2012-08-14T12:40:26-05:00 2011-09-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-10-01 550404900 Herbert J Thomas Memorial Hospital Association HERB 3047663528 4605 MacCorkle Avenue SW South Charleston WV 25309 Charles O Covert 3047663528 2012-08-14 1 Harry C Harless 3043460441 2010 2016-02-24 21:20:13Z Thomas Memorial Hospital Stephen P Dexter 4605 MacCorkle Avenue SW South Charleston WV 25309 180573349 0 X www.thomaswv.org X 1946 WV To provide health care services to residents of South Charleston, WV and surrounding communities. 7 6 1520 127 1301 0 945755 1176806 153688063 153251120 1117194 2340111 2291621 2577763 158042633 159345800 81908 78825 0 0 71061942 69665510 0 0 0 91811626 97744062 162955476 167488397 -4912843 -8142597 228541315 222186958 162656738 160635326 65884577 61551632 To provide health care services to residents of South Charleston, WV and surrounding communities. 0 0 163518922 78825 153251120 Services provided by the hospital include 52,297 inpatient days and 178,585 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 $5,462,032. The hospital provided community education activities and sponsors free health screening and wellness programs. 163518922 1 1 0 1 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 1 166 0 1 1520 1 1 1 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Charles O Covert 3047663528 4605 MacCorkle Ave SW South Charleston WV 25309 Michael DeWitt 1.00 X 0 0 0 Daniel J Lauffer 1.00 X 0 392918 55981 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 Heyliger 1.00 X 0 0 0 Stephen P Dexter 40.00 X 619100 0 23660 Charles O Covert 40.00 X 281829 0 24058 Robert J Gray 40.00 X 258454 0 23830 Cynthia W Barnette 40.00 X 258568 0 23810 Tarek Anderson 40.00 X 288506 0 19592 Magdaleno Nucum 40.00 X 160388 0 15443 William Priddy 40.00 X 157877 0 19361 Mary Beth Smith 40.00 X 153708 0 4563 Carmelita Bautista 40.00 X 149746 0 19571 2328176 392918 229869 36 0 1 0 Advanced Technical Solutions 107 Erskine Lane Scott Depot WV 25560 Computer consulting 1808679 Professional Anesthesia Associates 110 Roane St Charleston WV 25302 Anesthesia service 1273820 Hospital Medicine Group 4535 Dressler Rd NW Canton OH 44718 Hospitalist service 915800 FFF Enterprises PO Box 840150 Los Angeles CA 900840150 Reference lab service 864465 Aramark 25271 Network Place Chicago IL 606731252 Nutrition service management 775649 30 1154930 21876 1176806 Patient services 622110 153251120 153251120 153251120 1279222 1301 1277921 1471640 1471640 1471640 1471640 22288438 21227549 1060889 1060889 1060889 Cafeteria & vending 722212 610069 610069 Other income 900099 304488 304488 Parking 812930 191566 191566 1106123 159345800 153251120 1301 4916573 78825 78825 1548634 1514254 34380 50978578 49846854 1131724 5620605 5495828 124777 7840598 7666537 174061 3677095 3595463 81632 188964 188964 262381 262381 10841965 10601273 240692 771818 754684 17134 36876038 36057390 818648 3146729 3076872 69857 4103597 4012497 91100 104224 101910 2314 6225647 6087438 138209 11817533 11555184 262349 2245040 2195200 49840 Bad debts 14138705 14138705 Healthcare provider tax 2864533 2864533 Sales & use tax 1756802 1717801 39001 Red Cross fees & transp 963518 942128 21390 Dues and subscriptions 394388 385633 8755 1042180 829913 212267 167488397 163518922 3969475 0 486659 441331 43896159 42040443 14713912 15480102 3315192 3125418 1049077 1286698 285073234 145820807 146343378 139252427 16097447 17904904 323552 569249 2315939 2086386 228541315 222186958 12166840 12780294 49163 102016018 102127331 197443 145833 48276437 45532705 162656738 160635326 X 65884577 61551632 65884577 61551632 228541315 222186958 X -8142597 3809652 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 41946 0 0 0 41946 0 12423235 12423235 148687614 55158384 93529230 112570509 87529065 25041444 11391876 3133358 8258518 139252427 Accrued pension benefits 29146013 Estimated malpractice liability 8600435 Estimated third party settlements 1766331 Capital lease obligations 311442 Due to related party 881563 Accrued interest payable 4826921 45532705 159345800 167488397 -8142597 -27609 3837261 3809652 -4332945 158680561 0 158680561 665239 665239 159345800 166934798 10216 10216 166924582 563815 563815 167488397 Part XI, Line 8 - Other Adjustments: Income from K-1 - Premier Purchasing Partners LP -658,691. Defined benefit pension plan adjustment 3,948,901. Distributions from Premier Purchasing Partners LP 557,267. Audit adjustment for prior period -10,216. Part XII, Line 4b - Other Adjustments: Income from K-1: Premier Purchasing Partners LP 658,691. Expense offset against income in the financial statements 6,548. Part XIII, Line 2d - Other Adjustments: Audit adjustment for prior period 10,216. Part XIII, Line 4b - Other Adjustments: Distributions from Premier Purchasing Partners LP 557,267. Expense offset against income in the financial statements 6,548. 1 1 X 1 X 1 X 1 1 0 0 2342119 0 2342119 0.01530 21625115 10876974 10748141 0.07010 23967234 10876974 13090260 0.08540 102000 102000 0.00070 78825 78825 0.00050 180825 180825 0.00120 24148059 10876974 13271085 0.08660 0 5601474 35466806 35757700 -290894 X 1 0 1 1 Thomas Memorial Hospital

4605 MacCorkle Avenue SW South Charleston WV 25309

X X X Skilled nursing facility Herbert J Thomas Memorial Hospital 1 1 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, as well as the cost 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 $ 14138705. 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 cost of bad debts reported in Schedule H was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. 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 financial assistance. Additionally, the organization has a separate Patient Assistance policy; patients who qualify for assistance under the policy do not receive a bill. 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 organization 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. 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 6: All members of the hospital's board 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 over $1,176,000 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 7: 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 a full range of innovative and cost-effective health care services to the Kanawha Valley and surrounding areas. Economies of scale have allowed for cost reductions is 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. 0 American Heart Association 162 Court St Charleston WV 25301 135613797 501(c)(3) 5000 Funding for medical research 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 uninsuredTo assist a free clinic located in Charleston, WV that supplies free 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 program and sponsorship of 2011 annual celebration X X X X 0 1 0 0 0 0 0 0 0 Daniel J Lauffer 0 319118 0 64500 0 9300 0 37223 0 27602 0 457743 0 0 Stephen P Dexter 503600 0 87000 0 28500 0 9075 0 14585 0 642760 0 0 0 Charles O Covert 241966 0 31736 0 8127 0 6533 0 17525 0 305887 0 0 0 Robert J Gray 222961 0 27753 0 7740 0 6305 0 17525 0 282284 0 0 0 Cynthia W Barnette 219616 0 30900 0 8052 0 6285 0 17525 0 282378 0 0 0 Tarek Anderson 288506 0 0 0 0 0 3675 0 15934 0 308115 0 0 0 Magdaleno Nucum 160388 0 0 0 0 0 0 0 15451 0 175839 0 0 0 William Priddy 157877 0 0 0 0 0 2453 0 17184 0 177514 0 0 0 Mary Beth Smith 153708 0 0 0 0 0 2347 0 2453 0 158508 0 0 0 Carmelita Bautista 149746 0 0 0 0 0 4152 0 15430 0 169328 0 0 0 Part I, Line 4b Line 4b - Deferrals under 457(b) plan: Stephen P. Dexter $16,500; Charles O. Covert $16,500; Robert J. Gray $16,500; Cynthia W. Barnett $16,500. West Virginia Hospital Finance Authority 621256910 956622XRO 2008-06-30 94030170 Capital expenditures and equipment purchases 0 0 0 92695993 7223714 10534952 1489249 73448078 2010 1 0 1 1 0 1 1 0 1 0.03000 0.00000 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 finance committee is responsible for financial management of the organization. A copy of the 990 is reviewed by the CFO and a copy is provided to the System finance committee 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -27,609. Income from K-1 - Premier Purchasing Partners LP -658,691. Defined benefit pension plan adjustment 3,948,901. Distributions from Premier Purchasing Partners LP 557,267. Audit adjustment for prior period -10,216. Total to Form 990, Part XI, Line 5: 3,809,652. 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) 3 N/A 0 Charleston Hospital Inc 333 Laidley St Charleston WV 25301 611272692 Hospital WV 501(c)(3) 3 N/A 0 Thomas Memorial Hospital Foundation Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 550694220 Hospital support WV 501(c)(7) 7 N/A 0 THM Services Inc 437 Division Street Ste 311 South Charleston WV 25309 550676607 Equipment sales, rental and related services and vending sales WV N/A C 82427 4817044 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Thomas Memorial Hospital Foundation Inc C 1154930 FMV - Cash