2013-02-04T16:47:21-06:00 2012-03-31 MITCHELL & TITUS LLP ONE BATTERY PARK PLAZA NEW YORK NY 10004 990 2011-04-01 362448028 Jackson Park Hospital Foundation % NELSON VASQUEZ JACK 7739477500 7531 SOUTH STONY ISLAND Avenue CHICAGO IL 60649 Nelson Vasquez 2013-01-31 KEVIN FULLER 2127094500 2011 2016-03-07 17:11:31Z Merritt Hasbrouck 7531 South Stony Island Avenue Chicago IL 60649 128106396 false X www.jacksonparkhospital.org X 1912 IL The mission of the physicians, staff, and Board of Directors of the organization is to provide compassionate and high quality healthcare services to meet the needs of the patients and communities we serve. 10 3 1023 8 0 0 43990 30000 117179840 122172577 4035 5545 6587894 5898274 123815759 128106396 0 0 0 0 40147997 42366604 0 0 0 76382071 78512906 116530068 120879510 7285691 7226886 105711225 115743843 29359725 32602855 76351500 83140988 TO PROVIDE COMPASSIONATE AND HIGH QUALITY HEALTHCARE SERVICES TO MEET THE NEEDS OF THE PATIENTS AND COMMUNITIES WE SERVE. false false 115152868 122172577 Jackson Park Hospital Foundation provides inpatient and outpatient medical care and behavioral medicine services to Chicago's south side communities regardless of the patients ability to pay. Jackson Park Hospital Foundation provides medical education to 18 Family Practice residents. 115152868 true true false true false false false false false false true false false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false false true 146 0 true 1023 true false false false false false false false false false false X 10 3 false false false false false false false true true false false true true true true true true true true false IL X NELSON VASQUEZ 7739477989 7531 SOUTH STONY ISLAND AVENUE CHICAGO IL 60649 Dr Arol Augsburger 2.0 X 0 0 0 James I Clark III 2.0 X 0 0 0 Dr Lakshmi Dodda 40.0 X 177200 91878 10891 Dr William O Dorsey III 40.0 X X 221768 0 1515 Dr Harshad Mehta 40.0 X 120308 0 0 Dr Joyce R Miller 40.0 X 0 71875 0 Dr Bangalore R Murthy 40.0 X 0 130193 0 Dr Haroon Olomi 40.0 X 0 175655 24891 Dr Emra Brooks Williams 2.0 X 0 0 0 Dr CARYN CARRANZA 40.0 X 0 377817 0 Merritt Hasbrouck 40.0 X 480132 0 0 G Randall Smith 40.0 X 469965 0 19865 Nelson Vasquez 40.0 X 202715 0 19369 Thodur Ranganathan 40.0 X 291021 0 16351 ROSE ETTE RN 40.0 X 193654 0 6225 Dr NAVEED MUHAMMAD 40.0 X 173965 0 9921 BARRY MANDELL 40.0 X 147404 0 16351 PATRICA SIMON 40.0 X 141253 0 10891 2619385 847418 136270 11 false true false NICL Laboratories 306 Era Drive NORTHBROOK IL 60062 see schedule o 3458954 Amerisourcebergen PO Box 27550 CHICAGO IL 60673 see schedule O 1477488 Rush Nursing Services LLC 7501 S Stony Island CHICAGO IL 60649 see schedule o 1744092 EMCARE Inc 7032 Collection Center Drive CHICAGO IL 60693 see schedule o 1443547 Cardinal Health PO Box 98347 CHICAGO IL 60693 see schedule o 831056 29 30000 30000 NET PATIENT SERVICE REVENUE 611710 105455628 105455628 PROVIDER TAX PROCEEDS 621500 16716949 16716949 122172577 5545 5545 0 0 0 0 0 0 MEDICAL SCHOOL BILLINGS 900099 4305667 4305667 RADIOLOGY PHYSICIANS 900099 297888 297888 ALL OTHER INCOME 900099 1294719 1294719 5898274 128106396 128070851 0 5545 0 0 0 0 3152773 0 3152773 0 0 30261007 30261007 0 0 0 8952824 8111033 841791 0 0 1128110 0 1128110 0 481123 0 481123 0 122845 0 122845 0 0 0 0 20082093 20082093 0 0 0 9824568 9824568 0 0 0 0 1895590 1895590 0 0 0 0 0 316879 316879 0 0 0 2021706 2021706 0 0 1426695 1426695 0 0 PROVISION FOR BAD DEBTS 34045916 34045916 0 0 PROVIDER TAX EXPENSES 7131636 7131636 0 0 PENSION EXPENSE 35745 35745 0 0 120879510 115152868 5726642 0 11854003 2919609 0 0 0 0 72192367 83622210 0 0 0 0 0 0 837204 1038425 2091150 2075623 76820357 51368649 18099265 25451708 0 0 0 0 0 0 0 0 637236 636268 105711225 115743843 11157567 12281117 0 0 7193210 4179238 0 0 0 0 0 0 3649736 9661827 0 0 7359212 6480673 29359725 32602855 X 75911696 83140988 439804 0 0 0 76351500 83140988 105711225 115743843 X 7226886 -437398 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 160000 false false 160000 false false Form 990, Schedule C, Part II-B, Line 1g Lobbying activity related to health care reimbursement matters, Pursuant to the affordable care act. 2482024 2482024 42214433 32231069 9983364 23563154 18894185 4668969 8560746 243395 8317351 25451708 0 SELF-INSURANCE LIABILITY 6480673 6480673 Form 990, Schedule D, Part X, Line 2 Accounting for Uncertainty in Income Taxes On March 31, 2010, the Corporation adopted the requirements of Financial Accounting Standards Board (FASB) Accounting Standards Update (ASU) 2009-06 regarding uncertain tax positions. ASU 2009-06 defines how uncertain tax positions should be recognized, measured, presented, and disclosed in the financial statements. It requires entities to recognize a tax benefit from an uncertain tax position only if it is more-likely-than-not that the position is sustainable, based solely on its technical merits, and consideration of the relevant taxing authoritys widely understood administrative practices and precedents. The Corporation has evaluated tax positions taken or expected to be taken to determine whether the tax positions are more-likely-than-not to be sustained by the applicable taxing authority, and has determined that it currently does not have any uncertain tax positions. true true X true X true X true true true false true true 3730271 0 3730271 0.03090 0 0 0 0 0 0 3730271 0 3730271 0.03090 151649 0 151649 0.00130 2858501 0 2858501 0.02360 7328716 0 7328716 0.06060 0 0 0 0 0 0 10338866 0 10338866 0.08550 14069137 0 14069137 0.11640 true 35045916 33293620 26792000 26792000 false 1 1 JACKSON PARK HOSPITAL FOUNDATION

7531 South Stony Island chicago IL 60649

X X X X X JACKSON PARK HOSPITAL FOUNDATION 1 false true true 200. true 200. true X X X X X true X X X X false X false X X X X true X false false Form 990, Schedule H, Part III, Line 4 The amount of bad debt expense at cost is based on worksheet 2 in the instructions to schedule H. The basis for this costing methodology is operating expenses adjusted by non-patient care activities, Medicare provider taxes, and community benefit expense divided by gross patient charges. Form 990, Schedule H, Part III, Line 8 The shortfall should be treated as a community benefit because the amount represents the difference between the hospitals cost and amounts received from both Medicaid and Medicare. Form 990, Schedule H, Part III, Line 9b Patients who are known to qualify for charity care or financial assistance are placed into their own financial class in our business system. This insures they are not billed or placed into collections. Form 990, Schedule H, Part VI, Line 1 Form 990, Schedule H, Part I, Line 3c - Financial Counselor visits all appropriate patients with no insurance after a pre-screening for medical assistance through the state is completed. Daily census reports are utilized to identify uninsured patients and patients who may have the potential for large responsibilities after insurance payment. While the patient is in-house, the onsite counselor will immediately work with the patient or the responsible party in obtaining acceptable payment arrangement. Those patients identified as not having the ability to make financial arrangements should complete financial assistance paperwork. When it is known or suspected by an employee of any department within the hospital that a current patient may require assistance in satisfying his/her bill, a Financial Counselor should be immediately notified. All patients under review for financial assistance consideration are given guidance in applying for assistance through external agencies. Form 990, Schedule H, Part I, Line 6a - Jackson Park Hospital files an annual community benefit report with the Illinois Attorney Generals Office. Form 990, Schedule H, Part V, Line 19d - Jackson Park Hospital uses its policy for charity assistance in determining amounts billed to patients who do not have insurance. Form 990, Schedule H, Part VI, Line 2 The hospital has not completed a needs assessment for our community. In 2012, the hospital will participate with the Metropolitan Chicago Health Care Council on completing a needs assessment. Form 990, Schedule H, Part VI, Line 3 The hospital contracts with a third party named FirstSource to educate and assist all of our patients upon admission or treatment in our emergency room as to enrollment into state and federal programs. If a patient is not eligible for a federal or state program, FirstSource will assist the patient with our charity care application and submit it to management for approval. Form 990, Schedule H, Part VI, Line 4 Jackson Park Hospital is a full service community hospital providing medical, surgical, obstetric, intensive care and acute mental illness care to our community. The hospital is located in the economically challenged south side of Chicago. The hospital is very dependent on state funded programs to sustain its day to day operations. Medicaid accounts for 37% of the hospitals revenues and self pay patients accounted for 19% of revenues. Form 990, Schedule H, Part VI, Line 5 The hospital sponsors a school based medical clinic at one of our local high schools. In addition, the hospital sponsors various screening programs at community events. Form 990, Schedule H, Part VI, Line 6 n/a Form 990, Schedule H, Part VI, Line 7 Jackson Park Hospital files an annual community benefit report with the Illinois Attorney Generals Office. Form 990, Schedule H, Part V, Section B, Line 9 Our outside contractor, FirstSource, will screen and work with the patient to assist them with a Medicaid application or charity application. Form 990, Schedule H, Part V, Line 12 First Source will assist patients to complete applications. Form 990, Schedule H, Part V, Line 19d not applicable. individuals did not require financial assistance during the year. X X X X false false false false false false false false false Dr Lakshmi Dodda 177200 91878 0 0 0 0 0 0 10891 0 188091 91878 0 0 Dr William O Dorsey III 209494 0 0 0 12274 0 0 0 1515 0 223283 0 0 0 Dr Haroon Olomi 0 175655 0 0 0 0 0 14000 0 10891 0 200546 0 0 Merritt Hasbrouck 460068 0 0 20064 0 0 480132 0 0 G Randall Smith 449901 0 0 20064 0 19865 489830 0 0 Nelson Vasquez 201425 0 0 0 1290 0 0 0 19369 0 222084 0 0 0 Thodur Ranganathan 290525 0 0 496 0 16351 307372 0 0 ROSE ETTE RN 193602 0 0 52 0 6225 199879 0 0 Dr CARYN CARRANZA 0 377817 0 0 0 0 0 0 0 0 0 377817 0 0 Dr NAVEED MUHAMMAD 173854 0 0 111 0 9921 183886 0 0 BARRY MANDELL 147017 0 0 387 0 16351 163755 0 0 PATRICA SIMON 136749 0 0 4504 0 10891 152144 0 0 Form 990, Part VI, Line 11A The management and members of the audit committee review the return prior to its release. Form 990, Part VI, Line 12c All officers, directors or trustees, and key employees are required to complete a conflict of interest disclosure form every three years. Jackson Park Hospital Foundation is scheduled to complete this procedure in its fiscal year 2011. Form 990, Part VI, Line 15a & B Jackson Park Hospital Foundation has a compensation committee. The Chairman of The Board reviews the compensation of senior management and key employees on an annual basis. Form 990, Part VI, Line 19 Jackson Park Hospital Foundations makes its 990, Conflict of Interest Policy, Community Benefit Report and Financial Statements available to the public by appointment with its Vice President of Finance. Form 990, Part XI, Line 5 Other changes in net assets or fund balance: Restrictions satisfied by performance: ($439,804) Unrestricted contributions and other, net: $38,150 Pension expense: ($35,744) Total other changes in net assets or fund balance: ($437,398) Form 990, Part VII, Section B, Line 1, Column (B) Description of service: NICL Laboratories - Hospital laboratory testing Amerisourcebergen - Drugs & I.V.s for patients Rush Nursing Services, LLC - Temporary Registered Nurse staffing EMCARE, Inc. - Emergency Physician Staffing Cardinal Health - Patient medical supplies Foundation For Jackson Park Hospital 7531 South Stony Island chicago IL 60649 270029181 Fundraising IL 11 501(c)(3) na false The Friedell Clinic SC 7531 South Stony Island chicago IL 60649 363290656 Primary Care IL na c corp. 100 100 1.00000 false false true false false false false false false false false false false false false false false false Medical staff c 10000 actual receipts Jackson Park Foundation c 30000 actual receipts