2011-08-12T14:30:11-05:00 2010-09-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2009-10-01 550440086 Pleasant Valley Hospital PLEA 3046754340 2520 Valley Drive Pt Pleasant WV 25550 Thomas Schauer 3046754340 2011-08-11 1 Harry C Harless 3043460441 2009 2016-02-24 21:20:13Z Thomas Schauer 2520 Valley Drive Pt Pleasant WV 25550 75228827 0 X www.pvalley.org X 1955 WV Provide quality inpatient and outpatient healthcare to the community regardless of ability to pay. Provide a wellness center to promote community health through fitness programs. 19 15 1005 55 6536 0 361004 282315 76094711 73864388 176547 117367 929576 951302 77561838 75215372 0 0 42975146 41872167 0 0 33636591 34105052 76611737 75977219 950101 -761847 46009205 44280503 18991785 18042366 27017420 26238137 To operate an acute care hospital facility for the citizens of Point Pleasant, West Virginia and the surrounding communities and counties. 0 0 63385915 73570774 The hospital provided 44,860 acute, nursery and skilled nursing days; 133,237 outpatient visits; 18,141 ER visits; 2,486 ambulatory surgeries; 1,993 observation visits; 7,989 home health visits; 2,586 hospice visits; and 59,813 physician office visits. 100935 143854 The hospital operates a wellness center which provides community health education and fitness programs that are available to hospital employees and all residents of the surrounding communities. 63486850 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 1 44 0 1 1005 1 1 1 0 0 0 0 0 0 19 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Thomas Schauer CEO 3046754340 2520 Valley Drive Point Pleasant WV 25550 Michael Lieving 3.00 X 0 0 0 Mario Liberatore 3.00 X 0 0 0 Annette Boyles 3.00 X 0 0 0 James Lockhart DDS 3.00 X 0 0 0 Clayton Faber 3.00 X 0 0 0 Charles Lanham 3.00 X 0 0 0 C Dallas Kayser Esq 3.00 X 0 0 0 Pete Allinder 3.00 X 0 0 0 Scott Barnitz 3.00 X 0 0 0 Dorsel Keefer 3.00 X 0 0 0 Mike Bartrum 3.00 X 0 0 0 Jack Buxton OD 3.00 X 0 0 0 William Knight 3.00 X 0 0 0 Gus Douglass 3.00 X 0 0 0 James Rossi CPA 3.00 X 0 0 0 Randall Hawkins MD 3.00 X 0 0 0 R Michael Shaw Esq 3.00 X 0 0 0 William Tatterson 3.00 X 0 0 0 Lannes Williamson 3.00 X 0 0 0 Alvin Lawson 40.00 X 337760 0 37600 Thomas Schauer 40.00 X 161795 0 28532 William A Barker Jr 40.00 X 151260 0 21462 Sandra Wood 40.00 X 156628 0 15570 Ori Tzuk MD 40.00 X 629430 0 31445 William Casto MD 80.00 X 526516 0 37650 James Toothman DO 60.00 X 511126 0 40245 David Felder MD 40.00 X 499992 0 40245 Clifford Roberson MD 40.00 X 500353 0 40245 3474860 0 292994 38 0 1 0 NAPs Inc 714 1/2 Lee St Charleston WV 25301 CRNA Services 577604 Quest Diagnostics PO Box 7407009 Atlanta GA 30374 Lab Services 472373 Crest Services 735 Plaza Blvd 210 Copell TX 75019 Biomedical 469833 Virtual Radiologic Corp 11995 Singletree Lane Suite 500 Minneapolis MN 55344 Radiologists 292625 Colonial Consulting Group 625 Colonial Park Roswell GA 30075 Consultants 139166 8 230409 51906 282315 Patient Services 622110 73570774 73570774 From K-1: Premier Pur 900099 149760 6536 143224 Wellness Center 621111 143854 143854 73864388 117035 117035 426252 13455 412797 412797 412797 332 332 332 332 Cafeteria & vending 722212 384322 384322 Gift shop 453220 48802 48802 Purchase discounts 900099 31872 31872 73509 73509 538505 75215372 73714628 6536 1211893 987774 797430 190344 29923414 24157172 5766242 1563023 1261828 301195 7471687 6031893 1439794 1926269 1555077 371192 88316 88316 39762 39762 4254975 3435041 819934 397811 321153 76658 8762993 7074364 1688629 514821 415615 99206 1012284 817217 195067 328995 265598 63397 527199 425608 101591 3184946 2571207 613739 932209 752572 179637 Bad debts 10146068 10146068 Medicaid provider tax 1401947 1401947 0 Service contracts 1191874 962200 229674 Sales & use tax 423935 342243 81692 Dues & subscriptions 329866 266301 63565 567051 486316 80735 75977219 63486850 12490369 0 1200034 1039369 7576163 9444743 12056876 11779089 108560 1232649 1175304 599270 681509 69136920 50491313 19532914 18645607 227903 1949574 89376 1861725 1089043 46009205 44280503 7781630 7111953 28900 28900 9200000 8530000 1981255 2371513 18991785 18042366 X 27017420 26238137 27017420 26238137 46009205 44280503 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1254831 1254831 235562 23207194 13910508 9532248 233667 228182 5485 40697256 34585107 6112149 3508410 1767516 1740894 18645607 Capital lease agreements 2005880 Estimated third party payor settlements 365633 2371513 75215372 75977219 -761847 -17435 -17435 -779282 75204492 138880 138880 75065612 149760 149760 75215372 75983774 6555 6555 75977219 0 75977219 Part XI, Line 8 - Other Adjustments: Income per K-1: Premier Purchasing Partners: -149760. Distribution: Premier Purchasing Partners: 132325. Part XII, Line 2d - Other Adjustments: Distributions from Premier Purchasing Partners: 132325. Depreciation included in rental expenses on 990: 6555. Part XII, Line 4b - Other Adjustments: From K-1: Premier Purchasing Partners: 149760. Part XIII, Line 2d - Other Adjustments: Depreciation included in rental expenses on 990 : 6555. 1 1 X 1 X 1 X 1 1 0 0 207302 0 207302 0.00310 12903538 11484641 1418897 0.02160 13110840 11484641 1626199 0.02470 13 275 3981 43 3938 0.00010 2994 2994 0.00000 13 275 6975 43 6932 0.00010 13 275 13117815 11484684 1633131 0.02480 1 60 300 300 0.00000 1 19377 19377 0.00030 2 60 19677 19677 0.00030 3618247 878027 12277005 12290684 -13679 X 1 1 Pleasant Valley Hospital

2520 Valley Drive Pt Pleasant WV 25550

X X X Skilled nursing facility Part I, Line 7: The cost of charity care and unreimbursed Medicaid were estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H Instructions. The cost of community health improvement services was obtained from the hospital's accounting records. Part I, Line 7g: Part I, Line 7f: Bad debt expense amounting to $10,135,147 was eliminated from total expenses for purposes of calculating percentage of total expenses reported in Part I, Line 7. 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.Cost of bad debts was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. Part III, Line 8: Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions. Part III, Line 9b: Pleasant Valley Hospital has a charity care policy and a Collection and Bad Debt policy that discusses qualifying and eligibility for charity care, collection practices and handling of bad debt accounts. It is a practice to handle all patient accounts in the same manner/precedent. Patients are sent monthly statements - even while applying and pending financial assistance and will continue to receive statements until determination is made. Once determination is made the account balance or the % portion of the account balance is adjusted to "Financial Assistance". Part VI, Line 2: The hospital has started the formal process of assessing the Needs of the Community. The hospital serves area businesses with mostly lab and radiology services, along with annual flu vaccines at a discounted rate. We have a representative work with the owners of the business to determine what their immediate needs are. Part VI, Line 3: The process in place offers the uninsured and underinsured patient the ability to apply for charity care through a formal application process established by reviewing both income and expense to make a final determination of eligibility. It requires proper verification of income through a pay stub, tax return, etc. It is also verified that the patient is not eligible for a state assisted program via a denial letter from the program or verification through the state caseworker. The patient will either be contacted by the Business Office or will contact the Business Office during the collection and statement process to discuss financial arrangements regarding their patient account. All options of payments will be discussed and charity care offered as an alternative option after screening the patient's financial ability to make payment. Once a patient has been deemed eligible for charity care, they are not eligible again for 12 months from the approval date. Part VI, Line 4: Pleasant Valley Hospital is a rural hospital in Point Pleasant, WV. Pleasant Valley Hospital serves mainly the people of Mason and Jackson County, WV and Meigs and Gallia County, OH. We are a federally designated medically underserved area. Mason County has 27,324 residents, the median Household income is $35,000, and 20.4% are below poverty levels. Jackson County has 29,211 residents, the median household income is $39,000, and 13.5% are below poverty levels. Meigs County has 23,770 residents, the median household income is $34,359, and 20.0% are below poverty levels. Gallia County has 30,934 residents, the median household income is $31,000 and 20.9% are below poverty levels. Medicaid patients made up 29% of our total discharges and 18% of our total outpatient visits in FY2010. Uninsured paitients made up of 5% of our total discharges and 6% of our total outpatient visits in FY2010. There is one other not-for-profit hospital within 15 miles of PVH. They serve many of the same areas that we do. Part VI, Line 5: Our weight loss challenge gives the community the ability to use our wellness services. Our wellness services includes cardio and weight lifting machines and certified exercise physiologists. Blood pressure, weight, body fat were monitored before the challenge and after the challenge. This promotes a healthly lifestyle in the community. Mason County is a medically underserved area and the hospital spends money for recruitment for this area. The amount shown for workforce development is the amount paid to recruit new physicians to the area. Part VI, Line 6: The majority of the organization's governing body is comprised of persons who reside in the organization's primary service area, who are neither employees or contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community. The hospital provides a 24 hour emergency room and is available to all regardless of the ability to pay. All the