2016-05-12T15:29:57-05:00 2015-06-30 550486667 ARNETT CARBIS TOOTHMAN LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2014-07-01 550562976 GRANT MEMORIAL HOSPITAL GRAN 3042575802 117 HOSPITAL DRIVE PETERSBURG WV 26847 MARY BETH BARR CHIEF EXECUTIVE OFF CHIEF EXECUTIVE OFFICER 3042575802 2016-05-11 1 JEFFREY J PETRELL CPA P00138808 4126356270 2016-05-11 2014 2016-08-17 19:52:53Z MARY BETH BARR 117 HOSPITAL DRIVE PETERSBURG WV 26847 33725182 0 X WWW.GRANTMEMORIAL.COM X 1957 WV TAX-EXEMPT HOSPITAL DEDICATED TO SERVICING THE COUNTIES OF GRANT, HARDY, & PENDLETON IN WEST VIRGINIA. 14 9 444 19 0 0 10979 31895 33150501 33070413 120999 74286 783060 504107 34065539 33680701 0 0 0 0 14141430 16348213 0 0 0 19283969 16662954 33425399 33011167 640140 669534 22398184 23802633 6228094 6963009 16170090 16839624 X GRANT MEMORIAL HOSPITAL IS A REGIONAL PROVIDER OF QUALITY, COST EFFECTIVE HEALTH CARE SERVICE RESPONSIVE TO THE COMMUNITY NEEDS AND SUPPORTED BY INNOVATIVE EFFORTS WITH OTHERS. THE VISION OF GRANT MEMORIAL HOSPITAL, BASED UPON DEFINED OBJECTIVES OF PATIENT AND COMMUNITY SERVICE, IS TO BE THE LEADER IN PROVIDING THE HIGHEST QUALITY SERVICE AS EFFICIENTLY AS POSSIBLE BASED ON ASSESSED NEEDS. 0 0 27188299 33485105 THE HOSPITAL PROVIDES A FULL COMPLIMENT OF HEALTH SERVICES INCLUDING INPATIENT ACUTE, OBSTETRICS, INTENSIVE CARE, SWING-BED SERVICES, NURSING FACILITY SERVICES (BOTH SKILLED AND INTERMEDIATE), TRADITIONAL OUTPATIENT SERVICES AND PHYSICIAN SERVICES TO THE RESIDENTS OF GRANT, HARDY, AND PENDLETON COUNTIES OF WEST VIRGINIA. THE HOSPITAL IS LOCATED IN THE EASTERN PANHANDLE OF WEST VIRGINIA WITH THE CLOSEST HOSPITALS BEING APPROXIMATELY 1.25 TO 1.5 HOURS AWAY. SINCE THE HOSPITAL IS LOCATED IN THE MOUNTAINS, DRIVING TIMES CAN BE MUCH LONGER DURING THE WINTER MONTHS. DURING THE YEAR, THE HOSPITAL HAD 10,300 ADULT AND PEDIATRIC DAYS, 1,225 SWING-BED DAYS, 497 INTENSIVE CARE DAYS, 437 NURSERY DAYS AND 4,183 NURSING FACILITY DAYS. 27188299 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 86 0 444 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 9 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 0 1 1 0 WV X X X ACCOUNTING DEPARTMENT 3042575802 117 HOSPITAL DRIVE PETERSBURG WV 26847 MARY BETH BARR CHIEF EXECUTIVE OFFICER, SECRETARY 40.00 X X 128638 0 5484 JOE A BARNES CHIEF FINANCIAL OFFICER, TREASURER 40.00 X X 107812 0 12308 ROBERT CHEHI CHAIRMAN 1.00 X X 0 0 0 MATT HARPER VICE CHAIR 1.00 X X 0 0 0 JANIE BERG TRUSTEE 1.00 X 0 0 0 STEPHEN THOMPSON DO TRUSTEE 57.00 X 285387 0 0 TOM KIMBLE TRUSTEE 1.00 X 0 0 0 RALPH SITES TRUSTEE 1.00 X 0 0 0 JASON SITES TRUSTEE 1.00 X 0 0 0 JANET FRYE TRUSTEE 1.00 X 0 0 0 ALAN KILE SR TRUSTEE 1.00 X 0 0 0 DOUG SWICK TRUSTEE 1.00 X 0 0 0 BETTY MOOMAU TRUSTEE 1.00 X 0 0 0 MARK WRIGHT TRUSTEE 1.00 X 0 0 0 JOHN L HAHN MD PHYSICIAN 70.00 X 1124467 0 43062 ANIL MAKANI MD PHYSICIAN 70.00 X 248995 0 12683 BRENTON R HARMAN PHARMACY MANAGER 40.00 X 108000 0 12531 DAVID W BROSH PHARMACIST 40.00 X 107671 0 11223 MARK SAVILLE PHARMACIST 40.00 X 102339 0 12282 2213309 0 109573 8 0 1 0 AMERISOURCEBERGEN 1300 MORRIS DRIVE CHESTERBROOK PA 19087 PHARMACEUTICALS 1014743 ADVANTAGE RN LLC 9021 MERIDIAN WAY WEST CHESTER OH 45069 TRAVELING NURSES 744147 NES OF WEST VIRGINIA INC 39 MAIN STREET TIBURON CA 94920 ER PHYSICIANS 720686 GE HEALTHCARE PO BOX 643065 PITTSBURGH PA 15264 X-RAY EQUIPMENT 599216 MEDHOST 2739 MONUMENTUM PLACE CHICAGO IL 60689 IT SERVICES 550825 48 1000 30895 31895 NET PATIENT SERVICE REVENUE 621400 33070413 33070413 33070413 118767 118767 89415 0 89415 89415 89415 44481 -44481 -44481 -44481 CAFETERIA 722210 194914 194914 OTHER OPERATING REVENUE 900099 109890 109890 109888 109888 414692 33680701 33485105 0 163701 254242 254242 12505016 10445454 2059562 231084 189443 41641 2466243 2036412 429831 891628 730957 160671 175793 175793 59976 59976 5443516 4462594 980922 76524 62734 13790 870653 713761 156892 274798 225279 49519 636425 521741 114684 7352 6027 1325 129455 106127 23328 53650 43982 9668 1964340 1610366 353974 377204 377204 SUPPLIES 3715980 3046360 669620 REPAIRS & MAINTENANCE 887322 727427 159895 LICENSES AND TAXES 715764 715764 BAD DEBT EXPENSE 677448 677448 596754 489219 107535 33011167 27188299 5822868 0 69254 27171 3372189 2727915 5368303 4863904 997317 1190130 120851 255031 31085835 22540973 8485385 8544862 3517643 4546435 112242 822242 355000 824943 22398184 23802633 2583537 3069224 229 229 1183498 892603 2460830 3000953 6228094 6963009 X 16170090 16839624 16170090 16839624 22398184 23802633 669534 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6129 6129 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, THE WV HOSPITAL ASSOCIATION AND THE AMERICAN HEALTH CARE ASSOCIATION. A PORTION OF THESE DUES ARE USED FOR LOBBYING ACTIVITES BY THESE ASSOCIATIONS. 70684 70684 16432470 12905967 3526503 14579281 9635006 4944275 3400 3400 8544862 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 250000 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2750953 3000953 X 33003253 -677448 -677448 33680701 0 33680701 32333719 0 32333719 677448 677448 33011167 PART X, LINE 2: THE HOSPITAL FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS THAT PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE GUIDANCE ALSO ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, AND DISCLOSURE. MANAGEMENT HAS DETERMINED THAT THIS GUIDANCE HAD NO MATERIAL EFFECT ON THE FINANCIAL STATEMENTS. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN PROFESSIONAL FEES AND MISCELLANEOUS EXPENSES. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED ON THE STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS (DEFICIT) AS A RESULT OF THIS GUIDANCE. GENERALLY, TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2012, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -677,448. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 677,448. 1 1 X 1 X 140.000000000000 1 X 1 1 0 1 1 1477447 1208233 269214 0.00830 739037 689475 49562 0.00150 2216484 1897708 318776 0.00980 2216484 1897708 318776 0.00980 0 337118 0 6419763 6419763 X 1 1 1 1 GRANT MEMORIAL HOSPITAL 117 HOSPITAL LANE PETERSBURG WV 26847 WWW.GRANTMEMORIAL.COM 1036-4136 X X X X SNF/NF & PRIMARY CARE PHYSICAN SERVICES GRANT MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X WWW.GRANTMEMORIAL.COM/INDEX.PHP/RESOURCES X X 1 12 1 WWW.GRANTMEMORIAL.COM/INDEX.PHP/RESOURCES 0 0 1 X 140.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X WWW.GRANTMEMORIAL.COM/ X WWW.GRANTMEMORIAL.COM/ X WWW.GRANTMEMORIAL.COM/ X X X X X X 1 0 X X X X 1 X 0 0 GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL PERFORMED TELEPHONE SURVEYS TO RESIDENTS OF THE SERVICE AREAS. THE DATA FROM THE TELEPHONE SURVEYS WAS USED DURING THE COMMUNITY SUMMIT WITH COMMUNITY LEADERS AND OTHER CITIZENS THROUGHOUT THE COMMUNITY. THE COMMUNITY LEADERS INCLUDED PHYSICIANS, A SCHOOL PRINCIPAL, A COUNTY COMMISSIONER, A BANKER, A TEACHER, THE CEO OF THE LOCAL COMMUNITY HEALTH CENTER, BOARD MEMBERS AND HOSPITAL LEADERSHIP. THE DATA THAT RESULTED FROM THE COMMUNITY SUMMIT WAS THEN REVIEWED BY HOSPITAL LEADERSHIP TO DETERMINE THE NEEDS TO BE ADDRESSED. GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL CONDUCTED A FORUM THAT PROVIDED THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. PERSONS WHO PARTICIPATED IN THE ASSESSMENTS WERE INVITED, AND THE FORUM WAS ALSO OPEN TO THE PUBLIC. GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: IT IS UNDERSTOOD THAT IN ORDER TO BE THE MOST EFFECTIVE AND MAKE THE GREATEST IMPACT, THAT NOT ALL COMMUNITY NEEDS CAN BE ADDRESSED AT ONCE IN AN IMPLEMENTATION PLAN. IT IS IMPORTANT TO NOTE THAT WHILE THREE NEEDS WERE PRIORITIZED AND ADOPTED BY THE HOSPITAL FOR ITS IMPLEMENTATION PLAN, FOR THOSE NEEDS THAT THE HOSPITAL DID NOT MAKE A PRIORITY, WE CONTINUE TO WORK WITH THE COMMUNITY ORGANIZATIONS TO HELP ADDRESS THOSE NEEDS. THE NEEDS THAT ARE BEING ADDRESSED ARE AROUND INCREASING THE LIFESTYLE, WELLNESS, NUTRITION AND ACTIVITIES OF THE POPULATION, CREATING GREATER ACCESS TO CARE, AND DECREASING CHRONIC DISEASE. THE NEEDS THAT WERE IDENTIFIED THAT ARE NOT CURRENTLY BEING ADDRESSED ARE INCREASING EDUCATION TO HIGH SCHOOL STUDENTS ON LIFESTYLE AND TEEN PREGNANCY, DECREASING TOBACCO USE, DECREASE OF DIABETES THROUGHOUT THE COMMUNITY, AND DECREASE OF BEHAVIORAL HEALTH ISSUES (PRIMARILY DRUG ABUSE) THROUGHOUT THE COMMUNITY. IT IS THE HOSPITAL'S HOPE THAT BY ADEQUATELY ADDRESSING THE THREE PRIORITIZED NEEDS, THE OTHER NEEDS WILL BE INDIRECTLY IMPACTED AS WELL. GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 16I: THE FINANCIAL ASSISTANCE POLICY IS ALSO PUBLISHED IN THE LOCAL NEWSPAPERS ON AN ANNUAL BASIS. GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: THE AMOUNT THAT CAN BE CHARGED TO FAP ELIGIBLE INDIVIDUALS IS BASED UPON AN AMOUNT THAT IS LOWER THAN THE DISCOUNT PROVIDED TO BLUE CROSS PATIENTS. IF THE HOSPITAL WOULD PROVIDE A HIGHER DISCOUNT PERCENTAGE, THEN THE HOSPITAL WOULD HAVE TO PROVIDE THE SAME DISCOUNT TO BLUE CROSS PATIENTS. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.GRANTMEMORIAL.COM/ GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.GRANTMEMORIAL.COM/ GRANT MEMORIAL HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: WWW.GRANTMEMORIAL.COM/ 1 GRANT MEMORIAL HOMECARE AND HOSPICE LLC 100 HOSPITAL DR 2 PETERSBURG WV 26847 HOME CARE AND HOSPICE PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY GRANT MEMORIAL HOSPITAL. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS DETERMINED BASED UPON MEDICARE PRINCIPLES OF REIMBURSEMENT. FOR MEDICAID INPATIENT AND OUTPATIENT REIMBURSEMENT, THE ACTUAL COSTS WERE DETERMINED BASED UPON THE MEDICAID COST REPORT. THE COST FOR FINANCIAL ASSISTANCE WAS ALSO COMPUTED BASED UPON ACTUAL COST-TO-CHARGE RATIOS FOR THE FINANCIAL ASSISTANCE PAYER CLASSIFICATION. ALL OTHER ESTIMATES WERE COMPUTED BASED UPON DIRECT COSTS AND ALLOCATED OVERHEAD COSTS DERIVED FROM THE MEDICARE COST REPORT. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $677,448. PART II, COMMUNITY BUILDING ACTIVITIES: TO ASSIST IN BUILDING THE COMMUNITY, THE HOSPITAL PROVIDES STAFFING TO TRAIN STUDENTS AT THE LOCAL COMMUNITY COLLEGE FOR STUDENTS ENTERING VARIOUS HEALTHCARE CAREERS. THE HOSPITAL ALSO PROVIDES EMS TRAINING TO AMBULANCE SQUADS AND OTHER HEALTHCARE PROFESSIONALS IN THE AREA. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE COSTING METHODOLOGY WAS OBTAINED FROM THE MEDICARE COST REPORT WHICH IS BASED ON COST-TO-CHARGE RATIOS.AS WITH ANY BUSINESS, A HOSPITAL MUST GENERATE A PROFIT TO CONTINUE TO PROVIDE SERVICES TO THE RESIDENTS OF THE AREA IN WHICH THE HOSPITAL SERVES. THESE DISCOUNTS ARE DICTATED BY THE MEDICAID PROGRAM, AND DUE TO BUDGET CONSTRAINTS, THE MEDICARE PROGRAM HISTORICALLY HAS PROVIDED MOST OF THE PAYMENT REDUCTIONS ON HOSPITALS. THE HOSPITAL HAS NO CONTROL OVER REDUCTIONS, AND THE LARGEST CONSUMER OF HEALTH SERVICES ARE MEDICARE BENEFICIARIES. PRIOR TO 1966 WHEN THE MEDICARE PROGRAM WAS IMPLEMENTED, MANY ELDERLY PEOPLE WERE GOING WITHOUT CARE OR WERE RECEIVING A SUB-STANDARD OF CARE. IN ADDITION, THESE PATIENTS, DUE TO THEIR AGE, UTILIZE THE HIGHEST LEVEL OF RESOURCES THAT ARE PROVIDED TO THE HOSPITAL'S PATIENTS. THE HOSPITAL IS DESIGNATED BY THE MEDICARE/MEDICAID PROGRAMS AS A CRITICAL ACCESS HOSPITAL (CAH). WHEN THIS DESIGNATION WAS ESTABLISHED BY THE MEDICARE PROGRAMS IN THE 1990S, THIS PROGRAM WAS DESIGNED TO PROVIDE SAFETY NET HOSPITALS THAT ARE LOCATED IN RURAL, ISOLATED AREAS THE ADDITIONAL REIMBURSEMENT THAT WILL ALLOW THEM TO REMAIN OPEN. HOWEVER, AGAIN DUE TO BUDGET CONSTRAINTS, THE MEDICARE PROGRAM HAS SIGNIFICANTLY REDUCED REIMBURSEMENT TO THESE SAFETY NET HOSPITALS. THE HOSPITAL MUST TAKE THE LEAD IN ENSURING THAT QUALITY HEALTHCARE SERVICES ARE BEING PROVIDED. THE HOSPITAL PARTICIPATES IN A PHYSICIAN RESIDENCY PROGRAM WHERE PHYSICIANS FROM VARIOUS MEDICAL SCHOOLS WILL DO RURAL ROTATIONS AT THE HOSPITAL. THE HOSPITAL ALSO SUPPORTS RN EDUCATION AT THE LOCAL COMMUNITY COLLEGE TO PROVIDE QUALIFIED RNS FOR THE AREA. THE HOSPITAL ENCOURAGES EMPLOYEES TO OBTAIN FACULTY POSITIONS FOR OTHER PROGRAMS AT THE LOCAL COMMUNITY COLLEGE, AND THE HOSPITAL IS WILLING TO ACCOMMODATE WORK SCHEDULES FOR EMPLOYEES THAT DO TEACH. OTHER TRAINING PROGRAMS THAT THE HOSPITAL PROVIDES ARE FOR RADIOLOGY STUDENTS. ALSO, DUE TO THE LIMITED RESOURCES IN THE COMMUNITY, THE HOSPITAL MUST ALSO TAKE THE LEAD IN RECRUITING PHYSICIANS TO THE AREA. DURING THE TAX YEAR 2013, THE HOSPITAL INCURRED APPROXIMATELY $50,000 IN RECRUITING NEW PHYSICIANS. WHILE THE HOSPITAL HAS BEEN SUCCESSFUL IN RECRUITING NEW PHYSICIANS FOR THE TAX YEAR 2014, THE HOSPITAL WAS NOT SUCCESSFUL FOR THE 2013 TAX YEAR. IN ADDITION, THESE COSTS ARE NOT REIMBURSABLE BY THE MEDICARE/MEDICAID PROGRAMS ON THEIR RESPECTIVE COST REPORTS. PART III, LINE 9B: IF IT IS DETERMINED THAT A PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE, THE PATIENT IS ADVISED TO APPLY FOR MEDCIAL ASSISTANCE. IF APPROVED FOR MEDCIAL ASSISTANCE, THE PATIENT'S BILL WOULD BE PAID BY MEDICAL ASSISTANCE. IF THE PATIENT CANNOT QUALIFY FOR MEDICAL ASSISTANCE, HE OR SHE MUST COMPLETE THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION. INCOME IS PRIMARILY USED TO DETERMINE ELIGIBILITY, BUT THE PATIENT'S ASSETS ARE ALSO CONSIDERED. THE PATIENT MUST PROVIDE DOCUMENTATION OF INCOME SUCH AS INCOME TAX RETURNS, W-2'S, ETC. THE POVERTY INCOME GUIDELINES AS DEVELOPED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) ARE USED TO DETERMINE ELIGIBILITY. IF A PERSON'S INCOME IS AT 140% OF THESE GUIDELINES, THE PATIENT WILL RECEIVE A 75% FINANCIAL ASSISTANCE WRITE-OFF, FROM 201% - 300% OF THE INCOME GUIDELINE WILL EARN A FINANCIAL ASSISTANCE WRITE-OFF, THE INCOME GUIDELINE WILL RECEIVE A 25% FINANCIAL ASSISTANCE DISCOUNT. ONCE A PATIENT IS DEEMED TO QUALIFY FOR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITIES WILL CEASE. IT IS POLICY THAT IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THERE IS NO COLLECTION AGAINST THAT AMOUNT THAT THEY QUALIFY FOR.IN SPITE OF THE HOSPITAL'S COLLECTION POLICIES, PATIENTS ARE NOT DENIED TREATMENT. IN FACT, FOR PATIENTS WHO PRESENT THEMSELVES TO THE EMERGENCY ROOM FOR SERVICES, NO FINANCIAL INFORMATION IS REQUESTED UNTIL AFTER THE PATIENT HAS RECEIVED AN INITIAL MEDICAL EVALUATION FROM A TRIAGE NURSE. IF THE PATIENT DOES NOT HAVE INSURANCE OR MAKE PAYMENT, SERVICES ARE STILL PROVIDED TO THE PATIENT. THE SAME IS TRUE FOR PATIENTS THAT ARE ADMITTED TO THE HOSPITAL. PART VI, LINE 2: THE NEEDS ASSESSMENT MADE DURING THE 2012 TAX YEAR OBTAINED THE NEEDS OF THE COMMUNITY THROUGH TELEPHONE SURVEYS AND A COMMUNITY SUMMIT. THE COMMUNITY SUMMIT INCLUDED SPECIFIC COMMUNITY LEADERSHIP AS NOTED ABOVE, AS WELL AS OTHER CITIZENS. THE DATA GATHERED WAS REVIEWED BY THE BOARD OF DIRECTORS AND HOSPITAL LEADERSHIP TO DEVELOP THE IMPLEMENTATION PLAN TO ADDRESS NEEDS IDENTIFIED.IT IS ALSO BASED UPON WHAT RNS, SOCIAL WORKERS AND OTHER CLINICAL PERSONNEL SEE ON A DAILY BASIS IN THE PROVISION OF MEDICAL CARE. PART VI, LINE 3: WHENEVER A PATIENT PRESENTS THEMSELVES FOR SERVICE AND DOES NOT HAVE INSURANCE COVERAGE, THE HOSPITAL REQUESTS THAT A CHARITY CARE APPLICATION BE COMPLETED AND RETURNED TO THE HOSPITAL ALONG WITH ALL DOCUMENTATION NEEDED TO SUPPORT INCOME AMOUNTS THAT WILL BE USED TO DETERMINE IF AND HOW MUCH CHARITY ASSISTANCE THE PATIENT MAY QUALIFY. THE HOSPITAL USES THE CURRENT FEDERAL POVERTY GUIDELINES TO MAKE THIS DETERMINATION. IF THE PATIENT DOES QUALIFY FOR COMPLETE OR PARTIAL CHARITY ASSISTANCE, ALL COLLECTION ACTIVITIES CEASE ON THOSE AMOUNTS THAT HAVE BEEN DEEMED TO BE CHARITY. IF THE PATIENT IS RESPONSIBLE FOR A PORTION OF THE BALANCE, THE HOSPITAL DOES HAVE PAYMENT SCHEDULES TO ASSIST THE PATIENT IN MEETING HIS/HER FINANCIAL OBLIGATIONS. AT THE TIME THE CHARITY APPLICATION IS BEING PREPARED, THE HOSPITAL REQUIRES THAT THE PATIENT APPLY FOR MEDICAID COVERAGE AT THE LOCAL WELFARE OFFICE.IN CONNECTION WITH SERVICES PROVIDED IN THE HOSPITAL'S EMERGENCY ROOM, NO FINANCIAL INFORMATION IS OBTAINED UNTIL AFTER THE PATIENT HAS BEEN TRIAGED BY AN RN AND SEEN BY A PHYSICIAN. ACCORDING TO EMTALA, A FEDERAL LAW REGARDING TREATMENT IN EMERGENCY ROOMS, FINANCIAL INFORMATION COULD BE OBTAINED AFTER BEING TRIAGED BY AN RN. CONSEQUENTLY, THE HOSPITAL'S POLICY FOLLOWS A LESS RESTRICTIVE POLICY THAN IS MANDATED BY EMTALA. IN A TRUE EMERGENCY SITUATION, NO FINANCIAL INFORMATION IS REQUESTED UNTIL AFTER THE PATIENT HAS BEEN STABILIZED.THE HOSPITAL ALSO HAS AN ENROLLMENT SPECIALIST, WHO ON A DAILY BASIS, REVIEWS ADMISSIONS AND OUTPATIENT REGISTRATIONS FROM THE PRIOR DAY TO DETERMINE IF THEY CAN QUALIFY FOR FINANCIAL ASSISTANCE. AS PART OF THIS PROCESS, THE HOSPITAL ALSO MAKES THE DETERMINATION AS TO WHETHER THE PATIENT MAY QUALIFY FOR MEDICAID. BASED UPON THE INFORMATION THAT THE ENROLLMENT SPECIALIST OBTAINS, THE HOSPITAL CAN PRESUMPTIVELY APPROVE A PATIENT FOR MEDICAID COVERAGE THAT AT LEAST WILL COVER THAT STAY. REGISTRATION CLERKS DURING THE ADMISSION PROCESS WILL ALSO ADVISE THE PATIENT THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. ON AN ANNUAL BASIS, INFORMATION REGARDING THE HOSPITAL FINANCIAL ASSISTANCE POLICY AND THE PRELIMINARY COLLECTION POLICIES ARE ALSO PUBLISHED IN LOCAL NEWSPAPERS.TO FURTHER EDUCATE PATIENTS ABOUT FINANCIAL ASSISTANCE, THERE ARE SIGNS POSTED THROUGHOUT THE FACILITY; THE FINANCIAL ASSISTANCE POLICY IS ON THE HOSPITAL'S WEBSITE, AND A FINANCIAL COUNSELOR IS MADE AVAILABLE UPON REQUEST AND THROUGHOUT NORMAL BUSINESS HOURS. PART VI, LINE 4: THE HOSPITAL IS LOCATED IN THE POTOMAC HIGHLANDS IN THE MOUNTAINS OF THE EASTERN PANHANDLE OF WEST VIRGINIA. THE CLOSEST HOSPITALS ARE LOCATED APPROXIMATELY 1 1/2 HOURS AWAY DURING GOOD WEATHER. DURING THE WINTER, IT TYPICALLY WILL TAKE MUCH LONGER DEPENDING ON WEATHER CONDITIONS. THE HOSPITAL'S PRIMARY SERVICE AREA IS COMPOSED OF THE WEST VIRGINIA COUNTIES OF GRANT, HARDY AND PENDLETON. THE TOTAL POPULATION OF THE THREE COUNTIES COMBINED IS APPROXIMATELY 30,000. DUE TO THE DISTANCE FROM OTHER AREA HOSPITALS, THE HOSPITAL DOES PROVIDE OB SERVICES. DURING THIS TAX YEAR, THE HOSPITAL HAD APPROXIMATELY 240 DELIVERIES WITH THE VAST MAJORITY OF THESE PATIENTS BEING COVERED UNDER THE MEDICAID PROGRAM OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THIS SERVICE DOES OPERATE AT A LOSS, BUT THE HOSPITAL BOARD BELIEVES THAT THIS SERVICE MUST BE PROVIDED EVEN AT A LOSS.IN ADDITION, DUE TO THE LACK OF MOBILITY OF THE ELDERLY AND THE FACT THAT FAMILY MEMBERS NO LONGER RESIDE IN THE COMMUNITY, THE ELDERLY POPULATION IS DEPENDENT UPON THE HOSPITAL FOR THE PROVISION OF HEALTHCARE SERVICES. THE HOSPITAL ALSO HAS TO COORDINATE CARE FOR ITS PATIENTS AS THEY MOVE THROUGH THE CONTINUUM OF CARE AS NURSING HOMES, PHYSICIANS, HOME HEALTH AND HOSPICE SERVICES.THE ECONOMY IS PRIMARILY AGRICULTURAL, HARDWOOD MANUFACTURING AND POULTRY PROCESSING. THE MAJOR EMPLOYERS ARE (POULTRY PROCESSING PLANTS) AND TWO HARDWOOD COMPANIES, THE VARIOUS BOARDS OF EDUCATION AND THE HOSPITAL. DURING THE LAST COUPLE OF YEARS THERE HAVE BEEN SIGNIFICANT REDUCTIONS IN STAFF AT BOTH HARDWOOD COMPANIES.SINCE THE HOSPITAL IS A POLITICAL SUB-DIVISION OF GRANT COUNTY, THE BOARD MEMBERS ARE APPOINTED BY THE GRANT COUNTY COMMISSION FOR ALL THREE COUNTIES. EACH OF THE BOARD MEMBERS LIVE IN EACH OF THE MAGISTERIAL DISTRICTS FOR EACH OF THE THREE COUNTIES. A FEW YEARS AGO, IT WAS DECIDED THAT BOARD REPRESENTATION SHOULD INCLUDE HARDY AND PENDLETON COUNTIES AS WELL AS GRANT COUNTY. UNDER WEST VIRGINIA LAW, THE COMPOSITION OF THE BOARD MUST REPRESENT A BROAD SECTION OF THE HOSPITAL'S SERVICE AREA. AS A RESULT, OCCUPATIONS OF THE BOARD MEMBERS ARE BANKERS, LAWYERS, EDUCATORS, SMALL BUSINESS AND UNION MEMBERS. PART VI, LINE 5: MEMBERSHIP TO THE MEDICAL STAFF IS OPEN TO ANY PROVIDER WHO POSSESSES THE APPROPRIATE QUALIFICATIONS TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY. THE HOSPITAL PERFORMS BACKGROUND CHECKS ON EDUCATION, STATE LICENSES, EXPERIENCE, ANY ACTIONS WHERE THE PHYSICIAN MAY HAVE BEEN REPORTED TO THE NATIONAL DATA BANK, POTENTIAL LITIGATION AND CRIMINAL ISSUES. IF THESE COME BACK FAVORABLE TO THE PHYSICIAN, THE PROSPECTIVE MEMBER IS INTERVIEWED BY THE CHIEF OF STAFF. BASED UPON THIS PROCESS, THE CHIEF OF STAFF WILL MAKE A RECOMMENDATION TO EITHER ACCEPT OR REJECT THE PROSPECTIVE MEMBER TO THE MEDICAL STAFF. IF THE RECOMMENDATION IS TO ACCEPT THE PROSPECTIVE MEMBER, THE MEDICAL STAFF WILL HOLD A FORMAL VOTE ON WHETHER TO ACCEPT OR REJECT THE PHYSICIAN. IF THE MEDICAL STAFF APPROVES THE PHYSICIAN FOR MEMBERSHIP TO THE MEDICAL STAFF, THIS IS THEN TAKEN TO THE BOARD OF TRUSTEES FOR A VOTE. THE CURRENT MEDICAL STAFF HAS A VERY DIVERSE BACKGROUND IN THAT THERE ARE BOTH MEN AND WOMEN ON THE MEDICAL STAFF AS WELL AS MEMBERS WHO WERE BORN IN FOREIGN COUNTRIES SUCH AS INDIA, SOUTH KOREA, THE DOMINICAN REPUBLIC AS WELL AS THE UNITED STATES. THE HOSPITAL HAS RECRUITED NEW PHYSICIANS DURING THE LAST COUPLE OF YEARS, AND THIS TREND HAS CONTINUED. SINCE THE HOSPITAL IS A POLITICAL SUB-DIVISION OF GRANT COUNTY, THE GRANT COUNTY COMMISSION APPOINTS MEMBERS TO THE BOARD. A FEW YEARS AGO, IT WAS DECIDED THAT THERE SHOULD BE BOARD REPRESENTATION FROM HARDY AND PENDLETON COUNTIES AS WELL AS GRANT COUNTY. UNDER WEST VIRGINIA LAW, THE COMPOSITION OF THE BOARD MUST REPRESENT A BROAD SECTION OF THE HOSPITAL'S SERVICE AREA. CONSEQUENTLY, OCCUPATIONS OF THE BOARD MEMBERS ARE BANKERS, LAWYERS, EDUCATORS, OWNERS OF SMALL BUSINESS, RETIRED CITIZENS AND UNION MEMBERS. PART VI, LINE 6: ALTHOUGH NOT ACTUALLY OWNED BY VALLEY HEALTH SYSTEM LOCATED IN WINCHESTER, VIRGINIA, AS PART OF BECOMING CERTIFIED AS A CAH, THERE IS A FORMAL NETWORK BETWEEN THE TWO HOSPITALS. THE VAST MAJORITY OF THE MEDICAL SERVICES THAT CANNOT BE PROVIDED BY THE HOSPITAL ARE TRANSFERRED TO VALLEY HEALTH SYSTEM. OTHER HOSPITALS IN WHICH PATIENTS ARE TRANSFERRED TO ARE WEST VIRGINIA UNIVERSITY LOCATED IN MORGANTOWN, WEST VIRGINIA; SENTARA MEDICAL CENTER LOCATED IN HARRISONBURG, VIRGINIA; AND THE UNIVERSITY OF VIRGINIA MEDICAL CENTER LOCATED IN CHARLOTTESVILLE, VIRGINIA. PART VI, LINE 7, REPORTS FILED WITH STATES WV X X X 0 0 0 0 0 1 0 1 0 STEPHEN THOMPSON DO TRUSTEE 285387 0 0 0 0 0 0 0 0 0 285387 0 0 0 JOHN L HAHN MD PHYSICIAN 312370 0 812097 0 0 0 33963 0 9099 0 1167529 0 0 0 ANIL MAKANI MD PHYSICIAN 236495 0 12500 0 0 0 7531 0 5152 0 261678 0 0 0 PART I, LINE 6 COMPENSATION FOR DR. HAHN (OB/GYN) IS BASED ON NET EARNINGS. DR. HAHN IS AN INNOVATOR IN THE PROFESSION OF OB, NORMAL DELIVERIES. HE DEVELOPED THE CATHETER, FOR WHICH HE HAS A PATENT THAT IS USED IN ADMINISTERING EPIDURALS. CONSEQUENTLY, GRANT MEMORIAL HOSPITAL WAS PROVIDING EPIDURALS TO WOMEN WHO WERE IN LABOR PRIOR TO WHEN IT BECAME A STANDARD PRACTICE THROUGHOUT THE UNITED STATES. DUE TO HIS REPUTATION, A BOOK AND DOCUMENTARY ARE BEING PRODUCED ABOUT HIS CLINICAL ACHIEVEMENTS IN PROVIDING OB/GYN PHYSICIAN SERVICES. HE HAS BEEN IN PRACTICE AT GRANT MEMORIAL HOSPITAL FOR OVER 25 YEARS. WITH THE EXCEPTION OF ONE WEEK DURING THE YEAR, HE IS ALWAYS ON CALL. IN A SUBURBAN AREA, THE AVERAGE NUMBER OF DELIVERIES PER YEAR BY AN OBSTETRICIAN IS BETWEEN 250-300. DR. HAHN AVERAGES BETWEEN 225-250 DELIVERIES WITH THE VAST MAJORITY OF THESE BEING MEDICAID OR UNINSURED PATIENTS. ALSO THE HOSPITAL SEES ABOUT 49 TEEN BIRTH RATES PER 1,000, WHILE THE NATIONAL AVERAGE IS 21. THE HOSPITAL COMPENSATES DR. HAHN FOR THE SERVICES HE PROVIDES FOR THE HOSPITAL AND TO THE COMMUNITY. OVERALL, HIS COMPENSATION COMPARES TO NATIONAL AVERAGES TAKING INTO CONSIDERATION THAT IT IS DIFFICULT TO RECRUIT OB/GYN PHYSICIANS TO A RURAL AREA, YEARS OF EXPERIENCE, PATENTS THAT HAVE BEEN RECEIVED IN IMPROVING PATIENT CARE AND THE AMOUNT OF CALL PROVIDED BY THE PHYSICIAN. PART I, LINE 7 THE CHIEF FINANCIAL OFFICER'S BONUS IS DETERMINED BY THE CHIEF EXECUTIVE OFFICER AND THE AMOUNT OF THE BONUS MAY VARY EACH YEAR. THE BONUS IS NOT BASED ON THE HOSPITAL'S PROFITABILITY. AMY KILE ALAN KILE (BOARD MEMBER) IS RELATED TO AMY KILE 48192 0 STACEY SITES JASON SITES (BOARD MEMBER) IS RELATED TO STACEY SITES 74150 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIRPERSON, VICE-CHAIRPERSON, TWO OTHER MEMBERS OF THE BOARD, THE CEO, CFO AND CHIEF OF STAFF. DURING INTERVALS BETWEEN BOARD MEETINGS, THE EXECUTIVE COMMITTEE MAY ACT IN THE NAME, AND WITH THE FULL POWER, OF THE BOARD PROVIDED THAT ANY SUCH ACTION SHALL NOT CONFLICT WITH THE POLICIES OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 2 TOM KIMBLE (BOARD MEMBER) AND MARK WRIGHT (BOARD MEMBER) HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL HAS A DUAL CERTIFICATION IN THAT IT IS A POLITICAL SUB-DIVISION OF GRANT COUNTY. FORM 990, PART VI, SECTION A, LINE 7A THE GRANT COUNTY COMMISSION APPOINTS MEMBERS TO THE BOARD WHO RESIDE IN GRANT, HARDY, AND PENDLETON COUNTIES. THE HOSPITAL IS A POLITICAL SUB-DIVISION OR COMPONENT UNIT OF GRANT COUNTY (COUNTY HOSPITAL). FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN WILL BE REVIEWED BY MANAGEMENT AND IS GIVEN TO EVERY MEMBER OF THE BOARD PRIOR TO ISSUANCE. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES AND ADMINISTRATION OFFICIALS SHALL BE REQUIRED TO COMPLETE A WRITTEN CONFLICT OF INTEREST STATEMENT ANNUALLY WHICH SHALL DISCLOSE THE EXTENT OF FINANCIAL DEALINGS WITH THE ORGANIZATION BY ALL BUSINESSES OR OTHER ORGANIZATIONS IN WHICH THEY, OR MEMBERS OF THEIR IMMEDIATE FAMILIES, HAVE A BENEFICIAL INTEREST. A BENEFICIAL INTEREST WITH AN ORGANIZATION WILL BE CONSIDERED TO EXIST WHEN A TRUSTEE OR ADMINISTRATION OFFICIAL OR A MEMBER OF HIS/HER IMMEDIATE FAMILY IS AN OFFICER, DIRECTOR, TRUSTEE, PARTNER, EMPLOYEE OR AGENT OF THE ORGANIZATION, OR OWNS FIVE PERCENT OF THE VOTING STOCK OR CONTROLLING INTEREST IN THAT ORGANIZATION, OR HAS ANY OTHER SUBSTANTIAL INTEREST OR DEALINGS WITH THE ORGANIZATION. AT SUCH TIME, IF ANY MATTER SHOULD COME BEFORE THE BOARD OF TRUSTEES IN SUCH A WAY AS TO GIVE RISE TO A CONFLICT OF INTEREST, THE AFFECTED MEMBER OF THE BOARD SHALL MAKE KNOWN THE POTENTIAL CONFLICT AND IF ADVISABLE, WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO VOTE, THE AFFECTED MEMBER SHALL NOT VOTE, NOR BE COUNTED IN ESTABLISHING A QUORUM FOR THE VOTE ON THAT MATTER. PROCEEDINGS RELATED TO THE CONFLICT OF INTEREST MATTERS BEFORE THE BOARD OF TRUSTEES SHALL BE DOCUMENTED IN THE MINUTES OF THAT MEETING. EVERY JANUARY, THE CEO AND CHAIRMAN ENSURE THE CONFLICT OF INTEREST FORMS ARE COMPLETED. THEY REVIEW THE FORMS TO IDENTIFY ANY INSTANCES THEY CAN FORESEE AND DISCUSS THEM WITH THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 EVERY YEAR A SURVEY IS CONDUCTED THROUGH THE STATE ON AVERAGE SALARIES FOR OFFICERS OF THE ORGANIZATION. THIS ENSURES THE HOSPITAL IS PAYING NO MORE THAN FAIR MARKET VALUE FOR OFFICER COMPENSATION. AFTERWARDS, THE COMPENSATION AVERAGES ARE GIVEN TO THE EXECUTIVE COMMITTEE AND THE COMMITTEE HAS FINAL SAY ON THE ACTUAL COMPENSATION FOR EACH OFFICER OF THE HOSPITAL. THE COMPENSATION PROCESS IS DOCUMENTED IN THE COMMITTEE MINUTES. FORM 990, PART VI, SECTION C, LINE 18 THE TAX RETURN IS SUBMITTED TO THE WEST VIRGINIA HEALTHCARE AUTHORITY UNDER THE STATE OF WEST VIRGINIA'S FINANCIAL DISCLOSURE STATUTE. FORM 990, PART VI, SECTION C, LINE 19 IT IS REQUIRED BY WEST VIRGINIA LAW THAT ALL HOSPITALS FILE FINANCIAL STATEMENTS, MEDICARE/MEDICAID COST REPORTS, TAX RETURNS AND OTHER FINANCIAL INFORMATION TO THE WEST VIRGINIA HEALTH CARE AUTHORITY. IN ADDITION, FINANCIAL STATEMENTS ARE ALSO REQUIRED TO BE PUBLISHED IN LOCAL NEWSPAPERS. INFORMATION SUBMITTED TO THE WEST VIRGINIA HEALTH CARE AUTHORITY MAY BE OBTAINED UNDER THE FREEDOM OF INFORMATION ACT. THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S BOARD OF DIRECTORS ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED.