2011-10-04T15:52:42-04:00 2010-12-31 EHRHARDT KEEFE STEINER & HOTTMAN PC 7979 E TUFTS AVENUE SUITE 400 DENVER CO 802372843 990 2010-01-01 840460697 Longmont United Hospital LONG 3036515023 1950 West Mountain View Avenue Longmont CO 80501 Mitchell C Carson 2011-10-04 true CRAIG R CHOUN 3037409400 2010 2016-03-07 17:11:31Z MITCHELL C CARSON 1950 WEST MOUNTAIN VIEW AVE LONGMONT CO 80501 185998606 false X www.luhcares.org X 1955 CO DEDICATED TO IMPROVING THE HEALTH OF OUR PATIENTS AND COMMUNITIES WE SERVE. 11 8 1429 874 14832 65293 172168 161935960 172488710 2869198 1574134 1288039 2481850 166158490 176716862 0 275172 0 0 77370869 74225146 0 0 0 85401172 95001029 162772041 169501347 3386449 7215515 237517511 235688378 131325739 121853307 106191772 113835071 DEDICATED TO IMPROVING THE HEALTH OF OUR PATIENTS AND COMMUNITIES WE SERVE. false false 151393984 275172 172488710 THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE, AND SKILLED NURSING. FOR A COMPLETE ANNUAL REPORT OF LONGMONT UNITED HOSPITAL SERVICES, MISSION AND COMMUNITY BENEFIT, PLEASE VISIT US AT: HTTP://WWW.LUHCARES.ORG/ABOUT/ANNUALREPORT.ASPX 151393984 true true false true false false false false false true false false false true true false true false false false false false false true false true false true false true true false false false false false false false false false false false false false false true true true true false false true 178 0 true 1429 true true true false false false false true true false false false false X 11 8 false false false false false false false true true false false true true true true true true true true true true X X NEIL BERTRAND 3036515023 1950 WEST MOUNTAIN VIEW AVE LONGMONT CO 80501 MARTIN PLASTER 5.0 X X 0 0 0 CLAIR VOLK 5.0 X X 0 0 0 EDWINA SALAZAR 5.0 X 0 0 0 DAN GUST 5.0 X X 0 0 0 JOHN SHETTER 5.0 X 0 0 0 LEONA STOECKER 5.0 X X 0 0 0 RICHARD LYONS 5.0 X X 0 0 0 MITCHELL C CARSON 40.0 X X 469765 0 112764 E PATRICIA GILL MD 5.0 X 22725 0 0 TOM CHAPMAN 5.0 X 0 0 0 MARK HINMAN MD 5.0 X 18750 0 0 NEIL BERTRAND 40.0 X 287692 0 79203 SHARON ROMINGER 30.0 X 150026 0 18220 CAROL SMITH 40.0 X 203734 0 55688 NANCY DRISCOLL 40.0 X 171390 0 45307 WARREN LAUGHLIN 40.0 X 160741 0 43715 REBECCA HERMAN 40.0 X 166714 0 46164 FABIO PIVETTA 40.0 X 201822 0 17626 MATTHEW BRETT 40.0 X 173464 0 17110 KATHERINE WALKER 40.0 X 150136 0 7496 JOHN PETERSON 40.0 X 147626 0 40805 MAUREEN BEAVIN 40.0 X 139453 0 12268 HOLLY SPITZER 37.7 X 145396 0 7250 DANIEL FRANK 40.0 X 143014 0 32283 JOHN IVES 40.0 X 144333 0 11183 2896781 0 547082 50 false true false Mayo Medical Laboratories PO Box 9146 MINNEAPOLIS MN 554809146 Medical 778333 The Children's Hospital 13123 East 16th Avenue AURORA CO 80045 Medical 699840 Longmont Hospitalist's Group 6895 E Hampden Avenue DENVER CO 80224 Medical 608546 Boulder Valley Thoracic Cardiovas 6800 N 79th Street NIWOT CO 80503 Medical 514776 Rocky Mountain Cancer Centers PO Box 911263 DALLAS TX 753911263 Medical 513337 28 98965 73203 172168 PATIENT SERVICE REVENUE 621990 172488710 172488710 172488710 1464244 1464244 0 0 1585850 1085115 500735 500735 500735 8263511 8153621 109890 109890 109890 24280 98965 43008 -18728 -18728 0 0 CAFETERIA 722210 471952 471952 HEALTH CENTER INTEGRATED THERAPY 621990 356660 356660 VENDOR REBATE 900099 187626 187626 983605 14832 968773 1999843 176716862 172989445 14832 3540417 275172 275172 0 0 0 2620253 1206951 1413302 0 0 0 58578938 52799650 5779288 0 15791 14026 1765 0 8720172 7693335 1026837 0 4289992 3810467 479525 0 0 0 78281 78281 0 113802 113802 0 0 0 0 0 0 0 402726 373707 29019 0 659848 1048 658800 0 661543 334702 326841 0 2265474 1487622 777852 0 0 0 1730966 1730966 0 188848 167739 21109 0 0 0 0 0 5017645 4079588 938057 0 0 0 11814609 10346138 1468471 0 1506346 1506346 0 SUPPLIES 35638007 34901101 736906 0 BAD DEBT 16244594 16244594 0 EQUIPMENT RENTAL & MAINT. 5560152 5104691 455461 0 PHYSICIAN FEES 5875114 5875114 0 PURCHASED SERVICES 5629211 5067234 561977 0 1613863 1611105 2758 0 169501347 151393984 18107363 0 11962530 16031707 16609597 11072834 384666 336340 23363357 22594330 297547 279163 4363954 5982881 5898784 2492425 215905790 104420038 126589536 111485752 41039148 56333455 7008392 9079491 237517511 235688378 20306925 20298091 103386128 93751483 4667686 4611733 2965000 3192000 131325739 121853307 X 103409613 110667952 2782159 3167119 106191772 113835071 237517511 235688378 X 7215515 427784 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 10402 false false false 10402 false false Grants to other organizations for lobbying purposes PART II-B, LINE 1f Portion of dues paid to the American Hospital Association for lobbying expenses: $6,313. Portion of dues paid to the Colorado Hospital Association for lobbying expenses: $4,089. 6091317 6091317 141971062 55748594 86222468 67345737 48671444 18674293 497674 497674 111485752 0 MEDICARE SETTLEMENT 3192000 3192000 176716862 169501347 7215515 64324 372009 436333 7651848 178695353 64324 1914167 1978491 176716862 176716862 171043505 1542158 1542158 169501347 169501347 FIN 48 Footnote Part X, Line 2 The Hospital applies a more-likely-than-not measurement methodology to reflect the financial statement impact of uncertain tax positions taken or expected to be taken in a tax return. After evaluating the tax positions taken, none are considered to be uncertain; therefore, no amounts have been recognized as of December 31, 2010 and 2009. If incurred, interest and penalties associated with tax positions are recorded in the period assessed in supplies and other expenses. No interest or penalties have been assessed as of December 31, 2010 and 2009. Tax years that remain subject to examination include 2007 through the current period for the federal return and 2006 through the current period for the Colorado return. Other Adjustments Part XI, Line 8 United Medical Building Condominium Association change in net assets $8,549 Change in interest in net assets held by Longmont United Hospital Foundation $363,460 Total other adjustments $372,009 Other reconciling items Part XII, Line 2d United Medical Building Condominium Association revenue $422,469 Rental expenses $1,085,115 Fundraising events expenses $43,008 Change in interest in net assets held by Longmont United Hospital Foundation $363,460 Total other reconciling items $1,914,167 Other reconciling items Part XIII, Line 2d United Medical Building Condominium Association expenses $414,035 Rental expenses $1,085,115 Fundraising events expenses $43,008 Total other reconciling items $1,542,158 Dinner dance 91735 81375 10360 16584 3000 11236 Golf tournament 31510 17590 13920 1160 7630 2668 730 0 123245 98965 24280 1160 24214 2668 3000 11966 43008 -18728 true true true X 250. true X true true false true true 13012135 8727588 4284546 0.02800 21375221 15824097 5551124 0.03620 34387356 24551685 9835670 0.06420 421239 421239 0.00270 3872803 3872803 0.02530 5729000 5729000 0.03740 275172 275172 0.00180 10298214 10298214 0.06720 44685570 24551685 20133884 0.13140 27570 27570 0.00020 913 913 2122 2122 13736 13736 0.00010 859 859 45200 45200 0.00030 false 5529000 2000000 45489000 66066000 -20577000 X true true UMB Condo Assoc Maintenance of common areas 0.92000 0.08000 LMC-MOB LLC Construction of office bldg 0.17180 0.82820 LMC Comm LLC Operation of comm equipment 0.50000 0.50000 Tri-town med campus Construction of care clinic 0.50000 0.50000 Twin Peaks med imag Provision of diag. imaging 0.50000 0.50000 1 1 LONGMONT UNITED HOSPITAL

1950 MOUNTAIN VIEW AVE LONGMONT CO 80501

X X X LONGMONT UNITED HOSPITAL 1 true true 250. true 300. true X X X X X X true true X X true X X true X X X X true X true true Part I, Line 7, Column F The bad debt expense per form 990 removed from the denominator = $16,244,594. Part I, Line 7 Charity care at cost is calculated by taking gross charity care charges, offsetting them by revenues received from uncompensated care pools, and then multiplying that result by our facility cost/charge ratio. The unreimbursed cost of Medicaid comes from an internal cost accounting system that addresses all patient segments. Part III, Line 4 Bad Debt Footnote From The Audited Financial Statements: Uncollectible amounts from patients who do not meet the criteria under the Hospital's charity care policy are included as operating expenses in the provision for uncollectible patient accounts. Costing Methodology Used in Determining Part III, Line 2: Bad debt expense at cost is calculated by taking total bad debt expense and multiplying it by the facility cost to charge ratio. That cost to charge ratio is calculated by taking total expenses (less bad debt) and dividing by total gross charges. No bad debt is included in our community benefit numbers. Costing Methodology Used in Determining Part III, Line 3: Hospital collection staff were asked for their opinion of how much bad debt would qualify for charity had the patients completed the eligibility verification process. This is a best estimate - Longmont is not able to formally calculate this amount. Part III, Line 8 Shortfall Reported in Part III, Line 7: Longmont does not include Medicare reimbursement shortfalls as part of community benefit. Costing Methodology Used to Determine Part III, Line 6: Longmont uses a cost accounting system to calculate unreimbursed costs of Medicaid. Part III, Line 9b If a patient is known to qualify for charity care, their patient liability is either written off or written down to the Colorado Indigent Care Program(CICP) copayment schedule amount. This practice applies only to patients that have been verified as eligible for the hospital's charity care. Needs Assessment Part VI, Line 2 Longmont United Hospital assesses healthcare needs of the communities it serves with the following: * Geographic Area Community Benefit is provided to communities in our primary and secondary service areas. These service areas represent roughly a 20-mile radius around the hospital and encompass mountain towns, suburban cities, and rural plains communities. * Frequency of Assessment Longmont United Hospital's mission: Dedicated to improving the health of our patients and communities Longmont serves. This encompasses all aspects of improving community and individual healthcare. It requires the Board of Directors and Leadership to be active in the community to understand and assess the critical needs of the community. Leadership also presents annually to the Board of Directors the organizations supported financially and through involvement of employees. Future support priorities are discussed and determined at that time. Leadership also assesses, as needed, financial support requests by community organizations. Priority criteria for approval are services supporting elderly or low-income families, as well as, education and wellness. * Assessment Updates Assessment updates are performed and presented annually to the Board of Directors for review. * Community Leader Input The Board of Directors includes key community leaders who possess special knowledge of the communities and populations Longmont serves. Hospital Leadership and staff members also serve on several key boards such as Hospice Care, United Way, Chambers of Commerce, Community Food Share, Economic Councils, Salud Family Health Clinic, Special Transit, and the Education Foundation. * Communication of Community Benefit Information on organizations served and financial support is reported in the hospital annual report which is available on-line to the community. Patient Education of Eligibility for Assistance Part VI, Line 3 * Communication of Community Benefit Longmont has full-time financial counselors that are available to provide guidance to any patient. The contact information of such counselors, including phone numbers, is communicated verbally to patients and their families when they access hospital services. The counselors discuss government benefits and resources that might be available with patients who have questions or who have asked for more information, as well as assist with determining patient eligibility of various programs. Longmont is working towards providing written information and brochures in the future. Upon discharge, Longmont personnel provide verbal communication of contact information and phone numbers of financial counselors. Invoices to patients include a phone number if they have questions or would like assistance regarding financial resources. Community Information Part VI, Line 4 The communities that Longmont United Hospital serves are described as follows: * Geographic Area Community Benefit is provided to communities in our primary service areas (PSA) and secondary service areas (SSA). These service areas represent roughly a 20-mile radius around the hospital and encompass mountain towns, suburban cities, and rural plains communities. Longmont United Hospital, a community non-for-profit hospital, is the only hospital in the primary service area. Zipcodes 80501 Longmont PSA 80503 Longmont PSA 80504 Longmont PSA 80513 Berthoud PSA 80530 Frederick PSA 80540 Lyons PSA 80520 Firestone (80504) PSA 80502 Longmont (80501) PSA 80533 Hygiene (80503) PSA 80544 Niwot (80503) PSA 80514 Dacono PSA 80542 Mead PSA 80516 Erie PSA 80534 Johnstown SSA 80026 Lafayette SSA 80651 Platteville SSA 80621 Fort Lupton SSA 80538 Loveland SSA 80301 Boulder SSA 80623 Platteville (80651) SSA 80541 Loveland (80537) SSA 80537 Loveland SSA * Demographic Profile Information City of Longmont/ Boulder County = 2010 US Census Boulder County: http://quickfacts.census.gov/qfd/states/08/08013.html Longmont: http://www.ci.longmont.co.us/planning/census/ Statistics from Boulder Community Foundation: Boulder County Trends Report 2009 * Health Coverage: * Race: 53% of Latinos and 92% Non-Hispanic whites have healthcare coverage in Boulder County. * Age: 24% (25-34), 13% (35-44), 8% ( 45-65) 0.4% (+65) are lacking health coverage. * Medicaid and Medicare account for 13% and 12% of all Colorado health coverage, respectively, but qualifying for these programs is extremely difficult as a non-pregnant or non-disabled adult. 15-20% of adults in Boulder County are uninsured and a disproportionate number of those uninsured are Latino. * 91% of the children in Boulder County have health coverage. 59% of Boulder County children have an identified primary care provider. * Adults: Five chronic diseases - heart disease, diabetes, hypertension, asthma and depression - account for $16.5 billion in health spending in Colorado. * Children: * 20% of Boulder County Children reported food insecurity. * 20% of Boulder County Children ages 1-14 are overweight or obese. * 26% of parents reported behavioral or mental health problems ages 1-14. * 30% high school students were offered illegal drugs on school property * Overall teen fertility rate is low however of those teen mothers, 70% are Latino, and substantially fewer Latina women receive late or no prenatal care. * 500 children were present at formally reported domestic violence incidents in 2007. * St. Vrain Valley School District has a 2.7% drop out rate * Economy * 11% of Boulder County residents live below Federal Poverty Level. 5% of the families in Boulder County live below the Federal Poverty Level. * 18% of the households in Boulder County live on an annual income of less than $25,000. 8% of the family households in Boulder County live on an annual income of less than $25,000. * Health Related Information Five chronic diseases in Colorado are heart disease, diabetes, hypertension, asthma and depression. * 33% of total deaths are caused by cardiovascular disease in Boulder County. * Cancer is responsible for another 22% of deaths in Boulder County. (Boulder Foundation) In Colorado, 17.6% of the adult population (aged 18+ years)-over 658,000 individuals-are current cigarette smokers. Across all states, the prevalence of cigarette smoking among adults ranges from 9.3% to 26.5%. Colorado is ranked 21st among the states. Among youth aged 12-17 years, 10.3% smoke in Colorado. The range across all states is 6.5% to 15.9%. Colorado is ranked 22nd among the states. (Center of Disease Control and Prevention) * Provisions for Uninsured Longmont United Hospital provides a safety net for uninsured persons through the following: * Longmont United Hospital provides more Charity Care than any other hospital in Boulder County. * Subsidizing and supporting the Salud Family Health Centers, a low-income primary healthcare service. * Supporting Women's Health Center who provides quality healthcare and services regardless of a client's insured status, economic circumstances or immigration status. Promotion of Community Health Part VI, Line 5 Longmont United Hospital improves the health of the community through support or partnerships in activities or organizations focused on better health for everyone in the community. Listed below are the key initiatives with explanations in which the hospital is involved. * Health Professionals Education Demands for nurses, physical therapists, imaging technologists, etc. in the Front Range of Colorado continue to be high. Colleges and universities work with the Hospital to facilitate programs to assist individuals in completing the health care certifications. Longmont United Hospital offers one-on-one training that is needed to begin work in the healthcare field. * Senior Health Education and Services Since 1991, Longmont United Hospital has offered a senior wellness program to empower the senior community to assume responsibility for their health and wellness by providing the requisite knowledge, resources and tools to accomplish that goal. At the end of 2010, there were 833 members participating education programs, health clinics and low-cost laboratory services. * Low-Income Primary Health Care Services Primary health care services are offered to improve access and reduce barriers to care including ability to pay, transportation, and language. All services are designed to reduce health disparities and delivered to all community members, without regard to age, sex or disease process. Population served includes all community members with the low-income and the medically underserved population with the migrant and seasonal farm worker population as the priority clientele. Patients are not turned away based on a patient's finances, insurance coverage, or ability to pay. * Lactation Consulting Qualified lactation specialists educate on the benefits of breastfeeding, how the process works, proper positioning, prevention of common difficulties, and managing breastfeeding when working outside the home. Cultures exist in our communities that do not understand these benefits or have to go against practiced beliefs in their community. Studies repeatedly prove the infant will receive health benefits by breastfeeding. * Community Support Services Mobility options are provided to all people, regardless of age, health, disability, income or ethnicity or sexual orientation to enhance their independence and quality of life. In 2010, expanded mobility options were provided. This includes 912,078 trips on the HOP (public transportation), 90,238 trips on access-a-Ride and 127,824 trips on call-n-Ride. One-way demand-response trips increased seven percent to 124,500 with 25% of these trips for medical and therapy purposes. * Promotion of Lifestyle Changes and Prevention Organizations through out Colorado are joining together to promote active living and healthy eating. Their primary focuses are on establishing obesity prevention iniatives, as well as, having healthy foods and physical activity accessible in places where Coloradans live, work, learn and play. Efforts are directed to working strategically with stakeholders to achieve overall healthy living in all Colorado communities. * Community Building Activities Maintain healthy communities through supporting the creation and retention of jobs and industries in surrounding communities. Build a business environment that encourages new industry to these communities. Affiliated Health Care System Part VI, Line 6 Not applicable Other information Longmont United Hospital furthers the purpose of community benefit with the following: * Governing Body The Board of Directors establishes and maintains Longmont United Hospital for the care of all persons suffering from any illness or disability requiring hospital care. All directors are a representative of the Longmont United Hospital service area. The Board is representative of the communities it serves. * Medical Staff Privileges are extended to all qualified physicians in Longmont United Hospital's service areas for all Hospital departments. * Surplus Funds The Board of Directors adheres to investing surplus funds to improve patient care, offer medical education, and support research. * Advocacy, Involvement, Financial Support to the Community Longmont United Hospital: * Provides more Charity Care than any other hospital in Boulder County. * Works with colleges and universities to facilitate programs that assist individuals in completing the healthcare certifications. Longmont United Hospital offers training that is needed to begin work in the healthcare field. Demands for nurses, physical therapists, imaging technologists, etc. in the Front Range of Colorado continue to be high. The Hospital also provides financial support to the Colorado Cancer Research Program and the Justin Parker Neurological Institute. * Offers financials assistance and sliding scale discounts according the Charity Policy. * Partners with organizations focused on human services, patient information sharing, cultural education, environment, health education to improve community health * Provides financial and/or leadership support to hospice care, senior transportation, higher and K-12 education, senior programs, low income health clinics, economic councils, chambers of commerce, and food share programs. * Provides emergency care to all persons regardless of ability to pay * Participates in Medicaid, Medicare, CHAMPUS, Tricare, and the Colorado Indigent Care Program. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CO, true Colorado Cancer Research Program 2253 South Oneida St Third Floor Suite B Denver CO 80224 501(c)(3) 37531 program support Front Range Community College 3645 West 112th Ave Westminster CO 80031 501(c)(3) 37500 program support OUR Center 303 Atwood St Longmont CO 80501 501(c)(3) 6570 program support Salud Family Health Centers 203 South Rollie Ave Fort Lupton CO 80621 501(c)(3) 138355 program support A Woman's Work 2204 18th Ave Longmont CO 80503 501(c)(3) 5399 program support 5 Procedures for monitoring use of grant funds Part I, Line 2 All donations are based on community need. In order to assess the community needs, members of the leadership council have formed long-term professional relationships with the recipient organizations. No donations are made without this long-term relationship being in place. X X X X X X false false false false false false false false false MITCHELL C CARSON 447064 0 0 0 22701 0 0 0 112764 0 582529 0 0 0 NEIL BERTRAND 280667 0 0 0 7025 0 0 0 79203 0 366895 0 0 0 SHARON ROMINGER 149144 0 0 0 882 0 16500 0 1720 0 168246 0 0 0 CAROL SMITH 200386 0 0 0 3348 0 0 0 55688 0 259422 0 0 0 NANCY DRISCOLL 168848 0 0 0 2542 0 0 0 45307 0 216697 0 0 0 WARREN LAUGHLIN 158676 0 0 0 2065 0 0 0 43715 0 204456 0 0 0 REBECCA HERMAN 164614 0 0 0 2100 0 0 0 46164 0 212878 0 0 0 JOHN PETERSON 145593 0 0 0 2033 0 0 0 40805 0 188431 0 0 0 FABIO PIVETTA 200081 0 0 0 1741 0 0 0 17626 0 219448 0 0 0 MATTHEW BRETT 171881 0 0 0 1583 0 0 0 17110 0 190574 0 0 0 MAUREEN BEAVIN 138228 0 0 0 1225 0 0 0 12268 0 151721 0 0 0 HOLLY SPITZER 144250 0 0 0 1146 0 0 0 7250 0 152646 0 0 0 DANIEL FRANK 141697 0 0 0 1317 0 15000 0 17283 0 175297 0 0 0 KATHERINE WALKER 148790 0 0 0 1346 0 0 0 7496 0 157632 0 0 0 JOHN IVES 142986 0 0 0 1347 0 0 0 11183 0 155516 0 0 0 Colorado Health Facilities Authority 840752932 196474M49 2003-12-01 14915000 REFUND SERIES 1993 BONDS false false false Colorado Health Facilities Authority 840752932 000000000 2006-06-12 40000000 HOSPITAL CONSTRUCTION & EQUIPment false false false Colorado Health Facilities Authority 840752932 1964744D9 2006-06-12 48965000 REFUND SERIES 1997 & 2000 BOnds false false false 16132365 1269311 14149510 713544 false true true true 40000000 174400 39825600 2008 false false true true 53470608 3814000 47852141 1804467 false true true true 0.00000 0.00000 0.00000 false false false false false 0.00000 0.00000 0.00000 true 0.00000 0.00000 0.00000 true false false false false false false false false false false false false false false false false false false false false false false false Private Business Use Part III THE 2003 HOSPITAL REVENUE BONDS (REFUNDING THE SERIES 1993 BONDS) AND THE 2006B HOSPITAL REVENUE BONDS (REFUNDING THE SERIES 1997 & 2000 BONDS) QUALIFY FOR THE SPECIAL RULES FOR REFUNDING OF PRE-2003 ISSUES. SUCH REFUNDING BONDS ARE SUBJECT TO THE GENERALLY APPLICABLE REPORTING REQUIREMENTS OF PARTS I, II & IV OF SCH K. HOWEVER, THE ORGANIZATION NEED NOT COMPLETE PART III TO REPORT PRIVATE BUSINESS USE INFORMATION. Review of Form 990 Part VI, Section B, Question 11b THE ORGANIZATION ENGAGES A PAID PREPARER EXPERIENCED IN THE PREPARATION OF FORM 990 TO PREPARE THE FORM. ACCOUNTING DEPARTMENT STAFF AND THE CONTROLLER WORK CLOSELY WITH THE PAID PREPARER IN THE PREPARATION OF THE RETURN AND THE CONTROLLER AND CFO REVIEW THE RETURN AS PREPARED BY THE PREPARER. COPIES OF THE FORM 990 ARE PROVIDED TO THE BOARD. IT IS REVIEWED BY THE AUDIT COMMITTEE, A SUBCOMMITTEE OF THE BOARD OF DIRECTORS BEFORE IT IS FILED. THE ORGANIZATION WILL THEN DISCUSS ANY CHANGES OR ISSUES THAT THE AUDIT COMMITTEE/BOARD MAY HAVE. ONCE QUESTIONS/ISSUES HAVE BEEN ADDRESSED AND THE FORM APPROVED, IT WILL THEN BE FILED. Conflict of Interest Policy Part VI, Section B, Question 12c AN ANNUAL CONFLICT OF INTEREST STATEMENT IS DISTRIBUTED AND SIGNED BY ALL MEMBERS OF EXECUTIVE MANAGEMENT AND DEPARTMENT DIRECTORS, AS WELL AS EVERY MEMBER OF THE BOARD OF DIRECTORS. WHEN A CONFLICT IS IDENTIFIED, THAT PERSON MUST RECUSE THEMSELVES FROM ANY DISCUSSION CONCERNING THE CONFLICTING PERSON OR ORGANIZATION. Process for Determining Compensation Part VI, Section B, Question 15a & 15b IN 2008, INTEGRATED HEALTHCARE STRATEGIES (IHSTRATEGIES), AN INDEPENDENT COMPENSATION CONSULTANT, PERFORMED A THOROUGH COMPENSATION STUDY. IHSTRATEGIES ANALYZED LONGMONT UNITED HOSPITAL'S (LUH) EXECUTIVE CASH COMPENSATION AND BENEFITS PROGRAM TO ASSESS COMPETITIVENESS, COST-EFFECTIVENESS, TAX-EFFECTIVENESS, AND REASONABLENESS. IHSTRATEGIES BASED ITS COMPARISONS ON COMPETITIVE PRACTICES IN LUH'S PEER GROUP, USING THEIR PROPRIETARY DATABASE AND PUBLISHED SURVEYS. IN 2011, LUH IS PLANNING TO ENGAGE IN ANOTHER THOROUGH COMPENSATION STUDY. IN THE INTERMITTENT YEARS, THE CONSULTANT PROVIDES LIMITED RECOMMENDATIONS ON COMPENSATION RANGES THAT LUH FOLLOWS. IHSTRATEGIES: - COLLECTED AND REVIEWED BACKGROUND INFORMATION FROM LUH, INCLUDING ORGANIZATIONAL DEMOGRAPHICS, JOB DESCRIPTIONS, ORGANIZATION CHARTS, AND CURRENT COMPENSATION DATA - CONDUCTED TELEPHONE CALLS WITH LUH'S CEO AND VICE PRESIDENT, HUMAN RESOURCES TO DISCUSS JOB CONTENT AND SCOPE OF RESPONSIBILITY FOR THE POSITIONS INCLUDED IN THIS REVIEW - MATCHED LUH'S EXECUTIVE POSITIONS WITH SIMILAR BENCHMARK JOBS BASED ON JOB CONTENT, SCOPE OF RESPONSIBILITY, AND REPORTING RELATIONSHIPS - COMPARED EXECUTIVE SALARIES AT LUH TO PEER GROUP SALARY LEVELS - COMPARED EXECUTIVE BENEFIT EXPENDITURES AT LUH TO COMPETITIVE INDUSTRY PRACTICES - COMPARED EXECUTIVE TOTAL COMPENSATION (SALARIES PLUS BENEFITS) AT LUH TO PEER GROUP LEVELS - IHSTRATEGIES PRESENTED THIS INFORMATION TO THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IN A WRITTEN REPORT. - THE COMPENSATION COMMITTEE REVIEWED AND DISCUSSED THE FINDINGS OF THE COMPENSATION STUDY AND APPROVED THE EXECUTIVE COMPENSATION OF THE KEY EXECUTIVES. THIS DISCUSSION AND DELIBERATION PROCESS WAS DOCUMENTED IN THE COMMITTEE'S MEETING MINUTES. Documents Available to the Public Part VI, Section C, Question 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Temporarily Restricted Net Assets Part X, Line 28 LONGMONT UNITED HOSPITAL FOUNDATION (THE FOUNDATION) WAS FORMED TO PLAN, ORGANIZE, INSTITUTE, AND ADMINISTER PROJECTS THAT PROVIDE PUBLIC SUPPORT FOR THE HOSPITAL. IN THE ABSENCE OF DONOR RESTRICTIONS, THE FOUNDATION'S BOARD OF DIRECTORS HAS DISCRETIONARY CONTROL OVER THE AMOUNTS TO BE DISTRIBUTED TO THE HOSPITAL, THE TIMING OF SUCH DISTRIBUTIONS, AND THE PURPOSES FOR WHICH SUCH FUNDS ARE TO BE USED. TWO MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS SERVE ON THE 14 MEMBER BOARD OF DIRECTORS OF THE FOUNDATION. UNDER U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE HOSPITAL IS DEEMED TO BE A FINANCIALLY INTERRELATED BENEFICIARY OF THE FOUNDATION. THEREFORE, THE NET ASSETS OF THE FOUNDATION HAVE BEEN SHOWN ON THE HOSPITAL'S CONSOLIDATED BALANCE SHEETS AS TOTAL NET ASSETS HELD BY LONGMONT UNITED HOSPITAL FOUNDATION. THE NET ASSETS OWNED BY THE FOUNDATION ARE REFLECTED IN TEMPORARILY RESTRICTED NET ASSETS. Reconciliation of net assets Part XI, Line 5 Unrealized gain on investments $64,324 Change in interest in net assets held by Longmont United Hospital Foundation $363,460 Total other changes in net assets $427,784 Delegation of Authority Part VI, Section A, Question 1A The Executive Committee shall consist of the Chairperson of the Board, as Chairperson, the Vice-Chairperson, the Treasurer, the Secretary, the Assistant Secretary-Treasurer, and the President and CEO. The Executive Committee shall have the power to transact all regular business and other confidential matters of the Hospital during the interim between the meetings of the Board of Directors, provided that any action taken shall not conflict with policies and expressed wishes of the Board of Directors, that there are at least three (3) affirmative votes to initiate any action, and all matters of major importance should be referred to the Board of Directors. The Executive Committee shall review proposals and advise, as necessary, regarding planning and development of the Hospital physical plant, programs, and services. It shall also be the responsibility of the Executive Committee to nominate candidates for officers and members of the Board when vacancies are to be filled. Such nominations for candidates shall be submitted in writing to the Secretary of the Board at least thirty (30) days prior to the date of the meeting at which candidates shall be elected. Specifically, this Committee shall be responsible for the annual performance evaluation of the President and CEO. This Committee, minus the President and CEO, will also serve as the Executive Compensation Committee. This Committee shall meet at least Quarterly. Board of Directors independence Part VI, Section A, Question 1B Dr. Patricia Gill and Dr. Mark Hinman are compensated for medical services provided to Longmont United Hospital rather than Board membership. 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