2018-05-15T11:02:47-05:00 2017-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2016-07-01 556005561 Webster County Memorial Hospital WEBS 3048475682 324 Miller Mountain Drive Webster Springs WV 26288 James Westfall CEO 3048475682 2018-05-14 1 Dolores Rose P01286262 3043460441 2016 2022-09-23 18:48:47Z James Parker 324 Miller Mountain Drive Webster Springs WV 26288 16129485 0 X www.wcmhwv.org X 1951 WV To provide acute short-term care to residents of Webster and surrounding counties of West Virginia. 9 9 225 9 0 0 70858 27621 16114972 15645209 21815 2663 730645 453992 16938290 16129485 0 0 0 0 11421031 11000600 0 0 0 7072538 6824089 18493569 17824689 -1555279 -1695204 6280049 5687876 5530571 6633602 749478 -945726 The mission of Webster County Memorial Hospital is to provide excellent, high quality care in a compassionate and cost-effective manner. 0 0 14357755 16098701 Critical Access Hospital services provided included 437 inpatient days, 35,020 outpatient visits, and 13,754 RHC visits. Charges forgone for charity amounted to $94,277. 14357755 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 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 0 0 0 0 1 11 0 225 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Julie Clutter 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 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 Tammy Garland 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 Robert Mace MD CEO 5/1/15-1/17/17 40.00 X 321064 0 0 James Westfall CEO 1/18/17-8/10/17 40.00 X 0 0 0 Julie Clutter Director of Financial Services 40.00 X 48971 0 977 Christopher Conrad DO Physician/Chief of Staff 40.00 X 196656 0 890 Johnathan Beam Pharmacy Director 40.00 X 194124 0 1833 Luke McElwain DO Physician 40.00 X 333377 0 1764 Jeanette Boyce DO Physician 20.00 X 172094 0 0 Heather Meadows FNP Nurse Practitioner 40.00 X 145134 0 0 Wesley Hutchinson RPh Pharmacist 40.00 X 139705 0 1370 Jerri Oney PA Physician Assistant 40.00 X 138679 0 1344 1689804 0 8178 17 0 1 1 LabCorp 3701 MacCorkle Avenue SE Charleston WV 25304 Lab Services 546583 B&L Imaging PO Box 52253 Knoxville TN 37950 MRI Consultants 189428 Resolution PO Box 270903 Louisville CO 80027 Billing Professional Services 175992 3 18929 8692 27621 Patient Service Revenue 624100 14068165 14068165 340B Pharmacy Revenue 900099 1577044 1577044 15645209 2663 2663 500 0 500 500 500 EHR Revenue 900099 298000 298000 Employee Meals 722210 31826 31826 Consulting Fees 900099 19643 19643 104023 104023 453492 16129485 16098701 0 3163 446831 345177 101654 8426451 6509433 1917018 33038 25522 7516 1309773 1011800 297973 784507 606032 178475 231262 231262 1379429 1147160 232269 1684 1684 463625 358150 105475 460801 355969 104832 345274 266724 78550 73871 57065 16806 96254 74356 21898 375473 290053 85420 214187 165459 48728 Medical supplies 1632441 1632441 Bad debt expense 1087407 1087407 Provider tax 205701 205701 Repairs and Maintenance 46236 35717 10519 210444 183589 26855 17824689 14357755 3466934 0 647880 585940 15417 15425 2521702 2080874 326947 361207 49800 61847 7996008 6132343 1929634 1863665 788669 718918 6280049 5687876 3793741 4185472 1736830 2448130 5530571 6633602 X 734879 -958316 14599 12590 749478 -945726 6280049 5687876 -1695204 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32757 32757 1793535 1730431 63104 6004081 4308369 1695712 165635 93543 72092 1863665 Third Party Payor Settlements 452399 Other Receivables 266519 718918 14947801 0 14947801 1181684 1181684 16129485 16643005 0 16643005 1181684 1181684 17824689 Part XI, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 1,087,407. Charity care netted against income on financial statements 94,277. Part XII, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 1,087,407. Charity care netted against income on financial statements 94,277. 1 1 1 X 175.000000000000 1 X 175.000000000000 1 1 0 0 328727 328727 3194769 3037442 157327 0.00880 3523496 3366169 157327 0.00880 6149 6149 0.00030 6925 6925 0.00040 13074 13074 0.00070 3536570 3366169 170401 0.00950 1 1087407 3708294 3708294 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 14 1 0 0 1 X https://irp-cdn.multiscreensite.com/c4a705fe/files/uploaded/Webster%20Co%20 X 1 14 1 https://irp-cdn.multiscreensite.com/c4a705fe/files/uploaded/WebsterCHNAImpl 0 1 X 175.000000000000 175.000000000000 X X X 0 1 X X X 1 X http://www.wcmhwv.org/ X https://irp-cdn.multiscreensite.com/c4a705fe/files/uploaded/webster.pdf X http://www.wcmhwv.org/ X X 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: Through a process of primary research, data analysis, validation and prioritization, the assessment process identified the following significant community health related needs: Increased education and promotion of community resources Promote healthier lifestyle choices Chronic disease maintenance and prevention Improve overall health statusAddressing all of the health needs present in a community will require resources beyond what any single hospital may provide. The Hospital will focus its efforts in order to make a true and measurable impact, and thus plans to implement actions that will address those needs identified through the Community Health Needs Assessment as "Most Important". The Hospital will continue to evaluate opportunities for funding or resources to commit to addressing the remaining needs. 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 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 is any services we can provide here. Then we find out cost and reimbursement issues and present to CEO. Part VI, Line 3: If the patient presents to the registration desk and is private pay, the registration clerk informs the patient that we currently have a Financial Assistance program that will help them receive a discount or have the total amount written off and offers them the application. If a patient is private pay and admitted as an observation or inpatient, the social worker reviews the financial assistance program with the patient and offers them the application before discharge. If a patient calls into the billing office to ask about their billing statement and they state they don't think they can pay or want to make a payment contract, the billers will offer the patient information on the program and offer to mail them an application. Part VI, Line 4: Our geographical service area is rural. The majority (91.2%) of the Hospital's patients reside in Webster County, West Virginia. A portion of the remaining patients reside in Nicholas County (3.1%) and Randolph County (1.5%). The population of Webster County is 8,930. The residents of Webster County have a median household income of $27,645 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, which decreased this year due to the swing from private pay to Medicaid eligibility. The Hospital also serves as a source of community volunteer activities. X 0 0 0 0 0 0 0 0 0 Robert Mace MD CEO 5/1/15-1/17/17 321064 0 0 0 0 0 0 0 0 0 321064 0 0 0 Christopher Conrad DO Physician/Chief of Staff 196656 0 0 0 0 0 890 0 0 0 197546 0 0 0 Johnathan Beam Pharmacy Director 194124 0 0 0 0 0 1833 0 0 0 195957 0 0 0 Luke McElwain DO Physician 333377 0 0 0 0 0 1764 0 0 0 335141 0 0 0 Jeanette Boyce DO Physician 172094 0 0 0 0 0 0 0 0 0 172094 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) and provides support to the CEO in the performance of his or her duties as appropriate. James Westfall, an employee of DHS, was appointed as CEO of the Hospital as of 1/18/17 and termed as CEO as of 8/10/17. 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.