Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 120,900 | 118,854 | 286,467 | 378,363 | 534,639 | 1,439,223 |
| 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 ..... | 431 | 6,797 | 2,265 | 334 | 2,120 | 11,947 |
| 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 | 121,331 | 125,651 | 288,732 | 378,697 | 536,759 | 1,451,170 |
| 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.) | 1,451,170 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 121,331 | 125,651 | 288,732 | 378,697 | 536,759 | 1,451,170 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 33 | 381 | 128 | 132 | 1,168 | 1,842 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 33 | 381 | 128 | 132 | 1,168 | 1,842 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 121,364 | 126,032 | 288,860 | 378,829 | 537,927 | 1,453,012 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | ENSURE INDIANA'S PEDIATRIC PRACTICES CAN STAY OPEN AND VIABLE DURING THE PANDEMIC-- INDIANA WAS ONE OF THE FIRST STATES IN THE COUNTRY TO ALLOW REIMBURSEMENT FOR VIRTUAL WELL-CHILD VISITS, WHICH ALSO INCLUDED REIMBURSEMENT FOR DELAYED IN-PERSON FOLLOW-UP VISITS. THIS CRITICAL CHANGE ALLOWED MANY OF OUR PRACTICES TO CONTINUE TO FUNCTION AT A TIME WHEN THEY HAD BEEN WORRIED ABOUT GOING OUT OF BUSINESS. INAAP'S WEBINAR "TRANSITIONING YOUR PRACTICE TO TELEHEALTH DURING THE COVID-19 PANDEMIC" WAS ATTENDED BY OVER 75 INAAP MEMBERS, AND THE WEBINAR "TAKING ADVANTAGE OF FEDERAL FINANCIAL RELIEF" WA ATTENDED BY OVER 50 INAAP MEMBERS. ADVOCATE ON THE IMPORTANCE OF IN-PERSON CHILD EDUCATION AND COLLABORATE WITH STATE OFFICIALS ON HOW TO DO SO SAFELY-- INDIANA WAS ONE OF THE FIRST THREE STATES IN THE COUNTRY TO RETURN TO IN- PERSON EDUCATION. INAAP PRESIDENT DR. EMILY SCOTT JOINED THE COMMISSIONER OF THE INDIANA STATE DEPARTMENT OF HEALTH DR. KRIS BOX TO SPEAK WITH HUNDREDS OF SCHOOL BOARD LEADERS VIA WEBINARS ABOUT THE REOPENING PROCESS AND WHAT SCHOOLS COULD DO TO STAY SAFE. ENSURE CRITICAL INFORMATION BE PASSED ALONG TO BOTH PEDIATRICIANS AND FAMILIES FROM A TRUSTED SOURCE-- INAAP COLLABORATED WITH THE INDIANA STATE TEACHERS ASSOCIATION (ISTA) TO PUT ON A WEBINAR ABOUT HOW TEACHERS CAN HELP KEEP THEMSELVES SAFE DURING IN-PERSON EDUCATION. THREE INAAP PEDIATRICIANS HELD A PANEL DISCUSSION THAT HELPED ALLEVIATE FEARS OF TEACHERS ACROSS THE STATE.INAAP HOSTED A WEBINAR WITH THE INDIANA STATE DEPARTMENT OF HEALTH (ISDH) WHERE THE CHIEF MEDICAL OFFICER TALKED TO INAAP MEMBERS ABOUT WHEN KIDS SHOULD REFRAIN FROM GOING TO SCHOOL AFTER A CLOSE CONTACT, AND WHEN THEY SHOULD RETURN TO SCHOOL AFTER AN ILLNESS. INAAP IMMEDIATE PAST PRESIDENT TONY GIAQUINTA WAS A GUEST AT ONE OF GOVERNOR ERIC HOLCOMB'S COVID-19 PRESS CONFERENCES TO TALK ABOUT THE STEPS PEDIATRIC PRACTICES HAD TAKEN TO KEEP PATIENTS SAFE, AND INFORM FAMILIES ABOUT THE IMPORTANCE OF CONTINUING MEDICAL CARE DURING THE PANDEMIC. INAAP ISSUED REGULAR BULLETINS TO MEMBERS WITH COVID-19 UPDATES FROM BOTH THE STATE AND FEDERAL GOVERNMENT. INAAP COMPILED A COVID-19 RESOURCE LIST ON ITS WEBSITE, WHICH INCLUDED RECORDINGS OF THE COVID-19 RELATED WEBINARS, AND OTHER RESOURCES THAT WERE DEVELOPED IN RESPONSE TO THE PANDEMIC. OUTCOMES ON COVID-19 RESPONSES ARE ONGOING AND DIFFICULT TO QUANTIFY. IN THE JOINT WEBINAR WITH ISTA, OVER 120 TEACHERS ATTENDED TO LEARN ABOUT EDUCATOR SAFETY. IN THE WEBINAR WITH ISDH, 80 INAAP MEMBERS ATTENDED TO DISCUSS CHILD AND SCHOOL SAFETY DURING THE PANDEMIC. THE ONGOING COLLABORATION WITH OUR PARTNERS AT THE STATE LEVEL HAVE RESULTED IN FREE-FLOWING INFORMATION AND A STRONGER ABILITY FOR INAAP TO GET BREAKING INFORMATION TO ITS MEMBERS QUICKLY AND EFFICIENTLY. INCREASE SCOPE AND EFFECTIVENESS OF REACH OUT AND READ PROGRAM-- SECURED OVER 250,000 IN NEW FUNDING FOR REACH OUT AND READ INDIANA TO SUPPORT ADMINISTRATION OF THE PROGRAM AND BUY BOOKS FOR USE IN PARTICIPATING PRACTICES. RECEIVED AN IN-KIND DONATION OF OVER 30,000 BOOKS (IN-KIND VALUE OF OVER 150,000) WHICH WERE DISTRIBUTED TO PRACTICES ACROSS THE STATE. IT WAS ONE OF THE LARGEST IN-KIND DONATIONS TO A REACH OUT AND READ AFFILIATE IN THE HISTORY OF THE PROGRAM. KEEP THE REACH OUT AND READ MODEL VIABLE DURING THE COVID-19 PANDEMIC-- DEVELOPED AND HELPED IMPLEMENT WAYS FOR PRACTICES TO CONTINUE THE REACH OUT AND READ INTERVENTION VIRTUALLY EITHER BY MAILING BOOKS TO PATIENTS AHEAD OF THE VISIT AND DISCUSSING THE BOOK VIRTUALLY DURING THE WELL CHILD CHECK, OR BY HAVING FAMILIES UTILIZE AN EXISTING BOOK IN THEIR HOME. INAAP PARTNERED THE IU SCHOOL OF MEDICINE TO PRODUCE 19 VIDEOS OF RESIDENTS READING CHILDREN'S BOOKS ALOUD. THE VIDEOS WERE POSTED ON YOUTUBE AND ON INAAP'S WEBSITE FOR FAMILIES TO VIEW. THE VIDEOS COVERED NUMEROUS AGE RANGES AND INCLUDED 2 SPANISH LANGUAGE VIDEOS AS WELL. ENSURE THAT REACH OUT AND READ WAS RESPONSIVE TO SOCIAL JUSTICE ISSUES AND THE EPIDEMIC OF RACISM. THE BOOK LIST WAS DISTRIBUTED NATIONALLY AND PROVIDED TO ALL OF OUR PARTICIPATING REACH OUT AND READ PRACTICES. INCREASE DEVELOPMENTAL SCREENING IN INDIANA-- INAAP'S ASHEW TEAM RECRUITED 10 PEDIATRIC PRACTICES TO PARTICIPATE IN THE PROGRAM. THROUGH ASHEW, THESE PRACTICES WERE PROVIDED WITH PEER-TO-PEER LEARNING, EDUCATION, AND TECHNICAL ASSISTANCE TO IMPLEMENT THE PROJECT'S CHANGE PACKAGE, WHICH IS ELIGIBLE FOR 25 POINTS OF ABP MOC PART 4, 20 POINTS OF MOC PART 2, AND CME. THE TEAM PROVIDED EACH PRACTICE WITH TOOLS TO ADDRESS MANY STRESSORS FACING CHILDREN, YOUTH, AND FAMILIES. THE PROGRAM ALSO LINKS WITH STATEWIDE STRATEGIES TO SCREEN AND DEVELOP CLOSED-LOOP REFERRALS. THROUGH ASHEW, PARTICIPATING PRACTICES