2011-03-14T12:23:36-05:00 2010-06-30 DIXON HUGHES PLLC PO BOX 1556 MORGANTOWN WV 265071556 990 2009-07-01 556005561 WEBSTER COUNTY MEMORIAL HOSPITAL WEBS 3048475682 324 MILLER MOUNTAIN DRIVE WEBSTER SPRINGS WV 26288 ANNETTE KEENAN 3048475682 2011-03-02 1 Chris McElroy 3042927343 2009 2016-02-24 21:20:13Z ANNETTE KEENAN 324 MILLER MOUNTAIN DRIVE WEBSTER SPRINGS WV 26288 11486112 0 X N/A X 1951 WV TO PROVIDE ACUTE SHORT-TERM CARE TO RESIDENTS OF WEBSTER AND SURROUNDING COUNTIES IN WEST VIRGINIA. 7 7 167 5 0 0 139584 240601 10226111 11155488 83564 3047 64221 86976 10513480 11486112 0 0 5941514 6371083 0 0 4094266 4861366 10035780 11232449 477700 253663 3010606 3430227 2840892 2987512 169714 442715 THE MISSION OF WEBSTER COUNTY MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENT, HIGH QUALITY CARE IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. 1 0 7956896 11234814 CRITICAL ACCESS HOSPITAL SERVICES PROVIDED INCLUDED 1,182 INPATIENT DAYS, 21,041 OUTPATIENT VISITS, AND 16,370 RHC VISITS. CHARGES FORGONE FOR CHARITY AMOUNTED TO $421,490. 7956896 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 9 0 167 1 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X SARAH WILLS 3048475682 324 MILLER MOUNTAIN DRIVE WEBSTER SPRINGS WV 26288 ELSWORTH HELMICK 2.00 X X 0 0 0 Estil hughes 2.00 X X 0 0 0 JOYCE MORTON 2.00 X X 0 0 0 LARRY LYNCH 2.00 X X 0 0 0 MaRY ANNE CARPENTER 2.00 X 0 0 0 John LESLIE 2.00 X 0 0 0 StephaNIE LOUGHRIDGE 2.00 X 0 0 0 john rEED 2.00 X 0 0 0 annETTE KEENAN 40.00 X 113291 0 3248 robERT MACE 40.00 X 482706 0 4639 JAMIE MILLER 40.00 X 267499 0 0 LUKE MCELWAIN 40.00 X 187492 0 3241 JOHN BLAKE 40.00 X 185393 0 5111 VoNDA MCELWAIN 40.00 X 161627 0 6338 1398008 0 22577 8 0 1 0 THE ERX COMPANY 109 LAND OAK LANE KNOXVILLE TN 37922 EMERGENCY ROOM CONSULTANTS 123132 1 181001 59600 240601 PATIENT SERVICE REVENU 621400 11155488 11155488 11155488 3047 3047 7650 7650 7650 7650 Miscellaneous Revenue 621400 79326 79326 79326 11486112 11234814 0 10697 125194 125194 5147964 3432051 1715913 694796 463207 231589 403129 268759 134370 232182 232182 667849 445242 222607 18823 12549 6274 1182949 788650 394299 222137 148095 74042 20181 13454 6727 57050 57050 238477 158988 79489 139918 93281 46637 BAD DEBT EXPENSE 1474474 1474474 CHARITY CARE EXPENES 421490 421490 HEALTH CARE TAX 167145 167145 FEES AND LICENSES 18691 12461 6230 11232449 7956896 3275553 0 472985 342107 1484341 1684668 107164 93787 28964 67139 4813378 3717347 837949 1096031 79203 98542 47953 3010606 3430227 1976951 1652751 552955 424483 310986 910278 2840892 2987512 X 98735 417079 70979 25636 169714 442715 3010606 3430227 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32757 32757 1737018 1515416 221602 2995418 2177222 818196 48185 24709 23476 1096031 OTHER PAYABLES 6319 THIRD PARTY PAYABLES 903959 910278 11486112 11232449 253663 19338 19338 273001 9609486 19338 -1895964 -1876626 11486112 0 11486112 9336485 0 9336485 1895964 1895964 11232449 Part XII, Line 2d - Other Adjustments: BAD DEBT EXPENSE NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS: -1474474. CHARITY CARE EXPENSES NETTED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS: -421490. Part XIII, Line 4b - Other Adjustments: BAD DEBT EXPENSE INCLUDED IN EXPENSES ON FORM 990: 1474474. CHARITY CARE EXPENSES INCLUDED IN EXPENSES ON FORM 990: 421490. PART X, LINE 2: EFFECTIVE JULY 1, 2009, THE ORGANIZATION ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ("FASB") AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST AS OF JUNE 30, 2010, AND THE ADOPTION OF THE GUIDANCE DID NOT HAVE A MATERIAL EFFECT ON THE FINANCIAL POSITION OR RESULTS OF OPERATIONS. 1 1 1 X 1 X 150.000000000000 1 1 1 0 1 1 385147 110447 274700 0.02820 2545164 1961485 583679 0.05980 46988 0 46988 0.00480 2977299 2071932 905367 0.09280 2637 0 2637 0.00030 2637 2637 0.00030 2979936 2071932 908004 0.09310 1370 1370 0.00010 333 333 0.00000 1703 1703 0.00010 1 762598 212765 2764198 4621858 -1857660 X 1 0 WEBSTER COUNTY MEMORIAL HOSPITAL

324 MILLER MOUNTAIN DRIVE WEBSTER SPRINGS WV 26288

X X X Part I, Line 3c: THE ORGANIZATION DIFFERENTIATES BETWEEN FREE AND DISCOUNTED CARE BY PERFORMING A SECOND TEST (BEYOND THE FAMILY INCOME LIMIT PROVIDED BY THE FEDERAL POVERTY GUIDELINES) RELATED TO THE PATIENT'S ASSETS. PATIENTS CAN ONLY OWN ONE HOUSE AND ONE VEHICLE. NON BUSINESS OWNERS CAN ONLY HAVE $10,000 IN ASSETS (CONVERTIBLE TO CASH). BUSINESS OWNERS CAN ONLY HAVE $50,000 IN ASSETS (CONVERTIBLE TO CASH). IF THE PATIENT OWNS ASSETS BEYOND THEIR RESPECTIVE LIMIT, THEY WILL ONLY BE ELIGIBLE FOR DISCOUNTED CARE. Part I, Line 7: A COST TO CHARGE RATIO OF 51.72% WAS USED TO HELP DETERMINE SOME AMOUNTS IN THIS TABLE. PART I, LINE 7, COLUMN (F): PERCENTAGES WERE CALCULATED USING THE TOTAL EXPENSES FROM PART IX, LINE 25, COLUMN (A) MINUS BAD DEBT EXPENSE. Part I, Line 7g: 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.TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE AT COST, BAD DEBT EXPENSE OF $1,474,474 WAS MULTIPLIED BY THE COST TO CHARGE RATIO OF 51.72% FROM THE COST REPORT.BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY WAS ESTIMATED BY MULTIPLYING BAD DEBT AT COST BY THE POVERTY RATE IN WEBSTER COUNTY, 27.9%. Part III, Line 8: THE COSTING METHODOLOGY USED TO DETERMINE MEDICARE ALLOWABLE COSTS OF CARE WAS AS FOLLOWS: gross Medicare charges multiplied by the Cost-to-Charge ratio OF 51.72%.THE ORGANIZATION PROVIDES SERVICES TO AN ELDERLY COMMUNITY THAT LIVES IN MOUNTAINOUS TERRAIN MAKING TRAVEL DIFFICULT. THE ORGANIZATION PROVIDES CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY; THIS PREVENTS CITIZENS FROM TRAVELING LONG DISTANCES TO RECEIVE CARE. APPROXIMATELY 27.9% OF THE POPULATION OF WEBSTER COUNTY IS BELOW THE POVERTY LEVEL, THEREFORE, THE SHORTFALL CAUSED BY EXCESS MEDICARE EXPENSES SHOULD BE TREATED AS COMMUNITY BENEFIT TO THAT EXTENT. Part III, Line 9b: PATIENTS HAVE 60 DAYS FROM DATE OF SERVICE TO APPLY FOR FINANCIAL ASSISTANCE OR CHARITY CARE. Part V: Part VI, Line 2: IN 2007, THE ORGANIZATION ENGAGED A FIRM TO COMPLETE A FORMAL COMMUNITY NEEDS ASSESSMENT. IN 2010, THE ORGANIZATION UPDATED THEIR RESULTS WITH AN INTERNALLY PREPARED COMMUNITY SURVEY. THIS SURVEY WAS DISTRIBUTED TO EVERY INPATIENT AND SWING BED PATIENT AND TO A SAMPLE OF OUTPATIENTS. Part VI, Line 3: WHEN A PATIENT IS REGISTERED AT THE REGISTRATION DESK AND THEY ARE PRIVATE PAY, THEY ARE OFFERED AN APPLICATION FOR THE FINANCIAL ASSISTANCE PROGRAM. IF THE PATIENT DOES NOT GET AN APPLICATION AT TIME OF REGISTRATION, AND THEY INQUIRE ABOUT IT AFTER THE FACT, THEY WILL SEE THE PATIENT ACCOUNTS ADVOCATE. IF THE PATIENT HAS OTHER INSURANCE AND IS STRUGGLING TO PAY THE COPAY, COINSURANCE, OR DEDUCTIBLES, THEY ALSO RECEIVE THE APPLICATION FROM THE PATIENT ACCOUNTS ADVOCATE. Part VI, Line 4: WEBSTER COUNTY MEMORIAL HOSPITAL IS LOCATED IN A MOUNTAINOUS RURAL COMMUNITY WITH A POPULATION OF 9,444. WEBSTER COUNTY, WEST VIRGINIA IS 555.97 SQUARE MILES WITH 17.5 PEOPLE PER SQUARE MILE. OF THE POPULATION, 17% IS 65 YEARS OF AGE OR OLDER, AND 27.9% IS BELOW THE POVERTY LEVEL. THE NEXT CLOSEST HOSPITAL IS AT LEAST 40 MILES AWAY. Part VI, Line 5: THE ORGANIZATION RECEIVED GRANT FUNDING TO LAUNCH THREE CANCER SUPPORT GROUPS IN WEBSTER COUNTY, WEST VIRGINIA. THESE GROUPS SUPPORT INDIVIDUALS DEALING WITH ALL TYPES OF CANCER. THE ORGANIZATION PARTICIPATES IN THE FOLLOWING COALITIONS: MOUNTAINS OF HOPE CANCER COALITION, TOBACCO FREE COALITION, WEBSTER COUNTY HEALTH EDUCATION COMMITTEE, WVRHEP (COLLEGE CLINICAL PLACEMENT FOR NURSING STUDENTS), RELAY FOR LIFE (AMERICAN CANCER SOCIETY), PARTNERS IN HEALTH, WV HOSPITAL ASSOCIATION, WEBSTER COUNTY COMMUNITY FUND, WEBSTER COUNTY ECONOMIC DEVELOPMENT CENTER AND PARTNERS IN EDUCATION WITH DIANA ELEMENTARY SCHOOL. THE ORGANIZATION MAILED OUT RECRUITING LETTERS TO PHYSICIANS THROUGHOUT WEST VIRGINIA. THE ORGANIZATION HAS ADDED OUT-PATIENT NURSING AND CARDIAC REHAB TO ITS SERVICES THIS YEAR IN AN EFFORT TO OFFER MORE TO THE COMMUNITY. THE ORGANIZATION ALSO PARTICIPATED IN THE WEBSTER COUNTY HIGH SCHOOL CAREER FAIR. Part VI, Line 6: THE ORGANIZATION STRIVES TO REDUCE PATIENT MIGRATION THROUGH THE ADDITION OR ENHANCEMENT OF PATIENT SERVICES PROVIDED. THE ORGANIZATION UPGRADES EQUIPMENT WHEN SURPLUS FUNDS ARE AVAILABLE TO IMPROVE PATIENT CARE.THE ORGANIZATION IS A PARTNER IN EDUCATION WITH A LOCAL GRADE SCHOOL WHICH EDUCATES THE STUDENTS ON HOW TO LIVE A HEALTHY LIFESTYLE. THE ORGANIZATION ALSO OFFERS HEALTH FAIRS WITH FREE OR DISCOUNTED SCREENINGS AND TESTS TO THE COMMUNITY. WV X X X X 0 0 0 0 0 0 0 0 0 robERT MACE 482706 0 0 0 0 0 0 0 4639 0 487345 0 0 0 JAMIE MILLER 267499 0 0 0 0 0 0 0 0 0 267499 0 0 0 LUKE MCELWAIN 169556 0 0 0 17936 0 1794 0 1447 0 190733 0 0 0 JOHN BLAKE 182793 0 0 0 2600 0 650 0 4461 0 190504 0 0 0 VoNDA MCELWAIN 145651 0 0 0 15976 0 1598 0 4740 0 167965 0 0 0 X 1 14000 FMV X Equipment 8 45600 fMV 0 0 0 Method for Determining Number of Contributors: Part I, Column (b): ONE VEHICLE WAS DONATED TO THE ORGANIZATION BY ONE CONTRIBUTOR. EIGHT PIECES OF EQUIPMENT WERE DONATED TO THE ORGANIZATION BY ANOTHER CONTRIBUTOR. Form 990, Part III, line 2 New Program Services IN JUNE 2010, THE ORGANIZATION STARTED A CARDIAC REHABILITATION DEPARTMENT. CARDIAC REHABILITATION IS A PROGRAM THAT PROVIDES CARDIAC AND VITAL SIGN MONITORING WHILE THE PATIENT EXERCISES PER A DOCTOR'S PRESCRIPTION. IT ALSO PROVIDES MEDICATION AND NUTRITIONAL EDUCATION. THE ORGANIZATION ALSO PURCHASED NEW EQUIPMENT TO HELP TREAT PATIENTS AND BETTER ASSIST THEM AFTER THE SERVICES ARE RENDERED. Form 990, Part VI, Section B, line 11 DURING A REGULARLY SCHEDULED BOARD MEETING, EACH BOARD MEMBER RECEIVES A COPY OF THE COMPLETED FORM 990. THE BOARD WILL VOTE AND APPROVE THE COMPLETED FORM BEFORE FILING. Form 990, Part VI, Section B, line 12c OFFICERS AND DIRECTORS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. THIS QUESTIONNAIRE IS THEN REVIEWED BY THE BOARD OF DIRECTORS, ANNUALLY, FOR ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IF A CONFLICT WOULD ARISE, THE INDIVIDUAL WOULD HAVE TO DISLOSE THIS CONFLICT TO THE BOARD OF DIRECTORS. THE BOARD MEMBER WOULD NOT BE PERMITTED TO VOTE ON THE ISSUE, IF APPLICABLE. Form 990, Part VI, Section B, line 15 TO DETERMINE COMPENSATION OF THE ORGANIZATION'S CEO, THE ORGANIZATION COMPARES FORMS 990 OF OTHER ORGANIZATIONS, REVIEWS WRITTEN EMPLOYMENT CONTRACTS, AND PERFORMS COMPENSATION SURVEYS OF SIMILAR FACILITIES. A REVIEW OF COMPENSATION IS CONDUCTED INTERNALLY BY THE BOARD OF DIRECTORS. Form 990, Part VI, Section C, line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 2C THE BOARD OF DIRECTORS OF THE ORGANIZATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. FORM 990, PART VII, SECTION B, LINE 1 THE 6/30/2009 FORM 990, PART VII, SECTION B DISCLOSED INFORMATION PERTAINING TO INDEPENDENT CONTRACTORS PAID IN 2009 INSTEAD OF 2008. THIS WAS AN ERROR. THE APPROPRIATE DISCLOSURE ON THE 2008 FORM 990 SHOULD HAVE BEEN ZERO INDEPENDENT CONTRACTORS RECEIVING GREATER THAN $100,000. ON THE CURRENT YEAR FORM 990, THE 2009 INFORMATION WILL BE DISCLOSED AGAIN TO ENSURE A COMPLETE AND ACCURATE RETURN.