2017-11-15T11:13:11-06:00 2016-12-31 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2016-01-01 880065829 Boulder City Hospital Inc BOUL 7022934111 901 Adams Blvd Boulder City NV 89005 THOMAS MAHER CEO 7022934111 2017-11-13 1 Terri Rexrode CPA MST P00096513 9206620016 2017-11-13 74.87.127.142 2017-11-13 15:22:42 CS P A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2016 2021-01-29 14:40:06Z THOMAS MAHER 901 Adams Blvd Boulder City NV 89005 25805024 0 X www.bchcares.org X 1954 NV Boulder City Hospital, Inc. is a nonprofit, nonstock corporation which operates a 25-bed acute care facility, a 47-bed long term care facility, a 10-bed geriatric behavorial medicine center, and a home health agency. The hospital provides comprehensive medical, surgical, emergency, outpatient, skilled nursing, and home health services to residents of Clark County. 10 9 360 61 0 0 246578 370195 24454012 24737893 1263 -371 -1084 674633 24700769 25782350 0 0 0 0 12633735 14097526 0 0 0 11699640 15241564 24333375 29339090 367394 -3556740 27411093 24272475 25268329 25686451 2142764 -1413976 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 areas visitors by meeting their health care needs with compassion, integrity, and sincerity without regard to one's ability to pay. 0 0 25194872 25365827 Boulder City Hospital operates an acute care hospital with emergency services, a behavioral medicine center, a long term care facility, and a skilled nursing unit. 25194872 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 0 0 0 0 1 23 0 360 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Frey Belete 7022934111 901 Adams Blvd Boulder City NV 89005 Alan Bowman PRESIDENT 0.50 X X 0 0 0 LINDA FAISS VICE PRESIDENT 0.50 X X 0 0 0 ROSS JOHNSON TREASURER 0.50 X X 0 0 0 CHRISTINE MILBURN SECRETARY 0.50 X X 0 0 0 WENDELL WHITMAN DIRECTOR 0.50 X 0 0 0 ROBERT KENNEY DIRECTOR 0.50 X 0 0 0 MICHAEL RAVITCH MD FORMER DIRECTOR 0.50 X 0 0 0 VERNON BURK DIRECTOR 0.50 X 0 0 0 DEREK MEEKS DO DIRECTOR AND CHIEF OF STAFF 0.50 X 0 0 0 BRUCE WOODBURY DIRECTOR 0.50 X 0 0 0 PEGGY CASPAR DIRECTOR 0.50 X 0 0 0 SUE MANTERIS DIRECTOR 0.50 X 0 0 0 THOMAS MAHER CEO 40.00 X 227515 0 10326 DOUGLAS LEWIS CFO 40.00 X 131464 0 377 ANDRE PASTIAN CNO 40.00 X 117155 0 4663 LINDA BURDNO HOME HEALTH DIRECTOR 40.00 X 134636 0 377 STEPHANIE WEST PHARMACY MANAGER 40.00 X 128783 0 13374 Jeanne Solakiewicz RN 40.00 X 108192 0 1886 Frezewed Belete Controller 40.00 X 103956 0 3289 951701 0 34292 7 0 1 0 horizon health po box 840839 dallas TX 75001 PSYCHIATRIC UNIT PURCHASED SERVICES 1739963 MCKESSON 1220 SENLAC DRIVE carrollton TX 75006 pharmacy 707641 LEASING INNOVATIONS INC 261 N Highway 101 SOLANA BEACH CA 92075 FINANCED EHR 543480 emcare inc 7032 collection center drive chicago IL 60693 er physicians 491616 medsmart inc 1701 n gv ste 2a henderson NV 89074 x-ray purchased services 486961 27 268019 102176 370195 NET PATIENT SERVICE REVENUE 621500 24443657 24443657 OTHER 909999 241049 241049 CAFETERIA INCOME 722210 53187 53187 24737893 1115 1115 14700 21188 -6488 -6488 -6488 1486 -1486 -1486 -1486 Meaningful Use revenue 621110 762044 762044 CHANGE IN INTEREST IN FOUNDATION 909999 -80923 -80923 681121 25782350 25365827 0 46328 X 491501 491501 9775221 8488673 1286548 3007745 2558028 449717 823059 686416 136643 267886 267886 53375 53375 5047848 4325170 722678 56351 56351 2072181 1949935 122246 500540 500540 305973 243910 62063 25234 10888 14346 991301 790228 201073 1668010 1329674 338336 155265 155265 bad debt expense 3433331 3433331 repairs & maintenance 503403 316190 187213 RENT 109738 100651 9087 taxes and licenses 51128 38087 13041 29339090 25194872 4144218 0 777157 1292390 9043 10690 8385610 5286492 305288 299974 70516 135340 33261171 17029689 17659282 16231482 411 203786 1016107 27411093 24272475 5509968 3556395 1040092 17528045 21089964 2230316 25268329 25686451 X 2121699 -1435041 21065 21065 2142764 -1413976 27411093 24272475 -3556740 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 652289 652289 21654940 8637192 13017748 10828942 8392497 2436445 125000 125000 16231482 22349019 -3433331 -3433331 25782350 0 25782350 25905759 0 25905759 3433331 3433331 29339090 Part XI, Line 2d - Other Adjustments: bad debt expense -3,433,331. Part XII, Line 4b - Other Adjustments: bad debt expense 3,433,331. 1 1 X 1 X 1 X 1 1 0 0 36947 36947 0.00140 6227667 5237893 989774 0.03820 6264614 5237893 1026721 0.03960 6264614 5237893 1026721 0.03960 1 1647999 12110811 11425712 685099 X 1 1 1 1 BOULDER CITY HOSPITAL 901 adams blvd boulder city NV 89005 www.bchcares.org 633ruh-27 X X X BOULDER CITY HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://bchcares.org/community X 0 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X www.bchcares.org X www.bchcares.org X www.bchcares.org X X X X 1 X 1 X X X X X 1 X 0 0 BOULDER CITY HOSPITAL Part V, Section B, Line 5: A SURVEY WAS CONDUCTED FROM 9/21/15 TO 11/16/15. THE SURVEY WAS OPEN TO ANYONE. THERE WERE A TOTAL OF 143 RESPONSES, 99% OF THE RESPONDENTS RESIDE IN BOULDER CITY. BOULDER CITY HOSPITAL Part V, Section B, Line 11: THE TWO MAJOR THEMES OF THE 2016 NEEDS ASSESSMENT WERE ACCESS AND COST OF HEALTHCARE. THE FOLLWING IS INTENDED TO ADDRESS THESE ISSUES:1) Establish a rural health clinic: The CHNA identified access as a concern in relation to primary care. The establishment of a rural health clinic will help this widespread issue. The hosptial will start to generate the necessary startup capital and clear some space in the medical office building. The will also need to recruit the doctor and mid level providers required for clinical operations. All of these effors are underway and we expect to have the clinic certified and operational by early 2018.2) Pursue affiliation with Universal Health Services - The CHNA identified cost of care and acceptance of insurance as concerns. A relationship with a larger health system will help address these concerns. The hospital has already been discussing this strategy with a great deal of interest from both parties. A fornal letter of intent was signed and anticpated affiliation is expected to be complete by March 31, 2018. PART V, SECTION B, LINE 8 THE HOSPITAL IS WORKING ON AN IMPLEMENTATION STRATEGY. A FINAL IMPLEMENTATION STRATEGY WAS APPROVED BY THE BOARD OF DIRECTORS IN 2017. We have always worked with our community on healthcare needs. We don't believe anyone was harmed by not releasing our written implementation strategy until 2017. Part I, Line 3c: Boulder City Hospital ('The Hospital') uses 200% of the federal poverty guidelines ('FPG') to qualify patients for patient 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 of 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, 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 $ 3,433,331. Part III, Line 2: Bad Debt Expense Gross Charges written off less recoveries reported on finacial statements applied to ratio of cost to charge ratio of 48%. Part III, Line 4: To determine the cost of bad debt expense, the hospital uses a cost-to-charge ratio. Financial statement footnote regarding bad debts - accounts receivable are recorded in the accompanying balance sheets net of contractual adjustments and allowances for doubtful accounts which reflect management's best estimate of the amounts that will not be collected. Management provides for contractual adjustments under terms of third-part reimbursement agreements through a debit against gross revenue and a credit to patient accounts receivable. In addition, management provides for probable uncollectible amounts, primarily from uninsured patients and amounts patients are personally responsible for, through a debit against gross revenue and a credit to a valuation allowance. In evaluating the collectibility of accounts receivable, the hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Mangement regualarly reviews data about these major payor sources of revenue in evaulating the sufficiency of the allowance for doubtful accounts and a provision for bad debts. For expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely. For receivables associates with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Because of the inherent nature of the allowance, it is at least reasonable possible that the estimates will change within the near term. The hospital is in compliance with Healthcare Management Association Statement No. 15 and therefore would not report any bad debt atrributable 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 do 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 the fee schedule reimbursement 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 benefit that 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 the the year ended December 31, 2016 and does not consider medicare non-allowable expeneses, as it is based on total hospital patient services revenue (ignoring contractual adjustments on fee schedule reimbursement items and non-allowable medicare expenses as noted above). Whethere there is a shortfall or a surplus on services provided to medicare beneficiaries, these people, which are typically 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 PATIENT'S 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 hand out pamphlets explaining the charity policy to patients. The patient is instructed to read the pamphlet and complete if necessary. Business office staff contact patients 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, Nevada and the western portion of Henderson, Nevada. Nearly half of the area's residents rely on medicare subsidies to pay for health care. For 2016, 56% 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 designated a critical access hospital, and therefore, the hospital provides health care to residents who would not otherwise have access to readily available health care. X X X X 0 0 0 0 0 0 0 0 0 THOMAS MAHER CEO 217515 0 10000 0 0 0 0 0 10326 0 237841 0 0 0 Form 990, Part VI, Section B, line 11b Prior to Form 990 being signed by the CEO, Thomas Maher, a copy is forwarded to all board members. Additionally, the finance committee reviews the 990 at a committee 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). 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 are documented. The CEO's 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. Form 990, Part IX, line 11g Surgery purchased services: Program service expenses 1,279,073. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,279,073. CLINIC PURCHASED SERVICES: Program service expenses 854,524. Management and general expenses 0. Fundraising expenses 0. Total expenses 854,524. LONG TERM CARE PURCHASED SERVICES: Program service expenses 992,841. Management and general expenses 0. Fundraising expenses 0. Total expenses 992,841. EMERGENCY ROOM PURCHASED SERVICES: Program service expenses 494,323. Management and general expenses 0. Fundraising expenses 0. Total expenses 494,323. PURCHASED SERVICES: Program service expenses 704,409. Management and general expenses 722,678. Fundraising expenses 0. Total expenses 1,427,087. Form 990, Part XII, Line 2c: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.