2020-07-08T08:58:56-05:00 2019-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2018-07-01 556005561 Webster County Memorial Hospital WEBS 3048475682 324 Miller Mountain Drive Webster Springs WV 26288 James Parker CEO 3048475682 2020-07-01 1 Dolores Rose P01286262 3043460441 216.12.119.47 2020-07-01 15:43:11 ED P 5E5CA3B19F03F57B7682B8F0EA19F10A24F2CF22 EF272E949B022F30B68C60E053C4FB8C6906CCF1 2018 2021-01-29 14:40:06Z James Parker 324 Miller Mountain Drive Webster Springs WV 26288 19151866 0 X www.wcmhwv.org X 1951 WV To provide acute short-term care to residents of Webster and surrounding counties of West Virginia. 8 6 248 8 0 0 39068 51370 19556142 19025006 2561 -23651 96118 73350 19693889 19126075 0 0 0 0 10214782 10346711 0 0 0 8245963 7378088 18460745 17724799 1233144 1401276 5048497 5827077 4761079 4138383 287418 1688694 The mission of Webster County Memorial Hospital is to provide excellent, high quality care in a compassionate and cost-effective manner. 0 0 14277093 19070347 Critical Access Hospital services provided included 563 inpatient days, 34,430 outpatient visits, and 10,985 RHC visits. Charges forgone for charity amounted to $48,425. 14277093 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 9 0 248 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Dalila Miller 3048475682 324 Miller Mountain Drive Webster Springs WV 26288 Louise Hamrick Chairman 1.00 X X 0 0 0 Mary Anne Carpenter Vice Chair 1.00 X X 0 0 0 Larry Lynch Secretary/Treasurer 1.00 X X 0 0 0 Karen Dotson Trustee 1.00 X 0 0 0 Keith Hamrick Trustee 1.00 X 0 0 0 Jim Phares Trustee 1.00 X 0 0 0 Betsy Morris Trustee 1.00 X 0 0 0 Chris Graham Trustee 1.00 X 0 0 0 Julie Clutter Director of Financial Serv 40.00 X 68926 0 2600 James Parker CEO 10/1/17 to present 40.00 X 0 0 0 Jonathan Beam PharmD Pharmacy Director 40.00 X 197451 0 23088 Frankie Pucket MD Physician 40.00 X 495175 0 4523 Luke McElwain DO Physician 40.00 X 292896 0 21500 Robert Mace MD Medical Director 40.00 X 265456 0 93 Todd Lares MD Physician 40.00 X 208347 0 2193 1528251 0 53997 15 0 1 1 LabCorp 3701 MacCorkle Avenue SE Charleston WV 25304 Lab Services 627082 B&L Imaging 555 Mount Carmel Road Mosheim TN 37818 MRI Consultants 163400 2 51370 51370 Patient Service Revenue 624100 16509230 16509230 340B Pharmacy Revenue 900099 2515776 2515776 19025006 2140 2140 2218 0 2218 2218 2218 25791 -25791 -25791 -25791 Debt Forgiveness 900099 33756 33756 Employee Meals 722210 28847 28847 Consulting Fees 900099 8529 8529 71132 19126075 19070347 0 4358 74098 55744 18354 8874267 6676111 2198156 32985 24815 8170 770068 579322 190746 595293 447839 147454 137829 137829 878993 677786 201207 5223 5223 383852 288772 95080 375200 282263 92937 338758 254848 83910 82157 61807 20350 71018 53427 17591 372061 279901 92160 255059 191881 63178 Medical supplies 2420663 2420663 Bad debt expense 1569452 1569452 Provider tax 183582 183582 Repairs and Maintenance 169010 127146 41864 135231 101734 33497 17724799 14277093 3447706 0 1367783 1252368 16865 20331 1519087 1581637 305790 331777 683 40070 7787558 5858488 1663056 1929070 175233 671824 5048497 5827077 2687999 1979941 1677689 1475554 395391 682888 4761079 4138383 X 270553 1668363 16865 20331 287418 1688694 5048497 5827077 1401276 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 6217 6217 0 Part II-B, Line 1: A portion of dues paid by the Hospital to the American Hospital Association and West Virginia Hospital Association is attributable to lobbying. 32757 32757 1793535 1752807 40728 5795631 3987570 1808061 165635 118111 47524 1929070 Other Receivables 671824 671824 Third-party settlements 682888 682888 17555945 0 17555945 1570130 1570130 19126075 16154669 0 16154669 1570130 1570130 17724799 Part XI, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 1,569,452. Expense offsetting income on financial statements 678. Part XII, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 1,569,452. Expense offsetting income on financial statements 678. 