2022-11-14T12:26:58-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2021-01-01 841285505 LA CLINICA TEPEYAC LACL 7202742923 4725 HIGH STREET DENVER CO 80216 JIM GARCIA CEO 7202742923 2022-11-11 1 JIM GARCIA XXX-XX-XXXX SARAH HINTZ P00492291 3037795710 2022-11-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z TEPEYAC COMMUNITY HEALTH CENTER JIM GARCIA 4725 HIGH STREET DENVER CO 80216 7464165 0 X WWW.TEPEYACHEALTH.ORG X 1994 CO INSPIRE HEALTH, WELLBEING, AND HUMANITY IN OUR COMMUNITY, THROUGH ALL OF LIFE'S STAGES. 14 14 84 14 0 0 5170843 5889761 966451 1399528 8396 97306 128052 3160 6273742 7389755 599845 0 0 0 3410180 3969706 88366 49076 265989 2354713 2531823 6453104 6550605 -179362 839150 15588630 16516064 8915948 8999395 6672682 7516669 X INSPIRE HEALTH, WELLBEING, AND HUMANITY IN OUR COMMUNITY, THROUGH ALL OF LIFE'S STAGES. WE ENVISION A HEALTHY COMMUNITY WITH ACCESS TO REGULAR AND ONGOING HEALTH CARE. AS WE EXPAND OUR REACH AND BRING CULTURAL RESPONSIVENESS INTO THE COMMUNITY WE STRIVE FOR EXCEPTIONAL, TRUSTWORTHY CARE THAT EMPOWERS OUR PATIENTS, DECREASES ROUTINE VISITS TO EMERGENCY ROOMS, AND CREATES HEALTHIER FAMILIES OVERALL. 0 0 3857373 0 1399528 CLINIC: PROVIDE BASIC PRIMARY CARE SERVICES, BASIC WELLNESS, PHYSICAL EXAMS, BEHAVIORAL HEALTH AND HEALTH EDUCATION. THIS INCLUDES WOMEN'S HEALTH EXAMS, MAMMOGRAPHY, PRENATAL CARE, IMMUNIZATIONS, SCHOOL PHYSICALS, DIABETES MANAGEMENT, COLPOSCOPIES, PREVENTIVE HEALTH EDUCATION, WELLNESS CLASSES, AND ORAL HEALTH CARE.HEALTH PROMOTION: PROVIDES EDUCATION FOR THE LATINX COMMUNITY AND THEIR FAMILIES TO REDUCE THE RISK OF CHRONIC DISEASE THROUGH COMMUNITY OUTREACH AND PREVENTIVE HEALTH EDUCATION CONDUCTED BY THE PROMOTORAS DE SALUD (HEALTH PROMOTERS). 3857373 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 25 0 1 84 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JOHANNA HELLER 7202742923 4725 HIGH STREET DENVER CO 80216 DR LINDA OSTERLUND PHD PRESIDENT 1.00 0.00 X X 0 0 0 DR HARVEY BOGRAD BOARD MEMBER & CO-VICE PRESIDENT 1.00 0.00 X X 0 0 0 JESSE OGAS BOARD MEMBER & CO-VICE PRESIDENT 1.00 0.00 X X 0 0 0 CANDY HERNANDEZ TREASURER 1.00 0.00 X X 0 0 0 LUDY ESPERANZA CHACON SECRETARY 1.00 0.00 X X 0 0 0 JACQUELINE MORALES-LOZANO ASSISTANT SECRETARY 0.50 0.00 X X 0 0 0 CAROLINE ACHA CONSUMER BOARD MEMBER 0.50 0.00 X 0 0 0 JOHN BAUER-MARTINEZ BOARD MEMBER 0.50 0.00 X 0 0 0 STEVE CHAVEZ BOARD MEMBER 0.50 0.00 X 0 0 0 YUVICELA GARCIA-DIAZ BOARD MEMBER (THRU 06/21) 0.50 0.00 X 0 0 0 JUANA MALDONADO CONSUMER BOARD MEMBER 0.50 0.00 X 0 0 0 GEORGINA MILLAN CONSUMER BOARD MEMBER 0.50 0.00 X 0 0 0 DR SAMIT SHAH BOARD MEMBER 0.50 0.00 X 0 0 0 RITA TORO CONSUMER BOARD MEMBER 0.50 0.00 X 0 0 0 DR GILBERT VIGIL DDS BOARD MEMBER 0.50 0.00 X 0 0 0 DR PAMELA VALENZA MD CHO 50.00 0.00 X 232016 0 16887 JIM GARCIA CEO 60.00 1.00 X 140400 0 15702 AMANDA SILK CFO 50.00 0.00 X 80538 0 2377 OLGA WEBBER COO (THRU 02/2021) 50.00 0.00 X 16417 0 3505 JOHANNA HELLER INTERIM CFO 40.00 0.00 X 0 0 0 SHANA MOTROSE CAO 40.00 0.00 X 8484 0 1648 DR PATRICK HUFFER MD FAMILY PHYSICIAN 40.00 0.00 X 173744 0 19185 651599 0 59304 3 0 1 0 