2023-05-13T10:21:58-05:00 2022-06-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2021-07-01 550477361 BOONE MEMORIAL HOSPITAL INC BOON 3043691230 701 MADISON AVENUE MADISON WV 25130 DOUGLAS COLE MALCOLM CFO 3043691230 2023-05-13 1 DOUGLAS COLE MALCOLM 999009999 AMY BIBBY P00445891 8282542254 2023-05-13 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z VIRGIL UNDERWOOD 701 MADISON AVENUE MADISON WV 25130 67370697 0 X WWW.BMH.ORG X 2010 WV BOONE MEMORIAL HOSPITAL STRIVES TO SUPPLY A COMPREHENSIVE RANGE OF INPATIENT AND OUTPATIENT SERVICES 9 9 499 45 0 0 6495534 3636735 51499271 63097379 25838 104781 291576 531802 58312219 67370697 0 155548 0 0 28596320 35476823 0 0 1077944 25548037 29523777 54144357 65156148 4167862 2214549 68497760 67379046 51009371 47676108 17488389 19702938 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 51846855 155548 63097379 IN PERFORMING ITS MISSION, BOONE MEMORIAL HOSPITAL, INC. HAD 1,064 ACUTE CARE ADMISSIONS AND 149 SKILLED NURSING CARE ADMISSIONS. THE HOSPITAL ALSO HAD 18 RESPITE CARE PATIENTS, 16,105 EMERGENCY ROOM VISITS, 51,251 OUT-PATIENT VISITS AND 54,240 VISITS IN ITS TWO RURAL HEALTH CLINICS.BMH RESPITE CARE PROGRAM. THE HOSPITAL HAD 18 RESPITE CARE ADMISSIONS AND 398 RESPITE DAYS FOR ITS 6/30/22 FISCAL YEAR. THE RESPITE CARE PROGRAM IS A CASH ONLY PROGRAM AND IS NOT BILLED TO INSURANCE. WE OFFER THIS AS A COMMUNITY BENEFIT. 51846855 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 72 0 1 499 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 X 0 0 0 JAMES HENSLEY VICE PRESIDENT 1.25 X X 0 0 0 THOMAS BIAS BOARD MEMBER 1.25 X 0 0 0 JAMES GORE BOARD MEMBER 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 267740 0 188041 CHAD HOVIS CHIEF FINANCIAL OFFICER 50.00 X 198529 0 77067 ANGELA CHRISTIAN CHIEF OPERATING OFFICER 50.00 X 184974 0 76809 AMY SAYRE MD CHIEF MEDICAL OFFICER 50.00 X 256728 0 22507 CASEY SHAUN HAGER DOCTOR 40.00 X 572644 0 26603 SHANE EDWARD COOK DOCTOR 40.00 X 613877 0 26041 CHARLES D CRIGGER DOCTOR 40.00 X 448740 0 22507 JAMES STOLLINGS DOCTOR 40.00 X 450156 0 0 THOMAS CORTELLESI DOCTOR 40.00 X 457207 0 29658 3450595 0 469233 38 0 1 0 CARDINAL HEALTH 110 LLC 5303 COLLECTION CENTER DRIVE CHICAGO IL 60693 HEALTHCARE 3201371 CPSI PO BOX 11407 BIRMINGHAM AL 35246 SYSTEM SOFTWARE VENDOR 2343305 BIOFIRE DIAGNOSTICS LLC PO BOX 581463 SALT LAKE CITY UT 84158 HEALTHCARE 1933415 CANON MEDICAL SYSTEMS USA INC PO BOX 7476 CAROL STREAM IL 60197 HEALTHCARE 1215955 CAMC LABWORKS PO BOX 45728 BALTIMORE MD 21297 HEALTHCARE 1014446 36 3588179 48556 3636735 PATIENT SERVICE REVENUE 622110 55352123 55352123 PHARMACY 446110 6429486 6429486 340B PROGRAM REVENUE 900099 1131692 1131692 DIETARY SALES 900099 184078 184078 63097379 104781 104781 8100 0 8100 8100 8100 OTHER REVENUE 900099 523702 523702 523702 67370697 63097379 0 636583 155548 155548 993160 993160 28825570 24465133 4023315 337122 1773841 1441845 312577 19419 2046077 1423747 609914 12416 1838175 1506179 312577 19419 52557 52557 189833 189833 6240208 2565225 3452316 222667 227083 227083 1559872 1315875 243997 102677 90229 12448 2756569 1445087 1246669 64813 226272 136490 89782 1142669 941857 95416 105396 2703289 2228216 225731 249342 521154 520046 1108 MEDICAL SUPPLIES 10233608 10233608 PROVIDER TAX 1301931 1301931 OTHER EXPENSES 1171736 981520 142866 47350 BAD DEBT EXPENSE 742530 742530 351789 351789 65156148 51846855 12231349 1077944 27790867 26597442 2703983 2966318 155582 4945632 5149193 559193 30527 932408 885538 173733 410429 48014102 17629071 30575391 30385031 816553 798986 68497760 67379046 16110685 6304842 271102 32309911 32253509 2317673 9117757 51009371 47676108 X 17488389 19702938 17488389 19702938 68497760 67379046 2214549 0 X X 0 1 X 0 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 323672 323672 32204645 10017369 22187276 9506822 6521354 2985468 5978963 1090348 4888615 30385031 OTHER LIABILITIES 849320 DSH PAYABLE CURRENT YEAR 7972568 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 295869 9117757 X 66628167 0 66628167 742530 742530 67370697 64413618 0 64413618 742530 742530 65156148 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 742,530. CHARITY CARE EXPENSE NETTED AGAINST REVENUE PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 742,530. CHARITY CARE EXPENSE NETTED AGAINST REVENUE 1 1 X 1 X 1 X 240.000000000000 1 1 0 0 91830 91830 0.00140 31176949 15808037 15368912 0.23860 31268779 15808037 15460742 0.24000 155548 155548 0.00240 155548 155548 0.00240 31424327 15808037 15616290 0.24240 1 742530 222000 10847343 9190649 1656694 X 1 1 1 1 BOONE MEMORIAL HOSPITAL INC 701 MADISON AVENUE MADISON WV 25130 WWW.BMH.ORG X X X X TWO 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 X 1 X 0 0 BOONE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: THE BMH PROJECT TEAM COMPLETED THE COMMUNITY NEEDS ASSESSMENT DURING FISCAL YEAR 2022 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. 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 $ 742,530. 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 6/30/22. 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 DURING FISCAL YEAR 2022 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 BOONE COUNTY 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 CITY OF MADISON 255 WASHINGTON AVENUE MADISON WV 25130 59700 0 TENNIS COURTS CITY OF MADISON 255 WASHINGTON AVENUE MADISON WV 25130 12500 0 FITNESS PARK THE TOWN OF DANVILLE 500 HOPKINS AVENUE DANVILLE WV 25053 27100 0 SPLASH PAD THE TOWN OF DANVILLE 500 HOPKINS AVENUE DANVILLE WV 25053 10000 0 SPLASH PAD THE TOWN OF DANVILLE 500 HOPKINS AVENUE DANVILLE WV 25053 46248 0 BRIDGE IMPROVEMENTS 2 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 0 1 X 0 1 0 0 0 0 0 0 0 SHANE EDWARD COOK DOCTOR 613877 0 0 0 0 0 3534 0 22507 0 639918 0 0 0 CASEY SHAUN HAGER DOCTOR 572644 0 0 0 0 0 4096 0 22507 0 599247 0 0 0 THOMAS CORTELLESI DOCTOR 457207 0 0 0 0 0 7351 0 22307 0 486865 0 0 0 CHARLES D CRIGGER DOCTOR 448740 0 0 0 0 0 0 0 22507 0 471247 0 0 0 VIRGIL UNDERWOOD CHIEF EXECUTIVE OFFICER 267740 0 0 0 0 0 165534 0 22507 0 455781 0 0 0 JAMES STOLLINGS DOCTOR 450156 0 0 0 0 0 0 0 0 0 450156 0 0 0 AMY SAYRE MD CHIEF MEDICAL OFFICER 256728 0 0 0 0 0 0 0 22507 0 279235 0 0 0 CHAD HOVIS CHIEF FINANCIAL OFFICER 198529 0 0 0 0 0 54560 0 22507 0 275596 0 0 0 ANGELA CHRISTIAN CHIEF OPERATING OFFICER 184974 0 0 0 0 0 54302 0 22507 0 261783 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 SPOUSE. 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). VIRGIL UNDERWOOD RECEIVED $160,000 DEFERRED COMPENSATION FROM PARTICIPATION IN THE 457(F) PLAN. CHAD HOVIS RECEIVED $50,000 DEFERRED COMPENSATION FROM PARTICIPATION IN THE 457(F) PLAN. ANGELA CHRISTIAN RECEIVED $50,000 DEFERRED COMPENSATION FROM PARTICIPATION IN THE 457(F) PLAN. FORM 990, PART VI, SECTION B, LINE 11B THE CFO 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 TRUSTEES RECUSE THEMSELVES ON CONFLICT OF INTEREST ISSUES FORM 990, PART VI, SECTION B, LINE 15A AN OUTSIDE FIRM IS CONSULTED. THE CEO PRESENTS RECOMMENDATIONS TO THE BOARD. THE BOARD WILL HOLD AN EXECUTIVE SESSION AND DECIDE THE CEO'S COMPENSATION 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.