2011-11-15T11:00:17-06:00 2010-12-31 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 55402 990 2010-01-01 820207116 Bonner General Hospital Inc BONN 2082631441 PO Box 1448 Sandpoint ID 83864 Norilina Harvel 2082631441 2011-11-14 1 Kim Hunwardsen 6122536500 2011-11-14 2010 2016-02-24 21:20:13Z Bonner General Hospital Sheryl Rickard PO Box 1448 Sandpoint ID 83864 44857334 0 X www.bonnergen.org X 1949 ID To provide excellence in healthcare close to home. 9 9 470 9 0 0 277947 171859 45418251 44416567 243020 37843 1780562 211735 47719780 44838004 0 0 0 0 21424070 21622594 0 0 9695 22726705 22364632 44150775 43987226 3569005 850778 30834847 33332550 15530511 17016419 15304336 16316131 X To provide excellence in healthcare close to home. 0 0 36999478 44575502 Bonner General Hospital (BGH), located in Sandpoint, Idaho, is a full-service critical access hospital licensed for 25 beds. BGH is accredited by the Joint Commission on Accreditation of Healthcare Organizations and is a member of the Voluntary Hospitals of America, Mountain States region. 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 57,000. 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 01/01/10 to 12/31/10, BGH admitted 2,163 patients, serviced 8,531 emergency room visits, delivered 344 babies and performed 4,117 surgical procedures. During that same period, BGH provided 5,577 days of patient care, 6,360 Home Health care visits and 4,576 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 01/01/10 to 12/31/10 BGH provided $18,217,447 in unreimbursed care to government-sponsored health care program (i.e. Medicare and Medicaid), $6,556,122 in uncompensated care to private pay patients, and $1,243,089 in charity care, based on gross charges. 36999478 1 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 83 0 1 470 1 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Norilina Harvel 2082631441 PO Box 1448 Sandpoint ID 83864 Ford Elsaesser 1.00 X X 0 0 0 Tim Cochran 1.00 X X 0 0 0 Thomas Lawrence MD 1.00 X 0 0 0 Richard Neher MD 1.00 X 0 0 0 Verna White 1.00 X 0 0 0 Jack Parker 1.00 X 0 0 0 Howard Faux 1.00 X 0 0 0 Mike Feurer 1.00 X 0 0 0 Edie Holmes 1.00 X 0 0 0 Sheryl Rickard 40.00 X 204512 0 92867 Norilina Harvel 40.00 X 140557 0 14202 Jeff Bales 40.00 X 103618 0 11868 Mauria Prince 40.00 X 124530 0 13129 Charlene Godec 40.00 X 118580 0 15585 Jeffrey B Fowler DO 40.00 X 148633 0 9614 Charles Falter DO 35.00 X 136373 0 36869 976803 0 194134 8 0 1 0 Pend Orielle Radiology Inc 520 N 3rd Sandpoint ID 83864 Radiologist Services 1507042 Lake Pend Orielle Emergency Medicine 520 N 3rd Sandpoint ID 83864 ER Physician Staffing 1158221 Thermo Fisher Scientific LLC 28 Schenck Parkway Ste 400 Sasheville NC 28803 Equipment Maintenance Support 324769 Information Resource Management PO Box 469 Spokane WA 99210 Software Support Services 278168 Aureus Radiology LLC 13609 California ST Omaha NE 68154 Contract Staffing 234119 12 8740 163119 24905 171859 Patient Service Revenu 622110 43132665 43132665 Property Tax Revenue 900099 952969 952969 Miscellaneous Revenue 900099 219981 219981 Cafeteria Revenue 900099 153272 153272 Investment in Pinegrov 900099 -42320 -42320 44416567 39868 39868 178990 11305 167685 167685 158935 8750 6000 8025 -2025 -2025 -2025 Interest Income 900099 44050 44050 44050 44838004 44575502 0 90643 452137 452137 14529853 11833009 2696844 321994 252069 69925 5033820 3916828 1116992 1284790 1004183 280607 35418 35131 287 46493 46493 5519787 5465959 53828 49800 49084 716 7022769 6759294 259896 3579 581666 147510 434156 505208 505208 121626 91940 27493 2193 870232 870232 1299769 681937 617832 618653 610879 7774 Bad Debt Expense 3454143 3454143 Equipment Lease and Ren 1188360 1096678 91682 Patient Accounting Coll 419603 419603 Dues and Subscriptions 60012 38136 21347 529 571093 271473 297229 2391 43987226 36999478 6978053 9695 10218814 10136796 7031977 5678337 221724 64534 918177 900417 440561 265008 27330552 16480791 10338773 10849761 3916631 386863 1664821 1134203 30834847 33332550 3581440 3079081 11240000 11020000 709071 652492 0 2264846 15530511 17016419 X 14973247 15746173 307186 569958 23903 0 15304336 16316131 30834847 33332550 X 850778 161017 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X public display 0 2003760 1345 210914 5319 21518 2189182 1769645 -9 255043 6119 14800 2003760 1508783 1344727 -265724 809455 8686 1769645 0.86040 0.13960 0 0 792523 507866 1300389 12756260 7342005 5414255 11325122 8865980 2459142 1948781 272806 1675975 10849761 Third-Party Payor Settlements 1330274 Contract Payable 934572 2264846 44838004 43987226 850778 184920 -23903 161017 1011795 44805338 1523 1523 44803815 34189 34189 44838004 43998531 11305 11305 43987226 0 43987226 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. Description of Intended Use of Endowment Funds: Part V, Line 4: The Term Endowment is a Restricted Endowment strictly for nursing education. The Board designated is an unrestricted fund for future capital improvements at this time. In 2007, the original endowments were restricted at 25% for the term endowment and 75% for the board designated. Description of Uncertain Tax Positions Under FIN 48: Part X: The Hospital has adopted the provisions of FASB Accounting Standards Codification Topic ASC 740-10, Accounting for Uncertainty in Income Taxes, on January 1, 2009. The implementation of this standard had no impact on the financial statements. As of both the date of adoption, and as of December 31, 2010 and 2009, the unrecognized tax benefit accrual was zero. The Hospital will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense if incurred. The Hospital is no longer subject to Federal tax examinations by tax authorities for years before 2007 and state examinations for years before 2007. Part XII, Line 2d - Other Adjustments: Net Assets Released from Restrictions not Reported for Tax Return Purposes 1,523. Part XII, Line 4b - Other Adjustments: Contributions Reported in Fund Balance on Financial Statements 45,494. Rental Expenses Reported in Expenses on Financial Statements -11,305. Part XIII, Line 2d - Other Adjustments: Rental Expenses Reported in Revenues on Form 990 11,305. 1 1 X 1 X 210.000000000000 1 X 240.000000000000 1 1 0 0 403 721449 721449 0.01780 4603496 4928199 -324703 0.00000 505655 524373 -18718 0.00000 403 5830600 5452572 378028 0.01780 5639 5639 0.00010 423 423 0.00010 67030 58723 8307 0.00020 16393 16393 0.00040 89485 58723 30762 0.00080 403 5920085 5511295 408790 0.01860 2 923 923 0.00030 260 2550 2550 0.00070 172 13078 13078 0.00380 625 387 387 0.00010 1059 16938 16938 0.00490 0 2004674 501169 9271319 11626511 -2355192 X 1 1 1 Pinegrove Medical Bldg LLC operate medical office building 0.50000 0.50000 1 1 Bonner General Hospital Inc

520 N 3rd Avenue Sandpoint ID 83864

X X X X Not required 1 7 Hospice Agency

602 N 3rd Ave Sandpoint ID 83864

hospice agency Urgent Care Physician Clinic

400 Schweitzer Plaza Drive Suite 1 Ponderay ID 83852

urgent care physician clinic Home Health Agency

602 N 3rd Ave Sandpoint ID 83864

home health agency Priest River Physician Clinic

314 Albeni Hwy Priest River ID 83856

physician clinic Pinegrove Medical Office Building

606 N 3rd Ave Suite 202 Sandpoint ID 83864

provider based physical therapy clinic Ponderay Medical Village

30544 Hwy 200 Suite 103 Ponderay ID 83852

provider based physical therapy clinic Priest River Therapy Clinic

314 Albeni Hwy Priest River ID 83856

provider based physical therapy clinic Part I, Line 7: Charity care, unreimbursed Medicaid and unreimbursed, other means-tested government programs, and subsidized health services were all calculated using the cost-to-charge ratio derived from the Ratio of Patient Care Cost-to-Charges worksheet 2. Community health improvements, health professions education and cash and in-kind contributions to community groups are based on actual expenses reported in the general ledger. Part I, L7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $3,454,143. Part II: Bonner General Hospital's coalition building activities included support for a low-cost health care provider, Bonner Partners in Care. Nurses, Lab Techs, and Med Techs all receive training at BGH to assist their completion of their education programs. Additionally, BGH provides job shadowing opportunities for students interested in health care careers. The community receives educational health information from BGH through health fairs, workplace fairs, school fieldtrips, First Aid Tents, and BGH employees giving talks at area schools. Part III, Line 4: Bad debt was converted to cost using the cost-to-charge ratio derived from Worksheet 2.Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. The organization reasonably estimates the portion of bad debt that would be considered charity care by taking the percentage (%) of applications denied due to lack of information of 25% and multiplying that by bad debt at cost. Had the individuals applied, they would have been considered charity care.Financial Statement Footnote:The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Part III, Line 8: BGH was a PPS Hospital for 9 months of the year and then became a critical access hospital. As a result of being a PPS hospital the majority of the year, Medicare for 2010 resulted in a shortfall. BGH's position is that 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 promote access to healthcare services which is a key community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. Part III, Line 9b: Bonner General Hospital's policy establishes the Hospital's financial requirements for payment of services based on consistent criteria incorporating individual patient financial conditions and circumstances. This policy will ensure the appropriate resolution of patient financial obligations to Bonner General Hospital while maintaining optimal customer satisfaction. As a non-profit hospital, Bonner General Hospital is committed to providing medically necessary service to all patients regardless of their ability to pay. The Business Services representatives follow a detailed procedure applicable to the patient situations such as billing for valid insurance plans as a primary; reviewing financial assistance, if applicable; providing payment options for patient balances not covered by insurance or if not qualified for financial assistance programs. If a patient qualifies for financial assistance, Bonner General Hospital will hold all billings and collections until financial assistance is determined. Part VI, Line 2: Bonner General Hospital conducted a comprehensive community needs assessment focused on the health care needs of Bonner and Boundary Counties, as well as a sampling in the Lincoln County of Montana. Part VI, Line 3: Bonner General Hospital provides information about BGH Cares, financial assistance policy, during pre-registration and registration process at admitting and the emergency departments. Business Services include information in patient statements, and a Patient Financial Advocate to assist 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 board of Washington. Part VI, Line 6: 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 that 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 that 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 that 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 that there continues to be a strong workforce far into the future. We do that 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 0 1 X X X 0 0 0 0 0 0 0 0 0 Sheryl Rickard 164736 0 10282 0 29494 0 22009 0 70858 0 297379 0 0 0 Norilina Harvel 129917 0 282 0 10358 0 3929 0 10274 0 154760 0 0 0 Jeffrey B Fowler DO 148351 0 282 0 0 0 4500 0 5114 0 158247 0 0 0 Charles Falter DO 136091 0 282 0 0 0 4172 0 32697 0 173242 0 0 0 Part I, Line 1a The CEO and CFO received a vehicle allowance. The benefit was treated as taxable compensation to the individuals. Part I, Line 1b The determination of the discretionary expense for the CEO and CFO is to compensate for travel to meetings in lieu of the mileage reimbursement policy. This determination was made by the Board of Directors and has been in place for many years. Idaho Health Facilities Authority 826051863 451295ST7 2006-03-22 11815000 Refinance 2000 Revenue Bond and purchase equipment. 0 0 0 1030000 11815000 1044465 233937 722752 9813846 1 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 X 3 0 price by artist X 5 24905 FMV 0 0 0 0 Non Reporting of Revenue: Part I, Line 33: The contributions for art work are donations by local artist. The intent is to provide art for the walls of the hospital, while displaying the artist name for future reference of visitors and patients. Form 990, Part VI, Section A, line 2 Ford Elsaesser and Jack Parker have a business relationship. Form 990, Part VI, Section A, line 6 Membership in the Corporation shall be open without restriction as to race, sex, religion, political, or other affiliation to any person of majority age who is in agreement with its aims and purposes, who agrees to abide by its Bylaws, and who has completed the application for membership and paid a one-time minimum fifty dollar membership fee. Form 990, Part VI, Section A, line 7a The members elect directors and remove them from office. Form 990, Part VI, Section A, line 7b The membership has responsibility to: A. Elect directors and remove them from office, if and when they are derelict in their duties. B. Hear and pass on the report of officers and the administrator of the hospital and of any committee responsible to it. C. Act as final arbitrator in any disputes or disagreements which may arise between the Board of Directors and any committee or individual members. D. Determine what amendments shall be made in the Bylaws. E. Exercise its final authority in all other matters vitally affecting the corporation. Form 990, Part VI, Section B, line 11 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 has a direct or indirect financial interest as defined in the Conflict of Interest Policy last reviewed 2/25/2011. 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 conflict 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 15 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 organization follows the process described in Part VI, Line 15. The process is done annually. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 184,920. Prior period adjustments: -23,903. Total to Form 990, Part XI, Line 5: 161,017.