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
2012
Open to Public Inspection
Name of the organization
MID CENTRAL AREA HEALTH EDUCATION C
Employer identification number
14-1941590
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
281,567
281,567
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
281,567
281,567
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.
281,567
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
281,567
281,567
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.)..
4,760
4,760
11
Total support (Add lines 7 through 10).
286,327
12
Gross receipts from related activities, etc. (see instructions)
..................
12
4,760
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
98.340 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to 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
PART II, PUBLIC SUPPORT SCHEDULE, SECTION A. PUBLIC SUPPORT, LINE 1. PUBLIC SUPPORT RECORDS FOR THE FOUR YEARS PRIOR TO 2012 ARE UNAVAILABLE. DURING THIS PERIOD, THE ORGANIZATION'S PROGRAM WAS INACTIVE AND THE IRS FORM 990 WAS FILED USING THE ELECTRONIC POSTCARD METHOD. IN SEPTEMBER OF 2012,THE PROGRAMING WAS REINSTATED AND PUBLIC SUPPORT HAS BEEN RECORDED. PART II, LINE 10 - OTHER INCOME THE OTHER INCOME REPORTED ON LINE 10 IS FROM COMMUNITY DEVELOPMENT REGISTRATION AND TRAINING FEES.
Schedule A (Form 990 or 990-EZ) 2012
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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MID CENTRAL AREA HEALTH EDUCATION C
Employer identification number
14-1941590
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
MID CENTRAL AREA HEALTH EDUCATION CENTER IS A NON-PROFIT CORPORATE ORGANIZATION WHO'S PURPOSE IS: A. TO ENHANCE ACCESS TO HIGH QUALITY HEALTH CARE, PARTICULARLY PRIMARY AND PREVENTATIVE CARE BY IMPROVING THE SUPPLY, DISTRIBUTION, DIVERSITY AND QUALITY OF HEALTH CARE PROFESSIONALS THROUGH COMMUNITY/ACADEMIC PARTNERSHIPS. B. IMPROVE ACCESS TO HIGH QUALITY HEALTH CARE FOR UNDERSERVED AREAS AND UNDERSERVED POPULATIONS IN THE MID CENTRAL AREA HEALTH EDUCATION CENTERS (AHEC)REGION. C. TO RECEIVE AND ADMINISTER FUNDS AND TO OPERATE EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, LITERARY OR EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, OR COMPARABLE PROVISIONS OF SUBSEQUENT LEGISLATION (THE "CODE"), AND TO GIVE FUNDS AND PROPERTY FROM TIME TO TIME TO OTHER ORGANIZATIONS TO BE USED (OR HELD FOR USE) DIRECTLY IN CARRYING OUT ONE OR MORE SUCH PURPOSES. D. TO ACQUIRE, OWN, DISPOSE OF AND DEAL WITH REAL AND PERSONAL PROPERTY AND INTERESTS THEREIN AND TO APPLY GIFTS, GRANTS, BEQUESTS AND DEVISES AND THE PROCEEDS THEREOF IN THE FURTHERANCE OF THE PURPOSES OF THE CORPORATION. E. TO DO SUCH THINGS AND TO PERFORM SUCH ACTS TO ACCOMPLISH ITS PURPOSES AS THE BOARD OF TRUSTEES MAY DETERMINE TO BE APPROPRIATE AND AS ARE NOT FORBIDDEN BY SECTION 501 (C)(3) OF THE CODE, WITH ALL THE POWER CONFERRED UPON NON-PROFIT CORPORATIONS UNDER THE LAWS OF THE STATE OF MICHIGAN.
