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JEFFERSON MEMORIAL HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
JEFFERSON MEMORIAL HOSPITAL (EIN 55-0359755)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201303179349301240
Schema version
2012v2.2
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

FieldValueIRS element (for citing)
Timestamp2013-11-13T09:08:08-00:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN550359755EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jefferson Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlJEFFNameControl
Phone3042641358Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Room 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameChristopher KnightName
TitleVice President of FinanceTitle
Phone3042641358Phone
Date Signed2013-10-23DateSigned
Authorize Third PartyfalseAuthorizeThirdParty
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonChristopher KnightNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Suite 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts52003627GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.wvuh-east.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1912YearFormation
State Legal DomicileWVStateLegalDomicile
Activity Or Mission DescriptionJefferson Memorial Hospital is a non profit, critical access hospital serving the residents of the Eastern Panhandle of WV, that strives to improve the health status of Eastern Panhandle residents by providing high-quality, health and wellness service regardless of the patients ability to pay.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees454TotalNbrEmployees
Total Nbr Volunteers30TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year137889ContributionsGrantsPriorYear
Contributions Grants Current Year113847ContributionsGrantsCurrentYear
Program Service Revenue Prior Year49594533ProgramServiceRevenuePriorYear
Program Service Revenue CY51052159ProgramServiceRevenueCY
Investment Income Prior Year-4920InvestmentIncomePriorYear
Investment Income Current Year132957InvestmentIncomeCurrentYear
Other Revenue Prior Year500545OtherRevenuePriorYear
Other Revenue Current Year522006OtherRevenueCurrentYear
Total Revenue Prior Year50228047TotalRevenuePriorYear
Total Revenue Current Year51820969TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year4174GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY21702GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year20577322SalariesEtcPriorYear
Salaries Etc Current Year21498903SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year23794875OtherExpensePriorYear
Other Expenses Current Year27185420OtherExpensesCurrentYear
Total Expenses Prior Year44376371TotalExpensesPriorYear
Total Expenses Current Year48706025TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5851676RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3114944RevenuesLessExpensesCY
Total Assets BOY44304321TotalAssetsBOY
Total Assets EOY48814707TotalAssetsEOY
Total Liabilities BOY21737507TotalLiabilitiesBOY
Total Liabilities EOY22245135TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY22566814NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY26569572NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionJefferson Memorial Hospital is a non profit critical access hospital serving the residents in the Eastern Panhandle of WV. It operates a 24/7 emergency room. Jefferson Memorial Hospital is organized to provide quality hospital patient care services to the Eastern Panhandle of WV regardless of the patients ability to pay.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense7734230Expense
Revenue15297222Revenue
DescriptionAs a not for profit critical access hospital, Jefferson Memorial Hospital JMH provides general medical services in the community of Ranson, WV. Such services include family medicine, internal medicine, observation to see if hospital admission is necessary, and outpatient ancillary testing. During 2012, JMH documented 1,362 outpatients in the observation status and 35,983 outpatient ancillary tests were performed.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2075925Expense
Revenue4105888Revenue
DescriptionJMH provides general surgical services to those residents in need located in Ranson, WV. JMH operates as a critical access hospital and operates a 24 hours per day, 7 days per week emergency department which cares for patients regardless of their ability to pay. The hospital also provides a One Day Surgical Unit that provided care to 2,459 patients during 2012. These patients undergo procedures by a variety of surgical subspecialties, including opthalmology, otolarynology, urology, gastroenterology, orthopedics, and gynecology.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1717234Expense
Revenue3396449Revenue
DescriptionJMH Obstetrics Unit features family centered maternity care services that include birthing rooms, whirlpools, rooming in and sibling visitation. In 2012, Jefferson Memorial Hospital reported 280 births.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp23513809TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev28252600TotalOfOtherProgramServiceRev
Total Program Service Expense35041198TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvesttrueReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109674NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees454NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonChristopher KnightNamePerson
Telephone Number3042641000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Suite 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Richard Pill
Chairman000.03000.72XX000
Walter Washington
Vice-Chairman000.03000.72XX000
Robert Baronner Jr
Treasurer000.03000.72XX000
Jackee Long
Director000.03000.72X000
Keith B Berkeley DVM
Director000.03000.72X000
John A Draper Jr MD
Director/ CHI Med Staff President000.03000.72X000
Dr Richard Knapp
Director000.03000.72X000
D Scott Roach
Director000.03000.72X000
Fred Butcher PhD
Director000.03000.72X000
David A Baltierra MD
Director/ JMH Med Staff President000.03000.72X000
Suzanne Shipley
Director000.03000.72X000
Betty Gunnoe
Secretary000.03000.72XX000
Rhonda Monroe
Director000.03000.72X000
Nicholas Trietsch
Director000.03000.72X000
KC Nau MD
Director000.03000.72X000
Christina Coad
CAO050.00X29091100
Lauren Cianciaruso
VP Medical Affairs040.00X000
Linda Blanc
Administrative Director Nursing040.00117025032538X
Charles Keeling
CRNA040.00259553016412X
Gary Matthews
Pharmacy Director040.00144782024324X
Ray Bernard
CRNA040.00245226028847X
Ryan Nau
CRNA040.00219783028436X
Frew Nagatu
Pharmacist043.00136346027280X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1413626TotalReportableCompFromOrg
Total Other Compensation157837TotalOtherCompensation
Number Individuals GT100 K14NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Alliance Healthcare Services
100 Bayview CirNewport BeachCA92660Mobile MRI Equipment358244
JMH Emergency Physicians
20010 Century Blvd suite 200GermantownMD20874Medical Staff Coverage670344
Quest Diagnostic
14225 Newbrook DrChantilyVA20151Medical Services234685
Ready Tech-Go Inc
PO Box 1027FremontNE68026Medical Staff Coverage136423
WVU Medical Corporation
255 Scott AveMorgantownWV26507Physician Services140000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Related Organizations97629RelatedOrganizations
Government Grants16218GovernmentGrants
Total Contributions113847TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient Service RevenueDescription
Total Revenue Column51052159TotalRevenueColumn
Related Or Exempt Function Income51052159RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue51052159TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column315615TotalRevenueColumn
Exclusion$315,615ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real42202Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real42202Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column42202TotalRevenueColumn
Exclusion$42,202ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other182658Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-182658Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-182658TotalRevenueColumn
Exclusion-$182,658ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Cafeteria Income133067$133,067
Patient Pharmacy Income190045$190,045
Cash Discounts74655$74,655

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column82037TotalRevenueColumn
Exclusion$82,037ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue479804TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column51820969TotalRevenueColumn
Related Or Exempt Function Income51052159RelatedOrExemptFunctionIncome
Exclusion$654,963ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total21702Total
Program Services21702ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total290911Total
Management And General290911ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16943067Total
Program Services12857611ProgramServices
Management And General4085456ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total487131Total
Program Services369670ProgramServices
Management And General117461ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2223244Total
Program Services1687157ProgramServices
Management And General536087ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1554550Total
Program Services1179704ProgramServices
Management And General374846ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total113536Total
Program Services7648ProgramServices
Management And General105888ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total19419Total
Program Services2520ProgramServices
Management And General16899ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total7370Total
Management And General7370ManagementAndGeneral
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7371361Total
Program Services5393410ProgramServices
Management And General1977951ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total207465Total
Program Services1537ProgramServices
Management And General205928ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6127519Total
Program Services5033698ProgramServices
Management And General1093821ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total52059Total
Program Services3453ProgramServices
Management And General48606ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total786738Total
Program Services71745ProgramServices
Management And General714993ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total119081Total
Program Services14504ProgramServices
Management And General104577ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total641800Total
Management And General641800ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2658510Total
Management And General2658510ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total292599Total
Management And General292599ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Provision for Doubtful Accounts73125177312517
Association Dues718933103440859
Recruiting21295615644456512
Taxes, Licenses, Fees1143540885708257832

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total47057Total
Program Services11136ProgramServices
Management And General35921ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total48706025Total
Program Services35041198ProgramServices
Management And General13664827ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY56979BOY
EOY57343EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6844389BOY
EOY6396500EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5816112BOY
EOY6592693EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY420000BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY362314BOY
EOY475728EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY114159BOY
EOY54844EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis33995985LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16238155LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY17205585BOY
EOY17757830EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY11777349BOY
EOY15820460EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1707434BOY
EOY1659309EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY44304321BOY
EOY48814707EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7966946BOY
EOY9108121EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY11899811BOY
EOY11518058EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY679373BOY
EOY512386EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1191377BOY
EOY1106570EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY21737507BOY
EOY22245135EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY17503991BOY
EOY21040804EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY137549BOY
EOY426327EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4925274BOY
EOY5102441EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22566814BOY
EOY26569572EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY44304321BOY
EOY48814707EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3114944ReconcilationRevenueExpenses
Reconciliation Unrealized Invest517249ReconciliationUnrealizedInvest
Reconcilation Other Changes380565ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Pertcentage1700.00000PublicSupportPertcentage170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$7,370OtherActivitiesAmount
Total Lobbying Expenditures IIB7370TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierII-BIdentifier
Return Reference1iReturnReference
ExplanationAs a member of the WV Hospital Association and the American Hospital Assoiation, a portion of the dues paid have been identified by the above mentioned organizations as attributable to lobbying activities.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FSfalseIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis417155OtherCostOrOtherBasis
Book Value417155BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis17503800OtherCostOrOtherBasis
Depreciation5992611Depreciation
Book Value11511189BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis45647OtherCostOrOtherBasis
Depreciation34814Depreciation
Book Value10833BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis13237313OtherCostOrOtherBasis
Depreciation8264721Depreciation
Book Value4972592BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2792070OtherCostOrOtherBasis
Depreciation1946009Depreciation
Book Value846061BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings17757830TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescription
Financial derivatives and other financial products
Closely-held equity interests

Investments Program Related InvestmentsProgramRelated (5 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Beneficial Interests in Perpetual Trusts5102441F
Bond Fund7831F
Other Investments983517F
Funded Depreciation8883372F
Self Insurance Fund843299F
FieldValueIRS element (for citing)
Total Of Book Value Program Related15820460TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Federal income taxes
Capital Leases$81,801
Self Insurance Liabilities$616,320
Interest Rate Swaps$408,449
FieldValueIRS element (for citing)
Total Of Amounts1106570TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt44917112TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments516288NetUnrealizedGainsInvestments
Other Revenues-7410145OtherRevenues
Revenue Not Rptd F990-6893857RevenueNotRptdF990
Revenue Subtotal51810969RevenueSubtotal
Total Revenue Per Form99051810969TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt41393504TotExpensesEtcAuditedFinclStmt
Other Expenses Included-7312521OtherExpensesIncluded
Expenses Not Rptd F990-7312521ExpensesNotRptdF990
Expenses Subtotal48706025ExpensesSubtotal
Total Expenses Per Form99048706025TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
X2The annual audit and financial statements of Jefferson Memorial Hospital are prepared on a consolidated basis as a member of the WV United Health System. The System accounts for uncertainty in income taxes using 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 is met. There were no tax uncertainties that met the recognition threshold in 2012 and 2011.
XI2dThe amount shown on line 2d consists of 97,629 Capital Campaign Conributions reported on the balance sheet, and 7,312,516 provision for doubtful accounts reported as an offset to revenue on the financial statements.
XII2dThe amount shown on line 2d consists of 7,312,516 provision for doubtful accounts reported as an offset to revenue on the financial statements and 5 rounding.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2451214TotalCommunityBenefitExpense
Direct Offsetting Revenue1085094DirectOffsettingRevenue
Net Community Benefit Expense1366120NetCommunityBenefitExpense
Percent Of Total Expense0.03300PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense8753694TotalCommunityBenefitExpense
Direct Offsetting Revenue6135291DirectOffsettingRevenue
Net Community Benefit Expense2618403NetCommunityBenefitExpense
Percent Of Total Expense0.06330PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense73631TotalCommunityBenefitExpense
Direct Offsetting Revenue49210DirectOffsettingRevenue
Net Community Benefit Expense24421NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense11278539TotalCommunityBenefitExpense
Direct Offsetting Revenue7269595DirectOffsettingRevenue
Net Community Benefit Expense4008944NetCommunityBenefitExpense
Percent Of Total Expense0.09690PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense108268TotalCommunityBenefitExpense
Direct Offsetting Revenue1790DirectOffsettingRevenue
Net Community Benefit Expense106478NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense578852TotalCommunityBenefitExpense
Net Community Benefit Expense578852NetCommunityBenefitExpense
Percent Of Total Expense0.01400PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1344TotalCommunityBenefitExpense
Net Community Benefit Expense1344NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense688464TotalCommunityBenefitExpense
Direct Offsetting Revenue1790DirectOffsettingRevenue
Net Community Benefit Expense686674NetCommunityBenefitExpense
Percent Of Total Expense0.01660PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11967003TotalCommunityBenefitExpense
Direct Offsetting Revenue7271385DirectOffsettingRevenue
Net Community Benefit Expense4695618NetCommunityBenefitExpense
Percent Of Total Expense0.11350PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,608,689BadDebtExpenseAmount
Amount Attributable To143372AmountAttributableTo
Amount Reimbursed By Medicare12939876AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare13161317CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-221441MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jefferson Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1300 South Preston StreetAddressLine1
CityRansonCity
StateWVState
ZIP Code25438ZIPCode
FieldValueIRS element (for citing)
Website Addresshttp//www.wvuniversityhealthcare.comWebsiteAddress
Licensed HospitalXLicensedHospital
Teaching HospitalXTeachingHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours
Facility Reporting GroupAFacilityReportingGroup

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent0000000002.000000000000FPGFreePercent
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasistrueExplainsBasis
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection ActivitiestrueCollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (31 entries)

IdentifierIdentifierExplanationExplanation
Part I Line 3cJefferson Memorial Hospital JMH uses 200 Federal Poverty Guideline to determine free care eligibility. JMH offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discounted the patient/guarantor must meet certain requirements.
Part I Line 6aCommunity Benefit amounts for Jefferson Memorial Hospital are reported on WV United Health Systems website www.wvunitedhealthsystem.org under community responsibility report.
Part I Line 7Column f - Total community benefit expense for 2012 is 11,967,003 and is 24.57 of total net expenses. To calculate net expense, bad debt of 7,312,517 was deducted from total expenses of 48,706,025 as shown in Part IX line 25 of the core Form 990.
Part I Line 7Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-charge ratio, which was used to calculate Charity Care, Unreimbursed Medicaid and other means-tested government programs at cost. To calculate the Medicare allowable cost shown in Part III question 8 we used the allowable costs from the Medicare Cost report.
Part IIPhysical improvements and housing - Jefferson Memorial Hospital employees spent a weekday volunteering at two local social service agencies on behalf of the United Way of the Eastern Panhandle, Childrens First Day Care Center and Eastern Panhandle Free Clinic.
Part IIEconomic Development - A respresentative from JMH serves on the Jefferson County Development Authority and the Jefferson County Chamber of Commerce Board of Directors.
Part IICommunity Support - We sponsor and have a team participate in the annual March of Dimes Walk Jefferson County, American Cancer Society Relay for Life in Jefferson County and various other fundraising events for local, health related, non-profit organizations. Many WVUH-East employees serve as volunteer board directors on community non-profit organizations such as Hospice of the Panhandle, Boys Girls Club of the Eastern Panhandle, Eastern Panhandle Free Clinic and the United Way of the Eastern Panhandle as well as participate in other non-profit organizations such as FLOC which provides children the opportunity for hands on learning through programs and youth development. EPIC an autism awareness and advocacy group. Young Lives a group that provides mentoring, referrals to community resources, and life skills training to teenage moms.
Part IILeadership Development and Training - Two managers participated in the Chamber of Commerces Leadership Jefferson program during 2012.
Part IICoalition building - JMH staff participate in the Health Human Services Council as well as Community Health Initiative -Healthier Jefferson County. These activities focus on improving community access to health care, human services in general, and determine ways to encourage healthy lifestyles. JMH also sponsored health and wellness events with the local schools and Jefferson County Parks Recreation.
Part IICommunity Health Improvement Advocacy - WVUH-East is also a partner in the MAPP project which is a collaborative initiative to assess community social services needs and develop a plan to tackle these issues. In 2012, Jefferson Memorial Hospital produced the final community health needs assessment report and is in the process of developing implementation plans to address four health needs in the community chronic disease, cancer lung and breast, behavioral health, and perinatal/prenatal care. JMH staff participate on wellness committees for the Jefferson County School board and well as for the individual schools. JMH staff also participate in ATAC, Tobacco Awareness Coalition, and sponsored a food program at the Jefferson County Community Ministries, another local nonprofit agency. promoting healthy eating and teaching healthier cooking.
Part IIWorkforce Development - WVUH-East is a major sponsor of the Womens Network established by the Berkeley and Jefferson County Chambers. This group sponsors womens professional activities, social networking and professional development seminars. Jefferson Memorial Hospital also has agreements with area community colleges and universities to allow students to complete clinical rotations at the hospital.
Part III Line 4Jefferson Memorial Hospitals financial statements are prepared on a consolidated bases as a member of WV United Health System. The footnote for Accounts Receivable - Patients states Accounts receivable are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon managements assessment of individual accounts.
Part III Line 8The amount reported in Part III Line 6 12,939,876 was calculated using the total Medicare allowable cost from the Medicare cost report.
Part III Line 8Jefferson Memorial Hospitals 221,441 shortfall of Medicare program reimbursement should be considered a community benefit because we are relieving a government burden by providing care in excess of our costs to these patients.
Part III Line 9bJMH does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy.
Part VLine 11 - Jefferson Memorial offers discounted care only to individuals who qualify for free care. JMH offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discounted the patient/guarantor must meet certain requirements.
Part VLine 22 - JMH charges all patients with or without insurance gross charges for services rendered.
Part VI Line 2Jefferson Memorial Hospital is a critical care hospital within the health care system of West Virginia University Hospitals, East WVUH-East. The Marketing Department considers several components in assessing how the organization determines the need of the communities it serves. Through outside consultants to collaborating with various departments, a needs assessment takes into account several factors including physician to population ratios, physician availability in the entire service area, and general health risks for the community. The Primary Service Area PSA for WVUH-East includes Berkeley County, WV and Jefferson County, WV with Morgan County, WV being a secondary service area. This data is then analyzed to provide general estimates to where WVUH-East could better care for residents of West Virginias Eastern Panhandle.
Part VI Line 2Sources utilized to help gather this information come from a variety of areas. Physician distribution and population data come from the American Medical Association and the U.S Census Bureau and the general health risk for our community come from clinical diagnosis information gathered by the West Virginia Health Care Authority and Thomson Reuters Market Planner Plus. We also conduct market research to ask consumers how to perceive the health system and where they go for health care services. Once all the data is gathered to determine where residents of West Virginia are going for care and what types of services they are receiving, a needs assessment can then begin based on physician distribution and population estimates. Note that WVUH-East is working with other local organizations in a project known as MAPP Mobilizing for Action through Planning and Partnerships to create and implement a community health improvement plan. Recommendations and an Implementation Plan were presented in July 2013, outlining the process and priorities to be addressed related to community health needs.
Part VI Line 3JMH employs 2 financial analysts to meet with patients to discuss financial eligibility for our charity care program. JMH has applications for charity care and the qualification requirements for receiving charity available at all registration areas. Patients who do not qualify for state or federal funded programs can apply for the charity care program. The Financial Policy and Charity Care Policy for City Hospital can be found online at www.wvuniversityhealthcare.com under the Patient Visitors section.
Part VI Line 4Jefferson Memorial Hospital is a non-profit critical access hospital located in Jefferson County, WV population 54,504 in the City of Ranson with a total population of 3,098 residents. Jefferson Memorial Hospital along with City Hospital, Inc. which is located in Martinsburg makes up WVUH-East which is part of the West Virginia United Health System.
Part VI Line 4WVUH-East provides the majority of inpatient services for the population in our Primary Service Area PSA. The PSA for University Healthcare includes Berkeley County, WV and Jefferson County, WV. The 2011 market share for JMH PSA is 10.74 with 17.6 of those patients covered by Medicaid and 10.95 of the patients uninsured. City Hospital, Inc., a non-profit acute care hospital under common management, is within the PSA and War Memorial Hospital, a non-profit critical access hospital, operated by Valley Health System, is in the extended service area.
Part VI Line 4Jefferson Countys population is 54,504, with an average household income of 65,285 and an unemployment rate of 4.1. Currently, 9.1 of Jefferson County residents live below the poverty line. Berkeley County has a population of 107,098, with an average household income of 52,504 and an unemployment rate of 5.6. Currently, 11.9 of the people residing in Berkeley County live below the Federal Poverty Guideline according to the U.S. Census Bureau 2007-2011 census. In WVUH-Easts extended service area, Morgan County has a population of 17,471, with an average household income of 36,703 and unemployment rate 7.3. Currently, 12.7 of Morgan County residents live below the poverty line.
Part VI Line 5The JMH board of directors is a community board, with fourteen of the fifteen members living in or around Martinsburg, WV. The remaining board member lives in Morgantown, WV and has connections with City Hospital, Inc. through the WV United Health System. Having members living outside our PSA allows us to be more aware of the healthcare needs in other areas of West Virginia. None of the board members are employees nor contractors of the organization, nor family members thereof.
Part VI Line 5JMH Extends privileges to all qualified medical staff in Jefferson County and surrounding communities to meets its healthcare needs.
Part VI Line 5JMH allocates available funding to capital purchases and expanded services to improve patient care, support medical education in Jefferson County and surrounding counties in West Virginia and bordering states.
Part VI Line 5In 2009, WVUH-East began offering discounted screenings in response to a struggling economy. Recognizing that individuals were putting off scheduling routine, preventive testing such as mammograms and blood work, WVUH-East offered Discounted Mammogram Clinics in April and October 2012 cash, no insurance. The clinics were successful in serving over 50 patients at Jefferson Memorial Hospital.
Part VI Line 5Our Mini-Medical School Program, which is held twice a year in Jefferson County, is a community health education program featuring local physicians and topics that address health needs in our communities. The program is jointly sponsored by WVUH-East and WVU Robert C. Byrd Health Sciences Center Eastern Division. It is offered free to the community with an average attendance of 20-30 in Jefferson County.
Part VI Line 6JMH is a part of the WV United Health System. JMH plays a significant role in improving the general health care of the community. The strategic plan of the System states intent to build a regional health care delivery system in its services area, defined above, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves.
Part VI Line 6System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems services areas. Other hospitals in the System include United Health Center, which is more centrally located in the state, City Hospital, Inc. which is located in the Eastern Panhandle of West Virginia, West Virginia University Hospital located in Morgantown, WV, and Camden-Clark Medical Center in Parkersburg, WV.
Part VI Line 6The System also includes the physician practices of United Physicians Care, Inc. and Camden-Clark Physician Corp that operate in conjunction with the System hospitals. United Summit Center is a behavioral health center located in Clarksburg, WV. In addition to these practices, the System also includes WVUH-East, Inc. and Camden-Clark Health Services which operate as management companies for their respective hospitals. The System also has Foundations that do various fundraising activities for the hospitals. City Hospital Foundation and Jefferson Healthcare Foundation operate in the Eastern Panhandle, United Health Foundation operates in Clarksburg, and Camden-Clark Foundation operates in Parkersburg, WV.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Jefferson Healthcare FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Suite 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient550768901EINOfRecipient
IRC Section501c3IRCSection
Amount Of Cash Grant12500AmountOfCashGrant
Purpose Of GrantSupportPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierIIdentifier
Return Reference1ReturnReference
ExplanationJefferson Memorial Hospital does not typically give grants or contributions. Employees that chose to participate in the capital campaign for Jefferson Memorial Hospital could donate through a payroll deduction. The amount reported in Part II represents the amount withheld from employee paychecks during 2012 to be donated to the Jefferson Healthcare Foudnation as part of the capital campaign. The use of such funds is known to Jefferson Memorial Hospital and there is no written process for monitoring use of such funds.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg
Christina Coad
CAO246725428721314290911
Charles Keeling
CRNA25929525827596516412
Gary Matthews
Pharmacy Director14451227016910624324
Ray Bernard
CRNA24496825827407328847
Ryan Nau
CRNA2197354824821928436
Frew Nagatu
Pharmacist13620813816362627280

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierIIdentifier
Return Reference3ReturnReference
ExplanationSalaries of all officers are subject to the approval of a compensation committee designated by the WVUH-East Board of Directors. This committee uses the work of an independent salary and benefit consultant to determine the compensation packages to be made available to officers and that the compensation does not exceed fair market value of comparable positions at similar organizations. All data is retained and all decisions are appropriately documented pertaining to the compensation setting practices. This review occurs annually and was last completed in 2011 for 2012 compensation amounts.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

ExplanationExplanation
Form 990, Part III, Line 4d Program Service Expenses 23,513,809, Grants and allocations 0, Revenue 28,252,600 Jefferson Memorial Hospital JMH is a not-for-profit critical access hospital that operates twenty-four 24 hours a day, seven 7 days a week. The hospital offers acute care services, as well as emergency services. It serves as part of a regional health system, West Virginia University Hospitals-East, Inc. WVUH-East which serves Berkeley, Jefferson and Morgan Counties in West Virginia.
Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 The WVUH-East Board of Directors serves as the official Board for JMH. This Board includes representatives from the medical community, business and industry, labor, and advocates for the poor in Berkeley and Jefferson Counties. WVUs Vice President of Health Services in Morgantown and the Dean of the WVU School of Medicine-Eastern Division also serve as Board Directors.
Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 Other services provided by Jefferson Memorial Hospital, in addition to patient care, include a teaching program and a variety of community outreach involvement programs. In 2012, JMH continued to use surveying vendor Press Ganey. With over 900 hospitals in their database, this vendor offers comparison of JMH survey results to a much larger base of hospitals, creating more opportunities for future improvements.
Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 In 2011, JMH completed renovations of the third floor and planned for a remodel of the surgery department. A spiritual care program was also established and volunteer chaplains were recruited to staff the service. Perhaps the biggest event for JMH in 2011 was the announcement of the purchase of 50 acres of land in Jefferson County that will be developed into a new medical campus.
Form 990 Part IV Line 24a Bond issuances allocated to Jefferson Memorial Hospital are being reported on Schedule K of West Virginia University Hospitals, Inc EIN 55-0643304. West Virginia University Hospitals, Inc is a 501c3 and is the parent hospital of Jefferson Memorial Hospital.
Form 990 Part VI Section B Line 11b The Form 990 is prepared by the WVUH accounting department and then reviewed by the WVUH-East controller. Upon approval, it is then reviewed by the WVUH-East Vice President of Finance. After approval by the VP of Finance, it is presented to all Board Members for final review and approval. After it is approved by the Board of Directors, it is signed and submitted to the IRS.
Form 990 Part VI Section B Line 12c Each board member is required to disclose, annually, any relationships which may give rise to a potential conflict of interest. These responses are processed and maintained by the WVUH-East Compliance Committee. All board members are to be willing to identify conflicts of interest and abstain from voting when appropriate.
Form 990 Part VI Section B Line 15b Executive compensation is based upon the work of an independent salary consulting firm, which compiles data from comparable facilities in comparable geographic regions. The information is then used by the board of directors and compensation committee to set salaries. This work is documented and retained.
Form 990 Part VI Section C Line 19 All financial and governing documents, including the conflict of intrest policy are maintained on site and made available to the public upon written request.
Form 990 Part IX Line 11g This total consists of Consulting Professional Fees 232,750 all considered Management and General expense, Contracted Labor 2,040,245 - 1,026,133 considered Program Service Expense and 1,014,112 Management and General Expense, Lab fees 671,499 all considered Program Service Expense , Contracted Labor - Patient Care 1,003,787 - 872,948 considered Program Service Expense and 130,839 considered Management and General Expense, Physician Practice Supp. 752,056 all Program Service Expense, CP Medical Staff 1,649,953 - 1,504,372 Program Service Expense and 145,581 Management and General Expense, CP Medical Staff Director 596,527 - 566,402 Program Service Expense and 30,125 Management and General Expense, and Collection Agency Fees 424,544 all considered Management and General Expense.
Form 990 Part XI Line 9 Other changes in net assets or fund balance includes 478,190 of related organization capitalization and 97,629 of capital contributions from Jefferson Healthcare Foundation posted to equity accounts.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (16 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
WVU Hospitals - East Inc
2000 Foundation Way Suite 2310MartinsburgWV25401202337985Health SystemWV501C311aN/Afalse
WVU Hospitals Inc
PO Box 8034MorgantownWV26506550643304Patient CareWV501C33N/Afalse
WV United Health System Inc
1000 Technology DriveFairmontWV26554550754713Health SystemWV501C311aN/Afalse
City Hospital Inc
2000 Foundation Way Suite 2310MartinsburgWV25401550383321Patient CareWV501C33N/Afalse
City Hospital Foundation
2000 Foundation Way Suite 2310MartinsburgWV25401311118075Hospital SupportWV501C311aN/Afalse
Jefferson Healthcare Foundation Inc
2000 Foundation Way Suite 2310MartinsburgWV25401550768901Hospital SupportWV501C311aN/Afalse
WVUH - East Services Corp
2000 Foundation Way Suite 2310MartinsburgWV25401311118076Patient CareWV501C33N/Afalse
United Summit Center
6 Hospital PlazaClarksburgWV26301550752788Behavioral HealthWV501C33N/Afalse
United Hospital Center Inc
327 Medical Park DriveBridgeportWV26330550525724Patient CareWV501C33N/Afalse
United Physicians Care Inc
686 South Pike StreetShinnstonWV26431550638563Patient CareWV501C33N/Afalse
United Health Foundation
327 Medical Park DriveBridgeportWV26330550621706Hospital SupportWV501C311aN/Afalse
WVU Healthcare Co-Op
PO Box 8059MorgantownWV26506550650441SupportWV501C311aN/Afalse
Camden-Clark Health Services
800 Garfield AveParkersburgWV26102550769602Healthcare AccessWV501C311a, IN/Afalse
Camden-Clark Foundation
604 Ann StreetParkersburgWV26102550667789SupportWV501C311a, IN/Afalse
Camden-Clark Memorial Hospital
800 Garfield AveParkersburgWV26102311524546Patient CareWV501C33N/Afalse
Camden-Clark Physician Corp
800 Garfield AveParkersburgWV26102264058719Patient CareWV501C311a, IN/Afalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrg
Allied Health Services Inc
PO Box 782MorgantownWV26507550652017Medical LabWVN/AC Corpfalse
West Virginia United Insurance Services Inc
1000 Technology Drive Suite 2320FairmontWV26554550756055Provider NetworkWVN/AC Corpfalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg