COMMUNITY HEALTH ASSOCIATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH ASSOCIATION (EIN 55-0462730)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201602289349304650
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-15T13:30:20-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550486667 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Carbis Toothman LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1Txt |
| City | Charleston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25329 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550462730 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Health Association dba | BusinessNameLine1Txt |
| Business Name Line2 | Jackson General Hospital | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3043722731 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 Pinnell Street | AddressLine1Txt |
| City | Ripley | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25271 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Angela Frame | PersonNm |
| Person Title | Interim CEO | PersonTitleTxt |
| Phone | 3043722731 | PhoneNum |
| Signature | 2016-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tessa W Carr | PreparerPersonNm |
| PTIN | P01291277 | PTIN |
| Phone | 3043460441 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson General Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Angela Frame | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 Pinnell Street | AddressLine1Txt |
| City | Ripley | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25271 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,898,850 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.jacksongeneral.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1964 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 340 | TotalEmployeeCnt |
| Total Volunteers | 38 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $16,135 | PYContributionsGrantsAmt |
| CY Contributions Grants | $19,945 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,728,345 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,501,979 | CYProgramServiceRevenueAmt |
| PY Investment Income | $200 | PYInvestmentIncomeAmt |
| CY Investment Income | -$29,381 | CYInvestmentIncomeAmt |
| PY Other Revenue | $356,875 | PYOtherRevenueAmt |
| CY Other Revenue | $376,519 | CYOtherRevenueAmt |
| PY Total Revenue | $29,101,555 | PYTotalRevenueAmt |
| CY Total Revenue | $30,869,062 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,610,464 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,832,944 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,138,267 | PYOtherExpensesAmt |
| CY Other Expenses | $13,619,812 | CYOtherExpensesAmt |
| PY Total Expenses | $27,748,731 | PYTotalExpensesAmt |
| CY Total Expenses | $29,452,756 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,352,824 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,416,306 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,396,910 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,938,154 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,598,790 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,723,728 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,798,120 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,214,426 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $24,060,499 | ExpenseAmt |
| Revenue | $30,744,224 | RevenueAmt |
| Desc | Services provided included 3,692 inpatient days, 11,489 emergency room visits, 30,656 outpatient visits, and 12,451 rural health clinic visits. Charity care for the year amounted to $507,203. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $66,419 | ExpenseAmt |
| Revenue | $1,603 | RevenueAmt |
| Desc | The organization provided several community health improvement services including free breast cancer screenings, 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 and various other programs. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $24,126,918 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 74 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 340 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Angela D Frame Interim CEO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3043731476 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 Pinnell St | AddressLine1Txt |
| City | Ripley | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25271 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Robert Fisher | |||||||
| Chairman | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tom Weyer | |||||||
| Vice Chairman | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| John Gorrell | |||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dr James Gaal | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mitch Carmichael | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Lee Corder | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Naoma Fisher | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Luke Hunter | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Keith Rake | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Todd Ritchie | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Becky Scarberry | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Sarah Brown | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Gareth Smith | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Joe Parsons | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dr James T Hughes | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Stephanie McCoy | |||||||
| CEO (termed 5/6/2016) | 40.00 | Yes (X) | $153,739 | $0 | $0 | ||
| Angela D Frame | |||||||
| President/Interim CEO | 40.00 | Yes (X) | $125,040 | $0 | $15,149 | ||
| Edward Stewart | |||||||
| Emergency Physician | 40.00 | $378,924 | $0 | $5,734 | Yes (X) | ||
| Carl Overmiller | |||||||
| General Surgeon | 40.00 | $275,097 | $0 | $15,741 | Yes (X) | ||
| Jeffrey Barton | |||||||
| General Surgeon | 40.00 | $270,019 | $0 | $25,066 | Yes (X) | ||
| Paul Nielsen | |||||||
| Emergency Physician | 40.00 | $259,165 | $0 | $20,129 | Yes (X) | ||
| Stephan Ulaki | |||||||
| Emergency Physician | 40.00 | $271,545 | $0 | $6,668 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,733,529 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $88,487 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Emergency Providers of Parkersburg | |||||
| 5 Foxboro Drive | Vienna | WV | 26105 | Emergency Physician Services | $301,140 |
| Alliance Healthcare Services | |||||
| PO Box 96485 | Chicago | IL | 60693 | MRI Services | $298,305 |
| LabCorp of America | |||||
| PO Box 12140 | Burlington | NC | 27216 | Laboratory Services | $278,093 |
| American Red Cross | |||||
| PO Box 33093 | Newark | NJ | 07188 | Blood Services | $181,795 |
| Ohio Valley Physicians | |||||
| PO Box 390 | Huntington | WV | 25708 | Emergency Physician Services | $155,050 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $19,945 | GovernmentGrantsAmt |
| Total Contributions | $19,945 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Services | 621990 | $30,066,671 | $30,066,671 |
| Walmart clinic | 621990 | $435,308 | $435,308 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,501,979 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $407 | TotalRevenueColumnAmt |
| Exclusion | $407 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $102,883 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $102,883 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $102,883 | TotalRevenueColumnAmt |
| Exclusion | $102,883 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $29,788 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$29,788 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$29,788 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$29,788 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Cafeteria & Vending | 722210 | $127,906 | $127,906 |
| Rebates and discounts | 900099 | $92,955 | $92,955 |
| Medical Record Transcription | 900099 | $7,851 | $7,851 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,924 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,924 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $273,636 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,869,062 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,745,827 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $103,290 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $302,571 | TotalAmt |
| Program Services | $238,305 | ProgramServicesAmt |
| Management And General | $64,266 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,478,195 | TotalAmt |
| Program Services | $9,040,226 | ProgramServicesAmt |
| Management And General | $2,437,969 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,996 | TotalAmt |
| Program Services | $147,278 | ProgramServicesAmt |
| Management And General | $39,718 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,008,056 | TotalAmt |
| Program Services | $2,369,145 | ProgramServicesAmt |
| Management And General | $638,911 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $857,126 | TotalAmt |
| Program Services | $675,072 | ProgramServicesAmt |
| Management And General | $182,054 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,859 | TotalAmt |
| Management And General | $74,859 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,498 | TotalAmt |
| Management And General | $113,498 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,812,403 | TotalAmt |
| Program Services | $2,215,048 | ProgramServicesAmt |
| Management And General | $597,355 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,174 | TotalAmt |
| Program Services | $81,260 | ProgramServicesAmt |
| Management And General | $21,914 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,516,647 | TotalAmt |
| Program Services | $1,194,511 | ProgramServicesAmt |
| Management And General | $322,136 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,063,138 | TotalAmt |
| Program Services | $837,327 | ProgramServicesAmt |
| Management And General | $225,811 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $418,417 | TotalAmt |
| Program Services | $329,545 | ProgramServicesAmt |
| Management And General | $88,872 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,800 | TotalAmt |
| Program Services | $7,718 | ProgramServicesAmt |
| Management And General | $2,082 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,220 | TotalAmt |
| Program Services | $123,039 | ProgramServicesAmt |
| Management And General | $33,181 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $904,792 | TotalAmt |
| Program Services | $712,614 | ProgramServicesAmt |
| Management And General | $192,178 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $449,685 | TotalAmt |
| Program Services | $354,172 | ProgramServicesAmt |
| Management And General | $95,513 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Bad Debts | $3,020,402 | $3,020,402 |
| Medical Supplies | $1,657,371 | $1,657,371 |
| Charity Care Expenses | $507,203 | $507,203 |
| Medicaid Provider Tax | $394,601 | $394,601 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $417,602 | TotalAmt |
| Program Services | $222,081 | ProgramServicesAmt |
| Management And General | $195,521 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,452,756 | TotalAmt |
| Program Services | $24,126,918 | ProgramServicesAmt |
| Management And General | $5,325,838 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $325,226 | BOYAmt |
| EOY | $199,497 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,983 | BOYAmt |
| EOY | $7,862 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,158,916 | BOYAmt |
| EOY | $4,361,708 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $212,600 | BOYAmt |
| EOY | $230,272 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $311,084 | BOYAmt |
| EOY | $378,113 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,234,141 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,901,533 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,358,326 | BOYAmt |
| EOY | $4,332,608 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,775 | BOYAmt |
| EOY | $1,428,094 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,396,910 | BOYAmt |
| EOY | $10,938,154 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,964,151 | BOYAmt |
| EOY | $3,735,194 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,577,131 | BOYAmt |
| EOY | $1,612,896 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,057,508 | BOYAmt |
| EOY | $2,375,638 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,598,790 | BOYAmt |
| EOY | $7,723,728 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,798,120 | BOYAmt |
| EOY | $3,214,426 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,798,120 | BOYAmt |
| EOY | $3,214,426 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,396,910 | BOYAmt |
| EOY | $10,938,154 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,416,306 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $92,189 | OtherCostOrOtherBasisAmt |
