2015-08-17T10:34:11-05:00 2014-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2013-10-01 550462730 Community Health Association dba Jackson General Hospital COMM 3043722731 PO Box 720 Pinnell Street Ripley WV 25271 Stephanie L McCoy CEO 3043722731 2015-08-17 1 Harry C Harless P01042847 3043460441 2013 2016-04-25 22:37:26Z Jackson General Hospital Stephanie L McCoy PO Box 720 Pinnell Street Ripley WV 25271 29101555 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 15 342 47 0 0 44508 16135 27787605 28728345 -65681 200 509037 356875 28275469 29101555 0 0 0 0 14213537 15610464 0 0 0 12989725 12138267 27203262 27748731 1072207 1352824 6372475 8396910 5927179 6598790 445296 1798120 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 23299488 28719908 Services provided included 4,415 inpatient days, 11,592 emergency room visits, and 15,209 rural health clinic visits. Charity care for the year amounted to $974,423. 43576 8437 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. 23343064 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 35 0 1 342 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 CFO 3043731476 PO Box 720 Pinnell St Ripley WV 25271 Rob Fisher Chairman 3.00 X 0 0 0 Tom Weyer Vice Chairman 3.00 X 0 0 0 John Gorrell Treasurer 3.00 X 0 0 0 Dr James Gaal Secretary 3.00 X 0 0 0 Mitch Carmichael Director 3.00 X 0 0 0 Lee Corder Director 3.00 X 0 0 0 Naoma Fisher Director 3.00 X 0 0 0 Luke Hunter Director 3.00 X 0 0 0 Keith Rake Director 3.00 X 0 0 0 Todd Ritchie Director 3.00 X 0 0 0 Becky Scarberry Director 3.00 X 0 0 0 Sarah Brown Director 3.00 X 0 0 0 Dick Waybright Director 3.00 X 0 0 0 Joe Parsons Director 3.00 X 0 0 0 Dr James T Hughes Director 3.00 X 0 0 0 Stephanie McCoy CEO 40.00 X 149552 0 11494 Angela D Frame CFO 40.00 X 106124 0 8002 Edward Stewart Emergency Physician 40.00 X 313485 0 6126 Carl Overmiller General Surgeon 40.00 X 275026 0 6126 Jeffrey Barton General Surgeon 40.00 X 274997 0 16453 Paul Nielsen Emergency Physician 40.00 X 244800 0 11494 Michael McIntosh Physician 40.00 X 230050 0 0 1594034 0 59695 9 0 1 0 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Services 438945 Ohio Valley Physicians PO Box 390 Huntington WV 25708 Emergency Physician Services 331145 LabCorp of America PO Box 12140 Burlington NC 27216 Laboratory Services 236248 American Red Cross PO Box 33093 Newark NJ 07188 Blood Services 211051 CAMC Labworks PO Box 388 Charleston WV 25323 Laboratory Services 208287 7 5000 11135 16135 Patient services 621990 28336311 28336311 Walmart clinic 621990 392034 392034 28728345 200 200 105469 0 105469 105469 105469 Cafeteria & Vending 722210 121462 121462 Rebates and discounts 900099 45902 45902 84042 84042 251406 29101555 28728345 0 357075 294981 230557 64424 11658417 9112219 2546198 145826 113978 31848 2650196 2071393 578803 861044 672992 188052 47192 47192 88211 88211 2488050 2488050 94571 73917 20654 1562141 1220969 341172 477520 373230 104290 329121 257241 71880 13146 10275 2871 133767 104552 29215 497811 389089 108722 454655 355358 99297 Bad Debts 3374997 3374997 Medical Supplies 1883111 1883111 Medicaid Provider Tax 436989 436989 Dues & Subscriptions 44513 34791 9722 212472 139356 73116 27748731 23343064 4405667 0 107719 325226 9089 16983 3554089 4158916 187464 212600 194867 311084 15019402 11661076 2301536 3358326 17711 13775 6372475 8396910 3499063 2964151 1756474 1577131 671642 2057508 5927179 6598790 X 445296 1798120 445296 1798120 6372475 8396910 1352824 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92189 92189 5638686 4404388 1234298 8856354 6918517 1937837 432173 338171 94002 3358326 Capital leases 826770 Estimated third-party payor settlements 742288 Line of credit 463450 Malpractice Claim Contingent Liability 25000 2057508 25756102 39216 39216 25716886 3384669 3384669 29101555 24364062 0 24364062 3384669 3384669 27748731 Part XI, Line 2d - Other Adjustments: Foundation income not included on financial statements 39,216. Part XI, Line 4b - Other Adjustments: Bad debts netted against income in financial statements 3,374,997. Grant expenses netted against grant income on financial statements 9,672. Part XII, Line 4b - Other Adjustments: Bad debts netted against income in financial statements 3,374,997. Grant expenses netted against grant income on financial statements 9,672. 1 1 X 1 X 0 1 1 0 0 316980 316980 4831344 4831344 5148324 5148324 7 309 43576 8437 35139 0.00130 7 309 43576 8437 35139 0.00130 7 309 5191900 5156761 35139 0.00130 0 1097887 4813049 4813049 X 1 1 1 1 Jackson General Hospital PO Box 720 Ripley WV 25271 X X X X Jackson General Hospital 1 1 X X X X X X X X X 12 1 0 1 X www.jacksongeneral.com X X X X X X X X X 1 0 1 1 200.000000000000 0 1 X X X X X X X 1 1 X X X X X X X 1 0 X X X X X 1 X 0 0 Jackson General Hospital Part V, Section B, Line 3: 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 5d: Copies were provided to all participants in the study. Jackson General Hospital Part V, Section B, Line 7: The Hospital has been recruiting specialists to meet the needs identified, but have not been successful in all placements. The Hospital has added a gynecologist but hasn't been able to recruit a pediatrician. 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 14g: 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 18e: 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 20d: 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%. 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 $ 1,097,887. Part III, Line 2: The cost of bad debts was estimated using a cost to charge ratio derived from Worksheet 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 2012. 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 29,211, a 4.3% increase over the 2000 census. The percentage of persons over 65 years is 17.7% while that of the State is 16.0%, indicating that Jackson County has a slightly older population. Of the population in Jackson County, 50.6% of those are female, which is comparable with the State at 50.7%. Ninety-eight point two percent (98.2%) 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 (2010 dollars) was $20,633 while that of the State was $21,232. Persons below the poverty level for Jackson County were 18.1%, while that number for the State was 17.4%.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 149552 0 0 0 0 0 0 0 12787 0 162339 0 0 0 Edward Stewart Emergency Physician 313485 0 0 0 0 0 0 0 6277 0 319762 0 0 0 Carl Overmiller General Surgeon 275026 0 0 0 0 0 0 0 6277 0 281303 0 0 0 Jeffrey Barton General Surgeon 274997 0 0 0 0 0 0 0 16603 0 291600 0 0 0 Paul Nielsen Emergency Physician 244800 0 0 0 0 0 0 0 11645 0 256445 0 0 0 Michael McIntosh Physician 230050 0 0 0 0 0 0 0 150 0 230200 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.