2015-11-12T12:46:09-07:00 2014-12-31 990 2014-01-01 840175870 Boulder Community Health BOUL 3034402358 PO Box 9019 1100 Balsam Ave Boulder CO 803019019 William A Munson Jr CFO & Vice President 3034157433 2015-11-12 2014 2016-03-07 17:11:31Z Boulder Community Hospital Robert J Vissers PO Box 9019 1100 Balsam Ave Boulder CO 803019019 592834990 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 10 2765 520 1148694 0 3358726 2929458 291528637 298932421 15680487 21523795 14726569 16369077 325294419 339754751 363851 298436 0 0 153542796 155461914 0 0 362624 156469324 153160845 310375971 308921195 14918448 30833556 627149726 648918164 253465927 271694024 373683799 377224140 To provide our community with the safest and highest quality healthcare in an innovative, patient-centered environment. 0 0 229170820 298436 324005969 Health Care Delivery of IP and OP medical care. In 2014, the hospital discharged 8,127 adult & pediatric patients with an average length of stay of 4.5 days. 52,100 patients were seen in our ER/Urgent Care facilities. 5,095 surgeries were performed. The hospital had adjusted patient days of 87,545. 0 0 0 229170820 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 0 1 1 1 0 0 1 233 0 1 2765 1 1 1 0 0 0 0 0 0 0 0 0 X 15 10 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 1625 0 0 Janet Martin Vice Chairman 4 0 X X 0 0 0 Susan Graf Secretary 4 0 X X 0 0 0 Dee Perry Treasurer 4 0 X X 0 0 0 Randy Bjerke MD Board Member 2 0 X 0 0 0 Jeff Morgan Board Member 2 0 X 0 0 0 Jean Dubofsky Board Member 2 0 X 0 0 0 Mako Shimoda MD Board Member 2 0 X 16050 0 0 Steve Fries MD Board Member 2 0 X 0 0 0 Harold Flowers Board Member 2 0 X 0 0 0 Lou DellaCava Board Member 2 0 X 0 0 0 R David Hoover 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 40 0 X X 919351 0 41389 Robert J Vissers Exec VP & COO 40 0 X 345577 0 90531 Paul Kenneth Lewis Jr VP & Chief Medical Officer 40 0 X 415020 0 101412 William A Munson Jr VP & CFO 40 0 X 323115 0 92520 Jacqueline M Attlesey-Pries VP & Chief Nursing Officer 40 0 X 279827 0 71683 Sarah E Meshak VP & General Counsel 40 0 X 247635 0 55850 Linda S Minghella VP & Chief Information Officer 40 0 X 224032 0 52931 Ronald Secrist BCH Foundation President 20.00 20.00 X 229425 0 45342 Jamie D Jensen Physician Clinic COO 40 0 X 179413 0 39769 Sameer A Oza Physician 40 0 X 671799 0 24879 Jamie J Doucet Physician 40 0 X 629353 0 25596 Nelson P Trujillo Jr Physician 40 0 X 645727 0 27944 Daniel S White Physician 40 0 X 624067 0 27944 John A Schutz Physician 40 0 X 629123 0 27019 James Peters VP 0 0 X 256316 0 11192 6637455 0 736001 189 1 1 0 Navin Haffty & Associates LLC 1900 West Park Drive Suite 180 Westborough MA 01581 Information Technology Consulting 3007790 Favorite Healthcare Staffing Inc PO Box 803356 Kansas City MO 641803356 agency nursing services 2327022 Colorado Cardiovascular Surgical Associates PC 950 E Harvard Ave Suite 550 Suite 203 Denver CO 80210 Cardiovascular surgery coverage and employee lease 1240210 Boulder Valley Anesthesiology LLC c/o Wendll Walker & Assoc 1420 28th St Ste 100 Boulder CO 80303 Anesthesiology coverage 1072067 Boulder Neurosurgical Assoc PLLC 4743 Arapahoe Ave Suite 202 Boulder CO 80303 trauma call 952000 33 0 2958 0 2423962 496242 6296 0 2929458 Acute care hospital 622000 298932421 298153032 708494 70895 0 0 0 0 298932421 4414531 0 0 4414531 11446 0 0 11446 0 0 0 0 0 0 0 0 0 0 0 0 0 0 255206007 14900236 247070035 5938390 8135972 8961846 17097818 8961846 0 8135972 0 0 0 0 0 0 7542 424 7118 0 0 7118 100233 71390 28843 0 0 28843 Health Care Joint Ventures 621400 6471609 6471609 0 0 Misc Hospital Revenue 622000 9861507 9270788 440200 150519 0 0 0 0 16333116 339754751 322857275 1148694 12819324 174216 174216 76794 76794 47426 47426 0 0 3959509 16500 3667158 275851 0 0 0 0 123914203 95186516 28699480 28207 7242827 5528176 1711082 3569 11597343 8827262 2759025 11056 8748032 6459092 2275822 13118 1644786 142661 1502125 0 184930 0 184930 0 94200 5700 88500 0 0 0 0 0 0 0 668299 0 668299 0 21657806 18131459 3513293 13054 736304 0 736304 0 5159578 2452644 2695565 11369 10103186 636830 9466356 0 0 0 0 0 6661382 3893651 2748400 