Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Pueblo StepUp
Employer identification number
84-1234295
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
182,614
269,256
444,647
385,217
272,627
1,554,361
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
182,614
269,256
444,647
385,217
272,627
1,554,361
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
146,283
6
Public Support. Subtract line 5 from line 4.
1,408,078
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
182,614
269,256
444,647
385,217
272,627
1,554,361
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
13,175
12,511
9,480
9,181
8,298
52,645
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
2
3
1
25
31
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
54
9,885
15,180
14,945
13,413
53,477
11
Total support (Add lines 7 through 10).
1,660,514
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
1,250,099
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
84.798 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
95.080 %
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Pueblo StepUp
Employer identification number
84-1234295
Identifier
Return Reference
Explanation
FORM 990, PART III, LINE 4A
Statement of Program Service Accomplishments
I. Introduction: A. Market Based Organization Mission and Vision Pueblo StepUp is a 501 (c)(3) nonprofit organization in Pueblo whose mission is to positively impact the health, well-being and access to healthcare for Pueblo's underserved. We provide access to health and wellness services for at-risk members of our community, including the low-income, uninsured or underinsured populations of Pueblo. StepUp is the result of a merger in 2005 of two health and wellness agencies serving low-income, medically underserved populations: Pueblo SET for Well Being and Pueblo Coalition for the Medically Underserved. Pueblo StepUp enrolls eligible children into Child Health Plan Plus and Medicaid. Pueblo StepUp also processes Child Health Plan Plus (CHP+) and Medicaid applications for St. Mary-Corwin and Penrose St. Francis Medical Centers as well as Valley Wide Health Systems located in Alamosa, Colorado. Our agency assists CHP+ and Medicaid clients in obtaining medical providers and receiving access to services and prescription medications. Pueblo StepUp's Board of Directors is comprised of independent representatives from diverse segments of the Pueblo community. B. Community Benefit Approach Pueblo StepUp's approach to providing community benefit focuses on connecting people to available medical, wellness and prevention resources. Pueblo County is a blue collar community with a high rate of poverty, large senior population and high teenage pregnancy rates. Our population has a high incidence of obesity, diabetes, asthma and heart disease. Our target population is Pueblo County's medically underserved of all ages. Pueblo StepUp collaborates with St. Mary-Corwin Medical Center, Parkview Medical Center, Pueblo City School District 60, Pueblo County School District 70, Pueblo Area Agency on Aging, Pueblo Community Health Center, Southern Colorado Family Medicine, Catholic Charities, Senior Resource Development Agency, AARP, Pueblo Department of Social Services, Pueblo City/County Health Department and many other nonprofits and physician and dental offices. C. Financial Assistance Policies and Programs Pueblo StepUp educates the public regarding government and other programs for low-income persons. We do not charge a fee to assist clients in enrolling in programs for which they are eligible. II. Quantitative Description of Community Benefit: Estimated Number of People Served Benefit for the Poor: Wellness clinics 538 Children's Medicaid case management 4,032 Tai Chi & Arthritis Foundation Exercise 54 Chronic Disease Self Management Program 52 Assist clients to apply for government healthcare programs 3,660 Assistance with rent rebate program 115 Total Benefit for the Poor 8,451 Total Benefit for the Community 8,451 III. Qualitative Description of Community Benefit: A. Community Outreach for the Poor Children's Programs for Pueblo County low-income children: Pueblo StepUp provided individualized case management for parents of children who are enrolled in Children's Medicaid (EPSDT) to 5,105 clients. StepUp employs four Children's Medicaid case workers. Case workers provide education to clients on accessing providers, healthcare and other factors that can impact children's health. Senior Programs for Pueblo County low-income seniors: Pueblo StepUp is in the process of revitalizing our senior programming to offer the most comprehensive programs to seniors in Pueblo County. Our agency has spearheaded a Healthy Aging Initiative with several local nonprofits, healthcare agencies, and government entities to determine the acute needs of Pueblo's senior population. This will allow us to deliver care, education, and wellness programs that will deliver long-term results. Pueblo StepUp assisted 850 families in enrolling eligible children into CHP+, Medicaid and Presumptive Eligibility. We are the only service in Pueblo that provides assistance to all the above services regardless of choice of provider. B. Community Outreach for the Broader Community Most of Pueblo StepUp's programs focus on the needs of low-income seniors and children.
FORM 990, PART VI, Line 1a
EXECUTIVE COMMITTEE
The Executive Committee shall consist of only directors of the corporation and shall be composed of the Chairperson of the board, the Vice Chairperson of the Board, the President and Executive Director, and the Secretary. Each individual appointed to the Executive Committee shall serve for a term of one (1) year or until his or her successor is duly appointed by the Board of Directors. Any vacancy of an appointed Executive Committee membership may be filled for the unexpired portion of the term in the manner that the original committee member was appointed. Except as provided by law, the Executive Committee shall have and may exercise such powers as may be delegated to it by the Board of Directors. Additionally, the Executive Committee shall have and may exercise such powers to transact routine business of the Corporation in the interim period between regularly scheduled meetings of the Board of Directors, provided that such actions taken shall be consistent with and not conflict with any actions or policies of the Board of Directors or of the Corporate Member, with these Bylaws, or with applicable law. All actions taken by the Executive Committee shall be promptly reported to the Board of Directors at the next regular or annual meeting of the Board of Directors. The Executive Committee shall meet at such times as shall be determined by the Chairperson. The Executive Committee shall keep regular minutes of its proceedings and report the same to the Board of Directors at each regular meeting of the Board.
