2017-08-15T15:44:39-05:00 2016-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-10-01 273128197 Highland-Clarksburg Hospital Inc HIGH 3049693100 3 Hospital Plaza Clarksburg WV 26301 Shelly Giaquinto CFO 3049693107 2017-08-15 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z Michael Casdorph 3 Hospital Plaza Clarksburg WV 26301 18154919 0 X www.highlandhosp.com/clarksburg/ X 2010 WV To provide psychiatric care to adults and children. 7 7 353 4 0 0 14756 61348 15293830 17966257 0 0 43461 104173 15352047 18131778 0 0 0 0 9335203 10212355 0 0 0 7793187 7802247 17128390 18014602 -1776343 117176 47780383 47412688 38794984 38310113 8985399 9102575 To provide psychiatric care to adults and children. 0 0 10873274 18029174 Highland-Clarksburg Hospital, Inc. (HCHI) is a non-profit organization formed in 2011 to develop and operate a behavioral health hospital in Harrison County, WV. HCHI began generating operating revenues after October 29, 2013, the date of the Joint Commission Accreditation. The Hospital provides psychiatric care to north central West Virginia and surrounding communities. The facility has 115 inpatient beds serving children, adolescents and adults. 10873274 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 27 0 353 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Shelly Giaquinto 3049693107 3 Hospital Plaza Clarksburg WV 26301 James H Dissen Chairman 1.00 X X 0 0 0 Greg Gordon Board Member 1.00 X 0 0 0 Margaret Bailey Board Member 1.00 X 0 0 0 Martin Howe Board Member 1.00 X 0 0 0 Paul Howe Board Member 1.00 X 0 0 0 Cynthia Persily PhD Board Member 1.00 X 0 0 0 Joe Elliot Board Member 1.00 X 0 0 0 Mike Casdorph CEO 40.00 X 126833 0 479 Shelly Giaquinto CFO 40.00 X 74830 0 5921 Marilou B Patalinjug Tyner MD Chief Medical Officer 40.00 X 351050 0 5921 Toni B Goodykoontz MD Physician 40.00 X 450005 0 0 Gregory A Rock Pharmacist 40.00 X 120399 0 0 Fred Frazier NP Nurse Practitioner 40.00 X 120569 0 0 Paula Herndon RN Chief Nurse Executive 40.00 X 128792 0 8058 1372478 0 20379 6 0 1 0 Security America PO Box 4525 Charleston WV 25364 Security Services 776440 Alpha Technologies PO Box 1114 Scott Depot WV 25560 Contracted IT 179460 Barton Associates PO Box 417844 Boston MA 02241 Contract Physician 126405 GR&WHarmony PO Box 4562 Star City WV 26504 Contract Physician 123500 4 34819 26529 15000 61348 Patient services 622110 17966257 17966257 17966257 52052 0 52052 52052 52052 12345 34819 23141 -10796 -10796 Commissary Revenue 722210 30489 30489 Lunch Revenue 722210 20124 20124 Rebates & Other 900099 12304 12304 62917 18131778 18029174 0 41256 195665 114758 80907 8632791 5063132 3569659 463 272 191 773821 453846 319975 609615 357539 252076 24293 24293 43085 43085 84730 84730 1360034 797660 562374 39658 23259 16399 771849 452689 319160 1124764 659674 465090 23221 13619 9602 300 176 124 1326623 778064 548559 1274523 747508 527015 234848 137738 97110 Healthcare Provider Tax 440188 440188 Medical Supplies 426206 426206 Repairs & Maintenance 265641 155798 109843 Staff Training & Develo 173852 101964 71888 188432 149184 39248 18014602 10873274 7141328 0 1016899 1160227 17500 2500 1526895 2201542 56121 53265 181321 211302 46442942 3307115 43969729 43135827 1011918 648025 47780383 47412688 1885930 2805014 2000 35718418 34712855 1190636 790244 38794984 38310113 X 8985399 9102575 8985399 9102575 47780383 47412688 117176 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 300000 300000 45453104 3109805 42343299 25648 1979 23669 664190 195331 468859 43135827 Related party payables 767312 Leases payable 22932 790244 X 18061508 23141 23141 18038367 93411 93411 18131778 17944332 23141 23141 17921191 93411 93411 18014602 Part X, Line 2: HCHI is exempt from Federal and state income taxes under Section 501(c)(3) of the internal Revenue Code and similar state statutes relating to not-for-profit organizations. Accounting principles generally accepted in the United States of America require the management of HCHI to evaluate tax positions taken by HCHI. Management has evaluated HCHI's tax positions and did not become aware of any course of action on services or events that might adversely affect the entity's tax status. Therefore, no provision or liability for income taxes has been included in the financial statements. Part XI, Line 2d - Other Adjustments: Fundraising expenses offsetting income on 990 23,141. Part XI, Line 4b - Other Adjustments: Bad debts netted with revenue on financial statements 93,411. Part XII, Line 2d - Other Adjustments: Fundraising expenses 23,141. Part XII, Line 4b - Other Adjustments: Bad debts netted with revenue on financial statements 93,411. Huggs & Kisses 47164 34819 12345 8720 3750 10671 47164 34819 12345 8720 3750 10671 23141 -10796 1 1 X 1 X 1 X 1 1 0 0 460656 460656 0.02570 1977496 1977496 208778 96108 112670 0.00630 2646930 2073604 573326 0.03200 2646930 2073604 573326 0.03200 823694 823694 0.04600 6400 6400 0.00040 1508 1508 0.00010 7500 7500 0.00040 2500 2500 0.00010 841602 841602 0.04700 1 93411 1 1 1 1 Highland-Clarksburg Hospital Inc 3 Hospital Place Clarksburg WV 26301 X Inpatient mental health Highland-Clarksburg Hospital Inc 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X https://highlandclarksburghospital.com/healthassessment/ X 1 13 1 https://highlandclarksburghospital.com/healthassessment/ 0 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X https://highlandclarksburghospital.com/financialpolicy/ X https://highlandclarksburghospital.com/financialpolicy/ X https://highlandclarksburghospital.com/financialpolicy/ X X X X X 1 X 0 X X X X 1 X 0 0 Highland-Clarksburg Hospital, Inc. Part V, Section B, Line 5: Interviews were conducted with internal and external stakeholders and included individuals from the following organizations: Clarksburg Mission, Harrison County Commission, Harrison County Chamber of Commerce, Harrison-Clarksburg Health Department, Health Access, Inc. (free clinic), Harrison County Child Advocate Center, Harrison County DHHR, and Harrison County Board of Education. Highland-Clarksburg Hospital, Inc. Part V, Section B, Line 22d: Amounts Generally Billed is calculated by a look back during the prior 12 month period of all medically necessary care allowed by all health insurers including Medicaid. 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 $ 93,411. Part II, Community Building Activities: Economic Development- provided job growth for the communityCommunity Support-Disaster readiness preparation and 7-week parenting class to community.Environmental Improvements-Agreement to place electricity on a grid allowoing outside agent to be able to distribute electricity to community while increasing the efficiency of energy output.Coalition Building-Project Isaac & Energy Express Team; Engage in community forums over drug epidemic; Hospital serves as a member of Prevention, Intervention, Treatment, Recovery (PITAR) GroupCommunity Health Improvement Advocacy- three blood drives for the American Red Cross; seven days of ACA open enrollment offered to community. Part III, Line 2: The bad debt expense listed on Part III, Line 2 is derived from the financial statements. Part III, Line 4: HCHI recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the service rendered. For uninsured patients that do not qualify for charity care, HCHI recognizes revenue on the basis of its standard rates for services provided (or on the basis of discounted rates, if negotiated or provided by policy). On the basis of historical experience, a significant portion of HCHI s uninsured patients will be unable or unwilling to pay for the services provided. Thus HCHI records a significant provision for bad debts related to uninsured patients in the period the services are provided. Part III, Line 9b: Former patients with delinquent private pay accounts will be notified and given the option of paying the account in full or participating in a predefined monthly payment plan. Former patients will be notified of their financial obligation for services redndered by receiving monthly statements with balance due. Former patients who did not wish to apply during their hospitalization will be given another opportunity to apply for charity care or sliding fee scale financial assistance program during the collection process. All private pay accounts will be reviewed to determine the last date of payment. The colletion specialist will attempt to contact the debtor by phone to setup a payment arrangement. The collection specialist wil also remind the patient or responsible party of the hospital charity care and sliding fee scale financial assistance programs. The collection specialist will document all conversations with the debtor in the patient's billing database. If the patient should apply for the charity care or sliding fee scale financial assistance programs within 240 days from the date of the first billing statement, and it is determined that the patient qualifies for one of the assistance programs, the Hospital's collection representative will contact the collection agency and instruct that the account be removed from collection and that the credit bureau be notified to remove the balance from the patient's credit report. Part VI, Line 2: The Hospital assesses the health care needs of the community it serves by first considering services offered by healthcare providers in the area, population trends, socio-economic demographics and the region's overall sufficiency of mental healthcare providers in the community. The Hospital obtains data from numerous health organizations and conducts interviews with community leaders and hospital staff. This information is used to determine the future health needs of the community. Since the Hospital is a licensed psychiatric hospital, the primary focus is on needs that relate to mental health services. Part VI, Line 3: Uninsured patients are notified of the charity care and sliding fee scale discount policies at admission and again during the collection process if they have not already taken advantage of the available programs. Part VI, Line 4: The Hospital is located in Clarksburg, a north central city of West Virginia, four hours west of Washington, D.C., and less than two hours south of Pittsburgh, Pennsylvania. The Hospital's primary service area consists of the following West Virginia Counties: Harrison, Marion, Upshur, Monongalia, Lewis, Randolph, Wood, Taylor, Barbour and Doddridge. The population of the total service area is projected to steadily increase through 2030. The largest increase in population is projected in Monongalia County. Marion, Randolph, Taylor and Upshur Counties are projected to remain stable during the projection period. Harrison, Lewis and Wood Counties are projected to steadily decline during the period. The estimated 2013 population for the service area was 427,302. Residents of the primary service area are predominantly White/Caucasians (95.99%) followed by Black/African American (1.70%). Housing is generally stable and comparable between the service area and the state. Nearly 22% of West Virginia's veterans live in the service area. The service area and the State of West Virginia has a higher percentage of those below the poverty level than that of the United States. All counties in the service area had a higher percentage of adults living in poverty than the average for the United States which was 14.9%. Monongalia County was 22.6% and the other Counties in the service area were comparable to the statewide average of 17.6%. The median household and family income for the service area Counties ranged from a low in Doddridge County of $31,261 to a high of $42,734. The median income is $40,400 for West Virginia and $53,046 for the United States. X X X 0 0 0 0 0 0 0 0 0 Marilou B Patalinjug Tyner MD Chief Medical Officer 346023 0 5027 0 0 0 0 0 8415 0 359465 0 0 0 Toni B Goodykoontz MD Physician 450005 0 0 0 0 0 0 0 0 0 450005 0 0 0 Form 990, Part VI, Section B, line 11 The 990 is received from the accounting firm and reviewed by the CEO and CFO to make sure nothing is omitted. The CFO then signs the return and mails it to all regulatory and tax authorities. Form 990, Part VI, Section B, line 12c The Quality Control Director keeps a copy of the policy on file, with all board members signing a copy every year. Also, as situations arise, board members will excuse themselves from any vote that may have a conflict of interest. Form 990, Part VI, Section B, line 15 The board of directors approves compensation for the CEO and CFO using a separate finance committee and comparative data. Form 990, Part VI, Section C, line 18 The organizing documents and the Form 990 are available through direct inquiry of the fiscal office of the organization. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and the financial statements are available through direct inquiry of the fiscal office of the organization. Form 990, Part XII, Line 2C Highland Clarksburg Hospital has a separate finance committee, which oversees the audit of the financial statements. There has been no change in the process.