POTOMAC VALLEY HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- POTOMAC VALLEY HOSPITAL INC (EIN 55-0420956)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-11
- IRS object ID
- 202113169349304146
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-11T09:39:07-00:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550420956 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Potomac Valley Hospital of W VA Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POTO | BusinessNameControlTxt |
| Phone | 3045973500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 Pin Oak Lane | AddressLine1Txt |
| City | Keyser | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 267265908 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Amy Boothe | PersonNm |
| Person Title | VP of Operations | PersonTitleTxt |
| Phone | 3045973500 | PhoneNum |
| Signature | 2021-11-09 | SignatureDt |
| Discuss With Paid Preparer | false | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Amy | PersonFirstNm |
| Person Last | Boothe | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Amy Boothe | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 Pin Oak Lane | AddressLine1Txt |
| City | Keyser | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26726 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,581,105 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | https://wvumedicine.org/potomac-valley-hospital/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | Potomac Valley strives to improve the total health status of area residents and provide supportive care for the chronically and/or terminally ill patients at home. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 362 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $4,388 | PYContributionsGrantsAmt |
| CY Contributions Grants | $29,254 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $34,386,350 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,334,863 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$46,871 | PYInvestmentIncomeAmt |
| CY Investment Income | -$15,345 | CYInvestmentIncomeAmt |
| PY Other Revenue | $251,925 | PYOtherRevenueAmt |
| CY Other Revenue | $200,946 | CYOtherRevenueAmt |
| PY Total Revenue | $34,595,792 | PYTotalRevenueAmt |
| CY Total Revenue | $40,549,718 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $9,254 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,000 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,390,504 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,160,596 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,621,125 | PYOtherExpensesAmt |
| CY Other Expenses | $17,547,711 | CYOtherExpensesAmt |
| PY Total Expenses | $34,020,883 | PYTotalExpensesAmt |
| CY Total Expenses | $36,713,307 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $574,909 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,836,411 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,214,566 | TotalAssetsBOYAmt |
| Total Assets EOY | $36,441,115 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $24,960,241 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $31,688,768 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,254,325 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,752,347 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Potomac Valley strives to improve the total health status of area residents and provide supportive care for the chronically and/or terminally ill patients at home. PVH recognizes health as a condition to which everyone has a just claim and will make a priority of meeting the changing needs of the community within the limits of available resources. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $14,894,114 | ExpenseAmt |
| Revenue | $22,031,084 | RevenueAmt |
| Desc | Family medicine services are provided in multiple clinic locations, and as rural health clinics, to serve the primary care needs of the population in Mineral County and provide access to care. During 2020, PVH had 4,181 family medicine patient encounters. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,044,611 | ExpenseAmt |
| Revenue | $8,731,071 | RevenueAmt |
| Desc | PVH Emergency Department is staffed 24 hours everyday with specially trained physicians and nursing staff. The level of care ranges from continuation or initiation of advanced life support, to the assessment and treatment of minor illness, injuries or the acceleration of chronic medical conditions. The Emergency Department is connected by ration to Civil Defense and all area rescue squads and ambulances, thus allowing the staff to be fully prepared for any incoming emergency in advance of the arrival. The Emergency Department saw 9,795 patients in 2020. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,684,489 | ExpenseAmt |
| Revenue | $4,248,312 | RevenueAmt |
| Desc | General surgical services are provided as emergent and scheduled services on both an inpatient and an outpatient basis. PVH had 1,955 general surgery visits in 2020. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $3,881,000 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $5,361,399 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $29,504,214 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 88 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 361 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Amy Boothe | PersonNm |
| Phone | 3045973500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 Pin Oak Lane | AddressLine1Txt |
| City | Keyser | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26726 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Michael Gould DO | |||||||
| Physician | 040.00 | Yes (X) | $527,496 | $0 | $24,797 | ||
| Mark Boucot | |||||||
| Director, CEO | 040.00 | $414,626 | $0 | $73,365 | Yes (X) | Yes (X) | |
| James Viglianco MD | |||||||
| Physician | 040.00 | Yes (X) | $427,478 | $0 | $25,412 | ||
| Lisa Hamilton MD | |||||||
| Physician | 040.00 | Yes (X) | $408,806 | $0 | $15,701 | ||
| Boyd Sprenkle MD | |||||||
| Physician | 040.00 | Yes (X) | $361,563 | $0 | $11,828 | ||
| Gregory Casey MD | |||||||
| Physician | 040.00 | Yes (X) | $347,123 | $0 | $20,614 | ||
| Amy Boothe | |||||||
| VP Operations Finance | 040.00 | $179,155 | $0 | $30,101 | Yes (X) | ||
| Charles Bess MD | |||||||
| Director, Physician | 001.00 | $187,105 | $0 | $0 | Yes (X) | ||
| Rabie Zalzal MD | |||||||
| Director, Chief of Staff | 001.00 | $184,435 | $0 | $0 | Yes (X) | ||
| Elaine Geroski | |||||||
| VP, Nursing | 040.00 | $117,570 | $0 | $16,954 | Yes (X) | ||
| Robin Haupt | |||||||
| Director, Secretary | 001.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Jerry Whisner | |||||||
| Director, President | 001.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Dinah Courrier | |||||||
| Director | 001.00 | $0 | $0 | $0 | Yes (X) | ||
| Frances Jones | |||||||
| Director | 001.00 | $0 | $0 | $0 | Yes (X) | ||
| Kevin Clark | |||||||
| Director | 001.00 | $0 | $0 | $0 | Yes (X) | ||
| Brandon Combs | |||||||
| Director, Treasurer | 001.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,155,357 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $218,772 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 26 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| West Edge Medical Care Inc | |||||
| 9680 Alexandra Nicole Drive | Lorton | VA | 220793471 | Physician Services | $398,250 |
| Fusion Medical Staffing LLC | |||||
| PO Box 82674 | Lincoln | NE | 685012674 | Medical Staffing Services | $172,439 |
| Laboratory Corporation of America | |||||
| PO Box 12140 | Burlington | NC | 272162140 | Laboratory Services | $171,178 |
| Harshad Bokil | |||||
| 16008 Winchester Road SW | Cumberland | MD | 21502 | Physician Services | $149,645 |
| AYA Healthcare Inc | |||||
| 5930 Cornerstone Ct W Suite 300 | San Diego | CA | 921213772 | Medical Staffing Services | $141,137 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $650 | FundraisingAmt |
| Government Grants | $13,044 | GovernmentGrantsAmt |
| All Other Contributions | $15,560 | AllOtherContributionsAmt |
| Total Contributions | $29,254 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Services | 900099 | $35,717,194 | $35,717,194 |
| COVID Relief Funds | 900099 | $4,615,475 | $4,615,475 |
| Pharmacy Revenue | 900099 | $2,194 | $2,194 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,334,863 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$15,345 | TotalRevenueColumnAmt |
| Exclusion | -$15,345 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $27,732 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $31,387 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$3,655 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,655 | TotalRevenueColumnAmt |
| Exclusion | -$3,655 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $650 | ContriRptFundraisingEventAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Cafeteria Income | 900099 | $102,522 | $102,522 |
| Rebate Revenue | 900099 | $43,790 | $43,790 |
| Revenue Share | 900099 | $21,286 | $21,286 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,003 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,003 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $204,601 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,549,718 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,371,866 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $148,598 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,000 | TotalAmt |
| Program Services | $5,000 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $831,772 | TotalAmt |
| Program Services | $134,524 | ProgramServicesAmt |
| Management And General | $697,248 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,562,442 | TotalAmt |
| Program Services | $13,030,300 | ProgramServicesAmt |
| Management And General | $1,532,142 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $260,467 | TotalAmt |
| Program Services | $241,872 | ProgramServicesAmt |
| Management And General | $18,595 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,363,011 | TotalAmt |
| Program Services | $2,196,381 | ProgramServicesAmt |
| Management And General | $166,630 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,142,904 | TotalAmt |
| Program Services | $1,022,657 | ProgramServicesAmt |
| Management And General | $120,247 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,988 | TotalAmt |
| Program Services | $116 | ProgramServicesAmt |
| Management And General | $54,872 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,778 | TotalAmt |
| Program Services | $4,778 | ProgramServicesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees For Services Prof Fundraising | FeesForServicesProfFundraising |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,485,076 | TotalAmt |
| Program Services | $2,991,534 | ProgramServicesAmt |
| Management And General | $493,542 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,705 | TotalAmt |
| Program Services | $18,406 | ProgramServicesAmt |
| Management And General | $188,299 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,398,403 | TotalAmt |
| Program Services | $1,090,214 | ProgramServicesAmt |
| Management And General | $308,189 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465 | TotalAmt |
| Management And General | $465 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $512,770 | TotalAmt |
| Program Services | $447,547 | ProgramServicesAmt |
| Management And General | $65,223 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,684 | TotalAmt |
| Program Services | $44,756 | ProgramServicesAmt |
| Management And General | $35,928 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $513,619 | TotalAmt |
| Program Services | $425,225 | ProgramServicesAmt |
| Management And General | $88,394 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,977,230 | TotalAmt |
| Program Services | $37,140 | ProgramServicesAmt |
| Management And General | $2,940,090 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,279,278 | TotalAmt |
| Program Services | $1,061,577 | ProgramServicesAmt |
| Management And General | $217,701 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413,233 | TotalAmt |
| Program Services | $404,870 | ProgramServicesAmt |
| Management And General | $8,363 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $4,035,853 | $4,035,853 | |
| Provision for Doubtful Accounts | $1,488,444 | $1,488,444 | |
| Taxes, Licenses and Fees | $770,207 | $636,187 | $134,020 |
| Recuiting | $269,149 | $184,120 | $85,029 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,829 | TotalAmt |
| Program Services | $2,713 | ProgramServicesAmt |
| Management And General | $54,116 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,713,307 | TotalAmt |
| Program Services | $29,504,214 | ProgramServicesAmt |
| Management And General | $7,209,093 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,205 | BOYAmt |
| EOY | $95,681 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $414,357 | BOYAmt |
| EOY | $4,094,504 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,557,717 | BOYAmt |
| EOY | $6,401,328 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,433 | BOYAmt |
| EOY | $17,206 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $664,281 | BOYAmt |
| EOY | $704,804 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,908 | BOYAmt |
| EOY | $394,545 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,976,441 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,099,033 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,467,611 | BOYAmt |
| EOY | $19,877,408 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,902,054 | BOYAmt |
| EOY | $4,855,639 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,214,566 | BOYAmt |
| EOY | $36,441,115 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,131,351 | BOYAmt |
| EOY | $6,408,928 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $5,304,524 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,500,000 | BOYAmt |
| EOY | $18,500,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,465,684 | BOYAmt |
| EOY | $1,043,979 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$136,794 | BOYAmt |
| EOY | $431,337 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,960,241 | BOYAmt |
| EOY | $31,688,768 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,254,325 | BOYAmt |
| EOY | $4,729,522 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $22,825 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,254,325 | BOYAmt |
| EOY | $4,752,347 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,214,566 | BOYAmt |
| EOY | $36,441,115 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,836,411 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$338,389 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $4,778 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,778 | TotalLobbyingExpendituresAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | II-B 1i | FormAndLineReferenceDesc |
| Explanation | This amount is calculated based on information provided by the West Virginia Hospital Association and the American Hospital Association. The American Hospital Association estimates that 25.56 of the 2020 dues were allocated to lobbying expense. The West Virginia Hospital Association estimates that during 2020, 16.77 of the dues paid should be allocated to lobbying expense. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,240,397 | OtherCostOrOtherBasisAmt |
| Book Value | $1,240,397 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,858,678 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,893,279 | DepreciationAmt |
| Book Value | $13,965,399 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $577,149 | OtherCostOrOtherBasisAmt |
| Depreciation | $123,372 | DepreciationAmt |
| Book Value | $453,777 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,718,347 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,075,868 | DepreciationAmt |
| Book Value | $2,642,479 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,581,870 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,514 | DepreciationAmt |
| Book Value | $1,575,356 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,877,408 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc |
|---|
| Financial derivatives and other financial products |
| Closely-held equity interests |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Goodwill and other intangible | $4,878,278 |
| Other Non-Current Assets | -$22,639 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,855,639 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Federal income taxes | |
| Self Insurance | |
| Debt Issuance Costs | -$134,496 |
| Long Term Lease Liability | $565,833 |
| Finance Lease Liability - Long Term |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $431,337 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $39,092,661 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,488,444 | OtherRevenueAmt |
| Revenue Not Reported | -$1,488,444 | RevenueNotReportedAmt |
| Revenue Subtotal | $40,581,105 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$31,387 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$31,387 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $40,549,718 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $35,256,250 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $31,387 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $31,387 | ExpensesNotReportedAmt |
| Expenses Subtotal | $35,224,863 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,488,444 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,488,444 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $36,713,307 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| X 2 | Most of the entities that comprise the System are tax-exempt organizations and not subject to federal or state income taxes in accordance with Section 501c3 of the Internal Revenue Code. On such basis, they will not incur any liability for income taxes, except for possible unrelated business income. AHS and WVUIS are organizations subject to federal and/or state income taxes. The System does not have any material uncertain tax positions as of December 31, 2020 and 2019. |
| XI 2d | The amount shown on line 2d consists of 1,488,444 provision for doubtful accounts reported as an offset to revenue on the financial statements but is reported as an expense on the Form 990. |
| XI 4b | The amount on line 4b consists of 31,387 of rental expenses that is recorded as an offset to revenue on the Form 990. |
| XII 2d | The amount shown on line 2d consists of 31,387 of rental expenses that is recorded as an offset to revenue on the Form 990. |
| XII 4b | The amount shown on line 4b consists of 1,488,444 provision for doubtful accounts reported as an offset to revenue on the financial statements but is reported as an expense on the Form 990. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $658,056 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $51,763 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $606,293 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01720 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,493,547 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,493,546 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1 | NetCommunityBenefitExpnsAmt |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $83,747 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $79,532 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,215 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,235,350 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,624,841 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $610,509 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01730 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $78,021 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $78,021 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,943 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,943 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,234 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,234 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $143,198 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $143,198 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,378,548 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,624,841 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $753,707 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02140 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $155 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $155 | NetCommunityBenefitExpnsAmt |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $190 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $190 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $345 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $345 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $809,378 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $99,697 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $17,990,257 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $18,887,323 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$897,066 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Potomac Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 Pin Oak Lane | AddressLine1Txt |
| City | Keyser | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26726 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | wvumedicine.org/potomac-valley-hospital/ | WebsiteAddressTxt |
| State License | 02 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Facility Reporting Group | A | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | wvumedicine.org/potomac-valley-hospital/wp-content/uploads/sites/2/2019/02/2018-CHNA.pdf | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https//wvumedicine.org/potomac-valley-hospital/wp-content/uploads/sites/2/2019/12/Final-CHNA-Impleme | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 0000000200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https//wvumedicine.org/bill-pay/financial-assistance/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | wvumedicine.org/bill-pay/financial-assistance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | wvumedicine.org/bill-pay/financial-assistance/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Group Potomac Valley Hospital Line Part V, Section B, Line 5 | As a part of the West Virginia United Health System WVUHS, PVH contracted with the WVU School of Public Health WVU SPH to assist in the CHNA process and report. The 2018 CHNA was prepared by Thomas Bias and Emily Sarkees from the West Virginia University Health Research Center. The CHNA process utilized two primary sources of data, which included a public input survey and a community meeting. The public input survey was developed by the WVU SPH with the leadership team following an iterative process to gain stakeholder input. Members of the leadership team were selected because of their familiarity with Mineral County, Potomac Valley Hospital, and health services and needs in the area. These individuals included Andrew Root - Administrator, Mineral County Health Department Christian Brooks - Directors of Public Relations, Potomac Valley Hospital Michael Gould, DO - Emergency Physician, Potomac Valley Hospital Amy Boothe - VP of Operations, Potomac Valley Hospital Paula Eisenhour - Administrative Associate, Potomac Valley Hospital Mark Boucot - CEO, PVH and Garrett Regional Medical Center Daniel Staggers - Board of Directors, Potomac Valley Hospital Brenna Earnest, RN - Diabetes Prevention/Education - Potomac Valley Hospital Connie Moore - Director of Care Management, Potomac Valley Hospital Curtis Crawford - Volunteer Clergy, Potomac Valley Hospital Teresa White - Director of Nursing, Potomac Valley Hospital. The public interest survey topics included questions about specific health issues, thoughts on overall health of the community, quality of life, access to healthcare and medical needs including specialist care, risky behaviors, and demographic information including geographic location and income. This survey was intended to solicit the communitys perception of their health needs and was collected both online and through hard copies from residents who are 18 or older. The CHNA can be found here - https//wvumedicine.org/potomac-valley-hospital/wp-content/uploads/sites/2/2019/02/2018-CHNA.pdf. |
| Group Potomac Valley Hospital Line Part V, Section B, Line 11 | The leadership team met in September 2018 to review the data collected through the survey and community event and identify priority areas for developing implementation strategies. The WVU SPH reviewed survey data, including responses to the three most important health problems or issues in the three counties Mineral County, WV Allegany County, MD Garrett County, MD it defined as the community served. Mineral Countys top three health concerns were 1 Drug Abuse 2 Obesity and 3 Cancer. Allegany Countys top concerns were 1 Drug Abuse 2 Cancer 3 Low Income while Garrett County reported top concerns in 1 Obesity 2 Drug Abuse and 3 Mental Health Problems respectively. In conclusion, the 2018 CHNA identified two main health priorities and significant needs obesity and diabetes that will guide PVH and the leadership team in the implementation planning process. According to the CHNA, implementation activities will aim to address these issues using existing resources and partnerships with other community organizations where possible and building upon past success, including past efforts to address health needs identified in the last CHNA report. |
| Group Potomac Valley Hospital Line Part V, Section B, Line 13b | Potomac Valley Hospital of W Va Inc. PVH offers discounted care only to individuals who qualify for free care. PVH offers a Prompt-Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount, the patient/guarantor must meet certain requirements. |
| Group Potomac Valley Hospital Line Part V, Section B, Line 24 | All patients are charged an amount equal to gross charges regardless of payment method. Once FAP eligibility is confirmed, charge amounts are moved to Charity Care and no longer charged to the patient. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Mineral County Rural Health Clinic | ||||
| 100 Pin Oak Lane | Keyser | WV | 26726 | Rural Health Clinic |
| Fort Ashby Rural Health Clinic | ||||
| 10261 Frankfort Hwy | Fort Ashby | WV | 26719 | Rural Health Clinic |
| Riverside Clinic | ||||
| 122 Ashfield St | Piedmont | WV | 26750 | Rural Health Clinic |
Supplemental Information Detail SupplementalInformationDetail (25 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I Line 3c | Potomac Valley Hospital PVH uses 200 Federal Poverty Guideline to determine free care eligibility. PVH offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either discount the patient/guarantor must meet certain requirements. |
| Part I Line 6a | Potomac Valley Hospital community benefit numbers are reported in total with the other hospitals within West Virginia United Health System. The 2019 amounts can be found at the following web address http//wvumedicine.org/about/community-benefit/. |
| Part I Line 7 | Column f - Total community benefit expense for 2020 is 9,378,548 and is 26.62 of total net expenses. To calculate net expense, bad debt of 1,488,444 was deducted from total expenses of 36,713,307 as shown in Part IX line 25 of the core Form 990. |
| Part I Line 7 | Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-charge ratio, which was used to calculate Charity Care, Unreimbursed Medicaid and other means-tested government programs at cost. To calculate the Medicare allowable cost shown in Part III question 8, we used the allowable costs from the Medicare Cost report. |
| Part II | For 2020, PVH employees spent work time volunteering for the Mineral County United Way Day of Caring. |
| Part III Line 2 | Bad Debt Expense at Cost on Line 2 was calculated by multiplying bad debt expense of 1,488,444 by our cost-to-charge ratio of 59.02 for a total of 878,480 less DSH allocations to self-pay patient accounts of 69,102 for a total of 809,378. |
| Part III Line 3 | Estimated bad debt attributable to patients eligible for charity care on Line 3 was calculated by pulling all outstanding patient balances of 5,000 or greater from our patient accounting system. That report totaled 168,921, which was then multiplied by the cost-to-charge ratio of 59.02 for a total of 99,697. |
| Part III Line 3 | We feel that at a minimum, the estimated bad debt attributable to patients eligible for charity care of 99,697 should be considered community benefit due to the fact that anyone with outstanding balances of 5,000 or greater in our demographic usually qualifies as catastrophic if the patient completes the application process. In our Charity Care Policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year and would have qualified for charity care if paperwork was completed. |
| Part III Line 4 | Potomac Valley Hospitals financial statements are prepared on a consolidated basis as a member of the WV United Health System. The footnote for Accounts Receivable is as follows Patient accounts receivable are reported at net realizable value. For accounts receivable associated with services provided to patients who have third-party coverage, the System estimates net realizable value based on estimated contractual reimbursement percentage, which in turn is based on current contract provisions and historical paid claims by payor. For self-pay accounts, including uninsured and patient responsibility accounts, the net realizable value is determined using historical collection experience, adjusted for estimated conversions of patient responsibility portions, expected recoveries and changes in trends to estimate implicit price concessions. Management continually reviews the estimated net realizable value of accounts receivable by monitoring cash collections, economic conditions and trends, changes in payor mix, changes in federal or state healthcare coverage and other matters. The System grants credit without collateral to its patients, most of whom are local residents and are insured under third-party payor agreements, primarily with Medicare, Medicaid and various commercial insurance companies. The System records accounts receivable net of estimated price concessions and such amounts have historically been within managements expectations. The mix of accounts receivable at December 31, 2020 from patients and third-party payors is as follows Medicare - 29, Medicaid - 17, Blue Cross - 21, Commercial, managed care and other - 28, Patients - 5, totaling 100. |
| Part III Line 4 | For receivables associated with self-pay patients, which includes both patients without insurance and insured patients with deductible and copayment balances, the System records a significant provision for bad debt 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 billed rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. |
| Part III Line 8 | The amount reported in Part III Line 6 18,887,323 was calculated using the total Medicare allowable cost from the Medicare cost report. |
| Part III Line 8 | Potomac Valley is reimbursed 100 by Medicare reimbursement includes DSH and IME for services provided to Medicare patients. |
| Part III Line 9b | PVH does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity care, the patient will not be sent to a bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy. |
| Part VI Line 2 | The CHNA included review of publicly available secondary data related to counties within PVHs service area, including census data and County Health Ranking Data. Using these reports, the CHNA leadership team started the initial discussion around critical health needs. According to the CHNA, primary data collection was comprised of a survey of community members perceptions of health issues and a community event focused on reviewing survey data, discussing community assets that impact population health in PVHs service area, and working as a group to outline possible strategies for each area of concern. |
| Part VI Line 2 | PVH leadership continually monitors issues in their primary service area that impact patient care. PVH works with West Virginia University Hospitals and University Health Associates to expand the services available to PVH patients. |
| Part VI Line 2 | As a member of the West Virginia United Health System WVUHS, PVH will be utilizing the West Virginia University School of Public Health to assist with the CHNA process and reports. |
| Part VI Line 2 | Potomac Valley Hospital PVH completed their first Community Health Needs Assessment process in December 2015. The CHNA was issued and approved by the Board of Directors in January 2016. A new CHNA was completed in 2018 and plans to build on the community health priorities, goals and strategies outlined in the prior CHNA report as well as offering new insight and plans to address emerging health priorities. |
| Part VI Line 3 | The Director of Patient Financial Services at PVH along with collections representatives are available to meet with patients to discuss financial eligibility for our charity care program. PVH has applications for charity care and the qualification requirements for receiving charity available to patients. |
| Part VI Line 4 | PVH is a non-profit critical access hospital located in Mineral County, WV in the city of Keyser. In 2020, Mineral County had a total population of 26,938, a median household income of 49,936, an employment rate of 51.5 and 6.2 of residents reported they were without healthcare coverage. Approximately 14 of residents were living in poverty. |
| Part VI Line 4 | According to the 2018 CHNA, the leadership team defined the community served as a tri-county area comprised of Mineral County in West Virginia, as well as neighboring Allegany and Garrett counties in Maryland. Garrett County, MD had a total population of 28,806, a median household income of 52,617, an employment rate of 56.7 and 7.0 of residents reported they were without healthcare coverage. Meanwhile, Allegany County, MD had a total population of 68,106, a median household income of 48,867, an employment rate of 43.9 and 4.9 of residents reported they were without healthcare coverage. Population and demographic information was obtained from the United States Census Bureau https//data.census.gov/cedsci/. |
| Part VI Line 5 | The PVH board of directors is a community board, with all nine members living in or around Mineral County. |
| Part VI Line 5 | PVH extends privileges to all qualified medical staff in Mineral County and surrounding communities to meet its healthcare needs. PVH allocates available funding to capital purchases, expanded services to improve patient care, and support medical education in Mineral County and surrounding counties in West Virginia and bordering states. |
| Part VI Line 6 | Potomac Valley Hospital is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery team. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its service areas, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves. |
| Part VI Line 6 | System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include West Virginia University Hospitals, Inc. in Morgantown, WV, United Hospital Center in Bridgeport, WV, Camden-Clark Memorial Hospital in Parkersburg, WV, City Hospital, Inc. in Martinsburg, WV, Jefferson Memorial Hospital in Ranson, WV, St. Josephs Hospital of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Hospital, in Glen Dale, WV, West Virginia Healthcare Cooperative, doing business as, Summersville Regional Medical Center, in Summersville, WV, Braxton County Memorial Hospital in Gassaway, WV, Community Health Association, doing business as, Jackson General Hospital in Ripley, WV, and Wetzel County Hospital, Inc. in New Martinsville, WV. |
| Part VI Line 6 | In addition to the above mentioned hospitals, the System includes physician practices of United Physicians Care, Inc. and Camden-Clark Physician Corp that operate in conjunction with the System hospitals along with United Summit Center, Inc. a behavioral health center located in Clarksburg, WV. The System also includes, WVUH-East, Inc. and Camden-Clark Health Services, Inc. which operate as management companies for their respective hospitals. University Healthcare Foundation, Inc. in Martinsburg, WV, United Health Foundation, Inc. in Bridgeport, WV, Camden-Clark Foundation, Inc. in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc. in Buckhannon, WV, and Reynolds Memorial Foundation, Inc. in Glen Dale, WV, which perform various fundraising activities for their respective hospitals. In 2020, the System formed WVUHS Home Care, LLC to provide Home Health and Hospice services to our service areas, supporting System hospitals by providing continuous care to our patients. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Scholarships for students pursuing medical careers | GrantTypeTxt |
| Recipient | 2 | RecipientCnt |
| Cash Grant | $5,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part III Line 1-3 | FormAndLineReferenceDesc |
| Explanation | PVH awarded scholarships to local high school students that will be pursuing education in a medical field. Recipients are chosen based on an essay submission and need. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (true) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt |
|---|---|---|---|---|---|---|
| Charles Bess MD | ||||||
| Director, Physician | $187,105 | $187,105 | ||||
| Rabie Zalzal MD | ||||||
| Director, Chief of Staff | $184,435 | $184,435 | ||||
| Michael Gould DO | ||||||
| Physician | $506,564 | $552,293 | $20,500 | $432 | $8,217 | $16,580 |
| James Viglianco MD | ||||||
| Physician | $423,746 | $452,890 | $500 | $3,232 | $5,476 | $19,936 |
| Lisa Hamilton MD | ||||||
| Physician | $405,984 | $424,507 | $500 | $2,322 | $5,327 | $10,374 |
| Boyd Sprenkle MD | ||||||
| Physician | $360,044 | $373,391 | $1,519 | $3,769 | $8,059 | |
| Amy Boothe | ||||||
| VP Operations Finance | $157,578 | $209,256 | $14,800 | $6,777 | $3,624 | $26,477 |
| Mark Boucot | ||||||
| Director, CEO | $296,710 | $487,991 | $101,814 | $16,102 | $56,928 | $16,437 |
| Gregory Casey MD | ||||||
| Physician | $343,744 | $367,737 | $500 | $2,879 | $3,923 | $16,691 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I Line 6a | Per the WVUHS Incentive Plan incentives are contingent on meeting a net earning target. |
| Part I Line 4b | Mark Boucot received deferred commpensation contributions of 50,545 in 2020. This amount is properly recorded in deferred compensation on the Form 990 Schedule J. |
| Part I Line 3 | Compensation for CEOs are determined by the WV United Health System compensation committee. The System engages an independent group to perform an executive compensation review and compensation survey every two years. This information is provided to the committee, which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package offered does not exceed fair market value. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Charles Bess MD | |||
| Board of Director | $187,105 | Medical Services | false |
| Rabie Zalzal MD | |||
| Board of Director | $184,435 | Medical Services | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4d | Program Service Expenses 3,881,000, Grants and allocations 0, Revenue 5,361,399 PVH is a Critical Access Hospital with licensure for 25 beds. PVH provides both inpatient and outpatient services, including cardiac rehabiliation, care management, diabetes education/prevention, hospital, laboratory, orthopaedics, physical therapy, radiology, respiratory therapy, same day surgery, and skilled swing beds. |
| Form 990, Part XI, Line 9 | Other changes in net assets includes 361,218 of related organization capitalization, 22,825 change in temporarily restricted net assets and 4 rounding. |
| Form 990, Part VI, Section B, Line 12c | Each board member is required to disclose, annually, any relationship which may give rise to a potential conflict of interest. These responses are processed and maintained by the Director of Health Information Management. All board members are to be willing to identify conflicts of interest and abstain from voting when appropriate. |
| Form 990, Part VI, Section B, Line 15a | The compensation of the CEO is determined by the WV United Health System Compensation Committee based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This information is provided to the compensation committee which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package does not exceed fair market value based on the data from the consultant group. The minutes of the compensation committee are contemporaneously documented and retained. A full compensation survey was completed in 2019 for 2020 compensation amounts. |
| Form 990, Part VI, Section B, Line 15b | The compensation of all officers at the Vice President level and below is determined based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This data is then interpreted and provided to an independent compensation committee. The independent compensation committee then uses this data to determine a fair and reasonable compensation package. All relevant data as well as minutes from each meeting are retained. |
| Form 990, Part VI, Section B, Line 19 | All financial and governing documents, including the conflict of interest policy are maintained onsite and made available to the public upon written request. |
| Form 990, Part IX, Line 11g | This total consists of Consulting Professional fees of 104,600 of which 18,375 is considered program service expense and 86,225 management and general expense Contracted Labor expense of 970,023 of which 621,015 is program service expense and 349,008 is considered management and general expense PVH Contracted Physician expense of 1,312,075 of which all is considered program service expense Consulting Professional Fees- Medical Staff of 12,000 of which all is considered management and general expense Lab Fees of 394,677 all of which is considered program service expense Contract Labor fees for patient care of 306,385 all of which is considered program service expense, and Consulting Professional Fees - Medical Staff Director of 385,316 of which 339,007 is considered program service expense and 46,309 is considered management and general expense. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| West Virginia United Health System | |||||||||||
| PO Box 8034 | Morgantown | WV | 26506 | 550754713 | Healthcare access | WV | 501c3 | 12a | N/A | false | |
| West Virginia University Hospitals East Inc | |||||||||||
| 2500 Foundation Way | Martinsburg | WV | 25401 | 202337985 | Healthcare access | WV | 501c3 | 12a | false | West Virginia University Hospitals Inc | |
| City Hospital Inc | |||||||||||
| 2500 Foundation Way | Martinsburg | WV | 25401 | 550383321 | Patient Care | WV | 501c3 | 3 | false | West Virginia University Hospitals East Inc | |
| Jefferson Memorial Hospital | |||||||||||
| 300 S Preston St | Ranson | WV | 25438 | 550359755 | Patient Care | WV | 501c3 | 3 | false | West Virginia University Hospitals East Inc | |
| University Healthcare Foundation | |||||||||||
| 2500 Foundation Way | Martinsburg | WV | 25401 | 311118075 | Hospital Support | WV | 501c3 | 12a | false | West Virginia University Hospitals Inc | |
| United Summit Center | |||||||||||
| 6 Hospital Plaza | Clarksburg | WV | 26301 | 550752788 | Behavioral Health | WV | 501c3 | 3 | false | West Virginia University Hospitals Inc | |
| United Hospital Center Inc | |||||||||||
| 327 Medical Park Drive | Bridgeport | WV | 26330 | 550525724 | Patient Care | WV | 501c3 | 3 | false | West Virginia United Health System | |
| United Physicians Care Inc | |||||||||||
| 686 South Pike Street | Shinnston | WV | 26431 | 550638563 | Patient Care | WV | 501c3 | 3 | false | United Hospital Center Inc | |
| United Health Foundation | |||||||||||
| 327 Medical Park Drive | Bridgeport | WV | 26330 | 550621706 | Hospital Support | WV | 501c3 | 12a | false | United Hospital Center Inc | |
| West Virginia Health Care Cooperative Inc | |||||||||||
| 400 Fairview Heights Rd | Summersville | WV | 26651 | 550650441 | Patient Care | WV | 501c3 | 3 | false | West Virginia University Hospitals Inc | |
| Camden-Clark Health Services | |||||||||||
| 800 Garfield Ave | Parkersburg | WV | 26101 | 550769602 | Healthcare Access | WV | 501c3 | 12a | false | West Virginia United Health System | |
| Camden-Clark Foundation | |||||||||||
| 800 Garfield Ave | Parkersburg | WV | 26101 | 550667789 | Hospital Support | WV | 501c3 | 7 | false | Camden-Clark Health Services | |
| Camden-Clark Memorial Hospital | |||||||||||
| 800 Garfield Ave | Parkersburg | WV | 26101 | 311524546 | Patient Care | WV | 501c3 | 3 | false | Camden-Clark Health Services | |
| Camden-Clark Physician Corp | |||||||||||
| 604 Ann Street | Parkersburg | WV | 26101 | 264058719 | Patient Care | WV | 501c3 | 3 | false | Camden-Clark Health Services | |
| St Joseph's Hospital of Buckhannon Inc | |||||||||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | 550356996 | Patient Care | WV | 501c3 | 3 | false | West Virginia United Health System | |
| West Virginia University Hospitals Inc | |||||||||||
| PO Box 8034 | Morgantown | WV | 26506 | 550643304 | Patient Care | WV | 501c3 | 3 | false | West Virginia United Health System | |
| St Joseph's Foundation of Buckhannon Inc | |||||||||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | 550727650 | Hospital Support | WV | 501c3 | 12b | false | St Joseph's Hospital of Buckhannon | |
| Reynolds Memorial Hospital Inc | |||||||||||
| 800 Wheeling Avenue | Glen Dale | WV | 26038 | 550357045 | Patient Care | WV | 501c3 | 3 | false | West Virginia University Hospitals Inc | |
| Reynolds Memorial Foundation | |||||||||||
| 800 Wheeling Avenue | Glen Dale | WV | 26038 | 550710402 | Hospital Support | WV | 501c3 | 12a | false | Reynolds Memorial Hospital Inc | |
| Braxton County Memorial Hospital | |||||||||||
| 100 Hoylman Drive | Gassaway | WV | 26624 | 550611919 | Patient Care | WV | 501c3 | 3 | false | West Virginia University Hospitals Inc | |
| Community Health Association | |||||||||||
| 122 Pinnell Street | Ripley | WV | 25271 | 550462730 | Patient Care | WV | 501c3 | 3 | false | West Virginia University Hospitals Inc | |
| Wetzel County Hospital Inc | |||||||||||
| 3 East Benjamin Drive | New Martinsville | WV | 26155 | 843480493 | Patient Care | WV | 501c3 | 3 | false | West Virginia University Hospitals Inc | |
| WVUHS Home Care LLC | |||||||||||
| PO Box 8059 | Morgantown | WV | 26506 | 852915642 | Home Health and Hospice | WV | 509a2 | false | West Virginia United Health System | ||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Allied Health Sourcing Solutions | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8034 | AddressLine1Txt |
| City | Morgantown | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 842403526 | EIN |
| Primary Activities | Supply Chain Management | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | false | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Allied Health Services Inc | |||||||||
| PO Box 782 | Morgantown | WV | 26507 | 550652017 | Medical Lab | WV | West Virginia United Health System | C Corp | false |
| West Virginia United Insurance Services Inc | |||||||||
| 3040 University Ave Suite 3200 | Morgantown | WV | 26505 | 550756055 | Provider Network | WV | West Virginia United Health System | C Corp | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |