2011-11-15T10:52:17-06:00 2010-12-31 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-01-01 550372580 Montgomery General Hospital Inc MONT 3044425151 Washington Sixth Avenue Montgomery WV 25136 Vickie Gay 3044425151 2011-11-12 1 Harry C Harless 3043460441 2010 2016-03-07 17:11:31Z Vickie Gay Washington Sixth Avenue Montgomery WV 25136 22113881 0 X www.mghwv.com X 1970 WV To provide quality, cost-effective, and convenient healthcare services that meet and exceed reasonable internal and external customer expectations. 12 11 264 17 0 0 32330 84725 22513880 21908840 704 5 165977 120311 22712891 22113881 0 0 0 0 12631752 12204151 0 0 0 10306227 10209188 22937979 22413339 -225088 -299458 7408001 7787787 6759857 7243742 648144 544045 Montgomery General Hospital is a critical access hospital. It also provides outpatient services including laboratory, radiology, surgery and therapy services; physician services; and skilled nursing services. 0 0 16114361 21908840 The Hospital provided health care services including 2,767 acute inpatient days; 12,576 skilled nursing days; 31,441 outpatient visits; 9,261 emergency room visits; 1,151 ambulatory surgery procedures; and 21,445 physician office visits. Charges foregone for charity care amounted to $191,655. 16114361 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 53 0 1 264 1 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Sherri Murray 3044427437 Washington Sixth Avenue Montgomery WV 25136 Vickie Gay 40.00 X X 141092 0 2174 Raleigh Collins 1.00 X 0 0 0 Robert Gilliam 1.00 X 0 0 0 Carl Harris 1.00 X 0 0 0 Robert Neal 1.00 X 0 0 0 Patsy Tucker 1.00 X 0 0 0 Rita Bohanna 1.00 X 0 0 0 Donald Smith 1.00 X 0 0 0 Ghassan Dagher 1.00 X 0 0 0 Percy Mosley Jr 1.00 X 0 0 0 Barbara Crist 1.00 X 0 0 0 Naaman G Clonch 1.00 X 0 0 0 Sherry Murray 40.00 X 89479 0 1374 Mohamad Sankari 40.00 X 320013 0 10106 Adin Timbayan 40.00 X 322875 0 9934 Paul Jackson 40.00 X 415855 0 0 Kenneth Dwyer 40.00 X 252629 0 21851 Samuel R Davis 40.00 X 252323 0 3654 1794266 0 49093 6 0 1 0 Advantage Rehab 5407 Morning Dove Lane Cross Lanes WV 25313 Therapy Services 381634 Interim Physicians 12140 Woodcrest Executive Dr Suite St Louis MO 63141 Physician Services 211106 SVI Laboratory Services 3004 Chesterfield Ave Charleston WV 25304 Lab 144651 Alliance Healthcare Services 100 Bayview Circle Suite 400 Newport Beach CA 92660 MRI Services 131880 Arnett & Foster PLLC 101 Washington St Charleston WV 25301 Accounting Fees 130809 5 69725 15000 84725 Patient services 900099 21908840 21908840 21908840 5 5 63300 63300 63300 63300 Cafeteria 722210 39703 39703 Medical records 900099 6000 6000 11308 11308 57011 22113881 21908840 0 120316 234119 158633 75486 8954987 6067669 2887318 223135 151190 71945 2138519 1449005 689514 653391 442721 210670 137289 137289 86741 86741 1193124 808430 384694 90551 61355 29196 2779442 1883278 896164 149258 101133 48125 664634 450339 214295 60047 40686 19361 162560 162560 651354 441341 210013 349190 236602 112588 Bad debts 3343000 3343000 Health care provider ta 357049 357049 Licenses, dues & permit 25383 17199 8184 Use taxes 19577 13265 6312 Staff training 14613 9901 4712 125376 81565 43811 22413339 16114361 6298978 0 2684230 3392931 5849 9798 358432 341479 129415 178338 30336626 26507343 4171472 3829283 58603 35958 7408001 7787787 3935329 4526718 1883578 1971979 160000 940950 585045 6759857 7243742 X 648144 544045 648144 544045 7408001 7787787 X -299458 195359 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 869878 869878 12565681 11071147 1494534 16519235 15057481 1461754 381832 378715 3117 3829283 Capital lease obligations 186653 Due to third-party payors 398392 585045 22113881 22413339 -299458 195359 195359 -104099 22092598 0 22092598 21283 21283 22113881 22392056 0 22392056 21283 21283 22413339 Part XI, Line 8 - Other Adjustments: Additional minimum pension liability recognized 182,176. Transfer from related party 13,183. Part XII, Line 4b - Other Adjustments: Grant expenses netted against income on financial statements 21,283. Part XIII, Line 4b - Other Adjustments: Grant expense netted against income on financial statements 21,283. 1 1 X 1 X 0 0 0 0 96460 96460 0.00510 790531 749173 41358 0.00220 886991 749173 137818 0.00730 886991 749173 137818 0.00730 0 1682532 4708921 4854008 -145087 X 1 1 Montgomery General Hospital Inc

Washington Sixth Avenue Montgomery WV 25136

X X Not required for 2010 1 Part I, Line 7: The cost of charity care has been calculated by obtaining gross charges from the audited financial statements for charity care write off's and multiplying these charges by the aggregate hospital cost to charge ratio. The resulting charity care cost was then increased for the estimated "charity portion" of broad-based taxes paid to the State of WV. The net amount was then reduced by the estimated "charity portion" of the revenue "disproportionate share" payment received from the state. Medicaid cost was computed by multiplying the Medicaid HMO charges for each hospital department by the respective cost-to-charge ratio that relates to each department. The ratios are obtained from this year's Medicare cost report. The Medicaid cost is then reduced by the payments received from Medicaid HMO plans. Only Medicaid HMO charges and payments were included as "tradtional" Medicaid is reimbursed by WV Medicaid at 100% of cost so the cost and related payments from non-HMO Medicaid services nets to zero. 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 $ 3343000. Part III, Line 4: Patient Accounts Receivable: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectable 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 reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The shortfall is not being reported as a community benefit because the hospital will be reimbursed through a Medicare cost report settlement.The Hospital is cost reimbursed at 101% of allowable cost for Medicare and WV Medicaid traditional payer types. HMO Medicare and HMO Medicaid payers are reimbursed based on the individual contracts signed by the hospital with each HMO payer. HMO's do not have a year end settlement process. Part III, Section B, Line 8 Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions. Part VI, Line 2: Montgomery General Hospital provides acute care services, swing bed SNF serves, skilled nursing services for both skilled patients and intermediate care patients and physicians in general practice and many specialites. As the only hospital in Fayette County, Montgomery General Hospital is aware of the health needs of the community and works to provide all necessary services to all citizens of the county. Part VI, Line 4: Montgomery General Hospital is a Critical Access Hospital located in Fayette County, West Virginia. Montgomery General Hospital is the only hospital for rural Fayette County. Fayette County is a low income area that must compete with Urban Kanawha county to attract and retain physicians, nurses and medical personnel. In addition of having to pay higher salaries to attract top medical professional, Montgomery General Hospital has a high percentage of Medicare and Medicaid patient population. Montgomery General Hospital is listed as a Health Professional Shortage Area and a Medically Underserved Area for portions of Fayette County. X 0 0 0 0 0 0 0 0 0 Mohamad Sankari 320013 0 0 0 0 0 4948 0 5158 0 330119 0 0 0 Adin Timbayan 322875 0 0 0 0 0 3137 0 6797 0 332809 0 0 0 Paul Jackson 415855 0 0 0 0 0 0 0 0 0 415855 0 0 0 Kenneth Dwyer 252629 0 0 0 0 0 3846 0 18005 0 274480 0 0 0 Samuel R Davis 252323 0 0 0 0 0 3654 0 0 0 255977 0 0 0 Ghassan Dagher MD Board member 17020 Rental of office space. 0 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the CFO and CEO. Form 990, Part VI, Section B, line 12c Annually we provide the board members with the conflict of interest policy and questionnaire. Once these are completed they are returned to administration and reviewed by our in house council. Form 990, Part VI, Section B, line 15 The Board of Directors determines the President/CEO's salary based upon comparative industry standards. The CEO determines the CFO salary based upon comparative industry standards. Form 990, Part VI, Section C, line 19 The governing documents and conflict of interest policy are available upon request. The financial statements are published annually in the local newspaper. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Additional minimum pension liability recognized 182,176. Transfer from related party 13,183. Total to Form 990, Part XI, Line 5: 195,359. Oversight of the audit Form 990 Part XII Line 2C No changes have been made to the oversight of the Financial Statement audit. Laird Health Care Foundation Inc Washington Sixth Avenue Montgomery WV 25136 550632743 Support tax-exempt health care organizations WV 501(c)(3) 11 N/A 0 Montgomery General Elderly Care Center Washington Sixth Avenue Montgomery WV 25136 550623339 Extended care facility WV 501(c)(3) 9 N/A 0 Montgomery General Healthcare System Inc Washington Sixth Avenue Montgomery WV 25136 550632601 Provide support to affiliated exempt health care providers WV 501(c)(3) 11 N/A 0 Montgomery MedCorp Inc washington Sixth Avenue montgomery WV 25136 550767169 Physicians Practice WV 501(c)(3) 9 N/A 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0