2024-12-23T09:44:23-06:00 2024-06-30 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2023-07-01 741894581 UCHEALTH NORTHERN COLORADO FOUNDATION UCHE 9702377400 2315 E HARMONY RD 200 FORT COLLINS CO 80528 DAVID THOMPSON CFO 9702377400 2024-12-18 1 0 RYAN C HARRIS P00614618 3037409400 2024-12-18 2023 2024-10-15 13:58:12Z DAVID THOMPSON 2315 E HARMONY RD FORT COLLINS CO 80528 6577136 0 X WWW.UCHEALTH.ORG X 1976 CO SUPPORT & PROMOTE ACTIVITIES THAT BEST SERVE THE HEALTH INTERESTS OF THE HOSPITALS. 12 11 12 10 0 0 5562561 4840555 0 0 746596 1670883 -109490 32317 6199667 6543755 2618778 8355996 0 0 1012975 759988 60000 40624 535337 289859 174636 3981612 9331244 2218055 -2787489 28323578 26533347 1119216 895940 27204362 25637407 X SEE SCHEDULE O THE MISSION OF UCHEALTH NORTHERN COLORADO FOUNDATION IS TO SUPPORT ITS AFFILIATED HOSPITALS AND CLINICS IN THE DELIVERY AND ADVANCEMENT OF WORLD-CLASS HEALTH CARE IN NORTHERN COLORADO. THE FOUNDATION REALIZES ITS MISSION THROUGH THE DEVELOPMENT AND STEWARDSHIP OF PHILANTHROPIC RESOURCES IN SUPPORT OF THE HOSPITALS' MISSION AND STRATEGIC GOALS. 0 0 8065399 8030602 RESTRICTED FUND (USE OF FUNDS IS RESTRICTED BY DONOR/GRANTOR PURPOSE) - THE BREADTH OF SUPPORT INCLUDES FUNDING FOR EDUCATION MATERIALS, MEDICAL EQUIPMENT AND SERVICES, ACCESS TO HEALTHCARE, EMPLOYEE SCHOLARSHIPS, CONTINUING EDUCATION, PATIENT EDUCATION PROGRAMS, EQUIPMENT, BASIC NEEDS FOR PERSONS WITH CANCER, PRESCRIPTION ASSISTANCE, RESEARCH, NEWBORN HOME VISITATION, CHILDREN'S PROSTHETICS AND ORTHOTICS, BEHAVIORAL HEALTH PROFESSIONAL CO-RESPONDER IN PARTNERSHIP WITH LAW ENFORCEMENT, POUDRE VALLEY HOSPITAL BUILDING RENOVATION CAPITAL CAMPAIGN, MEDICAL CENTER OF THE ROCKIES CAPITAL EXPANSION, EQUIPMENT TECHNOLOGY, SUPPLIES, PATIENT ASSISTANCE, SHORT-TERM FINANCIAL ASSISTANCE FOR CRITICAL BASIC NEEDS TO ELIGIBLE EMPLOYEES, AND MANY OTHERS. 397623 325394 UNRESTRICTED FUND - (USE OF FUNDS NOT RESTRICTED BY THE DONOR, USED FOR THE GREATEST NEED OF THE HOSPITALS) - PROVIDES FUNDING FOR HOSPITAL PROGRAM SERVICES INCLUDING BEHAVIORAL HEALTH PROFESSIONAL CO-RESPONDER IN PARTNERSHIP WITH LAW ENFORCEMENT AND CAPITAL EQUIPMENT. 8463022 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 233 0 1 12 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X DAVID THOMPSON 9702377400 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 KEVIN UNGER PVHC CEO 1.00 33.00 X X 0 714494 118999 CHRIS OSBORN DIRECTOR 1.00 2.00 X 0 2424 0 LISA CLAY BOARD CHAIR 1.00 2.00 X X 0 2422 0 MIKE DELLENBACH DIRECTOR 1.00 2.00 X 0 1986 0 CHRISTINE CHIN DIRECTOR 1.00 2.00 X 0 1404 0 DENNIS HOUSKA PAST BOARD CHAIR 1.00 2.00 X 0 1271 0 DAN STROH DIRECTOR 1.00 2.00 X 0 235 0 JIM PARKE BOARD VICE CHAIR 1.00 2.00 X X 0 121 0 DOUG ERION DIRECTOR 1.00 2.00 X 0 119 0 FARAZ NAQVI DIRECTOR 1.00 2.00 X 0 0 0 JOHN MCKAY PVH BOARD ONLY/HEALTH DISTRICT 1.00 2.00 X 0 0 0 BRAD OLDEMEYER DIRECTOR 1.00 2.00 X 0 0 0 DAVID THOMPSON BOARD TREASURER & CFO 1.00 29.00 X 0 437812 57204 DAVID CRUM TERM END 1023 FORMER NCF SENIOR DIRECTOR 40.00 0.00 X 194528 0 36625 MICHELLE ALBRIGHT BOARD SECRETARY (TERM END 7/24) 1.00 40.00 X 0 59477 12163 AMANDA GIACALONE NCF SENIOR DIRECTOR (TERM BEGIN 2/24) 40.00 0.00 X 0 0 0 ANNETTE GEISELMAN DEVELOPMENT MANAGER 40.00 0.00 X 115875 0 28754 310403 1221765 253745 2 0 1 0 0 24840 1235471 3580244 101539 4840555 786264 786264 50118 22838 27280 27280 27280 884619 0 884619 884619 884619 15580 24840 10543 5037 5037 6543755 0 0 1703200 5820758 5820758 2535238 2535238 231478 115739 115739 420791 57543 110630 252618 41830 5822 10450 25558 54985 7346 15390 32249 10904 1518 2724 6662 5700 5700 40624 40624 41380 41380 2114 2114 61887 61887 12687 12687 7394 7394 640 640 HOSPITAL INITIATIVES 34797 34797 CORPORATE ALLOCATION 371 371 7666 7666 9331244 8463022 332885 535337 3377446 402511 1562049 1424709 269 0 23318857 24706127 64957 0 28323578 26533347 253241 243331 865975 343861 0 308748 1119216 895940 X 6843594 9137282 20360768 16500125 27204362 25637407 28323578 26533347 -2787489 1220534 0 X 0 1 X 1 0 X 5334907 6392205 6654050 5562561 4840555 28784278 5334907 6392205 6654050 5562561 4840555 28784278 4258059 24526219 352859 229170 325749 631016 836382 2375176 5037 5037 31164491 0.78700 0.80530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7951438 115564 788252 15783 162891 37217 8639363 7505139 15248 739495 51797 256647 7951438 8519574 80607 -772629 45447 242696 34270 7505139 7696043 67691 1053774 36975 222882 38077 8519574 7552046 76521 186928 28707 55954 34791 7696043 0.05290 0.79940 0.14770 1 0 0 RELATED PARTY PAYABLE 308748 308748 7756290 1220534 1220534 6535756 41380 -33381 7999 6543755 9323245 33381 33381 9289864 41380 41380 9331244 PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR THE INTENDED PURPOSE TO FUND SCHOLARSHIPS, EDUCATION, PROGRAMS, AND COMMUNITY BENEFIT. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -10,543. RENTAL EXPENSE -22,838. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 22,838. FUNDRAISING EXPENSES 10,543. X X X X X X X 1 ALLIANCE PHILANTHROPY 27459 FRONTAGE ROAD BOZEMAN MT 59715 MCR CAMPAIGN 0 0 40624 0 40624 CO NORTHERN COLORADO GOLF TOURNAMENT 40420 24840 15580 5966 4140 437 40420 24840 15580 5966 4140 437 10543 5037 1 POUDRE VALLEY HEALTH CARE INC 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 841262971 501 (C)(3) 877418 269673 FMV MEDICAL EQUIPMENT VARIOUS PROGRAM SUPPORT MEDICAL CENTER OF THE ROCKIES 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 043730045 501 (C)(3) 926 5191 FMV MEDICAL EQUIPMENT VARIOUS PROGRAM SUPPORT POUDRE VALLEY HEALTH CARE INC PVH CAMPAIGN 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 841262971 501 (C)(3) 0 4650000 FMV BUILDING CAPITAL IMPROVEMENT VARIOUS PROGRAM SUPPORT UCH HEALTH GREELEY HOSPITAL 6767 W 29TH STREET GREELEY CO 80634 822666059 501 (C)(3) 0 17549 FMV MEDICAL EQUIPMENT VARIOUS PROGRAM SUPPORT 4 EMPLOYEE ASSISTANCE 243 350165 SCHOLARSHIPS 40 62260 CANCER PATIENT ASSISTANCE 777 312052 MEDICARE COUNSELING 1155 31908 NEWBORN FAMILY VISITS 336 2536 CHILDREN'S BICYCLE HELMETS & CAR SEATS 864 37695 DIABETES EDUCATION 294 16242 BREAST PUMP RENTALS 56 1400 PATIENT EDUCATION-ENHANCE WELLNESS 2169 36945 ACCESS TO HEALTHCARE 960 1403341 CHOLESTEROL/HEART HEALTH SCREENING 12939 44788 FOOD PANTRY 9827 79838 PATIENT ASSISTANCE 1027 156068 PART I, LINE 2: THE FOUNDATION REQUESTS GRANT RECIPIENTS TO REPORT BACK TO THE FOUNDATION ON USE AND OUTCOME OF FUNDING. 1 0 0 0 0 0 0 1 0 KEVIN UNGER PVHC CEO 0 504539 0 193905 0 16050 0 100766 0 18233 0 833493 0 0 DAVID THOMPSON BOARD TREASURER & CFO 0 358113 0 76154 0 3545 0 37015 0 20189 0 495016 0 0 DAVID CRUM TERM END 1023 FORMER NCF SENIOR DIRECTOR 132396 0 13413 0 48719 0 17383 0 19242 0 231153 0 0 0 PART I, LINE 4A DAVID CRUM RECEIVED A SEVERANCE PAYMENT OF $33,384. PART I, LINE 7 THE ORGANIZATION OFFERS A BONUS PLAN THAT PAYS A PERCENTAGE OF AN EMPLOYEE'S BASE PAY. THE INTENT OF THE PLAN IS TO REWARD AN EMPLOYEE'S PERFORMANCE TOWARDS ACHIEVEMENT OF STRATEGIC GOALS DURING THE FISCAL YEAR. SUCCESSFUL ACCOMPLISHMENT OF GOALS THAT CONTRIBUTE TO THE ORGANIZATION'S OVERALL STRATEGIC DIRECTION RESULT IN VARIABLE PAYMENTS ALIGNED WITH THE ORGANIZATION'S TOTAL COMPENSATION STRATEGY. THIS PROGRAM REWARDS EMPLOYEES BASED ON ORGANIZATIONAL PERFORMANCE MEASURES AND INDIVIDUAL EMPLOYEE GOAL PERFORMANCE. ALL PAYOUTS ARE CONTINGENT BASED ON THE UCHEALTH BOARD OF DIRECTORS APPROVAL EACH FISCAL YEAR. X 1 16799 FMV X DUST CONTAINMENT UNITS 20 60800 FMV X AIR MACHINES 12 13440 FMV X REFIRGERATOR FOR FMC FOOD PANTRY 1 10500 FMV 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 POUDRE VALLEY HEALTH CARE, INC., DBA THE POUDRE VALLEY HEALTH SYSTEM, A 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF UCHEALTH NORTHERN COLORADO FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF UCHEALTH NORTHERN COLORADO FOUNDATION, POUDRE VALLEY HEALTH CARE INC. APPOINTS ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B A UNANIMOUS VOTE OF THE MEMBERS IS REQUIRED FOR AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS, ACTION REGARDING DISSOLUTION, MERGER OR CONSOLIDATION, ACTION REGARDING SALE, LEASE, MORTGAGE, OR OTHER TRANSFER OF SUBSTANTIALLY ALL ASSETS, OR ADMITTING A NEW MEMBER OR TRANSFER OF A MEMBER'S INTEREST. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY A THIRD PARTY. A PRELIMINARY DRAFT IS REVIEWED BY THE INTERNAL FINANCE DEPARTMENT. THE FINAL COPY OF THE FORM 990 IS PROVIDED IN AN ELECTRONIC FORMAT TO ALL BOARD OF DIRECTOR MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE COVERED UNDER THIS POLICY. CONFLICTS ARE REVIEWED AT MANAGEMENT LEVEL. BOARD MEMBERS RESCIND ON VOTING IF A CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 UCHEALTH NOTHERN COLORADO FOUNDATION DOES NOT HAVE EMPLOYEES FOR FORM 990 REPORTING PURPOSES, AS ALL EMPLOYEES OF UCHEALTH NOTHERN COLORADO FOUNDATION ARE REPORTED ON THE PAYROLL OF UNIVERSITY OF COLORADO HOSPITAL AUTHORITY THROUGH 6/30/2024. EMPLOYEES ARE LEASED TO UCHEALTH NORTHERN COLORADO FOUNDATION. THE EXPENSES THAT ARE REPORTED FOR SALARIES AND BENEFITS ON THE STATEMENT OF FUNCTIONAL EXPENSES REPRESENT THE EMPLOYEE LEASE EXPENSE FOR THE YEAR ENDED 6/30/2024. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST WITH A LEGITIMATE BUSINESS PURPOSE. POUDRE VALLEY HEALTH CARE INC 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 841262971 HOSPITAL CO 501(C)(3) LINE 3 N/A 0 MEDICAL CENTER OF THE ROCKIES 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 043730045 HOSPITAL CO 501(C)(3) LINE 3 N/A 0 INNOVATION ENTERPRISES 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 202036774 IT CONSULTING CO N/A C 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0