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 |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 2,539,207 | 2,611,317 | 3,393,972 | 3,977,806 | 4,446,014 | 16,968,316 |
| 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 | 2,539,207 | 2,611,317 | 3,393,972 | 3,977,806 | 4,446,014 | 16,968,316 |
| 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) .. | 555,717 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 16,412,599 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,539,207 | 2,611,317 | 3,393,972 | 3,977,806 | 4,446,014 | 16,968,316 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 4,111 | 2,324 | 726 | 439 | 6,637 | 14,237 |
| 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.).. | 92,161 | 67,081 | 234,065 | 121,710 | 122,934 | 637,951 |
| 11 | Total support. Add lines 7 through 10 | 17,620,504 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 on 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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 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) |
||||
| 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): |
|||||
| 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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| 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, PART III, LINE 4D | OTHER PROGRAM SERVICES: IN ADDITION TO THE THREE LARGEST PROGRAMS, IOWA PRIMARY CARE ASSOCIATION PROVIDES OTHER TECHNICAL ASSISTANCE TO COMMUNITY HEALTH CENTERS AND MIGRANT HEALTH PROGRAMS IN IOWA IN THE AREAS OF ADVOCACY AND POLICY, PROVIDER RECRUITMENT AND WORKFORCE DEVELOPMENT, HEALTH INFORMATION TECHNOLOGY, EXPANSION OF ORAL HEALTH SERVICES TO THE UNDERSERVED AND QUALITY AND PERFORMANCE IMPROVEMENT. IN ADDITION TO THE SERVICES PROVIDED TO COMMUNITY HEALTH CENTERS AND MIGRANT HEALTH PROGRAMS IN IOWA DESCRIBED PREVIOUSLY, IOWA PRIMARY CARE ASSOCIATION PROVIDES TECHNICAL, ADMINISTRATIVE AND/OR PROGRAMMATIC ASSISTANCE TO THE UNIVERSITY OF IOWA AND THE IOWA ASSOCIATION OF RURAL HEALTH CLINICS. |
| FORM 990, PART V, LINE 2A AND PART IX, LINES 5, 7, 8, 9, & 10 | COMMON PAYMASTER: IOWA PRIMARY CARE ASSOCIATION CONTRACTS WITH FOCUS ONESOURCE, A PROFESSIONAL EMPLOYER ORGANIZATION, TO FILE ALL EMPLOYEE PAYROLL TAXES AND W-3 FILINGS. THE SALARY EXPENSES, PAYROLL TAXES, PENSION EXPENSES, AND EMPLOYEE BENEFITS LISTED ON PART IX ARE PAID BY IOWA PRIMARY CARE ASSOCIATION AND ALLOCATED TO IN CONCERTCARE AND IOWA HEALTH CENTERS FOR ACCOUNTABILITY-WEST, LLC FOR THE EMPLOYEES THAT ARE WORKING ON THEIR RESPECTIVE PROGRAMS. THESE EXPENSES ARE REIMBURSED BY IN CONCERTCARE AND IOWA HEALTH CENTERS FOR ACCOUNTABILITY-WEST, LLC TO IOWA PRIMARY CARE ASSOCIATION AS PART OF THE MANAGEMENT AGREEMENT REFERENCED IN PART III, LINE 4A. |
| FORM 990, PART VI, SECTION B, LINE 6 & 7A | MEMBERS: THE ORGANIZATION HAS MEMBERS WHO PAY A FEE TO BELONG TO THE ASSOCIATION. THERE ARE THREE CATEGORIES OF MEMBERS WITHIN THE ASSOCIATION: DIRECTING MEMBERS, AFFILIATE MEMBERS AND ASSOCIATE MEMBERS. -DIRECTING MEMBERS ARE 14 FEDERALLY FUNDED COMMUNITY HEALTH CENTERS LOCATED IN THE STATE OF IOWA. AS DIRECTING MEMBERS, THESE ORGANIZATIONS AND THEIR SUCCESSORS WOULD BE ENTITLED TO ELECT THE BOARD OF DIRECTORS OF THE ORGANIZATION. -AFFILIATE MEMBERS INCLUDE ONE REPRESENTATIVE FROM THE CLINICAL COMPONENT OF THE ORGANIZATION AND ANY ASSOCIATION OR STATE DEPARTMENT INTERESTED IN PRIMARY CARE. AFFILIATE MEMBERS OR REPRESENTATIVES OF THESE ORGANIZATIONS ARE INVITED TO ATTEND AND PARTICIPATE IN ALL MEETINGS OF THE ASSOCIATION. BUT, THESE REPRESENTATIVES WOULD NOT HAVE VOTING PRIVILEGES ON MATTERS BROUGHT BEFORE THE ASSOCIATION. -ASSOCIATE MEMBERS INCLUDE HEALTH CLINICS OR INDIVIDUAL PROFESSIONALS ENGAGED OR INTERESTED IN PRIMARY HEALTH CARE. THESE REPRESENTATIVES WOULD NOT HAVE VOTING PRIVILEGES ON MATTERS BROUGHT BEFORE THE ASSOCIATION. -EACH MEMBER IS ENTITLED TO BE REPRESENTED BY ONE INDIVIDUAL AT ALL BOARD MEETINGS OF THE ASSOCIATION. EACH MEMBER SHALL SELECT ITS OWN REPRESENTATIVE BY WHATEVER METHOD IT DEEMS APPROPRIATE. EACH MEMBER SHALL SUBMIT TO THE SECRETARY THE NAME AND MAILING ADDRESS OF THE REPRESENTATIVE ON OR BEFORE DECEMBER 31 OF EACH YEAR OR WITHIN 30 DAYS OF REPRESENTATIVE. |
| FORM 990, PART VI, SECTION B, LINE 11B | 990 REVIEW PROCESS: 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. PRIOR TO BEING FILED, A DRAFT OF THE FORM 990 IS REVIEWED BY MANAGEMENT AND THE BOARD FINANCE COMMITTEE. THE PUBLIC DISCLOSURE COPY IS THEN PROVIDED TO THE FULL BOARD FOR REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: PER THE IOWA PRIMARY CARE ASSOCIATION CONFLICT OF INTEREST POLICY, THE IOWA PCA REQUIRES THAT ALL EMPLOYEES, AGENTS, OFFICERS, AND MEMBERS OF THE BOARD OF DIRECTORS AND CANDIDATES FOR BOARD MEMBERSHIP DISCLOSE IN WRITING (AND UPDATE AT LEAST ANNUALLY) ALL BUSINESS, CIVIC, COMMUNITY, BOARD, COMMITTEE, AND FAMILY RELATIONSHIPS WHICH MIGHT POTENTIALLY CREATE A CONFLICT OF INTEREST AND WHERE APPLICABLE, PROVIDE A STATEMENT SUGGESTING HOW SUCH CONFLICT COULD BE AVOIDED OR MITIGATED. TO COMPLY WITH THIS POLICY, THE IOWA PRIMARY CARE ASSOCIATION GATHERS FULL CONFLICT OF INTEREST QUESTIONNAIRES ANNUALLY FROM KEY EMPLOYEES AND BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION REVIEW POLICY: THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF IOWA PRIMARY CARE ASSOCIATION LAST REVIEWED THE COMPENSATION OF THE CEO IN JULY 2023 USING SALARY INFORMATION COMPILED BY THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC). THE CEO'S SALARY IS PAID BY IOWA PRIMARY CARE ASSOCIATION AND IS ALLOCATED TO IN CONCERTCARE BASED ON ACTUAL WORK PERFORMED. THE BOARD CHAIR RETAINS A FILE DOCUMENTING THE COMPENSATION REVIEW PROCESS. |
| FORM 990, PART VI, SECTION B, LINE 15B | OTHER OFFICER COMPENSATION REVIEW POLICY: THE CHIEF EXECUTIVE OFFICER REVIEWED AND APPROVED THE COMPENSATION OF THE CHIEF FINANCIAL OFFICER IN JULY 2023 USING SALARY INFORMATION COMPILED BY THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC). THE CHIEF EXECUTIVE OFFICER RETAINS A FILE DOCUMENTING THE COMPENSATION REVIEW PROCESS. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE AT THE ORGANIZATION OFFICES OR UPON REQUEST. |
| Software ID: | |
| Software Version: |