2024-11-15T17:55:36-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2023-01-01 851563851 TEPEYAC QALICB INC TEPE 7202742923 4725 HIGH STREET DENVER CO 80216 JIM GARCIA PRESIDENT 7202742923 2024-11-14 1 1 BECKY DETTMANN CPA P01408585 3037795710 2024-11-10 2023 2024-10-15 13:58:12Z JIM GARCIA 4725 HIGH STREET DENVER CO 80216 305250 0 X WWW.TEPEYACHEALTH.ORG X 2020 CO HOLD PROPERTY IN SUPPORT OF LA CLINICA TEPEYAC. 4 3 0 3 0 0 60000 0 0 0 0 0 0 305250 60000 305250 0 1020223 0 0 0 0 0 0 0 255120 971903 255120 1992126 -195120 -1686876 17220537 15685425 17149894 17301658 70643 -1616233 THE PURPOSE OF TEPEYAC QALICB IS TO OWN AND DEVELOP LA CLINICA TEPEYAC BUILDING, GROUNDS AND RELATED PROPERTY AND LEASE THE FACILITY BACK TO LA CLINICA TEPEYAC. 0 0 1884075 1020223 305250 OWN AND DEVELOP LA CLINICA TEPEYAC BUILDINGS GROUNDS AND RELATED PROPERTY AND LEASE THE FACILITY BACK TO LA CLINICA TEPEYAC. 1884075 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 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 3 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X JIM GARCIA 7202742941 4725 HIGH STREET DENVER CO 80216 JIM GARCIA PRESIDENT 1.00 60.00 X X 0 171035 10738 ANN MURPHY VICE PRESIDENT 1.00 0.00 X X 0 0 0 DARRELL VIGIL SECRETARY 1.00 0.00 X X 0 0 0 DILLON BAYNES DIRECTOR 1.00 0.00 X 0 0 0 0 171035 10738 0 0 1 0 0 305250 0 305250 305250 305250 305250 305250 0 0 1020223 1020223 842 842 46995 46995 60214 60214 131618 131618 341484 341484 390345 390345 405 405 1992126 1884075 108051 0 4569799 1183030 4646 14888094 390345 12476225 14497749 174513 0 17220537 15685425 1386203 404430 500000 15763691 16397228 17149894 17301658 X 70643 -1616233 70643 -1616233 17220537 15685425 -1686876 0 X X 0 1 X 1 0 X X 1 LA CLINICA TEPEYAC 841285505 7 1 1884075 0 1 1884075 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 0 SCHEDULE A, PAGE 5, SECTION D, LINE 3 THIS CORPORATION IS PARTICULARLY FOR THE PURPOSES OF (I) OWNING AND DEVELOPING THE BUILDINGS, GROUNDS, AND RELATED PROPERTY COMPRISING AN APPROXIMATELY 28,800 SQUARE FOOT FACILITY GENERALLY KNOWN AS "CLINICA TEPEYAC" LOCATED AT 2101 E. 48TH AVENUE, DENVER, COLORADO 80216 AND 2111 E. 48TH AVENUE, DENVER, COLORADO 80216 (THE "CLINICA TEPEYAC BUILDING"), AND (II) LEASING THE CLINICA TEPEYAC BUILDING TO LA CLINICA TEPEYAC, INC., A COLORADO NONPROFIT CORPORATION ("CLINICA TEPEYAC"), SO THAT CLINICA TEPEYAC MAY PROVIDE QUALITY HEALTH SERVICES TO THOSE IN NEED, INCLUDING INDIVIDUALS WHO NEED HEALTH SERVICES IN A BI-LINGUAL (ENGLISH/SPANISH) ENVIRONMENT OR IN OTHER LANGUAGES AS CLINICA TEPEYAC IS CAPABLE OF PROVIDING. SCHEDULE A, PAGE 5, SECTION E, LINE 2A LA CLINICA TEPEYAC IS THE SOLE SUPPORTED ORGANIZATION. TEPEYAC QALICB EXISTS TO SUPPORT THE DEVELOPMENT OF LA CLINICA TEPEYAC BUILDING, GROUNDS AND RELATED PROPERTY. THE EXPENDITURES OF TEPEYAC QALICB SUPPORT THE CONSTRUCTION OF LA CLINICA TEPEYAC BUILDING, GROUNDS AND RELATED PROPERTY. 