2016-11-15T16:16:50-07:00 2015-12-31 990 2015-01-01 840175870 Boulder Community Health BOUL 3034402358 PO Box 9019 1100 Balsam Ave Boulder CO 803019019 William A Munson Jr CFO & Vice President 3034157433 2016-11-15 2015 2017-02-10 21:41:12Z Boulder Community Hospital Robert J Vissers President and CEO PO Box 9019 Boulder CO 803019019 538323730 0 X www.bch.org X 1922 CO To provide our community with the safest and highest quality healthcare in an innovative, patient-centered environment. 15 13 2786 578 1238722 0 2929458 3068851 298932421 317641624 21523795 25456494 16369077 18294183 339754751 364461152 298436 325749 0 0 155461914 167129963 0 0 410565 153160845 180901161 308921195 348356873 30833556 16104279 648918164 655698658 271694024 267078954 377224140 388619704 To provide our community with the safest and highest quality healthcare in an innovative, patient-centered environment. 0 0 248329733 325749 357549786 Health Care Delivery of IP and OP medical care. In 2015, the hospital discharged 8,554 adult & pediatric patients with an average length of stay of 4.4 days. 55,041 patients were seen in our ER/Urgent Care facilities. 5,297 surgeries were performed. The hospital had adjusted patient days of 88,008. 0 0 0 248329733 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 1 230 0 1 2786 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 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 3034402358 PO Box 9019 1100 Balsam Ave Boulder CO 803019019 Richard Porreca Chairman 4 0 X X 0 0 0 Janet Martin Vice Chairman 4 0 X X 1451 0 0 Jean Dubofsky Secretary 4 0 X X 0 0 0 Dee Perry Treasurer 4 0 X X 0 0 0 Randy Bjerke MD Board Member 40.00 0 X 83537 0 8069 Jeff Morgan Board Member 2 0 X 2137 0 0 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 1610 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 David Gehant Exec Director/CEO 38.00 2.00 X X 1125904 0 40941 Robert J Vissers Exec Director/CEO 38.00 2.00 X X 726646 0 166848 Rhonda Williams Board Member 2 0 X 0 0 0 Bryan Pieper Board Member 2 2.00 X 0 0 0 Paul Kenneth Lewis Jr VP & Chief Medical Officer 40 0 X 431128 0 97298 William A Munson Jr VP & CFO 40 0 X 373603 0 86405 Jacqueline M Attlesey-Pries VP & Chief Nursing Officer 40 0 X 278661 0 70974 Sarah E Meshak VP & General Counsel 40 0 X 241928 0 53372 Linda S Minghella VP & Chief Information Officer 40 0 X 255633 0 53722 Ronald Secrist BCH Foundation President 0.00 40.00 X 182399 0 22898 Jamie D Jensen Physician Clinic COO 40 0 X 197355 0 38453 Frank Bruno BCH Foundation President 0.00 40.00 X 141157 0 18319 Sameer A Oza Physician 40 0 X 683605 0 55456 Jamie J Doucet Physician 40 0 X 648294 0 54940 Nelson P Trujillo Jr Physician 40 0 X 676051 0 57456 Daniel S White Physician 40 0 X 648661 0 57316 John A Schutz Physician 40 0 X 652272 0 57193 James Peters Former VP 0 0 X 125883 0 0 7477915 0 939660 220 1 1 0 Favorite Healthcare Staffing Inc PO Box 803356 Kansas City MO 641803356 agency nursing services 2152402 Navin Haffty & Associates LLC 1900 West Park Drive Suite 180 Westborough MA 01581 Information Technology Consulting 1778460 Colorado Cardiovascular Surgical Associates PC 950 E Harvard Ave Suite 550 Suite 203 Denver CO 80210 Cardiovascular surgery coverage and employee lease 1145941 Boulder Neurosurgical Assoc PLLC 4743 Arapahoe Ave Suite 202 Boulder CO 80303 trauma call 1020992 Boulder Valley Anesthesiology LLC c/o Wendll Walker & Assoc 1420 28th St Ste 100 Boulder CO 80303 Anesthesiology coverage 961600 30 0 0 0 2574023 486915 7913 0 3068851 Acute Care Hospital 622000 317641624 317035034 516678 89912 0 0 0 0 317641624 4043121 0 0 4043121 11 0 0 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 155170188 40047556 155665157 18139225 -494969 21908331 21413362 21908331 0 -494969 0 0 0 0 0 0 8514 380 8134 0 0 8134 117464 57816 59648 0 0 59648 Health Care Joint Ventures 621400 7780911 7780911 0 0 Misc Hospital Revenue 622000 10445490 9586788 722044 136658 0 0 0 0 18226401 364461152 356311064 1238722 3842515 149914 149914 105033 105033 70802 70802 0 0 4173209 92523 3787427 293259 0 0 0 0 128547464 95105629 33405836 35999 10812842 7905093 2907749 0 14790353 10616968 4142632 30753 8806095 6461078 2324863 20154 2074824 180266 1894558 0 221319 0 221319 0 97980 5940 92040 0 0 0 0 0 0 0 749042 0 749042 0 21092094 17073070 4019024 0 833492 0 833492 0 5429554 2487366 2932649 9539 10165863 652009 9513854 0 0 0 0 0 7238607 4036833 3182443 19331 439039 238688 200351 0 0 0 0 0 326851 149687 177164 0 4188663 955958 3232705 0 25000 0 0 25000 28567979 10238935 18322325 6719 2090950 2090950 0 0 Medical Supplies 49088081 48740991 347090 0 Provision for Bad Debts 17202933 17202933 0 0 Repairs and Maintenance 8336995 3570524 4764360 2111 Medicaid Provider Fee 18905276 18905276 0 0 3826619 1293267 2565652 -32300 348356873 248329733 99616575 410565 17858 317773 10538828 4191316 0 43184328 47486674 0 0 1445598 1354278 2394533 2851629 4269204 7588269 378535850 150302910 253411803 228232940 194999026 209922879 89603973 104986183 4317826 4938704 303897 385893 44431290 43442120 648918164 655698658 49042708 46487623 0 0 169607784 170815013 0 0 0 79519 72066 52964013 49704252 271694024 267078954 X 341473297 354798055 29495509 27376397 6255334 6445252 377224140 388619704 648918164 655698658 X 16104279 -9235479 0 0 0 4526764 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 13312 0 0 0 13312 0 Schedule C, Part II-B, Line 1 6.19% of dues paid to the Colorado Hospital Association are spent on lobbying activities, amounting to $5,109. 22.12% of dues paid to the American Hospital Association are spent on lobbying activities, amounting to $8,203. 35750843 2580067 -402645 0 4119616 0 33808649 34604553 4337617 1664839 0 4856166 0 35750843 31318621 3221343 4678434 0 4613845 0 34604553 23522148 7987150 2442969 0 2633646 0 31318621 22231845 4805197 -332547 0 3182347 0 23522148 0 0.19 0.81 0 1 1 0 16446336 16446336 0 207586068 63632718 143953350 0 2585345 534966 2050379 0 150860077 86135226 64724851 0 1058024 0 1058024 228232940 -5928799 F 16033952 F Municipal bonds, infrequently traded 329589 F Corporate bonds and notes, infrequently traded 19760527 F Asset backed securities, infrequently traded 7092531 F Long/Short Fixed Income Funds 38187678 F Long/Short Equity Funds 22905470 F Real Assets, Infrequently traded 6261797 F Fund of Hedge Funds 343438 F 104986183 Interest in Net Assets Held by Foundation 33462084 Unamortized Bond Issue Costs 1306783 Deferred Comp Investments 6195635 Misc Other AR 2366709 Unamortized Swap Fees 110909 43442120 0 Accrued Pension Liability 43508617 Deferred Compensation Liability 6195635 49704252 341670926 -9235479 0 0 -12729965 -21965444 363636370 749042 75740 824782 364461152 330250362 0 0 0 0 0 330250362 749042 17357469 18106511 348356873 Schedule D, Part V, Line 4 Boulder Community Hospital 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 12,729,965 included in tax return revenue but not in audited revenue includes Bad Debt Provision of -17,202,933 + Change in foundation Net Assets of -2,005,113 + Change in minimum pension liability of 6,771,512 + Amortization of Effective Loss on Swap of -239,635 + Other Expenses shown net in FS revenue and Gross in Tax return of -122,625 + Ambassador component of Temp Rest Net Assets of 68,829. Schedule D, Part XI, Line 4b Other of 75,740 = Ambassador expenses reflected as Restricted Contributions in Audit. Schedule D, Part XII, Line 4b Other expenses of 17,357,469 included on TR but not on Audit = Bad Debt provision of 17,202,933 + Non-op Expenses shown in net revenue on audit of 122,625 + Ambassador expenses reflected as Restricted Contribution in Audit of 31,911. 1 Sub-Saharan Africa 0 0 Program Services The hospital is the recipient of a grant from the Department of Health and Human Services via the American International Health Alliance Training Center to help with the development of zonal laboratories in Tanzania, Africa in response to the HIV/AIDS crisis. 24415 Central America and the Caribbean 0 0 Program Services The hospital participated in a medical mission to Haiti. 46388 Central America and the Caribbean 0 0 Investments Passive investments in Cayman Islands have a YE market value of $54,301,732 and incurred management fees of $809,553. 55111285 Europe (including Iceland and Greenland) 0 0 Investments Passive investments in Ireland have a YE market value of $7,134,853 and incurred management fees of $69,208. 7204061 0 0 62386149 Sub-Saharan Africa The hospital is a recipient of a grant from the Department of Health and Human Services via the American International Health Alliance Training Center to help with the development of zonal laboratories in Tanzania, Africa in response to the HIV/AIDS crisis. 