2020-07-15T13:08:00-05:00 2019-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2018-07-01 556000526 Grafton City Hospital GRAF 3042657152 1 Hospital Plaza Grafton WV 26354 George Boyles Chief Administrative Officer 3042657152 2020-07-15 1 Dolores Rose P01286262 3043460441 216.12.119.47 2020-07-15 10:48:17 ED P DBF3DF03C93CF583714802DAD1D2E8B1989575BE 9AFB8F7DCAEAE646C8A447A10E05C77C177DBB4B 2018 2021-01-29 14:40:06Z George Boyles 1 Hospital Plaza Grafton WV 26354 17456503 0 X www.graftonhospital.com X 1972 WV To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities. 9 8 243 20 828000 0 1500 39107 15546756 16159631 130400 56110 4913354 1201655 20592010 17456503 2000 1765 0 0 12133471 10215042 0 0 0 7391430 6478740 19526901 16695547 1065109 760956 8129998 6660252 10387548 8156846 -2257550 -1496594 To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities. 0 0 12519895 16525621 The Hospital provided health care services including 5,529 emergency room visits, 1,251 acute hospital days, 0 long-term care days, 2,004 swing-bed days, and 237 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. Changes foregone for charity care during the year amounted to $289,660. Additionally, the Hospital's Rural Health Clinic recorded 14,565 visits for the year. The Hospital sponsored several community health improvement services/events that included a health fair, flu shot clinic, New You Youth Fitness, and a pneumonia vaccine clinic. The program operated at a loss this year and the expenses and revenue are included on line 4a above. 1765 1765 The organization provided several grants to community organizations including a $500 sponsorship of a five mile run, $100 Christmas Toy Drive, $250 Grafton Rotary Club, $250 Grafton Adventure Club, Goodwill Publishers $500, Grafton Wrestling Club $65, and GHS yearbook $100. 12521660 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 6 0 243 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 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 Whitescarver President 2.00 X X 0 0 0 John L Bord Vice-President 2.00 X X 0 0 0 Wanda Taylor Secretary 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 297674 0 2145 Kenneth Cole 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 Wayne McDevitt Trustee 2.00 X 0 0 0 Patrick D Shaw CEO (termed 9/21/19) 40.00 X 102454 0 767 Regina Pickens CFO (termed 9/21/19) 40.00 X 87156 0 2145 Joseph Duvert MD Physician 40.00 X 323859 0 2145 Andrew Berardinelli MD Physician 40.00 X 288633 0 2145 Thomas Wilshire DO Physician 40.00 X 288355 0 2145 Thomas Stevens DO Physician 40.00 X 268365 0 2145 Alan Barnett DO Physician 40.00 X 182639 0 0 1839135 0 13637 14 0 1 0 Labcorp 231 Maple Avenue Burlington NC 27215 Lab testing services 138427 Odyssey Rehabilitation 415 Benedum Drive Bridgeport WV 26330 Speech/Occupational Therapy Services 133311 Alliance Healthcare PO Box 96485 Chicago IL 60693 MRI Services 103158 3 19170 19937 39107 Net patient services 622110 15185158 15185158 340B program revenue 900099 974473 974473 16159631 56110 56110 7665 0 7665 7665 7665 Nursing Home Service Reimbursemen 900099 828000 828000 Chart Dividend 900099 88638 88638 277352 277352 1193990 17456503 16525621 828000 63775 1765 1765 224788 163443 61345 8254428 6001795 2252633 11477 8345 3132 1106533 804560 301973 617816 449214 168602 152784 152784 42645 42645 871022 633321 237701 981740 713988 267752 290172 210984 79188 127503 92707 34796 6042 4393 1649 130516 94898 35618 723590 526122 197468 449753 327015 122738 Medical supplies 994501 994501 Repairs & maintenance 696317 506293 190024 Bad Debt and Charity Ex 542658 542658 Medicaid provider tax 194568 194568 274929 251090 23839 16695547 12521660 4173887 0 23976 13451 1236410 479957 1616693 1515398 209458 213940 166672 180054 20135296 16766599 4046512 3368697 830277 886387 0 2368 8129998 6660252 3277857 3023674 69000 0 149000 149000 6891691 4984172 10387548 8156846 X -2257550 -1496594 -2257550 -1496594 8129998 6660252 760956 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 15753 15753 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 06/30/19, the amount of dues related to lobbying activities was $15,752.50. 26597 26597 8952610 7553224 1399386 240185 122398 117787 10618789 9090977 1527812 297115 297115 3368697 CHART RRG - Investment 886387 C 886387 Capital leases 371346 Accrued Pension 18860 Third-party payor settlements 1321452 Taxable bonds 3272514 4984172 16913845 0 16913845 542658 542658 17456503 16152889 0 16152889 542658 542658 16695547 Part XI, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 542,658. Part XII, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 542,658. 1 1 X 1 X 0 1 1 0 0 370532 370532 1560319 937157 623162 0.03860 1930851 1307689 623162 0.03860 11081 11081 16184 16184 0.00100 5413 5413 0.00030 1765 1765 0.00010 34443 11081 23362 0.00140 1965294 1318770 646524 0.04000 1 542658 4228726 4228726 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. 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 $ 542,658. 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 areas 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 (Dec., 2013). 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 65,000 based on the 2010 Census information. 2011 data from the U.S. Dept. of Agriculture show that 17.60% of Taylor county residents, 16.80% for Preston county residents and 22.80% of Barbour county residents are living in poverty. The median household income for Taylor, Preston and Barbour counties is $39,142, $43,434 and $33,158, respectively. The Median household income for the State of WV is $38,482 (based on 2011 data). The combined Medicare and Medicaid population is approximately 20% for both Preston and Barbour counties. The combined Medicare and Medicaid population in Taylor County is approximately 35%. 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. X X X 0 0 0 0 0 0 0 0 0 David Bender MD Executive Credentials Chair 262040 0 32384 0 3250 0 0 0 2145 0 299819 0 0 0 Joseph Duvert MD Physician 323859 0 0 0 0 0 0 0 2145 0 326004 0 0 0 Andrew Berardinelli MD Physician 249710 0 15677 0 23246 0 0 0 2145 0 290778 0 0 0 Thomas Wilshire DO Physician 288355 0 0 0 0 0 0 0 2145 0 290500 0 0 0 Thomas Stevens DO Physician 217869 0 24512 0 25984 0 0 0 2145 0 270510 0 0 0 Alan Barnett DO Physician 175965 0 5174 0 1500 0 0 0 0 0 182639 0 0 0 David BenderMD Physician/Board Member 82214 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 2019, moneys paid through accounts payable to Grafton Medical Associates amounted to $82,214. 0 Violet Shaw Former Administrator's wife- Patrick Shaw 90612 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 106428 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.