ST DOMINIC-JACKSON MEMORIAL HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ST DOMINIC-JACKSON MEMORIAL HOSPITAL (EIN 64-0303091)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201233199349302893
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-14T11:18:42-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN201941244EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1HORNE LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11020 HIGHLAND COLONY PKWY STE 400AddressLine1
CityRIDGELANDCity
StateMSState
ZIP Code39157ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN640303091EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST DOMINIC-JACKSON MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTDONameControl
Phone6012002000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1969 LAKELAND DRIVEAddressLine1
CityJACKSONCity
StateMSState
ZIP Code392164699ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLESTER DIAMONDName
TitleCURRENT PRESIDENTTitle
Phone6012002000Phone
Date Signed2012-11-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMARSHA H DIECKMAN CPAName
PTINP00246741PTIN
Phone6013261000Phone
Date Prepared2012-11-08DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLESTER DIAMONDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1969 LAKELAND DRIVEAddressLine1
CityJACKSONCity
StateMSState
ZIP Code392164699ZIPCode
FieldValueIRS element (for citing)
Gross Receipts379889188GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.STDOM.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1946YearFormation
State Legal DomicileMSStateLegalDomicile
Activity Or Mission DescriptionST. 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees3632TotalNbrEmployees
Total Nbr Volunteers319TotalNbrVolunteers
Total Gross UBI1559923TotalGrossUBI
Net Unrelated Business Txbl Income-81009NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3622710ContributionsGrantsPriorYear
Contributions Grants Current Year45524ContributionsGrantsCurrentYear
Program Service Revenue Prior Year360396274ProgramServiceRevenuePriorYear
Program Service Revenue CY369811065ProgramServiceRevenueCY
Investment Income Prior Year855785InvestmentIncomePriorYear
Investment Income Current Year879254InvestmentIncomeCurrentYear
Other Revenue Prior Year8699707OtherRevenuePriorYear
Other Revenue Current Year9230888OtherRevenueCurrentYear
Total Revenue Prior Year373574476TotalRevenuePriorYear
Total Revenue Current Year379966731TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2262977GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2155550GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year164550851SalariesEtcPriorYear
Salaries Etc Current Year170094001SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year187911165OtherExpensePriorYear
Other Expenses Current Year197899145OtherExpensesCurrentYear
Total Expenses Prior Year354724993TotalExpensesPriorYear
Total Expenses Current Year370148696TotalExpensesCurrentYear
Revenues Less Expenses Prior Year18849483RevenuesLessExpensesPriorYear
Revenues Less Expenses CY9818035RevenuesLessExpensesCY
Total Assets BOY304339006TotalAssetsBOY
Total Assets EOY322550925TotalAssetsEOY
Total Liabilities BOY82871635TotalLiabilitiesBOY
Total Liabilities EOY137325027TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY221467371NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY185225898NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionST. 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense353924820Expense
Grants2155550Grants
Revenue368251142Revenue
DescriptionHOSPITAL 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 HOSPITAL ("ST. DOMINIC'S") IS CELEBRATING ITS 66TH YEAR OF PROVIDING A CHRISTIAN MINISTRY OF HEALING TO THE GREATER JACKSONDescription

Activity2 Activity2

FieldValueIRS element (for citing)
DescriptionCOMMUNITY.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 3,300 NURSES,Description

Activity3 Activity3

FieldValueIRS element (for citing)
DescriptionPHYSICIANS, SKILLED CAREGIVERS AND STAFF. ST. DOMINIC HOSPITAL PROVIDED OVER $1 BILLION (CHARGES) IN HOSPITAL SERVICES IN 2011 TO PATIENTS THROUGHOUT THE CENTRAL REGION OF MISSISSIPPI. ST. DOMINIC'S AND ITS AFFILIATES EMPLOYED OVER 3,300 PEOPLE MAKING IT ONE OF THE AREA'S LARGEST EMPLOYERS. THESE CLEAN (GREEN) JOBS INFUSED THE ECONOMY WITH OVER $137 MILLION IN SALARIES AND WAGES IN 2011. THE MISSISSIPPI BUSINESS JOURNAL HAS RECOGNIZED ST. DOMINIC HOSPITAL AS ONE OF THE TOP FIVE "BEST PLACES TO WORK IN MISSISSIPPI". OUR MEDICAL STAFF, OF NEARLY 500 LEADING PHYSICIANS AND SPECIALISTS, MAKES ST. DOMINIC'S ONE OF THE MOST COMPREHENSIVE HOSPITALS IN MISSISSIPPI.SINCE 2005, ST. DOMINIC'S HAS ASSISTED IN RELOCATING 20 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 114 JOBS AND $13.2 MILLION IN SALARIES A 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 APPROXIMATELY 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 66 YEARS 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 2011 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.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
DescriptionST. 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 37 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. IN 2011, HHA SCREENED 441 REGISTRANTS, 65 OF WHICH WERE RETURNING PATIENTS. OUT OF THOSE SCREENED, 223 PATIENTS WERE ENCOURAGED TO SEE A PRIMARY CARE PHYSICIAN CONCERNING HYPERTENSION, LIPID MANAGEMENT AND/OR DIABETES MANAGEMENT; 20 PATIENTS WERE REFERRED TO CARDIOLOGISTS FOR FURTHER TESTING DUE TO THEIR RESULTS, AND 22 WERE EVALUATED FURTHER WITH ADDITIONAL TESTS AND PROGRAM OFFERINGS.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 THE SECOND CONSECUTIVE YEAR, ST. DOMINIC'S HAS BEEN RANKED THE NO. 1 HOSPITAL IN THE JACKSON METRO AREA IN THE U.S. NEWS MEDIA & WORLD REPORT'S 2012-13 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 IS THE ONLY HOSPITAL IN MISSISSIPPI "AND ONE OF ONLY 156 HOSPITALS IN THE NATION" TO RECEIVE THE PRESTIGIOUS DESIGNATION, WHICH IDENTIFIES HIGH PERFORMING HOSPITALS THAT ACHIEVE TOP GRADES FOR ELECTRONIC MEDICAL RECORD ADOPTION AND QUALIFY FOR THE FEDERAL GOVERNMENT'S MEANINGFUL USE STANDARDS. ST. DOMINIC'S IS 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 FURTHER ESTABLISHED ITS REPUTATION AS A TOP PROVIDER FOR CANCER CARE IN MISSISSIPPI IN 2009 WHEN THE PROGRAM RECEIVED THE OUTSTANDING ACHIEVEMENT AWARD FROM THE COMMISSION ON CANCER (COC) OF THE AMERICAN COLLEGE OF SURGEONS. THIS AWARD WAS EARNED BY ONLY 18% OF CANCER PROGRAMS IN THE NATION IN 2009. ST. DOMINIC'S WAS THE ONLY HOSPITAL IN MISSISSIPPI AND ONE OF 82 HEALTHCARE FACILITIES IN THE COUNTRY TO RECEIVE THIS PRESTIGIOUS AWARD. 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. IN MARCH OF 2011, ST. DOMINIC'S CANCER CENTER OPENED THE HIGH-DOSE-RADIATION (HDR) BRACHYTHERAPY SUITE, WHICH IS A QUICKER MORE EFFECTIVE WAY TO TREAT PATIENTS BEING GIVEN HIGH DOSES OF RADIATION FOR DIFFERENT TYPES OF CANCER. 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 EQUAL APPROXIMATELY 1,300 ANNUALLY OF WHICH HIGH PERCENTAGES ARE MEDICAID RECIPIENTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense353924820TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096234NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3632NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JENNIFER SINCLAIRBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6012006955TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1969 LAKELAND DRAddressLine1
CityJACKSONCity
StateMSState
ZIP Code392164699ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
SR MARY DOROTHEA SONDGEROTH OP
CHAIRMAN0.50XX000
DAN GRAFTON
VICE CHAIRMAN0.50XX000
SR MARY TRINITA EDDINGTON OP
SECRETARY/TREASURER0.50XX000
TOD ETHEREDGE
DIRECTOR0.50X000
JEFF FLETCHER MD
DIRECTOR0.50X000
LEROY WALKER
DIRECTOR0.50X000
CON MALONEY
DIRECTOR0.50X000
SR M THECLA KUHNLINE OP
DIRECTOR0.50X000
SR M CELESTINE RONDELLI OP
DIRECTOR0.50X000
CLAUDE W HARBARGER
HOSPITAL PRESIDENT40.00XX575203042262
JIMMY JONES MD
DIRECTOR0.50X1500000
SR REBECCA ANN GEMMA OP
DIRECTOR0.50X000
BILL TEW MD
DIRECTOR0.50X000
DONNA SIMS
DIRECTOR0.50X000
SR KRISTIN REVER OP
DIRECTOR0.50X000
JENNIFER SINCLAIR
VP- FINANCE40.00X274298038804
LESTER DIAMOND
EXEC VP- OPERATIONS40.00358366037855X
ROBERT MOBLEY MD
EXEC VP- MEDICAL AFFAIRS40.00407599042232X
PAUL ARRINGTON
VP- BUSINESS DEVELOPMENT40.00241370038773X
KEITH VAN CAMP
VP- INFORMATION TECH40.00263308032914X
STEPHEN BOMGARDNER
VP- NURSING40.00227387037230X
BECKY LOWE
VP- ANCILLARY SERVICES40.00216377028548X
TRACE SWARTZFAGER
VP- ANCILLARY SERVICES40.00207366032184X
LORRAINE WASHINGTON
VP - HUMAN RESOURCES40.00022422033279X
HUEY B MCDANIEL MD
PHYSICIAN40.0058452908208X
KYLE GORDON MD
PHYSICIAN40.0074266908325X
JOHN LANCON MD
PHYSICIAN40.00122022508325X
GERHARD MUNDINGER MD
PHYSICIAN40.0086537707225X
RONALD KENNEDY MD
PHYSICIAN40.0086860708325X
RALPH E SULSER MD
FORMER VICE CHAIRMAN0.0026189706832X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7329578TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs224220TotalReportableCompFrmRltdOrgs
Total Other Compensation411321TotalOtherCompensation
Number Individuals GT100 K121NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALLIED EMERGENCY SERVICES PC
PO BOX 2120RIDGELANDMS39158ER PHYSICIANS6829439
HARRELL CONTRACTING GROUP LLC
368 HIGHLAND COLONY PARKWAYRIDGELANDMS39157CONSTRUCTION SERVICES2978737
PHYSICIANS ANESTHESIA GROUP PA
PO BOX 460JACKSONMS39296CONTRACT MEDICAL SERVICES2756846
COGENT HEALTHCARE OF JACKSON MS
969 LAKELAND DRIVEJACKSONMS39216CONTRACT MEDICAL SERVICES1990086
JACKSON HEART CLINIC
970 LAKELAND DRIVEJACKSONMS39216CONTRACT MEDICAL SERVICES1906866
FieldValueIRS element (for citing)
Number Of Contractors GT100 K26NumberOfContractorsGT100K
Related Organizations45000RelatedOrganizations
All Other Contributions524AllOtherContributions
Total Contributions45524TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PROGRAM REVENUE621990365643331365643331
PHARMACEUTICAL SALES446110362090824601681160740
SPA SALES812900546826147643399183
FieldValueIRS element (for citing)
Total Program Service Revenue369811065TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column769912TotalRevenueColumn
Exclusion$769,912ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real4441756Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real4441756Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column4441756TotalRevenueColumn
Exclusion$4,441,756ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other31799Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other-77543Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other109342Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column109342TotalRevenueColumn
Exclusion$109,342ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA SALES7222102302014$2,302,014
DAY CARE CENTER624410651406$651,406
MISCELLANEOUS INCOME900099545370$545,370

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1290342TotalRevenueColumn
Exclusion$1,290,342ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue4789132TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column379966731TotalRevenueColumn
Related Or Exempt Function Income368251142RelatedOrExemptFunctionIncome
Unrelated Business Revenue1559923UnrelatedBusinessRevenue
Exclusion$10,110,142ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2155550Total
Program Services2155550ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2771573Total
Management And General2771573ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total134566702Total
Program Services124921002ProgramServices
Management And General9645700ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total11248408Total
Program Services10231397ProgramServices
Management And General1017011ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total12048953Total
Program Services10959562ProgramServices
Management And General1089391ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total9458365Total
Program Services8603198ProgramServices
Management And General855167ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total350946Total
Program Services350946ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total554088Total
Management And General554088ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total290946Total
Management And General290946ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total861849Total
Program Services861849ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3192729Total
Program Services3192729ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total654703Total
Program Services654703ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total91652Total
Program Services91652ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total20173475Total
Program Services20173475ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total3997810Total
Program Services3997810ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
SUPPLIES6645776266457762
PHARMACEUTICAL DRUGS2305212423052124
BAD DEBTS2070321720703217
EQUIPMENT RENTAL AND MA1580952215809522

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total41708322Total
Program Services41708322ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total370148696Total
Program Services353924820ProgramServices
Management And General16223876ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY59187379BOY
EOY67791416EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY53309890BOY
EOY54125916EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY6390602BOY
EOY7256467EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY24193765BOY
EOY24192445EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis414988238LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec249788003LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY158002654BOY
EOY165200235EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3254716BOY
EOY3984446EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY304339006BOY
EOY322550925EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY34229136BOY
EOY43521436EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY48642499BOY
EOY93803591EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY82871635BOY
EOY137325027EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY221467371BOY
EOY185225898EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY221467371BOY
EOY185225898EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY304339006BOY
EOY322550925EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses9818035ReconcilationRevenueExpenses
Reconcilation Other Changes-46059508ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$30,110OtherActivitiesAmount
Total Lobbying Expenditures IIB30110TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationST. DOMINIC-JACKSON MEMORIAL HOSPITAL PAID DUES TO THE MISSISSIPPI HOSPITAL ASSOCIATION. THE MISSISSIPPI HOSPITAL ASSOCIATION REPORTS THAT 24.6% OF THE $122,400 OF DUES PAID WERE FOR LOBBYING EXPENSES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis18239944OtherCostOrOtherBasis
Book Value18239944BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis133399368OtherCostOrOtherBasis
Depreciation85819074Depreciation
Book Value47580294BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis254877507OtherCostOrOtherBasis
Depreciation163968929Depreciation
Book Value90908578BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8471419OtherCostOrOtherBasis
Book Value8471419BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings165200235TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLIABILITY FOR PENSION BENEFITSDescription
Amount$93,803,591Amount
FieldValueIRS element (for citing)
Total Of Amounts93803591TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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, 2011 OR 2010. INCOME TAX EXPENSE FOR SDIS TOTALED $141,821 AND $0 FOR THE YEARS ENDED DECEMBER 31, 2011 AND 2010, 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, 2011 OR 2010. 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 2007 REMAIN OPEN TO EXAMINATION BY THE FEDERAL AND STATE TAXING JURISDICTIONS TO WHICH THE HOSPITAL IS SUBJECT.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense15591349TotalCommunityBenefitExpense
Direct Offsetting Revenue4756246DirectOffsettingRevenue
Net Community Benefit Expense10835103NetCommunityBenefitExpense
Percent Of Total Expense0.03100PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense45375029TotalCommunityBenefitExpense
Direct Offsetting Revenue46740060DirectOffsettingRevenue
Net Community Benefit Expense-1365031NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense1214479TotalCommunityBenefitExpense
Direct Offsetting Revenue1235267DirectOffsettingRevenue
Net Community Benefit Expense-20788NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense62180857TotalCommunityBenefitExpense
Direct Offsetting Revenue52731573DirectOffsettingRevenue
Net Community Benefit Expense9449284NetCommunityBenefitExpense
Percent Of Total Expense0.03100PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1751904TotalCommunityBenefitExpense
Net Community Benefit Expense1751904NetCommunityBenefitExpense
Percent Of Total Expense0.00500PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense88681TotalCommunityBenefitExpense
Net Community Benefit Expense88681NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense11171167TotalCommunityBenefitExpense
Direct Offsetting Revenue6633093DirectOffsettingRevenue
Net Community Benefit Expense4538074NetCommunityBenefitExpense
Percent Of Total Expense0.01300PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense635366TotalCommunityBenefitExpense
Net Community Benefit Expense635366NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense13647118TotalCommunityBenefitExpense
Direct Offsetting Revenue6633093DirectOffsettingRevenue
Net Community Benefit Expense7014025NetCommunityBenefitExpense
Percent Of Total Expense0.02010PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense75827975TotalCommunityBenefitExpense
Direct Offsetting Revenue59364666DirectOffsettingRevenue
Net Community Benefit Expense16463309NetCommunityBenefitExpense
Percent Of Total Expense0.05110PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$20,703,217BadDebtExpenseAmount
Amount Attributable To6210965AmountAttributableTo
Amount Reimbursed By Medicare102441828AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare126017857CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-23576029MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 ST DOMINIC AMBULATORY SURGERY CENTER LLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityOUTPATIENT SURGERY CENTERDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50010OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.49990PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST DOMINIC - JACKSON MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1969 LAKELAND DRIVEAddressLine1
CityJACKSONCity
StateMSState
ZIP Code392164699ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherAMBULATORY SURGERY CENTER AND PHYSICIAN CLINICSOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1STDOMINIC- JACKSON MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent350.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities15NumberOfOtherFacilities

Other Facilities OtherFacilities (15 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityTypeAddress Line2Address/AddressLine2
ST DOMINIC AMBULATORY SURGERY CENTER
969 LAKELAND DRIVEJACKSONMS392164699OUTPATIENT SURGERY CENTER
ST DOMINIC'S CARDIOVASCULAR SURGERY ASS
971 LAKELAND DRIVE SUITE 1159JACKSONMS39219PHYSICIAN CLINIC
EAR NOSE & THROAT SURGICAL GROUP AT ST
970 LAKELAND DRIVE SUITE 40 JACKSONJACKSONMS39216PHYSICIAN CLINICM
ST DOMINIC INTERNAL MEDICINE GROUP
970 LAKELAND DRIVE SUITE 40 JACKSONJACKSONMS39216PHYSICIAN CLINICM
ST DOMINIC NEUROSURGERY ASSOCIATES
971 LAKELAND DRIVE SUITE 657JACKSONMS39216PHYSICIAN CLINICJACKSON
ST DOMINIC'S FAMILY MEDICINE - MADISON
HIGHLAND MEDICAL ARTS BUILDING 106MADISONMS39110PHYSICIAN CLINICHIGH
ST DOMINIC'S FAMILY MEDICINE OF CLINTON
728 CLINTON PARKWAY SUITE B CLINTONCLINTONMS39056PHYSICIAN CLINICMS
ST DOMINIC'S FAMILY MEDICINE OF FLOWOOD
1050 RIVER OAKS DRIVE FLOWOOD MSFLOWOODMS39232PHYSICIAN CLINIC39232
ST DOMINIC'S PSYCHIATRIC ASSOCIATES
969 LAKELAND DRIVE JACKSON MSJACKSONMS39216PHYSICIAN CLINIC
ST DOMINIC'S INFECTIOUS DISEASE
971 LAKELAND DRIVE SUITE 954JACKSONMS39216PHYSICIAN CLINICJACKSON
ST DOMINIC'S CLINIC AT WALMART
WALMART SUPERCENTER 5520 HWY 80PEARLMS39208PHYSICIAN CLINICEAST
ST DOMINIC'S CHRONIC CARE CLINIC
3800 I-55 NORTH SUITE 102 JACKSONJACKSONMS39211PHYSICIAN CLINICMS
ST DOMINIC'S EMPLOYEE CLINIC
969 LAKELAND DRIVE JACKSON MSJACKSONMS39216PHYSICIAN CLINIC
ST DOMINIC'S CLINIC AT WALMART
WALMART SUPERCENTER 127 GRANDVIEWMADISONMS39110PHYSICIAN CLINICBLVD
ST DOMINIC'S CLINIC AT WALMART
WALMART SUPERCENTER 950 HWY 80 EASTCLINTONMS39056PHYSICIAN CLINICCL

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanationIdentifierIdentifier
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 50% DISCOUNT OFF GROSS CHARGES TO ALL UNINSURED PATIENTS.
PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR ST. DOMINIC HOSPITAL IS CONSOLIDATED WITH THE PARENT ORGANIZATION, ST. DOMINIC HEALTH SERVICES, INC.
PART I, LINE 7: ST. DOMINIC HOSPITAL USED A COST-TO-CHARGE RATIO BASED ON WORKSHEET 2.
PART I, LINE 7G: ST. DOMINIC HOSPITAL DID NOT INCLUDE LOSSES ON ITS OWNED PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. IN ORDER TO MEET THE NEEDS OF THE COMMUNITY WE SERVE, ST. DOMINIC CONTINUES ITS MINISTRY IN VARIOUS SERVICE LINES THAT ARE NOT PROFITABLE TO THE ORGANIZATION. EXAMPLES OF THESE SERVICES INCLUDE BUT ARE NOT LIMITED TO EMERGENCY DEPARTMENT AND INFUSION THERAPY.
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 $ 20703217.
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 62.2 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2010, TO 63.3 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011. IN ADDITION, THE HOSPITAL'S SELF-PAY BAD DEBT WRITEOFFS INCREASED FROM $4,038,066 IN 2010 TO $12,116,019 IN 2011. THE HOSPITAL'S UNINSURED DISCOUNT POLICY HAS NOT CHANGED DURING 2011 OR 2010. 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 6.2 PERCENT OF THIRD-PARTY GOVERNMENT ACCOUNTS RECEIVABLE AT DECEMBER 31,2010, TO 5.0 PERCENT OF THIRD-PARTY GOVERNMENT ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011. IN ADDITION, THE HOSPITAL'S THIRD-PARTY GOVERNMENT BAD DEBT WRITEOFFS INCREASED FROM $975,236 IN 2010 TO $2,539,618 IN 2011. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THIRD-PARTY COMMERCIAL PAYORS INCREASED FROM 6.2 PERCENT OF THIRD-PARTY COMMERCIAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2010, TO 8.5 PERCENT OF THIRD-PARTY COMMERCIAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011. IN ADDITION, THE HOSPITAL'S THIRD-PARTY COMMERCIAL BAD DEBT WRITEOFFS INCREASED FROM $3,166,477 IN 2010 TO $6,620,115 IN 2011. THE NOTED INCREASES RESULTED FROM ACTUAL BAD DEBT WRITEOFFS 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 WRITEOFFS NOTED ABOVE.
PART III, LINE 8: N/A - THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT TOTAL.
PART III, LINE 9B: ST. DOMINIC HOSPITAL HAS A BOARD APPROVED COLLECTION POLICY AND HAS WRITTEN CONTRACTS IN PLACE WITH ITS COLLECTION AGENCIES SO THE APPROPRIATE COLLECTION ACTIVITIES ARE FOLLOWED. THE COLLECTION AGENCIES THAT ST. DOMINIC USES ARE FULLY INFORMED ABOUT THE HOSPITAL'S FINANCIAL AID POLICY AND ASSIST IN EDUCATING OUR PATIENTS. THEY ROUTINELY SEND FINANCIAL AID APPLICATIONS TO PATIENTS AND REFER THOSE PATIENTS BACK TO THE HOSPITAL'S FINANCIAL COUNSELORS WHEN APPROPRIATE.
PART V, SECTION B, LINE 13G: THE HOSPITAL'S WEBSITE ALSO INFORMS PATIENTS OF THE POLICY.ST.DOMINIC- JACKSON MEMORIAL HOSPITAL
PART V, SECTION B, LINE 19D: HOSPITAL OFFERS A DISCOUNT OF 50% WHICH IS EQUIVALENT TO THE AVERAGE COMMERCIAL DISCOUNT.ST.DOMINIC- JACKSON MEMORIAL HOSPITAL
PART VI, LINE 2: ST. DOMINIC HOSPITAL ASSESSES THE COMMUNITY WE SERVE THROUGH VARIOUS SOURCES WHICH INCLUDE:1-NEEDS ASSESSMENT PERFORMED BY THE LOCAL UNITED WAY OFFICE2-ANALYSIS OF THE PAYOR SOURCE AND DISEASE CATEGORIES OF PATIENTS TREATED AT ST. DOMINIC HOSPITAL WITH PARTICULAR ANALYSIS DONE ON PATIENTS PRESENTING TO OUR EMERGENCY DEPARTMENT3-FEEDBACK FROM THE BOARD MEMBERS WHO REPRESENT THE COMMUNITY WE SERVE4-REQUESTS MADE TO US FROM OUR COMMUNITY5-PUBLIC HEALTH INFORMATION
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: ST. DOMINIC-JACKSON MEMORIAL HOSPITAL (ST. DOMINIC HOSPITAL) IS AN ADULT TERTIARY REFERRAL CENTER SERVING RESIDENTS FROM COUNTIES IN THE CENTRAL REGION OF MISSISSIPPI. THE HOSPITAL DEFINES ITS SERVICE AREA AS THE COUNTIES EQUATING TO APPROXIMATELY 85 PERCENT OF THE HOSPITAL'S ACUTE INPATIENT DISCHARGES. BASED ON A REVIEW OF THE 2012 INTERNAL ACUTE CARE DISCHARGE DATA, 12 COUNTIES CONSTITUTE THAT PERCENTAGE OF ST. DOMINIC HOSPITAL'S INPATIENT DISCHARGES (HINDS, MADISON, RANKIN, WARREN, YAZOO, HOLMES, ATTALA, LEAKE, SCOTT, SIMPSON, COPIAH, AND LINCOLN COUNTIES). THE TOTAL POPULATION FOR ST. DOMINIC'S 12 COUNTY SERVICE AREA EQUALED 750,111 BASED ON POPULATION ESTIMATES FOR 2011 AND IS PROJECTED TO INCREASE TO 764,987 BY 2016. THE TOTAL POPULATION OF ST. DOMINIC'S SERVICE AREA IN 2011 REPRESENTS 24.9 PERCENT OF THE TOTAL POPULATION FOR THE STATE OF MISSISSIPPI. FEMALES CONSTITUTE 51.6 PERCENT OF THE TOTAL POPULATION IN ST. DOMINIC'S SERVICE AREA IN 2011, WITH FEMALES OF CHILD BEARING AGE (I.E., 18-44 YEARS OF AGE) EQUALING 138,722 OR 18.5 PERCENT OF THE TOTAL POPULATION FOR THE SERVICE AREA. THE LARGEST POPULATION AGE COHORT IN THE HOSPITAL'S SERVICE AREA - IN 2011 - IS PEOPLE 18-44 YEARS OF AGE (275,266 OR 36.7 PERCENT). THE FASTEST GROWING AGE COHORT PROJECTED FOR 2011 TO 2016 IS PEOPLE AGES 65 AND OVER, INCREASING 2.5 PERCENT ON A COMPOUND ANNUAL GROWTH RATE (I.E., 102,769 COMPARED TO 90,929). WHITE-NON