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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MICHIGAN PRIMARY CARE ASSOCIATION
Employer identification number
38-2294018
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
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
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.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
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.)..
11
Total support (Add lines 7 through 10).
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
17,651,079
18,562,316
20,988,393
23,424,704
25,779,797
106,406,289
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......
793,285
1,854,727
2,293,705
2,245,886
2,555,920
9,743,523
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.
18,444,364
20,417,043
23,282,098
25,670,590
28,335,717
116,149,812
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.
608,625
608,625
c
Add lines 7a and 7b..
608,625
608,625
8
Public support (Subtract line 7c from line 6.)
115,541,187
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
18,444,364
20,417,043
23,282,098
25,670,590
28,335,717
116,149,812
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
13,976
14,456
7,331
51,626
27,915
115,304
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
13,976
14,456
7,331
51,626
27,915
115,304
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
7,647
12,520
14,796
10,689
11,605
57,257
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.)..
18,465,987
20,444,019
23,304,225
25,732,905
28,375,237
116,322,373
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.330 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.670 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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
Schedule A (Form 990 or 990-EZ) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MICHIGAN PRIMARY CARE ASSOCIATION
Employer identification number
38-2294018
Return Reference
Explanation
FORM 990, PAGE 2, PART III, LINE 4D
PLACEMENT OF AMERICORP WORKERS IN HEALTH CENTERS TO DEVELOP PROGRAMS AND RECRUIT VOLUNTEERS. 4000 PEOPLE SERVED. TOTAL EXPENSES: 426,445. RECRUITED AND MOBILIZED OUTREACH AND ENROLLMENT STAFF AT HEALTH CENTERS AND THE PCA. TOTAL EXPENSES: 250,590.
FORM 990, PAGE 6, PART VI, LINE 4
THE BYLAWS WERE REVISED ON DECEMBER 17, 2013. SIGNIFICANT CHANGES INCLUDED: - THE NUMBER OF MEMBERS COMPRISING THE BOARD OF DIRECTORS - THE NOMINATION AND ELECTION PROCESS FOR THE BOARD OF DIRECTORS
FORM 990, PAGE 6, PART VI, LINE 6
THE ORGANIZATION HAS APPROXIMATELY 40 MEMBERS. THERE ARE THREE CLASSES OF MEMBERS: ACTIVE, ASSOCIATE, AND STUDENT. ACTIVE MEMBERS ARE THE ONLY ONES WITH FULL VOTING PRIVILEGES AND THE ONLY ONES ELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS. ASSOCIATE MEMBERS HAVE VOTING PRIVILEGES ONLY ON COMMITTEES ON WHICH THEY SERVE.
FORM 990, PAGE 6, PART VI, LINE 7A
THE BOARD OF DIRECTORS IS COMPRISED OF ELEVEN MEMBERS THAT ARE ELECTED OR APPOINTED AS FOLLOWS: - EIGHT MEMBERS ARE ELECTED REGIONALLY BY A VOTE OF THE ACTIVE MEMBERS. - ONE MEMBER IS APPOINTED BY THE MAJORITY VOTE OF THE HEALTH CENTER BOARD MEMBER COMMITTEE. - ONE MEMBER IS APPOINTED BY THE MAJORITY VOTE OF THE CLINICAL SERVICES COMMITTEE. - ONE MEMBER IS APPOINTED BY THE MAJORITY VOTE OF THE FINANCE OFFICERS NETWORK.
FORM 990, PAGE 6, PART VI, LINE 7B
THE DECISION TO DISSOLVE THE ORGANIZATION IS RESERVED TO A VOTE OF THE ACTIVE MEMBERS.
FORM 990, PAGE 6, PART VI, LINE 11B
THE FORM 990 IS SENT ELECTRONICALLY TO THE MPCA BOARD MEMBERS FOR REVIEW PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12C
THE ORGANIZATION CONSISTENTLY AND REGULARLY MONITORS AND ENFORCES THE POLICY BY HAVING EMPLOYEES ANNUALLY DISCLOSE ANY CONFLICT OF INTEREST ISSUES.
FORM 990, PAGE 6, PART VI, LINE 15A
THE COMPENSATION COMMITTEE UNDERTAKES A PROCESS EACH YEAR TO REVIEW AND APPROVE THE CHIEF EXECUTIVE OFFICER'S COMPENSATION FOR THE COMING YEAR. THIS PROCESS INCLUDES CONTRACTING AN INDEPENDENT HR SPECIALTY FIRM TO IMPLEMENT A SALARY ADMINISTRATION PLAN (SAP) WITH SALARY RANGES FOR MULTIPLE POSITIONS, AND RANGES BASED ON THE NON-PROFIT SECTOR. IN ADDITION, MULTIPLE SALARY SURVEYS ARE UTILIZED TO ENSURE THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS IN LINE WITH APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER FOLLOWS THE SAP AND IS WELL IN LINE WITH NON-PROFITS OF SIMILAR SIZE AND SCOPE. DOCUMENTATION OF THE COMPENSATION COMMITTEE'S MEETINGS AND DECISIONS IS MAINTAINED ALONG WITH PERFORMANCE REVIEWS AND THE REPORT OF THE INDEPENDENT COMPENSATION CONSULTANT.
FORM 990, PAGE 6, PART VI, LINE 15B
THE COMPENSATION COMMITTEE UNDERTAKES A PROCESS EACH YEAR TO REVIEW AND APPROVE THE COMPENSATION FOR KEY EMPLOYEES FOR THE COMING YEAR. THIS PROCESS INCLUDES CONTRACTING AN INDEPENDENT HR SPECIALTY FIRM TO IMPLEMENT A SALARY ADMINISTRATION PLAN (SAP) WITH SALARY RANGES FOR MULTIPLE POSITIONS, AND RANGES BASED ON THE NON-PROFIT SECTOR. IN ADDITION, MULTIPLE SALARY SURVEYS ARE UTILIZED TO ENSURE THE SAP FOR ALL STAFF POSITIONS IS IN LINE WITH APPROPRIATE COMPARABILITY DATA. DOCUMENTATION OF THE COMPENSATION COMMITTEE'S MEETINGS AND DECISIONS IS MAINTAINED ALONG WITH PERFORMANCE REVIEWS AND THE SAP.
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.