2021-03-09T15:12:19-06:00 2020-05-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BOULEVARD SUITE 500 BROOMFIELD CO 80021 990 2019-06-01 840613540 PLAN DE SALUD DEL VALLE INC PLAN 3032895147 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 DAVID MADSEN CHIEF FINANCIAL OFFICER 3032895147 2021-03-05 1 SARAH HINTZ P00492291 3034668822 2021-03-05 2019 2022-09-23 18:48:47Z JOHN SANTISTEVAN 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 88569158 0 X WWW.SALUDCLINIC.ORG X 1971 CO COMMUNITY HEALTH SERVICES 10 10 876 10 0 0 17309053 20868426 67179189 67565799 91404 85184 110548 49749 84690194 88569158 0 12848000 0 0 53475060 52375051 0 0 46063 31882359 33360240 85357419 98583291 -667225 -10014133 72495872 77267243 20704524 22641886 51791348 54625357 X SALUD IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC), OPERATING 13 CLINIC LOCATIONS, 11 SCHOOL SITES AND A MOBILE UNIT. WE PROVIDE MEDICAL, DENTAL, PHARMACY AND BEHAVIORAL HEALTH CARE SERVICES TO KEEP YOU AND YOUR FAMILY HEALTHY.WE FOCUS ON LOW-INCOME, MEDICALLY UNDERSERVED POPULATIONS AS WELL AS THE MIGRANT AND SEASONALFARMWORKER POPULATION. SALUD ACCEPTS MEDICAID, MEDICARE, CHP+, AND MOST PRIVATE INSURANCE PLANS. WEOFFER A SLIDING FEE SCALE BASED ON FAMILY SIZE AND INCOME. INSURANCE ENROLLMENT ASSISTANCE IS AVAILABLE.SALUD REMAINS COMMITTED TO PROVIDING CARE TO ALL COMMUNITY MEMBERS REGARDLESS OF FINANCES, INSURANCE COVERAGE, OR ABILITY TO PAY. 0 0 84736889 12848000 67565799 PROVIDE HEALTH CARE SERVICES TO MEDICAID, MEDICARE, CHP+ AND OTHER PATIENTS IN RURAL COMMUNITIES. SALUD HAD 328,340 VISITS IN THE FISCAL YEAR ENDED 5/31/2020. 84736889 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 20 0 1 876 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CO X DAVID MADSEN 3038926401 203 SOUTH ROLLIE AVENUE FORT LUPTON CO 80621 TILLMAN FARLEY CHIEF MEDICAL OFFICER 40.00 X 348434 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 40.00 X 296094 0 27479 DR HANS ELZINGA PHYSICIAN 40.00 X 271480 0 43391 DR ALINE HANSEN-GUZMAN PHYSICIAN 40.00 X 254460 0 36310 DR MATTHEW BRETT PHYSICIAN 40.00 X 250924 0 31305 DR MAUREEN FLEMING PHYSICIAN 30.00 X 244794 0 22862 DR LAURIE MILLER PHYSICIAN 40.00 X 228880 0 46557 ETHAN KERNS CHIEF DENTAL OFFICER 40.00 X 169298 0 33116 KANDACE BUCKLAND CHIEF OPERATING OFFICER 40.00 X 166814 0 18421 DAVID MADSEN CFO 40.00 X 125079 0 40563 COLLEEN LAEGER CHAIR 1.00 X X 0 0 0 JESUS TIJERINA VICE CHAIR 1.00 X X 0 0 0 MICHAEL MARTINEZ TREASURER 1.00 X X 0 0 0 LINDA HUGHES SECRETARY 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 2356257 0 300004 90 0 1 0 TRINIDAD CONSTRUCTION GROUP 133 N COMMERCIAL STREET TRINIDAD CO 81082 CONSTRUCTION 595530 UNIVERSITY PHYSICIANS INC PO BOX 110247 AURORA CO 80042 CONTRACT DOCTORS 586655 COE CONSTRUCTION 2302 E 13TH STREET LOVELAND CO 80537 CONSTRUCTION 563716 TOP NOTCH CLEANING SERVICES 2824 EAGLE CIRCLE ERIE CO 80516 CLEANING SERVICES 208655 ECLINICAL WORKS PO BOX 847950 BOSTON MA 02284 E.H.R. SUPPORT 204744 9 19972443 895983 2218510 20868426 PATIENT FEES 621400 54590503 54590503 PHARMACY REVENUE 621400 12390696 12390696 GAIN ON JOINT VENTURES 621400 584600 584600 67565799 85184 85184 30842 0 30842 30842 30842 OTHER INCOME 900099 18907 18907 18907 88569158 67565799 0 134933 X 12848000 12848000 1240856 1240856 40037824 36660175 3344741 32908 1678096 1539660 137307 1129 6442287 5804335 633695 4257 2975988 2657768 316271 1949 186325 186325 123644 123644 9879612 5846299 4033313 67471 8597 58874 1462587 734848 721919 5820 945089 864331 80758 203450 114968 88482 715267 275230 440037 364998 126003 238995 2858502 2189590 668912 377411 353399 24012 MEDICAL SUPPLIES 12417105 12417105 0 REPAIRS & MAINTENANCE 1772729 1564505 208224 EQUIPMENT 1169284 553932 615352 DUES & SUBSCRIPTIONS 517559 178144 339415 299207 299207 98583291 84736889 13800339 46063 6588496 10314216 6840312 7173344 3366166 3502546 1820089 1816838 59641 83381 84401624 31699499 52730975 52702125 1090193 1674793 72495872 77267243 8771442 7183891 319002 1647666 11613938 13810329 142 0 20704524 22641886 X 51291348 54625357 500000 0 51791348 54625357 72495872 77267243 X -10014133 12848142 X X 0 1 X 1 1 1 X 16030406 17827183 16758173 17309053 20868426 88793241 16030406 17827183 16758173 17309053 20868426 88793241 88793241 78333 62364 138595 101952 116026 497270 100000 18907 118907 89409418 312175183 0.99310 0.99370 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12624963 12624963 71288396 31699499 39588897 488265 488265 52702125 X 89472393 903093 142 903235 88569158 0 88569158 86638384 903093 903093 85735291 12848000 12848000 98583291 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 142. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE PROVIDED 12,848,000. 0 CHARITY CARE 17937 12848000 FMV CHARITY CARE TO UNINSURED PATIENTS PART I, LINE 2: THE CORPORATION HAS A POLICY OF PROVIDING CHARITY CARE TO UNINSURED PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS POLICY AT AMOUNTS LESS THAN ITS ESTABLISHED RATES, OR WITHOUT CHARGE. HOWEVER, ALL PATIENTS ARE REQUESTED TO PAY A MINIMUM FEE FOR EACH VISIT, ALTHOUGH NO PATIENT IS DENIED SERVICES BECAUSE OF INABILITY TO PAY. AS THE CHARITY CARE GRANTS ARE IN THE FORM OF A SLIDING FEE OR NO FEE SERVICE, NO ADDTIONAL MONITORING AFTER THE CHARITY CARE IS GRANTED IS DEEMED NECESSARY. X 0 0 0 0 0 0 0 0 0 TILLMAN FARLEY CHIEF MEDICAL OFFICER 348434 0 0 0 0 0 0 0 0 0 348434 0 0 0 JOHN SANTISTEVAN PRESIDENT & CEO 296094 0 0 0 0 0 14975 0 12504 0 323573 0 0 0 DR HANS ELZINGA PHYSICIAN 245016 0 22205 0 4259 0 13838 0 29553 0 314871 0 0 0 DR ALINE HANSEN-GUZMAN PHYSICIAN 251911 0 141 0 2408 0 13070 0 23240 0 290770 0 0 0 DR MATTHEW BRETT PHYSICIAN 223569 0 27355 0 0 0 12708 0 18597 0 282229 0 0 0 DR MAUREEN FLEMING PHYSICIAN 243239 0 0 0 1555 0 12241 0 10621 0 267656 0 0 0 DR LAURIE MILLER PHYSICIAN 172998 0 52317 0 3565 0 11896 0 34661 0 275437 0 0 0 ETHAN KERNS CHIEF DENTAL OFFICER 169298 0 0 0 0 0 8920 0 24196 0 202414 0 0 0 KANDACE BUCKLAND CHIEF OPERATING OFFICER 166814 0 0 0 0 0 8394 0 10027 0 185235 0 0 0 DAVID MADSEN CFO 125079 0 0 0 0 0 6682 0 33881 0 165642 0 0 0 A COLORADO HEALTH FACILITIES AUTHORITY 840752932 2020-04-24 12491750 REFUND SERIES 2010 BONDS 0 0 0 A 48277 12491750 158488 11833262 500000 1 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 X 1 2218510 COST 0 0 0 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTERS USED IN PART I 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 VERBIAGE WAS ADDED TO THE BYLAWS TO SPECIFY BOARD COMPOSITION AND IDENTIFY SKILL SETS OF THE BOARD MEMBERS. 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 CONTROLLER AND CHIEF FINANCIAL OFFICER. THE FORM 990 WAS 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 AND ADJUSTED ON 1/27/20. 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 5,846,299. MANAGEMENT AND GENERAL EXPENSES 4,033,313. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,879,612. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP 142. CHARITY CARE PROVIDED 12,848,000. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSEEING AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. SALUD HEALTH CENTER LLC 1830 LAPORTE AVENUE FORT COLLINS CO 80521 474476465 LAND AND WAREHOUSES CO 900 2352020 PLAN DE SALUD DEL VALLE INC