2020-02-09T18:30:27-06:00 2019-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2018-06-01 840742145 MOUNTAIN FAMILY HEALTH CENTERS MOUN 9709452840 2700 GILSTRAP COURT NO 100 GLENWOOD SPRINGS CO 81601 ROSS BROOKS CHIEF EXECUTIVE OFFICER 9709452840 2020-01-29 1 KURT BENNION P01469618 3034668822 2020-01-29 67.137.57.251 2020-01-29 10:57:09 PS P 94307BE716D664C10DC46CE445DCF2BF31E531AB 72C56C6F533A7CAE8F7235CA15DC6DF10360C772 2018 2020-09-23 17:36:50Z ROSS BROOKS 2700 GILSTRAP COURT NO 100 GLENWOOD SPRINGS CO 81601 18905041 0 X WWW.MOUNTAINFAMILY.ORG X 1977 CO TO PROVIDE HIGH QUALITY INTEGRATED PRIMARY, DENTAL AND BEHAVIORAL HEALTH CARE. 11 11 221 20 0 0 8408498 8411183 9905379 10473484 2712 2935 21463 17439 18338052 18905041 2300 3650 0 0 12087199 12468645 155762 98546 98546 4689236 5690426 16934497 18261267 1403555 643774 7629902 9925307 1172020 2823632 6457882 7101675 X TO PROVIDE HIGH QUALITY, INTEGRATED PRIMARY MEDICAL, BEHAVIORAL AND DENTAL HEALTH CARE IN THE COMMUNITIES WE SERVE, WITH SPECIAL CONSIDERATION FOR THE MEDICALLY UNDER-SERVED, REGARDLESS OF ABILITY TO PAY. 1 0 14461993 3650 10473484 MOUNTAIN FAMILY HEALTH CENTERS PROVIDES PRIMARY MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES AT EIGHT LOCATIONS. SERVICES ARE PROVIDED TO THE GENERAL PUBLIC, INCLUDING LOW-COST AND DONATED SERVICES FOR LOW-INCOME AND INDIGENT PERSONS. THE CLINICS ARE PARTIALLY FUNDED BY AN OPERATING GRANT FROM THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. FOR THE FISCAL YEAR ENDED MAY 31, 2019, 16,917 PATIENTS WERE SERVED THROUGH 62,674 BILLABLE ENCOUNTERS. 14461993 1 1 0 1 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 106 0 221 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 CO X ANNETTE FRANTA 9709452840 2700 GILSTRAP COURT NO 100 GLENWOOD SPRINGS CO 81601 JON FOX RUBIN CHAIR 4.00 X X 0 0 0 ROB STEIN PHD VICE CHAIR 2.00 X X 0 0 0 MONICA PEREZ RHODES TREASURER 2.00 X X 0 0 0 RICHARD GONZALES SECRETARY 2.00 X X 0 0 0 FAVIOLA ALDERETE BOARD MEMBER 2.00 X 0 0 0 KARYN RENAE ANDERSON BOARD MEMBER 2.00 X 0 0 0 SAMUEL BERNAL BOARD MEMBER 2.00 X 0 0 0 TOM BOAS BOARD MEMBER (THROUGH JAN 2019) 2.00 X 0 0 0 MEGAN BURCH BOARD MEMBER 2.00 X 0 0 0 TRISH KRAMER BOARD MEMBER 2.00 X 0 0 0 VICTOR MAMLIN BOARD MEMBER 2.00 X 0 0 0 MIKE NUGENT BOARD MEMBER (THROUGH JAN 2019) 2.00 X 0 0 0 HAIDITH RAMIREZ BOARD MEMBER 2.00 X 0 0 0 ROSS BROOKS CEO 50.00 X 174483 0 19508 ANNETTE FRANTA CFO 50.00 X 127586 0 12811 ARTURO FERNANDEZ COO 50.00 X 121092 0 18784 MATTHEW PERCY MD CHIEF MEDICAL TEAM 50.00 X 161558 0 35227 ANNELIESE HECKERT DO CHIEF MEDICAL TEAM 50.00 X 181993 0 19030 JENNIFER LANG FNP CHIEF MEDICAL TEAM 50.00 X 135624 0 22001 SCOTT OWENS SPHR CHIEF WORKFORCE OFFICER 50.00 X 98876 0 10230 CHRIS TONOZZI MD PHYSICIAN, DIRECTOR OF DATA QUALITY 40.00 X 188918 0 14765 CASEY AGUIRRE DO PHYSICIAN 40.00 X 200622 0 8101 STEPHEN GLASS DDS DENTAL DIRECTOR 40.00 X 144867 0 13070 SARAH RIEVES MD PHYSICIAN 40.00 X 137062 0 24495 CONNOR RIVERS DMD DENTIST 40.00 X 136507 0 10003 1809188 0 208025 17 0 1 0 ROCHE CONSTRUCTORS INC 361 71ST AVENUE GREELEY CO 80634 CONSTRUCTION SERVICES 2510648 ITENTIVE HEALTHCARE SOLUTIONS 1 PIERCE PLACE SUITE 400E ITASCA IL 60143 SOFTWARE MAINTENANCE 158156 OSIS PO BOX 772852 CHICAGO IL 60677 SOFTWARE LICENSING/HOSTING 157512 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LABORATORY SERVICES 117365 QUALITY SYSTEMS INC PO BOX 511449 LOS ANGELES CA 90051 SOFTWARE MAINTENANCE 106666 6 5314863 3096320 424554 8411183 PATIENT FEES 621400 8434600 8434600 CONTRACT REVENUE 621400 1134710 1134710 PHARMACY REVENUE 621400 904174 904174 10473484 1558 1558 1377 0 1377 1377 1377 MISCELLANEOUS INCOME 900099 17439 17439 17439 18905041 10473484 0 20374 3650 3650 1171061 354823 816238 9287245 7999417 1287828 128368 117680 10688 1092903 889717 203186 789068 625142 163926 27939 27939 56487 56487 98546 98546 1504363 1087289 417074 90553 9158 81395 213776 133746 80030 549194 455860 93334 98702 33449 65253 126829 42980 83849 16982 8997 7985 312175 248516 63659 47930 35031 12899 MEDICAL SUPPLIES 1394999 1394999 BAD DEBT EXPENSE 721604 721604 REPAIRS & MAINTENANCE 328972 226528 102444 DUES & SUBSCRIPTIONS 101060 13206 87854 98861 60201 38660 18261267 14461993 3700728 98546 1246 1246 3041950 1233039 393356 895567 1465552 1963032 67306 106230 7931143 2225482 2637424 5705661 23068 20532 7629902 9925307 976930 990643 195090 29403 0 1803586 1172020 2823632 X 4861883 6209363 1595999 892312 6457882 7101675 7629902 9925307 643774 19 0 X 0 1 X 1 1 1 X 4399317 5637061 7048980 8408498 8411183 33905039 4399317 5637061 7048980 8408498 8411183 33905039 33905039 1588 2687 2639 2875 1558 11347 28424 33232 14382 21465 17439 114942 34031328 46571466 0.99630 0.99520 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 1 3548 3548 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE COLORADO COMMUNITY HEALTH NETWORK, A PORTION OF WHICH ARE USED BY THE NETWORK TO LOBBY ON BEHALF OF ALL MEMBER ORGANIZATIONS. 1 0 2399 2399 0 0 2309160 472071 1837089 2907851 147526 2760325 2714132 1605885 1108247 5705661 X 18060238 19 319768 518349 838136 17222102 1682939 1682939 18905041 17859431 319768 319768 17539663 721604 721604 18261267 PART IV, LINE 1B: MOUNTAIN FAMILY HEALTH CENTERS ACTS AS FISCAL AGENT FOR THE WEST MOUNTAIN REGIONAL HEALTH ALLIANCE. PART X, LINE 2: 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: NET ASSETS RELEASED FROM RESTRICTIONS 518,349. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 721,604. RESTRICTED CONTRIBUTIONS 961,335. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 721,604. X X X X X X 1 CAROLYN HARDIN PO BOX 1396 CARBONDALE CO 81623 GRANT WRITING 0 5613691 89024 5524667 ELISE THATCHER 175 NETZ LANE 102 DURANGO CO 81301 GRANT WRITING 0 18500 9522 8978 5632191 98546 5533645 CO X X X X X 0 1 0 0 0 0 0 0 0 ROSS BROOKS CEO 169451 0 32 0 5000 0 5455 0 14053 0 193991 0 0 0 MATTHEW PERCY MD CHIEF MEDICAL TEAM 160539 0 1019 0 0 0 5524 0 29703 0 196785 0 0 0 ANNELIESE HECKERT DO CHIEF MEDICAL TEAM 171212 0 10781 0 0 0 5648 0 13382 0 201023 0 0 0 JENNIFER LANG FNP CHIEF MEDICAL TEAM 135426 0 198 0 0 0 4391 0 17610 0 157625 0 0 0 CHRIS TONOZZI MD PHYSICIAN, DIRECTOR OF DATA QUALITY 188828 0 90 0 0 0 5732 0 9033 0 203683 0 0 0 CASEY AGUIRRE DO PHYSICIAN 200586 0 36 0 0 0 0 0 8101 0 208723 0 0 0 STEPHEN GLASS DDS DENTAL DIRECTOR 144155 0 685 0 27 0 4396 0 8674 0 157937 0 0 0 SARAH RIEVES MD PHYSICIAN 137035 0 27 0 0 0 4456 0 20039 0 161557 0 0 0 PART I, LINE 4B CHRISTOPHER TONOZZI, MD, PARTICIPATES IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. DURING 2018, $16,250 WAS CONTRIBUTED TO THE PLAN, $375 ACCRUED WITHIN THE PLAN, AND THERE WERE NO DISTRIBUTIONS. X 60 424554 DONOR DETERMINED 0 0 1 0 FORM 990, PART III, LINE 2 DURING THE FISCAL YEAR ENDED MAY 31, 2019, MOUNTAIN FAMILY HEALTH CENTERS BEGAN PROVIDING MEDICATION ASSISTED THERAPY (MAT) TREATMENT, PSYCHIATRIC SERVICES, AND RECEIVED TITLE X FUNDING FOR ITS FAMILY PLANNING SERVICES. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS A SERVICE CONTRACT WITH THE VAIL HEALTH THAT GIVES VAIL HEALTH THE POWER TO APPOINT ONE MEMBER TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED IN DETAIL BY THE FINANCE TEAM. IT WAS THEN REVIEWED BY THE CEO. THE BOARD OF DIRECTORS WAS THEN GIVEN A COPY OF THE FORM 990 WITH A SUMMARY STATEMENT BY MANAGEMENT FOR REVIEW AND APPROVAL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED MONTHLY WITH THE BOARD OF DIRECTORS AND INDIVIDUALLY WITH EACH NEW MEMBER AS THEY COME ON BOARD. ANNUALLY THE ORGANIZATION FORMALLY SURVEYS ALL BOARD OF DIRECTOR MEMBERS ON CONFLICTS OF INTEREST. WHEN A MATTER COMES BEFORE THE BOARD OF DIRECTORS THAT GIVES RISE TO A POTENTIAL CONFLICT OF INTEREST, THE AFFECTED DIRECTOR MAKES THE ISSUE KNOWN TO THE BOARD. AFTER DISCLOSING THE RELEVANT FACTS AND ANSWERING ANY QUESTIONS, THE AFFECTED DIRECTOR LEAVES THE MEETING FOR FURTHER DISCUSSION AND ANY VOTES. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE REMAINING DIRECTORS MAKE THE DETERMINATION. IF THE BOARD OF DIRECTORS BELIEVES A DIRECTOR HAS FAILED TO DISCLOSE A CONFLICT, IT INFORMS THE DIRECTOR AND GIVES THEM A CHANCE TO RESPOND AND EXPLAIN. AFTER THIS, IF THE BOARD DETERMINES THAT THE DIRECTOR HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE BOARD TAKES APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15A SALARY SURVEYS FROM THE EMPLOYERS COUNCIL AND NACHC/CCHN ARE USED TO DETERMINE COMPENSATION OF TOP MANAGEMENT OFFICIALS AND KEY EMPLOYEES. THE CEO'S COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED AND APPROVED BY THE CEO. THIS PROCESS LAST OCCURRED IN SEPTEMBER 2019. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST, ON MOUNTAIN FAMILY HEALTH CENTERS' WEBSITE, AND ON THE STATE OF COLORADO'S WEBSITE. OTHER DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. MOUNTAIN FAMILY HEALTH SOLUTIONS LLC 2700 GILSTRAP COURT SUITE 100 GLENWOOD SPRINGS CO 81601 840742145 TO HOLD MEDICAL SERVICE CONTRACTS WITH EMPLOYERS CO 0 0 MOUNTAIN FAMILY HEALTH CENTERS