2023-05-15T08:02:32-05:00 2022-06-30 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2021-07-01 550599096 COMMUNITY CARE OF WEST VIRGINIA INC % JEFFREY JENKINS CFO COMM 3049246262 PO BOX 217 ROCK CAVE WV 26234 RICHARD SIMON CEO 3049246262 2023-05-15 true RICHARD SIMON XXX-XX-XXXX Krystal K Creach P01248198 4178658701 2023-05-15 3 2021 2023-04-26 12:10:37Z DBA TRI-COUNTY HEALTH CLINIC INC RICHARD SIMON PO BOX 217 ROCK CAVE WV 26234 73009573 false X CCWV.ORG X 1979 WV TO PROVIDE HIGH QUALITY, ACCESSIBLE COMPREHENSIVE AND COST-EFFECTIVE HEALTHCARE SERVICES TO OUR PATIENTS WHILE SERVING AS THEIR MEDICAL HOME. 10 10 553 10 1764 714 16396174 13387185 35577722 59607604 1384 5784 844 2017 51976124 73002590 66943 42304 0 0 27050374 31750952 0 0 0 18833037 21796841 45950354 53590097 6025770 19412493 25800917 42702802 13349719 10839111 12451198 31863691 X THE MISSION OF CCWV IS TO HELP OUR COMMUNITIES LIVE THE HEALTHIEST LIVES POSSIBLE BY MEETING THEIR IMMEDIATE AND LONG-TERM HEALTHCARE NEEDS. SEE SCHEDULE O. false false 42589105 42304 59607604 THE ORGANIZATION PROVIDES RURAL MEDICAL, DENTAL AND PHARMACY HEALTHCARE SERVICES TO APPROXIMATELY 56,000 PATIENTS IN BRAXTON, CLAY, HARRISON, LEWIS, POCAHONTAS, RANDOLPH AND UPSHUR COUNTIES IN WEST VIRGINIA. 42589105 true true false false false false false false false false true false false true true false true false false false false false false false false false false false true true false false false false false false false false true false false false false false false false false true 30 0 true 553 true false false false false false false false false false false false false X 10 10 false false false false false false false true true false false true true true true true true true true false X JEFFREY JENKINS CFO 3049246262 PO BOX 217 ROCK CAVE WV 26234 SARAH CHOUINARD MEDICAL DIRECTOR 40.0 0.0 X 404601 0 15924 RICHARD SIMON CEO 40.0 0.0 X 349768 0 40573 KEVIN JUNKINS PSYCHIATRIST 40.0 0.0 X 291273 0 1923 KELLY DUNAVENT PHYSICIAN 40.0 0.0 X 267900 0 15825 GREGORY PETERS PHYSICIAN 40.0 0.0 X 263844 0 16234 BENJAMIN HINES PSYCHIATRIST 40.0 0.0 X 270999 0 1391 KIMBERLY BECHER PHYSICIAN 40.0 0.0 X 256309 0 12387 PATRICIA COLLETT COO 40.0 0.0 X 177620 0 14745 CONNIE JOHNSTON CFO END 05/22 40.0 0.0 X 173624 0 12042 JOHN MEUER CIO 40.0 0.0 X 88920 0 5165 J CHAD MORRISON BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID TAYLOR BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID MALCOMB BOARD MEMBER 1.0 0.0 X 0 0 0 ROSEMARY THOMAS PRESIDENT 1.0 0.0 X X 0 0 0 KATHERINE HORNER VICE PRESIDENT 1.0 0.0 X X 0 0 0 JAMES ESTEP TREASURER 1.0 0.0 X X 0 0 0 MICHELLE SAMPLES SECRETARY 1.0 0.0 X X 0 0 0 STEVE FLAUGHERS BOARD MEMBER 1.0 0.0 X 0 0 0 SELAH RAINES BOARD MEMBER 1.0 0.0 X 0 0 0 SARINA SMITH BOARD MEMBER 1.0 0.0 X 0 0 0 JEFFREY JENKINS CFO BEG 05/22 40.0 0.0 X 0 0 0 2544858 0 136209 57 false true false QUALITY HOME AND OFFICE CLEANING WV 34 BOGGESS ST BUCKHANNON WV 26201 CLEANING 266558 FORVIS LLP 910 E ST LOUIS ST STE 200 SPRINGFIELD MO 65801 AUDIT/TAX/CONSULTING 145396 2 12515826 871359 69877 13387185 NET PATIENT SERVICE REVENUE 621300 56522352 56522352 OTHER INCOME 900099 3085252 3085252 59607604 5784 5784 0 0 9000 6983 2017 0 2017 1764 253 0 0 0 0 0 0 0 0 0 0 0 73002590 59607604 1764 6037 0 42304 42304 0 0 1282982 612890 670092 0 24807001 20607879 4199122 379981 287764 92217 3361131 2980664 380467 1919857 1549530 370327 0 45151 45151 164497 164497 0 0 0 3333579 257747 3075832 180650 21106 159544 1395177 1004502 390675 2940728 2396563 544165 0 1498828 1160055 338773 179790 77975 101815 0 177795 116650 61145 158025 128282 29743 0 622002 506237 115765 227095 227095 MEDICAL SUPPLIES & DRUGS 10783849 10783849 LICENSES, DUES, SUBSCRIPTIONS 89675 55108 34567 53590097 42589105 11000992 0 7020498 3627500 687736 5734467 1693318 784278 3532465 4890805 0 0 0 0 0 0 1203498 1792133 284865 433708 17022865 6956257 6267831 10066608 0 0 0 0 21472 24850 155750 133500 4933484 15214953 25800917 42702802 6382654 4889834 0 0 43725 122794 38119 0 0 0 0 0 6548915 5627277 100000 0 236306 199206 13349719 10839111 X 12451198 31288691 0 575000 12451198 31863691 25800917 42702802 19412493 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1502625 1502625 7271747 2185550 5086197 4507698 2099317 2408381 3717464 2671390 1046074 23331 23331 10066608 DUE FROM THIRD PARTY 14833000 DEPOSITS 18901 OTHER RECEIVABLE 363052 15214953 0 LESSOR FINANCED DEBT 199206 199206 72766511 331938 331938 72434573 568017 568017 73002590 53929018 331938 6983 338921 53590097 53590097 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 4B AMOUNTS ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ (6,983) RENTAL EXPENSE 575,000 TRNA CONTRIBUTIONS ---------- 568,017 SCHEDULE D, PART XII, LINE 2D AMOUNTS ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ 6,983 RENTAL EXPENSE true PATIENT ASSISTANCE PROGRAM 124 42304 SCHEDULE I, PART I, LINE 2 MONITORING USE OF GRANT FUNDS: THE PATIENT MUST BE ELIGIBLE FOR SLIDING FEE IN ORDER TO BE ELIGIBLE FOR KV GRANT ASSSISTANCE. THE PATIENT REQUESTS ASSISTANCE THROUGH THEIR MEDICAL PROVIDER, WHO REFERS THE PATIENT FOR ELIGIBILITY REVIEW FOR THE PROGRAM ASSISTANCE. THE FUNDS ARE AVAILABLE ON A FIRST COME, FIRST SERVE BASIS. FOR UTILITY ASSISTANCE, A COPY OF THE PATIENT'S APPROVED SLIDING FEE APPLICATION AND COPY OF THE UTILITY BILL ARE FORWARDED TO THE ACCOUNTING DEPARTMENT WHERE A CHECK IS CUT DIRECTLY TO THE UTILITY COMPANY. FOR PRESCRIPTION ASSISTANCE, THE MEDICAL PROVIDER SENDS A COPY OF THE PATIENT'S APPROVED SLIDING FEE PROGRAM APPROVAL FORM THAT INCLUDES BEGINNING AND ENDING DATES TO THE PHARMACY. THE PHARMACY SCANS THE INFORMATION INTO THE PATIENT'S ELECTRONIC PHARMACY RECORD. FOR RENT AND MORTGAGE ASSISTANCE, THE PATIENT MUST MEET INCOME LIMITS, COMPLETE A SLIDING FEE APPLICATION, AND BE A PATIENT OF COMMUNITY CARE OF WEST VIRGINIA. CLAY AWARE GRANT FUNDING FOR PATIENTS RECEIVING SCHOOL BASED BEHAVIORAL SERVICES IN CLAY COUNTY. X X X X false false false false false false false false false SARAH CHOUINARD MEDICAL DIRECTOR 404601 0 0 0 0 0 12646 0 3278 0 420525 0 0 0 RICHARD SIMON CEO 349768 0 0 0 0 0 36098 0 4475 0 390341 0 0 0 PATRICIA COLLETT COO 177620 0 0 0 0 0 6356 0 8389 0 192365 0 0 0 CONNIE JOHNSTON CFO END 05/22 173624 0 0 0 0 0 6092 0 5950 0 185666 0 0 0 KEVIN JUNKINS PSYCHIATRIST 291273 0 0 0 0 0 0 0 1923 0 293196 0 0 0 BENJAMIN HINES PSYCHIATRIST 270999 0 0 0 0 0 0 0 1391 0 272390 0 0 0 KELLY DUNAVENT PHYSICIAN 267900 0 0 0 0 0 10908 0 4917 0 283725 0 0 0 GREGORY PETERS PHYSICIAN 263844 0 0 0 0 0 10756 0 5478 0 280078 0 0 0 KIMBERLY BECHER PHYSICIAN 256309 0 0 0 0 0 10197 0 2190 0 268696 0 0 0 X 489 69877 FMV false false false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTORS: THE NUMBER REPORTED IN COLUMN B REPRESENTS THE NUMBER OF ITEMS CONTRIBUTED. FORM 990, PART III, LINE 1 ORGANIZATION MISSION: THIS MISSION IS ACCOMPLISHED BY PROVIDING HIGH QUALITY, ACCESSIBLE, COMPREHENSIVE, CULTURALLY APPROPRIATE, COST-EFFECTIVE HEALTHCARE SERVICES, BY SERVING AS A TRUE COMPREHENSIVE MED HOME FOR OUR PATIENTS AND CUSTOMERS, AND BY STRIVING TO FULFILL THE OBJECTIVES OF THE INSTITUTE FOR HEALTHCARE IMPROVEMENT'S TRIPLE AIM. THE TRIPLE AIM SIMULTANEOUSLY SEEKS TO ACCOMPLISH THESE THREE (3) OBJECTIVES: (1) IMPROVING THE HEALTH OF POPULATIONS; (2) IMPROVING THE PATIENT EXPERIENCE OF CARE (INCLUDING QUALITY AND SATISFACTION); AND (3) REDUCING THE PER CAPITA COST OF HEALTHCARE SERVICES. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. ONCE THE FORM 990 IS PREPARED BY THE ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT, THE FORM IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO FILING. ANY QUESTIONS AND COMMENTS RAISED REGARDING THE FINAL FORM 990 ARE ADDRESSED AT THE FULL BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: NO MEMBER OF THE BOARD OF DIRECTORS SHALL VOTE ON ANY QUESTION IN WHICH HE/SHE IS INTERESTED OTHERWISE THAN AS A BOARD MEMBER, EXCEPT WITH REGARD TO THE ELECTION OF A PRESIDENT OR OTHER OFFICER OR EMPLOYEE, OR BE PRESENT AT THE MEETING OF THE BOARD OF DIRECTORS WHILE THE SAME IS BEING CONSIDERED; BUT IF HIS/HER RETIREMENT FROM THE BOARD IN SUCH CASES REDUCES THE NUMBER PRESENT TO LESS THAN A QUORUM, THE QUESTION MAY NEVERTHELESS BE DECIDED BY THOSE WHO REMAIN. ON ANY QUESTION, THE NAMES OF THOSE VOTING EACH WAY SHALL BE ENTERED IN THE MINUTES OF THE PROCEDINGS, IF ANY DIRECTOR AY THE TIME REQUIRES IT. EACH BOARD MEMBER IS REQUIRED TO DISCLOSE ANY PROSPECTIVE CONFLICT OF INTEREST AND TO REFRAIN FROM ATTEMPTING TO INFLUENCE ANY CONSIDERATION OF ANY MATTER THAT WOULD CREATE A CONFLICT OF INTEREST FOR THE BOARD OF CORPORATION. EACH BOARD MEMBER IS ALSO REQUIRED TO REVIEW AND ACCEPT, AS A CONDITION OF ELECTION TO THE BOARD OF DIRECTORS, THE TERMS OF THE COMMUNITY CARE OF WEST VIRGINIA BOARD OF DIRECTORS CODE OF CONDUCT, AS ADOPTED BY THE CORPORATION, AND TO DISCLOSE ANY CONDITION OR SITUATION THAT EITHER WOULD CONSTITUTE A VIOLATION OF OR COULD CAUSE A VIOLATION OF ANY POLICY, PROCEDURE, RESTRICTION, OR PROHIBITION CONTAINED IN SAID CODE OF CONDUCT. CONFLICT OF INTEREST ISSUES ARE REPORTED TO THE SENIOR MANAGEMENT TEAM AND BOARD OF DIRECTORS, IF APPLICABLE. THE GOVERNING BOARD AND SENIOR MANAGEMENT ADDRESS AND MONITOR ANY ISSUES. CONFLICT OF INTEREST ISSUES ARE REPORTED TO THE SENIOR MANAGEMENT TEAM. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: THE CEO'S COMPENSATION IS REVIEWED BY KEY MANAGEMENT PERSONNEL, THE BOARD PERSONNEL COMMITTEE, AND THE FULL BOARD OF DIRECTORS DURING CONTRACT REWNEWAL USING COMPARIBILITY DATA PULLED FROM FORMS 990S OF SIMILAR SIZED FEDERAL QUALIFIED COMMUNITY HEALTH CENTERS. THE COMMITTEE DOCUMENTS THE DELIBERATIONS. THE LAST REVIEW WAS CONDUCTED IN 2020. THE CEO AND BOARD PRESIDENT REVIEWS COMPENSATION OF KEY EMPLOYEES AND OTHER OFFICERS DURING CONTRACT RENEWAL USING COMPARABILITY DATA PULLED FORM 990S OF SIMILAR SIZED FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS. THE LAST REVIEW WAS CONDUCTED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.