2012-11-15T14:22:30-06:00 2011-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 982013510 990 2011-01-01 205126945 BMH INC BMHI 2087854100 98 POPLAR STREET BLACKFOOT ID 832211799 D JEFFERY DANIELS 2087853803 2012-11-15 1 ROBERT GRANNUM P00355876 4252597227 2011 2016-02-24 21:20:13Z LOUIS KRAML 98 POPLAR STREET BLACKFOOT ID 832211799 85491412 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. 9 7 869 45 0 0 46396 315480 72208252 77035131 2742362 292960 1188056 1076290 76185066 78719861 0 73542 0 0 36652142 39496701 0 0 1175 36067588 38506529 72719730 78076772 3465336 643089 51745850 52378387 28397801 28686912 23348049 23691475 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 43669278 73542 59207769 ACUTE CARE HOSPITAL - THE HOSPITAL PROVIDED SERVICE TO 2,311 INPATIENTS, WHICH INCLUDED 6,546 TOTAL SURGERIES (INPATIENT AND OUTPATIENT), 444 NEWBORN INFANTS, AND 9,960 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. 17238345 14624724 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 68,829 SEPARATE SERVICE ENCOUNTERS FOR INDIVIDUAL PATIENTS. 2784016 3799084 NURSING HOME - THE NURSING HOME AVERAGED 46.7 RESIDENTS PER DAY RECEIVING INPATIENT SERVICES (EITHER SKILLED OR LONG-TERM CARE) DURING THE YEAR. 63691639 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 1 0 0 0 0 1 1 1 1 0 0 1 130 0 1 869 1 0 0 0 0 0 0 0 0 0 0 X 9 7 1 0 0 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 HOWARD HARRINGTON 5.00 X X 0 0 117 LEE KNIFFIN 5.00 X X 0 0 91 ALICE CANNON 5.00 X X 0 0 88 GORDON ARAVE 3.00 X 0 0 35 JOHN FULLMER 3.00 X 0 0 53 NORMAN STANLEY 3.00 X 0 0 127 WALLACE DRISCOLL 3.00 X 0 0 325 JOE CANNON 3.00 X 0 0 63 DR CLARK ALLEN 3.00 X 0 0 127 LOUIS KRAML 70.00 X 439846 0 63459 JEFF DANIELS 70.00 X 329588 0 25216 DAN COCHRAN 70.00 X 249328 0 17709 DR GARY CALL 40.00 X 149332 0 10000 CINDY CHRISTENSON 70.00 X 126450 0 16542 DR ADAM WRAY 40.00 X 827310 0 25921 DR DAVID SHELLEY 40.00 X 1015646 0 16584 DR DAVID PETERSON 40.00 X 499944 0 16584 DR TIMOTHY WOODS 40.00 X 469985 0 15921 DR GAIL FIELDS 40.00 X 477765 0 0 4585194 0 208962 48 0 1 0 IDAHO PATHOLOGY LABORATORY LLC 98 POPLAR STREET BLACKFOOT ID 83221 PATHOLOGICAL LABORATORY SERVICES 768113 MSVM GROUP LLC PO BOX 4864 POCATELLO ID 83201 MARKETING 728235 NORTHWEST EMERGENCY PHYSICIANS PO BOX 634850 CINCINNATI OH 452634850 PHYSICIAN MEDICAL SERVICES 508220 INTERMOUNTAIN NEUROSURGERY PA 285 VISTA DR POCATELLO ID 83201 PHYSICIAN MEDICAL SERVICES 320000 PIETRA LLC 4501 COLLEGE BLVD SUITE 320 LEAWOOD KS 66211 ENDOSCOPY SERVICES 270998 18 57749 257731 315480 PATIENT REVENUE 621110 155175419 155175419 PROFESSIONAL FEES REVE 621110 6727295 6727295 FACILITY FEES REVENUE 621110 301994 301994 CHARITY CARE 621110 -1151215 -1151215 CONTRACTUAL ALLOWANCE 621110 -84018362 -84018362 77035131 173840 173840 104298 172764 104298 172764 0 0 0 6592589 7500 6480969 0 111620 7500 119120 119120 13378 13520 -142 -142 MANAGEMENT SERVICE CON 624200 802336 802336 CAFETERIA 722210 479986 479986 ANCILLARY CARE SERVICE 621500 76990 76990 -282880 -282880 1076432 78719861 76829241 0 1575140 73542 73542 1428497 1025187 403310 31608306 27502338 4105968 200412 200412 4079641 3372113 707528 2179845 1807474 372371 4867060 3778100 1088960 104007 104007 115500 115500 119924 119924 1989371 1885871 103500 1598512 1598512 947815 947485 330 768021 768021 1875441 1241779 633662 422728 142941 279787 153712 113897 39815 567127 567127 2322123 2322123 568084 568084 MEDICAL EXPENSES 8781024 8781024 BAD DEBT EXPENSE 5416911 5416911 OTHER SUPPLIES 4922854 4819539 102470 845 STATE ASSESSMENT 1030147 1030147 1936168 640304 1295864 78076772 63691639 14383958 1175 1543779 101762 933602 250000 11130222 14740300 3079975 1445208 2483589 2849770 748182 1550105 47574878 27972208 18499735 19602670 13062849 11163572 263917 0 0 675000 51745850 52378387 8576075 11182992 11606416 12619360 8215310 4884560 28397801 28686912 X 23348049 23691475 23348049 23691475 51745850 52378387 X 643089 -299663 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3210 3210 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 ASSOCIATION. THE PORTION OF IDAHO HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING WAS $2,375 AND $835 RESPECTIVELY. 771904 771904 20942539 15006553 5935986 1591852 482962 1108890 19385443 12482693 6902750 4883140 4883140 19602670 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1299107 OBLIGATION UNDER CAPITAL LEASE 601836 OBLIGATION UNDER PENSION PLAN 1227560 INVESTMENTS IN AFFILIATES 1756057 4884560 78719861 78076772 643089 -220903 -78760 -299663 343426 80663048 -220903 2969178 2748275 77914773 805088 805088 78719861 78632654 1880580 1880580 76752074 1324698 1324698 78076772 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2011 OR 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: BOOK TAX DIFFERENCES FROM SUBSIDIARIES K-1 -78,760. PART XII, LINE 2D - OTHER ADJUSTMENTS: GIFT SHOP COST OF GOODS SOLD 13,520. PIETRA, LLC REVENUE FROM CONSOLIDATION 284,496. RENTAL EXPENSES 277,062. BINGHAM PHYSICIANS REVENUE FROM CONSOLIDATION 1,409,586. LOSS ON INTEREST RATE SWAP AGREEMENT -753,988. IDAHO PATHOLOGY LABORATORY INCOME FROM CONSOLIDATION 1,119,708. MISCELLANEOUS EXPENSE -2,976. 2010 BMH LAND INCOME FROM BINGHAM PHYSICIANS 621,770. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTERCOMPANY REVENUE ELIMINATED UPON CONSOLIDATION 723,807. PENTALTY EXPENSE 2,521. BOOK TAX DIFFERENCES FROM SUBSIDIARIES K-1 78,760. PART XIII, LINE 2D - OTHER ADJUSTMENTS: GIFT SHOP COST OF GOODS SOLD 13,520. PIETRA, LLC EXPENSES FROM CONSOLIDATION 137,181. RENTAL EXPENSES 277,062. BINGHAM PHYSICIANS EXPENSES FROM CONSOLIDATION 937,003. IDAHO PATHOLOGY LABORATORY EXPENSES FROM CONSOLIDATION 518,790. MISCELLANEOUS EXPENSE -2,976. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INTERCOMPANY EXPENSES ELIMINATED UPON CONSOLIDATION 1,322,177. PENALTY EXPENSE 2,521. 1 1 1 X 1 X 1 1 0 0 3 2025461 962153 1063308 0.01460 3 9777181 8932472 844709 0.01160 547729 480194 67535 0.00090 6 12350371 10374819 1975552 0.02710 437448 32991 404457 0.00560 971990 73750 898240 0.01240 0.00000 95079 2420 92659 0.00130 76046 76046 0.00100 1580563 109161 1471402 0.02030 6 13930934 10483980 3446954 0.04740 1 5416911 1354228 26209388 27100130 -890742 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 11 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 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 $ 5416911. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS 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 WOULDN'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 EVENT 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 LINE 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 $19,260,648 COST REPORT MEDICARE NET REVENUE $7,029,289 PROFESSIONAL & FACILITY FEES MEDICARE NET REVENUE $76,602 OTHER MEDICARE NET REVENUE$26,366,539 TOTAL ORGANIZATION MEDICARE NET REVENUE RECONCILATION OF AMOUNT REPORTED ON PART III, LINE 6$19,534,637 COST REPORT MEDICARE ALLOWABLE EXPENSES $7,047,589 ADDITIONAL MEDICARE ALLOWABLE EXPENSES* $200,093 MARKETING COST $317,811 RECRUITMENT COST$27,100,130 TOTAL ORGANIZATION MEDICARE NET REVENUE *BASED ON PROPORTION OF COST TO NET CHARGES FROM COST REPORT BINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 13G: ABRIDGED BROCHURE WITH POLICY HIGHLIGHTS AVAILABLE IN ER, ADMISSIONS, AND PATIENT FINANCIAL SERVICES. BINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: 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 GENERAL SUPPORT ISU FOUNDATION CAMPUS BOX 8050 POCATELLO ID 83209 826013543 501(C)(3) 5000 GENERAL SUPPORT 2 0 X X X 0 1 0 0 0 0 0 1 0 LOUIS KRAML 384057 0 34254 0 21535 0 35000 0 28459 0 503305 0 0 0 JEFF DANIELS 292831 0 27507 0 9250 0 0 0 25216 0 354804 0 0 0 DAN COCHRAN 184424 0 56707 0 8197 0 0 0 17709 0 267037 0 0 0 DR GARY CALL 149254 0 78 0 0 0 0 0 10000 0 159332 0 0 0 DR ADAM WRAY 310163 0 510813 0 6334 0 10000 0 15921 0 853231 0 0 0 DR DAVID SHELLEY 346317 0 668876 0 453 0 0 0 16584 0 1032230 0 0 0 DR DAVID PETERSON 468617 0 30920 0 407 0 0 0 16584 0 516528 0 0 0 DR TIMOTHY WOODS 468017 0 1148 0 820 0 0 0 15921 0 485906 0 0 0 DR GAIL FIELDS 473000 0 715 0 4050 0 0 0 0 0 477765 0 0 0 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 2011, $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. CRESTWOOD ENTERPRISES PARTNERSHIP MORE THAN 5% OWNED BY TWO DIRECTORS 228405 LEASE WITH A PARTNERSHIP MORE THAN 5% OWNED BY GORDON ARAVE, DIRECTOR, AND JOHN FULLMER, DIRECTOR, DURING 2011. 0 PART IV CRESTWOOD ENTERPRISES OWNERSHIP GORDON ARAVE, DIRECTOR, SOLD HIS INTEREST IN CRESTWOOD ENTERPRISES DURING 2011 AND DID NOT OWN ANY INTEREST IN THE ENTITY AS OF DECEMBER 31, 2011. FORM 990, PART VI, SECTION A, LINE 2 TWO DIRECTORS OF THE ORGANIZATION DISCLOSED ON SCHEDULE L ARE JOINT OWNERS OF CRESTWOOD ENTERPRISES LLC, FROM WHICH THE HOSPITAL LEASES PHYSICIAN OFFICE SPACE. 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 TRUSTEES FOR REVIEW PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBER MAY DECLARE CONFLICT AT A BOARD MEETING, DURING DISCUSSION AND ANNUALLY WITH CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 IN ORDER TO ENSURE THAT OUR EXECUTIVE COMPENSATION IS IN LINE WITH WHERE IT SHOULD BE, WE HAVE COMPARED OUR DATA TO A COUPLE OF DIFFERENT SOURCES, MOST NOTABLY AN EXECUTIVE COMPENSATION EVALUATION CONDUCTED BY MERCER IN 2009. MERCER CONSIDERED OUR TOTAL EXECUTIVE CASH COMPENSATION PROGRAM IN COMPARISON WITH OTHER HOSPITALS OF A SIMILAR SERVICES AND REVENUE LEVEL. IN THAT EVALUATION, EACH POSITION WAS MATCHED TO AT LEAST THREE OTHER SURVEY SOURCES TO DEVELOP A MORE COMPREHENSIVE PICTURE OF CURRENT MARKET PRACTICES. IT WAS DETERMINED THAT OVERALL, TARGET TOTAL CASH COMPENSATION IS AT THE MARKET MEDIAN. ADDITIONALLY, IN 2011, ANOTHER STUDY WAS COMMISSIONED BY INTEGRATED HEALTHCARE STRATEGIES THAT SOUGHT TO VALIDATE THE SPECIFIC COMPENSATION LEVELS OF EXECUTIVES, INCLUDING THE CEO AT BINGHAM MEMORIAL HOSPITAL. THE BOARD OF DIRECTORS APPROVE THE CEO'S COMPENSATION. 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 5: NET UNREALIZED LOSSES ON INVESTMENTS: -220,903. BOOK TAX DIFFERENCES FROM SUBSIDIARIES K-1 -78,760. TOTAL TO FORM 990, PART XI, LINE 5: -299,663. FORM 990, PART XI, LINE 2C: THE HOSPITAL'S FINANCE COMMITTEE ANNUALLY ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF ITS ANNUAL AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. 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