TEST AND REFINE QUALITY IMPROVEMENT CHANGES USING FAMILY-CENTERED, STRENGTH-BASED APPROACHES TO SCREENING, REFERRAL, AND FOLLOW-UP FOR MATERNAL DEPRESSION, SOCIAL DETERMINANTS OF HEALTH, AND SOCIAL- EMOTIONAL DEVELOPMENT. THE PROJECT TRACKS THIS WORK THROUGH MONTHLY DATA REPORTS THAT THE PRACTICES ENTER TO QIDA AS WELL AS MONTHLY PDSA CYCLES. THROUGH THIS DATA DRIVEN APPROACH, THE CHAPTER TEAM IS ABLE TO ASSIST PRACTICES IN MAKING CONTINUOUS QUALITY IMPROVEMENT. INCREASE SCOPE AND EFFECTIVENESS OF CEASE PROGRAM-- TOOK FUNDING THAT HAD PREVIOUSLY BEEN USED TO SUBCONTRACT WITH MASS GENERAL TO HIRE A NEW FULL-TIME PROGRAM COORDINATOR. THE SAVINGS FROM BRINGING THE PROJECT IN-HOUSE ALSO ALLOWED INAAP TO MORE THAN DOUBLE THE NUMBER OF PRACTICES ENROLLED IN CEASE FROM 10 TO 24. CREATED A NEW WORKFLOW FOR VIRTUAL VISITS THAT INCLUDED FRONT-OFFICE STAFF CALLING PATIENTS AHEAD OF THEIR VIRTUAL APPOINTMENT TO COLLECT SURVEY DATA, AND THEN HAVING THE PEDIATRICIANS DISCUSS TOBACCO USE AS PART OF THE VIRTUAL VISIT. WHEN MORE PATIENTS STARTED COMING BACK TO PRACTICES, WE PHASED OUT THE USE OF IPADS TO COLLECT SURVEY DATA (DUE TO COVID-19 CONCERNS) AND INSTEAD CREATED A QR CODE THAT PATIENTS WERE ABLE TO SCAN WITH THEIR OWN DEVICES TO COMPLETE THE CEASE SURVEY. THE INAAP CEASE TEAM WAS ALSO ABLE TO WORK WITH TWO PRACTICES TO GET THE CEASE SURVEY IMPLEMENTED DIRECTLY INTO THEIR EMR SYSTEM FOR A MORE STREAMLINED APPROACH. IMPLEMENT A NEW ORAL HEALTH PROJECT-- RECEIVED 7,000 TO PROMOTE BRUSH BOOK BED AND INCREASE COLLABORATION BETWEEN PEDIATRICIANS AND PEDIATRIC DENTISTS. CREATED AND DISTRIBUTED ORAL HEALTH SURVEY TO PEDIATRICIANS IN FORT WAYNE, INDIANA ABOUT THEIR ORAL HEALTH SCREENING PRACTICES. CREATED AND DISTRIBUTED 1,600 BRUSH BOOK BED PACKETS WHICH INCLUDED A TOOTHBRUSH, TOOTHPASTE, A BOOK FOR READING BEFORE BED, AND INFORMATION ABOUT LOCAL PEDIATRICIANS AND PEDIATRIC DENTISTS. LOCAL PEDIATRIC OFFICES HAVE BEGUN DISTRIBUTION OF THE PACKETS AND ADDITIONAL ORAL HEALTH EDUCATION AS PART OF THE 9 MONTH WELL-CHILD VISIT. |
| FORM 990, PAGE 6, PART VI, LINE 11B | BOARD MEMBERS ARE PROVIDED AN ELECTRONIC COPY OF THE 990 RETURN FOR REVIEW AND DISCUSSION. |
| FORM 990, PAGE 6, PART VI, LINE 12C | BOARD MEMBERS ARE EDUCATED ABOUT CONFLICTS OF INTEREST AND ARE REQUIRED TO DISCLOSE ANY CONFLICTS BEFORE A VOTE BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION FOR TOP EMPLOYEES IS SET ON A YEARLY BASIS. EACH YEAR THE TOP EMPLOYEES ARE SUBJECT TO A PERFORMANCE REVIEW WITH MEMBERS OF THE EXECUTIVE COMMITTEE. THE RESULTS OF THAT REVIEW ARE DISCUSSED BY THE BOARD OF DIRECTORS AND USED TO ESTABLISH THE EMPLOYEE'S SALARY FOR THE NEXT YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS ARE AVAILABLE UPON REQUEST |
| Software ID: | |
| Software Version: |