2021-09-13T15:42:18-05:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2020-01-01 840921521 PUEBLO COMMUNITY HEALTH CENTER INC PUEB 7195438711 110 EAST ROUTT AVENUE PUEBLO CO 81004 PHILLIP DAVIS CFO 7195438711 2021-09-10 1 PHILLIP DAVIS 999009999 SARAH HINTZ P00492291 3034668822 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DONALD MOORE 110 EAST ROUTT AVENUE PUEBLO CO 81004 35955551 0 X WWW.PUEBLOCHC.ORG X 1983 CO TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED. 9 9 384 11 0 0 7439690 9183352 25389104 26684838 367477 69981 167349 10424 33363620 35948595 59897 4734353 0 0 24633772 25621845 0 0 0 7962219 7532382 32655888 37888580 707732 -1939985 39476547 53349120 2373875 16231970 37102672 37117150 TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED BY OFFERING TOP QUALITY CARE THROUGH ACCESSIBILITY, LEADERSHIP, AND FINANCIAL INDEPENDENCE. 0 0 26826529 4734353 21212239 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. 1916181 0 4778813 PHARMACEUTICAL SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 3193635 0 693786 PREVENTATIVE, RESTORATIVE, AND EMERGENCY DENTAL HEALTH CARE SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 31936345 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 44 0 1 384 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 CO X PHILLIP DAVIS 7195438718 110 EAST ROUTT AVENUE PUEBLO CO 81004 CLAIRE REED MD CMO 40.00 0.00 X 294693 0 43751 BRETT HULET MD PHYSICIAN 40.00 0.00 X 224936 0 32429 DAVID KRAUSE MD SENIOR MEDICAL DIRECTOR 40.00 0.00 X 212478 0 39168 DANA RILEY MD PHYSICIAN 40.00 0.00 X 212235 0 40120 STEPHANIE PARKER DO PHYSICIAN 40.00 0.00 X 215043 0 30938 DONALD MOORE CEO 40.00 2.00 X 182429 0 38685 CARLY A LACROIX DO PHYSICIAN 40.00 0.00 X 209617 0 17613 STEPHANIE PAYNE MD PHYSICIAN 40.00 0.00 X 199395 0 20235 KAREN MILLER DDS CDO 40.00 0.00 X 185977 0 20464 JUSTIN MCCARTHY COO 40.00 0.00 X 149620 0 28397 CINDY PRATT FORMER CFO 40.00 0.00 X 119778 0 14619 LAURA KELLEY CHIEF FOUNDATION OFFICER 40.00 0.00 X 93684 0 24385 PHILLIP DAVIS CFO 40.00 0.00 X X 24898 0 1659 ARTHUR YARBROUGH JR PRESIDENT(THRU FEB 2020) 1.00 0.00 X X 0 0 0 MICHAEL GAGE PRESIDENT-ELECT & PRESIDENT 1.00 0.00 X X 0 0 0 LINDA RIKHOFF RN PRESIDENT-ELECT 1.00 0.00 X X 0 0 0 DON ORTEGA TREASURER 1.00 0.00 X X 0 0 0 REBECCA GOODMAN SECRETARY 1.00 0.00 X X 0 0 0 LOUIS BALIZET MD DIRECTOR 1.00 0.00 X 0 0 0 YESENIA BEASCOCHEA DIRECTOR 1.00 0.00 X 0 0 0 SHIRLEY CORDOVA DIRECTOR 1.00 0.00 X 0 0 0 ANGELINA MARTINEZ DIRECTOR 1.00 0.00 X 0 0 0 STEVE SHIRLEY DIRECTOR 1.00 0.00 X 0 0 0 2324783 0 352463 51 0 1 0 BRYAN CONSTRUCTION 7025 CAMPUS DRIVE COLORADO SPRINGS CO 80920 CONSTRUCTION 1347867 CARDINAL HEALTH PHARMACY MANAGEMENT 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT SERVICES 1230372 RTA INC 19 S TEJON ST SUITE 300 COLORADO SPRINGS CO 80903 ARCHITECTURAL DESIGN SERVICES 850989 OSIS PO BOX 772852 CHICAGO IL 60677 SOFTWARE SUPPORT SERVICES 479290 COMMOND 2711 KING ST DENVER CO 80211 INFORMATION TECHNOLOGY INFRASTRUCTURE 341624 23 8920477 262875 15669 9183352 PATIENT REVENUE 621110 21906025 21906025 PHARMACY REVENUE 621110 4778813 4778813 26684838 76937 76937 6956 -6956 -6956 -6956 MISCELLANEOUS 900099 10424 10424 10424 35948595 26684838 0 80405 1867091 1867091 2867262 2867262 1449344 656138 