2022-11-01T15:33:06-05:00 2021-12-31 390859910 Baker Tilly US LLP 101 Washington Street East Charleston WV 25329 990 2021-07-01 556005561 Webster County Memorial Hospital WEBS 3048475682 324 Miller Mountain Drive Webster Springs WV 26288 William Dempsey CEO 3048475682 2022-10-20 1 William Dempsey 999009999 Dolores Rose P01286262 3043460441 2022-10-03 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z William Dempsey 324 Miller Mountain Drive Webster Springs WV 26288 10023837 0 X www.wcmhwv.org X 1951 WV To provide acute short-term care to residents of Webster and surrounding counties of West Virginia. 6 6 211 6 0 0 139587 1828118 17982743 8137420 3255 771 3855794 57528 21981379 10023837 0 0 0 0 11705283 6436279 0 0 0 7226905 4220542 18932188 10656821 3049191 -632984 11179382 9245641 6742928 4842496 4436454 4403145 The mission of Webster County Memorial Hospital is to provide excellent, high quality care in a compassionate and cost-effective manner. 0 0 8584050 8194948 Critical Access Hospital services provided included 386 inpatient days, 35,707 outpaitent visits, and 7,108 RHC visits. Charges forgone for charity amounted to $5,561. 8584050 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 7 0 211 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Dalila Miller 3048475682 324 Miller Mountain Drive Webster Springs WV 26288 Mary Anne Carpenter Chair 1.00 X X 0 0 0 Christopher Graham Vice Chair 1.00 X X 0 0 0 Larry Lynch Secretary/Treasurer 1.00 X X 0 0 0 Karen Dotson Trustee 1.00 X 0 0 0 Keith Hamrick Trustee 1.00 X 0 0 0 Jim Phares Trustee 1.00 X 0 0 0 Dalila Miller Director of Business Opera 40.00 X 60146 0 1300 William Dempsey CEO 40.00 X 0 0 0 Frankie Pucket MD ER Director 40.00 X 682057 0 0 Robert Sutherland MD ER Physician 40.00 X 354635 0 15000 Johathan Beam MD Pharmacist 40.00 X 173224 0 19405 Jeanette Boyce MD Physician 40.00 X 175202 0 8643 Janak Patel MD Chief of Staff 40.00 X 525630 0 0 1970894 0 44348 17 0 1 1 McKesson Medical Surgical 9954 Mayland Drive Richmond VA 23233 Medical Supplies 511469 HealthlandCPSI PO Box 11407 Birmingham AL 35246 Electronic Medical Records 335247 LabCorp PO Box 12140 Burlington NC 27216 Lab Services 286079 Arnet Carbis Toothman PO Box 45723 Charleston WV 25239 CPA's 151424 Concordance Healthcare PO Box 94631 Cleveland OH 44101 Medical Supplies 104953 5 1789521 38597 1828118 Patient Service Revenue 622110 4443935 4443935 340B Pharmacy Revenue 900099 3693485 3693485 8137420 771 771 Other Revenue 900099 44010 44010 Employee Meals 722514 13518 13518 57528 10023837 8194948 0 771 60905 45307 15598 5323056 3959821 1363235 52744 39236 13508 665580 495125 170455 333994 248458 85536 101871 101871 412397 398029 14368 2709 2709 239607 210190 29417 278269 207004 71265 124165 92366 31799 39761 29578 10183 13155 9786 3369 235415 175125 60290 181006 134650 46356 Medical supplies 1752537 1752537 Bad debt expense 516419 516419 Repairs & maintenance 164773 122575 42198 Provider tax 116679 116679 41779 31165 10614 10656821 8584050 2072771 0 7312445 5750863 44546 44515 1390687 1093249 369838 600148 42716 8141870 6482509 1786028 1659361 275838 54789 11179382 9245641 1495137 1437687 1200000 954865 639717 3092926 2765092 6742928 4842496 X 4391908 4358630 44546 44515 4436454 4403145 11179382 9245641 -632984 599675 0 X X 0 1 X 1 1 1 X 1 3800 3800 0 Part II-B, Line 1: A portion of dues paid by the Hospital to the American Hospital Association and West Virginia Hospital Association is attributable to lobbying. 152765 152765 1793535 1767904 25631 6029935 4570827 1459108 165635 143778 21857 1659361 Third-party settlements 1226918 Covid 19 Advance 1538174 2765092 X 9507418 0 9507418 516419 516419 10023837 10127247 -13155 -13155 10140402 516419 516419 10656821 Part X, Line 2: The Hospital is a not-for-profit corporation and is exempt from income taxes under Section 115 of the Internal Revenue Code. Accordingly, no provision for income taxes has been provided. The Hospital follows the guidance for accounting for uncertainty in income taxes recognized in a companys financial statements that prescribes a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. The Hospitals policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. There were no interest or penalties recognized on the statements of revenue and expenses and changes in net position as a result of this guidance. Part XI, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 516,419. Part XII, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 516,419. 1 1 1 X 175.000000000000 1 X 175.000000000000 1 1 0 0 121136 121136 168808 160030 8778 0.00090 289944 281166 8778 0.00090 1100 1100 0.00010 1100 1100 0.00010 291044 281166 9878 0.00100 1 516419 1196544 1196544 X 1 1 1 1 Webster County Memorial Hospital PO Box 312 Webster Springs WV 26288 https://www.wcmhwv.org/ X X X Rural Health Clinic Webster County Memorial Hospital 1 0 0 1 X X X X X X X 20 1 0 0 1 X https://www.wcmhwv.org/downloadable-forms-1 X 1 20 1 https://www.wcmhwv.org/downloadable-forms-1 0 1 X 175.000000000000 175.000000000000 X X X 1 1 X X X 1 X https://www.wcmhwv.org/downloadable-forms-1 X https://www.wcmhwv.org/downloadable-forms-1 X https://www.wcmhwv.org/downloadable-forms-1 X X X X 1 X 0 X X X X 1 X 0 0 Webster County Memorial Hospital Part V, Section B, Line 5: The Community Health Needs Assessment (CHNA) questionnaire was taken to multiple public locations for community members to fill out and give their opinion of services needed and their satisfaction with services already provided by the hospital. Officials and employees were interviewed for the CHNA from the following: Webster County Health Department, Board of Education, Family Resource Network, United National Bank, Catholic Charities, and the food pantry. Webster County Memorial Hospital Part V, Section B, Line 11: Based upon the results of the Community Health Needs Assessment, Webster County Memorial Hospital will develop a three-year Implementation Strategy to address the following significant community health related needs:*Increased education and promotion of community resources*Utilize existing affiliations to promote healthier lifestyle choices*Chronic disease maintenance and prevention (Diabetes, Cardiovascular, Respiratory)*Improve overall health statusThe CHNA, approved on June 30, 2021, has provided valuable insight to the contributing factors of health related issues faced by the residents of Webster County and the surrounding communities. It will assist Webster County Memorial Hospital as well as other community providers to collaborate their efforts to provide the necessary resources for the community. Initiatives were aggregated among two main categories, increased education and promotion of community resources and promotion of healthier lifestyle choices. 2 1 - The Cowen Clinic 70 Technology Drive Cowen WV 26206 Prenatal primary care, pain management, wellness clinic 2 - Webster Physical Therapy 139 Bakers Island Webster Springs WV 26288 Physical therapy Part I, Line 3c: The patient's income is considered and reviewed to determine the amount of discount they receive, if not free care. The patient's assets are also reviewed. They can only have one vehicle and one house. If the patient has more than one vehicle, the total value of the vehicles cannot exceed $2,000. If the value exceeds $2,000, the patient will automatically be reduced to a percentage less than 100%. Part I, Line 7: The Hospital is a CAH and is paid 100% costs from Medicaid with the exception of the RHC which is PPS. The Medicaid community benefit expense reported on Part I, Line 7b is from the RHC excess cost over reimbursements. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 516,419. Part II, Community Building Activities: The Hospital distributes educational material regarding smoking cessation, healthy eating, saying no to drugs, cancer, diabetes & other diseases, how to live a healthier life along with physical activities. The Hospital also assists the community with kids needs for sports. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectibility. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The Medicare cost report was used to report Medicare revenue and expenses.CAH's receive cost reimbursement for Medicare services. A settlement process takes place after the Medicare cost report is filed in order to make payments (revenue) equal allowable cost. Thus, there is no "shortfall" of cost versus payments for CAH Medicare services. Part III, Line 9b: Patient's are informed about the finanical assistance program when they call to ask about their medical bills. The billers offer patient information about the program over the phone or if the patient is seen by the biller in person, they are shown the application and the documents that are needed. Part VI, Line 2: Director of Clinical Operations & Quality continuously reviews referral logs made by secretaries to see if there are any services we can provide here. Then we find out cost and reimbursement issues and present to CEO. Part VI, Line 3: If the patient presents to the registration desk and is private pay, the registration clerk informs the patient that we currently have a Financial Assistance program that will help them receive a discount or have the total amount written off and offers them the application. If a patient is private pay and admitted as an observation or inpatient, the social worker reviews the financial assistance program with the patient and offers them the application before discharge. If a patient calls into the billing office to ask about their billing statement and they state they don't think they can pay or want to make a payment contract, the billers will offer the patient information on the program and offer to mail them an application. Part VI, Line 4: Our geographical service area is rural. The majority (91.2%) of the Hospital's patients reside in Webster County, West Virginia. A portion of the remaining patients reside in Nicholas County (3.1%) and Randolph County (1.5%). The population of Webster County is 8249. The residents of Webster County have a median household income of $33,358 and 23% of the residents live in poverty. There is one hospital serving the community and the next nearest facility is 40 miles away. Part VI, Line 5: Governing body is comprised of members of all areas of the community and are not employees of the organization. The Hospital extends privileges to all qualified staff working for the facility. The Hospital uses surplus funds to provide new services for patients. The emergency room is available to all patients whether they have the ability to pay or not. The Hospital offers MRI, Cardiac and Pulmonary Rehab and Nuclear medicine, which are not available at any other location in the County. The Hospital offers charitable care and serves as a source of community volunteer activities. X 0 0 0 0 0 0 0 0 0 Frankie Pucket MD ER Director 681545 0 512 0 0 0 0 0 0 0 682057 0 0 0 Janak Patel MD Chief of Staff 525630 0 0 0 0 0 0 0 0 0 525630 0 0 0 Robert Sutherland MD ER Physician 354635 0 0 0 0 0 15000 0 0 0 369635 0 0 0 Johathan Beam MD Pharmacist 172717 0 507 0 0 0 19405 0 0 0 192629 0 0 0 Jeanette Boyce MD Physician 174695 0 507 0 0 0 8643 0 0 0 183845 0 0 0 Form 990, Part VII, Section A, Line 5 Webster County Memorial Hospital (Hospital) entered into a management services agreement with Davis Health System (DHS) in January 2017. DHS provides a full-time Chief Executive Officer (CEO) to the Hospital. As of the filing date of the 990, William Dempsey is the CEO. The Hospital reimburses DHS for the CEO's compensation and benefits. The compensation and benefits paid to the CEO for the year ended December 31, 2021 was $162,059. Christopher Dotson Family Member of Karen Dotson, Board Member 10837 Employee compensation 0 Lisa Clutter Family Member of Chris Graham, Board Member 15618 Employee compensation 0 Form 990, Part VI, Section A, line 3 On January 1, 2022, the Hospital's operations were disposed of and transferred to a nonprofit corporation, Davis Health System, Inc. Form 990, Part VI, Section A, line 4 Webster County Memorial Hospital (Hospital) entered into a Management Services Agreement with Davis Health System (DHS) in January 2017. DHS provides a full-time Chief Executive Officer(CEO) and provides support to the CEO in the performance of his or her duties as appropriate. As of the filing date of the 990, William Dempsey is the CEO. The Hospital reimburses DHS for the CEO's compensation and benefits. Form 990, Part VI, Section B, line 11b During a regularly scheduled board meeting, each board member receives a copy of the completed Form 990. The board will vote and approve the completed form before filing. If the return is completed and due between regularly scheduled board meetings, an electronic copy of the 990 is emailed to all board members and approved before the return is filed. Form 990, Part VI, Section B, line 12c Officers and Directors are required to complete an annual conflict of interest questionnaire. This questionnaire is then reviewed by the Board of Trustees, annually, for any interests that could give rise to conflicts. If a conflict should arise, the individual would have to disclose this conflict to the Board of Trustees. The board member would not be permitted to vote on the issue, if applicable. Form 990, Part VI, Section B, line 15 To determine compensation of the Organization's CEO, the organization compares Forms 990 of other organizations, reviews written employment contracts and performs compensation surveys of similar facilities. A review of compensation is conducted internally by the Board of Trustees. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are made available upon request. Form 990, Part XII, Line 2c: The Organization's finance committee of the board of directors selects the independent accountant. The process remains unchanged from prior years.