HIGHLAND-CLARKSBURG HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- HIGHLAND-CLARKSBURG HOSPITAL INC (EIN 27-3128197)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201632289349300233
- Schema version
- 2014v6.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-15T07:29:40-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550486667 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Carbis Toothman LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1Txt |
| City | Charleston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25329 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273128197 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Highland-Clarksburg Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HIGH | BusinessNameControlTxt |
| Phone | 3049693100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Hospital Plaza | AddressLine1Txt |
| City | Clarksburg | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26301 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Shelly Giaquinto | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3049693107 | PhoneNum |
| Signature | 2016-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tessa W Carr | PreparerPersonNm |
| PTIN | P01291277 | PTIN |
| Phone | 3043460441 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | Michael Casdorph | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Hospital Plaza | AddressLine1Txt |
| City | Clarksburg | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26301 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,352,047 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.highlandhosp.com/clarksburg/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | To provide psychiatric care to adults and children. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 344 | TotalEmployeeCnt |
| Total Volunteers | 4 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $70,982 | PYContributionsGrantsAmt |
| CY Contributions Grants | $14,756 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,485,709 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,293,830 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$6,232 | PYOtherRevenueAmt |
| CY Other Revenue | $43,461 | CYOtherRevenueAmt |
| PY Total Revenue | $7,550,459 | PYTotalRevenueAmt |
| CY Total Revenue | $15,352,047 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,204,967 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,335,203 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,868,387 | PYOtherExpensesAmt |
| CY Other Expenses | $7,793,187 | CYOtherExpensesAmt |
| PY Total Expenses | $11,073,354 | PYTotalExpensesAmt |
| CY Total Expenses | $17,128,390 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,522,895 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,776,343 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $48,735,823 | TotalAssetsBOYAmt |
| Total Assets EOY | $47,780,383 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $37,955,995 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $38,794,984 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,779,828 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,985,399 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide psychiatric care to adults and children. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,331,695 | ExpenseAmt |
| Revenue | $15,334,591 | RevenueAmt |
| Desc | Highland-Clarksburg Hospital, Inc. (HCHI) is a non-profit organization formed in 2011 to develop and operate a behavioral health hospital in Harrison County, WV. HCHI began generating operating revenues after October 29, 2013, the date of the Joint Commission Accreditation. The Hospital provides psychiatric care to north central West Virginia and surrounding communities. The facility has 90 inpatient beds and 16 Crisis Stabilization beds open. The hospital has 150 licensed beds as approved with the certificate of need through the WV Healthcare Authority. During the year HCHI provided 18,704 days of inpatient psychiatric care. | Desc |
| Total Program Service Expenses | $8,331,695 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 344 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Shelly Giaquinto | PersonNm |
| Phone | 3049693107 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Hospital Plaza | AddressLine1Txt |
| City | Clarksburg | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| James H Dissen | |||||||||
| Chairman/President/CEO | 1.00 | Yes (X) | Yes (X) | $0 | $136,030 | $757 | |||
| Mike Casdorph | |||||||||
| Secretary/Treasurer | 40.00 | Yes (X) | Yes (X) | $0 | $101,092 | $757 | 5.00 | ||
| Margaret Bailey | |||||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Martin Howe | |||||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Paul Howe | |||||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Greg Gordon | |||||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Cynthia Persily | |||||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Joe Elliot | |||||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Nancy M Giaquinto | |||||||||
| CFO | 40.00 | Yes (X) | $69,346 | $0 | $5,594 | ||||
| G Eric Carpenter | |||||||||
| Interim COO | 40.00 | Yes (X) | $40,797 | $0 | $2,140 | ||||
| Marilou B Patalinjug Tyner | |||||||||
| Chief Medical Officer | 40.00 | $345,023 | $0 | $5,594 | Yes (X) | ||||
| Christi L Cooper-Lehki | |||||||||
| Physician | 40.00 | $117,775 | $0 | $0 | Yes (X) | ||||
| Toni B Goodykoontz | |||||||||
| Physician | 40.00 | $328,555 | $0 | $0 | Yes (X) | ||||
| Gregory A Rock | |||||||||
| Pharmacist | 40.00 | $116,697 | $0 | $0 | Yes (X) | ||||
| Paula Herndon | |||||||||
| Chief Nurse Executive | 40.00 | $103,244 | $0 | $9,884 | Yes (X) | ||||
| Emmylou McDaniel | |||||||||
| Advance Nurse Practitioner | 40.00 | $109,560 | $0 | $11,915 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,230,997 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $237,122 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $36,641 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Security America | |||||
| PO Box 4525 | Charleston | WV | 25364 | Security Services | $416,097 |
| Alpha Technologies | |||||
| PO Box 1114 | Scott Depot | WV | 25560 | Contracted IT | $119,161 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $14,756 | AllOtherContributionsAmt |
| Total Contributions | $14,756 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient services | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $15,293,830 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,293,830 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,293,830 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,700 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,700 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,700 | TotalRevenueColumnAmt |
| Exclusion | $2,700 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Commissary Revenue | 722210 | $20,219 | $20,219 |
| Lunch Revenue | 722210 | $18,627 | $18,627 |
| Rebates & Other | 900099 | $1,915 | $1,915 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $40,761 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,352,047 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,334,591 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,700 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $644,030 | TotalAmt |
| Program Services | $298,637 | ProgramServicesAmt |
| Management And General | $345,393 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,481,143 | TotalAmt |
| Program Services | $3,469,006 | ProgramServicesAmt |
| Management And General | $4,012,137 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,873 | TotalAmt |
| Program Services | $869 | ProgramServicesAmt |
| Management And General | $1,004 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $656,870 | TotalAmt |
| Program Services | $304,591 | ProgramServicesAmt |
| Management And General | $352,279 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $551,287 | TotalAmt |
| Program Services | $255,632 | ProgramServicesAmt |
| Management And General | $295,655 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,585 | TotalAmt |
| Management And General | $48,585 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,314 | TotalAmt |
| Management And General | $79,314 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,872 | TotalAmt |
| Management And General | $75,872 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,528,985 | TotalAmt |
| Program Services | $708,990 | ProgramServicesAmt |
| Management And General | $819,995 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,216 | TotalAmt |
| Program Services | $50,180 | ProgramServicesAmt |
| Management And General | $58,036 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $610,186 | TotalAmt |
| Program Services | $282,943 | ProgramServicesAmt |
| Management And General | $327,243 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,068,133 | TotalAmt |
| Program Services | $495,293 | ProgramServicesAmt |
| Management And General | $572,840 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,713 | TotalAmt |
| Program Services | $23,979 | ProgramServicesAmt |
| Management And General | $27,734 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,473 | TotalAmt |
| Program Services | $1,610 | ProgramServicesAmt |
| Management And General | $1,863 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,436,885 | TotalAmt |
| Program Services | $666,284 | ProgramServicesAmt |
| Management And General | $770,601 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,210,519 | TotalAmt |
| Program Services | $561,318 | ProgramServicesAmt |
| Management And General | $649,201 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $238,837 | TotalAmt |
| Program Services | $110,749 | ProgramServicesAmt |
| Management And General | $128,088 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $365,007 | $365,007 | |
| Healthcare Provider Tax | $361,413 | $361,413 | |
| Repairs & Maintenance | $311,997 | $144,673 | $167,324 |
| Bad debt expense | $175,539 | $175,539 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,513 | TotalAmt |
| Program Services | $54,982 | ProgramServicesAmt |
| Management And General | $63,531 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,128,390 | TotalAmt |
| Program Services | $8,331,695 | ProgramServicesAmt |
| Management And General | $8,796,695 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $567,506 | BOYAmt |
| EOY | $1,016,899 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,500 | BOYAmt |
| EOY | $17,500 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,888,583 | BOYAmt |
| EOY | $1,526,895 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,399 | BOYAmt |
| EOY | $56,121 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,530 | BOYAmt |
| EOY | $181,321 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $46,031,986 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,062,257 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,005,291 | BOYAmt |
| EOY | $43,969,729 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,034,014 | BOYAmt |
| EOY | $1,011,918 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,735,823 | BOYAmt |
| EOY | $47,780,383 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,226,918 | BOYAmt |
| EOY | $1,885,930 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,599,175 | BOYAmt |
| EOY | $35,718,418 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,124,902 | BOYAmt |
| EOY | $1,190,636 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,955,995 | BOYAmt |
| EOY | $38,794,984 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,779,828 | BOYAmt |
| EOY | $8,985,399 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,779,828 | BOYAmt |
