2012-03-30T10:44:37-05:00 2011-03-31 MITCHELL & TITUS LLP ONE BATTERY PARK PLAZA NEW YORK NY 10004 990 2010-04-01 362448028 Jackson Park Hospital Foundation JACK 7739477989 7531 SOUTH STONY ISLAND Avenue CHICAGO IL 60649 Mr William OP Dorsey MD 2012-03-30 JOHN BAIARDI 2127094500 X 2010 2016-02-24 21:20:13Z Merritt Hasbrouck 7531 South Stony Island Avenue Chicago IL 60649 123815759 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. 13 8 977 8 0 0 467457 43990 106046224 117179840 22781 4035 6122727 6587894 112659189 123815759 0 0 0 0 39489900 40147997 0 0 0 60335472 76382071 99825372 116530068 12833817 7285691 93455032 105711225 24829027 29359725 68626005 76351500 X TO PROVIDE COMPASSIONATE AND HIGH QUALITY HEALTHCARE SERVICES TO MEET THE NEEDS OF THE PATIENTS AND COMMUNITIES WE SERVE. false false 32374275 79103440 Acute inpatient hospital services. 5464423 18274037 Emergency Room services. 2769989 12574187 Inpatient behavorial medicine services. 72452925 7228176 113061612 true true false true 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 false 153 0 true 977 true false false false false false false false false false false X 13 8 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 274970 0 0 Dr William O Dorsey III 40.0 X 131840 0 0 Dr Harshad Mehta 40.0 X 40900 0 0 Dr Joyce R Miller 2.0 X 0 0 0 Kay L Murray 2.0 X 0 0 0 Dr Bangalore R Murthy 40.0 X 149027 0 0 Dr Haroon Olomi 40.0 X 98427 0 0 Dinah Ramirez 2.0 X 0 0 0 Alderman Todd Stroger 2.0 X 0 0 0 Michael Wilczynski 2.0 X 0 0 0 Dr Emra Brooks Williams 2.0 X 0 0 0 Merritt Hasbrouck 40.0 X 490133 0 0 G Randall Smith 40.0 X 488843 0 0 Margo Brooks-Pugh 40.0 X 125434 0 0 Alvin L Kruse 2.0 X 0 0 0 James M Schraidt 2.0 X 0 0 0 Edward J Silha 40.0 X 216024 0 0 Nelson Vasquez 40.0 X 216931 0 0 Thodur Ranganathan 40.0 X 442326 0 0 Rose Ette 79.0 X 177637 0 0 Chioma Uche 69.0 X 170410 0 0 Gloria Ifebueme 60.0 X 138882 0 0 Onyekachi Abuwa 61.0 X 145223 0 0 3307007 0 0 13 false true false NICL Laboratories 306 Era Drive NORTHBROOK IL 60062 Pathology & Lab MGT 3458954 Cardinal Health PO Box 70539 CHICAGO IL 60673 Medical Products 831056 Emcare 7032 Collection Center Drive CHICAGO IL 60693 EMERG MED PHYSICIANS 1443547 Rush Nursing Agency 7501 South Stony Island CHICAGO IL 60649 Nurse Staffing 1744092 Amerisourcebergen 1001 West Taylor Road ROMEOVILLE IL 60446 DRUGS FOR PNT CARE 1477488 5 43990 43990 NET PATIENT SERVICE REVENUE 611710 100462891 100462891 PROVIDER TAX PROCEEDS 621500 16716949 16716949 117179840 4035 4035 0 0 0 0 0 0 MEDICAL SCHOOL BILLINGS 900099 3617142 3617142 AUXILIARY INCOME 900099 1670616 1670616 RADIOLOGY PHYSICIANS 900099 318786 318786 981350 981350 6587894 123815759 123767734 4035 0 0 0 0 2064017 0 2064017 0 0 29550185 29550185 0 0 0 8533795 8533795 0 0 0 990587 0 990587 0 241352 0 241352 0 172500 0 172500 0 0 0 0 19779672 19779672 0 0 0 9845928 9845928 0 0 0 0 2018356 2018356 0 0 0 0 0 243069 243069 0 0 0 1929298 1929298 0 0 2117351 2117351 0 0 PROVISION FOR BAD DEBTS 31783037 31783037 0 0 PROVIDER TAX EXPENSES 7131636 7131636 0 0 PENSION EXPENSE 129285 129285 0 0 116530068 113061612 3468456 0 6937276 11854003 0 0 66033613 72192367 815193 837204 430644 2091150 67458891 49359626 18709386 18099265 528920 637236 93455032 105711225 10655571 11157567 3013973 7193210 4340709 3649736 6818774 7359212 24829027 29359725 X 68626005 75911696 0 439804 68626005 76351500 93455032 105711225 X 7285691 439804 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 174000 false false 174000 false false 2482024 2482024 40985555 31575906 9747945 21782410 17542892 4844963 962250 240828 1024333 18099265 0 SELF-INSURANCE LIABILITY 7359212 7359212 Accounting for Uncertainty in Income Taxes Schedule D, Part X On March 31, 2010, the Corporations 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 authority's widely understood administrative practices and precedents. The Corporations have 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 have determined that they currently do not have any uncertain tax positions. true true X true X true X true true true false true true 14411685 14411685 0.17030 45319325 14570777 30748548 0.36240 59731010 14570777 45160233 0.53270 3025968 470966 2555002 0.03020 -99990980 -91633790 -8357190 0.09880 -96965012 -91162824 -5802188 0.06860 -37234002 -76592047 39358045 0.46410 true 8029730 0 26868010 27206785 -338775 X true true 1 1 JACKSON PARK HOSPITAL FOUNDATION

7531 South Stony Island chicago IL 60649

X JACKSON PARK HOSPITAL FOUNDATION 1 false true true 200. false false true X X X false false 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 - Charity Care is based on 200% of the Federal Poverty Income Guidelines. 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. X X false false false false false false false false false Dr Lakshmi Dodda 274970 0 0 0 0 0 0 0 0 0 274970 0 286465 0 Merritt Hasbrouck 342586 0 143846 0 3701 0 0 0 0 0 490133 0 442360 0 G Randall Smith 342586 0 143846 0 2411 0 0 0 0 0 488843 0 440920 0 Edward J Silha 149202 0 63598 0 3224 0 0 0 0 0 216024 0 278886 0 Nelson Vasquez 190195 0 25396 0 1340 0 0 0 0 0 216931 0 187958 0 Thodur Ranganathan 441148 0 0 0 1178 0 0 0 0 0 442326 0 269200 0 Rose Ette 177506 0 0 0 131 0 0 0 0 0 177637 0 169381 0 Chioma Uche 170410 0 0 0 0 0 0 0 0 0 170410 0 137490 0 Form 990, Part VI, Line 11A The Chairman of The Board and Audit Committee along with the senior management team reviews the Form 990 prior to its filing. 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 III, Line 4d Salaries/Purchased Services/Professional Fees/Utilities/Insurance/Other Supplies REASONABLE CAUSE STATEMENT THIS RETURN IS BEING FILED BETWEEN MARCH 1, 2012, AND MARCH 30, 2012, AS DIRECTED BY THE IRS IN NOTICE 2012-4, BECAUSE ELECTRONIC FILING WAS NOT AVAILABLE JANUARY 1, 2012 THROUGH FEBRUARY 29, 2012. WE REQUEST THAT PENALTIES BE WAIVED BECAUSE IT WOULD BE INEQUITABLE TO IMPOSE A PENALTY ON US DUE TO THE UNUSUAL CIRCUMSTANCES REQUIRING US TO DELAY THE FILING OF THIS RETURN. Foundation For Jackson Park Hospital 7531 South Stony Island chicago IL 60649 270029181 healthcare IL 11 501(c)(3) na Friedell Clinic 7531 South Stony Island chicago IL 60649 363290656 healthcare sv IL na c corp. 100 100 1.00000 false false true false false false false false false false false false false true false false false false friedell clinic n 91157 Jackson Park Foundation c 26000 Medical Staff c 10000