2018-02-15T16:04:47-07:00 2017-03-31 990 2016-04-01 362448028 JACKSON PARK HOSPITAL FOUNDATION JACK 7739477989 7531 Stony Island Chicago IL 60649 William Dorsey MD Chairman/CEO 7739477920 2018-02-15 207.181.195.34 2016 2021-01-29 14:40:06Z William Dorsey MD 7531 Stony Island Chicago IL 60649 90425092 0 X jacksonparkhospital.org X 1960 IL The mission of the physicians, staff and Board of Directors of the organization is to provide compassionate and high quality healthcare services to meet the needs of the patients and communities we serve. 10 2 927 0 0 0 347219 147048 60711660 58571802 31014 27666 26197426 31678576 87287319 90425092 0 0 0 0 41819113 43940811 0 0 0 38882008 38455043 80701121 82395854 6586198 8029238 137907122 146583721 24909325 25530175 112997797 121053546 The mission of the physicians, staff and Board of Directors of the organization is to provide compassionate and high quality healthcare services to meet the needs of the patients and communities we serve 0 0 15278866 0 16937131 Jackson Park Hospital Foundation provides inpatient and outpatient medical care to Chicago's south side communities regardless of the patient's ability to pay. Inpatient services include medical surgical, ICU, obstetrics, labor and delivery and hospice. in 2016 the hospital serverd 5,759 acute care admissions which amounted to 20,757 patient days 3711275 0 3094573 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 services to its community. In 2016 Jackson Park Hospital served 2,509 inpatient behavioral medicine patients which amounted to 10,637 patient days. 6612191 0 3954983 Jackson Park Hospital provides basic emergency room services to its community 24 hours a day, seven days a week regardless of the patient's ability to pay. In 2016, the hospital served 28,498 emergency patients. 50286070 36243380 Other outpatient revenue and support services 50286070 0 36243380 75888402 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 66 0 1 927 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 2 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IL X Nelson Vasquez 7739477989 7531 Stony Island Chicago IL 60649 William Dorsey MD Chairman/CEO 40 0 X X 684735 0 7087 Harshad Mehta Director 40 X 135380 0 5050 Dr Arol Augsburger Director 2 X 0 0 0 James Clark Director 2 X 0 0 0 Haroon Olomi MD Director 4 36 X 87756 205686 14341 Bangalore R Murthy MD Director 40 X 165507 129334 18679 Lakshmi Dodda MD Director 2 0 X 225040 99618 14342 James Nunn MD Director 2 40 X 67679 350236 18679 Sameera Qureshi MD Director 2 32 X 19652 141914 18679 Siddiq Hasan MD Director 2 40 X 157694 299675 18679 Merritt Hasbrouck President 40 X 803019 0 201 G Randall Smith Executive Vice President 40 X 582216 0 18679 Nelson Vasquez Vice President Finance 40 X 231721 0 18679 Barry Mandell Vice President Special Projects 40 X 194110 0 18679 M Patrica Simon Senior Vice President Quality & Compliance 40 X 207577 0 13985 Thodur Ranganathan MD Physician 40 X 415940 0 18042 Matthew Malters MD Physician 4 40 X 29336 618759 0 Karen Carranza MD Physician 0 40 X X 204002 407496 0 Surrenthia R Parker MD Physician 0 40 X 268077 417095 0 Pratap Kumar MD Physician 0 40 X 189014 296646 0 4668455 2966459 203801 69 1 1 1 Northern Illinois Clinical Laboratory 306 E Era Drive Northbrook IL 60062 Clinical Laboratory Services 3419186 White Cap Nursing Inc 2600 Michigan Ave 60649 Chicago IL 60616 Temporary Nurse Staffing 2167560 Rush Nursing Services 7531 Stony Island Chicago IL 60649 Temporary Nursing Services 972913 Emergency Room Care Providers 6111 N River Road Suite 800 Rosemont IL 60018 Emergency Room Physician Services 1513060 McKesson 6111 N River Road Suite 110 Rosemont IL 60018 Technology Services 1272299 66 0 0 147048 0 0 0 0 147048 Net Patient Service Revenue 622110 58571802 58571802 0 0 0 0 0 0 58571802 27666 27666 0 0 0 0 0 0 0 0 0 0 168752 0 0 0 168752 0 168752 168752 0 0 0 0 147048 Provider Tax Proceeds 622110 27797973 27797973 0 0 Miscellaneous Income 622110 3711851 3711851 0 0 0 0 0 0 31509824 90425092 90278044 0 0 X 0 0 0 0 0 0 0 0 4014953 0 4014953 0 0 0 0 0 32657445 32657445 0 0 348635 348635 0 0 4302089 4302089 0 0 2617689 2617689 0 0 162395 0 162395 0 553203 0 553203 0 379666 0 379666 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1397235 0 1397235 0 0 0 0 0 1254643 1254643 0 0 0 0 0 0 0 0 0 0 0 0 0 0 404888 404888 0 0 0 0 0 0 2357678 2357678 0 0 619443 619443 0 0 31325892 31325892 0 0 82395854 75888402 6507452 0 7517879 7579150 0 0 103157956 112705949 0 0 0 0 12275 935993 975581 381477 287075 89061844 64525228 25276384 24536616 0 637433 487075 137907122 146583721 12524180 9763203 0 0 0 0 0 0 7559111 10043778 0 4826034 5723194 24909325 25530175 X 112997797 121053546 0 0 0 0 112997797 121053546 137907122 146583721 X 8029238 26511 0 0 0 0 X 0 1 X 1 0 X 2482024 0 2482024 53933738 0 37130952 16802786 0 0 0 0 32011765 0 27008923 5002842 634317 0 385353 248964 24536616 0 Pension Liability 677991 professional liability 5045203 5723194 X 90425092 0 0 0 0 0 90425092 0 0 0 90425092 82395854 0 0 0 0 0 82395854 0 0 0 82395854 Schedule D, Part X, Line 2 Other liabilities includes Pension and Professional Liabilities Schedule D, Part XI, Line 2d Investment Income Annual Gala 125133 0 125133 0 0 0 0 0 0 Annual Golf Outing 21915 0 21915 0 0 0 0 0 0 0 147048 0 147048 0 0 0 0 0 0 0 147048 0 1 1 2602539 0 0 2602539 0 0 0 4033495 9539054 0 0 13572549 0 0 0 0 0 16175088 0 0 0 1 6341049 3170525 17369745 17369745 0 X 1 1 1 1 Jackson Park Hospital Foundation Chicago 7531 Stony Island Chicago IL 60649 jacksonparkhospital.org 0001115 X X X X Jackson Park Hospital Foundation Chicago 1 1 0 1 X X X X X X X X X 15 1 1 1 1 X jacksonparkhospital.org X 1 17 1 jacksonparkhospital.org 0 0 1 X 200 200 X X X X X X 1 1 X X X X 1 X jacksonparkhospital.org X jacksomparkhospital.org X X X X X X 1 X 0 X X X 1 0 0 Schedule H, Part V, Section B, Line 5-Jackson Park Hospital Foundation Jackson Park Hospital Foundation begins outreach and assessment of its community health by evaluating which health conditions and diseases are prevalent among its inpatients and outpatients. The hospital prepared it community health needs their bill including discounts and charity care. The hospital has contracted with a third party that assist any patient through the application process of assessment using Professional Research Consultant's Inc. data on behalf of the Metropolitan Chicago Health Care Council which included focus groups with-in our primary service area. Together, they confirm the need for education and other interventions for diabetes, asthma Medicaid, Medicare and the affordable care act. This same company will also assist a patient and or family through the hospital's charity and specialty clinics. and behavioral medicine. The hospital has responded to these needs through the development of several community education programs Schedule H, Part V, Section B, Line 6a-Jackson Park Hospital Foundation Other hospital participants in the Community Health Needs Assessment include Amita Health Behavioral Health Hospital Alexian Brothers Medical Center Alexian Brothers Women & Children's Hospital St. Alexius Medical Center Memorial Hospital Edward Elmhurst Healthcare Edward Hospital & Health Services Elmhurst Memorial Hospital Franciscan Alliance LaGrange Memorial Hospital The University of Chicago Medicine Council (MCHC) contracted with Professional Research Consultants, Inc. to conduct focus groups and collect data in our primary zip codes. strengthening current relationships and building new alliances with agencies and organizations that have the same goals and dedications To improve and maintain health within our communities. Schedule H, Part V, Section B, Line 6b-Jackson Park Hospital Foundation The hospital participated with the Metropolitan Health Care Council in preparation of the Community Health Needs Assessment with over twenty hospital participating in the project. Schedule H, Part V, Section B, Line 11-Jackson Park Hospital Foundation In response to the Community Health Needs Assessment data for our primary service area, the hospital has added a diabetes, weight loss and smoking cessation program to our out patient clinic Schedule H, Part V, Section B, Line 15e-Jackson Park Hospital Foundation The hospital has contracted with FirstSource to assist patients and their families in the application for financial assistance and charity care Schedule H, Part I, Line 7 The hospital used the actual cost of services provided based on the total cost to charge ratio derived from the hospitals Medicare cost Report Schedule H, Part III, Section A, Line 4 The footnote concerning bad debts is on page 11 Schedule H, Part III, Section A, Line 4 The organization estimate of bad debt expenses included in community benefits is based on the Medicare cost report ratio of cost to charges Schedule H, Part III, Section B, Line 8 The Medicare cost to charge ratio was used Schedule H, Part III, Section C, Line 9b The hospital's collection policies clearly state how to treat patients that cannot pay their portion of their bill including discounts and charity care Schedule H, Part VI, Line 2 Jackson Park Hospital Foundation begins outreach and assessment of its community health by evaluating which health conditions and diseases are prevalent among its inpatients and outpatients The hospital prepared its community health needs assessment using Professional Research Consultant's Inc. data on behalf of the Metropolitan Chicago Health Care Council which included focus groups with-in our primary service area Together they confirm the need for education and other interventions for diabetes, asthma and behavioral medicine The hospital has responded to these needs through the development of several community education programs and speciality clinics Schedule H, 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 Schedule H, Part VI, Line 4 Jackson Park Hospital's primary service area is 60649, 60620, 60617 and 60628 Our primary care service area for behavioral patients is much broader and encompass the City of Chicago The average income in the hospital's primary service area is approximately 53% of the State of Illinois average Schedule H, Part VI, Line 5 In addition to various education programs with-in the hospital, the hospital has begun regular education and outreach programs at local grocery stores and banks In January 2018, the hospital began a outreach program for senior patients This senior program will manage the primary healthcare needs and match the patient with a physician Schedule H, Part VI, Line 7 Jackson Park Hospital Foundation prepares and submits an annual Community Benefits Report to the Attorney General of the State of Illinois This report is also made available to the general public upon request X X X X 0 0 0 0 0 0 0 0 0 William Dorsey MD Chairman/CEO 684735 0 0 0 12000 0 0 0 7087 0 703822 0 0 0 Merritt Hasbrouck President 803019 0 0 0 12000 0 0 0 201 0 815220 0 0 0 G Randall Smith Executive Vice President 582216 0 0 0 12000 0 0 0 18679 0 612895 0 0 0 Nelson Vasquez Vice President Finance 231721 0 0 0 0 0 0 0 18679 0 250400 0 0 0 Barry Mandell Vice President Special Projects 194110 0 0 0 0 0 0 0 18679 0 212789 0 0 0 Harshad Mehta Director 136724 0 0 0 0 0 0 0 13985 0 150709 0 0 M Patrica Simon Senior Vice President Quality & Compliance 207577 0 0 0 0 0 0 0 13985 0 221562 0 199244 0 Dr Arol Augsburger Director 0 0 0 0 0 0 0 0 0 0 0 0 0 0 James Clark Director 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Haroon Olomi MD Director 87756 205686 0 0 0 0 0 0 14342 0 102098 205686 0 Thodur Ranganathan MD Physician 267709 148230 0 0 0 0 0 0 18042 0 285751 148230 0 0 Bangalore R Murthy MD Director 165507 0 0 0 0 129334 0 0 18679 0 184186 129334 0 137718 Lakshmi Dodda MD Director 189904 0 0 0 0 35136 0 0 14342 0 204246 35136 0 0 James Nunn MD Director 67679 0 0 0 0 350236 0 0 18679 0 86358 350236 0 0 Sameera Qureshi MD Director 19652 141914 0 0 0 0 0 0 18679 0 38331 141914 0 0 Siddiq Hasan MD Director 120520 0 0 0 0 299675 0 0 18679 0 139199 299675 0 0 Matthew Malters MD Physician 29336 618759 0 0 0 0 0 0 0 0 29336 618759 0 0 Karen Carranza MD Physician 0 204002 0 0 0 407496 0 0 0 0 0 611498 0 0 Surrenthia R Parker MD Physician 59530 0 0 0 208547 417095 0 0 0 0 268077 417095 0 0 Pratap Kumar MD Physician 0 0 0 0 189014 296646 0 0 0 0 189014 296646 0 0 Bangalore Murthy MD Director 378375 Medical Education 0 Bangalore Murthy MD Director 726325 Temporary Nurse Staffing 0 Bangalore Murthy MD Director 117602 Medical Education Billing 0 Form 990, Part VI, Section B, Line 11b The Management and the Chairman of the Audit Committee review the return prior to its release Form 990, Part VI, Section B, Line 12c All officers, Directors or Trustees and key employees are required to complete a conflict of interest disclosure for annually and submit it to the Compliance Officer. This process was completed in February 2017 Form 990, Part VI, Section B, Line 15 Jackson Park Hospital Foundation has a compensation committee. The Chairman of the Board 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 own website and by appointment with its Vice President 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 24e Other expenses include contract labor and purchased services $11,371,931, supplies $10,033,913, professional fees $3,378,885, repair and maintenance $378,376 and provider tax expense $8,655,285 Form 990, Part XI, Line 9 Investment in Friedell Clinic The Friedell Clinic SC 7531 Stony Island Chicago IL 60649 363290656 Primary Health Care IL Jackson Park Hospital Foundation C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 There was a delay in completing our audited financial statements