PUEBLO COMMUNITY HEALTH CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PUEBLO COMMUNITY HEALTH CENTER INC (EIN 84-0921521)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-08-24
- IRS object ID
- 202222369349301112
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-24T09:30:47-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 370 INTERLOCKEN BLVD SUITE 500 | AddressLine1Txt |
| City | BROOMFIELD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 840921521 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUEBLO COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PUEB | BusinessNameControlTxt |
| Phone | 7195438711 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 EAST ROUTT AVENUE | AddressLine1Txt |
| City | PUEBLO | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81004 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PHILLIP DAVIS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7195438711 | PhoneNum |
| Signature | 2022-08-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | PHILLIP | PersonFirstNm |
| Person Last | DAVIS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BECKY DETTMANN | PreparerPersonNm |
| PTIN | P01408585 | PTIN |
| Phone | 3034668822 | PhoneNum |
| Preparation | 2022-08-23 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DONALD MOORE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 EAST ROUTT AVENUE | AddressLine1Txt |
| City | PUEBLO | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,314,401 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PUEBLOCHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | CO | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 385 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,183,352 | PYContributionsGrantsAmt |
| CY Contributions Grants | $11,748,789 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,684,838 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $28,274,662 | CYProgramServiceRevenueAmt |
| PY Investment Income | $69,981 | PYInvestmentIncomeAmt |
| CY Investment Income | $235,894 | CYInvestmentIncomeAmt |
| PY Other Revenue | $10,424 | PYOtherRevenueAmt |
| CY Other Revenue | $55,056 | CYOtherRevenueAmt |
| PY Total Revenue | $35,948,595 | PYTotalRevenueAmt |
| CY Total Revenue | $40,314,401 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,734,353 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,249,666 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,621,845 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,922,191 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,532,382 | PYOtherExpensesAmt |
| CY Other Expenses | $8,326,681 | CYOtherExpensesAmt |
| PY Total Expenses | $37,888,580 | PYTotalExpensesAmt |
| CY Total Expenses | $37,498,538 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,939,985 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,815,863 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $53,349,120 | TotalAssetsBOYAmt |
| Total Assets EOY | $55,236,903 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,231,970 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,205,238 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $37,117,150 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $40,031,665 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED BY OFFERING TOP QUALITY CARE THROUGH ACCESSIBILITY, LEADERSHIP, AND FINANCIAL INDEPENDENCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $25,506,922 | ExpenseAmt |
| Grant | $3,249,666 | GrantAmt |
| Revenue | $22,618,161 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,036,538 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,953,981 | RevenueAmt |
| Desc | PHARMACEUTICAL SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,821,923 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $702,520 | RevenueAmt |
| Desc | PREVENTATIVE, RESTORATIVE, AND EMERGENCY DENTAL HEALTH CARE SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $30,365,383 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 39 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 385 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CO | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHILLIP DAVIS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7195438718 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 EAST ROUTT AVENUE | AddressLine1Txt |
| City | PUEBLO | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81004 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| CLAIRE REED MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | 0.00 | Yes (X) | $329,509 | $0 | $30,574 | ||
| DANA RILEY MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $246,677 | $0 | $26,733 | Yes (X) | ||
| STEPHANIE PARKER DO | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $231,134 | $0 | $24,000 | Yes (X) | ||
| DAVID KRAUSE MD | ||||||||
| SENIOR MEDICAL DIRECTOR | 40.00 | 0.00 | $226,355 | $0 | $22,411 | Yes (X) | ||
| CARLY A LACROIX DO | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $225,340 | $0 | $15,100 | Yes (X) | ||
| BRETT HULET MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $220,787 | $0 | $19,105 | Yes (X) | ||
| DONALD MOORE | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 2.00 | Yes (X) | $208,752 | $0 | $19,540 | ||
| KAREN MILLER DDS | ||||||||
| CHIEF DENTAL OFFICER (THRU 11/21) | 40.00 | 0.00 | Yes (X) | $167,175 | $0 | $16,740 | ||
| JUSTIN MCCARTHY | ||||||||
| CHIEF OPERATIONS OFFICER | 40.00 | 0.00 | Yes (X) | $161,917 | $0 | $21,448 | ||
| PHILLIP DAVIS | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0.00 | Yes (X) | $127,764 | $0 | $14,196 | ||
| LAURA KELLEY | ||||||||
| CDO/CHIEF FOUNDATION OFFICER | 28.00 | 0.00 | Yes (X) | $102,188 | $0 | $17,066 | ||
| DON ORTEGA | ||||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LOUIS BALIZET MD | ||||||||
| PRESIDENT-ELECT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| STEVE SHIRLEY | ||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| YESENIA BEASCOCHEA | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LINDA RIKHOFF RN | ||||||||
| PAST-PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SHIRLEY CORDOVA | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| MICHAEL GAGE | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| SANDRA LEMING | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| ARTHUR YARBROUGH JR | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,247,598 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $226,913 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 47 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BRYAN CONSTRUCTION | |||||
| 7025 CAMPUS DRIVE | COLORADO SPRINGS | CO | 80920 | CONSTRUCTION | $1,300,247 |
| CARDINAL HEALTH PHARMACY MANAGEMENT | |||||
| 21377 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY MANAGEMENT SERVICES | $1,155,244 |
| OSIS | |||||
| PO BOX 772852 | CHICAGO | IL | 60677 | SOFTWARE SUPPORT SERVICES | $485,537 |
| JD'S JANITORIAL SERVICE | |||||
| 225 BROADWAY AVE | PUEBLO | CO | 81004 | JANITORIAL SERVICES | $268,691 |
| RTA INC | |||||
| 19 S TEJON STREET | COLORADO SPRINGS | CO | 80903 | ARCHITECTURE | $268,681 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 30 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $10,438,529 | GovernmentGrantsAmt |
| All Other Contributions | $1,310,260 | AllOtherContributionsAmt |
| Noncash Contributions | $6,699 | NoncashContributionsAmt |
| Total Contributions | $11,748,789 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621110 | $23,320,681 | $23,320,681 |
| PHARMACY REVENUE | 621110 | $4,953,981 | $4,953,981 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $28,274,662 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $235,894 | TotalRevenueColumnAmt |
| Exclusion | $235,894 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $55,056 | TotalRevenueColumnAmt |
| Exclusion | $55,056 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $55,056 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,314,401 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,274,662 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $290,950 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,000 | TotalAmt |
| Program Services | $27,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,222,666 | TotalAmt |
| Program Services | $3,222,666 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,216,869 | TotalAmt |
| Program Services | $530,602 | ProgramServicesAmt |
| Management And General | $686,267 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,554,216 | TotalAmt |
| Program Services | $16,850,992 | ProgramServicesAmt |
| Management And General | $2,703,224 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $778,626 | TotalAmt |
| Program Services | $620,155 | ProgramServicesAmt |
| Management And General | $158,471 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,881,961 | TotalAmt |
| Program Services | $2,246,666 | ProgramServicesAmt |
| Management And General | $635,295 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,490,519 | TotalAmt |
| Program Services | $1,236,198 | ProgramServicesAmt |
| Management And General | $254,321 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,418 | TotalAmt |
| Management And General | $71,418 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,763 | TotalAmt |
| Program Services | $650 | ProgramServicesAmt |
| Management And General | $59,113 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,564,400 | TotalAmt |
| Program Services | $1,261,692 | ProgramServicesAmt |
| Management And General | $302,708 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,294 | TotalAmt |
| Program Services | $16,606 | ProgramServicesAmt |
| Management And General | $125,688 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $457,365 | TotalAmt |
| Program Services | $324,251 | ProgramServicesAmt |
| Management And General | $133,114 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,028,804 | TotalAmt |
| Program Services | $357,448 | ProgramServicesAmt |
| Management And General | $671,356 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $835,440 | TotalAmt |
| Program Services | $625,003 | ProgramServicesAmt |
| Management And General | $210,437 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,015 | TotalAmt |
| Program Services | $24,749 | ProgramServicesAmt |
