2011-11-15T13:57:36-06:00 2010-12-31 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2010-01-01 880065829 BOULDER CITY HOSPITAL INC BOUL 7022934111 901 ADAMS BOULEVARD BOULDER CITY NV 89005 FREY BELETE 7022934111 2011-11-14 1 KATHLEEN J LABRAKE CPA 7158453111 2011-11-14 2010 2016-02-24 21:20:13Z FREY BELETE 901 ADAMS BOULEVARD BOULDER CITY NV 89005 19653073 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 47-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. 13 13 259 669 0 0 46210 64514 19172014 18963342 -64194 16575 36757 40855 19190787 19085286 0 0 0 0 10174453 10023340 0 0 0 9638507 9810388 19812960 19833728 -622173 -748442 11912478 11946754 8422159 8156154 3490319 3790600 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 16945688 18920193 BOULDER CITY HOSPTIAL OPERATES AN ACUTE CARE HOSPITAL WITH EMERGENCY SERVICES AND SKILLED NURSING UNIT. ADMISSIONS FOR THE HOSPTIAL AND SKILLED NURSING FACILITY WERE 517 AND 150, RESPECTIVELY. TOTAL PATIENT DAYS WERE 1,887 AND 13,587, RESPECTIVLEY. THERE WERE 5,183 EMERGENCY ROOM VISITS. 16945688 1 1 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 31 0 1 259 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NV X FREY BELETE CONTROLLER 7022934111 901 ADAMS BLVD BOULDER CITY NV 89005 KATHY CALHOUN 2012 0.50 X 0 0 0 GOLDIE BEGLEY 2010 0.50 X X 0 0 0 DEREK MEEKS DO 2012 0.50 X 0 0 0 MICHAEL RAVITCH MD 2012 0.50 X 0 0 0 JOE HARDY MD 2010 0.50 X 0 0 0 VERNON BURK 2012 0.50 X 0 0 0 SCOTT LIEN 2012 0.50 X X 0 0 0 CHRISTINE A MILBURN 2011 0.50 X X 0 0 0 BOB KENNEY 2011 0.50 X X 0 0 0 LINDA FAISS 2011 0.50 X 0 0 0 ANDREA ANDERSON 2011 0.50 X 0 0 0 WENDELL WHITMANN 2012 0.50 X 0 0 0 BRUCE WOODBURY 2012 0.50 X 0 0 0 THOMAS E MAHER 40.00 X 171776 0 15355 DEBRA K BALIDO 40.00 X 122219 0 4350 FREY BELETE 40.00 X 76912 0 3781 JACKSON C BAILEY 40.00 X 101750 0 10799 472657 0 34285 3 0 1 0 EPIPHANY SURGICAL 2110 E FLAMINGO 109 LAS VEGAS NV 89119 OP SURGICAL COMPANY 414517 DANIEL ROLLINS MD PO BOX 91930 HENDERSON NV 89009 ER PHYSICIAN 216330 DEREK MEEKS DO PC 1885 HILLSBORO DRIVE HENDERSON NV 89074 ER PHYSICIAN 184142 GREEN VALLEY MEDICAL IMAGING 743 DESCARTES AVENUE HENDERSON NV 89002 EKG & ULTRASOUND IMAGING 145345 WILLIAM HARRINGTON 2020 HOMEVIEW CT LAS VEGAS NV 89117 ER PHYSICIAN 110154 5 64514 64514 NET PATIENT SERVICE RE 900099 18853257 18853257 OTHER OPERATING REVENU 900099 66936 66936 CAFETERIA SALES 900099 43149 43149 18963342 6829 6829 60354 19499 40855 40855 40855 558034 548288 9746 9746 9746 19085286 18920193 0 100579 506942 506942 7773134 7038065 735069 43569 37034 6535 1089120 925752 163368 610575 518989 91586 5632 5632 54500 54500 2321922 1653703 668219 27458 27458 347783 262122 85661 365167 318738 46429 926432 886218 40214 216647 184150 32497 PROVISION FOR BAD DEBTS 2403000 2403000 PATIENT CARE SUPPLIES 2195245 2085483 109762 EQUIPMENT RENTAL AND MA 569863 341918 227945 OTHER 234986 173890 61096 REGISTRY EXPENSE 141753 116626 25127 19833728 16945688 2888040 0 286881 366028 3065782 2570919 1891492 1919275 119555 568066 517785 323360 104679 220227 19545874 13719780 5775978 5826094 150326 152785 11912478 11946754 1946913 2193240 5304232 5021237 1171014 941677 8422159 8156154 X 3324813 3622957 165506 167643 3490319 3790600 11912478 11946754 X -748442 1048723 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 49 49 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: DUES TO NEVADA HOSPITAL ASSOCIATION THAT ARE ALLOCATED TO LOBBYING ON BEHALF OF MEMBERS. 287987 287987 8430896 5612158 2818738 351099 279574 71525 9617836 7828048 1789788 858056 858056 5826094 19085286 19833728 -748442 1048723 1048723 300281 19196336 111050 111050 19085286 0 19085286 19833728 0 19833728 0 19833728 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: BOULDER CITY HOSPITAL IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAX. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN INCOME TAX POSITIONS, ASC TOPIC 740-10, ACCOUNT FOR UNCERTAINTY IN INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS 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 RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: CONTRIBUTIONS FOR CAPITAL ACQUISITION 928,887. CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY 5,923. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 113,913. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION AND AUXILLIARY 111,050. 1 1 1 X 1 X 150.000000000000 1 0 0 34575 34575 0.00200 1674888 1674888 0.09610 94796 94796 0.00540 1804259 1804259 0.10350 1804259 1804259 0.10350 1 1377822 0 5667345 6373409 -706064 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 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: A COST-TO-CHARGE RATIO WAS DETERMINED USING WORKSHEET 2. PART I, L7 COL(F): BAD DEBT EXPENSE FOR THE YEAR WAS $2,403,000. 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: A COST-TO-CHARGE RATIO IS USED TO PREPARE THE MEDICARE COST REPORT. THE DATA REPORTED ABOVE WAS TAKEN FROM THE MEDICARE COST REPORT. 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. 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 2009, 49% OF GROSS PATIENT REVENUE WAS ATTRIBUTABLE TO MEDICARE PATIENT SERVICES. PART VI, LINE 6: 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 171776 0 0 0 0 0 0 0 15355 0 187131 0 0 0 DEREK MEEKS DO PC DR. MEEKS IS A CONTRACTED ER PHYSICIAN WITH BOULDER CITY HOSPITAL, INC. 184142 DR. MEEKS IS CONTRACTED ER PHYSICIAN WITH BOULDER CITY HOSPITAL, INC. 0 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS. THE RETURN IS REVIEWED BY THE BOARD AT THEIR MONTHLY 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 5: CONTRIBUTIONS FOR CAPITAL ACQUISITION 928,887. CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY 5,923. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 113,913. TOTAL TO FORM 990, PART XI, LINE 5: 1,048,723. FORM 990, PART XI, LINE 2C THE 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) 509 (A) (1) N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0