19331 449262 195690 253203 369 0 0 0 0 330424 108917 221507 0 2182552 955958 1226594 0 0 0 0 0 19466130 8575848 10876844 13438 2039373 2039373 0 0 Medical Supplies 45225027 44973645 251382 0 Provision for Bad Debts 15288320 15288320 0 0 Repairs and Maintenance 6227528 2990249 3237244 35 Medicaid Provider Fee 11060979 11060979 0 0 3980779 1402914 2604638 -26773 308921195 229170820 79387751 362624 1389445 17858 13817848 10538828 35009275 43184328 10156572 1445598 2688826 2394533 3934441 4269204 456074730 202662927 207701042 253411803 228890116 194999026 75764948 89603973 3072181 4317826 424077 303897 44300955 44431290 627149726 648918164 57490284 49042708 168701018 169607784 86140 79519 27188485 52964013 253465927 271694024 X 339079246 341473297 29432103 29495509 5172450 6255334 373683799 377224140 627149726 648918164 X 30833556 -3050715 0 0 0 -24242500 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 26527 0 0 0 26527 0 Schedule C, Part II-B, Line 1 9.9% of dues paid to the Colorado Hospital Association are spent on lobbying activities, amounting to $8,197. 22.8% of dues paid to the American Hospital Association are spent on lobbying activities, amounting to $8,330. Also $10,000 was given to The Safety Net Campaign to promote passage of a ballot issue for funding of assistance for families in need(health care, rent, food, childcare). 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 20637790 3702912 2390484 0 4499341 0 22231845 0 0.17 0.83 0 1 1 0 16856399 16856399 0 286332393 118914550 167417843 0 710637 551265 159372 0 148585936 83197112 65388824 0 3589365 0 3589365 253411803 -8842773 F 22795681 F Municipal bonds, infrequently traded 330288 F Corporate bonds and notes, infrequently traded 18513462 F Asset Backed Securities, infrequently traded 7467537 F Long/Short Fixed Income Funds 41218537 F Real Assets, Infrequently traded 7477748 F Fund of Hedge Funds 643493 F 89603973 Interest in Net Assets Held by Foundation 35467197 Unamortized Bond Issue Costs 1428915 Deferred Comp Investments 6080812 Misc Other AR 1330789 Unamortized Swap Fees 123577 44431290 0 Accrued Pension Liability 46883201 Deferred Compensation Liability 6080812 52964013 295952190 -3050715 0 0 -39590912 -42641627 338593817 668299 492635 1160934 339754751 292411849 0 0 0 0 0 292411849 668299 15841047 16509346 308921195 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 -39,590,912 included in tax return revenue but not in audited revenue includes Bad Debt Provision of -15,288,320 + Change in Foundation Net Assets of 1,189,615 + Change in minimum pension liability of -25,192,480 + Amortization of Effective Loss on Swap of -239,635 + Other Expenses shown net in FS rev and Gross in Tax return of -122,708 + Ambassador component of Temp Rest Net Assets of 62,616. Schedule D, Part XI, Line 4b Other of 462,635 = Flood Expenses of 422,054 related to the Sept 2013 Federally Declared Disaster and Ambassador expenses reflected as Restricted Contribution in Audit of 70,581. Schedule D, Part XII, Line 4b Other expenses of 15,841,047 included on TR but not on Audit = Bad Debt provision of 15,288,320 + Non-Op Flood Expenses shown in net revenue on audit of 422,054 + Other non-op expenses shown in net revenue on audit of 122,708 + Ambassador expenses reflected as Restricted Contribution in Audit of 7,965. 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. 37542 Central America and the Caribbean 0 0 Program Services The hospital participated in a medical mission to Haiti. 9884 Central America and the Caribbean 0 0 Investments Passive investments in Cayman Islands have a YE market value of $41,900,866 and incurred management fees of $600,215. 42501081 0 0 42548507 Sub-Saharan Africa 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. 0 37542 Airfare, in-country expenses for mission, and other expenses such as books and computer supplies which totaled $25,577, In-kind labor cost totaled $11,965. Cost Central America and the Caribbean Medical mission to Haiti 0 9884 Airfare and medical supplies totallin 9,884 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 7503101 5035158 2467943 0.008 34832041 19311936 15520105 0.051 0 0 42335142 24347094 17988048 0.059 371914 47994 323920 0.001 297632 297632 0.001 606632 606632 0.002 0 0 1276178 47994 1228184 0.004 0 0 43611320 24395088 19216232 0.063 9520 9520 0 5193 5193 0 150006 150006 0 0 0 164719 0 164719 0 1 15288320 1 50317022 68395208 -18078186 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 Community Sleep Services LLC Sleep Lab Services 0.45 0 0.55 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 2 1 Boulder Community Hospital 1100 Balsam Avenue Boulder CO 80304 www.bch.org 010323 X X X Rehab DPU, Psych DPU A 2 Boulder Community Foothills Hospital 4747 Arapahoe Avenue Boulder CO 80303 www.bch.org 01W737 X X X A A 0 0 1 X X X X X X X X 13 1 1 0 1 X www.bch.org X 1 13 1 www.bch.org 0 0 1 X 250 400 X X X X X X 1 1 X X X X 1 X X X X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Group A 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 6a-Group A The Community Health Needs Assessment includes both the Boulder Community Hospital and the Boulder Community Foothills Hospital. Schedule H, Part V, Section B, Line 7d-Group A 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-Group A 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 2014, 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 34 education sessions for the public in 2014 on a variety health issues, including heart disease, diabetes, orthopedic injuries and macular degeneration. 2. MENTAL HEALTH: The Hospital continued in 2014 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 began 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. These planning and constructions 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 began the expansion of mental health services in the Hospital's primary care physician practices, which expansion has continued into 2015. 3. AWARENESS TRAINING: The Hospital trains its employees, including its employed physicians in cultural awareness. In 2014, continuing into 2015, the Hospital has 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. These efforts are ongoing and will continue into 2016. The Hospital offered, 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 2014, 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. [what can we say about this program in 2014; how many patients we served and what agencies we worked with?] In 2014, the Hospital implemented its patient centered medical home program in 12 of 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 launched its transitional care program in 2014, 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. In 2014 the transitional care program served 283 patients discharged with a diagnosis of heart failure, AMI or pneumonia. The Hospital also planned for the expansion of the program in 2015 to include COPD diagnosis. Schedule H, Part V, Section B, Line 16a-Group A www.bch.org Schedule H, Part V, Section B, Line 16b-Group A www.bch.org Schedule H, Part V, Section B, Line 16c-Group A www.bch.org Schedule H, Part V, Section B, Line 22d-Group A 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. 35 Community Medical Center 1000 W South Boulder Road Lafayette CO 80026 Urgent-care center Mapleton Center 311 Mapleton Ave Boulder CO 80304 Outpatient clinic for rehabilitation, sports medicine, outpatient mental health and homecare. 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 Beacon Clinic 1136 Alpine Ave Suite 205 Boulder CO 80304 Infectious Disease Clinic Boulder Community Sleep Services LLC 1000 Alpine Ave Suite 201 Boulder CO 80304 Sleep study center Boulder Community Sleep Services LLC 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 IMA at Balfour Clinic 1336 Hecla Drive Louisville CO 80027 physician clinic 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 Table Mesa Family Medicine 1755 48th St Suite 200 Boulder CO 80303 Physician clinic Boulder Community Hospital Occupational Medicine 4745 Arapahoe Ave Suite G40 Boulder CO 80303 Occupational medicine clinic Gunbarrel Medical Center 6685 Gunpark Drive Suite 110 Boulder CO 80301 Physician clinic Spruce Street Internal Medicine 2575 Spruce Street Boulder CO 80302 Physician clinic Associated Neurologists of Boulder 1155 Alpine Suite 320 Boulder CO 80304 Physician clinic Dakota Ridge Medical Center 2995 Baseline Road Suite 210 Boulder CO 80303 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 Care Costs to Patient Care Charges Schedule H, Part I, Line 7, Column f 15,288,320 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 of the audited financial statements contains Note 2(f) which describes the significant accounting policies related to Patient Accounts Receivable. 