2016-08-15T12:53:24-05:00 2015-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2014-10-01 550440086 Pleasant Valley Hospital PLEA 3046754340 2520 Valley Drive Pt Pleasant WV 25550 Grover G Kerns III CFO 3046754340 2016-08-12 1 Tessa W Carr P01291277 3043460441 2014 2016-09-27 15:27:22Z Glen Washington 2520 Valley Drive Pt Pleasant WV 25550 68392152 0 X www.pvalley.org X 1955 WV Provide quality inpatient and outpatient healthcare to the community regardless of ability to pay. Provide a wellness center to promote community health through fitness programs. 18 12 880 100 2103 0 77668 98997 68652995 68081362 288538 12230 1104339 -29615 70123540 68162974 49383 47029 0 0 39881479 36520325 0 0 0 30678722 35376192 70609584 71943546 -486044 -3780572 35112016 33094574 15181291 16944421 19930725 16150153 To operate an acute care hospital facility for the citizens of Point Pleasant, West Virginia and the surrounding communities and counties. 0 0 60343703 47029 67521595 The hospital provided 38,603 acute, nursery, and skilled nursing days; 118,198 outpatient visits; 15,222 emergency room visits; 2,225 ambulatory surgeries; 1,122 observation visits; 17,838 home health visits; 1,342 hospice visits; and 33,182 physician office visits. 88876 91285 The hospital operates a wellness center which provides community health education and fitness programs that are available to hospital employees and all residents of the surrounding communities. 60432579 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 1 51 0 880 1 1 1 0 0 0 0 0 0 0 0 0 X 18 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC NY X Grover G Kerns III 3046754340 2520 Valley Drive Point Pleasant WV 25550 Amanda Clark Trustee 0.50 0.20 X 0 0 0 Annette Boyles Vice Chairperson 0.50 0.30 X X 0 0 0 C Dallas Kayser Trustee 0.50 0.20 X 0 0 0 Charles Lanham Trustee 0.50 0.20 X 0 0 0 Clayton Faber Trustee 0.50 0.20 X 0 0 0 Dorsel Keefer Trustee 0.50 0.20 X 0 0 0 Jack Buxton Trustee 0.50 0.20 X 0 0 0 James Lockhart Trustee 1.50 0.20 X 0 0 0 James Rossi Trustee 1.50 0.20 X 0 0 0 John Sauer Trustee 0.50 0.20 X 0 0 0 Lannes Williamson Secretary 1.50 0.20 X X 0 0 0 Mario Liberatore Trustee 1.50 0.30 X 0 0 0 Michael Lieving Trustee 1.50 0.30 X 0 0 0 Pete Allinder Chairman 1.50 0.20 X X 0 0 0 Randall Hawkins Trustee 39.90 0.20 X 367885 0 27726 Scott Barnitz Trustee 0.50 0.20 X 0 0 0 Thomas Willoughby Treasurer 1.50 0.20 X 0 0 0 William Knight Trustee 0.50 0.20 X 0 0 0 Glen Washington CEO 40.00 X 0 0 0 Richard Hogan CFO 40.00 X 177329 0 27743 Clifford Roberson MD Physician 40.00 X 553228 0 19795 Daniel Trent MD Physician 40.00 X 372645 0 32434 James Toothman MD Physician 40.00 X 604569 0 32434 Ori Tzuk MD Physician 40.00 X 639738 0 32434 Timothy Crouch MD Physician 40.00 X 356927 0 32434 3072321 0 205000 28 0 1 1 Quest Diagnostics P O Box 740709 Atlanta GA 30374 Lab Services 446934 NAPS Incorporated 714 1/2 Lee Street Charleston WV 25301 Professional Anesthesia Services 443642 Crest Services 735 Plaza Blvd 210 Coppell TX 75019 Biomedical 357327 Hammack Medical 143 Benhring Street Lavalette WV 25535 Emergency Physicians 349835 Jackson & Coker P O Box 277638 Atlanta GA 303847638 Emergency Physicians 282575 8 62723 36274 98997 Patient Services 622110 67990048 67990048 Wellness Center 621111 91285 91285 Sale of Drugs 622110 29 29 68081362 63823 63823 412756 27585 385171 385171 385171 150000 201593 -51593 -51593 -51593 Electronic health records incenti 900099 645000 645000 Cafeteria & vending 722212 213321 213321 Purchase discounts 900099 106940 106940 -1380047 -1382150 2103 -414786 68162974 67612880 2103 448994 X 47029 47029 215513 171484 44029 24921800 19830276 5091524 622767 495536 127231 8977974 7143774 1834200 1782271 1418153 364118 15326 15326 50688 50688 8797690 7000322 1797368 398375 316987 81388 2372754 1886537 486217 32628 25962 6666 985217 783937 201280 469630 373685 95945 412430 328171 84259 2713610 2159219 554391 1092321 869160 223161 Bad debts 8340835 8340835 Medical supplies 5805320 5805320 Medicaid provider tax 1517712 1517712 Repairs & maintenance 1453504 1156553 296951 918152 761927 156225 71943546 60432579 11510967 0 88306 260362 4675198 4421603 10930441 10236491 185048 193670 