Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 26,044 | 40,693 | 670,266 | 340,316 | 1,049,678 | 2,126,997 |
| 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 | 26,044 | 40,693 | 670,266 | 340,316 | 1,049,678 | 2,126,997 |
| 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) .. | 617,541 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,509,456 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 26,044 | 40,693 | 670,266 | 340,316 | 1,049,678 | 2,126,997 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 42 | 32 | 18 | 92 | ||
| 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 | 2,127,089 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| 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, PAGE 2, PART III, LINE 4A | CPCQC - CPCQC LEADS FOUR ACTIVE QI INITIATIVES THAT ADDRESS HIGH-PRIORITY NEEDS ACROSS THE STATE'S PERINATAL POPULATION. A PRIMARY FOCUS OF OUR PROJECTS IS TO ADDRESS THE OPIOID EPIDEMIC'S IMPACT ON BIRTHING PERSONS AND THEIR INFANTS. BECAUSE WE KNOW THAT MENTAL HEALTH DISORDERS ARE NOT ONLY A LEADING CAUSE OF MATERNAL DEATH, BUT ALSO A MAJOR COMORBIDITY OF SUBSTANCE USE DISORDERS, OUR PROGRAMS ALSO ADDRESS PERINATAL MOOD AND ANXIETY DISORDERS IN ADDITION TO SUPPORT FOR SOCIAL NEEDS. ADDITIONALLY, BECAUSE WE KNOW THAT GAPS IN CARE ACROSS THE PERINATAL CONTINUUM LEAD TO NEGATIVE HEALTH OUTCOMES, INCLUDING MATERNAL MORTALITY DUE TO "DEATHS OF DESPAIR," CPCQC IS SPEARHEADING WORK TO IMPROVE THE COMPREHENSIVENESS AND CONTINUITY OF CARE ACROSS OB AND NEONATAL CARE, BEHAVIORAL HEALTH TREATMENT, AND SOCIAL SUPPORTS THROUGHOUT THE PERINATAL PERIOD. |
| FORM 990, PAGE 2, PART III, LINE 4B | COLORADO HOSPITALS SUBSTANCE EXPOSED NEWBORNS (CHOSEN QIC) - VARIABILITY ACROSS COLORADO HOSPITALS EXISTS IN MATERNAL AND INFANT DRUG SCREENING, INFANT ASSESSMENT FOR WITHDRAWAL, LOCATION OF CARE FOR SUBSTANCE EXPOSED NEWBORNS, DEGREE OF ENGAGEMENT OF BIRTHING PARENTS, PHARMACOLOGIC TREATMENT MODALITIES, INITIATION AND WEANING PROTOCOLS, CRITERIA FOR DISCHARGE, AND MANY OTHER ELEMENTS OF CARE. SINCE 2017, CHOSEN QIC HAS LED EFFORTS TO INCREASE CONSISTENCY IN CLINICAL CARE PRACTICES AND OPTIMIZE FAMILY ENGAGEMENT DURING BIRTH HOSPITALIZATION. WHEN THE PROGRAM STARTED IN 2017, NEARLY 70% OF SUBSTANCE EXPOSED NEWBORNS (SEN) AT HOSPITALS IN THE PROGRAM WERE TREATED WITH MEDICATION. BY 2019, THE RATE DECLINED TO 23% AND MOST RECENTLY, 0% OF SENS WERE TREATED WITH MEDICATION IN PARTICIPATING HOSPITALS. THE AVERAGE HOSPITAL STAY FOR SENS ALSO DECREASED FROM OVER 2 WEEKS TO 6 DAYS. TWENTY-SIX HOSPITALS TOTAL ARE ENGAGED IN CHOSEN QIC, WITH 19 IN COLORADO. WHILE THE BIRTH OUTCOMES MEASURES FAR EXCEEDED OUR INITIAL AIMS, CHOSEN QIC RECOGNIZED THAT THE PERIODS BEFORE AND AFTER BIRTH HOSPITALIZATION REQUIRE GREATER TARGETED INTERVENTIONS. RATES OF PRENATAL EDUCATION OF FAMILIES ABOUT THE CARE OF SENS AND RATES OF COMPLETION OF A TRANSITION PLAN TO THE OUTPATIENT PEDIATRIC PROVIDERS WERE FAR FROM OPTIMAL AT LESS THAN 20%. ADDITIONAL FIVE-YEAR FUNDING WOULD ALLOW CHOSEN QIC TO FOCUS ON THESE PERIODS OF TRANSITION AS WE CONTINUE TO SUSTAIN BIRTH HOSPITALIZATION OUTCOMES. OF THE 19 PARTICIPATING HOSPITALS, 14 ARE ACTIVELY ENGAGED IN QI WORK (23.7% OF CO HOSPITALS). THESE 14 HOSPITALS DELIVER 37% OF COLORADO BIRTHS EACH YEAR. THE CHOSEN COLLABORATIVE IN COLORADO ACCOUNTS FOR 85.7% OF REGIONAL ACCOUNTABLE ENTITY (RAE) REGIONS AND 65% OF HEALTH STATISTIC REGIONS (HSRS). |
| FORM 990, PAGE 2, PART III, LINE 4C | COLORADO AIM SUBSTANCE USE DISORDER LEARNING COLLABORATIVE (CO AIM: SUD LC) AIM SUD LC IS AN INITIATIVE ALIGNED WITH HEALTHY PEOPLE 2030 GOALS, COLORADO'S STATE MEDICAID HOSPITAL QUALITY INCENTIVE PROJECT (HQIP), AND CDPHE'S MATERNAL MORTALITY REVIEW COMMITTEE RECOMMENDATIONS. THERE IS A SIGNIFICANT NEED TO ENHANCE CARE FOR PERINATAL PATIENTS IN COLORADO WITH SUBSTANCE USE AND MOOD AND ANXIETY DISORDERS. SUCH CARE IS ADMINISTERED UNEVENLY ACROSS POPULATIONS AND, SUBSEQUENTLY, SOME PATIENTS ARE LEFT UNTREATED WHICH CAN LEAD TO PREVENTABLE DEATHS FROM THE TWO LEADING CAUSES OF MATERNAL DEATH IN COLORADO - SUICIDE AND ACCIDENTAL OVERDOSE.3 CO AIM: SUD LC FOCUSES ON INCREASING AND IMPROVING IDENTIFICATION, DIAGNOSIS, AND TREATMENT FOR SUBSTANCE USE DISORDER AND PERINATAL MOOD AND ANXIETY DISORDERS IN PREGNANT AND POSTPARTUM INDIVIDUALS. THIS QI INITIATIVE ESTABLISHES GUIDELINES AND PROTOCOLS FOR SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) FOR SUBSTANCE USE DISORDER (SUD) AND PERINATAL MOOD AND ANXIETY DISORDERS (PMADS) IN THE PERINATAL HEALTHCARE SETTING. IT IS BASED ON THE AIM OBSTETRIC CARE FOR PREGNANT AND POSTPARTUM PEOPLE WITH SUBSTANCE USE DISORDER PATIENT SAFETY BUNDLE. PARTICIPATING CO AIM: SUD LC HOSPITALS HAVE SEEN A 144% INCREASE IN OVERALL COMPREHENSIVE UNIVERSAL SCREENING FOR ANXIETY, DEPRESSION, AND SUBSTANCE USE. THE PROGRAM BEGAN IN FEBRUARY 2021, AND HAS NOW GROWN TO HAVE 50.4% OF COLORADO LIVE BIRTHS DELIVERED IN CO AIM: SUD LC-PARTICIPATING HOSPITALS. ADDITIONAL FIVE-YEAR FUNDING WOULD ALLOW CO AIM: SUD LC TO INCREASE NOT ONLY SCREENING, BUT REFERRAL FOR TREATMENT AND FOCUS ON CLINICAL COMMUNITY LINKAGES AND ENGAGING MORE INDIVIDUALS WITH LIVED EXPERIENCE AS WE CONTINUE TO SUSTAIN BIRTH HOSPITALIZATION OUTCOMES. |
| FORM 990, PAGE 2, PART III, LINE 4D | DATA-DRIVEN ENGAGEMENT OF FAMILIES TO IMPROVE THE NICU EXPERIENCE IN COLORADO (DEFINE COLORADO) - DEFINE COLORADO SEEKS TO OPTIMIZE THE ENGAGEMENT OF PARENTS AFFECTED BY PROLONGED NICU HOSPITALIZATION FOR THEIR PRETERM INFANTS, CENTERING THEIR ROLE IN THE MEDICAL AND DEVELOPMENTAL CARE OF THEIR NEWBORNS. IN PARTICULAR, DEFINE COLORADO SEEKS TO IDENTIFY AND ADDRESS THE SOCIAL DETERMINANTS OF HEALTH THAT IMPACT PARENTS' ABILITY TO BE PRESENT AND ENGAGED IN THEIR INFANTS' CARE IN THE NICU, THEREBY ALSO REDUCING DISPARITIES IN PARENTAL ENGAGEMENT BY RACE/ETHNICITY, PRIMARY LANGUAGE, AND GEOGRAPHIC LOCATION. DEFINE COLORADO IMPROVES PARENTAL ENGAGEMENT BY USING A QUALITY IMPROVEMENT FRAMEWORK WITH IMPLEMENTATION OF A BUNDLE OF CARE PRACTICES. CRITICALLY IMPORTANT, DEFINE FOCALIZES THE EXPERIENCE OF PARENTS AND THE REDUCTION OF DISPARITIES IN THIS EFFORT. UNLIKE OTHER QI INITIATIVES THAT RELY ON ELECTRONIC MEDICAL RECORD (EMR) OR STATE VITAL STATISTICS DATA, DEFINE COLLECTS DATA ON THE PARENT EXPERIENCE THROUGH LONGITUDINAL ELECTRONIC SURVEYS TO PARENTS OF HOSPITALIZED PRETERM INFANTS THAT ARE THEN LINKED TO CLINICAL DATA. MOREOVER, DEFINE RECOGNIZES THAT SOCIODEMOGRAPHIC DATA FROM THE EMR IS OFTEN INACCURATE OR MISSING, MAKING IT NEARLY IMPOSSIBLE TO MEASURE AND THEN REDUCE DISPARITIES. THUS, DEFINE COLLECTS THIS CRITICALLY IMPORTANT INFORMATION DIRECTLY FROM PARENTS WHO SELF-REPORT THEIR RACE/ETHNICITY, PRIMARY LANGUAGE, AND RESIDENCE. BECAUSE INFANTS OF COLOR ARE OVER-REPRESENTED IN NICUS, THIS PROJECT SERVES AND SUPPORTS MINORITIZED FAMILIES. BY FOCUSING ON FAMILY ENGAGEMENT IN THE NICU AND ALSO RELYING ON PARENT REPORTS OF ENGAGEMENT, DEFINE IS SERVING AND SUPPORTING FAMILIES WHO BEAR THE GREATEST BURDEN OF PREMATURITY AND ITS ASSOCIATED COMPLICATIONS. DEFINE LAUNCHED LAST YEAR AND AT PRESENT, 13.3% OF COLORADO LIVE BIRTHS ARE DELIVERED IN DEFINE-PARTICIPATING HOSPITALS. SUPPORTING VAGINAL DELIVERY FOR LOW-RISK MOTHERS (SOAR) - SOAR AIMS TO IMPROVE MATERNAL OUTCOMES BY REDUCING VARIATION IN CARE OFTEN ASSOCIATED WITH GEOGRAPHICAL LOCATION AND REDUCE THE RISKS AND COMPLICATIONS THAT RESULT FROM UNNECESSARY CESAREAN SECTIONS IN LOW-RISK POPULATIONS. SOAR IS AN INITIATIVE ALIGNED WITH HEALTHY PEOPLE 2030 GOALS, JOINT COMMISSION REQUIREMENTS, AND COLORADO'S STATE MEDICAID HOSPITAL QUALITY INCENTIVE PROJECT (HQIP) TO REDUCE UNNECESSARY CESAREAN DELIVERY FOR LOW-RISK, FIRST-TIME PREGNANT PEOPLE (NULLIPAROUS, TERM, SINGLETON, VERTEX BIRTHS, OR NTSV). THE AIM SAFE REDUCTION OF PRIMARY CESAREAN BIRTH PATIENT SAFETY BUNDLE AND AIM DATA CENTER ARE USED TO SUPPORT THIS PROJECT. PARTICIPATING SOAR HOSPITALS AVERAGE A 24.4% NTSV CESAREAN BIRTH RATE COMPARED TO THE NATIONAL AVERAGE OF 30.6%.16 SOAR PARTICIPATING HOSPITALS DELIVER 29% OF COLORADO BIRTHS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD WILL AUTHORIZE PREPARATION OF FORM 990. FORM 990 WILL BE PREPARED BY THE AUDITORS IN CONSULTATION WITH THE TREASURER, PRESIDENT/CHAIR, AND EXECUTIVE DIRECTOR, AND WILL BE SIGNED BY AN OFFICER OF THE BOARD. A COPY OF FORM 990 WILL BE FILED IN CPCQC FINANCIAL FILES, AND A COPY OF THE FORM 990 AND FORM 1023 SHALL BE MADE AVAILABLE FOR PUBLIC INSPECTION AND/OR COPYING. |
| FORM 990, PAGE 6, PART VI, LINE 19 | COLORADO PERINATAL CARE QUALITY COLLABORATIVE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON AN "AS REQUESTED" BASIS. |
| FORM 990, PART IX, LINE 11G | OTHER CONTRACTOR FEES 170,155 7,904 26,845 |
| Software ID: | |
| Software Version: |