TY 2013 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) JANIE BERG........................................................................ TRUSTEE	1.00 .......................	X			0	0
(2) ROBERT CHEHI........................................................................ CHAIRMAN	1.00 .......................	X	X		0	0
(3) DOUG SWICK........................................................................ TRUSTEE	1.00 .......................	X			0	0
(4) BETTY MOOMAU........................................................................ TRUSTEE	1.00 .......................	X			0	0
(5) MATT HARPER........................................................................ TRUSTEE	1.00 .......................	X			0	0
(6) STEPHEN THOMPSON DO........................................................................ TRUSTEE	1.00 .......................	X			0	0
(7) ALAN KILE SR........................................................................ TRUSTEE	1.00 .......................	X			0	0
(8) TOM KIMBLE........................................................................ TRUSTEE	1.00 .......................	X			0	0
(9) RALPH SITES........................................................................ TRUSTEE	1.00 .......................	X			0	0
(10) JASON SITES........................................................................ TRUSTEE	1.00 .......................	X			0	0
(11) JANET FRYE........................................................................ TRUSTEE	1.00 .......................	X			0	0
(12) MARK WRIGHT........................................................................ VICE CHAIR	1.00 .......................	X	X		0	0
(13) MARY BETH BARR........................................................................ CHIEF EXECUTIVE OFFICER, SECRETARY	40.00 .......................	X	X		140,794	5,388
(14) JOE A BARNES........................................................................ CHIEF FINANCIAL OFFICER, TREASURER	40.00 .......................	X	X		125,107	25,167
(15) JOHN L HAHN MD........................................................................ PHYSICIAN	70.00 .......................			X	746,329	21,855
(16) AMANDA G SHERMAN DO........................................................................ PHYSICIAN	70.00 .......................			X	169,231	8,618
(17) BRENTON R HARMAN........................................................................ PHARMACY MANAGER	40.00 .......................			X	110,846	25,188

(A) Name and business address	(B) Description of services	(C) Compensation
RELIABLE HEALTHCARE LLC3120 UNIVERSITY AVENUEMORGANTOWNWV26505	ER PHYSICIAN COVERAGE	1,961,225
MEDHOST2739 MONUMENTUM PLACECHICAGOIL60689	IT SERVICES	588,377
PULMONARY ASSOCIATES INC96 W MAINROMNEYWV26757	RESPIRATORY THEARPY SERVICES	455,551
US MOBILE IMAGINGPO BOX 800CUMBERLANDMD21501	MRI	454,183
RIDDLEBERGER BROTHERS INCPO BOX 27MT CRAWFORDVA22841	HEATING/REFRIGERATION REPAIRS	436,583
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 18

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	297,005		297,005
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	10,304,602	8,447,646	1,856,956
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	212,486	174,195	38,291
9	Other employee benefits .......	2,577,797	2,113,261	464,536
10	Payroll taxes ...........	749,540	614,468	135,072
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	154,941		154,941
c	Accounting ...........	52,416		52,416
d	Lobbying ...........	5,532		5,532
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	6,435,221	5,275,552	1,159,669
12	Advertising and promotion ....	62,229	51,015	11,214
13	Office expenses .......	513,993	421,368	92,625
14	Information technology ......	312,328	256,044	56,284
15	Royalties ..
16	Occupancy ...........	717,581	588,268	129,313
17	Travel ............	12,065	9,891	2,174
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	79,552	65,216	14,336
20	Interest ...........	63,917	52,399	11,518
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	1,823,988	1,495,294	328,694
23	Insurance ..............	356,976	356,976
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	SUPPLIES	4,368,457	3,581,233	787,224
b	BAD DEBT EXPENSE	2,254,987	2,254,987
c	REPAIRS AND MAINTENANCE	833,497	683,295	150,202
d	LICENSES AND TAXES	641,575	641,575
e	All other expenses	594,714	487,543	107,171
25	Total functional expenses. Add lines 1 through 24e	33,425,399	27,570,226	5,855,173	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	38,703	1	69,254
2	Savings and temporary cash investments .........	2,965,110	2	3,372,189
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	5,493,959	4	5,368,303
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	883,463	8	997,317
9	Prepaid expenses and deferred charges ..........	144,431	9	120,851
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	29,285,454
b	Less: accumulated depreciation .....	10b	20,800,069	8,758,192	10c	8,485,385
11	Investments—publicly traded securities ..........	3,125,280	11	3,517,643
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....	112,242	13	112,242
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	220,086	15	355,000
16	Total assets. Add lines 1 through 15 (must equal line 34)......	21,741,466	16	22,398,184
	17	Accounts payable and accrued expenses .........	2,698,232	17	2,583,537
18	Grants payable .................		18
19	Deferred revenue ................	229	19	229
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,569,076	23	1,183,498
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	2,035,262	25	2,460,830
26	Total liabilities. Add lines 17 through 25.........	6,302,799	26	6,228,094
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	15,438,667	27	16,170,090
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	15,438,667	33	16,170,090
34	Total liabilities and net assets/fund balances ........	21,741,466	34	22,398,184

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

GRANT MEMORIAL HOSPITAL

Employer identification number

55-0562976

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2012. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2012. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

GRANT MEMORIAL HOSPITAL

Employer identification number

55-0562976

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2013

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2013

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

5,532

Total. Add lines 1c through 1i ...............................

5,532

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	THE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, THE WV HOSPITAL ASSOCIATION AND THE AMERICAN HEALTH CARE ASSOCIATION. A PORTION OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES BY THESE ASSOCIATIONS.

Schedule C (Form 990 or 990EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

GRANT MEMORIAL HOSPITAL

Employer identification number

55-0562976

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	70,684		70,684
b	Buildings ................	16,129,242	12,337,937	3,791,305
c	Leasehold improvements ............
d	Equipment ................	13,041,921	8,462,132	4,579,789
e	Other .................	43,607		43,607
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				8,485,385

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY		250,000
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS		2,210,830







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		2,460,830
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	32,002,748
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	250,205
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-2,254,987
e	Add lines 2a through 2d .....................			2e	-2,004,782
3	Subtract line 2e from line 1.....................			3	34,007,530
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	58,009
c	Add lines 4a and 4b.......................			4c	58,009
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	34,065,539

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	31,271,325
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	100,913
e	Add lines 2a through 2d......................			2e	100,913
3	Subtract line 2e from line 1.....................			3	31,170,412
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	2,254,987
c	Add lines 4a and 4b.......................			4c	2,254,987
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	33,425,399

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART XI, LINE 2D - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE -2,254,987.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	RENTAL EXPENSES -100,913. PASS-THROUGH INCOME - HOMECARE AND HOSPICE 158,922.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 100,913.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE 2,254,987.

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

GRANT MEMORIAL HOSPITAL

Employer identification number

55-0562976

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 14000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	853,000		853,000	2.740 %
b	Medicaid (from Worksheet 3, column a) ....	4,364,568	4,092,873	271,695	0.870 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	5,217,568	4,092,873	1,124,695	3.610 %
Other Benefits		132,191	28,335	103,856	0.330 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	132,191	28,335	103,856	0.330 %
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	132,191	28,335	103,856	0.330 %
k	Total. Add lines 7d and 7j .	5,349,759	4,121,208	1,228,551	3.940 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,011,598

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

9,630,145

Enter Medicare allowable costs of care relating to payments on line 5.....

10,366,653

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-736,508

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 GRANT MEMORIAL HOMECARE AND HOSPICE LLC	PROVIDES HOME CARE AND HOSPICE SERVICES	33.000 %	0 %	0 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2013

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number						Other (Describe)
1	GRANT MEMORIAL HOSPITAL 117 HOSPITAL LANE PETERSBURG,WV26847 WWW.GRANTMEMORIAL.COM 1036-4136	X	X	X	X	SNF/NF & PRIMARY CARE PHYSICIAN SERVICES

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	GRANT MEMORIAL HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.GRANTMEMORIAL.COM/INDEX.PHP/RESOURCES

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 140.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 3: THE HOSPITAL PERFORMED TELEPHONE SURVEYS TO RESIDENTS OF THE SERVICE AREAS. THE DATA FROM THE TELEPHONE SURVEYS WAS USED DURING THE COMMUNITY SUMMIT WITH COMMUNITY LEADERS AND OTHER CITIZENS THROUGHOUT THE COMMUNITY. THE COMMUNITY LEADERS INCLUDED PHYSICIANS, A SCHOOL PRINCIPAL, A COUNTY COMMISSIONER, A BANKER, A TEACHER, THE CEO OF THE LOCAL COMMUNITY HEALTH CENTER, BOARD MEMBERS AND HOSPITAL LEADERSHIP. THE DATA THAT RESULTED FROM THE COMMUNITY SUMMIT WAS THEN REVIEWED BY HOSPITAL LEADERSHIP TO DETERMINE THE NEEDS TO BE ADDRESSED.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 5D: THE HOSPITAL CONDUCTED A FORUM THAT PROVIDED THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. PERSONS WHO PARTICIPATED IN THE ASSESSMENTS WERE INVITED, AND THE FORUM WAS ALSO OPEN TO THE PUBLIC.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 7: IT IS UNDERSTOOD THAT IN ORDER TO BE THE MOST EFFECTIVE AND MAKE THE GREATEST IMPACT, THAT NOT ALL COMMUNITY NEEDS CAN BE ADDRESSED AT ONCE IN AN IMPLEMENTATION PLAN. IT IS IMPORTANT TO NOTE THAT WHILE THREE NEEDS WERE PRIORITIZED AND ADOPTED BY THE HOSPITAL FOR ITS IMPLEMENTATION PLAN, FOR THOSE NEEDS THAT THE HOSPITAL DID NOT MAKE A PRIORITY, WE CONTINUE TO WORK WITH COMMUNITY ORGANIZATIONS TO HELP ADDRESS THOSE NEEDS. THE NEEDS THAT ARE BEING ADDRESSED ARE AROUND INCREASING THE LIFESTYLE, WELLNESS, NUTRITION AND ACTIVTIES OF THE POPULATION, CREATING GREATER ACCESS TO CARE, AND DECREASING CHRONIC DISEASE. THE NEEDS THAT WERE IDENTIFIED THAT ARE NOT CURRENTLY BEING ADDRESSED ARE INCREASING EDUCATION TO HIGH SCHOOL STUDENTS ON LIFESTYLE AND TEEN PREGNANCY, DECREASING TOBACCO USE, DECREASE OF DIABETES THROUGHOUT THE COMMUNITY, AND DECREASE OF BEHAVIORAL HEALTH ISSUES (PRIMARILY DRUG ABUSE) THROUGHOUT THE COMMUNITY. IT IS THE HOSPITAL'S HOPE THAT BY ADEQUATELY ADDRESSING THE THREE PRIORITIZED NEEDS, THE OTHER NEEDS WILL BE INDIRECTLY IMPACTED AS WELL.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS ALSO PUBLISHED IN THE LOCAL NEWSPAPERS ON AN ANNUAL BASIS.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 20D: THE AMOUNT THAT CAN BE CHARGED TO FAP ELIGIBLE INDIVIDUALS IS BASED UPON AN AMOUNT THAT IS LOWER THAN THE DISCOUNT PROVIDED TO BLUE CROSS PATIENTS. IF THE HOSPITAL WOULD PROVIDE A HIGHER DISCOUNT PERCENTAGE, THEN THE HOSPITAL WOULD HAVE TO PROVIDE THE SAME DISCOUNT TO BLUE CROSS PATIENTS.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 3: THE HOSPITAL PERFORMED TELEPHONE SURVEYS TO RESIDENTS OF THE SERVICE AREAS. THE DATA FROM THE TELEPHONE SURVEYS WAS USED DURING THE COMMUNITY SUMMIT WITH COMMUNITY LEADERS AND OTHER CITIZENS THROUGHOUT THE COMMUNITY. THE COMMUNITY LEADERS INCLUDED PHYSICIANS, A SCHOOL PRINCIPAL, A COUNTY COMMISSIONER, A BANKER, A TEACHER, THE CEO OF THE LOCAL COMMUNITY HEALTH CENTER, BOARD MEMBERS AND HOSPITAL LEADERSHIP. THE DATA THAT RESULTED FROM THE COMMUNITY SUMMIT WAS THEN REVIEWED BY HOSPITAL LEADERSHIP TO DETERMINE THE NEEDS TO BE ADDRESSED.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 5D: THE HOSPITAL CONDUCTED A FORUM THAT PROVIDED THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. PERSONS WHO PARTICIPATED IN THE ASSESSMENTS WERE INVITED, AND THE FORUM WAS ALSO OPEN TO THE PUBLIC.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 7: IT IS UNDERSTOOD THAT IN ORDER TO BE THE MOST EFFECTIVE AND MAKE THE GREATEST IMPACT, THAT NOT ALL COMMUNITY NEEDS CAN BE ADDRESSED AT ONCE IN AN IMPLEMENTATION PLAN. IT IS IMPORTANT TO NOTE THAT WHILE THREE NEEDS WERE PRIORITIZED AND ADOPTED BY THE HOSPITAL FOR ITS IMPLEMENTATION PLAN, FOR THOSE NEEDS THAT THE HOSPITAL DID NOT MAKE A PRIORITY, WE CONTINUE TO WORK WITH COMMUNITY ORGANIZATIONS TO HELP ADDRESS THOSE NEEDS. THE NEEDS THAT ARE BEING ADDRESSED ARE AROUND INCREASING THE LIFESTYLE, WELLNESS, NUTRITION AND ACTIVTIES OF THE POPULATION, CREATING GREATER ACCESS TO CARE, AND DECREASING CHRONIC DISEASE. THE NEEDS THAT WERE IDENTIFIED THAT ARE NOT CURRENTLY BEING ADDRESSED ARE INCREASING EDUCATION TO HIGH SCHOOL STUDENTS ON LIFESTYLE AND TEEN PREGNANCY, DECREASING TOBACCO USE, DECREASE OF DIABETES THROUGHOUT THE COMMUNITY, AND DECREASE OF BEHAVIORAL HEALTH ISSUES (PRIMARILY DRUG ABUSE) THROUGHOUT THE COMMUNITY. IT IS THE HOSPITAL'S HOPE THAT BY ADEQUATELY ADDRESSING THE THREE PRIORITIZED NEEDS, THE OTHER NEEDS WILL BE INDIRECTLY IMPACTED AS WELL.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS ALSO PUBLISHED IN THE LOCAL NEWSPAPERS ON AN ANNUAL BASIS.
GRANT MEMORIAL HOSPITAL	PART V, SECTION B, LINE 20D: THE AMOUNT THAT CAN BE CHARGED TO FAP ELIGIBLE INDIVIDUALS IS BASED UPON AN AMOUNT THAT IS LOWER THAN THE DISCOUNT PROVIDED TO BLUE CROSS PATIENTS. IF THE HOSPITAL WOULD PROVIDE A HIGHER DISCOUNT PERCENTAGE, THEN THE HOSPITAL WOULD HAVE TO PROVIDE THE SAME DISCOUNT TO BLUE CROSS PATIENTS.

