2018-08-15T11:05:52-05:00 2017-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2016-10-01 550462730 Community Health Association dba Jackson General Hospital COMM 3043722731 PO Box 720 Pinnell Street Ripley WV 25271 Angela Frame CFO 3043722731 2018-08-15 1 Dolores Rose P01286262 3043460441 2016 2022-09-23 18:48:47Z Jackson General Hospital Stephanie McCoy PO Box 720 Pinnell Street Ripley WV 25271 30065469 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 15 317 38 0 0 16228 109660 28974624 29544703 1199 3022 419865 408084 29411916 30065469 0 0 0 0 16063803 17021542 0 0 0 13288268 13856512 29352071 30878054 59845 -812585 10389941 10446562 7115670 7984876 3274271 2461686 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 25130397 29843905 Services provided included 2,728 inpatient days, 1,200 observation days, 11,090 emergency room visits, 29,682 outpatient visits, and 12,165 rural health clinic visits. Charity care for the year amounted to $447,495. 120872 The organization provided several community health improvement services, including lunch and learn programs, patient/community resource center, free sports physicals, prostate screenings, cardiac kits, advance directives presentations, CPR classes, diabetic counseling, dinner discussions, health fairs, County Disaster Preparedness, and various other programs. 25251269 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 1 107 0 317 1 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 Angela D Frame CFO 3043731476 PO Box 720 Pinnell St 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 Gareth Smith 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 160562 0 9931 Angela D Frame CFO 40.00 X 128850 0 15083 Carl L Overmiller MD General Surgeon 40.00 X 273615 0 27454 Jeffry S Barton DO General Surgeon 40.00 X 261277 0 26638 Leigh A Levine DO Hospitalist 40.00 X 161262 0 3611 Jacalyn L Denemark PharmD Chief Pharmacist 40.00 X 150075 0 17469 Dennis C Foreman PharmD Pharmacist 40.00 X 134039 0 21269 1269680 0 121455 7 0 1 0 Ohio Valley Physicians PO Box 390 Huntington WV 25708 Emergency Physician Services 447010 Haven Ltd 1 Haven Lane Kenna WV 25248 Emergency Physician Services 280082 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Services 247283 Divurgent 4445 Corporation Lane Suite 228 Virginia Beach VA 23462 IT Consulting Services 226858 Stephen Ulaki 203 Buckhorn Road Charleston WV 25314 Emergency Physician Services 167820 7 109660 109660 Patient Services 621990 29215023 29215023 Walmart clinic 621990 329680 329680 29544703 3022 3022 108882 0 108882 108882 108882 Cafeteria & Vending 722210 153712 153712 Miscellaneous Revenue 900099 127666 127666 Rebates and discounts 900099 17824 17824 299202 30065469 29843905 0 111904 X 315026 248556 66470 12387438 9773689 2613749 221487 174753 46734 3212736 2534849 677887 884855 698151 186704 74307 74307 96931 96931 3990333 3148373 841960 85963 67825 18138 1465878 1156578 309300 812214 640837 171377 333240 262926 70314 7054 5566 1488 188122 148428 39694 997724 787204 210520 422483 333339 89144 Bad Debts 2481355 2481355 Medical Supplies 1645754 1645754 Charity Care Expenses 447495 447495 Medicaid Provider Tax 430411 430411 377248 265180 112068 30878054 25251269 5626785 0 140731 272945 22649 388644 4905110 5918295 214605 245822 397757 340060 17132588 13852759 4003149 3279829 705940 967 10389941 10446562 3545832 3912644 1348044 1072248 500452 2221794 2499532 7115670 7984876 X 3274271 2461686 3274271 2461686 10389941 10446562 -812585 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92189 92189 6042303 4912188 1130115 10548615 8574858 1973757 449481 365713 83768 3279829 Capital leases 672955 Line of credit 278299 Malpractice Claim Contingent Liability 774436 Third Party Settlements 773842 2499532 27159449 22830 22830 27136619 2928850 2928850 30065469 27949204 0 27949204 2928850 2928850 30878054 Part XI, Line 2d - Other Adjustments: Foundation income not included on 990 22,830. Part XI, Line 4b - Other Adjustments: Bad debts and charity care netted against income on financial statements 2,928,850. Part XII, Line 4b - Other Adjustments: Bad debts and charity care netted against income on financial statements 2,928,850. 1 1 X 1 X 0 1 1 0 0 153114 153114 5813403 5514509 298894 0.01050 5966517 5667623 298894 0.01050 120872 120872 0.00430 120872 120872 0.00430 6087389 5667623 419766 0.01480 0 2481355 4848269 4848269 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 14 1 0 0 1 X http:/www.jacksongeneral.com/ X X 1 14 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 1 X 0 0 Jackson General Hospital Part V, Section B, Line 5: The Hospital collected information from various organizations in the community that included the County Commission, County Health Department, County EMS, Healthnet Air Ambulance, etc. 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. 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: As of January 16, 2018 a sliding fee process became effective. The patient responsibility amount is determined according to the most current poverty guidelines listed on the federal registry. The patient must pay the patient responsibility amount according to the sliding fee requirements before the financial assistance application process can be completed. 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 $ 2,481,355. 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 2014. 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 29,226, a 0.3% decrease between April 1 2010 to July 1, 2014. The percentage of persons over 65 years is 18.7% while that of the State is 17.3%, indicating that Jackson County has a slightly older population. Of the population in Jackson County, 50.8% of those are female, which is comparable with the State at 50.6%. Ninety-eight percent (98%) of the population in Jackson County is Caucasian (white), showing very little ethnic diversity in the county.The per capita money income in the past 12 months (2013 dollars) was $22,527 while that of the State was $22,966. Persons below the poverty level for Jackson County were 19%, while that number for the State was 17.9%.The median age in Jackson County is 41.13 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 is 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 Stephanie McCoy CEO 160562 0 0 0 0 0 0 0 9931 0 170493 0 0 0 Carl L Overmiller MD General Surgeon 273615 0 0 0 0 0 11000 0 16454 0 301069 0 0 0 Jeffry S Barton DO General Surgeon 261277 0 0 0 0 0 10520 0 16118 0 287915 0 0 0 Leigh A Levine DO Hospitalist 161262 0 0 0 0 0 0 0 3611 0 164873 0 0 0 Jacalyn L Denemark PharmD Chief Pharmacist 150075 0 0 0 0 0 5905 0 11564 0 167544 0 0 0 Dennis C Foreman PharmD Pharmacist 134039 0 0 0 0 0 5442 0 15827 0 155308 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 589,931. Management and general expenses 157,764. Fundraising expenses 0. Total expenses 747,695. Other fees: Program service expenses 358,930. Management and general expenses 95,988. Fundraising expenses 0. Total expenses 454,918. Emergency Department Services: Program service expenses 1,297,391. Management and general expenses 346,957. Fundraising expenses 0. Total expenses 1,644,348. Radiology and Nuclear Medicine: Program service expenses 591,927. Management and general expenses 158,297. Fundraising expenses 0. Total expenses 750,224. Lab Services: Program service expenses 310,194. Management and general expenses 82,954. Fundraising expenses 0. Total expenses 393,148.