2014-05-14T16:58:34-05:00 2013-06-30 BKD LLP 2800 POST OAK BLVD SUITE 3200 HOUSTON TX 77056 990 2012-07-01 710329353 Jefferson Hospital Association Inc % BRYAN G JACKSON JEFF 8705417100 1600 West 40th Avenue Suite Pine Bluff AR 71603 BRYAN G JACKSON 8705417100 2014-05-15 true 7134994600 2012 2015-11-30 17:44:51Z WALTER JOHNSON 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 180717129 false X WWW.JRMC.ORG X 1959 AR JEFFERSON HOSPITAL ASSOCIATION, INC. PROVIDES A WIDE RANGE OF HEALTH CARE SERVICES TO PATIENTS FROM JEFFERSON COUNTY AND SURROUNDING AREAS IN SOUTHEAST ARKANSAS. 15 5 2214 61 166172 -34992 1419947 1537684 176078282 170702750 2465169 3533843 8839559 4842247 188802957 180616524 366572 554025 0 0 89619300 93907944 0 0 0 90215463 85872702 180201335 180334671 8601622 281853 241797556 243604272 64420486 63603958 177377070 180000314 X JEFFERSON REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDING MEASURABLE QUALITY HEALTH SERVICES IN A CARING ENVironMENT, WHICH FULFILL THE NEEDS OF OUR PATIENTS, PHYSICIANS, EMPLOYERS, EMPLOYEES AND COMMUNITY. false false 162371826 554025 170702750 Jefferson Hospital Association, Inc. (JHA) operates Jefferson Regional Medical Center (JRMC), a 471 bed tertiary care facility located in Southeast Arkansas that serves a population base of 222,000 people living in 11 counties. JRMC is a not-for-profit, sole community hospital, licensed by the Arkansas State Health Department and accredited by the Joint Commission on Accreditation of Healthcare Organizations. JRMC has a long tradition of providing significant benefits to our community which is rooted in our Mission, "To provide measurable quality health services in a caring environment which fulfill the needs of our patients, physicians, employers, employees and community" and Vision, "To be widely recognized as the health care leader and referral center of choice for South Arkansas by providing quality health care services in a cost effective manner." During fiscal year 2013, JRMC conducted a Community Health Needs Assessment (CHNA) and adopted an implementation strategy to address the needs of the community, in accordance with IRS Code Section 501(r)(3). In many cases, JRMC and other organizations already addressed community health needs of Southeast Arkansas, but conducting the CHNA gave JRMC the opportunity to study health care needs, with input from various sources, which confirmed our continued and important role in the community. We are proud that we can continue to provide leading healthcare services to everyone in Southeast Arkansas, regardless of ability to pay. JRMC provides several centers of excellence providing a wide range of programs and medical services. These include Cardiology, Surgery, Critical Care, Rehabilitation, Psychiatry, Laboratory, Gastroenterology, Orthopedics, Neurology, Emergency, Obstetrics/Gynecology, Radiology, Hospice, and many more. We operate an emergency room that is open to all persons regardless of ability to pay; have an open medical staff with privileges available to all qualified physicians in the area; have a governing body comprised of individuals who are representative of the community; engages in the training and education of health care professionals; and participates in Medicaid, Medicare CHAMPUS, Tricare and/or other government-sponsored health care programs. JRMC also operates and manages several satellite clinics which provide primary and specialty healthcare to the community and outlying areas. Community service and education continue to be a significant part of our mission. JRMC provides numerous sponsorships within the community, and offers dozens of free health screenings and educational events each year. Not only is information shared about healthcare related issues, but participants are given the opportunity to visit one-on-one with physicians and other healthcare professionals. We believe everyone in Southeast Arkansas is impacted, either directly or indirectly, through the community health efforts and community building activities championed by JRMC. Our commitment to bring new and innovative programs and services to Southeast Arkansas is evident. During fiscal year 2013, JRMC invested approximately $6 million in capital additions and improvements to our facilities and equipment. This was accomplished by connecting thoughtful, deliberate, disciplined planning, budgeting and spending with the need to provide state-of-the-art technologies in a caring environment. JRMC continues to be a leader in electronic medical record system advancement, continuing to meet Stage 1 meaningful use requirements set forth as part of The American Recovery and Reinvestment Act of 2009. Since the beginning of the program, JRMC has received monetary incentives from the Arkansas Medicaid quality program by achieving performance goals in quality, documentation and validation excellence. Our organization was recognized for entering outcomes measure data in ALL APPICABLE AREAS, and improving patient safety and quality as part of the AHA/HRET Hospital Engagement Network Program. JRMC continues to participate in the HCAHPS Patient Perspectives on Care. We have chosen the phone methodology which ensures a higher response rate in our service area. We continually analyze the HCAHPS survey results and make adjustments, when needed, to improve the overall patient experience at JRMC. During the past several years, the Board of Directors via its Audit Committee has focused on maintaining recommendations made by Fitch rating which urged not-for-profit healthcare providers to adopt nine specific provisions of Sarbanes-Oxley Compliance. During this period we have continued to maintain compliance with all nine of the Fitch/SOX provisions. These include: Prohibition of Specified Non-Audit Services by Auditors, Five Year Audit Partner Rotation, Auditor Communications, Audit Committee Standards, Management Certification of Financial Statements, Bonus Forfeiture, Adoption of a Code of Ethics, Audit Committee Financial Expert, and Internal Control Evaluation. In addition to the complete adoption of the Fitch/Sox provisions, the JHA Board of Directors has undertaken a comprehensive self-assessment regarding its not-for-profit status utilizing a compliance check tool and proposed guidelines published by the IRS. JHA has no reason to believe its tax exempt status has ever been in jeopardy. This initiative is part of a larger compliance program intended to ensure JHA continually self evaluates its regulatory compliance. Today's public demands more information in a fully transparent manner. To be transparent, we must provide information openly, candidly, and accurately. We provide information on the following topics: inpatient pricing, outpatient pricing, quality outcomes, and patient satisfaction. This goes over and beyond the efforts and requirements of the Arkansas Hospital Association and American Hospital Association. The complete information can be viewed at www.jrmc.org. 162371826 true true false true false false false false false false true false false true true false false true false false false false false false false false true true true true true true false false false false false false false true true true false false false false false true true true false false true 196 0 true 2214 true true true false false false false false false false false false X 15 5 true false false false true true false true true false false true true true true true true true true true true X BRYAN G JACKSON 8705417100 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 X FRANK ANTHONY 1.0 0.0 X 0 0 0 DREW ATKINSON 1.0 0.0 X 0 0 JERREL BOAST 1.0 0.0 X 0 0 DAVID BROWN 1.0 0.0 X JAMES A CAMPBELL MD 1.0 0.0 X MARTY CASTEEL 1.0 0.0 X X MICHELLE ECKERT MD FACS 1.0 0.0 X 111721 ANNETTE KLINE 1.0 0.0 X GEORGE MAKRIS 1.0 0.0 X X JOANN B MAYS MD 1.0 0.0 X CHUCK MORGAN 1.0 0.0 X X SCOTT PITTILLO 1.0 0.0 X CLIFTON ROAF DDS 1.0 0.0 X HENRY FORD TROTTER III 1.0 0.0 X OT GORDON MD 15.0 0.0 X 27500 WALTER JOHNSON 40.0 0.0 X X 745414 28546 THOMAS HARBUCK 40.0 0.0 X 629962 31146 BRIAN THOMAS 40.0 0.0 X 376350 29326 BRYAN G JACKSON 40.0 0.0 X 285559 79411 LOUISE HICKMAN 40.0 0.0 X 315878 27526 AARON KUPERMAN 40.0 0.0 X 429828 17398 ALI ALNASHIF 40.0 0.0 X 441660 22933 CHARLES HOFFLER 40.0 0.0 X 486602 24595 JAMES ALAN POLLARD 40.0 0.0 X 476765 23633 JOHN O LYTLE 40.0 0.0 X 762630 33763 5089869 0 318277 64 false true false EMURGENT CARE INC 8 SHACKLEFORD PLAZA LITTLE ROCK AR 72211 PHYSICIAN SERVICES 3766608 REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 63150 THERAPY SERVICES 3119182 SODEXHO INC AFFILIATES PO BOX 536922 ATLANTA GA 30353 NUTRITIONAL SERVICES 2646126 UAMS - AHEC 4010 MULBERRY ST PINE BLUFF AR 71603 PHYSICIAN SERVICES 1980428 JEFFERSON ANESTHESIOLOGY PO BOX 1272 PINE BLUFF AR 71613 PROFESSIONAL SERVICE 1855987 51 X 1140454 397230 1537684 PATIENT SERVICE REVENUE 621400 169040483 169040483 EHR INCENTIVE REVENUE 900099 1662267 1662267 170702750 3511372 13572 3497800 0 0 545425 545425 0 545425 2400 543025 106397 10410 52212 42124 54185 -31714 22471 22471 13536 6269 7267 7267 0 0 CAFETERIA 722320 1289901 1289901 WELLNESS CENTER 713940 944510 944510 PATHOLOGY/OUTSIDE LAB BILLING 900099 150200 150200 1904944 1904944 4289555 180616524 170702750 166172 8209918 X 122361 122361 431664 431664 0 0 2892759 383275 2509484 210297 189395 20902 75650500 68407156 7243344 2411285 2110875 300410 7198313 6267958 930355 5544790 4853991 690799 4144967 3757631 387336 219331 145560 73771 194770 194770 0 0 0 26408832 24114965 2293867 69645 20492 49153 6438344 4570728 1867616 1529168 1276235 252933 0 2594269 2340990 253279 308494 190566 117928 0 173135 156941 16194 995673 958061 37612 0 8883258 8547685 335573 1999743 1954552 45191 DUES & FEES 443748 170465 273283 MEDICAL SUPPLIES 27014637 27014637 PAYMENTS TO RELATED PARTIES 1774546 1735000 39546 LICENSES & TAXES 2683074 2660831 22243 -2932 -10188 7256 180334671 162371826 17962845 0 18572418 -361052 0 10893481 0 0 22929527 23934247 0 0 0 0 1812431 1467006 4941179 4724705 2797891 2999683 200791469 145320665 58914277 55470804 97514664 108576141 2278826 2220107 0 0 0 0 32036343 33679150 241797556 243604272 34845472 35871605 0 0 3355512 2714498 25483245 24181006 0 0 0 0 0 0 0 0 736257 836849 64420486 63603958 X 177377070 180000314 0 0 0 0 177377070 180000314 241797556 243604272 281853 1756352 585039 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 0 false true 28721 28721 false LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1I A PORTION OF DUES PAID TO ARKANSAS HOSPITAL ASSOCIATION and AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING EXPENSES. Additional lobbying expenses were paid to McDermott Will & Emory for the Sole Community Hospital Coalition and related media advocacy. 4805853 4805853 82610077 55956339 26653738 1739592 1323880 415712 110504787 88040446 22464341 1131160 1131160 55470804 DEFERRED FINANCING COSTS 547498 457 PLAN - FMV 836849 DUE FROM AFFILIATES 32294803 33679150 0 457 PLAN 836849 836849 true true X true X true X true true true false true true 8257 13009395 13009395 0.07210 10832 1985951 1985951 0.01100 19089 14995346 14995346 0.08310 81125 8400 72725 0.00040 6284747 2527443 3757304 0.02080 2951871 908583 2043288 0.01130 554025 431664 122361 0.00070 9871768 3876090 5995678 0.03320 19089 24867114 3876090 20991024 0.11630 201515 1381 200134 0.00110 201515 1381 200134 0.00110 true 10910082 0 56190930 57699479 -1508549 X true true JEFFERSON SURGERY CENTER PLLC AMBULATORY SURGERY CENTER 0.61000 0.02000 0.37000 1 1 JEFFERSON REGIONAL MEDICAL CENTER

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PHYSICIAN CLINIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6B THE ORGANIZATION MAKES ITS ANNUAL COMMUNITY BENEFIT REPORT AVAILABLE ON THE ORGANIZATION'S WEBSITE and UPON REQUEST. COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. BAD DEBT METHODOLOGY SCHEDULE H, PART III, LINE 2 THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE SCHEDULE H, PART III, LINE 3 THE ORGANIZATION HAS ESTIMATED THE AMOUNT OF BAD DEBT EXPENSE OTHERWISE ATTRIBUTABLE TO ACCOUNTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE UTILIZING HISTORIC INFORMATION AND HAS EXCLUDED THESE AMOUNTS FROM BAD DEBT EXPENSE, OFFSETTING NET PATIENT SERVICE REVENUE ACCORDINGLY. BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Association analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Association analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Association records a significant provision for uncollectible accounts 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 or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. For the years ended June 30, 2013 and 2012, there were no significant changes in the underlying assumptions used in estimating the allowance for uncollectible and charity accounts or in the policies regarding uncollectible accounts for charity care. MEDICARE SHORTFALL and costing methodology SCHEDULE H, PART III, LINE 8 THE ORGANIZATION MAINTAINS A COST ACCOUNTING SYSTEM THAT COMPUTES COSTS AT THE PATIENT LEVEL. THE COSTING METHODOLOGIES ARE APPLIED TO THE ORGANIZATION'S MEDICARE PATIENTS TO DETERMINE THE COST OF PROVIDING CARE. AS A SAFETY NET HOSPITAL, THE ORGANIZATION PROVIDES CARE TO ALL PATIENTS REGARDLESS OF SOURCE OF PAYMENT; THEREFORE, COSTS TO PROVIDE CARE TO MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT TO THE EXTENT COSTS EXCEED MEDICARE REIMBURSEMENT. COLLECTIONS POLICY SCHEDULE H, PART III, LINE 9B PATIENT ACCOUNTS QUALIFYING FOR CHARITY CARE WOULD NOT INTENTIONALLY BE PLACED WITH A DEBT COLLECTION SERVICE. FROM TIME TO TIME, INFORMATION THAT RESULTS IN THE DETERMINATION OF CHARITY QUALIFICATION IS OBTAINED SUBSEQUENT TO A PATIENTS ACCOUNT BEING PLACED WITH A DEBT COLLECTION AGENCY. THE ORGANIZATIONS "COLLECTION AGENCY POLICY" REQUIRES CONTRACTED COLLECTION AGENTS, IN ADDITION TO MANY OTHER PRUDENT PROCEDURES, TO INFORM THE DEBTOR OF THE APPROPRIATE HOSPITAL FINANCIAL ASSISTANCE PROFESSIONAL TO CONTACT IF THE COLLECTION AGENT IS MADE AWARE OF A PATIENTS FINANCIAL HARDSHIP. THE COLLECTION AGENT IS ALSO REQUIRED TO NOTIFY THE ORGANIZATION OF THE PATIENTS FINANCIAL HARDSHIP SO THE ORGANIZATION CAN ASSIST THE PATIENT IN ACCESSING THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAMS. FINANCIAL ASSISTANCE POLICY ELIGIBILITY SCHEDULE H, PART V, SECTION B, LINE 20 AMOUNTS CHARGED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY ARE DETERMINED BASED ON A SLIDING-SCALE THAT CONSIDERS INCOME AS COMPARED TO FEDERAL POVERTY GUIDeLINES. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 A FINANCIAL COUNSELOR INITIATES A FINANCIAL SCREENING ON ALL INPATIENTS, OBSERVATION PATIENTS AND OUTPATIENTS OCCUPYING A BED HAVING NO INSURANCE INDICATED ON THEIR ACCOUNT. THIS PROCESS INCLUDES SCREENING FOR CHARITY CARE ASSISTANCE, MEDICAID COVERAGE AND OTHER THIRD PARTY COVERAGE. OUTPATIENTS RECEIVE A FINANCIAL ASSISTANCE GUIDE SHEET SUMMARIZING ASSISTANCE OFFERED BY JRMC AT THE TIME OF REGISTRATION. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 THIS IS NOT APPLICABLE FOR TAX YEAR 2012. STATE FILING of COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 ARKANSAS CONSULTING REPRESENTATIVES OF THE COMMUNITY SCHEDULE H, PART V, SECTION B, LINE 3 THE HOSPITAL took into account input from all three groups outlined in IRS notice 2011-52. The hospital consulted individuals from the following organizations: the Center for Business and Economic Research, SAM M. WALTON COLLEGE OF BUSINESS,UNIVERSITY OF ARKANSAS; the Arkansas Department of Health; and the Centers for Medicare and Medicaid Services. The hospital also engaged FIVE focus groups with business and Community leaders, Health care Consumers, Southeast Arkansas community members, and Physicians from its primary and secondary service areas. There were over 100 individuals consulted. Their names can be found in the chna report. Needs not addressed From CHNA Schedule H, part v, section b, Line 7 ONE COMMUNITY HEALTH NEED IDENTIFIED IN THE CHNA WAS DETERMINED TO BE OUTSIDE THE SCOPE OF THE ORGANIZATION. OTHER ORGANIZATIONS, INCLUDING THE ARKANSAS DEPARTMENT OF HEALTH, SCHOOLS AND OTHER HEALTHCARE ORGANIZATIONS HAVE TAKEN ON THE RESPONSIBILITY OF EDUCATION AND PREVENTION OF SEXUALLY TRANSMITTED DISEASES IN THE YOUTH OF THE COMMUNITY. true UNIVERSITY OF AR - PINE BLUFF 1200 N UNIVERSITY MAIL SLOT 4891 PINE BLUFF AR 71601 716010030 501(C)(3) 50000 SPONSORSHIPS 2011-2012 AND 2010-2011 UNITED WAY OF SE ARKANSAS PO BOX 8702 PINE BLUFF AR 71611 710236869 501(C)(3) 44485 2011 CAMPAIGN PLEDGE ARTS & SCIENCE CENTER FOR SE ARKANSAS 701 MAIN STREET PINE BLUFF AR 71601 710401966 501(C)(3) 15000 PROGRAM SPONSORSHIP 3 FEDERAL PELL GRANT (US DEPT OF EDUCATION) 73 349979 ACADEMIC CHALLENGE SCHOLARSHIPS (STATE OF AR) 3 5250 REHABILITATION GRANTS (STATE OF AR) 12 33701 WIA ADULT PROGRAM GRANTS (US DEPT OF LABOR) 15 24134 GO! OPPORTUNITIES GRANTS (STATE OF AR) 12 5250 PROCEDURES FOR MONITORING GRANTS SCHEDULE I, PART I, LINE 2 JEFFERSON HOSPITAL ASSOCIATION, INC. MAINTAINED RECORDS TO SUBSTANTIATE THE AMOUNT OF THE GRANTS OR ASSISTANCE, THE GRANTEES' ELIGIBILITY FOR THE GRANTS OR ASSISTANCE, AND THE SELECTION CRITERIA USED TO AWARD GRANTS OR ASSISTANCE. DIFFERENCE BETWEEN SCHEDULE I AND STATEMENT OF FUNCTIONAL EXPENSES FORM 990, PART IX, LINE 1 & SCHEDULE I, PART II, LINE 1 THE ORGANIZATION IS REPORTING THE CONTRIBUTIONS PAID ON SCHEDULE I, WHICH IS NOT NECESSARILY ON THE ACCRUAL BASIS BECAUSE THE ORGANIZATION RECORDS LONG-TERM PLEDGES AT THEIR NPV AND RECORDS ACCRETION OF INTEREST OVER TIME. THE PLEDGES, WHEN PAID, ARE A REDUCTION OF THIS LIABILITY AND NOT CURRENT YEAR EXPENSE WHICH MAY CAUSE A DIFFERENCE BETWEEN AMOUNT REPORTED ON FORM 990, PAGE 10 AND SCHEDULE I, PART II. X X X false true X X X X X false true false false false false false true false WALTER JOHNSON 367243 109200 268971 10794 0 20164 0 776372 0 0 0 THOMAS HARBUCK 317216 99053 213693 10794 0 22600 0 663356 0 0 0 BRIAN THOMAS 228007 56517 91826 10794 0 20369 0 407513 0 0 0 BRYAN G JACKSON 189931 45000 50628 60359 0 20565 0 366483 0 0 0 LOUISE HICKMAN 167172 41408 107298 10794 0 18113 0 344785 0 0 0 AARON KUPERMAN 314658 98004 17166 10669 0 8162 0 448659 0 0 0 ALI ALNASHIF 408321 16000 17339 10794 0 14513 0 466967 0 0 0 CHARLES HOFFLER 433180 51823 1599 4905 0 21316 0 512823 0 0 0 JAMES ALAN POLLARD 298120 166696 11949 11114 0 13976 0 501855 0 0 0 JOHN O LYTLE 223646 516388 22596 10794 0 24548 0 797972 0 0 0 SCHEDULE J, PART I, LINE 1A - Tax gross-up payments are included in the supplemental nonqualified retirement plan identified below. - A discretionary spending account is provided for the CEO. - COUNTRY CLUB MEMBERSHIPS ARE MAINTAINED BY THE ORGANIZATION FOR THE USE OF SPECIFIC EMPLOYEES AS DESIGNATED BY THE BOARD OF DIRECTORS. SCHEDULE J, PART I, LINE 1B There is no written policy regarding provision of country club memberships. The Board of Directors designates which employees may use memberships maintained by the organization. PARTICIPANTS IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN SERP PLAN REPORTED IN W-2 -------------------------- ----------------- WALTER JOHNSON $122,422 THOMAS HARBUCK $104,699 BRIAN THOMAS $49,671 LOUISE HICKMAN $52,868 BRYAN JACKSON NONE NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 THE ORGANIZATION PROVIDES DEFINED MEMBERS OF MANAGEMENT A NON-FIXED PERFORMANCE BASED INCENTIVE PLAN. THE PLANS COMPONENTS ARE ESTABLISHED AND EVALUATED BY THE ORGANIZATIONS EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. A JEFFERSON COUNTY AR 716009958 472705DF6 2011-12-15 26013416 REFUND 2001 BONDS false false false A 510000 0 26013416 0 0 25395168 372172 246076 0 0 0 0 2012 true false false true A false false false false 0 false false false true A false true false false false false 0 false 0 false true A true RICHARD MORGAN See Schedule O. 0 See Schedule O. false Simmons First National Bank See Schedule O. 0 See Schedule O. false CENTRAL MOLONEY See Schedule O. 0 See Schedule O. false LINDSAY MAKRIS See Schedule O. 0 See Schedule O. false ARKANSAS HOSPITAL ASSOCIATION See Schedule O. 0 See Schedule O. false REBECCA PITTILLO See Schedule O. 0 See Schedule O. false STRONG MANUFACTURING See Schedule O. 0 See Schedule O. false DELEGATION OF AUTHORITY FORM 990, PART VI, SECTION A, LINE 1A AN EXECUTIVE COMMITTEE MAY BE ELECTED BY THE BOARD OF DIRECTORS TO CONSIST OF NOT LESS THAN THREE DIRECTORS. THE COMMITTEE IS ABLE TO EXERCISE ALL AUTHORITY OF THE BOARD DURING INTERVALS BETWEEN MEETINGS OF THE BOARD WITH RESPECT TO THE AFFAIRS OF THE CORPORATION, BUT SHALL BE SUBJECT TO THE CONTROL AND DIRECTION OF THE FULL BOARD. THE COMMITTEE SHALL ALSO CONDUCT AN EVALUATION OF THE CHIEF EXECUTIVE OFFICER ANNUALLY FOR THE FULL BOARD OF DIRECTORS TO REVIEW. RELATIONSHIPS OF OFFICERS, DIRECTORS, AND TRUSTEES FORM 990, PART VI, SECTION A, LINE 2 Chuck Morgan (JHA Director) and Annette Kline (JHA Director) have a business relationship. Marty Casteel (JHA Director) and Dr. Clifton Roaf (JHA Director) have a business relationship. George Makris (JHA Director) and Dr. Clifton Roaf (JHA Director) have a business relationship. George Makris (JHA Director) and Marty Casteel (JHA Director) have a business relationship. H. Ford Trotter III (JHA Director) and Dr. Clifton Roaf (JHA Director) have a business relationship. H. Ford Trotter III (JHA Director) and Marty Casteel (JHA Director) have a business relationship. H. Ford Trotter III (JHA Director) and George Makris (JHA Director) have business relationships. H. Ford Trotter III (JHA Director) and David Brown (JHA Director) have a business relationship. H. Ford Trotter III (JHA Director) and Walter Johnson (JHA President and CEO) have a business relationship. George Makris (JHA Director) and David Brown (JHA Director) have a business relationship. Frank Anthony (JHA Director) and Walter Johnson (JHA President and CEO) have a business relationship. Marty Casteel (JHA Director) and Chuck Morgan (JHA Director) have a business relationship. Scott Pittillo (JHA Director) and Annette Kline (JHA Director) have a business relationship. Scott Pittillo (JHA Director) and Chuck Morgan (JHA Director) have a business relationship. Drew Atkinson (JHA Director) and Frank Anthony (JHA Director) have a business relationship. Drew Atkinson (JHA Director) and Walter Johnson (JHA President & CEO) have a business relationship. BRYAN JACKSON (JHA OFFICER) AND FRANK ANTHONY (JHA DIRECTOR) HAVE A BUSINESS RELATIONSHIP. BRYAN JACKSON (JHA OFFICER) AND DREW ATKINSON (JHA DIRECTOR) HAVE A BUSINESS RELATIONSHIP. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A MEMBERSHIP CONSISTING OF 30 JEFFERSON COUNTY ARKANSAS RESIDENTS. POWER TO ELECT OR APPOINT MEMBERS OF GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERSHIP OF THE ORGANIZATION HAS THE RESPONSIBILITY OF ELECTING THE BOARD OF DIRECTORS AT THE ANNUAL MEMBERSHIP MEETING. DESCRIBE PROCESS TO REVIEW FORM 990 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND FORM 990-T ARE PREPARED AND REVIEWED UNDER THE DIRECTION OF THE CHIEF FINANCIAL OFFICER. FINAL DRAFTS OF THE RETURNS ARE PRESENTED TO THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS, WHICH IS DESIGNATED BY THE BOARD OF DIRECTORS TO FULFILL THE FIDUCIARY RESPONSIBILITY OF THE GOVERNING BODY TO REVIEW AND APPROVE THE RETURNS BEFORE THEY ARE FILED WITH THE IRS. AFTER ANY FINAL REVISIONS ARE MADE AND THE RETURNS ARE APPROVED BY THE GOVERNANCE COMMITTEE AND THE BOARD OF DIRECTORS, A FINAL VERSION IS POSTED TO AN INTERNAL SECURE WEBSITE WITH A LINK E-MAILED TO EACH VOTING MEMBER OF THE BOARD OF DIRECTORS. MONITOR AND ENFORCEMENT OF COMPLIANCE WITH POLICIES FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES NOT ONLY AN ANNUAL CONFLICT OF INTEREST DISCLOSURE, BUT ALSO disclosure WHEN SITUATIONS SUBSEQUENT TO THE ANNUAL DISCLOSURE DEVELOP THAT WOULD POTENTIALLY PLACE THE INDIVIDUAL IN A CONFLICT OF INTEREST. IN THOSE SITUATIONS, IMMEDIATE DISCLOSURE IS REQUIRED. THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS CONDUCTS THE ANNUAL REVIEW OF CONFLICT OF INTEREST DISCLOSURES. IN THE EVENT THE GOVERNANCE COMMITTEE DETERMINES THAT A CONFLICT EXISTS, LEGAL COUNSEL IS CONSULTED. IF LEGAL COUNSEL DETERMINES THAT A CONFLICT EXISTS, THE PERSON IS INFORMED AND THE MATTER IS REPORTED TO THE BOARD FOR ACTION. ANY DIRECTOR OR OFFICER WHOSE TRANSACTIONS ARE BEING REVIEWED WOULD ABSENT HIMSELF/HERSELF FROM THE REVIEW. COMPENSATION OF CEO AND OTHER OFFICERS FORM 990, PART VI, SECTION B, LINE 15A & 15B THE BOARD OF DIRECTORS HAS ESTABLISHED A SEPARATE COMPENSATION COMMITTEE CHARGED WITH PERFORMING AN ANNUAL PERFORMANCE AND COMPENSATION REVIEW OF THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE MOST RECENTLY ENGAGED A THIRD-PARTY GLOBAL HUMAN CAPITAL CONSULTING FIRM IN 2012 TO DEVELOP AND MAINTAIN A COMPENSATION PACKAGE THAT IS REASONABLE AS COMPARED TO SIMILAR POSITIONS AT NON-PROFIT HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY. THE COMPENSATION COMMITTEE THEN MAKES A REPORT TO THE FULL BOARD OF DIRECTORS OF ANY COMPENSATION ADJUSTMENTS. AVAILABILITY OF DOCUMENTS TO THE PUBLIC FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND OTHER DOCUMENTS TO ALL WHO REQUEST ONE OR MORE OF THE ITEMS. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G PHYSICIAN FEES $9,805,127 PURCHASED SERVICES $8,539,086 PROFESSIONAL FEES $3,082,196 CONTRACT LABOR $2,232,828 OTHER FEES $2,749,595 ------------- TOTAL $26,408,832 BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV, COLUMNS B, C, & D (A) NAME OF PERSON: RICHARD MORGAN (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF CHUCK MORGAN (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC (A) NAME OF PERSON: SIMMONS FIRST NATIONAL BANK AND/OR SIMMONS FIRST NATIONAL CORPORATION (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: ENTITY IN WHICH DR. CLIFTON ROAF, MARTY CASTEEL, GEORGE MAKRIS AND FORD TROTTER III ARE OFFICERS OR DIRECTORS (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $100,000 (D) DESCRIPTION OF TRANSACTION: INTEREST INCOME & BANK/TRUSTEE FEES (A) NAME OF PERSON: CENTRAL MOLONEY (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: ENTITY IN WHICH CHUCK MORGAN (JHA DIRECTOR) IS AN OFFICER (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $100,000 (D) DESCRIPTION OF TRANSACTION: HEALTH CARE PAYMENTS (A) NAME OF PERSON: LINDSAY MAKRIS (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF GEORGE MAKRIS (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC (A) NAME OF PERSON: ARKANSAS HOSPITAL ASSOCIATION (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: WALTER JOHNSON (JHA PRESIDENT & CEO) IS A BOARD MEMBER (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $100,000 (D) DESCRIPTION OF TRANSACTION: HOSPITAL MEMBERSHIP DUES (A) NAME OF PERSON: REBECCA PITTILLO (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF SCOTT PITTILLO (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC (A) NAME OF PERSON: STRONG MANUFACTURING (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: ENTITY IN WHICH ANNETTE KLINE (JHA DIRECTOR) IS AN OFFICER (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $100,000 (D) DESCRIPTION OF TRANSACTION: HEALTH CARE PAYMENTS JEFFERSON SURGERY CENTER PLLC 1600 W 40TH AVE PINE BLUFF AR 71603 710810564 AMB SURGERY AR JHA RELATED 264729 1232757 false 0 true 0.61000 JRMC DEVELOPMENT INC 1600 W 40TH AVE PINE BLUFF AR 71603 710664723 REAL ESTATE MGMT AR JHA C CORP -125526 16843494 1.00000 true JEFFERSON MANAGEMENT SERVICES INC 1600 W 40TH AVE PINE BLUFF AR 71603 710582753 PHYS PRACTICE MGT AR JHA C CORP 0 886189 1.00000 true true false false false false false false false false false true true true false false false false true true JRMC DEVELOPMENT INC A 1633688 G/L ACTIVITY JRMC DEVELOPMENT INC R 314346 G/L ACTIVITY JRMC DEVELOPMENT INC S 444104 G/L ACTIVITY JRMC DEVELOPMENT INC K 679790 G/L ACTIVITY JRMC DEVELOPMENT INC L 365444 G/L ACTIVITY JEFFERSON MANAGEMENT SERVICES INC L 285013 G/L ACTIVITY JEFFERSON MANAGEMENT SERVICES INC R 100000 G/L ACTIVITY Jefferson Surgery Center PLLC L 1512591 G/L ACTIVITY Jefferson Surgery Center PLLC M 1151747 G/L ACTIVITY Jefferson Surgery Center PLLC R 1112609 G/L ACTIVITY Jefferson Surgery Center PLLC S 1498104 G/L ACTIVITY