1 1 1 X 175.000000000000 1 X 175.000000000000 1 1 0 0 243779 243779 1063900 999792 64108 0.00400 1307679 1243571 64108 0.00400 3225 3225 0.00020 500 500 0.00000 3725 3725 0.00020 1311404 1243571 67833 0.00420 1 1569452 3540587 3540587 X 1 1 1 1 Webster County Memorial Hospital PO Box 312 Webster Springs WV 26288 X X X Rural Health Clinic and a Wellness Center Webster County Memorial Hospital 1 0 0 1 X X X X X X X 17 1 0 0 1 X https://www.wcmhwv.org/downloadable-forms-1 X 1 17 1 https://www.wcmhwv.org/downloadable-forms-1 0 1 X 175.000000000000 175.000000000000 X X X 1 1 X X X 1 X https://www.wcmhwv.org/downloadable-forms-1 X https://www.wcmhwv.org/downloadable-forms-1 X https://www.wcmhwv.org/downloadable-forms-1 X X X 1 X 0 X X 1 X 0 0 Webster County Memorial Hospital Part V, Section B, Line 5: The Community Health Needs Assessment (CHNA) questionnaire was taken to multiple public locations for community members to fill out and give their opinion of services needed and their satisfaction with services already provided by the hospital. Officials and employees were interviewed for the CHNA from the following: Webster County Health Department, Board of Education, Family Resource Network, United National Bank, Catholic Charities, and the food pantry. Webster County Memorial Hospital Part V, Section B, Line 11: Based upon the results of the Community Health Needs Assessment, Webster County Memorial Hospital will develop a three-year Implementation Strategy to address the following significant community health related needs:*Increased education and promotion of community resources*Utilize existing affiliations to promote healthier lifestyle choices*Chronic disease maintenance and prevention (Diabetes, Cardiovascular, Respiratory)*Improve overall health statusThe CHNA, approved on June 29, 2018, has provided valuable insight to the contributing factors of health related issues faced by the residents of Webster County and the surrounding communities. It will assist Webster County Memorial Hospital as well as other community providers to collaborate their efforts to provide the necessary resources for the community. Part I, Line 3c: The patient's income is considered and reviewed to determine the amount of discount they receive, if not free care. The patient's assets are also reviewed. They can only have one vehicle and one house. If the patient has more than one vehicle, the total value of the vehicles cannot exceed $2,000. If the value exceeds $2,000, the patient will automatically be reduced to a percentage less than 100%. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,569,452. Part II, Community Building Activities: The Hospital distributes educational material regarding smoking cessation, healthy eating, saying no to drugs, cancer, diabetes & other diseases, how to live a healthier life along with physical activities. The Hospital also assists the community with kids needs for sports. Part III, Line 2: Bad debt expense as reported on the audited financial statements. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectibility. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The Medicare cost report was used to report Medicare revenue and expenses.CAH's receive cost reimbursement for Medicare services. A settlement process takes place after the Medicare cost report is filed in order to make payments (revenue) equal allowable cost. Thus, there is no "shortfall" of cost versus payments for CAH Medicare services. Part III, Line 9b: Patient's are informed about the finanical assistance program when they call to ask about their medical bills. The billers offer patient information about the program over the phone or if the patient is seen by the biller in person, they are shown the application and the documents that are needed. Part VI, Line 2: Director of Clinical Operations & Quality continuously reviews referral logs made by secretaries to see if there are any services we can provide here. Then we find out cost and reimbursement issues and present to CEO. Part VI, Line 3: If the patient presents to the registration desk and is private pay, the registration clerk informs the patient that we currently have a Financial Assistance program that will help them receive a discount or have the total amount written off and offers them the application. If a patient is private pay and admitted as an observation or inpatient, the social worker reviews the financial assistance program with the patient and offers them the application before discharge. If a patient calls into the billing office to ask about their billing statement and they state they don't think they can pay or want to make a payment contract, the billers will offer the patient information on the program and offer to mail them an application. Part VI, Line 4: Our geographical service area is rural. The majority (84.9%) of the Hospital's patients reside in Webster County, West Virginia. A portion of the remaining patients reside in Nicholas County (7.7%) and Braxton County (2.8%). The population of Webster County is 8,372. The residents of Webster County have a median household income of $29,982 and 25.2% of the residents live in poverty. There is one hospital serving the community and the next nearest facility is 40 miles away. Part VI, Line 5: Governing body is comprised of members of all areas of the community and are not employees of the organization. The Hospital extends privileges to all qualified staff working for the facility. The Hospital uses surplus funds to provide new services for patients. The emergency room is available to all patients whether they have the ability to pay or not. The Hospital offers MRI, Cardiac and Pulmonary Rehab and Nuclear medicine, which are not available at any other location in the County. The Hospital offers charitable care and serves as a source of community volunteer activities. X 0 0 0 0 0 0 0 0 0 Jonathan Beam PharmD Pharmacy Director 197451 0 0 0 0 0 18488 0 4600 0 220539 0 0 0 Frankie Pucket MD Physician 495175 0 0 0 0 0 4523 0 0 0 499698 0 0 0 Luke McElwain DO Physician 292896 0 0 0 0 0 18500 0 3000 0 314396 0 0 0 Robert Mace MD Medical Director 265456 0 0 0 0 0 0 0 93 0 265549 0 0 0 Todd Lares MD Physician 208347 0 0 0 0 0 0 0 2193 0 210540 0 0 0 Form 990, Part VII, Section A, Line 5 Webster County Memorial Hospital (Hospital) entered into a management services agreement with Davis Health System (DHS) in January 2017. DHS provides a full-time Chief Executive Officer (CEO) to the Hospital. As of the filing date of the 990, James Parker is the CEO. The Hospital reimburses DHS for the CEO's compensation and benefits. The compensation and benefits paid to the CEO for the year ended December 31, 2018 was $175,107. Christopher Dotson Family Member of Karen Dotson, Board Member 86053 Employee compensation 0 Lisa Clutter Family Member of Chris Graham, Board Member 28655 Employee compensation 0 Form 990, Part VI, Section A, line 3 Webster County Memorial Hospital (Hospital) entered into a Management Services Agreement with Davis Health System (DHS) in January 2017. DHS provides a full-time Chief Executive Officer(CEO) and provides support to the CEO in the performance of his or her duties as appropriate. As of the filing date of the 990, James Parker is the CEO. The Hospital reimburses DHS for the CEO's compensation and benefits. Form 990, Part VI, Section B, line 11b During a regularly scheduled board meeting, each board member receives a copy of the completed Form 990. The board will vote and approve the completed form before filing. If the return is completed and due between regularly scheduled board meetings, an electronic copy of the 990 is emailed to all board members and approved before the return is filed. Form 990, Part VI, Section B, line 12c Officers and Directors are required to complete an annual conflict of interest questionnaire. This questionnaire is then reviewed by the Board of Trustees, annually, for any interests that could give rise to conflicts. If a conflict should arise, the individual would have to disclose this conflict to the Board of Trustees. The board member would not be permitted to vote on the issue, if applicable. Form 990, Part VI, Section B, line 15 To determine compensation of the Organization's CEO, the organization compares Forms 990 of other organizations, reviews written employment contracts and performs compensation surveys of similar facilities. A review of compensation is conducted internally by the Board of Trustees. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are made available upon request. Form 990, Part XII, Line 2c: The Organization's finance committee of the board of directors selects the independent accountant. The process remains unchanged from prior years.