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
MISSOURI COALITION FOR PRIMARY HEALTH CARE
Employer identification number
43-1419937
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.") ....
23,857,188
19,146,941
9,649,495
7,301,272
8,317,280
68,272,176
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
23,857,188
19,146,941
9,649,495
7,301,272
8,317,280
68,272,176
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)..
0
6
Public support. Subtract line 5 from line 4.
68,272,176
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..
23,857,188
19,146,941
9,649,495
7,301,272
8,317,280
68,272,176
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
1,446
1,008
2,366
1,795
5,766
12,381
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
11
Total support (Add lines 7 through 10).
68,284,557
12
Gross receipts from related activities, etc. (see instructions)
..................
12
5,563,525
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
99.982 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
99.955 %
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.") .
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
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
MISSOURI COALITION FOR PRIMARY HEALTH CARE
Employer identification number
43-1419937
Return Reference
Explanation
FORM 990, PART III, LINE 4D
OTHER PROGRAM SERVICES PRIMARY CARE ASSN. GRANT- SUPPORTS OPERATIONS OF THE ASSOCIATION THROUGH GRANT FUNDING FROM THE BUREAU OF PRIMARY HEALTH CARE. EXPENSES $ 881,943. INCLUDING GRANTS OF $ 0. REVENUE $ 5,244. MISSOURI CLINICAL & QUALITY CONFERENCE-AN ANNUAL CONFERENCE HELD FOR THE PURPOSE OF OFFERING EDUCATIONAL ACTIVITIES FOR PHYSICIANS, NURSE PRACTITIONERS, NURSES, PHYSICIAN'S ASSISTANTS, DENTIST, DENTAL HYGIENISTS, DENTAL ASSISTANTS AND COMMUNITY HEALTH CENTER ADMINISTRATIVE PERSONNEL. EXPENSES $ 96,881. INCLUDING GRANTS OF $ 0. REVENUE $ 63,507. REGIONAL CENTER FOR HIT ASSISTANCE - MO COALITION FOR PRIMARY HEALTH CARE IS INVOLVED WITH THE UNIVERSITY OF MISSOURI, THROUGH THE DEPT. OF HEALTH MANAGEMENT AND INFORMATICS, THE CENTER FOR HEALTH POLICY, AND THE MISSOURI TELEHEALTH NETWORK TO ESTABLISH THE MISSOURI HEALTH INFORMATION TECHNOLOGY ASSISTANCE CENTER (MISSOURI HIT ASSISTANCE CENTER) AS A COMPREHENSIVE REGIONAL CENTER TO SUPPORT PRIMARY CARE PROVIDERS AND OTHER HEALTH CARE PROFESSIONALS IN ADOPTING ELECTRONIC HEALTH RECORDS (EHRS) AND UTILIZING HEALTH INFORMATION TECHNOLOGY EFFECTIVELY TO IMPROVE THE QUALITY OF HEALTH CARE IN MISSOURI. EXPENSES $ 108,309. INCLUDING GRANTS OF $ 0. REVENUE $ 0. HEALTH CENTER CONTROLLED NETWORKS - SUPPORTS ADOPTION, IMPLEMENTATION, AND UPGRADE OF ELECTRONIC HEALTH RECORDS SYSTEMS, APPLICATION AND PAYMENT OF HIT MEANINGFUL USE INCENTIVES AND LEVERAGING PATIENT DATA FOR CLINICAL QUALITY IMPROVEMENT. EXPENSES $ 380,766. INCLUDING GRANTS OF $ 0. REVENUE $ 950. CENTER FOR MEDICARE SERVICES ADVANCED PRIMARY CARE PRACTICE DEMONSTRATION - PROVIDES SUPPORT TO HEALTH CENTER SITES SELECTED TO PARTICIPATE IN THE CMS ADVANCED PRIMARY CARE PRACTICE DEMONSTRATION PROJECT IN 14 STATES THROUGH THE RESPECTIVE PRIMARY CARE