2017-11-15T11:34:41-06:00 2016-12-31 910189318 Moss Adams LLP 2707 Colby Avenue Suite 801 Everett WA 98201 990 2016-01-01 205126945 BMH Inc BMHI 2087854100 98 Poplar Street Blackfoot ID 832211799 John Fullmer CFO 2087853803 2017-11-11 1 Robert Grannum P00355876 4252597227 2017-11-11 50.35.121.79 2017-11-11 16:52:18 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 866574987CA565ABE6CC9265146BBE3F5B9624AD 2016 2017-02-10 21:41:12Z John Fullmer 98 Poplar Street Blackfoot ID 832211799 128464542 0 X WWW.BINGHAMMEMORIAL.ORG X 2006 ID ENDEAVORING TO PROVIDE QUALITY HEALTHCARE SERVICES FOR RESIDENTS AND VISITORS TO BINGHAM COUNTY. 7 6 853 81 1385457 0 464812 979112 94909042 107285653 1031970 990910 5236653 3948737 101642477 113204412 190635 171363 0 0 48270996 56158890 0 0 0 50157432 56058762 98619063 112389015 3023414 815397 65751604 71470583 25000784 29865064 40750820 41605519 BINGHAM MEMORIAL HOSPITAL IS COMMITTED TO THE PURSUIT OF EXCELLENCE IN ITS ENDEAVOR TO PROVIDE A CONTINUUM OF QUALITY, COMPASSIONATE HEALTHCARE SERVICES FOR OUR RESIDENTS AND FOR VISITORS TO BINGHAM COUNTY, IN THE MOST EFFECTIVE AND COST EFFECTIVE MANNER POSSIBLE. 0 0 59551332 171363 53099162 ACUTE CARE HOSPITAL - THE HOSPITAL PROVIDED SERVICE TO 1,821 INPATIENTS, including 7,237 TOTAL SURGERIES (INPATIENT AND OUTPATIENT), 322 NEWBORN INFANTS, AND 9,638 EMERGENCY ROOM PATIENTS. THE HOSPITAL HAS FULL SERVICE RADIOLOGY, PHYSICAL THERAPY, RESPIRATORY THERAPY, PHARMACY AND LABORATORY TO SUPPORT THE NEEDS OF THE HOSPITAL'S INPATIENTS AND OUTPATIENTS. 26649103 49269008 CLINIC SERVICES - THE HOSPITAL EMPLOYS AND CONTRACTS WITH PHYSICIANS TO PROVIDE MEDICAL CARE TO INDIVIDUALS IN THE COMMUNITY AND SERVICE AREA. DURING THE YEAR, THESE PHYSICIANS PROVIDED 106,554 SEPARATE SERVICE ENCOUNTERS FOR INDIVIDUAL PATIENTS. 3240484 4917483 NURSING HOME - THE NURSING HOME AVERAGED 43.5 RESIDENTS PER DAY RECEIVING INPATIENT SERVICES (EITHER short-term OR LONG-TERM skilled CARE) DURING THE YEAR. 89440919 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 135 0 1 853 1 1 1 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X John Fullmer 2087853803 98 POPLAR STREET BLACKFOOT ID 83221 ALICE CANNON CHAIRMAN 10.00 X X 0 0 155 Joe Cannon Vice Chair through 2/2016, Director 10.00 X X 0 0 158 T Layne VanOrden Treasurer 10.00 X X 0 0 178 Dean Jones DIRECTOR 6.00 X 0 0 185 Gary Baumgartner Director 6.00 X 0 0 137 Wayne Brower Director 6.00 X 0 0 174 LEE KNIFFIN Director Through 1/2016 6.00 X 0 0 0 Dr Adam Wray Chief of Medical Staff 70.00 X 1289790 0 20344 LOUIS KRAML CEO Through 01/2016 70.00 X 3122486 0 35290 Jeffery Daniels CEO 70.00 X 417927 0 22785 John Fullmer CFO 70.00 X 196537 0 19553 Dan Cochran COO Through 2/2016 70.00 X 524977 0 7743 Jacob Erickson COO 70.00 X 267486 0 19540 Carolyn Hansen CNO 70.00 X 212737 0 438 Dr Baldwin Stutts Physician 40.00 X 997299 0 19574 Dr Nathan Richardson Physician 40.00 X 732368 0 19574 Dr David Shelley Physician 40.00 X 684236 0 20603 Dr Hugh Selznick Physician 40.00 X 551550 0 0 Dr J Sule Physician 40.00 X 536564 0 19574 9533957 0 206005 88 0 1 0 IDAHO PATHOLOGY LABORATORY LLC 98 POPLAR STREET BLACKFOOT ID 83221 Pathology Laboratory Services 2466731 TD THERAPY LLC 1757 LANCE DR POCATELLO ID 83204 THERAPY SERVICES 2272323 MSVM GROUP LLC PO BOX 4864 POCATELLO ID 83204 ADVERTISING 237731 Speedy CPS LLC 1680 Bentley Way Idaho Falls ID 83401 ADVERTISING 219790 Moss Adams LLP PO Box 101822 Pasadena CA 91189 Auditing/Consulting Services 197716 12 929014 50098 979112 PATIENT REVENUE 621110 194613947 194613947 professional fees revenue 621110 30036269 30036269 facility fees revenue 621110 2357611 2357611 Program Related Investments 621110 1403571 1403571 Ancillary Care Services 621500 303869 303869 -121429614 -121429614 107285653 343469 343469 527224 179239 277681 6519 249543 172720 422263 172720 249543 15199470 5000 14557029 0 642441 5000 647441 647441 1801170 418901 1382269 1382269 MANAGEMENT SERVICE CONTRACT 561000 953285 953285 k-1 activity 900099 514041 259452 254589 CAFETERIA 722210 432449 432449 244430 244430 2144205 113204412 107285653 1385457 3554190 164913 164913 6450 6450 6157634 270790 5886844 40369716 36260205 4109511 284629 284629 6729894 5454144 1275750 2617017 2095472 521545 12860430 9802604 3057826 247010 247010 311205 311205 52419 52419 1421395 1414367 7028 1820222 1820222 1008609 1008609 828491 828491 3611899 2201017 1410882 479259 201916 277343 583047 505021 78026 512493 512493 3607956 3607956 594299 594299 MEDICAL EXPENSES 17229108 17227202 1906 bad debt expense 6961105 6961105 other supplies 2118129 1947982 170147 State Assessment 418131 418131 1393555 440847 952708 112389015 89440919 22948096 0 225274 975945 410318 1064604 14543742 13980321 430000 586027 1439582 3718773 4144518 831077 1051163 68281690 44560825 20365006 23720865 18515355 16727336 4199686 3871602 135000 131000 1791346 4363647 65751604 71470583 11962937 14893551 4050000 3855000 6025201 7970441 2962646 3146072 25000784 29865064 X 40750820 41605519 40750820 41605519 65751604 71470583 815397 39302 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3759 3759 0 Part II-B, Line 1: A small portion of the organization's American Hospital Association, Idaho Hospital Association and National Rural Health Association dues are allocated to lobbying activities based on studies conducted by the respective Association. 2508790 2508790 27626130 19547860 8078270 1921832 1274008 647824 33637250 23738957 9898293 2587688 2587688 23720865 3871602 C 3871602 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 4081647 Insurance Recoveries 282000 4363647 OBLIGATION UNDER CAPITAL LEASE 1564053 OBLIGATION UNDER PENSION PLAN 1300019 MALPRACTICE INSURANCE Liability 282000 3146072 X Part X, Line 2: The Organization is a not-for-profit corporation and has been recognized as tax exempt pursuant to Section 501(c)(3) of the Internal Revenue Code (IRC). The Organization is exempt from federal income tax under Section 501(c)(3) of the IRC except to the extent of unrelated business taxable income as defined under IRC Sections 511 through 515. The Organization has adopted accounting for uncertain tax positions. The accounting standard prescribes a recognition threshold and measurement process for uncertain tax positions. The Organization had no uncertain tax positions as of December 31, 2016 or 2015. 1 1 X 1 X 1 X 1 1 0 0 257030 0 257030 0.00240 13424075 12398035 1026040 0.00970 631557 0 631557 0.00600 14312662 12398035 1914627 0.01810 860849 24390 836459 0.00790 2113963 0 2113963 0.02010 0 0 113490 36565 76925 0.00070 159181 0 159181 0.00150 3247483 60955 3186528 0.03020 17560145 12458990 5101155 0.04830 1 7030068 1757517 24130461 26054222 -1923761 X 1 1 1 PIETRA LLC endoscopy services 0.60000 0.40000 2 BMH PHYSICIANS CLINIC LLC rental real estate 0.58720 0.41280 3 IDAHO PATHOLOGY LAB llc pathology services 0.55000 0.45000 4 Doctors & Hospital Health System of Idaho LLC Surgical services 0.60000 0.40000 7 Skyline Surgery Center LLC Surgical services 0.25200 0.45800 8 Crestwood Enterprises LLC RENTAL REAL ESTATE 0.21420 0.25000 2 1 BINGHAM MEMORIAL HOSPITAL 98 POPLAR STREET BLACKFOOT ID 832211799 X X X X X X 2 IDAHO DOCTORS HOSPITAL 98 POPLAR STREET BlacKFOOT ID 832211799 X X BINGHAM MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X www.binghammemorial.org/about-bmh/community-health-needs-assessment X 1 16 1 www.binghammemorial.org/about-bmh/community-health-needs-assessment 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X binghammemorial.org/uploads/Financial%20Statement%20Application%20Form.pdf X 1 X 0 X X X 1 X 0 0 IDAHO DOCTORS HOSPITAL 2 0 1 0 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X binghammemorial.org/uploads/Financial%20Statement%20Application%20Form.pdf X 1 X 0 X X X 0 X 0 0 BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 5: Bingham Memorial Hospital (Bingham), located in Blackfoot ID, conducted a Community Health Needs Assessment (CHNA) between May 2016 and October 2016.Bingham contracted with Lamprophony Enterprises, LLC (LE) to facilitate and conduct this CHNA. LE provides support to non-profit hospitals and other community groups to conduct needs assessments and planning activities to improve health and increase health equity. The CHNA included compilation and analysis of existing secondary data from a variety of sources including state and federal agencies, such as the public health department, as well as national foundations in order to create a community health profile for Bingham's service area. The process also included community input via key stakeholder interviews, an online survey, and regional community health needs assessments. Priority health issues were identified by Bingham staff in partnership with LE by looking at findings from across all data and perspectives. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 6b: The hospital facility's CHNA was conducted with Lamprophony Enterprises. LLC. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 11: Analysis and comparisons of the primary (interviews and surveys) and secondary (public databases) sources of data facilitated the identification of health needs in Bingham's service area. The top eight causes of death, which are the same in both Bingham and Bannock Counties, were included as identified needs. Health risk factors with higher rates and clinical care factors that lead to worse health outcomes in Bingham County when compared with the state of Idaho were also included as identified needs. The following were identified as the 10 most highly prioritized health needs, and addressed in the following manner:1. High Cost of Care: BMH offers health fairs, reduced cost flu shots, access to emergency care, and charity care. For BMH rural clinics, a low income sliding fee schedule is also offered.2. Uninsured/Underinsured: An insurance benefits community class has been proposed for uninsured or underinsured patients.3. Diabetes: BMH operates a diabetes and osteoporosis center in Pocatello that offers hyperbaric, and wound ostomy treatment. A certified diabetes education program is in development over the next three years which will result in a diabetes self-management program. The current diabetes prevention program is transitioning to a patient.4. Healthy Lifestyle Choices: A tobacco cessation class is offered to help individuals stop smoking.5. Obesity: A diabetes prevention program is offered as well as weight loss seminars to prevent obesity. A cooking matters class is proposed to be offered as a way to teach individuals to eat healthier diets.6. Mental Health Services: Anger management, love and logic classes, and counseling services are currently offered. Local mental health specialists are proposed to be provided to address mental health issues.7. Heart Disease: Cardiology services are offered to help prevent heart disease.8. Limited Health Knowledge: Heart health screenings and a diabetes prevention program are offered to increase health knowledge. A diabetes self-management program is proposed to be offered. Spanish interpreters, health fairs, and weight loss seminars are also provided and designed to help educate patients.9. Drug/Alcohol Abuse: A patient centered medical home model is proposed to be offered to work with patients' primary physicians to ensure that they receive proper care.10. Health Screenings: Free wellness screenings, bumps and bruises clinics, health fairs, and weight loss seminars are all offered as a way to help patients monitor their health.BMH'S DESIRE TO EXCEED EXPECTATIONS MEANS THAT IT IS CONTINUALLY IMPROVING ON THESE AREAS OF NEEDS THROUGH NEW PROGRAMS AND AFFILIATIONS. WHILE ALL SIGNIFICANT NEEDS OF THE COMMUNITY ARE BEING MET SOME OF THE INITIAL PLANS TO MEET THOSE NEEDS HAVE CHANGED DUE TO NEW HEALTHCARE PROVIDERS, GRANTS, AND PROGRAMS. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 13b: CONSIDERATIONS ARE GIVEN TO INCOME LEVEL IN COMBINATION WITH OTHER LISTED FACTORS. IDAHO DOCTORS HOSPITAL Part V, Section B, Line 13b: CONSIDERATIONS ARE GIVEN TO INCOME LEVEL IN COMBINATION WITH OTHER LISTED FACTORS. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 13h: CONSIDERATIONS ARE GIVEN TO MEDICAID/MEDICARE AND HOMELESS. IDAHO DOCTORS HOSPITAL Part V, Section B, Line 13h: CONSIDERATIONS ARE GIVEN TO MEDICAID/MEDICARE AND HOMELESS. IDAHO DOCTORS HOSPITAL Part V, Section B, Line 15e: CONSIDERATIONS ARE GIVEN TO INCOME LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNINSURED DISCOUNT, MEDICAID/ MEDICARE, ASSET LEVEL, AND HOMELESSNESS. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 16j: ABRIDGED BROCHURE WITH POLICY HIGHLIGHTS WAS MADE AVAILABLE IN THE ER, ADMISSIONS, AND PATIENT FINANCIAL SERVICES. IDAHO DOCTORS HOSPITAL Part V, Section B, Line 16j: ABRIDGED BROCHURE WITH POLICY HIGHLIGHTS WAS MADE AVAILABLE IN THE ER, ADMISSIONS, AND PATIENT FINANCIAL SERVICES. 14 1 - BINGHAM MEMORIAL SKILLED NURSING & REHAB 98 POPLAR STREET BLACKFOOT ID 83221 SKILLED NURSING FACILITY 2 - BMH PHYSICIANS 98 POPLAR STREET BLACKFOOT ID 83221 PHYSICIAN OFFICES 3 - PHYSICIANS & SURGEONS CLINIC OF POCATELL 1151 HOSPITAL WAY POCATELLO ID 83201 PHYSICIAN OFFICES 4 - FIRST CHOICE URGENT CARE 1350 PARKWAY DR BLACKFOOT ID 83221 PHYSICIAN OFFICES 5 - PHYSICIANS & SURGEONS CLINIC OF SHELLEY 275 W LOCUST SHELLEY ID 83274 PHYSICIAN OFFICES 6 - BINGHAM MEMORIAL HOSPITAL SLEEP LAB 53 Poplar Street BLACKFOOT ID 83274 HOSPITAL OFFICES 7 - Bingham Memorial Family Medicine (1) 353 N 4th Ave Ste 102 Pocatello ID 83201 Physician Offices 8 - Bingham Memorial Family Medicine (2) 1595 Bannock Hwy Pocatello ID 83204 Physician Offices 9 - Bingham Memorial Family Medicine (3) 315 W Idaho St Blackfoot ID 83221 PHYSICIAN OFFICES 10 - Bingham Memorial Family Medicine (4) 1740 E 17th Street Idaho FALLS ID 83404 PHYSICIAN OFFICES 11 - pHYSICIANS & SURGEONS CLINIC OF IDAHO FA 2375 SUNNYSIDE IDAHO FALLS ID 83404 PHYSICIAN OFFICES 12 - BINGHAM MEMORIAL SPECIALTY PLAZA 326 POPLAR STREET Blackfoot ID 83221 PHYSICIAN OFFICES 13 - GRADUATE MEDICAL STUDENTS 310 W IDAHO STREET Blackfoot ID 83221 HOSPITAL OFFICES 14 - DIABETES INTERNAL MEDICINE ARTHRITIS C 2302 E TERRY STREET POCATELLO ID 83201 PHYSICIAN OFFICES Part I, Line 7: THE COSTING METHODOLOGY USED TO DETERMINE THE FINANCIAL ASSISTANCE IS THE COST TO CHARGE RATIO. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 6,961,105. Part III, Line 2: The costing methodology used to determine bad debt expense is the cost to charge ratio. Part III, Line 3: PATIENTS ARE NOTIFIED OF THE FINANCIAL ASSISTANCE PROGRAM VIA APPOINTMENTS WITH PATIENT FINANCIAL COUNSELORS, CALLS WITH PATIENT FINANCIAL ADVOCATES AND BROCHURES AVAILABLE IN THE ADMISSION AND BUSINESS OFFICE AREAS OF THE HOSPITAL. EVEN THOUGH THERE ARE MULTIPLE AVENUES USED TO EDUCATE AND ASSIST PATIENTS IN APPLYING FOR THE FINANCIAL ASSISTANCE PROGRAM, SOME PATIENTS ARE RELUCTANT TO SPEND THE TIME GOING THROUGH THE QUALIFICATION PROCESS. THERE ARE ALSO THOSE PATIENTS THAT APPLY FOR THE PROGRAM BUT FAIL TO PROVIDE THE NECESSARY PAPERWORK TO SUPPORT THE APPLICATION. THIS PREVENTS ACCURATELY IDENTIFYING THEIR FINANCIAL NEEDS. MANY PATIENTS IN THE AREA HAVE A STEADY INCOME PROVIDED TO THEM BY THE GOVERNMENT AND HAVE NO NEED FOR A HEALTHY CREDIT SCORE. THERE ARE ALSO PATIENTS THAT ARE WELL ABOVE THE FINANCIAL GUIDELINES FOR FINANCIAL ASSISTANCE THAT ALLOW THEIR ACCOUNTS TO GO TO A BAD DEBT AGENCY. IN ADDITION, THERE ARE THOSE PATIENTS THAT DO NOT PLACE A HIGH IMPORTANCE ON PAYING MEDICAL BILLS AND BELIEVE THAT CREDITORS DO NOT FAULT THEM FOR HAVING MEDICAL BAD DEBT. FOR THE ABOVE REASONS, IT IS ESTIMATED THAT THE PERCENTAGE OF THE BAD DEBT EXPENSE THAT WOULD QUALIFY AS CHARITY UNDER OUR FINANCIAL ASSISTANCE PROGRAM IS 25%. Part III, Line 4: SEE PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE ORGANIZATION'S BAD DEBT EXPENSE DESCRIPTION. Part III, Line 8: THE SHORTFALL IN MEDICARE UNREIMBURSED COST SHOULD BE INCLUDED AS COMMUNITY BENEFIT AS SERVICES ARE RENDERED TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY AND/OR THE REIMBURSEMENT EXPECTED TO BE RECEIVED FROM MEDICARE, MEDICAID OR OTHER PAYERS. THE COSTING METHODOLOGY USED TO DETERMINE MEDICARE COSTS IS THE COST TO CHARGE RATIO. BINGHAM MEMORIAL IS DESIGNATED A CRITICAL ACCESS HOSPITAL. AS SUCH, A PORTION OF ITS MEDICARE CHARGES IS PAID UNDER A COST BASED REIMBURSEMENT SYSTEM. ONLY THAT PORTION OF THE TOTAL MEDICARE REVENUE EARNED AND THE ASSOCIATED ALLOWABLE COSTS INCURRED BY THE ORGANIZATION IS REPORTED ON ITS MEDICARE COST REPORT. PER THE SCHEDULE H INSTRUCTIONS THE AMOUNTS REPORTED IN PART III LINES 5-7 ARE FROM OUR MEDICARE COST REPORT. THE RESULTANT SHORTFALL ON LINE 7 IS $1,923,761. THERE IS SIGNIFICANT DIFFERENCE, HOWEVER, BETWEEN OUR TOTAL MEDICARE PROGRAM SERVICES AND THE SUBSET OF THE TOTAL WHICH IS ACCOUNTED FOR ON THE COST REPORT. IN ORDER TO CLEARLY AND FULLY DESCRIBE THESE SERVICES, MANAGEMENT HAS MADE INTERNAL CALCULATIONS WHICH TAKE INTO CONSIDERATION OUR MEDICARE SERVICES IN ITS ENTIRETY. BINGHAM MEMORIAL OPERATES 14 CLINICS (BOTH PRIMARY CARE AND SPECIALTY). BINGHAM HAS RECRUITED AND EMPLOYS 43 PHYSICIANS AND 13 MID LEVEL PROFESSIONALS PROVIDING VITAL CARE FOR OUR COMMUNITY'S CITIZENS. MUCH OF THESE SERVICES ARE REIMBURSED USING FEE SCHEDULE RATES THAT ARE (IN THE AGGREGATE) BELOW THE COST OF PROVIDING THAT CARE. IN ORDER TO SUPPORT THE DELIVERY OF THESE HEALTH SERVICES, THE HOSPITAL INCURS OTHER ASSOCIATED COSTS, LIKE: DIRECT SUPPORT STAFF, INFRASTRUCTURE, SUPPORTING DEPARTMENTS (ACCOUNTING, PATIENT FINANCIAL SERVICES, INFORMATION TECHNOLOGY, HUMAN RESOURCES, ETC.) AND EXECUTIVE LEADERSHIP. IF NOT FOR TAX EXEMPT AND CRITICAL ACCESS HOSPITALS SUCH AS BINGHAM MEMORIAL ABSORBING THE DEFICIT ATTACHED TO PROVIDING THESE VITAL SERVICES TO MEDICARE RECIPIENTS, THE CENTERS FOR MEDICARE AND MEDICAID SERVICES WOULD BEAR THE FINANCIAL BURDEN OF THESE CITIZENS' CARE. Part III, Line 9b: Once a patient applies for financial assistance, we hold all collections efforts until a determination is made. We send the patient a letter notifying them of approval or denial of financial assistance. Approved financial assistance is good for 3 months unless financial situation has changed, and then a patient must reapply for assistance. Any non-emergency services require a new application. Part VI, Line 2: BINGHAM MEMORIAL HOSPITAL'S DEPARTMENT OF PUBLIC RELATIONS UTILIZES A COMMUNITY SURVEY TO IDENTIFY THE HEALTHCARE NEEDS OF OUR COMMUNITY. SURVEYS ARE MAILED TO APPROXIMATELY 25% OF OUR COUNTY POPULATION. ON-SITE SURVEYS ARE ALSO DISTRIBUTED AT HOSPITAL EVENTS. SURVEYS ASK WHICH SERVICES AND EDUCATION PROGRAMS COMMUNITY MEMBERS ARE INTERESTED IN. THE RESULTS ARE SHARED WITH ADMINISTRATION, AFTER WHICH, COMMUNITY EVENTS AND OUTREACH EFFORTS ARE PLANNED ACCORDINGLY.THE HOSPITAL ALSO RECEIVES A VARIETY OF DIRECT REQUESTS FROM COMMUNITY ORGANIZATIONS AND MEMBERS TO PROVIDE SERVICES AND EDUCATION. EXAMPLES INCLUDE DISCOUNTED FLU CLINICS, DISCOUNTED LAB TESTING, FREE HEALTH EDUCATION CLASSES AND SEMINARS RELATED TO JOINT PAIN, ARTHRITIS PAIN, WEIGHT LOSS, AND BACK PAIN. WE PERFORM FREE PHYSICAL EXAMS FOR STUDENT ATHLETES, PLACE AN ATHLETIC TRAINER FREE OF CHARGE AT HIGH SCHOOL SPORTING EVENTS, AND PROVIDE FREE EXAMS FOR STUDENT ATHLETES INJURED AT A SPORTING EVENT. Part VI, Line 3: WE NOTIFY PATIENTS VERBALLY PRIOR TO ADMISSIONS VIA THE FRONT OFFICE, PATIENT FINANCIAL COUNSELOR OR ADMISSION CLERK. WHEN THEY PRESENT FOR SERVICES, WE SCREEN FOR INSURANCE COVERAGE AND, IF APPROPRIATE, WE GET THEM AN APPOINTMENT WITH A FINANCIAL COUNSELOR. AFTER THE SERVICES, WHEN WE CALL THEM FOR PAYMENTS, WE EXPLAIN THE PROCESS AGAIN TO ANY APPLICABLE PATIENTS. IF THEY ARE HAVING TROUBLE MEETING THEIR OBLIGATIONS, OR IF THEY EXPRESS NEED, WE SEND THEM OUT A LETTER EXPLAINING THE PROCESS AGAIN AND PROVIDE AN APPLICATION FOR THEIR COMPLETION. Part VI, Line 4: BMH, Inc. serves the 45,000 residents of Bingham County with medical services. Located between the fourth and fifth largest cities in Idaho, Bingham County incorporates just over 2,000 square miles. The county population consists mostly of younger families with children with a median age of 30. The county's population age breakdown is as follows: 32% age 0-18, 10% age 18-25, 12% age 25-35, 12% age 35-45, 11% age 45-55, 8% age 55-65, and 15% over age 65. Bingham County's rural communities have over 1,300 uninsured individuals (2.9% of population) and it is estimated to have an even greater percentage of underinsured individuals. In Bingham County's agricultural based economy, the median household income, $50,155 (US Census Bureau 2015), is 12% lower than the national average of $57,230 (US Census Bureau 2015).Additionally, BMH serves the Fort Hall Indian Reservation and its 3,000 inhabitants, as well as a number of bannock and bonneville residents. Part VI, Line 5: The community board steers the organizational goals and mission towards providing the best healthcare for the community. BMH supports a multitude of physician specialists in their efforts to provide care to the community on a regular schedule. With this assistance, and an open medical staff, numerous physicians are able to provide our community with specialized medical care, from neurology to podiatry. Our financial assistance policies and protocols allow those community members who may have less ability to pay receive the medical attention they need to live a healthy life. The various seminars, classes and events we provide to the community free of charge gives the community opportunities to educate themselves about some of the major health concerns people have. Part VI, Line 6: N/A 1 ISU FOUNDATION 921 S 8TH AVE STOP 8050 POCATELLO ID 83209 826013543 501(c)(3) 24000 INFORMATICS TECHNOLOGY PROGRAM BINGHAM ECONOMIC DEVELOPMENT CORPORATION PO BOX 1435 BLACKFOOT ID 83221 820525983 501(c)(3) 20000 STATUE SPONSOR KIND COMMUNITY 315 W CENTER SUITE 103 POCATELLO ID 83204 475336005 501(c)(3) 10000 General Support BLACKFOOT CHAMBER OF COMMERCE 70 W JUDICIAL ST BLACKFOOT ID 83221 820099637 501(c)(6) 8000 GOLF TOURNAMENT IDAHO COMMUNITY FOUNDATION INC DBA IDAHO HOMETOWN HEROES 444 HOSPITAL WAY SUITE 607 POCATELLO ID 83201 820425063 501(c)(3) 7500 HOMETOWN HERO MEDAL SPONSOR BLACKFOOT HIGH SCHOOL 870 S FISHER BLACKFOOT ID 83221 BLACKFOOT SCHOOL DI 6160 FOOTBALL SCOREBOARD CITY OF BLACKFOOT 157 N BROADWAY BLACKFOOT ID 83221 City of Blackfoot 5600 MUSIC IN THE PARK 5 1 Scholarships 13 6450 Part I, Line 2: THE RECIPIENTS OF GRANTS ARE REQUIRED TO MAKE SOME KIND OF PUBLIC RECOGNITION OF THE FUNDS GIVEN. X 1 1 X X X X 1 1 0 0 0 0 0 1 0 Dr Adam Wray Chief of Medical Staff 321176 0 949439 0 19175 0 0 0 20344 0 1310134 0 0 0 LOUIS KRAML CEO Through 01/2016 43695 0 0 0 3078791 0 0 0 35290 0 3157776 0 0 0 Jeffery Daniels CEO 372925 0 17102 0 27900 0 0 0 22785 0 440712 0 0 0 John Fullmer CFO 177567 0 0 0 18970 0 0 0 19553 0 216090 0 0 0 Dan Cochran COO Through 2/2016 506871 0 0 0 18106 0 0 0 7743 0 532720 0 0 0 Jacob Erickson COO 194875 0 66352 0 6259 0 0 0 19540 0 287026 0 0 0 Carolyn Hansen CNO 195598 0 8300 0 8839 0 0 0 438 0 213175 0 0 0 Dr Baldwin Stutts Physician 996318 0 576 0 405 0 0 0 19574 0 1016873 0 0 0 Dr Nathan Richardson Physician 596318 0 135645 0 405 0 0 0 19574 0 751942 0 0 0 Dr David Shelley Physician 397025 0 267777 0 19434 0 0 0 20603 0 704839 0 0 0 Dr Hugh Selznick Physician 551250 0 300 0 0 0 0 0 0 0 551550 0 0 0 Dr J Sule Physician 535884 0 275 0 405 0 0 0 19574 0 556138 0 0 0 Part I, Line 1a It is estimated that 4 executives are accompanied by spouses on approximately 3-4 business trips per year for a total of approximately 10 companion-trips per year. costs include economy-class airfare, meals, and shared lodging. Such costs are included in executive compensation as applicable. Part I, Lines 4a-b Louis Kraml received severance compensation in the amount of $3,060,346 during 2016. THE BMH, INC. SUPPLEMENTAL RETIREMENT PLAN IS A PLAN MAINTAINED BY BMH PRIMARILY FOR THE PURPOSE OF PROVIDING DEFERRED COMPENSATION PURSUANT TO A PLAN DESCRIBED IN SECTION 457(F) OF THE INTERNAL REVENUE CODE. THE PLAN IS ADMINISTERED AND CONSTRUED IN A MANNER CONSISTENT WITH SAID INTENT AND ACCORDING TO THE LAWS OF THE STATE OF IDAHO TO THE EXTENT THAT SUCH LAWS ARE NOT PREEMPTED BY FEDERAL LAWS. THE PLAN IS A NON-ELECTIVE ACCOUNT BALANCE NONQUALIFIED DEFERRED COMPENSATION PLAN SUBJECT TO CLIFF VESTING. THE PLAN IS INTENDED TO QUALIFY FOR THE "SHORT-TERM DEFERRAL" EXEMPTION FROM SECTION 409A OF THE CODE. LOUIS KRAML waS THE SOLE PARTICIPANT OF THE PLAN FOR WHOM BMH, INC. CONTRIBUTEd. THE plan's final year IS 2016 due to Mr. Kraml's departure before the vesting date of plan. As such, there were no accruals or distributions in the plan. BMH PROVIDED THE NONQUALIFIED DEFERRED COMPENSATION PACKAGE TO THE CEO AS A RESULT OF A COMPENSATION SURVEY PERFORMED BY AN INDEPENDENT CONSULTING FIRM. THE BOARD APPROVED THE PACKAGE DURING 2014. AN ADDITIONAL 457(F) PLAN IS AVAILABLE TO HIGHLY COMPENSATED AND CERTAIN MANAGEMENT EMPLOYEES IN WHICH THEY ARE ALLOWED TO DEFER COMPENSATION. THIS PLAN IS FUNDED BUT THE ASSETS REMAIN PART OF BMH, INC. UNTIL SUCH TIME AS AN APPROPRIATE ELECTION IS MADE BY THE PARTICIPANT TO HAVE THE FUNDS PAID TO THE PARTICIPANT. Part I, Line 7 Some performance-based bonuses are paid to executives. Those bonuses are tied to performed work duties and are determined on an ad-hoc basis by the CEO AND THE BOARD OF DIRECTORS. Form 990, Part VI, Section A, line 6 THE MEMBERS OF THE Hospital CONSIST OF A BROAD REPRESENTATION OF THE CITIZENS OF BINGHAM COUNTY, IDAHO, INCLUDING AT LEAST ONE RESIDENT OF EACH INCORPORATED CITY IN BINGHAM COUNTY, IDAHO AND OF THE UNINCORPORATED AREA OF BINGHAM COUNTY. Form 990, Part VI, Section A, line 7a directors are elected by a majority of the votes cast by the members entitled to vote in the election at the meeting at which a quorum of members is present. Form 990, Part VI, Section A, line 7b Each member of record of the hospital is entitled to vote at the meetings. an affirmative vote of a majority of the members at a meeting in which a quorum was present is an act of the members. Form 990, Part VI, Section B, line 11b AFTER PREPARATION OF FORM 990 IT IS REVIEWED BY THE CFO, CEO, AND BOARD PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. Form 990, Part VI, Section B, line 12c HOSPITAL BOARD MEMBERS ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, READ AND UNDERSTANDS THE POLICY, AND AGREES TO COMPLY. PER THE CONFLICT OF INTEREST POLICY, A BOARD MEMBER MUST DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT. AFTER DISCLOSURE, THE INTERESTED PERSON SHALL LEAVE THE MEETING WHILE THE DETERMINATION OF A CONFLICT ON INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF ONE EXISTS, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OR COMMITTEE BUT MUST LEAVE THE MEETING DURING THE DISCUSSION OF AND VOTE ON THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. Form 990, Part VI, Section B, line 15 INTEGRATED HEALTHCARE STRATEGIES, A NATIONALLY RECOGNIZED EXECUTIVE COMPENSATION FIRM EVALUATES ALL EXECUTIVE POSITIONS FOR COMPENSATION. IN ADDITION AN EXECUTIVE COMPENSATION REVIEW COMMITTEE REVIEWS COMPENSATION. THE BOARD OF DIRECTORS ESTABLISHES THE CEO COMPENSATION AND THE CEO ESTABLISHES THE OTHER EXECUTIVES' COMPENSATION WITH THE APPROVAL OF THE BOARD OF DIRECTORS. THESE PROCEDURES ARE COMPLETED EVERY TWO TO THREE YEARS, and the procedures were completed in 2016. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY, FORM 990, FORM 1023, FINANCIAL STATEMENTS AND OTHER GOVERNANCE DOCUMENTS AVAILABLE UPON REQUEST BY CONTACTING John Fullmer, CFO AT 98 POPLAR ST, BLACKFOOT, ID 83221. THE ORGANIZATIONS' AUDITED, CONSOLIDATED FINANCIAL STATEMENTS ARE PUBLICALLY AVAILABLE THROUGH THE MUNICIPAL SECURITIES RULEMAKING BOARD AT HTTP://EMMA.MSRB.ORG/DEFAULT.ASPX. 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