JACKSON HOSPITAL & CLINIC INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- JACKSON HOSPITAL & CLINIC INC (EIN 63-6001820)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-13
- IRS object ID
- 201543179349307329
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-13T14:55:18-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1Txt |
| City | ASHEVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 636001820 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON HOSPITAL AND CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JACK | BusinessNameControlTxt |
| Phone | 3342938000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET NO 1200 | AddressLine1Txt |
| City | MONTGOMERY | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 36106 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOE B RILEY | PersonNm |
| Person Title | PRESIDENT / CEO | PersonTitleTxt |
| Phone | 3342938000 | PhoneNum |
| Signature | 2015-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY BIBBY | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOE B RILEY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET NO 1200 | AddressLine1Txt |
| City | MONTGOMERY | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 36106 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $196,167,950 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.JACKSON.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | AL | LegalDomicileStateCd |
| Activity Or Mission | COMMUNITY NOT-FOR-PROFIT 344 BED HOSPITAL SERVING MONTGOMERY AND ALABAMA RIVER REGION | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1754 | TotalEmployeeCnt |
| Total Volunteers | 49 | TotalVolunteersCnt |
| Total Gross UBI | $317,202 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $277,897 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $182,781 | PYContributionsGrantsAmt |
| CY Contributions Grants | $140,954 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $187,916,415 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $188,998,563 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,422,874 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,510,670 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,314,565 | PYOtherRevenueAmt |
| CY Other Revenue | $4,517,763 | CYOtherRevenueAmt |
| PY Total Revenue | $195,836,635 | PYTotalRevenueAmt |
| CY Total Revenue | $196,167,950 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $115,306 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $37,466 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $71,345,311 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $76,094,698 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $107,643 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $117,754,466 | PYOtherExpensesAmt |
| CY Other Expenses | $118,807,964 | CYOtherExpensesAmt |
| PY Total Expenses | $189,215,083 | PYTotalExpensesAmt |
| CY Total Expenses | $194,940,128 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,621,552 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,227,822 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $232,769,121 | TotalAssetsBOYAmt |
| Total Assets EOY | $229,344,065 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $130,874,941 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $123,160,570 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $101,894,180 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $106,183,495 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE SUPERIOR HEALTHCARE IN A SAFE, COMPASSIONATE ENVIRONMENT WHILE FULFILLING OUR CHARITABLE OBLIGATION AS A NOT-FOR-PROFIT ORGANIZATION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $159,365,865 | ExpenseAmt |
| Grant | $37,466 | GrantAmt |
| Revenue | $191,418,964 | RevenueAmt |
| Desc | JACKSON HOSPITAL OPERATES A GENERAL ACUTE CARE HOSPITAL THAT PROVIDES CERTAIN TERTIARY SERVICES SUCH AS NEUROLOGY AND NEUROSURGERY, CARDIOLOGY (INCLUDING CARDIAC CATHERIZATION AND CARDIOVASCULAR SURGERY) AND ONCOLOGY. JACKSON HOSPITAL IS LICENSED FOR 344 BEDS THAT INCLUDE 30 INTENSIVE CARE BEDS AND 22 OBSTETRIC BEDS. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS.THE INPATIENT ANCILLARY AND SUPPORT SERVICES OFFERED BY JACKSON HOSPITAL ARE AS FOLLOWS; ACUTE DIALYSIS, BLOOD BANK, CARDIAC CATHETERIZATION LABORATORY, NUCLEAR MEDICINE, NURSERY (LEVEL II), PHARMACY, PHYSICAL THERAPY, POST ANESTHESIA CARE, RESPIRATORY CARE, ELECTRO CARDIOLOGY, INTENSIVE CARE, LABOR AND DELIVERY, MRI, CARDIOVASCULAR SURGERY, CARDIOVASCULAR LABORATORY, CLINICAL AND ANATOMICAL LABORATORY, COMPUTERIZED TOMOGRAPHY, CORONARY CARE, DIAGNOSTIC RADIOLOGY, SURGICAL FACILITIES AND ULTRASOUND. THE OUTPATIENT ANCILLARY AND SUPPORT SERVICES OFFERED BY JACKSON HOSPITAL ARE AS FOLLOWS; BLOOD BANK, CARDIAC CATHETERIZATION LABORATORY, EMERGENCY DEPARTMENT, ENDOSCOPY, LITHOTRIPSY, DIABETES TREATMENT CENTER, PAIN MANAGEMENT, PHYSICAL THERAPY, RESPIRATORY CARE, SLEEP LAB, ELECTRO CARDIOLOGY, MRI, CARDIOVASCULAR LABORATORY, CLINICAL LABORATORY, COMPUTERIZED TOMOGRAPHY, DIAGNOSTIC RADIOLOGY, AMBULATORY SURGERY, ULTRASOUND AND WOUND CARE CENTER. FOR THE 12 MONTHS ENDING DECEMBER 31, 2014, JACKSON HOSPITAL HAD 12,662 ADMISSIONS, 60,864 PATIENT DAYS, 1,279 DELIVERIES, 18,841 OUTPATIENT SURGERIES,43,272 EMERGENCY DEPARTMENT VISITS, 579,629 OUTPATIENT LABORATORY TESTS, 2,217 CATHETERIZATIONS AND 103,453 OUTPATIENT RADIOLOGY PROCEDURES. | Desc |
| Total Program Service Expenses | $159,365,865 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1754 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAUL PEIFFER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3342938819 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET SUITE 1200 | AddressLine1Txt |
| City | MONTGOMERY | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 36106 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| W KEN UPCHURCH | ||||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PATRICK G RYAN MD | ||||||||
| VICE CHARIMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RANDALL G COOK MD | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $27,500 | $0 | $0 | ||
| KYLE KYSER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KEITH KARST | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GLENN YATES MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GEORGE W THOMPSON III | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| WILBUR HUFMAN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| STEVE BARRINGTON MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHARLOTTE MUSSAFER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RENE' A LLERA MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOE RILEY | ||||||||
| PRESIDENT/CEO | 40.00 | Yes (X) | $562,928 | $0 | $8,514 | |||
| MICHAEL JAMES | ||||||||
| VICE PRESIDENT COO | 40.00 | Yes (X) | $215,770 | $0 | $18,068 | |||
| PETE VERRECCHIA | ||||||||
| PAST VP CFO | 40.00 | Yes (X) | $119,226 | $0 | $0 | |||
| PAUL PEIFFER | ||||||||
| VICE PRESIDENT CFO AS OF MARCH | 40.00 | Yes (X) | $203,483 | $0 | $21,769 | |||
| JANET MCQUEEN | ||||||||
| VICE PRESIDENT MARKETING | 40.00 | $160,649 | $0 | $27,410 | Yes (X) | |||
| SHARON GOODISON | ||||||||
| VICE PRESIDENT PATIENT CARE | 40.00 | $185,498 | $0 | $24,568 | Yes (X) | |||
| MICHAEL RITZUS | ||||||||
| VICE PRESIDENT PHYSICIAN SERVICES | 40.00 | $150,192 | $0 | $5,910 | Yes (X) | |||
| LARRY SHERBETT | ||||||||
| AVP FINANCE | 40.00 | $177,723 | $0 | $21,210 | Yes (X) | |||
| PETER VANDERVOORT | ||||||||
| AVP SUPPORT SERVICES | 40.00 | $151,319 | $0 | $21,850 | Yes (X) | |||
| BRIAN RICHARDSON MD | ||||||||
| PHYSICIAN | 40.00 | $1,213,077 | $0 | $39,410 | Yes (X) | |||
| BRIAN SELLERS MD | ||||||||
| PHYSICIAN | 40.00 | $693,198 | $0 | $42,785 | Yes (X) | |||
| JAMES MRACEK MD | ||||||||
| PHYSICIAN | 40.00 | $397,838 | $0 | $8,514 | Yes (X) | |||
| BRIAN GARY MD | ||||||||
| PHYSICIAN | 40.00 | $393,556 | $0 | $26,014 | Yes (X) | |||
| REZA SEIRAFI MD | ||||||||
| PHYSICIAN | 40.00 | $379,115 | $0 | $8,514 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,031,072 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $274,536 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 56 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LIFESOUTH COMMUNITY BLOOD CENTERS INC | |||||
| PO BOX 830469 | BIRMINGHAM | AL | 352830469 | BLOOD PRODUCTS | $1,897,158 |
| MONTGOMERY ANESTHESIA ASSOCIATES PC | |||||
| PO BOX 230725 | MONTGOMERY | AL | 231230725 | ANESTHESIA SERVICES | $1,596,000 |
| JACKSON NURSE PROFESSIONALS LLC | |||||
| PO BOX 404118 | ATLANTA | GA | 303844118 | STAFFING NURSING | $1,369,861 |
| PHYSIOTHERAPY ASSOCIATES | |||||
| 1215 MULBERRY STREET | MONTGOMERY | AL | 36106 | PHYSICAL THERAPY | $987,713 |
| DIVERSIFIED CLINICAL SERVICES | |||||
| PO BOX 636981 | CINCINNATI | OH | 452636981 | WOUND CARE TREATMENT | $939,363 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 39 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $140,954 | AllOtherContributionsAmt |
| Total Contributions | $140,954 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE | 621400 | $184,523,066 | $184,461,167 | $61,899 |
| ANCILLIARY SERVICES | 900099 | $1,729,150 | $1,729,150 | |
| SURGERY CENTER REVENUES | 621400 | $1,416,815 | $1,416,815 | |
| IMAGING CENTER REVENUES | 621400 | $1,201,314 | $1,201,314 | |
| HOME HEALTH SERVICES | 621610 | $128,218 | $128,218 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $188,998,563 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,510,670 | TotalRevenueColumnAmt |
| Exclusion | $2,510,670 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,482,300 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,482,300 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,482,300 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,482,300 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA | 722210 | $1,378,951 | $1,378,951 | |
| JOINT VENTURE | 900099 | $255,303 | $255,303 | |
| COFFEE SHOP | 722210 | $188,611 | $188,611 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $212,598 | TotalRevenueColumnAmt |
| Exclusion | $212,598 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,035,463 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $196,167,950 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $191,418,964 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $317,202 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,290,830 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,466 | TotalAmt |
| Program Services | $37,466 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,040,618 | TotalAmt |
| Program Services | $260,155 | ProgramServicesAmt |
| Management And General | $780,463 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,542 | TotalAmt |
| Program Services | $66,542 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,385,522 | TotalAmt |
| Program Services | $49,452,733 | ProgramServicesAmt |
| Management And General | $12,845,106 | ManagementAndGeneralAmt |
| Fundraising | $87,683 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,649,694 | TotalAmt |
| Program Services | $2,077,399 | ProgramServicesAmt |
| Management And General | $568,623 | ManagementAndGeneralAmt |
| Fundraising | $3,672 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,692,499 | TotalAmt |
| Program Services | $4,463,003 | ProgramServicesAmt |
| Management And General | $1,221,608 | ManagementAndGeneralAmt |
| Fundraising | $7,888 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,259,823 | TotalAmt |
| Program Services | $3,339,764 | ProgramServicesAmt |
| Management And General | $914,156 | ManagementAndGeneralAmt |
| Fundraising | $5,903 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,848 | TotalAmt |
| Management And General | $189,848 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $252,709 | TotalAmt |
| Management And General | $252,709 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,599,078 | TotalAmt |
| Program Services | $20,768,319 | ProgramServicesAmt |
| Management And General | $4,830,759 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $468,335 | TotalAmt |
| Management And General | $468,335 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,130,974 | TotalAmt |
| Program Services | $4,293,076 | ProgramServicesAmt |
| Management And General | $6,836,196 | ManagementAndGeneralAmt |
| Fundraising | $1,702 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,793,691 | TotalAmt |
| Management And General | $2,793,691 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,231,280 | TotalAmt |
| Program Services | $4,231,280 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $227,962 | TotalAmt |
| Program Services | $183,703 | ProgramServicesAmt |
| Management And General | $43,464 | ManagementAndGeneralAmt |
| Fundraising | $795 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,888,250 | TotalAmt |
| Program Services | $4,888,250 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,275,789 | TotalAmt |
| Program Services | $11,275,789 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,555,998 | TotalAmt |
| Program Services | $1,555,998 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| UBIT | $91,630 | $91,630 | |
| SUPPLIES | $40,320,910 | $3,581,167 | $36,739,743 |
| BAD DEBT EXPENSE | $15,727,584 | $15,727,584 | |
| RECRUITMENT | $48,621 | $48,621 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,305 | TotalAmt |
| Program Services | $5,061 | ProgramServicesAmt |
| Management And General | $244 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,940,128 | TotalAmt |
| Program Services | $159,365,865 | ProgramServicesAmt |
| Management And General | $35,466,620 | ManagementAndGeneralAmt |
| Fundraising | $107,643 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,318,166 | BOYAmt |
| EOY | $7,902,584 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,457,261 | BOYAmt |
| EOY | $7,335,966 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,258,571 | BOYAmt |
| EOY | $32,652,902 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,930,248 | BOYAmt |
| EOY | $6,204,772 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $891,011 | BOYAmt |
| EOY | $1,185,750 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $211,387,650 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $110,015,767 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,241,954 | BOYAmt |
| EOY | $101,371,883 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,043,894 | BOYAmt |
| EOY | $62,610,634 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,723,532 | BOYAmt |
| EOY | $8,832,221 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,904,484 | BOYAmt |
| EOY | $1,247,353 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $232,769,121 | BOYAmt |
| EOY | $229,344,065 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,647,780 | BOYAmt |
| EOY | $19,184,054 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,540,021 | BOYAmt |
| EOY | $1,540,021 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,465,000 | BOYAmt |
| EOY | $96,095,000 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,500,000 | BOYAmt |
| EOY | $950,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,722,140 | BOYAmt |
| EOY | $5,391,495 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $130,874,941 | BOYAmt |
| EOY | $123,160,570 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,894,180 | BOYAmt |
| EOY | $106,183,495 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,894,180 | BOYAmt |
| EOY | $106,183,495 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $232,769,121 | BOYAmt |
| EOY | $229,344,065 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,227,822 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $279,555 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,781,938 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $10,682 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $10,682 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE ALABAMA HOSPITAL ASSOCIATION. EACH YEAR, A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TOWARDS LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES. FOR 2014, AMOUNTS OF MEMBERSHIP DUES ALLOCATED TO THESE EXPENDITURES WERE APPROXIMATELY $ 7,000 FOR AHA AND $ 3,000 FOR ALABAMA HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,644,606 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $5,140,921 | OtherCostOrOtherBasisAmt |
| Book Value | $6,785,527 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $92,031,818 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,383,635 | DepreciationAmt |
| Book Value | $47,648,183 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,305,481 | OtherCostOrOtherBasisAmt |
| Depreciation | $614,001 | DepreciationAmt |
| Book Value | $691,480 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $109,977,541 | OtherCostOrOtherBasisAmt |
| Depreciation | $65,018,131 | DepreciationAmt |
| Book Value | $44,959,410 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,287,283 | OtherCostOrOtherBasisAmt |
| Book Value | $1,287,283 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $101,371,883 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED INTEREST | $1,596,568 |
| PENSION LIABILITY | $761,047 |
| UNAMORTIZED BOND PREMIUM | $1,907,821 |
| NOTES PAYABLE BBVA COMPASS | $1,126,059 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,391,495 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION FILES A CONSOLIDATED FINANCIAL STATEMENT WITH ITS SUBSIDIARIES. THE FOLLOWING FOOTNOTE REFERENCES ENTITIES WHOSE ACTIVITY IS NOT REPORTED ON THE FORM 990 FOR JACKSON HOSPITAL AND CLINIC, INC. "THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3); ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AS A LIMITED LIABILITY COMPANY, THE SURGERY CENTER AND IMAGING CENTER'S TAXABLE INCOME OR LOSS IS ALLOCATED TO THE MEMBERS AND IS INCLUDED IN THE CALCULATION OF THEIR TAXABLE INCOME. ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR INCOME TAXES. THE COMPANY DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2014 AND 2013. YEARS ENDING ON OR AFTER DECEMBER 31, 2011, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES." | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,361,025 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,361,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04110 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,754,073 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,231,052 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,523,021 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01970 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,115,098 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,231,052 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,884,046 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06080 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,413,115 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,938,674 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,474,441 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01380 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,766 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $39,766 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,467,881 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,938,674 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,529,207 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $38,582,979 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,169,726 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,413,253 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07490 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,496,862 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $2,500,000 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $59,003,624 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $55,766,814 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $3,236,810 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|
| 1 JACKSON IMAGING CENTER LLC | ||
| RADIOLOGY PROCEDURES | 0.67000 | 0.33000 |
| 2 JACKSON SURGERY CENTER LLC | ||
| OUTPATIENT SURGERY | 0.54580 | 0.45420 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON HOSPITAL AND CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET | AddressLine1Txt |
| City | MONTGOMERY | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 361061117 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DISPROPORTIONATE SHARE HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON HOSPITAL & CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.JACKSON.ORG/PDFS/CHNA.PDF | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.JACKSON.ORG/PDFS/CHNA.PDF | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| JACKSON HOSPITAL & CLINIC | PART V, SECTION B, LINE 5: TWENTY IN-PERSON INTERVIEWS WERE CONDUCTED FROM MAY 15-16, 2013. INTERVIEWS REQUIRED APPROXIMATELY 30 MINUTES TO COMPLETE. INTERVIEWERS FOLLOWED THE SAME PROCESS FOR EACH INTERVIEW, WHICH INCLUDED DOCUMENTING THE INTERVIEWEE'S EXPERTISE AND EXPERIENCE RELATED TO THE COMMUNITY. ADDITIONALLY, THE FOLLOWING COMMUNITY-FOCUSED QUESTIONS WERE USED AS THE BASIS FOR DISCUSSION: - INTERVIEWEE'S NAME - INTERVIEWEE'S TITLE - INTERVIEWEE'S ORGANIZATION - OVERVIEW INFORMATION ABOUT THE INTERVIEWEE'S ORGANIZATION - WHAT ARE THE TOP HEALTH STRENGTHS OF THE COMMUNITY? - WHAT ARE THE TOP HEALTH CONCERNS OF THE COMMUNITY? - WHAT ARE THE HEALTH ASSETS AND RESOURCES AVAILABLE IN THE COMMUNITY? - WHAT ARE THE HEALTH ASSETS OR RESOURCES THAT THE COMMUNITY LACKS? - WHAT ARE THE BARRIERS TO OBTAINING HEALTH SERVICES IN THE COMMUNITY? - WHAT IS THE SINGLE MOST IMPORTANT THING THAT COULD BE DONE TO IMPROVE THE HEALTH IN THE COMMUNITY? - WHAT OTHER INFORMATION CAN BE PROVIDED ABOUT THE COMMUNITY THAT HAS NOT ALREADY BEEN DISCUSSED? |
| JACKSON HOSPITAL & CLINIC | PART V, SECTION B, LINE 11: 1 CARDIOVASCULAR DISEASE-HEART DISEASE IS THE LEADING CAUSE OF DEATH IN AUTAUGA, ELMORE AND MONTGOMERY COUNTIES.-STROKE IS THE THIRD LEADING CAUSE OF DEATH IN MONTGOMERY.-MORTALITY RATES FROM ESSENTIAL HYPERTENSION ARE HIGHER IN AUTAUGA, ELMORE AND MONTGOMERY COUNTIES COMPARED TO ALABAMA AND THE UNITED STATES.-HEART CONDITIONS ARE AMONG THE MOST COMMON REASONS FOR DISCHARGE AT JACKSON HOSPITAL.-HYPERTENSION (HIGH BLOOD PRESSURE) IS THE TOP REASON FOR BEING SEEN AT THE JACKSON CLINIC, ACCOUNTING FOR 28 PERCENT OF ALL VISITS.HOW WE ARE HELPINGJACKSON HOSPITAL HAS BEEN RECOGNIZED AS AN ADVANCED PRIMARY STROKE CENTER BY THE JOINT COMMISSION. THIS DESIGNATION IS GIVEN TO HOSPITALS THAT HAVE DEMONSTRATED THAT THEIR PROGRAM MEETS CRITICAL ELEMENTS OF PERFORMANCE TO ACHIEVE LONG-TERM SUCCESS IN IMPROVING OUTCOMES FOR STROKE PATIENTS. JACKSON HOSPITAL DISTRIBUTES STROKE AWARENESS CARDS THROUGH AREA WALGREENS LOCATIONS AND PROVIDES PUBLIC EDUCATION THROUGHOUT THE YEAR. WE ARE ALSO INCREASING HEALTH FAIR INVOLVEMENT AND COMMUNITY HEALTH SCREENINGS THROUGH OUR WELLNESS WORKS PROGRAM AND ARE IMPLEMENTING A LOW-COST HEART AND STROKE SCREENING PROGRAM FOR INDIVIDUALS AT RISK.2 DIABETES-THE DIABETES MORTALITY RATE IN MONTGOMERY IS SUBSTANTIALLY HIGHER THAN THE STATE AND NATIONAL RATES.-DIABETES-RELATED CONDITIONS ACCOUNT FOR 12.8 PERCENT OF ALL VISITS TO THE JACKSON CLINIC.-ADULTS IN THE MONTGOMERY REGION ARE MORE LIKELY TO REPORT DIAGNOSED DIABETES THAN ADULTS IN THE REST OF THE U.S.HOW WE ARE HELPINGJACKSON HOSPITAL OFFERS FREE WEEKLY DIABETES EDUCATION COURSES. WE HAVE ALSO ADDED ANOTHER ENDOCRINOLOGY SPECIALIST, A. BAHADIR ERGIN, MD, WHO JOINED THE JACKSON CLINIC IN JULY. THIS WILL HELP MEET THE HIGH DEMAND FOR THESE SERVICES.3 ACCESS TO HEALTHCARE-THE LACK OF PHYSICIANS ACCEPTING MEDICAID AND MEDICARE PATIENTS IS A SERIOUS HEALTH CONCERN.-THE AGING PHYSICIAN POPULATION WAS A MAJOR CONCERN FOR THE COMMUNITY.-A LACK OF ACCESS TO PREVENTION AND SCREENING RESOURCES WAS A CONCERN.HOW WE ARE HELPING-HEALTH SERVICES, INC., RECEIVED A GRANT THROUGH THE HEALTH RESOURCES AND SERVICES ADMINISTRATION TO PROVIDE OUTREACH AND ENROLLMENT SERVICES FOR UNINSURED INDIVIDUALS FOR THE AFFORDABLE INSURANCE MARKETPLACE. THE ORGANIZATION PLANS TO WORK WITH AREA HOSPITALS, INCLUDING JACKSON HOSPITAL, TO INCREASE ACCESS AND AWARENESS OF THIS SERVICE.-JACKSON HOSPITAL HAS RECRUITED MORE THAN A DOZEN NEW PHYSICIANS TO THE AREA OVER THE PAST 18 MONTHS.4 MENTAL HEALTH-SUICIDE IS THE EIGHTH LEADING CAUSE OF DEATH IN AUTAUGA, WITH A RATE SUBSTANTIALLY HIGHER THAN THAT OF ALABAMA AND THE UNITED STATES.-THE LACK OF RESOURCES AND SERVICES FOR THESE PATIENTS WAS A CONCERN.-REDUCING STIGMA AND RAISING COMMUNITY AWARENESS WAS A PRIORITY.HOW WE ARE HELPING-JACKSON HOSPITAL WILL START AN INITIATIVE FOR DEPRESSION SCREENING AT INTAKE IN KIOSKS THROUGH CARE COORDINATION SERVICES.-WE ARE ALSO PARTNERING WITH LOCAL PROVIDERS TO PROVIDE PUBLIC EDUCATION ABOUT MENTAL HEALTH ISSUES AND THE COMMUNITY RESOURCES AVAILABLE.5 OBESITYOBESITY WAS A MAJOR CONCERN. POOR NUTRITIONAL HABITS AND LACK OF EXERCISE WERE DISCUSSED AS THE PRIMARY CAUSES.HOW WE ARE HELPING-JACKSON HOSPITAL DIETITIANS OFFER NUTRITIONAL COUNSELING AT HEALTH FAIRS AND COMMUNITY EVENTS. THEY FOCUS ON HEALTHY EATING FOR WEIGHT AND DISEASE MANAGEMENT.-JACKSON HOSPITAL HAS ALSO PARTNERED WITH EAT SOUTH TO OFFER EDUCATION ABOUT HEALTHY EATING AND SUSTAINABLE FOOD PRODUCTION THROUGH COMMUNITY HEALTH FAIRS.-JACKSON IS A FOUNDING MEMBER OF THE MONTGOMERY AREA COMMUNITY WELLNESS COALITION. THE COALITION HOSTS SEMINARS AND PRESENTATIONS FOR HEALTH PROFESSIONALS IN THE COMMUNITY, DISCUSSING CHRONIC DISEASE AND RISK FACTORS.-JACKSON HOSPITAL IS STRIVING TO INCREASE THE NUMBER OF EMPLOYEES AT A HEALTHY WEIGHT BY CREATING AN EMPLOYEE WELLNESS COMMITTEE.-THE HOSPITAL ENCOURAGES PARTICIPATION IN THE SCALE BACK ALABAMA INITIATIVE AND HAS RECENTLY ADDED SIGNS FOR AN INDOOR WALKING PATH. THE HOSPITAL CAFETERIA OFFERS BARCODES SO PEOPLE DINING CAN USE THEIR SMARTPHONES TO SCAN AND DETERMINE THE NUTRITIONAL VALUE OF FOODS THEY ARE EATING.6 SEXUALLY TRANSMITTED INFECTIONSIN MONTGOMERY, CHLAMYDIA, GONORRHEA, SYPHILIS, HIV AND AIDS INCIDENCE RATES ARE ALL SUBSTANTIALLY HIGHER THAN IN ALABAMA.HOW WE ARE HELPINGJACKSON HOSPITAL WAS THE HOST SITE FOR A REGIONAL INFECTIOUS DISEASE CONFERENCE IN APRIL 2014. THE COLLABORATIVE EFFORT WITH THE ALABAMA DEPARTMENT OF HEALTH AND THE MEDICAL AIDS OUTREACH PROGRAM PROVIDED INFORMATION ABOUT SEXUALLY TRANSMITTED INFECTIONS. |
| JACKSON HOSPITAL & CLINIC | PART V, SECTION B, LINE 16I: PATIENTS ARE INTERVIEWED FOR SELF PAY ADMISSIONS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| JACKSON CLINIC FAMILY MEDICINE CENTER | ||||
| 1111 OLIVE STREET | MONTGOMERY | AL | 36106 | FAMILY MEDICINE/OUTPATIENT |
| JACKSON SURGERY CENTER | ||||
| 1725 PARK PLACE | MONTGOMERY | AL | 36106 | OUTPATIENT SURGERY |
| JACKSON IMAGING CENTER | ||||
| 1825 PARK PLACE | MONTGOMERY | AL | 36106 | MEDICAL IMAGING |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ALL SELF-PAY PATIENTS RECEIVE A 73% DISCOUNT SO THAT THEY ARE ONLY BILLED FOR 27% OF TOTAL CHARGES. |
| PART I, LINE 7G: | JACKSON HOSPITAL HAS ONE HEALTH PROGRAM THAT OPERATED AT A LOSS FOR THE BENEFIT OF THE COMMUNITY. THE DEPARTMENT, INCLUDED ON PART I, LINE 7(G) IS: EMERGENCY ROOM - $2,474,441 |
| PART I, LN 7 COL(F): | THE AMOUNT LISTED ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $ 15,727,584 THAT HAS BEEN REMOVED FOR PURPOSES OF CALCULATING PERCENT OF TOTAL EXPENSE ON PART I, LINE 7, COLUMN (F). |
| PART III, LINE 4: | WORKSHEET 2 OF THE 2014 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE BAD DEBT EXPENSE AT COST FOR PURPOSES OF PART III, LINE 2.RECEIVABLES FROM PATIENTS, INSURANCE COMPANIES, AND THIRD-PARTY CONTRACTUAL AGENCIES ARE RECORDED AT REGULAR PATIENT SERVICE CHARGE RATES. A MAJORITY OF THE COMPANY'S PATIENTS ARE INSURED BY CERTAIN THIRD PARTY INSURERS (PRINCIPALLY BLUE CROSS, MEDICARE, AND MEDICAID) BASED ON CONTRACTUAL AGREEMENTS WHICH GENERALLY RESULT IN THE COMPANY COLLECTING LESS THAN THE ESTABLISHED CHARGE RATES. FINAL DETERMINATION OF PAYMENTS UNDER THESE AGREEMENTS IS SUBJECT TO REVIEW BY APPROPRIATE AUTHORITIES. ADEQUATE ALLOWANCES ARE PROVIDED FOR DOUBTFUL ACCOUNTS, CONTRACTUAL ADJUSTMENTS AND OTHER UNCERTAINTIES. CREDIT LOSSES HAVE HISTORICALLY BEEN WITHIN MANAGEMENT'S EXPECTATIONS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBTS IF SUBSEQUENTLY COLLECTED. |
| PART III, LINE 8: | THE ORGANIZATION USED ITS MEDICARE COST REPORT TO CALCULATE ALLOWABLE COSTS OF CARE RELATED TO MEDICARE FOR PURPOSES OF PART III, LINE 6. |
| PART III, LINE 9B: | THE ORGANIZATION QUALIFIES PATIENTS FOR ITS CHARITY CARE POLICY AT TIME OF DISCHARGE. DISCOUNTS ON SELF-PAY PATIENTS ARE APPLIED USING A NON-FINANCIAL MEASURE, SO ACCOUNTS IN BAD DEBTS ARE NOT LIKELY ELIGIBILE FOR FURTHER FINANCIAL ASSISTANCE AFTER HAVING THEIR FINAL BILLS ISSUED. THE HOSPITAL PRIMARILY USES A THIRD-PARTY TO HANDLE BAD DEBT COLLECTIONS, AND ROUTINELY REEVALUATES ITS BAD DEBT ACCOUNTS TO DETERMINE PATIENTS THAT QUALIFY UNDER THE ORGANIZATION'S CHARITY CARE POLICY. |
| PART VI, LINE 2: | JACKSON HOSPITAL IS A COMMUNITY NOT-FOR-PROFIT HOSPITAL SERVING MONTGOMERY AND THE ALABAMA RIVER REGION LICENSED FOR 344 BEDS. OUR COMPREHENSIVE HEALTHCARE SERVICES INCLUDE CARDIAC, CANCER, NEUROSCIENCES, ORTHOPEDICS AND WOMEN'S AND CHILDREN'S CARE, ALONG WITH 24 HOUR EMERGENCY SERVIES. IT RANKS AMONG THE LARGEST HOSPITALS IN ALABAMA AND IS WIDELY RECOGNIZED FOR PROVIDING EXCELLENCE IN CARE. EVEN WITH OUR LEADING TECHNOLOGY AND FACILITIES, WE REMAIN TRUE TO OUR MISSION OF PROVIDING SUPERIOR PERSONAL HEALTHCARE IN A SAFE, COMPASSIONATE ENVIRONMENT WHILE FULFILLING OUR COMMITMENT AS A CHARITABLE ORGANIZATION |
| PART VI, LINE 3: | THE HOSPITAL PROVIDES SIGNAGE IN AND AROUND THE EMERGENCY ROOM STATING THE CONTACT INFORMATION FOR FINANCIAL ASSISTANCE REPRESENTATIVES. "YOU MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE TERMS AND CONDITIONS THE HOSPITAL OFFERS TO QUALIFIED PATIENTS. FOR ADDITIONAL INFORMATION, CONTACT THE HOSPITAL FINANCIAL ASSISTANCE REPRESENTATIVE AT 334-293-6970."IN ADDITION, A REPRESENTATIVE VISITS EACH SELF-PAY INPATIENT, AND AN APPLICATION FORM FOR ASSISTANCE IS COMPLETED AT THAT TIME. EACH PRIVATE PAY PATIENT IS INTERVIEWED TO DETERMINE QUALIFICATION BASED ON NATIONAL POVERTY GUIDELINES FOR FINANCIAL ASSISTANCE. BASED ON THIS DETERMINATION, A DECISION IS MADE AS TO ELIGIBILTY FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | JACKSON HOSPITAL'S PRIMARY SERVICE AREA IS COMPRISED OF MONTGOMERY, ELMORE, AND AUTAUGA COUNTIES, LOCATED IN THE EASTERN CENTRAL PART OF THE STATE OF ALABAMA. THE SECONDARY SERVICE AREA IS COMPRISED OF BULLOCK, BUTLER, CRENSHAW, DALLAS, LOWNDES, MACON, AND PIKE COUNTRIES. JACKSON HOSPITAL IS ADJACENT TO I-85 AND NEAR THE INTERSECTION OF I-65 AND I-85, PROVIDING FOR EASY ACCESS FROM THE PRIMARY AND SECONDARY SERVICE AREAS. MAJOR PRIMARY SERVICE AREA EMPLOYERS ARE MAXWELL AIR FORCE BASE, STATE OF ALABAMA, HYUNDAI MOTOR MANUFACTURING ALABAMA, ALFA INSURANCE COMPANIES, ALABAMA STATE UNIVERSITY, AUBURN UNIVERSITY MONTGOMERY AND CITY OF MONTGOMERY. |
| PART VI, LINE 5: | A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES, INDEPENDENT CONTRACTORS, NOR A FAMILY MEMBER OF AN EMPLOYEE OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO MOST OF ITS DEPARTMENTS. IN ADDITION, SURPLUS FUNDS ARE REINVESTED IN THE HOSPITAL THROUGH THE PURCHASE OF TECHNOLOGY, PROPERTY, AND PLANT EQUIPMENT. |
| PART VI, LINE 6: | THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOE RILEY | ||||||||||||||
| PRESIDENT/CEO | $434,600 | $0 | $127,500 | $0 | $828 | $0 | $0 | $0 | $8,514 | $0 | $571,442 | $0 | $0 | $0 |
| MICHAEL JAMES | ||||||||||||||
| VICE PRESIDENT COO | $200,000 | $0 | $15,500 | $0 | $270 | $0 | $12,000 | $0 | $6,068 | $0 | $233,838 | $0 | $0 | $0 |
| PAUL PEIFFER | ||||||||||||||
| VICE PRESIDENT CFO AS OF MARCH | $192,709 | $0 | $10,000 | $0 | $774 | $0 | $17,218 | $0 | $4,551 | $0 | $225,252 | $0 | $0 | $0 |
| JANET MCQUEEN | ||||||||||||||
| VICE PRESIDENT MARKETING | $142,800 | $0 | $17,136 | $0 | $713 | $0 | $23,000 | $0 | $4,410 | $0 | $188,059 | $0 | $0 | $0 |
| SHARON GOODISON | ||||||||||||||
| VICE PRESIDENT PATIENT CARE | $150,000 | $0 | $34,875 | $0 | $623 | $0 | $18,500 | $0 | $6,068 | $0 | $210,066 | $0 | $0 | $0 |
| MICHAEL RITZUS | ||||||||||||||
| VICE PRESIDENT PHYSICIAN SERVICES | $140,205 | $0 | $9,900 | $0 | $87 | $0 | $1,500 | $0 | $4,410 | $0 | $156,102 | $0 | $0 | $0 |
| LARRY SHERBETT | ||||||||||||||
| AVP FINANCE | $177,154 | $0 | $0 | $0 | $569 | $0 | $16,800 | $0 | $4,410 | $0 | $198,933 | $0 | $0 | $0 |
| PETER VANDERVOORT | ||||||||||||||
| AVP SUPPORT SERVICES | $151,319 | $0 | $0 | $0 | $0 | $0 | $21,850 | $0 | $0 | $0 | $173,169 | $0 | $0 | $0 |
| BRIAN RICHARDSON MD | ||||||||||||||
| PHYSICIAN | $546,369 | $0 | $666,384 | $0 | $324 | $0 | $35,000 | $0 | $4,410 | $0 | $1,252,487 | $0 | $0 | $0 |
| BRIAN SELLERS MD | ||||||||||||||
| PHYSICIAN | $495,000 | $0 | $197,838 | $0 | $360 | $0 | $34,271 | $0 | $8,514 | $0 | $735,983 | $0 | $0 | $0 |
| JAMES MRACEK MD | ||||||||||||||
| PHYSICIAN | $330,398 | $0 | $67,170 | $0 | $270 | $0 | $0 | $0 | $8,514 | $0 | $406,352 | $0 | $0 | $0 |
| BRIAN GARY MD | ||||||||||||||
| PHYSICIAN | $373,958 | $0 | $19,245 | $0 | $353 | $0 | $17,500 | $0 | $8,514 | $0 | $419,570 | $0 | $0 | $0 |
| REZA SEIRAFI MD | ||||||||||||||
| PHYSICIAN | $309,022 | $0 | $69,473 | $0 | $620 | $0 | $0 | $0 | $8,514 | $0 | $387,629 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE HOSPITAL PROVIDED INITIAL DUES AND MONTHLY DUES FOR A COUNTRY CLUB MEMBERSHIP FOR THE PRESIDENT/CEO. |
| PART I, LINE 4A | CFO PETE VERRECCHIA LEFT THE ORGANIZATION ON JANUARY 6, 2014. HE RECEIVED 3 MONTHS OF SEVERANCE PAYMENTS DURING 2014. THIS AMOUNT IS REFLECTED ON PART II COLUMN B (III). |
| PART I, LINE 6 | EXECUTIVE BONUS CALCULATIONS INCLUDE A METRIC FOR NET EARNINGS. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEDICAL CLINIC BOARD OF THE CITY OF MONTGOMERY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 630881546 | BondIssuerEIN |
| CUSIP | 013058CG9 | CUSIPNum |
| Bond Issued | 2006-12-05 | BondIssuedDt |
| Issue Price | $113,221,823 | IssuePriceAmt |
| Purpose | REFUNDING, CAPITAL ACQUISITION | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $14,480,000 | RetiredAmt |
| Total Proceeds | $115,784,596 | TotalProceedsAmt |
| In Reserve Fund | $7,263,706 | InReserveFundAmt |
| Issuance Costs From Proceeds | $1,260,470 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $6,203,213 | CapitalExpendituresAmt |
| Substantial Completion | 2007 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | Yes (1) | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | Yes (1) | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: THE MEDICAL CLINIC BOARD OF THE CITY OF MONTGOMERY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/28/2015 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| MONTGOMERY ANESTHESIA | |||
| COMPANY OWNED BY BOARD MEMBER RENE A. LLERA | $1,596,000 | PAYMENT STIPEND TO ANESTHESIA GROUP | 0 |
| EDITH JAMES | |||
| FAMILY MEMBER OF OFFICER MICHAEL JAMES, COO | $66,542 | COMPENSATION | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | CASH AND IN-KIND DONATIONS - JACKSON HOSPITAL BELIEVES IN GIVING BACK TO THE COMMUNITY. IN THE PAST YEAR, THE HOSPITAL DONATED FUNDS AND SERVICES TO THE FOLLOWING ORGANIZATIONS: -AMERICAN CANCER SOCIETY -AUBURN UNIVERSITY SCHOOL OF NURSING -ENVISION 20/20 -FIVE POINTS OF LIFE FOUNDATION, INC -HOSPICE OF MONTGOMERY -LEADERSHIP MONTGOMERY -MONTGOMERY AREA BUSINESS COMMITTEE FOR THE ARTS -MONTGOMERY AREA CHAMBER OF COMMERCE -RIVER REGION MEDICAL ALLIANCE -MONTGOMERY LIONS CLUB -FAMILY SUNSHINE CENTER -AFA CHAPTER 102 -HALO -NATIONAL FALLEN FIRE FIGHTERS FOUNDATION -CAMP WHEEZEAWAY -PSIF -SPINA BIFIDA ASSOCIATION OF ALABAMA -ARTHRITIS FOUNDATION -MONTGOMERY CORPORATE CHALLENGE -CAMELLIA BOWL -MONTGOMERY AREA COMMITTEE OF 100 -FELLOWSHIP OF CHRISTIAN ATHLETES -MONTGOMERY BAPTIST ASSOCIATION |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS FOUR CLASSES OF MEMBERS: ACTIVE MEMBERS, SENIOR ACTIVE MEMBERS, ASSOCIATE MEMBERS, AND COMMUNITY MEMBERS. ACTIVE MEMBERS - TO QUALIFY AS AN ACTIVE MEMBER, AN APPLICANT MUST: BE ACTIVE IN THE PRACTICE OF MEDICINE, BE A MEMBER OF THE ACTIVE MEDICAL STAFF OF THE HOSPITAL, HAVE SERVED AS AN ASSOCIATE MEMBER FOR NOT LESS THAN THREE YEARS, HAVE DEMONSTRATED INTEREST IN AND ADHERENCE TO THE OBJECTIVES OF THE ORGANIZATION, AND BE IN COMPLIANCE WITH ALL OTHER PROVISIONS FROM TIME TO TIME ADOPTED BY THE BOARD RELATING TO MEMBERSHIP. SENIOR ACTIVE MEMBERS - ACTIVE MEMBERS THAT HAVE RETIRED FROM ACTIVE PRACTICE BUT EXPRESS A DESIRE TO CONTINUE TO PARTICIPATE IN THE OBJECTIVES OF THE ORGANIZATION. ASSOCIATE MEMBERS - TO QUALIFY AS AN ASSOCIATE MEMBER, AN APPLICANT MUST: BE ACTIVE IN THE PRACTICE OF MEDICINE, HAVE SERVED AS A MEMBER OF THE MEDICAL STAFF OF THE HOSPITAL FOR NOT LESS THAN TWO YEARS, HAVE DEMONSTRATED INTEREST IN AND ADHERENCE TO THE OBJECTIVES OF THE ORGANIZATION, AND BE IN COMPLIANCE WITH ALL OTHER PROVISIONS FROM TIME TO TIME ADOPTED BY THE BOARD RELATING TO MEMBERSHIP. COMMUNITY MEMBERS - A COMMUNITY MEMBER MUST BE A CITIZEN OF THE UNITED STATES OF NOT LESS THAN 21 YEARS OF AGE AND A PERMANENT RESIDENT OF MONTGOMERY COUNTY, ALABAMA, OR ANY OTHER COUNTY WITHIN THE STATE WHICH IS WITHIN THE SERVICE AREA OF THE HOSPITAL AND SHALL POSSESS SUCH ADDITIONAL QUALIFICATIONS AS SHALL BE SET FORTH FROM TIME TO TIME BY THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7A | ACTIVE MEMBERS HAVE THE EXCLUSIVE RIGHT TO VOTE ON THE APPROVAL OF THE ADMISSION OF ANY PERSON AS AN ACTIVE OR ASSOCIATE MEMBER OF THE NON-PROFIT CORPORATION. COMMUNITY MEMBERS ARE PERMITTED TO PARTICIPATE IN THE ELECTION OF THE MEMBERS OF THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL VOTING RIGHTS OF MEMBERS ACCRUING TO MEMBERS GENERALLY, UNDER THE ALABAMA NONPROFIT CORPORATION ACT OR UNDER THE RESTATED ARTICLES OF INCORPORATION, ARE RESERVED TO THE ACTIVE MEMBERS, EXCEPT FOR THE PARTICIPATION OF COMMUNITY MEMBERS IN THE ELECTION OF MEMBERS OF THE BOARD OF TRUSTEES AND EXCEPT IN THOSE INSTANCES WHERE THE BOARD OF TRUSTEES, IN ITS DISCRETION, DESIRES TO REFER A PARTICULAR MATTER TO THE MEMBERSHIP AS A WHOLE OR TO ANY RESTRICTED CLASS OR CLASSES FOR CONSIDERATION AND ADVICE AS PROVIDED HEREIN, PROVIDED, HOWEVER, THAT NO CLASS OF MEMBERS OTHER THAN ACTIVE MEMBERS SHALL, BY SUCH PROCEDURE, BE GIVEN THE RIGHT TO VOTE ON ANY MATTER REQUIRING THE VOTE OR APPROVAL OF MEMBERS GENERALLY UNDER THE ALABAMA NONPROFIT CORPORATION ACT OR THE VOTE OF ACTIVE MEMBERS UNDER THE RESTATED ARTICLES OF INCORPORATION. THE MATTERS UPON WHICH THE ACTIVE MEMBERS SHALL HAVE THE EXCLUSIVE RIGHT TO VOTE ARE THOSE MATTERS GENERALLY RESERVED TO MEMBERS IN THE ALABAMA NONPROFIT CORPORATION ACT AS IT MAY EXIST FROM TIME TO TIME, INCLUDING, WITHOUT LIMITATION, THE FOLLOWING: - THE LIQUIDATION, DISSOLUTION, OR REORGANIZATION OF THE CORPORATION, - THE SALE, EXCHANGE, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTIES OF THE CORPORATION, BUT NOT THE POWER TO MORTGAGE OR CONVEY SUCH PROPERTY SOLELY FOR THE PURPOSE OF SECURING ANY INDEBTEDNESS OR OTHER OBLIGATIONS OF THE CORPORATION, WHICH THE BOARD OF TRUSTEES, ACTING ALONE, SHALL HAVE AND EXERCISE, - THE APPROVAL OF THE AMENDMENT OF THE RESTATED ARTICLES OF INCORPORATION, - THE APPROVAL OF THE ADMISSION OF ANY PERSON AS AN ACTIVE OR ASSOCIATE MEMBER OF THE CORPORATION. SUCH MATTERS SHALL BE SUBMITTED FOR VOTE OF THE ACTIVE MEMBERS UPON RECOMMENDATION OF THE BOARD OF TRUSTEES. NO ACTION UPON ANY SUCH MATTERS SHALL BE TAKEN BY THE ACTIVE MEMBERS (OR ANY OTHER MEMBER ENTITLED TO VOTE) WITHOUT NOTICE OF SUCH PURPOSE BEING GIVEN PRIOR TO THE MEETING, OTHER THAN THE ELECTION OF THE BOARD OF TRUSTEES WHICH SHALL OCCUR AT EACH ANNUAL MEETING WITHOUT REQUIREMENT OF FURTHER NOTICE. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY HOSPITAL MANAGEMENT. THE RETURN WAS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING WITH THE IRS. THE BOARD REVIEWED THE FORM 990 AT A SUBSEQUENT BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION UPDATES ITS CONFLICT OF INTEREST POLICY ANNUALLY FOR KEY HOSPITAL EMPLOYEES AND BOARD MEMBERS TO PROVIDE INFORMATION ON ANY POTENTIAL CONFLICTS OF INTEREST. THE UPDATES OF THE POLICY FORMS ARE REVIEWED BY HOSPITAL ADMINISTRATION. IN THE EVENT OF A POTENTIAL CONFLICT OF INTEREST, A BOARD MEMBER WILL ABSTAIN FROM VOTING ON MATTERS PERTAINING TO THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | AN OUTSIDE INDEPENDENT CONSULTING FIRM REVIEWS THE COMPENSATION OF OFFICERS EVERY TWO YEARS TO ENSURE COMPENSATION IS COMPARABLE TO THE MARKET. THE HOSPITAL EXECUTIVE COMMITTEE REVIEWS THE RECOMMENDATIONS OF THE OUTSIDE CONSULTING COMPANY AND APPROVES THE COMPENSATION AND ANY CHANGES TO THE COMPENSATION OF OFFICERS. THE EXECUTIVE COMMITEE IS COMPOSED OF MEMBERS OF THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PLEASE SEE PART VI, LINE 20. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PLEASE SEE PART VI, LINE 20. |
| FORM 990, PART VII, SECTION A, LINE 1A: | BOARD MEMBER COMPENSATION: THE COMPENSATION PAID TO BOARD MEMBER RANDALL G. COOK, MD IS FOR HIS SERVICES AS A MEDICAL DIRECTOR OF THE HOSPITAL, NOT FOR HIS POSITION AS A BOARD MEMBER. |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,717,039. MANAGEMENT AND GENERAL EXPENSES 10,546. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,727,585. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 16,099,347. MANAGEMENT AND GENERAL EXPENSES 4,047,538. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,146,885. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,951,933. MANAGEMENT AND GENERAL EXPENSES 474,567. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,426,500. BILLING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 298,108. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 298,108. |
| FORM 990, PART XI, LINE 9: | MINIMUM PENSION LIABILITY ADJUSTMENT 2,781,938. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OAK PARK HIGHLAND LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET | AddressLine1Txt |
| City | MONTGOMERY | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 36106 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 260752650 | EIN |
| Primary Activities | REAL ESTATE | PrimaryActivitiesTxt |
| Legal Domicile State | AL | LegalDomicileStateCd |
| Total Income | $499 | TotalIncomeAmt |
| End Of Year Assets | $12,798 | EndOfYearAssetsAmt |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JACKSON IMAGING CENTER LLC | |||||||||||||
| 1825 PARK PLACE | MONTGOMERY | AL | 36106 | 260339264 | MEDICAL IMAGING | AL | N/A | RELATED | $1,414,713 | $4,825,465 | 0 | 0 | 0.67000 |
| JACKSON SURGERY CENTER LLC | |||||||||||||
| 1725 PARK PLACE | MONTGOMERY | AL | 36106 | 204173305 | OUTPATIENT SURGERY | AL | N/A | RELATED | $1,253,144 | $6,488,794 | 0 | 0 | 0.54500 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON HEALTH INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET | AddressLine1Txt |
| City | MONTGOMERY | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 36106 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 471701457 | EIN |
| Primary Activities | PHYSICIAN PRACTICES | PrimaryActivitiesTxt |
| Legal Domicile State | AL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON HOSPITAL AND CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| JACKSON IMAGING CENTER LLC | ||
| A | $47,102 | CASH |
| JACKSON SURGERY CENTER LLC | ||
| A | $90,424 | CASH |
| JACKSON IMAGING CENTER LLC | ||
| S | $881,050 | CASH |
| JACKSON SURGERY CENTER LLC | ||
| S | $1,124,908 | CASH |
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