2015-08-17T09:14:28-05:00 2014-09-30 550526247 WILSON KOZICKI & GWYNN PLLC 32 TWENTIETH STREET SUITE 300 WHEELING WV 26003 990 2013-10-01 340714643 BELMONT COMMUNITY HOSPITAL BELM 7406711200 4697 HARRISON STREET BELLAIRE OH 43906 JAMES B MURDY CFO 3042433681 2015-08-14 DENNIS A KOZICKI P00366642 3042322280 2015-08-14 2013 2016-04-25 22:37:26Z RONALD VIOLI 1 MEDICAL PARK WHEELING WV 26003 23301752 0 X WWW.WHEELINGHOSPITAL.ORG X 1903 OH TO PROVIDE NEEDED CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. 6 4 242 17 3062013 -2307 1446455 915967 19741196 18252271 58760 72965 3195868 3952493 24442279 23193696 0 0 0 0 11243722 11337029 0 0 0 14181272 13970258 25424994 25307287 -982715 -2113591 12126728 11475045 5827464 6847965 6299264 4627080 X BELMONT COMMUNITY HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE TO PATIENTS FROM BELMONT COUNTY AND SURROUNDING COMMUNITIES REGARDLESS OF RACE, CREED, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES, AND OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH BELMONT COMMUNITY HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT OR BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXIST. 0 0 23718671 18252271 BELMONT COMMUNITY HOSPITAL SERVED 695 INPATIENTS AND 78,681 OUTPATIENTS DURING THE PERIOD OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014. 23718671 1 0 0 1 0 0 0 0 0 1 1 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 36 0 242 1 1 1 0 0 0 0 0 0 0 X 6 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X JAMES B MURDY CFO 3042433681 ONE MEDICAL PARK WHEELING WV 26003 X ROBERT A BITTENGLE TRUSTEE 1.00 X 0 0 0 NELLIE T MAGYAR TRUSTEE 1.00 X 0 0 0 CHAGANLAL N PATEL TRUSTEE/CHIEF OF STAFF 41.00 X 195697 0 22958 BRUCE A ARCHER TRUSTEE 1.00 40.00 X 0 120478 27939 C GARY HILL PRESIDENT 1.00 X 0 0 0 RICHARD M POLINSKY VICE PRESIDENT/SECT-TREAS 1.00 X 0 0 0 JAMES B MURDY CHIEF FINANCIAL OFFICER 4.00 56.00 X 0 295019 40983 JOHN DEBLASIS ADMINISTRATOR 30.00 30.00 X 0 153692 18261 MARWAN YANES PHYSICIAN 40.00 X 214758 0 10800 SHASHI GUPTA PHYSICIAN 40.00 X 247544 0 23498 DANIEL B JONES PHYSICIAN 40.00 X 322380 0 21111 GEORGE CHOLAK PHYSICIAN 40.00 X 275120 0 1814 MAHESHWER MUSUNURI PHYSICIAN 40.00 X 238888 0 29608 1494387 569189 196972 15 0 1 0 DEREK H ANDREINI MD 4697 HARRISON STREET BELLAIRE OH 43906 PHYSICIAN SERVICES 207500 1 915967 915967 GROSS PATIENT REVENUE 623990 47238305 47238305 CHARITY CARE 623990 -1026084 -1026084 BAD DEBT 623990 -1143243 -1143243 CONTRACTUAL ALLOWANCE 623990 -26816707 -26816707 18252271 72965 72965 166801 10800 108056 0 58745 10800 69545 69545 OUTPATIENT PHARMACY 446110 3062013 3062013 OTHER 624210 772390 772390 CONVENIENCE 900099 48545 48545 3882948 23193696 18252271 3062013 963445 217772 217772 9073730 9017060 56670 28872 28692 180 1400157 1391545 8612 616498 607015 9483 144939 144939 60 60 67225 67225 661 661 4498280 4482914 15366 148979 148979 938138 938138 21647 443 21204 60824 60824 858514 858514 573716 573716 PURCHASED SERVICES 5669397 4771046 898351 OTHER EXPENSES 745365 550696 194669 MEDICAL SERVICES 163500 163500 DUES, BOOKS, SUBSCRIPTI 79013 56796 22217 25307287 23718671 1588616 0 1702219 592667 103429 104051 2271231 1923508 623872 714387 233630 294074 21643668 17194664 4866519 4449004 1766276 2035024 559552 1362330 12126728 11475045 5584746 6664264 242718 183701 5827464 6847965 X 4700348 2586757 66713 67153 1532203 1973170 6299264 4627080 12126728 11475045 X -2113591 441407 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 661 661 0 Part II-B, Line 1: BELMONT COMMUNITY HOSPITAL IS A MEMBER OF THE OHIO HOSPITAL ASSOCIATION AND PAYS ANNUAL DUES. FOR 2014, THE PERCENTAGE OF OHA DUES RELATED TO LOBBYING ACTIVITIES IS 3.4%. 1532203 512811 71844 1973170 1603404 -16205 54996 1532203 1080422 578017 55035 1603404 238912 877121 35611 1080422 1188491 -946938 2641 238912 1.00000 1 0 274164 274164 8659765 6764824 1894941 12196471 10064615 2131856 513268 365225 148043 4449004 DORIS C NARDELLA TRUST 61854 F MELLOTT TRUST 1973170 F 2035024 MELLOTT TRUST RECEIVABLE 11654 OTHER RECEIVABLE 6033 AMOUNTS DUE 3RD PARTY PAYORS 1042813 ACUITY RECEIVABLE 277374 WHEELING HOSPITAL PHYSICIAN RENT RECEIVABLE 1163 GIFT SHOP EMPLOYEE SALES RECEIVABLE 2189 CAPTURE RX RECEIVABLE 21104 1362330 Part V, Line 4: THE INCOME FROM THE ENDOWMENT FUND MUST BE USED FOR THE UPKEEP AND MAINTENANCE OF THE HOSPITAL. 1 1 1 X 1 X 0 1 0 1 1 191666 191666 0.00760 4524445 1773569 2750876 0.10870 4716111 1773569 2942542 0.11630 581 581 0.00000 581 581 4716692 1773569 2943123 0.11630 526578 4772 3374927 5400431 -2025504 X 1 1 1 1 BELMONT COMMUNITY HOSPITAL 4697 HARRISON STREET BELLAIRE OH 43906 X X X BELMONT COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X WWW.WHEELINGHOSPITAL.ORG X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X 1 1 X X 1 0 X 1 X 0 0 BELMONT COMMUNITY HOSPITAL Part V, Section B, Line 3: INTERVIEWS WERE CONDUCTED WITH SELECTED STAKEHOLDERS FROM THE WHEELING SERVICE AREA TO DISCUSS THE COMMUNITY HEALTH NEEDS IN THE WHEELING SERVICE AREA. THE FOLLOWING IDEAS 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'S HEALTH CARE-WHEELING HOSPITAL'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'S POSSIBLE ROLES FOR MEETING FUTURE HEALTH CARE NEEDS FOR COMMUNITY HEALTH SERVICES-POTENTIAL FOR SUCCESS IN EXPANDING SERVICES AT WHEELING HOSPITAL AND THE CHALLENGES FACED IN EXPANDING SERVICES IN THE AREAA VARIETY OF VARIOUS COMMUNITY REPRESENTATIVES WERE INTERVIEWED, INCLUDING A REPRESENTATIVE FROM BELMONT COMMUNITY HOSPITAL, THE WHEELING HOSPITAL DIRECTOR OF NURSING, WHEELING HOSPITAL'S SUPPLIES AND INVENTORY MANAGER, FORMER MAYOR OF WHEELING AND MEMBERS OF THE WHEELING HOSPITAL 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. BELMONT COMMUNITY HOSPITAL Part V, Section B, Line 7: BELMONT COMMUNITY HOSPITAL IS A SMALL FACILITY WITH LIMITED FINANCIAL RESOURCES AND, AS SUCH, IS NOT FINANCIALLY CAPABLE OF HIRING IN EVERY AREA OF MEDICAL PRACTICE LISTED IN THE CHNA OR ESTABLISHING PROJECTS THAT ADDRESS THE NEED FOR THE AREA'S AGING POPULATION. HOWEVER, THE HOSPITAL DID ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BUT WAS NOT FULLY ABLE TO MEET ALL OF THOSE NEEDS. IT SHOULD BE NOTED THAT BELMONT COMMUNITY HOSPITAL COLLABORATES WITH ITS PARENT HOSPITAL, WHEELING HOSPITAL, ON RECRUITING INITIATIVES. THE PARENT HOSPITAL HAS ALSO TAKEN ON FEASIBILITY STUDIES IN RELATION TO THE PROJECTS THAT ADDRESS THE NEED FOR THE AREA'S AGING POPULATION. THE PARENT HOSPITAL IS LOCATED LESS THAN 9 MILES FROM BELMONT COMMUNITY HOSPITAL. BELMONT COMMUNITY HOSPITAL Part V, Section B, Line 20d: THE HOSPITAL CHARGES THE SAME TO EVERY PATIENT REGARDLESS OF FINANCIAL CLASS. BELMONT COMMUNITY HOSPITAL 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. INPATIENT SERVICE PERCENTAGE IN 64%. OUTPATIENT SERVICE PERCENTAGE IS 53%.REFERENCE TO THE FINANCIAL ASSISTANCE POLICY AND INSTRUCTIONS ON HOW TO ACCESS THE FINANCIAL ASSISTANCE POLICY ARE PRINTED ON THE BACK OF THE PATIENT BILLING STATEMENTS. Part I, Line 7: THE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS WAS USED. Part I, Ln 7 Col(f): NO BAD DEBT EXPENSE WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), AS BAD DEBT WAS REPORTED AS A REDUCTION TO NET PATIENT SERVICE REVENUE. Part III, Line 4: THE PERCENTAGE FROM WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE AT COST REFLECTED ON LINE 2. THIS RATIO WAS APPLIED TO THE TOTAL BAD DEBT EXPENSE INCLUDED IN NET PATIENT SERVICES 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 TO GROSS PATIENT REVENUE TO THE TOTAL BAD DEBT EXPENSE AT COST.BELMONT COMMUNITY HOSPITAL DOES NOT HAVE SEPARATE AUDITED FINANCIAL STATEMENTS SO THERE IS NO TEXT OF THE BAD DEBT EXPENSE FOOTNOTE TO PROVIDE. THE 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 STATEMENTS PRODUCED. THEREFORE, THE BAD DEBT AMOUNTS WOULD BE AFTER ANY DISCOUNTS OR PATIENT PAYMENTS HAVE BEEN APPLIED. Part III, Line 8: THE COSTS REFLECTED IN LINE 6 ARE THE ALLOWABLE INPATIENT COSTS FROM WORKSHEET D-1 AND ALLOWABLE OUTPATIENT COSTS FROM D, PART V OF THE 12/31/13 CMS COST REPORT. THIS REPORT WAS USED AS BELMONT COMMUNITY HOSPITAL'S COST REPORT IS FILED ON A CALENDAR YEAR BASIS, AND 12/31/13 CMS COST REPORT IS THE CALENDAR YEAR FILING THAT WOULD FALL IN THE FISCAL YEAR REPORTED ON FORM 990. NONE OF THE 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, IT IS NOT TREATED AS COMMUNITY BENEFIT TO BE CONSISTENT WITH THE PRESENTATION OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. Part III, Line 9b: BELMONT COMMUNITY HOSPITAL'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 BYTHE APPLICANT ATTESTING TO THE TRUTHFULNESS AND ACCURACY OF THE INFORMATION PROVIDED. CERTAIN DENIAL LETTERS ARE REQUIRED IN ORDER TO BE ELIGIBLE FOR CHARITY CARE. 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 AND HAVE PROVIDED THE REQUIRED DOCUMENTATION ARE ELIGIBLE TO RECEIVE CHARITY CARE, AND THOSE WHO ARE FROM 201% TO 400% OF THOSE LIMITS ARE ELIGIBILE FOR DISCOUNTS. IN REGARDS TO COLLECTION PRACTICES FOR PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE (I.E. "CHARITY FOR A PORTION OF THEIR BILL") FROM THE HOSPITAL: THE HOSPITAL'S BILLING AND COLLECTION POLICIES NOTE THAT HOSPITAL PERSONNEL ARE TO OBTAIN THE DETAILS OF EACH PATIENT'S FINANCIAL SITUATION AND ASSIST EACH PATIENT BY PROVIDING THEM WITH THE VARIOUS SETTLEMENT OPTIONS THAT THE HOSPITAL MAKES AVAILABLE. FOR PATIENTS WHO ARE FAP-ELIGIBLE FOR A PORTION OF THEIR BILL, THIS GENERALLY MEANS THAT A PATIENT FINANCIAL COUNSELOR WILL ARRANGE A PAYMENT PLAN THAT IS MANAGEABLE FOR THE PATIENT. REFERENCE TO THE FINANCIAL ASSISTANCE POLICY AND INSTRUCTIONS ON HOW TO ACCESS THE FINANCIAL ASSISTANCE POLICY ARE PRINTED ON THE BACK OF THE PATIENT BILLING STATEMENTS. Part VI, Line 2: BELMONT COMMUNITY HOSPITAL 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. AN IMPLEMENTATION PLAN WAS ADOPTED BY BELMONT COMMUNITY HOSPITAL IN RESPONSE TO THE CHNA. Part VI, Line 3: INFORMATION IS INCLUDED ON THE BACK OF PATIENT INVOICES REGARDING THE HCAP PROGRAM. REFERENCE TO THE FINANCIAL ASSISTANCE POLICY AND INSTRUCTIONS ON HOW TO ACCESS THE FINANCIAL ASSISTANCE POLICY ARE PRINTED ON THE BACK OF THE PATIENT BILLING STATEMENTS. SELF PAY ACCOUNTS OVER $500 ARE SCREENED BY THE MEDICAL ADVOCACY SERVICES FOR HEALTHCARE (MASH) SERVICE OFF SITE FOR GOVERNMENT PROGRAM ELIGIBILITY. IN ADDITION, SELF PAY PATIENTS ARE CONTACTED BY THE PATIENT ACCOUNTING DEPARTMENT TO DISCUSS MEANS OF PAYMENT. IF THE PATIENT STATES THAT THEY DO NOT HAVE THE MEANS TO PAY, BCH STAFF REVIEWS OTHER OPTIONS, SUCH AS PAYMENT PLAN, CHARITY OR DISCOUNT. Part VI, Line 4: BELMONT COMMUNITY HOSPITAL PREDOMINANTLY SERVICES THE WHEELING METROPOLITAN STATISTICAL AREA. THE PRIMARY SERVICES 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 PECENTAGE 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: BELMONT COMMUNITY HOSPITAL IS AN AFFILIATE OF WHEELING HOSPITAL, OFFERING PRIMARY CARE AND SELECTED SPECIALITY SERVICES FOR THE RESIDENTS OF THE UPPER OHIO VALLEY. X X 0 0 0 1 0 0 0 0 0 CHAGANLAL N PATEL TRUSTEE/CHIEF OF STAFF 195594 0 103 0 0 0 1836 0 21122 0 218655 0 0 0 JAMES B MURDY CHIEF FINANCIAL OFFICER 0 244918 0 50101 0 0 0 18185 0 22798 0 336002 0 0 JOHN DEBLASIS ADMINISTRATOR 0 143591 0 10101 0 0 0 9426 0 8835 0 171953 0 0 MARWAN YANES PHYSICIAN 214655 0 103 0 0 0 0 0 10800 0 225558 0 0 0 SHASHI GUPTA PHYSICIAN 207238 0 40306 0 0 0 2503 0 20995 0 271042 0 0 0 DANIEL B JONES PHYSICIAN 322278 0 102 0 0 0 0 0 21111 0 343491 0 0 0 GEORGE CHOLAK PHYSICIAN 275018 0 102 0 0 0 0 0 1814 0 276934 0 0 0 MAHESHWER MUSUNURI PHYSICIAN 141491 0 97397 0 0 0 2351 0 27257 0 268496 0 0 0 Part I, Line 5 MUSUNURI'S INCENTIVES ARE BASED ON NET INCOME. GUPTA'S INCENTIVES ARE BASED ON CASH RECEIPTS. OVERALL PHYSICIAN COMPENSATION WAS DETERMINED TO BE REASONABLE. PART II: THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JAMES B MURDY IS FOR SERVICES RENDERED AS CFO FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. EXPLANATION: THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JOHN DEBLASIS IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION. HIS TIME IS SPENT EVENLY BETWEEN THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. EXPLANATION: THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR BRUCE ARCHER IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. NONE OF THE WAGES PAID ARE RELATED TO BEING A TRUSTEE ON THE BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 11 AN OUTSIDE CPA FIRM IS HIRED TO REVIEW THE 990. COPIES OF THE 990 ARE SENT TO ALL BOARD MEMBERS PRIOR TO FILING THE RETURN. 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 BELMONT COMMUNITY HOSPITAL. RESPONSES ARE REVIEWED AND IDENTIFIED. CONFLICTS ARE REFERRED TO THE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. 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 OFFICERS AND KEY EMPLOYEES COMPENSATION IS REVIEWED BY A BELMONT COMMUNITY HOSPITAL 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. PART VII, SECTION A, 1A (E) THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JAMES B MURDY IS FOR SERVICES RENDERED AS CFO FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JOHN DEBLASIS IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION AND FOR OTHER SERVICES TO THE RELATED ORGANIZATION. THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR BRUCE ARCHER IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION AND FOR OTHER SERVICES TO THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. NONE OF THE WAGES PAID ARE RELATED TO BEING A TRUSTEE ON THE BOARD OF DIRECTORS. Form 990, Part XI, line 9: REVALUATION OF PERMANENTLY RESTRICTED FOR OTHER-THAN-TEMPORARY IMPAIRMENT 440,967. TEMPORARILY RESTRICTED CONTRIBUTIONS 440. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED. WHEELING HOSPITAL INC ONE MEDICAL PARK WHEELING WV 26003 550357057 HOSPITAL WV 501C(3) 3 0 BELMONT COMMUNITY HOSPITAL AUXILIARY 4697 HARRISON STREET BELLAIRE OH 43906 346567473 FUNDRAISING FOR HOSPITAL OH 501C(3) 9 0 THE MEDICAL PARK FOUNDATION ONE MEDICAL PARK WHEELING WV 26003 550744690 RAISING CONTRIBUTIONS FOR RELATED ORGANIZATION WV 501C(3) 1 0 MOUNTAINEER FREEDOM RISK RETENTION GROUP INC ONE MEDICAL PARK WHEELING WV 26003 320184323 CAPTIVE INSURANCE COMPANY WV C 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 0 1 WHEELING HOSPITAL L 172671 ACTUAL AMOUNT WHEELING HOSPITAL M 650391 ACTUAL AMOUNT WHEELING HOSPITAL O 2319590 ACTUAL AMOUNT WHEELING HOSPITAL P 3022286 ACTUAL AMOUNT wHEELING HOSPITAL K 108616 ACTUAL AMOUNT WHEELING HOSPITAL E 67530 ACTUAL AMOUNT WHEELING HOSPITAL S 1012427 ACTUAL AMOUNT WHEELING HOSPITAL K 100209 ACTUAL AMOUNT