2013-04-25T08:38:20-05:00 2012-06-30 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2011-07-01 550387249 Weirton Medical Center Inc WEIR 3047976000 601 Colliers Way Weirton WV 260625014 Robert Frank 3047976000 2013-03-27 1 Harry C Harless P01042847 3043460441 2011 2016-03-07 17:11:31Z Weirton Medical Center Charles O'Brien 601 Colliers Way Weirton WV 260625014 119502747 0 X www.weirtonmedical.com X 1949 WV Weirton Medical Center, in partnership with physicians, will lead the tri-state area in the provision of coordinated, safe, effective, quality healthcare services through a process of teamwork, innovation, and continuous improvement. 11 9 1147 72 2747 0 156988 833695 93068659 88606006 1717938 1809696 981632 862430 95925217 92111827 0 0 0 0 46957455 50194205 0 0 0 50227379 51986697 97184834 102180902 -1259617 -10069075 80476335 75258936 51386584 63629181 29089751 11629755 Weirton Medical Center, in partnership with physicians, will lead the tri-state area in the provision of coordinated, safe, effective, quality healthcare services through a process of teamwork, innovation, and continuous improvement. 0 0 95794243 88435407 The medical center provided inpatient, outpatient, emergency, psychiatric, home health, physician and skilled nursing services including 31,948 inpatient days, 185,859 outpatient visits, 38,181 emergency room visits and 9,438 home health visits. Charges foregone for charity amounted to $1,797,155. 78590 170599 Abeyance reduction program including 45 programs at local schools, businesses, churches and in-house designed to provide community benefits including health fairs, BPW and laboratory blood analysis, health clinics, cholestoral screening, presentation to WV HFMA, and other health related events. 95872833 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 86 0 1 1147 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA NY NC X Kellie Henwood 3047976440 601 Colliers Way Weirton WV 26062 Joseph P Endrich 40.00 X X 359808 0 16544 James R Shockley 10.00 X 0 0 0 Michael Wehr 4.00 X 0 0 0 John J York 4.00 X 0 0 0 Jon M Rogers 8.00 X 0 0 0 Charles M O'Brien Jr 40.00 X X 0 0 0 Richard Ajayi 8.00 X 6936 0 0 William R Kiefer 2.00 X 0 0 0 Art L Miser Jr 2.00 X 0 0 0 David L Snyder 4.00 X 0 0 0 John A Spadafora 2.00 X 0 0 0 Sondra Weigel 2.00 X 0 0 0 Keith Bravo 40.00 X 597615 0 25476 Craig Oser 40.00 X 375442 0 5275 Lisa Noble 40.00 X 297636 0 5600 Stephen Alatis 40.00 X 502969 0 9901 Carl Jones 40.00 X 273072 0 924 2413478 0 63720 24 0 1 0 Siemans Medical Solutions I PO Box 7777 W 3580 Philadelphia PA 19175 Equipment maintenance 2665009 R & V Associates 310 Grant St Suite 1120 Pittsburgh PA 15219 Consulting agency 628801 Quorum Health Resources 105 Continental Place Blvd Brentwood TN 37027 Consulting agency 598913 ARUP PO Box 27964 Salt Lake City UT 84127 Lab 445157 Central Blood Bank PO Box 3475 Pittsburgh PA 15230 Lab 438492 36 768557 65138 833695 Health care services 622110 88606006 88606006 88606006 1303605 2747 1300858 373707 0 373707 373707 373707 27897011 27390920 506091 506091 506091 Cafeteria & Vending In 722100 434282 434282 Insurance Reimbursemen 900099 32871 32871 Medical Records 900099 9036 9036 12534 12534 488723 92111827 88606006 2747 2669379 476776 439206 37570 37876562 34891889 2984673 1211158 1115719 95439 7389582 6807283 582299 3240127 2984805 255322 38167 38167 227866 227866 92186 92186 13930597 12853533 1077064 3336277 3073378 262899 1622897 1495013 127884 115194 106117 9077 1162617 1071003 91614 2676560 2465647 210913 1230763 1133779 96984 Medical supplies 13122473 13122473 Bad debts 10589342 10589342 Health care provider ta 2327778 2327778 Sales taxes 656628 604886 51742 857352 790982 66370 102180902 95872833 6308069 0 3448144 9202406 14271893 10223703 99989 100931 1092696 1084312 1959708 1579688 95944390 75492729 20181639 20451661 35948395 26700986 1191714 1777475 2282157 4137774 80476335 75258936 11149725 15130900 23745367 22386333 4772254 7075646 11719238 19036302 51386584 63629181 X 29089751 11629755 29089751 11629755 80476335 75258936 X -10069075 -7390921 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124015 124015 47791381 37787058 10004323 211247 211247 0 41434104 35079510 6354594 6383643 2414914 3968729 20451661 Deferred financing costs 259405 Accrued interest receivable 35846 Interest in net assets of Weirton Medical Center Foundation 1294672 Other Receivables 