2015-11-11T09:07:15-06:00 2014-12-31 540504608 BROWN EDWARDS & COMPANY LLP 124 NEWMAN AVENUE HARRISONBURG VA 22801 990 2014-01-01 540505913 BATH COMMUNITY HOSPITAL BATH 5408397000 POST OFFICE DRAWER Z HOT SPRINGS VA 24445 PETER FARAONE CHAIRMAN 5408397000 2015-11-03 1 JAMES R FRIES P01320612 5404346736 2015-11-03 2014 2016-04-25 22:37:26Z PETER FARAONE POST OFFICE DRAWER Z HOT SPRINGS VA 24445 19873211 0 X WWW.BATHHOSPITAL.ORG X 1925 VA BATH COMMUNITY HOSPITAL ACCEPTS PRIMARY RESPONSIBILITY FOR IMPROVING THE HEALTH OF OUR AREA BY PROVIDING HIGH QUALITY, COMPASSIONATE, AND AFFORDABLE HEALTH CARE TO OUR REGION. 11 9 179 0 0 0 4038898 3928138 13248258 15480007 1405184 33745 398161 416228 19090501 19858118 0 0 0 0 8757511 10716321 0 0 0 7534017 10494068 16291528 21210389 2798973 -1352271 14474366 26854809 1884147 19006926 12590219 7847883 TO TAKE PRIMARY RESPONSIBILITY FOR IMPROVING THE HEALTH OF OUR AREA BY PROVIDING HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTH CARE TO OUR REGION. 0 0 16604866 15534724 BATH COMMUNITY HOSPITAL OPERATES A 25-BED CRITICAL ACCESS HOSPITAL, TWENTY-FOUR HOUR EMERGENCY SERVICES, PRIMARY CARE, AS WELL AS A SELECT RANGE OF DIAGNOSTIC SERVICES, REHABILITATIVE SERVICES AND SPECIALTY CLINICS. 16604866 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 70 0 1 179 1 0 0 0 0 0 0 0 0 0 0 X 11 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X X THE ORGANIZATION 5408397000 106 PARK DR HOT SPRINGS VA 24445 AMORY MELLEN DIRECTOR 1.00 0.50 X 0 0 0 WILEY KLING DIRECTOR 1.00 0.50 X 0 0 0 WILLIAM BRATTON DIRECTOR 1.00 0.50 X 0 0 0 MICHAEL BOST DIRECTOR, PHYSICIAN 47.00 0.50 X 177838 0 56142 RUTH RODGERS DIRECTOR 1.00 0.50 X 0 0 0 GEORGE PHILLIPS DIRECTOR 1.00 0.50 X 0 0 0 TRACY PHILLIPS DIRECTOR 1.00 0.50 X 0 0 0 DON KILLOREN CO-CHAIRMAN 1.00 0.50 X 0 0 0 PETER FARAONE DIRECTOR 1.00 0.50 X 0 0 0 DAVID TROAST CHAIRMAN, CO-CHAIRMAN 1.00 0.50 X X 0 0 0 HENLEY CARTER SECRETARY 1.00 X X 0 0 0 JAMES REDINGTON CHIEF MEDICAL OFFICER 40.00 0.50 X X 169122 0 277555 JASON PARET PRESIDENT AND CEO, TREAS, SEC 40.00 0.50 X X 207234 0 422964 SARAH MCWILLIAMS VICE CHAIRMAN 1.00 0.50 X X 0 0 0 KATHY LANDRETH ACTING CEO 40.00 X 25781 0 2865 GREG GUTMEIR CFO, TREASURER 40.00 X 93162 0 7024 KYNA MOORE DIRECTOR OF NURSING 40.00 X 128658 0 20312 STEVEN CURTIAN PT & WELLNESS DIRECTOR 40.00 X 101374 0 12556 JEFFREY MCCRAY PHYSICIAN 47.00 X 180883 0 43255 WILLIAM PEARSON PHARMACIST 40.00 X 142651 0 19672 LEVI RIZK PHYSICIAN 40.00 X 180537 0 19852 1407240 0 882197 8 0 1 0 NIELSEN BUILDERS INC 3588 EARLY RD HARRISONBURG VA 24059 BUILDERS FOR HOSPITAL REMODEL 6459213 CPSI PO BOX 850309 MOBILE AL 36685 COMPUTER AND BILLING SERVICES 766833 THE ERX GROUP LLC 9724 KINGSTON