EXEC VP FINANCE/INFO TECH

2013-09-10T09:15:58-05:00 2013-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2012-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3038990004 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 JOHN SANTISTEVAN EXEC VP FINANCE/INFO TECH 3038990004 2013-09-05 1 V E SHOUP CPA P00220967 3034668822 2012 2016-02-24 21:20:13Z STANLEY J BRASHER 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 47261788 0 X WWW.SALUDCLINIC.ORG X 1971 CO COMMUNITY HEALTH SERVICES 10 10 621 5 0 0 16605899 17538488 30658480 29668758 50213 24764 13506 15806 47328098 47247816 0 0 0 0 30794906 32070465 0 0 41243 13443759 14108936 44238665 46179401 3089433 1068415 62210725 62290900 20804804 19816564 41405921 42474336 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 39847060 29693522 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. 39847060 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 32 0 1 621 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 1 0 CO X JOHN SANTISTEVAN 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 STANLEY J BRASHER PRESIDENT/CEO 40.00 X 206440 0 0 JOHN D SANTISTEVAN EXEC VICE PRESIDENT/CFO 40.00 X 137407 0 0 VIRGILIO LICONA ASSOCIATE MEDICAL DIRECTOR 40.00 X 201359 0 0 LAYNE BRACY PHYSICIAN 40.00 X 167120 0 0 ELIAS HERNANDEZ PHYSICIAN 40.00 X 190351 0 0 HANS ELZINGA PHYSICIAN 40.00 X 202889 0 0 PRADEEP DHAR PHYSICIAN 40.00 X 164470 0 0 1270036 0 0 46 0 1 0 UNIVERSITY PHYSICIANS INC PO BOX 460578 GLENDALE CO 80246 CONTRACT DOCTORS 269917 1 17538488 1847910 17538488 MEDICAID 621400 15934224 15934224 PATIENT PAY 621400 4011956 4011956 PHARMACY REVENUE 621400 2684350 2684350 PRIVATE INSURANCE 621400 1665178 1665178 CHILD HEALTH PROGRAM 621400 1153402 1153402 4219648 4219648 29668758 38736 38736 15806 0 15806 15806 15806 13972 -13972 -13972 -13972 47247816 29693522 0 15806 343847 343847 23510076 21038860 2446074 25142 8216542 7449770 758475 8297 292354 17667 274687 477042 387901 89141 255934 178229 77496 209 435219 161665 272857 697 314089 108892 205197 1978010 1496778 481232 294354 257560 36794 SUPPLIES 3526666 3481177 39491 5998 CONSULTANTS & CONTRACT 3205777 2804394 401383 REPAIRS & MAINTENANCE 1281208 1179034 102174 TELEPHONE 666469 541814 124655 1381814 743319 637595 900 46179401 39847060 6291098 41243 3804902 4496425 12440675 13554683 2310299 1838180 927070 844376 45000 30639 54921815 13523460 42513860 41398355 168919 128242 62210725 62290900 4527301 4436729 722503 299835 15555000 15080000 20804804 19816564 X 41405921 42474336 41405921 42474336 62210725 62290900 1068415 0 X X 0 1 X 1 0 X 22992127 22702971 22833697 19886375 20470634 108885804 22992127 22702971 22833697 19886375 20470634 108885804 108885804 175155 156014 63234 63719 40570 498692 109384496 140296381 0.99540 0.99220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4138348 4138348 43676035 8360765 35315270 331829 280970 50859 6726278 4840293 1885985 49325 41432 7893 41398355 50869961 3622145 3622145 47247816 0 47247816 49801546 3622145 3622145 46179401 0 46179401 PART XI, LINE 2D - OTHER ADJUSTMENTS: IN-KIND CONTRIBUTIONS PART XII, LINE 2D - OTHER ADJUSTMENTS: IN-KIND PART XII, LINE 2D - OTHER: IN-KIND CONTRIBUTIONS: 3,622,145 PART XIII, LINE 2D - OTHER: IN-KIND: 3,622,145 X X X 0 0 0 0 0 0 0 0 0 STANLEY J BRASHER PRESIDENT/CEO 206440 0 0 0 0 0 0 0 0 0 206440 0 0 0 VIRGILIO LICONA ASSOCIATE MEDICAL DIRECTOR 201359 0 0 0 0 0 0 0 0 0 201359 0 0 0 LAYNE BRACY PHYSICIAN 167120 0 0 0 0 0 0 0 0 0 167120 0 0 0 ELIAS HERNANDEZ PHYSICIAN 190351 0 0 0 0 0 0 0 0 0 190351 0 0 0 HANS ELZINGA PHYSICIAN 202889 0 0 0 0 0 0 0 0 0 202889 0 0 0 PRADEEP DHAR PHYSICIAN 164470 0 0 0 0 0 0 0 0 0 164470 0 0 0 A COLORADO HEALTH FACILITIES AUTHORITY 840752932 NC15163C1 2010-12-16 9770000 REFINANCE AND NEW FACILITIES 0 0 0 B COLORADO HEALTH FACILITIES AUTHORITY 840752932 NC15163C2 2010-12-16 6340000 REFINANCE AND NEW FACILITIES 0 0 0 A 0 0 0 0 B 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 1 KEY BANK 5.000000000000 0 0 0 0 0 B 0 0 0 0 0 1 KEY BANK 5.000000000000 0 0 0 0 0 X 3 1847910 FAIR MARKET VALUE 0 0 0 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. 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. FORM 990, PART VI, SECTION B, LINE 15 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 BOARD OF DIRECTORS FOR REVIEW DURING THEIR ANNUAL EVALUATION. 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 THAT THE PUBLIC MAY REQUEST COPIES OF SALUD'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.