2014-08-15T07:24:45-05:00 2013-09-30 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2012-10-01 550462730 Community Health Association dba Jackson General Hospital COMM 3043722731 PO Box 720 Pinnell Street Ripley WV 25271 Stephanie L McCoy 3043722731 2014-08-08 1 Harry C Harless P01042847 3043460441 2012 2015-11-30 17:44:51Z Jackson General Hospital Stephanie L McCoy PO Box 720 Pinnell Street Ripley WV 25271 28341928 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 15 320 43 0 0 142086 44508 27446673 27787605 595 -65681 359975 509037 27949329 28275469 0 0 0 0 14432364 14213537 0 0 0 13293009 12989725 27725373 27203262 223956 1072207 10891778 6372475 11518689 5927179 -626911 445296 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 22284192 27787605 Services provided included 6,035 inpatient days, 12,623 emergency room visits, and 15,377 rural health clinic visits. Charity care for the year amounted to $1,862,378. The organization provided several community health improvement services including a patch 21 program, 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.Expenses and revenue related to these programs are included above on line 4a. 22284192 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 65 0 1 320 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 Gareth Smith 1.00 X 0 0 0 Rob Fisher 1.00 X 0 0 0 John Gorrell 1.00 X 0 0 0 Dr James Gaal 1.00 X 0 0 0 Mitch Carmichael 1.00 X 0 0 0 Lee Corder 1.00 X 0 0 0 Naoma Fisher 1.00 X 0 0 0 Luke Hunter 1.00 X 0 0 0 Keith Rake 1.00 X 0 0 0 Todd Ritchie 1.00 X 0 0 0 Becky Scarberry 1.00 X 0 0 0 Debbie Sisson 1.00 X 0 0 0 Dick Waybright 1.00 X 0 0 0 Tom Weyer 1.00 X 0 0 0 Sr James T Hughes 1.00 X 0 0 0 Stephanie McCoy 40.00 X 153104 0 16242 Angela D Frame 40.00 X 91836 0 16242 Edward Stewart 40.00 X 313485 0 8245 Carl Overmiller 40.00 X 275026 0 8245 Jeffrey Barton 40.00 X 274997 0 23333 Paul Nielsen 40.00 X 244800 0 16242 Michael McIntosh 40.00 X 230050 0 0 1583298 0 88549 8 0 1 0 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Services 435222 Ohio Valley Physicians PO Box 390 Huntington WV 25708 Emergency Physician Services 308765 LabCorp of America PO Box 12140 Burlington NC 27216 Laboratory Services 228836 American Red Cross PO Box 33093 Newark NJ 07188 Blood Services 203209 Arnett Foster Toothman PLLC PO Box 2629 Charleston WV 25329 Accounting Services 187837 8 8550 35958 44508 Patient services 621990 27428043 27428043 Walmart clinic 621990 359562 359562 27787605 778 778 98369 0 98369 98369 98369 66459 -66459 -66459 -66459 Forgiveness of debt 900099 172275 172275 Cafeteria & Vending 722210 127855 127855 Rebates and discounts 900099 32093 32093 78445 78445 410668 28275469 27787605 0 443356 287367 211358 76009 10762387 7915736 2846651 2389960 1757816 632144 773823 569147 204676 121474 121474 87131 87131 2558091 2558091 94613 69588 25025 1359155 999317 359838 277719 204262 73457 338801 249188 89613 21226 15612 5614 161037 118443 42594 589168 433333 155835 454447 334246 120201 Bad Debts 4534737 4534737 Medical Supplies 1765407 1765407 Medicaid Provider Tax 442666 442666 Dues & Subscriptions 76813 56496 20317 107240 48749 58491 27203262 22284192 4919070 0 71609 107719 483659 9089 7332066 3554089 180890 187464 237650 194867 13468737 11167201 2570774 2301536 15130 17711 10891778 6372475 5426855 3499063 1856167 476112 1756474 3759555 671642 11518689 5927179 X -626911 445296 -626911 445296 10891778 6372475 1072207 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92189 92189 5341736 4459464 882272 7602639 6346944 1255695 432173 360793 71380 2301536 Capital leases 2637 Estimated third-party payor settlements 116910 Line of credit 552095 671642 23764958 24226 24226 23740732 4534737 4534737 28275469 22668525 0 22668525 4534737 4534737 27203262 Part XI, Line 2d - Other Adjustments: Foundation income not included on financial statements 24,226. Part XI, Line 4b - Other Adjustments: Bad debts netted against income in financial statements 4,534,737. Part XII, Line 4b - Other Adjustments: Bad debts netted against income in financial statements 4,534,737. 1 1 X 1 X 0 0 1 1 0 1 1 2861044 2861044 2861044 2861044 9 44184 8386 35798 0.00160 9 44184 8386 35798 0.00160 9 2905228 2869430 35798 0.00160 0 1459278 4778382 4778382 X 1 1 1 1 Jackson General Hospital

PO Box 720 Ripley WV 25271

X X X X Jackson General Hospital 1 1 X X X X X X X X X 11 1 0 1 X X X X X X X X X 1 0 1 1 200.000000000000 0 1 X X X X X X 1 1 X X 0 0 X X X X X 1 X 0 0 Part I, Line 3c: Discounted care (i.e. sliding scale) is not provided by the hospital. Patients will qualify for a 100% discount (charity) or no discount at all. 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 $ 4534737. 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. Jackson General Hospital Part V, Section B, Line 14g: 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 18e: 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 20d: Patients who qualify for Financial Assistance are never billed for their services. These bills are written off at 100%. 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 2012. 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 29,211, a 4.3% increase over the 2000 census. The percentage of persons over 65 years is 17.7% while that of the State is 16.0%, indicating that Jackson County has a slightly older population. Of the population in Jackson County, 50.6% of those are female, which is comparable with the State at 50.7%. Ninety-eight point two percent (98.2%) 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 (2010 dollars) was $20,633 while that of the State was $21,232. Persons below the poverty level for Jackson County were 18.1%, while that number for the State was 17.4%.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) Jackson General Hospital has a governing board comprised largely of independent community members representing the makeup of the area we serve. 2) Jackson General Hospital is privileged to have an open medical staff comprised of qualified physicians who work with us to provide care to our community. All qualified physicians who are granted privileges to serve must undergo thorough and comprehensive credentialing and ongoing peer review processes. 3) Jackson General Hospital reinvests all surplus funds back in to the community we serve though expanded health services, new and updated technologies, and facility improvements. In fiscal year 2013, Jackson General Hospital expended more than $470,000 for capital projects, most notably for new Siemens Chemistry and Microbiology Analyzers for the Laboratory Department and Electronic Health Records software and hardware equipment that will allow portability of information for our Community's patients. 4) Jackson General Hospital provides an emergency room 24 hours per day open to all those in need of emergent care, regardless of patient's ability to pay. 5) Specialized services provided at Jackson General Hospital include general surgery, anesthesia, urology, ophthalmology, ENT, and emergency services. 6) Jackson General Hospital is helped through the charitable efforts of the Jackson General Hospital Foundation Board and JGH Hospital Auxiliary. 7) The report of community benefit is included as a written report and summarizes activities and programs to improve health including proactive community health services conducted during the prior year. The annual report is simply a snapshot of how the organization distinguishes itself in its vision to be the outstanding rural healthcare provider in WV through recruitment and retention of high quality medical staff and employees, through reasonable investment in new technology, and through networking with local and regional healthcare partners and to have a key leadership role in providing high quality acute care services and improve the health status of the community through outreach, networking, and implementation of community based programs. The Jackson General Hospital Community Benefit Report can be found at www.jacksongeneral.com. Jackson General Hospital provides a full range of inpatient and outpatient services to the people of Jackson and surrounding counties. The hospital conducts all activities and serves its health care purpose without regard to race, color, creed, religion, gender, orientation, disability, age or national origin. Jackson General Hospital collaborates with communities, churches, businesses, and other health care organizations to facilitate and strengthen accessibility of quality comprehensive health care services for all, particularly the vulnerable and underserved populations. JGH also supports local community health services, offering convenient locations for primary and urgent care, mobile outreach programs, and other outreach services such as free health physicals, health fair activities offering basic lab testing at cost, as well as free patient education on an outpatient basis. Jackson General Hospital is dedicated to improving the health status of the community through programs that place needed services where they are needed the most, with special attention and preference given to programs that support and benefit the health and welfare of the poor and underserved. Jackson General Hospital is one of the community's largest private employers. 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 153104 0 0 0 0 0 0 0 17535 0 170639 0 0 0 Edward Stewart 313485 0 0 0 0 0 0 0 8395 0 321880 0 0 0 Carl Overmiller 275026 0 0 0 0 0 0 0 8395 0 283421 0 0 0 Jeffrey Barton 274997 0 0 0 0 0 0 0 23484 0 298481 0 0 0 Paul Nielsen 244800 0 0 0 0 0 0 0 16393 0 261193 0 0 0 Michael McIntosh 230050 0 0 0 0 0 0 0 150 0 230200 0 0 0 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.