2020-04-14T20:27:39-05:00 2019-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2018-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3032895147 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 DAVID MADSEN CHIEF FINANCIAL OFFICER 3032895147 2020-03-28 1 KURT BENNION P01469618 3034668822 2020-03-28 67.137.57.251 2020-03-28 09:49:57 PD P DB638E471739F1D4B23C74843775E8025F07CF1B 5FDBAA4BB10DC37B886353302A6A7E613F599072 2018 2020-09-23 17:36:50Z JOHN SANTISTEVAN 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 84690194 0 X WWW.SALUDCLINIC.ORG X 1971 CO COMMUNITY HEALTH SERVICES 10 10 875 10 0 0 16758173 17309053 64810469 67179189 14722 91404 23037 110548 81606401 84690194 18147 0 0 0 47541300 53475060 0 0 30356 30692561 31882359 78252008 85357419 3354393 -667225 72144156 72495872 19742685 20704524 52401471 51791348 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 71548168 0 67179189 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. SALUD HAD 318,577 VISITS IN THE FISCAL YEAR ENDED 5/31/2019. 71548168 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 19 0 875 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 1 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 JESUS TIJERINA CHAIR & VICE CHAIR 1.00 X X 0 0 0 COLLEEN LAEGER VICE CHAIR & CHAIR 1.00 X X 0 0 0 LINDA HUGHES SECRETARY 1.00 X X 0 0 0 MICHAEL MARTINEZ TREASURER 1.00 X 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 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 300692 0 35131 DAVID MADSEN CFO 40.00 X 125138 0 26251 DR HANS ELZINGA PHYSICIAN 40.00 X 277169 0 45583 DR ALINE HANSEN-GUZMAN PHYSICIAN 40.00 X 261721 0 37556 DR MATTHEW BRETT PHYSICIAN 40.00 X 254563 0 37107 DR MAUREEN FLEMING PHYSICIAN 30.00 X 247101 0 31191 DR LAURIE MILLER PHYSICIAN 40.00 X 238449 0 42610 1704833 0 255429 7 0 1 0 CORUS GROUP 6430 S FIDDLERS GREEN CIRCLE GREENWOOD VILLAGE CO 80111 I.T. SUPPORT 657191 UNIVERSITY PHYSICIANS INC PO BOX 460578 GLENDALE CO 80246 CONTRACT DOCTORS 351876 TOP NOTCH CLEANING SERVICES 2824 EAGLE CIRCLE ERIE CO 80516 CLEANING SERVICES 334575 ECLINICAL WORKS 7011 KOLL CENTER PARKWAY 230 PLEASANTON CA 94566 E.H.R. SUPPORT 331220 LEWAN & ASSOCIATES PO BOX 207839 DALLAS TX 75320 PRINTING SERVICES 116793 10 16809053 500000 2362886 17309053 PATIENT FEES 621400 55857351 55857351 PHARMACY REVENUE 621400 10731645 10731645 GAIN ON JOINT VENTURES 621400 590193 590193 67179189 91404 91404 10548 0 10548 10548 10548 OTHER INCOME 900099 100000 100000 100000 84690194 67179189 0 201952 487212 487212 41380412 36476231 4887613 16568 1641039 1477588 162660 791 6875895 6145702 726903 3290 3090502 2746436 342596 1470 193579 193579 104217 104217 8436264 5889056 2547208 80117 33183 46934 1711444 876882 826325 8237 1095599 1003450 92149 269195 119280 149915 529675 250199 279476 429885 206443 223442 2838746 2155927 682819 427709 402822 24887 MEDICAL SUPPLIES 11739926 11739926 REPAIRS & MAINTENANCE 1553449 1296808 256641 EQUIPMENT 1295204 227289 1067915 DUES & SUBSCRIPTIONS 513055 150553 362502 664295 350393 313902 85357419 71548168 13778895 30356 9308391 6588496 8848153 6840312 4217057 3366166 1614955 1820089 181071 59641 81571973 28840998 47474529 52730975 500000 1090193 72144156 72495872 7161892 8771442 282057 319002 12246908 11613938 51828 142 19742685 20704524 X 52401471 51291348 500000 52401471 51791348 72144156 72495872 X -667225 57102 X 0 1 X 1 1 1 X 15886044 16030406 17827183 16758173 17309053 83810859 15886044 16030406 17827183 16758173 17309053 83810859 83810859 50411 78333 62364 138595 101952 431655 100000 100000 84342514 292490185 0.99370 0.99600 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12624963 12624963 68341959 28840998 39500961 605051 605051 52730975 ACCRUED BOND DERIVATIVE 142 142 X 84351914 455011 57102 512113 83839801 850393 850393 84690194 85462037 455011 455011 85007026 350393 350393 85357419 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 57,102. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 350,393. CONTRIBUTIONS WITH DONOR RESTRICTIONS 500,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 350,393. X X X 0 0 0 0 0 0 0 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 290000 0 0 0 10692 0 14975 0 20156 0 335823 0 0 0 DAVID MADSEN CFO 124906 0 0 0 232 0 6682 0 19569 0 151389 0 0 0 DR HANS ELZINGA PHYSICIAN 254550 0 22205 0 414 0 13838 0 31745 0 322752 0 0 0 DR ALINE HANSEN-GUZMAN PHYSICIAN 261400 0 141 0 180 0 13070 0 24486 0 299277 0 0 0 DR MATTHEW BRETT PHYSICIAN 226800 0 27355 0 408 0 12708 0 24399 0 291670 0 0 0 DR MAUREEN FLEMING PHYSICIAN 244815 0 0 0 2286 0 12241 0 18950 0 278292 0 0 0 DR LAURIE MILLER PHYSICIAN 185909 0 52165 0 375 0 11896 0 30714 0 281059 0 0 0 A COLORADO HEALTH FACILITIES AUTHORITY 840752932 2010-12-16 16110000 REFUND SERIES 2005 & 2008 BONDS 0 0 0 A 4410000 16110000 16110000 2010 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 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 2362886 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 7A THE ORGANIZATION HAS DIVIDED ITS SERVICE AREA INTO NINE GEOGRAPHIC AREAS. EACH GEOGRAPHIC AREA ELECTS ONE INDIVIDUAL TO THE BOARD OF DIRECTORS BY A MAJORITY VOTE OF THE CONSUMERS RESIDING IN THAT GEOGRAPHIC AREA. 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 USE TO 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 2019. 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 XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP 57,102. SALUD HEALTH CENTER LLC 1830 LAPORTE AVENUE FORT COLLINS CO 80521 474476465 LAND AND WAREHOUSES CO 900 2571220 PLAN DE SALUD DEL VALLE INC