2017-08-15T13:06:32-05:00 2016-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-10-01 550484469 Hospital Development Co HOSP 3049274444 200 Hospital Drive Spencer WV 25276 Douglas Bentz CEO 3049274444 2017-08-11 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z Roane General Hospital Douglas Bentz 200 Hospital Drive Spencer WV 25276 33417079 0 X www.roanegeneralhospital.com X 1966 WV To promote the general health and welfare of Roane County and surrounding areas and all of the citizens thereof by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public, including but not limited to the operation of hospitals, nursing schools, nursing homes and medical research facilities; to foster and conduct education in medicine in all its branches and in those adjacent and kindred arts and sciences such as nursing and technical training which contribute to the diagnosis, treatment, care and prevention of disease. 16 14 338 30 0 0 14439 8837 26191752 32311993 284212 274337 1111736 787930 27602139 33383097 0 0 0 0 16444056 17033701 0 0 0 11945784 15548890 28389840 32582591 -787701 800506 17997633 20056858 10644410 11799200 7353223 8257658 X Roane General Hospital is dedicated to the delivery of high-quality, cost effective health care to all members of our community. The work we do makes a difference in people's lives. 0 0 27277517 33089163 Roane General Hospital generated gross revenue of $60,566,588 of which $29,883,592 was uncollectible due to contractual agreements with Medicare, Medicaid and other third-party payors. Bad debts due to inability or unwillingness of patients to pay amounted to $1,185,154. Additionally, charges for patients meeting 200% of the poverty level and who qualified for charity care were written off totaling $426,422. As a Critical Access hospital we provided health care services to our community which included the following days of care: Skilled/Intermediate Care Facility 12,268; Swing 1,997; Respite 31; and Acute Care 1,101.Additionally, we provided 31,553 outpatient diagnostic visits; 7,540 emergency room visits and 32,433 rural health clinic provider visits. Revenue and expenses related to these services are included above in box 4a. 184311 9450 The Hospital provided community health education and health screening services at reduced fees during the year including health fairs; diabetes education seminars and screenings; and sports physicals. The Hospital served a total of 6,140 community participants through its community health education and health screening programs. Other programs provided include Cardiac Rehab, Laboratory Services, Emergency Room, Pharmacy, Radiology, CT Scan, Ultrasound, MRI, Nuclear Medicine, Physical Therapy, Operating Room and RHC's. Revenue and expenses related to these services are included above in box 4a. 27461828 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 142 0 338 1 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Kyle Pierson CFO 3049276201 200 Hospital Drive Spencer WV 25276 Jack D Garrett II Board President 0.50 X X 0 0 0 William G Downey Jr Board Vice President 0.50 X X 0 0 0 Gregory A Boggs Board Vice President 0.50 X X 0 0 0 John A Varda Board Treasurer 0.50 X X 0 0 0 Jennifer McCulty Board Secretary 0.50 X X 0 0 0 Bob Ashley Board Member 0.50 X 0 0 0 G Jeanette Atkinson Board Member 0.50 X 0 0 0 Richard E Bowlby Board Member 0.50 X 0 0 0 Martha Cooper Board Member 0.50 X 0 0 0 Christine M Hedges Board Member 0.50 X 0 0 0 Paul Hughes Board Member 0.50 X 0 0 0 John H Taylor Board Member 0.50 X 0 0 0 Gerald M Titus Jr Board Member 0.50 X 0 0 0 Robert E Zdanek Board Member 0.50 X 0 0 0 Hong-Kin Ng MD Board Member/Med Staff Director 40.00 X 363401 0 38300 Douglas Bentz Board Member/CEO 40.00 X X 291866 0 28700 Louise Ward CFO termed 2/15/16 40.00 X 128541 0 23442 Kyle Pierson CFO as of 6/20/17 40.00 X 0 0 0 Daniel B Prudich MD ER Physician 40.00 X 311626 0 38300 Christopher Lambert MD ER Physician 40.00 X 282370 0 38300 Grant Parkins DO Physician 40.00 X 261629 0 37514 Brent Watson MD ER Physician 40.00 X 312641 0 38300 Emery McCoy MD Hospitalist/Physician 40.00 X 314435 0 20925 2266509 0 263781 22 0 1 0 Odyssey Rehabilitation 415 Benedum Drive Bridgeport WV 26330 Rehabilitation Services 367497 US Mobile Imaging LLC PO Box 808 Cumberland MD 215010808 Mobile BRI 255540 Medical Information Technology Inc PO Box 74569 Chicago IL 60696 Meditech 254949 MonPower PO Box 3615 Akron OH 443093615 Electricity 201146 Newtech Systems Inc 1850 Dalton Avenue Ashland KY 41102 IT Services 194095 14 1500 7337 8837 Patient services 622110 30682996 30682996 Pharmacy-340B Program 900099 1493164 1493164 Wellness center 713940 135833 135833 32311993 263447 263447 1310 0 1310 1310 1310 44872 33982 10890 10890 10890 EHR Incentives 900099 478938 478938 Cafeteria 722210 198182 198182 Rebates 900099 41135 41135 68365 68365 786620 33383097 33098613 0 275647 803637 651830 151807 12933598 10490441 2443157 315932 256252 59680 2081016 1687912 393104 899518 729599 169919 48946 48946 123124 123124 2354508 2009988 344520 108408 87930 20478 2143932 1738943 404989 590267 478766 111501 356761 289369 67392 63068 51154 11914 89343 89343 1557564 1263340 294224 650112 527306 122806 Medical supplies 3110036 3110036 Bad debt & charity care 2271576 2271576 Health care provider ta 679894 679894 Maintenance and repairs 600767 487282 113485 800584 650210 150374 32582591 27461828 5120763 0 86820 176812 3067010 2386378 3462590 4316962 340180 438911 172167 185572 25005966 16607983 8120299 8397983 1692188 2201795 564422 684973 491957 1267472 17997633 20056858 3814347 5020641 955474 591286 2275607 2432202 302193 180056 3296789 3575015 10644410 11799200 X 7110194 8014196 243029 243462 7353223 8257658 17997633 20056858 X 800506 83986 19943 X 0 1 X 1 0 X 243029 433 243462 242317 712 243029 241772 545 242317 241141 631 241772 240468 673 241141 1.00000 0 0 125809 125809 4841889 2947550 1894339 19677311 13607902 6069409 360957 52531 308426 8397983 Interest in net assets of Roane General Foundation 511900 Other Receivables 755572 1267472 Capital leases 91153 Patient funds 8222 Third party payor settlements 3475640 3575015 X 31215017 83986 19943 103929 31111088 2272009 2272009 33383097 30311015 0 30311015 2271576 2271576 32582591 Part V, Line 4: The income is restricted for the purchase of hospital equipment and for hospital operations. Part X, Line 2: The Hospital is exempt from Federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code. Accounting principles generally accepted in the United States of America require the management of the Hospital to evaluate tax positions taken by the Hospital. Management has evaluated the Hospital's tax positions and concluded that the Hospital had maintained its tax exempt status and had taken no uncertain tax positions that require recognition or disclosure in the financial statements. Therefore, no provision or liability for income taxes has been included in the financial statements. The Hospital is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The management of the Hospital believes it is no longer subject to income tax examinations for years prior to the fiscal year ended September 30, 2013. Part XI, Line 2d - Other Adjustments: Changes in interest in Roane General Foundation 19,943. Part XI, Line 4b - Other Adjustments: Bad debt expense netted with revenue on financial statements 1,845,154. Charity care expense netted with revenue on financial statements 426,422. Immaterial adjustment booked through beginning net assets 433. Part XII, Line 4b - Other Adjustments: Bad debt expense netted with revenue on financial statements 1,845,154. Charity care expense netted with revenue on financial statements 426,422. 1 1 X 1 X 1 X 1 1 0 0 216348 216348 3249345 2711179 538166 0.01750 3465693 2927527 538166 0.01750 204 6140 184311 9450 174861 0.00570 204 6140 184311 9450 174861 0.00570 204 6140 3650004 2936977 713027 0.02320 1 1845154 5858896 5858896 X 1 1 1 1 Roane General Hospital 200 Hospital Drive Spencer WV 25276 X X X Distinct Part Skilled/Intermediate Care Facility Unit Roane General Hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://media.wix.com/ugd/d196df_cb489da5948c42aea5d295a8c0095d8f.pdf X 1 15 0 0 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X https://docs.wixstatic.com/ugd/d196df_697825c8c9124b99a44ec5e86a352a4c.pdf X http://media.wix.com/ugd/d196df_e4aaf6b9f19f49bab5ed2e088c707c6c.pdf X https://docs.wixstatic.com/ugd/d196df_d53dd71125c241298b1711b1702cf276.pdf X X X X 1 X 0 X X X 1 X X 0 0 Roane General Hospital Part V, Section B, Line 5: Key Informant SurveyParticipantsIndividuals selected to participate in the key informant survey were health and human services providers, business leaders, and individuals with unique knowledge of the community and/or public health.Survey MethodologyKey informants were identified and were requested to participate in the health care needs assessment process by completing the key informant survey. Invitations to take the survey were communicated to 56 community and business leaders and health care professionals. The surveys were distributed in July 2016.Results of the Key Informant SurveyThe overall response rate was 48% for the key informant survey. Key informants were asked to respond to the questions regarding health care and health service delivery issues in the community. Respondents were also asked to identify their perception of Roane General Hospital and how the community is addressing key health care services. In addition, key informants were asked about potential solutions to health care issues and their priority for solving the identified issues. Detailed key informant survey results are located in Appendix A of the CHNA. Roane General Hospital Part V, Section B, Line 11: Needs were reviewed in the strategic planning process for 2017 and included in goals. Implementation will depend on coordinating specialty clinics to meet the needs and finding partners willing to provide services at Roane General Hospital. Some services identified will be reviewed for financial feasibility and available space to provide services. Roane General Hospital Part V, Section B, Line 22d: Use of the Medicare fee schedule as a baseline and review by outside consultants for appropriate rates. 5 1 - Long Term Care Facility 200 Hospital Drive Spencer WV 25276 Distinct Part Skilled/Intermediate Care Facility Unit 2 - Roane General Medical Clinic 200 Hospital Drive Spencer WV 25276 Rural Health Clinic 3 - Roane General Medical Associates 200 Hospital Drive Spencer WV 25276 Rural Health Clinic 4 - Southern Roane Medical Clinic 1 Liberty Lane Left Hand WV 25251 Rural Health Clinic 5 - Walton Medical Clinic 94 School Drive Walton WV 25286 Rural Health Clinic 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.The cost of community health improvement services was derived from three factors: 1. Average hourly rate per department x employee hours. 2. Actual supply expense 3. Total charges that would have been generated if services were not "free". 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 $ 1,845,154. 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 costs were obtained from the hospital's Medicare cost report. Part III, Line 9b: SCREENING: All patients identified as self-pay will be screened for Medicaid eligibility referral, provided financial counseling and processed for appropriate financial assistance. FINANCIAL ASSISTANCE: Roane General Hospital encourages patients to apply for financial assistance; patients will be screened according to eligibility rules as defined in governmental assistance program guidelines and/or Roane General Hospital's Financial Assistance Policy and Procedure. CHARITY CARE: Patients with income at or below 200% of Federal Poverty Guidelines are eligible to apply for Roane General Hospital's Charity Care program. Remaining self-pay accounts will be flagged and followed up for financial education regarding their obligation to finalize a mutually acceptable financial agreement to resolve their bill. Part VI, Line 2: Specific goals of the health care needs assessment was to identify:1. Health Care Issues of the Community: The health care needs assessment identified prevalent health care issues and gaps in the current health services delivery in this region.2. Vulnerable Populations: The health care needs assessment identified persons with barriers to receiving health care services. Rural citizens are a vulnerable population in general due to the lack of specialty services and the required travel to meet many health care needs, and this region provides no exception. Children, seniors, and uninsured/underinsured citizens face the greatest barriers due to the lack of specific services that are available for these populations. If these populations are also of low income, this further compounds the barriers and subsequent access to health care.3. Disparities in the Health Care Services Delivery System: Although many health care services are offered in the region, a number of factors influence access. For example, insurance status, income, and provider and community awareness all affect the ability to access care.4. Health Care Resources in the Community: An assessment of health care services was completed in order to gain an understanding of the availability of health care services in the country. The assessment of the health care services was compiled through general data collection.5. Next Steps (Strategic Planning): The community health needs assessment is a crucial step in future strategic planning. Setting priorities cannot be accomplished without gaining an understanding of the community's health care needs and concerns. Addressing the health care service issues identified during the assessment is the next step in the process. Part VI, Line 3: All self-pay patients are screened at pre-registration, registration or final bill and are referred to the Financial Counselor for charity eligibility or referred to our in-house Medicaid Case Worker to establish Medicaid coverage. Part VI, Line 4: The total population in Roane County is 14,749 within a total land area of 483.56 square miles; the population density of the area is 30.5 (per square mile). The population is 50.57% female, which is comparable with state and national data. The total population decreased by 3.37% from the 2000 to the 2010 US Census.Roane County shows little ethnic diversity with a population that is 98.01% white; this ethnic diversity rate is similar to the rate for West Virginia.The median age of individuals residing in Roane County is 43.6, which is higher than that of the state (41.6) and the US (37.4). In addition, approximately one-half of the population in Roane County is above the age of 45, with approximately one-third of the population between 45-64 years old. This is especially critical to note since the 45-64 years old group will be reaching retirement age within the next 20 years.Roane County's linguistic isolated population is very small at 0.03%. This percent comparable with the state percent (0.32%) but is significantly less than the national percentage (4.66%).The population with any disability is a relevant indicator because disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers; Roane County has a higher rate (22.51%) than the state (19.31%) and national (12.25%) rates. Roane County has a comparable rate of the population aged 18 and older who identify as a veteran with 9.96%. Part VI, Line 5: The members of the Board of Directors of Roane General Hospital are all local business leaders and other community representatives. Medical Staff privileges are extended to all qualified employed physicians, consulting physicians, independent practice physicians and medical staff of the local Federally Qualified Health Center. All surplus funds are reinvested in the new medical equipment, technology or upgrades and renovation of facilities built in 1970. Specifically in 2011, funds were invested to upgrade technology for Electronic Medical Records and to meet the standards for Meaningful Use. The hospital filed for Stage 1 Meaningful Use in September 2011 and was one of only two Critical Access Hospitals in West Virginia to meet these standards of providing and tracking quality patient care. The Emergency Room is operated 24/7 and is staffed by Board Certified Emergency Medicine physicians. The hospital also operates three Rural Health Clinics, provides Walk-In services and three School Based Clinics staffed by physicians employed by Roane General Hospital. Physicians including an orthopedist, urologist, podiatrist, and general practice/wound skin care use our clinics on specified days to screen and provide care not available in our community. Roane General Hospital's Auxiliary, operated independently from the hospital, has approx. 40 members who provide information and customer support services. They also conduct several fund raising events during the year and proceeds from their sales are donated to the hospital to offset the expense of new equipment or renovations. Roane General Hospital Foundation, Inc. was formed to allow charitable contributions to support the hospital and also as a vehicle for formal fundraising activities as required by the Hospital. This Foundation has a separate Board of Directors which oversees the operation and approves any donations to the Hospital. In 2016, Roane General Hospital hired new specialists to meet the needs of their community. An interventional pain psychiatrist was hired to combat the opioid epidemic, a full time cardiologist was hired to provide greater access to care for the community, and a part time orthopedic surgeon was hired to provide greater access to care for orthopedic needs. X X X 0 0 0 0 0 1 0 0 0 Hong-Kin Ng MD Board Member/Med Staff Director 333278 0 4600 0 25523 0 10400 0 28056 0 401857 0 0 0 Douglas Bentz Board Member/CEO 243038 0 44727 0 4101 0 10400 0 18456 0 320722 0 0 0 Louise Ward CFO termed 2/15/16 115897 0 12644 0 0 0 5142 0 18456 0 152139 0 0 0 Daniel B Prudich MD ER Physician 311626 0 0 0 0 0 10400 0 28056 0 350082 0 0 0 Christopher Lambert MD ER Physician 232370 0 0 0 50000 0 10400 0 28176 0 320946 0 0 0 Grant Parkins DO Physician 206906 0 12030 0 42693 0 9614 0 28056 0 299299 0 0 0 Brent Watson MD ER Physician 300237 0 0 0 12404 0 10400 0 28056 0 351097 0 0 0 Emery McCoy MD Hospitalist/Physician 229435 0 15000 0 70000 0 0 0 21042 0 335477 0 0 0 Part I, Line 6 The Organization offers an incentive compensation plan to certain members of its executive staff including the CEO, Chief of Staff, VP of Financial and Support Services, VP of Quality and Ancillary Services, VP of Nursing Services and VP of Information Services/Technology. The program is intended to provide motivation and direction for the management team to accomplish the goals and objectives set forth by the Board at the beginning of each calendar year. These goals are based upon the annual strategic plan as well as the financial performance of the hospital. Shortly after the calendar year, the management team will present its progress and accomplishments to the Board with a recommended bonus based upon the criteria set forth. The board has discretion to approve, amend, or deny any recommendations. To be eligible for the program, the executive member must serve in his/her position for at least four months and be employed at the end of the program calendar year. If the individual serves less than one year but more than four months, the incentive will be prorated. A Roane County Building Commission 464100302 2013-11-20 2950000 Renovation of building and equipment acquisition 0 0 0 A 597894 2950000 43259 109541 2797200 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 Form 990, Part VI, Section A, line 6 The corporation has one class of members which consist of (a) the original incorporators of the corporation; (b) each of the corporation's directors; (c) those individual residents of Roane County who are at least 25 years of age and have (i) contributed their time, talent or money to effectuate the purposes of the corporation, (ii) been invited by the Board of Directors of corporation of membership, (iii) received a notice of membership, and (iv) have been appointed as members by the Board of Directors in accordance with the bylaws of the corporation; and (d) who is at least 25 years of age of those companies (including sole proprietorships, partnerships, limited liability companies, and corporations) with their place of business located in Roane County that have (i) contributed their time, talent or money to effectuate the purposes of the corporation, (ii) been invited by the Board of Directors of corporation for a representative of the company identified by the Board of Directors to be a member, (iii) received a notice of membership, and (iv) had such representative approved as a member by the Board of Directors of the corporation in accordance with the bylaws of the corporation. However if such designated member ceases to be affiliated with such company, his membership in the corporation will be automatically revoked. Members of the corporation shall not be entitled to vote on any matter other than (a) election of directors at the annual meeting of the members of the corporation, (b) the removal of directors for cause, (c) the approval of any amendment to the articles of incorporation approved and recommended by the Board of Directors, (d) the amendment or repeal of the corporation's bylaws, and (e) the dissolution and liquidation of the corporation. There are 16 Board of Directors and 36 members that make up the class of members. Form 990, Part VI, Section A, line 7a See line 6 explanation above. Form 990, Part VI, Section B, line 11 The 990 is prepared by our accounting firm who works with the CEO and the VP of Finance to obtain data. Once complete, the 990 is submitted to the CEO for review and approval prior to filing. Form 990, Part VI, Section B, line 12c Board members are required to complete and sign a conflict of interest statement each year sent from either the hospital auditors or from the hospital compliance officer. We monitor compliance by making this part of the annual review of our compliance program. Form 990, Part VI, Section B, line 15 The CEO's salary/benefits are identified in his employment contract and an annual increase is recommended based on comparison data from public records showing other CEO salaries of similar sized hospitals in West Virginia and is approved by the Executive Committee of the Board. The key employee and physician salaries are contract driven and negotiated by the CEO based on market data. All other employees' salaries are based on an annual review ranging from 2-4% (avg. 3%) and reviewed annually against the WVHA salary survey with pay scale market upgrades as appropriate. Form 990, Part VI, Section C, line 19 An annual audited financial statement is published in the local newspaper as required by the Health Care Authority under Public Disclosure requirements. Audited financial statements are also submitted to any financing entities as required. Form 990, Part XI, line 9: Change in interest in net assets of Foundation 19,943. Roane General Hospital Foundation 200 Hospital Drive Spencer WV 25276 550745015 To support in furthering development of high quality health care. WV 501(c)(3) Line 11a, I N/A 0 Roane Medical Building Inc 200 Hospital Drive Spencer WV 25276 550521219 Health care and social assistance - offices of physicians WV Hospital Development Co dba Roane General Hospital C 25044 1.00000 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0