TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) Carissa Tripi...................................................................... Physician	40.0 ................. 0.0			X	686,356	31,563
(2) Jason Defee...................................................................... Physician	40.0 ................. 0.0			X	637,694	37,936
(3) Konnie Martin...................................................................... CEO	40.0 ................. 2.0		X		538,697	35,600
(4) Julian Maendel...................................................................... Physician	40.0 ................. 0.0			X	488,184	34,701
(5) James Grigsby...................................................................... Physician	40.0 ................. 0.0			X	486,147	31,563
(6) Maureen Cooper...................................................................... Physician	40.0 ................. 0.0			X	497,496	15,015
(7) Dennard Ellison...................................................................... Trustee, Physician	40.0 ................. 0.0	X			430,112	37,732
(8) Carmelo Hernandez...................................................................... CMO	40.0 ................. 0.0		X		414,721	37,595
(9) Shane Mortensen...................................................................... CFO	40.0 ................. 1.0		X		259,095	30,214
(10) Christine Hettinger-Hunt...................................................................... COO	40.0 ................. 0.0		X		237,596	27,837
(11) Roberta Bean...................................................................... COO	40.0 ................. 0.0		X		230,766	19,014
(12) Antonio Gurule...................................................................... Clinic Administrator	40.0 ................. 0.0		X		221,409	21,391
(13) Zachary Weiderspon...................................................................... CCH Administrator	40.0 ................. 0.0		X		173,764	8,425
(14) Susan Geiger...................................................................... Trustee, Physician	20.0 ................. 0.0	X			75,964	3,748
(15) Karla Hardesty...................................................................... President	2.0 ................. 0.0	X	X		2,900	0
(16) Donald Shawcroft...................................................................... Trustee	2.0 ................. 0.0	X			1,100	0
(17) Jan Gay...................................................................... Trustee	2.0 ................. 0.0	X			1,100	0

(A) Name and business address	(B) Description of services	(C) Compensation
INNOVA EMERGENCY MEDICAL ASSOCIATES, PO Box 17028 DENVER,CO80217	Medical Staff	2,664,745
CompHealth Associates Inc, PO Box 972670 DALLAS,TX75397	MEDICAL STAFF	697,986
Colorado Springs Urological Associa, PO Box 7408 COLORADO SPRINGS,CO80933	MEDICAL STAFF	324,698
GWI Security Services, 104 Price Avenue ALAMOSA,CO81101	SECURITY	323,838
Weatherby Locums, PO Box 972633 DALLAS,TX75397	MEDICAL STAFF	294,432
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 14

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
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)
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):
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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2021 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-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS VALLEY

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS VALLEY		Employer identification number 84-0255530

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS VALLEY			Employer identification number 84-0255530
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

2,376

Total. Add lines 1c through 1i ....................................................................................................

2,376

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
schedule c, Part II-B, Line 1i	Description of lobbying activities: San Luis Valley Health received correspondence from the Colorado Health and Hospital Association and the American Hospital Association regarding their membership dues. A portion of their dues were attributable to lobbying and appear on line 1i.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	417,934	179,871	15,629	15,600	46,368
b	Contributions ...	12,662	156,789	160,259		9,194
c	Net investment earnings, gains, and losses	-62,363	81,274	3,983	29	38
d	Grants or scholarships ...					40,000
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	368,233	417,934	179,871	15,629	15,600

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

100.000 %

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	3,432,682		3,432,682
b	Buildings ....	62,062,492	29,813,334	32,249,158
c	Leasehold improvements
d	Equipment ....	27,058,200	20,417,414	6,640,786
e	Other .....	17,261,456	3,560,554	13,700,902
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				56,023,528

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	606,781
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	121,849,628
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-937,275
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	162,022
e	Add lines 2a through 2d .....................			2e	-775,253
3	Subtract line 2e from line 1..................			3	122,624,881
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	122,624,881

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	118,778,383
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	73,011
e	Add lines 2a through 2d....................			2e	73,011
3	Subtract line 2e from line 1...................			3	118,705,372
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	118,705,372

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART V, LINE 4	DESCRIBE THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS: SAN LUIS VALLEY HEALTH FOUNDATION (THE FOUNDATION) AND THE MEDICAL CENTER ARE FINANCIALLY INTERRELATED ORGANIZATIONS. THE MISSION OF THE FOUNDATION IS TO SUPPORT THE HEALTH CARE SERVICES OF THE MEDICAL CENTER AND THE COMMUNITIES IT SERVES. THE MEDICAL CENTER ACCOUNTS FOR ITS INTEREST IN THE NET ASSETS OF THE FOUNDATION IN A MANNER SIMILAR TO THE EQUITY METHOD. THE TEMPORARILY RESTRICTED NET ASSETS REPRESENTS THE INTEREST IN THE NET ASSETS OF THE FOUNDATION. WHEN ASSETS ARE TRANSFERRED TO THE SLVH BY THE FOUNDATION, THE CONTRIBUTIONS ARE RESTRICTED TO THE PURCHASE OF EQUIPMENT AND FACILITY EXPANSION.
Schedule D, Part X, Line 2	Uncertain Tax Positions: Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements.
SCHEDULE D, PART XI, LINE 2D	REVENUE ON BOOKS, NOT ON RETURN: 89,011 - change in investment in foundation 73,011 - Rental Expense reclassed from Expense to Revenue 162,022 - Total
SCHEDULE D, PART XII, LINE 2d	Expense on Books, Not on Return: 73,011 - Rental Expense Reclassed from Expense to Revenue 73,011 - Total

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	729,147	114,512	614,635	0.520 %
b	Medicaid (from Worksheet 3, column a) . . . . .	43,686,455	41,421,545	2,264,910	1.910 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	1,215,119	506,016	709,103	0.600 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	45,630,721	42,042,073	3,588,648	3.030 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	157,794	0	157,794	0.130 %
f	Health professions education (from Worksheet 5) . . .	213,093	0	213,093	0.180 %
g	Subsidized health services (from Worksheet 6) . . . .	2,509,706	1,934,222	575,484	0.480 %
h	Research (from Worksheet 7) .	389	0	389	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	23,390	0	23,390	0.020 %
j	Total. Other Benefits . .	2,904,372	1,934,222	970,150	0.810 %
k	Total. Add lines 7d and 7j .	48,535,093	43,976,295	4,558,798	3.840 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	3,527	0	3,527	0 %
3	Community support	27,374	0	27,374	0.020 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	3,935	0	3,935	0 %
7	Community health improvement advocacy
8	Workforce development	2,606	0	2,606	0 %
9	Other	727	0	727	0 %
10	Total	38,169	0	38,169	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,414,882

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

19,679,766

Enter Medicare allowable costs of care relating to payments on line 5.....

21,829,204

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-2,149,438

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)							Facility reporting group
1	LUTHERAN HOSPITAL OF THE SLV 106 BLANCA AVENUE ALAMOSA,CO81101 WWW.SANLUISVALLEYHEALTH.ORG 011001	X	X	X		X	A
2	CONEJOS COUNTY HOSPITAL 19021 US HWY 285 LA JARA,CO81140 WWW.SANLUISVALLEYHEALTH.ORG 011020	X			X	X	A

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): X

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C FOR URL

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100%
and FPG family income limit for eligibility for discounted care of 250.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

part v, section c for url

The FAP application form was widely available on a website (list url):

part v, section c for url

A plain language summary of the FAP was widely available on a website (list url):
part v, section c for url

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5	INPUT FROM REPRESENTATIVES OF THE COMMUNITY: SLVH LEADERSHIP REPRESENTATIVES, IN COLLABORATION WITH COLORADO RURAL HEALTH CENTER, CONDUCTED A SURVEY OF INTERESTED SAN LUIS VALLEY RESIDENTS. THE SURVEY INCLUDED 44 QUESTIONS ON A VARIETY OF HEALTH AND PROVIDER ISSUES. THE HEALTH QUESTIONNAIRE FOR SLVH WAS DISTRIBUTED BY THE HOSPITAL AND THE COMMUNITY GROUP MEMBERS USING PAPER AND WEB-BASED SURVEYS. THEY WERE GIVEN TO THE COMMUNITY GROUP FOLLOWING THE FIRST MEETING AND PARTICIPANTS WERE ENCOURAGED TO HAVE THEIR COLLEAGUES, FRIENDS, AND FAMILY COMPLETE THE SURVEY AS WELL. TO AID LEADERSHIP REPRESENTATIVES IN THE ASSESSMENT OF THE COMMUNITY'S HEALTH NEEDS, THE COMMUNITY GROUP WAS COMPRISED OF INTERESTED AGENCIES AND ORGANIZATIONS SERVING HEALTH, EDUCATION, COMMERCIAL AND GOVERNMENT INTERESTS IN THE SAN LUIS VALLEY. - ADAMS STATE UNIVERSITY - ADAMS STATE UNIVERSITY VETERANS PROGRAM - BLUE PEAKS DEVELOPMENTAL SERVICES - CITY OF ALAMOSA AND CITY COUNCIL - CITY OF MONTE VISTA AND CITY COUNCIL - RIO GRANDE COUNTY PUBLIC HEALTH - SAN LUIS VALLEY BEHAVIORAL HEALTH GROUP - SAN LUIS VALLEY DEVELOPMENT RESOURCE GROUP - SAN LUIS VALLEY PUBLIC HEALTH PARTNERSHIPS - SAN LUIS VALLEY SMALL BUSINESS DEVELOPMENT CENTER - VALLEY WIDE HEALTH SYSTEMS - VALLEY WIDE HEALTH SYSTEMS, NURSE - FAMILY PARTNERSHIPS
SCHEDULE H, PART V, SECTION B, LINE 7A & 10A	DIRECT URL TO CHNA AND IMPLEMENTATION STRATEGY: www.sanluisvalleyhealth.org/documents/files/2022-Community-Health-Needs-As smnt.pdf
SCHEDULE H, PART V, SECTION B, LINE 11	San Luis Valley Health (SLVH) completed their Community Health Needs Assessment in the spring/summer of 2022. The following priorities were identified as pressing community health needs for the San Luis Valley (SLV) region: 1. Access to Care a. As an integrated health care organization, SLVH aspires to achieve the quadruple aim in meeting the health care needs of patients. This includes: 1) enhancing access and patient satisfaction; 2) improving outcomes; 3) reducing cost, and 4) improving provider and staff satisfaction. SLVH monitors Patient Experiences of Care (PEC) through participation in innovative primary care transformation models focused on the whole person, in a patient-centered model. Clinic measures include Timely Appointments, Care, and Information; How Well Providers Communicate; Attention to Care From Other Providers; Providers Support Patient in Taking Care of Own Health; and Patient Rating of Provider and Care. In addition, SLVH participates in analytics and strategic advisory solutions through Press Ganey and includes several measures as strategic priorities, reviewed quarterly by SLVH departments, Leadership, Senior Team, and the Governing Board. To promote advancement toward organizational goals and objectives, measures that fall below organizational goals are identified for performance and process improvements. b. SLVH has developed processes to increase access to patient care by optimizing clinic schedules and staffing patterns so that patients are scheduled with their primary care provider (PCP) as a first choice or another provider on their health care team as a second choice, or offered an acute care visit with the acute care provider. Primary care clinics have also extended weekday hours of operation weekdays. In response to the COVID-19 pandemic, SLVH telehealth and telemedicine services were implemented using a secure, Health Insurance Portability and Accountability Act (HIPAA) platform. Telehealth services provide an important method to stay connected to some of the organization's most vulnerable patient populations while accounting for social distancing for patients and staff. This group of patients includes those with serious health care conditions, including cancer, diabetes, cardiac, and prenatal conditions, as well as those who have significant social barriers including transportation, financial, and other social emotional issues. The service quickly met or exceeded patients' expectations of convenient and quality. Telehealth aims to provide an alternative visit option for patients, as part of best practices encouraged through Team Based Care and Alternative Payment Model best practices. By making visits more convenient and accessible, SLVH expects to better-address population health through enhancing care plan adherence. SLVH also opened a dedicated Respiratory Clinic at the onset of the pandemic for acute respiratory conditions, including COVID. This helped segregate patient populations seeking medical care. c. SLVH continues to evaluate and assess potential service lines to benefit the health needs of our patient population. Nephrology service days have recently been increased, and Cardiology service expansions are under consideration. Monitor clinic access and measure 3rd next available appointments within 3 days of demand. (According to research, 3rd next available national average for hospital-owned clinics is 3 days per MGMA, but best practice/the ultimate goal is 0 days for primary care.) SLVH's goal is an average of 3 days among its primary care clinic sites (including women's health and pediatric clinics. Primary care provider (PCP) schedules also allow access for post-hospital and emergency department follow up to ensure patients connect to their PCP for continuity of care. Providers also maintain two acute, same day appointments. SLVH is currently able to offer the next available appointment within 3.75 days. Primary care provider recruitment efforts have an increased focus due to provider vacancies and continued higher demands for care. d. On March 10, 2020, in response to the global COVID-19 pandemic, SLVH leadership initiated it's Hospital Emergency Incident Command System. Organizational objectives were: caring for our community by providing essential health care services; and, ensuring the safety and wellbeing of our team. Overall community support included participation on the SLV Health Care Coalition, establishing a nurse telephone triage system to help direct and guide patients appropriately, and establishing telemed and virtual visits for patients to maintain access to medical services. Vaccination PODS (point of distribution) were implemented to administer vaccinations to large groups of the eligible population, eventually transitioning vaccination delivery in to day-to-day operations within clinic settings. e. Transportation issues and barriers often deter maximal health care utilization. SLVH provided a $25,000 donation toward the purchase of a transport vehicle that is specially equipped to accommodate patients in wheelchairs. The new van was purchased by Valley-Wide Health Systems, Inc., and adds to the fleet of vehicles offered by the "Valley-Wide Ride" program to help address transportation needs for medical and non-medical appointments for the SLV population 2. Chronic Disease Management a. SLVH has worked to improve communication through appropriate exchange of information through the continuum of care to support overall health care management. Emphasis has been placed on the use of care coordination to ensure patients and their information follows them at all care levels. In October 2020, SLVH transitioned their electronic health record to a comprehensive and integrated system that supports availability of information at every level of care within SLVH including all functions of health care services, billing, data and analysis to support appropriate utilization, evaluation, and performance improvement processes. Focusing on the identification of patients' PCP will help drive chronic disease management while improving patient/provider relationships and experiences, access, continuity of care, transitions of care, and communication among providers. b. SLVH continues to organize, participate, and contribute to local food banks and helps assemble and distribute food boxes during the holidays. 3. Mental Health Prevention and Improvement a. In order to improve patient safety, advance integrated behavioral health (BH) services and screenings in Emergency Departments (ED) help identify high-risk patients, SLVH has continued to develop its BH department and hired an additional Licensed Clinical Social Worker to provide direct therapy services. The department is working to expand behavioral health services and increase a Behavior Health Consultant FTE to work in the inpatient setting to provide brief interventions, warm hand-offs and referrals into ambulatory care. SLVH has expanded Medication Assisted Therapy (MAT) in clinic settings, and continues to partner with external agencies to implement and/or support behavioral health resources within the organization as well as within the community. Behavioral health workforce shortages challenge recruitment and retention organizationally as well as among community partners. In addition, COVID has limited the role of community partners providing in-person crisis-level evaluations. b. SLVH standardized screenings in EDs to be more effective in addressing and providing protective factors during clinical visits. This begins with general screening during nurse triage to identify patients at risk, followed by more intense screening, following the evidence-based Columbia Suicide Severity Rating Scale. SLVH has also updated its policy and procedures for patients who are at risk for self-destructive behavior to provide, as best as possible, a safe environment, appropriate medical screening, and crisis behavioral health care services. i. September 2020, SLVH participated in National Suicide Prevention Month through SLV Voices, a local podcast discussion, to help listeners learn more about tools and strategies to cope with stress and life challenges, and services available to help. ii. SLVH has initiated a system-wide approach to suicide prevention through the Zero Suicide initiative. During the month of February 2022, SLVH will offer Question, Persuade, and Refer (QPR) train the trainer coursework for approximately 20 staff, who will then proceed training other care providers within the organization. c. SLVH continues efforts to improve transitions of care through safe discharge planning, coordinated access to BH services in primary care settings, connecting patients to community-based services and resources, and ensuring follow up at appropriate intervals. d. SLVH participates with a practice improvement initiative to improve Integrated Care for Women and Babies (June 2020), expanding the number of providers inducting patients into MAT t
SCHEDULE H, PART V, SECTION B, LINE 16A	URL where FAP is made widely available on a website: https://www.sanluisvalleyhealth.org/documents/Financial-Assitance-Policy-S LVH-Update-02242023.pdf The financial assistance policy can also be found by going to the home page of organization's website, under quick links click on get financial assistance and there will be a Financial Assistance policy hyperlink.
SCHEDULE H, PART V, SECTION B, LINE 16B	URL where FAP application form is made widely available on a website: https://www.sanluisvalleyhealth.org/documents/charity_care_application.pdf THE FAP APPLICATION FORM CAN ALSO BE FOUND BY GOING TO THE HOME PAGE OF ORGANIZATION'S WEBSITE, UNDER QUICK LINKS CLICK ON "GET FINANCIAL ASSISTANCETHERE WILL BE AN "APPLICATION" HYPERLINK. ASSISTANCETHERE WILL BE AN "APPLICATION" HYPERLINK.
SCHEDULE H, PART V, SECTION B, LINE 16C	URL WHERE THE PLAIN LANGUAGE SUMMARY OF THE FAP IS MADE WIDELY AVAILABLE: https://www.sanluisvalleyhealth.org/documents/plain_language_summary.pdf THE PLAIN LANGUAGE SUMMARY CAN ALSO BE FOUND BY GOING TO THE HOME PAGE OF ORGANIZATION'S WEBSITE, UNDER QUICK LINKS CLICK ON "GET FINANCIAL ASSISTANCETHERE WILL BE A "PLAIN LANGUAGE SUMMARY" HYPERLINK.

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address		Type of Facility (describe)
1	STUART AVENUE CLINIC 2115 STUART ST ALAMOSA,CO81101	PHYSICIAN CLINIC
2	RURAL HEALTH CLINIC - ANTONITO 115 MAIN ST ANTONITO,CO81120	RURAL HEALTH CLINIC
3	RURAL HEALTH CLINIC - LA JARA 509 MAIN ST LA JARA,CO81140	RURAL HEALTH CLINIC
4	RURAL HEALTH CLINIC - MONTE VISTA 103 CHICO COURT MONTE VISTA,CO81144	RURAL HEALTH CLINIC
5	MONTE VISTA PRO THERAPY 2360 SHERMAN AVENUE MONTE VISTA,CO81144	SPORTS MEDICINE physical therapy
6
7
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C	DESCRIPTION OF FACTORS USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: IN ADDITION TO THE FEDERAL POVERTY GUIDELINES THE FOLLOWING ELIGIBILITY CRITERIA ARE ALSO USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY MEDICAL INDIGENCY, INSURANCE STATUS AND UNDERINSURANCE STATUS.
SCHEDULE H, PART I, LINE 7	THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A,7B AND 7C. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS.
SCHEDULE H, PART II, LINES 1 - 10	EACH ACTIVITY AND EXPENSE IN THIS CATEGORY IS RELATED TO THE LOCAL COMMUNITY BY PROMOTING OR SUPPORTING HABITAT FOR HUMANITY, PLAYGROUND CONSTRUCTION, SERVING AT THE LOCAL HOMELESS SHELTER, VOLUNTEERING AT THE LOCAL FOOD BANK, RAISING FUNDS FOR SCHOOL SUPPLIES, TRAUMA PREPARATION, WORKFORCE DEVELOPMENT, AND SAFETY OF FAMILIES AND CHILDREN THROUGH A BIKE/HELMET SAFETY EVENT.
SCHEDULE H, PART III, SECTION A, LINE 2	THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
SCHEDULE H, PART III, SECTION A, LINE 3	THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.
SCHEDULE H, PART III, SECTION B, LINE 8	ALL OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE HOSPITALS ARE REQUIRED TO TREAT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A RURAL HOSPITAL IN SOUTHERN COLORADO, SAN LUIS VALLEY HEALTH, IS CRITICAL TO PROVIDING HEALTHCARE IN AN AREA THAT HAS LIMITED ACCESS TO SPECIALTY CARE. ACCESSIBLE, HIGH-QUALITY HEALTHCARE IS NEEDED FOR THE OVERALL HEALTH OF THE RESIDENTS OF THE SAN LUIS VALLEY EVEN IF MEDICARE REIMBURSEMENT DOES NOT MEET THE COST OF PROVIDING THAT CARE. RURAL HEALTHCARE IS OFTEN MORE COSTLY AS PATIENTS TEND TO HAVE A HIGHER THAN AVERAGE ACUITY AND LENGTH OF STAY DUE TO LIMITED SPECIALTY CARE IN THE TREATMENT AND PATIENT CARE FOLLOW PROCESS. THE MEDICARE SHORTFALL REFLECTS THE EXCESS OF COSTS CONSISTENTLY DRIVEN UP BY REGULATORY REQUIREMENTS, SKILLED LABOR SHORTAGES AND EVOLVING MEDICAL AND INFORMATION TECHNOLOGY, ABOVE NON-NEGOTIABLE PAYMENTS BASED ON UPDATES THAT HAVE FALLEN BEHIND ACTUAL HEALTHCARE COST INFLATION. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE COST OF CARE REPORTED.
SCHEDULE H, PART III, SECTION C, LINE 9B	FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE COLLECTION PROCESS FOLLOWS THESE STEPS: A. PATIENTS ARE CONTACTED BY BROCHURE, MAIL AND PHONE CALLS FROM A FINANCIAL COUNSELOR, OR THE PATIENT ACCESS MANAGER. LETTERS SENT, BROCHURES GIVEN AND OUTBOUND PHONE CALLS AND RESPONSES ARE NOTED IN PATIENT NOTES IN THE PATIENT'S PROFILE. B. PATIENTS WHO QUALIFY FOR ASSISTANCE WILL PRESENT INFORMATION TO THE FINANCIAL COUNSELORS WHO WILL UPDATE THE REGISTRATION SECTION OF THE PATIENT PROFILE. BILINGUAL COUNSELORS OR INTERPRETERS ARE AVAILABLE. C. PATIENTS WILL BE INFORMED OF THEIR RESPONSIBILITY TO PAY CO PAYMENTS OR OTHER SLIDING FEE PATIENT RESPONSIBILITY AMOUNTS. THEY WILL BE INFORMED IN PERSON AND BY PHONE WHENEVER POSSIBLE. PAYMENT PLANS ARE ALWAYS OFFERED FOR PATIENTS WHO CANNOT AFFORD THEIR PORTION. D. PATIENTS WHO DO NOT PAY THEIR PORTION OR CO-PAYMENT WILL RECEIVE AN INVOICE, PRINTED IN ENGLISH AND SPANISH, DIRECTING THEM TO PAY OR TO CALL. IF THE PATIENT CALLS AND REQUESTS ASSISTANCE FROM THE FINANCIAL COUNSELOR, THEY WILL BE DIRECTED TO THE CUSTOMER SERVICE PHONE NUMBER. E. PATIENTS WILL RECEIVE UP TO 3 LETTERS AND 2 PHONE CALLS FROM A CONTRACTED, 3RD PARTY VENDOR WHO HAVE BILINGUAL SPECIALISTS. WHEN 90 DAYS HAVE PASSED WITHOUT ANY RESPONSE FROM THE PATIENT, THE ACCOUNT WILL BE REVIEWED BY THE PATIENT ACCESS MANAGER AS WELL AS THE PATIENT ACCOUNT MANAGER-CASH POSTING, BOTH MEMBERS OF THE BUSINESS REVENUE CYCLE TEAM. F. UPON REVIEW, IF THE PORTION IS DEEMED TO BE THE RESPONSIBILITY OF THE PATIENT, THE PROCESS TOWARD COLLECTIONS WILL BEGIN. A LETTER IS SENT TO THE PATIENT FROM THE THIRD PARTY COMPANY. THE THIRD PARTY COLLECTION COMPANY FOLLOWS LEGAL PROCEEDINGS AT THIS POINT.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: SLV HEALTH SUBMITS MANY GRANTS EVERY YEAR TO IMPROVE COMMUNITY HEALTH. EACH GRANT INCLUDES A SUMMARY OF KNOWN HEALTH DATA TO JUSTIFY THE NEED FOR THE FUNDS. AS A CONSEQUENCE WE ARE VERY ATTUNED TO OUR COMMUNITY HEALTH NEEDS. THROUGH COMMUNICATION WITH PROVIDERS AND COMMUNITY NON PROFITS, THIS NEED IS ADDRESSED AS REQUIRED. SAMPLE CURRENT AND PAST PROGRAMMING HAVE INCLUDED FREE COLONOSCOPIES, BREAST HEALTH RELATED TESTING, PSA TESTING AND MUCH MORE.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SLV HEALTH PROVIDES A PATIENT FINANCIAL COUNSELOR WHO IDENTIFIES RESOURCES AND ELIGIBILITY ASSESSMENT FOR PROGRAMS THROUGH FEDERAL AND STATE GOVERNMENT PROGRAMS, AS WELL AS GRANT FUNDED PROGRAM. WE ALSO PROVIDE A SLIDING FEE SCALE FOR SERVICE FOR THOSE SELF PAY PATIENTS NOT FITTING WITHIN ANY OF THESE PROGRAMS. PAY PLANS ARE ALSO SET UP FOR SELF PAY PATIENTS.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: LOCATED IN SOUTH-CENTRAL COLORADO, THE SAN LUIS VALLEY (SLV) IS THE LARGEST AND HIGHEST VALLEY IN NORTH AMERICA, SURROUNDED BY THREE MOUNTAIN RANGES THAT EFFECTIVELY ISOLATE THE VALLEY FROM OTHER MEDICAL RESOURCES. THE SLV CONSISTS OF THREE RURAL AND THREE FRONTIER COUNTIES COVERING 8194 SQUARE MILES (2,000,000 ACRES), LARGER THAN THE STATE OF CONNECTICUT. FRONTIER AREAS, DEFINED AS COUNTIES HAVING A POPULATION DENSITY OF SIX OR FEWER PEOPLE PER SQUARE MILE, FACE CHALLENGES IN PROVIDING ACCESS TO HEALTH AND HUMAN SERVICES WHICH ARE EVEN GREATER THAN THE CHALLENGES FACED BY OTHER RURAL COMMUNITIES. FIVE OF THE SIX COUNTIES ARE FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA (AREAS/POPULATIONS THAT LACK ACCESS TO PRIMARY CARE SERVICES) AND ALL SIX COUNTIES ARE FEDERALLY DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS (SHORTAGES OF PRIMARY MEDICAL CARE, DENTAL OR MENTAL HEALTH PROVIDERS). THE SLV HAS A DIVERSE POPULATION OF 47,049, WITH 45% WHO IDENTIFY WITH A HISPANIC, LATINO, OR SPANISH ORIGIN [STATE DEMOGRAPHY OFFICE]. ADDITIONALLY, THERE IS A LARGE POPULATION OF INDIGENT AND MIGRANT FARM WORKERS. PREDOMINANTLY AGRICULTURAL IN NATURE, THE SLV IS ONE OF THE POOREST AREAS IN COLORADO (CO) WITH 19% LIVING IN POVERTY, COMPARED TO 9.6% FOR THE ENTIRE STATE, AND THE MEDIAN HOUSEHOLD INCOME IS $39,773, COMPARED TO $68,811 FOR CO [US CENSUS 2014-2018]. CENSUS DATA ALSO STATES FIVE OF THE SIX SLV COUNTIES HAVE THE HIGHEST PERCENT OF RESIDENTS THAT SPEAK A LANGUAGE OTHER THAN ENGLISH (OVER 33%), COMPARED TO CO AT 17%. THE SLV'S UNINSURED RATE IS 13% COMPARED TO 8% FOR CO, AND 43% OF SLV RESIDENTS ARE ON MEDICAID, COMPARED TO 24% OF COLORADOANS [COLORADO HEALTH INSTITUTE].
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: SLVH IS ACTIVE IN THE COMMUNITY AND SUPPORTS STAFF WHO PROVIDE COMMUNITY RESOURCES IN AREAS THAT INCLUDE HEALTH EDUCATION AND INFORMATION, PROMOTING SAFETY AND WELLNESS TO THE GENERAL POPULATION, AND SPONSORS BEHAVIORAL HEALTH SUPPORT GROUPS. HOSPITAL LEADERSHIP AND CLINICAL PROVIDERS CONDUCT HEALTH EDUCATION INFORMATION IN THE AREAS OF ADOLESCENT HEALTH, ARE FOR PATIENTS WITH DEMENTIA, SKIN CARE, AND WOMEN'S HEALTH. SLVH STAFF ALSO PARTICIPATE IN COMMUNITY HEALTH INITIATIVES SUCH AS ADOLESCENT PREVENTION COALITIONS, OPIOID USE/ABUSE TASK FORCE, A NEONATAL TASK FORCE, COORDINATION OF HEALTH CARE SERVICES ACROSS THE CONTINUUM, AND WORKFORCE DEVELOPMENT ISSUES. PATIENT AND FAMILY ADVISORY COUNCILS HAVE ALSO BEEN ESTABLISHED TO BRING THE VOICE OF PATIENTS AND THEIR FAMILIES INTO PROGRAM DESIGN AND IMPROVEMENT PROCESSES.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: SLV HEALTH HAS A PROFESSIONAL AFFILIATION WITH CENTURA HEALTH SYSTEMS TO COORDINATE CARE FOR OUR SHARED PATIENTS.
SCHEDULE H, PART VI, LINE 7	DESCRIPTION OF STATE FILINGS: SLV HEALTH FILES A COMMUNTIY BENEFIT REPORT ANNUALLY WITH COLORADO.

Schedule H (Form 990) 2021

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number
84-0255530

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) San Luis Valley RETAC 8900 Independence Way Alamosa,CO81101	84-1567701	501(C)(3)	10,000				AMBULANCE SERVICES

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
SCHEDULE I, PART I, LINE 2	ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS: FUNDS ARE PROVIDED TO BE USED FOR DESIGNATED PURPOSES ONLY. ALL GRANTEES ARE SELECTED AND STRICTLY SCREENED BY THE MEDICAL CENTER. MULTI-YEAR AGREEMENTS ARE MADE WITH THE RECIPIENT ORGANIZATIONS AND ARE EVALUATED ON AN ANNUAL BASIS BEFORE FUNDING IS CONTINUED.

Schedule I (Form 990) 2021

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Yes

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Antonio Gurule Clinic Administrator	(i) (ii)	174,031 ------------- 0	45,798 ------------- 0	1,580 ------------- 0	11,008 ------------- 0	10,383 ------------- 0	242,800 ------------- 0	-------------
2Carissa Tripi Physician	(i) (ii)	568,476 ------------- 0	117,340 ------------- 0	540 ------------- 0	14,400 ------------- 0	17,163 ------------- 0	717,919 ------------- 0	-------------
3Carmelo Hernandez CMO	(i) (ii)	332,679 ------------- 0	79,720 ------------- 0	2,322 ------------- 0	14,139 ------------- 0	23,456 ------------- 0	452,316 ------------- 0	-------------
4Christine Hettinger-Hunt COO	(i) (ii)	183,112 ------------- 0	51,828 ------------- 0	2,656 ------------- 0	10,959 ------------- 0	16,878 ------------- 0	265,433 ------------- 0	-------------
5Dennard Ellison Trustee, Physician	(i) (ii)	397,655 ------------- 0	28,893 ------------- 0	3,564 ------------- 0	14,195 ------------- 0	23,537 ------------- 0	467,844 ------------- 0	-------------
6James Grigsby Physician	(i) (ii)	415,896 ------------- 0	66,687 ------------- 0	3,564 ------------- 0	14,400 ------------- 0	17,163 ------------- 0	517,710 ------------- 0	-------------
7Jason Defee Physician	(i) (ii)	588,230 ------------- 0	48,222 ------------- 0	1,242 ------------- 0	14,400 ------------- 0	23,536 ------------- 0	675,630 ------------- 0	-------------
8Julian Maendel Physician	(i) (ii)	405,323 ------------- 0	82,430 ------------- 0	431 ------------- 0	14,287 ------------- 0	20,414 ------------- 0	522,885 ------------- 0	-------------
9Konnie Martin CEO	(i) (ii)	396,051 ------------- 0	140,324 ------------- 0	2,322 ------------- 0	12,728 ------------- 0	22,872 ------------- 0	574,297 ------------- 0	-------------
10Maureen Cooper Physician	(i) (ii)	458,783 ------------- 0	27,588 ------------- 0	11,125 ------------- 0	14,214 ------------- 0	801 ------------- 0	512,511 ------------- 0	-------------
11Roberta Bean COO	(i) (ii)	187,292 ------------- 0	42,743 ------------- 0	731 ------------- 0	5,394 ------------- 0	13,620 ------------- 0	249,780 ------------- 0	-------------
12Shane Mortensen CFO	(i) (ii)	198,853 ------------- 0	57,334 ------------- 0	2,908 ------------- 0	13,298 ------------- 0	16,916 ------------- 0	289,309 ------------- 0	-------------
13Zachary Weiderspon CCH Administrator	(i) (ii)	140,497 ------------- 0	33,177 ------------- 0	90 ------------- 0	355 ------------- 0	8,070 ------------- 0	182,189 ------------- 0	-------------

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 6A	ALL ORGANIZATIONAL OFFICERS, AS WELL AS DIRECTORS, ARE ELIGIBLE FOR AN ANNUAL VARIABLE PAY BONUS BASED UPON A NUMBER OF MEASURES, ONE OF THEM BEING THAT THE ORGANIZATION AS A WHOLE MEETS BUDGETED PROFITABILITY.
SCHEDULE J, PART I, LINE 7	NON-FIXED PAYMENTS: PHYSICIANS MAY EARN A PRODUCTIVITY BONUS. SENIOR MANAGEMENT IS ELIGIBLE FOR ANNUAL VARIABLE PAY UP TO 35% FOR CEO AND 20% FOR ALL OTHER SENIOR MANAGEMENT BASED UPON CRITERIA INCLUDING HOSPITAL WIDE MEASURES AND POSITION SPECIFIC GOALS. VARIABLE PAY IS AWARDED AT THE DISCRETION OF THE BOARD FOR THE CEO AND THE CEO FOR ALL OTHER SENIOR MANAGEMENT.

Schedule J (Form 990) 2021

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Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) DAVID GEIGER	SEE PART V	316,772	EMPLOYMENT WAGES		No
(2) SUSAN GEIGER	SEE PART V	17,483	EMPLOYMENT WAGES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

SCHEDULE L, PART IV, COLUMN B

Relationship between interested person and the organization: BOARD MEMBER SUSAN GEIGER HAS A FAMILY RELATIONSHIP WITH Former Interim Chief Medical Officer DAVID GEIGER, WHO RECEIVED EMPLOYMENT WAGES FROM THE ORGANIZATION DURING THE YEAR. Former Interim Chief Medical Officer David Geiger has a family relationship with Board Member Susan Geiger, Who Received Employment Wages from the organization during the year.

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	FAMILY/BUSINESS RELATIONSHIPS: BOARD OF DIRECTOR MEMBERS CHERI CROWDER AND PATRICK CROWDER HAVE A FAMILY RELATIONSHIP. BOARD MEMBER SUSAN GEIGER IS MARRIED TO DAVID GEIGER, FORMER INTERIM CHIEF MEDICAL OFFICER.
FORM 990, PART VI, SECTION B, LINE 11B	PROCESS TO REVIEW THE FORM 990: THE 990 IS PREPARED BY A THIRD PARTY ORGANIZATION, REVIEWED BY THE CFO AND CEO, AND APPROVED BY THE FINANCE COMMITTEE. THE BOARD OF DIRECTORS IS ALSO PROVIDED A COPY OF THE 990 FOR REVIEW PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: SAN LUIS VALLEY HEALTH HAS A CURRENT CONFLICT OF INTEREST POLICY THAT IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES AND THE CEO. THE REVIEW PROCESS IS CONDUCTED FIRST WITH THE CEO AND THEN THE BOARD OF TRUSTEES. WHEN NECESSARY, THE POLICY HAS BEEN REVIEWED BY LEGAL COUNSEL. EACH YEAR, TRUSTEES ARE ASKED TO REVIEW THE POLICY AND CONFIRM AND AMEND ANY POTENTIAL CONFLICT. THESE CONFLICTS ARE REVIEWED BY THE CEO AND THE ENTIRE BOARD. CONFLICTS ARE ROUTINELY DISCUSSED AND ARE THE RESPONSIBILITY OF ALL BOARD MEMBERS TO DISCLOSE; EITHER FOR THEMSELVES OR OTHERS. THE BOARD CHAIRMAN WILL MAKE A DECISION AS TO THE NATURE OF THE CONFLICT AND THE APPROPRIATE ACTION ACCORDING TO THE POLICY.
FORM 990, PART VI, SECTION B, LINE 15A	REVIEW OF CEO OR TOP MANAGEMENT OFFICIAL COMPENSATION: HUMAN RESOURCES PROVIDES THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY SURVEY DATA FROM CHA, AHA, AND HFMA. AFTER STUDYING THE DATA, THE EXECUTIVE COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD IN EXECUTIVE SESSION. THE FULL BOARD APPROVES THE CEO'S COMPENSATION. SLVH CONDUCTS AN ANNUAL EVALUATION AND QUARTERLY REVIEWS OF THE CEO'S PERFORMANCE, WHICH IS DOCUMENTED. COMPENSATION FOR THE CEO IS DETERMINED ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15B	REVIEW OF OTHER OFFICER OR KEY EMPLOYEES COMPENSATION: HUMAN RESOURCES GATHERS COMPENSATION SURVEY DATA FROM CHA, AHA, AND HFMA. HUMAN RESOURCES MAKES RECOMMENDATIONS FOR OTHER OFFICERS' COMPENSATION AND PROVIDES SURVEY DATA TO THE CEO. THE CEO PERFORMS EVALUATIONS AND DETERMINES ALL OF THE WAGE CHANGES FOR THE OTHER OFFICERS ON AN ANNUAL BASIS. ALL CHANGES ARE DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19	DESCRIBE HOW GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part XI, Line 9	Other Changes in Net Assets Change in investment in foundation 89,011

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LUTHERAN HOSPITAL ASSOC OF THE SAN LUIS
VALLEY

Employer identification number

84-0255530

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)SAN LUIS VALLEY HEALTH FOUNDATION 106 BLANCA AVENUE ALAMOSA,CO81101 20-3799814	FUNDRAISING	CO	501(C)(3)	LINE 7	SLVH	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO BE A PREMIER, FULLY INTEGRATED RURAL HEALTH CARE SYSTEM PROVIDING EXCEPTIONAL PATIENT-CENTERED SERVICES TO THE SAN LUIS VALLEY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,003
6	Total number of volunteers (estimate if necessary) .............	6	12
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	9,292,842	4,064,667
9	Program service revenue (Part VIII, line 2g) .........	106,691,405	117,271,540
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	283,662	19,444
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	383,308	1,269,230
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	116,651,217	122,624,881
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	42,955	23,390
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	62,098,935	65,280,267
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 535,644
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	46,152,251	53,401,715
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	108,294,141	118,705,372
19	Revenue less expenses. Subtract line 18 from line 12.......	8,357,076	3,919,509
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	124,351,894	120,012,858
21	Total liabilities (Part X, line 26).............	45,426,539	38,016,258
22	Net assets or fund balances. Subtract line 21 from line 20.....	78,925,355	81,996,600

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 89,447,478 including grants of $ 23,390 ) (Revenue $ 118,205,450 )
	SAN LUIS VALLEY HEALTH WAS FORMED JULY 1, 2013. PRIOR TO THE MERGER THAT CREATED SAN LUIS VALLEY HEALTH, THE HOSPITAL OPERATED AS AN INDEPENDENT, NOT FOR PROFIT HOSPITAL FOR OVER 83 YEARS. THE MERGER BROUGHT TOGETHER SAN LUIS VALLEY REGIONAL MEDICAL CENTER AND CONEJOS COUNTY HOSPITAL. PRIOR TO THE MERGER, CONEJOS COUNTY HOSPITAL HAD BEEN MANAGED BY SAN LUIS VALLEY REGIONAL MEDICAL CENTER SINCE 2003. SLV HEALTH SERVES THE SIX COUNTIES OF THE SAN LUIS VALLEY WITH A POPULATION OF JUST UNDER 50,000 AND AN AREA OF OVER 8,200 SQUARE MILES; LARGER THAN THE STATE OF NEW JERSEY. SLV HEALTH EMPLOYS OVER 650 EMPLOYEES AND IS THE LARGEST EMPLOYER IN THE SAN LUIS VALLEY. THE TRUSTEES, PROVIDERS AND STAFF OF SLV HEALTH ARE UNDERSTANDABLY PROUD OF THEIR TRADITION FOR PROVIDING CARE AND SERVICE TO OUR COMMUNITIES. SERVING OUR LOW-INCOME COMMUNITY MEANS THAT WE HAVE A CHALLENGING PAYER MIX WITH HIGH MEDICAID, UNINSURED AND RELATIVELY LOW COMMERCIAL PERCENTAGES. THIS HAS LED TO OUR ORGANIZATION BEING RESOURCEFUL, CREATIVE AND INNOVATIVE IN ORDER TO CONTINUE SERVICE WITH POSITIVE OPERATING MARGINS. OVER THE LAST TEN YEARS, OUR GROSS REVENUE HAS INCREASED FROM $20M TO IN EXCESS OF $200M AND THE NUMBER OF PATIENTS SERVED HAS EXPANDED SEVERAL FOLD. NEW SERVICES HAVE BEEN ADDED IN MEDICATION ONCOLOGY, INPATIENT REHABILITATION, SLEEP DISORDERS, WOMEN'S IMAGING CENTER, FIXED WING MEDICAL TRANSPORTATION, GENETIC COUNSELING, BEHAVIORAL HEALTH, CARDIOLOGY, CHIROPRACTIC, ONCOLOGY/INFUSION THERAPY, UROLOGY, AND MORE.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses89,447,478

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Kasey Russell........................................................................ Trustee	2.0 .......................0.0	X		1,100	0	0
(19) Kendall Knaus........................................................................ Sec/Treas	2.0 .......................0.0	X	X	1,100	0	0
(20) Jim Ehrlich........................................................................ Vice President	2.0 .......................0.0	X	X	1,017	0	0
(21) Rosalie Martinez........................................................................ Trustee	2.0 .......................0.0	X		1,000	0	0
(22) Patrick Crowder........................................................................ Trustee	2.0 .......................0.0	X		917	0	0
(23) Cheri Crowder........................................................................ Trustee	2.0 .......................0.0	X		900	0	0
(24) Kathy Lorenz........................................................................ Trustee	2.0 .......................0.0	X		800	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,389,935	0	372,334

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	3,275,560

f	All other contributions, gifts, grants, and similar amounts not included above		1f	789,107

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		4,064,667

		Business Code
2a	Patient Service Revenue	561110	114,221,210	114,221,210
b	Ambulance District Revenue	561110	642,019	642,019
c	340B Payments	900099	2,075,370	2,075,370
d	Other Revenue	621910	332,941	332,941
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		117,271,540

3 Investment income (including dividends, interest, and othersimilar amounts) ......			19,444			19,444
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		56,103	6a
b	Less: rental expenses		73,011	6b
c	Rental income or (loss)	0	-16,908	6c
d	Net rental income or (loss).......			-16,908		-15,357	-1,551
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Cafeteria Sales		722514	290,034			290,034
b	Abstract Revenue		900099	1,533	92		1,441
c	Miscellaneous Revenue		900099	933,818	933,818
d	All other revenue ....			60,753			60,753
e	Total. Add lines 11a–11d ......			1,286,138
12	Total revenue. See instructions.....			122,624,881	118,205,450	-15,357	370,121

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	23,390	23,390
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	2,810,709	1,761,326	1,038,807	10,576
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	316,772	316,772
7	Other salaries and wages........	49,968,786	35,691,812	14,182,333	94,641
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,618,354	1,225,426	384,823	8,105
9	Other employee benefits .......	6,979,960	5,259,831	1,685,811	34,318
10	Payroll taxes ...........	3,585,686	2,696,436	871,680	17,570
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	316,053	1,856	314,197
c	Accounting ...........	120,000		120,000
d	Lobbying ...........	2,376		2,376
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	11,218,023	8,793,334	2,424,689
12	Advertising and promotion ....	185,727	185,477		250
13	Office expenses .......	1,912,082	369,054	1,540,578	2,450
14	Information technology ......	971,133	343,369	627,764
15	Royalties ..	0
16	Occupancy ...........	1,154,022	686,213	467,809
17	Travel ............	509,029	254,709	254,320
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	67,450		67,450
20	Interest ...........	880,683	660,512	220,171
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	4,559,405	2,981,668	1,577,737
23	Insurance ...	1,388,499	673,104	714,281	1,114
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	19,492,732	19,492,732
b	Provider Fees	5,795,481	5,795,481
c	Repairs & Maintenance	2,538,634	1,094,603	1,444,031
d	Books/Dues/Subscriptions	460,745	406,857	53,888
e	All other expenses	1,829,641	733,516	729,505	366,620
25	Total functional expenses. Add lines 1 through 24e	118,705,372	89,447,478	28,722,250	535,644
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			11,902,483	1	6,805,564
2	Savings and temporary cash investments .........			10,547,389	2	8,753,562
3	Pledges and grants receivable, net ......			0	3	53,849
4	Accounts receivable, net .............			16,839,443	4	17,676,170
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				42,042	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			2,753,600	8	3,095,123
9	Prepaid expenses and deferred charges ......			2,287,459	9	2,953,367
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	109,814,830
b	Less: accumulated depreciation	10b	53,791,302	53,200,093	10c	56,023,528
11	Investments—publicly traded securities .			25,628,813	11	23,542,131
12	Investments—other securities. See Part IV, line 11 .....			12,000	12	12,000
13	Investments—program-related. See Part IV, line 11 ..			632,420	13	721,422
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			506,152	15	376,142
16	Total assets. Add lines 1 through 15 (must equal line 33)...			124,351,894	16	120,012,858

17	Accounts payable and accrued expenses .....	24,259,526	17	14,432,973
18	Grants payable ...	0	18	0
19	Deferred revenue .........	431,936	19	1,919,366
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	20,262,885	23	21,057,138
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	472,192	25	606,781
26	Total liabilities. Add lines 17 through 25..	45,426,539	26	38,016,258

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	78,292,923	27	81,275,157
28	Net assets with donor restrictions ...........	632,432	28	721,443
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	78,925,355	32	81,996,600
33	Total liabilities and net assets/fund balances ........	124,351,894	33	120,012,858