POUDRE VALLEY HEALTH CARE INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: POUDRE VALLEY HEALTH CARE INC (EIN 84-1262971)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2019-05-15
IRS object ID: 201901359349311935
Schema version: 2017v2.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule K
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-05-15T16:26:37-05:00	ReturnTs
Tax Period End	2018-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	381357951	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	PLANTE & MORAN PLLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	8181 E TUFTS AVE SUITE 600	AddressLine1Txt
City	DENVER	CityNm
State Abbreviation	CO	StateAbbreviationCd
ZIP	80237	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2017-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	841262971	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	POUDRE VALLEY HEALTH CARE INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	POUD	BusinessNameControlTxt
Phone	9702377000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2315 E HARMONY ROAD NO 200	AddressLine1Txt
City	FORT COLLINS	CityNm
State Abbreviation	CO	StateAbbreviationCd
ZIP	80528	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	STEVE SCHWARTZ	PersonNm
Person Title	CHIEF FINANCIAL OFFICER	PersonTitleTxt
Phone	9702377000	PhoneNum
Signature	2019-05-15	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	DORI J EGGETT	PreparerPersonNm
PTIN	P00645252	PTIN
Phone	3037409400	PhoneNum
Preparation	2019-05-15	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	208.42.238.142	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-05-15	IPDt
IP Tm	10:57:38	IPTm
IP Timezone	MD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	2B300E1FC09CCA321063079848B1E489E0A7BF4B	AtSubmissionCreationDeviceId
At Submission Filing Device Id	321DDE24B35CC1D1467AEA03569F7C6B0A555C82	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	KEVIN UNGER	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2315 E HARMONY RD 200	AddressLine1Txt
City	FT COLLINS	CityNm
State Abbreviation	CO	StateAbbreviationCd
ZIP	80528	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$1,545,168,059	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.UCHEALTH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1994	FormationYr
Legal Domicile State	CO	LegalDomicileStateCd
Activity Or Mission	WE IMPROVE LIVES THROUGH LEARNING, HEALING, DISCOVERY, AND THROUGH HUMAN CONNECTION.	ActivityOrMissionDesc
Voting Members Governing Body	12	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	4347	TotalEmployeeCnt
Total Volunteers	526	TotalVolunteersCnt
Total Gross UBI	$8,402,483	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$7,232,949	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$2,840,052	PYContributionsGrantsAmt
CY Contributions Grants	$2,438,879	CYContributionsGrantsAmt
PY Program Service Revenue	$577,191,100	PYProgramServiceRevenueAmt
CY Program Service Revenue	$659,740,233	CYProgramServiceRevenueAmt
PY Investment Income	$22,577,481	PYInvestmentIncomeAmt
CY Investment Income	$38,386,133	CYInvestmentIncomeAmt
PY Other Revenue	$12,670,163	PYOtherRevenueAmt
CY Other Revenue	$12,210,328	CYOtherRevenueAmt
PY Total Revenue	$615,278,796	PYTotalRevenueAmt
CY Total Revenue	$712,775,573	CYTotalRevenueAmt
PY Grants And Similar Paid	$41,334,657	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$43,656,988	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$216,412,492	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$231,007,789	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$259,555,547	PYOtherExpensesAmt
CY Other Expenses	$276,218,006	CYOtherExpensesAmt
PY Total Expenses	$517,302,696	PYTotalExpensesAmt
CY Total Expenses	$550,882,783	CYTotalExpensesAmt
PY Revenues Less Expenses	$97,976,100	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$161,892,790	CYRevenuesLessExpensesAmt
Total Assets BOY	$4,835,353,781	TotalAssetsBOYAmt
Total Assets EOY	$5,905,134,945	TotalAssetsEOYAmt
Total Liabilities BOY	$3,498,192,542	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$4,290,573,331	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$1,337,161,239	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$1,614,561,614	NetAssetsOrFundBalancesEOYAmt
Mission	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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$507,475,284	ExpenseAmt
Grant	$43,656,988	GrantAmt
Revenue	$656,997,915	RevenueAmt
Desc	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 2018, PVHC RECORDED 58,908 PATIENT DAYS, 15,669 ADMISSIONS, 292,627 OUTPATIENT VISITS, 65,233 EMERGENCY VISITS, 1,986 DELIVERIES, 4,105 INPATIENT SURGERIES, AND 5,759 OUTPATIENT SURGERIES.	Desc
Total Program Service Expenses	$507,475,284	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	225	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	4347	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	12	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	STEVE SCHWARTZ	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	9702377000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2315 E HARMONY ROAD SUITE 200	AddressLine1Txt
City	FORT COLLINS	CityNm
State Abbreviation	CO	StateAbbreviationCd
ZIP	80528	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
MIKE DELLENBACH
BOARD CHAIR	1.00	2.00	Yes (X)	Yes (X)	$0	$0	$0
DENNIS HOUSKA
VICE BOARD CHAIR	1.00	2.00	Yes (X)	Yes (X)	$0	$0	$0
CHRISTINE CHIN
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
LISA CLAY
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
DOUG ERION
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
CHRIS OSBORN
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
JIM PARKE
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
JAMES SPROWELL MD
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
DAN STROH
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
KEVIN UNGER
PRESIDENT/CEO	25.00	26.00	Yes (X)	Yes (X)	$428,022	$428,022	$102,724
TESS HEFFERNAN
DIRECTOR	1.00	2.00	Yes (X)		$0	$0	$0
RICH LOWE
DIRECTOR	1.00	2.00	Yes (X)		$0	$0	$0
STEPHANIE DOUGHTY
CHIEF FINANCIAL OFFICER	25.00	26.00		Yes (X)	$308,293	$308,293	$62,176
DIANA BREYER
VP CHIEF QUALITY OFFICER	25.00	26.00			$162,675	$325,352	$38,210	Yes (X)
THOMAS DOWNES
CHIEF MEDICAL OFFICER	25.00	26.00			$310,908	$310,908	$58,292	Yes (X)
YVONNE ROCKWOOD
COO (TERM ENDED 07/17)	25.00	26.00			$153,837	$153,838	$27,104	Yes (X)
RYAN ROHMAN
CHIEF OPERATING OFFICER	25.00	26.00			$145,397	$145,397	$30,024	Yes (X)
DONNA PODUSKA
CHIEF NURSING OFFICER	50.00				$274,086	$0	$37,141	Yes (X)
DAVID MARCHANT
MEDICAL DIRECTOR	50.00				$318,163	$0	$47,597		Yes (X)
HERMANN MORENO
PSYCHIATRIST	50.00				$278,883	$0	$48,130		Yes (X)
DAVID SEHR
MEDICAL DIRECTOR	50.00				$287,543	$0	$50,004		Yes (X)
KENNETH WATANABE
MEDICAL DIRECTOR	50.00				$320,967	$0	$45,692		Yes (X)
JANELL WOZNIAK
PROGRAM DIRECTOR, FMC	50.00				$303,688	$0	$40,419		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,292,462	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,671,810	TotReportableCompRltdOrgAmt
Total Other Compensation	$587,513	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	186	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
ALLIED UNIVERSITY SECURITY
PO BOX 31001-2374	PASADENA	CA	91110	SECURITY	$3,248,161
NORTHERN COLORADO HOSPITALISTS
2121 E HARMONY RD 300	FT COLLINS	CO	80528	MEDICAL	$2,247,758
FORT COLLINS WOMEN'S CLINIC
1107 S LEMAY AVE 300	FT COLLINS	CO	80524	MEDICAL	$1,966,525
SUMMIT PATHOLOGY
5802 WRIGHT DR	LOVELAND	CO	80538	MEDICAL	$1,806,309
ARUP LABRORATORIES
PO BOX 27964	SALT LAKE CITY	UT	84127	MEDICAL	$1,508,757

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	40	CntrctRcvdGreaterThan100KCnt
Related Organizations	$1,056,629	RelatedOrganizationsAmt
Government Grants	$1,030,696	GovernmentGrantsAmt
All Other Contributions	$351,554	AllOtherContributionsAmt
Noncash Contributions	$897,843	NoncashContributionsAmt
Total Contributions	$2,438,879	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
NET PATIENT SVC REV	900099	$617,911,409	$617,911,409
PROVIDER FEE INCOME	621400	$36,118,359	$36,118,359
JOINT VENTURE	621400	$3,438,275	$2,957,824	$480,451
DIETARY SVC INCOME	900099	$2,223,489			$2,223,489

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$48,701	TotalRevenueColumnAmt
Related Or Exempt Func Income	$10,323	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$38,378	UnrelatedBusinessRevenueAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$659,740,233	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$18,358,401	TotalRevenueColumnAmt
Exclusion	$18,358,401	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$310,484	TotalRevenueColumnAmt
Exclusion	$310,484	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$12,382,457	RealAmt
Personal	$163,477	PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,809,983	RealAmt
Personal	$163,477	PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$10,572,474	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$10,572,474	TotalRevenueColumnAmt
Unrelated Business Revenue	$7,883,654	UnrelatedBusinessRevenueAmt
Exclusion	$2,688,820	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$850,005,864	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$830,282,737	SecuritiesAmt
Other	$5,879	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$19,723,127	SecuritiesAmt
Other	-$5,879	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$19,717,248	TotalRevenueColumnAmt
Exclusion	$19,717,248	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$365,816	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$130,410	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$235,406	TotalRevenueColumnAmt
Exclusion	$235,406	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt
MISCELLANEOUS REVENUE	621400	$1,363,719	$1,363,719
EHR REVENUE	624100	$31,598	$31,598
INCOME TAX REFUND	624100	$7,131		$7,131

Field	Value	IRS element (for citing)
Other Revenue Total	$1,402,448	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$712,775,573	TotalRevenueColumnAmt
Related Or Exempt Func Income	$658,393,232	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$8,402,483	UnrelatedBusinessRevenueAmt
Exclusion	$43,540,979	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$43,656,988	TotalAmt
Program Services	$43,656,988	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,024,361	TotalAmt
Program Services	$331,575	ProgramServicesAmt
Management And General	$1,692,786	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$176,394,567	TotalAmt
Program Services	$163,643,267	ProgramServicesAmt
Management And General	$12,751,300	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$16,253,750	TotalAmt
Program Services	$14,937,911	ProgramServicesAmt
Management And General	$1,315,839	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$34,024,055	TotalAmt
Program Services	$31,269,603	ProgramServicesAmt
Management And General	$2,754,452	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,311,056	TotalAmt
Program Services	$2,123,962	ProgramServicesAmt
Management And General	$187,094	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$2,051	TotalAmt
Management And General	$2,051	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$83,083	TotalAmt
Program Services	$15,144	ProgramServicesAmt
Management And General	$67,939	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$37,798	TotalAmt
Management And General	$37,798	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$1,666,643	TotalAmt
Management And General	$1,666,643	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$26,939,652	TotalAmt
Program Services	$19,567,353	ProgramServicesAmt
Management And General	$7,372,299	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$3,033,314	TotalAmt
Program Services	$2,966,964	ProgramServicesAmt
Management And General	$66,350	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$4,066,795	TotalAmt
Program Services	$3,679,072	ProgramServicesAmt
Management And General	$387,723	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$9,113,678	TotalAmt
Program Services	$8,331,739	ProgramServicesAmt
Management And General	$781,939	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,805,052	TotalAmt
Program Services	$2,201,071	ProgramServicesAmt
Management And General	$603,981	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$1,204,710	TotalAmt
Program Services	$974,802	ProgramServicesAmt
Management And General	$229,908	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$504,755	TotalAmt
Program Services	$476,944	ProgramServicesAmt
Management And General	$27,811	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$7,622,944	TotalAmt
Program Services	$7,622,944	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$26,465,931	TotalAmt
Program Services	$23,781,256	ProgramServicesAmt
Management And General	$2,684,675	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$2,569,012	TotalAmt
Program Services	$134,703	ProgramServicesAmt
Management And General	$2,434,309	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$121,344,726	$120,995,558	$349,168
PROVIDER FEE EXPENSE	$27,673,042	$27,673,042
BAD DEBT	$22,561,634	$22,561,634
TAXES PAID	$2,823,056		$2,823,056

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$15,700,130	TotalAmt
Program Services	$10,529,752	ProgramServicesAmt
Management And General	$5,170,378	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$550,882,783	TotalAmt
Program Services	$507,475,284	ProgramServicesAmt
Management And General	$43,407,499	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$101,680,312	BOYAmt
EOY	$103,317,710	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$1,910,410	BOYAmt
EOY	$2,094,616	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$59,387,946	BOYAmt
EOY	$64,649,593	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$44,807	BOYAmt
EOY	$44,543	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$9,500,542	BOYAmt
EOY	$10,047,221	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$7,126,559	BOYAmt
EOY	$9,552,888	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$685,340,817	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$390,967,241	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$309,635,211	BOYAmt
EOY	$294,373,576	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$1,039,103,384	BOYAmt
EOY	$1,217,788,470	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$26,424,622	BOYAmt
EOY	$24,535,932	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$3,280,539,988	BOYAmt
EOY	$4,178,730,396	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,835,353,781	BOYAmt
EOY	$5,905,134,945	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$85,287,624	BOYAmt
EOY	$102,376,764	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$1,494,757	BOYAmt
EOY	$1,655,984	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$196,985,054	BOYAmt
EOY	$184,335,104	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$19,705,807	BOYAmt
EOY	$17,304,433	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$85,807	BOYAmt
EOY	$68,772	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$3,194,633,493	BOYAmt
EOY	$3,984,832,274	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$3,498,192,542	BOYAmt
EOY	$4,290,573,331	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,337,161,239	BOYAmt
EOY	$1,614,561,614	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,337,161,239	BOYAmt
EOY	$1,614,561,614	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$4,835,353,781	BOYAmt
EOY	$5,905,134,945	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$161,892,790	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$52,434,159	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$63,073,426	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	Yes (1)	DirectContactLegislatorsInd
Direct Contact Legislators	$37,798	DirectContactLegislatorsAmt
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	0	OtherActivitiesInd
Total Lobbying Expenditures	$37,798	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	PORTION OF DUES FROM MEMBERSHIP IN CHA AND AHA THAT ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$7,098,243	BeginningYearBalanceAmt
Contributions	$34,394	ContributionsAmt
Investment Earnings Or Losses	$536,004	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$4,257	GrantsOrScholarshipsAmt
Other Expenditures	$100,183	OtherExpendituresAmt
Administrative Expenses	$35,255	AdministrativeExpensesAmt
End Year Balance	$7,528,946	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$6,872,466	BeginningYearBalanceAmt
Contributions	$76,668	ContributionsAmt
Investment Earnings Or Losses	$163,048	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	-$6,188	GrantsOrScholarshipsAmt
Other Expenditures	-$12,899	OtherExpendituresAmt
Administrative Expenses	$33,026	AdministrativeExpensesAmt
End Year Balance	$7,098,243	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$7,151,577	BeginningYearBalanceAmt
Contributions	$39,217	ContributionsAmt
Investment Earnings Or Losses	$55,040	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$19,049	GrantsOrScholarshipsAmt
Other Expenditures	$317,893	OtherExpendituresAmt
Administrative Expenses	$36,426	AdministrativeExpensesAmt
End Year Balance	$6,872,466	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$7,079,697	BeginningYearBalanceAmt
Contributions	$46,722	ContributionsAmt
Investment Earnings Or Losses	$95,036	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$22,644	GrantsOrScholarshipsAmt
Other Expenditures	$14,222	OtherExpendituresAmt
Administrative Expenses	$33,012	AdministrativeExpensesAmt
End Year Balance	$7,151,577	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$6,455,719	BeginningYearBalanceAmt
Contributions	$409,384	ContributionsAmt
Investment Earnings Or Losses	$261,997	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$4,960	GrantsOrScholarshipsAmt
Other Expenditures	$9,813	OtherExpendituresAmt
Administrative Expenses	$32,630	AdministrativeExpensesAmt
End Year Balance	$7,079,697	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.06070	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.86190	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.07740	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	Yes (1)	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$58,703,442	OtherCostOrOtherBasisAmt
Book Value	$58,703,442	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$283,212,522	OtherCostOrOtherBasisAmt
Depreciation	$129,694,847	DepreciationAmt
Book Value	$153,517,675	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$99,989,388	OtherCostOrOtherBasisAmt
Depreciation	$76,042,388	DepreciationAmt
Book Value	$23,947,000	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$189,846,485	OtherCostOrOtherBasisAmt
Depreciation	$139,524,164	DepreciationAmt
Book Value	$50,322,321	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$53,588,980	OtherCostOrOtherBasisAmt
Depreciation	$45,705,842	DepreciationAmt
Book Value	$7,883,138	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$294,373,576	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
INTERCOMPANY RECEIVABLE	$4,160,946,587
DEFERRED DEBT ISSUANCE COSTS	$2,527,838
OTHER RECEIVABLES	$4,426,701
DEFERRED PENSION OUTFLOW COSTS	$10,829,270

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$4,178,730,396	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDesc	AmtAmt
INTERCOMPANY PAYABLES	$3,963,975,964
ACCRUED INTEREST PAYABLE	$1,816,229
OTHER DEFERRED EXPENSES	$2,525,841
PENSION LIABILITIES	$16,514,240