13605275 283443 13321832 1282819 106902 1175917 14497749 X 10680887 10375637 10375637 305250 0 305250 10647744 9675841 9675841 971903 1020223 1020223 1992126 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 ORGANIZATIONS CONSOLIDATED 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: CONSOLIDATED REVENUE FOR LA CLINICA TEPEYAC 10,625,728. ELIMINATION ON FINANCIAL STATEMENT -250,091. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED EXPENSES FOR LA CLINICA TEPEYAC 9,970,445. ELIMINATION ON FINANCIAL STATEMENT -294,604. PART XII, LINE 4B - OTHER ADJUSTMENTS: EQUITY TRANSFER TO LA CLINICA TEPEYAC 1,020,223. 1 LA CLINICA TEPEYAC 4725 HIGH STREET DENVER CO 80216 841285505 501(C)(3) 1020223 0 N/A N/A EQUITY TRANSFER 1 0 PART I, LINE 2: LA CLINICA TEPEYAC IS A RELATED CONTROLLED ORGANIZATION AND PROVIDES FINANCIAL REPORTS TO TEPEYAC QALICB. THE CEO OF TEPEYAC QALICB IS ALSO ON THE BOARD OF LA CLINICA TEPEYAC. EQUITY TRANSFER BETWEEN RELATED ORGANIZATIONS AND DOESN'T REQUIRE GRANT TRACKING. 0 0 0 0 0 0 0 0 0 JIM GARCIA PRESIDENT 0 171035 0 0 0 0 0 5826 0 4912 0 181773 0 0 PART I, LINE 3 THE PRESIDENT OF TEPEYAC, QALICB, INC IS COMPENSATED THROUGH LA CLINICA TEPEYAC, A RELATED ORGANIZATION. THE METHODS USED TO DETERMINE THE PRESIDENT'S COMPENSATION ARE (A) INDEPENDENT COMPENSATION CONSULTANT, (B) FORM 990 OF OTHER ORGANIZATIONS, (C) COMPENSATION SURVERY OR STUDY, AND (D) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 8B THERE WAS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON INFORMATION PREPARED BY MANAGEMENT. THE FORM 990 IS THEN REVIEWED BY THE BOARD PRESIDENT OF TEPEYAC, QALICB AND THE CFO OF LA CLINICA TEPEYAC, AND THEN PROVIDED TO THE ENTIRE BOARD OF TEPEYAC, QALICB BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, EACH BOARD MEMBER COMPLETES A CONFLICT OF INTEREST DISCLOSURE. IF A POTENTIAL CONFLICT OF INTEREST ARISES WITH A BOARD MEMBER THE INDIVIDUAL PROVIDES WRITTEN NOTICE OF THE POTENTIAL CONFLICT OF INTEREST TO THE BOARD OF DIRECTORS AND REFRAINS FROM PARTICIPATION IN ANY DISCUSSION OR VOTING ON ANY MATTERS PERTAINING TO THE CONFLICT OF INTEREST. THE DELIBERATION AND DOCUMENTATION OF EVENTS CAN BE FOUND IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSEEING AND SELECTING AN INDEPENDENT ACCOUNTANT IS IN LINE WITH THE ORGANIZATION'S SUPPORTING ORGANIZATION, LA CLINICA TEPEYA. LA CLINICA TEPEYAC 4725 HIGH STREET DENVER CO 80216 841285505 HEALTHCARE PROVIDER CO 501(C)(3) LINE 7 N/A 0 0 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0