2014-08-15T10:11:25-05:00 2013-09-30 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2012-10-01 550440086 Pleasant Valley Hospital PLEA 3046754340 2520 Valley Drive Pt Pleasant WV 25550 Richard Hogan 3046754340 2014-08-14 1 Dale Carpenter P00189642 3043460441 2012 2015-11-30 17:44:51Z Glen Washington 2520 Valley Drive Pt Pleasant WV 25550 70816817 0 X www.pvalley.org X 1955 WV Provide quality inpatient and outpatient healthcare to the community regardless of ability to pay. Provide a wellness center to promote community health through fitness programs. 19 15 914 82 3441 0 53248 50198 70786499 69367500 34913 244120 870872 896245 71745532 70558063 15637 80728 0 0 39867268 40403175 0 0 0 33177217 32276133 73060122 72760036 -1314590 -2201973 40584241 36272220 17965499 15855451 22618742 20416769 To operate an acute care hospital facility for the citizens of Point Pleasant, West Virginia and the surrounding communities and counties. 0 0 60970768 80728 69215218 The hospital provided 41,295 acute, nursery, and skilled nursing days; 120,613 outpatient visits; 16,258 emergency room visits, 1,985 ambulatory surgeries; 1,246 observation visits; 18,157 home health visits; 1,355 hospice visits; and 41,838 physician office visits. 147662 152282 The hospital operates a wellness center which provides community health education and fitness programs that are available to hospital employees and all residents of the surrounding communities. 61118430 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 1 42 0 1 914 1 1 1 0 0 0 0 0 0 0 0 0 X 19 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Richard Hogan CFO 3046754340 2520 Valley Drive Point Pleasant WV 25550 Mario Liberatore 3.00 0.50 X 0 0 0 Peter Allinder 3.00 0.30 X 0 0 0 Annette Boyles 3.00 0.50 X 0 0 0 Thomas Willoughby 3.00 0.30 X 0 0 0 Michael Lieving 3.00 0.50 X 0 0 0 Scott Barnitz 3.00 0.30 X 0 0 0 Jack Buxton 3.00 0.30 X 0 0 0 Amanda Clark 3.00 0.30 X 0 0 0 Clayton Faber 3.00 0.30 X 0 0 0 Randall Hawkins 3.00 0.30 X 0 0 0 C Dallas Kayser 3.00 0.30 X 0 0 0 Dorsel Keefer 3.00 0.30 X 0 0 0 William Knight 3.00 0.30 X 0 0 0 James Lockhart 3.00 0.30 X 0 0 0 James Rossi 3.00 0.30 X 0 0 0 R Michael Shaw 3.00 0.30 X 0 0 0 William Tatterson 3.00 0.30 X 0 0 0 Lannes Williamson 3.00 0.30 X 0 0 0 Charles Lanham 3.00 0.50 X 0 0 0 Thomas E Schauer 40.00 X 183508 0 20631 Larry Unroe 40.00 X 0 0 0 Richard Hogan 40.00 X 44140 0 3201 William A Barker Jr 40.00 X 160325 0 19468 Ori Tzuk 40.00 X 617339 0 24500 James Toothman 40.00 X 567081 0 24500 Clifford Roberson 40.00 X 554829 0 16330 Robert Lewis 40.00 X 533141 0 24500 Stephen Rerych 40.00 X 425870 0 24500 3086233 0 157630 28 0 1 0 NAPS Inc 714 1/2 Lee St Charleston WV 25301 Anesthesia Services 518212 Quest Diagnostics PO Box 740709 Atlanta GA 30374 Laboratory Services 400340 Crest Services 735 Plaza Blvd 210 Coppelli TX 75019 Biomedical Services 349265 3 23838 26360 50198 Patient Services 622110 67117981 67117981 Electronic health records incenti 900099 2097237 2097237 Wellness Center 621111 152282 152282 69367500 235425 3441 231984 431659 73320 358339 358339 358339 194129 185434 8695 8695 8695 Cafeteria & vending 722212 262198 262198 Purchase discounts 900099 159770 159770 Gift shop 453220 46764 46764 69174 69174 537906 70558063 69367500 3441 1136924 80728 80728 661640 528650 132990 27333153 21839189 5493964 661957 528904 133053 9663877 7721438 1942439 2082548 1663956 418592 118127 118127 86632 86632 5811563 4643439 1168124 348677 278593 70084 2314316 1835690 478626 42761 34166 8595 1005817 803648 202169 457158 365269 91889 446443 356708 89735 2804146 2240513 563633 1132056 904513 227543 Bad debts 8099911 8099911 Medical supplies 5561733 5561733 Medicaid provider tax 1757147 1757147 Repairs & maintenance 1654321 1321802 332519 635325 552433 82892 72760036 61118430 11641606 0 578367 0 8628887 5366936 9426373 9360126 202913 227546 1276175 1263211 662721 453905 75885883 59167317 17470134 16718566 138290 35817 2200381 2846113 40584241 36272220 6435935 6861438 7110000 6360000 4419564 2634013 17965499 15855451 X 22618742 20416769 22618742 20416769 40584241 36272220 -2201973 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1254831 1254831 320643 24400762 16486286 8235119 233667 233667 0 47161261 40557895 6603366 2514719 1889469 625250 16718566 Due from related parties 167821 Other receivables 2649355 Accrued interest 28937 2846113 Capital lease agreements 1667285 Estimated third party payor settlements 950949 Bond issue liabilities 15779 2634013 1 1 X 1 X 1 X 100.000000000000 1 1 0 1 1 874239 874239 0.01350 15024862 12213774 2811088 0.04350 15899101 12213774 3685327 0.05700 40544 4250 36294 0.00060 1139962 1139962 0.01760 26569 26569 0.00040 1207075 4250 1202825 0.01860 17106176 12218024 4888152 0.07560 13994 13994 0.00020 1107 1107 0.00000 7291 7291 0.00010 1000 1000 0.00000 222930 222930 0.00340 10112 10112 0.00020 256434 256434 0.00390 1 3266694 10385798 10926266 -540468 X 1 0 1 1 Pleasant Valley Hospital

2520 Valley Drive Pt Pleasant WV 25550

X X X Skilled nursing facility, home health, hospice Pleasant Valley Hospital 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X 1 0 1 1 100.000000000000 1 100.000000000000 1 X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 1 Pleasant Valley Hospital Nursing & Rehab

640 Sand Hill Road Point Pleasant WV 25550

Skilled nursing facility Part I, Line 3c: All uninsured (private pay) patients receive a 20% discount. There is an additional 20% prompt pay discount. Part I, Line 7: The cost of charity care and unreimbursed Medicaid were estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H Instructions.The cost of (1) community health improvement services and community bnefit operations, (2) health professions education, and (3) cash and in-kind contributions was obtained from the hospital's accounting records. 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 $ 8099911. Part II: Our weight loss challenge gives the community the ability to use our wellness services. Our wellness services include cardio and weight lifting machines and certified exercise physiologists. Blood pressure, weight, body fat were monitored before the challenge and after the challenge. This promotes a healthy lifestyle in the community. Mason County is a medically underserved area and the hospital spends money for recruitment for this area. The amount shown for workforce development is the amount paid to recruit new physicians to the area. How these activities promote the health of the communities served Part II - Community Building Activities Representation on boards of coalitions that build community capacity and share ideas. 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.Cost of bad debts was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. Part III, Line 8: Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions. Part III, Line 9b: The organization's collection policies do not apply to patients that are known to qualify for financial assistance. Additionally, the organization has a separate Financial Assistance policy; patients who qualify for assistance under the policy do not receive a bill. Pleasant Valley Hospital Part V, Section B, Line 3: First account perspectives were obtained from key community representatives through three different modes. These are: surveys, personal interviews and a focus group. The focus group was conducted on March 14, 2013 at the hospital. The focus group represented nine different community organizations plus various community representatives. The individuals who participated in the focus group are as follows: 1. City Dept. of Point Pleasant, WV / Mayor - Point Pleasant, 2. City Department of Point Pleasant, WV / City Clerk, 3. Early Education Station / Director, 4. Family Resource Network / Executive Director, 5. Mason County Health Department / Representative, 6. Mason County Schools / Director, 7. Mason County Commission / Commissioner, 8. Mason County Healthy Families / Supervisor, 9. Pleasant Valley Hospital / Director of Marketing, 10. Pleasant Valley Hospital / Radiologist, and 11. Prestera Ctr. / Clinical Psychologist. Pleasant Valley Hospital Part V, Section B, Line 14g: The policy is discussed with patients before they are discharged. Copy of the policy is provided to patients prior to discharge. Pleasant Valley Hospital Part V, Section B, Line 20d: Charges to bill patients are based on income level, asset level, and medical indigence. These were for patients who qualified for financial assistance. The Hospital also gave self-pay patients prompt pay discounts of gross charges. Patients were not denied financial assistance because the applications were incomplete. The applications were put on hold until the missing information was obtained. Part VI, Line 2: The Hospital participates in the State of West Virginia Abeyance program. We prepare reports for this program identifying our community benefit programs. This information is reported to the West Virginia Healthcare Authority which makes its records available to the public. Part VI, Line 3: The organization informs and educates patients about their eligibility for assistance by: (1) providing a copy of the policy, or a summary thereof, and financial assistance contact information to patients as a part of the intake process; (2) including the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and (3) discussing with the patient the availability of various government benefits, such as Medicaid or state programs, and assisting the patient with qualification for such programs, where available. Part VI, Line 4: Pleasant Valley Hospital is a rural hospital in Point Pleasant, WV. Pleasant Valley Hospital serves mainly the people of Mason and Jackson County, WV and Meigs and Gallia County, OH. We are a federally designated medically underserved area. Mason County has 27,179 residents, the median household income is $36,468, and 17.8% are below poverty levels. Jackson County has 29,234 residents, the median household income is $43,191, and 16.7% are below poverty levels. Meigs County has 23,593 residents, the median household income is $33,708, and 21.3% are below poverty levels. Gallia County has 30,708 residents, the median household income is $36,918 and 20% are below poverty levels. Medicaid patients made up 23.8% of our total discharges and 16.3% of our total outpatient visits in FY 2012. Uninsured patients made up 4.6% of our total discharges and 4.3% of our total outpatient visits in FY 2012. There is one other not-for-profit hospital within 15 miles of PVH. They serve many of the same areas that we do. Part VI, Line 5: The majority of the organization's governing body is comprised of persons who reside in the organization's primary service area, who are neither employees nor contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community. The hospital provides a 24 hour emergency room and is available to all regardless of the ability to pay. All the services provided by the hospital are provided regardless of the ability to pay. The hospital has an auxiliary that helps our patients and visitors if they need a wheelchair when they arrive or if they need directions on where to go within the Hospital. The hospital provides Breast Cancer Screenings/Mammograms free to patients who cannot pay for the service. The hospital has a fitness center for the community and it also conducts many health fairs throughout the year. The hospital provides many health screenings throughout the year in addition to a nutritional program. Our SNF provides transportation for its residents to health facilities. The hospital has support groups for members of the community. The hospital donates money to the community for various projects. 1 Mason County Board of Education 1200 Main Street Point Pleasant WV 25550 556000353 501(c)(3) 10000 High school athletic program support, kids expo Mason County Fair Inc PO Box 334 Point Pleasant WV 25550 550628521 501(c)(3) 6539 Support of fair activities 2 X X 1 1 X X X X 1 0 0 0 0 0 0 0 0 Thomas E Schauer 183407 0 101 0 0 0 7828 0 13505 0 204841 0 0 0 William A Barker Jr 160224 0 101 0 0 0 6665 0 13505 0 180495 0 0 0 Ori Tzuk 525138 0 92201 0 0 0 11697 0 13505 0 642541 0 0 0 James Toothman 566980 0 101 0 0 0 11697 0 13505 0 592283 0 0 0 Clifford Roberson 529228 0 25601 0 0 0 11697 0 5335 0 571861 0 0 0 Robert Lewis 399418 0 133723 0 0 0 11697 0 13505 0 558343 0 0 0 Stephen Rerych 425769 0 101 0 0 0 11697 0 13505 0 451072 0 0 0 Part I, Line 4a Thomas Schauer $46,250 A The County Commission of Mason County WV 556000352 575194BM6 2003-06-17 7805000 To refund Series 1993 bonds 0 0 0 B The County Commission of Mason County WV 556000352 575194CH6 2006-10-12 3895000 Capital improvements & equipment acquisition 0 0 0 A 2630000 7805000 7021907 156100 626993 2003 0 0 1 1 B 1960000 3895000 389500 77900 3427600 2008 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 Lee Anne Kayser Family member of C. Dallas Kayser, Hospital Trustee 47365 Wages 0 Carrie Dillard MD Family member of James Lockhart, Hospital trustee 62888 Wages 0 Heather Lloyd Family member of James Lockhart, Hospital Trustee 32541 Fees for service-independent contractor 0 Jane Zirkle Family member of Mike Lieving, Hospital Trustee 22693 Wages 0 Wes Lieving DO Family member of Mike Lieving, Hospital Trustee 234434 Wages 0 Peoples Bank James Lockhart, Hospital Trustee, is a board member of the bank 810 Interest bearing checking accounts 0 Peoples Bank Dorsal Keefer, Hospital Truste, is a board member of the bank 810 Interest bearing checking accounts 0 Peoples Bank R. Michael Shaw, Hospital Trustee, is a board member of the bank 810 Interest bearing checking accounts 0 Ohio Valley Bank Mario Liberatore, Hospital Trustee, is an officer of the bank 44 Interest on certificates of deposit 0 Ohio Valley Bank Lannes Williamson, Hospital Trustee, is a board member of the bank 44 Interest on certificates of deposit 0 Farmers Bank Michael Lieving, Hospital Trustee, is an officer of the bank 7356 Interest on certificates of deposit 0 Carrie Dillard MD Family member of James Lockhart, Hospital Trustee 10000 Matching grant funds received to pay student loans. The hospital is in a federally designated medically underserved area. To aid in physician recruitment, the hospital received grant funds. The grant funds were paid directly to the educatinal institution. 0 Form 990, Part VI, Section A, line 2 Dallas Kayser, Charles Lanham, and Michael Shaw have a business relationship. Mario Liberatore and Lannes Williamson have a business relationship. Dallas Kayers's spouse and James Rossi have a business relationship. Form 990, Part VI, Section B, line 11 The 990 is prepared by the Hospital's independent accountants. It is then reviewed by the CFO and CEO and a copy is provided to the governing board before it is filed with the IRS. Form 990, Part VI, Section B, line 12c Each board member fills out a questionnaire at the end of the fiscal year. The questionnaire has questions on it that determine independence status and other relationships between board members and between the board member and the hospital. This helps in determining possible conflicts that may arise. In addition, the board members must sign a conflict of interest policy that requires them with due diligence to state that they have a conflict of interest when that conflict arises. The board member must leave the board meeting during discussions and voting. Form 990, Part VI, Section B, line 15 The compensation committee is made up of independent board members. These members are appointed by the board. The compensation committee decides the compensation of the CEO and VPs. The compensation committee consults with an independent consultant to determine a fair compensation for the CEO and VPs based on peer data. The Compensation committee has used this study to determine base salary for the CEO and VPs. The CEO contract is taken back to the board for final approval. Form 990, Part VI, Section C, line 19 These documents are available upon request for inspection at the hospital or by mailing a copy upon request. Pleasant Valley Hospital Foundation Inc 2420 Valley Dr Pt Pleasant WV 25550 200120079 Fundraising WV 501(c)(3) Line 9 N/A 0 Pleasant Valley Hospital Health Foundation Inc 2420 Valley Dr Pt Pleasant WV 25550 550649849 Scholarships/Healthcare WV 501(c)(3) Line 11b, II N/A 0 Pleasant Valley Home Medical Equipment Viand St Pt Pleasant WV 25550 550653315 Retail - Medical equipment sales & rental WV Pleasant Valley Hospital C -180345 1741304 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0