2023-09-22T12:18:48-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2022-01-01 840921521 PUEBLO COMMUNITY HEALTH CENTER INC PUEB 7195438711 110 EAST ROUTT AVENUE PUEBLO CO 81004 PHILLIP L DAVIS CFO 7195438711 2023-09-18 1 PHILLIP DAVIS XXX-XX-XXXX 1 BECKY DETTMANN CPA P01408585 3034668822 2023-08-28 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DONALD MOORE 110 EAST ROUTT AVENUE PUEBLO CO 81004 40509459 0 X WWW.PUEBLOCHC.ORG X 1983 CO TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED. 9 9 392 10 0 0 11748789 11992133 28274662 27862659 235894 381226 55056 273441 40314401 40509459 3249666 2960967 0 0 25922191 27002995 0 0 0 8326681 10203747 37498538 40167709 2815863 341750 55236903 53628854 15205238 15139607 40031665 38489247 TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED BY OFFERING TOP QUALITY CARE THROUGH ACCESSIBILITY, LEADERSHIP, AND FINANCIAL INDEPENDENCE. 0 0 28065779 2960967 22074332 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. 2959433 0 4869313 PHARMACEUTICAL SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 2063721 0 919014 PREVENTATIVE, RESTORATIVE, AND EMERGENCY DENTAL HEALTH CARE SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 33088933 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 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 40 0 1 392 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X PHILLIP DAVIS 7195438718 110 E ROUTT AVE PUEBLO CO 81004 CLAIRE REED MD CHIEF MEDICAL OFFICER 40.00 0.00 X 288021 0 54145 DANA RILEY MD PHYSICIAN 40.00 0.00 X 219341 0 36245 STEPHANIE PARKER DO PHYSICIAN 40.00 0.00 X 223431 0 30360 DONALD MOORE CHIEF EXECUTIVE OFFICER 40.00 2.00 X 195266 0 54145 DAVID KRAUSE MD SENIOR MEDICAL DIRECTOR 30.00 0.00 X 211141 0 25509 STEPHANIE PAYNE PHYSICIAN 40.00 0.00 X 213327 0 17184 CARLY A LACROIX DO PHYSICIAN 40.00 0.00 X 217684 0 11648 AARON MURRAY CHIEF DENTAL OFFICER 40.00 0.00 X 148556 0 20184 PHILLIP DAVIS CHIEF FINANCIAL OFFICER 40.00 0.00 X 129205 0 22249 JUSTIN MCCARTHY CHIEF OPERATIONS OFFICER THRU 07/22 40.00 0.00 X 140848 0 7584 JASON PITTS CHIEF OPERATING OFFICER 40.00 0.00 X 121019 0 27145 LAURA KELLEY CDO/CHIEF FOUNDATION OFFICER 40.00 0.00 X 102139 0 36034 LOUIS BALIZET MD PRESIDENT 1.00 0.00 X X 0 0 0 YESENIA BEASCOCHEA PRESIDENT-ELECT 1.00 0.00 X X 0 0 0 STEVE SHIRLEY TREASURER 1.00 0.00 X X 0 0 0 SANDRA LEMING SECRETARY 1.00 0.00 X X 0 0 0 LINDA RIKHOFF RN PAST-PRESIDENT 1.00 0.00 X X 0 0 0 SHIRLEY CORDOVA DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL GAGE DIRECTOR 1.00 0.00 X 0 0 0 TRACY PHILLIPS DIRECTOR 1.00 0.00 X 0 0 0 ARTHUR YARBROUGH DIRECTOR 1.00 0.00 X 0 0 0 2209978 0 342432 49 0 1 0 CARDINAL HEALTH PHARNACY 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT SERVICES 1244981 OSIS PO BOX 772852 CHICAGO IL 60677 ELECTRONIC HEALTH RECORD SUPPORT 491330 JD'S JANITORIAL SERVICE 225 BROADWAY AVENUE PUEBLO CO 81004 JANITORIAL SERVICE 322490 340B TECHNOLOGIES INC 161GAITHER DRIVE SUITE 201 MT LAUREL NJ 08054 340B SUPPORT 249824 STRATUS INDEMAND INTERPRETING INC PO BOX 675248 DETROIT MI 48267 TRANSLATION SERVICES 242183 10 900002 10672603 419528 11992133 PATIENT REVENUE 621110 23506090 23506090 PHARMACY REVENUE 621110 4356569 4356569 27862659 381226 381226 MISCELLANEOUS 621990 273441 273441 273441 40509459 27862659 0 654667 27000 27000 2933967 2933967 1403603 400544 1003059 20918956 19511608 1407348 764711 718380 46331 2274362 2064899 209463 1641363 1473966 167397 64462 64462 82013 650 81363 1478305 1287033 191272 224611 40312 184299 422035 260199 161836 1675041 500685 1174356 1195793 35446 1160347 74580 71410 3170 143171 116535 26636 521850 521850 919271 632003 287268 95303 23893 71410 MEDICAL SUPPLIES 2876236 2876236 OTHER EXPENSES 245143 44618 200525 DUES & LICENSES 185933 69549 116384 40167709 33088933 7078776 0 2061414 9474972 12804584 1584478 453075 3640166 2715462 22025700 22025700 61451 65834 204869 372840 24479489 11886432 12952594 12593057 1605286 1328344 1607226 0 18747 1269958 55236903 53628854 2832788 2618285 12372450 12307115 0 214207 15205238 15139607 X 36819153 37160903 3212512 1328344 40031665 38489247 55236903 53628854 X 341750 -1884168 X X 0 1 X 1 1 1 X 6863038 7439690 9183352 11748789 11992133 47227002 6863038 7439690 9183352 11748789 11992133 47227002 11294 47215708 589410 371817 76937 235894 381226 1655284 46752 167349 10424 55056 273441 553022 49435308 135485158 0.95510 0.95430 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2018 AMOUNT: $ 46,752. 2019 AMOUNT: $ 167,349. 2020 AMOUNT: $ 10,424. 2021 AMOUNT: $ 55,056. 2022 AMOUNT: $ 273,441. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 25746 25746 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. 2369385 2369385 17659589 8604586 9055003 4450515 3281846 1168669 12593057 NEGATIVE CASH BALANCE 214207 214207 X 35791396 100072 -4818135 -4718063 40509459 0 40509459 37333814 100072 100072 37233742 2933967 2933967 40167709 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 -2,933,967. CHANGE IN BENEFICIAL INTEREST -1,884,168. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS 2,933,967. 1 PUEBLO COMMUNITY HEALTH CENTER FOUNDATION 310 COLORADO AVENUE PUEBLO CO 81004 041404345 501(C)(3) 27000 0 N/A N/A GENERAL OPERATING EXPENSES 1 0 PATIENT GRANTS 2333 2933967 0 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 CLAIRE REED MD CHIEF MEDICAL OFFICER 286771 0 1250 0 0 0 27000 0 27145 0 342166 0 0 0 DANA RILEY MD PHYSICIAN 218216 0 1125 0 0 0 9100 0 27145 0 255586 0 0 0 STEPHANIE PARKER DO PHYSICIAN 222306 0 1125 0 0 0 13176 0 17184 0 253791 0 0 0 DONALD MOORE CHIEF EXECUTIVE OFFICER 194016 0 1250 0 0 0 27000 0 27145 0 249411 0 0 0 DAVID KRAUSE MD SENIOR MEDICAL DIRECTOR 210112 0 1029 0 0 0 6500 0 19009 0 236650 0 0 0 STEPHANIE PAYNE PHYSICIAN 212111 0 1216 0 0 0 0 0 17184 0 230511 0 0 0 CARLY A LACROIX DO PHYSICIAN 216434 0 1250 0 0 0 2600 0 9048 0 229332 0 0 0 AARON MURRAY CHIEF DENTAL OFFICER 148021 0 535 0 0 0 8649 0 11535 0 168740 0 0 0 PHILLIP DAVIS CHIEF FINANCIAL OFFICER 127955 0 1250 0 0 0 5065 0 17184 0 151454 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 $1,244,981 IN 2022. 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 15A 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 2022. 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 -1,607,226. CHANGE IN BENEFICIAL INTEREST IN PPC QALICB -276,942. 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 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 PUEBLO PRIMARY CARE QALICB C 900002 FMV PUEBLO PRIMARY CARE QALICB E 126030 FMV