2014-08-11T10:28:11-05:00 2013-09-30 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2012-10-01 550404900 Herbert J Thomas Memorial Hospital Association HERB 3047663528 4605 MacCorkle Avenue SW South Charleston WV 25309 Charles O Covert 3047663528 2014-08-08 1 Dale Carpenter P00189642 3043460441 2012 2015-11-30 17:44:51Z Thomas Memorial Hospital Stephen P Dexter 4605 MacCorkle Avenue SW South Charleston WV 25309 186764618 0 X www.thomaswv.org X 1946 WV To provide health care services to residents of South Charleston, WV and surrounding communities. 9 6 1519 152 18956 14081 586972 652072 166250434 168904095 1276389 1857041 2725841 2806627 170839636 174219835 132462 96956 0 0 70991385 74370004 0 0 0 106181675 108829881 177305522 183296841 -6465886 -9077006 220262039 216987149 172612781 160173476 47649258 56813673 To provide health care services to residents of South Charleston, WV and surrounding communities. 0 0 180367933 96956 168904095 Services provided by the hospital include 48,375 inpatient days and 177,036 outpatient visits. 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 forgone for charity amounted to $4,739,166. The hospital provided community education activities and sponsors free health screening and wellness programs. 180367933 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 0 0 0 0 0 0 0 0 1 1 1 0 0 1 158 0 1 1519 1 1 1 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Charles O Covert 3047663528 4605 MacCorkle Ave SW South Charleston WV 25309 Larry Bissett 1.00 1.00 X 0 0 0 Daniel J Lauffer 1.00 40.00 X 0 406733 29044 Jeffrey Holmes MD 1.00 X 0 0 0 Donna Panucci DDS 1.00 X 0 0 0 Steve White 1.00 1.00 X 0 0 0 Dennis Sutton 1.00 1.00 X 0 0 0 Matthew MacCallum DO 1.00 X 25920 0 0 John Neville MD 1.00 X 18000 0 0 Darren Harris MD 1.00 X 0 0 0 Stephen P Dexter 40.00 X 691478 0 37336 Charles O Covert 40.00 X 295439 0 26477 Robert J Gray 40.00 X 278502 0 26245 Cynthia W Barnette 40.00 X 274416 0 26224 Tarek Anderson 40.00 X 292945 0 22499 Magdaleno Nucum 40.00 X 170829 0 20322 Paul Stobie 40.00 X 301571 0 22499 Ken Priddy 40.00 X 167673 0 20235 Rodney Dean 40.00 X 380000 0 0 2896773 406733 230881 35 0 1 0 Professional Anesthesia Services 110 Roane St Charleston WV 25302 Anesthesia service 1553300 HMP of Kanawha County PO Box 645037 Cincinnati OH 452645037 Hospitalist physicians 1080375 Advanced Technical Solutions 107 Erskine Lane Scott Depot WV 25560 Information systems consulting 967038 Tri-State Roofing PO Box 1231 Charleston WV 25324 Construction 935158 Neighborgall Construction 1216 Seventh Avenue Huntington WV 25701 Construction 921333 35 652072 652072 Patient services 622110 168904095 168904095 168904095 557857 18956 538901 1537920 0 1537920 1537920 1537920 13297501 546466 12002639 542144 1294862 4322 1299184 1299184 Cafeteria & vending 722212 519156 519156 Parking 812930 232975 232975 Laboratory outreach 900099 119965 119965 396611 396611 1268707 174219835 168904095 18956 4644712 96956 96956 1777651 1743520 34131 53595565 52566530 1029035 7368349 7226877 141472 7775535 7626245 149290 3852904 3778928 73976 104192 104192 213394 213394 48000 48000 11075671 10863018 212653 223736 219440 4296 12609902 12367792 242110 4053024 3975206 77818 4016660 3939540 77120 123024 120662 2362 6156531 6038326 118205 10903465 10694118 209347 5251008 5150189 100819 Medical supplies 26940324 26940324 Bad debts 18751433 18751433 Healthcare provider tax 3894816 3894816 Sales & use taxes 1977183 1939221 37962 2487518 2434792 52726 183296841 180367933 2928908 0 353213 508867 26936639 11017623 15601841 15707448 3336044 3814848 1313792 1644214 292966933 164804987 132859329 128161946 35295065 50912351 555126 456916 4010990 4762936 220262039 216987149 14959630 15576716 127756 109097 101098724 101358016 91600 34593 56335071 43095054 172612781 160173476 X 47649258 56813673 47649258 56813673 220262039 216987149 X -9077006 1139625 17101796 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 13703 1 48000 0 0 61703 0 Explanation of Lobbying Activities: Part II-B, Line 1: Line 1f: A portion of dues paid by the hospital to the American Hospital Association and the West Virginia Hospital Association is attributable to lobbying. 11229437 11229437 150403455 63152696 87250759 119932665 97823323 22109342 11401376 3828968 7572408 128161946 Accrued pension benefits 21300227 Estimated malpractice liability 12349549 Estimated third party settlements 1543975 Capital lease obligations 3132881 Accrued interest payable 4768422 43095054 1 1 X 1 X 0 1 1 1 0 1 1 1793774 0 1793774 0.01090 26979044 18651601 8327443 0.05060 28772818 18651601 10121217 0.06150 3334 0 3334 0.00000 96956 0 96956 0.00060 100290 100290 0.00060 28873108 18651601 10221507 0.06210 0 7097417 39464425 40300206 -835781 X 1 0 1 1 Thomas Memorial Hospital

4605 MacCorkle Avenue SW South Charleston WV 25309

X X X Herbert J Thomas Memorial Hospital 1 1 X X X X X X X X 12 1 1 1 X X X X X X 0 0 1 1 200.000000000000 0 1 X X X X 1 1 X X 1 0 X 1 X 0 0 Part I, Line 3c: All uninsured (private pay) patients receive a 20% discount. There is an additional 20% prompt pay discount. Part I, Line 6a: Kanawha Coalition For Community Health Improvement, PO Box 1547, Charleston, WV 25326. Part I, Line 7: The cost of charity care and unreimbursed Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The cost of community health improvement services and community benefit operations was calculated based on the hospital's accounting records.The amount of cash and in-kind contributions to community groups 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 $ 18751433. Clarification of 'yes' response Part I, 6b The community benefit report was posted on the Hospital's website and hard copies are available. Part III, Line 4: Bad debt expense is described in the consolidated financial statements as follows: 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.The amount of patient charges written off reported on line 2 represents amounts that were actually billed to patients, less any payments subsequently received. For example, if an uninsured patient received the 20% uninsured discount and subsequently made only partial payment, the amount written off would be the discounted amount less the subsequent payment. Part III, Line 8: Medicare costs were obtained from the Hospital's Medicare cost report. 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. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 3: The Coalition conducted a randomized home telephone survey, conducted interviews with professional representatives of key sectors of the community, conducted focus groups with under-represented populations, and held a health issues forum. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 4: St. Francis Hospital, Charleston Area Medical Center, Highland Hospital, Women & Children's Hospital Herbert J. Thomas Memorial Hospital Part V, Section B, Line 7: Due to limited financial resources, not all needs identified have been addressed. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 11: The hospital provides a 20% discount to individuals who do not have commercial insurance coverage and who do not qualify for Medicare, Medicaid, or free care. An additional 20% prompt pay discount is provided to patients who pay at the time service is rendered. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 18e: If a private pay patient presents to the Hospital for a scheduled procedure, prior to the procedure the patient is screened for Medicaid or any other type of third-party payor. If the patient does not qualify for any of the previous mentioned procedures and the procedure is deemed medically necessary then the patient is given a financial assistance application. If a patient comes through the Emergency Room or is admitted to the Hospital, the patient is screened by a third party organization to determine if they qualify for Medicaid or any other payor. If they are found ineligible for the previous mentioned programs, they are handed a financial assistance application. With every statement the patient receives, the financial assistance application is on the back of the statement. Herbert J. Thomas Memorial Hospital Part V, Section B, Line 20d: The hospital analyzed its reimbursements from commercial insurance carriers and determined that reimbursement was approximately 80% of charges. The hospital provides a 20% discount to all patients who do not have commercial insurance and who do not qualify for Medicare, Medicaid, or financial assistance. The report was posted on the Hospital's website and hard copies are available. Part VI, Line 2: The hospital is a member of the Kanawha Coalition for Community Health Improvement. The Coalition conducts a survey every three years to assess health care needs of the community. Results of the survey are presented in a meeting of community leaders and other interested persons, and are conveyed to the general public by local media. Results of the most recent survey were releas0ed in 2012. 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: The organization's geographic service area includes approximately 476,000 persons in a 12 county area of south-central West Virginia. Heart disease, cancer and pulmonary disease are the leading causes of death in the service area. Patients in the service area are typical of West Virginia as a whole. The population served is 48% male, 52% female. Approximately 20% of residents in the area have no healthcare insurance coverage and no family doctor or other healthcare provider. Except for the area within the Charleston, WV city limits, all of the counties in the organization's geographic service area are federally-designated Medically Underserved and Health Manpower Shortage Areas. Part VI, Line 5: All members of the hospital's Board of Directors reside in the local community. The hospital extends medical staff privileges to all qualified physicians in the community who meet specific credentialing criteria. The hospital's 24 hour emergency room is available to all persons, regardless of ability to pay. The hospital prepares its budget to ensure adequate funding for capital improvements that are made on an on-going basis. During the year, the hospital received $586,972 in contributions. These contributions enabled the hospital to fund its capital improvements and to provide financial assistance to individuals unable to pay for some or all or their care. Part VI, Line 6: The hospital, along with St. Francis Hospital, is part of Thomas Health System, Inc. The health system was formed to forge a partnership based on the strength of the two established hospitals. Bringing the two hospitals under the umbrella of the Thomas Health System allows them to provide innovative and cost-effective health care services to the Kanawha Valley and surrounding areas. Economies of scale have allowed for cost reductions in numerous areas, while providing advanced technology to a larger community, with access to the highest quality of physicians, nurses and support staff in our service area. The system provides a wide range of services that serves the entire community. 1 West Virginia Symphony Orchestra Inc PO Box 2292 Charleston WV 25328 550339426 501(c)(3) 20000 Sponsorship of events WV Health Right 1520 Washington St East Charleston WV 25311 311066881 501(c)(3) 30000 Support of indigent clinic American Heart Association 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 12500 Annual gala sponsorship 3 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Organization does not consider monitoring the use of grant proceeds a necessity as the organizations receiving the grants all receive audited financial statements. X X X X 0 0 0 0 0 0 0 0 0 Daniel J Lauffer 0 317758 0 79375 0 9600 0 10342 0 20697 0 437772 0 0 Stephen P Dexter 528768 0 129600 0 33110 0 6875 0 30461 0 728814 0 0 0 Charles O Covert 256518 0 36008 0 2913 0 6665 0 24996 0 327100 0 0 0 Robert J Gray 236072 0 38925 0 3505 0 6433 0 25435 0 310370 0 0 0 Cynthia W Barnette 234292 0 39153 0 971 0 6412 0 25032 0 305860 0 0 0 Tarek Anderson 292945 0 0 0 0 0 6875 0 16506 0 316326 0 0 0 Magdaleno Nucum 170829 0 0 0 0 0 4698 0 16200 0 191727 0 0 0 Paul Stobie 301571 0 0 0 0 0 6875 0 16506 0 324952 0 0 0 Ken Priddy 167673 0 0 0 0 0 4611 0 17400 0 189684 0 0 0 Rodney Dean 380000 0 0 0 0 0 0 0 0 0 380000 0 0 0 A West Virginia Hospital Finance Authority 621256910 956622XRO 2008-06-30 94030170 Capital expenditures and equipment purchases 0 0 0 A 1477509 92695993 7223714 10534952 1489249 73448078 2010 1 0 1 1 A 0 1 1 1 0 0.03000 0.03000 0 0 0 A 0 0 1 0 0 0 1 Trinity Plus Funding 1 0 0 Form 990, Part VI, Section A, line 6 Thomas Health System, Inc., a nonprofit corporation organized under the laws of the State of West Virginia, is the sole member of the organization. Form 990, Part VI, Section A, line 7a The organization's board of directors is elected by its sole member, Thomas Health System, Inc. Form 990, Part VI, Section B, line 11 Thomas Health System, Inc. (the System) is the sole member of the organization. The System's finance committee is responsible for financial management of the organization. The 990 is reviewed by the organization's CFO and the chairman of the finance committee. The 990 is then discussed with the System's finance committee and a copy is provided to all board members before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with our written conflict of interest policy by asking annually that all Trustees, officers and employees (managers) who have decision making/purchasing authority disclose any potential conflicts of interest. Disclosure forms are signed annually then logged onto a spread sheet that identifies any potential conflicts. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee, comprised of members who are free of any conflicts of interest, adheres to a disciplined process for reviewing compensation for senior executives to ensure that the compensation is reasonable. The Committee has retained an independent consulting and advisory firm, Yaffe & Company, to provide appropriate market data as to comparability. The Committee reviews comparability data and other relevant evidence and approves the compensation of senior executives; provided, however, that in the case of the CEO, the Board, after review of the comparability data and other relevant evidence, including a recommendation from the Committee, has the final approval with regard to the CEO's compensation. Only those Board members who are free of conflicts of interest vote on the CEO's compensation. All compensation decisions, including the comparability data reviewed and any other relevant information considered, are contemporaneously documented in meeting minutes. Form 990, Part VI, Section C, line 19 The Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon request. These documents are maintained in the administrative offices of the hospital and are provided via copy upon request. The documents also can be reviewed on site at the hospital upon advance notice. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Defined benefit pension plan adjustment 17,719,947. Equity transfer to related exempt organization -618,151. Explanation of amounts reported Schedule K On June 30, 2008, the West Virginia Hospital Finance Authority issued $148,920,000 Hospital Improvement Revenue Bonds Series 2008 on behalf of Thomas Health System, Inc. Thomas Health System, Inc. is the sole member of Herbert J. Thomas Memorial Hospital Association (Thomas Memorial Hospital) and Charleston Hospital, Inc. dba St. Francis Hospital. Bond proceeds, and related liability, were allocated between the two hospitals. Total proceeds of the issue reported in Part II, line 3 are net of bond discount in the amount of $1,333,842. Thomas Health System Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 260440674 Corporate office WV 501(c)(3) Line 3 N/A 0 St Francis Hospital 333 Laidley St Charleston WV 25301 611272692 Hospital WV 501(c)(3) Line 3 Thomas Health System Inc 0 THS Physician Partners Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 454395947 Medical services WV 501(c)(3) Line 3 Thomas Health System Inc 0 TMH Services Inc 437 Division Street Ste 311 South Charleston WV 25309 550676607 Equipment sales, rental and related services, vending sales WV Thomas Memorial Hospital C -7625 5527019 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 TMH Services Inc P 111503 FMV - Cash TMH Services Inc Q 92509 FMV - Cash