2013-11-27T12:36:13-07:00 2012-12-31 990 2012-01-01 840175870 THE COMMUNITY HOSPITAL ASSOCIATION COMM 3034402358 PO Box 9019 1100 Balsam Ave Boulder CO 803019019 William A Munson Jr 3034402214 2013-11-27 2012 2016-02-25 16:41:14Z Boulder Community Hospital William A Munson Jr The Community Hospital Associatin dba Boulder Community Hospital 1100 Balsam Ave P O Box 9019 Boulder CO 803019019 490287979 0 X www.bch.org X 1922 CO To provide our community with the safest and highest quality healthcare in an innovative, patient-centered environment. 15 12 2737 725 2978512 -919292 2061134 1170727 285658576 292245681 10288445 11821051 11726464 18580776 309734619 323818235 359389 397939 0 0 136024969 147908726 0 0 333233 150357124 151796746 286741482 300103411 22993137 23714824 493392565 584504013 223315809 279157334 270076756 305346679 To provide our community with the safest and highest quality healthcare in an innovative, patient-centered environment. 0 0 220383210 397940 310136680 Health Care Delivery of IP and OP medical care. In 2012, the hospital discharged 8,710 adult & pediatric patients with an average length of stay of 4.4 days. 48,740 patients were seen in our ER/Urgent Care facilities. 7,301 surgeries were performed. The hospital had adjusted patient days of 89,788. 0 0 0 220383210 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 243 0 1 2737 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Lisa Rogowski Controller 3034402358 PO Box 9019 1100 Balsam Ave Boulder CO 803019019 Lou DellaCava 4 0 X X 0 0 0 Richard Porreca 4 0 X X 0 0 0 R David Hoover 4 0 X X 0 0 0 Karen McMurry 4 0 X X 0 0 0 Randy Bjerke MD 2 0 X 14350 0 0 Jean Dubofsky 2 0 X 1182 0 0 Harold Flowers 2 X 0 0 0 Steve Fries MD 2 0 X 6900 0 0 David Gehant 40 X X 893860 0 36169 Susan Graf 2 0 X 0 0 0 Richard V Lopez 2 0 X 0 0 0 Janet Martin 2 0 X 0 0 0 Tom Metz 2 0 X 1567 0 0 Dee Perry 2 0 X 0 0 0 Mako Shimoda MD 2 0 X 6150 0 0 Paul Kenneth Lewis Jr 40 0 X 393453 0 102793 William A Munson Jr 40 0 X 320189 0 82899 Jacqueline M Attlesey-Pries 40 0 X 236920 0 70353 Sarah E Meshak 40 0 X 234999 0 56985 James Peters 40 0 X 226366 0 61394 Linda S Minghella 40 0 X 231393 0 49526 Ronald Secrist 40 0 X 201427 0 44230 Jamie D Jensen 40 X 159424 0 37267 Daniel S White 40 0 X 647116 0 59429 Sameer A Oza 40 0 X 673397 0 53888 Nelson P Trujillo Jr 40 0 X 660087 0 53388 John A Schutz 40 0 X 644722 0 51581 John R McNeil III 40 0 X 638275 0 55705 6191777 0 815607 155 0 1 0 Rightsourcing Comforce Technical Services Inc PO BOX 9695 Uniondale NY 115559695 Agency staffing 1892387 Dr Laurie Coryell Community Medical Center 1000 W So Boulder Rd Suite 100 Lafayette CO 80026 Urgent Care Phys. Group 1159441 Colorado Cardiovascular Surgical Associates PC 950 E Harvard Ave Suite 550 Suite 203 Denver CO 80210 Cardiovascular surgery coverage and employee lease 964309 Emergency Courier Services in care of Aaron Ramsey 7713 N 41st St Niwot CO 80503 medical courier service 821656 Boulder Valley Anesthesiology LLC c/o Wendll Walker & Assoc 1420 28th St Ste 100 Boulder CO 80303 Anesthesiology coverage 744852 22 0 5430 0 467833 624934 72530 0 1170727 Acute care hospital 622000 292245681 289979085 2204047 62549 0 0 0 0 292245681 6869813 0 0 6869813 163088 0 0 163088 0 0 0 0 0 0 0 0 0 0 0 0 0 0 163527156 7651109 159488438 6901677 4038718 749432 4788150 749432 0 4038718 0 0 0 0 0 0 13210 169 13041 0 0 13041 108741 79460 29281 0 0 29281 Health Care Joint Ventures 621400 6121129 6121129 0 0 Misc Hospital Revenue 622000 12417325 10308522 774465 1334338 0 0 0 0 18538454 323818235 307158168 2978512 12510828 173749 173749 83009 83009 141181 141181 0 0 3501368 0 3263013 238355 0 0 0 0 117872913 92411511 25429239 32163 8685546 6719541 1949312 16693 9497199 7440933 2046695 9571 8351700 6291304 2048386 12010 1912607 136445 1776162 0 192971 0 192971 0 93942 3942 90000 0 0 0 0 0 578560 0 578560 0 19325102 15237109 4064105 23888 1089467 0 1089467 0 6450164 2301919 4121988 26257 6056990 539269 5517721 0 0 0 0 0 5384442 2326065 3056471 1906 346842 214488 131802 552 0 0 0 0 593714 225205 368509 0 2452922 0 2452922 0 0 0 0 0 18083120 5835965 12229951 17204 1914280 579290 1334990 0 Repairs & Maintenance 6294380 645739 5648641 0 Provision for Bad Debts 18326057 18326057 0 0 Medical Supplies 44297867 44105946 191921 0 Medicaid Provider Fee 15750703 15750703 0 0 2652616 893840 1804142 -45366 300103411 220383210 79386968 333233 1140091 976885 1557558 5771613 37424133 35303088 2426771 2241430 3111110 2871946 3342813 3638310 367719178 196383698 147720367 171335480 223005143 254533177 43170874 66215850 2583946 3325638 307310 320020 27602449 37970576 493392565 584504013 38322850 46848302 151405644 176359214 128475 98599 33458840 55851219 223315809 279157334 X 246554608 274028058 18646896 26307590 4875252 5011031 270076756 305346679 493392565 584504013 X 23714824 22744925 0 0 0 -11189826 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 21691 0 0 0 21691 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 11.45% of dues paid to the Colorado Hospital Association are spent on lobbying activities, amounting to $4,021. 23.98% of dues paid to the American Hospital Association are spent on lobbying activities, amounting to $17,670. 23522148 7987150 2442969 0 2633646 0 31318621 22231845 4805197 -332547 0 3182347 0 23522148 20637790 3702912 2390484 0 4499341 0 22231845 17569973 3021313 3252269 0 3205765 0 20637790 22397933 3484109 -4795385 0 3516684 0 17569973 0 0.16 0.84 0 1 1 0 23081774 23081774 0 190335931 119723021 70612910 0 737661 471871 265790 0 111116360 76188806 34927554 0 42447452 0 42447452 171335480 -12224411 F 25676714 F Municipal bonds, infrequently traded 1608462 F Asset Backed Securities, infrequently traded 11424605 F Long/Short Fixed Income Funds 27031225 F Fund of Hedge Funds 2074003 F Corp Bonds and Notes, infrequently traded 10625252 F 66215850 Interest in Net Assets Held by Foundation 30958764 Unamortized Bond Issue Costs 1513570 Deferred Comp Investments 4097924 Misc Other AR 1250733 Unamortized Swap Fees 149585 37970576 0 Accrued Pension Liability 51753295 Deferred Compensation Liability 4097924 55851219 316326222 22744925 0 0 -29567362 -6822437 323148659 578560 91016 669576 323818235 281072950 0 0 0 0 0 281072950 578560 18451901 19030461 300103411 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Boulder Community Hospital Foundation, a related organization, holds permanent endowment funds. The income earned on these endowment funds is used to support hospital programs for diabetes, cancer, neonatology, heart and surgery center, healthcare scholarships, or for the foundation to direct if the endowment fund does not restrict how the income is to be spent. Temporarily restricted funds held by the Foundation include funds for the new Foothills medical office facilities, cancer center, as well as other hospital programs. Any Unrestricted funds held at the Foundation are for the hospital, but designation is decided by the Foundation board when granting to the hospital. SchD_P11_S00_L02d Schedule D, Part XI, Line 2d Other of -29,327,727 included in audited revenue but not on TR includes Bad Debt Provision of -18,326,057 + Change in Foundation Net Assets of 7,818,322 - Changed in minimum pension liability of 18,768,513 + Tas vs. Book JV income recognition of -16,652 - Other Expenses shown net in FS rev and gross in Tax return of 106,282+ Auxiliary component of Temp Rest Net assets on Audit of 71,455. SchD_P11_S00_L04b Schedule D, Part XI, Line 4b Other 91,016 = Auxiliary revenue reflected in Rev on TR but as restricted donation on Audit. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Other expenses of 18,451,901 included on TR but not on Audit = Bad Debt provision of 18,326,057 + 106,282 if expenses shown in net revenue on audit + 19,562 of Auxiliary expenses reflected as Restricted Contribution in Audit. 1 Sub-Saharan Africa 0 0 Program Services The hospital is the recipient of a grant from the Department of Health and Human Services via the American International Health Alliance Training Center to help with the development of zonal laboratories in Tanzania, Africa in response to the HIV/AIDS crisis. 141181 Central America and the Caribbean 0 0 Investments Pasive investments in Cayman Islands have a YE market values of $51,808,855 and incurred management fees of $485,578. 52294433 0 0 52435614 Sub-Saharan Africa The hospital is the recipient of a grant from the Department of Health and Human Services via the American International Health Alliance Training Center to help with the development of zonal laboratories in Tanzania, Africa in response to the HIV/AIDS crisis. 0 141181 Airfare, in-country expenses for mission, and other expenses such as books, computer supplies which totalled 88,954 and in-kind labor totalling $52,227 cost 1 0 1 0 1 1 0 0 SchF_P01_S00_L02 Schedule F, Part I, Line 2 The Tanzania, Africa project is subject to American International Health Alliance monthly grant reporting requirements. The project requires work plans to be approved by AIHA, quarterly project reporting, and monthly financial reporting. 1 1 X 1 X 2.5 1 X 4 1 1 1 0 1 1 13961889 3635828 10326061 0.036 23059753 14546746 8513007 0.03 0 0 37021642 18182574 18839068 0.066 391683 62994 328689 0.001 292715 262 292453 0.001 863665 0 863665 0.003 0 0 1548063 63256 1484807 0.005 0 0 38569705 18245830 20323875 0.071 26869 26869 0.0 2881 2881 0 121031 121031 0.001 0 0 150781 0 150781 0.001 1 18326057 1 44115941 59073720 -14957779 X 1 1 Boulder Community Musculoskeletal Surgery Center LLC Outpatient Orthopedic Surgery Center 0.5 0 0.5 Endoscopy Center of the Rockies LLC Outpatient Endoscopy Center 0.5 0 0.5 Boulder Community Sleep Services LLC Sleep Lab Services 0.45 0 0.55 Boulder MRI LLC outpatient MRI center 0.51 0 0.49 Foothills Surgery Center LLC Ambulatory Surgical Center 0.51 0 0.49 2 1 Boulder Community Hospital

1100 Balsam Avenue Boulder CO 80304

X X X Rehab DPU, Psych DPU 2 Boulder Community Foothills Hospital

4747 Arapahoe Avenue Boulder CO 80303

X X X Boulder Community Hospital 1 1 X X X X X X X X 11 1 1 1 X X X X X X X X X X X X 1 0 1 1 250 1 400 1 X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 Boulder Community Foothills Hospital 2 1 X X X X X X X X 11 1 1 1 X X X X X X X X X X X X 1 0 1 1 250 1 400 1 X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 35 Community Medical Center

1000 W South Boulder Road Lafayette CO 80026

Urgent-care center Mapleton Center

311 Mapleton Ave Boulder CO 80304

Outpatient clinic for rehabilitation, sports medicine, outpatient mental health and homecare. BCH at Bouolder Medical Center

2750 Broadway Boulder CO 80304

laboratory and imaging services Boulder Community Musculoskeletal Surgery LLC

1136 Alpine Avenue Boulder CO 80304

Ambulatory Surgical Center BCH Cyberknife Services

905 Alpine Boulder CO 80304

outpatient cyberknife services Endoscopy Center of the Rockies in Lafayette

1000 W South Boulder Road Suite 202 Lafayette CO 80026

Endoscopic Ambulatory Surgery Center Endoscopy Center of the Rockies in Boulder

1755 48th Street Suite 110 Boulder CO 80303

Endoscopic Ambulatory Surgical Center Endoscopy Cener of the Rockies in Longmont

1551 Professional Lane Suite 295 Longmont CO 80501

Endoscopic Ambulatory Surgical Center Family Medical Associates

1000 W South Boulder Rd Suite 110 Lafayette CO 80026

Physician clinic Table Mesa Family Medicine

1755 48th St Suite 200 Boulder CO 80303

Physician clinic Boulder Community Hospital Occupational Medicine

4745 Arapahoe Ave Suite G40 Boulder CO 80303

Occupational medicine clinic Gunbarrel Medical Center

6685 Gunpark Drive Suite 110 Boulder CO 80301

Physician clinic Internal Medicine Associates

1155 Alpine Unite 360 Boulder CO 80304

Physician clinic Internal Medical Associates Foothills

4745 Arapahoe Ave Unit G50 Boulder CO 80303

Physician clinic Beacon Clinic

1136 Alpine Ave Suite 205 Boulder CO 80304

Infectious Disease Clinic Boulder Community Sleep Services LLC

1000 Alpine Ave Suite 201 Boulder CO 80304

Sleep study center Boulder Community Sleep Services LLC

13654 Xavier Lane Suite 210A Broomfield CO 80020

Sleep study center Internal Medical Associates of Lafayette

100 W South Boulder Rd Suite 214 Lafayette CO 80026

Physician clinic Sports Medicine East

400 S McCaslin Blvd Louisville CO 80027

Sports medicine clinic Foothills Gynecology

4745 Arapahoe Suite G50 Boulder CO 80303

Physician clinic Buffalo Ridge Medical Center

16677 Lowell Blvd Broomfield CO 80023

Physician clinic Center for Integrative Care

4715 Arapahoe Unit 100 Boulder CO 80303

Outpatient integrative care for cancer patients Broomfield Imaging

36 Garden Center Broomfield CO 80020

Laboratory and imaging services Boulder Gynecology and Minimally Invasive Surgery