| EOY | $8,985,399 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,735,823 | BOYAmt |
| EOY | $47,780,383 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,776,343 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$18,086 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $300,000 | OtherCostOrOtherBasisAmt |
| Book Value | $300,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,324,271 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,975,217 | DepreciationAmt |
| Book Value | $43,349,054 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $407,715 | OtherCostOrOtherBasisAmt |
| Depreciation | $87,040 | DepreciationAmt |
| Book Value | $320,675 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $43,969,729 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Related party payables | $1,160,665 |
| Leases payable | $29,971 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,190,636 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $15,176,508 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,176,508 | RevenueSubtotalAmt |
| Other Revenues Not Included | $175,539 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $175,539 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,352,047 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $16,970,937 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $18,086 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $18,086 | ExpensesNotReportedAmt |
| Expenses Subtotal | $16,952,851 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $175,539 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $175,539 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,128,390 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | HCHI is 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. Accounting principles generally accepted in the United States of America require the management of HCHI to evaluate tax positions taken by HCHI. Management has evaluated HCHI's tax positions and did not become aware of any course of action on services or events that might adversely affect the entity's tax status. Therefore, no provision or liability for income taxes has been included in the financial statements. |
| Part XI, Line 4b - Other Adjustments: | Bad debts netted with revenue on financial statements 175,539. |
| Part XII, Line 2d - Other Adjustments: | Nondeductible expenses 18,086. Fundraising expenses |
| Part XII, Line 4b - Other Adjustments: | Bad debts netted with revenue on financial statements 175,539. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $388,240 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $388,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,626,625 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,626,625 | DirectOffsettingRevenueAmt |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,846,072 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,846,072 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,860,937 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,472,697 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $388,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02290 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,860,937 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,472,697 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $388,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02290 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,347,825 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,347,825 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13850 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,250 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,250 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,508 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,270 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,270 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,755 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,755 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,368,608 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,368,608 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13980 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $131,129 | BadDebtExpenseAmt |
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Highland-Clarksburg Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Hospital Place | AddressLine1Txt |
| City | Clarksburg | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26301 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | Inpatient mental health | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Highland-Clarksburg Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.highlandhosp.com/clarksburg/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://highlandhospitalwv.com/health-assessment/ | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://highlandhospitalwv.com/financial-policy/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://highlandhospitalwv.com/financial-policy/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://highlandhospitalwv.com/financial-policy/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Highland-Clarksburg Hospital, Inc. | Part V, Section B, Line 5: Interviews were conducted with internal and external stakeholders and included individuals from the following organizations: Clarksburg Mission, Harrison County Commission, Harrison County Chamber of Commerce, Harrison-Clarksburg Health Department, Health Access, Inc. (free clinic), Harrison County Child Advocate Center, Harrison County DHHR, and Harrison County Board of Education. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Highland-Clarksburg Hospital, Inc. Part V, Section B, line 16a website: | https://highlandhospitalwv.com/financial-policy/ |
| Highland-Clarksburg Hospital, Inc. Part V, Section B, line 16b website: | https://highlandhospitalwv.com/financial-policy/ |
