2015-05-15T14:45:24-05:00 2014-06-30 461497033 EKS&H LLLP 7979 E TUFTS AVENUE SUITE 400 DENVER CO 802372521 990 2013-07-01 460796114 UCH-MHS UCH- 7208488778 1400 E BOULDER STREET COLORADO SPRINGS CO 80909 DAN RIEBER CFO 7208488778 2015-05-15 1 CRAIG R CHOUN P00173718 3037409400 2013 2016-02-25 16:41:14Z X MEMORIAL HOSPITAL GEORGE HAYES 1400 E BOULDER STREET COLORADO SPRINGS CO 80909 597633573 0 X WWW.MEMORIALHEALTHSYSTEM.COM X 2012 CO WE IMPROVE LIVES. 10 10 4416 674 312120 -13450 794285 861642 480612968 595414863 1442029 -1881358 120302 182078 482969584 594577225 3390780 6740904 0 0 180593788 242638971 0 0 0 300167266 354102407 484151834 603482282 -1182250 -8905057 491120595 475332247 492302845 485324333 -1182250 -9992086 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 528124132 6740904 595596941 MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE TO COLORADO SPRINGS, COLORADO AND THE SURROUNDING COMMUNITIES. DURING FISCAL YEAR 2014, MEMORIAL HOSPITAL PROVIDED 19,261 ADMISSIONS, 6,353 INPATIENT SURGERIES, 14,067 OUTPATIENT SURGERIES, 134,193 EMERGENCY DEPARTMENT VISITS, AND 399,992 OUTPATIENT VISITS. MEMORIAL'S PATIENTS, REGARDLESS OF CIRCUMSTANCE, HAVE ALWAYS COME FIRST. THIS IS ONE OF THE ORGANIZATION'S MOST DEEPLY HELD VALUES. AS PART OF UCHEALTH, MEMORIAL REMAINS COMMITTED TO PROVIDING CHARITY CARE TO PERSONS WHO HAVE HEALTH CARE NEEDS AND ARE UNABLE TO PAY. 528124132 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 1 594 0 1 4416 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X LAUREN JERVIK 7193652324 2420 EAST PIKES PEAK AVENUE COLORADO SPRINGS CO 80909 LILY MARKS CHAIR 1.00 X X 0 0 0 ELIZABETH SLIFER BOARD OF DIRECTORS 1.00 X 0 0 0 STEVEN A DAWES BOARD OF DIRECTORS 1.00 X 0 0 0 RICHARD L MONTFORT VICE CHAIR 1.00 X X 0 0 0 JERRY RUTLEDGE BOARD OF DIRECTORS 1.00 X 0 0 0 BRUCE D BENSON BOARD OF DIRECTORS 1.00 X 0 0 0 RICHARD D KRUGMAN MD BOARD OF DIRECTORS 1.00 X 0 0 0 ROBERT C MCINTYRE MD BOARD OF DIRECTORS 1.00 X 0 0 0 DENISE O'LEARY BOARD OF DIRECTORS 1.00 X 0 0 0 RAY BAKER BOARD OF DIRECTORS 1.00 X 0 0 0 MICHAEL SCIALDONE CEO, TERM END 1/14 40.00 X 412832 0 39627 PATRICK FARICY MD CHIEF MEDICAL OFFICER 40.00 X 412995 0 44240 TRACY NARVET CFO, TERM END 1/14 40.00 X 234012 0 33530 MICHELLE SMITH CHIEF CLINICAL OFFICER 40.00 X 292370 0 35886 WILLIAM MOHON COO, TERM END 1/14 40.00 X 35271 0 9478 GEORGE HAYES CEO, TERM BEGIN 1/14 40.00 X 0 0 0 DANIEL RIEBER INTERIM CFO, TERM BEGIN 1/14 40.00 X 0 0 0 COLETTE MARTIN COO, TERM BEGIN 11/13 40.00 X 22096 0 3459 ODA ROOZEBOOM VP QUALITY 40.00 X 230666 0 36926 HELEN MARKLEY PHYSICIAN URGENT CARE 40.00 X 333065 0 41325 