2022-09-27T07:34:13-05:00 2021-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-01-01 820207116 Bonner General Hospital Inc BONN 2082631441 520 N Third Avenue Sandpoint ID 83864 Sheryl Rickard CEO 2082631441 2022-09-26 1 Sheryl Rickard 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-09-26 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Bonner General Health Sheryl Rickard 520 N Third Avenue Sandpoint ID 83864 70499021 0 X www.bonnergeneral.org X 1949 ID To provide excellence in healthcare 8 7 590 120 0 0 5903804 6302957 53410237 63295172 -10534 -5500 161855 272997 59465362 69865626 0 0 0 0 30238571 33550222 0 0 0 25516982 27907756 55755553 61457978 3709809 8407648 53667089 61157636 20384995 19147959 33282094 42009677 X To provide excellence in healthcare 0 0 53407909 63295172 Bonner General Hospital (BGH), located in Sandpoint, Idaho, is a full-service critical access hospital licensed for 25 beds. BGH is accredited by the DNV. BGH is the sole provider of inpatient acute care and many other outpatient services in Bonner county. BGH provides services to a largely rural and widely dispersed population of approximately 60,000. Its patient service areas extend to the Canadian border, the western edge of Montana and the eastern border of Washington. BGH provides inpatient and outpatient services regardless of an individual's ability to pay, utilizing moral and ethical principles. Services provided include emergency care, diagnostic and therapeutic services, and prevention programs. BGH also provides educational programs, support groups, counseling and seminars for patients and the general public, as well as professional education programs for high school and college students and its staff. BGH is dedicated to providing quality, patient-focused services that are determined to be both necessary and feasible. Through evaluation and planning by hospital leadership, BGH will continue to identify the existing and future needs of the patients to be served and will strive to continually improve its performance in meeting those needs. During the period of 01/01/21 to 12/31/21, BGH admitted 1,584 patients, serviced 10,695 emergency room visits, delivered 281 babies, and performed 2,458 surgical procedures. During that same period, BGH provided 5,248 days of patient care and 3,321 Hospice visits. BGH provides care to persons covered by government-sponsored health care programs (i.e., Medicare and Medicaid) at below cost, as well as free and/or subsidized care to indigent patients. For the period of 01/01/21 to 12/31/21 BGH provided $35,057,482 in unreimbursed care to government-sponsored health care program (i.e., Medicare and Medicaid), $2,578,193 in uncompensated care to private pay patients, and $425,801 in charity care, based on gross charges. 53407909 1 1 0 0 0 0 0 1 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 71 0 1 590 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X Sheryl Rickard 2082631441 520 N Third Avenue Sandpoint ID 83864 Sheryl Rickard CEO 40.00 X X 255634 0 33016 Ford Elsaesser Chairman 0.50 X X 0 0 0 Tim Cochran Vice-Chairman 0.50 X X 0 0 0 Thomas Lawrence MD Secretary/Treasurer 0.50 X X 0 0 0 Scott Burghstaher MD Director 0.50 X 0 0 0 James Frank Director 0.50 X 0 0 0 Bart Casey Director 0.50 X 0 0 0 Michelle Anderson DNP Director 0.50 X 0 0 0 John Hennessy CFO (Sep-Dec) 40.00 X 91576 0 3350 Geoff Mandala Prior CFO (Jan-July) 40.00 X 124301 0 11507 Tracy Autler CNO 40.00 X 163360 0 247307 Jonathan Klauke MD Orthopedic Surgeon 40.00 X 595934 0 20504 Susan Anderson MD Otolaryngology Surgeon 40.00 X 414846 0 13484 Douglas Cipriano MD Orthopedic Surgeon 40.00 X 561689 0 26488 Brent Leedle MD Orthopedic Surgeon 40.00 X 576401 0 12622 Mark TorresMD Ophthalmologist 40.00 X 350086 0 3922 3133827 0 372200 31 0 1 0 Lake Pend Orielle Emergency Medicine 3734 Lakeshore Dr Sagle ID 83860 Emergency Services 2030520 Kootenai Imaging 700 W Ironwood Dr 175 Coeur DAlene ID 83814 Radiology 1725639 FocusOne Solutions LLC 13609 California Street Suite 420 Omaha NE 68154 Contract Staffing Agency 1144446 Sandpoint Hospitalist Group LLC PO Box 205 Sandpoint ID 83864 Hospitalist 900000 Kootenai Health 2003 Kootenai Health Way Coeur DAlene ID 83814 Software, Lab Services 849198 10 5201875 1101082 6302957 Patient Service Revenue 622110 61585878 61585878 Property Tax Revenue 900099 1428167 1428167 Cafeteria Revenue 900099 149402 149402 Investment in Pinegrove LLC 900099 84312 84312 Other Revenue 900099 47413 47413 63295172 12525 12525 208803 10400 198403 198403 198403 543741 4250 565099 917 -21358 3333 -18025 -18025 131573 56979 74594 74594 69865626 63295172 0 267497 X 794243 794243 133344 133344 24352735 20841662 3511073 567574 476350 91224 5897231 4608141 1289090 1805095 1481460 323635 9420 9420 61945 61945 6627489 6407352 220137 98747 98747 1015067 781574 233493 1322032 828128 493904 659473 659473 110829 97333 13496 408517 385334 23183 1431213 1106229 324984 852774 852547 227 Medical Supplies 10532617 10532617 Equipment Lease Rental 2031182 1743054 288128 Repair & Maintenance 1135053 1127805 7248 1611398 1345506 265892 61457978 53407909 8050069 0 15739578 19269800 9164182 11252388 3903656 4088211 160691 144601 45619738 31100554 13422659 14519184 9835708 10209162 29844 1440615 1644446 53667089 61157636 4158578 4758504 9362865 8917626 182985 1457715 1564845 5222852 101753 0 3805231 20384995 19147959 X 32545644 41301882 736450 707795 33282094 42009677 53667089 61157636 8407648 319935 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X Public Display 0 2369739 507866 2877605 17419656 11725463 5694193 1069897 343700 726197 22572983 18613807 3959176 1679597 417584 1262013 14519184 Estimated Third Party Settlements 1627877 Refundable Advance 2177354 3805231 X 70252940 319935 319935 69933005 -67379 -67379 69865626 61525357 67379 67379 61457978 0 61457978 Part III, Line 4: The art contributed to Bonner General Hospital is strictly for display and the benefit of the patients and visitors as part of the healing process. Art benefits patients by aiding their physical, mental and emotional recovery as noted by the Society for the Arts in Healing. As a note, in 1997 the Joint Commission on Accreditation of Healthcare Organizations cited studies in which patients who viewed art recovered more quickly. Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Rental Expenses Reported in Expenses on Financial Statements -10,400. Cost of Sales Reported in Expenses on Financial Statements -56,979. Part XII, Line 2d - Other Adjustments: Rental Expenses Reported in Revenues on Form 990 10,400. Cost of Sales Reported in Revenues on Form 990 56,979. 1 1 X 1 X 210.000000000000 1 X 1 1 0 0 230000 230000 0.00370 230000 230000 0.00370 12075 12075 0.00020 6229513 4520502 1709011 0.02780 6241588 4520502 1721086 0.02800 6471588 4520502 1951086 0.03170 1 2578193 515638 12534995 12410886 124109 X 1 1 1 Pinegrove Medical Bldg LLC Operation of medical office building 0.50000 0.50000 1 1 Bonner General Hospital Inc 520 N 3rd Avenue Sandpoint ID 83864 www.bonnergeneral.org 22 X X X X 6 Provider Based Clinics Bonner General Hospital Inc 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X See Part V, line 7d X X 1 19 1 See Part V, line 7d 0 1 X 210.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X https://bonnergeneral.org/patient-billing/ X https://bonnergeneral.org/patient-billing/ X https://bonnergeneral.org/patient-billing/ X X X X X X 1 X 0 X X X X 1 X 0 1 Bonner General Hospital, Inc. Part V, Section B, Line 5: We utilized our Advisory Council, a diverse group of business owners and representatives, patients, community leaders, hospital staff, allied health professionals and volunteers. Bonner General Hospital, Inc. Part V, Section B, Line 6b: Panhandle Health District Bonner General Hospital, Inc. Part V, Section B, Line 7d: https://bonnergeneral.org/forms-resources/community-health-needs-assessment-2019/ Bonner General Hospital, Inc. Part V, Section B, Line 11: In 2019 Bonner General Hospital performed a Community Health Needs Assessment. The four needs identified in the CHNA were: Obesity, Abuse/Neglect -- Children, Elderly & Special Needs, Mental Health/Suicide & Substance Abuse. In 2021, BGH addressed the four needs in the following way:Obesity:*Provided diabetes education & awareness in the hospital & community.*Participated in community partnerships to promote and educate on the benefits of a healthy diet and good nutrition.*Sponsored and supported community events involving exercise.Abuse & Neglect -- Children Elderly & Special Needs:*Sponsored Kinderhaven's fundraisers and community awareness activities to ensure that abused and/or neglected children have a safe place to live.*Sponsored Food for Our Children Program to ensure that children have food on the weekend.*Provided awareness among clinicians, schools and others on issues related to abuse.*Partnered with Panhandle Alliance for Education through the Books for Babies program, which provides a new book after birth & information on the importance of reading to children.Mental Health/Suicide:*BGH collaborates with law enforcement, the court system and physicians to improve the mental health hold process.*BGH has a Behavioral Health Clinic staffed by a Psychiatrist, Psychologist, two Psychiatric Nurse Practitioners and Licensed Master Social Worker to help address the needs in our service area.*BGH identifies, organizes and leads community support groups related to mental health, suicide and grief.Substance Abuse:*Collaborated with the community, regional and state partners to provide education materials and programs to help individuals to change their unhealthy lifestyle and behaviors due to alcohol, drug and tobacco use.