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OMB No. 1545-0047

½½´

Form

Return of Organization Exempt From Income Tax

Department of the Treasury Internal Revenue Service

I

, 20 D Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697

Address change

Doing Business As

Name change

Number and street (or P.O. box if mail is not delivered to street address)

Initial return

1950 WEST MOUNTAIN VIEW AVENUE

Terminated

City or town, state or country, and ZIP + 4

Amended return Application pending

Inspection

, 2010, and ending

C Name of organization Check if applicable:

Open to Public

The organization may have to use a copy of this return to satisfy state reporting requirements.

A For the 2010 calendar year, or tax year beginning B

À¾µ´

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

Room/suite

E Telephone number

(303 ) 651-5023

G Gross receipts $ 185,998,606. H(a) Is this a group return for Yes MITCHELL C. CARSON X No affiliates? Yes No 1950 WEST MOUNTAIN VIEW AVE., LONGMONT, CO 80501 H(b) Are all affiliates included? If "No," attach a list. (see instructions) Tax-exempt status: I X 501(c)(3) 501(c) ( ) (insert no.) 4947(a)(1) or 527 J Website: H(c) Group exemption number WWW.LUHCARES.ORG CO K Form of organization: X Corporation Trust Association Other L Year of formation: 1955 M State of legal domicile: Summary Part I

LONGMONT, CO 80501

F Name and address of principal officer:

J

I

Activities & Governance

1

I

I

Briefly describe the organization's mission or most significant activities:

DEDICATED TO IMPROVING THE HEALTH OF OUR PATIENTS AND COMMUNITIES WE SERVE. 2 3 4 5 6 7a b

Check this box

I

if the organization discontinued its operations or disposed of more than 25% of its net assets.

mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m 65,293. mmmmmmmmmmmmmmmmmmmmmmmmm 161,935,960. mmmmmmmmmmmmmmmmmmmmmmmmm 2,869,198. mmmmmmmmmmmmmmmmm 1,288,039. mmmmmm m m m m m m m m m m m m m 166,158,490.0. mmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmm 77,370,869.0. mmmmmmm 0. mmmmmmmmmmm mmmmmm 0. I mmmmmmmmmmmmmmmm 85,401,172. 162,772,041. m m m m m m m m m m mmmmmmmmmm m m m m m m m m m m 3,386,449. mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 237,517,511. 131,325,739. mmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m 106,191,772.

Number of voting members of the governing body (Part VI, line 1a)

Total number of individuals employed in calendar year 2010 (Part V, line 2a) Total number of volunteers (estimate if necessary)

Total gross unrelated business revenue from Part VIII, column (C), line 12 Net unrelated business taxable income from Form 990-T, line 34

Net Assets or Fund Balances

Expenses

Revenue

Prior Year

8 9 10 11 12 13 14 15 16 a

11. 8. 1,429. 874. 14,832.

3 4 5 6 7a 7b

Number of independent voting members of the governing body (Part VI, line 1b)

Contributions and grants (Part VIII, line 1h)

Program service revenue (Part VIII, line 2g)

Investment income (Part VIII, column (A), lines 3, 4, and 7d)

Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)

Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) Grants and similar amounts paid (Part IX, column (A), lines 1-3) Benefits paid to or for members (Part IX, column (A), line 4)

Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) Professional fundraising fees (Part IX, column (A), line 11e)

Current Year

172,168. 172,488,710. 1,574,134. 2,481,850. 176,716,862. 275,172. 0. 74,225,146. 0.

b Total fundraising expenses (Part IX, column (D), line 25) 17 18 19

Other expenses (Part IX, column (A), lines 11a-11d, 11f-24f)

Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 18 from line 12

Beginning of Current Year

20 21 22

Total assets (Part X, line 16)

Total liabilities (Part X, line 26)

Net assets or fund balances. Subtract line 21 from line 20

Part II

95,001,029. 169,501,347. 7,215,515. End of Year

235,688,378. 121,853,307. 113,835,071.

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

M M

CLIENT COPY

Signature of officer

Date

Type or print name and title

Print/Type preparer's name

Paid CRAIG R. Preparer Use Only Firm's name Firm's address

Preparer's signature

7979 E. TUFTS AVENUE, SUITE 400 DENVER, CO 80237-2843

May the IRS discuss this return with the preparer shown above? (see instructions)

Check if selfemployed

PTIN

I P00173718 I84-0869721 303-740-9400 mmmmmmmmmmmmmmmmmmmmmmmmX

CHOUN EHRHARDT KEEFE STEINER & HOTTMAN PC

I I

Date

9/26/2011

Firm's EIN Phone no.

Yes

For Paperwork Reduction Act Notice, see the separate instructions.

Form

No

990 (2010)

JSA 0E1010 1.000

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12:09:52 PM

RCH 4822-00

PAGE 2

Part III

Page 2

84-0460697

Form 990 (2010)

Statement of Program Service Accomplishments Check if Schedule O contains a response to any question in this Part III

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1 Briefly describe the organization's mission:

DEDICATED TO IMPROVING THE HEALTH OF OUR PATIENTS AND COMMUNITIES WE SERVE.

2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990-EZ? If "Yes," describe these new services on Schedule O. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services?

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

X No

Yes

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

X No

Yes If "Yes," describe these changes on Schedule O. 4 Describe the exempt purpose achievements for each of the organization's three largest program services by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. 4a (Code:

) (Expenses $

151,393,984.

including grants of $

275,172.

) (Revenue $

172,488,710.

)

THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE, AND SKILLED NURSING. FOR A COMPLETE ANNUAL REPORT OF LONGMONT UNITED HOSPITAL SERVICES, MISSION AND COMMUNITY BENEFIT, PLEASE VISIT US AT: HTTP://WWW.LUHCARES.ORG/ABOUT/ANNUALREPORT.ASPX

4b (Code:

) (Expenses $

4c (Code:

) (Expenses $

including grants of $

including grants of $

4d Other program services. (Describe in Schedule O.) (Expenses $ including grants of $ 4e Total program service expenses 151,393,984.

I

) (Revenue $

)

) (Revenue $

)

) (Revenue $

) Form

JSA

990

(2010)

0E1020 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 3

Part IV

Page 3

84-0460697

Form 990 (2010)

Checklist of Required Schedules Yes

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1 2 3 4 5

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A Is the organization required to complete Schedule B, Schedule of Contributors? (see instructions) Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV Did the organization, directly or through a related organization, hold assets in term, permanent, or quasi-endowments? If "Yes," complete Schedule D, Part V If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable. Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete Schedule D, Part VI Did the organization report an amount for investments—othersecurities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII Did the organization report an amount for investments-program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X

1 2

X X X

3 4

No

X

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6

5

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

7 8 9

6

X

7

X

8

X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

10 11 a b c d

9

X

10

X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmm

e f Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses

11a 11b

X

11c

X

11d 11e

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the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X

12 a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete Schedule D, Parts XI, XII, and XIII b Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional

13 Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E 14 a Did the organization maintain an office, employees, or agents outside of the United States? b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If "Yes," complete Schedule F, Parts I and IV 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If "Yes," complete Schedule F, Parts II and IV 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If "Yes," complete Schedule F, Parts III and IV 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III 20 a Did the organization operate one or more hospitals? If "Yes," complete Schedule H b If "Yes" to line 20a, did the organization attach its audited financial statements to this return? Note. Some Form 990 filers that operate one or more hospitals must attach audited financial statements (see instructions)

11f

X X X X

12a 12b 13 14a

X X X

14b

X

15

X

16

X

17

X

18

X

19 20a

X

20b Form

JSA

X

X

X 990 (2010)

0E1021 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 4

Part IV

Page 4

84-0460697

Form 990 (2010)

Checklist of Required Schedules (continued) Yes

21

Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b through 24d and complete Schedule K. If “No,� go to line 25 Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If "Yes," complete Schedule L, Part III Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions): A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III, IV, and V, line 1 Is any related organization a controlled entity within the meaning of section 512(b)(13)? Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, X Yes Part V, line 2 No Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O.

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22 23

21

b c d 25 a b

X X

22

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24 a

23

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmm mmmmmmmmmmmmmmmmmmm

24a 24b

X

X X

24c 24d

X X

25a

X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm m

26 27

25b

X

26

X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

28 a b c 29 30 31 32 33 34 35 a

36 37

38

No

X

27

mmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmm

28a

X

28b

X

28c 29

X X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmm

30

X

31

X

32

X

33

X

34 35

X X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm

X

36

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmm

X

37 38 Form

X 990 (2010)

JSA 0E1030 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 5

Form 990 (2010)

Part V

Page 5

84-0460697 Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule O contains a response to any question in this Part V

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1a 1 a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable 1b b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? 2 a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax 2a Statements, filed for the calendar year ending with or within the year covered by this return b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions) 3 a Did the organization have unrelated business gross income of $1,000 or more during the year? b If "Yes," has it filed a Form 990-T for this year? If "No," provide an explanation in Schedule O 4 a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? b If “Yes,� enter the name of the foreign country: See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. 5 a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? c If "Yes," to line 5a or 5b, did the organization file Form 8886-T? 6 a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible? b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? b If "Yes," did the organization notify the donor of the value of the goods or services provided? c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? 7d d If "Yes," indicate the number of Forms 8282 filed during the year

1c

2b

mmmmmmmmmm mmmmmmmmmmmmm

3a 3b

X X

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e f g h 8

9 a b 10 a b

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year? Sponsoring organizations maintaining donor advised funds. Did the organization make any taxable distributions under section 4966? Did the organization make a distribution to a donor, donor advisor, or related person? Section 501(c)(7) organizations. Enter: 10a Initiation fees and capital contributions included on Part VIII, line 12 10b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

X

5a 5b 5c

X X

6a

X

6b

7a 7b

X X

7c

X

7e 7f 7g 7h

X X

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Section 501(c)(12) organizations. Enter: 11a a Gross income from members or shareholders b Gross income from other sources (Do not net amounts due or paid to other sources 11b against amounts due or received from them.) 12 a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? 12b b If "Yes," enter the amount of tax-exempt interest received or accrued during the year 11

13

4a

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Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

No

Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organization licensed to issue qualified health plans in more than one state? Note. See the instructions for additional information the organization must report on Schedule O. b Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans 13b 13c c Enter the amount of reserves on hand

8

9a 9b

12a

13a

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14 a Did the organization receive any payments for indoor tanning services during the tax year? b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O JSA 0E1040 1.000

14a 14b Form

5709CF N752 9/16/2011

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RCH 4822-00

X 990 (2010)

PAGE 6

Page 6

84-0460697

Form 990 (2010)

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions. Check if Schedule O contains a response to any question in this Part VI X Section A. Governing Body and Management Part VI

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11 mmmmmm 8 mmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmm mmmmmm mmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmm

1a 1a Enter the number of voting members of the governing body at the end of the tax year 1b b Enter the number of voting members included in line 1a, above, who are independent 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 5 Did the organization become aware during the year of a significant diversion of the organization's assets? 6 Does the organization have members or stockholders? 7a Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? b Are any decisions of the governing body subject to approval by members, stockholders, or other persons? 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: a The governing body? b Each committee with authority to act on behalf of the governing body? 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? If "Yes," provide the names and addresses in Schedule O

Yes

No

2

X

3 4 5 6

X X X X

7a 7b

X X

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X X

8a 8b

X

9

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

mmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmm

10 a Does the organization have local chapters, branches, or affiliates? b If "Yes," does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? 11 a Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form? b Describe in Schedule O the process, if any, used by the organization to review this Form 990. 12 a Does the organization have a written conflict of interest policy? If "No," go to line 13 b Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? c Does the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this is done 13 Does the organization have a written whistleblower policy? 14 Does the organization have a written document retention and destruction policy? 15 Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization's CEO, Executive Director, or top management official b Other officers or key employees of the organization If "Yes" to line 15a or 15b, describe the process in Schedule O. (See instructions.) 16 a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? b If "Yes," has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization's exempt status with respect to such arrangements?

10b 11a

X

12a

X

12b

X

12c 13 14

X X X

X X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

X

15a 15b

16a

mmmmmmmmmmmmmmmmmmmmmmmm I

17 18

List the states with which a copy of this Form 990 is required to be filed Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply. X Own website X Upon request Another's website

19

Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public. State the name, physical address, and telephone number of the person who possesses the books and records of the organization: NEIL BERTRAND 1950 WEST MOUNTAIN VIEW AVE.; LONGMONT, CO 80501

No

X

mmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

Section C. Disclosure

20

Yes

10a

16b

X

I303-651-5023

JSA 0E1042 1.000

Form

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

990 (2010)

PAGE 7

Form 990 (2010)

Part VII

Section A.

Page 7

84-0460697 Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check if Schedule O contains a response to any question in this Part VII

mmmmmmmmmmmmmmmmmmmmm

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.

% % % % %

List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid. List all of the organization's current key employees, if any. See instructions for definition of "key employee." List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations. List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. List persons in the following order: individual compensated employees; and former such persons.

trustees

or directors;

institutional

trustees;

officers;

key employees;

highest

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. (A) Name and Title

Former

Highest compensated employee

Key employee

Officer

Institutional trustee

(describe hours for related organizations in Schedule O)

(C) Position (check all that apply) Individual trustee or director

(B) Average hours per week

(D) Reportable compensation from the organization (W-2/1099-MISC)

(E) Reportable compensation from related organizations (W-2/1099-MISC)

(F) Estimated amount of other compensation from the organization and related organizations

(1) MARTIN PLASTER

CHAIRPERSON

5.00

X

X

0.

0.

0.

5.00

X

X

0.

0.

0.

5.00

X

0.

0.

0.

5.00

X

0.

0.

0.

5.00

X

0.

0.

0.

5.00

X

X

0.

0.

0.

5.00

X

X

0.

0.

0.

40.00

X

X

469,765.

0.

112,764.

5.00

X

22,725.

0.

0.

5.00

X

0.

0.

0.

5.00

X

18,750.

0.

0.

287,692.

0.

79,203.

(2) CLAIR VOLK

ASST. SEC-TREASURER (3) EDWINA SALAZAR

DIRECTOR (4) DAN GUST

VICE-CHAIRPERSON

X

(5) JOHN SHETTER

DIRECTOR (6) LEONA STOECKER

SECRETARY (7) RICHARD LYONS

TREASURER (8) MITCHELL C CARSON

PRESIDENT & CEO (9) E. PATRICIA GILL, M.D.

DIRECTOR (10) TOM CHAPMAN

DIRECTOR (11) MARK HINMAN, M.D.

DIRECTOR (12) NEIL BERTRAND

CFO

40.00

X

(13) SHARON ROMINGER

CHIEF NURSING OFFICER

30.00

X

150,026.

0.

18,220.

40.00

X

203,734.

0.

55,688.

40.00

X

171,390.

0.

45,307.

40.00

X

160,741.

0.

(14) CAROL SMITH

VP LEGAL/REGULATORY AFFAIRS (15) NANCY DRISCOLL

VP PATIENT CARE SERVICES (16) WARREN LAUGHLIN

VP HUMAN RESOURCES

Form

JSA

43,715. 990 (2010)

0E1041 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 8

Form 990 (2010)

Part VII

Page 8

84-0460697 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees(continued) (A) Name and title

(B)

(C)

Average

Position (check all that apply)

REBECCA HERMAN VP CLINICAL SUPPORT SERVICES (18) FABIO PIVETTA MILESTONE PHYSICIAN (19) MATTHEW BRETT MILESTONE PHYSICIAN (20) KATHERINE WALKER MILESTONE PHYSICIAN (21) JOHN PETERSON VP INFORMATION SERVICES (22) MAUREEN BEAVIN LEAD CLINICAL PHARMACIST (23) HOLLY SPITZER CLINICAL PHARMACIST (24) DANIEL FRANK CONTROLLER (25) JOHN IVES DIRECTOR PHARMACY

Former

in Schedule O)

Highest compensated employee

Key employee

related organizations

Officer

hours for

Institutional trustee

week (describe

Individual trustee or director

hours per

(D) Reportable compensation from the organization (W-2/1099-MISC)

(E) Reportable compensation from related organizations (W-2/1099-MISC)

(F) Estimated amount of other compensation from the organization and related organizations

(17)

40.00

X

166,714.

0.

46,164.

40.00

X

201,822.

0.

17,626.

40.00

X

173,464.

0.

17,110.

40.00

X

150,136.

0.

7,496.

40.00

X

147,626.

0.

40,805.

40.00

X

139,453.

0.

12,268.

37.70

X

145,396.

0.

7,250.

40.00

X

143,014.

0.

32,283.

40.00

X

144,333.

0.

11,183.

(26) (27) (28)

mmmmmmmmmmmmmmmmmmmmmmmmmm m m m m m m m m m m m m I m m m m m m m m m m m m m mmmmmmmmmmmmmmmmmmmmmmmmmmmmI I m I

1b c d 2

2,896,781. Sub-total Total from continuation sheets to Part VII, Section A 2,896,781. Total (add lines 1b and 1c) Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organization 50

0.

547,082.

0.

547,082.

3

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual

3

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual

4

Yes

4

mmmmmmmmmmmmmmmmmmmmmmmmmm

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmm

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person 5 Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 compensation from the organization. 5

(A) Name and business address

(B) Description of services

No

X

X X of

(C) Compensation

ATTACHMENT 1

2

Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 28

I

Form

JSA

990

(2010)

0E1050 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 9

Part VIII

Statement of Revenue (A) Total revenue

1a

Membership dues

1b

c

Fundraising events

1c

98,965.

d

Related organizations

1d

73,203.

e

Government grants (contributions)

1e

f

All other contributions, gifts, grants,

Contributions, gifts, grants and other similar amounts

g h

Program Service Revenue

mmmmmmmm mmmmmmmmm mmmmmmmmm mmmmmmmm mm m mmmmmmmmmmmmmmmmmmm I

Federated campaigns

b

1a

Page 9

84-0460697

Form 990 (2010)

and similar amounts not included above

1f

Noncash contributions included in lines 1a-1f:

$

Total. Add lines 1a-1f

(B) Related or exempt function revenue

(C) Unrelated business revenue

(D) Revenue excluded from tax under sections 512, 513, or 514

172,168.

Business Code

2a

PATIENT SERVICE REVENUE

621990

172,488,710.

172,488,710.

b c d

mmmmmmm mm mm mm mm mmmmmmmmm I mmmmmmmmmmmmmmmmmmm I m m m I mmmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmm mmm mm mmmmmmmmmmmmmmmmm I

e f g 3

All other program service revenue Total. Add lines 2a-2f other similar amounts)

1,464,244.

4

Income from investment of tax-exempt bond proceeds

0.

5

Royalties

0.

(i) Real

Gross Rents

1,585,850.

Less: rental expenses

1,085,115.

c d

Rental income or (loss) Net rental income or (loss)

7a b

500,735.

(i) Securities

Gross amount from sales of assets other than inventory

8a

500,735.

500,735.

(ii) Other

8,263,511.

mmmm mmm mm mm mm mm mmmmmmmmmmmmmmmmm I

Less: cost or other basis

8,153,621.

and sales expenses c d

1,464,244.

(ii) Personal

b

6a

Other Revenue

172,488,710.

Investment income (including dividends, interest, and

109,890.

Gain or (loss) Net gain or (loss) Gross

income

from

109,890.

109,890.

-18,728.

-18,728.

fundraising

events (not including $

ATCH 2

98,965.

mmmmmmmmmmm mmmmmmmmmmm mmmmm m ATCH 3m I mmmmmmmmmmm mmmmmmmmmmmmmmmmmmm I mmmmmmmmm mmmmmmmmmmmmmmmmmm I

of contributions reported on line 1c).

a

24,280.

Less: direct expenses b Net income or (loss) from fundraising events

43,008.

See Part IV, line 18 b c 9a b c 10a b c

11a b

Gross income from gaming activities. See Part IV, line 19

Less: direct expenses Net income or (loss) from gaming activities Gross sales of inventory, returns and allowances

b

0.

less

a

Less: cost of goods sold b Net income or (loss) from sales of inventory Miscellaneous Revenue Business Code

0.

CAFETERIA

722210

471,952.

471,952.

HEALTH CENTER INTEGRATED THERAPY

621990

356,660.

356,660.

c VENDOR REBATE

12

a

mmmmm m m m m m mm mm mm m m m m m I mmmmmm mm mm mm mm mm mm mm mm m I

d

All other revenue

e

Total. Add lines 11a-11d Total revenue. See instructions

900099

187,626.

187,626.

983,605.

14,832.

968,773.

1,999,843. 176,716,862.

172,989,445.

14,832.

3,540,417. Form

990

(2010)

JSA 0E1051 2.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 10

Part IX

Page 10

84-0460697

Form 990 (2010)

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D). (A) (B) (C) Do not include amounts reported on lines 6b, Total expenses Program service Management and 7b, 8b, 9b, and 10b of Part VIII. expenses general expenses

mm mmmmmmmmmm

1

Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21

275,172.

2

Grants and other assistance to individuals in the U.S. See Part IV, line 22

0.

3

Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16

4

Benefits paid to or for members

5

Compensation of current officers, directors, trustees, and key employees

6

Compensation not included above, to disqualified

mmmmmmmm mmmmmmmmm mmmmmmmmmm

mmmmmm mmmmmmmmmmmm mmmmmm mmmmmmmmmmmm mmmmmmmmmmmmmmmmmm mmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m m m m m m m m m m m m m m m m m m m mmmmmmmmmmmmmmmmmmm mmmmmmmmm mmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmm mmmmmmmmmmmmmmmm mmmmmmmmmmmmm mm m m m m m m m m m m m m m m m m m m mmmmmm m m m m m m m m m m m m mmmmmmmmmmmmmmmmmmmmm

persons (as defined under section 4958(f)(1))

Other salaries and wages

8

Pension plan contributions

10 11

0. 0. 2,620,253.

1,206,951.

1,413,302.

0.

0. 58,578,938.

52,799,650.

5,779,288.

0. 0.

15,791. 8,720,172. 4,289,992.

14,026. 7,693,335. 3,810,467.

1,765. 1,026,837. 479,525.

0. 0. 0.

(include section 401(k)

and section 403(b) employer contributions)

9

275,172.

and

persons described in section 4958(c)(3)(B)

7

(D) Fundraising expenses

Other employee benefits Payroll taxes

Fees for services (non-employees): a Management b Legal

c Accounting d Lobbying

e Professional fundraising services. See Part IV, line 17 f Investment management fees g Other 12

Advertising and promotion

13

Office expenses

14

Information technology

15

Royalties

16

Occupancy

17

Travel

18

Payments of travel or entertainment expenses for any federal, state, or local public officials

19

Conferences, conventions, and meetings

20

Interest

21

Payments to affiliates

22

Depreciation, depletion, and amortization

23

Insurance

24

Other

mmmm mmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmm mmmm mmmmmmmmmmmmmmmmmmm

expenses. Itemize

expenses

not

0. 78,281. 113,802. 0. 0. 0. 402,726. 659,848. 661,543. 2,265,474. 0. 1,730,966. 188,848. 0. 0. 5,017,645. 0. 11,814,609. 1,506,346.

0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0.

78,281. 113,802.

373,707. 1,048. 334,702. 1,487,622.

29,019. 658,800. 326,841. 777,852.

167,739.

1,730,966. 21,109.

4,079,588.

938,057.

10,346,138.

1,468,471. 1,506,346.

34,901,101. 16,244,594. 5,104,691. 5,875,114. 5,067,234. 1,611,105. 151,393,984.

736,906.

0. 0. 0. 0. 0. 0.

covered

above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)

a SUPPLIES b BAD

DEBT c EQUIPMENT RENTAL & MAINT. d PHYSICIAN FEES e PURCHASED SERVICES f All other expenses 25

Total functional expenses. Add lines 1 through 24f

26

Joint Costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

JSA 0E1052 1.000

I

35,638,007. 16,244,594. 5,560,152. 5,875,114. 5,629,211. 1,613,863. 169,501,347.

0. 0. 0. 0. 0. 0. 0.

455,461. 561,977. 2,758. 18,107,363.

mmmmmm Form

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

990 (2010)

PAGE 11

Part X

Page 11

84-0460697

Form 990 (2010)

Balance Sheet

mmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmm

1 2 3 4 5

Cash - non-interest-bearing Savings and temporary cash investments Pledges and grants receivable, net Accounts receivable, net Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L

6

Receivables from other disqualified persons (as defined under section 4958(f)(1)),

(A) Beginning of year

11,962,530. 16,609,597. 384,666. 23,363,357.

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

(B) End of year

1 2 3 4

16,031,707. 11,072,834. 336,340. 22,594,330.

5

persons

Assets

described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of

mmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmm

6

section 501(c)(9) voluntary employees' beneficiary organizations (see instructions)

Notes and loans receivable, net Inventories for sale or use Prepaid expenses and deferred charges Land, buildings, and equipment: cost or 215,905,790. other basis. Complete Part VI of Schedule D 10a 104,420,038. 10b b Less: accumulated depreciation 11 Investments - publicly traded securities 12 Investments - other securities. See Part IV, line 11 13 Investments - program-related. See Part IV, line 11 14 Intangible assets 15 Other assets. See Part IV, line 11 16 Total assets. Add lines 1 through 15 (must equal line 34) 17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue 20 Tax-exempt bond liabilities 21 Escrow or custodial account liability. Complete Part IV of Schedule D 22 Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule L 23 Secured mortgages and notes payable to unrelated third parties 24 Unsecured notes and loans payable to unrelated third parties 25 Other liabilities. Complete Part X of Schedule D 26 Total liabilities. Add lines 17 through 25 X and complete Organizations that follow SFAS 117, check here lines 27 through 29, and lines 33 and 34. 7 8 9 10 a

297,547. 7 4,363,954. 8 5,898,784. 9

Net Assets or Fund Balances

Liabilities

mmmmm mm mm mm mm mm mmmmmmmmmmmmmmmm 126,589,536. 41,039,148. mmmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 7,008,392. mmmmmmmmmmmmmmmmmmmmmmmm 237,517,511. mmmmmmmmmm mmmmmmmmmmmmmmmmmmmm 20,306,925. mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 103,386,128. mmmmmmmmmmmmmmmmmmmmmmmmmmm

27 28 29

30 31 32 33 34

mmmmmmmmmmmmmmmmmmmmmmmmm 4,667,686. mmmmmmm mmmmmmmmm 2,965,000. mmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmm 131,325,739. I mmmmmmmmmmmmmmmmmmmmmmmmmmmmm 103,409,613. mmmmmmmmmmmmmmmmmmmmmmmm 2,782,159. mmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmmmmmmm mmmmmmmm mmmm mmmmmmmmmmmmmmmmmmmmmmmm 106,191,772. mmmmmmmmmmmmmmmmmm 237,517,511.

Unrestricted net assets Temporarily restricted net assets Permanently restricted net assets Organizations that do not follow SFAS 117, check here complete lines 30 through 34.

10c 11 12 13 14 15 16 17 18 19 20 21

22 23 24 25 26

27 28 29

279,163. 5,982,881. 2,492,425.

111,485,752. 56,333,455.

9,079,491. 235,688,378. 20,298,091.

93,751,483.

4,611,733. 3,192,000. 121,853,307.

110,667,952. 3,167,119.

and

Capital stock or trust principal, or current funds Paid-in or capital surplus, or land, building, or equipment fund Retained earnings, endowment, accumulated income, or other funds Total net assets or fund balances Total liabilities and net assets/fund balances

30 31 32 33 34

113,835,071. 235,688,378. Form 990 (2010)

JSA 0E1053 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 12

84-0460697

Form 990 (2010)

Part XI

Page 12

mmmmmmmmmmmmmmmmmmmmmmmX mmmmmmmmmmmmmmmmmmmmmmmmmm 176,716,862. mmmmmmmmmmmmmmmmmmmmmmmmmm 169,501,347. 7,215,515. mmmmmmmmmmmmmmmmmmmmmmmmmmmm 106,191,772. mmmmmmmm 427,784. mmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 113,835,071. Financial Statements and Reporting mmmmmmmmmmmmmmmmmmmmmm Reconciliation of Net Assets

Check if Schedule O contains a response to any question in this Part XI 1 2 3 4 5 6

Total revenue (must equal Part VIII, column (A), line 12) Total expenses (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 2 from line 1 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) Other changes in net assets or fund balances (explain in Schedule O) Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B))

Part XII

1 2 3 4 5 6

Check if Schedule O contains a response to any question in this Part XII

Yes 1

2a b c

d

3a b

X Accrual Accounting method used to prepare the Form 990: Cash Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O. Were the organization's financial statements compiled or reviewed by an independent accountant? Were the organization's financial statements audited by an independent accountant? If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both: Both consolidated and separate basis X Consolidated basis Separate basis As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.

mmmmmmmm mmmmmmmmmmmmmmmm mmmmm

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

2a 2b

X

2c

X

No

X

3a

X

3b Form

990

(2010)

JSA 0E1054 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 13

SCHEDULE A (Form 990 or 990-EZ)

OMB No. 1545-0047

Public Charity Status and Public Support

À¾µ´

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

I

Department of the Treasury Internal Revenue Service

I

Attach to Form 990 or Form 990-EZ.

Open to Public Inspection

See separate instructions.

Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL 84-0460697 Reason for Public Charity Status (All organizations must complete this part.) See instructions. Part I The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.) 1 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). 2 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.) 3 X A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). 4 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: 5 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.) 6 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). 7 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.) 8 A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) 9 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.) 10 An organization organized and operated exclusively to test for public safety. See section 509(a)(4). 11 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 that describes the type of supporting organization and complete lines 11e through 11h. a Type I b Type II c Type III - Functionally integrated d Type III - Other e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? Yes No (i) A person who directly or indirectly controls, either alone or together with persons described in (ii) 11g(i) and (iii) below, the governing body of the supported organization? 11g(ii) (ii) A family member of a person described in (i) above? 11g(iii) (iii) A 35% controlled entity of a person described in (i) or (ii) above? h Provide the following information about the supported organization(s).

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmm

(i) Name of supported organization

(ii) EIN

(iii) Type of organization (described on lines 1-9 above or IRC section (see instructions) )

(iv) Is the organization in col. (i) listed in your governing document? Yes

No

(v) Did you notify the organization in col. (i) of your support?

Yes

No

(vi) Is the organization in col. (i) organized in the U.S.? Yes

(vii) Amount of support

No

(A) (B) (C) (D) (E)

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

Schedule A (Form 990 or 990-EZ) 2010

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84-0460697 Page 2 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 fails to qualify under the tests listed below, please complete Part III.) Section A. Public Support Schedule A (Form 990 or 990-EZ) 2010

Part II

Calendar year (or fiscal year beginning in)

I

1

Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")

2

Tax revenues levied for the organization's benefit and either paid to or expended on its behalf

3

The value of services or facilities furnished by a governmental unit to the organization without charge

4

Total. Add lines 1 through 3

5

The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) Public support. Subtract line 5 from line 4.

6

(a) 2006

(b) 2007

(c) 2008

(d) 2009

(e) 2010

(f) Total

(a) 2006

(b) 2007

(c) 2008

(d) 2009

(e) 2010

(f) Total

mmmmmm

mmmmmmmmmmmmmmmm mmmmmmm mmmmmmm mmmmmmm

Section B. Total Support

mmmmmmmmI mm

Calendar year (or fiscal year beginning in)

7 8

Amounts from line 4 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources

mmmmmmmmmmmmmmmmm

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 IV.)

11 12 13

Total support. Add lines 7 through 10

mmmmmmmmmm

mmmmmmmmmmm mm mmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I Section C. Computation of Public Support Percentage mmmmmmmm mmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmmmmmmmm I 12

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

First five 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

14 14 Public support percentage for 2010 (line 6, column (f) divided by line 11, column (f)) 15 15 Public support percentage from 2009 Schedule A, Part II, line 14 16a 33 1/3 % support test - 2010. 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 b 33 1/3 % support test - 2009. 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 17a 10%-facts-and-circumstances test - 2010. 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 IV how the organization meets the "facts-and-circumstances� test. The organization qualifies as a publicly supported organization b 10%-facts-and-circumstances test - 2009. 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 IV how the organzation meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization 18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions

% %

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I Schedule A (Form 990 or 990-EZ) 2010

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84-0460697 Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 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 Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Calendar year (or fiscal year beginning in) 1

I

(a) 2006

(b) 2007

(c) 2008

(d) 2009

(e) 2010

(f) Total

(a) 2006

(b) 2007

(c) 2008

(d) 2009

(e) 2010

(f) Total

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

mmmmmm m

organization's tax-exempt purpose

3

Gross receipts from activities that are not an unrelated trade or business under section 513

Tax revenues levied for the organization's

4

benefit and either paid to or expended on its behalf The

5

mmmmmmmmmmmmmmmm

value

of

services

or

facilities

furnished by a governmental unit to the organization without charge Total. Add lines 1 through 5

6

mmmmmmm mmmmmmm mmmm

7 a 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

mmmmmmmmmmmmmmm mmmmmmmmmmm mmmmmmmmmmmmmmmmm Section B. Total Support I mmmmmmmmmm m c Add lines 7a and 7b 8 Public support (Subtract line 7c from

line 6.)

Calendar year (or fiscal year beginning in)

9 Amounts from line 6 10 a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources

mmmmmmmmmmmmmmmmm

b Unrelated business taxable income (less

section

511

taxes) from

businesses

mmmmmm mmmmmmmmm

acquired after June 30, 1975 c Add lines 10a and 10b

Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)

11

mmmmmmmmmmmmmmm

12

mmmmmmmmmmm mmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I Section C. Computation of Public Support Percentage mmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm m Section D. Computation of Investment Income Percentage mmmmmmmmmm mmmmmmmmmmmmmmmmmmmm I I I 13

Total support. (Add lines 9, 10c, 11,

14

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)

and 12.)

organization, check this box and stop here

15

Public support percentage for 2010 (line 8, column (f) divided by line 13, column (f))

15

16

Public support percentage from 2009 Schedule A, Part III, line 15

16

17

Investment income percentage for 2010 (line 10c, column (f) divided by line 13, column (f))

17

18

Investment income percentage from 2009 Schedule A, Part III, line 17

18

19 a 33 1/3 % support tests - 2010.

% % % %

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

b 33 1/3 % support tests - 2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3 %, and

20

line 18 is not more than 33 1/3 %, check this box and stop here . The organization qualifies as a publicly supported organization Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions

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84-0460697 Page 4

Schedule A (Form 990 or 990-EZ) 2010

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Schedule A (Form 990 or 990-EZ) 2010

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Schedule B

Schedule of Contributors

OMB No. 1545-0047

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

À¾µ´

I

(Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service

Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL 84-0460697 Organization type (check one): Filers of:

Section:

Form 990 or 990-EZ

X

501(c)( 3

) (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

X

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33 1/3 % support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution 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 a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III. For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not aggregate to 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. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more during the year $

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not 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 line 2 of its Form 990-PF, to certify that it does not 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.

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

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Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Name of organization

Page

LONGMONT UNITED HOSPITAL

of

of Part I

Employer identification number

84-0460697 Part I Contributors (see instructions) (a) No.

1

(b) Name, address, and ZIP + 4

LONGMONT UNITED HOSPITAL FOUNDATION 1950 W. MOUNTAIN VIEW AVENUE LONGMONT, CO

(a) No.

(c) Aggregate contributions

$

73,203.

(d) Type of contribution Person Payroll Noncash

X

(Complete Part II if there is a noncash contribution.)

80501

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(d) Type of contribution Person Payroll Noncash

$

(Complete Part II if there is a noncash contribution.) (a) No.

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(d) Type of contribution Person Payroll Noncash

$

(Complete Part II if there is a noncash contribution.) (a) No.

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(d) Type of contribution Person Payroll Noncash

$

(Complete Part II if there is a noncash contribution.) (a) No.

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(d) Type of contribution Person Payroll Noncash

$

(Complete Part II if there is a noncash contribution.) (a) No.

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(d) Type of contribution Person Payroll Noncash

$

(Complete Part II if there is a noncash contribution.) Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

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SCHEDULE C (Form 990 or 990-EZ)

Department of the Treasury Internal Revenue Service

Political Campaign and Lobbying Activities

OMB No. 1545-0047

À¾µ´

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

I

I

Complete if the organization is described below.

Attach to Form 990 or Form 990-EZ.

I

Open to Public Inspection

See separate instructions.

If the organization answered "Yes," to Form 990, Part IV, line 3, or Form 990-EZ, Part VI, line 46 (Political Campaign Activities), then Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.

% % % % % %

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B. Section 527 organizations: Complete Part I-A only.

If the organization answered "Yes," to Form 990, Part IV, line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then

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. 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," to Form 990, Part IV, line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then

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

Name of organization

Employer identification number

LONGMONT UNITED HOSPITAL 84-0460697 Complete if the organization is exempt under section 501(c) or is a section 527 organization. Part I-A Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV. $ Political expenditures

1 2 3

Volunteer hours

Part I-B 1 2 3 4a b

2 3 4 5

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

mmmmmI mmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m

Enter the amount of any excise tax incurred by the organization under section 4955 Enter the amount of any excise tax incurred by organization managers under section 4955 If the organization incurred a section 4955 tax, did it file Form 4720 for this year? Was a correction made? If "Yes," describe in Part IV.

Part I-C 1

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm m $ $

Yes

No

Yes

No

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 Enter the amount of the filing organization's funds contributed to other organizations for section $ 527 exempt function activities Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, $ line 17b 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 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.

I mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmm

(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 Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Schedule C (Form 990 or 990-EZ) 2010

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84-0460697 Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)). if the filing organization belongs to an affiliated group. if the filing organization checked box A and "limited control" provisions apply.

Page 2

Schedule C (Form 990 or 990-EZ) 2010

Part II-A A Check B Check

I I

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)

1a b c d e f

(a) Filing organization's totals

mmmmmm mmmmmmm mmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmm

(b) Affiliated group totals

Total lobbying expenditures to influence public opinion (grass roots lobbying) Total lobbying expenditures to influence a legislative body (direct lobbying) Total lobbying expenditures (add lines 1a and 1b) Other exempt purpose expenditures Total exempt purpose expenditures (add lines 1c and 1d) 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:

g h i j

Not over $500,000

20% 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.

mmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

Grassroots nontaxable amount (enter 25% of line 1f) Subtract line 1g from line 1a. If zero or less, enter -0Subtract line 1f from line 1c. If zero or less, enter -0If 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 instructions for lines 2a through 2f on page 4.) Lobbying Expenditures During 4-Year Averaging Period Calendar year (or fiscal year beginning in)

(a) 2007

(b) 2008

(c) 2009

(d) 2010

(e) Total

2 a 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 or 990-EZ) 2010

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Page 3

84-0460697 Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

Schedule C (Form 990 or 990-EZ) 2010

Part II-B

(a) Yes

1

a b c d e f g h i j 2a b c d

No

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? If "Yes," describe in Part IV Total. Add lines 1c through 1i 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?

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm m mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm m mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mX mmmmmm mmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m mmmmmmmm mmm mmmmmmmmmmmmmmmm mmmm mm m

Part III-A

1 2 3

(b) Amount

X X X X X 10,402. X X X 10,402. X

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

mmmmmmmmmmmmmmmmmmm mmmmmmmm m m m m m m m m m m m m m m m m m m m m

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 carryover lobbying and political expenditures from the prior year?

Part III-B

Yes

No

1 2 3

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

mmmmmmmmmmmmmmmmmmmmmmmmmmmm

1 2

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). a Current year b Carryover from last year c Total 3 Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues 4 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? 5 Taxable amount of lobbying and political expenditures (see instructions)

1

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmm

2a 2b 2c 3

mmmmmmmmmmmmmmmmmmmm m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m

Part IV

4 5

Supplemental Information

Complete this part to provide the descriptions required for Part I-A, line 1; Part I-B, line 4; Part I-C, line 5; and Part II-B, line 1i. Also, complete this part for any additional information.

SEE PAGE 4

Schedule C (Form 990 or 990-EZ) 2010

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84-0460697 Page 4

Schedule C (Form 990 or 990-EZ) 2010

Part IV

Supplemental Information (continued)

GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES PART II-B, LINE 1F PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION FOR LOBBYING EXPENSES: $6,313.

PORTION OF DUES PAID TO THE COLORADO HOSPITAL ASSOCIATION FOR LOBBYING EXPENSES: $4,089.

Schedule C (Form 990 or 990-EZ) 2010

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PAGE 23

SCHEDULE D (Form 990)

OMB No. 1545-0047

Supplemental Financial Statements

À¾µ´

I

Complete if the organization answered "Yes," to Form 990, Part IV, line 6, 7, 8, 9, 10, 11, or 12.

I

Department of the Treasury Internal Revenue Service Name of the organization

Attach to Form 990.

I

Open to Public Inspection

See separate instructions.

Employer identification number

LONGMONT UNITED HOSPITAL 84-0460697 Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

mmmmmmmmmmm mmmm mmmmmm mmmmmmmmm

1 2 3 4 5

(a) Donor advised funds

(b) Funds and other accounts

Total number at end of year Aggregate contributions to (during year) Aggregate grants from (during year) 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? 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?

6

mmmmmmmmmmm

Yes

No

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

Yes

No

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

Part II

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

1

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. Held at the End of the Tax Year

2

mmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmm mmmmmm mmmmmmmmmmmmmmmmmmmmmmmmm

6

2a Total number of conservation easements 2b Total acreage restricted by conservation easements 2c Number of conservation easements on a certified historic structure included in (a) Number of conservation easements included in (c) acquired after 8/17/06, and not on a 2d historic structure listed in the National Register Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year Number of states where property subject to conservation easement is located Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? Yes Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year

7

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year

8

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

a b c d 3

I

4 5

I mmmmmmmmmmmmmmmmmmmmmmm

No

I I $

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

9

Part III 1a b

2 a b

No

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

If the organization elected, as permitted under SFAS 116 (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 XIV, the text of the footnote to its financial statements that describes these items. If the organization elected, as permitted under SFAS 116 (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) Revenues included in Form 990, Part VIII, line 1 $ (ii) Assets included in Form 990, Part X $ 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 SFAS 116 (ASC 958) relating to these items: Revenues included in Form 990, Part VIII, line 1 $ Assets included in Form 990, Part X $

mmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI I

mmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mI I

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

Schedule D (Form 990) 2010

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PAGE 24

84-0460697 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets(continued)

Schedule D (Form 990) 2010

Part III 3

Page 2

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 a d Scholarly research Other b e Preservation for future generations c 4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIV. 5 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

mmmmmm

Part IV

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

1a Is the organization an agent, trustee, custo dian or other intermediary for contributions or other assets not included on Form 990, Part X? b If "Yes," explain the arrangement in Part XI V and complete the following table:

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

Yes

No

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmm

Yes

No

Amount

c d e f 2a b

Beginning balance Additions during the year Distributions during the year Ending balance Did the organization include an amount on Form 990, Part X, line 21? If "Yes," explain the arrangement in Part XI V.

Part V

1c 1d 1e 1f

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

mmmm mmmmmmmmmmm mmmmmmmmmmmmm mmmmmm m mmmmmmmmmmm mmmmm mmmmmmmm

(a) Current year

(b) Prior year

(c) Two years back

(d) Three years back

(e) Four years back

1a Beginning of year balance b Contributions c Net investment earnings, gains, and losses d Grants or scholarships e Other expenditures for facilities and programs f Administrative expenses g End of year balance 2 a b c 3a

Provide the estimated percentage of the y ear end balance held as: Board designated or quasi-endowment % Permanent endowment % Term endowment % Are there endowment funds not in the pos session of the organization that are held and administered for the organization by: (i) unrelated organizations (ii) related organizations b If "Yes" to 3a(ii), are the related organizati ons listed as required on Schedule R? 4 Describe in Part XIV the intended uses of t he organization's endowment funds.

I

I

I

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmm

Part VI

Yes

No

3a(i) 3a(ii) 3b

Land, Buildings, and Equipment.See Form 990, Part X, line 10. Description of investment

(a) Cost or other basis

(b) Cost or other basis

(c) Accumulated

(investment)

(other)

depreciation

mmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmm mmmmmmmmmm mmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmm

1a Land 6,091,317. b Buildings 141,971,062. 55,748,594. c Leasehold improvements d Equipment 67,345,737. 48,671,444. e Other 497,674. Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)

mmmmmm I

(d) Book value

6,091,317. 86,222,468. 18,674,293. 497,674. 111,485,752. Schedule D (Form 990) 2010

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PAGE 25

Part VII

Investments - Other Securities. See Form 990, Part X, line 12. (a) Description of security or category (including name of security)

(b) Book value

mmmmmmmmmmmmmmmmm mmmmmmmmmmmmm

(1) Financial derivatives (2) Closely-held equity interests (3) Other (A) (B) (C) (D) (E) (F) (G) (H) (I)

Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

(c) Method of valuation: Cost or end-of-year market value

I

Investments - Program Related. See Form 990, Part X, line 13. (a) Description of investment type

(b) Book value

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Total. (Column (b) must equal Form 990, Part X, col. (B) line 13.)

Part IX

Page 3

84-0460697

Schedule D (Form 990) 2010

(c) Method of valuation: Cost or end-of-year market value

I

Other Assets. See Form 990, Part X, line 15. (a) Description

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Total. (Column (b) must equal Form 990, Part X, col. (B) line 15.)

Part X 1.

(b) Book value

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI

Other Liabilities. See Form 990, Part X, line 25. (a) Description of liability

(b) Amount

(1) Federal income taxes (2) MEDICARE SETTLEMENT (3) (4) (5) (6) (7) (8) (9) (10) (11)

3,192,000.

Total. (Column (b) must equal Form 990, Part X, col. (B) line 25.)

I

3,192,000.

2. FIN 48 (ASC 740) Footnote. In Part XIV, 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). JSA 0E1270 1.000

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PAGE 26

Page 4

84-0460697 Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements

Schedule D (Form 990) 2010

Part XI

mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmm mm mm mm mm mm mm m

Total revenue (Form 990, Part VIII, column (A), line 12) Total expenses (Form 990, Part IX, column (A), line 25) Excess or (deficit) for the year. Subtract line 2 from line 1 Net unrealized gains (losses) on investments Donated services and use of facilities Investment expenses Prior period adjustments Other (Describe in Part XIV.) Total adjustments (net). Add lines 4 through 8 Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9

1 2 3 4 5 6 7 8 9 10

Part XII 1 2 a b c d e 3 4 a b c 5 1 2 a b c d e 3 4 a b c 5

mmmmmmmmmmmmmmmmm 64,324. mmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm 1,914,167. mmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m

1

178,695,353.

2e 3

1,978,491. 176,716,862.

2a 2b 2c 2d

mmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm m Reconciliation of Expenses per Audited Financial Statements With Expenses per Return mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 1,542,158. mmmmmmmmmmmmmmmmmmmmmmmmmmm mmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m mmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm m

Total expenses and losses per audited financial statements Amounts included on line 1 but not on Form 990, Part IX, line 25: Donated services and use of facilities Prior year adjustments Other losses Other (Describe in Part XIV.) Add lines 2a through 2d Subtract line 2e from line 1 Amounts included on Form 990, Part IX, line 25, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIV.) Add lines 4a and 4b Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.)

Part XIV

372,009. 436,333. 7,651,848.

Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

Total revenue, gains, and other support per audited financial statements Amounts included on line 1 but not on Form 990, Part VIII, line 12: Net unrealized gains on investments Donated services and use of facilities Recoveries of prior year grants Other (Describe in Part XIV.) Add lines 2a through 2d Subtract line 2e from line 1 Amounts included on Form 990, Part VIII, line 12, but not on line 1 : Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIV.) Add lines 4a and 4b Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.)

Part XIII

176,716,862. 169,501,347. 7,215,515. 64,324.

1 2 3 4 5 6 7 8 9 10

4a 4b

4c 5

176,716,862.

1

171,043,505.

2e 3

1,542,158. 169,501,347.

4c 5

169,501,347.

2a 2b 2c 2d

4a 4b

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

SEE PAGE 5

Schedule D (Form 990) 2010 JSA 0E1271 1.000

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PAGE 27

Page 5

Schedule D (Form 990) 2010

Part XIV

Supplemental Information (continued)

FIN 48 FOOTNOTE PART X, LINE 2 THE HOSPITAL APPLIES A MORE-LIKELY-THAN-NOT MEASUREMENT METHODOLOGY TO REFLECT THE FINANCIAL STATEMENT IMPACT OF UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN.

AFTER EVALUATING THE TAX

POSITIONS TAKEN, NONE ARE CONSIDERED TO BE UNCERTAIN; THEREFORE, NO AMOUNTS HAVE BEEN RECOGNIZED AS OF DECEMBER 31, 2010 AND 2009.

IF

INCURRED, INTEREST AND PENALTIES ASSOCIATED WITH TAX POSITIONS ARE RECORDED IN THE PERIOD ASSESSED IN SUPPLIES AND OTHER EXPENSES.

NO

INTEREST OR PENALTIES HAVE BEEN ASSESSED AS OF DECEMBER 31, 2010 AND 2009.

TAX YEARS THAT REMAIN SUBJECT TO EXAMINATION INCLUDE 2007 THROUGH

THE CURRENT PERIOD FOR THE FEDERAL RETURN AND 2006 THROUGH THE CURRENT PERIOD FOR THE COLORADO RETURN.

OTHER ADJUSTMENTS PART XI, LINE 8 UNITED MEDICAL BUILDING CONDOMINIUM ASSOCIATION CHANGE IN NET ASSETS

$8,549

CHANGE IN INTEREST IN NET ASSETS HELD BY LONGMONT UNITED HOSPITAL FOUNDATION

TOTAL OTHER ADJUSTMENTS

$363,460

$372,009

Schedule D (Form 990) 2010

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PAGE 28

Page 5

Schedule D (Form 990) 2010

Part XIV

Supplemental Information (continued)

OTHER RECONCILING ITEMS PART XII, LINE 2D UNITED MEDICAL BUILDING CONDOMINIUM ASSOCIATION REVENUE

$422,469

RENTAL EXPENSES

$1,085,115

FUNDRAISING EVENTS EXPENSES

$43,008

CHANGE IN INTEREST IN NET ASSETS HELD BY LONGMONT UNITED HOSPITAL FOUNDATION

TOTAL OTHER RECONCILING ITEMS

$363,460

$1,914,167

OTHER RECONCILING ITEMS PART XIII, LINE 2D UNITED MEDICAL BUILDING CONDOMINIUM ASSOCIATION EXPENSES

$414,035

RENTAL EXPENSES

$1,085,115

FUNDRAISING EVENTS EXPENSES

$43,008

TOTAL OTHER RECONCILING ITEMS

$1,542,158

Schedule D (Form 990) 2010

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PAGE 29

OMB No. 1545-0047

Supplemental Information Regarding Fundraising or Gaming Activities

SCHEDULE G (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service Name of the organization

À¾µ´ Open To Public

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Attach to Form 990 or Form 990-EZ. See separate instructions.

I

I

Inspection

Employer identification number

LONGMONT UNITED HOSPITAL 84-0460697 Fundraising Activities.Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Part I Form 990-EZ filers are not required to complete this part. 1 a b c d

Indicate whether the organization raised funds through any of the following activities. Check all that apply. Mail solicitations e Solicitation of non-government grants Internet and email solicitations f Solicitation of government grants Phone solicitations g Special fundraising events In-person solicitations

2 a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

No

b If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. (i) Name and address of individual or entity (fundraiser)

(ii) Activity

(iii) Did fundraiser have custody or control of contributions?

Yes

(iv) Gross receipts from activity

(v) Amount paid to (or retained by) fundraiser listed in col. (i)

(vi) Amount paid to (or retained by) organization

No

1 2 3 4 5 6 7 8 9 10

Total 3

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Schedule G (Form 990 or 990-EZ) 2010

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Page 2

84-0460697 Fundraising Events.Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more

Schedule G (Form 990 or 990-EZ) 2010

Part II

than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000. (a) Event #1

(b) Event #2

DINNER DANCE Revenue

(event type)

mmmmmmmmmmmm mmmmmmmmmmmmm mmmmmmmmmmmmmmmmm mmmmmmmmmmmmm mmmmmmmmmmm mmmmmmmmmm mmmmmmmmm mmmmmmmmmmmm mmmmmmmm

1 Gross receipts 2 Less: Charitable contributions 3 Gross income (line 1 minus line 2)

(c) Other Events

GOLF TOURNAMEN (event type)

(d) Total events (add col. (a) through col. (c))

0. (total number)

91,735.

31,510.

123,245.

81,375.

17,590.

98,965.

10,360.

13,920.

24,280.

1,160.

1,160.

7,630.

24,214.

2,668.

2,668.

4 Cash prizes

Direct Expenses

5 Noncash prizes

16,584.

6 Rent/facility costs

7 Food and beverages

3,000.

8 Entertainment

3,000.

11,236.

9 Other direct expenses

730.

11,966.

