2024-05-15T15:17:02-05:00 2023-06-30 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2022-07-01 841262971 POUDRE VALLEY HEALTH CARE INC POUD 9702377000 2315 E HARMONY ROAD 200 FORT COLLINS CO 80528 DAVID THOMPSON CHIEF FINANCIAL OFFICER 9702377000 2024-05-14 1 DAVID THOMPSON 999009999 1 AMY CIMINELLO P00796388 3037409400 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KEVIN UNGER 2315 E HARMONY ROAD 200 FORT COLLINS CO 80528 1861692313 0 X WWW.UCHEALTH.ORG X 1994 CO WE IMPROVE LIVES THROUGH LEARNING, HEALING, DISCOVERY, AND THROUGH HUMAN CONNECTION. 11 10 5147 287 13677 181498 5650691 550836 751173507 797484699 101884971 36357949 5643443 7866664 864352612 842260148 47277350 65197578 0 0 299023140 323851651 0 0 0 351323088 351658750 697623578 740707979 166729034 101552169 9385047111 10902217792 6712461190 7963780783 2672585921 2938437009 WE IMPROVE LIVES. IN BIG WAYS THROUGH LEARNING, HEALING AND DISCOVERY. IN SMALL, PERSONAL WAYS THROUGH HUMAN CONNECTION. BUT IN ALL WAYS, WE IMPROVE LIVES. 0 0 656787081 65197578 801820558 POUDRE 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 2023, PVHC RECORDED 64,761 PATIENT DAYS, 12,975 INPATIENT ADMISSIONS, 4,278 OBSERVATION PATIENTS ADMISSIONS, 584,225 OUTPATIENT VISITS, 77,333 EMERGENCY VISITS, 1,713 DELIVERIES, 2,159 INPATIENT SURGERIES, 7,170 OUTPATIENT SURGERIES. 656787081 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 258 0 1 5147 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X DAVID THOMPSON 9702377000 2315 E HARMONY ROAD SUITE 200 FORT COLLINS CO 80528 KEVIN UNGER CHIEF EXECUTIVE OFFICER 22.00 27.00 X X 409748 519922 36561 CHRISTINE CHIN DIRECTOR 1.00 2.00 X 1404 0 0 LISA CLAY CHAIR 1.00 2.00 X X 2422 0 0 MIKE DELLENBACH DIRECTOR 1.00 2.00 X 101 0 0 DOUG ERION DIRECTOR 1.00 2.00 X 119 0 0 DENNIS HOUSKA DIRECTOR 1.00 2.00 X 1271 0 0 BRAD OLDEMEYER DIRECTOR 1.00 2.00 X 0 0 0 CHRIS OSBORN DIRECTOR 1.00 2.00 X 2424 0 0 JIM PARKE DIRECTOR 1.00 2.00 X 121 0 0 DAN STROH DIRECTOR 1.00 2.00 X 235 0 0 CELESTE KING DIRECTOR 1.00 2.00 X 1215 0 0 MICHELLE ALBRIGHT SECRETARY 18.00 22.00 X 32367 41069 15846 DAVID THOMPSON CHIEF FINANCIAL OFFICER 21.00 27.00 X 222001 281693 35346 GEORGE BOST DIR LAB SERVICES 29.00 21.00 X 112757 83554 23514 DIANA BREYER CHIEF MEDICAL OFFICER 22.00 27.00 X 271053 379867 38111 ASHLEY BRUNING CHIEF NURSING OFFICER PVH 50.00 0.00 X 295014 0 58084 ANDREW HARMON DIRECTOR OF PHARMACY 29.00 21.00 X 131551 97481 50691 GRACE KOWALYSHYN-TAYLOR VP OF OPERATIONS 22.00 27.00 X 146012 185273 58914 WILLIAM NEFF ASSOCIATE CHIEF MEDICAL OFFICER 22.00 27.00 X 126696 160030 16115 RYAN ROHMAN CHIEF OPERATING OFFICER 22.00 27.00 X 182505 231578 13418 ANGELICA THIEL DIRECTOR OF IMAGING 22.00 27.00 X 80054 101116 45774 ANNETTE VIZENA VP CHIEF QUALITY OFFICER 22.00 27.00 X 172953 218455 40222 JILLIAN BUSCH PSYCHIATRIST 50.00 0.00 X 365168 0 55376 AARON MENG PSYCHIATRIST 50.00 0.00 X 343671 0 55445 HERMANN MORENO PSYCHIATRIST 50.00 0.00 X 337318 0 55376 KENNETH WATANABE PSYCHIATRIST 50.00 0.00 X 322293 0 57902 JANELL WOZNIAK PGRM DIRECTOR FAMILY MED CENTER 50.00 0.00 X 366600 0 54552 3927073 2300038 711247 434 0 1 0 VAYA WORKFORCE SOLUTIONS 5930 CORNERSTONE CT WEST ST 300 SAN DIEGO CA 92121 CONTRACT LABOR 5358623 NORTHERN COLORADO HOSPITALISTS 2121 E HARMONY RD STE 300 FORT COLLINS CO 80528 MEDICAL 4650660 ALLIED BARTON SECURITY PO BOX 31001-2374 PASADENA CA 91110 SECURITY 3878932 NORTHERN COLORADO ANESTHESIA 1236 E ELIZABETH ST STE 1 FORT COLLINS CO 80524 MEDICAL 3413708 ORTHOPAEDIC & SPINE CENTER OF THE ROCKIE 2500 E PROSPECT RD FORT COLLINS CO 80525 MEDICAL 2655645 46 435744 103686 11406 217082 550836 NET PATIENT SVC REV 900099 749260385 749260385 PROVIDER FEE INCOME 621400 29455132 29455132 JOINT VENTURE 621400 8045549 8046514 -965 LAB SERVICES 621400 6938895 6938895 DIETARY SVC INCOME 900099 2651177 2651177 1133561 1118919 14642 797484699 52924429 52924429 2132582 6675 1354053 6675 778529 0 778529 778529 1001156121 227606 1017950207 0 -16794086 227606 -16566480 -16566480 208652 121230 87422 87422 OTHER REVENUE 621400 4495753 4495753 RENT INCOME - AFFILIAT 532000 2504960 2504960 7000713 842260148 801820558 13677 39875077 65197578 65197578 2088688 740308 1348380 248581710 211678966 36902744 24469135 20704492 3764643 45502604 38502405 7000199 3209514 2715722 493792 1351094 1351094 61544 61544 37414 37414 2971540 2971540 41093245 30334230 10759015 3271011 3207335 63676 6415551 5898714 516837 13485867 12045714 1440153 5082240 4258381 823859 1420594 1220583 200011 593927 288275 305652 5126481 4931221 195260 30188227 22019848 8168379 986476 920998 65478 MEDICAL SUPPLIES 151504590 151493317 11273 PROVIDER FEE EXPENSE 39274685 39274685 BAD DEBT 26885484 26875164 10320 REPAIRS & MAINTENANCE 14985716 10316990 4668726 6923064 4162155 2760909 740707979 656787081 83920898 0 93622713 67569167 2312627 2385126 77986417 79524220 12200604 14589153 13364394 9886054 839213504 454462215 297084338 384751289 1817759288 2026497136 46727749 41822202 7023988981 8275193445 9385047111 10902217792 106670601 97954535 898152 1210652 143542807 135786666 67724485 37961 46262 6461311669 7661058183 6712461190 7963780783 X 2672585921 2938437009 2672585921 2938437009 9385047111 10902217792 X 101552169 164268640 30279 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 17939 0 1 19475 37414 0 PART II-B, LINE 1: PORTION OF DUES FROM MEMBERSHIP IN CHA AND AHA THAT ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES - $19,475. INTERNAL STAFF TIME AND EXPENSE SPENT ON DIRECT LOBBYING ACTIVITIES - $17,939. 7505139 15248 739495 51797 256647 7951438 8519574 80607 -772629 45447 242696 34270 7505139 7696043 67691 1053774 36975 222882 38077 8519574 7552046 76521 186928 28707 55954 34791 7696043 7528946 61289 260065 33759 234908 29587 7552046 0.05740 0.85410 0.08850 1 1 1 58004543 58004543 295279334 153559799 141719535 89472728 81838934 7633794 211883612 161440190 50443422 184573287 57623292 126949995 384751289 INTERCOMPANY RECEIVABLE 8182013766 DEFERRED PENSION OUTFLOW COSTS 23894030 OTHER RECEIVABLES 2973957 LEASE RECEVIABLE LT 13905224 DEFERRED OUTFLOW PUBLIC PRIVATE PARTNERSHIP 52406468 8275193445 INTERCOMPANY PAYABLES 7549637694 ACCRUED INTEREST PAYABLE 1231811 OTHER DEFERRED EXPENSES 4899576 PENSION LIABILITIES 37468762 DEFERRED INFLOW OF LEASES 12714826 PUBLIC PRIVATE PARTNERSHIP LIABILITY TRANSFER 55105514 7661058183 971895382 164268640 1481958 165750598 806144784 2971540 33143824 36115364 842260148 709110591 1481958 1481958 707628633 2971540 30107806 33079346 740707979 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 UCHEALTH NORTHERN COLORADO FOUNDATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE INCLUDED IN EXPENSE ON AFS 1,360,728. COGS REPORTED AS EXPENSE ON AFS 121,230. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 26,875,164. RENTAL EXP AS INCOME ON 990 19,137. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 14,642. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS 3,036,018. INTERCO EXPENSE ALLOCATIONS RECLASS 2,980,200. CASH CONTRIBUTIONS FROM FDN NOT IN AFS REVENUE 218,663. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE INCLUDED IN EXPENSE ON AFS 1,360,728. COGS REPORTED AS EXPENSE ON AFS 121,230. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT IN AFS INCOME 26,875,164. RENTAL EXP AS INCOME ON 990 19,137. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 14,642. CASH CONTRIBUTIONS FROM FOUNDATION NOT IN AFS REVENUE 218,663. INTERCO EXPENSE ALLOCATIONS RECLASS 2,980,200. 1 1 X 1 X 250.000000000000 1 X 1 0 1 1 4411038 269990 4141048 0.00500 114918511 77108403 37810108 0.04610 17069026 12600281 4468745 0.00540 136398575 89978674 46419901 0.05650 3810327 218796 3591531 0.00440 7086145 1024825 6061320 0.00740 16493116 8164641 8328475 0.01010 543349 128390 414959 0.00050 65210572 0 65210572 0.07950 93143509 9536652 83606857 0.10190 229542084 99515326 130026758 0.15840 1763 1763 0.00000 117856 117856 0.00010 119619 119619 0.00010 0 27642051 151885385 176428941 -24543556 X 1 1 1 HARMONY SURGERY CENTER LLC AMBULATORY SURG 0.50000 0.50000 2 PEAK SURGICAL MANAGEMENT MANAGEMENT SERVICES 0.14000 0.86000 3 HARMONY IMAGING CENTER LLC MEDICAL IMAGING 0.46000 0.54000 4 SURGERY CENTER OF FORT COLLINS AMBULATORY SURG 0.26000 0.49000 5 GATEWAY MEDICAL SERVICES REAL ESTATE/MEDICAL EQUIPMENT 0.50000 0.50000 6 PVHS-ICM EHW LLC MEDICAL CLINIC 0.50000 0.50000 7 OCR OF LOVELAND LLC AMBULATORY SURG 0.50000 0.50000 8 OCR OF FT COLLINS LLC AMBULATORY SURG 0.50000 0.50000 1 1 POUDRE VALLEY HOSPITAL 1024 S LEMAY FORT COLLINS CO 80524 X X X X X PHARMACY, LAB, IMAGING, BIRTH CENTER, HEART AND VASCULAR POUDRE VALLEY HEALTH CARE 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X HTTPS://WWW.UCHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 22 1 HTTPS://WWW.UCHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 250.000000000000 400.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.UCHEALTH.ORG/BILLING-AND-PRICING/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.UCHEALTH.ORG/BILLING-AND-PRICING/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.UCHEALTH.ORG/BILLING-AND-PRICING/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 POUDRE VALLEY HEALTH CARE PART V, SECTION B, LINE 5: PVH/MCR ASKED MEMBERS OF THE LARIMER COUNTY COMMUNITY TO RESPOND TO THE SURVEY TO HELP SELECT IDENTIFIED HEALTH NEEDS IN LARIMER COUNTY. A SURVEY WAS SENT TO 50 IMPACTFUL COMMUNITY ORGANIZATIONS/PEOPLE, INCLUDING THOSE WHO REPRESENT UNDERSERVED POPULATIONS, HIGHER EDUCATION, LOCAL SCHOOL DISTRICT SUPERINTENDENTS, THE SHERIFF'S OFFICE, AND LARIMER COUNTY, INCLUDING THOSE WHO ARE ACTIVELY INVOLVED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN FOR LARIMER COUNTY. RESPONSES WERE RECEIVED FROM 39 PEOPLE, A 78% RESPONSE RATE. POUDRE VALLEY HEALTH CARE PART V, SECTION B, LINE 6A: POUDRE VALLEY HOSPITAL (PVH) AND MEDICAL CENTER OF THE ROCKIES (MCR) PREPARED A JOINT CHNA AS BOTH HOSPITALS SERVE RESIDENTS FROM THE SAME GEOGRAPHIC LOCATIONS. POUDRE VALLEY HEALTH CARE PART V, SECTION B, LINE 6B: IN 2022, THE CHNA PROCESS FOR MEDICAL CENTER OF THE ROCKIES (MCR) AND POUDRE VALLEY HOSPITAL (PVH), INCLUDED A MULTI-PHASED APPROACH TO IDENTIFY THE TOP HEALTH PRIORITIES AND A COMPREHENSIVE ANALYSIS OF LOCAL POPULATION HEALTH INDICATORS, SOLICITATION OF COMMUNITY INPUT ON LOCAL HEALTH ISSUES THROUGH A WEB-BASED SURVEY AND A WEB-BASED SURVEY DISTRIBUTED TO HEALTH CARE PROVIDERS AT PVH AND MCR TO GATHER INPUT ON COMMUNITY HEALTH NEEDS. POUDRE VALLEY HEALTH CARE PART V, SECTION B, LINE 11: EXAMPLES OF HOW PVH/MCR IS ADDRESSING ISSUES RELATED TO ACCESS TO CARE FOR VULNERABLE INDIVIDUALS INCLUDES STAFFING A RN HOME VISIT PROGRAM FOR POSTPARTUM WOMEN WHO ARE ELIGIBLE FOR OR ENROLLED IN MEDICAID. NURSES ASSESS THE NEWBORN, PROVIDE THE MOTHER WITH LACTATION COUNSELING, SELF-CARE GUIDELINES AND ACHIEVE AN INCREASE IN THE MOTHER'S CONFIDENCE TO CARE FOR HER NEWBORN. ADDITIONALLY, COMPREHENSIVE CARE COORDINATION SERVICES ASSIST FAMILIES OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS AS WELL AS VULNERABLE ADULTS WITH MEDICALLY COMPLEX, CHRONIC CONDITIONS. TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES, PVH/MCR IS EXPANDING THE USE OF TECHNOLOGY TO PROVIDE TELE-PSYCH SERVICES TO RESIDENTS WHO ARE NOT ABLE TO ACCESS A LOCAL MENTAL HEALTH PROVIDER OR TO BRIDGE GAPS IN PROVIDER AVAILABILITY. WE ARE ALSO EMBEDDING TEAMS OF LICENSED CLINICAL SOCIAL WORKERS AND PSYCHOLOGISTS INTO PRIMARY CARE PRACTICES. FOR PERSONS WITH SUBSTANCE USE DISORDERS, PVH/MCR DIRECTS RESOURCES TO PROVIDING MEDICALLY ASSISTED ADDICTION TREATMENT AS WELL AS PARTICIPATING IN THE COLORADO ALTERNATIVES TO OPIOIDS TREATMENT PROTOCOLS. INCREASED SCREENING AND REFERRAL TO TREATMENT FOR PERSONS USING ALCOHOL HAS ALSO BEEN IMPLEMENTED. THE IDENTIFIED HEALTH ISSUES ARE DESCRIBED IN THE 2022-24 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE FULL SPECTRUM OF SERVICES AND PROGRAMS ARE NOTED IN THE 2023-25 IMPLEMENTATION STRATEGY REPORT POSTED TO THE UCHEALTH WEBSITE: HTTPS://WWW.UCHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PREVIOUS ASSESSMENTS AND IMPLEMENTATION STRATEGIES CAN BE FOUND THERE AS WELL. 6 1 - UCHEALTH HARMONY CAMPUS AMBULATORY CARE 2127 E HARMONY RD FORT COLLINS CO 80528 SURGERY CENTER, IMAGING 2 - CENTRE AVE HEALTH AND REHAB - JV 915 CENTRE AVE FORT COLLINS CO 80526 REHABILITATION 3 - SURGERY CENTER OF FT COLLINS - JV 1100 E PROSPECT FORT COLLINS CO 80524 SURGERY CENTER 4 - COLUMBINE POUDRE HOMECARE - JV 915 CENTRE AVE FORT COLLINS CO 80526 HOME HEALTHCARE 6 - OCR LOVELAND 3470 E 15TH STREET LOVELAND CO 80538 SURGERY CENTER 7 - OCR FORT COLLINS 2500 E PROSPECT FORT COLLINS CO 80525 SURGERY CENTER PART I, LINE 7: LINE 7A LINE 7A WAS DERIVED USING A COST-TO-CHARGE RATIO FROM THE COST REPORT.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. 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 = $27,642,051 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: $132,276,391CENTER AVE COST REPORT: $1,565,412COLUMBINE HOMECARE COST REPORT: $1,022,106PVHC DISALLOWED PROGRAMS: $4,472,741JOINT VENTURES: $12,548,435TOTAL TO LINE 5: $151,885,085PART III, LINE 6: ALLOWABLE COSTS AS REPORTED ON THE POUDRE VALLEY HEALTH CARE INC. FY22 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: $150,756,021CENTRE AVE COST REPORT: $6,936,337COLUMBINE HOMECARE COST REPORT: $1,606,947 PVHC DISALLOWED PROGRAMS: $2,525,524JOINT VENTURES: $14,604,112TOTAL TO LINE 6: $176,428,941 PART III, LINE 8: APPROXIMATELY 31.11% 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: IF UCHEALTH DETERMINES THAT AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE FOLLOWING UCHEALTH'S REVIEW OF A COMPLETE APPLICATION, UCHEALTH WILL REVERSE ECAS (IF ANY) AND WILL REFUND AMOUNTS PREVIOUSLY PAID FOR CARE COVERED BY THIS POLICY IN EXCESS OF THE AMOUNT OWED, EXCEPT OVERPAYMENTS THAT ARE $5 OR LESS. IF THE GUARANTOR STILL OWES ANY AMOUNT, UCHEALTH WILL PROVIDE AN UPDATED BILLING STATEMENT SHOWING HOW THE ADJUSTED AMOUNT WAS DETERMINED. PART VI, LINE 2: SEE NARRATIVES FOR PART V, SECTION B, LINES 5 AND 6B. 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. ONCE A PERSON HAS RECEIVED CARE IN THE ED, 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. ADDITIONALLY, WE WIDELY PUBLICIZE OUR FINANCIAL ASSISTANCE POLICY AS REQUIRED BY LAW, INCLUDING A PLAIN LANGUAGE SUMMARY. PART VI, LINE 4: POUDRE VALLEY HEALTH CARE INC. IS A LOCALLY OWNED, PRIVATE, NON-PROFIT ORGANIZATION WITH A STRONG VISION: FROM HEALTHCARE TO HEALTH. BASED IN NORTHERN COLORADO, PVH 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. PVH IS A PART OF THE UCHEALTH 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, UCHEALTH GREELEY HOSPITAL, UCHEALTH 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 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 FUNDING TO OTHER ENTITIES THAT WORK TO IMPROVE THE HEALTH OF OUR COMMUNITY. EXAMPLES INCLUDE: DEMENTIA RESOURCES, RESOURCES FOR THOSE WITH DISABILITIES, RESOURCES FOR THOSE EXPERIENCING HOMELESSNESS, HOUSING RESOURCES OFFERING HOMELESSNESS PREVENTION AND HOMEBUYER EDUCATION; IMPROVED FOOD SECURITY FOR LOW INCOME RESIDENTS; SUICIDE PREVENTION; PROGRAMS FOR CHILDREN WHO HAVE BEEN ABUSED AND NEGLECTED; HEART HEALTH, HEALTHY EATING AND SUBSTANCE ABUSE PREVENTION EDUCATION FOR YOUTH AND YOUNG ADULTS; 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 STATES CO 1 UCHEALTH MEDICAL GROUP 2315 E HARMONY RD 200 FORT COLLINS CO 80528 800348943 501(C)(3) 61177616 0 SEE SCH I, PART IV UNIVERSITY SCHOOL OF MEDICINE 13001 17TH PLACE AURORA CO 80045 846000555 501(C)(3) 3046810 0 SEE SCH I, PART IV UCHEALTH NORTHERN COLORADO FOUNDATION 2315 E HARMONY RD 200 FORT COLLINS CO 80528 741894581 501(C)(3) 801530 0 SEE SCH I, PART IV FRONT RANGE COMMUNITY COLLEGE FOUNDATION 3645 W 112TH AVENUE WESTMINSTER CO 80031 383721881 GOVERNMENT 22037 0 SEE SCH I, PART IV UNITED WAY OF LARIMER COUNTY 424 PINE ST 102 FORT COLLINS CO 80524 846031503 501(C)(3) 9346 0 SEE SCH I, PART IV AMERICAN CANCER SOCIETY 3380 CHASTAIN MEADOWS PKY 200 KENNESAW GA 30144 131788491 501(C)(3) 12273 0 SEE SCH I, PART IV GREELEY PHILHARMONIC ORCHESTRA PO BOX 1535 GREELEY CO 80632 846031376 501(C)(3) 7508 0 SEE SCH I, PART IV CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION 214 E 23RD ST CHEYENNE WY 82001 830236858 501(C)(3) 19922 0 SEE SCH I, PART IV FOOD FOR THOUGHT DENVER 3559 W 44TH AVE DENVER CO 80211 812971428 501(C)(3) 14598 0 SEE SCH I, PART IV 9 0 PART I, LINE 2: THE ORGANIZATION AWARDS GRANTS BASED ON THE BENEFIT TO THE COMMUNITY. THE ORGANIZATION REQUESTS INFORMATION FROM THE GRANTEES TO ENSURE THAT THE FUNDS WILL BE USED FOR THE SPECIFIED PURPOSE. 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. X X X 1 1 X X X X 0 0 0 0 0 0 0 1 0 KEVIN UNGER CHIEF EXECUTIVE OFFICER 301090 382048 98713 125255 9945 12619 3952 5015 12162 15432 425862 540369 0 0 DIANA BREYER CHIEF MEDICAL OFFICER 232686 331406 36353 45917 2014 2544 3738 5239 12132 17002 286923 402108 0 0 DAVID THOMPSON CHIEF FINANCIAL OFFICER 185755 235701 34408 43660 1838 2332 3912 4964 11667 14803 237580 301460 0 0 ANNETTE VIZENA VP CHIEF QUALITY OFFICER 149878 189310 22606 28553 469 592 13848 17491 3925 4958 190726 240904 0 0 RYAN ROHMAN CHIEF OPERATING OFFICER 154105 195542 28060 35605 340 431 3952 5015 1962 2489 188419 239082 0 0 JANELL WOZNIAK PGRM DIRECTOR FAMILY MED CENTER 335232 0 30153 0 1215 0 28853 0 25699 0 421152 0 0 0 JILLIAN BUSCH PSYCHIATRIST 364892 0 0 0 276 0 28853 0 26523 0 420544 0 0 0 AARON MENG PSYCHIATRIST 343217 0 0 0 454 0 28853 0 26592 0 399116 0 0 0 HERMANN MORENO PSYCHIATRIST 336126 0 0 0 1192 0 28853 0 26523 0 392694 0 0 0 GRACE KOWALYSHYN-TAYLOR VP OF OPERATIONS 122669 155652 22929 29095 414 526 13707 17393 12259 15555 171978 218221 0 0 KENNETH WATANABE PSYCHIATRIST 320517 0 0 0 1776 0 28853 0 29049 0 380195 0 0 0 ASHLEY BRUNING CHIEF NURSING OFFICER PVH 248730 0 45702 0 582 0 28135 0 29949 0 353098 0 0 0 WILLIAM NEFF ASSOCIATE CHIEF MEDICAL OFFICER 75627 95524 0 0 51069 64506 3829 4836 3292 4158 133817 169024 0 0 ANDREW HARMON DIRECTOR OF PHARMACY 119859 88817 11505 8526 187 138 12572 9316 16544 12259 160667 119056 0 0 ANGELICA THIEL DIRECTOR OF IMAGING 72800 91953 7089 8955 165 208 7687 9709 12539 15839 100280 126664 0 0 GEORGE BOST DIR LAB SERVICES 101429 75160 9451 7003 1877 1391 8297 6148 5209 3860 126263 93562 0 0 PART I, LINE 1A 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, 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. PART I, LINE 7 THE ORGANIZATION OFFERS A BONUS PLAN THAT PAYS A PERCENTAGE OF AN EMPLOYEE'S BASE PAY. THE INTENT OF THE PLAN IS TO REWARD AN EMPLOYEE'S PERFORMANCE TOWARDS ACHIEVEMENT OF STRATEGIC GOALS DURING THE FISCAL YEAR. SUCCESSFUL ACCOMPLISHMENT OF GOALS THAT CONTRIBUTE TO THE ORGANIZATION'S OVERALL STRATEGIC DIRECTION RESULT IN VARIABLE PAYMENTS ALIGNED WITH THE ORGANIZATION'S TOTAL COMPENSATION STRATEGY. THIS PROGRAM REWARDS EMPLOYEES BASED ON ORGANIZATIONAL PERFORMANCE MEASURES AND INDIVIDUAL EMPLOYEE GOAL PERFORMANCE. ALL PAYOUTS ARE CONTINGENT BASED ON THE UCHEALTH BOARD OF DIRECTORS APPROVAL EACH FISCAL YEAR. A UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2018 SERIES A 841179794 914183BH0 2018-07-26 45915000 REFUNDING 2005A BONDS 0 0 0 B UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2018 SERIES B 841179794 914183BJ6 2018-07-26 24374400 REFUNDING 2005B BONDS 0 0 0 C UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2017 SERIES A 841179794 914183BB3 2017-02-16 43493450 REFUNDING 2015A BONDS 0 0 0 D UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2017 SERIES B1B2 841179794 914183BC1 2017-02-16 57125000 REFUNDING 2015BC BONDS 0 0 0 A 45915000 318692 45596308 2018 1 0 1 1 B 24374400 169360 24205040 2018 1 0 1 1 C 43493450 213070 43280380 2017 1 0 1 1 D 40970000 16155000 276146 56848854 2017 1 0 1 1 A 0 1 1 0 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 0 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 0 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 1 1 0 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 CITI 21.500000000000 0 0 0 0 1 B 0 1 0 0 1 1 CITI 21.500000000000 0 0 0 0 1 C 0 1 0 0 0 1 CITI 10.000000000000 0 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2017 SERIES C2 841179794 914183AZ1 2017-02-16 7296822 NEW CONSTRUCTION ON PVH 0 0 0 B UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2019 SERIES C 841179794 914183BP2 2019-10-30 6631618 REFUNDING 2017C1 BONDS 0 0 0 A 7296822 62956 7233866 2017 0 0 1 1 B 6631618 42642 6588976 2019 1 0 1 1 A 0 1 1 0 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 0 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 X MEDICAL EQUIPMENT 21 217082 FMV 0 1 0 FORM 990, PART I, LINE 6 POUDRE VALLEY HOSPITAL (PVH) HAD 287 ACTIVE VOLUNTEERS IN FISCAL YEAR 2023. THESE VOLUNTEERS PROVIDED OVER 42,000 HOURS OF SERVICE DURING THE YEAR. AT PVH, 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, GIFT SHOP, VOLUNTEER PATIENT LIAISONS, BABY KNITTERS, VOLUNTEENS, AND PET THERAPY TO NAME JUST A FEW OF THE MANY PROGRAMS. EVERY VOLUNTEER CONTRIBUTES TO THE SUCCESS OF THE UCHEALTH NORTH TO ENHANCE THE COMFORT AND CARE OF THE PATIENTS AND THEIR FAMILIES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY INDEPENDENT CPAS. A PRELIMINARY DRAFT IS REVIEWED BY THE INTERNAL FINANCE DEPARTMENT. THE FINAL COPY OF THE FORM 990 IS PROVIDED IN AN ELECTRONIC FORMAT TO ALL BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES COMPLETION OF THE FORM ON AN ANNUAL BASIS BY THE BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. COMPLETED FORMS ARE SUBMITTED AND REVIEWED BY THE INTERNAL COMPLIANCE DEPARTMENT TO ENSURE COMPLIANCE WITH THE WRITTEN POLICY. ANY QUESTIONS OR ULTIMATE ENFORCEMENT WOULD BE HANDLED BY THE COMPLIANCE DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15 UCHEALTH CONTRACTS WITH SULLIVAN COTTER FOR SENIOR EXECUTIVE COMPENSATION CONSULTING SERVICES. ON OUR BEHALF, THE SULLIVAN COTTER COLLECTS AND REVIEWS COMPENSATION LEVELS FROM LIKE ORGANIZATIONS FOR LIKE JOBS AND PROVIDES UCHEALTH WITH THE COMPARATIVE MARKET DATA. THE DATA IS SUBMITTED TO THE CHIEF HUMAN RESOURCES OFFICER WHO ADVISES THE SYSTEM PRESIDENT AND CEO ON COMPENSATION DECISIONS FOR SENIOR EXECUTIVES. BASED ON THE MARKET DATA, THE SYSTEM PRESIDENT AND CEO DETERMINE THE SALARY OF THE ENTITY CEO'S COMPENSATION ANNUALLY. OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE REVIEWED ANNUALLY BY AN INTERNAL HUMAN RESOURCES COMPENSATION TEAM. PUBLISHED COMPENSATION REPORTS ARE UTILIZED TO COMPARE INCUMBENT PAY TO COMPARABLE ROLES IN LIKE-SIZED ORGANIZATIONS. THE DATA IS REVIEWED WITH THE CHIEF HUMAN RESOURCES OFFICER EACH YEAR AND RECOMMENDATIONS FOR CHANGES ARE INCLUDED IN THE FOLLOWING YEARS' BUDGET PLANNING PROCESS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC BASED ON THE BUSINESS PURPOSE FOR THE REQUEST. THESE REQUESTS ARE ADDRESSED BY THE SENIOR MANAGEMENT TEAM ON A CASE BY CASE BASIS. FORM 990, PART XI, LINE 9: MCR DISTRIBUTIONS TO PVH 7,419,193. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS -3,036,018. PUBLIC PRIVATE PARTNERSHIP LEASE ADOPTION -2,786,543. HERON LAKE NET ASSET ADJ TO UCHMG -657,292. UMA WRITE OFF OLD ENTITY -925,833. TIMBERLINE TO UCHMG 16,772. LAKOTA LAKE LLC 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 841447761 OUTPATIENT CO 179018 51101368 PVHC INC MEDICAL CENTER OF THE ROCKIES 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 043730045 TERTIARY CARE CO 501(C)(3) LINE 3 PVHC INC 1 UCHEALTH NORTHERN COLORADO FOUNDATION 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 741894581 BENEFIT HEALTH CO 501(C)(3) LINE 7 PVHC INC 1 POUDRE VALLEY MEDICAL GROUP 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 800348943 MEDICAL SERVICES CO 501(C)(3) LINE 10 PVH INC 1 HARMONY SURGERY CENTER 2127 E HARMONY RD 200 FORT COLLINS CO 80528 841479751 AMBULATORY SURG CO N/A RELATED 3334735 6653028 0 0 0.50000 CENTRE AVENUE HEALTH AND REHAB 947 WORTHINGTON CIRCLE FORT COLLINS CO 80526 841560494 NURSING FACILITY CO N/A RELATED -1139542 463612 0 0 0.50000 COLUMBINE POUDRE HOME CARE 947 WORTHINGTON CIRCLE FORT COLLINS CO 80526 841529817 NURSING CARE CO N/A RELATED -141904 453057 0 0 0.50000 GATEWAY MEDICAL SERVICES 2500 E PROSPECT RD FORT COLLINS CO 80525 841427970 REAL EST/MED CO N/A UNRELATED 539193 4689498 0 0 0.50000 HARMONY IMAGING CENTER 1951 WILMINGTON DRIVE FORT COLLINS CO 80528 582479187 MEDICAL IMAGING CO N/A RELATED 237296 3522358 0 0 0.46000 SURGERY CENTER OF FORT COLLINS 1100 E PROSPECT ROAD FORT COLLINS CO 80525 841541559 SURGICAL PROC CO N/A UNRELATED -200293 444114 0 0 0.26000 PVHS-ICM EHW 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 463311308 MEDICAL SERVICES CO N/A RELATED 54089 304492 0 0 0.50000 PEAK SURGICAL MANAGEMENT 2127 E HARMONY RD 200 FORT COLLINS CO 80528 260899618 SURGICAL MGMT CO N/A UNRELATED 201201 94333 0 0 0.14290 OCR LOVELAND 2500 E PROSPECT RD FORT COLLINS CO 80525 301069701 AMBULATORY SURG CO N/A UNRELATED 3937369 3398409 0 0 0.10000 OCR FT COLLINS 2500 E PROSPECT RD FORT COLLINS CO 80525 611896214 AMBULATORY SURG CO N/A UNRELATED 1240638 1001727 0 0 0.50000 INNOVATION ENTERPRISES 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 202036774 IT CONSULTING CO PVHC C 16071 155968 1.00000 1 1 1 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 0 1 INNOVATION ENTERPRISES A 366262 TRANSACTION TOTAL HARMONY SURGERY CENTER A 936540 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP B 61177616 TRANSACTION TOTAL CENTRE AVE HEALTH & REHAB LLC B 500000 TRANSACTION TOTAL UCHEALTH NORTHERN COLORADO FOUNDATION B 801530 TRANSACTION TOTAL UCHEALTH NORTHERN COLORADO FOUNDATION C 435744 TRANSACTION TOTAL INNOVATION ENTERPRISES J 120328 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP J 3739371 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP L 4939148 TRANSACTION TOTAL MEDICAL CENTER OF THE ROCKIES L 10989585 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP M 5205443 TRANSACTION TOTAL MEDICAL CENTER OF THE ROCKIES N 1657764 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP N 1161960 TRANSACTION TOTAL HARMONY SURGERY CENTER Q 687349 TRANSACTION TOTAL GATEWAY MEDICAL SERVICES S 83138 TRANSACTION TOTAL MEDICAL CENTER OF THE ROCKIES S 7419193 TRANSACTION TOTAL HARMONY SURGERY CENTER S 3025000 TRANSACTION TOTAL OCR LOVELAND S 3595271 TRANSACTION TOTAL MEDICAL CENTER OF THE ROCKIES H 103728 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP H 1241019 TRANSACTION TOTAL OCR FT COLLINS S 1545385 TRANSACTION TOTAL INNOVATION ENTERPRISES S 1961773 TRANSACTION TOTAL