2013-07-19T10:02:20-05:00 2012-09-30 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2011-10-01 550404900 Herbert J Thomas Memorial Hospital Association HERB 3047663528 4605 MacCorkle Avenue SW South Charleston WV 25309 Charles O Covert 3047663528 2013-07-16 1 Harry C Harless P01042847 3043460441 2011 2016-02-24 21:20:13Z Thomas Memorial Hospital Stephen P Dexter 4605 MacCorkle Avenue SW South Charleston WV 25309 186533302 0 X www.thomaswv.org X 1946 WV To provide health care services to residents of South Charleston, WV and surrounding communities. 7 6 1478 127 8650 0 1176806 586972 153251120 166250434 2340111 1276389 2577763 2725841 159345800 170839636 78825 132462 0 0 69665510 70991385 0 0 0 97744062 106181675 167488397 177305522 -8142597 -6465886 222186958 220262039 160635326 172612781 61551632 47649258 To provide health care services to residents of South Charleston, WV and surrounding communities. 0 0 172680698 105198 163631653 Services provided by the hospital include 50,128 inpatient days and 192,652 outpatient visits. The hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Charges forgone for charity amounted to $4,245,075. The hospital provided community education activities and sponsors free health screening and wellness programs. 172680698 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 0 0 0 0 0 0 0 0 1 0 0 0 0 1 150 0 1 1478 1 1 1 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Charles O Covert 3047663528 4605 MacCorkle Ave SW South Charleston WV 25309 X Michael DeWitt 1.00 X 0 0 0 Daniel J Lauffer 1.00 X 0 375994 51502 Tom McHugh 1.00 X 0 0 0 Darshan Dave 1.00 X 0 0 0 Steve White 1.00 X 0 0 0 Nancy Fox 1.00 X 0 0 0 Grace Vandecruze 1.00 X 0 0 0 John Neville 1.00 X 0 0 0 Betty Goad 1.00 X 0 0 0 Stephen P Dexter 40.00 X 622304 0 25265 Charles O Covert 40.00 X 281738 0 24074 Robert J Gray 40.00 X 259806 0 23846 Cynthia W Barnette 40.00 X 262003 0 23826 Tarek Anderson 40.00 X 296922 0 19824 Magdaleno Nucum 40.00 X 162005 0 16200 Paul Stobie 40.00 X 294289 0 20184 Marybeth Smith 40.00 X 158349 0 4392 Rodney Dean 40.00 X 292308 0 0 2629724 375994 209113 40 0 1 0 Professional Anesthesia Associates 110 Roane St Charleston WV 25302 Anesthesia service 1421331 Information Technology Associates 20 NW 4th St Suite 301 Evansville IN 47708 Information systems consulting 1030419 Advanced Technical Solutions 107 Erskine Lane Scott Depot WV 25560 Information systems consulting 824785 HMP of Kanawha County PO Box 645037 Cincinnati OH 452645037 Hospitalist physicians 775000 Aramark 25271 Network Place Chicago IL 606731252 Food service management 568494 35 586972 586972 Patient services 622110 163631653 163631653 Electronic health reco 900099 2618781 2618781 166250434 1143032 8650 1134382 1609257 0 1609257 1609257 1609257 15030900 796123 15025022 668644 5878 127479 133357 133357 Cafeteria & vending 722212 576129 576129 Other income 900099 293912 293912 Parking 812930 246543 246543 1116584 170839636 163631653 8650 6612361 132462 132462 1657188 1605981 51207 52863120 51229650 1633470 5178441 5018427 160014 7505831 7273901 231930 3786805 3669793 117012 172344 172344 374826 374826 30000 30000 11834715 11469022 365693 486310 471283 15027 13585216 13165433 419783 3626433 3514376 112057 4237936 4106984 130952 112113 108649 3464 6186861 5995687 191174 11126983 10783159 343824 4503130 4363983 139147 Medical supplies 25217681 25217681 Bad debts 16147197 16147197 Healthcare provider tax 4304208 4304208 Sales & use taxes 1339219 1297837 41382 2896503 2804985 91518 177305522 172680698 4624824 0 441331 353213 42040443 26936639 15480102 15601841 3125418 3336044 1286698 1313792 287447291 154587962 139252427 132859329 17904904 35295065 569249 555126 2086386 4010990 222186958 220262039 12780294 14959630 49163 127756 102127331 101098724 145833 91600 45532705 56335071 160635326 172612781 X 61551632 47649258 61551632 47649258 222186958 220262039 X -6465886 -7436488 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 15109 1 30000 0 0 45109 0 Explanation of Lobbying Activities: Part II-B, Line 1: Line 1f: A portion of dues paid by the hospital to the American Hospital Association and the West Virginia Hospital Association is attributable to lobbying. 11689559 11689559 148842151 59141977 89700174 115523705 91991053 23532652 11391876 3454932 7936944 132859329 Accrued pension benefits 37464650 Estimated malpractice liability 10327691 Estimated third party settlements 1658886 Capital lease obligations 1203860 Due to related party 881563 Accrued interest payable 4798421 56335071 170839636 177305522 -6465886 1773833 -9210321 -7436488 -13902374 154041513 0 154041513 16798123 16798123 170839636 160488409 0 160488409 16817113 16817113 177305522 Part XI, Line 8 - Other Adjustments: Income from K-1 - Premier Purchasing Partners LP -650,926. Defined benefit pension plan adjustment -9,174,683. Distributions from Premier Purchasing Partners LP 655,288. Equity transfer to related exempt organization -40,000. Total to Schedule D, Part XI, Line 8: -9,210,321. Part XII, Line 4b - Other Adjustments: Income from K-1: Premier Purchasing Partners LP 650,926. Bad debts deducted from income in the financial statements 16,147,197. Part XIII, Line 4b - Other Adjustments: Distributions from Premier Purchasing Partners LP 655,288. Bad debts deducted from income in the financial statements 16,147,197. Equipment contributed to related organization 14,628. 1 1 X 1 X 0 1 1 0 0 1728595 1728595 0.01070 23656748 14636363 9020385 0.05600 25385343 14636363 10748980 0.06670 98070 98070 0.00060 98070 98070 0.00060 25483413 14636363 10847050 0.06730 0 15126881 37475341 38238898 -763557 X 1 0 1 1 Thomas Memorial Hospital

4605 MacCorkle Avenue SW South Charleston WV 25309

X X X Herbert J Thomas Memorial Hospital 1 1 1 200.000000000000 0 1 X X X 1 1 X X 1 0 1 X 0 0 Part I, Line 3c: The hospital provides a 20% discount to individuals who do not have commercial insurance coverage and who do not qualify for Medicare, Medicaid, or free care. An additional 20% prompt pay discount is provided to patients who pay at the time services are rendered. Part I, Line 7: The cost of charity care and unreimbursed Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The cost of community health improvement services and community benefit operations was calculated based on the hospita's accounting records.The amount of cash and in-kind contributions to community groups 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 $ 16147197. Part III, Line 4: Bad debt expense is described in the consolidated financial statements as follows: 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.The amount of patient charges written off reported on line 2 represents amounts that were actually billed to patients, less any payments subsequently received. For example, if an uninsured patient received the 20% uninsured discount and subsequently made only partial payment, the amount written off would be the discounted amount less the subsequent payment. Part III, Line 8: Medicare costs were obtained from the Hospital's Medicare cost report. Part III, Line 9b: The organization's collection policies do not apply to patients that are known to qualify for charity care. Additionally, the organization has a separate Patient Assistance Policy; patients who qualify for charity care under the policy do not receive a bill. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 10: The hospital provides a 20% discount to individuals who do not have commercial insurance coverage and who do not qualify for Medicare, Medicaid, or free care. An additional 20% prompt pay discount is provided to patients who pay at the time service is rendered. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 13g: At the point of registration for all uninsured patients, we print out and give them the charity forms to apply for our program. We explain to them what this means and tell them they must forward these completed items with the requested documentation to RPAS (our billing office); the address is on the form. We have them sign page one (acknowledgement) and scan it into the account for verification they were given and have had the process explained to them. For those patients who come into our office after they receive a bill, we will explain this same process for them. Notification about financial assistance available from Thomas Health System shall include a contact number, shall be disseminated by Thomas Health System by various means, which may include, but are not limited to, the publication of notices in patient bills and by conspicuously displaying the FAP within the hospital and at other public places as Thomas Health System may elect. Hard copies of the FAP are available for interested persons free of charge. The FAP is posted on Thomas Health System's web page. Thomas Health System may also publish and widely publicize a summary of this Financial Assistance Policy within the hospital, facility websites, brochures and at other places within the community served by the hospital as may be elected. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 19d: The hospital analyzed its reimbursements from commercial insurance carriers and determined that reimbursements were approximately 80% of charges. Accordingly, the hospital provides a 20% discount to all patients who do not have commercial insurance coverage and who do not qualify for Medicare, Medicaid, or free care. There is an aditional 20% prompt pay discount if mayment is made at the time of service. Part VI, Line 2: The hospital is a member of the Kanawha Coalition for Community Health Improvement. The Coalition conducts a survey every three years to assess health care needs of the community. Results of the survey are presented in a meeting of community leaders and other interested persons, and are conveyed to the general public by local media. Results of the most recent survey were released in September, 2011. Part VI, Line 3: The hospital informs and educates patients about their eligibility for assistance by: (1) providing a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (2) including the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and (3) discussing with the patient the availablity of various government benefits, such as Medicaid or state programs, and assisting the patient with qualification for such programs, where applicable. For those patients who come into our office after they receive a bill, we explain this same process to them. We also employ an outside agency, Advanced Patient Advocacy (APA), to speak with patients regarding Medicaid and other state and federal funding options. APA may speak with the patient during a stay or visit or after discharge. Part VI, Line 4: The organization's geographic service area includes approximately 476,000 persons in a 12 county area of south-central West Virginia. Heart disease, cancer and pulmonary disease are the leading causes of death in the service area. Patients in the service area are typical of West Virginia as a whole. The population served is 48% male, 52% female. Approximately 20% of residents in the area have no healthcare insurance coverage and no family doctor or other healthcare provider. Except for the area within the Charleston, WV city limits, all of the counties in the organization's geographic service area are federally-designated Medically Underserved and Health Manpower Shortage Areas. Part VI, Line 5: All members of the hospital's Board of Directors reside in the local community. The hospital extends medical staff privileges to all qualified physicians in the community who meet specific credentialing criteria. The hospital's 24 hour emergency room is available to all persons, regardless of ability to pay. The hospital prepares its budget to ensure adequate funding for capital improvements that are made on an on-going basis. During the year, the hospital received $586,972 in contributions. These contributions enabled the hospital to fund its capital improvements and to provide financial sssistance to individuals unable to pay for some or all or their care. Part VI, Line 6: The hospital, along with St. Francis Hospital, is part of Thomas Health System, Inc. The health system was formed to forge a partnership based on the strength of the two established hospitals. Bringing the two hospitals under the umbrella of the Thomas Health System allows them to provide innovative and cost-effective health care services to the Kanawha Valley and surrounding areas. Economies of scale have allowed for cost reductions in numerous areas, while providing advanced technology to a larger community, with access to the highest quality of physicians, nurses and support staff in our service area. The system provides a wide range of services that serves the entire community. 1 West Virginia Symphony Orchestra Inc PO Box 2292 Charleston WV 25328 550339426 501(c)(3) 13500 Sponsorship of concert and fund raising gala WV Health Right 1520 Washington St East Charleston WV 25311 311066881 501(c)(3) 30000 Support for a free clinic that provides medical care and drugs to the uninsuredSupport for a free clinic that suppplies medical care and drugs to the uninsuredTo support a free clinic located in Charleston, WV that supplies free drugs to the uninsured Charleston Area Alliance 1116 Smith St Charleston WV 25301 556024192 501(c)(4) 6400 Support for economic development programs Charleston Hospital Hospital Inc dba St Francis Hospital 333 Laidley Street Charleston WV 25301 611272692 501(c)(3) 14628 Book value Equipment To assist the efforts of St. Francis Hospital CAMC Health Education and Research Institute Inc 3200 MacCorkle Avenue SE Charleston WV 25304 550753754 501(c)(3) 27264 Health education and research that benefits the people of Kanawha County 4 1 X X X X 0 0 0 0 0 0 0 0 0 Daniel J Lauffer 0 309191 0 60895 0 5908 0 31536 0 23654 0 431184 0 0 Stephen P Dexter 510619 0 86800 0 24885 0 9072 0 16193 0 647569 0 0 0 Charles O Covert 245507 0 28878 0 7353 0 6530 0 17544 0 305812 0 0 0 Robert J Gray 226012 0 26700 0 7094 0 6302 0 17544 0 283652 0 0 0 Cynthia W Barnette 222751 0 31723 0 7529 0 6282 0 17544 0 285829 0 0 0 Tarek Anderson 296922 0 0 0 0 0 3672 0 16152 0 316746 0 0 0 Magdaleno Nucum 162005 0 0 0 0 0 0 0 16200 0 178205 0 0 0 Paul Stobie 294289 0 0 0 0 0 3672 0 16512 0 314473 0 0 0 Marybeth Smith 142264 0 16085 0 0 0 2352 0 2040 0 162741 0 0 0 Rodney Dean 292308 0 0 0 0 0 0 0 0 0 292308 0 0 0 West Virginia Hospital Finance Authority 621256910 956622XRO 2008-06-30 94030170 Capital expenditures and equipment purchases 0 0 0 719812 92695993 7223714 10534952 1489249 73448078 2010 1 0 1 1 0 1 1 1 0 0.03000 0.03000 1 0 0 0 1 Trinity Plus Funding 1 0 1 Form 990, Part VI, Section A, line 6 Thomas Health System, Inc., a nonprofit corporation organized under the laws of the State of West Virginia, is the sole member of the organization. Form 990, Part VI, Section A, line 7a The organization's board of directors is elected by its sole member, Thomas Health System, Inc. Form 990, Part VI, Section B, line 11 Thomas Health System, Inc. (the System) is the sole member of the organization. The System's finance committee is responsible for financial management of the organization. The 990 is reviewed by the organization's CFO and the chairman of the finance committee. The 990 is then discussed with the System's finance committee and a copy is provided to all board members before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with our written conflict of interest policy by asking annually that all Trustees, officers and employees (managers) who have decision making/purchasing authority disclose any potential conflicts of interest. Disclosure forms are signed annually then logged onto a spread sheet that identifies any potential conflicts. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee, comprised of members who are free of any conflicts of interest, adheres to a disciplined process for reviewing compensation for senior executives to ensure that the compensation is reasonable. The Committee has retained an independent consulting and advisory firm, Yaffe & Company, to provide appropriate market data as to comparability. The Committee reviews comparability data and other relevant evidence and approves the compensation of senior executives; provided, however, that in the case of the CEO, the Board, after review of the comparability data and other relevant evidence, including a recommendation from the Committee, has the final approval with regard to the CEO's compensation. Only those Board members who are free of conflicts of interest vote on the CEO's compensation. All compensation decisions, including the comparability data reviewed and any other relevant information considered, are contemporaneously documented in meeting minutes. Form 990, Part VI, Section C, line 19 The Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon request. These documents are maintained in the administrative offices of the hospital and are provided via copy upon request. The documents also can be reviewed on site at the hospital upon advance notice. Hours worked for related organization Form 990, Part VII, Section A Daniel J. Lauffer, Trustee, is the CEO of Charleston Hospital, Inc. dba St. Francis Hospital. Mr. Lauffer works 40 hours per week for St. Francis Hospital. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 1,773,833. Income from K-1 - Premier Purchasing Partners LP -650,926. Defined benefit pension plan adjustment -9,174,683. Distributions from Premier Purchasing Partners LP 655,288. Equity transfer to related exempt organization -40,000. Total to Form 990, Part XI, Line 5: -7,436,488. Explanation of amounts reported Schedule K On June 30, 2008, the West Virginia Hospital Finance Authority issued $148,920,000 Hopital Inprovement Revenue Bonds Series 2008 on behalf of Thomas Health System, Inc. Thomas Health System, Inc. is the sole member of Herbert J. Thomas Memorial Hospital Association (Thomas Memorial Hospital) and Charleston Hospital, Inc. dba St. Francis Hospital. Bond proceeds, and related liability, were allocated between the two hospitals. Total proceeds of the issue reported in Part II, line 3 are net of bond discount in the amount of $1,333,842. Thomas Health System Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 260440674 Corporate office WV 501(c)(3) Line 3 N/A 0 St Francis Hospital 333 Laidley St Charleston WV 25301 611272692 Hospital WV 501(c)(3) Line 3 N/A 0 THS Physician Partners Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 454395947 Medical services WV 501(c)(3) Line 3 N/A 0 THM Services Inc 437 Division Street Ste 311 South Charleston WV 25309 550676607 Equipment sales, rental and related services, vending sales WV N/A C 143264 5167361 1.00000 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0