2016-05-13T13:43:56-05:00 2015-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2014-07-01 556000526 Grafton City Hospital GRAF 3042657152 1 Hospital Plaza Grafton WV 26354 Pat Shaw CEO 3042657152 2016-05-09 1 Tessa W Carr P01291277 3043460441 2014 2016-08-17 19:52:53Z Pat Shaw 1 Hospital Plaza Grafton WV 26354 19943055 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. 10 8 323 100 0 0 70944 81236 19761449 19216499 102730 164197 333514 481123 20268637 19943055 2500 1375 0 0 12581629 12810170 0 0 0 8315196 7752957 20899325 20564502 -630688 -621447 8160249 6300094 7812803 6574095 347446 -274001 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 15348490 19623933 The Hospital provided health care services including 5,627 emergency room visits; 1,240 acute hospital days; 22,297 long-term care days; 2,734 swing-bed days and 237 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 $326,286. Additionally, the Hospital's Rural Health Clinic recorded 17,079 visits for the year. 73511 70964 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. 1375 1375 The Hospital provided several grants to community organizations that included $1,000 sponsorship of a five mile run, $100 for a Christmas toy drive, $75 donation to West Taylor Elementary School and $200 was donated to high school basketball teams. 15423376 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 6 0 323 1 0 0 0 0 0 0 0 0 0 0 X 10 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 Ronald L Cole President 1.00 X X 0 0 0 David Efaw Vice-President 1.00 X X 0 0 0 Wanda Taylor Secretary 1.00 X X 0 0 0 John L Bord Trustee 1.00 X 0 0 0 John Whitescarver Trustee 1.00 X 0 0 0 Nancy Fowler Trustee 1.00 X 0 0 0 Wayne McDevitt Trustee 1.00 X 0 0 0 Samuel McDaniel Trustee 1.00 X 0 0 0 Mark Witkowski MD Trustee/Physician 40.00 X 143463 0 16037 Christopher Villaraza MD Trustee/Physician 40.00 X 190038 0 15827 Pat Shaw CEO 40.00 X 114983 0 12345 Regina Pickens CFO 01/2015 40.00 X 0 0 0 Susannah Higgins CFO 7/1/14-11/11/14 40.00 X 82245 0 16037 Joseph Duvert Physician 40.00 X 248720 0 27792 Stephen Harris Physician 40.00 X 138347 0 11890 David Bender Physician 40.00 X 279375 0 29400 Thomas Wilshire Physician 40.00 X 249933 0 17495 James Woodford Physician 40.00 X 130371 0 3864 1577475 0 150687 13 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 63918 17318 81236 Net patient services 622110 18844099 18844099 340B program revenue 900099 372400 372400 19216499 164197 164197 2725 0 2725 2725 2725 EHR Incentive Payments 900099 214502 214502 Debt Forgiveness 900099 74230 74230 Cafeteria 722212 71568 71568 118098 118098 478398 19943055 19694897 0 166922 1375 1375 581520 417822 163698 9565330 6872690 2692640 160355 115215 45140 1780070 1278980 501090 722895 519400 203495 75140 75140 59175 59175 1182183 849398 332785 1298984 933320 365664 352630 253365 99265 96332 69215 27117 16890 12135 4755 125056 89853 35203 569804 409404 160400 465667 334582 131085 Medical supplies 1092440 1092440 Bad Debt and Charity Ex 1067791 1067791 Repairs & maintenance 750662 539351 211311 Medicaid provider tax 395073 395073 205130 171967 33163 20564502 15423376 5141126 0 19362 132858 165081 204617 2147144 1956907 298856 205669 93062 86318 17450686 14276928 3534046 3173758 316327 480523 1586371 59444 8160249 6300094 5085269 4286798 516932 356231 770467 688016 334156 332787 1105979 910263 7812803 6574095 X 347446 -274001 347446 -274001 8160249 6300094 -621447 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 16329 16329 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 06/30/15, the amount of dues related to lobbying activities was $16,329. 26597 26597 274995 7065287 6499958 840324 9868088 7658606 2209482 215719 118364 97355 3173758 CHART RRG - Investment 480523 C 480523 Capital leases 292866 Accrued pension 617397 910263 18875264 0 18875264 1067791 1067791 19943055 19496711 0 19496711 1067791 1067791 20564502 Part XI, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 741,505. Charity care expenses netted against revenue on financial statements 326,286. Part XII, Line 4b - Other Adjustments: Bad debt expense netted against revenue on financial statements 741,505. Charity care expenses netted against revenue on financial statements 326,286. 1 1 X 1 X 1 X 1 1 0 0 633434 608584 24850 0.00130 3530260 3454004 76256 0.00380 4163694 4062588 101106 0.00510 94511 70964 23547 0.00120 12147 12147 0.00060 106658 70964 35694 0.00180 4270352 4133552 136800 0.00690 1 541689 4935797 4786045 149752 X 1 1 1 1 Grafton City Hospital Inc 500 Market Street Grafton WV 25354 X X X X SNF-Wallace B. Murphy Nursing Facility Grafton City Hospital 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X http://www.graftonhospital.com/images/Grafton_CHNA_2.pdf X 1 13 0 0 0 1 X 100.000000000000 100.000000000000 X X 1 1 X X X 1 X X X X 1 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. 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 $ 741,505. 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 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. 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 Mark Witkowski MD Trustee/Physician 143463 0 0 0 0 0 0 0 16092 0 159555 0 0 0 Christopher Villaraza MD Trustee/Physician 190038 0 0 0 0 0 8062 0 7806 0 205906 0 0 0 Joseph Duvert Physician 248720 0 0 0 0 0 10297 0 17536 0 276553 0 0 0 Stephen Harris Physician 138347 0 0 0 0 0 4125 0 7806 0 150278 0 0 0 David Bender Physician 279375 0 0 0 0 0 11905 0 17550 0 308830 0 0 0 Thomas Wilshire Physician 249933 0 0 0 0 0 0 0 17550 0 267483 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.