2019-11-14T11:49:27-06:00 2018-12-31 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2018-01-01 550372580 Montgomery General Hospital Inc MONT 3044425151 401 Sixth Avenue Montgomery WV 25136 Vickie Gay CEO 3044425151 2019-11-14 1 Dolores Rose P01286262 3043460441 216.12.119.47 2019-11-14 00:45:46 ES P 4922351D67124356B1C43EE3C9710DC6A31D3181 A4BFA3AB87143958067DA1F41CA4A9B8234C6C6B 2018 2020-04-17 16:48:07Z Vickie Gay 401 Sixth Avenue Montgomery WV 25136 23990195 0 X www.mghwv.com X 1970 WV To provide quality, cost-effective, and convenient healthcare services that meet and exceed reasonable internal and external customer expectations. 10 9 307 75 0 0 20429 27320 22045440 22144226 -92598 37 1836664 1818612 23809935 23990195 0 0 0 0 12962892 13080296 0 0 0 11540339 11136249 24503231 24216545 -693296 -226350 7140621 6472356 6701757 5635908 438864 836448 Montgomery General Hospital is a critical access hospital. It also provides outpatient services including laboratory, radiology, surgery and therapy services; physician services; and skilled nursing services. 0 0 18886649 23896316 The Hospital provided health care services including 3,008 acute inpatient days; 12,704 skilled nursing days; 30,575 outpatient visits; 7,396 emergency room visits; 717 ambulatory surgery procedures; and 15,851 physician office visits. Charges foregone for charity care amounted to $63,373. 18886649 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 48 0 307 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Sherri Murray 3044421246 401 Sixth Avenue Montgomery WV 25136 Raleigh Collins Chair 0.50 1.50 X X 1400 0 0 Ghassan Dagher MD Vice Chair 0.50 1.50 X X 1000 0 0 Joyce Brown Secretary 0.50 1.50 X X 1400 0 0 Barbara Crist Treasurer 0.50 1.50 X X 1000 0 0 Vickie Gay President & CEO 39.50 0.50 X X 145359 0 0 Rita Bohanna Trustee 0.50 1.50 X 1400 0 0 Donald Smith Trustee 0.50 1.50 X 1400 0 0 Patsy Tucker Trustee 0.50 1.50 X 1200 0 0 Kelli Vance Trustee 0.50 1.50 X 2000 0 0 Garnes Reed Trustee 0.50 1.50 X 1400 0 0 Sherri Murray CFO 39.50 0.50 X 108456 0 0 Mohamad Sankari MD Physician 24.00 X 351588 0 280 Myra Priddy MD Physician 36.00 X 261180 0 0 Robert Eggleston MD Physician 40.00 X 253208 0 1918 Louis Yancich MD Physician 36.00 X 252931 0 4658 Samuel Davis MD Physician 20.00 X 247443 0 0 1632365 0 6856 12 0 1 0 Advantage Rehab 150 Hidden Valley Road Scott Depot WV 25560 Therapy Services 1113376 Kanawha Valley Radiologists PO Box 3428 Charleston WV 25334 Radiologist Services 290968 Labcorp of America PO Box 60850 Charlotte NC 28260 Lab Services 145310 Arnett Carbis Toothman LLP PO Box 2629 Charleston WV 25329 Accounting Services 129584 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Services 106691 5 19000 8320 27320 Patient services 622110 22144226 22144226 22144226 37 37 66522 0 66522 66522 66522 340B Program 900099 1701679 1701679 Cafeteria 722210 34711 34711 Refunds 900099 921 921 14779 14779 1752090 23990195 23896316 0 66559 253815 187791 66024 10443963 7727203 2716760 246084 182071 64013 1386324 1025703 360621 750110 554986 195124 87835 87835 84706 84706 2106525 1558561 547964 38860 28751 10109 2026060 1499027 527033 483088 357424 125664 602546 445807 156739 63381 46894 16487 3206 3206 585625 433288 152337 532075 393668 138407 Bad debts 2250000 2250000 Medical supplies 1572841 1572841 Health care provider ta 404009 404009 Licenses, dues & permit 153370 113474 39896 142122 105151 36971 24216545 18886649 5329896 0 514495 57633 2498603 2276630 372085 439609 104200 45540 32451311 29004108 3458619 3447203 192619 205741 7140621 6472356 2324908 2360976 511440 449304 3865409 2825628 6701757 5635908 X 438864 836448 438864 836448 7140621 6472356 X -226350 623934 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 869878 869878 12579917 12107820 472097 18333361 16517573 1815788 668155 378715 289440 3447203 Accrued pension obligation 2677498 Due to third party payers 148130 2825628 X 21739274 0 21739274 2250921 2250921 23990195 21965624 -921 -921 21966545 2250000 2250000 24216545 Part X, Line 2: Accounting principles generally accepted in the United States of America require management of the Organization to evaluate tax positions taken by the Organization. Management has evaluated the Organization's tax positions and concluded that the Organization has maintained its tax exempt status and has taken no uncertain tax positions that require recognition or disclosure in the consolidated financial statements. Therefore, no provision or liability for income taxes has been included in the consolidated financial statements. Generally, tax returns for years ended December 31, 2015, and thereafter remain subject to examination by federal and state tax authorities. Part XI, Line 4b - Other Adjustments: Bad debt netted with revenue 2,250,000. Refund reclassified 921. Part XII, Line 2d - Other Adjustments: Refund reclassified -921. Part XII, Line 4b - Other Adjustments: Bad debt netted with revenue 2,250,000. 1 1 X 1 X 120.000000000000 1 X 120.000000000000 1 0 0 436698 436698 2235489 1951843 283646 0.01290 2672187 2388541 283646 0.01290 2672187 2388541 283646 0.01290 1 2250000 4723849 4723849 X 1 1 1 1 Montgomery General Hospital Inc 401 Sixth Avenue Montgomery WV 25136 X X X X Montgomery General Hospital Inc 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, page 8 X 1 16 1 See Part V, page 8 0 1 X 120.000000000000 120.000000000000 X X X 1 1 X X X X 1 X See Part V, page 8 X See Part V, page 8 X See Part V, page 8 X X X 1 X 0 X X X X 1 X 0 0 Montgomery General Hospital, Inc. Part V, Section B, Line 5: Data was obtained from numerous health organizations as well as interviews with community leaders, hospital staff and the Hospital's Board of Directors. A survey was conducted which included anonymous participants and key community leaders. The survey collected demographic information that assessed the health status, health care access, and health care demands of the service area. Key participants represented a variety of sectors including public health, medical providers, fire and ambulance representatives, youth services, government and educational organizations. Montgomery General Hospital, Inc. Part V, Section B, Line 11: The following are the health care needs identified in the 2016 CHNA that are being addressed by the hospital:Need: Increased focus on diabetes education and servicesThe following has been implemented by the hospital's certified dietary educator to promote diabetes education:*holds Lunch and Learn sessions open to the community*publishes a monthly newsletter*one of 4 American Diabetes AADE CDE Mentor's in WV*participates in our annual Kids Fair to promote awareness among children*advertises her services in local school sports programNeed: Improve the availability of transportation for the impoverished and elderly who are unable to drive.The social service director works with the following organizations to provide transportation:*Fayette County Senior Service*MTM- service that provides transportation for Medicaid patients*UMWA- provides transportation for UMWA patients*Local cab company- the hospital pays the costNeed: Access to mental health care (facilities and physicians)1. Need for substance abuse services *recently hired a provider that offers addiction counseling and treatment with suboxone2. Need for outpatient mental health services *Partnering with Highland Hospital to offer telehealth consults *Social services offers screening and referral assistance to patientsNeed: Improved utilization of emergency room*extended the hours at provider based clinics for non-emergent patients*walk-ins now accepted at provider based clinics*ER triage to refer non-emergencies to clinic during clinic office hours*recently added a mid-level provider to assist with less emergent patientsNeed: Outpatient oncology and infusion therapy and outpatient cardiac rehabilitation and pulmonary therapy*some infusion services are offered*hospital does not have dedicated cardiac rehab program since there were not enough participants in the past--but offers the use of a fitness center, representatives, youth services, government and educational organizations. Line 16a Link for Financial Assistance Policy (FAP):http://mghwv.com/community/financial-assistance/financial-assistance-policy Line 16b Link for FAP Application:http://mghwv.com/community/financial-assistance/financial-assistance-application Line 16c Link for FAP Plain Language Summary:http://mghwv.com/community/financial-assistance/plain-language-policy Line 7a Link for Community Health Needs Assessment (CHNA):http://www.mghwv.com/community/community-helth-needs-assessment Line 10a Link for CHNA Implementation Strategy:http://www.mghwv.com/community/community-helth-needs-assessment-2 Part I, Line 7: The cost of charity care has been calculated by obtaining gross charges from the audited financial statements for charity care write offs and multiplying these charges by the aggregate hospital cost to charge ratio. The resulting charity care cost was then increased for the estimated "charity portion" of broad-based taxes paid to the State of WV. The net amount was then reduced by the estimated "charity portion" of the revenue "disproportionate share" payment received from the state. Medicaid community benefit cost was estimated based on the costs in excess of reimbursements for the hospital's skilled nursing unit. Other hospital services are reimbursed by WV Medicaid at 100% of cost. Since those costs and reimbursements would net to zero community benefit expense, those amounts are not included in the Medicaid costs and off-setting revenue totals reported. 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 $ 2,250,000. Part III, Line 2: Bad debt expense as reported on the 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 a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The Medicare costs and reimbursements were derived from the Hospital's Medicare cost report. Part III, Line 9b: Charity application is available to any person interested. Collection staff will meet with interested patient to help complete and assess all required information. Part VI, Line 2: Montgomery General Hospital provides acute care services, swing bed SNF services, skilled nursing services for both skilled patients and intermediate care patients and physicians in general practice and many specialties. As the only hospital in Fayette County, Montgomery General Hospital is aware of the health needs of the community and works to provide all necessary services to all citizens of the county. Part VI, Line 3: MGH will make reasonable efforts to explain the benefits of Medicaid and other available public and private programs to patients and provide information on those programs that may provide coverage for services. Information on public or private coverage and MGH's Financial Assistance Policy will be communicated to patients in easy-to-understand, culturally appropriate language, and in the most prevalent languages spoken in applicable hospital service area communities. MGH will make resources available to assist patients in enrolling in and/or applying for federal and government programs. Requests for financial assistance will be processed promptly and MGH will notify the patient or applicant in writing within 60 days of receipt of a completed application. Part VI, Line 4: Montgomery General Hospital is a Critical Access Hospital located in Fayette County, West Virginia. Montgomery General Hospital is the only hospital for rural Fayette County. Fayette County is a low income area that must compete with Urban Kanawha county to attract and retain physicians, nurses and medical personnel. In addition of having to pay higher salaries to attract top medical professionals, Montgomery General Hospital has a high percentage of Medicare and Medicaid patient population. Montgomery General Hospital is listed as a Health Professional Shortage Area and a Medically Underserved Area for portions of Fayette County. Part VI, Line 5: The majority of Montgomery General Hospital's board of directors is comprised of persons who reside in the Organization's primary service area. The Organization extends medical staff privileges to all qualified physicians in the community. The Organization uses surplus funds for improvements in patient care. Currently, the Organization is in the process of updating all patient rooms and implementing an EMR. The Organization operates an emergency room available to all, regardless of ability to pay. The Organization offers open MRI services and is in the process of implementing digital radiology. The Organization involves itself in the community by sponsoring health fairs as well as lunch and learn opportunities to address the diabetic population. X X 0 0 0 0 0 0 0 0 0 Mohamad Sankari MD Physician 351588 0 0 0 0 0 0 0 280 0 351868 0 0 0 Myra Priddy MD Physician 261180 0 0 0 0 0 0 0 0 0 261180 0 0 0 Robert Eggleston MD Physician 253208 0 0 0 0 0 0 0 1918 0 255126 0 0 0 Louis Yancich MD Physician 252931 0 0 0 0 0 0 0 4658 0 257589 0 0 0 Samuel Davis MD Physician 247443 0 0 0 0 0 0 0 0 0 247443 0 0 0 Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the CFO and CEO. Form 990, Part VI, Section B, line 12c Annually board members are provided the conflict of interest policy and questionnaire. Once these are completed they are returned to administration and reviewed by our in-house counsel. Form 990, Part VI, Section B, line 15 The Board of Directors determines the President/CEO's salary based upon comparative industry standards. The CEO determines the CFO salary based upon comparative industry standards. Form 990, Part VI, Section C, line 19 The governing documents and conflict of interest policy are available upon request. The financial statements are published annually in the local newspaper. Form 990, Part XI, line 9: Transfers from related parties 200,380. Change in pension funded plan status 423,554. Laird Health Care Foundation Inc Washington Sixth Avenue Montgomery WV 25136 550632743 Support tax-exempt health care organizations WV 501(c)(3) Line 7 Montgomery General Health Care System 0 Montgomery General Elderly Care Center Washington Sixth Avenue Montgomery WV 25136 550623339 Extended care facility WV 501(c)(3) Line 11 Montgomery General Health Care System 0 Montgomery General Health Care System Inc Washington Sixth Avenue Montgomery WV 25136 550632601 Provide support to affiliated exempt health care providers WV 501(c)(3) Line 12c, III-FI N/A 0 Montgomery MedCorp Inc Washington Sixth Avenue Montgomery WV 25136 550767169 Physicians Practice WV 501(c)(3) Line 11 Montgomery General Health Care System 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1