ST JOSEPHS HOSPITAL OF BUCKHANNON INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
ST JOSEPHS HOSPITAL OF BUCKHANNON INC (EIN 55-0356996)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-15
IRS object ID
201733199349310628
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-15T08:59:11-00:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN550356996EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1St Joseph's Hospital of Buckhannon IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTJOBusinessNameControlTxt
Phone3044732000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 Amalia DriveAddressLine1Txt
CityBuckhannonCityNm
State AbbreviationWVStateAbbreviationCd
ZIP26201ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonIvar GjolbergPersonNm
Person TitleAdministratorPersonTitleTxt
Signature2017-11-14SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address157.182.216.2IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-15IPDt
IP Tm13:32:41IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id301490902228FB36277D3D3837D95EF666DC4F65AtSubmissionCreationDeviceId
At Submission Filing Device Id234EA096CFDA6C5369FDA0DB45BC1B6247EDF7C0AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerIvar GjolbergPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 Amalia DriveAddressLine1Txt
CityBuckhannonCityNm
State AbbreviationWVStateAbbreviationCd
ZIP26201ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$45,182,022GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresshttp://www.stj.net/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1989FormationYr
Legal Domicile StateWVLegalDomicileStateCd
Activity Or MissionWe are inspired by the love of Christ to provide our community with quality health care in ways that respect the God-given dignity of each person and the sacredness of human life.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee473TotalEmployeeCnt
Total Volunteers28TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$25,844CYContributionsGrantsAmt
PY Program Service Revenue$11,604,702PYProgramServiceRevenueAmt
CY Program Service Revenue$44,588,363CYProgramServiceRevenueAmt
PY Investment Income$49,111PYInvestmentIncomeAmt
CY Investment Income-$210,919CYInvestmentIncomeAmt
PY Other Revenue$156,852PYOtherRevenueAmt
CY Other Revenue$778,734CYOtherRevenueAmt
PY Total Revenue$11,810,665PYTotalRevenueAmt
CY Total Revenue$45,182,022CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,396,992PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$24,914,211CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,926,866PYOtherExpensesAmt
CY Other Expenses$20,230,598CYOtherExpensesAmt
PY Total Expenses$11,323,858PYTotalExpensesAmt
CY Total Expenses$45,144,809CYTotalExpensesAmt
PY Revenues Less Expenses$486,807PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$37,213CYRevenuesLessExpensesAmt
Total Assets BOY$42,867,366TotalAssetsBOYAmt
Total Assets EOY$40,939,815TotalAssetsEOYAmt
Total Liabilities BOY$34,171,205TotalLiabilitiesBOYAmt
Total Liabilities EOY$32,133,732TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$8,696,161NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,806,083NetAssetsOrFundBalancesEOYAmt
MissionWe are inspired by the love of Christ to provide our community with quality health care in ways that respect the God-given dignity of each person and the sacredness of human life.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$36,832,191ExpenseAmt
Revenue$45,302,853RevenueAmt
DescThe hospital provides impartial access to treatment or accommodation for care that is available or medically indicated regardless of race, creed, sex, national orgin or source of payment. In order to enable our patients to lead healthy, productive lives, the hospital strives to supply a comprehensive range of acute inpatient, long-term and outpatient care, outreach clinics, home care and emergency room services including prevention, guidance, diagnosis, treatment, restoration, rehabilitation, and other efforts as may be required, to meet the health care needs of the community as the hospital resources will permit. Although payment for services rendered is essential to the operation and stability of the hospital, it is recognized that not all individuals possess the financial means to purchase essential medical services. Our mission is to serve the community with respect to providing health care services and health care education. In keeping with this commitment, the hospital will serve all members of its community regardless of means or source of payment.Desc
Total Program Service Expenses$36,832,191TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingYes (true)LoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document24IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee473EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Quid Pro Quo Contri DisclfalseQuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonRenee HoferPersonNm
Phone3044732185PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 Amalia DriveAddressLine1Txt
CityBuckhannonCityNm
State AbbreviationWVStateAbbreviationCd
ZIP26201ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Terry Cronin
Chairperson001.00Yes (X)Yes (X)$0$0$0
Robert Blake MD
Director001.00Yes (X)$0$0$0
Sr Gail Borgmeyer
Director001.00Yes (X)$0$0$0
Bartley Brown DO
Director040.00Yes (X)$204,852$0$24,582
Doug Coffman
Director001.00Yes (X)$0$634,325$4,865039.00
Steve Foster
Treasurer001.00Yes (X)Yes (X)$0$0$0
Skip Gjolberg
Administrator001.00Yes (X)$0$0$0
Sister Francesca Lowis
Vice Chairperson / Secretary040.00Yes (X)Yes (X)$25,750$0$3,090
Michael C Tillman
Director001.00Yes (X)$0$625,807$39,720039.00
Katherine Wagner
Director001.00Yes (X)$0$0$0
Dennis Xander
Director001.00Yes (X)$0$0$0
Renee Hofer
Chief Financial Officer040.00Yes (X)$130,424$0$12,411
Eric Rice
VP - Ancillary Services040.00Yes (X)$96,641$0$11,597
Susan Long
Physician040.00$668,203$0$80,184Yes (X)
Salvatore Lanasa
Physician040.00$541,692$0$65,003Yes (X)
Tawfik A Zein
Physician040.00$468,773$0$56,253Yes (X)
Yaser Kalash
Physician040.00$437,458$0$52,495Yes (X)
Amy Pearson
Physician040.00$346,022$0$41,523Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,919,815TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,260,132TotReportableCompRltdOrgAmt
Total Other Compensation$391,723TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K24IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Related Organizations$25,844RelatedOrganizationsAmt
Total Contributions$25,844TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPatient Service RevenueDesc
Total Revenue Column$44,588,363TotalRevenueColumnAmt
Related Or Exempt Func Income$44,588,363RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$44,588,363TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$257,064TotalRevenueColumnAmt
Exclusion$257,064ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$64,244RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$64,244RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$64,244TotalRevenueColumnAmt
Exclusion$64,244ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other-$467,983OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$467,983OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$467,983TotalRevenueColumnAmt
Exclusion-$467,983ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Pharmacy Income446110$301,615$301,615
Cafeteria Income722210$211,676$211,676
Clinicial Lab900099$98,821$98,821

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$102,378TotalRevenueColumnAmt
Related Or Exempt Func Income$102,378RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$714,490OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$45,182,022TotalRevenueColumnAmt
Related Or Exempt Func Income$45,302,853RelatedOrExemptFuncIncomeAmt
Exclusion-$146,675ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$251,072TotalAmt
Management And General$251,072ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$18,894,489TotalAmt
Program Services$15,106,029ProgramServicesAmt
Management And General$3,788,460ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$879,233TotalAmt
Program Services$702,941ProgramServicesAmt
Management And General$176,292ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,583,656TotalAmt
Program Services$2,884,305ProgramServicesAmt
Management And General$699,351ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,305,761TotalAmt
Program Services$1,043,948ProgramServicesAmt
Management And General$261,813ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$32,171TotalAmt
Management And General$32,171ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$7,667TotalAmt
Management And General$7,667ManagementAndGeneralAmt
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,410,742TotalAmt
Program Services$3,484,486ProgramServicesAmt
Management And General$926,256ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$197,863TotalAmt
Program Services$156,312ProgramServicesAmt
Management And General$41,551ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,747,363TotalAmt
Program Services$1,380,417ProgramServicesAmt
Management And General$366,946ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$704,322TotalAmt
Program Services$556,414ProgramServicesAmt
Management And General$147,908ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$11,692TotalAmt
Program Services$9,237ProgramServicesAmt
Management And General$2,455ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$51,725TotalAmt
Program Services$40,863ProgramServicesAmt
Management And General$10,862ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$272,017TotalAmt
Program Services$214,893ProgramServicesAmt
Management And General$57,124ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$229,882TotalAmt
Management And General$229,882ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,141,736TotalAmt
Management And General$1,141,736ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$996,492TotalAmt
Program Services$996,492ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Provision of Bad Debt$2,560,172$2,560,172
Medical Supplies$6,185,007$6,185,007
Taxes, Licenses Fees$959,881$934,344$25,537
Recruiting$248,508$196,321$52,187

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$473,358TotalAmt
Program Services$380,010ProgramServicesAmt
Management And General$93,348ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$45,144,809TotalAmt
Program Services$36,832,191ProgramServicesAmt
Management And General$8,312,618ManagementAndGeneralAmt
Fundraising$0FundraisingAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$24,307BOYAmt
EOY$41,427EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,875,097BOYAmt
EOY$2,389,563EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$6,936,259BOYAmt
EOY$4,480,917EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$5,192BOYAmt
EOY$19,891EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,161,707BOYAmt
EOY$718,838EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$920,173BOYAmt
EOY$881,523EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$16,273,295LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,482,439LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,369,915BOYAmt
EOY$14,790,856EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,563,697BOYAmt
EOY$855,435EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$5,043,378BOYAmt
EOY$5,824,210EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$10,967,641BOYAmt
EOY$10,937,155EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$42,867,366BOYAmt
EOY$40,939,815EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,130,621BOYAmt
EOY$4,325,852EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,860,000BOYAmt
EOY$7,860,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$10,779,469BOYAmt
EOY$8,384,563EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,401,115BOYAmt
EOY$11,563,317EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$34,171,205BOYAmt
EOY$32,133,732EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,637,829BOYAmt
EOY$8,747,751EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$33,332BOYAmt
EOY$33,332EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$25,000BOYAmt
EOY$25,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,696,161BOYAmt
EOY$8,806,083EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$42,867,366BOYAmt
EOY$40,939,815EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$37,213ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$72,709OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd
Public Support CY1700.00000PublicSupportCY170Pct
Public Support CY5090.00000PublicSupportCY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$7,667OtherActivitiesAmt
Total Lobbying Expenditures$7,667TotalLobbyingExpendituresAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceII-B 1iFormAndLineReferenceDesc
ExplanationAs a member of the WV Hospital Association and the American Hospital Association, a portion of the dues paid have been identified by the above mentioned organizations as attributable to lobbying activities.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Incl Escrow Custodial Acct LiabfalseInclEscrowCustodialAcctLiabInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,340,839OtherCostOrOtherBasisAmt
Book Value$1,340,839BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,965,359OtherCostOrOtherBasisAmt
Depreciation$756,592DepreciationAmt
Book Value$10,208,767BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$125,082OtherCostOrOtherBasisAmt
Depreciation$19,637DepreciationAmt
Book Value$105,445BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,347,205OtherCostOrOtherBasisAmt
Depreciation$697,917DepreciationAmt
Book Value$2,649,288BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$494,810OtherCostOrOtherBasisAmt
Depreciation$8,293DepreciationAmt
Book Value$486,517BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$14,790,856TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (4 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
Financial derivatives and other financial products
Closely-held equity interests
Other Investments$5,824,210F
Current InvestmentsF
FieldValueIRS element (for citing)
Total Book Value Securities$5,824,210TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
Unamortized Borrowing Costs$385,011
Goodwill Other Intangibles$10,552,144
FieldValueIRS element (for citing)
Total Book Value Other Assets$10,937,155TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDescAmtAmt
Federal income taxes
Estimated Malpractice Costs - Current$331,569
Due to Third Party Payors$1,988,632
Other Current Liabilities$32,865
Pension Obligation$8,908,897
Miniumum Pension Liability$301,354
FieldValueIRS element (for citing)
Total Liability$11,563,317TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$42,621,851TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$2,560,171OtherRevenueAmt
Revenue Not Reported-$2,560,171RevenueNotReportedAmt
Revenue Subtotal$45,182,022RevenueSubtotalAmt
Total Revenue Per Form990$45,182,022TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$42,584,638TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$42,584,638ExpensesSubtotalAmt
Other Expenses Not Included$2,560,171OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$2,560,171ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$45,144,809TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
X 2The annual audit and financial statements of SJH are prepared on a consolidated basis as amember of the West Virginia United Health System WVUHS. WVUHS accounts for uncertainty in income taxes using a recognition threshold of more-likely-than not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold is met. There were no tax uncertainties for SJH that met the recognition threshold in 2016 or 2015.
XI 2dThis amount shown on line 2d consists of 2,560,172 provision for doubtful accounts reported as an offset to revenue on the financial statements but is reported as an expense on the Form 990 and 1 rounding.
XII 4bThe amount shown on line 4b consists of 2,560,172 provision for doubtful accounts reported as an offset to revenue on the financial statements but is reported as an expense on the Form 990 and 1 rounding.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CarefalseFPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$149,102TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$149,102NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,538,691TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,973,326DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,565,365NetCommunityBenefitExpnsAmt
Total Expense0.06020TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,687,793TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,973,326DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,714,467NetCommunityBenefitExpnsAmt
Total Expense0.06370TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,687,793TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,973,326DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,714,467NetCommunityBenefitExpnsAmt
Total Expense0.06370TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,118,013BadDebtExpenseAmt
Bad Debt Expense Attributable$11,791BadDebtExpenseAttributableAmt
Reimbursed By Medicare$11,410,628ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$14,753,168CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$3,342,540MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1St Joseph's Hospital of BuckhannonBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 Amalia DriveAddressLine1Txt
CityBuckhannonCityNm
State AbbreviationWVStateAbbreviationCd
ZIP26201ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.stj.netWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherSkilled Nursing Facility, OutpatientOtherDesc
Facility Reporting GroupaFacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1aBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp//wvumedicine.org/st-josephs-hospital/wp-content/uploads/sites/15/2016/12/SJHCHNA2016Final.pdfOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLhttp//wvumedicine.org/st-josephs-hospital/wp-content/uploads/sites/15/2016/12/SJHCHIP2016Final.pdfStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care0000000200.000000000000FPGFamilyIncmLmtFreeCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttp//www.stj.net/STJFinassistancepolicyApril2016.pdfFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttp//www.stj.net/charitycareapp2016.pdfFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttp//www.stj.net/finassistance.htmlFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Prospective Medicare MedicaidYes (X)ProspectiveMedicareMedicaidInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Group St. Josephs Hospital of Buckhannon Line Part V, Section B, Line 5Input for the completion of the initial Community Health Needs Assessment CHNA was obtained from public health officials, local health department and agencies, publically elected officials, religious officials, long-term care executives, and representatives of or members of chronic disease groups and organizations. In early 2016 St. Josephs Hospital SJH conducted a CHNA centered around community engagement and input. For the 2016 CHNA update SJH contracted with WVU School of Public Health to help with the process. The resulting report and implementation plan can be found on our website at www.stj.net.
Group St. Josephs Hospital of Buckhannon Line Part V, Section B, Line 11Based on the CHNA results, the leadership team chose two priority areas which they felt SJH could adequately target and address through an implementation plan. These areas were 1. Access to Wellness Opportunities 2. Obesity/Diabetes Additionally, it was a goal of the SJH Leadership Team to incorporate sensitivity to issues of limited transportation and poverty, especially children in poverty, into the overall CHNA. Complete details of the prioritization process and findings are available within the CHNA report at http//www.stj.net/CHNA2016.html.
Group St. Josephs Hospital of BuckhannonPatients with no insurance coverage are considered self-pay patients. Those patients are automatically given a 50 uninsured discount from gross charges, based on commercial insurance average.
Group St. Josephs Hospital of BuckhannonAs of 10/01/2015, St. Josephs Hospital STH transferred sponsorship from Pallottine Health Systems, Inc. to United Hospital Center, a founding member of West Virginia United Health System, Inc.. With this transfer, STH changed from a fiscal year-end to a calendar year-end. The previous CHNA was completed during the 2013 calendar year. With the sponsorship transfer and new year-end, STH completed its most recent CHNA in March 2016.

Supplemental Information Detail SupplementalInformationDetail (27 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I Line 3cUncompensated Care Procedure 1 Anyone applying for uncompensated care will be required to fill out an uncompensated care application. This can be done in the following manner a the credit/collection department can take the application when doing financial assessment, b the application can be taken any time during the billing cycle, or c the application can be mailed to the patient.
Part I Line 3c2 Anyone applying for uncompensated care will be required to provide the hospital with proof of income. The proof of income can be as listed a tax return from most recent year of filing, check stubs from the last three months or a check stub showing year-to-date earnings b a statement of earnings from the employer or source of income c medicaid denial letter or verification through WVDHHR screening website. The associate will insure that Medicaid eligibility is solicited. If appropriate documentation is not attached, application will be denied or d listing of all assets, ATVs, boats, campers, property, stocks, bonds, CDs, etc. The most current months bank statement is required.
Part I Line 3c3 The Business Office Manager or his/her designee will make all determinations a the monthly income is listed and multiplied by 12 b the chart is referenced to determine uncompensated eligibility c if eligible, this is noted and signed by the associate d if not eligible, expense information is analyzed. Non-discretionary expenses are considered necessities of life or job shelter, food, utilities, car loan, etc. e comparison of expenses to income determines disposable income for payment of a hospital debt f total expenses are then totaled, with the same expense to income comparison g accounts will be required to have asset information verified with the county assessors office. If cash convertible asset information is exactly twice the amount of the patient portion of the St. Josephs Hospital bill or more, applicant is not eligible for assistance. If substantial hard assets exist, they will be considered.
Part I Line 3c4 A patient will be notified if uncompensated care is denied or a percentage is granted.
Part I Line 3c5 Accounts approved for uncompensated care will be written off using the appropriate forms and codes.
Part I Line 3c6 Medicare accounts that are written off to uncompensated care must be listed on the medicare bad debt compliance checklist.
Part I Line 3c7 Determination for uncompensated care will be based on annual income guidelines see attachment.
Part I Line 3c8 St. Josephs Hospital will make medically necessary services available on an inpatient or outpatient basis to individuals who cannot afford to pay for such services.
Part I Line 3c9 Accounts that have been referred to a collection agency will not be eligible for consideration.
Part I Line 7Charity care at cost and unreimbursed medicaid are computed using the cost to charge ratio method on worksheet 2 of the Schedule H instructions.
Part I Line 7The bad debt expense included on Form 990, Part IX, Line 24a, but subtracted for purposes of calculating the percentage in this column is 2,560,172.
Part IICommunity Benefit Activities The recruitment of physicians to this community is vital for the health of the community.
Part III Line 2The cost of bad debt was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.
Part III Line 3Estimated bad debt attributable to patients eligible for charity care was calculated by running a report within our patient revenue software of all bad debt account balances greater than 15,000. The total of that report was 27,000 which we then multiplied by our cost to charge ratio of 43.67 for a total of 11,791.
Part III Line 3The estimated bad debt attributable to patients eligible for charity care of 11,791 should be considered community benefit due to the fact that anyone with outstanding balances of 50,000 or greater usually qualifies as catastrophic if the patient completes the application process.
Part III Line 3In our charity care policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year. Regardless, that bad debt should be considered community benefit as we provide services to those in need regardless of their ability to pay.
Part III Line 4Patient accounts receivable patient accounts receivable are carried at the net realizable value less an estimate 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 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 8The medicare allowable costs and revenues were derived from the medicare cost report.
Part III Line 9bPrior to an account going to collections, especially if it is a self-pay patient, the organization checks medicaid and charity eligibility. St. Josephs hospital requires all self-pay patients to talk to a financial counselor to determine qualification for charity care and medicaid programs. Self-pay patients are required to show proof that they have been denied by medicaid. After it is determined that self-pay patients do not qualify for assistance, and if they are still unable to pay their bills, they are set up on a payment plan suited to their income level. Only when a self-pay patient falls behind on his/her payments and it is certain he or she does not qualify for assistance are they sent to a collection agency.
Part VI Line 2St. Josephs Hospital has contracted with the West Virginia University School of Public Health to perform the community wide needs assessment survey and has translated this information into the Community Health Needs Assessment Report which outlines actions taken. In addition, an outside company performs post admission surveys for all inpatients. This survey includes questions regarding whether the patients needs were met during the stay, and the hospital reviews this HCAHPS data to determine what services may need to be added based on that data.
Part VI Line 3St. Josephs Hospital of Buckhannon will advise patients and their families of financial assistance through the following means direct patient contact, in person or over the phone notice of availability of financial assistance will be posted in each registration area and emergency department and other waiting areas notice of availability of financial assistance will be printed with each patient initial bill availability of financial assistance will be printed on applicable letters and statements notice of availability will be posted on the hospitals website published in additional languages if needed by more than 10 of the population outreach to community most likely to utilize the FAP to include outreach to public agencies and other non-for-profit agencies and availability of financial assistance will be posted annually in local paper.
Part VI Line 4St. Josephs Hospital is located in a small town in a rural, moutainous region of West Virginia. The hospital serves its home county with a population of approximately 24,658 residents, as well as parts of five surrounding counties. The population served is an aging population with nearly 30 of the population in the 45 to 65 year old age group and will be reaching retirement age over the next 20 years, resulting in a major impact on health care in the area. In St. Josephs Hospitals home county, 17.3 of the population is below the poverty level and 8.1 of the population is uninsured, with 4 of the children in the county having no insurance. The teen pregnancy rate is 31.23. The following hospitals provide a full range of acute care, ancillary and case mangement services and many also provide long-term care. The hospitals are located in the immediate service area or the contiguous service area Stonewall Jackson Memorial Hospital, United Hospital Center, Davis Memorial Hospital, Louis A. Johnson VA Medical Center, and Broaddus Hospital. In addition, William J. Sharpe Hospital in Weston, West Virginia provides comprehensive psychiatric services for patients that have been involuntarily committed to the facility.
Part VI Line 5St. Josephs hospital promotes the health of the community by maintaining an open medical staff, using community members on its board of directors, providing support of community health activities blood screenings, health fair, flu shot clinics, etc.. The hospital has also been actively recruiting both primary care providers and specialists to meet the healthcare needs of our service area.
Part VI Line 6St. Josephs Hospital of Buckhannon, Inc. is a not-for-profit health care facility wholly owned and sponsored by United Hospital Center, Inc. UHC. United Hospital Center is a subsidiary of the West Virginia United Health System which includes the following hospitals and their subsidiaries United Hospital Center, Camden Clark Memorial, and West Virginia University Hospital. St. Josephs Hospital is committe to the core values of compassion, hospitality, reverence, interdependence, stewardship, and trust.
Part VI Line 6St. Josephs is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery team. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its services area, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves.
Part VI Line 6System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include United Hospital Center in Bridgeport, WV, West Virginia University Hospital in Morgatnown, WV, City Hospital, Inc. in Martinsburg, WV, Jefferson Memorial Hospital in Ranson, WV, Camden-Clark Medical Center located in Parkersburg, WV, Potomac Valley Hospital located in Keyser, WV. Reynolds Memorial Hospital in Glen Dale, WV joined the system in October 2016.
Part VI Line 6The System also includes the phsyician practices of United Physicians Care, Inc. and Camden-Clark Physician Corp that operate in conjunction with the System hospitals along with United Summit Center, a behavioral health center located in Clarksburg, WV. In addition to these practices, the System also includes WVUH-East, Inc. and Camden-Clark Health Services which operate as management companies for their respective hospitals. The System also includes University Healthcare Foundation in Martinsburg, WV, United Health Foundation in Clarksburg, WV, Camden-Clark Foundation in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc. in Buckhannon, WV, and Reynolds Memorial Foundation, in Glen Dale, WV. In addition to these practices, the System includes WVUH-East, Inc. and Camden-Clark Health Services which operate as management companies for their respective hospitals.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmt
Susan Long
Physician$593,652$74,551$80,184$748,387
Salvatore Lanasa
Physician$530,639$11,053$65,003$606,695
Tawfik A Zein
Physician$468,773$56,253$525,026
Yaser Kalash
Physician$437,458$52,495$489,953
Amy Pearson
Physician$346,022$41,523$387,545
Bartley Brown DO
Director$204,852$24,582$229,434
Doug Coffman
Director$500,851$35,460$98,014$4,865$639,190$26,074
Michael C Tillman
Director$481,431$143,980$396$22,495$665,527$17,225

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I Line 3FormAndLineReferenceDesc
ExplanationThe CEOs compensation is paid by United Hospital Center, Inc. UHC. United Hospital Center uses the following methods to establish the compensation of the CEO compensation committee, independent compensation consultant, Form 990 of other non-profit organizations, compensation survey or study, and approval by the board of directors or compensation committee.ExplanationTxt

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonJoseph Reed MDPersonNm
Relationship With OrgFormer board memberRelationshipWithOrgTxt
Loan PurposePurchase of a buildingLoanPurposeTxt
Loan To OrganizationYes (X)LoanToOrganizationInd
Original Principal$220,500OriginalPrincipalAmt
Balance Due$27,468BalanceDueAmt
DefaultfalseDefaultInd
Board Or Committee ApprovalYes (true)BoardOrCommitteeApprovalInd
Written AgreementYes (true)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$27,468TotalBalanceDueAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II Line 1FormAndLineReferenceDesc
ExplanationName of Person Joseph Reed, M.D. Relationship with Organization Former board member Purpose of Loan Purchase of a buildingExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section B, Line 11The Form 990 is prepared by the West Virginia University Hospitals, Inc. tax accountant and then reviewed by the Director of Finance at St. Josephs Hospital of Buckhannon. After gaining approval from the Director of Finance, it is then presented to the board members for a final review. Upon board review, it is signed and submitted to the IRS.
Form 990, Part VI, Section B, Line 12cUpon employment and annually thereafter, each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can 1 determine whether any potential or actual conflicts of interest may exist, and 2 monitor work or service assignments to avoid placing the key employee, officer, or director in a position where there may be an appearance potential or actual of a conflict of interest or a question of objectivity. The completed conflict of interest and disclosure forms for directors are returned to the organization. These members are monitored and not assigned any projects that would create any potential conflict of interest. Any board member with a potential conflict recuses himself or herself from all discussions regarding the conflict.
Form 990, Part VI, Section B, Line 15The compensation of the CEO is determined by the West Virginia United Health System Compensation Committee based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This information is provided to the compensation committee which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compenstion package does not exceed fair market value based on the data from the consultant group. The minutes of the compensation committee are contemporaneously documented and retained. A full compensation survey was completed in 2015 for 2016 compensation amounts.
Form 990, Part VI, Section C, Line 19The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 1 Amalia Drive, Buckhannon, WV 26201. A nominal fee is charged if copies are requested.
Form 990, Part XI, Line 9Other changes in net assets / fund balance consist of related organization capitalization of 72,709.
Form 990, Part X, Line 27Beginning balance sheet numbers differ from prior year, short year return due to the previous return being a short year as well as St. Josephs of Buckhannon becoming a part of a consolidated audit for calendar year 2016.
Form 990, Part VI, Section A, Line 6The organization is a membership not a stock corporation under West Virginia State law. The Organizations sole corporate member is United Hospital Center, Inc., a related not-for-profit organization.
Form 990, Part VI, Section A, Line 7aIn accordance with the terms and requirements of its governing documents i.e. bylaws, on an annual basis, the organizations current board members recommend the list of candidates for membership to the governing body for the subsequent term to the St. Josephs hospital board of directors. The United Hospital Center, Inc. board of directors will approve and elect these candidates to serve as the organizations board of directors.
Form 990, Part VI, Section A, Line 7bUnited Hospital Center, Inc., as the sole corporate member, also has the right to approve or ratify significant decisions of the organizations governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (20 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
West Virginia United Health System Inc
PO Box 8034MorgantownWV26506550754713Healthcare AccessWV501C312aN/Afalse
West Virginia University Hospitals
PO Box 8034MorgantownWV26506550643304Patient CareWV501C33falseWest Virginia United Health System Inc
West Virginia University Hospitals - East Inc
2000 Foundation WayMartinsburgWV25401202337985Patient AccessWV501C312afalseWest Virginia University Hospitals
Jefferson Memorial Hospital Inc
2000 Foundation WayMartinsburgWV25401550359755Patient CareWV501C33falseWest Virginia University Hospitals - East Inc
University Healthcare Foundation
2000 Foundation WayMartinsburgWV25401311118075Hospital SupportWV501C312aN/Afalse
United Health Foundation
327 Medical Park DriveBridgeportWV26330550621706Hospital SupportWV501C312afalseUnited Hospital Center Inc
United Hospital Center Inc
327 Medical Park DriveBridgeportWV26330550525724Patient CareWV501C33falseWest Virginia United Health System Inc
United Physicians Care Inc
686 South Pike StreetShinnstonWV26431550638563Patient CareWV501C33N/Afalse
United Summit Center Inc
6 Hospital PlazaClarksburgWV26301550752788Behavioral HealthWV501C33N/Afalse
West Virginia Health Care Co-Op
PO Box 8059MorgantownWV26506550650441SupportWV501C312afalseWest Virginia United Health System
Camden-Clark Memorial Hospital
800 Garfield AveParkersburgWV26102311524546Patient CareWV501C33falseCamden-Clark Health Services
Camden-Clark Health Services
800 Garfield AveParkersburgWV26102550769602Healthcare AccessWV501C312a, IfalseWest Virginia United Health System Inc
Camden-Clark Foundation
800 Garfield AveParkersburgWV26102550667789SupportWV501C312afalseCamden-Clark Health Services
Camden-Clark Physician Corp
604 Ann StreetParkersburgWV26101264058719Patient CareWV501C312a, IfalseCamden-Clark Health Services
University Healthcare Physicians
2500 Foundation WayMartinsburgWV25401900893455Patient CareWV501C312aN/Afalse
Potomac Valley Hospital of W Va Inc
100 Pin Oak LaneKeyserWV26726550420956Patient CareWV501C33falseWest Virginia University Hospitals
Reynolds Memorial Hospital
800 Wheeling AveGlen DaleWV26038550357045Patient CareWV501C33falseWest Virginia University Hospitals
Reynolds Memorial Foundation
800 Wheeling AveGlen DaleWV26038550710402SupportWV501C312aN/Afalse
St Joseph's Foundation of Buckhannon Inc
1 Amalia DriveBuckhannonWV26201550727650SupportWV501C312aN/Afalse
City Hospital Inc
2000 Foundation WayMartinsburgWV25401550383321Patient CareWV501C33falseWest Virginia University Hospitals - East Inc

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
Allied Health Services Inc
PO Box 782MorgantownWV26507550652017Medical LabWVN/AC Corpfalse
West Virginia United Insurance Services Inc
3040 University Avenue Suite 3200MorgantownWV26505550756055Provider NetworkWVN/AC Corpfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.