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2014 ANNUAL REPORT

The mission of Summit Community Care Clinic is to provide exceptional, integrated, patient-centered health care services designed to meet the needs of people who experience barriers to accessing care, regardless of their ability to pay.“The Care Clinic provides an invaluable service to the community of Summit County and its neighboringcommunities. I love the progressive nature of their approach and the fact that they treat the whole person.The impacts they have on their patients are not short term. They are changing the lives of our residents notonly in an emergency, but for the long term. We all benefit because of the Care Clinic.” – Rob Millisor Developer, Breckenridge Grand Vacations

Dear Friends, 2014 has been a year of tremendous change and growth for the Summit Community Care Clinic. We continue to provide integrated primary care, dental, and behavioral health services at the main office located in the Medical Office Building and at four school-based health centers strategically located atWilson Strong, MD four different schools in the County. Visit and patient counts Sarah Vaine, M.A., L.P.C.Board Chairman continue to grow, partially due to the closure of four safety net Chief Executive Officer clinics in our neighboring communities in 2014. Most recentdata indicates that almost 25% of patients at the Care Clinic come from communities outside of SummitCounty. This is an increase over last year of 5%. The Care Clinic has stepped up and responded to theincreased need despite significant financial challenges and critical changes to infrastructure.This past year brought greater focus on improving financial management and clinical quality assuranceefforts for the organization. With funding from the Office of Rural Health Policy, the Care Clinic added aQuality Assurance Manager and Data Coordinator to maximize clinical quality improvement and complianceinitiatives. In April, Tommy Barnhart was hired as our first ever Chief Financial Officer. Mr. Barnhart bringsover 30 years of finance and health care experience to the Care Clinic. His expertise on our team comesat a critical time, as financial operations and internal controls have increased in terms of complexity andcompliance requirements. Having closed out the most challenging fiscal year in our history, we are alreadyseeing the benefits of his wisdom and experience.Despite many challenges, 2014 resulted in increased access to care improved health outcomes for patients,and stronger internal controls and financial management for the Care Clinic. All these positive steps wouldnot be possible without the dedication and hard work of the staff and volunteers, or the generosity of theindividual donors, foundations, organizations, and businesses that support us. We thank you all for makingit possible to pursue our mission of providing exceptional, integrated, patient-centered health care servicesdesigned to meet the needs of those who experience barriers to accessing care, regardless of a patient’sability to pay. We believe the future of the organization is bright because of your support!Sincerely,Wilson Strong, MD Sarah Vaine, M.A., L.P.C.Board Chariman Chief Executive Officer page one

CREATING HEALTHY LIVES: THEN, NOW, AND FOR THE FUTURELeadership TeamSarah Vaine, M.A. Tommy Barnhart, F.H.F.M.A. Dr. Christine Hoppe, M.D. Dr. Dan Young, DMD Helen Royal, M.A.Chief Executive Officer Dental Director Behavioral Health Chief Financial Officer Chief Medical Officer DirectorBoard of Directors Brian Duchinsky, Board Member Maureen Westerland, Board Member Retired Marketing Director Retired Professional FundraiserWilson Strong, MD, PresidentRetired Physician Gaston Feuereisen, Board Member Ed Casias, Advisory Board Member Health Care Navigator JudgeDon Parsons, MD, Vice PresidentRetired Physician Margery Gavenda, Board Member Marsha Cooper, Advisory Board Member Retired Banking Professional Retired School AdministratorKyle Richardson, TreasurerSenior Vice President, First Bank Aleda Kresge, Board Member Harold Dobbs, MD, Advisory Board Member Certified Financial Planner Retired PhysicianPat Kopystianskyj, SecretaryRetired Chief Nursing Officer Margery Langmuir, Board Member Mitzie Hawkins, Advisory Board Member Retired, Community Member Retired TeacherKaryn Blanco, Board MemberBusiness Owner Larry Lunceford, Board Member Business OwnerCathy Cheroutes, Board MemberAttorney Tom Marmins, Board Member Retired Community MemberDana Cottrell, Board MemberReal Estate Agent Robin Robson, Board Member Certified Financial PlannerDeb Crook, Board MemberRetired Public Health Director page two