PIKE STE 406 KNOXVILLE TN 37922 ER CONTRACT DOCTORS 465679 HOSPICE DESIGN RESOURCE PLLC 10229 SUGAR CAMP CREEK RD BENT MTN VA 24059 ARCHITECT FOR REMODEL 338340 DURRETTECRUMP PLC 1111 E MAIN ST RICHMOND VA 23219 ATTORNEY 280119 10 68901 29134 3830103 3928138 OTHER PROFESSIONAL SERVICES 621300 14217067 14217067 OTHER NURSING SERVICES 621300 4860932 4860932 DAILY PATIENT SERVICES 621300 2343190 2343190 CHARITY CARE 621300 -721815 -721815 CONTRACTUAL ADJUSTMENTS 621300 -5219367 -5219367 15480007 40659 40659 40278 8179 32099 32099 32099 6914 -6914 -6914 -6914 GAIN ON CONSOLIDATION OF PHARMACY 621300 329412 329412 MEANINGFUL USE REIMBURSEMENT 621300 25735 25735 MISC CAFETERIA AND DIETARY REVENU 621300 19691 19691 9291 9291 384129 19858118 15534724 0 395256 1439686 680657 759029 7456320 6324493 1131827 233840 189781 44059 1052320 854046 198274 534155 433512 100643 688747 688747 46948 46948 19992 19992 2025598 1429361 596237 85214 11931 73283 138733 121419 17314 98576 48451 50125 350127 345234 4893 44855 36704 8151 838730 838730 198595 13033 185562 SUPPLIES 2737396 2722662 14734 PROVISION FOR BAD DEBTS 1752939 1752939 EQUIPMENT RENTAL & MAIN 608900 504146 104754 EDUCATION AND RELATED 153829 120893 32936 704889 176874 528015 21210389 16604866 4605523 0 3168817 1899252 7652 4533143 2640882 1931231 364707 347152 297320 527363 202769 493454 26036051 9692719 7432954 16343332 205143 587388 154122 192494 14474366 26854809 1884147 2851576 16155350 1884147 19006926 X 11195400 6453064 1394819 1394819 0 0 12590219 7847883 14474366 26854809 X -1352271 -3390065 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 648918 648918 8259473 5850345 2409128 415585 202668 212917 4919583 3285511 1634072 11792492 354195 11438297 16343332 18039931 8176 8176 18031755 4524 1821839 1826363 19858118 19461105 8179 8179 19452926 4524 1752939 1757463 21210389 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 8,179. ROUNDING ADJ -3. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,752,939. TRANSFER FROM RELATED FOUNDATION 68,900. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 8,179. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,752,939. 1 1 1 X 1 X 1 1 1 0 1 1 1 639244 639244 0.03010 1 394922 394922 0.01860 2 1034166 1034166 0.04870 32 684 10102 10102 0.00050 24 235 15688 15688 0.00070 56 919 25790 25790 0.00120 58 919 1059956 1059956 0.04990 2 3546 3546 0.00020 2 3546 3546 0.00020 1 1552415 7981521 8078805 -97284 X 0 1 1 BATH COMMUNITY HOSPITAL 106 PARK DR HOT SPRINGS VA 24445 WWW.BATHHOSPITAL.ORG H1827 VA X X X X BATH COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 1 0 1 X X 1 12 0 0 0 1 X 100.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X 1 X 1 X X X X 1 X 0 0 BATH COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: HELD COMMUNITY MEETINGS, DID RANDOM PHONE INTERVIEWS AND HELD MEETINGS WITH LEADERS OF THE COMMUNITY. CONSULTED WITH PEARL BUZZARD, JON TREES, BRUCE MCWILLIAMS, GEORGE PHILLIPS, DAVID TROAST, DON KILLOREN, TRUDY WOODZELL, JONAH WILLIAMS, DENNIS CROPPER, MICHAEL BELL, MARY ADDERTON, BOARD OF SUPERVISORS, VIRGINIA HEALTH DEPARTMENT, JACKIE BAUGHAN, PAT FOUTZ, AND DEBBIE LIPES. PHONE INTERVIEW NAMES NOT AVAILABLE. BATH COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: AUGUSTA MEDICAL CENTER BATH COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: HELD MEETING TO PROVIDE COMMUNITY WITH DATA. BATH COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: BASED UPON THE CHNA, BCH HAS INCREASED PROVIDERS, PROVIDER HOURS AND THE NUMBER OF DAYS THE CLINIC IS OPEN IN MILLBORO. THERE HAS BEEN AN INCREASE IN THE NUMBER OF DIABETIC EDUCATION SESSIONS, WITH AN IMPROVEMENT PROJECT THAT SHOWED A DECREASE IN HEMOGLOBIN A1C. THERE IS MOVEMENT ON ANOTHER OFFSITE CLINIC AREA. WE HAVE INCREASED SPECIALISTS BY ADDING AN OPTOMETRIST TO PERFORM CATARACT SURGERY, PARTNERED WITH MENTAL HEALTH TO ADDRESS NEW LAWS AND EXPECTATIONS, CONTINUED PARTNERSHIP WITH THE SCHOOLS TO OBTAIN BODY MASS INDEX OF THE 7TH GRADERS GOING TO THE 8TH GRADE TO DETERMINE PERCENTAGES OF OBESITY. A RISK ASSESSMENT FOR THOSE FEELING AT RISK OF HARMING OTHERS OR HARMING THEMSELVES HAS BEEN INSTITUTED AT EACH TIME OF REGISTRATION. BCH HAS PARTNERED WITH THE FARMERS MARKET TO ALLOW THOSE QUALIFYING FOR SNAP TO HAVE DOUBLE THE MONIES TO SPEND AT THE FARMERS MARKET AND IS ALSO HELPING WITH THE FOOD PANTRIES. 1 BATH COMMUNITY REHAB & WELLNESS CENTER PO DRAWER Z HOT SPRINGS VA 24445 REHAB AND WELLNESS PART I, LINE 3C: WE ALSO CONSIDER ASSETS SUCH AS MONEY IN THE BANK AND ASSETS THAT COULD BE LIQUIDATED INTO CASH, AND WE REVIEW BANK STATEMENTS TO SEE IF MONEY IS FREQUENTLY SPENT ON LUXURY ITEMS INSTEAD OF NEEDED ITEMS. PART I, LINE 7: ALL FIGURES ARE DERIVED FROM THE FINANCIAL STATEMENTS, WHICH ARE PREPARED ON THE INCOME TAX BASIS. THE COST TO CHARGE RATIO FROM WORKSHEET 2 IS USED. PART III, LINE 2: SEE THE FOLLOWING RESPONSE TO PART III, LINE 4. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. BALANCES ARE CONSIDERED DELINQUENT WHEN THEY ARE OUTSTANDING FOR 90 DAYS WITH NO ACTIVITY AT WHICH TIME THE BALANCES ARE TRANSFERRED TO A COLLECTION AGENCY AND THE BALANCE IS MOVED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENT'S EVALUATION OF THE ACCOUNTS RECEIVABLE. THE BAD DEBT EXPENSE REPORTED ON SCH H, PART III, LINE 2 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. THIS WAS DETERMINED USING THE RATIO OF PATIENT CARE COST TO CHARGES. PART III, LINE 8: NONE SHOULD BE TREATED AS A COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS AS DETERMINED BY FILING OF THE CMS 2552-10 COST REPORT. PART VI, LINE 2, NEEDS ASSESSMENT: WE SEND SURVEYS OUT TO ALL PATIENTS ASKING THEM TO PROVIDE FEEDBACK ON THE SERVICES THEY RECEIVE. WE ARE OUT IN THE COMMUNITY AT THE FARMERS' MARKET, CHAMBER OF COMMERCE AND OTHER COMMUNITY EVENTS TALKING ABOUT OUR SERVICES. PART VI, LINE 3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PATIENTS WHO VISIT THE ER ARE GIVEN AN APPLICATION WHILE THERE. INPATIENT AND SWINGBED PATIENTS ARE ADVISED OF THE FINANCIAL ASSISTANCE PROGRAM THROUGH OUR SOCIAL WORKER. ALL ARE DIRECTED TO OUR PATIENT FINANCIAL ADVOCATE, WHO HANDLES OUR FINANCIAL ASSISTANCE. THE ADVOCATE MEETS WITH THE INPATIENT AND SWINGBED PATIENTS IN THEIR ROOMS AND HELPS THEM FILL OUT THE APPLICATIONS WHEN NEEDED. WHEN MEETING WITH POTENTIAL APPLICANTS OR SPEAKING WITH THEM BY PHONE, THE ADVOCATE ADVISES THEM OF OUR FINANCIAL ASSISTANCE PROGRAM AND SCREENS THEM FOR POSSIBLE MEDICAID ASSISTANCE BY ASKING QUALIFYING QUESTIONS. IF THEY MEET THE REQUIREMENTS, THE ADVOCATE REFERS THEM TO SOCIAL SERVICES TO FILL OUT THE MEDICAID APPLICATION WHICH IS NOW DONE ONLINE THERE AT THE OFFICE. THEY ARE FURTHER ADVISED IF THEY NEED HELP WITH THAT PROCESS TO CONTACT THE ADVOCATE FOR ASSISTANCE WITH THE ONLINE APPLICATION. IF THEY ARE DENIED MEDICAID, THEY ARE TOLD TO COME BACK TO THE ADVOCATE WITH THE DENIAL AND A FINANCIAL ASSISTANCE APPLICATION WILL BE PROCESSED FOR THEM ONCE IT IS COMPLETED. PART VI, LINE 4, COMMUNITY INFORMATION: THIS IS A VERY RURAL COMMUNITY. BATH COUNTY HAS APPROXIMATELY 4,700 RESIDENTS. APPROXIMATELY 22% OF THE POPULATION IS OLDER THAN 65 COMPARED TO VIRGINIA AT 13% AND THE U.S. AT 14%. SINCE 2000, THE POPULATION OF BATH COUNTY HAS DECREASED BY 6.3% COMPARED TO VIRGINIA INCREASING BY 13% AND THE U.S. INCREASING BY 9.71%. PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: VIRGINIA ONLY X 0 1 X X X X 0 0 0 0 0 0 0 0 0 MICHAEL BOST DIRECTOR, PHYSICIAN 177838 0 0 0 0 0 26687 0 29455 0 233980 0 0 0 JAMES REDINGTON CHIEF MEDICAL OFFICER 169122 0 0 0 0 0 248906 0 28649 0 446677 0 0 0 JASON PARET PRESIDENT AND CEO, TREAS, SEC 207234 0 0 0 0 0 403076 0 19888 0 630198 0 0 0 JEFFREY MCCRAY PHYSICIAN 180883 0 0 0 0 0 14606 0 28649 0 224138 0 0 0 WILLIAM PEARSON PHARMACIST 142651 0 0 0 0 0 9925 0 9747 0 162323 0 0 0 LEVI RIZK PHYSICIAN 180537 0 0 0 0 0 19561 0 291 0 200389 0 0 0 PART I, LINE 1A RESIDENCE FOR PERSONAL USE WAS PROVIDED TO JASON PARET (6 MONTHS), GREG GUTMEIR (3 MONTHS), AND MICHAEL BOST (6 MONTHS). HOUSING PAYMENTS OF $3,600 WERE MADE ON BEHALF OF MICHAEL BOST. HOUSING PAYMENTS OF $1,650 WERE MADE ON BEHALF OF KATHY LANDRETH. HOUSING ALLOWANCE OF $6,000 WAS INCLUDED IN TAXABLE COMPENSATION PAID TO LEVI RIZK. PART I, LINE 1B HOUSING BENEFITS WERE PROVIDED PER INDIVIDUAL EMPLOYMENT AGREEMENTS. DR JAMES REDINGTON ON THE BOARD OF DIRECTORS 113130 WORKED AS AN CONTRACT EMPLOYEE VIA BATH FAMILY PRACTICE. 