1210736 1213137 320461 235136 77812269 63419458 14585812 14392811 284646 44646 2831368 2096718 35112016 33094574 7549600 8743282 5785000 5195000 470827 1846691 2535312 15181291 16944421 X 19930725 16150153 19930725 16150153 35112016 33094574 -3780572 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1219905 1219905 320643 24346804 17949017 6718430 311829 237575 74254 49088472 43246342 5842130 2524616 1986524 538092 14392811 Due from related parties 442876 Other receivables 1601518 Accrued interest 7658 Estimated third party receivables 44666 2096718 Capital lease agreements 1509613 Estimated third party settlements 190105 Bond issue liablities 78752 Due to related parties 756842 2535312 X Part X, Line 2: The Hospital, Foundation and Health Foundation are 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. In addition, the Foundation and the Health Foundation have been classified as organizations other than a private foundation meaning of Section 509(a) of the Internal Revenue Code. Pleasant Valley Home Medical Equipment, Inc., the wholly-owned subsidiary corporation, is not exempt from Federal and state income taxes. Income tax expense, when incurred, is based upon reported income, with deferred income taxes provided on a liability method whereby deferred tax assets are recognized for deductible temporary differences and operating loss and tax credit carryforwards and deferred tax liabilities are recognized for taxable temporary differences. Temporary differences are the differences between the reported amounts of assets and liabilities and their tax bases. Deferred tax assets are reduced by a valuation allowance when, in the opinion of management, it is more likely than not that some portion or all of the deferred tax assets will not be realized. Deferred tax assets and liabilities are adjusted for the effects of changes in tax laws and rates on the date of enactment. Temporary differences result primarily from using accelerated depreciation methods and from reporting bad debts when incurred for tax purposes. Accounting principles generally accepted in the United States of America require the management of the Company to evaluate tax positions taken by the Company. Management has evaluated the Company s tax positions and concluded that the Company has maintained its tax exempt status and had taken no uncertain tax positions that require recognition or disclosure in the financial statements. Therefore, no provision or liability for income taxes has been included in the financial statements. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The management of the Company believes it is no longer subject to income tax examinations for years prior to the fiscal year ended September 30, 2012. 1 1 X 1 X 1 X 100.000000000000 1 1 0 1 1 363850 363850 0.00570 17608099 15067264 2540835 0.03990 17971949 15067264 2904685 0.04560 234873 52832 182041 0.00290 1114897 1114897 0.01750 58060 58060 0.00090 1407830 52832 1354998 0.02130 19379779 15120096 4259683 0.06690 1914 1914 0.00000 17141 17141 0.00030 3006 3006 0.00000 22061 22061 0.00030 1 8292639 1326822 9342221 9046508 295713 X 1 1 1 1 Pleasant Valley Hospital 2520 Valley Drive Pt Pleasant WV 25550 X X X Skilled nursing facility Pleasant Valley Hospital 1 0 0 1 X X X X X X X X 12 1 0 0 1 X www.pvalley.org X 1 14 0 0 0 1 X 100.000000000000 100.000000000000 1 1 X X X 1 X http://pvalley.org/wp-content/uploads/2015/07/Financial-Assistance-Applicat X http://pvalley.org/patients/financial-counseling/ X X X X X 1 X 0 X X X X 1 X 0 0 Pleasant Valley Hospital Part V, Section B, Line 5: First account perspectives were obtained from key community representatives through three different modes. These are: surveys, personal interviews and a focus group. The focus group was conducted on March 14, 2013 at the hospital. The focus group represented nine different community organizations plus various community representatives. The individuals who participated in the focus group are as follows: 1. City Dept. of Point Pleasant, WV / Mayor - Point Pleasant, 2. City Department of Point Pleasant, WV / City Clerk, 3. Early Education Station / Director, 4. Family Resource Network / Executive Director, 