2011-11-14T13:42:05-06:00 2010-12-31 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-01-01 550629032 Minnie Hamilton Health Care Center Inc MINN 3043549244 186 Hospital Drive Grantsville WV 26147 Randy Lindauer 3043549244 2011-11-09 1 Harry C Harless 3043460441 2010 2016-02-24 21:20:13Z Minnie Hamilton Health System Randy Lindauer 186 Hospital Drive Grantsville WV 26147 16574617 0 X www.mhhcc.com X 1983 WV The organization operates a critical access hospital, community health center, federal qualified health center, and long-term care unit. 8 8 294 20 0 0 2051730 1936882 13778338 14478148 4350 2853 166772 156734 16001190 16574617 57319 0 0 0 10029063 10291100 0 0 0 5813081 5950581 15899463 16241681 101727 332936 6070880 6713748 3153786 3463718 2917094 3250030 Minnie Hamilton Health System is dedicated to maintaining the health and improving the quality of life of all people in our service area through an innovative delivery system of services and education. 0 0 13967276 14468313 Inpatient services provided included 1,107 acute care days, 8,278 long term care days and 924 swing bed days. Outpatient services included 16,972 outpatient visits and 1,733 emergency room visits. Primary care services include 36,759 clinic visits and 2,934 dental clinic visits. 9081 9835 A total of 203 mammography procedures were performed during the year. 13976357 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 1 294 1 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Stephen J Whited 3043549244 186 Hospital Drive Grantsville WV 26147 Jean Simers 2.00 X 0 0 0 Randy Ball 2.00 X 0 0 0 Reta Kight 2.00 X 0 0 0 Kathy Frederick 2.00 X 0 0 0 John Oshoway 2.00 X 0 0 0 Neal Benson 2.00 X 0 0 0 Ronald Blankenship 2.00 X 0 0 0 Harold Carpenter 2.00 X 0 0 0 Barbara W Lay 40.00 X 148818 0 265 Stephen S Whited 40.00 X 112801 0 635 Alfonso P Cinco 56.00 X 392776 0 8522 Suresh Balasubramony 41.00 X 318437 0 7998 Autumn Whitlock-Morales 45.00 X 317914 0 5763 Vish Hande 26.00 X 200795 0 5142 Rudolph Kevak 26.00 X 193091 0 1947 1684632 0 30272 8 0 1 0 Nextgen PO Box 809390 Chicago IL 60680 Computer Operating Systems 402561 Radiological Physician Associates 70 Village Drive Fairmont WV 26554 Radiological Professional Services 218917 CPSI 600 Wall Street Mobile AL 36695 Computer Operating Systems 197691 Coast to Coast 5195 Hampstead Village Center New Albany OH 43054 ER Professional Services 175648 Labcorp of America 231 Maple Ave Burlington NC 27216 Reference Lab 122448 5 1910891 25991 1936882 Patient services 622110 14309910 14309910 Other health care 622110 168238 168238 14478148 2853 2853 15002 15002 15002 15002 Cafeteria Income 722210 71905 71905 Day Care 624410 54759 54759 Rebate/refund income 900099 14123 14123 945 945 141732 16574617 14478148 0 159587 262576 225316 37260 8749684 7508104 1241580 653481 560752 92729 625359 536621 88738 16481 16481 87258 87258 985421 985421 36379 31217 5162 1393863 1196074 197789 443092 380217 62875 88984 76357 12627 124464 124464 711945 610920 101025 146460 146460 Bad debts 1320232 1320232 Health care provider ta 237930 237930 Repairs & Maintenance 116567 100026 16541 WV Use tax 89296 76625 12671 Dues & licenses 65573 56268 9305 86636 74277 12359 16241681 13976357 2265324 0 4779 4624 754841 660963 42634 25257 1717821 2322993 117496 121204 60925 43067 8087630 4551990 3372384 3535640 6070880 6713748 841805 1175150 39580 29845 1784627 1555957 153825 130930 333949 571836 3153786 3463718 X 2917094 3250030 2917094 3250030 6070880 6713748 332936 0 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2286173 941388 1344785 473615 80641 392974 5327842 3529961 1797881 3535640 Capital leases 447378 Estimated Third Party Payor Settlements 124458 571836 16574617 16241681 332936 0 332936 16580889 6272 6272 16574617 0 16574617 16247953 6272 6272 16241681 0 16241681 Part XII, Line 2d - Other Adjustments: Loss on disposal of assets netted with expenses in financial statements 6,272. Part XIII, Line 2d - Other Adjustments: Loss on disposal of assets netted with expenses in financial statements 6,272. 1 1 X 1 X 1 X 1 1 0 0 623108 545240 77868 0.00520 1044251 951225 93026 0.00620 1667359 1496465 170894 0.01140 14 600 83512 80512 3000 0.00020 14 600 83512 80512 3000 0.00020 14 600 1750871 1576977 173894 0.01160 0 1332770 3313712 3269312 44400 X 1 1 1 1 Minnie Hamilton Health Care Center

186 Hospital Drive Grantsville WV 26147

X X X X Long Term Care Minnie Hamilton Health Care Center Inc 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X X X 1 X X X 1 X X X X X 1 X Part I, Line 3c: 1. The qualifications for the Sliding Fee Program are based on both the number of people in the household and the total gross income received in the household. 2. The applicants are required to complete the Sliding Fee Program application and to provide a proof of income within 30 days after filing their application. Acceptable proof of income includes: wage statement, W-2 forms, check stub, retirement statement, unemployment statement, social security check or benefit letter, alimony check, child support check, food stamp voucher, or other documents approved by financial management.3. If the patient has no income, they are asked to declare so by signing a Lack of Income Verification form. 4. The Financial Assistance Application, along with the above mentioned documents verifying income or lack of it, will be processed promptly by the cashier/clerk.5. After the patient has been approved for the Sliding Fee Program, they will receive a Sliding Fee identification card describing the benefits such as: A. Fee of $5 or $10 for an office visit, collected at the time of the visit B. 40% or 50% discount for lab tests C. 40% to 50% discount for the technical component of diagnostic, non-invasive radiology services D. 40 to 50% discount on respiratory procedures6. Qualification for Sliding Fee remains in effect for one year from the date of approval, unless the patient or the household income should change within that year.7. The Sliding Fee Program benefits may apply to the outstanding patient accounts which do not exceed 365 days from the day of service. Accounts which have already been sent to a collection agency may not qualify for this program. 8. It is the patient's responsibility to reapply annually for continued participation in the Sliding Fee Program. 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 $ 1320232. Part III, Line 8: Medicare Cost Report Part III, Line 9b: Patients who complete an application and qualify for account exoneration or a sliding fee, will have accounts classified as charity care. Minnie Hamilton Health Care Center, Inc. Part V, Section B, Line 11h: Patients are charged the amount via the item master and discounted according to policy and income guideline levels. Minnie Hamilton Health Care Center, Inc. Part V, Section B, Line 15e: Utilized collection agencies as well as magistrate court. Minnie Hamilton Health Care Center, Inc. Part V, Section B, Line 17e: Utilized collection agencies as well as magistrate court. Minnie Hamilton Health Care Center, Inc. Part V, Section B, Line 19d: Patients are charged the amount via the item master and discounted according to policy and income guideline levels. Part 1, Line 7, Additional Information: The Organization's charity care policy outlines the purpose, guidelines and qualifications for charity care. Some of the qualifications include: a family income within the Federal Poverty Guidelines, exceptions where economic assets and total income are considered, and consideration of undue hardship. The Organization's sliding fee policy is similar with procedures and percentage amounts clearly written down. The sliding fee policy applies when a patient is uninsured, underinsured or insured with a deductible or co-pay and meets the Federal Income Poverty Guidelines but does not qualify for Medicaid. Part VI, Line 2: Records of types of visits and diagnosis are kept and analyzed for adjustment of appropriate services. Official community needs assessments are periodically performed by an outside agency. Part VI, Line 3: The organization's charity care policy outlines the purpose, guidelines and qualifications for charity care. Some of the qualifications include: a family income within the Federal Poverty guidelines, exceptions where economic assets and total income are considered, and consideration of undue hardship. The Organization's sliding fee policy is similar with procedures and percentage amounts clearly written down. The sliding fee policy applies when a patient is uninsured, underinsured or insured with a deductible or co-pay and meets the Federal Income Poverty guidelines but does not qualify for Medicaid. Part VI, Line 4: The organization services a rural area of 16,000 people in Calhoun, Gilmer and surrounding counties. The county has one of the highest unemployment rates in the State of WV. Patient principal payers percentages are: 38% medicare, 19% medicaid, 17% commercial, and 26% private pay. The nearest Hospital is over 30 miles away. The Health Care Center is designated as an HPSA site. Part VI, Line 6: All board members reside in the service area and none are employed by, or have contractual arrangements with Minnie Hamilton Health Care Center. The medical staff privileges are available to all qualified providers in the area. All profit and available funding is utilized for continuation and improvement of the provision of appropriate health services through staffing and acquisition of equipment and supplies. A 24-hour emergency room doctor is provided regardless of a patient's ability to pay. The nearest hospital is 40 minutes away, by car. An active auxiliary is made up of local volunteers and has been present during all years of the facilities hospital services. X X X X 0 0 0 0 0 0 0 0 0 Alfonso P Cinco 392776 0 0 0 0 0 0 0 8551 0 401327 0 0 0 Suresh Balasubramony 318437 0 0 0 0 0 0 0 8026 0 326463 0 0 0 Autumn Whitlock-Morales 317914 0 0 0 0 0 0 0 5792 0 323706 0 0 0 Vish Hande 200795 0 0 0 0 0 0 0 5161 0 205956 0 0 0 Rudolph Kevak 193091 0 0 0 0 0 0 0 1947 0 195038 0 0 0 Calhoun County Building Commission 556000308 2006-12-13 2455000 Refinance existing debt and new capital expenditures 0 0 0 2455000 955614 1499386 2007 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 Form 990, Part VI, Section B, line 11 Form 990 is reviewed by Senior Management, the Finance Committee and the Board of Directors. Form 990, Part VI, Section B, line 12c The Board of Directors sign the statement annually. Individual members are excused from decision making on issues where conflicts my arise. A Board of Director member recuses themself from voting on issues where a conflict may exist. Form 990, Part VI, Section B, line 15 A survey of alike facilities in the state, utilizing the Health Care Authority information that is available, to compare salaries of top executives, as well as looking at job responsibilities and years of experience. The CEO is a contracted position and approved by the Board of Directors. Senior management is approved by the CEO. Form 990, Part VI, Section C, line 19 Audited Financial Statements are available upon request to the public. Annually the audited balance sheet and income statement are published in the local newspaper as per the Health Care Authority financial disclosure requirements. Volunteers Form 990, Page 1, Line 6 Volunteers of the organization include members of the hospital auxiliary and teenagers involved in a volunteer program.