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS WILEY B. KLING, JR. AND AMORY MELLEN, III HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 ALL MEMBERS OF THE BOARD REVIEW A COPY OF THE 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM IS SIGNED ANNUALLY BY ALL MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS USED THE MCCRACKIN GROUP IN THE PAST TO LOOK AT REASONABLENESS OF COMPENSATION. THIS GROUP WAS RECOMMENDED BY VHHA, AND HAS BEEN CONTACTED ON AN AS-NEEDED BASIS BY INDIVIDUAL BOARD MEMBERS. THE BOARD OF DIRECTORS ALSO USE THE VASHHRA REPORT FOR SALARY SURVEY PURPOSES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE ALL AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER TO BATH COMMUNITY HOSPITAL FOUNDATION -3,390,063. ROUNDING ADJ -2. FORM 990, PART XII, LINE 1 THE ORGANIZATION USES INCOME TAX BASIS OF ACCOUNTING. THAT BASIS DIFFERS FROM GENERALLY ACCEPTED ACCOUNTING PRINCIPLES PRIMARILY BECAUSE THE HOSPITAL DOES NOT RECORD, AS A PERMANENTLY RESTRICTED ASSET, FUNDS HELD IN TRUST BY OTHERS. THE HOSPITAL ALSO DOES NOT RECORD ITS LONG-TERM INVESTMENTS AT FAIR VALUE AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE ORGANIZATION DID NOT CHANGE ITS ACCOUNTING METHOD IN CURRENT YEAR. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SELECTION OF AN AUDIT COMMITTEE THAT OVERSEES PREPARATION OF FINANCIAL STATEMENTS AND AUDIT PROCESS. THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS IN CURRENT YEAR. STATEMENT PURSUANT TO SECTION 332 BY BATH COMMUNITY HOSPITAL, EIN #54-0505913, A CORPORATION RECEIVING A LIQUIDATING DISTRIBUTION: THE LIQUIDATING CORPORATION WAS HOT SPRINGS PHARMACY, INC. EIN #54-1887343. THE LIQUIDATING DISTRIBUTION WAS MADE ON 01/01/2014. THE AGGREGATE FAIR MARKET VALUE OF ALL ASSETS OF THE PHARMACY WHICH WERE TRANSFERRED TO THE HOSPITAL, DETERMINED IMMEDIATELY BEFORE THE DISTRIBUTION, WAS $534,556. THE BASIS OF THE HOSPITAL'S OWNERSHIP IN THE PHARMACY WAS $205,143. THE PLAN OF COMPLETE LIQUIDATION WAS ADOPTED ON 12/19/2013 AND THE LIQUIDATION WAS COMPLETED ON 01/01/2014. BATH COMMUNITY HOSPITAL FOUNDATION PO DRAWER Z HOT SPRINGS VA 24445 571137401 SUPPORT FUNDRAISING EFFORTS OF BATH COMMUNITY HOSPITAL VA 501(C)(3) LINE 11B, II BATH COMMUNITY HOSPITAL 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 BATH COMMUNITY HOSPITAL FOUNDATION B 3390063 FACE VALUE BATH COMMUNITY HOSPITAL FOUNDATION C 68901 CASH