2015-11-13T15:21:38-07:00 2014-12-31 990 2014-01-01 311156960 FAIRMONT GENERAL HOSPITAL INC FAIR 3043677100 1325 LOCUST AVENUE FAIRMONT WV 26554 Whitney Patterson CFO 3043677109 2015-11-13 2014 2016-02-25 16:41:14Z Whitney Patterson 1325 Locust Ave Fairmont WV 26554 49648026 0 X www.fghi.com X 1985 WV THE ORGANIZATION OPERATES A HOSPITAL THAT PROVIDES PATIENT CARE FOR THE COMMUNITY. X 8 8 925 0 0 0 318375 528954 83995372 45340993 21471 26414 5122792 3390504 89458010 49286865 0 0 0 0 41852025 27159464 0 0 0 51363063 30161965 93215088 57321429 -3757078 -8034564 49222993 13092928 45147783 36382727 4075210 -23289799 THE ORGANIZATION IS A HOSPITAL WHICH PROVIDES INPATIENT AND OUTPATIENT CARE TO THE COMMUNITY, AS WELL AS HEALTH DIAGNOSTIC, INTERVENTION AND TREATMENT. 0 0 15384270 31067064 PATIENT CARE: THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HOSPITAL CARE TO THE COMMUNITY, INCLUDING GENERAL MEDICAL, INTENSIVE/CARDIAC CARE, WOMEN'S AND CHILDREN'S HEALTHCARE SERVICES AND INPATIENT DRUG AND ALCOHOL REHAB 1298046 178 ANCILLARY SERVICES: THE HOSPITAL HAS ANCILLARY SERVICES WHICH PROVIDE THE NECESSARY DIRECT SUPPORT TO THE PATIENT CARE DEPARTMENTS. SOME OF THE ANCILLARY SERVICES INCLUDE HOUSEKEEPING, NUTRITION, AND STERILE SUPPLY 2687497 7168412 HEALTH DIAGNOSTIC, INTERVENTION, AND TREATMENT: THE HOSPITAL ALSO OFFERS OUTPATIENT DIAGNOSTIC IMAGING SERVICES. SOME OF THE RADIOLOGY DEPARTMENT SERVICES INCLUDE RADIOLOGY DIAGNOSTIC, EKG, ULTRASOUND, MRI, NUCLEAR MEDICINE, CT SCAN, AND PET SCAN 2379835 7105339 Laboratory Services: The hospital also has several laboratory departments including pathology, hematology, microbiology, chemistry, lab diagnostic and bloodbank. 1538292 777805 Wellness Center: The hospital operates a wellness center for the benefit of the community to promote overall physical well-being. 3918127 0 7883144 23287940 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 1 20 0 925 1 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X WHITNEY PATTERSON CFO 3043677109 1325 LOCUST AVENUE FAIRMONT WV 26554 TONI NESSELROTTE CHAIRMAN OF BOARD 0 0 X 0 0 0 PATRICK BONASSO MD VICE-CHAIRMAN OF BOARD 0 0 X 0 0 0 ROBIN SMITH DC SECRETARY OF BOARD 0 0 X 0 0 0 MIKE MARTIN TREASURER OF BOARD 0 0 X 0 0 0 REV WESLEY DOBBS BOARD DIRECTOR 0 0 X 0 0 0 DAVID FOX BOARD DIRECTOR 0 0 X 0 0 0 JOHN PANZA BOARD DIRECTOR 0 0 X 0 0 0 T WESLEY STEELE MD BOARD DIRECTOR 0 0 X 0 0 0 PEGGY COSTER CEO 40 0 X 118425 0 13885 WHITNEY PATTERSON CFO 40 0 X 113909 0 16808 CAROL WEBER CNO 40 0 X 87263 0 22654 319597 0 53347 2 0 0 0 REHABCARE GROUP DIVISION OF KINDRED HEALTHCARE POP BOX 502096 ST LOUIS MO 631502096 PURCHASED MEDICAL SERVICES 988026 SPILMAN THOMAS & BATTLE PLLC 300 KANAWHA BOULEVARD EAST CHARLESTON WV 25301 LEGAL SERVICES 779375 PREMIER ANESTHESIA 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 ANESTHESIA MEDICAL SERVICE 708729 SILLS CUMMINS & GROSS PC THE LEGAL CENTER ONE RIVERFRONT PLAZA NEWARK NJ 07102 RESTRUCTURING CONSULTING SERVICES 481010 PSI PHARMACY PO BOX 571 0716 COLUMBUS OH 43271 PHARMACY SERVICES 467817 21 0 0 0 0 0 528954 0 528954 45340993 45340993 0 0 45340993 26414 0 0 26414 0 0 0 0 0 0 0 0 816777 0 0 0 816777 0 816777 0 0 816777 0 0 0 221589 361161 -139572 -139572 0 0 FITNESS CENTER REVENUE 624100 777805 777805 0 0 REBATES AND REFUNDS 624100 96607 96607 0 0 UPL/ACUTE CARE REVENUE 624100 1772962 1772962 0 0 65925 65925 0 0 2713299 49286865 47914720 0 843191 X 0 0 0 0 0 0 0 0 319597 0 319597 0 0 0 0 0 19071363 5917508 13153855 0 581172 177355 403817 0 5768519 1760370 4008149 0 1418813 432977 985836 0 379122 278558 100564 0 20654 0 20654 0 5799 0 5799 0 0 0 0 0 0 0 0 0 0 0 12073041 4669181 7403860 0 44213 5426 38787 0 305648 80120 225528 0 0 0 0 0 0 0 0 0 2283869 1195624 1088245 0 48427 38532 9895 0 0 0 0 0 0 0 0 0 687654 209850 477804 0 0 0 0 0 1910372 1010445 899927 0 566074 0 566074 0 BAD DEBT EXPENSE 1224925 0 1224925 0 REPAIRS AND MAINTENANCE 1000565 667212 333353 0 TAXES AND ASSESSMENTS 1884182 2903 1881279 0 SUPPLIES AND MATERIALS 5917305 5215400 701905 0 1810115 1626479 183636 0 57321429 23287940 34033489 0 2855446 9110977 0 0 0 0 11291910 0 0 0 0 0 1158214 133034 1373932 770760 1778538 715254 28204834 1874770 1869843 0 0 0 0 0 0 685349 493060 49222993 13092928 23340026 14466497 0 0 0 0 14700768 14705201 0 0 0 0 1066732 943286 0 0 6040257 6267743 45147783 36382727 X 4075210 -23289799 0 0 0 0 4075210 -23289799 49222993 13092928 X -8034564 12567 0 0 0 -19343012 X 0 0 0 X 0 0 0 0 0 1 6629 0 0 0 6629 0 Schedule C, Part II-B, Line 1 THE HOSPITAL PAYS MEMBERSHIP DUES TO ORGANIZATIONS THAT HAVE VARIOUS LOBBYING EFFORTS. A PERCENTAGE OF THE TOTAL DUES IS ATTRIBUTED TO POLITICAL ACTIVITIES. 