2020-07-14T08:44:40-05:00 2019-06-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2018-07-01 550422958 Stonewall Jackson Memorial Hospital STON 3042698059 230 Hospital Plaza Weston WV 26452 Avah L Stalnaker CEO 3042698059 2020-07-01 1 Dolores Rose P01286262 3043460441 216.12.119.47 2020-07-01 10:22:37 ED P DBF3DF03C93CF583714802DAD1D2E8B1989575BE EF272E949B022F30B68C60E053C4FB8C6906CCF1 2018 2020-09-23 17:36:50Z Avah L Stalnaker 230 Hospital Plaza Weston WV 26452 51553454 0 X www.stonewallhospital.com X 1959 WV It is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve. 9 7 547 16 18950 16783 28190 51864 30255992 47277524 2520265 2382109 233626 920862 33038073 50632359 11063 21550 0 0 18515905 27314281 0 0 0 20777664 26053527 39304632 53389358 -6266559 -2756999 67957460 64636289 14656610 14412837 53300850 50223452 X It is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve. 0 0 43632779 49639601 Stonewall Jackson Memorial Hospital provides acute medical and outpatient services to residents of Weston, West Virginia and surrounding communities which covers 10 different counties. Services included 5,402 days of inpatient care, 74,936 outpatient visits, 13,911 emergency room visits, 1,204 ambulatory surgery visits, 4,823 Home Health visits and 37,516 Physician Clinic visits. The Hospital had 154 deliveries during the year in which approximately 65% were Medicaid patients. Many of these babies had significant substance abuse problems. Due to the drug addiction problems of the Mothers, very few of these women have received prenatal care. 10150 10150 33910 Annual Blood Screening: Stonewall Jackson Memorial Hospital provides all supplies and staff to operate the program. A portion of the excess revenue is forwarded to the local Rotary Club to promote charitable services. Other programs include: scoliosis screening at county elementary and middle schools, health fairs at the local senior citizens center, free sports physicals to middle and high school students, Children's Safety Day to promote healthy choices to children under 12 years of age, events for free osteoporosis screenings, events for free Dermascans to screen for skin cancer, Weston Walk-run to promote exercise as a way to improve cardiac health, free women's health screening for breast and cervical cancer, free vein screenings and free hearing screenings. Revenue and expenses are included in Line 4a above. 11400 11400 19295 William Adler Scholarship Fund - Stonewall Jackson Memorial Hospital sponsored program to provide scholarships to local graduating high school seniors who are pursuing a career in the health care field. It is hoped that this program will encourage more students to seek health care professions and lesson the health care staffing shortage. 43654329 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 185 0 547 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X Avah Stalnaker 3042698050 230 Hospital Plaza Weston WV 264528558 John Law CPA President 1.00 1.00 X X 0 0 0 Joseph Snead MD Vice-President 22.50 X X 136597 0 966 R Gerald Wood RPH Secretary 1.00 X X 0 0 0 Denver Turner Treasurer 1.00 X X 0 0 0 Robin Poling Director 1.00 X 0 0 0 John W Wyllie III MD Director 40.00 X 383548 0 15703 C Gregory Cunningham Director 1.00 1.00 X 0 0 0 Kimberly Gum Director 1.00 X 0 0 0 Gregory St Clair Director 1.00 X 0 0 0 Avah Stalnaker CEO 40.00 X 292227 0 16016 David Goldberg President/CEO Mon Health 1.00 39.00 X 0 192729 3929 Lisa Simon CPA VP Finance/CFO Mon Health 1.00 39.00 X 0 315066 6726 Darryl Duncan Former President/CEO Mon Health 1.00 39.00 X 0 2093744 7465 Daris Rosencrance Former VP Finance/CFO Mon Health 1.00 39.00 X 0 361627 30399 Ronald Pearson MD Physician 40.00 X 449430 0 13750 Doyle Sickles MD Physician 40.00 X 564754 0 28724 Michael Gregory DO Physician 40.00 X 516010 0 31353 Virgil W McMillion DO Physician 40.00 X 474292 0 26365 Thomas Benz MD Physician 40.00 X 396938 0 30410 3213796 2963166 211806 27 1 1 0 Sodexo Inc & Affiliates PO Box 536922 Atlanta GA 503536922 Maintenance/Dietary 622092 WV Emergency Physicians LLP PO Box 