2024-09-13T08:07:45-05:00 2024-01-31 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2023-02-01 823052286 CLINICA HOLDING COMPANY CLIN 3036504460 1735 SOUTH PUBLIC ROAD LAFAYETTE CO 80026 SIMON SMITH PRESIDENT & CEO 3036504460 2024-09-11 1 1 BECKY DETTMANN CPA P01408585 3037795710 2024-09-11 2023 2024-08-08 14:25:15Z SIMON SMITH 1735 SOUTH PUBLIC ROAD LAFAYETTE CO 80026 701782 0 X N/A X 2017 CO HOLD PROPERTY IN SUPPORT OF CLINICA CAMPESINA FAMILY HEALTH SERVICES. 4 4 0 4 0 0 0 0 814970 701782 0 0 0 0 814970 701782 0 0 0 0 0 0 0 0 0 1140633 1142298 1140633 1142298 -325663 -440516 17824310 17246284 19559318 19408756 -1735008 -2162472 HOLD PROPERTY IN SUPPORT OF CLINICA CAMPESINA FAMILY HEALTH SERVICES. 0 0 1130510 0 701782 ACQUIRE AND HOLD TITLE TO PROPERTY IN LAFAYETTE, COLORADO; BORROW LOW-INTEREST RATE FUNDS; COMPLETE CONSTRUCTION OF A NEW COMMUNITY MEDICAL CLINIC, DENTAL CLINIC, PHARMACY, ADMINISTRATION SUITE, AND TRAINING CENTER; AND LEASE THE MAJORITY OF THE PROPERTY AND EQUIPMENT TO CLINICA CAMPESINA FAMILY HEALTH SERVICES. THIS PROVIDES COMPREHENSIVE PRIMARY HEALTH CARE TO THOUSANDS OF PATIENTS ANNUALLY IN THE COMMUNITY. 1130510 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X BRIAN JOHNSTON 3036653036 1735 S PUBLIC ROAD LAFAYETTE CO 80026 HEATHER ELKINS CHAIR 0.10 0.50 X X 0 0 0 MANDY RIGG TREASURER 0.10 0.00 X X 0 0 0 BEN GOLDSTEIN DIRECTOR 0.10 0.00 X 0 0 0 THOMAS RAZO DIRECTOR 0.10 0.00 X 0 0 0 SIMON SMITH PRESIDENT & CEO 1.00 39.00 X 0 254794 22519 BRIAN JOHNSTON CFO 1.00 39.00 X 0 144218 34486 0 399012 57005 0 0 1 0 0 RENT INCOME 531120 701782 701782 701782 701782 701782 0 0 10040 10040 1469 1469 279 279 422013 422013 708497 708497 1142298 1130510 11788 0 443261 2778 105098 20039253 4093295 16654455 15945958 621496 1297548 17824310 17246284 36594 102677 19522724 19306079 19559318 19408756 X -1735008 -2162472 -1735008 -2162472 17824310 17246284 X -440516 13052 X 0 1 X 0 0 X X X 1 CLINICA CAMPESINA FAMILY HEALTH SERVICES 840743432 7 1 1142298 0 1 1142298 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2907674 2907674 17131579 4093295 13038284 15945958 DUE FROM RELATED ORGANIZATIONS 1181000 INTEREST RATE SWAP AGREEMENT 116548 1297548 X 71142486 70440704 70440704 701782 0 701782 79247523 78105225 78105225 1142298 0 1142298 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 13,052. CLINICA FAMILY HEALTH REVENUE NOT INCLUDED 71,195,652. ELIMINATING ENTRY TO CONSOLIDATE FINANCIAL STATEMENTS -768,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: CLINICA FAMILY HEALTH EXPENSES NOT INCLUDED 78,873,225. ELIMINATING ENTRY TO CONSOLIDATE FINANCIAL STATEMENTS -768,000. 0 0 0 0 0 0 0 0 0 SIMON SMITH PRESIDENT & CEO 0 254794 0 0 0 0 0 5199 0 17320 0 277313 0 0 BRIAN JOHNSTON CFO 0 144218 0 0 0 0 0 3158 0 31328 0 178704 0 0 PART I, LINE 3 THE FOLLOWING WERE USED BY CLINICA CAMPESINA FAMILY HEALTH SERVICES TO DETERMINE THE PRESIDENT & CEO'S COMPENSATION. 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. COMPENSATION SURVEY OR STUDY 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE 5. FORM 990 OF OTHER ORGANIZATIONS FORM 990, PART VI, SECTION A, LINE 3 CLINICA FAMILY HEALTH EXECUTIVE TEAM, MANAGEMENT AND ADMINISTRATIVE SERVICES FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS CLINICA CAMPESINA FAMILY HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 7A CLINICA CAMPESINA FAMILY HEALTH SERVICES HAS THE RIGHT TO ELECT THREE MEMBERS OF THE BOARD OF DIRECTORS. THOSE THREE BOARD MEMBERS HAVE THE POWER TO ELECT OTHER BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE APPROVAL OF CLINICA CAMPESINA FAMILY HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES THAT HAVE BEEN GRANTED AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY THE ORGANIZATIONS INDEPENDENT CPA WITH INFORMATION PROVIDED BY MANAGEMENT. MANAGEMENT PROVIDES THE FORM 990 AND 990 EDUCATIONAL MATERIALS VIA EMAIL TO ALL DIRECTORS PRIOR TO FILING FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD 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 MEMBERS MAKE THE DETERMINATION. THE CHAIR MAY APPOINT A DISINTERESTED PERSON TO INVESTIGATE ALTERNATIVES TO THE TRANSACTION. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT IDENTIFIED, THE BOARD VOTES ON WHETHER TO ENTER THE TRANSACTION. IF THE BOARD BELIEVES A PERSON HAS FAILED TO DISCLOSE A CONFLICT, THE INDIVIDUAL IS GIVEN AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE. IF THE BOARD 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 ALL COMPENSATION DETERMINATIONS ARE MADE BY CLINICA CAMPESINA FAMILY HEALTH SERVICES. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2023. 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. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 13,052. CLINICA CAMPESINA FAMILY HEALTH SERVICES 1735 SOUTH PUBLIC ROAD LAFAYETTE CO 80026 840743432 HEALTH CARE CO 501(C)(3) LINE 7 N/A 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 1 1 1 1 1