2015-11-16T14:25:59-06:00 2014-12-31 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2014-01-01 550491651 Summersville Regional Medical Center SUMM 3048722891 400 Fairview Heights Road Summersville WV 266519308 MARK LOVELL Interim CFO 3048722891 2015-11-13 1 Marlin Witt P00946392 3043460441 2014 2016-03-07 17:11:31Z Randy Simmons 400 Fairview Heights Road Summersville WV 266519308 47114540 0 X www.summersvilleregional.org X Municipal Public Work 1968 WV Summersville Regional Medical Center provides acute care services through 53 licensed beds including Intensive Care Unit, Medical/Surgery, OB and Swing Bed. In addition there are 52 extended care beds providing Long Term Care services to the residents. Summersville Regional Medical Center operates an Emergency Room taking all patients regardless of insurance in conjunction with a regional medical center approach, connecting patients to tertiary care facilities as necessary for services. Ancillary diagnostic services are also provided including Lab, X-ray, CT, MRI, Ultrasound, PT/OT, Nuclear medicine, Surgery, and Emergency Room. Physician clinics include Rural Health Clinics, Surgery practice, Women's health practice and Orthopedics practice. 14 13 604 26 0 0 44460 7660 40586823 44644258 90158 94270 3336284 2350122 44057725 47096310 0 0 0 0 28234177 30181725 0 0 0 18617592 19538408 46851769 49720133 -2794044 -2623823 28984718 25556926 18461781 17641231 10522937 7915695 Above all else, Summersville Regional Medical Center is committed to the care and improvement of human life. In recognition of this commitment, we will strive to deliver quality, cost effective healthcare to the communities we serve. 0 0 42354687 44644258 The Hospital provided 25,099 inpatient days of care as follows: acute intensive care 6,128, 632 nursery, 2,116 swing and 16,233 long-term care. Other services provided include 41,175 outpatient visits, 23,283 emergency room visits, 29,493 rural health clinic visits and 3,429 ambulatory surgeries. The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Charges foregone for charity during the year amounted to $218,942 for hospital services. 42354687 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 32 0 604 1 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 X Mark Lovell Interim CFO 3048728571 400 Fairview Heights Road Summersville WV 26651 Robert Shafer Chairman 1.00 1.00 X 0 0 0 Elizabeth Anderson Vice Chairman 1.00 1.00 X 0 0 0 Mike Steadham Trustee 1.00 1.00 X 0 0 0 Bandy Mullins MD Trustee/Chief of Staff 40.00 X 460598 0 7800 Brad Dorsey Trustee 1.00 X 0 0 0 Barbara LeRose Trustee 1.00 X 0 0 0 Brian Johnson Trustee 1.00 X 0 0 0 Bruce Tallamy Trustee 1.00 X 0 0 0 Fred Reed Trustee 1.00 1.00 X 0 0 0 John Estep Trustee 1.00 X 0 0 0 Kenny Baker Trustee 1.00 X 0 0 0 Lewis Gilbert Trustee 1.00 X 0 0 0 Valerie Phillips Trustee 1.00 X 0 0 0 Saundra Kinser Trustee 1.00 X 0 0 0 James Marsh Trustee 1.00 X 0 0 0 Deborah A Hill CEO 40.00 X 216384 0 6526 Brian Kelbaugh CFO 40.00 X 119427 0 0 Dan Ayres CEO 40.00 X 49094 0 0 Mark Lovell CFO 40.00 X 43075 0 0 Yancy S Short Physician 40.00 X 460115 0 7800 Paul Conley Physician 40.00 X 385864 0 7800 Lukasz Rostocki Physician 40.00 X 378392 0 7800 John Baughman Physician's assistant 44.00 X 387282 0 7800 Thomas J Reynolds CRNA 40.00 X 378698 0 7800 2878929 0 53326 35 0 1 0 Rehab One 1834 Park Avenue Belle WV 25215 Physical Therapy 1011948 Weatherby Locums PO Box 972633 Dallas TX 75397 Locum Physicians 401222 Precision Diagnostic Services 4152 30th Ave S Suite 103 Fargo ND 58104 Sleep Studies 167057 Arnett Carbis Toothman PO Box 2629 Charleston WV 25329 Accounting Services 137283 4 7660 7660 Patient service revenue 622110 44644258 44644258 44644258 93620 93620 176056 18230 157826 157826 157826 650 0 650 650 650 Pharmacy 446110 1432830 1432830 Webster County Memorial Pharmacy 446110 408670 408670 Settlement 900099 184161 184161 166635 166635 2192296 47096310 44644258 0 2444392 434506 376760 57746 23878884 20705380 3173504 535392 464238 71154 3778886 3276672 502214 1554057 1347523 206534 321165 321165 148855 148855 3848242 3336811 511431 61292 53146 8146 801626 695841 105785 664562 576242 88320 84757 73493 11264 559909 559909 2106886 1826880 280006 1538508 1334040 204468 Medical supplies 7112499 6167248 945251 Repairs and maintenance 1106441 959395 147046 Provider tax 880616 880616 Recruitment 132637 132637 170413 147765 22648 49720133 42354687 7365446 0 2045 2045 4242826 1638619 5755950 5607787 1413840 1444844 287462 511341 45027406 28858641 17282595 16168765 0 183525 28984718 25556926 6922577 5932153 10640758 10343839 898446 1365239 18461781 17641231 X 9850317 7907227 672620 8468 10522937 7915695 28984718 25556926 -2623823 16581 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 288184 288184 22164207 11097293 11066914 20892706 17071067 3821639 1682309 690281 992028 16168765 Capital leases 743882 Due to third party payors 621357 1365239 47131121 16581 18230 34811 47096310 0 47096310 49738363 18230 18230 49720133 0 49720133 Part XI, Line 2d - Other Adjustments: Rental expenses netted with income on form 990 18,230. Part XII, Line 2d - Other Adjustments: Rental expenses netted with income on form 990 18,230. 1 1 X 1 X 1 X 225.000000000000 0 1 0 1 1 91386 91386 0.00210 14665202 13895405 769797 0.01800 14756588 13895405 861183 0.02010 1278930 1278930 1278930 1278930 16035518 15174335 861183 0.02010 0 2888371 8798041 9120396 -322355 X 1 1 1 1 Summersville Regional Medical Center 400 Fairview Heights Road Summersville WV 26651 X X X Long-term nursing care Summersville Regional Medical Center 1 0 0 1 X X X 12 0 0 0 1 X 0 0 1 X 100.000000000000 225.000000000000 X X X 1 1 1 X 1 0 X X 1 X 0 0 Summersville Regional Medical Center Part V, Section B, Line 11: Financial constraints prevent the Hospital from addressing all needs. Part I, Line 3c: Charity care is administered to all individuals based upon filing an application for charity care, sliding fee scale, etc. To qualify for the finance assistance, patients must show proof of coverage of Medicare, Medicaid or other type of financial sponsorship. Financial assistance is based upon family size and income. Unreimbursed Medicaid revenues not reimbursed are not collected but written off as contractual adjustment. Charity care at cost and unreimbursed Medicare are computed using the cost to charge ratio method in worksheet 2 of the Schedule H instructions. Part I, Line 7: Charity care is administered to all individuals based upon filing an application for charity care, sliding fee scale, etc. To qualify for the financial assistance, patients must show proof of coverage of Medicare, Medicaid or other type of financial sponsorship. Financial assistance is based upon family size and income. Unreimbursed Medicaid revenues not reimbursed are not collected but written off as contractual adjustments. Charity care at cost and unreimbursed medicare are computed using the cost to charge ratio method in worksheet 2 of 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 $ 6,919,912. Part I, Line 6a The organization makes its community benefit report available to the public through public meetings. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The organization used the Medicare cost report information for revenues and expenses. The organization does not consider this to be a community benefit expense due to fluctuations in reimbursements related to Medicare audits. Part III, Line 9b: See Part III, line 4b explanation above. Part VI, Line 4: We are a small rural hospital which is surrounded by Critical Access hospitals and also the only remaining hospital in Nicholas County as the other hospital closed in bankruptcy in 2008. We have a group of volunteers who are able to gain