FURP.ORG / PUBLIC DATA EXPLORER

JEFFERSON HOSPITAL ASSN INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
JEFFERSON HOSPITAL ASSN INC (EIN 71-0329353)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201111339349304441
Schema version
2009v1.7
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)
Timestamp2011-05-13T15:36:56-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1600 WASHINGTON AVENUE SUITE 1800AddressLine1
CityST LOUISCity
StateMOState
ZIP Code63101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN710329353EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jefferson Hospital Association IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlJEFFNameControl
Phone8705417100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11600 west 40th streetAddressLine1
CityPine bluffCity
StateARState
ZIP Code71603ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBRYAN JACKSONName
TitleChief financial OfficerTitle
Phone8705417100Phone
Date Signed2011-05-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone3149254300Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer Personwalter johnsonNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11600 west 40th streetAddressLine1
CityPine bluffCity
StateARState
ZIP Code71603ZIPCode
FieldValueIRS element (for citing)
Gross Receipts199136177GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.JRMC.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1959YearFormation
State Legal DomicileARStateLegalDomicile
Activity Or Mission DescriptionHealth Care Service ProviderActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees2254TotalNbrEmployees
Total Nbr Volunteers133TotalNbrVolunteers
Total Gross UBI267470TotalGrossUBI
Net Unrelated Business Txbl Income-58830NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1099033ContributionsGrantsPriorYear
Contributions Grants Current Year645225ContributionsGrantsCurrentYear
Program Service Revenue Prior Year191428147ProgramServiceRevenuePriorYear
Program Service Revenue CY189590548ProgramServiceRevenueCY
Investment Income Prior Year2004285InvestmentIncomePriorYear
Investment Income Current Year2285079InvestmentIncomeCurrentYear
Other Revenue Prior Year7593794OtherRevenuePriorYear
Other Revenue Current Year6455843OtherRevenueCurrentYear
Total Revenue Prior Year202125259TotalRevenuePriorYear
Total Revenue Current Year198976695TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1163790GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY685020GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year80602022SalariesEtcPriorYear
Salaries Etc Current Year84385904SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year16000TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year159482TotalFundrsngExpCurrentYear
Other Expense Prior Year114216470OtherExpensePriorYear
Other Expenses Current Year102679472OtherExpensesCurrentYear
Total Expenses Prior Year195998282TotalExpensesPriorYear
Total Expenses Current Year187750396TotalExpensesCurrentYear
Revenues Less Expenses Prior Year6126977RevenuesLessExpensesPriorYear
Revenues Less Expenses CY11226299RevenuesLessExpensesCY
Total Assets BOY202619663TotalAssetsBOY
Total Assets EOY215609044TotalAssetsEOY
Total Liabilities BOY59690966TotalLiabilitiesBOY
Total Liabilities EOY60177727TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY142928697NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY155431317NetAssetsOrFundBalancesEOY
Mission DescriptionJefferson Regional Medical Center is committed to providing measurable quality health services in a caring environment, which fulfill the needs of our patients, physicians, employers, employees and community.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense168752440Expense
Grants685020Grants
Revenue189597873Revenue
DescriptionJefferson Hospital Association, Inc. (JHA) operates Jefferson Regional Medical Center (JRMC), a 471 bed tertiary care facility located in Southeast Arkansas that serves a population base of 222,000 people living in 11 counties. JRMC is a not-for-profit, sole community hospital, licensed by the Arkansas State Health Department and accredited by the Joint Commission on Accreditation of Healthcare Organizations.JRMC has a long tradition of providing significant benefits to our community which is rooted in our Mission, "To provide measurable quality health services in a caring environment which fulfill the needs of our patients, physicians, employers, employees and community" and Vision, "To be widely recognized as the health care leader and referral center of choice for South Arkansas by providing quality health care services in a cost effective manner."We provide several centers of excellence providing a wide range of programs and medical services. These include Cardiology, Surgery, Critical Care, Rehabilitation, Psychiatry, Laboratory, Gastroenterology, Orthopedics, Neurology, Emergency, Obstetrics/Gynecology, Radiology, Hospice, and many more. We also operate and manage several satellite clinics which provide primary and specialty healthcare to the community and outlying areas.JRMC operates an emergency room that is open to all persons regardless of ability to pay; has an open medical staff with privileges available to all qualified physicians in the area; has a governing body in which independent persons representative of the community comprise a majority; engages in the training and education of health care professionals; and participates in Medicaid, Medicare, CHAMPUS, Tricare and/or other government-sponsored health care programs.Community service and education continued to be a significant part of our mission. JRMC provides numerous sponsorships within the community, and offers dozens of free health screenings and educational events each year. Not only is information shared about healthcare related issues, but participants are given the opportunity to visit one-on-one with physicians and other healthcare professionals. A total of 370,007 lives were touched through these community activities, with 7,355 employee hours donated to the events during fiscal year 2010.Our commitment to bring new and innovative programs and services to Southeast Arkansas is evident. During fiscal year 2010, JRMC invested over $9 million in capital additions and improvements to our facilities and equipment. This was accomplished by connecting thoughtful, deliberate, disciplined planning, budgeting and spending with the need to provide state-of-the-art technologies in a caring environment. JRMC continues to be the first or one of the first hospitals in the state to acquire and implement many leading healthcare technologies. We are proud that we can continue to provide leading healthcare services to everyone in Southeast Arkansas, regardless of ability to pay.JRMC continues to be a leader in electronic medical record system advancement. The Healthcare Information and Management Systems Society (HIMSS) maintains a system for measuring the progress and impact of electronic medical records systems. There are a total of 8 stages (0-7) a hospital can achieve with a goal of reaching Stage 7, where paper charts are not used to manage the delivery of patient care and clinical data is used for the performance improvement and analytics of healthcare. HIMSS currently recognizes JRMC as a Stage 6 provider, which puts JRMC in the top 3% of providers nationally. During fiscal year 2010, we implemented significant upgrades and enhancements to our systems in preparation to be among the first providers in the nation to meet Stage 1 of the meaningful use requirements set forth as part of The American Recovery and Reinvestment Act of 2009.JRMC continues to participate in the HCAHPS Patient Perspectives on Care. We have chosen the core survey and the phone methodology which ensures a higher response rate in our service area. We continually analyze the HCAHPS survey results and make adjustments, when needed, to improve the overall patient experience at JRMC. Additionally, during fiscal year 2010, we hosted a survey by the Joint Commission. The results of the survey were arguably the best results JRMC has ever had, with very few direct and indirect findings. During the past five years, the Board of Directors via its Audit Committee has focused on maintaining several recommendations made by Fitch rating which urged not-for-profit healthcare providers to adopt nine specific provisions of Sarbanes-Oxley Compliance. During this period we have continued to maintain compliance with all nine of the Fitch/SOX provisions. These include: Prohibition of Specified Non-Audit Services by Auditors, Five Year Audit Partner Rotation, Auditor Communications, Audit Committee Standards, Management Certification of Financial Statements, Bonus Forfeiture, Adoption of a Code of Ethics, Audit Committee Financial Expert, and Internal Control Evaluation. In addition to the complete adoption of the Fitch/Sox provisions, the JHA Board of Directors has undertaken a comprehensive self-assessment regarding its not-for-profit status utilizing a compliance check tool and proposed guidelines published by the IRS. JHA has no reason to believe its tax exempt status has ever been in jeopardy. This initiative is part of a larger compliance program intended to ensure JHA continually self evaluates its regulatory compliance.Today's public demands more information in a fully transparent manner. To be transparent, we must provide information openly, candidly, and accurately. We provide information on the following topics: inpatient pricing, outpatient pricing, quality outcomes, and patient satisfaction. This goes over and beyond the efforts and requirements of the Arkansas Hospital Association and American Hospital Association. The complete information can be viewed at www.jrmc.org.Description
Total Program Service Expense168752440TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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 Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
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 Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096218NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees2254NumberOfEmployees
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
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
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 Line1Jeremy JefferyBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8705415985TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11600 West 40th StreetAddressLine1
CityPine BluffCity
StateARState
ZIP Code71603ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Kline Annette
Director1.00X000
Morgan Chuck
Director1.00X000
Roaf DDS Clifton
Director1.00X000
Brown David
Vice Chairman1.00X000X
Atkinson Drew
Secretary1.00X000X
Copeland Ed
Director1.00X000
Anthony Frank
Director1.00X000
Roberson MD George
Director1.00X6740000
Campbell MD James A
Director1.00X000
Boast Jerrel
Chairman1.00X000X
Forestiere MD Lee
Director1.00X3581200
Casteel Marty
Director1.00X000
Atiq MD Omar
Chief of Staff (thru 12/31/09)1.00X2750000X
Coleman MD Doug
Chief of Staff (beg 1/1/10)1.00X000X
Makris George
Director1.00X000
Atkinson Robert P
CEO-Emeritus40.00X675863023008X
Johnson Walter
President & CEO40.00X437647021970X
Harbuck Thomas
Executive Vice President40.00565384024300X
VanGenderen Nathan
Vice President40.00298914021222X
Thomas Brian
Senior Vice President40.00000X
Holman Brock
Vice President40.00125952014220X
Hickman Louise
Vice President40.00251646020007X
Alnasif MD Ali
employee40.00329286017176X
Imran MD Adil
employee40.00338284018232X
Alsebai MD Tamer
employee40.00264361026631X
Pearce MD Malcolm
employee40.00222809023407X
Scott M Daryl
employee40.00211353019713X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3852211TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation229886TotalOtherCompensation
Number Individuals GT100 K46NumberIndividualsGT100K
Formers Listed0FormersListed
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
EMURGENT CARE INC
8 SHACKLEFORD PLAZA SUITE 207LITTLE ROCKAR72211PHYSICIAN SERVICES3707676
REHAB CARE GROUP INC
PO BOX 502096ST LOUISMO631502096THERAPY SERVICES3021148
SODEXHO INC & AFFILIATES
PO BOX 536922ATLANTAGA303536922NUTRITIONAL SERVICES2449663
UAMS-AHEC
4010 Mulberry StPine bluffAR71603PhysICIAN SERVICES1958476
jefferson anesthesiology
PO Box 1272Pine bluffAR71613professional services1361660
FieldValueIRS element (for citing)
Number Of Contractors GT100 K51NumberOfContractorsGT100K
Fundraising Events131638FundraisingEvents
Government Grants207600GovernmentGrants
All Other Contributions305987AllOtherContributions
Total Contributions645225TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUDescription
Business Code621400BusinessCode
Total Revenue Column189590548TotalRevenueColumn
Related Or Exempt Function Income189590548RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue189590548TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2285079TotalRevenueColumn
Exclusion$2,285,079ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real470415Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real470415Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column470415TotalRevenueColumn
Exclusion$470,415ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events0GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events131638CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses159482FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-159482TotalRevenueColumn
Exclusion-$159,482ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
OP Pharmacy and Gift S4461101345916$1,345,916
CAFETERIA722320988300$988,300
WELLNESS CENTER713940854889$854,889

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2955805TotalRevenueColumn
Related Or Exempt Function Income7325RelatedOrExemptFunctionIncome
Unrelated Business Revenue267470UnrelatedBusinessRevenue
Exclusion$2,681,010ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue6144910TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column198976695TotalRevenueColumn
Related Or Exempt Function Income189597873RelatedOrExemptFunctionIncome
Unrelated Business Revenue267470UnrelatedBusinessRevenue
Exclusion$8,466,127ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total477420Total
Program Services477420ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total207600Total
Program Services207600ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1682323Total
Program Services181055ProgramServices
Management And General1501268ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total69305895Total
Program Services62168236ProgramServices
Management And General7137659ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2330590Total
Program Services2046641ProgramServices
Management And General283949ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5625109Total
Program Services4909135ProgramServices
Management And General715974ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5441987Total
Program Services4778958ProgramServices
Management And General663029ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1199062Total
Program Services1198361ProgramServices
Management And General701ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total127106Total
Management And General127106ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total220361Total
Management And General220361ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total23605Total
Management And General23605ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total27701357Total
Program Services25388340ProgramServices
Management And General2250167ManagementAndGeneral
Fundraising62850Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total170461Total
Program Services93269ProgramServices
Management And General77192ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total33844364Total
Program Services31663060ProgramServices
Management And General2084672ManagementAndGeneral
Fundraising96632Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total938022Total
Program Services914045ProgramServices
Management And General23977ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2814302Total
Program Services2615841ProgramServices
Management And General198461ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total156713Total
Program Services73228ProgramServices
Management And General83485ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total208412Total
Program Services132440ProgramServices
Management And General75972ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1622080Total
Program Services1560549ProgramServices
Management And General61531ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total1598203Total
Program Services1590512ProgramServices
Management And General7691ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total9523594Total
Program Services9162330ProgramServices
Management And General361264ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2508938Total
Program Services1238955ProgramServices
Management And General1269983ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROVISION FOR BAD DEBTS1819704218197042
LICENSE/tAXES1392045250241367021
DUES & FEES420211120594299617
MINOR EQUIPMENT94129089323
OTHER MISCELLANEOUS41827163466

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total187750396Total
Program Services168752440ProgramServices
Management And General18838474ManagementAndGeneral
Fundraising159482Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY31721853BOY
EOY45985632EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY24988459BOY
EOY21038766EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY9050645BOY
EOY8245334EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY5707340BOY
EOY5153372EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2274004BOY
EOY2484947EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis193975651LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec131390701LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY62173363BOY
EOY62584950EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY38536215BOY
EOY40695325EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY28167784BOY
EOY29420718EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY202619663BOY
EOY215609044EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY29569331BOY
EOY30029231EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY2041048BOY
EOY2973178EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY27769688BOY
EOY26755618EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY310899BOY
EOY419700EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY59690966BOY
EOY60177727EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY142928697BOY
EOY155431317EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY142928697BOY
EOY155431317EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY202619663BOY
EOY215609044EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed0FederalGrantAuditPerformed

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$23,605OtherActivitiesAmount
Total Lobbying Expenditures IIB23605TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationA PORTION OF DUES PAID TO ARKANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING EXPENSES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4805853OtherCostOrOtherBasis
Book Value4805853BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis82611092OtherCostOrOtherBasis
Depreciation50163658Depreciation
Book Value32447434BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis106558706OtherCostOrOtherBasis
Depreciation81227043Depreciation
Book Value25331663BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings62584950TotalOfBookValueLandBuildings

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value1917419BookValue
Method Of ValuationCMethodOfValuation

Other Securities OtherSecurities (6 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Cash and Short-Term Investments6279889F
U.S. Treasury and Government Agency Obligations18526573F
Corporate Obligations2464762F
Equity Securities and Mutual Funds11120989F
Accrued Investment Income167125F
Held by Trustee Under Indenture Agreement218568F
FieldValueIRS element (for citing)
Total Of Book Value Securities40695325TotalOfBookValueSecurities

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
dEFERRED FINANCING COSTS368881
457 PLAN - FMV ASSET419700
Due From Affiliates28632137
FieldValueIRS element (for citing)
Total Book Value Other Assets29420718TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
Description457 Plan - LiabilityDescription
Amount$419,700Amount
FieldValueIRS element (for citing)
Total Of Amounts419700TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X:Identifier
Return ReferenceDescription of Uncertain Tax Positions Under FIN 48:ReturnReference
ExplanationTHE ASSOCIATION HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE aSSOCIATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. tHE ASSOCIATION APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ASSOCIATION's INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ASSOCIATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ASSOCIATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES THAT ARE NOT CURRENTLY BEING RECOGNIZED. THE TAX RETURNS FOR TAX YEARS 2007 TO 2009 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Bob ATKINSON GALANameOfEvent1
Gross Receipts Event171400GrossReceiptsEvent1
Charitable Contributions Event171400CharitableContributionsEvent1
Rent Facility Costs Event15497RentFacilityCostsEvent1
Food And Beverage Event139342FoodAndBeverageEvent1
Entertainment Event116430EntertainmentEvent1
Other Direct Expenses Event183340OtherDirectExpensesEvent1
Name Of Event2Fundraising-Wee Care FundraisersNameOfEvent2
Gross Receipts Event233463GrossReceiptsEvent2
Charitable Contributions Event233463CharitableContributionsEvent2
Other Direct Expenses Event214873OtherDirectExpensesEvent2
Gross Receipts Total104863GrossReceiptsTotal
Charitable Contributions Total104863CharitableContributionsTotal
Rent Facility Costs Total Events5497RentFacilityCostsTotalEvents
Food And Beverage Total Events39342FoodAndBeverageTotalEvents
Entertainment Total Events16430EntertainmentTotalEvents
Other Direct Expenses Total Events98213OtherDirectExpensesTotalEvents
Direct Expense Summary Events159482DirectExpenseSummaryEvents
Net Income Summary-159482NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
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)
Persons Served22148PersonsServed
Total Community Benefit Expense8626259TotalCommunityBenefitExpense
Net Community Benefit Expense8626259NetCommunityBenefitExpense
Percent Of Total Expense0.04590PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served26507PersonsServed
Total Community Benefit Expense1257925TotalCommunityBenefitExpense
Net Community Benefit Expense1257925NetCommunityBenefitExpense
Percent Of Total Expense0.00670PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served48655PersonsServed
Total Community Benefit Expense9884184TotalCommunityBenefitExpense
Net Community Benefit Expense9884184NetCommunityBenefitExpense
Percent Of Total Expense0.05260PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs94NumberOfActivitiesOrPrograms
Persons Served56282PersonsServed
Total Community Benefit Expense361191TotalCommunityBenefitExpense
Direct Offsetting Revenue72805DirectOffsettingRevenue
Net Community Benefit Expense288386NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served45026PersonsServed
Total Community Benefit Expense5103528TotalCommunityBenefitExpense
Direct Offsetting Revenue2042876DirectOffsettingRevenue
Net Community Benefit Expense3060652NetCommunityBenefitExpense
Percent Of Total Expense0.01630PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served10028PersonsServed
Total Community Benefit Expense1990945TotalCommunityBenefitExpense
Direct Offsetting Revenue1204630DirectOffsettingRevenue
Net Community Benefit Expense786315NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs121NumberOfActivitiesOrPrograms
Total Community Benefit Expense491952TotalCommunityBenefitExpense
Net Community Benefit Expense491952NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs231NumberOfActivitiesOrPrograms
Persons Served111336PersonsServed
Total Community Benefit Expense7947616TotalCommunityBenefitExpense
Direct Offsetting Revenue3320311DirectOffsettingRevenue
Net Community Benefit Expense4627305NetCommunityBenefitExpense
Percent Of Total Expense0.02460PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs231NumberOfActivitiesOrPrograms
Persons Served159991PersonsServed
Total Community Benefit Expense17831800TotalCommunityBenefitExpense
Direct Offsetting Revenue3320311DirectOffsettingRevenue
Net Community Benefit Expense14511489NetCommunityBenefitExpense
Percent Of Total Expense0.07720PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs53NumberOfActivitiesOrPrograms
Persons Served275719PersonsServed
Total Community Building Expense164018TotalCommunityBuildingExpense
Direct Offsetting Revenue1300DirectOffsettingRevenue
Net Community Building Expense162718NetCommunityBuildingExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served2PersonsServed
Total Community Building Expense10917TotalCommunityBuildingExpense
Net Community Building Expense10917NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs54NumberOfActivitiesOrPrograms
Persons Served275721PersonsServed
Total Community Building Expense174935TotalCommunityBuildingExpense
Direct Offsetting Revenue1300DirectOffsettingRevenue
Net Community Building Expense173635NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$6,229,557BadDebtExpenseAmount
Amount Reimbursed By Medicare60753213AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare57594655CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall3158558MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
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 Line1Jefferson Surgery Center PLLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityAmbulatory Surgery CenterDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.62500OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.01000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.36500PhysicansProfitOrOwnership

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jefferson Regional Medical CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11600 W 40th AveAddressLine1
CityPine BluffCity
StateARState
ZIP Code71603ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Bad Debt FootnotePart III, Line 4: Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: The organization maintains a cost accounting system that computes program costs at the patient level. The costing methodologies are applied to the organization's bad debt expense to determine the organization's cost of bad debt expense.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: Patient accounts qualifying for charity care would not intentionally be placed with a debt collection service. From time to time, information that results in the determination of charity qualification is obtained subsequent to a patient's account being placed with a debt collection agency. The Organization's "collection Agency Policy" requires contracted collection agents, in addition to many other prudent procedures, to inform the debtor of the appropriate hospital financial assistance professional to contact if the collection agent is made aware of a patient's financial hardship. The collection agent is also required to notify the Organization of the patient's financial hardship so the organization can assist the patient in accessing the Organization's financial assistance programs.DebtCollectionPolicy
General ExplanationPart I, Line 6b: The organization makes its annual community benefit report available upon request.GeneralExplanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistancePurpose Of GrantPurposeOfGrant
AR COMMUNITY FOUNDATION
1400 W MARKHAMUNION STA STE 206little rockAR722012519521055743501(c)(3)500000community endowment (honoring bob atkinson)
SEABROOK
6808 S HAZELpine bluffAR71603581641894501(c)(3)269000capital sponsorship
PINE BLUFF COUNTRY CLUB
PO BOX 6809pine bluffAR71611710141610501(c)(7)1225000sponsorship for club renovations and centennial partner program.
UNITED WAY OF SE AR
PO BOX 8702pine bluffAR71611710236869501(c)(3)375000pledge of support for 2009.
JEFFERSON COMPREHENSIVE CARE SYSTEM INC
PO BOX 1285pine bluffAR71613710433902501(c)(3)500000area physician recruitment and retention contribution.
COMMITTEE AGAINST SPOUSAL ABUSE (CASA)
PO BOX 6705pine bluffAR716116705710562152501(c)(3)100000pledge of support.
AR AFFILIATE OF SUSAN G KOMEN FOR THE CURE
904 AUTUMN RD STE 500little rockAR72211710724439501(c)(3)50000race for the cure sponsor.
GREATER PINE BLUFF CHAMBER OF COMMERCE
PO BOX 5069pine bluffAR71611710765850501(C)(6)365400partners in progress pledge of support.
