2012-08-15T08:21:55-05:00 2011-09-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-10-01 550462730 Community Health Association dba Jackson General Hospital COMM 3043722731 PO Box 720 Pinnell Street Ripley WV 25271 Stephanie L McCoy 3043722731 2012-08-13 1 Harry C Harless 3043460441 2010 2016-02-24 21:20:13Z Jackson General Hospital Stephanie L McCoy PO Box 720 Pinnell Street Ripley WV 25271 27676422 0 X www.jacksongeneral.com X 1964 WV To promote the general health and welfare of citizens of Jackson County, West Virginia and surrounding areas by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public. 14 14 344 46 0 0 252543 186141 26524612 26998052 -3395 113226 288688 379003 27062448 27676422 0 0 0 0 15528349 14555573 0 0 0 12365706 13114710 27894055 27670283 -831607 6139 7761213 7741929 14209995 8592796 -6448782 -850867 To promote the general health and welfare of citizens of Jackson County, West Virginia and surrounding areas by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public. 0 0 20561836 26950803 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. 96232 47249 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. 20658068 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 35 0 1 344 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Angela D Frame CFO 3043731476 PO Box 720 Pinnell St Ripley WV 25271 Gareth Smith 1.00 X 0 0 0 Gwen Botkin 1.00 X 0 0 0 John Gorrell 1.00 X 0 0 0 Dr James G Gaal 1.00 X 0 0 0 Mitch Carmichael 1.00 X 0 0 0 Lee Corder 1.00 X 0 0 0 Naoma Fisher 1.00 X 0 0 0 Rob Fisher 1.00 X 0 0 0 Barbara Heckert 1.00 X 0 0 0 Dr James T Hughes 1.00 X 0 0 0 Luke Hunter 1.00 X 0 0 0 Keith Rake 1.00 X 0 0 0 Todd Ritchie 1.00 X 0 0 0 Becky Scarberry 1.00 X 0 0 0 Dick Waybright 1.00 X 0 0 0 Tom Weyer 1.00 X 0 0 0 Mary Anne Clendenin 0.00 X 0 0 0 Sandra J Elza 40.00 X 144630 0 19046 Stephanie McCoy 40.00 X 89594 0 17805 Angela D Frame 40.00 X 91827 0 17198 Jeffrey Barton 40.00 X 298151 0 24179 Paul Burke 40.00 X 264237 0 17198 Michael Mcintosh 40.00 X 237393 0 21698 Edward Stewart 40.00 X 273344 0 17198 Paul Nielsen 40.00 X 242515 0 37506 1641691 0 171828 9 0 1 0 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 5 12677 138404 35060 186141 Patient services 621990 26998052 26998052 26998052 113226 113226 99529 99529 99529 99529 Cafeteria & Vending 722210 132157 132157 Rebates 900099 17711 17711 Retail Pharmacy 446110 5375 5375 124231 124231 279474 27676422 26998052 0 492229 364380 257617 106763 10626281 7512781 3113500 93178 65877 27301 2703340 1911261 792079 768394 543255 225139 76456 76456 93877 93877 3097101 2189650 907451 92384 65315 27069 3649749 2580373 1069376 350440 247761 102679 17254 12199 5055 223786 158217 65569 548260 387620 160640 393369 278112 115257 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 289490 208760 80730 27670283 20658068 7012215 0 286795 89473 450700 453681 3627905 3846869 248674 179438 179799 114386 14588757 11630740 2496052 2958017 471288 100065 7761213 7741929 5173038 5191742 2420000 2175000 500000 6616957 726054 14209995 8592796 X -6448782 -850867 -6448782 -850867 7761213 7741929 X 6139 5591776 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92189 92189 5345314 4288598 1056716 8730977 7004949 1726028 420277 337193 83084 2958017 Capital leases 238576 OIG Settlement 215183 Estimated third-party payor settlements 272295 726054 27676422 27670283 6139 5591776 5591776 5597915 28016844 432132 432132 27584712 91710 91710 27676422 27652418 1 1 27652417 17866 17866 27670283 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. 1 1 1 X 0 0 0 0 576784 0 576784 0.02400 3314203 2286593 1027610 0.04280 3890987 2286593 1604394 0.06680 43 4890 96232 47249 48983 0.00200 43 4890 96232 47249 48983 0.00200 43 4890 3987219 2333842 1653377 0.06880 0 1252349 6287405 6366032 -78627 X 1 1 1 1 Jackson General Hospital

PO Box 720 Ripley WV 25271

X X X Jackson General Hospital 1 1 1 200.000000000000 0 1 X X X X X X X 1 1 X X 1 X X X 1 X X X X X X X X 1 X 0 0 1 Morad Hughes Health Center

PO Box 588 Ripley WV 25271

Hospital Based Rural Health Clinic 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. Jackson General Hospital 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 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. X X X X X 0 0 0 0 0 0 0 0 0 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 Form 990, Part VI, Section B, line 11 The 990 is reviewed by the CEO and CFO and a copy is provided to members of the finance/executive committee before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization requires all board members, officers, key employees, and committee members to annually review and fill out a form which verifies compliance with the written conflict of interest policy. The signing of this document occurs immediately after the annual meeting. Form 990, Part VI, Section B, line 15 The finance committee of the board of directors and the CEO meet annually to discuss compensation of senior administrative staff. Several reliable external sources are used to gather data for this meeting including economic data and comparable salaries. A decision is then made after thorough discussion. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available to anyone in the public upon request. Also, the financial statements are published as a legal advertisement annually in the Jackson Herald/Star News. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Defined benefit pension plan net actuarial gain 5,591,776. Total to Form 990, Part XI, Line 5: 5,591,776. Clarification of 'yes' response Form 990, Part XII, Line 2C The Organization has not changed its selection or oversight process in the past year.