*Supported the use of medication drop off sites within the community. Bonner General Hospital, Inc. Part V, Section B, Line 16j: The policy was provided, in writing, to patients for all outpatient and inpatient services upon request. The hospital includes language referencing that we offer assistance to uninsured patients who meet certain financial criteria through the BGH Cares program. We provide this language in the billing invoices, to patients on admissions to the facility and our website. Bonner General Hospital, Inc. Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. 2 1 - Immediate Care Physician Clinic 520 N 3rd Ave Sandpoint ID 83864 Urgent Care Clinic 2 - Hospice Agency 400 Schweitzer Plaza Drive Suite 1 Ponderay ID 83852 Hospice Agency Part I, Line 7: Financial assistance, line 7a, was calculated by multiplying the ratio of cost to gross charges by service line for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Community health improvement services, line 7e, was based on actual costs. Subsidized health services, line 7g, was converted to cost using the cost-to-charge ratio derived from the relevant cost center on the Medicare cost report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The organization reasonably estimates the portion of implicit price concessions that could have qualified for charity care by identifying the uninsured, unemployed single adult account balances assigned to a collection agency in the current year. An estimated 20% of implicit price concessions in 2021 are attributable to patients potentially eligible for charity care. Part III, Line 4: The financial statement footnote regarding implicit price concessions may be found on pages 18-19 of the audited financial statements. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services.BGH's position is that if there is a shortfall the entire Medicare shortfall is a community benefit. Medicare patients are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key community benefit. Part III, Line 9b: If a patient qualifies for financial assistance, Bonner General Hospital will hold all billings and collections until financial assistance is determined. No extraordinary collection actions will be undertaken during the 120 day notification period and financial assistance applications will be processed when received within 240 days. Part VI, Line 2: Bonner General Hospital's quality service department gives a survey to each patient they discharge to get feedback on the quality of care received and areas of improvement. The Hospital also has internal physician committees that discuss common patient needs and provide feedback to management. Part VI, Line 3: Bonner General Hospital provides information about BGH Cares, its financial assistance policy, during the pre-registration and registration process at admitting and the emergency departments. Business Services includes information in patient statements, and a Patient Financial Advocate assists patients with financial assistance programs and options. Part VI, Line 4: Bonner General Hospital (BGH) is the sole provider of inpatient, acute care and many other outpatient services in Bonner County. BGH provides services to a large rural and widely dispersed population of approximately 57,000. Its patient service areas extend to the Canadian border, the western edge of Montana and the eastern border of Washington. Approximately 20.4% of the population served by BGH is 65 years of age and older. Additionally, 49.8% of the population served by BGH is female. The population of children served by BGH is approximately 25.8%, with 4.7% of these children being under the age of 5. Part VI, Line 5: Bonner General Hospital (BGH) has an ongoing and steadfast commitment to a mission that provides real and tangible benefits for our community. As a community-owned health care provider, our commitment is to improve the health of people in our region. We feel that one way to make improvements is to build partnerships with other agencies and institutions that serve the uninsured and underserved population of the communities we serve. By providing support to our local volunteer health clinic, we help in the delivery of medical care to the people in our community who have no other access to healthcare. BGH aims to prevent disease and injury, promote healthy habits, and improve quality of life in the communities we serve. We do this by offering many free education classes. These classes educate our community members on the health consequences of unhealthy habits, help people to understand their illnesses, encourage compliant behavior through medication, exercise and diet, and support those people who need help dealing with unfortunate circumstances in their lives. We also offer classroom space for others who