MALIHEH FREE CLINIC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- MALIHEH FREE CLINIC (EIN 20-2313461)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-14
- IRS object ID
- 202333189349317858
- Schema version
- 2022v5.0
- 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 | 2023-11-14T18:09:56-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5929 Fashion Point Dr Ste 300 | AddressLine1Txt |
| City | Ogden | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 844034684 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202313461 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Maliheh Free Clinic | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MALI | BusinessNameControlTxt |
| Phone | 8012663700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 941 E 3300 S | AddressLine1Txt |
| City | Salt Lake City | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84106 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Elaine Ellis | PersonNm |
| Person Title | Board Chair | PersonTitleTxt |
| Phone | 8012663700 | PhoneNum |
| Signature | 2023-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Elaine | PersonFirstNm |
| Person Last | Ellis | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Chett Campbell CPA | PreparerPersonNm |
| PTIN | P01301037 | PTIN |
| Phone | 8016211575 | PhoneNum |
| Preparation | 2023-11-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Elaine Ellis | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 941 E 3300 S | AddressLine1Txt |
| City | Salt Lake City | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84106 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,286,532 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.malihehfreeclinic.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | UT | LegalDomicileStateCd |
| Activity Or Mission | Provide free quality medical services to uninsured and low-income individuals and families. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 29 | TotalEmployeeCnt |
| Total Volunteers | 910 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,373,736 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,160,736 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $236,623 | PYInvestmentIncomeAmt |
| CY Investment Income | $124,550 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $1,246 | CYOtherRevenueAmt |
| PY Total Revenue | $1,610,359 | PYTotalRevenueAmt |
| CY Total Revenue | $1,286,532 | 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 | $847,400 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $841,484 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $16,178 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $1,377 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $51,699 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $374,961 | PYOtherExpensesAmt |
| CY Other Expenses | $448,727 | CYOtherExpensesAmt |
| PY Total Expenses | $1,238,539 | PYTotalExpensesAmt |
| CY Total Expenses | $1,291,588 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $371,820 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,056 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,000,851 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,709,882 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $30,718 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $44,453 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,970,133 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,665,429 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Maliheh Free Clinic seeks to improve the quality of life in the greater Salt Lake City area by providing free, quality medical services for uninsured and low income individuals and families to help reverse the cycle of poverty and suffering created by poor health. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,120,317 | ExpenseAmt |
| Desc | Maliheh Free Clinic provides free, quality medical care to uninsured and low-income individuals and families in the greater Salt Lake City area. Patients are all living below 250% of the federal poverty guidelines and are not eligible for Medicare, Medicaid, CHIP and other programs. In 2022, the clinic had 15,327 appointments with 5,122 individuals in need of medical care in our community. This was accomplished with a small core paid staff and the services of 910 active volunteers who provided over 28,219 volunteer hours of service. | Desc |
| Total Program Service Expenses | $1,120,317 | 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 | Yes (1) | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | 0 | 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 | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 29 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | UT | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Organization | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8012663700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 941 East 3300 South | AddressLine1Txt |
| City | Millcreek | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84106 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 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 |
|---|---|---|---|---|---|---|---|
| Elaine Ellis | |||||||
| Chairman | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Ghazaleh Semnani | |||||||
| Vice Chair | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Doug White Esq | |||||||
| Secretary | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Taymour Semnani | |||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Adan Batar | |||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Khosrow Semnani | |||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Dr David Sundwall | |||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Dr Karen Miller | |||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Lisa Nichols | |||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Mansoor Emam | |||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| David Miner | |||||||
| Medical Director | 40.00 | Yes (X) | $217,616 | $0 | $28,120 | ||
| Mary Ann Lucero | |||||||
| Executive Director - Resigned 2/22 | 40.00 | Yes (X) | $14,672 | $0 | $1,770 | ||
| Brenda Spearman | |||||||
| Executive Director | 40.00 | Yes (X) | $27,700 | $0 | $831 | ||
| Uaisele Panisi | |||||||
| Physician Assistant | 40.00 | $101,020 | $0 | $15,994 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $361,008 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $46,715 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $270,517 | GovernmentGrantsAmt |
| All Other Contributions | $890,219 | AllOtherContributionsAmt |
| Noncash Contributions | $4,000 | NoncashContributionsAmt |
| Total Contributions | $1,160,736 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $117,815 | TotalRevenueColumnAmt |
| Exclusion | $117,815 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,735 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,735 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,735 | TotalRevenueColumnAmt |
| Exclusion | $6,735 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Other Revenue | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,246 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,246 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,246 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,286,532 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,246 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $124,550 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,847 | TotalAmt |
| Program Services | $256,045 | ProgramServicesAmt |
| Management And General | $22,943 | ManagementAndGeneralAmt |
| Fundraising | $11,859 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469,068 | TotalAmt |
| Program Services | $436,003 | ProgramServicesAmt |
| Management And General | $1,037 | ManagementAndGeneralAmt |
| Fundraising | $32,028 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,527 | TotalAmt |
| Program Services | $6,996 | ProgramServicesAmt |
| Management And General | $17 | ManagementAndGeneralAmt |
| Fundraising | $514 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,534 | TotalAmt |
| Program Services | $16,298 | ProgramServicesAmt |
| Management And General | $39 | ManagementAndGeneralAmt |
| Fundraising | $1,197 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,508 | TotalAmt |
| Program Services | $52,525 | ProgramServicesAmt |
| Management And General | $125 | ManagementAndGeneralAmt |
| Fundraising | $3,858 | FundraisingAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,377 | TotalAmt |
| Fundraising | $1,377 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,600 | TotalAmt |
| Management And General | $68,600 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,315 | TotalAmt |
| Program Services | $39,200 | ProgramServicesAmt |
| Management And General | $3,249 | ManagementAndGeneralAmt |
| Fundraising | $866 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,581 | TotalAmt |
| Program Services | $216,987 | ProgramServicesAmt |
| Management And General | $17,594 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,310 | TotalAmt |
| Program Services | $5,698 | ProgramServicesAmt |
| Management And General | $1,612 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $35,181 | $35,181 | |
| Utilities | $32,493 | $30,056 | $2,437 |
| Maintenance | $25,588 | $23,669 | $1,919 |
| Medicine | $1,659 | $1,659 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,291,588 | TotalAmt |
| Program Services | $1,120,317 | ProgramServicesAmt |
| Management And General | $119,572 | ManagementAndGeneralAmt |
| Fundraising | $51,699 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $686,113 | BOYAmt |
| EOY | $713,500 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,014 | BOYAmt |
| EOY | $27,259 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,899 | BOYAmt |
| EOY | $64,233 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,401 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,288,953 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,087,326 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $409,693 | BOYAmt |
| EOY | $201,627 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,876,132 | BOYAmt |
| EOY | $5,700,862 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,000,851 | BOYAmt |
| EOY | $6,709,882 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,718 | BOYAmt |
| EOY | $44,453 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,718 | BOYAmt |
| EOY | $44,453 | 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 | $861,680 | BOYAmt |
| EOY | $712,902 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,108,453 | BOYAmt |
| EOY | $5,952,527 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,970,133 | BOYAmt |
| EOY | $6,665,429 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,000,851 | BOYAmt |
| EOY | $6,709,882 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$5,056 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,299,648 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,631,047 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,173,342 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,042,731 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,373,736 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,160,736 | CurrentTaxYearAmt |
| Total | $6,381,592 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,631,047 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,173,342 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,042,731 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,373,736 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,160,736 | CurrentTaxYearAmt |
| Total | $6,381,592 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $904,208 | SubstantialContributorsTotAmt |
| Public Support Total170 | $5,477,384 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $104,531 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $118,885 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $97,666 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $124,553 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $117,815 | CurrentTaxYearAmt |
| Total | $563,450 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $6,945,042 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $1,246 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.78870 | PublicSupportCY170Pct |
| Public Support PY170 | 0.70870 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,876,132 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$1,175,270 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $5,700,862 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,013,153 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $862,979 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $6,876,132 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,208,281 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $804,872 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $6,013,153 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,229,890 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $978,391 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $5,208,281 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,543,344 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$313,454 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,229,890 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.53501 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.46499 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $985,893 | OtherCostOrOtherBasisAmt |
| Depreciation | $880,507 | DepreciationAmt |
| Book Value | $105,386 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $303,060 | OtherCostOrOtherBasisAmt |
| Depreciation | $206,819 | DepreciationAmt |
| Book Value | $96,241 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $201,627 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,980,109 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$1,299,648 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $2,993,225 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $1,693,577 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,286,532 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,286,532 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,284,813 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $2,993,225 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $2,993,225 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,291,588 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,291,588 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Clinic believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Clinic would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | David Miner | PersonNm |
| Title | Medical Director | TitleTxt |
| Base Compensation Filing Org | $217,616 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $6,618 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $21,598 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $245,832 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 3 | FormAndLineReferenceDesc |
| Explanation | Compensation is determined looking at nationwide statistics and compares wages with other non-profit organizations, locally and nationally. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1a | The executive committee has authority to act on behalf of the governing body. |
| Form 990, Part VI, Section A, line 2 | Khosrow, Ghazaleh and Taymour Semnani have a family relationship. Douglas White is employed by a company owned and operated by Khosrow Semnani. |
| Form 990, Part VI, Section B, line 11b | The Organization will review the Form 990 with all board members at its next quarterly meeting. |
| Form 990, Part VI, Section B, line 12c | All board members sign a conflict of interest statement annually. The conflict of interest policy is addressed annually in a quarterly board meeting. |
| Form 990, Part VI, Section B, line 15a | The board of directors approves the officer compensation by performing a local review of positions for simliar sized orgnaizations on an annual basis. |
| Form 990, Part VI, Section C, line 19 | All governing documents, conflict of interest policy and financial statements are available from the Executive Director, as requested. |
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