2015-10-15T17:37:44-07:00 2014-03-31 990 2013-04-01 362448028 JACKSON PARK HOSPITAL FOUNDATION JACK 7739477989 7531 Stony Island Avenue Chicago IL 60649 William Dorsey MD Chairman/CEO 7739477989 2014-09-27 2013 2016-02-25 16:41:14Z X William Dorsey MD 7531 Stony Island Avenue Chicago IL 60649 96164268 0 X www.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 3 835 0 0 0 13622330 4017411 63089919 66263748 6038 37102 22478182 25846007 99196469 96164268 0 0 0 0 41507450 40041696 0 0 0 48455243 47260921 89962693 87302617 9233776 8861651 123963251 127240624 31575135 26016819 92388116 101223805 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 83660305 0 66263748 Jackson Park Hospital Foundation provides inpatient and outpatient medical care and behavioral medicine services to Chicago's south side communities regardless of the patients ability to pay. Jackson Park Hospital serves a economically challenged community with high rates of foreclosures, unemployment, violence and some of the worst health indices in the City of Chicago. Jackson Park Hospital itself is challenged to stay viable in such a poorly resourced area. However, Jackson Park Hospital works to deploy its limited resources in ways that most appropriately meets the needs of our community. 0 0 0 83660305 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 835 1 0 0 0 0 0 0 X 10 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Nelson Vasquez 7739477989 7531 Stony Island Chicago IL 60649 X Dr Arol Augsburger Director 2 0 X 0 0 0 Bangalore Murthy MD Director 40 0 X 154924 137718 23604 Sameera T Qureshi MD Director 40 0 X 84982 81554 24178 James Nunn MD Director 40 0 X 67721 341694 23688 James Clark III Director 2 0 X 0 0 0 Haroon Olomi MD Director 40 0 X 92825 200649 15861 Lakshmi Dodda MD Director 40 0 X 209700 0 655 Dr Erma Brooks Williams Director 2 0 X 0 0 0 William Dorsey MD Chairman / CEO 40 0 X X 605788 0 8360 Harshad Mehta MD Director 40 0 X 125415 0 3966 Merritt Hasbrouck President 40 0 X 525716 0 2879 G Randall Smith Executive Vice President 40 0 X 517331 0 17924 Nelson Vasquez VP Finance 40 0 X 194230 0 17837 Barry Mandell VP Special Projects 40 0 X 154443 0 17837 Patricia Simon VP Quality and Compliance 40 0 X 141650 0 12564 Thodur Ranganathan MD Physician 40 0 X 237385 0 23688 Rose Ette RN Registered Nurse 60 0 X 213125 0 15387 Georgia Lubben MD Physician 40 0 X 131539 33657 84 Naveed Muhammad MD Physician 40 0 X 136176 0 23285 Nina Pope Advance Practice Nurse 40 0 X 123296 0 23966 3716246 795272 255763 30 0 1 1 The George Sollitt Construction Company 790 N Central Ave Wood Dale IL 60191 Construction 2684993 McKesson 5995 Windward Parkway Alpharetta GA 30005 Healthcare IT Services and Systems 1648824 EMCARE INC 7032 Collection Center Chicago IL 60693 Provides Emergency Room Physicians 1487421 NICL Laboratories 306 ERA Drive BNorthbrook IL 60062 Laboratory Services 1468207 Rush Nursing Services 7501 Stony Island Chicago IL 60649 Temporary Nurse Staff 1403454 54 0 0 0 0 0 4017411 0 4017411 The provision of inpatient and outpatient healthcare 622110 66263748 66263748 0 0 0 0 0 0 66263748 37102 0 0 37102 0 0 0 0 0 0 0 0 120783 0 0 0 120783 0 120783 120783 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25725224 25725224 0 0 25725224 96164268 92109755 0 37102 X 0 0 0 0 0 0 0 0 3035672 0 3035672 0 0 0 0 0 30439645 30439645 0 0 301964 301964 0 0 3793658 3793658 0 0 2470757 2470757 0 0 263859 0 263859 0 185121 0 185121 0 157660 0 157660 0 0 0 0 0 0 0 0 0 0 0 23446133 23446133 0 0 0 0 0 0 0 0 0 0 1523563 1523563 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 487446 487446 0 0 0 0 0 0 2280418 2280418 0 0 852529 852529 0 0 Bad Debt 9957504 9957504 0 0 Provider Tax Expense 8106688 8106688 0 0 0 0 0 0 87302617 83660305 3642312 0 2706969 6695550 0 0 0 0 92690513 92288855 0 0 0 0 0 0 984524 954944 2079164 468445 82186266 55990266 24865751 26196000 0 0 0 0 0 0 0 0 636330 636830 123963251 127240624 11448602 10997861 0 0 4556966 0 0 0 0 0 0 0 9089057 8755356 0 6480510 6263602 31575135 26016819 X 92388116 101223805 0 0 0 0 92388116 101223805 123963251 127240624 X 8861651 0 0 0 0 -25962 X 0 1 1 0 X 2482024 0 2482024 47217910 0 34302215 12915695 349716 0 266402 83314 24653500 0 21421649 3231851 7483116 0 0 7483116 26196000 Self Insurance Liability 5526198 Pension Liability 737404 6263602 96164268 0 0 0 0 0 96164268 0 0 0 96164268 87302617 0 0 0 0 0 87302617 0 0 0 87302617 1 1 X 1 X 1 X 1 1 1 0 1 1 5988104 5988104 0.0685 0 0 5988104 0 5988104 0.0685 63964 63964 0.0007 3112193 3112193 0.0356 8820337 8820337 0.1009 0 0 11996494 0 11996494 0.1372 0 0 17984598 0 17984598 0.2057 1 5146042 2592142 19354014 19354014 0 X 0 1 1 Jackson Park Hospital Foundation 7531 Stony Island Chicago IL 60649 www.jacksonparkhospital.org X X X X Behavioral Medicine Jackson Park Hospital Foundation 1 1 X X X X X X 13 1 0 0 X 1 0 1 1 200 1 200 1 X X X X X X X 1 1 X X X 0 X 1 X X X 1 0 0 Schedule H, Part V, Section B, Line 3-Jackson Park Hospital Foundation We consulted with the Metropolitan Chicago Healthcare Council. They provided us with the results of intensive data analysis and focus group input for our specific service area. Schedule H, Part I, Line 7 The costing methodology used to calculate financial assistance at cost is the cost -to-charge ratio derived from the hospitals Medicare cost report. Worksheet S-10 line one. Schedule H, Part I, Line 7, Column f The hospital reported a total of $20,064,106 Schedule H, Part III, Section A, Line 4 In July 2011, the FASB issued ASU 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debt, and the Allowance for Doubtful Accounts for Certain Health Care Entities. ASU 2011-07 amends Accounting Standards Codification 954, Health Care Entities, to provide financial statement users with greater transparency about a health care entity's net patient service revenue, which is sometimes grossed up and recognized at the time the services are rendered regardless of whether the entity expects to collect that amount, and the related allowance for doubtful accounts. ASU 2011-07 provides information to assist financial statement users in assessing an entity's sources of net patient service revenue and related changes in its allowance for doubtful accounts. It requires health care entities that recognize significant amounts of patient service revenue at the time the services are rendered, even though they do not assess the patient's ability to pay, to present the provision for bad debts related to patient service revenue as a deduction from patient service revenue (net of contractual allowances and discounts) on their statement of operations. For non-public entities, ASU 2011-07 is effective for the first annual period ending after December 15, 2012 and interim and annual periods thereafter, with early adoption permitted. The Corporation adopted this new standard in fiscal year 2013. Schedule H, Part III, Section B, Line 8 The cost of providing care to Medicare patients was based on completion of the Medicare 2014 cost report. 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 inpatient and outpatients. The hospital also purchased community health information services from the Metropolitan Chicago Health Care Council. 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 specialty clinics. Schedule H, Part VI, Line 3 The hospital has contracted with a third party that assists any patient through the application process of Medicaid or Medicare. This company will also assist a patient and or the family through the hospital's charity application process. Schedule H, Part VI, Line 4 Jackson Park Hospital's primary service area is 60649, 60619, 60620, 60617, and 60628. Our primary service area for behavioral patients is much broader and encompass the City of Chicago. The average income in the hospitals primary service area is approximately 46% of the State of Illinois average. Schedule H, Part VI, Line 7 Jackson Park Hospital Foundation prepared an annual Community Benefits Report which is submitted to the Attorney General of the State of Illinois annually. 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 605788 0 0 0 0 0 0 0 8360 0 614148 0 589203 0 Merritt Hasbrouck President 525716 0 0 0 0 0 0 0 2879 0 528595 0 497963 0 G Randall Smith Executive Vice President 517331 0 0 0 0 0 0 0 17924 0 535255 0 503902 0 Haroon Olomi MD Director 92825 200649 0 0 0 0 0 0 15861 0 108686 200649 293632 195724 Thodur Ranganathan MD Physician 237385 0 0 0 0 0 0 0 23688 0 261073 0 276801 0 Rose Ette RN Registered Nurse 213125 0 0 0 0 0 0 0 15387 0 228512 0 193332 0 Lakshmi Dodda MD Director 209700 0 0 0 0 0 0 0 654 0 210354 0 210369 0 Nelson Vasquez VP Finance 194230 0 0 0 0 0 0 0 17837 0 212067 0 217787 0 Sameera T Qureshi MD Director 84982 81554 0 0 0 0 0 0 24177 0 109159 81554 0 0 Georgia Lubben MD Physician 131539 33657 0 0 0 0 0 0 84 0 131623 33657 128664 32831 Bangalore Murthy MD Director 154924 137718 0 0 0 0 0 0 23604 0 178528 137718 153698 148359 Barry Mandell VP Special Projects 154443 0 0 0 0 0 0 0 17837 0 172280 0 160897 0 Patricia Simon VP Quality and Compliance 141650 0 0 0 0 0 0 0 12564 0 154214 0 144715 0 James Nunn MD Director 67721 341694 0 0 0 0 0 0 23688 0 91409 341694 80428 333360 Naveed Muhammad MD Physician 136176 0 0 0 0 0 0 0 23285 0 159461 0 157221 0 Form 990, Header, Line B There was a audit adjustment made and I corrected the statements Form 990, Part VI, Section B, Line 11b The management and members 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 form every three years. Jackson Park Hospital Foundation is scheduled to complete this procedure in its fiscal year 2014. 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 990, conflict of interest policy, community benefit report and financial statements available to the public by appointment with its vice president of finance. Form 990, Part VII, Section B, Line 1(A) George Sollitt Construction performs remodeling and renovation work at the hospital. NICL Laboratories performs laboratory services. McKesson provides health care Information Technology systems and services. EmCare provides emergency room physician staffing. Rush Nursing Services provides temporary registered nurse staffing. Form 990, Part IX, Line 11g Contract labor and purchased services $12,981,092. Supplies and other $7,365,305. Professional fees $3,140,989. Utilities $1,592,384. Repair and maintenance $496,566. Please note these amounts may include amounts that appear on other lines in Part IX. Form 990, Part XI, Line 5 Net unrealized gains (losses) on investments as reported by the hospitals pension trustee. Form 990, Part XI, Line 9 Pension gain during 2014. The Friedell Clinic SC 7531 Stony Island Avenue Chicago IL 60649 363290656 Primary Health Care IL C 100 100 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 This is an amended return.