2024-05-09T07:47:40-05:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-01-11 921690774 AXIS HEALTH SYSTEM QALICB INC AXIS 9703352222 150 MERCURY VILLAGE DRIVE DURANGO CO 81301 RYAN PIERCE VP OF FINANCE 9703352222 2024-05-08 1 RYAN PIERCE 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2024-05-08 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z X X RYAN PIERCE 150 MERCURY VILLAGE DRIVE DURANGO CO 81301 0 0 X N/A X 2023 CO AXIS HEALTH SYSTEM QALICB, INC. (QALICB), IS A SUPPORTING ORGANIZATION OF SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC., A COLORADO NONPROFIT CORPORATION, DBA AXIS HEALTH SYSTEM (AXIS). QALICB WAS FORMED SOLELY AND EXCLUSIVELY TO SUPPORT AXIS IN SECURING FUNDING FROM THE FEDERAL NEW MARKETS TAX CREDIT PROGRAM TO FINANCE THE ACQUISITION OF A NEW FACILITY IN DURANGO, CO. 4 3 0 4 0 0 0 0 0 0 0 0 0 0 0 0 45174 45174 -45174 29206250 27240613 1965637 TO BE A SUPPORTING ORGANIZATION OF SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC., A COLORADO NONPROFIT CORPORATION, DBA AXIS HEALTH SYSTEM. 0 0 45174 TO SUPPORT AXIS HEALTH SYSTEM IN SECURING FUNDING FROM THE FEDERAL NEW MARKETS TAX CREDIT PROGRAM TO FINANCE THE ACQUISITION OF A NEW FACILITY IN DURANGO, CO. 45174 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 3 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X THE ORGANIZATION 9703352222 150 MERCURY VILLAGE DRIVE DURANGO CO 81301 ALEX CONRAD BOARD CHAIR 1.00 40.00 X X 0 164761 40414 DOYLE FORRESTAL SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 SHAK POWERS DIRECTOR 1.00 0.00 X 0 0 0 ARNOLD SALAZAR DIRECTOR 1.00 0.00 X 0 0 0 RYAN PIERCE VP OF FINANCE 1.00 40.00 X 0 105540 26166 0 270301 66580 0 0 1 0 0 0 0 0 0 9013 9013 36161 36161 45174 45174 0 0 69188 10592570 18544492 0 0 18544492 0 29206250 4585 27162410 0 73618 0 27240613 X 1965637 0 0 1965637 0 29206250 X -45174 2010811 X X 0 1 X 1 0 X X 1 AXIS HEALTH SYSTEM 840506701 10 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A, PART IV, SECTION B, QUESTION 1: AXIS HEALTH SYSTEM, THE SUPPORTED ORGANIZATION, HAS THE AUTHORITY TO SELECT ONE OF THE MEMBERS OF THE BOARD. THE QALICB BOARD CHAIR IS THE CFO OF AXIS HEALTH SYSTEM. QALICB HAS ALSO DELEGATED MANAGEMENT DUTIES TO THE AXIS HEALTH SYSTEM, THE SUPPORTED ORGANIZATION. 753770 753770 17790722 17790722 18544492 RELATED PARTY PAYABLE 73618 73618 X PART X, LINE 2: THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2023, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 0 1 0 0 0 0 0 0 0 ALEX CONRAD BOARD CHAIR 0 164625 0 0 0 136 0 10055 0 30359 0 205175 0 0 PART I, LINE 3 THE COMPENSATION PAID TO THE BOARD CHAIR IS PAID BY AXIS HEALTH SYSTEM, THE SUPPORTED ORGANIZATION, FOR HIS SERVICES AS CFO OF AXIS HEALTH SYSTEM. AXIS HEALTH SYSTEM USES THE FOLLOWING TO DETERMINE COMPENSATION FOR ITS OFFICERS: 1) COMPENSATION COMMITTEE, 2) COMPENSATION STUDY/SURVEY, AND 3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B AXIS HEALTH SYSTEM'S OFFICERS PARTICIPATE IN A DEFERRED COMPENSATION PLAN UNDER THE PROVISIONS OF CODE SECTION 457(F). THE PLAN RUNS ON A THREE YEAR CYCLE. DURING THE FISCAL YEAR ENDED JUNE 30, 2023, AXIS HEALTH SYSTEM CONTRIBUTED $5,000 TO ALEX CONRAD. NO PLAN FUNDS WERE PAID OUT DURING THE FISCAL YEAR ENDED JUNE 30, 2023. FORM 990, PART VI, SECTION A, LINE 3 AXIS HEALTH SYSTEM QALICB, INC. HAS CONTRACTED WITH AXIS HEALTH SYSTEM FOR KEY MANAGEMENT DUTIES. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CEO AND VP OF FINANCE FOR AXIS HEALTH SYSTEM AND A COMPLETED DRAFT IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND OFFICERS ARE COVERED BY THE POLICY. DETERMINATIONS ARE MADE AT THE BOARD LEVEL WITH THE ASSISTANCE OF GENERAL COUNSEL. ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD. IF A CONFLICT IS FOUND IT WILL BE CURED BY RECUSAL. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S BOARD CHAIR IS COMPENSATED BY AXIS HEALTH SYSTEM, THE SUPPORTED ORGANIZATION. AXIS HEALTH SYSTEM'S COMPENSATION POLICY IS AS FOLLOWS: COMPENSATION FOR ALL JOB CLASSIFICATIONS, INCLUDING EXECUTIVE MANAGEMENT, IS REVIEWED PERIODICALLY USING INDEPENDENT RESOURCES. COMPENSATION INFORMATION IS ALSO OBTAINED FROM ALL COMMUNITY MENTAL HEALTH CENTERS AND FQHCS IN THE STATE TO ENSURE A VALID ASSESSMENT IS MADE. IN ADDITION, THE CEO COMPENSATION IS SUBJECT TO ADDITIONAL ANNUAL REVIEW BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFER 2,010,811. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF AXIS HEALTH SYSTEM, THE SUPPORTED ORGANIZATION, ASSUMES THE RESPONSIBILTY FOR SELECTING THE INDEPENDENT AUDITORS. THEY ARE ALSO RESPONSIBLE FOR ENSURING THE AUDIT IS COMPLETE. AXIS HEALTH SYSTEM'S BOARD DIRECTS THE CEO TO ENSURE TIMELY COMPLETION OF THE FINANCIAL STATEMENTS FOR REGULAR BOARD REVIEW AND THE PERFORMANCE OF THE ANNUAL AUDIT OF ITS FINANCIAL STATEMENTS. AXIS HEALTH SYSTEM'S CEO DIRECTS/DELEGATES THIS FUNCTION TO THE CFO. AXIS HEALTH SYSTEM 150 MERCURY VILLAGE DRIVE DURANGO CO 81301 840506701 MENTAL HEALTH CARE CO 501(C)(3) LINE 10 N/A 0 UNCOMPAHGRE MENTAL HEALTH SERVICES INC 150 MERCURY VILLAGE DRIVE DURANGO CO 81301 840850552 REAL ESTATE CO 501(C)(2) AXIS HEALTH SYSTEM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1