MALIHEH FREE CLINIC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MALIHEH FREE CLINIC (EIN 20-2313461)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-10-12
- IRS object ID
- 201602869349301500
- Schema version
- 2015v2.1
- 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 | 2016-10-12T17:09:06-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 5 TRIAD CENTER STE 600 | AddressLine1Txt |
| City | SALT LAKE CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 841801128 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | 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 | 415 EAST 3900 SOUTH | AddressLine1Txt |
| City | SALT LAKE CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84107 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR SCOTT BROWNING | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 8012663700 | PhoneNum |
| Signature | 2016-10-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARK C FURNISS CPA | PreparerPersonNm |
| PTIN | P00242966 | PTIN |
| Phone | 8015322200 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR SCOTT BROWNING | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 415 EAST 3900 SOUTH | AddressLine1Txt |
| City | SALT LAKE CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,281,681 | 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 | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 26 | TotalEmployeeCnt |
| Total Volunteers | 548 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $681,122 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,281,681 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $69,651 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$7,310 | PYOtherRevenueAmt |
| CY Other Revenue | -$5,910 | CYOtherRevenueAmt |
| PY Total Revenue | $743,463 | PYTotalRevenueAmt |
| CY Total Revenue | $1,275,771 | 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 | $454,660 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $585,858 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $26,055 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $29,271 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $71,339 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $203,225 | PYOtherExpensesAmt |
| CY Other Expenses | $212,528 | CYOtherExpensesAmt |
| PY Total Expenses | $683,940 | PYTotalExpensesAmt |
| CY Total Expenses | $827,657 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $59,523 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $448,114 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,610,874 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,025,089 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $58,882 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $55,295 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,551,992 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,969,794 | NetAssetsOrFundBalancesEOYAmt |
| Mission | MALIHEH FREE CLINIC SEEKS TO IMPROVE THE QUALITY OF LIFE IN THE GREATER SALT LAKE 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 | $693,773 | ExpenseAmt |
| Desc | MALIHEH FREE CLINIC PROVIDES FREE, QUALITY MEDICAL CARE TO UNINSURED AND LOW INCOME INDIVIDUALS AND FAMILIES IN THE GREATER SALT LAKE AREA. PATIENTS ARE ALL BELOW 150% OF FEDERAL POVERTY GUIDELINES AND ARE NOT ELIGIBLE FOR MEDICARE, MEDICAID, CHIP AND OTHER PROGRAMS. IN 2015, THE CLINIC PROVIDED NEARLY 19,000 MEDICAL APPOINTMENTS FOR 6,000 INDIVIDUALS IN NEED IN OUR COMMUNITY. THIS WAS ACCOMPLISHED WITH A SMALL CORE PAID STAFF AND THE SERVICES OF OVER 500 VOLUNTEERS WHO GAVE THEIR TIME AND TALENTS TO THOSE IN NEED. | Desc |
| Total Program Service Expenses | $693,773 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| 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 | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 26 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | 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 | 0 | 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 | Yes (1) | 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 | JEANIE ASHBY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8012663700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 415 EAST 3900 SOUTH | AddressLine1Txt |
| City | SALT LAKE CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84107 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| DR SCOTT BROWNING | ||||||
| PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ELAINE ELLIS | ||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DOUG WHITE ESQ | ||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KYM MCCLELLAND | ||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DR MANSOUR EMAM | ||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |
| SUE FERRY | ||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |
| GHAZALEH SEMNANI | ||||||
| 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 | |
| MIKELLE MOORE | ||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |
| JEANIE ASHBY | ||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $82,868 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $82,868 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $15,000 | FederatedCampaignsAmt |
| Fundraising | $89,865 | FundraisingAmt |
| Government Grants | $134,151 | GovernmentGrantsAmt |
| All Other Contributions | $1,042,665 | AllOtherContributionsAmt |
| Total Contributions | $1,281,681 | TotalContributionsAmt |
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $89,865 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $5,910 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,910 | TotalRevenueColumnAmt |
| Exclusion | -$5,910 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,275,771 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$5,910 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,868 | TotalAmt |
| Management And General | $41,434 | ManagementAndGeneralAmt |
| Fundraising | $41,434 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $460,271 | TotalAmt |
| Program Services | $457,592 | ProgramServicesAmt |
| Management And General | $2,679 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,719 | TotalAmt |
| Program Services | $42,470 | ProgramServicesAmt |
| Management And General | $249 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,750 | TotalAmt |
| Management And General | $7,750 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,271 | TotalAmt |
| Fundraising | $29,271 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,683 | TotalAmt |
| Program Services | $28,673 | ProgramServicesAmt |
| Management And General | $2,376 | ManagementAndGeneralAmt |
| Fundraising | $634 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,422 | TotalAmt |
| Program Services | $45,715 | ProgramServicesAmt |
| Management And General | $3,707 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,965 | TotalAmt |
| Program Services | $5,151 | ProgramServicesAmt |
| Management And General | $1,814 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $54,840 | $54,840 | |
| CANCER SCREENING | $24,777 | $24,777 | |
| MAINTENANCE | $18,063 | $16,708 | $1,355 |
| UTILITIES | $15,751 | $14,570 | $1,181 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,277 | TotalAmt |
| Program Services | $3,277 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $827,657 | TotalAmt |
| Program Services | $693,773 | ProgramServicesAmt |
| Management And General | $62,545 | ManagementAndGeneralAmt |
