2020-08-17T16:31:21-05:00 2019-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2018-10-01 550462730 Community Health Association dba Jackson General Hospital COMM 3043722731 PO Box 720 Pinnell Street Ripley WV 25271 Dewey Clayton CFO 3043722731 2020-08-17 1 Dolores Rose P01286262 3043460441 216.12.119.47 2020-08-17 17:12:10 ED P C6195626C106BC5422D8340B10DC95F601C02BF1 CDEB922E3D28122EE93E49492A4CB10256DE4ED3 2018 2020-09-22 18:59:49Z Jackson General Hospital Stephanie McCoy PO Box 720 Pinnell Street Ripley WV 25271 38476694 0 X www.jacksongeneral.com X 1964 WV To promote the general health and welfare of citizens of Jackson County, West Virginia and surrounding areas by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public. 15 15 340 38 0 0 15244 10170 34976465 37847312 7643 3299 470325 615913 35469677 38476694 0 0 0 0 18596175 20571078 0 0 0 15589738 17016254 34185913 37587332 1283764 889362 10478979 11766577 6733529 7131765 3745450 4634812 To promote the general health and welfare of citizens of Jackson County, West Virginia and surrounding areas by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public. 0 0 30782614 38316850 Services provided included 3,001 inpatient days, 533 observation days, 11,349 emergency room visits, 29,620 outpatient visits, and 9,409 rural health clinic visits. Charity care for the year amounted to $229,575. 192598 The organization provided several community health improvement services, including a patient/community resource center, free sports physicals, prostate screenings, cardiac kits, advance directives presentations, CPR and first aid classes, diabetic counseling, dinner discussions, health fairs, County Disaster Preparedness, and various other programs. Costs related to these totaled $192,598. 30975212 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 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 0 0 0 0 0 0 1 86 0 340 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Dewey Clayton 3043722731 122 Pinnell Street Ripley WV 25271 Robert Fisher Chairman 4.00 X X 0 0 0 Keith Rake Vice Chairman 1.00 X X 0 0 0 John Gorrell Treasurer 1.00 X X 0 0 0 James Gaal DO Secretary 1.00 X X 0 0 0 Sarah Brown Director 0.50 X 0 0 0 Lee Corder Director 0.50 X 0 0 0 James T Hughes MD Director 0.50 X 0 0 0 Luke Hunter Director 0.50 X 0 0 0 Joe Parsons Director 1.00 X 0 0 0 Carolyn Rader Director 0.50 X 0 0 0 Todd Ritchie Director 1.00 X 0 0 0 Becky Scarberry Director 0.50 X 0 0 0 Mike Casdorph Director 1.00 X 0 0 0 Steve Westfall Director 0.50 X 0 0 0 Jamion Wolford Director 0.50 X 0 0 0 Stephanie McCoy CEO 40.00 X 119185 0 0 Angela D Frame CFO (resign 12/14/18) 40.00 X 120979 0 0 Dewey Clayton CFO (start 12/3/18) 40.00 X 0 0 0 Carl L Overmiller MD General Surgeon 40.00 X 314725 0 0 Jeffry S Barton DO General Surgeon 40.00 X 261598 0 0 Clinton Mills Hospitalist 40.00 X 228714 0 0 Edward Stewart ER Physician 40.00 X 232790 0 0 Brian Brown MD Orthopedic Surgeon 40.00 X 373270 0 0 1651261 0 0 13 0 1 0 Laboratory Corporation of America PO Box 12140 Burlington NC 27216 Lab Management/Ref Lab 946970 Marietta Memorial Hospital 401 Matthew Street Marietta OH 45750 ER & Pain Physicians 917046 Haven LTD 1 Haven Lane Kenna WV 25248 ER Physician 466183 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Services 379953 WVU Hospitals Inc PO Box 8034 Morgantown WV 26506 Hospital Management Services 243849 5 10170 10170 Patient Services 621990 37565246 37565246 Walmart clinic 621990 282066 282066 37847312 3299 3299 146375 0 146375 146375 146375 Miscellaneous Revenue 900099 283189 283189 Cafeteria & Vending 722210 161009 161009 Rebates and discounts 900099 25340 25340 469538 38476694 38316850 0 149674 X 148337 116637 31700 14624872 11499537 3125335 302381 237762 64619 4442263 3492951 949312 1053225 828151 225074 187897 187897 53988 53988 4663802 3667147 996655 87857 69082 18775 1068534 840188 228346 804728 632758 171970 348510 274033 74477 12160 9561 2599 133036 104606 28430 808162 635458 172704 494226 388610 105616 Bad Debts 5000226 5000226 Medical Supplies 2145707 2145707 Medicaid Provider Tax 506670 506670 Dues & Subscriptions 113005 88856 24149 587746 437272 150474 37587332 30975212 6612120 0 239367 122380 513796 935064 4686157 5533519 252960 294427 168752 171791 17078074 12605586 4206712 4472488 411235 236908 10478979 11766577 4114178 3054653 1131338 1880225 1488013 2196887 6733529 7131765 X 3745450 4634812 3745450 4634812 10478979 11766577 889362 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92189 92189 6369917 4727095 1642822 10173999 7550746 2623253 441969 327745 114224 4472488 Capital leases 929937 Current Portion of Long Term Debt 389752 Third Party Settlements 877198 2196887 X 33530890 54422 54422 33476468 5000226 5000226 38476694 32587106 0 32587106 5000226 5000226 37587332 Part X, Line 2: The Hospital is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code (Code) and has been recognized as tax exempt under Section 501(a) of the Code and similar state statutes relating to not-for-profit organizations. Accordingly, no provision for income taxes has been provided. The Hospital follows the guidance for uncertainty in income taxes recognized in the Hospitals financial statements that prescribes a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. The Hospital's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. There were no interest or penalties recognized on the statements of operations and changes in net assets in 2019 or 2018. Generally, tax returns for years ended September 30, 2016, and thereafter remain subject to examination by federal and state tax authorities. Part XI, Line 2d - Other Adjustments: Foundation income not included on 990 54,422. Part XI, Line 4b - Other Adjustments: Bad debts netted against revenue on financial statements 5,000,226. Part XII, Line 4b - Other Adjustments: Bad debts netted against revenue on financial statements 5,000,226. 1 1 X 1 X 0 1 1 0 0 586896 584792 2104 0.00010 5233437 4851528 381909 0.01170 5820333 5436320 384013 0.01180 192598 192598 0.00590 192598 192598 0.00590 6012931 5436320 576611 0.01770 0 5000226 4884429 4884429 X 1 1 1 1 Jackson General Hospital PO Box 720 Ripley WV 25271 X X X X Rural Health Clinic Jackson General Hospital 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X http://www.jacksongeneral.com X X 1 17 1 http://www.jacksongeneral.com/ 0 1 X 200.000000000000 X X X X X 1 1 X X X X 1 X http://www.jacksongeneral.com/patient-services/#forpatients X http://www.jacksongeneral.com/patient-services/#forpatients X http://www.jacksongeneral.com/patient-services/#forpatients X X X X X 1 X 0 X X X X 1 X 0 0 Jackson General Hospital Part V, Section B, Line 5: Assembled an Health Advisory Committee comprised of representatives from community leaders, health care providers, and citizens to guide the assessment process. Conducted primary data collection through surveys of providers, key informants, and the general population in collaboration with the WVU Medicine Mid- Ohio Valley Community. Collected and analyzed secondary data sources such as US Census Data, state health statistics and behavioral risk assessments. Created a comprehensive community health care services inventory. Jackson General Hospital Part V, Section B, Line 7d: Copies were provided to all participants in the study. Jackson General Hospital Part V, Section B, Line 11: The Hospital has been recruiting specialists to meet the needs identified, but have not been successful in all placements. The Hospital hasn't been able to recruit a pediatrician or retain a gynecologist. Mental health and drug abuse is a serious problem in the County. The Hospital has made several attempts to develop a strategy that can be financially supported by the Hospital. The strategy involves partnering with other local healthcare providers in the area to do a collaborative outpatient clinic. Jackson General Hospital Part V, Section B, Line 16j: We publicize that the application is available and for assistance to call. We also list on the back of our statements our notice of charity applications, discounts, etc. with contact information. Jackson General Hospital Part V, Section B, Line 20e: JGH staff also attempts to call the patient and/or send a pre-bad debt letter to the patient advising if no response is received that their account may be turned over to an external collection agency. 2 1 - Morad Hughes Health Center PO Box 720 122 Pinnell St Ripley WV 25271 Hospital-based rural health center 2 - Jackson General Hospital Clinic-Walmart 200 Academy Drive Ripley WV 25271 Provider-based health clinic Part I, Line 3c: A sliding scale discount is not applicable to Jackson General Hospital services. Payment received for balances over $100.00 for uninsured patients are eligible for prompt pay (50%) discounts for same date of service. For balances of $100.00 or more, under-insured patients also have the opportunity upon receipt of 1st statement of receiving a 30% discount. If patients do not respond to 1st statement discount offer as an option, they have the opportunity upon receipt of the 2nd statement to be eligible for a 20% discount. Uninsured patients not taking advantage of the same day dicount can also apply for the 1st and 2nd statement discounts. These discounts are reviewed and approved by the financial counselors- no discounts are automatically taken by the patient. Part I, Line 7: The cost of charity care, Medicaid at cost and other means tested government programs were 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 $ 5,000,226. Part III, Line 2: The bad debt expense listed on Part III, Line 2 is derived from the financial statements. 