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POUDRE VALLEY HEALTH CARE INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
POUDRE VALLEY HEALTH CARE INC (EIN 84-1262971)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-16
IRS object ID
201641379349306119
Schema version
2014v6.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-16T13:29:09-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN461497033PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EKS&H LLLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line17979 E TUFTS AVENUE SUITE 400AddressLine1Txt
CityDENVERCityNm
State AbbreviationCOStateAbbreviationCd
ZIP802372521ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN841262971EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1POUDRE VALLEY HEALTH CARE INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPOUDBusinessNameControlTxt
Phone9702377000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12315 E HARMONY ROAD NO 200AddressLine1Txt
CityFORT COLLINSCityNm
State AbbreviationCOStateAbbreviationCd
ZIP80528ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSTEPHANIE DOUGHTYPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone9702377000PhoneNum
Signature2016-05-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDORI J EGGETTPreparerPersonNm
PTINP00645252PTIN
Phone3037409400PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKEVIN UNGERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12315 E HARMONY RD 200AddressLine1Txt
CityFT COLLINSCityNm
State AbbreviationCOStateAbbreviationCd
ZIP80528ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$512,813,222GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.UCHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1994FormationYr
Legal Domicile StateCOLegalDomicileStateCd
Activity Or MissionWE IMPROVE LIVES THROUGH LEARNING, HEALING, DISCOVERY, AND THROUGH HUMAN CONNECTION.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee4255TotalEmployeeCnt
Total Volunteers600TotalVolunteersCnt
Total Gross UBI$4,645,969TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$3,061,887NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,199,637PYContributionsGrantsAmt
CY Contributions Grants$2,220,807CYContributionsGrantsAmt
PY Program Service Revenue$446,107,775PYProgramServiceRevenueAmt
CY Program Service Revenue$471,312,432CYProgramServiceRevenueAmt
PY Investment Income$15,060,636PYInvestmentIncomeAmt
CY Investment Income$23,773,424CYInvestmentIncomeAmt
PY Other Revenue$12,929,131PYOtherRevenueAmt
CY Other Revenue$10,670,778CYOtherRevenueAmt
PY Total Revenue$478,297,179PYTotalRevenueAmt
CY Total Revenue$507,977,441CYTotalRevenueAmt
PY Grants And Similar Paid$36,808,195PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$31,381,120CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$186,655,969PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$185,330,975CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$216,747,452PYOtherExpensesAmt
CY Other Expenses$205,327,882CYOtherExpensesAmt
PY Total Expenses$440,211,616PYTotalExpensesAmt
CY Total Expenses$422,039,977CYTotalExpensesAmt
PY Revenues Less Expenses$38,085,563PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$85,937,464CYRevenuesLessExpensesAmt
Total Assets BOY$1,439,397,024TotalAssetsBOYAmt
Total Assets EOY$2,242,473,093TotalAssetsEOYAmt
Total Liabilities BOY$687,341,243TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,327,312,245TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$752,055,781NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$915,160,848NetAssetsOrFundBalancesEOYAmt
MissionWE IMPROVE LIVES. IN BIG WAYS THROUGH LEARNING, HEALING AND DISCOVERY. IN SMALL, PERSONAL WAYS THROUGH HUMAN CONNECTION. BUT IN ALL WAYS, WE IMPROVE LIVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$384,072,441ExpenseAmt
Grant$31,381,120GrantAmt
Revenue$471,145,859RevenueAmt
DescPOUDRE VALLEY HEALTH CARE INC. (PVHC) PROVIDES TERTIARY, ACUTE, INPATIENT, OUTPATIENT AS WELL AS EMERGENCY CARE. PVHC SERVICES COMMUNITIES IN NORTHERN COLORADO, SOUTHWESTERN NEBRASKA, AND SOUTHEASTERN WYOMING. DURING FISCAL YEAR 2015, PVHC RECORDED 59,798 PATIENT DAYS, 15,358 ADMISSIONS, 223,571 OUTPATIENT VISITS, 58,589 EMERGENCY VISITS, 2,297 DELIVERIES, 4,502 INPATIENT SURGERIES, AND 4,987 OUTPATIENT SURGERIES.Desc
Total Program Service Expenses$384,072,441TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document265IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee4255EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STEPHANIE DOUGHTYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9702377000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12315 E HARMONY ROAD SUITE 200AddressLine1Txt
CityFORT COLLINSCityNm
State AbbreviationCOStateAbbreviationCd
ZIP80528ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
CHRISTINE CHIN
BOARD CHAIR1.002.00Yes (X)Yes (X)$0$0$0
MIKE DELLENBACH
VICE BOARD CHAIR1.002.00Yes (X)Yes (X)$0$0$0
DENNIS HOUSKA
BOARD MEMBER1.002.00Yes (X)$0$0$0
THAINE MICHIE
BOARD MEMBER1.002.00Yes (X)$0$0$0
CHRIS OSBORN
BOARD MEMBER1.002.00Yes (X)$0$0$0
JOHN MENTEN
BOARD MEMBER1.002.00Yes (X)$0$0$0
JAMES SPROWELL MD
BOARD MEMBER1.002.00Yes (X)$0$0$0
LAURIE STEELE
BOARD MEMBER1.002.00Yes (X)$0$0$0
DAN STROH
BOARD MEMBER1.002.00Yes (X)$0$0$0
STEVE THORSON MD
BOARD MEMBER1.002.00Yes (X)$0$0$0
KEVIN UNGER
PRESIDENT/CEO25.0025.00Yes (X)Yes (X)$538,803$538,803$108,353
STEPHANIE DOUGHTY
CFO25.0025.00Yes (X)$293,273$293,273$61,859
DONNA PODUSKA
CNO50.00$235,278$0$33,364Yes (X)
MICHAEL RANDLE
CMO, CHMG50.00$369,807$0$54,037Yes (X)
STANLEY GUNSTREAM
VP CHIEF QUALITY OFFICER40.00$399,640$0$52,039Yes (X)
KENNETH WATANABE
PSYCHIATRIST40.00$268,454$0$46,452Yes (X)
JANELL WOZNIAK
PHYSICIAN-RESIDENCY PGRM DIRECTOR40.00$269,788$0$45,828Yes (X)
JOSEPH GOTTFRIED
PSYCHIATRIST40.00$258,080$0$47,667Yes (X)
DANNY ROBINSON
CEO, CHMG25.0025.00$215,053$198,520$58,081Yes (X)
STEVEN SCHWARTZ
CFO, CHMG25.0025.00$94,617$124,677$37,248Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,942,793TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,155,273TotReportableCompRltdOrgAmt
Total Other Compensation$544,928TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K105IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
NORTHERN COLORADO HOSPITALISTS
2121 E HARMONY RD 300FT COLLINSCO80528MEDICAL$2,123,439
FORT COLLINS WOMEN'S CLINIC
1107 S LEMAY AVE 300FT COLLINSCO80524MEDICAL$1,697,678
ALLIED BARTON SECURITY
161 WASHINGTON ST 600CONSHOHOCKENPA19428SECURITY$1,691,419
SUMMIT PATHOLOGY
5802 WRIGHT DRLOVELANDCO80538MEDICAL$1,368,374
FORT COLLINS YOUTH CLINIC
1214 OAK PARK DRFORT COLLINSCO80525MEDICAL$1,315,833
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K47CntrctRcvdGreaterThan100KCnt
Related Organizations$1,572,744RelatedOrganizationsAmt
Government Grants$374,771GovernmentGrantsAmt
All Other Contributions$273,292AllOtherContributionsAmt
Noncash Contributions$1,486,876NoncashContributionsAmt
Total Contributions$2,220,807TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SVC REV900099$472,344,142$472,344,142
PROVIDER FEE INCOME621400$28,906,490$28,906,490
DIETARY SVC INCOME900099$2,088,151$2,088,151
JOINT VENTURE621400-$32,303,826-$32,948,229$644,403

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$277,475TotalRevenueColumnAmt
Related Or Exempt Func Income$252,116RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$25,359UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$471,312,432TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,081,537TotalRevenueColumnAmt
Exclusion$11,081,537ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$880,994TotalRevenueColumnAmt
Exclusion$880,994ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$9,444,483RealAmt
Personal$123,404PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$1,987,551RealAmt
Personal$123,404PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$7,456,932RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,456,932TotalRevenueColumnAmt
Unrelated Business Revenue$3,452,131UnrelatedBusinessRevenueAmt
Exclusion$4,004,801ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$7,105,547SecuritiesAmt
Other$7,146,673OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$2,441,327OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$7,105,547SecuritiesAmt
Other$4,705,346OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,810,893TotalRevenueColumnAmt
Exclusion$11,810,893ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$381,521GrossSalesOfInventoryAmt
Cost Of Goods Sold$283,499CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$98,022TotalRevenueColumnAmt
Exclusion$98,022ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
MISCELLANEOUS REVENUE621400$2,054,043$1,529,967$524,076
EHR REVENUE624100$1,061,373$1,061,373
INCOME TAX REFUND621400$408$408
FieldValueIRS element (for citing)
Other Revenue Total$3,115,824OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$507,977,441TotalRevenueColumnAmt
Related Or Exempt Func Income$471,145,859RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$4,645,969UnrelatedBusinessRevenueAmt
Exclusion$29,964,806ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$31,381,120TotalAmt
Program Services$31,381,120ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,300,678TotalAmt
Program Services$383,497ProgramServicesAmt
Management And General$917,181ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$65,727TotalAmt
Program Services$65,727ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$141,932,975TotalAmt
Program Services$128,797,885ProgramServicesAmt
Management And General$13,135,090ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$23,357,875TotalAmt
Program Services$21,142,024ProgramServicesAmt
Management And General$2,215,851ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$16,803,450TotalAmt
Program Services$15,911,454ProgramServicesAmt
Management And General$891,996ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,870,270TotalAmt
Program Services$1,692,846ProgramServicesAmt
Management And General$177,424ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$30,250TotalAmt
Management And General$30,250ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$67,051TotalAmt
Management And General$67,051ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$26,600TotalAmt
Management And General$26,600ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$939,162TotalAmt
Management And General$939,162ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$28,033,581TotalAmt
Program Services$23,673,138ProgramServicesAmt
Management And General$4,360,443ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$3,039,738TotalAmt
Program Services$7,258ProgramServicesAmt
Management And General$3,032,480ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,054,559TotalAmt
Program Services$3,615,057ProgramServicesAmt
Management And General$439,502ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$5,847,192TotalAmt
Program Services$5,108,102ProgramServicesAmt
Management And General$739,090ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$3,894,293TotalAmt
Program Services$3,524,859ProgramServicesAmt
Management And General$369,434ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,074,293TotalAmt
Program Services$784,771ProgramServicesAmt
Management And General$289,522ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$323,351TotalAmt
Program Services$278,506ProgramServicesAmt
Management And General$44,845ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$9,696,030TotalAmt
Program Services$9,696,030ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$22,440,248TotalAmt
Program Services$17,268,543ProgramServicesAmt
Management And General$5,171,705ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,966,969TotalAmt
Program Services$127,182ProgramServicesAmt
Management And General$1,839,787ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
UBI TAXES$944,998$944,998
MEDICAL SUPPLIES$76,833,971$91,107$76,742,864
BAD DEBT$21,354,240$21,354,240
PROVIDER FEE EXPENSE$20,647,416$20,647,416

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$4,113,940TotalAmt
Program Services$1,869,922ProgramServicesAmt
Management And General$2,244,018ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$422,039,977TotalAmt
Program Services$384,072,441ProgramServicesAmt
Management And General$37,967,536ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$3,709,644BOYAmt
EOY$68,533,778EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,026,320BOYAmt
EOY$1,489,346EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$56,214,512BOYAmt
EOY$50,779,998EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,364,113BOYAmt
EOY$45,308EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$6,500,134BOYAmt
EOY$6,998,323EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,427,999BOYAmt
EOY$3,617,968EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$554,669,199LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$299,827,366LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$261,849,234BOYAmt
EOY$254,841,833EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$6,123,945BOYAmt
EOY$780,602,336EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$2,997,063BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$24,095,655BOYAmt
EOY$26,245,368EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,072,088,405BOYAmt
EOY$1,049,318,835EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,439,397,024BOYAmt
EOY$2,242,473,093EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$53,074,553BOYAmt
EOY$63,770,176EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$69,473BOYAmt
EOY$59,968EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$131,401,661BOYAmt
EOY$204,385,503EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$131,854,723BOYAmt
EOY$23,496,487EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$1,379,436BOYAmt
EOY$61,245EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$369,561,397BOYAmt
EOY$1,035,538,866EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$687,341,243BOYAmt
EOY$1,327,312,245EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$752,055,781BOYAmt
EOY$915,160,848EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$752,055,781BOYAmt
EOY$915,160,848EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,439,397,024BOYAmt
EOY$2,242,473,093EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$85,937,464ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$3,658,679NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$80,826,282OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$26,600DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other Activities0OtherActivitiesInd
Total Lobbying Expenditures$26,600TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationPORTION OF DUES FROM MEMBERSHIP IN CHA AND AHA THAT ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$11,287,236BeginningYearBalanceAmt
Contributions$2,977,196ContributionsAmt
Investment Earnings Or Losses$98,459InvestmentEarningsOrLossesAmt
Grants Or Scholarships$1,595,156GrantsOrScholarshipsAmt
Other Expenditures$1,525,623OtherExpendituresAmt
End Year Balance$11,242,112EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$10,692,037BeginningYearBalanceAmt
Contributions$4,841,525ContributionsAmt
Investment Earnings Or Losses$985,793InvestmentEarningsOrLossesAmt
Grants Or Scholarships$3,756,845GrantsOrScholarshipsAmt
Other Expenditures$1,455,274OtherExpendituresAmt
End Year Balance$11,287,236EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$8,938,992BeginningYearBalanceAmt
Contributions$2,680,308ContributionsAmt
Investment Earnings Or Losses$520,466InvestmentEarningsOrLossesAmt
Grants Or Scholarships$565,964GrantsOrScholarshipsAmt
Other Expenditures$881,765OtherExpendituresAmt
End Year Balance$10,692,037EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$8,589,487BeginningYearBalanceAmt
Contributions$1,202,986ContributionsAmt
Investment Earnings Or Losses$379,517InvestmentEarningsOrLossesAmt
Grants Or Scholarships$448,977GrantsOrScholarshipsAmt
Other Expenditures$784,021OtherExpendituresAmt
End Year Balance$8,938,992EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$8,012,240BeginningYearBalanceAmt
Contributions$3,552,647ContributionsAmt
Investment Earnings Or Losses-$345,716InvestmentEarningsOrLossesAmt
Grants Or Scholarships$1,678,528GrantsOrScholarshipsAmt
Other Expenditures$712,777OtherExpendituresAmt
Administrative Expenses$238,379AdministrativeExpensesAmt
End Year Balance$8,589,487EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY0.56390PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.43610TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$59,951,616OtherCostOrOtherBasisAmt
Book Value$59,951,616BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$189,616,546OtherCostOrOtherBasisAmt
Depreciation$103,943,845DepreciationAmt
Book Value$85,672,701BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$92,100,199OtherCostOrOtherBasisAmt
Depreciation$63,372,188DepreciationAmt
Book Value$28,728,011BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$153,624,020OtherCostOrOtherBasisAmt
Depreciation$100,998,658DepreciationAmt
Book Value$52,625,362BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$59,376,818OtherCostOrOtherBasisAmt
Depreciation$31,512,675DepreciationAmt
Book Value$27,864,143BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$254,841,833TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
INTERCOMPANY RECEIVABLE$1,022,579,823
DEFERRED DEBT ISSUANCE COSTS$3,057,982
OTHER RECEIVABLES$3,994,117
DEFERRED PENSION OUTFLOW COSTS$19,686,913
FieldValueIRS element (for citing)
Total Book Value Other Assets$1,049,318,835TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
INTERCOMPANY PAYABLES$1,013,097,204
ACCRUED INTEREST PAYABLE$1,355,370
OTHER DEFERRED EXPENSES$2,852,960
PENSION LIABILITIES$18,233,332
FieldValueIRS element (for citing)
Total Liability$1,035,538,866TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$521,456,621TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$3,658,679NetUnrealizedGainsInvstAmt
Other Revenue$2,110,955OtherRevenueAmt
Revenue Not Reported-$1,547,724RevenueNotReportedAmt
Revenue Subtotal$523,004,345RevenueSubtotalAmt
Other Revenues Not Included-$15,026,904OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$15,026,904RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$507,977,441TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$401,486,954TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$2,110,955OtherExpensesIncludedAmt
Expenses Not Reported$2,110,955ExpensesNotReportedAmt
Expenses Subtotal$399,375,999ExpensesSubtotalAmt
Other Expenses Not Included$22,663,978OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$22,663,978ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$422,039,977TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:ENDOWMENT FUNDS ARE USED FOR THE INTENDED PURPOSE TO FUND SCHOLARSHIPS, EDUCATION, PROGRAMS, AND COMMUNITY BENEFIT. TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE FOUNDATION HAVE BEEN LIMITED BY THE DONOR TO A SPECIFIC TIME PERIOD OR PURPOSE. THESE NET ASSETS ARE AVAILABLE FOR VARIOUS HEALTH CARE PURPOSES AS DEFINED BY DONORS. THE ENDOWMENT FUND IS OWNED BY POUDRE VALLEY HEALTH SYSTEM FOUNDATION.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSE INCLUDED IN EXPENSE ON AFS 2,110,955.
