Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 1,914,632 | 1,844,507 | 2,101,282 | 2,700,111 | 1,343,384 | 9,903,916 |
| 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 | 1,914,632 | 1,844,507 | 2,101,282 | 2,700,111 | 1,343,384 | 9,903,916 |
| 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).. | 5,211,229 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 4,692,687 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,914,632 | 1,844,507 | 2,101,282 | 2,700,111 | 1,343,384 | 9,903,916 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 560,364 | 1,406,363 | 657,079 | 655,460 | 572,180 | 3,851,446 |
| 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 | 13,800,773 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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 | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| 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. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL BE COMPRISED OF NOT LESS THAN THREE AND NOT MORE THAN SIX INDIVIDUALS, WHICH SHALL INCLUDE THE FOLLOWING OFFICERS: THE CHAIR AND PRESIDENT OF THE BOARD, THE VICE PRESIDENT(S), IF ANY, THE SECRETARY, THE TREASURER, AND THE IMMEDIATE PAST PRESIDENT. THE EXECUTIVE COMMITTEE SHALL PERFORM OR CAUSE TO BE PERFORMED THE FOLLOWING FUNCTIONS (EXCEPT AS SET FORTH BELOW): (I) REVIEW AND EVALUATE THE ON-GOING PERFORMANCE OF THE BOARD EXECUTIVE, MEMBERS OF THE BOARD (BOTH INDIVIDUALLY AND COLLECTIVELY), AND CHAIRS, AND PROCURE ANNUAL CONFLICT OF INTEREST STATEMENTS FROM RELATED PARTIES EACH YEAR; (II) DIRECT THE ON-GOING BUSINESS AND AFFAIRS OF THE CORPORATION IN THE INTERIM BETWEEN REGULARLY SCHEDULED BOARD MEETINGS, PROVIDING ADVICE AND COUNSEL TO THE CHAIR AND PRESIDENT AND TO THE BOARD EXECUTIVE OFFICER AND ACTING ON PENDING MATTERS ON BEHALF OF THE BOARD WHEN IT IS NOT IN SESSION; (III) MAINTAIN THE "GOOD STANDING" OF THE CORPORATION AS A LEGAL COLORADO ENTITY AND ITS TAX-EXEMPT, NON-PROFIT STATUS UNDER FEDERAL AND STATE TAX LAWS. NOTWITHSTANDING THE PRECEDING, THE EXECUTIVE COMMITTEE SHALL NOT HAVE THE AUTHORITY TO APPROVE ANY OF THE FOLLOWING ACTIONS: (A) APPOINT, REMOVE OR FILL VACANCIES IN THE BOARD; (B) ANY AMENDMENT TO THE ARTICLES OR BYLAWS OF THE ORGANIZATION; (C) ADOPT A PLAN OF MERGER OR CONSOLIDATION WITH ANOTHER ORGANIZATION; (D) AUTHORIZE THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE ORGANIZATION; (E) AUTHORIZE THE VOLUNTARY DISSOLUTION OF THE ORGANIZATION OR REVOKING PROCEEDINGS THEREFOR; (F) AMENDING, ALTERING OR REPEALING ANY RESOLUTION OF THE BOARD WHICH BY ITS TERMS PROVIDES THAT IT SHALL NOT BE AMENDED, ALTERED OR REPEALED BY SUCH COMMITTEE; OR (G) APPOINT, OTHER THAN ON A TEMPORARY OR INTERIM BASIS, THE CHAIR AND PRESIDENT OF THE BOARD OR CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 2 | THE CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER ARE OFFICERS OF AND EMPLOYED BY THE WELD TRUST, A RELATED TAX-EXEMPT ORGANIZATION. MEMBERS OF THE BOARD ARE ALSO MEMBERS OF THE BOARD OF DIRECTORS OF THE WELD TRUST. THEREFORE, BUSINESS RELATIONSHIPS EXIST BETWEEN THESE INDIVIDUALS. |
| FORM 990, PART VI, SECTION A, LINE 3 | BEGINNING IN APRIL OF 2020 THE WELD TRUST, A RELATED TAX-EXEMPT ORGANIZATION, PERFORMED EXECUTIVE MANAGEMENT SERVICES INCLUDING CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER SERVICES. SEE FORM 990, PART VII FOR COMPENSATION PAID BY THE RELATED ENTITY FOR THESE SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 4 | AMENDMENTS TO THE FOUNDATION'S ARTICLES OF INCORPORATION AND BYLAWS INCLUDED THE FOLLOWING: - UPDATED THE FOUNDATION'S PURPOSE CLAUSE TO STATE ITS PRIMARY PURPOSE WILL BE TO ENHANCE AND IMPROVE THE QUALITY OF LIFE IN WELD COUNTY, COLORADO, BY PROMOTING EXCELLENCE IN HEALTH, EDUCATION, AND WELL-BEING WITHIN WELD COUNTY AND BY RAISING FUNDS FOR AND PROVIDING FINANCIAL SUPPORT TO ACHIEVE SUCH MISSION. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE FOUNDATION DOES NOT HAVE ANY COMMITTEE WITH BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS PROVIDED TO THE ENTIRE BOARD AND IS REVIEWED BY THE FINANCE COMMITTEE PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS ANNUALLY REVIEWED WITH THE BOARD. EACH BOARD MEMBER IS REQUIRED TO ANNUALLY SIGN A DECLARATION OF POTENTIAL CONFLICTS OF INTEREST. BOARD MEMBERS ARE ASKED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST AT EACH MEETING AND ANY SUCH CONFLICTS ARE DOCUMENTED IN THE MEETING MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION PAID TO THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, AND OTHER EMPLOYEES IS PAID BY THE WELD TRUST, A RELATED TAX-EXEMPT ORGANIZATION. THE WELD TRUST USES A COMPENSATION SURVEY, COMPARABILITY SALARY DATA FOR SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATION, AND APPROVAL BY THE BOARD OF DIRECTORS TO DETERMINE COMPENSATION LEVELS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE IN THE NORTH COLORADO MEDICAL CENTER FOUNDATION OFFICES AT 815 8TH AVENUE, GREELEY, COLORADO. THEY ARE AVAILABLE FOR THE PUBLIC REVIEW AT THIS SITE ONLY. |
| FORM 990, PART VII, SECTION A, LINE 1A: | THE FORMER PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE FOUNDATION LEFT HIS POSITION DURING 2020 AND BECAME THE DIRECTOR OF HEALTH GRANTS AND FUNDRAISING FOR THE FOUNDATION AND FOR THE WELD TRUST, A RELATED TAX-EXEMPT ORGANIZATION. THE COMPENSATION REPORTED ON FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (D) IS THE AMOUNT PAID BY BANNER HEALTH, AN UNRELATED TAX-EXEMPT ORGANIZATION, FOR PRESIDENT/CHIEF EXECUTIVE OFFICER SERVICES. IN ADDITION, THE COMPENSATION REPORTED ON FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (E) WAS PAID BY THE WELD TRUST FOR DIRECTOR OF HEALTH GRANTS AND FUNDRAISING SERVICES TO THE FOUNDATION AND REPRESENTS ONLY THE PORTION OF COMPENSATION PAID FOR THOSE SERVICES. THE FOUNDATION IS NOT REPORTING ANY FORM W2S ON FORM 990, PART V, LINE 2A RELATED TO THESE PAYMENTS, BECAUSE THE W2S ARE FILED BY THE WELD TRUST AND BANNER HEALTH. THE COMPENSATION PAID TO THE CURRENT CHIEF EXECUTIVE OFFICER (CEO) AND THE CHIEF OPERATING OFFICER (COO) IS PAID BY THE WELD TRUST, A RELATED TAX-EXEMPT ORGANIZATION. THE CEO AND COO PROVIDE SERVICES TO BOTH NORTH COLORADO MEDICAL CENTER FOUNDATION AND TO THE WELD TRUST. THE COMPENSATION REPORTED ON FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (E) WAS PAID BY THE WELD TRUST AND REPRESENTS ONLY THE PORTION OF COMPENSATION PAID FOR CEO AND COO SERVICES TO THE FOUNDATION. THE FOUNDATION IS NOT REPORTING ANY FORM W2S ON FORM 990, V, LINE 2A RELATED TO THESE PAYMENTS, BECAUSE THE W2S ARE FILED BY THE WELD TRUST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT -8,313. |
| Software ID: | |
| Software Version: |