ST DOMINIC-JACKSON MEMORIAL HOSPITAL: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- ST DOMINIC-JACKSON MEMORIAL HOSPITAL (EIN 64-0303091)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-15
- IRS object ID
- 202431369349313043
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-05-15T15:30:27-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 MAIN STREET SUITE 2150 | AddressLine1Txt |
| City | BATON ROUGE | CityNm |
| State Abbreviation | LA | StateAbbreviationCd |
| ZIP | 70801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 640303091 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST DOMINIC - JACKSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STDO | BusinessNameControlTxt |
| Phone | 6012006570 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 969 LAKELAND DRIVE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 392164699 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SAM SCOTT | PersonNm |
| Person Title | REGIONAL CFO | PersonTitleTxt |
| Phone | 6012006570 | PhoneNum |
| Signature | 2024-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SAM | PersonFirstNm |
| Person Last | SCOTT | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RYAN HOOKS | PreparerPersonNm |
| PTIN | P00746825 | PTIN |
| Phone | 2253444000 | PhoneNum |
| Preparation | 2024-05-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 969 LAKELAND DRIVE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 392164699 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $554,438,669 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STDOM.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | MS | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE FOR THE CARE OF THE ILL, INJURED, OR DISABLED PERSONS, AND TO PROVIDE FOR RESEARCH, EDUCATION, AND FOR THE ENHANCEMENT OF HEALTH OF THOSE IN THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 4062 | TotalEmployeeCnt |
| Total Volunteers | 259 | TotalVolunteersCnt |
| Total Gross UBI | $457,959 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $11,779,404 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,167,444 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $530,365,163 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $530,787,522 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$2,121,726 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,940,635 | CYInvestmentIncomeAmt |
| PY Other Revenue | $9,747,841 | PYOtherRevenueAmt |
| CY Other Revenue | $4,720,867 | CYOtherRevenueAmt |
| PY Total Revenue | $549,770,682 | PYTotalRevenueAmt |
| CY Total Revenue | $545,616,468 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,381,455 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $526,950 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $284,102,007 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $265,022,579 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $310,240,020 | PYOtherExpensesAmt |
| CY Other Expenses | $371,660,584 | CYOtherExpensesAmt |
| PY Total Expenses | $596,723,482 | PYTotalExpensesAmt |
| CY Total Expenses | $637,210,113 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$46,952,800 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$91,593,645 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $457,480,771 | TotalAssetsBOYAmt |
| Total Assets EOY | $403,117,319 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $230,428,767 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $293,375,103 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $227,052,004 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $109,742,216 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING - WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $502,257,361 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $527,597,609 | RevenueAmt |
| Desc | THE ST. DOMINIC - JACKSON MEMORIAL HOSPITAL PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES TO ITS PATIENTS. IN THE CURRENT YEAR, SERVICES WERE PROVIDED FOR 130,811 PATIENT DAYS, 45,619 EMERGENCY ROOM VISITS AND 21,455 INPATIENT DISCHARGES. THE MEDICAL CENTER IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. ADDITIONAL COSTS WERE INCURRED FOR PARTICIPATION IN PROGRAMS WHICH, IN SOME CASES, PAY AMOUNTS LESS THAN THE COST OF PROVIDING SERVICES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $526,950 | ExpenseAmt |
| Grant | $526,950 | GrantAmt |
| Desc | THE HOSPITAL SERVES THE COMMUNITY IN NUMEROUS WAYS. SOME EXAMPLES INCLUDE ASSISTING IN EDUCATING THE COMMUNITY REGARDING HEALTH-RELATED ISSUES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $502,784,311 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 4062 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAM SCOTT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6012006570 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 969 LAKELAND DRIVE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 392164699 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| JOHNNY DONALDSON | ||||||||||
| VICE CHAIR | 0.75 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| SISTER M TRINITA EDDINGTON OP | ||||||||||
| SECRETARY | 0.75 | 40.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JEFF FLETCHER | ||||||||||
| CHAIR | 0.75 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| RICK GUYNES MD | ||||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| REGINALD MARTIN MD | ||||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | 0.00 | Yes (X) | $337,888 | $0 | $38,100 | ||||
| REBEKAH MOULDER MD | ||||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | 0.00 | Yes (X) | $772,889 | $0 | $17,360 | ||||
| SISTER ROSE MIRIAM SCHULTE OP | ||||||||||
| BOARD MEMBER | 0.75 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| D PAUL SEAGO MD | ||||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | 0.50 | Yes (X) | $974,725 | $0 | $34,517 | ||||
| SISTER KARINA DICKEY OP | ||||||||||
| BOARD MEMBER | 0.75 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| SISTER DOROTHEA SONDGEROTH OP | ||||||||||
| BOARD MEMBER | 0.75 | 41.50 | Yes (X) | $0 | $0 | $0 | ||||
| MONSIGNOR ELVIN SUNDS | ||||||||||
| BOARD MEMBER | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| SISTER KATHLEEN ANNE TAIT OP | ||||||||||
| BOARD MEMBER | 0.75 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| STEVEN GREMILLION MD | ||||||||||
| BD MEMBER/FMOLHS EVP CMO | 0.75 | 40.00 | Yes (X) | $0 | $929,358 | $40,368 | ||||
| SCOTT KASHMAN | ||||||||||
| MARKET PRESIDENT (UNTIL 7/22) | 40.00 | 2.50 | Yes (X) | Yes (X) | $610,569 | $0 | $97,937 | |||
| GENE LOPER MD | ||||||||||
| BOARD MEMBER/PHYSICIAN | 5.00 | 0.00 | Yes (X) | $35,825 | $0 | $0 | ||||
| BRYAN MILLER MD | ||||||||||
| BD MEMBER/FMOLHS VP CHIEF CTO | 0.75 | 41.00 | Yes (X) | $0 | $421,403 | $33,362 | ||||
| KRISTIN WOLKART | ||||||||||
| INTERIM MARKET PRESIDENT (START 7/22) | 0.75 | 42.50 | Yes (X) | Yes (X) | $0 | $575,846 | $115,578 | |||
| SAMUEL SCOTT | ||||||||||
| SVP, CFO | 41.50 | 0.00 | Yes (X) | $484,817 | $0 | $32,087 | ||||
| THU PHAN | ||||||||||
| VP COO | 40.00 | 0.00 | $287,070 | $0 | $22,259 | Yes (X) | ||||
| JOHN LANCON | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,301,731 | $0 | $43,100 | Yes (X) | ||||
| BRYAN A GASPARD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $979,749 | $0 | $41,008 | Yes (X) | ||||
| PB KERR | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,116,047 | $0 | $40,400 | Yes (X) | ||||
| ZACHARY BALDWIN | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $757,978 | $0 | $40,400 | Yes (X) | ||||
| DAVID THEODORO | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,018,412 | $0 | $33,356 | Yes (X) | ||||
| LESTER DIAMOND | ||||||||||
| FORMER PRESIDENT | 0.00 | 0.00 | $0 | $531,654 | $0 | Yes (X) | ||||
| ROBERT NELSON | ||||||||||
| FORMER VP CHIEF NURSING OFFICER | 0.00 | 0.00 | $287,127 | $0 | $14,410 | Yes (X) | ||||
| WILLIAM MORGAN | ||||||||||
| FORMER COO | 0.00 | 0.00 | $171,654 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $9,136,481 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,458,261 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $644,242 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 470 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PHYSICIANS ANESTHESIA GROUP PA | |||||
| PO BOX 3749 | JACKSON | MS | 39207 | PROFESSIONAL SERVICES | $7,289,029 |
| AYA HEALTHCARE INC | |||||
| 5930 CORNERSTONE COURT WEST | SAN DIEGO | CA | 92121 | AGENCY CONTRACT LABOR | $6,554,852 |
| TRIMEDX INC | |||||
| PO BOX 636129 | CINCINNATI | OH | 45263 | BIOMED SERVICES | $6,446,797 |
| SAVISTA LLC | |||||
| P O BOX 676188 | DALLAS | TX | 75267 | REVENUE CYCLE SERVICES | $4,018,706 |
| JACKSON HEART CLINIC PA | |||||
| PO BOX 5169 | JACKSON | MS | 39296 | PROFESSIONAL FEE SERVICES | $3,889,941 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 96 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $5,652,761 | RelatedOrganizationsAmt |
| Government Grants | $250,741 | GovernmentGrantsAmt |
| All Other Contributions | $1,263,942 | AllOtherContributionsAmt |
| Total Contributions | $7,167,444 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| PATIENT SERVICE REVENU | 621990 | $523,509,470 | $523,509,470 | ||
| OTHER PROGRAM SERVICE | 621990 | $4,062,466 | $3,604,507 | $457,959 | |
| CAFETERIA | 722514 | $2,576,368 | $2,576,368 | ||
| LAB | 621990 | $483,632 | $483,632 | ||
| VENDING REVENUE | 900099 | $82,719 | $82,719 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $72,867 | TotalRevenueColumnAmt |
| Exclusion | $72,867 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $530,787,522 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,619,825 | TotalRevenueColumnAmt |
| Exclusion | $2,619,825 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,720,867 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,720,867 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,720,867 | TotalRevenueColumnAmt |
| Exclusion | $4,720,867 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,143,011 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,822,201 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $320,810 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $320,810 | TotalRevenueColumnAmt |
| Exclusion | $320,810 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $545,616,468 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $527,597,609 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $457,959 | UnrelatedBusinessRevenueAmt |
| Exclusion | $10,393,456 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $526,950 | TotalAmt |
| Program Services | $526,950 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,341,570 | TotalAmt |
| Program Services | $3,149,805 | ProgramServicesAmt |
| Management And General | $191,765 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,163,892 | TotalAmt |
| Program Services | $210,356,999 | ProgramServicesAmt |
| Management And General | $12,806,893 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,837,076 | TotalAmt |
| Program Services | $6,428,714 | ProgramServicesAmt |
| Management And General | $408,362 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,006,749 | TotalAmt |
| Program Services | $15,992,289 | ProgramServicesAmt |
| Management And General | $1,014,460 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,673,292 | TotalAmt |
| Program Services | $13,796,893 | ProgramServicesAmt |
| Management And General | $876,399 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,837,084 | TotalAmt |
| Program Services | $46,348,930 | ProgramServicesAmt |
| Management And General | $47,488,154 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,412 | TotalAmt |
| Program Services | $31,070 | ProgramServicesAmt |
| Management And General | $307,342 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,400 | TotalAmt |
| Program Services | $8,392 | ProgramServicesAmt |
| Management And General | $83,008 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,701 | TotalAmt |
| Management And General | $67,701 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,655,362 | TotalAmt |
| Program Services | $11,079,670 | ProgramServicesAmt |
| Management And General | $23,575,692 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,002,399 | TotalAmt |
| Program Services | $151,221 | ProgramServicesAmt |
| Management And General | $851,178 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,259,678 | TotalAmt |
| Program Services | $12,911,452 | ProgramServicesAmt |
| Management And General | $17,348,226 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,956,549 | TotalAmt |
| Program Services | $295,164 | ProgramServicesAmt |
| Management And General | $1,661,385 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,529,460 | TotalAmt |
| Program Services | $13,792,951 | ProgramServicesAmt |
| Management And General | $2,736,509 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,948 | TotalAmt |
| Program Services | $43,590 | ProgramServicesAmt |
| Management And General | $245,358 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,303 | TotalAmt |
| Program Services | $8,343 | ProgramServicesAmt |
| Management And General | $46,960 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $865,201 | TotalAmt |
| Program Services | $10,779 | ProgramServicesAmt |
| Management And General | $854,422 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,488,386 | TotalAmt |
| Program Services | $14,015,129 | ProgramServicesAmt |
| Management And General | $2,473,257 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,242,902 | TotalAmt |
| Program Services | $1,130,039 | ProgramServicesAmt |
| Management And General | $5,112,863 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL & OTHER SUPPLIE | $130,500,333 | $117,929,733 | $12,570,600 |
| PENSION RELATED ADJUSTM | $29,493,590 | $26,652,585 | $2,841,005 |
| OTHER EXPENSES | $7,554,353 | $6,828,176 | $726,177 |
| REPAIRS & MAINTENANCE | $1,396,233 | $1,261,739 | $134,494 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,290 | TotalAmt |
| Program Services | $33,698 | ProgramServicesAmt |
| Management And General | $3,592 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $637,210,113 | TotalAmt |
| Program Services | $502,784,311 | ProgramServicesAmt |
