2015-10-19T12:22:21-05:00 2014-12-31 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2014-01-01 840482695 Brighton Community Hospital Association % THE ORGANIZATION BRIG 3034981600 1600 Prairie Center Parkway Brighton CO 80601 HAROLD DUPPER VP FINANCE 3034981600 2015-08-30 true Rita F Worster CPA P00290681 7194714290 2014 2016-02-25 16:41:14Z Platte Valley Medical Center JOHN HICKS 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 146734056 false X WWW.PVMC.ORG X 1958 CO The mission of Platte Valley Medical Center is to provide excellent quality comprehensive health services, which are affordable, convenient, and responsive to community needs. 15 10 727 209 77275 36269 515669 320692 100141312 107565152 4508251 3626303 71365 1151917 105236597 112664064 65260 136476 0 0 40133132 42585168 0 0 198523 54071446 58089071 94269838 100810715 10966759 11853349 218966317 230554929 100329868 98663341 118636449 131891588 X To provide high quality health care services in a setting which considers not only the physical, but also the mental and spiritual needs of the community it serves. The medical center accepts all patients in emergency situations without regard to race, religion, national origin, or ability to pay. Individuals are classified as charity patients by the medical center if their income falls within pre-established parameters and they are not eligible for assistance under federal and/or state financial assistance programs. Because the hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as net revenue. Charity care provided at established rates for the years ended December 31, 2014 and 2013 were $10,179,266 and $16,516,145 respectively. false false 16286929 0 13896169 INPATIENT ROUTINE CARE, TOTAL PATIENT DAYS: 9,393 54459874 136476 70254231 INPATIENT/OUTPATIENT ANCILLIARY SERVICES, WEIGHTED PATIENT DAYS: 24,445 15550630 0 23762098 TOTAL EMERGENCY ROOM VISITS AND AMBULANCE CALLS: 26,633 86297433 true true false true false false false false false true true false false true false false false true false false false false false false false false true true true false true true false false false false false false false false false true false false false false true true true true false true 130 0 true 727 true true true false false false false false false false false false X 15 10 true false false false true true false true true false false true true true true true true true true false X THE ORGANIZATION 3034981600 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 JOHN HICKS CEO/PRESIDENT 50.0 1.0 X X 679009 0 38909 GERRY LEWIS-JENKINS DIRECTOR 3.0 0.0 X 250 0 0 MICHAEL DOLAN DIRECTOR/FOUNDATION CHAIR 3.0 1.0 X 350 0 0 WILLIAM LEE MD DIRECTOR 3.0 0.0 X 250 0 0 SUE CORBETT DIRECTOR 3.0 0.0 X 250 0 0 MICHELLE LEBLANC-GROSS DIRECTOR 3.0 0.0 X 250 0 0 ROBERT R FEIS DIRECTOR/VICE CHAIR 3.0 1.0 X X 350 0 0 MATT FLAHERTY MD DIRECTOR 3.0 0.25 X 19875 0 0 FAYE HUMMEL PHD DIRECTOR/CHAIR 3.0 0.0 X X 250 0 0 SONYA NORMAN MD DIRECTOR 3.0 0.0 X 250 200543 16084 LOWELL PALMQUIST DIRECTOR 3.0 0.0 X 250 0 0 JOHN RHOADES DIRECTOR 3.0 1.0 X 350 0 0 ROD BLUNCK DIRECTOR 3.0 0.0 X 250 0 0 KIRK QUACKENBUSH MD DIRECTOR/CHIEF OF STAFF 3.0 0.0 X 22830 0 0 RICHARD GONZALES DIRECTOR 3.0 0.0 X 250 0 0 HAROLD DUPPER CFO/CORPORATE SECRETARY 50.0 0.0 X 366060 0 33991 KURT GENSERT COO/CNO 50.0 0.0 X 314271 0 47941 DUANE LIVADNEY RADIOLOGY SUPERVISOR 50.0 0.0 X 140675 0 35375 MARY FEENEY DIRECTOR OF EMERGENCY SERVICES 40.0 0.0 X 145886 0 18199 DARRELL MESSERSMITH DIRECTOR OF INFORMATION SERVIC 40.0 0.0 X 133682 0 29510 ERIC STIRM PHARMACY DIRECTOR 40.0 0.0 X 180730 0 57417 KAREN WELZ OR DIRECTOR 40.0 0.0 X 152770 0 35691 2159088 200543 313117 53 false true false SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DALLAS TX 75312 SOFTWARE SUPPORT 1716459 SOUND PHYSICIANS 1123 PACIFIC AVENUE TACOMA WA 98402 Hospitalist services 1194885 ANESTHESIA SERVICES INC 15797 FORTUNE CT BRIGHTON CO 80601 ANESTHESIA SERVICES 886503 CHILDREN'S HOSPITAL 13123 E 16TH AVE AURORA CO 80045 SPECIAL CARE NURSERY 809359 INTEGRAL HEALTHCARE SERVICES 750 W HAMPDEN AVE 501 ENGLEWOOD CO 80110 COLLECTION SERVICES 693269 43 X 320692 320692 PATIENT SERVICES REV, NET OF ALLOWANCE 900099 87152231 87152231 MEDICARE/MEDICAID 900099 16858820 16858820 CLINIC SUPPORT SERVICES REVENUE 900099 2461278 2461278 ELECTRONIC HEALTH RECORDS REVENUE 900099 1046696 1046696 LOSS FROM SPECIALTY CLINC SUBSIDIARY 900099 -263130 -263130 309257 309257 107565152 2599068 77275 2521793 0 0 808638 786691 21947 0 21947 21947 34190536 120000 33217994 65307 972542 54693 1027235 1027235 0 0 0 CAFETERIA SALES 900099 474161 474161 340B PHARMACY REVENUE 900099 257796 257796 MISCELLANEOUS REVENUE 900099 398013 89550 308463 1129970 112664064 107912498 77275 4353599 X 136476 136476 0 0 0 1476360 1270703 205657 0 0 30570527 26919165 3563759 87603 869203 757479 105148 6576 7214022 6267695 923864 22463 2455056 2176559 266448 12049 14175 14175 309892 309892 383067 9845 373222 5759 5759 0 213714 213714 10764424 8110054 2635070 19300 242591 242591 4454772 3935166 476014 43592 3644589 1098906 2540883 4800 0 885877 754685 131192 71407 42237 28589 581 0 101004 77580 23344 80 3081255 2652036 429219 0 0 0 0 10570696 8921948 1648194 554 684145 586384 97761 MEDICAL SUPPLIES 12224222 12224222 BAD DEBT EXPENSE 5024756 5024756 PROVIDER FEE 4087891 4087891 OTHER DIRECT EXPENSES 1324835 1243646 80264 925 100810715 86297433 14314759 198523 X 8662142 8065330 17183753 20857021 0 0 12221640 13974564 0 0 0 0 212051 31820 590647 694460 1671748 1931469 162867112 80190296 85160951 82676816 71758998 75894482 6252200 9091548 0 0 0 0 15252187 17337419 218966317 230554929 9541167 11609736 0 0 0 0 90788701 87053605 0 0 0 0 0 0 0 0 0 0 100329868 98663341 X 116700490 129901843 1935959 1989745 0 0 118636449 131891588 218966317 230554929 X 11853349 1577415 -175625 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 5759 false false 5759 false LOBBYING EXPENSE PART II-B LINE 1G BRIGHTON COMMUNITY HOSPITAL ASSOCIATION D/B/A PLATTE VALLEY MEDICAL CENTER RECEIVED CORRESPONDENCE FROM THE AMERICAN HOSPITAL ASSOCIATION AND COLORADO HEALTH AND HOSPITAL ASSOCIATION REGARDING THEIR MEMBERSHIP DUES. A PORTION OF THEIR DUES WAS ATTRIBUTABLE TO LOBBYING. 1935964 374478 320692 1989750 1823296 628337 515669 1935964 1483995 487280 147979 1823296 1387279 186906 90190 1483995 1295994 416950 102928 222737 1387279 0.00000 0.00000 1.00000 false true true 11132497 11132497 90239560 40192462 50047098 255631 255631 50430146 36385083 14045063 10809278 3357120 7452158 82676816 DEFERRED FINANCING COSTS 8248344 FOUNDATION 1989750 INTEREST INVESTMENT RECEIVABLE 397394 RELATED PARTY RECEIVABLE 6701931 17337419 106366405 1577415 117590 1695005 104671400 202177 7790487 7992664 112664064 93111544 63804 63804 93047740 202177 7560798 7762975 100810715 Describe the intended uses of the organization's endowment funds SCHEDULE D, PART V, LINE 4 THE TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE MEDICAL CENTER HAS BEEN LIMITED BY DONORS TO A SPECIFIC TIME PERIOD OR PURPOSE. UNCERTAIN TAX POSITIONS PART X, LINE 2 Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. REVENUE ON BOOKS, NOT ON RETURN SCHEDULE D, PART XI, LINE 2D CHANGE IN INTEREST IN NET ASSETS OF PLATTE VALLEY MEDICAL CENTER FOUNDATION 53,786 ELIMINATIONS BETWEEN DISREGARDED ENTITY & PVMC 63,804 TOTAL 117,590 REVENUE ON RETURN, NOT ON BOOKS SCHEDULE D, PART XI, LINE 4B REVENUE PASSED THRU THE COLORADO HOSPITAL ASSN TRUST FOR WORKER'S COMPENSATION 227,178 REVENUE OF PVMC CLINIC SUPPORT SERVICES (SINGLE MEMBER LLC) included in the clinic subsidiary information on the consolidated financial statements 2,461,278 BAD DEBT EXPENSE CLASSED AS REVENUE IN FINANCIAL STATEMENTS 5,024,756 IMPUTED INTEREST - CLINICS 77,275 TOTAL 7,790,487 EXPENSE ON RETURN, NOT ON BOOKS SCHEDULE D, SCHEDULE D, PART XII, LINE 4B EXPENSE PASSED THRU THE COLORADO HOSPITAL ASSN TRUST FOR WORKER'S COMPENSATION 74,764 EXPENSE OF PVMC CLINIC SUPPORT SERVICES (SINGLE MEMBER LLC) included in the clinic subsidiary information on the consolidated financial statements 2,461,278 BAD DEBT EXPENSE CLASSED AS REVENUE IN FINANCIAL STATEMENTS 5,024,756 TOTAL 7,560,798 EXPENSE ON BOOKS, NOT ON RETURN SCHEDULE D, PART XII, LINE 2D ELIMINATIONS BETWEEN DISREGARDED ENTITY & PVMC 63,804 true true X true X 125. true X true true true false true true 425 3390713 0 3390713 0.03540 16524 24039207 14523622 9515585 0.09930 16949 27429920 14523622 12906298 0.13470 15 102671 113664 9663 104001 0.00110 1 202 150454 0 150454 0.00160 3 119399 136878 0 136878 0.00140 19 222272 400996 9663 391333 0.00410 19 239221 27830916 14533285 13297631 0.13880 1 58 895 1 58 895 true 5024756 18990710 17243080 1747630 X true true 1 1 BRIGHTON COMMUNITY HOSPITAL ASSOC 1600 Prairie Center Parkway BRIGHTON CO 80601 www.pvmc.org X X X X BRIGHTON COMMUNITY HOSPITAL ASSOC false false true X X X X X X X X X 13 true false false true X PVMC.ORG/ABOUT-US/COMMUNITY-BENEFITS/ true 13 true PVMC.ORG/ABOUT-US/COMMUNITY-BENEFITS/ false false true X 125. 250. X X X X X X true true X X X X true X X X X X X X X true X false X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 Targeted interviews were used to gather information and opinions from persons who represent the broad interests of the community served by pvmc. Sixteen interviews were completed during september and october, 2012. For the interviews, community stakeholders identified by pvmc were contacted and asked to participate in the needs assessment. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, minority and chronic disease populations, or regional, state or local health or other departments or agencies that have "current data or other information relevant to the health needs of the community served by the hospital facility". A list of the stakeholder interview respondents, their titles, organizations and leadership roles can be found in attachment 2 of the community health needs assessment. SCHEDULE H, PART V, SECTION B, LINE 11 The needs that were identified as priorities by the 2013 CHNA included: Access to Care, Cancer and Cardiovascular Disease. To address the identified health need of access to care, PVMC is: - Offering financial assistance to individuals who do not qualify for the State Safety-net Healthcare Programs, Colorado Indigent Care Program (CICP) or Medicaid and who do not have the resources to pay for their care. - Offering assistance with financial counseling, education on insurance programs, screening for Medicaid, and assistance with Medicaid application process to our inpatient, outpatient and Emergency department clients. Financial counseling is available if the patient does not qualify for Medicaid. - Providing infrastructure in two communities (Ft. Lupton and Commerce City) that currently have very limited access to medical providers by building medical office buildings. - Subsidizing primary care and specialty medical providers in communities where access to these services is limited. - Subsidizing an ambulance service for our service area. - Providing resources for recruitment of local primary care physicians (PCP). We provide staff for the recruitment process and financial guarantees when necessary. - Providing a hospitalist program for management of inpatient care to the patients of community primary care providers, allowing community providers to remain full-time at their clinics for primary care visits. - Offering health education, preventive services and free and low-cost screenings to the community including: * An annual health fair, offering low-cost blood tests as well as free screenings, exams and consultation with a medical professional. Calls are made to participants with critically abnormal lab values. Assistance is provided to people who do not have access to health care services. * Girl's Night Out, which is an annual event that offers education, screening exams, consultations with medical professionals, and easy access to making mammogram appointments. - Subsidizing the cost of a health coach for the employee wellness program for the local municipality of Brighton. To address the identified health need of cancer, PVMC offers: - A monthly Cancer Support Group, which is open to the public. - Low-cost mammograms for uninsured women. - Free cancer screenings: skin cancer checks, pap smears, breast exams at an annual health fair. - Educational seminars on cancer topics which are open to the public and presented at the hospital and the local senior center. To address the identified health need of cardiovascular disease, PVMC offers: - A stroke support group, which is open to the community. - Cardiac Rehab and Cardiac Support Group which are open to the community. - Educational seminars related to cardiac care are open to the community. - An Annual Health Fair offering blood pressure checks and Cardiac Risk Assessment. - A Stroke Fair to provide stroke education to the community. Other Health Needs not addressed: Platte Valley Medical Center has chosen not to actively address the remaining health needs identified in the CHNA as they were not selected as priority health needs: birth indicators (prenatal care, low birth weight), housing / homelessness, mental health, overweight and obesity, preventive care, smoking, transportation, and unintentional injuries. Taking existing community resources into consideration, Platte Valley Medical Center has selected to concentrate on those health needs that we can most effectively address given our areas of focus and expertise. Therefore, the hospital's charitable resources will be placed on the selected priority health needs. SCHEDULE H, PART V, SECTION B, LINE 13b EXPLAIN INCOME LEVEL OTHER THAN FPG: PLATTE VALLEY MEDICAL CENTER LOOKS AT OTHER FACTORS IN ADDITION TO FAMILY INCOME LIMITS AS A PERCENTAGE OF FEDERAL POVERTY GUIDELINES, SUCH AS MONTHLY EXPENSES AND INDIVIDUAL FINANCIAL SITUATIONS. SCHEDULE H, PART V, SECTION B, LINE 16a & 16C WEBSITE URL FOR FAP AND PLAIN LANGUAGE FAP SUMMARY: https://www.pvmc.org/patients-visitors/billing-insurance/charity-care-poli cy/ SCHEDULE H, PART I, LINE 3C FREE AND DISCOUNTED CARE ELIGIBILITY PERCENTAGES PLATTE VALLEY MEDICAL CENTER LOOKS AT OTHER FACTORS IN ADDITION TO FAMILY INCOME LIMITS AS A PERCENTAGE OF FEDERAL POVERTY GUIDELINES, SUCH AS MONTHLY EXPENSES AND INDIVIDUAL FINANCIAL SITUATIONS. SCHEDULE H, PART I, LINE 7, COLUMN F BAD DEBT EXPENSE The organization's bad debt expense is presented as a component of net patient service revenue on the financial statements, therefore it is not reduced from the denominator in arriving at the percentage calculation. Total bad debt expense netted against patient service revenue was $5,024,756. SCHEDULE H, PART I, LINE 7 The organization used a cost-to charge ratio for lines 7a and 7b. The cost-to-charge ratio was derived from Form 990, Schedule H instructions, Worksheet 2, Ratio of Patient Care Cost-to-Charges. 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. SCHEDULE H, PART II, Coalition Building DESCRIBE HOW THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITY IT SERVES: PVMC sponsors a quarterly meeting of agencies in our service area known as the Brighton Service Agency Coalition. This meeting is a networking meeting for community service organizations to hear about resources for their clients. Some of the members of the coalition include people from: local health clinics, mental health counseling centers, school district, home health care agencies, transportation providers, homeless shelter, Adams County Human Services Agency, and Adams County Work Force Center. The PVMC staff also forwards any emails generated by the members to the full coalition to help promote upcoming events or educational offerings. SCHEDULE H, PART III, LINE 2 & 4 Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Medical Center analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Medical Center analyzes contractually due amounts and provides an allowance for the difference between contract rates for services and the amounts charged for services and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make unlikely the realization of amounts due). For receivables associated with patients with self-pay account balances (including both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a significant provision for uncollectible accounts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Medical Center's allowance for doubtful accounts for self-pay patients was 74% and 67% of self-pay accounts receivable at December 31, 2014 and 2013, respectively. The Medical Center identified and wrote off bad debt accounts of approximately $4,316,000 for the year ended December 31, 2014, which was a decrease of approximately $505,000 over approximately $4,821,000 for the year ended December 31, 2013. Due to financial class changes as a result of the Affordable Care Act and Medicaid expansion, much of the decrease was the result of the dynamics associated with increased Medicaid eligibility and a reduction in self-pay, although higher out-of-pocket responsibilities of consumer-driven health care plans continue to impact doubtful account write-offs. Bad debt expense is determined using the methodology as described in the note to the financial statements as shown above. SCHEDULE H, PART III, LINE 8 The Medicare allowable costs were determined from the Medicare cost report. IRS Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with government health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. This implies that treating Medicare patients is a community benefit. SCHEDULE H, PART III, LINE 9B The hospital charity care policy outlines steps for financial counselors to follow to identify and qualify patients eligible for charity care and steps to collect information. The policy also describes the application form to be completed by the patient, the review process by a financial counselor, patient follow up, and the write off of patient charges to charity care. SCHEDULE H, PART VI, NEEDS ASSESSMENT Programs and services provided by the hospital to the community are based upon strategic assessment of community need conducted by hospital administration and the hospital board of directors. Information considered in the assessment include Platte Valley Medical Center historic and projected inpatient admissions, historic and projected outpatient and emergency room visit data, County and State demographics, Colorado Department of Public Health and Environment health statistics, and community requests. SCHEDULE H, PART VI, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE Platte Valley Medical Center makes available to patients a Frequently Asked Questions (FAQ's) hand-out, which includes information about financial assistance, and whom to call. The same FAQ is located on Platte Valley Medical Center's website. Financial counselors are located in the emergency department during peak days and hours to screen for, identify, and advise patients who need financial assistance. In addition, financials counselors are staffed monday through friday to work with patients who need financial assistance to settle their accounts or schedule hospital services. SCHEDULE H, PART VI, COMMUNITY INFORMATION Our primary service area includes the communities of Brighton (zip codes 80601,80602, and 80603), Ft. Lupton (80621), and Commerce City (80022). Specifically the following : Carrier Routes: RR1, RR3, RR4, 445, RR6, RR7 & Census Tracts: 008512 and 00870. Our secondary service area includes: Thornton (80241), Henderson (80640), Hudson (80642), & Keenesberg (80643). SCHEDULE H, PART VI, PROMOTION OF COMMUNITY HEALTH PVMC utilizes a tithing program to fund the "Community Health Improvement Program." Through a granting process, this program provides funding to local non-profit organizations whose programs have a link to health promotion. The hospital provides a site for clinical education for local Community colleges and Universities. Student programs include nursing, pharmacist, phlebotomy, medical imaging, EMT, dietitian, physical therapist, surgical and nursing assistant. The hospital provides educational support programs through the cancer and stroke support groups and educational seminars which are offered monthly. Through the annual flu clinics, members of the community have access to low cost or no copay influenza and pneumonia immunizations. Due to the hospital's dedication to an annual health fair and to an annual stroke fair and women's health fair, members of the community have access to low or no cost health screenings and blood tests. The ambulance service provides first aid stand by to the majority of community sponsored events (city celebrations, school sponsored athletic events, county events) throughout the year at no cost to the organizations that are sponsoring the event. The emergency department sponsors an educational event for high school students during the prom season. Students are videotaped during the simulation of a fatal drunk driving accident, trip to the emergency department and notification to the parents of the death of the child. There is an entire day centered around this event for the students involved in the simulation as well as all the students at the school. At the end of the school day, the video is shown to the entire student body to show the devastating consequences of drunk driving. true WELD CENTRAL HIGH SCHOOL 99 WEST BROADWAY AVE KEENESBURG CO 80643 846013310 GOVERNMENT 18500 ATHLETIC TRAINER COLORADO MISSION OF MERCY 430 COLORADO AVENUE PUEBLO CO 81004 271586585 501(C)(3) 15000 SUBSIDIZE COST FREE DENTAL CARE UNITED WAY OF WELD COUNTY PO BOX 1944 GREELEY CO 80632 846011918 501(C)(3) 9000 SUBSIDIZE THREE CHILDRENS PROGRAMS PENNOCK CENTER FOR COUNSELING 211 S 21ST AVE BRIGHTON CO 80601 200986823 501 (C)(3) 10572 SUBSIDIZE COST HOPE MIRACLE HOUSE 306 PARK AVE FORT LUPTON CO 80621 465508034 501(C)(3) 9000 HOMELESS SHELTER SPRINKLER SYSTEM SENIOR HUB 2360 WEST 90TH AVENUE FEDERAL HEIGHTS CO 80260 742412032 501 (C)(3) 7000 SUBSIDIZE COST THE BOYS & GIRLS CLUBS OF WELD PO BOX 812 GREELEY CO 80632 840529902 501(C)(3) 20000 SUPPORT PROGRAMS CASA 1100 JUDICIAL CENTER DR BRIGHTON CO 80601 311657019 501(C)(3) 10000 HELP WITH COST ADVOCATE COORDINATOR 8 DESCRIBE THE ORGANIZATION'S PROCEDURES FOR MONITORING USE OF GRANT FUNDS SCHEDULE I, PART I, LINE 2 All grant recipients are first required to submit applications which detail the intended uses of grant funds. After grants have been awarded, recipients are required to complete a final report indicating how grant funds were actually spent. X X true true X X X X X X true false false false false false false true false JOHN HICKS CEO/PRESIDENT 454318 0 133488 0 91203 0 20800 0 18109 0 717918 0 0 0 SONYA NORMAN MD DIRECTOR 0 200379 0 0 250 164 0 16018 0 66 250 216627 0 0 DUANE LIVADNEY RADIOLOGY SUPERVISOR 90268 0 0 0 50407 0 6049 0 29326 0 176050 0 0 0 MARY FEENEY DIRECTOR OF EMERGENCY SERVICES 94547 0 8883 0 42456 0 1787 0 16412 0 164085 0 0 0 DARRELL MESSERSMITH DIRECTOR OF INFORMATION SERVIC 119857 0 13617 0 208 0 4220 0 25290 0 163192 0 0 0 HAROLD DUPPER CFO/CORPORATE SECRETARY 247793 0 73329 0 44938 0 20800 0 13191 0 400051 0 0 0 KURT GENSERT COO/CNO 227006 0 68839 0 18426 0 20800 0 27141 0 362212 0 0 0 ERIC STIRM PHARMACY DIRECTOR 161335 0 19131 0 264 0 27968 0 29449 0 238147 0 0 0 KAREN WELZ OR DIRECTOR 131579 0 10399 0 10792 0 20801 0 14890 0 188461 0 0 0 Information Regarding BenefITS Provided SCHEDULE J, PART I, LINE 1A CHRISTMAS GIFTS ARE GROSSED UP FOR HOSPITAL EMPLOYEES AND TAXED: JOHN HICKS, HAROLD DUPPER, KURT GENSERT, ERIC STIRM, KAREN WELZ, DUANE LIVADNEY RECEIVED CHRISTMAS GIFTS DURING 2014. SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A MARY FEENEY WAS PAID A ONE TIME SEVERANCE PAYMENT DURING 2014 IN THE AMOUNT OF $42,388.06. THIS AMOUNT IS INCLUDED ON SCHEDULE J, PART II, COLUMN (B)(III) AS OTHER REPORTABLE COMPENSATION. Explanation of non-fixed payments SCHEDULE J, PART I, LINE 7 The organization has an incentive bonus policy that is determined and adopted by the board and administration of the organization. The policy has multi-tiered financial, operational/strategic, quality performance, and community integration objectives. INFORMATION REGARDING COMPENSATION REPORTING SCHEDULE J, PART II BONUSES EARNED FOR THE 2014 CALENDAR YEAR WERE PAID OUT WITHIN 2.5 MONTHS AFTER YEAR END FOR ALL EXECUTIVES. THE FOLLOWING INDIVIDUALS DID NOT RECEIVE 2014 BONUS PAYOUTS WITHIN THAT TIME FRAME, THEREFORE THE W-2 WAGE AMOUNT ON PART II INCLUDES THE 2014 BONUS (EARNED IN 2013, PAID OUT IN 2014), AND THE OTHER DEFERRED COMPENSATION COLUMN WILL INCLUDE THE ACCRUAL OF THE 2014 BONUS (EARNED IN 2014, PAID IN 2015). - ERIC STIRM - KAREN WELZ A ADAMS COUNTY COLORADO 846000732 005622BE4 2005-06-15 123605753 CONSTRUCT AND EQUIP FACILITY false false false A 31346395 0 123671567 8679000 7855216 0 1335822 1056070 5708505 85981654 13055000 0 2007 true false true true A false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true A false false false true false true GOLDMAN SACHS CAP 0.5 false false true JP MORGAN CHASE 2.1 true false true A true SCHEDULE K, PART IV, LINE 2C THE REBATE COMPUTATION WAS PERFORMED ON AUGUST 25, 2010 FOR THE PERIOD JUNE 15, 2005 TO JUNE 15, 2010. Anesthesia Services LLC see part IV 886503 anesthesia services false COPIC see part IV 388004 insurance services false RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION PART IV, COLUMN B ANESTHESIA SERVICES, LLC - MATTHEW FLAHERTY IS A DIRECTOR OF PVMC, AND OWNS A GREATER THAN 5% INTEREST IN ANESTHESIA SERVICES, LLC. PVMC PAID ANESTHESIA SERVICES $886,503 DURING 2014. COPIC - GERRY LEWIS-JENKINS IS A DIRECTOR OF PVMC, AND IS AN OFFICER OF COPIC. PVMC PAID COPIC $388,004 DURING 2014. Material Differences in Voting Rights Form 990, Part VI, Section A, line 1a The CEO serves on the Board and is paid by Platte Valley Medical Center as an employee. Therefore, he does not vote on his own compensation but is permitted to vote on all other matters. Family/Business Relationship Form 990, Part VI, Section A, Line 2 John Hicks and Harold Dupper have a business relationship because they are directors of the wholly owned subsidiaries disclosed on Schedule R, Part IV. Classes of Members or Stockholders and voting rights Form 990, Part VI, Section A, Line 6 & 7a The membership of the Brighton Community Hospital Association shall consist of Founders (Founders are defined as contributors to the original 1960 capital campaign and are Association members for life.); all duly elected and appointed members of the Hospital Board of Directors then in office; and all individuals, families, entities or organizations who have made a donation to the Association or the Platte Valley Medical Center Foundation in a qualifying amount. Qualifying membership levels per calendar year are: Individual (one vote) $50, Family (two votes) $75, Corporation (one vote) $150. Gifts from other foundations in any amount would not qualify to receive a ballot. If a donor is in compliance with a multi-year pledge, they will receive the appropriate number for their level of contribution for that voting cycle. In the event that a donor has made a multi-year pledge and completes the gift prior to the pledge due date, the donor will continue to receive the appropriate number of ballots and mailings through the initial terms of the pledge. If the pledge is in default and has been written off by the Foundation Finance Committee, the donor will receive the appropriate number of ballots for the amount of the pledge that was received during the voting cycle. There may be variations from the above or extenuating circumstances regarding particular donors that may require a judgment call to be made. For this reason, prior to each ballot mailing, the mailing list will be reviewed by the CEO or an appointed representative. MEMBERSHIP CALENDAR Association Board Member Elections: A rolling two-year list of qualifying donors who have contributed from the last election to the present election will be created for the ballot mailing. This provides all Association Members a vote whether they gave in an election year or not. Membership Mailings (i.e. Annual Report and event invitations): The last full calendar year of qualifying donors and all donors in the current calendar year up to the time of the mailing will be used. Process to Review the Form 990 Form 990, Part VI, Section B, line 11b The form 990 is prepared by a third party. The 990 goes through a detailed review by the accounting manager and chief financial officer. Once this review is complete, the 990 is presented to the audit/finance committee where they approve and recommend the 990 to the board of directors. Once approved, a copy of the 990 is made available to each board member before filing with the IRS. Process for Monitoring Compliance with Conflict of Interest Policy Form 990, Part VI, Section B, line 12c The organization has a compliance officer who monitors the organization's conflict of interest policy. The board of directors, officers and key employees are required annually to complete and review the conflict of interest policy and disclose any potential conflicts. Directors are not permitted to vote on issues where they have a conflict of interest. Review of CEO & other officer's compensation Form 990, Part VI, Section B, line 15a & 15b Platte Valley Medical Center uses the services of an independent compensation consultant, Yaffee & Company, to establish compensation for the CEO, other officers and Key Employees. A review was done in 2014. Upon completion of the compensation analysis, the compensation package is recommended to the compensation committee of the board for approval. Officers have written employment contracts which are signed and maintained by the human resource department. Governing Documents Available to the Public Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are made available to the public upon request. Other Changes in Net Assets Form 990, Part XI, Line 9 CHANGE IN INTEREST IN NET ASSETS OF PLATTE VALLEY MEDICAL CENTER FOUNDATION 53,786 NET REVENUE PASSED THRU THE COLORADO HOSPITAL ASSN TRUST FOR WORKER'S COMPENSATION (152,414) IMPUTED INTEREST - CLINICS (77,275) EQUITY ADJUSTMENT 278 TOTAL (175,625) FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:4010766 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED STAFF LABOR TOTAL FEES:701943 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:1013537 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION SERVICES TOTAL FEES:1144849 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:1001767 FORM 990 PART IX LINE 11G DESCRIPTION:SURGICAL ASSISTANT TOTAL FEES:45032 FORM 990 PART IX LINE 11G DESCRIPTION:NURSERY SPECIALIST TOTAL FEES:814118 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:107298 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE TOTAL FEES:649694 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER HEALTH SERVICES TOTAL FEES:453017 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER SERVICES TOTAL FEES:822403 PVMC CLINIC SUPPORT SERVICES INC 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 453962647 CLINICAL SVCs CO 2461278 441191 PVMC PLATTE VALLEY MEDICAL IMAGING LLC 1606 PRAIRIE CENTER PARKWAY 130 BRIGHTON CO 80601 320402320 XRAY SERVICE CO 50942 51942 PVMC PLATTE VALLEY MEDICAL CENTER FOUNDATION 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 742255936 FUNDRAISING CO 501(C)(3) ln11 type I PVMC true PVMC PHYSICIAN SERVICES INC 1606 PRAIRIE CENTER PARKWAY SUITE 2 BRIGHTON CO 80601 943458548 MEDICAL CO PVMC C-Corporation 944 2053 1.00000 true HIGH PLAINS HEART AND VASCULAR CENTER 1606 PRAIRIE CENTER PARKWAY SUITE BRIGHTON CO 80601 272038197 MEDICAL CO PVMC C-Corporation 1449033 318144 1.00000 true INTEGRATED INTERNAL MEDICINE ACUPUNCTURE 1606 PRAIRIE CENTER PARKWAY SUITE BRIGHTON CO 80601 274433325 MEDICAL CO PVMC C-Corporation 508121 154916 1.00000 true MOUNTAIN VIEW ORTHOPEDICS INC 1606 PRAIRIE CENTER PARKWAY SUITE BRIGHTON CO 80601 275382523 MEDICAL CO PVMC C-Corporation 2535437 384162 1.00000 true EAGLE RIDGE MEDICAL INC 1606 PRAIRIE CENTER PKWY SUITE 240 BRIGHTON CO 80601 462387681 MEDICAL CO PVMC C-Corporation 950886 219383 1.00000 true true true true true false false false false false false false true true true true true true true false PVMC Physician Services Inc A 300 imputed amount High Plains Heart & Vascular Center Inc A 214634 imputed amount INTEGRATED INTERNAL MEDICINE ACUPUNCTURE A 127175 imputed amount Mountain View Orthopedics Inc A 192243 imputed amount EAGLE RIDGE MEDICAL INC A 140113 imputed amount Platte Valley Medical Center Foundation C 320692 CASH TRANSFER High Plains Heart & Vascular Center D & R 2719941 a/r balance Integrated Internal Medicine & Acupuncture D & R 938878 a/r balance Mountain View Orthopedics Inc D & R 2325416 a/r balance eagle ridge medical inc D & R 687511 a/r balance high plains heart & vascular center Q 758799 billed amount Integrated Internal Medicine & Acupuncture Q 330727 billed amount Mountain View Orthopedics Inc Q 895398 billed amount eagle ridge medical inc Q 476354 billed amount