2012-10-15T13:16:15-05:00 2011-12-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2011-01-01 840446259 VALLEY VIEW HOSPITAL ASSOCIATION VALL 9709456535 PO BOX 1970 GLENWOOD SPRINGS CO 816021970 LARRY DUPPER 9709456535 2012-09-27 1 CHRISTOPHER E RIVARD P00022321 5092487750 2011 2016-02-24 21:20:13Z GARY BREWER 1906 BLAKE AVE GLENWOOD SPRINGS CO 81601 235521229 0 X WWW.VVH.ORG X 1950 CO VALLEY VIEW HOSPITAL IS AN ACUTE CARE HOSPITAL OWNED BY VALLEY VIEW HOSPITAL ASSOCIATION, INC., A NOT-FOR-PROFIT CORPORATION. THE HOSPITAL PRIMARILY EARNS REVENUE BY PROVIDING INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN GLENWOOD SPRINGS, COLORADO. 9 6 979 265 7036 5710 449992 366859 143335563 158794946 2724091 3080931 294577 -260123 146804223 161982613 10000 7500 0 0 64498510 68251188 65000 12500 12500 62888639 60649429 127462149 128920617 19342074 33061996 277019713 314465137 138735275 141424307 138284438 173040830 X TO BE THE LEADER FOR EXCELLENCE IN PERSONALIZED CARE AND HEALING. 0 0 25100786 44970594 OPERATING ROOM - TOTAL SURGICAL VISITS OF 3,518.VALLEY VIEW HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, AGE, CREED, SEX, NATIONAL ORIGIN, OR HANDICAP. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF VALLEY VIEW HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND, FURTHER, THAT OUR MISSION IS TO PROVIDE ACUTE HEALTHCARE SERVICES TO OUR COMMUNITY. THEREFORE IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. 14114285 25287167 PHARMACY - TOTAL PATIENT DAYS OF 10,760VALLEY VIEW HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, AGE, CREED, SEX, NATIONAL ORIGIN, OR HANDICAP. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF VALLEY VIEW HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND, FURTHER, THAT OUR MISSION IS TO PROVIDE ACUTE HEALTHCARE SERVICES TO OUR COMMUNITY. THEREFORE IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. 10343251 19305456 LAB - TOTAL PATIENT DAYS OF 10,760VALLEY VIEW HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, AGE, CREED, SEX, NATIONAL ORIGIN, OR HANDICAP. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF VALLEY VIEW HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND, FURTHER, THAT OUR MISSION IS TO PROVIDE ACUTE HEALTHCARE SERVICES TO OUR COMMUNITY. THEREFORE IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. 48621506 7500 67723720 THE HOSPITAL ALSO OPERATES AN EMERGENCY ROOM, ACUTE CARE, FAMILY BIRTH PLACE, RADIOLOGY, CARDIOLOGY, CRITICAL CARE, AND OTHER PROGRAM SERVICES. 48621506 7500 67723720 98179828 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 85 0 1 979 1 1 1 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CO X THE ORGANIZATION 9709456535 PO BOX 1970 GLENWOOD SPRINGS CO 816021970 MIKE FATTOR 1.00 X X 0 0 0 JEFF CARLSON 1.00 X X 0 0 0 PAUL SALMEN MD 1.00 X 0 0 0 MATT GOODSTEIN MD 1.00 X 0 0 0 MARIANNE VIRGILI 1.00 X 0 0 0 LOUIS MEYER 1.00 X X 0 0 0 ROBERT DERKASH MD 1.00 X 0 0 0 STEVE VANDERHOOF 1.00 X X 0 0 0 LYNN KLEAGER 1.00 X 0 0 0 GARY BREWER 40.00 X 988042 0 23187 LARRY DUPPER 40.00 X 417613 0 23187 DEB WIEPKING 40.00 X 319550 0 22925 FRANK LAWS MD 40.00 X 812443 0 23187 DAVID MILLER MD 40.00 X 983510 0 23187 BRIAN MURPHY MD 40.00 X 474191 0 23187 JEFFREY FEGAN MD 40.00 X 469339 0 23187 JAMIE LOWE MD 40.00 X 486271 0 23187 4950959 