| Highland-Clarksburg Hospital, Inc. Part V, Section B, line 16c website: | https://highlandhospitalwv.com/financial-policy/ |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $ 175,539. |
| Part III, Line 2: | The bad debt expense was estimated using a cost-to-charge ratio derived from Worksheet 2 of the Schedule H instructions. |
| Part III, Line 9b: | Former patients with delinquent private pay accounts will be notified and given the option of paying the account in full or participating in a predefined monthly payment plan. Former patients will be notified of their financial obligation for services redndered by receiving monthly statements with balance due. Former patients who did not wish to apply during their hospitalization will be given another opportunity to apply for charity care or sliding fee scale financial assistance program during the collection process. All private pay accounts will be reviewed to determine the last date of payment. The colletion specialist will attempt to contact the debtor by phone to setup a payment arrangement. The collection specialist wil also remind the patient or responsible party of the hospital charity care and sliding fee scale financial assistance programs. The collection specialist will document all conversations with the debtor in the patient's billing database. If the patient should apply for the charity care or sliding fee scale financial assistance programs within 240 days from the date of the first billing statement, and it is determined that the patient qualifies for one of the assistance programs, the Hospital's collection representative will contact the collection agency and instruct that the account be removed from collection and that the credit bureau be notified to remove the balance from the patient's credit report. |
| Part VI, Line 2: | The Hospital assesses the health care needs of the community it serves by first considering services offered by healthcare providers in the area, population trends, socio-economic demographics and the region's overall sufficiency of mental healthcare providers in the community. The Hospital obtains data from numerous health organizations and conducts interviews with community leaders and hospital staff. This information is used to determine the future health needs of the community. Since the Hospital is a licensed psychiatric hospital, the primary focus is on needs that relate to mental health services. |
| Part VI, Line 4: | The Hospital is located in Clarksburg, a north central city of West Virginia, four hours west of Washington, D.C., and less than two hours south of Pittsburgh, Pennsylvania. The Hospital's primary service area consists of the following West Virginia Counties: Harrison, Marion, Upshur, Monongalia, Lewis, Randolph, Wood, Taylor, Barbour and Doddridge. The population of the total service area is projected to steadily increase through 2030. The largest increase in population is projected in Monongalia County. Marion, Randolph, Taylor and Upshur Counties are projected to remain stable during the projection period. Harrison, Lewis and Wood Counties are projected to steadily decline during the period. The estimated 2013 population for the service area was 427,302. Residents of the primary service area are predominantly White/Caucasians (95.99%) followed by Black/African American (1.70%). Housing is generally stable and comparable between the service area and the state. Nearly 22% of West Virginia's veterans live in the service area. The service area and the State of West Virginia has a higher percentage of those below the poverty level than that of the United States. All counties in the service area had a higher percentage of adults living in poverty than the average for the United States which was 14.9%. Monongalia County was 22.6% and the other Counties in the service area were comparable to the statewide average of 17.6%. The median household and family income for the service area Counties ranged from a low in Doddridge County of $31,261 to a high of $42,734. The median income is $40,400 for West Virginia and $53,046 for the United States. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Marilou B Patalinjug Tyner | ||||||||||||||
| Chief Medical Officer | $345,023 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,566 | $0 | $353,589 | $0 | $0 | $0 |
| Toni B Goodykoontz | ||||||||||||||
| Physician | $328,555 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $328,555 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | The 990 is received from the accounting firm and reviewed by the CEO and CFO to make sure nothing is omitted. The CFO then signs the return and mails it to all regulatory and tax authorities. |
| Form 990, Part VI, Section B, line 12c | The Quality Control Director keeps a copy of the policy on file, with all board members signing a copy every year. Also, as situations arise, board members will excuse themselves from any vote that may have a conflict of interest. |
| Form 990, Part VI, Section B, line 15 | The board of directors approves compensation for the CEO and CFO using a separate finance committee and comparative data. |
| Form 990, Part VI, Section C, line 18 | The organizing documents and the Form 990 are available through direct inquiry of the fiscal office of the organization. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy and the financial statements are available through direct inquiry of the fiscal office of the organization. |
| Form 990, Part XI, line 9: | Nondeductible expenses-Penalties -18,086. |
| Form 990, Part XII, Line 2C | Highland Hospital Association, a related entity, has a separate finance committee, which oversees the audits of all of the members of Highland Health System, including Highland-Clarksburg Hospital, Inc. |
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