0 PROFESSIONAL AND GENERAL INSURANCE LLC 1591375 THIRD PARTY SETTLEMENTS 4625559 RELATED PARTY PAYABLE 50809 6267743 1 1 1 X 1 X 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1224925 0 17294224 16505410 788814 X 1 0 1 1 FAIRMONT GENERAL HOPSPITAL INC 1325 LOCUST AVE FAIRMONT WV 26554 X X X FAIRMONT GENERAL HOPSPITAL INC 1 1 0 1 X X X X X X X X X 13 1 0 0 1 X WWW.FGHI.COM 0 0 1 X 150 300 X X X X X 1 1 X X X X 1 X X X X X X X 1 X X 1 X X X X 1 0 1 Schedule H, Part V, Section B, Line 5-FAIRMONT GENERAL HOPSPITAL INC Fairmont General Hospital Inc - A series of focus groups, surveys, and opinions from key informants throughout the community were used in developing a comprehensive health needs assessment for Marion County. In addition to community participants, 22 active physicians participated in the survey process in December 2013. Schedule H, Part V, Section B, Line 11-FAIRMONT GENERAL HOPSPITAL INC Fairmont General Hospital Inc - The CHNA was conducted in the last quarter of the fiscal year 2013. The hospital and related organizations had not yet determined a plan of action to address the community health needs by the end of the year, but it is currently evaluating the recommendations of the survey. Schedule H, Part V, Section B, Line 16a-FAIRMONT GENERAL HOPSPITAL INC WWW.FGHI.COM Schedule H, Part V, Section B, Line 16b-FAIRMONT GENERAL HOPSPITAL INC WWW.FGHI.COM Schedule H, Part V, Section B, Line 16c-FAIRMONT GENERAL HOPSPITAL INC WWW.FGHI.COM Schedule H, Part V, Section B, Line 22-FAIRMONT GENERAL HOPSPITAL INC Patient charges are consistent by service regardless of payer (Medicare, commercial, self-pay, etc.). Charges may be discounted for self-pay patients based on the Hospital's Financial Assistance Policy. Schedule H, Part V, Section B, Line 24-FAIRMONT GENERAL HOPSPITAL INC Fairmont General Hospital Inc - Patient charges are consistent by services regardless of payer (Medicare, commercial, self-pay, etc.) Charges may be discounted for self-pay patients based on the Hospital's Financial Assistance Policy. Schedule H, Part I, Line 7 N/A Schedule H, Part III, Section A, Line 4 Patient Accounts Receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. In evaluating the collectability of accounts receivable, the hospital analyzes its past history and it identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. 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 for receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill). The hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Recoveries of accounts previously written off are recorded as a reduction to the provision for bad debt expense when received. Interest is not charged on patient accounts receivable. The hospital does not maintain a material allowance for doubtful accounts from third-party payors, nor does it have significant write offs from third party payors. Schedule H, Part III, Section B, Line 8 The hospital provides care to the community at a cost in excess of the payment received for Medicare patients. This absorption of costs benefits the community the organization serves. Line 6 was determined using the cost to charge ratio of .954389 from the 2014 Medicare cost report from Worksheet D-1. The title XVIII PPS hospital general inpatient routine service cost to charge ratio was multiplied by the Medicare receipts in Line 5. Schedule H, Part III, Section C, Line 9b The organization's debt collection policy is titled The Credit and Collection Policy. It discusses non-discrimination of service, payment responsibilities, insured patients, pre-admission program, pre-admission deposits, third party litigation, payment arrangements, payment agreements, and referred for outside collection and legal action. There is no discussion of charity care in this policy. However, the organization does have a separate charity care policy. Schedule H, Part VI, Line 2 The