2012-10-15T15:22:12-05:00 2012-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2011-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3038990004 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 JOHN SANTISTEVAN 3038990004 2012-10-09 1 V E SHOUP CPA P00220967 3034668822 2011 2016-02-24 21:20:13Z STANLEY J BRASHER 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 47369820 0 X WWW.SALUDCLINIC.ORG X 1971 CO COMMUNITY HEALTH SERVICES 10 10 605 8 0 0 19170489 16605899 27650529 30658480 49826 50213 13408 13506 46884252 47328098 0 0 0 0 30626008 30794906 0 0 33887 13118926 13443759 43744934 44238665 3139318 3089433 59823499 62210725 21507011 20804804 38316488 41405921 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 38269762 30708693 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. 38269762 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 0 1 36 0 1 605 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 1.00 X X 0 0 0 JESUS TIJERINA 1.00 X X 0 0 0 CONSUELO CHAVEZ 1.00 X 0 0 0 MANUEL GALLEGOS 1.00 X 0 0 0 LINDA HUGHES 1.00 X 0 0 0 COLLEEN LAEGER 1.00 X X 0 0 0 RICHARD OLMEDO 1.00 X X 0 0 0 MICHAEL MARTINEZ 1.00 X 0 0 0 VICTORIA MEDINA 1.00 X 0 0 0 JODI TRAYLER 1.00 X 0 0 0 STANLEY J BRASHER 40.00 X 206000 0 0 VIRGILIO LICONA 40.00 X 183750 0 0 JACQUES LEBLANC 40.00 X 185000 0 0 ELIAS HERNANDEZ 40.00 X 192000 0 0 HANS ELZINGA 40.00 X 200000 0 0 ALINE C HANSEN-GUZMAN 40.00 X 172000 0 0 1138750 0 0 52 0 1 0 UNIVERSITY PHYSICIANS INC PO BOX 460578 GLENDALE CO 80246 CONTRACT DOCTORS 212793 1 16605899 2351880 16605899 MEDICAID 621400 15707229 15707229 PATIENT PAY 621400 4015153 4015153 CHILD HEALTH PROGRAM 621400 3194421 3194421 PHARMACY REVENUE 621400 2576045 2576045 PRIVATE INSURANCE 621400 2067277 2067277 3098355 3098355 30658480 31135 31135 13506 0 13506 13506 13506 60800 41722 19078 19078 19078 47328098 30708693 0 13506 206000 206000 23589998 21324872 2241816 23310 6998908 6272089 719966 6853 243954 21689 222265 543131 449894 93237 235308 148071 86368 869 331979 146803 185176 514034 112515 401519 1923787 1453526 470261 168455 147420 21035 SUPPLIES 3493350 3393004 98161 2185 CONSULTANTS & CONTRACT 2936398 2638911 297487 REPAIRS & MAINTENANCE 1442882 1301109 141773 EQUIPMENT 598778 132876 465902 1011703 726983 284050 670 44238665 38269762 5935016 33887 2263642 3804902 10853752 12440675 1505612 2310299 945599 927070 0 45000 54134082 11620222 37384635 42513860 6870259 168919 59823499 62210725 5115878 4527301 396133 722503 15995000 15555000 21507011 20804804 X 38316488 41405921 38316488 41405921 59823499 62210725 3089433 0 X X 0 1 1 X 0 X 22651535 22992127 22702971 22833697 19886375 111066705 22651535 22992127 22702971 22833697 19886375 111066705 111066705 410493 175155 156014 63234 63719 868615 111935320 133547240 0.99220 0.98950 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4138348 4138348 43266010 7072183 36193827 331829 273925 57904 6348570 4234576 2113994 49325 39538 9787 42513860 47328098 44238665 3089433 3089433 51602370 4274272 4274272 47328098 0 47328098 48512937 4274272 4274272 44238665 0 44238665 PART XII, LINE 2D - OTHER: IN-KIND CONTRIBUTIONS: 4,274,272 PART XIII, LINE 2D - OTHER: IN-KIND: 4,274,272 X X X 0 0 0 0 0 0 0 0 0 STANLEY J BRASHER 206000 0 0 0 0 0 0 0 0 0 206000 0 0 0 VIRGILIO LICONA 183750 0 0 0 0 0 0 0 0 0 183750 0 0 0 JACQUES LEBLANC 185000 0 0 0 0 0 0 0 0 0 185000 0 0 0 ELIAS HERNANDEZ 192000 0 0 0 0 0 0 0 0 0 192000 0 0 0 HANS ELZINGA 200000 0 0 0 0 0 0 0 0 0 200000 0 0 0 ALINE C HANSEN-GUZMAN 172000 0 0 0 0 0 0 0 0 0 172000 0 0 0 COLORADO HEALTH FACILITIES AUTHORITY 840752932 NC15163C1 2010-12-16 9770000 REFINANCE AND NEW FACILITIES 0 0 0 COLORADO HEALTH FACILITIES AUTHORITY 840752932 NC15163C2 2010-12-16 6340000 REFINANCE AND NEW FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 KEY BANK 5.000000000000 0 0 0 0 0 0 0 1 KEY BANK 5.000000000000 0 0 0 0 0 X 3 2351880 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.