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.") .. | 2,601,949 | 2,012,841 | 2,498,984 | 1,994,737 | 2,788,290 | 11,896,801 |
| 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 | 2,601,949 | 2,012,841 | 2,498,984 | 1,994,737 | 2,788,290 | 11,896,801 |
| 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).. | 2,527,541 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 9,369,260 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,601,949 | 2,012,841 | 2,498,984 | 1,994,737 | 2,788,290 | 11,896,801 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,548 | 920 | 3,004 | 6,399 | 10,175 | 22,046 |
| 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.).. | 9,423 | 32,291 | 250 | 1,803 | 10,987 | 54,754 |
| 11 | Total support. Add lines 7 through 10 | 11,997,930 | |||||
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.") . | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) |
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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 |
|---|
| Return Reference | Explanation |
|---|---|
| PART II, LINE 10 | OTHER/MISC INCOME 54,754 |
| 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, PAGE 2, PART III, LINE 4D | SUSAN B. KOMEN PROJECT - TO PROVIDE FUNDING TO CHCS TO DECREASE BREAST CANCER MORBIDITY AND MORTALITY AMONG LOW-INCOME UNINSURED WOMEN. EMERGENCY PREPAREDNESS - TO PROVIDE TRAINING, TECHNICAL ASSISTANCE, OTHER EDUCATION AND EQUIPMENT TO COLORADO CHCS. WORKFORCE DEVELOPMENT - TO DEVELOP AND DELIVER WORKFORCE TRAINING OPPORTUNITIES FOR COLORADO CHCS AND TO GROW AND MAINTAIN RELATIONSHIPS WITH KEY WORKFORCE PARTNERS IN ORDER TO PROVIDE PROGRAMS AND RESOURCES WHICH SUSTAIN AND GROW THE EXISTING CHC WORKFORCE. ORAL HEALTH - TO IMPROVE THE DENTAL HEALTH OF VULNERABLE POPULATIONS BY INCREASING INTEGRATION OF ORAL HEALTH PREVENTIVE SERVICES IN PRIMARY CARE DELIVERY SYSTEMS. COMMUNITY HEALTH PROVIDER ALLIANCE (CHPA) - THE ORGANIZATION PROVIDES EMPLOYEES AND SERVICES TO MANAGE CHPA'S ACTIVITIES. SIM - TO PROVIDE FACILITATORS WHO ASSIST PRACTICES WITH THE INTEGRATION OF BEHAVIORAL HEALTH AND PRIMARY CARE AS PART OF THE COLORADO STATE INNOVATION MODEL PROJECT. GROUP PURCHASING PROGRAM - THE ORGANIZATION HAS ENTERED INTO AGREEMENTS WITH SUPPLIERS OF GOODS AND SERVICES FOR CHCS AND OTHER HEALTH CARE SAFETY NET CLINICS. THE ORGANIZATION RECEIVES A FEE FROM THE SUPPLIERS TO COVER EXPENSES ASSOCIATED WITH ADMINISTERING THESE CONTRACTS. HEALTHCARE IMPROVEMENT - TO PROVIDE TRAVEL STIPENDS IN THE FORM OF SCHOLARSHIPS FOR CHC STAFF TO ATTEND INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI) PROFESSIONAL DEVELOPMENT PROGRAMS. COLORADO HEALTH SERVICE CORPS - TO REVIEW LOAN REPAYMENT APPLICATIONS FROM HEALTH CARE PROVIDERS EMPLOYED BY FACILITIES SERVING MEDICALLY UNDERSERVED POPULATIONS. PRIMARY CARE TRAINING AND ENHANCEMENT - TO DEVELOP A SUSTAINABLE MODEL TO TRANSFORM PARTICIPATING SAFETY NET CLINICS INTO PATIENT CENTERED MEDICAL HOMES, ENHANCING PATIENT ACCESS AND CARE COORDINATION WHILE IMPROVING CLINICAL OUTCOMES. TECHNICAL ASSISTANCE PROGRAM - TO ASSIST PRACTICES WITH IMPLEMENTATION OF TEAM-BASED CARE WORK PLANS AND ENSURE SUSTAINABILITY OF THE TEAM-BASED CARE MODEL. ECHO - TO SUPPORT THE ECHO COLORADO PROGRAM CENTER WITH SEVERAL FUNCTIONS, INCLUDING NEEDS ASSESSMENT, DEVELOPMENT, MARKETING, AND IMPLEMENTATION. PAYMENT REFORM - TO WORK WITH COLORADO CHCS AND THE STATE MEDICAID AGENCY TO DEVELOP A NEW POPULATION-BASED PAYMENT METHODOLOGY FOR CHC MEDICAID REIMBURSEMENT AND TO SUPPORT CHCS IN SYSTEM AND CARE CHANGES. PROJECT CATALYST - TO IMPROVE HEALTHCARE RESPONSES TO DOMESTIC VIOLENCE. CANCER PREVENTION AND EARLY DETECTION - TO IMPLEMENT STRATEGIES TO ADDRESS CANCER PREVENTION AND EARLY DETECTION AT ONE OR MORE LEVELS OF THE SOCIO- ECOLOGICAL FRAMEWORK, DEPENDING ON THE NEEDS OF THE UNDERSERVED POPULATION SERVED BY AND LIVING WITHIN THE SERVICE AREA. HPV VACCINATION - TO IMPROVE HPV VACCINATION DISPARITIES AMONG UNDERSERVED WOMEN. |
| FORM 990, PAGE 6, PART VI, LINE 6 | CCHN'S MEMBERS INCLUDE COLORADO'S 21 COMMUNITY HEALTH CENTERS WHICH OPERATE CLINIC SITES AND CARE FOR PATIENTS LIVING IN 61 COUNTIES. |
| FORM 990, PAGE 6, PART VI, LINE 7A | EACH MEMBER SHALL HAVE THE RIGHT TO APPOINT ONE MEMBER TO THE BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE CCHN BOARD OF DIRECTORS DELEGATES AUTHORITY TO THE CCHN FINANCE COMMITTEE TO REVIEW AND APPROVE THE FORMS 990 AND 990-T. BEFORE APPROVAL BY THE FINANCE COMMITTEE, THE FORMS WILL BE DISTRIBUTED TO MEMBERS OF THE BOARD OF DIRECTORS FOR REVIEW. ONCE APPROVED BY THE CCHN FINANCE COMMITTEE, THE FORMS 990 AND 990-T WILL BE SHARED AGAIN WITH ALL MEMBERS OF THE CCHN BOARD OF DIRECTORS AND THE CHAIR OF THE CCHN BOARD OF DIRECTORS WILL SIGN THE FORMS ON THE RECOMMENDATION OF THE FINANCE COMMITTEE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | AT THE BEGINNING OF EACH CCHN BOARD MEETING AND EXECUTIVE COMMITTEE MEETING AND AT ANY TIME DURING THE MEETING, ALL PARTICIPANTS ARE ASKED TO DECLARE CONFLICTS OF INTEREST. IF ANY CONFLICT OF INTEREST IS DECLARED, THE PARTICIPANT MAY BE ASKED TO RECUSE HIM OR HERSELF FROM ANY DECISIONS INVOLVING THE STATED CONFLICT OF INTEREST ISSUE. ANNUALLY, ALL CCHN BOARD MEMBERS ARE FORMALLY SURVEYED TO DETERMINE ANY CONFLICTS OF INTEREST ENCOUNTERED IN THE PAST YEAR. ALL CCHN BOARD MEMBERS MUST COMPLETE AND SIGN THE ANNUAL SURVEY. CCHN KEEPS ON FILE THE SIGNATURES AND COMPLETED SURVEYS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE PROCESS INCLUDES ALL OF THESE ELEMENTS: (1) REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS OR COMPENSATION COMMITTEE OF THE ORGANIZATION; (2) USE OF DATA AS TO COMPARABLE COMPENSATION; AND (3) CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING. |
| FORM 990, PAGE 6, PART VI, LINE 19 | CCHN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTUAL AGREEMENTS 769,842 837 0 LESS SCHEDULE I -218,223 0 0 OTHER 10,516 0 0 TOTAL 562,135 837 0 |
| Software ID: | |
| Software Version: |