2017-08-15T12:44:31-05:00 2016-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-10-01 550422958 Stonewall Jackson Memorial Hospital STON 3042698059 230 Hospital Plaza Weston WV 26452 Avah L Stalnaker CEO 3042698059 2017-07-27 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z Avah L Stalnaker 230 Hospital Plaza Weston WV 26452 75943298 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 7 585 30 5981 4981 104137 84296 45424033 48261302 1614998 581470 469539 1143763 47612707 50070831 30626 34349 0 0 27648093 27786962 0 0 0 20966158 21795229 48644877 49616540 -1032170 454291 67911425 71934756 7621658 8072985 60289767 63861771 X It is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve. 0 0 37222385 49462741 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 6,557 days of inpatient care, 90,210 outpatient visits, 15,558 emergency room visits, 1,288 ambulatory surgery visits, 6,093 Home Health visits and 58,810 Physician Clinic visits. 15526 10749 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. 28402 23600 28637 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. 37266313 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 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 1 0 0 1 199 0 585 1 1 1 0 0 0 0 1 1 0 0 0 0 X 9 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X Joe A Barnes CPA 3042698050 230 Hospital Plaza Weston WV 264528558 John Law CPA President 1.00 X X 0 0 0 Joseph Snead MD Vice-President 20.00 X X 187528 0 34261 R Gerald Wood RPH Secretary 1.00 X X 0 0 0 Denver Turner Treasurer 1.00 X X 0 0 0 C Gregory Cunningham Director 1.00 X 0 0 0 Robin Poling Director 1.00 X 0 0 0 John W Wyllie III MD Director 38.00 X 429779 0 46773 David Gallien Director 1.00 X 0 0 0 Michael Hager Director 1.00 X 0 0 0 Avah Stalnaker CEO 37.50 X 288304 0 48605 Delphia Arbogast CFO (termed 5/31/16) 37.50 X 125265 0 56741 Kevin Stalnaker Assistant CEO 37.50 X 167097 0 50300 Ronald Pearson MD Physician 37.80 X 402000 0 13250 Doyle Sickles MD Physician 37.50 X 463528 0 60168 Peter Edgerton MD Physician 37.50 X 420863 0 29258 Shafic Sraj MD Physician 37.50 X 470758 0 53988 Michael Gregory DO Physician 41.50 X 431867 0 35988 3386989 0 429332 34 0 1 0 Atlanticon PO Box 621 Fairborn OH 45324 Consulting 606076 Sodexo Inc & Affiliates PO Box 536922 Atlanta GA 503536922 Maintenance/Dietary 445760 Laboratory Corporation PO Box 12140 Burlington NC 272162140 Laboratory Services 257034 CPS Inc P O Box 638316 Cincinnati OH 452638316 Pharmacy Consulting 225902 AMN Healthcare Inc 2375 Collections Ctr Dr Chicago IL 60693 Nurse Staffing 196732 15 18351 65945 84296 Patient Services 622110 48261302 48261302 48261302 1017713 1017713 49287 7200 76979 1219 -27692 5981 -21711 5981 -27692 25161680 186766 25709181 75508 -547501 111258 -436243 111258 -547501 56236 18351 9580 46656 46656 EHR Incentive Income 900099 834365 834365 Cafeteria/Vending sales 722310 199084 199084 Purchase discounts 900099 74788 74788 10581 10581 1118818 50070831 49491378 5981 489176 10749 10749 23600 23600 1339901 940744 399157 22912336 16086751 6825585 983200 690305 292895 1045373 733956 311417 1506152 1057469 448683 276799 276799 229824 229824 340066 340066 2392358 1679675 712683 231535 162561 68974 1823446 1280242 543204 332744 233620 99124 1172354 823110 349244 88938 62443 26495 14752 10357 4395 2256620 1584373 672247 884047 620689 263358 Medical supplies 7968141 7968141 Repairs and maintenance 1107658 777687 329971 Bad debts 965491 965491 Charity Care Expenses 633672 633672 1076784 920678 156106 49616540 37266313 12350227 0 544631 392366 9554723 9284479 7320151 7775594 1195535 1275263 377623 410827 41500421 28980090 10987182 12520331 36329225 37682640 67668 67668 1534687 2525588 67911425 71934756 6348984 7142672 37254 38881 631901 891432 603519 0 7621658 8072985 X 60289767 63861771 60289767 63861771 67911425 71934756 454291 3117713 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5000 0 0 0 5000 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. 646015 646015 13307432 10608012 2699420 23663588 18372078 5291510 3883386 3883386 12520331 X 48047014 1219 1219 48045795 2025036 2025036 50070831 47592723 1219 1219 47591504 2025036 2025036 49616540 Part X, Line 2: The Hospital follows the guidance for accounting for uncertainty in income taxes recognized in a company s 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 guidance also addresses derecognition, classification, interest and penalties, accounting in interim periods, and disclosures. Management has determined that this guidance had no material effect on the financial statements. The Hospital s policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in management and general expenses. There were no interest or penalties recognized on the statements of operations and changes in net assets as a result of this guidance. Generally, tax returns for years ended September 30, 2013, and thereafter remain subject to examination by federal and state tax authorities. Part XI, Line 2d - Other Adjustments: Rental expense netted with rental income on 990 1,219. Part XI, Line 4b - Other Adjustments: Investment expenses netted with revenue on the financial statements 340,066. Bad debt and Charity expense netted with revenue on the financial statements 1,599,163. Expenses netted with donation revenue on the financial statements 46,656. Net fundraising revenue netted with expenses on financial statements 39,151. Part XII, Line 2d - Other Adjustments: Rental expense netted with rental income on 990 1,219. Part XII, Line 4b - Other Adjustments: Investment expenses netted with revenue on the financial statements 340,066. Bad debt expense netted with revenue on the financial statements 1,599,163. Expenses netted with donation revenue on the financial statements 46,656. Net fundraising revenue netted with expenses on financial statements 39,151. Charity Golf Tournament 28637 18351 10286 920 3882 Rotary Blood Screening 45950 45950 4778 74587 18351 56236 920 3882 4778 9580 46656 1 1 X 1 X 1 X 162.000000000000 1 1 1 0 0 278864 66447 212417 0.00440 9690255 6884952 2805303 0.05770 9969119 6951399 3017720 0.06210 24967 42015 -17048 0.00000 23600 23600 0.00050 4325 4325 0.00010 52892 42015 10877 0.00060 10022011 6993414 3028597 0.06270 1 427074 8043702 8089563 -45861 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 15 1 0 1 1 X http://www.stonewalljacksonhospital.com/docs/SJMH_Community_Assessment_2016 X 1 15 1 http://www.stonewalljacksonhospital.com/docs/SJMH_Community_Assessment_2016 0 0 1 X 150.000000000000 162.000000000000 X X X X X 1 1 X X X X 1 X http://www.stonewalljacksonhospital.com/getpage.php?name=charity&sub=Patien X http://www.stonewalljacksonhospital.com/docs//Patient_Financial_Assistant_P X http://www.stonewalljacksonhospital.com/docs//Patient_Financial_Assistant_P X X X X 1 X 0 X X X X 1 X 0 0 Stonewall Jackson Memorial Hospital Part V, Section B, Line 5: The Hospital took into account input from representatives from health department, schools, local businesses and town Mayor. 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. To combat this, SJMH's emergency department has adopted the WV hospital association guidelines for prescribing opiates. All nursing staff at SJMH is required to complete continuing education on "drug diversion education on opiates". All SJMH pharmacists 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, we received a grant to fund a walking program in the fall of 2012, we provide annual physicals for athletes in the area for free, we sponsor the Weston 5K run and wellness walk, we created a walking path in the parking lot, we established a wellness committee for our employees. 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. Stonewall Jackson Memorial Hospital Part V, Section B, Line 22d: Basis for Calculating Amounts Generally Billed. After the patient's account is reduced by the financial assistance adjustment based on this policy and guidelines, the patient is responsible for no more than the amount generally billed to individuals with Medicare fee for service or private health insurers in need of emergency and other medically necessary care. The Look Back Method is used to determine AGB. Patients or members of the public may obtain the percentage used by the hospital and description of the calculation in writing at no charge by contacting the hospital billing office. Hospital billing office contact information is provided in the Request a Copy section of this policy. 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 $ 965,491. Part III, Line 2: The cost of bad debt expense was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. 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 when 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 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 24 hours 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) 10749 To help the Rotary support various children's programs in Lewis County. 0 1 Healthcare scholarships for recent high school graduates. 24 23600 FMV - Cash X X 0 0 0 0 0 0 0 0 0 Joseph Snead MD Vice-President 176865 0 10449 0 214 0 33471 0 3518 0 224517 0 0 0 John W Wyllie III MD Director 408169 0 20067 0 1543 0 37250 0 11494 0 478523 0 0 0 Avah Stalnaker CEO 277797 0 9314 0 1193 0 39442 0 11779 0 339525 0 0 0 Delphia Arbogast CFO (termed 5/31/16) 121371 0 3587 0 307 0 33445 0 24051 0 182761 0 0 0 Kevin Stalnaker Assistant CEO 166934 0 0 0 163 0 26636 0 26853 0 220586 0 0 0 Ronald Pearson MD Physician 402000 0 0 0 0 0 13250 0 0 0 415250 0 0 0 Doyle Sickles MD Physician 463528 0 0 0 0 0 37250 0 28344 0 529122 0 0 0 Peter Edgerton MD Physician 420863 0 0 0 0 0 20150 0 11706 0 452719 0 0 0 Shafic Sraj MD Physician 470758 0 0 0 0 0 31250 0 26216 0 528224 0 0 0 Michael Gregory DO Physician 297517 0 0 0 134350 0 13250 0 26281 0 471398 0 0 0 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 B, line 11 The process the Hospital uses to review their 990 before filing with the IRS is the Assistant CEO is responsible for reviewing the form 990 for completeness and accuracy. A completed copy is provided for the board. It is then signed and submitted to the IRS. Form 990, Part VI, Section B, line 12c All board members disclose possible conflicts of interest prior to appointment and periodically throughout their terms as trustees. Form 990, Part VI, Section B, line 15 The Hospital obtains salary survey data. Performance evaluations are done on each of these personnel & financial conditions are considered. 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. Stonewall Home Oxygen Therapy Inc 100 Market Place Mall Suite 8 Weston WV 26452 550754278 Oxygen Therapy Services WV Stonewall Jackson Memorial Hospital C 50367 383890 1.00000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Stonewall Home Oxygen Therapy Inc A 7200 FMV - Cash