2020-06-30T09:49:18-05:00 2019-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-07-01 550562976 GRANT MEMORIAL HOSPITAL GRAN 3042575802 117 HOSPITAL DRIVE PETERSBURG WV 26847 DAVID APPLEWOOD CFO 3042575802 2020-06-15 1 AMY BIBBY P00445891 8282542254 96.255.208.156 2020-06-15 14:27:55 ED P 32F9AC66A2B04758B89F16BB940F117C042CAF37 839A658C77C9BD915FB92B1F12127266767FB63C 2018 2020-09-23 17:36:50Z ROBERT MILVET 117 HOSPITAL DRIVE PETERSBURG WV 26847 35596039 0 X WWW.GRANTMEMORIAL.COM X 1957 WV TAX-EXEMPT HOSPITAL DEDICATED TO SERVICING THE COUNTIES OF GRANT, HARDY, & PENDLETON IN WEST VIRGINIA 11 8 448 8 0 0 1016 3925 37539213 34503455 606314 233352 412199 427194 38558742 35167926 0 0 0 0 17764727 17708502 0 0 0 20866579 22352942 38631306 40061444 -72564 -4893518 23173878 17183817 7618324 6521781 15555554 10662036 THE GRANT MEMORIAL HOSPITAL IS A REGIONAL PROVIDER OF QUALITY, COST EFFECTIVE HEALTH CARE SERVICE RESPONSIVE TO THE COMMUNITY NEEDS AND SUPPORTED BY INNOVATIVE EFFORTS WITH OTHERS. 0 0 31685833 34855790 THE HOSPITAL PROVIDES A FULL COMPLEMENT OF HEALTH SERVICES INCLUDING INPATIENT ACUTE, OBSTETRICS, INTENSIVE CARE, SWING-BED SERVICES, NURSING FACILITY SERVICES (BOTH SKILLED AND INTERMEDIATE), TRADITIONAL OUTPATIENT SERVICES AND PHYSICIAN SERVICES TO THE RESIDENTS OF GRANT, HARDY, AND PENDLETON COUNTIES OF WEST VIRGINIA. THE LONG TERM CARE FACILITY WAS CLOSED IN APRIL 2019. THE HOSPITAL IS LOCATED IN THE EASTERN PANHANDLE OF WEST VIRGINIA WITH THE CLOSEST HOSPITALS LOCATED 1.5 HOURS AWAY DURING GOOD WEATHER. DURING THE WINTER, IT WILL TYPICALLY TAKE LONGER DEPENDING ON WEATHER CONDITIONS. DURING THE YEAR, THE HOSPITAL HAD 4,156 ADULT AND PEDIATRIC DAYS, 1,302 SWING-BED DAYS, 473 NURSERY DAYS, 279 SKILLED CARE DAYS, AND 3,270 NURSING FACILITY DAYS. 31685833 1 0 0 1 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 0 0 0 0 0 0 0 1 0 0 0 1 103 0 448 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 WV X X X ACCOUNTING DEPARTMENT 3042575802 117 HOSPITAL DRIVE PETERSBURG WV 26847 TAMMY KESNER CHAIRPERSON 1.00 X X 0 0 0 THOMAS HEDRICK VICE CHAIRPERSON 1.00 X X 0 0 0 ALLAN KILE SR TRUSTEE 1.00 X 0 0 0 JANET FRYE TRUSTEE 1.00 X 0 0 0 JEFF BERG TRUSTEE 1.00 X 0 0 0 JENNIFER GARTIN TRUSTEE 1.00 X 0 0 0 JULIA HARTMAN TRUSTEE 1.00 X 0 0 0 TEDDY KETTERMAN TRUSTEE 1.00 X 0 0 0 CAROLINE ARMSTRONG DO TRUSTEE, PHYSICIAN, CHIEF OF STAFF 40.00 X 336255 0 0 BEN LESLIE TRUSTEE, PHYSICIAN, VICE CHIEF OF STAFF 40.00 X 350160 0 0 ROBERT MILVET CEO (START 08.28.18) 40.00 1.00 X X 98647 0 7280 RAYMOND SNEAD INTERIM CEO (03/18 - 08/18) 40.00 X X 0 0 0 GEORGE HALAMA CFO (THROUGH DEC 18) 40.00 1.00 X 125654 0 8773 DAVID APPLEWOOD CFO (START DEC 18) 40.00 1.00 X 6958 0 0 ANIL MAKANI PHYSICIAN 40.00 X 629645 0 33061 SCOTT ROBERTS PHYSICIAN 40.00 X 541231 0 19135 ULUNNA MACBEAN PHYSICIAN 40.00 X 259425 0 17033 AMANDA BORROR PHYSICIAN 40.00 X 241984 0 20278 NISHAT ALLY PHYSICIAN 40.00 X 215954 0 7736 2805913 0 113296 12 0 1 0 UNITED PHYSICIANS CARE INC ATTN SARA GOFF PO BOX 897 MORGANTOWN WV 265070000 PHYSICIANS 1760470 CLINICAL COLLEAGUES INC PO BOX 824246 PHILADELPHIA PA 191824246 MANAGEMENT AND CONSULTING 491672 JACKSON KELLY PLLC PO BOX 45705 BALTIMORE MD 212975705 LEGAL SERVICES 483346 MEDHOST OF TENNESSEE INC 2739 MONUMENTUM PLACE CHICAGO IL 606895327 IT AND CONSULTING 480308 US MOBILE IMAGING LLC PO BOX 808 CUMBERLAN MD 215010808 IMAGING SERVICES 438257 42 3925 3925 NET PATIENT SERVICE REVENUE 621400 34503455 34503455 34503455 661465 661465 74859 0 74859 74859 74859 428113 -428113 -428113 -428113 CAFETERIA 722210 158219 158219 MISCELLANEOUS REVENUE 900099 151933 151933 OTHER OPERATING REVENUE 900099 42183 42183 352335 35167926 34855790 0 308211 X 14367843 11363971 3003872 445282 352187 93095 1890852 1495533 395319 1004525 794510 210015 1154599 1154599 175875 175875 8225572 6505859 1719713 101822 80534 21288 484003 382814 101189 724568 573083 151485 74783 59148 15635 30395 24040 6355 44008 34807 9201 1206656 954381 252275 386679 305836 80843 SUPPLIES 5630105 5505337 124768 BAD DEBT EXPENSE 2333405 1845562 487843 REPAIRS AND MAINTENANCE 938089 741964 196125 LICENSES AND TAXES 842383 666267 176116 40061444 31685833 8375611 0 37831 6036 3464181 1435670 4568129 2524593 1161483 1123374 203357 246829 31049004 25732674 6221308 5316330 5950030 6383224 857761 147761 709798 23173878 17183817 2826726 3472640 966 1500 482260 169066 4308372 2878575 7618324 6521781 X 15555554 10662036 15555554 10662036 23173878 17183817 -4893518 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4804 4804 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, THE WV HOSPITAL ASSOCIATION AND THE AMERICAN HEALTH CARE ASSOCIATION. A PORTION OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES BY THESE ASSOCIATIONS. 70684 70684 17240266 14567306 2672960 13581776 11165368 2416408 156278 156278 5316330 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 2878575 2878575 X 33500513 0 33500513 1667413 1667413 35167926 38394031 0 38394031 1667413 1667413 40061444 PART X, LINE 2: THE HOSPITAL IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, IS NOT SUBJECT TO FEDERAL INCOME TAX UNDER CURRENT INCOME TAX REGULATIONS. CURRENT ACCOUNTING STANDARDS DEFINE THE THRESHOLD FOR RECOGNIZING UNCERTAIN INCOME TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS AS "MORE LIKELY THAN NOT" THAT THE POSITION IS SUSTAINABLE, BASED ON ITS TECHNICAL MERITS AND ALSO PROVIDE GUIDANCE ON THE MEASUREMENT, CLASSIFICATION AND DISCLOSURE OF TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS. MANAGEMENT BELIEVES THERE IS NO IMPACT ON THE ACCOMPANYING FINANCIAL STATEMENTS RELATED TO UNCERTAIN INCOME TAX POSITIONS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISIONS FOR BAD DEBT 2,333,405. INTEREST EXPENSE 44,008. IMPAIRMENT OF GOODWILL -710,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISIONS FOR BAD DEBT 2,333,405. INTEREST EXPENSE 44,008. IMPAIRMENT OF GOODWILL -710,000. 1 1 1 X 1 X 1 1 0 0 1913701 1913701 0.05070 4826327 5295707 0 0.00000 6740028 5295707 1913701 0.05070 762623 762623 0.02020 549353 549353 0.01460 84508 84508 0.00220 1396484 1396484 0.03700 8136512 5295707 3310185 0.08770 1792 1792 0.00000 1792 1792 0.00000 0 2333405 10940729 10828173 112556 X 1 1 1 1 GRANT MEMORIAL HOSPITAL 117 HOSPITAL DRIVE PETERSBURG WV 26847 WWW.GRANTMEMORIAL.COM X X X X X SNF/NF & PRIMARY CARE PHYSICIAN SERVICES GRANT MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X HTTPS://WWW.GRANTMEMORIAL.COM/ X X 1 18 1 HTTPS://WWW.GRANTMEMORIAL.COM/ 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X WWW.GRANTMEMORIAL.COM/INDEX.PHP/RESOURCES/CHARITY-CARE-GUIDELINES X WWW.GRANTMEMORIAL.COM/INDEX.PHP/RESOURCES/CHARITY-CARE-GUIDELINES X WWW.GRANTMEMORIAL.COM/INDEX.PHP/RESOURCES/CHARITY-CARE-GUIDELINES X X X X X X 1 0 X X X 1 X 0 0 GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL PERFORMED TELEPHONE SURVEYS TO RESIDENTS OF THE SERVICE AREAS. THE DATA FROM THE TELEPHONE SURVEYS WAS USED DURING THE COMMUNITY SUMMIT WITH COMMUNITY LEADERS AND OTHER CITIZENS THROUGHOUT THE COMMUNITY. THE COMMUNITY LEADERS INCLUDED PHYSICIANS, A SCHOOL PRINCIPAL, A COUNTY COMMISSIONER, A BANKER, A TEACHER, THE CEO OF THE LOCAL COMMUNITY HEALTH CENTER, BOARD MEMBERS AND HOSPITAL LEADERSHIP. THE DATA THAT RESULTED FROM THE COMMUNITY SUMMIT WAS THEN REVIEWED BY HOSPITAL LEADERSHIP TO DETERMINE THE NEEDS TO BE ADDRESSED. GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL CONDUCTED A FORUM THAT PROVIDED THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. PERSONS WHO PARTICIPATED IN THE ASSESSMENTS WERE INVITED AND THE FORUM WAS ALSO OPEN TO THE PUBLIC. GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 11. IT IS UNDERSTOOD THAT IN ORDER TO BE THE MOST EFFECTIVE AND MAKE THE GREATEST IMPACT, THAT NOT ALL COMMUNITY NEEDS CAN BE ADDRESSED AT ONCE IN AN IMPLEMENTATION PLAN. IT IS IMPORTANT TO NOTE THAT WHILE THREE NEEDS WERE PRIORITIZED AND ADOPTED BY THE HOSPITAL FOR ITS IMPLEMENTATION PLAN, FOR THOSE NEEDS THAT THE HOSPITAL DID NOT MAKE A PRIORITY, WE CONTINUE TO WORK WITH THE COMMUNITY ORGANIZATIONS TO HELP ADDRESS THOSE NEEDS. THE NEEDS THAT ARE BEING ADDRESSED ARE AROUND CANCER, SUBSTANCE USE AND ABUSE, OBESITY AND CO-MORBID ISSUES. GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J. UNINSURED PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY AND FAP APPLICATION FORM. BILLING STATEMENTS INCLUDE A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN INFORMATION. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS DETERMINED BASED UPON MEDICARE PRINCIPLES OF REIMBURSEMENT FOR MEDICAID INPATIENT AND OUTPATIENT REIMBURSEMENT, THE ACTUAL COSTS WERE DETERMINED BASED UPON THE MEDICAID COST REPORT. THE COST FOR FINANCIAL ASSISTANCE WAS ALSO COMPUTED BASED UPON ACTUAL COST-TO-CHARGE RATIOS FOR THE FINANCIAL COSTS AND ALLOCATED OVERHEAD COSTS DERIVED FROM THE MEDICARE COST REPORT. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,333,405. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL IS LOCATED IN THE POTOMAC HIGHLANDS IN THE MOUNTAINS OF THE EASTERN PANHANDLE OF WEST VIRGINIA. THE CLOSEST HOSPITALS ARE LOCATED APPROXIMATELY 1.5 HOURS AWAY DURING GOOD WEATHER. DURING THE WINTER, IT TYPICALLY WILL TAKE MUCH LONGER DEPENDING ON WEATHER CONDITIONS. THE HOSPITAL'S PRIMARY SERVICE AREA IS COMPOSED OF THE WEST VIRGINIA COUNTIES OF GRANT, HARDY, PENDLETON, MINERAL AND HAMPSHIRE. THE TOTAL POPULATION OF THE FIVE COUNTIES COMBINED IS APPROXIMATELY 30,000. DUE TO THE DISTANCE FROM OTHER AREA HOSPITALS, THE HOSPITAL DOES PROVIDE OB SERVICES. DURING THIS TAX YEAR, THE HOSPITAL HAD APPROXIMATELY 285 DELIVERIES WITH THE VAST MAJORITY OF THESE PATIENTS BEING COVERED UNDER THE MEDICAID PROGRAM. THE HOSPITAL BOARD BELIEVES THAT THIS SERVICE MUST BE PROVIDED EVEN AT A LOSS. IN ADDITION, DUE TO THE LACK OF MOBILITY OF THE ELDERLY AND THE FACT THAT FAMILY MEMBERS NO LONGER RESIDE IN THE COMMUNITY, THE ELDERLY POPULATION IS DEPENDENT UPON THE HOSPITAL FOR THE PROVISION OF HEALTHCARE SERVICES. THE HOSPITAL ALSO HAS TO COORDINATE CARE FOR ITS PATIENTS AS THEY MOVE THROUGH THE CONTINUUM OF CARE AS NURSING HOMES, PHYSICIANS, HOME HEALTH AND HOSPICE SERVICES. THE ECONOMY IS PRIMARILY AGRICULTURAL, HARDWOOD MANUFACTURING, AND POULTRY PROCESSING. THE MAJOR EMPLOYERS ARE POULTRY PROCESSING PLANTS AND HARDWOOD COMPANIES, THE VARIOUS BOARDS OF EDUCATION AND THE HOSPITAL. DURING THE LAST COUPLE OF YEARS THERE HAVE BEEN SIGNIFICANT REDUCTIONS IN STAFF AT BOTH HARDWOOD COMPANIES. SINCE THE HOSPITAL IS A POLITICAL SUB-DIVISION OF GRANT COUNTY, THE BOARD MEMBERS ARE APPOINTED BY THE GRANT COUNTY COMMISSION. UNDER WEST VIRGINIA LAW, THE COMPOSITION OF THE BOARD MUST REPRESENT A BROAD SECTION OF THE HOSPITAL'S SERVICE AREA. AS A RESULT, OCCUPATIONS OF THE BOARD MEMBERS ARE BANKERS, EDUCATORS, SMALL BUSINESS AND UNION MEMBERS. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE 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 COSTING METHODOLOGY WAS OBTAINED FROM THE MEDICARE COST REPORT WHICH IS BASED ON COST-TO-CHARGE RATIOS. AS WITH ANY BUSINESS, A HOSPITAL MUST GENERATE A PROFIT TO CONTINUE TO PROVIDE SERVICES TO THE RESIDENTS OF THE AREA IN WHICH THE HOSPITAL SERVES. THESE DISCOUNTS ARE DICTATED BY THE MEDICAID PROGRAM, AND DUE TO BUDGET CONSTRAINTS, THE MEDICARE PROGRAM HISTORICALLY HAS PROVIDED MOST OF THE PAYMENT REDUCTIONS ON HOSPITALS. THE HOSPITAL HAS NO CONTROL OVER REDUCTIONS, AND THE LARGEST CONSUMER OF HEALTH SERVICES ARE MEDICARE BENEFICIARIES. PRIOR TO 1966 WHEN THE MEDICARE PROGRAM WAS IMPLEMENTED, MANY ELDERLY PEOPLE WERE GOING WITHOUT CARE OR WERE RECEIVING A SUB STANDARD OF CARE. IN ADDITION, THESE PATIENTS, DUE TO THEIR AGE, UTILIZE THE HIGHEST LEVEL OF RESOURCES THAT ARE PROVIDED TO THE HOSPITAL'S PATIENTS. THE HOSPITAL IS DESIGNATED BY THE MEDICARE/MEDICAID PROGRAMS AS A CRITICAL ACCESS HOSPITAL (CAH). WHEN THIS DESIGNATION WAS ESTABLISHED BY THE MEDICARE PROGRAMS IN THE 1990S, THIS PROGRAM WAS DESIGNED TO PROVIDE SAFETY NET HOSPITALS THAT ARE LOCATED IN RURAL, ISOLATED AREAS, THE ADDITIONAL REIMBURSEMENT THAT WILL ALLOW THEM TO REMAIN OPEN. HOWEVER, AGAIN DUE TO BUDGET CONSTRAINTS, THE MEDICARE PROGRAM HAS SIGNIFICANTLY REDUCED REIMBURSEMENT TO THESE SAFETY NET HOSPITALS. THE HOSPITAL MUST TAKE THE LEAD IN ENSURING THAT QUALITY HEALTHCARE SERVICES ARE BEING PROVIDED. THE HOSPITAL PARTICIPATES IN A MEDICAL EDUCATION PROGRAM WHERE STUDENTS FROM VARIOUS MEDICAL SCHOOLS WILL DO RURAL ROTATIONS AT THE HOSPITAL. THE HOSPITAL ALSO SUPPORTS RN EDUCATION AT THE LOCAL COMMUNITY COLLEGE TO PROVIDE QUALIFIED RNS FOR THE AREA. THE HOSPITAL ENCOURAGES EMPLOYEES TO OBTAIN FACULTY POSITIONS FOR OTHER PROGRAMS AT THE LOCAL COMMUNITY COLLEGE, AND THE HOSPITAL IS WILLING TO ACCOMMODATE WORK SCHEDULES FOR EMPLOYEES THAT DO TEACH OTHER TRAINING PROGRAMS. ALSO, DUE TO THE LIMITED RESOURCES IN THE COMMUNITY, THE HOSPITAL MUST ALSO TAKE THE LEAD IN RECRUITING PHYSICIANS TO THE AREA. PART III, LINE 9B: IF IT IS DETERMINED THAT A PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE, THE PATIENT IS ADVISED TO APPLY FOR FINANCIAL ASSISTANCE. IF APPROVED FOR FINANCIAL ASSISTANCE, THE PATIENT'S BILL WOULD BE PAID BY FINANCIAL ASSISTANCE. IF THE PATIENT CANNOT QUALIFY FOR FINANCIAL ASSISTANCE, HE OR SHE MUST COMPLETE THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION. INCOME IS PRIMARILY USED TO DETERMINE ELIGIBILITY, BUT THE PATIENT'S ASSETS ARE ALSO CONSIDERED. THE PATIENT MUST PROVIDE DOCUMENTATION OF INCOME SUCH AS INCOME TAX RETURNS, W-2'S, ETC. THE POVERTY INCOME GUIDELINES AS DEVELOPED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) ARE USED TO DETERMINE ELIGIBILITY. IF A PERSON'S INCOME IS FROM 201% - 250% OF THESE GUIDELINES, THE PATIENT WILL RECEIVE A 50% FINANCIAL ASSISTANCE WRITE-OFF. FROM 251% - 300% OF THE INCOME GUIDELINE WILL EARN A FINANCIAL ASSISTANCE WRITE-OFF, THIS INCOME GUIDELINE WILL RECEIVE A 25% FINANCIAL ASSISTANCE DISCOUNT. IT IS POLICY THAT IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THERE IS NO COLLECTION AGAINST THAT AMOUNT THAT THEY QUALIFY FOR. IN SPITE OF THE HOSPITAL'S COLLECTION POLICIES, PATIENTS ARE NOT DENIED TREATMENT. IN FACT, FOR PATIENTS WHO PRESENT THEMSELVES TO THE EMERGENCY ROOM FOR SERVICES, NO FINANCIAL INFORMATION IS REQUESTED UNTIL AFTER THE PATIENT HAS RECEIVED AN INITIAL MEDICAL EVALUATION. IF THE PATIENT DOES NOT HAVE INSURANCE OR MAKE PAYMENT, SERVICES ARE STILL PROVIDED TO THE PATIENT. THE SAME IS TRUE FOR PATIENTS THAT ARE ADMITTED TO THE HOSPITAL. PART VI, LINE 2: THE NEEDS ASSESSMENT MADE DURING THE 2018 TAX YEAR OBTAINED THE NEEDS OF THE COMMUNITY THROUGH TELEPHONE SURVEYS AND A COMMUNITY SUMMIT. THE COMMUNITY SUMMIT INCLUDED SPECIFIC COMMUNITY LEADERSHIP AS NOTED ABOVE, AS WELL AS OTHER CITIZENS. THE DATA GATHERED WAS REVIEWED BY THE BOARD OF DIRECTORS AND HOSPITAL LEADERSHIP TO DEVELOP THE IMPLEMENTATION PLAN TO ADDRESS NEEDS IDENTIFIED. IT IS ALSO BASED UPON WHAT RNS, SOCIAL WORKERS AND OTHER CLINICAL PERSONNEL SEE ON A DAILY BASIS IN THE PROVISION OF MEDICAL CARE. PART VI, LINE 3: WHENEVER A PATIENT PRESENTS THEMSELVES FOR SERVICE AND DOES NOT HAVE INSURANCE COVERAGE, THE HOSPITAL REQUESTS THAT A FINANCIAL ASSISTANCE APPLICATION BE COMPLETED AND RETURNED TO THE HOSPITAL ALONG WITH ALL DOCUMENTATION NEEDED TO SUPPORT INCOME AMOUNTS THAT WILL BE USED TO DETERMINE IF AND HOW MUCH FINANCIAL ASSISTANCE THE PATIENT MAY QUALIFY. THE HOSPITAL USES THE CURRENT FEDERAL POVERTY GUIDELINES TO MAKE THIS DETERMINATION. IF THE PATIENT IS RESPONSIBLE FOR A PORTION OF THE BALANCE, THE HOSPITAL DOES HAVE PAYMENT SCHEDULES TO ASSIST THE PATIENT IN MEETING HIS/HER FINANCIAL OBLIGATIONS. AT THE TIME THE FINANCIAL ASSISTANCE APPLICATION IS BEING PREPARED, THE HOSPITAL REQUIRES THAT THE PATIENT APPLY FOR MEDICAID COVERAGE AT THE DHHR. IN CONNECTION WITH SERVICES PROVIDED IN THE HOSPITAL'S EMERGENCY ROOM, NO FINANCIAL INFORMATION IS OBTAINED UNTIL AFTER THE PATIENT HAS BEEN TRIAGED BY AN RN. CONSEQUENTLY, THE HOSPITAL'S POLICY FOLLOWS A LESS RESTRICTIVE POLICY THAN IS MANDATED BY EMTALA. IN A TRUE EMERGENCY SITUATION, NO FINANCIAL INFORMATION IS REQUESTED UNTIL AFTER THE PATIENT HAS BEEN STABILIZED. THE HOSPITAL ALSO HAS AN ENROLLMENT SPECIALIST, WHO ON A DAILY BASIS, REVIEWS ADMISSIONS AND OUTPATIENT REGISTRATIONS FROM THE PRIOR DAY TO DETERMINE IF THEY CAN QUALIFY FOR FINANCIAL ASSISTANCE. AS PART OF THIS PROCESS, THE HOSPITAL ALSO MAKES THE DETERMINATION AS TO WHETHER THE PATIENT MAY QUALIFY FOR MEDICAID. BASED UPON THE INFORMATION THAT THE ENROLLMENT SPECIALIST OBTAINS, THE HOSPITAL CAN PRESUMPTIVELY APPROVE A PATIENT FOR MEDICAID COVERAGE THAT AT LEAST WILL COVER THAT STAY REGISTRATION. CLERKS DURING THE ADMISSIONS PROCESS WILL ALSO ADVISE THE PATIENT THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE ON AN ANNUAL BASIS. TO FURTHER EDUCATE PATIENTS ABOUT FINANCIAL ASSISTANCE, INFORMATION IS ON THE HOSPITAL'S WEBSITE, AND A FINANCIAL COUNSELOR IS MADE AVAILABLE UPON REQUEST AND THROUGHOUT NORMAL BUSINESS HOURS. PART VI, LINE 5: MEMBERSHIP TO THE MEDICAL STAFF IS OPEN TO ANY PROVIDER WHO POSSESSES THE APPROPRIATE QUALIFICATIONS TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY. THE HOSPITAL PERFORMS BACKGROUND CHECKS ON EDUCATION, STATE LICENSES, EXPERIENCE, ANY ACTIONS WHERE THE PHYSICIAN MAY HAVE BEEN REPORTED TO THE NATIONAL DATA BANK, POTENTIAL LITIGATION AND CRIMINAL ISSUES. IF THESE COME BACK FAVORABLE TO THE PHYSICIAN, THE PROSPECTIVE MEMBER IS INTERVIEWED BY THE CHIEF OF STAFF. BASED UPON THIS PROCESS, THE CHIEF OF STAFF WILL MAKE A RECOMMENDATION TO EITHER ACCEPT OR REJECT THE PROSPECTIVE MEMBER TO THE MEDICAL STAFF. IF THE RECOMMENDATION IS TO ACCEPT THE PROSPECTIVE