2012-08-15T08:09:59-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP PO BOX 1556 MORGANTOWN WV 265071556 990 2010-10-01 550675666 CABELL HUNTINGTON HOSPITAL INC CABE 3045262167 1340 HAL GREER BOULEVARD HUNTINGTON WV 25701 DAVID M WARD 3045262167 2012-08-14 1 SUSAN S DULL 3042927343 2010 2016-02-24 21:20:13Z BRENT MARSTELLER 1340 HAL GREER BLVD HUNTINGTON WV 25701 427318133 0 X WWW.CABELLHUNTINGTON.ORG X 1986 WV TO MEET LIFETIME HEALTHCARE NEEDS OF THOSE SERVED. 17 16 2476 302 64909 19409 71520 89024 358696787 380687573 4584972 5658041 2214806 1985502 365568085 388420140 11053506 11527889 0 0 166016926 169545555 0 0 0 182435197 200188471 359505629 381261915 6062456 7158225 414291810 418415802 310345510 326831402 103946300 91584400 X TO MEET THE LIFETIME HEALTHCARE NEEDS OF THOSE SERVED. TO PROVIDE THE HIGHEST LEVEL OF SERVICE, QUALITY AND EFFICIENCY. TO ADVANCE HEALTHCARE THROUGH EDUCATION. 0 0 349262717 11527889 381142313 IT IS THE MISSION OF CABELL HUNTINGTON HOSPITAL TO PROMOTE HEALTH IN THE REGION THROUGH DEVELOPMENT AND DELIVERY OF A FULL SPECTRUM OF SERVICES THAT IMPROVE THE PHYSICAL, MENTAL AND SPIRITUAL DIMENSIONS OF LIVES OF THOSE SERVED. CABELL HUNTINGTON HOSPITAL IS LICENSED FOR 313 BEDS AND STAFFED 2476 INDIVIDUALS DURING FISCAL YEAR 2011. IN ADDITION TO ITS ADULT AND PEDIATRIC UNITS, IT OPERATES A PEDIATRIC INTENSIVE CARE UNIT, A NEONATAL INTENSIVE CARE UNIT, A BURN INTENSIVE CARE UNIT, A SURGICAL INTENSIVE CARE UNIT, A MEDICAL INTENSIVE CARE UNIT, AND A CORONARY CARE UNIT. IN THE VERY NEAR FUTURE, IT WILL HAVE A FULL CHILDREN'S HOSPITAL UNIT. CABELL HUNTINGTON HOSPITAL IS GOVERNED BY A VOLUNTARY BOARD OF INDEPENDENT CITIZENS OF THE COMMUNITY. ALL EXPENSES FOR PROGRAM SERVICES RELATE TO PROVIDING HEALTHCARE SERVICES TO THE PATIENTS OF CABELL HUNTINGTON HOSPITAL. DURING FISCAL YEAR 2011, THE ORGANIZATION PROVIDED SERVICES TO 18,770 INPATIENTS, WHICH RESULTED IN PROVIDING 81,373 DAYS OF CARE. THE ORGANIZATION ALSO PROVIDED CARE TO 447,316 OUTPATIENTS. THIS INCLUDED 59,247 PATIENT VISITS TO THE ORGANIZATION'S EMERGENCY ROOM, WHICH IS OPERATED 24 HOURS AND IS OPEN TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IT ALSO PROVIDED AN ADDITIONAL 15,871 OUTPATIENT SURGICAL PROCEDURES AND 17,254 HOME HEALTH VISITS. ALTHOUGH REIMBURSEMENT FOR THE SERVICES INDICATED ABOVE IS VITAL TO THE CONTINUING FINANCIAL STABILITY OF THE ORGANIZATION, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR THEIR CARE. ACCORDINGLY, THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET ITS CHARITY ESTABLISHED RATES. IN FISCAL YEAR 2011, THE ORGANIZATION PROVIDES $25,083,295 OF UNCOMPENSATED CARE, WHICH REPRESENTS 2.9% OF ITS TOTAL PATIENT REVENUE. THE ESTIMATED COST OF PROVIDING THIS UNCOMPENSATED CARE WAS $11,358,294. THE ORGANIZATION ALSO PROVIDES SERVICES TO PATIENTS WITH SPECIAL NEEDS AND LOW INCOME THROUGH ITS OBSTETRIC CLINIC. THIS CLINIC PROVIDES EDUCATION AND SUPPORT TO EXPECTANT MOTHERS WHO MIGHT OTHERWISE HAVE INSUFFICIENT OR NO PRENATAL CARE.THE ORGANIZATION CONTRIBUTED $50,004 TO THE EBENEZER OUTREACH CENTER FOR COMMUNITY PHARMACY SUPPLIES WHICH PROVIDES FREE MEDICATION FOR THOSE WHO QUALIFY. THE ORGANIZATION ALSO PARTNERS WITH THE EBENEZER MEDICAL OUTREACH CENTER TO PROVIDE FREE MEDICAL TESTING FOR THE LOCAL INDIGENT POPULATION. DURING THE FISCAL YEAR 2011, THE ORGANIZATION PROVIDED $258,608 IN FREE MEDICAL TESTS, WHICH IS INCLUDED IN THE UNCOMPENSATED CARE NOTE ABOVE.AS A CONTINUED SUPPORT TO A PROGRAM ESTABLISHED THE PRIOR YEAR, THE ORGANIZATION CONTRIBUTED $65,087 TO HUNTINGOTN'S KITCHEN WHICH IS OPERATED BY EBENEZER OUTREACH CENTER AND PURPOSE IS TO OFFER FREE AND LOW COST HEALTHY COOKING LESSONS TO ANYONE IN THE