2022-05-12T15:01:38-05:00 2021-06-30 390859910 Baker Tilly US LLP 101 Washington Street East Charleston WV 25329 990 2020-07-01 556000526 Grafton City Hospital GRAF 3042657152 1 Hospital Plaza Grafton WV 26354 Kevin Gessler Chief Administrative Officer 3042657152 2022-05-11 1 Kevin Gessler 999009999 Dolores Rose P01286262 3043460441 2022-05-11 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z Kevin Gessler 1 Hospital Plaza Grafton WV 26354 20348599 0 X www.graftonhospital.com X 1972 WV To provide inpatient hospital care, outpatient services and emergency room services to the residents of Taylor County, WV and surrounding communities. 7 6 230 10 776662 0 592459 970940 13993203 16530794 41876 39639 1349218 2569960 15976756 20111333 900 1350 0 0 9998139 10022069 0 0 0 6900742 8220649 16899781 18244068 -923025 1867265 12850828 12579232 15270447 13131586 -2419619 -552354 To provide inpatient hospital care, outpatient services and emergency room services to the residents of Taylor County, WV and surrounding communities. 0 0 13668998 18317667 The Hospital provided health care services including 5,154 emergency room visits, 997 acute hospital days, 0 long-term care days, 1,516 swing-bed days, and 233 surgeries. The Hospital provided charity care without charge or at less than its established rates to patients who meet certain criteria under its charity care policy. Charges foregone for charity care during the year amounted to $144,231. Additionally, the Hospital's Rural Health Clinic recorded 9,479 visits for the year. 12700 Due to Covid-19, the Hospital had a muted community health improvement program; however, the hospital did provide drive-through Covid testing in the community throughout the year. 1350 1350 The organization provided grants to community organizations including a $1,000 donation to the United Way, $250 sponsorship of a five mile run, and a $100 Christmas Toy Drive. 13683048 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 27 0 230 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Kevin Gessler 3043294700 1 Hospital Plaza Grafton WV 26354 John L Bord President 2.00 X X 0 0 0 John Whitescarver Vice President 2.00 X X 0 0 0 Nancy Fowler Finance Chair 2.00 X 0 0 0 David Bender MD Executive Credentials Chair 40.00 X 316669 0 0 Wayne McDevitt Trustee 2.00 X 0 0 0 Larry Richman Trustee 2.00 X 0 0 0 Orville Wright Trustee 2.00 X 0 0 0 George Boyles CAO (termed 10/31/2021) 40.00 X 94678 0 2140 Kevin Gessler CAO/CFO 20.00 X 0 0 0 Andrew Berardinelli MD Physician 40.00 X 376532 0 2568 Thomas Stevens DO Physician 40.00 X 364492 0 2568 Joseph Duvert MD Physician 40.00 X 352707 0 2568 Thomas Wilshire DO Physician 40.00 X 282935 0 2568 Stephen Harris PA-C Physician Assistant 40.00 X 153067 0 2568 1941080 0 14980 10 0 1 1 Labcorp 231 Maple Avenue Burlington NC 27215 Lab testing services 272918 West Virginia Therapy Services LLC 415 Benedum Drive Bridgeport WV 26330 Occupational and Speech Therapy Services 136629 TTG Healthcare LLC 2403 Sidney Street Suite 220-B Pittsburgh PA 15203 Nuclear Medicine Services 128041 3 969340 1600 970940 Net patient services 622110 15862374 15862374 340B program revenue 900099 668420 668420 16530794 49905 49905 6425 0 6425 6425 6425 227000 237266 -10266 -10266 -10266 PPP Loan Forgiveness 900099 1422322 1422322 Nursing Home Service Reimb 900099 776662 776662 CHART Dividend 900099 96782 96782 267769 267769 2563535 20111333 18317667 776662 46064 1350 1350 413487 286216 127271 8000488 5537937 2462551 1034294 715938 318356 573800 397184 176616 255610 176933 78677 20605 20605 35000 35000 1054016 729589 324427 1110727 768213 342514 217913 150839 67074 100043 69250 30793 2209 1529 680 122505 84798 37707 497060 344065 152995 464316 321400 142916 Bad Debt Expense 2167689 2167689 Medical supplies 1049628 1049628 Repairs & maintenance 690673 478085 212588 Medicaid provider tax 235591 235591 197064 166814 30250 18244068 13683048 4561020 0 2763649 2701898 4234161 2758722 1534726 2099775 199248 239323 208608 336482 20997920 17522705 2982174 3475215 928262 967817 12850828 12579232 2242863 2211228 3300000 2657650 9727584 8262708 15270447 13131586 X -2419619 -552354 -2419619 -552354 12850828 12579232 1867265 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16600 16600 0 Part II-B, Line 1: Part II-B, Line(i), Other Lobbying Activities: Grafton City Hospital pays dues to the West Virginia Hospital Association. The West Virginia Hospital Association represents hospitals and health systems. For the year ended 06/30/21, the amount of dues related to lobbying activities was $16,599.78. 26597 26597 8906249 7930283 975966 618847 145862 472985 11149112 9446560 1702552 297115 297115 3475215 CHART RRG - Investment 967817 C 967817 Capital leases 348126 Third-party payor settlements 4816272 Taxable bonds 3098310 8262708 17943644 0 17943644 2167689 2167689 20111333 16076379 0 16076379 2167689 2167689 18244068 Part XI, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 2,167,689. Part XII, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 2,167,689. 1 1 X 1 X 0 1 1 0 0 335303 335303 50895 50895 386198 386198 0 0.00000 12700 12700 0.00080 12700 12700 0.00080 398898 386198 12700 0.00080 1 2167689 3547064 3547064 X 1 1 1 1 Grafton City Hospital Inc 500 Market Street Grafton WV 25354 X X X X Grafton City Hospital 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X http://www.graftonhospital.com/assets/grafton-city-hospital-chna-2019.pdf X 1 19 1 http://www.graftonhospital.com/assets/chna-2019-implementation-plan-1.pd 0 1 X 100.000000000000 100.000000000000 X X X 1 1 X X X 1 X http://www.graftonhospital.com/patients---vistors.html X http://www.graftonhospital.com/patients---vistors.html X http://www.graftonhospital.com/patients---vistors.html X X X X X X 1 X 0 X X X X 1 X 0 0 Grafton City Hospital Part V, Section B, Line 5: A cross-section of various community representatives were interviewed and include a representative from the Taylor County Emergency Medical Services (EMS), the mayor of Grafton, four administrative representatives from Taylor County, a provider and administrator from a local clinic, a local nursing home administrator, the Taylor County schools superintendent, the Grafton City manager and members of the Grafton City Hospital board. The selected individuals provided diversified backgrounds and a range of perspectives on the state of the community and healthcare. Grafton City Hospital Part V, Section B, Line 11: Hospital management has made significant progress on needs addressed in the CHNA relating to: 1. Recruitment of Primary Care Physicians, 2. Specialty Services and Chronic Disease Management,(lack of transportation) and 3. collaboration with other hospitals. Needs that are currently being addressed, to date are: 1. Illicit drug use. The problems of substance abuse require determined, collaborative action involving public health, education, health care and criminal justice systems at the community and state level. This is a huge initiative that will take a great deal of planning and coordination with regulatory agencies on the State and Federal level. Grafton City Hospital recently opened the doors to an inpatient detox program for substance abuse. The Hospital also collaborated with WVU to offer a medication assisted treatment program. Grafton City Hospital Part V, Section B, Line 16j: The admission department has signs posted that offer financial assistance information. Private Pay patients are offered financial assistance information at the time of admission. Grafton City Hospital Part V, Section B, Line 20e: Every 30 days patients receive a statement and after 4 statements each patient receives a letter asking if the are any concerns with the bill and to please call the hospital. If the account is not paid the patient is either called or receives a letter indicating that collection efforts will start. At the point of calling, the patient is offered Charity Care, assistance with the Medicaid application, or a discount if the bill is paid in full. Part I, Line 7: The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.As a WV CAH, GCH is reimbursed 100% of costs from Medicaid for hospital level services (the exception to this cost reimbursement is for the RHC). The only component that would have a Medicaid community benefit expense relates to the RHC. 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 $ 2,167,689. Part III, Line 2: Bad debt expense as reported on audited financial statements. Part III, Line 4: Patient Accounts Receivable: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectable 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 collectability. 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 reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The Medicare allowable costs were obtained from the Hospital's Medicare cost report. Part VI, Line 2: To assess the health care needs of the population base of Grafton City Hospital, the facility is heavily involved with the area's community forums. Through this venue the hospital takes the inquiries that are voiced and applies an economic forecast to the program to verify its stability. The facility also uses the Bureau for Public Health, for risk factors that would have an impact on the lives of the population that Grafton City Hospital serves. Part VI, Line 3: The patient population is educated and informed of the financial assistance programs through the financial counselors and admission personnel. The hospital also has this information published in the public areas within the hospital and on the website. Part VI, Line 4: The facility is a rural 25-bed Critical Access Hospital located in Grafton, WV. The service area has been defined based on patient days, discharges and charges compiled by Zip code during the preparation of the latest Community Health Needs Assessment (2019). The service area is concentrated in Grafton, WV and spans the counties of Taylor, Preston and Barbour. There are two other hospitals located within the service area. These are Preston Memorial Hospital and Broaddus Hospital. Both of these hospitals are rural 25-bed Critical Access Hospitals. The population coverage by the service area is approximately 67,000 based on the 2010 Census information. 2014 data from Health Indicators.gov: 17.20% of Taylor county residents, 17.0% for Preston county residents and 21.4% of Barbour county residents are living in poverty. The median household income for Taylor, Preston and Barbour counties is $39,536, $45,413 and $37,327, respectively. The Median household income for the State of WV is $41,043 (based on 2013 data). The combined Medicare and Medicaid population is approximately 20% for both Preston and Barbour counties. All three counties in the hospital's primary service area are designated "shortage areas" by the U.S. Department of Health and Human Services. The counties are designated HPSA's (Health Professional Shortage Area) for primary care, dental and mental health services. All three counties are also designated as MUA's and/or MUP's (Medically Underserved Areas/Populations). Part VI, Line 5: The organization's health care facilities further its exempt purpose in the following ways: The organization's governing body is comprised of persons who reside in the organization's primary service area and are neither employees or contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified providers in its community for some or all of its departments. The organization operates an emergency room available to all, regardless of ability to pay. Specialized services offered by the organization that are not available elsewhere include pulmonology, critical care medicine, general surgery, internal medicine, and family medicine. The organization serves as a vehicle for attracting charitable support, as well as a source of community volunteer activities. Part VI, Line 6: Grafton City Hospital has a management services agreement with Mon Health, an integrated health system, in neighboring Monongalia County. Grafton City Hospital works with hospitals within Mon Health to gain access to specific specialties, including cardiology, to help promote gaps identified in the Taylor County community. X X 0 0 0 0 0 0 0 0 0 Andrew Berardinelli MD Physician 323241 0 26600 0 26691 0 0 0 2568 0 379100 0 0 0 Thomas Stevens DO Physician 300292 0 32973 0 31227 0 0 0 2568 0 367060 0 0 0 Joseph Duvert MD Physician 352707 0 0 0 0 0 0 0 2568 0 355275 0 0 0 David Bender MD Executive Credentials Chair 255977 0 57692 0 3000 0 0 0 0 0 316669 0 0 0 Thomas Wilshire DO Physician 282935 0 0 0 0 0 0 0 2568 0 285503 0 0 0 Stephen Harris PA-C Physician Assistant 125295 0 4122 0 23650 0 0 0 2568 0 155635 0 0 0 Form 990, Part IV, Line 23 Grafton City Hospital has a management agreement with Monongalia Health System. Kevin Gessler is the contracted CFO through the agreement. The portion of his 2020 compensation allocated to his time as Grafton's CFO was $75,376. During calendar year 2020, George Boyles, CAO was hired by Grafton City Hospital. Prior to becoming an employee, his 2020 compensation through the management agreement with Monongalia Health System was $36,000. David BenderMD Physician/Board Member 64158 Dr. Bender is compensated for his services to the Hospital through payroll compensation. Grafton Medical Associates, of which Dr. Bender is an owner, also supplies services to the Hospital for which the Hospital is billed through invoices from the company. In FY 2021, moneys paid through accounts payable to Grafton Medical Associates amounted to $64,158. 0 Form 990, Part VI, Section A, line 3 Grafton City Hospital has a managment agreement with Monongalia Health System to provide the services of a Chief Financial Officer. Form 990, Part VI, Section B, line 11b The form 990 will be reviewed by the Chief Administrative Officer and CFO before it is filed. A copy of the final form 990 will be provided to the board of directors prior to filing. Form 990, Part VI, Section B, line 12c Trustees are made aware of the conflict of interest policy. Should a Trustee feel there is a subject in which they have a conflict, they recuse themselves from the discussion and any possible action. Form 990, Part VI, Section B, line 15 A compensation committee determines the compensation of the CEO and other officers by comparing salaries with other hospitals located in the West Virginia Critical Access Hospital Network with board approval. Form 990, Part VI, Section C, line 18 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part XII, Line 2C: The Organization's finance committee of the board of directors selects the independent accountant. This process remains unchanged from prior years.