2011-11-10T19:14:38-06:00 2010-12-31 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2010-01-01 840482695 Brighton Community Hospital Association BRIG 3034981600 1600 Prairie Center Parkway Brighton CO 80601 Harold Dupper 2011-11-15 true Rita F Worster CPA 7194714290 2010 2016-02-24 21:20:13Z Platte Valley Medical Center John Hicks 1600 Prairie Center Parkway Brighton CO 80601 172161707 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 10 687 192 56 2673887 325665 85380246 87583287 2580039 3195585 -25107 500664 90609065 91605201 59579 102928 0 0 36232992 37160621 0 0 215121 47118064 49099968 83410635 86363517 7198430 5241684 209303321 213551307 114414362 112530850 94888959 101020457 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 RESIDING OUTSIDE THE SERVICE AREA 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 FEDERALLY ASSISTED 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, 2010 AND 2009 WERE $15,330,000 AND $13,890,000 RESPECTIVELY. false false 16245723 14412823 Inpatient Routine Care, Total Patient Days: 9,404. 48930402 102928 57472670 Inpatient/Outpatient Ancillary Services, Weighted Patient Days: 21,566. 11739875 15252964 Total Emergency room visits and Ambulance Calls: 25,262. 76916000 true true false true false false false false true true false false false true false true false false false false false false false false false true false true true true true false false false false false false false false false false false false false false false true true true false false true 82 0 true 687 true false false false false false false false false false false X 15 10 false false true 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 X JOHN HICKS 50.0 X X 673766 0 24123 GERRY LEWIS-JENKINS 3.0 X 0 0 0 MICHAEL DOLAN 3.0 X X 0 0 0 WILLIAM LEE MD 3.0 X 50000 0 0 SUE CORBETT 3.0 X 0 0 0 TILLMAN FARLEY MD 3.0 X 18500 0 0 BOB FEIS 3.0 X 0 0 0 MATT FLAHERTY MD 3.0 X 30625 0 0 FAYE HUMMEL PHD 3.0 X 0 0 0 ELAINE PADILLA 3.0 X 0 0 0 LOWELL PALMQUIST 3.0 X 0 0 0 JOHN RHOADES 3.0 X 0 0 0 TED SHIPMAN 3.0 X 0 0 0 KIRK QUACKENBUSH MD 3.0 X 15566 0 0 SHAWN WIANT 3.0 X X 0 0 0 CHERYL BENTLEY 50.0 X 321257 0 22302 HAROLD DUPPER 50.0 X 332776 0 32306 KURT GENSERT 50.0 X 246463 0 38516 ERIC STIRM 40.0 X 166844 0 31835 ROBERT NEBEL 40.0 X 140600 0 6214 KAREN WELZ 40.0 X 129344 0 34559 DUANE LIVADNEY 48.0 X 124100 0 31680 JACKIE DUNKIN 40.0 X 120401 0 31254 2370242 0 252789 39 false true false SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DALLAS TX 75312 SOFTWARE SUPPORT 1428591 ANESTHESIA SERVICES INC 15797 FORTUNE CT BRIGHTON CO 80601 ANESTHESIA SERVICES 871957 QUAMMEN HEALTHCARE CONSULTANTS PO BOX 550070 MONTVERDE FL 34756 CONSULTANTS 847674 CHILDREN'S HOSPITAL 13123 E 16TH AVE BOX 010 AURORA CO 80045 SPECIAL CARE NURSERY 762204 NORTHERN HEMATOLOGYONCOLOGY PO BOX 151029 LAKEWOOD CO 80215 ONCOLOGY SERVICE 475000 37 325665 325665 PATIENT SERVICES REV, NET OF ALLOWANCE 900099 83870640 83870640 CAFETERIA SALES 900099 345893 345893 ALTERNATE CARE SERVICES 900099 52050 52050 EDUCATION 900099 83674 83674 2009 MEDICAID PROVIDER PAYMENT 621500 3132093 3132093 98937 98937 87583287 2054041 56 2053985 0 0 1239809 739145 500664 500664 500664 80958355 550 79817361 1140994 550 1141544 1141544 0 0 0 0 91605201 87138457 56 4141023 90272 90272 12656 12656 0 0 1738308 1551092 187216 0 25422150 22433821 2867952 120377 605630 490843 109678 5109 7373155 6501099 849949 22107 2021378 1747696 263201 10481 0 260104 31 260073 113241 7533 105708 3863 3863 0 169672 169672 7772389 6299635 1452854 19900 176124 29513 146611 11429441 11100641 297207 31593 1728354 657739 1067744 2871 0 751842 670869 80973 68633 41359 26511 763 0 71337 59560 11747 30 5701312 5087281 614031 0 10011175 9573095 437385 695 535672 478360 57312 OTHER DIRECT EXPENSE 1157448 933544 222709 1195 BAD DEBT 4746644 4746644 PROVIDER FEE 4396082 4396082 TAXES ON WORK COMP THRU CHA TR 5449 5449 EXP ON WORK COMP THRU CHA TRUS 1186 1186 86363517 76916000 9232396 215121 4255894 9084273 14228549 9326498 10799389 10169347 1158375 818260 465096 560469 1763314 1735784 142260616 41552078 106158977 100708538 58633925 69264106 5147366 5289439 6692436 6594593 209303321 213551307 9013030 8897921 105401332 102732556 0 900373 114414362 112530850 X 93592965 99633178 1295994 1387279 94888959 101020457 209303321 213551307 X 5241684 889814 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 3863 false false 3863 false LOBBYING EXPENSE PART II-B LINE 1G BRIGHTON COMMUNITY HOSPITAL ASSOCIATION D/B/A PLATTE VALLEY MEDICAL CENTER RECEIVED CORRESPONDANCE FROM THE AMERICAN HOSPITAL ASSOCIATION AND COLORADO HEALTH AND HOSPITAL ASSOCIATION REGARDING THEIR MEMBERSHIP DUES. A PORTION OF THEIR DUES WAS ATTRIBUTABLE TO LOBBYING. 1295994 416950 102928 222737 1387279 2277935 -508054 473887 1295994 3245878 92168 1060111 2277935 0.00000 0.00000 1.00000 false true true 10648458 10648458 88786452 19617727 69168725 248974 74692 174282 33475670 20181470 13294200 9101062 1678189 7422873 100708538 0 ACCRUED SELF INSURANCE 900373 900373 91605201 86363517 5241684 843660 46154 889814 6131498 92257160 843660 91285 934945 91322215 157723 125263 282986 91605201 86125662 86125662 157723 80132 237855 86363517 PART V, QUESTION 4 INTENDED USES OF ENDOWMENT FUNDS 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. PART XII, LINE 2D OTHER REVENUE ON BOOKS NOT ON RETURN CHANGE IN INTEREST IN NET ASSETS OF PLATTE VALLEY MEDICAL CENTER FOUNDATION 91,285 PART XI, LINE 8 OTHER CHANGES TO NET ASSETS CHANGE IN INTEREST IN NET ASSETS OF PLATTE VALLEY MEDICAL CENTER FOUNDATION 91,285 NET REVENUE OVER EXPENSE PASSED THRU THE COLORADO HOSPITAL ASSN TRUST FOR WORKER'S COMPENSATION (45,131) TOTAL 46,154 PART X, LINE 2 UNCERTAIN TAX POSITIONS 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. PART XII LINE 4B REVENUE ON RETURN NOT ON BOOKS REVENUE PASSED THRU THE COLORADO HOSPITAL ASSN TRUST FOR WORKER'S COMPENSATION 125,263 PART XIII LINE 4B EXPENSES ON RETURN NOT ON BOOKS EXPENSES PASSED THRU THE COLORADO HOSPITAL ASSN TRUST FOR WORKER'S COMPENSATION 80,132 true true true X 40. true X true true true false true true 575 6356736 6356736 0.07790 16357 16260441 11298746 4961695 0.06080 16932 22617177 11298746 11318431 0.13870 11 87585 30682 444 30238 0.00040 7 148 1037313 1037313 0.01270 3 169360 169360 0.00210 21 87733 1237355 444 1236911 0.01520 21 104665 23854532 11299190 12555342 0.15390 1 71 1224 1224 0.00000 1 71 1224 1224 0.00000 true 1967886 0 9540089 15216567 -5676478 X true true 1 1 PLATTE VALLEY MEDICAL CENTER

1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601

X X X X PLATTE VALLEY MEDICAL CENTER 1 SCHEDULE H, PART I, LINES 3A &3B 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 Total bad debt expense removed from the denominator prior to the percentage calculation = 4,746,644. SCHEDULE H, PART I, LINE 7 CALCULATION OF COMMUNITY BENEFIT EXPENSES The organization used a cost-to charge ratio for lines 7a and 7b. The cost-to-charge ratio was derived from 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 III, LINE 4 BAD DEBT EXPENSE The Medical Center reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients, and others. The Medical Center provides an allowance for doubtful accounts based upon a review of the outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Medical Center bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Our costing methodology used to determine bad debt expense uses a ratio of patient care costs to charges. A number of patients are truly unable to pay their out-of-pocket liability, but do not complete the process required to apply for financial assistance under the hospital's charity care policy. These patients would qualify for charity care if they completed the paperwork, so the bad debt expense associated with treating them should be treated as community benefit. SCHEDULE H, PART III, LINE 8 MEDICARE 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 CHARITY CARE Our charity care policy outlines steps for financial counselors to follow to identify 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 if possible. SCHEDULE H, PART VI NEEDS ASSESSMENT Programs and services provided by the hospital for the community are based upon Platte Valley Medical Center inpatient admission, 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 We provide a hand-out with FAQ's, which includes information about financial assistance, and whom to call. The same FAQ is located on our website. "HIS" financial counselors are located in the emergency department during peak days and time. We have 2.5 full time employees dedicated to financial assistance. 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 We further promote the health of the community through the use of Chip funds for community programs, health fair sponsorships, flu shots below market, free education seminars, student education programs, first aide stations at community events, injury prevention and athletic trainer programs for schools, car seat check point programs, and cancer support groups. SCHEDULE H, PART V, SECTION B FACILITY INFORMATION The IRS released Announcement 2011-37 on July 5, 2011. The announcement advises that Part V Section B of Schedule H is optional for the 2010 tax year. The taxpayer has exercised its option to leave Part V Section B blank for the 2010 year. true CASA 1100 JUDICIAL CENTER DR BRIGHTON CO 80601 311657019 501(C)(3) 10000 HELP PAY VOL COORD FORT LUPTON FOOD BANK 421 DENVER AVE FORT LUPTON CO 80621 981707800 501(C)(3) 7500 FOOD & HOUSE ITEMS SCHOOL DISTRICT 27J 18851 E 160TH AVE BRIGHTON CO 80601 846012304 GOVERNMENT 38879 SCIENCE 3 0 FREE MEALS 1808 12656 COST MEALS Part I, Question 2 Grant Monitoring Procedures 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 true true X X X X X X false false false false false false false true false JOHN HICKS 443746 0 128448 0 101572 0 9800 0 14323 0 697889 0 0 0 CHERYL BENTLEY 223739 0 65664 0 31854 0 9800 0 12502 0 343559 0 0 0 HAROLD DUPPER 224446 0 67104 0 41226 0 9800 0 22506 0 365082 0 0 0 KURT GENSERT 174599 0 48504 0 23360 0 13136 0 25380 0 284979 0 0 0 ERIC STIRM 148530 0 17946 0 368 0 5351 0 26484 0 198679 0 0 0 KAREN WELZ 124403 0 4620 0 321 0 10394 0 24165 0 163903 0 0 0 DUANE LIVADNEY 82498 0 2230 0 39372 0 3211 0 28469 0 155780 0 0 0 JACKIE DUNKIN 102791 0 12966 0 4644 0 2690 0 28564 0 151655 0 0 0 Information Regarding Beneftis Provided Part I, Question 1a The benefits marked on line 1 of Schedule J are provided to executives and board of directors for attendance at educational and similar events and are taxed accordingly including gross-up payments. Explanation of non-fixed payments Part 1 Question 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. The CEO's performance criteria also has objectives related to the Platte Valley Medical Center Foundation in addition to the objectives listed above. Information Regarding Compensation Reporting Part II The intent of the compensation information is to provide information on the total compensation package provided to officers, key employees, and highly compensated employees. Including the annual accumulation of long-term deferred compensation provides useful information on the annual compensation package. However, including as deferred compensation the bonus accrual at year-end, which is paid out a few months after year-end, results in an unfair duplication of the annual bonus for calendar year taxpayers. Following the instructions for reporting deferred compensation provides a result on Part VII and Schedule J that includes two years of bonus information and no opportunity on Part VII to shown the amount relating to the prior year. The prior year bonus is in the cash-basis W-2 and the accrued bonus is reportable as deferred compensation. The amount of the bonus each year is relatively similar for each employee. To provide information that is consistent with information on the total annual compensation Part VII Column F and Schedule J Column C include the retirement contributions and deferred compensation except that only the increase in the bonus accrued at year-end over the amount included in the current year W-2 is included. No amount is shown as reported on prior 990 since the duplication has been removed. If the entire bonus accrued were included as deferred compensation the reporting would be as follows: RETIRMENT TOTAL REPORTED IN NET TOTAL NAME: & DEFERRED: COMPENSATION: PRIOR 990: COMPENSATION John Hicks 138,248 826,337 (128,448) 697,889 Cheryl Bentley 75,464 409,223 (65,664) 343,559 Harold Dupper 76,904 432,186 (67,104) 365,082 Kurt Gensert 61,640 333,483 (48,504) 284,979 Eric Stirm 23,297 216,625 (17,946) 198,679 Robert Nebel 5,570 146,814 (2,850) 143,964 Karen Welz 15,014 168,523 (4,620) 163,903 Duane Livadney 3,211 155,780 (2,230) 153,550 Jackie Dunkin 15,656 164,621 (12,966) 151,655 Adams County Colorado 846000732 005622BE4 2005-05-01 123605753 CONSTRUCT AND EQUIP FACILITY false false false 15667444 0 123671567 8877544 7855216 13055000 1335822 1056070 5708505 85981954 0 0 2007 true false true true false false false false false 0.00000 0.00000 0.00000 true false false true GOLDMAN SACHS CAP 0.5 false false true JP MORGAN CHASE BANK 2.1 true false false Changes to Organizational Documents since Prior 990 Form 990, Part VI, Question 4 Articles and Bylaws were revised in 2010. In 2010, Article V Section 5.09 of the bylaws was modified to address the compensation of Directors. Classes of Members or Stockholders and Voting Rights Form 990, Part VI, Question 6 and 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, Question 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 COMMITTIEE WHERE THEY APPROVE AND RECOMMEND THE 990 TO THE BOARD OF DIRECTORS. ONCE APPROVED, A COPY OF THE 990 IS SENT TO EACH BOARD MEMBER BEFORE FILING WITH THE IRS. Process for Monitoring Compliance with Conflict of Interest Policy Form 990, Part VI, Question 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 and other Officers Compensation Form 990, Part VI, Question 15a and 15b Platte Valley Medical Center uses the services of an independent compensation consultant, Integrated Healthcare Strategies (Chicago, IL), to establish compensation for the CEO, other officers and Key Employees. 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. Public Disclosure of Documents Form 990, Part VI, Question 19 The governing documents, conflict of interest policy, and financial statements are made available to the public upon request. Board Voting Rights Part VI, 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 issues. Other Changes in Net Assets Part XI, Line 5 843,660 - Unrealized Gains 91,285 - Change in Interest in Net Assets of Platte Valley Medical Ctr Fdn 45,131 - Net Revenue over Expense passed thru CO Hospital Assn Trust for Worker's Compensation 934,945 - Total HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN HICKS TITLE:CEO/PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL DOLAN TITLE:DIRECTOR/VICE CHAIR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BOB FEIS TITLE:DIRECTOR/FOUNDATION CHAIR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN RHOADES TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIRK QUACKENBUSH, MD TITLE:DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KURT GENSERT TITLE:VICE PRESIDENT OF NURSING HOURS:1 Platte Valley Medical Center Foundation 1600 Prairie Center Parkway Brighton CO 80601 742255936 Fundraising CO 501(c)(3) LN11 TYPE I NA PVMC Physician Services Inc 1606 PRAIRIE CENTER PARKWAY SUITE BRIGHTON CO 80601 943458548 MEDICAL CO NA C 271550 32192 1.00000 High Plains Heart & Vascular Center Inc 1606 Prairie Center Parkway Suite Brighton CO 80601 272038197 Medical CO NA C 299968 167778 1.00000 false false true false false false false false false false true true true true true false true false Platte Valley Medical Center Foundation c 325665 PVMC Physician Services Inc q 75000 High Plains Heart & Vascular Center Inc q 341000