Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 4,564,181 | 4,763,406 | 4,676,551 | 4,600,000 | 4,600,000 | 23,204,138 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | 2,770,247 | 2,137,764 | 2,845,580 | 2,753,478 | 2,917,739 | 13,424,808 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 7,334,428 | 6,901,170 | 7,522,131 | 7,353,478 | 7,517,739 | 36,628,946 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 36,628,946 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 7,334,428 | 6,901,170 | 7,522,131 | 7,353,478 | 7,517,739 | 36,628,946 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 2,209 | 3,437 | 8,767 | 1,649 | 2,074 | 18,136 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 2,209 | 3,437 | 8,767 | 1,649 | 2,074 | 18,136 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 7,336,637 | 6,904,607 | 7,530,898 | 7,355,127 | 7,519,813 | 36,647,082 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, Line 6 | DESCRIBE CIRCUMSTANCES FOR HAVING MEMBERS OR STOCKHOLDERS The organization has a single member, Vail Health Services. |
| Form 990, Part VI, Section A, Line 7a | DESCRIBE CIRCUMSTANCES FOR MEMBERS ELECTING GOVERNING BODY The Single member, Vail Health Services, can appoint Board members. Form 990, Part VI, Section A, Line 7b Governance Decisions Reserved to Members or Stockholders THE SINGLE MEMBER HAS THE AUTHORITY TO: 1) ELECT DIRECTORS; 2) APPOINT THE PRESIDENT; 3) APPROVE ARTICLES AND BYLAWS; 4) APPROVE BUDGETS; 5) APPROVE UNBUDGETED EXPENDITURES IN EXCESS OF $100,000; 6) APPROVE UNBUDGETED BORROWINGS IN EXCESS OF $1,000,000; 7) CAUSE VOLUNTARY DISSOLUTION, MERGER, CONSOLIDATION, OR BANKRUPTCY; 8) APPROVE SALE OF ASSETS IN EXCESS OF $1,000,000; 9) CREATE SUBSIDIARY OR AFFILIATE; 10) SELECT PUBLIC ACCOUNTANTS; 11) ESTABLISH INVESTMENT POLICIES; 12) ESTABLISH POLICIES ON THE DISTRIBUTION AND USE OF FUNDS; 13) ADD/DELETE MAJOR PROGRAM/SERVICE LINES. |
| Form 990, Part VI, Section B, line 11b | DESCRIBE THE PROCESS TO REVIEW THE 990 Review of the Form 990 is delegated to more qualified personnel since the Board members are not trained in tax matters. The CFO, Controller and accounting staff of Vail Clinic, Inc., dba Vail HEALTH HOSPITAL, providing services to VAIL HEALTH CLINICS, reviews the tax form and works with an external CPA/Tax firm in the production of the Form 990. An electronic version is provided to directors and officers for review, discussion and comment prior to filing the form 990 with the irs. |
| Form 990, Part VI, Section B, line 12c | PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY THE CONFLICT OF INTEREST POLICY APPLIES TO VAIL HEALTH HOSPITAL (VHH) BOARD MEMBERS, OFFICERS, MEDICAL STAFF, LICENSED INDEPENDENT PRACTITIONERS, VOLUNTEERS, AGENTS, CONTRACTORS AND EMPLOYEES. ALL BOARD MEMBERS, MEDICAL STAFF, NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS, AND EMPLOYEES OF VHH ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST BY COMPLETING A CONFLICT OF INTEREST ELECTRONIC QUESTIONNAIRE UPON HIRE OR APPOINTMENT AND THEN ANNUALLY. BOARD MEMBERS AND AGENTS MUST COMPLETE AND SUBMIT CONFLICT OF INTEREST ELECTRONIC QUESTIONNAIRE TO THE CHIEF ETHICS AND COMPLIANCE OFFICER UPON HIRE OR APPOINTMENT AND THEN ANNUALLY. VOLUNTEERS MUST COMPLETE AND SUBMIT DISCLOSURE FORMS TO THE MANAGER OF VOLUNTEERS WHEN THEY BEGIN PROVIDING SERVICES TO VHH AND THEN ANNUALLY. IF DURING THE YEAR ANY NEW POTENTIAL CONFLICTS OF INTEREST ARISE, COVERED PERSONS MUST REPORT THE POTENTIAL CONFLICTS OF INTEREST IMMEDIATELY (AND PRIOR TO UNDERTAKING ANY ACTIVITY THAT MAY RAISE A POTENTIAL CONFLICT OF INTEREST). THE CHIEF ETHICS AND COMPLIANCE OFFICER, THE VOLUNTEER SERVICES PROGRAM MANAGER AND THE COMMITTEE SHALL CONSIDER THE FOLLOWING FACTORS WHEN REVIEWING COMPLETED DISCLOSURE FORMS: - WHETHER THE COLLEAGUE OR AN IMMEDIATE FAMILY MEMBER IS A PARTY TO, OR MAY DIRECTLY OR INDIRECTLY BENEFIT FROM, A PROPOSED AGREEMENT OR TRANSACTION INVOLVING VHH; - WHETHER THE COLLEAGUE'S DESIRE FOR, OR EXPECTATION OF, DIRECT OR INDIRECT EXTERNAL ECONOMIC ADVANTAGE COULD DISTORT A VHH DECISION OR ACTIVITY; - WHETHER THE COLLEAGUE OR AN IMMEDIATE FAMILY MEMBER IS ENGAGING IN AN ACTIVITY, BUSINESS, OR TRANSACTION IN WHICH VHH IS LIKELY TO ENGAGE; - WHETHER THE COLLEAGUE'S OUTSIDE ACTIVITIES MAY CONFLICT WITH RIGHTS OF, OR THE COLLEAGUE'S OBLIGATIONS TO, VHH OR VHH'S PATIENTS; - WHETHER THE CONFLICT OF INTEREST CAN BE CURED OR MANAGED BY RECUSAL OR OTHER APPROPRIATE ACTION; - WHETHER THERE IS AN APPEARANCE OF A CONFLICT OF INTEREST. - WHETHER THE COLLEAGUE OR AN IMMEDIATE FAMILY MEMBER IS ENGAGING IN AN ACTIVITY, BUSINESS, OR TRANSACTION IN WHICH VHH IS LIKELY TO ENGAGE; - WHETHER THE COLLEAGUE'S OUTSIDE ACTIVITIES MAY CONFLICT WITH RIGHTS OF, OR THE COLLEAGUE'S OBLIGATIONS TO, VHH OR VHH'S PATIENTS; - WHETHER THE CONFLICT OF INTEREST CAN BE CURED OR MANAGED BY RECUSAL OR OTHER APPROPRIATE ACTION; - WHETHER THERE IS AN APPEARANCE OF A CONFLICT OF INTEREST. |
| Form 990, Part VI, Section B, line 15a | PROCESS TO DETERMINE EXECUTIVE COMPENSATION Executive compensation is paid and determined by a related party, Vail Clinic, Inc., DBA Vail HEALTH HOSPITAL. A FORMAL EXTERNAL REVIEW IS CONDUCTED EVERY YEAR. EXECUTIVE cOMPENSATION WAS LAST FORMALLY REVIEWED IN 2016 BY SULLIVAN COTTER. THIS rEVIEW EVALUATES TOTAL COMPENSATION OF THE EXECUTIVE AGAINST COMPENSATION DATA FOR THE SAME OR SIMILAR JOB BY INDUSTRY, REVENUE SIZE AND GEOGRAPHIC LOCATION AND OTHER FACTORS TO ENSURE THAT THE COMPENSATION PAID IS APPROPRIATE AND REASONABLE. THAT INFORMATION IS THEN REVIEWED BY THE COMPENSATION COMMITTEE AND THE BOARD OF DIRECTORS. INTERNAL REVIEWS ARE PERFORMED AS WELL AT TIME OF HIRE AND ON AN ONGOING BASIS USING COMPENSATION SURVEYS. |
| Form 990, Part VI, Section B, line 15b | PROCESS TO DETERMINE OFFICER COMPENSATION Executive compensation is paid and determined by a related party, Vail Clinic, Inc., DBA Vail HEALTH HOSPITAL. A FORMAL EXTERNAL REVIEW IS CONDUCTED EVERY YEAR. Other officer, and key employee COMPENSATION WAS LAST FORMALLY REVIEWED IN 2016 BY SULLIVAN COTTER. THIS rEVIEW EVALUATES TOTAL COMPENSATION OF THE individual AGAINST COMPENSATION DATA FOR THE SAME OR SIMILAR JOB BY INDUSTRY, REVENUE SIZE AND GEOGRAPHIC LOCATION AND OTHER FACTORS TO ENSURE THAT THE COMPENSATION PAID IS APPROPRIATE AND REASONABLE. THAT INFORMATION IS THEN REVIEWED BY THE COMPENSATION COMMITTEE AND THE BOARD OF DIRECTORS. INTERNAL REVIEWS ARE PERFORMED AS WELL AT TIME OF HIRE AND ON AN ONGOING BASIS USING COMPENSATION SURVEYS. |
| Form 990, Part VI, Section C, line 19 | DESCRIBE HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC FOR VIEWING FOR VALID BUSINESS PURPOSES. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES TOTAL FEES:2159742 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CODING FEES TOTAL FEES:79885 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION FEES TOTAL FEES:2662 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAUNDRY TOTAL FEES:1516 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONSULTING TOTAL FEES:520 |
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