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 | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 2,788,290 | 2,182,584 | 1,978,685 | 4,249,337 | 3,841,270 | 15,040,166 |
| 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 | 2,788,290 | 2,182,584 | 1,978,685 | 4,249,337 | 3,841,270 | 15,040,166 |
| 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) .. | 2,183,146 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 12,857,020 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,788,290 | 2,182,584 | 1,978,685 | 4,249,337 | 3,841,270 | 15,040,166 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 10,175 | 47,523 | 11,596 | 2,721 | 39,604 | 111,619 |
| 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.).. | 10,987 | 6,861 | 10,516 | 6,812 | 25,578 | 60,754 |
| 11 | Total support. Add lines 7 through 10 | 15,274,445 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART II, LINE 10 | 60,754 |
| 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 3 | THE ORGANIZATION HAD AN EXECUTED MANAGEMENT SERVICES AGREEMENT WITH COMMUNITY HEALTH PROVIDER ALLIANCE (CHPA) TO PROVIDE EMPLOYEES AND SERVICES TO MANAGE CHPA'S ACTIVITIES. EFFECTIVE SEPTEMBER 30, 2022, THE ORGANIZATION COMPLETELY SEPARATED FROM CHPA, AND THE MANAGEMENT SERVICES AGREEMENT WAS TERMINATED. |
| FORM 990, PAGE 2, PART III, LINE 4D | AMERICAN RESCUE PLAN: TO PROVIDE TRAINING/TECHNICAL ASSISTANCE TO ASSIST HEALTH CENTERS IN COVID VACCINATION CAPACITY; COVID RESPONSE AND TREATMENT; MAINTAINING AND INCREASING CAPACITY; AND RECOVERY AND STABILIZATION. 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. COMMUNITY HEALTH ASSOCIATION OF MOUNTAIN/PLAINS STATES (CHAMPS): CCHN PROVIDES ADMINISTRATIVE AND ACCOUNTING SERVICES TO CHAMPS UNDER A PROFESSIONAL SERVICES AGREEMENT. EMERGENCY PREPAREDNESS: TO PROVIDE TRAINING, TECHNICAL ASSISTANCE, OTHER EDUCATION AND EQUIPMENT TO COLORADO CHCS. COVERING KIDS AND FAMILIES (CKF): TO IMPROVE HOW COLORADANS ACCESS AND RETAIN AFFORDABLE HEALTH COVERAGE. SYNCUP GROW YOUR OWN: TO BUILD AWARENESS OF HEALTH CENTER CAREER OPPORTUNITIES AND PROVIDE AN ACCESSIBLE PATHWAY FOR ENTRY AND ADVANCEMENT TO MEANINGFUL AND FINANCIALLY SUSTAINABLE CAREERS, WITH A SPECIFIC FOCUS ON MEDICAL ASSISTING AS A FIRST STEP. ORAL HEALTH: TO IMPROVE THE DENTAL HEALTH OF VULNERABLE POPULATIONS BY INCREASING INTEGRATION OF ORAL HEALTH PREVENTIVE SERVICES IN PRIMARY CARE DELIVERY SYSTEMS. 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. RACIAL EQUITY: TO DEVELOP EQUITY GOALS AND A ROADMAP THAT WILL SERVE AS A GUIDE TO BEGIN OR STRENGTHEN HEALTH CENTERS- AND CCHN'S EQUITY JOURNEY. SIX BUILDING BLOCKS OF PRESCRIPTION OPIOID MANAGEMENT: TO SUPPORT THE IMPLEMENTATION OF SAFE PRESCRIBING PRACTICES AND DECREASE HIGH-RISK PRESCRIBING AT CHCS. CANCER, CHRONIC DISEASE, AND DIABETES PREVENTION AND EARLY DETECTION: TO IMPLEMENT STRATEGIES TO ADDRESS CANCER PREVENTION AND EARLY DETECTION AT ONE OR MORE LEVELS OF THE SOCIOECOLOGICAL FRAMEWORK, DEPENDING ON THE NEEDS OF THE UNDERSERVED POPULATION SERVED BY AND LIVING WITHIN THE SERVICE AREA. 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. COLORADO HEALTH SERVICE CORPS: TO REVIEW LOAN REPAYMENT APPLICATIONS FROM HEALTH CARE PROVIDERS EMPLOYED BY FACILITIES SERVING MEDICALLY UNDERSERVED POPULATIONS. TEAM-BASED CARE: TO PROVIDE TRAINING/TECHNICAL ASSISTANCE TO HEALTH CENTERS TO FACILITATE CONTINUED TRANSFORMATION AROUND TEAM-BASED CARE COMPONENTS OF PATIENT CENTERED MEDICAL HOME. VIRTUAL CARE NETWORK: TO PARTICIPATE IN THE VIRTUAL CARE INNOVATION NETWORK BY ENGAGING MEMBER CHCS, INFORMING THE APPLICATION PROCESS AND PROGRAM DESIGN, PROVIDING ADVOCACY SUPPORT, AND DISSEMINATING LESSONS. |
| FORM 990, PAGE 6, PART VI, LINE 6 | CCHN'S MEMBERS INCLUDE COLORADO'S 20 COMMUNITY HEALTH CENTERS WHICH OPERATE CLINIC SITES AND CARE FOR PATIENTS LIVING IN 63 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 OF THE MEMBERS OF THE CCHN BOARD OF DIRECTORS, AND THE CHAIR OF THE BOARD OF DIRECTORS, OR THE PRESIDENT AND CEO 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 3. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING |
| FORM 990, PAGE 6, PART VI, LINE 19 | CCHN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTUAL AGREEMENTS 550,110 25,789 0 PROFESSIONAL FEES 14,143 35,282 0 COMPUTER CONSULTANT 71,249 16,091 1,815 GROUP PURCHASING-990T -7,037 0 0 GROUP PURCHASING GROUP PURCHASING 7,037 0 0 TOTAL 635,502 77,162 1,815 |
| FORM 990, PAGE 12, PART XII, LINE 2C | PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |