2011-11-14T16:39:14-06:00 2010-12-31 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2010-01-01 640303091 ST DOMINIC-JACKSON MEMORIAL HOSPITAL STDO 6012002000 969 LAKELAND DRIVE JACKSON MS 392164699 CLAUDE HARBARGER 6012002000 2011-11-14 1 MARSHA H DIECKMAN CPA 6013261000 2011-11-10 2010 2016-03-07 17:11:31Z CLAUDE W HARBARGER 969 LAKELAND DRIVE JACKSON MS 392164699 373871023 0 X WWW.STDOM.COM X 1946 MS ST. DOMINIC-JACKSON MEMORIAL HOSPITAL OPERATES A 535 BED PATIENT FACILITY FOR THE CITIZENS OF THE JACKSON, MISSISSIPPI METROPOLITAN AREA. BEING MISSION DRIVEN AND SERVICE ORIENTED, LEADERSHIP AT ST. DOMINIC HOSPITAL RECOGNIZES THAT HEALTHCARE SERVICES AND PROGRAMS SHOULD BE EXTENDED FAR OUTSIDE THE HOSPITAL'S PHYSICAL WALLS AND INTO THE COMMUNITY TO HAVE THE GREATEST IMPACT, ESPECIALLY FOR THE UNDERSERVED. OUR CIVIC AND SOCIAL RESPONSIBILITIES LIE NOT ONLY IN PROVIDING QUALITY HEALTHCARE FOR THE SICK BUT ALSO IN PROVIDING HEALTHCARE EDUCATION AND ILLNESS PREVENTION FOR THOSE WHO ARE MARGINALLY CHALLENGED AND WITH LIMITED ACCESS TO MAINSTREAM HEALTHCARE SOURCES. 15 12 3427 301 1263203 -167290 188926 3622710 343709934 360396274 481382 855785 10476078 8699707 354856320 373574476 2257545 2262977 0 0 161141545 164550851 0 0 0 189501081 187911165 352900171 354724993 1956149 18849483 282756831 304339006 78920718 82871635 203836113 221467371 X ST. DOMINIC'S RECOGNIZES ITS BASIC PARTICIPATION IN THE MISSION OF THE CHURCH WHICH INVOLVES TWO MAIN MINISTRIES: EDUCATION AND HEALTH CARE. THREE ACTIVITIES--COMMUNICATING A CHRISTIAN MESSAGE, ESTABLISHING COMMUNITY AND PERFORMING SERVICE--EXPRESS OUR MISSION OF CHRISTIAN HEALING. 0 0 338152885 2262977 359133071 HOSPITAL SERVICES-ST. DOMINIC'S IS MORE THAN JUST A HOSPITAL. IT IS A FAMILY OF SERVICES FOCUSED ON FULFILLING A MISSION OF CHRISTIAN HEALING TO THOSE IN NEED. ST. DOMINIC HEALTH SERVICES, INC. IS THE PARENT COMPANY FOR A LARGE GROUP OF SUBSIDIARY ORGANIZATIONS 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 65TH YEAR OF PROVIDING A CHRISTIAN MINISTRY OF HEALING TO THE GREATER JACKSON COMMUNITY. 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 OF 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, PHYSICIANS, SKILLED CAREGIVERS AND STAFF. ST. DOMINIC HOSPITAL PROVIDED OVER $960 MILLION (CHARGES) IN HOSPITAL SERVICES IN 2010 TO PATIENTS THROUGHOUT THE CENTRAL REGION OF MISSISSIPPI. ST. DOMINIC'S AND ITS AFFILIATES EMPLOYED OVER 3,000 PEOPLE MAKING IT ONE OF THE AREA'S LARGEST EMPLOYERS. THESE CLEAN (GREEN) JOBS INFUSED THE ECONOMY WITH OVER $131 MILLION IN SALARIES AND WAGES IN 2010. THE MISSISSIPPI BUSINESS JOURNAL HAS RECOGNIZED ST. DOMINIC HOSPITAL AS ONE OF THE TOP FIVE "BEST PLACES TO WORK IN MISSISSIPPI". SINCE 2005, ST. DOMINIC'S HAS ASSISTED IN RELOCATING 19 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 HOSPITAL IS A LICENSED 535-BED TERTIARY CARE REFERRAL HOSPITAL LOCATED IN JACKSON, MS SERVING ALL OF CENTRAL MISSISSIPPI. THE MEDICAL STAFF, OF NEARLY 500 LEADING PHYSICIANS AND SPECIALISTS, MAKES ST. DOMINIC'S ONE OF THE MOST COMPREHENSIVE HOSPITALS IN THE STATE. THROUGH 65 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 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 HOSPITAL'S SERVICE AREA IS DEFINED BASED ON INPATIENT DISCHARGES FOR SHORT TERM ACUTE PATIENTS. IN THE 2010 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. ST. DOMINIC'S, IN PROVIDING QUALITY COMPASSION HEALTH CARE, EXTENDS ITS MISSION OF HEALING TO OVER 750,000 RESIDENTS (I.E., TOTAL POPULATION ACCORDING TO 2010 CENSUS ESTIMATES) OF CENTRAL MISSISSIPPI.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. 338152885 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 1 161 0 1 3427 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X JENNIFER SINCLAIR 6012006955 969 LAKELAND DR JACKSON MS 392164699 SR MARY DOROTHEA SONDGEROTH OP 0.50 X X 0 0 0 DAN GRAFTON 0.50 X X 0 0 0 SR MARY TRINITA EDDINGTON OP 0.50 X X 0 0 0 TOD ETHEREDGE 0.50 X 0 0 0 JEFF FLETCHER MD 0.50 X 0 0 0 LEROY WALKER 0.50 X 0 0 0 CON MALONEY 0.50 X 0 0 0 SR M THECLA KUHNLINE OP 0.50 X 0 0 0 SR M CELESTINE RONDELLI OP 0.50 X 0 0 0 CLAUDE W HARBARGER 40.00 X X 606737 0 39304 JIMMY JONES MD 0.50 X 15000 0 0 SR REBECCA ANN GEMMA OP 0.50 X 0 0 0 BILL TEW MD 0.50 X 0 0 0 DONNA SIMS 0.50 X 0 0 0 SR KRISTIN REVER OP 0.50 X 0 0 0 JENNIFER SINCLAIR 40.00 X 248933 0 38166 LESTER DIAMOND 40.00 X 324181 0 40372 ROBERT MOBLEY MD 40.00 X 385311 0 39304 PAUL ARRINGTON 40.00 X 219497 0 36952 KEITH VAN CAMP 40.00 X 239502 0 32866 STEPHEN BOMGARDNER 40.00 X 217731 0 35647 BECKY LOWE 40.00 X 198990 0 26695 TRACE SWARTZFAGER 40.00 X 204250 0 33509 LAMAR NESBIT 40.00 X 273514 0 39304 JOHN LANCON MD 40.00 X 1156621 0 7506 GERHARD MUNDINGER MD 40.00 X 877030 0 6438 RONALD KENNEDY MD 40.00 X 878979 0 7506 KYLE GORDON MD 40.00 X 848103 0 0 HUEY B MCDANIEL MD 40.00 X 567767 0 0 RALPH E SULSER MD 0.00 X 212825 0 6438 7474971 0 390007 97 1 1 0 ALLIED EMERGENCY SERVICES PC PO BOX 2120 RIDGELAND MS 39158 ER PHYSICIANS 6645229 HENSEL PHELPS CONSTRUCTION COMPANY PO BOX 4419 JACKSON MS 29296 CONSTRUCTION SERVICES 1902939 PHYSICIANS ANESTHESIA GROUP PA PO BOX 460 JACKSON MS 39296 CONTRACT MEDICAL SERVICES 1584088 JACKSON HEART CLINIC 970 LAKELAND DRIVE JACKSON MS 39216 CONTRACT MEDICAL SERVICES 1414333 CAPITAL ORTHOPEDIC & SPORTS MEDICINE 290 EAST LAYFAIR DRIVE SUITE A FLOWOOD MS 39232 CONTRACT MEDICAL SERVICES 749563 23 3613048 9662 3622710 PROGRAM REVENUE 621990 357164239 357164239 PHARMACEUTICAL SALES 446110 2719053 1759227 959826 SPA SALES 812900 512982 209605 303377 360396274 1006308 1006308 4166856 4166856 4166856 4166856 146024 296547 -150523 -150523 -150523 CAFETERIA SALES 722210 2219743 2219743 DAY CARE CENTER 624410 638339 638339 DELI 722210 420772 420772 1253997 1253997 4532851 373574476 359133071 1263203 9555492 2262977 2262977 3131470 3131470 128251769 119061082 9190687 11723153 10623663 1099490 12498660 11326437 1172223 8945799 8106791 839008 351080 351080 819863 819863 319367 319367 1153860 1153860 3082263 3082263 431135 431135 19820568 19820568 6379350 6379350 SUPPLIES 64415282 64415282 PHARMACEUTICAL DRUGS 21391418 21391418 BAD DEBTS 18507535 18507535 EQUIPMENT RENTAL AND MA 13488848 13488848 MEDICAL PROFESSIONAL FE 12814593 12814593 24936003 24936003 354724993 338152885 16572108 0 41573521 59187379 58033809 53309890 6156699 6390602 20144704 24193765 433814547 275811893 153810481 158002654 3037617 3254716 282756831 304339006 34438750 34229136 44481968 48642499 78920718 82871635 X 203836113 221467371 203836113 221467371 282756831 304339006 X 18849483 -1218225 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 24076 24076 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: ST. DOMINIC-JACKSON MEMORIAL HOSPITAL PAID DUES TO THE MISSISSIPPI HOSPITAL ASSOCIATION. THE MISSISSIPPI HOSPITAL ASSOCIATION REPORTS THAT 19.67% OR $24,076 OF DUES PAID WERE FOR LOBBYING EXPENSES. 18307370 18307370 153785746 102534619 51251127 259888565 173277274 86611291 1832866 1832866 158002654 LIABILITY FOR PENSION BENEFITS 48642499 48642499 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ASC IS TREATED AS A PARTNERSHIP FOR INCOME TAX PURPOSES, AND THEREFORE, NO ASSOCIATED INCOME TAX PROVISION IS REQUIRED IN THE HOSPITAL'S CONSOLIDATED FINANCIAL STATEMENTS. IN JULY 2006, THE FASB ISSUED INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO. 109, CODIFIED IN FASB ASC TOPIC 740 ("ASC 740"). THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'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 THE 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 ADOPTED THIS STANDARD EFFECTIVE JANUARY 1, 2009. THE HOSPITAL HAD NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT THE DATE OF ADOPTION OR AT DECEMBER 31, 2010. ACCORDINGLY, THE ADOPTION DID NOT HAVE A MATERIAL EFFECT ON THE HOSPITAL'S FINANCIAL POSITION OR CHANGES IN NET ASSETS. 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. 1 1 1 X 1 X 0 1 1 0 1 1 15796102 8825260 6970842 0.01970 44632607 50392663 -5760056 0.00000 1363527 1494300 -130773 0.00000 61792236 60712223 1080013 0.01970 1350445 1350445 0.00380 145094 145094 0.00040 19131599 14131213 5000386 0.01410 755134 755134 0.00210 21382272 14131213 7251059 0.02040 83174508 74843436 8331072 0.04010 1 0 0 113245277 127259667 -14014390 X 1 1 1 ST DOMINIC AMBULATORY SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.51000 0.00000 0.49000 1 1 ST DOMINIC - JACKSON MEMORIAL HOSPITAL

969 LAKELAND DRIVE JACKSON MS 392164699

X X X NOT REQUIRED 1 2 ST DOMINIC AMBULATORY SURGERY CENTER

969 LAKELAND DRIVE JACKSON MS 392164699

OUTPATIENT SURGERY CENTER ST DOMINIC MEDICAL ASSOCIATES

969 LAKELAND DRIVE JACKSON MS 392164699

PHYSICIAN CLINICS 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 BEHAVIORAL HEALTH, EMERGENCY DEPARTMENT, INFUSION THERAPY, ETC. 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: ST. DOMINIC HOSPITAL MAKES EVERY EFFORT TO ASSIST PATIENTS WHO CANNOT PAY THEIR MEDICAL BILLS. DURING 2010, WE REVISED THE HOSPITAL'S CHARITY POLICY TO ALLOW USE OF THIRD PARTY SOFTWARE TO PREDICT WHEN PATIENTS QUALIFY FOR CHARITY DISCOUNTS. THIS CHANGE ALLOWS US TO MAKE CHARITY ADJUSTMENTS WHEN THE PATIENTS DO NOT COMPLY WITH THE APPLICATION PROCESS WHICH WILL MORE PROPERLY REFLECT THE PROPER SPLIT BETWEEN BAD DEBT AND CHARITY CARE. DUE TO TIMING AND RECORDING ISSUES WITH THE STATE'S DSH/UPL PROGRAM, THE HOSPITAL RECEIVED AND RECORDED EIGHTEEN MONTHS OF DSH/UPL BENEFIT IN 2010. THESE FUNDS ARE NETTED AGAINST THE HOSPITAL'S BAD DEBT AND CHARITY EXPENSE AND AS A RESULT THE REPORTED 2010 NUMBERS ARE LOWER THAN THEY WOULD NORMALLY BE. WE DO NOT INCLUDE BAD DEBT EXPENSE IN OUR COMMUNITY BENEFIT NUMBERS. IN ORDER TO CALCULATE THE COST OF PROVIDING SERVICES THAT WERE ULTIMATELY WRITTEN OFF TO BAD DEBT, WE USE THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT.THE FINANCIAL STATEMENT FOOTNOTE READS- PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FOR SERVICES RENDERED COLLECTIBLE FROM FEDERAL AND STATE AGENCIES (UNDER THE MEDICARE AND MEDICAID PROGRAMS), MANAGED HEALTH PLANS, COMMERCIAL INSURANCE COMPANIES, WORKERS' COMPENSATION, EMPLOYERS AND PATIENTS. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON HISTORICAL LOSSES AND ON ANALYSIS OF CURRENTLY OUTSTANDING AMOUNTS. THIS ACCOUNT IS GENERALLY INCREASED BY CHARGES TO A PROVISION FOR BAD DEBTS AND DECREASED BY WRITE-OFFS OF ACCOUNTS DETERMINED BY MANAGEMENT TO BE UNCOLLECTIBLE. 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 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. 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 24/7 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 85 PERCENT OF THE HOSPITAL ACUTE INPATIENT DISCHARGES. BASED ON 2011 INTERNAL ACUTE DISCHARGE DATA, 12 COUNTIES CONSTITUTE THAT PERCENTAGE OF PATIENT DISCHARGES.THE TOTAL POPULATION FOR ST. DOMINIC'S 12 COUNTY SERVICE AREA EQUALED 746,065 FOR 2010 AND IS PROJECTED TO INCREASE MARGINALLY TO 757,123 IN 2015. THE POPULATION FOR THE HOSPITAL'S SERVICE AREA REPRESENTS 25.1 PERCENT OF THE TOTAL STATE POPULATION FOR 2010 (I.E., STATE POPULATION FOR 2010 EQUALS 3,018,012). FEMALES CONSTITUTE 51.7 PERCENT OF THE TOTAL POPULATION IN THE HOSPITAL'S SERVICE AREA IN 2010, WITH FEMALES OF CHILD BEARING AGE (I.E., 18-44 YEARS OF AGE) EQUALING 136,786 OR 18.3 PERCENT OF THE SERVICE AREA TOTAL POPULATION. THE LARGEST AGE COHORT OF THE HOSPITAL'S SERVICE AREA TOTAL POPULATION IN 2010 ARE PEOPLE 18-44 YEARS OF AGE (271,276 OR 36.4 PERCENT). THE FASTEST GROWING AGE COHORT (2010 TO 2015) IS AGE 65 AND OVER, INCREASING 2.4 PERCENT COMPOUND ANNUAL GROWTH RATE. WHITE-NON HISPANIC CONSTITUTES THE LARGEST PERCENT (I.E., 49.5 PERCENT) OF THE HOSPITAL'S SERVICE AREA TOTAL POPULATION IN 2010. BLACK-NON HISPANIC REPRESENTS 46.3 PERCENT AND HISPANICS REPRESENT 2.2 PERCENT OF THE SERVICE AREA TOTAL POPULATION. STATEWIDE IN 2010, WHITE-NON HISPANIC CONSTITUTED 57.9 PERCENT OF THE TOTAL POPULATION COMPARED TO 36.9 PERCENT FOR BLACK-NON HISPANIC AND 2.6 PERCENT FOR HISPANIC.ACCORDING TO THE MISSISSIPPI DEPARTMENT OF HEALTH'S FY 2010 MISSISSIPPI STATE HEALTH PLAN, THE BIRTH RATE STATEWIDE IN 2007 WAS 15.9 LIVE BIRTHS PER 1,000 POPULATION. THE FERTILITY RATE EQUALED 76.8 LIVE BIRTHS PER 1,000 WOMEN AGED 15-44 YEARS. A TOTAL OF 76.6 PERCENT OF THE LIVE BIRTHS IN 2007 WERE ASSOCIATED WITH AT RISK MOTHERS (35,577 OF THE 46,455 TOTAL BIRTHS), ACCORDING TO THE MISSISSIPPI DEPARTMENT OF HEALTH. THE STATEWIDE FIVE-YEAR AVERAGE INFANT MORTALITY RATE (I.E., 2003 TO 2007) EQUALED 10.5 PER 1,000 POPULATION COMPARED TO 15.0 FOR NON-WHITE AND 6.6 FOR WHITE POPULATION. THE COUNTY WITH THE HIGHEST INFANT MORTALITY RATE IN ST. DOMINIC'S SERVICE AREA IS HINDS COUNTY AT 14.1 PER 1,000 LIVE BIRTHS WITH RANKIN COUNTY REPRSENTING THE LOWEST (8.0). HEART DISEASE WAS 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 2010 STATE HEALTH PLAN, MISSISSIPPI RANKED 49TH AMOUNG THE STATES IN PER CAPITA INCOME AND 49TH IN MEDIAN FAMILY INCOME ACCORDING TO THE 2000 CENSUS. IN 2000, THE PER CAPITA INCOME FOR THE STATE EQUALED $14,293, COMPARED TO THE 12 COUNTY SERVICE AREA OF $15,585. PART VI, LINE 6: ST. DOMINIC HOSPITAL RECOGNIZES ITS BASIC PARTICIPATION IN THE MISSION OF THE CHURCH WHICH INVOLVES TWO MAIN MINISTRIES: EDUCATION AND HEALTH CARE. THREE ACTIVITIES - COMMUNICATING A CHRISTIAN MESSAGE, ESTABLISHING COMMUNITY AND PERFORMING SERVICE - EXPRESS OUR MISSION OF CHRISTIAN HEALING. ST. DOMINIC'S INVOLVES MEMBERS OF ITS COMMUNITY IN GOVERNANCE TO MAINTAIN THE FOCUS ON THE NEEDS OF THE COMMUNITY. ST. DOMINIC'S HAS AN OPEN MEDICAL STAFF. ST. DOMINIC HOSPITAL ALSO INVESTS BACK PROFITS AND CASH INTO THE HOSPITAL SO THAT NO LOCAL FUNDS LEAVE THE COMMUNITY. PART VI, LINE 7: 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. 1 VOICE OF CALVARY PO BOX 10562 JACKSON MS 39289 640564343 501(C)(3) 37500 CHARITABLE SUPPORT TUTWILER COMMUNITY EDUCATION CENTER 301 HANCOCK AVE TUTWILER MS 38963 581887449 501(C)(3) 20000 CHARITABLE SUPPORT THE CENTER FOR VIOLENCE PREVENTION PO BOX 6279 PEARL MS 39288 581959108 501(C)(3) 37500 CHARITABLE SUPPORT ST DOMINIC HEALTH SERVICES INC 969 LAKELAND DR JACKSON MS 392164699 640714999 501(C)(3) 1500000 AFFILIATE SUPPORT OPERATION SHOESTRING 1711 BAILEY AVENUE JACKSON MS 39283 640471554 501(C)(3) 25000 CHARITABLE SUPPORT NEIGHBORHOOD CHRISTIAN CENTER 417 W ASH ST JACKSON MS 39203 640800919 501(C)(3) 18000 CHARITABLE SUPPORT MISSION MISSISSIPPI 120 N CONGRESS ST JACKSON MS 39201 640824240 501(C)(3) 30000 CHARITABLE SUPPORT HOSPICE MINISTRIES 450 TOWNE CENTER BOULEVARD RIDGELAND MS 39157 640789919 501(C)(3) 50000 CHARITABLE SUPPORT COMMUNITY HEALTH SERVICES-ST DOMINIC INC (CARE-A-VAN) 969 LAKELAND DR JACKSON MS 392164699 640714997 501(C)(3) 130000 AFFILIATE SUPPORT CHRISTIAN MEDICAL AND DENTAL P O BOX 4569 JACKSON MS 39296 362284267 501(C)(3) 5000 CHARITABLE SUPPORT CATHOLIC CHARITIES 200 N CONGRESS ST JACKSON MS 39201 640468850 501(C)(3) 145000 CHARITABLE SUPPORT BREAKTHRU MINISTRIES PO BOX 39236 JACKSON MS 39236 621284192 501(C)(3) 15000 CHARITABLE SUPPORT BOY SCOUTS OF AMERICA 855 RIVERSIDE DR JACKSON MS 39202 640303071 501(C)(3) 32000 CHARITABLE SUPPORT BEGINNING AGAIN IN CHRIST PO BOX 26 BRANDON MS 390430026 640592123 501(C)(3) 15000 CHARITABLE SUPPORT SOUTHERN CHRISTIAN SERVICES 860 EAST RIVER PLACE SUITE 104 JACKSON MS 39202 640758344 501(C)(3) 40000 CHARITABLE SUPPORT CENTER FOR PREGNANCY CHOICES PO BOX 55664 JACKSON MS 39296 640757399 501(C)(3) 22500 CHARITABLE SUPPORT COHA INC 805 EAST RIVER PLACE SUITE 104 JACKSON MS 39202 640861570 501(C)(3) 25000 CHARITABLE SUPPORT DEPORRES DELTA MINISTRIES 220 EAST MAIN STREET PO DRAWER 347 MARKS MS 38646 640807096 501(C)(3) 60000 CHARITABLE SUPPORT DREAM INC 310 AIRPORT ROAD MARKS MS 39208 640655629 501(C)(3) 12500 CHARITABLE SUPPORT LANTERN MEDICAL CLINIC 198 KIRKWOOD PLACE JACKSON MS 39211 262621541 501(C)(3) 20000 CHARITABLE SUPPORT MISSISSIPPI CHILDREN'S HOME SERVICES PO BOX 1078 JACKSON MS 39215 640303085 501(C)(3) 15000 CHARITABLE SUPPORT 21 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE HOSPITAL HAS A CONTRIBUTIONS COMMITTEE, WHICH IS A SUB-COMMITTEE OF THE BOARD, THAT OVERSEES THE HOSPITAL'S GIVING. THEY MONITOR THE REQUESTS AND OVERSEE ALL GIFTS. X X X X X 0 0 0 0 0 0 0 0 0 CLAUDE W HARBARGER 603302 0 0 0 3435 0 32866 0 6438 0 646041 0 0 0 JENNIFER SINCLAIR 248933 0 0 0 0 0 32866 0 5300 0 287099 0 0 0 LESTER DIAMOND 324181 0 0 0 0 0 32866 0 7506 0 364553 0 0 0 ROBERT MOBLEY MD 385311 0 0 0 0 0 32866 0 6438 0 424615 0 0 0 PAUL ARRINGTON 219497 0 0 0 0 0 29446 0 7506 0 256449 0 0 0 KEITH VAN CAMP 239502 0 0 0 0 0 32866 0 0 0 272368 0 0 0 STEPHEN BOMGARDNER 217731 0 0 0 0 0 29209 0 6438 0 253378 0 0 0 BECKY LOWE 198990 0 0 0 0 0 26695 0 0 0 225685 0 0 0 TRACE SWARTZFAGER 204250 0 0 0 0 0 27400 0 6109 0 237759 0 0 0 LAMAR NESBIT 273514 0 0 0 0 0 32866 0 6438 0 312818 0 0 0 JOHN LANCON MD 1106611 0 50010 0 0 0 0 0 7506 0 1164127 0 0 0 GERHARD MUNDINGER MD 736030 0 141000 0 0 0 0 0 6438 0 883468 0 0 0 RONALD KENNEDY MD 736479 0 142500 0 0 0 0 0 7506 0 886485 0 0 0 KYLE GORDON MD 740465 0 107638 0 0 0 0 0 0 0 848103 0 0 0 HUEY B MCDANIEL MD 507204 0 60563 0 0 0 0 0 0 0 567767 0 0 0 RALPH E SULSER MD 212825 0 0 0 0 0 0 0 6438 0 219263 0 0 0 MELANIE GRAFTON DAUGHTER OF BOARD MEMBER, DAN GRAFTON 60096 MELANIE GRAFTON IS AN EMPLOYEE OF ST. DOMINIC-JACKSON MEMORIAL HOSPITAL. 0 JACKSON PULMONARY DR. JIMMY JONES, DIRECTOR, IS A GREATER THAN 5% OWNER 491790 HOSPITAL CONTRACTS WITH JACKSON PULMONARY FOR INTENSIVIST SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 ST. DOMINIC HEALTH SERVICES, INC. IS THE SOLE MEMBER OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL'S SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC., HAS THE AUTHORITY TO ELECT THE PRESIDENT/CEO, THE CHAIR OF THE BOARD OF DIRECTORS AND THE VICE-CHAIR OF THE BOARD OF DIRECTORS OF THE HOSPITAL AND TO APPROVE THE ELECTION OF ALL OTHER OFFICERS OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF THE SOLE MEMBER OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL, ST. DOMINIC HEALTH SERVICES, INC., HAS THE RIGHT TO APPROVE THE FORMATION OF, OR PARTICIPATION IN, ANY JOINT VENTURE OR PARTNERSHIP OF THE HOSPITAL. ST. DOMINIC HEALTH SERVICES, INC.'S BOARD OF DIRECTORS ALSO HAS THE RIGHT TO APPROVE ANY DISSOLUTION OR MERGER ENACTED BY ST. DOMINIC- JACKSON MEMORIAL HOSPITAL. IF THE ST. DOMINIC- JACKSON MEMORIAL HOSPITAL'S BOARD OF DIRECTORS HAS A STALEMATE IN ANY VOTE, THE FINAL DECISION RESTS WITH THE BOARD OF DIRECTORS OF ITS SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC. THE GOVERNING COUNCIL OF THE DOMINICAN SISTERS OF SPRINGFIELD ILLINOIS HAS THE AUTHORITY TO BREAK ANY TIE VOTE OF THE BOARD OF DIRECTORS OF ST. DOMINIC HEALTH SERVICES, INC. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO THE AUDIT/FINANCE COMMITTEE OF THE BOARD PRIOR TO FILING. A FULL COPY, AS APPROVED BY THE AUDIT/FINANCE COMMITTEE, WAS PROVIDED TO THE BOARD AND RATIFIED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO FILL OUT AND SIGN A CONFLICT FORM ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S EXECUTIVE COMPENSATION PROGRAM IS ADMINISTERED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THE EXECUTIVE COMPENSATION COMMITTEE IS RESPONSIBLE FOR ESTABLISHING AND MAINTAINING A COMPETITIVE COMPENSATION PROGRAM FOR THE KEY EXECUTIVES OF THE ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE MEETS AS NEEDED TO REVIEW THE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS FOR ANY CHANGES AS APPROPRIATE. THE EXECUTIVE COMPENSATION COMMITTEE COMMISSIONS AN ANNUAL REVIEW BY AN INDEPENDENT CONSULTING FIRM TO EVALUATE THE THE ORGANIZATION'S EXECUTIVE COMPENSATION PROGRAM AGAINST THE COMPETITIVE MARKET. THE EVALUATION IS REVIEWED IN THE FIRST QUARTER OF EACH YEAR AND IS INTENDED TO ENSURE THAT THE COMPENSATION PROGRAM FALLS WITHIN A REASONABLE RANGE OF COMPETITIVE PRACTICES FOR COMPARABLE POSITIONS AMONG SIMILARLY SITUATED ORGANIZATIONS AS DESCRIBED IN SECTION 4958. FOLLOWING THIS REVIEW, THE COMMITTEE REVIEWS AND APPROVES, FOR SELECTED KEY EXECUTIVES, BASE SALARY AND TOTAL COMPENSATION RANGE FOR THE UPCOMING YEAR. THE EXECUTIVE COMPENSATION COMMITTEE MAINTAINS MINUTES AND RECORDS TO ENSURE THAT IT CAN CLAIM THE REBUTTABLE PRESUMPTION OF REASONABLE COMPENSATION FOR PURPOSES OF SECTION 4958. THE CHIEF EXECUTIVE OFFICER FOR THE HOSPITAL ASSIGNS PAY CHANGES FOR THE UPCOMING YEAR FOR EACH OF THE HOSPITAL EXECUTIVES WITHIN THE LIMITS ESTABLISHED BY THE EXECUTIVE COMPENSATION COMMITTEE. THE CHAIRMAN OF THE BOARD AND THE EXECUTIVE COMMITTEE OF THE ORGANIZATION ASSIGNS THE PAY CHANGE FOR THE HOSPITAL'S CHIEF EXECUTIVE OFFICER WITHIN THE LIMITS ESTABLISHED BY THE EXECUTIVE COMPENSATION COMMITTEE. KEY EXECUTIVES OF THE ORGANIZATION MAY ATTEND THE COMMITTEE MEETING OF THE EXECUTIVE COMPENSATION COMMITTEE TO PROVIDE THE INFORMATION NEEDED BY SUCH COMMITTEE. THESE EXECUTIVES ARE EXCUSED AND THE EXECUTIVE COMPENSATION COMMITTEE MEETS IN EXECUTIVE SESSION TO RENDER ITS RECOMMENDATIONS. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,942,306. PENSION TRANSITION ADJUSTMENT PER FAS 158 -4,160,531. TOTAL TO FORM 990, PART XI, LINE 5: -1,218,225. COMMITTEE FOR AUDIT OVERSIGHT FORM 990, PART XI, LINE 2C THE FINANCE COMMITTEE MEETS, AS NEEDED, AND IS CHARGED WITH REVIEWING THE BUDGET, CURRENT PERFORMANCE, THE AUDIT, AND THE FORM 990. THE FINANCE COMMITTEE MAKES RECOMMENDATIONS THAT ARE THEN TAKEN TO THE FULL BOARD FOR FINAL APPROVAL. REPORTABLE COMPENSATION- RALPH E. SULSER, MD FORM 990, PART VII, SECTION A DR. SULSER SERVES AS A MEDICAL DIRECTOR OF THE ORGANIZATION'S WEIGHT LOSS PROGRAM AND WAS PAID COMPENSATION REPORTED ON FORM 1099 FOR 2010 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. AVERAGE HOURS PER WEEK- RELATED ORGS. FORM 990, PART VII, LINE 1A, COLUMN B SISTER 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. ST DOMINIC MEDICAL ASSOCIATES 969 LAKELAND DRIVE JACKSON MS 392164699 261969846 HEALTHCARE MS 16336867 4341696 ST DOMINIC HEALTH SERVICES FOUNDATION INC 969 LAKELAND DRIVE JACKSON MS 392164699 431992975 OPERATION TO OVERSEE FUNDS FOR ST. DOMINIC HEALTH SERVICES & SUBSIDIARIES MS 501(C)(3) 509(A)(3)(1) 0 ST DOMINIC HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON MS 392164699 640714999 OPERATION AS A HOLDING COMPANY TO ACQUIRE OWNERSHIP OF RELATED ENTITY MS 501(C)(3) 509(A)(3)(1) 0 ST CATHERINE'S VILLAGE INC 969 LAKELAND DRIVE JACKSON MS 392164699 640714997 OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY MS 501(C)(3) 170(B)(1)(A) (III) 0 COMMUNITY HEALTH SERVICES - ST DOMINIC INC 969 LAKELAND DRIVE JACKSON MS 392164699 640884870 OPERATION TO PROVIDE COMMUNITY HEALTH PROGRAMS MS 501(C)(3) 170(B)(1)(A) (III) 0 CONGREGATION OF THE DOMINICAN SISTERS OF SPRINGFIELD ILLINOIS 1237 WEST MONROE ST SPRINGFIELD IL 62704 RELIGIOUS CONGREGATION SPONSORING EDUCATION AND HEALTHCARE INSTITUTIONS IL 501(C)(3) 170(B)(1)(A) (I) 0 ST DOMINIC AMBULATORY SURGERY CENTER LLC 971 LAKELAND DRIVE SUITE 200 JACKSON MS 392164699 640908713 HEALTHCARE MS RELATED -142243 1136143 0 0 0.51000 ST DOMINIC MADISON HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON MS 392164699 202870254 HEALTHCARE MS C FIRST INTERMED 308 CORPORATE DRIVE RIDGELAND MS 39157 640824796 HEALTHCARE MS C PHYSICIANSPLUS BAPTIST & ST DOMINIC INC 969 LAKELAND DRIVE JACKSON MS 392164699 640889895 HEALTHCARE MS C ST DOMINIC INTEGRATED SERVICES INC 969 LAKELAND DRIVE JACKSON MS 392164699 271493623 INVESTMENT IN MEDICAL MS C 207872 1685865 1.00000 0 1 1 0 0 0 0 0 1 1 0 1 1 0 1 1 1 0