2021-12-15T16:02:03-06:00 2021-05-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-06-01 840742145 MOUNTAIN FAMILY HEALTH CENTERS MOUN 9709452840 2700 GILSTRAP COURT NO 100 GLENWOOD SPRINGS CO 81601 ROSS BROOKS CHIEF EXECUTIVE OFFICER 9709452840 2021-12-09 1 ROSS BROOKS 999009999 KURT BENNION CPA P01469618 4252506100 2021-12-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ROSS BROOKS 2700 GILSTRAP COURT NO 100 GLENWOOD SPRINGS CO 81601 21955122 0 X WWW.MOUNTAINFAMILY.ORG X 1977 CO PROVIDING EQUITABLE AND AFFORDABLE MEDICAL, BEHAVIORAL, AND DENTAL HEALTHCARE FOR ALL. 10 10 234 20 5507 0 9665941 11503099 10126869 10444759 -841 1478 8665 5786 19800634 21955122 7068 2658 0 0 13560838 13824575 143069 93196 93196 5597879 5732180 19308854 19652609 491780 2302513 12754527 12157748 5161107 2261843 7593420 9895905 X WE IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING EQUITABLE AND AFFORDABLE MEDICAL, BEHAVIORAL, AND DENTAL HEALTHCARE FOR ALL. 1 0 15782879 2658 10439252 MOUNTAIN FAMILY HEALTH CENTERS PROVIDES PRIMARY MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES AT TEN 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, 2021, 18,260 PATIENTS WERE SERVED THROUGH 70,579 BILLABLE ENCOUNTERS. DURING THE FISCAL YEAR, MOUNTAIN FAMILY HEALTH CENTERS OPENED FIVE NEW SCHOOL-BASED HEALTH CENTER SITES IN THE ROARING FORK SCHOOL DISTRICT. DURING THE FISCAL YEAR, MOUNTAIN FAMILY PROVIDED APPROXIMATELY 8,000 COVID VACCINES TO THE COMMUNITY. 15782879 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 1 0 0 0 0 1 98 0 234 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 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 MONICA PEREZ RHODES CHAIR 2.00 X X 0 0 0 RICHARD GONZALES VICE CHAIR (THROUGH NOV 2020) 2.00 X X 0 0 0 ROB STEIN PHD SECRETARY 2.00 X X 0 0 0 JON FOX-RUBIN TREASURER 2.00 X X 0 0 0 KARYN RENAE ANDERSON BOARD MEMBER 2.00 X 0 0 0 SAMUEL BERNAL BOARD MEMBER (THROUGH AUG 2020) 2.00 X 0 0 0 MEGAN BURCH BOARD MEMBER (THROUGH MARCH 2021) 2.00 X 0 0 0 PAZ ESCOBAR KOSTRBA BOARD MEMBER 2.00 X 0 0 0 TRISH KRAMER BOARD MEMBER 2.00 X 0 0 0 BETTY LUCAS BOARD MEMBER 2.00 X 0 0 0 VICTOR MAMLIN BOARD MEMBER 2.00 X 0 0 0 MARISOL PALOMO BOARD MEMBER 2.00 X 0 0 0 SYDNEY SCHALIT BOARD MEMBER 2.00 X 0 0 0 ROSS BROOKS CEO 50.00 X 195401 0 20360 ANNETTE FRANTA CFO 50.00 X 132850 0 13195 ARTURO FERNANDEZ COO 50.00 X 129640 0 16374 SCOTT OWENS SPHR CHIEF WORKFORCE OFFICER 50.00 X 110479 0 12665 MATTHEW PERCY MD CHIEF MEDICAL TEAM 50.00 X 189654 0 23089 ANNELIESE HECKERT DO CHIEF MEDICAL TEAM 50.00 X 192027 0 17362 JENNIFER LANG FNP CHIEF MEDICAL TEAM 50.00 X 150018 0 21700 STEPHEN GLASS DDS DENTAL DIRECTOR 40.00 X 141787 0 12092 ZACKARY KENT MD PHYSICIAN 40.00 X 203375 0 29564 CHRIS TONOZZI MD PHYSICIAN 40.00 X 196020 0 12911 CASEY AGUIRRE DO PHYSICIAN 40.00 X 192678 0 9263 MARIA CHANSKY MD PHYSICIAN 40.00 X 173835 0 22644 2007764 0 211219 20 0 1 0 OSIS PO BOX 772852 CHICAGO IL 60677 SOFTWARE LICENSING/HOSTING 369738 LABORATORY CORPORATION OF AMERICA PO BO 12140 BURLINGTON NC 27216 LABORATORY SERVICES 118499 2 8735865 2767234 449121 11503099 PATIENT FEES 621400 8731772 8726265 5507 CONTRACT REVENUE 621400 1173232 1173232 PHARMACY REVENUE 621400 539755 539755 10444759 1478 1478 MISCELLANEOUS INCOME 900099 5786 5786 5786 21955122 10439252 5507 7264 1350 1350 1308 1308 1431646 462872 968774 10239591 8762710 1476881 148547 138320 10227 1146236 952644 193592 858555 689408 169147 11616 11616 71425 71425 93196 93196 1606827 1234842 371985 25612 3647 21965 265735 206613 59122 703079 616437 86642 31940 14785 17155 4318 1999 2319 33558 20953 12605 459213 404859 54354 72661 52587 20074 MEDICAL SUPPLIES 1330863 1330863 BAD DEBT EXPENSE 515085 515085 REPAIRS & MAINTENANCE 418369 306843 111526 DUES & SUBSCRIPTIONS 95718 11953 83765 86161 52801 33360 19652609 15782879 3776534 93196 1446 1446 4211031 3550653 1195377 988039 1887666 