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COMMUNITY HEALTH ASSOCIATION: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH ASSOCIATION (EIN 55-0462730)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-11
IRS object ID
201122239349300917
Schema version
2009v1.7
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)
Timestamp2011-08-11T12:55:21-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Arnett & Foster PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1P O Box 2629AddressLine1
CityCharlestonCity
StateWVState
ZIP Code25329ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN550462730EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Community Health Association dbaBusinessNameLine1
Business Name Line2Jackson General HospitalBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone3043722731Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 720 Pinnell StreetAddressLine1
CityRipleyCity
StateWVState
ZIP Code25271ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameStephanie L McCoyName
TitleCEOTitle
Phone3043722731Phone
Date Signed2011-08-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGreg GibbsName
Phone3043460441Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Jackson General HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonStephanie L McCoyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 720 Pinnell StreetAddressLine1
CityRipleyCity
StateWVState
ZIP Code25271ZIPCode
FieldValueIRS element (for citing)
Gross Receipts27067084GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.jghosp.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileWVStateLegalDomicile
Activity Or Mission DescriptionTo 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 Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees360TotalNbrEmployees
Total Nbr Volunteers48TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year216082ContributionsGrantsPriorYear
Contributions Grants Current Year252543ContributionsGrantsCurrentYear
Program Service Revenue Prior Year27505280ProgramServiceRevenuePriorYear
Program Service Revenue CY26524612ProgramServiceRevenueCY
Investment Income Prior Year5096InvestmentIncomePriorYear
Investment Income Current Year-3395InvestmentIncomeCurrentYear
Other Revenue Prior Year257117OtherRevenuePriorYear
Other Revenue Current Year288688OtherRevenueCurrentYear
Total Revenue Prior Year27983575TotalRevenuePriorYear
Total Revenue Current Year27062448TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year15507563SalariesEtcPriorYear
Salaries Etc Current Year15528349SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12440797OtherExpensePriorYear
Other Expenses Current Year12365706OtherExpensesCurrentYear
Total Expenses Prior Year27948360TotalExpensesPriorYear
Total Expenses Current Year27894055TotalExpensesCurrentYear
Revenues Less Expenses Prior Year35215RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-831607RevenuesLessExpensesCY
Total Assets BOY8671208TotalAssetsBOY
Total Assets EOY7761213TotalAssetsEOY
Total Liabilities BOY13616776TotalLiabilitiesBOY
Total Liabilities EOY14209995TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-4945568NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-6448782NetAssetsOrFundBalancesEOY
Mission DescriptionTo 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense20588847Expense
Revenue26524612Revenue
DescriptionServices provided included 6,304 inpatient days, 42,776 outpatient visits, 12,957 emergency room visits, and 12,871 rural health clinic visits. Charity care for the year amounted to $1,817,899.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense238633Expense
DescriptionThe 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.Description
FieldValueIRS element (for citing)
Total Program Service Expense20827480TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109642NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees360NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Angela D Frame CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3043731476TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 720 Pinnell StAddressLine1
CityRipleyCity
StateWVState
ZIP Code25271ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
James T Hughes MD
Chair1.00X000
Gwen Botkin
Vice Chair1.00X000
James G Gaal DO
Secretary1.00X000
Gareth Smith
Treasurer1.00X000
Barbara Heckert
Director1.00X000
Dick Waybright
Director1.00X000
John Gorrell
Director1.00X000
Luke Hunter
Director1.00X000
Keith Rake
Director1.00X000
Melanie Pierson
Director1.00X000
Rob Fisher
Director1.00X000
Amy Callow
Director1.00X000
Mitch Carmichael
Director1.00X000
Sandra J Elza
CEO40.00154200019077X
Angela Frame
CFO40.0085828016893X
Stephanie L McCoy
COO40.0087073017458X
Paul Burke
Physician40.0016909409092X
Edward Stewart
Physician40.0026166009040X
Paul Nielson
Physician40.00268317043010X
Jeffrey S Barton
Physician40.00298151023743X
Michael McIntosh
Physician40.00285834029340X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1610157TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation167653TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Alliance Healthcare Services
PO Box 96485ChicagoIL25281MRI Services615132
Anthony J McEldowney
PO Box 720RipleyWV25271Physician258277
NAPS Inc
PO Box 11686CharlestonWV25339Anesthesia Services217951
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants178430GovernmentGrants
All Other Contributions74113AllOtherContributions
Total Contributions252543TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient servicesDescription
Business Code621990BusinessCode
Total Revenue Column26524612TotalRevenueColumn
Related Or Exempt Function Income26524612RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue26524612TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1241TotalRevenueColumn
Exclusion$1,241ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real78223Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real78223Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column78223TotalRevenueColumn
Exclusion$78,223ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other4636Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-4636Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-4636TotalRevenueColumn
Exclusion-$4,636ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Cafeteria & Vending722210123022$123,022
Rebates90009918003$18,003
Retail Pharmacy4461109082$9,082

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column60358TotalRevenueColumn
Exclusion$60,358ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue210465TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column27062448TotalRevenueColumn
Related Or Exempt Function Income26524612RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$285,293ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total382791Total
Program Services271322ProgramServices
Management And General111469ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10695588Total
Program Services7581033ProgramServices
Management And General3114555ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total257139Total
Program Services182260ProgramServices
Management And General74879ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3396389Total
Program Services2407361ProgramServices
Management And General989028ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total796442Total
Program Services564518ProgramServices
Management And General231924ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total23301Total
Management And General23301ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total81306Total
Management And General81306ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2567505Total
Program Services1891098ProgramServices
Management And General676407ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total72510Total
Program Services51395ProgramServices
Management And General21115ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3735824Total
Program Services2647952ProgramServices
Management And General1087872ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total404356Total
Program Services286608ProgramServices
Management And General117748ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total9820Total
Program Services6960ProgramServices
Management And General2860ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total235984Total
Program Services167265ProgramServices
Management And General68719ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total512546Total
Program Services363293ProgramServices
Management And General149253ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total421737Total
Program Services298927ProgramServices
Management And General122810ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debts32672933267293
Medicaid Provider Tax481856481856
Dues & Subscriptions802185685923359
Collection Fees5623556235
Grant Expense2730627306

