2013-08-15T15:27:43-05:00 2012-12-31 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2012-01-01 880065829 BOULDER CITY HOSPITAL INC BOUL 7022934111 901 ADAMS BOULEVARD BOULDER CITY NV 89005 LANCE SPINDLER 7022934111 2013-08-14 1 KATHLEEN J LABRAKE CPA P00164006 7158453111 2013-08-12 2012 2016-02-25 16:41:14Z LANCE SPINDLER 901 ADAMS BOULEVARD BOULDER CITY NV 89005 17333148 0 X WWW.BOULDERCITYHOSPITAL.ORG X 1954 NV BOULDER CITY HOSPITAL, INC. IS A NONPROFIT, NONSTOCK CORPORATION WHICH OPERATES A 20-BED ACUTE CARE FACILITY, A 39-BED SKILLED NURSING FACILITY, AND A HOME HEALTH AGENCY. THE HOSPITAL PROVIDES COMPREHENSIVE MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, SKILLED NURSING, AND HOME HEALTH SERVICES TO THE RESIDENTS OF CLARK COUNTY. 11 11 261 709 0 0 29449 33351 15889983 17257311 9800 5776 29349 21339 15958581 17317777 0 0 0 0 9991468 10059212 0 0 0 7624154 8856715 17615622 18915927 -1657041 -1598150 10996836 10290839 7962382 8668582 3034454 1622257 X BOULDER CITY HOSPITAL SEEKS TO CONTINUALLY IMPROVE THE QUALITY OF THE CARE AND SERVICE TO OUR PATIENTS, GUESTS, AND PHYSICIANS. WE PROMOTE EFFECTIVE AND EFFICIENT UTILIZATION OF AVAILABLE RESOURCES TO ENSURE LONG-TERM FINANCIAL VIABILITY. BOULDER CITY HOSPITAL SEEKS TO EARN THE TRUST OF THE RESIDENTS OF BOULDER CITY, NEIGHBORING COMMUNITIES AND AREA VISITORS BY MEETING THEIR HEALTH CARE, SAFETY AND RELATED EDUCATIONAL NEEDS WITH COMPASSION, INTEGRITY, AND SINCERITY WITHOUT REGARD TO ONE'S ABILITY TO PAY. 0 0 16055120 17212333 BOULDER CITY HOSPTIAL OPERATES AN ACUTE CARE HOSPITAL WITH EMERGENCY SERVICES AND SKILLED NURSING UNIT. ADMISSIONS FOR THE HOSPTIAL AND SKILLED NURSING FACILITY WERE 399 AND 72, RESPECTIVELY. TOTAL PATIENT DAYS WERE 1,992 AND 11,984, RESPECTIVLEY. THERE WERE 5,354 EMERGENCY ROOM VISITS. 16055120 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 15 0 1 261 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X FREY BELETE CONTROLLER 7022934111 901 ADAMS BLVD BOULDER CITY NV 89005 MICHAEL RAVITCH MD 2017 0.50 X 0 0 0 DEREK MEEKS DO 2017 0.50 X 0 0 0 BOB KENNY 2016 0.50 X X 0 0 0 PEGGY CASPAR2015 0.50 X X 0 0 0 VERNON BURK 2013 0.50 X 0 0 0 CHRISTINE A MILBURN 2016 0.50 X 0 0 0 WENDELL WHITMAN 2013 0.50 X X 0 0 0 LINDA FAISS 2016 0.50 X X 0 0 0 CRESENT HARDY 2015 0.50 X 0 0 0 ALAN BOWMAN 2015 0.50 X 0 0 0 ROSS JOHNSON 2017 0.50 X 0 0 0 BRUCE WOODBURY 2013 0.50 X 0 0 0 THOMAS E MAHER 40.00 X 178526 0 8878 ANDRE R PATIEN 40.00 X 96864 0 11029 FREY BELETE 40.00 X 94543 0 6934 LANCE A SPINDLER 40.00 X 97436 0 0 NANCY TARDY 40.00 X 126382 0 0 593751 0 26841 2 0 1 0 EMCARE 1373 NOEL ROAD SUITE 1600 DALLAS TX 75240 ER PHYSICIANS 407453 1 33351 33351 NET PATIENT SERVICE RE 900099 17167994 17167994 CAFETERIA SALES 900099 44978 44978 OTHER OPERATING REVENUE 900099 44339 44339 17257311 5276 5276 36710 15371 21339 21339 21339 500 0 500 500 500 17317777 17212333 0 72093 8383025 7125571 1257454 1089492 926068 163424 586695 498691 88004 14258 14258 60000 60000 2573632 2187086 386546 197501 148126 49375 340775 255127 85648 340539 294110 46429 703164 668006 35158 122076 103765 18311 PROVISION FOR BAD DEBT 2395883 2036501 359382 PATIENT CARE SUPPLIES 1539568 1462590 76978 EQUIPMENT RENTAL AND MA 533466 320080 213386 REGISTRY EXPENSE 35853 29399 6454 18915927 16055120 2860807 0 267559 570882 1633883 887642 1980237 2387646 174549 350759 389004 305073 191151 56251 17961924 12404504 6201421 5557420 159032 175166 10996836 10290839 2232197 3517174 4723242 4405246 1006943 746162 7962382 8668582 X 3013389 1601192 21065 21065 3034454 1622257 10996836 10290839 X -1598150 185953 X X 0 1 X 1 0 X 652289 652289 9142707 5738174 3404533 351099 298392 52707 7610096 6217640 1392456 205733 150298 55435 5557420 X 15107847 -2209930 -2209930 17317777 0 17317777 16520044 0 16520044 2395883 2395883 18915927 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN INCOME TAX POSITIONS, THE HOSPITAL DETERIMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. IN 2012 AND 2011, THERE WERE NO PAYMENTS OF INCOME TAX, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE HOSPITAL IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 AND 2011. FEDERAL RETURNS FOR 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION AND AUXILLARY 185,953. BAD DEBT PROVISION -2,395,883. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT PROVISION 2,395,883. 1 1 1 X 1 X 1 0 0 76109 76109 0.00460 2217680 2015809 201871 0.01220 2293789 2015809 277980 0.01680 2293789 2015809 277980 0.01680 1 1482511 6664641 6552895 111746 X 1 1 1 1 BOULDER CITY HOSPITAL INC

901 ADAMS BLVD BOULDER CITY NV 89005

X X X X BOULDER CITY HOSPITAL INC 1 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X 1 X 1 X X X X X 1 X 0 0 1 BOULDER CITY HOSPITAL INC

901 ADAMS BLVD BOULDER CITY NV 89005

SKILLED NURSING PART I, LINE 3C: BOULDER CITY HOSPITAL ("THE HOSPITAL") USES 150% OF THE FEDERAL POVERTY GUIDELINES ("FPG") TO QUALIFY PATIENTS FOR CHARITY CARE. ONCE QUALIFIED, THE HOSPITAL USES A SLIDING SCALE BASED ON INCOME AND NUMBER OF DEPENDENTS TO DETERMINE THE AMOUNT A PATIENT IS REQUIRED TO PAY IN FULL SATISFACTION OF THEIR HOSPITAL LIABILITY. PATIENTS NOT FALLING WITHIN THE FPG MAY QUALIFY FOR CHARITY CARE AFTER BEING CONSIDERED BY THE CHARITY CARE COMMITTEE. PART I, LINE 7: BOULDER CITY HOSPITAL, INC. USES A COST TO CHARGE RATIO FOR DETERMINING THE AMOUNT REPORTED IN PART I, LINE 7A. THE COST TO CHARGE RATIO USED TO REPORT LINE 7A WAS CALCULATED USING THE TOTAL COST FOR THE ENTIRE HOSPITAL ORGANIZATION TO THE TOTAL PATIENT CHARGES FOR THE ENTIRE HOSPITAL. A SEPARATE COST TO CHARGE RATIO WAS USED TO CALCULATE THE UNREIMBURSED MEDICAID TO SHOW A MORE ACCURATE REPRESENTATION THE COMMUNITY BENEFIT EXPENSE.LINE 7B USES A COST TO CHARGE RATIO DETERMINED FROM THE MEDICARE COST REPORT TO MORE ACCURATELY REPRESENT THE COMMUNITY BENEFIT EXPENSE FROM MEDICAID. PART I, L7 COL(F): BAD DEBT EXPENSE FOR THE YEAR WAS $2,395,883. THIS AMOUNT WAS OMITTED FROM TOTAL EXPENSES WHEN CALCULATING COMMUNITY BENEFIT EXPENSE FOR SCHEDULE H. PART II: NEW PROGRAMS AND EQUIPMENT ARE PAID FROM FUNDS GENERATED INTERNALLY THROUGH OPERATIONS. PART III, LINE 4: TO DETERMINE THE COST OF BAD DEBT EXPENSE, THE HOSPITAL USES A COST-TO-CHARGE RATIO CALCULATED ON WORKSHEET 2.FINANCIAL STATMENT FOOTNOTE REGARDING BAD DEBTS - THE CARRYING AMOUNTS OF ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO GROSS REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE.THE HOSPITAL IS IN COMPLIANCE WITH HEALTHCARE MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND THEREFORE WOULD NOT REPORT ANY BAD DEBT ATTRIBUTABLE TO CHARITY CARE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DUE NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SHCEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COST OF CARING FOR PATIENTS. EMERGENCY AND SURGICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD BE CONSIDERED AS A BENEFITS TAHT BOULDER CITY HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR THE IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED DECEMBER 31, 2011 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICES REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TEYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING THE SERVICES TO ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: WITHIN BOULDER CITY HOSPITAL'S COLLECTION POLICY, PROVISIONS ARE MADE FOR COLLECTION PRACTICES FOR THOSE WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. THE PATIENT MUST REQUEST, OR THE COLLECTION COORDINATOR MAY RECOMMEND A PATIENT FOR CHARITY CARE ASSISTANCE. PATIENTS MUST ALSO EXHAUST OTHER ASSISTANCE PROGRAMS AVAILABLE, SUCH AS ASSISTANCE FROM CLARK COUNTY OR THE STATE OF NEVADA. PATIENTS WHO QUALIFY FOR COUNTY AND STATE ASSISTANCE ARE SUBJECT TO TRADITIONAL COLLECTION PRACTICES TO THE EXTENT OF THE PATIENTS LIABILITY FOR CARE PROVIDED. PATIENTS ON FINANCIAL ASSISTANCE CAN ALSO BE PLACED ON PAYMENT PLANS TO HELP THEM PAY DOWN AMOUNTS OWED TO THE HOSPITAL. BOULDER CITY HOSPITAL, INC PART V, SECTION B, LINE 20D: BOULDER CITY HOSPITAL FOLLOWS ITS FINANCIAL ASSISTANCE POLICY TO DETERMINE WHAT THEY EXPECT TO RECEIVE FROM FAP ELIGIBLE PATIENTS. FAP ELIGIBLE INDIVIDUALS WITH INCOME UP TO 100% FPG ARE NOT CHARGED ANYTHING AND INDIVIDUALS UP TO 200% OF FPG ARE CHARGED ON SLIDING DISCOUNTED SCALE. PART VI, LINE 2: THE HOSPITAL IDENTIFIES NEEDS OF THE COMMUNITY THROUGH INTERACTION AND FEEDBACK FROM BOARD MEMBERS, PHYSICIANS, STAFF AND PATIENTS. PART VI, LINE 3: ADMITTING STAFF HANDS PAMPHLET EXPLAINING CHARITY POLICY TO PATIENT. THE PATIENT IS INSTRUCTED TO READ PAMPHLET AND COMPLETE IF NECESSARY. BUSINESS OFFICE STAFF CONTACTS PATIENT AFTER FIRST BILL IS SENT. PATIENT IS INSTRUCTED TO APPLY FOR CHARITY CARE AT THAT TIME IF NEEDED. PART VI, LINE 4: BOULDER CITY HOSPITAL SERVES BOULDER CITY, NV AND THE WESTERN PORTION OF HENDERSON, NV. NEARLY HALF OF THE AREAS RESIDENTS RELY ON MEDICARE SUBSIDIES TO PAY FOR HEALTH CARE. FOR 2011, 59% OF GROSS PATIENT REVENUE WAS ATTRIBUTABLE TO MEDICARE PATIENT SERVICES. PART VI, LINE 5: BOULDER CITY HOSPITAL MAINTAINS A 24 HOUR EMERGENCY ROOM THAT IS AVAILABLE TO RESIDENTS IN ITS COMMUNITY WITHOUT REGARD TO ABILITY TO PAY. THE HOSPITAL IS ALSO THE SOLE COMMUNITY PROVIDER OF HEALTH CARE, AS IT IS DESIGNATED A CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDES HEALTH CARE TO RESIDENTS WHO WOULD NOT OTHERWISE HAVE ACCESS TO READILY AVAILABLE HEALTH CARE. X X X 0 0 0 0 0 0 0 0 0 THOMAS E MAHER 178526 0 0 0 0 0 0 0 8878 0 187404 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS SIGNED BY THE CEO THOMAS MAHER. A COPY IS EMAILED TO ALL BOARD MEMBERS. THE BOARD OFFICIALLY REVIEWS THE 990 AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES COMPLETE THE CONFLICT OF INTEREST DISCLOSURE STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THESE INDIVIDUALS IS DETERMINED BY THE HUMAN RESOURCES DEPARTMENT. HR USES A SALARY SURVEY FROM THE NEVADA HOSPITAL ASSOCIATION TO DETERMINE THE APPROPRIATE COMPENSATION AMOUNTS. PERSONS INVOLVED IN THIS PROCESS ARE INDEPENDENT AND THE CONCLUSIONS WERE PROPERLY DOCUMENTED. THE CEO COMPENSATION IS DETERMINED AND APPROVED BY AN INDEPENDENT COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 BOULDER CITY HOSPITAL MAKES ITS DOCUMENTS AVAILABLE TO THE PUBLIC THROUGH THE HOSPITAL'S ADMINISTRATION DEPARTMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CONTRIBUTIONS FOR CAPITAL ACQUISITION CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY 177,109. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 8,844. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BOULDER CITY HOSPITAL FOUNDATION 901 ADAMS BOULEVARD BOULDER CITY NV 89005 943141555 FINANCIAL SUPPORT OF BOULDER CITY HOSPITAL, INC. NV 501 C (3) LINE 11C, III-FI N/A 0 AUXILIARY OF THE BOULDER CITY HOSPITAL INC 901 ADAMS BOULEVARD BOULDER CITY NV 89005 886001696 SUPPORT THE WELFARE OF BOULDER CITY HOSPITAL, INC. NV 501 C (3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0