CHARLES PECK PSYCHIATRIST 40.00 X 225295 0 31723 IAN TULLBERG PHYSICIAN URGENT CARE 40.00 X 218667 0 29852 SUSAN DERN PHYSICIAN URGENT CARE 40.00 X 215835 0 21410 TIMOTHY COLEMAN PHYSICIAN URGENT CARE 40.00 X 197585 0 34856 2830689 0 362312 92 0 1 0 SODEXHO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 DIETARY/CAFETERIA 5871460 CROTHALL HEALTHCARE 955 CHESTERBROOK BLVD SUITE 300 WAYNE PA 19087 HOUSEKEEPING 5869812 SHIFTWISE 2501 SW 1ST AVE SUITE 200 PORTLAND OR 97201 CONTRACT LABOR 2786939 ANESTHESIA ASSOCIATES OF COLO SPGS PO BOX 973354 DALLAS TX 75397 MEDICAL 2236357 REPUBLIC PARKING SYSTEM 1600 REPUBLIC CTR CHATTANOOGA TN 37450 VALET 1707551 42 581017 280625 861642 NET PATIENT SVC REV 900099 532251185 532251185 PROVIDER FEE INCOME 621400 47032586 47032586 ANCILLARY SERVICES 621400 9126983 9126983 RENTAL INCOME 532000 3155105 3155105 LAB REVENUE 900099 1934150 1622030 312120 1914854 1914854 595414863 765234 765234 5284 226032 33722 2844186 -28438 -2618154 -2646592 -2646592 360518 178440 182078 182078 594577225 595284821 312120 -1881358 X 6740904 6740904 1575796 1575796 192250330 166579936 25670394 15194273 14741481 452792 33618572 32671662 946910 112659 112659 45785 45785 33372 33372 939 939 64780263 52002975 12777288 1621420 88972 1532448 2406738 2050915 355823 2422466 149065 2273401 10507704 7929624 2578080 1231289 1205790 25499 218243 212648 5595 14770885 14770885 28769322 13149851 15619471 2437341 47054 2390287 MEDICAL SUPPLIES 123390457 122892046 498411 BAD DEBT 52300718 52300718 PROVIDER FEE EXPENSE 28795382 28795382 REPAIRS & MAINT 7611958 6877463 734495 12645466 4916761 7728705 603482282 528124132 75358150 0 10547935 21099 2479061 2478871 133419453 90842513 14389563 13204012 7269346 8836103 614902060 304434593 319510929 310467467 1235651 1469562 2268657 48012620 491120595 475332247 74688951 81148227 274414261 265575000 105978654 105978654 37220979 32622452 492302845 485324333 X -1182250 -9992086 -1182250 -9992086 491120595 475332247 -8905057 95221 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 33372 0 0 33372 0 PART II-B, LINE 1: PORTION OF DUES FROM MEMBERSHIP IN CHA AND AHA THAT ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 384118102 145356114 238761988 7939603 4776044 3163559 214759609 153678127 61081482 8084746 624308 7460438 310467467 INTERCOMPANY RECEIVABLE 48012620 48012620 INTERCOMPANY PAYABLES 21102429 OTHER DEFERRED EXPENSES 970134 PAYABLE TO CITY OF CO SPRING 7206900 VEBA TRUST LIABILITY 3342989 32622452 1 1 X 1 X 250.000000000000 1 X 1 0 1 1 859847 859847 0.00160 95504190 72219903 23284287 0.04220 38602640 23989573 14613067 0.02650 134966677 96209476 38757201 0.07030 835356 835356 0.00150 7928880 7928880 0.01440 8764236 8764236 0.01590 143730913 96209476 47521437 0.08620 108372 108372 0.00020 108372 108372 0.00020 1 52300718 121844570 153161699 -31317129 X 1 1 1 BRIARGATE ENDOSCOPY GI SERVICES 0.40000 0.60000 2 THE ORTHOPAEDIC & SPINE CENTER OF SOUTHERN COLORADO SURGICAL SERVICES 0.11490 0.88510 2 1 MEMORIAL HOSPITAL CENTRAL 1400 E BOULDER STREET COLORADO SPRINGS CO 80909 X X X 2 MEMORIAL HOSPITAL NORTH 4050 BRIARGATE PARKWAY COLORADO SPRINGS CO 80920 X X X MEMORIAL HOSPITAL CENTRAL 1 1 X X X X X X X X X 13 1 1 1 X SEE PART V, SECTION C X X X X 1 0 1 1 250.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 X 1 X X X X X X X 1 X 0 0 MEMORIAL HOSPITAL NORTH 2 1 X X X X X X X X X 13 1 1 1 X SEE PART V, SECTION C X X X X 1 0 1 1 250.000000000000 1 400.000000000000 1 X X X X X X 1 1 X 1 X X X 1 X X X X X X X 1 X 0 0 MEMORIAL HOSPITAL CENTRAL PART V, SECTION B, LINE 3: THE HEALTHY COMMUNITY COLLABORATIVE (HCC) WAS FORMED BY A GROUP OF ROUGHLY 49 COMMUNITY AGENCIES AND OVER 80 MEMBERS BY EL PASO COUNTY DEPARTMENT OF HEALTH & ENVIRONMENT. THE HCC CONSISTS OF REPRESENTATIVES FROM SCHOOLS, HOSPITALS AND HEALTH SYSTEMS (INCLUDING REPRESENTATIVES FROM MEMORIAL HOSPITAL), NON-PROFIT ORGANIZATIONS, CITY AND COUNTY GOVERNMENT AGENCIES, PUBLIC HEALTH, MEDICAL PROVIDERS AND INTERESTED CITIZENS. THROUGHOUT THE HEALTH ASSESSMENT PROCESS, THE HCC ALIGNED ITS WORK WITH COLORADO'S 10 WINNABLE BATTLES (DEVELOPED BY CDPHE) TO PROVIDE A FRAMEWORK FOR SELECTION OF SPECIFIC HEALH INDICATORS AND ASSOCIATED COUNTY-SPECIFIC DATA. COLORADO'S 10 WINNABLE BATTLES ARE PUBLIC HEALTH AND ENVIORNMENTAL PRIORITIES WITH LARGE SCALE IMPACT ON HEALTH AND THE ENVIRONMENT, AND WITH KNOWN, EFFECTIVE STRATEGIES TO ADDRESS THEM. ACKNOWLEDGING THE FINDINGS OF THE HCC, THE ADMINISTRATIVE TEAM CHOSE TO ALSO DIRECT RESOURCES AND IMPLEMENT PLANNING STRATEGIES TO WORK TOWARD IMPROVING HEALTHY EATING AND ACTIVE LIVING FOR RESIDENTS OF EL PASO COUNTY. AN EQUALLY HIGH PRIORITY ISSUE, THE NEED TO INCREASE THE PRIMARY CARE WORKFORCE IN EL PASO COUNTY WAS IDENTIFIED BY THE MEMORIAL HOSPITAL ADMINISTRATIVE TEAM.THE LIST OF COMMUNITY AGENCIES THAT PARTICIPATED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AS FOLLOWS:ACADEMY SCHOOL DISTRICT 20ALLIANCE FOR DRUG ENDANGERED CHILDRENAMERICAN CANCER SOCIETYAMERICAN MEDICAL RESPONSEASPEN POINTECARE AND SHARE FOOD BANK FOR SOUTHERN COLORADOCEDAR SPRINGS BEHAVIORAL HEALTHCENTRO DE LA FAMILIACITY OF COLORADO SPRINGSCITY OF COLORADO SPRINGS PARKS, RECREATION & CULTURAL SERVICESCITY OF FOUNTAINCITY OF MANITOU SPRINGSCOLORADO BUSINESS GROUP