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total387909Total
Program Services274174ProgramServices
Management And General113735ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total27894055Total
Program Services20827480ProgramServices
Management And General7066575ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY284382BOY
EOY286795EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY637056BOY
EOY450700EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4006313BOY
EOY3627905EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY278109BOY
EOY248674EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY161038BOY
EOY179799EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis13591397LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11095345LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2736532BOY
EOY2496052EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY6000BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY561778BOY
EOY471288EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8671208BOY
EOY7761213EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5367735BOY
EOY5173038EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY2650000BOY
EOY2420000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5599041BOY
EOY6616957EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY13616776BOY
EOY14209995EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-4945568BOY
EOY-6448782EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-4945568BOY
EOY-6448782EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8671208BOY
EOY7761213EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

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 D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis92189OtherCostOrOtherBasis
Book Value92189BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5038351OtherCostOrOtherBasis
Depreciation3618965Depreciation
Book Value1419386BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis8040581OtherCostOrOtherBasis
Depreciation7261124Depreciation
Book Value779457BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis420276OtherCostOrOtherBasis
Depreciation215256Depreciation
Book Value205020BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2496052TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Estimated third-party payor settlements359051
Other receivables13618
Bond issue costs, net of amortization98619
FieldValueIRS element (for citing)
Total Book Value Other Assets471288TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Capital leases$388,112
Accrued pension liability$6,028,845
OIG Settlement$200,000
FieldValueIRS element (for citing)
Total Of Amounts6616957TotalOfAmounts
Total Revenue27062448TotalRevenue
Total Expenses27894055TotalExpenses
Excess Or Deficit For Year-831607ExcessOrDeficitForYear
Other-$671,607OtherAmount
Total Adjustments-671607TotalAdjustments
Excess Or Deficit Per FS-1503214ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt27062178TotRevenueEtcAuditedFinclStmt
Other Revenues27036OtherRevenues
Revenue Not Rptd F99027036RevenueNotRptdF990
Revenue Subtotal27035142RevenueSubtotal
Other Revenues Not Included27306OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt27306RevenueNotRptdOnFinStmt
Total Revenue Per Form99027062448TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt27866749TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal27866749ExpensesSubtotal
Other Expenses Not Included27306OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt27306ExpensesNotRptdOnFinStmt
Total Expenses Per Form99027894055TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:There was no footnote included in the financial statements related to uncertain tax positions under FIN 48.
Part XI, Line 8 - Other Adjustments:Defined benefit pension plan net actuarial loss: -671607.
Part XII, Line 2d - Other Adjustments:Foundation Income: 27035. Rounding: 1.
Part XII, Line 4b - Other Adjustments:Grant Expenses Netted Against Revenue on Financial Statements: 27306.
Part XIII, Line 4b - Other Adjustments:Grant Expenses Netted Against Revenue on Financial Statements: 27306.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense813328TotalCommunityBenefitExpense
Net Community Benefit Expense813328NetCommunityBenefitExpense
Percent Of Total Expense0.02920PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4594655TotalCommunityBenefitExpense
Direct Offsetting Revenue4566250DirectOffsettingRevenue
Net Community Benefit Expense28405NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense5407983TotalCommunityBenefitExpense
Direct Offsetting Revenue4566250DirectOffsettingRevenue
Net Community Benefit Expense841733NetCommunityBenefitExpense
Percent Of Total Expense0.03020PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense238633TotalCommunityBenefitExpense
Direct Offsetting Revenue1034DirectOffsettingRevenue
Net Community Benefit Expense237599NetCommunityBenefitExpense
Percent Of Total Expense0.00850PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense238633TotalCommunityBenefitExpense
Direct Offsetting Revenue1034DirectOffsettingRevenue
Net Community Benefit Expense237599NetCommunityBenefitExpense
Percent Of Total Expense0.00850PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5646616TotalCommunityBenefitExpense
Direct Offsetting Revenue4567284DirectOffsettingRevenue
Net Community Benefit Expense1079332NetCommunityBenefitExpense
Percent Of Total Expense0.03870PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,461,787BadDebtExpenseAmount
Amount Reimbursed By Medicare6459921AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare6588574CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-128653MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jackson General HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1PO Box 720AddressLine1
CityRipleyCity
StateWVState
ZIP Code25271ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart 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.IncomeBasedCriteria
Costing Method UsedPart 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.CostingMethodUsed
Bad Debt FootnotePart 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.BadDebtFootnote
Debt Collection PolicyPart 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.DebtCollectionPolicy
Needs AssessmentPart 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 2007.NeedsAssessment
Patient Education AssistancePart 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Other InformationPart 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 Board Foundation 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, 2011.OtherInformation
Affiliated Health Care SystemPart VI, Line 7: The organization is not part of an affiliated health care system.AffiliatedHealthCareSystem

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Sandra J Elza
1542000000000200900174290000
Paul Burke
1690940000000103270179421000
Edward Stewart
2616600000000102750271935000
Paul Nielson
26831700000256410188810312839000
Jeffrey S Barton
2981510000069810182750323407000
Michael McIntosh
28583400000125000183520316686000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section B, line 11The 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 12cThe 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 15The 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 19The 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 XI, Line 2cThe procedure for audit oversight did not change from the prior year.Audit Oversight