2020-11-12T14:59:19-07:00 2019-12-31 990 2019-01-01 840175870 BOULDER COMMUNITY HEALTH BOUL 3034155220 PO Box 9019 Boulder CO 803019019 William A Munson Jr CFO & Vice President 3034157433 2020-11-12 69.161.206.5 2019 2021-01-29 14:40:06Z Boulder Community Hospital Robert J Vissers President and CEO PO Box 9019 Boulder CO 803019019 599420799 0 X www.bch.org X 1922 CO Partnering to create and care for the healthiest community in the nation. 15 13 2978 527 2348967 0 2385388 2879189 349589866 359691641 14863357 10539320 23145903 19586402 389984514 392696552 257884 308355 0 0 197069773 201684575 0 0 506514 184129551 183931092 381457208 385924022 8527306 6772530 708360010 784754764 264197084 292164296 444162926 492590468 To provide our community the highest value healthcare in an innovative, patient-centered environment. 0 0 285785156 308355 376709292 Health Care Delivery of IP and OP medical care. In 2019, the hospital discharged 7,818 adult & pediatric patients with an average length of stay of 4.0 days. 40,174 patients were seen in our ER facilities and 15,043 in Urgent Care. 6,021 surgeries were performed. 0 0 0 285785156 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 259 0 1 2978 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Lisa Rogowski Controller 3034155220 PO Box 9019 Accounting Dept Boulder CO 803019019 Charles Jones Physician 40 0 X 1398805 0 212346 Daniel O'Hair Physician 40 0 X 1100286 0 44237 Bryan Mahan Physician 40 0 X 963811 0 35858 Robert J Vissers Exec Director/CEO 40 0 X X 890953 0 33151 Srinivas Iyengar Physician 40 0 X 781649 0 42938 Sameer A Oza Physician 40 0 X 714449 0 45301 Benjamin J Keidan VP & Chief Medical Officer 40 0 X 414972 0 96507 William A Munson Jr VP & CFO 40 0 X 349332 0 105938 Paul R Hinchey VP Business Development 40 0 X 340918 0 89686 Sarah E Meshak VP & General Counsel 40 0 X 315082 0 79546 Jacqueline M Attlesey-Pries VP , Chief Nursing Officer & Chief Operating Officer 40 0 X 304144 0 86220 Valerie Lipetz MD Board Member 40.00 0 X 309761 0 43929 Jamie D Jensen VP & Chief Population Health Officer 40 0 X 322486 0 29203 Michael J Jefferies VP & Chief Information Officer 40 0 X 276198 0 54955 Grant Besser Foundation President & VP Public Affairs 12 28 X 240249 0 77419 Dee Perry Chairman 4 0 X X 0 0 0 Jeff Morgan Vice Chairman 4 0 X X 0 0 0 Suzy Ageton Secretary 4 0 X X 0 0 0 Bryan Pieper Treasurer 4 0 X X 0 0 0 Randy Bjerke MD Board Member 2 0 X 0 0 0 Susan Graf Board Member 2 0 X 0 0 0 John Greff Board Member 2 0 X 0 0 0 Harold Flowers Board Member 2 0 X 0 0 0 Rhonda Wallen Board Member 2 0 X 0 0 0 Debbie Lund MD Board Member 2 0 X 0 0 0 Benita Duran Board Member 2 0 X 0 0 0 Phil DeStefano Board Member 2 0 X 0 0 0 George Karakehian Board Member 2 0 X 0 0 0 8723095 0 1077234 295 0 1 0 Favorite Healthcare Staffing Inc PO Box 803356 Kansas City MO 641803356 agency nursing services 2666078 Boulder Emergency Physicians CarePoint PC 5600 S Quebec St Suite 312 A Greenwood Village CO 80111 CMC Emergency Room Coverage & ER medical director 1518405 Courier Ventures DBA Action Stat Logistics 2032 35th Ave Suite A 104 Greeley CO 80634 Courier services 1228731 Boulder Valley Anesthesiology LLC c/o Wendll Walker & Assoc 1420 28th St Ste 100 Boulder CO 80303 Anesthesiology coverage 1155102 Boulder Neurosurgical Assoc PLLC 4743 Arapahoe Ave Suite 202 Boulder CO 80303 trauma call 1125817 27 0 2325 0 2191725 675520 9619 0 2879189 Acute Care Hospital 622000 357861417 357802011 0 59406 Lab Service Revenue 621500 1830224 0 1830224 0 0 0 0 0 359691641 8094777 0 0 8094777 2301 0 0 2301 0 0 0 0 0 0 0 0 0 0 0 0 0 0 208544361 437026 206027299 511846 2517062 -74820 2442242 -74820 0 2517062 0 0 0 0 0 0 6775 0 6775 0 0 6775 288500 185102 103398 103398 0 0 Hospital Care Joint Ventures 621400 8776310 8776310 0 0 Misc Hospital Revenue 622000 10181176 10102393 0 78783 Lab Service Revenue 621500 518743 0 518743 0 0 0 0 0 19476229 392696552 376709292 2348967 10759104 116988 116988 191367 191367 0 0 0 0 4433535 0 4230508 203027 0 0 0 0 157013118 120412720 36292684 307714 11574932 6186689 5388243 0 18151168 13835673 4285417 30078 10511822 7765694 2717476 28652 2277224 34479 2242745 0 226813 0 226813 0 106560 0 106560 0 13591 13591 0 0 0 0 257256 0 257256 0 20836079 16378904 4461226 -4051 900881 0 900881 0 5208070 2756514 2446419 5137 11868827 523463 11345364 0 0 0 0 0 8881948 5858381 3002483 21084 368629 225648 142981 0 0 0 0 0 251741 139673 112068 0 4270799 1870610 2400189 0 0 0 0 0 21462489 8686720 12765790 9979 1919723 793847 1125876 0 Medical Supplies 59179987 58920021 259934 32 Repairs and Maintenance 6396653 3932257 2464169 227 Medicaid Provider Fee 23069898 23069898 0 0 Provision for Bad Debts 12464478 12464478 0 0 3969446 1607541 2457270 -95365 385924022 285785156 99632352 506514 17374 17864 1563438 2415714 0 0 47849131 54743523 0 163111 0 0 0 0 4232921 5080685 6418632 6780658 500345595 183601144 277671499 316744451 306650233 297991823 7776298 4074345 5427032 7949697 78270 0 50675182 88792893 708360010 784754764 55343756 54154957 0 0 0 0 154267777 156964822 0 0 0 0 0 0 70000 70000 54515551 80974517 264197084 292164296 X 405294503 446889655 38868423 45700813 444162926 492590468 708360010 784754764 X 6772530 34038816 0 0 0 7616196 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13591 13591 0 Schedule C, Part II-B, Line 1 4.22% of dues paid to the Colorado Hospital Association are spent on lobbying activities, amounting to $4,161. 23.32% of dues paid to the American Hospital Association are spent on lobbying activities, amounting to $9,430. 38868424 4705495 6127021 0 4000127 0 45700813 40598507 3573511 -2326363 0 2977231 0 38868424 35294066 4976709 4478339 0 4150607 0 40598507 33808649 4348700 1349134 0 4212417 0 35294066 35750843 2706467 -402645 0 4119616 0 33935049 0 0.29 0.71 0 1 1 0 20151602 20151602 0 280130841 82869134 197261707 0 6793515 0 6793515 0 191782473 100732010 91050463 0 1487164 0 1487164 316744451 Interest in Net Assets held by Foundation 44917881 Unamortized Swap Fees 62716 Unamortized BIC 864645 Deferred Comp Investments 10514785 Right of Use Assets - Operating Leases 27001560 Misc Other A/R 5431306 88792893 0 Accrued Pension Liability 45025833 Deferred Compensation Liability 10560104 Operating Lease Liability, Net of Curr Maturities 25388580 80974517 421569241 34038816 0 0 -4789665 29249151 392320090 257256 119206 376462 392696552 369355596 0 0 0 0 0 369355596 257256 16311170 16568426 385924022 Schedule D, Part V, Line 4 Boulder Community Hospital Foundation, a related organization, holds permanent endowment funds. The income earned on these endowment funds is used to support hospital programs for diabetes, cancer, neonatology, heart and surgery center, healthcare scholarships, or for the foundation to direct if the endowment fund does not restrict how the income is to be spent. Temporarily restricted funds held by the Foundation include funds for the Foothills Medical Office facilities, cancer center, as well as other hospital programs. Any unrestricted funds held at the Foundation are for the hospital, but designation is decided by the Foundation board when granting to the hospital. Schedule D, Part XI, Line 2d Other of -$4,789,666 included in TR but not in audited revenue includes Bad Debt Provision of -$12,464,478 + Change in Foundation Net Assets of $6,713,801 + Change in minimum pension liability of $1,142,031 + Amortization of ineffective loss on swaps of -$239,635 + Other expenses shown net in FS rev of -$40,000 + Auxiliary component of contributions to restricted net assets of $98,616 Schedule D, Part XI, Line 4b Other of $119,206 = Ambassador revenue of $304,307 + Ambassador event direct expenses of -$185,101 Schedule D, Part XII, Line 4b Other expenses of $16,311,170 included in TR, but not on Audit = Bad Debt Provision of $12,464,478 + Non-Op expenses reflected in net reveneu on audit of $40,000 + Ambassador expenses reflected as Restricted Contribution in Audit of $20,590 + Non-op expenses for Pension Contributions of $3,786,102 Central America and the Caribbean 0 0 Investments Passive Investments in Cayman Islands. 214296 0 0 214296 0 0 1 1 0 0 1 1 X 1 X 2.5 1 X 1 1 0 0 4104961 1329058 2775903 0.007 53802746 32994621 20808125 0.053 0 0 57907707 34323679 23584028 0.060 1155615 623186 532429 0.001 393310 0 393310 0.001 530903 0 530903 0.001 0 0 2079828 623186 1456642 0.003 0 0 59987535 34946865 25040670 0.063 2175 2175 0 19167 19167 0 70862 70862 0 150000 150000 0 0 0 242204 0 242204 0 1 3972424 993106 58802395 82064414 -23262019 X 1 1 Boulder Community Musculoskeletal Surgery Center LLC Outpatient Orthopedic Surgery Center 0.5 0 0.5 Endoscopy Center of the Rockies LLC Outpatient Endoscopy Center 0.5 0 0.5 Boulder MRI LLC outpatient MRI center 0.51 0 0.49 Foothills Surgery Center LLC Ambulatory Surgical Center 0.51 0 0.49 Riverbend Sleep LLC Property ownership and lease to Approved Entities 0.5 0 0.5 Premier Eye Surgery Center of Colorado ambulatory surgery center for eyes 0.501 0 0.499 1 1 Boulder Community Foothills Hospital 4747 Arapahoe Avenue Boulder CO 80303 www.bch.org 010323 X X X Boulder Community Foothills Hospital 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X See H, Part V, Section C X 1 19 1 See H, Part V, Section C 0 0 1 X 250 350 X X X X X 1 1 X X X X 1 X See H, Part V, Section C X See H, Part V, Section C X See H, Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Boulder Community Foothills Hospital Please refer to Community Input on pages 5 and 6 of the 2020-2022 CHNA, and to Appendix One of this report. Schedule H, Part V, Section B, Line 7a-Boulder Community Foothills Hospital https://www.bch.org/About-Us/Community-Reports.aspx Report is at the bottom of the page. Schedule H, Part V, Section B, Line 11-Boulder Community Foothills Hospital Please refer to pages 10 - 14 and 20 - 28 of the 2020-2022 CHNA. The top four health needs identified are: Chronic disease management and traumatic injury, Mental health including chronic pain management and substance abuse, Wellness and preventative health including aging of the population and access to care and Community education. Details of the how BCH is addressing these needs are included in the CHNA. The CHNA did not identify any significant health needs that are not being addressed. Two large social determinants of care which impact health are affordable housing and transportation. BCH is not directly addressing these because it is not in a position to have a direct impact. However, it partners with organizations within the community that are attempting to create positive change in these areas. Schedule H, Part V, Section B, Line 16a-Boulder Community Foothills Hospital https://www.bch.org/Pay-My-Bill/FINANCIAL-ASSISTANCE.aspx Schedule H, Part V, Section B, Line 16b-Boulder Community Foothills Hospital https://www.bch.org/documents/Pay-My-Bill/FINANCIAL-ASSISTANCE-APPLICATION-New-2017.pdf Schedule H, Part V, Section B, Line 16c-Boulder Community Foothills Hospital https://www.bch.org/Pay-My-Bill/FINANCIAL-ASSISTANCE.aspx 49 BCH Behavioral Health DPU 4801 Riverbend Road Boulder CO 80301 Psych DPU Inpatient Rehabilitation DPU 11820 Destination Dr Broomfield CO 80021 Rehab DPU Community Medical Center 1000 W South Boulder Road Lafayette CO 80026 Emergency Room BCH at Boulder Medical Center 2750 Broadway Boulder CO 80304 laboratory and imaging services Boulder Community Musculoskeletal Surgery LLC 4740 Pearl Parkway Boulder CO 80301 Ambulatory Surgical Center Endoscopy Center of the Rockies in Lafayette 1000 W South Boulder Road Suite 202 Lafayette CO 80026 Endoscopic Ambulatory Surgery Center Endoscopy Center of the Rockies in Boulder 1755 48th Street Suite 110 Boulder CO 80303 Endoscopic Ambulatory Surgical Center Endoscopy Cener of the Rockies in Longmont 1551 Professional Lane Suite 295 Longmont CO 80501 Endoscopic Ambulatory Surgical Center Boulder MRI LLC 1000 W South Boulder Road Suite 105 Lafayette CO 80026 MRI Imaging Center Foothils Surgery Center LLC 4743 Arapahoe Avenue Suite 101 Boulder CO 80303 Ambulatory Surgical Center Boulder Heart 4743 Arapahoe Avenue Suite 201 Boulder CO 80303 Physician clinic Boulder Heart Lafayette 1000 W South boulder Road Suite 216 Lafayette CO 800262089 Physician clinic Boulder Heart Longmont 2101 Ken Pratt Blvd Suite 104 Longmont CO 805016568 Physician clinic Internal Medical Associates of Boulder 5495 Arapahoe Avenue Boulder CO 80303 Physician clinic Boulder Valley Surgical Associates 4743 Arapahoe Avenue Boulder CO 80303 Surgical services Boulder Valley Pulmonology 4820 Riverbend Road Boulder CO 80301 Physician clinic CU Sports Medicine and Performance Center 2150 Stadium Drive Second Floor Boulder CO 80309 outpatient sports medicine clinic Boulder Community Health Sports Medicine Imaging LLC 2150 Stadium Drive Boulder CO 80309 Imaging IDTF Beacon Center for Infectious Disease 4800 Riverbend Rd Boulder CO 80301 Infectious Disease Clinic Boulder Community Health Sleep Diagnostice 4895 Riverbend Rd Boulder CO 80301 Sleep study center Sleep Fit 13654 Xavier Lane Suite 210A Broomfield CO 80020 Sleep study center Internal Medical Associates of Lafayette 1000 W South Boulder Rd Suite 214 Lafayette CO 80026 Physician clinic Internal Medicine Associates at Buffalo Ridge 101 Erie Parkway Erie CO 80516 Physician clinic Center for Integrative Care 4715 Arapahoe Unit 100 Boulder CO 80303 Outpatient integrative care for cancer patients Broomfield Imaging 36 Garden Center Broomfield CO 80020 Laboratory and imaging services Frontier Internal Medicine 2101 Ken Pratt Blvd Ste 104 Longmont CO 80501 Physician clinic Wellneww Program of BCH 5495 Arapahoe Avenue Boulder CO 80303 Physician clinic Northwest Family Medicine 3 Superior Dr Superior CO 80027 Physician clinic Family Medical Associates 1000 W South Boulder Rd Suite 110 Lafayette CO 80026 Physician clinic Spruce Street Internal Medicine 2575 Spruce Street Boulder CO 80302 Physician clinic Boulder Creek Family Medicine 1755 48th St Suite 200 Boulder CO 80303 Physician clinic Associated Neurologists of Boulder 4801 Riverbend Rd Boulder CO 80301 Physician clinic Occupational Health Services 1000 W South Boulder Rd Lafayette CO 80026 Occupational medicine clinic Dakota Ridge Medical Center 2995 Baseline Road Suite 210 Boulder CO 80303 Physician clinic Gunbarrel Medical Center 6685 Gunpark Drive Suite 110 Boulder CO 80301 Physician clinic BMC East Laboratory 80 Health Park Dr Louisville CO CO 80027 Laboratory draw station Boulder Heart at Erie Medical Center 101 Erie Parkway Erie CO 80516 Physician clinic Boulder Women's Care 4745 Arapahoe Ave Suite 320 Boulder CO 80303 Physician Clinic Boulder Women's Care at Erie Medical Center 101 Erie Parkway Eire CO 80516 Physician Clinic Center for Mind Body Medicine 4801 Riverbend Road Boulder CO 80301 Physician Clinic Endocrinology Associates of BCH 5495 Arapahoe Avenue Boulder CO 80303 Physician Clinic Endocrinology Associates of BCH - Superior 3 Superior Drive Superior CO 80027 Physician Clinic Erie Family Medicine 101 Erie Parkway Erie CO 80519 Physician Clinic Foothills Community Midwives 4745 Arapahoe Ave Boulder CO 80303 midwife clinic Urgent Care Center - Erie 6685 Gunpark Dr Boulder CO 80301 Urgent Care Center Urgent Care Center - Superior 3 Superior Dr Superior CO 80027 Urgent Care Center Worldwide Travel Clinic 4800 Riverbend Rd Boulder CO 80301 Physician clinic Wound Healing Center 4880 Riverbend Rd Boulder CO 80301 Wound Clinic Community Medical Center- Emergency Department 1000 W South Boulder Rd Lafayette CO 80026 Freestanding ER Schedule H, Part I, Line 3c Criteria used to determine eligibility for financial assistance in addition to the FPG include Asset level, Medical Indigency, Insurance Status, Underinsurance status and Residency. Schedule H, Part I, Line 7 The costing methodology used for Part 1, Lines 7a and 7b, is the Worksheet 2 Ratio of Cost-to-Charges. The costs for Lines e, 7f and 7i are directly identifiable costs from our internal accounting records. Schedule H, Part I, Line 7, Column f $12,464,478 Schedule H, Part II Community Support Activities include diaster readiness training in conjunction with numerous local agencies (fire, police, sheriff, other counties, other hospitals) to ensure coordinated and effective response to a disaster. Coalition building includes the hospitals participation in the development of the Colorado Regional Health Information Organization (CORHIO) and Boulder County Health Improvement Collaborative (BCHIC), which are both electronic health exchanges aimed at promoting effective and efficient health care delivery as well as information for community health assessments. BCHIC also helps underinsured and uninsured patients in the county obtain specialist care. Community health improvement advocacy includes participation on the Colorado Hospital Association Board, the Medicaid Provider Rate Review Advisory Committee, and a Purchasing Coalition to reduce costs. The Workforce development includes physician recruitment expense. Boulder is a Medically Underserved Area for low income and Medicare. Schedule H, Part III, Section A, Line 4 The January 1, 2018 adoption of Financial Accounting Standards Board Accounting Standards Update 2014-09, Revenue from Contracts with Customers (ASU 2014-09) impacts the explicit recognition of the provision for doubtful accounts. Prior to January 1, 2018 the provision for doubtful accounts was explicitly recognized on the income statements; after January 1, 2018 it is reported net in Patient care service revenue and is not explicitly recognized on the audited financial statements. Footnote 2 Summary of Significant Accounting Policies, (o) Patient Care Service Revenue found on page 11 of the audited financial statements discusses implicit price concessions such as charity and bad debts. The amount reported on Line 2 as bad debt is an estimate of the cost of the actual balances on accounts written off to bad debt. It is estimated that 85% of the amount written off is stated at charges. This 85% is then converted to cost using the RCC developed on Worksheet 2. The remaining 15% is estimated to be related to a patient liability for deductibles and coinsurance. The amount reported on Ln 3 is estimated to be 25 % of Ln 2. Schedule H, Part III, Section B, Line 8 100% and more of Line 7 Medicare shortfall should be treated as community benefit. Boulder County has a demonstrated community need for physicians who accept Medicare. (Many physician providers do not.) The hospital not only serves the Medicare population for hospital services, it also employs numerous primary care, internal medicine, surgeons, neurologists, pulmonology and cardiology providers who accept Medicare in order to provide our community with adequate coverage. The Cost Report shortfall reported on Line 7 excludes Medicare HMO enrollee shortfalls, excludes shortfalls from ancillary procedures which are paid by fee schedule and are therefore not included in the Cost Report, and excludes the shortfall related to employed physicians serving the Medicare population. The hospitals total Medicare shortfall, including these programs, is actually $39,229,542. The source for Line 6 is the filed Medicare Cost Report. Schedule H, Part III, Section C, Line 9b The hospital employs financial counselors to assist patients in determining eligibility for Medicaid, Colorado Indigent Care Program (CICP), or the hospital's charity program (WeCare). Financial arrangements with Emergency Room patients are not discussed until the patient has been assessed and treated in accordance with EMTALA. The hospital's debt collection policy contains a Communications section addressing courtesy, confidentiality, cultural sensitivity, and primary language of a patient. It contains a section on Billing and Collection Practices which addresses when an account will be referred to a licensed collection agency and that those agencies will treat all patients with dignity, compassion and respect, as well as adhering to Colorado State Laws and the Fair Debt Collection Act. BCH will not knowingly send a patient's bill to a collection agency if they have an application pending for either government -sponsored coverage or for financial assistance. Patients may apply/reapply for financial assistance before, during or after care, or after collection agency assignment. Schedule H, Part VI, Line 2 In 2010, a comprehensive facilities study was performed to evaluate each of the existing hospital campuses and determine the most efficient and effective methods of delivering the safest, highest quality health care. The Planning Committee uses the Community Health Needs Assessment, the Comprehensive Facilities study, as well as market and demographic studies to ensure BCH meets the future health care needs of our community. BCH is completeing a 10 year transitional strategy to consolidate health care delivery in order to meet the needs of the community in a safe and sustainable manner. As of October, 2014 all acute care inpatient services have been consolidated at the Foothills campus. BCH opened a new facility adjacent to the Foothills hospital in the spring of 2019 to move Behavioral Health services, and partnered with UCHealth to jointly provide Inpatient Rehabilitation services in Broomfield, CO, which opened mid 2019. Schedule H, Part VI, Line 3 The Hospital employs financial counselors to assist patients in determining eligibility for Medicaid, Colorado Indigent Care Program (CICP), or the Hospitals charity program (WeCare). The hospital employs Spanish speaking financial counselors and would utilize interpreter services for other languages. Financial Assistance programs are referenced in patient discharge information, billing statements, and on the hospitals web site. Schedule H, Part VI, Line 4 Please refer to pages 15 through 19 of the 2020-2022 CHNA. This section of the CHNA discusses Service Area, Demographics, Gender, Age, Diversity and Employment/Income. Schedule H, Part VI, Line 7 Colorado - The Hospital Community Benefit Accountability Reprot was filed August 2020 pertaining to the 12/31/18 Schedule H. 1 Community Foundation Boulder County 1123 Spruce Street Boulder CO 80302 841171836 501(c)3 12000 0 FMV Support for local quality of life improvement Boulder Valley Schoold District 6500 E Arapahoe Ave Boulder CO 80303 846014683 501(c)3 0 76988 FMV Provide athletic trainer to school district To support high school athletics and help to reduce student athlete injuries Boulder Community Health Foundation PO Box 19320 Boulder CO 80308 840772664 501(c)3 18350 FMV Rent paid on behalf of Foundation To support the efforts of the BCH Foundation in the form of rental space 3 0 Assistance for IP rehab patients 6 4124 Cost Healthcare education scholarships 22 49000 Cost Assistance for Mental Health patients 41 24016 Cost Assistance with winter gear for wound healing indigent patients 157 11767 Cost Oncology patient support for qualifying patients 57 43695 Cost Assistance with food and transportation post-discharge for indigent patient 36 7567 Cost Assistance with RX post-discharge for indigent patients 26 9673 Cost Take home medications donated to indigent patients post-discharge Assistance with housing post-discharge for indigent patients 72 41524 Cost Schedule I, Part I, Line 2 Grants are only made to non-profit organizations supporting our local community with health and welfare services. Grants in excess of $10,000 are specifically approved by the hospital board of directors during the budget process. The CEO has a discretionary budget for which he may approve distributions of less than $10,000. Monitoring of grants over $10,000 is done by having representation on their non-profit board. Scholarship applications for healthcare education are reviewed by a committee and payments are sent directly to the school on the student's behalf with a letter indicating that the money should be returned to the hospital if the student does not register. X X X X X 1 1 0 0 0 1 0 1 0 Robert J Vissers Exec Director/CEO 702977 0 143998 0 43978 0 13900 0 20364 0 925217 0 0 0 Benjamin J Keidan VP & Chief Medical Officer 394169 0 0 0 20803 0 79802 0 17818 0 512592 0 0 0 William A Munson Jr VP & CFO 305459 0 0 0 43873 0 74251 0 32800 0 456383 0 0 0 Jacqueline M Attlesey-Pries VP , Chief Nursing Officer & Chief Operating Officer 279173 0 0 0 24970 0 64536 0 22797 0 391476 0 0 0 Paul R Hinchey VP Business Development 296918 0 0 0 44000 0 66400 0 24399 0 431717 0 0 0 Sarah E Meshak VP & General Counsel 290082 0 0 0 25000 0 69634 0 10984 0 395700 0 0 0 Jamie D Jensen VP & Chief Population Health Officer 296669 0 0 0 18500 0 19637 0 10043 0 344849 0 0 0 Michael J Jefferies VP & Chief Information Officer 264384 0 0 0 11814 0 54955 0 1010 0 332163 0 0 0 Grant Besser Foundation President & VP Public Affairs 199909 0 27334 0 13006 0 46591 0 30828 0 317668 0 0 0 Valerie Lipetz MD Board Member 251657 0 21686 0 36418 0 27650 0 17310 0 354721 0 0 0 Charles Jones Physician 1106527 0 267278 0 25000 0 202458 0 11001 0 1612264 0 209511 0 Daniel O'Hair Physician 1012042 0 69244 0 19000 0 13200 0 32150 0 1145636 0 0 0 Bryan Mahan Physician 893669 0 45141 0 25000 0 12931 0 24040 0 1000781 0 0 0 Srinivas Iyengar Physician 691079 0 53058 0 37512 0 13900 0 30151 0 825700 0 0 0 Sameer A Oza Physician 525350 0 151098 0 38000 0 16650 0 29764 0 760862 0 0 0 Schedule J, Part I, Line 3 The Executive Committee of the Board serves as the compensation committee as specified by the bylaws of the hospital. The Executive Committee is comprised of the Chairman, Vice Chairman, Secretary, Treasurer, President/CEO and two at large members of the Board. The President/CEO does not participate in or vote on compensation matters related to his own compensation. The Executive Committee proposes an Executive Compensation Philosophy for approval by the Board, which sets parameters for compensation of the CEO and the Vice Presidents. The Executive Committee (without the CEO) reviews the compensation and benefits of the CEO annually, subject to Board ratification. The CEO sets compensation for the Vice Presidents within the ranges established by the Compensation Philosophy. Compensation outside the approved ranges requires Executive Committee review and approval. The Executive Committee engages a consulting firm to provide comparative compensation studies for similarly qualified executives in functionally comparable positions at similarly situated organizations. Compensation study and performance review are considered in developing executive compensation decisions. Any benefits for executives beyond what is provided to all employees must be consistent with the Compensation Philosophy. All compensation-related meetings of the Executive Committee are formally documented. Schedule J, Part I, Line 4 Ln 4a-Jamie Jensen, VP & Chief Population Health Officer received a severance payment of $$70,017. Ln 4b--The hospital contributes to a nonqualified 457(f) plan for the benefit of its executive leadership. Participants include: Benjamin Keidan, VP & Chief Medical Officer ($63,152 contributed), William Munson Jr, VP & CFO ($57,601 contributed), Jacqueline Attlesey-Pries, VP ,COO & CNO ($47,886 contributed), Paul Hinchey, VP Business Development ($52,500 contributed), Michael Jefferies, VP & CIO ($541,430 contributed), Sarah Meshak, VP & General Counsel ($53,280 contributed), and Grant Besser, Foundation President & VP Public Affairs ($35,999 contributed). Schedule J, Part I, Line 6 See response to Line 7. Board approval required for any payment. Schedule J, Part I, Line 7 For 2018, the hospital had an Incentive Compensation Plan for Vice Presidents and Directors whereby a percentage of base salary is paid out if goals are met, if a net operating income before interest expense gate is met, and if authorized by the Board of Directors. The net operating income before interest expense gate was not met and therefore no Incentive compensation expense was accrued for the 2018 plan year and no payments were made in early 2019 for 2018 incentive compensation. The exception to this was the Foundation President & VP Public Affairs, who was paid incentive compensation in February 2019 for the plan year 2018 based upon achieving goals set by the Foundation Board. For 2019, the Incentive Compensation Plan paying a percentage of base salary was modified to allow up to a 2/3 payment if individual goals were met but the net operating income before interest expense target was not met. This target was not met and therefore limited Incentive compensation expense was accrued for the 2019 plan year and those payments were made in early 2020 for 2019 incentive compensation. A Colorado Health Facilities Authority 840752932 19648AVF9 2010-12-01 93535431 Foothills expansion; balance for debt refunding 0 0 0 B Colorado Health Facilities Authority 840752932 19648AZL2 2012-08-28 31748673 Foothills hospital expansion 0 0 0 C Colorado Health Facilities Authority 840752932 2014-12-30 30000000 acquiring,constructing & equipping Financed Facilities 0 0 0 A 42530000 225000 93716361 0 0 0 1080618 0 0 25180923 67458941 0 2014 1 0 1 1 B 4105000 0 31815214 0 0 0 452449 0 0 31362765 0 0 2014 0 0 1 1 C 1000000 0 30041484 0 0 0 153502 0 0 29887982 0 0 2019 0 0 1 1 A 0 0 1 1 0 0 0 0 0 1 0.00308 1 1 B 0 0 1 1 0 0 0 0 0 0 1 C 0 0 1 1 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 Schedule K, Part I, Column e-12/01/2010 93,535,431 Colorado Health Facilities Ln A(e) of $93,535,431 < Pt II Ln 3(A) of 93,716,361 by the cumulative trust fund interest income of $180,930. Schedule K, Part I, Column e-08/28/2012 31,748,673 Colorado Health Facilities Ln B(e) of $31,748,673 < than Pt II Ln 3(B) of 31,815,214 by the cumulative trust fund interest income of $66,541. Schedule K, Part I, Column e-12/30/2014 30,000,000 Colorado Health Facilities Authority Ln C(e) of $30,000,000 < Pt II Line 3(C) of 30,034,171 by the cumulative trust fund interest income of $41,484. Schedule K, Part II, Line 3-12/01/2010 93,535,431 Colorado Health Facilities Lines 4 through 12 > Ln 3 by 4,121 which is the amount transferred into the 2010 Cost of Issuance Bond Trust Account from the close-out of the 2003 Bond Fund. Schedule K, Part II, Line 11-12/01/2010 93,535,431 Colorado Health Facilities Other Spent Proceeds includes $14,546,298 to refund Series 1994B, $26,456,321 to refund Series 2003A and $26,456,321 to refund Series 2003B. Schedule K, Part IV, Line 2c-12/01/2010 93,535,431 Colorado Health Facilities Rebate calculation for Series 2010 performed by Kutak Rock Arbitrage Consulting LLC for the period 12/1/2010 to 10/01/2015, the end of the first five-year rebate calculation period. The report concludes that there is no arbitrage rebate liability as of 10/01/2015 and no federal reporting requirement. Schedule K, Part IV, Line 2c-08/28/2012 31,748,673 Colorado Health Facilities Rebate calculation for Series 2012 performed by Kutak Rock Arbitrage Consulting LLC for the period 08/28/2012 to 10/01/2016, the end of the first five-year rebate calculation period. The report concludes that there is no arbitrage rebate liability as of 10/01/2016 and no federal reporting requirement. Schedule K, Part IV, Line 2c-12/30/2014 30,000,000 Colorado Health Facilities Authority Rebate calculation for Series 2014 performed by Kutak Rock Arbitrage Consulting LLC for the period 12/31/20142 to 12/01/2019, the end of the first five-year rebate calculation period. The report concludes that there is no arbitrage rebate liability as of 12/01/2019 and no federal reporting requirement. Robert J Vissers Executive Director/CEO personal home purchase X 250000 163111 0 1 1 163111 Form 990, Part VI, Section B, Line 11b Form 990 is prepared by the Controller based upon audited financial statements. The 990 is reviewed by the nonprofit tax manager of our external audit firm, by the CEO, CFO, VP & General Counsel, Compliance Officer, and the Audit and Compliance Committee of the Board of Directors. Final copies are provided to each voting Board member electronically before filing with the IRS. Form 990, Part VI, Section B, Line 12c The hospital has a conflict of interest policy for all staff and requires that staff members director level and above complete an annual conflict of interest questionnaire that is reviewed by the compliance department. The hospital also has a conflict of interest policy for all medical staff members that requires disclosure on a conflict of interest statement form during the credentialing and/or re-credentialing periods. Board members complete an annual statement of interest form which discloses employment, family member employment, business relationships, service on other Boards or governance positions and identifies other conflicts of interest. The statement of interest also identifies transactions requiring disclosure. Form 990, Part VI, Section B, Line 15 The Executive Committee of the Board serves as the compensation committee as specified by the bylaws of the hospital. The Executive Committee is comprised of the Chairman, Vice Chairman, Secretary , Treasurer, President/CEO and two at large members of the Board. The President/CEO does participate in or vote on compensation matters related to his own compensation. The Executive Committee proposes an Executive Compensation Philosophy for approval by the board, which sets parameters for compensation of the CEO and the Vice Presidents. The Executive Committee (without the CEO) reviews the compensation and benefits of the CEO annually, subject to Board ratification. The CEO sets compensation for the Vice Presidents within the ranges established by the Compensation Philosophy. Compensation outside the approved ranges requires Executive Committee review and approval. The Executive Committee engages a consulting firm to provide comparative compensation studies for similarly qualified executives in functionally comparable positions at similarly situated organizations. Compensation study and performance review are considered in developing executive compensation decisions. Any benefits for executives beyond what is provided to all employees must be consistent with the Compensation Philosophy. All compensation-related meetings of the Executive Committee are formally documented. Form 990, Part VI, Section C, Line 19 The hospital's web site is www.bch.org. The web site includes the hospital's Mission, Vision and Beliefs Statement, our financial assistance policies, the Community Health Needs Assessment, the Board of Directors, and the Annual Report which contains key financial data, and information on new programs, patient safety and quality, and community benefits. The web site also has a section for Compliance policies including the Code of Conduct and Conflict of Interest. Annual audited financial statements are made available to the public at the Annual Meeting of Boulder Community Health. The tax return is made available to anyone who requests the return through our Public Information Office. Form 990, Part XI, Line 9 Other change in Net Assets of $7,616,196 = Change in minimum pension liability of $1,142,030 + Charge for amortization of ineffective loss on swaps of -$239,635 + Change in Foundation Net Assets of $6,713,801 Boulder Community Health Sports Medicine Imaging LLC 2150 Stadium Drive 2nd Floor Boulder CO 80309 474243430 imaging services CO 1323222 1681307 Boulder Communty Health Boulder Valley Care Network LLC 4141 Arapahoe Avenue Suite 200 Boulder CO 80303 821488664 Clincally Integrated Provider Network CO 200989 0 Boulder Community Health Boulder Community Health Rehab LLC 4747 Arapahoe Ave Boulder CO 803019019 Participate in a 50/50 JOA with another non-profit to operate an Inpatient Rehabilitation hospital CO 0 1337642 Boulder Community Health Boulder Community Hospital Foundation 4860 Riverbend Boulder CO 80301 840772664 Fundraising for Boulder Community Health CO 501(c)3 Line 7 N/A 0 Boulder Community Musculoskeletal Surgery Center LLC 4740 Pearl Parkway Suite 100 Boulder CO 80301 201391702 Outpatient surgery center CO N/A Related 1744468 4307297 0 0 0 0.5 Endoscopy Center of the Rockies LLC 382 S Arthur Ave Ste 140 Louisville CO 80027 841562782 Outpatient Endoscopy CO N/A Related 4188604 1003214 0 0 0 0.5 Boulder MRI LLC 1000 W South Boulder Road Suite 105 Lafayette CO 80026 452676500 outpatient MRI center CO Boulder Community Health Related 214602 113335 0 0 0 0.51 Foothills Surgery Center LLC 4743 Arapahoe Avenue Suite 101 Boulder CO 80303 455328252 Ambulatory Surgical Center CO Boulder Community Health Related 2003202 2198562 0 0 0 0.51 Riverbend Sleep LLC 4895 Riverbend Road Boulder CO 80301 464514151 own building and lease to Approved Entities CO N/A Excluded 48115 1019609 0 36433 0 0.5 Premier Eye Surgery Center of Colorado 4545 Arapahoe Suite 100 Boulder CO 80303 823760640 Outpatient Eye Surgery Center CO Boulder Community Health Related -160982 815379 0 0 0 0.501 0 1 1 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 Boulder Community Musculoskeletal Surgery Center LLC c 2045720 K-1 capital distibution Boulder Community Musculoskeletal Surgery Center LLC d 1479653 Loan guarantee document (not > ownership %) Endoscopy Center of the Rockies LLC c 4392500 K-1 capital distribution Boulder MRI LLC c 204001 K-1 capital distribution Boulder MRI LLC j 60935 Property Manager Recap of Income Boulder MRI LLC q 174030 35,775 for PACS engagement, 12,500 for managed care contracting, 125,755 for pass-thru of MRI service contract. Riverbend Sleep LLC c 50000 K-1 capital distribution Riverbend Sleep LLC k 173481 Vendor history recap Foothills Surgery Center LLC c 1785000 K-1 capital distribution Foothills Surgery Center LLC d 284234 Loan document guarantees 35% of Loan outstanding at YE Foothills Surgery Center LLC j 377080 Lease payments received Premier Eye Surgery Center of Colorado b 851700 K-1 capital contributed CP211A received which extends filing due date for Form 990 to November 15, 2020.