2015-09-30T08:18:09-05:00 2014-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2014-01-01 742358522 NCMC INC NCMC 9708106052 1801 16TH STREET GREELEY CO 80631 ROBERT E MURPHY TREASURER 9703506052 2015-09-21 1 LISA CHAFFEE CPA P00193453 7012398500 2015-09-21 2014 2016-02-25 16:41:14Z KEN SCHULTZ 1801 16TH STREET GREELEY CO 80631 155226116 0 X N/A X 1984 CO LEASING OF HOSPITAL FACILITIES TO ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE IRS CODE FOR THE PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY. 10 10 0 10 39276 38276 567255 627478 32221099 31982287 20030681 23291509 252694 3709376 53071729 59610650 4300000 5140000 0 0 4489141 2446601 0 0 0 35964124 29745212 44753265 37331813 8318464 22278837 515667379 505341409 243613937 225618032 272053442 279723377 TO PROVIDE QUALITY HEALTHCARE AT A REASONABLE COST TO THE NCMC SERVICE COMMUNITY. 0 0 35899519 5140000 31982287 NCMC, INC. LEASES A HOSPITAL BUILDING, EQUIPMENT AND BUSINESS FRANCHISE TO BANNER HEALTH SYSTEM (AN ARIZONA 501(C)(3) ORGANIZATION), WHO OPERATES THE HOSPITAL IN A CHARITABLE FASHION. NCMC, INC IS RESPONSIBLE FOR MAINTAINING THE PROPERTY AND EQUIPMENT FOR ITS USE BY BANNER HEALTH (NORTH COLORADO MEDICAL CENTER) TO PROVIDE ACUTE MEDICAL SERVICES. 35899519 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 18 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 1 1 1 1 0 0 1 1 1 1 0 1 0 0 0 X KEN SCHULTZ 9708106052 1801 16TH STREET GREELEY CO 80631 X AL DOMINGUEZ PRESIDENT & CHAIR 1.00 X X 0 0 0 ROBERT NOFFSINGER VICE CHAIR 1.00 X X 0 0 0 ROBERT E MURPHY TREASURER 1.00 X X 0 0 0 BRANDON HOUTCHENS SECRETARY 1.00 X X 0 0 0 LINDA WINTER DIRECTOR (THRU 1/28/14) 1.00 X 0 0 0 KAY KOSMICKI DIRECTOR 1.00 X 0 0 0 JEFFREY CARLSON DIRECTOR 1.00 X 0 0 0 VICKI WILSON PHD RN DIRECTOR 1.00 X 0 0 0 MICHAEL J GEILE DIRECTOR 1.00 X 0 0 0 DAVE OWEN DIRECTOR (THRU 1/28/14) 1.00 X 0 0 0 TOM GRANT DIRECTOR (BEGINNING 1/28/14) 1.00 X 0 0 0 SUSAN CARTER MD DIRECTOR (BEGINNING 1/28/14) 1.00 X 0 0 0 KEN SCHULTZ BOARD EXECUTIVE 40.00 X 0 0 0 0 0 0 0 0 0 0 HENSEL PHELPS CONSTRUCTION 420 6TH AVE GREELEY CO 80632 CONSTRUCTION CONTRACTOR 10070942 JE DUNN CONSTRUCTION 1001 LOCUST KANSAS CITY MO 64106 CONSTRUCTION CONTRACTOR 5475586 ADOLFSON & PETERSON CONSTRUCTION 797 VENTURA STREET AURORA CO 80011 CONSTRUCTION CONTRACTOR 2012787 STURGEON ELECTRIC CO INC 22389 NETWORK PLACE CHICAGO IL 606731223 CONSTRUCTION CONTRACTOR 965332 LAYTON CONSTRUCTION CO INC 9090 S SANDY PKWY SANDY UT 84070 CONSTRUCTION CONTRACTOR 695126 16 627478 627478 HOSPITAL FACILITY RENT 532000 31862576 31862576 119711 119711 31982287 18497941 18497941 556593 245165 311428 311428 311428 99194848 969021 94601538 768763 4593310 200258 4793568 4793568 ENVIRONMENTAL REMEDIATION BENEFIT 900099 3358672 3358672 INVESTMENT IN BLUETREND ASP FUND 523000 39276 39276 3397948 59610650 31982287 39276 26961609 5140000 5140000 2446601 2446601 186322 186322 25755 25755 40095 40095 1154863 1154863 23268 23268 3039 1048 1991 181747 181747 520 520 554 554 6609661 6609661 21346595 21346595 BOND FEES 84438 84438 SALES AND USE TAX AND O 64123 64123 ALL OTHER EXPENSES 24232 24232 37331813 35899519 1432294 0 20641851 7782807 84089 1097951 451278432 256725468 178978442 194552964 279355422 264306251 25888171 28151608 3670929 3670929 7048475 5778899 515667379 505341409 10279179 4744972 218728577 207387214 14606181 13485846 243613937 225618032 X 272053442 279723377 272053442 279723377 515667379 505341409 X 22278837 -9844256 -4764646 X 0 1 X 1 0 X X 1 NCMC BOARD OF TRUSTEES 846000813 6 1 5140000 53280000 1 5140000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART I, LINE 11G, COLUMN (VI): IN ADDITION TO DIRECT GRANTS PROVIDED, THE ORGANIZATION FUNDED CAPITAL OUTLAYS TOTALING $35,354,000 AND FUNDED NET PRINCIPAL AND INTEREST PAYMENTS OF $17,926,000 ON LONG-TERM DEBT. PART IV, SECTION A, LINE 2: THE ORGANIZATION SUPPORTS THE NCMC BOARD OF TRUSTEES, WHICH IS NOT REQUIRED TO OBTAIN RECOGNITION OF EXEMPT STATUS BECAUSE IT IS CONSIDERED TO BE A GOVERNMENTAL ENTITY. PART IV, SECTION D, LINE 3: THE SUPPORTED ORGANIZATION HAS A SIGNIFICANT VOICE IN THE ORGANIZATION'S INVESTMENT POLICIES AND IN DIRECTING THE USE OF THE ORGANIZATION'S INCOME OR ASSETS. ALL THREE OF THE REPRESENTATIVES APPOINTED BY THE SUPPORTED ORGANIZATION ARE VOTING MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AND PARTICIPATE IN THE DECISION-MAKING PROCESS AT THE HIGHEST LEVEL. IN ADDITION, THE PRESIDENT OF THE SUPPORTED ORGANIZATION SERVES ON THE FINANCE COMMITTEE, WHICH GENERALLY OVERSEES THE OPERATIONS AND FINANCIAL CONDITION OF THE ORGANIZATION, INCLUDING ITS INVESTMENT POLICIES. TWO TRUSTEES OF THE SUPPORTED ORGANIZATION SERVE ON AN INTERNAL COMMITTEE WHICH MONITORS ADHERENCE TO ANY QUALITATIVE CONTRACTUAL REQUIREMENTS. NO NEW DEBT IS INCURRED BY THE ORGANIZATION WITHOUT THE APPROVAL OF THE SUPPORTED ORGANIZATION. LASTLY, THE SUPPORTED ORGANIZATION IS GIVEN A SIGNIFICANT VOICE IN THE CONDUCT OF THE ORGANIZATION'S AFFAIRS BY VIRTUE OF ITS OPERATING SUBLEASE WITH THE ORGANIZATION. PART IV, SECTION E, LINE 2A: THE ORGANIZATION SUPPORTS THE NCMC BOARD OF TRUSTEES THROUGH THE LEASING OF A HOSPITAL BUILDING, EQUIPMENT AND BUSINESS FRANCHISE TO BANNER HEALTH SYSTEM (AN ARIZONA 501(C)(3) ORGANIZATION), WHO OPERATES THE NORTH COLORADO MEDICAL CENTER. UNDER THE TERMS OF THE CONTRACT, BANNER HEALTH SYSTEM PAYS AN ANNUAL USE CHARGE TO THE ORGANIZATION. THESE FUNDS, TOGETHER WITH OTHER CASH RESERVES, ARE USED BY THE ORGANIZATION TO PROVIDE THE NORTH COLORADO MEDICAL CENTER WITH LIQUID WORKING CAPITAL AND FUNDING FOR MAJOR AND ROUTINE CAPITAL EXPENDITURES. THE ORGANIZATION MAY BORROW MONEY TO FUND CAPITAL PROJECTS, WHICH RESULTS IN THE ORGANIZATION SERVICING THE DEBT INCURRED. IN ADDITION, THE ORGANIZATION ALSO PROVIDES GRANTS TO SUPPORT LOCAL HEALTHCARE CHARITIES. PLEASE SEE SCHEDULE A, PART I, LINE 11G FOR THE AMOUNT OF SUPPORT PROVIDED. THESE ACTIVITIES DIRECTLY FURTHER THE EXEMPT PURPOSE OF THE ORGANIZATION, WHICH IS TO PROVIDE QUALITY HEALTHCARE AT A REASONABLE COST TO THE NORTH COLORADO MEDICAL CENTER SERVICE AREA. PART IV, SECTION E, LINE 2B: IF THE ORGANIZATION DID NOT CONDUCT THE ACTIVITIES DESCRIBED IN SECTION E, LINE 2A, THE SUPPORTED ORGANIZATION WOULD HAVE TO DIRECTLY UNDERTAKE THE ACTIVITIES. THE SUPPORTED ORGANIZATION WAS FORMED TO PROVIDE FOR HEALTHCARE NEEDS OF THE REGION, WHICH INCLUDES THE AVAILABILITY OF HOSPITAL FACILITIES. THE SUPPORTED ORGANIZATION IS PROVIDING FOR THE HEALTHCARE NEEDS OF THE REGION THROUGH THE USE OF THE ORGANIZATION AND ITS ACTIVITIES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4185365 4185365 13379305 257586924 138957055 132009174 144187996 111558345 32629651 5861886 26076956 6210068 25728774 194552964 ALTERNATIVE INVESTMENTS 28151608 F 28151608 INTEREST RATE SWAP 9844518 ASSET RETIREMENT OBLIGATIONS 3641328 13485846 X 36665658 -9844256 -9481956 -19326212 55991870 3618780 3618780 59610650 28995723 -3181227 -3181227 32176950 5154863 5154863 37331813 PART X, LINE 2: NCMC, INC. IS A COLORADO NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) OF THE CODE, AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 509(A)(3) OF THE CODE. NCMC, INC. IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE CORPORATION MAY BE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. NORMEDCO CARE, LLC; SOUTHSIDE INVESTMENTS, LLC; AND SHEEP DRAW FARMS, LLC ARE CONSIDERED DISREGARDED ENTITIES AND THEIR INCOME AND EXPENSES ARE REPORTED IN THE TAX RETURN OF THE SOLE MEMBER (NCMC). NCMC BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. NCMC WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. NCMC'S HISTORICAL FEDERAL AND STATE TAX RETURNS ARE SUBJECT TO EXAMINATIONS BY TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHARITY CARE GRANT TO BANNER HEALTH SYSTEM -4,000,000. INCREASE IN FAIR VALUE OF HEDGING INTEREST RATE SWAP -623,197. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 97,369. INVESTMENT MANAGEMENT FEES, INCLUDED IN INCOME FOR FINANCIAL STATEMENTS -1,154,863. NET LOSS ON NON-HEDGING INTEREST RATE SWAPS -3,801,265. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUES -177,445. ENVIRONMENTAL REMEDIATION BENEFIT INCLUDED IN EXPENSE FOR FINANCIALS 3,358,672. BLUETREND ASP K-1 INCOME 437,553. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUES 177,445. ENVIRONMENTAL REMEDIATION BENEFIT INCLUDED IN EXPENSE FOR FINANCIALS -3,358,672. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE GRANT TO BANNER HEALTH SYSTEM 4,000,000. INVESTMENT MANAGEMENT FEES, INCLUDED IN INCOME FOR FINANCIAL STATEMENTS 1,154,863. 1 BANNER HEALTH SYSTEM 1801 16TH STREET GREELEY CO 80631 450233470 501(C)(3) 4000000 CHARITY CARE NCMC FOUNDATION 1801 16TH STREET GREELEY CO 80631 840718355 501(C)(3) 1140000 OPERATIONAL ASSISTANCE AND DONATION 2 0 PART I, LINE 2: THERE IS CURRENTLY NO PROCESS IN PLACE THAT MONITORS THE USE OF GRANT FUNDS BY THE RECIPIENTS. IT IS THE POLICY OF THE BOARD OF DIRECTORS TO DISTRIBUTE GRANTS ONLY TO NOT-FOR-PROFIT ENTITIES. MOST CHARITABLE CONTRIBUTIONS ARE MADE THROUGH NCMC INC'S DONOR ADVISED FUND WHICH IS MAINTAINED BY THE NCMC FOUNDATION. THE NCMC FOUNDATION DOES VET RECIPIENTS PRIOR TO MAKING GRANTS AND ALSO MONITORS THE USE OF PROCEEDS. A COLORADO HEALTH FACILITIES AUTHORITY 840752932 196474K25 2003-11-13 98000000 PARTIAL REFUND SERIES 1993,RENOVATE HOSPITAL & PAY 2003 ISSUANCE COSTS. 0 0 0 B COLORADO HEALTH FACILITIES AUTHORITY 840752932 2012-07-31 60000000 FUND MCP PROJECT AND ROUTINE CAPEX 0 0 0 C COLORADO HEALTH FACILITIES AUTHORITY 840752932 2013-05-15 82000000 REFINANCE 2008 BONDS ISSUED 10/27/08 AND 2009 BONDS ISSUED 11/17/09 0 0 0 A 17220000 98000000 884500 3759456 76964179 16391865 2006 1 0 1 1 B 7630000 60000000 3560432 595000 56439568 0 0 0 0 C 8126530 82000000 618950 81381050 2013 1 0 1 1 A 0 1 0 0 0.00050 0.00000 0.00050 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 1 FSA CAPITAL MANAGEMENT SERVICES 2.000000000000 1 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 1 1 BANCO BILBAO VIZCAYA ARGENTARIA 14.000000000000 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/29/2009 FORM 990, SCHEDULE K, PART II, LINE 11 THE AMOUNT REPORTED ON SCHEDULE K, PART II, LINE 11, COLUMN A AND C IS THE AMOUNT OF BOND PROCEEDS USED TO REFUND THE PRIOR BONDS ISSUED. KEN SCHULTZ KEN IS NCMC INC. BOARD EXECUTIVE AND 33.33% OWNER OF NORTHSTAR MGMT 195754 PAYMENTS MADE TO NORTHSTAR MANAGEMENT GROUP, INC IN 2014 WERE $195,754. 0 FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE WHICH IS ABLE TO EXERCISE AUTHORITY OF THE BOARD WHEN THE BOARD IS NOT IN SESSION EXCEPT AS SUCH AUTHORITY IS LIMITED BY STATUTE OR BY RESOLUTION CREATING OR OTHERWISE CONTROLLING THE EXECUTIVE COMMITTEE. THE MEMBERSHIP OF THE EXECUTIVE COMMITTEE SHALL INCLUDE THE CHAIR AND PRESIDENT OF THE BOARD OF THE CORPORATION, THE CHAIR OF THE FINANCE COMMITTEE, THE CHAIR OF THE EXTERNAL COMMITTEE, THE CHAIR OF THE INTERNAL COMMITTEE AND THE VICE CHAIR OF THE BOARD. THE CHAIR AND PRESIDENT OF THE BOARD OF THE CORPORATION SHALL SERVE AS CHAIR OF THE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL NOT HAVE THE AUTHORITY OF THE BOARD IN REFERENCE TO (I) APPOINTING, REMOVING OR FILLING VACANCIES IN THE MEMBERSHIP OF THE BOARD, BOARD COMMITTEES OR OFFICERS OF THE CORPORATION; (II) AMENDING THE ARTICLES OF INCORPORATION; (III) RESTATING THE ARTICLES OF INCORPORATION; (IV) ADOPTING A PLAN OF MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION; (V) AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION; (VI) AUTHORIZING THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOKING PROCEEDINGS THEREFOR; (VII) ADOPTING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE CORPORATION OR (VIII) AMENDING, ALTERING OR REPEALING ANY RESOLUTION OF THE BOARD WHICH BY ITS TERMS PROVIDES THAT IT SHALL NOT BE AMENDED, ALTERED OR REPEALED BY SUCH COMMITTEE. FORM 990, PART VI, SECTION A, LINE 3 NORTHSTAR MANAGEMENT GROUP INC. IS THE MANAGEMENT COMPANY. KEN SCHULTZ IS A 33.33% OWNER OF THE MANAGEMENT COMPANY AND SUPERVISES ALL OF THE OPERATIONS OF NCMC, INC. PAYMENTS MADE TO NORTHSTAR MANAGEMENT GROUP FOR PROFESSIONAL FEES IN 2014 WERE $190,000 WHICH REPRESENTS THE COMPENSATION PAID TO THE BOARD EXECUTIVE FOR 2014. EXPENSE REIMBURSEMENTS PAID TO THE BOARD EXECUTIVE FOR 2014 TOTALED $5,754. FORM 990, PART VI, SECTION A, LINE 7A THE NCMC BOARD OF TRUSTEES IS ELIGIBLE TO APPOINT 3 OF THE BOARD MEMBERS OF NCMC, INC. NCMC, INC. IS A SUPPORTING ORGANIZATION OF NCMC BOARD OF TRUSTEES. NCMC BOARD OF TRUSTEES IS A GOVERNMENT BODY APPOINTED BY THE COUNTY COMMISSIONERS. WELD COUNTY OWNS THE LAND THAT THE HOSPITAL SITS ON. FORM 990, PART VI, SECTION A, LINE 7B BOND ISSUES MUST BE APPROVED BY COMMISSIONERS AND THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 KEN SCHULTZ AND THE FINANCE COMMITTEE WILL REVIEW A COPY OF THE DRAFT FORM 990 AND THEN PRESENT IT TO FULL BOARD FOR APPROVAL PRIOR TO FILING THE FINAL COPY. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS RECEIVES THE CONFLICT OF INTEREST POLICY AT THE ANNUAL MEETING. KEN SCHULTZ RECEIVES THE RESPONSES AND FORWARDS THEM TO THE GENERAL COUNSEL OF THE BOARD. IF THERE ARE ANY ITEMS THAT COME UP FOR DISCUSSION IN WHICH A CONFLICT OF INTEREST IS PRESENT, THE BOARD MEMBER EXCUSES HIM OR HERSELF AND ABSTAINS FROM VOTING. THE BOARD HAS THE OPTION TO ALLOW THE MEMBER TO BE PART OF THE DISCUSSION. FORM 990, PART VI, SECTION C, LINE 19 THE GENERAL PUBLIC IS ALLOWED TO VIEW THE DOCUMENTS BUT NOT ALLOWED TO MAKE COPIES AND TAKE THEM OFF OF THE PREMISES. FORM 990, PART XI, LINE 9: REDUCTION IN FAIR VALUE OF HEDGING INTEREST RATE SWAPS -623,197. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 97,369. NET LOSS ON NON-HEDGING INTEREST RATE SWAPS -3,801,265. BLUETREND ASP K-1 INCOME -437,553. SHEEP DRAW FARMS LLC 1801 16TH STREET GREELEY CO 80631 680540676 HOLDS TITLE TO FARM RENT INCOME CO 8000 5786414 NCMC INC SOUTHSIDE INVESTMENTS 1801 16TH STREET GREELEY CO 80631 680611503 OWNS HOUSES ADJACENT TO THE HOSPITAL CO 108653 1014162 NCMC INC NORMEDCO CARE LLC 1801 16TH STREET GREELEY CO 80631 742354112 OWNS FACILITY LEASED TO A FEDERALLY QUALIFIED HEALTH CENTER FOR $1 PER YEAR CO 1 2696273 NCMC INC NCMC BOARD OF TRUSTEES 1801 16TH STREET GREELEY CO 80631 846000813 GOVERNMENTAL ACTIVITY - HOSPITAL CO GOVERNMENTAL UNIT 6 WELD COUNTY BOARD OF COUNTY COMMISSIONERS 0 NCMCBH GREELEY I LLC 1801 16TH STREET GREELEY CO 80631 900824175 LAND INVESTMENT CO NCMC INC RELATED 2274756 0 0 0.50000 NCMCBH GREELEY II LLC 1801 16TH STREET GREELEY CO 80631 900824173 LAND INVESTMENT CO NCMC INC RELATED 1199921 0 0 0.50000 NMSI DBA NORTHCARE 1801 16TH STREET GREELEY CO 80634 742354291 MEDICAL CLAIMS PROCESSING CO NCMC INC C 13930 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0