0 185234 80 0 1 0 HFR DESIGN INC PO BOX 1974 BRENTWOOD TN 370241974 ARCHITECTURAL SERVICES 1343239 MORRISON MGMT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 FOOD MGMT SERVICES 436817 A-1 COLLECTION AGENCY PO BOX 1929 GRAND JUNCTION CO 81502 COLLECTION SERVICES 391233 ROARING FORK ANESTHESIA PO BOX 1150 GLENWOOD SPRINGS CO 81602 ANESTHESIA SERVICES 374506 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 PATHOLOGICAL SERVICES 372652 28 366859 366859 PATIENT SERVICES REVEN 621400 157075455 157075455 CATERING/CAFETERIA 722320 947580 947580 MEDICAL/PHARMACY/MISCE 561499 273897 273897 HEALTHCARE MANAGEMENT 561499 196228 189192 7036 CHILD CARE 624410 179016 179016 122770 22290 100480 158794946 2929274 2929274 1282271 1542394 -260123 -260123 -260123 71945035 202844 71794251 201971 150784 873 151657 151657 161982613 157286937 7036 4321781 7500 7500 1794504 1794504 48346338 38555888 9790450 2215919 1762823 453096 12725618 10123570 2602048 3168809 2520872 647937 382711 382711 140825 140825 10300 10300 12500 12500 20229 20229 12076419 5151541 6924878 69176 16333 52843 887418 560850 326568 962403 962403 2597944 2130314 467630 72584 47944 24640 404377 245080 159297 4764125 4764125 9325643 7833540 1492103 1121186 602743 518443 SUPPLIES 13646728 13496124 150604 BAD DEBT EXPENSE 7070401 7070401 MEDICAID PROVIDER FEES 4321299 4321299 MEDICAL SPECIALIST FEES 2770603 2770603 5058 5058 128920617 98179828 30728289 12500 33068600 42151953 14764682 16819670 3055913 2996804 956572 935248 218345455 68709189 119231373 149636266 105942573 101925196 277019713 314465137 18712202 23070877 115720885 113649164 4302188 4704266 138735275 141424307 X 137315209 172327631 969229 713199 138284438 173040830 277019713 314465137 X 33061996 1694396 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10300 10300 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTION OF ANNUAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND COLORADO HEALTH & HOSPITAL ASSOCIATION WERE USED FOR LOBBYING PURPOSES. 5640265 244308 5884573 20322344 109906166 42233781 87994729 40113931 26475408 13638523 42118441 42118441 149636266 BOND ISSUANCE COSTS, NET 1274284 INTEREST RECEIVABLE 679030 INVESTMENT IN EAGLE HEALTH CARE CENTER, INC. 7644844 OTHER SECURITIES 92327038 101925196 ACCRUED COMPENSATION RELATED TAXES 3883815 ESTIMATED MALPRACTICE COSTS 820451 4704266 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL ADOPTED THE INCOME TAX STANDARD RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE INCOME TAX STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2011. 1 1 1 X 0.000000000000 1 X 500.000000000000 1 1 1 0 1 1 6675914 6675914 0.05480 18695770 7895178 10800592 0.08860 3553100 604027 2949073 0.02420 28924784 8499205 20425579 0.16760 554630 209477 345153 0.00280 17250 17250 0.00010 571880 209477 362403 0.00290 29496664 8708682 20787982 0.17050 8477000 1574000 6903000 0.05670 1540000 913000 627000 0.00510 3840 3840 0.00000 40000 40000 0.00030 10060840 2487000 7573840 0.06210 1 2866129 2527926 15561397 20707042 -5145645 X 1 1 1 1 VALLEY VIEW HOSPITAL ASSOCIATION

1906 BLAKE AVE GLENWOOD SPRINGS CO 81601

