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 (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 | |||||
| (A)
PHOENIX INDIAN MEDICAL CENTER |
860212139 | 3 | Yes | 35,041 | 40,898 | |
| Total 1 | 35,041 | 40,898 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | ||||||
| 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 | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 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. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Part I Section A Line 2 PHOENIX INDIAN MEDICAL CENTER PIMC IS OWNED/OPERATED BY THE INDIAN HEALTH SERVICE, A FEDERAL AGENCY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. |
| Return Reference | Explanation |
|---|---|
| Part I Section D Line 2 | THE PHOENIX INDIAN MEDICAL CENTER AUXILIARY PIMCA MAINTAINS A CLOSE AND CONTINUOUS WORKING RELATIONSHIP WITH PHOENIX INDIAN MEDICAL CENTER PIMC. PIMCA OPERATES A GIFT SHOP IN THE PIMC LOBBY. UPON THE BASIS OF PIMCA ANNUALLY BUDGETED GRANTS TO PIMC, THEIR ADMINISTRATIVE LEADERSHIP DIRECTLY COMMUNICATES WITH THE OFFICERS OF PIMCA TO REQUEST DURABLE MEDICAL EQUIPMENT, OR OTHER REIMBURSEMENTS AND RESOURCES. |
| Part I Section E Line 1 C | PIMCA SUPPORTED PIMC, A FEDERAL AGENCY OF THE DHHS, THROUGH MAINTAINING A CLOSE AND CONTINUOUS WORKING RELATIONSHIP WITH PIMC AND ENGAGING IN ACTIVITIES FOR THE BENEFIT OF PIMC SUCH AS OPERATING A HOSPITAL GIFT SHOP IN THE PIMC LOBBY FOR THE CONVENIENCE AND SERVICE TO PATIENTS AND STAFF WHICH SELLS AMERICAN INDIAN AI ART AND JEWELRY. AI ART AND JEWELRY SOLD CONTRIBUTE TO THE CULTURAL COMPETENCY OF PIMC. |
| Part I Section E Line 1 C | LINE 1 C CONTINUED AN ESSENTIAL ASPECT OF ITS UNIQUE HEALTHCARE OF AMERICAN INDIANS, PIMCS CULTURAL COMPETENCY IS AN IMPORTANT CRITERIA THAT MUST BE MET FOR ITS NATIONAL JOINT COMMISSION ACCREDITATION. IN THE AI CULTURE THESE ITEMS OF ETHIC JEWELRY AND ART ARE MUCH MORE THAN MERE ADORNMENT, BUT ARE IMPORTANT ASPECTS OF THEIR HERITAGE, CULTURE, SELF- IDENTIFICATION AND SPIRITUALITY. A SIGNIFICANT NUMBER OF THESE ITEMS ARE PURCHASED BY PIMC EMPLOYEES. |
| Part I Section E Line 1 C | LINE 1 C CONTINUED THE 10 EMPLOYEE DISCOUNT, WHICH PIMC EMPLOYEES RECEIVE, IS RECORDED AS A GRANT-IN-KIND TO THEIR CULTURAL SELF-IDENTIFICATION AND THUS PIMCAS CULTURAL COMPETENCE. PIMCA PURCHASES DURABLE MEDICAL EQUIPMENT FOR PIMC MEDICAL DEPARTMENTS, SUPPORTS HEALTH FAIRS ON THE PIMC CAMPUS THROUGHOUT THE YEAR FOR THE PURPOSE OF HEALTH EDUCATION WITH AN OUTREACH TO THE LOCAL AMERICAN INDIAN COMMUNITIES, AND |
| Part I Section E Line 1 C | LINE 1 C CONTINUED PIMCA ALSO FUNDS PIMC IN-PATIENT CHRISTMAS GIFTS, PUBLIC TRANSPORTATION PASSES FOR SOCIAL SERVICE USE FOR INDIGENT PATIENTS, SUPPORTS PIMC POW-WOW CLUB FOR ANNUAL SOCIAL POW-WOW ON PIMC CAMPUS, PROVIDES BLOOD DONOR APPRECIATION MOMENTOS, AND PURCHASES PERIODIC MEALS THROUGH PIMC FOOD SERVICES FOR OUT-OF-TOWN INDIGENT PATIENTS. |
| Part I Section A Line 11 G VII | GOODS AND SERVICES PROVIDED FOR THE BENEFIT OF THE SUPPORTED ORGANIZATION PIMCA OPERATES A HOSPITAL GIFT SHOP IN THE PIMC LOBBY FOR THE CONVENIENCE AND SERVICE TO PATIENTS AND STAFF WHICH SELLS AMERICAN INDIAN AI ART AND JEWELRY. AI ART AND JEWELRY SOLD CONTRIBUTE TO THE CULTURAL COMPETENCY OF PIMC. |
| Software ID: | 15000290 |
| Software Version: | 15.3.0.0 |
