2025-11-10T20:17:33-06:00 2024-12-31 990PF 2024-01-01 841197083 COPIC MEDICAL FOUNDATION COPI 7208586000 7351 E LOWRY BLVD STE 400 DENVER CO 80230 SHANE SCHATTINGER ACCOUNTING MANAGER 7208586000 2025-11-07 0 2024 2025-03-06 01:10:19Z X 22546573 X 350474 11653 11653 385986 385986 278105 607233 278105 1026218 675744 0 0 0 0 0 10000 0 0 0 206606 0 0 209262 216606 0 0 209262 456568 456568 673174 0 0 665830 353044 675744 0 180554 373662 373662 35400 37220 37220 485 340 485 485 14241596 15255628 15255628 794576 936968 936968 7171352 5942610 5942610 22423818 22546573 22546573 18713 16058 7171352 5942610 7190065 5958668 X 15233753 16587905 15233753 16587905 22423818 22546573 15233753 353044 1001108 16587905 0 16587905 COMMON STOCK. NVIDIA ORD, 111 SHS D 107233 98457 8776 8776 BLACKROCK: IS TUS SM INST, 21240 SHS P 500000 230671 269329 269329 278105 0 9393 0 9393 0 9393 10000 0 0 0 10000 0 607 0 607 0 0 0 0 0 0 0 0 0 0 1 1 CO 1 0 0 0 0 1 WWW.COPIC.COM SHANE SCHATTINGER 7208586000 7351 E LOWRY BLVD STE 400 DENVER CO 802306902 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 BEVERLY RAZON 2959 S PONTIAC ST DENVER CO 80224 SECRETARY 0.50 0 0 0 SHELYCE FOSTER 9237 WOLFDALE DR LONE TREE CO 80124 TREASURER 0.50 0 0 0 SOPHIA G MEHARENA DO 16123 E CRESTLINE PLACE CENTENNIAL CO 80015 DIRECTOR 0.50 0 0 0 HARRIS A FRANKEL MD 1515 S 79TH STREET OMAHA NE 68124 DIRECTOR 0.50 0 0 0 ALAN Y SYNN MD 1302 SOUTH UINTA CT DENVER CO 80231 DIRECTOR 0.50 0 0 0 REBECCA S VOGEL MD 7 REDHAWK RUN ENGLEWOOD CO 80113 DIRECTOR 0.50 0 0 0 ROMANA HASNAIN-WYNIA PHD 777 BANNOCK ST DENVER CO 80204 DIRECTOR 0.50 0 0 0 KELLY JOINES 3331 QUITMAN ST DENVER CO 80212 DIRECTOR 0.50 0 0 0 MEREDITH HINTZE 2704 LIMA ST DENVER CO 80238 DIRECTOR, FOUNDATION 25.00 75000 20000 0 0 NONE 0 0 15632959 7079652 0 22712611 0 0 22712611 7154592 15558019 777901 777901 9393 9393 768508 0 768508 0 768508 665830 0 665830 768508 0 0 248991 223287 161120 633398 665830 0 0 0 665830 0 102678 102678 530720 0 0 0 0 0 0 146313 384407 223287 161120 MEREDITH HINTZE 7351 E LOWRY BLVD STE 400 DENVER CO 80230 7208586000 COMPLETED APPLICATION; COPY OF 501(C)(3) LETTER, TOTAL PROJECT COST AND AMOUNT OF REQUEST TO BE CONSIDERED, MOST RECENT FINANCIAL STATEMENTS AND CURRENT AUDIT REPORT. NONE CHARITABLE EDUCATION, CIVIC AND SCIENTIFIC PURPOSES RELATED TO MEDICINE, MEDICAL EDUCATION, MEDICAL RESEARCH AND OTHER MEDICAL CHARITABLE PURPOSES. ST ELIZABETH MEDICAL CENTER 1 MEDICAL VILLAGE DRIVE EDGEWOOD KY 41017 PUBLIC FOR GENERAL PROGRAM SUPPORT 174568 VISITING NURSE ASSOCIATION OF THE MIDLAND 12565 W CENTER RF STE 100 OMAHA NE 68144 PUBLIC FOR GENERAL PROGRAM SUPPORT 157000 DANE COUNTY MULTI-AGENCY CENTER ONE EAST MAIN STREET STE 500 MADISON WI 53703 PUBLIC FOR GENERAL PROGRAM SUPPORT 125000 456568 0 14 11653 14 385986 18 278105 0 675744 0 675744 0 0 0 0 0 0 0 0 0 0 X X 1 COPIC INSURANCE COMPANY 7351 E LOWRY BLVD STE 400 DENVER CO 80230 347974 X 2 HAROLD R ROTH 4933 S FRANKLIN ST ENGLEWOOD CO 80113 2000 X 3 THEODORE J CLARK 25149 US HIGHWAY 40 GOLDEN CO 80401 500 X THE COPIC MEDICAL FOUNDATION HAS AGREED TO BE THE ADMINISTERING ENTITY OF THEPHYSICIANS' PEER HEALTH ASSISTANCE FUND ('THE FUND") AND HAS ENTERED INTO ACONTRACT WITH THE STATE OF COLORADO, DEPARTMENT OF REGULATORY AGENCIES,COLORADO MEDICAL BOARD ("CMB"). THE CONTRACT RELATES TO THE COLLECTION ANDDISBURSEMENT OF FUNDS PAID BY COLORADO PHYSICIANS AND PHYSICIAN ASSISTANTS ASPART OF THEIR BIENNIAL LICENSE RENEWAL.THE CONTRACT WITH CMB, WHICH EXPIRES ON SEPTEMBER 30, 2029 BUT CANBE TERMINATED BY EITHER PARTY ON 30 DAYS NOTICE, STIPULATES:1. THE FOUNDATION WILL COLLECT THE PAYMENTS AND MAINTAIN A SEPARATEBANK ACCOUNT.2. THE FOUNDATION WILL VERIFY TO CMB THE NAMES OF ALL PHYSICIAN ANDPHYSICIAN ASSISTANT APPLICANTS WHO HAVE PAID THE FEE.3. THE FOUNDATION WILL DISTRIBUTE THE FUNDS AS DIRECTED BY CMB TO THEAPPROVED DESIGNATED PROVIDER (CURRENTLY COLORADO PHYSICIAN HEALTH PROGRAM, ASEPARATE NONPROFIT CORPORATION).(SEE ATTACHED STATEMENT FOR CONTINUATION) FORM 990-PF CASH DEEMED CHARITABLE EXPLANATION STATEMENT STATEMENT 6 (CONTINUATION OF STATEMENT 8)4. THE FOUNDATION WILL PROVIDE AN ANNUAL ACCOUNTING TO CMB OF ALL AMOUNTS COLLECTED, EXPENSES INCURRED, AND AMOUNTS DISTRIBUTED. WE BELIEVE THAT THE PAYMENTS RECEIVED BY THE FOUNDATION ARE NOT "CONTRIBUTIONS AND THE PAYMENTS BY THE FOUNDATION TO CPHP ARE NOT"GRANTS PAID". THE PAYMENTS RECEIVED BY THE FOUNDATION ARE A PORTION OF THE LICENSE RENEWAL FEE PAID BY PHYSICIANS/PHYSICIAN ASSISTANTS AND ARE NOT VOLUNTARY, WHICH MEANS THEY ARE NOT CONTRIBUTIONS. THE PAYMENTS MADE BY THE FOUNDATION TO CPHP ARE NOT GRANT PAYMENTS-RATHER, THEY ARE TO REIMBURSE CPHP FOR SERVICES PERFORMED BY CPHP.IRS REGULATIONS ALLOW CERTAIN ASSETS TO BE EXCLUDED FROM THE CALCULATION, BUT THE PEER ASSISTANCE FUNDS DO NOT MEET ANY OF THE SPECIFIC EXCEPTIONS OUTLINED IN THE REGULATIONS (REG. 53.4942(A)-2(C)(2)). THE INSTRUCTIONS TO FORM 990-PF SPECIFICALLY STATE THAT "ASSETS THAT ARE HELD FOR THE PRODUCTION OF INCOME OR FOR INVESTMENT ARE NOT CONSIDERED TO BE USED DIRECTLY FOR CHARITABLE FUNCTIONS EVEN THOUGH THE INCOME FROM THE ASSETS IS USED FOR THE CHARITABLE FUNCTIONS". ACCORDINGLY, IT APPEARS THAT THE PEER ASSISTANCE FUNDS HELD BY THE FOUNDATION MEET THIS DEFINITION AND SHOULD BE INCLUDED ON PART X, LINE 1B. HOWEVER, A DEDUCTION IS ALLOWED ON LINE 4 FOR "CASH DEEMED HELD FOR CHARITABLE ACTIVITIES". THOUGH THIS IS USUALLY AN AUTOMATIC 1.5% OF THE AVERAGE FAIR VALUE, A FOUNDATION IS ALLOWED TO DEDUCT MORE "IF UNDER THE FACTS AND CIRCUMSTANCES AN AMOUNT LARGER THAN THE DEEMED AMOUNT IS NECESSARY TO PAY EXPENSES AND DISBURSEMENTS". WE BELIEVE IT IS APPROPRIATE TO DEDUCT THE FULL AMOUNT OF PEER ASSISTANCE FUNDS ON THIS LINE, PLUS THE USUAL 1.5%, BECAUSE CMB CAN INSTRUCT THE FOUNDATION TO DISBURSE THE REMAINING FUNDS AT ANY TIME. BLACKROCK: IS TUS SM INST 6120774 6120774 VANGUARD TOT I S ADM 5198013 5198013 VANGUARD TOT BD ADM 3936841 3936841 BOOMTOWN FMV 936968 936968 ADMIN. OF STATE REG. PROGRAM 7171352 5942610 5942610 PUBLIC RELATIONS 8020 0 0 3597 ADMINISTRATIVE FEES 143535 0 0 150614 OFFICE SUPPLIES 13 0 0 13 INSURANCE EXPENSE 2346 0 0 2346 TRAVEL 18631 0 0 18631 BUSINESS MEALS & ENTERTAINMENT 28108 0 0 28108 DUES 4904 0 0 4904 FILING FEES 49 0 0 49 FEDERAL TAX PREP 1000 0 0 1000 UNREALIZED GAINS/(LOSSES) - INVESTMENTS 1001108 7171352 5942610 TAXES 10000 0 0 0