2012-05-14T08:42:29-05:00 2011-09-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-10-01 550422958 STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY STON 3042698059 230 HOSPITAL PLAZA WESTON WV 26452 Dodie Arbogast 3042698059 2012-05-04 1 Harry C Harless 3043460441 2010 2016-02-24 21:20:13Z Avah L Stalnaker 230 HOSPITAL PLAZA WESTON WV 26452 51317306 0 X www.stonewallhospital.com X 1959 WV The mission is to provide quality medical care to the citizens of Lewis and surrounding counties regardless of the patient's ability to pay. To enable the citizens of our service area to receive quality care close to home. 9 8 530 45 12337 11337 56866 79133 39331770 42984578 989387 1336593 203771 224496 40581794 44624800 35400 33430 0 0 21776127 23888959 0 0 0 16750135 17403206 38561662 41325595 2020132 3299205 57875135 58409902 8198777 7588125 49676358 50821777 X It is the mission of Stonewall Jackson Memorial Hospital to provide the best possible combination of primary care in a safe, efficient, and compassionate manner. It is, and always shall be, our duty to assess the quality of care provided and to continue to seek methods of improving both our evaluation of and delivery of patient care. It is our unswerving faith in this mission that assures our role as a vital community hospital and as an economic resource for our community. 0 0 29034063 42933578 Stonewall Jackson Memorial Hospital provides Acute medical and outpatient services to residents of Weston, West Virginia and surrounding communities which covers 9 different counties. Services included 10,675 days of inpatient care, 81,702 outpatient visits, 15,129 emergency room visits, 1,548 ambulatory surgery visits, 4,755 Home Health visits and 35,829 Physician Clinic visits. 42000 26000 Annual blood screening: Stonewall Jackson Memorial Hospital provides all supplies and staff to operate the program. Excess revenue is forwarded to the local Rotary Club to promote charitable services. Other programs include: Glucose & blood pressure screenings at local Senior Center, Scoliosis screening at county elementary and middle schools, free sports physicals to middle school and high school students, October fest program to promote healthy choices to childrenunder 12 years old, events for free Osteoporosis screenings, events for free Dermascans to screen for skin cancer, and Weston Walk-run to promote exercise as a way to improve cardiac health; free women's health screening for breast and cervical cancer, free hearing screenings. 27700 20000 25000 William Adler Scholarship Fund - Stonewall Jackson Memorial Hospital sponsored program to provide scholarships to local graduating high school seniors who are pursuing career in the health care field through an accredited program. It is hoped that this program will encourage more students to seek health care professions and lessen the health care staffing shortage. 2600 Relay for Life sponsor 2600 29106363 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 61 0 1 530 1 1 1 0 0 0 0 1 1 0 0 0 0 X 9 8 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Dodie Arbogast 3042698050 230 Hospital Plaza Weston WV 264528558 John Law 1.00 X 0 0 0 Joseph Snead 40.00 X 240041 0 22065 R Gerald Wood 1.00 X 0 0 0 Denver Turner 1.00 X 0 0 0 Jean Bennett 1.00 X 0 0 0 R G Lockard 1.00 X 0 0 0 Richard Cronin 1.00 X 0 0 0 Robin Poling 1.00 X 0 0 0 Debbie Bennett 1.00 X 0 0 0 David Shaffer 40.00 X 298096 0 24967 Avah Stalnaker 40.00 X 148324 0 11689 Delphia Arbogast 40.00 X 108593 0 15492 Peter Edgerton 40.00 X 425132 0 27303 John Wyllie 40.00 X 401792 0 24363 Antoine Naim 40.00 X 353030 0 27714 Mario Estolano 40.00 X 291132 0 18830 John Burdette 40.00 X 279114 0 24018 2545254 0 196441 30 0 1 0 Mountain Radiology Services 21 W Third Street Washington MO 63090 Radiology 445200 Lab Corp PO Box 12140 Burlington NC 27216 Laboratory Services 322916 CPS PO Box 1000 Memphis TN 38148 Consulting 238158 Sodexo PO Box 936522 Atlanta GA 503536922 Consulting 216342 Arnett & Foster PO Box 2629 Charleston WV 25329 Accounting 140493 8 19701 59432 79133 Patient Services 622110 42984578 42984578 42984578 1322597 1322597 47173 13800 66736 1463 -19563 12337 -7226 12337 -19563 6624244 6359 6616607 7637 6359 13996 13996 5280 19701 7700 -2420 -2420 Cafeteria Sales 722310 125470 125470 Vending Machines 454210 70802 70802 Miscellaneous 900099 37870 37870 234142 44624800 42984578 12337 1548752 13430 13430 20000 20000 875499 591312 284187 19838964 13399236 6439728 734628 496168 238460 1168973 789525 379448 1270895 858362 412533 93295 93295 138057 138057 52301 52301 1257491 849309 408182 155692 105154 50538 7426920 5014452 2412468 75494 50989 24505 647732 437478 210254 69999 47277 22722 77203 52143 25060 1716021 1159001 557020 173645 117280 56365 Bad Debts 3803011 3803011 0 Repairs & Maintenance 878019 593014 285005 Medicaid Provider Tax 321653 321653 0 Continuing Education 153193 103467 49726 Dues & Subscriptions 122030 82419 39611 241450 201683 39767 41325595 29106363 12219232 0 162232 249191 23096 663502 6631588 7871244 1068843 1047805 342751 354012 32203130 22851526 9864500 9351604 38342445 37347792 75402 75402 1364278 1449350 57875135 58409902 5962876 6007407 26758 191227 2209143 1389491 8198777 7588125 X 49676358 50821777 49676358 50821777 57875135 58409902 X 3299205 -2153786 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 646015 646015 11661275 8995430 2665845 18922058 13856096 5065962 973782 973782 9351604 44624800 41325595 3299205 -2153786 -2153786 1145419 44557553 9163 9163 44548390 76410 76410 44624800 41258348 9163 9163 41249185 76410 76410 41325595 Description of Uncertain Tax Positions Under FIN 48: Part X: The organization had no uncertain tax positions under Fin 48 as reported in the financial statements. Part XII, Line 2d - Other Adjustments: Van rent depreciation included in expenses on the financial statements 1,463. Fundraising expenses included in expenses on the financial statements 7,700. Part XII, Line 4b - Other Adjustments: Scholarships netted against donations in the financial statements 20,000. Investment fees netted with investment income in financial statements 52,301. Gain included in expenses on the financial statement 4,109. Part XIII, Line 2d - Other Adjustments: Van rent depreciation included in expenses on the financial statements 1,463. Fundraising expenses included in expenses on the financial statements 7,700. Part XIII, Line 4b - Other Adjustments: Scholarships netted against donations in the financial statements 20,000. Investment fees netted with investment income in financial statements 52,301. Gain included in expenses on the financial statement 4,109. Charity Golf Tournament 24981 19701 5280 1000 6152 548 24981 19701 5280 1000 6152 548 7700 -2420 1 1 X 0 0 1 1 1 0 0 593666 0 593666 0.01580 8333639 6678838 1654801 0.04410 570791 90559 480232 0.01280 9498096 6769397 2728699 0.07270 9 2700 42000 26000 16000 0.00040 3 32 27300 10800 16500 0.00040 5770 0 5770 0.00020 12 2732 75070 36800 38270 0.00100 12 2732 9573166 6806197 2766969 0.07370 118937 118937 0.00320 118937 118937 0.00320 0 1564939 8202753 8384925 -182172 X 1 1 1 1 Stonewall Jackson Memorial Hospital

230 Hospital Plaza Weston WV 26452

X X X Stonewall Jackson Memorial Hospital 1 0 0 0 1 X X X 0 1 X X X 0 0 1 0 0 Part I, Line 3c: WV food stamp eligibility guidelines are used. We have signes posted at registration, around and in the emergency department and in all physician clinics. We send letters to patients who are not paying their bills. We give the application to private pay inpatients. We also tell the patients when during telephone conversations if the patient indicates he/she is not able to pay the bill or pay all of the bill. Part I, Line 7: The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The unreimbursed cost of Medicaid was 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 $ 3803011. Part II: We recruit physicians to this area based entirely on what services the patients need. Our goal is to be able to provide physicians who can address these needs in the community. 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 collectibility. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable Part III, Line 9b: Our collections policy applies to all patients regardless of financial class or any other classification. During our collections process, if the patient indicates they do not have the ability to pay their bill, the credit staff offers exoneration. Part VI, Line 3: We have signs posted at Registration, around and in the Emergency Department and in all physician clinics. We send letters to patients who are not paying their bills. We give the application to Private Pay inpatients. We tell the patients when during telephone converations if the patient indicates he/she is not able to pay the bill or pay all of the bill. Part VI, Line 4: Stonewall Jackson Memorial Hospital serves a relatively large rural population of about 65,000 people with an average household income of $32,000. 30% of the population is disabled. Approximately 30% are Medicaid Eligible or are uninsured. We are the largest hospital in our service area, which includes two other hospitals, one being a Critical Access Hospital. We are located in a federally-designated medically underserved area. Part VI, Line 6: Stonewall Jackson Memorial Hospital (SJMH) is a 70 bed rural acute hospital located in Lewis county West Virginia. SJMH is the only hospital located in the county as such it is solely responsible for the healthcare of this rural community. SJMH provides 24 hours Emergency Room and Obstetrics services and provides care regardless of the patient's ability to pay. The majority of the governing body is comprised of community members. Medical privileges are offered to all qualified physicians in the community and SJMH has worked diligently to provide other physician services by expanding the services they provide.SJMH continues to make capital improvement to the facility and expand patient care services to meet the needs of the community. 1 Rotary Club of Weston PO Box 222 Weston WV 26452 550371556 501(c) (4) 13430 The purpose of the donation is to promote charitable services. Nursing School Scholarships for recent high school graduates. 24 20000 1 X X 0 0 0 0 0 0 0 0 0 Joseph Snead 240041 0 0 0 0 0 12002 0 11921 0 263964 0 0 0 David Shaffer 298096 0 0 0 0 0 14905 0 12210 0 325211 0 0 0 Avah Stalnaker 148324 0 0 0 0 0 7416 0 5520 0 161260 0 0 0 Peter Edgerton 425132 0 0 0 0 0 21257 0 8314 0 454703 0 0 0 John Wyllie 401792 0 0 0 0 0 20090 0 6420 0 428302 0 0 0 Antoine Naim 353030 0 0 0 0 0 17652 0 12326 0 383008 0 0 0 Mario Estolano 291132 0 0 0 0 0 14557 0 6393 0 312082 0 0 0 John Burdette 279114 0 0 0 0 0 13956 0 11469 0 304539 0 0 0 Form 990, Part VI, Section A, line 3 Management duties customarily are performed under the direct supervision of officers, directors, trustees or key employees, but the Hospital has contracted out the management duties of the Maintenance department. The manager of the Maintenance department (also considered a department head) is employed by the Maintenance company. All other Maintenance staff are employees of the Hospital. The Hospital contracts out the management duties of the Pharmacy department. The manager of the Pharmacy department (also considered a department head) is employed by the Pharmacy company. All other Pharmacy staff are employees of the Hospital. Form 990, Part VI, Section B, line 11 The process the Hospital uses to review their 990 before filing with the IRS is the CFO is responsible for reviewing the form 990 for completeness and accuracy. A completed copy is provided for the board. It is then signed and submitted to the IRS. Form 990, Part VI, Section B, line 12c All board members disclose possible conflicts of interest prior to appointment and periodically throughout their terms as trustees. Form 990, Part VI, Section B, line 15 The Hospital obtains salary survey data. Performance evaluations are done on each of these personnel & financial conditions are considered. Form 990, Part VI, Section C, line 19 The Hospital places a publication in the local newspaper stating the governing documents, conflicts of interest policy and financial statements are available upon request. The policies and procedures are on the Stonewall Jackson website. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -2,153,786. Clarification of 'yes' response Form 990, Part XII, Line 2c The organization has not changed its process for oversight of the audit during the year. Stonewall Home Oxygen Therapy Inc 100 Market Place Mall Suite 8 Weston WV 26452 550754278 Oxygen Therapy Services WV N/A C 17975 331212 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 Stonewall Home Oxygen Therapy Inc A 55707 Stonewall Home Oxygen Therapy Inc P 247837 Stonewall Home Oxygen Therapy Inc Q 30385