24415 Airfare, in-country expenses for mission, and other expenses such as books and computer supplies which total $18,552, as well as in-kind labor of $5,863. Cost Central America and the Caribbean Medical mission to Haiti 0 46388 Airfare and medical supplies totaling $46,388 Cost 2 0 1 0 1 1 0 0 Schedule F, Part I, Line 2 The Tanzania, Africa project is subject to American International Health Alliance monthly grant reporting requirements. The project requires work plans to be approved by AIHA, quarterly project reporting, and monthly financial reporting. 1 1 X 1 X 2.5 1 X 1 1 0 1 1 3084870 431272 2653598 0.008 54179978 33293070 20886908 0.061 0 0 0 0 0 0 57264848 33724342 23540506 0.069 335085 45298 289787 0.001 304577 0 304577 0.001 0 0 567848 0 567848 0.002 0 0 1207510 45298 1162212 0.004 0 0 58472358 33769640 24702718 0.073 6379 0 6379 0.0 5131 0 5131 0 83323 0 83323 0 0 0 94833 0 94833 0.0 1 17702933 1 53681360 75241376 -21560016 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 2 Boulder Community Foothills Hospital 4747 Arapahoe Avenue Boulder CO 80303 www.bch.org 010323 X X X Boulder Community Foothills Hospital 2 0 0 1 X X X X X X X X 13 1 0 0 1 X www.bch.org/media/648783/bch-community-health-needs-assessment-final-august-26-2016.pdf X 1 13 1 www.bch.org/media/648783/bch-community-health-needs-assessment-final-august-26-2016.pdf 0 0 1 X 250 400 X X X X X 1 1 X X X X 1 X www.bch.org/media/589901/fin-assis-appl-english-2015.pdf X www.bch.org/media589901/fin-assis-appl-english-2015.pdf X www.bch.org/patientportal/billing-and-payment-policies.aspx X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Boulder Community Foothills Hospital In preparing this Community Health Needs Assessment, BCH collaborated with a number of community service agencies and their staff. Focus groups were conducted, consisting of representatives from over 25 agencies and programs, primarily targeting and serving "traditionally under-served" populations within the hospital's service area. The Boulder County Public Health Department, the Community Foundation serving Boulder County, The Boulder County Planning Department and the Boulder Valley School District were important collaborators in the preparation of this report and we express the hospitals thanks to them for their cooperation and for the wonderful services they provide to our jointly-served citizens. Schedule H, Part V, Section B, Line 7d-Boulder Community Foothills Hospital The Community Health Needs Assessment for 2014 - 2016 was reviewed and endorsed by the BCH Board of Directors at its meeting on November 19, 2013. Schedule H, Part V, Section B, Line 11-Boulder Community Foothills Hospital The strategies to address the community's health needs identified in the Hospital's 2014-2016 Community Health Needs Assessment and the activities undertaken by the Hospital as part of these strategies are as follows: 1. SUPPORT OF COMMUNITY ORGANIZATIONS ADDRESSING UNMET NEEDS: In 2015, the Hospital supported the organizations listed in Schedule I, Part IV, Statement 1with financial grants. These organizations provide services to the safety net populations of the community. The Hospital also supported the Community Foundation, a nonprofit organization which identifies and addresses community trends and service gaps. Additionally, the Hospital, in collaboration with health providers in the community, offered education sessions for the public in 2015 on a variety health issues. . MENTAL HEALTH: The Hospital continued in 2015 to offer inpatient and outpatient mental health services to the community and continues to be the only nonprofit provider of inpatient mental health services in Boulder County. The Hospital continued its planning process to build a new psychiatric hospital on adjacent to the Foothills Campus in order to enhance its psychiatric services and facilitate continuity of care for those services. It obtained local approval for the facility and began construction. These planning and construction efforts will continue through 2017. The Hospital continues to coordinate with the nonprofit mental health service provider in the community to for the evaluation and placement of patients in need of mental health services, regardless of ability to pay. The Hospital also continued the expansion of mental health services in the Hospital's primary care physician practices, and currently has mental health services available to all of its primary care practices. 3. AWARENESS TRAINING: The Hospital trains its employees, including its employed physicians in cultural awareness. The Hospital established a task force to assess the Hospital's efforts in addressing cultural and language differences in its patient populations, enhance the resources offered to these populations, and train employees and medical staff on these issues. This task force has reviewed and revised and provided training to employees on the Hospital's policies related to providing services to patients with disabilities and limited English proficiency and is overseeing the Hospital's efforts to comply with Section 1557 of the Rehabilitation Act. These efforts are ongoing and will continue into 2016. The Hospital continued to offer, through its ethics committee and continuing medical education efforts, forums on addressing the needs of various patient populations. 4. PROGRAM SERVICES TO TARGETED POPULATIONS: In 2015, the Hospital continued and enhanced its palliative care program to assist families with critical end of life decisions, and supported this program with its ethics consultation program and ethics committee, which educate staff and assist in addressing the ethical component of end of life decisions. The Hospital works with community agencies to provide a medical respite program for continuity of care for homeless and indigent patients. The Hospital worked cooperatively with its local hospice provider to furnish space to the provider within one of the Hospital's facilities. The Hospital expanded its cancer navigation program to additional cancer diagnoses. The Hospital also continued and strengthened its patient centered medical home program in its primary care clinics. This program coordinates patient care to improve outcomes, increase patient satisfaction and experience and reduce costs. As part of this program, the Hospital continued its transitional care program in 2015, offering free services to patients discharged from the hospital. The service provides home visits and phone calls from a transitional care nurse to assist patients with their transition to home, including medication management, communication with physicians, identifying health risks, coordinating with community resources and coaching patients on maintaining a health lifestyle. The Hospital expanded this program in 2015 to include patients receiving joint replacements, as part of the Hospital's participation in the CMS comprehensive joint replacement program. Schedule H, Part V, Section B, Line 16a-Boulder Community Foothills Hospital www.bch.org Schedule H, Part V, Section B, Line 16b-Boulder Community Foothills Hospital www.bch.org Schedule H, Part V, Section B, Line 16c-Boulder Community Foothills Hospital www.bch.org Schedule H, Part V, Section B, Line 22d-Boulder Community Foothills Hospital All patients without insurance are eligible for a 60% prompt pay discount if payment is made at time of service (or within 72 hours following discharge for emergencies) or a 50% discount if paid within 30 days for medically urgent, emergency, prenatal, and obstetric services. Those patients who qualify for financial assistance receive a discount rate that exceeds the lowest negotiated commercial discount rate. 39 BCH Behavioral Health DPU 1100 Balsam Avenue Boulder CO 80304 Psych DPU Mapleton Center 311 Mapleton Ave Boulder CO 80304 Outpatient clinic for rehabilitation, sports medicine, outpatient mental health and homecare. 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 4745 Arapahoe Ave Unit G50 Boulder CO 80303 Physician clinic 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 1136 Alpine Ave Suite 205 Boulder CO 80304 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 Sports Medicine East 1000 W South Boulder Rd Suite 212 220 226 Louisville CO 80026 Sports medicine 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 Community Medical Associates of Lafayette 401 E Cleveland Street Lafayette CO 80026 Physician clinic 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 320 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 Patient Cost to Patient Charges Schedule H, Part I, Line 7, Column f 17,702,933 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 Information Exchange (BCHIE), 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 4 Page 10 and 11 of the audited financial statements contains 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, The hospital does not have a mechanism to reasonably estimate the amount 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 information were known. 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, 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 $26,858,811. 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. 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 the Rehabilitation and Behavioral Health services, and is expected to complete this facility in early 2018. 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 Boulder Community Hospital is dedicated to providing access to high quality health care while continuously responding to the evolving healthcare needs of our community. The hospitals primary service areas in Boulder County include the cities of Boulder, Erie, Lafayette, Longmont, Louisville, Nederland, Superior and Ward. Additionally, BCH also serves a growing portion of the City and County of Broomfield. According to the most recent population data, the following population trends have been identified for Boulder County: The population of Boulder County is growing slowly compared to neighboring counties. The population of Boulder County is aging .The population of Boulder County is becoming more diverse, specifically more Hispanic and Latino. Schedule H, Part VI, Line 5 The Hospital is governed by a volunteer community board. The Hospital has an open medical staff. All surplus funds are reinvested in the hospital to fund charity, subsidize under performing health programs, develop new health programs, or as an investment in plant, equipment and technology. 1 Boulder County Fire Fighters Assoc Sunshine Fire Protection District PO Box 7461 Golden CO 80302 846000600 501 (c)3 24000 0 FMV Support for local fire association. Boulder Valley School District 6500 E Arapahoe Boulder CO 80303 846014683 501 (c)3 0 73677 FMV Provide athletic trainer to school district Support high school athletics and help to reduce student athlete injuries. The Community Foundation 1123 Spruce St Boulder CO 80302 841171836 501(c)3 12000 0 FMV To support civic forum on health care and sponsorship of the Conversation Justin Parker Neurological Institute 4743 Arapahoe Ave Ste 202 Boulder CO 80303 263588986 501 (c)3 7500 0 FMV To support education related to brain and trauma disorders. American Red Cross 444 Sherman St Denver CO 80203 530196605 501 (c) 3 6000 FMV Nepal Relief 5,000 General 1,000 5 0 Healthcare educational scholarships 22 44840 0 Cost Assistance for IP rehab patients 11 7383 0 Cost Assistance with RX post-discharge for indigent patients 50 12024 Cost Take home medications donated to indigent patients post-discharge Assistance with food, housing and transportation post=discharge for indigent patients 111 40306 cost Assistance with pro fee for reading for indigent mammography 6 480 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 0 1 X X X X X 0 1 0 0 0 0 0 1 0 David Gehant Exec Director/CEO 752621 0 0 0 373283 0 23791 0 20019 0 1169714 0 331283 0 Robert J Vissers Exec Director/CEO 533564 0 157082 0 36000 0 144222 0 23606 0 894474 0 0 0 Paul Kenneth Lewis Jr VP & Chief Medical Officer 320282 0 69827 0 41019 0 83276 0 15002 0 529406 0 0 0 William A Munson Jr VP & CFO 281744 0 73859 0 18000 0 61279 0 26106 0 460988 0 0 0 Jacqueline M Attlesey-Pries VP & Chief Nursing Officer 238417 0 32144 0 8100 0 54102 0 17852 0 350615 0 0 0 Linda S Minghella VP & Chief Information Officer 174198 0 39723 0 41712 0 52973 0 1728 0 310334 0 0 0 Sarah E Meshak VP & General Counsel 172301 0 27627 0 42000 0 53372 0 980 0 296280 0 0 0 Jamie D Jensen Physician Clinic COO 149883 0 24548 0 22924 0 16149 0 23169 0 236673 0 0 0 Ronald Secrist BCH Foundation President 90279 0 28312 0 63808 0 11555 0 11811 0 205765 0 42230 0 Frank Bruno BCH Foundation President 133015 0 0 0 8142 0 0 0 19039 0 160196 0 0 0 Sameer A Oza Physician 502480 0 145126 0 36000 0 32935 0 23501 0 740042 0 0 0 Nelson P Trujillo Jr Physician 508200 0 125851 0 42000 0 32935 0 25502 0 734488 0 0 0 John A Schutz Physician 500641 0 115632 0 36000 0 32935 0 28965 0 714173 0 0 0 Daniel S White Physician 490451 0 116210 0 42000 0 32935 0 25361 0 706957 0 0 0 Jamie J Doucet Physician 499810 0 112484 0 36000 0 32935 0 22985 0 704214 0 0 0 James Peters VP 0 0 0 0 125883 0 0 0 0 0 125883 0 125883 0 Schedule J, Part I, Line 1a The hospital pays for board member companion travel at its annual educational conference. Companion travel is reported as Misc Income on the 1099 of the board member. Schedule J, Part I, Line 1b Travel for companions is only reimbursed for board members attending the annual educational conference. Companion travel is reimbursed based upon substantiated receipts and is reported as Miscellaneous Income on 1099 of the board member. In all other circumstances, companion travel is not reimbursable by the hospital. 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 4b--The hospital contributes to a nonqualified 457(f) plan for the benefit of its executive leadership. Participants include: Robert Vissers, Pres & CEO ($141,731 contributed, Paul Lewis Jr, VP & Chief Medical Officer ($59,485 contributed), , William Munson Jr, VP & CFO ($41,463 contributed), Sarah Meshak, VP & General Counsel ($34,235 contributed), Linda Minghella, VP & CIO ($33,618 contributed), Ron Secrist, Foundation President ($1,419 contributed), and Jacqueline Attlesey-Pries, VP & CNO ($50,335) 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 17485000 0 93716361 0 0 0 1080618 0 0 25180923 67458941 0 2014 1 0 1 1 B 1640000 0 31815214 0 0 0 452449 0 0 31362765 0 0 2014 0 0 1 1 C 0 0 18305000 0 0 0 153502 0 0 18151500 0 0 2017 0 0 0 1 A 0 0 1 1 0 0 0 0 0 0 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 1 1 0 0 0 0 0 1 C 0 1 1 0 0 0 0 0 1 A 1 B 1 C 1 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 $18,305,000 < Pt II Line 3(B) of 18,305,002 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 performed by Kutak Rock Arbtrage Consulting LLC for the period 12/1/2010 to 10/1/2015, the end of the first five-year rebate calculation period. The report concludes that there is no arbitrage rebate liability as of 10/1/2015. Boulder Valley Pulmonology PC (BVP) Dr. Randall Bjerke, Boardmember, is a >5% member of BVP, and as of 10/1/2015 is employed by BCH. 666359 BVP was paid $310,250 for intensivist coverage in the ICU, #11,400 for trauma call, $6,000 for Medical Directorship of ICU, and $338,709 for practice aquisition. 0 Randall Bjerke MD Boardmember 84454 Employee compensation. Dr. Bjerke became an employee of BCH on 10/01/15. 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 The Community Hospital Association. 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 $4,526,764 = Change in Foundation Assets of -2,005,113 + Change in Minimum Pension Liability of 6,771,512 + 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 -144783 1911287 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 1136 Alpine Avenue Boulder CO 80304 201391702 Outpatient surgery center CO N/A Related 2631148 2452562 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 4726415 1299096 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 678398 356544 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 1031026 2489789 0 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 13778 1144279 0 0 0 0.5 0 1 1 1 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 Boulder Community Musculoskeletal Surgery Center LLC c 2275000 K-1 capital distributions Boulder Community Musculoskeletal Surgery Center LLC j 381635 Lease receipts Boulder Community Musculoskeletal Surgery Center LLC q 18569 Recap of expenditures reimbursed per contract Endoscopy Center of the Rockies LLC c 4750000 K-1 capital distributions Boulder MRI LLC c 663000 K-1 capital distributions Boulder MRI LLC d 1338750 Loan Guaranty document (not > ownership %) Boulder MRI LLC j 61763 Lease Agmt Boulder MRI LLC q 71850 Receipts from PACS agreement Riverbend Sleep LLC c 50000 K-1 capital distribution Riverbend Sleep LLC b 50000 K-1 capital contribution Foothills Surgery Center LLC c 1157700 K-1 capital distribution Foothills Surgery Center LLC d 1026348 Loan document: 35% of Loan outstanding at YE Foothills Surgery Center LLC j 355308 Lease payments received CP211A dated June 13,2016 grants a filing extension to November 15, 2016.