2018-03-07T15:46:40-06:00 2017-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2016-06-01 840742145 MOUNTAIN FAMILY HEALTH CENTERS MOUN 9709452840 2700 GILSTRAP COURT NO 230 GLENWOOD SPRINGS CO 81601 ROSS BROOKS CHIEF EXECUTIVE OFFICER 9709452840 2018-02-26 1 KURT BENNION P01469618 3034668822 67.137.57.251 2018-02-26 15:11:43 PS P 08F840E075ACB581FBD6619D481DF53759D1F891 65D9D98F5895FA0B49312EE1EB3C28152888AA91 2016 2021-01-29 14:40:06Z ROSS BROOKS 2700 GILSTRAP COURT NO 230 GLENWOOD SPRINGS CO 81601 16803906 0 X WWW.MOUNTAINFAMILY.ORG X 1977 CO TO PROVIDE HIGH QUALITY INTEGRATED PRIMARY, DENTAL AND BEHAVIORAL HEALTH CARE. 9 9 206 11 0 0 5637061 7048980 8090605 9736447 2687 4097 33232 14382 13763585 16803906 0 16282 0 0 9462876 11844421 77787 114850 114850 3908050 5082560 13448713 17058113 314872 -254207 6443831 6448129 1135276 1393765 5308555 5054364 TO PROVIDE HIGH QUALITY, INTEGRATED PRIMARY, BEHAVIORAL AND DENTAL HEALTH CARE IN THE COMMUNITIES WE SERVE, WITH SPECIAL CONSIDERATION FOR THE MEDICALLY UNDER-SERVED AND UNINSURED REGARDLESS OF ABILITY TO PAY. 0 0 12614928 16282 9736447 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, 15,650 PATIENTS WERE SERVED THROUGH 44,367 BILLABLE ENCOUNTERS. 12614928 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 95 0 206 1 0 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 X X ANNETTE FRANTA 9709452840 2700 GILSTRAP COURT NO 230 GLENWOOD SPRINGS CO 81601 ROB STEIN PHD CHAIR 2.00 X X 0 0 0 JON FOX RUBIN VICE CHAIR 2.00 X X 0 0 0 MONICA PEREZ RHODES TREASURER 2.00 X X 0 0 0 SANDRO TORRES SECRETARY (THROUGH JUNE 2016) 2.00 X X 0 0 0 RICHARD GONZALES DIRECTOR & SECRETARY 2.00 X X 0 0 0 KARYN RENAE ANDERSON DIRECTOR 2.00 X 0 0 0 TOM BOAS DIRECTOR 2.00 X 0 0 0 AMANDA KLAHR DIRECTOR (THROUGH FEBRUARY 2017) 2.00 X 0 0 0 LIZ STARK RN BSN DIRECTOR (THROUGH MARCH 2017) 2.00 X 0 0 0 KELLEY STRAIGHT DIRECTOR 2.00 X 0 0 0 ROSS BROOKS CEO 40.00 X 135660 0 8340 ANNETTE FRANTA CFO 40.00 X 115120 0 8340 AMY RYN DO CMO 40.00 X 207000 0 16550 CHRIS TONOZZI MD IT DIRECTOR 40.00 X 188989 0 16010 MATTHEW PERCY MD SITE DIRECTOR 40.00 X 169932 0 15438 ANNELIESE HECKERT MD SITE DIRECTOR 40.00 X 169496 0 16417 JOSHUA RUSK MD PHYSICIAN 40.00 X 166930 0 15348 1153127 0 96443 15 0 1 0 ITENTIVE HEALTHCARE SOLUTIONS PO BOX 661391 CHICAGO IL 60666 SOFTWARE HOSTING 229543 LABORATORY CORPORATION OF AMERICA 8490 UPLAND DRIVE ENGLEWOOD CO 80112 LABORATORY SERVICES 122696 QUALITY SYSTEMS INC 18111 VON KARMAN AVE STE 600 IRVINE CA 92612 SOFTWARE MAINTENANCE 115338 3 4946898 2102082 507390 7048980 PATIENT FEES 621400 7356044 7356044 CONTRACT REVENUE 621400 1612511 1612511 PHARMACY REVENUE 621400 767892 767892 9736447 2639 2639 1458 0 1458 1458 1458 MISCELLANEOUS INCOME 621400 14382 14382 14382 16803906 9736447 0 18479 16282 16282 331499 331499 9570594 7721774 1848820 96127 57523 38604 1111781 778677 333104 734420 705187 29233 7592 2000 5592 33260 33260 114850 114850 1313882 740171 573711 181042 93277 87765 241145 160234 80911 394931 269813 125118 87345 37931 49414 137613 18593 119020 196559 161006 35553 36036 24242 11794 MEDICAL SUPPLIES 1414324 1024756 389568 BAD DEBT EXPENSE 510713 510713 REPAIRS AND MAINTENANCE 374306 283581 90725 DUES AND SUBSCRIPTIONS 115130 5619 109511 38682 3549 35133 17058113 12614928 4328335 114850 946 1246 2174833 790556 220869 550420 1641798 2240653 134199 169359 4367935 1695071 2248257 2672864 21646 22030 1283 1001 6443831 6448129 1030696 1299864 92552 79755 12028 14146 1135276 1393765 X 4934700 4702565 373855 351799 5308555 5054364 6443831 6448129 -254207 16 0 X 0 1 X 1 1 1 X 3344012 4227236 4399317 5637061 7048980 24656606 3344012 4227236 4399317 5637061 7048980 24656606 24656606 1136 1404 1588 2687 2639 9454 66150 33860 28424 33232 14382 176048 24842108 36035254 0.99250 0.99000 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 1 16282 0 0 0 16282 0 PART II-B, LINE 1: CAMPAIGN CONTRIBUTION IN SUPPORT OF THE COLORADO TOBACCO TAX INCREASE. 1 121573 98546 23027 0 2309160 351867 1957293 124085 85950 38135 1925515 1257254 668261 9175 9175 2672864 DEFERRED RENT 14146 14146 X 16623026 16 307761 425998 733775 15889251 914655 914655 16803906 16855161 307761 307761 16547400 510713 510713 17058113 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 FUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 425,998. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 510,713. TEMPORARILY RESTRICTED CONTRIBUTIONS 403,942. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 510,713. X X X X X 1 CAROLYN HARDIN PO BOX 1396 CARBONDALE CO 81623 GRANT WRITING 0 4942097 108550 4833547 ELISE THATCHER PO BOX 9505 ASPEN CO 81612 GRANT WRITING 0 6360 6300 60 4948457 114850 4833607 CO 1 COLORADO COMMUNITY HEALTH NETWORK 600 GRANT STREET SUITE 800 DENVER CO 80203 840910590 501(C)(3) 16282 TOBACCO TAX INCREASE CAMPAIGN CONTRIBUTION 1 0 PART I, LINE 2: MOUNTAIN FAMILY HEALTH CENTERS WORKS CLOSELY WITH THE RECIPIENT ORGANIZATION, BUT DID NOT CONDUCT ANY SPECIFIC FOLLOW-UP ACTIVITIES TO MONITOR USE OF THE FUNDS. X X X X X 0 0 0 0 0 0 0 0 0 AMY RYN DO CMO 207000 0 0 0 0 0 6210 0 10340 0 223550 0 0 0 CHRIS TONOZZI MD IT DIRECTOR 188989 0 0 0 0 0 5670 0 10340 0 204999 0 0 0 MATTHEW PERCY MD SITE DIRECTOR 169932 0 0 0 0 0 5098 0 10340 0 185370 0 0 0 ANNELIESE HECKERT MD SITE DIRECTOR 169496 0 0 0 0 0 6077 0 10340 0 185913 0 0 0 JOSHUA RUSK MD PHYSICIAN 166930 0 0 0 0 0 5008 0 10340 0 182278 0 0 0 JERRY EVANS FORMER BOARD MEMBER 33000 EVALUATION SERVICES 0 X 1 507390 DONOR DETERMINED 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS A SERVICE CONTRACT WITH THE VAIL VALLEY MEDICAL CENTER THAT GIVES VAIL VALLEY MEDICAL CENTER 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 APRIL 2017. 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.