2018-08-15T13:18:46-05:00 2017-09-30 861065772 Deloitte Tax LLP 250 East Fifth Suite 1900 Cincinnati OH 45202 990 2016-10-01 550357057 Wheeling Hospital Inc WHEE 3042433681 1 Medical Park Wheeling WV 260036300 James B Murdy CFO 3042433681 2018-08-15 1 Rebecca Lyons P01487105 5137847100 2016 2022-09-23 18:48:47Z James B Murdy 1 Medical Park Wheeling WV 260036300 384961041 0 0928 X www.wheelinghospital.org X 1850 WV To provide needed care to the community regardless of an individual's ability to pay. 15 13 3105 189 5591675 1041745 981055 1315119 320275803 332803758 3998615 18217112 15449939 14268412 340705412 366604401 635000 31898 0 0 159810127 176457532 0 0 0 143240830 158131651 303685957 334621081 37019455 31983320 401455786 436314624 102291913 105341479 299163873 330973145 X Wheeling Hospital, Inc. is a Catholic Hospital that serves as a health ministry, providing compassionate care to people of all faiths in a loving, spiritual environment. God gives us the responsibility to carry out His mission of healing and to promote the well-being of our employees and community. In doing so, we, the Wheeling Hospital, Inc. family, fulfill our mission through our:-Healing-Understanding-Ministry-Advanced Technology-Nurturance-Tradition-Ongoing Education-Unity-Care-Hope 0 0 296229578 31898 323913918 Wheeling Hospital, Inc. serviced 11,942 inpatients, 609,283 outpatients, and 15,764 home health visits during fiscal year 2017. Community services included medical screening, diabetic education, cancer support, etc., all of which is provided free of charge. This includes the Physician Practice Division, the Wheeling Pediatrics Division, and the Women's Health Service Division. See Schedule H. 8678823 9552205 Continuous Care Center serviced 537 skilled and long-term patients for a total of 37,421 patient days. 304908401 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 1 1 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 1 211 0 1 3105 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 15 13 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 WV X James B Murdy 3042433681 1 Medical Park Wheeling WV 26003 The Most Reverend Michael J Bransfield - Chairman 1.00 0.00 X X 0 0 0 Very Rev Kevin M Quirk JCDJV President/Secretary 1.00 0.00 X X 0 0 0 James E Altmeyer Sr Board Member 1.00 0.00 X 0 0 0 Rev Mon Frederick P AnnieVG Board Member 1.00 0.00 X 0 0 0 John J Battaglino Jr MD Board Member 1.00 0.00 X 16704 0 0 Thomas F Burgoyne Board Member 1.00 0.00 X 0 0 0 Frank L Carenbauer III DDS Board Member 1.00 0.00 X 0 0 0 C Gary Hill Board Member 1.00 0.00 X 0 0 0 Richard A Irvin DO Board Member 1.00 0.00 X 80000 0 0 Curtis R Oliver Board Member 1.00 0.00 X 0 0 0 Sister Mary Palmer CSJ Board Member 1.00 0.00 X 0 0 0 Richard M Polinsky Board Member 1.00 0.00 X 0 0 0 Michael A Sliva Board Member 1.00 0.00 X 0 0 0 Nicholas A Sparachane Board Member 1.00 0.00 X 0 0 0 Raymond V Thalman III Board Member 1.00 0.00 X 0 0 0 Ronald L Violi Chief Executive Officer 57.00 3.00 X 0 0 0 Michael S McKeets Chief Operating Officer 52.00 8.00 X 202783 0 24270 James B Murdy Chief Financial Officer 52.00 8.00 X 325355 0 47204 Angelo Georges MD Chief Medical Officer 56.00 4.00 X 533157 0 38068 Dennis Niess MD Chief Med Info Officer 57.00 3.00 X 265970 0 39005 David Rapp Chief Info Officer 56.00 4.00 X 298230 0 37719 John DeBlasis Senior Administrator 20.00 40.00 X 181957 0 22187 Kareen Simon Vice President of Operations 56.00 4.00 X 361069 0 13418 Shawn Stern Medical Director 52.00 8.00 X 369219 0 39288 Anthony Martinelli Senior Director 52.00 8.00 X 186563 0 26943 Heidi Porter Senior Director 48.00 12.00 X 151881 0 14607 Gregory S Merrick Physician 40.00 0.00 X 1275919 0 14506 Jondavid Pollock Physician 40.00 0.00 X 1156412 0 36691 Chandra S Swamy Physician 40.00 0.00 X 1027990 0 33005 Allan Tissenbaum Physician 40.00 0.00 X 729249 0 39650 Jeffrey Abbott Physician 40.00 0.00 X 693351 0 39683 Louis Longo Former Key Employee 0.00 0.00 X 274180 0 16720 8129989 0 482964 145 1 1 0 R & V Associates 310 Grant Street Ste 1120 Pittsburgh PA 15219 Consulting 3952625 Quest Diagnostics 2249 Collection Center Drive Chicago IL 60693 Lab Testing 1608291 Mountain Emer Phys LLP 4075 Copper Ridge Drive Traverse City MI 49684 ER Physicians 1491776 Three Rivers Pain and Anesthesia 117 Ammons Drive McMurray PA 15317 Physicians 1457478 First Capital Emergency Physicians PO Box 37670 Philadelphia PA 191017670 ER Physicians 765763 32 589214 725905 375698 1315119 Medicare Revenue 621990 152205922 152205922 Net Patient Svc Rev 621500 144314388 144314388 Medicaid Revenue 621990 36283448 36283448 332803758 2856084 662365 2193719 1395735 343612 1052123 1052123 1052123 20418065 12665221 17604059 118199 2814006 12547022 15361028 15361028 339571 290770 48801 48801 Apothecary Income 446110 6085159 2383652 3701507 Non Operating Revenue 713940 1788715 1978391 -189676 Med Svcs/Diagn Lab 621500 1229632 1229632 4063982 4063982 13167488 366604401 333466123 5591675 26231484 31898 31898 3291551 379747 2911804 136205631 125669848 10535783 6500715 5984308 516407 21032357 19178245 1854112 9427278 8281962 1145316 887874 887874 293558 293558 45728 45728 112183 112183 20101008 18770888 1330120 1896665 34090 1862575 15572321 13728097 1844224 742053 742053 3755424 3676564 78860 670595 514524 156071 1649481 1649481 16238555 15601631 636924 5542348 5541346 1002 Medical Supplies 67336104 67328549 7555 Licenses & Taxes 11377750 11282724 95026 Consult/Mgmt Contracts 4240774 2504 4238270 UBIT 522692 522692 0 7146538 6729303 417235 334621081 304908401 29712680 0 132588616 126148485 5619708 5720319 30974117 34257890 3249546 3585677 9496275 3747331 418587748 262390426 121010714 156197322 74765677 62587110 12705408 28742643 11045725 15327847 401455786 436314624 39282859 46548988 60787446 56466245 2221608 2326246 102291913 105341479 X 290996578 318820980 8167295 12152165 299163873 330973145 401455786 436314624 X 31983320 3599015 -3773063 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 18750 0 1 26978 45728 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying and amounts paid to Lewis, Glasser, Casey, & Rollins for government relations. Wheeling Hospital, Inc. does not participate in or intervene in (including publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 5655343 5655343 166049490 92006123 74043367 176667 110822 65845 218309848 164101066 54208782 28396400 6172415 22223985 156197322 Securities 28742643 C 28742643 Deferred Compensation Payable 267484 Long-Term Portion Accrued Property Tax 263001 Asset Retirement Obligation 1341263 Estimated Amounts Due to Third Party Payors 454498 2326246 X Part X, Line 2: From the consolidated audited financial statements of Wheeling Hospital, Inc.: The Hospital, CCC, Belmont Hospital, the Foundation, WP, WHS, HCH, and HCF all qualify as tax-exempt organizations under Section 501(c)(3) of the U.S. Internal Revenue Code. WHH II is treated as a disregarded entity of the Hospital. MFLTD is a foreign entity, incorporated in the Cayman Islands. The effect of income taxes on MFLTD in the accompanying consolidated financial statements is not material. The Hospital does not have any material uncertain tax positions as of September 30, 2017 and 2016. Central America & the Caribbean 0 2 Program services Captive Insurance Activity 349606 0 2 0 0 0 2 349606 0 349606 1 0 1 0 0 0 Uniform Sale 128905 128905 101442 Jewelry Sale 23003 23003 14594 3 187663 187663 4812 169922 339571 339571 4812 285958 290770 48801 1 1 X 1 X 1 X 1 1 0 0 2192931 0 2192931 0.00660 50726885 27701334 23025551 0.06880 52919816 27701334 25218482 0.07540 441900 9935 431965 0.00130 2423220 1222766 1200454 0.00360 2865120 1232701 1632419 0.00490 55784936 28934035 26850901 0.08030 1 5186163 36777 55633145 65210838 -9577693 X 1 1 1 Wheeling Renal Care LLC Special Outpatient Facility-Dialysis 0.50000 0.00000 0.50000 1 1 Wheeling Hospital Inc 1 Medical Park Wheeling WV 26003 www.wheelinghospital.org 89 X X X X Wheeling Hospital Inc 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X See Schedule H, Part V, Section C X 1 16 0 1 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X https://wheelinghospital.org/about/financialassistance.aspx X https://wheelinghospital.org/about/financialassistance.aspx X https://wheelinghospital.org/about/financialassistance.aspx X X X X X 1 X 0 X X X 1 X 0 0 Wheeling Hospital, Inc. Part V, Section B, Line 5: Interviews were conducted over a three day period in late August and the beginning of September 2016 with selected stakeholders from the Wheeling service area to discuss the community health needs in the Wheeling service area. The following areas werediscussed:- Population and economic trends in both the primary and secondary service areas and future expectations,- Current perceptions about overall health care in the service area, including Wheeling Hospital, Inc.'s health care,- Wheeling Hospital, Inc.'s current operations and the extent to which these services are meeting community needs,- The quality and access of primary care services, emergency services, inpatient services, long term care services and public health services in the service area,- Wheeling Hospital, Inc.'s possible roles for meeting future health care needs for community health services, and- Potential for success in expanding services at Wheeling Hospital, Inc. and the challenges faced in expanding services in the area.A variety of various community representatives were interviewed, including the Director of Nursing from Belmont Community Hospital, the Wheeling Hospital, Inc. Director of Family Medicine, the Wheeling Health Department's Deputy Health Commissioner, a local Catholic Charities representative, and the Administrator of Bishop J. Hodges Continuous Care Center. These individuals were chosen because they provided a range of perspectives on the state of the community and health care, as well as providing diversified backgrounds. Additionally, a month long online survey was conducted by the Hospital in order to gather information from recent patients and/or their family members. They were asked to rate their experience as well as comment on existing or needed services.In addition, the following organizations were consulted by the Hospital inconducting its most recent CHNA:- Belmont County Health Department- Belmont Behavioral Health & Rehab- Bishop J. Hodges, CCC- Catholic Charities- Wheeling Hospital Board of Directors- Wheeling Corporate Health- Wheeling Hospital Family Medicine Wheeling Hospital, Inc. Part V, Section B, Line 6a: The hospital facility's CHNA was conducted with Belmont Community Hospital. Wheeling Hospital, Inc. Part V, Section B, Line 11: The needs identified in the most recently completed Community Health Needs Assessment (dated September 30, 2016) are as follows:1. Chronic Disease Management2. Unhealthy Lifestyles3. Drug and Alcohol AbuseWheeling Hospital, Inc. currently has various community outreach and education programs in place for all three of these needs. As a result, the Hospital addressed all three of the identified health issues during FY2017:Chronic Disease ManagementWheeling Hospital, Inc. has continued its tradition of providing outreach and education to the residents of Wheeling, WV and surrounding communities regarding the causes of chronic disease, preventative measure and treatment. During the fiscal year ended September 30, 2017, approximately 2,400 area residents participated in health fairs conducted by Wheeling Hospital, Inc. The health fairs provided diabetes screenings and education, blood pressure monitoring, cholesterol screening as well as education on breast health and bone health. Unhealthy Lifestyles Wheeling Hospital, Inc. provided outreach and education for smoking cessation, proper nutrition and the importance of physical activity to approximately 780 community members during the fiscal year ended September 30, 2017. Particular attention was given to health & wellness education for the older adults in the community given the aging of the population in the Wheeling Hospital, Inc. service area. The Hospital will continue to assist with health and wellness programs and provide the necessary resources for those seeking healthy lifestyle through diet and exercise. Drug and Alcohol AbuseWheeling Hospital, Inc. will maintain its collaboration and referral network to address patients' needs with regard to addiction and abuse. The Hospital will provide outreach and education to its surrounding communities. Additionally, Wheeling Hospital, Inc. will engage with local law enforcement and other community agencies in initiatives aimed at addressing the opioid epidemic that is currently ravaging the Ohio Valley. Part V, Section B, Line 7a: The Community Health Needs Assessment ("CHNA") of the Hospital facility can be found at the following web address:https://wheelinghospital.org/about/chna.aspx 2 1 - Continuous Care Center PO Box 6313 Wheeling WV 26003 Skilled Nursing Facility 2 - Wheeling Renal Care LLC 500 Medical Park Suite 100 Wheeling WV 26003 Specialty Outpatient Facility (Dialysis) Part I, Line 3c: Eligibility for financial assistance is determined by referencing the Financial Assistance Matrix, which is based on the Federal Poverty Guidelines for the most current year available as issued by the Department of Health and Human Services. Applicants are required to provide proof of income, such as unemployment, worker's compensation, social security, alimony/child support. They are also asked if they have Medicaid or any other third party insurance. Applicants claiming that they have no income are required to provide a letter of support from the individual providing the support for the patient. Additionally, applicants may provide letters of denial from insurance providers as support. Assets are also considered when deciding whether to grant financial assistance as the patient is required to provide copies of bank statements, certificates of deposit, money market account statements, etc. Part I, Line 7: The cost of charity care is computed by multiplying the amount of gross patient charges written off during the fiscal year in accordance with the Hospital's financial assistance policy by an overall cost-to-charge ratio that is computed based on the methodology of "Worksheet 2" of the 990 Schedule H instructions. Part III, Line 2: Bad debt expense was calculated by taking the bad debt write offs for 9/30/17 (based on gross charges) from the General Ledger. The total bad debt write offs were then multiplied by the overall cost-to-charge ratio of 35.82% calculated on Worksheet 2 of Schedule H. Discounts to patient accounts are recorded as contractual write-off's and not as bad debt. Therefore, the calculated bad debt expense does not include any portion of a patient's charges that were discounted. Part III, Line 3: Estimate of facility bad debts whom may qualify for charity: This is estimated by calculating the charity write-offs as a percentage of total revenue and applying this percentage (.71%) to the total bad debt write offs for the period. The resulting amount is then multiplied by the overall cost/charge ratio computed on Worksheet 2 of the 990 instructions. Part III, Line 4: Wheeling Hospital, Inc. does not have separate audited financial statements, but the following footnote is included in the consolidated audited financial statements:The provision for bad debts is based upon management's assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor. The results of this review are then used to make modifications to the provision for bad debts to establish an appropriate allowance for uncollectible accounts. The provision for bad debts as a percentage of net patient revenues was 4.29% and 2.96% for the years ended September 30, 2017 and 2016, respectively.Provisions for bad debt include: 2017 2016Government and state provision $0 $0Commercial, other, and self-pay $16,121,670 $10,408,036The bad debt reflected on the financial statements is the gross amount of the accounts deemed uncollectible. This would be for accounts that have had no payment for 60 days and have had a minimum of five statements produced. Therefore, the bad debt amounts would be after any discounts or patient payments have been applied.The ratio from Worksheet 2 of the Schedule H instructions was used. This ratio was applied to the total bad debt expense included in net patient service revenue.The estimated amount of bad debt expense that could reasonably be attributable to patients who likely would qualify for financial assistance under the Hospital's Charity Care Policy was calculated by applying the percentage of charity care to gross patient revenue to the total bad debt expense at cost. Part III, Line 8: The costs reflected in Line 6 are the allowable inpatient & outpatient costs from Worksheet D-1 and D, Pt. V of the 9/30/17 CMS cost report. Approximately $1.2M of the $9.6M shortfall on Line 7 is treated as community benefit. Despite the fact that the program serves all elderly and disabled beneficiaries and could represent community benefit, the majority of the shortfall is not treated as community benefit. The $1.2M treated as a community benefit is the Medicare shortfall relating to the interns' & residents' medical education program. The community benefit for the intern & resident program is reported on Line 7f (Health Professions Education) of Schedule H. Medicare costs of $65.2M on Line 6 of Pt. III, Section B, are obtained from worksheet D-1, D, and Pt. V of the 9/30/17 Medicare Cost Report. Part III, Line 9b: Wheeling Hospital, Inc.'s Collection Policy has been established to defray the costs of medically necessary services for those patients who meet certain guidelines and have no other medical funding sources. Inpatient, outpatient, emergency room services, professional services of employed physicians and prescription drugs on an acute/emergent basis are eligible for financial assistance/charity care. The Financial Assistance/Charity Care Application must be signed by the applicant attesting to the truthfulness and accuracy of the information provided. Eligibility is determined by referencing the Financial Assistance/Charity Care Matrix, which is based on the Federal Poverty Guidelines for the most current year available. Those approved applicants who are at or below 200% of the Federal Poverty Guidelines are eligible to receive charity care, and those who are from 201% to 400% of those limits are eligible for discounts. Part VI, Line 2: Wheeling Hospital, Inc. engaged Arnett, Carbis, Toothman, PLLC to perform a formal needs assessment to assess the health care needs for the community that it serves. This assessment was completed and dated September 2016.The primary tool utilized, throughout the year, to gauge the health care needs of the community are the numerous community education and healthscreening programs that the Hospital provides. The community's attendance at these programs, as well as their comments on the benefits received fromthe programs, provide the Hospital with a barometer of the type of health care needs that are most prevalent in the community. We can also monitor emerging trends in new/previously unknown needs through these programs. Examples of some of the programs are: blood pressure screenings, Men's Health Forum, health fairs throughout the service area, osteoporosisscreenings and bone density screenings. Part VI, Line 3: If the patient has a scheduled procedure and has been pre-registered as self pay, they are directed to the financial counselor, where payment arrangements and discounts/charity are discussed, if applicable. Self pay accounts over $500 are screened by MedAssist, an offsite service for government program eligibility. Once an account drops to billing, the credit/collection staff gets that account and research for other accounts, noting insurance or charity. If nothing prior, the patient is called to discuss payment/charity as applicable. Part VI, Line 4: Wheeling Hospital, Inc. predominantly services the Wheeling Metropolitan Statistical Area. The primary service area includes one county in the Northern Panhandle of West Virginia (Ohio County) and one county in Ohio (Belmont County), with a total population of approximately 110,064.The racial makeup of the MSA as of the 2016 census was 93.45% white, 3.85% African American, 0.65% Asian, 0.2% Native American, with the remainder from other races or a combination of two or more races. The median household income for 2016 was approximately $43,353, while the median household income for the United States was approximately $55,322. The below poverty level percentage for 2016 was approximately 15.75%, while the below poverty level percentage was approximately 12.7% for the United States. Part VI, Line 5: A majority of the Hospital's board members are residents of the primary service area and are neither employees nor contractors of the Hospital.In addition, the Hospital extends medical staff privileges to any qualified physician in the community. Part VI, Line 6: Wheeling Hospital, Inc. (the "Hospital or "Wheeling Hospital") was created by an Act of the Virginia General Assembly in 1850. Currently, the Hospital operates and exists under the laws of West Virginia as a not-for-profit corporation. Under its corporate charter, the Hospital is operated, supervised, and controlled by the Roman Catholic Diocese of Wheeling/Charleston (the "Diocese"). The Hospital consists of the Wheeling Hospital Division, a full-service regional teaching hospital offering a wide range of medical and surgical services on an inpatient and outpatient basis, and the Bishop Joseph H. Hodges Continuous Care Center Division, housing a 120-bed skilled and intermediate care center. The Hospital also owns and operates the Physician Practice Division as a department of the Hospital. This division consists of a group of primary care and multispecialty physicians practicing at the Hospital.The Hospital is the sole member of Belmont Community Hospital, Inc. ("Belmont Hospital") located in Bellaire, Ohio, and wholly owns a captive insurance company, Mountaineer Freedom, Ltd. (MFLTD).The Hospital is also the sole member of the Medical Park Foundation (the "Foundation"), which raises contributions solely for the use of the Hospital controlled entities. The purpose of the Foundation is to cultivate philanthropic support for patient care services, improve hospital facilities, support the uncompensated care program, and support community outreach programs.In 2017, the Hospital became the sole member of Harrison Community Hospital (HCH), located in Cadiz, Ohio, and Harrison Community Hospital Foundation (HCF), which raises contributions for the use of HCH.The Hospital is also the sole member of Wheeling Pediatrics, LLC (WP) and Women's Health Services (WHS). However, there are no assets nor activityfor either of these legal entities as of and for the years ended September 30, 2017 or September 30, 2016.The Hospital also owns two holding companies, WH Holdings I, LLC (WHH I) and WH Holdings II, Inc. (WHH II). WHH I is a taxable limited liability company. WHH II is a nonprofit corporation. These holding companies may be used for any future endeavors that might be undertaken and capitalized by the Hospital outside of the covenants and agreements governing the US Department of Housing and Urban Development (HUD)-insured mortgage. As of and for the years ended September 30, 2017 and 2016, there were no assets nor activity for WHH I. 1 WV Medical Professionals Health Program Inc 4013 Buckhannon Pike Mount Clare WV 26408 743226821 501(c)(3) 10000 Donation Belmont County Fire & Squad Officers Association 69604 Sunset Heights Bridgeport OH 43912 341416410 501(c)(3) 21898 Donation for purchase of replacement Modem and Leads for cardiac monitoring equipment. 2 0 Part I, Line 2: For all grants, each department is responsible for maintaining any grant documentation and is responsible for completing all necessary reporting. Neither of the grants summarized carry specific goals, benchmarks or specifications as required by Wheeling Hospital, Inc. The grant given to the Belmont County Fire & EMS Officers Association was provided to aid them in upgrading their technology so that it was compatible with the cardiac monitoring equipment in the Wheeling Hospital, Inc. Emergency Room. X X X 0 0 0 0 0 0 0 0 0 Michael S McKeets Chief Operating Officer 177682 0 25101 0 0 0 14887 0 9383 0 227053 0 0 0 James B Murdy Chief Financial Officer 250253 0 75102 0 0 0 19772 0 27432 0 372559 0 0 0 Angelo Georges MD Chief Medical Officer 508055 0 25102 0 0 0 10070 0 27998 0 571225 0 0 0 Dennis Niess MD Chief Med Info Officer 239868 0 26102 0 0 0 16638 0 22367 0 304975 0 0 0 David Rapp Chief Info Officer 243128 0 55102 0 0 0 13866 0 23853 0 335949 0 0 0 John DeBlasis Senior Administrator 156856 0 25101 0 0 0 11486 0 10701 0 204144 0 0 0 Kareen Simon Vice President of Operations 330967 0 30102 0 0 0 11631 0 1787 0 374487 0 0 0 Shawn Stern Medical Director 344117 0 25102 0 0 0 11195 0 28093 0 408507 0 0 0 Anthony Martinelli Senior Director 156462 0 30101 0 0 0 7866 0 19077 0 213506 0 0 0 Heidi Porter Senior Director 116780 0 35101 0 0 0 5667 0 8940 0 166488 0 0 0 Gregory S Merrick Physician 1257817 0 18102 0 0 0 11915 0 2591 0 1290425 0 0 0 Jondavid Pollock Physician 1156310 0 102 0 0 0 11990 0 24701 0 1193103 0 0 0 Chandra S Swamy Physician 523040 0 504950 0 0 0 12520 0 20485 0 1060995 0 0 0 Allan Tissenbaum Physician 602172 0 127077 0 0 0 11195 0 28455 0 768899 0 0 0 Jeffrey Abbott Physician 693249 0 102 0 0 0 10930 0 28753 0 733034 0 0 0 Louis Longo Former Key Employee 274180 0 0 0 0 0 2450 0 14270 0 290900 0 0 0 Part I, Line 5: Dr. Swamy's incentives are based on a percentage of net revenue. Dr. Tissenbaum's incentives are based on a percentage of net income. Overall physician compensation was determined to be reasonable. Valorie Satkoske Daughter of Chief Executive Officer 197540 Payments - Employee Compensation 0 R & V Associates Chief Executive Officer is Principal of R & V Associates. 3980055 Payments - Include other consulting services and expense for reimbursements. 0 Part IV, Line 3: Explanation of Relationship/Transaction with R & V Associates: R & V Associates is an independent business consulting firm that provides services to Wheeling Hospital, Inc. (the "Hospital"). Mr. Violi, independent consultant, is a principal and one of the managing directors of the consulting firm. Mr. Violi receives all compensation directly from R & V Associates for his services at the Hospital, and not from the Hospital. Although Mr. Violi currently serves as Chief Executive Officer of the Hospital, he does so through his affiliation with R & V Associates and not through direct employment with the Hospital. The compensation paid to R & V Associates by the Hospital is established by an independent Ad Hoc Committee of the Board of Directors of the Hospital. It is the practice of the Ad Hoc Committee to conduct its deliberations in full compliance with the established procedures under Section 4958 of the Internal Revenue Code of 1986, as amended, and with the settled purpose of establishing a rebuttable presumption of reasonableness with respect to the compensation paid to R & V Associates. Additionally, the Ad Hoc Committee has sole authority over the retention and discharge of R & V Associates, and Mr. Violi, as Chief Executive Officer, has no authority over such retention or any other aspect of that engagement. The payments to R & V Associates include compensation payments for Mr. Violi, expense reimbursement, and other consulting services. X 4 375698 Other 0 0 1 0 Part I, Column (b): Wheeling Hospital, Inc. is reporting the above information based on the number of contributions. Form 990, Part VI, Section A, line 2 The Very Reverend Monsignor Kevin M. Quirk is the Assistant to the Most Reverend Michael J. Bransfield, Bishop of the Diocese of Wheeling-Charleston. Form 990, Part VI, Section A, line 3 Ronald L. Violi, Chief Executive Officer of Wheeling Hospital, Inc., is not an employee of Wheeling Hospital, Inc. Ronald L. Violi, independent consultant, is a 50% partner in R & V Associates, a consulting firm which Wheeling Hospital, Inc. contracts with for consulting and management services. Form 990, Part VI, Section A, line 6 Wheeling Hospital, Inc. has a single member, The Most Reverend Michael J. Bransfield, Bishop of the Diocese of Wheeling-Charleston. Form 990, Part VI, Section A, line 7a Wheeling Hospital, Inc. has a single member, The Most Reverend Michael J. Bransfield, Bishop of the Diocese of Wheeling-Charleston, who has the ability to elect members of the governing body of Wheeling Hospital, Inc. Form 990, Part VI, Section B, line 11b Following completion of Form 990 by the Wheeling Hospital, Inc. tax preparer, Form 990 is reviewed by internal personnel and the executive team prior to filing. The draft return is sent to the Ad Hoc Committee of the Board via Courier, Fed Ex, or UPS, prior to filing. Form 990, Part VI, Section B, line 12c All members of the Board of Directors and Officers receive a copy of the Conflict of Interest policy annually. Recipients are annually asked to acknowledge they have read the policy, identify any areas of conflict and return the signed disclosure form to Wheeling Hospital, Inc. Responses are reviewed and identified. Conflicts are referred to the Board of Directors for discussion and approval. Key employees and other employees are required to complete a conflict of interest questionnaire at hiring and when a change occurs that may be a conflict of interest. Form 990, Part VI, Section B, line 15 Ronald L. Violi, Chief Executive Officer of Wheeling Hospital, Inc., is not an employee of Wheeling Hospital, Inc. Ronald L. Violi, independent consultant, receives his compensation from R & V Associates, which receives payment from Wheeling Hospital, Inc. for consulting and management services it provides, including for Ronald L. Violi's services as Chief Executive Officer. Wheeling Hospital, Inc. has determined by means of committee review that the payments to R & V Associates are reasonable and at fair market value. Therefore, all compensation payments to Ronald L. Violi are reasonable. Other officers and key employees' compensation is reviewed by the Wheeling Hospital Ad Hoc Committee. The committee reviews national, regional, and local compensation surveys. Additionally, years of service are also taken into account. Form 990, Part VI, Section C, line 19 Governing documents, Conflict of Interest Policy, and financial statements are available upon request. Wheeling Hospital, Inc. also files the financial statements with WVHCA annually. Form 990, Part XI, line 9: Net Restricted Grant Activity 36,224. Transfers/Dividends -4,001,713. Unrealized Gain Restricted Investments 191,407. Restricted Activity Variance 1,019. Part XII, Line 3A Wheeling Hospital, Inc. entered into a HUD/FHA Section 242 Mortgage Insurance Agreement and was required by this arrangement to undergo an A-133 audit. Part XI, Line 9, Change in Net Assets Unrealized Gain Restricted Investments $191,406 Net Restricted Grant Activity $36,224 Transfer from Related Parties $(20,000,000) Other $1,020 Transfers Related to NTTC Purchase and Investment in DRE $22,673,287 Forgiveness of Debt $(6,675,000) Total Line 9, Part XI $(3,773,063) Wheeling Pediatrics LLC 222 N 5th St Martins Ferry OH 43935 261482791 Physician Offices OH 0 0 Wheeling Hospital Inc Women's Health Specialists of Wheeling Hospital LLC 1 Medical Park Center 3 Suite 232 Wheeling WV 26003 262809731 Physician Offices WV 0 0 Wheeling Hospital Inc WH Holdings II LLC 1 Medical Park Wheeling WV 26003 273193246 Purchase Real Estate WV -1828163 38184863 Wheeling Hospital Inc WH Holdings I Inc 1 Medical Park Wheeling WV 26003 273193207 Purchase Real Estate WV 0 0 Wheeling Hospital Inc Belmont Community Hospital 4697 Harrison Street Bellaire OH 43906 340714643 Hospital OH 501(c)(3) Section A, Line 3 Wheeling Hospital Inc 1 Medical Park Foundation 1 Medical Park Wheeling WV 26003 550744690 Church WV 501(c)(3) Section A, Line 1 Wheeling Hospital Inc 1 Self Insurance Trust Agreement of Wheeling Hospital Inc 1 Medical Park Wheeling WV 26003 550676674 Insurance WV 501(c)(3) Sec. A, Line 12, Typ Wheeling Hospital Inc 1 Harrison Community Hospital 951 East Market Street Cadiz OH 43907 341571750 Hospital OH 501(c)(3) Section A, Line 3 Wheeling Hospital Inc 1 Harrison Community Hospital Foundation 951 East Market Street Cadiz OH 43907 341571749 Support of Hospital OH 501(c)(3) Sec. A, Line 12 Type Wheeling Hospital Inc 1 Mountaineer Freedom Limited 94 Solaris Ave 2nd Fl Camana Bay Grand Cayman CJ KY1-1102 981217988 Captive Insurance CJ Wheeling Hospital Inc C -168627 24478178 1.00000 1 Mountaineer Freedom Physician & Hospital Association Inc 1 Medical Park Wheeling WV 26003 300386759 Physician Hospital WV Wheeling Hospital Inc C 1.00000 1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 Belmont Community Hospital Inc I 78058 Cost Belmont Community Hospital Inc Q 1520747 Cost Belmont Community Hospital Inc L 421053 Cost Belmont Community Hospital Inc O 1052175 Cost Belmont Community Hospital Inc M 57759 Cost Belmont Community Hospital Inc J 105577 Cost Belmont Community Hospital Inc R 293614 Cost Harrison Community Hospital O 115304 Cost Harrison Community Hospital Q 221137 Cost Harrison Community Hospital S 2000000 Cost