2020-10-20T09:10:27-05:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-01-01 841285505 LA CLINICA TEPEYAC LACL 7202742923 4725 HIGH STREET DENVER CO 80216 JIM GARCIA CEO 7202742923 2020-10-19 1 KURT BENNION CPA P01469618 4252506100 2020-10-19 67.137.57.251 2020-10-19 14:23:24 PD P FD4E4733CD88BB852BC71ECFBAEF90C681185790 437A48F7A65F248D0909731AA99F0A79285329FF 2019 2021-01-29 14:40:06Z JIM GARCIA 4725 HIGH STREET DENVER CO 80216 5677410 0 X WWW.CLINICATEPEYAC.ORG X 1994 CO PROVIDES COMPETENT HEALTH CARE AND PREVENTIVE HEALTH SERVICES FOR THE MEDICALLY UNDERSERVED. 14 14 79 16 0 0 6264586 4270179 1057632 1110104 8730 15186 -91967 126571 7238981 5522040 0 0 0 0 2977566 2877693 0 41500 621026 1755709 1876612 4733275 4795805 2505706 726235 7570391 7955666 900118 1109549 6670273 6846117 LA CLINICA TEPEYAC OPERATES TO PROVIDE CULTURALLY COMPETENT HEALTH CARE AND PREVENTIVE HEALTH SERVICES FOR THE MEDICALLY UNDERSERVED. 0 0 2952558 0 1110104 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). 2952558 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 48 0 79 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JOSHUA DUAME 7202742923 4725 HIGH STREET DENVER CO 80216 PAMELA VALENZA MD CHO 50.00 X 210000 0 10370 JIM GARCIA CEO 60.00 X 128012 0 12708 OLGA WEBBER COO 50.00 X 90000 0 6219 ED GONZALES CONTROLLER (JUNE-SEP 2019) 40.00 X 27404 0 1849 ROBYN FLEMING CONTROLLER (THROUGH MARCH 2019) 40.00 X 21490 0 1516 TIM HALLIDAY INTERIM CONTROLLER 20.00 X 0 0 0 LINDA OSTERLUND PHD PRESIDENT 1.00 X X 0 0 0 DARRELL VIGIL VICE PRESIDENT (THROUGH JUNE 2019) 1.00 X X 0 0 0 DR HARVEY BOGRAD BOARD MEMBER & CO-VICE PRESIDENT 1.00 X X 0 0 0 JESSE OGAS BOARD MEMBER & CO-VICE PRESIDENT 1.00 X X 0 0 0 CANDY HERNANDEZ TREASURER 1.00 X X 0 0 0 CARLOS CONTRERAS ASSISTANT TREASURER 1.00 X X 0 0 0 LUDY ESPERANZA CHACON SECRETARY 1.00 X X 0 0 0 JACQUIELINE MORALES-LOZANO ASSISTANT SECRETARY 0.50 X 0 0 0 JOHN BAUER-MARTINEZ BOARD MEMBER 0.50 X 0 0 0 YUVICELA GARCIA-DIAZ CONSUMER BOARD MEMBER 0.50 X 0 0 0 JUANA MALDONADO CONSUMER BOARD MEMBER 0.50 X 0 0 0 DAVID MARTINEZ PC BOARD MEMBER 0.50 X 0 0 0 PATRICIA MARTINEZ CONSUMER BOARD MEMBER (THROUGH DEC 2019) 0.50 X 0 0 0 STEPHANIE MORRIS BOARD MEMBER 0.50 X 0 0 0 RITA TORO CONSUMER BOARD MEMBER 0.50 X 0 0 0 GILBERT VIGIL DDS BOARD MEMBER 0.50 X 0 0 0 476906 0 32662 2 0 1 0 MOA ARCHITECTURE 414 14TH STREET 300 DENVER CO 80202 ARCHITECTURAL SERVICES 174287 PLANTE & MORAN PLLC 8181 E TUFTS AVENUE SUITE 600 DENVER CO 80237 ACCOUNTING SERVICES 127740 2 23225 1934724 2312230 87082 4270179 PATIENT FEES 621110 1110104 1110104 1110104 15186 15186 225644 23225 155370 70274 70274 MISCELLANEOUS INCOME 900099 56297 56297 56297 5522040 1110104 0 141757 X 509568 195540 252929 61099 1914380 1356152 441138 117090 25876 17882 7994 223732 136808 74426 12498 204137 118771 72426 12940 17045 17045 160866 160866 41500 41500 869768 438528 87096 344144 20581 20000 88 493 147635 106881 32667 8087 79879 74199 1625 4055 147528 126586 17164 3778 18730 10079 5741 2910 10079 4972 4220 887 96430 77212 15316 3902 37574 31739 5088 747 MEDICAL SUPPLIES 155840 155840 DUES & MEMBERSHIPS 39427 20910 14464 4053 EQUIPMENT 31734 29542 2078 114 TRAINING 21323 19549 1483 291 22173 11368 8367 2438 4795805 2952558 1222221 621026 60355 60195 4030552 3664307 1231270 1961615 209413 153045 11081 27893 2619073 639770 1979237 1979303 4220 41663 48268 6820 56820 7570391 7955666 205539 214531 250000 694579 645018 900118 1109549 X 2643300 2544699 4026973 4301418 6670273 6846117 7570391 7955666 X 726235 -556996 6605 X 0 1 X 1 1 1 X 3240528 3049832 4331157 6076810 4270179 20968506 3240528 3049832 4331157 6076810 4270179 20968506 20968506 1645 3329 3704 8730 15186 32594 284532 34699 28084 245749 281941 875005 21876105 4050520 0.95850 0.95290 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME FUNDRAISING EVENT REVENUES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 0 1 530 530 0 PART II-B, LINE 1: A PORTION OF THE ORGANIZATIONS MEMBERSHIP DUES TO CERTAIN ASSOCIATIONS AS USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF THEIR MEMBERS. 41663 7057 452 48268 44285 -2180 442 41663 38788 5497 44285 36380 2408 38788 819648 1176164 -1171 729138 1265503 0.00000 1.00000 0.00000 1 0 22500 274000 296500 1905509 345253 1560256 417064 294517 122547 1979303 X 4575701 16049 7612 23661 4552040 970000 970000 5522040 4812861 16049 1007 17056 4795805 0 4795805 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 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 1,007. CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY OTHERS 6,605. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION RESTRICTED FOR PURCHASE OF PROPERTY 970,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 1,007. X X X X X X X 1 RIPPLE AFFECT LLC 4000 LIPAN STREET DENVER CO 80211 CAPITAL CAMPAIGN CONSULTING 0 632500 30000 602500 EVENTFUL PROS 1427 LARIMER STREET DENVER CO 80202 EVENT MANAGEMENT 0 248019 11500 236519 880519 41500 839019 CO FIESTA ON THE PLAZA 154140 14800 139340 10180 35697 4400 40217 TORTILLAS FOR TEPEYAC 73745 8425 65320 4248 23862 300 18938 1 20134 20134 100 400 17028 248019 23225 224794 14528 59559 5100 76183 155370 69424 X X X X 0 0 0 0 0 0 0 0 0 PAMELA VALENZA MD CHO 210000 0 0 0 0 0 3231 0 7139 0 220370 0 0 0 X 1 4220 DAILY TRADING PRICE X 12 56416 INVOICE PRICE X AUCTION ITEMS 61 26446 FAIR MARKET VALUE 0 0 1 1 PART I, LINE 32B: DONATED SECURITIES ARE RECEIVED BY OUR INVESTMENT BROKER AND ARE IMMEDIATELY CONVERTED INTO CASH. FORM 990, PART VI, SECTION A, LINE 1 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 CONERSION 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. THE EXECUTIVE COMMITTEE, AMONG OTHER THINGS, CONDUCTS EVALUATIONS, AT LEAST ANNUALLY, OF THE EXECUTIVE DIRECTOR'S PERFORMANCE. AND RECOMMENDS HIS OR HER APPROPRIATE COMPENSATION. FORM 990, PART VI, SECTION A, LINE 3 DURING 2019, PLANTE & MORAN PLLC PROVIDED INTERIM FINANCIAL MANAGEMENT SERVICES AND DOUG BACH SERVED AS INTERIM CIO THROUGH A SERVICES AGREEMENT WITH HIGHLAND DATA CONSULTING CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS REVIEWED BY THE CFO AND THE CEO, THEN BY THE FINANCE COMMITTEE. IT WAS 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. 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. 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 2019. 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 438,528. MANAGEMENT AND GENERAL EXPENSES 87,096. FUNDRAISING EXPENSES 344,144. TOTAL EXPENSES 869,768. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY OTHERS 6,605.