677979 Dallas TX 752677979 Emergency Room Physicians 447505 Medic Management Group 275 Springside Drive Suite 100 Akron OH 44333 Coding 261052 Wesley G Saher (Beach Medicine LLC) PO Box 520 Frisco NC 27936 Emergency Room Physicians 249750 Laboratory Corporation PO Box 12140 Burlington NC 272162140 Laboratory Services 227881 12 14800 37064 51864 Patient Services 622110 47277524 47277524 47277524 856283 856283 46286 18950 62695 0 -16409 18950 2541 18950 -16409 2374686 848860 1525826 1525826 1525826 38405 14800 9540 28865 28865 Refunds & Expense Reimbursements 900099 692106 692106 Cafeteria 722310 158216 158216 Vending Machine Sales 722310 29950 29950 9184 9184 889456 50632359 49692806 18950 868739 10150 10150 11400 11400 536814 422097 114717 22488845 17682979 4805866 814448 640400 174048 2021507 1589511 431996 1452667 1142232 310435 883073 883073 425136 425136 72673 57143 15530 306849 241275 65574 1790900 1407323 383577 1409193 1108048 301145 1052931 827920 225011 110858 87168 23690 66131 51999 14132 2560042 2012961 547081 -25028 -19680 -5348 Medical supplies 8143585 8143585 Bad debts 3801038 3801038 Purchased services 2475772 1946700 529072 Repairs and maintenance 1602280 1259873 342407 1378094 1230207 147887 53389358 43654329 9735029 0 360931 897089 6224653 3975564 5417862 6086757 1454296 1099627 247402 280747 50642658 37181173 15978701 13461485 35493711 34564849 523576 523940 2256328 3746231 67957460 64636289 11654963 12204693 31912 48340 2969735 2159804 14656610 14412837 X 52844942 49767180 455908 456272 53300850 50223452 67957460 64636289 -2756999 -320399 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5781 0 0 0 5781 0 Part II-B, Line 1: A portion of dues paid by the hospital to the American Hospital Assocation and the West Virginia Hospital Association is attributable to lobbying. 6519778 6519778 13403703 11640341 1763362 30467708 25540832 4926876 251469 251469 13461485 Other receivables 344292 Due from SHOT 455263 Estimated third party settlements 2413866 Insurance recoveries receivables 532810 3746231 X Part X, Line 2: The Health System follows the FASB's authoritative guidance on accounting for uncertainty in income taxes. The guidance clarifies the accounting for the recognition and measurement of the benefits of individual tax positions in the consolidated financial statements. Tax positions must meet a recognition threshold of more-likely-than-not in order for the benefit of those tax positions to be recognized in the consolidated financial statements. The Health System has determined that no material unrecognized tax benefits or obligations exist. Generally, tax returns for years ended June 30, 2016, and thereafter remain subject to examination by federal and state tax authorities. Charity Golf Tournament 19295 11400 7895 700 3284 Rotary Blood Screening 33910 3400 30510 5556 53205 14800 38405 700 3284 5556 9540 28865 1 1 X 1 X 1 X 162.000000000000 1 1 1 0 0 288357 288357 11913853 7684606 4229247 0.08530 12202210 7972963 4229247 0.08530 12202210 7972963 4229247 0.08530 1 3801038 1388007 8143821 8278587 -134766 X 1 1 1 1 Stonewall Jackson Memorial Hospital 230 Hospital Plaza Weston WV 26452 X X X Stonewall Jackson Memorial Hospital 1 0 0 1 X X X X X X X 18 1 0 1 1 X www.stonewalljacksonhospital.com X 1 18 1 www.stonewalljacksonhospital.com 0 1 X 150.000000000000 162.000000000000 X X X X X 1 1 X X X X 1 X See Part V, page 8 X See Part V, page 8 X See Part V, Page 8 X X X X 1 X 0 X X 1 X 0 0 Stonewall Jackson Memorial Hospital Part V, Section B, Line 5: The Hospital took into account input from community leaders at the health department, schools, local businesses and the town Mayor. Three hundred ninety-two people participated in a survey from July 2018 to February 2019. The survey was promoted in the local newspaper, local radio stations, social media and email. Another 70 paper surveys were completed at the Lewis County Health Department, waiting areas in SJMH, physician offices, senior center and other areas in the county. In April 2019, a staff member from SJMH coordinated two focus groups. Participants of the focus groups included representatives from the Lewis County Health Department, Day Report Center, the William R. Sharpe Hospital, the City of Weston and the hospital. Stonewall Jackson Memorial Hospital Part V, Section B, Line 6b: Lewis County Health Department Stonewall Jackson Memorial Hospital Part V, Section B, Line 11: Drug abuse was the number one health concern of the residents. The other concerns in order of importance were: obesity, cancer, heart disease, diabetes, and high blood pressure. To combat drug abuse, SJMH's emergency department has adopted the WV Hopital Association Guidelines for prescribing opiates. Lewis County now has a drug court. All nursing staff at SJMH are required to complete continuing education on "drug diversion education on opiates". All SJMH pharmacists must complete continuing education on drug diversion education on opiates, and all SJMH physicians are registered with the WV board of pharmacies. The second concern for the community was obesity. To combat this, SJMH has an adult fitness program, SJMH created a county-wide walking group; the SJMH Therapy Department provides annual physicals for student athletes at no cost. SJMH created a safe walking path in the parking lot, we established a wellness committee for our employees, and we do not serve pop at activities. We also coordinate with the City of Weston to refurbish playgrounds in the area. Stonewall Jackson Memorial Hospital Part V, Section B, Line 13h: Patients whose family income exceeds 162% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of SJMH; however the discounted rates shall not be greater than the amounts generally billed to (received by the hospital for) commercially insured or Medicare patients. Part V, Section B, Line 16A https://www2.stonewalljacksonhospital.com/docs/SJMH_Financial_Assistance_Policy_and_Procedures-1.pdf Part V, Section B, Line 16B https://www2.stonewalljacksonhospital.com/docs/SJMH_Financial_Assistance_application_2019_good_one.pdf Part V, Section B, Line 16C www2.stonewalljacksonhospital.com/getpage.php?name=Patient _Financial_Aid&sub=Patients%20%26%20Visitors 1 1 - Stonewall Jackson Home Care 456 Suite B Market Place Mall Weston WV 26452 Home Health Care Part I, Line 3c: The Health Resources and Services Administration eligibility guidelines are used. We also evaluate the patient's assets and the amount of medical debt. We have signs posted at Registration, around and in the Emergency Department and in all physician clinics. We send letters to patients who are not paying their bills and give the application to private pay inpatients. We also tell the patients during telephone conversations if the patient indicates he/she is not able to pay the bill or pay all of the bill. Part I, Line 7: The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The unreimbursed cost of Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 3,801,038. Part III, Line 3: Based on historical information, we estimate 41.7% of the bad debt expense represents amounts from patients eligible under the hospital financial assistance policy. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: The Medicare cost report was used to determine revenue allowable costs associated with the revenue. Part III, Line 9b: Our collections policy applies to all patients regardless of financial class or any other classification. During our collections process, if the patient indicates they do not have the ability to pay their bill, the credit staff offers exoneration. Part VI, Line 2: The assessment was conducted in three phases: The first phase was attaining background information on the healthcare problems of the local area and state. The second phase was a survey conducted online and by paper. The last phase was a focus group conducted by an experienced mediator. Part VI, Line 3: We have signs posted at Registration, around and in the Emergency Department, and in all physician clinics. We send letters to patients who are not paying their bills. We give the application to Private Pay inpatients. We tell the patients during telephone conversations, if the patient indicates he/she is not able to pay the bill or pay all of the bill. Part VI, Line 4: Stonewall Jackson Memorial Hospital serves a relatively large rural population of about 65,000 people with an average household income of $32,000. 30% of the population is disabled. Approximately 30% are Medicaid Eligible or are uninsured. We are the largest hospital in our service area, which includes two other hospitals, one being a Critical Access Hospital. We are located in a federally-designated medically underserved area. Part VI, Line 5: Stonewall Jackson Memorial Hospital (SJMH) is a 70 bed rural acute care hospital located in Lewis county West Virginia. SJMH is the only hospital located in the county as such it is solely responsible for the healthcare of this rural community. SJMH provides a 24 hour Emergency Room and Obstetrics services and provides care regardless of the patient's ability to pay. The majority of the governing body is comprised of community members. Medical privileges are offered to all qualified physicians in the community and SJMH has worked diligently to provide other physician services by expanding the services they provide.SJMH continues to make capital improvement to the facility and expand patient care services to meet the needs of the community. 1 Rotary Club of Weston PO Box 222 Weston WV 26452 550371556 501(c)4 10150 To help the Rotary support various children's programs in Lewis County. 0 1 Healthcare scholarships for recent high school graduates. 24 11400 FMV - Cash X X 1 1 0 0 0 0 0 0 0 John W Wyllie III MD Director 383548 0 0 0 0 0 13750 0 1953 0 399251 0 0 0 Avah Stalnaker CEO 286255 0 0 0 5972 0 5500 0 10516 0 308243 0 0 0 David Goldberg President/CEO Mon Health 0 115277 0 60000 0 17452 0 2538 0 1391 0 196658 0 0 Lisa Simon CPA VP Finance/CFO Mon Health 0 267247 0 0 0 47819 0 0 0 6726 0 321792 0 0 Darryl Duncan Former President/CEO Mon Health 0 438492 0 87656 0 1567596 0 6461 0 1004 0 2101209 0 0 Daris Rosencrance Former VP Finance/CFO Mon Health 0 327863 0 0 0 33764 0 24500 0 5899 0 392026 0 0 Ronald Pearson MD Physician 449430 0 0 0 0 0 13750 0 0 0 463180 0 0 0 Doyle Sickles MD Physician 564724 0 0 0 30 0 13750 0 14974 0 593478 0 0 0 Michael Gregory DO Physician 515580 0 400 0 30 0 13750 0 17603 0 547363 0 0 0 Virgil W McMillion DO Physician 447595 0 26667 0 30 0 13750 0 12615 0 500657 0 0 0 Thomas Benz MD Physician 396908 0 0 0 30 0 13750 0 16660 0 427348 0 0 0 Part I, Lines 4a-b THE FOLLOWING INDIVIDUALS DEFERRED THE FOLLOWING AMOUNTS UNDER A 457(F) PLAN - DARRYL DUNCAN ($50,780), DARIS ROSENCRANCE ($15,264), and Lisa Simon ($29,319). The following individual received a severance payment - Darryl Duncan ($452,449) Form 990, Part VI, Section A, line 3 Management duties customarily are performed under the direct supervision of officers, directors, trustees or key employees, but the Hospital has contracted out the management duties of the Maintenance department. The manager of the Maintenance department (also considered a department head) is employed by the Maintenance company. All other Maintenance staff are employees of the Hospital. The Hospital contracts out the management duties of the Pharmacy department. The manager of the Pharmacy department (also considered a department head) is employed by the Pharmacy company. All other Pharmacy staff are employees of the Hospital. The Hospital contracts out the management duties of the Dietary department. The manager of the Dietary department (also considered a department head) is employed by the Dietary company. The certified Dietary Manager and the Dietitian are also the employees of the Dietary company. All other Dietary staff are employees of the Hospital. Form 990, Part VI, Section A, line 6 Monongalia Health System, Inc., a West Virginia non-profit corporation, is the sole member of the Hospital. Form 990, Part VI, Section A, line 7a Stonewall Jackson Memorial Hospital board members are elected or appointed by Monongalia Health System. Form 990, Part VI, Section A, line 7b Stonewall Jackson Memorial Hospital's board shall give notice to Monongalia Health System and receive its approval before acting on any of the following matters: (A) amendment of the articles of incorporation of the Hospital or the bylaws; (B) sale, lease or exchange of all or substantially all of the property or assets of the Hospital and any expenditure in excess of $750,000; (C) merger or consolidation with any other corporation; (D) election to dissolve the Hospital entity; (E) approval of the budget of the Hospital; (F) approval in advance of the hiring of the President of the Hospital. Form 990, Part VI, Section B, line 11b The governing body is provided a copy of the Form 990 for their review prior to submission. The board members are asked to inform management of any questions or revisions they may have. If changes are made, based on board member's revisions, management redistributes a final version to all board members. Form 990, Part VI, Section B, line 12c Annually, a conflict of interest questionnaire is sent out to all board members. The board then reviews all responses for possible conflicts of interest. If a conflict is noted, the board members determine which decisions the conflicted members shall not participate in. Form 990, Part VI, Section B, line 15 Annually, a consultant compiles a market data report on executive CEO compensation. This report is then reviewed by the executive committee to determine compensation for the individual. Form 990, Part VI, Section C, line 19 The Hospital places a publication in the local newspaper stating the governing documents, conflicts of interest policy and financial statements are available upon request. Form 990, part XII, Line 2C: The Organization's Finance Committee of the Board of Directors selects the independent accountant. This process remains unchanged from prior years. Monongalia County General Hospital Company 1200 JD Anderson Drive Morgantown WV 26505 237441353 Hospital WV 501(c)(3) Line 3 Monongalia Health Systems Inc 0 Mon Elder Services Inc 1200 JD Anderson Drive Morgantown WV 26505 311520863 Continuing care retirement village WV 501(c)(3) Line 10 Monongalia Health Systems Inc 0 Monongalia Emergency Medical Services Inc 1200 JD Anderson Drive Morgantown WV 26505 550725494 Emergency ambulance and rescue service WV 501(c)(3) Line 10 Monongalia Health Systems Inc 0 Monongalia Health System Inc 1200 JD Anderson Drive Morgantown WV 26505 550621551 Parent/management company WV 501(c)(3) Line 12c, III-FI N/A 0 The Foundation of Monongalia General Hospital 1200 JD Anderson Drive Morgantown WV 26505 550570338 Raise funds for Monongalia General Hospital WV 501(c)(3) Line 7 N/A 0 Preston Memorial Hospital 150 Memorial Drive Kingwood WV 26537 311097818 Hospital WV 501(c)(3) Line 3 Monongalia Health Systems Inc 0 Preston Memorial Medical Group 150 Memorial Drive Kingwood WV 26537 550717988 Provide primary and urgent care WV 501(c)(3) Line 3 Monongalia Health Systems Inc 0 Preston Memorial Hospital Foundation 150 Memorial Drive Kingwood WV 26537 550740121 Support activities of other charitable organizations WV 501(c)(3) Line 12a, I Monongalia Health Systems Inc 0 Auxiliary of Monongalia General Hospital 1200 JD Anderson Drive Morgantown WV 26505 550362965 Raise funds for Monongalia General Hospital WV 501(c)(3) Line 12a, I Monongalia Health Systems Inc 0 Liability Insurance Trust for Monongalia Health System 1200 JD Anderson Drive Morgantown WV 26505 550689535 Liability Insurance Trust WV 501(c)(3) Line 12a, I Monongalia Health Systems Inc 0 Stonewall Home Oxygen Therapy Inc 100 Market Place Mall Suite 8 Weston WV 26452 550754278 Oxygen Therapy Services WV Stonewall Jackson Memorial Hospital C -38353 267797 1.00000 1 Mon Health Care Inc 1200 JD Anderson Drive Morgantown WV 26505 550654973 Home Medical Equipment WV Monongalia Health System Inc C 0 Morgantown Medical Arts Building Inc 1199 Van Voorhis Road Suite 6 Morgantown WV 26202 550570209 Office Rental WV Monongalia Health System Inc C 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 Stonewall Home Oxygen Therapy Inc A 18950 FMV - Cash