2019-04-08T15:49:21-05:00 2018-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2017-06-01 840742145 MOUNTAIN FAMILY HEALTH CENTERS MOUN 9709452840 2700 GILSTRAP COURT NO 100 GLENWOOD SPRINGS CO 81601 ROSS BROOKS CHIEF EXECUTIVE OFFICER 9709452840 2019-03-26 1 KURT BENNION P01469618 3034668822 2019-03-26 67.137.57.251 2019-03-26 12:21:07 PD P B4AE3E2A15759F9337A2B81BCAF9FF6505250763 A52F513B8D8172ADA5E5426B2D9DBB033DEB48E6 2017 2019-02-21 02:37:17Z ROSS BROOKS 2700 GILSTRAP COURT NO 100 GLENWOOD SPRINGS CO 81601 18340215 0 X WWW.MOUNTAINFAMILY.ORG X 1977 CO TO PROVIDE HIGH QUALITY INTEGRATED PRIMARY, DENTAL AND BEHAVIORAL HEALTH CARE. 9 9 209 20 0 6617 7048980 8408498 9736447 9905379 4097 2712 14382 21463 16803906 18338052 16282 2300 0 0 11844421 12087199 114850 155762 155762 5082560 4689236 17058113 16934497 -254207 1403555 6448129 7629902 1393765 1172020 5054364 6457882 TO PROVIDE HIGH QUALITY, INTEGRATED MEDICAL, BEHAVIORAL AND DENTAL HEALTHCARE IN THE COMMUNITIES WE SERVE WITH SPECIAL CONSIDERATION FOR THE MEDICALLY UNDER-SERVED, REGARDLESS OF ABILITY TO PAY. 0 0 13089106 2300 9905379 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, 2018, 17,201 PATIENTS WERE SERVED THROUGH 64,158 BILLABLE ENCOUNTERS. 13089106 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 0 0 0 0 0 1 99 0 209 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 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 SARA AMBERG DIRECTOR (THROUGH APRIL 2018) 2.00 X 0 0 0 KARYN RENAE ANDERSON DIRECTOR 2.00 X 0 0 0 SAMUEL BERNAL DIRECTOR 2.00 X 0 0 0 TOM BOAS DIRECTOR 2.00 X 0 0 0 TRISH KRAMER DIRECTOR 2.00 X 0 0 0 HAIDITH RAMIREZ DIRECTOR 2.00 X 0 0 0 KELLEY STAIGHT DIRECTOR (THROUGH APRIL 2018) 2.00 X 0 0 0 ROSS BROOKS CEO 40.00 X 154682 0 30646 ANNETTE FRANTA CFO 40.00 X 118918 0 10888 ARTURO FERNANDEZ COO 40.00 X 112957 0 7177 AMY ARCHER DO CMO 40.00 X 216067 0 12499 CHRIS TONOZZI MD IT DIRECTOR 40.00 X 186497 0 33159 JOSHUA RUSK MD PHYSICIAN 40.00 X 176312 0 25666 ANNELIESE BURCH MD SITE DIRECTOR 40.00 X 176032 0 9925 MATTHEW PERCY MD SITE DIRECTOR 40.00 X 157933 0 19335 CASEY AGUIRRE DO PHYSICIAN 40.00 X 134693 0 4522 1434091 0 153817 13 0 1 0 ITENTIVE HELATHCARE SOLUTIONS 1 PIERCE PLACE SUITE 400E ITASCA IL 60143 SOFTWARE MAINTENANCE 220940 VAIL HEALTH INC PO BOX 40000 VAIL CO 81658 LEASE & PATIENT SERVICES 194695 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LABORATORY SERVICES 142711 CAROLYN HARDIN PO BOX 1396 CARBONDALE CO 81623 GRANT CONSULTING 127702 QUALITY SYSTEMS INC PO BOX 511449 LOS ANGELES CA 90051 SOFTWARE MAINTENANCE 107976 6 4979814 3428684 385687 8408498 PATIENT FEES 621400 8317353 8317353 CONTRACT REVENUE 621400 857313 857313 PHARMACY REVENUE 621400 730713 730713 9905379 2875 2875 2000 2163 -163 -163 -163 MISCELLANEOUS INCOME 900099 21463 21463 21463 18338052 9905379 0 24175 2300 2300 672160 672160 9384800 7756461 1628339 154072 93496 60576 1137188 860479 276709 738979 685823 53156 9182 9182 39995 39995 155762 155762 1197821 815425 382396 87157 24248 62909 196041 136583 59458 391341 271577 119764 79981 45657 34324 100604 16718 83886 230492 188909 41583 47676 30858 16818 UBI TAXES 1157 1157 MEDICAL SUPPLIES 1243656 1234855 8801 BAD DEBT EXPENSE 733989 733989 REPAIRS AND MAINTENANCE 186019 169445 16574 144125 22283 121842 16934497 13089106 3689629 155762 1246 1246 790556 3041950 550420 393356 2240653 1465552 169359 67306 4550730 1913306 2672864 2637424 22030 23068 1001 6448129 7629902 1299864 976930 93901 195090 1393765 1172020 X 4702565 4861883 351799 1595999 5054364 6457882 6448129 7629902 1403555 -37 0 X 0 1 X 1 1 1 X 4227236 4399317 5637061 7048980 8408498 29721092 4227236 4399317 5637061 7048980 8408498 29721092 29721092 1404 1588 2687 2639 2875 11193 33860 28424 33232 14382 21463 131361 29863646 41445174 0.99520 0.99250 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 0 0 0 0 0 0 0 0 1 3558 3558 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 23027 0 23027 0 0 2309160 412786 1896374 124085 98087 25998 1976832 1402433 574399 140653 140653 2637424 X 16667587 -37 307761 311889 619613 16047974 2290078 2290078 18338052 16508269 307761 307761 16200508 733989 733989 16934497 PART IV, LINE 1B: MOUNTAIN FAMILY HEALTH CENTERS ACTED AS FISCAL AGENT FOR THE WEST MOUNTAIN REGIONAL HEALTH ALLIANCE FOR A PORTION OF THE YEAR. 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 311,889. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 733,989. TEMPORARILY RESTRICTED CONTRIBUTIONS 1,556,089. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 733,989. X X X X X X 1 CAROLYN HARDIN PO BOX 1396 CARBONDALE CO 81623 GRANT WRITING 0 5054409 127702 4926707 ELISE THATCHER PO BOX 9505 ASPEN CO 81612 GRANT WRITING 0 52500 28060 24440 5106909 155762 4951147 CO X X X X X 0 1 0 0 0 0 0 0 0 ROSS BROOKS CEO 146921 0 0 0 7761 0 18000 0 12646 0 185328 0 0 0 AMY ARCHER DO CMO 197764 0 15000 0 3303 0 1427 0 11072 0 228566 0 0 0 CHRIS TONOZZI MD IT DIRECTOR 182491 0 0 0 4006 0 17934 0 15225 0 219656 0 0 0 JOSHUA RUSK MD PHYSICIAN 174484 0 0 0 1828 0 18000 0 7666 0 201978 0 0 0 ANNELIESE BURCH MD SITE DIRECTOR 175183 0 0 0 849 0 2269 0 7656 0 185957 0 0 0 MATTHEW PERCY MD SITE DIRECTOR 140061 0 0 0 17872 0 5412 0 13923 0 177268 0 0 0 PART I, LINE 4B CHRISTOPHER TONOZZI, MD, PARTICIPATES IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. DURING 2017, $16,509 WAS CONTRIBUTED TO THE PLAN, $564 ACCRUED WITHIN THE PLAN, AND THERE WERE NO DISTRIBUTIONS. X 1 385687 DONOR DETERMINED 0 0 1 0 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 BOARD OF DIRECTORS WAS 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 SURVEY INFORMATION FROM MOUNTAIN STATES EMPLOYERS COUNCIL AND NACHC/CCHN IS 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 2018. 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.