| Book Value | $92,189 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,028,568 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,445,223 | DepreciationAmt |
| Book Value | $1,583,345 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,679,726 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,137,349 | DepreciationAmt |
| Book Value | $2,542,377 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $433,658 | OtherCostOrOtherBasisAmt |
| Depreciation | $318,961 | DepreciationAmt |
| Book Value | $114,697 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,332,608 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Estimated third party payor settlements | $1,418,254 |
| Loan costs net | $9,840 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,428,094 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Capital leases | $1,219,557 |
| Line of credit | $1,106,764 |
| Malpractice Claim Contingent Liability | $49,317 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,375,638 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $27,378,453 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $36,996 | OtherRevenueAmt |
| Revenue Not Reported | $36,996 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,341,457 | RevenueSubtotalAmt |
| Other Revenues Not Included | $3,527,605 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,527,605 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $30,869,062 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $25,925,151 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $25,925,151 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,527,605 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,527,605 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $29,452,756 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 2d - Other Adjustments: | Foundation income not included on 990 36,996. |
| Part XI, Line 4b - Other Adjustments: | Bad debts and charity care netted against income in financial statements 3,527,605. |
| Part XII, Line 4b - Other Adjustments: | Bad debts and charity care netted against income in financial statements 3,527,605. |
| Part X, Line 2 | The Hospital, which is not classified as a private foundation, is exempt from Federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code and similar state statutes relating to not-for-profit organizations. The Hospital is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The management of the Hospital believes it is no longer subject to income tax examinations for years prior to the fiscal year ended September 30, 2012. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $177,356 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $177,356 | DirectOffsettingRevenueAmt |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,222,483 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,222,483 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,399,839 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,399,839 | DirectOffsettingRevenueAmt |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,419 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,603 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $64,816 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,419 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,603 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $64,816 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,466,258 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,401,442 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $64,816 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,056,157 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,422,786 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,422,786 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson General Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 | AddressLine1Txt |
| City | Ripley | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25271 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson General Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.jacksongeneral.com/sg_userfiles/JGH-CHNA-final-2015.pdf | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.jacksongeneral.com/for-visitors---patient-financial-services.php | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 16i: 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. |
| Jackson General Hospital | Part V, Section B, Line 22d: Patients who apply and are approved for financial assistance for each service date reviewed, are not billed for those services. These bills are written off at 100%. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Jackson General Hospital Part V, Section B, line 16a website: | http://www.jacksongeneral.com/for-visitors---patient-financial-services.php |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Morad Hughes Health Center | ||||
| PO Box 720 122 Pinnell St | Ripley | WV | 25271 | Hospital-based rural health center |
| Jackson General Hospital Clinic-Walmart | ||||
| 200 Academy Drive | Ripley | WV | 25271 | Provider-based health clinic |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $ 3,020,402. |
| Part III, Line 2: | The cost of bad debt was estimated using the cost to charge ratio from Schedule 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.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 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Stephanie McCoy | ||||||||||||||
| CEO (termed 5/6/2016) | $153,739 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $153,739 | $0 | $0 | $0 |
| Edward Stewart | ||||||||||||||
| Emergency Physician | $378,924 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,705 | $0 | $385,629 | $0 | $0 | $0 |
| Carl Overmiller | ||||||||||||||
| General Surgeon | $275,097 | $0 | $0 | $0 | $0 | $0 | $10,008 | $0 | $6,705 | $0 | $291,810 | $0 | $0 | $0 |
| Jeffrey Barton | ||||||||||||||
| General Surgeon | $270,019 | $0 | $0 | $0 | $0 | $0 | $9,804 | $0 | $16,233 | $0 | $296,056 | $0 | $0 | $0 |
| Paul Nielsen | ||||||||||||||
| Emergency Physician | $259,165 | $0 | $0 | $0 | $0 | $0 | $9,461 | $0 | $11,640 | $0 | $280,266 | $0 | $0 | $0 |
| Stephan Ulaki | ||||||||||||||
| Emergency Physician | $271,545 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,639 | $0 | $279,184 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | 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. Also, the financial statements are published as a legal advertisement annually in the Jackson Herald/Star News. |