2016-08-15T10:59:53-05:00 2015-09-30 861065772 Deloitte Tax LLP 250 East Fifth Suite 1900 Cincinnati OH 45202 990 2014-10-01 550357057 Wheeling Hospital Inc WHEE 3042433681 1 Medical Park Wheeling WV 260036300 James B Murdy CFO 3042433681 2016-08-15 1 Rebecca Lyons P01487105 5137847100 2014 2016-09-27 15:27:22Z James B Murdy 1 Medical Park Wheeling WV 260036300 337549053 0 0928 X www.wheelinghospital.org X 1850 WV To provide needed care to the community regardless of an individual's ability to pay. 14 12 2971 319 5439044 1379485 3539327 1788898 287664952 304934120 4908146 6862564 12226837 10733443 308339262 324319025 25000 325000 0 0 146565628 148351455 0 0 0 130414682 135833372 277005310 284509827 31333952 39809198 343230704 372977047 100459675 100046886 242771029 272930161 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 our 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 248297746 325000 297509502 Wheeling Hospital, Inc. serviced 11,352 inpatients, 584,927 outpatients, and 15,850 home health patients during fiscal year 2015. Community services include medical screening, diabetic education, cancer support, etc., all of which are provided free of charge. This includes the Physician Practice Division, the Wheeling Pediatrics Division, and the Women's Health Service Division. See Schedule H. 7843234 9115559 Continuous Care Center serviced 577 skilled and long-term care patients for a total of 39,159 patient days. 256140980 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 227 0 1 2971 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 14 12 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 Annie VG Board Member 1.00 0.00 X 0 0 0 John J Battaglino Jr MD Board Member 1.00 0.00 X 19704 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 Howard W Long Board Member (End 5/15) 1.00 0.00 X 0 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 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 Michael T Wayt MD Board Member 1.00 0.00 X 26400 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 200802 0 22004 James B Murdy Chief Financial Officer 56.00 4.00 X 305859 0 42395 Angelo Georges MD Chief Medical Officer 56.00 4.00 X 500789 0 33882 Dennis Niess MD Chief Med Info Officer 57.00 3.00 X 271199 0 35031 David Rapp Chief Info Officer 56.00 4.00 X 274238 0 29914 Louis Longo Executive Vice President 56.00 4.00 X 395090 0 35767 George Couch Vice President 60.00 0.00 X 495412 0 33060 John DeBlasis Assistant Administrator 30.00 30.00 X 157952 0 19454 Kareen Simon Assistant Administrator 56.00 4.00 X 310094 0 12795 Shawn Stern Medical Director 52.00 8.00 X 305348 0 27032 Gregory S Merrick Physician 40.00 0.00 X 1272619 0 13902 Jondavid Pollock Physician 40.00 0.00 X 1139320 0 29940 Chandra S Swamy Physician 40.00 0.00 X 1110714 0 27262 Peter Bala Physician 40.00 0.00 X 661411 0 41447 Michael Zilles Physician 40.00 0.00 X 607040 0 36547 8053991 0 440432 128 0 1 0 R & V Associates 310 Grant Street Ste 1120 Pittsburgh PA 15219 Consulting 3494242 Tristate Pain & Spine Center 40 Medical Park 507 Wheeling WV 26003 Physician Services 1589524 Quest Diagnostics 2249 Collection Center Drive Chicago IL 60693 Lab Testing 1222621 ITXM Clinical Services PO Box 3455 Pittsburgh PA 15230 Lab Testing 733047 WVU Medical Corporation PO Box 780 Morgantown WV 26607 Trauma Call 728540 31 767199 1021699 1788898 Net Patient Svc Rev 621500 150922964 150922964 Medicare Revenue 621500 127529793 127529793 Medicaid Revenue 621500 26481363 26481363 304934120 6108536 1690941 4417595 1240076 250184 989892 989892 989892 13180766 100603 12434940 92401 745826 8202 754028 754028 725605 452503 273102 273102 Apothecary Income 446110 4150654 1785018 2365636 Med Svcs/Diagn Lab 621500 1532212 1532212 Non Operating Revenue 713940 -86101 2121814 -2207915 3873684 3873684 9470449 324319025 306625061 5439044 10466022 325000 325000 3681157 450854 3230303 117658992 107731418 9927574 5372717 4894593 478124 13386818 12118841 1267977 8251771 7235931 1015840 831440 831440 346222 346222 135509 135509 184489 184489 15218534 14566936 651598 1674899 35492 1639407 69535867 68375523 1160344 633928 633928 3542285 3479759 62526 524415 389342 135073 3045646 3045646 14865470 14592511 272959 5250186 5249178 1008 Licenses and Taxes 7997177 7896202 100975 Consult/Mgmt Contracts 4459078 2322 4456756 Dues/Books 471417 329463 141954 UBIT 77416 77416 7039394 5344553 1694841 284509827 256140980 28368847 0 75013543 111574047 5674052 5512810 29029567 28213119 2871358 3040318 4745277 9423785 356930105 241872894 116997209 115057211 85499691 77157329 10781970 12216131 12618037 10782297 343230704 372977047 41693432 38406892 57202248 59995367 1563995 1644627 100459675 100046886 X 234534540 265125546 8236489 7804615 242771029 272930161 343230704 372977047 X 39809198 -7256017 -2394049 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 112500 0 1 23009 135509 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 LGCR Government Relations for governmental relations. Wheeling Hospital, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 5548922 5548922 144762845 83819207 60943638 168231 77035 91196 193992152 152296507 41695645 12457955 5680145 6777810 115057211 Deferred Compensation Payable 206009 Deferred Purchase - Long Term Portion 214624 Asset Retirement Obligation 1223994 1644627 X Part X, Line 2: From the consolidated audited financial statements of Wheeling Hospital, Inc. ("The Hospital"): The Hospital, CCC, Belmont Hospital, the Foundation, WP, and WHS, 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 WH. MFLTD is a taxable 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 at September 30, 2015 and 2014. Central America and the Caribbean 0 1 Program Service Activity Captive Insurance Company 302224 0 1 0 0 0 1 302224 0 302224 1 0 1 0 0 0 Book Sale 36589 36589 29145 Uniform Sale 95693 95693 78521 8 593323 593323 7715 337122 725605 725605 7715 444788 452503 273102 1 1 X 1 X 1 X 1 1 0 0 2181121 0 2181121 0.00770 44925667 28513156 16412511 0.05770 47106788 28513156 18593632 0.06540 629149 10259 618890 0.00220 2340417 1237400 1103017 0.00390 2969566 1247659 1721907 0.00610 50076354 29760815 20315539 0.07150 1 3087769 25937 46156248 47955388 -1799140 X 1 1 1 Wheeling Renal Care LLC Specialty 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 12 1 0 0 1 X See Part V X 1 12 0 1 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X 1 X See Part V X See Part V X See Part V 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 with selected stakeholders from the Wheeling service area to discuss the Community Health Needs in the Wheeling service area. The following areas were discussed:- 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 a representative from Belmont Community Hospital, Inc., the Wheeling Hospital, Inc. Director of Nursing, Wheeling Hospital, Inc.'s Supplies and Inventory Manager, the former mayor of Wheeling, and members of the Wheeling Hospital, Inc. Board. 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. Wheeling Hospital, Inc. Part V, Section B, Line 11: The Wheeling Hospital, Inc. CHNA identified multiple areas that should be the focus for further service development in the community. The following summary presents those findings as well as the plans for implementation or, when applicable, the reasons for not implementing.1. Physician Shortages:Wheeling Hospital, Inc. has conducted an aggressive physician recruiting campaign over the course of the past ten years. During this span of time, including some during 2015, the Hospital has recruited multiple physicians, growing the ranks of its employed physicians to 80+ physicians and approximately 25 non-physician practioners (NPPs), consisting of Nurse Practitioners and Physician Assistants. Wheeling Hospital, Inc. management recognizes that additional recruitment is necessary in several of these areas of medicine and is committed to continuing the recruitment campaign in an active manner.2. Mental Health Services Expansion Efforts:Wheeling Hospital, Inc. management will enter into discussions with a local mental health psychiatry group to explore the feasibility of implementing an outpatient behavioral health service line at Belmont Community Hospital, Inc., a subsidiary of Wheeling Hospital, Inc. The challenge faced is finding funding sources to support the cost of the program due to the payer mix and the fact that mental health services have trended to not receive sufficient support from insurance plans and government agencies. It is hoped that the new mental health parity requirements under the PPACA will help to improve funding for this important service. 3. Expanded Access to Wheeling Health Right: Participants in the CHNA suggested that access to Wheeling Health Right, a local free care clinic, be expanded to residents of counties adjacent to Ohio and Belmont counties. The Hospital is unable to exercise control over Wheeling Health Right, as it is an unrelated organization. It should be noted that the hospital and its employed physicians carry their full contingent of Wheeling Health Right on the even numbered months as part of the shared arrangement with Ohio Valley Medical Center, which takes odd numbered months. It should also be noted that it is not technically necessary for patients to access their care through Wheeling Health Right since the Hospital makes its financial assistance plan available to all qualified patients. 4. Diabetes and Weight Management Programs:The Howard Long Wellness Center and the community outreach department of Wheeling Hospital, Inc. offer a wide range of nutritional education, exercise, weight loss and diabetic education classes, smoking cessation, cancer survivor support, men's health seminars, medical ethics classes and other services to members of the community. The Hospital also employs a pediatric endocrinologist and an adult endocrinologist that provide counseling and treatment related to obesity and diabetes.5. Increased Education of Charity Care Policy:The Hospital has posted its Financial Assistance Policy (FAP) on its web site and has deployed signage and literature in key points in the facility and in physician offices to educate patients about the availability of the program. Additionally, the Hospital has employed several financial counselors skilled in the PPACA requirements around financial assistance and presumptive Medicaid. 6. Improved Transportation:The Hospital operates two vehicles that provide transportation to elderly patients who cannot drive or have difficulty getting to and from the Hospital and its physician offices. This service is provided at no charge to the patients. The Hospital also routinely provides free taxi cab vouchers to patients who are unable to obtain transportion home after being discharged from the Emergency Department or the inpatient units of the Hospital.7. Construction Projects for Assisted Living/Independent Living Communities:Wheeling Hospital, Inc. has taken on feasibility studies in relation to the projects that addressed the need for additional assisted living and/or independent living communities for the area's aging population. Significant further review and consideration is required before Hospital management will make a decision regarding moving forward with such facilities. This remains an area of focus and interest and the Hospital is committed to exploring options in this regard. Additionally, Wheeling Hospital, Inc. is planning on building a replacement for the Bishop Hodges Continuous Care Center (SNF/ICF) facility on its campus during 2016-2017. This will be a state-of-the-art facility with private rooms and baths, large rooms and a de-institutionalized theme of decor. Project is subject to CON approval by WVHCA. Wheeling Hospital, Inc. Part V, Section B, Line 22d: Wheeling Hospital, Inc. utilizes the 'look-back method' to determine the amounts generally billed (AGB) to determine the charges billed to patients that qualify for participation in the financial assistance program. Inpatient and outpatient services were calculated separately. The percentages were determined by utilizing the calculation of the sum of all claims paid by Medicare fee for service and all private health insurers divided by the sum of the gross charges for these claims. 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/facilities/wheelinghospital/CommunityHealthNeedsAssessment_WH.pdf Part V, Section B, Line 16a: The Financial Assistance Policy ("FAP") of the Hospital facility can be found at the following web address:https://wheelinghospital.org/documents/Financial%20Assistance%20Policy-WH.pdf Part V, Section B, Line 16b: The Financial Assistance Policy ("FAP") Application of the Hospital facility can be found at the following web address:https://wheelinghospital.org/documents/Financial%20Assistance%20Application-WH.pdf Part V, Section B, Line 16c: A plain language summary of the Financial Assistance Policy ("FAP") of the Hospital facility can be found at the following web address:https://wheelinghospital.org/documents/Plain%20Language%20Summary-WH.pdf Part V, Section B, Line 16 Financial Assistance Policy Website Availability Wheeling Hospital, Inc. Part V, Section B, line 16a website: See Part V Wheeling Hospital, Inc. Part V, Section B, line 16b website: See Part V Wheeling Hospital, Inc. Part V, Section B, line 16c website: See Part V 2 Continuous Care Center PO Box 6313 Wheeling WV 26003 Skilled Nursing Facility Wheeling Renal Care LLC 500 Medical Park Suite 100 Wheeling WV 26003 Specialty Outpatient Facility (Dialysis) 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 9/30/15 (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 36.51% 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 (.84%) 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, which relates entirely to commercial, other and self-pay payors, 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 2.88% and 4.15% for the years ended September 30, 2015 and 2014, respectively.Provisions for bad debt include: 2015 2014 Government and state provision $ 0 $ 0 Commercial, other, and self-pay $9,338,354 $12,664,667The 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 9/30/15 CMS cost report. Approximately $1.1M of the $1.8M 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 $1.1M 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 $47.9M on Line 6 of Pt. III, Section B, are obtained from worksheet D-1, D, and Pt. V of the 9/30/15 Medicare Cost Report.Medicare cost is obtained directly from the 9/30/15 Wheeling Hospital, Inc. Medicare cost report. Worksheets D-1 and D, Pt. V of the cost report calculate Medicare inpatient and outpatient cost, respectively, based on a full-costing methodology. 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 & Foster to perform a formal needs assessment to assess the health care needs for the community that it serves. This assessment was completed and dated December 2012. The Community Health Needs Assessment will be updated during the Hospital's fiscal year ending 9/30/16. 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 114,000.The racial makeup of the MSA as of the 2012 census was 93.75% white, 3.85% African American, 0.6% Asian, 0.1% Native American, with the remainder from other races or a combination of two or more races. The median household income for 2012 was approximately $41,000, while the median household income for the United States was approximately $53,000. The below poverty level percentage for 2012 was approximately 15%, while the below poverty level percentage was approximately 14.9% 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") 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 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 (CCC) 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) which was formed to replace Mountaineer Freedom Risk Retention Group, Inc. (MFRRG). MFLTD began operation in December 2014 at which time all liabilities and assets of MFRRG were legally assumed by MFLTD except $8,000,000 which was transferred to Medical Park Foundation and subsequently transferred to the Bishop's Charitable Fund, an affiliate of the Roman Catholic Diocese of Wheeling/Charleston. 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.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, while WHH II, Inc. is a non-profit 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 HUD-insured mortgage. For the fiscal year ended September 30, 2015, there were no assets or activity for WHH I. 1 Wheeling Jesuit University 316 Washington Avenue Wheeling WV 26003 550394213 501(c)(3) 300000 Nursing Education Catholic Charities USA 2050 Ballenger Avenue Suite 400 Alexandria VA 22314 530196620 501(c)(3) 15000 Mardi Gras Donation Roman Catholic Diocese of Charleston PO Box 230 Wheeling WV 26003 550357023 501(c)(3) 10000 School Dinner Donation 3 0 Part I, Line 2: As is the case with most hospitals in the United States, Wheeling Hospital, Inc. struggles to maintain a steady flow of well-educated nurses from the local area to replace outgoing nurses who are retiring or relocating. To that end, senior management from Wheeling Hospital, Inc. conducted several meetings with Wheeling Jesuit University administration to discuss various benchmarks and goals aimed at strengthening and adding depth to the nursing education program at Wheeling Jesuit University. In order to help foster this goal, Wheeling Hospital, Inc. agreed to donate $300,000 to Wheeling Jesuit University. Specific stipulations were not made by Wheeling Hospital, Inc., however, the mutual agreement between the parties was that Wheeling Jesuit University would use the funds to make improvements to their nursing education program in order to better serve Wheeling Hospital, Inc.'s ongoing needs for well-trained nurses. Wheeling Hospital, Inc. administration continues to meet with Wheeling Jesuit University administration regarding various aspects of the nursing education program. For all other grants, each department is responsible for maintaining grant documentation and is responsible for completing all necessary reporting for the grants. X X X 0 0 0 1 0 0 0 0 0 Michael S McKeets Chief Operating Officer 177701 0 23101 0 0 0 14887 0 7117 0 222806 0 0 0 James B Murdy Chief Financial Officer 245757 0 60102 0 0 0 18050 0 24345 0 348254 0 0 0 Angelo Georges MD Chief Medical Officer 500687 0 102 0 0 0 9360 0 24522 0 534671 0 0 0 Dennis Niess MD Chief Med Info Officer 245097 0 26102 0 0 0 15158 0 19873 0 306230 0 0 0 David Rapp Chief Info Officer 224136 0 50102 0 0 0 12224 0 17690 0 304152 0 0 0 Louis Longo Executive Vice President 344988 0 50102 0 0 0 11030 0 24737 0 430857 0 0 0 George Couch Vice President 495310 0 102 0 0 0 12070 0 20990 0 528472 0 0 0 John DeBlasis Assistant Administrator 147851 0 10101 0 0 0 9962 0 9492 0 177406 0 0 0 Kareen Simon Assistant Administrator 303992 0 6102 0 0 0 11030 0 1765 0 322889 0 0 0 Shawn Stern Medical Director 305246 0 102 0 0 0 2458 0 24574 0 332380 0 0 0 Gregory S Merrick Physician 1254517 0 18102 0 0 0 11290 0 2612 0 1286521 0 0 0 Jondavid Pollock Physician 1139218 0 102 0 0 0 11290 0 18650 0 1169260 0 0 0 Chandra S Swamy Physician 543474 0 567240 0 0 0 11810 0 15452 0 1137976 0 0 0 Peter Bala Physician 170497 0 490914 0 0 0 17394 0 24053 0 702858 0 0 0 Michael Zilles Physician 606938 0 102 0 0 0 11030 0 25517 0 643587 0 0 0 Part I, Line 5 Dr. Swamy's incentives are based on a percentage of net revenue. Dr. Bala's incentives are based on a percentage of cash receipts. Overall physician compensation was determined to be reasonable. Valerie Satkoske Daughter of Chief Executive Officer 173961 Payments - Employee Compensation 0 Scott Satkoske Son-In-Law of Chief Executive Officer 164742 Payments - Employee Compensation 0 R & V Associates Chief Executive Officer is Principal of R & V Associates. 5493458 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 that 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 any direct employment relationship 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 this 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. 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 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 11 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 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 payments 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 the WVHCA annually. Form 990, Part XI, line 9: Contributed Capital -238,225. Grant Activity -147,954. BCH Forgiveness of Debt -2,000,000. Other -7,870. Form 990, 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. WH Holdings I LLC 1 Medical Park Wheeling WV 26003 273193207 Purchase Real Estate WV 0 0 Wheeling Hospital Inc WH Holdings II LLC 1 Medical Park Wheeling WV 26003 273193246 Purchase Real Estate WV -972332 7417024 Wheeling Hospital Inc Women's Health Specialists of Wheeling Hospital LLC 1 Medical Park Wheeling WV 26003 262809731 Physician Offices WV 0 0 Wheeling Hospital Inc Wheeling Pediatrics LLC 222 N 5th Street Martins Ferry OH 43935 261482791 Physician Offices OH 0 0 Wheeling Hospital Inc Self Insurance Trust Agreement of Wheeling Hospital Inc 1 Medical Park Wheeling WV 26003 550676674 Insurance WV Section 501(c)(3) Section A, Line 11a Wheeling Hospital Inc 1 Medical Park Foundation 1 Medical Park Wheeling WV 26003 550744690 Church WV Section 501(c)(3) Section A, Line 1 Wheeling Hospital Inc 1 Belmont Community Hospital Inc 4697 Harrison Street Bellaire OH 43906 340714643 Hospital OH Section 501(c)(3) Section A, Line 3 Wheeling Hospital Inc 1 Mountaineer Freedom Limited 94 Solaris Avenue 2nd Floor Caman Grand Cayman CJ Captive Insurance CJ Wheeling Hospital Inc C 2360793 28864595 1.00000 1 Mountaineer Freedom Physician & Hospital Association Inc 1 Medical Park Wheeling WV 26003 300386759 Physician Hospital Association WV Wheeling Hospital Inc C 1.00000 1 Mountaineer Freedom Risk Retention Group Inc 1 Medical Park Wheeling WV 26003 320184323 Captive Insurance WV Wheeling Hospital Inc C 251992 0.97000 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 Belmont Community Hospital Inc M 155831 Actual Amount Paid Mountaineer Freedom Risk Retention Group Inc B 110044 Actual Amount Paid Belmont Community Hospital Inc Q 1505735 Actual Amount Paid Belmont Community Hospital Inc J 106830 Actual Amount Paid Belmont Community Hospital Inc L 561803 Actual Amount Paid Belmont Community Hospital Inc O 1622671 Actual Amount Paid Belmont Community Hospital Inc S 291799 Actual Amount Paid Mountaineer Freedom Limited R 8658076 Actual Amount Paid