793206 19943067 17231276 2711791 760708 634564 126144 2161918 1743680 418238 1306808 1087673 219135 177648 177648 78103 14550 63553 1718707 1553086 165621 123885 28971 94914 407820 237402 170418 584008 276797 307211 830111 600443 229668 38817 29841 8976 72286 57795 14491 839305 579648 259657 68335 25870 42465 MEDICAL SUPPLIES 2391771 2382706 9065 DUES & LICENSES 163575 56063 107512 OTHER EXPENSES 38011 5489 32522 37888580 31936345 5952235 0 1069089 944581 17792957 10003873 827999 907808 2748771 2852770 22025700 74937 61451 233301 207494 23421229 10208393 15551349 13212836 1159397 1307715 1806145 18747 18747 39476547 53349120 2373875 2378739 13853231 2373875 16231970 X 35943275 34003290 1159397 3113860 37102672 37117150 39476547 53349120 X -1939985 1954463 X X 0 1 X 1 1 1 X 6560591 7380878 6863038 7439690 9183352 37427549 6560591 7380878 6863038 7439690 9183352 37427549 37427549 18240 320032 589410 371817 76937 1376436 159231 50628 46752 167349 10424 434384 39238369 126218645 0.95390 0.94780 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 10847 10847 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 17600116 7302890 10297226 3451728 2905503 546225 13212836 X 33169883 88550 88550 33081333 2867262 2867262 35948595 33274309 88550 88550 33185759 4702821 4702821 37888580 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 2,867,262. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANT TO PUEBLO PRIMARY CARE QALICB 1,835,559. CHARITY CARE NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS 2,867,262. 1 PUEBLO PRIMARY CARE QALICB 110 E ROUTT AVENUE PUEBLO CO 81004 853699288 501(C)(3) 1835559 N/A N/A OPENING FUNDS TO QALICB PUEBLO COMMUNITY HEALTH CENTER FOUNDATION 310 COLORADO AVENUE PUEBLO CO 81004 041404345 501(C)(3) 27000 0 N/A N/A GENERAL OPERATING EXPENSES 2 0 CHARITY CARE 23553 2867262 0 FMV PROVIDE SERVICES TO UNINSURED AND UNDERINSURED PATIENTS. PART I, LINE 2: 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. X X X 0 0 0 0 0 0 0 0 0 CLAIRE REED MD CMO 278531 0 800 0 15362 0 16399 0 27352 0 338444 0 0 0 BRETT HULET MD PHYSICIAN 218651 0 400 0 5885 0 14016 0 18413 0 257365 0 0 0 DAVID KRAUSE MD SENIOR MEDICAL DIRECTOR 197751 0 3160 0 11567 0 13725 0 25443 0 251646 0 0 0 DANA RILEY MD PHYSICIAN 193988 0 2885 0 15362 0 11167 0 28953 0 252355 0 0 0 STEPHANIE PARKER DO PHYSICIAN 104562 0 785 0 109696 0 13211 0 17727 0 245981 0 0 0 DONALD MOORE CEO 166267 0 800 0 15362 0 11577 0 27108 0 221114 0 0 0 CARLY A LACROIX DO PHYSICIAN 201481 0 797 0 7339 0 7691 0 9922 0 227230 0 0 0 STEPHANIE PAYNE MD PHYSICIAN 188040 0 386 0 10969 0 2429 0 17806 0 219630 0 0 0 KAREN MILLER DDS CDO 177838 0 800 0 7339 0 11002 0 9462 0 206441 0 0 0 JUSTIN MCCARTHY COO 137052 0 800 0 11768 0 9375 0 19022 0 178017 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 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 $1,230,372 IN 2020. 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 2020. 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 148,318. CHANGE IN BENEFICIAL INTEREST IN PPC QALICB 1,806,145. PART XII LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNT 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 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 PUEBLO PRIMARY CARE QALICB B 1835559 ACTUAL EXPENDITURE