2016-11-15T13:32:40-06:00 2015-12-31 910189318 Moss Adams LLP 2707 Colby Avenue Suite 801 Everett WA 98201 990 2015-01-01 205126945 BMH Inc BMHI 2087854100 98 Poplar Street Blackfoot ID 832211799 D JEFFERY DANIELS CEO 2087853803 2016-11-14 1 Robert Grannum P00355876 4252597227 2016-11-14 2015 2017-02-10 21:41:12Z D Jeffery Daniels 98 Poplar Street Blackfoot ID 832211799 104894186 0 X WWW.BINGHAMMEMORIAL.ORG X 2006 ID ENDEAVORING TO PROVIDE QUALITY HEALTHCARE SERVICES FOR RESIDENTS AND VISITORS TO BINGHAM COUNTY. 8 7 835 62 914406 -131224 376808 464812 89386844 94909042 859033 1031970 2954985 5236653 93577670 101642477 198592 190635 0 0 46115132 48270996 0 0 0 47380536 50157432 93694260 98619063 -116590 3023414 62113424 65751604 29145489 25000784 32967935 40750820 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 51484981 190635 57071542 ACUTE CARE HOSPITAL - THE HOSPITAL PROVIDED SERVICE TO 1,926 INPATIENTS, including 6,372 TOTAL SURGERIES (INPATIENT AND OUTPATIENT), 393 NEWBORN INFANTS, AND 9,809 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. 27070598 37145464 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 94,908 SEPARATE SERVICE ENCOUNTERS FOR INDIVIDUAL PATIENTS. 335915 2494735 NURSING HOME - THE NURSING HOME AVERAGED 39.4 RESIDENTS PER DAY RECEIVING INPATIENT SERVICES (EITHER short-term OR LONG-TERM skilled CARE) DURING THE YEAR. 78891494 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 137 0 1 835 1 1 1 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X D JEFFERY DANIELS 2087853803 98 POPLAR STREET BLACKFOOT ID 83221 ALICE CANNON CHAIRMAN 10.00 X X 0 0 145 Joe Cannon Vice Chairman 10.00 X X 0 0 0 Dr Clark Allen Vice Chairman through 9/2015 10.00 X X 0 0 0 Wallace Driscoll Treasurer 10.00 X X 0 0 533 Dean Jones DIRECTOR 6.00 X 0 0 126 Gordon Arave Director 6.00 X 0 0 106 Wayne Brower Director 6.00 X 0 0 117 Dr Tom Call Chief Medical Staff 6.00 X 0 0 0 LEE KNIFFIN DIRECTOR 6.00 X 0 0 81 LOUIS KRAML CEO 70.00 X 509071 0 660506 Jeffery Daniels CFO 70.00 X 345676 0 20380 Dan Cochran COO 70.00 X 337225 0 20798 Carolyn Hansen CNO 70.00 X 213076 0 870 Dr Adam Wray Physician 40.00 X 1050992 0 20798 Dr Baldwin Stutts Physician 40.00 X 1034898 0 20798 Dr Hugh Selznick Physician 40.00 X 609150 0 0 Dr Jared Wagner Physician 40.00 X 577438 0 20798 Dr Nathan Richardson Physician 40.00 X 574776 0 21047 5252302 0 787103 69 0 1 0 IDAHO PATHOLOGY LABORATORY LLC 98 POPLAR STREET BLACKFOOT ID 83221 Pathology Laboratory Services 2239064 TD THERAPY LLC 1757 LANCE DR POCATELLO ID 83204 THERAPY SERVICES 2172123 MSVM GROUP LLC PO BOX 4864 POCATELLO ID 83204 ADVERTISING 332724 CRESTWOOD ENTERPRISES LLC 98 POPLAR STREET BLACKFOOT ID 83221 RENTAL PROPERTY SERVICES 295652 ERICH GARLAND MD 3920 WASHINGTON PARKWAY IDAHO FALLS ID 83406 PROFESSIONAL MEDICAL SERVICES 202199 18 398017 66795 464812 PATIENT REVENUE 621110 182895337 182895337 professional fees revenue 621110 26669870 26669870 facility fees revenue 621110 2251276 2251276 Contr. Allow. & Charity Care 621110 -116907441 -116907441 94909042 361408 361408 261152 184664 162699 123278 98453 61386 159839 61386 98453 2946877 314677 2421057 169935 525820 144742 670562 670562 1094847 374740 720107 720107 k-1 activity 900099 1341438 1140211 6359 194868 DHHS Distribution 900099 1200000 1200000 MANAGEMENT SERVICE CONTRACT 561000 846661 846661 968608 662488 306120 4356707 101642477 96711741 914406 3551518 186035 186035 4600 4600 2108710 213946 1894764 37478152 32278979 5199173 98913 98913 6304408 4927267 1377141 2280813 1880282 400531 504998 705 504293 256612 256612 30101 30101 51904 51904 1422931 1415072 7859 2011025 2011025 914968 914968 738961 738961 3057000 1425372 1631628 386027 198325 187702 561370 486784 74586 467856 467856 3472579 3472579 604025 604025 MEDICAL EXPENSES 15519512 15516591 2921 Management Service Allo 9768183 7611015 2157168 bad debt expense 6501105 6501105 other supplies 1775549 1651938 123611 2112726 387860 1724866 98619063 78891494 19727569 0 2240621 225274 25000 410318 14189668 14543742 430000 430000 1049683 586027 3625402 3718773 609030 831077 63114719 42749713 17764472 20365006 20085613 18515355 547295 4199686 39000 135000 1507640 1791346 62113424 65751604 13594638 11962937 4235000 4050000 5791505 6025201 5524346 2962646 29145489 25000784 X 32967935 40750820 32967935 40750820 62113424 65751604 X 3023414 -868129 5627600 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 33543 33543 0 Part II-B, Line 1: A SMALL PORTION OF THE ORGANIZATION'S IDAHO HOPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES ARE ALLOCATED TO LOBBYING ACTIVITIES BASED ON STUDIES CONDUCTED BY THE RESPECTIVE ASSOCIATION. THE PORTION OF IDAHO HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING WAS $1,079 AND $2,363 RESPECTIVELY. THE ORGANIZATION ALSO SUPPORTS LOBBYING SERVICES SPECIFICALLY FOR CRITICAL ACCESS HOSPITAL DESIGNATION IN THE AMOUNT OF $30,000. 2310976 2310976 26892492 20330806 6561686 1801370 1090306 711064 31015180 21328601 9686579 1094701 1094701 20365006 4199686 C 4199686 OBLIGATION UNDER CAPITAL LEASE 541961 OBLIGATION UNDER PENSION PLAN 2170685 MALPRACTICE INSURANCE Liability 250000 2962646 X Part X, Line 2: The Organization is a notforprofit 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, 2015 or 2014. 1 1 X 1 X 1 X 1 1 0 0 779456 0 779456 0.00850 11261064 11116966 144098 0.00160 360641 0 360641 0.00390 12401161 11116966 1284195 0.01400 761215 75162 686053 0.00740 1909281 0 1909281 0.02070 0 0 162757 42458 120299 0.00130 179541 0 179541 0.00190 3012794 117620 2895174 0.03130 15413955 11234586 4179369 0.04530 1 6547113 1636778 22132422 23586669 -1454247 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 5 PORTNEUF BRACE physical thereapy services 0.25500 0.24500 1 1 BINGHAM MEMORIAL HOSPITAL 98 POPLAR STREET BLACKFOOT ID 832211799 X X X X X X BINGHAM MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 0 1 1 X www.binghammemorial.org/about-bmh/Community-Health-Needs-Assessment.html X 1 14 1 www.binghammemorial.org/about-bmh/Community-Health-Needs-Assessment.html 0 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X 1 X 0 X X X X 1 X 0 0 BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 5: Researchers collected primary data from community stakeholders, healthcare workers, and hospital administrators to assess perceptions of health problems and healthcare resources, including strengths and weaknesses. Data was collected through qualitative methods, focus groups and interviews, and through surveys. The local health department was contacted for participation in a healthcare provider focus group. Researchers also completed interviews and focus groups with community stakeholders who were defined as patients, local officials, and formal and informal community leaders. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 6b: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH IDAHO STATE UNIVERSITY AND THE IDAHO DEPARTMENT OF HEALTH AND WELFARE. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 11: THROUGH DATA REVIEW AND EXTERNAL INPUT FROM THOSE REPRESENTING THE BROAD INTERESTS IN THE COMMUNITY, A PRIORITIZED LIST OF THE HEALTH NEEDS OF BINGHAM COUNTY SERVICE AREA WAS CREATED: PROVIDER RECRUITMENT, LOW-COST SERVICES, OUTREACH PREVENTIVE, TRANSPORTATION, PATIENT SATISFACTION, OBESITY, DIABETES, LANGUAGE BARRIER, UNINSURED ADULTS, AND REFERRAL FOLLOW-UPS. MANY OF THESE OBJECTIVES WERE IN FACT ALREADY BEING ADDRESSED PRIOR TO BMH'S LATEST COMMUNITY HEALTH NEEDS ASSESSMENT SUCH AS PROVIDER RECRUITMENT, LOW-COST SERVICES, PATIENT SATISFACTION, AND REFERRAL FOLLOW-UPS. YET, BMH'S DESIRE TO EXCEED EXPECTATIONS MEANS THAT IT IS CONTINUALLY IMPROVING ON THESE AREAS OF NEEDS THROUGH NEW PROGRAMS AND AFFILIATIONS SUCH AS BMH'S PACIFIC NORTHWEST UNIVERSITY RESIDENTS PROGRAM, CONTINUITY CLINIC, ATHLETIC TRAINERS OUTREACH FOR INJURY PREVENTION PROGRAM, REDUCED COST VACCINES, AND LINX TRIAL STUDY. 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. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 13h: CONSIDERATIONS ARE GIVEN TO UNINSURED DISCOUNT, MEDICAID/ MEDICARE, AND HOMELESSNESS. BINGHAM MEMORIAL 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 16i: ABRIDGED BROCHURE WITH POLICY HIGHLIGHTS WAS MADE AVAILABLE IN THE ER, ADMISSIONS, AND PATIENT FINANCIAL SERVICES. BINGHAM MEMORIAL HOSPITAL Part V, Section B, Line 22d: FAPELIGIBLE INDIVIDUALS RECEIVE AN AUTOMATIC 30% DISCOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. 15 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 6 - PHYSICIANS & SURGEONS CLINIC OF SHELLEY 275 W LOCUST SHELLEY ID 83274 PHYSICIAN OFFICES 7 - BINGHAM MEMORIAL HOSPITAL SLEEP LAB 53 Poplar Street BLACKFOOT ID 83274 HOSPITAL OFFICES 8 - Bingham Memorial Hospital Business Offic 1600 Highland BLACKFOOT ID 83221 HOSPITAL OFFICES 11 - Bingham Memorial Family Medicine (1) 353 N 4th Ave Ste 102 Pocatello ID 83201 Physician Offices 12 - Bingham Memorial Family Medicine (2) 1595 Bannock Hwy Pocatello ID 83204 Physician Offices 13 - Bingham Memorial Family Medicine (3) 315 W Idaho St Blackfoot ID 83221 PHYSICIAN OFFICES 14 - MEDICAL RECORDS 124 NORTH OAK STREET Blackfoot ID 83221 Hospital Offices 15 - pHYSICIANS & SURGEONS CLINIC OF IDAHO FA 2375 SUNNYSIDE IDAHO FALLS ID 83404 PHYSICIAN OFFICES 16 - BINGHAM MEMORIAL SPECIALTY PLAZA 326 POPLAR STREET Blackfoot ID 83221 PHYSICIAN OFFICES 17 - GRADUATE MEDICAL STUDENTS 310 W IDAHO STREET Blackfoot ID 83221 HOSPITAL OFFICES 18 - 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 $ 6,501,105. 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 $1,454,247. 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 8 CLINICS (BOTH PRIMARY CARE AND SPECIALTY). BINGHAM HAS RECRUITED AND EMPLOYS 32 PHYSICIANS AND 12 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.THE COSTING METHODOLOGY USED TO DETERMINE MEDICARE COSTS IS THE COST TO CHARGE RATIO. 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, if they still don't pay according to policy we send them to a collection agency. Approved financial assistance is good for 6 months unless financial situation has changed, and then a patient must reapply for assistance. 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 HURT 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. 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 IDAHO COMMUNITY FOUNDATION INC DBA IDAHO HOMETOWN HEROES 444 HOSPITAL WAY SUITE 607 POCATELLO ID 83201 820425063 501(c)(3) 7500 General Support CITY OF BLACKFOOT 157 N BROADWAY BLACKFOOT ID 83221 City of Blackfoot 5100 Concerts in the park & fireworks Biggest Show in Idaho 1437 Yellowstone Pocatello ID 83204 820405362 501(c)(3) 10000 Music Festival Sponsor AMERICAN FOUNDATION FOR SUICIDE PREVENTION 120 WALL STREET NEW YORK NY 10005 133393329 501(c)(3) 10000 General Support AMERICAN RED CROSS 5371 W FRANKLIN RD BOISE ID 83705 463132024 501(c)(3) 5000 REAL HEROES SUPPORT BINGHAM ECONOMIC DEVELOPMENT CORPORATION 1487 PARKWAY DR BLACKFOOT ID 83221 820525983 501(c)(3) 5000 General Support BLACKFOOT CHAMBER OF COMMERCE PO BOX 801 BLACKFOOT ID 83221 820099637 501(c)(6) 15000 FIREWORKS SHOW & BLACKFOOT GOLF TOURNAMENT SPONSOR EASTERN IDAHO STATE FAIR Foundation PO BOX 250 BLACKFOOD ID 83221 820492146 501(c)(3) 21000 2015 FAIR SPONSORSHIP KIND COMMUNITY 315 W CENTER SUITE 103 POCATELLO ID 83204 475336005 501(c)(3) 5000 KIND COMMUNITY SPONSORSHIP 8 1 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 X 0 1 0 0 0 0 0 1 0 LOUIS KRAML CEO 435681 0 154 0 73236 0 645636 0 14870 0 1169577 0 0 0 Jeffery Daniels CFO 317492 0 0 0 28184 0 0 0 20380 0 366056 0 0 0 Dan Cochran COO 278527 0 36154 0 22544 0 0 0 20798 0 358023 0 0 0 Carolyn Hansen CNO 203569 0 101 0 9406 0 0 0 870 0 213946 0 0 0 Dr Adam Wray Physician 337123 0 695099 0 18770 0 0 0 20798 0 1071790 0 0 0 Dr Baldwin Stutts Physician 1033771 0 300 0 827 0 0 0 20798 0 1055696 0 0 0 Dr Hugh Selznick Physician 609000 0 150 0 0 0 0 0 0 0 609150 0 0 0 Dr Jared Wagner Physician 479964 0 96727 0 747 0 0 0 20798 0 598236 0 0 0 Dr Nathan Richardson Physician 573490 0 525 0 761 0 0 0 21047 0 595823 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, Line 4b 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 IS THE SOLE PARTICIPANT OF THE PLAN FOR WHOM BMH, INC. CONTRIBUTES AND IN 2015, $645,636 WAS ACCRUED. 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. COMPENSATION IS INCLUDED IN SALARY ON SCHEDULE J IN ACCORDANCE WITH THE VESTING SCHEDULE AND THE IRS INSTRUCTIONS. 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. ARAVE CONSTRUCTION COMPANY INC A 35% OR MORE CONTROLLED ENTITY OF GORDON ARAVE, BOARD MEMBER Investment X 430000 430000 0 0 1 430000 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 11 AFTER PREPARATION OF FORM 990 IT IS REVIEWED BY THE CFO AND CEO prior to being filed with the internal revenue service. A COPY IS submitted to the board of DIRECTORS AFTER BEING FILED. 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. THESE PROCEDURES ARE COMPLETED EVERY TWO TO THREE YEARS. 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 JEFF DANIELS, 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. Form 990, Part XI, line 9: Net Assets Aquired Through Hospital Lease 5,627,600. 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