2017-05-12T14:41:10-05:00 2016-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-07-01 556005561 Webster County Memorial Hospital WEBS 3048475682 324 Miller Mountain Drive Webster Springs WV 26288 James Westfall CEO 3048475682 2017-05-11 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z James Westfall 324 Miller Mountain Drive Webster Springs WV 26288 17153913 0 X www.wcmhwv.org X 1951 WV To provide acute short-term care to residents of Webster and surrounding counties of West Virginia. 9 9 222 0 0 0 51517 70858 17738025 16114972 12249 21815 83151 730645 17884942 16938290 0 0 0 0 10620265 11421031 0 0 0 7818552 7072538 18438817 18493569 -553875 -1555279 7327080 6280049 5022323 5530571 2304757 749478 The mission of Webster County Memorial Hospital is to provide excellent, high quality care in a compassionate and cost-effective manner. 0 0 14896535 16840056 Critical Access Hospital services provided included 330 inpatient days, 24,354 outpatient visits, and 13,340 RHC visits. Charges forgone for charity amounted to $42,199. 14896535 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 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 0 0 0 0 1 10 0 222 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 1 0 X Julie Clutter 3048475682 324 Miller Mountain Drive Webster Springs WV 26288 John Reed Chairman 1.00 X X 0 0 0 Mary Anne Carpenter Vice Chair 1.00 X X 0 0 0 Larry Lynch Secretary/Treasurer 1.00 X X 0 0 0 Betsy Morris Trustee 1.00 X 0 0 0 Louise Hamrick Trustee 1.00 X 0 0 0 Karen Dotson Trustee 1.00 X 0 0 0 Keith Hamrick Trustee 1.00 X 0 0 0 Tammy Garland Trustee 1.00 X 0 0 0 Jim Phares Trustee 1.00 X 0 0 0 Robert Mace CEO 5/16-1/17 40.00 X 303505 0 92 Annette Keenan CEO until 5/15/16 40.00 X 86932 0 900 Christopher Conrad Physician/Chief of Staff 40.00 X 373313 0 22134 Luke McElwain Physician 40.00 X 404347 0 19500 Seth Deatley Physician 36.00 X 358995 0 23200 Cathy McCoy Nurse Practitioner Specialist 40.00 X 243126 0 20315 Rondal Boyce Physician 36.00 X 230480 0 3440 Stephen Craft Physician 36.00 X 192607 0 0 2193305 0 89581 15 0 1 0 LabCorp 3701 MacCorkle Avenue SE Charleston WV 25304 Lab Services 716362 B&L Imaging PO Box 52253 Knoxville TN 37950 MRI Consultants 203357 Summersville Regional Medical Center 400 Fairview Heights Road Summersville WV 26651 Pharmacy Consultants 146377 3 66328 4530 2530 70858 Patient Service Revenue 624100 15043087 15043087 340B Pharmacy Revenue 900099 1071885 1071885 16114972 5038 5038 5561 0 5561 5561 5561 232400 215623 16777 16777 16777 EHR Revenue 900099 608176 608176 Consulting Fees 900099 33669 33669 Employee Meals 722210 25775 25775 57464 57464 725084 16938290 16840056 0 27376 406039 308265 97774 8885258 6745687 2139571 22193 16849 5344 1480419 1123934 356485 627122 476111 151011 8360 8360 143369 143369 1484042 1286983 197059 3743 3743 581873 441758 140115 182661 138676 43985 307111 233159 73952 60867 46210 14657 88456 67156 21300 394294 299348 94946 199284 151296 47988 Medical supplies 1603509 1603509 Bad debt expense 1460936 1460936 Provider tax 272206 272206 Repairs and Maintenance 89130 67667 21463 192697 156785 35912 18493569 14896535 3597034 0 285325 647880 11484 15417 2814158 2521702 385069 326947 149038 49800 7746503 5816869 2211650 1929634 215623 1254733 788669 7327080 6280049 4191115 3793741 831208 1736830 5022323 5530571 X 2296349 734879 8408 14599 2304757 749478 7327080 6280049 -1555279 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32757 32757 1783798 1706459 77339 5764313 4031107 1733206 165635 79303 86332 1929634 Third Party Payor Settlements 576079 Other Receivables 212590 788669 X 15432624 0 15432624 1505666 1505666 16938290 16987903 0 16987903 1505666 1505666 18493569 Part X, Line 2: The Hospital is classified under Section 501(c)(3) of the Internal Revenue Code as a nonprofit organization other than a private foundation, and is exempt from income taxes derived from its exempt activities. 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 June 30, 2013. Part XI, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 1,460,936. Charity care netted against income on financial statements 42,198. Revenue offsetting expense on financial statement 2,532. Part XII, Line 4b - Other Adjustments: Bad debts netted against income on financial statements 1,460,936. Charity care netted against income on financial statements 42,198. Revenue offsetting expense on financial statement 2,532. 1 1 1 X 175.000000000000 1 X 175.000000000000 1 1 0 0 25964 25964 2854788 2392581 462207 0.02710 2880752 2418545 462207 0.02710 13960 13960 0.00080 13960 13960 0.00080 2894712 2418545 476167 0.02790 1 898863 4056506 4056506 X 1 1 1 1 Webster County Memorial Hospital PO Box 312 Webster Springs WV 26288 X X X Rural Health Clinic and a Wellness Center Webster County Memorial Hospital 1 0 0 1 X X X X X X X 14 1 0 0 1 X https://irp-cdn.multiscreensite.com/c4a705fe/files/uploaded/Webster%20Co%20 X 1 14 1 https://irp-cdn.multiscreensite.com/c4a705fe/files/uploaded/WebsterCHNAImpl 0 0 1 X 175.000000000000 175.000000000000 X X X 0 1 X X X 1 X X X X X 1 X 0 X X X X 1 X 0 0 Webster County Memorial Hospital Part V, Section B, Line 5: The Community Needs Assessment questionnaire was taken to multiple public locations for community members to fill out and give their opinion of services needed and their satisfaction with services already provided by the hospital. Officials and employees were interviewed for the CHNA from the following: Webster County Health Department, Board of Education, Family Resource Network, United National Bank, Catholic Charities, and the food pantry. Webster County Memorial Hospital Part V, Section B, Line 11: Through a process of primary research, data analysis, validation and prioritization, the assessment process identified the following significant community health related needs: Increased education and promotion of community resources Promote healthier lifestyle choices Chronic disease maintenance and prevention Improve overall health statusAddressing all of the health needs present in a community will require resources beyond what any single hospital may provide. The Hospital will focus its efforts in order to make a true and measurable impact, and thus plans to implement actions that will address those needs identified through the Community Health Needs Assessment as "Most Important". The Hospital will continue to evaluate opportunities for funding or resources to commit to addressing the remaining needs. Part I, Line 3c: The patient's income is considered and reviewed to determine the amount of discount they receive, if not free care. The patient's assets are also reviewed. They can only have one vehicle and one house. If the patient has more than one vehicle, the total value of the vehicles cannot exceed $2,000. If the value exceeds $2,000, the patient will automatically be reduced to a percentage less than 100%. 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 $ 1,460,936. Part II, Community Building Activities: The Hospital distributes educational material regarding smoking cessation, healthy eating, saying no to drugs, cancer, diabetes & other diseases, how to live a healthier life along with physical activities. The Hospital also assists the community with kids needs for sports. Part III, Line 2: The cost to charge ratio as calculated from worksheet 2 of the Schedule H instructions was used to estimate bad debt expense. 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: The Medicare cost report was used to report Medicare revenue and expenses.CAH's receive cost reimbursement for Medicare services. A settlement process takes place after the Medicare cost report is filed in order to make payments (revenue) equal allowable cost. Thus, there is no "shortfall" of cost versus payments for CAH Medicare services. Part III, Line 9b: Patient's are informed about the finanical assistance program when they call to ask about their medical bills. The billers offer patient information about the program over the phone or if the patient is seen by the biller in person, they are shown the application and the documents that are needed. Part VI, Line 2: Director of Clinical Operations & Quality continuously reviews referral logs made by secretaries to see if there is any services we can provide here. Then we find out cost and reimbursement issues and present to CEO. Part VI, Line 3: If the patient presents to the registration desk and is private pay, the registration clerk informs the patient that we currently have a Financial Assistance program that will help them receive a discount or have the total amount written off and offers them the application. If a patient is private pay and admitted as an observation or inpatient, the social worker reviews the financial assistance program with the patient and offers them the application before discharge. If a patient calls into the billing office to ask about their billing statement and they state they don't think they can pay or want to make a payment contract, the billers will offer the patient information on the program and offer to mail them an application. Part VI, Line 4: Our geographical service area is rural. The majority (91.2%) of the Hospital's patients reside in Webster County, West Virginia. A portion of the remaining patients reside in Nicholas County (3.1%) and Randolph County (1.5%). The population of Webster County is 8,930. The residents of Webster County have a median household income of $27,645 and 25.2% of the residents live in poverty. There is one hospital serving the community and the next nearest facility is 40 miles away. Part VI, Line 5: Governing body is comprised of members of all areas of the community and are not employees of the organization. The Hospital extends privileges to all qualified staff working for the facility. The Hospital uses surplus funds to provide new services for patients. The emergency room is available to all patients whether they have the ability to pay or not. The Hospital offers MRI, Cardiac and Pulmonary Rehab and Nuclear medicine, which are not available at any other location in the County. The Hospital offers charitable care, which decreased this year due to the swing from private pay to Medicaid eligibility. The Hospital also serves as a source of community volunteer activities. X 0 0 0 0 0 0 0 0 0 Robert Mace CEO 5/16-1/17 303505 0 0 0 0 0 0 0 1217 0 304722 0 0 0 Christopher Conrad Physician/Chief of Staff 373313 0 0 0 0 0 17859 0 4275 0 395447 0 0 0 Luke McElwain Physician 404347 0 0 0 0 0 18000 0 1500 0 423847 0 0 0 Seth Deatley Physician 358995 0 0 0 0 0 18000 0 5200 0 382195 0 0 0 Cathy McCoy Nurse Practitioner Specialist 243126 0 0 0 0 0 18000 0 3071 0 264197 0 0 0 Rondal Boyce Physician 230480 0 0 0 0 0 0 0 3440 0 233920 0 0 0 Stephen Craft Physician 192607 0 0 0 0 0 0 0 1143 0 193750 0 0 0 Form 990, Part VI, Section B, line 11 During a regularly scheduled board meeting, each board member receives a copy of the completed Form 990. The board will vote and approve the completed form before filing. Form 990, Part VI, Section B, line 12c Officers and Directors are required to complete an annual conflict of interest questionnaire. This questionnaire is then reviewed by the Board of Trustees, annually, for any interests that could give rise to conflicts. If a conflict should arise, the individual would have to disclose this conflict to the Board of Trustees. The board member would not be permitted to vote on the issue, if applicable. Form 990, Part VI, Section B, line 15 To determine compensation of the Organization's CEO, the organization compares Forms 990 of other organizations, reviews written employment contracts and performs compensation surveys of similar facilities. A review of compensation is conducted internally by the Board of Trustees. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are made available upon request.