2015-08-14T11:02:49-05:00 2014-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2013-10-01 550440086 Pleasant Valley Hospital PLEA 3046754340 2520 Valley Drive Pt Pleasant WV 25550 Richard Hogan CFO 3046754340 2015-08-14 1 Harry C Harless P01042847 3043460441 2013 2016-04-25 22:37:26Z Glen Washington 2520 Valley Drive Pt Pleasant WV 25550 70153147 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 13 858 100 -1196 -1446 50198 77668 69367500 68652995 244120 288538 896245 1104339 70558063 70123540 80728 49383 0 0 40403175 39881479 0 0 0 32276133 30678722 72760036 70609584 -2201973 -486044 36272220 35112016 15855451 15181291 20416769 19930725 To operate an acute care hospital facility for the citizens of Point Pleasant, West Virginia and the surrounding communities and counties. 0 0 59192631 49383 68510264 The hospital provided 39,620 acute, nursery, and skilled nursing days; 122,478 outpatient visits; 15,541 emergency room visits; 2,261 ambulatory surgeries; 1,152 observation visits; 19,284 home health visits; 1,228 hospice visits; and 41,740 physician office visits. 119419 142731 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. 59312050 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 45 0 1 858 1 1 1 0 0 0 0 0 0 0 0 0 X 18 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Richard Hogan CFO 3046754340 2520 Valley Drive Point Pleasant WV 25550 Mario Liberatore Trustee 3.00 0.50 X 0 0 0 Peter Allinder Chairman 3.00 0.30 X 0 0 0 Annette Boyles Vice Chairman 3.00 0.50 X 0 0 0 Charles Lanham Treasurer 3.00 0.50 X 0 0 0 Michael Lieving Trustee 3.00 0.50 X 0 0 0 Scott Barnitz Trustee 3.00 0.30 X 0 0 0 Jack Buxton OD Trustee 3.00 0.30 X 0 0 0 Clayton Faber Trustee 3.00 0.30 X 0 0 0 Randall Hawkins MD Trustee 40.00 0.30 X 308859 0 27714 William Tatterson Trustee 3.00 0.30 X 0 0 0 Thomas Willoughby Trustee 3.00 0.30 X 0 0 0 C Dallas Kayser Trustee 3.00 0.30 X 0 0 0 Dorsel Keefer Trustee 3.00 0.30 X 0 0 0 James Lockhart DDS Trustee 3.00 0.30 X 0 0 0 William Knight Trustee 3.00 0.30 X 0 0 0 James Rossi Trustee 3.00 0.30 X 0 0 0 Lannes Williamson Secretary 3.00 0.30 X 0 0 0 Amanda Clark Trustee 3.00 0.30 X 0 0 0 Thomas E Schauer President/CEO 40.00 X 231774 0 19510 Larry Unroe President/CEO 40.00 X 101778 0 0 Richard Hogan CFO 40.00 X 173639 0 17792 Robert Tayengco MD Physician 40.00 X 383371 0 27714 James Toothman MD Physician 40.00 X 790421 0 27714 Ori Tzuk MD Physician 40.00 X 566940 0 27131 Clifford Roberson MD Physician 40.00 X 552330 0 17604 Stephen Rerych MD Physician 40.00 X 425870 0 27714 3534982 0 192893 9 0 1 0 NAPS Incorporated 714 1/2 Lee Street Charleston WV 25301 Anesthesia Services 492979 Quest Diagnostics PO Box 740709 Atlanta GA 30374 Laboratory Services 416147 Crest Services 735 Plaza Blvd 210 Coppeil TX 75019 Biomedical Services 308190 3 2496 75172 77668 Patient Services 622110 66922264 66922264 Electronic health records incenti 900099 1588000 1588000 Wellness Center 621111 142731 142731 68652995 288538 -1196 289734 416526 29607 386919 386919 386919 Cafeteria & vending 722212 201993 201993 Purchase discounts 900099 102303 102303 Gift shop 453220 38950 38950 374174 374174 717420 70123540 68652995 -1196 1394073 49383 49383 812935 649616 163319 26278072 20998807 5279265 695531 555799 139732 10265267 8202975 2062292 1829674 1462092 367582 50177 50177 54628 54628 5858563 4681578 1176985 346609 276975 69634 2092603 1661835 430768 7812 6243 1569 986276 788133 198143 486512 388772 97740 372135 297373 74762 2676804 2139034 537770 580775 464097 116678 Bad debts 7770407 7770407 Medical supplies 5420809 5420809 Repairs & maintenance 1646491 1315711 330780 Medicaid provider tax 1251207 1251207 1076914 931204 145710 70609584 59312050 11297534 0 0 88306 5366936 4675198 9360126 10930441 227546 185048 1263211 1210736 453905 320461 76350782 61764970 16718566 14585812 35817 284646 2846113 2831368 36272220 35112016 6861438 7549600 6360000 5785000 2634013 1846691 15855451 15181291 X 20416769 19930725 20416769 19930725 36272220 35112016 -486044 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1254831 1254831 320643 24556628 17338017 7539254 233667 233667 0 47744298 42257310 5486988 2240715 1935976 304739 14585812 Due from related parties 128107 Other receivables 2304351 Accrued interest 2551 Estimated third party receivables 396359 2831368 Capital lease agreements 1116217 Estimated third party payor settlements 683208 Bond issue liabilities 47266 1846691 1 1 X 1 X 1 X 100.000000000000 1 1 0 1 1 250325 250325 0.00400 16060304 13422159 2638145 0.04200 16310629 13422159 2888470 0.04600 163803 30553 133250 0.00210 1113372 1113372 0.01770 47735 47735 0.00080 1324910 30553 1294357 0.02060 17635539 13452712 4182827 0.06660 754 754 0.00000 6582 6582 0.00010 1315 1315 0.00000 351624 351624 0.00560 6646 6646 0.00010 366921 366921 0.00580 1 2753832 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 1 X X X X X X X X 12 1 0 1 www.pvalley.org X X X X X X X 1 0 1 1 100.000000000000 1 100.000000000000 1 X X X 1 1 X X X 1 0 X X X X 1 X 0 0 Pleasant Valley Hospital Part V, Section B, Line 3: 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 14g: 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 20d: 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. 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 $ 7,770,407. 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 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.Cost of bad debts was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. Part III, Line 8: Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions. 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 27,016 residents, the median household income is $38,411, and 19% are below poverty levels. Jackson County has 29,126 residents, the median household income is $40,376, and 19% are below poverty levels. Gallia county has 30,397 residents, the median household income is $39,226 and 17.7% is below poverty levels. Meigs County has 23,331 residents, the median household income is $35,469 and 21.9% is below poverty levels. Medicaid patients made up 24.8% of our total discharges and 18.5% of our total outpatient visits in FY2014. Uninsured patients made up of 3.3% of our total discharges and 2.4% of our total outpatient vists in FY2014. There is one other not-for-profit hospital within 15 miles of PVH. They serve many of the same areas that PVH does. 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) 10000 High school athletic program support and Kids Expo Mason County Fair Inc PO Box 334 Point Pleasant WV 25550 550628521 501(c)(3) 21305 Support of fair activities. X X 1 1 X X X X 1 0 0 0 0 0 0 0 0 Randall Hawkins MD Trustee 200984 0 107875 0 0 0 11889 0 16607 0 337355 0 0 0 Thomas E Schauer President/CEO 139274 0 0 0 92500 0 7796 0 12337 0 251907 0 0 0 Richard Hogan CFO 173538 0 101 0 0 0 0 0 18576 0 192215 0 0 0 Robert Tayengco MD Physician 383269 0 102 0 0 0 11889 0 16669 0 411929 0 0 0 James Toothman MD Physician 790319 0 102 0 0 0 11889 0 16701 0 819011 0 0 0 Ori Tzuk MD Physician 525138 0 41802 0 0 0 11889 0 16339 0 595168 0 0 0 Clifford Roberson MD Physician 526228 0 26102 0 0 0 11889 0 6811 0 571030 0 0 0 Stephen Rerych MD Physician 425768 0 102 0 0 0 11889 0 16835 0 454594 0 0 0 Part I, Line 4a Thomas Schauer $92,500 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 2800000 7805000 7021907 156100 626993 2003 0 0 1 1 B 2365000 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 Lee Anne Kayser Family member of C. Dallas Kayser, Hospital Trustee 24787 Wages 0 Heather Lloyd Family member of James Lockhart, Hospital Trustee 12998 Fees for service-independent contractor 0 Jane Zirkle Family member of Mike Lieving, Hospital Trustee 23029 Wages 0 Wes Lieving DO Family member of Mike Lieving, Hospital Trustee 237333 Wages 0 Peoples Bank James Lockhart, Hospital Trustee, is a board member of the bank 271 Interest bearing checking accounts 0 Peoples Bank Dorsal Keefer, Hospital Truste, is a board member of the bank 271 Interest bearing checking accounts 0 Ohio Valley Bank Charles Lanham, Hospital Trustee, is an officer of the bank` 31112 Interest on certificates of deposit 0 Ohio Valley Bank Mario Liberatore, Hospital Trustee, is an officer of the bank 31112 Interest on certificates of deposit 0 Ohio Valley Bank Lannes Williamson, Hospital Trustee, is a board member of the bank 31112 Interest on certificates of deposit 0 Farmers Bank Michael Lieving, Hospital Trustee, is an officer of the bank 8432 Interest on certificates of deposit 0 David Faber MD Family member of Clayton Faber, Hospital Trustee 175583 Wages 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. 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 Home Medical Equipment Viand St Pt Pleasant WV 25550 550653315 Retail - Medical equipment sales & rental WV Pleasant Valley Hospital C -276964 1480788 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0