2019-05-15T12:23:11-05:00 2018-06-30 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2017-07-01 800348943 POUDRE VALLEY MEDICAL GROUP LLC POUD 9702377000 2315 E HARMONY ROAD NO 200 FORT COLLINS CO 80528 STEVE SCHWARTZ CFO 9702377000 2019-05-11 1 DORI J EGGETT P00645252 3037409400 2019-05-11 208.42.238.142 2019-05-11 15:35:35 MD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 321DDE24B35CC1D1467AEA03569F7C6B0A555C82 2017 2019-02-21 02:37:17Z UCHEALTH MEDICAL GROUP DR MIKE RANDLE 2315 E HARMONY ROAD NO 200 FORT COLLINS CO 80528 406303011 0 X N/A X 2013 CO 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. 5 5 2410 5 0 0 38714496 97680190 107918948 308551632 -140193 51143 0 0 146493251 406282965 731021 1967734 0 0 129128815 372641515 0 0 0 47089763 125562297 176949599 500171546 -30456348 -93888581 40708166 42647031 240361755 336189201 -199653589 -293542170 WE IMPROVE LIVES. IN BIG WAYS THROUGH LEARNING, HEALING AND DISCOVERY. IN SMALL, PERSONAL WAYS THROUGH HUMAN CONNECTION. BUT IN ALL WAYS, WE IMPROVE LIVES. 0 0 431223312 1967734 308551632 UCHEALTH MEDICAL GROUP (UCHMG) OPERATES MORE THAN 50 CLINICS ACROSS COLORADO, NEBRASKA AND WYOMING. UCHMG PROVIDES A FULL CONTINUUM OF MEDICAL CARE THROUGH AN INTEGRATED, MULTI-SPECIALTY PHYSICIAN GROUP. IN FISICAL YEAR 2018, THE GROUP HAD 1,355,079 OUTPATIENT VISITS AND 150,106 URGENT CARE VISITS. AT YEAR-END, UCHMG WAS COMPRISED OF MORE THAN 416 EMPLOYED PHYSICIANS AND 210 ADVANCED PRACTICE PROVIDERS REPRESENTING 43 SPECIALTIES. 431223312 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 184 0 1 2410 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X STEVE SCHWARTZ 9702377000 2315 E HARMONY ROAD NO 200 FORT COLLINS CO 80528 CHRIS OSBORN BOARD CHAIR 1.00 X X 0 0 0 GENE RENUART BOARD MEMBER 1.00 X 0 0 0 DR WILLIAM NEFF BOARD MEMBER 1.00 X 0 0 0 DR TODD WHITSITT BOARD MEMBER 1.00 X 0 0 0 LAURIE STEELE BOARD MEMBER 1.00 X 0 0 0 DR MIKE RANDLE TERM BEGIN 11 PRESIDENT AND CEO 40.00 X 481582 0 59690 DEBORAH CHANDLER TERM END 111 PRESIDENT AND CEO 40.00 X 455349 0 40518 STEVE SCHWARTZ CFO 40.00 X 254087 0 42123 DONNA LANKFORD VP REGIONAL PRACTICE MGMT OPERATION 40.00 X 229852 0 37029 MARY YANTIS VP REGIONAL PRACTICE MGMT OPERATION 40.00 X 300440 0 40322 SCOTT HURLBERT VP CHIEF QUALITY OFFICER 40.00 X 602769 0 50160 DIANA BREYER VP CHIEF QUALITY OFFICER 40.00 X 162675 325352 38210 JOSHUA PETIT PHYSICIAN 40.00 X 2194652 0 47732 HANS COESTER MEDICAL DIRECTOR 40.00 X 1789911 0 44768 LARS WIDDEL PHYSICIAN 40.00 X 1297467 0 47958 JOSEPH LEE PHYSICIAN 40.00 X 1193226 0 53467 JOHN STATHIS PHYSICIAN 40.00 X 1150156 0 45957 10112166 325352 547934 598 0 1 0 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 MEDICAL 1699358 ONYX HEALTHCARE INC 4202 324 W BLUERIDGE AVE ORANGE CA 92865 MEDICAL 1190820 STAFF CARE INC PO BOX 281923 ATLANTA GA 30384 MEDICAL 1042531 CHG COMPANIES DBA COMPHEALTH PO BOX 972633 DALLAS TX 75397 MEDICAL 935023 MINDY JOY SIEGEL 6980 BAKER RD COLORADO SPRINGS CO 80908 MEDICAL 422391 22 97680190 2624 97680190 NET PATIENT SVC REV 621110 251042891 251042891 COST REIMBURSEMENT 621110 42570322 42570322 OTHER PROGRAM REVENUE 621110 14938419 14938419 308551632 71189 71189 20046 -20046 -20046 -20046 406282965 308551632 0 51143 1967734 1967734 2273465 175412 2098053 315091073 281195099 33895974 14073115 12477007 1596108 37340986 33105943 4235043 3862876 3424766 438110 62346 62346 21616 21616 28353925 12292898 16061027 3117283 3117283 2395487 2344130 51357 8381243 6971010 1410233 22621478 22199392 422086 973801 847365 126436 4836364 4156810 679554 559449 559449 9496739 