2023-02-09T15:22:31-06:00 2022-03-31 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2021-04-01 362448028 JACKSON PARK HOSPITAL FOUNDATION JACK 7739477500 7531 STONY ISLAND AVENUE CHICAGO IL 60649 WILLIAM DORSEY MD CHAIRMAN/CEO 7739477500 2023-02-06 1 WILLIAM DORSEY MD 999009999 JEFF PARKER P00970069 6182331200 2023-02-06 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z WILLIAM DORSEY MD 7531 STONY ISLAND AVENUE CHICAGO IL 60649 107987360 0 X WWW.JACKSONPARKHOSPITAL.ORG X 1960 IL TO PROVIDE COMPASSIONATE CARE AND HIGH QUALITY HEALTHCARE SERVICES TO MEET THE NEEDS OF THE PATIENTS AND COMMUNITIES WE SERVE. 8 1 846 1 0 0 6824036 8579657 105042471 98627710 3522 184945 596093 595048 112466122 107987360 0 0 0 0 42957325 42284840 0 0 0 61492147 57538932 104449472 99823772 8016650 8163588 120530174 132629667 40888008 45291102 79642166 87338565 X 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. 0 0 58998908 0 62928465 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. 19149783 0 20425233 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. 11890873 0 12682852 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. 2429356 0 2591160 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. 2429356 0 2591160 92468920 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 0 0 1 76 0 846 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 8 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 IL X KEN MCGHEE 7739477621 7531 STONY ISLAND CHICAGO IL 60649 JAMES I CLARK III DIRECTOR 2.00 0.00 X 0 0 0 DR WILLIAM O DORSEY III CHAIRMAN/CEO 40.00 0.00 X X 836481 0 23295 DR HARSHAD MEHTA DIRECTOR/PHYSICIAN 40.00 0.00 X 216625 0 24021 DR LAKSHMI DODDA DIRECTOR/PHYSICIAN 25.00 15.00 X 244839 0 24604 DR HAROON OLOMI DIRECTOR/PHYSICIAN 4.00 36.00 X 11977 209996 24604 DR ZAHIDUR RAHMAN DIRECTOR/PHYSICIAN 4.00 36.00 X 80631 85111 24604 DR SURRENTHIA PARKER DIRECTOR/PHYSICIAN 4.00 36.00 X 49378 0 35874 DR BANGALORE R MURTHY DIRECTOR/PHYSICIAN 25.00 15.00 X 167902 0 35874 MERRITT HASBROUCK PRESIDENT 40.00 0.00 X 678340 0 9841 G RANDALL SMITH EXECUTIVE VP 40.00 0.00 X 664603 0 45489 M PATRICIA SIMON SENIOR VP QUALITY & COMPLIANCE 40.00 0.00 X 203816 0 33396 NELSON VASQUEZ VP FINANCE 40.00 0.00 X 239898 0 45489 BARRY MANDELL VP SPECIAL PROJECTS 40.00 0.00 X 181903 0 35874 RAYLENE SWINOCK NURSE 40.00 0.00 X 265273 0 9094 SYED ALA MD PHYSICIAN 12.00 28.00 X 74933 170000 24604 ROSE ETTE NURSE 40.00 0.00 X 247755 0 24604 MATTHEW MALTERS MD PHYSICIAN 2.00 38.00 X 14870 694540 35874 SRIKANTH RAVINDRAN MD PHYSICIAN 15.00 25.00 X 108442 123300 35874 4287666 1282947 493015 70 0 1 0 SIMPLE LABORATORIES 5960 NORTH MILWAUKEE AVENUE CHICAGO IL 60646 LAB SERVICES 2855361 WHITE CAP NURSING 2600 SOUTH MICHIGAN AVENUE CHICAGO IL 60616 TEMPORARY NURSE STAFFING 2725660 GREAT LAKES MEDICAL GROUP 1001 GALAXY WAY SUITE 400 CONCORD CA 94520 EMERGENCY ROOM DOCTORS 1617000 ALLSCRIPTS 7444 WEST WILSON AVENUE HARWOOD HEIGHTS IL 60706 SOFTWARE SERVICES 1568364 ACUMEN MEDICAL STAFFING 689 NORTH MILWAUKEE AVENUE CHICAGO IL 60642 TEMPORARY NURSE STAFFING 1317312 69 7358300 1221357 708297 8579657 PATIENT SERVICE REVENUE 621110 60341672 60341672 PROVIDER TAX PROCEEDS 621110 38286038 38286038 98627710 184945 184945 275033 0 275033 275033 275033 CAFETERIA 722514 238613 238613 REFUNDS 621110 52466 52466 MISCELLANEOUS INCOME 621110 26953 26953 1983 1983 320015 107987360 98627710 0 779993 X 3939358 3939358 31225910 30827529 398381 518651 497373 21278 4138155 3968383 169772 2462766 2361728 101038 790292 790292 346362 346362 21297 21297 59232 59232 18054062 17619997 434065 100717 100562 155 6471023 4543604 1927419 1403045 1324030 79015 217 217 65228 61210 4018 3361866 3140745 221121 630457 630457 BAD DEBT 17505223 17505223 HOSPITAL PROVIDER TAX & 7816952 7816952 MISC. EXPENSE 904097 904097 PATIENT TRANSPORTATION 7978 7978 884 884 99823772 92468920 7354852 0 399290 879089 2500000 600000 857312 6762007 6165706 1356421 1236520 243451 638363 87756607 64405575 21812497 23351032 13357429 17005268 5871 5871 486163 486163 73007045 82004343 120530174 132629667 17068690 16331844 8606111 5403633 1053793 7238910 8107667 9056835 6051747 7259880 40888008 45291102 X 79642166 87338565 79642166 87338565 120530174 132629667 X 8163588 -444605 206325 -228909 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21297 21297 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO VARIOUS HOSPITAL ASSOCIATIONS ARE RELATED TO LOBBYING. 2482024 2482024 40314330 35523414 4790916 22692276 11573084 11119192 20427698 17309077 3118621 1840279 1840279 23351032 DUE FROM RELATED PARTY 78164343 COMMUNITY DEVELOPMENT FUND - LOAN PROCEEDS RECEIVABLE 3840000 82004343 THIRD PARTY PAYOR SETTLEMENTS 1388957 PENSION LIABILITY 1000451 PROFESSIONAL LIABILITY 4870472 7259880 X PART X, LINE 2: 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. 1 1 1 X 1 X 1 1 1 0 1 1 8506839 981206 7525633 0.09140 46668833 38250501 8418332 0.10230 55175672 39231707 15943965 0.19370 2158450 2051628 106822 0.00130 8510439 5678707 2831732 0.03440 10668889 7730335 2938554 0.03570 65844561 46962042 18882519 0.22940 1 6851331 1950320 9111659 10449216 -1337557 X 1 1 1 1 JACKSON PARK HOSPITAL FOUNDATION 7531 STONY ISLAND CHICAGO IL 60649 JACKSONPARKHOSPITAL.ORG 0001115 X X X X JACKSON PARK HOSPITAL FOUNDATION 1 0 0 1 X X X X X X X X X 20 1 0 0 1 X SEE PART V, SECTION C X 1 18 1 SEE PART V, SECTION C 0 1 X 200.000000000000 200.000000000000 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 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 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 X X X 0 0 0 0 0 0 0 0 0 DR WILLIAM O DORSEY III CHAIRMAN/CEO 836481 0 0 0 0 0 9615 0 13680 0 859776 0 0 0 MATTHEW MALTERS MD PHYSICIAN 14870 694540 0 0 0 0 0 0 35874 0 50744 694540 0 0 G RANDALL SMITH EXECUTIVE VP 664603 0 0 0 0 0 9615 0 35874 0 710092 0 0 0 MERRITT HASBROUCK PRESIDENT 678340 0 0 0 0 0 9615 0 226 0 688181 0 0 0 NELSON VASQUEZ VP FINANCE 239898 0 0 0 0 0 9615 0 35874 0 285387 0 0 0 RAYLENE SWINOCK NURSE 265273 0 0 0 0 0 0 0 9094 0 274367 0 0 0 ROSE ETTE NURSE 247755 0 0 0 0 0 0 0 24604 0 272359 0 0 0 SYED ALA MD PHYSICIAN 74933 170000 0 0 0 0 0 0 24604 0 99537 170000 0 0 DR LAKSHMI DODDA DIRECTOR/PHYSICIAN 244839 0 0 0 0 0 0 0 24604 0 269443 0 0 0 SRIKANTH RAVINDRAN MD PHYSICIAN 108442 123300 0 0 0 0 0 0 35874 0 144316 123300 0 0 DR HAROON OLOMI DIRECTOR/PHYSICIAN 11977 209996 0 0 0 0 0 0 24604 0 36581 209996 0 0 DR HARSHAD MEHTA DIRECTOR/PHYSICIAN 160625 0 0 0 56000 0 0 0 24021 0 240646 0 0 0 M PATRICIA SIMON SENIOR VP QUALITY & COMPLIANCE 203816 0 0 0 0 0 9375 0 24021 0 237212 0 0 0 BARRY MANDELL VP SPECIAL PROJECTS 181903 0 0 0 0 0 0 0 35874 0 217777 0 0 0 DR BANGALORE R MURTHY DIRECTOR/PHYSICIAN 167902 0 0 0 0 0 0 0 35874 0 203776 0 0 0 DR ZAHIDUR RAHMAN DIRECTOR/PHYSICIAN 80631 85111 0 0 0 0 0 0 24604 0 105235 85111 0 0 BANGALORE MURTHY MD DIRECTOR OF ORGANIZATION/BUSINESS OWNER 589042 TEMPORARY STAFFING 0 BANGALORE MURTHY MD DIRECTOR OF ORGANIZATION/BUSINESS OWNER 71604 MEDICAL EDUCATION BILLING 0 SURRENTHIA PARKER MD DIRECTOR OF ORGANIZATION/BUSINESS OWNER 425436 MEDICAL STAFFING 0 ZAHIDUR RAHMAN MD DIRECTOR OF ORGANIZATION/BUSINESS OWNER 157664 MEDICAL STAFFING 0 LAKSHMI DODDA MD DIRECTOR OF ORGANIZATION/BUSINESS OWNER 106861 MEDICAL STAFFING 0 X 3 708297 FMV 0 0 0 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. THE FRIEDELL CLINIC SC 7531 STONY ISLAND CHICAGO IL 60649 363290656 PRIMARY HEALTH CARE IL JACKSON PARK HOSPITAL FOUNDATION C -4914350 227962 1.00000 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 THE FRIEDELL CLINIC SC D 78164343 GL