2019-10-31T08:57:23-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-01-01 043634356 BOUNDARY REGIONAL HEALTH CENTER INC BOUN 2082678422 301 CEDAR STREET NO 206 SANDPOINT ID 83864 KEVIN KNEPPER COO & CFO 2082678422 2019-10-30 1 KURT BENNION CPA P01469618 4252506100 2019-10-30 67.137.57.251 2019-10-30 13:37:43 PD P 4E1019BFE9B9EF55B23EDC930650553A5FF3285A 0A137849BC389FB7B51D6FC2D6742665ACC5CBED 2018 2019-02-21 02:37:17Z KANIKSU HEALTH SERVICE VICTORIA MCCLELLAN KING 301 CEDAR STREET NO 206 SANDPOINT ID 83864 13351727 0 X WWW.KANIKSUHEALTHSERVICES.ORG X 2002 ID TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. 10 10 173 13 0 0 3049220 3602844 9186263 9395117 1 0 392304 353766 12627788 13351727 4500 8692 0 0 9237729 9513440 0 0 0 3129103 3538348 12371332 13060480 256456 291247 2510907 2820749 2129336 2147931 381571 672818 X THE MISSION OF KANIKSU HEALTH SERVICES IS TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. 0 0 5819314 8692 5092153 KANIKSU HEALTH SERVICES (CENTER) PROVIDED MEDICAL VISITS TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED MEDICAL ATTENTION REGARDLESS OF A PERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. 2147348 0 1879023 KANIKSU HEALTH SERVICES (CENTER) PROVIDED PEDIATRIC MEDICAL VISITS TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED PEDIATRIC CARE REGARDLESS F A PERSON'S ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. 1868193 0 1634750 KANIKSU HEALTH SERVICES (CENTER) PROVIDED DENTAL VISITS TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED DENTAL ATTENTION REGARDLESS OF A PERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. 901887 0 789191 KANIKSU HEALTH SERVICES (CENTER) PROVIDED BEHAVIORAL HEALTH SERVICES TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED BEHAVIORAL HEALTH ATTENTION REGARDLESS OF A PERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. 901887 0 789191 10736742 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 12 0 173 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X KEVIN KNEPPER CFO 2082678422 301 CEDAR STREET NO 206 SANDPOINT ID 83864 SHEILA FARMIN-AUMICK CHAIR 2.00 X X 0 0 0 JOY JANSEN PHD VICE CHAIR 2.00 X X 0 0 0 MARY READER SECRETARY 2.00 X X 0 0 0 JANET SHELBY TREASURER (THROUGH APRIL 2019) 2.00 X X 0 0 0 MATTHEW WILLIAMS DIRECTOR & TREASURER 2.00 X X 0 0 0 DEBORAH KERR DIRECTOR 2.00 X 0 0 0 JOE ENGLISH DIRECTOR 2.00 X 0 0 0 PEGGY FRYE DIRECTOR 2.00 X 0 0 0 KATE MCALLISTER DIRECTOR 2.00 X 0 0 0 KARI SNYDER DIRECTOR 2.00 X 0 0 0 ASHLEY WENDLAND DIRECTOR 2.00 X 0 0 0 SUSAN EDWARDS DIRECTOR (THROUGH APRIL 2019) 2.00 X 0 0 0 ELIZABETH MORRIS DIRECTOR (THROUGH APRIL 2019) 2.00 X 0 0 0 VICTORIA MCCLELLAN KING CEO 40.00 X 180752 0 16268 KEVIN KNEPPER CFO 40.00 X 139194 0 24000 JADE JARDINE FAMILY PRACTICE CHIEF 30.00 X 214462 0 8607 HAILEY ROSE PEDIATRICS CHIEF 40.00 X 192894 0 14245 ADAM WEAVER DENTAL CHIEF 40.00 X 191557 0 18500 PETER KELTERBORN INTERNAL MEDICINE PHYSICIAN 40.00 X 208032 0 20749 STEPHEN CHRISTENSEN FAMILY PRACTICE PHYSICIAN 36.00 X 211988 0 26660 KRISTINE KUPER PEDIATRICIAN 40.00 X 241467 0 23859 NICK MILLER DENTIST 40.00 X 181967 0 7131 GEORGE DELAND PEDIATRICIAN 36.00 X 209190 0 13013 1971503 0 173032 19 0 1 0 N IDAHO FAMILY PHYSICIANS 700 IRONWOOD DR 220E COEUR DALENE ID 83814 BILLING SERVICES 547518 BARTON ASSOCIATES PO BOX 417844 BOSTON MA 02241 LOCUMS PHYSICIANS 248588 KOOTENAI HEALTH 2003 KOOTENAI HEALTH WAY COEUR DALENE ID 83814 SOFTWARE SUPPORT 161391 3 3602844 87937 3602844 PATIENT REVENUE, NET 621110 8078675 8078675 340B PHARMACY REVENUE 621110 1316442 1316442 9395117 MISCELLANEOUS REVENUE 561499 353766 353766 353766 13351727 9395117 0 353766 8692 8692 1001778 577408 424370 6191373 5530453 660920 151784 151784 1588971 1347187 241784 579534 488547 90987 145626 54912 90714 1159310 619827 539483 10727 4831 5896 51920 51920 733640 664000 69640 41567 18721 22846 72715 62542 10173 104919 104919 19850 15853 3997 MEDICAL SUPPLIES 834059 834059 BAD DEBT 152176 152176 EQUIP. MAINT. & REPAIRS 98151 80529 17622 MISCELLANEOUS EXPENSES 45362 45362 68326 20302 48024 13060480 10736742 2323738 0 94339 408074 622580 717149 41186 48234 2824029 1176737 1752802 1647292 2510907 2820749 705739 861339 1423597 1286592 2129336 2147931 X 381571 672818 381571 672818 2510907 2820749 291247 0 X 0 1 X 1 1 1 X 1700131 2698187 3103320 3049220 3602844 14153702 1700131 2698187 3103320 3049220 3602844 14153702 14153702 18 1 19 185825 100524 201075 392304 353766 1233494 15387215 39670195 0.91980 0.92060 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 266881 266881 1783231 413347 1369884 95063 95063 678854 763390 -84536 1647292 X 13263790 0 13263790 87937 87937 13351727 12972543 0 12972543 87937 87937 13060480 PART X, LINE 2: THE CENTER HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE CENTER'S TAX POSITIONS AND CONCLUDED THAT THE CENTER HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. PART XI, LINE 4B - OTHER ADJUSTMENTS: DONATED VACCINES 87,937. PART XII, LINE 4B - OTHER ADJUSTMENTS: DONATED VACCINES 87,937. 1 PART I, LINE 2: CONTRIBUTIONS ARE MADE TO LOCAL CHARITIES AND GOVERNMENT AGENCIES. CONTRIBUTIONS ARE MADE TO OTHER ORGANIZATIONS WHOSE MISSION AND ACTIVITIES ARE CONSISTENT WITH OUR MISSION. ASIDE FROM CONFIRMING CHARITABLE OR GOVERNMENTAL STATUS OF THE RECIPIENT, WE DO NOT MONITOR HOW THE FUNDS ARE USED. PART II: NO RECIPIENT ORGANIZATION RECEIVED MORE THAN $5,000 DURING 2018. X X 0 0 X X X X 0 0 0 0 0 0 0 0 0 VICTORIA MCCLELLAN KING CEO 180752 0 0 0 0 0 16268 0 0 0 197020 0 0 0 KEVIN KNEPPER CFO 139194 0 0 0 0 0 24000 0 0 0 163194 0 0 0 JADE JARDINE FAMILY PRACTICE CHIEF 214462 0 0 0 0 0 8607 0 0 0 223069 0 0 0 HAILEY ROSE PEDIATRICS CHIEF 192894 0 0 0 0 0 12945 0 1300 0 207139 0 0 0 ADAM WEAVER DENTAL CHIEF 191557 0 0 0 0 0 18500 0 0 0 210057 0 0 0 PETER KELTERBORN INTERNAL MEDICINE PHYSICIAN 208032 0 0 0 0 0 18500 0 2249 0 228781 0 0 0 STEPHEN CHRISTENSEN FAMILY PRACTICE PHYSICIAN 211988 0 0 0 0 0 24500 0 2160 0 238648 0 0 0 KRISTINE KUPER PEDIATRICIAN 241467 0 0 0 0 0 23859 0 0 0 265326 0 0 0 NICK MILLER DENTIST 181967 0 0 0 0 0 7131 0 0 0 189098 0 0 0 GEORGE DELAND PEDIATRICIAN 209190 0 0 0 0 0 13013 0 0 0 222203 0 0 0 PART I, LINE 1A THE ORGANIZATION RENTS A CONDOMINIUM FROM GEORGE DELAND FOR A PEDIATRIC RESIDENT TO STAY AT. THE MONTHLY RENT PAYMENTS OF $1,000 ARE BELOW FAIR MARKET VALUE. THE ORGANIZATION OFFERS TO PAY $10 PER MONTH FOR ANY EMPLOYEE WITH A GYM MEMBERSHIP. JORDAN MCCLELLAN DAUGHTER OF CEO 28634 EMPLOYEE COMPENSATION 0 X 12 87937 INVOICE PRICE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS CHAIRED BY THE BOARD CHAIR AND IS RESPONSIBLE FOR MAKING RECOMMENDATIONS ON PROGRAMMATIC AND POLICY ISSUES AT TIMES WHEN THE BOARD IS UNABLE TO MEET. ALL SUCH DECISIONS MUST BE RATIFIED BY THE FULL BOARD AT ITS NEXT MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO AND CEO, THEN PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED AND REVIEWED ANNUALLY FOR THE BOARD OF DIRECTORS AND KEY EMPLOYEEES. EACH INDIVIDUAL IS REQUIRED TO DISCLOSE ANY PERSONAL INTEREST WHICH THEY MAY HAVE IN ANY MATTER PENDING BEFORE THE ORGANIZATION AND REFRAINS FROM PARTICIPATION IN ANY DECISION ON SUCH MATTER. SUCH REFRAINING MAY TAKE THE FORM OF SIMPLE DISCLOSURE, LEAVING THE ROOM DURING DISCUSSION, NOT PARTICIPATING IN THE DISCUSSION, OR RECUSING ONESELF FROM THE ISSUE ALTOGETHER. FORM 990, PART VI, SECTION B, LINE 15 THE KANIKSU HEALTH SERVICES COMPENSATION MODEL - AS APPROVED BY THE BOARD OF DIRECTORS (BOD) - IS A COMPENSATION SCHEDULE BASED ON THE MOST RECENT NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) REGION 10 (WASHINGTON, OREGON, IDAHO) COMPENSATION SURVEY BASED ON SIZE OF THE ORGANIZATION - ANNUAL REVENUES, SCOPE OF RESPONSIBILITY, YEARS OF EXPERIENCE AND EDUCATIONAL DEGREES, CERTIFICATIONS, ETC. ALL JOB CATEGORIES (INCLUDING CEO, OTHER OFFICERS AND KEY EMPLOYEES, ALL CLINICAL PROVIDERS AND ALL STAFF) HAVE AN ASSOCIATED COMPENSATION MODEL - THIS APPROACH HAS BEEN APPROVED BY THE BOD. THIS IS USED FOR ALL NEW HIRES AND IS EVALUATED ANNUALLY TO BE SURE THAT THERE IS INTERNAL EQUITY AMONG EMPLOYEES, ETC. THIS COMPENSATION MODEL IS ADJUSTED ANNUALLY BASED ON THE MOST RECENT NACHC DATA - RANGES OF SALARY ARE REVIEWED. IT IS THE GOAL OF KHS TO BE IN THE MEDIAN RANGE OF THE COMPENSATION MODEL - THIS APPROACH HAS BEEN APPROVED BY THE BOD. ANY ADJUSTMENTS MADE TO CURRENT EMPLOYEES ARE BASED ON AVAILABILITY OF BUDGET AS APPROVED BY THE BOD AND ARE DETERMINED BY "RANGE MOVEMENT" FOR STAFF POSITIONS AND FOR MAINTAINING COMPETITIVE RECRUITMENT AND RETENTION FOR PROVIDERS AS COMPARED TO THE OTHER COMMUNITY HEALTH CENTERS IN IDAHO AND IN REGION 10. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. THIS PROCESS WAS LAST COMPLETED IN 2018 FOR THE CEO AND 2016 FOR THE REST OF THE OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THE CONFLICT OF INTEREST POLICY OR GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE FEDERAL AUDIT CLEARINGHOUSE WEBSITE.