charitable support in order to encourage charitable donations by providing activities throughout our facility and through the State of West Virginia NIPS program that were not previously available to our community. As of 2012, the population of Nicholas county was 26,229. The estimated median household income in 2009 was $34,003 versus a median of $37,435 for the whole state of West Virginia. An estimated 19.2% of residents lived below the poverty level in 2009 while 7.7% were estimated to live below 50% of the poverty level. Part VI, Line 5: Our Board of Directors all reside in our primary care area of Nicholas County, West Virginia. The Board is comprised of small business, union, low income, members at large, medical staff director, and mayor of the City of Summersville. Board members are not employees, contractors of the organization nor family members. We extend medical staff privileges to all qualified physicians in our community or providers who have a visiting clinic in our community. Any surplus funds are reinvested back into the organization through capital expenditure projects, or payment on existing debt, which has been secured on a tax-free basis. Our emergency room is available to all clients regardless of ability to pay. Part VI, Line 6: The organization is not part of a health care system. X X X X 0 0 0 0 0 0 0 0 0 Bandy Mullins MD Trustee/Chief of Staff 434047 0 26551 0 0 0 7800 0 0 0 468398 0 0 0 Deborah A Hill CEO 38881 0 0 0 177503 0 6526 0 0 0 222910 0 0 0 Yancy S Short Physician 371436 0 88679 0 0 0 7800 0 0 0 467915 0 0 0 Paul Conley Physician 133109 0 252755 0 0 0 7800 0 0 0 393664 0 0 0 Lukasz Rostocki Physician 378392 0 0 0 0 0 7800 0 0 0 386192 0 0 0 John Baughman Physician's assistant 133831 0 253451 0 0 0 7800 0 0 0 395082 0 0 0 Thomas J Reynolds CRNA 378698 0 0 0 0 0 7800 0 0 0 386498 0 0 0 A City of Summersville Building Commission 550716940 2006-09-29 7750000 Debt refunding and hospital improvements 0 0 0 B City of Summersville Building Commission 550716940 2008-03-03 5000000 Hospital facilities 0 0 0 A 1672224 7750000 3843860 3906140 2007 0 1 1 1 B 733937 5000000 5000000 2009 0 0 1 1 A 0 0 0 0 0 0 0 B 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 1 B 1 Form 990, Part VI, Section B, line 11 The board reviews and approves the 990 form before it is filed with the IRS. If this cannot be accomplished at a regularly scheduled meeting, a special meeting will be held to uphold this board action. Form 990, Part VI, Section B, line 12c Conflict of interest statements require a board member with a conflict to excuse themselves from the discussion and boardroom if a matter of discussion and voting would be a conflict of interest with them individually. Statements completed by other board members are reviewed by the Chairman. The vice-chairman reviews the chairman's conflict of interest statement. Form 990, Part VI, Section B, line 15 Compensation for the CEO is reviewed by a CEO compensation committee. They are responsible to help set goals, review achievement of goals and make a recommendation to the board for the incentive compensation. At a separate time, they review the CEO compensation contract and make recommendations to the board based on comparative CEO compensation using Yaffee, WVHA Compensation Survey and other applicable and available compensation tools. The CFO's compensation is reviewed and benchmarked against other compensation tools and is set by the CEO on an annual basis. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements are available upon request by persons. They are not posted on the website at the present time. This has been discussed in public session of the board meetings. Summersville Building Commission 400 Fairview Heights Road Summersville WV 26651 550716940 Building Commission WV 501(C)(3) 6 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0