2011-08-15T12:05:56-05:00 2010-09-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2009-10-01 550404900 Herbert J Thomas Memorial Hospital Association HERB 3047663528 4605 MacCorkle Avenue SW South Charleston WV 25309 Charles O Covert 3047663528 2011-08-13 1 Harry C Harless 3043460441 2009 2016-02-24 21:20:13Z Thomas Memorial Hospital Stephen P Dexter 4605 MacCorkle Avenue SW South Charleston WV 25309 159430886 0 X www.thomaswv.org X 1946 WV To provide health care services to residents of South Charleston, WV and surrounding communities. 5 4 1499 89 24700 0 964911 945755 158384863 153688063 1455440 1117194 2875002 2291621 163680216 158042633 81908 0 68814431 71061942 0 0 94823679 91811626 163638110 162955476 42106 -4912843 236142603 228541315 164703709 162656738 71438894 65884577 To provide health care services to residents of South Charleston, WV and surrounding communities. 0 0 156290597 81908 153688063 Services provided by the hospital include 54,653 inpatient days and 119,786 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 $2,771,433. The hospital provided community education activities and sponsors free health screening and wellness programs. 156290597 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 161 0 1 1499 1 1 1 0 0 0 0 0 0 0 0 5 4 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 Michael DeWitt 1.00 X 0 0 0 Daniel J Lauffer 1.00 X 0 420846 50764 Tom McHugh 1.00 X 0 0 0 Phil Surface 1.00 X 0 0 0 Steve White 1.00 X 0 0 0 Stephen P Dexter 40.00 X 655863 0 26724 Charles O Covert 40.00 X 285034 0 24182 Robert J Gray 40.00 X 267751 0 23954 Cynthia W Barnette 40.00 X 265256 0 23934 Sue Painter 40.00 X 120373 0 11755 Tarek Anderson 50.00 X 311954 0 21108 Paul De Franco 50.00 X 260000 0 0 Carmelita Baustista 50.00 X 168625 0 18343 Magdaleno Nucum 50.00 X 163612 0 17464 Mary Beth Smith 40.00 X 153051 0 11235 2651519 420846 229463 37 0 1 0 Professional Anesthesia Associates 110 Roane St Charleston WV 25302 Anesthesia 1199951 Hospital Medicine Group 4535 Dressler Rd NW Canton OH 44718 Hospitalist Service 913825 Jackson Kelly PLLC PO Box 11276 Charleston WV 25339 Legal Service 571923 Kanawha Radiological Physicians 3324 Pennsylvania Ave Charleston WV 25302 Radiation Therapy Service 271542 Concise Coding 96 Private Drive 1277 Ironton OH 45638 Coding of Medical Records 228817 14 931441 14314 945755 Patient services 622110 153688063 153688063 153688063 1107134 24700 1082434 1453685 1453685 1453685 1453685 1377313 21000 1332539 55714 44774 -34714 10060 10060 Cafeteria & Vending 722212 540139 540139 Parking 812930 204363 204363 Other income 900099 93434 93434 837936 158042633 153688063 24700 3384115 81908 81908 1754062 1678462 75600 51596011 49372223 2223788 5258878 5032220 226658 8680483 8306354 374129 3772508 3609913 162595 22654 22654 180868 180868 10272269 9829534 442735 572632 547952 24680 33584937 32137426 1447511 3275035 3133881 141154 2490235 2382906 107329 103957 99476 4481 1977639 1892403 85236 10644864 10186070 458794 2076756 1987248 89508 Bad debts 13451609 13451609 Repairs & maintenance 4756325 4551327 204998 Healthcare provider tax 2903364 2903364 Sales & use tax 1764222 1688184 76038 Recruiting 1666440 1594616 71824 2067820 1823521 244299 162955476 156290597 6664879 0 938572 486659 42071000 43896159 15413473 14713912 2932893 3315192 921677 1049077 280698317 134354939 119334577 146343378 50939306 16097447 509809 323552 3081296 2315939 236142603 228541315 20895566 12166840 101968123 102016018 246525 197443 41593495 48276437 164703709 162656738 X 71438894 65884577 71438894 65884577 236142603 228541315 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12318729 12318729 146638192 51029365 95608827 110427115 80668433 29758682 11314281 2657141 8657140 146343378 Accrued pension benefits 32835374 Estimated malpractice liability 7857827 Estimated third party settlements 1309592 Capital lease obligations 565161 Due to related parties 881563 Accrued interest payable 4826920 48276437 158042633 162955476 -4912843 1250687 -1892161 -641474 -5554317 157476715 0 157476715 565918 565918 158042633 162454591 0 162454591 500885 500885 162955476 Part XI, Line 8 - Other Adjustments: Income from K-1 - Premier Purchasing Partners LP: -565918. Defined benefit pension plan adjustment: -1827128. Distributions from Premier Purchasing Partners LP: 500885. Part XII, Line 4b - Other Adjustments: Income from K-1: Premier Purchasing Partners LP: 565918. Part XIII, Line 4b - Other Adjustments: Distributions from Premier Purchasing Partners LP: 500885. 1 1 X 1 X 1 X 1 1 1 0 0 2771433 0 2771433 0.01850 20359831 9640843 10718988 0.07170 23131264 9640843 13490421 0.09020 96000 96000 0.00060 81908 81908 0.00050 177908 177908 0.00110 23309172 9640843 13668329 0.09130 0 5886424 36889312 37248486 -359174 X 1 0 Thomas Memorial Hospital

4605 MacCorkle Avenue SW South Charleston WV 25309

X X X Skilled nursing facility 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, as well as the cost of cash and in-kind contributions to community groups was obtained from the hospital's accounting records. Part I, Line 7f: Bad debt expense amounting to $13,451,609 was eliminated from total operating expenses for purposes of Schedule H percentage of total expense calculations. 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 collectibility. 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 cost of bad debts reported in Schedule H was estimated using a cost to charge ratio derived from Worksheet 2 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 Patient Assistance policy; patients who qualify for assistance under the policy do not receive a bill. 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 will by released by September, 2011. It is anticipated that a link to the survey will be provided on the hospital's website in the future. 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 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 availablity of various government benefits, such as Medicaid or state programs, and assisting the patient with qualification for such programs, where applicable. 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 6: All members of the hospital's board 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 over $945,000 in contributions. These contributions enabled the hospital to fund its capital improvements and to provide financial sssistance to individuals unable to pay for some or all or their care. Part VI, Line 7: 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 a full range of innovative and cost-effective health care services to the Kanawha Valley and surrounding areas. Economies of scale have allowed for cost reductions is many areas, while providing advanced technology to a larger community, with access to the highest quality of physicians, nurses and support staff in the service area. 0 American Heart Association 162 Court St Charleston WV 25301 135613797 501(c)(3) 10000 To support fund raising activity that provides funding for medical research WV Health Right 1520 Washington St East Charleston WV 25311 311066881 501(c)(3) 30000 To support a free clinic that provides medical care and drugs to the uninsuredTo assist a free clinic located in Charleston, WV that supplies free drugs to the uninsuredTo support a free clinic located in Charleston, WV that supplies free drugs to the uninsured 2 0 X X X X 0 1 0 0 0 0 0 0 0 Daniel J Lauffer 0 354969 0 65877 0 0 0 36294 0 16795 0 473935 0 0 Stephen P Dexter 521414 0 106086 0 28363 0 9072 0 19131 0 684066 0 0 0 Charles O Covert 242967 0 34202 0 7865 0 6530 0 18627 0 310191 0 0 0 Robert J Gray 224174 0 36163 0 7414 0 6302 0 18522 0 292575 0 0 0 Cynthia W Barnette 221008 0 36370 0 7878 0 6282 0 18522 0 290060 0 0 0 Tarek Anderson 311954 0 0 0 0 0 7675 0 13433 0 333062 0 0 0 Paul De Franco 260000 0 0 0 0 0 0 0 0 0 260000 0 0 0 Carmelita Baustista 168625 0 0 0 0 0 4910 0 13433 0 186968 0 0 0 Magdaleno Nucum 163612 0 0 0 0 0 4031 0 13433 0 181076 0 0 0 Mary Beth Smith 153051 0 0 0 0 0 4294 0 6941 0 164286 0 0 0 Part I, Line 4b: Line 4b - Deferrals under 457(b) plan: Stephen P. Dexter $16,500; Charles O. Covert $16,500; Robert J. Gray $16,500; Cynthia W. Barnett $16,500 West Virginia Hospital Finance Authority 621256910 956622XRO 2008-06-30 92695993 Capital expenditures and equipment purchases 0 0 92695993 1414481 51455161 2010 1 0 1 1 0 1 1 0 1 0.03000 0.00000 0.03000 1 0 0 0 1 Trinity Plus Funding 1 0 1 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 The 990 is prepared by the hospital's independent accountants. It is then reviewed by the CFO and a copy is provided to the governing board 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. Schedule K Explanation of amounts reported On June 30, 2008, the West Virginia Hospital Finance Authority issued $148,920,000 Hopital Inprovement 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. Thomas Health System Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 260440674 Corporate office WV 501(c)(3) 3 N/A Charleston Hospital Inc 333 Laidley St Charleston WV 25301 611272692 Hospital WV 501(c)(3) 3 N/A Thomas Memorial Hospital Foundation Inc 4605 MacCorkle Avenue SW South Charleston WV 25309 550694220 Hospital support WV 501(c)(7) 7 N/A THM Services Inc 437 Division Street Ste 311 South Charleston WV 25309 550676607 Equipment sales, rental and related services and vending sales WV N/A C -76022 4370179 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0