2016-05-16T13:29:00-05:00 2015-06-30 461497033 EKS&H LLLP 7979 E TUFTS AVENUE SUITE 400 DENVER CO 802372521 990 2014-07-01 043730045 MEDICAL CENTER OF THE ROCKIES MEDI 9702377000 2315 EAST HARMONY ROAD NO 200 FORT COLLINS CO 80528 STEPHANIE DOUGHTY CHIEF FINANCIAL OFFICER 9702377000 2016-05-13 1 DORI J EGGETT P00645252 3037409400 2014 2016-08-17 19:52:53Z KEVIN UNGER 2315 E HARMONY RD 200 FT COLLINS CO 80528 429769781 0 X WWW.UCHEALTH.ORG X 2002 CO WE IMPROVE LIVES THROUGH LEARNING, HEALING, DISCOVERY, AND THROUGH HUMAN CONNECTION. 11 10 2445 345 20416 0 59494 80375 366542500 423165504 3232894 4888223 2113059 1464018 371947947 429598120 39552316 56355522 0 0 111193776 120381336 0 0 0 170118096 178020883 320864188 354757741 51083759 74840379 366108836 389555382 254325207 252518748 111783629 137036634 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 313593767 56355522 423270537 MEDICAL CENTER OF THE ROCKIES (MCR) PROVIDES TERTIARY, ACUTE, INPATIENT, OUTPATIENT, AS WELL AS EMERGENCY CARE. MCR SERVICES COMMUNITIES IN NORTHERN COLORADO, SOUTHWESTERN NEBRASKA, AND SOUTHEASTERN WYOMING. DURING FISCAL YEAR 2015, MCR RECORDED 43,620 PATIENT DAYS, 10,589 ADMISSIONS, 34,389 OUTPATIENT CLINIC VISITS, 52,803 EMERGENCY VISITS, 1,330 BIRTHS, 3,884 INPATIENT SURGERIES, AND 4,474 OUTPATIENT SURGERIES. 313593767 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 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 107 0 1 2445 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X STEPHANIE DOUGHTY 9702377000 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 CHRISTINE CHIN BOARD CHAIR 1.00 2.00 X X 0 0 0 MIKE DELLENBACH VICE BOARD CHAIR 1.00 2.00 X X 0 0 0 DENNIS HOUSKA BOARD MEMBER 1.00 2.00 X 0 0 0 THAINE MICHIE BOARD MEMBER 1.00 2.00 X 0 0 0 CHRIS OSBORN BOARD MEMBER 1.00 2.00 X 0 0 0 JOHN MENTEN BOARD MEMBER 1.00 2.00 X 0 0 0 JAMES SPROWELL MD BOARD MEMBER 1.00 2.00 X 0 0 0 LAURIE STEELE BOARD MEMBER 1.00 2.00 X 0 0 0 DAN STROH BOARD MEMBER 1.00 2.00 X 0 0 0 STEVE THORSON MD BOARD MEMBER 1.00 2.00 X 0 0 0 KEVIN UNGER PRESIDENT/CEO 25.00 25.00 X X 538803 538803 108353 STEPHANIE DOUGHTY CFO 25.00 25.00 X 293273 293273 61859 GEORGE HAYES CEO ENDED 1/14 50.00 X 459468 0 36172 RUSSELL WOOLLEY VP OPERATIONS 50.00 X 175450 0 34069 BONNIE CLIPPER CNO TERM ENDED 4/15 50.00 X 281436 0 42279 KAREN MARTIN DIRECTOR PERIO SVS, MCR 50.00 X 191138 0 16508 LARRY MITCHELL PHARMACIST 50.00 X 125291 0 19996 TODD STIRM PHARMACIST 50.00 X 146101 0 25538 DARREN STOTT PHARMACIST 50.00 X 145805 0 30917 BARBARA OCHSNER CLINICAL DIRECTOR 50.00 X 141037 0 18636 2497802 832076 394327 51 0 1 0 N COLORADO HOSPITALISTS 2121 E HARMONY RD STE 300 FT COLLINS CO 80528 MEDICAL 1789465 NORTHERN COLORADO ANESTHESIA 1236 ELIZABETH STE 1 FT COLLINS CO 80524 MEDICAL 962378 SPECIALTYCARE CARDIOVASCULAR RESOURCES 3100 WEST END AVE 150 NASHVILLE TN 37203 MEDICAL 903400 TALEMED LLC 6279 TRI RIDGE BLVD 110 LOVELAND OH 45140 MEDICAL 840072 CHILDRENS HOSPITAL COLORADO 1056 E 19TH AVE DENVER CO 80218 MEDICAL 824196 24 80375 80375 NET PATIENT SVC REV 900099 403343850 403343850 PROVIDER FEE REVENUE 900099 17855428 17855428 DIETARY SVC INCOME 900099 1309153 1309153 RESEARCH CONTRACT REV 900099 636657 636657 OUTSIDE PHARM SALES 446110 20416 20416 423165504 2658237 2658237 485147 485147 29416 0 29416 29416 29416 1746387 1260 0 2808 1746387 -1548 1744839 1744839 285582 168853 116729 116729 ELECTRONIC HEALTH RECO 900099 999676 999676 MISCELLANEOUS 900099 318197 318197 1317873 429598120 423270537 20416 6226792 56355522 56355522 1946054 533233 1412821 91571291 71231276 20340015 1459495 1120005 339490 24491725 18794766 5696959 912771 700454 212317 200 200 40435 40435 20540 20540 225041 225041 29769753 20452762 9316991 13318 11568 1750 1485260 1218422 266838 4989075 4344662 644413 2445588 2445588 240504 205496 35008 407291 96039 311252 8600769 8600769 24939418 24939418 582058 485927 96131 UBIT 3167 3167 MEDICAL SUPPLIES 68109472 67793260 316212 BAD DEBT 17701454 17701454 PROVIDER FEE EXPENSE 11980998 11980998 6466542 4581948 1884594 354757741 313593767 41163974 0 17160428 14430550 45214395 48605333 5060 5983 7871470 7446197 789669 912316 292895953 152063963 150307216 140831990 132855012 169055084 4787517 7118069 8267929 366108836 389555382 19239528 19694105 225216420 225246126 5176698 4113246 4692561 3465271 254325207 252518748 X 111783629 137036634 111783629 137036634 366108836 389555382 X 74840379 -569874 -49017500 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 20540 0 0 20540 0 PART II-B, LINE 1: PORTION OF DUES FROM MEMBERSHIP IN CHA AND AHA THAT ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 12609956 12609956 172930009 76481684 96448325 1427328 522702 904626 86201537 62406043 23795494 19727123 12653534 7073589 140831990 INTERCOMPANY PAYABLES 67330 BOND INTEREST EXPENSE 2422700 OTHER DEFERRED EXPENSES 975241 3465271 411251736 -569874 170401 -399473 411651209 17946911 17946911 429598120 336981231 170401 170401 336810830 17946911 17946911 354757741 PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD IN EXPENSE ON AFS 168,853. LOSS ON SALE OF ASSETS 1,548. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 17,701,454. UBI PHARMACY 20,416. INVESTMENT EXPENSE REPORTED AS INCOME ON AFS 225,041. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD IN EXPENSE ON AFS 168,853. LOSS ON SALE OF ASSETS IN EXPENSE ON AFS 1,548. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 17,701,454. UBI PHARMACY 20,416. INVESTMENT EXPENSE REPORTED AS INCOME ON AFS 225,041. 1 1 X 1 X 250.000000000000 1 X 1 0 1 1 107557 107557 0.00030 41085028 25175450 15909578 0.04480 16138158 13913245 2224913 0.00630 57330743 39088695 18242048 0.05140 889052 96088 792964 0.00220 255095 255095 0.00070 93758 12195 81563 0.00020 56515272 56515272 0.15930 57753177 108283 57644894 0.16240 115083920 39196978 75886942 0.21380 806 806 0.00000 3187 3187 0.00000 3993 3993 1 17701454 78812720 107543289 -28730569 X 1 1 1 1 MEDICAL CENTER OF THE ROCKIES 2500 ROCKY MOUNTAIN AVE LOVELAND CO 80538 X X X X LAB, PHARMACY, CARDIOVASCULAR MEDICAL CENTER OF THE ROCKIES 1 0 0 1 X X X X X X X X X X 12 1 1 1 1 X SEE PART V, SECTION C X 1 12 1 SEE PART V, SECTION C 0 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X 1 X 0 X X X X 1 X 0 0 MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 3J: THE CHNA REPORT ALSO DESCRIBES CLINICAL SERVICES PROVIDED BY HOSPITAL FACILITY ADDRESSING THE FOUR LEADING CAUSES OF MORTALITY IN THE COUNTY. MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 5: TWO COMMUNITY MEETINGS WERE HELD DURING FEBRUARY 2013 WHERE FINDINGS FROM THE CHNA WERE PRESENTED, QUESTIONS AND COMMENTS WERE RECEIVED AND RESPONSES PROVIDED. THE FOLLOWING INDIVIDUALS WERE CONSULTED:ANNETTE ALFANO, UNIVERSITY OF COLORADO HEALTHMARY ATCHISON, KAISER PERMANENTEKRISTIN BIERI, FOOD BANK FOR LARIMER COUNTYDEBORAH CAMPBELL, LARIMER COUNTY COMPASSJENNIFER CHASE, NORTHERN COLORADO AIDS PROJECTANDREA CLEMENT-JOHNSON, LARIMER COUNTY DEPARTMENT OF HEALTH & ENVIRONMENTBRUCE COOPER, HEALTH DISTRICT OF NORTHERN LARIMER COUNTYLORI DAIGLE, NORTHERN COLORADO AIDS PROJECTALISON DAWSON, DISABLED RESOURCE SERVICESEMILY DAWSON PETERSEN, TOUCHSTONE HEALTH PARTNERSTOM DONNELLY, LARIMER COUNTY COMMISSIONERSMICHELE DOYLE, COLUMBINE HEALTH CARE SYSTEMSLINDA FELLION, EARLY CHILDHOOD COUNCIL OF LARIMER COUNTYLEW GAITER, LARIMER COUNTY COMMISSIONERSCHAZZ GLAZE, SALUD FAMILY HEALTH CENTERNEIL GLUCKMAN, LARIMER COUNTY, ASSISTANT COUNTY MANAGERMARTHA HARGRAVES, COMMUNITY MEMBERBARBARA HARTMAN, THOMPSON SCHOOL DISTRICTSUE HEWITT, HEALTH DISTRICT OF NORTHERN LARIMER COUNTYJESSICA HINTERBERG, CANDO WITH UNIVERSITY OF COLORADO HEALTHERICA IVERSON, FOOD BANK FOR LARIMER COUNTYSTEVE JOHNSON, LARIMER COUNTY COMMISSIONERSASHLEY KASPRZAK, TEAM FORT COLLINSKATY KOHNEN, LEAGUE OF WOMEN VOTERSJENNY LANGNESS, ALPHA CENTERJENNIFER LEE, LARIMER COUNTY BOARD OF HEALTHDIANA LINDEN, PLANNED PARENTHOOD OF THE ROCKY MOUNTAIN'S RESPONSIBLE SEX EDUCATION INSTITUTEMARIE MACPHERSON, LARIMER COUNTY DEPT OF HEALTH AND ENVIRONMENTJOHN MCGEE, CROSSROADS SAFEHOUSEDAWN NANNINI, TEAM FORT COLLINSKAREN NICHOLSON, ESTES PARK MEDICAL CENTERTRACI ODDY, BANNER MCKEE MEDICAL CENTERCAROL PLOCK, HEALTH DISTRICT OF NORTHERN LARIMER COUNTYMARK RICHARDS, LARIMER COUNTY BOARD OF HEALTHDOUG RYAN, LARIMER COUNTY DEPARTMENT OF HEALTH & ENVIRONMENTKIM SHARPE, HEALTHIER COMMUNITIES COALITION OF LARIMER COUNTYBILL STOUT, WOMEN'S RESOURCE CENTERAVERIL STRAND, LARIMER COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENTDEIRDRE SULLIVAN, CANDO WITH UNIVERSITY OF COLORADO HEALTHJILL TAYLOR, UNIVERSITY OF COLORADO HEALTHGRACE TAYLOR, UNIVERSITY OF COLORADO HEALTHMARILYN THAYER, COMMUNITY ORGANIZING TO REACH EMPOWERMENT (CORE) CENTERLEE THIELEN, THIELEN CONSULTINGCOLETTE THOMPSON, UNIVERSITY OF COLORADO HEALTHJANE VISTE, LARIMER COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENTSCOTT VON BARGEN, TURNING POINT CENTER FOR YOUTH & FAMILY DEVELOPMENTMARGARET WATSON, UNITED WAY 2-1-1 OF LARIMER COUNTYNANCY WEBER, POUDRE SCHOOL DISTRICTVALERIE WENDELL, BOHEMIAN FOUNDATIONLISE YOUNGBLADE, HUMAN DEVELOPMENT AND FAMILY STUDIES/COLORADO STATE UNIVERSITYSTEVE YURASH, LARIMER COUNTY BOARD OF HEALTH MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 6A: POUDRE VALLEY HOSPITAL ALSO PARTICIPATED IN THE 2013 CHNA. MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 6B: THE FOLLOWING ORGANIZATIONS ALSO PARTICIPATED IN THE CHNA:ALPHA CENTERBOHEMIAN FOUNDATIONCOLUMBINE HEALTH CARE SYSTEMSCOMMUNITY ORGANIZING TO REACH EMPOWERMENT CENTERCROSSROADS SAFEHOUSEDISABLES RESOURCE SERVICESEARLY CHILDHOOD COUNCIL OF LARIMER COUNTYFOOD BANK FOR LARIMER COUNTYHEALTH DISTRICT OF N. LARIMER COUNTYHEALTHIER COMMUNITIES COALITION OF LARIMER COUNTYHUMAN DEVELOMENT AND FAMILY STUDIES @ CSUKAISER PERMANENTELARIMER COUNTRY DEPARTMENT OF HEALTH AND ENVIRONMENTLARIMER COUNTYLARIMER COUNTY BOARD OF HEALTHLARIMER COUNTY COMMISSIONERSLARIMER COUNTY COMPASSLEAGUE OF WOMEN VOTERSNORTHERN COLORADO AIDS PROJECTPLANNED PARENTHOODPOUDRE SCHOOL DISTRICTSALUD FAMILY HEALTH CENTERTEAM FORT COLLINSTHIELEN CONSULTINGTHOMPSON SCHOOL DISTRICTTOUCHSTONE HEALTH PARTNERSTURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENTUNITED WAY OF LARIMER COUNTYWOMEN'S RESOURCE CENTERPART V, SECTION B, LINE 7A: HTTPS://WWW.UCHEALTH.ORG/DOCUMENTS/FILE-PDF/ABOUT-CHNA-WEB201213.PDFPART V, SECTION B, LINE 10A: IMPLEMENTATION STRATEGYHTTPS://WWW.UCHEALTH.ORG/DOCUMENTS/FILE-PDF/ABOUT-2013-IMPLEMENTATION STRATEGY-UCHEALTHNORTH.PDF MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 11: AN IDENTIFIED HEALTH ISSUE RELATED TO A HIGH RATE OF UNINTENDED TEEN PREGNANCY IN WELD COUNTY IS NOT BEING ADDRESSED WITH DIRECT RESOURCES ALLOCATED FROM POUDRE VALLEY HOSPITAL OR THE MEDICAL CENTER OF THE ROCKIES. THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PROVIDES REPRODUCTIVE HEALTH SERVICES FOR TEENS THROUGH A TITLE X CLINIC. ADDITIONAL EDUCATION AND OUTREACH TO WELD COUNTY TEENS IS PROVIDED BY A COMMUNITY ORGANIZATION; LUTHERAN FAMILY SERVICES. POUDRE VALLEY HOSPITAL AND MEDICAL CENTER OF THE ROCKIES PROVIDED SUPPORT TO THIS ORGANIZATION THROUGH CASH DONATIONS TOTALING $2,460.00 DURING THE 2012/13 FISCAL YEAR AND $2,500 DURING THE 2013/14 FISCAL YEAR. ANOTHER IDENTIFIED HEALTH ISSUE - MOTOR VEHICLE SAFETY FOR TEENS IN WELD COUNTY - IS ALSO NOT BEING DIRECTLY ADDRESSED DUE TO LACK OF RESOURCES. THE ISSUE IS BEING ADDRESSED BY A NON-PROFIT COMMUNITY COALITION - DRIVE SMART WELD COUNTY - WHICH HAS DEDICATED RESOURCES AND ACTION PLANS TO ADDRESS THIS ISSUE.PART V, SECTION B, LINE 16A, 16B, AND 16C:HTTPS://WWW.UCHEALTHBILLPAY.ORG/PAYMENTOPTIONS.ASPX?TABID=4 PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 16A WEBSITE: SEE PART V, SECTION C MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 16B WEBSITE: SEE PART V, SECTION C MEDICAL CENTER OF THE ROCKIES PART V, SECTION B, LINE 16C WEBSITE: SEE PART V, SECTION C 4 GREELEY INFUSION CENTER 1675 18TH AVE GREELEY CO 80631 INFUSION GREELEY MEDICAL CLINIC 1900 16TH ST 4TH FLOOR GREELEY CO 80631 CARDIOVASCULAR, LAB, IMAGING GREELEY EMERGENCY & SURGERY CENTER 6906 10TH ST GREELEY CO 80634 EMERGENCY, OUTPT SURGERY, LAB, IMAGING, PHARMACY PEAKVIEW MEDICAL CENTER 5881 W 16TH ST GREELEY CO 80634 IMAGING PART I, LINE 7: THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINE 7A, 7B AND 7C. THE COST-TO-CHARGE RATION WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE TO COST-TO-CHARGES.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. 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 = $17,701,454PART 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 6: THE AMOUNT ON LINE 6 WAS DETERMINED BY ALLOWABLE COSTS AS REPORTED ON THE MEDICAL CENTER OF THE ROCKIES 2015 COST REPORT. PART III, LINE 8: APPROXIMATELY 19.57% OF NET PATIENT SERVICE REVENUES 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 III, LINE 9B: PATIENT PROVIDES DOCUMENTATION BASED ON COLORADO INDIGENT CARE GUIDELINES, REVIEWED BY FINANCIAL ASSISTANCE COMMITTEE (FAC), CROSS FUNCTIONAL TEAM CHAIRED BY DIRECTOR PATIENT FINANCIAL SERVICES. UPON APPROVAL OR DENIAL OF THE REQUEST FOR CHARITABLE AID FROM THE FAC, THE PATIENT WILL BE ADVISED OF THE DECISION. THE BILL IS PARTIALLY OR TOTALLY ADJUSTED AS APPROVED BY THE FAC, NO FURTHER COLLECTION PROCESS WITH THE PATIENT. FOR ANY PORTION NOT ADJUSTED OFF, THE PROPER SEQUENCE OF ATTEMPTS TO COLLECT ARE FOLLOWED. FINAL ASSIGNMENT OF THE BILL IS TO A COLLECTION AGENCY. 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. PART VI, LINE 4: MEDICAL CENTER OF THE ROCKIES IS A LOCALLY OWNED, PRIVATE, NON-PROFIT ORGANIZATION WITH A STRONG VISION: FROM HEALTHCARE TO HEALTH. BASED IN NORTHERN COLORADO, MCR 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.MCR IS A PART OF THE UNIVERSITY OF COLORADO HEALTH WHICH AIMS TO DELIVER THE HIGHEST QUALITY PATIENT CARE WITTHT THE HIGHEST QUALITY PATIENT EXPERIENCE. THE PARTNERSHIP COMBINES POUDRE VALLEY HOSPITAL, MEDICAL CENTER OF THE ROCKIES, COLORADO HEALTH MEDICAL GROUP, UNIVERSITY OF COLORADO HOSPITAL AND MEMORIAL HEALTH SYSTEM INTO AN ORGANIZAION DEDICATED TO BUILDING HEALTHIER COMMUNITIES AND PROVIDING UNMATCHED PATIENT CARE IN THE ROCKY MOUNTAIN WEST. THE ORGANIZATION'S MISSION : WE IMPROVE LIVES. IN BIG WAYS THROUGH LEARNING, HEALING AND DISCOERY. 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 1 POUDRE VALLEY MEDICAL GROUP LLC 2315 EAST HARMONY ROAD SUITE 200 FORT COLLINS CO 80528 800348943 N/A 50716613 COMMUNITY HEALTHCARE POUDRE VALLEY HEALTH SYSTEM FOUNDATION 2315 EAST HARMONY ROAD SUITE 200 FORT COLLINS CO 80528 741894581 501(C)(3) 825800 COMMUNITY HEALTHCARE UNIVERSITY OF CO SCHOOL OF MEDICINE 13001 17TH PLACE AURORA CO 80045 846000555 501(C)(3) 4809004 HEALTHCARE EDUCATION 2 1 PART I, LINE 2: THE GRANTS ARE SPECIFIC REQUESTS FROM RELATED ENTITIES FOR THE FUNDS TO BE USED TO BENEFIT THE HEALTHCARE COMMUNITY OF NORTHERN COLORADO. EACH REQUEST IS EVALUATED ON AN INDIVIDUAL BASIS. POUDRE VALLEY MEDICAL GROUP, LLC'S MEMBERS ARE POUDRE VALLEY HEALTH CARE, INC AND UNIVERSITY OF COLORADO HEALTH. X X X X 1 0 0 0 0 0 0 0 0 KEVIN UNGER PRESIDENT/CEO 226390 226390 302581 302581 9832 9832 3900 3900 50276 50277 592979 592980 0 0 STEPHANIE DOUGHTY CFO 239943 239943 51939 51939 1391 1391 3900 3900 27030 27029 324203 324202 0 0 GEORGE HAYES CEO ENDED 1/14 26335 0 432016 0 1117 0 851 0 35321 0 495640 0 432016 0 RUSSELL WOOLLEY VP OPERATIONS 147873 0 27446 0 131 0 3281 0 30788 0 209519 0 0 0 BONNIE CLIPPER CNO TERM ENDED 4/15 236450 0 44309 0 677 0 7800 0 34479 0 323715 0 0 0 KAREN MARTIN DIRECTOR PERIO SVS, MCR 11376 0 0 0 179762 0 1114 0 15394 0 207646 0 0 0 TODD STIRM PHARMACIST 143429 0 2573 0 99 0 4408 0 21130 0 171639 0 0 0 DARREN STOTT PHARMACIST 143784 0 1805 0 216 0 4484 0 26433 0 176722 0 0 0 BARBARA OCHSNER CLINICAL DIRECTOR 130312 0 10628 0 97 0 4231 0 14405 0 159673 0 0 0 PART I, LINE 4A KAREN MARTIN RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $154,461. A COLORADO HEALTH FACILITIES AUTHORITY - 2006 SERIES B 840752932 196474W48 2005-03-31 56705193 CONSTRUCT/EQUIP NEW TERTIARY CARE 0 0 0 B COLORADO HEALTH FACILITIES AUTHORITY - 2005 SERIES C 840752932 196474W48 2005-03-31 82000000 CONSTRUCT/EQUIP NEW TERTIARY CARE 0 0 0 C UNIVERSITY OF COLORADO HOSPITAL AUTHORITY SERIES 2012C 840752932 2012-10-01 87510000 REFUND SERIES 2005D & 2005E BONDS 0 0 0 A 56705193 3618371 4393224 856248 3811472 44106237 2005 0 0 1 1 B 82000000 5228112 4398417 1040224 5977210 65467916 2005 0 0 1 1 C 87510000 87510000 2012 1 0 1 1 A 0 1 1 1 1 1 0.00060 0.00060 0 0 1 B 0 1 1 1 1 1 0.00060 0.00060 0 0 1 C 0 1 1 1 1 1 0.00060 0.00060 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART I, COLUMN (E) BOND ISSUANCE 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. THE 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 THE TWO 2005 BOND ISSUANCES. FORM 990, PART I, LINE 6 MEDICAL CENTER OF THE ROCKIES (MCR) HAD 345 ACTIVE VOLUNTEERS IN FISCAL YEAR 2015. AT MCR, 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, GIFT SHOP, VOLUNTEER PATIENT LIAISONS, BABY KNITTERS, VOLUNTEENS, AND PET THERAPY TO NAME JUST A FEW OF THE MANY PROGRAMS, EVERY VOLUNTEER CONTRIBUTES TO THE SUCCESS OF THE UNIVERSITY OF COLORADO HEALTH NORTHERN REGION TO ENHANCE THE COMFORT AND CARE OF THE PATIENTS AND THEIR FAMILIES. FORM 990, PART VI, SECTION A, LINE 6 POUDRE VALLEY HEALTH CARE, INC & REGIONAL WEST HEALTH SERVICES, BOTH 501(C)(3) ORGANIZATIONS, ARE THE SOLE MEMBERS OF MEDICAL CENTER OF THE ROCKIES. FORM 990, PART VI, SECTION A, LINE 7A POUDRE VALLEY HEALTH CARE, INC & REGIONAL WEST HEALTH SERVICES, THE SOLE MEMBERS OF MEDICAL CENTER OF THE ROCKIES, APPOINT ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B A UNANIMOUS VOTE OF THE MEMBERS IS REQUIRED FOR AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS, ACTION REGARDING DISSOLUTION, MERGER OR CONSOLIDATION, ACTION REGARDING SALE, LEASE, MORTGAGE OR TRANSFER OF SUBSTANTIALLY ALL ASSETS, OR ADMITTING A NEW MEMBER OR TRANSFER OF A MEMBER INTEREST. FORM 990, PART VI, SECTION B, LINE 11 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 ADVICES 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: DISTRIBUTION TO RWMC -5,882,100. DISTRIBUTION TO PVHC -43,135,400. POUDRE VALLEY HEALTHCARE INC 2315 E HARMONY RD 200 FORT COLLINS CO 80528 841262971 TERTIARY CARE CO 501(C)(3) LINE 3 N/A 0 POUDRE VALLEY HEALTH SYSTEM FOUNDATION 2315 E HARMONY RD 200 FORT COLLINS CO 80528 741894581 FUNDRAISING CO 501(C)(3) LINE 7 N/A 0 INNOVATION ENTERPRISES 2315 E HARMONY RD 200 FORT COLLINS CO 80528 202036774 IT CONSULTING CO N/A C 0 0 1 1 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1