2017-05-04T07:26:10-04:00 2016-06-30 990 2015-07-01 540544705 JOHNSTON MEMORIAL HOSPITAL INC JOHN 2762582800 16000 JOHNSTON MEMORIAL DR ABINGDON VA 24211 JOHN JETER CFO/ASST. ADMIN. JMH 2762581000 2017-04-26 2015 2021-01-29 14:40:06Z STAN HICKSON 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 155320089 false X HTTPS://MOUNTAINSTATESHEALTH.COM/JMH X 1917 VA JOHNSTON MEMORIAL HOSPITAL (JMH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. 15 11 20 366 68877 17495 201573 55626 141532395 148637385 3942994 4161982 1918651 1646128 147595613 154501121 215442 146073 0 49514279 51342118 0 0 71507692 80188059 121237413 131676250 26358200 22824871 357363368 360732839 51294925 34382073 306068443 326350766 X JOHNSTON MEMORIAL HOSPITAL (JMH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. false false 106029569 146073 148538051 JOHNSTON MEMORIAL HOSPITAL (JMH) IS A 116-BED NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN ABINGDON, VIRGINIA, PRIMARILY SERVING 7 COUNTIES IN SOUTHWEST VIRGINIA. JMH IS THE SOLE MEMBER OF ABINGDON PHYSICIAN PARTNERS, A TAX EXEMPT ORGANIZATION THAT OWNS AND OPERATES PHYSICIAN PRACTICES. JMH IS PART OF THE MOUNTAIN STATES HEALTH ALLIANCE NETWORK. ITS MEMBERSHIP CONSISTS OF MOUNTAIN STATES HEALTH ALLIANCE (MAJORITY OWNER) AND JOHNSTON MEMORIAL HEALTHCARE FOUNDATION, INC. (CONTINUED ON SCHEDULE O). (CONT'D) DURING FY16, 8,409 PATIENTS WERE ADMITTED TO OUR HOSPITAL, WITH JUST UNDER 30,000 PATIENT DAYS. THERE WERE AN ADDITIONAL 4,301 OBSERVATION DAYS AND JUST UNDER 1,500 NEWBORN DAYS. WE EXPERIENCED 239,399 OUTPATIENT VISITS THIS YEAR, AN INCREASE OF 4.5% OVER PRIOR YEAR. THERE WERE 41,030 VISITS TO OUR EMERGENCY DEPARTMENT. SURGERIES INCREASED 8.1% THIS YEAR TO 7,279. WE DELIVERED 701 BABIES. PROMOTE COMMUNITY HEALTH: IN AN EFFORT TO REDUCE READMISSION RATES AND IMPROVE THE PATIENT EXPERIENCE, JMH DEVELOPED COORDINATED CARE GUIDES. CARE GUIDES FOCUS ON PATIENT CARE BY ASSISTING WITH PATIENT NEEDS AT DISCHARGE AND WORKING DAILY WITH CASE MANAGEMENT, SOCIAL WORK, AND NURSING STAFF TO REDUCE THE FACTORS THAT COULD LEAD TO A PATIENT BEING READMITTED. ASSISTANCE IS PROVIDED WITH PATIENTS' MEDICATIONS, DURABLE MEDICAL EQUIPMENT, AND OTHER OUTPATIENT NEEDS FOLLOWING INPATIENT DISCHARGE. AFTER PLANNING A NURSE NAVIGATION PROGRAM FOR ONCOLOGY PATIENTS LAST YEAR, THE PROGRAM WAS UP AND OPERATIONAL THIS YEAR. OUR NAVIGATOR PROGRAM IS DESIGNED TO SUPPORT CANCER PATIENTS AND THEIR FAMILIES, ADVOCATE FOR THE PATIENT, AND TO HELP COORDINATE THE PATIENT'S CARE THROUGHOUT THE CONTINUUM OF TREATMENT - FROM DIAGNOSIS TO SURVIVORSHIP. THERE IS NO CHARGE FOR THESE SERVICES REGARDLESS OF WHETHER A PATIENT CHOOSES TO RECEIVE THEIR TREATMENT AT JMH OR AN UNRELATED FACILITY. THOSE THAT JOIN THE PROGRAM RECEIVE ONE- ON-ONE ASSISTANCE FROM SPECIALLY TRAINED ONCOLOGY PROFESSIONALS. OUR CANCER NAVIGATORS COMMUNICATE WITH THE PATIENT'S DOCTOR, WILL COORDINATE TRANSPORTATION, SET UP APPOINTMENT REMINDERS AND PROVIDE EMOTIONAL SUPPORT FOR BOTH THE PATIENT AND THE PATIENT'S FAMILY. OUR NAVIGATORS WILL ALSO COORDINATE SUPPORT SERVICES SUCH AS TREATMENT PLANNING, PROSTHESIS SELECTION, NUTRITION COUNSELING, AND IDENTIFICATION OF RESOURCES FOR SPIRITUAL CARE, FINANCIAL ASSISTANCE AND OTHER NEEDS. OUR NAVIGATORS PARTICIPATE IN COMMUNITY EVENTS SUCH AS HEALTH FAIRS, CANCER EDUCATION EVENTS, AND CANCER SUPPORT GROUPS. THEY VISIT PHYSICIAN OFFICES, SENIORS' GROUPS, ATTEND MEETINGS WITH LOCAL BUSINESS ORGANIZATIONS, AND THEY WORK WITH MANY OTHER ORGANIZATIONS TO EXPLAIN THE NAVIGATION PROGRAM AND PROVIDE CANCER AWARENESS/EDUCATION THROUGH THE COMMUNITY. WE STARTED A DIAPER ASSISTANCE PROGRAM THE LAST QUARTER OF THIS FISCAL YEAR. DIAPERS ARE PROVIDED TO LOW-INCOME FAMILIES THAT DELIVER AT JMH FOR THE FIRST 6 MONTHS OF THE BABIES LIFE. WE ENROLLED 23 BABIES THE FIRST MONTH THAT HAS GROWN TO AN AVERAGE OF 39 SINCE. BASED ON PROJECTIONS, WE EXPECT THE PROGRAM TO COST THE HOSPITAL 24,000 FOR A FULL YEAR. THE REGIONAL CANCER CENTER AT JMH HOSTED A FAMILY FUN DAY ON THE GROUNDS OF THE CENTER TO EDUCATE PATIENTS AND FAMILY AND TO CELEBRATE OUR COMMUNITY. IN ADDITION TO A COOK-OUT AND ENTERTAINMENT, A PRESENTATION WAS GIVEN ON HOW TO RECOGNIZE AND PREVENT COMMON SKIN CANCERS. SAMPLES OF SUN SCREEN AND SKIN CARE INFORMATION WERE DISTRIBUTED. THE OUTPATIENT DIABETES CARE CENTER (CENTER) AT JMH CONTINUED TO EXPERIENCE INCREASED VOLUMES THIS YEAR. AFTER AN INCREASE OF ALMOST 170% FROM FY14 TO FY15, OUR VOLUME GREW AN ADDITIONAL 43% IN FY16. THE CENTERS FOR DISEASE CONTROL AND PREVENTION IDENTIFIES THE COUNTIES SERVED BY JMH AS BEING LOCATED IN WHAT IS REFERRED TO AS THE "DIABETES BELT" OF THE U.S. JMH'S DIABETES CENTER PROVIDES MEDICAL MANAGEMENT OF DIABETES AND DIABETES- RELATED CONDITIONS FOR PATIENTS AGED 12 AND UP. A COMPREHENSIVE DIABETES EDUCATION PROGRAM THAT IS RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION IS PART OF THE CENTER'S PROGRAM OF CARE. OUR FAMILY BIRTH CENTER HAS 16 LARGE PRIVATE ROOMS, 11 OF WHICH ARE DESIGNED FOR LABOR/DELIVERY/RECOVERY/POSTPARTUM STAYS. THE REMAINING FIVE ROOMS SERVE TO CARE FOR GYNECOLOGY PATIENTS. TRADITIONAL NURSES STATIONS HAVE BEEN REPLACED WITH "TOUCHDOWN STATIONS" THAT MAKE COMMUNICATION WITH FAMILY MEMBERS MORE INVITING. DEDICATED PEDIATRIC HOSPITALISTS ARE ONSITE DURING DELIVERY AND AFTERWARD TO CARE FOR BABIES AND COVERAGE IS AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. THE JMH CENTER FOR COMPREHENSIVE WOUND CARE IS THE ONLY FACILITY IN SOUTHWEST VIRGINIA OFFERING HYPERBARIC OXYGEN THERAPY - THE DELIVERY OF OXYGEN AT LEVELS HIGHER THAN ATMOSPHERIC PRESSURE IN A CHAMBER SETTING THAT STIMULATES THE HEALING PROCESS. THE NEAREST FACILITY OFFERING HYPERBARIC OXYGEN THERAPY IS AN HOUR AWAY. OUR TRAINED STAFF FOLLOW A TEAM APPROACH TO WOUND HEALING. EACH PATIENT RECEIVES A COMPREHENSIVE INDIVIDUALIZED PLAN DESIGNED TO HELP DIFFICULT-TO-HEAL WOUNDS. JMH STAFF STRIVE TO ADDRESS THE UNDERLYING CAUSE OF THE PROBLEM, CONTROL INFECTION, AND IMPROVE THE OVERALL HEALTH OF OUR PATIENTS. OUR WOUND CENTER CONDUCTED A RAPID IMPROVEMENT EVENT THIS YEAR FOCUSED ON EXPEDITING PATIENT VISITS TO REDUCE WAIT TIMES IN TREATMENT ROOMS. PATIENTS SOMETIMES EXPERIENCE STRESS WHEN LEFT ALONE WHILE AWAITING A PHYSICIAN AND TREATMENT. THE WOUND CENTER WAS ABLE TO REDUCE PATIENT FLOW TIME 27% BY STANDARDIZING ALL ROOMS AND EQUIPMENT AND IMPLEMENTING A SUPPLY BIN SYSTEM. OTHER CHANGES INCLUDED ADDING SIGNAGE SETTING EXPECTATIONS TO REINFORCE THE PURPOSE OF ARRIVING ON TIME FOR APPOINTMENTS SO THAT OTHER PATIENTS ARE NOT NEGATIVELY IMPACTED BY PATIENTS ARRIVING OUTSIDE OF THEIR SCHEDULED APPOINTMENT TIMES. THIS SIMPLE CHANGE RESULTED IN A DROP OF 86% IN THE NUMBER OF PATIENTS ARRIVING OUTSIDE OF THEIR SCHEDULED APPOINTMENT AND THE NUMBER OF LATE PATIENT ARRIVALS CONTINUES TO DECLINE AS EXPECTATIONS FOR TIMELINESS ARE REINFORCED. MSHA HOLDS AN ANNUAL SYSTEM-WIDE QUALITY AWARDS COMPETITION. TEAM MEMBERS FROM ACROSS THE ORGANIZATION RECEIVE RECOGNITION FOR IMPROVEMENT PROJECTS THAT MAKE THINGS BETTER FOR OUR PATIENTS AS WELL AS FELLOW TEAM MEMBERS. PROJECTS MUST SHOW A MEASURED BENEFIT. JMH HAD 15 PROJECTS RECOGNIZED FOR RESULTS THEY ACHIEVED DURING THE YEAR. TWO OF THOSE PROJECTS RECEIVED SOME OF THE HIGHEST RECOGNITION, AS DETERMINED BY A TEAM OF EXPERT JUDGES FROM THE BUSINESS WORLD: -JMH'S CARDIAC CATH LAB'S PROJECT CALLED "THE HEART OF THE PROBLEM IS TIME", WHICH HELPED REDUCE THE AMOUNT OF TIME IT TAKES TO RECEIVE TREATMENT FOR STEMI HEART PATIENTS (ST SEGMENT ELEVATION MYOCARDIAL INFARCTION) WHO TRANSFER TO JMH FROM ANOTHER FACILITY. EVERY MINUTE IS CRUCIAL FOR HEART ATTACK PATIENTS. -"GOT SEPSIS" WAS A QUALITY PROJECT RECOGNIZED LAST YEAR FOR ITS REMARKABLE RESULTS IN LOWERING THE SEPSIS MORTALITY RATE AND THE AVERAGE LENGTH OF STAY AND COST FOR SEPSIS PATIENTS. THIS YEAR THE PROJECT WAS GIVEN A "HOLD THE GAINS AWARD" FOR CONTINUING TO DRIVE IMPROVEMENT. ANOTHER QUALITY PROJECT WITH OUTSTANDING RESULTS WAS A PROJECT TITLED "90 IN 90" TO INCREASE PHYSICIAN USE OF STANDARDIZED ORDER SETS AND PROTOCOLS THAT HAVE BEEN PROVEN TO IMPROVE THE QUALITY OF MEDICAL CARE AND ENHANCE PATIENT SAFETY. ORDER SET USAGE INVOLVES THE USE OF PRE-SET, CAREFULLY CREATED, BEST EVIDENCE-BASED PROCESSES ON WHAT KIND OF CARE THE PATIENT SHOULD RECEIVE FOR A PARTICULAR CONDITION. BY FOLLOWING THESE ORDER SETS, PATIENT CARE IS MORE EFFICIENT, MORE CONSISTENT AND HAS LESS CHANCE FOR ERROR OR REDUNDANCY. JMH'S PROJECT MEASURED ORDER SET USAGE FOR SEVEN COMMON ADMITTING MEDICAL DIAGNOSES AND FOUND USAGE WAS BETWEEN 45-49% AT THE BEGINNING OF THE PROJECT. THE PROJECT'S GOAL WAS TO INCREASE USAGE TO 90% WITHIN 90 DAYS. WITHIN JUST 60 DAYS, THE GOAL WAS MET WITH USAGE INCREASING TO 95% AND 97% COMPLIANCE WAS REACHED WITHIN 90 DAYS. BECAUSE THIS PROJECT SAW SUCH SUCCESS AT JMH, IT WAS ROLLED OUT TO ALL MSHA FACILITIES. JMH CONTINUES THE "LEAN" PROCESS OF PROVIDING VALUE TO CUSTOMERS (OUR PATIENTS, PHYSICIANS AND TEAM MEMBERS) THROUGH QUALITY IMPROVEMENT TEAMS THAT MEET ALL DAY FOR SEVERAL DAYS TO DEVELOP PROCESSES THAT WILL OPTIMIZE CARE OF PATIENTS, REDUCE RESOURCE UTILIZATION; AND, OFTENTIMES, IMPROVE BOTH. SOME OF THE PROJECTS THAT OCCURRED DURING THE YEAR INCLUDE: -MORE APPROPRIATE PATHWAYS WERE DEVELOPED FOR PATIENTS PRESENTING IN THE ER WITH LOW RISK CHEST PAIN RESULTING IN A LENGTH OF STAY REDUCTION OF 80%. -SEVERAL ADDITIONAL IMPROVEMENTS RELATING TO BED ASSIGNMENTS, DISCHARGE PROCESSES, ETC. POSITIVELY IMPACTED OTHER AREAS, SUCH AS AN 86% IMPROVEMENT IN AVOIDABLE DAYS (UNNECESSARY HOSPITAL DAYS DUE TO PLACEMENT, TESTING/TREATMENT ISSUES, AND OTHER PREVENTABLE FACTORS); A 57% REDUCTION IN ADMISSIONS HELD IN THE ER DUE TO A LIMITED BED CAPACITY WITHIN THE HOSPITAL; A 54% IMPROVEMENT IN DISCHARGE TURNAROUND TIME LESS THAN 90 MINUTES; AND A 21% IMPROVEMENT IN PATIENT SATISFACTION SCORES. -PROCESSES 106029569 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false true false false false false false true true true true false false true X 141 0 true 20 true true true false false false false false false false false false X 15 11 false false false false true true true true true false false true true true true true true false false false VA X JOHN L JETER 2762582800 16000 JOHNSTON MEMORIAL DR ABINGDON VA 24211 MARVIN EICHORN MSHA EVP. CO 7.00 48.00 X X 0 747271 39264 JIM GARDNER MD APP PHY DIRECTOR 3.00 40.00 X 0 245113 28955 BRIAN DAWSON MD DIRECTOR 3.00 X 61328 0 0 KATHY MITCHELL DIRECTOR 3.00 0.00 X 0 0 0 GARY PEACOCK DIRECTOR 3.00 8.50 X 0 0 0 JOANNE GILMER VICE-CHAIR 4.00 10.00 X X 0 0 0 BILL HAYTER SECRETARY 3.00 X X 0 0 0 RACHEL FOWLKES DIRECTOR 3.00 X 0 0 0 ERIC MILLER DIRECTOR 3.00 X 0 0 0 RICHARD DICK GAIL DIRECTOR 3.00 X 0 0 0 JOSEPH B LYLE DIRECTOR 3.00 X 0 0 0 BRENDAN MCSHEEHY CHAIR 4.00 X X 0 0 0 JOHN THOMAS FOWLKES DIRECTOR 3.00 X 0 0 0 MIKE SPIEGLER DIRECTOR 3.00 X 0 0 0 MARVIN GILLIAM DIRECTOR 3.00 X 0 0 0 SEAN MCMURRAY VP/CEO NE MK 38.00 7.00 X 0 385990 51190 JOHN JETER CFO/ASST. AD 27.00 18.00 X 0 217684 26523 BRYAN MULLINS COO 45.00 X 0 187087 10663 BRIAN CONDIT MD VP/CMO NE MA 45.00 X 0 344736 21836 WILEY KENT PA HOSPITALIST 40.00 X 0 305607 39037 JOHN RAY MD HOSPITALIST 40.00 X 0 284650 26182 SCOTT HUNTER PA HOSPITALIST 40.00 X 0 283162 30525 SAMUEL MELTON MD PHYSICIAN 40.00 X 0 234854 28330 STEPHEN GIVENS RCMC ADMINISTRATOR FMR JMH KEY 45.00 X 0 200093 26426 DAMIAN SOOKLAL MD MSMG PHYSICIAN FMR JMH HIGH X 0 395933 27908 61328 3832180 356839 true true false VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON VA 24212 ANESTHESIA 2749169 VEP MSHA ED INC 1990 N CALIFORNIA BLVD STE 400 WALNUT CREEK CA 94596 ER PHYS. SERVS, 792000 MEDIAS INC PO BOX 10452 BLACKSBURG VA 24062 SLEEP STUDIES 591126 ABINGDON PHYSICIANS ASC GROUP 613 CAMPUS DRIVE SUITE 300 ABINGDON VA 24210 SURG. CTR. MGMT 556702 CROTHALL SERVICES EAST TN 13028 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LINEN SERVICES 455243 19 45278 10348 55626 PATIENT SERVICE REVENUE 621110 146618693 146618693 WELLNESS PROGRAMS 621110 1672136 1672136 RENT TO EXEMPT AFFILIATES 621110 277679 277679 LABORATORY 621511 68877 68877 148637385 3252248 3252248 805922 632783 173139 173139 173139 1009068 86851 186185 1009068 -99334 909734 -99334 1009068 CAFETERIA & VENDING 900099 681243 681243 VENDOR SETTLEMENT 722210 560823 560823 REVENUE FROM PARENT 900099 111464 111464 119459 119459 1472989 154501121 148469174 68877 5907444 X 146073 146073 552373 552373 39505422 33998775 5506647 1338369 1172025 166344 7250599 5615272 1635327 2695355 2488174 207181 24915 24915 73071 73071 59925 59925 364441 364441 29422386 26545226 2877160 547985 28921 519064 1260632 961208 299424 2520726 2408603 112123 2429947 1738451 691496 289723 236718 53005 282644 282644 11395029 3576730 7818299 1142270 5483 1136787 MEDICAL SUPPLIES & DRUGS 23225915 23225915 REPAIRS AND MAINTENANCE 3542584 3351410 191174 MANAGEMENT FEES TO PARENT 2173001 2173001 TAXES - UBI 2624 2624 1430241 530585 899656 131676250 106029569 25646681 0 X 7500362 9574841 20618495 19890264 1958992 96435 2934503 3143185 817019 886996 266661255 111546811 158339470 155114444 164507633 170814547 199510 142230 35200 35200 452184 1034697 357363368 360732839 11063228 11921477 2662198 1831821 35684507 18405000 1884992 2223775 51294925 34382073 X 306067962 326297995 481 52771 306068443 326350766 357363368 360732839 X 22824871 -2957709 415161 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 9940 false false 9940 false SCHEDULE C, PART IV PART II-B, LINE 1 JMH HAD LOBBYING EXPENSES OF 9,940 WHICH REPRESENTS THE PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION ATTRIBUTABLE TO DIRECT LOBBYING. 6784856 6784856 153822345 35455340 118367005 6106231 2304146 3802085 99022295 73351481 25670814 925528 435844 489684 155114444 DUE TO AFFILIATES 891228 PROF. LIABILITIES, ETC. 841603 DUE TO THIRD-PARTY 274938 CAPITAL LEASE OBLIGATIONS 167011 OTHER LONG-TERM LIABILITIES 48995 2223775 X SCHEDULE D, PAGE 3, PART X FOOTNOTES FROM JOHNSTON MEMORIAL HOSPITAL'S JUNE 30, 2016 CONSOLIDATED AUDITED FINANCIAL STATEMENTS INCLUDE THE FOLLOWING TEXT "THE HOSPITAL AND APP ARE CLASSIFIED AS ORGANIZATIONS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3)OF THE INTERNAL REVENUE CODE. JMH ER IS ORGANIZED AS A LIMITED LIABIITY CORPORATION AND IS CONSIDERED A DISREGARDED ENTITY FOR TAX PURPOSES. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2016 AND 2015. AT JUNE 30, 2016, TAX RETURNS FOR 2013 THROUGH 2015 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE." true true X true X true X true true false false 1313691 1313691 0.01000 18905112 14956482 3948630 0.03000 20218803 14956482 5262321 0.04000 474974 474974 0.00360 3473301 275710 3197591 0.02430 6923398 5491461 1431937 0.01090 125251 125251 0.00100 10996924 5767171 5229753 0.03970 31215727 20723653 10492074 0.07970 525 525 1300 1300 1825 1825 true 20435845 14300303 44851834 44336935 514899 X true true 1 1 JOHNSTON MEMORIAL HOSPITAL INC 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 WWW.MOUNTAINSTATESHEALTH.COM H 1864 X X X X JOHNSTON MEMORIAL HOSPITAL INC 1 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false FACILITY 1, JOHNSTON MEMORIAL HOSPITAL, INC. - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES, INCLUDING JMH. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 5 TO 18 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S PERCEIVED HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS, AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE FACILITY COMMUNITY BOARDS (SUCH AS JMH'S BOARD) WERE PRESENTED THIS INFORMATION AND SHARED THEIR THOUGHTS AS WELL ON THE HEALTH NEEDS TO PRIORITIZE. THE SPECIFIC NEEDS FOR EACH COUNTY WERE THEN ADDRESSED IN THE RESPECTIVE FACILITY IMPLEMENTATION PLAN WHICH WAS ADOPTED SEVERAL MONTHS LATER. FACILITY 1, JOHNSTON MEMORIAL HOSPITAL, INC. - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. JMH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 1, JOHNSTON MEMORIAL HOSPITAL, INC. - PART V, LINE 11 MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2015. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2014 AND 2015. DUE TO LIMITED RESOURCES, EACH FACILITY PRIORITIZED FOUR TO FIVE HEALTH PRIORITIES ON WHICH TO FOCUS AND DEVELOP IMPLEMENTATION PLANS TO IMPACT. THERE WERE SEVEN COMMON HEALTH PRIORITIES SELECTED BY THE VARIOUS 11 FACILITIES, BUT NOT ALL FACILITIES SELECTED THE SAME AREAS. THE SEVEN ARE OBESITY, SUBSTANCE/PRESCRIPTION DRUG ABUSE, DIABETES, CANCER, HEART DISEASE, SMOKING AND MENTAL HEALTH. ALL OF THESE ARE SIGNIFICANT ISSUES FOR ALL 11 FACILITIES, BUT EACH CHOSE TO PRIORITIZE ON A DIFFERENT SET SO THEY COULD TARGET THEIR EFFORTS AND BE MORE EFFECTIVE WITH LIMITED RESOURCES. FOR EXAMPLE, WHILE NEARLY ALL THE FACILITIES IDENTIFIED OBESITY (11 OF 11) AND SUBSTANCE/ PRESCRIPTION DRUG ABUSE (10 OF 11), ONLY CERTAIN FACILITIES ELECTED TO FOCUS ON SOME NUMBER OF THE OTHER FIVE COMMON HEALTH PRIORITIES. WHILE MENTAL HEALTH IS CLEARLY A SIGNIFICANT ISSUE FOR ALL 11 FACILITIES, ONLY THREE ARE FOCUSED ON IT DUE TO LIMITED RESOURCES. THE SAME IS TRUE WITH SMOKING WHERE ONLY 5 OF THE 11 FACILITIES ARE FOCUSED ON IT, BUT IT IS AN ISSUE FOR ALL FACILITIES. SIX OF THE 11 FACILITIES SELECTED CANCER; 6 OF THE 11 SELECTED HEART DISEASE; AND 9 OF THE 11 CHOSE DIABETES. ANOTHER WAY TO STATE THIS IS BY FACILITY. FOR EXAMPLE, WHILE CANCER AND MENTAL HEALTH ARE PREVALENT CHALLENGES FOR JCMC'S PRIMARY SERVICE AREA, THE HOSPITAL ELECTED NOT TO FOCUS ON THOSE DUE TO LIMITED TIME, FUNDING, PERSONNEL AND OTHER RESOURCES NEEDED TO EFFECTUATE CHANGE. UCMH FELT IT WAS UNABLE TO ADDRESS HEART DISEASE, SMOKING, AND MENTAL HEALTH ISSUES IN ITS PRIMARY SERVICE AREA. SOME FACILITIES IDENTIFIED ISSUES SUCH AS TRANSPORTATION AND EDUCATION AS BARRIERS TO GOOD HEALTH, BUT WERE ALSO UNABLE TO SET ASIDE SUFFICIENT RESOURCES TO MEANINGFULLY IMPACT THOSE CHALLENGES. AFTER THE FACILITIES SELECTED A REASONABLE NUMBER OF HEALTH PRIORITIES THEY FELT THEY COULD ADEQUATELY IMPACT, AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF NOVEMBER AND DECEMBER 2015. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. THE FACILITIES HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, JMH SUPPORTS THE LOCAL MORNING MILE PROGRAM WHICH IS A SCHOOL BASED PROGRAM IN WHICH KIDS ARRIVE AT SCHOOL EARLY AND PARTICIPATE IN A SUPERVISED WALK OR RUN FOR A MILE. SCCH SPONSORS THE LOCAL COMMUNITY ACTION NETWORK AND PROVIDES NUTRITIONAL AND WELLNESS INFORMATION TARGETING OBESITY. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA HOSPITALS TO SUPPORT THEIR IMPLEMENTATION PLANS. PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE FINANCIAL ASSISTANCE APPROVAL CAN APPLY TO AN ASSORTMENT OF PATIENTS SUCH AS THOSE WHO HAVE EXHAUSTED THEIR MEDICAID BENEFITS, THOSE WHO QUALIFIED FOR MEDICAID AFTER THE DATE OF SERVICE, DECEASED PATIENTS WITH NO ESTATE OR ASSETS, UNINSURED PATIENTS, AND UNDERINSURED PATIENTS. MSHA CHARITY QUALIFICATION IS BASED ON FEDERAL POVERTY GUIDELINES BUT ALSO USES ASSET VALUES TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. CHARITY APPROVAL COVERS ALL DATES OF SERVICE FOR THE PATIENT WHEN THEY ARE APPROVED AND THERE IS NO LIMITATION OR CAP ON THE AMOUNT OF CHARITY THAT THEY CAN RECEIVE. MSHA ALWAYS ATTEMPTS TO FULFILL ITS OBLIGATION TO PROVIDE FINANCIAL ASSISTANCE TO THOSE PATIENTS WITHOUT THE ABILITY TO PAY. THE MAJORITY OF MSHA HOSPITALS ARE LOCATED IN TENNESSEE AND PURSUANT TO TENNESSEE LAW ALL PATIENTS WITHOUT THIRD-PARTY PAYER COVERAGE RECEIVE A DISCOUNT OF 67%, WITH THE EXCEPTION OF CRITICAL ACCESS HOSPITALS THAT RECEIVE 58%. THIS IS A CALCULATED DISCOUNT THAT IS UPDATED ON AN ANNUAL BASIS. ALTHOUGH VIRGINIA DOES NOT HAVE A LAW THAT REQUIRES HOSPITALS TO PROVIDE DISCOUNTS TO UNINSURED PATIENTS, MSHA EXTENDS THESE UNINSURED DISCOUNTS TO ITS VIRGINIA HOSPITALS AS WELL, INCLUDING JMH. PART I, LINE 6A - RELATED ORGANIZATION INFORMATION MSHA'S COMMUNITY BENEFIT REPORT COMPLETED IN FY15 INCLUDED JMH. OUR NEXT COMMUNITY BENEFIT REPORT WILL BE ISSUED DURING FY17. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE COST TO CHARGE RATIO (WORKSHEET 2 "RATIO OF PATIENT CARE COST TO CHARGES") WAS USED TO CALCULATE LINE 7A FINANCIAL ASSISTANCE COST. OUR COST ACCOUNTING SYSTEM PROVIDED MEDICAID/TENNCARE LOSSES REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH. WE USED A COST TO CHARGE RATIO FOR HOME HEALTH BECAUSE ITS DATA IS NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS, WITH NO ADDITIONAL OVERHEAD INCLUDED. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF STUDENT INTERNSHIPS (PRIMARILY NURSING, THERAPY, AND PHARMACY STUDENTS) WITH SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING AT A HOSPITAL AS PART OF THEIR EDUCATION AND TRAINING. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT KEEPS DETAILED RECORDS OF HOURS SPENT ON THESE STUDENT ACTIVITIES, THE NUMBER OF STUDENTS THAT ROTATE THROUGH OUR HOSPITAL, ETC. INFORMATION IS MAINTAINED FOR EACH HOSPITAL UNIT THAT PARTICIPATES. WE ONLY INCLUDE LABOR COSTS AND WE ONLY ASSUME A PERCENTAGE OF OUR INVOLVED TEAM MEMBERS' TIME IS DEVOTED TO THESE STUDENTS. NEW IN FY16 ARE HEALTH PROFESSION COSTS AND REIMBURSEMENTS RELATED TO MEDICARE- APPROVED FAMILY MEDICINE AND INTERNAL MEDICINE PROGRAMS. THE MEDICAL RESIDENT PROGRAM COST AND REIMBURSEMENT INFORMATION COMES FROM OUR FILED MEDICARE COST REPORT. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USE OUR COST ACCOUNTING SYSTEM. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND MEDICAID/TENNCARE ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITAL THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE OR SERVICES THAT ARE READILY AVAILABLE WITHIN OUR AREA. FOR THE SERVICE LINES WE DO REPORT, SUCH AS OUTPATIENT DIABETES, NEONATOLOGY, AND WOUND CARE, WE USED OUR COST ACCOUNTING SYSTEM SINCE THESE SERVICES HAVE ESTABLISHED, STANDARD FINANCIAL REPORTS. LINE 7I CASH AND IN-KIND CONTRIBUTIONS INCLUDE CASH DISBURSEMENTS AND THE IN-KIND DONATIONS OF MEDICATIONS TO LOCAL NONPROFIT RESCUE SQUADS AND FIRE DEPARTMENTS. IN- KIND DONATIONS OF MEDICATIONS ARE BASED ON OUR ACTUAL COST FOR THESE ITEMS. PART II - COMMUNITY BUILDING ACTIVITIES JMH LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. WE DO NOT CAPTURE COSTS ASSOCIATED WITH TEAM MEMBERS THAT SERVE ON OTHER NONPROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. JMH, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. MOST OF THESE ORGANIZATIONS WORK TO IMPROVE THE LIVES OF COMMUNITY MEMBERS THAT HAVE LIMITED, OR NO, FINANCIAL RESOURCES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY SELF-PAY BALANCES INCLUDE ACCOUNTS AFTER PAYMENTS AND CONTRACTUAL ADJUSTMENTS (DISCOUNTS) HAVE BEEN POSTED FROM ALL THIRD-PARTY PAYERS- GENERALLY LEAVING THE PATIENT RESPONSIBLE FOR ANY REMAINING DEDUCTIBLE AND/OR CO-PAYMENT. OTHER SELF-PAY ACCOUNTS ARE FROM PATIENTS WITH NO INSURANCE OR OTHER THIRD-PARTY COVERAGE. AFTER THE NORMAL COLLECTION PROCESS HAS INDICATED AN ACCOUNT IS UNCOLLECTIBLE, JMH WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO GATHER HISTORICAL INFORMATION TO APPLY TO THE CURRENT BALANCE. IN OTHER WORDS, THE HOSPITAL EVALUATES PAST COLLECTION HISTORY ON ACCOUNTS WRITTEN OFF TO BAD DEBT AND APPLIES THE HISTORICAL UNPAID RATE TO THE CURRENT SELF-PAY ACCOUNTS RECEIVABLE BALANCE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE JMH'S PATIENT FINANCIAL SERVICES MANAGEMENT ESTIMATE THAT 70% OF BAD DEBT EXPENSE IS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. WE BASE THIS PERCENTAGE ON THE COMPOSITION OF BAD DEBTS ATTRIBUTABLE TO PEOPLE WITH NO FORM OF INSURANCE OR OTHER THIRD-PARTY COVERAGE, WHICH REPRESENTS THE MAJORITY OF BAD DEBT ACCOUNTS. WE ALSO ESTIMATE A MUCH SMALLER PERCENTAGE OF LIKELY CHARITY-ELIGIBLE ACCOUNTS TO PEOPLE WITH BALANCES AFTER INSURANCE/THIRD-PARTY COVERAGE HAS PAID (E.G. DEDUCTIBLES AND CO-PAYMENT BALANCES). IT IS IMPLAUSIBLE TO DETERMINE WITH EXACTITUDE THE AMOUNT OF JMH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETED FINANCIAL ASSESSMENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSISTANCE FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT 95% OF OUR PATIENTS WHO COMPLETED OUR FINANCIAL ASSISTANCE APPLICATION WERE APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE. IN FACT 83% OF COMPLETED APPLICATIONS RECEIVED A COMPLETE WRITE-OFF OF ALL CHARGES (FREE CARE). ANOTHER 12% RECEIVED A PARTIAL DISCOUNT. DURING FY16, ONLY 5% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS WERE DENIED. UNFORTUNATELY, 33% OF SUBMITTED APPLICATIONS ARE INCOMPLETE. WE RETURN INCOMPLETE APPLICATIONS TO PATIENTS ALONG WITH A NOTICE OF MISSING INFORMATION. THE NOTICE ALSO PROVIDES A CONTACT PHONE NUMBER PATIENTS MAY CALL. WE HAVE MANY INSTANCES OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE ARE SURE WOULD QUALIFY FOR CHARITY CARE. ALTHOUGH HOSPITAL TEAM MEMBERS ENCOURAGE THESE INDIVIDUALS TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION, MANY WILL NOT DO SO. EVEN WHEN THESE INDIVIDUALS ARE TOLD WE FEEL SURE THEY DO QUALIFY FOR FULL OR PARTIAL ASSISTANCE, THEY STILL FAIL TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE TEXT OF JMH'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE APPEARS ON PAGE 11 IN OUR MOST RECENT AUDITED FINANCIAL STATEMENTS (ATTACHED). PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE REPORTED USING JMH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS TRANSPORTATION OF A PATIENT AND COMFORT ITEMS TO INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS AND PHYSICIAN GUARANTEES ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED. ALSO, A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS SUCH AS THOSE NOTED ABOVE, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. WHILE WE AGREE THAT COSTS SUCH AS MARKETING TO ATTRACT PATIENTS AND LOBBYING ARE REASONABLE TO EXCLUDE, IT DOES NOT SEEM REASONABLE TO EXCLUDE RECRUITMENT OF PHYSICIANS AND BASIC ITEMS SUCH AS TELEVISIONS IN PATIENT ROOMS. AS A NONPROFIT ORGANIZATION, WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITY AND THE INDIVIDUAL WHILE MAINTAINING A HIGH LEVEL OF HEALTH CARE SERVICES WITHOUT LOSSES. SINCE LOSSES DO OCCUR THROUGH THE CMS SYSTEM OF REIMBURSEMENT, THESE LOSSES ARE A COST OF DOING BUSINESS FOR OUR COMMUNITY AND SHOULD BE CONSIDERED A COMMUNITY BENEFIT. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, JMH IS REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR OUR MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW OUR COST. THEREFORE, IT IS ONLY LOGICAL TO ALLOW HOSPITALS TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT. BY MAKING THIS CHANGE, NONPROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES ECONOMICALLY INJURIOUS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION JMH HAS ESTABLISHED A STRONG COMMITMENT TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES WE SERVE. ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GENERAL GUIDELINES, WHILE ALLOWING FOR UNIQUE FINANCIAL CIRCUMSTANCES. JOHNSTON MEMORIAL HOSPITAL RECOGNIZES ITS OBLIGATION TO PROVIDE QUALITY HEALTHCARE TO THOSE WHO ARE UNABLE TO PAY. JMH CHARITY GUIDELINES ARE BASED ON THE NATIONAL POVERTY GUIDELINES. HOWEVER, FINANCIAL ASSISTANCE IS NOT BASED SOLELY ON INCOME. UNIQUE FINANCIAL CIRCUMSTANCES ARE CONSIDERED, WHICH CAN CHANGE THE CATEGORY OF ELIGIBILITY. IN ADDITION, CHARITY DETERMINATION MAY BE RETROACTIVE FOR ALL DATES OF SERVICE. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED. PART VI, LINE 2 - NEEDS ASSESSMENT MSHA INCLUDED AMERICA'S HEALTH RANKINGS (AHR) IN ITS ASSESSMENT IN ORDER TO BETTER DEFINE THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. IN 2016, VIRGINIA'S OVERALL HEALTH RANKING MOVED UP TO 19TH, WHILE TENNESSEE IS RANKED 44TH. HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE JMH IS LOCATED) CLOSELY RESEMBLES THE HEALTH RANKINGS FOR TENNESSEE. AMERICA'S HEALTH RANKINGS ARE BASED ON A SERIES OF MEASURES INCLUDING SEVERAL HEALTH OUTCOMES AND HEALTH FACTORS. A SURVEY WAS GIVEN TO 106 INDIVIDUALS REPRESENTING THE TEN COUNTIES IN WHICH MSHA OWNS A FACILITY. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH LEADERS, NONPROFIT DIRECTORS, SCHOOL NURSES AND OFFICIALS, AND BUSINESS LEADERS. A SURVEY WAS GIVEN TO EACH INDIVIDUAL SEEKING FEEDBACK REGARDING AVAILABLE RESOURCES IN EACH AREA, THE PERCEIVED HEALTH STATUS, HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. THE MAJORITY OF RESPONSES SUGGESTED FOCUSING ON EDUCATION IN ORDER TO PROMOTE HEALTHY HABITS AND INCREASED ACCESS TO RESOURCES. OTHER RESPONSES INCLUDED: MAKE PHYSICAL EDUCATION A REQUIREMENT AS PART OF SCHOOL CURRICULUM, IMPROVE NATURAL TRAILS AND WALKWAYS, INCREASE COMMUNITY SUPPORT FOR SMOKE-FREE AREAS, PARTNER WITH LOCAL FARMER'S MARKETS, SHARE HEALTH INFORMATION BETWEEN PHARMACIES, NETWORK WITH SMALL BUSINESSES AND NON-PROFITS IN ORDER TO AVOID DUPLICATING RESOURCES, AND PROVIDE EARLY SCREENINGS FOR THE UNINSURED OR UNDERINSURED. OVERALL, THE COMMUNITY MEMBERS GAVE MSHA'S CORE SERVICE AREA A HEALTH STATUS RANKING OF 4.55 OUT OF 10 (1 BEING THE LOWEST, 10 BEING THE HIGHEST). JMH WAS GIVEN A HEALTH STATUS RANKING OF 4.14. AMONG THE 106 PARTICIPANTS, THE AREAS OF OBESITY, CANCER, HEART DISEASE, SMOKING, SUBSTANCE/PRESCRIPTION DRUG ABUSE, AND DIABETES WERE THE TOP HEALTH PRIORITIES IN OUR REGION. ACCORDING TO THE MOST RECENT AHR REPORTS, VIRGINIA AND TENNESSEE BOTH SAW AN INCREASE IN DIABETES AND OBESITY WITHIN THE PAST TEN YEARS. VIRGINIA RANKS 25TH FOR CARDIOVASCULAR DEATHS, 23RD FOR CANCER DEATHS AND 28TH FOR DIABETES. THE ROBERT WOOD JOHNSON FOUNDATION REPORTS 30% OF WASHINGTON COUNTY'S ADULTS ARE CONSIDERED OBESE AND 27% ARE PHYSICALLY INACTIVE. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE MOUNTAIN STATES HEALTH ALLIANCE COMMUNICATES WITH AND EDUCATES OUR PATIENTS THROUGH VARIOUS AVENUES FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND HOSPITAL FINANCIAL ASSISTANCE. EDUCATION IS PROVIDED TO PATIENTS THROUGH SIGNAGE AND FINANCIAL ASSISTANCE BROCHURES AT ALL HOSPITAL AND AMBULATORY ADMISSION LOCATIONS. FINANCIAL ASSISTANCE APPLICATIONS AND PLAIN LANGUAGE SUMMARIES ARE PROVIDED TO PATIENTS SHOULD THEY REQUEST ONE DURING THEIR PRE- REGISTRATION, REGISTRATION OR FINANCIAL COUNSELING PROCESS. OUR GOVERNMENTAL PROGRAM ELIGIBILITY REPRESENTATIVES ASSIST PATIENTS IN SECURING ELIGIBILITY FOR MEDICAID, FEDERAL DISABILITY AND OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. ADDITIONALLY, IF A PATIENT OR COMMUNITY RESIDENT EXPRESSES AN INTEREST IN THE ACA-HEALTHCARE EXCHANGE, OUR REPRESENTATIVES HAVE THE QUALIFICATIONS AND EXPERIENCE TO ASSIST THEM THROUGH THE ENTIRE PROCESS. FINANCIAL COUNSELORS OFFER FINANCIAL ASSISTANCE APPLICATIONS TO PATIENTS WHO DO NOT QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND ARE UNABLE TO PAY FOR THE COST OF THEIR HEALTHCARE. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE ON OUR WEBSITE TO INCLUDE THE FINANCIAL ASSISTANCE APPLICATION, POLICY AND PLAIN LANGUAGE SUMMARY IN BOTH ENGLISH AND SPANISH. ALL PATIENT STATEMENTS HAVE VERBIAGE DISCUSSING FINANCIAL ASSISTANCE ALONG WITH THE CONTACT INFORMATION. OUR LAST LETTER TO THE PATIENT DISPLAYS THE PLAIN LANGUAGE SUMMARY. IN ALL ORAL CORRESPONDENCES WITH THE PATIENT, IF IT IS IDENTIFIED THEY CANNOT MEET THE PAYMENT REQUIREMENTS ON THEIR ACCOUNT, FINANCIAL ASSISTANCE IS DISCUSSED AS AN OPTION. PART VI, LINE 4 - COMMUNITY INFORMATION JMH IS LOCATED IN THE TOWN OF ABINGDON, WASHINGTON COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. SOUTHWEST VIRGINIA (SWVA) IS LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION AND HAS A HIGH RATE OF UNINSURED ADULTS. ACCORDING TO U.S. CENSUS BUREAU ESTIMATES, THE TOWN OF ABINGDON HAS A POPULATION OF 8,191, WHILE WASHINGTON COUNTY'S POPULATION IS 54,876. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF WASHINGTON COUNTY IS 44.7 WHICH IS OLDER THAN THE MEDIAN AGE OF 37.6 IN VIRGINIA. THE BUREAU ESTIMATES WASHINGTON COUNTY MEDIAN HOUSEHOLD INCOME AT 43,310 COMPARED TO 65,015 FOR THE STATE OF VIRGINIA. 21% OF WASHINGTON COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 16% STATEWIDE. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH JMH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. OPERATING SURPLUSES ARE INVESTED INTO IMPROVING TREATMENT OPTIONS FOR OUR PATIENTS THROUGH NEW TECHNOLOGIES, RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN SHORTAGE AREAS, AND IMPROVING OUR FACILITIES AND EQUIPMENT. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. THE MAJORITY OF JMH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREAS. ONLY TWO DIRECTORS: MARVIN EICHORN AND JOANNE GILMER LIVE OUTSIDE THE AREA. THERE ARE FOUR DIRECTORS DEEMED NON-INDEPENDENT, PER IRS INSTRUCTIONS: ONE IS A PHYSICIAN EMPLOYED BY A JMH SUBSIDIARY; ONE IS A PHYSICIAN EMPLOYED FOR A SHORT PERIOD OF TIME IN CALENDAR YEAR 2015 BY JMH; A THIRD IS AN EMPLOYEE OF MSHA, A RELATED ORGANIZATION; AND, THE FOURTH HAS A FAMILY MEMBER EMPLOYED BY JMH IN A NURSING ROLE. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY JMH. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM JMH IS A 116-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 15-MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. JMH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE, THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. JMH SERVES AS ITS COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM JMH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. IF NEEDED, PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS. MSHA HOSPITALS WORK CLOSELY WITH ONE ANOTHER TO SHARE EXPERTISE AND RESOURCES. FOR EXAMPLE, JMH ASSISTED SMYTH COUNTY COMMUNITY HOSPITAL (SCCH) ESTABLISH A DIABETES CENTER. JMH'S CENTER HAS BEEN OPERATIONAL FOR MANY YEARS SO THE EXPERIENCED CLINICAL TEAM AT JMH PROVIDED VALUABLE INSIGHT THAT SAVED SCCH TIME, MONEY, AND MISTAKES. THERE ARE MANY OTHER EXAMPLES OF SHARED EXPERTISE AND SERVICES BETWEEN MSHA FACILITIES - LABORATORY, CARDIAC SERVICES, ADMINISTRATIVE, ETC. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT VIRGINIA true TOWN OF ABINGDON PO BOX 789 ABINGDON VA 24212 546001096 501C3 20500 ADAPTIVE PLAYGROUND VHCC EDUCATIONAL FOUNDATION PO BOX 828 ABINGDON VA 24212 521225133 501C3 43817 FUND NURSING PROGRAM VIRGINIA HIGHLANDS COMM COLLEGE P O BOX 828 ABINGDON VA 24212 541268289 501C3 40002 FUND NURSING PROGRAM WASHINGTON COUNTY PUBLIC SCHOOLS 812 THOMPSON DRIVE ABINGDON VA 24210 546001671 501C3 7250 SPONSORSHIP WILLIAM KING MUSEUM PO BOX 2256 ABINGDON VA 24210 541144120 501C3 10000 SPONSORSHIP 5 SCHEDULE I, PAGE 1, PART I, LINE 2 JMH CHARITABLE DONATIONS REQUIRE FINAL APPROVAL BY THE CEO. DURING PART OF THE YEAR, WE ENCOURAGED DONATION REQUESTS TO BE COMPLETED USING OUR ONLINE DONATION APPLICATION FORM, BUT WE ACCEPTED DONATION REQUESTS IN THE FORM OF LETTERS WHEN AN ADEQUATE EXPLANATION FOR THE REQUEST WAS PROVIDED IN THE LETTER. IN ORDER TO IMPROVE THE OVERALL EFFICIENCY OF CONTRIBUTION REQUEST EVALUATION, WE CHANGED OUR PROCESS SO THAT ALL REQUESTS ARE NOW REQUIRED TO BE COMPLETED USING OUR ONLINE APPLICATION FORM. THE ONLINE FORM PROVIDES CONSISTENCY AMONG APPLICANTS AND GIVES US THE INFORMATION WE NEED IN ORDER TO MAKE A FULLY VETTED FUNDING DECISION. SOME OF THE INFORMATION WE REQUIRE FROM APPLICANTS INCLUDES: IF THE APPLICANT IS REQUESTING FUNDING FOR A SPECIFIC EVENT OR PROGRAM, THE DATE, LOCATION, AND TIME ARE REQUIRED DESCRIPTION OF THE EVENT/PROGRAM APPLICANTS OTHER SOURCES OF INCOME EVENT/PROGRAM BUDGET HOW THE EVENT/PROGRAM SUPPORTS JMH'S MISSION WHO WILL BENEFIT FROM OUR CONTRIBUTION WHAT WILL THE EVENT/PROGRAM ACCOMPLISH APPLICANT ORGANIZATION'S MISSION STATEMENT YEAR THE APPLICANT ORGANIZATION WAS FOUNDED NUMBER OF PEOPLE SERVED ANNUALLY BY THE APPLICANT APPLICANT'S WEBSITE TAX STATUS OF THE APPLICANT AND FEDERAL TAXPAYER ID NUMBER WITH FEW EXCEPTIONS, DONATIONS TO NATIONAL ORGANIZATIONS ARE HANDLED AT MSHA'S CORPORATE LEVEL, WHICH PREVENTS MULTIPLE CONTRIBUTIONS BEING MADE TO THE SAME NATIONAL ORGANIZATION AND ALLOWS ADDITIONAL CONTRIBUTION DOLLARS TO BE USED FOR REGION-SPECIFIC REQUESTS. DONATIONS FROM MSHA HOSPITALS, INCLUDING JMH, ARE ALMOST ENTIRELY DIRECTED TO LOCAL NONPROFIT ORGANIZATIONS. MSHA'S SOCIAL RESPONSIBILITY COMMITTEE, WHICH PROVIDES SYSTEM-WIDE GUIDANCE, IS COMPRISED OF COMMUNITY LEADERS INCLUDING THE DEAN OF A LOCAL UNIVERSITY, THE PRESIDENT OF A LOCAL COLLEGE, UNITED WAY OF WASHINGTON COUNTY'S PRESIDENT, COMMUNITY VOLUNTEERS, BUSINESS LEADERS, MOUNTAIN STATES FOUNDATION'S PRESIDENT, MSHA'S PRESIDENT AND CEO, AND OTHERS. COMMITTEE MEMBERS WERE SELECTED SO THAT MEMBERSHIP EXPERTISE INCLUDES PUBLIC HEALTH, HEALTH PROFESSIONS EDUCATION, KNOWLEDGE OF OTHER RESOURCES AVAILABLE TO CHARITABLE ORGANIZATIONS, AND INDIVIDUALS WITH HANDS-ON COMMUNITY VOLUNTEER EXPERIENCE. SOME OF THE ROUTINE ACTIVITIES OF THE COMMITTEE DURING QUARTERLY MEETINGS INCLUDE: QUARTERLY REVIEW OF THE SOCIAL RESPONSIBILITY SCORECARD; A MEASUREMENT OF ACTUAL ACCOMPLISHMENTS IN THE YEAR COMPARED TO TARGETS SET AT THE BEGINNING OF THE YEAR REVIEW OF CHARITABLE CONTRIBUTION GIVING FOR THE PREVIOUS QUARTER THIS YEAR, THE COMMITTEE BEGAN WORK TO DEVELOP A SOCIAL RESPONSIBILITY BUSINESS PLAN OPPORTUNITY FOR LOCAL TAX EXEMPT ORGANIZATIONS TO PRESENT TO THE COMMITTEE PROGRAMS THEY OFFER, ACHIEVEMENTS, AND FUNDING NEEDS THE COMMITTEE MAY OR MAY NOT RECOMMEND MSHA CORPORATE/HOSPITAL FUNDING OF PROGRAMS SOMETIMES, MSHA DEPARTMENTS WILL BRING PROPOSALS FOR NEW PROGRAMS TO BENEFIT A SPECIFIC POPULATION, SUCH AS CHILDREN X X false true false false false false false false false MARVIN EICHORN MSHA EVP. COO/TREAS. 571412 134090 41769 24504 18550 786535 JIM GARDNER MD APP PHY DIRECTOR 177072 66463 1578 19090 10085 274068 SEAN MCMURRAY VP/CEO NE MKT 302663 71472 11855 31719 23005 437180 JOHN JETER CFO/ASST. ADMIN. JMH 176353 37433 3898 8555 18399 244207 BRYAN MULLINS COO 159405 25736 1946 2531 10174 197750 BRIAN CONDIT MD VP/CMO NE MARKET 280441 35051 29244 24044 366572 WILEY KENT PA HOSPITALIST 109169 194481 1957 17396 21832 344644 JOHN RAY MD HOSPITALIST 199874 78963 5813 16508 9894 310832 SCOTT HUNTER PA HOSPITALIST 116605 162201 4356 11924 18790 313687 SAMUEL MELTON MD PHYSICIAN 225350 780 8724 21610 9436 263184 STEPHEN GIVENS RCMC ADMINISTRATOR FMR JMH KEY EMPLOYEE 168294 22465 9334 6969 21675 226519 DAMIAN SOOKLAL MD MSMG PHYSICIAN FMR JMH HIGHEST PAID 224260 162410 9263 12751 15227 423841 SCHEDULE J, PAGE 1, PART I, LINE 4 SEAN MCMURRAY 0 14,925 0 SAMUEL MELTON, M.D. 0 13,130 0 SCHEDULE J, PART III PART I, LINE 4B: SEAN MCMURRAY AND SAMUEL MELTON PARTICIPATED IN A 457(F)RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE 457(F)PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN). THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON- OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24-MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. A 2011 HOSPITAL FACILITY INVEST BOND INDUSTRIAL DEV AUTHORITY OF SMYTH 541758381 2011-11-16 24870000 REFINANCE CANCER CTR. false false false A 6465000 24870000 238423 24631577 2012 true false true true A false false true true false false true false true A false false false false true false false false true A true SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION 2011 HOSPITAL FACILITY INVEST. BOND (LINE A) REFINANCE OF CANCER TREATMENT CENTER AND REFINANCING OF SERIES 1998 BONDS PART III, LINES 8B & 8C: A PORTION OF THE BONDS ISSUED IN 1998 THAT WAS REFUNDED WITH A PORTION OF THE 2011 BOND ISSUE FINANCED HOSPITAL IMPROVEMENTS FOR A FACILITY THAT BECAME OUTMODED AND OBSOLETE. THE OBSOLETE FACILITY WAS SUBSEQUENTLY SOLD FOR A MINIMAL AMOUNT (LESS THAN 5% OF THE PROCEEDS OF THE BONDS). BASED ON THE AVAILABLE RECORDS, IT IS NOT POSSIBLE TO GIVE A PRECISE AMOUNT OF THE 1998 BOND PROCEEDS THAT WERE USED TO FINANCE THE PROPERTY THAT WAS DISPOSED. BECAUSE THE AMOUNT OF PRIVATE PAYMENTS WAS LESS THAN THE PERMITTED THRESHOLD, NO REMEDIAL ACTION WAS REQUIRED. PART IV, LINE 2C: THE 2011 BOND ISSUE HAS NO ARBITRAGE REBATE DUE SO THERE HAS BEEN NO REBATE COMPUTATION PERFORMED. GINGER MCSHEEHY FAMILY MEMBER 62401 EMPLOYMENT false GRAHAM GARDNER FAMILY MEMBER 14565 EMPLOYMENT false SCHEDULE L, PART V (A1) NAME OF PERSON: GINGER MCSHEEHY (B1) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF BRENDAN MCSHEEHY, JMH BOARD MEMBER (D1) DESCRIPTION OF TRANSACTION: BRENDAN MCSHEEHY,JMH BOARD MEMBER, IS A FAMILY MEMBER OF GINGER MCSHEEHY, AN EMPLOYEE OF JOHNSTON MEMORIAL HOSPITAL. (A2) NAME OF PERSON: GRAHAM GARDNER (B2) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JIM GARDNER, M.D., JMH BOARD MEMBER (D2) DESCRIPTION OF TRANSACTION: JIM GARDNER, M.D.,JMH BOARD MEMBER, IS A FAMILY MEMBER OF GRAHAM GARDNER, AN EMPLOYEE OF JOHNSTON MEMORIAL HOSPITAL. FORM 990 - ORGANIZATION'S MISSION JOHNSTON MEMORIAL HOSPITAL (JMH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. FORM 990, PAGE 2, PART III, LINE 4A (CONT'D) DURING FY16, 8,409 PATIENTS WERE ADMITTED TO OUR HOSPITAL, WITH JUST UNDER 30,000 PATIENT DAYS. THERE WERE AN ADDITIONAL 4,301 OBSERVATION DAYS AND JUST UNDER 1,500 NEWBORN DAYS. WE EXPERIENCED 239,399 OUTPATIENT VISITS THIS YEAR, AN INCREASE OF 4.5% OVER PRIOR YEAR. THERE WERE 41,030 VISITS TO OUR EMERGENCY DEPARTMENT. SURGERIES INCREASED 8.1% THIS YEAR TO 7,279. WE DELIVERED 701 BABIES. PROMOTE COMMUNITY HEALTH: IN AN EFFORT TO REDUCE READMISSION RATES AND IMPROVE THE PATIENT EXPERIENCE, JMH DEVELOPED COORDINATED CARE GUIDES. CARE GUIDES FOCUS ON PATIENT CARE BY ASSISTING WITH PATIENT NEEDS AT DISCHARGE AND WORKING DAILY WITH CASE MANAGEMENT, SOCIAL WORK, AND NURSING STAFF TO REDUCE THE FACTORS THAT COULD LEAD TO A PATIENT BEING READMITTED. ASSISTANCE IS PROVIDED WITH PATIENTS' MEDICATIONS, DURABLE MEDICAL EQUIPMENT, AND OTHER OUTPATIENT NEEDS FOLLOWING INPATIENT DISCHARGE. AFTER PLANNING A NURSE NAVIGATION PROGRAM FOR ONCOLOGY PATIENTS LAST YEAR, THE PROGRAM WAS UP AND OPERATIONAL THIS YEAR. OUR NAVIGATOR PROGRAM IS DESIGNED TO SUPPORT CANCER PATIENTS AND THEIR FAMILIES, ADVOCATE FOR THE PATIENT, AND TO HELP COORDINATE THE PATIENT'S CARE THROUGHOUT THE CONTINUUM OF TREATMENT - FROM DIAGNOSIS TO SURVIVORSHIP. THERE IS NO CHARGE FOR THESE SERVICES REGARDLESS OF WHETHER A PATIENT CHOOSES TO RECEIVE THEIR TREATMENT AT JMH OR AN UNRELATED FACILITY. THOSE THAT JOIN THE PROGRAM RECEIVE ONE- ON-ONE ASSISTANCE FROM SPECIALLY TRAINED ONCOLOGY PROFESSIONALS. OUR CANCER NAVIGATORS COMMUNICATE WITH THE PATIENT'S DOCTOR, WILL COORDINATE TRANSPORTATION, SET UP APPOINTMENT REMINDERS AND PROVIDE EMOTIONAL SUPPORT FOR BOTH THE PATIENT AND THE PATIENT'S FAMILY. OUR NAVIGATORS WILL ALSO COORDINATE SUPPORT SERVICES SUCH AS TREATMENT PLANNING, PROSTHESIS SELECTION, NUTRITION COUNSELING, AND IDENTIFICATION OF RESOURCES FOR SPIRITUAL CARE, FINANCIAL ASSISTANCE AND OTHER NEEDS. OUR NAVIGATORS PARTICIPATE IN COMMUNITY EVENTS SUCH AS HEALTH FAIRS, CANCER EDUCATION EVENTS, AND CANCER SUPPORT GROUPS. THEY VISIT PHYSICIAN OFFICES, SENIORS' GROUPS, ATTEND MEETINGS WITH LOCAL BUSINESS ORGANIZATIONS, AND THEY WORK WITH MANY OTHER ORGANIZATIONS TO EXPLAIN THE NAVIGATION PROGRAM AND PROVIDE CANCER AWARENESS/EDUCATION THROUGH THE COMMUNITY. WE STARTED A DIAPER ASSISTANCE PROGRAM THE LAST QUARTER OF THIS FISCAL YEAR. DIAPERS ARE PROVIDED TO LOW-INCOME FAMILIES THAT DELIVER AT JMH FOR THE FIRST 6 MONTHS OF THE BABIES LIFE. WE ENROLLED 23 BABIES THE FIRST MONTH THAT HAS GROWN TO AN AVERAGE OF 39 SINCE. BASED ON PROJECTIONS, WE EXPECT THE PROGRAM TO COST THE HOSPITAL 24,000 FOR A FULL YEAR. THE REGIONAL CANCER CENTER AT JMH HOSTED A FAMILY FUN DAY ON THE GROUNDS OF THE CENTER TO EDUCATE PATIENTS AND FAMILY AND TO CELEBRATE OUR COMMUNITY. IN ADDITION TO A COOK-OUT AND ENTERTAINMENT, A PRESENTATION WAS GIVEN ON HOW TO RECOGNIZE AND PREVENT COMMON SKIN CANCERS. SAMPLES OF SUN SCREEN AND SKIN CARE INFORMATION WERE DISTRIBUTED. THE OUTPATIENT DIABETES CARE CENTER (CENTER) AT JMH CONTINUED TO EXPERIENCE INCREASED VOLUMES THIS YEAR. AFTER AN INCREASE OF ALMOST 170% FROM FY14 TO FY15, OUR VOLUME GREW AN ADDITIONAL 43% IN FY16. THE CENTERS FOR DISEASE CONTROL AND PREVENTION IDENTIFIES THE COUNTIES SERVED BY JMH AS BEING LOCATED IN WHAT IS REFERRED TO AS THE "DIABETES BELT" OF THE U.S. JMH'S DIABETES CENTER PROVIDES MEDICAL MANAGEMENT OF DIABETES AND DIABETES- RELATED CONDITIONS FOR PATIENTS AGED 12 AND UP. A COMPREHENSIVE DIABETES EDUCATION PROGRAM THAT IS RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION IS PART OF THE CENTER'S PROGRAM OF CARE. OUR FAMILY BIRTH CENTER HAS 16 LARGE PRIVATE ROOMS, 11 OF WHICH ARE DESIGNED FOR LABOR/DELIVERY/RECOVERY/POSTPARTUM STAYS. THE REMAINING FIVE ROOMS SERVE TO CARE FOR GYNECOLOGY PATIENTS. TRADITIONAL NURSES STATIONS HAVE BEEN REPLACED WITH "TOUCHDOWN STATIONS" THAT MAKE COMMUNICATION WITH FAMILY MEMBERS MORE INVITING. DEDICATED PEDIATRIC HOSPITALISTS ARE ONSITE DURING DELIVERY AND AFTERWARD TO CARE FOR BABIES AND COVERAGE IS AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. THE JMH CENTER FOR COMPREHENSIVE WOUND CARE IS THE ONLY FACILITY IN SOUTHWEST VIRGINIA OFFERING HYPERBARIC OXYGEN THERAPY - THE DELIVERY OF OXYGEN AT LEVELS HIGHER THAN ATMOSPHERIC PRESSURE IN A CHAMBER SETTING THAT STIMULATES THE HEALING PROCESS. THE NEAREST FACILITY OFFERING HYPERBARIC OXYGEN THERAPY IS AN HOUR AWAY. OUR TRAINED STAFF FOLLOW A TEAM APPROACH TO WOUND HEALING. EACH PATIENT RECEIVES A COMPREHENSIVE INDIVIDUALIZED PLAN DESIGNED TO HELP DIFFICULT-TO-HEAL WOUNDS. JMH STAFF STRIVE TO ADDRESS THE UNDERLYING CAUSE OF THE PROBLEM, CONTROL INFECTION, AND IMPROVE THE OVERALL HEALTH OF OUR PATIENTS. OUR WOUND CENTER CONDUCTED A RAPID IMPROVEMENT EVENT THIS YEAR FOCUSED ON EXPEDITING PATIENT VISITS TO REDUCE WAIT TIMES IN TREATMENT ROOMS. PATIENTS SOMETIMES EXPERIENCE STRESS WHEN LEFT ALONE WHILE AWAITING A PHYSICIAN AND TREATMENT. THE WOUND CENTER WAS ABLE TO REDUCE PATIENT FLOW TIME 27% BY STANDARDIZING ALL ROOMS AND EQUIPMENT AND IMPLEMENTING A SUPPLY BIN SYSTEM. OTHER CHANGES INCLUDED ADDING SIGNAGE SETTING EXPECTATIONS TO REINFORCE THE PURPOSE OF ARRIVING ON TIME FOR APPOINTMENTS SO THAT OTHER PATIENTS ARE NOT NEGATIVELY IMPACTED BY PATIENTS ARRIVING OUTSIDE OF THEIR SCHEDULED APPOINTMENT TIMES. THIS SIMPLE CHANGE RESULTED IN A DROP OF 86% IN THE NUMBER OF PATIENTS ARRIVING OUTSIDE OF THEIR SCHEDULED APPOINTMENT AND THE NUMBER OF LATE PATIENT ARRIVALS CONTINUES TO DECLINE AS EXPECTATIONS FOR TIMELINESS ARE REINFORCED. MSHA HOLDS AN ANNUAL SYSTEM-WIDE QUALITY AWARDS COMPETITION. TEAM MEMBERS FROM ACROSS THE ORGANIZATION RECEIVE RECOGNITION FOR IMPROVEMENT PROJECTS THAT MAKE THINGS BETTER FOR OUR PATIENTS AS WELL AS FELLOW TEAM MEMBERS. PROJECTS MUST SHOW A MEASURED BENEFIT. JMH HAD 15 PROJECTS RECOGNIZED FOR RESULTS THEY ACHIEVED DURING THE YEAR. TWO OF THOSE PROJECTS RECEIVED SOME OF THE HIGHEST RECOGNITION, AS DETERMINED BY A TEAM OF EXPERT JUDGES FROM THE BUSINESS WORLD: -JMH'S CARDIAC CATH LAB'S PROJECT CALLED "THE HEART OF THE PROBLEM IS TIME", WHICH HELPED REDUCE THE AMOUNT OF TIME IT TAKES TO RECEIVE TREATMENT FOR STEMI HEART PATIENTS (ST SEGMENT ELEVATION MYOCARDIAL INFARCTION) WHO TRANSFER TO JMH FROM ANOTHER FACILITY. EVERY MINUTE IS CRUCIAL FOR HEART ATTACK PATIENTS. -"GOT SEPSIS" WAS A QUALITY PROJECT RECOGNIZED LAST YEAR FOR ITS REMARKABLE RESULTS IN LOWERING THE SEPSIS MORTALITY RATE AND THE AVERAGE LENGTH OF STAY AND COST FOR SEPSIS PATIENTS. THIS YEAR THE PROJECT WAS GIVEN A "HOLD THE GAINS AWARD" FOR CONTINUING TO DRIVE IMPROVEMENT. ANOTHER QUALITY PROJECT WITH OUTSTANDING RESULTS WAS A PROJECT TITLED "90 IN 90" TO INCREASE PHYSICIAN USE OF STANDARDIZED ORDER SETS AND PROTOCOLS THAT HAVE BEEN PROVEN TO IMPROVE THE QUALITY OF MEDICAL CARE AND ENHANCE PATIENT SAFETY. ORDER SET USAGE INVOLVES THE USE OF PRE-SET, CAREFULLY CREATED, BEST EVIDENCE-BASED PROCESSES ON WHAT KIND OF CARE THE PATIENT SHOULD RECEIVE FOR A PARTICULAR CONDITION. BY FOLLOWING THESE ORDER SETS, PATIENT CARE IS MORE EFFICIENT, MORE CONSISTENT AND HAS LESS CHANCE FOR ERROR OR REDUNDANCY. JMH'S PROJECT MEASURED ORDER SET USAGE FOR SEVEN COMMON ADMITTING MEDICAL DIAGNOSES AND FOUND USAGE WAS BETWEEN 45-49% AT THE BEGINNING OF THE PROJECT. THE PROJECT'S GOAL WAS TO INCREASE USAGE TO 90% WITHIN 90 DAYS. WITHIN JUST 60 DAYS, THE GOAL WAS MET WITH USAGE INCREASING TO 95% AND 97% COMPLIANCE WAS REACHED WITHIN 90 DAYS. BECAUSE THIS PROJECT SAW SUCH SUCCESS AT JMH, IT WAS ROLLED OUT TO ALL MSHA FACILITIES. JMH CONTINUES THE "LEAN" PROCESS OF PROVIDING VALUE TO CUSTOMERS (OUR PATIENTS, PHYSICIANS AND TEAM MEMBERS) THROUGH QUALITY IMPROVEMENT TEAMS THAT MEET ALL DAY FOR SEVERAL DAYS TO DEVELOP PROCESSES THAT WILL OPTIMIZE CARE OF PATIENTS, REDUCE RESOURCE UTILIZATION; AND, OFTENTIMES, IMPROVE BOTH. SOME OF THE PROJECTS THAT OCCURRED DURING THE YEAR INCLUDE: -MORE APPROPRIATE PATHWAYS WERE DEVELOPED FOR PATIENTS PRESENTING IN THE ER WITH LOW RISK CHEST PAIN RESULTING IN A LENGTH OF STAY REDUCTION OF 80%. -SEVERAL ADDITIONAL IMPROVEMENTS RELATING TO BED ASSIGNMENTS, DISCHARGE PROCESSES, ETC. POSITIVELY IMPACTED OTHER AREAS, SUCH AS AN 86% IMPROVEMENT IN AVOIDABLE DAYS (UNNECESSARY HOSPITAL DAYS DUE TO PLACEMENT, TESTING/TREATMENT ISSUES, AND OTHER PREVENTABLE FACTORS); A 57% REDUCTION IN ADMISSIONS HELD IN THE ER DUE TO A LIMITED BED CAPACITY WITHIN THE HOSPITAL; A 54% IMPROVEMENT IN DISCHARGE TURNAROUND TIME LESS THAN 90 MINUTES; AND A 21% IMPROVEMENT IN PATIENT SATISFACTION SCORES. -PROCESSES WERE IDENTIFIED AND IMPLEMENTED TO IMPROVE PHYSICIAN COVERAGE AND TO PROVIDE EASIER ACCESS FOR NEW ONCOLOGY PATIENTS FROM REFERRING PHYSICIANS ALLOWING PATIENTS TO SEE AN ONCOLOGIST AND BEGIN TREATMENT SOONER. -WORKING WITH TWO OTHER MSHA HOSPITALS, WE REALIGNED ONCOLOGY SERVICES AND PHYSICIAN RESOURCES, INCREASING PRODUCTIVITY AND PATIENT SATISFACTION. BASED ON COMMUNITY NEED, JMH INCURRED DIRECT EXPENSE OF 335,000 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. IN ADDITION, MSHA CORPORATE ALLOCATES A FORM 990, PART V LINE 2A: W-2 EMPLOYEES JMH TEAM MEMBERS ARE PAID BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). JMH REIMBURSES MSHA FOR ALL SALARY AND BENEFITS RELATED TO OUR TEAM MEMBERS AND THE EXPENSE IS RECORDED ON JMH'S BOOKS. THE ONLY EXCEPTION IS THAT PHYSICIANS WERE PAID DIRECTLY BY JMH FOR A SHORT PERIOD OF TIME THE FIRST OF 2015. FORM 990, PAGE 6, PART VI, LINE 6 THE CORPORATION IS ORGANIZED AS A VIRGINIA NON-STOCK, NONPROFIT CORPORATION WITH TWO MEMBERS: MOUNTAIN STATES HEALTH ALLIANCE, WHICH MAINTAINS A 50.1% INTEREST AND JOHNSTON MEMORIAL HEALTHCARE FOUNDATION, WHICH MAINTAINS A 49.9% INTEREST. FORM 990, PAGE 6, PART VI, LINE 7A THERE ARE TWO CLASSES OF MEMBERS, AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE JOHNSTON MEMORIAL HOSPITAL CLASS IS ELECTED BY THE JOHNSTON MEMORIAL HEALTHCARE FOUNDATION'S BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT. FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN DECISIONS OF THE BOARD ARE PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS, ETC. NO ORDINARY DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL. FORM 990, PAGE 6, PART VI, LINE 11B THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS. THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW. FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY, THE CORPORATE AUDIT AND COMPLIANCE DEPARTMENT OF MSHA FORWARDS THE CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO ALL MSHA MANAGEMENT TEAM MEMBERS AND BOARD MEMBERS, INCLUDING THOSE AT JMH. EMPLOYEES AND BOARD MEMBERS MUST NOTE ANY CONFLICTS OR ATTEST THEY HAVE "NONE", AND RETURN THE FORM TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION. FORM 990, PAGE 6, PART VI, LINE 15A MSHA'S HUMAN RESOURCE (H/R) DEPARTMENT EVALUATES SALARY AND BENEFITS FOR JMH'S CEO ON AN ANNUAL OR NEAR-ANNUAL BASIS. H/R'S EVALUATION IS BASED ON MARKET DATA OBTAINED FROM INDEPENDENT THIRD-PARTY CONSULTANTS FOR POSITIONS WITH SIMILAR RESPONSIBILITIES AT SIMILARLY SITUATED ORGANIZATIONS. BASED ON THAT REVIEW, H/R MAKES A RECOMMENDATION TO MSHA'S PRESIDENT & CEO, WHO HAS FINAL APPROVAL FOR THE COMPENSATION OF JMH'S CEO. IN ADDITION, MSHA OFFERS AN INCENTIVE PLAN TO EXECUTIVES BASED ON TARGETED ACHIEVEMENT METRICS SET IN ADVANCE OF THE PAY YEAR. ESTABLISHED METRICS INCLUDE: COMMUNICATION WITH PATIENTS, PATIENT EVIDENCE-BASED CARE SCORES AND PATIENT SAFETY, VALUE- BASED PURCHASING, ETC. THESE SAME METRICS ARE USED FOR ALL EMPLOYEES WITHIN MSHA, WITH A SMALL NUMBER OF EXCEPTIONS FOR OUR COMPANIES THAT DO NOT PROVIDE DIRECT PATIENT CARE. FORM 990, PAGE 6, PART VI, LINE 15B SIMILAR TO THE CEO'S COMPENSATION, THE CFO RECEIVES COMPENSATION AND BENEFITS THAT COMPLY WITH MSHA'S SALARY POLICY. HIS PAY IS SET AT A MARKET PERCENTILE SPECIFIC TO HIS POSITION. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY BASIS. FORM 990, PART VII - RELATED ORGANIZATIONS DIRECTOR COMPENSATION: JOHNSTON MEMORIAL HOSPITAL'S BOARD MEMBER, BRIAN DAWSON, M.D. HAS 990 REPORTABLE COMPENSATION DERIVED FROM MEDICAL SERVICES PROVIDED TO JMH. HE DOES NOT RECEIVE COMPENSATION FOR SERVICES AS A JMH BOARD MEMBER. MARVIN EICHORN AND JAMES GARDNER, M.D. RECEIVE COMPENSATION FOR SERVICES PROVIDED TO RELATED ORGANIZATIONS AND DO NOT RECEIVE COMPENSATION FOR SERVICES AS A JMH BOARD MEMBER. FORM 990, PART IX, LINE 11G HOSPITAL BASED PROVIDERS 5,671,241 0 0 HOSPITAL SUPPORTED CLINICS 10,135,236 0 0 PHYSICIAN FEES 4,593,307 0 0 COLLECTION SERVICE FEES 0 821,049 0 JANITORIAL & LINEN FEES 729,737 0 0 CONSULTING FEES 0 544,378 0 DIALYSIS SERVICES 403,086 0 0 HYPERBARIC SERVICES 115,010 0 0 SLEEP DIAGNOSTICS SERVICES 525,204 0 0 NUC. MED./ONCOLOGY /RADIOLOGY 499,212 0 0 LABORATORY TESTS 517,479 0 0 AMBULATORY SURGERY CENTER 320,781 0 0 ENGINEERING SERVICES 0 277,369 0 DIETARY 1,652,099 0 0 TRANSCRIPTION & CODING 0 500,311 0 OTHER FEES 1,382,834 734,053 0 FORM 990, PART XI, LINE 9 ELIMINATION OF INTERCOMPANY REC/PAY 362,871 TEMPORARILY RESTRICTED NET ASSET CHANGE 52,290 TOTAL 415,161 JMH EMERGENCY PHYSICIANS LLC 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 454786385 MED. SERV. 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