2019-05-13T16:54:13-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2018-01-01 840921521 PUEBLO COMMUNITY HEALTH CENTER INC PUEB 7195438711 110 EAST ROUTT AVENUE PUEBLO CO 81004 CINDY PRATT CFO 7195438711 2019-05-10 1 KURT BENNION P01469618 3034668822 2019-05-10 67.137.57.251 2019-05-10 07:18:36 PD P FE364397F9AD7E3202A1F249EA4C481637B034D8 FC22DA715B55187DFB022ABBE867634B2E01E370 2018 2019-02-21 02:37:17Z DONALD MOORE 110 EAST ROUTT AVENUE PUEBLO CO 81004 34773095 0 X WWW.PUEBLOCHC.ORG X 1983 CO TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED. 12 12 394 14 0 3066 7380878 6863038 24348087 27273895 320032 570109 50628 66053 32099625 34773095 46861 61941 0 0 20907801 22613092 0 0 0 7600741 8180942 28555403 30855975 3544222 3917120 34609605 38773571 2379615 2602781 32229990 36170790 TO PROVIDE PRIMARY HEALTH CARE TO THOSE IN NEED. 0 0 21660167 61941 22141596 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. 2305283 0 4088308 PHARMACEUTICAL SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 1700834 0 1043991 PREVENTATIVE, RESTORATIVE, AND EMERGENCY DENTAL HEALTH CARE SERVICES FOR LOW-INCOME, MEDICALLY UNINSURED AND UNDERINSURED OF PUEBLO COUNTY. 25666284 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 61 0 394 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X CINDY PRATT 7195438718 110 EAST ROUTT AVENUE PUEBLO CO 81004 REBECCA GOODMAN PRESIDENT & IMMEDIATE PAST PRESIDENT 1.00 X X 0 0 0 CHRIS MARKUSON PRESIDENT-ELECT & PRESIDENT 1.00 X X 0 0 0 MICHELLE HILL IMMEDIATE PAST PRESIDENT & DIRECTOR 1.00 X X 0 0 0 ARTHUR YARBROUGH JR SECRETARY & PRESIDENT-ELECT 1.00 X X 0 0 0 MICHAEL GAGE DIRECTOR & SECRETARY 1.00 X X 0 0 0 JAY RICHTER MD TREASURER (THROUGH MAY 2018) 1.00 X X 0 0 0 LINDA RIKHOFF RN DIRECTOR & TREASURER 1.00 X X 0 0 0 LOUIS BALIZET MD DIRECTOR 1.00 X 0 0 0 YESENIA BEASCOCHEA DIRECTOR 1.00 X 0 0 0 JAE BRIMHALL DMD DIRECTOR 1.00 X 0 0 0 SHIRLEY CORDOVA DIRECTOR 1.00 X 0 0 0 ANGELINA MARTINEZ DIRECTOR 1.00 X 0 0 0 DON ORTEGA DIRECTOR 1.00 X 0 0 0 DONALD MOORE CHIEF EXECUTIVE OFFICER 40.00 X 169544 0 24925 CINDY PRATT CHIEF FINANCIAL OFFICER 40.00 X 129919 0 15751 KAREN MILLER DDS CHIEF DENTAL OFFICER 40.00 X 164648 0 17556 JUSTIN MCCARTHY CHIEF OPERATIONS OFFICER 40.00 X 133403 0 20003 MICHAEL BARRIS MD CHIEF MED CO-OFFICER (THROUGH OCT 2018) 40.00 X 257496 0 27561 DAVID KRAUSE MD CHIEF MEDICAL CO-OFFICER & SENIOR MEDICAL DIRECTOR 34.00 X 206707 0 27723 CLAIRE REED MD CHIEF MEDICAL OFFICER 40.00 X 36094 0 100 LAURA KELLY CHIEF DEVELOPMENT & FOUNDATION OFFICER 28.00 X 78415 0 15768 CHAD HESS RN PA-C ASSOCIATE MEDICAL DIRECTOR (THROUGH OCT 2018) 40.00 X 173453 0 22517 DANA RILEY MD PHYSICIAN 36.00 X 236725 0 26417 STEPHANIE PARKER DO PHYSICIAN 36.00 X 199419 0 23091 BRETT HULET MD PHYSICIAN 24.00 X 196424 0 19508 RICHARD KING MD PHYSICIAN 28.00 X 151200 0 18238 MARK SCHWARTZ MD PHYSICIAN 28.00 X 163205 0 11013 2296652 0 270171 27 0 1 0 CARDINAL HEALTH PHARMACY MANAGEMENT 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT 1106559 COLORADO COMMUNITY MANAGED CARE NETWORK 1212 S BROADWAY DENVER CO 80210 SOFTWARE SUPPORT 378154 QUALITY SYSTEMS INC PO BOX 511456 LOS ANGELES CA 90051 SOFTWARE SUPPORT 330566 JD'S JANITORIAL SERVICE LLC 225 BROADWAY AVENUE PUEBLO CO 81004 JANITORIAL SERVICES 269186 VONAGE BUSINESS PO BOX 123151 DALLAS TX 75312 PHONE SUPPORT 128132 17 6832776 30262 18088 6863038 PATIENT REVENUE 621110 23117587 23117587 PHARMACY REVENUE 621110 4088308 4088308 MEANINGFUL USE REVENUE 621110 68000 68000 27273895 570109 570109 19301 0 19301 19301 19301 MISCELLANEOUS 900099 46752 46752 46752 34773095 27273895 0 636162 57262 57262 4679 4679 1521583 725367 796216 17176360 15409739 1766621 640991 542944 98047 1961196 1551467 409729 1312962 1119659 193303 85982 6450 79532 43956 550 43406 1800362 1407925 392437 199067 45834 153233 646023 533918 112105 663703 363044 300659 654423 477853 176570 52542 46521 6021 150560 77061 73499 896411 498722 397689 76457 35193 41264 UBI TAXES 644 644 MEDICAL SUPPLIES 2416788 2416703 85 BAD DEBT EXPENSE 224845 224845 0 DUES & LICENSES 161938 56683 105255 107241 63865 43376 30855975 25666284 5189691 0 1252135 1929456 14040012 16644107 795958 761803 2681591 3724480 65702 65890 194016 198609 21986532 8979154 13242510 13007378 1413913 1486521 911567 935247 1333 1333 10868 18747 34609605 38773571 2379615 2602781 2379615 2602781 X 31318423 35235543 911567 935247 32229990 36170790 34609605 38773571 X 3917120 23680 X 0 1 X 1 1 1 X 6249721 5784482 6560591 7380878 6863038 32838710 6249721 5784482 6560591 7380878 6863038 32838710 32838710 1014 2183 18240 320032 589410 930879 109856 148086 159231 50628 46752 514553 34284142 117584892 0.95780 0.97240 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 0 0 0 0 0 0 0 0 1 8896 8896 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE COLORADO COMMUNITY HEALTH NETWORK, A PORTION OF WHICH IS USED BY THE NETWORK TO LOBBY ON BEHALF OF ITS MEMBER ORGANIZATIONS. 2095616 2095616 16423664 6051832 10371832 3467252 2927322 539930 13007378 X 34773095 0 34773095 0 34773095 30855975 0 30855975 0 30855975 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. 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. 1 PUEBLO COMMUNITY HEALTH CENTER FOUNDATION 310 COLORADO AVENUE PUEBLO CO 81004 041404345 501(C)(3) 27000 GENERAL OPERATING EXPENSES 1 0 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. X X X X 0 0 0 0 0 0 0 0 0 DONALD MOORE CHIEF EXECUTIVE OFFICER 169044 0 500 0 0 0 9875 0 15050 0 194469 0 0 0 KAREN MILLER DDS CHIEF DENTAL OFFICER 164148 0 500 0 0 0 9915 0 7641 0 182204 0 0 0 JUSTIN MCCARTHY CHIEF OPERATIONS OFFICER 132903 0 500 0 0 0 8317 0 11686 0 153406 0 0 0 MICHAEL BARRIS MD CHIEF MED CO-OFFICER (THROUGH OCT 2018) 247196 0 10300 0 0 0 15755 0 11806 0 285057 0 0 0 DAVID KRAUSE MD CHIEF MEDICAL CO-OFFICER & SENIOR MEDICAL DIRECTOR 196407 0 10300 0 0 0 12916 0 14807 0 234430 0 0 0 CHAD HESS RN PA-C ASSOCIATE MEDICAL DIRECTOR (THROUGH OCT 2018) 172953 0 500 0 0 0 10810 0 11707 0 195970 0 0 0 DANA RILEY MD PHYSICIAN 223925 0 12800 0 0 0 11357 0 15060 0 263142 0 0 0 STEPHANIE PARKER DO PHYSICIAN 198919 0 500 0 0 0 11972 0 11119 0 222510 0 0 0 BRETT HULET MD PHYSICIAN 195924 0 500 0 0 0 12472 0 7036 0 215932 0 0 0 RICHARD KING MD PHYSICIAN 145100 0 6100 0 0 0 10162 0 8076 0 169438 0 0 0 MARK SCHWARTZ MD PHYSICIAN 158505 0 4700 0 0 0 9812 0 1201 0 174218 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. 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. 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 2018. 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 23,680.