2012-05-14T11:07:12-05:00 2011-06-30 PERSHING YOAKLEY & ASSOCIATES P C ONE CHEROKEE MILLS 2220 SUTHERLAND KNOXVILLE TN 379192363 990 2010-07-01 540544705 JOHNSTON MEMORIAL HOSPITAL INC JOHN 2762581000 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 JOHN L JETER 2762581000 2012-05-14 1 DEBORAH O ERNSBERGER 8656730844 2010 2016-02-24 21:20:13Z X JOHN L JETER 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 116176964 0 X HTTP://WWW.JMH.ORG X 1917 VA TO RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. 15 10 0 80 9355 7519 85272 18506 105584171 111418571 6294232 3914394 382119 635944 112345794 115987415 88355 90098 0 0 45020126 48436329 0 0 3393 58620461 58964455 103728942 107490882 8616852 8496533 321503562 349751817 49582770 64585564 271920792 285166253 X JOHNSTON MEMORIAL HOSPITAL, INC. 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. 0 0 74166645 90098 111418571 JOHNSTON MEMORIAL HOSPITAL ("HOSPITAL") IS A TAX-EXEMPT COMMUNITY-BASED HOSPITAL, WHICH IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. TEAM MEMBERS OF JOHNSTON MEMORIAL HOSPITAL RECOGNIZE A CORE SET OF VALUES TO HELP ASSURE OUR PATIENTS RECEIVE HIGH QUALITY AND COMPASSIONATE CARE AT A REASONABLE COST. THESE VALUES ARE:- INTEGRITY - HONESTY IN EVERYTHING WE DO- SERVICE - WITH CARING AND COMPASSION- LEADERSHIP - WITH CREATIVITY AND INNOVATION- EXCELLENCE - ALWAYS PURSUING A HIGHER STANDARDIN FISCAL YEAR 2010, JOHNSTON MEMORIAL HOSPITAL PROVIDED PATIENT CARE TO OVER 5,883 IN-PATIENTS, REPRESENTING 22,427 INPATIENT DAYS AND 1,311 NEWBORN DAYS. WE ALSO PROVIDED OUTPATIENT SERVICES TO OVER 154,021 PATIENTS. CARE GIVEN TO MEDICARE AND MEDICAID PATIENTS MAKE UP APPROXIMATELY 67% OF THE HOSPITAL'S TOTAL PATIENT REVENUE.COMMUNITY HEALTH EDUCATION AND OTHER COMMUNITY SUPPORTRECOGNIZING OUR MISSION TO THE COMMUNITY IN THE AREA OF HEALTHCARE EDUCATION, JOHNSTON MEMORIAL HOSPITAL AND ITS TEAM MEMBERS OFFER MANY FREE PROGRAMS THROUGHOUT THE YEAR AIMED AT IMPROVING COMMUNITY HEALTH. WE OFFERED THE FOLLOWING EDUCATIONAL CLASSES AND PROGRAMS:- ONGOING CANCER EDUCATION CLASSES- ONGOING DIABETES EDUCATION- ADVANCED CARDIAC LIFE SUPPORT CERTIFICATION COURSE- PEDIATRIC ADVANCED LIFE SUPPORT CERTIFICATION COURSE- CARDIO PULMONARY RESUSCITATION CERTIFICATION COURSE- TOTAL JOINT CLASSES- BABY ON THE WAY, BREASTFEEDING, PARENTING COURSES- ANNUAL BABY FAIR- PROSTATE CANCER SCREENING- AED TRAINING AND EDUCATION- DIABETES EDUCATION HEALTH FAIR- HEART SAVER FIRST AID CLASSES FOR DAY CARE, SCHOOLS, CHURCHES, ETC.- MONTHLY LUNCH AND LEARN AT LOCAL RECREATION CENTER- HEALTHY COOKING DEMONSTRATION- ANNUAL SPORTS PHYSICALS FOR LOCAL HIGH SCHOOLSWE SPONSORED OR ASSISTED LOCAL SUPPORT GROUPS IN THE FOLLOWING PROGRAMS:- HEART-TO-HEART EDUCATIONAL SUPPORT GROUP- CANCER EDUCATION SUPPORT GROUP- DIABETES EDUCATION SUPPORT GROUP- RESOLVE THROUGH SHARING SUPPORT GROUP - FOR THOSE GRIEVING THE LOSS OF NEWBORNS- ANNUAL ASTHMA CAMP- LADIES NIGHT OUT (BREAST CANCER AWARENESS EVENT)JOHNSTON MEMORIAL HOSPITAL RECOGNIZES THE IMPORTANCE OF HEALTHCARE EDUCATIONAL PROGRAMS TOWARD PROVIDING QUALITY HEALTHCARE TO OUR COMMUNITIES. IN FISCAL YEAR 2010, WE SUPPORTED A NURSING INSTRUCTOR POSITION AT THE LOCAL COMMUNITY COLLEGE TO ASSIST IN MAINTAINING AND DEVELOPING THE NURSING PROGRAM. IN ADDITION, WE PROVIDED A CLINICAL SETTING FOR MANY STUDENTS TRAINING IN HEALTH RELATED PROGRAMS SUCH AS REGISTERED NURSING, LICENSED PRACTICAL NURSING, RADIOLOGY, LAB, AND RESPIRATORY. JOHNSTON MEMORIAL HOSPITAL ALSO RECOGNIZES THE IMPORTANCE OF SUPPORTING OUR NOT-FOR-PROFIT COMMUNITY BASED ORGANIZATIONS IN FUNDRAISING AND OTHER EVENTS. THE HOSPITAL AND OUR EMPLOYEES CONTRIBUTED OVER $150,000 IN CASH AND IN-KIND CONTRIBUTIONS TO OUR COMMUNITY IN FISCAL YEAR 2009 TO SUCH ORGANIZATIONS AS THE AMERICAN LUNG ASSOCIATION, MARCH OF DIMES, UNITED WAY, RELAY FOR LIFE CANCER FUNDRAISER, AND MANY OTHERS. 74166645 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 123 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 15 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X JOHN L JETER 2762581000 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 BARBARA ALLEN 1.00 X 0 0 0 PAUL ARMSTRONG MD 1.00 X 0 301203 20826 OTEY DUDLEY 1.00 X 0 0 0 W HOUSTON FERGUSON III 1.00 X 0 0 0 ANN FLEMING 1.00 X 0 442795 65589 J THOMAS FOWLKES 1.00 X 0 0 0 DON JEANES 1.00 X 0 0 0 BRENDAN MCSHEEHY JR 1.00 X 0 0 0 EMORY ROBINETTE MD 1.00 X 15000 0 0 MARY RUSSELL 1.00 X 0 0 0 MIKE SPIEGLER 1.00 X 0 0 0 LARAMIE TRIPLETT MD 1.00 X 0 72476 0 CHARLES SYDNOR 1.00 X 0 0 0 WILLIAM WALKER MD 1.00 X 0 612004 1615 CHRIS WALTERS 1.00 X 0 0 0 SEAN S MCMURRAY 55.00 X 0 308937 47024 TIMOTHY G EVANS 55.00 X 0 177232 21837 STEPHEN K GIVENS 55.00 X 0 185431 27884 STEPHEN BLANKENSHIP MD 55.00 X 0 307975 31311 ANN CHANG MD 55.00 X 0 309604 24455 DAVID SIMMONS MD 55.00 X 0 296614 24936 ANDREW HAWKINS MD 55.00 X 0 296855 31202 STEVEN SIKORA MD 55.00 X 0 293497 22910 15000 3604623 319589 0 0 1 0 VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON VA 24210 ANESTHESIA 2367380 EARL SWENSSON ASSOCIATES PO BOX 410628 NASHVILLE TN 37241 CONSTRUCTION DESIGN 785645 MEDIAS LLC PO BOX 10452 BLACKSBURG VA 24062 SLEEP STUDY 587690 ABINGDON PHYS AMB SURG MGMT GROUP 613 CAMPUS DRIVE STE 300 ABINGDON VA 24210 ASC MANAGEMENT 524488 BLUE RIDGE MEDICAL SPECIALISTS PC 271 MEDICAL PARK BLVD BRISTOL TN 37620 ONCOLOGY 439450 11 10931 7575 18506 NET PATIENT REVENUE 621500 111116967 111108202 8765 PARTNERSHIP INCOME 561000 301604 590 301014 111418571 3854655 3854655 233707 233707 233707 233707 242476 6812 189549 52927 6812 59739 59739 CAFETERIA 722100 147589 147589 MANAGEMENT FEE 561000 144635 144635 PURCHASE DISCOUNTS 900099 49886 49886 60127 60127 402237 115987415 111108202 9355 4851352 90098 90098 774306 16250 758056 40836640 33529849 7306791 1444331 1203865 240466 3052068 2936609 115459 2328984 2199820 129164 53663 53663 358857 358857 79945 79945 160286 160286 9924246 6762867 3157986 3393 312964 250649 62315 2288935 1831977 456958 918867 908170 10697 2277133 2102154 174979 105420 96187 9233 90541 77865 12676 2178653 2178653 13442260 35468 13406792 -432152 17543 -449695 MEDICAL SUPPLIES & DRUG 20151425 19372188 779237 MANAGEMENT FEES 3605782 3605782 REPAIRS & MAINTENANCE 2367528 2350047 17481 BAD DEBT 585686 585686 OTHER 491117 385039 106078 3299 3299 107490882 74166645 33320844 3393 10247304 2305269 1545175 18087850 16224301 1397394 984575 3820438 4049872 1073714 822058 226744008 46362239 107819626 180381769 86216282 116676009 35200 35200 91260579 28272764 321503562 349751817 16442094 18255842 15240000 14115000 17900676 32214722 49582770 64585564 X 271920792 285151875 14378 271920792 285166253 321503562 349751817 X 8496533 4748928 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5009848 5009848 1073610 643784 429826 935572 299942 635630 90339913 45416927 44922986 129385065 1586 129383479 180381769 OTHER ASSETS 525623 DUE FROM AFFILIATES 17967933 BOND INDENTURE AGREEMENT 3340591 MSHA 2009 PROJECT FUND 6438617 28272764 CAPITAL LEASE OBLIGATIONS 31564974 MEDICARE AND MEDICAID, NET 649748 32214722 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL AND APP ARE CLASSIFIED AS ORGANIZATIONS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AT JUNE 30, 2011, TAX RETURNS FOR FISCAL YEARS 2008 THROUGH 2010 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2011 AND 2010. AS SUCH, NO INTEREST OR PENALTIES ARE RECOGNIZED IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RELATED TO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 1 X 380.000000000000 1 1 1 0 1 1 1824766 0 1824766 0.01710 12904685 9434767 3469918 0.03250 494781 432933 61848 0.00060 15224232 9867700 5356532 0.05020 105857 0 105857 0.00100 397050 0 397050 0.00370 0 66430 66430 0.00060 569337 569337 0.00530 15793569 9867700 5925869 0.05550 23510 23510 0.00020 23510 23510 0.00020 1 2688088 1612853 35058170 42755290 -7697120 X 1 1 1 1 JOHNSTON MEMORIAL HOSTPITAL INC

351 COURT STREET NE ABINGDON VA 24210

X X X JOHNSTON MEMORIAL HOSPITAL INC 1 PART I, LINE 6A: MOUNTAIN STATES HEALTH ALLIANCE (MSHA) PREPARED AN ANNUAL WRITTEN REPORT THAT DESCRIBES THE ORGANIZATION'S PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. JMH, AS A MEMBER OF MSHA, IS INCLUDED IN MSHA'S REPORT. PART I, LINE 7: A COST TO CHARGE RATIO WAS DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PART I, L7 COL(F): BAD DEBT EXPENSE OF $585,686 IS INCLUDED IN THE STATEMENT OF FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, BUT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING PERCENTAGES ON PART 1, LINE 7, COLUMN F. PART II: THE ACTIVITIES REPORTED IN PART II SEEK TO ACHIEVE SPECIFIED OBJECTIVES, INCLUDING: IMPROVING ACCESS TO HEALTH SERVICES, ENHANCING PUBLIC HEALTH, AND RELIEF OF GOVERNMENT BURDEN. THE ACTIVITIES ARE AVAILABLE TO THE GENERAL PUBLIC, FOCUSING ON LOW-INCOME CONSUMERS. PART III, LINE 4: WORKSHEET A WAS USED FOR PART III, LINES 2 AND 3 IN DETERMINING BAD DEBT AT COST. JMH FOLLOWS THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION'S PRINCIPLES AND PRACTICES BOARD ISSUED STATEMENT 15: VALUATION AND FINANCIAL STATEMENT PRESENTATION OF CHARITY CARE AND BAD DEBTS BY INSTITUTIONAL HEALTHCARE PROVIDERS ("THE STATEMENT"). THE STATEMENT PROVIDES GUIDANCE ON COLLECTABILITY CRITERIA AND EMPHASIZES REVENUE RECOGNITION ONLY WHEN COLLECTIONS ARE REASONABLY ASSURED. FOOTNOTE DISCLOSURE FROM JMH'S FISCAL YEAR 2011 AUDITED FINANCIAL STATEMENT READS "IN NOVEMEBER 2006, THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION'S (HFMA) PRINCIPLES AND PRACTICES BOARD ISSUED STATEMENT 15: VALUATION AND FINANCIAL STATEMENT PRESENTATION OF CHARITY CARE AND BAD DEBTS BY INSTITUTIONAL HEALTHCARE PROVIDERS (THE "STATEMENT"). THE STATEMENT PROVIDES GUIDANCE ON COLLECTABILITY CRITERIA AND EMPHASIZES REVENUE RECOGNITION ONLY WHEN COLLECTIONS ARE REASONABLY ASSURED. THE HOSPITAL ADOPTED THE STATEMENT AND EVALUATED ITS REVENUE RECOGNITION POLICIES RELATED TO CERTAIN TYPES OF PATIENT REVENUE (PRIMARILY SELF-PAY). AS A RESULT, AMOUNTS PREVIOUSLY RECOGNIZED AS NET PATIENT SERVICE REVENUE AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS ARE NO LONGER RECOGNIZED AS NET PATIENT REVENUE AND ESTIMATED PROVISION FOR BAD DEBT IN THE ACCOMPANYING FINANCIAL STATEMENTS."TO FURTHER EXPLAIN JMH'S REPORTING OF BAD DEBT EXPENSE, JMH'S FINANCIAL STATEMENT ACCOUNTS FOR BAD DEBT EXPENSES IN TWO LOCATIONS. FIRST, A DEDUCTION FROM REVENUE LINE CALLED "CONTRA-REVENUE" CONTAINS THE MAJORITY OF JMH'S ESTIMATED SELF-PAY BAD DEBT. FOR FISCAL YEAR 2011, 95% OF TOTAL BAD DEBT WAS MOVED TO THIS LINE. THIS PERCENTAGE IS SIMPLY AN ESTIMATE OF WHAT PATIENT FINANCIAL SERVICES ANTICIPATES WILL NOT BE COLLECTED AFTER ALL DEBT COLLECTION EFFORTS HAVE BEEN EXHAUSTED. THIS ESTIMATE IS BASED ON HISTORICAL INFORMATION. THE REMAINING 5% OF BAD DEBT IS RECORDED IN THE EXPENSE SECTION APPROPRIATELY CALLED "BAD DEBT". THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENT REPORT THE AMOUNT OF ESTIMATED UNCOLLECTIBLE SELF-PAY AND EXPLAINS THAT UNCOLLECTIBLE PATIENT ACOUNTS RECEIVABLE ESTIMATED RESERVES ARE BASED UPON PRIOR COLLECTION HISTORY FOR GROUPS OF RECEIVABLES, KNOWN COLLECTION RISKS AND OTHER ENVIRONMENTAL FACTORS, INCLUDING THE AGE OF THE RECEIVABLES.REGARDING LINE 3, IT IS IMPLAUSIBLE TO DETERMINE 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 FOR EACH PATIENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSESSMENT FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT MORE THAN 90% OF OUR PATIENTS WHO HAVE PROVIDED COMPLETED FINANCIAL ASSESSMENT FORMS HAVE BEEN APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE. OUR VICE PRESIDENT OF PATIENT FINANCIAL SERVICES CONSERVATIVELY ESTIMATES THAT 60% OF TOTAL BAD DEBT EXPENSE WAS ASSUMED ATTRIBUTABLE TO PATIENTS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE REPORTED USING JMH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP DOWN METHOD. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS: TRANSPORTATION OF A PATIENT, COMFORT ITEMS TO INCLUDE A TELEVISION, MAGAZINES, OR A TELEPHONE. ADDITIONAL NON-ALLOWABLE COSTS INCLUDE THE RECRUITMENT OF PHYSICIANS, PHYSICIAN GUARANTEES AND A PORTION OF THE BAD DEBT (30%) ASSOCIATED WITH THE CARE OF THE PATIENT. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. AS A NOT-FOR-PROFIT 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 MSHA TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT ON THIS DOCUMENT. BY MAKING THIS CHANGE, NON-PROFIT 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: JMH FOLLOWS A STRONG COLLECTION PROGRAM THAT COMMUNICATES FINANCIAL RESPONSIBILITY TO THE PATIENT PRIOR TO SERVICE. COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY AND NON-CHARITY. IN ROUTINE CIRCUMSTANCES WHEN IT IS DETERMINED THAT A PATIENT HAS NOT RESPONDED TO REQUESTS FOR PAYMENT, AN ACCOUNT CAN BE REFERRED TO AN OUTSIDE COLLECTION AGENCY FOR COLLECTION ASSISTANCE. JMH ENSURES THAT OUTSIDE COLLECTION AGENCIES FOLLOW HOSPITAL BILLING AND COLLECTION GUIDELINES. ONCE A DELINQUENT PATIENT ACCOUNT HAS BEEN SUBMITTED TO AN OUTSIDE COLLECTION AGENCY IT CAN BE RETRACTED IF IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL REQUESTS FOR FINANCIAL ASSISTANCE MUST BE ACCOMPANIED BY A COMPLETED FINANCIAL ASSESSMENT FORM AND SUPPORTING DOCUMENTATION. PART VI, LINE 2: JMH IS A MEMBER OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA). DURING FISCAL YEAR 2008 AND FISCAL YEAR 2009, MSHA CONDUCTED THE LARGEST COMMUNITY HEALTH NEEDS ASSESSMENT IN ITS HISTORY IN AN EFFORT TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN THE LOCAL REGION. THE ASSESSMENT FOCUSED ON STATE, REGIONAL, AND COUNTY SPECIFIC DATA COLLECTION. THIS ASSESSMENT ALSO INCLUDED PRIMARY DATA COLLECTED THROUGH APPROXIMATELY 50 ONE-ON-ONE INTERVIEWS. THOSE INTERVIEWED WERE INDIVIDUALS FROM AROUND THE REGION WHICH INCLUDED LOCAL AND STATE GOVERNMENT OFFICIALS, HEALTH DEPARTMENT REPRESENTATIVES, PHYSICIANS, GENERAL PUBLIC, LOCAL INDUSTRY, CIVIC ORGANIZATIONS, EDUCATION OFFICIALS, AND COMMUNITY RESOURCE GROUPS. THIS INFORMATION WAS COLLECTED, AND THEN ANALYZED, AND A SUMMARY OF THE FINDINGS WAS LISTED IN AN EFFORT TO OBTAIN A MORE DETAILED SNAPSHOT SPECIFIC TO EACH COUNTY LOCATED THROUGHOUT THE MSHA SERVICE AREA. THIS INFORMATION WAS REVIEWED BY MSHA'S STRATEGIC PLANNING TEAM ALONG WITH GOVERNMENT RELATIONS AND QUALITY DEPARTMENTS. THE MSHA STEERING COMMITTEE IDENTIFIED CHILDHOOD OBESITY AS THE HEALTH DISPARITY TARGETED FOR IMPROVEMENT, INCLUDING THE COMMUNITY SERVED BY JMH.DURING FISCAL YEAR 2009, MSHA BEGAN COLLABORATIVE EFFORTS WITH EAST TENNESSEE STATE UNIVERSITY'S COLLEGE OF PUBLIC HEALTH TO DEVELOP THE MSHA-ETSU OBESITY COLLABORATIVE COMMITTEE. THE FOCUS OF THIS COMMITTEE IS TO PULL TOGETHER MANY PARTNERS AND ORGANIZATIONS IN COLLABORATION TO REDUCE THE LEVEL OF CHILDHOOD OBESITY THROUGHOUT NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. DURING FISCAL YEAR 2011, THE COMMITTEE OFFERED 25 SEED GRANTS OF $2,000 EACH TO LOCAL COMMUNITY ORGANIZATIONS SUCH AS CHURCHES, COMMUNITY GROUPS, SCHOOLS, AND EMPLOYERS THAT WANT TO EXPLORE OBESITY REDUCTION EFFORTS.IN ADDITION TO THE GRANTS PROGRAM, AN ANNUAL SYMPOSIUM IS PROVIDED FREE TO THE REGION AND AVAILABLE TO RESIDENTS AND COMMUNITY GROUPS. NATIONAL, REGIONAL, AND LOCAL EXPERTS SHARE INFORMATION ON TRENDS REGARDING CHILDHOOD OBESITY AND PROVEN COMMUNITY-BASED STRATEGIES TO REDUCE THE PREVALENCE.MOUNTAIN STATES HEALTH ALLIANCE DOCUMENTED ITS CORPORATE RESPONSIBILITY PROGRAMS, PARTNERSHIPS, AND ACTIVITIES FOR COMMUNITY BENEFIT AND SOCIAL RESPONSIBILITY IN THE 2011 SOCIAL RESPONSIBILITY PLAN (THE PLAN). THE PLAN PROVIDES THE STRATEGIC DIRECTION OF SOCIAL RESPONSIBILITY FOR THE ORGANIZATION. MSHA CREATED A SOCIAL RESPONSIBILITY COMMITTEE TO ENSURE A STRATEGIC COMMITMENT TO THE ORGANIZATION'S SOCIAL RESPONSIBILITY THROUGH NEEDS PRIORITIZED FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IDENTIFIES SEVERAL PRIORITIES TO FOCUS THE ORGANIZATION'S COMMUNITY BENEFIT, COMMUNITY BUILDING AND OTHER INITIATIVES TO IMPACT THE HEALTH OF INDIVIDUALS AND COMMUNITIES WITHIN THE DEFINED SERVICE AREA. THE COMMITTEE MEETS ON A QUARTERLY BASIS AND INCLUDES MSHA BOARD MEMBERS; THE DEAN OF PUBLIC HEALTH AT EAST TENNESSEE STATE UNIVERSITY; THE PRESIDENT AND CEO OF UNITED WAY OF WASHINGTON COUNTY, TENNESSEE; MSHA'S CEO AND OTHER EXECUTIVES AS WELL AS OTHER COMMUNITY LEADERS. THE FOUNDATION OF MSHA'S SOCIAL RESPONSIBILITY IS THE CHNA TO PRIORITIZE FUTURE HEALTH IMPROVEMENT INITIATIVES TO BE COMPLETED IN COLLABORATION WITH LOCAL RESOURCES. THE PROJECT FULLY SUPPORTS THE MSHA MISSION 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". THE ASSESSMENT FOCUSES ON MSHA'S THIRTEEN CORE COUNTIES. ACTIVITIES ASSOCIATED WITH THE DEVELOPMENT OF THIS ASSESSMENT INCLUDE STATE, REGIONAL AND COUNTY-SPECIFIC SECONDARY DATA COLLECTION AND PRIMARY DATA OBTAINED THROUGH OVER 56 SURVEYS WITH INDIVIDUALS FROM