2024-10-11T14:22:38-05:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2023-01-01 840921521 PUEBLO COMMUNITY HEALTH CENTER INC PUEB 7195438711 110 EAST ROUTT AVENUE PUEBLO CO 81004 PHILLIP L DAVIS CFO 7195438711 2024-10-10 1 1 SARAH HINTZ P00492291 3034668822 2024-10-10 2023 2024-10-15 13:58:12Z DONALD MOORE 110 EAST ROUTT AVENUE PUEBLO CO 81004 44023066 0 X WWW.PUEBLOCHC.ORG X 1983 CO TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED. 12 12 392 13 0 0 11992133 8490299 27862659 34482650 381226 654951 273441 293872 40509459 43921772 2960967 3709114 0 0 27002995 28803315 0 0 0 10203747 11131201 40167709 43643630 341750 278142 53628854 52347187 15139607 13536265 38489247 38810922 TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED BY OFFERING TOP QUALITY CARE THROUGH ACCESSIBILITY, LEADERSHIP, AND FINANCIAL INDEPENDENCE. 0 0 30241280 3709114 27535584 PRIMARY HEALTH CARE SERVICES, INCLUDING PREVENTATIVE CARE,URGENT AND MINOR EMERGENCY CARE, BEHAVIORAL HEALTH, PERINATAL, AND DIAGNOSTIC LABORATORY AND RADIOLOGY, FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO AND HUERFANO COUNTIES. 3185211 5102641 PHARMACEUTICAL SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 2445360 1844425 PREVENTATIVE, RESTORATIVE, AND EMERGENCY DENTAL HEALTH CARE SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 35871851 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 43 0 1 392 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X PHILLIP DAVIS 7195438718 110 E ROUTT AVE PUEBLO CO 81004 LOUIS BALIZET PRESIDENT 0.00 X X 0 0 0 YESENIA BEASCOCHEA PRESIDENT-ELECT 0.00 X X 0 0 0 STEVE SHIRLEY TREASURER 0.00 X X 0 0 0 SANDRA LEMING SECRETARY 0.00 X X 0 0 0 LINDA RIKHOFF PAST-PRESIDENT 0.00 X X 0 0 0 SHIRLEY CORDOVA DIRECTOR 0.00 X 0 0 0 RICHARD DURAN DIRECTOR 0.00 X 0 0 0 MICHAEL GAGE DIRECTOR 0.00 X 0 0 0 TRACY PHILLIPS DIRECTOR 0.00 X 0 0 0 ALEXIS ROMERO STEWART DIRECTOR 0.00 X 0 0 0 TERRI WELDON DIRECTOR 0.00 X 0 0 0 ARTHUR YARBROUGH DIRECTOR 0.00 X 0 0 0 MOORE DONALD E CHIEF EXECUTIVE OFFICER 1.00 X 215878 0 53149 MURRAY AARON CHIEF DENTAL OFFICER 1.00 X 213162 0 50448 REED WARREN CLAIRE CMO OFFICER THRU 8/1/2024 1.00 X 197042 0 54603 PITTS JASON M CHIEF OPERATIONS OFFICER 1.00 X 144412 0 47172 DAVIS PHILLIP CHIEF FINANCIAL OFFICER 1.00 X 144230 0 20478 KELLY LAURA A CDO/CHIEF FOUNDATION OFFICER 1.00 X 114220 0 32629 RILEY DANA PHYSICIAN 1.00 X 242676 0 54670 LACROIX CARLY A PHYSICIAN 1.00 X 239309 0 19233 PAYNE STEPHANIE PHYSICIAN 1.00 X 236470 0 31920 SABATINI PATRICIA S PHYSICIAN 1.00 X 235814 0 35843 KRAUSE DAVID SENIOR MEDICAL DIRECTOR 1.00 X 226866 0 43491 2210079 0 443636 52 0 1 0 CARDINAL HEALTH PHARMACY MANAGEMENT 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT SERVICES 1167660 OSIS PO BOX 772852 CHICAGO IL 60677 SOFTWARE SUPPORT SERVICES 