Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,306,394 | 1,344,935 | 1,831,304 | 2,032,447 | 2,338,009 | 8,853,089 |
| 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 | 177,008 | 403,573 | 510,434 | 751,786 | 766,340 | 2,609,141 |
| 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 | 1,483,402 | 1,748,508 | 2,341,738 | 2,784,233 | 3,104,349 | 11,462,230 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 65,000 | 50,000 | 55,000 | 65,500 | 50,000 | 285,500 |
| 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. | 66,848 | 162,649 | 144,778 | 190,454 | 564,729 | |
| c | Add lines 7a and 7b.. | 131,848 | 212,649 | 199,778 | 255,954 | 50,000 | 850,229 |
| 8 | Public support. (Subtract line 7c from line 6.) | 10,612,001 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,483,402 | 1,748,508 | 2,341,738 | 2,784,233 | 3,104,349 | 11,462,230 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 2,115 | 2,493 | 2,230 | 2,568 | 4,312 | 13,718 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 2,115 | 2,493 | 2,230 | 2,568 | 4,312 | 13,718 |
| 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.).. | 1,485,517 | 1,751,001 | 2,343,968 | 2,786,801 | 3,108,661 | 11,475,948 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | OUR GROWTH CONTINUED IN 2018 SERVING 7,309 PATIENTS WITH AN INCREASE OF 7.6% IN PATIENT ENCOUNTERS TOTALING 15,887. WE ALSO WELCOMED AN ADDITIONAL FAMILY NURSE PRACTITIONER AND NOW HAVE EIGHT FULL-TIME HEALTH CARE PROVIDERS, AND THREE PART-TIME. OUR MODEL II - THE UPFH MOBILE MEDICAL CLINIC PROVIDED CARE TO 41 SITES INCLUDING AN EXPANSION INTO TOOELE COUNTY. THE MOBILE CLINIC PROVIDES FREE CARE FOR UNINSURED PATIENTS WITH INCOMES LESS THAN 200% FPL. A TOTAL OF 1,540 MEDICAL VISITS FOR ACUTE, CHRONIC, MENTAL HEALTH, AND PREVENTIVE CARE WERE PROVIDED. THIS PROGRAM PROVIDES CARE TO INDIVIDUALS WHO EXPERIENCE BARRIERS SUCH AS LANGUAGE, TRANSPORTATION, INCOME, AND LACK OF UNDERSTANDING OF OUR HEALTH CARE SYSTEM. OUR MODEL II - MOBILE EYE CARE CLINIC EFFORTS TARGET TITLE 1 SCHOOLS AS ACCESS POINTS TO PROVIDE EXAMS AND GLASSES FOR STUDENTS AND THEIR FAMILIES. THIS PROGRAM IS DRAMATICALLY IMPROVING EDUCATIONAL OUTCOMES FOR STUDENTS WITH VISION IMPAIRMENT. A TOTAL OF 1,834 PERSONS WITH LOW-VISION HAVE BEEN GIVEN AN EXAM, WITH 1,868 FREE OR LOW COST PAIR OF LENSES PROVIDED. TITLE 1 STUDENTS, HOMELESS, AND THE RECENTLY INCARCERATED RECEIVE LENSES AT NO COST. OUR MODEL III - MID-VALLEY HEALTH CLINIC IS A FEDERALLY QUALIFIED HEALTH CENTER OFFERING A DEEPLY DISCOUNTED SLIDING FEE SCHEDULE FOR INDIVIDUALS WITH INCOMES 200% OR LESS OF THE FEDERAL POVERTY LEVEL. THIS CLINIC PROVIDED 6,717 PRIMARY CARE VISITS IN 2018. OUR MODEL III - UTAH PARTNERS FOR HEALTH DENTAL CLINIC PROVIDED 2,964 LOW- COST VISITS INCLUDING CROWNS, DENTURES, AND OTHER TREATMENT PROGRAMS. THIS PROGRAM IS DESIGNED TO PROVIDE ACCESS TO DENTAL SERVICES FOR INDIVIDUALS WHO CANNOT GET TREATMENT DUE TO LACK OF INCOME. OUR MODEL III - UTAH PARTNERS FOR HEALTH BEHAVIORAL HEALTH CLINIC PROVIDED 1,032 COUNSELING VISITS INCLUDING NO COST VISITS FOR HOMELESS INDIVIDUALS. WE ACHIEVED OUR CLINICAL PERFORMANCE MEASURES FOR CHILD WEIGHT AND COUNSELING, ADULT WEIGHT AND COUNSELING, TOBACCO CESSATION, ASTHMA, CORONARY ARTERY DISEASE, ISCHEMIC VASCULAR DISEASE, DEPRESSION, HYPERTENSION, AND DENTAL SEALANTS. WE IMPROVED IN CERVICAL CANCER SCREENING, COLORECTAL CANCER SCREENING, IMMUNIZATIONS, AND DIABETES CONTROL, BUT MISSED OUR INTERNAL GOALS. WE ESTABLISHED AN INTEGRATED CARE MODEL WITH THE HIRING OF A FULL-TIME NURSE CARE MANAGER. THIS PROGRAM PROVIDES COMPREHENSIVE, PERSONALIZED AND INNOVATIVE CARE TO HELP OUR PATIENTS ACHIEVE THEIR HEALTH RELATED GOALS. IN 2019, WE LOOK FORWARD TO EXPANDING OUR SUBSTANCE ABUSE TREATMENT PROGRAMS TO INCLUDE MEDICATION ASSISTED TREATMENT (MAT), AND CO-LOCATING OUR BEHAVIORAL HEALTH AND MEDICAL TEAMS. OUR PASSION CONTINUES TO BE "TO FILL GAPS IN UTAH'S HEALTHCARE SYSTEM". |
| FORM 990, PAGE 2, PART III, LINE 4B | UTAH PARTNERS FOR HEALTH COLLABORATES WITH MULTIPLE FOR-PROFIT CLINICS WILLING TO PROVIDE IN-KIND DONATIONS TO INDIVIDUALS IN NEED OF HEALTH CARE IN MAGNA, WEST VALLEY, AND KEARNS, UTAH. OUR MODEL I - IN-CLINIC PROGRAM PROVIDES ACCESS TO LOW-INCOME AND UNINSURED INDIVIDUALS IN 14 FOR-PROFIT CLINICS THAT DISCOUNT THEIR FEES BY AN AVERAGE OF 71%. THIS ALLOWS PATIENTS TO RECEIVE CARE AT THE PRICE OF A CO-PAY. WE PROVIDED ACCESS TO 1,795 PATIENT ENCOUNTERS (MEDICAL, DENTAL, EYE CARE, PHYSICAL THERAPY, PULMONOLOGY, CARDIOLOGY, AND DIAGNOSTIC SERVICES), AND RECEIVED 223,177 IN-KIND DONATIONS FROM OUR PARTNER PROVIDERS IN 2018. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE ORGANIZATION'S CFO REVIEWS THE 990 BEFORE IT IS FILED. IN ADDITION, THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS THE 990 BEFORE IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | DURING 2014 ALL BOARD MEMBERS AND OFFICERS COMPLETED AND SIGNED THE ORGANIZATION'S CONFLICT OF INTEREST DISCLOSURE STATEMENT. THIS STATEMENT REQUIRES THAT ALL POTENTIAL CONFLICTS OF INTEREST BE DISCLOSED AT THE TIME THE BOARD MEMBER BECOMES AWARE OF THE CONFLICT OR BEFORE ANY DISCUSSION ON THE MATTER BY THE BOARD, WHICHEVER OCCURS FIRST. IF AN APPARENT CONFLICT OF INTEREST IS NOT DISCLOSED BY THE BOARD MEMBER HAVING THE CONFLICT, ANOTHER BOARD MEMBER IS REQUIRED TO BRING THE CONFLICT TO THE ATTENTION OF THE BOARD. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR DETERMINING WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. ONCE A CONFLICT OF INTEREST IS DISCLOSED, THE BOARD MEMBER SHOULD ALSO NOT PARTICIPATE IN FURTHER DISCUSSION OF THE MATTER BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15A | IN ESTABLISHING THE EXECUTIVE DIRECTOR'S COMPENSATION, THE ORGANIZATION USES MARKET COMPARABILITY DATA TO ENSURE THAT THE COMPENSATION IS REASONABLE. THE BOARD OF DIRECTORS ESTABLISHES THE EXECUTIVE DIRECTOR'S COMPENSATION INDEPENDENT FROM THE EXECUTIVE DIRECTOR. THE DELIBERATION AND DETERMINATION OF COMPENSATION IS CONTEMPORANEOUSLY DOCUMENTED IN THE BOARD MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICES DURING REGULAR BUSINESS HOURS. |
| FORM 990, PART XI, LINE 9 | CHANGE IN VALUE OF BENEFICIAL INTEREST -398 |
| Software ID: | |
| Software Version: |