ANY SIGNIFICANT NEW PROGRAM SERVICES NOT LISTED ON A PRIOR RETURN
FORM 990, PAGE 2, PART III, LINE 2
THE ORGANIZATION HAS ENHANCED IT'S PROGRAMMING IN THIS FISCAL YEAR BY ADDING STAFFING AND SETTING GOALS TO CARRY OUT THE MISSION. PROGRAMMING WILL FOCUS ON: 1. PROVIDING "PIPELINE" PROGRAMS THAT SUPPORT AND ENABLE K THROUGH 12TH GRADE STUDENTS TO EXPLORE CAREERS IN THE HEALTH PROFESSIONS. THIS INCLUDES VISITING HEALTH PROFESSIONS PROGRAMS AT COMMUNITY COLLEGES AND UNIVERSITIES, PARTICIPATING IN COMMUNITY HEALTH INITIATIVES, AND ATTENDING SUMMER HEALTH PROGRAMMING CAMPS. 2. TO SUPPORT CLINICAL ROTATIONS BY ASSISTING COMMUNITIES IN READYING THEMSELVES FOR STUDENTS WHO ARE COMPLETING ROTATIONS AT NEARBY PRACTICES WITH LOCAL PHYSICIANS AND HOSPITALS. 3. TO SUPPORT ONGOING EDUCATION AND PROVIDE CURRENT AND RELEVANT PROGRAMS IN HEALTH AND MEDICAL FIELDS THAT PROVIDE CONTINUING MEDICAL EDUCATION CREDITS OR CONTINUING EDUCATION CREDITS TO CURRENT PROVIDERS, LEADERS AND OTHER HEALTH PROFESSIONALS, ESPECIALLY THOSE IN UNDERSERVED AREAS.
ANY SIGNIFICANT CHANGES IN CONDUCT FOR PROGRAM SERVICES
FORM 990, PAGE 2, PART III, LINE 3
THE MID CENTRAL AREA PROGRAMMING FOR HEALTH EDUCATION SERVICES HAD PREVIOUSLY BEEN CONDUCTED UNDER THE AUSPICES OF MICHIGAN PRIMARY CARE AND CENTRAL & EASTERN MICHIGAN AREA HEALTH EDUCATION CENTER. IN AUGUST, 2012, MID CENTRAL AREA HEALTH EDUCATION CENTER REINSTATED AND EXPANDED THE PROGRAMMING FROM AN INACTIVE STATUS FOR THE MID CENTRAL REGION BY PROCURING FUNDING AND STAFF TO CARRY OUT THE ORGANIZATION'S MISSION TO ENHANCE ACCESS TO HIGH QUALITY HEALTH CARE, PARTICULARLY PRIMARY AND PREVENTATIVE CARE BY IMPROVING THE SUPPLY, DISTRIBUTION, DIVERSITY AND QUALITY OF HEALTH CARE PROFESSIONALS THROUGHOUT COMMUNITY/ADADEMIC PARTNERSHIPS.
SECOND ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
HOST THE NATIONAL HEALTH SERVICE CORP COMMUNITY DAY. THE CORPS COMMUNITY DAY FOCUSES ON INCREASING ACCESS TO PRIMARY CARE AND MEDICALLY UNDERSERVED AREAS. STUDENTS LEARN HOW TO REGISTER AND APPLY TO BE IN THE NHSC. WE HAD 12 INDIVIDUALS ATTEND THE PRESENTATON AT OUR SITE. THESE STUDENTS WERE MADE UP OF MEDICAL STUDENTS, PHYSICIAN ASSISTANTS AND SPEECH LANGUAGE PATHOLOGY STUDENTS.
THIRD ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4C
REGIONAL, NATIONAL AND REGULATORY PERSPECTIVES. PARTICIPANTS GAINED KNOWLEDGE REGARDING BEST PRACTICES THAT WERE DESIGNED TO DEVELOP, ENHANCE AND MAINTAIN QUALITY HEALTH CARE ACROSS THE CONTINUUM. THEY ENGAGED IN DIALOGUE THAT FACILITATED VISIONING FOR EFFECTIVENESS AND ACCOUNTABILITY IN HEALTH CARE TO ACHIEVE THE GOAL OF IMPROVED HEALTH OF THE REGION'S POPULATIONS AND PARTICIPANTS IDENTIFIED STRATEGIES THAT WOULD PROMOTE AND SUPPORT COMMUNITY AWARENESS REGARDING QUALITY HEALTH CARE. THE INTENDED AUDIENCE FOR THIS FORUM WAS HOSPITAL BOARD MEMBERS, HEALTH CARE EXECUTIVES, PHYSICIANS, OTHER HEALTH CARE PROVIDERS, AND COMMUNITY HEALTH LEADERS. THE CENTRAL MICHIGAN UNIVERSITY COLLEGE OF MEDICINE DESIGNATED THIS EDUCATIONAL ACTIVITY FOR A MAXIMUM OF 3.5 MAMPRA CATEGORY 1 CREDIT.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
ALL OTHER PROGRAMMING COSTS ARE RELATED TO ESTABLISHING AND FACILITATING EVENTS AS DESCRIBED IN PART III, LINE 2, UNDERTAKING SIGNIFICANT NEW PROGRAM SERVICES. THESE SERVICES ENCOMPASS PIPELINE PROGRAMS FOR CAREERS IN HEALTH PROFESSIONS, SUPPORTING CLINICAL ROTATIONS IN COMMUNITIES AND SUPPORTING ONGOING EDUCATION IN HEALTH AND MEDICAL FIELDS.
