2024-11-07T09:57:11-06:00 2023-12-31 990 2023-01-01 742255936 PLATTE VALLEY MEDICAL CENTER FOUNDATION PLAT 3034983630 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 ANTELIA SALAZAR-BALL CHAIR 3034983630 2024-11-06 0 2023 2024-10-15 13:58:12Z ANTELIA SALAZAR-BALL 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 1606040 0 X SEE SCHEDULE O X 1982 CO HELPING PEOPLE LIVE THE HEALTHIEST LIVES POSSIBLE. 18 13 0 25 0 0 861084 1375425 0 0 -231200 210665 -32834 -31089 597050 1555001 540111 970855 0 0 57078 153080 0 0 91356 37400 41620 634589 1165555 -37539 389446 3083840 3345185 433819 75527 2650021 3269658 X HELPING PEOPLE LIVE THE HEALTHIEST LIVES POSSIBLE. 0 0 972386 970855 THE PLATTE VALLEY MEDICAL CENTER FOUNDATION IS A NON-PROFIT ORGANIZATION WHOSE MISSION IS TO SUPPORT THE PROGRAMS AND SERVICES OF PLATTE VALLEY MEDICAL CENTER (PVMC). FOR OVER 30 YEARS, CHARITABLE CONTRIBUTIONS HAVE HELPED ADD NEW TECHNOLOGY, BRING NEW SERVICES TO THE COMMUNITY AND GREATLY ENHANCE THE COMFORT AND CARE OF PATIENTS AND FAMILIES SERVED.PLATTE VALLEY MEDICAL CENTER IS A REFLECTION OF THE ENERGY AND PIONEERING SPIRIT OF A PASSIONATE COMMUNITY. THIS COMMUNITY RALLIED TOGETHER IN 1958, FORMED AN ARMY OF LOCAL RESIDENTS, AND WENT DOOR TO DOOR TO RAISE FUNDS FOR THE CONSTRUCTION OF A NEW HOSPITAL. IN 1960, PVMC BECAME THE FIRST PRIVATE GENERAL MEDICAL-SURGICAL HOSPITAL IN ADAMS AND SOUTHERN WELD COUNTIES.PLATTE VALLEY MEDICAL CENTER AND THE FOUNDATION WERE PART OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM. ON APRIL 1, 2022, INTERMOUNTAIN HEALTH CARE, INC. AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AFFILIATED, CREATING A MODEL HEALTH SYSTEM THAT PROVIDES HIGH-QUALITY, ACCESSIBLE, AND AFFORDABLE HEALTHCARE TO COMMUNITIES IN UTAH, IDAHO, NEVADA, COLORADO, MONTANA, WYOMING, AND KANSAS. THE ORGANIZATION EMPLOYS MORE THAN 66,000 CAREGIVERS, OPERATES 33 HOSPITALS (INCLUDING ONE VIRTUAL HOSPITAL), AND RUNS HUNDREDS OF CLINICS, WHILE PROVIDING HEALTH INSURANCE TO OVER ONE MILLION PEOPLE IN UTAH, IDAHO AND NEVADA.AS PART OF INTERMOUNTAIN HEALTHCARE, PLATTE VALLEY HAS DIRECT ACCESS TO BEST PRACTICES, RESOURCES, TECHNOLOGY, TALENT AND STRATEGIC CAPITAL. 972386 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 18 13 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X COLIN QUINCY 8014423491 36 SOUTH STATE STREET SUITE 1600 SALT LAKE CITY UT 84111 X JAIME CAMPBELL DIRECTOR 1.00 50.00 X 0 477826 221516 KURT GENSERT DIRECTOR 1.00 50.00 X 0 388970 179177 MAGGIE MUNOZ FOUNDATION EXECUTIVE DIR/SECRETARY 50.00 0.00 X X 0 111845 50434 CANDACE HARROD DIRECTOR 1.00 50.00 X 0 31987 0 RYAN KLEMT DIRECTOR 1.00 50.00 X 0 4305 0 MAUREEN ALLEN DIRECTOR 1.00 0.00 X 0 0 0 LUZMARIA BANUELOS-SHEARER DIRECTOR 1.00 0.00 X 0 0 0 ALAN COLON DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL DOLAN CHAIR 1.00 0.00 X X 0 0 0 BRIAN ENGLE DIRECTOR 1.00 0.00 X 0 0 0 KARRI FAIR DIRECTOR 1.00 0.00 X 0 0 0 SERAFINA GARZA DIRECTOR 1.00 0.00 X 0 0 0 TOM JANNSEN DIRECTOR 1.00 0.00 X 0 0 0 SIMONE JONES DIRECTOR 1.00 1.00 X 0 0 0 JAN OLSON VICE CHAIR 1.00 0.00 X X 0 0 0 ANTELIA SALAZAR-BALL TREASURER 1.00 0.00 X X 0 0 0 HEIDI STORZ DIRECTOR 1.00 1.00 X 0 0 0 SUSAN WIANT DIRECTOR 1.00 0.00 X 0 0 0 0 1014933 451127 0 0 1 0 0 115787 214698 1004047 40893 17097 1375425 82257 82257 128408 0 128408 128408 128408 19950 115787 51039 -31089 -31089 1555001 0 0 179576 961982 961982 8873 8873 144227 1442 70671 72114 8853 89 4338 4426 5508 5508 12746 12746 1485 735 750 2416 1196 1220 DUES AND MEMBERSHIPS 11928 11928 SUPPLIES 7437 7437 PERMITS AND LICENSES 100 100 1165555 972386 101813 91356 556831 356697 2527009 2988488 3083840 3345185 433819 75527 433819 75527 X 28585 49746 2621436 3219912 2650021 3269658 3083840 3345185 389446 229891 300 0 X 0 1 X 1 0 X X 1 BRIGHTON COMMUNITY HOSPITAL ASSOCIATION 840482695 3 1 961982 0 1 961982 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART IV, SECTION B, LINE 1 DESCRIBE HOW THE SUPPORTED ORGANIZATION EFFECTIVELY OPERATED, SUPERVISED, OR CONTROLLED THE ORGANIZATION'S ACTVITIES: IN ADDITION TO THE 2 TRUSTEES APPOINTED BY BRIGHTON COMMUNITY HOSPITAL ASSOCIATION DBA PLATTE VALLEY MEDICAL CENTER (PVMC) (SUPPORTED ORGANIZATION), THE CEO OF PVMC AND THE EXECUTIVE DIRECTOR ARE TRUSTEES AND THEY ARE EMPLOYEES OF PVMC. NOMINEES FOR THE OTHER TRUSTEES MUST BE RECOMMENDED BY THE NOMINATING COMMITTEE WHICH CONSISTS OF THE 2 HOSPITAL MEMBERS, CEO, EXECUTIVE DIRECTOR, CHAIRMAN AND VICE CHAIRMAN. THE HOSPITAL HAS A MAJORITY CONTROL OF THE NOMINATING COMMITTEE. THE REQUIREMENT FOR THE HOSPITAL TO APPROVE CHANGES IN ARTICLES OF INCORPORATION OR BYLAWS IS ALSO EVIDENCE OF SUPERVISION AND CONTROL. IN ADDITION, ALL THE PERSONS WHO WORK ON BEHALF OF THE FOUNDATION ARE EMPLOYEES OF PVMC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2621436 1164608 407194 973326 3219912 2758255 744712 -345840 535691 2621436 2334314 254430 357498 187987 2758255 2081684 251820 255617 254807 2334314 2015576 314611 121579 370082 2081684 0.00000 0.71600 0.28400 0 0 0 INTERCOMPANY PAYABLES 75527 75527 PART V, LINE 4: THE FOUNDATION'S TEMPORARY ENDOWMENT FUNDS AND EARNINGS FROM THE PERMANENT ENDOWMENT FUNDS SUPPORT VARIOUS SERVICES AND PROGRAMS OF THE PLATTE VALLEY MEDICAL CENTER. FARM TO TABLE 125267 108609 16658 0 0 2119 5879 1600 35352 FESTIVAL OF TREES 10470 7178 3292 0 4065 0 1042 0 982 135737 115787 19950 4065 2119 6921 1600 36334 51039 -31089 1 BRIGHTON COMMUNITY HOSPITAL ASSOCIATION 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 840482695 501(C)(3) 961982 0 SUPPORT MISSION 1 0 HUMANITARIAN GRANTS 13 8873 PART I, LINE 2: GRANTS ARE REQUESTED AND REVIEWED AND APPROVED BY THE FOUNDATION BOARD. THE HOSPITAL RECEIVES GRANTS UPON DOCUMENTATION THAT THE CAPITAL OR PROGRAM EXPENDITURES HAVE BEEN COMPLETED. 0 1 0 0 0 0 0 0 0 JAIME CAMPBELL DIRECTOR 0 365125 0 78931 0 33770 0 211763 0 9753 0 699342 0 78931 KURT GENSERT DIRECTOR 0 307733 0 46344 0 34893 0 149065 0 30112 0 568147 0 75443 MAGGIE MUNOZ FOUNDATION EXECUTIVE DIR/SECRETARY 0 101937 0 9418 0 490 0 18245 0 32189 0 162279 0 8427 PART I, LINE 3 THE ORGANIZATION'S OFFICERS AND SENIOR MANAGEMENT ARE PAID BY A RELATED ORGANIZATION, PLATTE VALLEY MEDICAL CENTER. COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE INTERMOUNTAIN HEALTH CARE, INC. BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND ALL OF ITS AFFILIATES. THE COMMITTEE REVIEWS AND APPROVES COMPENSATION ARRANGEMENTS OF THE OFFICERS AND SENIOR MANAGEMENT AND MAKES RECOMMENDATIONS TO INTERMOUNTAIN HEALTH CARE, INC.'S BOARD FOR APPROVAL OF ANY CHANGES. THE COMMITTEE'S REVIEW IS CONDUCTED IN A MANNER THAT IS INTENDED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS RULES OF INTERNAL REVENUE CODE SECTION 4958. THE COMMITTEE CONDUCTS THE REVIEW WITH THE ASSISTANCE OF AN EXPERIENCED AND INDEPENDENT COMPENSATION CONSULTING FIRM THAT HAS DEEP NATIONAL EXPERTISE IN HEALTH SYSTEMS' EXECUTIVE COMPENSATION PROGRAMS AND LEVELS. THE COMMITTEE OBTAINS AND RELIES UPON CURRENT, COMPARABLE MARKET DATA FOR PEER ORGANIZATIONS PRIOR TO MAKING COMPENSATION RELATED DECISIONS. THE INFORMATION REVIEWED INCLUDES COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR FUNCTIONALLY COMPARABLE POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA SERVED BY INTERMOUNTAIN HEALTH CARE, INC. AND CURRENT COMPENSATION SURVEYS COMPILED BY AN INDEPENDENT FIRM. THE BOARD PLACES A HIGH PRIORITY ON THE NEED TO RECURIT AND RETAIN A STRONG LEADERSHIP TEAM AND TO CREATE A HIGHLY MOTIVATED AND ENGAGED WORKFORCE. COMPENSATION LEVELS FOLLOW IRS GUIDELINES AND ARE SUBJECT TO IRS OVERSIGHT. AS PART OF THE REVIEW PROCESS, INTERMOUNTAIN HEALTH CARE, INC. USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OFFICERS AND SENIOR MANAGEMENT. 1) COMPENSATION COMMITTEE 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) COMPENSATION SURVEYS AND STUDIES 5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ITEMS LISTED ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. PART I, LINE 4B PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN A RELATED ORGANIZATION PROVIDES NONQUALIFIED DEFERRED COMPENSATION PLANS (NQDC) KNOWN AS SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (SERP) FOR EXECUTIVES (SENIOR MANAGEMENT) TO COMPENSATE FOR REGULATORY IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT- FOR- PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. IN 2014, IN AN EFFORT TO REDUCE LONG-TERM COSTS AND HAVE GREATER CONTROL OVER FINANCIAL RISK, THE SERP WAS CONVERTED FROM A DEFINED BENEFIT (DB) TO A DEFINED CONTRIBUTION (DC) DESIGN. CERTAIN MEMBERS OF SENIOR MANAGEMENT WHOSE BENEFITS WERE CONVERTED FROM DB TO DC WOULD HAVE BEEN DISPROPORTIONATELY AND NEGATIVELY AFFECTED BY THE CHANGE, SO THE COMMITTEE DETERMINED IT WOULD BE APPROPRIATE TO GRANT "TRANSITION CREDITS" IN ORDER TO MITIGATE THE NEGATIVE IMPACT OF THE CHANGE ON THEIR RETIREMENT BENEFITS. THIS IS A COMMON APPROACH EMPLOYED BY OTHER ORGANIZATIONS UNDERGOING A SIMILAR TRANSITION. THE TRANSITION CREDITS VEST IN ACCORDANCE WITH THE TERMS OF THE DC SERP (I.E., AFTER THREE YEARS) AND ARE PAID TO THE EXECUTIVE UPON VESTING. NQDC SERP PLANS STARTING IN 2014 STARTING IN 2014, THE RELATED ORGANIZATION'S NQDC SERP PLAN PROVIDED A BENEFIT TO ELIGIBLE PARTICIPANTS BASED ON A PERCENTAGE OF THEIR BASE COMPENSATION. THE VESTING PERIOD IS ROLLING 3 YEARS OR WHEN THE PARTICIPANT IS AGE 65 OR OLDER. THERE WERE NO CONTRIBUTIONS TO THIS PLAN BEFORE JANUARY 1, 2014. ANY DISTRIBUTIONS FROM THIS PLAN ARE REPORTED BELOW. CERTAIN PARTICIPANTS ARE VESTED OR BECAME VESTED IN THE PLAN DURING 2023. VESTED AMOUNTS ARE PAYABLE TO THE RECIPIENT UPON THE END OF EMPLOYMENT. THE VESTED AMOUNTS ARE TAXABLE TO THE RECIPIENT IN THE CURRENT YEAR. THE TAXABLE AMOUNTS ARE INCLUDED ON THE RECIPIENT'S W-2. THE AMOUNTS WITHDRAWN FROM THE NQDC SERP PLANS IN 2023 WERE: KURT GENSERT - $29,099. ADDITIONAL OFFICER AND BOARD DISCLOSURES INTERMOUNTAIN HEALTH CARE, INC. AND RELATED TAX-EXEMPT ORGANIZATIONS ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING ACCOUNTABILITY. IN KEEPING WITH INTERMOUNTAIN HEALTH CARE, INC.'S CORE VALUE OF STEWARDSHIP, INTERMOUNTAIN HEALTH CARE, INC.'S BOARD COMPENSATION COMMITTEE (COMMITTEE) HAS RETAINED THE SERVICES OF AN INDEPENDENT COMPENSATION ADVISOR. THE COMPENSATION ADVISOR IS RESPONSIBLE FOR ADVISING THE COMMITTEE ON ALL MATTERS RELATING TO EXECUTIVE COMPENSATION INCLUDING SUPPORTING THE COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. THE SISTERS WHO SERVE AS OFFICERS AND/OR BOARD MEMBERS ARE MEMBERS OF THE SISTERS OF CHARITY OF LEAVENWORTH (A RELIGIOUS ORDER OF WOMEN). THE SISTERS HAVE TAKEN VOWS OF POVERTY AND RECEIVE NO COMPENSATION, EXPENSE ACCOUNT ALLOWANCE, OR CONTRIBUTIONS TO BENEFIT PLANS FOR THEIR SERVICES TO THE HEALTH CARE SYSTEM. HOWEVER, A PAYMENT IS MADE DIRECTLY TO THE SISTERS OF CHARITY OF LEAVENWORTH FOR THE SERVICES OF THOSE WHO PERFORM PROFESSIONAL, ADMINISTRATIVE, AND OTHER SUCH SERVICES. FORM 990, LINE J WEBSITE: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/FOUNDATION/PLATTE-VALLEY-FOUNDATION/ FORM 990, PART V, LINE 1A EXPLANATION FOR NUMBER REPORTED IN BOX 3 OF FORM 1096: THE ORGANIZATION'S EXPENSES ARE PAID BY A RELATED 501(C)(3) TAX-EXEMPT ORGANIZATION. THE RELATED ORGANIZATION FILES THE REQUIRED FORM 1096 AND RELATED 1099 TAX FORMS FOR ANY EXPENDITURE THAT REQUIRES A FORM 1099 TO BE FILED. FORM 990, PART V, LINE 2A EXPLANATION FOR NUMBER REPORTED ON FORM W-3: THE ORGANIZATION LEASES EMPLOYEES FROM A RELATED 501(C)(3) TAX-EXEMPT ORGANIZATION. THE RELATED ORGANIZATION FILES THE REQUIRED W-3 AND RELATED W-2 TAX FORMS FOR THESE INDIVIDUALS. ACCORDING TO THE FORM 990 INSTRUCTIONS FOR PART IX, WE REFLECT THE LEASED EMPLOYEE'S COMPENSATION ON THE FORM 990, PART IX AS IF THE ORGANIZATION COMPENSATES THESE INDIVIDUALS. FORM 990, PART VI, SECTION A, LINE 2 KURT GENSERT / MAGGIE MUNOZ / JAIME CAMPBELL - BUSINESS RELATIONSHIP (EMPLOYER/EMPLOYEE RELATIONSHIP IN BRIGHTON COMMUNITY HOSPITAL ASSOCIATION). FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT MEMBERS PLATTE VALLEY MEDICAL CENTER, THE SOLE MEMBER OF PLATTE VALLEY MEDICAL CENTER FOUNDATION, APPROVES MEMBERS OF PLATTE VALLEY MEDICAL CENTER FOUNDATION BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS PLATTE VALLEY MEDICAL CENTER HAS CERTAIN RESERVE POWERS TO APPROVE CHANGES TO THE ARTICLES OF INCORPORATION AND THE BYLAWS INCLUDING THE APPOINTMENT OR REMOVAL OF BOARD MEMBERS AND THE PRESIDENT/CEO. SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. ALSO HAS CERTAIN RESERVE POWERS OVER ANY CHANGE IN OWNERSHIP OF THE CORPORATION, CHANGE IN MISSION, ACQUISITION OF ASSETS, DISPOSAL OF ASSETS, LEASING OF ASSETS, INCURRENCE OF DEBT, MERGER OR DISSOLUTION, APPROVAL OF STRATEGIC PLANS AND BUDGETS, APPOINTMENT OF AUDITORS AND OVERSIGHT AND APPROVAL OF COMPENSATION AND BENEFITS FOR DIRECTORS, OFFICERS, KEY EMPLOYEES AND PHYSICIANS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS USED TO REVIEW THE FORM 990 THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF INTERMOUNTAIN HEALTH CARE, INC. AND SUBSIDIARIES. THE DRAFT FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. A COPY OF THE FINAL FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY: EACH OFFICER, DIRECTOR, TRUSTEE AND KEY EMPLOYEE IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AT LEAST ANNUALLY. THESE INDIVIDUALS HAVE BEEN INSTRUCTED TO UPDATE THEIR QUESTIONNAIRE INFORMATION IF THEY BECOME AWARE OF A NEW POTENTIAL CONFLICT, OR IF ANY OF THE PREVIOUSLY REPORTED INFORMATION CHANGES. ADDITIONALLY, BOARD MEMBERS ARE ASKED AT THE BEGINNING OF EACH BOARD OR COMMITTEE MEETING IF THEY ARE AWARE OF ANY CONFLICTS. ACCORDING TO POLICY, THE QUESTIONNAIRES ARE COLLECTED AND REVIEWED BY INTERMOUNTAIN'S CHIEF COMPLIANCE OFFICER. POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED WITH APPROPRIATE PERSONNEL, WHICH MAY INCLUDE (BUT IS NOT LIMITED TO) THE AUDIT AND COMPLIANCE COMMITTEE CHAIR, SENIOR MANAGEMENT AND THE LEGAL DEPARTMENT. IF AN INDIVIDUAL DISCLOSES A SITUATION THAT POSES A CONFLICT OF INTEREST, A DETERMINATION IS MADE WHETHER THE SITUATION CAN BE MANAGED (SUCH AS BY RECUSAL IN DECISION-MAKING SETTINGS) OR MUST BE ELIMINATED (SUCH AS THROUGH DIVESTITURE OF THE OUTSIDE INTEREST). FINDINGS ARE REPORTED TO THE AUDIT AND COMPLIANCE COMMITTEE OF INTERMOUNTAIN HEALTH CARE, INC. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S OFFICERS AND SENIOR MANAGEMENT ARE PAID BY A RELATED ORGANIZATION, PLATTE VALLEY MEDICAL CENTER. COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE INTERMOUNTAIN HEALTH CARE, INC. BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND ALL OF ITS AFFILIATES. THE COMMITTEE REVIEWS AND APPROVES COMPENSATION ARRANGEMENTS OF THE OFFICERS AND SENIOR MANAGEMENT AND MAKES RECOMMENDATIONS TO INTERMOUNTAIN HEALTH CARE, INC.'S BOARD FOR APPROVAL OF ANY CHANGES TO COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT. THE COMMITTEE'S REVIEW IS CONDUCTED IN A MANNER THAT IS INTENDED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS RULES OF INTERNAL REVENUE CODE SECTION 4958. THE COMMITTEE CONDUCTS THE REVIEW WITH THE ASSISTANCE OF AN EXPERIENCED AND INDEPENDENT COMPENSATION CONSULTING FIRM THAT HAS DEEP NATIONAL EXPERTISE IN HEALTH SYSTEMS' EXECUTIVE COMPENSATION PROGRAMS AND LEVELS. THE COMMITTEE OBTAINS AND RELIES UPON CURRENT, COMPARABLE MARKET DATA FOR PEER ORGANIZATIONS PRIOR TO MAKING COMPENSATION RELATED DECISIONS. THE INFORMATION REVIEWED INCLUDES COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR FUNCTIONALLY COMPARABLE POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA SERVED BY INTERMOUNTAIN HEALTH CARE, INC. AND CURRENT COMPENSATION SURVEYS COMPILED BY AN INDEPENDENT FIRM. CONSISTENT WITH THE PAY PHILOSOPHY SET BY INTERMOUNTAIN HEALTH CARE, INC.'S BOARD, THE COMMITTEE EMPHASIZES THE IMPORTANCE OF ENSURING TOTAL REMUNERATION IS REASONABLE AND APPROPRIATE WHEN REVIEWING AND MAKING RECOMMENDATIONS WITH RESPECT TO COMPENSATION PACKAGES FOR THE OFFICERS AND SENIOR MANAGEMENT. AS PART OF THE REVIEW PROCESS, INTERMOUNTAIN HEALTH CARE, INC. USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OFFICERS AND SENIOR MANAGEMENT. 1) COMPENSATION COMMITTEE 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) COMPENSATION SURVEYS AND STUDIES 5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ITEMS LISTED ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND GOVERNING DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION B INDEPENDENT CONTRACTORS: THE ORGANIZATION'S EXPENSES ARE PAID BY A RELATED 501(C)(3) TAX-EXEMPT ORGANIZATION. THE RELATED ORGANIZATION FILES THE REQUIRED FORM 1096 AND RELATED 1099 TAX FORMS FOR ANY EXPENDITURE THAT REQUIRES A FORM 1099 TO BE FILED. SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 237379161 MANAGEMENT OF RELATED TAX EXEMPT HOSPITALS AND HEALTHCARE SERVICES KS 501(C)(3) LINE 12B, II INTERMOUNTAIN HEALTH CARE INC 1 SCL HEALTH FOUNDATION 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 823290526 SUPPORT RELATED TAX EXEMPT ORGANIZATIONS CO 501(C)(3) LINE 7 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 SCL HEALTH RESEARCH INSTITUTE INC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 852014794 MEDICAL RESEARCH CO 501(C)(3) LINE 4 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 INTEGRITY HEALTH 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 474520350 SUPPORTING ORGANIZATION CO 501(C)(3) LINE 12C, III-FI SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 BRIGHTON COMMUNITY HOSPITAL ASSOCIATION 1600 PRAIRIE CENTER PARKWAY BRIGHTON CO 80601 840482695 HOSPITAL SERVICES CO 501(C)(3) LINE 3 INTEGRITY HEALTH 1 MOUNT ST VINCENT HOME INC 4159 LOWELL BOULEVARD DENVER CO 80211 840405260 RESIDENT CARE CO 501(C)(3) LINE 10 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 NJH-SJH INC 500 ELDORADO BLVD SUITE 4300 DENVER CO 80211 471194849 MANAGEMENT OF RELATED TAX EXEMPT HOSPITALS AND HEALTHCARE SERVICES CO 501(C)(3) LINE 12A, I SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 SAINT JOSEPH HOSPITAL INC 1375 EAST 19TH AVENUE DENVER CO 80218 840417134 HOSPITAL SERVICES CO 501(C)(3) LINE 3 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 SAINT JOSEPH HOSPITAL FOUNDATION 1375 EAST 19TH AVENUE DENVER CO 80218 840735096 SUPPORT RELATED TAX EXEMPT ORGANIZATIONS CO 501(C)(3) LINE 7 SAINT JOSEPH HOSPITAL INC 1 SCL HEALTH - FRONT RANGE INC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 841103606 HOSPITAL SERVICES CO 501(C)(3) LINE 3 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 GOOD SAMARITAN MEDICAL CENTER FOUNDATION 200 EXEMPLA CIRCLE LAFAYETTE CO 80026 841649162 SUPPORT RELATED TAX EXEMPT ORGANIZATIONS CO 501(C)(3) LINE 7 SCL HEALTH-FRONT RANGE INC 1 LUTHERAN MEDICAL CENTER FOUNDATION 8300 WEST 38TH AVENUE WHEAT RIDGE CO 80033 208846152 SUPPORT RELATED TAX EXEMPT ORGANIZATIONS CO 501(C)(3) LINE 7 SCL HEALTH-FRONT RANGE INC 1 ST MARY'S HOSPITAL & MEDICAL CENTER INC 2635 NORTH 7TH STREET GRAND JUNCTION CO 81501 840425720 HOSPITAL SERVICES CO 501(C)(3) LINE 3 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 ST MARY'S HOSPITAL FOUNDATION 2635 NORTH 7TH STREET GRAND JUNCTION CO 81501 237001007 SUPPORTING ORGANIZATION CO 501(C)(3) LINE 12A, I ST MARYS HOSPITAL & MEDICAL CENTER INC 1 CARITAS CLINICS INC 818 NORTH 7TH STREET LEAVENWORTH KS 66048 481009910 CLINIC SERVICES KS 501(C)(3) LINE 3 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 HOLY ROSARY HEALTHCARE 2600 WILSON STREET MILES CITY MT 59301 810231792 HOSPITAL SERVICES MT 501(C)(3) LINE 3 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 HOLY ROSARY HEALTHCARE FOUNDATION INC 2600 WILSON STREET MILES CITY MT 59301 202270238 SUPPORTING ORGANIZATION MT 501(C)(3) LINE 12A, I HOLY ROSARY HEALTHCARE 1 ST JAMES HEALTHCARE 400 SOUTH CLARK STREET BUTTE MT 59701 810231785 HOSPITAL SERVICES MT 501(C)(3) LINE 3 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 ST JAMES HEALTHCARE FOUNDATION INC 400 SOUTH CLARK STREET BUTTE MT 59701 651202190 SUPPORTING ORGANIZATION MT 501(C)(3) LINE 12A, I ST JAMES HEALTHCARE 1 SCL HEALTH - MONTANA 1233 NORTH 30TH STREET BILLINGS MT 59101 810232124 HOSPITAL SERVICES MT 501(C)(3) LINE 3 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 1 ST VINCENT HEALTHCARE FOUNDATION INC 1106 NORTH 30TH STREET BILLINGS MT 59101 810468034 SUPPORT RELATED TAX EXEMPT ORGANIZATIONS MT 501(C)(3) LINE 7 SCL HEALTH - MONTANA 1 INTERMOUNTAIN HEALTH CARE INC 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 870269232 HOLDING COMPANY UT 501(C)(3) LINE 12B, II N/A 0 INTERMOUNTAIN COMMUNITY CARE FOUNDATION INC 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 942853320 COMMUNITY HEALTH UT 501(C)(3) LINE 12B, II INTERMOUNTAIN HEALTH CARE INC 1 SELECTHEALTH INC 5381 GREEN STREET MURRAY UT 84123 870409820 DELIVERY OF HEALTH BENEFITS UT 501(C)(4) INTERMOUNTAIN HEALTH CARE INC 1 INTERMOUNTAIN HEALTH CARE RETIREE VEBA 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 742675605 RETIREE BENEFIT UT 501(C)(9) INTERMOUNTAIN HEALTH CARE INC 1 INTERMOUNTAIN HEALTHCARE FOUNDATION INC 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 800225150 COMMUNITY HEALTH UT 501(C)(3) LINE 7 INTERMOUNTAIN HEALTH SERVICES INC 1 INTERMOUNTAIN MEDICAL HOLDINGS NEVADA INC 6355 SOUTH BUFFALO LAS VEGAS NV 89113 200160881 HOLDING COMPANY DE 501(C)(3) LINE 3 INTERMOUNTAIN HEALTH SERVICES INC 1 IHC HEALTH SERVICES INC 36 S STATE STREET SUITE 2200 SALT LAKE CITY UT 84111 942854057 HEALTHCARE UT 501(C)(3) LINE 3 INTERMOUNTAIN HEALTH CARE INC 1 SCLH-GI ENDOSCOPY HOLDINGS LLC 382 S ARTHUR AVENUE LOUISVILLE CO 80027 812979243 OP ENDOSCOPY CO N/A 0 0 SCLTDI JV LLC 4200 SIX FORKS ROAD SUITE 1000 RALEIGH NC 27609 472294770 RADIOLOGY DE N/A 0 0 ATHLETIC MEDICINE & PERFORMANCE LLC (SVB IS PARTNER) 1144 NORTH 28TH STREET BILLINGS MT 59101 272270640 PHYSICAL THERAPY MT N/A 0 0 SUMMIT SURGERY CENTER LLC 434 SOUTH CLARK STREET BUTTE MT 59701 810536068 OP SURGERY MT N/A 0 0 GRAND VALLEY SURGICAL CENTER LLC 710 WELLINGTON AVENUE SUITE 21 GRAND JUNCTION CO 81501 841505075 OP SURGERY CO N/A 0 0 HEALTHCARE MANAGEMENT LLC PO BOX 1929 GRAND JUNCTION CO 81502 841238904 MANAGEMENT SERVICES CO N/A 0 0 MONUMENT HEALTH LLC 744 HORIZON CT STE 260 GRAND JUNCTION CO 81506 474424617 HEALTH CARE NETWORK CO N/A 0 0 PAVILION IMAGING LLC 750 WELLINGTON AVENUE GRAND JUNCTION CO 81501 030516198 RADIOLOGY CO N/A 0 0 SAN JUAN CANCER CENTER LLC 600 SOUTH 5TH STREET MONTROSE CO 81401 202856331 OP CANCER CO N/A 0 0 CAREFLIGHT OF THE ROCKIES LLC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 473525381 MEDICAL AIR TRANSPORT CO N/A 0 0 MED-MAP LLC PO BOX 1295 BILLINGS MT 59103 810491356 RENTAL REAL ESTATE MT N/A 0 0 YELLOWSTONE SURGERY CENTER LLC 1144 NORTH 28TH STREET BILLINGS MT 59101 721519467 OP SURGERY MT N/A 0 0 GALLATIN VALLEY SURGERY CENTER LLC 2825 WEST MAIN STREET SUITE C BOZEMAN MT 59718 882505265 OP SURGERY MT N/A 0 0 FIRST FLIGHT OF WYOMING LLC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 921785143 MEDICAL AIR TRANSPORT CO N/A 0 0 MCKAY DEE SURGICAL CENTER LLC 3895 HARRISON BLVD STE 200 OGDEN UT 84403 260286308 OP SURGERY UT N/A 0 0 GRANDEUR PEAK INTERNATIONAL STALWARTS LP 136 S MAIN STREET STE 720 SALT LAKE CITY UT 84101 475468723 INVESTMENTS DE N/A 0 0 INNOVATION FUND HOLDINGS COMPANY LLC 1000 WEST FULTON STREET STE 213 CHICAGO IL 60607 471525723 INNOVATION DE N/A 0 0 HEALTHBOX SALT LAKE CITY I LLC 33 WEST MONROE STREET STE 1700 CHICAGO IL 60603 465338772 INNOVATION DE N/A 0 0 INTERMOUNTAIN VENTURES FUND LLC 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 844037085 INVESTMENTS DE N/A 0 0 PELION OPPORTUNITY FUND III LLC 2750 E COTTONWOOD PARKWAY STE 600 SALT LAKE CITY UT 84121 842757193 INVESTMENTS DE N/A 0 0 AACP KOREA BUYOUT INVESTORS II LP ONE EMBARCADERO 16TH FLOOR SAN FRANCISCO CA 94111 824971663 INVESTMENTS CJ N/A 0 0 AACP SPECIAL SITUATIONS II LP ONE EMBARCADERO 16TH FLOOR SAN FRANCISCO CA 94111 832883726 INVESTMENTS CJ N/A 0 0 AACP KOREA BUYOUT INVESTORS IV LP ONE EMBARCADERO 16TH FLOOR SAN FRANCISCO CA 94111 981549044 INVESTMENTS CJ N/A 0 0 LOGAN SURGERY CENTER LLC 1300 NORTH 500 EAST LOGAN UT 84341 861965725 OP SURGERY UT N/A 0 0 ST GEORGE SURGERY CENTER LLC 652 SOUTH MEDICAL CENTER DRIVE ST GEORGE UT 84790 853880188 OP SURGERY UT N/A 0 0 SALTZER ASC TEN MILE LLC 875 S VANGUARD WAY SUITE 120 MERIDIAN ID 83642 845119941 OP SURGERY ID N/A 0 0 NORTHPOINTE SURGICAL CENTER LLC 2326 NORTH 400 EAST STE 100 TOOELE UT 84074 461487986 OP SURGERY UT N/A 0 0 HW AE CO-INVESTMENT PARTNERS LP 2500 N MILITARY TRAIL 470 BOCA RATON FL 33431 873405511 INVESTMENTS DE N/A 0 0 PERFORMANCE EQUITY GROWTH OPPORTUNITIES FUND LP 5 GREENWICH OFFICE PARK THIRD FLOOR GREENWICH CT 06831 853942801 INVESTMENTS DE N/A 0 0 MURRAY SURGERY CENTER LLC 5848 SOUTH FASHION BOULEVARD MURRAY UT 84107 873940183 OP SURGERY UT N/A 0 0 PROVO SURGERY CENTER LLC 1157 NORTH 300 WEST PROVO UT 84604 873623664 OP SURGERY UT N/A 0 0 SARATOGA SPRINGS SURGERY CENTER LLC 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 873875864 OP SURGERY UT N/A 0 0 PARK CITY SURGERY CENTER LLC 900 ROUND VALLEY DRIVE PARK CITY UT 84060 844898736 OP SURGERY UT N/A 0 0 PARK CITY SURGICAL CENTER REAL ESTATE LLC 900 ROUND VALLEY DRIVE PARK CITY UT 84060 862568233 OP SURGERY UT N/A 0 0 CDHC 3 LLC 265 N COUNTRY MANOR LANE ALPINE UT 84004 873215157 INVESTMENTS UT N/A 0 0 ARK GLOBAL EMERGING COMPANIES LP 22 EAST 100 SOUTH 3RD FLOOR SALT LAKE CITY UT 84111 823044843 INVESTMENTS UT N/A 0 0 PELION OPPORTUNITY FUND IV LLC 14761 S FUTURE WAY SUITE 500 SALT LAKE CITY UT 84020 853909188 INVESTMENTS UT N/A 0 0 CARITAS INC AND SUBSIDIARIES 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 480941069 HEALTHCARE KS N/A C 1 WEST END ASSOCIATION INC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 854261243 REAL ESTATE MANAGEMENT MT N/A C 1 LEAVEN INSURANCE COMPANY LTD 23 LIME TREE BAY AVENUE WEST BAY R GRAND CAYMAN KY CJ 980370522 INSURANCE CJ N/A C 1 ROCKY MOUNTAIN ACCOUNTABLE HEALTH NETWORK INC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 463632053 HEALTHCARE MT N/A C 1 SELECTHEALTH BENEFIT ASSURANCE COMPANY 5381 GREEN STREET MURRAY UT 84123 870497549 DELIVERY OF HEALTH BENEFITS UT N/A C 1 HEALTHCARE CAPTIVE INSURANCE COMPANY 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 201937561 INSURANCE AZ N/A C 1 ALLUCEO INC 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 824614934 MENTAL HEALTH INTEGRATION SERVICES DE N/A C 1 SALTZER MEDICAL GROUP INC 215 EAST HAWAII AVENUE NAMPA ID 83686 820299231 MEDICAL SERVICES ID N/A C 1 CLASSIC MEDICAL INC 1021 SOUTH DOUGLAS STREET SALT LAKE CITY UT 84105 461141912 AIRCRAFT HOLDING COMPANY UT N/A C 1 CLASSIC HELICOPTERS INC 1021 SOUTH DOUGLAS STREET SALT LAKE CITY UT 84105 461153642 AIRCRAFT HOLDING COMPANY UT N/A C 1 CULMINATION BIO INC 36 SOUTH STATE SUITE 2200 SALT LAKE CITY UT 84111 365016511 BIOREPOSITORY DE N/A C 1 CAN YOU PLAY INC 1541 SOUTH 120 EAST SALT LAKE CITY UT 84025 880846977 SOFTWARE DEVELOPMENT UT N/A C 1 CARENT LABORATORY SOLUTIONS LLC 22240 COUNTRY ROAD 39 LASALLE CO 80645 320557616 MEDICAL LABORATORY CO N/A C 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 BRIGHTON COMMUNITY HOSPITAL ASSOCIATION B 961982 COST BRIGHTON COMMUNITY HOSPITAL ASSOCIATION C 214698 COST