THE LOCAL COMMUNITIES. PART VI, LINE 3: JMH PROVIDES COMMUNICATION OF FINANCIAL ASSISTANCE ON ITS WEB SITE AND ON POSTERS PLACED IN PROMINENT AREAS SUCH AS ADMITTING AREAS, EMERGENCY DEPARTMENTS AND PATIENT PAYMENT (CASHIER) LOCATIONS. PRINTED EDUCATIONAL MATERIALS INCLUDING FINANCIAL ASSISTANCE CONTACT INFORMATION ARE ALSO PROVIDED IN THE PATIENT'S ADMITTING PAPERWORK. POSTERS AND REFERENCE MATERIALS ARE WRITTEN IN BOTH ENGLISH AND SPANISH. ADMITTING STAFF ARE TRAINED TO EDUCATE PATIENTS ON JMH'S FINANCIAL ASSISTANCE POLICY. JMH ALSO HAS FINANCIAL COUNSELORS WHICH COMMUNICATE THE PATIENT'S FINANCIAL RESPONSIBILITY PRIOR TO SERVICE AS WELL AS PROVIDE EDUCATION ON JMH'S FINANCIAL ASSISTANCE POLICY. THESE COUNSELORS ALSO HELP UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDICAID. IN ADDITION, JMH CONTRACTS WITH THE COMPANY FIRSTSOURCE SOLUTIONS USA TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. FIRSTSOURCE SOLUTIONS USA DETERMINES A PATIENT'S ELIGIBILITY IN MEDICAL COVERAGE OPTIONS AND ASSISTS WITH THEIR ENROLLMENT. JMH BEARS THE COST FOR THE FIRSTSOURCE SOLUTIONS USA PROGRAM. PART VI, LINE 4: JMH IS LOCATED IN ABINGDON, WASHINGTON COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. THE POPULATION OF WASHINGTON COUNTY IS JUST UNDER 55,000 AND ACCORDING TO THE U.S. CENSUS BUREAU, THE CITY OF ABINGDON HAS A POPULATION OF 8,191. 20.5% OF ABINGDON'S POPULATION IS AGE 65 AND OVER. ABINGDON HAS A MEDIAN HOUSEHOLD INCOME OF $33,524, WHICH IS SIGNIFICANTLY BELOW VIRGINIA'S MEDIAN HOUSEHOLD INCOME. PART VI, LINE 6: THE MAJORITY OF JMH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY JMH.JMH IS DEDICATED TO OPERATING ITS FACILITIES EFFICIENTLY SO THAT WASTE IS MINIMIZED AND SURPLUSES MAY BE APPLIED TO MAINTAINING ADEQUATE FACILITIES AND EQUIPMENT FOR THE CARE FOR OUR PATIENTS. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. PART VI, LINE 7: JMH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE. MSHA IS INTEGRATED BOTH VERTICALLY AND HORIZONTALLY AND IS THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. IN ADDITION TO ACUTE CARE HOSPITALS, THE SYSTEM ALSO INCLUDES SUCH SERVICES AS: PRIMARY / SPECIALTY PHYSICIAN PRACTICES, URGENT CARE CENTERS, EMERGENCY DEPARTMENTS, OCCUPATIONAL MEDICINE, REHABILITATION, TRANSPLANT, OUTREACH LABORATORY, MENTAL HEALTH, NEONATAL INTENSIVE CARE, A NACHRI AFFILIATED CHILDREN'S HOSPITAL, RENAL DIALYSIS, ST. JUDE'S ONCOLOGY, INPATIENT / OUTPATIENT SURGERY, SKILLED NURSING, HOME HEALTH, AIR AMBULANCE TRANSPORT, AN ORGAN TRANSPLANT DEPARTMENT, AND MORE. WITH THESE ADDITIONAL FACILITIES AND SERVICES, MSHA EXTENDS A HIGHLY EFFECTIVE HEALTH CARE DELIVERY SYSTEM. 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. PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY - JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS. REPORTS FILED WITH STATES PART VI, LINE 7 VA 1 BARTER THEATRE 127 W MAIN STREET ABINGDON VA 24210 546000120 501(C)(3) 20000 GENERAL DONATION VA FOUNDATION FOR COMMUNITY COLLEGE EDUCATION 101 N 14TH STREET 15 FLOOR ABINGDON VA 24210 237004354 501(C)(3) 5000 GENERAL DONATION WILLIAM KING MUSEUM 415 ACADEMY DRIVE NORTHWEST ABINGDON VA 24210 541144120 501(C)(3) 8000 SUPPORT FOR THE CENTER FOR ART AND CULTURAL HERITAGE ABINGDON AMBULANCE SERVICE 611 CAMPUS DRIVE SUITE 600 ABINGDON VA 24210 541061835 501(C)(3) 21865 FMV DONATION MEDICAL SUPPLIES TO RESTOCK EMS VEHICLES 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. X 1 1 X X X 0 0 0 0 0 0 0 1 0 PAUL ARMSTRONG MD 0 301203 0 0 0 0 0 12564 0 8262 0 322029 0 0 ANN FLEMING 0 328461 0 72944 0 41390 0 48481 0 17108 0 508384 0 0 WILLIAM WALKER MD 0 512691 0 98124 0 1189 0 0 0 1615 0 613619 0 0 SEAN S MCMURRAY 0 247007 0 49743 0 12187 0 27167 0 19857 0 355961 0 0 TIMOTHY G EVANS 0 152001 0 0 0 25231 0 7787 0 14050 0 199069 0 0 STEPHEN K GIVENS 0 174089 0 0 0 11342 0 10799 0 17085 0 213315 0 0 STEPHEN BLANKENSHIP MD 0 232037 0 46236 0 29702 0 9948 0 21363 0 339286 0 0 ANN CHANG MD 0 241143 0 44336 0 24125 0 15345 0 9110 0 334059 0 0 DAVID SIMMONS MD 0 223735 0 45883 0 26996 0 5382 0 19554 0 321550 0 0 ANDREW HAWKINS MD 0 234976 0 45314 0 16565 0 14658 0 16544 0 328057 0 0 STEVEN SIKORA MD 0 203713 0 39579 0 50205 0 6428 0 16482 0 316407 0 0 PART I, LINE 1A JMH PAYS TRAVEL EXPENSES FOR COMPANIONS OF BOARD MEMBERS AND EXECUTIVE STAFF DURING THE ANNUAL BOARD RETREAT. AN ITEMIZED LIST OF EXPENDITURES IS PROVIDED BY THE HOSTING RESORT TO JMH FOR APPROVAL AND SUBSEQUENT PAYMENT. EXPENSES NOT INCURRED FOR BONA FIDE BUSINESS PURPOSES ARE ANALYZED AND REPORTED AS PRESCRIBED BY APPLICABLE TAX LAWS. PART I, LINE 7 DISCRETIONARY BONUSES ARE PROVIDED TO EMPLOYEES WHEN APPLICABLE. FORM 990, PART VI, SECTION A, LINE 3 THE CORPORATION CONTRACTED WITH MOUNTAIN STATES HEALTH ALLIANCE, A 50.1% MEMBER, TO PERFORM MANAGEMENT DUTIES. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION IS ORGANIZED AS A VIRGINIA NON-STOCK, NONPROFIT ORGANIZATION WITH TWO MEMBERS: MOUNTAIN STATES HEALTH ALLIANCE WHICH MAINTAINS A 50.1% MEMBERSHIP AND JOHNSTON MEMORIAL HEALTHCARE FOUNDATION WHICH MAINTAINS A 49.9% INTEREST. FORM 990, PART VI, SECTION A, LINE 7A MOUNTAIN STATES HEALTH ALLIANCE'S BOARD OF DIRECTORS ELECTS THE MEMBERS OF THE GOVERNING BODY FOR JMH. JOHNSTON MEMORIAL HEALTHCARE FOUNATION'S BOARD OF DIRECTORS ELECTS THE MEMBERS OF THE GOVERNING BODY FOR JMH. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF TRUSTEES SUCH AS, DISSOLUTION OF THE CORPORATION, MERGER OF THE CORPORATION, ETC., ARE SUBJECT TO APPROVAL BY THE MEMBERSHIP. DECISIONS RELATING TO THE ORDINARY COURSE OF BUSINESS ARE NOT SUBJECT TO MEMBER APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990, WHICH WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, WAS REVIEWED BY FINANCIAL MANAGEMENT PRIOR TO FILING. COPIES OF THE RETURN WERE MADE AVAILABLE TO THE BOARD TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT PROVIDES THE POLICY AND CONFLICT OF INTEREST DISCLOSURE FORMS TO ALL COVERED PERSONS. EACH PERSON IS REQUIRED TO PROVIDE A COMPLETED DISCLOSURE FORM, NOTING ANY CONFLICTS OF ATTESTING THEY HAVE "NONE", AND RETURN THOSE TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTES 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 ENGAGE IN A CONFLICTED TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE, WHICH CONSISTS OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, OBTAINS THE SERVICES OF AN OUTSIDE, INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM COMPENSATION SURVEYS AND WITH ADVICE WHEN THE COMMITTEE MAKES RECOMMENDATIONS ON PAY AND BENEFITS FOR THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY, IN ADDITION TO OTHER GOVERNING POLICIES, IS AVAILABLE UPON REQUEST. ALL CORPORATE POLICIES AND CORPORATE FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,679,911. BOOK/TAX DIFFERENCE ON PARTNERSHIP INVESTMENT -33,523. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 14,378. CONTRIBUTION EXPENSES 88,162. TOTAL TO FORM 990, PART XI, LINE 5: 4,748,928. TRUSTEE COMPENSATION: FORM 990, PART VII, SECTION A, HOSPITAL BOARD OF TRUSTEES MEMBERS, PAUL ARMSTRONG, M.D., ANN FLEMING, LARAMIE TRIPLETT, AND WILLIAM WALKER, M.D., HAVE 990 REPORTABLE RELATED COMPENSATION DERIVED FROM SERVICES THEY PROVIDED TO RELATED ORGANIZATIONS. THEY DO NOT RECEIVE COMPENSATION FOR SERVICES AS HOSPITAL BOARD TRUSTEES. IN ADDITION, HOSPITAL BOARD OF TRUSTEES MEMBER, EMORY ROBINETTE, M.D. HAS 990 REPORTABLE COMPENSATION DERIVED FROM MEDICAL SERVICES HE PROVIDED TO THE HOSPITAL. HE DID NOT RECEIVE COMPENSATION FOR SERVICES AS A HOSPITAL BOARD OF TRUSTEES MEMBER. ABINGDON PHYSICIAN PARTNERS 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 205485346 MEDICAL SERVICES VA 501(C)(3) LINE 11A, I JOHNSTON MEMORIAL HOSPITAL INC 0 MOUNTAIN STATES HEALTH ALLIANCE 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 620476282 HOSPITAL TN 501(C)(3) LINE 3 N/A 0 DICKENSON COMMUNITY HOSPITAL ONE HOSPITAL DRIVE CLINTWOOD VA 24228 770599553 HOSPITAL VA 501(C)(3) LINE 3 NORTON COMMUNITY HOSPITAL INC 0 SMYTH COUNTY COMMUNITY HOSPITAL 565 RADIO HILL ROAD MARION VA 24354 540794913 HOSPITAL VA 501(C)(3) LINE 3 MOUNTAIN STATES HEALTH ALLIANCE 0 NORTON COMMUNITY HOSPITAL INC 100 15TH STREET NW NORTON VA 24273 540566029 HOSPITAL VA 501(C)(3) LINE 3 MOUNTAIN STATES HEALTH ALLIANCE 0 JOHNSTON MEMORIAL HEALTHCARE FOUNDATION INC 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 262870970 SUPPORTING ORGANIZATION TO JMH VA 501(C)(3) LINE 11B, II N/A 0 MOUNTIAN STATES FOUNDATION 2335 KNOB CREEK ROAD STE 101 JOHNSON CITY TN 37604 581418862 FUNDRAISING FOR MSHA HOSPITALS TN 501(C)(3) LINE 11A, I MOUNTAIN STATES HEALTH ALLIANCE 0 MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 581418345 SUPPORTING ORGANIZATION TO MSHA HOSPITALS TN 501(C)(3) LINE 11A, I N/A 0 COMMUNITY HEALTHCARE FOUNDATION 100 15TH STREET NW NORTON VA 24273 542002314 SUPPORTING ORGANIZATION TO NCH VA 501(C)(3) LINE 11A, I N/A 0 INTEGRATED SOLUTIONS HEALTH 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 621711997 INVESTMENT COMPANY TN N/A EMMAUS COMMUNITY HEALTHCARE PLLC 6070 HWY 11E PINEY FLATS TN 37686 200577483 MEDICAL SERVICES TN N/A MEDICAL SPECIALISTS OF JOHNSON CITY LLC 2528 WESLEY ST STE 2 JOHNSON CITY TN 37604 272199037 MEDICAL SERVICES TN N/A COMMUNITY HOME CARE INC 1640 PARK AVENUE NORTON VA 24273 541453810 MEDICAL PRODUCTS VA N/A C COMMUNITY PHYSICIAN SERVICES CORP 100 15TH STREET NW NORTON VA 24273 541641446 PHYSICIAN SERVICES VA N/A C SOUTHWEST COMMUNITY HEALTH SERVICES PO BOX 880 MARION VA 24354 541460695 HEALTH SERVICES VA N/A C BLUE RIDGE MEDICAL MANAGEMENT CORPORATION 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 621490616 PHYSICIAN OFFICES TN N/A C MEDISERVE MEDICAL EQUIP OF KINGSPORT 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37064 621212286 DURABLE MEDICAL EQUIPMENT TN N/A C MOUNTAIN STATES PROPERTIES 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 621845895 PROPERTY MANAGEMENT TN N/A C MOUNTAIN STATES MEDICAL GROUP 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 621700412 HEALTHCARE SERVICES TN N/A C 0 1 1 0 0 0 0 0 1 0 0 1 0 1 1 1 0 1 ABINGDON PHYSICIAN PARTNERS B 3519671