Field	Value	IRS element (for citing)
Total Liability	$3,984,832,274	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$739,160,148	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$52,434,159	NetUnrealizedGainsInvstAmt
Other Revenue	$2,103,870	OtherRevenueAmt
Revenue Not Reported	$54,538,029	RevenueNotReportedAmt
Revenue Subtotal	$684,622,119	RevenueSubtotalAmt
Investment Expenses Not Incld	$1,666,643	InvestmentExpensesNotIncldAmt
Other Revenues Not Included	$26,486,811	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$28,153,454	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$712,775,573	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$525,102,236	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$2,103,870	OtherExpensesIncludedAmt
Expenses Not Reported	$2,103,870	ExpensesNotReportedAmt
Expenses Subtotal	$522,998,366	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$1,666,643	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$26,217,774	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$27,884,417	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$550,882,783	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 POUDRE VALLEY HEALTH SYSTEM FOUNDATION.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSE INCLUDED IN EXPENSE ON AFS 1,973,460. COGS REPORTED AS EXPENSE ON AFS 130,410.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBT IN AFS INCOME 22,561,634. CONTRIBUTIONS FROM PV FOUNDATION NOT IN AFS INCOME 158,785. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 38,378. INCOME TAX REFUND REDUCED EXPENSES ON AFS 7,131. RENTAL EXP AS INCOME ON 990 11,828. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS 269,037. INTERCOMPANY EXPENSE ALLOCATIONS 3,440,018.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSE INCLUDED IN EXPENSE ON AFS 1,973,460. COGS REPORTED AS EXPENSE ON AFS 130,410.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBT IN AFS INCOME 22,561,634. RENTAL EXP AS INCOME ON 990 11,828. PHARMACY SALES INCLUDED IN EXPENSE ON AFS 38,378. CASH CONTRIBUTIONS FROM FOUNDATION NOT IN AFS REVENUE 158,785. INCOME TAX REFUND REDUCED EXPENSES ON AFS 7,131. INTERCOMPANY EXPENSE ALLOCATION 3,440,018.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
Most Hospitals Policy	Yes (X)	MostHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	250.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	0	FreeCareMedicallyIndigentInd
Financial Assistance Budget	0	FinancialAssistanceBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$288,236	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$288,236	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$111,451,742	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$74,897,068	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$36,554,674	NetCommunityBenefitExpnsAmt
Total Expense	0.06950	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,112,628	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$9,160,001	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,952,627	NetCommunityBenefitExpnsAmt
Total Expense	0.00940	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$125,852,606	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$84,057,069	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$41,795,537	NetCommunityBenefitExpnsAmt
Total Expense	0.07940	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,514,901	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$226,978	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,287,923	NetCommunityBenefitExpnsAmt
Total Expense	0.00630	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,094,735	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$809,182	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,285,553	NetCommunityBenefitExpnsAmt
Total Expense	0.01010	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,631,768	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,908,724	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,723,044	NetCommunityBenefitExpnsAmt
Total Expense	0.00330	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$21,293	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$21,293	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$43,752,223	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$43,752,223	NetCommunityBenefitExpnsAmt
Total Expense	0.08320	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$58,014,920	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,944,884	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$54,070,036	NetCommunityBenefitExpnsAmt
Total Expense	0.10290	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$183,867,526	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$88,001,953	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$95,865,573	NetCommunityBenefitExpnsAmt
Total Expense	0.18230	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$22,989	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$22,989	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$38,650	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$38,650	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$61,639	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$61,639	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$22,882,420	BadDebtExpenseAmt
Reimbursed By Medicare	$129,572,389	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$150,645,413	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$21,073,024	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	0	WrittenDebtCollectionPolicyInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (8 entries)

Primary ActivitiesPrimaryActivitiesTxt	Org Profit Or OwnershipOrgProfitOrOwnershipPct	Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
1 HARMONY SURGERY CENTER LLC
AMBULATORY SURGERY	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 SURGERY	0.26000	0.49000
5 GATEWAY MEDICAL SERVICES
REAL ESTATE/MEDICAL EQUIPMENT	0.50000	0.50000
6 EYE AND LASER CENTER OF NORTHERN COLO LLC
LASER SURGERY	0.50000	0.50000
7 VEIN AND LASER CENTER OF N COLO
LASER SURGERY	0.33000	0.67000
8 PVHS-ICM EHW LLC
MEDICAL CLINIC	0.50000	0.50000

Field	Value	IRS element (for citing)
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	POUDRE VALLEY HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1024 S LEMAY	AddressLine1Txt
City	FORT COLLINS	CityNm
State Abbreviation	CO	StateAbbreviationCd
ZIP	80524	ZIPCd

