TY 2021 Form 990

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

WASATCH FORENSIC NURSES INC

Employer identification number

87-0687017

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	135,144	142,957	179,522	191,477	222,787	871,887
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	307,777	333,203	380,293	356,304	383,319	1,760,896
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	442,921	476,160	559,815	547,781	606,106	2,632,783
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons	65,900	54,000	53,000	53,000	50,500	276,400
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.				1,022		1,022
c	Add lines 7a and 7b..	65,900	54,000	53,000	54,022	50,500	277,422
8	Public support. (Subtract line 7c from line 6.)						2,355,361

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...	442,921	476,160	559,815	547,781	606,106	2,632,783
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	33	58	67	24	21	203
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.	33	58	67	24	21	203
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.	3,103	7,065				10,168
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.)..	446,057	483,283	559,882	547,805	606,127	2,643,154

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

89.110 %

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

88.910 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

0 %

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

0 %

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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 0.015 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 0.035	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

WASATCH FORENSIC NURSES INC

Employer identification number

87-0687017

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization WASATCH FORENSIC NURSES INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization WASATCH FORENSIC NURSES INC		Employer identification number 87-0687017

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization WASATCH FORENSIC NURSES INC			Employer identification number 87-0687017
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

WASATCH FORENSIC NURSES INC

Employer identification number

87-0687017

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....	27,714	9,787	17,927
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				17,927

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	608,527
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b	2,400
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	2,400
3	Subtract line 2e from line 1..................			3	606,127
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	606,127

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	578,122
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a	2,400
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................			2e	2,400
3	Subtract line 2e from line 1...................			3	575,722
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	575,722