5. Mason County Health Department / Representative, 6. Mason County Schools / Director, 7. Mason County Commission / Commissioner, 8. Mason County Healthy Families / Supervisor, 9. Pleasant Valley Hospital / Director of Marketing, 10. Pleasant Valley Hospital / Radiologist, and 11. Prestera Ctr. / Clinical Psychologist. Pleasant Valley Hospital Part V, Section B, Line 16i: The policy is discussed with patients before they are discharged. Copy of the policy is provided to patients prior to discharge. Pleasant Valley Hospital Part V, Section B, Line 22d: Charges to bill patients are based on income level, asset level, and medical indigency. These were for patients who qualified for financial assistance. The Hospital also gave self-pay patients prompt pay discounts of of gross charges. Pateints were not denied financial assistance because the applications were incomplete. The applications were put on hold until the missing information was obtained. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Pleasant Valley Hospital Part V, Section B, line 16b website: http://pvalley.org/wp-content/uploads/2015/07/Financial-Assistance-Applicat Pleasant Valley Hospital Part V, Section B, line 16c website: http://pvalley.org/patients/financial-counseling/ 1 Pleasant Valley Hospital Nursing & Rehab 640 Sand Hill Road Point Pleasant WV 25550 Skilled nursing facility Part I, Line 7: The cost of charity care and unreimbursed Medicaid were estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H Instructions.The cost of (1) community health improvement services and community bnefit operations, (2) health professions education, and (3) cash and in-kind contributions was obtained from the hospital's accounting records. 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 $ 8,340,835. Part II, Community Building Activities: Our weight loss challenge gives the community the ability to use our wellness services. Our wellness services includes cardio and weight lifting machines and certified exercise physiologists. Blood pressure, weight, body fat were monitored before the challenge and after the challenge. This promotes a healthly lifestyle in the community. Mason County is a medically underserved area and the hospital spends money for recruitment for this area. The amount shown for workforce development is the amount paid to recruit new physicians to the area. Part III, Line 3: The Hospital determined that 16% of self pay accounts turned over to a collection agency came back as eligible for Financial Aid. The amount reported is 16% of the total bad debt expense. Part II - Community Building Activities Representation on boards of coalitions that build community capacity and share ideas. 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: Medicare allowable costs and reimbursements were obtained from the Medicare Cost Report. Part III, Line 9b: Pleasant Valley Hospital has a charity care policy and a Collection and Bad Debt policy that discusses qualifying and eligibility for charity care, collection practices and handling of bad debt accounts. It is a practice to handle all patient accounts in the same manner/precedent. Patients are sent monthly statements - even while applying and pending financial assistance and will continue to receive statements until determination is made. Once determination is made the account balance or the % portion of the account balance is adjusted to "Financial Assistance". Part VI, Line 2: The Hospital participates in the State of West Virginia Abeyance program. We prepare reports for this probran identifying our community benefit programs. This information is reported to the West Virginia Healthcare Authority which makes its records available to the publice. Part VI, Line 3: The process in place offers the uninsured and underinsured patient the ability to apply for charity care through a formal application process established by reviewing both income and expense to make a final determination of eligibility. It requires proper verification of income through a pay stub, tax return, etc. It is also verified that the patient is not eligible for a state assisted program via a denial letter from the program or verification through the state caseworker. The patient will either be contacted by the Business Office or will contact the Business Office during the collection and statement process to discuss financial arrangements regarding their patient account. All options of payments will be discussed and charity care offered as an alternative option after screening the patient's financial ability to make payment. Part VI, Line 4: Pleasant Valley Hospital is a rural hospital in Point Pleasant, WV. Pleasant Valley Hospital serves mainly the people of Mason and Jackson County, WV and Meigs and Gallia County, OH. We are a federally designated medically underserved area. Mason County has 27,179 residents, the median household income is $36,468, and 17.8% are below poverty levels. Jackson County has 29,234 residents, the median household income is $43,191, and 16.7% are below poverty levels. Meigs County has 23,593 residents, the median household income is $33,708, and 21.3% are below poverty levels. Gallia County has 30,708 residents, the median household income is $36,918 and 20% are below poverty levels. Medicaid patients made up 23.8% of our total discharges and 16.3% of our total outpatient visits in FY 2012. Uninsured patients made up 4.6% of our total discharges and 4.3% of our total outpatient visits in FY 2012. There is one other not-for-profit hospital within 15 miles of PVH. They serve many of the same areas that we do. Part VI, Line 5: The majority of the organization's governing body is comprised of persons who reside in the organization's primary service area, who are neither employees or contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community. The hospital provides a 24 hour emergency room and is available to all regardless of the ability to pay. All the services provided by the hospital are provided regardless of the ability to pay. The hospital has an auxiliary that helps our patients and visitors if they need a wheelchair when they arrive or if they need dirctions on where to go within the Hospital. The hospital provides Breast Cancer Screenings/Mammograms free to patients who cannot pay for the service. The hospital has a fitness center for the community and it also conducts many health fairs throughout the year. The hospital provides many health screenings throughout the year in addition to a nutritional program. Our SNF provides transportation for its residents to health facilities. The hospital has support groups for members of the community. The hospital donates money to the community for various projects. 1 Mason County Board of Education 1200 Main Street Point Pleasant WV 25550 556000353 501(c)(3) 15000 High school athletic program support Mason County Fair Inc P O Box 334 Point Pleasant WV 25550 550628521 501(c)(3) 25156 Support of Fair Activities. X X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Randall Hawkins Trustee 213771 0 154114 0 0 0 12090 0 16163 0 396138 0 0 0 Richard Hogan CFO 177329 0 0 0 0 0 7399 0 21046 0 205774 0 0 0 Clifford Roberson MD Physician 540228 0 13000 0 0 0 12090 0 8407 0 573725 0 0 0 Daniel Trent MD Physician 372645 0 0 0 0 0 12090 0 21046 0 405781 0 0 0 James Toothman MD Physician 604569 0 0 0 0 0 12090 0 21046 0 637705 0 0 0 Ori Tzuk MD Physician 525138 0 114600 0 0 0 12090 0 21046 0 672874 0 0 0 Timothy Crouch MD Physician 356927 0 0 0 0 0 12090 0 21046 0 390063 0 0 0 Form 990, Part VII, Section A, Line 5 Unrelated organization officer compensation: For the calendar year ended, 12/31/2014, Pleasant Valley Hospital paid Cabell-Huntington Hospital $287,925 for the services of Glen Washington, CEO of Pleasant Valley Hospital. A The County Commission of Mason County WV 556000352 575194BM6 2003-06-17 7805000 To refund Series 1993 bonds 0 0 0 B The County Commission of Mason County WV 556000352 575194CH6 2006-10-12 3895000 Capital improvements & equipment acquisition 0 0 0 A 3835000 7805000 7021907 156100 626993 2003 0 0 1 1 B 2670000 3895000 389500 77900 3427600 2008 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 Lee Anne Kayser Family member of C. Dallas Kayser, Hospital Trustee 25083 Wages 0 Jane Zirkle Family member of Mike Lieving, Hospital Trustee 23411 Wages 0 David Faber MD Family member of Clayton Faber, Hospital Trustee 57163 Wages 0 Wes Lieving DO Family member of Mike Lieving, Hospital Trustee 29012 Wages 0 Peoples Bank James Lockhart, Hospital Trustee, is a board member of the bank 373 Interest bearing checking accounts 0 Peoples Bank Dorsal Keefer, Hospital Truste, is a board member of the bank 373 Interest bearing checking accounts 0 Ohio Valley Bank Mario Liberatore, Hospital Trustee, is an officer of the bank 500 Interest on certificates of deposit 0 Ohio Valley Bank Lannes Williamson, Hospital Trustee, is a board member of the bank 500 Interest on certificates of deposit 0 Ohio Valley Bank Charles Lanham, Hospital Trustee, is a board member of the bank 500 Interest on certificates of deposit 0 Form 990, Part VI, Section A, line 2 Dallas Kayser, Charles Lanham, and Michael Shaw have a business relationship. Mario Liberatore and Lannes Williamson have a business relationship. Dallas Kayers's spouse and James Rossi have a business relationship. Form 990, Part VI, Section B, line 11 The 990 is prepared by the Hospital's independent accountants. It is then reviewed by the CFO and CEO and a copy is provided to the governing board before it is filed with the IRS. Form 990, Part VI, Section B, line 12c Each board member fills out a questionnaire at the end of the fiscal year. The questionnaire has questions on it that determine independence status and other relationships between board members and between the board member and the hospital. This helps in determining possible conflicts that may arise. In addition, the board members must sign a conflict of interest policy that requires them with due diligence to state that they have a conflict of interest when that conflict arises. The board member must leave the board meeting during discussions and voting. Form 990, Part VI, Section B, line 15 The compensation committee is made up of independent board members. These members are appointed by the board. The compensation committee decides the compensation of the CEO and VPs. The compensation committee consults with an independent consultant to determine a fair compensation for the CEO and VPs based on peer data. The Compensation committee has used this study to determine base salary for the CEO and VPs. The CEO contract is taken back to the board for final approval. Form 990, Part VI, Section C, line 19 These documents are available upon request for inspection at the hospital or by mailing a copy upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 463,592. Management and general expenses 119,030. Fundraising expenses 0. Total expenses 582,622. Nursing Services: Program service expenses 160,490. Management and general expenses 41,206. Fundraising expenses 0. Total expenses 201,696. Lab Services: Program service expenses 58,621. Management and general expenses 15,051. Fundraising expenses 0. Total expenses 73,672. Medical Services: Program service expenses 201,179. Management and general expenses 51,654. Fundraising expenses 0. Total expenses 252,833. Doctor Services: Program service expenses 3,792,301. Management and general expenses 973,692. Fundraising expenses 0. Total expenses 4,765,993. Therapy Services: Program service expenses 448,610. Management and general expenses 115,183. Fundraising expenses 0. Total expenses 563,793. Pharmacy Services: Program service expenses 74,293. Management and general expenses 19,075. Fundraising expenses 0. Total expenses 93,368. Administration Services: Program service expenses 1,801,236. Management and general expenses 462,477. Fundraising expenses 0. Total expenses 2,263,713. Pleasant Valley Hospital Foundation Inc 2420 Valley Dr Pt Pleasant WV 25550 200120079 Fundraising WV 501(c)(3) Line 9 N/A 0 Pleasant Valley Hospital Health Foundation Inc 2420 Valley Dr Pt Pleasant WV 25550 550649849 Scholarships/Healthcare WV 501(c)(3) Line 11b, II N/A 0 Pleasant Valley Medical Group Inc 2520 Valley Dr Pt Pleasant WV 25550 471358788 Healthcare WV 501(c)(3) Line 9 N/A 0 Pleasant Valley Home Medical Equipment Viand St Pt Pleasant WV 25550 550653315 Retail - Medical equipment sales & rental WV N/A C -437075 1658738 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0