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.") .. | 3,364,870 | 5,204,198 | 5,244,538 | 5,330,502 | 3,790,988 | 22,935,096 |
| 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 | 3,364,870 | 5,204,198 | 5,244,538 | 5,330,502 | 3,790,988 | 22,935,096 |
| 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. | 22,935,096 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,364,870 | 5,204,198 | 5,244,538 | 5,330,502 | 3,790,988 | 22,935,096 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 3,793 | 10,946 | 15,080 | 15,158 | 5,691 | 50,668 |
| 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.).. | 4,564 | 1,071 | 560 | 617 | 1,871 | 8,683 |
| 11 | Total support. Add lines 7 through 10 | 22,994,447 | |||||
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.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) |
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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 Version: |
| Return Reference | Explanation |
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| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND PROVIDED TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; UNDERSTAND THE ORGANIZATION IS A FEDERALLY QUALIFIED HEALTH CENTER AND WILL CONDUCT THEMSELVES AT ALL TIME IN A MANNER CONSISTENT WITH THE REQUIREMENTS OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | A COMPENSATION COMMITTEE USES A COMPENSATION STUDY, THE WRITTEN EMPLOYMENT CONTRACT, AND COMPARISON OF OTHER TAX-EXEMPT ORGANIZATIONS WITH SIMILAR EXEMPT PURPOSE TO DETERMINE THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER, OTHER OFFICERS, AND KEY EMPLOYEES' COMPENSATION. THE EXECUTIVE TEAM AND CEO UTILIZES COMPARABLE SALARY AND COMPENSATION STUDIES THAT ARE IN LINE WITH THE SIZE, REGION, AND FISCAL BUDGET OF THE ORGANIZATION. THE COMPENSATION AMOUNT DETERMINED BY THE COMMITTEE IS THEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST, THE GOVERNING DOCUMENTS ARE PROVIDED VIA EMAIL OR US POSTAL SERVICE. |
| FORM 990, ITEM B - AMENDED RETURN | FORM 990, HEADING, ITEM B: THE AUDITED FINANCIAL STATEMENTS WERE NOT AVAILABLE WHEN THE PREVIOUS FORM 990 WAS FILED. EACH PART OR SCHEDULE AND LINE ITEM OF THE FORM 990 THAT WAS AMENDED IS AS FOLLOWS: FORM 990, PART I LINE 9 PROGRAM SERVICE REVENUE: INCREASED BY $23,689 LINE 11 OTHER REVENUE: INCREASED BY $57,095 LINE 12 - TOTAL REVENUE: INCREASED BY $80,784 LINE 15 SALARIES, OTHER COMPENSATION, EMPLOYEE BENEFITS: INCREASED BY $1 LINE 16B TOTAL FUNDRAISING EXPENSES: INCREASED BY $10,788 LINE 17 - OTHER EXPENSES: DECREASED BY $94,510 LINE 18 - TOTAL EXPENSES: DECREASED BY $94,509 LINE 19 - REVENUE LESS EXPENSES: INCREASED BY $175,293 LINE 20 - TOTAL ASSETS: INCREASED BY $137,762 LINE 21 - TOTAL LIABILITIES: DECREASED BY $46,304 LINE 22 - NET ASSETS: INCREASED BY $184,066 FORM 990, PART III LINE 4A - EXPENSES: DECREASED BY $568,399 