services provided by the hospital are provided regardless of the ability to pay. The hospital has an auxiliary that helps our patients and visitors if they need a wheelchair when they arrive. The hospital provides Breast Cancer Screenings/mammograms free to patients who cannot pay for the service. The hospital has a fitness center for the community and it also conducts many healthfairs throughout the year. The hospital provides many health screenings througout the year in addition to a nutritional program. Our SNF provides transportation to health facilities. The hospital also has support groups for members of the community. X X 1 1 X X X 1 0 0 0 0 0 0 0 0 Alvin Lawson 327434 0 101 0 10225 0 21067 0 18551 0 377378 0 0 0 Thomas Schauer 161694 0 101 0 0 0 13107 0 16179 0 191081 0 0 0 William A Barker Jr 151159 0 101 0 0 0 6037 0 16138 0 173435 0 0 0 Sandra Wood 156527 0 101 0 0 0 9972 0 6325 0 172925 0 0 0 Ori Tzuk MD 498085 0 131345 0 0 0 12496 0 21762 0 663688 0 0 0 William Casto MD 526415 0 101 0 0 0 18701 0 20884 0 566101 0 0 0 James Toothman DO 511025 0 101 0 0 0 21296 0 20745 0 553167 0 0 0 David Felder MD 499891 0 101 0 0 0 21296 0 21859 0 543147 0 0 0 Clifford Roberson MD 500252 0 101 0 0 0 21296 0 21859 0 543508 0 0 0 Part I, Line 4a: William Casto, MD $69,590 The County Commission of Mason County WV 556000352 575194BM6 2003-06-17 7805000 To refund Series 1993 bonds 0 0 The County Commission of Mason County WV 556000352 575194CH6 2006-10-12 3895000 Capital improvements & equipment acquisition 0 0 7805000 783093 2003 1 0 1 1 3895000 77900 3427000 2008 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 Carrie Dillard MD Family member of James Lockhart, Trustee 10000 The hospital is in a federally designated medically underserved area. To aid in physician recruitment, the hospital received grant funds to help pay student loans of Dr. Dillard. The grant funds were paid directly to the educational institution. 0 Farmers Bank Hospital trustee, Mike Lieving, is an officer at Farmers Bank 46299 Interest on certificates of deposit 0 Lee Anne Kayser Family member of Dallas Kayser, Trustee 65981 Wages 0 Wes Lieving DO Family member of Mike Lieving, Trustee 217999 Wages 0 Carrie Dillard MD Family member of James Lockhart, Trustee 150111 Wages 0 Heather Lloyd Family member of James Lockhart, Trustee 27235 Fees for service-independent contractor 0 Jane Zirkle Family member of Mike Lieving, Trustee 22326 Wages 0 Ohio Valley Bank Hospital officer, Mario Liberatore, is an officer at Ohio Valley Bank 77953 Interest on certificates of deposit 0 People's Bank Hospital trustee, James Lockhart, is a board member at Peple's Bank PVH has accounts at People's bank 0 Ohio Valley Bank Hospital trustee, Lannes Williamson, is a bard member at Ohio Valley Bank 0 Form 990, Part VI, Section B, line 11 The 990 is prepared by the Hospital's independent accountants. It is then reviewed by the CFO and CEO and a copy is provided to the governing board before it is filed with the IRS. Form 990, Part VI, Section B, line 12c Each board member fills out a questionnaire at the end of the fiscal year. The questionnaire has questions on it that determine independence status and other relationships between board members and between the board member and the hospital. This helps in determining possible conflicts that may arise. In addition, the board members must sign a conflict of interest policy that requires them with due diligence to state that they have a conflict of interest when that conflict arises. The board member must leave the board meeting during discussions and voting. Form 990, Part VI, Section B, line 15 The compensation committee is made up of independent board members. These members are appointed by the board. The compensation committee decides the compensation of the CEO and VPs. In 2008, the compensation committee consulted with an independent consultant to determine a fair compensation for the CEO and VPs based on peer data. The Compensation committee has used this study to determine base salary for the CEO and VPs. The CEO contract is taken back to the board for final approval. Form 990, Part VI, Section C, line 19 These documents are available upon request for inspection at the hospital or by mailing a copy upon request. Form 990, Part XI, Line 2c Clarification of Item Marked Yes The audit committee, which is made up of independent board members, oversees the audit of the financial statements. This process has not changed since last year. Pleasant Valley Hospital Foundation Inc 2420 Valley Dr Pt Pleasant WV 25550 200120079 Fundraising WV 501(c)(3) 9 N/A Pleasant Valley Hospital Health Foundation Inc 2420 Valley Dr Pt Pleasant WV 25550 550649849 Scholarships/Healthcare WV 501(c)(3) 11, Type II N/A Pleasant Valley Home Medical Equipment Viand St Pt Pleasant WV 25550 550653315 Retail - Medical equipment sales & rental WV N/A C 77481 2034295 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pleasant Valley Hospital Foundation Inc C 38763