HISPANIC CONSTITUTES THE LARGEST ETHNIC POPULATION CO-HORT (I.E., 49 PERCENT) IN ST. DOMINIC'S SERVICE AREA. BLACK-NON-HISPANIC REPRESENTS 46.3 PERCENT AND HISPANICS REPRESENT 2.5 PERCENT OF THE TOTAL POPULATION IN THE SERVICE AREA. ACCORDING TO THE MISSISSIPPI DEPARTMENT OF HEALTH'S FY 2012 MISSISSIPPI STATE HEALTH PLAN, THE BIRTH RATE STATEWIDE IN 2009 WAS 14.5 LIVE BIRTHS PER 1,000 POPULATION. THE FERTILITY RATE WAS 70.7 LIVE BIRTHS PER 1,000 WOMEN AGED 15-44 YEARS OF AGE.INFANT MORTALITY RATE REMAINS A MAJOR CONCERN IN MISSISSIPPI AS THE RATE INCREASED TO 10.0 DEATHS PER 1,000 LIVE BIRTHS IN 2009 (7.0 PER THOUSAND FOR WHITE COMPARED TO 13.4 PER THOUSAND FOR NON-WHITE). OF THE 42,809 TOTAL BIRTHS IN 2009 IN MISSISSIPPI, 32,731 WERE ASSOCIATED WITH AT RISK MOTHERS (I.E., 76.5 PERCENT). THE COUNTY WITH THE HIGHEST INFANT MORTALITY RATE, IN ST. DOMINIC'S SERVICE AREA, IS HINDS COUNTY AT 13.2 DEATHS PER 1,000 LIVE BIRTHS AND THE LOWEST IS MADISON COUNTY AT 7.8.HEART DISEASE REMAINS THE LEADING CAUSE OF DEATH IN BOTH MISSISSIPPI AND IN THE UNITED STATES. MALIGNANT NEOPLASMS RANKED SECOND IN THE STATE FOLLOWED BY ACCIDENTS, CEREBROVASCULAR DISEASE AND EMPHYSEMA AND OTHER RESPIRATORY DISEASE.ACCORDING TO THE STATE HEALTH PLAN, MISSISSIPPI RANKED 49TH AMONG THE STATES IN PER CAPITA INCOME AND 49TH IN MEDIAN FAMILY INCOME. THE STATEWIDE PER CAPITA INCOME EQUALED $16,994 AND THE MEDIAN HOUSEHOLD INCOME EQUALED $31,997 IN 2011. MADISON COUNTY EXPERIENCED THE HIGHEST PER CAPITA INCOME AND MEDIAN HOUSEHOLD INCOME IN 2011 FOR COUNTIES IN THE SERVICE AREA WITH $54,182 AND $28,423, RESPECTIVELY. HOLMES COUNTY EXPERIENCED THE LOWEST WITH A PER CAPITA INCOME OF $12,961 AND MEDIAN HOUSEHOLD INCOME OF $25,214.
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 8: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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (21 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
REAL CHRISTIAN FOUNDATION
PO BOX 180059RICHLANDMS39218640885750501(C)(3)50000CHARITABLE SUPPORT
THE CENTER FOR VIOLENCE PREVENTION
PO BOX 6279PEARLMS39288581959108501(C)(3)30000CHARITABLE SUPPORT
OPERATION SHOESTRING
1711 BAILEY AVENUEJACKSONMS39283640471554501(C)(3)25000CHARITABLE SUPPORT
NEIGHBORHOOD CHRISTIAN CENTER
417 W ASH STJACKSONMS39203640800919501(C)(3)18000CHARITABLE SUPPORT
MISSION MISSISSIPPI
120 N CONGRESS STJACKSONMS39201640824240501(C)(3)30000CHARITABLE SUPPORT
HOSPICE MINISTRIES
450 TOWNE CENTER BOULEVARDRIDGELANDMS39157640789919501(C)(3)55000CHARITABLE SUPPORT
COMMUNITY HEALTH SERVICES-ST DOMINIC INC (CARE-A-VAN)
969 LAKELAND DRJACKSONMS392164699640714997501(C)(3)150000AFFILIATE SUPPORT
CHRISTIAN MEDICAL AND DENTAL
P O BOX 4569JACKSONMS39296362284267501(C)(3)5000CHARITABLE SUPPORT
CATHOLIC CHARITIES
200 N CONGRESS STJACKSONMS39201640468850501(C)(3)55000CHARITABLE SUPPORT
BREAKTHRU MINISTRIES
PO BOX 39236JACKSONMS39236621284192501(C)(3)15000CHARITABLE SUPPORT
BOY SCOUTS OF AMERICA
855 RIVERSIDE DRJACKSONMS39202640303071501(C)(3)32000CHARITABLE SUPPORT
BEGINNING AGAIN IN CHRIST
PO BOX 26BRANDONMS390430026640592123501(C)(3)15000CHARITABLE SUPPORT
SOUTHERN CHRISTIAN SERVICES
860 EAST RIVER PLACE SUITE 104JACKSONMS39202640758344501(C)(3)40000CHARITABLE SUPPORT
FAMILY MATTERS COUNCIL
2906 NORTH STATE STREET SUITE 207JACKSONMS39216264512639501(C)(3)20000CHARITABLE SUPPORT
COHA INC
805 EAST RIVER PLACE SUITE 104JACKSONMS39202640861570501(C)(3)12500CHARITABLE SUPPORT
100 BLACK MEN OF JACKSON
5360 HIGHLAND DRIVEJACKSONMS39286640817928501(C)(3)37500CHARITABLE SUPPORT
NEW LIFE FOR WOMEN
814 NORTH CONGRESS STREETJACKSONMS39202640765336501(C)(3)10000CHARITABLE SUPPORT
LANTERN MEDICAL CLINIC
198 KIRKWOOD PLACEJACKSONMS39211262621541501(C)(3)20000CHARITABLE SUPPORT
MISSISSIPPI CHILDREN'S HOME SERVICES
PO BOX 1078JACKSONMS39215640303085501(C)(3)15000CHARITABLE SUPPORT
ST DOMINIC HEALTH SERVICES INC
969 LAKELAND DRJACKSONMS39216640714999501(C)(3)1500000AFFILIATE SUPPORT
ST DOMINIC HEALTH SERVICES FOUNDATION INC
969 LAKELAND DRJACKSONMS39216431992975501(C)(3)20550AFFILIATE SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants21TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses0WrittenPolicyReTAndEExpenses
Substantiation Required0SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (16 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CLAUDE W HARBARGER
49694700078256035046072160617465000
JENNIFER SINCLAIR
2726660001632033015057890313102000
LESTER DIAMOND
31566400042702029741081140396221000
ROBERT MOBLEY MD
36668800040911035601066310449831000
PAUL ARRINGTON
2413700000030754080190280143000
KEITH VAN CAMP
263308000003260803060296222000
STEPHEN BOMGARDNER
2273870000030319069110264617000
BECKY LOWE
216377000002829702510244925000
TRACE SWARTZFAGER
2073660000025642065420239550000
LORRAINE WASHINGTON
02080200001620002836604913025749900
HUEY B MCDANIEL MD
584529000000082080592737000
KYLE GORDON MD
742669000000083250750994000
JOHN LANCON MD
12202250000000832501228550000
GERHARD MUNDINGER MD
865377000000072250872602000
RONALD KENNEDY MD
868607000000083250876932000
RALPH E SULSER MD
261897000000068320268729000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationHOUSING ALLOWANCE WAS PROVIDED TO ONE KEY EMPLOYEE AND WAS INCLUDED IN TAXABLE WAGES FOR 2011. THE ALLOWANCE IS INCLUDED IN THE TOTAL COMPENSATION TO THE KEY EMPLOYEE APPROVED UNDER THE EXECUTIVE COMPENSATION PROGRAM.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
MELANIE GRAFTON
DAUGHTER OF BOARD MEMBER, DAN GRAFTON61816MELANIE GRAFTON IS AN EMPLOYEE OF ST. DOMINIC-JACKSON MEMORIAL HOSPITAL.0
JACKSON PULMONARY
DR. JIMMY JONES, DIRECTOR, IS A GREATER THAN 5% OWNER516360HOSPITAL CONTRACTS WITH JACKSON PULMONARY FOR INTENSIVIST SERVICES0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6ST. DOMINIC HEALTH SERVICES, INC. IS THE SOLE MEMBER OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7ATHE 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 7BTHE 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 11THE 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 12CBOARD MEMBERS ARE REQUIRED TO FILL OUT AND SIGN A CONFLICT FORM ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15THE 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 19THESE DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART X, LINE 24EMEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 15,437,695. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,437,695. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 5,612,948. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,612,948. CONSULTANTS: PROGRAM SERVICE EXPENSES 4,333,895. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,333,895. UTILITIES: PROGRAM SERVICE EXPENSES 3,610,587. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,610,587. COLLECTION FEES: PROGRAM SERVICE EXPENSES 2,896,017. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,896,017. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 2,478,030. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,478,030. FOOD COMMODITIES: PROGRAM SERVICE EXPENSES 2,427,513. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,427,513. LAB SERVICES: PROGRAM SERVICE EXPENSES 1,299,298. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,299,298. TAXES: PROGRAM SERVICE EXPENSES 1,014,121. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,014,121. TELEPHONE: PROGRAM SERVICE EXPENSES 643,865. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 643,865. RECRUITING: PROGRAM SERVICE EXPENSES 482,573. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 482,573. LINENS: PROGRAM SERVICE EXPENSES 416,477. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 416,477. POSTAGE & SHIPPING: PROGRAM SERVICE EXPENSES 364,823. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 364,823. WASTE FEES: PROGRAM SERVICE EXPENSES 330,411. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 330,411. PRINTING & PUBLICATIONS: PROGRAM SERVICE EXPENSES 244,658. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 244,658. WEARING APPAREL: PROGRAM SERVICE EXPENSES 97,471. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,471. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 12,360. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,360. FILM: PROGRAM SERVICE EXPENSES 5,580. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,580.ALL OTHER FUNCTIONAL EXPENSES
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -898,415. PENSION TRANSITION ADJUSTMENT PER FAS 158 -45,161,092. ROUNDING -1. TOTAL TO FORM 990, PART XI, LINE 5: -46,059,508.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CTHE 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.COMMITTEE FOR AUDIT OVERSIGHT
FORM 990, PART VII, SECTION ADR. SULSER SERVES AS A MEDICAL DIRECTOR OF THE ORGANIZATION'S WEIGHT LOSS PROGRAM AND WAS PAID COMPENSATION REPORTED ON FORM 1099 FOR 2011 AND PAID W-2 WAGES FOR HIS EMPLOYMENT BY THE HOSPITAL'S 100% OWNED SINGLE MEMEBER LLC, ST. DOMINIC MEDICAL ASSOCIATES, AS SET FORTH ON PART VII. HIS EMPLOYMENT WITH MEDICAL ASSOCIATES BEGAN IN 2009, AND HIS BOARD TERM ENDED 12/31/2009 IN ORDER TO AVOID ANY POTENTIAL CONFLICTS.REPORTABLE COMPENSATION- RALPH E. SULSER, MD
FORM 990, PART VII, LINE 1A, COLUMN BSISTER MARY DOROTHEA SONDGEROTH, BOARD CHAIRMAN, SPENDS AN ADDITONAL 42 HRS/WEEK ON RELATED ORGS. SISTER MARY TRINITA EDDINGTON, BOARD SECRETARY/TREASURER, SPENDS AN ADDITONAL 40.5 HRS/WEEK ON RELATED ORGS. SISTER REBECCA ANN GEMMA, DIRECTOR, SPENDS AN ADDITONAL 1 HRS/WEEK ON RELATED ORGS.AVERAGE HOURS PER WEEK- RELATED ORGS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1ST DOMINIC MEDICAL ASSOCIATESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1969 LAKELAND DRIVEAddressLine1
CityJACKSONCity
StateMSState
ZIP Code392164699ZIPCode
FieldValueIRS element (for citing)
EIN261969846EIN
Primary ActivitiesHEALTHCAREPrimaryActivities
Legal Domicile StateMSLegalDomicileState
Total Income18429888TotalIncome
EOY Assets464997EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1ST DOMINIC -JACKSON MEMORIAL HOSPITALBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
ST DOMINIC HEALTH SERVICES FOUNDATION INC
969 LAKELAND DRIVEJACKSONMS392164699431992975OPERATION TO OVERSEE FUNDS FOR ST. DOMINIC HEALTH SERVICES & SUBSIDIARIESMS501(C)(3)509(A)(3)(1)ST DOMINIC HEALTH SERVICES INC0
ST DOMINIC HEALTH SERVICES INC
969 LAKELAND DRIVEJACKSONMS392164699640714999OPERATION AS A HOLDING COMPANY TO ACQUIRE OWNERSHIP OF RELATED ENTITYMS501(C)(3)509(A)(3)(1)0N/A
ST CATHERINE'S VILLAGE INC
969 LAKELAND DRIVEJACKSONMS392164699640714997OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITYMS501(C)(3)170(B)(1)(A) (III)ST DOMINIC HEALTH SERVICES INC0
COMMUNITY HEALTH SERVICES - ST DOMINIC INC
969 LAKELAND DRIVEJACKSONMS392164699640884870OPERATION TO PROVIDE COMMUNITY HEALTH PROGRAMSMS501(C)(3)170(B)(1)(A) (III)ST DOMINIC HEALTH SERVICES INC0
CONGREGATION OF THE DOMINICAN SISTERS OF SPRINGFIELD ILLINOIS
1237 WEST MONROE STSPRINGFIELDIL62704RELIGIOUS CONGREGATION SPONSORING EDUCATION AND HEALTHCARE INSTITUTIONSIL501(C)(3)170(B)(1)(A) (I)0N/A

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1ST DOMINIC AMBULATORY SURGERY CENTER LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1971 LAKELAND DRIVE SUITE 200AddressLine1
CityJACKSONCity
StateMSState
ZIP Code392164699ZIPCode
FieldValueIRS element (for citing)
EIN640908713EIN
Primary ActivityHEALTHCAREPrimaryActivity
Legal Domicile StateMSLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1ST DOMINIC - JACKSON MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income95605ShareOfTotalIncome
Share Of EOY Assets447594ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner
Percentage Ownership0.52850PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityDirect Controlling Entity NADirectControllingEntityNAShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
ST DOMINIC MADISON HEALTH SERVICES INC
969 LAKELAND DRIVEJACKSONMS392164699202870254HEALTHCAREMSST DOMINIC HEALTH SERVICESC
FIRST INTERMED
308 CORPORATE DRIVERIDGELANDMS39157640824796HEALTHCAREMSST DOMINIC HEALTH SERVICESC
PHYSICIANSPLUS BAPTIST & ST DOMINIC INC
969 LAKELAND DRIVEJACKSONMS392164699640889895HEALTHCAREMSCN/A
ST DOMINIC INTEGRATED SERVICES INC
969 LAKELAND DRIVEJACKSONMS392164699271493623INVESTMENT IN MEDICALMSST DOMINIC JACKSON MEMORIAL HOSPITALC36865319037091.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org1PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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