MEMBER, THE MEDICAL STAFF WILL HOLD A FORMAL VOTE ON WHETHER TO ACCEPT OR REJECT THE PHYSICIAN. IF THE MEDICAL STAFF APPROVES THE PHYSICIAN FOR MEMBERSHIP TO THE MEDICAL STAFF, THIS IS THEN TAKEN TO THE BOARD OF TRUSTEES FOR A VOTE. THE CURRENT MEDICAL STAFF HAS A VERY DIVERSE BACKGROUND IN THAT THERE ARE BOTH MEN AND WOMEN ON THE MEDICAL STAFF AS WELL AS MEMBERS WHO WERE BORN IN FOREIGN COUNTRIES AS WELL AS THE UNITED STATES. THE HOSPITAL HAS RECRUITED NEW PHYSICIANS DURING THE LAST COUPLE OF YEARS, AND THIS TREND HAS CONTINUED. SINCE THE HOSPITAL IS A POLITICAL SUB-DIVISION OF GRANT COUNTY, THE GRANT COUNTY COMMISSION APPOINTS MEMBERS TO THE BOARD. UNDER WEST VIRGINIA LAW, THE COMPOSITION OF THE BOARD MUST REPRESENT A BROAD SECTION OF THE HOSPITAL'S SERVICE AREA. CONSEQUENTLY, OCCUPATIONS OF THE BOARD MEMBERS ARE BANKERS, EDUCATORS, OWNERS OF SMALL BUSINESS, RETIRED CITIZENS AND UNION MEMBERS. PART VI, LINE 7, REPORTS FILED WITH STATES WV X X X 0 0 0 0 0 0 0 0 0 CAROLINE ARMSTRONG DO TRUSTEE, PHYSICIAN, CHIEF OF STAFF 336255 0 0 0 0 0 0 0 0 0 336255 0 0 0 BEN LESLIE TRUSTEE, PHYSICIAN, VICE CHIEF OF ST 350160 0 0 0 0 0 0 0 0 0 350160 0 0 0 ANIL MAKANI PHYSICIAN 521285 0 108360 0 0 0 18889 0 14172 0 662706 0 0 0 SCOTT ROBERTS PHYSICIAN 480069 0 61162 0 0 0 16237 0 2898 0 560366 0 0 0 ULUNNA MACBEAN PHYSICIAN 239425 0 0 0 20000 0 7783 0 9250 0 276458 0 0 0 AMANDA BORROR PHYSICIAN 228781 0 3203 0 10000 0 7259 0 13019 0 262262 0 0 0 NISHAT ALLY PHYSICIAN 213542 0 2412 0 0 0 6479 0 1257 0 223690 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THIS COMMITTEE SHALL CONSIST OF THE CHAIRPERSON, VICE CHAIRPERSON, THREE (3) OTHER VOTING MEMBERS OF THE BOARD, AND THE CEO AND CHIEF OF THE MEDICAL STAFF IN EX-OFFICIO, NON-VOTING CAPACITY. DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD, THE EXECUTIVE COMMITTEE MAY ACT IN THE NAME, AND WITH THE FULL POWER, OF THE BOARD PROVIDED THAT ANY SUCH ACTION SHALL NOT CONFLICT WITH THE POLICIES OF THE BOARD OF TRUSTEES AND BE OCCASIONED BY AN EMERGENT SITUATION IN WHICH AN EMERGENCY MEETING CANNOT BE HELD. ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE SHALL SET FORTH THE REASON ACTION WAS REQUIRED TO BE TAKEN PRIOR TO THE NEXT SCHEDULED MEETING OF THE BOARD AND WHY AN EMERGENCY MEETING WAS NOT CALLED. THIS COMMITTEE MAY REQUEST THE CHAIRPERSON TO CALL A SPECIAL MEETING OF THE BOARD OF TRUSTEES WHEN A SITUATION DICTATES. THIS COMMITTEE SHALL MEET AS NECESSARY AND SHALL REPORT TO THE BOARD AS A WHOLE. FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL HAS A DUAL CERTIFICATION IN THAT IT IS A POLITICAL SUB-DIVISION OF GRANT COUNTY. FORM 990, PART VI, SECTION A, LINE 7A THE GRANT COUNTY COMMISSION APPOINTS MEMBERS TO THE BOARD WHO RESIDE IN GRANT COUNTY. THE HOSPITAL IS A POLITICAL SUB-DIVISION OR COMPONENT UNIT OF GRANT COUNTY (COUNTY HOSPITAL). FORM 990, PART VI, SECTION B, LINE 11B THE TAX RETURN WILL BE REVIEWED BY MANAGEMENT AND IS GIVEN TO EVERY BOARD MEMBER OF THE BOARD AFTER THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES AND ADMINISTRATION OFFICIALS SHALL BE REQUIRED TO COMPLETE A WRITTEN CONFLICT OF INTEREST STATEMENT ANNUALLY WHICH SHALL DISCLOSE THE EXTENT OF FINANCIAL DEALINGS WITH THE ORGANIZATION BY ALL BUSINESSES OR OTHER ORGANIZATIONS IN WHICH THEY, OR MEMBERS OF THEIR IMMEDIATE FAMILIES, HAVE A BENEFICIAL INTEREST. A BENEFICIAL INTEREST WITH AN ORGANIZATION WILL BE CONSIDERED TO EXIST WHEN A TRUSTEE OR ADMINISTRATION OFFICIAL OR A MEMBER OF HIS/HER IMMEDIATE FAMILY IS AN OFFICER, DIRECTOR, TRUSTEE, PARTNER, EMPLOYEE OR AGENT OF THE ORGANIZATION, OR OWNS FIVE PERCENT OF THE VOTING STOCK OR CONTROLLING INTEREST IN THAT ORGANIZATION, OR HAS ANY OTHER SUBSTANTIAL INTEREST OR DEALINGS WITH THE ORGANIZATION. AT SUCH TIME, IF ANY MATTER SHOULD COME BEFORE THE BOARD OF TRUSTEES IN SUCH A WAY AS TO GIVE THE RISE TO A CONFLICT OF INTEREST, THE AFFECTED MEMBER OF THE BOARD SHALL MAKE KNOWN THE POTENTIAL CONFLICT AND IF ADVISABLE, WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO VOTE, THE AFFECTED MEMBER SHALL NOT VOTE, NOR BE COUNTED IN ESTABLISHING A QUORUM FOR THE VOTE ON THAT MATTER. PROCEEDINGS RELATED TO THE CONFLICT OF INTEREST MATTERS BEFORE THE BOARD OF TRUSTEES SHALL BE DOCUMENTED IN THE MINUTES OF THAT MEETING. EVERY JANUARY, THE CEO AND CHAIRMAN ENSURE THE CONFLICT OF INTEREST FORMS ARE COMPLETED. THEY REVIEW THE FORMS TO IDENTIFY ANY INSTANCES THEY CAN FORESEE AND DISCUSS THEM WITH THE BOARD. FORM 990, PART VI, SECTION B, LINE 15A EVERY YEAR A SURVEY IS CONDUCTED THROUGH THE STATE ON AVERAGE SALARIES FOR THE CEO OF THE ORGANIZATION. THIS ENSURES THE HOSPITAL IS PAYING NO MORE THAN FAIR MARKET VALUE FOR THE CEO COMPENSATION. THE COMPENSATION AVERAGES ARE GIVEN TO THE BOARD OF TRUSTEES AND THEY HAVE FINAL SAY ON THE ACTUAL COMPENSATION FOR THE CEO OF THE HOSPITAL FORM 990, PART VI, SECTION C, LINE 18 THE TAX RETURN IS SUBMITTED TO THE WEST VIRGINIA HEALTHCARE AUTHORITY UNDER THE STATE OF WEST VIRGINIA'S FINANCIAL DISCLOSURE STATUTE. FORM 990, PART VI, SECTION C, LINE 19 IT IS REQUIRED BY WEST VIRGINIA LAW THAT ALL HOSPITALS FILE AUDITED FINANCIAL STATEMENTS, MEDICARE/MEDICAID COST REPORTS, CHARGEMASTER AND SIGNED COPY OF WORKSHEET 12 OF THE UNIFORM REPORT N TO THE WEST VIRGINIA HEALTH CARE AUTHORITY. INFORMATION SUBMITTED TO THE WEST VIRGINIA HEALTH CARE AUTHORITY MAY BE OBTAINED UNDER THE FREEDOM OF INFORMATION ACT. THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 6,505,859. MANAGEMENT AND GENERAL EXPENSES 1,719,713. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,225,572. FORM 990, PART XII, LINE 2C THE ORGANIZATION'S BOARD OF DIRECTORS ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED. GRANT MEMORIAL HOSPITAL TRUST FOUNDATION INCORPORATED PO BOX 1019 PETERSBURG WV 26847 550491787 SUPPORT GRANT MEMORIAL HOSPITAL WV 501(C)(3) LINE 12C, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0