2024-05-15T06:52:08-05:00 2023-06-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-07-01 550477361 BOONE MEMORIAL HOSPITAL INC BOON 3043691230 701 MADISON AVENUE MADISON WV 25130 DOUGLAS COLE MALCOLM CFO 3043691230 2024-05-15 1 DOUGLAS COLE MALCOLM 999009999 1 AMY BIBBY P00445891 8282542254 2024-05-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BOONE MEMORIAL HEALTH VIRGIL UNDERWOOD 701 MADISON AVENUE MADISON WV 25130 72193272 0 X WWW.BMH.ORG X 2010 WV BOONE MEMORIAL HOSPITAL STRIVES TO SUPPLY A COMPREHENSIVE RANGE OF INPATIENT AND OUTPATIENT SERVICES 9 9 527 45 0 0 3636735 641264 63097379 69892989 104781 738715 531802 904482 67370697 72177450 155548 119368 0 0 35476823 37826410 0 15050 568255 29523777 32384997 65156148 70345825 2214549 1831625 67379046 72082428 47676108 50547865 19702938 21534563 X THE BASIC MISSION OF BOONE MEMORIAL HOSPITAL IS TO CREATE AN ENVIRONMENT IN WHICH QUALIFIED PHYSICIANS AND OTHER HEALTH CARE PERSONNEL CAN WORK TOGETHER TO PROVIDE HIGH QUALITY HEALTH CARE SERVICE, IN AN ATMOSPHERE OF BROTHERLY LOVE AND CONCERN, TO THE SERVICES, INCLUDING PREVENTION, GUIDANCE, DIAGNOSIS, TREATMENT, RESTORATION, REHABILITATION AND OTHER EFFORTS TO ENABLE PATIENTS TO LEAD HEALTHY, PRODUCTIVE LIVES, AS MAY BE NEEDED BY ITS COMMUNITY, AND AS ITS RESOURCES WILL PERMIT. IN CARRYING OUT ITS PROGRAMS, BOONE MEMORIAL HOSPITAL RECOGNIZES ITS RESPONSIBILITY TO MAKE SERVICES AVAILABLE TO ALL PERSONS WHO CAN BENEFIT FROM THEM AND TO PROVIDE THESE IN AN ECONOMICAL MANNER IN COMPLIANCE WITH HIGH PROFESSIONAL STANDARDS. THE HOSPITAL FURTHER RECOGNIZES RESPONSIBILITY TO DEVELOP AN ORGANIZATIONAL ENVIRONMENT IN WHICH PHYSICIANS, EMPLOYEES, VOLUNTEERS AND OTHER INDIVIDUALS CONSTITUTING ITS STAFF ARE STIMULATED TO HIGH STANDARDS OF PERFORMANCE AND CAN FIND MAXIMUM SATISFACTION, ACHIEVEM 0 0 57135941 119368 69892989 IN PERFORMING ITS MISSION, BOONE MEMORIAL HOSPITAL, INC. HAD 778 ACUTE CARE ADMISSIONS, 203 OBSERVATION ADMISSIONS, AND 203 SKILLED NURSING CARE ADMISSIONS. THE HOSPITAL ALSO HAD 7 RESPITE CARE PATIENTS, 16,128 EMERGENCY ROOM VISITS, AND 53,012 VISITS IN ITS FOUR RURAL HEALTH CLINICS. 57135941 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 83 0 1 527 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WV X DOUGLAS COLE MALCOLM 3043691230 701 MADISON AVENUE MADISON WV 25130 ROBERT BROWN PRESIDENT 1.25 X 0 0 0 JAMES HENSLEY VICE PRESIDENT 1.25 X 0 0 0 THOMAS BIAS BOARD MEMBER 1.25 X 0 0 0 JAMES GORE SECRETARY 1.25 X 0 0 0 NADA WOODIE BOARD MEMBER 1.25 X 0 0 0 SHAWN MILLER BOARD MEMBER 1.25 X 0 0 0 JOHN REGER BOARD MEMBER 1.25 X 0 0 0 SUSAN MCCORY BOARD MEMBER 1.25 X 0 0 0 WYATT SCAGGS BOARD MEMBER 1.25 X 0 0 0 VIRGIL UNDERWOOD CHIEF EXECUTIVE OFFICER 50.00 X 304307 0 409600 DOUGLAS COLE MALCOLM BEG 102022 CHIEF FINANCIAL OFFICER 50.00 X 67352 0 2715 CHAD HOVIS END 82022 CHIEF FINANCIAL OFFICER 50.00 X 144032 0 8188 ANGELA CHRISTIAN CHIEF OPERATING OFFICER 50.00 X 202676 0 183146 CASEY SHAUN HAGER DOCTOR 40.00 X 623272 0 23000 SHANE EDWARD COOK DOCTOR 40.00 X 589265 0 22700 CHARLES D CRIGGER DOCTOR 40.00 X 443342 0 2500 MICHAEL BLEDSOE DOCTOR 40.00 X 481419 0 20492 THOMAS CORTELLESI DOCTOR 40.00 X 475640 0 29250 3331305 0 701591 71 0 1 0 CPSI PO BOX 11407 BIRMINGHAM AL 35246 SYSTEM SOFTWARE VENDOR 2375106 CAMC LABWORKS 3004 CHESTERFIELD AVE CHARLESTON WV 25304 HEALTHCARE 864814 BYTES COMPUTER & NETWORK SOLUTIONS INC 1620 BROADWAY STE D SCOTTSBLUFF NE 69361 SYSTEM & SOFTWARE 780359 BASSAM HAFFAR 17 QUARRY RIDGE CHARLESTON WV 25304 HEALTHCARE 570272 JEFFREY WERCHOWSKI 204 NOTTINGHAM ROAD ROANOKE VA 24014 HEALTHCARE 200145 30 34529 441670 165065 641264 PATIENT SERVICE REVENUE 623000 61791509 61791509 PHARMACY 900099 5780580 5780580 340B PROGRAM REVENUE 900099 2081386 2081386 DIETARY SALES 900099 239514 239514 69892989 738715 738715 11583 0 11583 11583 11583 11000 34529 15822 -4822 -4822 OTHER REVENUE 900099 897721 897721 897721 72177450 69892989 0 1643197 119368 119368 718367 718367 30478906 25805201 4496522 177183 1891321 1553265 325741 12315 2744705 2051778 648448 44479 1993111 1655055 325741 12315 94133 94133 227745 227745 15050 15050 6476683 2565450 3649337 261896 260941 260941 1341662 820929 520733 536503 535289 1214 2664140 1794752 845155 24233 325836 207962 117874 1180825 987947 186094 6784 3068851 2817552 251299 632869 529495 99738 3636 MEDICAL SUPPLIES 11319613 11319613 PROVIDER TAX 1333144 1333144 OTHER EXPENSES 1282219 1138367 133488 10364 BAD DEBT EXPENSE 1226738 1226738 413095 413095 70345825 57135941 12641629 568255 26597442 29225740 2966318 2462007 155582 61854 5149193 5490373 30527 885538 1048468 410429 750998 51519785 20314342 30385031 31205443 798986 869906 0 967639 67379046 72082428 6304842 6114921 32253509 32285360 9117757 12147584 47676108 50547865 X 19702938 21434563 100000 19702938 21534563 67379046 72082428 1831625 0 X X 0 1 X 0 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 323672 323672 32211735 11429259 20782476 10976144 7598376 3377768 8008234 1286707 6721527 31205443 OTHER LIABILITIES 1341411 ESTIMATED DSH SETTLEMENTS 9918758 ESTIMATED THIRD-PARTY SETTLEMENTS 640000 ESTIMATED MALPRACTICE OBLIGATION 247415 12147584 X 70966534 0 70966534 1210916 1210916 72177450 69134909 0 69134909 1210916 1210916 70345825 PART X, LINE 2: THE HOSPITAL IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND THEREFORE IS NOT SUBJECT TO FEDERAL INCOME TAX UNDER CURRENT INCOME TAX REGULATIONS. CURRENT ACCOUNTING STANDARDS DEFINE THE THRESHOLD FOR RECOGNIZING UNCERTAIN INCOME TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS AS "MORE LIKELY THAN NOT" THAT THE POSITION IS SUSTAINABLE, BASED ON ITS TECHNICAL MERITS, AND ALSO PROVIDE GUIDANCE ON THE MEASUREMENT, CLASSIFICATION AND DISCLOSURE OF TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS. MANAGEMENT BELIEVES THERE IS NO IMPACT ON THE ACCOMPANYING FINANCIAL STATEMENTS RELATED TO UNCERTAIN INCOME TAX POSITIONS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,226,738. SPECIAL EVENT EXPENSES -15,822. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,226,738. SPECIAL EVENT EXPENSES -15,822. X X X 1 DENVER ALLEN 1504 LAKE O WOODS ROAD BRUCETON MILLS WV 26525 CONTRIBUTION SOLICTION 0 90500 15050 75450 90500 15050 75450 GOLF OUTING 45529 34529 11000 7487 5069 3266 45529 34529 11000 7487 5069 3266 15822 -4822 SCHEDULE G, PART I, LINE 2B, COLUMN (V) THE ORGANIZATION CONTRACTS WITH AN INDIVIDUAL TO SOLICIT CONTRIBUTIONS AS PART OF ITS FUNDRAISING ACTIVITIES 1 1 X 1 X 1 X 240.000000000000 1 1 0 0 117206 117206 0.00170 14266864 13087362 1179502 0.01710 14384070 13087362 1296708 0.01880 119368 119368 0.00170 119368 119368 0.00170 14503438 13087362 1416076 0.02050 1 1226738 284000 9172173 9731984 -559811 X 1 1 1 1 BOONE MEMORIAL HOSPITAL INC 701 MADISON AVENUE MADISON WV 25130 WWW.BMH.ORG X X X X FOUR RURAL HEALTH CLINICS BOONE MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X 21 1 0 0 1 X WWW.BMH.ORG X 1 21 1 WWW.BMH.ORG 0 1 X 100.000000000000 240.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.BMH.ORG/BILL-PAY X HTTPS://WWW.BMH.ORG/BILL-PAY X HTTPS://WWW.BMH.ORG/BILL-PAY X X X X X 1 X 0 X X X 1 X 0 0 BOONE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: ASSEMBLED AN ADVISORY PANEL COMPRISED OF REPRESENTATIVES FROM COMMUNITY LEADERS, HEALTH CARE PROVIDERS, AND LOCAL CITIZENS TO ASSIST WITH THE ASSESSMENT PROCESS. BOONE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: BOONE MEMORIAL HOSPITAL DEVELOPED AN IMPLEMENTATION PLAN THAT ADDRESSED THE MAJORITY OF THE SIGNIFICANT COMMUNITY NEEDS IDENTIFIED IN THE CHNA. THE AREAS ADDRESSED INCLUDED ALCOHOL AND DRUG ABUSE, DRUNK DRIVING AND LACK OF RECREATIONAL PROGRAMS. THE HOSPITAL SPONSORED MULTIPLE COMMUNITY EVENTS/EDUCATIONAL SEMINARS THAT INCLUDED HEALTH FAIRS, MONTHLY DIABETIC EDUCATIONAL CLASSES, DRUG AND ALCOHOL ABUSE PREVENTION FORUMS AND A LOW COST FITNESS CENTER PROGRAM FOR THE COMMUNITY. AS WITH MOST HEALTH CARE FACILITIES, WE HAVE LIMITED FINANCIAL RESOURCES TO ADDRESS ALL ISSUES. BOONE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16J: THE FOLLOWING MEASURES ARE USED TO PUBLICIZE THE FINANCIAL ASSISTANCE AVAILABLE FROM BMH TO THE COMMUNITY AND PATIENTS IN ACCORDANCE WITH FEDERAL AND STATE LAW:A. PROVIDING INFORMATION WHEN A PATIENT CALLS BMH AT (304) 369-1230;B. ANNUALLY POSTING AN ARTICLE IN A NEWSPAPER OF LOCAL CIRCULATION AND/OR OTHER MEANS AS DEEMED REASONABLY NECESSARY;D. POSTING OF A NOTICE IN THE EMERGENCY DEPARTMENT ADMITTING AREAS AND BUSINESS OFFICES AT BMH; AND/ORE. FINANCIAL COUNSELORS VISITING WITH BMH INPATIENTS. PART I, LINE 3C: PATIENTS MUST PROVIDE THEIR "TOTAL YEARLY INCOME" IN ORDER TO BE CONSIDERED FOR FINANCIAL ASSISTANCE.A. ADULTS: IF THE PATIENT IS AN ADULT, THE TERM "TOTAL YEARLY INCOME" MEANS THE SUM OF THE TOTAL YEARLY GROSS INCOME OF THE PATIENT AND THE PATIENT'S SPOUSE.B. MINORS: IF THE PATIENT IS A MINOR, THE TERM "TOTAL YEARLY INCOME" MEANS THE SUM OF THE TOTAL YEARLY GROSS INCOME OF THE PATIENT, THE PATIENT'S MOTHER AND THE PATIENT'S FATHER. THE PATIENT, IMMEDIATE FAMILY MEMBER OR PATIENT REPRESENTATIVE SHALL VERIFY THE PATIENT'S REPORTED TOTAL YEARLY INCOME, AS PROVIDED ON THE APPLICATION. THE TOTAL YEARLY INCOME MAY BE VERIFIED THROUGH ANY OF THE FOLLOWING MECHANISMS:A. INCOME INDICATORS. BY THE PROVISION OF THIRD PARTY FINANCIAL DOCUMENTATION INCLUDING IRS FORM W-2, WAGES AND TAX STATEMENT; PAY CHECK REMITTANCE; INDIVIDUAL TAX RETURN; TELEPHONE VERIFICATION BY EMPLOYER; BANK STATEMENTS; SOCIAL SECURITY PAYMENT REMITTANCE; WORKER'S COMPENSATION PAYMENT REMITTANCE; UNEMPLOYMENT INSURANCE PAYMENT NOTICE; UNEMPLOYMENT COMPENSATION DETERMINATION LETTERS; OR OTHER APPROPRIATE INDICATORS OF THE PATIENT'S TOTAL YEARLY INCOME. B. PARTICIPATION IN A BENEFIT PROGRAM. BY THE PROVISION OF DOCUMENTATION SHOWING CURRENT PARTICIPATION IN A PUBLIC BENEFIT PROGRAM SUCH AS MEDICAID; FOOD STAMPS; WIC; OR OTHER SIMILAR MEANS TESTED PROGRAMS. PROOF OF PARTICIPATION IN ANY OF THE ABOVE PROGRAMS INDICATES THAT THE PATIENT HAS BEEN DEEMED FINANCIALLY INDIGENT AND THEREFORE, IS NOT REQUIRED TO PROVIDE HIS OR HER INCOME ON THE ASSISTANCE APPLICATION.C. IN CASES WHERE THE PATIENT OR RESPONSIBLE PARTY IS UNABLE TO PROVIDE THIRD PARTY VERIFICATION OF PATIENT'S TOTAL YEARLY INCOME, VERIFICATION OF THE PATIENT'S TOTAL YEARLY INCOME CAN BE DONE IN EITHER OF THE FOLLOWING WAYS:1. OBTAINING THE PATIENT'S OR RESPONSIBLE PARTY'S WRITTEN ATTESTATION. BY OBTAINING AN APPLICATION SIGNED BY THE PATIENT OR RESPONSIBLE PARTY ATTESTING TO THE VERACITY OF THE PATIENT'S TOTAL YEARLY INCOME INFORMATION PROVIDED: OR 2. OBTAINING THE PATIENT'S OR RESPONSIBLE PARTY'S VERBAL ATTESTATION. THROUGH THE WRITTEN ATTESTATION OF THE BMH EMPLOYEE COMPLETING THE ASSISTANCE APPLICATION THAT THE PATIENT OR RESPONSIBLE PARTY VERBALLY VERIFIED THE PATIENT'S TOTAL YEARLY INCOME INFORMATION PROVIDED. 3. IN INSTANCES WHERE THE PATIENT OR RESPONSIBLE PARTY IS UNABLE TO PROVIDE THE REQUESTED THIRD PARTY VERIFICATION OF PATIENT'S TOTAL YEARLY INCOME, THE PATIENT OR RESPONSIBLE PARTY IS REQUIRED TO PROVIDE A REASONABLE EXPLANATION OF WHY THE PATIENT OR RESPONSIBLE PARTY IS UNABLE TO PROVIDE THE REQUIRED THIRD PARTY VERIFICATION. SOUND BUSINESS PRACTICES WILL BE EMPLOYED TO VERIFY PATIENT'S ATTESTATION AND SUPPORTING INFORMATION. UNMARRIED EXPIRED PATIENTS MAY BE DEEMED TO HAVE NO INCOME FOR PURPOSES OF CALCULATION OF TOTAL YEARLY INCOME. DOCUMENTATION OF TOTAL YEARLY INCOME IS NOT REQUIRED FOR EXPIRED PATIENTS; HOWEVER, DOCUMENTATION OF ESTATE ASSETS MAY BE REQUIRED. IF AN EXPIRED PATIENT IS MARRIED, THE SURVIVING SPOUSE MAY APPLY FOR FINANCIAL ASSISTANCE. PATIENTS, IMMEDIATE FAMILY MEMBERS OR PATIENT REPRESENTATIVES APPLYING FOR FINANCIAL ASSISTANCE MUST VERIFY THE NUMBER OF PEOPLE IN THE PATIENT'S HOUSEHOLD "NUMBER IN HOUSEHOLD").A. ADULTS: IN CALCULATING THE NUMBER IN HOUSEHOLD, INCLUDE THE PATIENT, THE PATIENT'S SPOUSE, AND ANY DEPENDENTS (AS DEFINED BY THE INTERNAL REVENUE CODE). B. MINORS: IN CALCULATING THE NUMBER IN HOUSEHOLD, INCLUDE THE PATIENT, THE PATIENT'S MOTHER, THE PATIENT'S FATHER, DEPENDENTS OF THE PATIENT'S MOTHER, AND DEPENDENTS OF THE PATIENT'S FATHER. DURING THE VERIFICATION PROCESS, WHILE INFORMATION TO DETERMINE A PATIENT'S TOTAL YEARLY INCOME IS BEING COLLECTED, THE PATIENT MAY BE TREATED AS A PRIVATE PAY PATIENT. 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 $ 1,226,738. PART III, LINE 2: COST OF BAD DEBT AS REPORTED ON AUDITED FINANCIAL STATEMENTS. 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 BOTH CURRENT AND 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. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE MEDICARE CARE COST REPORT FOR THE PERIOD ENDED 6/30/23. PART III, LINE 9B: AFTER THE PATIENT'S ACCOUNT IS REDUCED BY THE DISCOUNTS BASED ON THE FINANCIAL ASSISTANCE ELIGIBILITY DISCOUNT GUIDELINES, THE PATIENT IS RESPONSIBLE FOR THE REMAINDER OF THEIR OUTSTANDING ACCOUNT. PATIENTS WILL BE INVOICED FOR ANY REMAINING AMOUNTS IN ACCORDANCE WITH OTHER BMH DEBT COLLECTION POLICIES REGARDING THIS MATTER. PART VI, LINE 2: THE BMH PROJECT TEAM COMPLETED THE COMMUNITY NEEDS ASSESSMENT USING THE FOLLOWING STRATEGIES:-ASSEMBLED AN ADVISORY PANEL COMPRISED OF REPRESENTATIVES FROM COMMUNITY LEADERS, HEALTH CARE PROVIDERS, AND LOCAL CITIZENS TO ASSIST WITH THE ASSESSMENT PROCESS.-CONDUCTED PRIMARY DATA COLLECTION THROUGH SURVEYS OF PROVIDERS, KEY INFORMANTS, AND THE GENERAL POPULATION. PHONE INTERVIEWS WERE ALSO CONDUCTED.-COLLECTED SECONDARY DATA SOURCES SUCH AS INFORMATION FROM THE BOONE COUNTY HEALTH DEPARTMENT COMMUNITY NEEDS ASSESSMENT, STATE HEALTH STATISTICS AND BEHAVIORAL RISK ASSESSMENTS, US CENSUS DATA, CENTERS FOR DISEASE CONTROL STATISTICS AND DATA, ETC.-CREATED A COMPREHENSIVE DATABASE INCLUDING ANSWERS TO EACH SURVEY QUESTION WHICH WAS USED TO TRACK AND CALCULATE THE DATA.-HELD FOCUS GROUPS, SOME OF WHICH INCLUDED YOUTH REPRESENTATION IN ORDER TO OBTAIN A DIVERSE RANGE OF RESPONSES IN AN OPEN DISCUSSION FORMAT. PART VI, LINE 3: MEASURES TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY:THE FOLLOWING MEASURES ARE USED TO PUBLICIZE THE FINANCIAL ASSISTANCE AVAILABLE FROM BMH TO THE COMMUNITY AND PATIENTS IN ACCORDANCE WITH FEDERAL AND STATE LAW: A. POSTING ON THE BMH WEBSITE AT THE FOLLOWING LOCATION: WWW.BMH.ORG; B. PROVIDING INFORMATION WHEN A PATIENT CALLS BMH AT (304) 369-1230; C. ANNUALLY POSTING AN ARTICLE IN A NEWSPAPER OF LOCAL CIRCULATION AND/OR OTHER MEANS AS DEEMED REASONABLY NECESSARY; D. POSTING OF A NOTICE IN THE EMERGENCY DEPARTMENT ADMITTING AREAS AND BUSINESS OFFICES AT BMH; AND/OR E. FINANCIAL COUNSELORS VISITING WITH BMH INPATIENTS. PART VI, LINE 4: BMH SERVES PRIMARILY BOONE COUNTY, WV AND THE SURROUNDING COMMUNITIES.BOONE COUNTY HAD AN ESTIMATED POPULATION OF 24,224 IN 2013. THE MEDIAN HOUSEHOLD INCOME WAS $41,359 WITH 18.9% BELOW THE FEDERAL POVERTY GUIDELINE. 15% OF THE POPULATION IS OVER 65 AND 28.9% IS UNDER 18 WITH 40.7 YEARS AS THE MEDIAN AGE. 79% OF THE HOSPITAL'S PATIENTS WERE FROM BOONE COUNTY IS FY 13. PART VI, LINE 5: THE MAJORITY OF THE BOARD OF DIRECTORS ARE LOCAL, LIFELONG RESIDENTS. THE EMERGENCY ROOM IS ALWAYS AVAILABLE TO ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. BOONE MEMORIAL HEALTH HAS MADE THE MOST RECENT COMMUNITY NEEDS ASSESSMENT REPORT AVAILABLE ON ITS WEBSITE FOR ALL PATIENTS TO HAVE EASY ACCESS TO READ. BMH OFFERS PATIENTS ACCESS TO STATE OF THE ART MRI EQUIPMENT SEVEN DAYS A WEEK WHICH PROVIDES TOP QUALITY CARE CLOSE TO HOME WHICH IS A DIFFERENTIATING SERVICE LINE WHEN COMPARED TO OTHER CRITICAL ACCESS HOSPITALS THROUGHOUT WV. WE HAVE A FULLY DIGITAL RADIOLOGY DEPARTMENT WITH A PACS SYSTEM. OUR LAB HAS JUST RECENTLY EXPANDED TO INCORPORATE ADDITIONAL TESTING EQUIPMENT. WE ALSO OPERATE MULTIPLE RURAL HEALTH CLINICS THROUGHOUT THE REGION WITH EXTENDED / WEEKEND SERVICE HOURS TO HELP SERVE THE HEALTHCARE NEEDS OF OUR COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WV 1 SOUTHERN WV COMMUNITY COLLEGE 100 COLLEGE DR LOGAN WV 25601 50000 0 SCHOLARSHIP PRIOGRAM BOONE COUNTY SCHOOLS 69 AVE B MADISON WV 25130 38500 0 WV GAMECHANGER PROJECT SCOTT HIGH SCHOOL 1 SKYHAWK PL MADISON WV 25130 30868 0 VOLLEYBALL COURTS 3 PART I, LINE 2: GRANT APPLICATIONS ARE RECEIVED AND EVALUATED BY THE HOSPITALS LEADERSHIP TEAM INCLUDING CHIEF EXTERNAL AFFAIRS OFFICER AND CHIER EXECUTIVE OFFICER. APPLICATIONS ARE SELECTED BASED ON MERIT, EXPECTED BENEFIT TO THE COMMUNITY AND ALIGNMENT TO THE CORE VALUES OF THE FOUNDATION. GRANTEES ARE REQUIRED TO REPORT AND CONFER WITH BMH FOUNDATION EMPLOYEES ON A REGULAR BASIS CONCERNING THE STATUS AND EXECUTION OF THE PROJECT. GRANTEES ARE ALSO REQUIRED TO SUBMIT FINANCIAL REPORTS AND PROJECT STATUS REPORTS TO THE FOUNDATION NO LATER THAN THE FIRST DAY OF EACH MONTH DURING THE PROJECT PERIOD. FINANCIAL REPORTS COMPARE ACTUAL EXPENSES TO APPROVED PROJECT BUDGET. PROJECT STATUS REPORTS SHALL ALSO INCLUDE NARRATIVE ACCOUNTS OF ACCOMPLISHMENTS RESULTING FROM THE RECEIPT OF THE RESPECTIVE GRANT. X 1 1 X X X 0 1 0 1 0 0 0 0 0 VIRGIL UNDERWOOD CHIEF EXECUTIVE OFFICER 304307 0 0 0 0 0 407000 0 2600 0 713907 0 0 0 CASEY SHAUN HAGER DOCTOR 522522 0 100750 0 0 0 20500 0 2500 0 646272 0 0 0 SHANE EDWARD COOK DOCTOR 589265 0 0 0 0 0 20500 0 2200 0 611965 0 0 0 THOMAS CORTELLESI DOCTOR 475640 0 0 0 0 0 26000 0 3250 0 504890 0 0 0 MICHAEL BLEDSOE DOCTOR 481419 0 0 0 0 0 17992 0 2500 0 501911 0 0 0 CHARLES D CRIGGER DOCTOR 443342 0 0 0 0 0 0 0 2500 0 445842 0 0 0 ANGELA CHRISTIAN CHIEF OPERATING OFFICER 202676 0 0 0 0 0 180646 0 2500 0 385822 0 0 0 CHAD HOVIS END 82022 CHIEF FINANCIAL OFFICER 144032 0 0 0 0 0 6488 0 1700 0 152220 0 0 0 PART I, LINE 1A WVHA ANNUAL MEETING - BOARD MEMBERS AND THE EXECUTIVE TEAM (C-SUITE & MEDICAL LEADERSHIP) ARE REQUIRED TO ATTEND THE ANNUAL HOSPITAL ASSOCIATION MEETING. AS PART OF THIS MEETING, SPOUSES ARE REQUIRED TO ATTEND. THE HOSPITAL COVERS REASONABLE TRAVEL AND ACCOMODATIONS FOR BMH TEAM MEMBER AND SPOUSES. PART I, LINE 4B THREE EXECUTIVES (CEO, CFO & COO) PARTICIPATED IN A 457(F) PLAN. THE 457(F) PLAN IS BASED ON A PERCENTAGE OF HEALTH SYSTEM GROSS REVENUE (0.2% OF GROSS REVENUE). THE AMOUNT CAN ADDITIONALLY BE ADJUSTED THROUGH A REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE. VIRGIL UNDERWOOD RECEIVED $380,000 DEFERRED COMPENSATION FROM PARTICIPATION IN THE 457(F) PLAN. ANGELA CHRISTIAN RECEIVED $165,000 DEFERRED COMPENSATION FROM PARTICIPATION IN THE 457(F) PLAN. PART I, LINE 5 THE ORGANIZATION OFFERS A 457(F) PLAN TO THREE EXECUTIVES (CEO, CFO & COO). THE 457(F) PLAN IS BASED ON A PERCENTAGE OF HEALTH SYSTEM GROSS REVENUE (0.2% OF GROSS REVENUE). THE AMOUNT CAN ADDITIONALLY BE ADJUSTED THROUGH A REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND CEO WILL REVIEW THE FORM 990 FOR ACCURACY PRIOR TO FILING WITH THE IRS. A COPY OF THE FINAL FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE IS ENFORCED AND MONITORED WHEN BOARD MEMBERS RECUSE THEMSELVES ON CONFLICT OF INTEREST ISSUES. FORM 990, PART VI, SECTION B, LINE 15A THE CEO PRESENTS RECOMMENDATIONS TO THE COMPENSATION COMMITTEE WHICH WILL EVALUATE AND APPROVE ON BEHALF OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE SUBMITTED TO THE WV HEALTHCARE AUTHORITY AND SUBSEQUENTLY PUBLISHED. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST FORM 990, PART XII, LINE 2C: THE OVERSIGHT PROCESS FOR THE AUDIT OF THE FINANCIAL STATEMENTS HAS NOT CHANGED DURING THE TAX YEAR.