510074 JD'S JANITORIAL SERVICE LLC 225 BROADWAY AVENUE PUEBLO CO 81004 JANITORIAL SERVICES 345880 STRATUS INDEMAND SERVICE LLC PO BOX 675248 DETROIT MI 48267 TRANSLATION SERVICES 296920 340B TECHNOLOGIES INC 161 GAITHER DR STE 201 MT LAUREL NJ 08054 CONTRACT PHARMACY CONSULTING 276201 29 981449 7013119 495731 8490299 PATIENT REVENUE 621110 29380009 29380009 PHARMACY REVENUE 621110 5102641 5102641 34482650 756245 756245 101294 -101294 -101294 -101294 MISCELLANEOUS INCOME 621990 293872 293872 293872 43921772 34482650 0 948823 24000 24000 3685114 3685114 1225875 301940 923935 22323373 20730757 1592616 841424 767950 73474 2591601 2317982 273619 1821042 1622052 198990 44418 44418 90838 790 90048 1534010 1419470 114540 267278 89049 178229 453361 213837 239524 2103695 632996 1470699 1328274 39449 1288825 47940 41588 6352 116454 102036 14418 509316 509316 927891 621686 306205 101497 22338 79159 MEDICAL SUPPLIES 3153471 3153471 DUES & LICENSES 175750 59211 116539 SECURITY 161266 3444 157822 OTHER EXPENSES 115742 22691 93051 43643630 35871851 7771779 0 18509 12804584 8998427 453075 723746 2715462 6437982 22025700 22025700 65834 69777 372840 311499 21595341 10225338 12593057 11370003 1328344 1371877 1269958 1019667 53628854 52347187 2618285 2832823 142500 12307115 10560942 214207 0 15139607 13536265 X 37160903 37439045 1328344 1371877 38489247 38810922 53628854 52347187 X 278142 43533 X X 0 1 X 1 1 1 X 7439690 9183352 11748789 11992133 8490299 48854263 7439690 9183352 11748789 11992133 8490299 48854263 48854263 371817 76937 235894 381226 756245 1822119 167349 10424 55056 273441 293872 800142 51476524 142693913 0.94910 0.95510 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2019 AMOUNT: $ 167,349. 2020 AMOUNT: $ 10,424. 2021 AMOUNT: $ 55,056. 2022 AMOUNT: $ 273,441. 2023 AMOUNT: $ 293,872. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 25975 25975 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE COLORADO COMMUNITY HEALTH NETWORK AND THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. A PORTION OF THE DUES ARE ALLOCATED TO LOBBYING EXPENDITURES INCURRED ON BEHALF OF THEIR MEMBER ORGANIZATIONS. 2414582 2414582 14606181 6610414 7995767 4574578 3614924 959654 11370003 X 40359112 78921 -3641581 -3562660 43921772 0 43921772 40037437 78921 78921 39958516 3685114 3685114 43643630 PART X, LINE 2: THE ORGANIZATION HAS PREVIOUSLY RECEIVED NOTICE OF EXEMPTION OF INCOME TAX FROM THE INTERNAL REVENUE SERVICE UNDER SECTION 501(C)(3) OF THE FEDERAL INTERNAL REVENUE CODE (IRC). THE ORGANIZATION IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE IMPLEMENTATION OF THE ACCOUNTING STANDARDS REGARDING UNCERTAIN TAX PROVISIONS HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHARITY CARE NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS -3,685,114. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 43,533. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS 3,685,114. 1 PUEBLO COMMUNITY HEALTH CENTER FOUNDATION 310 COLORADO AVENUE PUEBLO CO 81004 041404345 501(C)(3) 24000 0 N/A N/A GENERAL OPERATING EXPENSES 1 0 PATIENT GRANTS 3488 3685114 N/A N/A PART I, LINE 2: THE ORGANIZATION MAKES CONTRIBUTIONS TO LOCAL CHARITIES AND GOVERNMENT AGENCIES. PUEBLO COMMUNITY HEALTH CENTER (PCHC) CONFIRMS THE CHARITABLE STATUS OF THE RECIPIENT ORGANIZATION, BUT DOES NOT MONITOR THE RECEIPTS FOR SPECIFIC USE OF THE FUNDS. FUNDS TRANSFERRED TO THE PUEBLO COMMUNITY HEALTH CENTER FOUNDATION ARE MONITORED BY COMMON MANAGEMENT WHO ENSURE THAT ALL TRANSFERRED FUNDS ARE USED FOR APPROPRIATE PURPOSES. PCHC PAYS THE INVOICES FOR PUEBLO PRIMARY CARE QALICB (PPC) AND THEN IS REIMBURSED FORM PPC AFTER THEY ARE PAID. PCHC KEEPS AN A/R ACCOUNT FROM PPC AND PPC KEEPS AN A/P ACCOUNT TO PCHC. CHARITY CARE PROVIDED IS MONITORED BY THE DETERMINATION OF FINANCIAL NEED. X X X 0 0 0 0 0 0 0 0 0 RILEY DANA PHYSICIAN 241676 0 1000 0 0 0 11830 0 42840 0 297346 0 0 0 SABATINI PATRICIA S PHYSICIAN 234814 0 1000 0 0 0 12275 0 23568 0 271657 0 0 0 KRAUSE DAVID SENIOR MEDICAL DIRECTOR 221066 0 5800 0 0 0 13556 0 29935 0 270357 0 0 0 MOORE DONALD E CHIEF EXECUTIVE OFFICER 214878 0 1000 0 0 0 12953 0 40196 0 269027 0 0 0 PAYNE STEPHANIE PHYSICIAN 234613 0 1857 0 0 0 7094 0 24826 0 268390 0 0 0 MURRAY AARON CHIEF DENTAL OFFICER 212162 0 1000 0 0 0 11062 0 39386 0 263610 0 0 0 LACROIX CARLY A PHYSICIAN 238309 0 1000 0 0 0 8479 0 10754 0 258542 0 0 0 REED WARREN CLAIRE CMO OFFICER THRU 8/1/2024 196264 0 778 0 0 0 11822 0 42781 0 251645 0 0 0 PITTS JASON M CHIEF OPERATIONS OFFICER 143412 0 1000 0 0 0 4332 0 42840 0 191584 0 0 0 DAVIS PHILLIP CHIEF FINANCIAL OFFICER 143230 0 1000 0 0 0 5769 0 14709 0 164708 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD. THE EXECUTIVE COMMITTEE HAS THE POWER TO ACT IN SITUATIONS THAT CANNOT WAIT FOR THE NEXT FULL BOARD MEETING. HOWEVER, THE EXECUTIVE COMMITTEE MAY NOT SUPERSEDE THE BOARD'S AUTHORITIES, FUNCTIONS AND RESPONSIBILITIES. THE EXECUTIVE COMMITTEE BRIEFS THE FULL BOARD ON ALL SUCH ACTIONS TAKEN. ON THOSE ACTIONS, THE BOARD SUBSEQUENTLY VOTES ON WHETHER TO RATIFY THE ACTIONS OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE ALSO HANDLES SPECIFIC QUESTIONS REFERRED BY THE FULL BOARD, ISSUES THAT NEED PRELIMINARY DISCUSSION BEFORE THE FULL BOARD CONSIDERS THEM, AND ROUTINE MATTERS NOT REQUIRING FULL BOARD ATTENTION. THE EXECUTIVE COMMITTEE ESTABLISHES AND IMPLEMENTS A PROCESS FOR ASSESSING THE PERFORMANCE OF THE CEO. FORM 990, PART VI, SECTION A, LINE 3 PHARMACY MANAGEMENT IS OUTSOURCED TO CARDINAL HEALTH AND WAS COMPENSATED $1,167,660 IN 2023. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO THE BY-LAWS INCLUDE REVISED RESPONSIBILITIES OF THE BOARD AND QUALITY/PERFORMANCE IMPROVEMENT COMMITTEE SECTION TO BE IN LINE WITH HRSA EXPECTATIONS INCLUDING: - SPECIAL MEETINGS OF THE BOARD MAY BE CALLED BY THE PRESIDENT, A MAJORITY OF THE EXECUTIVE COMMITTEE, OR A MAJORITY OF THE BOARD. - NOW APPROVE THE POSITION DESCRIPTION, SUPERVISE AND EVALUATION OF THE CEO. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED IN DETAIL BY THE CFO AND CEO. IT WAS THEN REVIEWED BY THE FINANCE COMMITTEE, THEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY PROHIBITS TRANSACTIONS THAT WOULD GIVE RISE TO A CONFLICT OF INTEREST. BOARD MEMBERS ARE PROVIDED WITH A CONFLICT OF INTEREST POLICY WHEN APPOINTED TO THE BOARD. ALL BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST AND COMPENSATION DISCLOSURE STATEMENT ANNUALLY. EMPLOYEES SIGN THAT THEY RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY WHEN HIRED AND ARE INFORMED THAT THEY NEED TO ADVISE THE ORGANIZATION IF A CONFLICT OF INTEREST ARISES. THE DISCLOSURE STATEMENTS ARE REVIEWED BY THE CEO AND PCHC'S LEGAL COUNSEL (IF NECESSARY). THE EXECUTIVE COMMITTEE DETERMINES THE APPROPRIATE PROCESS FOR RESOLVING AND/OR MANAGING THE CONFLICTS. AT EACH MONTHLY BOARD MEETING, BOARD MEMBERS ARE ASKED IF THEY HAVE ANY CONFLICTS TO DISCLOSE AND THIS IS NOTED IN THE BOARD MINUTES. BOARD MEMBERS WITH AN IDENTIFIED CONFLICT OF INTEREST RECUSE THEMSELVES FROM THE CONVERSATION AND THE VOTE, AND THIS IS REFLECTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD PERFORMS A THOROUGH REVIEW TO DETERMINE SUITABLE COMPENSATION FOR THE CEO. AFTER APPROVAL BY THE BOARD IN EXECUTIVE SESSION, A WRITTEN CONTRACT IS PREPARED AND SIGNED. COMPARABILITY DATA CAN INCLUDE COLORADO COMMUNITY HEALTH NETWORK OR MOUNTAIN STATES EMPLOYER'S COUNCIL COMPENSATION SURVEYS OR FORMS 990 OF SIMILAR ORGANIZATIONS. THE CEO AND HR DIRECTOR PERFORM A THOROUGH REVIEW TO DETERMINE SUITABLE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES. COMPARABILITY DATA CAN INCLUDE COLORADO COMMUNITY HEALTH NETWORK OR MOUNTAIN STATES EMPLOYER'S COUNCIL COMPENSATION SURVEYS OR FORMS 990 OF SIMILAR ORGANIZATIONS. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2023. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. REQUESTS MAY BE SUBMITTED TO THE CEO AND ARE FORWARDED TO THE BOARD PRESIDENT. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 43,533. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. PUEBLO PRIMARY CARE QALICB 110 EAST ROUTT AVENUE PUEBLO CO 81004 853699288 SUPPORT CLINIC CO 501(C)(3) LINE 12C, III-FI PUEBLO COMMUNITY HEALTH CENTER 1 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 PUEBLO PRIMARY CARE QALICB C 981449 FMV PUEBLO PRIMARY CARE QALICB L 70000 FMV PUEBLO PRIMARY CARE QALICB Q 158143 FMV PUEBLO PRIMARY CARE QALICB S 909062 FMV