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, Part III, Line 4d | Program Service Expenses 4,387, Grants and allocations 4,387, Revenue 0 OUTREACH GRANTS TO VARIOUS PIMC DEPARTMENTS AND ENTITIES THESE INCLUDED 2,745 FOR SEVEN HEALTH PROMOTIONS ON PIMC CAMPUS, 214 FOR BLOOD DRIVE SUPPORT 360 TO BEHAVIORAL HEALTH FOR SERIOUSLY MENTALLY ILL MAINTENANCE SUPPORT PROGRAM 400 FOR MEALS NEEDED FOR UNFUNDED INDIVIDUALS TRAVELING FROM RESERVATIONS FOR OUTPATIENT APPOINTMENTS 323 FOR INPATIENT AND COMMUNITY FAMILY SUPPORT XMAS GIFTS 105 FOR PIMC VOLUNTEER CHAPLAINS ASSOCIATION CHAPLAIN MINISTRY EXPENSE AND 60 TO CASE MANAGEMENT FOR BUS TICKETS HOME FROM HOSPITAL DISMISSAL FOR UNDIGENT PATIENTS. |
| Form 990, Part VI, Section A, Line 4 | THE ORGANIZATIONS GOVERNING DOCUMENTS WERE AMENDED IN THE FOLLOWING AREAS 1 MEMBERSHIP OF THE ORGANIZATION WAS SIMPLIFIED INTO ONE CLASS WITH TWO LIMITS ONE YEAR AND LIFE MEMBERSHIP 2 MEMBERS CAN NOW BE REMOVED BY NONPAYMENT OF DUES FOR 90 DAYS OR FOR CAUSE BY DUE PROCESS OF THE BOARD OF DIRECTORS, 3 MEMBERS WILL VOTE ON THE FOLLOWING THE NUMBER OF POSITIONS AND TERM OF THE BOARD OF DIRECTORS BETWEEN 3 AND 10 INDIVIDUALS, AND BOARD TERMS ARE SET AT TWO YEARS BUT BOARD DIRECTORS MAY SERVE INDEFINITELY PENDING RESIGNATION OR REMOVAL BY MEMBERSHIP, AND THE MEMBERSHIP WILL ELECT AND HAVE AUTHORITY TO REMOVE SUCH DIRECTORS. THE PIMC PRESIDENT WILL NO LONGER APPOINT BOARD MEMBERS BY VIRTURE OF COMMITTEE CHAIRMANSHIP OR MEMBERS-AT-LARGE. 4 AN INDEMNIFICATION SECTION PERTAINING TO BOARD DIRECTORS WAS ADDED TO THE BYLAWS, AND 5 A RESTRICTED CONTRIBUTIONS ACCOUNTS WAS ADDED TO PROVIDE CLARITY ON RESTRICTED CONTRIBUTIONS PIMCA RECEIVES AND PLACES IN BOARD DESIGNATED FUNDS AS A VEHICLE TO SERVE THE ACCOUNTING AND PROGRAM FUNDING NEEDS OF SPECIFIC DEPARTMENTS AND ENTITIES. |
| Form 990, Part VI, Section A, Line 6 | MEMBERSHIP IS OPEN TO ANY INDIVIDUAL OR ORGANIZATION. BASED ON THE FEE MEMBERS PAY, MEMBERS HAVE THE OPTION OF BECOMING A LIFETIME MEMBER OR AN ANNUAL MEMBER. |
| Form 990, Part VI, Section A, Line 7 A B | EACH MEMBER IN GOOD STANDING IS ELIGIBLE TO VOTE ON THE ORGANIZATIONS BOARD OF DIRECTORS AND OFFICERS. ELECTIONS ARE DONE ON A ONE MEMBER ONE VOTE BASIS. THE FOLLOWING ACTS REQUIRE APPROVAL FROM THE MEMBERSHIP BODY 1 THE NUMBER OF POSITIONS AND TERM OF THE BOARD OF DIRECTORS, AND 2 THE ELECTOIN AND REMOVAL OF BOARD DIRECTORS AND OFFICERS. THE ORGANIZATIONS CEO CONTINUES TO APPROVE ALL PIMCA BYLAWS AND AMENDMENTS IN ACCORDANCE TO OUR BYLAWS. |
| Form 990, Part VI, Section B, Line 11 | ALL MEMBERS OF THE BOARD OF DIRECTORS RECEIVED A COPY OF THIS FORM 990 FOR REVIEW AND COMMENT PRIOR TO THE FORM 990 BEING FILED. |
| Form 990, Part VI, Section B, Line 12 C | AT EACH BOARD AND COMMITTEE MEETING, IF THERE IS A DISCUSSION OF SELECTING OR ENGAGING A VENDOR OR SERVICE PROVIDER, ALL IN ATTENDANCE ARE ASKED TO RECUSE THEMSELVES FROM THIS DISCUSSION IF THERE COULD BE A PERCEIVED CONFLICT. ANNUALLY, THE ORGANIZATION REVIEWS AND DISCUSSES THE CONFLICT OF INTEREST POLICY AND REQUESTS THAT EACH BOARD MEMBER LIST AND ACKNOWLEDGE ANY KNOWN CONFLICTS. |
| Form 990, Part VI, Section C, Line 19 | THE ORGANIZATION WILL PROVIDE IN A TIMELY MANNER, COPIES OF ALL GOVERNING DOCUMENTS INCLUDING ITS CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS WHEN REQUESTED IN WRITING OR IN PERSON. |
| Software ID: | 15000290 |
| Software Version: | 15.3.0.0 |