Community Benefit Insight - Tax-exempt hospital

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Boulder Community Health

Boulder Community Hospital

4747 Arapahoe Avenue
Boulder, CO 80303

Bed count	211	Medicare provider number	060027	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 840175870

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

5.32%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 2,233,899 0.56 %
Medicaid as % of operating expenses	$ 17,727,837 4.42 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 292,971 0.07 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 597,529 0.15 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 469,462 0.12 %
Community building* as % of operating expenses	$ 152,422 0.04 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 152,422 0.04 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 1,428 0.94 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 4,879 3.20 %
Community health improvement advocacy as % of community building expenses	$ 146,115 95.86 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 2,945,709 0.73 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 736,427 25.00 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 289018509 including grants of $ 224291) (Revenue $ 401857869)
Health Care Delivery of IP and OP medical care. In 2021, the hospital discharged 7,506 adult & pediatric patients with an average length of stay of 4.3 days. 38,914 patients were seen in our ER facilities. 10,881 patients were seen in our Urgent Care facilities. 5,741 surgeries were performed in IP and OP settings.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Schedule H, Part V, Section B, Line 5-Boulder Community Foothills Hospital
Please refer to Community Input on pages 5 and 6 of the 2020-2022 CHNA, and to Appendix One of the CHNA report

Schedule H, Part V, Section B, Line 7-Boulder Community Foothills Hospital
https://www.bch.org/About-Us/Community-Reports.aspx Report is at the bottom of the page.

Schedule H, Part V, Section B, Line 10a-Boulder Community Foothills Hospital
https://www.bch.org/documents/forms/Community-Health-Needs-Assessment-Final-Approved-by-BCH-BOD-December-3-2019.pdf. Implementation Strategy begins on page 20 of the PDF.

Schedule H, Part V, Section B, Line 11-Boulder Community Foothills Hospital
Please refer to pages 10 - 14 and 20 - 28 of the 2020-2022 CHNA. The top four health needs identified are: Chronic disease management and traumatic injury, Mental health including chronic pain management and substance abuse, Wellness and preventative health including aging of the population and access to care and Community education. Details of how BCH is addressing these needs are included in the CHNA. The CHNA did not identify any significant health needs that are not being addressed. Two large social determinants of care which impact health are affordable housing and transportation. BCH is not directly addressing these because it is not in a position to have a direct impact. However, it partners with organizations within the community that are attempting to create positive change in these areas.

Schedule H, Part V, Section B, Line 16a-Boulder Community Foothills Hospital
https://www.bch.org/patient-visitors/patient-services/financial-assistance/

Schedule H, Part V, Section B, Line 16b-Boulder Community Foothills Hospital
https://www.bch.org/documents/content/FINANCIAL-ASSISTANCE-APPLICATION-New-2021.pdf

Schedule H, Part V, Section B, Line 16c-Boulder Community Foothills Hospital
https://www.bch.org/patient-visitors/FINANCIAL-ASSISTANCE.aspx

Supplemental Information

Schedule H (Form 990) Part VI

Schedule H, Part I, Line 3c
Criteria used to determine eligibility for financial assistance in addition to the FPG include Asset level, Medical Indigency, Insurance Status, Underinsurance status and Residency.

Schedule H, Part I, Line 7
The costing methodology used for Part 1, Lines 7a and 7b, is the Worksheet 2 Ratio of Cost-to-Charges. The costs for Lines e, 7f and 7i are directly identifiable costs from our internal accounting records.

Schedule H, Part II
Community Support Activities include disaster 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 Improvement Collaborative (BCHIC), which are both electronic health exchanges aimed at promoting effective and efficient health care delivery as well as information for community health assessments. BCHIC also helps underinsured and uninsured patients in the county obtain specialist care. Community health improvement advocacy includes participation on the Colorado Hospital Association Board, the Medicaid Provider Rate Review Advisory Committee, and a Purchasing Coalition to reduce costs. The Workforce development includes physician recruitment expense. Boulder is a Medically Underserved Area for low income and Medicare.

Schedule H, Part III, Section A, Line 4
The January 1, 2018 adoption of Financial Accounting Standards Board Accounting Standards Update 2014-09, Revenue from Contracts with Customers (ASU 2014-09) impacts the explicit recognition of the provision for doubtful accounts. Prior to January 1, 2018 the provision for doubtful accounts was explicitly recognized on the income statements; after January 1, 2018 it is reported net in Patient care service revenue and is not explicitly recognized on the audited financial statements. Footnote 2 Summary of Significant Accounting Policies, (o) Patient Care Service Revenue found on page 11 of the audited financial statements discusses implicit price concessions such as charity and bad debts. The amount reported on Line 2 as bad debt is an estimate of the cost of the actual balances on accounts written off to bad debt. It is estimated that 85% of the amount written off is stated at charges. This 85% is then converted to cost using the RCC developed on Worksheet 2. The remaining 15% is estimated to be related to a patient liability for deductibles and coinsurance. The amount reported on Ln 3 is estimated to be 25 % of Ln 2.

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, surgeons, neurologists, pulmonology 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 hospital's total Medicare shortfall, including these programs, is actually $43,054,254. The source for Line 6 is the filed Medicare Cost Report.

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. BCH will not knowingly send a patient's bill to a collection agency if they have an application pending for either government sponsored coverage or for financial assistance. Patients may apply/reapply for financial assistance before, during or after care, or after collection agency assignment.

Schedule H, Part VI, Line 2
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 health care. The Planning Committee uses the Community Health Needs Assessment, the Comprehensive Facilities study, as well as market and demographic studies to ensure BCH meets the future health care needs of our community. BCH is completing 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. As of October, 2014 all acute care inpatient services have been consolidated at the Foothills campus. BCH opened a new facility adjacent to the Foothills hospital in the spring of 2019 to move Behavioral Health services, and partnered with UCHealth to jointly provide Inpatient Rehabilitation services in Broomfield, CO, which opened mid 2019.

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 Hospitals 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.

Schedule H, Part VI, Line 4
Please refer to pages 15 through 19 of the 2020-2022 CHNA. This section of the CHNA discusses Service Area, Demographics, Gender, Age, Diversity and Employment/Income.

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.

Schedule H, Part VI, Line 7
The Hospital Community Benefit Accountability Report was filed August 2021 pertaining to the 12/31/19 Schedule H. This state reporting is required annually and includes figures from the previous year's 990 Schedule H filing. See https://www.bch.org/About-Us/Community-Reports.aspx

Operating expenses	$ 401,067,083
Total amount spent on community benefits as % of operating expenses	$ 21,321,698 5.32 %