2015-03-04T10:39:21-06:00 2012-12-31 954895294 R SHANE CHANCE CPA PC PO BOX 341 AZTEC NM 874100341 990 2012-01-01 850397883 NIZHONI SMILES INC NIZH 5053685626 PO BOX 3449 SHIPROCK NM 87420 JAMES M TUTT 5053685626 2014-07-21 1 R SHANE CHANCE P00170250 5053344375 2014-07-21 2012 2016-03-07 17:11:31Z JAMES M TUTT PO BOX 3449 SHIPROCK NM 87420 4599579 0 X NIZHONISMILES.COM X 1992 NM TO PROVIDE DENTAL AND ORTHODONTIC SERVICES TO INDIVIDUALS LIVING ON THE NAVAJO RESERVATION IN NW NEW MEXICO AND NE ARIZONA 5 5 36 0 0 0 0 0 2161087 1371501 -787 462849 243527 76353 2403827 1910703 0 0 0 0 745147 549396 0 0 0 1856022 1267049 2601169 1816445 -197342 94258 5441400 2334777 4454725 1253844 986675 1080933 TO PROVIDE DENTAL AND ORTHODONTIC SERVICES TO INDIVIDUALS LIVING ON THE NAVAJO RESERVATION IN NW NEW MEXICO AND NE ARIZONA 0 0 1556040 1910703 ORTHODONTIC AND DENTAL SERVICES PROVIDED TO INDIVIDUALS LIVING ON THE NAVAJO RESERVATION IN NW NEW MEXICO AND NE ARIZONA 1556040 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 8 0 1 36 1 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 1 0 NM X NIZHONI SMILES INC 5053685626 US HWY 491 N SHIPROCK NM 87420 PEGGY SUE NEZ 1.00 X X 0 0 0 THOMAS TODACHEENEY 1.00 X X 0 0 0 HARRY SLOAN JR 1.00 X X 0 0 0 DR DARLENE SORRELL 1.00 X 0 0 0 DR MICHAEL BECK 3.00 X X 0 0 0 JAMES TUTT 40.00 X 52494 0 0 52494 0 0 0 0 0 0 DR HELLEN BUSH MDS 3107 ASPEN DR FARMINGTON NM 87401 ORTHODONTICS 129225 CRAIG LAYTON DBA FOUR CORNERS DENTAL CON 6601 TENNYSON ST NE APT 11205 ALBUQUERQUE NM 87111 DENTAL 101343 2 REVENUE ORTHO-DENTAL SERVICES 621110 1291409 1291409 REVENUE-PRODUCTS &SERVICES 621110 80092 80092 1371501 76353 0 76353 76353 76353 3151725 2688876 462849 462849 462849 1910703 1910703 0 0 X 52494 52494 441548 273225 168323 -920 1135 -2055 7119 7050 69 49155 28567 20588 640 640 11267 11267 406111 406111 3259 3259 47114 47028 86 -2710 -2710 78140 78140 3013 751 2262 343707 332082 11625 235800 235800 -3600 -3600 BAD DEBT EXPENSE 78361 78361 LABORATORY 31118 31118 CREDIT CARD SERVICE CHA 23409 23409 SERVICE CHARGES 5921 5921 5499 4407 1092 1816445 1556040 260405 0 2248 234 452543 466413 36884 18979 450 859 2704107 1274128 4350943 1429979 598332 418313 5441400 2334777 216711 191453 598332 418313 120667 120667 3413779 434511 30300 30274 74936 58626 4454725 1253844 X 986675 1080933 986675 1080933 5441400 2334777 94258 0 X 0 0 0 X 133327 133327 3631581 3423465 2674393 2160683 1371501 13261623 3631581 3423465 2807720 2160683 1371501 13394950 0 0 0 13394950 27 7 1 35 27 7 1 35 178831 184901 187698 243527 76353 871310 3810439 3608373 2995419 2404210 1447854 14266295 0.93890 0.94120 0.00000 0.00010 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: PER FORM INSTRUCTIONS, OTHER INCOME ON PART III LINE 12 DOES NOT INCLUDE $462,849 GAIN ON THE DISPOSTION OF FIXED ASSETS THAT WERE USED IN THE PERFORMANCE OF THE ORGANIZATIONS PRIMARY MISSION. THE DISPOSITION WAS BY THE TRUSTEE FOR THE NATIONAL BANK OF ARIZONA IN ADVANCE OF PENDING FORECLOSURE ACTIONS BY THE BANK. THE SALE INCLUDED LAND, OFFICE BUILDING, FURNITURE, FIXTURES AND EQUIPMENT LOCATED IN ST. MICHAELS, AZ. THE TRUSTEE APPLIED THE TOTAL PROCEEDS FROM THE SALE TO OUTSTANDING MORTGAGE OBLIGATONS OF THE ORGANIZATION THAT WERE SECURED BY THE ASSETS SOLD. THE GAIN INCLUDES CANCELLATION OF DEBT INCOME IN THE AMOUNT OF $451,725 AS REPORTED BY THE USDA ON FORM 1099-C IN 2012. 1455379 247983 1207396 1248728 1026145 222583 1429979 L-T ORTHO CONTRACTS RECEIVABLE 418313 418313 ACCOUNTS PAYABLE TO RELATED PARTIES 58626 58626 DR MICHAEL BECK OFFICER AND DIRECTOR TEMPORARY WORKING CAPITAL ADVANCE X 30000 30000 0 1 1 MR JAMES TUTT OFFICER TEMPORARY WORKING CAPITAL ADANCE X 4000 4000 0 1 1 DR MICHAEL BECK OFFICER AND DIRECTOR INSTALLMENT PAYOUT CEO FEES ACCRUED IN PRIOR YEARS X 86667 86667 0 1 1 120667 TRUSTEE SALE OF LAND, OFFICE BUILDING, FURNITURE, FIXTURES AND EQUIPMENT LOCATED IN ST MICHAELS, AZ USED IN PERFORMING THE ORGANIZATIONS PRIMARY MISSION.THE PROPERTY WAS SOLD TO AN UNRELATED THIRD PARTY. 2012-09-20 2700000 FAIR MARKET VALUE BASED ON ACTUAL GROSS SALE PRICE RECEIVED BY TRUSTEE FOR NATIONAL BANK OF ARIZONA. THE TRUSTEE DIRECTLY APPLIED THE PROCEEDS FROM THE SALE TO OUTSTANDING MORTGAGE OBLIGATIONS OF THE ORGANIZATION SECURED BY THE ASSETS SOLD. 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 ORGANIZATION PRESENTS COPY OF FORM 990 TO ITS BOARD OF DIRECTORS FOR REVIEW, COMMENT AND APPROVAL AT REGUALAR BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST DISCLOSURE STATEMENT FORMS ARE PREPARED BY OFFICERS, DIRECTORS AND KEY EMPLOYEES ON AN ANNUAL BASIS WHICH ARE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. COPIES OF THE FORMS ARE MAINTAINED IN THE ORGANIZATIONS RECORDS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS, DIRECTORS, MANAGEMENT AND KEY EMPLOYEES IS BASED ON THE RESULTS OF ANNUAL PERFORMANCE EVALUATIONS AND COMPARATIVE REGIONAL COMPENSATION WHICH IS APPROVED BY THE BOARD OF DIRECTORS AND DOCUMENTED IN THE MINUTES OF MEETINGS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAINTAINS ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AT ITS CORPORATE OFFICES IN SHIPROCK, NEW MEXICO. ALL SUCH DOCUMENTS ARE AVAILABLE FOR PUBLIC REVIEW AT THAT LOCATION. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES DENTAL AND OR: PROGRAM SERVICE EXPENSES 406,111. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 406,111.