2014-11-17T09:11:04-06:00 2013-12-31 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2013-01-01 640303091 ST DOMINIC-JACKSON MEMORIAL HOSPITAL STDO 6012002000 969 LAKELAND DRIVE JACKSON MS 392164699 LESTER DIAMOND PRESIDENT 6012002000 2014-11-10 1 MARSHA H DIECKMAN CPA P00246741 6013261000 2014-11-05 2013 2015-11-30 17:44:51Z LESTER K DIAMOND 969 LAKELAND DRIVE JACKSON MS 392164699 404191084 0 X WWW.STDOM.COM X 1946 MS ST. DOMINIC-JACKSON MEMORIAL HOSPITAL OPERATES A 535 BED PATIENT FACILITY FOR THE CITIZENS OF THE JACKSON, MISSISSIPPI METROPOLITAN AREA. BEING MISSION DRIVEN AND SERVICE ORIENTED, LEADERSHIP AT ST. DOMINIC HOSPITAL RECOGNIZES THAT HEALTHCARE SERVICES AND PROGRAMS SHOULD BE EXTENDED FAR OUTSIDE THE HOSPITAL'S PHYSICAL WALLS AND INTO THE COMMUNITY TO HAVE THE GREATEST IMPACT, ESPECIALLY FOR THE UNDERSERVED. OUR CIVIC AND SOCIAL RESPONSIBILITIES LIE NOT ONLY IN PROVIDING QUALITY HEALTHCARE FOR THE SICK BUT ALSO IN PROVIDING HEALTHCARE EDUCATION AND ILLNESS PREVENTION FOR THOSE WHO ARE MARGINALLY CHALLENGED AND WITH LIMITED ACCESS TO MAINSTREAM HEALTHCARE SOURCES. 15 12 4000 449 1783374 -618951 15000 77932 377083742 388184639 922416 1824107 15920175 13881384 393941333 403968062 2291229 2080061 0 0 186046960 194282287 0 0 0 198934018 197592305 387272207 393954653 6669126 10013409 329447125 348502285 123917763 47830507 205529362 300671778 X 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 OUR MISSION OF CHRISTIAN HEALING. 0 0 387456566 2080061 386401265 ST. DOMINIC'S AND ITS MISSION - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL (ST. DOMINIC HOSPITAL), A 535-BED ACUTE CARE FACILITY IN JACKSON, MISSISSIPPI, TRACES ITS HISTORY TO 1946, WHEN THE DOMINICAN SISTERS OF SPRINGFIELD, ILLINOIS, PURCHASED THE JACKSON INFIRMARY IN THE CENTER OF THE CITY. THE INFIRMARY WAS THE FOUNDATION FOR A HEALTH SYSTEM THAT TODAY INCLUDES THE ACUTE CARE HOSPITAL, A CONTINUING CARE RETIREMENT COMMUNITY, AND A FULL RANGE OF OUTPATIENT AND COMMUNITY SERVICES. ST. DOMINIC HOSPITAL EMPLOYEES CONTRIBUTE TO COMMUNITY MEMBER WELFARE NOT ONLY THROUGH THE PROVISION OF HEALTH SERVICES BUT ALSO VIA VOLUNTARY COMMUNITY SERVICE AND BY EMPLOYEE FUNDED CHARITABLE CONTRIBUTIONS TO MANY LOCAL ORGANIZATIONS IN NEED. ST. DOMINIC HEALTH SERVICES, INC. (ST. DOMINIC HEALTH SERVICES OR SDHS) SPONSORED BY THE DOMINICAN SISTERS, IS THE PARENT ORGANIZATION OPERATING ST. DOMINIC HOSPITAL AS WELL AS ST. CATHERINE'S VILLAGE, ST. DOMINIC HEALTH SERVICES FOUNDATION, FIRST INTERMED CORPORATION (MEA CLINICS) AND ST. DOMINIC MADISON HEALTH SERVICES, INC. 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.MAJOR PROGRAMS AND ACCOMPLISHMENTS-AS PART OF THE MISSION OF ITS HEALING MINISTRY, ST. DOMINIC'S HAS BECOME ONE OF THE LARGEST EMPLOYERS IN THE AREA, AND THOSE EMPLOYEES, AS WELL AS THE HOSPITAL OPERATIONS, HELP FUEL THE LOCAL ECONOMY. IN 2013 ST. DOMINIC HOSPITAL PROVIDED OVER $1 BILLION (CHARGES) IN HOSPITAL SERVICES IN 2013 TO PATIENTS THROUGHOUT THE CENTRAL REGION OF MISSISSIPPI, AND ST. DOMINIC'S, AS A WHOLE, EMPLOYED OVER 3,300 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, THE CANCER CENTER (AND CANCER SERVICES AS A WHOLE) AND INNOVATIVE AND VARIED SURGICAL SERVICES.MISSISSIPPI HEART AND VASCULAR INSTITUTE-ST. DOMINIC'S IS A LEADING CARDIOVASCULAR PROVIDER IN THE STATE OF MISSISSIPPI. FOR 39 YEARS, ST. DOMINIC'S MISSISSIPPI HEART AND VASCULAR INSTITUTE, THROUGH ITS EXCEPTIONAL TEAM OF SKILLED PHYSICIANS AND STAFF, HAS SERVED THE COMMUNITY AND HAS WORKED DILIGENTLY TO MAKE IT A HEALTH AND WELLNESS CENTER OF EXCELLENCE FOR INTERVENTIONAL CARDIOVASCULAR MEDICINE. THROUGH ST. DOMINIC'S HEALTHY HEART PROGRAM AND OTHER HEALTH SCREENING OPPORTUNITIES AT VARIOUS VENUES, COMMUNITY PUBLIC AWARENESS AND PROGRAM EDUCATION IS ACCOMPLISHED. IN 2013 THIS SCREENING SERVICE WAS CHANGED TO OFFER A MORE COMPREHENSIVE DIAGNOSTIC VIEW OF THE PATIENT'S HEALTH. THIS CHANGE ALONG WITH AN INCREASED FOCUS ON COMMUNITY OUTREACH LED TO 480 INDIVIDUALS RECEIVING SCREENINGS AND IN TURN LED MANY INDIVIDUALS TO EARLY DETECTION OF POTENTIALLY LIFE THREATENING AILMENTS.IN ADDITION TO THE FOCUS ON EARLY DETECTION THROUGH SCREENINGS, ST. DOMINIC HOSPITAL WAS THE FIRST IN THE STATE TO DEVELOP A LEVEL 1 HEART ATTACK PROGRAM SETTING PROTOCOLS THAT TRIGGER A RESPONSE TEAM AND THE ON CALL STAFF FOR THE CATH LAB TO BE READY WHEN A PATIENT EXPERIENCING A HEART ATTACK ARRIVES BY EMERGENCY TRANSPORT.OVER THE YEARS THE FOCUS OF THE INSTITUTE HAS BROADENED TO INCLUDE THE WHOLE VASCULAR SYSTEM, AND A CONCENTRATED EFFORT IN THIS AREA HAS LED TO SOME ENCOURAGING RESULTS. ST. DOMINIC HOSPITAL WAS THE FIRST PROVIDER IN MISSISSIPPI WITH AN ACCREDITED CHEST PAIN CENTER WITH PERCUTANEOUS CORONARY INTERVENTION AND PRIMARY ACUTE STROKE CENTER. ST. DOMINIC HOSPITAL ALSO EARNED THE GOLD SEAL OF APPROVAL FROM THE JOINT COMMISSION FOR PRIMARY STROKE CENTERS. CANCER CENTER AND CANCER SERVICES-ST. DOMINIC'S CANCER PROGRAM IS A LEADER IN COMMUNITY OUTREACH AND EDUCATION ABOUT CANCER. EVERY OCTOBER THE PROGRAM HELPS RAISE AWARENESS FOR EARLY BREAST CANCER DETECTION BY SPONSORING AND HOSTING EDUCATIONAL EVENTS THROUGHOUT ITS PRIMARY SERVICE AREA. AT THESE EVENTS A PINK CAR IS BROUGHT IN FOR SUPPORTERS AND SURVIVORS ALIKE TO SIGN AND SHOW SUPPORT. SURGICAL SERVICES-ST. DOMINIC'S OFFERS A COMPREHENSIVE ARRAY OF TRADITIONAL SURGICAL SERVICES AND IS A MINIMALLY INVASIVE ROBOTIC SURGERY CENTER OF EXCELLENCE. IN 2010 ST. DOMINIC HOSPITAL PREFORMED THE FIRST SURGICAL CASE IN THE STATE USING THE MOST ADVANCED ROBOTICS TECHNOLOGY - THE DA VINCI SI. THIS ROBOT GIVES THE SURGEON BETTER CONTROL, WHICH ALLOWS FOR MORE PRECISE MOVEMENTS AND SMALLER INCISIONS, LESS PAIN AFTER SURGERY AND A VERY FAST RECOVERY IN MOST CASES.PROSTATECTOMY PATIENTS, FOR EXAMPLE, RECOVER MORE COMFORTABLY WHICH HAS DRAMATICALLY IMPROVED THE TREATMENT OF PROSTATE CANCER. IN ADDITION, ROBOTIC SURGERY HAS HELPED DEVELOP PARTIAL NEPHRECTOMY PROCEDURES, WHICH ALLOW ST. DOMINIC'S PHYSICIANS TO REMOVE A PORTION OF A KIDNEY AS OPPOSED TO COMPLETE REMOVAL - WHICH WAS THE PRACTICE IN THE PAST. IN LATE 2011 ST. DOMINIC'S BECAME THE FIRST IN THE STATE TO OFFER SINGLE INCISION ROBOTIC HYSTERECTOMY. THIS ALLOWS FOR ONE INCISION SITE WITH ONLY A TINY SCAR AND A RETURN TO NORMAL FUNCTION MUCH MORE QUICKLY. ST. DOMINIC HOSPITAL ALSO OFFERS ROBOTIC SACROCOLPOPEXY TO HELP WOMEN WHO HAVE EXPERIENCED PROLAPSE OF PELVIC FLOOR ORGANS. THIS MEANS LESS PAIN, LESS SCARRING, LESS BLOOD LOSS AND A SMALLER CHANCE OF INFECTION. SERVING THE COMMUNITYIN 2012 ST. DOMINIC HOSPITAL CONDUCTED A COMPREHENSIVE ASSESSMENT OF THE HEALTH NEEDS OF THE COMMUNITY. THE FINAL RESULTS OF THE STUDY WERE COMPILED AND RELEASED IN EARLY 2013. 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. ST. DOMINIC HOSPITAL'S OVERALL APPROACH TO COMMUNITY BENEFIT IS TO TARGET THE INTERSECTION OF DOCUMENTED UNMET COMMUNITY HEALTH NEEDS AND ST. DOMINIC'S KEY STRENGTHS AND MISSION COMMITMENTS. SPECIFICALLY, MEMBERS OF THE TASK FORCE THAT LED THE DEVELOPMENT OF THE ASSESSMENT IDENTIFIED PRIORITY HEALTH ISSUES IN ST. DOMINIC'S SERVICE AREA BASED ON ITS REVIEW OF DEMOGRAPHIC INFORMATION, FOCUS GROUP SUMMARIES AND RESULTS OF A COMMUNITY SURVEY. THOSE IDENTIFIED PRESSING ISSUES ARE:O OBESITY,O HEART DISEASE, ANDO MENTAL HEALTH NEEDS.ST. DOMINIC'S INTEGRATES ITS COMMITMENT TO COMMUNITY SERVICE INTO ITS MANAGEMENT AND GOVERNANCE STRUCTURES, AS WELL AS ITS STRATEGIC AND OPERATIONAL PLANS, AND MONITORS AND EVALUATES PROGRESS. SPECIFICALLY, ST. DOMINIC'S COMMUNITY BENEFIT PLANS AND THE NEEDS ASSESSMENT ARE WELL INTEGRATED IN ITS STRATEGIC PLANS. FOLLOWING IS A SUMMARY OF INITIATIVES FROM THE 2013-2015 PLAN THAT FOCUSED ON ADDRESSING IDENTIFIED NEEDS FROM THE ASSESSMENT. DISPARITY OR COMMUNITY NEED: OBESITY AND HEART DISEASE; EXPRESSED INITIATIVES IN THE 2013 STRATEGIC PLAN:EXPAND PHYSICIAN NETWORK INTO TARGETED COMMUNITIES IN SERVICE AREA (PRIMARY AND SECONDARY) TO INCREASE ACCESS FOR PATIENTS TO PRIMARY CARE AND NEEDED SPECIALISTS.; RESULTS: ST. DOMINIC HOSPITAL BEGAN CONSTRUCTION ON A NEW FAMILY MEDICINE CLINIC IN BRANDON. THE CLINIC WILL OPEN IN EARLY 2014. ST. DOMINIC'S ALSO INITIATED A DIRECT MAIL CAMPAIGN TO RAISE AWARENESS OF EXISTING CLINIC LOCATIONS TO THE COMMUNITY.DISPARITY OR COMMUNITY NEED: OBESITY AND HEART DISEASE; EXPRESSED INITIATIVES IN THE 2013 STRATEGIC PLAN:EXPAND EDUCATION AND SERVICE SCREENINGS FOR NEUROLOGICAL AND STROKE HEALTH ISSUES TO COMMUNITIES AND PATIENTS IN NEED.; RESULTS: ADDED THREE SPOKE HOSPITALS TO THE TELESTROKE PROGRAM: MONTFORT JONES MEMORIAL HOSPITAL IN KOSCIUSKO, BOLIVAR MEDICAL CENTER IN CLEVELAND AND KING'S DAUGHTERS MEDICAL CENTER IN BROOKHAVEN. ST. DOMINIC'S STROKE COORDINATOR ALSO PROVIDED STROKE EDUCATION TO SEVERAL BUSINESSES AND GROUPS THROUGHOUT THE YEAR, INCLUDING THE STATE CAPITOL, ST. DOMINIC'S NEW DIRECTIONS FOR OVER 55, PEARL COMMUNITY CENTER, LEVI STRAUSS, JACKSON ROTARY CLUB AND THE BOLTON LIBRARY.DISPARITY OR COMMUNITY NEED: OBESITY AND HEART DISEASE; EXPRESSED INITIATIVES IN THE 2013 STRATEGIC PLAN:EXPAND EDUCATION AND SERVICE SCREENINGS FOR CARDIOVASCULAR HEALTH ISSUES TO COMMUNITIES AND PATIENTS IN NEED.; RESULTS: ADDED ANKLE BRACHIAL INDEX AND A CALCIUM SCORING TO THE HEALTHY HEART PROGRAM TESTS. PARTICIPANTS IN 2012 TOTALED 327, AND IN 2013 THE NUMBERS ROSE TO 480.DISPARITY AND COMMUNITY NEED: OBESITY, HEART DISEASE AND ACCESS TO CARE; EXPRESSED INITIATIVES IN THE 2013 STRATEGIC PLAN: EXPAND EDUCATION AND SERVICE SCREENINGS FOR CARDIOVASCULAR HEALTH ISSUES TO COMMUNITIES AND PATIENTS IN NEED.; RESULTS: PARTNERED WITH LOCAL EMPLOYERS TO OFFER ON-SITE HEART AND SKIN CANCER SCREENINGS. THIS NEW OUTREACH PROGRAM CONDUCTED 965 SCREENINGS (INCLUDING MORE THAN 100 SKIN CANCER SCREENINGS) IN 2013.DISPARITY AND COMMUNITY NEEDS: MENTAL HEALTH NEEDS; EXPRESSED INITIATIVES IN THE 2013 STRATEGIC PLAN:COMPLETE NEW STATE-OF-THE-ART PSYCHIATRIC FACILITY (INPATIENT) AND EXPAND ACCESS TO BEHAVIORAL HEALTH SERVICES IN OUTLYING AREAS.; RESULTS: COMPLETED WORK AND OPENED A NEW 77-BED, TWO-STORY, 78,000 SQUARE FOOT FACILITY DEDICATED TO THE TREATMENT OF MENTAL AND BEHAVIORAL ILLNESSES INCLUDING A NEW UNIT FOR GERIATRIC PATIENTS. 387456566 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 0 1 296 0 1 4000 1 1 1 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X JENNIFER SINCLAIR 6012006955 969 LAKELAND DR JACKSON MS 392164699 SR M CORDE LENN DIRECTOR 0.50 X 0 0 0 DAN GRAFTON VICE CHAIRMAN 0.50 X X 0 0 0 SR MARY TRINITA EDDINGTON OP SECRETARY/TREASURER 0.50 40.50 X X 0 0 0 TOD ETHEREDGE DIRECTOR 0.50 X 0 0 0 JEFF FLETCHER MD CHAIRMAN 0.50 X X 0 0 0 WALTER JOHNSON DIRECTOR 0.50 X 0 0 0 EDDIE MALONEY DIRECTOR 0.50 0.50 X 0 0 0 SR M THECLA KUHNLINE OP DIRECTOR 0.50 X 0 0 0 SR M CELESTINE RONDELLI OP DIRECTOR 0.50 X 0 0 0 JAMES S JONES MD DIRECTOR 0.50 X 0 0 0 SR REBECCA ANN GEMMA OP DIRECTOR 0.50 1.00 X 0 0 0 WILLIAM E TEW MD DIRECTOR 0.50 X 0 0 0 DONNA SIMS DIRECTOR 0.50 X 0 0 0 SR KRISTIN REVER OP DIRECTOR 0.50 X 0 0 0 LESTER K DIAMOND PRES.-SEE SCH J FOR ADD'L INFO 40.00 X X 743710 0 31424 JENNIFER SINCLAIR EXEC. VP OPS- SEE J FOR ADD'L INFO 40.00 X 372711 0 20928 MATTHEW FISHER VP FINANCE 40.00 X 200330 0 17026 ROBERT MOBLEY MD EXEC VP- MEDICAL AFFAIRS - PART YEAR 40.00 X 265459 0 27894 KEITH VAN CAMP VP- INFORMATION TECH- SEE SCH J FOR ADD'L INFO 40.00 X 292214 0 20846 STEPHEN BOMGARDNER VP- NURSING 40.00 X 242933 0 28557 BECKY LOWE VP- ANCILLARY SERVICES 40.00 X 218541 0 17695 RAYMOND SWARTZFAGER VP- ANCILLARY SERVICES 40.00 X 217201 0 25712 LORRAINE WASHINGTON VP- HUMAN RESOURCES 24.00 16.00 X 0 234105 27346 MICHAEL L SANDERS EXEC VP- MEDICAL AFFAIRS - PART YEAR 40.00 X 274559 0 27157 HUEY B MCDANIEL MD PHYSICIAN 40.00 X 658489 0 9093 KYLE GORDON MD PHYSICIAN 40.00 X 685857 0 10911 JOHN LANCON MD PHYSICIAN 40.00 X 1265776 0 10911 RONALD KENNEDY MD PHYSICIAN 40.00 X 926706 0 10911 PAUL SEAGO PHYSICIAN 40.00 0.50 X 1064917 0 8823 RALPH E SULSER MD FORMER VICE CHAIRMAN 0.00 X 194633 0 8968 7624036 234105 304202 145 1 1 0 ALLIED EMERGENCY SERVICES PC PO BOX 2120 RIDGELAND MS 39158 ER PHYSICIANS 7891233 PHYSICIANS ANESTHESIA GROUP PA PO BOX 4608 JACKSON MS 39296 CONTRACT MEDICAL SERVICES 2763794 COGENT HEALTHCARE OF JACKSON MS 969 LAKELAND DRIVE JACKSON MS 39216 CONTRACT MEDICAL SERVICES 2646489 HARRELL CONTRACTING GROUP LLC PO BOX 12850 JACKSON MS 39236 CONSTRUCTION SERVICES 2540366 FOUNTAIN CONSTRUCTION CO INC PO BOX 10506 JACKSON MS 39289 CONSTRUCTION SERVICES 2353843 38 75000 2932 77932 PROGRAM REVENUE 621990 383541766 383541766 PHARMACEUTICAL SALES 446110 3807723 2726330 1081393 SPA SALES 812900 835150 133169 701981 388184639 1879663 1879663 4755686 0 4755686 4755686 4755686 167466 223022 -55556 -55556 -55556 MISCELLANEOUS INCOME 900099 4735028 4735028 CAFETERIA SALES 722210 2329727 2329727 DAY CARE CENTER 624410 699116 699116 1361827 1361827 9125698 403968062 386401265 1783374 15705491 2080061 2080061 2827657 2827657 155550736 153759123 1791613 9844141 9557026 287115 15362709 14914640 448069 10697044 10385054 311990 352197 352197 573818 573818 257825 257825 1177498 1177498 4300569 4300569 634092 634092 63432 63432 21369454 21369454 2291230 2291230 SUPPLIES 70161042 70161042 MEDICAL PROFESSIONAL FE 21136834 21136834 PHARMACEUTICAL DRUGS 20470929 20470929 EQUIPMENT RENTAL AND MA 16535630 16535630 38267755 38267755 393954653 387456566 6498087 0 66511158 67872602 49487544 48892187 6928173 7535504 32341392 42188756 432957523 255374581 169912655 177582942 4266203 4430294 329447125 348502285 37375055 34078722 86542708 13751785 123917763 47830507 X 205529362 300671778 205529362 300671778 329447125 348502285 X 10013409 5104763 80024244 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16036 16036 0 PART II-B, LINE 1: ST. DOMINIC-JACKSON MEMORIAL HOSPITAL PAID DUES TO THE MISSISSIPPI HOSPITAL ASSOCIATION. THE MISSISSIPPI HOSPITAL ASSOCIATION REPORTS THAT 11.62% OF THE $138,000 OF DUES PAID WERE RELATED TO POLITICAL AND LOBBYING ACTIVITIES. 18468228 18468228 209021810 129262992 79758818 203925905 126111589 77814316 1541580 1541580 177582942 LIABILITY FOR PENSION BENEFITS 12466474 NOTES PAYABLE 1285311 13751785 X PART X, LINE 2: PER NOTE IN AUDITED CONSOLIDATED FINANCIAL STATEMENTS: ST. DOMINIC-JACKSON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ASC IS TREATED AS A PARTNERSHIP FOR INCOME TAX PURPOSES, AND THEREFORE, NO ASSOCIATED INCOME TAX PROVISION IS REQUIRED IN THE HOSPITAL'S CONSOLIDATED FINANCIAL STATEMENTS. SDIS ACCOUNTS FOR INCOME TAXES USING THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, INCOME TAXES ARE PROVIDED FOR AMOUNTS CURRENTLY PAYABLE AND FOR AMOUNTS DEFERRED AS TAX ASSETS AND LIABILITIES BASED ON DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS AND THE TAX BASES OF EXISTING ASSETS AND LIABILITIES. DEFERRED INCOME TAXES ARE MEASURED USING THE ENACTED TAX RATES THAT ARE ASSUMED WILL BE IN EFFECT WHEN THE DIFFERENCES REVERSE. DEFERRED TAX ASSETS ARE REDUCED BY A VALUATION ALLOWANCE, WHEN, IN THE OPINION OF MANAGEMENT, IT IS MORE-LIKELY-THAN-NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED. SDIS HAD NO DEFERRED TAX ASSETS OR LIABILITIES AT DECEMBER 31, 2013 OR 2012. INCOME TAX EXPENSE FOR SDIS TOTALED $134,746 AND $150,587 FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012, RESPECTIVELY, AND IS INCLUDED IN ADMINISTRATIVE EXPENSES IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. THE HOSPITAL HAS DETERMINED THAT THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2013 OR 2012. IF INTEREST AND PENALTIES ARE INCURRED RELATED TO UNCERTAIN TAX POSITIONS, SUCH AMOUNTS WOULD BE RECOGNIZED IN INCOME TAX EXPENSE. TAX PERIODS FOR ALL FISCAL YEARS AFTER 2009 REMAIN OPEN TO EXAMINATION BY THE FEDERAL AND STATE TAXING JURISDICTIONS TO WHICH THE HOSPITAL IS SUBJECT. 1 1 1 X 1 X 0 1 1 0 1 1 18725048 1966092 16758956 0.04350 52993767 53664930 -671163 0.00000 964998 526619 438379 0.00110 72683813 56157641 16526172 0.04460 1160971 1160971 0.00300 109132 109132 0.00030 10503076 6482733 4020343 0.01040 2090106 2090106 0.00540 13863285 6482733 7380552 0.01910 86547098 62640374 23906724 0.06370 1 9052257 2715677 126083436 136369071 -10285635 X 1 1 1 ST DOMINIC AMBULATORY SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.53520 0.00000 0.46480 1 1 ST DOMINIC - JACKSON MEMORIAL HOSPITAL 969 LAKELAND DRIVE JACKSON MS 392164699 X X X AMBULATORY SURGERY CENTER AND PHYSICIAN CLINICS STDOMINIC- JACKSON MEMORIAL HOSPITAL 1 1 X X X X X X X X 12 1 0 1 X HTTP://WWW.STDOM.COM/GEDOWNLOAD!/CHNAWEB. X X X X X X X 1 0 1 1 200.000000000000 1 350.000000000000 1 X X X X 1 1 X X X X X X 1 X 1 X X X X X X 1 X 0 0 ST.DOMINIC- JACKSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: AS PART OF THE COMMUNITY NEEDS ASSESSMENT, SDHS SPONSORED SIX FOCUS GROUPS. THOSE SIX FOCUS GROUPS INCLUDED INTERNAL COMMUNITY LEADERS, SENIORS AT ST. CATHERINE'S VILLAGE, A CONTINUING CARE FACILTY THAT IS PART OF SDHS, SENIORS FROM THE COMMUNITY, ST. DOMINIC EMPLOYEES AND EXTERNAL COMMUNITY LEADERS. ST.DOMINIC- JACKSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: THE HOSPITAL'S WEBSITE ALSO INFORMS PATIENTS OF THE POLICY. ST.DOMINIC- JACKSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 18E: THE HOSPITAL PROACTIVELY SCREENS PATIENTS FOR FINANCIAL ASSISTANCE ELIGIBILITY IF THERE IS AN INDICATION THAT THE PATIENT MAY QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY. 23 ST DOMINIC AMBULATORY SURGERY CENTER 969 LAKELAND DRIVE JACKSON MS 392164699 OUTPATIENT SURGERY CENTER EAR NOSE & THROAT SURGICAL GROUP AT ST 970 LAKELAND DRIVE SUITE 40 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC INTERNAL MEDICINE GROUP 971 LAKELAND DRIVE SUITE 250 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC NEUROSURGERY ASSOCIATES 971 LAKELAND DRIVE SUITE 657 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S CARDIOVASCULAR SURGERY 971 LAKELAND DRIVE SUITE 657 JACKSON MS 39219 PHYSICIAN CLINIC ST DOMINIC'S GYNECOLOGIC ONCOLOGY 971 LAKELAND DRIVE SUITE 750 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S HOSPITAL MEDICINE 971 LAKELAND DRIVE SUITE 1453 JACKSON MS 39216 HOSPITALIST CLINIC ST DOMINIC'S INFECTIOUS DISEASE 971 LAKELAND DRIVE SUITE 954 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF MADISON HIGHLAND MEDICAL ARTS BUILDING 106 HIGH MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF FLOWOOD 1050 RIVER OAKS DRIVE FLOWOOD MS 39232 PHYSICIAN CLINIC ST DOMINIC'S PSYCHIATRIC ASSOCIATES 969 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 MARTIN SURGICAL ASSOCIATES 971 LAKELAND DRIVE SUITE 211 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S CHRONIC CARE CLINIC 890 LAKELAND DRIVE JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S PAIN MANAGEMENT CENTER 971 LAKELAND DRIVE SUITE 1159 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S CLINIC AT WALMART - PEARL WALMART SUPERCENTER 5520 HWY 80 EAST PEARL MS 39208 PHYSICIAN CLINIC ST DOMINIC'S CLINIC AT WALMART - MADISO WALMART SUPERCENTER 127 GRANDVIEW BLVD MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S CLINIC AT WALMART - CLINTO WALMART SUPERCENTER 950 HWY 80 EAST CLINTON MS 39056 PHYSICIAN CLINIC ST DOMINIC'S EMPLOYEE CLINIC 969 LAKELAND DRIVE JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S NEUROSCIENCE CENTER 971 LAKELAND DRIVE SUITE 557 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM - BROOKHA 427 HWY 51 N BROOKHAVEN MS 39601 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM - MORTON 321 HWY 13 SOUTH MORTON MS 39117 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM - CLEVELA 810 E SUNFLOWER ROAD CLEVELAND MS 38732 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. PART I, LINE 7: ST. DOMINIC HOSPITAL USED A COST-TO-CHARGE RATIO BASED ON WORKSHEET 2. 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 WE SERVE, ST. DOMINIC CONTINUES ITS MINISTRY IN VARIOUS SERVICE LINES THAT ARE NOT PROFITABLE TO THE ORGANIZATION. AN EXAMPLE OF THESE SERVICES INCLUDES BUT IS NOT LIMITED TO THE EMERGENCY DEPARTMENT. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9,052,257. PART II, COMMUNITY BUILDING ACTIVITIES: 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 4: THE FINANCIAL STATEMENT FOOTNOTE READS -- PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR 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 BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS 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 SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS 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 64.4 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012, TO 67.4 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2013. IN ADDITION, THE HOSPITAL'S SELF-PAY BAD DEBT WRITE-OFFS DECREASED FROM $12,219,261 IN 2012 TO $2,067,697 IN 2013. THE HOSPITAL ALSO MAINTAINS ALLOWANCES FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THIRD-PARTY GOVERNMENT PAYORS INCREASED FROM 4.5 PERCENT OF THIRD-PARTY GOVERNMENT ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012, TO 5.3 PERCENT OF THIRD-PARTY GOVERNMENT ACCOUNTS RECEIVABLE AT DECEMBER 31, 2013. IN ADDITION, THE HOSPITAL'S THIRD-PARTY GOVERNMENT BAD DEBT WRITE-OFFS DECREASED FROM $2,383,729 IN 2012 TO $1,209,245 IN 2013. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THIRD-PARTY COMMERCIAL PAYORS DECREASED FROM 5.3 PERCENT OF THIRD-PARTY COMMERCIAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012, TO 4.9 PERCENT OF THIRD-PARTY COMMERCIAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2013. IN ADDITION, THE HOSPITAL'S THIRD-PARTY COMMERCIAL BAD DEBT WRITE-OFFS DECREASED FROM $6,633,899 IN 2012 TO $1,532,238 IN 2013. THE NOTED INCREASES AND DECREASES RESULTED FROM ACTUAL BAD DEBT WRITE-OFFS MADE BY THE HOSPITAL. THEY DO NOT TAKE INTO ACCOUNT THE RESERVES THAT HAVE BEEN PLACED ON EXISTING PATIENT ACCOUNTS RECEIVABLE. THEREFORE, THE EXPENSE ACTUALLY RECOGNIZED BY THE HOSPITAL ON THEIR CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS DOES NOT EQUAL THE BAD DEBT WRITE-OFFS NOTED ABOVE. PART III, LINE 8: N/A - THIS AMOUNT IS NOT 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 USES ARE FULLY INFORMED ABOUT THE HOSPITAL'S FINANCIAL AID POLICY AND ASSIST IN EDUCATING OUR PATIENTS. THEY ROUTINELY SEND FINANCIAL AID APPLICATIONS TO PATIENTS AND REFER THOSE PATIENTS BACK TO THE HOSPITAL'S FINANCIAL COUNSELORS WHEN APPROPRIATE. PART VI, LINE 2: ST. DOMINIC HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING 2012. THE CHNA CAN BE ACCESSED AT:HTTP://WWW.STDOM.COM/GEDOWNLOAD!/CHNAWEB.PDF?ITEM_ID=544018&VERSION_ID=544019 PART VI, LINE 3: ST. DOMINIC HOSPITAL WORKS TO EDUCATE OUR PATIENTS AND COMMUNITY ON ASSISTANCE OPTIONS BY:1-POSTING SIGNAGE IN OUR EMERGENCY ROOM AND OTHER REGISTRATION AREAS INFORMING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE.2-PROVIDING BROCHURES IN OUR WAITING ROOMS AND AT THE REGISTRATION DESKS THAT EXPLAIN THE BILLING AND COLLECTION PROCESS AS WELL AS INFORMATION ABOUT THE HOSPITAL'S 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 HOSPITAL'S 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 NEEDED6-EDUCATING THE EARLY-OUT AND BAD DEBT COLLECTION AGENCIES ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES SO THEY CAN ASSIST PATIENTS WHOM THEY FIND MIGHT HAVE FINANCIAL NEED. PART VI, LINE 4: THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING GEOGRAPHIC AND DEMOGRAPHIC AREAS, IS ADDRESSED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED DURING 2012. THE CHNA CAN BE ACCESSED AT:HTTP://WWW.STDOM.COM/GEDOWNLOAD!/CHNAWEB.PDF?ITEM_ID=544018&VERSION_ID=544019 PART VI, LINE 5: ST. DOMINIC 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 OUR MISSION OF CHRISTIAN HEALING. WE INVOLVE MEMBERS OF OUR COMMUNITY IN OUR GOVERNANCE SO THAT WE MAINTAIN THE FOCUS ON THE NEEDS OF OUR COMMUNITY. WE HAVE AN OPEN MEDICAL STAFF. PART VI, LINE 6: ST. DOMINIC - JACKSON MEMORIAL HOSPITAL IS A FULLY OWNED SUBSIDIARY OF ST. DOMINIC HEALTH SERVICES, INC. AND PROVIDES ONE PIECE OF THE OVERALL COMMUNITY BENEFIT THAT THE ORGANIZATION PROVIDES. PART VI, LINE 7 ST. DOMINIC HOSPITAL (CONSOLIDATED WITH ST. DOMINIC HEALTH SERVICES, INC.) PREPARES ANNUALLY A COMMUNITY BENEFIT REPORT WHICH IS DISTRIBUTED TO KEY MEMBERS OF OUR LOCAL COMMUNITY AND STATE GOVERNMENT BUT THERE ARE CURRENTLY NO REQUIREMENTS TO DO SO IN THE STATE OF MISSISSIPPI. 1 100 BLACK MEN OF JACKSON 5360 HIGHLAND DRIVE JACKSON MS 39286 640817928 501(C)(3) 20000 CHARITABLE SUPPORT BEGINNING AGAIN IN CHRIST PO BOX 26 BRANDON MS 390430026 640592123 501(C)(3) 15000 CHARITABLE SUPPORT BOY SCOUTS OF AMERICA 855 RIVERSIDE DR JACKSON MS 39202 640303071 501(C)(3) 32000 CHARITABLE SUPPORT CATHOLIC CHARITIES 200 N CONGRESS ST JACKSON MS 39201 640468850 501(C)(3) 127500 CHARITABLE SUPPORT CENTER FOR PREVENTION OF VIOLENCE PO BOX 6279 PEARL MS 39288 581959108 501(C)(3) 37500 CHARITABLE SUPPORT COMMUNITY HEALTH SERVICES-ST DOMINIC INC 969 LAKELAND DR JACKSON MS 392164699 640714997 501(C)(3) 150000 AFFILIATE SUPPORT HOSPICE MINISTRIES 450 TOWNE CENTER BOULEVARD RIDGELAND MS 39157 640789919 501(C)(3) 37500 CHARITABLE SUPPORT NEIGHBORHOOD CHRISTIAN CENTER 417 W ASH ST JACKSON MS 39203 640800919 501(C)(3) 18000 CHARITABLE SUPPORT OPERATION SHOESTRING 1711 BAILEY AVENUE JACKSON MS 39283 640471554 501(C)(3) 25000 CHARITABLE SUPPORT REAL CHRISTIAN FOUNDATION PO BOX 180059 RICHLAND MS 39218 640885750 501(C)(3) 40000 CHARITABLE SUPPORT SOUTHERN CHRISTIAN SERVICES 860 EAST RIVER PLACE SUITE 104 JACKSON MS 39202 640758344 501(C)(3) 25000 CHARITABLE SUPPORT THE WINGARD HOME 1279 N WEST STREET JACKSON MS 39202 203861994 501(C)(3) 5000 CHARITABLE SUPPORT TUTWILER COMMUNITY EDUCATION CENTER INC PO BOX 448 TUTWILER MS 38963 581887449 501(C)(3) 10000 CHARITABLE SUPPORT CHRISTIAN MEDICAL AND DENTAL PO BOX 4569 JACKSON MS 39296 362284267 501(C)(3) 5000 CHARITABLE SUPPORT MISSION MISSISSIPPI PO BOX 22655 JACKSON MS 39225 640824240 501(C)(3) 30000 CHARITABLE SUPPORT ST DOMINIC HEALTH SERVICES INC 969 LAKELAND DR JACKSON MS 39216 640714999 501(C)(3) 1500000 DESIGNATED COMMUNITY BENEFIT SUPPORT 16 PART I, LINE 2: THE HOSPITAL HAS A CONTRIBUTIONS COMMITTEE, WHICH IS A SUB-COMMITTEE OF THE BOARD, THAT OVERSEES THE HOSPITAL'S GIVING. THEY MONITOR THE REQUESTS AND OVERSEE ALL GIFTS. X X X X X 0 1 0 0 0 0 0 0 0 LESTER K DIAMOND PRES.-SEE SCH J FOR ADD'L INFO 501415 0 0 0 242295 0 20519 0 10905 0 775134 0 0 0 JENNIFER SINCLAIR EXEC. VP OPS- SEE J FOR ADD'L INFO 341158 0 0 0 31553 0 20519 0 409 0 393639 0 0 0 MATTHEW FISHER VP FINANCE 200330 0 0 0 0 0 6465 0 10561 0 217356 0 0 0 ROBERT MOBLEY MD EXEC VP- MEDICAL AFFAIRS - PART YEAR 200308 0 0 0 65151 0 23244 0 4650 0 293353 0 0 0 KEITH VAN CAMP VP- INFORMATION TECH- SEE SCH J FOR 278238 0 0 0 13976 0 20519 0 327 0 313060 0 0 0 STEPHEN BOMGARDNER VP- NURSING 242933 0 0 0 0 0 19452 0 9105 0 271490 0 0 0 BECKY LOWE VP- ANCILLARY SERVICES 218541 0 0 0 0 0 17523 0 172 0 236236 0 0 0 RAYMOND SWARTZFAGER VP- ANCILLARY SERVICES 217201 0 0 0 0 0 17225 0 8487 0 242913 0 0 0 LORRAINE WASHINGTON VP- HUMAN RESOURCES 0 234105 0 0 0 0 0 18835 0 8511 0 261451 0 0 MICHAEL L SANDERS EXEC VP- MEDICAL AFFAIRS - PART YEAR 274559 0 0 0 0 0 16527 0 10630 0 301716 0 0 0 HUEY B MCDANIEL MD PHYSICIAN 539132 0 88000 0 31357 0 0 0 9093 0 667582 0 0 0 KYLE GORDON MD PHYSICIAN 561736 0 91461 0 32660 0 0 0 10911 0 696768 0 0 0 JOHN LANCON MD PHYSICIAN 1145738 0 59763 0 60275 0 0 0 10911 0 1276687 0 0 0 RONALD KENNEDY MD PHYSICIAN 732577 0 150000 0 44129 0 0 0 10911 0 937617 0 0 0 PAUL SEAGO PHYSICIAN 1014207 0 0 0 50710 0 0 0 8823 0 1073740 0 0 0 RALPH E SULSER MD FORMER VICE CHAIRMAN 172365 0 13000 0 9268 0 0 0 8968 0 203601 0 0 0 PART I, LINE 4B THE EXECUTIVE COMPENSATION COMMITTEE CONDUCTED A MARKET STUDY OF EXECUTIVE RETIREMENT BENEFITS FOR NON-PROFIT HEALTHCARE FACILITIES. AS A RESULT OF THIS STUDY, ST. DOMINIC HEALTH SERVICES, INC TERMINATED THE NON QUALIFIED PENSION RESTORATION PLAN AT 12/31/2012. THE FINAL PAYOUTS FROM THIS PLAN WERE MADE IN THE FIRST QUARTER OF 2013. THE TERMINATED PLAN WAS DESIGNED TO USE THE FORMULA OF THE FINAL AVERAGE PAY PENSION PLAN THAT WAS FROZEN AT THE END 12/31/2012 AS WELL. THE FINAL AVERAGE PAY PLAN WAS REPLACED WITH A CASH BALANCE PLAN THAT PROVIDES A CREDIT EQUAL TO 5% OF BASE SALARY UP TO THE IRS LIMIT (CODE SECTION 401(A)(17). THE TERMINATED RESTORATION PLAN WAS REPLACED WITH A NEW NON QUALIFIED RESTORATION PLAN THAT PROVIDES 5% OF PAY FOR SALARY IN EXCESS OF THE IRS LIMIT (CODE SECTION 401(A)(17). THE NEW PLAN WAS EFFECTIVE FOR THE PLAN YEAR BEGINNING 1/1/2013 WITH INITIAL PAYOUTS IN FIRST QUARTER 2014. FINAL PAYOUTS FROM THE TERMINATED PLAN WERE INCLUDED IN THE FORM W-2 BOX 5 WAGES AND REFLECTED IN OTHER REPORTABLE COMPENSATION ON SCHEDULE J. THESE AMOUNTS ARE: LESTER K. DIAMOND - 240,352 JENNIFER SINCLAIR - 31,553 ROBERT MOBLEY, M.D. - 63,051 KEITH VAN CAMP - 13,976 MELANIE GRAFTON DAUGHTER OF DIRECTOR, DAN GRAFTON 70488 MELANIE GRAFTON IS AN EMPLOYEE OF ST. DOMINIC-JACKSON MEMORIAL HOSPITAL. 0 JACKSON PULMONARY DR. JIMMY JONES, DIRECTOR, IS A GREATER THAN 5% OWNER 674196 HOSPITAL CONTRACTS WITH JACKSON PULMONARY FOR INTENSIVIST SERVICES 0 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 HOSPITAL'S 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 ST. DOMINIC- JACKSON MEMORIAL 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 ST. DOMINIC- JACKSON MEMORIAL HOSPITAL. IF THE ST. DOMINIC- JACKSON MEMORIAL HOSPITAL'S 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, WAS PROVIDED TO THE BOARD AND RATIFIED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO FILL OUT AND SIGN A CONFLICT FORM ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S 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 THE ORGANIZATION'S 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. 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 CHIEF EXECUTIVE OFFICER 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 SHALL ASSIGN 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 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: PENSION TRANSITION ADJUSTMENT PER FAS 158 74,076,234. OTHER INTERCOMPANY TRANSACTIONS 5,948,010. FORM 990, PART XI, LINE 2C THE FINANCE COMMITTEE MEETS, AS NEEDED, AND IS CHARGED WITH REVIEWING THE BUDGET, CURRENT PERFORMANCE, THE AUDIT, AND THE FORM 990. THE FINANCE COMMITTEE MAKES RECOMMENDATIONS THAT ARE THEN TAKEN TO THE FULL BOARD FOR FINAL APPROVAL. ST DOMINIC MEDICAL ASSOCIATES 969 LAKELAND DRIVE JACKSON MS 392164699 261969846 HEALTHCARE MS 43214137 5902685 ST DOMINIC -JACKSON MEMORIAL HOSPITAL ST DOMINIC HEALTH SERVICES FOUNDATION INC 969 LAKELAND DRIVE JACKSON MS 392164699 431992975 OPERATION TO OVERSEE FUNDS FOR ST. DOMINIC HEALTH SERVICES & SUBSIDIARIES MS 501(C)(3) 509(A)(3)(1) ST DOMINIC HEALTH SERVICES INC 0 ST DOMINIC HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON MS 392164699 640714999 OPERATION AS A HOLDING COMPANY TO ACQUIRE OWNERSHIP OF RELATED ENTITY MS 501(C)(3) 509(A)(3)(1) N/A 0 ST CATHERINE'S VILLAGE INC 969 LAKELAND DRIVE JACKSON MS 392164699 640714997 OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY MS 501(C)(3) 170(B)(1)(A) (III) ST DOMINIC HEALTH SERVICES INC 0 COMMUNITY HEALTH SERVICES - ST DOMINIC INC 969 LAKELAND DRIVE JACKSON MS 392164699 640884870 OPERATION TO PROVIDE COMMUNITY HEALTH PROGRAMS MS 501(C)(3) 170(B)(1)(A) (III) ST DOMINIC HEALTH SERVICES INC 0 CONGREGATION OF THE DOMINICAN SISTERS OF SPRINGFIELD ILLINOIS 1237 WEST MONROE ST SPRINGFIELD IL 62704 RELIGIOUS CONGREGATION SPONSORING EDUCATION AND HEALTHCARE INSTITUTIONS IL 501(C)(3) 170(B)(1)(A) (I) N/A 0 ST DOMINIC AMBULATORY SURGERY CENTER LLC 971 LAKELAND DRIVE SUITE 200 JACKSON MS 392164699 640908713 HEALTHCARE MS ST DOMINIC INTEGRATED SERVICES INC RELATED -11254 0 0 0.53520 HIGHLAND MEDICAL ARTS LLC PO BOX 55769 JACKSON MS 39296 743073171 MEDICAL BUILDING RENTAL MS ST DOMINIC MADISON HEALTH SERVICES INC N/A 0 0 D1 SPORTS TRAINING OF MISSISSIPPI LLC 7115 SOUTH SPRINGS DRIVE FRANKLIN TN 37067 275277568 ATHLETIC TRAINING MS ST DOMINIC MADISON HEALTH SERVICES INC N/A 0 0 ST DOMINIC MADISON HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON MS 392164699 202870254 HEALTHCARE MS ST DOMINIC HEALTH SERVICES C 0 FIRST INTERMED 308 CORPORATE DRIVE RIDGELAND MS 39157 640824796 HEALTHCARE MS ST DOMINIC HEALTH SERVICES C 0 PHYSICIANSPLUS BAPTIST & ST DOMINIC INC 969 LAKELAND DRIVE JACKSON MS 392164699 640889895 HEALTHCARE MS N/A C 0 ST DOMINIC INTEGRATED SERVICES INC 969 LAKELAND DRIVE JACKSON MS 392164699 271493623 INVESTMENT IN MEDICAL MS ST DOMINIC JACKSON MEMORIAL HOSPITAL C 320186 2398313 1.00000 1 0 1 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 0 ST DOMINIC INTEGRATED SERVICES INC Q 24739 CASH