2011-11-10T09:48:35-06:00 2010-12-31 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-01-01 311097818 Preston Memorial Hospital PRES 3043291400 300 South Price Street Kingwood WV 265371442 Robert Milvet 3043291400 2011-11-10 1 Harry C Harless 3043460441 2010 2016-02-24 21:20:13Z Melissa Lockwood 300 South Price Street Kingwood WV 265371442 20395155 0 X prestonmemorial.org X 1955 WV To provide acute medical, rehabilitative, and outpatient services to residents of Kingwood, West Virginia and surrounding communities. 10 10 375 45 0 0 404332 441539 18860599 19501186 423668 22122 269643 313863 19958242 20278710 0 0 0 0 11692431 11510949 0 0 0 7787475 8216962 19479906 19727911 478336 550799 9856241 7451644 6577518 6536732 3278723 914912 X To provide all patients state of the art, accessible, and cost effective healthcare. 0 0 13304503 19501186 The Hospital had 3,319 inpatient days, delivered 116 babies, and provided 48,039 emergency and outpatient visits to patients. The Hospital provides care regardless of the patient's ability to pay. Charges foregone for charity care amounted to $447,329.The hospital promotes and provides activities such as health fairs, blood drives, and a fitness center to improve the health and welfare of its patients. The Hospital strives to provide and promote needed services in the community by partnering with local agencies such as the Preston County Health Department, Family Resource Network, Preston Prevention Partnership, and the Preston County Chamber of Commerce.The hospital is committed to and will continue to strive to provide quality value priced health care in Preston and surrounding counties. 13304503 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 44 0 1 375 1 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X Robert Milvet CFO 3043291400 300 South Price Street Kingwood WV 265371442 Ron Crites 1.00 X 0 0 0 Kathy McNeil 1.00 X 0 0 0 Rita McCrobie 1.00 X 0 0 0 Roger Metheny 1.00 X 0 0 0 Grace Brailer 1.00 X 0 0 0 Vicki Cole 1.00 X 0 0 0 Mary Jo Gregg 1.00 X 0 0 0 Roger Hardesty 1.00 X 0 0 0 Larry Williams 1.00 X 0 0 0 Frederick Conley II 40.00 X 292356 0 22706 Melissa Lockwood 40.00 X 132866 0 4025 Robert Milvet 40.00 X 120258 0 6639 Marisa Holland 40.00 X 261934 0 7089 Dale Meyers 40.00 X 220069 0 6614 John Peterson 40.00 X 204159 0 17401 Hany Tadros 40.00 X 210224 0 6202 Timothy Miller 20.00 X 155723 0 0 1597589 0 70676 10 0 1 0 Monongalia Radiology Assoc PC 1200 JD Anderson Drive Morgantown WV 26505 Radiology Group 480000 QHR 105 Continental Place Brentwood TN 37027 Consulting 309403 RMTS LLC 6 Harrison Street New York NY 10013 Third Party Administrator 194860 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 Xray Services 149115 Russell Biundo MD 1160 Vanvoorhis Road Morgantown WV 26505 Physician Services 117700 5 161670 279869 441539 Patient services 622110 19501186 19501186 19501186 18743 18743 48471 15385 33086 33086 33086 104439 101060 3379 3379 3379 Rebate Revenue 900099 114513 114513 Cafeteria Sales 722212 84604 84604 81660 81660 280777 20278710 19501186 0 335985 579760 396150 183610 8631097 5897629 2733468 182291 124559 57732 1465799 1001580 464219 652002 445513 206489 270038 184517 85521 47191 47191 44000 44000 2149007 1468416 680591 114085 77954 36131 2564926 1752614 812312 127288 86976 40312 388608 265536 123072 72966 49858 23108 269187 269187 746736 510245 236491 115810 79133 36677 Healthcare provider tax 405365 405365 0 Repairs & maintenance 263446 180013 83433 Contribution expense 232075 158577 73498 Sales tax 121911 83302 38609 Collections & billing 68076 0 68076 216247 136566 79681 19727911 13304503 6423408 0 4148 4649 327121 1650193 2075315 389088 629256 94159 94978 14463583 10910023 3661166 3553560 225871 195509 40728 145787 3463767 752590 9856241 7451644 2862811 3033702 1640000 1265000 708013 455630 1366694 1782400 6577518 6536732 X 3012130 660535 266593 254377 3278723 914912 9856241 7451644 X 550799 -2914610 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4558 4558 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The organization pays membership fees in the West Virginia Hospital Association and the American Hospital Association, both which participate in lobbying activities. 31195 31195 7649866 6477254 1172612 6330271 4303446 2026825 452251 129323 322928 3553560 Beneficial interest in remainder trust 142580 Bond issue costs 24561 Other receivables 498040 Minority Interest - LHC 87409 752590 Capital leases 843561 Due to related Parties 18 Due to third party payors 938821 1782400 20278710 19727911 550799 -2914610 -2914610 -2363811 20294095 15385 15385 20278710 0 20278710 19743296 15385 15385 19727911 0 19727911 Part XI, Line 8 - Other Adjustments: Pension plan minimum liability adjustment 74,581. Audit adjustment - elimination of related party balances -2,989,191. Part XII, Line 2d - Other Adjustments: Rental expenses netted with income on 990 15,385. Part XIII, Line 2d - Other Adjustments: Rental expenses netted with income on 990 15,385. 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 357267 312008 45259 0.00260 0 0 154749 100487 54262 0.00310 512016 412495 99521 0.00570 49707 35579 14128 0.00080 500 500 0.00000 8949 1104443 775593 328850 0.01890 1690 1690 0.00010 8949 1156340 811172 345168 0.01980 8949 1668356 1223667 444689 0.02550 5400 5400 0.00030 5400 5400 0.00030 0 1501990 5044684 5108593 -63909 X 1 1 1 Preston Memorial Home Care Home health care 0.25000 0.00000 0.25000 1 1 Preston Memorial Hospital

300 South Price Street Kingwood WV 26537

X X X X Preston Memorial Hospital 1 0 1 1 300.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X X 1 X X X 1 X X X X X X X 1 X 0 1 Part I, Line 3c: The CFO and financial counselor review all charity applications. The CFO and counselor then determine, based on financial information given by the patient (tax returns, pay stubs, household expenses, and other family considerations), if deep discounts can be provided to the patient, or if a complete write-off to free-care is deemed appropriate. Part I, Line 7: Actual revenue and costs were taken from the general ledger. Reasonable estimates were used where appropriate.Financial assistance at cost was calculated from worksheet S-10, line 17 of the cost report multiplied by the calculated cost-to-charge ratio. Unreimbursed Medicaid and unreimbursed cost - other means-tested government programs were calculated using the calculated cost-to-charge ratio.Community health improvement services and community benefit operations and health professions education were calculated using internal cost accounting systems that use direct and indirect cost reporting. Part I, Line 7g: Emergency room and Level 4 trauma services. Part I, L7 Col(f): The cost of bad debt was estimated using a cost-to-charge ratio derived from woksheet 2 of the schedule H instructions. Part II: Preston offers its conference room space for multiple community meetings, including birthing classes, CPR, EMS & First Responder classes, parenting classes, etc. Part III, Line 4: Patients seeking financial assistance complete financial assistance applications and work with the hospital's financial counselor to determine appropriate levels of discounts (or complete free care) based on information supplied by the patient. All self pay patients are offered baseline discounts of 10% from charges, and an additional 30% prompt payment discount if payment is made within a certain time period after receiving a bill. Patients who refuse assistance and refuse payment options are turned over to a collection agency after 3 bills have been submitted, and bad debt is recognized at that time.The cost of bad debt was estimated using a cost-to-charge ratio derived from woksheet 2 of the schedule H instructions. Part III, Line 8: The majority of Medicare shortfall is included in subsidized services for ER and Level 4 Trauma. Part III, Line 9b: The hospital financial counseling staff helps patients seek financial assistance through government programs or other payment services before applying for charity care. If government programs or other services are denied, a financial counselor works with patient to obtain financial information like tax returns, household bills, bank account information, etc. The financial counselor works with the CFO to determine if a patient is eligble for full or partial charity care. Once this determination is made, the financial counselor communicates results with the patient. If partial payment is due after a discount has been recommended, the financial counselor works with the patient on a payment arrangement. If a patient who has been deemed eligible for partial charity care, agrees to a payment plan and then fails to pay the remaining balance agreed to, the remaining balance will be adjusted off as bad debt. The remaining balance will be turned over to a collection agency. Preston Memorial Hospital Part V, Section B, Line 1j: The Hospital has not formally conducted a community needs assessment. The hospital does submit patient satisfaction and awareness surveys to the community seeking input on awareness of services rendered, input on quality of hospital services, and input on what services the community deems to be lacking. Preston Memorial Hospital Part V, Section B, Line 11h: The CFO and financial counselor evaluate charges and discounts on a case-by-case basis for each request under the assistance program. Substantial discounts and complete write-offs are granted depending on information supplied and evaluation of resources supplied by the patients. Preston Memorial Hospital Part V, Section B, Line 13g: The Hospital presented the financial assistance program at a public meeting held by the Preston County Commission. Preston Memorial Hospital Part V, Section B, Line 19d: The CFO and financial counselor review charges for discount adjustments on all charity applications. Also, all self pay patients are offered discounts and prompt pay discounts from charges billed. Preston Memorial Hospital Part V, Section B, Line 21: The Hospital charges 'gross charges' for all services rendered to all patients. Charges are then reduced by either insrance contractuals or discounts offered to patients without insurance. Part I, Line 6b. The hospital presented results of financial assistance and other community benefits to the Preston County Commission (local government), and such report was posted in the local newpapers. The hospital also posts community benefit information on its website - www.prestonmemorial.org Part VI, Line 2: The hospital has not formally conducted a community needs assessment. The hospital does submit patient satisfaction and awareness surveys to the community seeking input on awareness of services rendered, input on quality of hospital services, and input on what services the community deems to be lacking. Part VI, Line 3: The Hospital personnel instruct patients during the registration process who do not have insurance or the inability to pay, to complete an application for chairty care after all other sources of financial assistance have been denied. Hospital personnel assist patients with obtaining other financial assistance before applying for charity care. The financial counseling policy is posted in the waiting rooms and at the front-desk. The hospital also has a formal resolution in place with the Preston County Commmision (local government) informing all local citizens of the Hospital's financial assistance program. Part VI, Line 4: Preston Memorial Hospital located in Kingwood, WV, is situated in a rural geographic location. Preston county has a population of 33,520, with more than 16% of the service area population being 65 or older. The average household income was $38,008 with a per capita income of $18,011. 15.1% of the population is below the federal poverty level. The Hospital's Medicaid utilization is 17%, Medicare utilization is 40%, and an estimated 12% of the Hospital's patients served are uninsured (or underinsured). Preston Memorial Hospital is the only hospital in the county. There are 2 major competitors outside of the county - West Virginia University Hospitals and Monongalia General Hospital. Both hospitals are located approximately 50 minutes away from the hospital and are situated in urbanized locations in Monongalia County, WV. Other hospitals are also approximately 45 minutes to one hour driving distance from Preston Memorial Hosptial. There is a FQHC located in the county (Preston-Taylor Community Health Center). There are no other designated medically underserves areas in the county. Part VI, Line 6: Preston Memorial Hospital has a governing body comprised of citizens of Preston County. They are not employees, contractors or family members thereof. They represent labor, elderly, the business community and the poor. The hospital extends priveleges to qualified physicians in the community and beyond to help take care of the needs of its patients. The organization routinely does not have surplus funds available from operations, and struggles to maintain operations with less than 5 days cash on hand. However, the hospital has identified resources through borrowing or fundraising to invest in new technologies for imaging services, electronic health records, facility improvements, patient care room upgrades and other clinical capital improvements (e.g., monitors, vents, surgical equipment, etc.). The hospital also provides 24 x 7 emergency services and a level 4 trauma center. The hospital's emergency department and all other clinical services where medical need is demonstrated is available to all patients regardless of ability to pay. The hospital's specialized services include: ENT, OB/Gyn care, general surgery, orthopaedics, physiatry, physical therapy, cardiology, laboratory, radiology, birthing center, and neurology. If these services were not available, patients in the primary service area would have to travel more than 45 minutes to obtain these services elsewhere. The hospital works diligently to attract charitable support through its Foundation, and engages over 30 volunteers to support multiple activities at the hospital. Part VI, Line 7: Preston Memorial Hospital is part of the Preston Healthcare Corporation (PHCC). The PHCC includes Preston Memorial Hospital, Preston Memorial Medical Group, and Preston Memorial Foundation. All entities are under common governance and control, and collectively operate to serve the healthcare needs and charitable needs of the community. The medical group provides women's healthcare services ranging from family planning and pre/postnatal care to weight management and healthy living. The Foundation serves as a fundraising arm of the Hospital to help provide support for capital improvements, maintenance costs for the radiology department, and to support community activities through charitable giving. 1 X X 0 0 0 0 0 0 0 0 0 Frederick Conley II 292356 0 0 0 0 0 7350 0 16266 0 315972 0 0 0 Marisa Holland 261934 0 0 0 0 0 7089 0 910 0 269933 0 0 0 Dale Meyers 220069 0 0 0 0 0 6614 0 682 0 227365 0 0 0 John Peterson 204159 0 0 0 0 0 6256 0 11755 0 222170 0 0 0 Hany Tadros 210224 0 0 0 0 0 6202 0 774 0 217200 0 0 0 Timothy Miller 155723 0 0 0 0 0 0 0 0 0 155723 0 0 0 Form 990, Part VI, Section B, line 11 The CFO reviews the return for accuracy to audited financial statements and to reasonableness to prior years returns. The CEO also reviews but more for their knowledge of what is on return. Form 990, Part VI, Section B, line 12c Board members are required to sign a conflict of interest statement annually/other ways to monitor are by following policies and procedures for obtaining bids or issuing RFP's for large dollar projects and also requiring the Board to approve any major contracts and purchases over $15,000. Form 990, Part VI, Section B, line 15 PMH utilizes salary surveys and local hospital comparisons in order to determine compensation. Form 990, Part VI, Section C, line 19 The organization only provides for these if requested. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Pension plan minimum liability adjustment 74,581. Audit adjustment - elimination of related party balances -2,989,191. Total to Form 990, Part XI, Line 5: -2,914,610. CLARIFICATION OF ITEM MARKED YES FORM 990, PART XII, LINE 2C The organization has not changed its financial oversight during the year. Preston Memorial Medical Group 300 South Price St Kingwood WV 26537 550717988 Primary care services WV 501(c)(3) Hospital N/A 0 Preston Memorial Foundation 300 South Price St Kingwood WV 26537 550740121 Support activities of other charitable organizations WV 501(c)(3) Supporting Organizat N/A 0 Preston Memorial Homecare LLC 420 West Pinhook Suite A Lafayette LA 70503 271446056 Home healthcare LA Related -6407 72076 0 0 0.25000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0