Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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 | ||||||
| 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).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 885,827 | 691,306 | 344,979 | 486,753 | 296,525 | 2,705,390 |
| 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 | 355,835 | 447,392 | 447,654 | 521,414 | 391,786 | 2,164,081 |
| 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 | 1,241,662 | 1,138,698 | 792,633 | 1,008,167 | 688,311 | 4,869,471 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 4,869,471 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,241,662 | 1,138,698 | 792,633 | 1,008,167 | 688,311 | 4,869,471 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 2,495 | 2,162 | 1,775 | 935 | 944 | 8,311 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 2,495 | 2,162 | 1,775 | 935 | 944 | 8,311 |
| 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.).. | 1,244,157 | 1,140,860 | 794,408 | 1,009,102 | 689,255 | 4,877,782 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III - ADDITIONAL INFORMATION: | STATE OF PROGRAM ACCOMPLISHMENTS ________________________________________ LEAPFROG GROUP: THIS IS A NATIONWIDE INITIATIVE DESIGNED TO REDUCE THE ESTIMATED 250,000 AVOIDABLE DEATHS PER YEAR IN US HOSPITALS BY ENCOURAGING THE ADOPTION OF BEST PRACTICE & SAFETY MEASURES IN HOSPITALS. COLORADO BUSINESS GROUP ON HEALTH IS THE DESIGNATED REGIONAL LEADER FOR COLORADO. CBGH SUPPORTS THIS SAFETY INITIATIVE WITH LETTERS TO HOSPITAL ADMINISTRATORS AND QUALITY DIRECTORS TO ENCOURAGE ADOPTION OF SAFETY MEASURES FOR THE FIRST AND SECOND RELEASES OF THE NATIONAL HOSPITAL PATIENT SAFETY SCORE AND GAVE PRESENTATIONS TO THE COLORADO BUSINESS GROUP ON HEALTH. WE ALSO SHARE AND PROMOTE LEAPFROG SURVEY RESULTS ON HOSPITAL SAFETY AND COMPLICATIONS WITH THE COMMUNITY 8% OF PROGRAM EXPENSES ________________________________________ PHARMACY BENEFITS MANAGEMENT: SEEKING TO MAKE PHARMACY MORE AFFORDABLE, WE ASSIST EMPLOYER MEMBERS MANAGING OR IMPLEMENTING A PHARMACY BENEFITS MANAGEMENT PROGRAM OFFERED THROUGH A SISTER COALITION, EMPLOYERS HEALTH. COORDINATED MEETINGS TO REVIEW AND DISCUSS PHARMACY DATA WITH MEMBERS. IMPLEMENTED DATA REPORTING WITH A SELECTED VENDOR AND CONTINUED WORK ON AGGREGATING THE DATA FROM DIFFERENT EMPLOYER MEMBERS. CONTINUED TO PROMOTE VALUE BASED PBM DESIGN WITH LOWER CO PAYS FOR EMPLOYEES. EMPLOYERS USING OUR PROGRAM ARE SAVING BETWEEN 25 AND 30%. 3% OF PROGRAM EXPENSES ________________________________________ BRIDGES TO EXCELLENCE: PROVIDED TECHNICAL ASSISTANCE TO PHYSICIAN PRACTICES FOR A NATIONAL PROGRAM THAT WILL ATTAIN BETTER PHYSICIAN CARE FOR PATIENTS AND REDUCED HEALTH BENEFIT COSTS FOR EMPLOYER AND EMPLOYEE WHILE ENCOURAGING PROACTIVE CHANGES IN THE WAY PHYSICIANS TAKE CARE OF THEIR PATIENTS WITH DIABETES. COORDINATED WITH NATIONAL PROGRAM SPONSORS, LOCAL MEDICAL SOCIETY, HEALTH DEPARTMENTS AND COMMUNITY PHYSICIANS. 3% OF PROGRAM EXPENSES _____________________________________ 11TH ANNUAL COLORADO CULTURE OF HEALTH CONFERENCE: PLANNED A CONFERENCE ON THE TOPIC OF HEALTH AND WELLNESS. OFFERED NATIONALLY RECOGNIZED SPEAKERS TO AN AUDIENCE OF MORE THAN 600 COLORADO EMPLOYERS, PHYSICIANS, AND HEALTH CARE INDUSTRY REPRESENTATIVES. 10% OF PROGRAM EXPENSES ________________________________________ COMMUNICATIONS & OUTREACH/COLLECTIVE IMPACT: PARTICIPATED IN COMMUNITY COLLABORATIVE DESIGNS IN FORT COLLINS AND COLORADO SPRINGS TO FOSTER SHARED APPROACHES IN IMPROVING HEALTHCARE IN COLORADO. 5% OF PROGRAM EXPENSES ________________________________________ NDPP GRANT: NATIONAL DIABETES PREVENTION PROGRAM IS A PARTNERSHIP OF PUBLIC AND PRIVATE ORGANIZATIONS WORKING TO PREVENT OR DELAY TYPE 2 DIABETES. THROUGH THE NATIONAL DPP, PARTNER ORGANIZATIONS: DELIVER CDC RECOGNIZED LIFESTYLE CHANGE PROGRAMS NATIONWIDE; ENSURE QUALITY AND ADHERENCE TO PROVEN STANDARDS; INCREASE REFERRALS TO AND PARTICIPATION IN CDC-RECOGNIZED LIFESTYLE CHANGE PROGRAMS; TRAIN COMMUNITY ORGANIZATIONS THAT CAN RUN LIFESTYLE CHANGE PROGRAM EFFECTIVELY; INCREASE COVERAGE BY EMPLOYERS AND PUBLIC AND PRIVATE INSURERS. 6% OF PROGRAM EXPENSES ________________________________________ G&A MEMBER OUTREACH, PRESENTATIONS, ETC. 15% OF PROGRAM EXPENSES ________________________________________ APCD ADVISORY: PARTICIPATE AS A BOARD MEMBER ON THE CO APCD ADVISORY COMMITTEE. THIS COMMITTEE WAS ESTABLISHED TO MAKE RECOMMENDATIONS TO CIVHC FOR ADMINISTRATION OF THE CO APCD INCLUDING ALL PUBLIC REPORTING OF CO APCD DATA. 2% OF PROGRAM EXPENSES ________________________________________ HOSPITAL PRICING TRANSPARENCY ANALYSIS: CBGH ARRANGED FOR A STATEWIDE ANALYSIS OF HOSPITAL PRICING AS A PERCENT OF MEDICARE ON A REGION BY REGION. OUR ANALYSIS SHOWED THAT, OVERALL, COLORADO HOSPITALS ARE BEING PAID 290% OF THE AMOUNT THAT THE MEDICARE PAYMENT ADVISORY COMMISSION CONSIDERS NECESSARY TO BREAK-EVEN ON IN-PATIENT SERVICES AND 520% FOR OUT-PATIENT SERVICES. THE INTENT OF THIS INITIATIVE IS TO BRING UNPRECEDENTED TRANSPARENCY TO HOSPITAL PRICING AND TO PROVIDE PURCHASERS WITH A REASONABLE POINT OF REFERENCE FOR ASSESSING VALUE. 18% OF PROGRAM EXPENSES ________________________________________ IMPLEMENTING A STATEWIDE PURCHASING ALLIANCE. IN ORDER TO ADDRESS PURCHASER CHALLENGES OF A HEALTH CARE MARKET/SYSTEM THAT IS INCONSISTENTLY EFFECTIVE, CONSISTENTLY INEFFICIENT, AND INCREASINGLY EXPENSIVE IN A MANNER CONSISTENT WITH THE INTENT AND PROVISIONS OF CRS 10.16.1001-1015 (AS BEING UPDATED), THE STATEWIDE PURCHASING ALLIANCE WILL SEEK TO IMPROVE THE VALUE OF CONTRACTED HEALTH SERVICES FOR PARTICIPATING EMPLOYERS/ PURCHASERS AND THEIR BENEFICIARIES THROUGH A GROUP PURCHASING AND DIRECT CONTRACTING WITH PROVIDERS. OBJECTIVES: SPECIFIC OBJECTIVES, BASED ON THE "QUADRUPLE AIM," WILL INCLUDE: CONTRACT FOR HIGH VALUE SERVICES. MAKE NEGOTIATED AGREEMENTS AVAILABLE TO THE SELF-FUNDED, FULLY-INSURED, AND INDIVIDUAL MARKET (THROUGH CONNECT FOR HEALTH COLORADO) O CONVERT ALL HOSPITAL CONTRACTS TO A PERCENT OF MEDICARE BELOW 200% O ESTABLISH CENTERS OF EXCELLENCE NETWORK WITH EPISODE-BASED PAYMENTS (EITHER WITHIN OR OUTSIDE OF COLORADO) IMPROVE OUTCOMES. WORK WITH MEMBERS TO IMPROVE POPULATION HEALTH AND OUTCOMES. PROMOTE CARE TEAM WELL-BEING. ENGAGE PROVIDERS THROUGH CONTRACTS THAT PROMOTE CARE TEAM WELL-BEING AND DELIVERY SYSTEM TRANSFORMATION. IMPROVE THE PATIENT EXPERIENCE. WORK WITH MEMBERS AND PROVIDERS TO ENHANCE THE PATIENT EXPERIENCE. 30% OF PROGRAM EXPENSES |
| FORM 990, PART VI, SECTION B, LINE 11B | AFTER THE CPA FIRM PREPARES THE DRAFT 990 FORM, THEY SUBMIT A COPY TO THE BOARD OF DIRECTORS FOR REVIEW. IF THE BOARD OF DIRECTORS HAVE ANY QUESTIONS OR CONCERNS, THEY ADDRESS THE CPA FIRM. ONCE THE 990 FORM HAS BEEN APPROVED BY THE BOARD OF DIRECTORS, THE 990 FORM IS FINALIZED, SIGNED, AND SUBMITTED TO THE IRS |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, OFFICER, AND MEMBERS OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY READ, UNDERSTAND, AND COMPLY WITH THE CONFLICT OF INTEREST POLICY. IN ADDITION, THE BOARD OF DIRECTORS REVIEW THEPOLICY ANNUALLY TO ENSURE COMPLIANCE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE DIRECTOR'S COMPENSATION IS SUBJECT TO AN ANNUAL REVIEW FROM THE BOARD OF DIRECTORS. THE APPROVAL PROCESS INCLUDES ANAYLZING CURRENT WAGE INFORMATION, EVALUATING THE ORGANIZATION'S PROGRESS UNDER THIS UPPER MANAGEMENT GROUP, AND BOARD DELIBERATIONS. THE KEY EMPLOYEE'S COMPENSATION IS SUBJECT TO AN ANNUAL REVIEW FROM THE BOARD OF DIRECTORS AND THE EXECUTIVE DIRECTOR. THE APPROVAL PROCESS INCLUDES ANAYLZING CURRENT WAGE INFORMATION, EVALUATING THE ORGANIZATION'S PROGRESS UNDER THIS EMPLOYEE'S MANAGEMENT, AND BOARD DELIBERATIONS. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC THROUGH A SIMPLE REQUEST PROCESS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC THROUGH A SIMPLE REQUEST PROCESS. |
| Software ID: | |
| Software Version: |