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
Migrant Clinicians Network Inc
Employer identification number
74-2662919
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.") ....
1,715,844
1,753,890
1,933,575
1,782,258
1,762,224
8,947,791
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3..
1,715,844
1,753,890
1,933,575
1,782,258
1,762,224
8,947,791
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)..
380,636
6
Public Support. Subtract line 5 from line 4.
8,567,155
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..
1,715,844
1,753,890
1,933,575
1,782,258
1,762,224
8,947,791
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
15,721
17,670
14,454
3,352
1,026
52,223
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
16,237
19,840
13,663
3,922
14,577
68,239
11
Total support (Add lines 7 through 10).
9,068,253
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
94.470 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
98.760 %
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.") .
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......
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.
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.)
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...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.).
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
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
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:
10000105
Software Version:
2010v3.2
-
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
Migrant Clinicians Network Inc
Employer identification number
74-2662919
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
Documents are made available upon request.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
The conflict of interest policy is reviewed and monitored biannually by Board Members.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
Form 990 was provided via email to the Board Members, and reviewed before filing. It is presented at the Fall Board Meeting by the CFO.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: Promotion of Health Issues of the Mobile Poor (continued)Kugel, C., Liebman, AK. & Boehler, B. (2010, December 7). Bringing Healthcare Justice to the Front Line: Integrating Environmental Health into Nursing Practice. Clinical Directors Network Webcast.Liebman, AK. (2010 October 14). Los Migrantes en los Estados Unidos: Los riesgos mas alla del cruce de la Frontera. Segundo Seminario Internacional Migracin: Mexico, DF.Liebman, AK., Manock S., Hoffman K., & Andino, A. (2010 November 8). Saving Lives by Changing Practices: Protecting workers by integrating occupational and environmental medicine into the primary care setting. 138th American Public Health Association Annual Meeting & Exposition: Denver, CO.Lyons, T.L. (2010 April 23). LIVESTRONG: Cancer Survivorship Resource Training. Promotora and Community Outreach Follow-up Meeting: Austin, TX. Lyons, T.L. (2010 June 14). LIVESTRONG: Cancer Survivorship Issues of Daily Life Follow-up Training. Promotora and Community Outreach Follow-up Meeting: Austin, TX. Lyons, T.L. (2010 September 25). Addressing Health Disparity Through The Use Of Patient Navigation and Bridge-Case Management. National Summit of Clinicians for Health Care Justice: Washington DC. McLaurin, Jennie A. (2010 October 19). The 100 Day Cough: The 2010 Pertussis Epidemic. A Clinical Directors Network Webcast.McLaurin, Jennie A. (March 2009 and April 2010). Bioethics and Christian Thought. Lecture, Christian Thought and Culture: Regent College, British Columbia, Canada.McLaurin, Jennie A. (March 2008, 2009 and 2010). Freedom and Finitude: An Introduction toChristian Bioethics." Guest lecture, Pastoral Ethics class: Regent College, British Columbia, Canada. McLaurin, Jennie A. (2010 May). Meaning and Medicine: Contemporary Issues in Bioethics. Regent College conference plenary presentation: Regent College, British Columbia, Canada. McLaurin, Jennie A. (2010 September 25). Bioethics, Vocation and Justice: A Clinician's Perspective on Reforming Health Care. National Summit on Health Care Justice: Washington, DC.McLaurin, Jennie A. (2010 October 14). Introduction to Migrant Health for global medicine interest group: Pacific Northwest University of Health Sciences: Seattle, WA.Mountain, K. (2010 November 18). Migrant 101. National Center for Farmworker Health's 21st Annual Midwest Stream Forum: Austin, TX.Mountain, K. (2010 November 18). Migrant Specific Performance Measures. National Center for Farmworker Health's 21st Annual Midwest Stream Forum: Austin, TX.Mountain, K. (2010 December 16). The Migrant Clinicians Network Efforts Involving Children and Agriculture. National Children's Center for Rural and Agricultural Health and Safety External Scientific Advisors Teleconference Meeting: Austin, TX. Mountain K. & Liebman AK. (2010 April 14). Migrant and Community Health Centers: Occupational Health and Safety for Latino Workers. OSHA National Action Summit for Latino Worker Health and Safety: Houston, TX.Sievert, J., Boehler, B. & Liebman, AK. (2010 February 11). Assessing Environmental and Occupational Health Risks in Primary Care. Western Migrant Stream Forum: Seattle, WA.Zuroweste, E. (2010 January 15). Update on H1N1 & H5N1 from the W.H.O. Global Influenza Program. Summit Health CME Chambersburg Hospital: Chambersburg, PA. Zuroweste, E. (2010 February 10). Pesticides and Primary Care: Engaging the Frontline Clinician Caring for Migrant and Seasonal Farmworkers. EPA/NIOSH; SENSOR Winter Meeting: Austin,TX.Zuroweste, E. (2010 March 23). Update H1N1 (swine flu) & H5N1 (avian flu) - Working at WHO in the Global Influenza Program. Directors Network Webcast.Zuroweste, E. (2010 April 9). Global Continuity of Care for Mobile Patients. 19th Annual GHEC Conference: Cuernavaca, Mexico. Zuroweste, E. (2010 April 20). Epidemiology of TB: Global, National and Regional. TB Intensive Workshop. New Jersey Medical School's Global Tuberculosis Institute: Newark, NJ. OTHER PROGRAM SERVICES 5: Promotion of Health Issues of the Mobile Poor (continued)Zuroweste, E. (2010 October 21). Patient Centered Medical Home: Where/How Do Migrant VoucherPrograms Fit? 23rd East Coast Migrant Stream Forum: Charleston, SC. Zuroweste, E. (2010 October 22). Protecting Farmworkers from Pesticides: Understanding the Role of Migrant Health Providers in the Worker Protection Standard. 23rd East Coast Migrant Stream Forum: Charleston, SC. Zuroweste, E. (2010 October 22). Patient Centered Medical Home: Adaptations Needed to Include Farmworkers and Other Mobile Poor. 23rd East Coast Migrant Stream Forum: Charleston, SC. Zuroweste, E. (2010 November 10). Tuberculosis Diagnosis and Management in the US and Honduras. Shoulder to Shoulder. Santa Lucia, Intibuca, Honduras. OTHER PROGRAM SERVICES 6: OTHER PROGRAM SERVICES 7: TBNet, an innovative approach to tuberculosis management in migrating patients, provides a compelling example of how TB control can be successfully accomplished in highly mobile populations, even those traveling internationally.MCN successfully provided continuity of care in 46 countries and to 38 states inside the United States on behalf of 1,117 patients. While the majority of contracts were to Central America; Peru, Ecuador and Brazil have seen increased numbers of patients requiring continuity of care assistance. Additionally, there is an increase in enrollments for individuals from Europe and East and Southeast Asia. OTHER PROGRAM SERVICES 8: MCN addresses environmental and occupational health (EOH) disparities as the work and lifestyle that accompanies this vulnerable population, places migrants at higher risk for exposures, injuries and other health problems. For over 25 years, MCN has fostered numerous environmental justice initiatives focusing on clinician training and community education. In 2010 MCN accomplished the following in the area of EOH and Environmental Justice: - Established and maintained 10 Centers of Excellence for Environmental and Occupational Health that resulted in:1. changes in clinical systems including intake, screening, outreach and education;2. demonstration of primary care providers' willingness to acknowledge and address environmental and occupational injury and exposure which leads to improved patient care;3. new linkages between clinics and clinicians and the agricultural work place; and4. connections between primary care providers and pesticide experts and Occupational and Environmental Medicine (OEM) Specialists.- Trained over 700 clinicians - Distributed over 13,000 clinical resources- Distributed over 65,000 pesticide patient educational materials - Fostered active partnerships with over 13 organizations with expertise in pesticides, occupational and environmental medicine and agricultural medicine
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.