2023-11-10T17:03:20-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2022-01-01 841285505 LA CLINICA TEPEYAC LACL 7202742923 4725 HIGH STREET DENVER CO 80216 JIM GARCIA CEO 7202742923 2023-11-10 1 JIM GARCIA XXX-XX-XXXX 1 BECKY DETTMANN CPA P01408585 3037795710 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TEPEYAC COMMUNITY HEALTH CENTER JIM GARCIA 4725 HIGH STREET DENVER CO 80216 8803658 0 X WWW.TEPEYACHEALTH.ORG X 1994 CO INSPIRE HEALTH, WELLBEING, AND HUMANITY IN OUR COMMUNITY, THROUGH ALL OF LIFE'S STAGES. 14 14 104 14 0 0 5889761 7104184 1399528 1490517 97306 103561 3160 -17868 7389755 8680394 0 60000 0 0 3969706 4355080 49076 34099 404862 2531823 2773618 6550605 7222797 839150 1457597 16516064 17261657 8999395 8297509 7516669 8964148 X INSPIRE HEALTH, WELLBEING, AND HUMANITY IN OUR COMMUNITY, THROUGH ALL OF LIFE'S STAGES. WE ENVISION A HEALTHY COMMUNITY WITH ACCESS TO REGULAR AND ONGOING HEALTH CARE. AS WE EXPAND OUR REACH AND BRING,(CONTINUED ON SCHEDULE O)CULTURAL RESPONSIVENESS INTO THE COMMUNITY WE STRIVE FOR EXCEPTIONAL, TRUSTWORTHY CARE THAT EMPOWERS OUR PATIENTS, DECREASES ROUTINE VISITS TO EMERGENCY ROOMS, AND CREATES HEALTHIER FAMILIES OVERALL. 0 0 4010702 60000 1490517 CLINIC: PROVIDE BASIC PRIMARY CARE SERVICES, BASIC WELLNESS, PHYSICAL EXAMS, BEHAVIORAL HEALTH AND HEALTH EDUCATION. THIS INCLUDES WOMEN'S HEALTH EXAMS, MAMMOGRAPHY, PRENATAL CARE, IMMUNIZATIONS, SCHOOL PHYSICALS, DIABETES MANAGEMENT, COLPOSCOPIES, PREVENTIVE HEALTH EDUCATION, WELLNESS CLASSES, AND ORAL HEALTH CARE.HEALTH PROMOTION: PROVIDES EDUCATION FOR THE LATINX COMMUNITY AND THEIR FAMILIES TO REDUCE THE RISK OF CHRONIC DISEASE THROUGH COMMUNITY OUTREACH AND PREVENTIVE HEALTH EDUCATION CONDUCTED BY THE PROMOTORAS DE SALUD (HEALTH PROMOTERS). 4010702 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 1 40 0 1 104 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X LACY BRADLEY 7202742923 4725 HIGH STREET DENVER CO 80216 DR PAMELA VALENZA MD CHO 50.00 0.00 X 231321 0 17508 DR PATRICK HUFFER MD PHYSICIAN 40.00 0.00 X 184165 0 19726 JIM GARCIA CEO 60.00 1.00 X 171410 0 14524 SHANA MONTROSE CAO 40.00 0.00 X 121862 0 10626 ALISON QUINN BEITSCHER ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 116924 0 8131 AMANDA SILK CFO (THROUGH FEB. 2022) 50.00 0.00 X 23177 0 736 JOHANNA HELLER INTERIM CFO 40.00 0.00 X 0 0 0 JOHN BAUER MARTINEZ PRESIDENT 1.00 0.00 X X 0 0 0 DR HARVEY BOGRAD MD VICE PRESIDENT 1.00 0.00 X X 0 0 0 STEVE CHAVEZ TREASURER 1.00 0.00 X X 0 0 0 LINDA OSTERLUND PHD SECRETARY 1.00 0.00 X X 0 0 0 CAROLINE ACHA CONSUMER MEMBER 0.50 0.00 X 0 0 0 LUDY ESPERANZA CHACON CONSUMER MEMBER 0.50 0.00 X 0 0 0 CANDY HERNANDEZ CONSUMER MEMBER 0.50 0.00 X 0 0 0 JUANA MALDONADO CONSUMER MEMBER 0.50 0.00 X 0 0 0 GINA MILLAN CONSUMER