| Management And General | $134,425,802 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,791,227 | BOYAmt |
| EOY | $15,151,818 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,956,160 | BOYAmt |
| EOY | $726,945 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,209,733 | BOYAmt |
| EOY | $63,883,921 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,612,202 | BOYAmt |
| EOY | $15,839,171 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,159,253 | BOYAmt |
| EOY | $12,952,326 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $289,525,618 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $60,421,464 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,916,694 | BOYAmt |
| EOY | $229,104,154 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,314,640 | BOYAmt |
| EOY | $33,594,463 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,260,054 | BOYAmt |
| EOY | $7,257,601 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,257,645 | BOYAmt |
| EOY | $13,410,813 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,003,163 | BOYAmt |
| EOY | $11,196,107 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $457,480,771 | BOYAmt |
| EOY | $403,117,319 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,671,979 | BOYAmt |
| EOY | $44,387,215 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,756,788 | BOYAmt |
| EOY | $248,987,888 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,428,767 | BOYAmt |
| EOY | $293,375,103 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $227,052,004 | BOYAmt |
| EOY | $109,742,216 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $227,052,004 | BOYAmt |
| EOY | $109,742,216 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $457,480,771 | BOYAmt |
| EOY | $403,117,319 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$91,593,645 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,682,759 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$28,398,902 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,930,000 | OtherCostOrOtherBasisAmt |
| Book Value | $14,930,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $212,840,642 | OtherCostOrOtherBasisAmt |
| Depreciation | $29,784,123 | DepreciationAmt |
| Book Value | $183,056,519 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,715,522 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,627,656 | DepreciationAmt |
| Book Value | $27,087,866 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,039,454 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,685 | DepreciationAmt |
| Book Value | $4,029,769 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $229,104,154 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FND DEPR - FMOL PORTFOLIO | Desc |
| Book Value | $33,594,463 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $33,594,463 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)
| DescDesc | AmtAmt |
|---|---|
| NET DUE TO/FROM AFFILIATES | $132,758,408 |
| OPERATING LEASE - LT | $6,343,818 |
| INTERCOMPANY AP | $2,125,576 |
| SELF INSURANCE LIABILITY LT | $5,543,345 |
| RETIREMENT PAYABLE LONG TERM | $95,368,991 |
| OBLIGATION OPERATING- ST | $2,339,585 |
| OTHER LIABILITIES | $4,508,165 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $248,987,888 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVE FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,086,665 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,574,365 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,512,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,367,934 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $66,367,934 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $82,454,599 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $68,942,299 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,512,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02120 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,654 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $165 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $48,489 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $43,935 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $43,935 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,232,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,493,685 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,739,220 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $484,814 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,587 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $478,227 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,810,308 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,500,437 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,309,871 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $101,264,907 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $84,442,736 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,822,171 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02650 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $186,240 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $186,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $186,240 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $186,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $13,913,630 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $161,883,684 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $134,971,866 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $26,911,818 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 ST DOMINIC ASC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | OUTPATIENT SURGERY CENTER | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.46300 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.53700 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST DOMINIC-JACKSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 969 LAKELAND DRIVE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 392164699 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://WWW.STDOM.COM/14-031 | WebsiteAddressTxt |
| State License | 14-031 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST DOMINIC-JACKSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. DOMINIC-JACKSON MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: AS PART OF THE COMMUNITY NEEDS ASSESSMENT, ST. DOMINIC HOSPITAL REACHED OUT TO AN EXPANSIVE AND HIGHLY DIVERSE GROUP OF INDIVIDUALS TO PARTICIPATE IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) LEADERSHIP TEAM AND TO CONTRIBUTE INSIGHT FROM COMMUNITY SERVICE ORGANIZATIONS. EACH MEMBER PROVIDED PROJECT INSIGHT, FEEDBACK REGARDING PERCEPTIONS OF AREA HEALTH NEEDS, DATA EVALUATION, AND OTHER GUIDANCE DURING THE CHNA DEVELOPMENT PROCESS. THESE INDIVIDUALS OFFERED A BREADTH OF COMMUNITY HEALTH VISION, KNOWLEDGE, AND POWER TO IMPACT THE WELL-BEING OF THE SERVICE AREA. INFORMATION WAS GATHERED ABOUT THE LARGER COMMUNITY USING SECONDARY RESEARCH, DISCUSSION GROUPS AND COMMUNITY SURVEYS. |
