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)
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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.") .. | ||||||
| 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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 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.") . | 4,751,752 | 5,000,153 | 6,080,743 | 12,452,199 | 7,938,833 | 36,223,680 |
| 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 | 24,407,243 | 25,494,090 | 25,842,345 | 26,260,027 | 28,991,027 | 130,994,732 |
| 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 | 29,158,995 | 30,494,243 | 31,923,088 | 38,712,226 | 36,929,860 | 167,218,412 |
| 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.) | 167,218,412 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 29,158,995 | 30,494,243 | 31,923,088 | 38,712,226 | 36,929,860 | 167,218,412 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 60,128 | 68,921 | 82,648 | 65,338 | 81,270 | 358,305 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 60,128 | 68,921 | 82,648 | 65,338 | 81,270 | 358,305 |
| 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.).. | 29,219,123 | 30,563,164 | 32,005,736 | 38,777,564 | 37,011,130 | 167,576,717 |
| 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 - ORGANIZATION'S MISSION | THE MISSION OF THE COMMUNITY HEALTH CENTERS OF BURLINGTON (CHCB) IS TO IMPROVE THE HEALTH OF ALL WITHIN THE COMMUNITIES CHCB SERVES. CHCB IS DEDICATED TO PROVIDING EXCEPTIONAL CARE WITH RESPECT AND COMPASSION AND WITH A COMMITMENT TO SERVING PEOPLE REGARDLESS OF FINANCIAL STATUS OR LIFE CIRCUMSTANCE. |
| FORM 990, PAGE 2, PART III, LINE 4A | THE COMMUNITY HEALTH CENTERS OF BURLINGTON (CHCB) ARE LEADERS IN PROVIDING QUALITY CARE TO OVER 30,000 PATIENTS IN CHITTENDEN AND SOUTHERN GRAND ISLE COUNTIES, REGARDLESS OF INCOME OR LIFE CIRCUMSTANCE. CELEBRATING THEIR 50TH YEAR, CHCB FOCUSED ON SHIFTING FROM PROVIDING AN EMERGENT RESPONSE TO THE COVID-19 PANDEMIC, TO PURSING THEIR MISSION BY INCREASING ACCESS TO VITAL HEALTH CARE SERVICES. HERE ARE SOME OF THE HIGHLIGHTS FROM FISCAL YEAR 2022: -CHCB CREATED AND HIRED MANY NEW POSITIONS THROUGHOUT THE YEAR, INCLUDING A DIRECTOR OF DIVERSITY, EQUITY AND INCLUSION FOCUSED ON ADVANCING DEI IDEALS IN CHCB'S SERVICES, POLICIES AND COLLABORATIONS WITH COMMUNITY PARTNERS, AND A CLINICAL PHARMACIST WHO IS AVAILABLE TO CHCB PROVIDERS AND PATIENTS FOR MEDICATION MANAGEMENT. -CHCB LAUNCHED TWO BLOOD PRESSURE CUFF "LENDING LIBRARIES" TO ALLEVIATE ACCESS ISSUES FOR PATIENTS AT THEIR MOST RURAL SITE IN THE CHAMPLAIN ISLANDS, AS WELL AS HOMEBOUND PATIENTS. -CHCB HOSTED "WALK WITH A DOC," A WALKING GROUP FUNDED THROUGH VERMONT DEPARTMENT OF HEALTH'S YOU FIRST PROGRAM. THIS GROUP ENCOURAGED PARTICIPANTS TO TAKE STEPS TOWARDS A HEALTHY LIFESTYLE BY ENJOYING A WALK AND FUN CONVERSATION WITH CHCB STAFF. -CHCB WORKED COLLABORATIVELY WITH MULTIPLE COMMUNITY PARTNERS AS WELL AS FEDERAL, CITY AND STATE OFFICIALS TO ENSURE ACCESS TO CARE THROUGHOUT THE COVID-19 PANDEMIC. THESE INITIATIVES INCLUDED: - A VAN TO PROVIDE TESTING AND VACCINATION FOR VULNERABLE POPULATIONS, SPECIFICALLY COMMUNITY MEMBERS EXPERIENCING HOMELESSNESS THROUGHOUT THE BURLINGTON AREA. - A WEEKLY VACCINATION CLINIC IN THE CHAMPLAIN ISLANDS. - A STATE-SPONSORED TESTING AND VACCINATION SITE OPERATING FIVE DAYS A WEEK ON NORTH WINOOSKI AVENUE IN BURLINGTON. - COLLABORATIONS WITH UVMMC, AALV, USCRI, PRIDE CENTER OF VERMONT, ISLAMIC SOCIETY OF VERMONT, AND VERMONT HEALTH EQUITY INITIATIVE TO PROVIDE VACCINATION ACCESS TO MARGINALIZED GROUPS. - PARTICIPATION IN HRSA'S COVID-19 N95 MASK, TESTING SUPPLY, AND VACCINE PROGRAMS TO ENHANCE PATIENT AND COMMUNITY ACCESS TO THESE KEY TOOLS IN THE FIGHT AGAINST COVID-19. -AT THE END OF THE FISCAL YEAR, RENOVATIONS BEGAN TO ESTABLISH CHCB'S NINTH LOCATION IN ESSEX JUNCTION. OFFICIALLY OPENING IN JUNE, 2022, THIS PRACTICE WILL OFFER KNOWLEDGEABLE PROVIDERS, CONVENIENT ACCESS, AND A BROAD ARRAY OF SERVICES FOR NEW AND EXISTING CHCB PATIENTS. CHCB REMAINS GRATEFUL TO THEIR PHILANTHROPIC DONORS AND COMMUNITY PARTNERS FOR THEIR STALWART SUPPORT OF CHCB'S WORK AND EFFORTS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | CHCB MAKES THE 990 AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW AND/OR COMMENT PRIOR TO FILING THEIR RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST FORMS ARE COMPLETED ANNUALLY BY EACH BOARD MEMBER AND REVIEWED BY THE GOVERNANCE COMMITTEE OF THE BOARD. IF A CONFLICT IS IDENTIFIED BY THE GOVERNANCE COMMITTEE, THEY TAKE THEIR FINDINGS TO THE FULL BOARD FOR RESOLUTION. IN ADDITION, CONFLICT OF INTEREST FORMS ARE BROUGHT TO EACH BOARD MEETING TO INSURE BOARD MEMBERS HAVE AN OPPORTUNITY TO AMEND THESE STATEMENTS AT ANY GIVEN TIME. DIRECTOR-LEVEL PERSONNEL STATEMENTS ARE SIGNED ANNUALLY OR AS NEEDED. FURTHERMORE, CHCB'S CONFLICT OF INTEREST EXPECTATIONS ARE OUTLINED IN THE CHCB EMPLOYEE HANDBOOK AS WELL AS THE CHCB CODE OF CONDUCT. ALL CHCB EMPLOYEES - EXISTING AND NEW - INCLUDING DIRECTORS ARE EXPECTED TO READ THE CODE OF CONDUCT AND SIGN AN ACKNOWLEGDEMENT THAT IS KEPT IN THEIR PERSONNEL FILE. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE COMPENSATION FOR THE CEO IS DRAFTED BY AN EXECUTIVE COMMITTEE BASED OFF OF INDUSTRY COMPARISONS. THEN THIS IS REVIEWED AND APPROVED BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IS BASED ON SALARY SURVEYS PERFORMED BY NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, AND IS APPROVED BY THE CEO. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | RENTAL EXPENSES 24,935 FUNDRAISING EXPENSES 12,942 RENTAL EXPENSES -24,935 FUNDRAISING EXPENSES -12,942 |
| Software ID: | |
| Software Version: |