Field	Value	IRS element (for citing)
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Teaching Hospital	Yes (X)	TeachingHospitalInd
Research Facility	Yes (X)	ResearchFacilityInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	PHARMACY, LAB, CARDIOVASCULAR	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	POUDRE VALLEY HEALTH CARE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	15	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V, SECTION C	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	0	StrategyPostedWebsiteInd
Strategy Attached	0	StrategyAttachedInd
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	250.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Explained Basis	0	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	SEE PART V, SECTION C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	SEE PART V, SECTION C	FAPAppAvailableOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	0	FAPActionsOnNonpaymentInd
Collection Activities	Yes (1)	CollectionActivitiesInd
Reporting To Credit Agency	Yes (X)	ReportingToCreditAgencyInd
Engaged Legal Judicial Process	Yes (X)	EngagedLegalJudicialProcessInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Amounts Generally Billed	Yes (1)	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
POUDRE VALLEY HEALTH CARE	PART V, SECTION B, LINE 5: TWO COMMUNITY MEETINGS WERE HELD DURING NOVEMBER 2015 WHERE FINDINGS FROM THE CHNA WERE PRESENTED, QUESTIONS AND COMMENTS WERE RECEIVED AND RESPONSES PROVIDED. PARTICIPANTS IDENTIFIED ADDITIONAL HEALTH ISSUES AND PROVIDED FEEDBACK AS TO HOW THE HOSPITALS MIGHT ADDRESS THEM. ATTENDEES REPRESENTED ORGANIZATIONS SERVING LOW-INCOME, UNINSURED AND MINORITY POPULATIONS. A LIST OF THE ORGANIZATIONS REPRESENTED IS INCLUDED AS AN APPENDIX TO THE CHNA REPORT. THE SECOND MEETING INCLUDED MEMBERS OF A COALITION SERVING LOW-INCOME, HISPANIC INDIVIDUALS. THE SYNOPSIS OF INFORMATION GATHERED DURING THESE MEETINGS IS INCLUDED IN AN APPENDIX OF THE 2016 CHNA REPORT.
POUDRE VALLEY HEALTH CARE	PART V, SECTION B, LINE 6A: MEDICAL CENTER OF THE ROCKIES ALSO PARTICIPATED IN THE 2016 CHNA. THE GEOGRAPHIC SERVICE AREA FOR BOTH POUDRE VALLEY HOSPITAL & MEDICAL CENTER OF THE ROCKIES IS THE SAME.
POUDRE VALLEY HEALTH CARE	PART V, SECTION B, LINE 6B: CENTENNIAL HIGH SCHOOL HEALTH CENTER POUDRE SCHOOL DISTRICT - WELLNESS TEAM THOMPSON SCHOOL DISTRICT TEAM WELLNESS & PREVENTION LUTHERAN FAMILY SERVICES THE MATTHEWS HOUSE CITY OF FORT COLLINS - HOUSING AUTHORITY FAMILY CENTER/LA FAMILIA HEALTH DISTRICT OF NORTHERN LARIMER COUNTY HOUSE OF NEIGHBORLY SERVICES LARIMER COUNTY FOOD BANK LARIMER COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENT SALUD FAMILY HEALTH CENTER-FORT COLLINS SUMMITSTONE BEHAVIORAL HEALTH THE CENTER FOR FAMILY OUTREACH VIDA SANA COALITION COLUMBINE HEALTH SYSTEM DEMENTIA FRIENDLY COMMUNITY PARTNERSHIP FOR AGE-FRIENDLY COMMUNITIES SHARING THE CARE CAMPAIGN UCHEALTH - COMMUNITY HEALTH IMPROVEMENT UNITED WAY OF LARIMER COUNTY WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PART V, SECTION B, LINE 7A: HTTPS://S3.AMAZONAWS.COM/UCHEALTH-WP-UPLOADS/WP-CONTENT/UPLOADS/2017/04/13015710/COMHEA-CHNA-PVH-MCR-INTERACTIVE.PDF
POUDRE VALLEY HEALTH CARE	PART V, SECTION B, LINE 11: HEALTH NEED - ACCESS TO CARE FOR OLDER ADULTS, MINORITY AND LOW-INCOME INDIVIDUALS: BOTH POUDRE VALLEY HOSPITAL AND MEDICAL CENTER OF THE ROCKIES PROVIDE A NO-COST COMMUNITY PARAMEDIC HOME BASED SERVICE WHICH PROVIDES CLINICAL REVIEW OF CHRONIC CONDITIONS TO HOME-BOUND OR FRAIL INDIVIDUALS. BOTH HOSPITALS ALSO PROVIDE AN RN HOME VISIT PROGRAM, SERVING MEDICAID-ELIGIBLE WOMEN WITH POST-PARTUM NEWBORN ASSESSMENTS AND LIMITED CASE MANAGEMENT SERVICES. COMMUNITY CASE MANAGEMENT NURSES PROVIDE NO-COST IN-HOME SERVICES TO PERSONS NEEDING ASSISTANCE IN MANAGING CHRONIC DISEASE. HEALTH NEED - CARDIOVASCULAR DISEASE PREVENTION AND CONTROL: BOTH HOSPITALS SUPPORT A SCHOOL-BASED HEART DISEASE SCREENING AND EDUCATION PROGRAM FOR ELEMENTARY, MIDDLE AND HIGH SCHOOL-AGED YOUTH; CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS PROVIDE COUNSELING AND ACHIEVE INCREASED SELF-EFFICACY BY PARTICIPANTS TO MANAGE THEIR CONDITION; COMMUNITY HEALTH WORKER MODEL PROVIDES NO-COST, COMMUNITY-BASED HEART DISEASE ASSESSMENT AND REFERRAL TO SCREENING SERVICES TO LOW-INCOME, OLDER ADULT AND/OR MINORITY POPULATIONS. HEALTH NEED - SUICIDE PREVENTION / SUBSTANCE ABUSE PREVENTION & TREATMENT: PLANNING TEAM FORMED TO DEVELOP METHODS TO IMPLEMENT EVIDENCE-BASED ZERO SUICIDE INITIATIVE AT BOTH HOSPITALS RESULTING IN ADDITIONAL STAFF RECRUITED TO TRAIN NON-BEHAVIORAL STAFF ON SUICIDE PREVENTION AND ALSO FOR BEHAVIORAL HEALTH PREVENTIVE SERVICES; SEVERAL NO-COST CARE COORDINATION INITIATIVES WORK TO REMOVE BARRIERS TO BEHAVIORAL HEALTH CARE FOR VULNERABLE POPULATIONS (E.G. CHILDREN IN FOSTER CARE OR AT RISK FOR REMOVAL FROM BIOLOGICAL HOME / LOW-INCOME, MEDICAID-ELIGIBLE COMMUNITY MEMBERS) BY ENROLLING INDIVIDUALS INTO A PATIENT-CENTERED MEDICAL HOME, ENSURING TIMELY ACCESS TO BEHAVIORAL HEALTH SERVICES, REMOVING TRANSPORTATION OR CHILD-CARE BARRIERS, ETC. FULL DESCRIPTION OF ALL INITIATIVES IS INCUDED IN THE IMPLEMENTATION STRATEGY REPORT ATTACHED. PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.UCHEALTHBILLPAY.ORG/PAYMENTOPTIONS.ASPX?TABID=4PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.UCHEALTHBILLPAY.ORG/PAYMENTOPTIONS.ASPX?TABID=4
POUDRE VALLEY HEALTH CARE	PART V, SECTION B, LINE 16J: IN ADDITION TO THE ACTIONS PVH TOOK TO WIDELY PUBLICIZE ITS FAP, WHICH ARE CHECKED IN RESPONSE TO PART V, LINE 16, PVH PROVIDED A CONSPICUOUS WRITTEN NOTICE ABOUT THE FAP ON PATIENTS' BILLING STATEMENTS AND VIA CONSPICUOUS PUBLIC DISPLAYS AND OTHER MEASURES REASONABLY CALCULATED TO ATTRACT PATIENTS' ATTENTION, AND IT TRANSLATED THE FAP AND FAP APPLICATION FORM INTO THE PRIMARY LANGUAGE SPOKEN BY LEP POPULATIONS. BECAUSE PVH DID NOT HAVE A PLAIN LANGUAGE SUMMARY OF THE FAP AVAILABLE DURING THE TAX YEAR, IT DID NOT NOTIFY INDIVIDUALS BY OFFERING A PLAIN LANGUAGE SUMMARY. PVH HAS SINCE CORRECTED ITS PRACTICE BY CREATING A PLAIN LANGUAGE SUMMARY AND MAKING IT AVAILABLE WITHOUT CHARGE, UPON REQUEST IN PUBLIC LOCATIONS THROUGHOUT THE HOSPITAL FACILITY AND BY MAIL, AND BY MAKING A PAPER COPY AVAILABLE TO INDIVIDUALS. PVH ALSO IS MAKING A DISCLOSURE IN SECTION VI OF SCHEDULE H, CONSISTENT WITH IRS CORRECTIVE ACTION GUIDELINES OUTLINED IN REVENUE PROCEDURE 2015-21."
POUDRE VALLEY HEALTH CARE	PART V, SECTION B, LINE 20E: IN ADDITION TO THE REASONABLE EFFORTS CHECKED IN RESPONSE TO PART V, LINE 20, PVH PROVIDED A WRITTEN NOTICE ABOUT UPCOMING ECAS (EXTRAORDINARY COLLECTION ACTION) AT LEAST 30 DAYS PRIOR TO INITIATING THOSE ECAS, BUT BECAUSE PVH DID NOT HAVE A PLAIN LANGUAGE SUMMARY OF THE FAP AVAILABLE DURING THE TAX YEAR, IT DID NOT INCLUDE A PLAIN LANGUAGE SUMMARY WITH SUCH NOTICE. PVH IS CORRECTING ITS PRACTICE BY INCLUDING A PLAIN LANGUAGE SUMMARY WITH THE WRITTEN NOTICE ABOUT UPCOMING ECAS PROVIDED AT LEAST 30 DAYS BEFORE INITIATING ECAS (AND BY WIDELY PUBLICIZING ITS PLAIN LANGUAGE SUMMARY, AS REQUIRED BY REGULATIONS). PVH ALSO IS MAKING A DISCLOSURE IN SECTION VI OF SCHEDULE H, CONSISTENT WITH IRS CORRECTIVE ACTION GUIDELINES OUTLINED IN REVENUE PROCEDURE 2015-21."
POUDRE VALLEY HEALTH CARE	PART V, SECTION B, LINE 23: DURING THE TAX YEAR, PVH DID NOT CALCULATE AGB, DUE TO A LACK OF CLARITY REGARDING 501(R) REQUIREMENTS. PVH APPLIED A DISCOUNT TO PATIENTS WHO WERE ELIGIBLE FOR FINANCIAL ASSISTANCE, BUT EVEN AFTER APPLICATION OF THE DISCOUNT, SOME PATIENTS PAID MORE THAN AGB (HAD AGB BEEN CALCULATED FOR THE TAX YEAR). PVH HAS SINCE CORRECTED ITS PRACTICES BY CALCULATING AGB AND INCLUDING A DESCRIPTION OF HOW AGB IS CALCULATED IN PVH'S FINANCIAL ASSISTANCE POLICY AND PLAIN LANGUAGE SUMMARY, AND IS INITIATING CORRECTIVE ACTION BY REFUNDING TO FAP-ELIGIBLE PATIENTS AMOUNTS PAID IN EXCESS OF AGB BY SUCH PATIENTS AND BY REVERSING ECAS TAKEN AGAINST SUCH PATIENTS IN RELATION TO AMOUNTS PAID IN EXCESS OF AGB, THUS RESTORING THE INDIVIDUALS TO THE PLACE THEY WOULD HAVE OCCUPIED IF NOT FOR PVH'S ERROR. PVH ALSO IS MAKING A DISCLOSURE IN SECTION VI OF SCHEDULE H, CONSISTENT WITH IRS CORRECTIVE ACTION GUIDELINES OUTLINED IN REVENUE PROCEDURE 2015-21."

Field	Value	IRS element (for citing)
Facility	24	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (24 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - HARMONY CAMPUS MOB
2121 E HARMONY RD	FORT COLLINS	CO	80528	ONCOLOGY, HCOR, CARDIAC REHAB, CANCER CENTER
2 - UCHEALTH HARMONY EMERGENCY
4630 SNOW MESA DRIVE	FORT COLLINS	CO	80528	HARMONY ED
3 - HARMONY CAMPUS AMBULATORY CARE CENTER
2127 E HARMONY RD	FORT COLLINS	CO	80528	SURGERY CENTER, DIAGNOSTIC CENTER, IMAGING
4 - UCHEALTH PENNOCK PLACE
1025 PENNOCK PLACE	FORT COLLINS	CO	80524	PHYSICIAN OFFICES (FMC), BLOOD BANK
5 - CENTRE AVE HEALTH AND REHAB-JV
915 CENTRE AVE	FORT COLLINS	CO	80526	REHAB
6 - MOUNTAIN CREST BEHAVIORAL HEALTH
4601 CORBETT DR	FORT COLLINS	CO	80528	BEHAVIORAL HEALTH
7 - UCHEALTH WESTBRIDGE
1107 S LEMAY	FORT COLLINS	CO	80524	SLEEP LAB, WEE STEPS,
8 - UCHEALTH PROSPECT MEDICAL PLAZA
1106 E PROSPECT SUITE 100	FORT COLLINS	CO	80524	OUTPATIENT REHAB
9 - SURGERY CENTER OF FT COLLINS-JV
1100 E PROSPECT RD	FORT COLLINS	CO	80524	SURGERY CENTER
10 - UCHEALTH CHILDREN'S THERAPY
1500 S LEMAY	FORT COLLINS	CO	80526	THERAPY
11 - UCHEALTH GREELEY MEDICAL CLINIC
1900 16TH STREET	GREELEY	CO	80631	LAB, RADIOLOGY & ONCOLOGY
12 - UCHEALTH EXPRESS LAB
1025 GARFIELD ST SUITE C	FORT COLLINS	CO	80524	EXPRESS LAB
13 - WALK IN CLINIC
2211 S COLLEGE AVE	FORT COLLINS	CO	80525	WALK IN CLINIC
14 - UCHEALTH WINDSOR MEDICAL CENTER
1455 MAIN STREET	WINDSOR	CO	80550	RADIOLOGY, LAB
15 - THE VEIN AND LASER CENTER-JV
2008 CARIBOU DRIVE	FORT COLLINS	CO	80525	PHYSICIAN OFFICES
16 - CSU MEDICAL CENTER
151 WEST LAKE	FORT COLLINS	CO	80525	MEDICAL CENTER
17 - EYE LASER CENTER OF N COLORADO-JV
1725 EAST PROSPECT RD	FORT COLLINS	CO	80525	PHYSICIAN OFFICES
18 - UCHEALTH WATER VALLEY
1870 MARINA PLAZA DRIVE	WINDSOR	CO	80550	CLINICAL EDUCATION, MED FITNESS CENTER
19 - PHLEBOTOMY STATION
1107 SOUTH LEMAY AVE	FORT COLLINS	CO	80526	LAB DRAWS
20 - PHLEBOTOMY STATION
1113 OAKRIDGE DRIVE	FORT COLLINS	CO	80525	LAB DRAWS
21 - PHLEBOTOMY STATION
2001 S SHIELDS	FORT COLLINS	CO	80526	LAB DRAWS
22 - PHLEBOTOMY STATION
2025 BIG HORN DRIVE	FORT COLLINS	CO	80525	LAB DRAWS
23 - PHLEBOTOMY STATION
3519 RICHMOND DRIVE	FORT COLLINS	CO	80526	LAB DRAWS
24 - COLUMBINE POUDRE HOMECARE-JV
915 CENTRE AVE	FORT COLLINS	CO	80526	HOME HEALTHCARE

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 7:	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.LINE 7A WAS DERIVED USING A COST-TO-CHARGE RATIO FROM THE COST REPORT.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.
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 = $22,882,420
PART II, COMMUNITY BUILDING ACTIVITIES:	AS MENTIONED UNDER PROMOTION OF COMMUNITY HEALTH WE HAVE A MULTITUDE OF PROGRAMS DESIGNED TO ADDRESS THE HEALTH OF OUR COMMUNITY INVOLVING ALL AGE GROUPS AND FOCUS ON WHAT AN INDIVIDUAL CAN DO TO IMPROVE HIS/HER HEALTH. MANY OF THE PROGRAMS REFLECTED IN PART II ARE DESIGNED TO PROMOTE HEALTHY OPTIONS AND CHOICES FOR OUR COMMUNITY WHICH IS AN IMPORTANT PART OF OVERALL COMMUNITY HEALTH AND THEREFORE A BENEFIT TO THE COMMUNITY.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: $117,918,704CENTER AVE COST REPORT: $3,196,836COLUMBINE HOMECARE COST REPORT: $1,236,216PVHC DISALLOWED PROGRAMS: $2,339,209JOINT VENTURES: $4,881,424TOTAL TO LINE 5: $129,572,389PART III, LINE 6: ALLOWABLE COSTS AS REPORTED ON THE POUDRE VALLEY HEALTH CARE INC. 2017 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: $136,446,887CENTRE AVE COST REPORT: $5,923,581COLUMBINE HOMECARE COST REPORT: $1,553,280PVHC DISALLOWED PROGRAMS: $1,188,669JOINT VENTURES: $5,532,996TOTAL TO LINE 6: $150,645,413
PART III, LINE 8:	APPROXIMATELY 26.7% 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 VI, LINE 2:	HEALTH CARE NEEDS ARE ADDITIONALLY IDENTIFIED THROUGH COLLABORATIVE RELATIONSHIPS WITH HEALTHCARE PROVIDERS IN THE COMMUNITIES WE SERVE. AN EXAMPLE IS OUR CARE COORDINATION INITIATIVE TARGETED TO AT-RISK CHILDREN WITH SPECIAL HEALTHCARE NEEDS . PHYSICIANS IDENTIFIED THE NEED TO IMPROVE THE COORDINATION AND TIMELINESS OF CARE FOR THIS POPULATION; WE RESPONDED BY DEVELOPING AND STAFFING A CARE COORDINATION / PATIENT NAVIGATION SERVICE MODEL (HEALTHY HARBORS).
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. FOR THOSE THAT ARE UNINSURED, OUR CONDITIONS OF SERVICE FORM HAS A SPOT THEY INITIAL STATING THAT WE HAVE OFFERED ASSISTANCE AND MADE THEM AWARE OF PROGRAMS AVAILABLE TO THEM. 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, WITH THE EXCEPTION THAT WE DID NOT HAVE A PLAIN LANGUAGE SUMMARY OF OUR FAB AVAILABLE DURING THE TAX YEAR.
PART VI, LINE 4:	POUDRE VALLEY HOSPITAL 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 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 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 DOLLARS TO OTHER ENTITIES THAT WORK TO IMPROVE THE HEALTH OF OUR COMMUNITY. EXAMPLES ARE: TEEN PREGNANCY PREVENTION EDUCATION; SUBSTANCE ABUSE PREVENTION EDUCATION FOR YOUTH AND YOUNG ADULTS; OBESITY PREVENTION; IMPROVED FOOD SECURITY FOR LOW INCOME RESIDENTS; 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
PART VI	DISCLOSURE PROVIDED PURSUANT TO REV. PROC. 2015-21:POUDRE VALLEY HEALTH CARE INC ("PVH") PROVIDES THE FOLLOWING INFORMATION PURSUANT TO SECTION 7 OF REVENUE PROCEDURE 2015-21 TO DISCLOSE CERTAIN NONCOMPLIANCE WITH THE REQUIREMENTS APPLICABLE TO CHARITABLE HOSPITALS AT 26 C.F.R. 1-501(R). THE REVENUE PROCEDURE REQUIRES NONCOMPLIANCE TO BE REPORTED ON THE FORM 990 FILED FOR THE YEAR SUCH NONCOMPLIANCE WAS DISCOVERED. SECTION 7.01(1)THE IMPLEMENTING REGULATIONS FOR INTERNAL REVENUE CODE (CODE) SECTIONS 26 U.S.C. 1-501(R)(4), (R)(5), AND (R)(6) REQUIRE A HOSPITAL FACILITY, IN PART, TO: (A) ESTABLISH A FINANCIAL ASSISTANCE POLICY ("FAP"); (B) ENSURE THAT INDIVIDUALS ELIGIBLE FOR ASSISTANCE UNDER THE FAP ARE CHARGED FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE NO MORE THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ("AGB"); AND (C) REFRAIN FROM ENGAGING IN EXTRAORDINARY COLLECTION ACTIONS ("ECAS"), AS DEFINED BY THE REGULATIONS, AGAINST AN INDIVIDUAL TO OBTAIN PAYMENT FOR CARE BEFORE THE HOSPITAL FACILITY HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE FOR THE CARE UNDER ITS FAP. IN THE SUMMER OF 2018, UCHEALTH DISCOVERED CERTAIN ERRORS WITH RESPECT TO ITS FAP AND PLAIN LANGUAGE SUMMARY AND ITS CALCULATION OF AGB DURING A ROUTINE REVIEW CONDUCTED IN 2018 BY UCHEALTH'S FINANCE DEPARTMENT. THE ERRORS, WHICH ARE FURTHER DESCRIBED BELOW, APPLY TO TAX YEARS 2015 THROUGH 2017 AND RESULTED FROM A LACK OF CLARITY OF THE 501(R) REQUIREMENTS AT THE TIME UCHEALTH INITIALLY IMPLEMENTED THE POLICY. PVH'S NONCOMPLIANCE PURSUANT TO 26 C.F.R. SECTIONS 1-501(R)-4, 1-501(R)-5, AND 1-501(R)-6 CONSISTED OF THE FOLLOWING:1. THE FAP THAT PVH ESTABLISHED AND IMPLEMENTED THROUGHOUT THE PERIOD SPECIFIED ABOVE WAS NOT WIDELY PUBLICIZED, PURSUANT TO 26 C.F.R. 1.501(R)-4(B)(1)(II), BECAUSE PVH DID NOT DEVELOP AND MAKE AVAILABLE A PLAIN LANGUAGE SUMMARY, AS FURTHER DESCRIBED AT 26 C.F.R. 1.501(R)-4(B)(5).2. THE FAP THAT PVH ESTABLISHED AND IMPLEMENTED THROUGHOUT THE PERIOD SPECIFIED ABOVE DID NOT INCLUDE ALL ACTIONS THAT PVH MAY HAVE TAKEN IN THE EVENT OF NONPAYMENT, AS REQUIRED BY 26 C.F.R. 1.501(R)-4(B)(1)(III)(D).3. THE FAP THAT PVH ESTABLISHED AND IMPLEMENTED THROUGHOUT THE PERIOD SPECIFIED ABOVE DID NOT INCLUDE A LIST OF PROVIDERS DELIVERING EMERGENCY OR MEDICALLY NECESSARY CARE IN THE HOSPITAL FACILITY THAT SPECIFIED WHICH PROVIDERS WERE COVERED BY PVH'S FAP AND WHICH WERE NOT, AS REQUIRED BY 26 C.F.R. 1.501(R)-4(B)(1)(III)(F).4. THE FAP THAT PVH ESTABLISHED AND IMPLEMENTED THROUGHOUT THE PERIOD SPECIFIED ABOVE DID NOT INCLUDE THE METHODOLOGY USED TO CALCULATE AGB, PURSUANT TO 26 C.F.R. 1.501(R)-4(B)(2)(I)(C). 5. PVH DID NOT DETERMINE AGB PURSUANT TO 26 C.F.R. 1.501(R)-5(B).6. PVH DID NOT ENSURE THAT ALL INDIVIDUALS WHO RECEIVED EMERGENCY OR MEDICALLY NECESSARY CARE AT PVH WHO WERE ELIGIBLE FOR ASSISTANCE UNDER PVH'S FAP WERE CHARGED NO MORE THAN AGB FOR SUCH CARE, PURSUANT TO 26 C.F.R. 1.501(R)-5(A)(1).PVH CALCULATED THAT THE NUMBER OF PATIENT ACCOUNTS THAT RECEIVED EMERGENCY OR MEDICALLY NECESSARY CARE AT PVH, WERE ELIGIBLE FOR ASSISTANCE UNDER PVH'S FAP, AND WERE CHARGED MORE THAN AGB IS 198. AN ESTIMATE OF THE TOTAL AMOUNT OF THE CHARGES THAT EXCEEDED AGB FOR HOSPITAL SERVICES PROVIDED BY PVH IS $141,630.7. PVH DID NOT HAVE A PLAIN LANGUAGE SUMMARY AVAILABLE AS PART OF ITS REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS FAP-ELIGIBLE BASED ON NOTIFICATION, AS REQUIRED BY 26 C.F.R. 1.501(R)-6(C)(3)(I) AND FURTHER DEFINED AT 26 C.F.R. 1.501(R)-6(C)(4)(I)(B).SECTION 7.01(2)PVH'S NONCOMPLIANCE AS DESCRIBED ABOVE WAS INADVERTENT AND DID NOT RISE TO THE LEVEL OF WILLFUL OR EGREGIOUS CONDUCT. PROMPTLY UPON DISCOVERY OF THE NONCOMPLIANCE, PVH EXERCISED REASONABLE DILIGENCE TO IDENTIFY THE FULL SCOPE OF NONCOMPLIANCE AND PROMPTLY TOOK CORRECTIVE ACTION. PVH'S CORRECTIVE ACTIONS HAVE INCLUDED, TO DATE, AND WILL INCLUDE:1. UCHEALTH SUBSTANTIALLY REWROTE ITS FAP AND VERIFIED THAT THE FAP CONTAINED ALL OF THE ELEMENTS REQUIRED AT 26 C.F.R. 1.501(R)-4(B), INCLUDING (A) ALL OF THE ACTIONS THAT PVH WILL TAKE IN THE EVENT OF NONPAYMENT, AS REQUIRED BY 26 C.F.R. 1.501(R)-4(B)(1)(III)(D); (B) A LIST OF PROVIDERS DELIVERING EMERGENCY OR MEDICALLY NECESSARY CARE IN THE HOSPITAL FACILITY THAT SPECIFIES WHICH PROVIDERS ARE COVERED BY PVH'S FAP AND WHICH ARE NOT, AS REQUIRED BY 26 C.F.R. 1.501(R)-4(B)(1)(III)(F); AND (C) THE METHODOLOGY USED TO CALCULATE AGB, AS REQUIRED BY 26 C.F.R. 1.501(R)-4(B)(2)(I)(C). UCHEALTH'S REVISED FAP WILL BE APPROVED FOR THE ENTIRE UCHEALTH SYSTEM BY THE UCHEALTH GOVERNING BODY AT ITS MAY OF 2019 MEETING.2. UCHEALTH DEVELOPED A PLAIN LANGUAGE SUMMARY AND VERIFIED THAT IT CONTAINED ALL OF THE ELEMENTS REQUIRED AT 26 C.F.R. 1.501(R)-1(B)(24). UCHEALTH BEGIN IMPLEMENTING ITS REVISED PLAIN LANGUAGE SUMMARY IN MAY OF 2019.3. UCHEALTH TOOK STEPS TO ENSURE THAT ITS REVISED FAP AND PLAIN LANGUAGE SUMMARY ARE WIDELY PUBLICIZED BY POSTING BOTH ON UCHEALTH'S WEBSITE AND MAKING BOTH AVAILABLE THROUGHOUT UCHEALTH FACILITIES, AS REQUIRED BY 26 C.F.R. 1.501(R)-4(B)(1)(II). UCHEALTH ACCOMPLISHED THIS IN MAY OF 2019.4. IN THE FALL OF 2018, PVH CALCULATED ITS AGB FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED AT PVH, IN ACCORDANCE WITH 26 C.F.R. 1.501(R)-5(B).5. PVH ISSUED TO EACH INDIVIDUAL WHO RECEIVED EMERGENCY OR MEDICALLY NECESSARY CARE AT PVH DURING THE RELEVANT PERIOD WHO WAS ELIGIBLE FOR ASSISTANCE UNDER PVH'S FAP AND WHO PAID MORE THAN AGB FOR HOSPITAL SERVICES A REFUND FOR THE AMOUNT OF SUCH OVERPAYMENT. PVH ISSUED SUCH REFUND BY SENDING IT VIA U.S. MAIL, ALONG WITH A LETTER DESCRIBING THE PURPOSE OF THE REFUND, ON MAY 15, 2019. UCHEALTH WILL USE DUE DILIGENCE TO LOCATE AN UPDATED ADDRESS FOR ANY INDIVIDUALS WHOSE LETTER AND REFUND CHECK ARE RETURNED DUE TO AN OUTDATED ADDRESS. 6. AS OF THIS FILING, UCHEALTH HAS NOT COMPLETED CALCULATIONS OF OVERPAYMENTS BY INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE WHO RECEIVED PROFESSIONAL SERVICES AT PVH PROVIDED BY THE UCHEALTH MEDICAL GROUP ("MEDICAL GROUP"), WHICH DURING THE REQUISITE PERIOD WAS PVH'S SUBSTANTIALLY RELATED ENTITY AS DEFINED AT 26 C.F.R. 1.501(R)-1(B)(28). UCHEALTH WILL SEND REFUNDS, ALONG WITH A LETTER DESCRIBING THE PURPOSE OF THE REFUND, AS SOON AS THOSE CALCULATIONS ARE COMPLETE, WHICH UCHEALTH EXPECTS TO BE ON OR BEFORE MAY 31, 2019. UCHEALTH WILL USE DUE DILIGENCE TO LOCATE AN UPDATED ADDRESS FOR ANY INDIVIDUALS WHOSE LETTER AND REFUND CHECK ARE RETURNED DUE TO AN OUTDATED ADDRESS.7. PVH IS IN THE PROCESS OF REVERSING ANY ECAS ISSUED AGAINST EACH INDIVIDUAL WHO RECEIVED EMERGENCY OR MEDICALLY NECESSARY CARE AT PVH DURING THE RELEVANT PERIOD WHO WAS ELIGIBLE FOR ASSISTANCE UNDER PVH'S FAP AND WHO PAID MORE THAN AGB. REVERSAL INCLUDES, AS APPLICABLE: (A) UNWINDING ANY NEGATIVE REPORT MADE TO CREDIT BUREAUS OR CREDIT REPORTING AGENCIES IN RELATION TO ANY AMOUNT OWED BY AN INDIVIDUAL ELIGIBLE FOR FINANCIAL ASSISTANCE WHO PAID MORE THAN AGB FOR HOSPITAL SERVICES; (B) REFUNDING ATTORNEYS' FEES AND COURT COSTS IN RELATION TO LEGAL PROCESSES INITIATED BY PVH PAID BY INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE WHO PAID MORE THAN AGB FOR HOSPITAL SERVICES, WHICH AMOUNT TOTALS $1,053 FOR ALL AFFECTED INDIVIDUALS; AND (C) REFUNDING INTEREST PAID ON LOANS (OF WHICH UCHEALTH IS AWARE) TAKEN BY INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE WHO PAID MORE THAN AGB FOR HOSPITAL SERVICES, WHICH AMOUNT TOTALS $138 FOR ALL AFFECTED INDIVIDUALS. UCHEALTH NOTIFIED EACH AFFECTED INDIVIDUAL WHOSE ECA WAS REVERSED OF THE ACTION TAKEN AND THE PURPOSE FOR SUCH ACTION IN THE LETTER DESCRIBED IN ITEM (5), ABOVE, AND INCLUDED THE REFUND, IF ANY, WITH THE REFUND CHECK DESCRIBED IN ITEM (5). UCHEALTH EXPECTS THE CREDIT BUREAUS TO REVERSE NEGATIVE REPORTS BY JULY 30, 2019, DEPENDING ON WHEN THEY UPDATE THEIR RECORDS. 8. PVH WILL INCLUDE A PLAIN LANGUAGE SUMMARY AS PART OF ITS REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS FAP-ELIGIBLE BASED ON NOTIFICATION, AS REQUIRED BY 26 C.F.R. 1.501(R)-6(C)(3)(I) AND FURTHER DEFINED AT 26 C.F.R. 1.501(R)-6(C)(4)(I)(B), AND WILL NOT INITIATE ECAS UNTIL MAKING ALL REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS FAP-ELIGIBLE.SECTION 7.01(3)PVH HAS REVISED AND NEWLY ESTABLISHED PRACTICES AND PROCEDURES TO MINIMIZE THE LIKELIHOOD OF RECURRING NONCOMPLIANCE WITH THE IRS'S REQUIREMENTS FOR CHARITABLE HOSPITALS AND TO FACILITATE THE PROMPT IDENTIFICATION AND CORRECTION OF ANY FAILURES THAT DO OCCUR, AND WILL PERIODICALLY REVIEW IT POLICIES AND PROCEDURES TO ASSURE THEY ARE UP-TO-DATE AND TO CONFIRM COMPLIANCE. IN ADDITION, PVH HAS APPOINTED SPECIFIC INDIVIDUALS TO ASSURE CONTINUED COMPLIANCE WITH THE 501(R) REGULATIONS.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
PVH FOUNDATION
2315 E HARMONY ROAD 200	FORT COLLINS	CO	80528	741894581	501(C )(3)	$1,261,481	SEE SCH I, PART IV
UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
13001 E 17TH PL	AURORA	CO	80045	846000555	GOVERNMENT	$5,201,007	SEE SCH I, PART IV
UCHEALTH MEDICAL GROUP
2315 E HARMONY ROAD 200	FORT COLLINS	CO	80528	800348943	501(C )(3)	$37,117,299	SEE SCH I, PART IV
UNITED WAY OF LARIMER COUNTY
424 PINE STREET 102	FORT COLLINS	CO	80524	846031503	501(C )(3)	$27,560	SEE SCH I, PART IV

