2014-08-13T12:43:59-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2013-01-01 043634356 BOUNDARY REGIONAL HEALTH CENTER INC BOUN 2082678422 30410 HIGHWAY 200 PONDERAY ID 83852 VICTORIA MCCLELLAN KING CEO 2082678422 2014-08-13 1 DANIEL M FREIN P00856532 4252506100 2013 2015-11-30 17:44:51Z KANIKSU HEALTH SERVICE VICTORIA MCCLELLAN KING 30410 HIGHWAY 200 PONDERAY ID 83852 6791048 0 X N/A X 2002 ID TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. 9 9 113 10 0 0 1718254 1955792 4103282 4636237 0 2 0 199017 5821536 6791048 0 0 0 0 4407170 5097498 0 0 0 1556046 1425504 5963216 6523002 -141680 268046 2770913 3011168 2489003 2461212 281910 549956 THE MISSION OF KANIKSU HEALTH SERVICES IS TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. 0 0 5112753 0 4636237 KANIKSU HEALTH SERVICES (CENTER) PROVIDED MEDICAL VISITS AND DENTAL VISITS TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED MEDICAL OR DENTAL ATTENTION REGARDLESS OF A PERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. 5112753 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 113 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X X KEVIN KNEPPER CFO 2082678422 30410 HIGHWAY 200 PONDERAY ID 83852 RAY MILLER CHAIR 2.00 X X 0 0 0 SHEILA FARMINAUMICK VICE CHAIR 2.00 X X 0 0 0 STEVE FOORD TREASURER 2.00 X X 0 0 0 SUSAN EDWARDS SECRETARY 2.00 X X 0 0 0 STEPHEN ACKER DIRECTOR 2.00 X 0 0 0 ERIN DELUDE DIRECTOR 2.00 X 0 0 0 JOE ENGLISH DIRECTOR 2.00 X 0 0 0 MARY READER DIRECTOR 2.00 X 0 0 0 JANET SHELBY DIRECTOR 2.00 X 0 0 0 KRIS TAYLOR DIRECTOR 2.00 X 0 0 0 VICTORIA MCCLELLAN KING CHIEF EXECUTIVE OFFICER 40.00 X 98325 0 6000 KEVIN KNEPPER CHIEF FINANCIAL OFFICER 40.00 X 84989 0 0 TOM LAWRENCE MD CHIEF MEDICAL OFFICER 40.00 X 195899 0 6000 WARD LEEDY MD PHYSICIAN 40.00 X 175603 0 6000 JAMIE HETTICK MD PHYSICIAN 40.00 X 160861 0 6000 JEFFERY FOWLER DO PHYSICIAN 40.00 X 149870 0 6000 MATTHEW SPRUNT PA PHYSICIAN ASSISTANT 40.00 X 134453 0 6000 HAILEY ROSE MD PHYSICIAN 40.00 X 123683 0 6000 1123683 0 42000 8 0 1 0 COMMUNITY LINK CONSULTING 23905 E WELLESLEY AVE OTIS ORCHARDS WA 99027 BILLING SERVICES 154525 KOOTENAI HEALTH 2003 KOOTENAI HEALTH WAY COEUR DALENE ID 83814 SOFTWARE SUPPORT 114689 2 1955792 1955792 PATIENT SERVICE REVENU 621110 4636237 4636237 4636237 2 2 MISCELLANEOUS REVENUE 561499 199017 199017 199017 6791048 4636237 0 199019 391213 326789 64424 3795802 3171013 624789 62657 52187 10470 442951 368934 74017 404875 337220 67655 8637 4240 4397 291567 143130 148437 935 534 401 189013 107870 81143 304956 149428 155528 88675 43451 45224 114204 55960 58244 12092 10266 1826 SUPPLIES AND POSTAGE 223942 199644 24298 BAD DEBT 66773 66773 TRAINING COSTS 58113 21357 36756 EQUIP. MAINT. & REPAIR 47168 44437 2731 19429 9520 9909 6523002 5112753 1410249 0 101484 180305 455921 705809 30392 56016 2651353 582315 2183116 2069038 2770913 3011168 742806 728441 1746197 1732771 2489003 2461212 X 281910 549956 281910 549956 2770913 3011168 268046 0 X 0 1 X 1 1 1 X 1509963 1702521 2441291 1718254 1955792 9327821 1509963 1702521 2441291 1718254 1955792 9327821 9327821 2 2 56584 52845 18187 130149 199017 456782 9784605 17576788 0.95330 1.00000 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME INCENTIVE PAYMENTS COMMUNITY EDUCATION MEDICAL RECORDS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 266881 266881 1708243 132770 1575473 95063 19364 75699 581166 430181 150985 2069038 X 6791048 0 6791048 0 6791048 6523002 0 6523002 0 6523002 PART X, LINE 2: THE CENTER HAS RECEIVED A DETERMINATION LETTER FROM THE IRS THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE CENTERS TAX POSITIONS AND CONCLUDED THAT THE CENTER HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. THE CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2010. X 0 0 X X X 0 0 0 1 0 0 0 0 0 TOM LAWRENCE MD CHIEF MEDICAL OFFICER 195899 0 0 0 0 0 0 0 6000 0 201899 0 0 0 WARD LEEDY MD PHYSICIAN 175603 0 0 0 0 0 0 0 6000 0 181603 0 0 0 JAMIE HETTICK MD PHYSICIAN 160861 0 0 0 0 0 0 0 6000 0 166861 0 0 0 JEFFERY FOWLER DO PHYSICIAN 149870 0 0 0 0 0 0 0 6000 0 155870 0 0 0 PART I, LINE 1A A VISITING PHYSICIAN STAYED AT TOM LAWRENCE'S CABIN FOR THREE NIGHTS. THE AMOUNT PAID TO DR. LAWRENCE FOR USE OF THE WATER-FRONT CABIN, $250 TOTAL, WAS MUCH LESS THAN FAIR MARKET VALUE. PART I, LINE 5 ALL OF THE PROVIDERS, INCLUDING THE CMO, RECEIVED A BONUS BASED ON A COMBINATION OF GROSS REVENUES AND ENCOUNTER-LEVEL TARGETS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED BY THE CFO AND CEO, THEN PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED AND REVIEWED ANNUALLY FOR THE BOARD OF DIRECTORS AND KEY EMPLOYEEES. EACH INDIVIDUAL IS REQUIRED TO DISCLOSE ANY PERSONAL INTEREST WHICH THEY MAY HAVE IN ANY MATTER PENDING BEFORE THE ORGANIZATION AND REFRAINS FROM PARTICIPATION IN ANY DECISION ON SUCH MATTER. SUCH REFRAINING MAY TAKE THE FORM OF SIMPLE DISCLOSURE, LEAVING THE ROOM DURING DISCUSSION, NOT PARTICIPATING IN THE DISCUSSION, OR RECUSING ONESELF FROM THE ISSUE ALTOGETHER. FORM 990, PART VI, SECTION B, LINE 15 THE KANIKSU HEALTH SERVICES COMPENSATI0N MODEL - AS APPROVED BY THE BOARD OF DIRECTORS (BOD) - IS A COMPENSATION SCHEDULE BASED ON THE MOST RECENT NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) REGION 10 (WASHINGTON, OREGON, IDAHO) COMPENSATION SURVEY BASED ON SIZE OF THE ORGANIZATION - ANNUAL REVENUES, SCOPE OF RESPONSIBILITY, YEARS OF EXPERIENCE AND EDUCATIONAL DEGREES, CERTIFICATIONS, ETC. ALL JOB CATEGORIES (INCLUDING CEO, OTHER OFFICERS AND KEY EMPLOYEES, ALL CLINICAL PROVIDERS AND ALL STAFF) HAVE AN ASSOCIATED COMPENSATION MODEL - THIS APPROACH HAS BEEN APPROVED BY THE BOD. THIS IS USED FOR ALL NEW HIRES AND IS EVALUATED ANNUALLY TO BE SURE THAT THERE IS INTERNAL EQUITY AMONG EMPLOYEES, ETC. THIS COMPENSATION MODEL IS ADJUSTED ANNUALLY BASED ON THE MOST RECENT NACHC DATA - RANGES OF SALARY ARE REVIEWED. IT IS THE GOAL OF KHS TO BE IN THE MEDIAN RANGE OF THE COMPENSATION MODEL - THIS APPROACH HAS BEEN APPROVED BY THE BOD. ANY ADJUSTMENTS MADE TO CURRENT EMPLOYEES WILL BE BASED ON AVAILABILITY OF BUDGET AS APPROVED BY THE BOD AND WILL BE DETERMINED BY "RANGE MOVEMENT" FOR STAFF POSITIONS AND FOR MAINTAINING COMPETITIVE RECRUITMENT AND RETENTION FOR PROVIDERS AS COMPARED TO THE OTHER COMMUNITY HEALTH CENTERS IN IDAHO AND IN REGION 10. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. THIS PROCESS WAS LAST COMPLETED IN 2013. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORMS 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THE CONFLICT OF INTEREST POLICY OR GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE FEDERAL AUDIT CLEARINGHOUSE WEBSITE.