Networking dinners or luncheons
• Forums on issues of importance to FPs: medical errors, access for uninsured, P4P
• Education in the community (i.e., Tar Wars or REDUCE)
• Linkage with county medical society leadership
• Ensuring family medicine is well-represented in local hospitals
• Participation in local practice-based research networks
• Support/involvement in local public health department activities
• Identifying key issues to be addressed by CAFP leadership (in Congress or at the Board)
• Linkage with local medical schools and/or family practice residency programs (i.e., precepting, teaching, speaking)
• Sponsorship of local medical students or residents to attend AAFP's National Conference of Family Practice Students and Residents or CAFP's Annual Scientific Assembly

Tips for Holding Successful Meetings

• Create an agenda that clearly accomplishes chapter business or provides members with useful information. Set specific discussion times for items and stick to those times. Adjourn on time.
• Start meetings at an exact time and end at an exact time. Keep introductions to a minimum.
• Send out ample notice of the meeting. If notice is sent out more than two weeks in advance, send a reminder e-mail two to four days before the meeting. Updated chapter membership lists are always available for chapter leaders. You can also order a set of labels directly from CAFP if your chapter doesn't have high volume printing capabilities. Labels and electronic mailing lists must only be used for CAFP-related mailings and should be ordered at least a month before you need them. Please e-mail Jessica Kuo at jkuo@familydocs.org for more information about this service.
• If a business meeting is planned, set an agenda so that you know in advance what subjects are to be discussed, who will start the discussion, and how much time will be allowed for each subject. Place action items on the agenda so that results will come from the meeting. The meeting facilitator should be aware of keeping the discussion focused and on time.
• Pick a location that is geographically accessible. Make sure the room is well lighted and quiet. For small chapters, private homes may be better than restaurants or hotels.
• Consider utilizing technology to "meet," e.g., conference calls and Webinars.
• If a cocktail period and a meal are involved, make sure they stay on schedule and are "optional."
• If you've asked a speaker to make a presentation, clearly delineate your expectations ahead of time. Specify in writing what you want covered and how much time will be allowed for the presentation. Be sure to send a "thank you" note after a speaker or visitor has been with you.
• If you plan to offer CME credit for the meeting, file the appropriate papers with a copy to each chapter president. Use this in planning CME activities. CME activities are one of the top three reasons physicians join the Academy. Contact CAFP to obtain guidelines.

CME Activities

Both the CAFP and AAFP may be able to help you present CME meetings at your county chapter. However, you must allow plenty of lead-time to obtain this type of assistance. In addition, there are expenses the county chapter must be willing to bear, either by charging a fee to attendees, securing an educational grant or by underwriting speaker expenses.

The AAFP has several activities it offers to chapters. Topics range from cardiology "round tables" to smoking cessation. It is best to know the type of activity your chapter wants and then to call the AAFP CME Accreditation Department for assistance: (866) 274-2237.

• CAFP can assist you with at least three types of activities:
  Speaker and topic suggestions
  Issue forums: legislative advocacy, privileging, medical errors, etc.
  Visits by state officers or Academy staff

Educational Grants

Chapter officers and staff should educate themselves on the new regulations regarding acceptance of moneys from pharmaceutical companies or other industry entities. OIG, PhRMA, ACCME and the AMA Gifts to Physicians regulations protect the continuing medical education environment. If you are providing CME, you should take steps against accepting any funds or offers from pharmaceutical companies that could, in any way, promote a particular product or subject of interest to a particular company. If you have any questions about commercial support of your meetings, please call Shelly Rodrigues, CAE at srodrigues@familydocs.org or at (415) 345-8667 ext. 229.

INCOME AND TAXES

Chapter Dues

County chapters that charge local dues receive dues payments from CAFP twice each year-in June and December. Chapter treasurers should deposit these checks within 60 days of the date of issue. If the check is not deposited within that time, it may be cancelled. If checks are not deposited within one year, it is CAFP's policy that funds will be contributed to the CAFP Foundation. If this is not done, state law requires such funds to be turned over to the State of California. Chapters will incur the cost of bank fees for cancelled checks. Chapter officers are reminded on several occasions with written notification to deposit checks before final action is taken.

The 1994 Congress of Delegates passed a resolution encouraging chapters to contribute $2 per Active member to the CAFP Foundation. This contribution is deducted, with the permission of the Chapter President or Treasurer, from the June and December checks. Chapters with multiple years of inactivity or minimal activity are encouraged to discontinue local chapter dues collection.

The 2007 Congress of Delegates passed a resolution adopting a $25 special assessment on Active members for 2008-10 to support the dramatically increased CAFP legislative activities being undertaken to meet goals set by the new strategic plan.

Federal ID and Federal and State Tax Exemption

County chapters enjoy tax-exempt status through the AAFP. Each chapter must have an employer identification number (EIN). If you do not have an EIN then one can be obtained by filing federal form SS-4 with the AAFP, that in turn will send it on to the IRS on a yearly basis with its form adding new chapters/organizations to its group number. (This form can be obtained online at www.irs.gov; at the home page do a search for the form "SS-4"). The AAFP will not add any chapter without an EIN. The addition of a chapter to the group exemption number only happens once a year around January, making it necessary to act on this as soon as possible after starting up a new organization.

The requirements for maintaining our group exemption letter include the following list of information that the AAFP must submit along with the SS-4 application.

• Complete name
• Address
• Employer identification number (EIN) or completed SS-4 application
• Chapter name or local number
• Form 990 filing requirement codes (code 1 means required to file - gross receipts over $25,000; code 2 means not required to file - gross receipts of $25,000 or less). Form 990 is "Tax Return of Exempt Organizations".
• Form 109 must be filed annually with the State of California if your unrelated business income for the year is more than $1,000. This would include such income as advertising, trade shows, etc. but generally does not include dues or unrestricted educational grants to support continuing professional development programming.

There is no such thing as a "tax-exemption letter" issued by the AAFP or CAFP. However, you may request a letter directly from the IRS at (877) 829-5500.

All corporations and unincorporated associations, even if organized on a nonprofit basis, are subject to California franchise or income tax. A grant of federal exemption does not automatically exempt you from California tax. You should submit form FTB 3500 and allow 90 days for processing your request. If you have received federal exempt status, furnish a copy of the federal determination letter with your state application form FTB 3500. You can download FTB 3500 from www.ftb.ca.gov.

1. On the far right side of the Web page go to "FORMS"
2. Select "ALL FORMS and PUBLICATIONS"
3. Select "FORMS"
4. Select "CURRENT YEAR"
5. Click on "GET LIST"
6. Scroll down to "FTB 3500" (view form)
7. Print

Once you are set up through the state, your current exempt status can be checked online at any given moment.

ASSESSING YOUR CHAPTER

The previous sections have outlined many of the components needed for an active, healthy chapter. The scope of your chapter's activity must ultimately be decided by the needs of family physicians in your community. It's obvious that a smaller, rural chapter may decide to be much less active than an urban chapter. Nonetheless, chapter leaders should conduct due diligence when assessing the scope of their chapter's activity.

CAFP Chapter Activity Levels

Level 1 - Inactive, but chartered
No officers, or officers are completely inactive
May or may not charge dues
No meetings/functions/activities with members
No localized communication among members
Minimal contact with CAFP
Rarely represented at Congress of Delegates

Level 2 - Minimal activity
One or two officers who are sporadically active
No development or recruitment of new leadership
May or may not charge dues
Meetings/functions that occur once a year or less
No localized communication among members
Minimal contact with CAFP
Sporadic representation to Congress of Delegates

Level 3 - Moderate activity
Elected or appointed officers
Mostly stagnant leadership
Collect dues
May have a budget-may or may not adhere to budget
Consistently has 2-4 meetings/activities per year with membership
May or may not have a variety of chapter activities
May have a communication vehicle (newsletter, postcard announcements)
May or may not have a leadership presence in county medical society
Sporadic contact with CAFP
No or minimal administrative staffing
COD delegation, but submission of resolutions has been absent or sporadic

Level 4 - High activity
Elected officers and/or Board, including possible committee structure
Dues collection and possible fundraising in addition
Budget that is adhered to annually
Consistently has at least 6 meetings/functions/activities per year with members
Chapter activities are varied
Has a leadership presence in county medical society
Has a communications vehicle with members
Regular communication/contact with CAFP
Administrative staff/support
COD delegation, submission of resolutions to COD is consistent
Dynamic flow of new leadership/leadership development (officers and COD delegation)

How is your chapter doing?

Could family physicians benefit from a more active CAFP chapter in your area? Once again, the size of membership and geographic location of a chapter will both play a large part in deciding the appropriate level of activity for a chapter.

If chapter leadership decides that your chapter does need to become more active, CAFP can assist you with assessing the needs of your community and establishing a strategy and work plan for increasing chapter activity. If you feel that such an undertaking is too much for your chapter to take on with its current leadership, we will work with you to identify other physicians who are willing to work with you or take the torch. Contact Jessica Kuo at (415) 345-8667 or jkuo@familydocs.org for further assistance.

ACADEMY RESOURCES FOR CHAPTERS

AAFP/CAFP can offer your local chapter much in the way of resources and assistance:

Resources

• Membership lists and member labels
• Names and contact information of new physician members in the area
• Speakers for events
• Ideas for chapter activities
• Ideas for CME/CPD offerings
• Assistance with Prescribed credit for CME offerings
• Chapter Officer elections balloting
• District Director elections balloting
• Sample member surveys
• Issue monographs on topics of importance to family physicians
• Membership marketing materials
• CME/Chapter events listing in California Family Physician, or at www.familydocs.org/professional-development/cme-activites.php

Assistance

• Volunteer/leadership recruitment and retention strategies
• Strategic planning and/or chapter development strategies
• Local privileging/scope of practice issues
• Linkage to local medical schools and/or family practice residency programs
• Practice management assistance and educational offerings
• Legislative/key contact development

QUESTIONS?
Want to discuss chapter issues with CAFP staff directly? Contact Jessica Kuo, CAFP Chapter Affairs Coordinator, at (415) 345-8667 or email jkuo@familydocs.org.