2547851 4137774 Estimated third-party settlements 612137 Estimated malpractice liability 3478296 Accrued pension liability 14945869 19036302 92111827 102180902 -10069075 -578645 -6812276 -7390921 -17459996 82269788 588261 366410 954671 81315117 10796710 10796710 92111827 91591560 0 91591560 10589342 10589342 102180902 Part XI, Line 8 - Other Adjustments: Defined benefit pension plan adjustment -6,971,318. Income per books:Premier Purchasing Partners LP 366,405. Income per K-1:Premier Purchasing Partners LP -207,368. Rounding 5. Total to Schedule D, Part XI, Line 8: -6,812,276. Part XII, Line 2d - Other Adjustments: Income per books:Premier Purchasing Partners LP 366,405. Rounding 5. Part XII, Line 4b - Other Adjustments: Income per K-1:Premier Purchasing Partners LP 207,368. Bad debts netted against revenue 10,589,342. Part XIII, Line 4b - Other Adjustments: Bad debts netted against revenue 10,589,342. 1 1 X 1 X 1 X 1 1 0 1 1 747976 0 747976 0.00820 14550641 10021617 4529024 0.04940 15298617 10021617 5277000 0.05760 38 3493 29962 4070 25892 0.00030 38 3493 29962 4070 25892 0.00030 38 3493 15328579 10025687 5302892 0.05790 0 4407284 20162882 20417594 -254712 X 1 0 1 1 Weirton Medical Center

601 Colliers Way Weirton WV 260625014

X X X Weirton Medical Center 1 0 1 1 200.000000000000 0 0 1 1 X X X X X X 1 X X X 1 X X X X X X X 1 0 0 Part I, Line 3c: Weirton Medical Center is required by law to give a reasonable amount of services without charge to eligible persons who cannot afford to pay for care. Eligibility for financial assistance is based upon US Citizenship, West Virginia Residency and the U.S. Government's Federal Poverty Guidelines. These guidelines are updated each year. A person may qualify for financial assistance if their household income is at or below 200% of the current guidelines. 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. The unreimbursed cost of Medicaid 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 $ 10589342. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. In evaluating the collectability of accounts receivable, the Medical Center analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance of doubtful accounts and provision for bad debts. 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. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. 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. The Medical Center's allowance for doubtful accounts for self-pay patients increased from 76 percent of self-pay accounts receivable at June 30, 2011, to 96 percent of self-pay accounts receivable at June 30,2012 (See final paragraph for more information related to this change in accounting estimate). The increase was the result of negative trends experienced in the collection of amounts from self-pay patients in fiscal year 2012. During 2012 and 2011, the Medical Center's uninsured discount policy was 50% for patients with no third-party coverage and who did not qualify for charity care. The Medical Center does not maintain a material allowance for doubtful accounts from third-party payors, nor did it have significant write offs from third-party payors.In 2012, the allowance for third-party payors and other uncollectible accounts was increased as a result of the Medical Center's retrospective review of self-pay collections and other third-party payors. The effect of this change was to decrease operating income for the year ended June 30, 2012 by approximately $3,700,000, which is included in the net patient service revenue in the accompanying statements of operations and changes in net assets. Part III, Line 8: The organization does not consider the shortfall reported in Medicare revenue to be community benefits since some years have shortfalls and others have overages. The unreimbursed cost of Medicare was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H Instructions. Part III, Line 9b: There is no collection from patients who qualify for charity care. If a patient qualifies, they receive no bill. Part VI, Line 2: Weirton Medical Center conducts a community health needs assessment of the residents of its service area every five years. The assessment results are tabulated and analyzed to determine the health needs. The health needs are then prioritized and a plan is developed to address the needs. Part VI, Line 3: A charity care Policy is posted at all registration areas. All self-patients are seen or called by the financial counselors to see what services can be offered. The patients are screened for charity care and provided education about the state Medicaid application. Part VI, Line 4: Weirton Medical Center serves the counties of Brooke and Hancock in West Virginia, and portions of Washington County in Pennsylvania and Jefferson County in Ohio.Brooke County, West Virginia had a 2014 projected population of 18,564. The median age is 40.6 years and 18.7 percent of the population is age 65 or older. The median household income is $43,361. The December 2011 unemployment rate was 10.2 percent. Brooke County residents make up 26.9 percent of the Medical Center's total patient volume.Hancock County, West Virginia had a 2014 projected population of 31,594. The median age is 44.6 and 20.0 percent of the population is age 65 or older. The median household income is $44,478 and 10.6 percent of the population was unemployed in December 2011. Hancock County residents make up 35.7 percent of the Medical Center's total patient volume.Jefferson County, Ohio had a 2014 projected population of 67,320 with a median age of 45.0 years. The percentage of population that is 65 years or older is 19.5 percent. The median household income is $43,471. The December 2011 unemployment rate was 10.6 percent. Jefferson County residents make up 19.4 percent of the Medical Center's total patient volume.The total service area population was 107,207 in 2009 and is projected to be 102,362 in 2014 - a decline of 4.5 percent. The region is also served by Trinity Health System in Steubenville, Ohio. Patients from the area also use Wheeling Hospital, Ohio Valley Medical Center in Wheeling, and Washington Hospital in Washington, Pennsylvania. Patients also seek medical care from tertiary hospitals located in Pittsburgh, Pennsylvania. 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 or contractors of the organization, nor family members thereof. The organization operates an emergency room available to all, regardless of ability to pay. 1 X X X X 1 0 0 0 0 0 0 0 0 Joseph P Endrich 359808 0 0 0 0 0 1745 0 19528 0 381081 0 0 0 Keith Bravo 597615 0 0 0 0 0 4100 0 25106 0 626821 0 0 0 Craig Oser 375442 0 0 0 0 0 0 0 9005 0 384447 0 0 0 Lisa Noble 297636 0 0 0 0 0 0 0 9330 0 306966 0 0 0 Stephen Alatis 502969 0 0 0 0 0 0 0 10133 0 513102 0 0 0 Carl Jones 273072 0 0 0 0 0 0 0 3284 0 276356 0 0 0 Part I, Line 4a The former CEO, Dr. Endrich received a $24,973.62 severance payment. Weirton Municipal Hospital Building Commission 556000623 2005-06-24 6700000 Capital expenditures, expansion of medical center and technology upgrades 0 0 0 4116870 6700000 6700000 2005 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 Form 990, Part VI, Section B, line 11 The 990 is reviewed by the Director, Finance Director, the CFO and the board before approval is given and it is submitted to the IRS. Form 990, Part VI, Section B, line 12c The board and medical staff executive are required to complete conflict of interest statements annually. The compliance committee oversees the process. Form 990, Part VI, Section B, line 15 A board designated compensation committee is utilized not only for the CEO but for all of senior management. Comparability data is obtained through the Director of Human Resources and a performance evaluation completed. Form 990, Part VI, Section C, line 19 The financial statements are available through the West Virginia Health Care Authority as part of the freedom of information act/sunshine laws and are also published in the legal section of the newspaper annually. The governing documents, conflict of interest policy and financial statements are available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -578,645. Defined benefit pension plan adjustment -6,971,318. Income per books:Premier Purchasing Partners LP 366,405. Income per K-1:Premier Purchasing Partners LP -207,368. Rounding 5. Total to Form 990, Part XI, Line 5: -7,390,921. Tri-State Community Care Network Inc 601 Colliers Way Weirton WV 26052 550731090 Healthcare WV 0 2540 N/A Weirton Medical Center Foundation 601 Colliers Way Weirton WV 26062 550689248 Supporting organization WV 501(c)(3) 11 N/A 0 Weirton Medical Corporation 601 Colliers Way weirton WV 26062 550689267 Supporting organization WV 501(c)(3) 11, Type II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0