2012-11-01T16:13:11-05:00 2011-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2011-01-01 742358522 NCMC INC NCMC 9703506052 1801 16TH STREET GREELEY CO 80631 ROBERT E MURPHY 9703506052 2012-11-01 1 LISA CHAFFEE CPA P00193453 7012398500 2012-11-01 2011 2016-02-24 21:20:13Z KEN SCHULTZ 1801 16TH STREET GREELEY CO 80631 148164179 0 X N/A X 1984 CO LEASING OF HOSPITAL FACILITIES TO ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE IRS CODE FOR THE PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY. 10 10 0 11 0 0 326900 602257 33884660 32193801 14944522 8991371 -50426 297216 49105656 42084645 3650000 3944150 0 0 724050 1459420 0 0 0 30375381 30983915 34749431 36387485 14356225 5697160 427798444 412072198 202837065 203362140 224961379 208710058 TO PROVIDE QUALITY HEALTHCARE AT A REASONABLE COST TO THE NCMC SERVICE COMMUNITY. 0 0 34725526 3944150 32193801 NCMC, INC OWNS A HOSPITAL BUILDING WHICH IT LEASES TO BANNER HEALTH SYSTEM (AN ARIZONA 501(C)(3) ORGANIZATION), WHO OPERATES THE HOSPITAL IN A CHARITABLE FASHION. NCMC, INC IS RESPONSIBLE FOR MAINTAINING THE PROPERTY AND EQUIPMENT FOR ITS USE BY BANNER HEALTH (NORTH COLORADO MEDICAL CENTER) TO PROVIDE ACUTE MEDICAL SERVICES. 34725526 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 18 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X KEN SCHULTZ 9703506052 1801 16TH STREET GREELEY CO 80631 X AL DOMINGUEZ SECRETARY JAN-MARCH 1.00 X X 0 0 0 KEN SCHULTZ PRESIDENT CHAIR JAN- 40.00 X X 0 0 0 ROBERT NOFFSINGER 1.00 X X 0 0 0 ROBERT E MURPHY 1.00 X X 0 0 0 BRANDON HOUTCHENS 1.00 X X 0 0 0 RICHERT QUINN MD 1.00 X 0 0 0 LINDA WINTER 1.00 X 0 0 0 KAY KOSMICKI 1.00 X 0 0 0 JEFFREY CARLSON 1.00 X 0 0 0 VICKI WILSON PHD RN 1.00 X 0 0 0 MICHAEL J GEILE 1.00 X 0 0 0 WILLIAM HUGHES JAN-MARCH 25.00 X 0 0 0 0 0 0 0 0 0 0 UBS FINANCIAL SERVICES INC 1901 56TH AVE SUITE 300 GREELEY CO 80634 INVESTMENT MANAGEMENT FEES 1074641 AT MOUNTAIN STATES 797 VENTURA STREET AURORA CO 80011 GENERAL CONTRACTORS 325318 COLORADO FINANCIAL MANAGEMENT INC 2725 ROCKY MOUNTAIN AVE STE 320 LOVELAND CO 80538 INVESTMENT MANAGEMENT FEES 190370 WELLS FARGO ADVISORS 1073 N LINCOLN AVE LOVELAND CO 80537 INVESTMENT MANAGEMENT FEES 145900 NORTHSTAR MANAGEMENT GROUP INC 2129 RESERVOIR ROAD GREELEY CO 80631 CONSULTING 140000 5 602257 602257 HOSPITAL FACILITY RENT 532000 32193801 32193801 32193801 8277343 8277343 508266 211050 297216 297216 297216 106514403 68109 105868484 0 645919 68109 714028 714028 42084645 32193801 0 9288587 3944150 3944150 1459420 1459420 176015 11015 165000 9514 9514 39500 39500 1430732 1430732 59902 50398 9504 22510 14801 7709 387786 387786 1999 1999 11141 11141 7182374 7182374 20163259 20163259 BOND FEES 1276508 1276508 222675 222675 36387485 34725526 1661959 0 6894781 3754142 82134 114982 27625 27625 400610533 225132441 178111848 175478092 236966973 227323053 211988 201438 5503095 5172866 427798444 412072198 12023510 13720151 182927112 177097520 7886443 12544469 202837065 203362140 X 224961379 208710058 224961379 208710058 427798444 412072198 X 5697160 -21948481 X 0 1 1 X 0 X X X 0 0 0 NCMC BOARD OF TRUSTEES 846000813 6 1 1 1 32689077 1 32689077 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7557342 7557342 18651492 232540408 111560400 139631500 138782591 113572041 25210550 3078700 3078700 175478092 INTEREST RATE SWAP 12544469 12544469 42084645 36387485 5697160 -15279275 -6669206 -21948481 -16251321 18330377 -15279275 -8644042 -23923317 42253694 -169049 -169049 42084645 34581698 194213 194213 34387485 2000000 2000000 36387485 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: NCMC IS A COLORADO NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 509(A)(3) OF THE CODE. NCMC IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE CORPORATION MAY BE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. NCMC BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. NCMC WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 8 - OTHER ADJUSTMENTS: REDUCTION IN FAIR VALUE OF INTEREST RATE SWAPS -4,658,026. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -1,986,016. K-1 INTEREST INCOME -164. ADJ FOR ORGANIZATIONAL GRANT RECORDED IN EXPENSE BUT VOIDED AFTER YEAR END -25,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -6,669,206. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHARITY CARE GRANT TO BANNER HEALTH SYSTEM -2,000,000. DECREASE IN FAIR VALUE OF INTEREST RATE SWAP -4,658,026. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -1,986,016. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUES -169,213. K-1 TAX INCOME - POWERSHARES DB AGRICULTURE FUND 164. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUES 169,213. ADJ. FOR ORGANIZATIONAL GRANT RECORDED IN EXPENSE BUT VOIDED AFTER YEAR END 25,000. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE GRANT TO BANNER HEALTH SYSTEM 2,000,000. 1 BANNER HEALTH SYSTEM 1801 16TH STREET GREELEY CO 80631 450233470 501(C)(3) 2000000 CHARITY CARE NCMC FOUNDATION 1802 16TH STREET GREELEY CO 80632 840718355 501(C)(3) 1679150 OPERATIONAL ASSISTANCE AND CONTRIBUTION TO DONOR ADVISED FUND UNIVERSITY OF NORTHERN COLORADO 501 20TH STREET CAMPUS BOX 128 GREELEY CO 80639 846044833 UNIV NORTHERN CO 250000 DONATION TO MONFORT SCHOOL OF BUSINESS UNITED WAY OF WELD COUNTY PO BOX 1944 GREELEY CO 80632 846011918 501(C)(3) 15000 WELD COUNTY PROJECT CONNECT - SPONSORSHIP OF MEDICAL SUPPLIES 4 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THERE IS CURRENTLY NO PROCESS IN PLACE THAT MONITORS THE USE OF GRANT FUNDS BY THE RECIPIENTS. MOST CHARITABLE CONTRIBUTIONS ARE MADE THROUGH NCMC INC'S DONOR ADVISED FUND AT NCMC FOUNDATION WHICH DOES VET RECIPIENTS PRIOR TO MAKING GRANTS, AND ALSO MONITORS THE USE OF PROCEEDS. COLORADO HEALTH FACILITIES AUTHORITY 840752932 196474K25 2003-11-13 98000000 PARTIAL REFUND SERIES 2003,RENOVATE HOSPITAL & PAY 2003B ISSUANCE COSTS. 0 0 0 COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AMY8 2008-10-27 55515000 REFUND SERIES 1993 BONDS, FD IMPROVEMENT TO HOSPITAL FACILITY 0 0 0 COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648ARR8 2009-11-17 44800000 REFUND ALL OUTSTANDING SERIES 2005 BONDS. 0 0 0 3495000 98000000 884500 3759456 76964179 16391865 2006 1 0 1 1 55515000 25000000 30515000 2011 1 0 1 1 44800000 443360 44356640 2009 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 1 FSA CAPITAL MANAGEMENT SERVICES 2.000000000000 1 0 0 0 1 1 CITIBANK NA 21.500000000000 1 1 0 0 0 1 1 1 CITIBANK NA 14.500000000000 1 1 0 0 0 THE AMOUNT REPORTED ON SCHEDULE K, PART II, LINE 11, COLUMN A, B AND C IS THE AMOUNT OF BOND PROCEEDS USED TO REFUND THE PRIOR BONDS ISSUED. WILLIAM HUGHES WILLIAM HUGHES WAS THE BOARD EXECUTIVE FOR NCMC THROUGH MARCH OF 2011 67318 WILLIAM HUGHES PROVIDES CONSULTING SERVICES AS AN INDEPENDENT CONTRACTOR FOR NCMC. FOR 2011 PAYMENTS MADE TO WILLIAM HUGHES CONSULTING ARE AS FOLLOWS: $65,000 FOR SERVICES, AND $2,318 FOR REIMBURSED EXPENSES. 0 KEN SCHULTZ KEN IS NCMC BOARD EXEC STARTING MARCH 2011/33.33% OWNER OF NORTHSTAR MGMT 140000 PAYMENTS MADE TO NORTHSTAR MANAGEMENT GROUP, INC IN 2011 WERE $140,000. 0 FORM 990, PART VI, SECTION A, LINE 3 NORTHSTAR MANAGEMENT GROUP INC. IS THE MANAGEMENT COMPANY. KEN SCHULTZ IS A 33.33% OWNER OF THE MANAGEMENT COMPANY AND SUPERVISES ALL OF THE OPERATIONS OF NCMC, INC. FORM 990, PART VI, SECTION A, LINE 7A THE NCMC BOARD OF TRUSTEES IS ELIGIBLE TO APPOINT 3 OF THE BOARD MEMBERS OF NCMC, INC. NCMC, INC. IS A SUPPORTING ORGANIZATION OF NCMC BOARD OF TRUSTEES. NCMC BOARD OF TRUSTEES IS A GOVERNMENT BODY APPOINTED BY THE COUNTY COMMISSIONERS. WELD COUNTY OWNS THE LAND THAT THE HOSPITAL SITS ON. FORM 990, PART VI, SECTION B, LINE 11 KEN SCHULTZ AND THE FINANCE COMMITTEE WILL REVIEW A COPY OF THE DRAFT FORM 990 AND THEN PRESENT IT TO FULL BOARD FOR APPROVAL PRIOR TO FILING THE FINAL COPY. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS RECEIVES THE CONFLICT OF INTEREST POLICY AT THE ANNUAL MEETING. KEN SCHULTZ RECEIVES THE RESPONSES AND FORWARDS THEM TO THE GENERAL COUNSEL OF THE BOARD. IF THERE ARE ANY ITEMS THAT COME UP FOR DISCUSSION IN WHICH A CONFLICT OF INTEREST IS PRESENT, THE BOARD MEMBER EXCUSES HIM OR HERSELF AND ABSTAINS FROM VOTING. THE BOARD HAS THE OPTION TO ALLOW THE MEMBER TO BE PART OF THE DISCUSSION. FORM 990, PART VI, SECTION C, LINE 19 THE GENERAL PUBLIC IS ALLOWED TO VIEW THE DOCUMENTS BUT NOT ALLOWED TO MAKE COPIES AND TAKE THEM OFF OF THE PREMISES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -15,279,275. REDUCTION IN FAIR VALUE OF INTEREST RATE SWAPS -4,658,026. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -1,986,016. K-1 INTEREST INCOME -164. ADJ FOR ORGANIZATIONAL GRANT RECORDED IN EXPENSE BUT VOIDED AFTER YEAR END -25,000. TOTAL TO FORM 990, PART XI, LINE 5: -21,948,481. SHEEP DRAW FARMS LLC 1801 16TH STREET GREELEY CO 80631 680540676 HOLDS TITLE TO FARM RENT INCOME CO 0 0 NCMC INC SOUTHSIDE INVESTMENTS 1801 16TH STREET GREELEY CO 80631 680611503 OWNS HOUSES ADJACENT TO THE HOSPITAL CO 11200 0 NCMC INC NCMC BOARD OF TRUSTEES 1801 16TH STREET GREELEY CO 80631 846000813 GOVERNMENTAL ACTIVITY - HOSPITAL CO GOVERNMENTAL UNIT 6 WELD COUNTY BOARD OF COUNTY COMMISSIONERS 0 NORMEDCO CARE INC 1801 16TH STREET GREELEY CO 80631 742354112 REAL ESTATE CO 501(C)(3) 9 NCMC INC 1 NMSI DBA NORTHCARE 1801 16TH STREET GREELEY CO 80634 742354291 MEDICAL CLAIMS PROCESSING CO NCMC INC C 21394 1.00000 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 NORMEDCO CARE INC E 175000 LOAN AMOUNT