2018-04-30T15:45:36-05:00 2017-09-30 550621482 GRAY GRIFFITH & MAYS AC 707 VIRGINIA STREETEASTSUITE 400 CHARLESTON WV 253012711 990 2016-10-01 273128197 HIGHLAND-CLARKSBURG HOSPITAL INC HIGH 3049693100 3 HOSPITAL PLAZA CLARKSBURG WV 26301 SHELLY GIAQUINTO CFO 3049693100 2018-04-30 1 J RYAN LINDSAY P01835061 3043459400 64.127.29.130 2018-04-30 14:02:14 ED P 6104933C3CB942CD8E19C5413446FBC14042BCEA 6104933C3CB942CD8E19C5413446FBC14042BCEA 2016 2021-01-29 14:40:06Z MICHAEL CASDORPH 3 HOSPITAL PLAZA CLARKSBURG WV 26301 25200938 0 X WWW.HIGHLANDCLARKSBURGHOSPITAL.COM X 2010 WV TO PROVIDE PSYCHIATRIC CARE TO ADULTS AND CHILDREN. 7 7 393 4 0 0 61348 66166 17966257 24938462 0 0 104173 162968 18131778 25167596 0 0 0 0 10212355 14369533 0 0 0 7802247 8901659 18014602 23271192 117176 1896404 47412688 48126495 38310113 37127516 9102575 10998979 TO PROVIDE PSYCHIATRIC CARE TO ADULTS AND CHILDREN. 0 0 14382051 25000896 HIGHLAND-CLARKSBURG HOSPITAL, INC. (HCHI) IS A NON-PROFIT ORGANIZATION FORMED 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. 14382051 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 13 0 1 393 1 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X SHELLY GIAQUINTO 3049693107 3 HOSPITAL PLAZA CLARKSBURG WV 26301 JAMES H DISSEN CHAIRMAN 1.00 X X 0 0 0 GREG GORDON SECRETARY 1.00 X 0 0 0 MARGARET BAILEY BOARD MEMBER 1.00 X 0 0 0 MARTIN HOWE BOARD MEMBER 1.00 X 0 0 0 PAUL HOWE BOARD MEMBER 1.00 X 0 0 0 JOE ELLIOT BOARD MEMBER 1.00 X 0 0 0 MIKE CASDORPH CEO 40.00 X 227100 0 2122 SHELLY GIAQUINTO CFO 40.00 X 144744 0 5848 DR CHRISTI COOPER-LEHKI CHIEF MEDICAL OFFICER 40.00 X 378711 0 2313 TONI B GOODYKOONTZ MD PHYSICIAN 40.00 X 370296 0 2313 GREGORY A ROCK PHARMACIST 40.00 X 148695 0 1484 DR SUSAN CHOBY FORMER PHYSICIAN 40.00 X 141789 0 3498 PAULA HERNDON RN FORMER CHIEF NURSE EXECUTIVE 40.00 X 138528 0 3465 1549863 0 21043 7 1 1 0 SECURITY AMERICA PO BOX 4525 CHARLESTON WV 25364 SECURITY SERVICES 825388 REINHART FOODSERVICE 6250 N RIVER ROAD ROSEMONT IL 60018 DIETARY 391188 AMERISOURCEBERGEN 227 WASHINGTON ST CONSHOHOCKEN PA 19428 PHARMACY 329358 NETSMART 4950 COLLEGE BOULEVARD OVERLAND PARK KS 66211 SOFTWARE 268745 ALPHA TECHNOLOGIES 4003 OUTLOOK DR HURRICANE WV 25526 IT 175703 9 29768 36398 66166 PATIENT SERVICES 622110 24938462 24938462 24938462 109856 0 109856 109856 109856 24020 29768 33342 -9322 -9322 COMMISSARY REVENUE 722210 33840 33840 LUNCH REVENUE 722210 22364 22364 REBATES & OTHER 900099 6230 6230 62434 25167596 25000896 0 100534 1549863 922452 627411 10997072 6545272 4451800 250 149 101 968942 576698 392244 853406 507933 345473 34378 34378 89349 89349 98521 98521 1313428 781730 531698 70347 41869 28478 328185 195330 132855 1542450 918040 624410 27625 16442 11183 1279287 761410 517877 1356130 807146 548984 232547 138408 94139 HEALTHCARE PROVIDER TAX 611727 611727 REPAIRS & MAINTENANCE 562527 334807 227720 MEDICAL SUPPLIES 478523 478523 FOOD PREP 455868 455868 420767 288247 132520 23271192 14382051 8889141 0 1160227 2277864 2500 2201542 2545455 53265 61599 211302 339095 47386061 4633579 43135827 42752482 648025 150000 47412688 48126495 2805014 3325302 2000 34712855 33802214 790244 0 38310113 37127516 X 9102575 10998979 9102575 10998979 47412688 48126495 1896404 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 300000 300000 45956776 4248734 41708042 25648 7109 18539 1103637 377736 725901 42752482 X 25107531 33342 33342 25074189 93407 93407 25167596 23211127 33342 33342 23177785 93407 93407 23271192 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 33,342. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NETTED WITH REVENUE ON FINANCIAL STATEMENTS 93,407. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 33,342. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NETTED WITH REVENUE ON FINANCIAL STATEMENTS 93,407. HUGGS & KISSES 49818 29768 20050 7474 1185 13294 1500 5813 UGLY SWEATER 5K 1785 0 1785 1922 3 2185 2185 2154 53788 29768 24020 7474 1185 13294 1500 9889 33342 -9322 1 1 X 1 X 1 X 1 1 0 0 620321 620321 0.02670 1915796 1915796 168089 127053 41036 0.00180 2704206 2042849 661357 0.02850 2704206 2042849 661357 0.02850 60 2760096 2760096 0.11860 69069 3515 3515 0.00020 282 13256 13256 0.00060 465 337 337 0.00000 69876 2777204 2777204 0.11940 1 93407 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 X 1 16 1 HTTPS://HIGHLANDCLARKSBURGHOSPITAL.COM 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 $93,407. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT - PROVIDED JOB GROWTH FOR THE COMMUNITY COMMUNITY SUPPORT - HOSTED MOVIE IN THE PARK FOR CHILDREN OF HARRISON COUNTY; CHRISTMAS PARADE SPONSOR AND PARTICIPANT; YOUTH SOCCER SPONSORENVIRONMENTAL IMPROVEMENTS - RETROFITTED ALL EXTERNAL LIGHTING TO LED TECHNOLOGYCOALITION BUILDING - PROJECT ISAAC & ENERGY EXPRESS TEAM; SUMMER READING PROGRAMS FOR LOW-INCOME STUDENTS OF HARRISON COUNTY & SURROUNDING AREASCOMMUNITY HEALTH IMPROVEMENT ADVOCACY - BLOOD DRIVES; ENGAGE IN COMMUNITY FORUMS OVER DRUG EPIDEMIC IN HARRISON COUNTYL; MEMBER OF PITAR GROUP 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 MIKE CASDORPH CEO 227100 0 0 0 0 0 0 0 2122 0 229222 0 0 0 SHELLY GIAQUINTO CFO 144744 0 0 0 0 0 5848 0 0 0 150592 0 0 0 DR CHRISTI COOPER-LEHKI CHIEF MEDICAL OFFICER 378711 0 0 0 0 0 2313 0 0 0 381024 0 0 0 TONI B GOODYKOONTZ MD PHYSICIAN 370296 0 0 0 0 0 2313 0 0 0 372609 0 0 0 GREGORY A ROCK PHARMACIST 148695 0 0 0 0 0 1484 0 0 0 150179 0 0 0 DR SUSAN CHOBY FORMER PHYSICIAN 141789 0 0 0 0 0 0 0 3498 0 145287 0 0 0 PAULA HERNDON RN FORMER CHIEF NURSE EXECUTIVE 138528 0 0 0 0 0 3465 0 0 0 141993 0 0 0 RC GENERAL CONTRACTORS GENERAL CONTRACTING COMPANY OWNED BY A FAMILY MEMBER OF THE CEO 163268 GENERAL CONTRACTOR WAS HIRED FOR VARIOUS CONSTRUCTION PROJECTS FOR THE HOSPITAL 0 FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS RECEIVED FROM THE ACCOUNTING FIRM AND REVIEWED BY THE CEO AND CFO TO MAKE SURE NOTHING IS OMITTED. THE CFO THEN SIGNS THE RETURN AND APPROVES IT FOR ELECTRONIC 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: HIGHLAND CLARKSBURG HOSPITAL HAS A SEPARATE FINANCE COMMITTEE, WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS. THERE HAS BEEN NO CHANGE TO THIS PROCESS