43,008. m -18,728. mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mI I Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more (

10 Direct expense summary. Add lines 4 through 9 in column (d) 11 Net income summary. Combine line 3, column (d), and line 10

Part III

)

Revenue

than $15,000 on Form 990-EZ, line 6a. (b) Pull tabs/Instant bingo/progressive bingo

(a) Bingo

mmmmmmmmmmmm mmmmmmmmmmmmm mmmmmmmmmmm mmmmmmmmmm mmmmmmmm mmmmmmmmmmm

(d) Total gaming (add col. (a) through col. (c))

(c) Other gaming

1 Gross revenue

Direct Expenses

2 Cash prizes

3 Noncash prizes

4 Rent/facility costs

5 Other direct expenses 6 Volunteer labor

Yes

%

Yes

No

7 Direct expense summary. Add lines 2 through 5 in column (d)

No

%

%

Yes No

mmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmI

(

)

8 Net gaming income summary. Combine line 1, column d, and line 7 9

Enter the state(s) in which the organization operates gaming activities: a Is the organization licensed to operate gaming activities in each of these states? b If "No," explain:

mmmmmmmmmmmmmmmmm

Yes

No

mmmmm

Yes

No

10 a Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? b If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2010 JSA 0E1282 1.000

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Page 3

Schedule G (Form 990 or 990-EZ) 2010

mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

Does the organization operate gaming activities with nonmembers? Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed to administer charitable gaming? 13 Indicate the percentage of gaming activity operated in: a The organization's facility 13a b An outside facility 13b 14 Enter the name and address of the person who prepares the organization's gaming/special events books and records:

11 12

Name

Yes

No

Yes

No

% %

I I

Address

Does the organization have a contract with a third party from whom the organization receives gaming revenue? b If "Yes," enter the amount of gaming revenue received by the organization $ and the amount of gaming revenue retained by the third party $ . c If "Yes," enter name and address of the third party:

15 a

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I I

Name

Yes

No

Yes

No

I I

Address

Gaming manager information:

16

Name

I I I

Gaming manager compensation

$

Description of services provided Director/officer 17

Employee

Independent contractor

Mandatory distributions: Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming license? b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization's own exempt activities during the tax year $ a

Part IV

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I

Supplemental Information. Complete this part to provide the explanation required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Schedule G (Form 990 or 990-EZ) 2010

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PAGE 32

Hospitals

SCHEDULE H (Form 990)

I

OMB No. 1545-0047

À¾µ´

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

I

Attach to Form 990.

Department of the Treasury Internal Revenue Service Name of the organization

I

See separate instructions.

Open to Public Inspection Employer identification number

LONGMONT UNITED HOSPITAL Financial Assistance and Certain Other Community Benefits at Cost Part I

84-0460697 Yes No

mmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

1a Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a b If "Yes," was it a written policy? 2 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.

1a 1b

X X

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.

3

mmmmmmmmmm

X

mmmmmmmmmm

X

a Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low income individuals? If “Yes,” indicate which of the following was the FPG family income limit for eligibility for free care: 100%

150%

200%

X

Other

250.0000

3a

%

b Did the organization use FPG to determine eligibility for providing discounted care to low income individuals? If "Yes," indicate which of the following was the family income limit for eligibility for discounted care: 200%

250%

X

300%

350%

400%

Other

3b

%

c If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria 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, to determine eligibility for free or discounted care. 4

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"?

mmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

5a Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? b If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? c If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted care to a patient who was eligible for free or discounted care? 6a Did the organization prepare a community benefit report during the tax year? b 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.

X X

4

5a 5b

X

5c

6a 6b

X X

Financial Assistance and Certain Other Community Benefits at Cost

7

Financial Assistance and Means-Tested Government Programs

a

(a) Number of activities or programs (optional)

mmm mmmm mmmm mmmmmmmmm

c d

(c) Total community benefit expense

(d) Direct offsetting revenue

(e) Net community benefit expense

(f) Percent of total expense

Financial Assistance at cost (from Worksheets 1 and 2)

b

(b) Persons served (optional)

13,012,135.

8,727,588.

4,284,546.

2.80

21,375,221.

15,824,097.

5,551,124.

3.62

34,387,356.

24,551,685.

9,835,670.

6.42

421,239.

421,239.

.27

3,872,803.

3,872,803.

2.53

5,729,000.

5,729,000.

3.74

275,172. 10,298,214. 44,685,570.

275,172. 10,298,214. 20,133,884.

.18 6.72 13.14

Unreimbursed Medicaid (from

Worksheet 3, column a) Unreimbursed costs - other meanstested government programs (from Worksheet 3, column b) Total Financial Assistance and Means-Tested Government Programs

Other Benefits e

Community health improvement services and community benefit operations (from Worksheet 4)

f

Health professions education

m mmmmm mmmmmmmm mm mmmm m m mm mm m m mmm m

(from Worksheet 5)

g

Subsidized health services (from Worksheet 6)

h

Research (from Worksheet 7)

i

Cash and in-kind contributions to community groups (from Worksheet 8)

j k

Total. Other Benefits

Total. Add lines 7d and 7j

24,551,685.

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

Schedule H (Form 990) 2010

JSA 0E1284 2.000

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PAGE 33

84-0460697 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.

Schedule H (Form 990) 2010

Part II

(a) Number of activities or programs (optional)

(b) Persons served (optional)

(c) Total community building expense

(d) Direct offsetting revenue

(e) Net community building expense

Page 2

(f) Percent of total expense

1 Physical improvements and housing 2 Economic development 3 Community support 4 Environmental improvements

27,570. 913. 2,122.

27,570. 913. 2,122.

.02

13,736.

13,736.

.01

859.

859.

45,200.

45,200.

5 Leadership development and training for community members

6 Coalition building 7 Community health improvement advocacy 8 Workforce development 9 Other 10 Total

Part III

.03

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense 1 2 3 4

Yes

Does the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? 5,529,000. 2 Enter the amount of the organization's bad debt expense (at cost) Enter the estimated amount of the organization's bad debt expense (at cost) attributable 2,000,000. 3 to patients eligible under the organization's financial assistance policy Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts in community benefit.

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmm mmmmmmmmmm

6 7 8

X

1

mmmmmmmmmm mmmmmmmmmm mmmmmmmmmmmmmmmm

Section B. Medicare 5

No

45,489,000. 5 Enter total revenue received from Medicare (including DSH and IME) 66,066,000. 6 Enter Medicare allowable costs of care relating to payments on line 5 -20,577,000. 7 Subtract line 6 from line 5. This is the surplus (or shortfall) 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: X

Cost accounting system

Cost to charge ratio

Other

Section C. Collection Practices 9a Does the organization have a written debt collection policy during the tax year?

mmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmm

9a

X

9b

X

b 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

Part IV

Management Companies and Joint Ventures (b) Description of primary activity of entity

(a) Name of entity

1 2 3 4 5 6 7 8 9 10 11 12 13

UMB CONDO. ASSOC. LMC-MOB, LLC LMC COMM., LLC TRI-TOWN MED. CAMPUS TWIN PEAKS MED. IMAG

JSA 0E1285 2.000

MAINTENANCE OF COMMON AREAS CONSTRUCTION OF OFFICE BLDG OPERATION OF COMM EQUIPMENT CONSTRUCTION OF CARE CLINIC PROVISION OF DIAG. IMAGING

5709CF N752 9/16/2011

(c) Organization's profit % or stock ownership %

(d) Officers, directors, trustees, or key employees' profit % or stock ownership %

92.00000 17.18000 50.00000 50.00000 50.00000

(e) Physicians' profit % or stock ownership %

8.00000 82.82000 50.00000 50.00000 50.00000

Schedule H (Form 990) 2010

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Part V

Page 3

84-0460697

Schedule H (Form 990) 2010

Facility Information ER-other

ER-24 hours

Research facility

Critical access hospital

Teaching hospital

Children's hospital

How many hospital facilities did the organization operate 1 during the tax year?

General medical & surgical

(list in order of size, measured by total revenue per facility, from largest to smallest)

Licensed hospital

Section A. Hospital Facilities

Name and address

Other (describe)

1 LONGMONT UNITED HOSPITAL

1950 MOUNTAIN VIEW AVE LONGMONT

CO 80501

X

X

X

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

Schedule H (Form 990) 2010 JSA 0E1286 2.000

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Page 4

Schedule H (Form 990) 2010

Part V

Facility Information (continued)

Section B. Facility Policies and Practices (Complete a separate Section B for each of the hospital facilities listed in Part V, Section A) Name of Hospital Facility:

LONGMONT UNITED HOSPITAL

Line Number of Hospital Facility (from Schedule H, Part V, Section A):

1 Yes

No

Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)

During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (Needs Assessment)? If "No," skip to line 8 If "Yes," indicate what the Needs Assessment describes (check all that apply): a A definition of the community served by the hospital facility b Demographics of the community c Existing health care facilities and resources within the community that are available to respond to the health needs of the community d How data was obtained e The health needs of the community f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups g The process for identifying and prioritizing community health needs and services to meet the community health needs h The process for consulting with persons representing the community's interests i Information gaps that limit the hospital facility's ability to assess all of the community's health needs j Other (describe in Part VI) 2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20 3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted 4 Was the hospital facility's Needs Assessment conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI 5 Did the hospital facility make its Needs Assessment widely available to the public? If "Yes," indicate how the Needs Assessment was made widely available (check all that apply): a Hospital facility's website b Available upon request from the hospital facility c Other (describe in Part VI) 6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply): a Adoption of an implementation strategy to address the health needs of the hospital facility's community b Execution of the implementation strategy c Participation in the development of a community-wide community benefit plan d Participation in the execution of a community-wide community benefit plan e Inclusion of a community benefit section in operational plans f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment g Prioritization of health needs in its community h Prioritization of services that the hospital facility will undertake to meet health needs in its community i Other (describe in Part VI) 7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs Financial Assistance Policy 1

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmm

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

8 9

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 includes free or discounted care? Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low income individuals? If "Yes," indicate the FPG family income limit for eligibility for free care: 2 5 0 %

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

JSA 0E1287 2.000

1

3 4 5

7

8

X

9

X

Schedule H (Form 990) 2010

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Page 5

Schedule H (Form 990) 2010

Part V

Facility Information (continued)

LONGMONT UNITED HOSPITAL

mmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmm

10 11 a b c d e f g h 12 13 a b c d e f g

Yes

10

X

11

X

12 13

X X

mmmmmmm

14

X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

16

X

Used FPG to determine eligibility for providing discounted care to low income individuals? 3 0 0% If "Yes," indicate the FPG family income limit for eligibility for discounted care: Explained the basis for calculating amounts charged to patients? If "Yes," indicate the factors used in determining such amounts (check all that apply): X Income level X Asset level X Medical indigency X Insurance status X Uninsured discount X Medicaid/Medicare State regulation Other (describe in Part VI) Explained the method for applying for financial assistance? Included measures to publicize the policy within the community served by the hospital facility? If "Yes," indicate how the hospital facility publicized the policy (check all that apply): X The policy was posted on the hospital facility's website The policy was attached to billing invoices The policy was posted in the hospital facility's emergency rooms or waiting rooms The policy was posted in the hospital facility's admissions offices The policy was provided, in writing, to patients on admission to the hospital facility X The policy was available on request Other (describe in Part VI)

mmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmm

Billing and Collections 14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment? 15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year: X Reporting to credit agency a X Lawsuits b c Liens on residences d Body attachments e Other actions (describe in Part VI) 16 Did the hospital facility engage in or authorize a third party to perform any of the following collection actions during the tax year? If "Yes," check all collection actions in which the hospital facility or a third party engaged (check all that apply): X Reporting to credit agency a X Lawsuits b c Liens on residences d Body attachments e Other actions (describe in Part VI) 17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in line 16 (check all that apply): a Notified patients of the financial assistance policy on admission b Notified patients of the financial assistance policy prior to discharge X Notified patients of the financial assistance policy in communications with the patients regarding the c patients' bills X Documented its determination of whether a patient who applied for financial assistance under the d financial assistance policy qualified for financial assistance e Other (describe in Part VI)

No

Schedule H (Form 990) 2010

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Page 6

Schedule H (Form 990) 2010

Facility Information (continued) Part V Policy Relating to Emergency Medical Care

LONGMONT UNITED HOSPITAL Yes No

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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? If "No," indicate the reasons why (check all that apply):

18

mmmmmmmmmmm

a b c d

18

X

The hospital facility did not provide care for any emergency medical conditions The hospital facility did not have a policy relating to emergency medical care The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI) Other (describe in Part VI)

Charges for Medical Care Indicate how the hospital facility determined the amounts billed to individuals who did not have insurance covering emergency or other medically necessary care (check all that apply):

19 a

The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility

The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility c The hospital facility used the Medicare rate for those services X Other (describe in Part VI) d 20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility's financial assistance policy, and 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? b

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

20

X

If "Yes," explain in Part VI. 21

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

Did the hospital facility charge any of its patients an amount equal to the gross charge for any service provided to that patient? If "Yes," explain in Part VI.

21

X

Schedule H (Form 990) 2010

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PAGE 38

Page 7

Schedule H (Form 990) 2010

Facility Information (continued) Part V Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?

Name and address

Type of Facility (describe)

1

2

3

4

5

6

7

8

9

10

Schedule H (Form 990) 2010

JSA 0E1325 1.000

5709CF N752 9/16/2011

12:09:52 PM

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PAGE 39

Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE PER FORM 990 REMOVED FROM THE DENOMINATOR = $16,244,594.

PART I, LINE 7 CHARITY CARE AT COST IS CALCULATED BY TAKING GROSS CHARITY CARE CHARGES, OFFSETTING THEM BY REVENUES RECEIVED FROM UNCOMPENSATED CARE POOLS, AND THEN MULTIPLYING THAT RESULT BY OUR FACILITY COST/CHARGE RATIO.

THE

UNREIMBURSED COST OF MEDICAID COMES FROM AN INTERNAL COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS.

PART III, LINE 4 BAD DEBT FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS: UNCOLLECTIBLE AMOUNTS FROM PATIENTS WHO DO NOT MEET THE CRITERIA UNDER THE HOSPITAL'S CHARITY CARE POLICY ARE INCLUDED AS OPERATING EXPENSES IN THE PROVISION FOR UNCOLLECTIBLE PATIENT ACCOUNTS.

COSTING METHODOLOGY USED IN DETERMINING PART III, LINE 2:

Schedule H (Form 990) 2010

JSA 0E1326 1.000

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PAGE 40

Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

BAD DEBT EXPENSE AT COST IS CALCULATED BY TAKING TOTAL BAD DEBT EXPENSE AND MULTIPLYING IT BY THE FACILITY COST TO CHARGE RATIO. THAT COST TO CHARGE RATIO IS CALCULATED BY TAKING TOTAL EXPENSES (LESS BAD DEBT) AND DIVIDING BY TOTAL GROSS CHARGES.

NO BAD DEBT IS INCLUDED IN OUR

COMMUNITY BENEFIT NUMBERS.

COSTING METHODOLOGY USED IN DETERMINING PART III, LINE 3: HOSPITAL COLLECTION STAFF WERE ASKED FOR THEIR OPINION OF HOW MUCH BAD DEBT WOULD QUALIFY FOR CHARITY HAD THE PATIENTS COMPLETED THE ELIGIBILITY VERIFICATION PROCESS.

THIS IS A BEST ESTIMATE - LONGMONT IS NOT ABLE TO

FORMALLY CALCULATE THIS AMOUNT.

PART III, LINE 8 SHORTFALL REPORTED IN PART III, LINE 7: LONGMONT DOES NOT INCLUDE MEDICARE REIMBURSEMENT SHORTFALLS AS PART OF COMMUNITY BENEFIT.

COSTING METHODOLOGY USED TO DETERMINE PART III, LINE 6:

Schedule H (Form 990) 2010

JSA 0E1326 1.000

5709CF N752 9/16/2011

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PAGE 41

Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

LONGMONT USES A COST ACCOUNTING SYSTEM TO CALCULATE UNREIMBURSED COSTS OF MEDICAID.

PART III, LINE 9B IF A PATIENT IS KNOWN TO QUALIFY FOR CHARITY CARE, THEIR PATIENT LIABILITY IS EITHER WRITTEN OFF OR WRITTEN DOWN TO THE COLORADO INDIGENT CARE PROGRAM(CICP) COPAYMENT SCHEDULE AMOUNT.

THIS PRACTICE APPLIES ONLY

TO PATIENTS THAT HAVE BEEN VERIFIED AS ELIGIBLE FOR THE HOSPITAL'S CHARITY CARE.

NEEDS ASSESSMENT PART VI, LINE 2 LONGMONT UNITED HOSPITAL ASSESSES HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES WITH THE FOLLOWING:

* GEOGRAPHIC AREA COMMUNITY BENEFIT IS PROVIDED TO COMMUNITIES IN OUR PRIMARY AND SECONDARY SERVICE AREAS. THESE SERVICE AREAS REPRESENT ROUGHLY A 20-MILE RADIUS

Schedule H (Form 990) 2010

JSA 0E1326 1.000

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 42

Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

AROUND THE HOSPITAL AND ENCOMPASS MOUNTAIN TOWNS, SUBURBAN CITIES, AND RURAL PLAINS COMMUNITIES.

* FREQUENCY OF ASSESSMENT LONGMONT UNITED HOSPITAL'S MISSION: DEDICATED TO IMPROVING THE HEALTH OF OUR PATIENTS AND COMMUNITIES LONGMONT SERVES. THIS ENCOMPASSES ALL ASPECTS OF IMPROVING COMMUNITY AND INDIVIDUAL HEALTHCARE. IT REQUIRES THE BOARD OF DIRECTORS AND LEADERSHIP TO BE ACTIVE IN THE COMMUNITY TO UNDERSTAND AND ASSESS THE CRITICAL NEEDS OF THE COMMUNITY. LEADERSHIP ALSO PRESENTS ANNUALLY TO THE BOARD OF DIRECTORS THE ORGANIZATIONS SUPPORTED FINANCIALLY AND THROUGH INVOLVEMENT OF EMPLOYEES. FUTURE SUPPORT PRIORITIES ARE DISCUSSED AND DETERMINED AT THAT TIME.

LEADERSHIP ALSO ASSESSES, AS NEEDED, FINANCIAL SUPPORT REQUESTS BY COMMUNITY ORGANIZATIONS. PRIORITY CRITERIA FOR APPROVAL ARE SERVICES SUPPORTING ELDERLY OR LOW-INCOME FAMILIES, AS WELL AS, EDUCATION AND WELLNESS.

Schedule H (Form 990) 2010

JSA 0E1326 1.000

5709CF N752 9/16/2011

12:09:52 PM

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PAGE 43

Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

* ASSESSMENT UPDATES ASSESSMENT UPDATES ARE PERFORMED AND PRESENTED ANNUALLY TO THE BOARD OF DIRECTORS FOR REVIEW.

* COMMUNITY LEADER INPUT THE BOARD OF DIRECTORS INCLUDES KEY COMMUNITY LEADERS WHO POSSESS SPECIAL KNOWLEDGE OF THE COMMUNITIES AND POPULATIONS LONGMONT SERVES. HOSPITAL LEADERSHIP AND STAFF MEMBERS ALSO SERVE ON SEVERAL KEY BOARDS SUCH AS HOSPICE CARE, UNITED WAY, CHAMBERS OF COMMERCE, COMMUNITY FOOD SHARE, ECONOMIC COUNCILS, SALUD FAMILY HEALTH CLINIC, SPECIAL TRANSIT, AND THE EDUCATION FOUNDATION.

* COMMUNICATION OF COMMUNITY BENEFIT INFORMATION ON ORGANIZATIONS SERVED AND FINANCIAL SUPPORT IS REPORTED IN THE HOSPITAL ANNUAL REPORT WHICH IS AVAILABLE ON-LINE TO THE COMMUNITY.

Schedule H (Form 990) 2010

JSA 0E1326 1.000

5709CF N752 9/16/2011

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PAGE 44

Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 * COMMUNICATION OF COMMUNITY BENEFIT LONGMONT HAS FULL-TIME FINANCIAL COUNSELORS THAT ARE AVAILABLE TO PROVIDE GUIDANCE TO ANY PATIENT.

THE CONTACT INFORMATION OF SUCH COUNSELORS,

INCLUDING PHONE NUMBERS, IS COMMUNICATED VERBALLY TO PATIENTS AND THEIR FAMILIES WHEN THEY ACCESS HOSPITAL SERVICES. THE COUNSELORS DISCUSS GOVERNMENT BENEFITS AND RESOURCES THAT MIGHT BE AVAILABLE WITH PATIENTS WHO HAVE QUESTIONS OR WHO HAVE ASKED FOR MORE INFORMATION, AS WELL AS ASSIST WITH DETERMINING PATIENT ELIGIBILITY OF VARIOUS PROGRAMS. LONGMONT IS WORKING TOWARDS PROVIDING WRITTEN INFORMATION AND BROCHURES IN THE FUTURE.

UPON DISCHARGE, LONGMONT PERSONNEL PROVIDE VERBAL COMMUNICATION

OF CONTACT INFORMATION AND PHONE NUMBERS OF FINANCIAL COUNSELORS. INVOICES TO PATIENTS INCLUDE A PHONE NUMBER IF THEY HAVE QUESTIONS OR WOULD LIKE ASSISTANCE REGARDING FINANCIAL RESOURCES.

Schedule H (Form 990) 2010

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

COMMUNITY INFORMATION PART VI, LINE 4 THE COMMUNITIES THAT LONGMONT UNITED HOSPITAL SERVES ARE DESCRIBED AS FOLLOWS:

* GEOGRAPHIC AREA COMMUNITY BENEFIT IS PROVIDED TO COMMUNITIES IN OUR PRIMARY SERVICE AREAS (PSA) AND SECONDARY SERVICE AREAS (SSA). THESE SERVICE AREAS REPRESENT ROUGHLY A 20-MILE RADIUS AROUND THE HOSPITAL AND ENCOMPASS MOUNTAIN TOWNS, SUBURBAN CITIES, AND RURAL PLAINS COMMUNITIES. LONGMONT UNITED HOSPITAL, A COMMUNITY NON-FOR-PROFIT HOSPITAL, IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA.

ZIPCODES 80501 LONGMONT

PSA

80503 LONGMONT

PSA

80504 LONGMONT

PSA

80513 BERTHOUD

PSA

Schedule H (Form 990) 2010

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

80530 FREDERICK 80540 LYONS

PSA

PSA

80520 FIRESTONE (80504) PSA 80502 LONGMONT (80501) PSA 80533 HYGIENE (80503) PSA 80544 NIWOT (80503) PSA 80514 DACONO

PSA

80542 MEAD

PSA

80516 ERIE

PSA

80534 JOHNSTOWN

SSA

80026 LAFAYETTE

SSA

80651 PLATTEVILLE

SSA

80621 FORT LUPTON

SSA

80538 LOVELAND 80301 BOULDER

SSA SSA

80623 PLATTEVILLE (80651) SSA 80541 LOVELAND (80537) SSA 80537 LOVELAND

SSA

Schedule H (Form 990) 2010

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

* DEMOGRAPHIC PROFILE INFORMATION CITY OF LONGMONT/ BOULDER COUNTY = 2010 US CENSUS BOULDER COUNTY: HTTP://QUICKFACTS.CENSUS.GOV/QFD/STATES/08/08013.HTML LONGMONT: HTTP://WWW.CI.LONGMONT.CO.US/PLANNING/CENSUS/

STATISTICS FROM BOULDER COMMUNITY FOUNDATION: BOULDER COUNTY TRENDS REPORT 2009

* HEALTH COVERAGE: * RACE: 53% OF LATINOS AND 92% NON-HISPANIC WHITES HAVE HEALTHCARE COVERAGE IN BOULDER COUNTY. * AGE: 24% (25-34), 13% (35-44), 8% ( 45-65) 0.4% (+65) ARE

LACKING

HEALTH COVERAGE. * MEDICAID AND MEDICARE ACCOUNT FOR 13% AND 12% OF ALL COLORADO HEALTH COVERAGE, RESPECTIVELY, BUT QUALIFYING FOR THESE PROGRAMS IS EXTREMELY DIFFICULT AS A NON-PREGNANT OR NON-DISABLED ADULT. 15-20% OF ADULTS IN BOULDER COUNTY ARE UNINSURED AND A DISPROPORTIONATE NUMBER OF

Schedule H (Form 990) 2010

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

THOSE UNINSURED ARE LATINO. * 91% OF THE CHILDREN IN BOULDER COUNTY HAVE HEALTH COVERAGE. 59% OF BOULDER COUNTY CHILDREN HAVE AN IDENTIFIED PRIMARY CARE PROVIDER.

* ADULTS: FIVE CHRONIC DISEASES - HEART DISEASE, DIABETES, HYPERTENSION, ASTHMA AND DEPRESSION - ACCOUNT FOR $16.5 BILLION IN HEALTH SPENDING IN COLORADO.

* CHILDREN: * 20% OF BOULDER COUNTY CHILDREN REPORTED FOOD INSECURITY. * 20% OF BOULDER COUNTY CHILDREN AGES 1-14 ARE OVERWEIGHT OR OBESE. * 26% OF PARENTS REPORTED BEHAVIORAL OR MENTAL HEALTH PROBLEMS AGES 1-14. * 30% HIGH SCHOOL STUDENTS WERE OFFERED ILLEGAL DRUGS ON SCHOOL PROPERTY * OVERALL TEEN FERTILITY RATE IS LOW HOWEVER OF THOSE TEEN MOTHERS, 70% ARE LATINO, AND SUBSTANTIALLY FEWER LATINA WOMEN RECEIVE LATE OR NO PRENATAL CARE.

Schedule H (Form 990) 2010

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

* 500 CHILDREN WERE PRESENT AT FORMALLY REPORTED DOMESTIC VIOLENCE INCIDENTS IN 2007. * ST. VRAIN VALLEY SCHOOL DISTRICT HAS A 2.7% DROP OUT RATE

* ECONOMY * 11% OF BOULDER COUNTY RESIDENTS LIVE BELOW FEDERAL POVERTY LEVEL. 5% OF THE FAMILIES IN BOULDER COUNTY LIVE BELOW THE FEDERAL POVERTY LEVEL. * 18% OF THE HOUSEHOLDS IN BOULDER COUNTY LIVE ON AN ANNUAL INCOME OF LESS THAN $25,000. 8% OF THE FAMILY HOUSEHOLDS IN BOULDER COUNTY LIVE ON AN ANNUAL INCOME OF LESS THAN $25,000.

* HEALTH RELATED INFORMATION FIVE CHRONIC DISEASES IN COLORADO ARE HEART DISEASE, DIABETES, HYPERTENSION, ASTHMA AND DEPRESSION. * 33% OF TOTAL DEATHS ARE CAUSED BY CARDIOVASCULAR DISEASE IN BOULDER COUNTY. * CANCER IS RESPONSIBLE FOR ANOTHER 22% OF DEATHS IN BOULDER COUNTY.

Schedule H (Form 990) 2010

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

(BOULDER FOUNDATION) IN COLORADO, 17.6% OF THE ADULT POPULATION (AGED 18+ YEARS)-OVER 658,000 INDIVIDUALS-ARE CURRENT CIGARETTE SMOKERS. ACROSS ALL STATES, THE PREVALENCE OF CIGARETTE SMOKING AMONG ADULTS RANGES FROM 9.3% TO 26.5%. COLORADO IS RANKED 21ST

AMONG THE STATES. AMONG YOUTH AGED 12-17 YEARS,

10.3% SMOKE IN COLORADO. THE RANGE ACROSS ALL STATES IS 6.5% TO 15.9%. COLORADO IS RANKED 22ND AMONG THE STATES. (CENTER OF DISEASE CONTROL AND PREVENTION)

* PROVISIONS FOR UNINSURED LONGMONT UNITED HOSPITAL PROVIDES A SAFETY NET FOR UNINSURED PERSONS THROUGH THE FOLLOWING: * LONGMONT UNITED HOSPITAL PROVIDES MORE CHARITY CARE THAN ANY OTHER HOSPITAL IN BOULDER COUNTY. * SUBSIDIZING AND SUPPORTING THE SALUD FAMILY HEALTH CENTERS, A LOW-INCOME PRIMARY HEALTHCARE SERVICE. * SUPPORTING WOMEN'S HEALTH CENTER WHO PROVIDES QUALITY HEALTHCARE AND SERVICES REGARDLESS OF A CLIENT'S INSURED STATUS, ECONOMIC

Schedule H (Form 990) 2010

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RCH 4822-00

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

CIRCUMSTANCES OR IMMIGRATION STATUS.

PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 LONGMONT UNITED HOSPITAL IMPROVES THE HEALTH OF THE COMMUNITY THROUGH SUPPORT OR PARTNERSHIPS IN ACTIVITIES OR ORGANIZATIONS FOCUSED ON BETTER HEALTH FOR EVERYONE IN THE COMMUNITY. LISTED BELOW ARE THE KEY INITIATIVES WITH EXPLANATIONS IN WHICH THE HOSPITAL IS INVOLVED.

* HEALTH PROFESSIONALS EDUCATION DEMANDS FOR NURSES, PHYSICAL THERAPISTS, IMAGING TECHNOLOGISTS, ETC. IN THE FRONT RANGE OF COLORADO CONTINUE TO BE HIGH. COLLEGES AND UNIVERSITIES WORK WITH THE HOSPITAL TO FACILITATE PROGRAMS TO ASSIST INDIVIDUALS IN COMPLETING THE HEALTH CARE CERTIFICATIONS. LONGMONT UNITED HOSPITAL OFFERS ONE-ON-ONE TRAINING THAT IS NEEDED TO BEGIN WORK IN THE HEALTHCARE FIELD.

* SENIOR HEALTH EDUCATION AND SERVICES

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

SINCE 1991, LONGMONT UNITED HOSPITAL HAS OFFERED A SENIOR WELLNESS PROGRAM TO EMPOWER THE SENIOR COMMUNITY TO ASSUME RESPONSIBILITY FOR THEIR HEALTH AND WELLNESS BY PROVIDING THE REQUISITE KNOWLEDGE, RESOURCES AND TOOLS TO ACCOMPLISH THAT GOAL. AT THE END OF 2010, THERE WERE 833 MEMBERS PARTICIPATING EDUCATION PROGRAMS, HEALTH CLINICS AND LOW-COST LABORATORY SERVICES.

* LOW-INCOME PRIMARY HEALTH CARE SERVICES PRIMARY HEALTH CARE SERVICES ARE OFFERED TO IMPROVE ACCESS AND REDUCE BARRIERS TO CARE INCLUDING ABILITY TO PAY, TRANSPORTATION, AND LANGUAGE. ALL SERVICES ARE DESIGNED TO REDUCE HEALTH DISPARITIES AND DELIVERED TO ALL COMMUNITY MEMBERS, WITHOUT REGARD TO AGE, SEX OR DISEASE PROCESS. POPULATION SERVED INCLUDES ALL COMMUNITY MEMBERS WITH THE LOW-INCOME AND THE MEDICALLY UNDERSERVED POPULATION WITH THE MIGRANT AND SEASONAL FARM WORKER POPULATION AS THE PRIORITY CLIENTELE. PATIENTS ARE NOT TURNED AWAY BASED ON A PATIENT'S FINANCES, INSURANCE COVERAGE, OR ABILITY TO PAY.

* LACTATION CONSULTING

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

QUALIFIED LACTATION SPECIALISTS EDUCATE ON THE BENEFITS OF BREASTFEEDING, HOW THE PROCESS WORKS, PROPER POSITIONING, PREVENTION OF COMMON DIFFICULTIES, AND MANAGING BREASTFEEDING WHEN WORKING OUTSIDE THE HOME. CULTURES EXIST IN OUR COMMUNITIES THAT DO NOT UNDERSTAND THESE BENEFITS OR HAVE TO GO AGAINST PRACTICED BELIEFS IN THEIR COMMUNITY. STUDIES REPEATEDLY PROVE THE INFANT WILL RECEIVE HEALTH BENEFITS BY BREASTFEEDING.

* COMMUNITY SUPPORT SERVICES MOBILITY OPTIONS ARE PROVIDED TO ALL PEOPLE, REGARDLESS OF AGE, HEALTH, DISABILITY, INCOME OR ETHNICITY OR SEXUAL ORIENTATION TO ENHANCE THEIR INDEPENDENCE AND QUALITY OF LIFE. IN 2010, EXPANDED MOBILITY OPTIONS WERE PROVIDED. THIS INCLUDES 912,078 TRIPS ON THE HOP (PUBLIC TRANSPORTATION), 90,238 TRIPS ON ACCESS-A-RIDE AND 127,824 TRIPS ON CALL-N-RIDE. ONE-WAY DEMAND-RESPONSE TRIPS INCREASED SEVEN PERCENT TO 124,500 WITH 25% OF THESE TRIPS FOR MEDICAL AND THERAPY PURPOSES.

* PROMOTION OF LIFESTYLE CHANGES AND PREVENTION

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

ORGANIZATIONS THROUGH OUT COLORADO ARE JOINING TOGETHER TO PROMOTE ACTIVE LIVING AND HEALTHY EATING. THEIR PRIMARY FOCUSES ARE ON ESTABLISHING OBESITY PREVENTION INIATIVES, AS WELL AS, HAVING HEALTHY FOODS AND PHYSICAL ACTIVITY ACCESSIBLE IN PLACES WHERE COLORADANS LIVE, WORK, LEARN AND PLAY.

EFFORTS ARE DIRECTED TO WORKING STRATEGICALLY WITH

STAKEHOLDERS TO ACHIEVE OVERALL HEALTHY LIVING IN ALL COLORADO COMMUNITIES.

* COMMUNITY BUILDING ACTIVITIES MAINTAIN HEALTHY COMMUNITIES THROUGH SUPPORTING THE CREATION AND RETENTION OF JOBS AND INDUSTRIES IN SURROUNDING COMMUNITIES. BUILD A BUSINESS ENVIRONMENT THAT ENCOURAGES NEW INDUSTRY TO THESE COMMUNITIES.

AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 NOT APPLICABLE

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Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

OTHER INFORMATION LONGMONT UNITED HOSPITAL FURTHERS THE PURPOSE OF COMMUNITY BENEFIT WITH THE FOLLOWING:

* GOVERNING BODY THE BOARD OF DIRECTORS ESTABLISHES AND MAINTAINS LONGMONT UNITED HOSPITAL FOR THE CARE OF ALL PERSONS SUFFERING FROM ANY ILLNESS OR DISABILITY REQUIRING HOSPITAL CARE. ALL DIRECTORS ARE A REPRESENTATIVE OF THE LONGMONT UNITED HOSPITAL SERVICE AREA. THE BOARD IS REPRESENTATIVE OF THE COMMUNITIES IT SERVES.

* MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN LONGMONT UNITED HOSPITAL'S SERVICE AREAS FOR ALL HOSPITAL DEPARTMENTS.

* SURPLUS FUNDS THE BOARD OF DIRECTORS ADHERES TO INVESTING SURPLUS FUNDS TO IMPROVE PATIENT CARE, OFFER MEDICAL EDUCATION, AND SUPPORT RESEARCH.

Schedule H (Form 990) 2010

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Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

* ADVOCACY, INVOLVEMENT, FINANCIAL SUPPORT TO THE COMMUNITY LONGMONT UNITED HOSPITAL: * PROVIDES MORE CHARITY CARE THAN ANY OTHER HOSPITAL IN BOULDER COUNTY. * WORKS WITH COLLEGES AND UNIVERSITIES TO FACILITATE PROGRAMS THAT ASSIST INDIVIDUALS IN COMPLETING THE HEALTHCARE CERTIFICATIONS. LONGMONT UNITED HOSPITAL OFFERS TRAINING THAT IS NEEDED TO BEGIN WORK IN THE HEALTHCARE FIELD. DEMANDS FOR NURSES, PHYSICAL THERAPISTS, IMAGING TECHNOLOGISTS, ETC. IN THE FRONT RANGE OF COLORADO CONTINUE TO BE HIGH. THE HOSPITAL ALSO PROVIDES FINANCIAL SUPPORT TO THE COLORADO CANCER RESEARCH PROGRAM AND THE JUSTIN PARKER NEUROLOGICAL INSTITUTE. * OFFERS FINANCIALS ASSISTANCE AND SLIDING SCALE DISCOUNTS ACCORDING THE CHARITY POLICY. * PARTNERS WITH ORGANIZATIONS FOCUSED ON HUMAN SERVICES, PATIENT INFORMATION SHARING, CULTURAL EDUCATION, ENVIRONMENT, HEALTH EDUCATION TO IMPROVE COMMUNITY HEALTH * PROVIDES FINANCIAL AND/OR LEADERSHIP SUPPORT TO HOSPICE CARE,

Schedule H (Form 990) 2010

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Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

SENIOR TRANSPORTATION,

HIGHER AND K-12 EDUCATION, SENIOR PROGRAMS, LOW

INCOME HEALTH CLINICS, ECONOMIC COUNCILS, CHAMBERS OF COMMERCE, AND FOOD SHARE PROGRAMS. * PROVIDES EMERGENCY CARE TO ALL PERSONS REGARDLESS OF ABILITY TO PAY * PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND THE COLORADO INDIGENT CARE PROGRAM.

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Page 8

Schedule H (Form 990) 2010

Part VI

Supplemental Information

Complete this part to provide the following information. 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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 demographic constituents it serves.

the organization serves, taking into account the geographic area and

5 Promotion of community health. Provide any other information important to describing how the organization's hospitals 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.

STATE FILING OF COMMUNITY BENEFIT REPORT CO,

Schedule H (Form 990) 2010

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SCHEDULE I (Form 990) Department of the Treasury Internal Revenue Service Name of the organization

2

À¾µ´ Open to Public Inspection

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

I

Employer identification number

LONGMONT UNITED HOSPITAL Part I General Information on Grants and Assistance 1

OMB No. 1545-0047

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

84-0460697

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

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmX

Part II

1

Yes

No

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 21, for any recipient that received more than $5,000. Check this box if no one recipient 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

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI (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 non-cash assistance

(h) Purpose of grant or assistance

(1) COLORADO CANCER RESEARCH PROGRAM 2253 SOUTH ONEIDA ST DENVER, CO 80224

501(C)(3)

37,531.

PROGRAM SUPPORT

501(C)(3)

37,500.

PROGRAM SUPPORT

501(C)(3)

6,570.

PROGRAM SUPPORT

501(C)(3)

138,355.

PROGRAM SUPPORT

501(C)(3)

5,399.

PROGRAM SUPPORT

(2) FRONT RANGE COMMUNITY COLLEGE 3645 WEST 112TH AVE WESTMINSTER, CO 80031

(3) OUR CENTER 303 ATWOOD ST LONGMONT, CO 80501

(4) SALUD FAMILY HEALTH CENTERS 203 SOUTH ROLLIE AVE FORT LUPTON, CO 80621

(5) A WOMAN'S WORK 2204 18TH AVE LONGMONT, CO 80503

(6) (7) (8) (9) (10) (11) (12)

mmmmmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mI I

2 Enter total number of section 501(c)(3) and government organizations 3 Enter total number of other organizations For Paperwork Reduction Act Notice, see the Instructions for Form 990.

5.

Schedule I (Form 990) (2010)

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84-0460697 Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 22. Part III can be duplicated if additional space is needed.

Schedule I (Form 990) (2010)

Part III

(a) Type of grant or assistance

(b) Number of recipients

(c) Amount of cash grant

(d) Amount of non-cash assistance

(e) Method of valuation (book,

Page 2

(f) Description of non-cash assistance

FMV, appraisal, other)

1 2 3 4 5 6 7

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

PROCEDURES FOR MONITORING USE OF GRANT FUNDS PART I, LINE 2 ALL DONATIONS ARE BASED ON COMMUNITY NEED.

IN ORDER TO ASSESS THE

COMMUNITY NEEDS, MEMBERS OF THE LEADERSHIP COUNCIL HAVE FORMED LONG-TERM PROFESSIONAL RELATIONSHIPS WITH THE RECIPIENT ORGANIZATIONS.

NO

DONATIONS ARE MADE WITHOUT THIS LONG-TERM RELATIONSHIP BEING IN PLACE.

Schedule I (Form 990) (2010)

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Compensation Information

SCHEDULE J (Form 990) Department of the Treasury Internal Revenue Service

OMB No. 1545-0047

For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Complete if the organization answered "Yes" to Form 990, Part IV, line 23. Attach to Form 990. See separate instructions.

I I

À¾µ´ Open to Public Inspection

I

Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL Part I Questions Regarding Compensation

84-0460697 Yes

No

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

First-class or charter travel Travel for companions Tax indemnification and gross-up payments Discretionary spending account

Housing allowance or residence for personal use Payments for business use of personal residence Health or social club dues or initiation fees Personal services (e.g., maid, chauffeur, chef)

b 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 2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a?

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmm

X Compensation committee X Independent compensation consultant X Form 990 of other organizations

X X X

Written employment contract Compensation survey or study Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization: a Receive a severance payment or change-of-control payment from the organization or a related organization? b Participate in, or receive payment from, a supplemental nonqualified retirement plan? c 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.

mm mmmmmmmmmmmmmm mmmmmmmmmmmmmmm

5 a b 6 a b 7 8

9

2

Indicate which, if any, of the following the organization uses to establish the compensation of the organization's CEO/Executive Director. Check all that apply.

3

4

1b

4a 4b 4c

X X X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

5a 5b

X X

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

6a 6b

X X

mmmmmmmmmmmmmmmmmmmmmmmm

7

X

8

X

Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5-9. For persons listed in 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" to line 5a or 5b, describe in Part III. For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation contingent on the net earnings of: The organization? Any related organization? If "Yes" to line 6a or 6b, describe in Part III. For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed payments not described in lines 5 and 6? If "Yes," describe in Part III Were any amounts reported in Form 990, Part VII, paid or accrued 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" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

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

9

Schedule J (Form 990) 2010

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Page 2

84-0460697 Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.Use duplicate copies if additional space is needed.

Schedule J (Form 990) 2010

Part II

For each individual whose compensation must be reported in 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) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a. (B) Breakdown of W-2 and/or 1099-MISC compensation (A) Name

(i) Base compensation

(i) 1

MITCHELL C CARSON

(ii)

2

NEIL BERTRAND

(ii)

3

SHARON ROMINGER

(ii)

4

CAROL SMITH

(ii)

5

NANCY DRISCOLL

(ii)

6

WARREN LAUGHLIN

(ii)

7

REBECCA HERMAN

(ii)

8

JOHN PETERSON

(ii)

9

FABIO PIVETTA

(ii)

10

MATTHEW BRETT

(ii)

11

MAUREEN BEAVIN

(ii)

12

HOLLY SPITZER

(ii)

13

DANIEL FRANK

(ii)

14

KATHERINE WALKER

(ii)

15

JOHN IVES

(ii)

(i) (i) (i) (i) (i) (i) (i) (i) (i) (i) (i) (i) (i) (i)

447,064. 0. 280,667. 0. 149,144. 0. 200,386. 0. 168,848. 0. 158,676. 0. 164,614. 0. 145,593. 0. 200,081. 0. 171,881. 0. 138,228. 0. 144,250. 0. 141,697. 0. 148,790. 0. 142,986. 0.

(ii) Bonus & incentive compensation

0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0.

(iii) Other reportable compensation

(C) Retirement and other deferred compensation

22,701. 0. 7,025. 0. 882. 0. 3,348. 0. 2,542. 0. 2,065. 0. 2,100. 0. 2,033. 0. 1,741. 0. 1,583. 0. 1,225. 0. 1,146. 0. 1,317. 0. 1,346. 0. 1,347. 0.

0. 0. 0. 0. 16,500. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 15,000. 0. 0. 0. 0. 0.

(D) Nontaxable benefits

112,764. 0. 79,203. 0. 1,720. 0. 55,688. 0. 45,307. 0. 43,715. 0. 46,164. 0. 40,805. 0. 17,626. 0. 17,110. 0. 12,268. 0. 7,250. 0. 17,283. 0. 7,496. 0. 11,183. 0.

(E) Total of columns (B)(i)-(D)

(F) Compensation reported in prior Form 990 or Form 990-EZ

582,529. 0. 366,895. 0. 168,246. 0. 259,422. 0. 216,697. 0. 204,456. 0. 212,878. 0. 188,431. 0. 219,448. 0. 190,574. 0. 151,721. 0. 152,646. 0. 175,297. 0. 157,632. 0. 155,516. 0.

0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0.

(i) (ii)

16

Schedule J (Form 990) 2010 JSA

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84-0460697 Page 3 Part III Supplemental Information Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information. Schedule J (Form 990) 2010

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SCHEDULE K (Form 990)

OMB No. 1545-0047

Supplemental Information on Tax-Exempt Bonds

I

À¾µ´

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions, explanations, and any additional information on Schedule O (Form 990).

I

Department of the Treasury Internal Revenue Service

Open to Public

I

Attach to Form 990.

See separate instructions.

Inspection

Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL Part I Bond Issues

84-0460697

(a) Issuer name

(b) Issuer EIN

(c) CUSIP #

(d) Date issued

(e) Issue price

(f) Description of purpose

(g) Defeased Yes

No

(h) On behalf of issuer

(i) Pooled

Yes

Yes

Financing

No

No

A COLORADO HEALTH FACILITIES AUTHORITY

84-0752932

196474M49

12/01/2003

14,915,000. REFUND SERIES 1993 BONDS

X

X

X

B COLORADO HEALTH FACILITIES AUTHORITY

84-0752932

000000000

06/12/2006

40,000,000. HOSPITAL CONSTRUCTION & EQUIPMENT

X

X

X

C COLORADO HEALTH FACILITIES AUTHORITY

84-0752932

1964744D9

06/12/2006

48,965,000. REFUND SERIES 1997 & 2000 BONDS

X

X

X

D

Part II 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Proceeds

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmm mmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmm mmmmm

Amount of bonds retired Amount of bonds legally defeased Total proceeds of issue Gross proceeds in reserve funds Capitalized interest from proceeds Proceeds in refunding escrows Issuance costs from proceeds Credit enhancement from proceeds Working capital expenditures from proceeds Capital expenditures from proceeds Other spent proceeds Other unspent proceeds Year of substantial completion

Were the bonds issued as part of a current refunding issue? Were the bonds issued as part of an advance refunding issue? Has the final allocation of proceeds been made?

Does the organization maintain adequate books and records to support the final allocation of proceeds?

Part III

A

B

16,132,365. 1,269,311.

C

40,000,000.

14,149,510. 713,544.

174,400.

D

53,470,608. 3,814,000. 47,852,141. 1,804,467.

39,825,600.

2008 Yes

No

Yes

No

X X X X

X X X X

Yes

No

Yes

No

X X X X

Private Business Use A

1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? 2 Are there any lease arrangements that may result in private business use of bond-financed property

mmmmmmmmmmmmmmmmmmmmmmmmmmm m

Yes

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

B No

Yes

C No

Yes

D No

Yes

Schedule K (Form 990) 2010

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No

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Part III

Private Business Use (Continued) A

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

3a Are there any management or service contracts that may result in private business use of bond-financed property?

Yes

B No

Yes

C No

X

c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property?

X

5

6

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmm I mmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI m mmmmmmmmmmmmmmmmmm Arbitrage

No

0.0000 %

0.0000 %

%

Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government Total of lines 4 and 5

0.0000 % 0.0000 %

0.0000 % 0.0000 %

0.0000 % 0.0000 %

% %

X A Yes

mmmmmmmmmmmmmmmmmmmm X mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmm

Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue?

2

Yes

0.0000 %

Part IV 1

D No

Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government

Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?

7

Yes

X

b Are there any research agreements that may result in private business use of bond-financed property?

4

Page 2

84-0460697

Schedule K (Form 990) 2010

Is the bond issue a variable rate issue?

3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?

B No

Yes

C No

Yes

D No

X

X X

X X

X

X

X

Yes

No

b Name of provider c Term of hedge

X X X

X X X

X X X

available temporary period?

X

X

X

Did the bond issue qualify for an exception to rebate?

X

X

X

d Was the hedge superintegrated? e Was the hedge terminated?

4a Were gross proceeds invested in a GIC? b Name of provider c Term of GIC

d Was the regulatory safe harbor for establishing the fair

market value of the GIC satisfied? 5

6

Were any gross proceeds invested beyond an

Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions). Part V PRIVATE BUSINESS USE PART III THE 2003 HOSPITAL REVENUE BONDS (REFUNDING THE SERIES 1993 BONDS) AND THE 2006B HOSPITAL REVENUE BONDS (REFUNDING THE SERIES 1997 & 2000 BONDS) QUALIFY FOR THE SPECIAL RULES FOR REFUNDING OF PRE-2003 ISSUES. SUCH JSA 0E1506 4.000

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Part III

Page 2

84-0460697

Schedule K (Form 990) 2010

Private Business Use (Continued) A

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

3a Are there any management or service contracts that may result in private business use of bond-financed property?

Yes

B No

Yes

C No

Yes

D No

Yes

No

b Are there any research agreements that may result in private business use of bond-financed property?

c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? 4

5

6

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmm I mmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI m mmmmmmmmmmmmmmmmmm Arbitrage

Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government

%

%

%

%

Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government Total of lines 4 and 5

% %

% %

% %

% %

Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?

7

Part IV

A

mmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmm

1

Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue?

2

Is the bond issue a variable rate issue?

Yes

B No

Yes

C No

Yes

D No

Yes

No

3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? b Name of provider c Term of hedge

d Was the hedge superintegrated? e Was the hedge terminated?

4a Were gross proceeds invested in a GIC? b Name of provider c Term of GIC

d Was the regulatory safe harbor for establishing the fair

market value of the GIC satisfied? 5

Were any gross proceeds invested beyond an available temporary period?

6

Did the bond issue qualify for an exception to rebate?

Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions). Part V REFUNDING BONDS ARE SUBJECT TO THE GENERALLY APPLICABLE REPORTING REQUIREMENTS OF PARTS I, II & IV OF SCH K. HOWEVER, THE ORGANIZATION NEED NOT COMPLETE PART III TO REPORT PRIVATE BUSINESS USE INFORMATION.

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SCHEDULE O (Form 990 or 990-EZ)

Supplemental Information to Form 990 or 990-EZ

Department of the Treasury Internal Revenue Service

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

I

Name of the organization

OMB No. 1545-0047

À¾µ´ Open to Public Inspection

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697

REVIEW OF FORM 990 PART VI, SECTION B, QUESTION 11B THE ORGANIZATION ENGAGES A PAID PREPARER EXPERIENCED IN THE PREPARATION OF FORM 990 TO PREPARE THE FORM. ACCOUNTING DEPARTMENT STAFF AND THE CONTROLLER WORK CLOSELY WITH THE PAID PREPARER IN THE PREPARATION OF THE RETURN AND THE CONTROLLER AND CFO REVIEW THE RETURN AS PREPARED BY THE PREPARER. COPIES OF THE FORM 990 ARE PROVIDED TO THE BOARD. IT IS REVIEWED BY THE AUDIT COMMITTEE, A SUBCOMMITTEE OF THE BOARD OF DIRECTORS BEFORE IT IS FILED. THE ORGANIZATION WILL THEN DISCUSS ANY CHANGES OR ISSUES THAT THE AUDIT COMMITTEE/BOARD MAY HAVE. ONCE QUESTIONS/ISSUES HAVE BEEN ADDRESSED AND THE FORM APPROVED, IT WILL THEN BE FILED.

CONFLICT OF INTEREST POLICY PART VI, SECTION B, QUESTION 12C AN ANNUAL CONFLICT OF INTEREST STATEMENT IS DISTRIBUTED AND SIGNED BY ALL MEMBERS OF EXECUTIVE MANAGEMENT AND DEPARTMENT DIRECTORS, AS WELL AS EVERY MEMBER OF THE BOARD OF DIRECTORS. WHEN A CONFLICT IS IDENTIFIED, THAT PERSON MUST RECUSE THEMSELVES FROM ANY DISCUSSION CONCERNING THE CONFLICTING PERSON OR ORGANIZATION.

PROCESS FOR DETERMINING COMPENSATION PART VI, SECTION B, QUESTION 15A & 15B IN 2008, INTEGRATED HEALTHCARE STRATEGIES (IHSTRATEGIES), AN INDEPENDENT COMPENSATION CONSULTANT, PERFORMED A THOROUGH COMPENSATION STUDY.

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

Schedule O (Form 990 or 990-EZ) (2010)

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Page 2

Schedule O (Form 990 or 990-EZ) 2010 Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697

IHSTRATEGIES ANALYZED LONGMONT UNITED HOSPITAL'S (LUH) EXECUTIVE CASH COMPENSATION AND BENEFITS PROGRAM TO ASSESS COMPETITIVENESS, COST-EFFECTIVENESS, TAX-EFFECTIVENESS, AND REASONABLENESS. IHSTRATEGIES BASED ITS COMPARISONS ON COMPETITIVE PRACTICES IN LUH'S PEER GROUP, USING THEIR PROPRIETARY DATABASE AND PUBLISHED SURVEYS. IN 2011, LUH IS PLANNING TO ENGAGE IN ANOTHER THOROUGH COMPENSATION STUDY. IN THE INTERMITTENT YEARS, THE CONSULTANT PROVIDES LIMITED RECOMMENDATIONS ON COMPENSATION RANGES THAT LUH FOLLOWS.

IHSTRATEGIES:

- COLLECTED AND REVIEWED BACKGROUND INFORMATION FROM LUH, INCLUDING ORGANIZATIONAL DEMOGRAPHICS, JOB DESCRIPTIONS, ORGANIZATION CHARTS, AND CURRENT COMPENSATION DATA

- CONDUCTED TELEPHONE CALLS WITH LUH'S CEO AND VICE PRESIDENT, HUMAN RESOURCES TO DISCUSS JOB CONTENT AND SCOPE OF RESPONSIBILITY FOR THE POSITIONS INCLUDED IN THIS REVIEW

- MATCHED LUH'S EXECUTIVE POSITIONS WITH SIMILAR BENCHMARK JOBS BASED ON JOB CONTENT, SCOPE OF RESPONSIBILITY, AND REPORTING RELATIONSHIPS

- COMPARED EXECUTIVE SALARIES AT LUH TO PEER GROUP SALARY LEVELS

- COMPARED EXECUTIVE BENEFIT EXPENDITURES AT LUH TO COMPETITIVE INDUSTRY

Schedule O (Form 990 or 990-EZ) 2010

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Schedule O (Form 990 or 990-EZ) 2010 Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697

PRACTICES

- COMPARED EXECUTIVE TOTAL COMPENSATION (SALARIES PLUS BENEFITS) AT LUH TO PEER GROUP LEVELS

- IHSTRATEGIES PRESENTED THIS INFORMATION TO THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IN A WRITTEN REPORT.

- THE COMPENSATION COMMITTEE REVIEWED AND DISCUSSED THE FINDINGS OF THE COMPENSATION STUDY AND APPROVED THE EXECUTIVE COMPENSATION OF THE KEY EXECUTIVES. THIS DISCUSSION AND DELIBERATION PROCESS WAS DOCUMENTED IN THE COMMITTEE'S MEETING MINUTES.

DOCUMENTS AVAILABLE TO THE PUBLIC PART VI, SECTION C, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

TEMPORARILY RESTRICTED NET ASSETS PART X, LINE 28 LONGMONT UNITED HOSPITAL FOUNDATION (THE FOUNDATION) WAS FORMED TO PLAN, ORGANIZE, INSTITUTE, AND ADMINISTER PROJECTS THAT PROVIDE PUBLIC SUPPORT FOR THE HOSPITAL.

IN THE ABSENCE OF DONOR RESTRICTIONS, THE FOUNDATION'S

BOARD OF DIRECTORS HAS DISCRETIONARY CONTROL OVER THE AMOUNTS TO BE DISTRIBUTED TO THE HOSPITAL, THE TIMING OF SUCH DISTRIBUTIONS, AND THE PURPOSES FOR WHICH SUCH FUNDS ARE TO BE USED.

TWO MEMBERS OF THE

Schedule O (Form 990 or 990-EZ) 2010

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Schedule O (Form 990 or 990-EZ) 2010 Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697

HOSPITAL'S BOARD OF DIRECTORS SERVE ON THE 14 MEMBER BOARD OF DIRECTORS OF THE FOUNDATION.

UNDER U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE HOSPITAL IS DEEMED TO BE A FINANCIALLY INTERRELATED BENEFICIARY OF THE FOUNDATION. THEREFORE, THE NET ASSETS OF THE FOUNDATION HAVE BEEN SHOWN ON THE HOSPITAL'S CONSOLIDATED BALANCE SHEETS AS TOTAL NET ASSETS HELD BY LONGMONT UNITED HOSPITAL FOUNDATION.

THE NET ASSETS OWNED BY THE

FOUNDATION ARE REFLECTED IN TEMPORARILY RESTRICTED NET ASSETS.

RECONCILIATION OF NET ASSETS PART XI, LINE 5 UNREALIZED GAIN ON INVESTMENTS

$64,324

CHANGE IN INTEREST IN NET ASSETS HELD BY LONGMONT UNITED HOSPITAL FOUNDATION

TOTAL OTHER CHANGES IN NET ASSETS

$363,460

$427,784

DELEGATION OF AUTHORITY PART VI, SECTION A, QUESTION 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, AS CHAIRPERSON, THE VICE-CHAIRPERSON, THE TREASURER, THE SECRETARY, THE ASSISTANT SECRETARY-TREASURER, AND THE PRESIDENT AND CEO. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS AND OTHER CONFIDENTIAL MATTERS OF THE HOSPITAL DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT ANY ACTION TAKEN SHALL

Schedule O (Form 990 or 990-EZ) 2010

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Schedule O (Form 990 or 990-EZ) 2010 Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697

NOT CONFLICT WITH POLICIES AND EXPRESSED WISHES OF THE BOARD OF DIRECTORS, THAT THERE ARE AT LEAST THREE (3) AFFIRMATIVE VOTES TO INITIATE ANY ACTION, AND ALL MATTERS OF MAJOR IMPORTANCE SHOULD BE REFERRED TO THE BOARD OF DIRECTORS.

THE EXECUTIVE COMMITTEE SHALL REVIEW PROPOSALS AND ADVISE, AS NECESSARY, REGARDING PLANNING AND DEVELOPMENT OF THE HOSPITAL PHYSICAL PLANT, PROGRAMS, AND SERVICES.

IT SHALL ALSO BE THE RESPONSIBILITY OF THE EXECUTIVE COMMITTEE TO NOMINATE CANDIDATES FOR OFFICERS AND MEMBERS OF THE BOARD WHEN VACANCIES ARE TO BE FILLED. SUCH NOMINATIONS FOR CANDIDATES SHALL BE SUBMITTED IN WRITING TO THE SECRETARY OF THE BOARD AT LEAST THIRTY (30) DAYS PRIOR TO THE DATE OF THE MEETING AT WHICH CANDIDATES SHALL BE ELECTED. SPECIFICALLY, THIS COMMITTEE SHALL BE RESPONSIBLE FOR THE ANNUAL PERFORMANCE EVALUATION OF THE PRESIDENT AND CEO. THIS COMMITTEE, MINUS THE PRESIDENT AND CEO, WILL ALSO SERVE AS THE EXECUTIVE COMPENSATION COMMITTEE. THIS COMMITTEE SHALL MEET AT LEAST QUARTERLY.

BOARD OF DIRECTORS INDEPENDENCE PART VI, SECTION A, QUESTION 1B DR. PATRICIA GILL AND DR. MARK HINMAN ARE COMPENSATED FOR MEDICAL SERVICES PROVIDED TO LONGMONT UNITED HOSPITAL RATHER THAN BOARD MEMBERSHIP.

Schedule O (Form 990 or 990-EZ) 2010

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Schedule O (Form 990 or 990-EZ) 2010 Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697 ATTACHMENT 1

990, PART VII- COMPENSATION OF THE FIVE HIGHEST PAID IND. CONTRACTORS NAME AND ADDRESS

DESCRIPTION OF SERVICES

COMPENSATION

MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS, MN 55480-9146

MEDICAL

778,333.

THE CHILDREN'S HOSPITAL 13123 EAST 16TH AVENUE AURORA, CO 80045

MEDICAL

699,840.

LONGMONT HOSPITALIST'S GROUP 6895 E HAMPDEN AVENUE DENVER, CO 80224

MEDICAL

608,546.

BOULDER VALLEY THORACIC & CARDIOVASCULAR 6800 N 79TH STREET NIWOT, CO 80503

MEDICAL

514,776.

ROCKY MOUNTAIN CANCER CENTERS PO BOX 911263 DALLAS, TX 75391-1263

MEDICAL

513,337.

TOTAL COMPENSATION

3,114,832.

ATTACHMENT 2 FORM 990, PART VIII - EXCLUDED CONTRIBUTIONS DESCRIPTION

AMOUNT

DINNER DANCE

81,375.

GOLF TOURNAMENT

17,590.

TOTAL

98,965.

ATTACHMENT 3

Schedule O (Form 990 or 990-EZ) 2010

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Schedule O (Form 990 or 990-EZ) 2010 Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697 ATTACHMENT 3 (CONT'D)

FORM 990, PART VIII - FUNDRAISING EVENTS

GROSS INCOME

DESCRIPTION

DIRECT EXPENSES

NET INCOME

DINNER DANCE

10,360.

30,820.

-20,460.

GOLF TOURNAMENT

13,920.

12,188.

1,732.

TOTALS

24,280.

43,008.

-18,728.

Schedule O (Form 990 or 990-EZ) 2010

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SCHEDULE R (Form 990)

OMB No. 1545-0047

Related Organizations and Unrelated Partnerships

I

À¾µ´

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

Department of the Treasury Internal Revenue Service

I

Attach to Form 990.

Open to Public Inspection

I

See separate instructions.

Name of the organization

Employer identification number

LONGMONT UNITED HOSPITAL

84-0460697

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

Part I

(a) Name, address, and EIN of disregarded entity

(b) Primary activity

84-1554099 (1) LONGMONT UNITED LAND HOLDING, LLC 1950 W. MOUNTAIN VIEW AVE LONGMONT, CO 80501 20-4781464 (2) LE DEAUVILLE, LLC 1950 W. MOUNTAIN VIEW AVE LONGMONT, CO 80501

(c) Legal domicile (state or foreign country)

(d) Total income

(e) End-of-year assets

(f) Direct controlling entity

REAL ESTATE

CO

23,601.

161,936. LUH

RENTAL

CO

722,934.

5,521,140. LUH

(3) (4) (5) (6)

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?

Yes

No

(1) (2) (3) (4) (5) (6) (7) For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Schedule R (Form 990) 2010

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Page 2

84-0460697 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.)

Schedule R (Form 990) 2010

Part III

(a) Name, address, and EIN of related organization

(b) Primary activity

(c) Legal domicile (state or foreign country)

(d) Direct controlling entity

(e) Predominant income (related, unrelated, excluded from tax under sections 512-514)

(f) Share of total income

(g) Share of end-of-year assets

(h) Disproportionate allocations?

(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)

Yes No

(j) General or managing partner?

(k) Percentage ownership

Yes No

(1) LMC COMM., LLC 75-3081353 1950 WEST MOUNTAIN VIEW AVE

VOICE & DATA

CO

LULH, LLC

UNRELATED

14,832.

-7,728.

X

14,832. X

50.0000

OFFICE LEASING

CO

LULH, LLC

RELATED

47,933.

132,886.

X

X

50.0000

IMAGING

CO

LUH

RELATED

22,123.

571,509.

X

X

50.0000

(2) TRI-TOWN, LLC 33-1035669 1950 WEST MOUNTAIN VIEW AVE

(3) TWIN PEAKS, LLC 73-1656489 1950 WEST MOUNTAIN VIEW AVE

(4) (5) (6) (7) 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

(1) UNITED MEDICAL BLDG CONDOMINIUM ASSOC.

(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

387,848.

98,588.

91.7800

84-1526130

1950 WEST MOUNTAIN VIEW AVE LONGMONT, CO 80501

CONDO ASSOCIATION

CO

N/A

C CORP

(2) (3) (4) (5) (6) (7) Schedule R (Form 990) 2010 JSA 0E1308 1.000

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84-0460697

Schedule R (Form 990) 2010

Part V

Page

3

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35, 35a, or 36.) Yes

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule. 1 During the tax year, did the organization 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 other organization(s) c Gift, grant, or capital contribution from other organization(s) d Loans or loan guarantees to or for other organization(s) e Loans or loan guarantees by other organization(s)

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m

1a 1b 1c 1d 1e

No

X X X X X X X X

f g h i

Sale of assets to other organization(s) Purchase of assets from other organization(s) Exchange of assets Lease of facilities, equipment, or other assets to other organization(s)

1f 1g 1h 1i

j k l m n

Lease of facilities, equipment, or other assets from other organization(s) Performance of services or membership or fundraising solicitations for other organization(s) Performance of services or membership or fundraising solicitations by other organization(s) Sharing of facilities, equipment, mailing lists, or other assets Sharing of paid employees

1j 1k 1l 1m 1n

o p

Reimbursement paid to other organization for expenses Reimbursement paid by other organization for expenses

1o 1p

X X

q r

1q Other transfer of cash or property to other organization(s) 1r Other transfer of cash or property from other 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.

X X

2

(a) Name of other organization

(1)

(b) Transaction type (a–r)

UNITED MEDICAL BLDG CONDOMINIUM ASSOC.

I

(c) Amount involved

68,705.

X X X X X X

(d) Method of determining amount involved

FMV

(2) (3) (4) (5) (6) Schedule R (Form 990) 2010

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Part VI

Page 4

84-0460697

Schedule R (Form 990) 2010

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)

(d) Are all partners section 501(c)(3) organizations?

Yes

No

(e) Share of end-of-year assets

(f) Disproportionate allocations?

Yes

(g) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)

No

(h) General or managing partner?

Yes

No

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Schedule R (Form 990) 2010

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84-0460697

Page 5

Schedule R (Form 990) 2010

Part VII

Supplemental Information Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

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Instructions for filing Longmont United Hospital Form 990T - Exempt Organization Business Return for the period ended December 31, 2010 ************************* Signature... The original return should be signed (using full name and title) and dated on page 2 by an authorized officer of the organization. Filing... The signed return should be filed on or before with... Department of the Treasury Internal Revenue Service Center Ogden, UT 84201-0027 Payment of tax... No payment of tax is required. *************************

Form

990-T

For calendar year 2010 or other tax year beginning

Department of the Treasury Internal Revenue Service

ending

Check box if address changed

A

501(

C

)(

3

220(e)

408A

530(a)

529(a) C Book value of all assets at end of year

235,688,378.

, 2010, and

I

D Employer identification number

Check box if name changed and see instructions.)

LONGMONT UNITED HOSPITAL Print or Type

84-0460697

Number, street, and room or suite no. If a P.O. box, see page 8 of instructions.

E Unrelated business activity codes (See instructions for Block E on page 9.)

1950 WEST MOUNTAIN VIEW AVENUE City or town, state, and ZIP code

LONGMONT, CO 80501 F

Group exemption number (See instructions for Block F on page 9.)

G

Check organization type

IX

501(c) corporation

H Describe the organization's primary unrelated business activity.

I

517000

I

401(a) trust

501(c) trust

VOICE AND DATA LINES

During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? If "Yes," enter the name and identifying number of the parent corporation.

I

I

NEIL BERTRAND Unrelated Trade or Business Income

J The books are in care of

Part I

À¾µ´

Open to Public Inspection for 501(c)(3) Organizations Only

See separate instructions.

.

(Employees' trust, see instructions for Block D on page 9.)

)

408(e)

, 20

Name of organization (

B Exempt under section

X

OMB No. 1545-0687

Exempt Organization Business Income Tax Return(and proxy tax under section 6033(e))

I

Other trust

mmmmmmm I

Yes

X

No

I

303-651-5023 Telephone number (A) Income (B) Expenses (C) Net

1 a Gross receipts or sales b

I mmmmmmmmmm m mmmmmmmmmm mmmmmmmm mm mmmmmmmmmmmmmm 14,832. 14,832. ATCH 1 mmmmmmmmmmmmmmmmm mmmmmmm mmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmm mmmmmmm mmmmmmmmmmmmmm m 14,832. 14,832. m m m m m m m m m m m m m Deductions Not Taken Elsewhere (See page 11 of the instructions for limitations on deductions.) (Except for c Balance

Less returns and allowances

1c

2

Cost of goods sold (Schedule A, line 7)

3

Gross profit. Subtract line 2 from line 1c

3

4 a Capital gain net income (attach Schedule D)

4a

2

b Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797)

4b

c Capital loss deduction for trusts

4c

5

Income (loss) from partnerships and S corporations (attach statement)

5

6

Rent income (Schedule C)

6

7

Unrelated debt-financed income (Schedule E)

7

8

Interest, annuities, royalties, and rents from controlled organizations (Schedule F)

9

8

Investment income of a section 501(c)(7), (9), or (17) organization (Schedule G)

9

10

Exploited exempt activity income (Schedule I)

10

11

Advertising income (Schedule J)

11

12

Other income (See page 10 of the instructions; attach schedule.) Total. Combine lines 3 through 12

12

13

Part II

13

contributions, deductions must be directly connected with the unrelated business income.)

mmmmmmmmmmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmm m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 0. mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmm mmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmm mmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

14

Compensation of officers, directors, and trustees (Schedule K)

14

15

Salaries and wages

15

16

Repairs and maintenance

16

17

Bad debts

17

18

Interest (attach schedule)

18

19

Taxes and licenses

19

20

Charitable contributions (See page 13 of the instructions for limitation rules.)

21

Depreciation (attach Form 4562)

21

22

Less depreciation claimed on Schedule A and elsewhere on return

22a

23

Depletion

24

Contributions to deferred compensation plans

24

25

Employee benefit programs

25

26

Excess exempt expenses (Schedule I)

26

27

Excess readership costs (Schedule J)

27

28

Other deductions (attach schedule)

28

29

Total deductions. Add lines 14 through 28

29

30

Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13

30

31

Net operating loss deduction (limited to the amount on line 30)

31

32

Unrelated business taxable income before specific deduction. Subtract line 31 from line 30

32

33

Specific deduction (Generally $1,000, but see line 33 instructions for exceptions.)

33

34

Unrelated business taxable income. Subtract line 33 from line 32. If line 33 is greater than line 32, enter the smaller of zero or line 32

34

20

23

JSA For Paperwork Reduction Act Notice, see instructions. 0E1610 0.020

5709CF N752 9/16/2011

0.

22b

12:09:52 PM

0. 14,832. 14,832. 0.

Form

RCH 4822-00

990-T (2010)

PAGE 80

Tax Computation

Part III 35

Organizations

Taxable

as

Corporations.

See

instructions

Controlled group members (sections 1561 and 1563) check here a Enter your share of the $50,000, (1) $

$25,000,

and $9,925,000

I

for

tax

computation

page

15.

taxable income brackets (in that order):

(2) $

(3) $

mmmmmmm mmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmm I mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I mmmmmmmmmmmmmmmmmmm m m m m m m m m m m m m m m m m m m m m m m m m m mmmmmmmmmmmmmmmmmmmmmmmmm m Tax and Payments mmmm mmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmm m m m m m m m m m m m mmmmmmmmmmmmmmmmmm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm m mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm m mmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmm mm mm mm mm mm mm m mmmmmm I mmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmm mmmmmmmmmmm mmmmmmmmmmmmmmI mmm I m m m m m m m m m m m m I I I Statements Regarding Certain Activities and Other Information $ $

(2) Additional 3% tax (not more than $100,000) c Income tax on the amount on line 34 Trusts Taxable at Trust Rates.

for tax computation

on page 16.

Income

tax on

Schedule D (Form 1041)

36

Proxy tax. See page 16 of the instructions Alternative minimum tax

37

Total. Add lines 37 and 38 to line 35c or 36, whichever applies

39

Part IV

38

40 a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116)

40b

c General business credit. Attach Form 3800

40c

d Credit for prior year minimum tax (attach Form 8801 or 8827)

40d

e Total credits. Add lines 40a through 40d

Subtract line 40e from line 39

42

Other taxes. Check if from:

43

Total tax. Add lines 41 and 42

40e

Form 8611

Form 8697

Form 8866

Other (attach schedule)

42

44b

c Tax deposited with Form 8868

44c

d Foreign organizations: Tax paid or withheld at source (see instructions)

44d

e Backup withholding (see instructions)

44e

Credit for small employer health insurance premiums (Attach Form 8941)

g Other credits and payments:

44f

Form 2439

Form 4136

44g

Total

Other

45

Total payments. Add lines 44a through 44g

45

46

Estimated tax penalty (see page 4 of the instructions). Check if Form 2220 is attached

46

47

Tax due. If line 45 is less than the total of lines 43 and 46, enter amount owed

47

48 49

Overpayment. If line 45 is larger than the total of lines 43 and 46, enter amount overpaid Enter the amount of line 48 you want: Credited to 2011 estimated tax

48

1

0.

43

44a

b 2010 estimated tax payments

Part V

0.

41

Form 4255

44 a Payments: A 2009 overpayment credited to 2010

f

0.

40a

b Other credits (see page 16 of the instructions)

41

0.

35c

See instructions

Tax rate schedule or

the amount on line 34 from: 37 38 39

on

See instructions and:

b Enter organization's share of: (1) Additional 5% tax (not more than $11,750)

36

Page 2

84-0460697

Form 990-T (2010)

Refunded

0. 0. 0.

49

(see instructions on page 17)

At any time during the 2010 calendar year, did the organization have an interest in or a signature or other authority over a financial

Yes

No

account (bank, securities, or other) in a foreign country? If YES, the organization may have to file Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. If YES, enter the name of the foreign country here 2

I

During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? If YES, see page 5 of the instructions for other forms the organization may have to file.

3

I$ I

Enter the amount of tax-exempt interest received or accrued during the tax year

Schedule A - Cost of Goods Sold. Enter method of inventory valuation

m mmmmmmmmmm mmmmmmmmm mmmmmmm m m

1

Inventory at beginning of year

1

6

Inventory at end of year

2

Purchases

2

7

Cost

3

Cost of labor

6

3

4 a Additional section 263A costs

(attach schedule)

Sign Here

from

goods

line

Part I, line 2

4a

b Other costs (attach schedule) 5 Total. Add lines 1 through 4b

of

8

Do

the

5.

5

X X

mmmmmmmmm

6

sold. Subtract

line

Enter here and in

mmmmmmmmmmmmmmm

rules

7

of

section

property produced to the organization?

4b

mmmm

263A

(with

respect

to

Yes

mmmmmmmmmmmmmmmmmmmm or

acquired

for

resale)

No

apply

X

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

M

M

CLIENT COPY

Signature of officer

Date

Print/Type preparer's name

Preparer's signature

Paid CRAIG R. CHOUN Preparer Firm's name EKS&H Use Only 7979 E. TUFTS AVE., #400 Firm's address DENVER, CO 80237-2843

I I

May the IRS discuss this return with the preparer shown below (see instructions) ? X Yes No

Title Date

9/26/2011

Check if self-employed Firm's EIN Phone no.

PTIN

P00173718 84-0869721 303-740-9400

I

Form

990-T (2010)

JSA 0E1620 0.040

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 81

Page 3

84-0460697 Schedule C - Rent Income (From Real Property and Personal Property Leased With Real Property) Form 990-T (2010)

(see instructions on page 18) 1. Description of property

(1) (2) (3) (4) 2. Rent received or accrued (a) From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)

(b) From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)

3(a) Deductions directly connected with the income in columns 2(a) and 2(b) (attach schedule)

(1) (2) (3) (4) Total

Total

(b) Total deductions. Enter here and on page 1, Part I, line 6, column (B)

mmmmm I

(c) Total income . Add totals of columns 2(a) and 2(b). Enter here and on page 1, Part I, line 6, column (A)

I

Schedule E - Unrelated Debt-Financed Income (see instructions on page 19) 1. Description of debt-financed property

2. Gross income from or allocable to debt-financed property

3. Deductions directly connected with or allocable to debt-financed property (a) Straight line depreciation (attach schedule)

(b) Other deductions (attach schedule)

(1) (2) (3) (4) 4. Amount of average acquisition debt on or allocable to debt-financed property (attach schedule)

5. Average adjusted basis of or allocable to debt-financed property (attach schedule)

6. Column 4 divided by column 5

(1)

%

(2)

%

(3)

%

(4)

%

7. Gross income reportable (column 2 x column 6)

8. Allocable deductions (column 6 x total of columns 3(a) and 3(b))

Enter here and on page 1, Part I, line 7, column (A).

Enter here and on page 1, Part I, line 7, column (B).

mmmmmmmmmmmmmmmmmmmmmmmmmm m m m m m m m m m m m m ImmmmmmmmmmmmmmI m m m m m m m m m m m m m m Schedule F - Interest, Annuities, Royalties, and Rents From Controlled Organizations Totals

Total dividends-received deductions included in column 8

(see instructions on page 20)

Exempt Controlled Organizations 1. Name of controlled organization

2. Employer identification number

3. Net unrelated income (loss) (see instructions)

4. Total of specified payments made

5. Part of column 4 that is included in the controlling organization's gross income

6. Deductions directly connected with income in column 5

(1) (2) (3) (4)

Nonexempt Controlled Organizations 7. Taxable Income

8. Net unrelated income (loss) (see instructions)

10. Part of column 9 that is included in the controlling organization's gross income

9. Total of specified payments made

11. Deductions directly connected with income in column 10

(1) (2) (3) (4) Add columns 5 and 10. Enter here and on page 1, Part I, line 8, column (A).

Totals

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I

Add columns 6 and 11. Enter here and on page 1, Part I, line 8, column (B).

Form

JSA

990-T (2010)

0E1630 0.020

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 82

Page 4

84-0460697 Schedule G - Investment Income of a Section 501(c)(7), (9), or (17) Organization (see instructions on page 20) Form 990-T (2010)

1. Description of income

2. Amount of income

3. Deductions directly connected (attach schedule)

5. Total deductions and set-asides (col. 3 plus col. 4)

4. Set-asides (attach schedule)

(1) (2) (3) (4)

Totals

mmmmmmmmmmmm I

Enter here and on page 1, Part I, line 9, column (A).

Enter here and on page 1, Part I, line 9, column (B).

Schedule I - Exploited Exempt Activity Income, Other Than Advertising Income (see instructions on page 21)

1. Description of exploited activity

2. Gross unrelated business income from trade or business

3. Expenses directly connected with production of unrelated business income

Enter here and on page 1, Part I, line 10, col. (A).

Enter here and on page 1, Part I, line 10, col. (B).

4. Net income (loss) from unrelated trade or business (column 2 minus column 3). If a gain, compute cols. 5 through 7.

5. Gross income from activity that is not unrelated business income

6. Expenses attributable to column 5

7. Excess exempt expenses (column 6 minus column 5, but not more than column 4).

(1) (2) (3) (4)

Totals

mmmmmmmmmmmm I

Enter here and on page 1, Part II, line 26.

Schedule J - Advertising Income (see instructions on page 21) Income From Periodicals Reported on a Consolidated Basis Part I 2. Gross advertising income

1. Name of periodical

3. Direct advertising costs

4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute cols. 5 through 7.

5. Circulation income

6. Readership costs

7. Excess readership costs (column 6 minus column 5, but not more than column 4).

(1) (2) (3) (4) Totals (carry to Part II, line (5))

Part II

mm I

Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns 2 through 7 on a line-by-line basis.) 2. Gross advertising income

3. Direct advertising costs

Enter here and on page 1, Part I, line 11, col. (A).

Enter here and on page 1, Part I line 11, col. (B).

1. Name of periodical

4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute cols. 5 through 7.

5. Circulation income

6. Readership costs

7. Excess readership costs (column 6 minus column 5, but not more than column 4).

(1) (2) (3) (4) (5) Totals from Part I

Totals, Part II (lines 1-5)

mmmm I

Enter here and on page 1, Part II, line 27.

Schedule K - Compensation of Officers, Directors, and Trustees(see instructions on page 21) 1. Name

2. Title

3. Percent of time devoted to business

4. Compensation attributable to unrelated business

(1)

%

(2)

%

(3)

%

(4)

mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm I %

Total. Enter here and on page 1, Part II, line 14 JSA

Form

990-T (2010)

0E1640 0.020

5709CF N752 9/16/2011

12:09:52 PM

RCH 4822-00

PAGE 83

LONGMONT UNITED HOSPITAL

84-0460697 ATTACHMENT 1

FORM 990T - LINE 5 -INCOME (LOSS) FROM PARTNERSHIPS

LMC COMMUNICATION, LLC

14,832.

INCOME (LOSS) FROM PARTNERSHIPS

5709CF N752

9/16/2011

12:09:52 PM

14,832.

ATTACHMENT 1 RCH 4822-00 PAGE 84

LONGMONT UNITED LAND HOLDINGS, LLC (SINGLE MEMBER LLC OF LONGMONT UNITED HOSPITAL) EIN: 84-1554099 DECEMBER 31, 2010

FORM 990-T, LINE 31: NET OPERATING LOSS DEDUCTION SCHEDULE

YEAR ENDING 12/31/2002 12/31/2003 12/31/2004 12/31/2005 12/31/2006 12/31/2007 12/31/2008 12/31/2009 12/31/2010 TOTALS

TAXABLE INCOME

NOL GENERATED

NOL UTILIZED

NOL AMOUNT CARRIED BACK

REMAINING CARRYOVER

(67,774) (31,190) 920 7,868 10,088 18,783 22,055 16,590 14,832

67,774 31,190 -

(920) (7,868) (10,088) (18,783) (22,055) (16,590) (14,832)

-

67,774 31,190 (920) (7,868) (10,088) (18,783) (22,055) (16,590) (14,832)

(7,828)

98,964

(91,136)

-

7,828

CARRYOVER AVAILABLE TO 12/31/11:

7,828

ATTACHMENT 2

* * * * * Longmont United Hospital Instructions for filing Form 112 Colorado State C Corporation Income Tax Return for the year ended December 31, 2010 * * * * * Signature . . . The original return should be signed and dated on page two by an authorized officer of the corporation. Filing . . . The original return should be filed as soon as possible with the following: Colorado Department of Revenue Denver, CO 80261-0006 No tax due . . . There is no tax due for the current year.

0XY923 1.000

Form 112 (11/09/10) COLORADO DEPARTMENT OF REVENUE DENVER, CO 80261-0006

DEPARTMENTAL USE ONLY

1062

DO NOT SEND FEDERAL RETURN, FORMS OR SCHEDULES WITH THIS RETURN.

(0023)

2010 Form 112 Colorado State C Corporation Income Tax Return For the tax year beginning Name of Corporation

01/01

, 2010, ending

12/31

, 20

10

. Colorado Account Number

 

LONGMONT UNITED HOSPITAL Address

Federal Employer I.D. Number

1950 WEST MOUNTAIN VIEW AVE City

State

84-0460697 ZIP

 X 

LONGMONT

CO

80501

IF YOU DO NOT NEED A CORPORATE TAX BOOKLET MAILED TO YOU NEXT YEAR, CHECK THIS BOX If you are attaching a statement disclosing a listed or reportable transaction, check this box

A. Apportionment of Income. This return is being filed for: (42) A corporation not apportioning income; (43) A corporation engaged in interstate business apportioning income using single-factor apportionment (Attach Schedule SF); (44) A corporation engaged in interstate business apportioning income under special regulation; (45) A corporation electing to pay a tax on its gross Colorado sales;

X

X

(47) Other, federal form filed 990-T

B. Separate/Consolidate/Combined Filing. This return is being filed by:

A single corporation filing a separate return; An affiliated group of corporations electing to file a consolidated return (Warning: such election is binding for four years). If your election was made in a prior year, enter the year of election here: (Attach Schedule C); An affiliated group of corporations required to file a combined return (Attach Schedule C); An affiliated group of corporations required to file a combined return that includes another affiliated, consolidated group (Attach Schedule C).

ROUND TO THE NEAREST DOLLAR

                      ���  

1 Federal taxable income from Form 1120 2 Federal taxable income of companies not included in this return 3 Net federal taxable income, line 1 minus line 2 Additions to federal taxable income 4 Federal net operating loss deduction

1 2 3

NONE .00

4

14,832. .00

5 Colorado income tax deduction

5

.00

6 Other additions, attach explanation

6

.00

7 Total of lines 3 through 6 Subtractions from federal taxable income 8 Exempt federal interest 9 Excludable foreign source income 1 0 Colorado source capital gain (assets acquired on or after 5/9/94, held five years) 1 1 Other subtractions, attach explanation

7

14,832. .00

8 9 10 11

.00 .00 .00 .00

1 2 Total of lines 8 through 11 1 3 Modified federal taxable income, line 7 minus line 12 1 4 Colorado taxable income before net operating loss deduction

12 13 14

14,832. .00 14,832. .00

15 16 17 18

15 16 17 18

14,832. .00 NONE .00 NONE .00

19 20

NONE .00

Colorado net operating loss deduction Colorado taxable income, line 14 minus line 15 Tax, 4.63% of the amount on line 16 Total non-refundable credits from line 72, Form 112CR (may not exceed tax on line 17)

1 9 Net tax, line 17 minus line 18 2 0 Recapture of prior year credits

0D0711 4.000

6605CG

N752

84-0460697

.00

NONE .00

.00

.00

.00

DO NOT SEND FEDERAL RETURN, FORMS OR SCHEDULES WITH THIS RETURN. 1062

Form 112

                  

Page 2 21

NONE .00

2 2 Estimated tax and extension payments and credits

22

.00

2 3 Refundable alternative fuel vehicle credit from line 73, Form 112CR

23

.00

2 4 Total of lines 22 and 23 2 5 Penalty, also include on line 28 if applicable

24 25

2 6 Interest, also include on line 28 if applicable

26

.00 .00 .00

2 7 Estimated tax penalty due, also include on line 28 if applicable

27

.00

2 8 If amount on line 21 exceeds amount on line 24, enter amount owed

28

NONE .00

2 9 Overpayment, line 24 minus line 21 3 0 Overpayment to be credited to estimated tax

29 30

.00 .00

3 1 Overpayment to be refunded

31

.00

2 1 Total of lines 19 and 20

Direct Deposit

Type:

Routing number

Checking

Savings

Account number

MAIL TO AND MAKE CHECKS PAYABLE TO: Colorado Department of Revenue, Denver, CO 80261-0006 The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.

C. The corporation's books are in care of:

Name

Telephone Number

NEIL BERTRAND

303-651-5023

Address

City

1950 WEST MOUNTAIN VIEW AVE D.

Business code number per federal return

State

LONGMONT 517000

E.

Year corporation began doing business in Colorado

F.

Kind of business in detail:VOICE

1955

CO May

the

ZIP

80501

Colorado

Department

of

Revenue

discuss this return with the paid preparer shown b elow (see instructions)?

X

Yes

AND DATA LINES

Has the Internal Revenue Service made any adjustments in the corporation's income or tax or have you filed amended federal income tax returns at any time during the last four years? Yes X No If Yes, for which year(s)? Did you file amended Colorado returns to reflect such changes or submit copies of the Federal Agent's reports? Yes No Under penalties of perjury in the second degree, I declare that I have examined this return and Person or Firm preparing return (name, address to the best of my knowledge is true, correct and complete. Declaration of preparer (other than and telephone number): taxpayer) is based on all information of which preparer has any knowledge. EKS&H Signature and Title of Officer Date 7979 E. TUFTS AVENUE, SUITE 400 G.

CLIENT COPY PRESIDENT AND CEO

DENVER, CO CO 80237-2843 (303) 740-9400

0D0712 3.000

6605CG

N752

84-0460697

No

LONGMONT UNITED LAND HOLDINGS, LLC (SINGLE MEMBER LLC OF LONGMONT UNITED HOSPITAL) EIN: 84-1554099 DECEMBER 31, 2010

FORM 990-T, LINE 31: NET OPERATING LOSS DEDUCTION SCHEDULE

YEAR ENDING 12/31/2002 12/31/2003 12/31/2004 12/31/2005 12/31/2006 12/31/2007 12/31/2008 12/31/2009 12/31/2010 TOTALS

TAXABLE INCOME

NOL GENERATED

NOL UTILIZED

NOL AMOUNT CARRIED BACK

REMAINING CARRYOVER

(67,774) (31,190) 920 7,868 10,088 18,783 22,055 16,590 14,832

67,774 31,190 -

(920) (7,868) (10,088) (18,783) (22,055) (16,590) (14,832)

-

67,774 31,190 (920) (7,868) (10,088) (18,783) (22,055) (16,590) (14,832)

(7,828)

98,964

(91,136)

-

7,828

CARRYOVER AVAILABLE TO 12/31/11:

7,828

ATTACHMENT 2


2010 Income Tax Return Form 990