Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 4,058,784 | 6,106,897 | 3,166,039 | 3,383,238 | 3,502,938 | 20,217,896 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | 4,058,784 | 6,106,897 | 3,166,039 | 3,383,238 | 3,502,938 | 20,217,896 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | 20,217,896 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 4,058,784 | 6,106,897 | 3,166,039 | 3,383,238 | 3,502,938 | 20,217,896 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 3,858 | 2,711 | 3,025 | 2,796 | 2,627 | 15,017 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | 20,232,913 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | HEALTH CARE FOR MIGRANT WORKERS |
| FORM 990, PAGE 6, PART VI, LINE 11B | PROVIDE COPY TO ORGANIZATION FOR BOARD MEMBERS TO REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 12C | POLICY OF ORGANIZATION IS TO REVIEW COMPLIANCE WITH NEW DIRECTORS, OFFICERS, AND KEY EMPLOYEES. |
| FORM 990, PAGE 6, PART VI, LINE 15A | BOARD OF DIRECTORS PERFORM EVALUATIONS AND DETERMINE COMPENSATION. |
| FORM 990, PAGE 6, PART VI, LINE 19 | COPIES AVAILABLE FOR PUBLIC AND PAYETTE, ID ADMINISTRITIVE OFFICES. |
| FORM 990, PART IX, LINE 24E | PATIENT STATEMENT FEES 61,042 0 0 SUPPLIES - MEDICAL 55,922 0 0 SUPPLIES - LAB 52,791 0 0 INJECTIBLES - MEDICAL 42,596 0 0 UTILITIES 24,262 6,473 0 MAINTENANCE AGREEMENTS - 27,810 0 0 TELEPHONE 15,778 8,740 0 PROFESSIONAL DUES/FEES/SU 24,416 0 0 UTILITIES - FACILITIY 23,916 0 0 AUDIT - ADMIN 0 23,445 0 CME 23,428 0 0 TELEPHONE - FACILITY 22,492 0 0 OFFICE PRODUCTS 21,395 0 0 MAINT/REPAIR - ADMIN FAC 0 19,973 0 MAINTENANCE & REPAIRS 19,915 0 0 OFFICE SUPPLIES - ADMIN 0 19,394 0 UTILITIES - FACILITY 19,176 0 0 INSURANCE - FACILITY 16,411 0 0 LAB 16,145 0 0 BANK FEES 15,931 0 0 FACILITY REPAIRS/MAINT - 15,466 0 0 340B PROCESSING COSTS 14,987 0 0 FACILITY - REPAIRS AND MA 14,772 0 0 INJECTIBLES - VALE 13,810 0 0 CME - MEDICAL 13,681 0 0 MAINTENANCE/REPAIRS - FAC 13,110 0 0 SUPPLIES - INJECTABLES 12,759 0 0 PAYROLL PROCESSING FEES 0 12,600 0 POSTAGE 9,966 2,531 0 OFFICE SUPPLIES 12,303 0 0 LAB SUPPLIES - VALE 12,014 0 0 ORGANIZATIONAL DUES 0 11,733 0 EQUIPMENT - FACILITY 560 10,472 0 UTILITIES - TOTAL 10,934 0 0 PRINTING/COPYING - MEDICA 10,920 0 0 INJECTIBLES 10,307 0 0 UTILITIES - VALE 9,640 0 0 MEDICAL SUPPLIES - VALE 9,550 0 0 CONTRACT MEDICAL 9,375 0 0 OFFICE PRODUCTS - TOTAL 8,990 0 0 TELEPHONE - NYSSA 8,868 0 0 INJECTIBLES - NYSSA 8,716 0 0 MEDICAL SUPPLIES - NYSSA 8,693 0 0 COMPUTER FEES - DENTAL 8,156 0 0 UTILITIES - NYSSA 7,942 0 0 CAPITAL OUTLAY 7,623 0 0 LAB SUPPLIES - NYSSA 