2023-05-15T20:21:30-05:00 2022-06-30 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2021-07-01 841262971 POUDRE VALLEY HEALTH CARE INC POUD 9702377000 2315 E HARMONY ROAD 200 FORT COLLINS CO 80528 DAVID THOMPSON CHIEF FINANCIAL OFFICER 9702377000 2023-05-15 1 DAVID THOMPSON 999009999 AMY CIMINELLO P00796388 3037409400 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KEVIN UNGER 2315 E HARMONY RD 200 FT COLLINS CO 80528 2241188495 0 X WWW.UCHEALTH.ORG X 1994 CO WE IMPROVE LIVES THROUGH LEARNING, HEALING, DISCOVERY, AND THROUGH HUMAN CONNECTION. 10 9 5302 129 2237990 346948 35354406 5650691 703079318 751173507 271879544 101884971 15035512 5643443 1025348780 864352612 44108673 47277350 0 0 262418225 299023140 0 0 0 313884595 351323088 620411493 697623578 404937287 166729034 9383080918 9385047111 6609612931 6712461190 2773467987 2672585921 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 618355542 47277350 751407783 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 2022, PVHC RECORDED 68,444 PATIENT DAYS, 12,824 INPATIENT ADMISSIONS, 4,059 OBSERVATION PATIENTS ADMISSIONS, 554,013 OUTPATIENT VISITS, 71,858 EMERGENCY VISITS, 1,829 DELIVERIES, 2,209 INPATIENT SURGERIES, 5,447 OUTPATIENT SURGERIES. 618355542 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 1 230 0 1 5302 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 9 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 CEO 22.00 26.00 X X 442355 520621 33143 CHRISTINE CHIN DIRECTOR 1.00 2.00 X 0 0 0 LISA CLAY VICE CHAIR 1.00 2.00 X X 0 0 0 MIKE DELLENBACH DIRECTOR 1.00 2.00 X 0 0 0 DOUG ERION DIRECTOR 1.00 2.00 X 0 0 0 DENNIS HOUSKA BOARD CHAIR 1.00 2.00 X X 0 0 0 CELESTE KLING DIRECTOR 1.00 2.00 X 0 0 0 CHRIS OSBORN DIRECTOR 1.00 2.00 X 0 0 0 JIM PARKE DIRECTOR 1.00 2.00 X 0 0 0 DAN STROH DIRECTOR 1.00 2.00 X 0 0 0 MICHELLE ALBRIGHT SECRETARY 23.00 27.00 X 34421 40511 16284 DAVID THOMPSON CFO 22.00 25.00 X 238229 280381 31089 GEORGE BOST DIRECTOR LABORATORY 30.00 20.00 X 120268 83241 21155 ASHLEY BRUNING CHIEF NURSING OFFICER 44.00 X 217412 0 82487 ANDREW HARMON DIRECTOR OF PHARM 30.00 20.00 X 138662 95972 82825 GRACE KOWALYSHYN-TAYLOR VP OPERATIONS 23.00 27.00 X 164684 193821 38768 WILLIAM NEFF CMO 11.00 17.00 X 514080 386381 17473 JULIE NUNLEY CHIEF NURSING OFFICER, LEFT 8/2021 50.00 X 191713 0 14605 RYAN ROHMAN CHIEF OPERATING OFFICER 23.00 27.00 X 194350 228737 12848 ANGELICA THIEL DIRECTOR OF IMAGING 23.00 27.00 X 83666 97978 33127 JILLIAN BUSCH PSYCHIATRIST 50.00 X 362306 0 52622 HERMANN MORENO PSYCHIATRIST 50.00 X 396871 0 33939 DAVID SEHR MEDICAL DIRECTOR MTN CREST 50.00 X 390112 0 36849 KENNETH WATANABE MEDICAL DIRECTOR MTN CREST 50.00 X 409273 0 36857 JANELL WOZNIAK PROGRAM DIRECTOR FMC 50.00 X 361278 0 31866 4259680 1927643 575937 386 0 1 0 ALLIED BARTON SECURITY PO BOX 31001-2374 PASADENA CA 91110 SECURITY 4140375 NORTHERN COLORADO HOSPITALISTS 2121 E HARMONY RD STE 300 FORT COLLINS CO 80528 MEDICAL 3595595 NORTHERN COLORADO ANESTHESIA 1236 E ELIZABETH ST STE 1 FORT COLLINS CO 80524 MEDICAL 3145676 ORTHOPAEDIC & SPINE CENTER OF THE ROCKIE 2500 E PROSPECT RD FORT COLLINS CO 80525 MEDICAL 2670635 LAB LOGISTICS PO BOX 84938 CHICAGO IL 60689 COURIER 2216966 51 614484 3853074 1183133 326939 5650691 NET PATIENT SVC REV 900099 706209526 706209526 PROVIDER FEE INCOME 621400 26146854 26146854 LAB SERVICES 621400 9865546 9865546 JOINT VENTURE 621400 4419204 2511052 1908152 RENT INCOME - AFFILIAT 900099 2408483 2408483 2123894 -5414 40264 2089044 751173507 42524006 42524006 2525497 6612 1252362 6612 1273135 0 1273135 289574 983561 1433421657 1388161 1375448853 0 57972804 1388161 59360965 59360965 226628 128056 98572 98572 OTHER REVENUE 621400 4271736 4271736 4271736 864352612 751407783 2237990 105056148 47277350 47277350 4711625 3094889 1616736 231739521 195413793 36325728 20861686 17585962 3275724 38678252 32604951 6073301 3032056 2555959 476097 457631 457631 60272 60272 41446 41446 3297225 3297225 41295507 29414068 11881439 2814095 2776996 37099 6645075 6224878 420197 9462040 8460728 1001312 4126613 3478648 647965 997162 888555 108607 552536 193852 358684 2659324 2631931 27393 29270824 21224638 8046186 1278644 1152987 125657 MEDICAL SUPPLIES 167469639 167313598 156041 PROVIDER FEE EXPENSE 37541705 37541705 BAD DEBT 24192545 24192545 UBIT TAXES 945000 945000 18215805 14327509 3888296 697623578 618355542 79268036 0 193420646 93622713 2316787 2312627 73884751 77986417 38807 0 12880443 12200604 12541086 13364394 736189761 439105423 279634073 297084338 2101114564 1817759288 30587656 46727749 6676662105 7023988981 9383080918 9385047111 167030320 106670601 897697 898152 157227700 143542807 10565321 0 37060 37961 6273854833 6461311669 6609612931 6712461190 X 2773467987 2672585921 2773467987 2672585921 9383080918 9385047111 X 166729034 -332975629 65364529 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 18064 0 1 23382 41446 0 PART II-B, LINE 1: PORTION OF DUES FROM MEMBERSHIP IN CHA AND AHA THAT ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 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 7098243 34394 536004 4257 100183 35255 7528946 0.06090 0.90280 0.03630 1 1 1 58004543 58004543 279309774 143431816 135877958 88372013 79627335 8744678 210625482 160843717 49781765 99877949 55202555 44675394 297084338 INTERCOMPANY RECEIVABLE 6976782818 DEFERRED PENSION OUTFLOW COSTS 28367180 OTHER RECEIVABLES 3066507 LEASE RECEVIABLE LT 15772476 7023988981 INTERCOMPANY PAYABLES 6395711964 ACCRUED INTEREST PAYABLE 768603 OTHER DEFERRED EXPENSES 3248217 PENSION LIABILITIES 36384728 LEASE LIABILITY 10457490 DEFERRED INFLOW OF LEASES 14740667 6461311669 504388214 -332975629 1387031 -331588598 835976812 3297225 25078575 28375800 864352612 668320422 1387031 1387031 666933391 3297225 27392962 30690187 697623578 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 1,258,975. COGS REPORTED AS EXPENSE ON AFS 128,056. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT IN AFS INCOME 24,192,545. CONTRIBUTIONS FROM FOUNDATION NOT IN AFS INCOME 287,545. RENTAL EXP AS INCOME ON 990 119,074. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 40,264. INTERCOMPANY EXPENSE ALLOCATIONS 2,753,534. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS -2,314,387. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE INCLUDED IN EXPENSE ON AFS 1,258,975. COGS REPORTED AS EXPENSE ON AFS 128,056. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT IN AFS INCOME 24,192,545. RENTAL EXP AS INCOME ON 990 119,074. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 40,264. CASH CONTRIBUTIONS FROM FOUNDATION NOT IN AFS REVENUE 287,545. INTERCOMPANY EXPENSE ALLOCATIONS 2,753,534. 1 1 X 1 X 250.000000000000 1 X 1 0 1 1 2974992 2974992 0.00380 115300471 68055807 47244664 0.06110 13789653 9110139 4679514 0.00600 132065116 77165946 54899170 0.07090 2826527 169021 2657506 0.00340 6086393 907529 5178864 0.00670 11787578 5175740 6611838 0.00850 1513425 1194641 318784 0.00040 47154247 47154247 0.06090 69368170 7446931 61921239 0.07990 201433286 84612877 116820409 0.15080 3208 3208 0.00000 131008 131008 0.00020 134216 134216 0.00020 0 23910728 150465883 184305195 -33839312 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 1 X 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. PART V, LINE 22 JULY 1, 2021 JANUARY 31, 2022 WE USED METHODOLOGY AS INDICATED BY OPTION 'B'. BEGINNING FEBRUARY 1, 2022, AND OUR PLAN GOING FORWARD, WE USE METHODOLOGY AS INDICATED BY OPTION 'C' (INCLUSIVE OF MEDICAID). 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 5 - THE VEIN AND LASER CENTER - JV 2008 CARIBOU DR FORT COLLINS CO 80525 SURGERY CENTER 6 - OCR LOVELAND 3470 E 15TH STREET LOVELAND CO 80538 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 = -$23,910,728 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: $129,051,057 CENTER AVE COST REPORT: $1,565,412 COLUMBINE HOMECARE COST REPORT: $1,215,079PVHC DISALLOWED PROGRAMS: $4,937,339 JOINT VENTURES: $13,588,163 TOTAL TO LINE 5: $150,357,050 PART 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: $157,558,018 CENTRE AVE COST REPORT: $6,348,540 COLUMBINE HOMECARE COST REPORT: $1,766,230 PVHC DISALLOWED PROGRAMS: $3,231,081 JOINT VENTURES: $15,470,476 TOTAL TO LINE 6: $184,374,345 PART III, LINE 8: APPROXIMATELY 31.45% 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) 43254549 0 SEE SCH I, PART IV UNIVERSITY SCHOOL OF MEDICINE 13001 17TH PLACE AURORA CO 80045 846000555 501(C)(3) 2868629 0 SEE SCH I, PART IV UCHEALTH NORTHERN COLORADO FOUNDATION 2315 E HARMONY RD 200 FORT COLLINS CO 80528 741894581 501(C)(3) 902528 0 SEE SCH I, PART IV CITY OF FORT COLLINS 300 WEST LAPORTE AVE FORT COLLINS CO 80522 846000587 GOVERNMENT 9197 0 SEE SCH I, PART IV COLORADO NONPROFIT DEVELOPMENT CENTER 789 SHERMAN STREET SUITE 250 DENVER CO 80203 841493585 501(C)(3) 9197 0 SEE SCH I, PART IV FRONT RANGE COMMUNITY COLLEGE FOUNDATION 3645 W 112TH AVENUE WESTMINSTER CO 80031 383721881 GOVERNMENT 22992 0 SEE SCH I, PART IV UNITED WAY OF LARIMER COUNTY 424 PINE ST 102 FORT COLLINS CO 80524 846031503 501(C)(3) 33932 0 SEE SCH I, PART IV AMERICAN CANCER SOCIETY 3380 CHASTAIN MEADOWS PKY 200 KENNESAW GA 30144 131788491 501(C)(3) 16359 0 SEE SCH I, PART IV GREELEY PHILHARMONIC ORCHESTRA PO BOX 1535 GREELEY CO 80632 846031376 501(C)(3) 6566 0 SEE SCH I, PART IV UNITED WAY OF WELD COUNTY PO BOX 1944 GREELEY CO 80632 846011918 501(C)(3) 14296 0 SEE SCH I, PART IV 10 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 1 1 X X X X 0 0 0 0 0 0 0 1 0 KEVIN UNGER CEO 275187 323876 156893 184652 10275 12093 3795 4466 11429 13453 457579 538540 0 0 WILLIAM NEFF CMO 387165 298540 120454 83369 6461 4472 0 0 9824 7649 523904 394030 0 0 DAVID THOMPSON CFO 177759 209211 58340 68663 2130 2507 3534 4160 10746 12649 252509 297190 0 0 KENNETH WATANABE MEDICAL DIRECTOR MTN CREST 311424 0 46000 0 51849 0 8700 0 28157 0 446130 0 0 0 RYAN ROHMAN CHIEF OPERATING OFFICER 150994 177710 42813 50388 543 639 3996 4704 1906 2242 200252 235683 0 0 HERMANN MORENO PSYCHIATRIST 325322 0 12262 0 59287 0 8700 0 25239 0 430810 0 0 0 DAVID SEHR MEDICAL DIRECTOR MTN CREST 315398 0 46000 0 28714 0 8700 0 28149 0 426961 0 0 0 JILLIAN BUSCH PSYCHIATRIST 332593 0 9550 0 20163 0 27434 0 25188 0 414928 0 0 0 GRACE KOWALYSHYN-TAYLOR VP OPERATIONS 125681 147918 38482 45290 521 613 3996 4704 13812 16256 182492 214781 0 0 JANELL WOZNIAK PROGRAM DIRECTOR FMC 312429 0 47625 0 1224 0 8700 0 23166 0 393144 0 0 0 ANDREW HARMON DIRECTOR OF PHARM 119360 82612 18897 13079 405 281 13246 9168 35702 24709 187610 129849 0 0 ASHLEY BRUNING CHIEF NURSING OFFICER 175576 0 31122 0 10714 0 20728 0 61759 0 299899 0 0 0 GEORGE BOST DIRECTOR LABORATORY 100196 69348 15679 10852 4393 3041 7769 5377 4733 3276 132770 91894 0 0 ANGELICA THIEL DIRECTOR OF IMAGING 69241 81086 11344 13284 3081 3608 2628 3077 12631 14791 98925 115846 0 0 JULIE NUNLEY CHIEF NURSING OFFICER, LEFT 8/2021 164332 0 0 0 27381 0 5759 0 8846 0 206318 0 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 27 213070 43280353 2017 1 0 1 1 D 33395000 23730000 276146 23453853 2017 1 0 1 1 A 0 1 1 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 C 0 1 1 0 1 0 0 0 1 D 0 1 1 0 1 0 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 0 1 B 0 1 1 0 1 0 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 AND FACILITY UPGRADES 16 326939 FMV 0 1 0 FORM 990, PART I, LINE 6 POUDRE VALLEY HOSPITAL (PVH) HAD 129 ACTIVE VOLUNTEERS IN FISCAL YEAR 2022. THESE VOLUNTEERS PROVIDED OVER 36,500 HOURS OF SERVICE DURING THE YEAR. AT PVH, IN A NORMAL YEAR, 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. DURING THE COVID-19 PANDEMIC THE VOLUNTEER PROGRAM HAS BEEN FORCED TO TEMPORARILY REDUCE OPPORTUNITIES. THE ORGANIZATION HAS THE INTENT TO RESTART THE VOLUNTEER PROGRAM AT THE CONCLUSION OF THE PANDEMIC. 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 59,772,650. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS 2,314,387. GASB 87 LEASE ADOPTION 3,277,492. TIMBERLINE MEDICAL CLINIC 131 STANLEY AVE ESTES PARK CO 80517 043772090 OUTPATIENT CO 0 -16785 PVHC INC LAKOTA LAKE LLC 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 841447761 OUTPATIENT CO 494028 50922349 PVHC INC HERON LAKE LLC 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 264189163 OUTPATIENT CO 0 657338 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 FT COLLINS CO 80528 841479751 AMBULATORY SURGERY CO N/A RELATED 3059837 2666158 0 0 0.50000 CENTRE AVENUE HEALTH & REHAB FACILITY 947 WORTHINGTON CIRCLE FT COLLINS CO 80526 841560494 NURSING FACILITY CO N/A RELATED -1069253 773874 0 0 0.50000 COLUMBINE POUDRE HOME CARE 947 WORTHINGTON CIRCLE FT COLLINS CO 80526 841529817 NURSING CARE CO N/A RELATED -42459 598818 0 0 0.50000 GATEWAY MEDICAL SERVICES 2500 E PROSPECT RD FT COLLINS CO 80525 841427970 REAL EST/MED CO N/A UNRELATED 966709 4760661 0 0 0.50000 HARMONY IMAGING CENTER 1951 WILMINGTON DRIVE FT COLLINS CO 80528 582479187 MEDICAL IMAGING CO N/A RELATED 316002 2143589 0 0 0.46000 SURGERY CENTER OF FORT COLLINS 1100 E PROSPECT ROAD FT COLLINS CO 80525 841541559 SURGICAL PROC CO N/A UNRELATED 246890 710490 0 0 0.26000 OCR LOVELAND 2500 E PROSPECT RD FT COLLINS CO 80525 301069701 REAL EST/MED CO N/A UNRELATED 1871889 30307901 0 0 0.50000 PVHS-ICM EHW 2315 E HARMONY RD STE 200 FT COLLINS CO 80528 463311308 MEDICAL SERVICES CO N/A RELATED 53369 194332 0 0 0.50000 PEAK SURGICAL MANAGEMENT 2127 E HARMONY RD 200 FT COLLINS CO 80528 260899618 SURGICAL MGMT CO N/A UNRELATED 164294 97217 0 0 0.07040 OCR FT COLLINS 2500 E PROSPECT RD FT COLLINS CO 80525 REAL EST/MED CO N/A UNRELATED -80769 2936760 0 0 0.50000 INNOVATION ENTERPRISES 2315 E HARMONY RD STE 200 FORT COLLINS CO 80528 202036774 IT CONSULTING CO PVHC C -12601 1653074 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 393282 TRANSACTION TOTAL HARMONY SURGERY CENTER A 909262 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP B 43254549 TRANSACTION TOTAL OCR LOVELAND B 15444600 TRANSACTION TOTAL CENTRE AVE HEALTH & REHAB LLC B 850000 TRANSACTION TOTAL UCHEALTH NORTHERN COLORADO FOUNDATION B 902528 TRANSACTION TOTAL UCHEALTH NORTHERN COLORADO FOUNDATION C 481382 TRANSACTION TOTAL INNOVATION ENTERPRISES J 127517 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP J 2709824 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP L 4836769 TRANSACTION TOTAL MEDICAL CENTER OF THE ROCKIES L 10812210 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP M 5317514 TRANSACTION TOTAL MEDICAL CENTER OF THE ROCKIES N 2032697 TRANSACTION TOTAL POUDRE VALLEY MEDICAL GROUP N 1418154 TRANSACTION TOTAL HARMONY SURGERY CENTER Q 651709 TRANSACTION TOTAL GATEWAY MEDICAL SERVICES S 840000 TRANSACTION TOTAL MEDICAL CENTER OF THE ROCKIES S 59772650 TRANSACTION TOTAL HARMONY SURGERY CENTER S 2800000 TRANSACTION TOTAL OCR LOVELAND S 2661551 TRANSACTION TOTAL