2025-07-31T14:17:20-04:00 2024-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2023-10-01 582510435 JASPER HEALTH SERVICES INC JASP 7064686411 898 COLLEGE STREET MONTICELLO GA 310641258 ROBERT CUMBIE ADMINISTRATOR 4784543522 2025-07-31 true false WILLIAM EDWARD PHILLIPS P00451499 2298837878 2025-07-31 2023 2025-03-06 01:10:19Z JASPER MEMORIAL HOSPITAL ROBERT CUMBIE 898 COLLEGE STREET MONTICELLO GA 31064 15265908 false X WWW.JASPERMEMORIALHOSPITAL.ORG X 1999 GA JASPER HEALTH SERVICES, INC. (JHS) IS COMMITTED TO DELIVERING COMPASSIONATE AND EXCEPTIONAL CARE FOR OUR COMMUNITY. 5 4 199 0 3388618 1308357 11875163 13735492 93261 26260 201984 134006 15559026 15204115 0 0 9508822 10660391 0 0 5547495 5775590 15056317 16435981 502709 -1231866 12360412 10569203 2710887 2073153 9649525 8496050 X JASPER HEALTH SERVICES, INC. (JHS) IS COMMITTED TO DELIVERING COMPASSIONATE AND EXCEPTIONAL CARE FOR OUR COMMUNITY. false false 11832774 13852338 JASPER HEALTH SERVICES, INC. (JHS) EXISTS TO PROVIDE A CONTINUUM OF HEALTHCARE FOR THE RESIDENTS OF JASPER COUNTY. THE FACILITY IS LOCATED IN A RURAL AREA WITH LIMITED ECONOMIC OPPORTUNITIES BUT PROVIDES NECESSARY MEDICAL CARE WITHOUT REGARD TO THE ABILITY TO PAY. THE EMERGENCY DEPARTMENT SERVED 3,799 PATIENTS DURING THE YEAR WITH A SIGNIFICANT PORTION UNINSURED AND UNABLE TO PAY FOR THEIR CARE. THERE WERE 3,947 OUTPATIENT ENCOUNTERS FOR DIAGNOSTIC SERVICES AND THERAPY. APPROXIMATELY 94% OF THE 1,315 INPATIENT DAYS WERE PROVIDED TO PERSONS COVERED UNDER THE MEDICARE OR MEDICAID RELATED PROGRAMS OR HAD NO INSURANCE COVERAGE AT ALL. JHS OPERATES A PHYSICIAN PRACTICE PROVIDING PRIMARY MEDICAL CARE WITH 10,958 ENCOUNTERS DURING THE YEAR. JHS PROVIDES SERVICES WITH CHARGES EITHER REDUCED OR ELIMINATED BASED ON THE PATIENT'S INCOME, GIVING DISCOUNTED CARE FOR PATIENTS WITH UP TO 250% OF THE FEDERAL POVERTY GUIDELINES. JHS PROVIDED APPROXIMATELY 6,064,000 IN UNCOMPENSATED CARE. 11832774 true true false true false false false false false false true false false false true true true false false false false false false false false false true true false false true false false false false false true true false false false false false false false false false false true 69 0 199 true false false false false false false false false false false false false X 5 4 false false false false false true false true true false false true true true true true true true false false GA X X X ROBERT CUMBIE 7064686411 898 COLLEGE STREET MONTICELLO GA 31064 NATALIYA KUBASOVA MD PHYSICIAN 40.00 X 363630 0 23034 DERRICK LANE PHYSICIAN 40.00 X 268360 0 11673 ROBERT CUMBIE ADMINISTRATO 40.00 X 180397 0 27351 ELIZABETH WOOD PHYSICIAN AS 40.00 X 162347 0 26557 ASHLEY NORDSTROM PHYSICIAN AS 40.00 X 162848 0 17533 JAMES STRICKLAND RN 40.00 X 153433 0 25974 STUART ABNEY CONTROLLER 40.00 X 128023 0 11189 ANGIE GORDON MEMBER 1.00 X X 0 0 0 ALISON HILDEBRANT CHAIR 1.00 X 0 0 0 LYNDSY JOHNSTON MEMBER 1.00 X 0 0 0 WALKER JORDON MEMBER 1.00 X 0 0 0 DAVID LEACH MEMBER 1.00 X 0 0 0 1419038 143311 19 false true false RURAL PHYSICIANS GROUP 7840 ROSEWELL RD STE 180 ATLANTA GA 30328 PHYSICIANS 349251 STAFFHEALTHCOM RIVIERIA FINANCE 4532 BONNEY ROAD SUITE C VIRGINIA BEACH VA 23462 NURSING STAFF 218639 UNITED EMERGENCY SERVICES INC 200 CORPORATE BLVD LAFAYETTE LA 70508 ER PHYSICIANS 211178 STAFF RELIEF INC 16 E MAIN STREET FORSYTH GA 31029 NURSING STAFF 119473 4 476912 831445 1308357 PROGRAM SERVICE REVENUE 623000 13735492 13735492 13735492 15057 15057 1843 1843 1843 1843 72996 61793 11203 11203 11203 MISCELLANEOUS REVENUE 623000 91704 91704 DISCOUNTS AND REBATES 623000 25142 25142 CAFETERIA AND VENDING 722210 15317 15317 132163 15204115 13852338 43420 X 346960 346960 8710058 6557378 2152680 224118 190433 33685 717415 609588 107827 661840 562365 99475 23986 23986 115073 115073 41200 41200 2269659 1494891 774768 5130 2330 2800 1078857 970598 108259 202520 137025 65495 74440 59485 14955 48909 22074 26835 41875 41875 754172 510273 243899 181106 86107 94999 PROVIDER TAX 285851 285851 MEDICAL SUPPLIES 280953 280953 REPAIRS & MAINTENANCE 249630 244426 5204 DUES AND SUBSCRIPTIONS 68607 32288 36319 53622 30685 22937 16435981 11832774 4603207 0 798670 418688 1532862 490316 1008624 1409980 204248 208789 393420 192561 14004320 6669728 7997906 7334592 424682 514277 12360412 10569203 1171326 1033452 192770 754614 593563 784947 253368 2710887 2073153 X 9649525 8496050 9649525 8496050 12360412 10569203 X -1231866 78391 X true true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1205 1205 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS DUES TO GEORGIA HEALTH CARE ASSOCIATION AND GEORGIA HOSPITAL ASSOCIATION, BOTH OF WHICH ARE ORGANIZATIONS THAT LOBBY ON BEHALF OF ITS MEMBERSHIP BODY, A PORTION OF THE DUES IS SPECIFICALLY RELATED TO LOBBYING. 242017 242017 7295611 2113069 5182542 5555118 3843307 1711811 911574 713352 198222 7334592 LEASE LIABILITIES 213271 THIRD PARTY SETTLEMENTS 37356 OTHER LIABILITIES 2741 253368 X 15282398 78391 78391 15204007 108 108 15204115 16435873 16435873 108 108 16435981 SCHEDULE D, PAGE 3, PART X THE CORPORATION IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPTPURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE CORPORATION ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES.BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2024 AND 2023 OR FOR THE YEARS THEN ENDED. THE CORPORATION'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 4B REBATES RECLASSIFIED 108 SCHEDULE D, PAGE 4, PART XII, LINE 4B REBATES RECLASSIFIED 108 true true X true X 1.250000000000 true X true true false false 96389 417988 555861 1120701 14233 5967 8266 0.00050 666483 1544656 8266 0.00050 399419 399419 0.02430 399419 399419 0.02430 1065902 1544656 407685 0.02480 false 1152475 864356 1356679 1364213 -7534 X true true 1 1 JASPER MEMORIAL HOSPITAL 898 COLLEGE STREET MONTICELLO GA 31064 WWW.JASPERMEMORIALHOSPITAL.ORG 079-592 X X X X SNF,SWING-BED,CLINIC JASPER MEMORIAL HOSPITAL 1 false false true X X X X X X X X X X 22 true false false true X WWW.JASPERMEMORIALHOSPITAL.ORG X true 22 true HTTP://WWW.JASPERMEMORIALHOSPITAL.ORG/ false false true X 125.000000000000 250.000000000000 X X true true X X X X true X WWW.JASPERMEMORIALHOSPITAL.ORG X WWW.JASPERMEMORIALHOSPITAL.ORG X WWW.JASPERMEMORIALHOSPITAL.ORG X X X X X X X true X false X X X X true X false false FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 3E JASPER MEMORIAL HOSPITAL IDENTIFIED AN OVERALL NEED TO IMPROVE COMMUNITY EDCUATION AND AWARENESS, AS WELL AS PROVIDE ACCESS TO SERVICES THAT ADDRESS THESE HEALTH NEEDS: OBESITY AND POOR NUTRITION MENTAL HEALTH AND SUBSTANCE ABUSE CANCER AND CANCER SCREENINGS CHRONIC PAIN CARDIOVASCULAR AND HYPERTENSION SPECIALTY CARE DIALYIS TRANSPOTATION AND EMERGENCY TRANSFERS FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 5 JASPER MEMORIAL HOSPITALS APPROACH TO ACHIEVING COMMUNITY HEALTH IMPROVEMENT PRIORITIES FOLLOWS A SIX- STEP PROCESS DESIGNED TO BE UPDATED EVERY THREE YEARS TO ASSESS PROGRESS IN ADDRESSING THE HEALTH NEEDS OF THE COMMUNITY. IT BEGINS WITH DEFINING JMHS TARGET COMMUNITY, AND THEN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY USING AVAILABLE HEALTH DATA AND INPUT FROM A BROAD RANGE OF ADVOCATES REPRESENTING THE HEALTH INTERESTS OF THE RESIDENTS WITHIN THE COMMUNITY. INPUT IS GATHERED VIA FACE-TO-FACE INTERVIEWS. FROM ANALYSIS OF DATA AND COMMUNITY INPUT, THE HEALTH NEEDS ARE IDENTIFIED AND PRIORITIZED. THE SIX-STEP PLANNING PROCESS FOLLOWS: 1. ASSESS THE HEALTH NEEDS OF JASPER COUNTY 2. SET HEALTH IMPROVEMENT PRIORITIES 3. PLAN HEALTH IMPROVEMENT INITIATIVES TO ADDRESS PRIORITIES 4. IMPLEMENT SPECIFIC HEALTH IMPROVEMENT STRATEGIES AND PLANS 5. REPORT HEALTH IMPROVEMENT PLANS AND BENEFITS TO THE JASPER COUNTY PUBLIC 6. EVALUATE OUTCOMES AND PROGRESS TOWARD HEALTH IMPROVEMENT GOALS. THE LEADERSHIP AT JASPER MEMORIAL HOSPITAL MEETS TO DEVELOP STRATEGIES AND PLANS TO ADDRESS THE IDENTIFIED HEALTH NEED PRIORITIES. THESE STRATEGIES AND PLANS ARE THEN IMPLEMENTED AND REPORTED TO THE PUBLIC VIA THE HOSPITALS WEBSITE AS JASPER MEMORIAL HOSPITALS COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN. FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 11 EACH OF THE EIGHT IDENTIFIED HEALTH NEEDS WERE EVALUATED AND PRIORITIZED BY INPUT FROM THE JMH CHNA STEERING COMMITTEE COMPOSED OF HOSPITAL LEADERSHIP. HEALTH NEEDS WERE PRIORITIZED BASED UPON THE SCOPE AND SEVERITY OF THE ISSUE. EACH NEED WAS EVALUATED BASED UPON THE PRIORITY OF THE ISSUE, THE FIT WITH THE JMH MISSION, THE ABILITY TO ACHIEVE IMPROVEMENT, AND THE AVAILABILITY OF HOSPITAL RESOURCES. THREE OF THE EIGHT IDENTIFIED HEALTH NEEDS WERE SELECTED FOR IMPLEMENTATION: 1) CANCER SCREENING EXPANSION (WITH EMPHASIS ON COLON CANCER) 2) INTERVENTIONAL PAIN SERVICES (TO ALLEVIATE CHRONIC PHYSICAL PAIN) 3) OBESITY AND NUTRITION WITH THE EMPHASIS ON DIABETES PREVENTION THE REMAINING FIVE IDENTIFIED HEALTH NEEDS WILL BE ADDRESSED INDIRECTLY THROUGH OTHER MEANS . WHILE MENTAL HEALTH, BEHAVIORAL ISSUES, AND SUBSTANCE ABUSE CONTINUE TO BE SIGNIFICANT HEALTH ISSUES IN JASPER COUNTY, COMMUNITY RESOURCES BEYOND THE JMH EMERGENCY DEPARTMENT AND PRIMARY CARE CENTER ARE LIMITED, SO OUT OF COUNTY AGENCIES WILL CONTINUE TO BE USED AS REFERRAL SOURCES; ALSO THE RECENTLY ACTIVATED NATION-WIDE 988 HOTLINE WILL BE PROMOTED. HEALTH EDUCATION AND SCREENING, ALONG WITH THE PRIMARY CARE CENTER WILL CONTINUE TO ADDRESS CARDIOVASCULAR AND HYPERTENSION HEALTH ISSUES. THE NEED FOR SPECIALTY CARE WILL BE ADDRESSED AS PART OF THE RECRUITMENT OF A GASTROENTEROLOGIST AND AN INTERVENTIONAL PAIN PHYSICIAN FOR COLON CANCER SCREENING AND PAIN MANAGEMENT RESPECTIVELY. DIALYSIS CARE WILL BE REFERRED TO THE COVINGTON DIALYSIS CENTER OPERATED BY US RENAL CARE. THE REMAINING NEED FOR TRANSPORTATION SOLUTIONS TO ADDRESS OUT- OF-HOSPITAL TRANSFERS WILL DEPEND UPON JASPER COUNTY EXPANDING ITS EMT SERVICES. AN INDIVIDUALS ACCESS TO CLINICAL CARE AND TREATMENT OPTIONS IS IMPACTED BY ECONOMIC CONSTRAINTS. JMH WILL CONTINUE TO PARTICIPATE AS A MEDICAID AND MEDICARE PROVIDER AND WILL CONTINUE TO EDUCATE ITS PATIENT POPULATION ABOUT COVERAGE AND PAYMENT OPTIONS IN ACCORDANCE WITH ESTABLISHED POLICIES. DUE TO RESOURCE CONSTRAINS, JMH IS UNABLE TO ADDRESS THIS NEED FURTHER AT THIS TIME. FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 16J JMH PROVIDES BOTH A TELEPHONE INTERPRETATION LINE AND A SPANISH SPEAKING ONSITE INTERPRETER (NORMAL BUSINESS HOURS FOR ONSITE INTERPRETER). 1 THE RETREAT NURSING HOME 898 COLLEGE STREET MONTICELLO GA 31064 LONG TERM CARE AND SKILLED NURSING SCHEDULE H, PART I, LINE 3C IN ADDITION TO PROVIDING FREE AND DISCOUNTED CARE ON THE BASIS OF INCOME, JASPER MEMORIAL HOSPITAL ALSO PROVIDES AN AUTOMATIC 50% DISCOUNT TO PATIENTS WITH NO INSURANCE. THE BILLING SYSTEM APPLIES THE DISCOUNT ONCE THE ACCOUNT IS READY TO BE BILLED. SCHEDULE H, PART I, LINE 7G THE EMERGENCY ROOM IS AVAILABLE WITH HOSPITAL SUPPORTED EMERGENCY ROOM PHYSICIAN COVERAGE ON A 24/7 BASIS. THERE IS NO BILLING BY THE HOSPITAL FOR EMERGENCY ROOM PHYSICIAN SERVICES AT ALL (BILLED DIRECTLY BY THE PHYSICIAN SERVICE) BUT THE HOSPITAL MUST PAY A SUPPLEMENTAL AMOUNT TO HAVE THE PHYSICIANS AVAILABLE. SCHEDULE H, PART I, LINE 7 THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. SCHEDULE H, PART III, LINE 2 AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AND INCLUDES IMPLICIT PRICE CONCESSIONS. SEE FOOTNOTE 2 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 3 BASED ON THE HIGHER THAN STATE AVERAGE UNEMPLOYMENT LEVELS FOR JASPER COUNTY AND UNOFFICIAL INFORMATION RELATING TO A SAMPLE OF ACCOUNTS, MANAGEMENT ESTIMATES 75% OF THE BAD DEBTS WOULD BE ELIGIBLE UNDER OUR POLICIES IF THE PATIENT APPLIED FOR ASSISTANCE. SCHEDULE H, PART III, LINE 4 SEE PAGES 14-20 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR THE DISCUSSION ON UNINSURED PATIENTS AND PROVISION FOR BAD DEBTS AS PART OF THE NET PATIENT SERVICE REVENUE FOOTNOTE. SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. THE FULL AMOUNT OF THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. MEDICARE IS A FEDERAL PROGRAM WHICH DICTATES PAYMENT RATES AND CONDITIONS OF PARTICIPATION FOR SERVING CERTAIN ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. SERVING THE NEEDS OF OUR CITIZENS AT BELOW MEDICARE'S COMPUTATION OF COST PROVIDES NECESSARY LOCAL CARE FOR A SEGMENT OF THE POPULATION OFTEN UNABLE TO TRAVEL GREAT DISTANCES FOR THEIR NEEDS. SCHEDULE H, PART III, LINE 9B THE POLICY ON HANDLING BAD DEBT REQUIRES A REVIEW TO SEE IF AN ACCOUNT HAS BEEN SCREENED FOR INDIGENT/CHARITY APPROVAL IN THE PROCESS TO DETERMINE IF THE ACCOUNT MAY BE SENT TO BAD DEBT. IN ADDITION, ACCOUNTS HAVE ONLINE DOCUMENTATION OF VARIOUS STEPS IN THE FINANCIAL ASSISTANCE PROCESS INCLUDING NOTICE WHEN AN APPLICATION HAS BEEN GIVEN/MAILED, REQUESTS FOR ADDITIONAL DATA, AND ULTIMATE DETERMINATION THAT ALLOWS COLLECTION EFFORTS TO BE BASED ON THE TRUE STATUS OF EACH PATIENT'S ACCOUNT. 1)THE BUSINESS OFFICE MAY CHARGE OFF AN ACCOUNT TO BAD DEBT WHEN ONE OR MORE OF THE FOLLOWING CONDITIONS APPLY: I)THE HOSPITAL RECEIVES DISCHARGE NOTICE FOR CHAPTER 7 OR CHAPTER 13 BANKRUPTCY. II)ALL THIRD-PARTY BALANCES HAVE BEEN COLLECTED OR EFFORTS TO COLLECT EXHAUSTED. III)SELF-PAY ACCOUNT IS AGED GREATER THAN 150 DAYS FROM DISCHARGE OR DATE OF SERVICE AND NO PAYMENT HAS BEEN RECEIVED WITHIN PRIOR 30 DAYS. IV)ACCOUNTS FOR PATIENTS/GUARANTORS WHO HAVE EXISTING ACCOUNTS IN BAD DEBT STATUS OR HAVE HAD CHECKS RETURNED FOR INSUFFICIENT FUNDS, OR WHO HAVE REPEATEDLY BROKEN PAYMENT PROMISES. V)EVIDENCE OF THE PATIENT'S UNWILLINGNESS TO PAY. 2)REVIEW SELECTION REPORTS TO EVALUATE PLACEMENT OF ACCOUNTS WITH AN OUTSIDE AGENCY. 3)DETERMINE IF THE FOLLOWING CONDITIONS EXIST PRIOR TO SUBMITTING FOR BAD DEBT WRITE OFF APPROVAL: A)ACCOUNT IS RETURNED FROM EXTENDED BUSINESS OFFICE WITH ALL COLLECTION EFFORT EXHAUSTED. I)NO SELF-PAY PAYMENT HAS BEEN POSTED WITHIN PRIOR 30 DAYS. II)GUARANTOR HAS RECEIVED A COMBINATION OF THREE LETTERS, STATEMENTS OR VERBAL CONTACT. III)GUARANTOR HAS DEFAULTED ON AN AGREED CONTRACT ARRANGEMENT. IV)FINANCIAL COMMENTS HAVE BEEN REVIEWED TO DETERMINE IF EXTENUATING CIRCUMSTANCES EXIST REGARDING LACK OF SELF-PAY PAYMENTS. V)ACCOUNTS HAVE BEEN SCREENED FOR INDIGENT/CHARITY APPROVAL. VI)ACCOUNT HAS BEEN SCREENED FOR APPROPRIATE ELIGIBILITY PROGRAM APPROVAL. VII)ACCOUNT HAS RETURN MAIL WITHOUT A NEW ADDRESS OBTAINED. VIII)REVIEW PATIENT/GUARANTOR ACCOUNT HISTORY. IX)ACCOUNTS FOR PATIENTS/GUARANTORS WHO HAVE EXISTING ACCOUNTS IN BAD DEBT STATUS OR HAVE HAD CHECKS RETURNED FOR INSUFFICIENT FUNDS, OR WHO HAVE REPEATEDLY BROKEN PAYMENT PROMISES. SCHEDULE H, PART VI, LINE 2 ONGOING DISCUSSIONS WITH AND FEEDBACK FROM LOCAL MEDICAL STAFF, NURSING AND CLINICAL PERSONNEL, COMMUNITY BOARD MEMBERS, AND LOCAL COMMUNITY LEADERS FROM ATTENDANCE AT BOTH REGULARLY SCHEDULED GROUP MEETINGS AND FROM MEETINGS WHERE HOSPITAL STAFF ARE INVITED TO ATTEND. PARTICIPATION IN COMMUNITY WIDE EMERGENCY MANAGEMENT PLANNING MEETINGS. REVIEW OF MARKET SHARE DATA SHOWING OUT-MIGRATION OF COUNTY RESIDENTS FOR SPECIFIC MEDICAL SERVICES. POTENTIAL NEEDS ARE EVALUATED AGAINST BOTH THE HOSPITAL'S CURRENT CAPACITY AND ITS LIMITATIONS AS A CRITICAL ACCESS HOSPITAL AS WELL AS THE AVAILABILITY OF SIMILAR SERVICES IN THE AREA. IN ADDITION, WE CONDUCTED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS AS IS REQUIRED. SCHEDULE H, PART VI, LINE 3 DURING THE REGISTRATION PROCESS, REGISTRATION STAFF OFFER A COPY OF THE APPLICATION FOR FINANCIAL ASSISTANCE AND AN EXPLANATION OF WHAT INFORMATION IS NEEDED TO MAKE A DECISION ON ELIGIBILITY AND WHAT SUPPORTING DOCUMENTS MUST BE PROVIDED. PATIENTS ARE INFORMED THAT IF APPROVED THE LEVEL OF ASSISTANCE WILL BE BASED UPON THEIR INCOME LEVEL. DURING ANY CONTACT BY PHONE, LETTER, OR PERSONAL VISIT, THE INDIVIDUAL IS MADE AWARE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND OFFERED AN APPLICATION IF INTERESTED. DURING PRESENTATIONS TO COMMUNITY GROUPS CONCERNING THE HOSPITAL, A MENTION OF THE FINANCIAL ASSISTANCE PROGRAM IS MADE. APPLICATIONS WILL BE PROVIDED TO ALL PARTIES UPON REQUEST, SO INDIVIDUALS OTHER THAN CURRENT PATIENTS MAY MAKE APPLICATION. ONCE APPROVED, AN INDIVIDUAL HAS TWELVE (12) MONTHS OF COVERAGE UNDER THE PROGRAM AND DOES NOT HAVE TO REAPPLY EACH TIME THEY RECEIVE SERVICES. THE HOSPITAL USES A TELEPHONE SERVICE FOR PATIENTS WHO DO NOT SPEAK ENGLISH AND ALL QUESTIONS DURING REGISTRATION, INCLUDING THE NEED FOR FINANCIAL ASSISTANCE, GO THROUGH THE TRANSLATOR. ON THE WEB, THE FIRST PARAGRAPH IN THE SECTION ABOUT BILLS AND INSURANCE DISCUSSES THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES. A SIGN IS PLACED BETWEEN THE EMERGENCY ROOM ENTRANCE AND THE REGISTRATION AREA. SCHEDULE H, PART VI, LINE 4 JHS'S PRIMARY SERVICE AREA COMPOSES MOST OF JASPER COUNTY, GEORGIA, WHICH HAS A POPULATION OF APPROXIMATELY 14,000 WITH APPROXIMATELY 16% OF THE POPULATION OVER AGE 65. CENSUS BUREAU RECORDS REFLECT NEARLY 73% OF THE POPULATION LISTED AS WHITE WITH 21% LISTED AS BLACK. AN ESTIMATED 19.4% OF THE POPULATION IS BELOW THE POVERTY LEVEL. 18% OF THE POPULATION WAS UNINSURED, ABOVE THE US AND STATE AVERAGES. SCHEDULE H, PART VI, LINE 5 IN ADDITION TO PROVIDING HEALTH RELATED INFORMATION IN NEWS ARTICLES FOR THE LOCAL NEWSPAPER, WE CONDUCT ANNUAL FLU IMMUNIZATION CAMPAIGNS INCLUDING REMOTE SITE VACCINATION DRIVES. JASPER MEMORIAL HOSPITAL PROVIDES REDUCED COST SPORTS PHYSICALS FOR THE LOCAL SCHOOLS, PROVIDES STAFF FOR PRESENTATIONS TO STUDENTS, AND SERVES AS A HOST FACILITY FOR THE HIGH SCHOOL'S CERTIFIED NURSING AIDE CLASSES. WE ALSO PARTICIPATE IN COMMUNITY WIDE EMERGENCY HEALTH TEAMS, LOCAL DISASTER PREPAREDNESS PROGRAMS/DRILLS, AND PROVIDE HEALTH EDUCATION TO COMMUNITY CLUBS. THE ORGANIZATION AND ALL ITS VOLUNTEER BOARD ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS. OUR EMERGENCY DEPARTMENT HAS 24/7 PHYSICIAN COVERAGE AND IS OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. ANY SURPLUS FUNDS ARE REINVESTED INTO THE OPERATIONS AND CAPITAL BUDGET OF THE ORGANIZATION. SCHEDULE H, PART VI, LINE 7 GEORGIA false false false false false false false false false NATALIYA KUBASOVA MD PHYSICIAN 322545 41085 17445 5589 386664 DERRICK LANE PHYSICIAN 267560 800 11673 280033 ROBERT CUMBIE ADMINISTRATOR 179597 800 9998 17353 207748 ELIZABETH WOOD PHYSICIAN ASSISTANT 140401 21946 9024 17533 188904 ASHLEY NORDSTROM PHYSICIAN ASSISTANT 117530 45318 17533 180381 JAMES STRICKLAND RN 152833 600 7327 18647 179407 SCHEDULE J, PART III BONUS/INCENTIVES CERTAIN PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE BONUSES ARE DETERMINED BASED ON THE ACHIEVEMENT OF VARIOUS ORGANIZATIONAL AND PERSONAL PERFORMANCE GOALS ESTABLISHED BY A FORMAL PROCESS IN KEEPING WITH THE ORGANIZATION'S TAX-EXEMPT STATUS. THE PAY IS BASED ON A FAIR MARKET VALUE ANALYSIS AND IS SET BY CONTRACTUAL ARRANGEMENTS WITH JHS. DONNA HOLMAN FAMILY BD MBR 7707 EMPLOYEE false JAN GASTON FORMER CEO 550 CONSULTING false SCHEDULE L, PART V DONNA HOLMAN IS EMPLOYED BY THE ORGANIZATION AS THE SKILLED NURSING HOME ADMINISTRATOR AND IS THE GRANDMOTHER OF BOARD MEMBER DR. LYNDSY JOHNSTON. JAN GASTON HAS A CONRACT FOR SERVICES PROVIDED TO THE ORGANIZATION AND WAS THE FORMER CEO OF THE ORGANIZATION. FORM 990 JASPER HEALTH SERVICES, INC. (JHS), INCORPORATED NOVEMBER 8, 1999, IS A NOT-FOR-PROFIT CORPORATION WHOSE PRIMARY PURPOSE IS TO OPERATE JASPER MEMORIAL HOSPITAL (JMH) (A 17-BED CRITICAL ACCESS HOSPITAL), RETREAT INTERMEDIATE CARE HOME (A 55-BED SKILLED NURSING FACILITY) AND THE PRIMARY CARE CENTER FOR MONTICELLO (PCC), A PROVIDER-BASED PHYSICIAN PRACTICE, LOCATED IN MONTICELLO, GEORGIA. PURSUANT TO A LEASE AND TRANSFER AGREEMENT DATED JULY 2, 1999, THE HOSPITAL AUTHORITY OF JASPER COUNTY LEASED ITS FACILITIES AND TRANSFERRED ITS OPERATING ASSETS, AS DEFINED IN THE AGREEMENT, TO OCONEE REGIONAL MEDICAL CENTER, INC. (ORMC). IN AN ASSIGNMENT AGREEMENT DATED JANUARY 1, 2000, THE ORMC ASSIGNED THE LEASE TO JASPER HEALTH SERVICES, INC. ON MAY 10, 2017, ORMC FILED A VOLUNTARY PETITION FOR RELIEF UNDER CHAPTER 11 OF THE BANKRUPTCY CODE IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF GEORGIA. THE BANKRUPTCY PROCEEDINGS WERE RESOLVED ON OCTOBER 2, 2019. FORM 990, PAGE 2, PART III, LINE 4A JASPER HEALTH SERVICES, INC. (JHS) EXISTS TO PROVIDE A CONTINUUM OF HEALTHCARE FOR THE RESIDENTS OF JASPER COUNTY. THE FACILITY IS LOCATED IN A RURAL AREA WITH LIMITED ECONOMIC OPPORTUNITIES BUT PROVIDES NECESSARY MEDICAL CARE WITHOUT REGARD TO THE ABILITY TO PAY. THE EMERGENCY DEPARTMENT SERVED 3,799 PATIENTS DURING THE YEAR WITH A SIGNIFICANT PORTION UNINSURED AND UNABLE TO PAY FOR THEIR CARE. THERE WERE 3,947 OUTPATIENT ENCOUNTERS FOR DIAGNOSTIC SERVICES AND THERAPY. APPROXIMATELY 94% OF THE 1,315 INPATIENT DAYS WERE PROVIDED TO PERSONS COVERED UNDER THE MEDICARE OR MEDICAID RELATED PROGRAMS OR HAD NO INSURANCE COVERAGE AT ALL. JHS OPERATES A PHYSICIAN PRACTICE PROVIDING PRIMARY MEDICAL CARE WITH 10,958 ENCOUNTERS DURING THE YEAR. JHS PROVIDES SERVICES WITH CHARGES EITHER REDUCED OR ELIMINATED BASED ON THE PATIENT'S INCOME, GIVING DISCOUNTED CARE FOR PATIENTS WITH UP TO 250% OF THE FEDERAL POVERTY GUIDELINES. JHS PROVIDED APPROXIMATELY 6,064,000 IN UNCOMPENSATED CARE. FORM 990, PAGE 6, PART VI, LINE 7A PRIOR TO OCTOBER 9, 2019, THREE MEMBERS OF THE BOARD NOMINATED BY THE HOSPITAL AUTHORITY OF JASPER COUNTY, GEORGIA (AUTHORITY) REQUIRED THE APPROVAL OF BOTH JHS AND ORHS, THE PREVIOUS SOLE MEMBER. ORHS APPOINTED FOUR BOARD MEMBERS, TWO OF WHICH WERE THE OCONEE REGIONAL MEDICAL CENTER, INC.'S (ORMC) CEO AND THE CHIEF-ELECT OF THE MEDICAL STAFF. ANY NOMINATIONS TO FILL VACANCIES ON THE BOARD WERE SUBJECT TO PRIOR WRITTEN APPROVAL OF THE ORHS BOARD OF DIRECTORS. WITH THE SALE AND DISSOLUTION OF ORHS (INCLUDING ORMC) EFFECTIVE SEPTEMBER 30, 2017, THE ORHS BOARD MEMBERS TENDERED THEIR RESIGNATION. SEE DISCUSSION ABOVE FOR CHANGES MADE EFFECTIVE OCTOBER 9, 2019, INCLUDING NOMINATION OF MEMBERS AND ELIMINATION OF THE REQUIREMENT FOR APPROVAL FROM ORHS. FORM 990, PAGE 6, PART VI, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT UPON COMPLETION. THE RETURN WAS REVIEWED BY MANAGEMENT AND SENT TO THE BOARD OF DIRECTORS FOR REVIEW. A PERIOD OF TIME WAS ALLOWED FOR DISCUSSION, QUESTIONS, AND COMMENTS BEFORE FILING THE RETURN WITH THE IRS. FORM 990, PAGE 6, PART VI, LINE 12C THE CONFLICT OF INTEREST POLICY QUESTIONNAIRE IS DISTRIBUTED TO AND SIGNED ANNUALLY BY ALL VOTING BOARD MEMBERS BEFORE MAJOR DISCUSSIONS AND VOTES, THE POLICY IS REVIEWED, AND ANY MEMBER WITH A POTENTIAL CONFLICT OF INTEREST DOES NOT PARTICIPATE IN EITHER THE DISCUSSION OR VOTE. FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION OF THE ADMINISTRATOR AND THREE OF THE HIGHEST COMPENSATED EMPLOYED PHYSICIANS IS SUBJECT TO THE REVIEW AND APPROVAL OF THE BOARD OF DIRECTORS. THE BOARD COMPARES SALARY OPTIONS WITH CURRENTLY AVAILABLE DATA FROM HOSPITAL ASSOCIATIONS AND OUTSIDE LITERATURE ON COMPENSATION. FORM 990, PAGE 6, PART VI, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PAGE 6, PART VI, LINE 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART IX, LINE 11G CONTRACT LABOR 693,652 0 0 PROFESSIONAL FEES 621,729 0 0 PURCHASED SERVICES 179,510 774,768 0 TOTAL 1,494,891 774,768 0 FORM 990, PART XI, LINE 9 REBATES RECLASSIFIED -108 REBATES RECLASSIFIED 108