COMMUNITY LINK CONSULTING PO BOX 276 NEWMAN LAKE WA 99025 MANAGEMENT SERVICES 203131 CREA RESULTS 3702 QUIVAS ST DENVER CO 80211 COMMUNITY OUTREACH 133695 VIRSAGE SOLUTIONS PO BOX 29650 PHOENIX AZ 85038 CONTRACTED IT DEPARTMENT 131655 ECLINICAL WORKS PO BOX 847950 BOSTON MA 02284 EHR SYSTEM 106056 4 80000 68696 3239780 2501285 172618 5889761 PATIENT FEES 621110 1399528 1399528 1399528 96090 96090 1216 0 1216 1216 1216 41767 68696 74410 -32643 -32643 MISCELLANEOUS INCOME 900099 35803 35803 35803 7389755 1399528 0 100466 X 517975 221717 228169 68089 2920432 2000773 851064 68595 34832 18021 16811 236400 121018 110461 4921 260067 130757 120944 8366 55039 55039 36455 36455 49076 49076 765290 184722 534057 46511 27851 9982 600 17269 126385 68737 56821 827 279767 159332 119584 851 164891 95502 68674 715 7882 5126 2756 19971 9045 10911 15 354070 317705 36365 88955 54489 34466 65833 14542 51162 129 MEDICAL SUPPLIES 233437 230734 2703 CLINIC 106621 105917 704 EQUIPMENT 84857 64178 20669 10 DUES & MEMBERSHIPS 67172 15136 51951 85 47347 29940 16877 530 6550605 3857373 2427243 265989 144697 239571 1949573 2435265 1795989 2115982 119449 233127 9496937 9496937 61159 28646 2718188 825004 1952311 1893184 54195 59032 14320 14320 15588630 16516064 356461 482272 500000 471966 8059487 8045157 8915948 8999395 X 2048881 4887989 4623801 2628680 6672682 7516669 15588630 16516064 X 839150 4837 X X 0 1 X 1 1 1 X 4331157 6264586 4270179 5170843 5889761 25926526 4331157 6264586 4270179 5170843 5889761 25926526 247993 25678533 3704 8730 15186 8375 96090 132085 70274 41564 111838 28084 31258 56297 86488 35803 237930 26408379 5219054 0.97240 0.96290 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 28,084. 2018 AMOUNT: $ 31,258. 2019 AMOUNT: $ 56,297. 2020 AMOUNT: $ 86,488. 2021 AMOUNT: $ 35,803. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 0 0 0 0 0 0 1 367 367 0 PART II-B, LINE 1: A PORTION OF THE ORGANIZATIONS MEMBERSHIP DUES TO CERTAIN ASSOCIATIONS ARE USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF THEIR MEMBERS. 54195 5404 567 59032 48268 6406 479 54195 41663 7057 452 48268 44285 -2180 442 41663 38788 5497 44285 0.00000 1.00000 0.00000 1 0 22500 274000 296500 1905509 471796 1433713 516179 353208 162971 1893184 X 7394592 4837 4837 7389755 0 7389755 6798883 248278 248278 6550605 0 6550605 PART V, LINE 4: THE PURPOSE OF THE ENDOWMENT FUND IS TO PAY FOR MEDICAL SERVICES FOR THE UNINSURED. PART X, LINE 2: THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE ORGANIZATIONS CONSOLIDATED 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: CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY OTHERS 4,837. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED EXPENSES - TEPEYAC QALICB 248,278. X X X X X X X 1 RIPPLE AFFECT LLC 4000 LIPAN STREET DENVER CO 80211 CAPITAL CAMPAIGN CONSULTING 0 0 26031 0 EVENTFUL PRODUCTION 1427 LARIMER STREET DENVER CO 80202 EVENT MANAGEMENT 0 0 23045 0 49076 CO FIESTA ON THE PLAZA 66618 45618 21000 10730 21659 TORTILLAS FOR TEPEYAC 23078 23078 33356 89696 68696 21000 10730 55015 65745 -44745 X X X X 0 0 0 0 0 0 0 0 0 DR PAMELA VALENZA MD CHO 232016 0 0 0 0 0 7876 0 9011 0 248903 0 0 0 DR PATRICK HUFFER MD FAMILY PHYSICIAN 173744 0 0 0 0 0 6550 0 12635 0 192929 0 0 0 JIM GARCIA CEO 140400 0 0 0 0 0 5147 0 10555 0 156102 0 0 0 X 2 172618 FAIR MARKET VALUE 0 0 0 0 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS WAS USED IN PART I. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT, VICE-PRESIDENT, SECRETARY, TREASURER, AND IMMEDIATE PAST-PRESIDENT OF THE BOARD OF DIRECTORS. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE HAS THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO THE LIMITATIONS IMPOSED BY THE COLORADO NONPROFIT CORPORATION ACT AND TO ANY LIMITATIONS IMPOSED BY THE BOARD, INCLUDING, THAT SUCH COMMITTEE SHALL NOT: (1) ELECT, APPOINT, OR REMOVE ANY DIRECTOR; (2) AMEND ARTICLES OF INCORPORATION; (3) ADOPT, AMEND, OR REPEAL BYLAWS; (4) APPROVE A PLAN OF CONVERSION OR PLAN OF MERGER WITH ANOTHER ENTITY; OR (5) APPROVE A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF ITS PROPERTY. THE EXECUTIVE COMMITTEE MUST REPORT ALL ACTIONS TAKEN INDEPENDENTLY AND ON BEHALF OF THE BOARD TO THE FULL GOVERNING BOARD, AND THE FULL GOVERNING BOARD MUST VOTE ON THESE ACTIONS AND REORD THEM IN THE BOARD MINUTES. FORM 990, PART VI, SECTION A, LINE 3 DURING 2021, THE ORGANIZATION PAID COMMUNITY LINK CONSULTING $203,131 FOR INTERIM FINANCIAL MANAGEMENT SERVICES, WHICH INCLUDED THE SERVICES PERFORMED BY JOHANNA HELLER, INTERIM CFO. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S INDEPENDENT CPA WITH INFORMATION PROVIDED BY MANAGEMENT. A COPY OF THE FORM 990 WAS REVIEWED BY THE CFO AND THE CEO, THEN BY THE FINANCE COMMITTEE. THE 990 IS THEN DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, EACH BOARD MEMBER COMPLETES A CONFLICT OF INTEREST DISCLOSURE. IF A POTENTIAL CONFLICT OF INTEREST ARISES WITH A BOARD MEMBER, THE INDIVIDUAL PROVIDES WRITTEN NOTICE OF THE POTENTIAL CONFLICT OF INTEREST TO THE BOARD OF DIRECTORS AND REFRAINS FROM PARTICIPATION IN ANY DISCUSSION OR VOTING ON ANY MATTERS PERTAINING TO THE CONFLICT OF INTEREST. ANY DISCUSSION OF POTENTIAL CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE CEO'S PERFORMANCE TO DETERMINE COMPENSATION. SALARY SURVEYS FROM THE COLORADO COMMUNITY HEALTH NETWORK AND THE COLORADO NONPROFIT ASSOCIATION ARE USED AS GUIDELINES. DISCUSSION RELATED TO THE DELIBERATION AND THE DECISION IS DOCUMENTED IN THE BOARD MINUTES. BASED ON COMPARABLE SALARY INFORMATION, THE CEO, CONTROLLER AND HR MANAGER REVIEW AND APPROVE THE COMPENSATION FOR THE OTHER OFFICERS OF THE ORGANIZATION. THE MOST RECENT COMPENSATION REVIEW WAS CONDUCTED IN 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 184,722. MANAGEMENT AND GENERAL EXPENSES 534,057. FUNDRAISING EXPENSES 46,511. TOTAL EXPENSES 765,290. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY OTHERS 4,837. PART XII, LINE 2C THE PROCESS AND OVERSIGHT FOR SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR. TEPEYAC QALICB INC 4725 HIGH STREET DENVER CO 80216 851563851 SUPPORT LA CLINICA TEPEYAC CO 501(C)(3) LINE 12C, III-FI LA CLINICA TEPEYAC 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0