hospital provides multi-phasic and lab testing to the Public. The organization also utilizes satellite locations and adjusts its hours of service to appropriately service the community's needs. The organization also conducts health fairs at various locations throughout the community during the year. Schedule H, Part VI, Line 3 The organization employs a patient eligibility advocate in its patient accounting department. This employee works with patients to assist them with his or her eligibility and filing for state and federal governmental programs. This employee also works with other individuals who are on the organization's financial counseling staff. If a patient is determined not eligible for government programs, the patient is taken to a financial counselor who will assess his or her eligible for government programs. Schedule H, Part VI, Line 4 The organization serves Marion County and the surrounding areas in North Central West Virginia. The area served is a small rural community. A MARION COUNTY COMMISSION 556000346 2007-07-01 13700000 DESIGN, CONSTRUCTION & EQUIPPING OF HEALTHPLUS FACILITY 0 1 0 B WEST VIRGINIA HOSPITAL FINANCE AUTHORTIY 621256910 2009-02-01 4385000 REFUND THE SERIES 1994 BONDS, FUND DEBT SERVICE RESERVE FUND, PAY ISSUANCE COSTS. 0 1 0 A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 PATRICK BONASSO MD VICE CHAIRMAN OF THE HOSPITAL 92000 MEDICAL SERVICES 0 Asset purchase agreement through Chapter 11 reorganization 2014-09-20 20323000 Consideration paid and appraisals 352507149 ALECTO HEALTHCARE SERVICES FAIRMONT LLC 1325 LOCUST AVENUE FAIRMONT WV 26554 0 1 0 0 Schedule N, Part II, Line 2 The following employees maintained their roles in the successor organization: Peggy Coster, CEO Whitney Patterson, CFO Carol Weber, CNO Form 990, Part VI, Section B, Line 11b The tax return is prepared by the hospital's accounting department. The return is reviewed by the Chief Financial Officer. Form 990, Part VI, Section B, Line 12c Annually, the organization will receive a conflict of interest disclosure from all board members, hospital directors, managers, and other senior management leadership team members. The board will review these to determine if anyone has a potential conflict of interest. Form 990, Part VI, Section B, Line 15 The Compensation Committee of the Board annually reviews the compensation of the CEO. The CEO annually reviews the compensation of the senior management team. Form 990, Part VI, Section C, Line 19 The hospital's forms 1023, annual 990. and policies/procedures are available for public inspection upon request. Any inquiries from the public are told to address the request in writing to the CFO. The hospital will provide copies as requested. Form 990, Part IX, Line 11g Fees for other services total $12,073,041. Program Contract Labor equals $3,614,312. General Consulting Fees equals $611,567. Program Purchased Services equals $1,054,869. General Purchased Services equal $6,792,293. Form 990, Part XI, Line 9 Equity transfers to the related organization - Fairmont Physicians Network. Fairmont Management Services Organization 1325 Locust Avenue Fairmont WV 26554 550739131 Office Management services for physicians WV 0 0 Fairmont General Hospital Inc Marion County Physicians-Hospital Organization Inc 1325 Locust Avenue Fairmont WV 26554 550737630 Network of Physician and Hosptial Service WV 0 0 Fairmont General Hospital Inc Marion Health Enterprises Inc 1325 Locust Avenue Fairmont WV 26554 541916408 50% of Joint Venture of Durable Home Medical Equipment WV 0 0 Fairmont General Hospital Inc Fairmont Physicians Network 1325 Locust Avenue Fairmont WV 26554 550738905 Network of Physicians WV 722451 -17 Fairmont General Hospital Inc Fairmont General Hospital Volunteer Association Inc 1325 Locust Avenue Fairmont WV 26554 Organizes Volunteers WV N/A Professional and General Liability Self-Coverage 1325 Locust Avenue Fairmont WV 26554 550622861 Admisters the self-insurance WV N/A The Regional Healthcare Foundation 1325 Locust Avenue Fairmont WV 26554 901108823 Supports healthcare related opportunity in Marion County WV WV N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 The Regional Healthcare Foundation p 57598 E-Filed the extension on 04/20/15 and mailed the extension on 8/12/15