| Fundraising | $71,339 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,766 | BOYAmt |
| EOY | $198,391 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,500 | BOYAmt |
| EOY | $513,948 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,087,895 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $324,938 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $803,503 | BOYAmt |
| EOY | $762,957 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,580,105 | BOYAmt |
| EOY | $2,549,793 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,610,874 | BOYAmt |
| EOY | $4,025,089 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,882 | BOYAmt |
| EOY | $55,295 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,882 | BOYAmt |
| EOY | $55,295 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $358,124 | BOYAmt |
| EOY | $340,656 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,133,868 | BOYAmt |
| EOY | $1,119,138 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,060,000 | BOYAmt |
| EOY | $2,510,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,551,992 | BOYAmt |
| EOY | $3,969,794 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,610,874 | BOYAmt |
| EOY | $4,025,089 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $448,114 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$30,312 | 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 | $848,801 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $663,469 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $513,724 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $681,122 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,281,681 | CurrentTaxYearAmt |
| Total | $3,988,797 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $848,801 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $663,469 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $513,724 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $681,122 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,281,681 | CurrentTaxYearAmt |
| Total | $3,988,797 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,804,566 | SubstantialContributorsTotAmt |
| Public Support Total170 | $2,184,231 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,320 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $425 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $45,560 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $69,651 | CurrentTaxYearMinus1YearAmt |
| Total | $117,956 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,106,753 | TotalSupportAmt |
| Public Support CY170 | 0.53190 | PublicSupportCY170Pct |
| Public Support PY170 | 0.39920 | 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 | $2,580,105 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$30,312 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,549,793 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,407,318 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $172,787 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,580,105 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,074,008 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $333,310 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,407,318 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $373,583 | BeginningYearBalanceAmt |
| Contributions | $1,700,000 | ContributionsAmt |
| Investment Earnings Or Losses | $425 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,074,008 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.98440 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.01560 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $90,000 | OtherCostOrOtherBasisAmt |
| Book Value | $90,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $695,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $110,277 | DepreciationAmt |
| Book Value | $584,723 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $85,707 | OtherCostOrOtherBasisAmt |
| Depreciation | $64,746 | DepreciationAmt |
| Book Value | $20,961 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $217,188 | OtherCostOrOtherBasisAmt |
| Depreciation | $149,915 | DepreciationAmt |
| Book Value | $67,273 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $762,957 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $3,235,758 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$30,312 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $1,990,299 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $1,959,987 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,275,771 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,275,771 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,817,956 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $1,990,299 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $1,990,299 | ExpensesNotReportedAmt |
| Expenses Subtotal | $827,657 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $827,657 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE CLINIC IS ORGANIZED AS A UTAH NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3), QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A)(VI), AND HAS BEEN DETERMINED NOT TO BE A PRIVATE FOUNDATION UNDER SECTION 509(A)(1). THE CLINIC IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE CLINIC IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE CLINIC HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. 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. THE CLINIC'S FORMS 990 ARE NO LONGER SUBJECT TO TAX EXAMINATION FOR YEARS BEFORE 2011. | ExplanationTxt |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FRCI | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8 EAST BROADWAY | AddressLine1Txt |
| City | SLC | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84111 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | GRANT WRITING | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $24,000 | RetainedByContractorAmt |
| Net To Organization | -$24,000 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $24,000 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$24,000 | TotalNetToOrganizationAmt |
| Licensed States | UT | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $89,865 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $89,865 | CharitableContriEvent1Amt |
| Rent Facility Costs Event1 | $1,454 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $2,203 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,253 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $89,865 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $89,865 | CharitableContributionsTotAmt |
| Rent Fclty Costs Total Events | $1,454 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $2,203 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,253 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $5,910 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$5,910 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | KHOSROW SEMNANI AND GHAZALEH SEMNANI ARE HUSBAND AND WIFE. DOUGLAS WHITE IS EMPLOYED BY A COMPANY OWNED ANDOPERATED BY KHOSROW SEMNANI. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION WILL REVIEW THE FORM 990 WITH ALL BOARD MEMBERS AT ITS NEXT QUARTERLY MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS ADDRESSED ANNUALLY IN A QUARTERLY BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION IS DETERMINED LOOKING AT NATIONWIDE STATISTICS AND COMPARES WAGES WITH OTHER NON PROFITS. |
| 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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