2016-08-15T13:30:20-05:00 2015-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2014-10-01 550462730 Community Health Association dba Jackson General Hospital COMM 3043722731 PO Box 720 Pinnell Street Ripley WV 25271 Angela Frame Interim CEO 3043722731 2016-08-15 1 Tessa W Carr P01291277 3043460441 2014 2016-09-27 15:27:22Z Jackson General Hospital Angela Frame PO Box 720 Pinnell Street Ripley WV 25271 30898850 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 15 340 38 0 0 16135 19945 28728345 30501979 200 -29381 356875 376519 29101555 30869062 0 0 0 0 15610464 15832944 0 0 0 12138267 13619812 27748731 29452756 1352824 1416306 8396910 10938154 6598790 7723728 1798120 3214426 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 24060499 30744224 Services provided included 3,692 inpatient days, 11,489 emergency room visits, 30,656 outpatient visits, and 12,451 rural health clinic visits. Charity care for the year amounted to $507,203. 66419 1603 The organization provided several community health improvement services including free breast cancer screenings, lunch and learn programs, patient/community resource center, free sports physicals, prostate screenings, cardiac kits, advance directives presentations, CPR classes, diabetic counseling, dinner discussions, health fairs and various other programs. 24126918 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 74 0 340 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 Interim CEO 3043731476 PO Box 720 Pinnell St Ripley WV 25271 Robert Fisher Chairman 3.00 X X 0 0 0 Tom Weyer Vice Chairman 1.00 X X 0 0 0 John Gorrell Treasurer 1.00 X X 0 0 0 Dr James Gaal Secretary 1.00 X X 0 0 0 Mitch Carmichael Director 0.50 X 0 0 0 Lee Corder Director 0.50 X 0 0 0 Naoma Fisher Director 1.00 X 0 0 0 Luke Hunter Director 0.50 X 0 0 0 Keith Rake Director 1.00 X 0 0 0 Todd Ritchie Director 1.00 X 0 0 0 Becky Scarberry Director 0.50 X 0 0 0 Sarah Brown Director 0.50 X 0 0 0 Gareth Smith Director 0.50 X 0 0 0 Joe Parsons Director 1.00 X 0 0 0 Dr James T Hughes Director 0.50 X 0 0 0 Stephanie McCoy CEO (termed 5/6/2016) 40.00 X 153739 0 0 Angela D Frame President/Interim CEO 40.00 X 125040 0 15149 Edward Stewart Emergency Physician 40.00 X 378924 0 5734 Carl Overmiller General Surgeon 40.00 X 275097 0 15741 Jeffrey Barton General Surgeon 40.00 X 270019 0 25066 Paul Nielsen Emergency Physician 40.00 X 259165 0 20129 Stephan Ulaki Emergency Physician 40.00 X 271545 0 6668 1733529 0 88487 13 0 1 0 Emergency Providers of Parkersburg 5 Foxboro Drive Vienna WV 26105 Emergency Physician Services 301140 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Services 298305 LabCorp of America PO Box 12140 Burlington NC 27216 Laboratory Services 278093 American Red Cross PO Box 33093 Newark NJ 07188 Blood Services 181795 Ohio Valley Physicians PO Box 390 Huntington WV 25708 Emergency Physician Services 155050 8 19945 19945 Patient Services 621990 30066671 30066671 Walmart clinic 621990 435308 435308 30501979 407 407 102883 0 102883 102883 102883 29788 -29788 -29788 -29788 Cafeteria & Vending 722210 127906 127906 Rebates and discounts 900099 92955 92955 Medical Record Transcription 900099 7851 7851 44924 44924 273636 30869062 30745827 0 103290 302571 238305 64266 11478195 9040226 2437969 186996 147278 39718 3008056 2369145 638911 857126 675072 182054 74859 74859 113498 113498 2812403 2215048 597355 103174 81260 21914 1516647 1194511 322136 1063138 837327 225811 418417 329545 88872 9800 7718 2082 156220 123039 33181 904792 712614 192178 449685 354172 95513 Bad Debts 3020402 3020402 Medical Supplies 1657371 1657371 Charity Care Expenses 507203 507203 Medicaid Provider Tax 394601 394601 417602 222081 195521 29452756 24126918 5325838 0 325226 199497 16983 7862 4158916 4361708 212600 230272 311084 378113 16234141 11901533 3358326 4332608 13775 1428094 8396910 10938154 2964151 3735194 1577131 1612896 2057508 2375638 6598790 7723728 X 1798120 3214426 1798120 3214426 8396910 10938154 1416306 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92189 92189 6028568 4445223 1583345 9679726 7137349 2542377 433658 318961 114697 4332608 Estimated third party payor settlements 1418254 Loan costs net 9840 1428094 Capital leases 1219557 Line of credit 1106764 Malpractice Claim Contingent Liability 49317 2375638 27378453 36996 36996 27341457 3527605 3527605 30869062 25925151 0 25925151 3527605 3527605 29452756 Part XI, Line 2d - Other Adjustments: Foundation income not included on 990 36,996. Part XI, Line 4b - Other Adjustments: Bad debts and charity care netted against income in financial statements 3,527,605. Part XII, Line 4b - Other Adjustments: Bad debts and charity care netted against income in financial statements 3,527,605. Part X, Line 2 The Hospital, which is not classified as a private foundation, is exempt from Federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code and similar state statutes relating to not-for-profit organizations. The Hospital is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The management of the Hospital believes it is no longer subject to income tax examinations for years prior to the fiscal year ended September 30, 2012. 1 1 X 1 X 0 1 1 0 0 177356 177356 5222483 5222483 5399839 5399839 66419 1603 64816 0.00250 66419 1603 64816 0.00250 5466258 5401442 64816 0.00250 0 1056157 5422786 5422786 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 0 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 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. Jackson General Hospital Part V, Section B, Line 22d: Patients who apply and are approved for financial assistance for each service date reviewed, are not billed for those services. These bills are written off at 100%. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Jackson General Hospital Part V, Section B, line 16a website: http://www.jacksongeneral.com/for-visitors---patient-financial-services.php 2 Morad Hughes Health Center PO Box 720 122 Pinnell St Ripley WV 25271 Hospital-based rural health center 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 dicount 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 $ 3,020,402. Part III, Line 2: The cost of bad debt was estimated using the cost to charge ratio from Schedule 2 of the Schedule H instructions. 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 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 X 0 0 0 0 0 0 0 0 0 Stephanie McCoy CEO (termed 5/6/2016) 153739 0 0 0 0 0 0 0 0 0 153739 0 0 0 Edward Stewart Emergency Physician 378924 0 0 0 0 0 0 0 6705 0 385629 0 0 0 Carl Overmiller General Surgeon 275097 0 0 0 0 0 10008 0 6705 0 291810 0 0 0 Jeffrey Barton General Surgeon 270019 0 0 0 0 0 9804 0 16233 0 296056 0 0 0 Paul Nielsen Emergency Physician 259165 0 0 0 0 0 9461 0 11640 0 280266 0 0 0 Stephan Ulaki Emergency Physician 271545 0 0 0 0 0 0 0 7639 0 279184 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.