2017-08-09T12:51:04-07:00 2016-09-30 990 2015-10-01 840404233 CRAIG HOSPITAL CRAI 3037898000 3425 S CLARKSON STREET ENGLEWOOD CO 80113 Julie Keegan VP Finance 3037898443 2017-08-09 2015 2021-01-29 14:40:06Z MICHAEL FORDYCE 3425 S CLARKSON STREET ENGLEWOOD CO 80113 136030766 0 X WWW.CRAIGHOSPITAL.ORG X 1910 CO Craig advocates for and provides exceptional patient and family centered care for those affected by spinal cord and brain injury. Together we bravely strive for optimal health, independence, and life quality with unyielding determination. 16 15 1059 225 0 0 10171567 20102900 88609245 97130325 827803 -1288587 2156394 2299812 101765009 118244450 95040 120225 0 0 52960163 57452030 0 0 0 34610821 37462773 87666024 95035028 14098985 23209422 214408843 240153186 57522329 56924701 156886514 183228485 CRAIG HOSPITAL IS A 93-BED, LONG-TERM ACUTE CARE AND REHABILITATION HOSPITAL THAT PROVIDES CARE EXCLUSIVELY FOR PATIENTS WITH SPINAL CORD AND TRAUMATIC BRAIN INJURY. THE HOSPITAL PROVIDES A COMPREHENSIVE SYSTEM OF INPATIENT AND OUTPATIENT MEDICAL CARE, REHABILITATION, NEUROSURGICAL, REHABILTATIVE CARE, AND LONG-TERM FOLLOW-UP SERVICES. 0 0 72956371 120225 97130325 CRAIG HOSPITAL PROVIDES REHABILITATION AND MEDICAL SERVICES EXCLUSIVELY TO PATIENTS WITH SPINAL CORD AND TRAUMATIC BRAIN INJURY ON BOTH AN INPATIENT AND OUTPATIENT BASIS AND DURING THE TAX YEAR, PROVIDED 29,017 DAYS OF PATIENT CARE IN ADDITION TO A MYRIAD OF OUTPATIENT SERVICES. 2801778 0 0 CRAIG HOSPITAL IS DESIGNATED BY NIDILRR AS A MODEL SYSTEM FOR BOTH SPINAL CORD INJURY AND TRAUMATIC BRAIN INJURY. THE HOSPITAL IS ALSO THE TRAUMATIC BRAIN INJURY MODEL SYSTEMS NATIONAL DATA & STATSTICAL CENTER AND ALSO CONDUCTED SEVERAL OTHER RESEACH PROJECTS SUPPORTED BY NIDILRR, CDC, DOD, OTHER FOUNDATIONS AND INDUSTRY. DURING THE YEAR, THE HOSPITAL'S RESEARCH DEPARMENT EMPLOYED A STAFF OF 21. 0 0 0 75758149 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 87 0 1 1059 1 0 0 0 0 0 0 X 16 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Julie Keegan VP Finance 3037898443 3425 S CLARKSON STREET ENGLEWOOD CO 80113 HUGH RICE CHAIR 2 X X 0 0 0 JANET HOUSER CHAIR ELECT 2 X X 0 0 0 COLLEEN FADDICK DIRECTOR 2 X 0 0 0 ERIC FEAGLER DIRECTOR 2 X 0 0 0 BOB LADENBURGER DIRECTOR 2 X 0 0 0 KEN KELLEY DIRECTOR 2 X 0 0 0 JUSTIN MONINGER DIRECTOR 2 X 0 0 0 TODD MUNSON DIRECTOR 2 X 0 0 0 GERRY LEWIS JENKINS DIRECTOR 2 X 0 0 0 MOLLY RAUZI DIRECTOR 2 X 0 0 0 JIM RODDY DIRECTOR 2 X 0 0 0 TOM BALAZY DIRECTOR 2 X 0 0 0 LAURIE FENSKE DIRECTOR 2 X 0 0 0 BETSY MANGONE DIRECTOR 2 X 0 0 0 MIKE NIXSON DIRECTOR 2 X 0 0 0 JASON REGIER DIRECTOR 2 X 0 0 0 MARY SISSEL DIRECTOR 2 X 0 0 0 VANDY VAN WAGENER DIRECTOR 2 X 0 0 0 BILL LINDSAY PAST CHAIR 2 X X 0 0 0 MARILYN TAYLOR SECRETARY 2 X X 0 0 0 NAN HINTON TREASURER 2 X X 0 0 0 MIKE FORDYCE PRESIDENT & CEO 40 8 X 624032 0 144541 DANA POLONSKY VP CLINICAL SERVICES 40 X 301328 0 69979 JULIE KEEGAN VP FINANCE 40 2.5 X 344394 0 64431 DIANE REINHARD VP PATIENT CARE 40 X 299990 0 70008 CHRIS WATKINS DIRECTOR IT 40 X 174051 0 20765 LESTER BUTT DIRECTOR PSYCHOLOGY 40 X 182472 0 30917 CYNTHIA HARRISON-FELIX DIRECTOR RESEARCH 40 X 177609 0 21001 KENNY HOSACK DIR-PROVIDER RELATIONS & MARKETING 40 X 187729 0 28461 MARY FELLER EXECUTIVE DIRECTOR-FOUNDATION 40 X 0 204012 10044 2291605 204012 460147 47 0 1 0 GE JOHNSON CONSTRUCTION 25 N CASCADE AVENUE COLORADO SPRINGS CO 80903 CONSTRUCTION SERVICES 16197285 SWEDISH MEDICAL CENTER 501 E HAMPDEN AVENUE ENGLEWOOD CO 80113 MEDICAL SERVICES 11191072 COLORADO HAZARD CONTROL 1775 W 55TH AVENUE DENVER CO 80221 ASBESTOS REMOVAL 1067359 CNS MEDICAL GROUP DEPT 710924 DENVER CO 80271 MEDICAL DIRECTOR AND RESEARCH 820913 HSS PO BOX 17033 DENVER CO 80217 SECURITY SERVICES 345904 14 0 0 0 17469698 2462529 170673 0 20102900 MEDICAL SERVICES 622310 95978891 95978891 0 0 PATIENT APARTMENTS 721000 1060354 1060354 0 0 MEDICAL OFFICE RENTALS 531190 91080 91080 0 0 0 0 0 0 97130325 1290535 0 0 1290535 0 0 0 0 0 0 0 0 0 0 15204694 2500 16794947 991369 -1590253 -988869 -2579122 0 0 -2579122 0 PEAK WELLNESS CENTER 900099 863638 863638 0 0 FEDERAL GRANT INDIRECT REIMBURSEMENT 900099 492142 492142 0 0 RDS REVENUE 900099 6750 6750 0 0 937282 937282 0 0 2299812 118244450 99430137 0 -1288587 X 120225 120225 1698134 1698134 0 42586568 35935947 6650621 2826827 2322506 504321 7239984 5864387 1375597 3100517 2604277 496240 185295 185295 83626 83626 90074 90074 134492 134492 13074397 12791639 282758 895737 895737 1121804 566516 555288 2510988 2510988 1595667 1292490 303177 553766 205451 348315 46274 46274 19453 19453 8310248 5900276 2409972 335261 335261 MEDICAL SUPPLIES 3826792 3820970 5822 0 RESEARCH EXPENSE 2801778 2801778 0 0 FOOD EXPENSE 889303 804646 84657 0 MINOR EQUIPMENT & REPAIR 732030 640932 91098 0 255788 86109 169679 95035028 75758149 19276879 0 7578666 7332114 18358881 13472912 481184 333158 20364716 24545777 561721 570811 1184366 1521146 175635125 49797374 116260470 125837751 47638389 64445853 1980450 2093664 214408843 240153186 21192329 21259701 36330000 35665000 0 57522329 56924701 X 156886514 183228485 0 0 0 0 156886514 183228485 214408843 240153186 X 23209422 3290257 0 0 0 -157708 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 81557 0 1 8517 90074 0 Schedule C, Part II-B, Line 1 Line 1g: The Hospital in conjunction with other hospitals are contracted with a consulting firm to help educate legislators as to why the current LTAC regulations are not appropriate for specialty hospitals. Line 1i: The portion of dues paid to professional organizations which were used for lobbying. 2807998 984511 274587 0 27006 0 4040090 3089373 258681 -99635 0 440421 0 2807998 2980065 8000 166189 0 64881 0 3089373 1610984 1421364 249411 0 301694 0 2980065 5660063 13940 919369 0 4982388 0 1610984 0 0.925 0.075 0 1 1 0 6651278 6651278 0 113887750 20692814 93194936 0 0 0 0 0 48125436 28651574 19473862 0 6970661 452986 6517675 125837751 0 X 121053977 3290257 0 0 -6989 3283268 117770709 134492 339249 473741 118244450 94556578 0 0 0 -4709 -4709 94561287 134492 339249 473741 95035028 Schedule D, Part V, Line 4 Endowment funds, which are held by the Craig Hospital Foundation, a related organization, serve a variety of purposes including supporting graduates, patient assistance programs, President's Leadership program and general purposes. Schedule D, Part X, Line 2 The Hospital applies a more-likely-than not measurement methodology to reflect the consolidated financial statement impact of uncertain tax provisions taken or expect to be taken on a tax return. After evaluating the tax positions taken, none are considered uncertain; therefore no amounts have been recognized as of Sept 30, 2016 and 2015. If incurred, interest and penalties with the tax positions are recorded in the period assessed in other programs and costs. No interest and penalties have been assessed as of Sept 30, 2016 and 2015. Schedule D, Part XI, Line 2d Part XI, Line 2d: RDS Revenue -$6,750 and Misc Reclass -$239 for a total of -$6,989. Schedule D, Part XI, Line 4b Revenue Received from Foundation for Research purposes $339,249 Schedule D, Part XII, Line 2d RDS expenses -$4,445 and Misc reclass -$264 for a total of -$4,709. Schedule D, Part XII, Line 4b Research Expenses funded by Foundation $339,249 1 1 X 1 X 3 1 X 5 1 1 0 1 1 759556 0 759556 0.008 8916270 3295443 5620827 0.059 0 0 0 0 0 9675826 3295443 6380383 0.067 417806 0 417806 0.004 258642 0 258642 0.003 2462529 2462529 0 0.0 120225 0 120225 0.001 0 0 3259202 2462529 796673 0.008 0 0 12935028 5757972 7177056 0.075 0 3306 0 5652907 9074825 -3421918 X 0 1 1 Craig Hospital 3425 S Clarkson Street Englewood CO 80113 www.craighospital.org 010435 X X X Craig Hospital 1 0 0 1 X X X X X X X X 15 1 0 0 1 X www.craighospital.org 1 15 1 www.craighospital.org 0 0 1 X 300 500 X X X 1 1 X X X X 1 X www.craighospital.org X www.craighospital.org X www.craighospital.org X X X X X 1 X 0 X X X X 0 X X 0 0 Schedule H, Part V, Section B, Line 5-Craig Hospital Community partners and individuals with special expertise in public health provided comparative data on our patient population. Health Data Analyst from the Health Surveys and Analysis Program of the Colorado Department of Public Health and Environment provided data on The Behavioral Risk Factor Surveillance System survey. Policy Analyst from the Colorado Health Institute provided data on the Colorado Health Access Survey. Schedule H, Part V, Section B, Line 11-Craig Hospital The CHNA identified several needs that are being addressed as follows: 1. Develop a decision tree to help patients find transportation resources in their community through a public, private, or non-profit organization. Continue development of resources to help disabled persons access medical services in their community through the Hospital's Nurse Advice Line and the Hospital website. The Nurse Advice Line staff is experienced in helping callers find a doctor in their community and guide patients in how to get an appointment with their PCP when needed. 2. Continue using social media to raise awareness about the importance of receiving a flu shot each year. We will also use social media to promote resources available on our website such as the list of dentists who provide affordable care and have accessible offices for disabled persons. The video we created addressing how patients can be assertive when advocating for their needs in the community will be available in shorter segments on the Hospital website. 3. Pilot a transition program from inpatients discharged to the community. Hospital staff to accompany patients home and help establish community resources for ongoing health needs including transportation and PCP identification. Schedule H, Part V, Section B, Line 13h-Craig Hospital Size of Household. Schedule H, Part V, Section B, Line 16i-Craig Hospital The financial assistance application is sent to patient with pre-collection letter. Patient billing statements also reference the policy and contact information is given if they require additional information or want to apply. Schedule H, Part V, Section B, Line 22d-Craig Hospital The annual calculation of AGB (Amounts Generally Billed) percentages for purposes of the hospitals financial assistance policy is determined by using the look-back method and including the claims for Medicare and private insurers that paid claims to the hospital during a prior 12-month period. Schedule H, Part I, Line 7 Costs were determined by using either actual costs or calculated costs based off a cost-to-charge ratio. Schedule H, Part III, Section A, Line 2 The Hospital continued to follow the presentation and disclosure of patient service revenue, provision for bad debts and the allowance for doubtful accounts as pronounced in the accounting standards updates 2011-07 and accounting standards codification topic 954. This requires organizations that do not have access to the collectability of a receivable prior to recognizing revenue to present their provision for bad debt related to a patient service revenue as a deduction from revenue, net of any contractual allowances and discounts on their statement of operations. The adoption of this did not impact the financial statements as the Hospital does not recognize significant revenue without assessing a patient's ability to pay. Schedule H, Part III, Section A, Line 4 Part III, Line 4 - There is not a footnote in the audited financial statements that describes bad debt expense. Please refer to page 9 of the Audited Financial Statements that addresses Patient Accounts Receivable. Schedule H, Part III, Section B, Line 8 Part III- Line 8 - The source of the data is the most recent filed Medicare Cost Report using the ratio of cost to charges method. The payment mechanism received for care provided to Medicare patients is not negotiated but set by federal regulations. The payment currently received for treatment is not sufficient to cover our costs and although we don't recognize this shortfall as charity, we believe it should be included in the calculation of community benefit. All patients receive the appropriate level of care and services regardless of payment source. Schedule H, Part VI, Line 2 In addition to conducting its annual CHNA, the Hospital assesses community needs through a variety of different programs. As a condition of federal grant funding, Craig Hospital's research department conducts ongoing longitudinal studies on the long-term effects and needs of persons with spinal cord injury and brain injury. Craig Hospital also operates a toll-free Nurse Advice Line and collects data on why former patients call for assistance. Craig Hospital also collaborates with the Brain Injury Alliance of Colorado, Operation TBI Freedom, The Hangout, The Christopher & Dana Reeve Peer Network Program, and other community organizations to assess and meet the long term needs of citizens with disabilities. Craig also implemented a Soft-Landing pilot program in 2016 to send clinicians home with patients to gain new insight into what challenges patients and families face early on in their transition home. We look to continue developing the program to better meet the needs of our patients. Schedule H, Part VI, Line 3 The Admissions Department identifies patients who have limited benefits and compare the benefits to the estimated length of stay. When there is a shortage of days allowed through insurance, the Admissions Director will have a discussion with the patient/family to determine alternative coverage. This discussion encompasses the patient/family's ability to pay for the care; potential eligibility for Federal and State programs; and the Charity Care program. Upon admission to the hospital, the social workers/case managers complete a thorough Psycho-Social Assessment of the patient/family specifically exploring financial status. The case managers consider: household income post-injury, family size, assets, current and future living expenses, and financial obligations including expectations of future care needs. The case managers, along with the patient/family, assess other potential resources/programs for which the patient may qualify. Resources and programs evaluated include but are not limited to: Medicaid, Victim's Assistance, Liability and Liquidity, Accidental Death and Dismemberment, and the Charity Care program. If it appears as though the patient will qualify for State or Federal Programs, the case manager will assist the patient /family in completing the applications, obtaining the required documentation and advising them how to position themselves to qualify. If patients do not meet the criteria for other State or Federal programs, the Financial Assistance Eligibility Discount Guideline is utilized to determine if the patient's bill will be discounted. If appropriate, the case manager will initiate and assist the patient/family in completing the Financial Assistance Application for the Charity Care Program. Applications may also be obtained on the Craig Website, completed over the phone or via mail. If it is not clear that the patient/family will have a balance prior to discharge (co-pays, out of pocket, etc.) the patient/family will receive information on the Charity Care Program which is noted on the monthly billing statements and the copy of application along with letter for pre-collection. At this time the patient can complete the application. All applications are reviewed by the A/R Manager, Vice President of Finance and/or the Controller. When it is determined that the Charity is appropriate, this is communicated to the patient/family by the case manager or the Accounts Receivable Manager. Schedule H, Part VI, Line 4 As one of the most recognized specialty rehabilitation and research hospitals in the world for patients with spinal cord and brain injury, Craig Hospital contributes to the local, state, and national communities in myriads of ways in the areas of education, disability awareness training, handicap accessibility, and other forms of support. During FY 2016, the Hospital provided financial assistance, community support, and subsidized health services from government programs totaling $10.6 million. As a non-profit free standing hospital, Craig Hospital has 1,059 full-time and part time employees and utilizes 225 active volunteers from the community. Craig Hospital is the largest medical/rehabilitation hospital in Colorado serving patients with spinal cord injury (SCI) and traumatic brain injury (TBI) and serves the largest percentage of the 150 newly injured SCI and 5,000 TBI patients per year in Colorado, with inpatient, outpatient, and long term follow-up services. There are approximately 2,400 people with SCI and 175,000 with TBI living in Colorado. Approximately 50% of Craig Hospital's patients are Colorado residents while the remaining come from virtually every other state, and even some from foreign countries. The average age of our patients is 41 years old, 75% are male, and all come from varied socio-economic backgrounds. Craig Hospital provides significant support to the community, supporting the Brain Injury Alliance of Colorado, conducting annual outpatient clinics in Pueblo and Grand Junction, Colorado and Casper, Wyoming, serving on multiple boards for state agencies and organizations (TBI Trust Fund, Division of Workers Compensation TBI medical treatment guidelines, Colorado Brain Injury Professionals Network, the Hangout Network and others), offering financial scholarships for Craig "graduates" for higher education, and financially supporting more than 100 local, regional, and national organizations each year. Craig Hospital collaborates on patient research and technology with several local colleges and universities. In FY 2016, Craig took over the operation of Operation TBI Freedom, a military case management program located in Colorado Springs, Co. In the past five years, Craig Hospital has served more than 2,500 inpatients with catastrophic spinal cord and brain injuries, of which approximately one half were from Colorado. In the same time period, Craig Hospital served more than 16,500 outpatients, of which three quarters were from Colorado. These numbers do not include patient support systems and community members - families, friends, co-workers, and employers. Craig Hospital's patient outcomes are superior in comparison to virtually every regional and national average in the most important measures of rehabilitation outcomes. On average, Craig graduates are more dependent when they are admitted, functionally make greater gains during their initial treatment, are discharged home at higher rates, return to work or school in greater numbers, are more functionally independent and require less attendant care, have fewer re-hospitalizations, have higher levels of community reintegration and satisfaction with life, and have higher earning power than their national peer group treated in other rehabilitation programs. Our exceptional outcomes validate that rehabilitation is an investment in long-term societal value. When we help patients become as independent and productive as possible, it is in their best interest - as well as in the best interest of their family, employer, insurance carrier, taxpayers, and to the community as a whole. Craig has received the prestigious Magnet Recognition for quality in nursing for 3 consecutive 5 year periods covering 2005 through 2020 and the Magnet Prize Award in 2012. Craig has also been ranked as a top ten rehabilitation center by U.S. News and World Report for 27 consecutive years. Another recent accomplishment is the Nurse Advice Line, which is a toll free national advice line, which has won national awards. Craig Hospital is the first hospital in Colorado to have group special license plates which were approved by the 2011 legislature. Each year, Craig Hospital staff and physicians receive national awards, and in 2016, Craig Hospital staff and physicians won several major awards. Craig Hospital is pioneering adaptive technology and cutting edge treatment, and in 2011 Craig Hospital founded the Peak Center at Craig Hospital, a state-of-the art wellness and fitness program for inpatients, outpatients, and community memberships. Schedule H, Part