GRAFTON CITY HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GRAFTON CITY HOSPITAL INC (EIN 55-6000526)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201411349349304556
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-05-14T13:09:17-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550486667 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Foster Toothman PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1 |
| City | Charleston | City |
| State | WV | State |
| ZIP Code | 25329 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 556000526 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grafton City Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GRAF | NameControl |
| Phone | 3042657152 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Market Street | AddressLine1 |
| City | Grafton | City |
| State | WV | State |
| ZIP Code | 26354 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Pat Shaw | Name |
| Title | CEO | Title |
| Phone | 3042657152 | Phone |
| Date Signed | 2014-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Dale Carpenter | Name |
| PTIN | P00189642 | PTIN |
| Phone | 3043460441 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Pat Shaw | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Market Street | AddressLine1 |
| City | Grafton | City |
| State | WV | State |
| ZIP Code | 26354 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 17711203 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.graftonhospital.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1972 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 340 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 14264 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 6475 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17682050 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16751836 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 60991 | InvestmentIncomePriorYear |
| Investment Income Current Year | 73964 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 194615 | OtherRevenuePriorYear |
| Other Revenue Current Year | 878928 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17951920 | TotalRevenuePriorYear |
| Total Revenue Current Year | 17711203 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 14250 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12319097 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12063696 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5717781 | OtherExpensePriorYear |
| Other Expenses Current Year | 5757984 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 18036878 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17835930 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -84958 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -124727 | RevenuesLessExpensesCY |
| Total Assets BOY | 7043861 | TotalAssetsBOY |
| Total Assets EOY | 8883216 | TotalAssetsEOY |
| Total Liabilities BOY | 5991000 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7955082 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1052861 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 928134 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 10687308 | Expense |
| Revenue | 16751836 | Revenue |
| Description | The Hospital provided health care services including 5,559 emergency room visits, 1,400 acute hospital days; 23,110 long-term care days; 2,463 swing-bed days and 202 surgeries. The Hospital provided charity care without charge or at less than its established rates to patients who meet certain criteria under its charity care policy. Charges foregone for charity care during the year amounted to $1,045,634. Additionally, the Hospital's Rural Health Clinic recorded 19,524 visits for the year. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 14250 | Expense |
| Grants | 14250 | Grants |
| Description | The organization provided several grants to community organizations including: a $12,500 grant for a high school football field, $1,500 for the sponsorship of a five mile run and $250 for Relay for Life. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 10701558 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 10 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 340 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susie Higgins | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3042657412 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Market Street | AddressLine1 |
| City | Grafton | City |
| State | WV | State |
| ZIP Code | 26354 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| John Whitescarver | |||||||
| President | 1.00 | X | 0 | 0 | 0 | ||
| Nancy Virginia Fowler | |||||||
| Vice President | 1.00 | X | 0 | 0 | 0 | ||
| Wanda Taylor | |||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | ||
| Paul Shroyer | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Christopher Villaraza II MD | |||||||
| Trustee | 40.00 | X | 191547 | 0 | 0 | ||
| Ronald L Cole | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Rusty Efaw | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Wayne McDevitt | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Mark Witkowski MD | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| John L Bord | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Pat Shaw | |||||||
| CEO | 40.00 | 114242 | 0 | 0 | X | ||
| Susannah Higgins | |||||||
| CFO | 40.00 | 73843 | 0 | 0 | X | ||
| David Bender | |||||||
| Physician | 40.00 | 260549 | 0 | 0 | X | ||
| Joseph Duvert | |||||||
| Physician | 40.00 | 245640 | 0 | 0 | X | ||
| Steven Smith | |||||||
| Physician | 40.00 | 276053 | 0 | 0 | X | ||
| Thomas Wilshire | |||||||
| Physician | 40.00 | 255028 | 0 | 0 | X | ||
| James W Woodford | |||||||
| Physician | 40.00 | 183851 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1600753 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| US Nursing | |||||
| PO Box 4070 | Clarksburg | WV | 26302 | Outside Nursing Services | 176894 |
| Insight | |||||
| PO Box 847689 | Dallas | TX | 752847689 | Mobile MRI | 133450 |
| Odyssey Rehabilitation | |||||
| 415 Benedum Drive | Bridgeport | WV | 26330 | Rehab Services | 124224 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| All Other Contributions | 6475 | AllOtherContributions |
| Total Contributions | 6475 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Net patient services | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 16751836 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16751836 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16751836 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 73964 | TotalRevenueColumn |
| Exclusion | $73,964 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4100 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4100 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4100 | TotalRevenueColumn |
| Exclusion | $4,100 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| EHR Incentive Payments | 900099 | 629602 | $629,602 |
| Cafeteria | 722212 | 73405 | $73,405 |
| Wellness revenue | 900099 | 60398 | $60,398 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 111423 | TotalRevenueColumn |
| Exclusion | $111,423 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 874828 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17711203 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16751836 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $952,892 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14250 | Total |
| Program Services | 14250 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 380565 | Total |
| Program Services | 218749 | ProgramServices |
| Management And General | 161816 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9636909 | Total |
| Program Services | 5539295 | ProgramServices |
| Management And General | 4097614 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 236567 | Total |
| Program Services | 135979 | ProgramServices |
| Management And General | 100588 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1048895 | Total |
| Program Services | 602905 | ProgramServices |
| Management And General | 445990 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 760760 | Total |
| Program Services | 437285 | ProgramServices |
| Management And General | 323475 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37589 | Total |
| Management And General | 37589 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47029 | Total |
| Management And General | 47029 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1111345 | Total |
| Program Services | 638801 | ProgramServices |
| Management And General | 472544 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1323124 | Total |
| Program Services | 760869 | ProgramServices |
| Management And General | 562255 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110328 | Total |
| Program Services | 63417 | ProgramServices |
| Management And General | 46911 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91983 | Total |
| Program Services | 52872 | ProgramServices |
| Management And General | 39111 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27996 | Total |
| Program Services | 16092 | ProgramServices |
| Management And General | 11904 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105823 | Total |
| Program Services | 60827 | ProgramServices |
| Management And General | 44996 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 423243 | Total |
| Program Services | 243280 | ProgramServices |
| Management And General | 179963 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 449856 | Total |
| Program Services | 258577 | ProgramServices |
| Management And General | 191279 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical supplies | 792575 | 792575 | |
| Repairs & maintenance | 785594 | 451559 | 334035 |
| Medicaid provider tax | 354040 | 354040 | |
| Dues and subscriptions | 45199 | 25980 | 19219 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52260 | Total |
| Program Services | 34206 | ProgramServices |
| Management And General | 18054 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17835930 | Total |
| Program Services | 10701558 | ProgramServices |
| Management And General | 7134372 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 312425 | BOY |
| EOY | 7663 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90317 | BOY |
| EOY | 256974 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2529795 | BOY |
| EOY | 1911558 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 202129 | BOY |
| EOY | 255662 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 238797 | BOY |
| EOY | 74080 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 16803146 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 13092580 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2682219 | BOY |
| EOY | 3710566 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 160406 | BOY |
| EOY | 234370 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 827773 | BOY |
| EOY | 2432343 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7043861 | BOY |
| EOY | 8883216 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3481192 | BOY |
| EOY | 5463167 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 923932 | BOY |
| EOY | 849034 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 414617 | BOY |
| EOY | 382206 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1171259 | BOY |
| EOY | 1260675 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5991000 | BOY |
| EOY | 7955082 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1052861 | BOY |
| EOY | 928134 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1052861 | BOY |
| EOY | 928134 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7043861 | BOY |
| EOY | 8883216 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -124727 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $16,959 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 16959 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| Explanation | 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 06/30/13, the amount of dues related to lobbying activities was $16,959. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26597 | OtherCostOrOtherBasis |
| Book Value | 26597 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 274995 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 7038963 | OtherCostOrOtherBasis |
| Depreciation | 6140873 | Depreciation |
| Book Value | 1173085 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8033808 | OtherCostOrOtherBasis |
| Depreciation | 6833649 | Depreciation |
| Book Value | 1200159 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1428783 | OtherCostOrOtherBasis |
| Depreciation | 118058 | Depreciation |
| Book Value | 1310725 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3710566 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Estimated third-party payor settlements | Description |
| Book Value | 2432343 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2432343 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Capital leases | $515,840 |
| Accrued pension | $744,835 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1260675 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 17711203 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 17711203 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 17711203 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 17835930 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 17835930 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 17835930 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1048968 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1367885 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -318917 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4238615 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3591953 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 646662 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03950 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5287583 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4959838 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 327745 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03950 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5287583 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4959838 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 327745 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03950 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $972,893 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 4330441 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4631203 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -300762 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grafton City Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Market Street | AddressLine1 |
| City | Grafton | City |
| State | WV | State |
| ZIP Code | 25354 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grafton City Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Services | X | PrioritizeServices |
| Other Needs Addressed | X | OtherNeedsAddressed |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 1 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 $ 1463877. | ||
| 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 V, Section B, Line 6i: 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. | Grafton City Hospital | |
| Part V, Section B, Line 7: 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 inititiave 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 21: Charges are based on services rendered by charging amounts in the charge master used for all patients - Based on financial needs, patients are granted charity care for services rendered to them. After a review of their personal finances, an award of charity care is granted on their ability to pay. The amount granted can be from 10% to 100%. Once charity care is granted, charges for services for the proceeding six months and the following six months are written off based on the percent of charity care granted. | Grafton City Hospital | |
| Part V, Section B, Line 22: Charges are based on services rendered by charging amounts in the charge master used for all patients - Based on financial needs, patients are granted charity care for services rendered to them. After a review of their personal finances, an award of charity care is granted on their ability to pay. The amount granted can be from 10% to 100%. Once charity care is granted, charges for services for the proceeding six months and the following six months are written off based on the percent of charity care granted. | Grafton City Hospital | |
| Grafton City Hospital was late in filing its Community Health Needs Assessment (CHNA) as defined by code section 501 (r) -3. This narrative outlines the factors contributing to the late filing and the corrective actions taken by the hospital. The hospital engaged the accounting firm of Arnett Foster Toothman, PLLC (AFT) to assist with the preparation of their CHNA. In April, 2013 the process of identifying and assembling data needed for the preparation of the CHNA was begun. Thus, work was started on the CHNA prior to the end of the 2012 tax year (7/1/12 6/30/13) but not soon enough to complete the CHNA by June 30, 2013. The primary reason for the delayed start was a hospital-wide information system conversion that occurred over a period of six months spanning September 1, 2012 thru March 31, 2013. Grafton City Hospital is a rural Critical Access Hospital with limited monetary and personnel resources. The system conversion stretched all available funds and personnel to the point that other projects (the CHNA included) had to be delayed until the system conversion was completed. The Hospital believed the CHNA was not due until November 15, 2013. The CHNA was completed in January 2014 at which time the report was approved by the board, published on the hospital's website and the implementation strategy adopted based on the needs identified in the CHNA. The hospitals 990 tax return is under its second extension (due date May 15, 2014). The hospital has taken corrective action by completing and filing the CHNA, as well as adopting an implementation strategy. The hospital has also adopted a corrective action plan. In accordance with Notice 2014-3 and through discussions with its author, the Hospital has self-corrected the deficiencies as outlined above without being contacted by the Internal Revenue Service. The Hospital believes the deficiencies to be minor and inadvertent and, therefore, would not be considered to be egregious. As a result of the process, the Hospital is now aware of the practices and procedures necessary to eliminate any future deficiencies. The Hospital believes the deficiencies had no effect on affected persons and that once the deficiencies were discovered, which was in November 2013, efforts were made to make timely corrections as described above. Based upon the above discussion, the Hospital believes it would not be subject to the excise tax under IRS Code Section 4959 and has not filed Form 4720. | CHNA - Late Filing | Part V, Section B, Line 1 |
| 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 areas 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 desiginated 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: The organization's health care facilities further its exempt purpose in the following ways: The organization's governing body is comprised of persons who reside in the organization's primary service area and are neither employees nor contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified providers in its community for some or all of its departments. The organization operates an emergency room available to all, regardless of ability to pay. Specialized services offered by the organization that are not available elsewhere include pulmonology, critical care medicine, general surgery, internal medicine, obstetrics and gynecology, and family medicine. The organization serves as a vehicle for attracting charitable support, as well as a source of community volunteer activities. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Taylor County Board of Education | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 71 Utt Drive | AddressLine1 |
| City | Grafton | City |
| State | WV | State |
| ZIP Code | 26354 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 550549257 | EINOfRecipient |
| IRC Section | Taylor Co. BOE | IRCSection |
| Amount Of Cash Grant | 12500 | AmountOfCashGrant |
| Purpose Of Grant | For high school football field | PurposeOfGrant |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Christopher Villaraza II MD | ||||||||||||||
| Trustee | 191547 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 191547 | 0 | 0 | 0 |
| David Bender | ||||||||||||||
| Physician | 260549 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 260549 | 0 | 0 | 0 |
| Joseph Duvert | ||||||||||||||
| Physician | 245640 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 245640 | 0 | 0 | 0 |
| Steven Smith | ||||||||||||||
| Physician | 276053 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 276053 | 0 | 0 | 0 |
| Thomas Wilshire | ||||||||||||||
| Physician | 255028 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 255028 | 0 | 0 | 0 |
| James W Woodford | ||||||||||||||
| Physician | 183851 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 183851 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 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. |
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