WHAT WE DOSummit Community Care Clinic provides the following services to medically underservedindividuals and families in the central Rocky Mountain region:Access to Care • Primary health care in the form of same day and scheduled appointments • Oral health maintenance and treatment • Behavioral health services • Universal drug and alcohol screenings and substance abuse treatment • Prenatal and postnatal care • Reproductive health and family planning services • Comprehensive immunization services • School based health services including primary care, behavioral health and oral health servicesHealth Education and Prevention • Personalized health coaching • Chronic disease management • Exercise and nutrition education • Referrals to physical therapy • Community health screening eventsCommunity Resources • Navigation for follow-up medical services and specialist appointments • Referrals to community support services such as emergency housing and food assistance • Education on insurance enrollment optionsPatient StoryA 52-year-old female patient came to the Care Clinic for a women’s wellness exam. It was discovered that she was uninsuredand previously had very little access to medical care. After meeting with one of the Care Clinic providers, she was encouragedto seek insurance and was able to qualify. The patient was able to then begin accessing care and making health decisionsthat previously she had avoided. She worked with a health educator to quit smoking and got her first mammogram andcolonoscopy through the Care Clinic. She began taking proactive steps to care for her health for the first time in her life andnow feels empowered to make better lifestyle decisions in the future. – Mid Level Providerpage three

Recent Accomplishments• Improved Payer Mix – Over the course of 2014, the Care Clinic worked aggressively toimprove and diversify its payer mix to increase sustainability and decrease reliance onoutside funding sources. Through enhanced outreach efforts to enroll patients in pubic and privateinsurance and improved billing and collection procedures, patient services generated 26% ofthe Care Clinic’s revenues ($1,047,795) in 2014. This represents a 21% increase from just threeyears ago. (See the payer mix chart on page eleven.)• Pursuit of the Federally Qualified Health Center Designation – The Care Clinic is a Fed-erally Qualified Health Center (FQHC) Look-Alike facility but is working toward full FQHCdesignation to access increased benefits for improved client service. During a two-day site visitin May, the Health Resources and Services Administration (HRSA) reviewed every aspect of theCare Clinic’s administration and operation, and in early October the Care Clinic submitted itsFQHC application. The Care Clinic will learn about a potential FQHC designation in May.• Increased Donor Giving – Between 2013 and 2014, the Care Clinic increased individual giftsby 22%, resulting in a $65,000 increase in annual giving. Every gift, no matter what size, makesan impact for the Care Clinic and demonstrates a high level of community support. In additionto increased annual giving, the Care Clinic also received a special series of large donations in2014. The special large gifts were initiated by an offer from an anonymous donor to match dollarfor dollar up to three individual gifts of $50,000. Three major supporters took the challenge,resulting in a combined $300,000 gift for the Care Clinic. The major supportors were Rob and AmyMillisor, Mike Millisor and Mary Jo Sokolowski, and Rick and Susie Grossman.page four

Recent Accomplishments• Patient Portal – In April, the Care Clinic launched its patient portal, providing patients theability to access health information via a secure web-based system. Patients can requestpersription refills, receive lab results, and ask questions of their primary care provider via thisservice. A Portal Enrollment Specialist, hired over the summer, is available in the Care Clinic waitingroom to help facilitate patient enrollment in the system. Since starting the program in August, theSpecialist has enrolled 841 patients in the portal. The Care Clinic hopes to have at least 50% ofpatients at the Care Clinic enrolled in the portal by the end of the next fiscal year.• Expanded Quality Assurance Efforts – In October, 2013, the Care Clinic was awarded agrant through the Office of Rural Health Policy to hire a Quality Assurance Manager and DataCoordinator. The Quality Assurance Manager works with teams throughout the Care Clinic toanalyze operations from a systems level, identify areas for improvement, and test possiblesolutions. This process has led to a new culture of data-driven decision making by CareClinic management. Examples of projects that have been completed this year include improvedpatient access to appointments, improved patient experience and Care Clinic customer service,increase in Hypertensive patients who have their blood pressure in control, and advancements inthe eligibility and registration process.page five

Model for Improvement in ActionIn 2014, staff teams completed 15 PlanDo Study Act (PDSA) cycles as part of theCare Clinic’s expanded focus on qualityassurance. PDSA cycles are a way to testand evaluate changes to see if the changehas the desired outcome. Provided belowis a brief description of a PDSA cycle andits results.Improving the Care Card Eligibility ProcessThe Problem Patients were experiencing delays in renewing their Care Cards due to reducedThe Goal availability of eligibility staff. Patients are required to have a Care Card to receivePlan & Predict discounted rates for service. The goal is to make it easier for patients to renew their Care Card by allowing them to drop off required paperwork for renewal at the front desk and not requiring face- to-face eligibility appointments. Eligibility and front desk staff will be able to input eligibility data during slow times and issue more Care Cards without face-to-face meetings with patients.Do Phase Staff implemented the drop-off model for one month. A total of 67 patients re-Study Phase ceived renewed Care Cards without appointments. There was no delay for newAct Phase patients in scheduling eligibility appointments. Studying the results, staff found that the drop-off renewal system saved staff time and provided patients with Care Cards in a more timely fashion. Staff was able to do the same amount of work with one eligibility specialist rather than two. The new system is being implemented for the 2015 calendar year. page six

2014 Accomplishments by the Numbers Unduplicated Patient NumbersPatient Visits per Disciplinepage seven

Our Patients Where SCCC Patients LivePatients by % of Poverty LevelPoverty Levels for a Family of Four 2015 Projected Payer MixUnder 100% - less than $24,250101% to 150%- $24,251-$36,375151% to 200%- $36,376-$48,500201% to 250%- $48,501-$60,625 2014 Payer Mixpage eight

Impact of Care Clinic Services on Patient Health OutcomesThe Care Clinic monitors a total of 21 Clinical and Financial Quality Measures as required by Federal HealthCenter guidelines and as part of the facility’s overall Quality Assurance program. Provided below are examplesof measures in which the Care Clinic exceeded national benchmarks.Prenatal Care:Proportion of prenatal care patients whoentered treatment during their first trimester.Description: In 2012, the Care Clinic notedthat low numbers of patients were accessingfirst trimester prenatal care. Given the correlationbetween early prenatal care and favorablepregnancy outcomes, the Care Clinic madeimprovement in this area a high priority. In 2013,it began offering prenatal care on-site instead of by referral. In 2014, the Care Clinic offered more tracking, outreachand follow up for each woman with a positive pregnancy test. All of these efforts have enabled an increase in thenumbers of women receiving timely prenatal care, resulting in positive health outcomes for the mother and the baby.Asthma:Percentage of patients aged 5 through 40with a diagnosis of mild, moderate or severepersistent asthma who received or wereprescribed accepted pharmacologic therapy.Description: In 2014, the Care Clinic utilizedits Electronic Health Record system to identifypatients with subtypes of asthma that put themat higher risk for asthma exacerbations. Using thatdata, medical providers were able to determine ifthose patients had active prescriptions for the appropriate medication(s) to keep their asthma well controlled.Care Clinic staff are now able to follow up when patients are due for care and when their prescriptions expire.Diabetes:Proportion of adult patients with Type I or IIdiabetes, whose hemoglobin A1c was lessthan or equal to 9% at the time of the lastreading in the measurement year.Description: The Care Clinic continues to supportoptimal diabetes management for all its patients.In 2014, the Clinic offered diabetes managementsupport groups for both Spanish and Englishspeaking patients. These groups are an importanteducational forum and allow patients to connect with and learn from other patients and their families. The Care Clinic’sElectronic Health Record allows staff to identify and reach out to patients who are overdue for routine diabetes care.The heath coaching program is heavily utilized with diabetic patients. Health coaches provide follow up phone visitsto address patient questions and concerns.page nine

FINANCIALS - Balance Sheet Fiscal Year 2014 Compared to Fiscal Year 2013 (Year Ending July 1, 2013 to June 30, 2014)ASSETS 2014 2013 Operating cash and investments Patient accounts receivable 10,610 338,099 Other current assets 200,311 158,506 Equipment and other assets 145,158 167,197 Endowment fund 104,137 162,253 661,253 552,564 Total assets 1,121,469 1,378,619LIABILITIES 431,085 173,512 Current liabilities 1,205,107NET ASSETS 690,384 1,378,619 Total liabilities and net assets 1,121,469 2,986,724STATEMENT OF ACTIVITIES FOR THE YEARS 908,523ENDED JUNE 30, 2014 and 2013 364,250 70,842REVENUES 2,537,039 69,951 Contributions and grants 1,047,795 Patient services 4,400,290 Contributed services and property 195,800 Investment income 83,301 2,749,933 Other income 208,305 364,250 4,072,240 108,240EXPENSES 336,816 Salaries and benefits 3,051,417 84,474 Contributed services and property 195,800 537,460 Contract services 234,782 Program supplies 342,846 4,181,173 Depreciation 70,927 219,117 Other expenses 691,191 Change in net assets 4,586,963 (514,723) page ten

FINANCIALS - Income and ExpensesIncome Expenses ONGOING NEEDSDespite significant progress towards clinical and financial goals in 2014, challenges persist in Summit CommunityCare Clinic’s efforts to provide affordable health care to residents of Summit County and the surrounding mountaincommunities. While growing numbers of residents are enrolling in Medicaid or purchasing plans through Connect forHealth Colorado, many local residents remain uninsured. In 2014, approximately 80% of Care Clinic patients were stillwithout health insurance.The Care Clinic is committed to providing high quality care to all residents regardless of insurance or income status. Patientcentered care is the highest priority for the Care Clinic and requires substantial outside funding streams in order to remainsustainable. While the payer mix slowly shifts over time to include more insured patients, the Care Clinic must currentlyrely on private donations and grants to make up a significant portion of the annual budget. As the changing landscape ofhealth care continues to evolve, the need for support from residents, businesses, government and foundations remains avital component to the Care Clinic’s future success. page eleven

SUPPORTING THE SUMMIT COMMUNITY CARE CLINICHow to HelpThere are many ways you can support the work of the Summit Community Care Clinic:Make a donation: • A $100 donation pays for two dental screenings and cleanings for one child • A $600 donation pays for five sessions of behavioral therapy • A $1,200 donation pays for a diabetic education and treatment program for an adult patient for one yearTo Donate: Go to our website www.summitclinic.org and follow the ‘donate now’ button or through mail:P.O. Box 4337, Frisco, CO 80443 (Checks payable to SCCC)Be an ambassador: Tell your friends and family about the work of the Care Clinic, and make sure youruninsured friends are enrolled for Care Clinic services.Volunteer: Call Jordan Schultz 970.423.8839Provide in-kind services:DONATE By mail: P.O. Box 4337, Frisco, CO 80443 (Checks payable to SCCC) NOW By Internet: www.summitclinic.org By phone: 970.423.8839, please ask for Jordan Schultz page twelve

Major Partners Neils Lunceford Park County School District Arapahoe Basin Peak One Pain and Spine All Smiles Dental Peak One Surgery Center Avalanche Physical Therapy Rocky Mountain Rural Health Axis Physical Therapy St. Anthony’s Summit Medical Center Boatyard American Grille Summit County Government Breckenridge Grand Vacations Summit County Head Start Caring for Colorado Foundation Summit County Public Health Clinic Net Summit County Rotary Colorado Association of School Based Health Centers Summit Dental Alliance Colorado Coalition for Medically Underserved Summit School District Colorado Community Health Network Swan Mountain Women’s Center Colorado Department of Public Health and Environment The Colorado Health Foundation Colorado Rural Health Network The Colorado Trust Copper Mountain The Summit Foundation Early Childhood Options Town of Breckenridge Ebert Children’s Clinic Town of Dillon Family and Intercultural Resource Center Town of Frisco First Bank of Colorado Town of Silverthorne Freeport McMoRan - Climax Molybdenum Vail Resorts Epic Promise Grand County Public Health Vail Summit Orthopedics Health Resources Services Adminstration Whole Foods Howard Head Sport Medicine Wilson Lass Brandon Lake County School District Mind Springs HealthLocation of Donor ListsThe Care Clinic greatly appreciates the individuals and organizations that contributefunds and services. A complete donor list can be found on the Care Clinic’s website at:www.summitclinic.org“When you look at what the Community Care Clinic has accomplished in the last ten years,you can’t help but be astounded...as the cost of health care in our country has skyrocketed,Summit Community Care Clinic has done SO much to counter that trend locally and give our working pop-ulation access to health care that they can afford. In the next five to 10 years, you’ll be even more amazedat how this nonprofit is not resting on its laurels; the Care Clinic is charging ahead in an incredibly dynamicenvironment to provide even better services in the future.” – Thomas Davidson Summit County Commissionerpage thirteen

The Summit Community Care Clinicis located on the first floor of the Medical Office Building. 360 Peak One Blvd., Suite 100 Frisco, Colorado 80443 970.668.4040 summitclinic.org Design & production: Wilson Lass Brandon wilsonlassbrandon.com Breckenridge, Colorado Photography by: Meredith Holt