2015-08-17T10:35:54-05:00 2014-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2013-10-01 550484469 Hospital Development Co HOSP 3049274444 200 Hospital Drive Spencer WV 25276 Douglas Bentz CEO 3049274444 2015-08-10 1 Harry C Harless P01042847 3043460441 2013 2016-04-25 22:37:26Z Roane General Hospital Douglas Bentz 200 Hospital Drive Spencer WV 25276 31462680 0 X www.roanegeneralhospital.com X 1966 WV To promote the general health and welfare of Roane County and surrounding areas and all of the citizens thereof by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public, including but not limited to the operation of hospitals, nursing schools, nursing homes and medical research facilities; to foster and conduct education in medicine in all its branches and in those adjacent and kindred arts and sciences such as nursing and technical training which contribute to the diagnosis, treatment, care and prevention of disease. 15 14 338 36 0 0 104952 97912 26150052 28787593 90443 148043 985703 268852 27331150 29302400 0 0 0 0 14545701 15405924 0 0 0 12275196 13284970 26820897 28690894 510253 611506 17398082 17075008 9843353 8845179 7554729 8229829 X Roane General Hospital is dedicated to the delivery of high-quality, cost effective health care to all members of our community. The work we do makes a difference in people's lives. 0 0 24390720 28778143 Roane General Hospital generated gross revenue of $47,897,936 of which $20,195,104 was uncollectible due to contractual agreements with Medicare, Medicaid and other third-party payors. Bad debts due to inability or unwillingness of patients to pay amounted to $2,248,118. Additionally, charges for patients meeting 200% of the poverty level and who qualified for charity care were written off totaling $861,572. As a Critical Access hospital we provided health care services to our community which included the following days of care: Skilled/Intermediate Care Facility 12,282; Swing 2,487; and Acute Care 966.Additionally, we provided 29,694 outpatient diagnostic visits; 7,761 emergency room visits and 28,899 rural health clinic provider visits. Revenue and expenses related to these services are included above in box 4a. 150648 9450 The Hospital also provided community health education and health screening services at reduced fees during the year including health fairs that served 2,010 participants; diabetes education seminars that served 694 participant; diabetes education screening that served 436 participants and provided sports physicals to 63 participants. The Hospital served a total of 3,203 community participants through its community health education and health screening programs. Other programs provided include Cardiac Rehab, Laboratory Services, Emergency Room, Pharmacy, Radiology, CT Scan, Ultrasound, MRI, Nuclear Medicine, Physical Therapy, Operating Room and RHC's. Revenue and expenses related to these services are included above in box 4a. 24541368 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 61 0 1 338 1 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Louise Ward 3049276201 200 Hospital Drive Spencer WV 25276 Jack D Garrett II President 0.50 X 0 0 0 Jeanette Atkinson Board Member 0.50 X 0 0 0 Martha Cooper Board Member 0.50 X 0 0 0 William Downey Jr Vice President 0.50 X 0 0 0 Christine Hedges Board Member 0.50 X 0 0 0 Paul Hughes Board Member 0.50 X 0 0 0 John Taylor Board Member 0.50 X 0 0 0 John Varda Treasurer 0.50 X 0 0 0 Robert Zdanek Board Member 0.50 X 0 0 0 Robert G Ashley Board Member 0.50 X 0 0 0 Gregory Boggs Vice President 0.50 X 0 0 0 Richard Bowlby Board Member 0.50 X 0 0 0 Jennifer McCulty Secretary 0.50 X 0 0 0 Gerald M Titus Board Member 0.50 X 0 0 0 Douglas Bentz CEO 40.00 X X 264518 0 24885 Hong-Kin Ng MD/Medical Director 40.00 X 340769 0 30612 Daniel B Prudich MD 40.00 X 308048 0 30612 Christopher Lambert MD/ER Director 40.00 X 282452 0 9830 Rudolph M Kevak MD 40.00 X 231413 0 17234 Brent Watson MD/Hospitalist 40.00 X 292851 0 30612 1720051 0 143785 19 0 1 0 Odyssey Rehabilitation 415 Benedum Drive Bridgeport WV 26330 Physical, speech, occupational therapy 362423 Barton Associates 10 Dearborn Road Peabody MA 18602 Physician Staffing 269657 US Mobile Imaging PO Box 808 Cumberland MD 21501 Mobile MRI 184190 Arnett Carbis Toothman PO Box 2629 Charleston WV 25329 Consulting/Accounting 141300 Global Reimbursement 656 Quince Orchard Road Gaithersburg MD 21501 Collections 126809 11 48724 49188 97912 Patient services 622110 26841260 26841260 Pharmacy-340B Program 446110 1160814 1160814 EHR Incentives 900099 655584 655584 Wellness center 713940 129935 129935 28787593 123512 123512 1310 0 1310 1310 1310 2184811 2150207 10073 34604 -10073 24531 24531 Cafeteria 722210 176772 176772 Rebates 900099 32296 32296 Tax refund settlement 900099 27655 27655 30819 30819 267542 29302400 28787593 0 416895 313131 268165 44966 11892271 10184541 1707730 257325 220373 36952 2160950 1850638 310312 782247 669916 112331 253953 253953 141300 141300 2319541 1986455 333086 102331 87636 14695 1542584 1321069 221515 446542 382419 64123 359846 308172 51674 92203 78963 13240 129694 129694 1526559 1307345 219214 579660 496421 83239 Bad debt expense 2248118 2248118 Medical supplies 1916667 1641434 275233 Health care provider ta 674805 674805 Maintenance and repairs 547309 468715 78594 403858 346183 57675 28690894 24541368 4149526 0 78892 19801 1686131 2066765 3193152 3690845 260622 284272 24069 65338 21397654 13512044 8418227 7885610 1890386 1821695 331405 405921 1515198 834761 17398082 17075008 4612283 4223960 1886901 1702401 1681448 2289201 420444 1054968 816926 9843353 8845179 X 7312957 7987512 241772 242317 7554729 8229829 17398082 17075008 X 611506 37384 26210 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 241772 545 242317 241141 631 241772 240468 673 241141 239558 910 240468 238305 1253 239558 1.00000 0 0 125809 125809 4841889 2754759 2087130 16246481 10711896 5534585 183475 45389 138086 7885610 Capital leases 356083 Patient funds 8941 Third party payor settlements 451902 816926 X 27013737 0 27013737 2288663 2288663 29302400 26402776 0 26402776 2288118 2288118 28690894 Part V, Line 4: The income is restricted for the purchase of hospital equipment and for hospital operations. Part X, Line 2: The organization had no uncertain tax positions under Fin 48 as reported in the financial statements. Part XI, Line 4b - Other Adjustments: Bad debt expense netted with revenue on financial statements 2,248,118. Immaterial audit adjustment booked through beginning net assets 545. Grant revenue netted with expense on financial statements 40,000. Part XII, Line 4b - Other Adjustments: Bad debt expense netted with revenue on financial statements 2,248,118. Grant revenue netted with expense on financial statements 40,000. 1 1 X 1 X 0 1 1 0 1 1 1133851 1136780 -2929 0.00000 2403207 2058282 344925 0.01300 3537058 3195062 341996 0.01300 3203 160099 160099 0.00610 3203 160099 160099 0.00610 3203 3697157 3195062 502095 0.01910 1 2248118 5134733 5134733 X 1 1 5 1 Roane General Hospital 200 Hospital Drive Spencer WV 25276 X X X Distinct Part Skilled/Intermediate Care Facility Unit 2 Roane General Medical Clinic 200 Hospital Drive Spencer WV 25276 Rural Health Clinic 3 Roane General Medical Associates 200 Hospital Drive Spencer WV 25276 Rural Health Clinic 4 Southern Roane Medical Clinic 200 Hospital Drive Spencer WV 25276 Rural Health Clinic 5 Walton Medical Clinic 200 Hospital Drive Spencer WV 25276 Rural Health Clinic Roane General Hospital 1 1 X X X X X X X X X 12 1 0 1 X www.roanegeneralhospital.com X X X X X X X 0 0 1 1 200.000000000000 0 1 X X X X X X X 1 1 X X 1 0 X X X 1 X X 0 0 Roane General Hospital Part V, Section B, Line 3: Individuals selected to participate in the key informant survey were health and human services providers, business leaders and individuals with unique knowledge of the community and/or public health. The key informants were requested to participate by completing a survey. Invitations to take the survey were communicated to 78 community and business leaders and health care professionals. Key informants identified obesity and overweight as the most serious health problem facing the community (96%). Also identified as serious issues were diabetes (69%), cardiovascular disease (54%), hypertension (31%) and COPD/asthma (13%). The top health behaviors to address were identified as prescription drug misuse/abuse (23%), illegal substance abuse (23%), and physical inactivity (21%). Roane General Hospital Part V, Section B, Line 7: Needs were reviewed in the strategic planning process for 2014 and included in goals. Implementation will depend of coordinating specialty clinics to meet the needs and finding partners willing to provide services at Roane General Hospital. Some services identified will be reviewed for financial feasibility and available space to provide services. Roane General Hospital Part V, Section B, Line 12i: All self-pay patients are given a 20% discount from gross charges at final bill. Roane General Hospital Part V, Section B, Line 20d: Use of the Medicare fee schedule as a baseline, review by outside consultants for appropriate rates. Part I, Line 3c: The financial assistance program has been established to defray the costs of medically necessary services for those patients who meet the guidelines set forth in the Financial Assistance Policy. Proof of financial status is required as follows: a. If the patient is older than eighteen years old, b. If the patient is married or there are two parents in the household, documents showing both incomes must be provided, c. A patient will be required to re-verify and to re-apply for assistance every six (6) months. When a patient has brought sufficient documentation to prove financial status, financial counseling will determine their eligibility by referencing the matrix based on 200% of the Federal Poverty Guidelines. Required documentation as follows: 1. W-2 withholding forms or 2. Pay stub or 3. Federal Income Tax Return or 4. Forms approving or denying unemployment compensation or workers' compensation or 5. Written verification from DHHR or any other governmental agency that can attest to the patient/responsible party's income status for the prior 12 months or 6. Statement verifying application for unemployment benefits, and Proof of household expenses, if required. Part I, Line 7: The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The cost of community health improvement services was derived from three factors: 1. Average hourly rate per department x employee hours. 2. Actual supply expense 3. Total charges that would have been generated if services were not "free". 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 $ 2,248,118. Part II, Community Building Activities: RGH's Board is comprised of local community members representing small business, labor, elderly, low income, CEO and Chief of Medical Staff. Medical staff privileges are granted to qualified local physicians and consulting physicians after review by the Medical Staff Executive Committee and approval by RGH Board. All funds are used for daily operations, capital equipment or capital physical plant improvements. The emergency room operates 24/7 and provides care to all who present for service. Community support is provided upon request for special projects and donations. RGH Auxiliary operates the gift shop and provides support to RGH for capital equipment upon request. The Community Benefit Report is posted on the hospital website for review by interested parties. Part III, Line 4: Management uses collection percentages based upon historical collection experience to determine collectability. 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. Part III, Line 8: Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions. Part III, Line 9b: SCREENING: All patients identified as self-pay will be screened for Medicaid eligibility referral, provided financial counseling and processed for appropriate financial assistance. FINANCIAL ASSISTANCE: Roane General Hospital encourages patients to apply for financial assistance; patients will be screened according to eligibility rules as defined in governmental assistance program guidelines and/or Roane General Hospital's Financial Assistance Policy and Procedure. CHARITY CARE: Patients with income at or below 200% of Federal Poverty Guidelines are eligible to apply for Roane General Hospital's Charity Care program. Remaining self-pay accounts will be flagged and followed up for financial education regarding their obligation to finalize a mutually acceptable financial agreement to resolve their bill. Part VI, Line 2: Specific goals of the health care needs assessment was to identify:1. Health Care Issues of the Community: The health care need assessment identified prevalent health care issues and gaps in the current health services delivery in this region.2. Vulnerable Populations: The health care need assessment identified persons with barriers to receiving health care services. Rural citizens are a vulnerable population in general due to the lack of specialty services and the required travel to meet many health care needs, and this region provides no exception. Children, seniors, and uninsured/underinsured citizens face the greatest barriers due to the lack of specific services that are available for these populations. If these populations are also of low income, this further compounds the barriers and subsequent access to health care.3. Disparities in the Health Care Services Delivery System: Although many health care services are offered in the region, a number of factors influence access. For example, insurance status, income, and provider and community awareness all affect the ability to access care.4. Health Care Resources in the Community: An assessment of health care services was completed in order to gain an understanding of the availability of health care services in the country. The assessment of the health care services was compiled through general data collection.5. Next Steps (Strategic Planning): The community health needs assessment is a crucial step in future strategic planning. Setting priorities cannot be accomplished without gaining an understanding of the communitys health care needs and concerns. Addressing the health care service issues identified during the assessment is the next step in the process. Part VI, Line 3: All self-pay patients are screened at pre-registration, registration or final bill and are referred to the Financial Counselor for charity eligibility or referred to our in-house Medicaid Case Worker to establish Medicaid coverage. Part VI, Line 4: The total population in Roane County is 15,116 within a total land area of 483.56 square miles; the population density of the area is 31.26 (per square mile). The population is 50.45% female, which is comparable with state and national data. The total population decreased by 3.37% from the 2000 to the 2010 US Census.Roane County shows little ethnic diversity with a population that is 94.34% white; this ethnic diversity rate is very similar to the rate for West Virginia.The median age of individuals residing in Roane County is 42.80, which is higher than that of the state (41.10) and the US (36.90). In addition, approximately one-half of the population in Roane County is between the ages of above the age of 45, with approximately one-third of the population between 45-64 years old. This is especially critical to note since the 45-64 years old group will be reaching retirement age within the next 20 years.Roane County's linguistic isolated population is very small at 0.60%. This percent comparable with the state percent (0.72%) but is significantly less than the national percentage (8.70%). Part VI, Line 5: The members of the Board of Directors of Roane General Hospital are all local business leaders and other community representatives. Medical Staff privileges are extended to all qualified employed physicians, consulting physicians, independent practice physicians and medical staff of the local Federally Qualified Health Center. All surplus funds are reinvested in the new medical equipment, technology or upgrades and renovation of facilities built in 1970. Specifically in 2011, funds were invested to upgrade technology for Electronic Medical Records and to meet the standards for Meaningful Use. The hospital filed for Stage 1 Meaningful Use in September 2011 and was one of only two Critical Access Hospitals in West Virginia to meet these standards of providing and tracking quality patient care. The Emergency Room is operated 24/7 and is staffed by Board Certified Emergency Medicine physicians. The hospital also operates three Rural Health Clinics, provides Walk-In services and three School Based Clinics staffed by physicians employed by Roane General Hospital. Physicians including an orthopedist, urologist, podiatrist, and general practice/wound skin care use our clinics on specified days to screen and provide care not available in our community. Roane General Hospital's Auxiliary, operated independently from the hospital, has approx. 40 members who provide information and customer support services. They also conduct several fund raising events during the year and proceeds from their sales are donated to the hospital to offset the expense of new equipment or renovations. Roane General Hospital Foundation, Inc. was formed to allow charitable contributions to support the hospital and also as a vehicle for formal fundraising activities as required by the Hospital. This Foundation has a separate Board of Directors which oversees the operation and approves any donations to the Hospital. X X 0 0 0 0 0 1 0 0 0 Douglas Bentz CEO 212981 0 36717 0 14820 0 9800 0 15368 0 289686 0 0 0 Hong-Kin Ng MD/Medical Director 340769 0 0 0 0 0 9800 0 21062 0 371631 0 0 0 Daniel B Prudich MD 308048 0 0 0 0 0 9800 0 21062 0 338910 0 0 0 Christopher Lambert MD/ER Director 282452 0 0 0 0 0 9800 0 280 0 292532 0 0 0 Rudolph M Kevak MD 231413 0 0 0 0 0 9800 0 7684 0 248897 0 0 0 Brent Watson MD/Hospitalist 292851 0 0 0 0 0 9800 0 21062 0 323713 0 0 0 Part I, Line 6 The Organization offers an incentive compensation plan to certain members of its executive staff including the CEO, Chief of Staff, VP of Financial and Support Services, VP of Quality and Ancillary Services, VP of Nursing Services and VP of Information Services/Technology. The program is intended to provide motivation and direction for the management team to accomplish the goals and objectives set forth by the Board at the beginning of each calendar year. These goals are based upon the annual strategic plan as well as the financial performance of the hospital. Shortly after the calendar year, the management team will present its progress and accomplishments to the Board with a recommended bonus based upon the criteria set forth. The board has discretion to approve, amend, or deny any recommendations. To be eligible for the program, the executive member must serve in his/her position for at least four months and be employed at the end of the program calendar year. If the individual serves less than one year but more than four months, the incentive will be prorated. A Roane County Building Commission 464100302 2013-11-20 2950000 Renovation of building and equipment acquisition 0 0 0 A 169909 1851357 43259 109541 1698557 0 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 Form 990, Part VI, Section A, line 6 The corporation has one class of members which consist of (a) the original incorporators of the corporation; (b) each of the corporation's directors; (c) those individual residents of Roane County who are at least 25 years of age and have (i) contributed their time, talent or money to effectuate the purposes of the corporation, (ii) been invited by the Board of Directors of corporation of membership, (iii) received a notice of membership, and (iv) have been appointed as members by the Board of Directors in accordance with the bylaws of the corporation; and (d) who is at least 25 years of age of those companies (including sole proprietorships, partnerships, limited liability companies, and corporations) with their place of business located in Roane County that have (i) contributed their time, talent or money to effectuate the purposes of the corporation, (ii) been invited by the Board of Directors of corporation for a representative of the company identified by the Board of Directors to be a member, (iii) received a notice of membership, and (iv) had such representative approved as a member by the Board of Directors of the corporation in accordance with the bylaws of the corporation. However if such designated member ceases to be affiliated with such company, his membership in the corporation will be automatically revoked. Members of the corporation shall not be entitled to vote on any matter other than (a) election of directors at the annual meeting of the members of the corporation, (b) the removal of directors for cause, (c) the approval of any amendment to the articles of incorporation approved and recommended by the Board of Directors, (d) the amendment or repeal of the corporation's bylaws, and (e) the dissolution and liquidation of the corporation. There are 16 Board of Directors and 36 members that make up the class of members. Form 990, Part VI, Section A, line 7a See line 6 explanation above. Form 990, Part VI, Section B, line 11 The 990 is prepared by our accounting firm who works with the CEO and the VP of Finance to obtain data. Once complete, the 990 is submitted to the CEO for review and approval prior to filing. Form 990, Part VI, Section B, line 12c Board members are required to complete and sign a conflict of interest statement each year sent from either the hospital auditors or from the hospital compliance officer. We monitor compliance by making this part of the annual review of our compliance program. Form 990, Part VI, Section B, line 15 The CEO's salary/benefits are identified in his employment contract and an annual increase is recommended based on comparison data from public records showing other CEO salaries of similar sized hospitals in West Virginia and is approved by the Executive Committee of the Board. The key employee and physician salaries are contract driven and negotiated by the CEO based on market data. All other employees' salaries are based on an annual review ranging from 2-4% (avg. 3%) and reviewed annually against the WVHA salary survey with pay scale market upgrades as appropriate. Form 990, Part VI, Section C, line 19 An annual audited financial statement is published in the local newspaper as required by the Health Care Authority under Public Disclosure requirements. Audited financial statements are also submitted to any financing entities as required. Form 990, Part XI, line 9: Change in interest in net assets of Foundation 26,210. Roane General Hospital Foundation 200 Hospital Drive Spencer WV 25276 550745015 To support in furthering development of high quality health care. WV 501(c)(3) Line 11a, I N/A 0 Roane Medical Building Inc 200 Hospital Drive Spencer WV 25276 550521219 Health care and social assistance - offices of physicians WV Hospital Development Co dba Roane General Hospital C -11744 1690 1.00000 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 Roane Medical Building Inc E 195613 Cost of Assets Pledged