2023-07-26T09:24:22-05:00 2023-01-31 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2022-02-01 840743432 CLINICA CAMPESINA FAMILY HEALTH SERVICES CLIN 3036504460 1735 SOUTH PUBLIC ROAD LAFAYETTE CO 80026 SIMON SMITH PRESIDENT & CEO 3036504460 2023-07-25 1 SIMON SMITH 999009999 1 SARAH HINTZ P00492291 3037795710 2023-07-25 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CLINICA FAMILY HEALTH SIMON SMITH 1735 SOUTH PUBLIC ROAD LAFAYETTE CO 80026 68397314 0 X WWW.CLINICA.ORG X 1977 CO PROVIDE HIGH-QUALITY, CULTURALLY APPROPRIATE MEDICAL, DENTAL, AND BEHAVIORAL HEALTH CARE. 12 12 827 17 0 0 35190999 25237490 37990885 42228773 187038 182954 1463270 747975 74832192 68397192 36421 8268 0 0 46552873 50728219 0 0 376300 19495366 21776520 66084660 72513007 8747532 -4115815 54834686 56549715 14417166 19610196 40417520 36939519 X CLINICA'S MISSION IS TO BE THE MEDICAL, DENTAL, AND BEHAVIORAL HEALTH CARE PROVIDER OF CHOICE FOR LOW INCOME AND OTHER UNDERSERVED PEOPLE IN IN SOUTH BOULDER, BROOMFIELD, GILPIN, AND WEST ADAMS COUNTIES. (CONTINUED ON SCHEDULE O)OUR CARE SHALL BE CULTURALLY APPROPRIATE AND PREVENTION FOCUSED.OUR VISION FOR THE FUTURE IS THAT EVERY LOW INCOME AND OTHER UNDERSERVED PERSON IN SOUTH BOULDER, BROOMFIELD, GILPIN, AND WEST ADAMS COUNTIES WILL HAVE ACCESS TO HIGH QUALITY, PREVENTATIVE MEDICAL AND DENTAL CARE WHICH IS INTEGRATED WITH BEHAVIORAL HEALTH CARE. 0 0 56981961 8268 42228773 FOR THE FISCAL YEAR ENDED JANUARY 31, 2023, CLINICA PROVIDED 185,945 MEDICAL VISITS, 38,090 DENTAL VISITS, 30,722 BEHAVIORAL HEALTH VISITS, 2,570 REGISTERED DIETICIAN VISITS, AND 30,677 CASE MANAGEMENT VISITS. 56981961 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 27 0 1 827 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRIAN JOHNSTON 3036653036 1735 S PUBLIC ROAD LAFAYETTE CO 80026 PHILIP KEPPELER PHYSICIAN 38.00 0.00 X 301446 0 36102 KAREN FUNK CHIEF MEDICAL OFFICER 40.00 0.00 X 295372 0 27593 LISA WINKLER PHYSICIAN 40.00 0.00 X 258927 0 34675 ANGELA FRYER PHYSICIAN 40.00 0.00 X 251280 0 30168 SIMON SMITH PRESIDENT & CEO 39.00 1.00 X 265749 0 20639 ALEX BULKACZ PHYSICIAN 40.00 0.00 X 250906 0 21960 BREANNA TOMLIN PHYSICIAN 40.00 0.00 X 242207 0 16091 AN NGUYEN CHIEF DENTAL OFFICER 40.00 0.00 X 231764 0 16080 BRIAN JOHNSTON CFO 39.00 1.00 X 132097 0 33758 ELLA PADILLA CHAIR 1.00 0.00 X X 0 0 0 JEFF ZAYACH VICE CHAIR 1.00 0.00 X X 0 0 0 MATTHEW ANTUSH TREASURER 1.00 0.00 X X 0 0 0 HEATHER ELKINS SECRETARY 1.00 0.10 X X 0 0 0 INEZ BUGGS DIRECTOR 0.50 0.00 X 0 0 0 LIZANDRO GONZALEZ DIRECTOR 0.50 0.00 X 0 0 0 EDSON HERNANDEZ DIRECTOR 0.50 0.00 X 0 0 0 W DOUGLAS JONES DIRECTOR 0.50 0.00 X 0 0 0 CAROLINA FLORES MANROSS DIRECTOR 0.50 0.00 X 0 0 0 CHERLYN MARRIOTT DIRECTOR 0.50 0.00 X 0 0 0 MAYRA MARTINEZ DIRECTOR 0.50 0.00 X 0 0 0 HEIDY ORDONEZ DIRECTOR 0.50 0.00 X 0 0 0 2229748 0 237066 88 0 1 0 OHIO SHARED INFORMATION SERVICES INC 8790 GOVERNORS HILL DR 202 CINCINNATI OH 45249 SOFTWARE LICENSE MAINTENANCE FEES 999720 MEDIX STAFFING SOLUTIONS INC 222 S RIVERDALE PLAZA SUITE 2120 CHICAGO IL 60606 TEMPORARY PERSONNEL 541388 MOJOS CLEANING SERVICES 17 N 12TH AVE UNIT B BRIGHTON CO 80601 JANITORIAL SERVICES 339282 WSI PERSONNEL SERVICES 8301 E PRENTICE AVE SUITE 207 GREENWOOD VILLAGE CO 80111 TEMPORARY PERSONNEL 320926 AMN HEALTHCARESTRATUS VIDEO 8840 CYPRESS WATERS BLVD SUITE 300 DALLAS TX 75019 VIDEO TRANSLATION SERVICES 301608 19 24834758 402732 3521051 25237490 PATIENT SERVICE REV. 621110 38736929 38736929 PHARMACY REVENUE 621110 3491844 3491844 42228773 183076 183076 122 -122 -122 -122 OTHER REVENUE 900099 747975 747975 747975 68397192 42228773 0 930929 8268 8268 1119169 198569 920600 42266265 35519459 6476732 270074 631794 526372 101679 3743 3463436 2932526 509992 20918 3247555 2644349 584526 18680 43462 8779 33399 1284 182388 36841 140158 5389 3362146 2431789 917492 12865 138430 22953 113604 1873 1565746 1040462 515748 9536 2066505 313640 1737737 15128 3204122 1922331 1280721 1070 115319 74609 40396 314 71707 46393 25119 195 358820 205354 153466 1335377 881349 454028 254749 120253 132163 2333 MEDICAL SUPPLIES 7445811 7445811 EDUCATION 648769 351317 294956 2496 EQUIP RENTAL & REPAIRS 588917 180263 405760 2894 DUES & SUBSCRIPTIONS 195767 39543 150439 5785 198485 30731 166031 1723 72513007 56981961 15154746 376300 3417997 1455568 15342404 12560637 1011352 580771 6459865 6426827 12469400 12469400 34074 46830 605161 777173 32125738 16466236 15375606 15659502 118827 6573007 54834686 56549715 6176179 4456673 392125 31900 6414434 13157935 1434428 1963688 14417166 19610196 X 39776171 36856545 641349 82974 40417520 36939519 54834686 56549715 X -4115815 637814 X X 0 1 X 1 1 1 X 18761551 18662293 21921691 35190999 25237490 119774024 18761551 18662293 21921691 35190999 25237490 119774024 119774024 775 165115 172410 187038 183076 708414 1269471 434287 630436 1463270 747975 4545439 125027877 196746307 0.95800 0.96100 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 1,269,471. 2019 AMOUNT: $ 434,287. 2020 AMOUNT: $ 630,436. 2021 AMOUNT: $ 1,463,270. 2022 AMOUNT: $ 747,975. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 12641 12641 72124066 72136707 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 13770 13942 9423 12641 49776 250000 250000 250000 250000 1000000 1500000 3835786 3835786 17036361 7681343 9355018 11035508 8784893 2250615 218083 218083 15659502 SECURITY DEPOSITS 115827 RIGHT OF USE ASSET 6203794 INTEREST RATE SWAP AGREEMENT 253386 6573007 PAYABLES TO RELATED ORGANIZATIONS 1963688 1963688 X 71507909 2165417 945300 3110717 68397192 0 68397192 75051057 2165417 372633 2538050 72513007 0 72513007 PART X, LINE 2: THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 637,814. HOLDING COMPANY REVENUE NOT INCLUDED 1,075,486. ELIMINATING ENTRY TO CONSOLIDATE FINANCIAL STATEMENTS -768,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: HOLDING COMPANY EXPENSES NOT INCLUDED 1,140,633. ELIMINATING ENTRY TO CONSOLIDATE FINANCIAL STATEMENTS -768,000. 1 PATIENT TRANSPORTATION ASSISTANCE 1900 8268 0 N/A N/A PART I, LINE 2: THE ORGANIZATION ENSURES APPROPRIATE USE OF TRANSPORTATION ASSISTANCE BY GIVING INDIVIDUALS TRANSPORTATION VOUCHERS THAT ARE ONLY GOOD FOR TRANSPORTATION OR BY PAYING THE TRANSPORTATION COMPANY DIRECTLY. X X X X 0 0 0 0 0 0 0 0 0 PHILIP KEPPELER PHYSICIAN 301446 0 0 0 0 0 6723 0 29379 0 337548 0 0 0 KAREN FUNK CHIEF MEDICAL OFFICER 295372 0 0 0 0 0 6349 0 21244 0 322965 0 0 0 LISA WINKLER PHYSICIAN 258927 0 0 0 0 0 5750 0 28925 0 293602 0 0 0 ANGELA FRYER PHYSICIAN 251280 0 0 0 0 0 5520 0 24648 0 281448 0 0 0 SIMON SMITH PRESIDENT & CEO 245749 0 20000 0 0 0 5312 0 15327 0 286388 0 0 0 ALEX BULKACZ PHYSICIAN 250906 0 0 0 0 0 5261 0 16699 0 272866 0 0 0 BREANNA TOMLIN PHYSICIAN 242207 0 0 0 0 0 5192 0 10899 0 258298 0 0 0 AN NGUYEN CHIEF DENTAL OFFICER 231764 0 0 0 0 0 4983 0 11097 0 247844 0 0 0 BRIAN JOHNSTON CFO 132097 0 0 0 0 0 3134 0 30624 0 165855 0 0 0 X 118227 3521051 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE NUMBER OF ITEMS RECEIVED IS REPORTED IN PART I. FORM 990, PART VI, SECTION A, LINE 1A THE GOVERNING BOARD OF DIRECTORS SHALL HAVE THE POWER TO DESIGNATE AND APPOINT ONE OR MORE COMMITTEES, EACH OF WHICH SHALL CONSIST OF TWO OR MORE DIRECTORS, WHICH COMMITTEES SHALL HAVE SUCH AUTHORITY AS DELEGATED BY THE BOARD, EXCEPT THAT NO SUCH COMMITTEE SHALL HAVE THE AUTHORITY TO AMEND, ALTER OR REPEAL THE BYLAWS; ELECT, APPOINT OR REMOVE ANY OFFICER OR DIRECTOR OF THE CORPORATION; AMEND THE ARTICLES OF INCORPORATION; RESTATE THE ARTICLES OF INCORPORATION; ADOPT A PLAN OF MERGER OR ADOPT A PLAN OF CONSOLIDATION WITH ANOTHER CORPORATION; AUTHORIZE THE SALE, LEASE, EXCHANGE, OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION; AUTHORIZE THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOKE PROCEEDINGS THEREFOR; ADOPT A PLAN FOR THE DISTRIBUTION OF ASSETS OF THE CORPORATION; AND/OR AMEND, ALTER OR REPEAL ANY RESOLUTION OF THE BOARD OF DIRECTORS WHICH BY ITS TERMS PROVIDES THAT IT SHALL NOT BE AMENDED, ALTERED, OR REPEALED BY SUCH COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 PRIOR TO IT BEING FILED WITH THE IRS. THE CFO PROVIDES AN ANNUAL EDUCATION PACKET WITH THE 990 FORM TO ASSIST THE DIRECTORS WITH THEIR REVIEW. THE FINANCE COMMITTEE HOLDS A Q&A SESSION AFTER DELIVERY OF THE FORM 990 TO REVIEW ANY QUESTIONS WITH THE CFO AND CONTROLLER. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS, VOTING COMMITTEE MEMBERS, AND OFFICERS. EACH INDIVIDUAL IS REQUIRED TO DISCLOSE THE EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND IS GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS. AFTER SUCH DISCLOSURE, THE INDIVIDUAL DOES NOT PARTICIPATE IN THE REMAINDER OF THE PROCESS, INCLUDING DISCUSSIONS AND VOTES. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE REMAINING BOARD OR COMMITTEE MEMBERS MAKE THE DETERMINATION. THE CHAIR MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE TRANSACTION. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT IDENTIFIED, THE BOARD OR COMMITTEE VOTES ON WHETHER TO ENTER THE TRANSACTION. IF THE BOARD OR A COMMITEE BELIEVES A PERSON HAS FAILED TO DISCLOSE A CONFLICT, THE INDIVIDUAL IS GIVEN AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE. IF THE BOARD OR COMMITTEE DETERMINES THAT A FAILURE HAS OCCURRED, APPROPRIATE DISCIPLINARY ACTION IS TAKEN. DELIBERATIONS AND DECISIONS MADE ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS' COMPENSATION COMMITTEE DETERMINES THE COMPENSATION OF THE CEO USING AN ANALYSIS OF MARKET SALARIES COMPILED BY THE CHIEF HR OFFICER, USING INFORMATION AVAILABLE FROM THE EMPLOYERS COUNCIL, THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, COMMUNITY HEALTH ASSOCIATION OF MOUNTAIN/PLAINS STATES, AND THE COLORADO COMMUNITY HEALTH NETWORK. THE DISCUSSION/DELIBERATION IS DOCUMENTED IN THE BOARD'S COMPENSATION COMMITTEE NOTES AND NOTED IN THE BOARD'S MEETING MINUTES. A PAYROLL NOTE DOCUMENTS THE FINAL DECISION AND IS APPROVED BY THE MEMBERS OF THE BOARD'S COMPENSATION COMMITTEE. THE LAST COMPENSATION REVIEW TOOK PLACE IN 2022. THE COMPENSATION OF OTHER OFFICERS IS EVALUATED USING AN ANALYSIS OF MARKET SALARIES COMPILED BY THE CHIEF HR OFFICER, USING INFORMATION AVAILABLE FROM THE EMPLOYERS COUNCIL, THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, COMMUNITY HEALTH ASSOCIATION OF MOUNTAIN/PLAINS STATES AND THE COLORADO COMMUNITY HEALTH NETWORK. THE CEO DETERMINES ANY COMPENSATION ADJUSTMENTS AND THE DECISION IS DOCUMENTED IN A PAYROLL NOTE APPROVED BY THE CEO. IN ADDITION, THE ORGANIZATION PERIODICALLY USES AN EXTERNAL COMPENSATION CONSULTANT TO DETERMINE COMPENSATION OF THE CEO, OFFICERS, KEY EMPLOYEES, AND CERTAIN OTHER EMPLOYEES OF THE ORGANIZATION. THE CONSULTANT REVIEWS THE ORGANIZATION'S STRATEGIC OBJECTIVES, RELEVANT POLICIES AND PROCEDURES AND CURRENT COMPENSATION DOCUMENTATION. THE CONSULTANT USES SURVEYS AND OTHER INFORMATION TO DEVELOP UP-TO-DATE MARKET INFORMATION BASED ON THE DETAILED JOB DESCRIPTIONS PROVIDED BY THE ORGANIZATION. THE CONSULTANT WORKS WITH LEADERSHIP TO DEVELOP BASE COMPENSATION SALARY RANGES INCLUDING COST ANALYSIS FOR PROPOSED PAY ADJUSTMENTS TO THOSE SALARIES FALLING OUTSIDE THE RANGE. A COMPENSATION ANALYSIS WAS COMPLETED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FINANCIAL INFORMATION INCLUDING FORM 990 AS WELL AS OUR ANNUAL AUDIT AND FINANCIAL STATEMENTS ARE ALSO MADE AVAILABLE THROUGH THE GUIDESTAR.ORG WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 637,814. FORM 990 PART XII LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. A COMPETITIVE REQUEST FOR PROPOSAL FOR AUDIT AND TAX SERVICES WAS CONDUCTED IN DECEMBER 2022. CLINICA HOLDING COMPANY 1735 SOUTH PUBLIC ROAD LAFAYETTE CO 80026 823052286 PROPERTY HOLDING CO 501(C)(3) LINE 12A, I CLINICA CAMPESINA FAMILY HEALTH SERVICES 1 0 0 0 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 CLINICA HOLDING COMPANY K 814970 FAIR MARKET VALUE CLINICA HOLDING COMPANY E 1963688 FAIR MARKET VALUE