2017-11-14T13:22:46-07:00 2016-12-31 990 2016-01-01 840175870 Boulder Community Health BOUL 3034155220 PO Box 9019 Boulder CO 803019019 William A Munson Jr CFO & Vice President 3034157433 2017-11-14 69.161.206.5 2016 2021-01-29 14:40:06Z Boulder Community Hospital Robert J Vissers MD PO Box 9019 Boulder CO 803019019 495456800 0 X www.bch.org X 1922 CO Partnering to create and care for the healthiest community in the nation. 14 11 2750 504 1462840 0 3068851 2939283 317641624 335907255 25456494 5777488 18294183 16642920 364461152 361266946 325749 237942 0 0 167129963 174150321 0 0 664754 180901161 161625680 348356873 336013943 16104279 25253003 655698658 689859299 267078954 267329257 388619704 422530042 To provide our community with the safest and highest quality healthcare in an innovative, patient-centered environment. 0 0 249532139 237942 349900366 Health Care Delivery of IP and OP medical care. In 2016, the hospital discharged 8,436 adult & pediatric patients with an average length of stay of 4.3 days. 54,540 patients were seen in our ER/Urgent Care facilities. 5,561 surgeries were performed. The hospital had adjusted patient days of 87,780. 0 0 0 249532139 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 1 1 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 1 218 0 1 2750 1 1 1 0 0 0 0 0 0 0 0 0 X 14 11 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 Janet Martin Chairman 4 0 X X 0 0 0 Dee Perry Vice Chairman 4 35 X X 91304 0 0 Jean Dubofsky Secretary 4 0 X X 0 0 0 Jeff Morgan Treasurer 4 0 X X 0 0 0 Randy Bjerke MD Board Member/Employed Intensivist 40 X 374096 0 23516 Susan Graf Board Member 2 0 X 0 0 0 Mako Shimoda MD Board Member 2 0 X 0 0 0 Steve Fries MD Board Member 2 0 X 0 0 0 Harold Flowers Board Member 2 0 X 0 0 0 Benita Duran Board Member 2 0 X 0 0 0 Suzy Ageton Board Member 2 0 X 0 0 0 Robert J Vissers Exec Director/CEO 38 2 X X 649384 0 244042 Rhonda Wallen Board Member 2 0 X 0 0 0 Bryan Pieper Board Member 2 0 X 0 0 0 Paul Kenneth Lewis Jr VP & Chief Medical Officer 40 0 X 422180 0 110233 William A Munson Jr VP & CFO 40 0 X 347881 0 97088 Jacqueline M Attlesey-Pries VP , Chief Nursing Officer & Chief Operating Officer 40 0 X 329306 0 81504 Sarah E Meshak VP & General Counsel 40 0 X 254119 0 58944 Jamie D Jensen VP & Chief Population Health Officer 40 0 X 280374 0 70515 Michael J Jefferies VP & Chief Information Officer 40 0 X 142407 0 28190 Grant Besser Foundation President 0 40 X 33937 0 4688 Bryan Mahan Physician 40 0 X 836718 0 25699 Sameer A Oza Physician 40 0 X 693581 0 27814 Nelson P Trujillo Jr Physician 40 0 X 679604 0 29815 John A Schutz Physician 40 0 X 655717 0 30137 Jamie J Doucet Physician 40 0 X 652012 0 27786 David Gehant Exec Director/CEO 0 0 X 287555 0 16115 Linda S Minghella VP & Chief Information Officer 0 0 X 238448 0 0 Frank Bruno BCH Foundation President 0 0 X 198919 0 26014 7167542 0 902100 204 1 1 0 Favorite Healthcare Staffing Inc PO Box 803356 Kansas City MO 641803356 agency nursing services 1770969 Boulder Neurosurgical Assoc PLLC 4743 Arapahoe Ave Suite 202 Boulder CO 80303 trauma call 1398488 Boulder Valley Anesthesiology LLC c/o Wendll Walker & Assoc 1420 28th St Ste 100 Boulder CO 80303 Anesthesiology coverage 1003510 Boulder Emergency Physicians CarePoint PC 5600 S Quebec St Suite 312 A Greenwood Village CO 80111 CMC Emergency Room Coverage 890000 Colorado Cardiovascular Surgical Associates PC 950 E Harvard Ave Suite 550 Suite 203 Denver CO 80210 Cardiovascular surgery coverage and employee lease 760648 33 0 3722 0 2533322 395540 6699 0 2939283 Acute Care Hospital 622000 335907255 334797945 1007480 101830 0 0 0 0 335907255 6145905 0 0 6145905 38 0 0 38 0 0 0 0 0 0 0 0 0 0 0 0 0 0 133599769 149940 133087285 1030879 512484 -880939 -368455 -880939 0 512484 0 0 0 0 0 0 14597 407 14190 0 0 14190 121731 71283 50448 0 0 50448 Health Care Joint Ventures 621400 6703371 6703371 0 0 Misc Hospital Revenue 622000 9874911 9279989 455360 139562 0 0 0 0 16578282 361266946 349900366 1462840 6964457 137598 137598 92622 92622 7722 7722 0 0 3676620 398592 3142060 135968 0 0 0 0 139255461 105687237 33150106 418118 6450968 4902301 1543168 5499 15475906 11703954 3705091 66861 9291366 6827829 2437567 25970 2328329 83904 2244425 0 273810 0 273810 0 102664 6120 95701 843 14254 14254 0 0 0 0 536124 0 536124 0 20173367 15803319 4370048 0 724954 0 724954 0 5519068 2571949 2938533 8586 8577358 594439 7982919 0 0 0 0 0 7595569 4476009 3119132 428 428028 202070 225958 0 0 0 0 0 301276 114020 187256 0 4298799 1882874 2415925 0 0 0 0 0 17950820 6684556 11266264 0 771422 771422 0 0 Medical Supplies 51300214 51059846 240368 0 Repairs and Maintenance 9056528 4290057 4764360 2111 Medicaid Provider Fee 17007134 17007134 0 0 Provision for Bad Debts 13048545 13048545 0 0 1617417 1163766 453281 370 336013943 249532139 85817050 664754 317773 17878 4191316 14383673 0 0 47486674 47613011 0 0 0 0 1354278 0 2851629 3073782 7588269 6250212 371248282 146453567 228232940 224794715 209922879 240781362 104986183 101843185 4938704 4541047 385893 209746 43442120 46350688 655698658 689859299 46487623 42227215 0 0 0 0 170815013 173971658 0 0 0 0 0 0 72066 72066 49704252 51058318 267078954 267329257 X 354798055 387235977 27376397 28738751 6445252 6555314 388619704 422530042 655698658 689859299 X 25253003 10971077 0 0 0 -2313742 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14254 14254 0 Schedule C, Part II-B, Line 1 6.56% of dues paid to the Colorado Hospital Association are spent on lobbying activities, amounting to $8,218.47. 21.78% of dues paid to the American Hospital Association are spent on lobbying activities, amounting to $6,035.52. 33808649 4348700 1349134 0 4212417 0 35294066 35750843 2706467 -402645 0 4119616 0 33935049 34604553 4337617 1664839 0 4856166 0 35750843 31318621 3221343 4678434 0 4613845 0 34604553 23522148 7987150 2442969 0 2633646 0 31318621 0 0.19 0.81 0 1 1 0 16446336 16446336 0 205292539 65724234 139568305 0 3058060 729670 2328390 0 140275578 79999663 60275915 0 6175769 0 6175769 224794715 -9092391 F 17995341 F Municipal Bonds, infrequently traded 1679776 F Coporate bonds and notes, infrequently traded 20741857 F Asset backed securities, infrequently traded 3981529 F Long/Short Equity Funds 23039378 F Long/Short Fixed Income Funds 36405392 F Real Assets, Infrequently traded 7092303 F 101843185 Interest in Net Assets Held by Foundation 35012999 Unamortized Swap Fees 98479 Unamortized Bond Issue Costs 1184778 Deferred Comp Investments 6783722 Misc Other AR 3270710 46350688 0 Accrued Pension Liability 43996208 Deferred Compensation Liability 7062110 51058318 361678985 10971077 0 0 -9861242 1109835 360569150 536124 161672 697796 361266946 322265938 0 0 0 0 0 322265938 536124 13211881 13748005 336013943 Schedule D, Part V, Line 4 Boulder Community Health 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 new 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 $9,861,242 included in tax return but not in audited revenue includes Bad Debt Provision of -$13,048,545 + Change in Foundation Net Assets of $1,550,915 + Change in minimum pension liability of $1,877,685 + Amortization of effective loss on Swap of -$239,635 + Other Expenses shown net in FS revenue and Gross in Tax return of -$73,402 + Ambassador component of temp rest assets of $71,740. Schedule D, Part XI, Line 4b Other of $161,672 =76,419 of Ambassador expenses reflected as Restricted Contributions in Audit + Foundation In Kind Contribution expenditure of 85,253. Schedule D, Part XII, Line 4b Other expenses of $13,511,881 included on TR but not on Audit = Bad Debt provision of $13,048,5445 + Non-op expenses shown in net revenue on audit of $73,402 + Ambassador expenses reflected as Restricted Contribution in Audit of $4,682 + Foundation In-Kind Expenditure of 85,253. 1 Central America and the Caribbean 0 0 Program Services The hospital participated in a medical mission to Haiti. 7722 Central America and the Caribbean 0 0 Investments Passive investments in Cayman Islands have a YE market value of $54,342,599 and incurred management fees of $1,002,080. 55344679 Europe (including Iceland and Greenland) 0 0 Investments Passive investments in Ireland have a YE market value of $7,224,453 and incurred management fees of $69,208. 