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

WASATCH FORENSIC NURSES INC

Employer identification number

87-0687017

Return Reference	Explanation
FORM 990, PAGE 2, PART III, LINE 4A	IN 2021 OUR TEAM PROVIDED SEXUAL ASSAULT FORENSIC MEDICAL EXAMINATIONS TO 882 PATIENTS. IN THE TWO YEARS SINCE EXPANDING OUR SERVICES, OF THOSE 882 PATIENTS 40 OF THEM WERE EVALUATED AND CARE WAS PROVIDED FOR INTERPERSONAL VIOLENCE RELATED ABUSE AND EVIDENCE COLLECTION. WHILE THE PANDEMIC WAS STILL ACTIVE THROUGHOUT 2021, WASATCH FORENSIC NURSES NEVER INTERRUPTED SERVICES TO VICTIMS. OUR TEAM CONTINUED TO ENSURE THAT IF A SURVIVOR REQUESTED AN EXAM OR SERVICES THAT WFN WAS AVAILABLE TO ANSWER THE CALL ANYTIME DAY OR NIGHT. IN 2021, WFN APPLIED FOR AND RECEIVED FEDERAL GRANT FUNDING FROM THE VICTIMS OF CRIME ACT (VAWA) TO HIRE A DEDICATED VICTIM ADVOCATE FOR OUR SANE TEAM. THE VICTIM ADVOCATE PROVIDES AN INTEGRAL PIECE OF THE PUZZLE AFTER OUR NURSES HAVE PROVIDED CARE FOR A SURVIVOR OF SEXUAL ASSAULT OR INTERPERSONAL VIOLENCE. THE VICTIM ADVOCATE'S MAIN FOCUS IS TO FOLLOW UP WITH PATIENTS THAT HAVE COME IN CONTACT WITH WFN. EVEN FOR DECLINED EXAMS, IF WE HAVE A WAY TO REACH THE PATIENT, OUR ADVOCATE WILL FOLLOW UP TO PROVIDE COMMUNITY REFERRALS AND ASSIST THE PATIENT WITH ANY COMMUNITY RESOURCES THEY MAY NEED. SIMILAR TO PATIENTS WHO COMPLETE AN EXAM, OUR ADVOCATE FOLLOWS UP WITHIN A WEEK OF THE EXAM TO ENSURE THE PATIENT HAS THE AFTERCARE THEY MAY NEED, RECEIVES ANSWERS TO ANY QUESTIONS THEY MAY HAVE AND IS ABLE TO EXPRESS ANY NEEDS THAT THE ADVOCATE CAN ASSIST THEM WITH. COMMUNITY REFERRALS, FOLLOW-UP EXAMS AND PROVIDING DIRECT CONTACT TO THE NURSE WHO PERFORMED THEIR EXAM ARE SOME EXAMPLES OF WHAT THE WFN VICTIM ADVOCATE CAN ASSIST PATIENTS WITH. WFN IS THE ONLY SANE TEAM WITHIN THE STATE OF UTAH WHO CURRENTLY PROVIDES THIS DIRECT TYPE OF SERVICE IN CONJUNCTION WITH SANE SERVICES. WE ARE HOPEFUL THAT WE CAN PAVE THE WAY FOR OTHER TEAMS TO HIRE ADVOCATES TO ASSIST SURVIVORS IN THIS WAY. AS PART OF THE VAWA GRANT THAT WFN WAS AWARDED, IT ALLOWED US TO CONTINUE TO HAVE RESOURCE NURSES (NURSES ON OUR TEAM WHO ASSIST OUR TEAM AND OTHER TEAMS THROUGHOUT THE STATE) AVAILABLE 24 HOURS-A-DAY, 365 DAYS-A-YEAR TO ASSIST OUR NURSES WHEN THEY ARE RESPONDING ON CASES AND HAVE QUESTIONS THAT COME UP DURING THE EXAM. OUR RESOURCE NURSE TEAM IS COMPRISED OF THREE OF OUR MOST EXPERIENCED NURSES ON THE TEAM. COLLECTIVELY BETWEEN THE THREE OF THEM THEY HAVE OVER 40 YEARS OF SANE EXPERIENCE. THEY ARE CONSIDERED EXPERTS IN THIS FIELD OF WORK. OUR RESOURCE NURSES ALSO PROVIDE ASSISTANCE TO OTHER SANE TEAMS AND LAW ENFORCEMENT AGENCIES THROUGHOUT THE STATE OF UTAH WHO NEED ASSISTANCE WITH A DATABASE CALLED FEMR (FORENSIC ELECTRONIC MEDICAL RECORD). IN 2021 OUR RESOURCE NURSES ASSISTED OVER 30 DIFFERENT LAW ENFORCEMENT AGENCIES AND SANE TEAMS WITH FEMR RELATED ISSUES. WFN PARTNERED WITH UCASA (UTAH COALITION AGAINST SEXUAL ASSAULT) TO EDUCATE OUR NURSES REGARDING UCASA'S PROMATHORA PROGRAM. UCASA VISITED OUR TEAM AT ONE OF OUR MONTHLY TRAININGS TO PROVIDE INSIGHT INTO THE INNER WORKINGS OF THE LATIN-X COMMUNITY AND TO EDUCATE OUR TEAM REGARDING THE EXPERIENCES OF LATIN-X INDIVIDUALS AND HOW OUR NURSES CAN TAKE A VICTIM-CENTERED, TRAUMA INFORMED LENS TO VIEW THE EXPERIENCES OF THESE INDIVIDUALS AND HOW BEST TO ASSIST THEM WHEN THEY ARE PROVIDING CARE TO THEM DURING AN EXAM. OUR TEAM IS ALWAYS OPEN TO INVITING EXPERTS IN THE FIELD TO