Facilities and related organizations required to file financial disclosure documents with this agency pursuant to the West Virginia Health Care Financial Disclosure Act W. Va. Code § 16-5F-1, et seq. and the Financial Disclosure Rule, 65 C.S.R. § 13 must submit the following documents within 120 days of the end of the facility or organization's fiscal year (unless otherwise stated). If any document does not apply to the facility or related organization, this must be stated in a cover letter accompanying the financial disclosure submissions. The following is an overview of the requirements. For the full text, please consult the above referenced links.
All covered facilities and related organizations must submit a:
1. Complete audited financial report prepared and presented by an independent accountant or auditor of the facility. All notes, schedules and documents as required by the audit guidelines of the American Institute of Certified Public Accountants shall accompany the report.
If an audited report is not prepared by the facility, the facility must provide a statement of revenue and expenses, statement of changes in retained earnings (fund balances), a statement of cash flows, a balance sheet and/or other statement as required by generally accepted accounting principles. Multi-state facilities must provide statements reflecting their West Virginia operations.
Under certain circumstances a consolidated format is acceptable for the audited statements; but if a covered facility is included in the consolidation, separate statements specific to the covered facility must be submitted. These may be unaudited.
All facilities except non profit, community-based primary care centers providing primary care services, must also submit:
The legal ad must be prepared in accordance with generally accepted accounting principles and must reflect the West Virginia operations. An incomplete advertisement will not be accepted. The advertisement must be published in a qualified newspaper in the West Virginia county where the operation is located.
3. Statement of services available and rendered for the West Virginia operations. If a facility is a nursing home, it shall complete and return a copy of the Annual Report of Nursing Homes within thirty (30) days of its receipt of the blank forms. If the facility is a hospital, it shall complete and return a copy of its annual report for the American Hospital Association within fifteen (15) days of rendering the report to the Association.
4. Approved budget for the current fiscal year for the West Virginia operations. For example, the FYE 2017 budget should accompany the FYE 2016 financial disclosure submissions.
5. Schedule of current rates for all patient services for the West Virginia operations.
6. Copies of Medicare, Medicaid, or other cost reports required to be filed with governmental funding agencies. If cost reports specific to West Virginia are not prepared, then submission of consolidated reports will be sufficient to meet the requirement. Medicare cost reports are due 150 days from the end of the fiscal year. Please remove any patient identifying information prior to submission.
7. Statement of charges, fees, and salaries in excess of $55,000 paid for goods and services rendered to the facility including the amount and the name and address of each entity which rendered the goods or services. Include any individual group, corporation or agency paid more than $55,000 by the facility in the fiscal year. The HCA requires submission of such statements only insofar as such payments relate in any manner to the West Virginia operations. (see Financial Disclosure Policy Statement 2000-1, Forms A, B, and C)
8. Statement of charges, fees, and other sums in excess of $55,000 collected by the facility including the amount and the name and address of each entity from which the sum was collected. Include any entity which paid to the facility more than $55,000 in the fiscal year. This does not apply to collections resulting from services rendered to patients. The HCA requires submission of such statements only insofar as such collections relate in any manner to the West Virginia operations. (see Financial Disclosure Policy Statement 2000-1, Form D)
9. Copy of Form 10K filed by the facility or parent organization with the Federal Securities and Exchange Commission.
10. Copies of all contracts that the facility entered into with any individual or group of health care providers for the provision of inpatient or outpatient services together with a schedule of rates charged by the health care providers for their services. Any contracts related to the West Virginia operations must be submitted. Please remove any social security numbers prior to submission.
11. Copies of all income tax returns and applicable substitutes, such as Form 990, which are required by state or federal laws.
Additionally, a facility that is a hospital must submit the following:
1. Copy of trial balance for the reporting period.
2. Copy of HCA Financial Report (Uniform Report), including the Wage and Salary Survey. (Due 150 days from the end of the fiscal year) (Submit in electronic format)
3. Uniform Bill (UB) data for each and every inpatient including Medicaid and Medicare patients. This must be submitted on a monthly basis in the format designated by the HCA board.
All documents except income tax documents and confidential UB patient data are available for public viewing either through the Authority's on-line document management system or by data request.
All financial disclosure documents should be mailed to the attention of:
West Virginia Health Care Authority
Financial Analysis Division
100 Dee Drive
Charleston, West Virginia 25311