2020-05-11T09:09:58-05:00 2019-06-30 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2018-07-01 800348943 POUDRE VALLEY MEDICAL GROUP LLC POUD 9702377000 2315 E HARMONY ROAD NO 200 FORT COLLINS CO 80528 STEVE SCHWARTZ CFO 9702377000 2020-05-05 1 DORI J EGGETT P00645252 3037409400 2020-05-05 73.229.126.131 2020-05-05 08:39:16 MD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 98F0443AB33D1E28F18E9C160D3887AD5153D212 2018 2020-09-23 17:36:50Z UCHEALTH MEDICAL GROUP DR MIKE RANDLE 2315 E HARMONY ROAD NO 200 FORT COLLINS CO 80528 481865221 0 X N/A X 2013 CO WE IMPROVE LIVES. IN BIG WAYS THROUGH LEARNING, HEALING AND DISCOVERY. IN SMALL, PERSONAL WAYS THROUGH HUMAN CONNECTION. BUT IN ALL WAYS, WE IMPROVE LIVES. 5 4 2949 5 0 0 97680190 108683182 308551632 373117654 51143 53217 0 0 406282965 481854053 1967734 2335262 0 0 372641515 438775384 0 0 0 125562297 145215724 500171546 586326370 -93888581 -104472317 42647031 59892582 336189201 457907069 -293542170 -398014487 WE IMPROVE LIVES. IN BIG WAYS THROUGH LEARNING, HEALING AND DISCOVERY. IN SMALL, PERSONAL WAYS THROUGH HUMAN CONNECTION. BUT IN ALL WAYS, WE IMPROVE LIVES. 0 0 511549033 2335262 373117654 UCHEALTH MEDICAL GROUP (UCHMG) OPERATES MORE THAN 250 CLINICS ACROSS COLORADO, NEBRASKA AND WYOMING. UCHMG PROVIDES A FULL CONTINUUM OF MEDICAL CARE THROUGH AN INTEGRATED, MULTI-SPECIALTY PHYSICIAN GROUP. IN FISICAL YEAR 2019, THE GROUP HAD 1,613,599 OUTPATIENT VISITS AND 184,440 URGENT CARE VISITS. AT YEAR-END, UCHMG WAS COMPRISED OF MORE THAN 486 EMPLOYED PHYSICIANS AND 250 ADVANCED PRACTICE PROVIDERS REPRESENTING 47 SPECIALTIES. 511549033 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 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 1 153 0 1 2949 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X STEVE SCHWARTZ 9702377000 2315 E HARMONY ROAD SUITE 200 FORT COLLINS CO 80528 X CHRIS OSBORN BOARD CHAIR 1.00 X 0 0 0 GENE RENUART BOARD MEMBER 1.00 X 0 0 0 DR WILLIAM NEFF BOARD MEMBER 1.00 X 0 0 0 DR TODD WHITSITT BOARD MEMBER/ PHYSICIAN 40.00 X 546805 0 41752 LAURIE STEELE BOARD MEMBER 1.00 X 0 0 0 DR MIKE RANDLE TERM BEGIN 11 PRESIDENT AND CEO 40.00 X 836133 0 98580 STEVE SCHWARTZ CFO 40.00 X 301932 0 42396 DONNA LANKFORD VP REGIONAL PRACTICE MGMT OPERATION 40.00 X 239175 0 35681 MARY YANTIS VP REGIONAL PRACTICE MGMT OPERATION 40.00 X 312075 0 42635 SCOTT HURLBERT VP CHIEF QUALITY OFFICER 40.00 X 210139 0 13569 DIANA BREYER VP CHIEF QUALITY OFFICER 40.00 X 190834 318399 39607 JENNY BAJAJ CHIEF MEDICAL OFFICER 40.00 X 362725 0 50198 TIMOTHY GRAMANN CHIEF OPERATING OFFICER 40.00 X 177531 0 26706 JOSHUA PETIT PHYSICIAN 40.00 X 1482921 0 48528 HANS COESTER MEDICAL DIRECTOR 40.00 X 1766776 0 45180 LARS WIDDEL PHYSICIAN 40.00 X 1439011 0 48671 MARK DOUTHIT PHYSICIAN 40.00 X 1225357 0 45927 MARK GUADAGNOLI PHYSICIAN 40.00 X 1148377 0 40079 DEBORAH CHANDLER TERM END 111 FORMER PRESIDENT AND CEO 0.00 X 324592 0 17105 10564383 318399 636614 732 1 1 0 WEATHERBY LOCUMS INC PO BOX 972633 DALLASS TX 75397 MEDICAL 2187798 ASPEN CREEK MEDICAL ASSOCIATES 9480 BRIAR VILLAGE POINT DR SUITE COLORADO SPRINGS CO 80920 MEDICAL 1928086 AMERICAN HEALTHCARE STAFFING PO BOX 1928 EDMOND OK 730831929 MEDICAL 1637641 STAFF CARE INC PO BOX 281923 ATLANTA GA 30384 MEDICAL 1374309 ONYX HEALTHCARE INC PO BOX 5935 TROY MI 48007 MEDICAL 1062294 29 108636182 47000 108683182 NET PATIENT SVC REV 621110 319989293 319989293 COST REIMBURSEMENT 621110 43809290 43809290 OTHER PROGRAM REVENUE 621110 9319071 9319071 373117654 64385 64385 11168 -11168 -11168 -11168 481854053 373117654 0 53217 2335262 2335262 3538399 788924 2749475 371625835 332259923 39365912 15827684 14151075 1676609 43196740 38620957 4575783 4586726 4100859 485867 1680 1680 47688 47688 21752 21752 29156928 13645409 15511519 3547169 3547169 2761896 2691930 69966 9942266 8419919 1522347 24477528 23929600 547928 1044895 829497 215398 7462622 6813369 649253 2898446 2898446 10540645 7492081 3048564 3989836 3775752 214084 MEDICAL SUPPLIES 35125324 35002458 122866 BAD DEBT 8435417 8435417 ALL OTHER EXPENSES 5183018 1246405 3936613 REPAIRS & MAINTENANCE 578614 562901 15713 586326370 511549033 74777337 0 31635 38450 24177455 29663256 601 0 238752 310775 1425781 1343588 51258458 23045295 16629351 28213163 143456 323350 42647031 59892582 41117542 52134515 0 6290 295071659 405766264 336189201 457907069 X -293542170 -398014487 -293542170 -398014487 42647031 59892582 -104472317 0 X 0 1 X 1 0 X 38714496 97680190 108683182 245077868 107918948 308551632 373117654 789588234 146633444 406231822 481800836 1034666102 0 0 0 1034666102 31573 71189 64386 167148 31573 71189 64386 167148 146665017 406303011 481865222 1034833250 X PART III, LINE 14 2017 WAS THE ORGANIZATION'S FIRST TAX YEAR AS A SECTION 501(C)(3) ORGANIZATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 21752 0 0 21752 0 5828606 3390630 2437976 9384159 2351933 7032226 29695601 13517869 16177732 6350092 3784863 2565229 28213163 PAYABLES TO AFFILIATES 400583546 COMP BAL-AUTHORITY 786502 RETENTION PAYABLE 35394 A/P - CONSTRUCTION 549711 COPIC TAIL ACCRUAL 3811111 405766264 473429804 11168 11168 473418636 8435417 8435417 481854053 577902121 11168 11168 577890953 8435417 8435417 586326370 PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 11,168. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 8,435,417. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF ASSETS 11,168. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 8,435,417. 1 UNIVERSITY OF COLORADO SCHOOL OF MEDICINE 13001 17TH PLACE AURORA CO 80045 846000055 501(C)(3) 2335262 COMMUNITY HEALTHCARE 1 PART I, LINE 2: THE ORGANIZATION AWARDS GRANTS BASED ON THE BENEFIT TO THE COMMUNITY. THE ORGANIZATION REQUESTS INFORMATION FROM THE GRANTEES TO ENSURE THAT THE FUNDS WILL BE USED FOR THE SPECIFIED PURPOSE. X X X 1 0 0 0 0 0 0 0 0 DR TODD WHITSITT BOARD MEMBER/ PHYSICIAN 414629 0 129570 0 2606 0 25355 0 16397 0 588557 0 0 0 DR MIKE RANDLE TERM BEGIN 11 PRESIDENT AND CEO 464043 0 367544 0 4546 0 77000 0 21580 0 934713 0 0 0 STEVE SCHWARTZ CFO 233186 0 66507 0 2239 0 27561 0 14835 0 344328 0 0 0 DONNA LANKFORD VP REGIONAL PRACTICE MGMT OPERATION 186249 0 52000 0 926 0 22231 0 13450 0 274856 0 0 0 MARY YANTIS VP REGIONAL PRACTICE MGMT OPERATION 245569 0 64177 0 2329 0 28160 0 14475 0 354710 0 0 0 SCOTT HURLBERT VP CHIEF QUALITY OFFICER 210139 0 0 0 0 0 2046 0 11523 0 223708 0 0 0 DIANA BREYER VP CHIEF QUALITY OFFICER 190834 267046 0 49984 0 1369 2753 22602 6779 7473 200366 348474 0 0 JENNY BAJAJ CHIEF MEDICAL OFFICER 314013 0 47700 0 1012 0 31704 0 18494 0 412923 0 0 0 TIMOTHY GRAMANN CHIEF OPERATING OFFICER 130906 0 37746 0 8879 0 16225 0 10481 0 204237 0 0 0 JOSHUA PETIT PHYSICIAN 1481674 0 0 0 1247 0 25355 0 23173 0 1531449 0 0 0 HANS COESTER MEDICAL DIRECTOR 1756892 0 0 0 9884 0 25355 0 19825 0 1811956 0 0 0 LARS WIDDEL PHYSICIAN 1438077 0 0 0 934 0 25355 0 23316 0 1487682 0 0 0 MARK DOUTHIT PHYSICIAN 1147884 0 72151 0 5322 0 25355 0 20572 0 1271284 0 0 0 MARK GUADAGNOLI PHYSICIAN 1066174 0 72151 0 10052 0 25355 0 14724 0 1188456 0 0 0 DEBORAH CHANDLER TERM END 111 FORMER PRESIDENT AND CEO 0 0 0 0 324592 0 17105 0 0 0 341697 0 0 0 PART I, LINE 4A DEBORAH CHANDLER RECEIVED SEVERANCE PAYMENTS OF $303,853. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY INDEPENDENT CPAS. A PRELIMINARY DRAFT IS REVIEWED BY THE INTERNAL FINANCE DEPARTMENT. THE FINAL COPY OF THE FORM 990 IS PROVIDED IN AN ELECTRONIC FORMAT TO ALL BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES COMPLETION OF THE FORM ON AN ANNUAL BASIS BY THE BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. COMPLETED FORMS ARE SUBMITTED AND REVIEWED BY THE INTERNAL COMPLIANCE DEPARTMENT TO ENSURE COMPLIANCE WITH THE WRITTEN POLICY. ANY QUESTIONS OR ULTIMATE ENFORCEMENT WOULD BE HANDLED BY THE COMPLIANCE DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15 UCHEALTH CONTRACTS WITH SULLIVAN COTTER FOR EXECUTIVE COMPENSATION CONSULTING SERVICES. ON OUR BEHALF, SULLIVAN COTTER COLLECTS AND REVIEWS COMPENSATION LEVELS FROM LIKE-ORGANIZATION FOR LIKE-JOBS AND PROVIDES UCHEALTH WITH THE COMPARATIVE MARKET DATA. THE DATA IS SUBMITTED TO THE CHIEF HUMAN RESOURCES OFFICER, WHO ADVISES THE SYSTEM PRESIDENT AND CEO ON COMPENSATION DECISIONS FOR SENIOR EXECUTIVES. BASED ON THE MARKET DATA, THE SYSTEM PRESIDENT AND CEO DETERMINES THE SALARY OF THE ENTITY CEO'S COMPENSATION ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC BASED ON THE BUSINESS PURPOSE FOR THE REQUEST. THESE REQUESTS ARE ADDRESSED BY THE SENIOR MANAGEMENT TEAM ON A CASE-BY-CASE BASIS. FORM 990 PART VII SECTION A DR. TODD WHITSITT IS COMPENSATED FOR PHYSICIAN SERVICES HE PROVIDES TO THE ORGANIZATION AND NOT FOR SERVING AS A BOARD MEMBER. POUDRE VALLEY HEALTHCARE INC 2315 E HARMONY ROAD SUITE 200 FORT COLLINS CO 80528 841262971 TERTIARY CARE CO 501(C)(3) LINE 3 0 UNIVERSITY OF COLORADO HEALTH 7901 E LOWRY BLVD SUITE 350 DENVER CO 80230 454552631 HEALTHCARE MANAGEMENT CO 501(C)(3) LINE 7 0 MEDICAL CENTER OF THE ROCKIES 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 043730045 TERTIARY CARE CO 501(C)(3) LINE 3 PVHC INC 0 PVHS FOUNDATION 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 741894581 BENEFIT HEALTH CO 501(C)(3) LINE 7 PVHC INC 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0