2016-11-14T15:52:49-06:00 2015-12-31 BKD LLP 190 E Capitol Street Ste 500 Jackson MS 392012190 990 2015-01-01 640303091 St Dominic - Jackson Memorial Hospital % SAM SCOTT STDO 6012002000 969 Lakeland Drive Jackson MS 392164699 LESTER K DIAMOND PRESIDENT 6012006955 2016-11-15 true Dustin W Taylor CPA P01250644 6019486700 2016-11-15 2015 2017-02-10 21:41:12Z LESTER K DIAMOND 969 LAKELAND DRIVE JACKSON MS 392164699 478333234 false X WWW.STDOM.COM X 1946 MS ST. DOMINIC-JACKSON MEMORIAL HOSPITAL OPERATES A 535 BED PATIENT FACILITY FOR THE CITIZENS OF THE JACKSON, MS METROPOLITAN AREA THAT EXPRESSES A MISSION OF CHRISTIAN HEALING. 15 12 4393 564 2085415 -505146 1755263 270810 433530647 466619686 2385465 -527133 13612063 11918075 451283438 478281438 2347028 2405783 0 0 197108203 228593995 0 0 0 235206697 247658116 434661928 478657894 16621510 -376456 356046225 350738384 90989951 91489911 265056274 259248473 ST. DOMINIC-JACKSON MEMORIAL HOSPITAL (THE HOSPITAL OR ST. DOMINIC'S) RECOGNIZES ITS BASIC PARTICIPATION IN THE MISSION OF THE CHURCH WHICH INVOLVES TWO MAIN MINISTRIES: EDUCATION AND HEALTH CARE. THREE ACTIVITIES-COMMUNICATING A CHRISTIAN MESSAGE, ESTABLISHING COMMUNITY, AND PERFORMING SERVICE-EXPRESS ITS MISSION OF CHRISTIAN HEALING. false false 446726592 467398246 ST. DOMINIC HOSPITAL IS A 535-BED ACUTE CARE FACILITY IN JACKSON, MS. AS PART OF ITS HEALING MINISTRY, ST. DOMINIC'S IS ONE OF THE LARGEST EMPLOYERS IN THE AREA, AND THOSE EMPLOYEES, AS WELL AS THE HOSPITAL OPERATIONS, SIGNIFICANTLY HELP TO SUPPORT THE LOCAL ECONOMY. IN 2015, ST. DOMINIC HOSPITAL PROVIDED OVER $1 BILLION (CHARGES) IN HOSPITAL SERVICES TO PATIENTS THROUGHOUT THE CENTRAL REGION OF MISSISSIPPI, AND EMPLOYED OVER 3,200 PEOPLE. ST. DOMINIC HOSPITAL'S MEDICAL STAFF OF NEARLY 500 LEADING PHYSICIANS AND SPECIALISTS MAKES ST. DOMINIC'S ONE OF THE MOST COMPREHENSIVE HOSPITALS IN MISSISSIPPI. THESE PHYSICIANS AND STAFF MEMBERS HAVE PLAYED AN INTEGRAL ROLE IN DEVELOPING HIGHLY REGARDED CLINICAL PROGRAMS AND SERVICES. SOME OF THOSE KEY SERVICES INCLUDE THE MISSISSIPPI HEART AND VASCULAR INSTITUTE, STROKE SERVICES, WOMEN'S SERVICES, BEHAVIORAL HEALTH SERVICES, EMERGENCY CARE, THE CANCER CENTER (AND CANCER SERVICES AS A WHOLE), AND SURGICAL SERVICES. MISSISSIPPI HEART AND VASCULAR INSTITUTE- IN 1974, ST. DOMINIC'S ESTABLISHED A CENTER FOR COMPREHENSIVE CARDIAC CARE. THEN KNOWN AS THE MISSISSIPPI HEART INSTITUTE THE NAME HAS SINCE BEEN REVISED TO MISSISSIPPI HEART AND VASCULAR INSTITUTE (MHVI) TO SHOW ST. DOMINIC'S ONGOING COMMITTMENT TO EXPERTISE AND CARE OF THE ENTIRE CIRCULATORY SYSTEM. MANY OF ST. DOMINIC'S HEART AND VASCULAR PHYSICIANS ARE NATIONALLY KNOWN FOR USING THE MOST ADVANCED TECHNOLOGY AND PROCEDURES AND FOR THEIR CLINICAL EXCELLENCE IN DELIVERING PATIENT CARE. SERVICES OFFERED RANGE FROM MINIMALLY INVASIVE CARDIAC TREATMENTS TO TRADITIONAL OPEN-HEART SURGERY TO COMPLICATED AND VERY SPECIALIZED VALVE REPAIRS. In 2015 heart and vascular service volumes continued to climb compared to prior years. Some highlights include 8,524 cardiac catheterization lab procedures (10.3% higher than 2014), 1,939 electrophysiology procedures (20% increase over 2014) and increased cardiovascular surgery case volume from 719 cases in 2014 to 1,262 in 2015. Much of these increases can be attributed to St. Dominics efforts to offer outreach services to the broader community. St. Dominics Clinical Outreach, first established in 2013, provides screenings, specialty clinic hubs and other health services to individuals in both the Jackson area and in outlying communities. The program is made up of two parts: screenings, which encompasses the Healthy Heart screening program and community screening events, and outreach, which includes telemedicine and specialty clinics in rural areas. Patients who schedule an appointment with the Healthy Heart program receive a full (hospital subsidized) heart risk assessment for $99. Up to 18 patients a day can be seen at two locations. Almost 1,400 patients were screened through the program in 2015 which is an all time high and is up from the over 900 that were screened in 2014. The Healthy Heart staff also brings their expertise out into the community by participating in various health fairs and events throughout the year. In 2015, the staff participated in 27 events and came into contact with 2,485 people through the events. Clinical Outreach also aims to bring its ministry further out by providing services to communities across the state to augment existing medical resources. One way this is accomplished is through specialty clinic hub sites, located in Greenville, Cleveland, Brookhaven, Vicksburg and Morton. COMPREHENSIVE STROKE CENTER- St. Dominics Comprehensive Stroke Center offers rapid diagnosis (as evidenced by its thrombolytic therapy administration rate of 17.9% compared to the national average of 15.3%), high-tech intervention, expert care and intensive rehabilitation in a caring, compassionate setting. St. Dominics is capable of delivering the full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. The chief component of the program is a highly collaborative, expertly-skilled team of clinical professionals who direct and provide evidence-based care for every stroke patient. The program provides care to the adult population of central Mississippi and outlying rural areas. St. Dominics tele-stroke network links five hospitals in rural areas with stroke neurologists at St. Dominics who can provide specialized, urgent