2018-05-15T10:15:07-05:00 2017-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2016-07-01 550477361 Boone Memorial Hospital Inc BOON 3043691230 701 Madison Avenue Madison WV 25130 Randell Foxx CFO 3043691230 2018-05-14 1 Dolores Rose P01286262 3043460441 2016 2022-09-23 18:48:47Z Virgil Underwood 701 Madison Avenue Madison WV 25130 34145747 0 X www.bmh.org X 2010 WV Boone Memorial hospital strives to supply a comprehensive range of inpatient and outpatient services, including prevention, guidance, diagnosis, treatment, restoration, rehabilitation and other efforts to enable patients to lead healthy, productive lives, as may be needed by its community, and as its resources will permit. In carrying out its programs, Boone Memorial Hospital recognizes its responsibility to make services available to all persons who can benefit from them and to provide these in an economical manner in compliance with high professional standards. The hospital further recognizes responsibility to develop an organizational environment in which physicians, employees, volunteers and other individuals constituting its staff are stimulated to high standards of performance and can find maximum satisfaction, achievement and opportunity. As an equal opportunity employer it will not permit discrimination because of race, color, religion, sex, age, national origin or handicap. 9 9 260 45 0 0 664861 608189 27436501 32954515 180906 162352 342299 404654 28624567 34129710 53417 27600 0 0 11521189 13220770 0 0 31832 15704957 20850253 27279563 34098623 1345004 31087 48592181 50167741 38681847 40226320 9910334 9941421 X The basic mission of Boone Memorial Hospital is to create an environment in which qualified physicians and other health care personnel can work together to provide high quality health care service, in an atmosphere of brotherly love and concern, to the residents of Boone County and surrounding areas. 0 0 27245387 33352855 In performing its mission, Boone Memorial Hospital had 606 acute care admissions and 200 skilled nursing care admissions. The Hospital also had 6 respite care patients, 14,250 emergency room visits, 23,013 out-patient visits and 26,017 visits in its two rural health clinics. 14811 13414 Boone Memorial Hospital conducts an annual health fair. The Hospital uses the local Madison Civic Center and offers very low cost blood work to the community. Approximately 450 community members attended the health fair and approximately 170 received low cost blood work. 55372 5372 BMH Respite Care Program. The Hospital had 6 respite care admissions and 29 respite days for its 6/30/17 fiscal year. The respite care program is a cash only program. It is not billed to insurance, but the rate is only $221 per day. We offer this as a community benefit. 27600 27600 The hospital provided student loan forgiveness grants during the year. 27600 27600 27343170 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 48 0 260 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WV X Randell D Foxx 3043691230 701 Madison Avenue Madison WV 25130 Robert Brown President 1.30 X X 0 0 0 James Hensley Vice President 1.30 X X 0 0 0 Thomas Bias Board Member 1.30 X 0 0 0 James Gore Board Member 1.30 X 0 0 0 Nada Woodie Board Member 1.30 X 0 0 0 Shawn Miller Board Member 1.30 X 0 0 0 John Reger Board Member 1.30 X 0 0 0 Susan McCoy Board Member 1.30 X 0 0 0 Douglas Bell Board Member 1.30 X 0 0 0 Virgil Underwood CEO 40.00 X 177227 0 26095 Randell D Foxx CFO 40.00 X 125591 0 26760 Rodrigo Velasco MD Physician 47.00 X 136607 0 2847 David Gresham CDO 40.00 X 128500 0 0 Kevin HillMPAS PA-C PA 49.00 X 194647 0 26771 Ziad Chanaa MD Physician 27.00 X 183578 0 12740 Tarah Hager MPAS PA-C PA 49.00 X 150262 0 17497 Mark Linville COO (Interim Co-CEO until 2/2015) 40.00 X 109360 0 24029 1205772 0 136739 10 1 1 0 Neighborgall Construction Co 1216 Seventh Avenue Huntington WV 25701 General Contractor-New Hospital 6052183 Rehab One Ltd 1834 Park Avenue Belle WV 25015 Physical Therapy Services 1084843 CPSI PO Box 850309 Mobile AL 36685 System Software Vendor 1012246 Cherry River Construction LLC 85 Legacy Ridge Red House WV 25168 General Contractor-New Hospital 838931 Pharmacy Management and Consulting Servi 928 Helene Street St Albans WV 25177 Pharmacy Management 677608 50 51058 10000 547131 608189 Patient Service Revenue 622110 31748890 31748890 340B Program Revenue 900099 1205625 1205625 32954515 162352 162352 200 0 200 200 200 3365 51058 16037 -12672 -12672 Dietary Sales 900099 134649 134649 Pharmacy 446110 116163 116163 EHR Incentive Revenue 900099 96000 96000 70314 70314 417126 34129710 33371641 0 149880 X 27600 27600 340891 243975 96916 9912616 7094459 2818157 100521 71943 28578 2130225 1524602 605623 736517 527125 209392 128709 128709 140160 140160 8652272 8178250 474022 176775 176775 2178077 1558849 619228 60871 43565 17306 517343 370262 147081 8193 5864 2329 59236 42395 16841 1248174 893318 354856 2516116 1800784 715332 373086 267018 106068 Medical supplies 2397572 2397572 Bad debt expense 1144461 1144461 Provider tax 772513 772513 Charity Care Expense 208808 208808 267887 169807 66248 31832 34098623 27343170 6723621 31832 3036781 1507044 6043822 7300298 2797384 3069342 27775 41520 430546 469556 107256 134970 42019582 4963473 35641252 37056109 507365 588902 48592181 50167741 5866777 3957587 96000 101400 29321918 34278784 3397152 1888549 38681847 40226320 X 8843961 9941421 1066373 0 9910334 9941421 48592181 50167741 31087 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1066373 570191 1636564 404472 661901 1066373 404472 404472 0 0 216178 216178 30891617 1990396 28901221 6921350 2806895 4114455 3990437 166182 3824255 37056109 Third Party Payor Settlements 1793346 Deferred revenue, net of current portion 95203 1888549 32790913 14472 14472 32776441 1353269 1353269 34129710 32759826 14472 14472 32745354 1353269 1353269 34098623 Part XI, Line 2d - Other Adjustments: Direct fundraising expense netted against fundraising income 14,472. Part XI, Line 4b - Other Adjustments: Bad debt expense netted with revenue on financial statements 1,144,461. Charity care expense netted with revenue on financial statements 208,808. Part XII, Line 2d - Other Adjustments: Direct fundraising expense netted against fundraising income 14,472. Part XII, Line 4b - Other Adjustments: Bad debt expense netted with revenue on financial statements 1,144,461. Charity care expense netted with revenue on financial statements 208,808. Golf Tournament 52858 51058 1800 4800 500 5469 5268 2016 5k Run 1565 1565 54423 51058 3365 4800 500 5469 5268 16037 -12672 1 1 X 1 X 1 X 240.000000000000 1 1 0 0 78895 78895 9348432 9348432 9427327 9427327 0 0.00000 70183 18786 51397 0.00150 70183 18786 51397 0.00150 9497510 9446113 51397 0.00150 1 1144461 6560076 6560076 X 1 1 1 1 Boone Memorial Hospital Inc 701 Madison Avenue Madison WV 25130 www.bmh.org X X X X Two rural health clinics, SNF/NF beds Boone Memorial Hospital Inc 1 1 0 1 X X X X X X X X 15 1 0 0 1 X http://www.bmh.org X 1 15 1 http://www.bmh.org 0 1 X 100.000000000000 240.000000000000 X X X X 1 1 X X X 1 X http://media.wix.com/ugd/3f447f_7f16f4d8221b4aeb80861e83adf1f875.pdf X http://media.wix.com/ugd/3f447f_f78c6d10ee0d43d8915549467626c606.pdf X http://media.wix.com/ugd/3f447f_d54b7cf9599d4b35b28620aa527b698f.pdf X X X X 1 X 0 X X X X 1 X 0 0 Boone Memorial Hospital, Inc. Part V, Section B, Line 5: Assembled an Advisory Panel comprised of representatives from community leaders, health care providers, and local citizens to assist with the assessment process. Boone Memorial Hospital, Inc. Part V, Section B, Line 11: Boone Memorial Hospital developed an implementation plan that addressed the majority of the significant community needs identified in the CHNA. The areas addressed included alcohol and drug abuse, drunk driving and lack of recreational programs. The Hospital sponsored multiple community events/educational seminars that included health fairs, monthly diabetic educational classes, drug and alcohol abuse prevention forums and a low cost fitness center program for the community. As with most health care facilities, we have limited financial resources to address all issues. Boone Memorial Hospital, Inc. Part V, Section B, Line 16j: MEASURES TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICYThe following measures are used to publicize the financial assistance available from BMH to the community and patients in accordance with Federal and State law: a. Providing information when a patient calls BMH at (304) 369-1230;b. Annually posting an article in a newspaper of local circulation and/or other means as deemed reasonably necessary;d. Posting of a notice in the emergency department admitting areas and business offices at BMH; and/ore. Financial Counselors visiting with BMH inpatients. Part I, Line 3c: Patients must provide their "Total Yearly Income" in order to be considered for financial assistance.a. Adults: If the patient is an adult, the term "Total Yearly Income" means the sum of the total yearly gross income of the patient and the patient's spouse.b. Minors: If the patient is a minor, the term "Total Yearly Income" means the sum of the total yearly gross income of the patient, the patient's mother and the patient's father.The patient, immediate family member or patient representative shall verify the patient's reported Total Yearly Income, as provided on the Application. The Total Yearly Income may be verified through any of the following mechanisms:a. Income Indicators. By the provision of third party financial documentation including IRS Form W-2, Wages and Tax Statement; pay check remittance; individual tax return; telephone verification by employer; bank statements; Social Security payment remittance; Worker's Compensation payment remittance; unemployment insurance payment notice; Unemployment Compensation Determination Letters; or other appropriate indicators of the patient's Total Yearly Income.b. Participation in a Benefit Program. By the provision of documentation showing current participation in a public benefit program such as Medicaid; Food Stamps; WIC; or other similar means tested programs. Proof of Participation in any of the above programs indicates that the patient has been deemed Financially Indigent and therefore, is not required to provide his or her income on the Assistance Application.c. In cases where the patient or responsible party is unable to provide third party verification of patient's Total Yearly Income, verification of the patient's Total Yearly Income can be done in either of the following ways:1. Obtaining the patient's or responsible party's Written Attestation. By obtaining an Application signed by the patient or responsible party attesting to the veracity of the patient's Total Yearly Income information provided: or2. Obtaining the patient's or responsible party's Verbal Attestation. Through the written attestation of the BMH employee completing the Assistance Application that the patient or responsible party verbally verified the patient's Total Yearly Income information provided.3. In instances where the patient or responsible party is unable to provide the requested third party verification of patient's Total Yearly Income, the patient or responsible party is required to provide a reasonable explanation of why the patient or responsible party is unable to provide the required third party verification. Sound business practices will be employed to verify patient's attestation and supporting information.Unmarried expired patients may be deemed to have no income for purposes of calculation of Total Yearly Income. Documentation of Total Yearly Income is not required for expired patients; however, documentation of estate assets may be required. If an expired patient is married, the surviving spouse may apply for financial assistance.Patients, immediate family members or patient representatives applying for financial assistance must verify the number of people in the patient's household ("Number in Household").a. Adults: In calculating the Number in Household, include the patient, the patient's spouse, and any dependents (as defined by the Internal Revenue Code).b. Minors: In calculating the Number in Household, include the patient, the patient's mother, the patient's father, dependents of the patient's mother, and dependents of the patient's father.During the verification process, while information to determine a patient's Total Yearly Income is being collected, the patient may be treated as a private pay patient. Part III, Line 2: Cost of bad debt as reported on audited financial statements. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible 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 collectibility. 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: Medicare allowable costs were derived from the Medicare care cost report for the period ended 6/30/17. Part III, Line 9b: After the patient's account is reduced by the discounts based on the Financial Assistance Eligibility Discount Guidelines, the patient is responsible for the remainder of their outstanding account. Patients will be invoiced for any remaining amounts in accordance with other BMH Debt Collection Policies regarding this matter. Part VI, Line 2: The BMH project team completed the community needs assessment using the following strategies:-Assembled an Advisory Panel comprised of representatives from community leaders, health care providers, and local citizens to assist with the assessment process.-Conducted primary data collection through surveys of providers, key informants, and the general population. Phone interviews were also conducted.-Collected secondary data sources such as information from the Boone County Health Department Community Needs Assessment, State health statistics and behavioral risk assessments, US Census Data, Centers for Disease Control statistics and data, etc.-Created a comprehensive database including answers to each survey question which was used to track and calculate the data.-Held focus groups, some of which included youth representation in order to obtain a diverse range of responses in an open discussion format. Part VI, Line 3: Measures to publicize the Financial Assistance Policy:The following measures are used to publicize the financial assistance available from BMH to the community and patients in accordance with Federal and State law: a. Posting on the BMH website at the following location: www.bmh.org; b. Providing information when a patient calls BMH at (304) 369-1230; c. Annually posting an article in a newspaper of local circulation and/or other means as deemed reasonably necessary; d. Posting of a notice in the emergency department admitting areas and business offices at BMH; and/or e. Financial Counselors visiting with BMH inpatients. Part VI, Line 4: BMH serves primarily Boone County, WV and portions of Logan and Lincoln Counties in WV. Boone County had an estimated population of 24,224 in 2013. The median household income was $41,359 with 18.9% below the federal poverty guideline. 15% of the population is over 65 and 28.9% is under 18 with 40.7 years as the median age. 79% of the hospital's patients were from Boone County is FY 13.Logan County had an estimated population of 35,987 in 2013. The median household income was $36,698 with 20.8% below the federal poverty guideline. 16% of the population is over 65 and 26% is under 18. 12% of the hospital's patients were from Logan County in FY 13. Lincoln County had an estimated population of 21,559 in 2013. The median household income was $34,066 with 26.9% below the federal poverty guideline. 16% of the population is over 65 and 28% is under 18. 7% of the hospital's patients were Lincoln County in FY 13. 23% of the hospital's patients were age 65+ for FY 2013. Part VI, Line 5: Each member of the Board of Trustees is a local, lifelong Boone County resident. The ER is always available to all patients, regardless of ability to pay. Boone Memorial has made the most recent Community Needs Assessment report available on its website for all patients to have easy access to read. BMH offers patients access to our own MRI seven days a week instead of having to travel to other larger hospitals in Charleston or Logan. Most other Critical Access Hospitals in WV only offer a mobile MRI service one or two days a week. We have a fully digital radiology department with a PACS system. Our lab has just recently expanded to incorporate additional testing equipment. We also operate two RHCs with extended hours (one has Saturday hours) to help serve the community. 0 Student Loan Assistance 7 27600 Cash - FMV Student loan assistance to professional employees X 0 0 0 0 0 0 0 0 0 Virgil Underwood CEO 177227 0 0 0 0 0 13148 0 12947 0 203322 0 0 0 Randell D Foxx CFO 125591 0 0 0 0 0 9532 0 17228 0 152351 0 0 0 Kevin HillMPAS PA-C PA 194647 0 0 0 0 0 12773 0 13998 0 221418 0 0 0 Ziad Chanaa MD Physician 183578 0 0 0 0 0 0 0 12740 0 196318 0 0 0 Tarah Hager MPAS PA-C PA 150262 0 0 0 0 0 8107 0 9390 0 167759 0 0 0 Mark Linville COO (Interim Co-CEO until 2/2015) 109360 0 0 0 0 0 7220 0 16809 0 133389 0 0 0 Form 990, Part VI, Section B, line 11b Randell Foxx, CFO will review the Form 990 for accuracy prior to filing with the IRS. A copy of the final Form 990 will be provided to the Board of Directors prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Compliance is enforced and monitored when trustees recuse themselves on conflict of interest issues. Form 990, Part VI, Section B, line 15a An outside firm is consulted. The CEO presents recommendations to the board. The board will hold an executive session and decide the CEO's compensation. Form 990, Part VI, Section C, line 19 Financial statements are published annually in the local newspaper. The governing documents and conflict of interest policy are available upon request. Form 990, Part IX, line 11g Surgery: Program service expenses 748,680. Management and general expenses 0. Fundraising expenses 0. Total expenses 748,680. Radiology: Program service expenses 593,820. Management and general expenses 0. Fundraising expenses 0. Total expenses 593,820. Pharmacy: Program service expenses 671,928. Management and general expenses 0. Fundraising expenses 0. Total expenses 671,928. Physicians: Program service expenses 2,718,877. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,718,877. Lab: Program service expenses 691,978. Management and general expenses 0. Fundraising expenses 0. Total expenses 691,978. Emergency room: Program service expenses 157,111. Management and general expenses 0. Fundraising expenses 0. Total expenses 157,111. Physical therapy: Program service expenses 1,402,549. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,402,549. Administrative: Program service expenses 846,585. Management and general expenses 336,292. Fundraising expenses 0. Total expenses 1,182,877. All other: Program service expenses 346,722. Management and general expenses 137,730. Fundraising expenses 0. Total expenses 484,452. Form 990, Part XII, Line 2c: The oversight process for the audit of the financial statements has not changed during the tax year.