| Management And General | $7,266 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,344 | TotalAmt |
| Program Services | $80,718 | ProgramServicesAmt |
| Management And General | $7,626 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $618,762 | TotalAmt |
| Management And General | $618,762 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $836,600 | TotalAmt |
| Program Services | $568,784 | ProgramServicesAmt |
| Management And General | $267,816 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,359 | TotalAmt |
| Program Services | $25,432 | ProgramServicesAmt |
| Management And General | $43,927 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,282,254 | $2,281,620 | $634 |
| DUES & LICENSES | $186,721 | $57,036 | $129,685 |
| OTHER EXPENSES | $53,142 | $7,115 | $46,027 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,498,538 | TotalAmt |
| Program Services | $30,365,383 | ProgramServicesAmt |
| Management And General | $7,133,155 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $944,581 | BOYAmt |
| EOY | $2,061,414 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,003,873 | BOYAmt |
| EOY | $9,474,972 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $907,808 | BOYAmt |
| EOY | $1,584,478 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,852,770 | BOYAmt |
| EOY | $3,640,166 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,025,700 | BOYAmt |
| EOY | $22,025,700 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,451 | BOYAmt |
| EOY | $61,451 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,494 | BOYAmt |
| EOY | $204,869 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,919,754 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,967,160 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,212,836 | BOYAmt |
| EOY | $12,952,594 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,307,715 | BOYAmt |
| EOY | $1,605,286 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,806,145 | BOYAmt |
| EOY | $1,607,226 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,747 | BOYAmt |
| EOY | $18,747 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,349,120 | BOYAmt |
| EOY | $55,236,903 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,378,739 | BOYAmt |
| EOY | $2,832,788 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,853,231 | BOYAmt |
| EOY | $12,372,450 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,231,970 | BOYAmt |
| EOY | $15,205,238 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,003,290 | BOYAmt |
| EOY | $36,819,153 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,113,860 | BOYAmt |
| EOY | $3,212,512 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,117,150 | BOYAmt |
| EOY | $40,031,665 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,349,120 | BOYAmt |
| EOY | $55,236,903 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,815,863 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $98,652 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,380,878 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,863,038 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,439,690 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,183,352 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,748,789 | CurrentTaxYearAmt |
| Total | $42,615,747 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,380,878 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,863,038 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,439,690 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,183,352 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,748,789 | CurrentTaxYearAmt |
| Total | $42,615,747 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $109,199 | SubstantialContributorsTotAmt |
| Public Support Total170 | $42,506,548 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $320,032 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $589,410 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $371,817 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $76,937 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $235,894 | CurrentTaxYearAmt |
| Total | $1,594,090 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $50,628 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $46,752 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $167,349 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,424 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $55,056 | CurrentTaxYearAmt |
| Total | $330,209 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $44,540,046 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $131,970,586 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.95430 | PublicSupportCY170Pct |
| Public Support PY170 | 0.95390 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS INCOME - 2017 AMOUNT: $ 50,628. 2018 AMOUNT: $ 46,752. 2019 AMOUNT: $ 167,349. 2020 AMOUNT: $ 10,424. 2021 AMOUNT: $ 55,056. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Political Expenditures | $0 | PoliticalExpendituresAmt |
| Volunteer Hours | 0 | VolunteerHoursCnt |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $10,284 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,284 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,369,385 | OtherCostOrOtherBasisAmt |
| Book Value | $2,369,385 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,600,116 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,958,027 | DepreciationAmt |
| Book Value | $9,642,089 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,508,229 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,009,133 | DepreciationAmt |
| Book Value | $499,096 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $442,024 | OtherCostOrOtherBasisAmt |
| Book Value | $442,024 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,952,594 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $37,177,431 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $85,696 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $85,696 | RevenueNotReportedAmt |
| Revenue Subtotal | $37,091,735 | RevenueSubtotalAmt |
| Other Revenues Not Included | $3,222,666 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,222,666 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $40,314,401 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $34,361,568 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $85,696 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $85,696 | ExpensesNotReportedAmt |
| Expenses Subtotal | $34,275,872 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,222,666 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,222,666 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $37,498,538 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 4B - OTHER ADJUSTMENTS: | CHARITY CARE NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS 3,222,666. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | CHARITY CARE NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS 3,222,666. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUEBLO COMMUNITY HEALTH CENTER FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 310 COLORADO AVENUE | AddressLine1Txt |
| City | PUEBLO | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 041404345 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $27,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
| Purpose Of Grant | GENERAL OPERATING EXPENSES | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | PATIENT GRANTS | GrantTypeTxt |
| Recipient | 2539 | RecipientCnt |
| Cash Grant | $3,222,666 | CashGrantAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION MAKES CONTRIBUTIONS TO LOCAL CHARITIES AND GOVERNMENT AGENCIES. PUEBLO COMMUNITY HEALTH CENTER 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 PPC QALICB 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLAIRE REED MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $300,036 | $0 | $550 | $0 | $28,923 | $0 | $15,214 | $0 | $15,360 | $0 | $360,083 | $0 | $0 | $0 |
| DANA RILEY MD | ||||||||||||||
| PHYSICIAN | $227,435 | $0 | $550 | $0 | $18,692 | $0 | $11,373 | $0 | $15,360 | $0 | $273,410 | $0 | $0 | $0 |
| STEPHANIE PARKER DO | ||||||||||||||
| PHYSICIAN | $218,584 | $0 | $550 | $0 | $12,000 | $0 | $13,032 | $0 | $10,968 | $0 | $255,134 | $0 | $0 | $0 |
| DAVID KRAUSE MD | ||||||||||||||
| SENIOR MEDICAL DIRECTOR | $225,842 | $0 | $513 | $0 | $0 | $0 | $13,550 | $0 | $8,861 | $0 | $248,766 | $0 | $0 | $0 |
| CARLY A LACROIX DO | ||||||||||||||
| PHYSICIAN | $215,405 | $0 | $550 | $0 | $9,385 | $0 | $7,762 | $0 | $7,338 | $0 | $240,440 | $0 | $0 | $0 |
| BRETT HULET MD | ||||||||||||||
| PHYSICIAN | $220,362 | $0 | $425 | $0 | $0 | $0 | $13,222 | $0 | $5,883 | $0 | $239,892 | $0 | $0 | $0 |
| DONALD MOORE | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $208,202 | $0 | $550 | $0 | $0 | $0 | $12,202 | $0 | $7,338 | $0 | $228,292 | $0 | $0 | $0 |
| KAREN MILLER DDS | ||||||||||||||
| CHIEF DENTAL OFFICER (THRU 11/21) | $166,875 | $0 | $300 | $0 | $0 | $0 | $10,013 | $0 | $6,727 | $0 | $183,915 | $0 | $0 | $0 |
| JUSTIN MCCARTHY | ||||||||||||||
| CHIEF OPERATIONS OFFICER | $161,367 | $0 | $550 | $0 | $0 | $0 | $9,682 | $0 | $11,766 | $0 | $183,365 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. CARDINAL HEALTH PROVIDES PHARMACY MANAGEMENT SERVICES AND WAS COMPENSATED $1,155,244 IN 2021. |
| 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. THESE PROCESSES LAST OCCURRED IN 2021. |
| 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 297,571. CHANGE IN BENEFICIAL INTEREST IN PPC QALICB -198,919. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUEBLO PRIMARY CARE QALICB | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 EAST ROUTT AVENUE | AddressLine1Txt |
| City | PUEBLO | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 853699288 | EIN |
| Primary Activities | SUPPORT CLINIC | PrimaryActivitiesTxt |
| Legal Domicile State | CO | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUEBLO COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUEBLO PRIMARY CARE QALICB | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | D | TransactionTypeTxt |
| Involved | $421,723 | InvolvedAmt |
| Method Of Amount Determination | AMOUNT OWED | MethodOfAmountDeterminationTxt |
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