2013-10-21T09:31:30-05:00 2011-12-31 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2011-01-01 880065829 BOULDER CITY HOSPITAL INC BOUL 7022934111 901 ADAMS BOULEVARD BOULDER CITY NV 89005 LANCE SPINDLER 7022934111 2013-08-09 1 KATHLEEN J LABRAKE CPA P00164006 7158453111 2013-08-08 2011 2016-02-24 21:20:13Z X LANCE SPINDLER 901 ADAMS BOULEVARD BOULDER CITY NV 89005 15986899 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. 11 11 259 682 0 0 64514 29449 18963342 15889983 16575 9800 40855 29349 19085286 15958581 0 0 0 0 10023340 9991468 0 0 0 9810388 7624154 19833728 17615622 -748442 -1657041 11946754 10996836 8156154 7962382 3790600 3034454 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 15276995 15848250 BOULDER CITY HOSPTIAL OPERATES AN ACUTE CARE HOSPITAL WITH EMERGENCY SERVICES AND SKILLED NURSING UNIT. ADMISSIONS FOR THE HOSPTIAL AND SKILLED NURSING FACILITY WERE 443 AND 82, RESPECTIVELY. TOTAL PATIENT DAYS WERE 1,783 AND 11,792, RESPECTIVLEY. THERE WERE 5,455 EMERGENCY ROOM VISITS. 15276995 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 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 1 0 0 0 0 1 24 0 1 259 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X FREY BELETE CONTROLLER 7022934111 901 ADAMS BLVD BOULDER CITY NV 89005 KATHY CALHOUN 2013 0.50 X X 0 0 0 DEREK MEEKS DO 2013 0.50 X 0 0 0 MICHAEL RAVITCH MD 2013 0.50 X X 0 0 0 PEGGY CASPAR2015 0.50 X 0 0 0 VERNON BURK 2013 0.50 X 0 0 0 CHRISTINE A MILBURN 2012 0.50 X 0 0 0 BOB KENNEY 2012 0.50 X X 0 0 0 LINDA FAISS 2012 0.50 X 0 0 0 ANDREA ANDERSON 2012 0.50 X 0 0 0 WENDELL WHITMANN 2013 0.50 X 0 0 0 BRUCE WOODBURY 2013 0.50 X 0 0 0 THOMAS E MAHER 40.00 X 170646 0 9490 DEBRA K BALIDO 40.00 X 117840 0 3389 FREY BELETE 40.00 X 77168 0 4088 JACKSON C BAILEY 40.00 X 111742 0 8890 477396 0 25857 3 0 1 0 EMCARE 1373 NOEL ROAD SUITE 1600 DALLAS TX 75240 ER PHYSICIANS 447073 GREEN VALLEY MEDICAL IMAGING 743 DESCARTES AVENUE HENDERSON NV 89002 EKG & ULTRASOUND IMAGING 148676 WIPFLI LLP PO BOX 3160 MILWAUKEE WI 532013160 CPA AUDITING 114951 2 29449 29449 NET PATIENT SERVICE RE 900099 15793603 15793603 OTHER OPERATING REVENU 900099 54647 54647 CAFETERIA SALES 900099 41733 41733 15889983 5550 5550 57667 28318 29349 29349 29349 4250 0 4250 4250 4250 15958581 15848250 0 80882 503253 503253 7711067 6982172 728895 1167849 992672 175177 609299 517904 91395 5633 5633 64506 64506 1509597 1298363 211234 257745 193309 64436 327702 245098 82604 339993 293564 46429 819979 778980 40999 127236 108151 19085 PROVISION FOR BAD DEBTS 2199000 2199000 PATIENT CARE SUPPLIES 1378795 1309855 68940 EQUIPMENT RENTAL AND MA 586944 352166 234778 REGISTRY EXPENSE 7024 5761 1263 17615622 15276995 2338627 0 366028 267559 2570919 1633883 1919275 1980237 568066 174549 323360 389004 220227 191151 17925851 11724430 5826094 6201421 152785 159032 11946754 10996836 2193240 2232197 5021237 4723242 941677 1006943 8156154 7962382 X 3622957 3013389 167643 21065 3790600 3034454 11946754 10996836 X -1657041 900895 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 185 185 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DUES TO NEVADA HOSPITAL ASSOCIATION THAT ARE ALLOCATED TO LOBBYING ON BEHALF OF MEMBERS. 652289 652289 9142707 5498293 3644414 351099 289625 61474 7574023 5810072 1763951 205733 126440 79293 6201421 15958581 17615622 -1657041 207085 693810 900895 -756146 16117798 159217 159217 15958581 0 15958581 17615622 0 17615622 0 17615622 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 2011 AND 2010. FEDERAL RETURNS FOR 2007 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 8 - OTHER ADJUSTMENTS: CONTRIBUTIONS FOR CAPITAL ACQUISITION 531,289. CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY 4,939. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 157,582. TOTAL TO SCHEDULE D, PART XI, LINE 8: 693,810. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION AND AUXILLIARY 159,217. 1 1 1 X 1 X 1 0 0 85832 85832 0.00560 1732166 1509040 223126 0.01450 0 0 1817998 1509040 308958 0.02010 1817998 1509040 308958 0.02010 1 1387821 0 6766202 6613616 152586 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 1 100.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X 1 X 1 X X X X X 1 X 0 0 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 $2,199,000. 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: 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 DUE 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 FEE SHCEDULE REIMBURSEMENT AT 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 BENEFITS TAHT 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 FOR THE YEAR ENDED DECEMBER 31, 2011 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICES REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TEYPICALLY 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 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. BOULDER CITY HOSPITAL, INC PART V, SECTION B, LINE 19D: BOULDER CITY HOSPITAL CHARGES THE SAME RATE FOR ALL PATIENTS REGARDLESS OF A PATIENT'S ABILITY TO PAY. FAP ELIGIBLE INDIVIDUALS WITH INCOME UP TO 100% FPG ARE NOT CHARGED ANYTHING AND INDIVIDUALS UP TO 200% OF FPG ARE CHARGED ON SLIDING DISCOUNTED SCALE. 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 2011, 59% 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 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 170646 0 0 0 0 0 0 0 9490 0 180136 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS SIGNED BY THE CEO THOMAS MAHER. A COPY IS EMAILED TO ALL BOARD MEMBERS. THE BOARD OFFICIALLY REVIEWS THE 990 AT A BOARD 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: PRIOR PERIOD ADJUSTMENTS: 207,085. CONTRIBUTIONS FOR CAPITAL ACQUISITION 531,289. CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY 4,939. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 157,582. TOTAL TO FORM 990, PART XI, LINE 5: 900,895. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AMENDED RETURN EXPLANATIONS: FORM 990, ITEM B THE TAXPAYER RECEIVED ADDITIONAL INFORMATION AFTER THE INITIAL FILING OF THE FORM 990 THAT REQUIRED AN AMENDED RETURN TO BE FILED. AS A RESULT OF FINALIZATION OF FINANCIAL STATEMENTS, THE FOLLOWING SECTIONS OF FORM 990 HAVE BEEN AMENDED. IN ADDITION, THERE ARE SEVERAL RECLASSIFICATIONS OF INFORMATION TO MAKE OUR FINANCIAL INFORMATION MORE TRANSPARENT. PART I, SUMMARY, REVENUE, EXPENSES, AND NET ASSETS PART III, EXPENSES AND REVENUES ASSOCIATED WITH LINE 4A PART IX, LINE 9, OTHER EMPLOYEE BENEFITS PART IX, LINE 23, INSURANCE PART IX, LINE 24, OTHER EXPENSES PART X, LINE 1, CASH-NON-INTEREST-BEARING PART X, LINE 4, ACCOUNTS RECEIVABLE, NET PART X, LINE 9, PREPAID EXPENSES AND DEFERRED CHARGES PART X, LINE 10B, ACCUMULATED DEPRECIATION PART X, LINE 15, OTHER ASSETS PART X, LINE 17, ACCOUNTS PAYABLE AND ACCRUED EXPENSES PART X, LINE 27, UNRESTRICTED NET ASSETS PART X, LINE 28, TEMPORARILY RESTRICTED NET ASSETS PART XI, LINE 5, OTHER CHANGES IN NET ASSETS SCHEDULE D, PART VI, LAND, BUILDING AND EQUIPMENT SCHEDULE D, PART XI, RECONCILIATION TO AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XII, RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XIII, RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS 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) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0