X X X SOLE COMMUNITY HOSPITAL VALLEY VIEW HOSPITAL ASSOCIATION 1 1 1 1 500.000000000000 1 X X X 1 1 X X X X X X 1 0 1 X 0 0 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 7070401. PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT IS AVAILABLE TO THE PUBLIC UPON REQUEST AND ON THE HOSPITAL'S WEBSITE. PART II: 2. THE HOSPITAL CREATES NEW EMPLOYMENT OPPORTUNITIES IN AREAS WITH HIGH RATES OF JOBLESSNESS3. THE HOSPITAL PROVIDES MENTORING PROGRAMS FOR TROUBLED TEENS IN SURROUNDING COMMUNITIES6. AS A MEMBER OF A LARGER ALLIANCE, THE HOSPITAL PARTICIPATES IN COLLABORATIVE EFFORTS WITH THE COMMUNITY TO ADDRESS HEALTH AND SAFETY ISSUES7. THE HOSPITAL SENT MEDICAL SUPPLIES TO THIRD WORLD COUNTRIES TO SAFEGUARD OR IMPROVE PUBLIC HEALTH AND ACCESS TO HEALTH CARE SERVICES PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FORDOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINSTTHE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS INCREASED FROM 78 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2010, TO 83 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011. HOSPITAL'S SELF-PAY WRITEOFFS DECREASED FROM $2,252,572 FOR FISCAL YEAR 2010 TO $1,743,949 FOR FISCAL YEAR 2011. THE HOSPITAL HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING THE FISCAL YEARS 2011 AND 2010.THE HOSPITAL USED A COST TO CHARGES METHODOLOGY IN DERIVING BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITALS CHARITY CARE POLICY. ANALYSES WERE DONE ON RANDOMLY SELECTED ACCOUNTS WRITTEN OFF TO BAD DEBT. IN APPROXIMATELY 88% OF ACCOUNTS TESTED, PATIENTS WOULD HAVE QUALIFIED FOR CHARITY CARE BUT REFUSED TO PROVIDE INFORMATION AND DOCUMENTATION FOR CHARITY ASSESSMENT, THEREFORE WERE INCLUDED IN BAD DEBT. PART III, LINE 8: VALLEY VIEW HOSPITAL IS THE HOSPITAL OF CHOICE FOR THE ELDERLY POPULATION BECAUSE MEDICAL STAFF IN THE SURROUNDING AREA RESISTS TAKING CARE OF THIS POPULATION.THE HOSPITAL USED A COST TO CHARGES METHODOLOGY IN DERIVING MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE HOSPITAL PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS MEETING CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. VALLEY VIEW HOSPITAL ASSOCIATION PART V, SECTION B, LINE 19D: THE HOSPITAL USES FPG TO DETERMINE THE AMOUNT OF DISCOUNT UP TO 95% TO BE DEDUCTED FROM GROSS CHARGES. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH SURVEYS TAKEN BY COMMUNITY HEALTH DEPARTMENTS AND INPUT FROM COMMUNITY FOCUS GROUPS. PART VI, LINE 3: THE HOSPITAL EMPLOYS CONSULTING GROUPS ON A FULL-TIME BASIS TO ASSIST PATIENTS IN COMPLETING FORMS THAT DETERMINE THEIR ELIGIBILITY FOR ATTAINING FINANCIAL ASSISTANCE. PART VI, LINE 4: THE HOSPITAL SERVES A RESORT COMMUNITY WITH GEOGRAPHIC CHALLENGES MAKING TRAVEL DIFFICULT AT TIMES, IN ADDITION TO BEING CHALLENGED BY THE NUMEROUS VISITORS THAT COME TO THE VALLEY. 1 SCHOLARSHIPS 2 7500 APPLICANTS APPLYING FOR THE NURSING STUDENT FINANCIAL ASSISTANCE PROGRAM MUST BE ENROLLED AS A FULL-TIME STUDENT IN AN ACCREDITED NURSING PROGRAM AND HAVE A CUMULATIVE GRADE POINT AVERAGE OF AT LEAST 2.5. AWARDS WERE DISBURSED IN TWO EQUAL INSTALLMENTS, AT THE BEGINNING OF EACH SEMESTER, CONTINGENT UPON PROOF OF A CUMULATIVE GRADE POINT AVERAGE OF AT LEAST 2.5. EACH STUDENT RECEIVING FINANCIAL ASSISTANCE WILL PRACTICE NURSING AT VVH FOR ONE YEAR, FOR EACH YEAR OF FINANCIAL ASSISTANCE. X 0 1 X X X X 0 1 0 0 0 0 0 0 0 GARY BREWER 566691 0 421351 0 0 0 20501 0 2686 0 1011229 0 0 0 LARRY DUPPER 296080 0 121533 0 0 0 20501 0 2686 0 440800 0 0 0 DEB WIEPKING 319550 0 0 0 0 0 20501 0 2424 0 342475 0 0 0 FRANK LAWS MD 745611 0 66832 0 0 0 20501 0 2686 0 835630 0 0 0 DAVID MILLER MD 883510 0 100000 0 0 0 20501 0 2686 0 1006697 0 0 0 BRIAN MURPHY MD 347656 0 126535 0 0 0 20501 0 2686 0 497378 0 0 0 JEFFREY FEGAN MD 346304 0 123035 0 0 0 20501 0 2686 0 492526 0 0 0 JAMIE LOWE MD 359736 0 126535 0 0 0 20501 0 2686 0 509458 0 0 0 PART I, LINE 1A CHRISTMAS GIFTS GIVEN TO UPPER MANAGEMENT INCLUDING LARRY DUPPER AND DEB WIEPKING. PART I, LINE 1B THE CEO DETERMINED CHRISTMAS GIFTS OF $250 WOULD BE GIVEN TO EACH PERSON OF UPPER MANAGEMENT. GARFIELD COUNTY COLORADO 840594277 36565PAB1 2003-05-01 44764767 SEE SCHEDULE O 0 0 0 COLORADO HEALTH FACILITIES AUTHORITY 840752932 1964742X7 2006-05-01 30359232 SEE SCHEDULE O 0 0 0 COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AFQ3 2007-10-18 44445997 SEE SCHEDULE O 0 0 0 COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AHR9 2008-05-06 50516309 SEE SCHEDULE O 0 0 0 45869480 3347258 17265000 1284705 23972517 2007 0 0 1 1 30056630 2562219 332724 27161687 2008 0 0 1 1 47988053 4423753 563072 43001229 2012 0 0 1 1 50662927 5118506 45000000 544422 2008 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 MATT GOODSTEIN MD TRUSTEE 63668 RENT PAID TO VVH FOR OFFICE SPACE 0 PAUL SALMEN MD TRUSTEE 23775 SERVICES RENDERED TO VVH AS DIRECTOR OF YRC 0 PAUL SALMEN MD TRUSTEE 261247 PHYSICIAN FEES PAID BY VVH TO GMA 0 PAUL SALMEN MD TRUSTEE 558471 NET RENT RECEIVED BY VVH FROM GMA FOR OFFICE SPACE 0 ROBERT DERKASH MD TRUSTEE 165958 RENT RECEIVED BY VVH FROM ORTHOPAEDIC ASSOCIATES OF ASPEN AND GLENWOOD FOR OFFICE SPACE. 0 PAUL SALMEN MD TRUSTEE 7500 PAYMENTS RECEIVED FROM GMA FOR USAGE OF RADIOLOGY FACILITIES. 0 FORM 990, PART VI, SECTION A, LINE 2 STEVE VANDERHOOF, VP OF US BANK, PROVIDES BANKING SERVICES PAUL SALMEN, M.D., A PARTNER OF GLENWOOD MEDICAL ASSOCIATES (GMA) AND A FAMILY PRACTICE PHYSICIAN, PROVIDES MEDICAL SERVICES TO PATIENTS AT GMA AND IS THE DIRECTOR OF VVH YOUTH RECOVERY CENTER MATT GOODSTEIN, M.D., ONTOLARYNGOLOGIST, PROVIDES MEDICAL SERVICES MARIANNE VIRGILI, PRESIDENT-CEO GLENWOOD SPRINGS CHAMBER RESORT ASSOCIATION, PROVIDES CHAMBER MEMBERSHIP, GOODS AND SERVICES ROBERT DERKASH, M.D., ORTHOPAEDIC SURGEON AND PARTNER OF ORTHOPAEDIC ASSOCIATES OF ASPEN AND GLENWOOD, PROVIDES MEDICAL SERVICES JEFF CARLSON IS THE OWNER OF A LOCAL CAR DEALERSHIP MIKE FATTOR, PRESIDENT OF WESTERN PETROLEUM, SELLS PETROLEUM BASED PRODUCTS LYNN KLEAGER, CPA, ABV, CFF, AND PRINCIPAL AT DALBY, WENDLAND & CO., P.C., PROVIDES ACCOUNTING, AUDIT, TAX AND BUSINESS SERVICES FORM 990, PART VI, SECTION A, LINE 6 THERE ARE TWO CLASSES OF MEMBERS, CHARTER OR LIFE MEMBERS AND ANNUAL MEMBERS. THOSE PERSONS OR ENTITIES WHO ARE CHARTER OR LIFE MEMBERS AS OF 7/31/95, WILL CONTINUE TO BE LIFE MEMBERS. PERSONS WHO BECOME MEMBERS OF THE ASSOCIATION AFTER 7/31/95, SHALL PAY AN ANNUAL MEMBERSHIP FEE OF $25. EACH MEMBER IN GOOD STANDING SHALL HAVE ONE VOTE IN THE BUSINESS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF THE CORPORATION IN GOOD STANDING SHALL BE QUALIFIED TO VOTE ON ELECTION OF BOARD MEMBERS AND THE DISPOSITION OF ASSETS AND TO HOLD ANY OFFICE IN THE CORPORATION TO WHICH HE MAY BE ELECTED OR APPOINTED. MEMBERS OF THE CORPORATION SHALL BE ELECTED TO THE BOARD OF TRUSTEES OF THE CORPORATION AS APPROPRIATE AT EACH ANNUAL MEETING OF THE CORPORATION. THE BOARD OF TRUSTEES SHALL CONSIST OF NINE ELECTED MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE ADMINISTRATIVE POWERS OF THE VALLEY VIEW HOSPITAL ASSOCIATION SHALL BE VESTED IN THE BOARD OF TRUSTEES, WHO SHALL HAVE CHARGE OF THE MANAGEMENT AFFAIRS, FUNDS AND PROPERTY OF THE HOSPITAL, AND WHO SHALL HAVE THE AUTHORITY TO PERFORM ALL ACTS AND FUNCTIONS NOT INCONSISTENT WITH THE BYLAWS OR WITH ANY ACTION TAKEN BY MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 INFORMATION FOR SCHEDULES COMPILED BY THE ASSISTANT CONTROLLER AND CONTROLLER, SUBMITTED TO INDEPENDENT AUDITORS TO ASSEMBLE INTO FORM 990 AND 990T, AND REVIEWED BY THE CFO AND BOD BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE OF INTEREST STATEMENT, DISCLOSING ANY INTERESTS WHICH MAY GIVE RISE TO A CONFLICT OF INTEREST OR THE APPEARANCE OF A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: INCLUDED BUT NOT LIMITED TO COMPARABILITY DATA FROM 2010/2011 WATSON WYATT DATA SERVICES "SURVEY REPORT ON HOSPITAL AND HEALTHCARE MANAGEMENT COMPENSATION", 2011 EXECUTIVE COMPENSATION SURVEY FOR COLORADO SMALL AND RURAL HOSPITALS INCLUDING CRITICAL ACCESS HOSPITALS DATA, AND IS REVIEWED AND APPROVED BY THE BODS. FORM 990, PART VI, SECTION B, LINE 15B: INCLUDED BUT NOT LIMITED TO COMPARABILITY DATA FROM 2010/2011 WATSON WYATT DATA SERVICES "SURVEY REPORT ON HOSPITAL AND HEALTHCARE MANAGEMENT COMPENSATION", 2010/2011 COLORADO HOSPITAL ASSOCIATION SURVEY, 2010/2011 MOUNTAIN STATES EMPLOYER'S COUNCIL SURVEY, AND IS REVIEWED AND APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 VALLEY VIEW'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,175,335. PRIOR PERIOD ADJUSTMENTS: -314,205. INCOME FROM COLORADO HOSPITAL ASSOCIATION TRUST -166,734. TOTAL TO FORM 990, PART XI, LINE 5: 1,694,396. FORM 990, PART XII, LINE 2C: NO CHANGE FROM THE PRIOR YEAR. SCHEDULE K, PART I, BOND ISSUES: A) ISSUER NAME: GARFIELD COUNTY, COLORADO (C)CUSIP #: 36565P AB 1 36565P AC 9 36565P AD 7 36565P AE 5 36565P AF 2 36565P AG 0 36565P AH 8 36565P AJ 4 36565P AK 1 36565P AL 9 36565P AM 7 36565P AN 5 36565P AP 0 36565P AQ 8 36565P AR 6 (F)DESCRIPTION OF PURPOSE: HOSPITAL REVENUE BONDS, SERIES 2003 OBLIGATION TO REFUND SERIES 1999 BONDS AND REIMBURSE THE HOSPITAL FOR CERTAIN CAPITAL EXPENDITURES AND IMPROVEMENT PROJECTS. SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY (C) CUSIP #: 196474 2X7 196474 2Y5 196474 2Z2 196474 3A6 196474 3B4 196474 3C2 196474 3D0 196474 3E8 196474 3F5 196474 2V1 (F)DESCRIPTION OF PURPOSE: HOSPITAL REVENUE BONDS, SERIES 2006 OBLIGATION TO REIMBURSE THE HOSPITAL FOR CERTAIN CAPITAL EXPENDITURES AND IMPROVEMENT PROJECTS. SCHEDULE K, PART I, BOND ISSUES: (A)ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY (C) CUSIP #: 19648AFQ3 19648AFR1 19648AFS9 (F) DESCRIPTION OF PURPOSE: HOSPITAL REVENUE BONDS, SERIES 2007 OBLIGATION TO REIMBURSE THE HOSPITAL FOR CERTAIN CAPITAL EXPENDITURES AND IMPROVEMENT PROJECTS. SCHEDULE K, PART I, BOND ISSUES: (A)ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY (C)CUSIP #: 19648AHR9 19648AHS7 (F) DESCRIPTION OF PURPOSE: HOSPITAL REVENUE BONDS, SERIES 2008 OBLIGATION TO REFUND SERIES 2003B AND SERIES 2006B BONDS.