ASSOCIATIONS THROUGH PRACTICE COACHING TOWARD ACHIEVEMENT OF NATIONAL COMMITTEE FOR QUALITY ASSURANCE RECOGNITION AS PATIENT CENTERED MEDICAL HOMES. MISSOURI PRIMARY CARE ASSOCIATION IS THE LEAD PCA AND PLANS, ORGANIZES, EXECUTES, AND OVERSEES REGIONAL TRAINING AND TECHNICAL ASSISTANCE SUPPORT. EXPENSES $ 254,307. INCLUDING GRANTS OF $ 0. REVENUE $ 0. MISSOURI FOUNDATION FOR HEALTH PRACTICE COACHING - PROVIDES PRACTICE COACHING SUPPORT FOR HEALTH CENTERS ENROLLED AS PROVIDERS IN THE MISSOURI PRIMARY CARE HEALTH HOME INITIATIVE TOWARD NATIONAL COMMITTEE FOR QUALITY ASSURANCE RECOGNITION AS PATIENT CENTERED MEDICAL HOMES. IT IS LIMITED TO HEALTH CENTERS IN THE MISSOURI FOUNDATION FOR HEALTH SERVICE AREA. EXPENSES $ 347,621. INCLUDING GRANTS OF $ 0. REVENUE $ 0. MISSOURI PRIMARY CARE HEALTH HOME INITIATIVE - PROVIDES CLINICAL QUALITY MEASURES REPORTING TO MO HEALTHNET DIVISION AND TO PROVIDERS PARTICIPATING IN THE MISSOURI PRIMARY CARE HEALTH HOME INITIATIVE. EXPENSES $ 488,138. INCLUDING GRANTS OF $ 0. REVENUE $ 451,626. DATA REPORTING AND VISUALIZATION SYSTEM - SUPPORTS SUBLICENSE OF DATA WAREHOUSE/CLINICAL QUALITY MEASURES REPORTING SYSTEM TO MEMBERS. EXPENSES $ 259,479. INCLUDING GRANTS OF $ 0. REVENUE $ 285,745. THE ORGANIZATION ALSO PROVIDED VARIOUS OTHER PROGRAM SERVICES THROUGHOUT THE YEAR. EXPENSES $1,355,006. INCLUDING GRANTS OF $ 17,060. REVENUE $ 406,212
FORM 990, PART VI, SECTION A, LINE 2
DIRECTOR BUSINESS RELATIONSHIPS ANDY GRIMM, GLORIA CRULL, DWAYNE BUTLER, ROBERT MASSIE, DAVE BARBER, AND DON MCBRIDE ALL SHARE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B
MEMBERS, STOCKHOLDERS, OR OTHER PERSONS MEMBERSHIP IN THE CORPORATION SHALL BE LIMITED, NOT AS TO NUMBER, BUT AS TO PERSONS REPRESENTING ORGANIZATIONS AND INTEREST PERTINENT TO THE INTEREST/BUSINESS OR GOVERNANCE OF PRIMARY CARE ORGANIZATIONS OR AS OTHERWISE DEFINED IN THE BYLAWS OF THE CORPORATION. ORGANIZATIONAL OR VOTING MEMBERSHIP SHALL INCLUDE ONE REPRESENTATIVE FROM EACH OF THE SECTION 330 FEDERALLY FUNDED HEALTH CENTERS IN THE STATE OF MISSOURI THAT DESIRES TO HAVE A MEMBER. EACH MEMBER SHALL BE ENTITLED TO ONE VOTE ON EACH MATTER SUBMITTED TO A VOTE OF MEMBERS. EACH OF THE MEMBERS MAY APPOINT ONE DIRECTOR TO THE BOARD OF DIRECTORS TO SERVE A ONE YEAR TERM.
FORM 990, PART VI, SECTION B, LINE 11B
990 REVIEW POLICY THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE CFO AND CEO REVIEW THE FORM 990 AND EMAIL TO THE ENTIRE BOARD OF DIRECTORS FOR REVIEW. ONCE ALL COMMENTS AND QUESTIONS HAVE BEEN RESOLVED, THE CEO SIGNS THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C
CONFLICT OF INTEREST POLICY ANNUALLY, MEMBERS AND EMPLOYEES ARE REQUIRED TO SIGN A "DISCLOSURE CONCERNING CONFLICT OF INTEREST" FORM. IF THERE IS A CONFLICT OF INTEREST, AN ATTACHED STATEMENT IS TO BE MADE WITH THE DISCLOSURE FORM. DISCLOSURE FORMS ARE REVIEWED BY THE CEO OR HIS DESIGNEE, OR THE BOARD PRESIDENT IN SPECIAL SITUATIONS, TO DETERMINE WHETHER ANY CONFLICTS OF INTEREST ARE DISCLOSED. IN THE EVENT CONFLICTS ARE DISCLOSED, THE "DISCLOSURE CONCERNING CONFLICT OF INTEREST" FORM LAYS OUT COURSES OF ACTION TO TAKE.
FORM 990, PART VI, SECTION B, LINE 15A
COMPENSATION REVIEW THE PROCESS FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO INCLUDES AN ANNUAL REVIEW IN MARCH BY THE BOARD MEMBERS WHICH IS EVALUATED BY THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE TAKES INTO ACCOUNT JOB PERFORMANCE FOR THE PREVIOUS YEAR AS WELL AS COMPARABILITY DATA OF OTHER COMPARABLE-SIZED ORGANIZATIONS. THE EXECUTIVE COMMITTEE'S DELIBERATION AND DECISION ARE CONTEMPORANEOUSLY SUBSTANTIATED AND A RECOMMENDATION IS MADE TO THE BOARD. THE COMPENSATION PACKAGE IS ULTIMATELY APPROVED BY THE ENTIRE BOARD. ADDITIONALLY DURING THE YEAR ENDED MARCH 31, 2014, THE BOARD ENGAGED A CONSULTING FIRM TO RESEARCH EXECUTIVE COMPENSATION AND MAKE A RECOMMENDATION FOR A 2013 SALARY RANGE FOR MPCA'S CHIEF EXECUTIVE AS WELL AS ITS OPERATING OFFICER, FINANCE OFFICER, AND ONE OTHER UPPER LEVEL MANAGEMENT POSITION.
FORM 990, PART VI, SECTION C, LINE 19
DOCUMENT DISCLOSURE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY REQUEST.
FORM 990, PART IX, LINE 11G
OTHER FEES FOR SERVICES THE BREAKOUT OF OTHER FEES FOR SERVICES IS AS FOLLOWS: SUBRECIPIENT/CONSORTIA COST: ADVANCED PRIMARY CARE PRACTICE DEMONSTRATION $ 140,300 DISTRIBUTION OF FUNDING TO FQHCS FOR OUTREACH PROGRAMS FOR WOMEN AND MINORITY HEALTHCARE $ 1,004,024 FQHC/CMHC MENTAL HEALTH AND PRIMARY CARE INTEGRATION $ 646,274 GRANT ADMINISTRATOR/EXPANSION & ORAL HEALTH INITIATIVE SERVICES $ 2,867,278 BIOTERRORISM EMERGENCY PREPAREDNESS $ 171,063 CHRONIC DISEASE COLLABORATIVE $ 64,285 RCHN GATEWAY TO MARKETPLACE $ 33,280 ----------- TOTAL SUBRECIPIENT/CONSORTIA COST $ 4,926,504 CONTRACTED SERVICES: HEALTH CENTER CONTROLLED NETWORKS $ 151,764 CHRONIC DISEASE COLLABORATIVE $ 67,068 MFH MEDICAID RESEARCH $ 28,000 MFH MEDICAID INITIATIVE $ 10,815 ADVOCACY (MFH) $ 9,981 HCFGKC MEDICAID INITIATIVE $ 22,660 MPCA MEMBERSHIP $ 28,049 EMR MANAGEMENT & HOSTING $ 17,211 MOQUIN SERVICES $ 97,995 MO PC HEALTH HOME INITIATIVE $ 462,330 MOSBIRT (UMSL-MIMH) $ 10,002 DRVS (AZARA) $ 258,727 PCMH ACCELERATOR PORTAL $ 53,250 CONSULTING AND TECHNICAL ASSISTANCE $ 535,096 MISCELLANEOUS PROGRAMS $ 1,127 ----------- TOTAL CONTRACTED SERVICES $ 1,754,075 ----------- TOTAL OTHER FEES FOR SERVICES $ 6,680,579
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.