2026-07-16T10:37:18-04:00 2025-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2024-10-01 582510435 JASPER HEALTH SERVICES INC JASP 7064686411 898 COLLEGE STREET MONTICELLO GA 310641258 ROBERT CUMBIE CEO 4784543522 2026-07-13 true false WILLIAM EDWARD PHILLIPS P00451499 2298837878 2026-07-13 2024 2025-03-06 01:10:19Z JASPER MEMORIAL HOSPITAL ROBERT CUMBIE 898 COLLEGE STREET MONTICELLO GA 31064 17280696 false X WWW.JASPERMEMORIALHOSPITAL.ORG X 1999 GA JASPER HEALTH SERVICES, INC. (JHS) IS COMMITTED TO DELIVERING COMPASSIONATE AND EXCEPTIONAL CARE FOR OUR COMMUNITY. 6 5 237 0 1308357 1157682 13735492 15444369 26260 127548 134006 151080 15204115 16880679 0 0 10660391 11755868 0 0 5775590 5742206 16435981 17498074 -1231866 -617395 10569203 10296300 2073153 2527161 8496050 7769139 X JASPER HEALTH SERVICES, INC. (JHS) IS COMMITTED TO DELIVERING COMPASSIONATE AND EXCEPTIONAL CARE FOR OUR COMMUNITY. false false 12600329 15575717 JASPER HEALTH SERVICES, INC. (JHS) EXISTS TO PROVIDE A CONTINUUM OF HEALTHCARE FOR THE RESIDENTS OF JASPER COUNTY. 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. THE HOSPITAL 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 4,297 PATIENTS DURING THE YEAR WITH A SIGNIFICANT PORTION UNINSURED AND UNABLE TO PAY FOR THEIR CARE. THERE WERE 4,612 OUTPATIENT ENCOUNTERS FOR DIAGNOSTIC SERVICES AND THERAPY. APPROXIMATELY 98% OF THE 1,082 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 12,477 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 8,954,000 IN UNCOMPENSATED CARE. 12600329 true true false true false false false false false false true false false true true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 72 0 237 true false false false false false false false false false false false false X 6 5 false false false false false true false true true false false true true true true true true true false false GA X X ROBERT CUMBIE 7064686411 898 COLLEGE STREET MONTICELLO GA 31064 NATALIYA KUBASOVA MD PHYSICIAN 40.00 X 343190 0 24838 ANDREW WILLIAM ODEGAARD PHYSICIAN 40.00 X 256604 0 6389 DERRICK LANE PHYSICIAN 40.00 X 243787 0 17428 ROBERT CUMBIE CEO 40.00 X 183343 0 30155 ELIZABETH WOOD PHYSICIAN AS 40.00 X 167885 0 28798 ASHLEY NORDSTROM PHYSICIAN AS 40.00 X 170818 0 19444 STUART ABNEY CFO 40.00 X 148647 0 8369 ANGELA GORDON MEMBER 1.00 X 0 0 0 ALISON HILDEBRANT CHAIR 1.00 X 0 0 0 LYNDSY JOHNSTON MEMBER 1.00 X 0 0 0 WALKER JORDAN MEMBER 1.00 X 0 0 0 DAVID LEACH MEMBER 1.00 X 0 0 0 WALTER SMITH MEMBER 1.00 X 0 0 0 1514274 135421 27 false true false RURAL PHYSICIANS GROUP 7840 ROSEWELL RD STE 180 ATLANTA GA 30328 PHYSICIANS 597626 UNITED EMERGENCY SERVICES INC PO BOX 677979 DALLAS TX 752677979 PHYSICIANS 211178 SOLIANT HEALTH 5550 PEACHTREE PKWY ST 500 PEACHTREE CORNERS GA 30092 NURSING 191291 STAFF RELIEF INC 16 E MAIN STREET FORSYTH GA 31029 NURSING STAFF 146342 DRAFFIN & TUCKER LLP 2617 GILLONSVILLE ROAD ALBANY GA 31707 AUDIT 123976 5 521444 636238 1157682 PROGRAM SERVICE REVENUE 623000 15444369 15444369 15444369 8380 8380 1843 1843 1843 1843 519185 400017 119168 119168 119168 MISCELLANEOUS REVENUE 623000 111112 111112 DISCOUNTS AND REBATES 623000 20236 20236 CAFETERIA AND VENDING 722210 17889 17889 149237 16880679 15575717 147280 X 370518 370518 9549412 7366473 2182939 240282 193835 46447 881679 711250 170429 713977 575965 138012 10469 10469 72148 72148 144000 144000 2083099 1373626 709473 9969 2041 7928 951420 875482 75938 213377 134428 78949 96755 74179 22576 63903 23903 40000 37561 37561 712811 449071 263740 285946 165945 120001 MEDICAL SUPPLIES 401299 401299 PROVIDER TAX 314563 314563 REPAIRS & MAINTENANCE 193762 192236 1526 DUES AND SUBSCRIPTIONS 87913 39355 48558 63211 21241 41970 17498074 12600329 4897745 0 418688 379720 490316 75766 1409980 1371469 208789 251836 192561 199386 14441190 7382538 7334592 7058652 514277 23929 935542 10569203 10296300 1033452 1294902 192770 192770 593563 592460 253368 447029 2073153 2527161 X 8496050 7769139 8496050 7769139 10569203 10296300 -617395 -109516 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2208 2208 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. 250236 250236 7067790 2289997 4777793 5753490 4151357 1602133 1369674 941184 428490 7058652 UPL & OTHER RECEIVABLES 871200 MEDICARE & THIRD PARTY SETTLEMENTS 64342 935542 LEASE LIABILITIES 444765 OTHER LIABILITIES 2264 447029 X 16771163 -109516 -109516 16880679 16880679 17498074 17498074 17498074 SCHEDULE D, PAGE 3, PART X THE CORPORATION IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT 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, 2025 AND 2024 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. true true X true X 1.250000000000 true X true true false false 266256 266256 0.01520 228836 1795761 495092 1795761 266256 0.01520 495092 1795761 266256 0.01520 false 1634154 1225616 1759700 1765269 -5569 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 25 true false false true X WWW.JASPERMEMORIALHOSPITAL.ORG X true 25 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 SIX SIGNFICANT HEALTH NEEDS WERE IDENTIFIED THROUGH THE CHNA: - THE NEED TO ADDRESS THE COMMUNITY PROBLEM OF OBESITY, POOR NUTRITION, LACK OF EXERCISE, WITH SPECIAL EMPHASIS ON DIABETES EDUCATION AND PREVENTION - THE CLOSELY LINKED ISSUE OF CARDIOVASCULAR HEALTH - THE OPPORTUNITY TO EXPAND JMH'S CANCER SCREENING CAPABILITIES - THE CONTINUING PROBLEM OF MENTAL HEALTH, BEHAVIORAL ISSUES, AND SUBSTANC ABUSE - THE COMMUNITY'S NEED FOR DIALYSIS CARE - THE NEED TO PROVIDE TRANSPORTATION SOLUTIONS FOR OUT-OF-HOSPITAL AND EMERGENCY TRANSFERS. HOSPITAL LEADERSHIP IDENTIFIED THE FOLLOWING PRIORITIZED NEEDS: 1) OBESITY, NUTRITION, EXECISE, DIABETES, 2) CARDOVASCULAR HEALTH, AND 3) CANCER SCREENING EXPANSION 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. THIRTY-SIX COMMUNITY LEADERS, GOVERNMENT OFFICIALS AND MEDICAL EXPERTS, INCLUDING A JASPER COUNTY HEALTH DEPARTMENT REPRESENTATIVE, CONTRIBUTED TO THE 2025-2027 COMMUNITY HEALTH NEEDS ASSESMENT 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 SIX 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 SIGNIFICANT HEALTH NEEDS WERE PRIORITIZED AND WILL BE ADDRESSED AS DISCUSSED ABOVE. THREE OTHER IDENTIFIED HEALTH NEEDS: MENTAL HEALTH, BEHAVIORAL ISSUES, AND SUBSTANCE ABUSE; THE NEED FOR DIALYSIS CARE; AND THE NEED TO PROVIDE TRANSPORTATION SOLUTIONS FOR OUT-OF-HOSPITAL AND EMERGENCY TRANSFERS WERE DETERMINED TO BE BEYOND THE RESOURCES OF THE HOSPITAL AND WILL BE ADDRESSED THROUGH COLLABORATION OR ARE BETTER SUITED FOR OTHER PROVIDERS, NONPROFIT AND GOVERNMENT AGENCIES TO ADDRESS. WHILE MENTAL HEALTH, BEHAVIORAL ISSUES, AND SUBSTANCE ABUSE CONTINUE TO BE SIGNFICIANT HEALTH ISSUES IN JASPER COUNTY, COMMUNITY RESOURCES ARE LIMITED BEYOND THE JMH EMERGENCY DEPT WORKING WITH BEHAVORIAL HEALTH CONNECTIONS AND PHYSICIANS IN THE PRIMARY CARE CENTERS PROVIDING CARE WITHIN THEIR SCOPE OF PRACTICE. OUT OF COUNTY AGENCIES WILL CONTINUE TO BE USED AS REFERRAL SOURCES; ALSO, THE NATION-WIDE 988 HOTLINE WILL BE PROMOTED. DIALYSIS CARE WILL BE REFERRED TO CENTERS IN COVINGTON, MADISON OR MACON. THE REMAINING NEED FOR TRANSPORTATION SOLUTIONS TO ADDRESS IN AND OUT-OF- HOSPITAL TRANSFERS IS AN ON-GOING ISSUE CURRENTLY BEING DISCUSSED BETWEEN JMH LEADERSHIP AND THE JASPER COUNTY FIRE RESCUE/EMS CHIEF WITH INVOLVEMENT OF JASPER COUNTY GOVERNMENT OFFICALS. EFFORTS ARE UNDERWAY TO REACH A COMPROMISE REGARDING THE TYPES OF PATIENT CONDITIONS THAT CAN BE MANAGED BY THE JMH EMERGENCY DEPARTMENT, AND HOW TRANSFERS OUT OF THE HOSPITAL CAN BE ADDRESSED. 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 17,310 WITH APPROXIMATELY 19% OF THE POPULATION OVER AGE 65. CENSUS BUREAU RECORDS REFLECT NEARLY 76% OF THE POPULATION LISTED AS WHITE WITH 14% LISTED AS BLACK. AN ESTIMATED 21% OF THE POPULATION IS BELOW THE POVERTY LEVEL. 14% 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 322190 21000 18617 6221 368028 ANDREW WILLIAM ODEGAARD PHYSICIAN 222605 33999 6389 262993 DERRICK LANE PHYSICIAN 223787 20000 3946 13482 261215 ROBERT CUMBIE CEO 182143 1200 10200 19955 213498 ELIZABETH WOOD PHYSICIAN ASSISTANT 142393 25492 9354 19444 196683 ASHLEY NORDSTROM PHYSICIAN ASSISTANT 117662 53156 19444 190262 STUART ABNEY CFO 146647 2000 8027 342 157016 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. 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. 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. THE HOSPITAL 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 4,297 PATIENTS DURING THE YEAR WITH A SIGNIFICANT PORTION UNINSURED AND UNABLE TO PAY FOR THEIR CARE. THERE WERE 4,612 OUTPATIENT ENCOUNTERS FOR DIAGNOSTIC SERVICES AND THERAPY. APPROXIMATELY 98% OF THE 1,082 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 12,477 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 8,954,000 IN UNCOMPENSATED CARE. FORM 990, PAGE 6, PART VI, LINE 7A AT LEAST ONE MEMBER OF THE BOARD OF DIRECTORS SHALL ALSO BE A MEMBER OF THE HOSPITAL AUTHORITY OF JASPER COUNTY. THE BOARD SHALL CONSIST OF NO LESS THAN 3 AND NO MORE THAN 7 MEMBERS. ALL OF THE MEMBERS SHALL BE PERSONS SELECTED FROM THE JASPER COUNTY, GEORGIA COMMUNITY, OR ITS CONTINGUOUS SURROUNDING COUNTIES. 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 365,162 0 0 PROFESSIONAL FEES 740,881 0 0 PURCHASED SERVICES 267,583 709,473 0 TOTAL 1,373,626 709,473 0