2019-02-14T10:38:57-06:00 2018-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2017-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3032895147 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 DAVID MADSEN CHIEF FINANCIAL OFFICER 3032895147 2019-02-13 1 KURT BENNION P01469618 3034668822 2019-02-13 67.137.57.251 2019-02-13 19:57:44 PS P 4FAD916B30D6483E6BED579D7996E7DFFFCB3996 1202DAF1DD9EDF691F49973CC850EA36AE43969D 2017 2019-02-21 02:37:17Z JOHN SANTISTEVAN 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 82199318 0 X WWW.SALUDCLINIC.ORG X 1971 CO COMMUNITY HEALTH SERVICES 10 10 792 13 0 0 17827183 16758173 59744119 64810469 27466 14722 30295 23037 77629063 81606401 0 18147 0 0 47500667 47541300 0 0 45475 27902677 30692561 75403344 78252008 2225719 3354393 68581329 72144156 19649082 19742685 48932247 52401471 SALUD IS A HEALTH CARE DELIVERY SYSTEM DEDICATED TO PROVIDING QUALITY, COMPREHENSIVE PRIMARY HEALTH SERVICES TO MEDICAL AND DENTAL UNDERSERVED POPULATIONS AND THE COMMUNITY WITHIN THE SIX COUNTIES IN NORTH CENTRAL COLORADO. 0 0 66446459 18147 64810469 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. SALUD HAD 320,885VISITS IN THE FISCAL YEAR ENDED 5/31/2018. 66446459 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 33 0 792 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 CO X DAVID MADSEN 3038926401 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 RICHARD OLMEDO CHAIR (THROUGH AUG 2017) 1.00 X X 0 0 0 JESUS TIJERINA VICE CHAIR & CHAIR 1.00 X X 0 0 0 COLLEEN LAEGER TREASURER & VICE CHAIR 1.00 X X 0 0 0 MICHAEL MARTINEZ SECRETARY & TREASURER 1.00 X X 0 0 0 LINDA HUGHES DIRECTOR & SECRETARY 1.00 X X 0 0 0 CONSUELO CHAVEZ DIRECTOR (THROUGH DEC 2017) 1.00 X 0 0 0 JOYLYNN GALLEGOS DIRECTOR 1.00 X 0 0 0 ARACELI NIELSON DIRECTOR 1.00 X 0 0 0 ALDO PARRA DIRECTOR 1.00 X 0 0 0 IGNACIO PURECO DIRECTOR (THROUGH AUG 2017) 1.00 X 0 0 0 CHANTAL ROBAR DIRECTOR 1.00 X 0 0 0 JODI TRAYLER DIRECTOR 1.00 X 0 0 0 VICTORIA VENGLEY DIRECTOR 1.00 X 0 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 40.00 X 263915 0 30426 DAVID MADSEN CFO 40.00 X 126210 0 29779 HANS ELZINGA PHYSICIAN 40.00 X 279380 0 39411 LAYNE BRACY PHYSICIAN 40.00 X 257716 0 33296 ALINE HANSEN-GUZMAN PHYSICIAN 40.00 X 254080 0 38449 DOUGLAS WHITMAN PHYSICIAN 40.00 X 235630 0 32991 JASON HEINE PHYSICIAN 40.00 X 229275 0 32497 1646206 0 236849 83 0 1 0 CORUS GROUP 6430 S FIDDLERS GREEN CIRCLE GREENWOOD VILLAGE CO 80111 I.T. SUPPORT 829181 UNIVERSITY PHYSICIANS INC PO BOX 460578 GLENDALE CO 80246 CONTRACT DOCTORS 496297 TOP NOTCH CLEANING SERVICES 2824 EAGLE CIRCLE ERIE CO 80516 CLEANING SERVICES 430927 ECLINICAL WORKS 7011 KOLL CENTER PARKWAY 230 PLEASANTON CA 94566 E.H.R. SUPPORT 376049 DIVERSIFIED RADIOLOGY 1746 COLE BOULEVARD SUITE 150 LAKEWOOD CO 80401 CONTRACT RADIOLOGISTS 288243 9 16758173 2200959 16758173 PATIENT FEES 621400 54388175 54388175 PHARMACY REVENUE 621400 10501490 10501490 LOSS ON JOINT VENTURES 621400 -79196 -79196 64810469 115558 115558 23037 0 23037 23037 23037 492081 592917 -100836 -100836 -100836 81606401 64810469 0 37759 X 18147 18147 447330 447330 37808338 33146960 4647242 14136 1656757 1456052 197918 2787 4863932 4259128 596650 8154 2764943 2401216 359130 4597 237426 237426 106711 106711 8047402 6343160 1704242 185597 88414 97183 1314353 652511 646386 15456 684691 540881 143810 234854 137554 97300 697639 346496 351143 413145 240658 172487 2928478 2170052 758426 498124 482900 15224 MEDICAL SUPPLIES 11672620 11672620 REPAIRS & MAINTENANCE 1919862 1738007 181855 EQUIPMENT 706022 276498 429524 DUES & SUBSCRIPTIONS 402495 135985 266165 345 643142 339220 303922 78252008 66446459 11760074 45475 4056167 9308391 8783127 8848153 3749304 4217057 1753487 1614955 260329 181071 73476782 26002253 49950294 47474529 28621 500000 68581329 72144156 6295183 7161892 343472 282057 12844878 12246908 165549 51828 19649082 19742685 X 48782247 52401471 150000 0 48932247 52401471 68581329 72144156 X 3354393 114831 X 0 1 X 1 1 1 X 25979325 15886044 16030406 17827183 16758173 92481131 25979325 15886044 16030406 17827183 16758173 92481131 92481131 46215 50411 78333 62364 138595 375918 92857049 258715078 0.99600 0.99710 X 5374963 5374963 67740153 26002253 41737900 361666 361666 47474529 ACCRUED BOND DERIVATIVE 51828 51828 X 81817124 285112 264831 549943 81267181 339220 339220 81606401 78197900 285112 285112 77912788 339220 339220 78252008 PART X, LINE 2: THE CORPORATION HAS PREVIOUSLY RECEIVED NOTICE OF EXEMPTION OF INCOME TAX FROM THE INTERNAL REVENUE SERVICE UNDER SECTION 501(C)(3) OF THE FEDERAL INTERNAL REVENUE CODE. THE CORPORATION IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE CORPORATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE CORPORATION FOLLOWS THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE IMPLEMENTATION OF THE ACCOUNTING STANDARDS REGARDING UNCERTAIN TAX PROVISIONS HAD NO IMPACT ON THE CORPORATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAP 114,831. NET ASSETS RELEASED FROM RESTRICTIONS 150,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 339,220. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 339,220. 1 CITY OF FORT MORGAN COLORADO 110 MAIN STREET FORT MORGAN CO 80701 846000588 FORT MORGAN, CO 0 18147 COST LAND - 729 E. RAILROAD AVENUE GENERAL OPERATING SUPPORT 1 0 PART I, LINE 2: THE ONLY GRANT WAS A SMALL PLOT OF LAND DONATED TO THE CITY OF FORT LUPTON. APPROPRIATE USE IS DETERMINED THROUGH VISUAL INSPECTION OF THE PROPERTY. 0 0 0 0 0 0 0 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 263698 0 217 0 0 0 13548 0 16878 0 294341 0 0 0 DAVID MADSEN CFO 126210 0 0 0 0 0 6304 0 23475 0 155989 0 0 0 HANS ELZINGA PHYSICIAN 256580 0 22800 0 0 0 14880 0 24531 0 318791 0 0 0 LAYNE BRACY PHYSICIAN 187256 0 70460 0 0 0 9350 0 23946 0 291012 0 0 0 ALINE HANSEN-GUZMAN PHYSICIAN 254080 0 0 0 0 0 13140 0 25309 0 292529 0 0 0 DOUGLAS WHITMAN PHYSICIAN 187828 0 47802 0 0 0 9407 0 23584 0 268621 0 0 0 JASON HEINE PHYSICIAN 180162 0 49113 0 0 0 9000 0 23497 0 261772 0 0 0 A COLORADO HEALTH FACILITIES AUTHORITY 840752932 2010-12-16 16110000 REFUND SERIES 2005 & 2008 BONDS 0 0 0 A 3770000 16110000 16110000 2010 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 1 KEY BANK 5.000000000000 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/16/2015 X 1 2200959 COST 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE CURRENT OFFICERS OF THE BOARD. THE EXECUTIVE COMMITTEE IS AUTHORIZED TO FUNCTION ON BEHALF OF THE BOARD BETWEEN BOARD MEETINGS. ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE IN THE INTERIM ARE RATIFIED BY THE BOARD AT ITS SUBSEQUENT MEETING. THE EXECUTIVE COMMITTEE ALSO PERFORMS THE PLANNING AND EVALUATION FUNCTION FOR THE BOARD. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED IN NOVEMBER 2017. THE AMENDMENTS INCLUDED THE FOLLOWING SIGNIFICANT CHANGES: 1. THE ORGANIZATION'S SERVICE AREA WAS EXPANDED TO INCLUDE SOUTHERN COLORADO AND THE DENVER METRO AREA; 2. THE MINIMUM NUMBER OF BOARD MEMBERS WAS DECREASED FROM 12 TO 9; 3. BOARD TERMS WERE SPECIFIED TO BE FOR THREE YEARS; AND 4. OFFICER TERMS WERE SPECIFIED TO BE FOR TWO YEARS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY SALUD'S CERTIFIED PUBLIC ACCOUNTING FIRM AND REVIEWED BY SALUD'S CHIEF FINANCIAL OFFICER. THE FORM 990 WAS THEN REVIEWED BY THE CHIEF EXECUTIVE OFFICER OF SALUD AND THEN PRESENTED TO THE BOARD OF DIRECTORS AT THEIR MONTHLY BOARD MEETING FOR REVIEW PRIOR TO FILING. 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, EMPLOYEES ARE REQUIRED TO COMPLETE ANNUAL MANDATORY COMPLIANCE TRAINING. SALUD'S 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. SALUD BOARD MEMBERS ARE BOUND BY THE CODE OF ETHICS ADOPTED BY THE BOARD IN REGARD TO CONFLICTS OF INTEREST OR THE APPEARANCE THEREOF. ON A YEARLY BASIS, EACH BOARD MEMBER SIGNS A NEW CONFLICT OF INTEREST STATEMENT. IF A BOARD MEMBER HAS A POTENTIAL CONFLICT, THEY INFORM THE CEO AND BOARD CHAIR. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE BOARD CHAIR MAKES THE DETERMINATION. IF A BOARD MEMBER IS DEEMED TO HAVE A CONFLICT, THE SITUATION IS MONITORED BY THE BOARD CHAIR. FORM 990, PART VI, SECTION B, LINE 15A SALUD'S COMPENSATION FOR THE CEO IS 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 CEO'S WAGE INFORMATION IS PRESENTED TO SALUD'S COMPENSATION COMMITTEE THAT CONSISTS OF FOUR INDEPENDENT DIRECTORS WHO THEN DELIBERATE AND APPROVE THE CEO'S SALARY. SALUD'S COMPENSATION FOR THE OTHER KEY EMPLOYEES IS 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 OF SALUD REVIEWS ALL OTHER TOP MANAGEMENT WAGE COMPARISONS. COMPENSATION WAS LAST REVIEWED IN 2018. FORM 990, PART VI, SECTION C, LINE 19 SALUD'S WEBSITE PROVIDES THE CONTACT INFORMATION WHERE THE PUBLIC MAY REQUEST COPIES OF SALUD'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, WHICH ARE THEN PROVIDED UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 6,343,160. MANAGEMENT AND GENERAL EXPENSES 1,704,242. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,047,402. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP 114,831. SALUD HEALTH CENTER LLC 1830 LAPORTE AVENUE FORT COLLINS CO 80521 474476465 LAND AND WAREHOUSES CO 17618 2818744 PLAN DE SALUD DEL VALLE INC