ON HEALTHCOLORADO SPRINGS CHAMBER OF COMMERCECOLORADO SPRINGS FIRE DEPARTMENTCOLORADO SPRINGS HEALTH PARTNERSCOLORADO SPRINGS REGIONAL BUSINESS ALLIANCECOLORADO SPRINGS SCHOOL DISTRICT 11COMMUNITY HEALTH PARTNERSHIPCOMMUNITY PARTNERSHIP FOR CHILD DEVELOPMENTEL PASO COUNTYEL PASO COUNTY COMMUNITY SERVICESEL PASO COUNTY MEDICAL SOCIETYEL PASO COUNTY PUBLIC HEALTHFORT CARSON WELLNESS SERVICESFOUNTAIN VALLEY COMMUNITY ACTIVITY AND NUTRITIONGOLDEN LOTUS FOUNDATIONHARRISON SCHOOL DISTRICT 2HEARTSMARTKIDSHUNGER FREE COLORADOKAISER PERMANENTEKING SOOPERS/CITY MARKETLATINO AMERICAN HEALTH NETWORKLIVEWELL COLORADO SPRINGSMANITOU SPRINGS SCHOOL DISTRICT 14MEDICALVOYCEMEMORIAL HEALTH SYSTEMNAACPOPEN BIBLE MEDICAL CLINICOWN YOUR OWN HEALTHPARTNERS FOR HEALTHY CHOICESPEAK VISTA COMMUNITY HEALTH CENTERSPENROSE-ST. FRANCIS HEALTH SERVICESPFIZER, INC.PHIL LONG DEALERSHIPSPIKES PEAK AREA COUNCIL OF GOVERNMENTSPIKES PEAK REGION HEALTHIER SCHOOLSROCKY MOUNTAIN HEALTH CARE SERVICESST. FRANCIS MISSION OUTREACHSET FAMILY MEDICAL CLINICSUICIDE PREVENTION PARTNERSHIPTELLER COUNTY PUBLIC HEALTHTRAILS AND OPEN SPACE COALITIONUCCS BETH-EL COLLEGE OF NURSING AND HEALTH SCIENCESURBAN PEAKUS FOODSWELLCENTERSYMCA OF THE PIKES PEAK REGION MEMORIAL HOSPITAL CENTRAL PART V, SECTION B, LINE 4: MEMORIAL HOSPITAL NORTHPART V, SECTION B, LINE 5A: HTTPS://WWW.UCHEALTH.ORG/PAGES/ABOUT-UCHEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX MEMORIAL HOSPITAL NORTH PART V, SECTION B, LINE 4: MEMORIAL HOSPITAL CENTRALPART V, SECTION B, LINE 5A: HTTPS://WWW.UCHEALTH.ORG/PAGES/ABOUT-UCHEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX 10 PRINTERS PARK MEDICAL PLAZA 175 S UNION BLVD COLORADO SPRINGS CO 80910 LAB, RADIOLOGY, REHABILITATION MEMORIAL MEDICAL BUILDING 525 N FOOTE AVE COLORADO SPRINGS CO 80909 ONCOLOGY CIRCLE SQUARE URGENT CARE 2767 JANITELL RD COLORADO SPRINGS CO 80906 URGENT CARE BRIARGATE MEDICAL CAMPUS 8890 N UNION BLVD COLORADO SPRINGS CO 80920 LAB, RADIOLOGY, URGENT CARE MEDICAL OFFICE BLDG ONE 4110 BRIARGATE PARKWAY COLORADO SPRINGS CO 80920 SLEEP STUDIES OP REHAB - POWERS BLVD 2999 NEW CENTER POINT COLORADO SPRINGS CO 80922 REHABILITATION OP REHAB - ROCKRIMMON 415 ROCKRIMMON BLVD COLORADO SPRINGS CO 80919 REHABILITATION WESTSIDE SERVICES 1902 W COLORADO AVE COLORADO SPRINGS CO 80904 REHABILITATION OP REHAB - STAR RANCH 3663 STAR RANCH ROAD COLORADO SPRINGS CO 80906 REHABILITATION DUBLIN RADIOLOGY 2685 DUBLIN BLVD COLORADO SPRINGS CO 80918 RADIOLOGY PART I, LN 7 COL (F) TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = $52,300,718 PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF ALLOWANCES