2013-11-14T16:45:04-06:00 2012-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 982013510 990 2012-01-01 205126945 BMH INC BMHI 2087854100 98 POPLAR STREET BLACKFOOT ID 832211799 D JEFFERY DANIELS 2087853803 2013-11-13 1 ROBERT GRANNUM P00355876 4252597227 2012 2016-02-24 21:20:13Z LOUIS KRAML 98 POPLAR STREET BLACKFOOT ID 832211799 97263588 0 X WWW.BINGHAMMEMORIAL.ORG X 2006 ID SEE SCHEDULE O FOR DESCRIPTIONBINGHAM 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 6 832 51 998875 0 315480 472564 77035131 81972492 292960 1106858 1076290 2806145 78719861 86358059 73542 93868 0 0 39496701 40123479 0 0 0 38506529 41044272 78076772 81261619 643089 5096440 52378387 60509854 28686912 29950653 23691475 30559201 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 44266568 93868 58024539 ACUTE CARE HOSPITAL - THE HOSPITAL PROVIDED SERVICE TO 2,140 INPATIENTS, WHICH INCLUDED 6,596 TOTAL SURGERIES (INPATIENT AND OUTPATIENT), 377 NEWBORN INFANTS, AND 9,903 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. 17345704 19603453 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 66,982 SEPARATE SERVICE ENCOUNTERS FOR INDIVIDUAL PATIENTS. 3493056 5144453 NURSING HOME - THE NURSING HOME AVERAGED 44.9 RESIDENTS PER DAY RECEIVING INPATIENT SERVICES (EITHER SKILLED OR LONG-TERM CARE) DURING THE YEAR. 65105328 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 144 0 1 832 1 1 1 0 0 0 0 0 0 0 0 0 X 8 6 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 ID X X D JEFFERY DANIELS 2087853803 98 POPLAR BLACKFOOT ID 83221 LEE KNIFFIN 10.00 X X 0 0 78 HOWARD HARRINGTON 10.00 X X 0 0 73 ALICE CANNON 10.00 X X 0 0 66 WALLACE DRISCOLL 10.00 X X 0 0 284 GORDON ARAVE 6.00 X 0 0 58 JOHN FULLMER 6.00 X 0 0 53 JOSEPH CANNON 6.00 X 0 0 74 DR CLARK ALLEN 6.00 X 0 0 152 MARK BAIR 6.00 X 0 0 0 NORMAN STANLEY 6.00 X 0 0 25 LOUIS KRAML 70.00 X 378512 0 88148 JEFF DANIELS 70.00 X 316204 0 26218 DAN COCHRAN 70.00 X 225522 0 20893 CINDY CHRISTENSON 70.00 X 125849 0 17451 DR ADAM WRAY 40.00 X 924750 0 27692 DR DAVID SHELLEY 40.00 X 908505 0 18836 DR BALDWIN STUTTS 40.00 X 853374 0 14736 DR DAVID PETERSON 40.00 X 556847 0 17585 HUGH SELZNICK 20.00 X 504381 0 0 4793944 0 232422 49 0 1 0 IDAHO PATHOLOGY LABORATORY LLC 98 POPLAR STREET BLACKFOOT ID 83221 PATHOLOGICAL LABORATORY SERVICES 1270657 HOLLAND & HART PO BOX 17283 DENVER CO 80217 LITIGATION SERVICES 478242 MSVM GROUP LLC PO BOX 4864 POCATELLO ID 83201 MARKETING 476197 COLTRIN & ASSOCIATES INC 801 FLORAL VALE BLVD MORRISVILLE PA 19067 MARKETING 324664 INTERMOUNTAIN NEUROSURGERY PA 285 VISTA DR POCATELLO ID 83201 PHYSICIAN MEDICAL SERVICES 320000 13 439117 33447 472564 PATIENT REVENUE 621110 163778199 163778199 PROFESSIONAL FEES REVENUE 621110 7861018 7861018 ANCILLARY CARE SERIVCES 621500 3371109 3371109 FACILITY FEES REVENUE 621110 721834 721834 CONTRACTUAL ALLOWANCE & CHARITY C 621110 -93759668 -93759668 81972492 213253 213253 98531 172764 98531 172764 0 0 11512806 5000 10624201 0 888605 5000 893605 893605 10048 10033 15 15 MANAGEMENT SERVICE CONTRACT-DHHS 561000 998875 998875 K-1 ACTIVITY 900099 799953 799953 DHHS DISTRIBUTION 900099 600000 600000 407302 407302 2806130 86358059 82772445 998875 2114175 88368 88368 5500 5500 1199662 143331 1056331 32101325 27721595 4379730 233371 233371 4614656 3630489 984167 1974465 1682689 291776 6311855 4878196 1433659 833777 833777 123874 123874 28680 28680 2090405 2082959 7446 1464411 1464411 1818930 200230 1618700 885373 885373 1736136 1220351 515785 323759 91590 232169 156184 122756 33428 625667 625667 3231516 3231516 532203 532203 MEDICAL EXPENSES 12341316 12341316 BAD DEBT EXPENSE 5220865 5220865 OTHER SUPPLIES 1584493 1467204 117289 STATE ASSESSMENT 807473 807473 927355 210799 716556 81261619 65105328 16156291 0 101762 1385326 250000 25000 14740300 13764451 1445208 5626808 2849770 3177964 1550105 1176346 51453286 31179031 19602670 20274255 11163572 14158315 185134 36255 675000 700000 52378387 60509854 11182992 12425180 12619360 11177787 4884560 6347686 28686912 29950653 X 23691475 30559201 23691475 30559201 52378387 60509854 X 5096440 161064 1136030 474192 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 3443 3443 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 $954 AND $2,489 RESPECTIVELY. 1111209 1111209 21268887 15831574 5437313 1792218 605088 1187130 25125715 14742369 10383346 2155257 2155257 20274255 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 3968455 OBLIGATION UNDER CAPITAL LEASE 1160691 OBLIGATION UNDER PENSION PLAN 1218540 6347686 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. EFFECTIVE JANUARY 1, 2009, THE ORGANIZATION 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, 2012 OR 2011. 1 1 1 X 1 X 1 1 0 0 3 1594910 906229 688681 0.00910 3 13171349 12667367 503982 0.00660 1 120981 103205 17776 0.00020 7 14887240 13676801 1210439 0.01590 44 20161 313873 24740 289133 0.00380 1568753 42500 1526253 0.02010 167666 33559 134107 0.00180 78680 78680 0.00100 44 20161 2128972 100799 2028173 0.02670 51 20161 17016212 13777600 3238612 0.04260 1 5220865 1305216 26687286 28168920 -1481634 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 1 150.000000000000 1 200.000000000000 1 X X X 1 1 X X 1 0 1 X 0 0 14 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 SUPERIOR HEALTH CLINIC

2302 E TERRY ST POCATELLO ID 83201

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 BMH HEALTH INFORMATION

124 N OAK ST BLACKFOOT ID 83221

HOSPITAL OFFICES PORTNEUF FAMILY MEDICINE

353 N 4TH AVE 102 POCATELLO ID 83201

PHYSICIAN OFFICES IDAHO PAIN GROUP

2375 SUNNYSIDE RD SUITE F IDAHO FALLS ID 83404

PHYSICIAN OFFICES HUMAN RESOURCES

9 AIRPORT WAY BLACKFOOT ID 83221

HOSPITAL OFFICES PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5220865. PART I, LINE 7E: BINGHAM MEMORIAL HOSPITAL'S FOCUS IN SUPPORTING LOCAL PROGRAMS HINGES ON OUR MISSION TO IMPROVE THE OVERALL HEALTH AND WELLNESS IN THE COMMUNITIES WE SERVE. THIS IS ACCOMPLISHED IN THE ADULT POPULATION AS WE CONDUCT ON-SITE HEALTH FAIRS, SCREENINGS AND AWARENESS EVENTS AT LOCAL BUSINESSES. BY DONATING TO OUR SCHOOLS AND OTHER ORGANIZED ATHLETIC GROUPS, WE PROVIDE FUNDING FOR YOUTH ATHLETIC TEAMS AND EVENTS THAT WON'T HAPPEN WITHOUT OUR SUPPORT. THE HOSPITAL'S PARTICIPATION IN BINGHAM COUNTY'S RELAY FOR LIFE PROVIDES MONEY FOR THE COMMUNITY'S SINGLE LARGEST HEALTH AWARENESS EVENT. ADDITIONALLY, WE SUPPORT NON HEALTH-RELATED ACTIVITIES SUCH AS THE EASTERN IDAHO STATE FAIR, ALLOWING US TO UNITE WITH THE LARGEST EVENTS OF OUR REGION AND PROMOTE HEALTH AND WELLNESS IN AN ENVIRONMENT WHERE YOU TYPICALLY WOULDN'T FIND IT. BINGHAM MEMORIAL HOSPITAL IS PROUD OF THE ECONOMIC SUPPORT WE PROVIDE TO OUR COMMUNITY AND WE BELIEVE OUR EFFORTS MAKE A DIFFERENCE IN OUR REGION'S HEALTH. PART III, LINE 4: THERE IS NO FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBE THE ORGANIZATION'S BAD DEBT EXPENSERECEIVABLE 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 UNCLOLLECTIBLE 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. 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. RECONCILIATION OF AMOUNTS REPORTED TO MEDICARE COST REPORT PART III, LINES 5 - 6 RECONCILIATON OF AMOUNT REPORTED ON PART III, LINE 5 $19,921,533 COST REPORT MEDICARE NET REVENUE $4,207,622 PROFESSIONAL FEES MEDICARE NET REVENUE $36,772 OTHER MEDICARE NET REVENUE $2,521,359 PROVIDER PATIENT MEDICARE NET REVENUE$26,687,286 TOTAL ORGANIZATION MEDICARE NET REVENUE RECONCILATION OF AMOUNT REPORTED ON PART III, LINE 6$20,714,127 COST REPORT MEDICARE ALLOWABLE EXPENSES $7,034,933 ADDITIONAL MEDICARE ALLOWABLE EXPENSES* $148,064 MARKETING COST $271,796 RECRUITMENT COST$28,168,920 TOTAL ORGANIZATION MEDICARE NET EXPENSES *BASED ON PROPORTION OF COST TO NET CHARGES FROM COST REPORT 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. 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) 15000 2012 FAIR SPONSORSHIP IDAHO COMMUNITY FOUNDATION INC DBA IDAHO HOMETOWN HEROES 444 HOSPITAL WAY SUITE 607 POCATELLO ID 83201 820425063 501(C)(3) 10000 GENERAL SUPPORT BINGHAM HEALTH CARE FOUNDATION 98 POPLAR STREET BLACKFOOT ID 83221 820525362 501(C)(3) 19625 GENERAL SUPPORT 3 0 SCHOLARSHIPS 10 5500 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 331909 0 7633 0 38970 0 59000 0 29148 0 466660 0 0 0 JEFF DANIELS 296369 0 3804 0 16031 0 0 0 26218 0 342422 0 0 0 DAN COCHRAN 178731 0 35831 0 10960 0 0 0 20893 0 246415 0 0 0 DR ADAM WRAY 337863 0 586763 0 124 0 10000 0 17692 0 952442 0 0 0 DR DAVID SHELLEY 357403 0 547661 0 3441 0 0 0 18836 0 927341 0 0 0 DR BALDWIN STUTTS 852425 0 461 0 488 0 0 0 14736 0 868110 0 0 0 DR DAVID PETERSON 513021 0 43241 0 585 0 0 0 17585 0 574432 0 0 0 HUGH SELZNICK 504000 0 381 0 0 0 0 0 0 0 504381 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 QUALIFIY 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 2012, $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. THESE BONUSES ARE UNDER $20,000 EACH. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED TO ADD ADDITIONAL COMMUNITY-BASED QUALIFICATIONS TO BEING A MEMBER OF THE BOARD OF DIRECTORS AND TO ADD A NEW BOARD NOMINATION AND SELECTION PROCESS TO STRENGTHEN THE REQUIREMENTS THAT MEMBERS OF THE BOARD OF DIRECTORS ARE COMMUNITY NEEDS FOCUSED, ARE DEDICATED TO THE CHARITABLE MISSION OF THE HOSPITAL AND HAVE THE SKILLS NECESSARY TO GOVERN A LARGE HEALTH CARE SYSTEM. THE BYLAWS WERE ALSO AMENDED TO FORMALLY ADD THE EXECUTIVE COMPENSATION REVIEW COMMITTEE AND TO ADD A NEW BOARD NOMINATIONS COMMITTEE TO THE BYLAWS. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: BOOK TAX DIFFERENCES FROM SUBSIDIARIES K-1 662,292. CONTRIBUTION REVENUE REPORTED IN PY FINANCIAL STATEMENTS -188,100. 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 90087 -525932 BMH INC PIETRA LLC 98 POPLAR STREET BLACKFOOT ID 83221 263634345 ENDOSCOPY SERVICES ID BMH INC RELATED 112452 74239 0 0 0.60000 BMH PHYSICIANS CLINIC LLC 98 POPLAR STREET BLACKFOOT ID 83221 263952823 RENTAL REAL ESTATE ID BINGHAM LAND LLC RELATED 64351 6126527 0 0 0.58720 IDAHO PATHOLOGY LABORATORY LLC 98 POPLAR STREET BLACKFOOT ID 83221 450956263 PATHOLOGY SERVICES ID BMH INC RELATED 623150 429134 0 0 0.55000 1 0 0 1 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 BMH PHYSICIANS CLINIC LLC A 9613 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC A 38230 GAAP ACCOUNTING BMH PHYSICIANS CLINIC LLC D 583870 GAAP ACCOUNTING PIETRA LLC E 125386 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC E 1126701 GAAP ACCOUNTING BMH PHYSICIANS CLINIC LLC J 1060118 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC K 623150 GAAP ACCOUNTING IDAHO PATHOLOGY LABORATORY LLC M 1956100 GAAP ACCOUNTING PIETRA LLC M 347118 GAAP ACCOUNTING