VI, Line 5 Craig Hospital's purpose is to provide patient care, education and research. The Board of Directors of Craig Hospital has ultimate authority in extending privileges only to professionally competent physicians, dentists and podiatrists, licensed to practice in the State of Colorado. There are 194 physicians on the medical staff of Craig Hospital, each assigned to one of four separate medical staff categories. The medical staff of Craig Hospital is organized and operates under the guidance of the medical staff bylaws, medical staff rules and regulations and medical staff policies and procedures. The organized medical staff is accountable to the governing body for the quality of care, treatment and services provided to patients by the practitioners with privileges. The medical staff is responsible for establishing and maintaining patient care standards, credentialing and delineation of clinical privileges. Additionally, there are approximately 60 allied health professionals, categorized as either independent or physician directed whom function within one or more health-related professions or occupations. The Hospital uses excess funds to fund capital improvements, equipment for patient programs, and patient education. The Hospital provides long-term community support through multiple programs such as: Toll-free Nurse Advice Line, On-Line free educational materials resource library, Tool on Craig Hospital's website, and social media including Facebook, Twitter, Linked In, You Tube, Instagram and Blog. Provide $120K support per year to community organizations including $10K support to Brain Injury Alliance of Colorado - board member. Staff serves on hundreds of community organizations. Published 31 paper chapters in professional literature; Presented 169 lectures on SCI/TBI; Chaired Colorado BL Professionals Network Meeting; NIDILRR Model System Center for SCI and TBI; Alumni higher education scholarship program; Collaborations with CU, School of Mines, DU Adaptive Technology; Accessible Homes Collaboration; Q & A feature on health matters on Craig's Facebook page; Emergency preparedness venues for Englewood Fire and Police; Columbine High School Run for Remembrance benefit; Collaborate with Christopher and Dana Reeve Peer Network Program; Training for Regis Neuropsychology classes; Training for Air Force Academy Cadets; AMI Wellness-Professional Advisory Committee; Camp Discovery Volunteers; Cathy Scott Foundation - board member; Center for Women's Health Research - board member; Colorado Hospital Association - board member; Homebuilders Foundation volunteers; National Sports Center for the Disabled - Winter Park - board member; FVA Mt States Chapter; and Denver Public Schools Career day. 1 High Fives Foundation PO Box 3212 Truckee CA 96160 264275773 501(c)(3) 25000 0 Partner Contribution Colorado Neurological Institute 701 E Hampden Ave Suite 415 Englewood CO 80113 841100975 501(c)(3) 11000 0 Sponsorship Chanda Plan Foundation 8725 West 14th Avenue Suite 170 Lakewood CO 80215 204358964 501(c)(3) 10000 0 Annual Support Brain Injury Alliance of Colorado 1385 S Colorado Blvd Suite 606A Denver CO 80222 840893049 501(c)(3) 10000 0 Sponsorship St Anthony Health Foundation 11600 W 2nd Place Lakewood CO 80228 840902211 501(c)(3) 6000 0 Sponsorship National Sports Center for the Disabled 1801 Mile High Stadium Circle Denver CO 80204 840738419 501(c)(3) 6000 0 Sponsorship 6 0 Schedule I, Part I, Line 2 The Hospital financially supports many different organizations that provide programs that are similar or complimentary to Craig's mission. These organizations service or provide assistance to individuals who are typical of Craig's patient population. Management carefully reviews each organization's mission when deciding which ones to support. X X 1 1 X X X 0 1 0 0 0 0 0 1 0 MIKE FORDYCE PRESIDENT & CEO 395936 0 150569 0 77527 0 130600 0 13941 0 768573 0 0 0 JULIE KEEGAN VP FINANCE 222644 0 51110 0 70640 0 50600 0 13831 0 408825 0 57263 0 DANA POLONSKY VP CLINICAL SERVICES 177146 0 52874 0 71308 0 49430 0 20549 0 371307 0 59881 0 DIANE REINHARD VP PATIENT CARE 178952 0 52813 0 68225 0 49459 0 20549 0 369998 0 57923 0 LESTER BUTT DIRECTOR PSYCHOLOGY 151522 0 30483 0 467 0 10287 0 20630 0 213389 0 0 0 KENNY HOSACK DIR-PROVIDER RELATIONS & MARKETING 155960 0 31189 0 579 0 7781 0 20681 0 216190 0 0 0 CYNTHIA HARRISON-FELIX DIRECTOR RESEARCH 148946 0 27987 0 676 0 7231 0 13770 0 198610 0 0 0 CHRIS WATKINS DIRECTOR IT 150316 0 23200 0 535 0 7108 0 13658 0 194817 0 0 0 MARY FELLER EXECUTIVE DIRECTOR-FOUNDATION 0 176752 0 26767 0 493 0 8184 0 1859 0 214055 0 Schedule J, Part I, Line 1a Country Club dues and financial, estate and tax planning services paid by Mike Fordyce, CEO, were reimbursed by the Hospital and included in employee's Form W2 taxable wages. Schedule J, Part I, Line 4 Line 4b: Officers participate in a non-qualified 457F retirement plan. During the tax year, the following amounts were earned and funded by the Hospital: Mike Fordyce $120,000, Julie Keegan $40,000, Dana Polonsky $40,000 and Diane Reinhard $40,000. Schedule J, Part I, Line 7 Discretionary bonuses of up to 10% of base pay are paid to department directors, up to 15% for Vice Presidents, and up to 30% for CEO all based upon attaining specified performance goals. A Colorado Health Facilities Authority 840752932 19648AG82 2012-12-03 40071072 Hospital Expansion & Refund 2003 Bonds 0 0 0 A 0 0 40071072 0 0 0 558654 0 0 31577932 7980000 0 2016 1 0 1 1 A 0 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Schedule K, Part II, Line 3-12/03/2012 40,071,072 Colorado Health Facilities Authority Par Amount $37,595,000, Net Premium $2,476,072, Total Proceeds of Issue $40,071,072 Form 990, Part VI, Section B, Line 11b Prior to filing, the Form 990 and related schedules were presented, reviewed, and approved by the Finance/Audit Committee of the Board of Directors. Copies were also distributed to the full Board along with a report from the Finance/Audit Committee. Form 990, Part VI, Section B, Line 12c All Board members, Vice Presidents and Director-Level positions complete a duality of interest form annually and any disclosures are brought to the attention of the Board of Directors. Form 990, Part VI, Section B, Line 15 The Executive Committee commissions an independent compensation consulting firm every 2-3 years to conduct a study of compensation of the key leadership positions within the Hospital utilizing data from both local and national hospitals. This data was utilized by the Executive Committee when it approves the compensation of the President/CEO and other top management positions within the Hospital. All of the details of the deliberation and decision making process are documented in the Executive Committee meeting minutes. Form 990, Part VI, Section C, Line 19 The Hospital's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part IX, Line 11g Program Services: Contracted Medical Services $10,828,465, Consulting $34,627, Medical Director Services $712,920, Laundry Services $312,687, Misc Purchased Services $397,638, Contact Labor $254,571, Other Services $250,731. Total Other Fees for Program Services $12,791,639. Management and General Exps: Consulting Services $114,770, Misc Purchased Services $112,336, Contact Labor $48,672, Other Services $6,980. Total Other Fees for Management and General Exps $282,758. Total Other Fees Column A $13,074,397. Form 990, Part XI, Line 9 Write off equity in discontinued operations of Rehabilitation Documentation Services -$157,708 Rehabilitation Documentation Services 3425 S Clarkson Street Englewood CO 80113 030434653 Software Development CO 6750 0 Craig Hospital Craig Hospital Foundation 3425 S Clarkson Street Englewood CO 80113 237352287 Fundraising CO 501(C)(3) 11A/TYPE I Craig Hospital 1 Adaptive Equipment Company 3425 S Clarkson Street Englewood CO 80113 841280869 Inactive CO Craig Hospital C 0 0 1.0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 Craig Hospital Foundation c 17469698 Actual cost Craig Hospital Foundation q 1970889 Actual cost