6694172 2802567 3461317 3261466 199851 MEDICAL SUPPLIES 27874067 27808067 66000 BAD DEBT 6554718 6554718 ALL OTHER EXPENSES 6086252 1337318 4748934 REPAIRS & MAINTENANCE 766212 733273 32939 500171546 431223312 68948234 0 26580 31635 24555741 24177455 961 601 260252 238752 847243 1425781 34454758 17825407 14820506 16629351 196883 143456 40708166 42647031 33305235 41117542 8403 0 207048117 295071659 240361755 336189201 X -199653589 -293542170 -199653589 -293542170 40708166 42647031 -93888581 0 X 0 1 X 1 0 X 38714496 97680190 136394686 107918948 308551632 416470580 146633444 406231822 552865266 0 0 0 552865266 31573 71189 102762 31573 71189 102762 146665017 406303011 552968028 X PART III, LINE 14 2017 WAS THE ORGANIZATION'S FIRST TAX YEAR AS A SECTION 501(C)(3) ORGANIZATION. 0 0 0 0 0 0 1 21616 0 0 21616 0 4249144 3019747 1229397 4803151 1380352 3422799 18855535 10212612 8642923 6546928 3212696 3334232 16629351 PAYABLES TO AFFILIATES 290489618 COMP BAL-AUTHORITY 609470 RETENTION PAYABLE 80782 A/P - CONSTRUCTION 621155 COPIC TAIL ACCRUAL 3270634 295071659 399747828 20046 20046 399727782 6555183 6555183 406282965 493636409 20046 20046 493616363 6555183 6555183 500171546 PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 20,046. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 6,554,718. CASH CONTRIBUTIONS 465. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 20,046. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 6,554,718. CASH CONTRIBUTIONS 465. 1 UNIVERSITY OF COLORADO SCHOOL OF MEDICINE 13001 17TH PLACE AURORA CO 80045 846000055 501(C)(3) 1963734 COMMUNITY HEALTHCARE 1 PART I, LINE 2: THE ORGANIZATION AWARDS GRANTS BASED ON THE BENEFIT TO THE COMMUNITY. THE ORGANIZATION REQUESTS INFORMATION FROM THE GRANTEES TO ENSURE THAT THE FUNDS WILL BE USED FOR THE SPECIFIED PURPOSE. X X X 1 0 0 0 0 0 0 0 0 DR MIKE RANDLE TERM BEGIN 11 PRESIDENT AND CEO 382958 0 95101 0 3523 0 40016 0 19674 0 541272 0 0 0 DEBORAH CHANDLER TERM END 111 PRESIDENT AND CEO 240951 0 0 0 214398 0 25999 0 14519 0 495867 0 0 0 STEVE SCHWARTZ CFO 201049 0 51157 0 1881 0 24652 0 17471 0 296210 0 0 0 DONNA LANKFORD VP REGIONAL PRACTICE MGMT OPERATION 181205 0 47751 0 896 0 22319 0 14710 0 266881 0 0 0 MARY YANTIS VP REGIONAL PRACTICE MGMT OPERATION 240922 0 57243 0 2275 0 28186 0 12136 0 340762 0 0 0 SCOTT HURLBERT VP CHIEF QUALITY OFFICER 454311 0 139529 0 8929 0 26028 0 24132 0 652929 0 0 0 DIANA BREYER VP CHIEF QUALITY OFFICER 147099 294199 15300 30600 276 553 8676 17352 4061 8121 175412 350825 0 0 JOSHUA PETIT PHYSICIAN 2193158 0 0 0 1494 0 26028 0 21704 0 2242384 0 0 0 HANS COESTER MEDICAL DIRECTOR 1780405 0 0 0 9506 0 26028 0 18740 0 1834679 0 0 0 LARS WIDDEL PHYSICIAN 1296665 0 0 0 802 0 26028 0 21930 0 1345425 0 0 0 JOSEPH LEE PHYSICIAN 838075 0 337769 0 17382 0 26028 0 27439 0 1246693 0 0 0 JOHN STATHIS PHYSICIAN 1141682 0 0 0 8474 0 26028 0 19929 0 1196113 0 0 0 PART I, LINE 4A DEBORAH CHANDLER RECEIVED SEVERANCE PAYMENT OF $179,810. 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. POUDRE VALLEY HEALTHCARE INC 2315 E HARMONY ROAD 200 FORT COLLINS CO 80528 841262971 TERTIARY CARE CO 501(C)(3) LINE 3 0 UNIVERSITY OF COLORADO HEALTH 7901 E LOWRY BLVD SUITE 350 DENVER CO 80230 454552631 HEALTHCARE MANAGEMENT CO 501(C)(3) LINE 7 0 MEDICAL CENTER OF THE ROCKIES 2315 E HARMONY ROAD 200 FORT COLLINS CO 80528 043730045 TERTIARY CARE CO 501(C)(3) LINE 3 PVHC INC 0 PVHS FOUNDATION 2315 E HARMONY ROAD 200 FORT COLLINS CO 80528 741894581 BENEFIT HEALTH CO 501(C)(3) LINE 7 PVHC INC 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0