1786341 95475 326701 8637958 3133578 5363208 5504380 324 188 12754527 12157748 1588841 1727523 885595 383774 1186671 150546 1500000 5161107 2261843 X 6250789 9140489 1342631 755416 7593420 9895905 12754527 12157748 2302513 -28 0 X 0 1 X 1 1 1 X 7048980 8408498 8411183 9665941 11503099 45037701 7048980 8408498 8411183 9665941 11503099 45037701 45037701 2639 2875 1558 1326 1478 9876 477 477 14382 21465 17439 8665 5786 67737 45115791 50681431 0.99830 0.99730 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 0 0 0 1 4020 4020 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 0 50009 50009 0 0 2309160 590641 1718519 2928316 360677 2567639 2976443 2182260 794183 424039 424039 5504380 X 22671570 -28 711846 839343 1551161 21120409 834713 834713 21955122 19849370 711846 711846 19137524 515085 515085 19652609 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 BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 839,343. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 515,085. RESTRICTED CONTRIBUTIONS 319,628. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 515,085. X X X X X X 1 CAROLYN HARDIN PO BOX 1396 CARBONDALE CO 81623 GRANT WRITING 0 6362818 93196 6269622 6362818 93196 6269622 CO X X X X X 0 1 0 0 0 0 0 0 0 ZACKARY KENT MD PHYSICIAN 202950 0 425 0 0 0 2097 0 27467 0 232939 0 0 0 ROSS BROOKS CEO 190842 0 43 0 4516 0 4793 0 15567 0 215761 0 0 0 MATTHEW PERCY MD CHIEF MEDICAL TEAM 189122 0 532 0 0 0 4470 0 18619 0 212743 0 0 0 ANNELIESE HECKERT DO CHIEF MEDICAL TEAM 191061 0 966 0 0 0 4530 0 12832 0 209389 0 0 0 CHRIS TONOZZI MD PHYSICIAN 195941 0 79 0 0 0 4112 0 8799 0 208931 0 0 0 CASEY AGUIRRE DO PHYSICIAN 192626 0 52 0 0 0 0 0 9263 0 201941 0 0 0 MARIA CHANSKY MD PHYSICIAN 173783 0 52 0 0 0 4487 0 18157 0 196479 0 0 0 JENNIFER LANG FNP CHIEF MEDICAL TEAM 149639 0 379 0 0 0 3752 0 17948 0 171718 0 0 0 STEPHEN GLASS DDS DENTAL DIRECTOR 141618 0 169 0 0 0 3305 0 8787 0 153879 0 0 0 PART I, LINE 4B THE ORGANIZATION HAS A 457(F) PLAN THAT IS AVAILABLE TO THE EXECUTIVE TEAM MEMBERS. TO DATE, THE ORGANIZATION HAS NOT CONTRIBUTED TO THE PLAN, BUT EACH ELIGIBLE INDIVIDUAL MAY CHOOSE TO CONTRIBUTE. X 1 2387 DAILY TRADING PRICE X 427 446734 DONOR DETERMINED 0 0 1 0 FORM 990, PART III, LINE 2 DURING THE FISCAL YEAR, THE ORGANIZATION OPENED FIVE NEW SCHOOL-BASED HEALTH CENTER SITES IN THE ROARING FORK SCHOOL DISTRICT. 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 ON BEHALF OF THE BOARD BETWEEN ITS MEETINGS, ESPECIALLY WITH RESPECT TO EMERGENT OR TIME-SENSITIVE MATTERS. THE EXECUTIVE COMMITTEE DOES NOT HAVE AUTHORITY WITH RESPECT TO AMENDING, ALTERING OR REPEALING THE BYLAWS; ELECTING, APPOINTING, OR REMOVING ANY BOARD MEMBER OR EXECUTIVE COMMITTEE MEMBER; AMENDING OR RESTATING THE ARTICLES OF INCORPORATION; ADOPTING A PLAN OF MERGER OR CONSOLIDATION WITH ANOTHER COMPANY; AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS; AUTHORIZING THE ORGANIZATION'S VOLUNTARY DISSOLUTION OR REVOKING PROCEEDINGS THEREFORE; ADOPTING A PLAN FOR THE DISTRIBUTION OF THE ORGANIZATION'S ASSETS; OR AMENDING, ALTERING OR REPEALING ANY RESOLUTION OF THE BOARD. THE EXECUTIVE COMMITTEE MUST KEEP THE BOARD TIMELY AND REASONABLY INFORMED OF ITS DELIBERATIONS AND ACTIONS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS A SERVICE CONTRACT WITH 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 FORM 990 WAS REVIEWED IN DETAIL BY THE FINANCE TEAM. IT WAS THEN REVIEWED BY THE CEO. THE BOARD OF DIRECTORS WAS THEN 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 SURVEYS FROM THE EMPLOYERS COUNCIL AND NACHC/CCHN ARE 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 2021. 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. MOUNTAIN FAMILY HEALTH SOLUTIONS LLC 2700 GILSTRAP COURT SUITE 100 GLENWOOD SPRINGS CO 81601 840742145 TO HOLD MEDICAL SERVICE CONTRACTS WITH EMPLOYERS CO 8714 6144 MOUNTAIN FAMILY HEALTH CENTERS