2014-08-05T08:41:01-05:00 2013-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2013-01-01 742358522 NCMC INC NCMC 9703506052 1801 16TH STREET GREELEY CO 80631 ROBERT E MURPHY TREASURER 9703506052 2014-07-31 1 LISA CHAFFEE CPA P00193453 7012398500 2014-07-31 2013 2015-11-30 17:44:51Z KEN SCHULTZ 1801 16TH STREET GREELEY CO 80631 185651711 0 X N/A X 1984 CO LEASING OF HOSPITAL FACILITIES TO ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE IRS CODE FOR THE PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY. 10 10 0 10 0 0 4029042 567255 30911590 32221099 9153925 20030681 247204 252694 44341761 53071729 2475000 4300000 0 0 3414007 4489141 0 0 0 30228187 35964124 36117194 44753265 8224567 8318464 489930200 515667379 261474188 243613937 228456012 272053442 TO PROVIDE QUALITY HEALTHCARE AT A REASONABLE COST TO THE NCMC SERVICE COMMUNITY. 0 0 43431163 4300000 32221099 NCMC, INC. LEASES A HOSPITAL BUILDING, EQUIPMENT AND BUSINESS FRANCHISE TO BANNER HEALTH SYSTEM (AN ARIZONA 501(C)(3) ORGANIZATION), WHO OPERATES THE HOSPITAL IN A CHARITABLE FASHION. NCMC, INC IS RESPONSIBLE FOR MAINTAINING THE PROPERTY AND EQUIPMENT FOR ITS USE BY BANNER HEALTH (NORTH COLORADO MEDICAL CENTER) TO PROVIDE ACUTE MEDICAL SERVICES. 43431163 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 21 0 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 1 1 1 1 0 0 1 1 1 1 0 1 0 0 0 X KEN SCHULTZ 9703506052 1801 16TH STREET GREELEY CO 80631 X AL DOMINGUEZ PRESIDENT & CHAIR 1.00 X X 0 0 0 ROBERT NOFFSINGER VICE CHAIR 1.00 X X 0 0 0 ROBERT E MURPHY TREASURER 1.00 X X 0 0 0 BRANDON HOUTCHENS SECRETARY 1.00 X X 0 0 0 LINDA WINTER DIRECTOR 1.00 X 0 0 0 KAY KOSMICKI DIRECTOR 1.00 X 0 0 0 JEFFREY CARLSON DIRECTOR 1.00 X 0 0 0 VICKI WILSON PHD RN DIRECTOR 1.00 X 0 0 0 MICHAEL J GEILE DIRECTOR 1.00 X 0 0 0 DAVE OWEN DIRECTOR 1.00 X 0 0 0 KEN SCHULTZ BOARD EXECUTIVE 40.00 X 0 0 0 0 0 0 0 0 0 0 JE DUNN CONSTRUCTION 1001 LOCUST KANSAS CITY MO 64106 CONSTRUCTION CONTRACTOR 4092024 HENSEL PHELPS CONSTRUCTION 420 6TH AVE GREELEY CO 80632 CONSTRUCTION CONTRACTOR 3342788 COE CONSTRUCTION INC 2302 EAST 13TH STREET LOVELAND CO 80537 CONSTRUCTION CONTRACTOR 1420215 UBS FINANCIAL SERVICES INC 1901 56TH AVE SUITE 300 GREELEY CO 806342950 INVESTMENT MANAGERS 623338 HKS INC PO BOX 731121 DALLAS TX 753731121 ARCHITECT SERVICES 434680 17 567255 567255 HOSPITAL FACILITY RENT 532000 32218651 32218651 2448 2448 32221099 14745879 14745879 508217 255523 252694 252694 252694 137455406 153855 131842827 481632 5612579 -327777 5284802 5284802 53071729 32221099 0 20283375 4300000 4300000 4489141 4489141 205100 3017 202083 15972 15972 64550 64550 1021692 1021692 14300 14300 4940 1435 3505 439104 439104 2300 2300 2574 2574 5777547 5777547 21011610 21011610 ENVIRONMENTAL REMEDIATI 7000000 7000000 BOND FEES 330690 330690 73745 73745 44753265 43431163 1322102 0 12611333 20641851 47802 84089 434078934 255100492 175581555 178978442 268527776 279355422 24045297 25888171 3670929 3670929 5445508 7048475 489930200 515667379 18898219 10279179 230087928 218728577 12488041 14606181 261474188 243613937 X 228456012 272053442 228456012 272053442 489930200 515667379 X 8318464 22079776 13199190 X 0 1 X 1 0 X X X 0 0 0 NCMC BOARD OF TRUSTEES 846000813 6 1 1 1 32041099 1 32041099 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4149239 4149239 13372605 249415580 130367431 132420754 148810903 119111952 29698951 5861886 12468721 5621109 12709498 178978442 ALTERNATIVE INVESTMENTS 25888171 C 25888171 INTEREST RATE SWAP 7606181 ASSET RETIREMENT OBLIGATIONS 7000000 14606181 X 84515500 22079776 9177498 31257274 53258226 -186497 -186497 53071729 40918070 186497 186497 40731573 4021692 4021692 44753265 PART X, LINE 2: NCMC, INC. IS A COLORADO NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) OF THE CODE, AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 509(A)(3) OF THE CODE. NCMC, INC. IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE CORPORATION MAY BE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. NORMEDCO CARE, LLC; SOUTHSIDE INVESTMENTS, LLC; AND SHEEP DRAW FARMS, LLC ARE CONSIDERED DISREGARDED ENTITIES AND THEIR INCOME AND EXPENSES ARE REPORTED IN THE TAX RETURN OF THE SOLE MEMBER (NCMC). NCMC BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. NCMC WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. NCMC'S HISTORICAL FEDERAL AND STATE TAX RETURNS ARE SUBJECT TO EXAMINATIONS BY TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHARITY CARE GRANT TO BANNER HEALTH SYSTEM -3,000,000. INCREASE IN FAIR VALUE OF HEDGING INTEREST RATE SWAP 3,348,391. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 9,850,799. INVESTMENT MANAGEMENT FEES, INCLUDED IN INCOME FOR FINANCIAL STATEMENTS -1,021,692. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUES -186,497. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUES 186,497. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE GRANT TO BANNER HEALTH SYSTEM 3,000,000. INVESTMENT MANAGEMENT FEES, INCLUDED IN INCOME FOR FINANCIAL STATEMENTS 1,021,692. 1 BANNER HEALTH SYSTEM 1801 16TH STREET GREELEY CO 80631 450233470 501(C)(3) 3000000 CHARITY CARE NCMC FOUNDATION 1801 16TH STREET GREELEY CO 80631 840718355 501(C)(3) 1300000 OPERATIONAL ASSISTANCE AND DONATION 2 0 PART I, LINE 2: THERE IS CURRENTLY NO PROCESS IN PLACE THAT MONITORS THE USE OF GRANT FUNDS BY THE RECIPIENTS. MOST CHARITABLE CONTRIBUTIONS ARE MADE THROUGH NCMC INC'S DONOR ADVISED FUND WHICH IS MAINTAINED BY THE NCMC FOUNDATION. THE NCMC FOUNDATION DOES VET RECIPIENTS PRIOR TO MAKING GRANTS AND ALSO MONITORS THE USE OF PROCEEDS. A COLORADO HEALTH FACILITIES AUTHORITY 840752932 196474K25 2003-11-13 98000000 PARTIAL REFUND SERIES 1993,RENOVATE HOSPITAL & PAY 2003 ISSUANCE COSTS. 0 0 0 B COLORADO HEALTH FACILITIES AUTHORITY 840752932 2012-07-31 60000000 FUND MCP PROJECT AND ROUTINE CAPEX 0 0 0 C COLORADO HEALTH FACILITIES AUTHORITY 840752932 2013-05-15 82000000 REFINANCE 2008 BONDS ISSUED 10/27/08 AND 2009 BONDS ISSUED 11/17/09 0 0 0 A 15340000 98000000 884500 3759456 76964179 16391865 2006 1 0 1 1 B 4175000 60000000 2349306 595000 28715161 28340533 0 0 0 0 C 2144759 82000000 618950 81381050 2013 1 0 1 1 A 0 1 0 0 0.00040 0.00040 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 1 FSA CAPITAL MANAGEMENT SERVICES 2.000000000000 1 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 1 1 BANCO BILBAO VIZCAYA ARGENTARIA 14.000000000000 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/29/2009 FORM 990, SCHEDULE K, PART II, LINE 11 THE AMOUNT REPORTED ON SCHEDULE K, PART II, LINE 11, COLUMN A AND C IS THE AMOUNT OF BOND PROCEEDS USED TO REFUND THE PRIOR BONDS ISSUED. KEN SCHULTZ KEN IS NCMC INC. BOARD EXECUTIVE AND 33.33% OWNER OF NORTHSTAR MGMT 203639 PAYMENTS MADE TO NORTHSTAR MANAGEMENT GROUP, INC IN 2013 WERE $203,639. 0 FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE WHICH IS ABLE TO EXERCISE AUTHORITY OF THE BOARD WHEN THE BOARD IS NOT IN SESSION EXCEPT AS SUCH AUTHORITY IS LIMITED BY STATUTE OR BY RESOLUTION CREATING OR OTHERWISE CONTROLLING THE EXECUTIVE COMMITTEE. THE MEMBERSHIP OF THE EXECUTIVE COMMITTEE SHALL INCLUDE THE CHAIR AND PRESIDENT OF THE BOARD OF THE CORPORATION, THE CHAIR OF THE FINANCE COMMITTEE, THE CHAIR OF THE EXTERNAL COMMITTEE, THE CHAIR OF THE INTERNAL COMMITTEE AND THE VICE CHAIR OF THE BOARD. THE CHAIR AND PRESIDENT OF THE BOARD OF THE CORPORATION SHALL SERVE AS CHAIR OF THE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL NOT HAVE THE AUTHORITY OF THE BOARD IN REFERENCE TO (I) APPOINTING, REMOVING OR FILLING VACANCIES IN THE MEMBERSHIP OF THE BOARD, BOARD COMMITTEES OR OFFICERS OF THE CORPORATION; (II) AMENDING THE ARTICLES OF INCORPORATION; (III) RESTATING THE ARTICLES OF INCORPORATION; (IV) ADOPTING A PLAN OF MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION; (V) AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION; (VI) AUTHORIZING THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOKING PROCEEDINGS THEREFOR; (VII) ADOPTING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE CORPORATION OR (VIII) AMENDING, ALTERING OR REPEALING ANY RESOLUTION OF THE BOARD WHICH BY ITS TERMS PROVIDES THAT IT SHALL NOT BE AMENDED, ALTERED OR REPEALED BY SUCH COMMITTEE. FORM 990, PART VI, SECTION A, LINE 3 NORTHSTAR MANAGEMENT GROUP INC. IS THE MANAGEMENT COMPANY. KEN SCHULTZ IS A 33.33% OWNER OF THE MANAGEMENT COMPANY AND SUPERVISES ALL OF THE OPERATIONS OF NCMC, INC. PAYMENTS MADE TO NORTHSTAR MANAGEMENT GROUP FOR PROFESSIONAL FEES IN 2013 WERE $187,500 WHICH REPRESENTS THE COMPENSATION PAID TO THE BOARD EXECUTIVE FOR 2013. FORM 990, PART VI, SECTION A, LINE 7A THE NCMC BOARD OF TRUSTEES IS ELIGIBLE TO APPOINT 3 OF THE BOARD MEMBERS OF NCMC, INC. NCMC, INC. IS A SUPPORTING ORGANIZATION OF NCMC BOARD OF TRUSTEES. NCMC BOARD OF TRUSTEES IS A GOVERNMENT BODY APPOINTED BY THE COUNTY COMMISSIONERS. WELD COUNTY OWNS THE LAND THAT THE HOSPITAL SITS ON. FORM 990, PART VI, SECTION A, LINE 7B BOND ISSUES MUST BE APPROVED BY COMMISSIONERS AND THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 KEN SCHULTZ AND THE FINANCE COMMITTEE WILL REVIEW A COPY OF THE DRAFT FORM 990 AND THEN PRESENT IT TO FULL BOARD FOR APPROVAL PRIOR TO FILING THE FINAL COPY. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS RECEIVES THE CONFLICT OF INTEREST POLICY AT THE ANNUAL MEETING. KEN SCHULTZ RECEIVES THE RESPONSES AND FORWARDS THEM TO THE GENERAL COUNSEL OF THE BOARD. IF THERE ARE ANY ITEMS THAT COME UP FOR DISCUSSION IN WHICH A CONFLICT OF INTEREST IS PRESENT, THE BOARD MEMBER EXCUSES HIM OR HERSELF AND ABSTAINS FROM VOTING. THE BOARD HAS THE OPTION TO ALLOW THE MEMBER TO BE PART OF THE DISCUSSION. FORM 990, PART VI, SECTION C, LINE 19 THE GENERAL PUBLIC IS ALLOWED TO VIEW THE DOCUMENTS BUT NOT ALLOWED TO MAKE COPIES AND TAKE THEM OFF OF THE PREMISES. FORM 990, PART XI, LINE 9: REDUCTION IN FAIR VALUE OF HEDGING INTEREST RATE SWAPS 3,348,391. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 9,850,799. SHEEP DRAW FARMS LLC 1801 16TH STREET GREELEY CO 80631 680540676 HOLDS TITLE TO FARM RENT INCOME CO 8000 5786414 NCMC INC SOUTHSIDE INVESTMENTS 1801 16TH STREET GREELEY CO 80631 680611503 OWNS HOUSES ADJACENT TO THE HOSPITAL CO 91334 1111990 NCMC INC NORMEDCO CARE LLC 1801 16TH STREET GREELEY CO 80631 742354112 OWNS FACILITY LEASED TO A FEDERALLY QUALIFIED HEALTH CENTER FOR $1 PER YEAR CO 1 3118426 NCMC INC NCMC BOARD OF TRUSTEES 1801 16TH STREET GREELEY CO 80631 846000813 GOVERNMENTAL ACTIVITY - HOSPITAL CO GOVERNMENTAL UNIT 6 WELD COUNTY BOARD OF COUNTY COMMISSIONERS 0 NCMCBH GREELEY I LLC 1801 16TH STREET GREELEY CO 80631 900824175 LAND INVESTMENT CO NCMC INC RELATED 2274755 0 0 0.50000 NCMCBH GREELEY II LLC 1801 16TH STREET GREELEY CO 80631 900824173 LAND INVESTMENT CO NCMC INC RELATED 1199921 0 0 0.50000 NMSI DBA NORTHCARE 1801 16TH STREET GREELEY CO 80634 742354291 MEDICAL CLAIMS PROCESSING CO NCMC INC C 14326 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0