EDUCATE US ON HOW WE CAN CONTINUE TO TREAT ALL INDIVIDUALS WHO EXPERIENCE VIOLENCE WITH EQUITY, DIGNITY AND COMPASSION. WFN IS COMMITTED TO SUPPORTING SOCIAL JUSTICE AND REJECTING ALL FORMS OF DISCRIMINATION, RACISM AND VIOLENCE. PARTNERING WITH UCASA TO RECEIVE INFORMATION AND INNOVATIVE TRAINING REGARDING THIS POPULATION EQUIPPED OUR NURSES WITH ADDITIONAL TOOLS THEY CAN UTILIZE TO ASSIST NOT ONLY VICTIMS OF THIS SPECIFIC POPULATION BUT OTHERS ALSO. THE COVID-19 PANDEMIC HAS RAVAGED THE HEALTHCARE INDUSTRY. AS A RESULT, HOSPITALS AND OTHER HEALTHCARE RELATED AGENCIES SAW A MASS EXODUS OF EMPLOYEES (NURSES AND DOCTORS) AND FOUND THEMSELVES WITH STAFFING SHORTAGES. IN 2021, WFN WAS ABLE TO MAINTAIN A STAFF OF QUALIFIED NURSES WHO MAINTAIN A CALL SCHEDULE WHERE OUR NURSES REMAINED AVAILABLE 24 HOURS- A-DAY, SEVEN DAYS-A-WEEK, 365 DAYS-A-YEAR. OUR DEDICATED TEAM OF MOBILE NURSES CONTINUED TO TRAVEL TO THE 24 HOSPITALS AND CLINICS WITHIN OUR SERVICE AREA AND COLLABORATIVELY COMMUNICATE WITH OVER 40 LAW ENFORCEMENT AGENCIES THROUGHOUT SALT LAKE, UTAH, SUMMIT AND WASATCH COUNTIES. OUR NURSES, ADVOCATE AND ADMINISTRATIVE STAFF PRIORITIZED PATIENT CARE, AVAILABILITY, AND ON-CALL STATUS OF OUR NURSES AS PRIORITY NUMBER ONE EVEN WITH THE PANDEMIC CONTINUING THROUGHOUT 2021. OUR TEAM WAS AND REMAINS DEDICATED TO BEING AVAILABLE ANYTIME A VICTIM REQUESTS AN EXAM, DAY OR NIGHT AND WE ARE PROUD TO PROVIDE SERVICES AT NO COST TO VICTIMS WHEN SERVICES ARE NECESSARY. PANDEMIC OR NOT, WFN HAS PROVIDED UNINTERRUPTED SERVICES TO PATIENTS REQUIRING CARE IN OUR SPECIALIZED AREA, THUS FREEING UP MEDICAL PROFESSIONALS IN THE HOSPITAL SETTING TO BE ABLE TO CARE FOR PANDEMIC PATIENTS AND OTHER EMERGENT CASES ENTERING THE ED. THE MEDICAL PROFESSIONALS IN THE HOSPITALS AND CLINICS WE SERVE NEVER HESITATED TO LET US ENTER AND ASSIST BECAUSE IN SOME INSTANCES THEY WERE OVERWHELMED WITH PANDEMIC PATIENTS AND EMERGENCY CASES AND OUR TEAM OF SPECIALIZED NURSES WERE AVAILABLE, EQUIPPED (WE OUTFITTED OUR NURSES WITH ADDITIONAL PPE) AND PREPARED TO CARE FOR VICTIMS OF SEXUAL AND INTERPERSONAL VIOLENCE. OUR NURSES CONTINUED PROVIDING QUALITY CARE, MAINTAINED RESPONSE TIMES OF UNDER ONE HOUR AND ALLOWED ONE-ON-ONE FOCUSED CARE TO CONTINUE, WITH MOST OF OUR NURSES SPENDING THREE TO FOUR HOURS PROVIDING DIRECT PATIENT CARE. TRAINING COMMUNITY PARTNERS, NURSES AND ADVOCATES THROUGHOUT THE COMMUNITY HAS ALWAYS BEEN AND CONTINUES TO BE A SECONDARY PRIORITY FOR WFN. OUR NURSES OFFER COMMUNITY TRAININGS WHEN REQUESTED. OUR LAW ENFORCEMENT LIAISON NURSE PERSONALLY VISITED ALL 40 OF OUR LAW ENFORCEMENT PARTNERS TO EXPRESS OUR APPRECIATION AND TO BUILD RAPPORT AND TRAINING TO DISPATCHERS, LAW ENFORCEMENT OFFICERS, DETECTIVES, SERGEANTS AND LIEUTENANTS OF MANY AGENCIES. WE HAVE THREE HOSPITAL LIAISONS THAT ARE NURSES THAT FOSTERED RELATIONSHIPS AND INITIATED TRAININGS WITH THE 24 HOSPITALS AND CLINICS WE WORK WITH. WHILE COVID HAS MADE IT DIFFICULT TO ENTER HOSPITALS FOR TRAINING, E-MAILS AND PERSONAL VISITS TO EMERGENCY DEPARTMENT HEADS WERE MADE WITH EACH OF OUR HOSPITAL PARTNERS. BECAUSE OF THE OPEN COMMUNICATION WE HAVE WITH EACH OF THE COMMUNITY AGENCIES WE WORK WITH, BE IT UNIVERSITIES, VICTIM ADVOCATES, HOSPITALS, LAW ENFORCEMENT, PROSECUTORS, ETC. OUR COMMUNITY PARTNERSHIPS ARE A CORNERSTONE OF OUR SUCCESS AND WE WILL CONTINUE THE COLLABORATIVE RELATIONSHIPS WITH OUR COMMUNITY PARTNERS. WFN HOSTED SIX PRECEPTEES IN 2021. THESE PRECEPTEES WERE NURSES FROM RURAL COMMUNITIES WHO VISITED US FOR THREE DAYS IN ORDER TO TRAIN AND RECEIVE A HIGH NUMBER OF CALLS SO THEY CAN TAKE BACK THEIR EXPERIENCE AND KNOWLEDGE TO THEIR TEAMS. WE CONTINUED TO PARTNER WITH UCASA IN 2021 VIA VICTIM OF CRIME ACT (VOCA) FUNDING TO BRING THESE NURSES FROM OTHER TEAMS TO RECEIVE TRAINING. BECAUSE THERE'S BEEN A SHORTAGE OF NURSES, SANE TEAMS HAVE STRUGGLES TO ALLOW NURSES TO COME TRAIN FOR THREE DAYS. IT IS A BURDEN ON THEIR COMMUNITIES, HOSPITALS AND SANE TEAMS TO LOSE A HEALTHY NURSE TO TRAIN, WHEN THEY ARE SO DESPERATELY NEEDED IN THEIR COMMUNITIES. BECAUSE OF THIS, WFN ALTERED THE NUMBER OF TRAINING DAYS REQUIRED, WORKED DIRECTLY WITH TEAMS TO ALLOW THEM TO SEND INDIVIDUALS WHEN THEY WERE AVAILABLE, ALLOWED TEAMS TO SEND NURSES FOR THREE DAYS INSTEAD OF FOUR DAYS AND WERE STILL ABLE TO PROVIDE MEANINGFUL TRAINING EXPERIENCES THAT WERE HELPFUL TO THEIR ORGANIZATIONS. IN 2021 WFN SUCCESSFULLY PARTNERED WITH THE STATE OF UTAH DEPARTMENT OF HUMAN SERVICES TO ALLOW SIX OF OUR NURSES TO ATTEND THE STRANGULATION INSTITUTE'S ADVANCED STRANGULATION TRAINING. SIX OF OUR NURSES ATTENDED THE FIVE-WEEK VIRTUAL COURSE EVERY FRIDAY DURING THE MONTH OF OCTOBER. THEY RECEIVED VALUABLE TRAINING THAT THEY WERE ABLE TO BRING BACK TO OUR TEAM AND SHARE WITH OTHER SANES. OUR ENTIRE TEAM BENEFITTED FROM THE TRAINING AND EXPERTISE THAT OUR SIX NURSES RECEIVED. THE EXPERTISE AND EDUCATION ASSISTED OUR NURSES WITH KNOWLEDGE REGARDING INTERPERSONAL VIOLENCE EXAMS AND STRANGULATION. AT TIMES OUR NURSES ARE CALLED TO TESTIFY AS EXPERTS IN THESE TYPES OF CASES IN COURT AND THE INFORMATION PROVIDED TO ALL OF OUR NURSES FROM THIS TRAINING ALLOWS OUR NURSES TO STAY UP-TO-DATE ON THE MOST RECENT PRACTICES AND MEDICAL FINDINGS INVOLVING THESE TYPES OF CRIME.
FORM 990, PAGE 6, PART VI, LINE 11B	THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT PRIOR TO FILING. IN ADDITION, THE EXECUTIVE DIRECTOR AND CONTRACT ACCOUNTANT THOROUGHLY REVIEW THE FORM 990 PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 15A	THE BOARD OF DIRECTORS REVIEWS THE EXECUTIVE DIRECTOR'S SALARY ANNUALLY BASED ON COMPARISONS WITH OTHER SIMILAR ORGANIZATIONS AND THE RESULTS OF OPERATIONS OF THE ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE MISSION OF WASATCH FORENSIC NURSES IS TO PROVIDE COMPASSIONATE CARE AND PROFESSIONAL TIMELY COLLECTION OF FORENSIC MEDICAL EVIDENCE AS PART OF A MULTIDISCIPLINARY TEAM.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	44
6	Total number of volunteers (estimate if necessary) .............	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	191,477	222,787
9	Program service revenue (Part VIII, line 2g) .........	356,304	383,319
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	24	21
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)		0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	547,805	606,127
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	444,204	484,166
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 17,029
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	91,264	91,556
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	535,468	575,722
19	Revenue less expenses. Subtract line 18 from line 12.......	12,337	30,405
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	274,215	345,515
21	Total liabilities (Part X, line 26).............	4,755	45,650
22	Net assets or fund balances. Subtract line 21 from line 20.....	269,460	299,865

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 512,212 including grants of $ ) (Revenue $ 383,319 )
	IN 2021 OUR TEAM PROVIDED SEXUAL ASSAULT FORENSIC MEDICAL EXAMINATIONS TO 882 PATIENTS. IN THE TWO YEARS SINCE EXPANDING OUR SERVICES, OF THOSE 882 PATIENTS 40 OF THEM WERE EVALUATED AND CARE WAS PROVIDED FOR INTERPERSONAL VIOLENCE RELATED ABUSE AND EVIDENCE COLLECTION. WHILE THE PANDEMIC WAS STILL ACTIVE THROUGHOUT 2021, WASATCH FORENSIC NURSES NEVER INTERRUPTED SERVICES TO VICTIMS. OUR TEAM CONTINUED TO ENSURE THAT IF A SURVIVOR REQUESTED AN EXAM OR SERVICES THAT WFN WAS AVAILABLE TO ANSWER THE CALL ANYTIME DAY OR NIGHT. IN 2021, WFN APPLIED FOR AND RECEIVED FEDERAL GRANT FUNDING FROM THE VICTIMS OF CRIME ACT (VAWA) TO HIRE A DEDICATED VICTIM ADVOCATE FOR OUR SANE TEAM. THE VICTIM ADVOCATE PROVIDES AN INTEGRAL PIECE OF THE PUZZLE AFTER OUR NURSES HAVE PROVIDED CARE FOR A SURVIVOR OF SEXUAL ASSAULT OR INTERPERSONAL VIOLENCE. THE VICTIM ADVOCATE'S MAIN FOCUS IS TO FOLLOW UP WITH PATIENTS THAT HAVE COME IN CONTACT WITH WFN. EVEN FOR DECLINED EXAMS, IF WE HAVE A WAY TO REACH THE PATIENT, OUR ADVOCATE WILL FOLLOW UP TO PROVIDE COMMUNITY REFERRALS AND ASSIST THE PATIENT WITH ANY COMMUNITY RESOURCES THEY MAY NEED. SIMILAR TO PATIENTS WHO COMPLETE AN EXAM, OUR ADVOCATE FOLLOWS UP WITHIN A WEEK OF THE EXAM TO ENSURE THE PATIENT HAS THE AFTERCARE THEY MAY NEED, RECEIVES ANSWERS TO ANY QUESTIONS THEY MAY HAVE AND IS ABLE TO EXPRESS ANY NEEDS THAT THE ADVOCATE CAN ASSIST THEM WITH. COMMUNITY REFERRALS, FOLLOW-UP EXAMS AND PROVIDING DIRECT CONTACT TO THE NURSE WHO PERFORMED THEIR EXAM ARE SOME EXAMPLES OF WHAT THE WFN VICTIM ADVOCATE CAN ASSIST PATIENTS WITH. WFN IS THE ONLY SANE TEAM WITHIN THE STATE OF UTAH WHO CURRENTLY PROVIDES THIS DIRECT TYPE OF SERVICE IN CONJUNCTION WITH SANE SERVICES. WE ARE HOPEFUL THAT WE CAN PAVE THE WAY FOR OTHER TEAMS TO HIRE ADVOCATES TO ASSIST SURVIVORS IN THIS WAY. AS PART OF THE VAWA GRANT THAT WFN WAS AWARDED, IT ALLOWED US TO CONTINUE TO HAVE RESOURCE NURSES (NURSES ON OUR TEAM WHO ASSIST OUR TEAM AND OTHER TEAMS THROUGHOUT THE STATE) AVAILABLE 24 HOURS-A-DAY, 365 DAYS-A-YEAR TO ASSIST OUR NURSES WHEN THEY ARE RESPONDING ON CASES AND HAVE QUESTIONS THAT COME UP DURING THE EXAM. OUR RESOURCE NURSE TEAM IS COMPRISED OF THREE OF OUR MOST EXPERIENCED NURSES ON THE TEAM. COLLECTIVELY BETWEEN THE THREE OF THEM THEY HAVE OVER 40 YEARS OF SANE EXPERIENCE. THEY ARE CONSIDERED EXPERTS IN THIS FIELD OF WORK. OUR RESOURCE NURSES ALSO PROVIDE ASSISTANCE TO OTHER SANE TEAMS AND LAW ENFORCEMENT AGENCIES THROUGHOUT THE STATE OF UTAH WHO NEED ASSISTANCE WITH A DATABASE CALLED FEMR (FORENSIC ELECTRONIC MEDICAL RECORD). IN 2021 OUR RESOURCE NURSES ASSISTED OVER 30 DIFFERENT LAW ENFORCEMENT AGENCIES AND SANE TEAMS WITH FEMR RELATED ISSUES. WFN PARTNERED WITH UCASA (UTAH COALITION AGAINST SEXUAL ASSAULT) TO EDUCATE OUR NURSES REGARDING UCASA'S PROMATHORA PROGRAM. UCASA VISITED OUR TEAM AT ONE OF OUR MONTHLY TRAININGS TO PROVIDE INSIGHT INTO THE INNER WORKINGS OF THE LATIN-X COMMUNITY AND TO EDUCATE OUR TEAM REGARDING THE EXPERIENCES OF LATIN-X INDIVIDUALS AND HOW OUR NURSES CAN TAKE A VICTIM-CENTERED, TRAUMA INFORMED LENS TO VIEW THE EXPERIENCES OF THESE INDIVIDUALS AND HOW BEST TO ASSIST THEM WHEN THEY ARE PROVIDING CARE TO THEM DURING AN EXAM. OUR TEAM IS ALWAYS OPEN TO INVITING EXPERTS IN THE FIELD TO EDUCATE US ON HOW WE CAN CONTINUE TO TREAT ALL INDIVIDUALS WHO EXPERIENCE VIOLENCE WITH EQUITY, DIGNITY AND COMPASSION. WFN IS COMMITTED TO SUPPORTING SOCIAL JUSTICE AND REJECTING ALL FORMS OF DISCRIMINATION, RACISM AND VIOLENCE. PARTNERING WITH UCASA TO RECEIVE INFORMATION AND INNOVATIVE TRAINING REGARDING THIS POPULATION EQUIPPED OUR NURSES WITH ADDITIONAL TOOLS THEY CAN UTILIZE TO ASSIST NOT ONLY VICTIMS OF THIS SPECIFIC POPULATION BUT OTHERS ALSO. THE COVID-19 PANDEMIC HAS RAVAGED THE HEALTHCARE INDUSTRY. AS A RESULT, HOSPITALS AND OTHER HEALTHCARE RELATED AGENCIES SAW A MASS EXODUS OF EMPLOYEES (NURSES AND DOCTORS) AND FOUND THEMSELVES WITH STAFFING SHORTAGES. IN 2021, WFN WAS ABLE TO MAINTAIN A STAFF OF QUALIFIED NURSES WHO MAINTAIN A CALL SCHEDULE WHERE OUR NURSES REMAINED AVAILABLE 24 HOURS- A-DAY, SEVEN DAYS-A-WEEK, 365 DAYS-A-YEAR. OUR DEDICATED TEAM OF MOBILE NURSES CONTINUED TO TRAVEL TO THE 24 HOSPITALS AND CLINICS WITHIN OUR SERVICE AREA AND COLLABORATIVELY COMMUNICATE WITH OVER 40 LAW ENFORCEMENT AGENCIES THROUGHOUT SALT LAKE, UTAH, SUMMIT AND WASATCH COUNTIES. OUR NURSES, ADVOCATE AND ADMINISTRATIVE STAFF PRIORITIZED PATIENT CARE, AVAILABILITY, AND ON-CALL STATUS OF OUR NURSES AS PRIORITY NUMBER ONE EVEN WITH THE PANDEMIC CONTINUING THROUGHOUT 2021. OUR TEAM WAS AND REMAINS DEDICATED TO BEING AVAILABLE ANYTIME A VICTIM REQUESTS AN EXAM, DAY OR NIGHT AND WE ARE PROUD TO PROVIDE SERVICES AT NO COST TO VICTIMS WHEN SERVICES ARE NECESSARY. PANDEMIC OR NOT, WFN HAS PROVIDED UNINTERRUPTED SERVICES TO PATIENTS REQUIRING CARE IN OUR SPECIALIZED AREA, THUS FREEING UP MEDICAL PROFESSIONALS IN THE HOSPITAL SETTING TO BE ABLE TO CARE FOR PANDEMIC PATIENTS AND OTHER EMERGENT CASES ENTERING THE ED. THE MEDICAL PROFESSIONALS IN THE HOSPITALS AND CLINICS WE SERVE NEVER HESITATED TO LET US ENTER AND ASSIST BECAUSE IN SOME INSTANCES THEY WERE OVERWHELMED WITH PANDEMIC PATIENTS AND EMERGENCY CASES AND OUR TEAM OF SPECIALIZED NURSES WERE AVAILABLE, EQUIPPED (WE OUTFITTED OUR NURSES WITH ADDITIONAL PPE) AND PREPARED TO CARE FOR VICTIMS OF SEXUAL AND INTERPERSONAL VIOLENCE. OUR NURSES CONTINUED PROVIDING QUALITY CARE, MAINTAINED RESPONSE TIMES OF UNDER ONE HOUR AND ALLOWED ONE-ON-ONE FOCUSED CARE TO CONTINUE, WITH MOST OF OUR NURSES SPENDING THREE TO FOUR HOURS PROVIDING DIRECT PATIENT CARE. TRAINING COMMUNITY PARTNERS, NURSES AND ADVOCATES THROUGHOUT THE COMMUNITY HAS ALWAYS BEEN AND CONTINUES TO BE A SECONDARY PRIORITY FOR WFN. OUR NURSES OFFER COMMUNITY TRAININGS WHEN REQUESTED. OUR LAW ENFORCEMENT LIAISON NURSE PERSONALLY VISITED ALL 40 OF OUR LAW ENFORCEMENT PARTNERS TO EXPRESS OUR APPRECIATION AND TO BUILD RAPPORT AND TRAINING TO DISPATCHERS, LAW ENFORCEMENT OFFICERS, DETECTIVES, SERGEANTS AND LIEUTENANTS OF MANY AGENCIES. WE HAVE THREE HOSPITAL LIAISONS THAT ARE NURSES THAT FOSTERED RELATIONSHIPS AND INITIATED TRAININGS WITH THE 24 HOSPITALS AND CLINICS WE WORK WITH. WHILE COVID HAS MADE IT DIFFICULT TO ENTER HOSPITALS FOR TRAINING, E-MAILS AND PERSONAL VISITS TO EMERGENCY DEPARTMENT HEADS WERE MADE WITH EACH OF OUR HOSPITAL PARTNERS. BECAUSE OF THE OPEN COMMUNICATION WE HAVE WITH EACH OF THE COMMUNITY AGENCIES WE WORK WITH, BE IT UNIVERSITIES, VICTIM ADVOCATES, HOSPITALS, LAW ENFORCEMENT, PROSECUTORS, ETC. OUR COMMUNITY PARTNERSHIPS ARE A CORNERSTONE OF OUR SUCCESS AND WE WILL CONTINUE THE COLLABORATIVE RELATIONSHIPS WITH OUR COMMUNITY PARTNERS. WFN HOSTED SIX PRECEPTEES IN 2021. THESE PRECEPTEES WERE NURSES FROM RURAL COMMUNITIES WHO VISITED US FOR THREE DAYS IN ORDER TO TRAIN AND RECEIVE A HIGH NUMBER OF CALLS SO THEY CAN TAKE BACK THEIR EXPERIENCE AND KNOWLEDGE TO THEIR TEAMS. WE CONTINUED TO PARTNER WITH UCASA IN 2021 VIA VICTIM OF CRIME ACT (VOCA) FUNDING TO BRING THESE NURSES FROM OTHER TEAMS TO RECEIVE TRAINING. BECAUSE THERE'S BEEN A SHORTAGE OF NURSES, SANE TEAMS HAVE STRUGGLES TO ALLOW NURSES TO COME TRAIN FOR THREE DAYS. IT IS A BURDEN ON THEIR COMMUNITIES, HOSPITALS AND SANE TEAMS TO LOSE A HEALTHY NURSE TO TRAIN, WHEN THEY ARE SO DESPERATELY NEEDED IN THEIR COMMUNITIES. BECAUSE OF THIS, WFN ALTERED THE NUMBER OF TRAINING DAYS REQUIRED, WORKED DIRECTLY WITH TEAMS TO ALLOW THEM TO SEND INDIVIDUALS WHEN THEY WERE AVAILABLE, ALLOWED TEAMS TO SEND NURSES FOR THREE DAYS INSTEAD OF FOUR DAYS AND WERE STILL ABLE TO PROVIDE MEANINGFUL TRAINING EXPERIENCES THAT WERE HELPFUL TO THEIR ORGANIZATIONS. IN 2021 WFN SUCCESSFULLY PARTNERED WITH THE STATE OF UTAH DEPARTMENT OF HUMAN SERVICES TO ALLOW SIX OF OUR NURSES TO ATTEND THE STRANGULATION INSTITUTE'S ADVANCED STRANGULATION TRAINING. SIX OF OUR NURSES ATTENDED THE FIVE-WEEK VIRTUAL COURSE EVERY FRIDAY DURING THE MONTH OF OCTOBER. THEY RECEIVED VALUABLE TRAINING THAT THEY WERE ABLE TO BRING BACK TO OUR TEAM AND SHARE WITH OTHER SANES. OUR ENTIRE TEAM BENEFITTED FROM THE TRAINING AND EXPERTISE THAT OUR SIX NURSES RECEIVED. THE EXPERTISE AND EDUCATION ASSISTED OUR NURSES WITH KNOWLEDGE REGARDING INTERPERSONAL VIOLENCE EXAMS AND STRANGULATION. AT TIMES OUR NURSES ARE CALLED TO TESTIFY AS EXPERTS IN THESE TYPES OF CASES IN COURT AND THE INFORMATION PROVIDED TO ALL OF OUR NURSES FROM THIS TRAINING ALLOWS OUR NURSES TO STAY UP-TO-DATE ON THE MOST RECENT PRACTICES AND MEDICAL FINDINGS INVOLVING THESE TYPES OF CRIME.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses512,212

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) DANA THOMAS...................................................................... EXECUTIVE DI	40.00 .................		X	66,799	0	0
(2) DIANNE FULLER...................................................................... BOARD MEMBER	9.00 .................	X		16,212	0	0
(3) DARA COHEN...................................................................... BOARD MEMBER	0.25 .................	X		0	0	0
(4) LT MELODY CUTLER...................................................................... BOARD MEMBER	0.25 .................	X		0	0	0
(5) KATHY FRANCHEK-ROSA...................................................................... BOARD MEMBER	0.25 .................	X		0	0	0
(6) MARTY LICCARDO...................................................................... BOARD MEMBER	0.25 .................	X		0	0	0
(7) JIM ANTONORI MD...................................................................... BOARD MEMBER	0.25 .................	X		0	0	0
(8) KEN ROACH...................................................................... CHAIR	0.25 .................	X	X	0	0	0
(9) LEISSA ROBERTS...................................................................... BOARD MEMBER	0.25 .................	X		0	0	0
(10) DONNA THOMAS...................................................................... BOARD MEMBER	0.25 .................	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	83,011

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	148,788

f	All other contributions, gifts, grants, and similar amounts not included above		1f	73,999

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		222,787

		Business Code
2a	EXAM INCOME		383,319	383,319
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		383,319

3 Investment income (including dividends, interest, and othersimilar amounts) ......			21			21
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			606,127	383,319		21

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	83,011	54,054	16,700	12,257
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	365,705	342,476	20,050	3,179
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........	35,450	31,328	2,903	1,219
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	763		763
c	Accounting ...........	4,410		4,410
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	2,695	2,695
12	Advertising and promotion ....	72	69	2	1
13	Office expenses .......	15,693	15,517	151	25
14	Information technology ......	2,698	2,698
15	Royalties ..
16	Occupancy ...........	21,694	20,937	651	106
17	Travel ............	104	104
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,995	4,820	150	25
23	Insurance ...	19,448	18,886	396	166
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	DUES AND SUBSCRIPTIONS	7,867	7,592	236	39
b	MEDICAL SUPPLIES	6,143	6,143
c	TEAM MEMBER TRAINING	2,661	2,661
d	MISCELLANEOUS	1,392	1,343	42	7
e	All other expenses	921	889	27	5
25	Total functional expenses. Add lines 1 through 24e	575,722	512,212	46,481	17,029
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			38,873	1	93,629
2	Savings and temporary cash investments .........			133,936	2	119,948
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			67,095	4	101,825
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			15,138	9	12,186
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	27,714
b	Less: accumulated depreciation	10b	9,787	19,173	10c	17,927
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 33)...			274,215	16	345,515

17	Accounts payable and accrued expenses .....	4,755	17	45,650
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D		25
26	Total liabilities. Add lines 17 through 25..	4,755	26	45,650

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	269,460	27	299,865
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	269,460	32	299,865
33	Total liabilities and net assets/fund balances ........	274,215	33	345,515