Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 1,071,998 | 661,172 | 559,004 | 1,774,578 | 747,618 | 4,814,370 |
| 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 | 1,071,998 | 661,172 | 559,004 | 1,774,578 | 747,618 | 4,814,370 |
| 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).. | 812,581 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 4,001,789 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,071,998 | 661,172 | 559,004 | 1,774,578 | 747,618 | 4,814,370 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 18,094 | 7,884 | 5,889 | 5,342 | 10,268 | 47,477 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | 4,861,847 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 | AXIS HEALTH SERVICES (AHS) PROVIDES A WIDE VARIETY OF HEALTHCARE SERVICES SUPPORTING THE NEEDS OF THE COMMUNITIES IN THE REGION. AHS IS THE DESIGNATED COMMUNITY MENTAL HEALTH CENTER, A LICENSED SUBSTANCE ABUSE PROVIDER AND PROVIDES INTEGRATED PRIMARY CARE IN SEVERAL CLINICS, TWO OF WHICH ARE HRSA COMMUNITY HEALTH CENTERS (OR FQHCS). AHS HAS A TOTAL OF 7 CLINICS LOCATED IN THE SOUTHWEST REGION OF COLORADO. AHS OFFERS A WIDE VARIETY AND RANGE OF BEHAVIORAL HEALTH AND INTEGRATED PRIMARY CARE SERVICES TO ASSIST PEOPLE IN MANAGING THEIR HEALTH AND HEALTH OUTCOMES ACROSS THE COUNTIES OF: LA PLATA, ARCHULETA, MONTEZUMA, SAN JUAN AND DOLORES. BEHAVIORAL HEALTH SERVICES ARE AVAILABLE ACROSS AGES AND INCLUDE FAMILY SERVICES DESIGNED TO BEST MEET THE MENTAL HEALTH, SUBSTANCE ABUSE AND VOCATIONAL NEEDS OF RESIDENTS. ESSENTIAL BEHAVIORAL HEALTH SERVICES PROVIDED FOR INCLUDE: SCREENINGS, INDIVIDUAL, GROUP AND FAMILY THERAPEUTIC SERVICES, COMMUNITY RESOURCE COORDINATION, SHORT-TERM RESIDENTIAL CRISIS STABILIZATION, PSYCHIATRIC EVALUATIONS AND MEDICATION MANAGEMENT, 24/7 CRISIS ASSESSMENT SERVICES, SUBSTANCE USE DISORDER EDUCATION, EVALUATIONS AND THERAPY, AS WELL AS DUAL DIAGNOSIS SERVICES FOR PATIENTS WITH CO-OCCURRING MENTAL HEALTH AND SUBSTANCE ABUSE DISORDERS. THE BEHAVIORAL HEALTH SERVICE DELIVERY CONTINUUM ALSO COVERS VOCATIONAL SERVICES INCLUDING: JOB PREPAREDNESS, COACHING, JOB READINESS ASSESSMENT, PLACEMENT AND MONITORING. PRIMARY CARE INTEGRATION SERVICES ARE DESIGNED TO TAKE A POPULATION BASED SCREENING APPROACH TO PROVIDE COMPREHENSIVE PRIMARY CARE DESIGNED TO SUPPORT WHOLE PERSON HEALTHCARE THAT INCLUDES SCREENING FOR DEPRESSION, ANXIETY AND SUBSTANCE USE AS PART OF THE PRIMARY CARE STANDARDS OF CARE. ACCESS TO HIGHER LEVELS OF BEHAVIORAL HEALTH SERVICES AND PSYCHIATRIC SERVICES ARE AVAILABLE AS PART OF THE CARE TEAM APPROACH WITHIN THE INTEGRATED CLINICS. |
| FORM 990, PART III, LINE 2 | IN MAY, 2015, CORTEZ INTEGRATED HEALTHCARE WAS DESIGNATED A FEDERAL QUALIFIED HEALTH CENTER. ALSO, IN DECEMBER, 2014, A STATEWIDE MOBILE CRISIS PROGRAM WAS IMPLEMENTED AND AXIS HEALTH SYSTEM WAS DESIGNATED AS THE PROVIDER FOR SOUTHWEST COLORADO. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY THE AUDIT FIRM BASED ON THE AUDITED FINANCIALS AND SCHEDULES PREPARED BY AXIS HEALTH SYSTEM ACCOUNTING STAFF. THE APPROVED FORM 990 IS REVIEWED BY THE BUDGET AND FINANCE COMMITTEE OF THE BOARD OF DIRECTORS, PRESENTED TO THE BOARD OF DIRECTORS, APPROVED AND SIGNED BY THE COO. THE FORM 990 IS FILED BY THE ESTABLISHED DEADLINE EACH YEAR. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL STAFF SIGN A CONFLICT OF INTEREST STATEMENT AS PART OF THEIR INITIAL ORIENTATION. A REMINDER NOTICE REGARDING THE TENETS OF THE CONFLICT OF INTEREST POLICY IS SHARED WITH ALL STAFF ANNUALLY, WITH GUIDANCE ON NOTIFYING AXIS HEALTH SYSTEM OF ANY CHANGE IN STATUS. THE STAFF ARE EXPECTED TO RAISE ANY POTENTIAL CONFLICT OF INTEREST ISSUES FOR ASSESSMENT BY THE CEO OR DESIGNEE. THE BOARD OF DIRECTORS HAS A CONFLICT OF INTEREST SECTION (SECTION 10) OF THE BOARD BYLAWS THAT IS REVIEWED ANNUALLY WITH CURRENT BOARD MEMBERS. AT EACH BOARD MEETING, MEMBERS ARE ASKED TO RAISE ANY POTENTIAL CONFLICT OF INTEREST ISSUES FOR ASSESSMENT AND RESOLUTION BY THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR ALL JOB CLASSIFICATIONS, INCLUDING EXECUTIVE MANAGEMENT, IS REVIEWED AGAINST THE MENTAL HEALTH COMPENSATION SURVEY FOR COLORADO PREPARED ANNUALLY BY MOUNTAIN STATES EMPLOYERS COUNCIL, INC. (MSEC), AN INDEPENDENT RESOURCE. COMPENSATION INFORMATION IS ALSO OBTAINED FROM ALL COMMUNITY MENTAL HEALTH CENTERS IN THE STATE TO ENSURE A VALID ASSESSMENT IS MADE. IN ADDITION, THE CEO COMPENSATION IS SUBJECT TO ADDITIONAL ANNUAL REVIEW BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE FROM THE ORGANIZATION UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILTY FOR SELECTING THE INDEPENDENT AUDITORS. THEY ARE ALSO RESPONSIBLE FOR ENSURING THE AUDIT IS COMPLETE. THE BOARD DIRECTS THE CEO TO ENSURE TIMELY COMPLETION OF THE FINANCIAL STATEMENTS FOR REGULAR BOARD REVIEW AND THE PERFORMANCE OF THE ANNUAL AUDIT OF ITS FINANCIAL STATEMENTS. THE CEO DIRECTS/DELEGATES THIS FUNCTION TO THE COO. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. |
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