2021-05-17T11:52:38-05:00 2020-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2019-07-01 556000526 Grafton City Hospital GRAF 3042657152 1 Hospital Plaza Grafton WV 26354 George Boyles Chief Administrative Officer 3042657152 2021-05-14 1 Dolores Rose P01286262 3043460441 2019 2022-09-23 18:48:47Z George Boyles 1 Hospital Plaza Grafton WV 26354 15976756 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 6 232 20 828000 0 39107 592459 16159631 13993203 56110 41876 1201655 1349218 17456503 15976756 1765 900 0 0 10215042 9998139 0 0 0 6478740 6900742 16695547 16899781 760956 -923025 6660252 12850828 8156846 15270447 -1496594 -2419619 To provide inpatient hospital care, outpatient services and emergency room services to the residents of Taylor County, WV and surrounding communities. 0 0 12662854 14489489 The Hospital provided health care services including 5,380 emergency room visits, 1,189 acute hospital days, 1,192 swing-bed days, and 227 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 $279,778. Additionally, the Hospital's Rural Health Clinic recorded 11,198 visits for the year. 11081 18650 The Hospital sponsored several community health improvement services/events that included Silver Sneakers fitness and Bread of Life Mission meals. 900 900 The organization provided several grants to community organizations including $100 Christmas Toy Drive, $250 5K Run, $200 GHS All Sports Boosters, $100 TCMS Football, $100 St. Jude Hospital, and $150 GHS Entertainers. 12674835 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 31 0 232 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 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 Exec Cred Chair 40.00 X 307259 0 2145 Wayne McDevitt Trustee 2.00 X 0 0 0 David Efaw Trustee 2.00 X 0 0 0 Kathy Green 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 40.00 X 94678 0 19626 Patrick D Shaw CEO (termed 9/21/19) 40.00 X 108227 0 767 Regina Pickens CFO (termed 9/21/19) 40.00 X 65629 0 2145 Joseph Duvert MD Physician 40.00 X 317757 0 2145 Andrew Berardinelli MD Physician 40.00 X 313351 0 2145 Thomas Wilshire DO Physician 40.00 X 284108 0 2145 Thomas Stevens DO Physician 40.00 X 301954 0 2145 Stephen Harris PA Physician Assistant 40.00 X 149016 0 2145 1941979 0 35408 100 0 1 0 Labcorp 231 Maple Avenue Burlington NC 27215 Lab testing services 174249 Alliance Healthcare PO Box 96485 Chicago IL 60693 MRI Services 120342 2 590309 2150 592459 Net patient services 622110 12928422 12928422 340B program revenue 900099 1064781 1064781 13993203 41876 41876 6282 0 6282 6282 6282 Nursing Home Service Reimb 900099 828000 828000 CHART Dividend 900099 92826 92826 422110 422110 1342936 15976756 14508139 828000 48158 900 900 181552 129192 52360 8366653 5953710 2412943 869214 618533 250681 580720 413240 167480 158235 112600 45635 41294 41294 43762 43762 900038 640468 259570 1033016 734530 298486 228488 162592 65896 121006 86108 34898 7311 5203 2108 127943 91044 36899 511272 363821 147451 416278 296223 120055 Medical supplies 1109312 1109312 Repairs & maintenance 988310 988310 Bad Debt and Charity Ex 743863 529334 214529 Medicaid provider tax 209092 209092 261522 230623 30899 16899781 12674835 4224946 0 13451 2763649 479957 4234161 1515398 1534726 213940 199248 182422 208608 20204552 17222378 3368697 2982174 886387 928262 6660252 12850828 3023674 2242863 3300000 149000 4984172 9727584 8156846 15270447 X -1496594 -2419619 -1496594 -2419619 6660252 12850828 -923025 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16428 16428 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 06/30/20, the amount of dues related to lobbying activities was $16,427.96. 26597 26597 8889776 7715189 1174587 240185 134130 106055 10750879 9373059 1377820 297115 297115 2982174 CHART RRG - Investment 928262 C 928262 Capital leases 331731 Accrued Pension 8280 PPP Loan Payable 1419100 Third-party payor settlements 4781686 Taxable bonds 3186787 9727584 14988445 0 14988445 988311 988311 15976756 15911470 0 15911470 988311 988311 16899781 Part XI, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 988,311. Part XII, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 988,311. 1 1 X 1 X 0 1 1 0 0 398010 398010 82972 82972 480982 480982 0 0.00000 2650 2650 0.00020 2276 2276 0.00010 4926 4926 0.00030 485908 480982 4926 0.00030 1 988310 3510672 3510672 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 18 1 0 0 1 X http://www.graftonhospital.com/assets/grafton-city-hospital-chna-2019.pdf X 1 18 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 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 $ 988,310. 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 X 0 0 0 0 0 0 0 0 0 David Bender MD Exec Cred Chair 252407 0 51852 0 3000 0 0 0 2145 0 309404 0 0 0 Joseph Duvert MD Physician 317757 0 0 0 0 0 0 0 2145 0 319902 0 0 0 Andrew Berardinelli MD Physician 265565 0 25142 0 22644 0 0 0 2145 0 315496 0 0 0 Thomas Wilshire DO Physician 284108 0 0 0 0 0 0 0 2145 0 286253 0 0 0 Thomas Stevens DO Physician 241781 0 31635 0 28538 0 0 0 2145 0 304099 0 0 0 Stephen Harris PA Physician Assistant 122670 0 3946 0 22400 0 0 0 2145 0 151161 0 0 0 David BenderMD Physician/Board Member 83092 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 2020, moneys paid through accounts payable to Grafton Medical Associates amounted to $83,092. 0 Violet Shaw Former Administrator's wife- Patrick Shaw 100538 Violet, Director of Nursing, is compensated for her services to the Hospital through W-2 compensation. 0 Eric Shaw Brother of Former Administrator- Patrick Shaw 110094 Eric, Physical Therapy Manager, is compensated for his services to the Hospital through W-2 compensation. 0 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.