PART XI, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR BAD DEBT IN AFS INCOME 21,354,239. AUXILIARY INCOME NOT INCLUDED IN AFS INCOME 98,022. CONTRIBUTIONS FROM PV FOUNDATION NOT IN AFS INCOME 225,739. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 25,359. RENTAL EXP AS INCOME ON 990 10,071. INCOME TAX REFUND REDUCED EXPENSES ON AFS 408. INVESTMENT EXPENSE REPORTED AS INCOME ON AFS 939,162. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS -37,679,904.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSE INCLUDED IN EXPENSE ON AFS 2,110,955.
PART XII, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR BAD DEBT IN AFS INCOME 21,354,239. AUXILIARY GRANTS NOT ON AFS 109,000. RENTAL EXP AS INCOME ON 990 10,071. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 25,359. INCOME TAX REFUND REDUCED EXPENSES ON AFS 408. CASH CONTRIBUTIONS FROM FOUNDATION NOT IN AFS REVENUE 225,739. INVESTMENT EXPENSE REPORTED AS INCOME ON AFS 939,162.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other250.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$759,922TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$759,922NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$61,689,920TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$50,887,549DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,802,371NetCommunityBenefitExpnsAmt
Total Expense0.02560TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$20,652,344TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,567,826DirectOffsettingRevenueAmt
Net Community Benefit Expns$84,518NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$83,102,186TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$71,455,375DirectOffsettingRevenueAmt
Net Community Benefit Expns$11,646,811NetCommunityBenefitExpnsAmt
Total Expense0.02760TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,417,945TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$177,800DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,240,145NetCommunityBenefitExpnsAmt
Total Expense0.00530TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,644,690TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,040,346DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,604,344NetCommunityBenefitExpnsAmt
Total Expense0.01090TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,016,258TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,065,985DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,950,273NetCommunityBenefitExpnsAmt
Total Expense0.00700TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,057,678TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$213,539DirectOffsettingRevenueAmt
Net Community Benefit Expns$844,139NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$31,289,872TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$31,289,872NetCommunityBenefitExpnsAmt
Total Expense0.07410TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$49,426,443TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,497,670DirectOffsettingRevenueAmt
Net Community Benefit Expns$41,928,773NetCommunityBenefitExpnsAmt
Total Expense0.09930TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$132,528,629TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$78,953,045DirectOffsettingRevenueAmt
Net Community Benefit Expns$53,575,584NetCommunityBenefitExpnsAmt
Total Expense0.12690TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$200TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$200NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$81,338TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$81,338NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,000NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,245TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,245NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$150,370TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$150,370NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$234,153TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$234,153NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$23,781,564BadDebtExpenseAmt
Reimbursed By Medicare$137,860,111ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$176,974,237CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$39,114,126MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (8 entries)

Primary ActivitiesPrimaryActivitiesTxtOrg Profit Or OwnershipOrgProfitOrOwnershipPctPhysicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
1 HARMONY SURGERY CENTER LLC
AMBULATORY SURGERY0.500000.50000
2 PEAK SURGICAL MANAGEMENT
MANAGEMENT SERVICES0.140000.86000
3 HARMONY IMAGING CENTER LLC
MEDICAL IMAGING0.460000.54000
4 SURGERY CENTER OF FORT COLLINS
AMBULATORY SURGERY0.260000.49000
5 GATEWAY MEDICAL SERVICES
REAL ESTATE/MEDICAL EQUIPMENT0.500000.50000
6 EYE AND LASER CENTER OF NORTHERN COLO LLC
LASER SURGERY0.500000.50000
7 VEIN AND LASER CENTER OF N COLO
LASER SURGERY0.330000.67000
8 PVHS-ICM EHW LLC
MEDICAL CLINIC0.500000.50000
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1POUDRE VALLEY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11024 S LEMAYAddressLine1Txt
CityFORT COLLINSCityNm
State AbbreviationCOStateAbbreviationCd
ZIP80524ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Teaching HospitalYes (X)TeachingHospitalInd
Research FacilityYes (X)ResearchFacilityInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherPHARMACY, LAB, CARDIOVASCULAROtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1POUDRE VALLEY HEALTH CAREBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
OtherYes (X)OtherInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt12ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, SECTION CStrategyWebsiteURLTxt
Strategy Attached0StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care250.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART V, SECTION CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART V, SECTION CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART V, SECTION CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Lowest Negotiated RatesYes (X)LowestNegotiatedRatesInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
POUDRE VALLEY HEALTH CAREPART V, SECTION B, LINE 3J: THE CHNA REPORT ALSO DESCRIBES CLINICAL SERVICES PROVIDED BY HOSPITAL FACILITY ADDRESSING THE FOUR LEADING CAUSES OF MORTALITY IN THE COUNTY.
POUDRE VALLEY HEALTH CAREPART V, SECTION B, LINE 5: TWO COMMUNITY MEETINGS WERE HELD DURING FEBRUARY 2013 WHERE FINDINGS FROM THE CHNA WERE PRESENTED, QUESTIONS AND COMMENTS WERE RECEIVED AND RESPONSES PROVIDED. THE FOLLOWING INDIVIDUALS WERE CONSULTED:ANNETTE ALFANO, UNIVERSITY OF COLORADO HEALTHMARY ATCHISON, KAISER PERMANENTEKRISTIN BIERI, FOOD BANK FOR LARIMER COUNTYDEBORAH CAMPBELL, LARIMER COUNTY COMPASSJENNIFER CHASE, NORTHERN COLORADO AIDS PROJECTANDREA CLEMENT-JOHNSON, LARIMER COUNTY DEPARTMENT OF HEALTH & ENVIRONMENTBRUCE COOPER, HEALTH DISTRICT OF NORTHERN LARIMER COUNTYLORI DAIGLE, NORTHERN COLORADO AIDS PROJECTALISON DAWSON, DISABLED RESOURCE SERVICESEMILY DAWSON PETERSEN, TOUCHSTONE HEALTH PARTNERSTOM DONNELLY, LARIMER COUNTY COMMISSIONERSMICHELE DOYLE, COLUMBINE HEALTH CARE SYSTEMSLINDA FELLION, EARLY CHILDHOOD COUNCIL OF LARIMER COUNTYLEW GAITER, LARIMER COUNTY COMMISSIONERSCHAZZ GLAZE, SALUD FAMILY HEALTH CENTERNEIL GLUCKMAN, LARIMER COUNTY, ASSISTANT COUNTY MANAGERMARTHA HARGRAVES, COMMUNITY MEMBERBARBARA HARTMAN, THOMPSON SCHOOL DISTRICTSUE HEWITT, HEALTH DISTRICT OF NORTHERN LARIMER COUNTYJESSICA HINTERBERG, CANDO WITH UNIVERSITY OF COLORADO HEALTHERICA IVERSON, FOOD BANK FOR LARIMER COUNTYSTEVE JOHNSON, LARIMER COUNTY COMMISSIONERSASHLEY KASPRZAK, TEAM FORT COLLINSKATY KOHNEN, LEAGUE OF WOMEN VOTERSJENNY LANGNESS, ALPHA CENTERJENNIFER LEE, LARIMER COUNTY BOARD OF HEALTHDIANA LINDEN, PLANNED PARENTHOOD OF THE ROCKY MOUNTAIN'S RESPONSIBLE SEX EDUCATION INSTITUTEMARIE MACPHERSON, LARIMER COUNTY DEPT OF HEALTH AND ENVIRONMENTJOHN MCGEE, CROSSROADS SAFEHOUSEDAWN NANNINI, TEAM FORT COLLINSKAREN NICHOLSON, ESTES PARK MEDICAL CENTERTRACI ODDY, BANNER MCKEE MEDICAL CENTERCAROL PLOCK, HEALTH DISTRICT OF NORTHERN LARIMER COUNTYMARK RICHARDS, LARIMER COUNTY BOARD OF HEALTHDOUG RYAN, LARIMER COUNTY DEPARTMENT OF HEALTH & ENVIRONMENTKIM SHARPE, HEALTHIER COMMUNITIES COALITION OF LARIMER COUNTYBILL STOUT, WOMEN'S RESOURCE CENTERAVERIL STRAND, LARIMER COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENTDEIRDRE SULLIVAN, CANDO WITH UNIVERSITY OF COLORADO HEALTHJILL TAYLOR, UNIVERSITY OF COLORADO HEALTHGRACE TAYLOR, UNIVERSITY OF COLORADO HEALTHMARILYN THAYER, COMMUNITY ORGANIZING TO REACH EMPOWERMENT (CORE) CENTERLEE THIELEN, THIELEN CONSULTINGCOLETTE THOMPSON, UNIVERSITY OF COLORADO HEALTHJANE VISTE, LARIMER COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENTSCOTT VON BARGEN, TURNING POINT CENTER FOR YOUTH & FAMILY DEVELOPMENTMARGARET WATSON, UNITED WAY 2-1-1 OF LARIMER COUNTYNANCY WEBER, POUDRE SCHOOL DISTRICTVALERIE WENDELL, BOHEMIAN FOUNDATIONLISE YOUNGBLADE, HUMAN DEVELOPMENT AND FAMILY STUDIES/COLORADO STATE UNIVERSITYSTEVE YURASH, LARIMER COUNTY BOARD OF HEALTH
POUDRE VALLEY HEALTH CAREPART V, SECTION B, LINE 6A: MEDICAL CENTER OF THE ROCKIES ALSO PARTICIPATED IN THE 2012 CHNA.
POUDRE VALLEY HEALTH CAREPART V, SECTION B, LINE 6B: ALPHA CENTERBOHEMIAN FOUNDATIONCOLUMBINE HEALTH CARE SYSTEMSCOMMUNITY ORGANIZING TO REACH EMPOWERMENT CENTERCROSSROADS SAFEHOUSEDISABLES RESOURCE SERVICESEARLY CHILDHOOD COUNCIL OF LARIMER COUNTYFOOD BANK FOR LARIMER COUNTYHEALTH DISTRICT OF N. LARIMER COUNTYHEALTHIER COMMUNITIES COALITION OF LARIMER COUNTYHUMAN DEVELOMENT AND FAMILY STUDIES @ CSUKAISER PERMANENTELARIMER COUNTRY DEPARTMENT OF HEALTH AND ENVIRONMENTLARIMER COUNTYLARIMER COUNTY BOARD OF HEALTHLARIMER COUNTY COMMISSIONERSLARIMER COUNTY COMPASSLEAGUE OF WOMEN VOTERSNORTHERN COLORADO AIDS PROJECTPLANNED PARENTHOODPOUDRE SCHOOL DISTRICTSALUD FAMILY HEALTH CENTERTEAM FORT COLLINSTHIELEN CONSULTINGTHOMPSON SCHOOL DISTRICTTOUCHSTONE HEALTH PARTNERSTURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENTUNITED WAY OF LARIMER COUNTYWOMEN'S RESOURCE CENTERPART V, LINE 7A:WEBSITE: HTTPS://WWW.UCHEALTH.ORG/DOCUMENTS/FILE-PDF/ABOUT- CHNA-WEB201213.PDFPART V, LINE 10A: HTTPS://WWW.UCHEALTH.ORG/DOCUMENTS/FILE-PDF /ABOUT-2013-IMPLEMENTATIONSTRATEGY-UCHEALTHNORTH.PDF
POUDRE VALLEY HEALTH CAREPART V, SECTION B, LINE 11: AN IDENTIFIED HEALTH ISSUE RELATED TO A HIGH RATE OF UNINTENDED TEEN PREGNANCY IN WELD COUNTY IS NOT BEING ADDRESSED WITH DIRECT RESOURCES ALLOCATED FROM POUDRE VALLEY HOSPITAL OR THE MEDICAL CENTER OF THE ROCKIES. THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PROVIDES REPRODUCTIVE HEALTH SERVICES FOR TEENS THROUGH A TITLE X CLINIC. ADDITIONAL EDUCATION AND OUTREACH TO WELD COUNTY TEENS IS PROVIDED BY A COMMUNITY ORGANIZATION; LUTHERAN FAMILY SERVICES. POUDRE VALLEY HOSPITAL AND MEDICAL CENTER OF THE ROCKIES PROVIDED SUPPORT TO THIS ORGANIZATION THROUGH CASH DONATIONS TOTALING $2,460.00 DURING THE 2012/13 FISCAL YEAR AND $2,500 DURING THE 2013/14 FISCAL YEAR. ANOTHER IDENTIFIED HEALTH ISSUE - MOTOR VEHICLE SAFETY FOR TEENS IN WELD COUNTY - IS ALSO NOT BEING DIRECTLY ADDRESSED DUE TO LACK OF RESOURCES. THE ISSUE IS BEING ADDRESSED BY A NON-PROFIT COMMUNITY COALITION - DRIVE SMART WELD COUNTY - WHICH HAS DEDICATED RESOURCES AND ACTION PLANS TO ADDRESS THIS ISSUE.PART V, LINE 16:FINANCIAL ASSISTANCE POLICY: HTTPS://WWW.UCHEALTHBILLPAY.ORG/PAYMENTOPTIONS.ASPX?TABID=4
PART V, SECTION B, LINE 16FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
POUDRE VALLEY HEALTH CARE PART V, SECTION B, LINE 16A WEBSITE:SEE PART V, SECTION C
POUDRE VALLEY HEALTH CARE PART V, SECTION B, LINE 16B WEBSITE:SEE PART V, SECTION C
POUDRE VALLEY HEALTH CARE PART V, SECTION B, LINE 16C WEBSITE:SEE PART V, SECTION C
FieldValueIRS element (for citing)
Facility56FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (56 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxtAddress Line2USAddress/AddressLine2Txt
HARMONY CAMPUS MOB
2121 E HARMONY RDFORT COLLINSCO80528PHYSICIAN OFFICES, ONCOLOGY, HCOR, CANCER CENTER
HARMONY CAMPUS AMBULATORY CARE CENTER
2127 E HARMONY RDFORT COLLINSCO80528SURGERY CENTER, DIAGNOSTIC CENTER, IMAGING, URGENT CARE
MCR NORTH MOB
2500 ROCKY MTN AVELOVELANDCO80538PHYSICIAN OFFICES
CHMG CLINICS
1400 E BOULDER STREETCOLORADO SPRINGSCO80909PHYSICIAN OFFICES
GREELEY MEDICAL CLINIC
1900 16TH STREETGREELEYCO80631PHYSICIAN OFFICES,LAB, RADIOLOGY & ONCOLOGY
REDSTONE
2315 E HARMONY RDFORT COLLINSCO80528OUTPAITENT LAB, PHYSICIAN OFFICE, UROLOGY
CHMG-LONGMONT
1925 MOUNTAIN VIEW AVELONGMONTCO80501PHYSICIAN OFFICES
PHYSICIAN CLINICS
4110 BRIARGATE PARKWAYCOLORADO SPRINGSCO80920PHYSICIAN OFFICES
PEAKVIEW MEDICAL CENTER
5881 W 16TH STREETGREELEYCO80634PHYSICIAN OFFICES, LAB & RADIOLOGY
PENNOCK PLACE
1025 PENNOCK PLACEFORT COLLINSCO80524PHYSICIAN OFFICES, BLOOD BANK
MOUNTAIN CREST BEHAVIORAL HEALTH
4601 CORBETT DRFORT COLLINSCO80528BEHAVORIAL HEALTH
PROSPECT MEDICAL PLAZA
1106 E PROSPECT SUITE 100FORT COLLINSCO80524PHYSICIAN OFFICES, OUTPAITENT REHAB, NEUROLOGY, INT MEDICINE
CENTRE AVE HEALTH AND REHAB-JV
915 CENTRE AVEFORT COLLINSCO80526REHAB
SNOW MESA
4674 SNOW MESA DRIVEFORT COLLINSCO80528PHYSICIAN OFFICES
CHMG CHEYENNE MEDICAL SPECIALISTS
5050 POWDERHOUSE RDCHEYENNEWY82009PHYSICIAN OFFICES
WESTBRIDGE
1107 S LEMAYFORT COLLINSCO80524PHYSICIAN OFFICES, BLOOD DRAW, SLEEP LAB, WEE STEPS
CHMG PHYSICIAN CLINICS
525 N FOOTE AVE SUITE 302COLORADO SPRINGSCO80910PHYSICIAN OFFICES
SURGERY CENTER OF FT COLLINS-JV
1100 E PROSPECT RDFORT COLLINSCO80524SURGERY CENTER
MCR SOUTH MOB
2500 ROCKY MTN AVELOVELANDCO80538PHYSICIAN OFFICES, HCOR, SSOR, SLEEP LAB, SURGERY CENTER
WINDSOR MEDICAL CENTER
1455 MAIN STREETWINDSORCO80550PHYSICIAN OFFICES, RADIOLOGY, LAB
MEMORIAL NEUROSCIENCES
1725 BOULDER STREET SUITE 101COLORADO SPRINGSCO80909PHYSICIAN OFFICES
UROLOGY CENTER OF THE ROCKIES
3520 E 15TH STREETLOVELANDCO80538PHYSICIAN OFFICES
EXPRESS LAB
1020 DOCTORS LANEFORT COLLINSCO80524LAB
CHMG OB-GYN CLINIC
1715 61ST AVENUEGREELEYCO80631PHYSICIAN OFFICES
NORTH SPRINGS FAMILY MEDICINE & URGENT C
8540 SCARBOROUGH DRIVECOLORADO SPRINGSCO80920PHYSICIAN OFFICES
CHILDREN'S THERAPY
1500 S LEMAYFORT COLLINSCO80526THERAPY
WEST LOVELAND
3850 N GRANT AVELOVELANDCO80538URGENT CARE, PHYSICIAN OFFICES
TIMBERLINE MEDICAL
131 STANLEY DRESTES PARKCO80517PHYSICIAN OFFICES
CHMG PRIMARY CARE AT BRIARGATE
8890 N UNION BLVD SUITE 100BCOLORADO SPRINGSCO80920PHYSICIAN OFFICES
PHYSICIAN CLINICS
175 S UNION BLVDCOLORADO SPRINGSCO80910PHYSICIAN OFFICES
COLUMBINE POUDRE HOMECARE-JV
915 CENTRE AVEFORT COLLINSCO80526HOME HEALTHCARE
HCORSCOTTSBLUFF
2 W 42ND ST 2200SCOTTSBLUFFNE69361PHYSICIAN OFFICES
CHMG PRIMARY CARE - ROCKRIMMON
6615 DELMONICO DRIVECOLORADO SPRINGSCO80919PHYSICIAN OFFICES
MEMORIAL SUNFLOWER FAMILY MEDICINE
1730 N CORONA STREETCOLORADO SPRINGSCO80907PHYSICIAN OFFICES
PRIMARY CARE-STERLING
620 IRIS DRIVESTERLINGCO80751PHYSICIAN OFFICES
EYE LASER CENTER OF N COLORADO-JV
1725 EAST PROSPECT RDFORT COLLINSCO80525PHYSICIAN OFFICES
CHMG-FIRESTONE
660 FIRESTONE BLVDFIRESTONECO80504PHYSICIAN OFFICES
THOMPSON VALLEY TOWNE CENTER
1327 EAGLE DRIVELOVELANDCO80537PHYSICIAN OFFICES
ORTHOPEDIC & HAND
3830 N GRANT AVELOVELANDCO80538PHYSICIAN OFFICES
YAMPA VALLEY STEAMBOAT
940 CENTRAL PARK DR 290STEAMBOAT SPRINGSCO80487PHYSICIAN OFFICES
THE VEIN AND LASER CENTER-JV
2008 CARIBOU DRIVEFORT COLLINSCO80525PHYSICIAN OFFICES
CHMG PRIMARY CARE - NO UNION
5333 N UNION BLVD SUITE 200COLORADO SPRINGSCO80918PHYSICIAN OFFICES
FORT MORGAN
1000 LINCOLN STREET 207FORT MORGANCO80701PHYSICIAN OFFICES
WATER VALLEY
1870 MARINA PLAZA DRIVEWINDSORCO80550OUTPATIENT REHAB
LARAMIE
3116 WILLET DRIVELARAMIEWY82070PHYSICIAN OFFICES
ESTES PARK
555 PROSPECT AVEESTES PARKCO80517PHYSICIAN OFFICES
CRAIG
595 RUSSELL STREETCRAIGCO81625PHYSICIAN OFFICES
SIDNEY
1625 DORWART DRIVESIDNEYNE69162PHYSICIAN OFFICES
CHMG HCOR CV SURGEON
2030 MOUNTAIN VIEW AVE 540LONGMONTCO80501PHYSICIAN OFFICES
PHLEBOTOMY STATION
1107 SOUTH LEMAY AVEFORT COLLINSCO80526LAB DRAWS
PHLEBOTOMY STATION
1113 OAKRIDGE DRIVEFORT COLLINSCO80525LAB DRAWS
PHLEBOTOMY STATION
2001 S SHIELDSFORT COLLINSCO80526LAB DRAWS
PHLEBOTOMY STATION
2025 BIG HORN DRIVEFORT COLLINSCO80525LAB DRAWS
PHLEBOTOMY STATION
3519 RICHMOND DRIVEFORT COLLINSCO80526LAB DRAWS
HAYTHORN BROTHERS
7251 W 20TH STGREELEYCO80631SLEEP LAB
PRIMARY CARE-MONUMENT
15854 JACKSON CREEK PARKWAY SUITEMONUMENTCO80132PHYSICIAN OFFICES120

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7:THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINE 7B AND 7C. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE TO COST-TO-CHARGES.LINE 7A WAS DERIVED USING A COST-TO-CHARGE RATIO FROM THE COST REPORT.THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS.
PART I, LINE 7G:INCLUDES PHYSICIAN GROUPS AS A SUBSIDIZED SERVICE. THESE CLINICS PROVIDE SERVICES IN UNDERSERVED AREAS IN COLORADO, NEBRASKA AND WYOMING.
PART I, LN 7 COL(F):TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = $23,781,564.
PART II, COMMUNITY BUILDING ACTIVITIES:AS MENTIONED UNDER PROMOTION OF COMMUNITY HEALTH WE HAVE A MULTITUDE OF PROGRAMS DESIGNED TO ADDRESS THE HEALTH OF OUR COMMUNITY INVOLVING ALL AGE GROUPS AND FOCUS ON WHAT AN INDIVIDUAL CAN DO TO IMPROVE HIS/HER HEALTH. MANY OF THE PROGRAMS REFLECTED IN PART II ARE DESIGNED TO PROMOTE HEALTHY OPTIONS AND CHOICES FOR OUR COMMUNITY WHICH IS AN IMPORTANT PART OF OVERALL COMMUNITY HEALTH AND THEREFORE A BENEFIT TO THE COMMUNITY.PART III, LINE 2: ACCOUNTS WITH UNRESOLVED PATIENT LIABILITY AFTER REASONABLE COLLECTION EFFORTS, SET BY POLICY AND IN CONJUNCTION WITH FEDERAL, STATE, AND PAYOR SPECIFIC REGULATIONS, WILL BE ASSIGNED TO BAD DEBT. THESE ACCOUNTS SHALL BE REFERRED TO AN OUTSIDE COLLECTION AGENCY, OR IN SELECTED INSTANCES, ATTORNEYS, FOR ADDITIONAL COLLECTION ACTIVITIES.
PART III, LINE 4:PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF ALLOWANCES FOR DOUBTFUL ACCOUNTS, CONTRACTUAL ADJUSTMENTS, AND MEDICALLY INDIGENT ALLOWANCES.PART III, LINE 5: MEDICARE REVENUE WAS COMPUTED AS FOLLOWS:PVHC COST REPORT: 87,131,659CENTER AVE COST REPORT: 3,678,552COLUMBINE HOMECARE COST REPORT: 1,200,461PVHC DISALLOWED PROGRAMS: 800,587JOINT VENTURES: 45,048,852TOTAL TO LINE 5: 137,860,111PART III, LINE 6: ALLOWABLE COSTS AS REPORTED ON THE POUDRE VALLEY HEALTH CARE INC. 2015 COST REPORT AGGREGATED WITH DISREGARDED ENTITIES AND OWNERSHIP PORTIONS OF JOINT VENTURES. PART III, LINE 6: MEDICARE ALLOWABLE COSTS OF CARE RELATING TO PAYMENTS WAS COMPUTED AS FOLLOWS:PVHC COST REPORT: 106,716,188CENTRE AVE COST REPORT: 5,645,512COLUMBINE HOMECARE COST REPORT: 1,436,645PVHC DISALLOWED PROGRAMS: 1,089,938JOINT VENTURES: 62,085,954TOTAL TO LINE 6: 176,974,237
PART III, LINE 8:APPROXIMATELY 23.48% OF NET PATIENT SERVICE REVENUE IS FROM PARTICIPATION IN THE MEDICARE PROGRAM, THUS PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES TO A SIGNIFICANT PORTION OF THE COMMUNITY POPULATION.
PART III, LINE 9B:PATIENT PROVIDES DOCUMENTATION BASED ON COLORADO INDIGENT CARE GUIDELINES, REVIEWED BY FINANCIAL ASSISTANCE COMMITTEE (FAC), CROSS FUNCTIONAL TEAM CHAIRED BY DIRECTOR PATIENT FINANCIAL SERVICES. UPON APPROVAL OR DENIAL OF THE REQUEST FOR CHARITABLE AID FROM THE FAC, THE PATIENT WILL BE ADVISED OF THE DECISION. THE BILL IS PARTIALLY OR TOTALLY ADJUSTED AS APPROVED BY THE FAC, NO FURTHER COLLECTION PROCESS WITH THE PATIENT. FOR ANY PORTION NOT ADJUSTED OFF, THE PROPER SEQUENCE OF ATTEMPTS TO COLLECT ARE FOLLOWED. FINAL ASSIGNMENT OF THE BILL IS TO A COLLECTION AGENCY.
PART VI, LINE 2:HEALTH CARE NEEDS ARE ADDITIONALLY IDENTIFIED THROUGH COLLABORATIVE RELATIONSHIPS WITH HEALTHCARE PROVIDERS IN THE COMMUNITIES WE SERVE. AN EXAMPLE IS OUR CARE COORDINATION INITIATIVE TARGETED TO AT-RISK CHILDREN WITH SPECIAL HEALTHCARE NEEDS . PHYSICIANS IDENTIFIED THE NEED TO IMPROVE THE COORDINATION AND TIMELINESS OF CARE FOR THIS POPULATION; WE RESPONDED BY DEVELOPING AND STAFFING A CARE COORDINATION / PATIENT NAVIGATION SERVICE MODEL (HEALTHY HARBORS).
PART VI, LINE 3:THERE ARE SEVERAL WAYS WE NOTIFY THE PATIENT AND ATTEMPT TO ASSIST THEM. FOR SURGERIES AND HIGH DOLLAR SCHEDULED PROCEDURES, WE PROVIDE THEM WITH AN ESTIMATE AT REGISTRATION AND GO OVER ALL FINANCIAL ASSISTANCE OPTIONS AVAILABLE IF THEY ARE INTERESTED. WE ALSO HAVE FINANCIAL COUNSELORS AVAILABLE EACH DAY THAT CAN ANSWER QUESTIONS AND HELP THEM FILL OUT CHARITY APPLICATIONS. FOR THOSE THAT ARE UNINSURED, OUR CONDITIONS OF SERVICE FORM HAS A SPOT THEY INITIAL STATING THAT WE HAVE OFFERED ASSISTANCE AND MADE THEM AWARE OF PROGRAMS AVAILABLE TO THEM. ONCE A PERSON HAS RECEIVED CARE IN THE EMERGENCY DEPARTMENT, WE ALSO HAVE EDUCATED STAFF THAT ASSISTS THEM AND EDUCATES THEM OF WHAT IS AVAILABLE FOR FINANCIAL ASSISTANCE. IN ADDITION, ONCE A PATIENT DOES RECEIVE A STATEMENT OR BILL, THERE IS INFORMATION ON THE BILL OF WHO THEY CAN CALL TO GET INFORMATION ON FINANCIAL ASSISTANCE.
PART VI, LINE 4:POUDRE VALLEY HEALTH CARE INC. IS A LOCALLY OWNED, PRIVATE, NON-PROFIT ORGANIZATION WITH A STRONG VISION: FROM HEALTH CARE TO HEALTH. BASED IN NORTHERN COLORADO, PVHC PROVIDES EVIDENCE-BASED HEALTHCARE AND WELLNESS SERVICES AND PRODUCTS IN COLORADO, NEBRASKA AND WYOMING, ACROSS A SERVICE AREA COVERING MORE THAN 50,000 SQUARE MILES.PVHC IS A PART OF THE UNIVERSITY OF COLORADO HEALTH WHICH AIMS TO DELIVER THE HIGHEST QUALITY PATIENT CARE WITH THE HIGHEST QUALITY PATIENT EXPERIENCE. THE PARTNERSHIP COMBINES POUDRE VALLEY HOSPITAL, MEDICAL CENTER OF THE ROCKIES, COLORADO HEALTH MEDICAL GROUP, UNIVERSITY OF COLORADO HOSPITAL AND MEMORIAL HEALTH SYSTEM INTO AN ORGANIZATION DEDICATED TO BUILDING HEALTHIER COMMUNITIES AND PROVIDING UNMATCHED PATIENT CARE IN THE ROCKY MOUNTAIN WEST. THE ORGANIZATION'S MISSION IS AS FOLLOWS: 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.
PART VI, LINE 5:WE HAVE IMPLEMENTED A MULTITUDE OF PROGRAMS AND SERVICES THAT ADDRESS THE HEALTH NEEDS OF OUR BROADER COMMUNITY TARGETING ALL AGE GROUPS WHILE MAINTAINING A SPECIAL FOCUS ON SERVING VULNERABLE POPULATIONS . WE ALSO GIVE DOLLARS TO OTHER ENTITIES THAT WORK TO IMPROVE THE HEALTH OF OUR COMMUNITY. EXAMPLES ARE: TEEN PREGNANCY PREVENTION EDUCATION; SUBSTANCE ABUSE PREVENTION EDUCATION FOR YOUTH AND YOUNG ADULTS; OBESITY PREVENTION; IMPROVED FOOD SECURITY FOR LOW INCOME RESIDENTS; AND MENTAL HEALTH SERVICES FOR THE UNDERSERVED.
PART VI, LINE 6:ALL THE SERVICES WE OFFER ARE AVAILABLE TO ANYONE THAT USES ANY OF OUR FACILITIES IN THE HEALTH SYSTEM. OUR GEOGRAPHY IS NOT THAT LARGE SO WE ARE ABLE TO ACCOMMODATE THE DIFFERENT COMMUNITIES THAT UTILIZE OUR SERVICES WITH THE SAME LEVEL OF COMMUNITY HEALTH PROGRAMMING.
PART VI, LINE 7, REPORTS FILED WITH STATESCO

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
COLORADO STATE UNIVERSITY
601 S HOWES STFORT COLLINSCO80523846000545GOVERNMENT$1,001,200SEE SCH I, PART IV
DOWNTOWN BUSINESS ASSOCIATION
19 OLD TOWN SQUARE 230FORT COLLINSCO80524840535419501(C )(3)$30,000SEE SCH I, PART IV
GREELEY CENTENNIAL ROTARY
1035 37TH AVE CTGREELEYCO80634840714073501(C )(3)$7,500SEE SCH I, PART IV
IVINSON MEMORIAL HOSPITAL FOUNDATION
255 N 30TH STREETLARAMIEWY82072836000188501(C )(3)$6,350SEE SCH I, PART IV
MARCH OF DIMES
1325 S COLORADO BLVD B308DENVERCO80222131846366501(C )(3)$12,500SEE SCH I, PART IV
POUDRE VALLEY MEDICAL GROUP
2315 E HARMONY ROAD 200FORT COLLINSCO80528800348943N/A$23,197,544SEE SCH I, PART IV
UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
13001 17TH PLACEAURORACO80045846000555501(C )(3)$5,900,180SEE SCH I, PART IV
THE COMMUNITY FOUNDATION
4745 WHEATON DR 100FORT COLLINSCO80528840699243501(C )(3)$6,970SEE SCH I, PART IV
UNITED WAY OF LARIMER COUNTY
424 PINE ST 102FORT COLLINSCO80524846031503501(C )(3)$39,146SEE SCH I, PART IV
UNIVERSITY OF N COLORADO
501 20TH STREETGREELEYCO80639846000546GOVERNMENT$49,400SEE SCH I, PART IV
NORTHERN COLORADO UNITED FOR YOU
2015 CLUBHOUSE 203GREELEYCO80634208575428501(C )(3)$24,500SEE SCH I, PART IV
PVH FOUNDATION
2315 E HARMONY ROAD 200FORT COLLINSCO80528741894581501(C )(3)$962,661SEE SCH I, PART IV
FieldValueIRS element (for citing)
Total501c3 Org11Total501c3OrgCnt
Total Other Org1TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE 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. QUESTION I, PART II, COLUMN H PURPOSE OF GRANT OR ASSISTANCE FOR RELATED ENTITIES, THE GRANTS ARE RELATED TO SPECIFIC REQUESTS. THE FUNDS ARE TO BE USED TO BENEFIT THE HEALTHCARE COMMUNITY OF NORTHERN COLORADO. EACH REQUEST IS EVALUATED ON AN INDIVIDUAL BASIS. FOR NON-RELATED COMMUNITY AND GOVERNMENTAL ORGANIZATIONS, THE GRANTS ARE MADE AT THE DISCRETION OF THE ORGANIZATION. THESE DISCRETIONARY GRANTS ARE TO BE USED TO BENEFIT THE HEALTHCARE COMMUNITY OF NORTHERN COLORADO.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KEVIN UNGER
PRESIDENT/CEO$226,390$226,390$302,581$302,581$9,832$9,832$3,900$3,900$50,277$50,276$592,980$592,979$229,185$229,185
STEPHANIE DOUGHTY
CFO$239,943$239,943$51,939$51,939$1,391$1,391$3,900$3,900$27,030$27,029$324,203$324,202$0$0
DONNA PODUSKA
CNO$192,486$0$39,783$0$3,009$0$7,001$0$26,363$0$268,642$0$0$0
MICHAEL RANDLE
CMO, CHMG$311,394$0$56,513$0$1,900$0$7,800$0$46,237$0$423,844$0$0$0
STANLEY GUNSTREAM
VP CHIEF QUALITY OFFICER$335,414$0$61,259$0$2,967$0$7,800$0$44,239$0$451,679$0$0$0
KENNETH WATANABE
PSYCHIATRIST$249,067$0$19,012$0$375$0$7,800$0$38,652$0$314,906$0$0$0
JANELL WOZNIAK
PHYSICIAN-RESIDENCY PGRM DIRECTOR$248,571$0$20,893$0$324$0$6,454$0$39,374$0$315,616$0$0$0
JOSEPH GOTTFRIED
PSYCHIATRIST$253,216$0$4,230$0$634$0$7,800$0$39,867$0$305,747$0$0$0
DANNY ROBINSON
CEO, CHMG$213,592$96,001$0$101,303$1,461$1,216$6,660$1,200$29,425$20,796$251,138$220,516$0$0
STEVEN SCHWARTZ
CFO, CHMG$94,415$88,080$0$36,308$202$289$2,888$3,776$13,931$16,653$111,436$145,106$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 1AFormAndLineReferenceDesc
ExplanationTRAVEL FOR COMPANIONS: PER SYSTEM POLICY, TRAVEL FOR COMPANIONS IS NOT REIMBURSABLE. FOR CONVENIENCE OF TRAVEL ARRANGEMENTS FOR THE ANNUAL BOARD MEMBER RETREAT AND SELECT CONFERENCES, PVHC PAYS FOR ONE COMPANION PER BOARD MEMBER AND EMPLOYEE ATTENDING THE CONFERENCE. EACH BOARD MEMBER RECEIVES A FORM 1099 FOR THIS INCOME. EACH EMPLOYEE HAS THIS ADDED TO THEIR FORM W-2. GROSS-UP PAYMENTS: GROSS UP PAYROLL IS CALCULATED AT YEAR END FOR SPECIAL CHECKS CREATED TO ADD SPECIFIC ITEMS TO EMPLOYEE'S FORM W-2 WAGES INCLUDING COUNTRY CLUB DUES, PERSONAL USE OF LAPTOP COMPUTERS AND IPADS, SPOUSE TRAVEL FOR ANNUAL BOARD RETREAT AND SELECT CONFERENCES AND IMPUTED INCOME ON LIFE INSURANCE POLICIES. CLUB DUES: THE HEALTH SYSTEM EXPECTS THE HOSPITAL MANAGEMENT TO PARTICIPATE IN COMMUNITY LIFE AND THEREFORE THE SYSTEM PAYS SOCIAL CLUB DUES FOR SPECIFIC MEMBERS OF THE SENIOR MANAGEMENT GROUP. THE CLUB DUES ARE ADDED TO THE SENIOR MANAGEMENT'S FORM W-2 ON AN ANNUAL BASIS.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
COLORADO HEALTH FACILITIES AUTHORITY SERIES A
A840752932196474W482005-03-31$50,000,000REFUNDING 1999A BONDS000
COLORADO HEALTH FACILITIES AUTHORITY SERIES B
B840752932196474W482005-03-31$26,294,807PAYMENT OF COMMERCIAL PAPER DEBT000
UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2015 SERIES A
C841179794914183AV02015-02-04$70,500,000CONSTRUCTION COSTS AT PVH000
UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2015 SERIES C
D841179794914183AX62015-02-04$56,850,000REFUNDING 2005F BONDS000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndCapital ExpendituresCapitalExpendituresAmtUnspentUnspentAmt
A$50,000,000$3,133,031$433,893$3,097,393$46,468,71320050Yes (1)Yes (1)Yes (1)
B$26,294,807$1,644,630$397,052$897,754$25,000,0002005Yes (1)0Yes (1)Yes (1)
C$70,500,000$625,1002015000Yes (1)$828,412$69,671,588
D$56,850,000$436,806$56,413,19420150Yes (1)Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A0Yes (1)000.002500.0025000Yes (1)
B0Yes (1)000.002500.0025000Yes (1)
C0Yes (1)000.002500.0025000Yes (1)
D0Yes (1)000.002500.0025000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A000Yes (1)0000Yes (1)
B000Yes (1)0000Yes (1)
C0Yes (1)00Yes (1)000Yes (1)
D0Yes (1)00Yes (1)000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)
CYes (1)
DYes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE K, PART I, COLUMN EBOND ISSUE PRICE THE BOND ISSUE PRICE FOR THE SERIES B BOND DOES NOT EQUAL THE ISSUE PRICE LISTED ON THE FILED FORM 8038 AS THIS BOND WAS SPLIT WITH A RELATED ENTITY. ISSUE PRICE AS REPORTED ON FORM 8038: $83,000,000.
SCHEDULE K, PART IV, LINE 2CTHE REBATE CALCULATION WAS PERFORMED IN APRIL 2015 FOR BOND ISSUANCES A AND B.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonKATHLEEN MICHIEPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionSEE PART VRelationshipDescriptionTxt
Transaction$65,727TransactionAmt
TransactionSEE PART VTransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONSFormAndLineReferenceDesc
Explanation(A) NAME OF PERSON: KATHLEEN MICHIE(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: KATHLEEN MICHIE IS A FAMILY MEMBER OF THAINE MICHIE, DIRECTOR(D) DESCRIPTION OF TRANSACTION: W-2 WAGESExplanationTxt

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)MEDICAL EQUIPMENT59$1,347,005FMV
Yes (X)SECURITY EQUIPMENT1$139,871FMV
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 6VOLUNTEERS PVH HAS 600 ACTIVE VOLUNTEERS IN FISCAL YEAR 2015. AT POUDRE VALLEY HOSPITAL, MEDICAL CENTER OF THE ROCKIES, AND OFF-SITE LOCATIONS, VOLUNTEERS PLAY AN INTEGRAL ROLE IN PROVIDING MUCH NEEDED SUPPORT FOR PATIENTS, VISITORS, PHYSICIANS, AND STAFF. FROM ASSISTING IN SURGERY AND CARDIAC WAITING ROOMS, INFORMATION DESK, VOLUNTEER PATIENT LIASONS, BABY KNITTERS, VOLUNTEENS, AND PET THERAPY TO NAME JUST A FEW OF THE MANY PROGRAMS, EVERY VOLUNTEER CONTRIBUTES TO THE SUCCESS OF POUDRE VALLEY HEALTH SYSTEM TO ENHANCE THE COMFORT AND CARE OF THE PATIENTS AND THEIR FAMILIES.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15UCHEALTH CONTRACTS WITH HAYGROUP FOR EXECUTIVE COMPENSATION CONSULTING SERVICES. ON OUR BEHALF THE HAYGROUP 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 ADVICES 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 19GOVERNING 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 XI, LINE 9:MCR DISTRIBUTIONS TO PVH 43,135,400. AUXILIARY INCOME ON 990, NOT IN AUDIT -98,022. DONATION TO FOUNDATION FROM AUXILLIARY NOT IN AUDIT EXPENSE 109,000. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS 37,679,904.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdTotal IncomeTotalIncomeAmtEnd Of Year AssetsEndOfYearAssetsAmtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
TIMBERLINE MEDICAL CLINIC
131 STANLEY AVEESTES PARKCO80517043772090OUTPATIENTCO$42,647$256,098PVHC INC
LAKOTA LAKE LLC
2315 E HARMONY RD STE 200FORT COLLINSCO80528841447761OUTPATIENTCO$5,538,239$16,883,808PVHC INC
HERON LAKE LLC
2315 E HARMONY RD STE 200FORT COLLINSCO80528264189163OUTPATIENTCO-$19,096$657,338PVHC INC
UNITED MED ALLIANCE
2021 BATTLECREEK DRIVE STE AFORT COLLINSCO80528820572743HEALTH CLAIMSCO$603,045PVHC INC

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
MEDICAL CENTER OF THE ROCKIES
2315 E HARMONY RD STE 200FORT COLLINSCO80528043730045TERTIARY CARECO501(C)(3)LINE 3PVHC INCYes (1)
PVHS FOUNDATION
2315 E HARMONY RD STE 200FORT COLLINSCO80528741894581BENEFIT HEALTHCO501(C)(3)LINE 7PVHC INCYes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
HARMONY SURGERY CENTER
2127 E HARMONY RD 200FT COLLINSCO80528841479751AMBULATORY SURGCON/ARELATED$1,900,616$2,787,702000.50000
CENTRE AVENUE HEALTH & REHAB FACILITY
947 WORTHINGTON CIRCLEFT COLLINSCO80526841560494NURSING FACILITYCON/ARELATED-$270,611$884,752000.50000
COLUMBINE POUDRE HOME CARE
947 WORTHINGTON CIRCLEFT COLLINSCO80526841529817NURSING CARECON/ARELATED$186,453$421,030000.50000
EYE LASER CENTER OF NO COLORADO
1725 E PROSPECT RDFORT COLLINSCO80525841518334LASER SURGERYCON/AUNRELATED$62,032$97,390000.50000
GATEWAY MEDICAL SERVICES
2500 E PROSPECT RDFORT COLLINSCO80525841427970REAL EST/MEDCON/AUNRELATED$4,091,236$10,495,595000.50000
POUDRE INFUSION THERAPY
947 WORTHINGTON CIRCLEFORT COLLINSCO80526841530973MEDICAL SERVICESCON/ARELATED-$46,748-$90,990000.50000
PVHS HOME MEDICAL SUPPLY
6820 N COUNTY RD 13LOVELANDCO80538202034599MEDICAL SUPPLYCON/AUNRELATED$199,583$1,214,1860Yes (1)0.50000
THE VEIN AND LASER CENTER OF NO COLORADO
2008 CARIBOU DRIVEFORT COLLINSCO80525204943970MEDICAL SERVICESCON/AUNRELATED$10,719$44,089000.33330
HARMONY IMAGING CENTER
1951 WILMINGTON DRIVEFORT COLLINSCO80528582479187MEDICAL IMAGINGCON/ARELATED$911,267$1,515,800000.46000
PEAK SURGICAL MANAGEMENT
2127 E HARMONY RD STE 200FORT COLLINSCO80528260899618SURGICAL MGMTCON/ARELATED$101,918$69,981000.14290
SURGERY CENTER OF FORT COLLINS
1100 E PROSPECT ROADFORT COLLINSCO80525841541559SURGICAL PROCCON/AUNRELATED$557,406$1,111,652000.26000
POUDRE VALLEY MEDICAL GROUP LLC
2315 E HARMONY RD STE 200FORT COLLINSCO80528800348943MEDICAL SERVICESCON/ARELATED-$35,583,712$24,787,4270Yes (1)0.99000
PVHS-ICM EHW
3702 AUTOMATION WAY 103FORT COLLINSCO80525463311308MEDICAL SERVICESCON/ARELATED-$24,509$147,454000.50000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1INNOVATION ENTERPRISESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12315 E HARMONY RD STE 200AddressLine1Txt
CityFORT COLLINSCityNm
State AbbreviationCOStateAbbreviationCd
ZIP80528ZIPCd
FieldValueIRS element (for citing)
EIN202036774EIN
Primary ActivitiesIT CONSULTINGPrimaryActivitiesTxt
Legal Domicile StateCOLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PVHCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income$981,858ShareOfTotalIncomeAmt
Share Of EOY Assets$2,385,612ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other OrgYes (1)AssetSaleToOtherOrgInd
Asset Purchase From Other OrgYes (1)AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (18 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
HARMONY SURGERY CENTER
A$914,950TRANSACTION TOTAL
HARMONY SURGERY CENTER
Q$587,134TRANSACTION TOTAL
HARMONY SURGERY CENTER
S$1,762,097TRANSACTION TOTAL
EYE LASER CENTER OF NO COLORADO
M$195,382TRANSACTION TOTAL
EYE LASER CENTER OF NO COLORADO
S$63,000TRANSACTION TOTAL
GATEWAY MEDICAL SERVICES
S$4,752,551TRANSACTION TOTAL
MEDICAL CENTER OF THE ROCKIES
L$7,692,636TRANSACTION TOTAL
MEDICAL CENTER OF THE ROCKIES
N$7,063,079TRANSACTION TOTAL
MEDICAL CENTER OF THE ROCKIES
S$43,135,400TRANSACTION TOTAL
PVHS FOUNDATION
B$914,115TRANSACTION TOTAL
PVHS FOUNDATION
C$1,572,744TRANSACTION TOTAL
PVHS FOUNDATION
L$65,301TRANSACTION TOTAL
PVHS FOUNDATION
N$71,335TRANSACTION TOTAL
INNOVATION ENTERPRISES
A$116,939TRANSACTION TOTAL
INNOVATION ENTERPRISES
A$265,445TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
B$23,197,253TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
J$3,179,116TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
M$3,728,747TRANSACTION TOTAL