2011-05-16T12:15:59-05:00 2010-06-30 ParenteBeard LLC 1650 Market Street Suite 4500 Philadelphia PA 19103 990 2009-07-01 550562976 Grant Memorial Hospital GRAN 3042575802 PO Box 1019 Petersburg WV 26847 Joe A Barnes 3042575802 2011-05-16 1 Julius Green CPA 2159720701 2009 2016-02-24 21:20:13Z Joe A Barnes PO Box 1019 Petersburg WV 26847 28462544 0 X www.grantmemorial.com X 1957 WV To provide healthcare services to residents of Grant, Hardy and Pendleton Counties of West Virginia 14 14 417 62 0 0 411553 382679 23188580 26066213 0 272559 770663 437591 24370796 27159042 0 0 12287519 12357460 0 0 14105910 14819029 26393429 27176489 -2022633 -17447 21793558 21018739 6771459 5784584 15022099 15234155 Grant Memorial Hospital is a regional provider of quality, cost effective health care service responsive to the community need and supported by innovative efforts with others. The vision of Grant Memorial Hospital, based upon defined objectives of patient and community service, is to be the leader in providing the highest quality service as efficiently as possible based on assessed needs. 0 0 23738686 0 26066213 inpatient acute services including obstetrics, special care, nursing facility and outpatient services to the residents of the rural counties of grant, hardy and pendleton counties located in eastern west virginia. the closest hospitals are approximately 1.25 to 1.5 hours from grant memorial hospital. in september 2009, the medicare and medicaid programs designated the hospital to be a critial access hospital. during the year the hospital had 4,767 patient days, 712 obsteric patient days, 549 special care days, 540 nursery patient days, 2,788 nursing facility patient days and 54,841 outpatient visits excluding emergency room.24/7 emergency room coverage as mentioned above, other area hospitals are located significant distances from grant memorial hospital. the hospital is located in the mountains of eastern west virginia, so driving times can be significantly longer during winter months. the hospital's emergency department treated 12,588 patients during the year. 23738686 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 62 0 1 417 1 0 0 0 0 0 0 0 0 0 14 14 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 0 1 0 1 0 WV X Joe A Barnes Chief Financial Offi 3042575802 one hospital drive petersburg WV 26847 janie berg 1.00 X 0 0 0 REV larry cantu 1.00 X X 0 0 0 robert chehi 1.00 X 0 0 0 jim cole 1.00 X 0 0 0 cynthia harman 1.00 X 0 0 0 matt harper 1.00 X 0 0 0 bruce leslie md 1.00 X 0 0 0 alan kile sr 1.00 X 0 0 0 tom kimble 1.00 X 0 0 0 ralph sites 1.00 X 0 0 0 jason sites 1.00 X 0 0 0 janet frye 1.00 X 0 0 0 gary kitzmiller 1.00 X 0 0 0 mark wright 1.00 X 0 0 0 robert l harman 40.00 X 169567 0 17643 mary beth barr 40.00 X 107350 0 11377 joe a barnes 40.00 X 0 0 0 john l hahn md 40.00 X 592885 0 8317 susan a schmitt md 40.00 X 172571 0 8512 brenton r harman 40.00 X 103841 0 18139 david w brosh 40.00 X 101287 0 17828 1247501 0 81816 6 0 1 0 reliable healthcare llc 3120 University Avenue morgantown WV 26505 er physician 1417456 us mobile imaging llc PO Box 808 cumberland MD 21501 mri 711996 pulmonary associates inc 2862 US Highway 2205 moorefield WV 26836 respiratory therapy 437747 aureus radiology llc po box 3037 omaha NE 68154 radiology 221764 jeffrey swingholm crna po box 536 petersburg WV 26847 crna 192000 5 379104 3575 382679 PATIENT REVENUE 621400 26066213 26066213 26066213 7795 7795 187091 98949 88142 88142 88142 1206557 262760 1146257 58296 60300 204464 264764 264764 medical supplies 900099 155734 155734 cafeteria 722210 148691 148691 ADMINISTRATIVE CASE MA 900099 24716 24716 20308 20308 349449 27159042 26066213 0 710150 305937 305937 9119594 9119594 236383 193064 43319 2052935 1676720 376215 642611 524848 117763 30260 30260 98820 98820 5148535 4205028 943507 44663 36478 8185 296098 241836 54262 742132 606131 136001 14910 12178 2732 30426 24850 5576 175849 143623 32226 1268668 1036175 232493 744309 744309 supplies 4450650 3635036 815614 0 repairs and maintenance 629211 513903 115308 0 licenses and taxes 491946 491946 0 0 food 214892 175511 39381 0 dues and subscriptions 111909 91401 20508 0 325751 266055 59696 27176489 23738686 3437803 0 2154377 960029 1170693 783283 4368335 5150442 267949 530098 623595 508001 257899 28425445 20494537 8593245 7930908 4031253 4495647 169607 112242 0 704694 21793558 21018739 2583442 2730197 30213 8853 2095000 1940000 1908294 992478 154510 113056 6771459 5784584 X 15022099 15234155 15022099 15234155 21793558 21018739 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3844 3844 0 Part IV, Supplemental Information: GRANT MEMORIAL HOSPITAL PAYS MEMBERSHIP DUES TO AMERICAN HOSPITAL ASSOCIATION, WEST VIRGINIA HOSPITAL ASSOCIATION and AMERICAN HEALTH CARE ASSOCIATION WHERE A PERCENTAGE OF THE DUES PAID ARE USED FOR LOBBYING EXPENSES. 70684 70684 15301153 9461409 5839744 12592536 10658665 1933871 461072 374463 86609 7930908 Investments 4495647 F 4495647 estimated malpractice insurance cost 113056 113056 27159042 27176489 -17447 229503 229503 212056 27487494 229503 229503 27257991 -98949 -98949 27159042 27275438 98949 98949 27176489 0 27176489 Part XII, Line 4b - Other Adjustments: rental expenses: -98949. Part XIII, Line 2d - Other Adjustments: rental expenses: 98949. 1 1 1 X 1 X 1 1 1 0 1 1 1 780225 780225 0.02870 4622315 3616677 1005638 0.03700 1 5402540 3616677 1785863 0.06570 1 5402540 3616677 1785863 0.06570 0 670334 7208869 7431165 -222296 X 1 1 LHC Group provides home care and hospice services 0.33000 0.00000 0.00000 Grant memorial hospital

po box 1019 petersburg WV 26847

X X X X 20 bed skilled/nf Part III, Line 4: cost-to-charge ratio. The amount of bad debt expense is net of any discounts or payments received. Part III, Line 8: Grant Memorial Hospital provides 24/7 ER coverage and also has an OB/GYN Doctor on staff. The closest medical facility providing similar services is located 1 1/2 hours away if traveling by vehicle and road conditions are clear. These are much needed services for the community as such; there is no discrimination for patients' ability to pay. Additionally, services that are provided to elderly residents in Grant, Hardy and Pendleton Counties of West Virginia that have limited resources and access to adequate transportation to seek medical care elsewhere.The organization used the Medicare principles of reimbursement and reported the amounts on lines 5 and 6 as taken directly off the Medicare costs report. Part III, Line 9b: Income guidelines are developed by the Health Resources and Services Administration. Patients who qualify for charity care are evaluated based upon their ability to pay and liquidate their outstanding balance in one year. Payments are monitored monthly and followed up with normal collection procedures. Account balances over 120 days are referred to a collection agency and written off. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY GRANT MEMORIAL HOSPITAL. Part VI, Line 2: During the process of becoming certified as a Critical Access Hospital, the Hospital conducted a formal "community needs assessment". During this process, not only was demographic information obtained to identify unmet medical needs, but local providers of healthcare services and community leaders were interviewed as to what their perception was regarding unmet needs in the area that included Grant, Hardy and Pendleton counties in West Virginia. In accordance with recent regulations, the Hospital will be conducting these assessments every three years. This assessment is available to the public. Part VI, Line 3: Information on eligibility for assistance is provided for those services that require pre-registration and once patients are identified as not having commercial insurance, these patients are interviewed by customer service representatives to ascertain what resources, including charity, to liquate the balance.Customer Service Representatives conduct interviews with patients who may qualify for charity assistance. During this time, documented income information must be provided by the patient to determine eligibility. Based upon this information, a determination is made if and how much charity the patient may qualify. Part VI, Line 4: The Hospital is located in the Potomac Highlands (Mountains) of eastern West Virginia. The closest hospitals are located approximately 1 1/2 hours away during good weather. During the winter, it typically will take much longer. There are no four-lane highways that individuals can travel 100% to other hospitals. Part VI, Line 6: The Hospital sponsors health fairs, conducts blood screenings and provides other health information at various times throughout Grant, Hardy and Pendleton counties. Due to the distance to other hospitals, the Hospital provides obstetrical care at a financial loss. The Hospital provides 24/7 emergency room coverage where a physician is present twenty-four hours per day even though the Hospital does not have the volume or patient mix to provide these services without incurring a financial loss. Members of the governing board must be residents of Grant, Hardy or Pendleton Counties. Members are selected from each magisterial district in every county to insure that there is proper represention on the board. In addition, it is required in WV that there is a broad representation on the board including educators, bankers, and members with union affilitation. Physicians seeking medical privileges have their qualifications review by the existing members of the medical staff with the medical staff making recommendations to the governing board as to whether medical privileges are granted. However, it is the governing board's decision as to whether physicians are granted privileges. Due to the small population of the Hospital's service area (less than 30,000 residents), it is difficult to find qualified board members. From time to time there are members of the board who may be related to employees of the hospital. All board members must sign a conflict of interest statement every year. Many times, board members have abstained on voting on certain issues due to these types of conflicts. Any surplus funds are used to provide much needed services as OB/GYN, 24/7 emergency room services, to provide skilled nursing services. During the last three years the Hospital has incurred capital purchases of $615,607 in 2010, $735,524 in 2009 and $824,428 in 2008. During FY 2009 and FY 2008, the Hospital incurred losses of approximately $2.0 million for each year. In spite of these losses, the Hospital continued to provide much needed services to the residents of the Tri-County area. WV X X X 0 0 0 1 0 0 0 0 0 robert l harman 169567 0 0 0 0 0 0 0 17643 0 187210 0 0 0 john l hahn md 325497 0 267388 0 0 0 0 0 8317 0 601202 0 0 0 susan a schmitt md 172571 0 0 0 0 0 0 0 8512 0 181083 0 0 0 Part I, Line 5 The OB/GYNs compensation is based upon the cash basis profit of the practice. john l hahn md physician owed amount-advance with no taxes at the time X 30000 30000 0 0 1 30000 Form 990, Part VI, Section A, line 7a THE COUNTY COMMISSION IN GRANT, HARDY AND PENDLETON COUNTIES APPOINT MEMBERS TO THE BOARD. THE HOSPITAL IS A POLITICAL SUB-DIVISION OF GRANT COUNTY. (COUNTY HOSPITAL). Form 990, Part VI, Section B, line 11 The tax return will be available for review by the Finance Committee for its approval before the tax return is filed. Every member of the board will receive a copy of the return. Form 990, Part VI, Section B, line 12c TRUSTEES AND ADMINISTRATION OFFICIALS SHALL BE REQUIRED TO COMPLETE A WRITTEN CONFLICT OF INTEREST STATEMENT ANNUALLY WHICH SHALL DISCLOSE THE EXTENT OF FINANCIAL DEALINGS WITH THE ORGANIZATION BY ALL BUSINESSES OR OTHER ORGANIZATIONS IN WHICH THEY, OR MEMBERS OF THEIR IMMEDIATE FAMILIES, HAVE A BENEFICIAL INTEREST. A BENEFICIAL INTEREST WITH AN ORGANIZATION WILL BE CONSIDERED TO EXIST WHEN A TRUSTEE OR ADMINISTRATION OFFICIAL OR A MEMBER OF HIS IMMEDIATE FAMILY IS AN OFFICER, DIRECTOR, TRUSTEE, PARTNER, EMPLOYEE OR AGENT OF THE ORGANIZATION, OR OWNS FIVE PERCENT OF THE VOTING STOCK OR CONTROLLING INTEREST IN THAT ORGANIZATION, OR HAS ANY OTHER SUBSTANTIAL INTEREST OR DEALINGS WITH THE ORGANIZATION. AT SUCH TIME, IF ANY MATTER SHOULD COME BEFORE THE BOARD OF TRUSTEES IN SUCH A WAY AS TO GIVE RISE TO A CONFLICT OF INTEREST, THE AFFECTED MEMBER OF THE BOARD SHALL MAKE KNOW THE POTENTIAL CONFLICT AND, IF ADVISABLE, WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO VOTE, THE AFFECTED MEMBER SHALL NOT VOTE, NOR BE COUNTED IN ESTABLISHING A QUORUM FOR THE VOTE ON THAT MATTER. PROCEEDINGS RELATED TO THE CONFLICT OF INTEREST MATTERS BEFORE THE BOARD OF TRUSTEES SHALL BE DOCUMENTED IN THE MINUTES OF THAT MEETING. Form 990, Part VI, Section B, line 15a Compensation committee does an annual evaluation of the CEO. The Salary is determined based upon the West Virginia Health Care Authority annual report. The board performs an annual evaluation prior to setting compensation for the following year. Form 990, Part VI, Section C, line 19 It is required by West Virginia law that all hospitals file financial statements, Medicare/Medicaid cost reports tax returns and other finanical information to the West Virginia Health Care Authority. In addition, financial statements are also required to be published in local newspapers. Information submitted to the West Virginia Health Care Authority may be obtained under the Freedom of Information Act. FORM 990, PART VI, LINE 14: GRANT MEMORIAL HOSPITAL IS IN THE PROCESS OF DEVELOPING A DOCUMENT RETENTION AND DESTRUCTION POLICY.