2015-05-13T14:22:08-05:00 2014-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2013-07-01 556000526 Grafton City Hospital GRAF 3042657152 1 Hospital Plaza Grafton WV 26354 Pat Shaw CEO 3042657152 2015-05-12 1 Harry C Harless P01042847 3043460441 2013 2016-02-25 16:41:14Z X Pat Shaw 1 Hospital Plaza Grafton WV 26354 20268637 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 8 316 0 0 0 6475 70944 16751836 19761449 73964 102730 878928 333514 17711203 20268637 14250 2500 0 0 12063696 12581629 0 0 0 5757984 8315196 17835930 20899325 -124727 -630688 8883216 8160249 7955082 7812803 928134 347446 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 15671994 19761449 The Hospital provided health care services including 5,601 emergency room visits; 969 acute hospital days; 21,406 long-term care days; 2,150 swing-bed days and 200 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 $696,735. Additionally, the Hospital's Rural Health Clinic recorded 16,879 visits for the year. 2500 2500 The Hospital provided several grants to community organizations including a $1,500 sponsorship of a five mile run, $500 for Relay for Life and $200 each to sponsor Little League and high school basketball teams. 15674494 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 11 0 1 316 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 John L Bord Trustee 1.00 X 0 0 0 John Whitescarver Trustee 1.00 X 0 0 0 Wanda Taylor Secretary 1.00 X 0 0 0 Paul Shroyer Trustee 1.00 X 0 0 0 David Efaw Vice-President 1.00 X 0 0 0 Ronald L Cole President 1.00 X 0 0 0 Nancy Fowler Trustee 1.00 X 0 0 0 Wayne McDevitt Trustee 1.00 X 0 0 0 Mark Witkowski MD Trustee/Physician 40.00 X 6346 0 16037 Samuel McDaniel Trustee 1.00 X 0 0 0 Christopher Villaraza MD Trustee/Physician 40.00 X 188389 0 7765 Pat Shaw CEO 40.00 X 114242 0 7765 Susannah Higgins CFO 40.00 X 90293 0 16037 Joseph Duvert Physician 40.00 X 254440 0 17495 Steven Smith Physician 40.00 X 194231 0 7765 David Bender Physician 40.00 X 278248 0 17495 Thomas Wilshire Physician 40.00 X 254600 0 17495 James Woodford Physician 40.00 X 183851 0 16037 1564640 0 123891 8 0 1 0 US Nursing PO Box 4070 Clarksburg WV 26302 Outside nursing services 179741 Insight PO Box 847689 Dallas TX 75284 Mobile MRI 138375 Odyssey Rehabilitation 415 Benedum Drive Bridgeport WV 26330 Rehabilitation Services 138359 3 8550 62394 70944 Net patient services 622110 19288672 19288672 EHR Incentive Payments 900099 437943 437943 340 B Program Revenue 900099 34834 34834 19761449 102730 102730 3875 0 3875 3875 3875 Rebates and Refunds 900099 116560 116560 Cafeteria 722212 77607 77607 Wellness revenue 900099 49514 49514 85958 85958 329639 20268637 19761449 0 436244 2500 2500 540788 380553 160235 9806398 6900762 2905636 191520 134773 56747 1317853 927373 390480 725070 510232 214838 117634 117634 35000 35000 999168 703115 296053 1243775 875244 368531 116191 81564 34627 86260 60701 25559 12554 8834 3720 119682 84220 35462 614549 432458 182091 451780 317918 133862 Bad Debt Expense 1560020 1560020 Medical supplies 1019245 1019245 Repairs and Maintenance 795061 559484 235577 Charity Care Expense 696736 696736 447541 418762 28779 20899325 15674494 5224831 0 7663 19362 256974 165081 1911558 2147144 255662 298856 74080 93062 17241174 13707128 3710566 3534046 234370 316327 2432343 1586371 8883216 8160249 5463167 5085269 516932 849034 770467 382206 334156 1260675 1105979 7955082 7812803 X 928134 347446 928134 347446 8883216 8160249 X -630688 50000 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16850 16850 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 06/30/14, the amount of dues related to lobbying activities was $16,850. 26597 26597 274995 7065287 6363729 976553 8289287 7011293 1277994 1585008 332106 1252902 3534046 Estimated third-party payor settlements 1586371 1586371 Capital leases 552144 Accrued pension 553835 1105979 18061881 50000 50000 18011881 2256756 2256756 20268637 18642569 0 18642569 2256756 2256756 20899325 Part XI, Line 2d - Other Adjustments: Revenue on financial statements not reported on Form 990 50,000. Part XI, Line 4b - Other Adjustments: Bad Debt Expense netted against revenue on financial statements 1,560,020. Charity Care Expense netted against revenue on financial statements 696,736. Part XII, Line 4b - Other Adjustments: Bad Debt Expense netted against revenue on financial statements 1,560,020. Charity Care Expense netted against revenue on financial statements 696,736. 1 1 X 1 X 1 X 1 1 0 0 1 805202 1349768 -544566 0.00000 3765212 3571534 193678 0.01000 1 4570414 4921302 -350888 0.01000 5 1271 57112 31160 25952 0.00130 5 1271 57112 31160 25952 0.00130 6 1271 4627526 4952462 -324936 0.01130 1 1560020 4177774 4909201 -731427 X 1 1 1 1 Grafton City Hospital Inc 1 Hospital Plaza Grafton WV 25354 X X X X SNF- Wallace B. Murphy Nursing Facility Grafton City Hospital 1 1 X X X X X X X X X X 13 1 0 1 X http://www.graftonhospital.com/ X X X 0 0 1 1 100.000000000000 1 100.000000000000 1 X X X X 1 1 X X X X 1 0 X X X 1 X 0 0 Grafton City Hospital Part V, Section B, Line 1j: 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 3: 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 its healthcare. Grafton City Hospital Part V, Section B, Line 6i: As a result of needs identified in its Needs Assessment the facility hired two new providers and have begun affiliation discussions with other local healthcare facilities. Grafton City Hospital Part V, Section B, Line 7: Due to financial constraints the hospital facility did not address all of its needs identified in its most recently conducted Needs Assessment. Grafton City Hospital Part V, Section B, Line 20d: 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. Individuals who fell under FAP were discounted from 10% to 100% of the bill. 1 Wallace B Murphy Nursing Home 1 Hospital Plaza Grafton WV 26354 Long-term and skilled nursing home Part I, Line 7: The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,560,020. Part I, Line 7e Flu shots are given free of charge to service personnel and the education system employees. The cost per shot is between 15.88 to 15.90 and the average cost of 15.89 by 350 vaccines equates to $5,561.50. New You Youth Fitness if offered 3 times per year for 6 weeks/3 days per week for 1 hr/15 mins per session. The pay rate of the employee who conducts the class was used to calculate the cost based upon the times it is offered. A flat 25% on compensation was used for the benefit portion of the employee. Concerning the HealthFair - a list of employees who assist and their rate of pay and hours dedicated is kept for the wage expense. An estimate of the decoration, advertisment, food and lab fees is used to determine the additonal expense. Silver Sneaker program is sponsored through Humana and provides Wellness Center membership at the Tygart Valley Rehabilitation Center to the senior population. Weight Management is offered though PEIA and the TVRC certified trainer runs this program. Cost is not kept on these two programs. Part III, Line 4: Patient Accounts Receivable: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectable accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 9b: The patient accounting system has a collection code that is assigned to accounts that indicates which patient has charity care at the time of service. Those accounts are written off immediately and do not run through a collection cycle. New patients without insurance are educated on the option of Medicaid and if they do not qualify for Medicaid they are given a charity care application. If they qualify for charity care the account is written off. 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 area's 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: 1.) The hospital's board of directors is comprised of volunteers who are residents of Taylor County. They are not employees, contractors, or family members. 2.) The hospital extends medical staff privileges to all qualified physicians in the community. 4.) The hospital operates an EMTALA compliant emergency room that is available to the public 24 hours a day 7 days a week. The emergency room is available to all who present regardless of their ability to pay. 6.) The long-term care unit attracts several volunteers who assist with the activates of the residents. Lastly the hospital has a ladies auxiliary that provides support through volunteering a hospital events. 7.) This hospital provides a link to the Community Needs Assessment report on the hospital website. X X X 0 0 0 0 0 0 0 0 0 Christopher Villaraza MD Trustee/Physician 188389 0 0 0 0 0 0 0 7765 0 196154 0 0 0 Joseph Duvert Physician 254440 0 0 0 0 0 0 0 17495 0 271935 0 0 0 Steven Smith Physician 194231 0 0 0 0 0 0 0 7765 0 201996 0 0 0 David Bender Physician 278248 0 0 0 0 0 0 0 17495 0 295743 0 0 0 Thomas Wilshire Physician 254600 0 0 0 0 0 0 0 17495 0 272095 0 0 0 James Woodford Physician 183851 0 0 0 0 0 0 0 16037 0 199888 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. Form 990, Part XI, line 9: Deposit for sale of long-term care unit 50,000.