2024-08-15T09:08:52-05:00 2023-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2022-10-01 570468486 WILLIAMSBURG REGIONAL HOSPITAL WILL 8433558888 PO DRAWER 568 KINGSTREE SC 29556 DOUGLAS BROACH CFO 8433558888 2024-08-14 1 1 JOHN NORMAN P01506766 7049985200 2024-08-14 2022 2024-08-08 14:25:15Z ALLEN ABERNETHY PO DRAWER 568 KINGSTREE SC 29556 6704989 0 X WWW.WMBGRH.ORG X 2002 SC OPERATION OF AN ACUTE CARE HOSPITAL. X 5 5 177 18 0 0 1637962 624425 23080475 6080564 0 0 0 0 24718437 6704989 0 0 0 0 15204595 3748093 0 0 0 10274297 11314458 25478892 15062551 -760455 -8357562 14810081 3238780 3545758 332019 11264323 2906761 X WILLIAMSBURG REGIONAL HOSPITAL IS A NOT FOR PROFIT ACUTE CARE HOSPITAL WITH 25 LICENSED BEDS, PROVIDING EXCELLENCE IN PATIENT CARE IN AN ENVIRONMENT THAT IS RESPECTFUL OF OTHERS, ADAPTIVE TO CHANGE, ACCOUNTABLE FOR OUTCOMES, AND ATTENTIVE TO THE NEEDS OF THE COMMUNITY. 0 0 15062551 6080564 WILLIAMSBURG REGIONAL HOSPITAL IS AN ACUTE CARE HOSPITAL IN KINGSTREE, SOUTH CAROLINA. THE GOAL OF THE HOSPITAL IS TO DELIVER THE BEST HEALTHCARE AVAILABLE TO THE RESIDENTS OF WILLIAMSBURG COUNTY AND THE SURROUNDING AREA AS WE SEEK TO MAKE THE COMMUNITY HEALTHIER. THE HOSPITAL'S MISSION IS TO PROVIDE EXCELLENCE IN PATIENT CARE IN AN ENVIRONMENT THAT IS RESPECTFUL OF OTHERS, ADAPTAVE TO CHANGE, ACCOUNTABLE FOR OUTCOMES, AND ATTENTIVE TO THE NEEDS OF THE COMMUNITY. WE TREAT OUR PATIENTS AS WE WOULD OUR FAMILIES; VISITORS AND FELLOW EMPLOYEES AS WE WOULD OUR FRIENDS; THE COMMUNITY AS OUR PARTNER; AND OUR HOSPITAL AS WE WOULD OUR HOME. CONTINUED ON SCHEDULE OWILLIAMSBURG REGIONAL HOSPITAL PROVIDES EXCELLENCE IN PATIENT CARE IN AN ENVIRONMENT THAT IS RESPECTFUL OF OTHERS, ADAPTIVE TO CHANGE, ACCOUNTABLE FOR OUTCOMES, AND IS ATTENTIVE TO THE NEEDS OF THE COMMUNITY. THE HOSPITAL PROVIDES AN ARRAY OF SERVICES, INCLUDING PAIN MANAGEMENT, SURGICAL SERVICES, LABORATORY, SLEEP LAB, RADIOLOGY, MAMMOGRAPHY, INTENSIVE CARE, MEDICAL/SURGICAL INPATIENT CARE, STROKE CARE, WOUND CARE, GYNECOLOGY, OPERATION OF A RURAL HEALTH CENTER, PHYSICAL THERAPY, NEPHROLOGY, EMERGENCY SERVICES, AND CARDIOLOGY SERVICES. 15062551 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 124 0 1 177 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 1 1 0 1 1 1 0 1 1 1 0 SC X DOUGLAS BROACH 8433550172 500 NELSON BLVD KINGSTREE SC 29556 MR JIM CHERRY SECRETARY 1.00 X X 0 0 0 MRS JULIE FLOYD BOARD CHAIR 1.00 X X 0 0 0 MR FRANK BRADLEY ERWIN VICE CHAIR 1.00 X X 0 0 0 MRS MANDY SHULER BOARD MEMBER 1.00 X 0 0 0 MS JENNIFER MCKNIGHT BOARD MEMBER 1.00 X 0 0 0 MR WILLIAM JENKINSON BOARD MEMBER 1.00 X 0 0 0 DR TIFFANY WRIGHT BOARD MEMBER 1.00 X 0 0 0 DR JOSEPH ASARO CHIEF OF STAFF 40.00 X 0 0 0 DR TROY GAMBLE JR CMO (THRU 11/22) 40.00 X 250814 0 6826 MR DAN HARRINGTON COO 40.00 X 89491 0 1316 MRS ROBIN COOPER CNO (THRU 1/23) 40.00 X 75211 0 5415 MR DOUGLAS BROACH CFO 40.00 X 117727 0 1146 533243 0 14703 2 0 1 0 0 624425 624425 NET PATIENT REVENUE 621400 5501664 5501664 578900 578900 6080564 6704989 6080564 0 0 2845018 2845018 27056 27056 522970 522970 353049 353049 138900 138900 16648 16648 76966 76966 536077 536077 12 12 788467 788467 297036 297036 146344 146344 4959 4959 527 527 355980 355980 1770102 1770102 MISC OTHER EXPENSES 6704989 6704989 REPAIRS & MAINTENANCE 231276 231276 LICENSES, PERMITS, & TA 160594 160594 LEASES AND RENTALS 85581 85581 15062551 15062551 0 0 2638289 1528744 103932 4772181 890172 889243 819032 477648 0 40760 0 512870 512038 4165295 832 1722733 0 14810081 3238780 3148303 85829 366408 246190 31047 0 3545758 332019 X 11264323 2906761 11264323 2906761 14810081 3238780 -8357562 0 X X 0 0 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 512870 512038 832 832 1 1 X 1 X 1 X 1 1 1 0 0 769919 500000 269919 0.01790 2174307 591091 1583216 0.10510 2944226 1091091 1853135 0.12300 2944226 1091091 1853135 0.12300 0 1341903 373049 5991206 6237234 -246028 X 1 1 1 1 WILLIAMSBURG REGIONAL HOSPITAL 500 NELSON BOULEVARD KINGSTREE SC 29556 WWW.WMBRGH.ORG X X X X WILLIAMSBURG REGIONAL HOSPITAL 1 0 0 1 X X X X X X X X 20 1 0 0 1 X WWW.WMBGRH.ORG/CHN-ASSESSMENT X 1 22 1 WWW.WMBGRH.ORG/CHN-ASSESSMENT 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WMBGRH.ORG/FINANCIAL-ASSISTANCE X HTTPS://WMBGRH.ORG/FINANCIAL-ASSISTANCE X HTTPS://WMBGRH.ORG/FINANCIAL-ASSISTANCE X X X X X X 0 0 X X X 1 X 0 0 PART V, SECTION A: WILLIAMSBURG REGIONAL HAD TO TEMPORARILY SUSPEND OPERATIONS IN THE MAIN HOSPITAL BUILDING DURING FEBRUARY 2016 DUE TO DAMAGES RECEIVED DURING THE CAROLINA FLOOD IN OCTOBER 2015. IN DECEMBER 2016, WILLIAMSBURG REGIONAL OPENED A TEMPORARY FACILITY FOR INPATIENT AND OUTPATIENT SERVICES. WILLIAMSBURG REGIONAL HOSPITAL PART V, SECTION B, LINE 5: INTERVIEWS WERE CONDUCTED WITH A NUMBER OF LOCAL HEALTHCARE EXPERTS IN THE AREA. THE ONE-ON-ONE DISCUSSSIONS WERE CONDUCTED USING AN INTERVIEW GUIDE, SO EACH WOULD COVER IN A STRUCTURED MANNER THE FOLLOWING TOPICS: SOCIO-DEMOGRAPHIC NEEDS, HEALTH LITERACY, CHRONIC DISEASE INFORMATION, AND HOSPITAL SERVICES AND CARE. WILLIAMSBURG REGIONAL HOSPITAL PART V, SECTION B, LINE 11: DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, THREE COMMUNITY HEALTH PRIORITIES WERE SELECTED USING A MIXED-METHODS APPROACH. FIRST, PRIMARY DATA WAS COLLECTED THROUGH THE COMMUNITY HEALTH NEEDS SURVEY, FOCUS GROUPS, AND ONE-ON-ONE INTERVIEWS. SECONDARY DATA WAS COLLECTED THROUGH ONLINE DATA REPOSITORIES. THE PRIMARY AND SECONDARY DATA WAS USED BY THE STEERING COMMITTEE IN THEIR FINAL SELECTION OF PRIORITIES THAT WERE IDENTIFIED THROUGH THE COMMUNITY HEALTH FORUM. THE STEERING COMMITTEE REVIEWED THIS INFORMATION FROM A VARIETY OF SOURCES IN TERMS OF MAGNITUDE, SEVERITY, THE COMMUNITY WILL, AND FEASIBILITY. THE THREE HEALTH PRIORITIES ULTIMATELY SELECTED WERE: (1) ACCESS TO HEALTH CARE, (2) CHRONIC DISEASE, AND (3) BEHAVIORAL AND MENTAL HEALTH.WILLIAMSBURG REGIONAL HOSPITAL IS A SMALL, RURAL CRITICAL ACCESS HOSPITAL DEDICATED TO SERVING ITS PATIENTS AND COMMUNITY. SINCE IT SERVES ONE OF THE POOREST COUNTIES IN THE STATE, THERE ARE NOT AMPLE RESOURCES TO ADDRESS THE IDENTIFIED NEEDS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. HOWEVER, WILLIAMSBURG REGIONAL HOSPITAL IS COMMITTED TO ADDRESSING THESE NEEDS AND WILL USE INTERNAL AND EXTERNAL RESOURCES AT ITS DISPOSAL.THE IMPLEMENTATION OF THIS COMMUNITY HEALTH IMPROVEMENT PLAN WILL BE LED BY WILLIAMSBURG REGIONAL HOSPITAL LEADERSHIP AND STAFF. COORDINATED EFFORTS FROM APPROPRIATE COMMUNITY PARTNERS, LIKE THE WILLIAMSBURG COUNTY INTERAGENCY COUNCIL, WHO SHARE THE COMMON GOAL OF ADVANCING THE WELL-BEING OF THE COMMUNITY SERVED, WILL PROVIDE ADDITIONAL SUPPORT TO THE MAINTENANCE AND SUSTAINABILITY OF THE PLAN. A LIST OF KEY PARTNERS HAS BEEN PROVIDED FOR EACH STRATEGY, HOWEVER, IT SHOULD BE NOTED THAT THESE LISTS MAY NOT INCLUDE ALL OF THE REQUIRED PARTNERSHIPS FOR THE IMPLEMENTATION OF THE PLAN. WILLIAMSBURG REGIONAL HOSPITAL PART V, SECTION B, LINE 16J: CHARITY PROGRAM MENTIONED UPON PATIENT ADMISSION AND DISCHARGE AND DURING THE COLLECTION PROCESS IF THE PATIENT INQUIRES. ALSO IF PATIENTS ARE UNINSURED, THEY RECEIVE A DISCOUNT IMMEDIATELY UPON BILLING. PART I, LINE 3C: THE HOSPITAL USES DIFFERENT SOURCES OF INFORMATION SUCH AS INCOME LEVEL, HOUSEHOLD SIZE, HOUSEHOLD INCOME, AND ASSETS. PART I, LINE 7: THE ORGANIZATION USED THE IRS WORKSHEETS TO CALCULATE THE AMOUNTS REPORTED ON SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: WILLIAMSBURG REGIONAL HOSPITAL CURRENTLY OPERATES OUT OF A TEMPORARY FACILITY FOR BOTH IN AND OUTPATIENT SERVICES. WILLIAMSBURG REGIONAL HOSPITAL PLANS ON CEASING OPERATIONS IN JANUARY 2023 WITH MUSC BUILDING A NEW STATE OF THE ART FACILITY IN WILLIAMSBURG COUNTY TO SUPPORT THE COMMUNITY. PART III, LINE 2: THE HOSPITAL ESTIMATES BAD DEBT EXPENSE BY COMPARING THE TOTAL OF ALL CHARGES BILLED OVER A CERTAIN TIME PERIOD, TO THE TOTAL AMOUNT SITTING UNPAID IN BAD DEBT STATUS . A PERCENTAGE IS DERIVED BY COMPARING THESE TOTALS AND THE PERCENTAGE IS APPLIED TO ACCOUNTS RECEIVABLE CURRENTLY OUTSTANDING. ALL ACCOUNTS RECEIVABLE OLDER THAN 180 DAYS IS CONSIDERED TO BE 100% BAD DEBT. ALL ACCOUNTS IN THE BILLING AND RECEIVABLE SYSTEM HAVE STATEMENTS THAT GO OUT EVERY 30 DAYS ON SELF PAY BALANCES. IF AN ACCOUNT RECEIVES FOUR STATEMENTS WITH NO PAYMENT, THAT ACCOUNT IS TRANSFERRED TO THE BAD DEBT LEDGER. IF PAYMENTS ARE RECEIVED ON THE ACCOUNT, THE ACCOUNT MAY NOT TRANSFER OVER TO BAD DEBT UNTIL 5 OR 6 STATEMENTS HAVE BEEN GENERATED. ONCE AN ACCOUNT IS TRANSFERRED TO BAD DEBT, ANY PAYMENTS/ADJUSTMENTS POSTED TO THOSE ACCOUNTS WOULD BE NETTTED AGAINST THE BAD DEBT EXPENSE. PART III, LINE 3: WILLIAMSBURG COUNTY PERSONS IN POVERTY PERCENTAGE ACCORDING TO 2020 TENTATIVE CENSUS FOR WILLIAMSBURG COUNTY IS ROUGHLY 28%. APPLYING THIS PERCENTAGE TO THE TOTAL BAD DEBT WOULD BE ACCEPTABLE IN THIS REGION IF NOT A HIGHER PERCENTAGE CONSIDERING HOUSEHOLDS WELL ABOVE THIS LINE ARE ASSUMED TO MIGRATE OUTWARDS FOR HEALTHCARE NEEDS. PART III, LINE 8: THE HOSPITAL PROVIDES MEDICAL SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A RESULT, THE HOSPITAL INCURRS LOSSES BY SERVIING MEDICARE PATIENTS.THE UNREIMBURSED COSTS THE HOSPITAL PROVIDES TO THE COMMUNITY SHOULD BE CONSIDERED A COMMUNITY BENEFIT, SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE GO UNMET IF THE HOSPITAL DID NOT EXIST. PART III, LINE 9B: IT IS THE POLICY OF WILLIAMSBURG REGIONAL HOSPITAL TO PRESERVE THE ASSETS OF THE HOSPITAL WHILE ACHIEVING THE GOAL OF ADMINISTERING MEDICAL CARE TO THOSE IN NEED, WITHOUT REGARD TO RACE, COLOR, ANCESTRY, NATIONAL ORIGIN, RELIGION, SEXUAL ORIENTATION, AGE, SEX, MARITAL OR DISABILITY STATUS. ALL WHO RECEIVE MEDICAL CARE AND ARE CAPABLE OF PAYING FOR ALL OR PART OF THE COST OF THESE SERVICES MUST DO SO. IT IS THE POLICY OF WILLIAMSBURG REGIONAL HOSPITAL TO COLLECT PAYMENT FOR SERVICES RENDERED OR PROVIDE FINANCIAL ASSISTANCE TO ALL PATIENTS WHO OWE OUTSTANDING PATIENT BALANCES. FINANCIAL COUNSELORS WILL SCREEN OR PRESCREEN ANY PATIENT OR RESPONSIBLE PARTY THAT IS UNEMPLOYED OR WHO INDICATES THAT FINANCIAL ASSISTANCE MAY BE NEEDED. THE PATIENTS MUST PROVIDE REQUESTED INFORMATION AND THE FINAL DETERMINATION OF ASSISTANCE IS MADE BY THE HOSPITAL CEO. EACH APPLICATION FOR ASSISTANCE MUST BE RENEWED/REASSESSED AFTER ONE YEAR. PART VI, LINE 2: IN COMPLETING THE LATEST COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL FOLLOWED GUIDELINES PUBLISHED BY THE IRS. OUR METHODOLOGY INCLUDED:1. DEFINING THE HOSPITAL'S SERVICE AREA;2. COMPILING AND ANALYZING DATA ON THE HEALTH NEEDS AND HEALTH SERVICES USED BY THE RESIDENTS OF WILLIAMSBURG COUNTY;3. GATHERING INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; 4. DETERMINING AND PRIORITIZING MAJOR HEALTH ISSUES;5. INVENTORYING HEALTHCARE RESOURCES AVAILABLE TO THE RESIDENTS OF WILLIAMSBURG COUNTY; AND6. CREATING AN ACTION PLAN TO ADDRESS HIGH PRIORITY HEALTH NEEDS TO THE EXTENT THEY CAN BE ADDRESSED PART VI, LINE 3: UPON REGISTRATION FOR NEEDED MEDICAL SERVICES, IF PATIENTS ARE IDENTIFIED AS HAVING NO INSURANCE OR MEANS TO PAY FOR THE SERVICE, REGISTRATION STAFF WILL ASSIST THE PATIENTS WITH APPLYING FOR MEDICAID OR ANY OTHER AVAILABLE COVERAGE. IF NO RESOURCES OR COVERAGE CAN BE OBTAINED, PATIENTS ARE TOLD ABOUT THE HOSPITAL'S CHARITY PROGRAM AND INVITED TO APPLY TO EITHER ASSIST WITH THE COST OF THE SERVICE OR COVER THE SERVICE IN FULL. ALL INCOME TESTING IS STRICTLY ADHERED TO TO DETERMINE THE PATIENTS ABILITY/NON ABILITY TO PAY. PART VI, LINE 4: WILLIAMSBURG COUNTY HAS A POPULATION ESTIMATE OF 30,484 RESIDENTS IN THE 2020 CENSUS. OVER 64% OF THESE RESIDENTS ARE AFRICAN-AMERICAN, AND 80% OF THE RESIDENTS HOLD A HIGH SCHOOL DIPLOMA OR HIGHER EDUCATION. WILLIAMSBURG REGIONAL IS THE ONLY HOSPITAL IN WILLIAMSBURG COUNTY. OTHER HEALTH PROVIDERS ARE SCDHEC, SC DEPT OF MENTAL HEALTH, A FEDERALLY QUALIFIED HEALTH CENTER, AND A LOCAL COUNCIL ON AGING. PART VI, LINE 5: WILLIAMSBURG REGIONAL HOSPITAL PARTICIPATED IN A PROGRAM THROUGH SCDHHS CALLED HEALTHY OUTCOMES. HEALTHY OUTCOMES FOCUSES ON PROVIDING A MEDICAL HOME TO CHRONICALLY ILL PATIENTS WHO FREQUENT THE EMERGENCY ROOM FOR TREATMENT OF ASTHMA, COPD, HYPERTENSION, DIABETES, AND/OR BEHAVIORAL HEALTH CONDTIONS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES SC X X 0 0 0 0 0 1 0 0 0 DR TROY GAMBLE JR CMO (THRU 11/22) 250814 0 0 0 0 0 0 0 6826 0 257640 0 0 0 PART I, LINE 6 ANGELA MORRIS RECEIVED INCENTIVE PAY FOR MONTHLY PAYMENTS OVEREXCEEDING MONTHLY OVERHEAD FOR PRACTICE EQUAL TO 95% OF OVERAGE AMOUNT. MEDICAL EQUIPMENT 2023-01-18 228908 BOOK VALUE 571098556 MUSC BLACK RIVER MEDICAL CENTER 3555 N WILLIAMSBURG HWY CADES SC 29518 501(C)(3) LAND AND BUILDINGS 2023-06-30 2335877 BOOK VALUE 920441763 WILLIAMSBURG COMMUNITY HEALTH FOUNDATION 505 NELSON BLVD KINGSTREE SC 29556 501(C)(3) CASH 2023-09-30 2551532 CASH VALUE 920441763 WILLIAMSBURG COMMUNITY HEALTH FOUNDATION 505 NELSON BLVD KINGSTREE SC 29556 501(C)(3) 1 0 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: BRAD ERWIN, JULIE FLOYD, MANDY SCHULER, ALLEN ABERNETHY PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: THE PERSONS LISTED ABOVE BECAME BOARD MEMBERS OF WILLIAMSBURG COMMUNITY HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION CONTRACTED A CEO THROUGH MUSC FORM 990, PART VI, SECTION B, LINE 11B FORM 990 TAX RETURN IS REVIEWED BY MANAGEMENT BEFORE FILING AND WILL BE MADE AVAILABLE TO THE GOVERNING BODY AFTER FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICTS OF INTEREST ARE DISCLOSED ANNUALLY. WHEN A CONFLICT ARISES, THE BOARD MEMBER IS EXCUSED FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO IS DETERMINED BY THE HOSPITAL BOARD AND DOCUMENTED BY BOARD MINUTES AND WRITTEN CONTRACT. COMPENSATION FOR OTHER OFFICERS IS DETERMINED BY THE HOSPITAL BOARD AND CEO AND DOCUMENTED BY BOARD MINUTES AND WRITTEN CONTRACT/EMPLOYMENT PAR FORM. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 3B THE ORGANIZATION IS CURRENTLY UNDERGOING AUDITS FROM PREVIOUS FISCAL YEARS. WILLIAMSBURG REGIONAL HOSPITAL FOUNDATION 500 NELSON BOULEVARD KINGSTREE SC 29556 200161602 FUNDRAISING SC 501(C)3 509(A)3 WILLIAMSBURG REGIONAL HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 1 1