COMMUNITY HEALTH ASSOCIATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH ASSOCIATION (EIN 55-0462730)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-15
- IRS object ID
- 201202289349300040
- Schema version
- 2010v3.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-15T08:21:55-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett & Foster PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1 |
| City | Charleston | City |
| State | WV | State |
| ZIP Code | 25329 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550462730 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Health Association dba | BusinessNameLine1 |
| Business Name Line2 | Jackson General Hospital | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 3043722731 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 Pinnell Street | AddressLine1 |
| City | Ripley | City |
| State | WV | State |
| ZIP Code | 25271 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Stephanie L McCoy | Name |
| Title | Interim CEO | Title |
| Phone | 3043722731 | Phone |
| Date Signed | 2012-08-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Harry C Harless | Name |
| Phone | 3043460441 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson General Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Stephanie L McCoy | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 Pinnell Street | AddressLine1 |
| City | Ripley | City |
| State | WV | State |
| ZIP Code | 25271 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 27676422 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.jacksongeneral.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1964 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 344 | TotalNbrEmployees |
| Total Nbr Volunteers | 46 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 252543 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 186141 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 26524612 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 26998052 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -3395 | InvestmentIncomePriorYear |
| Investment Income Current Year | 113226 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 288688 | OtherRevenuePriorYear |
| Other Revenue Current Year | 379003 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27062448 | TotalRevenuePriorYear |
| Total Revenue Current Year | 27676422 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 15528349 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 14555573 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 12365706 | OtherExpensePriorYear |
| Other Expenses Current Year | 13114710 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 27894055 | TotalExpensesPriorYear |
| Total Expenses Current Year | 27670283 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -831607 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 6139 | RevenuesLessExpensesCY |
| Total Assets BOY | 7761213 | TotalAssetsBOY |
| Total Assets EOY | 7741929 | TotalAssetsEOY |
| Total Liabilities BOY | 14209995 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8592796 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -6448782 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -850867 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 20561836 | Expense |
| Revenue | 26950803 | Revenue |
| Description | 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 $1,684,042. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 96232 | Expense |
| Revenue | 47249 | Revenue |
| Description | 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 20658068 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 35 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 344 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Angela D Frame CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3043731476 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 Pinnell St | AddressLine1 |
| City | Ripley | City |
| State | WV | State |
| ZIP Code | 25271 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Gareth Smith | |||||||
| Chair | 1.00 | X | 0 | 0 | 0 | ||
| Gwen Botkin | |||||||
| Vice Chair | 1.00 | X | 0 | 0 | 0 | ||
| John Gorrell | |||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | ||
| Dr James G Gaal | |||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | ||
| Mitch Carmichael | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Lee Corder | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Naoma Fisher | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Rob Fisher | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Barbara Heckert | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dr James T Hughes | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Luke Hunter | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Keith Rake | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Todd Ritchie | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Becky Scarberry | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dick Waybright | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Tom Weyer | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Mary Anne Clendenin | |||||||
| Director | 0.00 | X | 0 | 0 | 0 | ||
| Sandra J Elza | |||||||
| CEO | 40.00 | 144630 | 0 | 19046 | X | ||
| Stephanie McCoy | |||||||
| Interim CEO | 40.00 | 89594 | 0 | 17805 | X | ||
| Angela D Frame | |||||||
| CFO | 40.00 | 91827 | 0 | 17198 | X | ||
| Jeffrey Barton | |||||||
| Physician | 40.00 | 298151 | 0 | 24179 | X | ||
| Paul Burke | |||||||
| Physician | 40.00 | 264237 | 0 | 17198 | X | ||
| Michael Mcintosh | |||||||
| Physician | 40.00 | 237393 | 0 | 21698 | X | ||
| Edward Stewart | |||||||
| Physician | 40.00 | 273344 | 0 | 17198 | X | ||
| Paul Nielsen | |||||||
| Physician | 40.00 | 242515 | 0 | 37506 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1641691 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 171828 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Alliance Healthcare Services | |||||
| PO Box 96485 | Chicago | IL | 25281 | MRI Services | 356136 |
| Anthony J McEldowney | |||||
| 828 Malaub Drive 205 | Lexington | KY | 40502 | Orthopedic Surgeon | 251250 |
| Haven Ltd | |||||
| 1 Haven Lane | Kenna | WV | 25248 | Emergency Physicians | 216852 |
| NAPS Inc | |||||
| 2215 Smith Road | Charleston | WV | 25339 | Anesthesia Services | 124668 |
| Kimberly Ann Burgess | |||||
| PO Box 11690 | Charleston | WV | 25339 | Orthopedic Surgeon | 115781 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Related Organizations | 12677 | RelatedOrganizations |
| Government Grants | 138404 | GovernmentGrants |
| All Other Contributions | 35060 | AllOtherContributions |
| Total Contributions | 186141 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient services | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 26998052 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26998052 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 26998052 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 113226 | TotalRevenueColumn |
| Exclusion | $113,226 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 99529 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 99529 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 99529 | TotalRevenueColumn |
| Exclusion | $99,529 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Cafeteria & Vending | 722210 | 132157 | $132,157 |
| Rebates | 900099 | 17711 | $17,711 |
| Retail Pharmacy | 446110 | 5375 | $5,375 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 124231 | TotalRevenueColumn |
| Exclusion | $124,231 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 279474 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 27676422 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26998052 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $492,229 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 364380 | Total |
| Program Services | 257617 | ProgramServices |
| Management And General | 106763 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10626281 | Total |
| Program Services | 7512781 | ProgramServices |
| Management And General | 3113500 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93178 | Total |
| Program Services | 65877 | ProgramServices |
| Management And General | 27301 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2703340 | Total |
| Program Services | 1911261 | ProgramServices |
| Management And General | 792079 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 768394 | Total |
| Program Services | 543255 | ProgramServices |
| Management And General | 225139 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76456 | Total |
| Management And General | 76456 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93877 | Total |
| Management And General | 93877 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3097101 | Total |
| Program Services | 2189650 | ProgramServices |
| Management And General | 907451 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92384 | Total |
| Program Services | 65315 | ProgramServices |
| Management And General | 27069 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3649749 | Total |
| Program Services | 2580373 | ProgramServices |
| Management And General | 1069376 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 350440 | Total |
| Program Services | 247761 | ProgramServices |
| Management And General | 102679 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17254 | Total |
| Program Services | 12199 | ProgramServices |
| Management And General | 5055 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 223786 | Total |
| Program Services | 158217 | ProgramServices |
| Management And General | 65569 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 548260 | Total |
| Program Services | 387620 | ProgramServices |
| Management And General | 160640 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 393369 | Total |
| Program Services | 278112 | ProgramServices |
| Management And General | 115257 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debts | 3656493 | 3656493 | 0 |
| Medicaid Provider Tax | 478358 | 478358 | 0 |
| Dues & Subscriptions | 82885 | 58600 | 24285 |
| Other taxes | 37801 | 26725 | 11076 |
| Repairs and maintenance | 27007 | 19094 | 7913 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 289490 | Total |
| Program Services | 208760 | ProgramServices |
| Management And General | 80730 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27670283 | Total |
| Program Services | 20658068 | ProgramServices |
| Management And General | 7012215 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 286795 | BOY |
| EOY | 89473 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 450700 | BOY |
| EOY | 453681 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3627905 | BOY |
| EOY | 3846869 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 248674 | BOY |
| EOY | 179438 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 179799 | BOY |
| EOY | 114386 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14588757 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11630740 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2496052 | BOY |
| EOY | 2958017 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 471288 | BOY |
| EOY | 100065 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7761213 | BOY |
| EOY | 7741929 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5173038 | BOY |
| EOY | 5191742 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2420000 | BOY |
| EOY | 2175000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 500000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6616957 | BOY |
| EOY | 726054 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14209995 | BOY |
| EOY | 8592796 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -6448782 | BOY |
| EOY | -850867 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -6448782 | BOY |
| EOY | -850867 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7761213 | BOY |
| EOY | 7741929 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 6139 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 5591776 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 92189 | OtherCostOrOtherBasis |
| Book Value | 92189 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5345314 | OtherCostOrOtherBasis |
| Depreciation | 4288598 | Depreciation |
| Book Value | 1056716 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8730977 | OtherCostOrOtherBasis |
| Depreciation | 7004949 | Depreciation |
| Book Value | 1726028 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 420277 | OtherCostOrOtherBasis |
| Depreciation | 337193 | Depreciation |
| Book Value | 83084 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2958017 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Capital leases | $238,576 |
| OIG Settlement | $215,183 |
| Estimated third-party payor settlements | $272,295 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 726054 | TotalOfAmounts |
| Total Revenue | 27676422 | TotalRevenue |
| Total Expenses | 27670283 | TotalExpenses |
| Excess Or Deficit For Year | 6139 | ExcessOrDeficitForYear |
| Other | $5,591,776 | OtherAmount |
| Total Adjustments | 5591776 | TotalAdjustments |
| Excess Or Deficit Per FS | 5597915 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 28016844 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 432132 | OtherRevenues |
| Revenue Not Rptd F990 | 432132 | RevenueNotRptdF990 |
| Revenue Subtotal | 27584712 | RevenueSubtotal |
| Other Revenues Not Included | 91710 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 91710 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 27676422 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 27652418 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 1 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1 | ExpensesNotRptdF990 |
| Expenses Subtotal | 27652417 | ExpensesSubtotal |
| Other Expenses Not Included | 17866 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 17866 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 27670283 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | Defined benefit pension plan net actuarial gain 5,591,776. |
| Part XII, Line 2d - Other Adjustments: | Other income and expense netted with revenues on return 432,132. |
| Part XII, Line 4b - Other Adjustments: | Foundation income 73,844. Grant expenses netted with grant revenue in financial statements 17,866. |
| Part XIII, Line 2d - Other Adjustments: | Rounding 1. |
| Part XIII, Line 4b - Other Adjustments: | Grant expenses netted with grant revenue in financial statements 17,866. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 576784 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 576784 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02400 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3314203 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2286593 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1027610 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04280 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3890987 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2286593 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1604394 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06680 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 43 | NumberOfActivitiesOrPrograms |
| Persons Served | 4890 | PersonsServed |
| Total Community Benefit Expense | 96232 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 47249 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 48983 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 43 | NumberOfActivitiesOrPrograms |
| Persons Served | 4890 | PersonsServed |
| Total Community Benefit Expense | 96232 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 47249 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 48983 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 43 | NumberOfActivitiesOrPrograms |
| Persons Served | 4890 | PersonsServed |
| Total Community Benefit Expense | 3987219 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2333842 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1653377 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06880 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,252,349 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 6287405 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6366032 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -78627 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson General Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 720 | AddressLine1 |
| City | Ripley | City |
| State | WV | State |
| ZIP Code | 25271 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson General Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lien On Residence | X | LienOnResidence |
| Other Actions | X | OtherActions |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Morad Hughes Health Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 588 | AddressLine1 |
| City | Ripley | City |
| State | WV | State |
| ZIP Code | 25271 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | Hospital Based Rural Health Clinic | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: The organization determines eligiblity for discounted care on a case-by-case basis based on ineligibility for other coverage, income and prepay or "quick pay" discounts. | |
| Part I, Line 7: The cost of charity care, Medicaid at cost and other means tested goverment 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 $ 3656494. | |
| 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 collectibility. 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: The Hospital Financial Counselor attempts to contact each guarantor via telephone regarding payment arrangement for outstanding balances on accounts after a total of four statements are mailed. If guarantor is not able to be reached via telephone, a financial counselor will print PRE_-BDS letter in the event no response has been received from the patient/guarantor.Upon no response being received from the PRE-BDS Letter which allows 14 days for a response, account is then processed to be forwarded to a Collection Agency, which changes the status from a Final Billed to a Bad Debt Status.Any undeliverable mail received that the address can not be obtained to update, the account is forwarded to a Collection Agency. Upon the Collection Agency's inability to collect the balance due, the Agency notifies JGH and lists the accounts on the Closed Account Report. Account balance is then written off under Bad Debt write-off. The agencies involved are closing the accounts after 6 months of no activity. The accounts closed remain reported with the credit bureau. | |
| Part V, Section B, Line 11h: 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 13g: Jackson General Hospital Financial Counselors attempt to call patients and uses scripting that includes notifying the patient of charity applications, prompt pay discounts, contract agreements, etc. | Jackson General Hospital |
| Part V, Section B, Line 15e: Jackson General Hospital places claims with collection agency if they are over 120 days old with no response or any type of contact from the patient or guarantor. | Jackson General Hospital |
| Part V, Section B, Line 16e: Our collection agency reports any non payments to the credit bureau, also may file against an estate. | Jackson General Hospital |
| Part V, Section B, Line 17e: Jackson General Hospital Staff also attempts to call the patient and/or send a pre-bad debt letter to the patient advising if no response is received, their account may be turned over to an outside agency. | Jackson General Hospital |
| Part V, Section B, Line 19d: Aggressive prompt - pay discounts | Jackson General Hospital |
| 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: The organization has a Resource Center Coordinator that educates and discusses federal/state and/or local government guideline options with all Inpatients/Observations patients.The organization posts, at each point of registration, all services advising of prompt pay discounts, charity care program and discounted care program. Every statement has on the back stating how to inquire about charity assistance program and/or discount opportunities.Once statements are received, the organization's Financial Counselors attempt to contact every Self Pay individual for discussion of their payment options. | |
| Part VI, Line 4: Jackson County is a rural community with a population of 29,211. The median household income for Jackson County is $39,173, with 13.5% of residents below the federal poverty guideline. 6% of the hospital's patients are uninsured and 14% are covered by Medicaid.Jackson County is designated a medically underserved area. Surrounding counties are also federally designated to be medically underseved areas either entirely or partially, including Cabell County, Kanawha County, Mason County and Roane County. | |
| Part VI, Line 6: Individuals eligible for election to the Board must be residents of the community who are not employed by JGH and who possess leadership qualities and expertise to assist in the governance and decision-making processes at JGH. Only professionally competent individuals who continuously meet the qualifications, standards and requirements set forth in the bylaws and in such policies as are adopted from time to time by the Board shall be appointed to the medical staff. No individual shall be denied appointment to the medical staff on the basis of age, sex, race, creed, color or national origin. It is the Core Value of Jackson General Hospital to provide high quality health services to all patients without regard to race, creed, national origin, or religion and without regard to ability to pay, within the financial resources of the hospital. Jackson General Hospital services as a vehicle for attracting charitable support through the Jackson General Hospital Foundation Board and through application for various grants such as the SHIP grant, Susan B. Komen grant, Carelink grant and HRSA grant. The Foundation Board successfully generated $15,350 in charitable donations through fundraising events such as the Hospital Gala and Riverboat Cruise. The Jackson General Hospital Auxiliary is also a generous supporter of Jackson General Hospital having purchased patient care and building equipment through charitable contributions through the gift shop and other fundraising events. Information about charitable giving is accessible on the hospital website at http://www.jacksongeneral.com/default2.asp?active_page_id=88.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 kids, advance directives presentations, CPR classes, diabetic counseling, dinner discussions, health fairs and various other programs.Pending changes to our website, the Community Benefit report will be available on the internet August, 2012. | |
| Part VI, Line 7: The organization is not part of an affiliated health care system. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sandra J Elza | |||||||||||||
| 144630 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 20091 | 0 | 164721 | 0 | 0 | 0 |
| Jeffrey Barton | |||||||||||||
| 298151 | 0 | 0 | 0 | 0 | 0 | 6981 | 0 | 18322 | 0 | 323454 | 0 | 0 | 0 |
| Paul Burke | |||||||||||||
| 264237 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18322 | 0 | 282559 | 0 | 0 | 0 |
| Michael Mcintosh | |||||||||||||
| 237393 | 0 | 0 | 0 | 0 | 0 | 4500 | 0 | 18322 | 0 | 260215 | 0 | 0 | 0 |
| Edward Stewart | |||||||||||||
| 273344 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18322 | 0 | 291666 | 0 | 0 | 0 |
| Paul Nielsen | |||||||||||||
| 242515 | 0 | 0 | 0 | 0 | 0 | 20308 | 0 | 18322 | 0 | 281145 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. | |
| 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 12c | |
| 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 B, line 15 | |
| 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. | Form 990, Part VI, Section C, line 19 | |
| Changes in Net Assets or Fund Balances: | Defined benefit pension plan net actuarial gain 5,591,776. Total to Form 990, Part XI, Line 5: 5,591,776. | Form 990, Part XI, line 5: |
| Clarification of 'yes' response | The Organization has not changed its selection or oversight process in the past year. | Form 990, Part XII, Line 2C |