TUOLUMNE ME-WUK INDIAN HEALTH CENTER INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- TUOLUMNE ME-WUK INDIAN HEALTH CENTER INC (EIN 25-1902459)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-13
- IRS object ID
- 202403189349306045
- Schema version
- 2023v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-13T12:45:39-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4747 EXECUTIVE DR SUITE 1300 | AddressLine1Txt |
| City | SAN DIEGO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92121 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251902459 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TUOLUMNE ME-WUK INDIAN HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TUOL | BusinessNameControlTxt |
| Phone | 2099285400 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18880 CHERRY VALLEY BOULEVARD | AddressLine1Txt |
| City | TUOLUMNE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95379 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JANET PEPPER | PersonNm |
| Person Title | CHIEF ADMINISTRATIVE OFFICER | PersonTitleTxt |
| Phone | 2099285400 | PhoneNum |
| Signature | 2024-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PATRICIA J MAYER | PreparerPersonNm |
| PTIN | P00188643 | PTIN |
| Phone | 8586271400 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JANET PEPPER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18880 CHERRY VALLEY BOULEVARD | AddressLine1Txt |
| City | TUOLUMNE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95379 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,521,346 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | TMWIHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O.TO PROVIDE HIGH QUALITY, COMPREHENSIVE, PRIMARY HEALTH CARE FOR THE TUOLUMNE ME-WUK TRIBAL MEMBERS, OTHER NATIVE AMERICANS, AND RESIDENTS OF SURROUNDING COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 167 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,373,251 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,943,179 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,647,057 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,537,539 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$53,263 | PYInvestmentIncomeAmt |
| CY Investment Income | $31,735 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,158 | PYOtherRevenueAmt |
| CY Other Revenue | $8,893 | CYOtherRevenueAmt |
| PY Total Revenue | $19,972,203 | PYTotalRevenueAmt |
| CY Total Revenue | $22,521,346 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,916,413 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,173,924 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,193,946 | PYOtherExpensesAmt |
| CY Other Expenses | $8,087,039 | CYOtherExpensesAmt |
| PY Total Expenses | $18,110,359 | PYTotalExpensesAmt |
| CY Total Expenses | $21,260,963 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,861,844 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,260,383 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,083,146 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,972,834 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,811,730 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,538,173 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,271,416 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,434,661 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF THE TUOLUMNE ME WUK INDIAN HEALTH CENTER, INC. IS TO PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES TO THE TUOLUMNE BAND OF THE ME-WUK INDIANS, OTHER NATIVE AMERICANS, AND ALL OTHER RESIDENTS OF OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,311,005 | ExpenseAmt |
| Revenue | $7,505,721 | RevenueAmt |
| Desc | THE OUTPATIENT MEDICAL CENTER AT OUR COMMUNITY HEALTH CENTERS ARE OPEN AND AVAILABLE MONDAY THROUGH FRIDAY, FROM 8AM TO 5PM. THE HEALTH CENTERS PROVIDE ALL THE SERVICES OF A FAMILY MEDICAL PRACTICE AS WELL AS BEHAVIORAL HEALTH SERVICES. THE CENTERS PROVIDE CARE ACCESS TO THE TUOLUMNE BAND OF THE ME-WUK INDIANS OF THE TUOLUMNE RESERVATION, TO ALL OTHER NATIVE AMERICANS, AND TO ALL OTHER RESIDENTS OF THE COUNTY OF TUOLUMNE AND SURROUNDING AREAS. ALL OF THESE ARE MEDICALLY UNDER-SERVED AREAS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,809,850 | ExpenseAmt |
| Revenue | $6,214,862 | RevenueAmt |
| Desc | OUR DENTAL CENTER IS OPEN AND AVAILABLE MONDAY THROUGH FRIDAY, FROM 8AM TO 5PM. IT PROVIDES DENTAL CARE TO THE TUOLUMNE BAND OF ME-WUK INDIANS OF THE TUOLUMNE RESERVATION, TO ALL OTHER NATIVE AMERICANS, AND TO ALL RESIDENTS OF THE COUNTY OF TUOLUMNE AND SURROUNDING AREAS. ALL OF THESE ARE MEDICALLY UNDER-SERVED AREAS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,238,825 | ExpenseAmt |
| Revenue | $2,801,598 | RevenueAmt |
| Desc | OUR BEHAVIORAL HEALTH AND COUNSELING CENTER IS OPEN AND AVAILABLE MONDAY THROUGH FRIDAY, FROM 8AM TO 5PM. IT PROVIDES BEHAVIORAL HEALTH AND COUNSELING SERVICES TO THE TUOLUMNE BAND OF ME-WUK INDIANS OF THE TUOLUMNE RESERVATION, TO ALL OTHER NATIVE AMERICANS, AND TO ALL RESIDENTS OF THE COUNTY OF TUOLUMNE AND SURROUNDING AREAS. ALL OF THESE ARE MEDICALLY UNDER-SERVED AREAS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,595,724 | ExpenseAmt |
| Revenue | $3,015,358 | RevenueAmt |
| Desc | THE MISSION OF THE TUOLUMNE ME WUK INDIAN HEALTH CENTER, INC. IS TO OPERATE STATE LICENSED, FAMILY PRACTICE COMMUNITY HEALTH CENTERS THAT WILL PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES FOR NATIVE AMERICANS AND ALL OTHER MEMBERS OF THE COUNTY OF TUOLUMNE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,595,724 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $3,015,358 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $13,955,404 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 160 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 167 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHANNON RODGERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2092064740 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 MONO WAY | AddressLine1Txt |
| City | SONORA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95370 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| RENEE WESSELL | |||||||
| CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $4,800 | $0 | $0 | |
| JANELL LAVELL-BUNCH | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $4,800 | $0 | $0 | ||
| RHIANNON HENDRICKS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $4,800 | $0 | $0 | ||
| CARLOS GEISDORFF | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $4,800 | $0 | $0 | ||
| AUDREY GOWER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $4,800 | $0 | $0 | ||
| BRADY DAY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $4,000 | $0 | $0 | ||
| TY DAY | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $4,800 | $0 | $0 | |
| LAURA FORDE | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $4,800 | $0 | $0 | |
| LECIA SCOTFORD | |||||||
| CAO (THRU 8/4/23) | 40.00 | Yes (X) | $293,844 | $0 | $25,297 | ||
| LYNDON PETERS | |||||||
| COMPLIANCE OFFICER (THRU 1/6/23) | 40.00 | Yes (X) | $16,256 | $0 | $5,284 | ||
| GARY HALE | |||||||
| CFO (THRU 2/7/23) | 40.00 | Yes (X) | $37,356 | $0 | $3,039 | ||
| JANET PEPPER | |||||||
| CHIEF ADMIN OFFICER (FROM 9/1/23) | 40.00 | Yes (X) | $184,874 | $0 | $8,083 | ||
| SHANNON RODGERS | |||||||
| CFO (FROM 11/30/23) | 40.00 | Yes (X) | $131,278 | $0 | $29,649 | ||
| JAFEH ASKPE | |||||||
| COMPLIANCE OFFICER (THRU 10/23/23) | 40.00 | Yes (X) | $40,875 | $0 | $0 | ||
| JOHN NADONE | |||||||
| CFO (3/27/23-8/31/23) | 40.00 | Yes (X) | $82,908 | $0 | $11,295 | ||
| ERICA VEGA | |||||||
| PSYCHIATRIST | 40.00 | $313,215 | $0 | $36,862 | Yes (X) | ||
| SHAYNA YOUNG | |||||||
| MEDICAL DIRECTOR | 40.00 | $337,155 | $0 | $36,784 | Yes (X) | ||
| FELIX CONTE | |||||||
| PEDIATRICIAN | 40.00 | $297,535 | $0 | $36,645 | Yes (X) | ||
| HOANG NGUYEN | |||||||
| DENTAL DIRECTOR | 40.00 | $236,548 | $0 | $25,654 | Yes (X) | ||
| REBECCA VIERRA-BRICK | |||||||
| FAMILY NURSE PRACTITIONER | 40.00 | $176,009 | $0 | $7,324 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,185,453 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $225,916 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PROVIDER HEALTHCARE LLC | |||||
| 2455 EAST PARLEYS WAY STE 310 | SALT LAKE CITY | UT | 84109 | LOCUMS | $800,935 |
| MOSS ADAMS LLP | |||||
| PO BOX 101822 | PASADENA | CA | 911891822 | AUDITING | $279,660 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $416,762 | RelatedOrganizationsAmt |
| Government Grants | $2,293,425 | GovernmentGrantsAmt |
| All Other Contributions | $232,992 | AllOtherContributionsAmt |
| Total Contributions | $2,943,179 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621400 | $7,505,721 | $7,505,721 |
| DENTAL SERVICES | 621300 | $6,214,862 | $6,214,862 |
| OTHER MISC PROGRAM REV | 900099 | $3,015,358 | $3,015,358 |
| HEALTH & COUNSELING SERVICES | 621300 | $2,801,598 | $2,801,598 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,537,539 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,735 | TotalRevenueColumnAmt |
| Exclusion | $31,735 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,893 | TotalRevenueColumnAmt |
| Exclusion | $8,893 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $8,893 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,521,346 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,537,539 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $40,628 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $907,637 | TotalAmt |
| Program Services | $516,153 | ProgramServicesAmt |
| Management And General | $391,484 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,752,059 | TotalAmt |
| Program Services | $7,236,563 | ProgramServicesAmt |
| Management And General | $2,515,496 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,790 | TotalAmt |
| Program Services | $179,875 | ProgramServicesAmt |
| Management And General | $76,915 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,298,479 | TotalAmt |
| Program Services | $907,298 | ProgramServicesAmt |
| Management And General | $391,181 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $958,959 | TotalAmt |
| Program Services | $673,214 | ProgramServicesAmt |
| Management And General | $285,745 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,621 | TotalAmt |
| Management And General | $16,621 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,660 | TotalAmt |
| Management And General | $279,660 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,144,372 | TotalAmt |
| Program Services | $1,144,372 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,539 | TotalAmt |
| Management And General | $98,539 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $695,316 | TotalAmt |
| Program Services | $20,417 | ProgramServicesAmt |
| Management And General | $674,899 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243,138 | TotalAmt |
| Program Services | $18,063 | ProgramServicesAmt |
| Management And General | $225,075 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $401,473 | TotalAmt |
| Program Services | $3,802 | ProgramServicesAmt |
| Management And General | $397,671 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,518 | TotalAmt |
| Program Services | $23,139 | ProgramServicesAmt |
| Management And General | $52,379 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,476 | TotalAmt |
| Program Services | $28,143 | ProgramServicesAmt |
| Management And General | $41,333 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,687 | TotalAmt |
| Management And General | $195,687 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $740,263 | TotalAmt |
| Management And General | $740,263 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,796 | TotalAmt |
| Program Services | $555 | ProgramServicesAmt |
| Management And General | $168,241 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHARMACEUTICALS | $2,147,765 | $2,147,765 | |
| SPECIAL HEALTHCARE FUND | $416,762 | $416,762 | |
| PROGRAM MATERIALS & SUP | $409,486 | $398,665 | $10,821 |
| DUES, MEMBERSHIP, SUBSC | $199,547 | $19,946 | $179,601 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $784,620 | TotalAmt |
| Program Services | $220,672 | ProgramServicesAmt |
| Management And General | $563,948 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,260,963 | TotalAmt |
| Program Services | $13,955,404 | ProgramServicesAmt |
| Management And General | $7,305,559 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,021,398 | BOYAmt |
| EOY | $1,968,466 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,807 | BOYAmt |
| EOY | $7,020,124 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,553,217 | BOYAmt |
| EOY | $2,237,374 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $262,454 | BOYAmt |
| EOY | $396,460 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,067 | BOYAmt |
| EOY | $112,056 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,580,803 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,638,556 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,648,783 | BOYAmt |
| EOY | $5,942,247 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $501,420 | BOYAmt |
| EOY | $296,107 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,083,146 | BOYAmt |
| EOY | $17,972,834 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,255,986 | BOYAmt |
| EOY | $1,454,102 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $442,977 | BOYAmt |
| EOY | $590,169 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,639,584 | BOYAmt |
| EOY | $2,523,067 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $473,183 | BOYAmt |
| EOY | $970,835 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,811,730 | BOYAmt |
| EOY | $5,538,173 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,735,400 | BOYAmt |
| EOY | $9,986,316 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,536,016 | BOYAmt |
| EOY | $2,448,345 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,271,416 | BOYAmt |
| EOY | $12,434,661 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,083,146 | BOYAmt |
| EOY | $17,972,834 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,260,383 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $48,375 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$15,805 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $870,292 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,663,188 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,342,753 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,121,383 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,373,251 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,943,179 | CurrentTaxYearAmt |
| Total | $17,443,754 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,169,908 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,473,959 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $15,483,495 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $17,647,057 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,537,539 | CurrentTaxYearAmt |
| Total | $75,311,958 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,833,096 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,816,712 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $19,604,878 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $20,020,308 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $22,480,718 | CurrentTaxYearAmt |
| Total | $92,755,712 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $92,755,712 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,049 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,746 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $31,735 | CurrentTaxYearAmt |
| Total | $47,532 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,049 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,746 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $31,735 | CurrentTaxYearAmt |
| Total | $47,532 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $5,158 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,893 | CurrentTaxYearAmt |
| Total | $14,051 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,846,145 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,819,458 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $19,604,880 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $20,025,466 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $22,521,346 | CurrentTaxYearAmt |
| Total | $92,817,295 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99930 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99970 | PublicSupportPY509Pct |
| Investment Income CY | 0.00050 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00020 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISC INCOME - 2022 AMOUNT: $ 5,158. 2023 AMOUNT: $ 8,893. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,122,329 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,500,501 | DepreciationAmt |
| Book Value | $4,621,828 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $630,963 | OtherCostOrOtherBasisAmt |
| Depreciation | $436,752 | DepreciationAmt |
| Book Value | $194,211 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $963,319 | OtherCostOrOtherBasisAmt |
| Depreciation | $760,044 | DepreciationAmt |
| Book Value | $203,275 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,864,192 | OtherCostOrOtherBasisAmt |
| Depreciation | $941,259 | DepreciationAmt |
| Book Value | $922,933 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,942,247 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| SUBSCRIPTION LIABILITY | $673,395 |
| LEASE LIABILITY | $297,440 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $970,835 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $23,440,013 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $48,375 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $870,292 | OtherRevenueAmt |
| Revenue Not Reported | $918,667 | RevenueNotReportedAmt |
| Revenue Subtotal | $22,521,346 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $22,521,346 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $21,260,963 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $21,260,963 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $21,260,963 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART XI, LINE 2D - OTHER ADJUSTMENTS: | FormAndLineReferenceDesc |
| Explanation | EMPLOYEE RENTENTION TAX CREDIT 870,292. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHAYNA YOUNG | ||||||||||||||
| MEDICAL DIRECTOR | $335,655 | $0 | $1,500 | $0 | $0 | $0 | $12,600 | $0 | $24,184 | $0 | $373,939 | $0 | $0 | $0 |
| ERICA VEGA | ||||||||||||||
| PSYCHIATRIST | $311,715 | $0 | $1,500 | $0 | $0 | $0 | $12,646 | $0 | $24,216 | $0 | $350,077 | $0 | $0 | $0 |
| FELIX CONTE | ||||||||||||||
| PEDIATRICIAN | $296,035 | $0 | $1,500 | $0 | $0 | $0 | $12,333 | $0 | $24,312 | $0 | $334,180 | $0 | $0 | $0 |
| LECIA SCOTFORD | ||||||||||||||
| CAO (THRU 8/4/23) | $205,782 | $0 | $0 | $0 | $88,062 | $0 | $10,374 | $0 | $14,923 | $0 | $319,141 | $0 | $0 | $0 |
| HOANG NGUYEN | ||||||||||||||
| DENTAL DIRECTOR | $229,048 | $0 | $7,500 | $0 | $0 | $0 | $6,952 | $0 | $18,702 | $0 | $262,202 | $0 | $0 | $0 |
| JANET PEPPER | ||||||||||||||
| CHIEF ADMIN OFFICER (FROM 9/1/23) | $183,374 | $0 | $1,500 | $0 | $0 | $0 | $7,242 | $0 | $841 | $0 | $192,957 | $0 | $0 | $0 |
| REBECCA VIERRA-BRICK | ||||||||||||||
| FAMILY NURSE PRACTITIONER | $174,509 | $0 | $1,500 | $0 | $0 | $0 | $6,859 | $0 | $465 | $0 | $183,333 | $0 | $0 | $0 |
| SHANNON RODGERS | ||||||||||||||
| CFO (FROM 11/30/23) | $129,778 | $0 | $1,500 | $0 | $0 | $0 | $5,466 | $0 | $24,183 | $0 | $160,927 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | SALARIES OF OFFICERS AND KEY EMPLOYEES ARE DETERMINED BY CONDUCTING SALARY SURVEYS, OBTAINING STATISTICAL SALARY INFORMATION ABOUT EACH POSITION, DUTIES PERFORMED, AND GEOGRAPHICAL REGION OF ORGANIZATION. ALL SALARIES ARE APPROVED BY THE BOARD OF DIRECTORS USING ALL AVAILABLE INFORMATION. |
| PART I, LINE 4A | LECIA SCOTFORD RECEIVED A SEVERANCE PAYMENT DURING 2023 IN THE AMOUNT OF $88,062. |
| PART I, LINE 7 | SOME INDIVIDUALS REPORTED ON PART VII RECEIVED DISCRETIONARY BONUSES IN 2023. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A COMPLETE COPY OF THE 990 WAS PROVIDED TO THE FULL BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | COMPLIANCE OFFICER, CHIEF FINANCIAL OFFICER AND FINANCE CONTROLLER REVIEW CONTRACTS, VENDORS, AND PAYMENTS FOR POTENTIAL CONFLICTS OF INTEREST AND ENFORCE POLICY. IF A CONFLICT ARISES, BOARD MEMBERS WITH A CONFLICT ARE NOT ALLOWED TO VOTE ON THE TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | SALARIES OF OFFICERS AND KEY EMPLOYEES ARE DETERMINED BY CONDUCTING SALARY SURVEYS, OBTAINING STATISTICAL SALARY INFORMATION ABOUT EACH POSITION, DUTIES PERFORMED, AND GEOGRAPHICAL REGION OF ORGANIZATION. ALL SALARIES ARE APPROVED BY THE BOARD OF DIRECTORS USING ALL AVAILABLE INFORMATION. THE PROCESS IS DOCUMENTED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE AT ITS OFFICES. |
| FORM 990, PART XI, LINE 9: | EMPLOYEE RETENTION TAX CREDIT 870,292. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TUOLUMNE BAND OF ME-WUK INDIANS OF THE TUOLUMNE RANCHERIA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19595 MI WU STREET | AddressLine1Txt |
| City | TUOLUMNE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95379 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770121021 | EIN |
| Primary Activities | TO PROMOTE THE HEALTH, SAFETY AND WELFARE OF THE INDIAN PEOPLE | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Exempt Code Section | GOVT | ExemptCodeSectionTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments