2015-01-13T15:58:27-06:00 2014-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2013-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3032895147 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 DAVID MADSEN CHIEF FINANCIAL OFFICER 3032895147 2014-12-19 1 V E SHOUP CPA P00220967 3034668822 2013 2016-03-07 17:11:31Z JOHN SANTISTEVAN 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 59429622 0 X WWW.SALUDCLINIC.ORG X 1971 CO COMMUNITY HEALTH SERVICES 10 10 631 15 0 0 17538488 25979325 29668758 33404082 24764 28359 15806 17856 47247816 59429622 0 0 0 0 32070465 33517041 0 0 40499 14108936 19905843 46179401 53422884 1068415 6006738 62290900 68800850 19816564 20095652 42474336 48705198 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. ESTIMATE OVER 290,000 VISITS ANNUALLY. 0 0 45185057 33404082 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. 45185057 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 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 0 0 0 0 0 1 28 0 1 631 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 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 CAROLINE SWIETER CHAIRMAN 1.00 X X 0 0 0 JESUS TIJERINA TREASURER 1.00 X X 0 0 0 CONSUELO CHAVEZ DIRECTOR 1.00 X 0 0 0 MANUEL GALLEGOS DIRECTOR 1.00 X 0 0 0 LINDA HUGHES DIRECTOR 1.00 X 0 0 0 COLLEEN LAEGER VICE CHAIRMAN 1.00 X X 0 0 0 RICHARD OLMEDO SECRETARY 1.00 X X 0 0 0 MICHAEL MARTINEZ DIRECTOR 1.00 X 0 0 0 VICTORIA MEDINA DIRECTOR 1.00 X 0 0 0 JODI TRAYLER DIRECTOR 1.00 X 0 0 0 JOHN D SANTISTEVAN PRESIDENT/CEO 40.00 X 197302 0 58130 DAVID MADSEN CHIEF FINANCIAL OFFICER 40.00 X 9231 0 2487 VIRGILIO LICONA ASSOCIATE MEDICAL DIRECTOR 40.00 X 190792 0 54535 ELIAS HERNANDEZ PHYSICIAN 40.00 X 192120 0 55088 HANS ELZINGA PHYSICIAN 40.00 X 205943 0 57898 MELANIE METCALF PHYSICIAN 40.00 X 176140 0 50937 MICHAEL ALLEN PHYSICIAN 40.00 X 174663 0 50330 1146191 0 329405 44 0 1 0 UNIVERSITY PHYSICIANS INC PO BOX 460578 GLENDALE CO 80246 CONTRACT DOCTORS 288791 1 23049292 2930033 2930033 25979325 MEDICAID 621400 18393012 18393012 PATIENT PAY 621400 3888113 3888113 PHARMACY REVENUE 621400 3390976 3390976 PRIVATE INSURANCE 621400 1896077 1896077 CHILD HEALTH PROGRAM 621400 1148685 1148685 4687219 4687219 33404082 28359 28359 17856 0 17856 17856 17856 59429622 33404082 0 46215 X 340000 340000 25062915 22229804 2806881 26230 8114126 7275745 830512 7869 267069 15945 251124 538414 440017 98397 283117 180954 102163 419253 172347 246906 518147 181351 336796 1991572 1488052 503520 329280 279888 49392 SUPPLIES, DRUGS, VACCIN 4647591 4362580 278956 6055 CONSULTANTS & CONTRACT 3443540 2968145 475395 IN-KIND DRUGS/VACCINES 2930033 2930033 EQUIPMENT 2013739 707685 1306054 2524088 1952511 571232 345 53422884 45185057 8197328 40499 4496425 3914286 13554683 13871354 1838180 2703471 844376 1082017 30639 33938 62572574 15508002 41398355 47064572 128242 131212 62290900 68800850 4436729 5131808 299835 378844 15080000 14585000 19816564 20095652 X 42474336 48705198 42474336 48705198 62290900 68800850 X 6006738 224124 X X 0 1 X 1 0 X 22702971 22833697 19886375 20470634 25979325 111873002 22702971 22833697 19886375 20470634 25979325 111873002 111873002 156014 63234 63719 40570 46215 369752 112242754 149005864 0.99670 0.99540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4138348 4138348 58434226 15508002 42926224 47064572 X 59653746 224124 224124 59429622 0 59429622 53422884 0 53422884 0 53422884 PART X, LINE 2: 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 FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAP 224,124. X X X 0 0 0 0 0 0 0 0 0 JOHN D SANTISTEVAN PRESIDENT/CEO 197302 0 0 0 0 0 9865 0 48265 0 255432 0 0 0 VIRGILIO LICONA ASSOCIATE MEDICAL DIRECTOR 190792 0 0 0 0 0 9540 0 44995 0 245327 0 0 0 ELIAS HERNANDEZ PHYSICIAN 192120 0 0 0 0 0 9606 0 45482 0 247208 0 0 0 HANS ELZINGA PHYSICIAN 205943 0 0 0 0 0 10297 0 47601 0 263841 0 0 0 MELANIE METCALF PHYSICIAN 176140 0 0 0 0 0 8807 0 42130 0 227077 0 0 0 MICHAEL ALLEN PHYSICIAN 174663 0 0 0 0 0 8733 0 41597 0 224993 0 0 0 A COLORADO HEALTH FACILITIES AUTHORITY 840752932 2010-12-16 16110000 REFUND BONDS ISSUED 7/28/2005 & 12/4/2008 0 0 0 A 1525000 16110000 16110000 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 1 KEY BANK 5.000000000000 0 0 0 0 0 A 0 SCH K, PART III, LINE 9, PART IV, LINE 7 AND PART V: THE ORGANIZATION EMPLOYS BOND COUNCIL THAT ADVISES THEM CONCERNING THEIR BOND COMPLIANCE. IN ADDITION, THE ORGANIZATION PRIOR TO THE FIING OF THIS RETURN HAS COMPLETED AND ADOPTED IN-HOUSE BOND COMPLIANCE POLICIES AND PROCEDURES THAT WILL ENSURE THAT THEIR TAX-EXEMPT BONDS REMAIN IN COMPLIANCE AND WILL ENABLE THE ORGANIZATION TO CHECK YES TO THE QUESTIONS IN PART III, LINE 9, PART IV, LINE 7 AND PART V IN SUBSEQUENT YEARS. DURING THIS PROCESS, THE ORGANIZATION HAS NOT IDENTIFIED ANY BOND COMPLIANCE ISSUES TO DATE THAT WILL NEED TO BE ADDRESSED. X 4 2930033 FAIR MARKET VALUE 0 0 0 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTORS IS LISTED. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY SALUD'S CERTIFIED PUBLIC ACCOUNTING FIRM AND REVIEWED BY SALUD'S DIRECTOR OF ACCOUNTING AND FINANCE. THE FORM 990 IS THEN REVIEWED BY THE CHIEF EXECUTIVE OFFICER OF SALUD AND THEN PRESENTED TO THE BOARD OF DIRECTORS AT THEIR MONTHLY BOARD MEETING FOR REVIEW PRIOR TO FILING. 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, THE COMPLIANCE PROGRAM IS PRESENTED BY THE CHIEF EXECUTIVE OFFICER OF SALUD AT THEIR QUARTERLY STAFF MEETINGS TO ALL EMPLOYEES. 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. 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 IX, LINE 24E REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 1,109,866. MANAGEMENT AND GENERAL EXPENSES 156,612. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,266,478. COMMUNICATION SERVICES: PROGRAM SERVICE EXPENSES 547,152. MANAGEMENT AND GENERAL EXPENSES 136,611. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 683,763. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 113,578. MANAGEMENT AND GENERAL EXPENSES 155,748. FUNDRAISING EXPENSES 345. TOTAL EXPENSES 269,671. STAFF RECRUITMENT: PROGRAM SERVICE EXPENSES 95,589. MANAGEMENT AND GENERAL EXPENSES 39,665. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 135,254. POSTAGE: PROGRAM SERVICE EXPENSES 39,539. MANAGEMENT AND GENERAL EXPENSES 30,267. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 69,806. PRINTING: PROGRAM SERVICE EXPENSES 34,565. MANAGEMENT AND GENERAL EXPENSES 12,900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,465. BOARD COSTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 33,919. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,919. EQUIPMENT AND STORAGE RENTAL: PROGRAM SERVICE EXPENSES 12,222. MANAGEMENT AND GENERAL EXPENSES 5,510. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,732. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP 224,124. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE'S OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.