| ST. DOMINIC-JACKSON MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: DURING THE CURRENT YEAR, ST. DOMINIC'S CONTINUED TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS IDENTIFIED DURING THE PRIOR CHNA. THOSE NEEDS WERE: - HOMELESSNESS;- CRISIS CARE PROGRAMS FOR MENTAL HEALTH; - AFFORDABLE HEALTHCARE SERVICES FOR PEOPLE OR FAMILIES WITH LOW INCOME;- DOMESTIC VIOLENCE RESOURCES; - HOUSING FOR ALL INCOMES/AGES; - COUNSELING SERVICES FOR DEPRESSION OR ANXIETY; - JOB READINESS; - POST-ADDICTIONS TREATMENT SUPPORT PROGRAMS; - COUNSELING SERVICES FOR ADOLESCENTS AND - PRESCRIPTION ASSISTANCE.THE HOSPITAL WILL NOT ADDRESS HOMELESSNESS, HOUSING FOR ALL INCOMES/AGES, JOB READINESS, DOMESTIC VIOLENCE OR COUNSELING SERVICES FOR ADOLESCENTS/CHILDREN AS THOSE COMMUNITY NEEDS ARE OUTSIDE OF ITS SCOPE. THE HOSPITAL HAS DECIDED THAT IT WILL ADDRESS CRISIS CARE FOR MENTAL HEALTH, COUNSELING SERVICES FOR DEPRESSION OR ANXIETY, AND POST-ADDICTIONS TREATMENT SUPPORT PROGRAMS WITHIN THE NEXT 2-3 YEARS.DURING THE CURRENT YEAR, TO ADDRESS THE SIGNIFICANT COMMUNITY HEALTH NEEDS LISTED ABOVE, THE HOSPITAL DID THE FOLLOWING:A SIGNIFICANT INVESTMENT WAS MADE IN COMMUNITY-DRIVEN INITIATIVES THAT MET VULNERABLE POPULATIONS WHERE THEY ARE BEST SERVED IN THE COMMUNITY. THE CARE-A-VAN MOBILE MEDICAL UNIT PROVIDED APPROXIMATELY 2,500 SCREENINGS, ASSISTANCE, AND EDUCATION TO COMMUNITY MEMBERS. EXAMPLES OF ACTIVITIES INCLUDE THE BB KING MUSEUM CHILDRENS' SUMMER CAMP WHERE CHILDREN WERE SCREENED FOR THE SOCIAL DETERMINANTS OF HEALTH, VACCINATION CLINICS THAT PROVIDED FREE IMMUNIZATIONS (867 COVID-19 AND 63 FLU), PROJECT HOMELESS CONNECT IN WHICH ST. DOMINIC'S STAFF COLLABORATED WITH COMMUNITY PARTNERS TO PRESENT A ONE-STOP-SHOP FOR FAMILIES TO GET RESOURCES TO COMBAT HOMELESSNESS AND LEARN ABOUT ACCESS RESOURCES, AND HEALTH SCREENINGS THROUGHOUT THE AREA THAT PROVIDED FRONT LINE ACCESS TO CURRENT HEALTH DATA FOR 1,508 AREA RESIDENTS.ST. DOMINIC'S PROVIDED PROGRAMMING, WELLNESS OPPORTNITIES, AND EDUCAITON THROUGH ITS SENIOR-FOCUSED NEW DIRECTIONS. IN TOTAL, 2,228 LIVES WERE AFFECTED BY THE PROGRAM THROUGH OUTREACH EFFORTS, SUCH AS DIGITAL AND FISCAL LITERACY CLASSES, CLASSES FOCUSED ON ADDRESSING HEALTH AND WELLNESS, AND DANCE CLASSES TO ENCOURAGE SENIOR MOBILITY. ADDITIONALLY, ST. DOMINIC'S FOCUSED ITS COMMUNITIY BENEFIT FUNDING STRATEGIES IN AREAS THAT TARGETED ITS COMMUNITY HEALTH NEEDS ASSESSMENT GOALS. IN TOTAL, ST. DOMINIC'S INVESTED $485,850 IN THE JACKSON AREA COMMUNITY, WITH A FOCUS ON PROGRAMS SERVING VULNERABLE POPULATIONS AND ADDRESSING HEALTH ISSUES THAT WERE RELATED TO THE CHNA IDENTIFIED PRIORITY NEEDS. THE HOSPITAL ALSO CONTINUED TO ADDRESS BEHAVORIAL OR MENTAL HEALTH BY FOCUSING ON ACCESS, EARLY DETECTION AND INTERVENTION AS EVIDENCED BY STEERED SCREENING OR EDUCATION ACTIONS IN COMMUNITIES THROUGHOUT THE STATE, COMPLETED IN-PERSON AND THROUGH VIRTUAL MEANS. EARLY DETECTION WAS A FOCUS IN PROVIDING DEPRESSION SCREENING TOOLS TO SDMA AND MEA CLINICS, AS WELL AS OTHER CLINIC LOCATIONS FOR PATIENTS SEEN IN THE PHP SETTING. ST. DOMINIC'S ALSO CONTINUED THE TELEMEDICINE OFFERINGS TO ENCOMPASS BEHAVIORAL HEALTH AND ASSIST OUTLYING COMMUNITIES WITH LIMITED PERSONNEL AND RESOURCES TO CONDUCT PROPER ASSESSMENTS. |
| ST. DOMINIC-JACKSON MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1. THE PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND ISREFERRED TO THE HOSPITAL;2. STATE-FUNDED PRESCRIPTION PROGRAMS;3. HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT;4. PATIENTS' CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCEPROGRAMS;5. PATIENT ELIGIBLE FOR FOOD STAMPS;6. MEDICAID ELIGIBLE PATIENT;7. PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY;8. PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY |
| ST. DOMINIC-JACKSON MEMORIAL HOSPITAL | PART V, SECTION B, LINE 16J: REGISTRATION PERSONNEL REFER UNINSURED AND/OR LOW-INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. |
| PART V, SECTION A, LINES 7A &10: | HTTPS://WWW.FMOLHS.ORG/ABOUT-US/COMMUNITY-IMPACT |
| PART V, SECTION B, LINE 16 A, B, C: | THE FAP, FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY OF THE FAP ARE AVAILABLE AT:HTTPS://WWW.FMOLHS.ORG/PATIENTS-GUESTS/PATIENTS-RESOURCES/FINANCIAL-ASSISTANCE-POLICY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 35 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (35 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ST DOMINIC'S HOSPITAL MEDICINE | ||||
| 971 LAKELAND DRIVE SUITE 1453 | JACKSON | MS | 39216 | HOSPITALIST CLINIC |
| 2 - ST DOMINIC'S NEUROSURGERY ASSOCIATES | ||||
| 971 LAKELAND DRIVE SUITE 657 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 3 - ST DOMINIC'S NEUROCARE | ||||
| 971 LAKELAND DRIVE SUITE 557 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 4 - ST DOMINIC'S VASCULAR AND ENDOVASCULAR | ||||
| 971 LAKELAND DRIVE SUITE 1250 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 5 - ST DOMINIC'S EAR NOSE & THROAT SURGICA | ||||
| 970 LAKELAND DRIVE SUITE 40 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 6 - ST DOMINIC'S INTERNAL MEDICINE GROUP | ||||
| 971 LAKELAND DRIVE SUITE 250 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 7 - STDOMINIC'S FAMILY MEDICINE OF MADISON | ||||
| 106 HIGHLAND WAY 103 | MADISON | MS | 39110 | PHYSICIAN CLINIC |
| 8 - ST DOMINIC'S INTERNAL MEDICINE MADISON | ||||
| 106 HIGHLAND WAY 200 | MADISON | MS | 39110 | PHYSICIAN CLINIC |
| 9 - ST DOMINIC'S CARDIOVASCULAR SURGERY | ||||
| 971 LAKELAND DRIVE SUITE 657 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 10 - ST DOMINIC'S PAIN MANAGEMENT CENTER | ||||
| 971 LAKELAND DRIVE SUITE 1159 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 11 - ST DOMINIC'S GYNECOLOGIC ONCOLOGY | ||||
| 971 LAKELAND DRIVE SUITE 750 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 12 - ST DOMINIC'S UROLOGY | ||||
| 971 LAKELAND DRIVE SUITE 360 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 13 - ST DOMINIC'S INFECTIOUS DISEASE | ||||
| 971 LAKELAND DRIVE SUITE 954 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 14 - ST DOMINIC'S PSYCHIATRIC ASSOCIATES | ||||
| 890 LAKELAND DRIVE | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 15 - ST DOMINIC'S RHEUMATOLOGY | ||||
| 106 HIGHLAND WAY SUITE 200 | MADISON | MS | 39110 | PHYSICIAN CLINIC |
| 16 - ST DOMINIC'S FAMILY MEDICINE OF BRANDON | ||||
| 1297 WEST GOVERNMENT STREET | BRANDON | MS | 39042 | PHYSICIAN CLINIC |
| 17 - ST DOMINIC'S FAMILY MEDICINE OF CLINTON | ||||
| 728 CLINTON PARKWAY SUITE B | CLINTON | MS | 39056 | PHYSICIAN CLINIC |
| 18 - ST DOMINIC'S FAMILY MEDICINE OF FLOWOOD | ||||
| 1050 RIVER OAKS DRIVE | FLOWOOD | MS | 39232 | PHYSICIAN CLINIC |
| 19 - ST DOMINIC'S FAMILY MEDICINE OF DOGWOOD | ||||
| 205A BELLE MEADE POINTE | FLOWOOD | MS | 39232 | PHYSICIAN CLINIC |
| 20 - ST DOMINIC'S FAMILY MEDICINE OF MAGEE | ||||
| 360 SIMPSON HWY 149 SUITE 220 | MAGEE | MS | 39111 | PHYSICIAN CLINIC |
| 21 - ST DOMINIC'S FAMILY MEDICINE OF JACKSON | ||||
| 890 LAKELAND DRIVE | JACKSON | MS | 39056 | PHYSICIAN CLINIC |
| 22 - ST DOMINIC'S MARTIN SURGICAL ASSOCIATES | ||||
| 971 LAKELAND DRIVE SUITE 211 | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 23 - ST DOMINIC'S FAMILY MED OF PELAHATCHIE | ||||
| 610 2ND STREET | PELAHATCHIE | MS | 39145 | PHYSICIAN CLINIC |
