2019-11-14T16:53:26-07:00 2018-12-31 990 2018-01-01 840175870 Boulder Community Health BOUL 3034155220 PO Box 9019 Boulder CO 803019019 William A Munson Jr CFO & Vice President 3034157433 2019-11-14 69.161.206.5 2018 2020-03-31 21:24:44Z Boulder Community Hospital Robert J Vissers President and CEO PO Box 9019 Boulder CO 803019019 699494213 0 X www.bch.org X 1922 CO Partnering to create and care for the healthiest community in the nation. 15 13 2948 705 2235988 0 3065359 2385388 340882255 349589866 44012052 14863357 20098039 23145903 408057705 389984514 259639 257884 0 0 192489117 197069773 0 0 457506 178480045 184129551 371228801 381457208 36828904 8527306 731524575 708360010 264712333 264197084 466812242 444162926 To provide our community the highest value healthcare in an innovative, patient-centered environment. 0 0 285595872 258133 370220185 Health Care Delivery of IP and OP medical care. In 2018, the hospital discharged 7,616 adult & pediatric patients with an average length of stay of 4.5 days. 40,980 patients were seen in our ER facilities and 7,831 in Urgent Care. 5,731 surgeries were performed. The hospital had adjusted patient days of 84,684. 0 0 0 285595872 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 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 233 0 1 2948 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 Boulder CO 803019019 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 Mako Shimoda MD 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 Robert J Vissers Exec Director/CEO 40 0 X X 662272 0 180199 Benjamin J Keidan VP & Chief Medical Officer 40 0 X 428395 0 107737 William A Munson Jr VP & CFO 40 0 X 333947 0 88759 Jacqueline M Attlesey-Pries VP , Chief Nursing Officer & Chief Operating Officer 40 0 X 330433 0 81929 Paul R Hinchey VP Business Development 40 0 X 300584 0 97171 Michael J Jefferies VP & Chief Information Officer 40 0 X 296585 0 64817 Sarah E Meshak VP & General Counsel 40 X 290221 0 74000 Jamie D Jensen VP & Chief Population Health Officer 40 0 X 276473 0 63585 Grant Besser Foundation President & VP Public Affairs 12.00 28.00 X 219349 0 55165 Charles Jones Physician 40 0 X 1138482 0 228979 Bryan Mahan Physician 40 0 X 1017511 0 26585 Srinivas Iyengar Physician 40 0 X 771371 0 36917 Jamie Doucet Physician 40 0 X 758855 0 39582 Sameer A Oza Physician 40 0 X 742203 0 38577 Linda S Minghella VP & Chief Information Officer (former) 0 0 X 137732 0 0 7704413 0 1184002 268 1 1 0 Favorite Healthcare Staffing Inc PO Box 803356 Kansas City MO 641803356 agency nursing services 1832314 Boulder Emergency Physicians CarePoint PC 5600 S Quebec St Suite 312 A Greenwood Village CO 80111 CMC Emergency Room Coverage 1429830 Boulder Neurosurgical Assoc PLLC 4743 Arapahoe Ave Suite 202 Boulder CO 80303 trauma call 1124323 Boulder Valley Anesthesiology LLC c/o Wendll Walker & Assoc 1420 28th St Ste 100 Boulder CO 80303 Anesthesiology coverage 1005071 Courier Ventures DBA Action Stat Logistics 2032 35th Ave Suite A 104 Greeley CO 80634 Courier services 980198 29 0 3123 0 2012672 354334 15259 0 2385388 Acute Care Hospital 622000 347743850 347672900 0 70950 Lab Service Revenue 621500 1846016 0 1846016 0 0 0 0 0 349589866 8228473 0 0 8228473 9358 0 0 9358 0 0 0 0 0 0 0 0 0 0 0 0 0 0 316000783 15530 309256499 134288 6744284 -118758 6625526 -118758 0 6744284 0 0 0 0 0 0 0 0 0 0 0 0 201743 118912 82831 82831 0 0 Hospital Care Joint Ventures 621400 7272997 7272997 0 0 Misc Hospital Revenue 622000 15400103 15310145 0 89958 Lab Service Revenue 621500 389972 0 389972 0 0 0 0 0 23063072 389984514 370220115 2235988 15143023 112234 112234 145650 145650 0 0 0 0 3788164 0 3589566 198598 0 0 0 0 153811194 117395646 36206923 208625 10727157 4181849 6545308 0 18358391 16157714 2170026 30651 10384867 7540466 2823397 21004 2655962 241217 2414745 0 181017 0 181017 0 102444 0 102444 0 13857 13857 0 0 0 0 268089 0 268089 0 20734991 16189581 4545410 0 879348 0 879348 0 4853614 2540946 2302469 10199 10742422 528549 10213873 0 0 0 0 0 8080522 5326848 2732856 20818 389042 217301 171741 0 0 0 0 0 252676 135567 117109 0 3963633 1736071 2227562 0 0 0 0 0 18394414 7340331 11044104 9979 3123895 775641 2348254 0 Medical Supplies 54830831 54459397 371401 33 Repairs and Maintenance 6698094 4538510 2159384 200 Medicaid Provider Fee 23334051 23334051 0 0 Provision for Bad Debts 21162349 21162349 0 0 3468300 1522097 1988804 -42601 381457208 285595872 95403830 457506 291182 17374 408897 1563438 0 0 45608961 47849131 0 0 0 0 0 0 3692934 4232921 5755202 6418632 451527371 173855872 235078503 277671499 367188689 306650233 12869172 7776298 5174473 5427032 164326 78270 55292236 50675182 731524575 708360010 48105693 55343756 0 0 0 0 161550892 154267777 0 0 0 0 0 0 70000 70000 54985748 54515551 264712333 264197084 X 426200786 405294503 32293404 30564236 8318052 8304187 466812242 444162926 731524575 708360010 X 8527306 -25873655 0 0 0 -5302967 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13857 13857 0 Schedule C, Part II-B, Line 1 5.49% of dues paid to the Colorado Hospital Association are spent on lobbying activities, amounting to $4.933. 22.73% of dues paid to the American Hospital Association are spent on lobbying activities, amounting to $8,924. 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 34604553 4337617 1664839 0 4856166 0 35750843 0 0.21 0.79 0 1 1 0 20151602 20151602 0 207991921 75315599 132676322 0 6847299 1327792 5519507 0 151216903 97212481 54004422 0 65319646 0 65319646 277671499 Interest in Net Assets held by Foundation 38204080 Unamortized Swap Fees 74372 Unamortized BIC 965897 Deferred Comp Investments 9206565 Deposits 3016 Misc Other A/R 2221252 50675182 0 Accrued Pension Liability 45185978 Deferred Compensation Liability 9329573 54515551 337322914 -25873655 0 0 -26412956 -52286611 389609525 268089 106900 374989 389984514 357514602 0 0 0 0 0 357514602 268089 23674517 23942606 381457208 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 -$52,286,611 included in TR revenue by not in audited revenue includes Bad Debt Provisions of -$21,162,349 + Change in Foundation Net Assets of -$2,187,431 + Change in minimum pension liability of -$2,875,899 + Amortization ineffective loss on swap of -$239,635 + Other expenses shown net in FS revenue and gross in TR of -$40,036 + Ambassador component of Temp Rest Net Assets of $92,394 Schedule D, Part XI, Line 4b Other of $106,900 = Ambassador net revenues reflected as Restricted Contributions in Audit of $106,900 Schedule D, Part XII, Line 4b Other expenses of $2,472,132 included on TR but not on Audit = Bad Debt Provision of $21,162,349 + Other non-operating expenses shown in net revenue on audit of $40,036 + Ambassador expenses reflected as Restricted Contributions in Audit of $14,504 + Non-op Expenses of Pension Contributions of $2,457,629 Central America and the Caribbean 0 0 Investments Passive investments in Cayman Islands. 3902191 0 0 3902191 0 0 1 1 0 0 1 1 X 1 X 2.5 1 X 1 1 0 0 6023218 2625161 3398056 0.009 57392208 35317841 22074368 0.059 0 0 63415426 37943002 25472424 0.068 490184 50898 439286 0.001 320872 0 320872 0.001 512576 0 512576 0.001 0 0 1323632 50898 1272734 0.003 0 0 64739058 37993900 26745158 0.071 6761 0 6761 0.0 45282 0 45282 0.0 158518 0 158518 0.001 0 0 210561 0 210561 0.001 1 6840662 1710166 60362070 85961919 -25599849 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 16 1 0 0 1 X See H, Part V, Section C X 1 17 1 https://www.bch.org/documents/CHNA-Implementation-Strategy.pdf 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 pages 7 through 10 of the 2017-2019 CHNA. Schedule H, Part V, Section B, Line 7a-Boulder Community Foothills Hospital https://www.bch.org/documents/bch-community-health-needs-assessment-final-august-26-2016.pdf Schedule H, Part V, Section B, Line 11-Boulder Community Foothills Hospital BCH, with its Board of Directors and the community, is continually assessing the implementation of the CHNA. The strategies to address the community's health needs identified in the Hospital's 2017-2019 Community Health Needs Assessment and the activities undertaken by the Hospital as part of these strategies are as follows: 1. Chronic Disease Management. BCH has committed extensive resources to its chronic disease programs in the areas of personnel, supplies, and technology. Chronic disease self-management support groups, high risk patient care management and registries, diabetes and pre-diabetes group classes and individual support are included within this commitment. All of BCH's primary care clinics have an RN Care Manager on site to coach patients to better manage their chronic disease preventing complications. BCH hired its first ambulatory care pharmacist to focus on improving diabetes care and depression care for the community. BCH has a team of transitional care nurses that provide education and support to our highest risk patients after a hospitalization. Continuous collaboration across BCH departments and providers, community medical partners and agencies, skilled nursing facilities, and social support organizations provide patients with coordinated care. BCH has continued to enhance the infrastructure of its transitional care program and coordinated patient care material across the continuum of care so that all providers are teaching to the same material. The Boulder Valley Care Network, of which BCH is a collaborator, has recently added BCH transitional care services for its patients. 2. Mental Health. BCH has continued to expand our integrated behavioral health model into 10 primary care clinics. This model adds social workers to address the behavioral health needs common in primary care, such as insomnia, anxiety, depression, and substance abuse. Social Workers provide short term solution focused counseling, quick interventions for anxiety, depression and stress management, consult with primary care providers for assistance with diagnosis and treatment of mental health conditions, direct patient therapy, and assistance with support and referrals to higher levels of service. The practitioners also perform depression screening and higher intensity follow up for newly diagnosed depressed patients. Boulder Community Health is an active participant in a "Community Mental Health Initiative" and has added additional safe areas within its emergency room and a behavioral health nurse and therapist who facilitate mental health care prior to admission or transfer. BCH is the only comprehensive health system provider of both inpatient and outpatient mental health services within Boulder County. The new 70,000 square foot building includes an 18 bed inpatient behavioral health unit and outpatient behavioral therapy clinic. Inpatient behavioral health patients will benefit from earlier access and referral to outpatient therapy in the building, increasing continuity of care from the inpatient to outpatient setting. BCH Primary Care Clinics have identified dementia patients and their caregivers as an important focus population for complex care management. Twice yearly a registry of those patients is run through the EMR for RN Care Managers to reach out, assess for needed medical interventions and resources to support the patient and family. Linkages are provided to the Alzheimer's Association, The Area Agency on Aging and other community agencies that can provide in home services, respite, help with Advanced Care planning, transportation and other issues. The RN Care Managers and Behavioral Health Specialists help provide emotional support and resources to deal with diagnosis acceptance, grief and anger, and at transitions to higher levels of care. 3. Chronic Pain Management and Substance Abuse. BCH has trained practitioners in medication assisted treatment (MAT) techniques that reduce the use of opioids and embedded them within its primary care clinics. In 2019 BCH began initiating MAT for opioid dependence in the ED, one of the early adopters of this approach in Colorado that has been demonstrated to greatly reduce opioid related morbidity and mortality through eliminating barriers to treatment and capturing patients when they are most motivated and vulnerable. In 2019 BCH received a Health Equity Grant from the City of Boulder that allowed us to launch a Chronic Pain and Opioid Response Program (CPORP). Staffed by a Program Coordinator and a Patient Navigator, the program is available to all community members who need assistance linking to services to address chronic pain or substance use treatment. BCH has made scholarship dollars available for Medication Assisted Treatment and Alternatives to Opioid Therapy. 4. Wellness and Preventative Health (including aging of the population and access to care). Boulder Community Health began screening all primary care patients over the age of 60 for social determinants of health needs including: housing, transportation, food insecurity, financial need, literacy, child care, and safety in the home. Since piloting the screening, we have expanded to an annual social needs assessment for all primary care patients age 18 years and older. The care coordination team facilitates referrals to community support. BCH has specific programs in place to improve Influenza Vaccination rates, HPV vaccination rates using data transparency, retina screening to assist in detecting diabetes, and process improvement to increase rates of screening examinations with the goal of beating national benchmarks. BCH is partnering and leading various programs such as the Walk with a Doc, which couples a healthy walk around various locations in the community with current health topics, blood pressure screenings, and healthy food. Programs particular to child and teen safety include education partnering with Lake Eldora Ski Race team, Emergency Family Assistance Association (Boulder), Community Cycles Kids and Adult Cycling Programs through RETAC (Regional Trauma Medical Advisory Council), and Boulder Valley School District. New programs include ThinkFirst (concussion awareness and injury prevention), distracted driving awareness and training, Brain Injury Resource Team (BIRT), STOP the Bleed, and hands only CPR programs have been held at many community events where BCH personnel volunteer. BCH assists adults and seniors through partnership with the City of Boulder Senior Services (Area Agency on Aging), Boulder Fire, and others in fall prevention day, a car fit program, and other programs. Regular outreach to patients who have identified gaps in their care are performed electronically via a website portal, by phone call, or mail. BCH opened a 40,000 s.f. medical center in Erie which includes urgent care, primary care, cardiology, obstetrics and gynecology, diagnostic imaging laboratory services in Erie, allowing greater access to its services. The hospital partnered with community not for profits including other hospitals, Clinica, Salud, Mental Health Partners, and Boulder County Health to improve access to specialists for patients with Medicaid under the Boulder County Health Improvement Collaborative (BCHIC). In addition to providing significant sponsorship to the initiative, BCH spearheaded a specialty referral project for the Medicaid population which added 100 specialist appointments per month. BCH added Nurse Care Managers who identify high-risk patients in need of additional support. They provide telephonic and episodic outreach for patients with complex healthcare needs and work with patients to manage chronic conditions and encourage patient participation in self-management of chronic conditions. BCH also added Care Coordinator(s) who call patients after ER visits and schedule primary care follow-up appointments, review positive social determinants screenings, and connect patients with community resources for support with transportation, finances, housing, childcare, literacy, etc. The Coordinators also forward complex patients to a RN Care Manager or Behavioral Health Specialist, connect population health outreach for patients with chronic conditions, and facilitate Boulder County Medicaid specialist referrals through the Boulder County Health Improvement Collaborative. Foothills Hospital continues to participate in the Colorado Household Medication Take-Back Program. In our first 10 months participating in the program, we have collected over 1,000 pounds of medications. Boulder Community Health organized multiple flu vaccine clinics during the 2018/2019 flu season. BCH teamed up with the community organization, Bridge House to provide free flu vaccines to members of the community that may not have otherwise sought out an immunization and/or did not have the means to pay for a vaccination. In total, we vaccinated 150 community members and hope to expand the program for the 2019/2020 flu season. 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 37 BCH Behavioral Health DPU 1100 Balsam Avenue Boulder CO 80304 Psych DPU BCH Rehabilitation DPU 1100 Balsam Avenue Boulder CO 80304 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 1136 Alpine Avenue Boulder CO 80304 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 Medicine Associates 1155 Alpine Unite 360 Boulder CO 80304 Physician clinic Internal Medical Associates Foothills 4820 Riverbend Rd Boulder CO 80301 Physician clinic Boulder Valley Surgical Associates 4743 Arapahoe Avenue Boulder CO 80303 Surgical services Boulder Valley Pulmonology 1155 Alpine Unit 150 Boulder CO 80304 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 Clinic 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 Buffalo Ridge Medical Center 16677 Lowell Blvd Broomfield CO 80023 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 Holistic Family Practice 1155 Alpine Avenue Suite 360 Boulder CO 80304 Physician clinic Northwest Family Medicine 500 Discovery Parkway Suite 150 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 1155 Alpine Suite 180 Boulder CO 80304 Physician clinic Boulder Community Hospital Occupational Medicine 4745 Arapahoe Ave Suite G40 Boulder CO 80303 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 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 $21,162,349 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. 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 Page 14 of the audited financial statements contains an explanation of how 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. 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, 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 $35.527.708. 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 in the midst of 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 7 through 10 of the 2017-2019 CHNA. 1 Boulder County Fire Fighters Association Sunshine Fire Protection District PO Box 7461 Golden CO 80403 846000600 501(c)3 12000 0 FMV Support for local fire association Boulder Valley School District 6500 E Arapahoe Ave Boulder CO 80303 846014683 501(c)3 75113 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 18000 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 11 11701 0 Cost Healthcare education scholarships 17 36500 0 Cost Assistance with housing post-discharge for indigent patients 58 32375 0 Cost Assistance with food and transportation post-discharge for indigent patients 43 61183 0 Cost Assistance with RX post-discharge for indigent patients 31 36515 Cost Take home medications donated to indigent patients post-discharge 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 the money should be returned to the hospital if the student does not register. X X X X X 0 1 0 0 0 1 0 1 0 Robert J Vissers Exec Director/CEO 605272 0 20000 0 37000 0 152882 0 28847 0 844001 0 20000 0 Benjamin J Keidan VP & Chief Medical Officer 389207 0 18654 0 20534 0 92806 0 16458 0 537659 0 0 0 William A Munson Jr VP & CFO 260874 0 30561 0 42513 0 58792 0 31497 0 424237 0 0 0 Jacqueline M Attlesey-Pries VP , Chief Nursing Officer & Chief Operating Officer 275939 0 30002 0 24492 0 57959 0 25500 0 413892 0 0 0 Paul R Hinchey VP Business Development 247587 0 10000 0 42996 0 76293 0 22153 0 399029 0 0 0 Michael J Jefferies VP & Chief Information Officer 246243 0 34033 0 16309 0 64817 0 1337 0 362739 0 0 0 Sarah E Meshak VP & General Counsel 239849 0 26000 0 24373 0 64664 0 10689 0 365575 0 0 0 Jamie D Jensen VP & Chief Population Health Officer 232971 0 25002 0 18500 0 44120 0 20766 0 341359 0 0 0 Grant Besser Foundation President & VP Public Affairs 188191 0 18892 0 12266 0 26847 0 29350 0 275546 0 0 0 Charles Jones Physician 785585 0 334396 0 18500 0 219786 0 10723 0 1368990 0 245708 0 Bryan Mahan Physician 832437 0 142073 0 43000 0 5590 0 22525 0 1045625 0 0 0 Srinivas Iyengar Physician 599939 0 134432 0 37000 0 9600 0 28847 0 809818 0 0 0 Jamie Doucet Physician 508466 0 208159 0 42231 0 10275 0 30837 0 799968 0 0 0 Sameer A Oza Physician 510961 0 194256 0 36986 0 10275 0 29832 0 782310 0 0 0 Linda S Minghella VP & Chief Information Officer (former) 0 0 0 0 137732 0 0 0 0 0 137732 0 137732 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 4b--The hospital contributes to a nonqualified 457(f) plan for the benefit of its executive leadership. Participants include: Robert Vissers, Pres & CEO ($144,297 contributed), Benjamin Keidan, VP & Chief Medical Officer ($82,531 contributed), William Munson Jr, VP & CFO ($48,517 contributed), Jacqueline Attlesey-Pries, VP ,COO & CNO ($47,684 contributed), Paul Hinchey, VP Business Development ($68,043 contributed), Michael Jefferies, VP & CIO ($55,762 contributed), Sarah Meshak, VP & General Counsel ($54,899 contributed), Jamie Jensen, VP & Chief Population Officer ($26,682 contributed), and Grant Besser, Foundation President & VP Public Affairs ($19,837 contributed). Schedule J, Part I, Line 6 J, Ln 6 See response to Line 7. Board approval required for any payment Schedule J, Part I, Line 7 For 2017, the hospital has an Incentive Compensation Plan for Vice Presidents and Directors whereby a percentage of base salary is paid out if goals are met and if authorized by the Board of Directors. For Vice-Presidents, one-third of their incentive is based upon the Hospital meeting at least 85% of its budgeted net operating income before interest expense. One-third VP incentive is based on Safety goals and one-third is based on Performance Goals. The one-third financial goal for Directors is based on meeting their departmental financial targets, as well as a one-third safety goal and a one-third performance goal. Incentive Compensation payouts were made in February, 2018 for the 2017 plan year. For 2018, the Incentive Compensation Plan was modified to include meeting a net operating income before interest expense gate. This 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. 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 35800000 270000 93716361 0 0 0 1080618 0 0 25180923 67458941 0 2014 1 0 1 1 B 3460000 0 31815214 0 0 0 452449 0 0 31362765 0 0 2014 0 0 1 1 C 0 0 30041484 0 0 0 153502 0 0 29887982 0 0 2019 0 0 0 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 1 0 0 0 0 0 0 1 A 1 B 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. Interface Communications Co Jeff Morgan, Boardmember, is a 75% owner of Interface Communications 261717 BCH pays Interface Communications for communications services 0 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 changes in Net Assets of -$5,302,967 = Change in Foundation Assets of -$2,187,431 + Change in minimum pension liability of -$2,875,899 + Charge for amortization ineffective loss on swaps -$239,635 Boulder Community Health Sports Medicine Imaging LLC 2150 Stadium Drive 2nd Floor Boulder CO 80309 474243430 imaging services CO 1199603 1731932 Boulder Communty Health Boulder Valley Care Network LLC 4141 Arapahoe Avenue Suite 200 Boulder CO 80303 821488664 Clincally Integrated Provider Network CO 211120 0 Boulder Community Health Boulder Community Hospital Foundation 4860 Riverbend Boulder CO 80301 840772664 Fundraising for Boulder Community Health CO 501(c)3 509(a)3 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 2261693 4120540 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 49060200 1207266 0 0 0 0.5 Boulder MRI LLC 1000 W South Boulder Road Suite 105 Lafayette CO 80026 452676500 outpaient MRI center CO Boulder Community Health Related 348752 100469 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 1945205 2264136 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 57686 1052569 0 44090 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 -25050 24950 0 0 0 0.501 0 1 1 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 Boulder Community Musculoskeletal Surgery Center LLC c 2025000 K-1 capital distribution Boulder Community Musculoskeletal Surgery Center LLC d 1808294 Loan guarantee document (not > ownership %) Endoscopy Center of the Rockies LLC c 5050000 K-1 capital distribution Boulder MRI LLC c 395250 K-1 capital distribution Boulder MRI LLC j 59160 Property Manager Recap of Income Boulder MRI LLC q 216610 59,160 for PACS agreement, 12,500 for managed care contracting, 144,950 for pass-thru of MRI service contract. Riverbend Sleep LLC c 55000 K-1 capital distribution Riverbend Sleep LLC k 179848 Vendor history recap Foothills Surgery Center LLC c 1759500 K-1 capital distribution Foothills Surgery Center LLC d 469033 Loan document guarantees 35% of Loan outstanding at YE Foothills Surgery Center LLC j 369950 Lease payments received Premier Eye Surgery Center of Colorado b 50000 K-1 capital contribution to Premier Eye Surgery Center of Colorado. CP211A dated May 20, 2019 approved Form 8868, Application for Extension of Time to File an Exempt Organization Return to November 15, 2019.