2017-11-15T11:52:10-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2016-01-01 043634356 BOUNDARY REGIONAL HEALTH CENTER INC BOUN 2082678422 301 CEDAR STREET NO 206 SANDPOINT ID 83864 VICTORIA MCCLELLAN KING CEO 2082678422 2017-11-14 1 KURT BENNION CPA P01469618 4252506100 67.137.57.251 2017-11-14 16:30:46 PS P FA31AA04F1E9B994011BE7FD015D0A50D50384CF 5C00B405BF4A66E7F27E07300AA9AC0D580A9EB8 2016 2021-01-29 14:40:06Z KANIKSU HEALTH SERVICE VICTORIA MCCLELLAN KING 301 CEDAR STREET NO 206 SANDPOINT ID 83864 11769741 0 X WWW.KANIKSUHEALTHSERVICES.ORG X 2002 ID TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. 10 10 162 11 0 0 2698187 3103320 7571141 8465328 0 0 100524 201093 10369852 11769741 0 0 0 0 6970521 8854542 0 0 0 2851306 3431002 9821827 12285544 548025 -515803 3273869 2712611 2632951 2587496 640918 125115 X THE MISSION OF KANIKSU HEALTH SERVICES IS TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. 0 0 5426730 0 4588208 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. 2002483 0 1693066 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. 1742161 0 1472967 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. 841042 0 711087 KANIKSU HEALTH SERVICES (CENTER) PROVIDED BEHAVIORAL HEALTH SERVICES TOTHE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WEREPROVIDED TO ALL WHO NEEDED BEHAVIORAL HEALTH ATTENTION REGARDLESS OF APERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UPTO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFYBASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAYBE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. 841042 0 711087 10012416 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7 0 162 1 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 RAY MILLER CHAIR (THROUGH JUNE 2016) 2.00 X X 0 0 0 SHEILA FARMIN-AUMICK VICE CHAIR & CHAIR 2.00 X X 0 0 0 JOY JANSEN PHD DIRECTOR & VICE CHAIR 2.00 X X 0 0 0 SUSAN EDWARDS SECRETARY & DIRECTOR 2.00 X X 0 0 0 MARY READER DIRECTOR & SECRETARY 2.00 X X 0 0 0 JANET SHELBY TREASURER 2.00 X X 0 0 0 AMY BISTLINE 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 ELIZABETH MORRIS DIRECTOR 2.00 X 0 0 0 MATTHEW WILLIAMS DIRECTOR 2.00 X 0 0 0 VICTORIA MCCLELLAN KING CHIEF EXECUTIVE OFFICER 40.00 X 156004 0 6240 KEVIN KNEPPER CHIEF FINANCIAL OFFICER 40.00 X 124911 0 4996 KRIS KUPER CHIEF MEDICAL OFFICER 40.00 X 102774 0 4111 THOMAS LAWRENCE MD CMO (THROUGH AUG 2016) 40.00 X 230812 0 9232 GEORGE DELAND PEDIATRICS CHIEF OF STAFF 40.00 X 228599 0 9144 STEPHEN CHRISTENSEN FAMILY PRACTICE PHYSICIAN 40.00 X 211418 0 8457 NICHOLAS MILLER DENTIST 40.00 X 187909 0 7516 JENNIFER HUDSON FAMILY PRACTICE PHYSICIAN 40.00 X 179424 0 7177 1421851 0 56873 8 0 1 0 N IDAHO FAMILY PHYSICIANS 700 IRONWOOD DR 220E COEUR DALENE ID 83814 PHYSICIAN SERVICES 433614 COMP HEALTH PO BOX 972670 DALLAS TX 75397 LOCUM SERVICES 342201 KOOTENAI HEALTH 2003 KOOTENAI HEALTH WAY COEUR DALENE ID 83814 SOFTWARE SUPPORT 232857 3 3103320 3103320 PATIENT REVENUE, NET 621110 7855587 7855587 340B PHARMACY REVENUE 621110 609741 609741 8465328 MISCELLANEOUS REVENUE 561499 201093 201093 201093 11769741 8465328 0 201093 639080 546530 92550 6640730 5684925 955805 201933 168210 33723 785435 654267 131168 587364 489274 98090 119239 53201 66038 37847 37847 1065850 484477 581373 75430 29062 46368 29711 11289 18422 499950 431900 68050 41275 15903 25372 60785 54707 6078 125764 114445 11319 34015 28879 5136 MEDICAL SUPPLIES 670381 670381 BAD DEBT 422037 422037 EQUIP. MAINT. & REPAIRS 92544 78282 14262 MISCELLANEOUS EXPENSES 64950 31825 33125 91224 42822 48402 12285544 10012416 2273128 0 437087 0 854636 814305 63785 31274 2808485 941453 1918361 1867032 3273869 2712611 888503 1200585 233972 0 1510476 1386911 2632951 2587496 X 640918 125115 640918 125115 3273869 2712611 -515803 0 X 0 1 X 1 1 1 X 1718254 1955792 1700131 2698187 3103320 11175684 1718254 1955792 1700131 2698187 3103320 11175684 11175684 2 2 130149 199017 185825 100524 201093 816608 11992294 29698185 0.93190 0.94320 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 266881 266881 1783232 457051 1326181 95063 16218 78845 629809 468184 161625 33500 33500 1867032 X 11769741 0 11769741 0 11769741 12285544 0 12285544 0 12285544 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. X X 0 0 X X X X 0 0 0 0 0 0 0 0 0 VICTORIA MCCLELLAN KING CHIEF EXECUTIVE OFFICER 156004 0 0 0 0 0 6240 0 0 0 162244 0 0 0 THOMAS LAWRENCE MD CMO (THROUGH AUG 2016) 230812 0 0 0 0 0 9232 0 0 0 240044 0 0 0 GEORGE DELAND PEDIATRICS CHIEF OF STAFF 228599 0 0 0 0 0 9144 0 0 0 237743 0 0 0 STEPHEN CHRISTENSEN FAMILY PRACTICE PHYSICIAN 211418 0 0 0 0 0 8457 0 0 0 219875 0 0 0 NICHOLAS MILLER DENTIST 187909 0 0 0 0 0 7516 0 0 0 195425 0 0 0 JENNIFER HUDSON FAMILY PRACTICE PHYSICIAN 179424 0 0 0 0 0 7177 0 0 0 186601 0 0 0 PART I, LINE 1A A PEDIATRIC RESIDENT STAYED AT DR. TOM LAWRENCE'S CABIN. THE AMOUNT PAID TO DR. LAWRENCE FOR THE USE OF THE WATER-FRONT CABIN WAS $1,000 PER MONTH, MUCH LESS THAN FAIR MARKET VALUE. THE ORGANIZATION PAYS $10 PER MONTH FOR ALL EMPLOYEES FOR GYM MEMBERSHIPS. 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 2016. 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.