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 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 $32,269,611. 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. 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. Employment and Income: Boulder County ended 2012 with an unemployment rate of 5.5 percent and early reports for 2013 remain much the same. This is an improvement over 2011 which saw rates as high as 7.2 percent. Household income in Boulder County peaked in 2008 at $69,427 and dropped to a post peak low of $63,811 in 2010. 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 Women's Health Center 2855 Valmont Rd Boulder CO 803011374 840645786 501 (c)3 12500 0 FMV to support women's health Boulder Valley School District 6500 E Arapahoe Boulder CO 80303 846014683 501 (c)3 71142 FMV Provide athletic traner to school district Support high school athletics and help to reduce student athlete injuries. Via Mobility Services 2855 N 63rd Street Boulder CO 80301 840777296 501 (c)3 15000 0 FMV Support for transportation of the disabled. The Community Foundation 1123 Spruce St Boulder CO 80302 841171836 501(c)3 10000 FMV to support civic forum on health care and sponsorship of the Conversation (end-of-life planning). 36 Commuting Solutions 287 Century Circle Suite 103 Louisville CO 80027 841594869 501(c)3 5789 0 FMV Support the mission of enhancing the mobility of commuters along the US 36 corridor for today and the future. 6 0 Healthcare educational scholarships 20 40000 Cost Assistance fund for IP rehab patiets 16 9912 Cost Assistance with RX post-discharge for indigent patients 22 5376 cost Take home medications donated to indigent patients post-discharge. Assistance with housing and transportation post-discharge for indigent patients 74 20620 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 0 1 X X X X X 1 1 0 0 0 0 0 1 0 David Gehant Exec Director/CEO 878851 0 0 0 40500 0 24378 0 21931 0 965660 0 0 Paul Kenneth Lewis Jr VP & Chief Medical Officer 307063 0 68457 0 39500 0 86596 0 18796 0 520412 0 0 0 Robert J Vissers Exec VP & COO 298468 0 25109 0 22000 0 76871 0 14232 0 436680 0 0 0 William A Munson Jr VP & CFO 252859 0 38621 0 31635 0 67725 0 25775 0 416615 0 0 0 Jacqueline M Attlesey-Pries VP & Chief Nursing Officer 224782 0 47245 0 7800 0 48958 0 23705 0 352490 0 0 0 Sarah E Meshak VP & General Counsel 166545 0 40606 0 40484 0 55369 0 1461 0 304465 0 0 0 James Peters VP 9725 0 27934 0 218657 0 3460 0 8222 0 267998 0 87932 0 Ronald Secrist BCH Foundation President 168802 0 37623 0 23000 0 27261 0 19006 0 275692 0 0 0 Linda S Minghella VP & Chief Information Officer 158016 0 25516 0 40500 0 51539 0 2365 0 277936 0 0 0 Jamie D Jensen Physician Clinic COO 132656 0 24068 0 22689 0 15347 0 25224 0 219984 0 0 0 Sameer A Oza Physician 485174 0 151625 0 35000 0 3900 0 21959 0 697658 0 28960 0 Jamie J Doucet Physician 479358 0 114995 0 35000 0 3900 0 22676 0 655929 0 28960 0 Nelson P Trujillo Jr Physician 476780 0 128446 0 40500 0 3900 0 24059 0 673685 0 28960 0 Daniel S White Physician 476763 0 112304 0 35000 0 3900 0 25024 0 652991 0 28960 0 John A Schutz Physician 481125 0 112998 0 35000 0 3900 0 24248 0 657271 0 28960 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. In 2014, the hospital hired a new Exec Vice President and Chief Operating Officer. Interim housing costs were paid by the Hospital and reported as taxable income. 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. Interim housing was paid as part of employment contract. 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: James Peters, Vice President, retired at the end of 2013 and received six months severance payment in 2014. Ln 4b: The hospital contributes to a nonqualified 457(f) plan for the benefit of its executive leadership. Participants include: Paul Lewis Jr, VP & Chief Medical Officer ($62,218 contributed), Robert Vissers, Exec VP & COO ($76,871 contributed), William Munson Jr, VP & CFO ($43,679 contributed), Sarah Meshak, VP & General Counsel ($35,952 contributed), Linda Minghella, VP & CIO ($32,917 contributed), Ron Secrist, Foundation President ($9,564 contributed), and Jacqueline Attlesey-Pries, VP and CNO ($45,344) 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 5645000 0 93716361 0 0 0 1080618 0 0 25180923 67458941 0 2014 1 0 1 1 B 0 0 31815214 0 0 0 452449 0 0 31362765 0 0 2014 0 0 1 1 C 0 0 8852000 0 0 0 131000 0 0 8698500 0 22500 2016 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 1 1 0 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 LnA(e)$93,535,431<Pt II Ln3(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 LnB(e)$31,748,673 < Pt II Ln3(B) of $31,815,214 by the cumulative trust fund interest income of $66,541. 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. Boulder Medical Center PC (BMC) Dr. Fries, boardmember, is president of the BMC board and is a pediatrician with BMC. 753243 The hospital paid BMC $420,944 for ER trauma call coverage provided by the physicians who are a part of BMC. The hospital paid BMC $332,299 under a lab and imaging space lease agreement. The hospital has an agreement with BMC to provide on-site lab and imaging services to BMC patients. All lab and imaging charges are billed directly to patients and third party insurances by the hospital. 0 Boulder Valley Pulmonology PC Dr. Randall Bjerke, Boardmember, is a >5% member of Boulder Valley Pulmonolgy PC 372100 Boulder Valley Pulmonology PC was paid $356,875 for the provision of inensivist coverage in the ICU, and $15,225 for trauma call coverage. 0 Interface Communications Co Jeff Morgan, Boardmember, is a 75% owner of Interface Communications Co 114128 BCH paid Interface Communications Co for communications services in conjunction with the Foothills campus expansion. 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 staff, a Conflict of Interest policy for Board Members, and a Conflict of Interest disclosure form for physicians serving on committees. 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 -$24,242,500= Change in Foundation Assets of 1,189,615 plus Change in Minimum Pension Liability of -25,192,480, plus charge for amortization of ineffective loss on swap of -239,635. 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 2330649 1711018 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 4599623 1322681 0 0 0 0.5 Boulder Community Sleep Services LLC 1100 Balsam Ave Boulder CO 80304 262429064 Sleep Lab Services CO N/A Related 16574 0 0 0 1 0.45 Boulder MRI LLC 1000 W South Boulder Road Suite 105 Lafayette CO 80026 452676500 outpaient MRI center CO Boulder Community Health Related 774247 373505 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 732076 3172340 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 -135842 1191353 0 0 0 0.5 0 1 1 1 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 Boulder Community Musculoskeletal Surgery Center LLC c 1800000 K-1 capital distributions Boulder Community Musculoskeletal Surgery Center LLC j 707337 Lease receipts Boulder Community Musculoskeletal Surgery Center LLC q 56665 Recap of expenditures reimbursed per contract Endoscopy Center of the Rockies LLC c 4200000 K-1 capital distributions Boulder Community Sleep Services LLC c 58059 K-1 capital distributions Boulder MRI LLC c 561000 K-1 capital distribution Boulder MRI LLC d 1338750 Loan Guaranty document (not > ownership %) Boulder MRI LLC j 52800 Lease Agreement Boulder MRI LLC q 93725 Receipts from PACS agreement Foothills Surgery Center LLC c 318750 K-1 capital distribution Foothills Surgery Center LLC d 1206858 Loan document: 35% of Loan outstanding at YE Foothills Surgery Center LLC j 352861 Lease payments received Riverbend Sleep LLC b 398658 general ledger Notice CP211A approved for extension of filing deadline to November 15, 2015.