FORM 990, PART VI, Line 6
MEMBERS OR SHAREHOLDERS
The sole member of the Corporation shall be Catholic Health Initiatives, a Colorado nonprofit corporation (the "Corporate Member").
Form 990, Part VI, Line 7A
MEMBER ELECT ONE OR MORE MEMBERS OF GOVERNING BODY
THE SOLE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, Line 7b
GOVERNING POWERS
The organization's corporate member is Catholic Health initiatives ("CHI"). Pursuant to Section 5.4 of the organization's bylaws, except as otherwise provided in the Corporation's Articles of Incorporation, elsewhere in these Bylaws, or in the laws of the State of Colorado, the Corporate Member shall have the specific rights set forth in the Governance Matrix. In addition to the rights reserved to the Corporate Member under the Governance Matrix, the Corporate Member shall have the power to transfer assets of the Corporation or to require the Corporation to transfer assets to the Corporate Member, to the extent necessary to accomplish the Corporate Member's goals and objectives, and to provide for the payment of all indebtedness of the Corporate Member or an entity controlled by, controlling, or under common control with the Corporate Member, issued or incurred by or on behalf of the Corporate Member or a Corporate Member Affiliate in furtherance of the Corporate Member's goals and objectives. The Corporation shall not be required to violate its charitable purposes, the terms of any restricted gifts, or the covenants of its debt instruments as a result of any asset transfers made or directed by the Corporate Member. Except for transfers previously approved by the Corporate Member, either individually or as part of the CHI Healthcare System budget process, and except for transfers to an affiliate or subsidiary of the Corporation, the Corporation shall not transfer assets to entities other than the Corporate Member or Corporate Member Affiliates without the approval of the Corporate Member. Pursuant to Section 5.5.2 of the organization's bylaws, in the exercise of its approval powers, the Corporate Member may grant or, withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Executive Director of the Corporation, recommend such other or different actions as it deems appropriate.
Form 990, Part VI, Line 11A
Process the organization uses to review Form 990
THE PREPARED 990 IS FORWARDED BY E-MAIL FROM THE EXECUTIVE DIRECTOR TO MEMBERS OF THE FINANCE COMMITTEE, WHICH IS CHAIRED BY THE TREASURER OF THE BOARD OF DIRECTORS. ANY CHANGES OR QUESTIONS WILL BE SUBMITTED TO THE ENTIRE FINANCE COMMITTEE. THE DIRECTOR WILL THEN CONFIRM WITH THE TAX DEPARTMENT WHETHER THE COMMITTEE HAS ACCEPTED THE 990 AS PREPARED OR IF CHANGES ARE REQUIREd. AFTER APPROVAL, The tax department files the return with the appropriate federal agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted.
Form 990, Part VI, Line 12C
Procedures for monitoring and enforcing the COI policy
Pueblo StepUp Associates should, at all times, act appropriately to avoid "conflicts of interest" during their employment or affiliation that may interfere with their ability to serve in the best interest of Centura/Pueblo StepUp. Associates and their family members should avoid financial interest in or receipt of compensation from entities with which Pueblo StepUp has a business relationship or is negotiating a relationship. Associates should not approve the expenses of a family member or relative-in-law, significant other or roommate. Associates should take steps to avoid accepting gifts and gratuities unless they are of a nominal or token value. Associates should disclose a potential conflict to their manager when they become aware of the conflict. Additionally, associates may be asked to provide written disclosure of potential conflicts of interest. Potential conflicts will be assessed to determine whether a conflict exists and appropriate action will be taken to address the conflict. Members of the board are required to complete a questionnaire annually documenting potential conflicts of interest. At the beginning of each board meeting, members with a potential conflict are required to disclose the conflict. The board as a whole then determines whether the member should recuse themselves from all discussions concerning the pending matter or abstain from voting on the matter.
Form 990, Part VI, Line 15A & 15B
Process for Determining Executive Compensation
During the year ended 6/30/11, no officer, directors, or trustees were paid by the organization. All executive compensation was paid by Centura Health Corporation, a sponsoring organization. Outside consultants are engaged to provide recommendations to Centura's Compensation Committee regarding the compensation of facility CEOs and Centura Senior Executives. The consultant's recommendations are then presented to and approved by the Compensation Committee. Centura's Human Resources department performs analyses of the market to determine compensation ranges for the remainder of Centura associates which are reviewed and approved by Centura's Senior Leadership.
Form 990, Part VI, Line 19
Governing Documents - COI Policy - Financial Statements Available
Pueblo StepUp's Financial Statements and Conflict of Interest policy are available upon request from the administration department. In addition, the governing documents are available from the Colorado Secretary of State's website at www.sos.state.co.us. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at www.CatholicHealthInit.org or at www.DACBOND.org.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.