provide support for community members dealing with problems such as addiction, terminal illnesses, and mental health problems. We are committed to building a strong workforce and ensuring there continues to be a strong workforce far into the future. We do this by working with educational institutions by providing scholarships, encouraging and supporting our employees to be mentors and proctors, and providing the clinical setting and supervision required in the education of nursing students of all levels, medical laboratory technologists, radiology technologists, pharmacists and pharmacy technologist, therapists, and physicians.The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay. X 1 1 X X X 1 0 0 0 0 0 0 0 0 Jonathan Klauke MD Orthopedic Surgeon 595934 0 0 0 0 0 8700 0 11804 0 616438 0 0 0 Brent Leedle MD Orthopedic Surgeon 576401 0 0 0 0 0 8700 0 3922 0 589023 0 0 0 Douglas Cipriano MD Orthopedic Surgeon 561689 0 0 0 0 0 7727 0 18760 0 588176 0 0 0 Susan Anderson MD Otolaryngology Surgeon 414846 0 0 0 0 0 8700 0 4784 0 428330 0 0 0 Tracy Autler CNO 163360 0 0 0 0 0 4901 0 242407 0 410668 0 0 0 Mark TorresMD Ophthalmologist 350086 0 0 0 0 0 0 0 3922 0 354008 0 0 0 Sheryl Rickard CEO 255634 0 0 0 0 0 20713 0 12303 0 288650 0 0 0 Part I, Line 1a The discretionary expense for the CEO is a monthly vehicle allowance to cover the cost of a vehicle in lieu of the mileage reimbursement policy. This determination was made by the Board of Directors and has been in place for many years. The monthly allowance is included in the CEO's taxable wages on her W-2. Part I, Line 4a Geoff Mandala received a severance payment for $38,002 in the reporting year. A Idaho Health Facilities Authority 826051863 2016-07-07 11275327 Refunded 3/22/07 Note 0 0 0 A 2021483 11275327 277467 10997860 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 Schedule K, Part I, Bond Issues Refunded Revenue Note issued 3/22/07 and Panhandle State Bank Loan relating to the construction, acquisition and renovation of, and equipment for the Hospital. Jason Campbell Family Member of Key Employee 31845 Wages and Benefits 0 Molly Burgstahler Family Member of Director 55855 Wages,Pension and Benefits 0 Molly Behrens Family Member of Key Employee 45645 Wages and Benefits 0 Form 990, Part VI, Section A, line 1a The Bylaws allow for an Executive Committee. The Executive Committee consists of the Board Chair and three additional Board Members appointed by the Chair. The Chief of Staff will serve as an ex-officio, as needed. It meets and functions solely in an as needed capacity and acts upon those matters of importance. It is required to report its actions to the full governing Board. Form 990, Part VI, Section B, line 11b The draft Form 990 is reviewed by the CFO and CEO prior to filing. A copy of the Form 990 will be provided to the governing body prior to filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers board members, officers, committee members or staff members who have a direct or indirect financial interest as defined in the conflict of interest policy, which is reviewed annually. The Compliance Officer is responsible for determining whether a conflict exists once disclosed. Each interested person has a duty to disclose immediately. In addition, annual conflict of interest statements are obtained from all interested persons. Persons with conflicts are restricted from involvement in the review or decision making. Violations of the conflict of interest policy will be investigated and the Board of Directors or Compliance committee shall take appropriate disciplinary or corrective action. Form 990, Part VI, Section B, line 15a Compensation is determined by use of the most recent Idaho Hospital Association CEO compensation survey published. In addition, comparison to the American College of Healthcare Executives compensation is referred to as necessary. The CFO compensation is reviewed by the CEO with the assistance of the HR Director using the Idaho Hospital Association survey and HFMA survey. Compensation is reviewed by independent persons. The organization follows the process described in Part VI, Line 15 on an annual basis. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. The financial statements are attached to the Form 990. Form 990, Part IX, line 11g Professional Fees: Program service expenses 1,437,489. Management and general expenses 12,631. Fundraising expenses 0. Total expenses 1,450,120. Contracted Services: Program service expenses 1,167,201. Management and general expenses 26,878. Fundraising expenses 0. Total expenses 1,194,079. Physician Fees: Program service expenses 2,033,576. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,033,576. Other Fees: Program service expenses 1,769,086. Management and general expenses 180,628. Fundraising expenses 0. Total expenses 1,949,714.