Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| AMENDED RETURN: | FORM 990 IS BEING AMENDED FOR SCHEDULE H PART I LINE 7 COMMUNITY BENEFIT INFORMATION. NO OTHER CHANGES TO THE FORM HAVE BEEN MADE. |
| FORM 990, PART VI, SECTION A, LINE 6 | UCHEALTH IS THE MEMBER OF YAMPA VALLEY MEDICAL CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | UCHEALTH HAS THE AUTHORITY TO APPOINT THE MEMBERS OF THE BOARD. TWO MEMBERS ARE NOMINATED AND APPOINTED BY UCHEALTH. THE REMAINING 11 ARE NOMINATED BY YVMC AND APPOINTED BY UCHEALTH. |
| FORM 990, PART VI, SECTION A, LINE 7B | APPROVAL FROM UCHEALTH IS REQUIRED BUT NOT LIMITED TO THE FOLLOWING AREAS: - APPROVAL FOR CHANGE IN MISSION, PROGRAMS, SERVICE, FACILITIES OFFERED BY YVMC, CORPORATE STRUCTURE OR TERMINATION OF EXEMPT STATUS - SALE, TRANSFER, PLEDGE OR GRANTING OF SECURITY INTEREST OF ANY MATERIAL YVMC OR AFFILIATE ASSETS - AMENDMENT OF ARTICLES OF INCORPORATION OR BYLAWS - ENTRY BY YVMC OR ITS AFFILIATES INTO INSOLVENCY, BANKRUPTCY, REORGANIZATION, OR RECEIVERSHIP - APPROVAL OF THE APPOINTMENT OR REMOVAL OF YVMC'S CEO - APPROVAL OF YVMC'S AND ITS AFFILIATES ANNUAL BUDGETS - APPROVAL OF ENTRY INTO OR CHANGE IN ANY MATERIAL CONTRACT |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN AN INDEPENDENT ACCOUNTING FIRM, WITH THE ASSISTANCE OF THE ORGANIZATION'S ACCOUNTING DEPARTMENT AND FORM 990 COMMITTEE OF THE ORGANIZATION. THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE DRAFT OF THE FORM 990. PRIOR TO COMPLETION, THE FINAL DRAFT IS APPROVED BY THE BOARD OF TRUSTEES BEFORE FILING THE FORM 990 WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES COMPLETION OF THE COI DISCLOSURE FORM FOR ALL UCHEALTH TEAM MEMBERS WHO BELIEVE THAT THEY OR AN IMMEDIATE FAMILY MEMBER HAVE A PERSONAL, FINANCIAL OR OWNERSHIP INTEREST WITH AN ENTITY OR ORGANIZATION WHO COMPETES WITH UCHEALTH, DOES BUSINESS WITH UCHEALTH, OR REGULATES UCHEALTH MUST SUBMIT A COI DISCLOSURE. UCHEALTH DIRECTORS AND ABOVE, INCLUDING TEAM MEMBERS AUTHORIZED TO CONDUCT BUSINESS TRANSACTIONS WITH 3RD PARTIES ON BEHALF OF UCHEALTH MUST DISCLOSE ON AN ANNUAL BASIS TO THE BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. COMPLETED FORMS ARE SUBMITTED AND REVIEWED BY THE INTERNAL COMPLIANCE DEPARTMENT TO ENSURE COMPLIANCE WITH THE WRITTEN POLICY. ANY QUESTIONS OR ULTIMATE ENFORCEMENT WOULD BE HANDLED BY THE COMPLIANCE DEPARTMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | UCHEALTH CONTRACTS WITH SULLIVAN COTTER FOR EXECUTIVE COMPENSATION CONSULTING SERVICES. ON OUR BEHALF, SULLIVAN COTTER COLLECTS AND REVIEWS COMPENSATION LEVELS FROM LIKE ORGANIZATION FOR LIKE JOBS AND PROVIDES UCHEALTH WITH THE COMPARATIVE MARKET DATA. THE DATA IS SUBMITTED TO THE CHIEF HUMAN RESOURCES OFFICER WHO ADVISES THE SYSTEM PRESIDENT AND CEO ON COMPENSATION DECISIONS FOR SENIOR EXECUTIVES. BASED ON THE MARKET DATA, THE SYSTEM PRESIDENT AND CEO DETERMINES THE SALARY OF THE ENTITY CEO'S COMPENSATION ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC BASED ON THE BUSINESS PURPOSE FOR THE REQUEST. THESE REQUESTS ARE ADDRESSED BY THE SENIOR MANAGEMENT TEAM ON A CASE BY CASE BASIS. |
| FORM 990, PART IX, LINE 11G | EXTERNAL NURSING AGENCY: PROGRAM SERVICE EXPENSES 2,583,269. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,583,269. CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 2,134,349. MANAGEMENT AND GENERAL EXPENSES 609,175. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,743,524. HAZARDOUS WASTE REMOVAL: PROGRAM SERVICE EXPENSES 74,645. MANAGEMENT AND GENERAL EXPENSES 21,054. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,699. DUES/MEMBERSHIPS: PROGRAM SERVICE EXPENSES 50,616. MANAGEMENT AND GENERAL EXPENSES 15,561. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,177. PROFESSIONAL FEES-OTHER STAFF: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,053,013. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,053,013. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 439,803. MANAGEMENT AND GENERAL EXPENSES 124,047. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 563,850. UCH-CA - PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,335,144. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,335,144. CONSULTANTS: PROGRAM SERVICE EXPENSES 4,890. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,890. DUES/MEMBERSHIPS-CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 2,450. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,450. UNIFORMS: PROGRAM SERVICE EXPENSES 17,091. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,091. OUTSIDE LAB SERVICES: PROGRAM SERVICE EXPENSES 40,190. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,190. OTHER ALLOCATIONS - PURCHASED: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 254,693. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 254,693. EQUIP RENTALS-MEDICAL: PROGRAM SERVICE EXPENSES 579,701. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 579,701. MEDICAL PROVIDER SERVICES: PROGRAM SERVICE EXPENSES 8,177,371. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,177,371. OTHER: PROGRAM SERVICE EXPENSES 111. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 111. |
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