MEMBER 0.50 0.00 X 0 0 0 JAQUELINE MORALES-LOZANO CONSUMER MEMBER 0.50 0.00 X 0 0 0 JESSE OGAS DIRECTOR 0.50 0.00 X 0 0 0 DR SAMIT SHAH MD DIRECTOR 0.50 0.00 X 0 0 0 RITA TORO CONSUMER MEMBER 0.50 0.00 X 0 0 0 DR GILBERT VIGIL PHD DIRECTOR 0.50 0.00 X 0 0 0 848859 0 71251 5 0 1 0 COMMUNITY LINK CONSULTING PO BOX 276 NEWMAN LAKE WA 99025 MANAGEMENT SERVICES 292467 VIRSAGE SOLUTIONS PO BOX 29650 PHOENIX AZ 85038 CONTRACTED IT DEPARTMENT 219781 ECLINICALWORKS LLC PO BOX 847950 BOSTON MA 02284 EHR SYSTEM 141297 ROCHE BRAND ADVISORS 2890 GILPIN ST DENVER CO 80210 BRAND CONSULTING 110137 4 161932 5021919 1920333 234760 7104184 PATIENT FEES 621110 1490517 1490517 1490517 103801 103801 240 -240 -240 -240 54099 161932 123024 -68925 -68925 MISCELLANEOUS INCOME 900099 51057 51057 51057 8680394 1490517 0 85693 X 60000 60000 583110 228560 272997 81553 3194636 1975245 1048052 171339 38982 20580 17582 820 248636 126035 110260 12341 289716 144527 128236 16953 25098 25098 55194 55194 34099 34099 792932 125195 613127 54610 40393 1113 27774 11506 116310 52237 62763 1310 459375 268646 186612 4117 163388 110531 51982 875 19201 7976 11225 18859 1369 17488 2 363547 362807 740 89736 56007 33729 42559 4271 38288 MEDICAL SUPPLIES 300356 298016 2340 CLINIC 117898 116968 930 DUES & MEMBERSHIPS 55888 13179 42709 BAD DEBT 48315 18017 16367 13931 64569 19423 43740 1406 7222797 4010702 2807233 404862 239571 343285 2435265 3682231 2115982 1330776 233127 137717 9496937 9496937 28646 73885 3012410 914739 1893184 2097671 59032 48914 14320 50241 16516064 17261657 482272 693443 471966 917054 8045157 6512499 0 174513 8999395 8297509 X 4887989 5618473 2628680 3345675 7516669 8964148 16516064 17261657 X 1457597 -10118 X X 0 1 X 1 1 1 X 6264586 4270179 5170843 5889761 7104184 28699553 6264586 4270179 5170843 5889761 7104184 28699553 988741 27710812 8730 15186 8375 96090 103801 232182 70274 41564 111838 31258 56297 86488 35803 51057 260903 29304476 6024232 0.94560 0.97240 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 31,258. 2019 AMOUNT: $ 56,297. 2020 AMOUNT: $ 86,488. 2021 AMOUNT: $ 35,803. 2022 AMOUNT: $ 51,057. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 59032 -9599 -519 48914 54195 5404 567 59032 48268 6406 479 54195 41663 7057 452 48268 44285 -2180 442 41663 0.00000 1.00000 0.00000 1 0 22500 274000 296500 1905509 528861 1376648 538219 385878 152341 272182 272182 2097671 DUE TO TEPEYAC, QALICB, INC. 174513 174513 X 8684304 0 8684304 -3910 -3910 8680394 7421827 195120 195120 7226707 -3910 -3910 7222797 PART V, LINE 4: THE PURPOSE OF THE ENDOWMENT FUND IS TO PAY FOR MEDICAL SERVICES FOR THE UNINSURED. PART X, LINE 2: THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE 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 GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE ORGANIZATIONS CONSOLIDATED 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 4B - OTHER ADJUSTMENTS: ADDITIONAL FUNDRAISING EXPENSES REPORTED IN EXPENSE ON AUDITED F/S -3,910. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED EXPENSES - TEPEYAC QALICB 255,120. ELIMINATION ON FINANCIAL STATEMENT -60,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: ADDITIONAL FUNDRAISING EXPENSES REPORTED IN EXPENSE ON AUDITED F/S -3,910. X X X X X X X 0 RIPPLE AFFECT LLC 4000 LIPAN STREET DENVER CO 80211 CAPITAL CAMPAIGN CONSULTING 0 0 26099 0 EVENTFUL PRODUCTION 1427 LARIMER STREET DENVER CO 80202 EVENT MANAGEMENT 0 0 8000 0 34099 CO FIESTA ON THE PLAZA 140875 104395 36480 29000 36480 33627 TORTILLAS FOR TEPEYAC 75156 57537 17619 800 17619 5498 216031 161932 54099 29800 54099 39125 123024 -68925 1 TEPEYAC QALICB INC 4725 HIGH STREET DENVER CO 80216 851563851 501(C)(3) 60000 0 N/A N/A GENERAL SUPPORT 1 0 PART I, LINE 2: TEPEYAC QALICB IS A RELATED CONTROLLED ORGANIZATION AND PROVIDES FINANCIAL REPORTS TO LA CLINICA TEPEYAC. THE CEO OF LA CLINICA TEPEYAC IS ALSO ON THE BOARD OF TEPEYAC QALICB. X X X X 0 0 0 0 0 0 0 0 0 DR PAMELA VALENZA MD CHO 231321 0 0 0 0 0 8563 0 8945 0 248829 0 0 0 DR PATRICK HUFFER MD PHYSICIAN 184165 0 0 0 0 0 6991 0 12735 0 203891 0 0 0 JIM GARCIA CEO 171410 0 0 0 0 0 5814 0 8710 0 185934 0 0 0 X 8700 234760 FMV 0 0 0 0 PART I, COLUMN (B): THE NUMBER OF ITEMS CONTRIBUTED WAS USED IN PART I. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT, VICE-PRESIDENT, SECRETARY, TREASURER, AND IMMEDIATE PAST-PRESIDENT OF THE BOARD OF DIRECTORS. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE HAS THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO THE LIMITATIONS IMPOSED BY THE COLORADO NONPROFIT CORPORATION ACT AND TO ANY LIMITATIONS IMPOSED BY THE BOARD, INCLUDING, THAT SUCH COMMITTEE SHALL NOT: (1) ELECT, APPOINT, OR REMOVE ANY DIRECTOR; (2) AMEND ARTICLES OF INCORPORATION; (3) ADOPT, AMEND, OR REPEAL BYLAWS; (4) APPROVE A PLAN OF CONVERSION OR PLAN OF MERGER WITH ANOTHER ENTITY; OR (5) APPROVE A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF ITS PROPERTY. THE EXECUTIVE COMMITTEE MUST REPORT ALL ACTIONS TAKEN INDEPENDENTLY AND ON BEHALF OF THE BOARD TO THE FULL GOVERNING BOARD, AND THE FULL GOVERNING BOARD MUST VOTE ON THESE ACTIONS AND REORD THEM IN THE BOARD MINUTES. FORM 990, PART VI, SECTION A, LINE 3 DURING 2022, THE ORGANIZATION PAID COMMUNITY LINK CONSULTING $167,640. FOR INTERIM FINANCIAL MANAGEMENT SERVICES, WHICH INCLUDED THE SERVICES PERFORMED BY JOHANNA HELLER, INTERIM CFO. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED TO REFLECT THE FOLLOWING CHANGES: -NON-CONSUMER BOARD MEMBERS AT NO TIME MAY MORE THAN ONE-HALF OF THE NON-CONSUMER BOARD MEMBERS DERIVE MORE THAN 10% OF THEIR ANNUAL INCOME FROM THE HEALTH CARE INDUSTRY. -CLARIFIED RESPONSIBILITIES FOR BOARD OF DIRECTORS. -EACH DIRECTOR SHALL BE ENTITLED TO ONE VOTE ON ANY MATTER BEFORE THE BOARD. VOTING BY PROXY SHALL BE PERMITTED. A DIRECTOR MAY BE DEEMED TO BE PRESENT AT A MEETING AND TO VOTE IF THE DIRECTOR HAS GRANTED A SIGNED WRITTEN PROXY TO ANOTHER DIRECTOR WHO IS PRESENT AT THE MEETING, AUTHORIZING THE OTHER DIRECTOR TO CAST THE VOTE THAT IS DIRECTED TO CAST BY WRITTEN PROXY WITH RESPECT TO THE PARTICULAR PROPOSAL THAT IS DESCRIBED WITH REASONABLE SPECIFICITY IN THE PROXY. -ADDED POLICY FOR REMOVAL AND RESIGNATION OF CEO. -ANY VACANCY COUSED BY THE DEATH, RESIGNATION, REMOVAL, DISQUALIFICATION, OR OTHERWISE, OF THE CEO SHALL BE FILLED BY THE BOARD. VACANCIES OCCURRING IN THE OFFICES OF THE CEO APPOINTED AT THE DISCRETION OF THE BOARD MAY OR MAY NOT BE FILLED AS THE BOARD SHALL DETERMINE. -ADDED DUTIES OF CHIEF FINANCIAL OFFICER. -ADDED DUTIES OF CHIEF ADMINISTRATIVE OFFICER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S INDEPENDENT CPA WITH INFORMATION PROVIDED BY MANAGEMENT. A COPY OF THE FORM 990 WAS REVIEWED BY THE CFO AND THE CEO, THEN BY THE FINANCE COMMITTEE. THE 990 IS THEN DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, EACH BOARD MEMBER COMPLETES A CONFLICT OF INTEREST DISCLOSURE. IF A POTENTIAL CONFLICT OF INTEREST ARISES WITH A BOARD MEMBER, THE INDIVIDUAL PROVIDES WRITTEN NOTICE OF THE POTENTIAL CONFLICT OF INTEREST TO THE BOARD OF DIRECTORS AND REFRAINS FROM PARTICIPATION IN ANY DISCUSSION OR VOTING ON ANY MATTERS PERTAINING TO THE CONFLICT OF INTEREST. ANY DISCUSSION OF POTENTIAL CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE CEO'S PERFORMANCE TO DETERMINE COMPENSATION. SALARY SURVEYS FROM THE COLORADO COMMUNITY HEALTH NETWORK AND THE COLORADO NONPROFIT ASSOCIATION ARE USED AS GUIDELINES. DISCUSSION RELATED TO THE DELIBERATION AND THE DECISION IS DOCUMENTED IN THE BOARD MINUTES. BASED ON COMPARABLE SALARY INFORMATION, THE CEO, CONTROLLER AND HR MANAGER REVIEW AND APPROVE THE COMPENSATION FOR THE OTHER OFFICERS OF THE ORGANIZATION. THE MOST RECENT COMPENSATION REVIEW WAS CONDUCTED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 125,195. MANAGEMENT AND GENERAL EXPENSES 613,127. FUNDRAISING EXPENSES 54,610. TOTAL EXPENSES 792,932. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY OTHERS -10,118. PART XII, LINE 2C THE PROCESS AND OVERSIGHT FOR SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR. TEPEYAC QALICB INC 4725 HIGH STREET DENVER CO 80216 851563851 SUPPORT LA CLINICA TEPEYAC CO 501(C)(3) LINE 12C, III-FI LA CLINICA TEPEYAC 1 0 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 TEPEYAC QALICB INC B 60000 CASH PAID TEPEYAC QALICB INC D 174514 FAIR MARKET VALUE