FOR DOUBTFUL ACCOUNTS, CONTRACTUAL ADJUSTMENTS, AND MEDICALLY INDIGENT ALLOWANCES.PART III, LINE 8: THE MEDICARE SHORTFALL IS NOT CONSIDERED COMMUNITY BENEFIT BUT IT DOES INCREASE THE ACCESS TO HEALTH CARE WITHIN THE COMMUNITY. THE COST TO CHARGE RATIO IS PREPARED IN ACCORDANCE WITH THE RULES REQUIRED FOR THE MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS MAY APPLY OR REQUEST FOR FINANCIAL ASSISTANCE OR CHARITY CARE VIA PATIENT FINANCIAL SERVICES REPRESENTATIVES. PART 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 VI, LINE 2: MEMORIAL HOSPITAL RECEIVES INPUT VIA THE HOSPITAL BOARD MEMBERS AND VARIOUS COMMUNITY GROUPS THAT IT MEETS WITH ON A REGULAR BASIS WHERE COMMUNITY HEALTH NEEDS ARE DISCUSSED. PART VI, LINE 3: INFORMATION IS GIVEN TO PATIENTS UPON ADMISSION FOR CARE AND IS AVAILABLE ON MEMORIAL HOSPITAL'S WEBSITE DESCRIBING THE BILLING PROCESS, INCLUDING BILLING TO GOVERNMENT AND INSURANCE COMPANIES. INFORMATION REGARDING ELIGIBILITY FOR FEDERAL, STATE AND LOCAL INSURANCE AND ASSISTANCE PROGRAMS IS ALSO GIVEN TO PATIENTS AND AVAILABLE ON THE HOSPITAL'S WEBSITE. THE CHARITY POLICY AND FINANCIAL ASSISTANCE POLICY AND PROCESS ARE ALSO GIVEN TO PATIENTS AND AVAILABLE ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: MEMORIAL HOSPITAL AND CHMG SOUTH SERVE SOUTHERN COLORADO AREA. EL PASO COUNTY IS THE PRIMARY DEMOGRAPHIC AREA AND BY POPULATION IS COLORADO'S LARGEST COUNTY WITH OVER 622,000 REPORTED IN THE 2010 CENSUS. 91% OF EL PASO COUNTY RESIDENTS ARE CONSIDERED URBAN WITH 9% POPULATION RURAL. MEMORIAL HOSPITAL ALSO SERVES NEARBY TELLER AND PARK COUNTIES. MEMORIAL HAS THE LARGEST EMERGENCY ROOM IN THE STATE WITH OVER 100,000 VISITS ANNUALLY. DEMOGRAPHICALLY BY AGE, EL PASO COUNTY IS VERY EVENLY DISTRIBUTED WITH SLIGHTLY HIGHER CONCENTRATIONS OF POPULATION IN THE 20-24 AND 25-29 AGE CATEGORIES. COLORADO SPRINGS IS HOME TO FORT CARSON ARMY BASE, PETERSON FIELD AIR FORCE BASE, SCHRIEVER AIR FORCE BASE AND THE AIR FORCE ACADEMY. COLORADO SPRINGS IS ALSO HOME TO UNIVERSITY OF COLORADO COLORADO SPRINGS CAMPUS AND COLORADO COLLEGE. CHILDRENS HOSPITAL OF COLORADO OPERATES THE ONLY LEVEL III NICU IN SOUTHERN COLORADO LOCATED AT MEMORIAL HOSPITAL AND MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A LEVEL II TRAUMA CENTER. PATIENTS ARE SERVED FROM SOUTH WESTERN COLORADO TO SOUTH EASTERN COLORADO INCLUDING WESTERN KANSAS. PART VI, LINE 5: WE HAVE IMPLEMENTED A BROAD VARIETY OF HEALTHCARE PROGRAMS AND SERVICES TO SPECIFICALLY ADDRESS THE NEEDS OF OUR COMMUNITY, PARTICULARLY THOSE WHO ARE VULNERABLE AND HAVE DIFFICULTY IN RECEIVING HEALTH CARE. MEMORIAL PARTICIPATES IN SEVERAL GRANTS TO HELP OFFSET THE COST OF PROVIDING NEEDED SERVICES TO THE COMMUNITY SUCH AS HEALTHY COMMUNITIES, MEDICAL HOME, SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM AND A CAR SEAT SAFETY PROGRAM. PART VI, LINE 6: MEMORIAL HOSPITAL IS PART OF THE UNIVERSITY OF COLORADO HEALTH ORGANIZATION THAT ALSO INCLUDES POUDRE VALLEY HOSPITAL AND MEDICAL CENTER OF THE ROCKIES IN NORTHERN COLORADO AS WELL AS UNIVERSITY OF COLORADO HOSPITAL IN DENVER. THE ORGANIZATION ALSO INCLUDES COLORADO HEALTH MEDICAL GROUP WHICH IS COMPRISED OF A LARGE NUMBER OF PHYSICIANS IN SOUTHERN AND NORTHERN COLORADO. IN SOUTHERN COLORADO, MEMORIAL HOSPITAL AND CHMG SOUTH PROVIDE SERVICES TO RESIDENTS OF SOUTHERN COLORADO COMPREHENSIVE ARRAY OF SERVICES. MEMORIAL AND CHMG ALSO PROVIDE OUTREACH CLINICS FOR SPECIALTY CARE IN MANY LOCATIONS OF SOUTHERN COLORADO FROM THE EASTERN TO WESTERN BORDERS SERVING THE RURAL COMMUNITIES AND IMPROVING ACCESS TO CARE. MEMORIAL HOSPITAL IS ALSO IN PARTNERSHIP WITH CHILDRENS HOSPITAL OF COLORADO WHICH PROVIDES ON SITE CARE FOR ALL PEDIATRIC PATIENTS. PART VI, LINE 7, REPORTS FILED WITH STATES CO 1 UNIVERSITY OF COLORADO MEDICAL SCHOOL 13001 E 17TH PL AURORA CO 80045 846000555 501(C)3 5486181 TO SUPPORT MEDICAL SCHOOL EL PASO COUNTY 2721 E LAS VEGAS ST COLORADO SPRINGS CO 80906 846000764 GOVERNMENT 423649 DETOX CENTER MEMORIAL HOSPITAL FOUNDATION 1511 E BOULDER STREET COLORADO SPRINGS CO 80909 841576338 501(C)3 726790 PHILANTHROPIC RESOURCES TO ASSIST MEDICAL HEALTH SYSTEM PEAK VISTA COMMUNITY HEALTH CTRS FOUNDATION 722 S WAHSATCH AVENUE COLORADO SPRINGS CO 80903 203640104 501(C)3 93562 LEASE PAYMENTS 4 0 PART I, LINE 2: FUNDS ARE RECORDED AND ANALYZED MONTHLY. MEMORIAL HEALTH SYSTEM RECONCILES AND RECORDS ALL EXPENSES AS FINANCIAL STATEMENTS ARE PREPARED FOR THE FOUNDATION. 1 X X X X X 1 0 0 0 0 0 0 0 0 MICHAEL SCIALDONE CEO, TERM END 1/14 348480 0 64352 0 0 0 25596 0 14031 0 452459 0 0 0 PATRICK FARICY MD CHIEF MEDICAL OFFICER 375935 0 37060 0 0 0 33182 0 11058 0 457235 0 0 0 TRACY NARVET CFO, TERM END 1/14 202962 0 31050 0 0 0 20910 0 12620 0 267542 0 0 0 MICHELLE SMITH CHIEF CLINICAL OFFICER 265026 0 27344 0 0 0 25769 0 10117 0 328256 0 0 0 ODA ROOZEBOOM VP QUALITY 208786 0 21880 0 0 0 6476 0 30450 0 267592 0 0 0 HELEN MARKLEY PHYSICIAN URGENT CARE 315951 0 17114 0 0 0 7650 0 33675 0 374390 0 0 0 CHARLES PECK PSYCHIATRIST 223233 0 2062 0 0 0 6816 0 24907 0 257018 0 0 0 IAN TULLBERG PHYSICIAN URGENT CARE 207248 0 11419 0 0 0 3570 0 26282 0 248519 0 0 0 SUSAN DERN PHYSICIAN URGENT CARE 199617 0 16218 0 0 0 0 0 21410 0 237245 0 0 0 TIMOTHY COLEMAN PHYSICIAN URGENT CARE 191573 0 6012 0 0 0 5789 0 29067 0 232441 0 0 0 PART I, LINE 4A WILLIAM MOHON RECEIVED A SEVERENCE PAYMENT OF $293,136. A UNIV OF CO HOSPITAL AUTH SERIES 2012A 841179794 914183AT5 2012-10-01 272090000 FUND ACQUISITION COST OF MEMORIAL HOSPITAL 0 0 0 A 272090000 3154664 268935336 2012 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER, WHICH IS THE UNIVERSITY OF COLORADO HOSPITAL AUTHORITY. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE AUTHORITY TO APPOINT INDIVIDUALS TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER MUST APPROVE ANY AMENDMENTS OR MODIFICATIONS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION OR BY-LAWS. 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 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 MEMERS, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM PRESIDENT AND CEO DETERMINES THE SALARY OF THE ENTITY CEOS COMPENSATION ANNUALLY. THIS DETERMINATION IS ACCOMPLISHED THROUGH THE USE OF THE HAYGROUP. THESE SERVICES ANNUALLY COLLECT LIKE DATA ON LIKE JOBS FROM LIKE ORGANIZATIONS. THE DATA IS SUBMITTED TO THE CHIEF HUMAN RESOURCES OFFICER WHO ADVICES THE SYSTEM PRESIDENT AND CEO ON COMPENSATION DECISIONS FOR SENIOR EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC 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 IX, LINE 11G TRANSCRIPTION: PROGRAM SERVICE EXPENSES 791,926. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 791,926. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES -723. MANAGEMENT AND GENERAL EXPENSES 31,908. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,185. CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 23,550,054. MANAGEMENT AND GENERAL EXPENSES 11,674,036. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,224,090. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 16,786,493. MANAGEMENT AND GENERAL EXPENSES 162,186. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,948,679. CONTRACT LABOR SERVICES: PROGRAM SERVICE EXPENSES 5,126,150. MANAGEMENT AND GENERAL EXPENSES 909,158. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,035,308. COURIER SERVICES: PROGRAM SERVICE EXPENSES 620,247. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 620,247. LAB SERVICES: PROGRAM SERVICE EXPENSES 5,128,828. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,128,828. UNIVERSITY OF COLORADO HOSPITAL AUTHORITY 12401 E 17TH AVE MAIL STOP F417 AURORA CO 80045 841179794 HEALTHCARE CO 501(C)(3) LINE 3 YES 0 UNIVERSITY OF COLORADO HOSPITAL FOUNDATION PO BOX 6510 MAIL STOP F485 AURORA CO 80045 208575263 FUNDRAISING CO 501(C)(3) LINE 11A, I N/A 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0