| 24 - ST DOMINIC'S FAMILY MEDICINE OF RALEIGH | ||||
| 342 MAGNOLIA DRIVE | RALEIGH | MS | 39153 | PHYSICIAN CLINIC |
| 25 - ST DOMINIC'S FAMILY MEDICINE GLUCKSTADT | ||||
| 286 CALHOUN STATION PARKWAY | MADISON | MS | 39110 | PHYSICIAN CLINIC |
| 26 - ST DOMINIC'S COUMADIN CLINIC | ||||
| 890 LAKELAND DRIVE | JACKSON | MS | 39056 | PHYSICIAN CLINIC |
| 27 - ST DOMINIC'S CHRONIC CARE CLINIC | ||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 28 - ST DOMINIC'S OUTREACH PROGRAM-TELEMEDIC | ||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | PHYSICIAN CLINIC |
| 29 - ST DOMINIC'S OUTREACH PROGRAM-MAGEE | ||||
| 360 SIMPSON HWY 149 SUITE 370 | MAGEE | MS | 39111 | PHYSICIAN CLINIC |
| 30 - ST DOMINIC'S OUTREACH PROGRAM-CLEVELAND | ||||
| 810 E SUNFLOWER ROAD | CLEVELAND | MS | 38732 | PHYSICIAN CLINIC |
| 31 - ST DOMINIC'S OUTREACH PROGRAM-KOSCIUSKO | ||||
| 332 HIGHWAY 12 WEST | KOSCIUSKO | MS | 39090 | PHYSICIAN CLINIC |
| 32 - ST DOMINIC'S OUTREACH PROGRAM-PELAHATCH | ||||
| 610 2ND STREET | PELAHATCHIE | MS | 39145 | PHYSICIAN CLINIC |
| 33 - ST DOMINIC'S OUTREACH PROGRAM-VICKSBURG | ||||
| 4204 CLAY STREET | VICKSBURG | MS | 39180 | PHYSICIAN CLINIC |
| 34 - ST DOMINIC'S OUTREACH PROGRAM-BROOKHAVE | ||||
| 427 HWY 51 N | BROOKHAVEN | MS | 39601 | PHYSICIAN CLINIC |
| 35 - ST DOMINIC'S INTERNAL MEDICINE CLINIC | ||||
| 112 SOUTH LAKE CIRCLE | CANTON | MS | 39046 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULLY-DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. FULLY-DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS IF MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSOAVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1) PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND IS REFERREDTO THE HOPSITAL;2) STATE-FUNDED PRESCRIPTION PROGRAMS;3) HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT;4) PATIENT'S CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCEPROGRAMS;5) PATIENT ELIGIBLE FOR FOOD STAMPS;6) MEDICAID ELIGIBLE PATIENT;7) PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY;8) PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY. |
| PART I, LINE 7: | A COST TO CHARGE RATIO WAS USED TO CALCULATE PART I, LINE 7A AND 7B. THE COST TO CHARGE RATIO WAS DERIVED FROM IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. THE COST TO CHARGE RATIO IS APPLIED TO GROSS CHARGES RELATED TO CHARITY CARE AND CARE COVERED BY MEDICAID AND OTHER GOVERNMENT PROGRAMS. FOR PART I, LINES 7E THROUGH 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND THE MEDICARE COST REPORT LESS DIRECT OFFSESTTING REVENUE, WHERE APPLICABLE. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ST. DOMINIC PROVIDES SIGNIFICANT SUPPORT TO ITS COMMUNITY THROUGH A VARIETY OF WAYS INCLUDING FREE HEALTH SCREENINGS AT LOCAL SCHOOLS, PARTICIPATION IN VARIOUS NON-PROFIT BOARDS AS WELL AS FINANCIAL SUPPORT THROUGH CASH DONATIONS. |
| PART III, LINE 2: | THE AMOUNT REPORTED IN PART III, LINE 2 AS BAD DEBT EXPENSE MATCHES THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON THE HOSPITAL'S INTERNAL FINANCIAL STATEMENTS. |
| PART III, LINE 3: | ST. DOMINIC HOSPITAL FREQUENTLY HAS PATIENT ACCOUNTS THAT ARE INTITIALLY WRITTEN OFF AS A BAD DEBT EXPENSE, BUT LATER (THROUGH A SCREENING PROCESS) IT IS DETERMINED THAT THE PATIENT DOES QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE PERCENTAGE OF ACCOUNTS IS ESTIMATED TO BE 83 PERCENT. THE PERCENTAGE IS DETERMINED UTILIZING AN INTERNAL REPORT OF ACCOUNTS WRITTEN OFF AS A BAD DEBT EXPENSE IN ONE YEAR AND CLASSIFIED AS CHARITY IN A SUBSEQUENT YEAR. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND REPORTED AT NET REALIZABLE VALUE. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTABLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. |
| PART III, LINE 9B: | ST. DOMINIC HOSPITAL HAS A BOARD APPROVED COLLECTION POLICY AND HAS WRITTEN CONTRACTS IN PLACE WITH ITS COLLECTION AGENCIES SO THE APPROPRIATE COLLECTION ACTIVITIES ARE FOLLOWED. THE COLLECTION AGENCIES THAT ST. DOMINIC USES ARE FULLY INFORMED ABOUT THE HOSPITAL'S FINANCIAL AID POLICY AND ASSIST IN EDUCATING ITS PATIENTS. THEY ROUTINELY SEND FINANCIAL AID APPLICATIONS TO PATIENTS AND REFER THOSE PATIENTS BACK TO THE HOSPITAL'S FINANCIAL COUNSELORS WHEN APPROPRIATE. |
| PART VI, LINE 2: | ST. DOMINIC HOSPITAL ASSESSES THE COMMUNITY IT SERVES THROUGH VARIOUS SOURCES WHICH INCLUDE:1) ANALYSIS OF THE PAYOR SOURCE AND DISEASE CATEGORIES OF PATIENTS TREATED AT ST. DOMINIC HOSPITAL WITH PARTICULAR ANALYSIS DONE ON PATIENTS PRESENTING TO ITS EMERGENCY DEPARTMENT;2) FEEDBACK FROM THE BOARD MEMBERS WHO REPRESENT THE COMMUNITY IT SERVES;3) REQUESTS MADE FROM THE COMMUNITY; AND4) PUBLIC HEALTH INFORMATION. |
| PART VI, LINE 3: | ST. DOMINIC HOSPITAL WORKS TO EDUCATE ITS PATIENTS AND COMMUNITY OF ASSISTANCE OPTIONS BY:1) POSTING SIGNAGE IN THE EMERGENCY ROOM AND OTHER REGISTRATION AREAS INFORMING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE.2) PROVIDING BROCHURES IN THE WAITING ROOMS AND AT THE REGISTRATION DESKS THAT EXPLAIN THE BILLING AND COLLECTION PROCESS AS WELL AS INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND PHONE NUMBERS TO CALL FOR ASSISTANCE.3) CONTRACTING AND PAYING AN AGENCY TO MEET WITH ALL UNINSURED PATIENTS TO ASSIST THEM IN APPLYING FOR FEDERAL AND STATE ASSISTANCE (I.E. MEDICAID, DISABILITY, ETC.).4) PROVIDING FINANCIAL COUNSELORS TO MEET WITH PATIENTS. THESE COUNSELORS FULLY UNDERSTAND THE HOSPITAL'S CHARITY POLICY AND ARE AVAILABLE TO ASSIST WITH THE APPLICATIONS, SET UP INTEREST FREE PAYMENT PLANS AND OFFER ADVICE ON PUBLIC ASSISTANCE THAT MAY BE AVAILABLE.5) STAFFING PATIENT REPRESENTATIVES TO ANSWER QUESTIONS AND ASSIST PATIENTS AS NEEDED.6) EDUCATING THE EARLY-OUT AND BAD DEBT COLLECTION AGENCIES ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES SO THEY CAN ASSIST PATIENTS WHOM THEY FIND MIGHT HAVE FINANCIAL NEED. |
| PART VI, LINE 4: | COMMUNITY INFORMATION:ST. DOMINIC HOSPITAL IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN JACKSON, MISSISSIPPI, IN HINDS COUNTY. FOR PURPOSES OF THE CHNA, THE HOSPITAL DEFINES ITS PRIMARY SERVICE AREA AS THE MADISON, HINDS, AND RANKIN TRI-COUNTY REGION OF MISSISSIPPI. PURSUANT TO THE HOSPITAL'S LAST CHNA, ST. DOMINIC HOSPITAL'S PRIMARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 493,383 RESIDENTS. THE MEDIAN AGE FOR THE PRIMARY SERVICE AREA IS 37. THE MEDIAN INCOME OF THE PRIMARY SERVICE AREA IS $60,049 AND 13.1% OF RESIDENTS ARE LIVING IN POVERTY. |
| PART VI, LINE 5: | INSPIRED BY THE TEACHINGS OF JESUS CHRIST AND THE WITNESS OF OUR FOUNDING DOMINICAN SISTERS, WE PROVIDE COMPASSIONATE CARE AND HOPE AS A HEALING MINISTRY OF THE CATHOLIC CHURCH. ST. DOMINIC APPLIES THIS MISSION BY CONDUCTING NEEDS ASSESSMENTS, PUBLISHING THE RESULTS, ESTABLISHING GOALS AND STRATEGIES TO HELP RESOLVE IDENTIFIED ISSUES AND SEEKING OPPORTUNITIES TO WORK WITH THE COMMUNITY. ST. DOMINIC HOSPITAL IMPROVES THE HEALTH OF THE COMMUNITIES IT IS PRIVILEGED TO SERVE IN MANY WAYS THAT EXTEND FAR BEYOND THE HEALING MINISTRY OF BEDSIDE CARE. THROUGH APPROACHES SUCH AS OPEN MEDICAL STAFF POLICIES, UNIQUE TECHNOLOGY INNOVATIONS FOR BETTER OUTCOMES, AND DIVERSITY, EQUITY, AND INCLUSION STRATEGIES FOCUSED ON EVERY ASPECT OF HEALTH CARE FROM THE BEDSIDE TO THE PURCHASING DOCK TO EACH PATIENT WHO WALKS THROUGH OUR DOORS, THE HOSPITAL CONTINUOUSLY EXPANDS ITS DEFINITION OF WHAT IT MEANS TO HAVE A "COMMUNITY IMPACT." THE HOSPITAL ALSO INVOLVES MEMBERS OF ITS COMMUNITY IN ITS GOVERNANCE SO THAT IT MAINTAINS THE FOCUS ON THE NEEDS OF ITS COMMUNITY. ST. DOMINIC'S HEART FAILURE CLINIC IS A STAND-ALONE CLINIC OVERSEEN BY AN EXPERIENCED NURSE PRACTITIONER. THIS SPECIALIZED CLINIC OFFERS HEART FAILURE PATIENTS QUICK, EASY, ACCESSIBLE CARE AND PROVIDES DETAILED EDUCATION ABOUT THE DISEASE PROCESS., DIETARY RESTRICTIONS OF SODIUM AND FLUID, AND THERAPY OPTIONS. THE CLINIC ALSO OFFERS LABORATORY SERVICES, SUPPORT GROUPS, AND, IF WARRANTED, INTRAVENOUS OR INTRAMUSCULAR DIURETIC INJECTIONS. ST. DOMINIC'S IS THE FIRST HOSPITAL IN MISSISSIPPI TO RECEIVE THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S HEART-CHECK MARK FOR ADVANCED CERTIFICATION FOR COMPREHENSIVE STROKE CENTERS. ST. DOMINIC'S COMPREHENSIVE STROKE CENTER OFFERS RAPID DIAGNOSIS, HIGH-TECH INTERVENTION, EXPERT CARE, AND INTENSE REHABILITATION IN A CARING, COMPASSIONATE SETTING. ST. DOMINIC'S CAN DELIVER THE FULL SPECTRUM OF CARE TO SERIOUSLY ILL PATIENTS WITH STROKE AND CEREBROVASCULAR DISEASE. THE CHIEF COMPONENT OF THE PROGRAM IS A HIGHLY COLLABORATIVE, EXPERTLY SKILLED TEAM OF CLINICAL PROFESSIONALS WHO DIRECT AND PROVIDE EVIDENCE-BASED CARE FOR EVERY STROKE PATIENT. SERVICES PROVIDED INCLUDE: EMERGENCY DEPARTMENT, HOSPITALIST MEDICAL, ADULT NEUROLOGY, NEUROSURGERY, INTERVENTIONAL RADIOLOGY, ACUTE REHABILITATION AND OUTPATIENT REHABILITATION, AND CRITICAL CARE. ST. DOMINIC'S TELE-STROKE PROGRAM CONNECTS ST. DOMINIC'S NEUROLOGISTS TO PATIENTS IN ST. DOMONIC'S EMERGENCY DEPARTMENT AND TO PATIENTS IN OUTLYING HOSPITALS' EMERGENCY DEPARTMENTS USING A TELEMEDICINE CART AND LAPTOP CONNECTIONS. NEUROLOGISTS CAN QUICKLY AND EFFICIENTLY PROVIDE A DIAGNOSIS AND BEST TREATMENT OPTIONS USING THE TECHNOLOGY. ST. DOMINIC'S IS CURRENTLY PARTNERED WITH SIX MISSISSIPPI HOSPITALS AS PART OF ITS TELE-STROKE PROGRAM: COPIAH COUNTY MEDICAL CENTER IN HAZELHURT, GREENWOOD LEFLORE HOSPITAL IN GREENWOOD, NESHOBA GENERAL IN PHILADELPHIA, MAGEE GENERAL HOSPITAL IN MAGEE, DELTA REGIONAL MEDICAL CENTER IN GREENVILLE, AND SOUTHWEST REGIONAL MEDICAL CENTER IN MCCOMB. |
| PART VI, LINE 6: | ST. DOMINIC HEALTH SERVICES, INC. IS THE PARENT ORGANIZATION OF A SYSTEM THAT INCLUDES ST. DOMINIC - JACKSON MEMORIAL HOSPITAL (A 571-BED ACUTE CARE FACILITY), ST. CATHERINE'S VILLAGE (A CONTINUING CARE RETIREMENT COMMUNITY), ST. DOMINIC HEALTH SERVICES FOUNDATION (A FUNDRAISING/GRANT FOCUSED ENTITY) AND ST. DOMINIC MADISON HEALTH SERVICES, INC. (A MEDICAL OFFICE BUILDING AND FITNESS CENTER). IN ADDITION, ST. DOMINIC HEALTH SERVICES OPERATES COMMUNITY HEALTH SERVICES - ST. DOMINIC, INC., WHICH INCORPORATES THE OUTREACH SERVICES OF THE CLUB AT ST. DOMINIC'S, NEW DIRECTIONS FOR OVER 55, ST. DOMINIC COMMUNITY HEALTH CLINIC, MADISON SCHOOL NURSE PROGRAM AND THE CARE-A-VAN SCREENING PROGRAM. AS A WHOLE, ALL OF THE SERVICES, ENTITIES AND HOSPITAL ARE COLLECTIVELY REFERRED TO AS ST. DOMINIC'S. ST DOMINIC'S SEEKS TO GIVE TIME, TALENTS, AND RESOURCES TO MAKE THE COMMUNITIES SERVED BY THE ORGANIZATION BETTER PLACES TO LIVE. THE ST. DOMINIC'S FAMILY OF CAREGIVERS NOT ONLY SERVES PATIENTS, BUT ALSO CONTRIBUTES TO AN ATMOSPHERE OF CARE AND COMPASSION FOR THOSE OUTSIDE THE HOSPITAL'S WALLS. ST. DOMINIC STRIVES TO NOT ONLY PROVIDE CARE FOR THE SICK BUT ALSO TO OFFER EDUCATION AND WELLNESS SERVICES TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND HELP ELIMINATE RISK FACTORS FOR MORE SERIOUS HEALTH PROBLEMS. ADDITIONALLY ON JULY 1, 2019, ST. DOMINIC HEALTH SERVICES BECAME PART OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM (FMOLHS). AS SUCH, IT IS AFFILIATED WITH TAX-EXEMPT HOSPITALS THROUGHOUT THE STATE OF LOUISIANA INCLUDING:OUR LADY OF LOURDES REGIONAL MEDICAL CENTERST. FRANCIS MEDICAL CENTEROUR LADY OF THE LAKE ASSUMPTION HOSPITALOUR LADY OF THE ANGELS HOSPITALOUR LADY OF THE LAKE HOSPITAL |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (25 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| AMERICAN HEART ASSOCIATION | ||||||||
| 250 WILLIAMS STREET | ATLANTA | GA | 30303 | 135613797 | 501 (C)(3) | $50,000 | $0 | GENERAL SUPPORT |
| 100 BLACK MEN OF JACKSON INC | ||||||||
| 5360 HIGHLAND DRIVE | JACKSON | MA | 39286 | 640817928 | 501 (C)(3) | $40,000 | $0 | GENERAL SUPPORT |
| OPERATION SHOESTRING | ||||||||
| 1711 BAILY AVENUE | JACKSON | MA | 39283 | 640471554 | 501 (C)(3) | $40,000 | $0 | GENERAL SUPPORT |
| REAL CHRISTIAN FOUNDATION | ||||||||
| PO BOX 180059 | RICHLAND | MA | 39218 | 640885750 | 501 (C)(3) | $32,500 | $0 | GENERAL SUPPORT |
| CENTER FOR VIOLENCE PREVENTION THE | ||||||||
| PO BOX 6279 | PEARL | MA | 39288 | 581959108 | 501 (C)(3) | $30,000 | $0 | GENERAL SUPPORT |
| NEWKS CARES | ||||||||
| 814 NORTH CONGRESS STREET | JACKSON | MA | 39202 | 640765336 | 501 (C)(3) | $25,000 | $0 | GENERAL SUPPORT |
| CANOPY CHILDRENS SOLUTIONS | ||||||||
| 1465 LAKELAND DR | JACKSON | MA | 39216 | 640303085 | 501 (C)(3) | $25,000 | $0 | GENERAL SUPPORT |
| MS SYMPHONY ORCHESTRA | ||||||||
| PO BOX 2052 | JACKSON | MA | 39225 | 640273405 | 501 (C)(3) | $25,000 | $0 | GENERAL SUPPORT |
| JACKSON HEART FOUNDATION | ||||||||
| PO BOX 5021 | JACKSON | MA | 39206 | 270723542 | 501 (C)(3) | $20,000 | $0 | GENERAL SUPPORT |
| REFILL CAFE | ||||||||
| 136 SOUTH ADAMS STREET | JACKSON | MA | 39203 | 832814994 | 501 (C)(3) | $20,000 | $0 | GENERAL SUPPORT |
| DEVOTED DREAMERS FOUNDATION | ||||||||
| 454 OAK LAWN DRIVE | PEARL | MA | 39208 | 276601178 | 501 (C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| MISSION FIRST INC | ||||||||
| PO BOX 22655 | JACKSON | MA | 39225 | 640824240 | 501 (C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| CATHOLIC CHARITIES INC | ||||||||
| 850 EAST RIVER PLACE | JACKSON | MA | 39201 | 640466850 | 501 (C)(3) | $8,000 | $0 | GENERAL SUPPORT |
| B B KING MUSEUM AND DELTA INTERPREPTIVE CENTER | ||||||||
| 400 SECOND STREET | INDIANOLA | MA | 38751 | 460501512 | 501 (C)(3) | $7,500 | $0 | GENERAL SUPPORT |
| AMERICAN CANCER SOCIETY INC | ||||||||
| 250 WILLIAMS STREET | ATLANTA | GA | 30303 | 131788491 | 501 (C)(3) | $17,500 | $0 | CANCER SUPPORT |
| ST JOSEPH CATHOLIC SCHOOL | ||||||||
| 308 NEW MANNSDALE ROAD | MADISON | MA | 39110 | 640339825 | 501 (C)(3) | $25,000 | $0 | GENERAL SUPPORT |
| PLAYERS PHILANTHROPY FUND | ||||||||
| 454 OAK LAWN DRIVE | PEARL | MA | 39208 | 276601178 | 501 (C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| NATIONAL COALITION OF 100 BLACK WOMEN - CENT MS CHAPTER | ||||||||
| PO BOX 68412 | JACKSON | MA | 39286 | 582063167 | 501 (C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| CATHOLIC DIOCESE OF JACKSON | ||||||||
| PO BOX 22723 | JACKSON | MA | 39225 | 640303073 | 501 (C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| MISSION MISSISSIPPI | ||||||||
| PO BOX 22655 | JACKSON | MA | 39225 | 640824240 | 501 (C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| FONDREN RENAISSANCE FOUNDATION | ||||||||
| 4145 OLD CANTON ROAD | JACKSON | MA | 39216 | 640873626 | 501 (C)(3) | $11,000 | $0 | GENERAL SUPPORT |
| JUNIOR LEAGUE OF JACKSON | ||||||||
| 805 RIVERSIDE DRIVE | JACKSON | MA | 39202 | 646011106 | 501 (C)(3) | $10,750 | $0 | GENERAL SUPPORT |
| MISSISSIPPI HOUSING PARTNERSHIP | ||||||||
| PO BOX 22987 | JACKSON | MA | 39225 | 640816305 | 501 (C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| BRAIN INJURY ASSOCIATION OF MS | ||||||||
| 1640 LELIA DRIVE | JACKSON | MA | 39216 | 570885672 | 501 (C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| TUTWILER COMMUNITY EDUCATION CENTER INC | ||||||||
| PO BOX 448 | TUTWILER | MA | 38963 | 581887449 | 501 (C)(3) | $8,000 | $0 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 25 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL HAS A CONTRIBUTIONS COMMITTEE, WHICH IS A SUB-COMMITTEE OF THE BOARD, THAT OVERSEES THE HOSPITAL'S GIVING. THEY MONITOR THE REQUESTS AND OVERSEE ALL GIFTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (17 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN LANCON | ||||||||||||||
| PHYSICIAN | $1,094,837 | $0 | $203,634 | $0 | $3,260 | $0 | $15,250 | $0 | $27,850 | $0 | $1,344,831 | $0 | $0 | $0 |
| PB KERR | ||||||||||||||
| PHYSICIAN | $966,632 | $0 | $121,043 | $0 | $28,372 | $0 | $15,250 | $0 | $25,150 | $0 | $1,156,447 | $0 | $0 | $0 |
| DAVID THEODORO | ||||||||||||||
| PHYSICIAN | $904,504 | $0 | $110,344 | $0 | $3,564 | $0 | $14,300 | $0 | $19,056 | $0 | $1,051,768 | $0 | $0 | $0 |
| BRYAN A GASPARD | ||||||||||||||
| PHYSICIAN | $824,430 | $0 | $129,097 | $0 | $26,222 | $0 | $15,250 | $0 | $25,758 | $0 | $1,020,757 | $0 | $0 | $0 |
| D PAUL SEAGO MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $773,953 | $0 | $93,597 | $0 | $107,175 | $0 | $15,250 | $0 | $19,267 | $0 | $1,009,242 | $0 | $0 | $0 |
| STEVEN GREMILLION MD | ||||||||||||||
| BD MEMBER/FMOLHS EVP CMO | $0 | $639,829 | $0 | $277,388 | $0 | $12,141 | $0 | $15,250 | $0 | $25,118 | $0 | $969,726 | $0 | $0 |
| ZACHARY BALDWIN | ||||||||||||||
| PHYSICIAN | $616,959 | $0 | $139,777 | $0 | $1,242 | $0 | $15,250 | $0 | $25,150 | $0 | $798,378 | $0 | $0 | $0 |
| REBEKAH MOULDER MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $441,568 | $0 | $330,269 | $0 | $1,052 | $0 | $15,250 | $0 | $2,110 | $0 | $790,249 | $0 | $0 | $0 |
| SCOTT KASHMAN | ||||||||||||||
| MARKET PRESIDENT (UNTIL 7/22) | $499,303 | $0 | $108,077 | $0 | $3,189 | $0 | $70,852 | $0 | $27,085 | $0 | $708,506 | $0 | $0 | $0 |
| KRISTIN WOLKART | ||||||||||||||
| INTERIM MARKET PRESIDENT (START 7/22 | $0 | $440,832 | $0 | $131,783 | $0 | $3,231 | $0 | $95,636 | $0 | $19,942 | $0 | $691,424 | $0 | $0 |
| LESTER DIAMOND | ||||||||||||||
| FORMER PRESIDENT | $0 | $0 | $0 | $0 | $0 | $531,654 | $0 | $0 | $0 | $0 | $0 | $531,654 | $0 | $0 |
| SAMUEL SCOTT | ||||||||||||||
| SVP, CFO | $321,567 | $0 | $157,491 | $0 | $5,759 | $0 | $14,175 | $0 | $17,912 | $0 | $516,904 | $0 | $0 | $0 |
| BRYAN MILLER MD | ||||||||||||||
| BD MEMBER/FMOLHS VP CHIEF CTO | $0 | $366,022 | $0 | $52,860 | $0 | $2,521 | $0 | $15,250 | $0 | $18,112 | $0 | $454,765 | $0 | $0 |
| REGINALD MARTIN MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $316,384 | $0 | $18,940 | $0 | $2,564 | $0 | $12,950 | $0 | $25,150 | $0 | $375,988 | $0 | $0 | $0 |
| THU PHAN | ||||||||||||||
| VP COO | $241,578 | $0 | $44,000 | $0 | $1,492 | $0 | $14,173 | $0 | $8,086 | $0 | $309,329 | $0 | $0 | $0 |
| ROBERT NELSON | ||||||||||||||
| FORMER VP CHIEF NURSING OFFICER | $155,774 | $0 | $0 | $0 | $131,353 | $0 | $755 | $0 | $13,655 | $0 | $301,537 | $0 | $0 | $0 |
| WILLIAM MORGAN | ||||||||||||||
| FORMER COO | $0 | $0 | $0 | $0 | $171,654 | $0 | $0 | $0 | $0 | $0 | $171,654 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE FMOL HEALTH SYSTEM BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REIVEWS COMPENSATION PACKAGES AND APPRROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE. |
| PART I, LINES 4A-B | FMOLHS MAINTAINS THREE UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDE FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLANS IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. NO ONE LISTED ON PART VII, SECTION A RECEIVED A PAYMENT FROM THE PLANS IN THE CURRENT YEAR. |
| PART I, QUESTION 4A: | TWO OFFICERS AND ONE BOARD MEMBER ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. AN OFFICER IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 12 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS THIS YEAR - LESTER DIAMOND $531,654 WILLIAM MORGAN $171,654 ROBERT NELSON $129,466 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ST. DOMINIC HEALTH SERVICES, INC. IS THE SOLE MEMBER OF ST. DOMINIC JACKSON MEMORIAL HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL'S SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC., HAS THE AUTHORITY TO APPROVE THE ELECTION OF THE PRESIDENT/CEO, THE CHAIR OF THE BOARD OF DIRECTORS AND THE VICE-CHAIR OF THE BOARD OF DIRECTORS OF THE HOSPITAL AND ALL OTHER DIRECTORS AND OFFICERS OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE RESERVED POWER TO THE MEMBER, ST. DOMINIC HEALHT SERVICES, INC., ARE AS FOLLOWS: I. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION. II. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION. III. TO AMEND, ALTER, MODIFY, OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. IV. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES. V. TO DISSOLVE AND TO DISTRIBUTE ASSETS OF THE CORPORATION. VI. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. VII. TO ACQUIRE, PURCHASE, SELL, LEAASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF THE CORPORATION. VIII. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION. IX. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION. X. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION. XI. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION. XII. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE OF THE BOARD PRIOR TO FILING. A FULL COPY, AS APPROVED BY THE FINANCE COMMITTEE, IS PROVIDED TO THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST FORM ANNUALLY. THE PRESIDENT REVIEWS THE FORMS, AND ANY CONFLICTS ARE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD. PERSONS WITH CONFLICTS OF INTERESTS DO NOT VOTE OR USE HIS OR HER INFLUENCE ON THE MATTER AND ARE EXCLUDED FROM THE COUNT IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. |
| FORM 990, PART VI, SECTION B, LINE 15 | OUR BOARD OF DIRECTORS DESIGNATES AN EXECUTIVE COMMITTEE MADE UP OF INDEPENDENT BOARD MEMBERS TO REVIEW AND SET THE COMPENSATION ANNUALLY OF OUR OFFICERS AND KEY EMPLOYEES. THE EXECUTIVE COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY AN OUTSIDE CONSULTING FIRM. THE EXECUTIVE COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE EXECUTIVE COMMITTEE. THE COMPENSATION FOR THE CEO OF ST. DOMINIC JACKSON MEMORIAL HOSPITAL IS SET BY THE COMPENSATION COMMITTEE OF ST. DOMINIC HEALTH SERVICES (A RELATED TAX-EXEMPT ORGANIZATION) ACCORDING TO THEIR PAY PRACTICES WHICH ARE SIMILAR TO THOSE DESCRIBED ABOVE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SECTION 1.263(A)-3(N) - BOOK CONFORMITY ELECTION: ST. DOMINIC JACKSON MEMORIAL HOSPITAL IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2023. SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION: ST. DOMINIC JACKSON MEMORIAL HOSPITAL HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDED JUNE 30, 2023. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OR LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). |
| FORM 990, PART XI, LINE 9: | CAPITAL TRANSFER -28,398,902. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| ST DOMINIC MEDICAL ASSOCIATES | |||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 261969846 | HEALTHCARE | MS | $40,200,481 | -$40,495,682 | SDJMH |
| ST DOMINIC HOSPITAL MEDICINE LLC | |||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 814908606 | HEALTHCARE | MS | $0 | $0 | SDJMH |
| CENTRAL MISSISSIPPI IMAGING LLC DBA SOUTHERN DIAGNOSTIC IMAGING | |||||||||
| 1037 NORTH FLOWOOD DRIVE | FLOWOOD | MS | 39232 | 640928442 | HEALTHCARE | MS | $1,928,798 | $2,997,252 | SDJMH |
| MEA PRIMARY CARE PLUS LLC | |||||||||
| 308 CORPORATE DRIVE | RIDGELAND | MS | 39211 | 814502721 | HEALTHCARE | MS | $0 | $0 | SDJMH |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ST DOMINIC HEALTH SERVICES INC | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 640714999 | HOLDING CO | MS | 501(C)(3) | LINE 12C, III-FI | FMOLHS | 0 |
| COMMUNITY HEALTH SERVICES - ST DOMINIC | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 640884870 | HEALTH PROGRAM | MS | 501(C)(3) | LINE 10 - A | SDHS | 0 |
| ST DOMINIC - HEALTH SERVICES FOUNDATION | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 431992975 | FUNDRAISING | MS | 501(C)(3) | LINE 7 | SDHS | 0 |
| ST CATHERINE'S VILLAGE INC | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 640714997 | RET HOME | MS | 501(C)(3) | LINE 10 - A | SDHS | 0 |
| HEALTH CARE CENTERS IN SCHOOLS | ||||||||||
| 5000 HENNESSY BLVD | BATON ROUGE | LA | 70808 | 721443935 | HEALTHCARE | LA | 501(C)(3) | LINE 10 - A | OLOL | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (24 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| LOURDES IMAGING DEVELOPMENT LLC | ||||||||||
| 4801 AMBASSADOR CAFFERY PKWY | LAFAYETTE | LA | 70508 | 208326287 | REAL ESTATE | LA | N/A | N/A | 0 | 0 |
| PARK PLACE SURGERY CENTER LLC | ||||||||||
| 4811 AMBASSADOR CAFFERY PKWY | LAFAYETTE | LA | 70508 | 721404092 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| BRPT LAKE REHABILITATION CENTERS LLC | ||||||||||
| 175 S ENGLISH STATION RD STE 218 | LOUISVILLE | KY | 40245 | 721506100 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| CONVENIENT CARE LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 721439481 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| PERKINS PLAZA AMBULATORY SURGERY CENTER LLC | ||||||||||
| 7145 PERKINS ROAD | BATON ROUGE | LA | 70808 | 481264699 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| SURGICAL SPECIALTY CENTER OF BATON ROUGE LLC | ||||||||||
| 8080 BLUEBONNET BLVD | BATON ROUGE | LA | 70810 | 263120962 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| ST ELIZABETH-MARY BIRD PERKINS CANCER CENTER LLC | ||||||||||
| 4950 ESSEN LANE | BATON ROUGE | LA | 70809 | 260628752 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| NORTHEAST LA CANCER INSTITUTE LLC | ||||||||||
| 411 CALYPSO STREET | MONROE | LA | 71201 | 721329499 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LHCG-XIII LLC DBA LOURDES HOME HEALTH | ||||||||||
| 901 S HUGH WALLIS ROAD | LAFAYETTE | LA | 70508 | 208068308 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LOURDES AFTER HOURS LLC | ||||||||||
| 7777 HENNESSY BLVD SUITE 1004-202 | BATON ROUGE | LA | 70809 | 201367299 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LAKE URGENT CARE ASCENSION LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 352463092 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| ST FRANCIS URGENT CARE LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 474013731 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| GAMMA KNIFE OF LOUISIANA LLC | ||||||||||
| 4950 ESSEN LANE | BATON ROUGE | LA | 70809 | 811827194 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LHCG LXVII LLC | ||||||||||
| 901 S HUGH WALLIS ROAD | LAFAYETTE | LA | 70508 | 474283509 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| PINNACLE CARE HOLDINGS LLC | ||||||||||
| 5627 S SHERWOOD FOREST BLVD | BATON ROUGE | LA | 70816 | 821637627 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | ||||||||||
| 4801 AMBASSADOR CAFFERY PKWY | LAFAYETTE | LA | 70508 | 943419282 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| FREMAUX OFFICE MM LLC | ||||||||||
| 3500 NORTH CAUSEWAY BOULEVARD STE 6 | METAIRIE | LA | 70002 | 843084552 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| OLOL PONTCHARTRAIN SURGERY CENTER LLC | ||||||||||
| 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | 461379031 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LAKE SURGICAL HOSPITAL (SLIDELL) LLC | ||||||||||
| 1700 LINDBERG DR | SLIDELL | LA | 70458 | 474228147 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| PREMIER HEALTH HOLDINGS LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 472665226 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| PERKINS PLAZA DEVELOPMENT LLC | ||||||||||
| 5000 HENNESSY BLVD | BATON ROUGE | LA | 70808 | HEALTHCARE | LA | N/A | N/A | 0 | 0 | |
| JACKSON HEART & VASCULAR CENTER LLC | ||||||||||
| 969 LAKELAND DR | JACKSON | MS | 39216 | HEALTHCARE | MS | N/A | N/A | 0 | 0 | |
| CARDIOVASCULAR AND ARRYTHMIA CENTER LLC (CVAC) | ||||||||||
| PO BOX 82063 | BATON ROUGE | LA | 70884 | HEALTHCARE | LA | N/A | N/A | 0 | 0 | |
| CARDIOVASCULAR AND ARRYTHMIA MANAGEMENT LLC (CVAM) | ||||||||||
| PO BOX 82063 | BATON ROUGE | LA | 70884 | HEALTHCARE | LA | N/A | N/A | 0 | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LOUISE INSURANCE COMPANY | ||||||||||||||||
| PO BOX 1051 | CJ | KY1-1102 | INSURANCE | CJ | C | 0 | ||||||||||
| FRANCISICAN HEALTH & WELLNESS SERVICES I | ||||||||||||||||
| HEALTHCARE | C | 0 | 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | 455492379 | LA | ||||||||
| FMOL HEALTH SYSTEM HOLDINGS INC | ||||||||||||||||
| INVESTMENT | C | 0 | 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | 454405024 | LA | ||||||||
| ST DOMINIC MADISON HEALTH SERVICES INC | ||||||||||||||||
| HEALTHCARE | C | 0 | 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 202870254 | MS | ||||||||
| ST DOMINIC INTEGRATED SERVICES INC | ||||||||||||||||
| INVESTMENTS | C | Yes (1) | 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 271493623 | MS | SDJMH | $2,670,189 | $6,607,578 | 1.00000 | ||||
| LAFAYETTE SURGICARE INC | ||||||||||||||||
| HEALTHCARE | C | 0 | C/O C T CORPORATION SYSTEM 3867 PLA | BATON ROUGE | LA | 70816 | 943419282 | LA | ||||||||
| NMC OPERATING COMPANY LLC DBA SPINE HOSPITAL OF LOUISIANA | ||||||||||||||||
| HEALTHCARE | S | 0 | 10105 PARK ROWE CIRCLE STE 250 | BATON ROUGE | LA | 70810 | 270059959 | LA | ||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |