2024-05-01T08:48:34-05:00 2023-06-30 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2022-07-01 741894581 UCHEALTH NORTHERN COLORADO FOUNDATION UCHE 9702377400 2315 E HARMONY RD 200 FORT COLLINS CO 80528 DAVID THOMPSON CFO 9702377400 2024-04-24 1 DAVID THOMPSON 999009999 0 RYAN C HARRIS P00614618 3037409400 2024-04-24 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID THOMPSON 2315 E HARMONY RD FORT COLLINS CO 80528 6384732 0 X WWW.UCHEALTH.ORG X 1976 CO SUPPORT & PROMOTE ACTIVITIES THAT BEST SERVE THE HEALTH INTERESTS OF THE HOSPITALS. 11 10 12 15 0 0 6654050 5562561 0 0 620738 746596 3097 -109490 7277885 6199667 2794013 2618778 0 0 974248 1012975 30000 60000 796520 455196 289859 4253457 3981612 3024428 2218055 24720051 28323578 1110156 1119216 23609895 27204362 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 2633372 2535343 RESTRICTED FUND - PROVIDES FUNDING FOR EDUCATION MATERIALS, MEDICAL EQUIPMENT AND SERVICES. THE BREADTH OF SUPPORT INCLUDES EMPLOYEE SCHOLARSHIPS, CONTINUING EDUCATION, PATIENT EDUCATION PROGRAMS, EQUIPMENT, BASIC NEEDS FOR PERSONS WITH CANCER, OBESITY PREVENTION PROGRAMS, AFTERSCHOOL HEALTH AND WELLNESS PROGRAMS, PRESCRIPTION ASSISTANCE, RESEARCH, NEWBORN HOME VISITATION, CHILDREN'S PROSTHETICS AND ORTHOTICS, BEHAVIORAL HEALTH PROFESSIONAL CO-RESPONDER IN PARTNERSHIP WITH COLORADO STATE UNIVERSITY LAW ENFORCEMENT, POUDRE VALLEY HOSPITAL BUILDING RENOVATION CAPITAL CAMPAIGN, MEDICAL CENTER OF THE ROCKIES CAPITAL EXPANSION, AND MANY OTHERS. ALSO EQUIPMENT, TECHNOLOGY, SUPPLIES, PATIENT ASSISTANCE, AND SHORT-TERM FINANCIAL ASSISTANCE FOR CRITICAL BASIC NEEDS TO ELIGIBLE EMPLOYEES. 116058 83435 UNRESTRICTED FUND (USE OF FUNDS NOT RESTRICTED BY THE DONOR, USED FOR THE GREATEST NEED OF THE HOSPITALS) - PROVIDES FUNDING FOR HOSPITAL PROGRAM SERVICES AND CAPITAL EQUIPMENT. 2749430 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 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 1 270 0 1 12 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 10 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 DENNIS HOUSKA PAST BOARD CHAIR 1.00 2.00 X 0 0 0 LISA CLAY BOARD CHAIR 1.00 2.00 X X 0 0 0 JIM PARKE BOARD VICE CHAIR 1.00 2.00 X X 0 0 0 CHRISTINE CHIN DIRECTOR 1.00 2.00 X 0 0 0 MIKE DELLENBACH DIRECTOR 1.00 2.00 X 0 0 0 DOUG ERION DIRECTOR 1.00 2.00 X 0 0 0 BRAD OLDEMEYER DIRECTOR 1.00 2.00 X 0 0 0 CELESTE KING DIRECTOR 1.00 2.00 X 0 0 0 CHRIS OSBORN DIRECTOR 1.00 2.00 X 0 0 0 DAN STROH DIRECTOR 1.00 2.00 X 0 0 0 KEVIN UNGER PVHC CEO 1.00 33.00 X X 1988 713758 28147 DAVID THOMPSON BOARD TREASURER & CFO 1.00 29.00 X 1077 386713 27213 MICHELLE ALBRIGHT BOARD SECRETARY 1.00 40.00 X 157 56381 12199 DAVID CRUM NCF EXECUTIVE DIRECTOR 40.00 0.00 X 50649 0 7755 ANNETTE GEISELMAN DEVELOPMENT MANAGER 40.00 0.00 X 125810 0 29712 SHANNON MOSNESS DEVELOPMENT MANAGER 40.00 0.00 X 119004 0 34618 298685 1156852 139644 2 0 1 0 0 177801 1495054 3889706 39641 5562561 589181 589181 41835 36631 5204 5204 5204 157415 0 157415 157415 157415 33740 177801 148434 -114694 -114694 6199667 0 0 637106 687932 687932 1930846 1930846 172958 86479 86479 655844 26321 170467 459056 56662 2380 12767 41515 119484 3585 53375 62524 8027 337 1809 5881 5600 5600 60000 60000 31667 31667 20157 20157 81065 81065 19616 19616 4278 4278 5579 5579 2137 2137 HOSPITAL INITIATIVES 91047 91047 CORPORATE ALLOCATION 12348 12348 MISCELLANEOUS EXPENSES 9383 9383 INKIND EXPENSES 6982 6982 3981612 2749430 435662 796520 11726 10419452 3377446 2513882 1562049 30000 269 11742107 23318857 2884 64957 24720051 28323578 244732 253241 793447 865975 71977 0 1110156 1119216 X 5212097 6843594 18397798 20360768 23609895 27204362 24720051 28323578 2218055 1376412 0 X 0 1 X 1 0 X 5476029 5334907 6392205 6654050 5562561 29419752 5476029 5334907 6392205 6654050 5562561 29419752 4143263 25276489 426504 352859 229170 325749 631016 1965298 1000 1000 31386050 0.80530 0.84620 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 1,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7505139 15248 739495 51797 256647 0 7951438 8519574 80607 -772629 45447 242696 34270 7505139 7696043 67691 1053774 36975 222882 38077 8519574 7552046 76521 186928 28707 55954 34791 7696043 7528946 61289 260065 33759 234908 29587 7552046 0.05740 0.85410 0.08850 1 0 0 7761144 1376412 1376412 6384732 -185065 -185065 6199667 4166677 185065 185065 3981612 0 3981612 PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR THE INTENDED PURPOSE TO FUND SCHOLARSHIPS, EDUCATION, PROGRAMS, AND COMMUNITY BENEFIT. TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE FOUNDATION HAVE BEEN LIMITED BY THE DONOR TO A SPECIFIC TIME PERIOD OR PURPOSE. THESE NET ASSETS ARE AVAILABLE FOR VARIOUS HEALTH CARE PURPOSES AS DEFINED BY DONORS. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -148,434. RENTAL EXPENSE -36,631. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 36,631. FUNDRAISING EXPENSES 148,434. X X X X X X X 1 GHIORSI & SORRENTI INC 255 MADISON AVENUE WYCKOFF NJ 74810 CONSULTANTS FOR PVH CAPITAL CAMPAIGN 0 2721446 60000 2661446 2721446 60000 2661446 CO 2023 NOCO SPRING BENEFIT 210221 176481 33740 3041 37498 8409 96946 2022 NOCO GOLF TOURNAMENT 1320 1320 2 1254 1286 211541 177801 33740 4295 37498 8409 98232 148434 -114694 1 POUDRE VALLEY HEALTH CARE INC 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 841262971 501 (C)(3) 218662 217082 BOOK MEDICAL EQUIPMENT VARIOUS PROGRAM SUPPORT MEDICAL CENTER OF THE ROCKIES 2315 E HARMONY RD SUITE 200 FORT COLLINS CO 80528 043730045 501 (C)(3) 125536 124628 BOOK MEDICAL EQUIPMENT VARIOUS PROGRAM SUPPORT 2 EMPLOYEE ASSISTANCE 215 313386 SCHOLARSHIPS 45 59750 CANCER PATIENT ASSISTANCE 480 231930 MEDICARE COUNSELING 926 42617 NEWBORN FAMILY VISITS 240 2042 CHILDREN'S BICYCLE HELMETS & CAR SEATS 374 26501 DIABETES EDUCATION 122 6338 BREAST PUMP RENTALS 56 1400 BEHAVIORAL HEALTH ASSISTANCE 15 3805 ACCESS TO HEALTHCARE 741 988873 ENHANCE WELLNESS 196 27522 CHOLESTEROL SCREENING 72712 40141 FOOD PANTRY 4519 101901 PATIENT ASSISTANCE 451 84640 PART I, LINE 2: THE FOUNDATION REQUESTS GRANT RECIPIENTS TO REPORT BACK TO THE FOUNDATION ON USE AND OUTCOME OF FUNDING. 0 0 0 0 0 0 0 1 0 KEVIN UNGER PVHC CEO 1461 524483 479 171952 48 17323 19 6884 59 21185 2066 741827 0 0 DAVID THOMPSON BOARD TREASURER & CFO 901 323574 167 59937 9 3202 19 6814 57 20323 1153 413850 0 0 ANNETTE GEISELMAN DEVELOPMENT MANAGER 119132 0 5530 0 1148 0 11999 0 17713 0 155522 0 0 0 SHANNON MOSNESS DEVELOPMENT MANAGER 113321 0 5464 0 219 0 11344 0 23274 0 153622 0 0 0 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 10049 FMV-IMMEDIATE SALE X AUCTION ITEMS 105 23557 FMV X BASKETS 45 4500 FMV X MONITOR 1 1535 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 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 6/30/2023. 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 6/30/2023. 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 PVHC C 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0