LINE 4A REVENUE: INCREASED BY $80,784 LINE 4E - TOTAL PROGRAM SERVICE EXPENSES: DECREASED BY $568,399 FORM 990, PART IV LINE 11F MARKED YES TO REFLECT THAT THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE TAX YEAR INCLUDE A FOOTNOTE THAT ADDRESSES THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS. LINE 12A MARKED YES TO REFLECT THAT THE ORGANIZATION OBTAINED SEPARATE, INDEPENDENT AUDITED FINANCIAL STATEMENTS FOR THE TAX YEAR. LINE 26 MARKED YES TO REFLECT THE COMPLETION OF SCHEDULE L, PART II FOR LOANS PAYABLE TO OFFICERS OF THE ORGANIZATION FORM 990, PART VIII LINE 2A PROGRAM SERVICE REVENUE PATIENT MEDICAL SERVICES: INCREASED BY $23,689 LINE 10A GROSS SALES OF INVENTORY, LESS RETURNS AND ALLOWANCES: DECREASED BY $61,017 LINE 10B COST OF GOODS SOLD: DECREASED BY $118,112 LINE 10C NET INCOME FROM SALES OF INVENTORY: INCREASED BY $57,095 LINE 12 - TOTAL REVENUE: INCREASED BY $80,784 FORM 990, PART IX LINE 7 OTHER SALARIES AND WAGES, TOTAL EXPENSES: INCREASED BY $1 LINE 11G OTHER FEES FOR SERVICES, TOTAL EXPENSES: DECREASED BY $24,945 LINE 13 OFFICE EXPENSES, TOTAL EXPENSES: INCREASED BY $51,245 LINE 16 OCCUPANCY, TOTAL EXPENSES: DECREASED BY $78,546 LINE 17 TRAVEL, TOTAL EXPENSES: INCREASED BY $1 LINE 20 INTEREST, TOTAL EXPENSES: INCREASED BY $1 LINE 22 DEPRECIATION, DEPLETION, AND AMORTIZATION, TOTAL EXPENSES: INCREASED BY $1 LINE 24A BAD DEBT EXPENSE WAS REPLACED WITH MEDICAL SUPPLIES ORIGINALLY REPORTED ON LINE 24B. THERE WAS NO CHANGE TO THE AMOUNT REPORTED FOR MEDICAL SUPPLIES, TOTAL EXPENSES. LINE 24B MEDICAL SUPPLIES WAS REPLACED WITH REPAIRS & MAINTENANCE ORIGINALLY REPORTED ON LINE 24C. THERE WAS NO CHANGE TO THE AMOUNT REPORTED FOR REPAIRS & MAINTENANCE, TOTAL EXPENSES. LINE 24C REPAIRS & MAINTENANCE WAS REPLACED WITH BAD DEBT EXPENSES ORIGINALLY REPORTED ON LINE 24A. BAD DEBT EXPENSE, TOTAL EXPENSES: DECREASED BY $160,377 LINE 24E ALL OTHER EXPENSES, TOTAL EXPENSES: INCREASED BY $118,110 LINE 25, COLUMN A TOTAL FUNCTIONAL EXPENSES, TOTAL EXPENSES: DECREASED BY $94,509 LINE 25, COLUMN B TOTAL FUNCTIONAL EXPENSES, PROGRAM SERVICE EXPENSES: DECREASED BY $568,399 LINE 25, COLUMN C TOTAL FUNCTIONAL EXPENSES, MANAGEMENT AND GENERAL EXPENSES: INCREASED BY $463,102 LINE 25, COLUMN D TOTAL FUNCTIONAL EXPENSES, FUNDRAISING EXPENSES: INCREASED BY $10,788 FORM 990, PART X LINE 1 CASH NON-INTEREST BEARING: INCREASED BY $45,994 LINE 2 SAVINGS AND TEMPORARY CASH INVESTMENTS: DECREASED BY $45,994 LINE 4 - ACCOUNTS RECEIVABLE, NET: INCREASED BY $184,066 LINE 14 INTANGIBLE ASSETS: DECREASED BY $46,304 LINE 16 - TOTAL ASSETS: INCREASED BY $137,762 LINE 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: INCREASED BY $130,000 LINE 23 SECURED MORTGAGES AND NOTES PAYABLE TO UNRELATED THIRD PARTIES: DECREASED BY $176,304 LINE 26 - TOTAL LIABILITIES: DECREASED BY $46,304 LINE 27 - NET ASSETS WITHOUT DONOR RESTRICTIONS: INCREASED BY $184,066 LINE 32 - TOTAL NET ASSETS OR FUND BALANCES: INCREASED BY $184,066 LINE 33 - TOTAL LIABILITIES AND NET ASSETS/FUND BALANCES: INCREASED BY $137,762 FORM 990, PART XI LINE 1 - TOTAL REVENUE: INCREASED BY $80,784 LINE 2 - TOTAL EXPENSES: DECREASED BY $94,509 LINE 3 - REVENUE LESS EXPENSES: INCREASED BY $175,293 LINE 8 PRIOR PERIOD ADJUSTMENT: INCREASED BY $8,773 LINE 10 - NET ASSETS AT END OF YEAR: INCREASED BY $184,066 FORM 990 PART XII LINE 2B MARKED YES TO REFLECT THAT THE ORGANIZATION'S FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTANT. LINE 2C MARKED YES TO REFLECT THAT THE FINANCIAL STATEMENTS FOR THE YEAR WERE AUDITED ON A SEPARATE BASIS. LINE 3A MARKED YES TO REFLECT THAT AS A RESULT OF FEDERAL AWARDS, THE ORGANIZATION WAS REQUIRED TO UNDERGO AN AUDIT AS SET FORTH IN THE UNIFORM GUIDANCE, 2 C.F.R PART 200, SUBPART F. LINE 3B MARKED YES TO REFLECT THAT THE ORGANIZATION DID UNDERGO THE REQUIRED AUDIT MENTIONED IN LINE 3A. SCHEDULE A, PART II LINE 12 GROSS RECEIPTS FROM RELATED ACTIVITIES, ETC.: DECREASED BY $30,435. SCHEDULE D, PART XI LINE 1 - TOTAL REVENUE, GAINS, AND OTHER SUPPORT PER AUDITED FINANCIAL STATEMENTS: INCREASED BY $11,660,320 LINE 2D AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C: INCREASED BY $161,177 LINE 2E - ADD LINE 2A THROUGH 2D: INCREASED BY $159,546 LINE 3 - SUBTRACT LINE 2E FROM LINE 1: INCREASED BY $11,819,866 LINE 4B AMOUNT OF COST OF GOODS SOLD INCLUDED ON FORM 990, PART VIII, LINE 10B AND AMOUNT OF DIRECT FUNDRAISING EXPENSES INCLUDED ON FORM 990, PART VIII, LINE 8B: INCREASED BY $2,753,948 LINE 4C - ADD LINES 4A AND 4B: INCREASED BY $2,753,948 LINE 5 - TOTAL REVENUE: INCREASED BY $9,065,918 SCHEDULE D, PART XII LINE 1 - TOTAL EXPENSES AND LOSSES PER AUDITED FINANCIAL STATEMENTS: INCREASED BY $12,384,855 LINE 2D AMOUNT OF COST OF GOODS SOLD INCLUDED ON FORM 990, PART VIII, LINE 10B AND AMOUNT OF DIRECT FUNDRAISING EXPENSES INCLUDED ON FORM 990, PART VIII, LINE 8B: INCREASED BY $2,753,948 LINE 2E - ADD LINE 2A THROUGH 2D: INCREASED BY $2,753,948 LINE 3 - SUBTRACT LINE 2E FROM LINE 1: INCREASED BY $9,630,907 LINE 4B AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C: INCREASED BY $161,177 LINE 4C - ADD LINES 4A AND 4B: INCREASED BY $161,177 LINE 5 - TOTAL EXPENSES: INCREASED BY $9,792,084 SCHEDULE D, PART XIII THE SUPPLEMENTAL INFORMATION HAS BEEN UPDATED TO REFLECT THE ENTIRE FOOTNOTE SHOWN ON THE AUDITED FINANCIAL STATEMENTS THAT ADDRESSES THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS SCHEDULE L, PART II THIS SCHEDULE WAS CREATED TO REFLECT THE LOANS THAT THE ORGANIZATION'S CEO, TEMPLE ROBINSON AND BOARD CHAIR, DARYL PARKS MADE TO THE ORGANIZATION FOR $65,000 EACH TOTALING $130,000. SCHEDULE M, PART I LINE 25 OTHER-PHARMACEUTICALS MOVED TO LINE 20, DRUGS AND MEDICAL SUPPLIES. AMOUNT REPORTED DID NOT CHANGES. |
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