2016-08-15T16:57:59-05:00 2015-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2014-10-01 550422958 Stonewall Jackson Memorial Hospital STON 3042698059 230 Hospital Plaza WESTON WV 26452 Avah Stalnaker CEO 3042698059 2016-08-15 1 Tessa W Carr P01291277 3043460441 2014 2016-09-27 15:27:22Z Avah L Stalnaker 230 Hospital Plaza WESTON WV 26452 70995766 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 7 591 35 5999 4999 136130 104137 46451333 45424033 3510911 1614998 262761 469539 50361135 47612707 26500 30626 0 0 25267557 27648093 0 0 0 20920592 20966158 46214649 48644877 4146486 -1032170 71202442 67911425 6748860 7621658 64453582 60289767 X It is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve. 0 0 36858002 45858069 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 7,091 days of inpatient care, 92,406 outpatient visits, 16,713 emergency room visits, 1,371 ambulatory surgery visits, 5,458 Home Health visits and 62,482 Physician Clinic visits. 11161 11026 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. 24085 19600 29016 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. 36893248 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 1 140 0 591 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 Crystal Frazier 3042698050 230 Hospital Plaza Weston WV 264528558 John Law President 1.00 X X 0 0 0 Joseph Snead Vice-President 22.50 X X 189346 0 9471 R Gerald Wood Secretary 1.00 X X 0 0 0 Denver Turner Treasurer 1.00 X X 0 0 0 J Robert Bennett Director 1.00 X 0 0 0 Robin Poling Director 1.00 X 0 0 0 John W Wyllie III Director 37.50 X 448978 0 21054 David Gallien Director 1.00 X 0 0 0 Michael Hager Director 1.00 X 0 0 0 Avah Stalnaker CEO 22.50 X 278059 0 21054 Delphia Arbogast CFO 37.50 X 127729 0 26481 Kevin Stalnaker Assistant CEO 37.50 X 151044 0 28671 Ronald Pearson Physician 37.50 X 442600 0 13000 Doyle Sickles Physician 40.00 X 537816 0 33035 Virgil W McMillion Physician 62.80 X 518758 0 33035 Shafic Sraj Physician 40.00 X 524720 0 33035 Michael Gregory Physician 62.80 X 436800 0 33035 3655850 0 251871 33 0 1 0 Sodexo PO Box 936522 Atlanta GA 503536922 Maintenance/Dietary 438401 Laboratory Corporation PO Box 12140 Burlington NC 27216 Laboratory Services 290452 Onward Healthcare PO Box 27421 New York NY 100877421 Nurse Staffing 203554 CPS PO Box 1000 Memphis TN 38148 Pharmacy Consulting 195067 Atlanticon PO Box 621 Fairborn OH 45324 Consulting 178557 10 18731 7000 78406 104137 Patient Services 622110 45424033 45424033 45424033 1108651 1108651 49634 7200 88815 1201 -39181 5999 -33182 5999 -39181 23777244 6500 23270633 6764 506611 -264 506347 -264 506611 55051 18731 15646 39405 39405 EHR Incentive Income 900099 219591 219591 Cafeteria/Vending sales 722310 195962 195962 Purchase discounts 900099 34881 34881 12882 12882 463316 47612707 45887085 5999 1615486 11026 11026 19600 19600 1332151 941830 390321 21919061 15496776 6422285 709349 501510 207839 2270889 1605519 665370 1416643 1001567 415076 150644 150644 149023 149023 341236 341236 2320785 1649687 671098 157027 111018 46009 1842615 1300966 541649 149960 106022 43938 1120742 792365 328377 98249 69462 28787 20825 14723 6102 2290401 1619314 671087 455301 321898 133403 Medical supplies 8035584 8035584 Repairs and maintenance 1323539 935742 387797 Bad debts 972045 972045 Charity Care Expenses 550823 550823 987359 835771 151588 48644877 36893248 11751629 0 197202 544631 12048278 9554723 6810199 7320151 791698 1195535 382460 377623 37915482 26928300 10745543 10987182 38960423 36329225 67668 67668 1198971 1534687 71202442 67911425 5592132 6348984 57254 37254 1099474 631901 0 603519 6748860 7621658 X 64453582 60289767 64453582 60289767 71202442 67911425 -1032170 -3131645 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 646015 646015 13407350 10320826 3086524 22315143 16607474 5707669 1546974 1546974 10987182 Due to Medicare 603519 603519 45686628 1201 1201 45685427 1927279 1927279 47612706 46718798 1201 1201 46717597 1927279 1927279 48644876 Part XI, Line 2d - Other Adjustments: Rental expense netted with rental income on 990 1,201. Part XI, Line 4b - Other Adjustments: Investment expenses netted with revenue on the financial statements 341,236. Bad debt and Charity expense netted with revenue on the financial statements 1,522,868. Expenses netted with donation revenue on the financial statements 23,775. Net fundraising revenue netted with expenses on financial statements 39,400. Part XII, Line 2d - Other Adjustments: Rental expense netted with rental income on 990 1,201. Part XII, Line 4b - Other Adjustments: Investment expenses netted with revenue on the financial statements 341,236. Bad debt expense netted with revenue on the financial statements 1,522,868. Expenses netted with donation revenue on the financial statements 23,775. Net fundraising revenue netted with expenses on financial statements 39,400. Charity Golf Tournament 29017 18731 10286 310 4175 Rotary Blood Screening 44765 44765 11161 73782 18731 55051 310 4175 11161 15646 39405 1 1 X 0 0 1 1 1 0 0 233794 233794 0.00490 9281028 6576689 2704339 0.05670 9514822 6576689 2938133 0.06160 3740 3740 0.00010 3740 3740 0.00010 9518562 6576689 2941873 0.06170 1 412580 7934373 8190397 -256024 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 12 1 0 0 1 X www.stonewalljacksonhospital.com X 1 12 0 0 0 1 X X X X X 1 1 X X X X 1 X X X X 1 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 11: Action has been taken on the top 5 Community Needs identified in the Community Health Needs Assessment. The remaining items were not addressed due to low community need. Stonewall Jackson Memorial Hospital Part V, Section B, Line 22d: Charges are the same for all payers and private pay but private pay patients are given a 20% discount off of charges if the bill is paid within 30 days of the statement date. The Hospital's Financial Assistance Policy allows for 100% Write-Off of charges for patients whose family income is below 150% of the FPL and Partial Charity Care with a discount between 60% and 95% for patients who have family income between 150% and 260% of the FPL. Part I, Line 3c: WV food stamp 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 $ 972,045. Part II, Community Building Activities: We recruit physicians to this area based entirely on what services the patients need. Our goal is to be able to provide physicians who can address these needs in the community. 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 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: We completed the community needs assessment at the end of fiscal year 2012. The next one will not be completed until the end of fiscal year 2015. 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) 11026 To help the Rotary support various children's programs in Lewis County. Nursing School Scholarships for recent high school graduates. 18 19600 FMV - Cash 1 X X X 0 0 0 0 0 0 0 0 0 Joseph Snead Vice-President 189346 0 0 0 0 0 9471 0 1580 0 200397 0 0 0 John W Wyllie III Director 424209 0 24769 0 0 0 13250 0 9974 0 472202 0 0 0 Avah Stalnaker CEO 267956 0 0 0 10103 0 13250 0 10147 0 301456 0 0 0 Delphia Arbogast CFO 127729 0 0 0 0 0 6445 0 21230 0 155404 0 0 0 Kevin Stalnaker Assistant CEO 151044 0 0 0 0 0 8636 0 21464 0 181144 0 0 0 Ronald Pearson Physician 442600 0 0 0 0 0 13000 0 0 0 455600 0 0 0 Doyle Sickles Physician 537816 0 0 0 0 0 13000 0 22378 0 573194 0 0 0 Virgil W McMillion Physician 518758 0 0 0 0 0 13000 0 22378 0 554136 0 0 0 Shafic Sraj Physician 488720 0 36000 0 0 0 13000 0 22378 0 560098 0 0 0 Michael Gregory Physician 436800 0 0 0 0 0 13000 0 22378 0 472178 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. The policies and procedures are on the Stonewall Jackson website. Stonewall Home Oxygen Therapy Inc 100 Market Place Mall Suite 8 Weston WV 26452 550754278 Oxygen Therapy Services WV N/A C 17279 346475 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