Schedule H (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

GRANT MEMORIAL HOSPITAL

Employer identification number

55-0562976

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Yes

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2013

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)JOE A BARNESCHIEF FINANCIAL OFFICER, TREASURER	(i) (ii)	120,000 0	5,107 0	0 0	3,600 0	21,567 0	150,274 0	0 0
(2)JOHN L HAHN MDPHYSICIAN	(i) (ii)	319,306 0	427,023 0	0 0	0 0	21,855 0	768,184 0	0 0
(3)AMANDA G SHERMAN DOPHYSICIAN	(i) (ii)	169,231 0	0 0	0 0	0 0	8,618 0	177,849 0	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 6

COMPENSATION FOR DR. HAHN (OB/GYN) IS BASED UPON NET EARNINGS. DR. HAHN IS AN INNOVATOR IN THE PROFESSION OF OB, NORMAL DELIVERIES. HE DEVELOPED THE CATHETER, FOR WHICH HE HAS A PATENT, THAT IS USED IN ADMINISTERING EPIDURALS. CONSEQUENTLY, GRANT MEMORIAL HOSPITAL WAS PROVIDING EPIDURALS TO WOMEN WHO WERE IN LABOR PRIOR TO WHEN IT BECAME A STANDARD PRACTICE THROUGHOUT THE UNITED STATES. DUE TO HIS REPUTATION, A BOOK AND DOCUMENTARY ARE BEING PRODUCED ABOUT HIS CLINICAL ACHIEVEMENTS IN PROVIDING OB/GYN PHYSICIAN SERVICES. HE HAS BEEN IN PRACTICE AT GRANT MEMORIAL HOSPITAL FOR OVER 25 YEARS. WITH THE EXCEPTION OF ONE WEEK DURING THE YEAR, HE IS ALWAYS ON CALL. IN A SUBURBAN AREA, THE AVERAGE NUMBER OF DELIVERIES PER YEAR BY AN OBSTETRICIAN IS BETWEEN 250-300. DR. HAHN AVERAGES BETWEEN 225-250 DELIVERIES WITH THE VAST MAJORITY OF THESE BEING MEDICAID OR UNINSURED PATIENTS. ALSO THE HOSPITAL SEES ABOUT 49 TEEN BIRTH RATES PER 1,000, WHILE THE NATIONAL AVERAGE IS 21. THE HOSPITAL COMPENSATES DR. HAHN FOR THE SERVICES HE PROVIDES FOR THE HOSPITAL AND TO THE COMMUNITY. OVERALL, HIS COMPENSATION COMPARES TO NATIONAL AVERAGES TAKING INTO CONSIDERATION THAT IT IS DIFFICULT TO RECRUIT OB/GYN PHYSICIANS TO A RURAL AREA, YEARS OF EXPERIENCE, PATENTS THAT HAVE BEEN RECEIVED IN IMPROVING PATIENT CARE AND THE AMOUNT OF CALL PROVIDED BY THE PHYSICIAN.

PART I, LINE 7

THE CHIEF FINANCIAL OFFICER'S BONUS IS DETERMINED BY THE CHIEF EXECUTIVE OFFICER AND THE AMOUNT OF THE BONUS MAY VARY EACH YEAR. THE BONUS IS NOT BASED ON THE HOSPITAL'S PROFITABILITY.

Schedule J (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

GRANT MEMORIAL HOSPITAL

Employer identification number

55-0562976

Return Reference	Explanation
FORM 990, PART III, LINE 2	THE MOST IMPORTANT SHORT-TERM NEEDS FOR BOTH THE HOSPITAL AND THE AREA ARE TO OBTAIN A GENERAL SURGEON AND PHYSICIANS IN INTERNAL MEDICINE, FAMILY PRACTICE AND PEDIATRICS. A NEW OBSTETRICIAN BEGAN PRACTICE IN SEPTEMBER 2014 AND AN INTERNAL MEDICINE PHYSICIAN WILL BEGIN PRACTICING NEXT YEAR. CONSEQUENTLY, OVER THE NEXT YEAR THE FOCUS WILL BE ON RECRUITING A GENERAL SURGEON AND A PEDIATRICIAN. HOSPITALISTS ARE INTERNAL MEDICINE PHYSICIANS WHO TREAT PATIENTS WHILE THEY ARE IN THE HOSPITAL. IN MANY CASES, THE HOSPITALISTS ARE NOT THESE PATIENTS' PRIMARY CARE PHYSICIANS. WHENEVER ANY OTHER MEMBER OF THE MEDICAL STAFF WOULD HAVE A PATIENT THAT WOULD NEED TO BE ADMITTED AS AN INPATIENT, THAT PHYSICIAN HAS THE OPTION TO FOLLOW AND TREAT THE PATIENT WHILE THEY ARE AN INPATIENT OR THEY COULD REFER THEM TO ONE OF THE HOSPITALISTS. ONCE THE PATIENT IS DISCHARGED, THE PATIENT WOULD BE TREATED BY THEIR REGULAR PRIMARY CARE PHYSICIAN. THE HOSPITALIST WOULD ALSO CARE FOR UNASSIGNED PATIENTS (THOSE PATIENTS WHO DON'T HAVE AN AREA PRIMARY CARE PHYSICIAN) WHEN THESE PATIENTS WOULD REQUIRE INPATIENT TREATMENT. THIS IS A HUGE BENEFIT FOR THE OTHER PRIMARY CARE PHYSICIANS BECAUSE THEY DO NOT HAVE TO TAKE CALL. ALSO, IT WILL BE A BIG INCENTIVE IN RECRUITING NEW PHYSICIANS TO THE AREA BECAUSE THEY WOULD ONLY BE REQUIRED TO HAVE AN OFFICE PRACTICE (40 HOUR WORK WEEK). THE HOSPITAL IS ESSENTIALLY PAYING FOR "CALL." THE HOSPITALISTS DO THEIR OWN BILLING. THE HOSPITAL IS UNABLE TO BILL ANYONE FOR THIS CALL. THE BENEFIT TO THE HOSPITAL IS THAT IT HAS REDUCED THE NUMBER OF TRANSFERS TO OTHER HOSPITALS AND HAS INCREASED THE HOSPITAL'S AVERAGE DAILY CENSUS.
FORM 990, PART III, LINE 3	THE ORGANIZATION NO LONGER PROVIDES OUTPATIENT CLINICAL SERVICES TO VETERANS THROUGH THE VETERANS ADMINISTRATION (VA) BECAUSE THE CONTRACT WAS NOT RENEWED BY THE VA.
FORM 990, PART VI, SECTION A, LINE 1	THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIRPERSON, VICE-CHAIRPERSON, TWO OTHER MEMBERS OF THE BOARD, THE CEO, CFO AND CHIEF OF STAFF. DURING INTERVALS BETWEEN BOARD MEETINGS, THE EXECUTIVE COMMITTEE MAY ACT IN THE NAME, AND WITH THE FULL POWER, OF THE BOARD PROVIDED THAT ANY SUCH ACTION SHALL NOT CONFLICT WITH THE POLICIES OF THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 6	THE HOSPITAL HAS A DUAL CERTIFICATION IN THAT IT IS A POLITICAL SUB-DIVISION OF GRANT COUNTY.
FORM 990, PART VI, SECTION A, LINE 7A	THE GRANT COUNTY COMMISSION APPOINTS MEMBERS TO THE BOARD WHO RESIDE IN GRANT, HARDY AND PENDLETON COUNTIES. THE HOSPITAL IS A POLITICAL SUB-DIVISION OR COMPONENT UNIT OF GRANT COUNTY (COUNTY HOSPITAL).
FORM 990, PART VI, SECTION B, LINE 11	THE TAX RETURN WILL BE REVIEWED BY MANAGEMENT AND IS GIVEN TO EVERY MEMBER OF THE BOARD PRIOR TO ISSUANCE.
FORM 990, PART VI, SECTION B, LINE 12C	TRUSTEES AND ADMINISTRATION OFFICIALS SHALL BE REQUIRED TO COMPLETE A WRITTEN CONFLICT OF INTEREST STATEMENT ANNUALLY WHICH SHALL DISCLOSE THE EXTENT OF FINANCIAL DEALINGS WITH THE ORGANIZATION BY ALL BUSINESSES OR OTHER ORGANIZATIONS IN WHICH THEY, OR MEMBERS OF THEIR IMMEDIATE FAMILIES, HAVE A BENEFICIAL INTEREST. A BENEFICIAL INTEREST WITH AN ORGANIZATION WILL BE CONSIDERED TO EXIST WHEN A TRUSTEE OR ADMINISTRATION OFFICIAL OR A MEMBER OF HIS/HER IMMEDIATE FAMILY IS AN OFFICER, DIRECTOR, TRUSTEE, PARTNER, EMPLOYEE OR AGENT OF THE ORGANIZATION, OR OWNS FIVE PERCENT OF THE VOTING STOCK OR CONTROLLING INTEREST IN THAT ORGANIZATION, OR HAS ANY OTHER SUBSTANTIAL INTEREST OR DEALINGS WITH THE ORGANIZATION. AT SUCH TIME, IF ANY MATTER SHOULD COME BEFORE THE BOARD OF TRUSTEES IN SUCH A WAY AS TO GIVE RISE TO A CONFLICT OF INTEREST, THE AFFECTED MEMBER OF THE BOARD SHALL MAKE KNOWN THE POTENTIAL CONFLICT AND, IF ADVISABLE, WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO VOTE, THE AFFECTED MEMBER SHALL NOT VOTE, NOR BE COUNTED IN ESTABLISHING A QUORUM FOR THE VOTE ON THAT MATTER. PROCEEDINGS RELATED TO THE CONFLICT OF INTEREST MATTERS BEFORE THE BOARD OF TRUSTEES SHALL BE DOCUMENTED IN THE MINUTES OF THAT MEETING. EVERY JANUARY, THE CEO AND CHAIRMAN ENSURE THE CONFLICT OF INTEREST FORMS ARE COMPLETED. THEY REVIEW THE FORMS TO IDENTIFY ANY INSTANCES THEY CAN FORESEE AND DISCUSS THEM WITH THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15	EVERY YEAR A SURVEY IS CONDUCTED THROUGH THE STATE ON AVERAGE SALARIES FOR OFFICERS OF THE ORGANIZATION. THIS ENSURES THE HOSPITAL IS PAYING NO MORE THAN FAIR MARKET VALUE FOR OFFICER COMPENSATION. AFTERWARDS, THE COMPENSATION AVERAGES ARE GIVEN TO THE EXECUTIVE COMMITTEE AND THE COMMITTEE HAS FINAL SAY ON THE ACTUAL COMPENSATION FOR EACH OFFICER OF THE HOSPITAL. THE COMPENSATION PROCESS IS DOCUMENTED IN THE COMMITTEE MINUTES.
FORM 990, PART VI, SECTION C, LINE 18	THE TAX RETURN IS SUBMITTED TO THE WEST VIRGINIA HEALTHCARE AUTHORITY UNDER THE STATE OF WEST VIRGINIA'S FINANCIAL DISCLOSURE STATUTE.
FORM 990, PART VI, SECTION C, LINE 19	IT IS REQUIRED BY WEST VIRGINIA LAW THAT ALL HOSPITALS FILE FINANCIAL STATEMENTS, MEDICARE/MEDICAID COST REPORTS, TAX RETURNS AND OTHER FINANCIAL INFORMATION TO THE WEST VIRGINIA HEALTH CARE AUTHORITY. IN ADDITION, FINANCIAL STATEMENTS ARE ALSO REQUIRED TO BE PUBLISHED IN LOCAL NEWSPAPERS. INFORMATION SUBMITTED TO THE WEST VIRGINIA HEALTH CARE AUTHORITY MAY BE OBTAINED UNDER THE FREEDOM OF INFORMATION ACT. THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,686,219. MANAGEMENT AND GENERAL EXPENSES 590,483. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,276,702. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,587,714. MANAGEMENT AND GENERAL EXPENSES 568,830. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,156,544. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 1,619. MANAGEMENT AND GENERAL EXPENSES 356. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,975.
FORM 990, PART XI, LINE 9:	PASS-THROUGH INCOME - HOMECARE AND HOSPICE -158,922.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TAX-EXEMPT HOSPITAL DEDICATED TO SERVICING THE COUNTIES OF GRANT, HARDY & PENDLETON IN WEST VIRGINIA.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	425
6	Total number of volunteers (estimate if necessary) .............	6	30
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	39,064	10,979
9	Program service revenue (Part VIII, line 2g) .........	29,867,539	33,150,501
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	485,242	120,999
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	325,856	783,060
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	30,717,701	34,065,539
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	13,389,219	14,141,430
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	17,877,642	19,283,969
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	31,266,861	33,425,399
19	Revenue less expenses. Subtract line 18 from line 12.......	-549,160	640,140
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	21,741,466	22,398,184
21	Total liabilities (Part X, line 26).............	6,302,799	6,228,094
22	Net assets or fund balances. Subtract line 21 from line 20.....	15,438,667	16,170,090

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 27,570,226 including grants of $ ) (Revenue $ 33,751,959 )
	THE HOSPITAL PROVIDES A FULL COMPLEMENT OF HEALTH SERVICES INCLUDING INPATIENT ACUTE, OBSTETRICS, INTENSIVE CARE, SWING-BED SERVICES, NURSING FACILITY SERVICES (BOTH SKILLED AND INTERMEDIATE), TRADITIONAL OUTPATIENT SERVICES AND PHYSICIAN SERVICES TO THE RESIDENTS OF GRANT, HARDY AND PENDLETON COUNTIES OF WEST VIRGINIA. THE HOSPITAL IS LOCATED IN THE EASTERN PANHANDLE OF WEST VIRGINIA WITH THE CLOSET HOSPITALS BEING APPROXIMATELY 1.25 TO 1.5 HOURS AWAY. SINCE THE HOSPITAL IS LOCATED IN THE MOUNTAINS, DRIVING TIMES CAN BE MUCH LONGER DURING THE WINTER MONTHS. DURING THE YEAR, THE HOSPITAL HAD 5,368 ADULT AND PEDIATRIC DAYS, 814 SWING-BED DAYS, 471 INTENSIVE CARE DAYS, 478 NURSERY DAYS AND 4,158 NURSING FACILITY DAYS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses27,570,226

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,401,201	0	111,024

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) DAVID W BROSH........................................................................ PHARMACIST	40.00 .......................	X	108,894	0	24,808

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		10,224

f	All other contributions, gifts, grants, and similar amounts not included above1f		755

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			10,979
			Business Code
2a	NET PATIENT SERVICE REVENUE		621400	33,150,501	33,150,501
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			33,150,501
3	Investment income (including dividends, interest, and other similar amounts).......			276,313			276,313
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	117,394
b	Less: rental expenses	100,913
c	Rental income or (loss)	16,481
d	Net rental income or (loss).......			16,481			16,481
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses		155,314
c	Gain or (loss)		-155,314
d	Net gain or (loss)..........			-155,314			-155,314
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	OTHER OPERATING REVENUE		900099	328,810	328,810
b	HOMECARE & HOSPICE		621610	158,922	158,922
c	CAFETERIA		722210	155,947			155,947
d	All other revenue ....			122,900	113,726		9,174
e	Total. Add lines 11a–11d ......			766,579
12	Total revenue. See Instructions......			34,065,539	33,751,959	0	302,601


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			38,703	1	69,254
2	Savings and temporary cash investments .........			2,965,110	2	3,372,189
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			5,493,959	4	5,368,303
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			883,463	8	997,317
9	Prepaid expenses and deferred charges ..........			144,431	9	120,851
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	29,285,454
b	Less: accumulated depreciation .....	10b	20,800,069	8,758,192	10c	8,485,385
11	Investments—publicly traded securities ..........			3,125,280	11	3,517,643
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....			112,242	13	112,242
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			220,086	15	355,000
16	Total assets. Add lines 1 through 15 (must equal line 34)......			21,741,466	16	22,398,184
17	Accounts payable and accrued expenses .........			2,698,232	17	2,583,537
18	Grants payable .................				18
19	Deferred revenue ................			229	19	229
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			1,569,076	23	1,183,498
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			2,035,262	25	2,460,830
26	Total liabilities. Add lines 17 through 25.........			6,302,799	26	6,228,094
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			15,438,667	27	16,170,090
28	Temporarily restricted net assets ...........				28
29	Permanently restricted net assets ...........				29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			15,438,667	33	16,170,090
34	Total liabilities and net assets/fund balances ........			21,741,466	34	22,398,184