COMMUNITY. THIS PROJECT IS INTENDED TO PROMOTE HEALTHY EATING HABITS TO THE COMMUNITY.THE ORGANIZATION OFFERS A VARIETY OF EDUCATION CLASSES, HEALTH FAIRS, AND HEALTH SCREENINGS TO THE PUBLIC THROUGHOUT THE YEAR AT NO CHARGE. SERVICES OFFERED AND COSTS TO THE ORGANIZATION FOR FISCAL YEAR 2011 TOTALED AS FOLLOWS: EDUCATION $182,660; SCREENINGS $16,685; HEALTH FAIRS $11,271 AND ADDITIONAL COMMUNITY OUTREACH $14,889.THE ORGANIZATION'S SOCIAL WORK DEPARTMENT PROVIDED MEDICATIONS FOR THOSE UNABLE TO AFFORD THE MEDICINES PRESCRIBED BY THE ORGANIZATIONS EMERGENCY ROOM PHYSICIANS. ADDITIONALLY, THE DEPARTMENT PROVIDES CAR SEATS FOR INFANTS WHOSE FAMILIES CANNOT AFFORD THEM. THE DEPARTMENT ALSO DONATED INFANT CAR SEATS FOR NEONATES WHO WERE TOO SMALL FOR NORMAL CAR SEATS.THE ORGANIZATION'S DIETITIANS PROVIDED FREE DIETARY INSTRUCTIONS FOR OUTPATIENTS WHO COULD NOT AFFORD THE NOMINAL COST. THE ORGANIZATION PROVIDED FREE MEALS TO FAMILY MEMBERS OF PATIENTS THAT WERE UNABLE TO RETURN HOME FOR MEALS OR FAMILY MEMBERS OF PATIENTS WHO LIVED OUTSIDE A 30 MILE RADIUS OF THE HOSPITAL AND WERE UNABLE TO PAY FOR THESE MEALS.THE ORGANIZATION'S VOLUNTEER DEPARTMENT PROVIDED FREE WIGS TO INDIGENT CANCER PATIENTS. 349262717 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 56 0 1 2476 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WV X DAVID M WARD SENIOR VPCFO 3045262000 1340 HAL GREER BOULEVARD HUNTINGTON WV 25701 DAVID PORTER 2.00 X X 0 0 0 CAROLYN BAGBY 2.00 X X 0 0 0 DAVID FOX III 2.00 X X 0 0 0 FLOYD HARLOW JR 2.00 X X 0 0 0 PETER CHIRICO 2.00 X 0 0 0 MARIAN COX 2.00 X 0 0 0 TIM KINSEY 2.00 X 0 0 0 TIM MILLNE 2.00 X 0 0 0 SAMUEL MOORE 2.00 X 0 0 0 CHARLES MCKOWN 2.00 X 0 0 0 GERALD OAKLEY 2.00 X 0 0 0 ALAN MORRISON 2.00 X 0 0 0 ROSS PATTON 2.00 X 0 0 0 CLARA SADLER 2.00 X 0 0 0 JIM SCHNEIDER 2.00 X 0 0 0 VICKIE SMITH 2.00 X 0 0 0 STEVEN BURTON 2.00 X 0 0 0 BRENT MARSTELLER 45.00 X 632453 0 93291 DAVID M WARD 45.00 X 288875 0 137148 GLEN WASHINGTON 45.00 X 240457 0 50993 HOYT BURDICK 45.00 X 295556 0 98364 PAUL SMITH 45.00 X 186133 0 100951 ROSEMARY SMITH 45.00 X 187114 0 110927 BARRY TOURIGNY 45.00 X 195540 0 25431 W MARK TWILLA 45.00 X 172361 0 23929 DAVID GRALEY 45.00 X 189671 0 46826 MICHAEL VEGA MD 45.00 X 365281 0 39325 ALFREDO RIVAS MD 45.00 X 368740 0 53325 MARCOS JAVIER MD 45.00 X 361943 0 19229 MICKEY NEAL MD 45.00 X 427009 0 59298 FAROUK H ABADIR MD 45.00 X 359329 0 59825 4270462 0 918862 121 0 1 0 UNIVERSITY PHYSICIANS & SURGEONS INC 1600 MEDICAL CENTER DRIVE HUNTINGTON WV 25701 MEDICAL SCHOOL 20030059 BAILES CRAIG & YON PO BOX 1926 HUNTINGTON WV 25720 LEGAL FEES 1218076 RADIOLOGY INC PO BOX 910 HUNTINGTON WV 25712 RADIOLOGY SERVICES 999822 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 MEDICAL SERVICES 613775 HOSPITAL HOUSEKEEPING SYSTEMS PO BOX 826 SAN ANTONIO TX 78293 CONSULTING SERVICES 595382 20 89024 89024 NET PATIENT REVENUE 621990 369697431 369697431 LABORATORY INCOME 621500 10030928 9966978 63950 AEROMED INCOME 621990 954402 954402 4812 4812 380687573 2201548 959 2200589 10963 10963 283300 156295 127005 127005 127005 40736095 1451133 38741698 1994397 1451133 3445530 3445530 CAFETERIA 624200 1466812 1466812 OUTSIDE SERVICES 621990 310594 310594 81091 81091 1858497 388420140 381142313 64909 7123894 11527889 11527889 2914974 582995 2331979 118802727 106922454 11880273 14996826 13497143 1499683 24187041 21768337 2418704 8643987 7779588 864399 1046022 1046022 239464 239464 292522 292522 34038557 33698171 340386 3339768 3339768 59165145 56471830 2693315 3492357 3317739 174618 15222992 11417244 3805748 257594 180316 77278 6048227 4536170 1512057 17369023 15632121 1736902 6214625 6090332 124293 BAD DEBT 38575799 38575799 MEDICAL EDUCATION 7191597 7191597 PROVIDER TAX 6733224 6733224 961555 961555 381261915 349262717 31999198 0 50467503 70344516 363217 354710 49627212 50337317 5274297 5932843 1900983 1162003 369155849 187628507 192138747 181527342 75684400 77174615 12957302 14692458 25878149 16889998 414291810 418415802 57632916 60147855 128103450 124543324 6848625 7284444 117760519 134855779 310345510 326831402 X 82485205 71425578 21461095 20158822 103946300 91584400 414291810 418415802 X 7158225 -19520125 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6415591 6415591 184511648 28254928 156256720 164390672 158213186 6177486 13837938 1160393 12677545 181527342 ACCRUED PROFESSIONAL LIABILITY 13748000 ACCRUED POST RETIREMENT BENEFITS COST 114975185 DEFERRED GAIN 5687929 OTHER LIABILITIES 444665 134855779 388420140 381261915 7158225 -5109574 -4615 -14405936 -19520125 -12361900 372624414 -5109574 -10842447 -15952021 388576435 -156295 -156295 388420140 383679428 2710035 2710035 380969393 292522 292522 381261915 PART XI, LINE 8 - OTHER ADJUSTMENTS: DECREASE IN PENSION LIABILITY -13,543,557. CHANGE IN EFFECTIVE INTEREST RATE SWAP -2,553,740. ASSETS RELEASED FROM RESTRICTION FOR CANCER CENTER 1,691,361. PART XII, LINE 2D - OTHER ADJUSTMENTS: DECREASE IN PENSION LIABILITY INCLUDED IN REVENUE ON AFS -13,543,557. INVESTMENT MANAGEMENT FEES NETTED WITH REVENUE ON AFS -292,522. ASSETS RELEASED FROM RESTRICTION FOR CANCER CENTER 2,993,632. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH REVENUE ON FORM 990 -156,295. PART XIII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN EFFECTIVE INTEREST RATE SWAP INCLUDED IN EXPENSES ON AFS 2,553,740. RENTAL EXPENSES NETTED WITH REVENUE ON FORM 990 156,295. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES NETTED WITH REVENUE ON AFS 292,522. PART X, LINE 2 - FIN 48 FOOTNOTE: THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ISSUED ACCOUNTING GUIDANCE THAT PRESCRIBES A MINIMUM RECOGNITION THRESHOLD A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. IT ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICIATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. FUTURE INTEREST AND PENALTIES ATTRIBUTABLE TO INCOME TAXES, IF ANY, WILL BE RECOGNIZED AS A COMPONENT OF THE INCOME TAX PROVISION OR BENEFIT. THE ORGANIZATION RECORDS ANY ACCRUALS FOR UNCERTAIN TAX POSITIONS UNDER ASC 740, INCOME TAXES. THE ORGANIZATION HAD NO ACCRUALS FOR UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2011 AND 2010. 1 1 1 X 1 X 180.000000000000 1 1 1 0 0 16540447 0 16540447 0.04340 95221519 66999118 28222401 0.07400 111761966 66999118 44762848 0.11740 225505 0 225505 0.00060 11412797 2661431 8751366 0.02300 22271709 19319602 2952107 0.00770 402641 10839 391802 0.00100 34312652 21991872 12320780 0.03230 146074618 88990990 57083628 0.14970 32500 32500 0.00010 220290 220290 0.00060 252790 252790 0.00070 0 15082606 784820 91593526 100789539 -9196013 X 1 1 1 1 CABELL HUNTINGTON HOSPITAL

1340 HAL GREER BOULEVARD HUNTINGTON WV 25701

X X X NOT REQUIRED 1 PART II: THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES, AS REPORTED IN PART II, PROMOTE THE HEALTH OF THE COMMUNITY OR COMMUNITIES THE ORGANIZATION SERVES. DURING FY 2011, THE HOSPITAL COMMUNITY OUTREACH EVENTS TOTALED 274, WITH 682 VOLUNTEERS AND OVER 42,000 INDIVIDUALS WITHIN THE COMMUNITIES SERVED. THE HOSPITAL WELCOMES INPUT FROM THE COMMUNITIES AS TO WHICH EVENTS IT SHOULD PURSUE. FUTURE EVENTS ARE DETERMINED BASED UPON THE COMMUNITY NEEDS ASSESSMENT AND OTHER FACTORS. MANY OF THE ACTIVITIES PERFORMED MEET THE CRITERIA FOR COMMUNITY HEALTH IMPROVEMENT SERVICES: A REQUEST FROM A PUBLIC AGENCY OR COMMUNITY GROUP WAS THE BASIS FOR INITIATING OR CONTINUING THE ACTIVITY OR PROGRAM; ACTIVITIES OR PROGRAMS THAT SEEK TO ACHIEVE OBJECTIVES, INCLUDING: IMPROVING ACCESS TO HEALTH SERVICES, ENHANCING PUBLIC HEALTH, AND RELIEF OF GOVERNMENT BURDEN; AVAILABLE TO THE PUBLIC AND SERVE LOW-INCOME CONSUMERS; ADDRESS FEDERAL, STATE OR LOCAL PUBLIC HEALTH PRIORITIES; LEVERAGE OR ENHANCE PUBLIC HEALTH DEPARTMENT ACTIVITIES; AND OTHERWISE WOULD BECOME THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER TAX-EXEMPT ORGANIZATION. SOME OF THE HIGHLIGHTS INCLUDE: A SIGNIFICANT EFFORT TO PROMOTE HEALTHY LIFESTYLES IN THE TRI-STATE REGION BY PARTNERING WITH EBENEZER OUTREACH CENTER TO CONTINUE TO PROMOTE HEALTHY EATING CHOICES. THIS PROJECT CONTINUES WITH HUNTINGTON'S KITCHEN AND ALLOWS RESIDENTS OF OUR AREA TO TAKE HEALTHY COOKING CLASSES TO HELP ELIMINATE SOME OF THE LOCAL HEALTH PROBLEMS. ALONG THE SAME LINES, WE CONTINUE TO PARTNER WITH THE HUNTINGTON MALL TO OPEN A HEALTHY KIDS PLAY PLACE THAT ALLOWS CHILDREN TO HAVE A SAFE AND HEALTHY PLACE TO EXERCISE AND BE REMINDED OF HEALTHY LIFESTYLES. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATION TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. EFFECTIVE OCTOBER 1, 2010, THE ORGANIZATION CHANGED ITS POLICY OF WRITING OFF BAD DEBT PATIENT RECEIVABLES WHENEVER THE PATIENT AGREES TO A PAYMENT PLAN. AS THE ORGANIZATION HAS DEMONSTRATED SUCCESSFUL RESULTS IN COLLECTING RECEIVEABLES FOR PATIENTS WHO HAVE AGREED TO A PAYMENT PLAN, THESE AMOUNTS WILL REMAIN IN PATIENT ACCOUNTS RECEIVABLE AT THEIR ESTIMATED NET REALIZABLE AMOUNTS AND WILL BE EVALUATED AS PART OF MANAGEMENT'S ASSESSMENT OF THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS. THE COSTING METHOD USED FOR LINE TWO IS THE METHOD SUGGESTED IN THE INSTRUCTIONS FOR WORKSHEET 1, FINANCIAL ASSISTANCE AT COST IN THE INTERNAL REVENUE INSTRUCTIONS FOR FORM990 SCHEDULE H. THIS METHOD CALCULATES A COST RATIO BY USING TOTAL OPERATING EXPENSES LESS BAD DEBT AND OTHER EXPENSE ADJUSTMENTS DIVIDED BY GROSS PATIENT REVENUES. THE RATIO IS THEN APPLIED TO BAD DEBT EXPENSE TO GET THE ESTIMATED COST.LINE THREE IS A PERCENTAGE DERIVED BY AN ESTIMATED NUMBER OF PATIENTS WHO START THE FINANCIAL ASSISTANCE PROGRAM AND DO NOT COMPLETE THE PROCESS. THERE ARE A NUMBER OF PATIENTS THAT DO NOT APPLY FOR FINANCIAL ASSISTANCE AND ARE DEFINITELY UNABLE TO PAY FOR THEIR OUT OF POCKET MEDICAL EXPENSES. IF THESE PATIENTS WENT THROUGH THE FINANCIAL ASSISTANCE PROCESS, THEY WOULD QUALIFY. THESE PATIENTS STILL NEED TO BE TREATED AND THIS IS WHY WE BELIEVE THIS SHOULD BE TREATED AS A COMMUNITY BENEFIT. PART III, LINE 8: BECAUSE THE HOSPITAL IS A COMMUNITY BASED TEACHING HOSPITAL AND SERVING THE COMMUNITY WITHOUT REGARD TO ABILITY TO PAY, THIS AMOUNT SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THE EXPENSES ALLOCATED TO THE MEDICARE REVENUE ARE FROM THE UFR REPORT AND ARE ALLOCATED TO CARRIER BY GROSS CHARGE RATIO. PART III, LINE 9B: THE HOSPITAL HAS INFORMATION ABOUT ITS CHARITY CARE POLICY AND APPLICATIONS AVAILABLE IN ALL REGISTRATION AREAS OF THE HOSPITAL AS WELL AS ITS OFFSITE LOCATIONS. THE HOSPITAL EMPLOYS FINANCIAL COUNSELORS WHO VISIT INPATIENTS IN ELIGIBLE FINANCIAL CLASSES TO PROVIDE INFORMATION ABOUT CHARITY CARE AS WELL AS RESPOND TO INQUIRIES FROM OUTPATIENTS REGARDING CHARITY CARE AND PROVIDE ASSISTANCE WITH THE CHARITY CARE APPLICATION PROCESS. PATIENTS CAN COMMUNICATE WITH FINANCIAL COUNSELORS IN PERSON OR BY TELEPHONE, MAIL OR FAX IN ORDER TO LEARN MORE ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND PROVIDE INFORMATION REGARDING THEIR ELIGIBILITY FOR CHARITY CARE. THE HOSPITAL ALSO CONTRACTS WITH MEDICAID ELIGIBILITY SPECIALISTS TO ASSIST THOSE PATIENTS WHO QUALIFY FOR MEDICAID. INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND PROCESS IS POSTED ON THE HOSPITAL'S WEBSITE.IT IS THE RESPONSIBILITY OF THE PATIENT TO MAKE SURE ALL OF THE DOCUMENTATION TO QUALIFY FOR ASSISTANCE IS FILED WITH THE HOSPITAL AND ANY GOVENMENT ASSISTANCE PROGRAMS. IF THEY FAIL TO DO SO, THE PATIENT IS BILLED, AND IN MOST CASES, THEY WILL CALL THE BILLING DEPARTMENT. THE BILLING DEPARTMENT WILL REFER THEM BACK TO A FINANCIAL COUNSELOR TO FINISH THE NECESSARY FILINGS. BILLING WILL BE NOTIFIED IF THE ACCOUNT IS TO BE DISCOUNTED AND/OR SET UP ON A PAYMENT SCHEDULE. IF THE PATIENT FAILS TO FOLLOW THROUGH AT THIS TIME, LASTLY, THE ACCOUNT IS SENT TO THE COLLECTION AGENCY. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY CONDUCTING ITS OWN NEEDS ASSESSMENTS AND CONSULTING WITH COMMUNITY HEALTHCARE PROVIDERS, SUCH AS THE MARSHALL UNIVERSITY JOAN C. EDWARDS SCHOOL OF MEDICINE, AND COMMUNITY AGENCIES. A NEEDS ASSESSMENT WAS PERFORMED DURING FY 2009 AS PART OF THE HOSPITAL'S STRATEGIC PLANNING PROCESS IN ORDER TO IDENTIFY SERVICES NEEDED BY THE COMMUNITY. IN ADDITION, THE HOSPITAL HAS PROVIDED SUPPORT TO COMMUNITY AGENCIES WITH PROGRAMS SUCH AS COMMUNITY PHARMACIES IN ORDER TO MEET COMMUNITY NEEDS THAT THE HOSPITAL IS NOT DIRECTLY ABLE TO MEET. THE SENIOR LEADERSHIP AND/OR BOARD MEMBERS OF THE HOSPITAL PLAY AN ACTIVE ROLE IN THE NEEDS ASSESSMENT AND HAVE REVIEWED THE FINDINGS OF HEALTHCARE NEEDS ASSESSMENTS AND FACTORED THOSE FINDINGS INTO STRATEGY AND POLICY DEVELOPMENT. THERE WILL BE AN UPCOMING NEEDS ASSESSMENT PERFORMED IN SEPTEMBER 2012 IN CONJUNCTION WITH CABELL COUNTY HEALTH DEPARTMENT. PART VI, LINE 3: THE HOSPITAL HAS INFORMATION ABOUT ITS CHARITY CARE POLICY AND APPLICATIONS AVAILABLE IN ALL REGISTRATION AREAS OF THE HOSPITAL AS WELL AS ITS OFFSITE LOCATIONS. THE HOSPITAL EMPLOYS FINANCIAL COUNSELORS WHO VISIT INPATIENTS IN ELIGIBLE FINANCIAL CLASSES TO PROVIDE INFORMATION ABOUT CHARITY CARE AS WELL AS RESPOND TO INQUIRIES FROM OUTPATIENTS REGARDING CHARITY CARE AND PROVIDE ASSISTANCE WITH THE CHARITY CARE APPLICATION PROCESS. PATIENTS CAN COMMUNICATE WITH FINANCIAL COUNSELORS IN PERSON OR BY TELEPHONE, MAIL OR FAX IN ORDER TO LEARN MORE ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND PROVIDE INFORMATION REGARDING THEIR ELIGIBILITY FOR CHARITY CARE. THE HOSPITAL ALSO CONTRACTS WITH MEDICAID ELIGIBILITY SPECIALISTS TO ASSIST THOSE PATIENTS WHO QUALIFY FOR MEDICAID. INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND PROCESS IS POSTED ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: THE HOSPITAL IS LOCATED IN HUNTINGTON, CABELL COUNTY, WEST VIRGINIA. CABELL COUNTY IS LOCATED IN THE WESTERN PORTION OF THE STATE OF WEST VIRGINIA AND IS BORDERED ON THE NORTHWEST BY OHIO AND ON THE SOUTHWEST BY KENTUCKY (A REGION REFERRED TO AS THE TRI-STATE AREA). HUNTINGTON IS ONE OF THE THREE METROPOLITAN CENTERS IN THE TRI-STATE AREA.DUE TO SPECIALIZED SERVICES SUCH AS ITS BURN UNIT, PEDIATRIC INTENSIVE CARE AND NEONATAL INTENSIVE CARE UNITS, THE HOSPITAL IS A REGIONAL REFERRAL CENTER SERVING A POPULATION OF APPROXIMATELY 1,000,000 IN ITS PRIMARY AND SECONDARY SERVICE AREAS. THAT POPULATION IS EXPECTED TO DECLINE BY APPROXIMATELY 6,000 OVER THE NEXT FIVE YEARS, WHILE THE PORTION OF THAT POPULATION THAT IS OVER AGE 65 WILL INCREASE BY ABOUT 17,000. THE HOSPITAL DRAWS PATIENTS FROM MORE THAN 27 COUNTIES IN WEST VIRGINIA, EASTERN KENTUCKY AND SOUTHERN OHIO. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF CABELL, WAYNE AND LINCOLN COUNTIES IN WEST VIRGINIA AND LAWRENCE COUNTY, OHIO, ALL OF WHICH CONTAIN MEDICALLY UNDERSERVED AREAS AS DESIGNATED BY THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE HOSPITAL'S PRIMARY SERVICE AREA HAS A POPULATION OF OVER 220,000 AND APPROXIMATELY 65% OF THE TOTAL DISCHARGES IN 2009 ORIGINATE FROM ITS PRIMARY SERVICE AREA. THE HOSPITAL'S SECONDARY SERVICE AREA, WHICH INCLUDES COUNTIES IN WEST VIRGINIA, EASTERN KENTUCKY AND SOUTHERN OHIO, ACCOUNTS FOR AN ADDITIONAL 27% OF DISCHARGES IN 2009, WITH THE REMAINING 8% COMING FROM OUTSIDE THE SERVICE AREAS.THE AVERAGE MEDIAN HOUSEHOLD INCOME FOR THE PRIMARY SERVICE AREA IS APPROXIMATELY $35,000, WHILE APPROXIMATELY 21% OF THE POPULATION IN THE PRIMARY SERVICE AREA IS CLASSIFIED AS BEING IN POVERTY BY THE US CENSUS BUREAU.THE HOSPITAL IS AFFILIATED WITH THE MARSHALL UNIVERSITY JOAN C. EDWARDS SCHOOL OF MEDICINE AND ITS GRADUATE MEDICAL EDUCATION PROGRAMS, WHICH TRAINS PRIMARY CARE AND SPECIALTY PHYSICIANS FOR WEST VIRGINIA AND THE REGION. THE HOSPITAL'S AFFILIATION ALSO ENABLES IT TO PROVIDE SPECIALIZED HEALTHCARE SERVICES SUCH AS HIGH RISK OBSTETRICS, NEONATAL INTENSIVE CARE, PEDIATRIC INTENSIVE CARE, AND COMPREHENSIVE ONCOLOGY CARE. THE HOSPITAL ALSO SERVES AS A CLINICAL TRAINING SITE FOR A NUMBER OF HEALTH PROFESSION EDUCATION PROGRAMS, INCLUDING NURSING, PHARMACY, PHYSICAL AND OCCUPATIONAL THERAPY, AND RADIOLOGICAL TECHNOLOGY. PART VI, LINE 6: THE HOSPITAL IS GOVERNED BY A COMMUNITY-BASED BOARD OF DIRECTORS THAT INCLUDES REPRESENTATIVES OF SMALL BUSINESSES, ORGANIZED LABOR, THE ELDERLY AND LOWER-INCOME CONSUMERS, IN COMPLIANCE WITH STATE LAW. A MAJORITY OF THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES, CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL PROVIDES SPECIALIZED SERVICES NOT OTHERWISE AVAILABLE TO MEMBERS OF THE COMMUNITY, SUCH AS ITS NEONATAL AND PEDIATRIC SERVICES.. THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY. AS NOTED ABOVE, THE HOSPITAL PARTICIPATES IN THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS, AND PROVIDES SUPPORT FOR MEDICAL RESEARCH CARRIED OUT BY MEDICAL SCHOOL FACULTY AND PHYSICIANS IN TRAINING. THE HOSPITAL PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS. 1 EBENEZER MEDICAL OUTREACH CENTER 1448 TENTH AVE HUNTINGTON WV 25701 550745033 501(C)(3) 50004 MEDICAL/PHARMACY OUTREACH EBENEZER MEDICAL OUTREACH CENTER 1448 TENTH AVE HUNTINGTON WV 25701 550745033 501(C)(3) 65087 HEALTHY EATING PROGRAM MARSHALL UNIVERSITY ONE JOHN MARSHALL DRIVE HUNTINGTON WV 25755 556000789 501(C)(3) 11412798 MEDICAL SCHOOL 3 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS THE FOLLOWING PLAN ESTABLISHED TO MONITOR THE USE OF THE GRANT FUNDS: THE GRANTS AND FINANCIAL ASSISTANCE PROVIDED BY THE HOSPITAL ARE APPROVED BY THE HOSPITAL'S PRESIDENT/CEO. THEY ARE APPROVED BASED ON THE NEEDS OF THE ORGANIZATION APPLYING FOR THEM AND HOW THEY WILL USE THE FUNDS RELATED TO THE HOSPITAL'S MISSION. THE GRANTS AND ASSISTANCE GIVEN TO MARSHALL UNIVERSITY ARE TO AID IN THE DEVELOPMENT OF THE HOSPITAL THROUGH THE INTERN AND RESIDENT PROGRAMS. ASSISTANCE IS GIVEN TO A COMMUNITY MEDICAL OUTREACH PROGRAM FOR HEALTH SERVICES AND A HEALTHY EATING PROGRAM THAT WAS BEGUN IN THE PREVIOUS YEAR. THE HOSPITAL HAS VARIOUS STAFF MEMBERS WHO SERVE ON THE BOARD OF DIRECTORS OF THE ORGANIZATIONS RECEIVING THE FUNDS. THEY REVIEW THE FINANCIAL INFORMATION PRESENTED AT REGULAR MEETINGS AND REPORT BACK TO THE HOSPITAL AND PRESIDENT/CEO. THE FUNDS DISPERSED FOR THIS ASSISTANCE IS REQUESTED WITH AN INVOICE AND CHECK REQUEST SIGNED BY THE APPROPRIATE HOSPITAL REPRESENTATIVE. OTHER INFORMATION: PART IV: SCHEDULE I, PART I, LINE 1 AND 2: THE ORGANIZATION RESPONDS TO REQUESTS FOR ASSISTANCE FROM LEGITIMATE ORGANIZATIONS IN THE COMMUNITY THAT ARE KNOWN TO THE FILING ORGANIZATION. ELIGIBILITY IS BASED ON THE ORGANIZATIONS' MISSIONS (EDUCATION, HEALTHCARE, OR RELATED COMMUNITY BENEFITS), AND SELECTION IS BASED ON WHETHER THE FILING ORGANIZATION BELIEVES THE NEED FOR THE ASSISTANCE IS RESPONSIVE TO ITS MISSION. X 1 1 X X X X X X 0 0 0 0 0 0 0 0 0 BRENT MARSTELLER 616628 0 250 0 15575 0 74062 0 19229 0 725744 0 0 0 DAVID M WARD 287449 0 250 0 1176 0 126850 0 10298 0 426023 0 0 0 GLEN WASHINGTON 239169 0 250 0 1038 0 31764 0 19229 0 291450 0 0 0 HOYT BURDICK 294268 0 250 0 1038 0 79135 0 19229 0 393920 0 0 0 PAUL SMITH 184965 0 250 0 918 0 90111 0 10840 0 287084 0 0 0 ROSEMARY SMITH 185826 0 250 0 1038 0 100340 0 10587 0 298041 0 0 0 BARRY TOURIGNY 194372 0 250 0 918 0 6494 0 18937 0 220971 0 0 0 W MARK TWILLA 171271 0 250 0 840 0 4848 0 19081 0 196290 0 0 0 DAVID GRALEY 188245 0 250 0 1176 0 27889 0 18937 0 236497 0 0 0 MICHAEL VEGA MD 365031 0 250 0 0 0 20096 0 19229 0 404606 0 0 0 ALFREDO RIVAS MD 368490 0 250 0 0 0 34096 0 19229 0 422065 0 0 0 MARCOS JAVIER MD 361693 0 250 0 0 0 0 0 19229 0 381172 0 0 0 MICKEY NEAL MD 426759 0 250 0 0 0 40069 0 19229 0 486307 0 0 0 FAROUK H ABADIR MD 359079 0 250 0 0 0 40596 0 19229 0 419154 0 0 0 PART I, LINE 1A THE ORGANIZATION PAID DUES TO GUYAN COUNTRY CLUB FOR THE MEMBERSHIP OF BRENT MARSTELLER. THIS WAS NOT CONSIDERED TAXABLE INCOME TO HIM. WV HOSPITAL FINANCE AUTHORITY 2004 SERIES A 621256910 956622WA8 2004-12-16 14095000 RETIRE DEBT/CAPITAL IMPROVEMENTS. 0 0 0 WV HOSPITAL FINANCE AUTHORITY 2008 SERIES A 621256910 956622YU2 2008-10-16 48480000 REFUND 2004 SERIES A AND B. 0 0 0 WV HOSPITAL FINANCE AUTHORITY 2008 SERIES B 621256910 956622YV0 2008-10-16 48475000 REFUND 2004 SERIES A AND B. 0 0 0 WV HOSPITAL FINANCE AUTHORITY 2009 SERIES A 621256910 2009-01-27 14415000 REFINANCE TAXABLE DEBT. 0 0 0 14095000 1 0 1 1 48480000 47752368 806255 644009 1 0 1 1 48475000 47752368 1 0 1 1 14415000 127348 14287652 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 1 1 CITIBANK 25.800000000000 0 0 0 0 1 0 1 1 CITIBANK 25.800000000000 0 0 0 0 1 0 0 0 0 0 1 SCHEDULE K SUPPLENTAL INFORMATION PART I, COLUMN (F): B - THE WV HOSPITAL FINANCE AUTHORITY 2008 SERIES A BONDS WERE USED TO REFUND PRIOR TAX-EXEMPT BOND ISSUES (WV HOSPITAL FINANCE AUTHORITY 2004 SERIES B AND C BONDS), WHICH WERE ISSUED ON DECEMBER 31, 2004. C - THE WV HOSPITAL FINANCE AUTHORITY 2008 SERIES B BONDS WERE USED TO REFUND PRIOR TAX-EXEMPT BOND ISSUES (WV HOSPITAL FINANCE AUTHORITY 2004 SERIES B AND C BONDS), WHICH WERE ISSUED ON DECEMBER 31, 2004. D - THE WV HOSPITAL FINANCE AUTHORITY REVENUE BONDS 2009 SERIES A WERE USED TO REFINANCE TAXABLE DEBT. E - THE CITY OF HUNTINGTON, WEST VIRIGINA REVENUE BONDS 2008 SERIES WERE USED TO REFINANCE TAXABLE DEBT. F - THE COUNTY COMMISSION OF CABELL COUNTY REVENUE BONDS 2009 SERIES WERE USED TO REFINANCE TAXABLE DEBT AND FINANCE CAPITAL IMPROVEMENTS. CITY OF HUNTINGTON WEST VIRGINIA SERIES 2008 556000187 2008-12-30 9685000 REFINANCE TAXABLE DEBT. 0 0 0 THE COUNTY COMMISSION OF CABELL CNTY SERIES 2009 556000305 2009-02-12 6500000 REFINANCE TAXABLE DEBT. 0 0 0 9685000 87796 9597204 0 0 1 1 6500000 62856 5384787 1052357 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 PETER CHIRICO A BOARD MEMBER OF THE ORGANIZATION 999822 PETER CHIRICO IS AN OWNER OF RADIOLOGY, INC. WHICH PROVIDES PROFESSIONAL SERVICES TO THE ORGANIZATION. 0 FORM 990, PART VI, SECTION A, LINE 2 PAUL SMITH, OFFICER, AND ROSEMARY SMITH, OFFICER, ARE MARRIED. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED FORM 990 WILL BE REVIEWED BY THE CHIEF EXECUTIVE OFFICER, INTERNAL GENERAL COUNSEL, CHIEF FINANCIAL OFFICER, AND OUTSIDE LEGAL COUNSEL PRIOR TO FILING. THE COMPLETED FORM WILL ALSO BE PROVIDED TO ALL BOARD MEMBERS ELECTRONICALLY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IN THE FALL OF EACH YEAR, OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE SENT AN ANNUAL QUESTIONNAIRE ADDRESSING THE CONFLICT OF INTEREST POLICY. EACH COMPLETED QUESTIONNAIRE IS REVIEWED BY THE VICE PRESIDENT OVER THE RESPECTIVE INDIVIDUAL'S DEPARTMENT AND GENERAL COUNSEL TO DETERMINE IF A CONFLICT EXISTS. IF A CONFLICT DOES EXIST, AN IN-DEPTH ANALYSIS IS PERFORMED TO DETERMINE ANY IMPACT TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS OF THE ORGANIZATION HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION POLICY SETTING FORTH THE BOARD PHILOSOPHY WITH RESPECT TO THE COMPENSATION OF ITS OFFICERS. A COMPENSATION COMMITTEE COMPRISED OF BOARD MEMBERS HAS BEEN DELEGATED THE RESPONSIBILITY FOR ESTABLISHING COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF MEDICAL OFFICER OF THE ORGANIZATION. IN KEEPING WITH THE PHILOSOPHY ESTABLISHED BY THE BOARD, THE COMPENSATION COMMITTEE HAS ENGAGED THE OUTSIDE CONSULTING FIRM OF YAFFE & ASSOCIATES, A FIRM WHICH SPECIALIZES IN ANALYZING NON-PROFIT EXECUTIVE COMPENSATION. THE OUTSIDE CONSULTING FIRM PERIODICALLY PROVIDES THE COMMITTEE WITH RELEVANT DATA CONCERNING THE COMPENSATION LEVELS OF EXECUTIVES OF HOSPITALS SIMILAR IN SIZE TO THE ORGANIZATION AND IN COMPARABLE GEOGRAPHIC AREAS. THE COMPENSATION COMMITTEE CONSIDERS THIS DATA TOGETHER WITH THE EXTENT TO WHICH PRE-ESTABLISHED GOALS HAVE BEEN ACCOMPLISHED AND THE FINANCIAL PERFORMANCE OF THE HOSPITAL AND ESTABLISHES THE COMPENSATION LEVEL FOR THE CHIEF EXECUTIVE OFFICER. THIS INFORMATION, AS WELL AS THE RECOMMENDATION OF THE CHIEF EXECUTIVE OFFICER, IS CONSIDERED BY THE COMPENSATION COMMITTEE IN ESTABLISHING THE COMPENSATION OF THE CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF MEDICAL OFFICER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -5,109,574. PRIOR PERIOD ADJUSTMENTS: -4,615. DECREASE IN PENSION LIABILITY -13,543,557. CHANGE IN EFFECTIVE INTEREST RATE SWAP -2,553,740. ASSETS RELEASED FROM RESTRICTION FOR CANCER CENTER 1,691,361. TOTAL TO FORM 990, PART XI, LINE 5: -19,520,125. CABELL HUNTINGTON HOSPITAL FOUNDATION INC PO BOX 1427 HUNTINGTON WV 25716 311096222 PERFORMS FUNDRAISING FOR CABELL HUNTINGTON HOSPITAL, INC. WV 501(C)(3) LINE 7 N/A 0 CABELL HUNTINGTON HOSPITAL AUXILIARY INC 1340 HAL GREER BOULEVARD HUNTINGTON WV 25701 556014510 PERFORMS FUNDRAISING FOR CABELL HUNTINGTON HOSPITAL, INC. WV 501(C)(3) LINE 11A, I N/A 0 TRI-STATE MRI PO BOX 3108 HUNTINGTON WV 25702 550669726 OPERATES A FREE-STANDING MRI CENTER. WV N/A RELATED 0 1 OCCUMED LLC 1340 HAL GREER BOULEVARD HUNTINGTON WV 25701 432093064 OPERATES AN OCCUPATIONAL MEDICAL TESTING CENTER AND AN URGENT CARE CENTER. WV N/A RELATED 0 1 HUNTINGTON SURGERY CENTER LP 1201 HAL GREER BOULEVARD HUNTINGTON WV 25701 550647724 OPERATES AN AMBULATORY SURGERY CENTER - OUTPATIENT SURGERIES. WV N/A RELATED 0 0 CHH-CABELL INC 1201 HAL GREER BOULEVARD HUNTINGTON WV 25701 621223702 OPERATES HUNTINGTON SURGERY CENTER, LP. WV N/A C 0.51000 CHH-CABELL DEVELOPMENT CORPORATION 1201 HAL GREER BOULEVARD HUNTINGTON WV 25701 621184183 OPERATES HUNTINGTON SURGERY PROPERTIES, LP WV N/A C 0.51000 MOUNTAIN REGIONAL SERVICES INC PO BOX 636 HUNTINGTON WV 25711 550655843 RECORD OWNER OF REAL ESTATE NEAR CABELL HUNTINGTON HOSPITAL, INC. WV N/A C 1.00000 MOUNTAIN HEALTH NETWORK INC PO BOX 636 HUNTINGTON WV 25711 550675666 OWNS REAL ESTATE NEAR CABELL HUNTINGTON HOSPITAL, INC. WV N/A C 1.00000 1 1 1 1 0 0 0 0 1 0 1 0 0 1 0 1 0 0 CABELL HUNTINGTON HOSPITAL FOUNDATION INC C 89024 FMV HUNTINGTON SURGERY CENTER LP O 180762 FMV HUNTINGTON SURGERY CENTER LP K 292624 FMV OCCUMED LLC B 670463 FMV OCCUMED LLC D 821467 FMV OCCUMED LLC N 682274 FMV OCCUMED LLC O 330000 FMV