Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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 |
0 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 31,500 | 31,550 | 55,000 | 55,000 | 60,000 | 233,050 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | Total. Add lines 1 through 3 | 31,500 | 31,550 | 55,000 | 55,000 | 60,000 | 233,050 |
| 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) .. | 1,501 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 231,549 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 31,500 | 31,550 | 55,000 | 55,000 | 60,000 | 233,050 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 0 | |||||
| 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.).. | 0 | |||||
| 11 | Total support. Add lines 7 through 10 | 233,050 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | 0 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 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 | ||||
| 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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 22015534 |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Stephen Bright, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 670. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Lynn Andersen, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 162. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Andrew Olsen: 5090 S. 3200 W., Taylorsville, UT, 84122; None, 1099. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Desmond Marshburn, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 619. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; David Browning, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 63. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Sylvia Miller: PO Box 1179, Enterprise, UT, 84725; None, 3420. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Jeff Mann, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 312. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Benjamin Benavidez: 70858 N. Silver Springs Way, Eagle Mountain, UT, 84005; None, 790. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; James Dumas: 885 E. Main Street, Mt. Pleasant, UT, 84647; None, 2700. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Richard Roder, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 227. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Gabor Raya, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 2800. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Christian Pratt, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 445. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Scott Maddix, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 190. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Phillip Dolliver: 3705 N. 4100 W., Cedar City, UT, 84721; None, 528. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Carl K. Hansen: 1350 W. 100 N., Hurricane, UT, 84737; None, 104. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Mary Huddlestone: 515 E. 700 S., Suite A, Mt. Pleasant, UT, 84647; None, 508. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Amber Seghiri, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 135. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Jeffrey Mann, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 89. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Cody Johnson, c/o Riverside Dental: 368 E. Riverside Dr. #2a, St. George, UT, 84790; None, 175. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; John C. Pfau: 240 N. 500 E., Richfield, UT, 84701; None, 506. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Von Giorgen, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 60. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Thomas Plustwik: PO Box 184, Mt. Pleasant, UT, 84647; None, 2405. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Garry Carlson, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 2416. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Stephanie Johnson, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 1106. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Merrill Pack, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 390. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Bill Bowles: 11364 E. 16000 N., Mt. Pleasant, UT, 84647; None, 1000. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Paul Lane, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 178. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Nancy Royle, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 456. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Rodger Kingston, c/o Legacy Dental: 1345 E. 3900 S., Suite 116, Salt Lake City, UT, 84124; None, 1000. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Dana Hayes, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 273. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Scott A. Craig: 2929 E. 450 N., St. George, UT, 84790; None, 1056. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Carl Hansen: 470 W. 100 S., St. George, UT, 84770; None, 42. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; James Hunt: 1750 Bran Ave., Salt Lake City, UT, 84108; None, 284. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Robert Tober, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 1000. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Jeff Kempe, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 82. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Bill Hansen, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 2545. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Lynn Andersen, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 92. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Jaron Wolf: 184 Main Street, Cedar City, UT, 84720; None, 625. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Scott Craig: 2929 E. 450 N., St. George, UT, 84790; None, 56. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Edgard Garcia: 5520 W. Nautilus Drive, Kearns, UT, 84118; None, 2800. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Peter Schisinger: 4760 N. White Rocks Dr., St. George, UT, 84770; None, 193. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Mallerie Thurman: 48 W. 1675 N. Apt. #2, Sunset, UT, 84015; None, 1036. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Jason Hess, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 266. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Michael Shermer, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 151. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Richard Enbody, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 462. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental car; David Paxman, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 89. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Von G. Lofgreen, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 60. |
| Form 990EZ, Part I, Line 10 | Dental care for veterans; Dental care; Lynn Neilson, c/o Greenwood Health: 7495 S. State Street, Midvale, UT, 84047; None, 220. |
| Form 990EZ, Part I, Line 16 | Travel/Outreach 4601. |
| Software ID: | 22015534 |
| Software Version: |