JACKSON PARK HOSPITAL FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- JACKSON PARK HOSPITAL FOUNDATION (EIN 36-2448028)
- Tax period
- 2021-04-01 to 2022-03-31
- Filed
- 2023-02-09
- IRS object ID
- 202320409349301607
- Schema version
- 2021v4.2
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-02-09T15:22:31-06:00 | ReturnTs |
| Tax Period End | 2022-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 475 REGENCY PARK SUITE 175 | AddressLine1Txt |
| City | OFALLON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62269 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362448028 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON PARK HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JACK | BusinessNameControlTxt |
| Phone | 7739477500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 STONY ISLAND AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60649 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WILLIAM DORSEY MD | PersonNm |
| Person Title | CHAIRMAN/CEO | PersonTitleTxt |
| Phone | 7739477500 | PhoneNum |
| Signature | 2023-02-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | WILLIAM | PersonFirstNm |
| Person Last | DORSEY MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFF PARKER | PreparerPersonNm |
| PTIN | P00970069 | PTIN |
| Phone | 6182331200 | PhoneNum |
| Preparation | 2023-02-06 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-03-07 01:45:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WILLIAM DORSEY MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 STONY ISLAND AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60649 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $107,987,360 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.JACKSONPARKHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1960 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE COMPASSIONATE CARE AND HIGH QUALITY HEALTHCARE SERVICES TO MEET THE NEEDS OF THE PATIENTS AND COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 846 | TotalEmployeeCnt |
| Total Volunteers | 1 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,824,036 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,579,657 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $105,042,471 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $98,627,710 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,522 | PYInvestmentIncomeAmt |
| CY Investment Income | $184,945 | CYInvestmentIncomeAmt |
| PY Other Revenue | $596,093 | PYOtherRevenueAmt |
| CY Other Revenue | $595,048 | CYOtherRevenueAmt |
| PY Total Revenue | $112,466,122 | PYTotalRevenueAmt |
| CY Total Revenue | $107,987,360 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $42,957,325 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $42,284,840 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $61,492,147 | PYOtherExpensesAmt |
| CY Other Expenses | $57,538,932 | CYOtherExpensesAmt |
| PY Total Expenses | $104,449,472 | PYTotalExpensesAmt |
| CY Total Expenses | $99,823,772 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,016,650 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,163,588 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $120,530,174 | TotalAssetsBOYAmt |
| Total Assets EOY | $132,629,667 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $40,888,008 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $45,291,102 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $79,642,166 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $87,338,565 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF THE PHYSICIANS, STAFF AND BOARD OF DIRECTORS OF THE ORGANIZATION IS TO PROVIDE COMPASSIONATE CARE AND HIGH QUALITY HEALTHCARE SERVICES TO MEET THE NEEDS OF THE PATIENTS AND COMMUNITES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $58,998,908 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $62,928,465 | RevenueAmt |
| Desc | INPATIENT MEDICAL CARE TO CHICAGO'S SOUTH SIDE COMMUNITIES REGARDLESS OF THE PATIENT'S ABILITY TO PAY INPATIENT SERVICES INCLUDING MEDICAL SURGICAL, ICU AND HOSPICE. IN 2021 THE HOSPITAL SERVED 2,578 ACUTE CARE ADMISSIONS WHICH AMOUNTED TO 15,469 PATIENT DAYS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $19,149,783 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $20,425,233 | RevenueAmt |
| Desc | JACKSON PARK HOSPITAL FOUNDATION PROVIDES INPATIENT AND OUTPATIENT BEHAVIORAL MEDICINE SERVICES TO THE GREATER CHICAGOLAND AREA. JACKSON PARK HOSPITAL IS ONE OF THE FEW HOSPITALS IN CHICAGO THAT CONTINUES TO PROVIDE BEHAVIORAL MEDICINE TO ITS COMMUNITY. IN 2021 JACKSON PARK HOSPITAL SERVED 2,938 INPATIENT BEHAVIORAL MEDICINE PATIENTS WHICH AMOUNTED TO 13,713 PATIENT DAYS. JACKSON PARK HOSPITAL PROVIDES MULTIPLE LEVELS OF CARE TO MEET THE NEEDS OF AN ADULT INDIVIDUAL WITH EMOTIONAL AND BEHAVIORAL PROBLEMS. IN ADDITION TO 24 HOUR EMERGENCY PSYCHIATRIC AND INTAKE SERVICES, JACKSON PARK HOSPITAL OFFERS 86-BED INPATIENT PSYCHIATRIC SERVICES, PARTIAL HOSPITAL PROGRAM AND OUTPATIENT SERVICES. THE TREATMENT IS PROVIDED BY MULTIDISCIPLINARY STAFF INCLUDING PSYCHIATRIST, INTERNIST, PSYCHOLOGIST, PSYCHIATRIC NURSE, SOCIAL WORKER, CLINICAL THERAPIST, OCCUPATIONAL THERAPIST, AND NUTRITIONIST. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $11,890,873 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $12,682,852 | RevenueAmt |
| Desc | JACKSON PARK HOSPITAL PROVIDES BASIC EMERGENCY ROOM SERVICES TO ITS COMMUNITY 24 HOURS A DAY 7 DAYS A WEEK REGARDLESS OF THE PATIENTS' ABILITY TO PAY. IN 2021 THE HOSPITAL SERVED 17,840 EMERGENCY PATIENTS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,429,356 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,591,160 | RevenueAmt |
| Desc | MEDICAL EDUCATION - OUR VISION IS TO PROMOTE COMPETENCE IN HEALTH CARE AND CUSTOMER SERVICE BY PROVIDING EDUCATION, DIRECTION, TRAINING AND LEADERSHIP TO OUR STAFF. JPH EDUCATION DEPARTMENT WORKS WITH SEVERAL MEDICAL AND NURSING COLLEGES AND UNIVERSITIES SERVING AS A CLINICAL SITE FOR MEDICAL STUDENTS, NURSING STUDENTS AND ALLIED HEALTH PROFESSIONALS WHO COMPLETE THEIR CLINICAL AFFILIATION AT JPH AS PART OF THEIR ACADEMIC TRAINING. WE ALSO PARTICIPATE IN COMMUNITY OUTREACH AND HEALTH SCREENING TO PROMOTE WELLNESS IN OUR COMMUNITY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,429,356 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $2,591,160 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $92,468,920 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | 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 | 0 | 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 | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 76 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 846 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEN MCGHEE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7739477621 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 STONY ISLAND | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60649 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| JAMES I CLARK III | |||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DR WILLIAM O DORSEY III | |||||||||
| CHAIRMAN/CEO | 40.00 | 0.00 | Yes (X) | $836,481 | $0 | $23,295 | Yes (X) | ||
| DR HARSHAD MEHTA | |||||||||
| DIRECTOR/PHYSICIAN | 40.00 | 0.00 | Yes (X) | $216,625 | $0 | $24,021 | |||
| DR LAKSHMI DODDA | |||||||||
| DIRECTOR/PHYSICIAN | 25.00 | 15.00 | Yes (X) | $244,839 | $0 | $24,604 | |||
| DR HAROON OLOMI | |||||||||
| DIRECTOR/PHYSICIAN | 4.00 | 36.00 | Yes (X) | $11,977 | $209,996 | $24,604 | |||
| DR ZAHIDUR RAHMAN | |||||||||
| DIRECTOR/PHYSICIAN | 4.00 | 36.00 | Yes (X) | $80,631 | $85,111 | $24,604 | |||
| DR SURRENTHIA PARKER | |||||||||
| DIRECTOR/PHYSICIAN | 4.00 | 36.00 | Yes (X) | $49,378 | $0 | $35,874 | |||
| DR BANGALORE R MURTHY | |||||||||
| DIRECTOR/PHYSICIAN | 25.00 | 15.00 | Yes (X) | $167,902 | $0 | $35,874 | |||
| MERRITT HASBROUCK | |||||||||
| PRESIDENT | 40.00 | 0.00 | $678,340 | $0 | $9,841 | Yes (X) | |||
| G RANDALL SMITH | |||||||||
| EXECUTIVE VP | 40.00 | 0.00 | $664,603 | $0 | $45,489 | Yes (X) | |||
| M PATRICIA SIMON | |||||||||
| SENIOR VP QUALITY & COMPLIANCE | 40.00 | 0.00 | $203,816 | $0 | $33,396 | Yes (X) | |||
| NELSON VASQUEZ | |||||||||
| VP FINANCE | 40.00 | 0.00 | $239,898 | $0 | $45,489 | Yes (X) | |||
| BARRY MANDELL | |||||||||
| VP SPECIAL PROJECTS | 40.00 | 0.00 | $181,903 | $0 | $35,874 | Yes (X) | |||
| RAYLENE SWINOCK | |||||||||
| NURSE | 40.00 | 0.00 | $265,273 | $0 | $9,094 | Yes (X) | |||
| SYED ALA MD | |||||||||
| PHYSICIAN | 12.00 | 28.00 | $74,933 | $170,000 | $24,604 | Yes (X) | |||
| ROSE ETTE | |||||||||
| NURSE | 40.00 | 0.00 | $247,755 | $0 | $24,604 | Yes (X) | |||
| MATTHEW MALTERS MD | |||||||||
| PHYSICIAN | 2.00 | 38.00 | $14,870 | $694,540 | $35,874 | Yes (X) | |||
| SRIKANTH RAVINDRAN MD | |||||||||
| PHYSICIAN | 15.00 | 25.00 | $108,442 | $123,300 | $35,874 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,287,666 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,282,947 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $493,015 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 70 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| SIMPLE LABORATORIES | |||||
| 5960 NORTH MILWAUKEE AVENUE | CHICAGO | IL | 60646 | LAB SERVICES | $2,855,361 |
| WHITE CAP NURSING | |||||
| 2600 SOUTH MICHIGAN AVENUE | CHICAGO | IL | 60616 | TEMPORARY NURSE STAFFING | $2,725,660 |
| GREAT LAKES MEDICAL GROUP | |||||
| 1001 GALAXY WAY SUITE 400 | CONCORD | CA | 94520 | EMERGENCY ROOM DOCTORS | $1,617,000 |
| ALLSCRIPTS | |||||
| 7444 WEST WILSON AVENUE | HARWOOD HEIGHTS | IL | 60706 | SOFTWARE SERVICES | $1,568,364 |
| ACUMEN MEDICAL STAFFING | |||||
| 689 NORTH MILWAUKEE AVENUE | CHICAGO | IL | 60642 | TEMPORARY NURSE STAFFING | $1,317,312 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 69 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,358,300 | GovernmentGrantsAmt |
| All Other Contributions | $1,221,357 | AllOtherContributionsAmt |
| Noncash Contributions | $708,297 | NoncashContributionsAmt |
| Total Contributions | $8,579,657 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $60,341,672 | $60,341,672 |
| PROVIDER TAX PROCEEDS | 621110 | $38,286,038 | $38,286,038 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $98,627,710 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $184,945 | TotalRevenueColumnAmt |
| Exclusion | $184,945 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $275,033 | 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 | $275,033 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $275,033 | TotalRevenueColumnAmt |
| Exclusion | $275,033 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 722514 | $238,613 | $238,613 |
| REFUNDS | 621110 | $52,466 | $52,466 |
| MISCELLANEOUS INCOME | 621110 | $26,953 | $26,953 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,983 | TotalRevenueColumnAmt |
| Exclusion | $1,983 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $320,015 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $107,987,360 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $98,627,710 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $779,993 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,939,358 | TotalAmt |
| Management And General | $3,939,358 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,225,910 | TotalAmt |
| Program Services | $30,827,529 | ProgramServicesAmt |
| Management And General | $398,381 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $518,651 | TotalAmt |
| Program Services | $497,373 | ProgramServicesAmt |
| Management And General | $21,278 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,138,155 | TotalAmt |
| Program Services | $3,968,383 | ProgramServicesAmt |
| Management And General | $169,772 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,462,766 | TotalAmt |
| Program Services | $2,361,728 | ProgramServicesAmt |
| Management And General | $101,038 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $790,292 | TotalAmt |
| Program Services | $790,292 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $346,362 | TotalAmt |
| Program Services | $346,362 | ProgramServicesAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,297 | TotalAmt |
| Program Services | $21,297 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,232 | TotalAmt |
| Management And General | $59,232 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,054,062 | TotalAmt |
| Program Services | $17,619,997 | ProgramServicesAmt |
| Management And General | $434,065 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,717 | TotalAmt |
| Program Services | $100,562 | ProgramServicesAmt |
| Management And General | $155 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,471,023 | TotalAmt |
| Program Services | $4,543,604 | ProgramServicesAmt |
| Management And General | $1,927,419 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,403,045 | TotalAmt |
| Program Services | $1,324,030 | ProgramServicesAmt |
| Management And General | $79,015 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217 | TotalAmt |
| Program Services | $217 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,228 | TotalAmt |
| Program Services | $61,210 | ProgramServicesAmt |
| Management And General | $4,018 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,361,866 | TotalAmt |
| Program Services | $3,140,745 | ProgramServicesAmt |
| Management And General | $221,121 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $630,457 | TotalAmt |
| Program Services | $630,457 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BAD DEBT | $17,505,223 | $17,505,223 |
| HOSPITAL PROVIDER TAX & | $7,816,952 | $7,816,952 |
| MISC. EXPENSE | $904,097 | $904,097 |
| PATIENT TRANSPORTATION | $7,978 | $7,978 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $884 | TotalAmt |
| Program Services | $884 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,823,772 | TotalAmt |
| Program Services | $92,468,920 | ProgramServicesAmt |
| Management And General | $7,354,852 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $399,290 | BOYAmt |
| EOY | $879,089 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,500,000 | BOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600,000 | BOYAmt |
| EOY | $857,312 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,762,007 | BOYAmt |
| EOY | $6,165,706 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,356,421 | BOYAmt |
| EOY | $1,236,520 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243,451 | BOYAmt |
| EOY | $638,363 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $87,756,607 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $64,405,575 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,812,497 | BOYAmt |
| EOY | $23,351,032 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,357,429 | BOYAmt |
| EOY | $17,005,268 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,871 | BOYAmt |
| EOY | $5,871 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $486,163 | BOYAmt |
| EOY | $486,163 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,007,045 | BOYAmt |
| EOY | $82,004,343 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,530,174 | BOYAmt |
| EOY | $132,629,667 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,068,690 | BOYAmt |
| EOY | $16,331,844 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,606,111 | BOYAmt |
| EOY | $5,403,633 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,053,793 | BOYAmt |
| EOY | $7,238,910 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,107,667 | BOYAmt |
| EOY | $9,056,835 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,051,747 | BOYAmt |
| EOY | $7,259,880 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,888,008 | BOYAmt |
| EOY | $45,291,102 | 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 | $79,642,166 | BOYAmt |
| EOY | $87,338,565 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,642,166 | BOYAmt |
| EOY | $87,338,565 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,530,174 | BOYAmt |
| EOY | $132,629,667 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $8,163,588 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$444,605 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $206,325 | DonatedServicesAndUseFcltsAmt |
| Other Changes In Net Assets | -$228,909 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $21,297 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $21,297 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE MEMBERSHIP DUES PAID TO VARIOUS HOSPITAL ASSOCIATIONS ARE RELATED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,482,024 | OtherCostOrOtherBasisAmt |
| Book Value | $2,482,024 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,314,330 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,523,414 | DepreciationAmt |
| Book Value | $4,790,916 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,692,276 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,573,084 | DepreciationAmt |
| Book Value | $11,119,192 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,427,698 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,309,077 | DepreciationAmt |
| Book Value | $3,118,621 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,840,279 | OtherCostOrOtherBasisAmt |
| Book Value | $1,840,279 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $23,351,032 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM RELATED PARTY | $78,164,343 |
| COMMUNITY DEVELOPMENT FUND - LOAN PROCEEDS RECEIVABLE | $3,840,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $82,004,343 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYOR SETTLEMENTS | $1,388,957 |
| PENSION LIABILITY | $1,000,451 |
| PROFESSIONAL LIABILITY | $4,870,472 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,259,880 | 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 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. | 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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| 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 | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,506,839 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $981,206 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,525,633 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09140 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $46,668,833 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $38,250,501 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,418,332 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10230 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $55,175,672 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,231,707 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,943,965 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19370 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,158,450 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,051,628 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $106,822 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,510,439 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,678,707 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,831,732 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03440 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,668,889 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,730,335 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,938,554 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03570 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $65,844,561 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $46,962,042 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,882,519 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.22940 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $6,851,331 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,950,320 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,111,659 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,449,216 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,337,557 | 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 |
| 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 | JACKSON PARK HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 STONY ISLAND | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60649 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | JACKSONPARKHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 0001115 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON PARK HOSPITAL FOUNDATION | 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 | 20 | 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 PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 |
| 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 (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| JACKSON PARK HOSPITAL FOUNDATION | PART V, SECTION B, LINE 5: FOCUS GROUPS WERE CONDUCTED WITH MEMBERS OF THE COMMUNITY. |
| JACKSON PARK HOSPITAL FOUNDATION | PART V, SECTION B, LINE 11: 1. ACCESS AND TRANSPORTATION GOAL 1.A. PROVIDE COMPREHENSIVE MEDICAL AND SOCIAL SERVICES TO OLDER ADULTS (55+) TO MAINTAIN AND IMPROVE INDEPENDENT LIVING, WITH A PARTICULAR FOCUS ON RESIDENTS OF SENIOR BUILDINGS. STRATEGY: CONTINUE TO GROW THE JACKSON PARK HOSPITAL GOLDEN L.I.G.H.T. (LIVING IN GOOD HEALTH TODAY) SENIOR HEALTHCARE PROGRAM. GOLDEN L.I.G.H.T. PROVIDES SENIORS OVER THE AGE OF 55 WITH IMPORTANT SERVICES SUCH AS REFERRALS TO SOCIAL SERVICES, PRIMARY CARE, INTERNAL MEDICINE, CARDIOLOGY, UROLOGY, ENDOCRINOLOGY, RHEUMATOLOGY, PHYSICAL THERAPY, OPHTHALMOLOGY, PODIATRY AND GYNECOLOGY. TO ADDRESS THE OBSTACLES OUR SENIORS MAY FACE WHEN SEEKING MEDICAL AND SOCIAL SERVICES, THE GOLDEN L.I.G.H.T. PROGRAM INCLUDES BENEFITS SUCH AS: * FREE TRANSPORTATION TO ALL CLINIC APPOINTMENTS* MULTIDISCIPLINARY TEAM DEDICATED TO THE SENIOR'S CARE* DEDICATED SPECIALTY UNIT FOR ALL SENIORS WHO REQUIRE ADMISSION TO THE HOSPITAL* DISCOUNTS ON PRESCRIPTIONS, AND FREE DELIVERY OF PRESCRIPTIONS GOAL 1.B. PROVIDE HIGH QUALITY TRANSPORTATION SERVICES TO ENSURE COMMUNITY MEMBERS WHO FACE TRANSPORTATION BARRIERS ARE ABLE TO ACCESS HEALTH SERVICES. STRATEGY: EXPAND UPON TRANSPORTATION SERVICES PROVIDED THROUGH THE GOLDEN L.I.G.H.T. PROGRAM TO MAKE TRANSPORTATION SERVICES AVAILABLE TO PATIENTS FROM ALL AGE GROUPS WHO FACE TRANSPORTATION BARRIERS. ALL PATIENTS WHO SEE PHYSICIANS IN OUR MEDICAL OFFICE BUILDING AND PRENATAL PATIENTS WHO REQUIRE TRANSPORTATION WILL BE GIVEN FREE TRANSPORTATION TO AND FROM THEIR MEDICAL APPOINTMENTS. GOAL 1.C. PROVIDE COVERAGE AND SERVICES TO UNINSURED AND UNDERINSURED. STRATEGY: PARTNER WITH FIRST SOURCE TO ASSIST PATIENTS AND FAMILIES TO OBTAIN INSURANCE COVERAGE FROM MEDICAID, MEDICARE, OR OTHER GOVERNMENT SPONSORED PROGRAMS. STRATEGY: PROVIDE AND MAINTAIN CHARITY ASSISTANCE TO THE UNINSURED AND UNDERINSURED. THIS POLICY INCLUDES FREE AND DISCOUNTED CARE TO THOSE UNABLE TO PAY FOR MEDICAL CARE AND SERVICES. STRATEGY: PARTNER WITH ORGANIZATIONS, AGENCIES, AND BUSINESSES IN THE COMMUNITY TO PROVIDE PREVENTION AND WELLNESS SERVICES WITHIN THE COMMUNITY INCLUDING HEALTH SCREENINGS, HEALTH EDUCATION, TRAINING AND/OR SEMINARS. (SEE CHRONIC DISEASE PREVENTION STRATEGIES FOR MORE DETAIL.) 2. BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE) GOAL 2.A. INCREASE ACCESS TO SUBOXONE TREATMENT IN THE COMMUNITY. STRATEGY: IMPLEMENT A PROGRAM TO PROVIDE SUBOXONE TREATMENT IN BOTH INPATIENT AND OUTPATIENT SETTINGS. GOAL 2.B. EXPLORE DEVELOPMENT OF TELEHEALTH SERVICES FOR OUTPATIENT MENTAL HEALTH. STRATEGY: EXPLORE DEVELOPMENT OF TELEHEALTH SERVICES FOR OUTPATIENT MENTAL HEALTH. GOAL 2.C. EXPLORE PARTNERSHIPS FOR PROMOTING MENTAL HEALTH WELLNESS IN THE COMMUNITY. STRATEGY: WORK WITH THE ALLIANCE FOR HEALTH EQUITY AND COMMUNITY-BASED PARTNERS TO UNDERSTAND OPPORTUNITIES FOR PARTNERSHIPS RELATED TO MODELS FOR SERVING PEOPLE WITH BEHAVIORAL HEALTH NEEDS IN THE COMMUNITY SUCH AS DROP-IN CENTER/WELCOMING CENTER/LIVING ROOM, ADDRESSING BARRIERS TO MEDICATION ACCESS, AND COMMUNITY TRAININGS SUCH AS MENTAL HEALTH FIRST AID. STRATEGY: IDENTIFY WAYS TO LEVERAGE EXISTING OUTREACH STAFF AND EVENTS TO SHARE INFORMATION AND HEALTH EDUCATION ON BEHAVIORAL HEALTH. DEVELOP NEW RELATIONSHIPS WITH COMMUNITY-BASED PARTNERS AS PART OF THE 1115 WAIVER PROGRAM THAT IS IN VARIOUS STAGES OF IMPLEMENTATION BY THE STATE OF ILLINOIS. 3. CHRONIC DISEASE PREVENTION GOAL 3.A. INCREASE COMMUNITY ACCESS TO WELLNESS RESOURCES, KNOWLEDGE OF CHRONIC DISEASE RISK FACTORS, AND CHRONIC DISEASE PREVENTION THROUGH HEALTH EDUCATION AND PREVENTION SERVICES IN THE COMMUNITY. STRATEGY: PROVIDE ACCESS TO CHRONIC DISEASE PREVENTION AND MANAGEMENT SERVICES THROUGH THREE CLINICS: SMOKING CESSATION CLINIC, WEIGHT MANAGEMENT CLINIC, AND DIABETES CLINIC. STRATEGY: PROVIDE CHRONIC DISEASE SERVICES AND EDUCATION/OUTREACH TO OLDER ADULTS THROUGH THE GOLDEN L.I.G.H.T. PROGRAM. STRATEGY: PARTNER WITH COMMUNITY ORGANIZATIONS, AGENCIES, AND BUSINESSES TO PROVIDE PREVENTION AND WELLNESS SERVICES WITHIN THE COMMUNITY INCLUDING HEALTH SCREENINGS, HEALTH EDUCATION, TRAINING AND/OR SEMINARS. THIS INCLUDES: * HOSPITAL OUTREACH STAFF VISIT SURROUNDING NEIGHBORHOODS, PARTICIPATING IN EVENTS AND HEALTH FAIRS, PROVIDING INFORMATION AND SERVICES NOT ONLY TO PEOPLE WHO ARE SICK BUT ALSO TO TEACH COMMUNITY RESIDENTS HOW TO STAY HEALTHY.* FREE BLOOD PRESSURE/HYPERTENSION SCREENINGS, AND DIABETES RISK ASSESSMENTS* INFORMATION ON HEALTH AND NUTRITION, BREAST SELF-EXAMS AND MAMMOGRAPHY, P.S.A. LAB TESTING, AND PULMONARY FUNCTION TESTING AT OUTREACH EVENTS* CLINICAL EXPERTS FROM THE HOSPITAL PROVIDING HEALTH EDUCATION AND ANSWERING COMMUNITY QUESTIONS VIA COMMUNITY SEMINARS AND RADIO TALK SHOWS* THE HOSPITAL SPONSORS A FAMILY PRACTICE RESIDENCY PROGRAM THAT HAS 18 MEDICAL RESIDENTS. THESE RESIDENTS SEE PATIENTS AT LOCAL SUPPORTIVE LIVING FACILITIES AS WELL AS SKILLED NURSING HOMES IN ADDITION TO THE PATIENTS THEY SERVE AT THE HOSPITAL. GOAL 3.B. EXPLORE PARTNERSHIPS FOR COMMUNITY-BASED CHRONIC DISEASE PREVENTION RELATED TO NUTRITION AND DIET, DIABETES, OBESITY, CANCER, AND LUNG HEALTH. STRATEGY: WORK WITH THE ALLIANCE FOR HEALTH EQUITY AND COMMUNITY-BASED PARTNERS TO UNDERSTAND OPPORTUNITIES FOR PARTNERSHIPS FOR COMMUNITY-BASED CHRONIC DISEASE PREVENTION RELATED TO NUTRITION AND DIET, DIABETES, OBESITY, CANCER, AND LUNG HEALTH. 4. WORKFORCE DEVELOPMENT GOAL 4.A. EXPLORE PARTNERSHIPS FOR INCREASING COMMUNITY-BASED WORKFORCE DEVELOPMENT AND RETENTION IN ENTRY-LEVEL POSITIONS SUCH AS MEDICAL ASSISTANT (MA), CONSTANT OBSERVERS, AND OTHERS. STRATEGY: WORK WITH 8TH WARD ALDERMAN MICHELLE HARRIS, COMMUNITY PARTNERS, JOB TRAINING SITES, AND REGIONAL WORKFORCE COLLABORATIVES TO DESIGN A PILOT PROJECT FOR WORKFORCE DEVELOPMENT. |
| PART V, SECTION B, LINE 7A - HOSPITAL FACILITY'S WEBSITE FOR CHNA | HTTPS://WWW.JACKSONPARKHOSPITAL.ORG/ASSETS/1/7/CHNA%20FINAL%202021.PDF |
| PART V, SECTION B, LINE 10 - HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY | HTTPS://WWW.JACKSONPARKHOSPITAL.ORG/ASSETS/1/7/CHNA_IMPLEMENTATION_STRATEGY_FINAL1.PDF |
| PART V, SECTION B, LINE 16A - FAP WEBSITE | HTTPS://WWW.JACKSONPARKHOSPITAL.ORG/ASSETS/1/7/FINANCIAL%20ASSISTANCE%20POLICY%202021%20DOCX.PDF |
| PART V, SECTION B, LINE 16B - FAP APPLICATION WEBSITE | HTTPS://WWW.JACKSONPARKHOSPITAL.ORG/ASSETS/1/7/FINANCIAL_ASSISTANCE_GUIDELINES_PACKET.PDF |
| PART V, SECTION B, LINE 16C - PLAIN LANGUAGE SUMMARY WEBSITE | HTTPS://WWW.JACKSONPARKHOSPITAL.ORG/ASSETS/1/7/FAP%20PLAIN%20LANGUAGE%20SUMMARY.PDF |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | CHARITY CARE COST IS BASED ON THE TOTAL COST TO CHARGE RATIO DERIVED FROM THE MEDICARE COST REPORT FOR SERVICES PROVIDED TO PATIENTS. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 17,505,223. |
| PART III, LINE 2: | THE COST OF BAD DEBT EXPENSE IS BASED ON THE COST TO CHARGE DERIVED FROM THE HOSPITAL'S MEDICARE COST REPORT. |
| PART III, LINE 3: | MANAGEMENT HAS ESTIMATED THE CALCULATION USING THE RATIO OF THE HOSPITAL'S COST OF PROVIDING PATIENT CARE TO ITS CHARGES. THE HOSPITAL VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR ALL OR PART OF THEIR HEALTH CARE EXPENSES AND AS RESULT, THIS HAS BEEN INCLUDED AS COMMUNITY BENEFIT. |
| PART III, LINE 4: | SEE THE "UNCOMPENSATED CARE AND COMMUNITY BENEFIT" FOOTNOTE 9 ON PAGE 21 AND 22 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE MEDICARE SHORTFALL WAS NOT TREATED AS A COMMUNITY BENEFIT. THE MEDICARE ALLOWABLE COSTS REPORTED ON LINE 6 WERE CALCULATED USING THE FILED MEDICARE COST REPORT. |
| PART III, LINE 9B: | THE HOSPITAL HAS A PRESUMPTIVE ELIGIBILITY POLICY AS REQUIRED BY THE STATE OF ILLINOIS. |
| PART VI, LINE 2: | JACKSON PARK HOSPITAL FOUNDATION OUTREACH AND ASSESSMENT OF ITS COMMUNITY HEALTH BY EVALUATING WHICH HEALTH CONDITIONS AND DISEASES ARE PREVALENT AMONG ITS INPATIENT AND OUTPATIENTS. THE HOSPITAL PREPARED ITS COMMUNITY HEALTH NEEDS ASSESSMENT USING A PROFESSIONAL COMPANY EXPERIENCED IN ASSISTING HOSPITALS IN THE PROCESS. TOGETHER WE CONFIRMED THE NEED FOR EDUCATION AND OTHER INVENTIONS FOR DIABETES, ASTHMA, AND BEHAVIORAL MEDICINE. THE HOSPITAL HAS RESPONDED TO THESE NEEDS THROUGH THE DEVELOPMENT OF SEVERAL COMMUNITY PROGRAMS AND SPECIALTY CLINICS. THE HOSPITAL IMPLEMENTED FREE TRANSPORTATION FOR PATIENTS WHO ARE UNABLE TO KEEP APPOINTMENTS WITH THEIR PRIMARY CARE PROVIDER OR CONSULTANT. |
| PART VI, LINE 3: | THE HOSPITAL HAS CONTRACTED WITH A THIRD PARTY NAMED FIRST SOURCE TO ASSIST ANY PATIENT THROUGH THE FINANCIAL APPLICATION PROCESS TO QUALIFY FOR MEDICAID, MEDICARE AND THE AFFORDABLE CARE ACT. THIS SAME COMPANY WILL ALSO ASSIST A PATIENT AND OR FAMILY THROUGH THE HOSPITAL'S CHARITY APPLICATION PROCESS. |
| PART VI, LINE 4: | JACKSON PARK HOSPITAL'S PRIMARY SERVICE AREA IS 60649, 60621, 60637, 60619 AND 60617. OUR PRIMARY CARE AREA FOR BEHAVIORAL PATIENTS IS MUCH BROADER AND ENCOMPASSES THE CITY OF CHICAGO. THE AVERAGE INCOME IN THE HOSPITALS PRIMARY SERVICE AREA IS APPROXIMATELY 53% OF THE STATE OF ILLINOIS AVERAGE. |
| PART VI, LINE 5: | IN ADDITION TO VARIOUS EDUCATION PROGRAMS WITHIN THE HOSPITAL, THE HOSPITAL STARTED REGULAR EDUCATION AND OUTREACH PROGRAMS AT LOCAL GROCERY STORES AND BANKS IN 2019. THE HOSPITAL ALSO BEGAN AN OUTREACH PROGRAM FOR SENIOR PATIENTS. THIS SENIOR PROGRAM WILL MANAGE THE PRIMARY HEALTHCARE NEEDS AND MATCH THE PATIENT WITH THE PHYSICIAN. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR WILLIAM O DORSEY III | ||||||||||||||
| CHAIRMAN/CEO | $836,481 | $0 | $0 | $0 | $0 | $0 | $9,615 | $0 | $13,680 | $0 | $859,776 | $0 | $0 | $0 |
| MATTHEW MALTERS MD | ||||||||||||||
| PHYSICIAN | $14,870 | $694,540 | $0 | $0 | $0 | $0 | $0 | $0 | $35,874 | $0 | $50,744 | $694,540 | $0 | $0 |
| G RANDALL SMITH | ||||||||||||||
| EXECUTIVE VP | $664,603 | $0 | $0 | $0 | $0 | $0 | $9,615 | $0 | $35,874 | $0 | $710,092 | $0 | $0 | $0 |
| MERRITT HASBROUCK | ||||||||||||||
| PRESIDENT | $678,340 | $0 | $0 | $0 | $0 | $0 | $9,615 | $0 | $226 | $0 | $688,181 | $0 | $0 | $0 |
| NELSON VASQUEZ | ||||||||||||||
| VP FINANCE | $239,898 | $0 | $0 | $0 | $0 | $0 | $9,615 | $0 | $35,874 | $0 | $285,387 | $0 | $0 | $0 |
| RAYLENE SWINOCK | ||||||||||||||
| NURSE | $265,273 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,094 | $0 | $274,367 | $0 | $0 | $0 |
| ROSE ETTE | ||||||||||||||
| NURSE | $247,755 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $24,604 | $0 | $272,359 | $0 | $0 | $0 |
| SYED ALA MD | ||||||||||||||
| PHYSICIAN | $74,933 | $170,000 | $0 | $0 | $0 | $0 | $0 | $0 | $24,604 | $0 | $99,537 | $170,000 | $0 | $0 |
| DR LAKSHMI DODDA | ||||||||||||||
| DIRECTOR/PHYSICIAN | $244,839 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $24,604 | $0 | $269,443 | $0 | $0 | $0 |
| SRIKANTH RAVINDRAN MD | ||||||||||||||
| PHYSICIAN | $108,442 | $123,300 | $0 | $0 | $0 | $0 | $0 | $0 | $35,874 | $0 | $144,316 | $123,300 | $0 | $0 |
| DR HAROON OLOMI | ||||||||||||||
| DIRECTOR/PHYSICIAN | $11,977 | $209,996 | $0 | $0 | $0 | $0 | $0 | $0 | $24,604 | $0 | $36,581 | $209,996 | $0 | $0 |
| DR HARSHAD MEHTA | ||||||||||||||
| DIRECTOR/PHYSICIAN | $160,625 | $0 | $0 | $0 | $56,000 | $0 | $0 | $0 | $24,021 | $0 | $240,646 | $0 | $0 | $0 |
| M PATRICIA SIMON | ||||||||||||||
| SENIOR VP QUALITY & COMPLIANCE | $203,816 | $0 | $0 | $0 | $0 | $0 | $9,375 | $0 | $24,021 | $0 | $237,212 | $0 | $0 | $0 |
| BARRY MANDELL | ||||||||||||||
| VP SPECIAL PROJECTS | $181,903 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $35,874 | $0 | $217,777 | $0 | $0 | $0 |
| DR BANGALORE R MURTHY | ||||||||||||||
| DIRECTOR/PHYSICIAN | $167,902 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $35,874 | $0 | $203,776 | $0 | $0 | $0 |
| DR ZAHIDUR RAHMAN | ||||||||||||||
| DIRECTOR/PHYSICIAN | $80,631 | $85,111 | $0 | $0 | $0 | $0 | $0 | $0 | $24,604 | $0 | $105,235 | $85,111 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| BANGALORE MURTHY MD | |||
| DIRECTOR OF ORGANIZATION/BUSINESS OWNER | $589,042 | TEMPORARY STAFFING | 0 |
| BANGALORE MURTHY MD | |||
| DIRECTOR OF ORGANIZATION/BUSINESS OWNER | $71,604 | MEDICAL EDUCATION BILLING | 0 |
| SURRENTHIA PARKER MD | |||
| DIRECTOR OF ORGANIZATION/BUSINESS OWNER | $425,436 | MEDICAL STAFFING | 0 |
| ZAHIDUR RAHMAN MD | |||
| DIRECTOR OF ORGANIZATION/BUSINESS OWNER | $157,664 | MEDICAL STAFFING | 0 |
| LAKSHMI DODDA MD | |||
| DIRECTOR OF ORGANIZATION/BUSINESS OWNER | $106,861 | MEDICAL STAFFING | 0 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 3 | ContributionCnt |
| Noncash Contributions Rpt F990 | $708,297 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S SENIOR MANAGEMENT REVIEWS THE 990 BEFORE IT IS SUBMITTED. THIS INCLUDES THE ASSISTANT VP OF FINANCE, VP OF FINANCE, EXECUTIVE VP, PRESIDENT AND CEO. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMPLIANCE OFFICER REVIEWS POLICIES ON AN ANNUAL BASIS. |
| FORM 990, PART VI, SECTION B, LINE 15 | JACKSON PARK HOSPITAL FOUNDATION HAS AN AUDIT/COMPENSATION COMMITTEE. THE CHAIRMAN OF THIS COMMITTEE REVIEWS THE COMPENSATION OF SENIOR MANAGEMENT AND KEY EMPLOYEES ON AN ANNUAL BASIS. |
| FORM 990, PART VI, SECTION C, LINE 19 | JACKSON PARK HOSPITAL FOUNDATION MAKES ITS COMMUNITY HEALTH NEEDS ASSESSMENT AVAILABLE ON ITS WEBSITE AND BY APPOINTMENT WITH ITS VICE PRESIDENT OF FINANCE. THE CONFLICT OF INTEREST POLICY, COMMUNITY BENEFIT REPORT, FORM 990 AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY APPOINTMENT WITH ITS VICE PRESIDENT OF FINANCE OR ITS SENIOR VICE PRESIDENT OF QUALITY AND COMPLIANCE. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,828,947. MANAGEMENT AND GENERAL EXPENSES 204,699. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,033,646. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 7,651,890. MANAGEMENT AND GENERAL EXPENSES 229,366. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,881,256. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,139,160. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,139,160. |
| FORM 990, PART XI, LINE 9: | CHANGE IN MINIMUM PENSION LIABILITY -228,909. |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE FRIEDELL CLINIC SC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 STONY ISLAND | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60649 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363290656 | EIN |
| Primary Activities | PRIMARY HEALTH CARE | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON PARK HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$4,914,350 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $227,962 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE FRIEDELL CLINIC SC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | D | TransactionTypeTxt |
| Involved | $78,164,343 | InvolvedAmt |
| Method Of Amount Determination | GL | MethodOfAmountDeterminationTxt |