AUTHORITY DELEGATED TO COMMITTEE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 1A
THE BOARD OF TRUSTEES IS MADE UP OF A SIX MEMBER TEAM. THE PRESIDENT, VICE PRESIDENT AND SECRETARY/TREASURER FORM THE EXECUTIVE COMMITTEE. THIS COMMITTEE IS EMPOWERED TO MAKE AND IMPLEMENT MAJOR ORGANIZATIONAL DECISIONS. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES ORGANIZATION EXPENDITURES OF 5,000 AND GREATER AND HAS THE AUTHORITY TO REQUEST JUSTIFICATION OF CERTAIN MATTERS AS WELL AS TO PLAN ACTIVITIES.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE ORGANIZATION'S FORM 990 IS COMPILED BY AN INDEPENDENT ACCOUNTANT. PRIOR TO SUBMITTING THE FORM 990 TO THE GOVERNING AGENCY, IT IS REVIEWED BY THE ORGANIZATION'S EXECUTIVE DIRECTOR AND THE BOARD OF TRUSTEES.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
MID CENTRAL AREA HEALTH EDUCATION CENTER'S CONFLICT OF INTEREST POLICY IS MODELED AFTER WAYNE STATE UNIVERSITY'S POLICY. WHEN A BOARD OF TRUSTEE FOR MID CENTRAL AHEC IS APPOINTED, THEY SIGN TO ACKNOWLEDGE ACCEPTANCE OF SAID POLICY. IF NEW RESOURCES ARE CONTRACTED OR SIGNIFICANT AGREEMENTS FOR EXPENDITURES ARE IMPLEMENTED, THE POTENTIAL FOR A CONFLICT IS REVISITED.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
COMPENSATION FOR THE EXECUTIVE DIRECTOR OF MID CENTRAL AHEC IS BASED ON COMPARABILITY DATA TO BE CONSISTENT WITH SALARY RATES FOR LOCAL NON-PROFIT ORGANIZATIONS AND UNIVERSITY ENVIRONMENTS. THE RECOMMENDATIONS FOR COMPENSATION ADJUSTMENTS ARE INITIATED BY THE HUMAN RESOURCE DEPARTMENT OF CENTRAL MICHIGAN UNIVERSITY AND REVIEWED BY THE ORGANIZATION'S BOARD OF TRUSTEES AS WELL AS A MEMBER OF CMU'S SCHOOL OF MEDICINE'S ADMINISTRATION. SALARIES AND BENEFITS FOR MID CENTRAL AHEC ARE PROCESSED BY CMU'S PAYROLL DEPARTMENT.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC.
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 9
COLUMN A, BEGINNING OF YEAR FINANCIAL INFORMATION REFLECTS ZERO BALANCE ACTIVITY. PRIOR TO THE CURRENT YEAR PROGRAMMING, THE ORGANIZATION WAS INACTIVE. THE ANNUAL RETURNS FOR THE INACTIVE PERIODS WERE SUBMITTED USING THE FORM 990-N.
CHANGE IN FINANCIAL REVIEW PROCESS
FORM 990, PAGE 12, PART XII, LINE 2C
THE FINANCIAL STATEMENTS ARE COMPILED MONTHLY BY AN INDEPENDENT ACCOUNTANT AND REVIEWED QUARTERLY BY THE ORGANIZATIONS BOARD OF TRUSTEES
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.