2017-08-15T15:37:26-05:00 2016-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-10-01 550404900 Herbert J Thomas Memorial Hospital Association HERB 3047663528 4605 MacCorkle Avenue SW South Charleston WV 25309 Daniel Lauffer President & CEO 3047663528 2017-08-14 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z Thomas Memorial Hospital Daniel J Lauffer 4605 MacCorkle Avenue SW South Charleston WV 25309 240067901 0 X www.thomaswv.org X 1946 WV To provide health care services to residents of South Charleston, WV and surrounding communities. 7 6 1578 127 4898 536 132576 174718 176754263 183275388 2837813 907714 4293065 3632563 184017717 187990383 253367 287372 0 0 79242439 66455452 0 0 0 110536019 118158040 190031825 184900864 -6014108 3089519 200505634 198530395 174143280 178856176 26362354 19674219 To provide health care services to residents of South Charleston, WV and surrounding communities. 0 0 180594823 287372 185670295 Services provided by the hospital include 43,128 inpatient days and 202,888 outpatient visits which includes 29,485 in ER visits. The hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Charges forgone for charity amounted to $1,481,674. The hospital provided community education activities and sponsors free health screening and wellness programs. 180594823 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 158 0 1578 1 1 1 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Daniel Lauffer President & CEO 3043476663 4605 MacCorkle Ave SW South Charleston WV 25309 Larry Bissett Chairman 1.00 1.00 X X 0 0 0 Donna Panucci DDS Secretary 1.00 X X 0 0 0 Brian Ulery Vice President 20.00 20.00 X X 300519 0 32424 Muhib Tarakji MD Trustee/ Medical Staff President 1.00 X 0 0 0 Susan Lavenski Trustee 1.00 X 0 0 0 John Neville MD Trustee 1.00 X 0 0 0 Dennis Sutton Trustee 1.00 1.00 X 0 0 0 Daniel J Lauffer President/CEO (as of 8/1/15) 20.00 20.00 X 0 508957 28376 Stephen P Dexter President/CEO (termed 7/31/15) 40.00 X 1196230 0 26329 Charles O Covert Vice President/CFO (termed 8/24/17) 40.00 X 581818 0 14002 Renee Cross Vice President/CFO (termed 7/14/17) 20.00 20.00 X 0 287675 29341 Paul Stobie Neonatologist 40.00 X 316987 0 17604 Tarek Anderson Neonatologist 40.00 X 314991 0 20616 Aaron Alexander Legal 40.00 X 210408 0 20616 William Priddy Pharmacy Director 40.00 X 186889 0 20616 Mitch Vickers Director Pharmacy IT 40.00 X 184449 0 17604 Cindy Barnette VP/General Counsel (termed 12/31/14) 0.00 X 465934 0 1653 3758225 796632 229181 61 1 1 0 Sound Physicians of WV 1498 Pacific Avenue Tacoma WA 98402 Hospitalist & ED Physicians 1803347 Professional Anesthesia Services 110 Roane Street Charleston WV 25302 Anesthesia Services 1492200 Jackson Kelly 500 Lee Street Charleston WV 25301 Legal Services 574069 Barton and Associates PO Box 417844 Boston MA 022417844 Psychiatric Physicians 458864 Diamond Healthcare PO Box 85050 Richmond VA 23219 Psychiatric Services 373023 32 102860 71858 174718 Patient services 622110 179203312 179203312 340B Program Revenue 900099 4072076 4072076 183275388 696392 696392 1218080 0 1218080 1218080 1218080 51966811 322029 51740811 336707 226000 -14678 211322 -14678 226000 Cafeteria & vending 722212 1056231 1056231 EHR Incentive 900099 523976 523976 Purchase Discounts/Refunds 900099 451869 451869 382407 377509 4898 2414483 187990383 185670295 4898 2140472 X 287372 287372 338250 329489 8761 53111990 51736389 1375601 2423014 2360258 62756 7133290 6948538 184752 3448908 3359581 89327 394923 394923 374339 374339 26127 26127 20564397 20031780 532617 394545 384326 10219 13899651 13539650 360001 5243853 5108037 135816 44181 44181 4207778 4098797 108981 77480 75473 2007 6008803 5853175 155628 9044848 8810586 234262 3785099 3687065 98034 Medical supplies 34956775 34956775 Bad debts 8952945 8952945 Healthcare provider tax 4512987 4512987 Charity Care Expense 1481674 1481674 4187635 4079926 107709 184900864 180594823 4306041 0 852289 624635 2934457 4198486 17955521 19439511 4683813 5017987 1336134 1631353 305067786 193282721 115065909 111785065 53156481 51847347 1487482 1580319 3033548 2405692 200505634 198530395 16718935 22448936 74978 97687 99867142 99065304 57482225 57244249 174143280 178856176 X 26362354 19674219 26362354 19674219 200505634 198530395 X 3089519 2253259 -12030913 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 26127 0 0 0 26127 0 Part II-B, Line 1: Line 1f: A portion of dues paid by the hospital to the American Hospital Association and the West Virginia Hospital Association is attributable to lobbying. 11447532 11447532 152294893 74135984 78158909 126402834 114064975 12337859 14922527 5081762 9840765 111785065 Accrued pension benefits -2464995 Estimated malpractice liability 13882144 Estimated third party settlements 40287347 Capital lease obligations 879303 Accrued interest payable 4660679 Accrued payroll & payroll taxes -229 57244249 Part X, Line 2 The System, Thomas Memorial, the Foundation, Saint Francis and THS Physician Partners are recognized as exempt from Federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code and similar state statutes relating to not-for-profit organizations. Under applicable provisions of the Internal Revenue Code and state statutes, TMH Services, which is a for-profit entity and subject to Federal and state income taxes, elected to be treated as a C-corporation for income tax purposes. Accounting principles generally accepted in the United States of America require the management of the System to evaluate tax positions taken by the System. Management has evaluated the System's tax positions and concluded that the System 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 consolidated financial statements. The System is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The management of the System believes it is no longer subject to income tax examinations for years prior to the fiscal year ended September 30, 2013. 1 1 X 1 X 0 1 1 0 0 4959557 4959557 0.02820 30661844 28489347 2172497 0.01230 35621401 28489347 7132054 0.04050 287372 287372 0.00160 287372 287372 0.00160 35908773 28489347 7419426 0.04210 0 8952945 40194788 40559038 -364250 X 1 0 1 1 Thomas Memorial Hospital 4605 MacCorkle Avenue SW South Charleston WV 25309 X X X Herbert J Thomas Memorial Hospital 1 0 0 1 X X X X X X X X 13 1 1 1 1 X See Part V for complete URL X See Part V for complete URL X 1 13 1 See Part V for complete URL 0 0 1 X 200.000000000000 X X X 1 1 X X X X 1 X http://www.thomaswv.org/financial.html X http://www.thomaswv.org/financial.html X http://www.thomaswv.org/financial.html X X X X 1 X 0 X X X X X 1 X 0 0 Herbert J. Thomas Memorial Hospital Part V, Section B, Line 5: The Coalition conducted a randomized home telephone survey, conducted interviews with professional representatives of key sectors of the community, conducted focus groups with under-represented populations, and held a health issues forum. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 6a: St. Francis Hospital, Charleston Area Medical Center, Highland Hospital, Women & Children's Hospital Herbert J. Thomas Memorial Hospital Part V, Section B, Line 6b: Kanawha Coalition for Community Health Improvement Herbert J. Thomas Memorial Hospital Part V, Section B, Line 11: The needs identified in the CHNA are being addressed by multiple hospitals in addition to the "Kanawha Coalition for Community Health Improvement". The needs identified were large in scope. Thomas Memorial Hospital (TMH) is addressing the needs where TMH has the expertise & resources. Other health providers who collaborated on the CHNA are addressing needs based on their expertise & resources as well. Some needs will not be addressed simply due to cost constraints. The complete list of needs that cannot be met is not finalized to date. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 20e: If a private pay patient presents to the Hospital for a scheduled procedure, prior to the procedure the patient is screened for Medicaid or any other type of third-party payor. If the patient does not qualify for any of the previous mentioned procedures and the procedure is deemed medically necessary then the patient is given a financial assistance application. If a patient comes through the Emergency Room or is admitted to the Hospital, the patient is screened by a third party organization to determine if they qualify for Medicaid or any other payor. If they are found ineligible for the previous mentioned programs, they are handed a financial assistance application. With every statement the patient receives, the financial assistance application is on the back of the statement. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 22d: Once Thomas Health System determines that a patient is eligible for Financial Assistance, that patient shall not receive any future bills based on undiscounted gross charges. The amount charged for emergency or other medically necessary care to a Financial Assistance eligible individual will not be more than the amounts generally billed to Medicare fee-for-service and commercially insured patients (by either Thomas Memorial or Saint Francis Hospital). The amounts generally billed (AGB) are calculated using the look-back method based on actual past claims paid to Thomas Memorial Hospital (AGB 37.92%) or Saint Francis Hospital (AGB 36.79%), as applicable, in the prior fiscal year by Medicare fee-for-service together with all private health insurers. The amounts generally billed will be recalculated annually. If it is not known that a patient is eligible for Financial Assistance, usual charges will be billed and if it is later determined that the individual is eligible, any excess payments will be refunded. Schedule H, Part V, Section B, Line 7a The link to the complete copy of the Community Health Needs assessment is within the Implementation Strategy on the hospital's website:http://www.healthykanawha.org/2014Assessment/Final_2014_Assessment_Report.pdf Schedule H, Part V, Section B, Line 7b http://www.healthykanawha.org/2014Assessment/Final_2014_Assessment_Report.pdf Schedule H, Part V, Section B, Line 10a http://www.thomaswv.org/pdfs/Community%20Health%20Plan%20Thomas%20 Health%20System%202014%20and%202015.pdf Part I, Line 7: The cost of charity care and unreimbursed Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The amount of cash and in-kind contributions to community groups was obtained from the hospital's accounting records. 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 $ 8,952,945. Part III, Line 2: The bad debt expense was obtained from the hospital's accounting records. Part III, Line 4: Bad debt expense is described in the consolidated financial statements as follows: 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 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. Part III, Line 8: Medicare allowable reimbursements and cost were obtained from the hospital's Medicare cost report. Part III, Line 9b: The organization's collection policies do not apply to patients that are known to qualify for financial assistance. Additionally, the organization has a separate Financial Assistance policy; patients who qualify for assistance under the policy do not receive a bill. Part VI, Line 2: The hospital is a member of the Kanawha Coalition for Community Health Improvement. The Coalition conducts a survey every three years to assess health care needs of the community. Results of the survey are presented in a meeting of community leaders and other interested persons, and are conveyed to the general public by local media. Results of the most recent survey were released September 2014. Part VI, Line 3: The organization informs and educates patients about their eligibility for assistance by: (1) providing a copy of the policy, or a summary thereof, and financial assistance contact information to patients as a part of the intake process; (2) including the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and (3) discussing with the patient the availability of various government benefits, such as Medicaid or state programs, and assisting the patient with qualification for such programs, where available. Part VI, Line 4: The organization's geographic service area includes approximately 476,000 persons in a 12 county area of south-central West Virginia. Heart disease, cancer and pulmonary disease are the leading causes of death in the service area. Patients in the service area are typical of West Virginia as a whole. The population served is 48% male, 52% female. Approximately 20% of residents in the area have no healthcare insurance coverage and no family doctor or other healthcare provider. Except for the area within the Charleston, WV city limits, all of the counties in the organization's geographic service area are federally-designated Medically Underserved and Health Manpower Shortage Areas. Part VI, Line 5: All members of the hospital's Board of Directors reside in the local community. The hospital extends medical staff privileges to all qualified physicians in the community who meet specific credentialing criteria. The hospital's 24 hour emergency room is available to all persons, regardless of ability to pay. The hospital prepares its budget to ensure adequate funding for capital improvements that are made on an on-going basis. During the year, the hospital received $586,972 in contributions. These contributions enabled the hospital to fund its capital improvements and to provide financial assistance to individuals unable to pay for some or all or their care. Part VI, Line 6: The hospital, along with St. Francis Hospital, is part of Thomas Health System, Inc. The health system was formed to forge a partnership based on the strength of the two established hospitals. Bringing the two hospitals under the umbrella of the Thomas Health System allows them to provide innovative and cost-effective health care services to the Kanawha Valley and surrounding areas. Economies of scale have allowed for cost reductions in numerous areas, while providing advanced technology to a larger community, with access to the highest quality of physicians, nurses and support staff in our service area. The system provides a wide range of services that serves the entire community. 1 WV Health Right 1520 Washington St East Charleston WV 25311 311066881 501(c)(3) 30000 Support of indigent clinic Marshall University Foundation Inc 519 John Marshall Drive Huntington WV 25703 556011111 501(c)(3) 205000 To support the orthopedics department. Arthritis Foundation of West Virginia 1116 Smith Street Charleston WV 25301 581341679 501(c)(3) 5000 To support prevention, control and cure of arthritis. Part I, Line 2: The Organization does not consider monitoring the use of grant proceeds a necessity as the organizations receiving the grants all receive audited financial statements. X X X X 0 0 0 0 0 0 0 0 0 Brian Ulery Vice President 264469 0 36050 0 0 0 9408 0 23241 0 333168 0 0 0 Daniel J Lauffer President/CEO (as of 8/1/15) 0 391597 0 85536 0 31824 0 13250 0 16811 0 539018 0 0 Stephen P Dexter President/CEO (termed 7/31/15) 466382 0 122515 0 607333 0 3313 0 28458 0 1228001 0 0 0 Charles O Covert Vice President/CFO (termed 8/24/17) 180400 0 90564 0 310854 0 2266 0 15711 0 599795 0 0 0 Renee Cross Vice President/CFO (termed 7/14/17) 0 239461 0 34253 0 13961 0 9000 0 22623 0 319298 0 0 Paul Stobie Neonatologist 316987 0 0 0 0 0 0 0 20790 0 337777 0 0 0 Tarek Anderson Neonatologist 314991 0 0 0 0 0 0 0 25984 0 340975 0 0 0 Aaron Alexander Legal 210408 0 0 0 0 0 0 0 23896 0 234304 0 0 0 William Priddy Pharmacy Director 186889 0 0 0 0 0 0 0 25597 0 212486 0 0 0 Mitch Vickers Director Pharmacy IT 184449 0 0 0 0 0 0 0 22431 0 206880 0 0 0 Cindy Barnette VP/General Counsel (termed 12/31/14) 13101 0 39360 0 413473 0 186 0 2302 0 468422 0 0 0 A West Virginia Hospital Finance Authority 621256910 956622XRO 2008-06-30 94030170 Capital expenditures and equipment purchases 0 0 0 A 3987379 92695993 7223714 10534952 1489249 73448078 2010 1 0 1 1 A 0 1 1 1 0 0.03000 0.03000 0 0 0 A 0 0 1 0 0 0 1 Trinity Plus Funding 1 0 0 A 0 Form 990, Part VI, Section A, line 6 Thomas Health System, Inc., a nonprofit corporation organized under the laws of the State of West Virginia, is the sole member of the organization. Form 990, Part VI, Section A, line 7a The organization's board of directors is elected by its sole member, Thomas Health System, Inc. Form 990, Part VI, Section B, line 11 Thomas Health System, Inc. (the System) is the sole member of the organization. The System's finance committee is responsible for financial management of the organization. The 990 is reviewed by the organization's CFO and the chairman of the finance committee. The 990 is then discussed with the System's finance committee and a copy is provided to all board members before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with our written conflict of interest policy by asking annually that all Trustees, officers and employees (managers) who have decision making/purchasing authority disclose any potential conflicts of interest. Disclosure forms are signed annually then logged onto a spread sheet that identifies any potential conflicts. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee, comprised of members who are free of any conflicts of interest, adheres to a disciplined process for reviewing compensation for senior executives to ensure that the compensation is reasonable. The Committee has retained an independent consulting and advisory firm, Yaffe & Company, to provide appropriate market data as to comparability. The Committee reviews comparability data and other relevant evidence and approves the compensation of senior executives; provided, however, that in the case of the CEO, the Board, after review of the comparability data and other relevant evidence, including a recommendation from the Committee, has the final approval with regard to the CEO's compensation. Only those Board members who are free of conflicts of interest vote on the CEO's compensation. All compensation decisions, including the comparability data reviewed and any other relevant information considered, are contemporaneously documented in meeting minutes. Form 990, Part VI, Section C, line 19 The Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon request. These documents are maintained in the administrative offices of the hospital and are provided via copy upon request. The documents also can be reviewed on site at the hospital upon advance notice. Form 990, Part IX, line 11g Administrative Services: Program service expenses 6,860,913. Management and general expenses 182,422. Fundraising expenses 0. Total expenses 7,043,335. Medical Services: Program service expenses 7,673,001. Management and general expenses 204,015. Fundraising expenses 0. Total expenses 7,877,016. ER Services: Program service expenses 878,434. Management and general expenses 23,356. Fundraising expenses 0. Total expenses 901,790. Other Purchased Services: Program service expenses 3,102,565. Management and general expenses 82,493. Fundraising expenses 0. Total expenses 3,185,058. Nursing Services: Program service expenses 629,899. Management and general expenses 16,748. Fundraising expenses 0. Total expenses 646,647. Lab Services: Program service expenses 886,968. Management and general expenses 23,583. Fundraising expenses 0. Total expenses 910,551. Form 990, Part XI, line 9: Defined benefit pension plan adjustment -8,073,413. Equity transfer to related exempt organization -4,457,500. Dividend 500,000. Schedule K On June 30, 2008, the West Virginia Hospital Finance Authority issued $148,920,000 Hospital Improvement Revenue Bonds Series 2008 on behalf of Thomas Health System, Inc. Thomas Health System, Inc. is the sole member of Herbert J. Thomas Memorial Hospital Association (Thomas Memorial Hospital) and Charleston Hospital, Inc. dba St. Francis Hospital. Bond proceeds, and related liability, were allocated between the two hospitals. Total proceeds of the issue reported in Part II, line 3 are net of bond discount in the amount of $1,333,842. Thomas Health System Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 260440674 Corporate office WV 501(c)(3) Line 3 N/A 0 St Francis Hospital 333 Laidley St Charleston WV 25301 611272692 Hospital WV 501(c)(3) Line 3 Thomas Health System Inc 0 THS Physician Partners Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 454395947 Medical services WV 501(c)(3) Line 3 Thomas Health System Inc 0 TMH Services Inc 437 Division Street Ste 311 South Charleston WV 25309 550676607 Equipment sales, rental and related services, vending sales WV Thomas Memorial Hospital C 71293 7006337 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 TMH Services Inc P FMV - Cash TMH Services Inc Q FMV - Cash St Francis Hospital I FMV - Cash