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.In order to claim a receivable as a bad debt, it must be established that the debt relates to covered services and is derived from deductible, coinsurance amounts and/or noncovered services that ABN has been signed by patient and processed by Medicare as patient responsible, reasonable collection efforts were made, that the debt was actually uncollectible when claimed, and that sound business judgment indicates there is no likelihood of future recovery. Part III, Line 8: Medicare costs and revenues were obtained from the hospital's Medicare cost report. Part III, Line 9b: We use the same policy and procedure for all patients, regardless of whether we know they have/had qualified in the past. Any patient that presents for assistance will go through the same application process even if they have been previously approved. This is required in case of any financial changes to assure patient still qualifies for assistance, no change in employment or insurance acquired. Once a patient qualifies for charity care, and service was provided, we issue a financial assistance card effective with first date of service that was performed. This card is valid at our facility only, for services up to 6 months. They have to re-apply once additional services are performed after termination date. Once approved and within valid time frames if these patients present for services they are then registered as Charity Care instead of Self Pay. Part VI, Line 2: Jackson General Hospital assesses the health needs of the communities it serves through community needs assessments, patient satisfaction survey results, the complaint resolution process, and through interviews with the medical staff, employees, vendors and guests, as well as through collaboration with the local health department, EMS, county nursing homes and home health agencies. The latest formal Community Needs Assessment was performed in 2017. Part VI, Line 3: A charity care policy is posted at all registration areas. All patients are seen or called by the financial counselors and/or the Customer Service Department to determine what services can be offered. The patients are screened for charity care and provided education about the state Medicaid application. Part VI, Line 4: The total population in Jackson County is 29,152,which has not significantly changes since the prior CHNA.. The percentage of persons over 65 years is 19.6% while that of the State is 18.8%, indicating that Jackson County has a slightly older population. Of the population in Jackson County, 50.4% of those are female, which is comparable with the State at 50.5%. Ninety-seven percent (97%) of the population in Jackson County is Caucasian (white), showing very little ethnic diversity in the county.The mean median household income in the past 12 months (2013 dollars) was $43,500 while that of the State was $43,200. Twenty-three percent of children are living in poverty (state is 24%) while top performers in the United States are at 12%. The median age in Jackson County is 42.9 years. For planning purposes, it should be noted that close to one-third of the population is in the 46-64 year-old age group and will reach retirement age over the next 20 years.This can be a critical difference for health care needs assessment purposes. Part VI, Line 5: 1. The hospital's board of director members are all residents of Jackson County 2. The hospital extends medical staff privileges to qualified physicians and health care providers in the community who apply for priveleges. 3. No patient is turned away from the Emergency Department for financial reasons. The Emergency department is open 24 hours per day, 365 days per year. 4. The hospital invested $1,550,664 in capital improvements in FY 2014 to better serve the community. 5. Several local, non-profits conduct their meetings here at the JGH Learning Center facility free of charge. 6. The hospital is the leader in Jackson County for the collaborative group planning and drill meetings held for Disaster Preparedness. 7. Several members of the JGH Staff volunteer in the community in organizations such as Rotary, Pilot Club, Adopt-A-Family, etc. Part VI, Line 6: The organization is not part of an affiliated health care system. X X X X 0 0 0 0 0 0 0 0 0 Carl L Overmiller MD General Surgeon 314725 0 0 0 0 0 0 0 0 0 314725 0 0 0 Jeffry S Barton DO General Surgeon 261598 0 0 0 0 0 0 0 0 0 261598 0 0 0 Clinton Mills Hospitalist 228714 0 0 0 0 0 0 0 0 0 228714 0 0 0 Edward Stewart ER Physician 232790 0 0 0 0 0 0 0 0 0 232790 0 0 0 Brian Brown MD Orthopedic Surgeon 373270 0 0 0 0 0 0 0 0 0 373270 0 0 0 Form 990, Part VI, Section B, line 11b The 990 is reviewed by the CEO and CFO and a copy is provided to members of the finance/executive committee before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization requires all board members, officers, key employees, and committee members to annually review and fill out a form which verifies compliance with the written conflict of interest policy. The signing of this document occurs immediately after the annual meeting. Form 990, Part VI, Section B, line 15 The finance committee of the board of directors and the CEO meet annually to discuss compensation of senior administrative staff. Several reliable external sources are used to gather data for this meeting including economic data and comparable salaries. A decision is then made after thorough discussion. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available to anyone in the public upon request. Form 990, Part IX, line 11g Professional fees: Program service expenses 3,667,147. Management and general expenses 996,655. Fundraising expenses 0. Total expenses 4,663,802.