care for those suspected of having a stroke. In 2015 St. Dominics treated 1,470 strokes and transient ischemic attacks at both the main hospital and in coordination with the rural hospital network. WOMENS SERVICES- St. Dominics Maternal and Newborn Care Center emphasizes a team approach to care with physicians, nurses and educators working together to meet the total needs of the patient and the entire family. St. Dominics offers services and programs not only during a patients hospital stay, but also classes and resources to assist with the family transition long before and long after the birth of a baby. Services include prenatal care, labor and delivery, newborn care, digital mammography, wellness checks, lactation consultations, gynecological surgeries and a wide array of classes. In 2015, St. Dominics Womens Services worked with families to deliver 1,473 babies. Of those only 26 were low birth weight, which can be partially attributed to prenatal care efforts. BEHAVIORAL HEALTH SERVICES- St. Dominics Behavioral Health Services provides quality and compassionate treatment to individuals and their families suffering from mental illness. Board certified psychiatrists, social workers and other therapists work together within a multi-disciplinary team to meet the individualized needs of each patient. One of the specialty psychiatric units at St. Dominics, The Oakes, is a geriatric psychiatric unit that provides compassionate care for geriatric patients in a secure and therapeutic environment. The Oakes uses proven methods to help patients, such as social group interaction, reality orientation, sensory stimulation, recreation and self-expression. St. Dominics new behavioral health services facility was completed in 2013. The two-story, state-of-the-art facility contains 78,000 square feet and 77 private rooms. Separate units within the facility have individual group meeting and dining areas to help patients find shared strength and healing through interaction and comradery. In 2015, St. Dominics had 19,357 inpatient days with an average daily census of 53. CANCER CENTER AND CANCER SERVICES- St. Dominics cancer services is a leader in community outreach and cancer education. The comprehensive program was recognized in 2015 with an Outstanding Achivement Award by the Commission on Cancer (CoC) of the American College of Surgeons. St. Dominics is the only hospital in the state of Mississippi to receive this award in 2015 and is one of a select group of only 50 U.S. healthcare facilities with accredited cancer programs to receive this national honor. An integral part of St. Dominics cancer services is the freestanding Cancer Center, which provides easy access to a large variety of services as well as convenient parking. Treatments at the center include medical cancer therapy, radiation therapy and lymphedema treatment. In 2015 alone, 26,285 radiation therapy procedures were completed. Also, with the addition of a new infusion clinic at the main hospital, 8,636 infusions were conducted in 2015. In addition to therapies, St. Dominics has some of the most advanced PET and CT scanning services that pair with advanced surgical procedures for precise removal of affected tissue. However, the key to fighting any cancer is early detection, and that requires education and community outreach. Newks Cares and St. Dominics hosted the second annual Ovarian Cycle Jackson spin event on September 17 at The Club at the Township. The event aimed to spark awareness and support for research in the battle against ovarian cancer, a silent killer that affects one in 70 women. Cycle participants rode in 75-minute time slots from 8:30 a.m. to 2 p.m. A total of $143,374 was raised during the event. All funds were donated to the Ovarian Cancer Research Fund, a charity that gives grants to researchers in order to help find a cure for ovarian cancer. SURGICAL SERVICES- St. Dominics surgical services touches nearly every aspect of the Hospital from neurosurgical procedures to knee replacements to C-sections. Surgical services at St. Dominics comprise a wide array of traditional surgical services as well as advanced procedures within a minimally invasive robotic surgery center of excellence. In 2015, 9,990 surgical procedures were performed at St. Dominics with over 1,000 urology surgeries and nearly 1,500 each of neuro and orthopedic surgeries. Other categories of surgeries conducted include womens (GYN), oral, ENT, plastics and general. Many of the gynecological, urological and even general surgeries were minimally invasive procedures conducted with the assistance of one of four da Vinci surgical systems at St. Dominics. Robotic assisted surgery simply means a surgeon can perform what wer 20035639 THE HOSPITAL IS AN ACTIVE, CARING MEMBER OF THE COMMUNITY IT SERVES. IN CARRYING OUT ITS TEACHING AND HEALING MINISTRIES, THE BOARD OF DIRECTORS HAS ESTABLISHED A POLICY UNDER WHICH THE HOSPITAL PROVIDES CARE TO THE NEEDY MEMBERS OF ITS COMMUNITY. FOLLOWING THAT POLICY, THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICIES. THE DIRECT AND INDIRECT COSTS ASSOCIATED WITH THESE SERVICES CANNOT BE IDENTIFIED TO SPECIFIC CHARITY CARE PATIENTS. THEREFORE, MANAGEMENT ESTIMATED THE COSTS OF THESE SERVICES BY CALCULATING A COST TO GROSS CHARGE RATIO AND MULTIPLYING IT BY THE CHARGES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS MEETING THE HOSPITAL'S CHARITY CARE GUIDELINES. THE ESTIMATED COST OF CHARGES FOREGONE, BASED ON THE COST TO CHARGE RATIO, WAS APPROXIMATELY $16,326,000. THE FOREGONE CHARGES ARE NETTED AGAINST PATIENT SERVICE REVENUE TO ARRIVE AT NET PATIENT SERVICE REVENUE AS REFLECTED AS PROGRAM SERVICE REVENUE ON PART VIII OF FORM 990 IN ORDER TO BE CONSISTENT WITH FINANCIAL STATEMENT REPORTING AND ARE NOT REPORTED AS FUNCTIONAL EXPENSES ON THE FORM 990. THE HOSPITAL ALSO PROVIDES HEALTH CARE SERVICES TO A SIGNIFICANT PORTION OF THE UNINSURED POPULATION IN THE SURROUNDING COMMUNITY. WHILE A PORTION OF THESE PATIENTS MAY ULTIMATELY QUALIFY FOR COVERAGE UNDER THE MEDICAID PROGRAM OR THE CHARITY CARE POLICY DISCUSSED ABOVE, THE HOSPITAL IS UNABLE TO COLLECT A SIGNIFICANT PORTION OF THESE ACCOUNTS. CHARGES DEEMED UNCOLLECTIBLE DURING 2015 WERE APPROXIMATELY $ 20,040,000. 2405783 2405783 THE HOSPITAL SERVES THE COMMUNITY IN NUMEROUS WAYS. SOME EXAMPLES INCLUDE ASSISTING IN EDUCATING THE COMMUNITY REGARDING HEALTH-RELATED ISSUES. THE HOSPITAL PARTICIPATES IN NUMEROUS HEALTH FAIRS AND GIVES PRESENTATIONS TO VARIOUS SCHOOLS AND INDUSTRY REGARDING SUCH ISSUES AS DRUG ABUSE AND SAFETY IN THE WORKPLACE. THE HOSPITAL HAS SPONSORED ANNUAL CHOLESTEROL AND CANCER SCREENINGS UPON WHICH THE TEST IS MADE AVAILABLE TO THE PUBLIC FOR A NOMINAL FEE AND THE MAJORITY OF THE COSTS INCURRED ARE ABSORBED BY THE HOSPITAL. THE HOSPITAL ALSO ORGANIZES EMPLOYEE PARTICIPATION IN FUNDRAISING FOR ORGANIZATIONS, SUCH AS THE UNITED WAY, STEWPOT MINISTRIES AND JUNIOR ACHIEVEMENT, AMONG OTHERS. IN ADDITION, THE HOSPITAL GAVE APPROXIMATELY $728,000 DURING 2015 IN CHARITABLE CORPORATE DONATIONS TO VARIOUS AREA COMMUNITY SERVICE ORGANIZATIONS. ALTHOUGH THE HOSPITAL HAS ESTIMATED THE COST OF EACH OF THESE EFFORTS TO SERVE THE JACKSON, MISSISSIPPI, METROPOLITAN AREA, MANAGEMENT AND THE BOARD OF DIRECTORS BELIEVE THAT SUCH COSTS REPRESENT ONLY ONE FACET OF THE MANY WAYS THE HOSPITAL SERVES THE GREATER JACKSON COMMUNITY. THE ABOVE EXAMPLES RELATE ONLY TO CERTAIN MEASUREABLE BENEFITS THAT THE HOSPITAL PROVIDES TO ITS SERVICE AREA. THIS PRESENTATION IS NOT INTENDED TO MEASURE ALL SUCH COMMUNITY BENEFITS, MANY OF WHICH ARE INTANGIBLE IN NATURE OR OTHERWISE NOT QUANTIFIABLE. 469168014 true true false true false false false false false false true false false true true false false true false false false false false false false false true true true true true false false false false false false true true false false false false true true true false false false true 258 0 4393 true true true false false false false false false false false false X 15 12 false false false false true true true true true false false true true true true true true true true true false X SAM SCOTT 6012006570 969 LAKELAND DRIVE JACKSON MS 392164699 JEFF FLETCHER MD CHAIRMAN 0.75 0.0 X X 0 0 0 DAN GRAFTON VICE CHAIRMAN 0.75 0.0 X X 0 0 0 SISTER MARY TRINITA OP SECRETARY 0.75 40.5 X X 0 0 0 SISTER THECLA KUHNLINE OP DIRECTOR 0.75 0.0 X 0 0 0 SISTER CELESTINE RONDELLI OP DIRECTOR 0.75 0.0 X 0 0 0 SISTER KATHLEEN GALLAGHER OP DIRECTOR 0.75 1.0 X 0 0 0 SISTER KRISTIN REVER OP DIRECTOR 0.75 0.0 X 0 0 0 SISTER CORDE LENN OP DIRECTOR 0.75 0.0 X 0 0 0 DONNA SIMS DIRECTOR 0.75 0.0 X 0 0 0 RICK GUYNES MD CHIEF OF STAFF 0.75 0.0 X X 0 0 0 EDDIE MALONEY DIRECTOR 0.75 0.0 X 0 0 0 JIMMY JONES MD DIRECTOR 0.75 0.0 X 0 0 0 JOHNNY DONALDSON DIRECTOR 0.75 0.0 X 0 0 0 CLAUDE W HARBARGER DIRECTOR 0.75 42.0 X 0 853688 104248 LESTER K DIAMOND PRESIDENT 40.0 0.0 X X 614118 0 86867 JENNIFER SINCLAIR EXECUTIVE VP - OPERATIONS 40.0 0.0 X 390344 0 52829 KEITH VAN CAMP VP - INFORMATION TECH 40.0 0.0 X 327055 0 30188 RAYMOND SWARTZFAGER VP - BUSINESS DEVELOPMENT 40.0 0.0 X 255252 0 35895 LAWRENCE M RIDDLES EXEC VP - MEDICAL AFFAIRS 40.0 0.0 X 436482 0 49231 THERESA A HORNE VP - PATIENT CARE SERVICES 40.0 0.0 X 238826 0 16575 LORRAINE WASHINGTON VP - HUMAN RESOURCES 24.0 16.0 X 0 180606 27967 JOHN LANCON PHYSICIAN 40.0 0.0 X 1331544 0 15348 D P SEAGO PHYSICIAN 40.0 0.5 X 1385540 0 9246 RONALD KENNEDY PHYSICIAN 40.0 0.0 X 967027 0 9879 VERN A KELLER PHYSICIAN 40.0 0.0 X 959815 0 15348 RUTH K FREDERICKS PHYSICIAN 40.0 0.0 X 965116 0 10952 MATTHEW FISHER FORMER OFFICER 40.0 0.0 X 106062 0 6276 REBECCA LOWE FORMER KEY EMPLOYEE 40.0 0.0 X 179187 0 11645 STEPHEN BOMGARDNER FORMER KEY EMPLOYEE 40.0 0.0 X 148988 0 0 8305356 1034294 482494 230 true true false ALLIED EMERGENCY SERVICES PC PO BOX 2120 RIDGELAND MS 39158 E.R. PHYSICIANS 8114085 FOUNTAIN CONSTRUCTION COMPANY PO BOX 10506 JACKSON MS 39289 CONSTRUCTION 3710392 MEDICAL MANAGEMENT SERVICES 308 CORPORATE DRIVE RIDGELAND MS 39157 CLINIC MANAGEMENT 3336923 JACKSON HEART CLINIC PA 970 LAKELAND DRIVE JACKSON MS 39216 CO-MANAGEMENT 3273921 PHYSICIANS ANESTHESIA GROUP PA PO BOX 4608 JACKSON MS 39296 ANESTHESIA SERVICE 3061430 55 245810 25000 270810 Patient Service Revenue 621990 460837752 460837752 Pharmaceutical Sales 446110 5070447 3625370 1445077 Spa Sales 812900 711487 71149 640338 466619686 -510418 -510418 0 0 3753815 3753815 0 3753815 3753815 35081 51796 -16715 -16715 -16715 0 0 0 WEIGHT LOSS CENTER 812900 1181238 1181238 Cafeteria Sales 722514 3650814 3650814 Day Care Center 624410 903948 903948 2428260 1682737 745523 8164260 478281438 467398246 2085415 8526967 2312044 2312044 93739 93739 0 0 2533662 2533662 78940 78940 191351189 186538178 4813011 2792113 2903570 -111457 19762402 19088750 673652 12075689 11634595 441094 350000 350000 849566 849566 290352 290352 37817 37817 0 0 25698390 25698390 1647456 1647456 2195502 2195502 0 0 9270329 9270329 936388 936388 0 86147 86147 29093 29093 0 21945597 21945597 1683282 1683282 MEDICAL & OTHER SUPPLIES 82741158 82741158 Pharmaceutical Drugs 25196372 25196372 BAD DEBT EXPENSE 20035639 20035639 LICENSES & TAXES 19950461 19950461 34714567 34714567 478657894 469168014 9489880 0 766345 1176211 65893253 50163204 0 0 49919401 54068943 0 0 0 0 0 0 7782525 9813918 8037112 8467194 459290320 274221019 179167433 185069301 0 0 0 0 0 0 0 0 44480156 41979613 356046225 350738384 31804386 30425631 0 0 0 0 0 0 0 0 0 0 1285310 2281024 0 0 57900255 58783256 90989951 91489911 X 265056274 259248473 0 0 0 0 265056274 259248473 356046225 350738384 X -376456 430098 -5861443 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 37817 37817 false PART II-B, LINE 1I: ST. DOMINIC-JACKSON MEMORIAL HOSPITAL PAID DUES TO THE MISSISSIPPI HOSPITAL ASSOCIATION. THE MISSISSIPPI HOSPITAL ASSOCIATION REPORTS THAT 25.84% OF THE $146,350 OF DUES PAID WERE RELATED TO LOBBYING ACTIVITIES. 9272580 9272580 221176075 106995088 114180987 8808370 6045931 2762439 203229908 154625434 48604474 16803387 6554566 10248821 185069301 INVESTMENT IN AFFILIATES 4513897 Other Receivables 1754747 Due from Affiliates 33148676 Due from Third Party Payors 2562293 INVESTMENT-SPIVA TRUST 0 41979613 0 Liability for Pension Benefits 58783256 58783256 PART X, LINE 2: MANAGEMENT HAS EVALUATED THE COMPANY'S 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 FINANCIAL STATEMENTS. true true true X true X false true true false true true 16752011 16752011 0.03660 54810556 60368966 -5558410 194288 186043 8244 71756855 60555009 11201845 0.03660 1338921 1338921 0.00290 106656 106656 0.00020 25975103 23674493 2300610 0.00500 1727500 1727500 0.00380 29148180 23674493 5473687 0.01190 100905035 84229502 16675532 0.04850 507744 0.00110 507744 0.00110 true 20035639 7413188 139095482 150033767 -10938285 X true true ST DOMINIC ASC OUTPATIENT SURGERY CENER 0.51316 0.48684 1 1 ST DOMINIC-JACKSON MEMORIAL HOSPITAL 969 LAKELAND DRIVE JACKSON MS 392164699 HTTP://WWW.STDOM.COM/ 14-031 X X X 1 ST DOMINIC-JACKSON MEMORIAL HOSPITAL 1 true false true X X X X X X X X 15 true false false true X http://www.stdom.com/why/benefit/ X true 15 true http://www.stdom.com/why/benefit/ false false true X 200. 350. X X X true true X X X true X http://www.stdom.com/ X http://www.stdom.com/ X http://www.stdom.com/ X X X X true X false X X X X X true X false false PART V, SECTION B, LINE 5: AS PART OF THE COMMUNITY NEEDS ASSESSMENT,SDHS SPONSORED SIX FOCUS GROUPS. THOSE SIX FOCUS GROUPS INCLUDED INTERNAL COMMUNITY LEADERS, SENIORS AT ST. CATHERINES VILLAGE, A CONTINUING CARE FACILTY THAT IS PART OF SDHS, SENIORS FROM THE COMMUNITY, ST. DOMINIC EMPLOYEES AND EXTERNAL COMMUNITY LEADERS. PART V, SECTION B, LINE 11: In 2015 St. Dominics continued its focus on fulfilling community needs in the areas identified in the 20132015 Community Health Needs Assessment. The overarching goal of the assessment was to respond to identified community health needs, improve access and improve health status especially for the most vulnerable and underserved in the community. It is integral to St. Dominics mission to establish community and provide service, setting an example to others in community service. St. Dominic Hospitals overall approach to community benefit is to target the intersection of documented unmet community health needs and the organizations key strengths and mission commitments. Specifically, members of the task force that led the development of the assessment identified priority health issues in St. Dominics service area based on its review of demographic information, focus group summaries and results of a community survey. Those identified pressing issues are: - obesity; - heart disease; and - mental health needs. Future plans will include goals and strategies to address these identified needs. In 2015, St. Dominic's integrated its committment to community service into its management and governance structures as well as its strategic and operational plans. In 2015, the strategic plan contained a strategy specifically directed at allocating resources to meet the needs of the community in response to the identified focus areas in the needs assessment. The overaching strategy indicated, "Use the 2013-2015 Community Needs Assessment to ensure the Hospital is appropriately allocating resources to meet the needs of our community." Following are ways in which the strategy was implemented in 2015. DISPARITY OR COMMUNITY NEED: OBESITY AND HEART DISEASE; Completed 8,524 cath. lab procedures in 2015 (10.3% higher than 2014), 1,939 electrophysiology procedures (20% increase over 2014) and increased cardiovascular surgery case volume from 719 cases in 2014 to 1,262 in 2015. - Most of these increases come as a result of outreach efforts to the community including those conducted by St. Dominics Clinical Outreach program which provides screenings, specialty clinic hubs and other health services to individuals in both the Jackson area and in outlying communities. One such outreach effort is the Healthy Heart program, which offers a full (hospital subsidized) heart risk assessment for $99. Up to 18 patients a day can be seen at two locations. Almost 1,400 patients were screened through the program in 2015 which is an all time high and is up from the over 900 that were screened in 2014. In addition, the Healthy Heart program staff participated in 27 community events and came into contact with 2,485 community members who had some interest or need in its services. - St. Dominics also looked to the wellbeing of its own employees and offered physical activity options in the workplace, increased healthy eating options, promoted a wellness culture and programs and demonstrated measurable outcomes related to workplace wellness. This resulted in St. Dominics being recognized, for the second year in a row, by the American Heart Association as a Platinum-Level Fit Friendly Worksite. DISPARITY OR COMMUNITY NEED: OBESITY AND HEART DISEASE; Expanded St. Dominics tele-stroke network (added Greenwood Leflore Hospital as an additional stroke hospital bringing the total to five). St. Dominics tele-stroke network links five hospitals in rural areas with stroke neurologists at St. Dominics who can provide specialized, urgent care for those suspected of having a stroke. In 2015 St. Dominics treated 1,470 strokes and transient ischemic attacks at both the main hospital and in coordination with the rural hospital network. The program grew tremendously, increasing volume by 17 percent. Much of this growth can be attributed to outreach efforts and coordination with rural hospitals. - At the heart of the tele-stroke system is St. Dominics Comprehensive Stroke Center which offers diagnosis, high-tech intervention, expert care and intensive rehabilitation in a caring, compassionate setting. In 2015 the program achieved a 17.9% thrombolytic therapy administration rate compared to the national average of 15.3% (which means patients were rapidly diagnosed with stroke symptoms and specialized medication was administered within a critical window of time that would offer the greatest opportunity for positive results). - The team also participated in 20 community stroke awareness events throughout 2015 and collaborated with other local hospitals to create a community stroke support group. DISPARITY AND COMMUNITY NEED: MENTAL HEALTH NEEDS; Hosted a three-part series on living with Alzheimers and Dementia. The classes, open to the community, discussed signs and symptoms, stages, medications, legal issues, tips for organization and care as well as resources. for further evaluation and counseling and 225 were referred to cardiologists for needed care. PART V, SECTION B, LINE 20E: THE HOSPITAL PROACTIVELY SCREENS PATIENTS FOR FINANCIAL ASSISTANCE ELIGIBILITY IF THERE IS AN INDICATION THAT THE PATIENT MAY QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY. 29 ST DOMINIC'S CARDIOVASCULAR SURGERY 971 LAKELAND DRIVE SUITE 657 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S EAR NOSE & THROAT 970 LAKELAND DRIVE SUITE 40 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S HOSPITAL MEDICINE 971 LAKELAND DRIVE SUITE 1453 JACKSON MS 39216 HOSPITALIST CLINIC ST DOMINIC'S INTERNAL MEDICINE GROUP 971 LAKELAND DRIVE SUITE 250 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S NEUROSURGERY ASSOCIATES 971 LAKELAND DRIVE SUITE 657 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S GYNECOLOGIC ONCOLOGY 971 LAKELAND DRIVE SUITE 750 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S INFECTIOUS DISEASE 971 LAKELAND DRIVE SUITE 954 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S NEUROCARE 971 LAKELAND DRIVE SUITE 557 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S INTERNAL MEDICINE GROUP 971 LAKELAND DRIVE SUITE 950 JACKSON MS 39216 PHYSICIAN CLINIC STDOMINIC'S SURGICAL ONCOLOGY 106 HIGHLAND WAY SUITE 200 MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF MADISON 106 HIGHLAND WAY SUITE 103 MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S PAIN MANAGEMENT CENTER 971 LAKELAND DRIVE SUITE 1159 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S PSYCHIATRIC ASSOCIATES 890 LAKELAND DRIVE JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF CLINTON 728 CLINTON PARKWAY SUITE B CLINTON MS 39056 PHYSICIAN CLINIC ST DOMINIC'S UROLOGY 971 LAKELAND DRIVE SUITE 360 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF FLOWOOD 1050 RIVER OAKS DRIVE FLOWOOD MS 39232 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF BRANDON 1297 WEST GOVERNMENT STREET BRANDON MS 39042 PHYSICIAN CLINIC ST DOMINIC'S INTERNAL MEDICINE GROUP 112 SOUTH LAKE CIRCLE CANTON MS 39046 PHYSICIAN CLINIC ST DOMINIC'S MARTIN SURGICAL ASSOCIATES 971 LAKELAND DRIVE SUITE 211 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S RHEUMATOLOGY 106 HIGHLAND WAY SUITE 200 MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF RALEIGH 342 MAGNOLIA DRIVE RALEIGH MS 39153 PHYSICIAN CLINIC ST DOMINIC'S CHRONIC CARE CLINIC 890 LAKELAND DRIVE JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE 1777 ELLIS AVENUE JACKSON MS 39204 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-MORTON 321 HWY 13 SOUTH MORTON MS 39117 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-CLEVELAND 810 E SUNFLOWER ROAD CLEVELAND MS 38732 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF JACKSON 890 LAKELAND DRIVE JACKSON MS 39056 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-BROOKHAVE 427 HWY 51 N BROOKHAVEN MS 39601 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-GREENVILL 1502 S COLORADO STREET GREENVILLE MS 38703 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-VICKSBURG 4204 CLAY STREET VICKSBURG MS 39180 PHYSICIAN CLINIC PART I, LINE 3C: ST. DOMINIC HOSPITAL HAS A DISCOUNT POLICY THAT IS BASED ON FEDERAL POVERTY GUIDELINES WITH A SLIDING SCALE THAT OFFERS DISCOUNTS RANGING FROM 20% TO 100%. IN ADDITION, ST. DOMINIC OFFERS A 60% DISCOUNT OFF GROSS CHARGES TO ALL UNINSURED PATIENTS. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR ST. DOMINIC HOSPITAL IS CONSOLIDATED WITH THE PARENT ORGANIZATION, ST. DOMINIC HEALTH SERVICES, INC. THE REPORT IS AVAILABLE AT HTTP://WWW.STDOM.COM/WHY/BENEFIT/. PART I, LINE 7: ST. DOMINIC HOSPITAL USED A COST-TO-CHARGE RATIO BASED ON WORKSHEET 2 PROVIDED IN THE FORM 990, SCHEDULE H INSTRUCTIONS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $20,035,639. PART I, LINE 7G: ST. DOMINIC HOSPITAL DID NOT INCLUDE LOSSES ON ITS OWNED PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. IN ORDER TO MEET THE NEEDS OF THE COMMUNITY IT SERVES, ST. DOMINIC CONTINUES ITS MINISTRY IN VARIOUS SERVICE LINES THAT ARE NOT PROFITABLE TO THE ORGANIZATION. EXAMPLES OF THESE SERVICES INCLUDES BUT ARE NOT LIMITED TO THE EMERGENCY DEPARTMENT AND BEHAVIORAL HEALTH SERVICES. PART II: ST. DOMINIC HOSPITAL PROVIDES SIGNIFICANT SUPPORT TO ITS COMMUNITY THROUGH A VARIETY OF WAYS INCLUDING FREE HEALTH SCREENINGS AT LOCAL SCHOOLS, PARTICIPATION IN VARIOUS NON- PROFIT BOARDS AS WELL AS FINANCIAL SUPPORT THROUGH CASH DONATIONS. PART III, LINE 2: THE AMOUNT REPORTED IN PART III, LINE 2 AS BAD DEBT EXPENSE MATCHES THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. PART III, LINE 3: St. Dominic Hospital frequently has patient accounts that are initially written off as a bad debt expense, but later (through a screening process) it is determined that the patient does qualify for financial assistance under the Hospital's financial assistance policy. The percentage of accounts is estimated to be 37 percent. The percentage is determined utilizing an internal report of accounts written off as a bad debt expense in one year and subsequently classified as charity in a subsequent year. PART III, LINE 4: Patient accounts receivable are reduced by an allowance for doubtful accounts and reported at net realizable value. In evaluating the collectability of accounts receivable, the Hospital analyzes its historical experience and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for uncollectible accounts in the period of service on the basis of their past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Hospital's allowance for doubtful accounts for self-pay patients increased from 69.2%% of self-pay accounts receivable at December 31, 2014, to 54.6% of self-pay accounts receivable at December 31, 2015. In addition, the hospital's self-pay bad debt write-offs increased from approximately $19,726,000 in 2014 to $20,495,000 in 2015. PART III, LINE 8: THE SHORTFALL SHOULD NOT BE INCLUDED IN THE COMMUNITY BENEFIT TOTAL. PART III, LINE 9B: ST. DOMINIC HOSPITAL HAS A BOARD APPROVED COLLECTION POLICY AND HAS WRITTEN CONTRACTS IN PLACE WITH ITS COLLECTION AGENCIES SO THE APPROPRIATE COLLECTION ACTIVITIES ARE FOLLOWED. THE COLLECTION AGENCIES THAT ST. DOMINIC'S USES ARE FULLY INFORMED ABOUT THE HOSPITALS FINANCIAL AID POLICY AND ASSIST IN EDUCATING ITS PATIENTS. THEY ROUTINELY SEND FINANCIAL AID APPLICATIONS TO PATIENTS AND REFER THOSE PATIENTS BACK TO THE HOSPITALS FINANCIAL COUNSELORS WHEN APPROPRIATE. PART VI, LINE 2: NEEDS ASSESSMENT St. Dominic Hospital assesses the community it serves through various sources which include: 1)analysis of the payor source and disease categories of patients treated at St. Dominic Hospital with particular analysis done on patients presenting to its Emergency Department; 2) feedback from the Board members who represent the community it serves; 3) requests made from the community; and 4) public health information. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ST. DOMINIC HOSPITAL WORKS TO EDUCATE ITS PATIENTS AND COMMUNITY ON ASSISTANCE OPTIONS BY: 1-POSTING SIGNAGE IN THE EMERGENCY ROOM AND OTHER REGISTRATION AREAS INFORMING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. 2-PROVIDING BROCHURES IN THE WAITING ROOMS AND AT THE REGISTRATION DESKS THAT EXPLAIN THE BILLING AND COLLECTION PROCESS AS WELL AS INFORMATION ABOUT THE HOSPITALS FINANCIAL ASSISTANCE POLICY AND PHONE NUMBERS TO CALL FOR ASSISTANCE. 3-CONTRACTING AND PAYING AN AGENCY TO MEET WITH ALL UNINSURED PATIENTS TO ASSIST THEM IN APPLYING FOR FEDERAL AND STATE ASSISTANCE (I.E. MEDICAID, DISABILITY, ETC.). 4-PROVIDING FINANCIAL COUNSELORS TO MEET WITH PATIENTS. THESE COUNSELORS FULLY UNDERSTAND THE HOSPITALS CHARITY POLICY AND ARE AVAILABLE TO ASSIST WITH THE APPLICATIONS, SET UP INTEREST FREE PAYMENT PLANS AND OFFER ADVICE ON PUBLIC ASSISTANCE THAT MAY BE AVAILABLE. 5-STAFFING PATIENT REPRESENTATIVES TO ANSWER QUESTIONS AND ASSIST PATIENTS AS NEEDED. 6-EDUCATING THE EARLY-OUT AND BAD DEBT COLLECTION AGENCIES ON THE HOSPITALS FINANCIAL ASSISTANCE POLICIES SO THEY CAN ASSIST PATIENTS WHOM THEY FIND MIGHT HAVE FINANCIAL NEED. PART VI, LINE 4: COMMUNITY INFORMATION THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING GEOGRAPHIC AND DEMOGRAPHIC AREAS, IS ADDRESSED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED DURING 2015. THE CHNA CAN BE ACCESSED AT: http://www.stdom.com/about-us/community-benefit-and-needs/. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH ST. DOMINIC-JACKSON MEMORIAL HOSPITAL (THE HOSPITAL) RECOGNIZES ITS BASIC PARTICIPATION IN THE MISSION OF THE CHURCH WHICH INVOLVES TWO MAIN MINISTRIES: EDUCATION AND HEALTH CARE. THREE ACTIVITIES - COMMUNICATING A CHRISTIAN MESSAGE, ESTABLISHING COMMUNITY AND PERFORMING SERVICE - EXPRESS ITS MISSION OF CHRISTIAN HEALING. THE HOSPITAL INVOLVES MEMBERS OF ITS COMMUNITY IN ITS GOVERNANCE SO THAT IT MAINTAINS THE FOCUS ON THE NEEDS OF ITS COMMUNITY. THE HOSPITAL HAS AN OPEN MEDICAL STAFF. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM ST. DOMINIC HEALTH SERVICES, INC. IS THE PARENT ORGANIZATION OF A SYSTEM THAT INCLUDES ST. DOMINIC - JACKSON MEMORIAL HOSPITAL (A 535-BED ACUTE CARE FACILITY), ST. CATHERINE'S VILLAGE (A CONTINUING CARE RETIREMENT COMMUNITY), ST. DOMINIC HEALTH SERVICES FOUNDATION (A FUNDRAISING/GRANT FOCUSED ENTITY), FIRST INTERMED CORPORATION (PHYSICIAN CLINICS) AND ST. DOMINIC MADISON HEALTH SERVICES, INC. (A MEDICAL OFFICE BUILDING AND FITNESS CENTER). IN ADDITION, ST. DOMINIC HEALTH SERVICES OPERATES COMMUNITY HEALTH SERVICES -ST. DOMINIC, INC., WHICH INCORPORATES THE OUTREACH SERVICES OF THE CLUB AT ST. DOMINIC'S, NEW DIRECTIONS FOR OVER 55, ST. DOMINIC COMMUNITY HEALTH CLINIC, MADISON SCHOOL NURSE PROGRAM AND THE CARE-A-VAN SCREENING PROGRAM. AS A WHOLE, ALL OF THE SERVICES, ENTITIES AND HOSPITAL ARE COLLECTIVELY REFERRED TO AS ST. DOMINIC'S. ST. DOMINIC'S SEEKS TO FULFILL ITS CHRISTIAN HEALING MINISTRY BY ESTABLISHING COMMUNITY AND PERFORMING SERVICE. THAT MEANS GIVING OF TIME, TALENTS, AND RESOURCES TO MAKE THE COMMUNITIES SERVED BY ST. DOMINIC'S BETTER PLACES TO LIVE. THE ST. DOMINIC'S FAMILY OF CAREGIVERS NOT ONLY SERVES PATIENTS, BUT ALSO CONTRIBUTES TO AN ATMOSPHERE OF CARE AND COMPASSION FOR THOSE OUTSIDE THE HOSPITAL'S WALLS. ST. DOMINIC'S STRIVES TO NOT ONLY PROVIDE CARE FOR THE SICK BUT ALSO TO OFFER EDUCATION AND WELLNESS SERVICES TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND HELP ELIMINATE RISK FACTORS FOR MORE SERIOUS HEALTH PROBLEMS. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT ST. DOMINIC HOSPITAL (CONSOLIDATED WITH ST. DOMINIC HEALTH SERVICES, INC.) PREPARES ANNUALLY A COMMUNITY BENEFIT REPORT WHICH IS DISTRIBUTED TO KEY MEMBERS OF THE LOCAL COMMUNITY AND STATE GOVERNMENT. HOWEVER, THERE ARE CURRENTLY NO REQUIREMENTS TO DO SO IN THE STATE OF MISSISSIPPI. true 100 BLACK MEN OF JACKSON 5360 HIGHLAND DRIVE JACKSON MS 39286 640817928 501(C)(3) 25500 GENERAL SUPPORT BEGINNING AGAIN IN CHRIST PO BOX 26 BRANDON MS 39042 640592123 501(C)(3) 15000 GENERAL SUPPORT BOY SCOUTS OF AMERICA 855 RIVERSIDE DR JACKSON MS 39202 640303071 501(C)(3) 32000 GENERAL SUPPORT CATHOLIC CHARITIES 200 N CONGRESS ST STE 100 JACKSON MS 39201 640468850 501(C)(3) 127500 GENERAL SUPPORT CENTER FOR THE PREVENTION OF VIOLENCE PO BOX 6279 PEARL MS 39288 581959108 501(C)(3) 35000 GENERAL SUPPORT COMMUNITY HEALTH SERVICES 970 LAKELAND DR JACKSON MS 39216 640714997 501(C)(3) 175000 AFFILIATE SUPPORT HOSPICE MINISTRIES 45 TOWNE CENTER BLVD RIDGELAND MS 39157 640789919 501(C)(3) 12500 GENERAL SUPPORT MISSION MISSISSIPPI PO BOX 22655 JACKSON MS 39225 640824240 501(C)(3) 37500 GENERAL SUPPORT NEIGHBORHOOD CHRISTIAN CENTER 417 WEST ASH ST JACKSON MS 39203 640800919 501(C)(3) 18000 GENERAL SUPPORT OPERATION SHOESTRING 1711 BAILEY AVENUE JACKSON MN 39283 640471554 501(C)(3) 25000 GENERAL SUPPORT REAL CHRISTIAN FOUNDATION PO BOX 180059 RICHLAND MS 39218 640885750 501(C)(3) 40000 GENERAL SUPPORT SOUTHERN CHRISTIAN SERVICES 860 EAST RIVER PLACE SUITE 104 JACKSON MS 39202 640758344 501(C)(3) 25000 GENERAL SUPPORT TUTWILER COMMUNITY EDUCATION CENTER INC PO BOX 448 TUTWILER MS 38963 581887449 501(C)(3) 20000 GENERAL SUPPORT ST DOMINIC HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON MS 39216 640714999 501(c)(3) 1500000 AFFILIATE SUPPORT LANTERN MEDICAL CLINIC 198 KIRKWOOD PLACE JACKSON MS 39211 262621541 501(C)(3) 15000 GENERAL SUPPORT LEADERSHIP NEXT GENERATION PLUS 842 N PRESIDENT STREET JACKSON MS 39202 471606134 501(C)(3) 10000 GENERAL SUPPORT LEXINGTON MEDICAL CLINIC 22741 HIGHWAY 12 LEXINGTON MS 39095 200378262 501(C)(3) 20000 GENERAL SUPPORT METHODIST CHILDREN'S HOMES PO BOX 66 CLINTON MS 39060 640303087 501(C)(3) 20000 GENERAL SUPPORT MISSISSIPPI CHILDREN'S HOME SERVICES PO BOX 1078 JACKSON MS 39215 113667990 501(C)(3) 15000 GENERAL SUPPORT MISSISSIPPI HOUSING PARTNERSHIP PO BOX 22987 JACKSON MS 39225 640816305 501(C)(3) 10000 GENERAL SUPPORT NEWK'S CARES 2680 CRANE RIDGE DRIVE JACKSON MS 39216 270705547 501(C)(3) 25000 GENERAL SUPPORT THE WINGARD HOME 1279 N WEST STREET JACKSON MS 39202 203861994 501(C)(3) 20000 GENERAL SUPPORT 22 0 SCHOLARSHIPS/TUITION REIMBURSEMENT 39 93739 PART I, LINE 2: THE HOSPITAL HAS A CONTRIBUTIONS COMMITTEE, WHICH IS A SUB-COMMITTEE OF THE BOYRD, THAT OVERSEES THE HOSPITALS GIVING. THEY MONITOR THE REQUESTS AND OVERSEE ALL GIFTS. X X X X X true true false false false false false false false CLAUDE W HARBARGER DIRECTOR 0 815162 0 0 0 38526 0 92181 0 12067 0 957936 0 0 LESTER K DIAMOND PRESIDENT 592170 0 0 0 21948 0 71459 0 15408 0 700985 0 0 0 JENNIFER SINCLAIR EXECUTIVE VP - OPERATIONS 382157 0 0 0 8187 0 43387 0 9442 0 443173 0 0 0 MATTHEW FISHER FORMER OFFICER 106062 0 0 0 0 0 0 0 6276 0 112338 0 0 0 KEITH VAN CAMP VP - INFORMATION TECH 324261 0 0 0 2794 0 29821 0 367 0 357243 0 0 0 REBECCA LOWE FORMER KEY EMPLOYEE 179187 0 0 0 0 0 11522 0 123 0 190832 0 0 0 RAYMOND SWARTZFAGER VP - BUSINESS DEVELOPMENT 255252 0 0 0 0 0 26592 0 9303 0 291147 0 0 0 LAWRENCE M RIDDLES EXEC VP - MEDICAL AFFAIRS 426081 0 0 0 10401 0 33986 0 15245 0 485713 0 0 0 THERESA A HORNE VP - PATIENT CARE SERVICES 238826 0 0 0 0 0 16293 0 282 0 255401 0 0 0 JOHN LANCON PHYSICIAN 1212030 0 56107 0 63407 0 0 0 15348 0 1346892 0 0 0 D P SEAGO PHYSICIAN 1319562 0 0 0 65978 0 0 0 9246 0 1394786 0 0 0 RONALD KENNEDY PHYSICIAN 887328 0 33650 0 46049 0 0 0 9879 0 976906 0 0 0 VERN A KELLER PHYSICIAN 880460 0 33650 0 45705 0 0 0 15348 0 975163 0 0 0 RUTH K FREDERICKS PHYSICIAN 919158 0 0 0 45958 0 0 0 10952 0 976068 0 0 0 LORRAINE WASHINGTON VP - HUMAN RESOURCES 0 180606 0 0 0 0 0 22143 0 5824 0 208573 0 0 STEPHEN BOMGARDNER FORMER KEY EMPLOYEE 148988 0 0 0 0 0 0 0 0 0 148988 0 0 0 PART I, LINE 4A: FORMER OFFICER, MATTHEW FISHER, RECEIVED $25,128 IN SEVERANCE PAYMENTS DURING CALENDAR YEAR 2015. PART I, LINE 4B: EFFECTIVE FOR THE PLAN YEAR BEGINNING 1/1/2013, THE EXECUTIVE COMPENSATION COMMITTEE ADOPTED A NON QUALIFIED RESTORATION PLAN THAT PROVIDES 5% OF PAY FOR SALARY IN EXCESS OF THE IRS LIMIT (CODE SECTION 401(A)(17)). THE PAYOUTS BEGAN IN FIRST QUARTER 2014, WHICH ARE INCLUDED IN THE FORM W-2 BOX 5 WAGES AND REFLECTED IN OTHER REPORTABLE COMPENSATION ON SCHEDULE J. THESE AMOUNTS ARE: LESTER K. DIAMOND - 21,948 JENNIFER SINCLAIR - 8,187 KEITH VAN CAMP - 2,794 LAWRENCE M. RIDDLES - 10,401 CLAUDE HARBARGER- 38,526 DEFERRED AMOUNTS UNDER THE 457(F) PLAN REFLECTED IN RETIREMENT AND OTHER DEFERRED COMPENSATION ON SCHEDULE J INCLUDE: LESTER K. DIAMOND- 53,435 JENNIFER SINCLAIR - 25,363 CLAUDE HARBARGER- 74,157 KEITH VAN CAMP- 11,797 RAYMOND SWARTZFAGER- 9,175 LAWRENCE RIDDLES- 27,301 THERESA HORNE- 8,513 LORRAINE WASHINGTON- 9,852 MELANIE GRAFTON SEE PART V 78940 SEE PART V false PART VI, COLUMNS B & D: MELANIE GRAFTON RELATIONSHIP: DAUGHTER OF DIRECTOR, DAN GRAFTON TRANSACTION: EMPLOYEE OF ST. DOMINIC - JACKSON MEMORIAL HOSPITAL FORM 990, PART VI, SECTION A, LINE 6: ST. DOMINIC HEALTH SERVICES, INC. IS THE SOLE MEMBER OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A: THE BOARD OF DIRECTORS OF ST. DOMINIC- JACKSON MEMORIAL HOSPITALS SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC., HAS THE AUTHORITY TO ELECT THE PRESIDENT/CEO, THE CHAIR OF THE BOARD OF DIRECTORS AND THE VICE-CHAIR OF THE BOARD OF DIRECTORS OF THE HOSPITAL AND TO APPROVE THE ELECTION OF ALL OTHER OFFICERS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B: THE BOARD OF DIRECTORS OF THE SOLE MEMBER OF ST. DOMINIC-JACKSON MEMORIAL HOSPITAL, ST. DOMINIC HEALTH SERVICES, INC., HAS THE RIGHT TO APPROVE THE FORMATION OF, OR PARTICIPATION IN, ANY JOINT VENTURE OR PARTNERSHIP OF THE HOSPITAL. ST. DOMINIC HEALTH SERVICES, INC.S BOARD OF DIRECTORS ALSO HAS THE RIGHT TO APPROVE ANY DISSOLUTION OR MERGER ENACTED BY THE HOSPITAL. IF THE HOSPITALS BOARD OF DIRECTORS HAS A STALEMATE IN ANY VOTE, THE FINAL DECISION RESTS WITH THE BOARD OF DIRECTORS OF ITS SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC. THE GOVERNING COUNCIL OF THE DOMINICAN SISTERS OF SPRINGFIELD ILLINOIS HAS THE AUTHORITY TO BREAK ANY TIE VOTE OF THE BOARD OF DIRECTORS OF ST. DOMINIC HEALTH SERVICES, INC. FORM 990, PART VI, SECTION B, LINE 11: THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE OF THE BOARD PRIOR TO FILING. A FULL COPY, AS APPROVED BY THE FINANCE COMMITTEE, IS PROVIDED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C: ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND SIGN A CONFLICT FORM ANNUALLY. THE PRESIDENT REVIEWS THE FORMS AND ANY CONFLICTS ARE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD. PERSONS WITH CONFLICTS OF INTERESTS DO NOT VOTE OR USE HIS OR HER INFLUENCE ON THE MATTER AND ARE EXCLUDED FROM THE COUNT IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. FORM 990, PART VI, SECTION B, LINE 15: THE ORGANIZATIONS EXECUTIVE COMPENSATION PROGRAM IS ADMINISTERED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THE EXECUTIVE COMPENSATION COMMITTEE IS RESPONSIBLE FOR ESTABLISHING AND MAINTAINING A COMPETITIVE COMPENSATION PROGRAM FOR THE KEY EXECUTIVES OF THE ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE MEETS AS NEEDED TO REVIEW THE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS FOR ANY CHANGES AS APPROPRIATE. THE EXECUTIVE COMPENSATION COMMITTEE COMMISSIONS AN ANNUAL REVIEW BY AN INDEPENDENT CONSULTING FIRM TO EVALUATE THE ORGANIZATIONS EXECUTIVE COMPENSATION PROGRAM AGAINST THE COMPETITIVE MARKET. THE EVALUATION IS REVIEWED IN THE FIRST QUARTER OF EACH YEAR AND IS INTENDED TO ENSURE THAT THE COMPENSATION PROGRAM FALLS WITHIN A REASONABLE RANGE OF COMPETITIVE PRACTICES FOR COMPARABLE POSITIONS AMONG SIMILARLY SITUATED ORGANIZATIONS AS DESCRIBED IN SECTION 4958 OF THE INTERNAL REVENUE CODE. FOLLOWING THIS REVIEW, THE COMMITTEE REVIEWS AND APPROVES, FOR SELECTED KEY EXECUTIVES, BASE SALARY AND TOTAL COMPENSATION RANGE FOR THE UPCOMING YEAR. THE EXECUTIVE COMPENSATION COMMITTEE MAINTAINS MINUTES AND RECORDS TO ENSURE THAT IT CAN CLAIM THE REBUTTABLE PRESUMPTION OF REASONABLE COMPENSATION FOR PURPOSES OF SECTION 4958. THE PRESIDENT FOR THE HOSPITAL ASSIGNS PAY CHANGES FOR THE UPCOMING YEAR FOR EACH OF THE HOSPITAL EXECUTIVES WITHIN THE LIMITS ESTABLISHED BY THE EXECUTIVE COMPENSATION COMMITTEE. THE PRESIDENT OF ST. DOMINIC HEALTH SERVICES, INC. IN CONJUNCTION WITH THE CHAIR OF ST. DOMINIC-JACKSON MEMORIAL HOSPITAL BOARD OF DIRECTORS ASSIGNS THE PAY CHANGE FOR THE PRESIDENT (CHIEF EXECUTIVE OFFICER) OF ST. DOMINIC-JACKSON MEMORIAL HOSPITAL WITHIN THE LIMITS ESTABLISHED BY THE EXECUTIVE COMPENSATION COMMITTEE. KEY EXECUTIVES OF THE ORGANIZATION MAY ATTEND THE COMMITTEE MEETING OF THE EXECUTIVE COMPENSATION COMMITTEE TO PROVIDE THE INFORMATION NEEDED BY SUCH COMMITTEE. THESE EXECUTIVES ARE EXCUSED AND THE EXECUTIVE COMPENSATION COMMITTEE MEETS IN EXECUTIVE SESSION TO RENDER ITS RECOMMENDATIONS. FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 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