2022-05-12T14:40:17-05:00 2021-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2020-07-01 550477361 BOONE MEMORIAL HOSPITAL INC BOON 3043691230 701 MADISON AVENUE MADISON WV 25130 CHAD HOVIS CFO 3043691230 2022-05-12 1 CHAD HOVIS 999009999 AMY BIBBY P00445891 8282542254 2022-05-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z VIRGIL UNDERWOOD 701 MADISON AVENUE MADISON WV 25130 58386466 0 X WWW.BMH.ORG X 2010 WV BOONE MEMORIAL HOSPITAL STRIVES TO SUPPLY A COMPREHENSIVE RANGE OF INPATIENT AND OUTPATIENT SERVICES 8 8 454 45 0 0 2364556 6495534 46958798 51499271 392992 25838 176213 291576 49892559 58312219 0 0 0 0 24333532 28596320 0 0 -2738 22933509 25548037 47267041 54144357 2625518 4167862 61065632 68497760 47745105 51009371 13320527 17488389 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 47670662 51499271 IN PERFORMING ITS MISSION, BOONE MEMORIAL HOSPITAL HAD 738 ACUTE CARE ADMISSIONS AND 128 SKILLED NURSING CARE ADMISSIONS. THE HOSPITAL ALSO HAD 14 RESPITE CARE PATIENTS, 13,221 EMERGENCY ROOM VISITS, 45,919 OUT-PATIENT VISITS AND 42,306 VISITS IN ITS TWO RURAL HEALTH CLINICS.BOONE MEMORIAL HOSPITAL CONDUCTS AN ANNUAL HEALTH FAIR. THE HOSPITAL USES THE LOCAL MADISON CIVIC CENTER AND OFFERS VERY LOW COST BLOOD WORK TO THE COMMUNITY. APPROXIMATELY 350 COMMUNITY MEMBERS ATTENDED THE HEALTH FAIR AND APPROXIMATELY 124 RECEIVED LOW COST BLOOD WORK.BMH RESPITE CARE PROGRAM. THE HOSPITAL HAD 14 RESPITE CARE ADMISSIONS AND 210 RESPITE DAYS FOR ITS 6/30/21 FISCAL YEAR. THE RESPITE CARE PROGRAM IS A CASH ONLY PROGRAM. IT IS NOT BILLED TO INSURANCE, BUT THE RATE IS ONLY $221 PER DAY. WE OFFER THIS AS A COMMUNITY BENEFIT. 47670662 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 53 0 1 454 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WV X CHAD HOVIS 3043691230 701 MADISON AVENUE MADISON WV 25130 ROBERT BROWN PRESIDENT 1.30 X X 0 0 0 JAMES HENSLEY VICE PRESIDENT 1.30 X X 0 0 0 THOMAS BIAS BOARD MEMBER 1.30 X 0 0 0 JAMES GORE BOARD MEMBER 1.30 X 0 0 0 NADA WOODIE BOARD MEMBER 1.30 X 0 0 0 SHAWN MILLER BOARD MEMBER 1.30 X 0 0 0 JOHN REAGER BOARD MEMBER 1.30 X 0 0 0 SUSAN MCCORY BOARD MEMBER 1.30 X 0 0 0 VIRGIL UNDERWOOD CEO 50.00 X 229783 0 26449 DAVID GRESHAM CDO 50.00 X 136313 0 11036 TERRI CASTLE CNO 50.00 X 117840 0 5739 CHAD HOVIS CFO 50.00 X 164658 0 12290 ANGELA CHRISTIAN COO 50.00 X 146713 0 10889 MARK LINVILLE COO 50.00 X 115177 0 8649 AMY SAYRE MD CMO 50.00 X 203514 0 3049 CASEY SHAUN HAGER DOCTOR 40.00 X 559756 0 22549 PHILIP TODD BERRY DOCTOR 40.00 X 437151 0 9549 SHANE EDWARD COOK DOCTOR 40.00 X 522807 0 22549 CHARLES D CRIGGER DOCTOR 40.00 X 441011 0 3049 THOMAS BRIAN CORTELLESI DOCTOR 40.00 X 507103 0 29049 3581826 0 164846 34 0 1 0 CARDINAL HEALTH 110 LLC 5303 COLLECTION CENTER DRIVE CHICAGO IL 60693 HEALTHCARE 3541957 CPSI PO BOX 11407 BIRMINGHAM AL 35246 SYSTEM SOFTWARE VENDOR 1501592 BIOFIRE DIAGNOSTICS LLC PO BOX 581463 SALT LAKE CITY UT 84158 HEALTHCARE 1477598 REHAB ONE LTD 22 HIGH MEADOW DRIVE CHARLESTON WV 25311 PHYSICAL THERAPY SERVICES 918036 CAMC LABWORKS PO BOX 45728 BALTIMORE MD 21297 LAB SERVICES 733205 31 22105 2521812 3951617 6495534 PATIENT SERVICE REVENUE 622110 49146987 49146987 340B PROGRAM REVENUE 900099 2116450 2116450 DIETARY SALES 900099 154851 154851 PHARMACY 446110 80983 80983 51499271 100085 100085 85566 0 85566 85566 85566 74247 -74247 -74247 -74247 0 22105 0 0 OTHER REVENUE 900099 206010 206010 206010 58312219 51499271 0 317414 X 3276528 3276528 21268620 21268620 2371971 2117655 254316 404018 365499 38519 1275183 1101779 173404 81109 81109 6789672 4595681 2193991 147337 147337 1319003 1217530 101473 91481 77028 14453 1047737 914963 132774 201168 138639 62529 1138614 1138614 2761693 2761693 519724 519724 MEDICAL SUPPLIES 9475904 9475904 PROVIDER TAX 1049361 1049361 BAD DEBT EXPENSE 463793 463793 FOOD & DIETARY 266901 266901 194540 197278 -2738 54144357 47670662 6476433 -2738 14643881 27790867 8901957 2703983 3616770 4945632 76248 559193 914384 932408 96718 173733 45845417 15270026 31977926 30575391 837748 816553 61065632 68497760 9551373 16110685 2542247 271102 32845157 32309911 2017339 0 788989 2317673 47745105 51009371 X 13320527 17488389 13320527 17488389 61065632 68497760 4167862 0 X X 0 1 X 0 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1066373 570191 1636564 308927 308927 32194719 8459544 23735175 8222818 5917974 2304844 5118953 892508 4226445 30575391 OTHER LIABILITIES 2317673 2317673 X 57651148 0 57651148 661071 661071 58312219 53483286 0 53483286 661071 661071 54144357 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 463,793. CHARITY CARE EXPENSE NETTED AGAINST REVENUE 197,278. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 463,793. CHARITY CARE EXPENSE NETTED AGAINST REVENUE 197,278. GOLF OUTING 22105 22105 22105 22105 1 1 X 1 X 1 X 240.000000000000 1 0 0 82969 82969 0.00150 22418615 12117809 10300806 0.19190 22501584 12117809 10383775 0.19340 22501584 12117809 10383775 0.19340 1 463793 241172 6368996 7666089 -1297093 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, SNF/NF BEDS BOONE MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X 19 1 0 0 1 X WWW.BMH.ORG X 1 19 1 WWW.BMH.ORG 0 1 X 100.000000000000 240.000000000000 X X X X 1 1 X X X 1 X HTTP://MEDIA.WIX.COM/UGD/3F447F_7F16F4D8221B4AEB80861E83ADF1F875.PDF X HTTP://MEDIA.WIX.COM/UGD/3F447F_F78C6D10EE0D43D8915549467626C606.PDF X HTTP://MEDIA.WIX.COM/UGD/3F447F_D54B7CF9599D4B35B28620AA527B698F.PDF 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: THE BMH PROJECT TEAM COMPLETED THE COMMUNITY NEEDS ASSESSMENT DURING FISCAL YEAR 2020 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 $ 463,793. 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 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 6/30/21. 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 2020 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 PORTIONS OF LOGAN, LINCOLN , AND KANAWHA COUNTIES IN WV.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 IN FY 13. PART VI, LINE 5: THE MAJORITY OF THE BOARD OF TRUSTEES ARE LOCAL, LIFELONG BOONE COUNTY RESIDENTS. THE ER IS ALWAYS AVAILABLE TO ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. BOONE MEMORIAL 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 OUR OWN MRI SEVEN DAYS A WEEK INSTEAD OF HAVING TO TRAVEL TO OTHER LARGER HOSPITALS IN CHARLESTON OR LOGAN. MOST OTHER CRITICAL ACCESS HOSPITALS IN WV ONLY OFFER A MOBILE MRI SERVICE ONE OR TWO DAYS A WEEK. 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 TWO RHCS WITH EXTENDED HOURS (ONE HAS SATURDAY HOURS) TO HELP SERVE THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WV X 0 0 0 0 0 0 0 0 0 CASEY SHAUN HAGER DOCTOR 559756 0 0 0 0 0 19500 0 3049 0 582305 0 0 0 SHANE EDWARD COOK DOCTOR 522807 0 0 0 0 0 19500 0 3049 0 545356 0 0 0 THOMAS BRIAN CORTELLESI DOCTOR 507103 0 0 0 0 0 26000 0 3049 0 536152 0 0 0 PHILIP TODD BERRY DOCTOR 437151 0 0 0 0 0 6500 0 3049 0 446700 0 0 0 CHARLES D CRIGGER DOCTOR 441011 0 0 0 0 0 0 0 3049 0 444060 0 0 0 VIRGIL UNDERWOOD CEO 229783 0 0 0 0 0 23400 0 3049 0 256232 0 0 0 AMY SAYRE MD CMO 203514 0 0 0 0 0 0 0 3049 0 206563 0 0 0 CHAD HOVIS CFO 164658 0 0 0 0 0 9241 0 3049 0 176948 0 0 0 ANGELA CHRISTIAN COO 146713 0 0 0 0 0 7840 0 3049 0 157602 0 0 0 BROOKE BELL FAMILY RELATION TO TERRY CASTLE-CNO 23285 COMPENSATION AS AN EMPLOYEE-PHRAMACIST 0 LOGAN CHRISTIAN FAMILY RELATION TO ANGELA CHRISTIAN-COO 15679 COMPENSATION AS AN EMPLOYEE-LAB TECH 0 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 PUBLISHED ANNUALLY IN THE LOCAL NEWSPAPER. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,437,775. MANAGEMENT AND GENERAL EXPENSES 2,158,597. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,596,372. CONTRACT FEES: PROGRAM SERVICE EXPENSES 3,150. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,150. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 154,881. MANAGEMENT AND GENERAL EXPENSES 35,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 190,275. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES -125. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -125. FORM 990, PART XII, LINE 2C: THE OVERSIGHT PROCESS FOR THE AUDIT OF THE FINANCIAL STATEMENTS HAS NOT CHANGED DURING THE TAX YEAR.