7293661 0 0 62646062 Central America and the Caribbean Medical mission to Haiti 0 7722 Airfare and medical supplies totaling $7,722 Cost 1 0 1 0 1 1 0 0 Schedule F, Part I, Line 2 The hospital participated in a medical mission to Haiti. The costs associated with this mission are stated by cost for various airfare and medical costs. 1 1 X 1 X 2.5 1 X 1 1 1 0 1 1 4522682 1875636 2647045 0.008 50896171 31456843 19439328 0.058 0 0 0 0 0 0 55418853 33332479 22086373 0.066 353302 56540 296762 0.001 309585 0 309585 0.001 544113 0 544113 0.002 0 0 1207000 56540 1150460 0.004 0 0 56625853 33389019 23236833 0.070 4395 0 4395 0 5131 5131 0 80555 0 80555 0 0 0 90081 0 90081 0 1 13096114 1 56608505 79969256 -23360751 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 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 16 1 0 0 1 X https://www.bch.org/documents/bch-community-health-needs-assessment-final-august-26-2016.pdf X 1 16 1 https://www.bch.org/documents/CHNA-Implementation-Strategy.pdf 0 0 1 X 250 400 X X X X X 1 1 X X X X 1 X https://www.bch.org/documents/Pay-My-Bill/fin-assist-patient-payment-resp-2015-2016.pdf X https://www.bch.org/documents/Pay-My-Bill/Fin-Assis-Appl-English-2015.pdf X https://www.bch.org/documents/Pay-My-Bill/BCH-Billing-Brochure-2017-v1.pdf X X X X X X 1 X 0 X X X X 1 X 1 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 7-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 and it's Board of Directors, is continually assessing the implementation of the CHNA through it's strategic planning process. 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 Chronic diseases and conditions (such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis) are among the most common, costly, and preventable of all health problems. The goal of the BCH chronic disease management program is to improve health and quality of life while increasing value and decreasing cost. 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. Additionally, All of BCH's primary care clinics have an RN Care Coordinator on site to educate and coach patients in better management of their chronic disease and to prevent complications. To avoid readmissions back into the Hospital, BCH has two teams of transitional care nurses that provide education and support to our highest risk patients after a hospitalization and there is continuous collaboration across BCH departments and providers, community medical partners and agencies, skilled nursing facilities and social support organizations to provide patients with coordinated care when and where they need it. 2. Mental Health (including chronic pain management and substance abuse) BCH has recently expanded our integrative behavioral health model in all of our primary care clinics. This model adds social workers into all of our primary care teams to address the behavioral health needs common in primary care, such as insomnia, anxiety, depression, and substance abuse. These licensed clinical social workers or masters of social work provide short term solution focused counseling, quick interventions for anxiety, depression and stress management, consults 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 with community partners. BCH has six primary care clinics that are part of the State Innovation Model that is supporting advanced primary care and BH integration across Colorado. BCH is partnering with the state to train providers for medical assisted treatment for narcotic addiction with the goal of increasing access to substance abuse treatment in our community. Depression screening and higher intensity follow up for newly diagnosed depressed patients has been a recent initiative that is improving the care of our patients with depression. Boulder Community Health is an active participant in a "Community Mental Health Initiative" to improve care with Mental Health Partners (MHP), the county's largest provider of mental health care. This effort includes the development of a care compact between MHP and BCH Primary Care to improve communication about shared patients for the purpose of diagnosis, treatment recommendations and care continuity. BCH is the only provider of both inpatient and outpatient mental health services within Boulder County and has begun construction on a new building that will house both inpatient and outpatient programs. 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. Chronic Pain Management and Substance Abuse - Opiate deaths (meaning deaths from prescription painkillers or illegal opiates like heroin) have been climbing year-over-year in Colorado since at least 2000. Our primary care clinics have been trained and are skilled at managing chronic pain, and have care coordination assistance for referral to higher levels of treatment when needed. Advanced Practice Clinicians with expertise in pain management are embedded in three primary care clinics accepting referrals from internal PCPs. In partnership with the Colorado Hospital Association (CHA), BCH Emergency departments at Foothills Hospital in Boulder and Community Medical Center in Lafayette have implemented new guidelines for prescribing potentially addictive painkillers, with an emphasis on using alternatives to opioids. 3. Wellness and Preventative Health (including aging of the population and access to care) The inspirational vision of BCH in partnering to create and care for the healthiest community in the nation is a call to action for BCH and our community. Our population health approach is focusing on our total panel of patients to address patients who have not been seen or have routine screening and preventive care services that need to be addressed. We have specific programs in place to improve Influenza Vaccination rates and HPV vaccination rates using data transparency and process improvement to increase rates of screening examinations with the goal of beating national benchmarks. The Hospital is 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. This partnership with the community serves to promote exercise and overall health to community members. Partners include City of Boulder Parks and Recreation, Area Agency on Aging, Boulder County Public Health, Boulder Valley School District and more. New wellness group sessions will be offered in late 2017 through our Family Medical Associates clinic. Free of charge, the wellness groups are going to be ongoing, rotating 1 hour, 4 week sessions addressing stress reduction, sleep, forming healthy habits, and mindfulness. Programs particular to child and teen safety include education partnering with Boulder Valley School District, Lake Eldora Ski Race team, Emergency Family Assistance Association (Boulder), and Community Cycles Kids and Adult Cycling Programs in RETAC (Regional Trauma Medical Advisory Council), ThinkFirst, and distracted driving. BCH assists adults and seniors through partnership with the City of Boulder Senior Services, Boulder Fire, and others in fall prevention day and other onsite programs at retirement communities. Additionally a Car Fit program has been designed to fit seniors in their cars as their bodies change. Recognizing the changing demographics within the service area is crucial in providing care to our community. The aging of the population detailed within the Community Health Needs Assessment necessitates evolution of our services. The following areas of care within the organization have received significant resources to provide necessary care for our aging population: Heart and Lung Disease, Surgical Services, Joint Replacement, Palliative Care, and Home Visits. BCH collaborates on an annual screening for fall risk which includes targeted support, referral to exercise, balance training and home safety evaluations. In addition we are continuing to partner with the Boulder County Area Agency on Aging to provide education and exercise classes that maintain mobility and help prevent falls. The Hospital has placed significant resources into making sure that it is meeting the needs of the community by providing greater access to Health Care by expanding Hours of Service in all primary clinics by the end of 2017. BCH has also expanded the number of same day/next day appointments in all of its clinics and an after-hours nurse triage line has been opened which allows 24x7 access to a nurse. Planning for additional locations in Superior, and Erie as well as converting an urgent care to a freestanding emergency room in Lafayette are included within the Hospital's strategy geographic strategy. The Hospital is partnering with the Community Foundation and other community partners including other hospitals, Clinica, Salud, housing, dental aid, mental health partners, Boulder County Health to improve access to specialists for patients with Medicaid under the Boulder County Health Improvement Collaborative (BCHIC). Finally, BCH provides support through sponsorships and in-kind donations for community organizations that provide or participate in first order provision of health care in our community. Schedule H, Part V, Section B, Line 23-Boulder Community Foothills Hospital The hospital identified 13 instances where FAP-eligible patients were billed more than the amounts generally billed (AGB) to individuals who had insurance covering such care. Refunds of any payment in excess of the AGB were made to these patients in 2017. A multi-disciplinary team is meeting periodically to ensure compliance with 501r requirements and BCH procedures. 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 Urgent-care center 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 Ratio of Patent Cost to Patient Charges Schedule H, Part I, Line 7, Column f 13,048,545 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 (BCHC), which are both electronic health exchanges aimed at promoting effective and efficient health care delivery as well as information for community health assessments. Workforce development includes physician recruitment for physicians not employed by the hospital. Boulder is a Medically Underserved Area for low income and Medicare. Schedule H, Part III, Section A, Line 3 The hospital does not have a mechanism to estimate the amount of bad debt cost that would reasonably relate to patients who would qualify for financial assistance under the hospital's financial assistance policy, but for whom sufficient information was not obtained to make a determination of their eligibility. However, surely there are significant bad debts that would qualify for charity if the patient had submitted FAP information. Schedule H, Part III, Section A, Line 4 Page 10 and 11 of the audited financial statements contain Note 2(f) which describes the significant accounting policies related to Patient Accounts Receivable. The amount reported on Line 2 as bad debt is the actual balance on account written off to bad debt. It is not reduced to cost, since our system does not track what is a gross charge write-off versus what is a patient responsibility write -off after insurance and insurance discounts have been recognized. 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 $30,122,575. 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 is constructing a new facility adjacent to the Foothills hospital to move Behavioral Health services, and is expected to complete this facility in early 2019. Also BCH is planning on building a Rehabilitation hospital in Lafayette, CO with a partner, and is expected to complete this facility in early 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 Assoc Sunshine Fire Protection District PO Box 7461 Golden CO 80403 846000600 501 (c)3 24000 0 FMV Support for local fire association Justin Parker Neurological Institute 4743 Arapahoe Avenue Boulder CO 80303 263588986 501(c)3 10000 0 FMV To support education related to brain and trauma disorders Women's Health 2855 Valmont Road Boulder CO 80301 840645786 501(c)3 12500 0 FMV To support local women's health care organizations Boulder Valley School District 6500 E Arapahoe Ave Boulder CO 80303 846014683 501(c)3 0 71918 FMV Provide athletic trainer to school district Support high school athletics and help to reduce student athlete injuries 4 0 Assistance for IP rehab patients 10 8999 0 Cost Healthcare educational scholarships 22 44500 0 Cost Assistance with housing post-discharge for indigent patients 50 24893 0 Cost Assistance with food and transportation post-discharge for indigent patients 53 7387 0 Cost Assistance with RX post-discharge for indigent patients 50 0 3118 Cost Take home medications donated to indigent patients post-discharge Assistance with pro fee for reading for indigent mammography 6 3724 0 Cost Schedule I, Part I, Line 2 Grants are only made to non profit agencies 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 allocation for which he may approve disbursements 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 schools 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 1 1 0 0 0 0 0 1 0 Robert J Vissers Exec Director/CEO 542357 0 65500 0 41528 0 219621 0 25401 0 894407 0 0 0 Paul Kenneth Lewis Jr VP & Chief Medical Officer 311948 0 70732 0 39500 0 90112 0 21101 0 533393 0 0 0 William A Munson Jr VP & CFO 252527 0 59854 0 35500 0 70117 0 27951 0 445949 0 0 0 Jacqueline M Attlesey-Pries VP , Chief Nursing Officer & Chief Operating Officer 263989 0 48818 0 16500 0 63297 0 19187 0 411791 0 0 0 Sarah E Meshak VP & General Counsel 170189 0 41958 0 41972 0 58944 0 980 0 314043 0 0 0 Jamie D Jensen VP & Chief Population Health Officer 236288 0 26604 0 17482 0 53177 0 18319 0 351870 0 0 0 Bryan Mahan Physician 718158 0 76550 0 42000 0 0 0 26679 0 863387 0 0 0 Sameer A Oza Physician 501991 0 155589 0 36000 0 3975 0 24819 0 722374 0 28960 0 Nelson P Trujillo Jr Physician 519987 0 117617 0 42000 0 3975 0 26819 0 710398 0 28960 0 John A Schutz Physician 503628 0 116090 0 36000 0 3975 0 27142 0 686835 0 28960 0 Jamie J Doucet Physician 492500 0 118061 0 41451 0 3975 0 28691 0 684678 0 289660 0 David Gehant Exec Director/CEO 3000 0 0 0 0 0 284555 0 16115 0 303670 0 271468 0 Linda S Minghella VP & Chief Information Officer 30006 0 0 0 208442 0 0 0 490 0 238938 0 104639 0 Frank Bruno BCH Foundation President 20844 0 0 0 178076 0 0 0 26974 0 225894 0 0 0 Schedule J, Part I, Line 3 The hospital has a Compensation Committee as specified by the bylaws of the hospital (Article V, D). The Compensation Committee is comprised of the Chairman, Vice Chairman, Secretary and a member of the Finance Committee. The committee meets approximately three times per year to review the CEO compensation and approve annual contract changes. Compensation and contract changes are reported to the Board. The Committee engages a consulting firm to provide comparative compensation studies for similarly qualified persons in functionally comparable positions at similarly situated organizations. Compensation study and performance review are considered in developing the compensation decision. Compensation ranges and Benefit changes for Vice President level employees are reviewed and approved by the Compensation Committee if the are outside of hospital wide treatment. Compensation studies are also used for VP level assessment. All Compensation Committee meetings are formally documented through minutes. Schedule J, Part I, Line 4 Ln 4a Linda Minghella, former Chief Information Officer received $103,802 in severance; Frank Bruno, former Foundation President, received $177,171 in severance. Ln 4b The hospital contributes to a nonqualified 457(f) plan for the benefit of its executive leadership. Participants include: Robert Vissers, Pres & CEO ($150,146 contributed, Paul Lewis Jr, VP & Chief Medical Officer ($60,230 contributed), , William Munson Jr, VP & CFO ($40,929 contributed), Sarah Meshak, VP & General Counsel ($35,070 contributed), Michael Jefferies, VP & CIO ($28,190 contributed), Jamie Jensen, VP & Chief Population Officer ($24,193 contributed), and Jacqueline Attlesey-Pries, VP ,COO & CNO ($59,322) contributed. Schedule J, Part I, Line 7 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. 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 18550000 0 93716361 0 0 0 1080618 0 0 25180923 67458941 0 2014 1 0 1 1 B 2225000 0 31815214 0 0 0 452499 0 0 31362765 0 0 2014 0 0 1 1 C 0 0 30000002 11695000 0 0 153502 0 0 18151500 0 0 2018 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 C 0 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 30,000,002 by the cumulative trust fund interest income of $2. 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. Randall Bjerke MD Boardmember 398592 Employee compensation and benefits 0 Interface Communications Co Jeff Morgan, Boardmember, is a 75% owner of Interface Communications Co. 141078 BCH paid Interface Communications Co 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 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 hospital has a Compensation Committee as specified by the bylaws of the hospital (Article V, D). The Compensation Committee is comprised of the Chairman, Vice Chairman, Secretary and a member of the Finance Committee. The committee meets approximately three times per year to review the CEO compensation and approve annual contract changes. Compensation and contract changes are reported to the Board. The Committee engages a consulting firm to provide comparative compensation studies for similarly qualified persons in functionally comparable positions at similarly situated organizations. Compensation study and performance review are considered in developing the compensation decision. Compensation ranges and Benefit changes for Vice President level employees are reviewed and approved by the Compensation Committee if they are outside of hospital wide treatment. Compensation studies are also used for VP level assessment. All Compensation Committee meetings are formally documented through minutes. Form 990, Part VI, Section C, Line 19 The hospital's web site is www.bch.org. The web site includes the hospital's Mission, Vision and Beliefs Statement, our financial assistance policies, the Community Health Needs Assessment, the Board of Directors, and the Annual Report which contains key financial data, and information on new programs, patient safety and quality, and community benefits. The web site also has a section for Compliance policies including the Code of Conduct and Conflict of Interest. Annual audited financial statements are made available to the public at the Annual Meeting of Boulder Community Health. The tax return is made available to anyone who requests the return through our Public Information Office. Form 990, Part XI, Line 9 Other Change in Net Assets of -$2,313,740 = Change in Foundation Assets of $1,550,915 + Change in net Periodic Benefit Cost of -$5,502707 + Change in Minimum Pension Liability of $1,877,685 + charge for amortization of ineffective loss on swap of -$239,635 Boulder Community Health Sports Medicine Imaging LLC 2150 Stadium Drive 2nd Floor Boulder CO 80309 474243430 imaging services CO 247369 2445181 Boulder Communty Health Boulder Community Hospital Foundation 1155 Alpine Avenue Suite G40 Boulder CO 80304 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 1713010 4180676 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 5009529 1149625 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 725772 240000 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 767829 2288783 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 26892 1091006 0 0 0.5 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 Boulder Community Musculoskeletal Surgery Center LLC c 2050000 K-1 capital distributions Boulder Community Musculoskeletal Surgery Center LLC d 2408552 Loan guarantee document (nt > ownership %) Endoscopy Center of the Rockies LLC c 5150000 K-1 capital distribution Boulder MRI LLC c 210979 K-1 capital distribution Boulder MRI LLC d 330017 Loan for Biomed Services paid for by BCH. Loan repaid at 12/31/16. Boulder MRI LLC j 55788 Lease Agreement Boulder MRI LLC q 196530 71,325 for PACS Agreement + 125,015 pass thru of MRI service contract Riverbend Sleep LLC k 181164 GL recap of lease expense paid Foothills Surgery Center LLC c 918000 K-1 capital distribution Foothills Surgery Center LLC d 890490 Loan document: guarantee 35% of Loan outstanding at YE Foothills Surgery Center LLC j 357898 Lease payments received CP211A dated May 15, 2017 grants a filing extension to November 15, 2017.