2013-11-15T10:25:46-06:00 2012-12-31 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2012-01-01 640303091 ST DOMINIC-JACKSON MEMORIAL HOSPITAL STDO 6012002000 969 LAKELAND DRIVE JACKSON MS 392164699 LESTER DIAMOND 6012002000 2013-11-14 1 MARSHA H DIECKMAN CPA P00246741 6013261000 2013-11-14 2012 2016-02-25 16:41:14Z LESTER DIAMOND 969 LAKELAND DRIVE JACKSON MS 392164699 398029796 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 11 3691 385 1990958 -645581 45524 15000 369811065 377083742 879254 922416 9230888 15920175 379966731 393941333 2155550 2291229 0 0 170094001 186046960 0 0 0 197899145 198934018 370148696 387272207 9818035 6669126 322550925 329447125 137325027 123917763 185225898 205529362 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 380132037 2291229 375092784 HOSPITAL SERVICES - ST. DOMINIC'S IS MORE THAN JUST A HOSPITAL. IT IS A FAMILY OF SERVICES FOCUSED ON FULFILLING A MISSION OF CHRISTIAN HEALING TO THOSE IN NEED. ST. DOMINIC HEALTH SERVICES, INC. IS THE PARENT COMPANY FOR A LARGE GROUP OF SUBSIDIARY ORGANIZATIONS AND PROGRAMS DEDICATED TO THE SAME MISSION. THESE INCLUDE ST. DOMINIC HOSPITAL, THE COMMUNITY HEALTH CLINIC, ST. DOMINIC MEDICAL ASSOCIATES (PHYSICIAN NETWORK), NEW DIRECTIONS FOR OVER 55, MEA CLINICS, THE CLUB AT ST. DOMINIC'S, THE SCHOOL NURSE PROGRAM, ST. DOMINIC'S FOUNDATION, ST. CATHERINE'S VILLAGE AND CARE-A-VAN.ST. DOMINIC'S HAS SERVED THE AREA FOR NEARLY SEVEN DECADES. FUNDAMENTAL TO OUR MISSION IS ESTABLISHING COMMUNITY AND PERFORMING SERVICE. THUS, ST. DOMINIC'S IS PROUD OF ITS ROLE AS A LEADING HEALTH CARE PROVIDER IN POSITIVELY IMPACTING THE LOCAL ECONOMY, IMPROVING THE PRESTIGE AND ATTRACTING HUMAN CAPITAL TO THE GREATER JACKSON AREA AND PROVIDING TECHNOLOGICAL ADVANCES AND QUALITY HEALTHCARE SERVICES TO PATIENTS.ST. DOMINIC'S IMPACT ON THE LOCAL ECONOMY AND ROLE IN ATTRACTING HUMAN CAPITAL IN THE AREA: THE DOMINICAN SISTERS CAME TO JACKSON IN 1946 IN RESPONSE TO A COMMUNITY NEED FOR IMPROVED ACCESS TO QUALITY HEALTH CARE. TODAY, ST. DOMINIC'S (WWW.STDOM.COM) AND ITS AFFILIATES EMPLOY OVER 3,400 NURSES, PHYSICIANS, SKILLED CAREGIVERS AND STAFF. ST. DOMINIC HOSPITAL PROVIDED OVER $1 BILLION (CHARGES) IN HOSPITAL SERVICES IN 2012 TO PATIENTS THROUGHOUT THE CENTRAL REGION OF MISSISSIPPI. ST. DOMINIC'S AND ITS AFFILIATES EMPLOYED OVER 3,400 PEOPLE MAKING IT ONE OF THE AREA'S LARGEST EMPLOYERS. THESE CLEAN (GREEN) JOBS INFUSED THE ECONOMY WITH OVER $146 MILLION IN SALARIES AND WAGES IN 2012. THE MISSISSIPPI BUSINESS JOURNAL HAS RECOGNIZED ST. DOMINIC HOSPITAL AS ONE OF THE TOP FIVE "BEST PLACES TO WORK IN MISSISSIPPI" AND ST. DOMINIC HEALTH SERVICES HAS BEEN RECOGNIZED AS THE TOP EMPLOYER IN THE AREA.OUR MEDICAL STAFF, OF NEARLY 500 LEADING PHYSICIANS AND SPECIALISTS, MAKES ST. DOMINIC'S ONE OF THE MOST COMPREHENSIVE HOSPITALS IN MISSISSIPPI.ST. DOMINIC'S HAS ASSISTED IN RELOCATING MANY PHYSICIANS INTO THE GREATER JACKSON AREA THROUGH: THE RECRUITMENT OF PHYSICIAN SPECIALISTS TO ADDRESS A COMMUNITY NEED (I.E., DEFICIT); AND EMPLOYMENT FROM OUTSIDE THE MARKET INTO OUR OWNED PHYSICIAN NETWORK. ACCORDING TO A STUDY FROM THE MISSISSIPPI STATE MEDICAL ASSOCIATION, "IN SMALL TOWNS AND LARGE, MISSISSIPPI DOCTORS PUMP BILLIONS OF DOLLARS INTO THE LOCAL AND STATE ECONOMY. EACH DOCTOR GENERATES SOME $695,000 A YEAR IN WAGES AND CREATES AN AVERAGE OF SIX JOBS." FOR ST. DOMINIC'S, THAT TRANSLATES TO HUNDREDS OF JOBS AND MILLIONS IN SALARIES EACH YEAR IN THE COMMUNITY FROM OUR RECRUITMENT EFFORTS.ST. DOMINIC'S PROVIDES A WIDE RANGE OF LEARNING EXPERIENCES FOR EMPLOYEES TO ENHANCE THEIR SKILLS. CLASSES RANGE FROM LIFE SAVING SKILLS SUCH AS CPR, ACLS AND NRP TO BUSINESS AND MANAGEMENT DEVELOPMENT OPPORTUNITIES SUCH AS LEGAL ISSUES OF SUPERVISION AND CATHOLIC SOCIAL TEACHING. EMPLOYEES MAY PURSUE LEARNING THROUGH SEVERAL DIFFERENT AVENUES: ONLINE, INSTRUCTOR-LED, AND SELF-PACED.ST. DOMINIC HOSPITAL IS A LICENSED 535-BED TERTIARY CARE REFERRAL HOSPITAL LOCATED IN JACKSON, MS SERVING ALL OF CENTRAL MISSISSIPPI AND EMPLOYS MORE THAN 3,000 NURSES, PHYSICIANS, AND SKILLED CAREGIVERS. THE MEDICAL STAFF, OF NEARLY 500 LEADING PHYSICIANS AND SPECIALISTS, MAKES ST. DOMINIC'S ONE OF THE MOST COMPREHENSIVE HOSPITALS IN MISSISSIPPI. THROUGH SEVEN DECADES OF GROWTH, ST. DOMINIC'S HAS REMAINED TRUE TO ITS VISION. WE ARE ST. DOMINIC'S - A CHRISTIAN HEALING COMMUNITY CALLED TO PROVIDE QUALITY, COMPASSIONATE CARE AND AN EXCEPTIONAL ENCOUNTER EVERYTIME. ST. DOMINIC HOSPITAL'S SERVICE AREA IS DEFINED BASED ON INPATIENT DISCHARGES FOR SHORT TERM ACUTE PATIENTS. IN THE 2012 FISCAL YEAR, 12 COUNTIES CONSTITUTE OVER 85 PERCENT OF THE HOSPITAL'S ACUTE DISCHARGES. HINDS, RANKIN AND MADISON COUNTIES REPRESENT THE HOSPITAL'S PRIMARY SERVICE AREA WITH TWO-THIRDS OF THE TOTAL DISCHARGES. THE REMAINING NINE COUNTIES CONSTITUTE AN ADDITIONAL TWENTY PERCENT OF THE HOSPITAL ACUTE DISCHARGES. THE HOSPITAL'S MISSION IS EXPRESSED AS A CHRISTIAN MINISTRY OF HEALING. ST. DOMINIC HOSPITAL RECOGNIZES ITS BASIC PARTICIPATION IN THE MISSION OF THE CHURCH, WHICH INVOLVES TWO MAIN MINISTRIES: EDUCATION AND HEALTH CARE. THREE ACTIVITIES- COMMUNICATING A CHRISTIAN MESSAGE, ESTABLISHING COMMUNITY AND PERFORMING SERVICE- EXPRESS OUR MISSION OF CHRISTIAN HEALING. ST. DOMINIC HOSPITAL IS COMMITTED TO SERVING AS A LEADING ADULT TERTIARY REFERRAL CENTER FOR THE CENTRAL REGION OF MISSISSIPPI -FOCUSING ON PRIORITIES BUT RETAINING BALANCE EXPECTED OF A TERTIARY PROVIDER. ST. DOMINIC'S IS THE LEADING CARDIOVASCULAR PROVIDER IN THE STATE OF MISSISSIPPI. FOR 39 YEARS, ST. DOMINIC'S MISSISSIPPI HEART INSTITUTE THROUGH ITS EXCEPTIONAL TEAM OF SKILLED PHYSICIANS AND STAFF HAVE SERVED THE COMMUNITY AND HAVE WORKED HARD TO MAKE IT A HEALTH AND WELLNESS CENTER OF EXCELLENCE FOR INTERVENTIONAL CARDIOVASCULAR MEDICINE. THROUGH ST. DOMINIC'S HEALTHY HEART ADVANTAGE (HHA) PROGRAM AND OTHER HEALTH SCREENING OPPORTUNITIES AT VARIOUS VENUES, COMMUNITY PUBLIC AWARENESS AND PROGRAM EDUCATION IS ACCOMPLISHED. ST. DOMINIC'S CHRONIC CARE CLINIC BEGAN OPERATIONS IN AUGUST 2010. THE MISSION OF THIS CLINIC IS TO HELP PEOPLE MANAGING CONGESTIVE HEART FAILURE (HF) AND OTHER CHRONIC ILLNESSES BY ASSISTING IN IMPROVING THE PATIENT'S QUALITY OF LIFE. A FAMILY NURSE PRACTITIONER, ALONG WITH TWO REGISTERED NURSES, A PHLEBOTOMIST, TWO ADMINISTRATIVE ASSISTANTS AND AN OFFICE MANAGER TAKE PATIENTS MONDAY THROUGH FRIDAY. TIME IS SPENT EDUCATING THESE PATIENTS ON PROPER NUTRITION, EXERCISE REGIMENS AND DISEASE MANAGEMENT. THE CLINIC IS ALSO DEDICATED TO THE INPATIENT HEART FAILURE PATIENTS BY PROVIDING A FULL-TIME REGISTERED NURSE TO EDUCATE ALL ACUTE HF PATIENTS AND PROVIDE SUGGESTIONS ON FOLLOW UP WITH SERVICES ONCE DISCHARGED. SINCE THE OPENING OF THIS CLINIC THE RATE OF READMISSION TO THE HOSPITAL FOR HEART FAILURE HAS DROPPED FROM APPROXIMATELY 23 PERCENT TO AN ESTIMATED 14.7 PERCENT, INCREASING PATIENT ABILITY AND KNOWLEDGE IN MANAGING SERIOUS ILLNESS. ACCORDING TO THE MISSISSIPPI STATE DEPARTMENT OF HEALTH, IN MISSISSIPPI APPROXIMATELY 41 PERCENT OF PEOPLE DIE FROM CARDIOVASCULAR DISEASE EVERY YEAR. THIS CLINIC IS A DIRECT REFLECTION OF THOSE NUMBERS, AND THE STAFF HOPES TO HELP THESE PATIENTS LEAD HEALTHIER AND MORE ACTIVE LIFESTYLES.THE CHRONIC CARE CLINIC FURTHERED ITS DEDICATION TO CHANGING LIVES BY OFFERING A MONTHLY "COMMUNITY HEART EDUCATION PROGRAM." THIS PROGRAM PROVIDES COLLABORATIVE LEADERSHIP FROM A COMMITTEE TO PLAN AND CONDUCT EDUCATIONAL ACTIVITIES WITH AN EMPHASIS ON PREVENTION, LIFESTYLE CHANGES, AND INCREASE KNOWLEDGE OF HEART DISEASE. BY PROVIDING RESOURCES AND INFORMATION ON CARDIOVASCULAR DISEASE, DIETARY MODIFICATION AND RESOURCES FOR PATIENTS AND THEIR FAMILIES THIS GROUP OF PEERS HOPES TO MAKE A DIFFERENCE IN THE HEALTH OF THE COMMUNITY.ST. DOMINIC HOSPITAL OFFERS HEALTH SCREENINGS AND HEALTH FAIRS ACROSS THE CENTRAL REGION OF MISSISSIPPI THROUGHOUT THE YEAR IN ORDER TO IMPROVE THE GENERAL HEALTH OF THE COMMUNITY. ST. DOMINIC HOSPITAL AS A LEADING TERTIARY REFERRAL CENTER ACHIEVED SEVERAL AWARDS AND FIRSTS: FOR SEVERAL YEARS IN A ROW, ST. DOMINIC'S HAS BEEN RANKED THE NO. 1 HOSPITAL IN THE JACKSON METRO AREA IN THE U.S. NEWS MEDIA & WORLD REPORT'S BEST HOSPITALS RANKINGS. ST. DOMINIC'S SHARES THE NO. 1 RANKING WITH UNIVERSITY OF MISSISSIPPI MEDICAL CENTER. ST. DOMINIC'S ALSO RANKED AS "HIGH-PERFORMING" IN THE SPECIALTIES OF NEUROLOGY/NEUROSURGERY AND UROLOGY. U.S. NEWS ALSO RECOGNIZED ST. DOMINIC'S AS ONE OF THE "MOST CONNECTED" HOSPITALS IN THE COUNTRY.ST. DOMINIC'S WAS THE FIRST PROVIDER IN MISSISSIPPI WITH AN ACCREDITED CHEST PAIN CENTER WITH PCI AND PRIMARY ACUTE STROKE CENTER. ST. DOMINIC'S HAS ALSO EARNED THE GOLD SEAL OF APPROVAL FROM THE JOINT COMMISSION FOR PRIMARY STROKE CENTERS. "ST. DOMINIC HOSPITAL IS PROUD TO RECEIVE THIS DISTINCTION, "SAID RUTH FREDERICKS, MD, NEUROLOGIST AT ST. DOMINIC HOSPITAL. "THE PRIMARY ACUTE STROKE CENTER CERTIFICATION RECOGNIZES ST. DOMINIC'S COMMITMENT TO PROVIDING EXCEPTIONAL CARE TO THE CITIZENS OF MISSISSIPPI."ST. DOMINIC'S WAS THE FIRST IN THE STATE TO DEVELOP A LEVEL 1 HEART ATTACK PROGRAM SETTING PROTOCOLS THAT TRIGGERS 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 FOR PATIENTS IN CENTRAL MISSISSIPPI.ST. DOMINIC'S CANCER PROGRAM HAS ALSO BEEN APPROVED AS A COMMUNITY HOSPITAL COMPREHENSIVE CENTER PROGRAM BY THE AMERICAN COLLEGE OF SURGEONS. ACCORDING TO AMY SHARPE, RN, MBA, OCN, CANCER SERVICES COORDINATOR, "RECEIVING THE OUTSTANDING ACHIEVEMENT AWARD REQUIRED A COHESIVE EFFORT OF ALL THE DIFFERENT MEMBERS OF THE CANCER TEAM WHO ARE RESPONSIBLE FOR THE ELEMENTS THAT MAKE UP THE PROGRAM, INCLUDING: DIAGNOSTIC, TREATMENT, OTHER CLINICAL AREAS, REHABILITATION, SUPPORT, AND PREVENTION."LATEST TECHNOLOGICAL AND SERVICE ADVANCES AT ST. DOMINIC'S CANCER CENTER: THE FIRST HOSPITAL IN MISSISSIPPI TO ACQUIRE AND OFFER (FIRST PATIENT IN 2010) THE NOVALIS TX FOR ACCURATE IMAGE GUIDED NON-SURGICAL TREATMENTS FOR CANCER AND OTHER CONDITIONS IN THE BRAIN, HEAD, NECK, AND BODY. ST. DOMINIC HOSPITAL BEGAN HELPING WITH THE TESTING AND TREATMENT OF BREAST CANCER AND BREAST DISEASES WHEN THEY IMPLEMENTED SENTINELLE VANGUARD BREAST MRI TABLE IN THEIR RADIOLOGY DEPARTMENT. THE FIRST IN THE JACKSON AREA TO OFFER THIS NEW IMAGING CAPABILITY, WHICH NOT ONLY ALLOWS FOR SUPERIOR IMAGE QUALITY FOR BREAST IMAGING AND BIOPSIES, BUT CREATES THE OPPORTUNITY FOR IMMEDIATE MEDICAL INTERVENTION IF NEEDED.ST. DOMINIC'S IS A LEADER IN SURGICAL SERVICES AND ADVANCEMENTS: ST. DOMINIC'S IS THE MINIMALLY INVASIVE ROBOTIC SURGERY CENTER OF EXCELLENCE.ST. DOMINIC'S PREFORMED THE FIRST SURGICAL CASE IN THE STATE USING THE MOST ADVANCED ROBOTICS TECHNOLOGY - THE DAVINCI 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.ST. DOMINIC'S ROBOTIC SURGERY SERVICES HELPS PATIENTS RECOVER MORE COMFORTABLY IF THEY NEEDED PROSTATECTOMY - WHICH HAVE DRAMATICALLY IMPROVED THE TREATMENT OF PROSTATE CANCER, PARTIAL NEPHRECTOMIES, WHICH ALLOW ST. DOMINIC'S PHYSICIANS TO REMOVE A PORTION OF THE KIDNEY AS OPPOSED TO COMPLETE REMOVAL - WHICH WAS THE PRACTICE IN THE PAST. ST. DOMINIC'S WAS THE FIRST IN THE STATE TO OFFER SINGLE INCISION ROBOTIC HYSTERECTOMY. THIS ALLOWS FOR ONE INCISION SITE, WHICH IS VERY MEANINGFUL TO WOMEN, WITH ONLY A TINY SCAR TO CARRY AFTER RESUMING NORMAL FUNCTION MUCH MORE QUICKLY. ST. DOMINIC'S IS CURRENTLY THE ONLY HOSPITAL IN JACKSON OFFERING 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 FOR WOMEN. THE SURGERY HAS TRADITIONALLY BEEN DONE AS OPEN SURGERY.ST. DOMINIC'S IS ALSO A QUALITY PROVIDER IN WOMEN'S SERVICES FOR THE CITIZENS OF CENTRAL MISSISSIPPI. THE SERVICES INCLUDE LEADING OBSTETRICAL AND GYNECOLOGICAL SERVICES, LABOR AND DELIVERY SERVICES, NEONATAL SERVICES AND A FULL ARRAY OF SERVICES FOR WOMEN OF ALL AGES. NEWBORN DELIVERIES IN ST. DOMINIC'S LABOR AND DELIVERY UNIT NOW TOP MORE THAN 1,500 ANNUALLY OF WHICH HIGH PERCENTAGES ARE MEDICAID RECIPIENTS. 380132037 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 1 223 0 1 3691 1 1 1 0 0 0 0 0 0 0 X 15 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X MATT FISHER 6012006570 969 LAKELAND DR JACKSON MS 392164699 SR M CORDE LENN 0.50 X 0 0 0 DAN GRAFTON 0.50 X X 0 0 0 SR MARY TRINITA EDDINGTON OP 0.50 40.50 X X 0 0 0 TOD ETHEREDGE 0.50 X 0 0 0 JEFF FLETCHER MD 0.50 X 0 0 0 LEROY WALKER 0.50 X 0 0 0 CON MALONEY 0.50 X 0 0 0 SR M THECLA KUHNLINE OP 0.50 X 0 0 0 SR M CELESTINE RONDELLI OP 0.50 X 0 0 0 JIMMY JONES MD 0.50 X 17400 0 0 SR REBECCA ANN GEMMA OP 0.50 1.00 X 0 0 0 BILL TEW MD 0.50 X 0 0 0 DONNA SIMS 0.50 X 0 0 0 SR KRISTIN REVER OP 0.50 X 0 0 0 LESTER DIAMOND 40.00 X 543736 0 52429 JENNIFER SINCLAIR 40.00 X 312588 0 41919 MATTHEW FISHER 40.00 X 130053 0 14828 ROBERT MOBLEY MD 40.00 X 438062 0 50836 PAUL ARRINGTON 40.00 X 241518 0 51027 KEITH VAN CAMP 40.00 X 282376 0 41872 STEPHEN BOMGARDNER 40.00 X 230266 0 47559 BECKY LOWE 40.00 X 214991 0 35977 TRACE SWARTZFAGER 40.00 X 210536 0 43131 LORRAINE WASHINGTON 40.00 0.00 X 0 221975 45521 HUEY B MCDANIEL MD 40.00 X 702497 0 10827 KYLE GORDON MD 40.00 X 756203 0 10905 JOHN LANCON MD 40.00 X 1306979 0 10905 RONALD KENNEDY MD 40.00 X 929193 0 10905 PAUL SEAGO 40.00 X 806904 0 7347 RALPH E SULSER MD 0.00 X 197002 0 0 7320304 221975 475988 121 1 1 0 ALLIED EMERGENCY SERVICES PC PO BOX 2120 RIDGELAND MS 39158 ER PHYSICIANS 7280146 HARRELL CONTRACTING GROUP LLC PO BOX 12850 JACKSON MS 39236 CONSTRUCTION SERVICES 4716932 COGENT HEALTHCARE OF JACKSON MS 969 LAKELAND DRIVE JACKSON MS 39216 CONTRACT MEDICAL SERVICES 2547394 PHYSICIANS ANESTHESIA GROUP PA PO BOX 4608 JACKSON MS 39296 CONTRACT MEDICAL SERVICES 2035892 JACKSON HEART CLINIC 970 LAKELAND DRIVE JACKSON MS 39216 CONTRACT MEDICAL SERVICES 1951514 35 15000 15000 PROGRAM REVENUE 621990 372128530 372128530 PHARMACEUTICAL SALES 446110 4233710 2836586 1397124 SPA SALES 812900 721502 127668 593834 377083742 959738 959738 5174002 0 5174002 5174002 5174002 4051141 4088463 -37322 -37322 -37322 MISCELLANEOUS INCOME 900099 6083115 6083115 CAFETERIA SALES 722210 2572063 2572063 DAY CARE CENTER 624410 668111 668111 1422884 1422884 10746173 393941333 375092784 1990958 16842591 X 2291229 2291229 2621527 2621527 143587520 141343205 2244315 16580690 16028884 551806 13432189 12985165 447024 9825034 9498057 326977 351430 351430 691991 691991 256530 256530 1086342 1086342 4047151 4047151 745225 745225 75700 75700 21217988 21217988 1253399 1253399 SUPPLIES 68345741 68345741 PHARMACEUTICAL DRUGS 23894933 23894933 BAD DEBTS 19452183 19452183 MEDICAL PROFESSIONAL FE 15913127 15913127 41602278 41602278 387272207 380132037 7140170 0 67791416 66511158 54125916 49487544 7256467 6928173 24192445 32341392 436908106 266995451 165200235 169912655 3984446 4266203 322550925 329447125 43521436 37375055 93803591 86542708 137325027 123917763 X 185225898 205529362 185225898 205529362 322550925 329447125 X 6669126 4285342 9348996 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 18157 18157 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: ST. DOMINIC-JACKSON MEMORIAL HOSPITAL PAID DUES TO THE MISSISSIPPI HOSPITAL ASSOCIATION. THE MISSISSIPPI HOSPITAL ASSOCIATION REPORTS THAT 14.41% OF THE $126,000 OF DUES PAID WERE RELATED TO POLITICAL AND LOBBYING ACTIVITIES. 18245044 18245044 146609973 93979404 52630569 269908906 173016047 96892859 2144183 2144183 169912655 LIABILITY FOR PENSION BENEFITS 86542708 86542708 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE 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. THE 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, 2012 OR 2011. INCOME TAX EXPENSE FOR SDIS TOTALED $150,587 AND $141,821 FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY, AND IS INCLUDED IN ADMINISTRATIVE EXPENSES IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF ACTIVITIES. FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO. 109, CODIFIED IN FASB ASC TOPIC 740 ("ASC 740"), CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN, INCLUDING AN ENTITY'S STATUS AS A TAX-EXEMPT NOT-FOR-PROFIT ENTITY. ADDITIONALLY, ASC 740 PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. THE HOSPITAL HAD NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2012 OR 2011. 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 2008 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 14474347 5852040 8622307 0.02340 47515910 47887809 -371899 0.00000 1728583 1717432 11151 0.00000 63718840 55457281 8261559 0.02340 1126778 1126778 0.00310 80960 80960 0.00020 18932436 15256004 3676432 0.01000 791229 791229 0.00220 20931403 15256004 5675399 0.01550 84650243 70713285 13936958 0.03890 1 19452183 5835655 120977091 134276358 -13299267 X 1 1 1 ST DOMINIC AMBULATORY SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.50220 0.00000 0.49780 1 1 ST DOMINIC - JACKSON MEMORIAL HOSPITAL

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PHYSICIAN CLINIC ST DOMINIC'S EMPLOYEE CLINIC

969 LAKELAND DRIVE JACKSON MS JACKSON MS 39216

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, INCREASED FROM 50%, EFFECTIVE NOVEMBER 1, 2012. 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. EXAMPLES OF THESE SERVICES INCLUDE BUT ARE NOT LIMITED TO EMERGENCY DEPARTMENT AND BEHAVIORAL HEALTH. 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 $ 19452183. PART II: ST. DOMINIC HOSPITAL PROVIDES SIGNIFICANT SUPPORT TO ITS COMMUNITY THROUGH A VARIETY OF WAYS INCLUDING FREE HEALTH SCREENINGS AT LOCAL SCHOOLS, PARTICIPATION IN VARIOUS NON- PROFIT BOARDS AS WELL AS FINANCIAL SUPPORT THROUGH CASH DONATIONS. PART III, LINE 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 63.3 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011, TO 64.4 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012. IN ADDITION, THE HOSPITAL'S SELF-PAY BAD DEBT WRITE-OFFS INCREASED FROM $12,116,019 IN 2011 TO $12,219,261 IN 2012. THE HOSPITAL ALSO MAINTAINS ALLOWANCES FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THIRD-PARTY GOVERNMENT PAYORS DECREASED FROM 5.0 PERCENT OF THIRD-PARTY GOVERNMENT ACCOUNTS RECEIVABLE AT DECEMBER 31,2011, TO 4.5 PERCENT OF THIRD-PARTY GOVERNMENT ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012. IN ADDITION, THE HOSPITAL'S THIRD-PARTY GOVERNMENT BAD DEBT WRITE-OFFS DECREASED FROM $2,539,618 IN 2011 TO $2,383,729 IN 2012. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THIRD-PARTY COMMERCIAL PAYORS DECREASED FROM 8.5 PERCENT OF THIRD-PARTY COMMERCIAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011, TO 5.3 PERCENT OF THIRD-PARTY COMMERCIAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012. IN ADDITION, THE HOSPITAL'S THIRD-PARTY COMMERCIAL BAD DEBT WRITE-OFFS INCREASED FROM $6,620,115 IN 2011 TO $6,633,899 IN 2012. 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. 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 20D: HOSPITAL OFFERS A DISCOUNT OF 50% WHICH IS EQUIVALENT TO THE AVERAGE COMMERCIAL DISCOUNT. THIS DISCOUNT INCREASED TO 60%, EFFECTIVE NOVEMBER 1, 2012. PART V, SECTION B, LINE 5A PART VI, LINE 1 CHNA CAN BE ACCESSED AT: HTTP://WWW.STDOM.COM/GEDOWNLOAD!/CHNAWEB.PDF?ITEM_ID=544018&VERSION_ID=544019 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 A DETAIL DESCRIPTION OF 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. ST. DOMINIC ALSO INVESTS BACK 100% OF ALL PROFITS AND CASH INTO OUR HOSPITAL SO THAT NO LOCAL FUNDS LEAVE THIS COMMUNITY. 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 BREAKTHRU MINISTRIES PO BOX 39236 JACKSON MS 39236 621284192 501(C)(3) 3190 CHARITABLE SUPPORT CATHOLIC CHARITIES 200 N CONGRESS ST JACKSON MS 39201 640468850 501(C)(3) 255000 CHARITABLE SUPPORT CENTER FOR PREVENTION OF VIOLENCE PO BOX 6279 PEARL MS 39288 581959108 501(C)(3) 22500 CHARITABLE SUPPORT COMMUNITY HEALTH SERVICES-ST DOMINIC INC 969 LAKELAND DR JACKSON MS 392164699 640714997 501(C)(3) 185188 AFFILIATE SUPPORT HOSPICE MINISTRIES 450 TOWNE CENTER BOULEVARD RIDGELAND MS 39157 640789919 501(C)(3) 25000 CHARITABLE SUPPORT JACKSON FREE CLINIC PO BOX 4892 JACKSON MS 39296 640945749 501(C)(3) 10000 CHARITABLE SUPPORT LEXINGTON MEDICAL CLINIC 22741 HWY 12 LEXINGTON MS 39095 200378262 501(C)(3) 40000 CHARITABLE SUPPORT MISSION MISSISSIPPI 120 N CONGRESS ST JACKSON MS 39201 640824240 501(C)(3) 30000 CHARITABLE SUPPORT NEIGHBORHOOD CHRISTIAN CENTER 417 W ASH ST JACKSON MS 39203 640800919 501(C)(3) 18000 CHARITABLE SUPPORT NEW LIFE FOR WOMEN 814 NORTH CONGRESS STREET JACKSON MS 39202 640765336 501(C)(3) 10000 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) 45000 CHARITABLE SUPPORT REBIRTH ALLIANCE INC PO BOX 9431 JACKSON MS 39286 970741985 501(C)(3) 10000 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) 10000 CHARITABLE SUPPORT TUTWILER COMMUNITY EDUCATION CENTER INC PO BOX 448 TUTWILER MS 38963 581887449 501(C)(3) 10000 CHARITABLE SUPPORT 19 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 0 0 X X X X X 0 0 0 0 0 0 0 0 0 LESTER DIAMOND 471278 0 0 0 72458 0 41557 0 10872 0 596165 0 0 0 JENNIFER SINCLAIR 304359 0 0 0 8229 0 41557 0 362 0 354507 0 0 0 ROBERT MOBLEY MD 393162 0 0 0 44900 0 41557 0 9279 0 488898 0 0 0 PAUL ARRINGTON 240194 0 0 0 1324 0 40419 0 10608 0 292545 0 0 0 KEITH VAN CAMP 269982 0 0 0 12394 0 41557 0 315 0 324248 0 0 0 STEPHEN BOMGARDNER 230266 0 0 0 0 0 38465 0 9094 0 277825 0 0 0 BECKY LOWE 214991 0 0 0 0 0 35723 0 254 0 250968 0 0 0 TRACE SWARTZFAGER 210536 0 0 0 0 0 34654 0 8477 0 253667 0 0 0 LORRAINE WASHINGTON 0 221975 0 0 0 0 0 37029 0 8492 0 267496 0 0 HUEY B MCDANIEL MD 592712 0 76333 0 33452 0 0 0 10827 0 713324 0 0 0 KYLE GORDON MD 636749 0 83444 0 36010 0 0 0 10905 0 767108 0 0 0 JOHN LANCON MD 1191693 0 53049 0 62237 0 0 0 10905 0 1317884 0 0 0 RONALD KENNEDY MD 734946 0 150000 0 44247 0 0 0 10905 0 940098 0 0 0 PAUL SEAGO 768480 0 0 0 38424 0 0 0 7347 0 814251 0 0 0 RALPH E SULSER MD 197002 0 0 0 0 0 0 0 0 0 197002 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE WAS PROVIDED TO ONE KEY EMPLOYEE AND WAS INCLUDED IN TAXABLE WAGES FOR 2012. THE ALLOWANCE IS INCLUDED IN THE TOTAL COMPENSATION TO THE KEY EMPLOYEE APPROVED UNDER THE EXECUTIVE COMPENSATION PROGRAM. MELANIE GRAFTON DAUGHTER OF DIRECTOR, DAN GRAFTON 65325 MELANIE GRAFTON IS AN EMPLOYEE OF ST. DOMINIC-JACKSON MEMORIAL HOSPITAL. 0 JACKSON PULMONARY DR. JIMMY JONES, DIRECTOR, IS A GREATER THAN 5% OWNER 688107 HOSPITAL CONTRACTS WITH JACKSON PULMONARY FOR INTENSIVIST SERVICES 0 LAKELAND RADIOLOGIST DR. WILLIAM E. TEW, DIRECTOR, IS A GREATER THAN 5% OWNER 107023 HOSPITAL CONTRACTS WITH LAKELAND RADIOLOGIST FOR MEDICAL DIRECTOR 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 AUDIT/FINANCE COMMITTEE OF THE BOARD PRIOR TO FILING. A FULL COPY, AS APPROVED BY THE AUDIT/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 CHAIRMAN OF THE BOARD AND THE EXECUTIVE COMMITTEE OF THE ORGANIZATION ASSIGNS THE PAY CHANGE FOR THE HOSPITAL'S CHIEF EXECUTIVE OFFICER 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. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART IX, LINE 24E EQUIPMENT RENTAL AND MAINTENANCE: PROGRAM SERVICE EXPENSES 15,288,884. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,288,884. CONSULTANTS: PROGRAM SERVICE EXPENSES 5,214,150. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,214,150. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 4,618,406. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,618,406. UTILITIES: PROGRAM SERVICE EXPENSES 3,444,529. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,444,529. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 2,800,581. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,800,581. FOOD COMMODITIES: PROGRAM SERVICE EXPENSES 2,696,488. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,696,488. COLLECTION FEES: PROGRAM SERVICE EXPENSES 2,331,164. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,331,164. LAB SERVICES: PROGRAM SERVICE EXPENSES 1,675,191. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,675,191. TAXES: PROGRAM SERVICE EXPENSES 1,226,143. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,226,143. TELEPHONE: PROGRAM SERVICE EXPENSES 626,040. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 626,040. RECRUITING: PROGRAM SERVICE EXPENSES 517,154. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 517,154. POSTAGE & SHIPPING: PROGRAM SERVICE EXPENSES 425,800. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 425,800. LINENS: PROGRAM SERVICE EXPENSES 346,321. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 346,321. WASTE FEES: PROGRAM SERVICE EXPENSES 293,597. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 293,597. WEARING APPAREL: PROGRAM SERVICE EXPENSES 90,107. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90,107. FILM: PROGRAM SERVICE EXPENSES 6,487. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,487. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,236. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,236. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION TRANSITION ADJUSTMENT PER FAS 158 7,260,883. OTHER INTERCOMPANY TRANSACTIONS 2,088,113. COMMITTEE FOR AUDIT OVERSIGHT 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 23883761 4641206 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 - JACKSON MEMORIAL HOSPITAL RELATED 65191 457748 0 0 0.52780 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 352033 2136469 1.00000 1 0 1 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0 ST DOMINIC INTEGRATED SERVICES INC Q 28462 CASH VALUE OF TRANSACTION