2020-02-25T10:05:11-06:00 2019-09-30 550621482 GRAY GRIFFITH & MAYS AC 707 VIRGINIA STREETEASTSUITE 400 CHARLESTON WV 253012711 990 2018-10-01 273128197 HIGHLAND-CLARKSBURG HOSPITAL INC HIGH 3049693100 3 HOSPITAL PLAZA CLARKSBURG WV 26301 WHITNEY PATTERSON CFO 3049693100 2020-02-24 1 J RYAN LINDSAY P01835061 3043459400 207.192.238.246 2020-02-24 09:14:28 ES P 4D9CBFD79C2F1C677FD78621C14809450D65F5D6 149CDF77D96CBBF549F02EAC05248B85EA8946E9 2018 2020-09-23 17:36:50Z VICTORIA JONES 3 HOSPITAL PLAZA CLARKSBURG WV 26301 22103776 0 X WWW.HIGHLANDCLARKSBURGHOSPITAL.COM X 2010 WV HIGHLAND-CLARKSBURG HOSPITAL'S MISSION IS TO PROVIDE QUALITY BEHAVIORAL HEALTH SERVICES TO CHILDREN, ADOLESCENTS, AND ADULTS IN A CARING ENVIRONMENT. 10 9 480 10 0 0 53825 22334 23029583 21889259 0 0 196376 184535 23279784 22096128 0 0 0 0 16013257 15225087 0 0 0 9038933 7828064 25052190 23053151 -1772406 -957023 45464339 43997553 36237766 35728003 9226573 8269550 TO PROVIDE PSYCHIATRIC CARE TO ADULTS AND CHILDREN. 0 0 16966901 21953450 HIGHLAND-CLARKSBURG HOSPITAL, INC. (HCHI) IS A NON-PROFIT ORGANIZATION WHICH BEGAN OPERATIONS IN 2011 TO DEVELOP AND OPERATE A BEHAVIORAL HEALTH HOSPITAL IN HARRISON COUNTY, WV. HCHI BEGAN GENERATING OPERATING REVENUES AFTER OCTOVER 29, 2013, THE DATE OF THE JOINT COMMISSION ACCREDIDATION. THE HOSPITAL PROVIDES PSYCHIATRIC CARE TO NORTH CENTRAL WEST VIRGINIA AND SURROUNDING COMMUNITIES. THE FACILITY HAS 115 INPATIENT BEDS SERVING CHILDREN, ADOLESCENTS AND ADULTS. 16966901 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 23 0 1 480 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X WHITNEY PATTERSON CFO 3049693143 3 HOSPITAL PLAZA CLARKSBURG WV 26301 JILL RICE CHAIRMAN 1.00 X X 0 0 0 GREG GORDON VICE CHAIRMAN 1.00 X X 0 0 0 SHAWN MILLER SECRETARY 1.00 X X 0 0 0 DUSTIN FRESHOUR TREASURER 1.00 X X 0 0 0 MARGARET BAILEY BOARD MEMBER 1.00 X 0 0 0 MARTIN HOWE BOARD MEMBER 1.00 X 0 0 0 JOE ELLIOT BOARD MEMBER 1.00 X 0 0 0 LUKE NESLER BOARD MEMBER 1.00 X 0 0 0 VICTORIA JONES CHIEF EXECUTIVE OFFICER 40.00 X X 186117 0 2512 LYNDON AUVIL BOARD MEMBER 1.00 X 0 0 0 WHITNEY PATTERSON CHIEF FINANCIAL OFFICER 40.00 X 143755 0 20159 TONI B GOODYKOONTZ MD CHIEF MEDICAL OFFICER 40.00 X 399815 0 8153 BAHAR ALTAHA PSYCHIATRIST 40.00 X 171465 0 12958 CAITLIN CORBITT PSYCHIATRIST 40.00 X 278584 0 15326 JESSICA WHIPKEY PSYCHIATRIST 40.00 X 280721 0 12166 JORDAN GWINN NURSE PRACTIONER 40.00 X 154165 0 20048 EMMYLOU MCDANIEL NURSE PRACTIONER 40.00 X 146212 0 9266 1760834 0 100588 14 0 1 0 MON POWER PO BOX 3615 AKRON OH 443093615 UTILITIES 543597 AMERISOURCEBERGEN 27550 NETWORK PLACE CHICAGO IL 606731275 PHARMACY 336716 DOMINION PO BOX 26783 RICHMOND VA 232616828 UTILITIES 331865 REINHART FOODSERVICE 226 EASTVIEW DRIVE MT PLEASANT PA 15666 DIETARY 293112 MEDICAL SOLUTIONS PO BOX 310737 DES MOINES IA 503310737 CONTRACT NURSING 265958 5 1100 21234 22334 PATIENT SERVICES 622110 21889259 21889259 21889259 119528 0 119528 119528 119528 8464 1100 7648 816 816 REBATES & OTHER 900099 26938 26938 COMMISSARY REVENUE 722210 20131 20131 LUNCH REVENUE 722210 17122 17122 64191 22096128 21953450 0 120344 729687 591125 138562 12261196 9932877 2328319 5801 4699 1102 1325692 1079069 246623 902711 731293 171418 29796 29796 119426 119426 84507 84507 843280 678344 164936 2967 2967 243107 161583 81524 1329607 571337 758270 13593 4932 8661 1181812 470585 711227 1832558 1079973 752585 329967 147629 182338 HEALTHCARE PROVIDER TAX 536088 536088 0 MEDICAL SUPPLIES 403589 403589 0 FOOD PREP 299733 281156 18577 REPAIRS & MAINTENANCE 291219 115960 175259 286815 176662 110153 23053151 16966901 6086250 0 853289 69948 1892023 2865085 59068 67698 273171 244851 47856099 7392647 42248148 40463452 138640 286519 45464339 43997553 3275179 3922171 32962587 31805832 36237766 35728003 X 9226573 8269550 9226573 8269550 45464339 43997553 -957023 0 X X 0 1 X 1 0 X 300000 300000 46224019 6556783 39667236 28026 18279 9747 1304054 817585 486469 40463452 X 22064716 7648 7648 22057068 39060 39060 22096128 23021739 7648 7648 23014091 39060 39060 23053151 PART X, LINE 2: HCHI IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SIMILAR STATE STATUTES RELATING TO NOT-FOR-PROFIT ORGANIZATIONS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE MANAGEMENT OF HCHI TO EVALUATE TAX POSITIONS TAKEN BY HCHI. MANAGEMENT HAS EVALUATED HCHI'S TAX POSITIONS AND DID NOT BECOME AWARE OF ANY COURSE OF ACTION ON SERVICES OR EVENTS THAT MIGHT ADVERSELY AFFECT THE ENTITY'S TAX STATUS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES OFFSETTING INCOME ON 990 7,648. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NETTED WITH REVENUE ON FINANCIAL STATEMENTS 39,060. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES OFFSETTING INCOME ON 990 7,648. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NETTED WITH REVENUE ON FINANCIAL STATEMENTS 39,060. 1 1 X 1 X 1 X 1 1 0 0 537800 537800 0.02330 3061535 3061535 256049 48670 207379 0.00900 3855384 3110205 745179 0.03230 3855384 3110205 745179 0.03230 7907 7907 0.00030 10830 10830 0.00050 18737 18737 0.00080 1 39060 1 1 1 1 HIGHLAND-CLARKSBURG HOSPITAL 3 HOSPITAL PLAZA CLARKSBURG WV 26301 X INPATIENT MENTAL HEALTH HIGHLAND-CLARKSBURG HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X HTTPS://HIGHLANDCLARKSBURGHOSPITAL.COM/HEALTHASSESSMENT/ X 1 16 1 HTTPS://HIGHLANDCLARKSBURGHOSPITAL.COM/HEALTHASSESSMENT/ 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X HTTPS://HIGHLANDCLARKSBURGHOSPITAL.COM/FINANCIALPOLICY/ X HTTPS://HIGHLANDCLARKSBURGHOSPITAL.COM/FINANCIALPOLICY/ X HTTPS://HIGHLANDCLARKSBURGHOSPITAL.COM/FINANCIALPOLICY/ X X X X X 1 X 0 X X X 1 X 0 0 HIGHLAND-CLARKSBURG HOSPITAL PART V, SECTION B, LINE 5: INTERVIEWS WERE CONDUCTED WITH INTERNAL AND EXTERNAL STAKEHOLDERS AND INCLUDED INDIVIDUALS FROM THE FOLLOWING ORGANIZATIONS: HARRISON CLARKSBURG HEALTH DEPARTMENT, HEALTH ACCESS INC. (FREE CLINIC), HARRISON COUNTY CHILD ADVOCACY CENTER, HARRISON COUNTY BOARD OF EDUCATION, NOTRE DAME HIGH SCHOOL, STATE OF WV LEGISLATURE, WESTBROOK HEALTH SERVICES, HARRISON COUNTY CHAMBER OF COMMERCE, THE CULTURAL FOUNDATION, CLARKSBURG MISSION, A RETIRED COUNSELOR, AND A HOSPITAL ADMINISTRATION CONSULTANT. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSE OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $39,060. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT: EXPONENT ADVERTISING FOR MENTAL HEALTH AWARENESS AND DRUNK DRIVING PREVENTION; UGLY SWEATER 5K FOR MENTAL HEALTH AWARENESS; HOSTING WVHA SAFETY COMMITTEE MEETINGSCOMMUNITY HEALTH IMPROVEMENT ADVOCACY: 2 BLOOD DRIVES DURING THE YEAR; COAT DRIVES AND BACKPACK PROGRAMS AT HCHI; CHRISTMAS PRESENTS FOR PATIENTS + PATIENT ART SHOW; EDUCATIONAL CONFERENCES PART III, LINE 2: THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS. PART III, LINE 4: HCHI RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICE RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, HCHI RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF HCHI'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS HCHI RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 9B: FORMER PATIENTS WITH DELINQUENT PRIVATE PAY ACCOUNTS WILL BE NOTIFIED AND GIVEN THE OPTION OF PAYING THE ACCOUNT IN FULL OR PARTICIPATING IN A PREDEFINED MONTHLY PAYMENT PLAN. FORMER PATIENTS WILL BE NOTIFIED OF THEIR FINANCIAL OBLIGATION FOR SERVICES RENDERED BY RECEIVING MONTHLY STATEMENTS WITH BALANCE DUE. FORMER PATIENTS WHO DID NOT WISH TO APPLY DURING THEIR HOSPITALIZATION WILL BE GIVEN ANOTHER OPPORTUNITY TO APPLY FOR CHARITY CARE OR SLIDING FEE SCALE FINANCIAL ASSISTANCE PROGRAM DURING THE COLLECTION PROCESS. ALL PRIVATE PAY ACCOUNTS WILL BE REVIEWED TO DETERMINE THE LAST DATE OF PAYMENT. THE COLLECTION SPECIALIST WILL ATTEMPT TO CONTACT THE DEBTOR BY PHONE TO SETUP A PAYMENT ARRANGEMENT. THE COLLECTION SPECIALIST WILL ALSO REMIND THE PATIENT OR RESPONSIBLE PARTY OF THE HOSPITAL CHARITY CARE AND SLIDING FEE SCALE FINANCIAL ASSISTANCE PROGRAMS. THE COLLECTION SPECIALIST WILL DOCUMENT ALL CONVERSATIONS WITH THE DEBTOR IN THE PATIENT'S BILLING DATABASE. IF THE PATIENT SHOULD APPLY FOR THE CHARITY CARE OR SLIDING FEE SCALE FINANCIAL ASSISTANCE PROGRAMS WITHIN 240 DAYS FROM THE DATE OF THE FIRST BILLING STATEMENT, AND IT IS DETERMINED THAT THE PATIENT QUALIFIES FOR ONE OF THE ASSISTANCE PROGRAMS, THE HOSPITAL'S COLLECTION REPRESENTATIVE WILL CONTACT THE COLLECTION AGENCY AND INSTRUCT THAT THE ACCOUNT BE REMOVED FROM COLLECTION AND THAT THE CREDIT BUREAU BE NOTIFIED TO REMOVE THE BALANCE FROM THE PATIENT'S CREDIT REPORT. PART VI, LINE 4: THE HOSPITAL IS LOCATED IN CLARKSBURG, A NORTH CENTRAL CITY OF WEST VIRGINIA, FOUR HOURS WEST OF WASHINGTON D.C., AND LESS THAN TWO HOURS SOUTH OF PITTSBURGH, PENNSYLVANIA. THE PRIMARY SERVICE AREA CONSISTS OF THE FOLLOWING WEST VIRGINIA COUNTIES: HARRISON, MARION, UPSHUR, MONONGALIA, LEWIS, RANDOLPH, WOOD, TAYLOR, BARBOUR, AND DODDRIDGE. THE POPULATION OF THE TOTAL SERVICE AREA IS PROJECTED TO STEADILY INCREASE THROUGH 2030. THE LARGEST INCREASE IN POPULATION IS PROJECTED IN MONONGALIA COUNTY. MARION, RANDOLPH, TAYLOR AND UPSHUR COUNTIES ARE PROJECTED TO REMAIN STABLE DURING THE PROJECTION PERIOD. HARRISON, LEWIS, AND WOOD COUNTIES ARE PROJECTED TO STEADILY DECLINE DURING THE PERIOD. THE ESTIMATED 2015 POPULATION FOR THE SERVICE AREA WAS 402,604. RESIDENTS OF THE PRIMARY SERVICE AREA ARE PREDOMINANTLY WHITE/CAUCASIAN (94%), FOLLOWING BY BLACK/AFRICAN AMERICAN (1.9%). HOUSING IS GENERALLY STABLE AND COMPARABLE BETWEEN THE SERVICE AREA AND THE STATE. THE SERVICE AREA HAS A LOWER MEDIAN INCOME THAN THE REST OF WEST VIRGINIA AND IS MUCH LOWER THAN THE MEDIAN INCOME IN THE UNITED STATES. ALL COUNTIES IN THE SERVICE AREA HAD A HIGHER PERCENTAGE OF ADULTS LIVING IN POVERTY THAN THE AVERAGE FOR THE UNITED STATES WHICH WAS 14.7%. MONONGALIA COUNTY WAS 19.6%, LEWIS COUNTY WAS 20.6%, BARBOUR COUNTY WAS 20.1%, AND THE REST OF THE COUNTIES ARE COMPARABLE TO THE STATE AVERAGE OF 18%. THE AVERAGE MEDIAN INCOME OF THE REFERRAL AREA WAS $41,068 COMPARED TO THE NATIONAL AVERAGE OF $53,889 AND THE STATE AVERAGE OF $41,576. X X X 0 0 0 0 0 0 0 0 0 VICTORIA JONES CHIEF EXECUTIVE OFFICER 186117 0 0 0 0 0 0 0 2512 0 188629 0 0 0 WHITNEY PATTERSON CHIEF FINANCIAL OFFICER 143755 0 0 0 0 0 0 0 20159 0 163914 0 0 0 TONI B GOODYKOONTZ MD CHIEF MEDICAL OFFICER 399815 0 0 0 0 0 0 0 8153 0 407968 0 0 0 BAHAR ALTAHA PSYCHIATRIST 171465 0 0 0 0 0 0 0 12958 0 184423 0 0 0 CAITLIN CORBITT PSYCHIATRIST 278584 0 0 0 0 0 0 0 15326 0 293910 0 0 0 JESSICA WHIPKEY PSYCHIATRIST 280721 0 0 0 0 0 0 0 12166 0 292887 0 0 0 JORDAN GWINN NURSE PRACTIONER 154165 0 0 0 0 0 0 0 20048 0 174213 0 0 0 EMMYLOU MCDANIEL NURSE PRACTIONER 146212 0 0 0 0 0 0 0 9266 0 155478 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PROVIDED IN DRAFT FORM TO THE BOARD OF DIRECTORS TO REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE QUALITY CONTROL DIRECTOR KEEPS A COPY OF THE POLICY ON FILE, WITH ALL BOARD MEMBERS SIGNING A COPY EVERY YEAR. ALSO, AS SITUATIONS ARISE, BOARD MEMBERS WILL EXCUSE THEMSELVES FROM ANY VOTE THAT MAY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS APPROVES COMPENSATION FOR THE CEO, CMO, AND CFO USING A SEPARATE FINANCE COMMITTEE AND COMPARATIVE DATA. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZING DOCUMENTS AND THE FORM 990 ARE AVAILABLE THROUGH DIRECT INQUIRY OF THE FISCAL OFFICE OF THE ORGANIZATION FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND THE FINANCIAL STATEMENTS ARE AVAILABLE THROUGH DIRECT INQUIRY OF THE FISCAL OFFICE OF THE ORGANIZATION FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE SELECTION AND OVERSIGHT OF THE INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED.