2018-01-26T12:07:06-06:00 2017-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2016-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3032895147 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 DAVID MADSEN CHIEF FINANCIAL OFFICER 3032895147 2018-01-26 1 KURT BENNION P01469618 3034668822 67.137.57.251 2018-01-26 10:01:03 PS P D87ACCB16182BB95766E2503138A5EBEAC54CC57 BDE3236647F86B8AD5E61DCF27015D6D554B66D7 2016 2021-01-29 14:40:06Z JOHN SANTISTEVAN 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 78274467 0 X WWW.SALUDCLINIC.ORG X 1971 CO COMMUNITY HEALTH SERVICES 11 11 780 12 0 0 16030406 17827183 52875613 59744119 31790 27466 47911 30295 68985720 77629063 0 0 0 0 47051533 47500667 0 0 49986 25957879 27902677 73009412 75403344 -4023692 2225719 67353018 68581329 20785838 19649082 46567180 48932247 SALUD IS A HEALTH CARE DELIVERY SYSTEM DEDICATED TO PROVIDING QUALITY, COMPREHENSIVE PRIMARY HEALTH CARE SERVICES TO MEDICAL AND DENTAL UNDERSERVED POPULATIONS AND THE COMMUNITY WITHIN THE SIX COUNTIES IN NORTH CENTRAL COLORADO. 0 0 64569169 0 59744119 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. SALUD HAD 324,588 VISITS IN THE FISCAL YEAR ENDED 5/31/2017. 64569169 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 32 0 780 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 CO X DAVID MADSEN 3038926401 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 RICHARD OLMEDO CHAIRMAN 1.00 X X 0 0 0 JESUS TIJERINA VICE CHAIRMAN 1.00 X X 0 0 0 MICHAEL MARTINEZ SECRETARY 1.00 X X 0 0 0 COLLEEN LAEGER TREASURER 1.00 X X 0 0 0 CONSUELO CHAVEZ DIRECTOR 1.00 X 0 0 0 JOYLYNN GALLEGOS DIRECTOR 1.00 X 0 0 0 LINDA HUGHES DIRECTOR 1.00 X 0 0 0 IGNACIO PURECO DIRECTOR 1.00 X 0 0 0 CHANTAL ROBAR DIRECTOR 1.00 X 0 0 0 CAROLINE SWIETER DIRECTOR (THROUGH MARCH 2017) 1.00 X 0 0 0 JODI TRAYLER DIRECTOR 1.00 X 0 0 0 VICTORIA VENGLEY DIRECTOR 1.00 X 0 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 40.00 X 251096 0 75831 DAVID MADSEN CFO 40.00 X 118461 0 35775 ALINE HANSEN-GUZMAN PHYSICIAN 40.00 X 240595 0 72660 ANDREW HUGHES PHYSICIAN 40.00 X 215501 0 65081 HANS ELZINGA PHYSICIAN 40.00 X 213750 0 64553 PRADEEP DHAR PHYSICIAN 40.00 X 168550 0 50903 ALEXANDER WEAVER PHYSICIAN 40.00 X 150719 0 45517 1358672 0 410320 90 0 1 0 CORUS GROUP 6430 S FIDDLERS GREEN CIRCLE GREENWOOD VILLAGE CO 80111 I.T. SUPPORT 635537 UNIVERSITY PHYSICIANS INC PO BOX 460578 GLENDALE CO 80246 CONTRACT DOCTORS 439310 ECLINICAL WORKS 7011 KOLL CENTER PARKWAY 230 PLEASANTON CA 94566 E.H.R. SUPPORT 357471 DIVERSIFIED RADIOLOGY 1746 COLE BOULEVARD SUITE 150 LAKEWOOD CO 80401 CONTRACT RADIOLOGISTS 288088 CHANGE HEALTHCARE 3055 LEBANON PIKE NASHVILLE TN 37214 HEALTHCARE PROCESS CONSULTING 196571 7 17563980 263203 2557925 17827183 PATIENT FEES 621400 48398529 48398529 PHARMACY REVENUE 621400 11345590 11345590 59744119 32069 32069 30295 0 30295 30295 30295 640801 645404 -4603 -4603 -4603 77629063 59744119 0 57761 481163 481163 36110941 32047657 4037039 26245 1545151 1387312 155191 2648 6641537 5975253 654878 11406 2721875 2414952 302313 4610 202798 202798 134463 134463 5329532 3805019 1524513 140778 57736 83042 1051094 601620 444742 4732 615678 514385 101293 228209 127620 100589 438171 183750 254421 390588 243084 147504 2965956 2159521 806435 515601 504296 11305 MEDICAL SUPPLIES 12136020 12136020 REPAIRS & MAINTENANCE 1763525 1576490 187035 EQUIPMENT 757556 350444 407112 DUES & SUBSCRIPTIONS 455762 152946 302471 345 776946 331064 445882 75403344 64569169 10784189 49986 1808825 4056167 8804565 8783127 3971275 3749304 1564041 1753487 54870 260329 73051069 23100775 51082989 49950294 28621 66453 0 67353018 68581329 6674527 6295183 402222 343472 13407848 12844878 301241 165549 20785838 19649082 X 46267180 48782247 300000 150000 46567180 48932247 67353018 68581329 X 2225719 139348 X 0 1 X 1 1 1 X 20470634 25979325 15886044 16030406 17827183 96193592 20470634 25979325 15886044 16030406 17827183 96193592 96193592 40570 46215 50411 78333 62364 277893 96471485 224263366 0.99710 0.99720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5393110 5393110 67263212 23100775 44162437 394747 394747 49950294 ACCRUED BOND DERIVATIVE 165549 165549 X 77918345 330998 289348 620346 77297999 331064 331064 77629063 75403278 330998 330998 75072280 331064 331064 75403344 PART X, LINE 2: THE CORPORATION HAS PREVIOUSLY RECEIVED NOTICE OF EXEMPTION OF INCOME TAX FROM THE INTERNAL REVENUE SERVICE UNDER SECTION 501(C)(3) OF THE FEDERAL INTERNAL REVENUE CODE. THE CORPORATION IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE CORPORATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE CORPORATION FOLLOWS THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE IMPLEMENTATION OF THE ACCOUNTING STANDARDS REGARDING UNCERTAIN TAX PROVISIONS HAD NO IMPACT ON THE CORPORATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAP 139,348. NET ASSETS RELEASED FROM RESTRICTIONS 150,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 331,064. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 331,064. X X 0 0 0 0 0 0 0 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 251096 0 0 0 0 0 12555 0 63276 0 326927 0 0 0 DAVID MADSEN CFO 118461 0 0 0 0 0 5923 0 29852 0 154236 0 0 0 ALINE HANSEN-GUZMAN PHYSICIAN 240595 0 0 0 0 0 12030 0 60630 0 313255 0 0 0 ANDREW HUGHES PHYSICIAN 215501 0 0 0 0 0 10775 0 54306 0 280582 0 0 0 HANS ELZINGA PHYSICIAN 213750 0 0 0 0 0 10688 0 53865 0 278303 0 0 0 PRADEEP DHAR PHYSICIAN 168550 0 0 0 0 0 8428 0 42475 0 219453 0 0 0 ALEXANDER WEAVER PHYSICIAN 150719 0 0 0 0 0 7536 0 37981 0 196236 0 0 0 A COLORADO HEALTH FACILITIES AUTHORITY 840752932 2010-12-16 16110000 REFUND SERIES 2005 & 2008 BONDS 0 0 0 A 3165000 16110000 16110000 2010 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 1 KEY BANK 5.000000000000 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/16/2015 X 2 2557925 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE CURRENT OFFICERS OF THE BOARD. THE EXECUTIVE COMMITTEE IS AUTHORIZED TO FUNCTION ON BEHALF OF THE BOARD BETWEEN BOARD MEETINGS. ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE IN THE INTERIM ARE RATIFIED BY THE BOARD AT ITS SUBSEQUENT MEETING. THE EXECUTIVE COMMITTEE ALSO PERFORMS THE PLANNING AND EVALUATION FUNCTION FOR THE BOARD. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED IN NOVEMBER 2016. THE AMENDMENTS INCLUDED THE FOLLOWING SIGNIFICANT CHANGES: 1. THE MISSION STATEMENT WAS UPDATED, ALTHOUGH THE ORGANIZATION'S EXEMPT PURPOSE AND ACTIVITIES DID NOT CHANGE; AND 2. THE REQUIREMENT THAT BOARD MEMBERS RESIDE IN SPECIFIC GEOGRAPHIC LOCATIONS WAS REPLACED WITH A REQUIREMENT THAT THE BOARD BE REPRESENTATIVE OF THE GEOGRAPHIC AREA SERVED BY THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY SALUD'S CERTIFIED PUBLIC ACCOUNTING FIRM AND REVIEWED BY SALUD'S CONTROLLER. THE FORM 990 WAS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER OF SALUD. LASTLY, IT WAS PRESENTED TO THE CHIEF EXECUTIVE OFFICER AND THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C SALUD BOARD MEMBERS, EXECUTIVES AND STAFF ARE BOUND BY THE CODE OF ETHICS ADOPTED BY THE BOARD IN REGARD TO CONFLICTS OF INTEREST OR THE APPEARANCE THEREOF. ON AN ANNUAL BASIS, EACH BOARD MEMBER AND EXECUTIVE SIGNS A NEW CONFLICT OF INTEREST STATEMENT THAT IDENTIFIES ANY POTENTIAL CONFLICTS OF INTEREST. IF A BOARD MEMBER HAS A POTENTIAL CONFLICT, THEY INFORM THE CEO AND BOARD CHAIR. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE BOARD CHAIR MAKES THE DETERMINATION. IF A BOARD MEMBER IS DEEMED TO HAVE A CONFLICT, THE SITUATION IS MONITORED BY THE BOARD CHAIR. FORM 990, PART VI, SECTION B, LINE 15A SALUD'S COMPENSATION FOR THE CEO IS DETERMINED AS FOLLOWS: ON A PERIODIC BASIS, THE VICE PRESIDENT OF HUMAN RESOURCES OBTAINS WAGE INFORMATION FROM RELEVANT SOURCES WITHIN THE HEALTH INDUSTRY. THE CEO'S WAGE INFORMATION IS PRESENTED TO SALUD'S COMPENSATION COMMITTEE THAT CONSISTS OF FOUR INDEPENDENT DIRECTORS WHO THEN DELIBERATE AND APPROVE THE CEO'S SALARY. SALUD'S COMPENSATION FOR THE OTHER KEY EMPLOYEES IS DETERMINED AS FOLLOWS: ON A PERIODIC BASIS, THE VICE PRESIDENT OF HUMAN RESOURCES OBTAINS WAGE INFORMATION FROM RELEVANT SOURCES WITHIN THE HEALTH INDUSTRY. THE WAGE LEVELS ARE THEN COMPARED TO THE WAGES BEING PAID TO ASSURE THEY ARE WITHIN RELATIVE COMPARABLE RANGE. THE CEO OF SALUD REVIEWS ALL OTHER TOP MANAGEMENT WAGE COMPARISONS. FORM 990, PART VI, SECTION C, LINE 19 SALUD'S WEBSITE PROVIDES THE CONTACT INFORMATION WHERE THE PUBLIC MAY REQUEST COPIES OF SALUD'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, WHICH ARE THEN PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP 139,348. SALUD HEALTH CENTER LLC 1830 LAPORTE AVENUE FORT COLLINS CO 80521 474476465 LAND AND WAREHOUSES CO 25281 3050272 PLAN DE SALUD DEL VALLE INC