2014-11-17T13:46:39-06:00 2013-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 982013510 990 2013-01-01 205126945 BMH INC BMHI 2087854100 98 POPLAR STREET BLACKFOOT ID 832211799 D JEFFERY DANIELS CFO 2087853803 2014-11-12 1 ROBERT GRANNUM P00355876 4252597227 2013 2015-11-30 17:44:51Z LOUIS KRAML 98 POPLAR STREET BLACKFOOT ID 832211799 93854242 0 X WWW.BINGHAMMEMORIAL.ORG X 2006 ID 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. 8 7 838 48 1022444 -73854 472564 137773 81972492 83612303 1106858 840716 2806145 3498108 86358059 88088900 93868 168743 0 0 40123479 43680601 0 0 0 41044272 43348145 81261619 87197489 5096440 891411 60509854 61162783 29950653 28234387 30559201 32928396 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 47778314 168743 57587812 ACUTE CARE HOSPITAL - THE HOSPITAL PROVIDED SERVICE TO 2,151 INPATIENTS, INCLUDING 7,027 TOTAL SURGERIES (INPATIENT AND OUTPATIENT), 348 NEWBORN INFANTS, AND 9,579 EMERGENCY ROOM PATIENTS. THE HOSPITAL HAS A FULL SERVICE RADIOLOGY, PHYSICAL THERAPY, RESPIRATORY THERAPY, PHARMACY AND LABORATORY TO SUPPORT THE NEEDS OF THE HOSPITAL'S INPATIENTS AND OUTPATIENTS. 19007916 22359490 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 76,235 SEPARATE SERVICE ENCOUNTERS FOR INDIVIDUAL PATIENTS. 3573161 4793939 NURSING HOME - THE NURSING HOME AVERAGED 45.5 RESIDENTS PER DAY RECEIVING INPATIENT SERVICES (EITHER SHORT-TERM OR LONG-TERM SKILLED CARE) DURING THE YEAR. 70359391 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 161 0 1 838 1 1 1 0 0 0 0 0 0 0 0 0 X 8 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 ID X D JEFFERY DANIELS 2087853803 98 POPLAR BLACKFOOT ID 83221 ALICE CANNON CHAIRMAN 10.00 X X 0 0 33 DR CLARK ALLEN VICE-CHAIRMAN 10.00 X X 0 0 54 JOSEPH CANNON SECRETARY 6.00 X X 0 0 32 WALLACE DRISCOLL TREASURER 10.00 X X 0 0 132 LEE KNIFFIN DIRECTOR 6.00 X 0 0 27 HOWARD HARRINGTON DIRECTOR 6.00 X 0 0 45 GORDON ARAVE DIRECTOR 6.00 X 0 0 23 DR TOM CALL CHIEF MEDICAL STAFF 6.00 X 0 0 20 LOUIS KRAML CEO 70.00 X 458458 0 117424 JEFF DANIELS CFO 70.00 X 393821 0 29296 DAN COCHRAN COO 70.00 X 327042 0 68649 CAROLYN HANSEN CNO 70.00 X 128640 0 462 DR ADAM WRAY PHYSICIAN 40.00 X 817422 0 30698 DR DAVID SHELLEY PHYSICIAN 40.00 X 678043 0 14703 DR BALDWIN STUTTS PHYSICIAN 40.00 X 997237 0 20643 DR DAVID PETERSON PHYSICIAN 40.00 X 612423 0 20643 DR HUGH SELZNICK PHYSICIAN 40.00 X 493608 0 0 4906694 0 302884 56 0 1 0 IDAHO PATHOLOGY LABORATORY LLC 98 POPLAR STREET BLACKFOOT ID 83221 PATHOLOGICAL LABORATORY SERVICES 2836445 MSVM GROUP LLC PO BOX 4864 POCATELLO ID 83204 MARKETING 497111 HOLLAND & HART PO BOX 17283 DENVER CO 80217 LITIGATION SERVICES 421327 COLTRIN & ASSOCIATES INC 801 FLORAL VALE BLVD MORRISVILLE PA 19067 MARKETING 397516 MCDERMOTT WILL & EMERY LLP PO BOX 6043 CHICAGO IL 60680 LITIGATION SERVICES 353633 13 117582 20191 137773 PATIENT REVENUE 621110 176097513 176097513 PROFESSIONAL FEES REVENUE 621110 7726915 7726915 FACILITY FEES REVENUE 621110 639335 639335 ANCILLARY CARE SERIVCES 621500 3712 3712 CONTRACTUAL ALLOWANCE & CHARITY C 621110 -100855172 -100855172 83612303 307319 307319 145938 172764 145938 172764 0 0 5788656 5255259 533397 533397 533397 483203 191381 291822 291822 K-1 ACTIVITY 900099 1128938 1128938 MANAGEMENT SERVICE CONTRACT-DHHS 561000 1022444 1022444 DHHS DISTRIBUTION 900099 600000 600000 454904 454904 3206286 88088900 84741241 1022444 2187442 165493 165493 3250 3250 1524158 129101 1395057 34817740 30270884 4546856 181739 181739 5033952 4077669 956283 2123012 1786482 336530 7460953 5804642 1656311 674979 674979 117023 117023 80000 80000 41344 41344 1798539 1792684 5855 1990329 1990329 893520 893520 971245 971245 2708956 1654457 1054499 333845 105092 228753 169304 132607 36697 661957 661957 3319822 3319822 517034 517034 MEDICAL EXPENSES 14083182 14083182 BAD DEBT EXPENSE 4095623 4095623 OTHER SUPPLIES 1974364 1791370 182994 STATE ASSESSMENT 347738 347738 1108388 368260 740128 87197489 70359391 16838098 0 1385326 147686 25000 25000 13764451 13580132 5626808 4921516 3177964 3352844 1176346 1081517 52840052 34464966 20274255 18375086 14158315 17857553 185134 504759 36255 16690 700000 1300000 60509854 61162783 12425180 12846403 11177787 9914152 6347686 5473832 29950653 28234387 X 30559201 32928396 30559201 32928396 60509854 61162783 X 891411 1101001 376783 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 83340 83340 0 PART II-B, LINE 1: A SMALL PORTION OF THE ORGANIZATION'S IDAHO HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES ARE ALLOCATED TO LOBBYING ACTIVITIES BASED ON STUDIES CONDUCTED BY THE RESPECTIVE ASSOCIATIONS. THE PORTION OF IDAHO HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING WAS $866 AND $2,474 RESPECTIVELY. THE ORGANIZATION ALSO SUPPORTS LOBBYING SERVICES SPECIFICALLY FOR CRITICAL ACCESS HOSPITAL DESIGNATION IN THE AMOUNT OF $80,000. 1226209 1226209 22237238 16745544 5491694 1871762 757025 1114737 25909381 16962397 8946984 1595462 1595462 18375086 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 2852008 OBLIGATION UNDER CAPITAL LEASE 1035624 OBLIGATION UNDER PENSION PLAN 1586200 5473832 X PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT 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, 2013 OR 2012. 1 1 X 1 X 1 X 1 1 0 0 3 1090327 1090327 0.01250 3 8802424 8654898 147526 0.00170 1 187339 187339 0.00210 7 10080090 8654898 1425192 0.01630 584 31351 310990 26747 284243 0.00330 1179921 39861 1140060 0.01310 240756 985 239771 0.00270 514586 514586 0.00590 584 31351 2246253 67593 2178660 0.02500 591 31351 12326343 8722491 3603852 0.04130 1 4095623 1023906 22052749 23416981 -1364232 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 1 1 BINGHAM MEMORIAL HOSPITAL 98 POPLAR STREET BLACKFOOT ID 832211799 X X X X X X BINGHAM MEMORIAL HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X WWW.BINGHAMMEMORIAL.ORG X X X X 1 0 1 1 150.000000000000 1 200.000000000000 1 X X X 1 1 X X 1 0 1 X 0 0 BINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: RESEARCHERS COLLECTED INPUT FROM COMMUNITY STAKEHOLDERS, HEALTHCARE WORKERS, AND HOSPITAL ADMINISTRATORS. BINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: ABRIDGED BROCHURE WITH POLICY HIGHLIGHTS AVAILABLE IN ER, ADMISSIONS, AND PATIENT FINANCIAL SERVICES. BINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: ALL ADDITIONAL DISCOUNTS ARE CALCULATED AND DETERMINED BASED ON THE INDIVIDUAL PATIENT'S FINANCIAL CAPACITY. 9 BINGHAM MEMORIAL SKILLED NURSING & REHAB 98 POPLAR BLACKFOOT ID 83221 SKILLED NURSING FACILITY BMH PHYSICIANS 98 POPLAR BLACKFOOT ID 83221 PHYSICIAN OFFICES PHYSICIANS & SURGEONS CLINIC OF POCATELL 1151 HOSPITAL WAY POCATELLO ID 83201 PHYSICIAN OFFICES FIRST CHOICE URGENT CARE 1350 PARKWAY DR BLACKFOOT ID 83221 PHYSICIAN OFFICES TORO FAMILY MEDICINE 315 W IDAHO ST BLACKFOOT ID 83221 PHYSICIAN OFFICES PHYSICIANS & SURGEONS CLINIC OF SHELLEY 275 W LOCUST SHELLEY ID 83274 PHYSICIAN OFFICES BINGHAM MEMORIAL HOSPITAL SLEEP LAB 53 POPLAR STREET BLACKFOOT ID 83274 HOSPITAL OFFICES BINGHAM MEMORIAL HOSPITAL BUSINESS OFFIC 1600 HIGHLAND BLACKFOOT ID 83221 HOSPITAL OFFICES AEGIS HEALTH SYSTEMS 145 W IDAHO ST BLACKFOOT ID 83221 HOSPITAL OFFICES PART III, LINE 4: SEE PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE ORGANIZATION'S BAD DEBT EXPENSE DESCRIPTION.RECEIVABLES ARISING FROM PATIENT SERVICE REVENUES ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS, BASED ON EXPERIENCE, THIRD-PARTY CONTRACTUAL ARRANGEMENTS, AND ANY UNUSUAL CIRCUMSTANCES THAT MAY AFFECT THE ABILITY OF PATIENTS TO MEET THEIR OBLIGATIONS. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED AGAINST THIS ALLOWANCE. COSTS SHOWN IN LINES 2 AND 3 OF THIS PART ARE BASED ON A COST TO CHARGE RATIO.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 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 COSTS ARE BASED ON A 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 $1,364,232. 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. USING METHODOLOGY CONSISTENT WITH THE MEDICARE COST REPORT, THE REVENUE FOR SERVICES PROVIDED BUT NOT INCLUDED ON LINE 5 IS CALCULATED TO BE $6,214,092. APPLYING THE COST TO CHARGE RATIO (PER THE COST REPORT) YIELDS ADDITIONAL MEDICARE ALLOWABLE COSTS ASSOCIATED WITH THAT REVENUE OF $6,598,509. IN TOTAL, THE ORGANIZATION'S MEDICARE NET REVENUE IS $28,266,841; WHILE ITS COST IS $30,015,490. THE SHORTFALL (ADJUSTED FOR NON-ALLOWABLE BUT NECESSARY AND RELATED COSTS OF $283,406) IS $2,032,055. 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. PART III, LINE 9B: ONCE A PATIENT APPLIES, WE HOLD ALL COLLECTIONS EFFORTS UNTIL A DETERMINATION IS MADE. WE SEND THE PATIENT A LETTER NOTIFYING THEM OF APPROVAL OR DENIAL, IF THEY STILL DON'T PAY ACCORDING TO POLICY WE SEND THEM TO A COLLECTION AGENCY. THE APPLICATION IS GOOD FOR 6 MONTHS UNLESS FINANCIAL SITUATION HAS CHANGED. 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 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 EASTERN IDAHO STATE FAIR PO BOX 250 BLACKFOOT ID 83221 820492146 501(C)(3) 18000 2013 FAIR SPONSORSHIP IDAHO COMMUNITY FOUNDATION INC DBA IDAHO HOMETOWN HEROES 444 HOSPITAL WAY SUITE 607 POCATELLO ID 83201 820425063 501(C)(3) 7500 GENERAL SUPPORT IDAHO STATE UNIVERSITY 921 S 8TH AVE POCATELLO ID 83201 826000924 501(C)(3) 34450 VARIOUS SPORTS TEAM SPONSORSHIPS BLACKFOOT CHAMBER OF COMMERCE PO BOX 801 BLACKFOOT ID 83221 820099637 501(C)(3) 15200 FIREWORKS SHOW SPONSOR ISLAMIC SOCIETY OF NORTH AMERICA 343 S 4TH AVE APT 3 POCATELLO ID 83201 820464954 501(C)(3) 10000 SUPPORT BUILDING OF A NEW CULTURAL CENTER 5 0 PART I, LINE 2: THE RECIPIENTS OF GRANTS ARE REQUIRED TO MAKE SOME KIND OF PUBLIC RECOGNITION OF THE FUNDS GIVEN. X X 1 1 X X X X 0 1 0 0 0 0 0 1 0 LOUIS KRAML CEO 421816 0 0 0 36642 0 72000 0 45424 0 575882 0 0 0 JEFF DANIELS CFO 371331 0 4500 0 17990 0 0 0 29296 0 423117 0 0 0 DAN COCHRAN COO 295939 0 30500 0 603 0 45000 0 23649 0 395691 0 0 0 DR ADAM WRAY PHYSICIAN 341676 0 475746 0 0 0 10000 0 20698 0 848120 0 0 0 DR DAVID SHELLEY PHYSICIAN 348151 0 329892 0 0 0 0 0 14703 0 692746 0 0 0 DR BALDWIN STUTTS PHYSICIAN 996933 0 304 0 0 0 0 0 20643 0 1017880 0 0 0 DR DAVID PETERSON PHYSICIAN 611865 0 558 0 0 0 0 0 20643 0 633066 0 0 0 DR HUGH SELZNICK PHYSICIAN 493500 0 108 0 0 0 0 0 0 0 493608 0 0 0 PART I, LINE 1A IT IS ESTIMATED THAT 3 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. PART I, LINE 4B THE BMH, INC. SUPPLEMENTAL RETIREMENT PLAN IS AN UNFUNDED AND UNSECURED 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 2013, $0 WAS CONTRIBUTED. 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 AND APPROVED BY BOARD FINANCE COMMITTEE. THESE BONUSES ARE UNDER $20,000 EACH. FORM 990, PART VI, SECTION A, LINE 2 ALICE CANNON AND JOE CANNON HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE HOPSITAL 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, CEO, AND SUBMITTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C A BOARD MEMBER MAY DECLARE CONFLICT AT A BOARD MEETING, DURING DISCUSSION AND ANNUALLY WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 INTEGRATED HEALTHCARE STRATEGIES, A NATIONALLY RECOGNIZED EXECUTIVE COMPENSATION FIRM EVALUATES ALL EXECUTIVE POSITIONS FOR COMPENSATION. THE BOARD OF DIRECTORS ESTABLISHES THE CEO COMPENSATION AND THE CEO ESTABLISHES THE OTHER EXECUTIVES' COMPENSATION. IN 2012 THE BYLAWS WERE AMENDED TO FORMALLY ADD AN EXECUTIVE COMPENSATION REVIEW COMMITTEE. 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: BOOK TAX DIFFERENCES FROM SUBSIDIARIES K-1 376,783. FORM 990, PART XI, LINE 2C: THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. THE HOSPITAL'S FINANCE COMMITTEE ANNUALLY ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF ITS ANNUAL AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. BINGHAM LAND LLC 98 POPLAR ST BLACKFOOT ID 83221 711035721 REAL ESTATE HOLDING COMPANY ID 448863 -77069 BMH INC PIETRA LLC 98 POPLAR STREET BLACKFOOT ID 83221 263634345 ENDOSCOPY SERVICES ID BMH INC RELATED 132335 116573 0 0 0.60000 BMH PHYSICIANS CLINIC LLC 98 POPLAR STREET BLACKFOOT ID 83221 263952823 RENTAL REAL ESTATE ID BINGHAM LAND LLC RELATED 49171 748899 0 0 0.58720 IDAHO PATHOLOGY LABORATORY LLC 98 POPLAR STREET BLACKFOOT ID 83221 450956263 PATHOLOGY SERVICES ID BMH INC RELATED 947432 302966 0 1 0.55000 1 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 BMH PHYSICIANS CLINIC LLC A 35613 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC A 35044 GAAP ACCOUNTING BMH PHYSICIANS CLINIC LLC D 574854 GAAP ACCOUNTING PIETRA LLC E 291249 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC E 799219 GAAP ACCOUNTING BMH PHYSICIANS CLINIC LLC K 1064136 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC M 2558308 GAAP ACCOUNTING PIETRA LLC M 366478 GAAP ACCOUNTING PIETRA LLC S 90000 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC S 1073600 GAAP ACCOUNTING