4800 Riverbend Road Suite 200 Boulder CO 80301

Physician clinic IMA at Balfour Clinic

1336 Hecla Drive Louisville CO 80027

physician clinic Community Medical Associates of Lafayette

401 E Cleveland Street Lafayette CO 80026

Physician clinic Frontier Internal Medicine

2101 Ken Pratt Blvd Ste 104 Longmont CO 80501

Physician clinic Holistic Family Practice

1155 Alpine Avenue Suite 360 Boulder CO 80304

Physician clinic Northwest Family Medicine

500 Discovery Parkway Suite 150 Superior CO 80027

Physician clinic Rocky Mountain Cardiology Boulder

2505 4th Street Boulder CO 80304

Physician clinic Rocky Mountain Cardiology Broomfield

16677 Lowell Blvd Broomfield CO 800238053

Physician clinic Rocky Mountain Cardiology Lafayette

1000 W South boulder Road Suite 216 Lafayette CO 800262089

Physician clinic Rocky Mountain Cardilogy Longmont

2101 Ken Pratt Blvd Suite 104 Longmont CO 805016568

Physician clinic Colorado Cardiovascular Center

3000 Center Green Drive Suite 120 Boulder CO 80301

Physician clinic Spruce Street Internal Medicine

2575 Spruce Street Boulder CO 80302

Physician clinic SchH_P01_S00_L07 Schedule H, Part I, Line 7 Ratio of Patient Care Costs to Patient Care Charges SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f $18,326,057 SchH_P02_S00_L00 Schedule H, Part II Community Support Activities include diaster readiness training in conjunction with numerous local agencies (fire, police, sheriff, other counties, other hospitals) to ensure coordinated and effective response to a disaster. Coalition building includes the hospitals participation in the development of the Colorado Regional Health Information Organization (CORHIO) and Boulder County Health Information Exchange (BCHIE)-both are electronic health exchanges aimed at promoting effective and efficient health care delivery as well as information for community health assessments. Workforce development includes physician recruitment for physicians not employed by the hospital-Boulder is a Medically Underserved Area for low income and Medicare. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 1. The amount reported on Line 2 as bad debt is the actual balance on account written off to bad debt. It is not reduced to cost, since our system does not track what is a gross charge write-off versus what is a patient responsibility write -off after insurance and insurance discounts have been recognized, 2. The hospital does not have a mechanism to reasonably estimate the amount bad debt cost that would reasonably relate to patients who would qualify for financial assistance under the hospital's financial assistance policy, but for whom sufficient information was not obtained to make a determination of their eligibility. However, surely there are significant bad debts that would qualify for charity if the information were known. 3. See 2. 4. F/N 2 Summary of Significant Accounting Policies (f) Patient Accounts Receivable Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated 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 or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Hospital's allowance for doubtful accounts for self-pay patients increased from 105% of self-pay accounts receivable at December 31, 2011, to 112% of self-pay accounts receivable at December 31, 2012. The allowance includes a reserve for deductible and copayments classified within insured accounts receivable at year end. In addition, the Hospital's write-offs decreased approximately $799,000 from approximately $21,002,000 for the year ended December 31, 2011, to approximately $20,223,000 for the year ended December 31, 2012. The decrease in bad debt write-offs results from a focused effort to identify patients eligible for charity care and an expansion of the Hospital's prompt pay discount program. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 100% and more of Line 7 Medicare shortfall should be treated as community benefit. Boulder County has a demonstrated community need for physicians who accept Medicare. (Many physician providers do not.) The hospital not only serves the Medicare population for hospital services, it also employs numerous primary care, internal medicine and cardiology providers who accept Medicare in order to provide our community with adequate coverage. The Cost Report shortfall reported on Line 7 excludes Medicare HMO enrollee shortfalls, excludes shortfalls from ancillary procedures which are paid by fee schedule and are therefore not included in the Cost Report, and excludes the shortfall related to employed physicians serving the Medicare population. The hospitals total Medicare shortfall, including these programs, is actually $24,648,128. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The hospital employs financial counselors to assist patients in determining eligibility for Medicaid, Colorado Indigent Care Program (CICP), or the hospital's charity program (WeCare). Financial arrangements with Emergency Room patients are not discussed until the patient has been assessed and treated in accordance with EMTALA. The hospital's debt collection policy contains a Communications section addressing courtesy, confidentiality, cultural sensitivity, and primary language of a patient. It contains a section on Billing and Collection Practices which addresses when an account will be referred to a licensed collection agency and that those agencies will treat all patients with dignity, compassion and respect, as well as adhering to Colorado State Laws and the Fair Debt Collection Act. Patients may apply/reapply for financial assistance before, during or after care, or after collection agency assignment. SchH_P05_S0B_L04 Schedule H, Part V, Section B, Line 4 The Community Health Needs Assessment includes both the Boulder Community Hospital and the Boulder Community Foothills Hospital. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 The Community Health Needs Assessment was reviewed and endorsed by the BCH Board of Directors at its meeting on February 22, 2011. SchH_P05_S0B_L06 Schedule H, Part V, Section B, Line 6 BCH STRATEGIES FOR ADDRESSING COMMUNITY HEALTH NEEDS 2011-2013 As a result of the research and recommendations that appear in this assessment report and further dialog with the BCH Board of Directors and medical staff, the following four strategies will guide BCH leadership in addressing our community's health needs over the next three years: 1. STRENGTHEN PARTNERSHIPS WITH KEY COMMUNITY HEALTH PROVIDERS BCH will focus on strengthening institutional relationships with the following local organizations, developing collaborative efforts to improve health care within the Boulder Valley. Partnerships may include joint funding of initiatives, direct support funding, providing leadership to governing boards, information sharing and other possible cooperative ventures. While this listing includes many major community health providers in the Boulder Valley, it is not meant to be exhaustive and other organizations that address community health needs identified in this assessment may be added. According to our assessment, these agencies directly address identified community health needs and serve the populations in most need within the BCH service area: Boulder County Public Health Department Boulder Shelter for the Homeless Boulder Valley Women's Health Center Clinica Campensina Family Health Services/People's Clinic Dental Aid Intercambio de Communidades Mental Health Partners (The Mental Health Center Serving Boulder & Broomfield Counties) St. Benedict Health & Healing Ministry 2. EXPAND PRIMARY CARE ACCESS BCH intends to continue to increase the number of primary care providers within the hospital's service area. All BCH-owned clinics are accessible to patients with Medicare and many accept Medicaid. Through our collaborative relationship with Clinica/Peoples Clinic, we are committed to improving patient access to primary care providers regardless of a patient's medical insurance status. 10 Recognizing the Boulder area population is both aging and expanding to the east and south of Boulder proper, BCH has embarked upon an aggressive $125 million, 10-year transitional facilities plan that will expand and improve access to hospital facilities and clinics throughout the decade ahead. 3. PREVENTATIVE CARE FOCUS In 2011, BCH initiated a Certified Diabetes Educator program in the hospital's nine primary care clinics located throughout the Boulder Valley. Each clinic will identify patients with diabetes and afford them enhanced opportunities for one-on- one counseling, chronic disease management education and peer coaching. In addition, this clinic-wide initiative will identify and interview patients with pre- diabetic symptoms and offer patient education and, support and counseling to mitigate future impacts. Using the Diabetes Educator initiative as a model, BCH will consider similar strategies in future years that address other chronic diseases (asthma, hypertension, heart disease and depression) impacting Boulder Valley residents. BCH is an active partner in the Boulder Valley Care Network, a unique and innovative joint community effort of area hospitals and clinics assisting employees and families of the Boulder Valley School District (one of the area's larger employers) in improving preventative care and managing chronic diseases. A significant aspect of the Hospital Transition Plan described above is the development of a state-of-the art Heart Center on the Foothills campus, slated to open in 2014. The Hospital is aggressively striving for preeminence in cardiac care by directly addressing the chronic heart disease and hypertension. In 2011, BCH began providing Electroconvulsive Therapy (ECT), a treatment for certain mental disorders, most notably severe depression. In bringing this medical service to the community, allowances were made to treat selective Medicare, Medicaid and uninsured patients. 4. HEALTH INFORMATON EXCHANGE & INTEGRATED CARE BCH is an active leader and collaborator in the Colorado Regional Health Information Organization and will be the first hospital in the state to submit data to this health information exchange. This information exchange will help integrate care throughout the county by enabling all health care providers to have access to the medical information placed on the electronic system. At least 300 physicians and the four hospitals in the county will be involved in this record sharing project. Having ready access to extensive patient medical records will improve the quality and efficiency of care, enhance patient safety and assist health care providers and public health officials in identifying health needs and developing future initiatives to address those needs. 11 BCH has recently initiated a program in the Emergency Department (ED) designed to improve discharge planning and transitional care. A Registered Nurse will act as a Case Manager in the ED and will work directly with indigent and homeless patients, performing needs assessments and arranging for a primary care provider to continue the patient's treatment plan following release from the Emergency Department. BCH Social Workers will also be involved in this effort. Similarily, BCH is an active partner in the recently created Boulder County Respite Program designed to improve discharge planning and transitional care for homeless patients. Beginning in 2011, BCH has assumed full responsibility for its Hospitalists Program. The group's new Director comes to BCH from Denver Health and has extensive leadership experience in discharge planning for needy and underserved patients. BCH will be a collaborative leader in promoting increased cooperation and coordination among area health care providers to improve discharge planning and coordinated care. Endorsed by BCH Board of Directors February 22, 2011 SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 All patients without insurance are eligible for a 60% prompt pay discount if payment made at time or service (or within 72 hours following discharge for emergencies) or a 50% discount if paid within 30 days for medically urgent, emergency, prenatal, and obstetric services. Those patients who qualify for financial assistance receive a discount rate that exceeds the lowest negotiated commercial discount rate. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 The hospital collaborated with the Boulder County Public Health Department, the Community Foundation Serving Boulder County and over 50 other community organizations who participated in community health focus groups to prepare a Community Health Needs Assessment. The report was issued February 22, 2011. In 2010 a comprehensive facilities study was performed to evaluate each of the existing hospital campuses and determine the most efficient and effective methods of delivering the safest, highest quality and efficient health care. The Hospital's Board Planning Committee uses the Community Health Needs Assessment, the Comprehensive Facilities study, as well as market and demographic studies to ensure the Hospital meets the future health care needs of our community. The Hospital is embarking on a 10 year transitional strategy to consolidate health care delivery in order to meet the needs of the community in a safe and sustainable manner. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Hospital employs financial counselors to assist patients in determining eligibility for Medicaid, Colorado Indigent Care Program (CICP), or the Hospital's charity program (WeCare). The hospital employs Spanish speaking financial counselors and would utilize interpreter services for other languages. Financial Assistance programs are referenced in patient discharge information, billing statements, and on the hospital's web site. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The Corporation provides comprehensive health services to a diverse population of more than 300,000 people who reside in Boulder County and an adjacent portion of the City and County of Broomfield. The Corporation has refined delineation of its primary and secondary service areas based on its market share by zip code. The primary service area includes the Cities of Boulder, Lafayette (approximately 15 miles east of the Broadway Campus and 11 miles southeast of the Foothills Campus), and Louisville (approximately 11 miles southeast of the Broadway Campus) as well as the western portion of the City and County of Broomfield. The secondary service area encompasses the rest of Boulder County, including the City of Longmont, which is approximately 15 miles northeast of the Broadway Campus. According to the Community Foundation's Boulder County Trends report published in 2009, the Boulder community enjoys good health which appears to be related directly to the community's higher-than-average education and economic levels. However, the Foundation Trends Report estimates that 15% to 20% of adults in Boulder County are without health insurance and a disproportionate number of the uninsured are Latino. The community's teen fertility rate is low compared to state and national benchmarks, but 70% of teen mothers are Latina and Latinas also lag in receiving prenatal care. The Trends study states that Boulder County children are generally rather fortunate, since 91% of the estimated 69,000 children under age 18 have access to health insurance. However, just 45% of Boulder County residents report having dental insurance coverage SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital is governed by a volunteer community board. The Hospital has an open medical staff. All surplus funds are reinvested in the hospital to fund charity, subsidize under performing health programs, develop new health programs, or as an investment in plant, equipment and technology. 1 Boulder County Fire Fighters Assoc Sunshine Fire Protection District 311 County Road 83 Boulder CO 80302 846000600 501 (c) 3 24000 0 FMV support for local fire association Boulder Valley Women's Health Center 2855 Valmont Rd Boulder CO 803011374 840645786 501 (c) 3 22500 FMV to wupport women's health Mental Health Partners Foundation 1333 Iris Avenue Boulder CO 80304 840520493 501(c)3 15000 FMV Support for non-profit mental health center serving Boulder and Broomfield counties. Boulder Valley School District 6500 E Arapahoe Boulder CO 80303 846014683 501(c)3 66967 Cost Provide athletic trainer to school district Support high school athletics and help to reduce injuries to student athletes. 4 0 Healthcare educational scholarships 24 38550 cost Assistance fund for IP rehab patients used to support patient and family with living and medical expenses. 12 10527 cost Assistance with chemotherapy treatment expenses, mammography expenses and other cancer related expenses. 15 14053 cost Charity drugs given after discharge 53 12703 Pharmaceutical prescriptions filled at cost for patients dicharged with inability to pay. Transportation and housing for indigent patients 363 7177 cost SchI_P01_S00_L02 Schedule I, Part I, Line 2 Grants are only made to non profit agencies supporting our local community with health and welfare services. Grants in excess of $10,000 are specifically approved by the hospital board of directors during the budget process. The CEO has a discretionary budget allocation for which he may approve disbursements less than $10,000. Monitoring of grants over $10,000 is done by having representation on their non profit board. Scholarship applications for healthcare education are reviewed by a committee, and payments are sent directly to the schools on the student's behalf with a letter indicating the money should be returned to the hospital if the student does not register. X 0 1 X X X X X 0 1 0 0 0 0 0 1 0 David Gehant 854360 0 0 0 39500 0 17836 0 22993 0 934689 0 0 Paul Kenneth Lewis Jr 289559 0 64394 0 39500 0 81216 0 22297 0 496966 0 0 William A Munson Jr 253139 0 33050 0 34000 0 56579 0 27040 0 403808 0 0 Jacqueline M Attlesey-Pries 206759 0 13093 0 17068 0 47905 0 23168 0 307993 0 0 Sarah E Meshak 179407 0 39092 0 16500 0 52985 0 4718 0 292702 0 0 James Peters 159576 0 26890 0 39500 0 39985 0 23229 0 289180 0 0 Linda S Minghella 164925 0 42968 0 23500 0 49526 0 677 0 281596 0 0 0 Ronald Secrist 161114 0 17813 0 22500 0 26198 0 18687 0 246312 0 0 0 Jamie D Jensen 128698 0 13726 0 17000 0 11248 0 26586 0 197258 0 0 0 Daniel S White 495183 0 113011 0 20923 0 32411 0 23238 0 684766 0 27651 0 Sameer A Oza 476714 0 144683 0 34000 0 32710 0 21399 0 709506 0 29017 0 Nelson P Trujillo Jr 478899 0 123688 0 39500 0 32710 0 21399 0 696196 0 29989 0 John A Schutz 491255 0 116506 0 18962 0 29858 0 22443 0 679024 0 27651 0 John R McNeil III 475328 0 110947 0 34000 0 32710 0 23715 0 676700 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a The hospital pays for board member companion travel at its annual educational conference. Companion travel is reported as Misc Income on the 1099 of the board member. SchJ_P01_S00_L01b Schedule J, Part I, Line 1b Travel for companions is only reimbursed for board members attending the annual educational conference. Companion travel is reimbursed based upon substantiated receipts and is reported as Miscellaneous Income on 1099 of the board member. In all other circumstances, companion travel is not reimbursable by the hospital. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The hospital has a Compensation Committee as specified by the bylaws of the hospital (Article V, D). The Compensation Committee is comprised of the Chairman, Vice Chairman, Secretary and a member of the Finance Committee. The committee meets approximately three times per year to review the CEO compensation and approve annual contract changes. Compensation and contract changes are reported to the Board. The Committee engages a consulting firm to provide comparative compensation studies for similarly qualified persons in functionally comparable positions at similarly situated organizations. Compensation study and performance review are considered in developing the compensation decision. Compensation ranges and Benefit changes for Vice President level employees are reviewed and approved by the Compensation Committee if they are outside of hospital wide treatment. Compensation studies are also used for VP level assessment. All Compensation Committee meetings are formally documented through minutes. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Ln 4b--The hospital has a nonqualified 457(b) plan in which employee's may defer salary. Participants include: David Gehant ($17,000), Paul Lewis Jr ($17,000), William Munson Jr ($17,000), Jacqueline Attlesey-Pries ($250), Linda Minghella ($1,000), John McNeil ($17,000) , Sameer Oza ($17,000), James Peters ($17,000), John Schutz ($17,000), Nelson Trujillo Jr ($17,000) and Daniel White ($4,577). The hospital contributes to a nonqualified 457(f) plan for the benefit of its executive leadership. Participants include: Paul Lewis Jr, VP & Chief Medical Officer ($63,662 contributed), William Munson Jr, VP & CFO ($39,025 contributed), Sarah Meshak, VP & General Counsel ($38,752 contributed), James Peters, VP ($25,298 contributed), Linda Minghella, VP & CIO ($36,133 contributed), Ron Secrist, Foundation President ($13,226 contributed), and Jacqueline Attlesey-Pries, VP & CNO ($46,822) contributed. SchJ_P01_S00_L07 Schedule J, Part I, Line 7 The hospital has an Incentive Compensation Plan for Vice Presidents and Directors whereby a percentage of base salary is paid out if goals are met and if authorized by the Board of Directors. For Vice-Presidents, one-third of their incentive is based upon the Hospital meeting at least 85% of its budgeted net operating income before interest expense. One-third VP incentive is based on Safety goals and one-third is based on Performance Goals. The one-third financial goal for Directors is based on meeting their departmental financial targets, as well as a one-third safety goal and a one-third performance goal. A Colorado Health Facilities Authority 840752932 19648AVF9 2010-12-01 93535431 Foothills expansion; balance for debt refunding 0 0 0 B Colorado Health Facilities Authority 840752932 19648AZL2 2012-08-28 31748673 Foothills hospital expansion 0 0 0 A 5645000 0 93752796 0 0 0 1080618 0 0 17618204 67458941 7599154 2014 1 0 0 1 B 0 0 31747587 0 0 0 368228 0 0 0 0 31379359 2014 0 0 0 1 A 0 0 1 1 0 0 0 0 0 0 1 B 0 0 1 1 0 0 0 0 0 0 1 A 0 1 1 0 1 0 0 0 1 B 0 1 1 0 0 0 0 0 1 A 1 B 1 SchK_P01_S00_L00e Schedule K, Part I, Column e Part I, Ln A(e) of $93,535,431 is less than Part II Line 3(A) of 93,752,796 by the cumulative trust fund interest income of $217,365. Part I, Ln B(e) of $31,748,673 is greater than Part II Line 3(B) of 31,747,587 by the cumulative trust fund interest income loss of $1,086. SchK_P02_S00_L03 Schedule K, Part II, Line 3 (A), Line 3 minus Part II (A) Lines 4 through 12 exceeds Part II (A) Line 3 by 4,121 which is the amount transferred into the 2010 Cost of Issuance Bond Trust Account from the close-out of the 2003 Bond Interest Trust Fund. SchK_P02_S00_L11 Schedule K, Part II, Line 11 Line 11 (A) Other Spent Proceeds includes $14,546,298 to refund Series 1994B, $26,456,321 to refund Series 2003A and $26,456,321 to refund Series 2003B. Boulder Valley Pulmonology PC Dr. Randal Bjerke is a member of Boulder Valley Pulmonology PC 238527 Boulder Valley Pulmonology PC was paid $238,527 in 2012 for the provision of intensivist coverage for the ICU. 0 Boulder Medical Center PC (BMC) Dr. Fries is a board member of the hospital, a board member of BMC, and a pediatrician with BMC. 323521 The hospital paid Dr. Fries $2,400 as a Pediatric Rehab Medical DirecThe hospital paid BMC $303,521 under a lab and imaging space lease agreement. The hospital has an agreement with BMC to provide on-site lab and imaging services to BMC patients. All lab and imaging charges are billed directly to patients and third party insurances by the hospital. The hospital loaned BMC $20,000 for the recruitment of a urologoist; this loan will be forgiven as long as the urologist serves the community for 14 months. 0 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Form 990 is prepared by the Controller based upon audited financial statements. The 990 is reviewed by the nonprofit tax manager of our external audit firm, by the CEO, CFO, VP & General Counsel, Compliance Officer, and the Audit Committee of the Board of Directors. Final copies are provided to each voting Board member electronically before filing with the IRS. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The hospital has a Conflict of Interest policy for staff, a Conflict of Interest policy for Board Members, and a Conflict of Interest disclosure form for physicians serving on committees. Board members complete an annual Statement of Interest form which discloses employment, family member employment, business relationships, service on other Boards or governance positions and identifies other conflicts of interest. The Statement of Interest also identifies transactions requiring disclosure. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The hospital has a Compensation Committee as specified by the bylaws of the hospital (Article V, D). The Compensation Committee is comprised of the Chairman, Vice Chairman, Secretary and a member of the Finance Committee. The committee meets approximately three times per year to review the CEO compensation and approve annual contract changes. Compensation and contract changes are reported to the Board. The Committee engages a consulting firm to provide comparative compensation studies for similarly qualified persons in functionally comparable positions at similarly situated organizations. Compensation study and performance review are considered in developing the compensation decision. Compensation ranges and Benefit changes for Vice President level employees are reviewed and approved by the Compensation Committee if they are outside of hospital wide treatment. Compensation studies are also used for VP level assessment. All Compensation Committee meetings are formally documented through minutes. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The hospital's web site is www.bch.org. The web site includes the hospital's Mission, Vision and Beliefs Statement. It also includes the Annual Report which contains the hospital Board members, key financial data, and information on new programs, patient safety and quality, and community benefits. The web site also has a section for Compliance policies including the Code of Conduct and Conflict of Interest. Annual audited financial statements are made available to the public at the Annual Meeting of The Community Hospital Association. The tax return is made available to anyone who requests the return through our Public Information Office. F990_P11_S00_L09 Form 990, Part XI, Line 9 Other Change in Net Assets of -11,189,826 = Change in Foundation Assets of 7,818,322 plus Charge for Minimum Pension Liability of -18,768,513 plus charge for amortization of ineffective loss on swap of -239,635. Boulder Community Hospital Foundation 1155 Alpine Avenue Suite G40 Boulder CO 80304 840772664 Fundraising for hosp CO 509(c)3 509(a)3 N/A 0 Boulder Community Musculoskeletal Surgery Center LLC 1136 Alpine Avenue Boulder CO 80304 201391702 Outpatient surgery center CO N/A Related 1707668 1187801 0 0 0 0.5 Endoscopy Center of the Rockies LLC 382 S Arthur Ave Ste 140 Louisville CO 80027 841562782 Outpatient Endoscopy CO N/A Related 4252842 1040565 0 0 0 0.5 Boulder Community Sleep Services LLC 1100 Balsam Ave Boulder CO 80304 262429064 Sleep Lab Services CO N/A Related 161686 25568 0 0 1 0.45 Boulder MRI LLC 1000 W South Boulder Road Suite 105 Lafayette CO 80026 452676500 outpaient MRI center CO The Community Hospital Association dba Boulder Community Hospital Related -286222 830101 0 0 0 0.51 Foothills Surgery Center LLC 4743 Arapahoe Avenue Suite 101 Boulder CO 80303 455328252 Ambulatory Surgical Center CO N/A Related -10957 544438 0 0 0 0.51 0 1 1 1 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 Boulder Community Musculoskeletal Surgery Center LLC j 693585 Lease Agreement Boulder Community Musculoskeletal Surgery Center LLC q 64295 Recap of Expenditures reimburesed per contract Boulder Community Sleep Services LLC q 487982 Contract for services Boulder Community Sleep Services LLC m 995200 Contract for Services Boulder MRI LLC b 163508 K-1 Foothills Surgery Center LLC b 555395 K-1 Boulder Community Musculoskeletal Surgery Center LLC c 1750000 Capital Distribution checks Endoscopy Center of the Rockies LLC c 4350000 Capital distribution checks received. Boulder Community Sleep Services LLC c 165167 Capital distribution checks received. Boulder MRI LLC c 255000 Capital distribution checks received. Boulder MRI LLC d 1338750 Loan Guaranty document Notice CP211A approved our extension request to November 15, 2013. The September 2013 flood in Boulder county resulted in declaration as a federal disaster area. Automatic tax filing extensions for return deadlines between September 11 through December 2, 2013 have been postponed to December 2, 2013.