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 556000526 Grafton City Hospital GRAF 3042657152 1 Hospital Plaza Grafton WV 26354 Pat Shaw CEO 3042657152 2017-05-12 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z Pat Shaw 1 Hospital Plaza Grafton WV 26354 19349896 0 X www.graftonhospital.com X 1972 WV To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities. 9 8 333 100 0 0 81236 20824 19216499 18538971 164197 130638 481123 659463 19943055 19349896 1375 1300 0 0 12810170 12414828 0 0 0 7752957 7267698 20564502 19683826 -621447 -333930 6300094 7052909 6574095 7660840 -274001 -607931 To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities. 0 0 14648831 19096290 The Hospital provided health care services including 5,658 emergency room visits; 1,239 acute hospital days; 23,819 long-term care days; 2,047 swing-bed days and 233 surgeries. The Hospital provided charity care without charge or at less than its established rates to patients who met certain criteria under its charity care policy. Charges foregone for charity care during the year amounted to $327,063. Additionally, the Hospital's Rural Health Clinic recorded 15,692 visits for the year. 112739 98619 The Hospital sponsored several community health improvement services/events that included a health fair, flu shot clinic, New You Youth Fitness, and a pneumonia vaccine clinic. 1300 1300 The Hospital provided several grants to community organizations that included $500 sponsorship of a five mile run, $100 for a Christmas toy drive, $100 donation to West Taylor Elementary School, $100 donattion to high school choir department, and $250 to the Grafton Rotary Club. 14762870 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 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 7 0 333 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Regina Pickens 3042657412 1 Hospital Plaza Grafton WV 26354 David Efaw President 1.00 X X 0 0 0 Ronald L Cole Vice-President 1.00 X X 0 0 0 Wanda Taylor Secretary 1.00 X X 0 0 0 Nancy Fowler Trustee 1.00 X X 0 0 0 David Bender Exc Credential Chair 40.00 X X 277237 0 23742 John L Bord Trustee 1.00 X 0 0 0 Kathy Green Trustee 1.00 X 0 0 0 Wayne McDevitt Trustee 1.00 X 0 0 0 John Whitescarver Trustee 1.00 X 0 0 0 Pat Shaw CEO 40.00 X 113118 0 10253 Regina Pickens CFO 40.00 X 73673 0 21763 Thomas Wilshire Physician 40.00 X 299023 0 23742 Joseph Duvert Physician 40.00 X 295856 0 23742 Christopher Villaraza Physician 40.00 X 181465 0 8545 Stephen Harris Physician 40.00 X 140394 0 10253 James Woodford Physician 28.50 X 130870 0 0 1511636 0 122040 15 0 1 0 Odyssey Rehabilitation 415 Benedum Drive Bridgeport WV 26330 Rehabilitation Services 282000 Labcorp 231 Maple Avenue Burlington NC 27215 Lab Services 183478 Insight PO Box 847689 Dallas TX 75284 MRI Services 106565 Arnett Carbis Toothman LLP PO Box 2629 Charleston WV 25329 Accounting Services 105000 4 11096 9728 20824 Net patient services 622110 18076130 18076130 340B program revenue 900099 462841 462841 18538971 130638 130638 3525 0 3525 3525 3525 Insurance Settlement 900099 257184 257184 EHR Incentive Payments 900099 138129 138129 Cafeteria 722212 68897 68897 191728 191728 655938 19349896 19194909 0 134163 1300 1300 523020 374692 148328 9853266 7058880 2794386 29470 21112 8358 1274483 913040 361443 734589 526260 208329 36398 36398 38500 38500 1113184 797485 315699 1127551 807778 319773 238389 170782 67607 140204 100442 39762 12937 9268 3669 92825 66500 26325 567356 406454 160902 454539 325632 128907 Bad Debt and Charity Ex 1010477 1010477 Medical supplies 1008258 1008258 Repairs & maintenance 798639 572145 226494 Medicaid provider tax 391885 391885 236556 200480 36076 19683826 14762870 4920956 0 132858 23924 204617 111622 1956907 2183369 205669 200947 86318 299456 18466823 14844284 3173758 3622539 480523 611052 59444 0 6300094 7052909 4286798 3202329 356231 237638 688016 2395251 332787 50000 910263 1775622 6574095 7660840 X -274001 -607931 -274001 -607931 6300094 7052909 -333930 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15893 15893 0 Part II-B, Line 1: Part II-B, Line(i), Other Lobbying Activities: Grafton City Hospital pays dues to the West Virginia Hospital Association. The West Virginia Hospital Association represents hospitals and health systems. For the year ended 06/30/16, the amount of dues related to lobbying activities was $15,893. 26597 26597 274995 7065287 6633654 706628 10125529 7385532 2739997 974415 825098 149317 3622539 CHART RRG - Investment 611052 C 611052 Capital leases 216915 Accrued pension 599193 Third-party payor settlements 959514 1775622 18339420 0 18339420 1010476 1010476 19349896 18673350 0 18673350 1010476 1010476 19683826 Part XI, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 683,414. Charity care expenses netted against revenue on financial statements 327,062. Part XII, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 683,414. Charity care expenses netted against revenue on financial statements 327,062. 1 1 X 1 X 1 X 1 1 0 0 620310 505928 114382 0.00600 3666986 3243538 423448 0.02230 4287296 3749466 537830 0.02830 112739 98619 14120 0.00070 1300 1300 0.00010 114039 98619 15420 0.00080 4401335 3848085 553250 0.02910 1 477305 4401429 4401429 X 1 1 1 1 Grafton City Hospital Inc 500 Market Street Grafton WV 25354 X X X X Grafton City Hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://www.graftonhospital.com/images/Grafton_CHNA_2.pdf X 1 15 1 http://www.graftonhospital.com/assets/chna-2016-implementation-plan.pdf 0 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X 1 X http://www.graftonhospital.com/assets/grafton-city-hospital-financial-assis X http://www.graftonhospital.com/assets/financial-assistance-application.pdf X http://www.graftonhospital.com/assets/financial-assistance-on-line-policy.p X X X X 1 X 0 X X X X 1 X 0 0 Grafton City Hospital Part V, Section B, Line 5: A cross-section of various community representatives were interviewed and include a representative from the Taylor County Emergency Medical Services (EMS), the mayor of Grafton, four administrative representatives from Taylor County, a provider and administrator from a local clinic, a local nursing home administrator, the Taylor County schools superintendent, the Grafton City manager and members of the Grafton City Hospital board. The selected individuals provided diversified backgrounds and a range of perspectives on the state of the community and healthcare. Grafton City Hospital Part V, Section B, Line 11: Hospital management has made significant progress on needs addressed in the CHNA relating to: 1) Recruitment of physicians / Types of Hospital services 2) Barriers for Accessing Healthcare (lack of insurance) and Public Health Education. Needs that have not been addressed, to date are: 1) Lack of Available transportation and 2) Collaboration with area colleges to possibly establish para medical education programs for the training of nursing personnel, radiology technicians, etc. The transportation item was identified as a low priority need. CHNA findings that affect more individuals in the community were selected to be addressed ahead of the transportation need issue. The collaboration with the local Colleges is a very large initiative that will take a great deal of planning and coordination with accrediting agencies and regulatory agencies. Therefore, it was decided to address other identified needs first as the college collaboration initiative will demand a large amount of resources. Grafton City Hospital Part V, Section B, Line 22d: All payors are charged the same rate per procedure. The hospital did not have in place an "Amounts generally billed" calculation for individuals that were FAP eligible. Individuals who were FAP eligible were discounted from 10% to 100% of the bill. 1 1 - Wallace B Murphy Nursing Home 1 Hospital Plaza Grafton WV 26354 Long-term care nursing home 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. 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 $ 683,414. Part III, Line 2: The cost of bad debt was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. Part III, Line 4: Patient Accounts Receivable: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectable 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 reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The Medicare allowable costs were obtained from the Hospital's Medicare cost report. Part VI, Line 2: To assess the health care needs of the population base of Grafton City Hospital, the facility is heavily involved with the areas community forums. Through this venue the hospital takes the inquiries that are voiced and applies an economic forecast to the program to verify its stability. The facility also uses the Bureau for Public Health, for risk factors that would have an impact on the lives of the population that Grafton City Hospital serves. Part VI, Line 3: The patient population is educated and informed of the financial assistance programs through the financial counselors and admission personnel. The hospital also has this information published in the public areas within the hospital and on the website. Part VI, Line 4: The facility is a rural 25-bed Critical Access Hospital located in Grafton, WV. The service area has been defined based on patient days, discharges and charges compiled by Zip code during the preparation of the latest Community Health Needs Assessment (Dec., 2013). The service area is concentrated in Grafton, WV and spans the counties of Taylor, Preston and Barbour. There are two other hospitals located within the service area. These are Preston Memorial Hospital and Broaddus Hospital. Both of these hospitals are rural 25-bed Critical Access Hospitals. The population coverage by the service area is approximately 65,000 based on the 2010 Census information. 2011 data from the U.S. Dept. of Agriculture show that 17.60% of Taylor county residents, 16.80% for Preston county residents and 22.80% of Barbour county residents are living in poverty. The median household income for Taylor, Preston and Barbour counties is $39,142, $43,434 and $33,158, respectively. The Median household income for the State of WV is $38,482 (based on 2011 data). The combined Medicare and Medicaid population is approximately 20% for both Preston and Barbour counties. The combined Medicare and Medicaid population in Taylor County is approximately 35%. All three counties in the hospital's primary service area are designated "shortage areas" by the U.S. Department of Health and Human Services. The counties are designated HPSA's (Health Professional Shortage Area) for primary care, dental and mental health services. All three counties are also designated as MUA's and/or MUP's (Medically Underserved Areas/Populations). Part VI, Line 5: The organization's health care facilities further its exempt purpose in the following ways: The organization's governing body is comprised of persons who reside in the organization's primary service area and are neither employees or contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified providers in its community for some or all of its departments. The organization operates an emergency room available to all, regardless of ability to pay. Specialized services offered by the organization that are not available elsewhere include pulmonology, critical care medicine, general surgery, internal medicine, and family medicine. The organization serves as a vehicle for attracting charitable support, as well as a source of community volunteer activities. X X X 0 0 0 0 0 0 0 0 0 David Bender Exc Credential Chair 277237 0 0 0 0 0 0 0 23796 0 301033 0 0 0 Thomas Wilshire Physician 299023 0 0 0 0 0 0 0 23796 0 322819 0 0 0 Joseph Duvert Physician 295856 0 0 0 0 0 0 0 23796 0 319652 0 0 0 Christopher Villaraza Physician 181465 0 0 0 0 0 0 0 8599 0 190064 0 0 0 Stephen Harris Physician 140394 0 0 0 0 0 0 0 10308 0 150702 0 0 0 Form 990, Part VI, Section B, line 11 The form 990 will be reviewed by the CEO and CFO before it is filed. A copy of the final form 990 will be provided to the board of directors prior to filing. Form 990, Part VI, Section B, line 12c Trustees are made aware of the conflict of interest policy. Should a Trustee feel there is a subject in which they have a conflict, they recuse themselves from the discussion and any possible action. Form 990, Part VI, Section B, line 15 A compensation committee determines the compensation of the CEO and other officers by comparing salaries with other hospitals located in the West Virginia Critical Access Hospital Network with board approval. Form 990, Part VI, Section C, line 18 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request.