GRAFTON CITY HOSPITAL INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: GRAFTON CITY HOSPITAL INC (EIN 55-6000526)
Tax period: 2009-07-01 to 2010-06-30
Filed: 2011-02-15
IRS object ID: 201140469349300824
Schema version: 2009v1.7
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule C
Schedule D
Schedule H
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-02-15T11:53:25-06:00	Timestamp
Tax Period End Date	2010-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Arnett & Foster PLLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	P O Box 2629	AddressLine1
City	Charleston	City
State	WV	State
ZIP Code	25329	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2009-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	556000526	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Grafton City Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	GRAF	NameControl
Phone	3042656401	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	500 Market Street	AddressLine1
City	Grafton	City
State	WV	State
ZIP Code	26354	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Jeff Lilley	Name
Title	CEO	Title
Phone	3042656401	Phone
Date Signed	2011-02-11	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Steven S Robey	Name
Phone	3043460441	Phone

Field	Value	IRS element (for citing)
Tax Year	2009	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Jeff Lilley	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	500 Market Street	AddressLine1
City	Grafton	City
State	WV	State
ZIP Code	26354	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	17437293	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c	X	Organization501c
Web Site	www.graftonhospital.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1972	YearFormation
State Legal Domicile	WV	StateLegalDomicile
Activity Or Mission Description	To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	10	NbrIndependentVotingMembers
Total Nbr Employees	448	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	17017	ContributionsGrantsPriorYear
Contributions Grants Current Year	44895	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	16764064	ProgramServiceRevenuePriorYear
Program Service Revenue CY	17255915	ProgramServiceRevenueCY
Investment Income Prior Year	1468	InvestmentIncomePriorYear
Investment Income Current Year	6783	InvestmentIncomeCurrentYear
Other Revenue Prior Year	111082	OtherRevenuePriorYear
Other Revenue Current Year	129700	OtherRevenueCurrentYear
Total Revenue Prior Year	16893631	TotalRevenuePriorYear
Total Revenue Current Year	17437293	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	11090116	SalariesEtcPriorYear
Salaries Etc Current Year	11597682	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	5554845	OtherExpensePriorYear
Other Expenses Current Year	5776298	OtherExpensesCurrentYear
Total Expenses Prior Year	16644961	TotalExpensesPriorYear
Total Expenses Current Year	17373980	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	248670	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	63313	RevenuesLessExpensesCY
Total Assets BOY	7033378	TotalAssetsBOY
Total Assets EOY	7108950	TotalAssetsEOY
Total Liabilities BOY	5717559	TotalLiabilitiesBOY
Total Liabilities EOY	5729818	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1315819	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1379132	NetAssetsOrFundBalancesEOY
Mission Description	To provide inpatient hospital care, outpatient services, emergency room services and long-term care to the residents of Taylor County, WV and surrounding communities.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	10577207	Expense
Revenue	17255915	Revenue
Description	The Hospital provided health care services including 1,619 acute hospital days; 23,431 long-term care days; 2,621 swing-bed days; 290 observation patient days; 17,367 rural health clinic visits; 17,367 rural health visits;276 surgeries. Additionally, the Hospital provided charity care without charge or at less than its established rates to patients who meet certain criteria under its charity care policy. Charges foregone for charity care during the year amounted to $1,571,861.	Description
Total Program Service Expense	10577207	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Balance Sheet Amounts Reported	1	BalanceSheetAmountsReported
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	4	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	448	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	1	QuidProQuoContributions
Quid Pro Quo Disclosure	1	QuidProQuoDisclosure
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Nbr Voting Governing Body Members	10	NbrVotingGoverningBodyMembers
Number Independent Voting Members	10	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	0	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Brian Kelbaugh	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	3042656401	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	500 Market Street	AddressLine1
City	Grafton	City
State	WV	State
ZIP Code	26354	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
John Whitescarver
President	1.00	X	0	0	0
John L Bord
Vice President	1.00	X	0	0	0
Joan E Hawkins
Secretary	1.00	X	0	0	0
Paul Shroyer
Trustee	1.00	X	0	0	0
Samuel M Santibanez M
Trustee	1.00	X	0	0	0
Ronald L Cole
Trustee	1.00	X	0	0	0
Nancy Virginia Fowler
Trustee	1.00	X	0	0	0
Jeff May
Trustee	1.00	X	0	0	0
Kenny Peters
Trustee	1.00	X	0	0	0
Wanda Taylor
Trustee	1.00	X	0	0	0
Jeff Lilley
CEO	45.00		134912	0	6107	X
Brian Kelbaugh
CFO	40.00		90488	0	4996	X
Joseph Duvert
Physician	40.00		265016	0	6625		X
David Bender
Physician	40.00		213550	0	5339		X
Chris Villaraza
Physician	40.00		187981	0	4700		X
James Woodford
Physician	40.00		190481	0	4762		X
Thomas Wilshire
Physician	40.00		244120	0	6103		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1326548	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	38632	TotalOtherCompensation
Number Individuals GT100 K	10	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Insight Health
PO Box 847689	Dallas	TX	75284	Mobile MRI	200000
Mid-state Mechanical
PO Box 607	Bridgeport	WV	26330	Repair O2 & Suction Lines	139461
Therapy Services
1085 VanVoorhis Rd	Morgantown	WV	26505	ST & OT	125700

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	3	NumberOfContractorsGT100K
All Other Contributions	44895	AllOtherContributions
Total Contributions	44895	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	Net patient services	Description
Business Code	622110	BusinessCode
Total Revenue Column	17255915	TotalRevenueColumn
Related Or Exempt Function Income	17255915	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	17255915	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	6783	TotalRevenueColumn
Exclusion	$6,783	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Cafeteria	722212	77606	77606
Other income	900099	52094	52094

Field	Value	IRS element (for citing)
Total Other Revenue	129700	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	17437293	TotalRevenueColumn
Related Or Exempt Function Income	17385615	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$6,783	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	236504	Total
Program Services	141902	ProgramServices
Management And General	94602	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	9332480	Total
Program Services	5599488	ProgramServices
Management And General	3732992	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	231022	Total
Program Services	138613	ProgramServices
Management And General	92409	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	930508	Total
Program Services	558305	ProgramServices
Management And General	372203	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	867168	Total
Program Services	520301	ProgramServices
Management And General	346867	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	20940	Total
Management And General	20940	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	27627	Total
Management And General	27627	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	777725	Total
Program Services	466635	ProgramServices
Management And General	311090	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	2424956	Total
Program Services	1454974	ProgramServices
Management And General	969982	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	380760	Total
Program Services	228456	ProgramServices
Management And General	152304	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	20081	Total
Program Services	12049	ProgramServices
Management And General	8032	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	130566	Total
Program Services	78340	ProgramServices
Management And General	52226	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	493123	Total
Program Services	295874	ProgramServices
Management And General	197249	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	464770	Total
Program Services	278862	ProgramServices
Management And General	185908	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Medicaid provider tax	422931	422931
Maintenance & Repairs	416232	249739	166493
Dues & subscriptions	42991	25795	17196
Physician recruitment	31966	31966
Professional developmen	25237	15142	10095

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	96393	Total
Program Services	57835	ProgramServices
Management And General	38558	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	17373980	Total
Program Services	10577207	ProgramServices
Management And General	6796773	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	177775	BOY
EOY	163444	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	19869	BOY
EOY	145549	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2614438	BOY
EOY	2587745	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	267464	BOY
EOY	245239	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	100833	BOY
EOY	208476	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	14990646	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	11816291	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	3502253	BOY
EOY	3174355	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
EOY	51700	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	350746	BOY
EOY	532442	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	7033378	BOY
EOY	7108950	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	3057335	BOY
EOY	3245560	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	1124486	BOY
EOY	1060764	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	492032	BOY
EOY	469422	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	1043706	BOY
EOY	954072	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	5717559	BOY
EOY	5729818	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1315819	BOY
EOY	1379132	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1315819	BOY
EOY	1379132	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	7033378	BOY
EOY	7108950	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$2,269	OtherActivitiesAmount
Total Lobbying Expenditures IIB	2269	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Part II-B, Line 1i:	Identifier
Return Reference	Explanation of Other Lobbying Activities:	ReturnReference
Explanation	Part II-B, Line(i), Other Lobbying Activities: Grafton City Hospital pays dues to the West Virginia Hospital Association. The West Virginia Hospital Association represents hospitals and health systems. For the year ended 06/30/10, the amount of dues related to lobbying activities was $2,269.	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	26597	OtherCostOrOtherBasis
Book Value	26597	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	274995	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	7179796	OtherCostOrOtherBasis
Depreciation	5681093	Depreciation
Book Value	1773698	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	7509258	OtherCostOrOtherBasis
Depreciation	6135198	Depreciation
Book Value	1374060	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3174355	TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescription	Book ValueBookValue
Estimated third-party payor settlements	502710
Other receivables	29732

Field	Value	IRS element (for citing)
Total Book Value Other Assets	532442	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
Capital leases	$455,007
Accrued pension	$499,065

Field	Value	IRS element (for citing)
Total Of Amounts	954072	TotalOfAmounts
Total Revenue	17437293	TotalRevenue
Total Expenses	17373980	TotalExpenses
Excess Or Deficit For Year	63313	ExcessOrDeficitForYear
Total Adjustments	0	TotalAdjustments
Excess Or Deficit Per FS	63313	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	17437293	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	17437293	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	17437293	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	17373980	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	17373980	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	17373980	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Part X:	Identifier
Return Reference	Description of Uncertain Tax Positions Under FIN 48:	ReturnReference
Explanation	There was not a FIN 48 disclose included on the audited financial statements.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	0	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	885	PersonsServed
Total Community Benefit Expense	1653384	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1294837	DirectOffsettingRevenue
Net Community Benefit Expense	358547	NetCommunityBenefitExpense
Percent Of Total Expense	0.02340	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	885	PersonsServed
Total Community Benefit Expense	1653384	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1294837	DirectOffsettingRevenue
Net Community Benefit Expense	358547	NetCommunityBenefitExpense
Percent Of Total Expense	0.02340	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	6	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	51564	TotalCommunityBenefitExpense
Direct Offsetting Revenue	35370	DirectOffsettingRevenue
Net Community Benefit Expense	16194	NetCommunityBenefitExpense
Percent Of Total Expense	0.00110	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	6	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	51564	TotalCommunityBenefitExpense
Direct Offsetting Revenue	35370	DirectOffsettingRevenue
Net Community Benefit Expense	16194	NetCommunityBenefitExpense
Percent Of Total Expense	0.00110	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	7	NumberOfActivitiesOrPrograms
Persons Served	885	PersonsServed
Total Community Benefit Expense	1704948	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1330207	DirectOffsettingRevenue
Net Community Benefit Expense	374741	NetCommunityBenefitExpense
Percent Of Total Expense	0.02450	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$1,630,424	BadDebtExpenseAmount
Amount Reimbursed By Medicare	4576923	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4613754	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-36831	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	0	ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Grafton City Hospital Inc	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	500 Market Street	AddressLine1
City	Grafton	City
State	WV	State
ZIP Code	25354	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Costing Method Used	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.	CostingMethodUsed
Bad Debt Footnote	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.	BadDebtFootnote
Needs Assessment	Part VI, Line 2: To assess the health care needs of the population base of Grafton City Hospital, the facility is heavily involved with the areas community forums. Through this venue the hospital takes the inquiries that are voiced and applies an economic forecast to the program to verify its stability. The facility also uses the Bureau for Public Health, for risk factors that would have an impact on the lives of the population that Grafton City Hospital serves.	NeedsAssessment
Patient Education Assistance	Part VI, Line 3: The patient population is educated and informed of the financial assistance programs through the financial counselors and admission personnel. The hospital also has this information published in the public areas within the hospital.	PatientEducationAssistance
Community Information	Part VI, Line 4: The main population the facility serves is Taylor County. Grafton City Hospital is the only hospital within its county. Taylor County has a population of 16,328, with a estimated median household income of $34,192 as compared to WV estimated median household income of $37,435. Taylor County cost of living index is at 81.0 as compared to the United States average of 100.0.	CommunityInformation
Community Building Activities	Part VI, Line 5: The organization's health care facilities further its exempt purpose in the following ways: The organization's governing body is comprised of persons who reside in the organization's primary service area and are neither employees or contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified providers in its community for some or all of its departments. The organization operates an emergency room available to all, regardless of ability to pay. Specialized services offered by the organization that are not available elsewhere include pulmonology, critical care medicine, general surgery, internal medicine, obstetrics and gynecology, and family medicine. The organization serves as a vehicle for attracting charitable support, as well as a source of community volunteer activities.	CommunityBuildingActivities
Other Information	Part VI, Line 6: The organization's health care facilities further its exempt purpose in the following ways: The organization's governing body is comprised of persons who reside in the organization's primary service area and are neither employees or contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified providers in its community for some or all of its departments. The organization operates an emergency room available to all, regardless of ability to pay. Specialized services offered by the organization that are not available elsewhere include pulmonology, critical care medicine, general surgery, internal medicine, obstetrics and gynecology, and family medicine. The organization serves as a vehicle for attracting charitable support, as well as a source of community volunteer activities.	OtherInformation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Joseph Duvert
265016	0	0	0	0	0	6625	0	0	0	271641	0	0	0
David Bender
213550	0	0	0	0	0	5339	0	0	0	218889	0	0	0
Chris Villaraza
187981	0	0	0	0	0	4700	0	0	0	192681	0	0	0
James Woodford
190481	0	0	0	0	0	4762	0	0	0	195243	0	0	0
Thomas Wilshire
244120	0	0	0	0	0	6103	0	0	0	250223	0	0	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
Form 990, Part VI, Section B, line 11	The form 990 will be reviewed by the CEO and CFO before it is filed. A copy of the final form 990 will be provided to the board of directors prior to filing.
Form 990, Part VI, Section B, line 12c	Trustees are made aware of the conflict of interest policy. Should a Trustee feel there is a subject in which they have a conflict, they recuse themself from the discussion and any possible action.
Form 990, Part VI, Section B, line 15	A compensation committeee determines the compensation of the CEO and other officers by comparing salaries with other hospitals located in West Virginia Critical Access Hospital Network with board approval.
Form 990, Part VI, Section C, line 18	The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request.
Form 990, Part VI, Section C, line 19	The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request.
Form 990, Part XI, Line 2c explanation	The board of directors has a separate audit oversight committee, which has not changed since last year.	Audit Oversight Committee