4A (Expenses $ 25929174 including grants of $ 0) (Revenue $ 34813717)
As a not for profit critical access hospital, Jefferson Memorial Hospital JMH provides general medical services to the community of Ranson, WV. Such services include but are not limited to family medicine, internal medicine, observation to see if hospital admission is necessary, and outpatient ancillary testing. During 2021, JMH documented 1,075 outpatients in the observation status and 88,816 outpatient ancillary tests were performed.

4B (Expenses $ 12469698 including grants of $ 0) (Revenue $ 21680469)
Jefferson Memorial Hospital JMH is a critical access hospital and operates a 24 hours per day, 7 days per week emergency department which cares for patients regardless of their ability to pay. During 2021, the Emergency Department documented 20,910 patient visits.

4C (Expenses $ 3832804 including grants of $ 0) (Revenue $ 5520531)
Jefferson Memorial Hospital JMH provides both general and advanced surgical services to those residents located in Ranson, WV and the surrounding area. Surgical service areas at JMH include gall bladder, breast and colon, orthopaedics and joint replacement, otolaryngology, gynecology, urology, ophthalmology and cosmetic surgery. In addition, many of these surgical procedures performed at JMH utilize cutting edge laparoscopy and endoscopy techniques. The hospital also provides a One Day Surgical Unit that provided care to 2,649 patients during 2021.

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The 2019 Community Health Needs Assessment was prepared by Thomas Bias, Christiaan Abildso and Emily Sarkees of the West Virginia University Health Research Center. The Community Health Needs Assessment CHNA process began with a thorough review of the previous cycles needs assessment report and implementation plan. The CHNA also involved collecting both primary and secondary data. According to the CHNA, primary data was comprised of a survey of community members perceptions of health issues followed by a community event focused on reviewing survey data, discussing community resources and assets that impact population health in the area, and working as a group to outline possible implementation strategies for each area of concern. Secondary data included US census data and County Health Rankings Data. The stakeholders represent the broad interest of the communities served by University Healthcare WVUH-East. According to the CHNA, a community meeting was held in Martinsburg to get more input from the public, especially from organizations who provide social services to individuals within the service area of University Healthcare. Representatives from these organizations held discussions in small groups to compile a working list of existing resources, programs, policies, and ideas to address each area of concern, in addition to raising questions and providing information and perspective during overall discussion of the survey data results. The CHNA stated that they also worked in their small groups and as a part of a larger discussion to formulate some new suggestions to address each health area. The organizations represented at this community meeting included American Cancer Society, Berkeley County Chamber of Commerce, Berkeley County Development Authority, Berkeley County Health Department, Berkeley County Schools, Catholic Charities, City of Martinsburg, EPIC, Jefferson County Chamber of Commerce, Jefferson County Development Authority, Jefferson County Health Department, Jefferson County Sherriffs Department, Martinsburg Parks and Recreation, Panhandle Home Health, Shenandoah Community Health, United Methodist Church, United Way and WVU Medicine officials. The CHNA can be found here https//wvumedicine.org/wp-content/uploads/2020/11/BMCJMC-CHNA-Report-2019.pdf.

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In addition to the community meeting, a public survey was also utilized. The public survey was developed by the WVU SPH with the leadership team following an iterative process. Survey topics included questions about perceptions of overall health of the community, quality of life, access to healthcare and medical needs, personal behaviors and habits, and demographic information including age, education and income. The survey was collected both online and through hard copies from residents who are 18 or older. The survey link was distributed through email lists, patient charts, social media, and made available as hard copies in the community.

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The Community Needs Health Assessment CHNA was undertaken jointly with City Hospital, Inc..

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According to the CHNA, following the community meeting, the leadership team discussed the totality of information collected through the survey and community event, working to identify priority areas for developing implementation strategies. With leadership and the community meeting group, the WVU SPH reviewed summarized survey data, including overall responses to the three most important health problems or issues. Health problems pertains to mainly clinical items such as health and disease topics however, when creating the survey tool, the hospital leadership saw value in asking about factors affecting health outcomes. For this reason, according to the CHNA, topics were grouped into three questions clinical health and disease items e.g. heart disease, addiction, cancer, quality of life and built or natural environmental factors e.g. air quality, availability of sidewalks, cost of medications, as well as things seen as personal choices or behaviors e.g. vaping, distracted driving, poor eating choices. This allowed the leadership team to cross-reference clinical items with their life factors and personal choices for a deeper understanding of the common themes, and a snapshot perspective of where in life the Hospital might be able to implement strategies that will impact many. The CHNA survey results for health and disease included 1. Drug addiction/dependence, 2. Obesity and chronic disease 3. Mental health problems. CHNA survey results for quality of life and environmental included 1. Cost of care/medications 2. Low income 3. Lack of access to recreation spaces for all ages. CHNA survey results for personal choices and risky behaviors included 1. Drug abuse 2. Alcohol abuse 3. Bad eating choices.

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During the prioritization process that followed the community meeting, leadership team members revisited common priority areas within the context of discussions and feedback from the morning. Utilizing a prioritization matrix to guide discussion, the group considered the degree to which the hospitals can realistically affect health outcomes for each priority health concern, endeavors already underway for each, as well as level of importance relative to the reach of their impact. The list of top health concerns was pared down and reconfigured to the three that will be the focus moving forward with implementation planning. These included substance use and abuse, obesity and chronic disease and mental health.

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The top health concerns identified by the stakeholders are being addressed by University Healthcare in the following ways. For substance abuse, hospital leadership plans to get more MAT-trained providers in place, support for the potential Quick Response Team being developed in Jefferson County, and the importance of work to reduce stigma and use of negative terminology surrounding addiction. Potential strategies to combat obesity include further addressing and utilizing current partnerships and programming University Healthcare already has in place to help aid in the prevention of obesity and other chronic diseases. Efforts include a Diabetes Coalition and Chronic Disease and Chronic Pain Self-Management Programs. Lastly, hospital leadership discussed recent hospital efforts to address the issue of mental health. These efforts include four psychiatrists, a new clinic in Ranson, recent surveying of all physicians regarding burnout, etc. Some initial strategy ideas included child and adolescent services to address existing school-based issues, initiatives addressing patients via MyChart, a need for addressing stigma and for addressing increasing suicide rates in the area.

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Hospital leadership did take the time to discuss some of the issues beyond the top three identified at the community meeting. Aging problems, low income, employment access, and transportation, for example, are something that the hospital recognizes as a community and statewide concern. However, the team agrees that these are larger problems that cannot be addressed with the resources and tools available to the hospitals right now. Similarly, cost of care and health insurance appear repeatedly in the community data, but the leadership team acknowledges that these are also in many ways systemic issues over which they have little control. Leadership has not discounted these other issues, however, and will revisit at a later time, recognizing that potential collaborations with future partners could change the scope of their impact.

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Priority areas identified included chronic disease, mental health and substance use. Chronic disease is being addressed through various programs. A Diabetes Coalition was created, Chronic Disease and Chronic Pain Self-Management Program workshops are being offered virtually, Walk With Ease had been offered in person outdoors along with a multitude of other community outreach programs that address food insecurity, nutrition, physical activity and health prevention and management. Mental Health initiatives include chairing the Health and Human Services Collaborative Behavioral Health Work Group, Stigma Reduction Education in the community and the Bridges Community Collaborative. Substance use is being addressed with education and prevention as well as treatment and referral initiatives.

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Jefferson Memorial Hospital JMH offers discounted care only to individuals who qualify for free care. JMH offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount, the patient/guarantor must meet certain requirements.

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All patients are charged an amount equal to gross charges regardless of payment method. Once FAP eligibility is confirmed, charge amounts are moved to Charity Care and no longer charged to the patient.

Part I Line 3c
Jefferson Memorial Hospital JMH uses 200 Federal Poverty Guideline to determine free care eligibility. JMH offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount the patient/guarantor must meet certain requirements.

Part I Line 6a
Jefferson Memorial Hospital community benefit numbers are reported in total with the other hospitals within West Virginia United Health System. The most recent amounts can be found at the following web address http//wvumedicine.org/about/community-benefit/.

Part I Line 7
Column f - Total community benefit expense for 2021 is 18,800,909 and is 28.33 of total net expenses. To calculate net expense, bad debt of 3,446,509 was deducted from total expenses of 69,807,288 as shown in Part IX line 25 of the core Form 990.

Part I Line 7
Worksheet 2 from the IRS Schedule H instructions was used to derive the cost-to-charge ratio, which was used to calculate charity care, unreimbursed Medicaid and other means-tested government programs at cost.

Part II
Physical Improvements and Housing - No activities reported in 2021.

Part II
Economic Development - A representative from JMC serves on the Jefferson County Chamber of Commerce Board of Directors. A representative from JMH also serves on the Jefferson County Development Authority Board of Directors.

Part II
Community Support - We sponsor and have a team participate in the annual March of Dimes Walk Jefferson County, American Cancer Society Relay for Life in Jefferson County and various other fundraising events for local, health related, non-profit organizations. Most of these activities were cancelled in 2020 due to COVID. Support continues as possible. Many WVUH-East employees serve as volunteer board directors on community non-profit organizations such as Hospice of the Panhandle and the United Way of the Eastern Panhandle as well as participate in other non-profit organizations such as the Jefferson County Council of Aging Senior Center, Jefferson County Chamber of Commerce and various community support activities within Jefferson County Community Ministries.

Part II
Environmental Improvements - 2021 marked the sixth full year for Jefferson Memorial Hospital as a tobacco free campus.

Part II
Leadership Development and Training - Two managers participated in the Chamber of Commerces Leadership Jefferson program in 2021. Several managers participated in leadership development trainings and have sent several staff to services to enrich their skills.

Part II
Coalition building - JMH staff participates in the Health Human Services Collaborative and workgroups such as the Health Work Group and Behavioral Health Workgroup as well as On Track Jefferson, the Jefferson Berkley Alliance, Healthy Grandfamilies and Mountains of Hope Cancer Coalition.These activities focus on improving community access to health care, human services in general, and determine ways to encourage healthy lifestyles. JMH also sponsored health wellness events and participate in wellness events with the local schools, Jefferson County Parks Recreation, the City of Ranson, Ranson Parks and Recreation, the City of Charles Town and employer wellness fairs such as American Public University.

Part II
Community health improvement advocacy -In 2021, JMC leadership continued addressing health issues identified in the most recent CHNA.

Part II
Workforce Development - WVUH-East is also a major sponsor of the Womens Network which is an organization established by the Berkeley and Jefferson County Chambers. This group sponsors womens professional activities, social networking and professional development and womens health seminars. Jefferson Memorial Hospital also has agreements with area community colleges and universities to allow students to complete clinical rotations at the hospital. JMH also provides a job shadow program and a summer junior volunteer program to teens to allow them opportunities to shadow professionals to learn about possible careers in the workforce as well as participates in school career fairs in the elementary through high schools in the county as COVID allows.

Part II
Health programs are also offered free to the community. In 2021, the Walk with Ease program was offered in-person and the Chronic Pain Self-Management Program was offered virtually.

Part III Line 2
Bad Debt Expense at cost was calculated by multiplying bad debt expense of 3,446,509 by our cost to charge ratio of 42.00 derived from Worksheet 2 in the IRS Schedule H instructions for a total of 1,447,534 less DSH allocations to self-pay patient accounts of 231,562 for a total of 1,215,972.

Part III Line 3
Estimated bad debt attributable to patients eligible for charity care was calculated by running a report within our patient revenue software of all bad debt account balances greater than 15,000. The total of that report was 254,161 which we then multiplied by our cost to charge ratio of 42.00 for a total of 106,748.

Part III Line 3
The estimated bad debt attributable to patients eligible for charity care of 106,748 should be considered community benefit due to the fact that anyone with outstanding balances of 15,000 or greater usually qualifies as catastrophic if the patient completes the application process.

Part III Line 3
In our charity care policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year. Regardless, that bad debt should be considered community benefit as we provide services to those in need regardless of their ability to pay.

Part III Line 4
The System grants credit without collateral to its patients, most of whom are local residents, and are insured under third-party payor agreements, primarily with Medicare, Medicaid and various commercial insurance companies. The System records accounts receivable net of estimated prince concessions and such amounts have historically been within managements expectations.

Part III Line 4
The mix of accounts receivable at December 31, 2021 and 2020, from patients and third-party payors is as follows For the year-end December 31, 2021 Medicare - 31, Medicaid - 16, Blue Cross - 21, Commercial, managed care and other - 28, Patients - 4, totaling 100. For the year-end December 31, 2020, Medicare - 29, Medicaid - 17, Blue Cross - 21, Commercial, managed care and other - 28, Patients - 5, totaling 100.

Part III Line 8
The amount reported in Part III Line 6 26,552,488 was calculated using the total Medicare allowable cost from the Medicare cost report.

Part III Line 8
Jefferson Memorial Hospitals 1,025,669 shortfall of Medicare program reimbursement should be considered a community benefit because we are relieving a government burden by providing care in excess of our costs to these patients.

Part III Line 9b
JMH does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy.

Part III Line 4
Jefferson Memorial Hospitals financial statements are prepared on a consolidated basis as a member of the WV United Health System. The footnote for Accounts Receivable is as follows Patient accounts receivable are reported at net realizable value. For accounts receivable associated with services provided to patients who have third-party coverage, the System estimates net realizable value based on the estimated contractual reimbursement percentage, which in turn is based on current contract provisions and historical paid claims by payor. For self-pay accounts, including uninsured and patient responsibility accounts, the net realizable value is determined using historical collection experience, adjusted for estimated conversions of patient responsibility portions, expected recoveries and changes in trends to estimate implicit price concessions. Management continually reviews the estimated net realizable value of accounts receivable by monitoring cash collections, economic conditions and trends, changes in payor mix, changes in federal or state healthcare coverage and other matters.

Part VI Line 2
Jefferson Memorial Hospital is a critical care hospital within the health care delivery system of West Virginia University Hospital - East WVUH-East. The marketing department considers several components in assessing how the organization determines the needs of the communities it serves. Through outside consultants, to collaborating with various departments, a needs assessment takes into account several factors including physician to population ratios, physician availability in the entire service area, and general health risks for our community. The Primary Service Area PSA for WVUH-East includes Berkeley County, WV, Jefferson County, WV and Morgan County, WV. This data is then analyzed to provide general estimates to where WVUH-East entities could better care for residents of the West Virginia Eastern Panhandle.

Part VI Line 3
JMH employs a patient account representative to meet with patients to discuss financial eligibility for our charity care program. JMH has applications for charity and the qualification requirements for receiving charity available at all registration areas for both facilities. Patients who do not qualify for state or federal funded programs can apply for the charity care program at WVUH-EAST.

Part VI Line 4
Jefferson Memorial Hospital is a non-profit critical access hospital located in Jefferson County, WV in the city of Ranson. Jefferson Memorial Hospital along with City Hospital located in Martinsburg makes up the Eastern Region of WVU Medicine which is a part of the West Virginia United Health System.

Part VI Line 4
WVU Medicine provides a majority of inpatient services for the population in our Primary Service Area PSA. The PSA identified in the most recent CHNA for the Eastern Region of WVU Medicine includes Berkeley County, WV, Jefferson County, WV and Morgan County, WV. The 2020 market share for Jefferson Memorials Primary Service Area is 21.9, with 26.4 of those patients covered by Medicaid and 2.7 of the patients uninsured. City Hospital, Inc., a non-profit acute care hospital under common management, is within the Primary Service Area and War Memorial Hospital, a non-profit critical access hospital, located in the extended service area is operated by Valley Health System.

Part VI Line 4
Jefferson Countys population is 58,370, with a median household income of 82,551, an employment rate of 65, 7.8 of persons living in poverty and 7.1 without healthcare coverage. Berkeley County has a population of 126,069, a median household income of 62,286, an employment rate of 67, 10.0 of persons living in poverty and 7.8 without healthcare coverage. Morgan County, WV has a population of 17,221 with an average household income of 57,116, an employment rate of 57, 11.0 of persons living in poverty and 9.9 without healthcare coverage. Population and demographic information was obtained from the United States Census Bureau https//data.census.gov/cedsci/.

Part VI Line 5
In 2009, WVUH-East started offering discounted screening in response to a struggling economy. Recognizing that individuals were putting off scheduling routine, preventive testing such as mammograms and blood work, WVUH-East offered Discounted Mammogram Clinics in May and October 2021 cash, no insurance. The clinics were successful in serving 44 patients at Jefferson Memorial Hospital.

Part VI Line 5
2. Our Mini-Medical School Program, which is held 9 times a year in Berkeley County, is a community health education program featuring local physicians and topics that address health needs in our communities. The program is jointly sponsored by WVUH-East and the WVU Robert C. Byrd Health Sciences Center Eastern Division. The virtual program is jointly sponsored by WVUH-East and the WVU Robert C. Byrd Health Sciences Center Eastern Division. It is offered free to the community on our Facebook page with an average of 650 views.

Part VI Line 6
Jefferson Memorial Hospital is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery team. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its services area, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves.

Part VI Line 6
System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include West Virginia University Hospitals, Inc. in Morgantown, WV, United Hospital Center in Bridgeport, WV, Camden-Clark Memorial Hospital in Parkersburg, WV, City Hospital, Inc. in Martinsburg, WV, Potomac Valley Hospital in Keyser, WV, Reynolds Memorial Hospital, in Glen Dale, WV, West Virginia Health Care Cooperative, doing business as, Summersville Regional Medical Center in Summersville, WV, Braxton County Memorial Hospital in Gassaway, WV, Community Health Association, doing business as, Jackson General Hospital in Ripley, WV, St. Josephs Hospital of Buckhannon in Buckhannon, WV, Wetzel County Hospital, Inc. in New Martinsville, WV, Barnesville Hospital Assocation in Barnesville, OH, Uniontown Hospital in Uniontown, PA, Wheeling Hospital, Inc. in Wheeling, WV and Harrison Community Hospital, Inc. in Cadiz, OH.

Part VI Line 6
In addition to the above mentioned hospitals, the System includes physician practices of United Physicians Care, Inc., Camden-Clark Physician Corp, and Fayette Physician Network dba WVUHS Medical Group that operate in conjunction with the System hospitals along with United Summit Center, Inc. a behavioral health center located in Clarksburg, WV. The System also includes, WVUH-East, Inc. and Camden-Clark Health Services, Inc. which operate as management companies for their respective hospitals. University Healthcare Foundation, Inc. in Martinsburg, WV, United Health Foundation, Inc. in Bridgeport, WV, Camden-Clark Foundation, Inc. in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Foundation, Inc. in Glen Dale, WV, Barnesville Hospital Foundation in Barnesville, OH, and Harrison Community Hospital Foundation in Cadiz, OH which perform various fundraising activities for their respective hospitals. In 2020, the System formed WVUHS Home Care, LLC to provide Home Health and Hospice services to our service areas, supporting System hospitals by providing continuous care to our patients. Wheeling Hospital Ambulatory Surgical Center, LLC a surgical center located in Bridgeport, OH was acquired in 2021.