Field	Value	IRS element (for citing)
Total501c3 Org	4	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 2:	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (1)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KEVIN UNGER
PRESIDENT/CEO	$283,889	$283,889	$135,848	$135,848	$8,285	$8,285	$47,575	$47,575	$3,787	$3,787	$479,384	$479,384	$0	$0
STEPHANIE DOUGHTY
CHIEF FINANCIAL OFFICER	$239,752	$239,752	$64,974	$64,974	$3,567	$3,567	$24,958	$24,958	$6,130	$6,130	$339,381	$339,381	$0	$0
DIANA BREYER
VP CHIEF QUALITY OFFICER	$147,099	$294,199	$15,300	$30,600	$276	$553	$8,676	$17,352	$4,061	$8,121	$175,412	$350,825	$0	$0
THOMAS DOWNES
CHIEF MEDICAL OFFICER	$260,372	$260,372	$47,813	$47,813	$2,723	$2,723	$20,036	$20,036	$9,110	$9,110	$340,054	$340,054	$0	$0
YVONNE ROCKWOOD
COO (TERM ENDED 07/17)	$53,885	$53,886	$0	$0	$99,952	$99,952	$10,210	$10,210	$3,342	$3,342	$167,389	$167,390	$0	$0
RYAN ROHMAN
CHIEF OPERATING OFFICER	$116,502	$116,502	$28,679	$28,679	$216	$216	$13,444	$13,444	$1,568	$1,568	$160,409	$160,409	$0	$0
DONNA PODUSKA
CHIEF NURSING OFFICER	$211,924	$0	$54,763	$0	$7,399	$0	$25,919	$0	$11,222	$0	$311,227	$0	$0	$0
DAVID MARCHANT
MEDICAL DIRECTOR	$294,625	$0	$23,229	$0	$309	$0	$26,028	$0	$21,569	$0	$365,760	$0	$0	$0
HERMANN MORENO
PSYCHIATRIST	$271,760	$0	$6,538	$0	$585	$0	$26,028	$0	$22,102	$0	$327,013	$0	$0	$0
DAVID SEHR
MEDICAL DIRECTOR	$280,629	$0	$6,547	$0	$367	$0	$26,028	$0	$23,976	$0	$337,547	$0	$0	$0
KENNETH WATANABE
MEDICAL DIRECTOR	$288,131	$0	$32,191	$0	$645	$0	$26,028	$0	$19,664	$0	$366,659	$0	$0	$0
JANELL WOZNIAK
PROGRAM DIRECTOR, FMC	$274,625	$0	$28,662	$0	$401	$0	$25,727	$0	$14,692	$0	$344,107	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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 4A

YVONNE ROCKWOOD RECEIVED A SEVERANCE PAYMENT OF $93,463 FROM THE FILING ORGANIZATION AND $93,463 FROM A RELATED ORGANIZATION.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
COLORADO HEALTH FACILITIES AUTHORITY SERIES A
A	840752932	196474W48	2005-03-31	$50,000,000	REFUNDING 1999A BONDS	0	0	0
COLORADO HEALTH FACILITIES AUTHORITY SERIES B
B	840752932	196474W48	2005-03-31	$26,560,000	PAYMENT OF COMMERCIAL PAPER DEBT	0	0	0
UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 2017 SERIES A
C	841179794	914183BB3	2017-02-16	$43,493,450	REFUNDING 2015A BONDS	0	0	0
UNIVERISTY OF COLORADO HOSPITAL AUTHORITY 2017 SERIES B1B2
D	841179794	914183BD9	2017-02-16	$57,125,000	REFUNDING 2015BC BONDS	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Credit EnhancementCreditEnhancementAmt	Other Spent ProceedsOtherSpentProceedsAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$50,000,000	$3,645,870	$653,467	$1,578,477	$44,122,186	2005	0	Yes (1)	Yes (1)	Yes (1)
B	$26,560,000	$1,936,686	$347,122	$2,384,523	$21,891,669	2005	Yes (1)	0	Yes (1)	Yes (1)
C	$43,493,450				$43,493,450	2017	Yes (1)	0	Yes (1)	Yes (1)
D	$57,125,000		$97,273		$57,027,727	2017	Yes (1)	0	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Any Lease ArrangementsAnyLeaseArrangementsInd	Private Bus Concerning UBIPrivateBusConcerningUBIPct	Total Private Business UseTotalPrivateBusinessUsePct	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	Yes (1)	0.00050	0.00050	Yes (1)
B	Yes (1)	0.00050	0.00050	Yes (1)
C	Yes (1)	0.00050	0.00050	Yes (1)
D	Yes (1)	0.00050	0.00050	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd
(no name)
A	0	0	0	Yes (1)	0	0	0	0	Yes (1)
(no name)
B	0	0	0	Yes (1)	0	0	0	0	Yes (1)
CITI
C	0	Yes (1)	0	0	0	Yes (1)	0	0	Yes (1)	10.000000000000	0	0
(no name)
D	0	Yes (1)	0	0	Yes (1)	0	0	0	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE K, PART I, COLUMN E	BOND ISSUE PRICE THE BOND ISSUE PRICE FOR THE SERIES B BOND DOES NOT EQUAL THE ISSUE PRICE LISTED ON THE FILED FORM 8038 AS THIS BOND WAS SPLIT WITH A RELATED ENTITY. ISSUE PRICE AS REPORTED ON FORM 8038: $83,000,000.
SCHEDULE K, PART IV, LINE 2C	THE REBATE CALCULATION WAS PERFORMED IN APRIL 2015 FOR BOND ISSUANCES A AND B.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	UNIVERISTY OF COLORADO HOSPITAL AUTHORITY 2017 SERIES C1C2	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	841179794	BondIssuerEIN
CUSIP	914183BA5	CUSIPNum
Bond Issued	2017-02-16	BondIssuedDt
Issue Price	$18,406,000	IssuePriceAmt
Purpose	NEW CONSTRUCTION	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	$18,406,000	TotalProceedsAmt
Issuance Costs From Proceeds	$55,315	IssuanceCostsFromProceedsAmt
Capital Expenditures	$18,350,685	CapitalExpendituresAmt
Substantial Completion	2017	SubstantialCompletionYr
Current Refunding	0	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	0	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	Yes (1)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Concerning UBI	0.00050	PrivateBusConcerningUBIPct
Total Private Business Use	0.00050	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	Yes (1)	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Desc	MEDICAL EQUIPMENT	Desc
Contribution	47	ContributionCnt
Noncash Contributions Rpt F990	$897,843	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (1)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	0	ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART I, LINE 6	PVH HAS 526 ACTIVE VOLUNTEERS IN FISCAL YEAR 2018. AT POUDRE VALLEY HOSPITAL, MEDICAL CENTER OF THE ROCKIES, AND OFF-SITE LOCATIONS, 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, VOLUNTEER PATIENT LIASONS, BABY KNITTERS, VOLUNTEENS, AND PET THERAPY TO NAME JUST A FEW OF THE MANY PROGRAMS, EVERY VOLUNTEER CONTRIBUTES TO THE SUCCESS OF POUDRE VALLEY HEALTH SYSTEM 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 HAYGROUP FOR EXECUTIVE COMPENSATION CONSULTING SERVICES. ON OUR BEHALF THE HAYGROUP COLLECTS AND REVIEWS COMPENSATION LEVELS FROM LIKE ORGANIZATION 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 DETERMINES THE SALARY OF THE ENTITY CEO'S COMPENSATION ANNUALLY.
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 64,232,682. BOOK VS. TAX ADJUSTMENT IN EQUITY EARNINGS -269,037. YAMPA EPIC TRANSFER -890,219.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Total IncomeTotalIncomeAmt
TIMBERLINE MEDICAL CLINIC
131 STANLEY AVE	ESTES PARK	CO	80517	043772090	OUTPATIENT	CO	-$16,785	PVHC INC
LAKOTA LAKE LLC
2315 E HARMONY RD STE 200	FORT COLLINS	CO	80528	841447761	OUTPATIENT	CO	$38,557,887	PVHC INC	$7,664,586
HERON LAKE LLC
2315 E HARMONY RD STE 200	FORT COLLINS	CO	80528	264189163	OUTPATIENT	CO	$657,338	PVHC INC

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
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	Yes (1)
PVHS FOUNDATION
2315 E HARMONY RD STE 200	FORT COLLINS	CO	80528	741894581	BENEFIT HEALTH	CO	501(C)(3)	LINE 7	PVHC INC	Yes (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	Yes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (11 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
EYE LASER CENTER OF NO COLORADO
1725 E PROSPECT RD	FORT COLLINS	CO	80525	841518334	LASER SURGERY	CO	N/A	UNRELATED	$65,102	$115,431	0	0	0.50000
GATEWAY MEDICAL SERVICES
2500 E PROSPECT RD	FORT COLLINS	CO	80525	841427970	REAL EST/MED	CO	N/A	UNRELATED	$8,517,865	$12,361,479	0	0	0.50000
THE VEIN AND LASER CENTER OF NO COLORADO
2008 CARIBOU DRIVE	FORT COLLINS	CO	80525	204943970	MEDICAL SERVICES	CO	N/A	UNRELATED	-$13,185	$33,798	0	0	0.33330
SURGERY CENTER OF FORT COLLINS
1100 E PROSPECT ROAD	FORT COLLINS	CO	80525	841541559	SURGICAL PROC	CO	N/A	UNRELATED	$399,777	$1,039,876	0	0	0.26000
CENTRE AVENUE HEALTH & REHAB FACILITY
947 WORTHINGTON CIRCLE	FT COLLINS	CO	80526	841560494	NURSING FACILITY	CO	N/A	RELATED	-$292,315	$526,168	0	0	0.50000
COLUMBINE POUDRE HOME CARE
947 WORTHINGTON CIRCLE	FT COLLINS	CO	80526	841529817	NURSING CARE	CO	N/A	RELATED	$310,794	$372,591	0	0	0.50000
HARMONY SURGERY CENTER
2127 E HARMONY RD 200	FT COLLINS	CO	80528	841479751	AMBULATORY SURG	CO	N/A	RELATED	$2,364,475	$3,060,198	0	0	0.50000
HARMONY IMAGING CENTER
1951 WILMINGTON DRIVE	FORT COLLINS	CO	80528	582479187	MEDICAL IMAGING	CO	N/A	RELATED	$698,769	$1,657,028	0	0	0.46000
PVHS-ICM EHW
2315 E HARMONY RD STE 200	FORT COLLINS	CO	80528	463311308	MEDICAL SERVICES	CO	N/A	RELATED	$36,056	$199,412	0	0	0.50000
PEAK SURGICAL MANAGEMENT
2127 E HARMONY RD 200	FORT COLLINS	CO	80528	260899618	SURGICAL MGMT	CO	N/A	UNRELATED	$151,750	$87,046	0	0	0.14300
PVHS HOME MEDICAL SUPPLY
6820 N COUNTY RD 13	LOVELAND	CO	80538	202034599	MEDICAL SUPPLY	CO	N/A	UNRELATED	$163,490	$847,939	0	Yes (1)	0.50000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	INNOVATION ENTERPRISES	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2315 E HARMONY RD STE 200	AddressLine1Txt
City	FORT COLLINS	CityNm
State Abbreviation	CO	StateAbbreviationCd
ZIP	80528	ZIPCd

Field	Value	IRS element (for citing)
EIN	202036774	EIN
Primary Activities	IT CONSULTING	PrimaryActivitiesTxt
Legal Domicile State	CO	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	PVHC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Entity Type	C	EntityTypeTxt
Share Of Total Income	$822,450	ShareOfTotalIncomeAmt
Share Of EOY Assets	$1,661,359	ShareOfEOYAssetsAmt
Ownership	1.00000	OwnershipPct
Controlled Organization	Yes (1)	ControlledOrganizationInd

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	Yes (1)	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (1)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	Yes (1)	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	Yes (1)	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	Yes (1)	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (21 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
INNOVATION ENTERPRISES
A	$119,218	TRANSACTION TOTAL
INNOVATION ENTERPRISES
A	$260,376	TRANSACTION TOTAL
HARMONY SURGERY CENTER
A	$981,917	TRANSACTION TOTAL
CENTRE AVENUE HEALTH AND REHAB
B	$600,000	TRANSACTION TOTAL
PVHS FOUNDATION
B	$1,261,481	TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
B	$37,117,299	TRANSACTION TOTAL
PVHS FOUNDATION
C	$1,954,472	TRANSACTION TOTAL
MEDICAL CENTER OF THE ROCKIES
G	$54,482	TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
G	$85,049	TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
J	$2,132,787	TRANSACTION TOTAL
MEDICAL CENTER OF THE ROCKIES
L	$9,236,285	TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
L	$4,062,753	TRANSACTION TOTAL
EYE LASER CENTER OF NO COLORADO
M	$152,237	TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
M	$4,915,864	TRANSACTION TOTAL
MEDICAL CENTER OF THE ROCKIES
N	$4,098,944	TRANSACTION TOTAL
POUDRE VALLEY MEDICAL GROUP LLC
N	$2,682,211	TRANSACTION TOTAL
HARMONY SURGERY CENTER
Q	$644,663	TRANSACTION TOTAL
HARMONY SURGERY CENTER
S	$2,250,000	TRANSACTION TOTAL
COLUMBINE POUDRE HOME CARE
S	$550,000	TRANSACTION TOTAL
GATEWAY MEDICAL SERVICES
S	$8,147,677	TRANSACTION TOTAL
MEDICAL CENTER OF THE ROCKIES
S	$64,232,682	TRANSACTION TOTAL