2017-01-13T17:40:47-06:00 2016-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2015-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3032895147 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 DAVID MADSEN CHIEF FINANCIAL OFFICER 3032895147 2017-01-13 1 KURT BENNION P01469618 3034668822 2015 2021-01-29 14:40:06Z JOHN SANTISTEVAN 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 69222921 0 X WWW.SALUDCLINIC.ORG X 1971 CO PROVIDE QUALITY, COMPREHENSIVE PRIMARY HEALTH CARE SERVICES TO UNDERSERVED POPULATIONS. 10 10 778 10 0 0 15886044 16030406 47880801 52875613 33358 31790 18906 47911 63819109 68985720 0 0 0 0 39773129 47051533 0 0 44891 22218144 25957879 61991273 73009412 1827836 -4023692 70566763 67460170 20050010 20892990 50516753 46567180 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 62006658 0 52875613 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. SALUD HAD 307,146 VISITS IN THE FISCAL YEAR ENDED 5/31/2016. 62006658 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 30 0 778 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 1 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 MANUAL GALLEGOS DIRECTOR THROUGH 2/9/16 1.00 X 0 0 0 LINDA HUGHES DIRECTOR 1.00 X 0 0 0 IGNACIO PURECO DIRECTOR 1.00 X 0 0 0 CAROLINE SWIETER DIRECTOR 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 246698 0 17547 DAVID MADSEN CFO 40.00 X 118063 0 17406 HANS ELZINGA PHYSICIAN 40.00 X 208022 0 25032 ANDREW HUGHES PHYSICIAN 40.00 X 215315 0 24870 ELIAS HERNANDEZ PHYSICIAN 40.00 X 198040 0 22951 MICHAEL ALLEN PHYSICIAN 40.00 X 172942 0 22749 ALINE HANSEN-GUZMAN PHYSICIAN 40.00 X 169435 0 23650 1328515 0 154205 74 0 1 0 CORUS GROUP 6430 S FIDDLERS GREEN CIRCLE GREENWOOD VILLAGE CO 80111 I.T. SUPPORT 827274 UNIVERSITY PHYSICIANS INC PO BOX 460578 GLENDALE CO 80246 CONTRACT DOCTORS 616282 ECLINICAL WORKS 7011 KOLL CENTER PARKWAY 230 PLEASANTON CA 94566 E.H.R. SUPPORT 332388 DIVERSIFIED RADIOLOGY 1746 COLE BOULEVARD SUITE 150 LAKEWOOD CO 80401 CONTRACT RADIOLOGISTS 251764 CHANGE HEALTHCARE 3055 LEBANON PIKE NASHVILLE TN 37214 HEALTHCARE PROCESS CONSULTING 191336 6 15585167 445239 2349527 16030406 PATIENT FEES 621400 43808172 43808172 PHARMACY REVENUE 621400 9067441 9067441 52875613 30422 30422 47911 0 47911 47911 47911 238569 237201 1368 1368 1368 68985720 52875613 0 79701 411402 411402 34887309 30861393 4002093 23823 1366654 1195375 169527 1752 7840635 6778873 1051827 9935 2545533 2195846 346469 3218 162161 162161 120571 120571 4262465 2846697 1415768 447243 385270 61973 1090699 608268 476613 5818 612017 515517 96500 330108 215397 114711 515395 216892 298503 374874 74120 300754 2773401 2062036 711365 451379 440310 11069 MEDICAL SUPPLIES 10666354 10666354 REPAIRS & MAINTENANCE 2316206 2051564 264642 EQUIPMENT 1099264 456262 643002 DUES & SUBSCRIPTIONS 428866 129608 298913 345 306876 306876 73009412 62006658 10957863 44891 5335740 1808825 10308001 8804565 3442488 3971275 1681760 1564041 38085 54870 71799647 20716658 49572507 51082989 114182 107152 74000 66453 70566763 67460170 5265998 6674527 345824 402222 14060000 13515000 378188 301241 20050010 20892990 X 50516753 46267180 300000 50516753 46567180 70566763 67460170 X -4023692 74119 X 0 1 X 1 1 1 X 19886375 20470634 25979325 15886044 16030406 98252784 19886375 20470634 25979325 15886044 16030406 98252784 98252784 63719 40570 46215 50411 78333 279248 98532032 196171523 0.99720 0.99750 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5292389 5292389 65918929 20716658 45202271 588329 588329 51082989 ACCRUED BOND DERIVATIVE 301241 301241 X 68789942 336979 74119 411098 68378844 606876 606876 68985720 73039515 336979 336979 72702536 306876 306876 73009412 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 74,119. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 306,876. TEMPORARILY RESTRICTED CONTRIBUTIONS 300,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 306,876. X X 0 0 0 0 0 0 0 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 246698 0 0 0 0 0 12904 0 4643 0 264245 0 0 0 HANS ELZINGA PHYSICIAN 208022 0 0 0 0 0 12150 0 12882 0 233054 0 0 0 ANDREW HUGHES PHYSICIAN 215315 0 0 0 0 0 10711 0 14159 0 240185 0 0 0 ELIAS HERNANDEZ PHYSICIAN 198040 0 0 0 0 0 10105 0 12846 0 220991 0 0 0 MICHAEL ALLEN PHYSICIAN 172942 0 0 0 0 0 9975 0 12774 0 195691 0 0 0 ALINE HANSEN-GUZMAN PHYSICIAN 169435 0 0 0 0 0 9739 0 13911 0 193085 0 0 0 A COLORADO HEALTH FACILITIES AUTHORITY 840752932 2010-12-16 16110000 REFUND SERIES 2005 & 2008 BONDS 0 0 0 A 2595000 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 2349527 FAIR MARKET VALUE 0 0 0 0 PART I, COLUMN (B): THE NUMBER REPORTED IN PART I, LINE 20, COLUMN B IS THE NUMBER OF DONORS. 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 7A THE ORGANIZATION HAS DIVIDED ITS SERVICE AREA INTO NINE GEOGRAPHIC AREAS. EACH GEOGRAPHIC AREA ELECTS ONE INDIVIDUAL TO THE BOARD OF DIRECTORS BY A MAJORITY VOTE OF THE CONSUMERS RESIDING IN THAT GEOGRAPHIC AREA. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PREPARED BY SALUD'S CERTIFIED PUBLIC ACCOUNTING FIRM AND REVIEWED BY SALUD'S CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER, THEN PRESENTED TO THE BOARD OF DIRECTORS AT THEIR MONTHLY BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C SALUD DOES HAVE A FORMAL COMPLIANCE POLICY ADMINISTERED BY THE SALUD COMPLIANCE COMMITTEE. THE COMPLIANCE PROGRAM IS PRESENTED TO ALL NEW STAFF MEMBERS DURING NEW EMPLOYEE ORIENTATION. IN ADDITION, EMPLOYEES ARE REQUIRED TO COMPLETE ANNUAL MANDATORY COMPLIANCE TRAINING. SALUD COMPLIANCE PROGRAM DETAILS THE VARIOUS METHODS EMPLOYEES CAN REPORT AN ISSUE THEY CONSIDER TO BE NON-COMPLIANT. ANY REPORTED INSTANCES ARE REVIEWED AND APPROPRIATE ACTION TAKEN BY THE COMPLIANCE COMMITTEE. IN ADDITION, AN ANNUAL COMPLIANCE REPORT IS PREPARED AND PRESENTED TO SALUD'S BOARD OF DIRECTORS. SALUD BOARD MEMBERS ARE BOUND BY THE CODE OF ETHICS ADOPTED BY THE BOARD IN REGARD TO CONFLICT OF INTEREST OR THE APPEARANCE THEREOF. ON A YEARLY BASIS, EACH BOARD MEMBER SIGNS A NEW CONFLICT OF INTEREST STATEMENT. 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 AND OTHER KEY EMPLOYEES ARE DETERMINED AS FOLLOWS: ON AN ANNUAL BASIS THE DIRECTOR OF HUMAN RESOURCES WILL OBTAIN WAGE INFORMATION FROM SEVERAL 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'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. 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 74,119. SALUD HEALTH CENTER LLC 1830 LAPORTE AVENUE FORT COLLINS CO 80521 474476465 LAND AND WAREHOUSES CO 32381 3140262 PLAN DE SALUD DEL VALLE INC