TY 2021 Form 990PF

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	241,556	281,763	281,763
	2	Savings and temporary cash investments.........
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)
	b	Investments—corporate stock (attach schedule).......
	c	Investments—corporate bonds (attach schedule).......
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	15	Other assets (describe )		1
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	241,556	281,764	281,763
	17	Accounts payable and accrued expenses..........		23
	18	Grants payable.................		40,000
	19	Deferred revenue.................
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......
	22	Other liabilities (describe )
	23	Total liabilities (add lines 17 through 22).........		40,023
		Foundations that follow FASB ASC 958, check here
		and complete lines 24, 25, 29 and 30.
	24	Net assets without donor restrictions...........
	25	Net assets with donor restrictions............
		Foundations that do not follow FASB ASC 958, check here
		and complete lines 26 through 30.
	26	Capital stock, trust principal, or current funds........
	27	Paid-in or capital surplus, or land, bldg., and equipment fund
	28	Retained earnings, accumulated income, endowment, or other funds	241,556	241,741
	29	Total net assets or fund balances (see instructions).....	241,556	241,741
	30	Total liabilities and net assets/fund balances (see instructions).	241,556	281,764

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 ...................	3

1a	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
b	All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2...........................	3
4	Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	4
5	Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- .....	5
6	Credits/Payments:

a	2021 estimated tax payments and 2020 overpayment credited to 2021	6a
b	Exempt foreign organizations—tax withheld at source......	6b
c	Tax paid with application for extension of time to file (Form 8868)...	6c
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............	7
8	Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached.	8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......	9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...	10
11	Enter the amount of line 10 to be: Credited to 2022 estimated tax0	Refunded	11

(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)
KIM BANGERTER MBA	President/Sec. 0.00	0
1230 NE 3RD ST STE A-200 BEND,OR97701
SHIMIKO MONTGOMERY	Executive Dir. 0.00	0
1230 NE 3RD ST STE A-200 BEND,OR97701
JOHN TELLER MD	Director 2.00	0
1230 NE 3RD ST STE A-200 BEND,OR97701
KATHERINE MASTRANGELO	Director 2.00	0
1230 NE 3RD ST STE A-200 BEND,OR97701
REBECCA FERGUSON MD	Director 2.00	0
1230 NE 3RD ST STE A-200 BEND,OR97701

		(a) Corpus	(b) Years prior to 2020	(c) 2020	(d) 2021
1 Distributable amount for 2021 from Part X, line 7					0
2 Undistributed income, if any, as of the end of 2021:
a Enter amount for 2020 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2021:
a From 2016......
b From 2017......
c From 2018......
d From 2019......
e From 2020......
f Total of lines 3a through e ........
4Qualifying distributions for 2021 from Part
XI, line 4: $
a Applied to 2020, but not more than line 2a
b Applied to undistributed income of prior years (Election required—see instructions).....
c Treated as distributions out of corpus (Election required—see instructions)........
d Applied to 2021 distributable amount.....
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2021.
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2019. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2021. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2022 ..........					0
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8 Excess distributions carryover from 2016 not applied on line 5 or line 7 (see instructions) ...
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......
10 Analysis of line 9:
a Excess from 2017....
b Excess from 2018....
c Excess from 2019....
d Excess from 2020....
e Excess from 2021....

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2021	(b) 2020	(c) 2019	(d) 2018	(e) Total

b 85% (0.85) of line 2a .........
c Qualifying distributions from Part XI, line 4 for each year listed .....
d Amounts included in line 2c not used directly for active conduct of exempt activities ..........
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c ....
3 Complete 3a, b, or c for the alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b “Endowment" alternative test— enter 2/3 of minimum investment return shown in Part IX, line 6 for each year listed ..
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
Treehouse Therapies Associates PO BOX 1397 BEND,OR97709	N/A	PC	Treehouse Therapies is partnering with the Confederated Tribes of Warm Springs and the Central Oregon Disabilities Support Network(CODSN)to open a therapeutic clinic and directly serve children with special needs who live in the Warm Springs community and the surrounding areas. Currently, there are no such services in that community and families must drive to Redmond and BEnd to access therapy for their children. Coupled with insurance and financial limitations, often these children have to forgo therapy. The funding will go towards paying physical, occupational, and behavioral therapists from Treehouse to be based out of a new clinic in the Warm Springs Early Childhood Education Center to reduce the barriers to accessing high quality care for children in Warm Springs.	40,000
THE SHIELD 60401 TALL PINE AVENUE BEND,OR97702	N/A		The SHIELD works to eliminate barriers to accessing mental health services for veterans. Their process consists of a network of trauma-informed, culturally competent mental health providers ready to offer an appointment to veterans within 5 days. As a trusted, collaborative community resource that receives referrals from partners like the Central Oregon Veterans Council, Central Oregon Suicide Prevention Alliance, St. Charles, and Central Oregon Veteran's Ranch, we are pleased our funding will offer our veterans 100 hours of free counseling through THE SHIELD.	15,000
THE PEACFUL PRESENCE PO BOX 1963 BEND,OR97709	N/A		The Peaceful Presence is a non-profit that works to reimagine the way communities talk about, plan for and experience serious illness and the end-of-life. Evidence shows that the rate of advance care directive completion in the general population is around 30% of adults; in the unhoused and BIPOC populations it is even lower. This funding will support an initiative to improve proactive planning for serious illness and end-of-life care for maginalized, vulnerable and unhoused populations in Central Oregon. The organization envisions a community where every individual has the planning, support, and care to die where and how they prefer.	37,500
ONE COMMUNITY HEALTH 849 PACIFIC AVENUE HOOD RIVER,OR97031	N/A		This pilot is a collaborative effort in Hood River and Wasco Counties that will serve medically frail older adult patients, with a commitment to increasing services to Latin x and indigenous patients with in-home, patient-centered and integrated care and advocacy support delivered by Community Health Workers(CHWs). Based on the evidence-based GRACE Team Care model, the pilot is spearheaded by the Older Adult Working Group of the Clinical Advisory Panel for the Columbia Gorge Health Council in partnership with One Community Health and the Bridges to Health Pathways Program. Funding will support the adaptation and piloting of new older adult protocols for CHWs, codifying protocols, and developing related continuing education opportunities for pilot staff and CHWs regionally and across the state.	40,000
DESCHUTES COUNTY HEALTH SERVICES 2577 NE COURTNEY DRIVE BEND,OR97701	N/A		Central Oregon's Perinatal Care Coordination(PCC) is a community-developed and public health-led program to assist pregnant and postpartum individuals in Central Oregon access health insurance, prenatal care, nutritional services, and other referrals with ease and dignity. The PCC program was developed by Deschutes County perinatal care coordinators and implemented in 2016 in response to Central Oregon's worsening maternal health and birth outcomes. The program now serves approximately 60% of all pregnant persons in Central Oregon, mostly low-income and vulnerable populations. In March 2021, Oregon Health Authorities Healthier Together featured PCC as a promising model and intervention for improving maternal health and birth outcomes across Oregon. This funding will help create a comprehensive handbook to assist other communities with establishing a similar program, as well as to establish an evaluation methodology to continuously measure the effects of the program.	30,000
CENTRAL OREGON HEALTH COUNCIL PO BOX 6689 BEND,OR97708	N/A		This project is a collaboration between researches at Oregon State University-Cascades, St. Charles Health System's Nutrition and Diabetes Manager, and the Central Oregon Health Council(COHC) to bring together multiple disciplines to address to address a longstanding issue in healthcare delivery that affects diabetic patients and patients at risk for malnutrition. Currently, the method of tracking nutritional intake in an inpatient setting is subjective, unreliable and gathered depending on the capacity of the care team. The researchers from OSU bring expertise from the fields of Computer Science, Food & Beverage, Business Administration, and Mechanical Engineering to enhance and test a prototype that uses image recognition technology, machine learning, artificial intelligence(AI), and cloud-computing resources to track and quantify nutritional intake in an in patient setting to provide an accurate data point for care teams to make proactive care decisions. The funding will toward comp	37,500
Camp Fire of Central Oregon PO BOX 7031 BEND,OR97708	N/A	NC	Pilot a Latinx-youth outdoor program for underserved community.	11,275
Total ................................. 3a				211,275

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)	215,000
2	Check .............
3	Interest on savings and temporary cash investments
4	Dividends and interest from securities...
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10
b	Gross sales price for all assets on line 6a
7	Capital gain net income (from Part IV, line 2)...
8	Net short-term capital gain.........
9	Income modifications...........
10a	Gross sales less returns and allowances
b	Less: Cost of goods sold....
c	Gross profit or (loss) (attach schedule).....
11	Other income (attach schedule).......
12	Total. Add lines 1 through 11........	215,000		0
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......
15	Pension plans, employee benefits.......
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		1,845
c	Other professional fees (attach schedule)....
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		174
19	Depreciation (attach schedule) and depletion...
20	Occupancy..............
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		1,521
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	3,540		0	0
25	Contributions, gifts, grants paid.......	211,275			211,275
26	Total expenses and disbursements. Add lines 24 and 25	214,815		0	211,275
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	185
b	Net investment income (if negative, enter -0-)			0
c	Adjusted net income (if negative, enter -0-)...

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)		(b) How acquired P—Purchase D—Donation	(c) Date acquired (mo., day, yr.)	(d) Date sold (mo., day, yr.)
1a
b
c
d
e

(e) Gross sales price		(f) Depreciation allowed (or allowable)	(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a
b
c
d
e

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69	(j) Adjusted basis as of 12/31/69	(k) Excess of col. (i) over col. (j), if any
a
b
c
d
e

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation
NONE


(a) Name and address of each employee paid more than $50,000	(b) Title, and average hours per week devoted to position	(c) Compensation	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
NONE









Total number of other employees paid over $50,000...................

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.	Expenses
1	Grants to non-profits in conjuction with the medical practice field and programs.	211,275
2


3


4

bApproved for future payment

Total ................................. 3b

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........
4 Dividends and interest from securities ....
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....
6 Net rental income or (loss) from personal property
7 Other investment income .....
8 Gain or (loss) from sales of assets other than inventory ............
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory
11 Other revenue: a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ..

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Name of organization Central Oregon Health Quality Alliance

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
1	JOHN D TELLER PO BOX 78 OVANDO, MT59854	$ 15,000	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
2	CENTRAL OREGON INDEPENDENT PRACTICE 1230 NE 3RD STREET STE A-200 BEND, OR97701	$ 200,000	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Name of organization Central Oregon Health Quality Alliance		Employer identification number 81-4098939

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)


Name of organization Central Oregon Health Quality Alliance			Employer identification number 81-4098939
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

Description	Revenue and Expenses per Books	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
committee meeting	525
INSURANCE	322
Licenses and fees	652
POSTAGE AND DELIVERY	22

Software ID:	21013475
Software Version:	2021v4.1