2017-08-15T13:05:11-05:00 2016-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-10-01 550462730 Community Health Association dba Jackson General Hospital COMM 3043722731 PO Box 720 Pinnell Street Ripley WV 25271 Angela Frame CEO 3043722731 2017-08-14 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z Jackson General Hospital Angela Frame PO Box 720 Pinnell Street Ripley WV 25271 29411916 0 X www.jacksongeneral.com X 1964 WV To promote the general health and welfare of citizens of Jackson County, West Virginia and surrounding areas by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public. 15 15 344 38 0 0 19945 16228 30501979 28974624 -29381 1199 376519 419865 30869062 29411916 0 0 0 0 15832944 16063803 0 0 0 13619812 13288268 29452756 29352071 1416306 59845 10938154 10389941 7723728 7115670 3214426 3274271 To promote the general health and welfare of citizens of Jackson County, West Virginia and surrounding areas by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public. 0 0 24006614 29291006 Services provided included 2,618 inpatient days, 1,088 observation days, 11,456 emergency room visits, 31,588 outpatient visits, and 12,438 rural health clinic visits. Charity care for the year amounted to $451,161. 37825 The organization provided several community health improvement services, including lunch and learn programs, patient/community resource center, free sports physicals, prostate screenings, cardiac kits, advance directives presentations, CPR classes, diabetic counseling, dinner discussions, health fairs, County Disaster Preparedness, and various other programs. 24044439 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 77 0 344 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Angela D Frame CEO 3043731476 PO Box 720 Pinnell St Ripley WV 25271 Robert Fisher Chairman 3.00 X X 0 0 0 Keith Rake Vice Chairman 1.00 X X 0 0 0 John Gorrell Treasurer 1.00 X X 0 0 0 James Gaal DO Secretary 1.00 X X 0 0 0 Sarah Brown Director 0.50 X 0 0 0 Lee Corder Director 0.50 X 0 0 0 James T Hughes MD Director 0.50 X 0 0 0 Luke Hunter Director 0.50 X 0 0 0 Joe Parsons Director 1.00 X 0 0 0 Carolyn Rader Director 0.50 X 0 0 0 Todd Ritchie Director 1.00 X 0 0 0 Becky Scarberry Director 0.50 X 0 0 0 Gareth Smith Director 0.50 X 0 0 0 Steve Westfall Director 1.00 X 0 0 0 Jamion Wolford Director 0.50 X 0 0 0 Stephanie McCoy CEO 40.00 X 162303 0 10682 Angela D Frame CFO 40.00 X 121497 0 16478 Edward Stewart MD Emergency Physician 40.00 X 341131 0 5422 Carl Overmiller MD General Surgeon 40.00 X 293482 0 26845 Jeffrey Barton DO General Surgeon 40.00 X 271420 0 26347 Theresa Simon MD Physician 40.00 X 174445 0 22484 Jackie Denemark PharmD Director of Pharmacy 40.00 X 146304 0 16461 1510582 0 124719 13 0 1 0 Ohio Valley Physicians PO Box 390 Huntington WV 25708 Emergency Physician Services 612010 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Services 304278 Emergency Providers of Parkersburg 5 Foxboro Drive Vienna WV 26105 Emergency Physician Services 303998 LabCorp of America PO Box 12140 Burlington NC 27216 Laboratory Services 295771 American Red Cross PO Box 33093 Newark NJ 07188 Blood Services 163095 7 16228 16228 Patient Services 621990 28649355 28649355 Walmart clinic 621990 325269 325269 28974624 1199 1199 103483 0 103483 103483 103483 Cafeteria & Vending 722210 140553 140553 Rebates and discounts 900099 9298 9298 Medical Record Transcription 900099 7165 7165 159366 159366 316382 29411916 29291006 0 104682 X 317754 251756 65998 11414472 9043686 2370786 186512 147773 38739 3283373 2601416 681957 861692 682719 178973 82259 82259 104392 104392 3096965 2453726 643239 90841 71973 18868 1431598 1134255 297343 956512 757844 198668 416389 329905 86484 9805 7769 2036 241277 191164 50113 963376 763283 200093 432181 342417 89764 Bad Debts 2657049 2657049 Medical Supplies 1476202 1476202 Charity Care Expenses 451161 451161 Medicaid Provider Tax 438047 438047 440214 242294 197920 29352071 24044439 5307632 0 199497 140731 7862 22649 4361708 4905110 230272 214605 378113 397757 16864122 12860973 4332608 4003149 1428094 705940 10938154 10389941 3735194 3545832 1612896 1348044 2375638 2221794 7723728 7115670 X 3214426 3274271 3214426 3274271 10938154 10389941 59845 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92189 92189 6028568 4622234 1406334 10311193 7906926 2404267 432172 331813 100359 4003149 Estimated third party payor settlements 700036 Loan costs net 5904 705940 Capital leases 1147295 Line of credit 1037789 Malpractice Claim Contingent Liability 36710 2221794 26431619 127914 127914 26303705 3108211 3108211 29411916 26243860 0 26243860 3108211 3108211 29352071 Part XI, Line 2d - Other Adjustments: Foundation income not included on 990 127,914. Part XI, Line 4b - Other Adjustments: Bad debts and charity care netted against income on financial statements 3,108,211. Part XII, Line 4b - Other Adjustments: Bad debts and charity care netted against income on financial statements 3,108,211. 1 1 X 1 X 0 1 1 0 0 158397 158397 6551080 6320829 230251 0.00860 6709477 6479226 230251 0.00860 37825 37825 0.00140 37825 37825 0.00140 6747302 6479226 268076 0.01000 0 2657049 4962018 4962018 X 1 1 1 1 Jackson General Hospital PO Box 720 Ripley WV 25271 X X X X Jackson General Hospital 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X http://www.jacksongeneral.com/sg_userfiles/JGH-CHNA-final-2015.pdf X X 1 14 1 http://www.jacksongeneral.com/sg_userfiles/JGH-CHNA-final-2015.pdf 0 0 1 X 200.000000000000 X X X X X 1 1 X X X X 1 X http://www.jacksongeneral.com/for-visitors---patient-financial-services.php X http://www.jacksongeneral.com/for-visitors---patient-financial-services.php X http://www.jacksongeneral.com/for-visitors---patient-financial-services.php X X X X X 1 X 0 X X X X X 1 X 0 0 Jackson General Hospital Part V, Section B, Line 5: The Hospital collected information from various organizations in the community that included the County Commission, County Health Department, County EMS, Healthnet Air Ambulance, etc. Jackson General Hospital Part V, Section B, Line 7d: Copies were provided to all participants in the study. Jackson General Hospital Part V, Section B, Line 11: The Hospital has been recruiting specialists to meet the needs identified, but have not been successful in all placements. The Hospital hasn't been able to recruit a pediatrician or retain a gynecologist. Mental health and drug abuse is a serious problem in the County. The Hospital has made several attempts to develop a strategy that can be financially supported by the Hospital. The strategy involves partnering with other local healthcare providers in the area to do a collaborative outpatient clinic. Jackson General Hospital Part V, Section B, Line 16i: We publicize that the application is available and for assistance to call. We also list on the back of our statements our notice of charity applications, discounts, etc. with contact information. Jackson General Hospital Part V, Section B, Line 20e: JGH staff also attempts to call the patient and/or send a pre-bad debt letter to the patient advising if no response is received that their account may be turned over to an external collection agency. 2 1 - Morad Hughes Health Center PO Box 720 122 Pinnell St Ripley WV 25271 Hospital-based rural health center 2 - Jackson General Hospital Clinic-Walmart 200 Academy Drive Ripley WV 25271 Provider-based health clinic Part I, Line 3c: A sliding scale discount is not applicable to Jackson General Hospital services. Payment received for balances over $100.00 for uninsured patients are eligible for prompt pay (50%) discounts for same date of service. For balances of $100.00 or more, under-insured patients also have the opportunity upon receipt of 1st statement of receiving a 30% discount. If patients do not respond to 1st statement discount offer as an option, they have the opportunity upon receipt of the 2nd statement to be eligible for a 20% discount. Uninsured patients not taking advantage of the same day discount can also apply for the 1st and 2nd statement discounts. These discounts are reviewed and approved by the financial counselors- no discounts are automatically taken by the patient. Part I, Line 7: The cost of charity care, Medicaid at cost and other means tested government programs were estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 2,657,049. Part III, Line 2: The bad debt expense listed on Part III, Line 2 is derived from the financial statements. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible.Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable.In order to claim a receivable as a bad debt, it must be established that the debt relates to covered services and is derived from deductible, coinsurance amounts and/or noncovered services that ABN has been signed by patient and processed by Medicare as patient responsible, reasonable collection efforts were made, that the debt was actually uncollectible when claimed, and that sound business judgment indicates there is no likelihood of future recovery. Part III, Line 8: Medicare costs and revenues were obtained from the hospital's Medicare cost report. Part III, Line 9b: We use the same policy and procedure for all patients, regardless of whether we know they have/had qualified in the past. Any patient that presents for assistance will go through the same application process even if they have been previously approved. This is required in case of any financial changes to assure patient still qualifies for assistance, no change in employment or insurance acquired. Once a patient qualifies for charity care, and service was provided, we issue a financial assistance card effective with first date of service that was performed. This card is valid at our facility only, for services up to 6 months. They have to re-apply once additional services are performed after termination date. Once approved and within valid time frames if these patients present for services they are then registered as Charity Care instead of Self Pay. Part VI, Line 2: Jackson General Hospital assesses the health needs of the communities it serves through community needs assessments, patient satisfaction survey results, the complaint resolution process, and through interviews with the medical staff, employees, vendors and guests, as well as through collaboration with the local health department, EMS, county nursing homes and home health agencies. The latest formal Community Needs Assessment was performed in 2014. Part VI, Line 3: A charity care policy is posted at all registration areas. All patients are seen or called by the financial counselors and/or the Customer Service Department to determine what services can be offered. The patients are screened for charity care and provided education about the state Medicaid application. Part VI, Line 4: The total population in Jackson County is 29,226, a 0.3% decrease between April 1 2010 to July 1, 2014. The percentage of persons over 65 years is 18.7% while that of the State is 17.3%, indicating that Jackson County has a slightly older population. Of the population in Jackson County, 50.8% of those are female, which is comparable with the State at 50.6%. Ninety-eight percent (98%) of the population in Jackson County is Caucasian (white), showing very little ethnic diversity in the county.The per capita money income in the past 12 months (2013 dollars) was $22,527 while that of the State was $22,966. Persons below the poverty level for Jackson County were 19%, while that number for the State was 17.9%.The median age in Jackson County is 41.13 years. For planning purposes, it should be noted that close to one-third of the population is in the 46-64 year-old age group and will reach retirement age over the next 20 years. This is a critical difference for health care needs assessment purposes. Part VI, Line 5: 1. The hospital's board of director members are all residents of Jackson County 2. The hospital extends medical staff privileges to qualified physicians and health care providers in the community who apply for priveleges. 3. No patient is turned away from the Emergency Department for financial reasons. The Emergency department is open 24 hours per day, 365 days per year. 4. The hospital invested $1,550,664 in capital improvements in FY 2014 to better serve the community. 5. Several local, non-profits conduct their meetings here at the JGH Learning Center facility free of charge. 6. The hospital is the leader in Jackson County for the collaborative group planning and drill meetings held for Disaster Preparedness. 7. Several members of the JGH Staff volunteer in the community in organizations such as Rotary, Pilot Club, Adopt-A-Family, etc. Part VI, Line 6: The organization is not part of an affiliated health care system. X X X X 0 0 0 0 0 0 0 0 0 Stephanie McCoy CEO 162303 0 0 0 0 0 0 0 11625 0 173928 0 0 0 Edward Stewart MD Emergency Physician 341131 0 0 0 0 0 0 0 6674 0 347805 0 0 0 Carl Overmiller MD General Surgeon 293482 0 0 0 0 0 11423 0 16607 0 321512 0 0 0 Jeffrey Barton DO General Surgeon 271420 0 0 0 0 0 10924 0 16575 0 298919 0 0 0 Theresa Simon MD Physician 174445 0 0 0 0 0 7062 0 16406 0 197913 0 0 0 Jackie Denemark PharmD Director of Pharmacy 146304 0 0 0 0 0 5778 0 11570 0 163652 0 0 0 Form 990, Part VI, Section B, line 11 The 990 is reviewed by the CEO and CFO and a copy is provided to members of the finance/executive committee before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization requires all board members, officers, key employees, and committee members to annually review and fill out a form which verifies compliance with the written conflict of interest policy. The signing of this document occurs immediately after the annual meeting. Form 990, Part VI, Section B, line 15 The finance committee of the board of directors and the CEO meet annually to discuss compensation of senior administrative staff. Several reliable external sources are used to gather data for this meeting including economic data and comparable salaries. A decision is then made after thorough discussion. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available to anyone in the public upon request. Also, the financial statements are published as a legal advertisement annually in the Jackson Herald/Star News. Form 990, Part IX, line 11g Professional fees: Program service expenses 289,093. Management and general expenses 75,785. Fundraising expenses 0. Total expenses 364,878. Other fees: Program service expenses 371,637. Management and general expenses 97,424. Fundraising expenses 0. Total expenses 469,061. Emergency Department Services: Program service expenses 989,683. Management and general expenses 259,443. Fundraising expenses 0. Total expenses 1,249,126. Radiology and Nuclear Medicine: Program service expenses 497,879. Management and general expenses 130,518. Fundraising expenses 0. Total expenses 628,397. Lab Services: Program service expenses 305,434. Management and general expenses 80,069. Fundraising expenses 0. Total expenses 385,503.