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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 3,000,421 | 4,958,096 | 4,405,709 | 4,483,679 | 4,921,277 | 21,769,182 |
| 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 | 3,000,421 | 4,958,096 | 4,405,709 | 4,483,679 | 4,921,277 | 21,769,182 |
| 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. | 21,769,182 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,000,421 | 4,958,096 | 4,405,709 | 4,483,679 | 4,921,277 | 21,769,182 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 109 | 345 | 420 | 250 | 247 | 1,371 |
| 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.).. | 777 | 2,564 | 8,767 | 28 | 12,136 | |
| 11 | Total support. Add lines 7 through 10 | 21,782,689 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | PARENTING FEES - NYS UNCLAIMED FUNDS / REFUNDS - 2021 AMOUNT: $ 7,350. MEDICAL RECORDS FEE - 2019 AMOUNT: $ 160. 2020 AMOUNT: $ 240. OTHER REVENUE - 2019 AMOUNT: $ 617. 2020 AMOUNT: $ 2,324. 2021 AMOUNT: $ 1,417. 2022 AMOUNT: $ 28. |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 | CURRENTLY, WE PROVIDE AN ARRAY OF SERVICES SPANNING PEDIATRICS TO GERIATRICS, WITH TARGETED SUPPORT FOR OUR PATIENT POPULATION, INCLUDING MEDICATION-ASSISTED SUBSTANCE USE TREATMENT; OUTPATIENT SUBSTANCE USE TREATMENT; GROUP AND INDIVIDUAL COUNSELING; PSYCHIATRY; PARENTING AND HEALTH EDUCATION; OVERDOSE PREVENTION TRAINING AND NALOXONE DISTRIBUTION; AND PRIMARY CARE SERVICES, INCLUDING INTERNAL MEDICINE, HIV PREVENTION AND TREATMENT SERVICES, WOMEN'S HEALTH, PEDIATRICS AND TREATMENT FOR CHRONIC CONDITIONS SUCH AS HYPERTENSION, DIABETES, AND ASTHMA. WE ALSO PROVIDE FREE CHILDCARE FOR PATIENTS ACCESSING SERVICES, ADDRESSING A MAJOR BARRIER TO CARE FOR PARENTS AND CARETAKERS. IN 2023, CCHP RELOCATED ALL OF ITS SERVICES TO A NEWLY DESIGNED AND RENOVATED, STATE-OF-THE-ART, FULLY-CUSTOMIZED, AND ACCESSIBLE COMMUNITY HEALTH CENTER, WITHIN EASY REACH OF OUR EXISTING PATIENTS. WITH THE RENOVATION AND RETROFIT, OUR TOP PRIORITY WAS THAT ALL SPACES AND TECHNOLOGY ENCOURAGE STRONG STAFF AND PATIENT INTERACTIONS TO BEST ALIGN WITH AND SUPPORT OUR INTEGRATED MODEL OF CARE. THE RESULT, WE BELIEVE, IS A UNIQUELY EFFECTIVE HEALTHCARE FACILITY IN OUR GEOGRAPHIC REGION THAT IS CUSTOMIZED TO SUPPORT IMPROVED OUTCOMES FOR OUR PATIENT POPULATIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM, AND IS PRESENTED TO MANAGEMENT AND THE AUDIT COMMITTEE. ONCE ALL QUESTIONS AND ISSUES HAVE BEEN ADDRESSED A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES WHICH IS ENFORCED BY THE BOARD OF DIRECTORS. ALL OFFICERS AND MEMBERS OF THE BOARD ANNUALLY COMPLETE AND SIGN A DISCLOSURE FORM, DISCLOSING ANY POTENTIAL CONFLICTS THAT MAY EXIST. ANY PERSON WITH A POTENTIAL CONFLICT DISCLOSES ALL MATERIAL FACTS TO THE BOARD, COMMITTEE, OR CHAIR OF THE MEETING IN WHICH THE CONFLICT IS TO BE DISCUSSED. IF IT IS NOT CLEAR THAT A CONFLICT OF INTEREST EXISTS, THE CHAIR OR CHAIR'S DESIGNEE MAKES THE DETERMINATION. A PERSON WHO HAS A CONFLICT CANNOT PARTICIPATE IN OR HEAR THE BOARD'S OR COMMITTEE'S DISCUSSION OF THE MATTER EXCEPT TO DISCLOSE MATERIAL FACTS AND TO RESPOND TO QUESTIONS. THE EXISTENCE OF ALL SUCH CONFLICTS OF INTEREST AND THEIR RESOLUTIONS, AS WELL AS ANY ISSUES RELATING TO THEM, ARE DOCUMENTED IN THE MINUTES OF THE MEETING. THE ORGANIZATION HAS A CONFLICTOFINTEREST POLICY THAT APPLIES TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES WHICH IS ENFORCED BY THE BOARD OF DIRECTORS. ALL OFFICERS AND MEMBERS OF THE BOARD ANNUALLY COMPLETE AND SIGN A DISCLOSURE FORM, DISCLOSING ANY POTENTIAL CONFLICTS THAT MAY EXIST. ANY PERSON WITH A POTENTIAL CONFLICT DISCLOSES ALL MATERIAL FACTS TO THE BOARD, COMMITTEE, OR CHAIR OF THE MEETING IN WHICH THE CONFLICT IS TO BE DISCUSSED. IF IT IS NOT CLEAR THAT A CONFLICT OF INTEREST EXISTS, THE CHAIR OR CHAIR'S DESIGNEE MAKES THE DETERMINATION. A PERSON WHO HAS A CONFLICT CANNOT PARTICIPATE IN OR HEAR THE BOARD'S OR COMMITTEE'S DISCUSSION OF THE MATTER EXCEPT TO DISCLOSE MATERIAL FACTS AND TO RESPOND TO QUESTIONS. THE EXISTENCE OF ALL SUCH CONFLICTS OF INTEREST AND THEIR RESOLUTIONS, AS WELL AS ANY ISSUES RELATING TO THEM, ARE DOCUMENTED IN THE MINUTES OF THE MEETING. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION IS APPROVED IN CONJUNCTION WITH CEO AND CFO. THE PROCESS INCLUDES SALARY COMPARISONS WITH OTHER NONPROFITS SIMILAR IN SIZE AND FUNCTION AS WELL AS A REVIEW CURRENT SALARY TRENDS FOR ALL POSITIONS BEING FILLED, AND WAS LAST UNDERTAKEN IN 2023. THE DELIBERATIONS AND DECISIONS WERE CONTEMPORANEOUSLY DOCUMENTED IN JOB POSTINGS, OFFER LETTERS, PAYROLL. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S FORM 990 IS AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE ORGANIZATION MAKES ITS FORM 990, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 840,912. MANAGEMENT AND GENERAL EXPENSES 5,882. FUNDRAISING EXPENSES 150,738. TOTAL EXPENSES 997,532. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 188,344. MANAGEMENT AND GENERAL EXPENSES 18,842. FUNDRAISING EXPENSES 2,001. TOTAL EXPENSES 209,187. SECURITY: PROGRAM SERVICE EXPENSES 72,156. MANAGEMENT AND GENERAL EXPENSES 3,964. FUNDRAISING EXPENSES 3,172. TOTAL EXPENSES 79,292. JANITORIAL: PROGRAM SERVICE EXPENSES 45,466. MANAGEMENT AND GENERAL EXPENSES 1,546. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,012. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 600. |
| FORM 990, PART XI, LINE 9: | BAD DEBT EXPENSE - GRANTS -781. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |