2016-01-12T13:40:54-06:00 2015-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2014-06-01 840742145 MOUNTAIN FAMILY HEALTH CENTERS MOUN 9709452840 2700 GILSTRAP COURT NO 230 GLENWOOD SPRINGS CO 81601 ROSS BROOKS CHIEF EXECUTIVE OFFICER 9709452840 2016-01-12 1 KURT BENNION P01469618 3034668822 2014 2016-04-25 22:37:26Z X ROSS BROOKS 2700 GILSTRAP COURT NO 230 GLENWOOD SPRINGS CO 81601 12794940 0 X WWW.MOUNTAINFAMILY.ORG X 1977 CO TO PROVIDE HIGH QUALITY INTEGRATED PRIMARY, DENTAL AND BEHAVIORAL HEALTH CARE. 11 11 149 20 0 0 4227236 4399317 5347192 8365551 -16302 -82982 33860 28484 9591986 12710370 0 0 0 0 6421297 7963754 0 45000 45000 2847824 4222237 9269121 12230991 322865 479379 5281021 5998755 766514 1004877 4514507 4993878 X 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 1 9126320 0 8365551 PRIMARY CARE SERVICES - FOUR CLINICS PROVIDE OUTPATIENT MEDICAL TREATMENT FOR 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 US DEPARTMENT OF HEALTH AND HUMAN SERVICES. FOR THE FISCAL YEAR, 14,667 PATIENTS SERVED WITH 47,112 BILLABLE ENCOUNTERS. 9126320 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 68 0 149 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CO X X ANNETTE FRANTA 9709452840 2700 GILSTRAP COURT NO 230 GLENWOOD SPRINGS CO 81601 JOANN SORENSEN CHAIR (THROUGH JANUARY 2015) 2.00 X X 0 0 0 RACHEL OYS CHAIR (THROUGH APRIL 2015) 2.00 X X 0 0 0 JERRY EVANS CHAIR 2.00 X X 4167 0 0 MONICA PEREZ RHODES TREASURER 2.00 X X 0 0 0 SANDRO TORRES SECRETARY 2.00 X X 0 0 0 KARYN RENAE ANDERSON DIRECTOR 2.00 X 0 0 0 JOHN BARBEE DIRECTOR (THROUGH JUNE 2014) 2.00 X 0 0 0 TOM BOAS DIRECTOR 2.00 X 0 0 0 AMANDA BROOKE DIRECTOR 2.00 X 0 0 0 KEN FRIEDMAN DIRECTOR (THROUGH JANUARY 2015) 2.00 X 0 0 0 TOM LAMBRECHT DIRECTOR (THROUGH JANUARY 2015) 2.00 X 0 0 0 AMY LEE DIRECTOR (THROUGH MARCH 2015) 2.00 X 0 0 0 MILTON RODAS DIRECTOR 2.00 X 0 0 0 JON FOX RUBIN DIRECTOR 2.00 X 0 0 0 LIZ STARK DIRECTOR 2.00 X 0 0 0 ROB STEIN DIRECTOR 2.00 X 0 0 0 ROSS BROOKS CEO 40.00 X 128873 0 6516 ANNETTE FRANTA CFO 40.00 X 100611 0 9631 CHRIS TONOZZI MD IT DIRECTOR 40.00 X 185675 0 9301 KEN DAVIS PAC ICT MANAGER 40.00 X 156028 0 8856 GARRY MILLARD DDS CDO 40.00 X 150460 0 8773 AMY BROWN MD PHYSICIAN 40.00 X 131149 0 5501 PATRICIO GONZALEZ DDS DENTIST 40.00 X 118835 0 8122 975798 0 56700 8 0 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUM PHYSICIANS 248598 ITENTIVE CORPORATION PO BOX 661391 CHICAGO IL 60666 SOFTWARE HOUSING 148935 MINDSPRINGS HEALTH 715 HORIZON DRIVE SUITE 225 GRAND JUNCTION CO 81506 BEHAVIORAL HEALTH 110675 QUALITY SYSTEMS INC 18111 VON KARMAN AVENUE SUITE 600 IRVINE CA 92612 SOFTWARE MAINTENANCE 103029 LABORATORY CORPORATION OF AMERICA 8490 UPLAND DRIVE ENGLEWOOD CO 80112 LABORATORY SERVICES 101137 5 3193889 1205428 279647 4399317 PATIENT FEES 621400 6666202 6666202 CONTRACT REVENUE 621400 1494913 1494913 PHARMACY REVENUE 621400 204436 204436 8365551 1588 1588 84570 -84570 -84570 -84570 MISCELLANEOUS INCOME 621400 28484 28484 28484 12710370 8365551 0 -54498 X 261941 261941 6358145 4867054 1491091 45809 35317 10492 799148 630797 168351 498711 340270 158441 5540 5540 31720 31720 45000 45000 1448325 1132293 316032 57112 39661 17451 248285 180652 67633 330011 246471 83540 85606 36073 49533 76832 17648 59184 281182 196480 84702 15761 15761 MEDICAL SUPPLIES 708982 600185 108797 BAD DEBT EXPENSE 523093 523093 REPAIRS AND MAINTENANCE 264493 236655 27838 DUES AND SUBSCRIPTIONS 81401 5077 76324 63894 38594 25300 12230991 9126320 3059671 45000 1050 1046 827376 1379571 733211 764874 902462 1370042 108839 21049 3794532 1355170 2685352 2439362 18470 19118 4261 3693 5281021 5998755 729430 861235 28439 134166 8645 9476 766514 1004877 X 3914313 4198151 600194 795727 4514507 4993878 5281021 5998755 479379 -8 0 X 0 1 X 1 1 1 X 3966035 3259682 3344012 4227236 4399317 19196282 3966035 3259682 3344012 4227236 4399317 19196282 19196282 47706 5057 1136 1404 1588 56891 15532 66150 33860 28424 143966 19397139 25758737 0.98960 0.99620 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2273861 233216 2040645 118114 77191 40923 1402557 1044763 357794 2439362 DEFERRED RENT 9476 9476 X 12298777 -8 307041 704467 1011500 11287277 1423093 1423093 12710370 12014939 307041 307041 11707898 523093 523093 12230991 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 704,467. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 523,093. TEMPORARILY RESTRICTED CONTRIBUTIONS 900,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 523,093. X X X X 1 CAROLYN HARDIN PO BOX 1396 CARBONDALE CO 81623 GRANT WRITING 0 2600000 20000 2580000 RAY & ASSOCIATES LLC PO BOX 7608 CAVE CREEK AZ 85327 GRANT WRITING 0 0 25000 -25000 2600000 45000 2555000 CO X X X 0 0 0 1 0 0 0 0 0 CHRIS TONOZZI MD IT DIRECTOR 185675 0 0 0 0 0 2785 0 6516 0 194976 0 0 0 KEN DAVIS PAC ICT MANAGER 156028 0 0 0 0 0 2340 0 6516 0 164884 0 0 0 GARRY MILLARD DDS CDO 150460 0 0 0 0 0 2257 0 6516 0 159233 0 0 0 PART I, LINE 5 THERE IS A PRODUCTIVITY INCENTIVE THAT IS OFFERED TO EMPLOYEES THAT MEET CERTAIN PRODUCTIVITY THRESHOLDS. X 1 279647 DONOR DETERMINED 0 0 0 0 FORM 990, PART III, LINE 3 DURING THE FISCAL YEAR, THE ORGANIZATION CLOSED ITS BLACK HAWK CLINIC. 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 11 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 NOVEMBER 2014. 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. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,132,293. MANAGEMENT AND GENERAL EXPENSES 316,032. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,448,325.