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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 28,322 | 113,467 | 453,125 | 603,333 | 1,074,464 | 2,272,711 |
| 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 | 20,303 | 102,336 | 128,826 | 38,852 | 195,211 | 485,528 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 28,775 | 28,775 | ||||
| 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 | 48,625 | 215,803 | 581,951 | 642,185 | 1,298,450 | 2,787,014 |
| 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. | 15,000 | 90,723 | 384,574 | 301,400 | 848,879 | 1,640,576 |
| c | Add lines 7a and 7b.. | 15,000 | 90,723 | 384,574 | 301,400 | 848,879 | 1,640,576 |
| 8 | Public support. (Subtract line 7c from line 6.) | 1,146,438 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 48,625 | 215,803 | 581,951 | 642,185 | 1,298,450 | 2,787,014 |
| 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.).. | 48,625 | 215,803 | 581,951 | 642,185 | 1,298,450 | 2,787,014 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990 - ORGANIZATION'S MISSION | PREMIER MOBILE HEALTH SERVICES MISSION IS TO PROVIDE ACCESS TO QUALITY HEALTHCARE SERVICES TO THE MEDICALLY VULNERABLE AND THOSE WHO ARE MOST AT RISK OF DEVELOPING AND EXPERIENCING LONG-TERM ILLNESSES AND HOSPITALIZATION. |
| FORM 990, PAGE 2, PART III, LINE 4A | SINCE OUR FOUNDING IN 2018 WITH A SINGLE MOBILE MEDICAL CLINIC, OUR ORGANIZATION HAS GROWN RAPIDLY WITH OUR HIGHEST RATE OF GROWTH BEGINNING IN 2022. WE NOW HAVE 2 MOBILE MEDICAL CLINICS AND HAVE OPENED OUR BRICK-AND- MORTAR WALK-IN CLINIC THAT ALSO SERVES AS OUR ADMINISTRATIVE OFFICE. OUR HIGHLY SKILLED MULTILINGUAL PROFESSIONALS GREW FROM 6 TO 13 AND THE MEMBERS OF OUR VOLUNTEER RANKS GREW FROM 49 TO 84. IN 2023 OUR VOLUNTEERS DONATED OVER 2,400 SERVICE HOURS. OUR PATIENT COUNT IN 2023 WAS 2,409 WHICH REPRESENTS A GROWTH RATE OF 63% OVER 2022. OUR GENEROUS DONORS HELPED US TO CREATE A SENSE OF BELONGING AND SUPPORT DURING THESE DIFFICULT TIMES AS FAMILIES CONTINUE TO RECOVER FROM HURRICANE IAN THAT DEVASTED OUR COMMUNITY IN SEPTEMBER 2022. WE PARTICIPATED IN 24 COMMUNITY OUTREACH EVENTS IN 2023 WHERE WE SCREENED 512 INDIVIDUALS, PERFORMED 127 FREE SCHOOL PHYSICALS, AND ALSO PERFORMED 33 OTHER TESTS AND PROCEDURES INCLUDING HIV TESTS, PROSTATE AND BREAST EXAMS. CHILDREN HAVE RECEIVED 36 DENTAL SCREENINGS AND SUPPLIES, PLUS 54 VISION AND HEARING SCREENINGS. WE GAVE AWAY 350 BACKPACKS FILLED WITH DONATED SCHOOL SUPPLIES AT OUR BACK TO SCHOOL EVENT. WE ALSO PROVIDED 500 CHRISTMAS TOYS, 16 BICYCLES, 100 HEALTHY FOOD BOXES, MEDICAL SUPPLIES, FREE FLU SHOTS, HYGIENE SUPPLIES AND COUNTLESS OTHER ITEMS AT OUR BREAKFAST WITH SANTA EVENT. BECAUSE OF OUR COLLABORATION WITH OUR PARTNERS, WE ALSO DISTRIBUTED TOTE BAGS TO THE FAMILIES THROUGHOUT THE YEAR FILLED WITH SANITARY NAPKINS AND MEDICAL SUPPLIES TOTALING OVER 87,000. WE ALSO HELD SEVERAL OUTREACH EVENTS IN PARTNERSHIP WITH LEE HEALTH OFFERING FREE LUNG CANCER SCREENINGS. ALL OF THIS WAS DONE IN ADDITION TO MAINTAINING A VERY ROBUST MONTHLY TRAVEL SCHEDULE FOR OUR MOBILE CLINIC TO PROVIDE MEDICAL CARE IN THE UNDERSERVED AREAS IN OUR COMMUNITY. THE SIGNIFICANT GROWTH CAN BE ATTRIBUTED TO THE LONG-TERM RECOVERY EFFORTS FROM THE HURRICANE WHICH EXPANDED OUR PRESENCE IN THE COMMUNITY AND THEREFORE, INCREASED THE NUMBER OF REQUESTS FROM COMMUNITY CENTERS, CHURCHES, AND OTHER FACILITIES TO BE ADDED TO OUR MOBILE CLINIC ROUTE. IN ADDITION, THE UNWINDING OF MEDICAID HAS CREATED A HEALTHCARE CRISIS THAT REQUIRES URGENT ATTENTION AND SUPPORT TO ENSURE THAT EVERYONE IN THE COMMUNITY CAN RECEIVE THE CARE THEY DESERVE. MEDICAID PLAYS A VITAL ROLE IN PROVIDING AFFORDABLE HEALTHCARE COVERAGE TO LOW-INCOME INDIVIDUALS AND FAMILIES, ENSURING THAT THEY HAVE ACCESS TO ESSENTIAL MEDICAL TREATMENTS, PREVENTIVE CARE, AND MEDICATIONS. HOWEVER, AS MEDICAID PROGRAMS FACE BUDGET CUTS AND POLICY CHANGES, THERE IS A PROFOUND IMPACT ON COUNTLESS INDIVIDUALS, LEAVING THEM WITHOUT ACCESS TO CRUCIAL HEALTHCARE SERVICES. MANY INDIVIDUALS ARE BEING LEFT UNINSURED AND UNABLE TO AFFORD THE HEALTHCARE SERVICES THEY DESPERATELY NEED. THIS PLACES AN EVEN GREATER BURDEN ON THE MOBILE CLINICS AND THE COMMUNITY WE SERVE. OUR CLINICS, ALREADY OPERATING WITH LIMITED RESOURCES, NOW FACE AN INCREASED DEMAND FOR OUR SERVICES AS WE TRY TO MEET THE HEALTHCARE NEEDS OF THOSE WHO HAVE FALLEN THROUGH THE GAPS IN THE SYSTEM. WE ARE COMMITTED TO MAKING HEALTH CARE CONVENIENT FOR OUR PATIENTS. OUR PARTNERSHIPS AND DONORS HAVE FUNDED OUR CAPABILITY TO DISPENSE CONVENTIONAL MEDICATIONS AND THE OPERATION OF A POINT OF CARE IN-HOUSE LABORATORY. THIS LABORATORY IS A HUGE BENEFIT FOR THE UNINSURED PATIENTS WE SERVE AS IT ENSURES QUICK LAB RESULTS, SO THEY NO LONGER MUST WAIT FOR THEIR TEST RESULTS TO COME BACK FOR A SECOND VISIT. WE ALSO PROVIDE PATIENT-FRIENDLY TRANSPORTATION FOR THOSE UNABLE TO PICK UP THEIR PRESCRIPTIONS AND TRAVEL TO THEIR LIFE-SAVING APPOINTMENTS, SUCH AS DIALYSIS, PHYSICAL THERAPY, AND OTHER ESSENTIAL MEDICAL REFERRALS. FOR ADDED CONVENIENCE, WE ALSO OFFER TELEHEALTH VISITS. OUR ABILITY TO PROVIDE FREE HEALTH CARE SERVICES IS ALSO MADE POSSIBLE BY OUR 12 AFFILIATION AGREEMENTS WITH NATIONAL AND LOCAL UNIVERSITIES HELPING US PROVIDE SERVICES AT NO-COST AND LOW-COST. OUR ORGANIZATION IS A BRIDGE FOR MEDICAL RESIDENTS, NURSE PRACTITIONER STUDENTS, MEDICAL ASSISTANTS AND CERTIFIED NURSING ASSISTANT STUDENTS, AS THEY TRANSITION INTO PROFESSIONAL CAREERS. IN 2023 WE TRAINED 13 STUDENTS IN THE MEDICAL FIELD. WE WERE HONORED TO RECEIVE THE GOLD STANDARD SEAL FROM THE NATIONAL ASSOCIATION OF FREE AND CHARITABLE CLINICS. THIS RECOGNITION IS A TESTAMENT TO OUR HARD WORK, DEDICATION, AND UNWAVERING COMMITMENT TO PROVIDING QUALITY HEALTHCARE SERVICES TO THOSE IN NEED. THE TEAM EFFORTS HAVE UNDOUBTEDLY MADE A PROFOUND IMPACT ON THE LIVES OF COUNTLESS INDIVIDUALS AND COMMUNITIES. THIS AWARD IS A REMINDER OF THE INCREDIBLE DIFFERENCE THAT CAN BE MADE WHEN WE COME TOGETHER WITH A SHARED PURPOSE TO MAKE A POSITIVE IMPACT ON THE WORLD. OUR ORGANIZATION IS ALSO HONORED TO BE A PART OF THE HARVARD UNIVERSITY MOBILE HEALTH MAP, AS HARVARD CONTINUES TO MAKE THE CASE THAT "MOBILE HEALTHCARE IS GOOD FOR COMMUNITIES". WE BRING MUCH NEEDED MEDICAL CARE, AND BRING LOVE, HOPE, COMPASSION, AND A SENSE OF WELL-BEING TO THE INDIVIDUALS WE ARE SERVING DURING THE WORST TIME OF THEIR LIVES. OUR VAST EXPERIENCE IN CARING FOR THE MARGINALIZED AND THE UNDERSERVED COMMUNITIES IN OUR AREA HAS PREPARED US TO BE ABLE TO RESPOND THE WAY WE ARE TODAY. PREMIER MOBILE HEALTH SERVICES REMAINS COMMITTED TO PROVIDING ESSENTIAL LIFE-SAVING CARE TO THOSE AFFECTED WHILE CLOSING THE HEALTHCARE EQUITY GAP. |
| FORM 990, PAGE 6, PART VI, LINE 4 | THE ORGANIZATION'S BYLAWS WERE AMENDED DURING 2023 TO UPDATE THE ROLES AND RESPONSIBLITIES OF THE CHAIRPERSON OF THE BOARD OF DIRECTORS AND THE CEO OF THE ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE PRESIDENT/CEO AND BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICTS OF INTEREST ARE MONITORED DURING EMPLOYEE EVALUATIONS AND COMMUNICATING WITH BOARD MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE COMPENSATION OF THE PRESIDENT/CEO IS APPROVED BY THE BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | THE PRIOR PERIOD ADJUSTMENT CONSISTS OF THE NET EFFECT OF RECORDING BEGINNING BALANCES FOR ACCOUNTS RECEIVABLE AND ACCOUNTS PAYABLE IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. |
| FORM 990, PAGE 12, PART XII, LINE 2C | THE ORGANIZATION OBTAINED THEIR FIRST AUDIT OF THEIR FINANCIAL STATEMENTS AS OF AND FOR THE YEAR ENDED DECEMBER 31, 2023. |
| Software ID: | |
| Software Version: |