7,436 0 0 EQUIP - ADMIN 0 7,231 0 INS/BOARD BONDING 0 7,217 0 EQUIPMENT - ADMIN - NYSSA 7,108 0 0 OFFICE PRODUCTS - NYSSA 7,090 0 0 CONTINUING MEDICAL EDUCAT 7,033 0 0 OFFICE PRODUCTS - VALE 6,603 0 0 PROFESSIONAL FEES/DUES/SU 6,366 0 0 SUPPLIES - FACILITY 6,275 0 0 CONTINUING EDUCATION - VA 6,198 0 0 TELEPHONE - VALE 6,064 0 0 UTILITIES - DENTAL FACILI 5,151 0 0 EQUIPMENT - ADMIN 4,446 0 0 EQUIPMENT - ADMINISTRATIO 4,446 0 0 AUTO MAINT. ADMIN 0 4,386 0 MAINT/REPAIR - FACILITY 4,353 0 0 COMPUTER/IT SUPPORT 0 4,004 0 MAINT/REPAIR - DENTAL FAC 3,693 0 0 MAINTENANCE/REPAIR - ONT 3,500 0 0 CONTINUING EDUCATION - NY 3,420 0 0 FACILITY INSURANCE - ADMI 0 3,400 0 OFFICE SUPPLIES - DENTAL 3,076 0 0 TELEPHONE - DENTAL FACILI 3,060 0 0 LEGAL FEES 0 2,904 0 INSURANCE-DENTAL ACTIVITY 2,810 0 0 DUES/FEES/SUBSCRIPTIONS 2,519 0 0 INSURANCE FACILITY - VALE 2,504 0 0 CONFERENCES/WORKSHOPS 0 2,285 0 OTHER - COMMUNITY SERVICE 2,121 0 0 CME - DENTAL 2,048 0 0 POSTAGE - VALE 2,040 0 0 LAB EXPENSES - DENTAL 2,036 0 0 FACILITY SUPPLIES - NYSSA 1,959 0 0 R & R 1,898 0 0 POSTAGE - NYSSA 1,800 0 0 INSURANCE FACILITY - NYSS 1,793 0 0 FACILITY SUPPLIES 1,712 0 0 MEDICAL - PRINTING/COPYIN 1,712 0 0 FACILITY SUPPLIES - VALE 1,667 0 0 DUES/FEES/SUB - DENTAL 1,559 0 0 PROF DUES/SUBSCRIPTIONS 1,501 0 0 EQUIPMENT - ADMIN - VALE 1,482 0 0 EQUIPMENT 1,482 0 0 BANK S/C 1,476 0 0 PRINTING & COPYING 1,328 0 0 COMMUNITY SERVICE PROMOTI 1,242 0 0 CONTRACT - MEDICAL 1,210 0 0 AUTO MAINT/REPAIRS/INS 1,187 0 0 OTHER - ADMIN 0 1,183 0 POSTAGE - TOTAL 1,160 0 0 PRINT/COPYING - ADMIN 0 1,085 0 ANSWERING SERVICE 1,076 0 0 SUPPLIES - COMMUNITY SERV 1,007 0 0 JOB ANNOUNCEMENTS 675 157 0 MAINTENANCE AGREE - ADMIN 813 0 0 CONTRACT-MEDICAL-NYSSA 746 0 0 CONTRACT - DENTAL 742 0 0 CONFERENCE/WORKSHOPS 732 0 0 PRINTING/COPYING 652 0 0 MAINT AGREE - ADMIN 0 644 0 MAINT/REPAIRS - FACILITY 636 0 0 PRINTING/COPYING - DENTAL 635 0 0 REFERRALS - XRAY - VALE 560 0 0 MAINTENANCE CONTRACTS 552 0 0 REFERRALS - LAB 492 0 0 SUPPLIES - DENTAL FACILIT 433 0 0 FAC SUPPLIES - ADMIN 0 320 0 CONFERENCE WORKSHOPS 300 0 0 ANSWERING SERVICE - NYSSA 269 0 0 ANSWERING SERVICE - VALE 269 0 0 COMMUNITY PROMOTIONS 0 250 0 FACILITY EQUIPMENT 240 0 0 SUPPLIES - PHARMACEUTICAL 220 0 0 OTHER - LAB 219 0 0 OTHER - MEDICAL 207 0 0 MAINTENANCE CONTRACT 198 0 0 PHARMACEUTICALS - VALE 176 0 0 TAXES - PROPERTY 136 0 0 MAINTENANCE AGREEMENT - M 120 0 0 COMMUNITY SERVICE 98 0 0 PHARMACEUTICALS 90 0 0 INSURANCE/STAFF BONDING - -28 0 0 |
| FORM 990, PART XI, LINE 9 | CHANGE IN FIXED ASSETS 341,855 ROUNDING -1 |
| Software ID: | |
| Software Version: |