CITY OF PINE BLUFF GENERAL FUND-ATTNSAMPSON
200 EAST 8THpine bluffAR71601716009954Government132470support for davis hospital site project.
UAPB - ATHLETIC DEPT
1200 N UNIVERSITY DRMAIL SLOT 4891pine bluffAR71601716010030Government500000sponsorship for baseball complex.
PINE BLUFF SCHOOL DIST CO FRANK ANTHONY
512 SOUTH PINE STpine bluffAR71601716020519government361250Various sponsorship.
UAMS FOUNDATION FOR ALS RESEARCH
4301 W MARKHAM ST SLT 716little rockAR72205716046242government50000sponsorship for als program.
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants10TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations2TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (3 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
PELL GRANT - U.S. Department of Education571481790N/AN/A
WIA Adult Program - U.S. Department of Labor20538430N/AN/A
WIA Dislocated Worker - U.S. Department of Labor255780N/AN/A

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: Jefferson Hospital Association, Inc. maintained records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award grants or assistance.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses0WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
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 Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 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
Atkinson Robert P
370897010317802017880110400145360701439000
Johnson Walter
24084805319901436000108100129720461429000
Harbuck Thomas
272974013018801622220110400153690591793000
VanGenderen Nathan
1788710421230779200110620125130322489000
Hickman Louise
1405800345500765160100660111410272853000
Alnasif MD Ali
31256000016726011040080530348379000
Imran MD Adil
338140000144081000126470359031000
Alsebai MD Tamer
2167310364730111570109660170980292425000
Pearce MD Malcolm
1905690180000142400103260144210247556000
Scott M Daryl
129708019395062250091160117030232172000

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aCountry Club dues are maintained by the organization and utilized by specified employees of the organization.
Part I, Line 1bThere is no written policy regarding payment of those specific dues.
Part I, Line 4aRobert Atkinson $90,377.66; Walter Johnson $53,914.32; Thomas Harbuck $68,468.58; Nathan VanGenderen $36,097.28; Louise Hickman $35,138.42; M. Daryl Scott $16,189.61
Part I, Line 7The organization provides defined members of management a non-fixed performance based incentive plan. The plan's components are established and evaluated by the organization's executive committee of the board of directors.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Central Moloney
see schedule O.see sch. o0
Cindy Forestiere
see schedule O.see sch. o0
Richard Morgan
see schedule O.see sch. o0
Simmons First Nat'l Bank
see schedule O.see sch. o0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 2Chuck Morgan (JHA Director) and Annette Kline (JHA Director) have a business relationship. Marty Casteel (JHA Director) and Dr. Clifton Roaf (JHA Director) have a business relationship. George Makris (JHA Director) and Dr. Clifton Roaf (JHA Director) have a business relationship. George Makris (JHA Director) and Marty Casteel (JHA Director) have a business relationship. Chuck Morgan (JHA Director) and Ed Copeland (JHA Director) have a business relationship.
Form 990, Part VI, Section A, line 6The organization has a membership consisting of 30 Jefferson County Arkansas residents.
Form 990, Part VI, Section A, line 7aThe membership of the organization has the responsibility of electing the Board of Directors at the annual membership meeting.
Form 990, Part VI, Section B, line 11A copy of Form 990 and 990-T is reviewed by the governing body before it is filed. The return is formally presented to the board of directors at a regularly scheduled board of directors meeting. A final draft of the 990 is posted to an internal website available to the board of directors until the return is filed.
Form 990, Part VI, Section B, line 12cThe organization requires not only an annual conflict of interest disclosure, but also when situations subsequent to the annual disclosure develop that would potentially place the individual in a conflict of interest. In those situations, immediate disclosure is required. The Executive Committee of the Board of Directors conducts the annual review of conflict of interest disclosures. In the event the Executive Committee determines that a conflict exists, legal counsel is consulted. If legal counsel determines that a conflict exists, the person is informed and the matter is reported to the Board for action. Any Director or Officer whose transactions are being reviewed would absent himself/herself from the review.
Form 990, Part VI, Section B, line 15The board of directors established a seperate compensation committee charged with performing an annual performance review of the ceo and all officers and reviewing their compensation packages. the compensation committee engaged a third-party global human capital consulting firm to: (1) develop an annual ceo and officer performance review process, including a new evaluation form, and (2) develop a compensation package based on its knowledge of similarly sized non-profit organizations in order to ensure that the compensation paid to the ceo and officers is reasonable. all members of the board complete an annual evaluation, which the compensation committee summarizes and reviews. the compensation committee then makes a recommendation to the full board of directors for any compensation adjustments.
Form 990, Part VI, Section C, line 19although not a requirement, the organization provides photocopies of its governing documents, conflict of interest policy, financial statements, and other documents to all who request one or more of the items.
Form 990,Part XI, Line 2cThe organization's policy regarding oversight of audit is consistent with the prior year.
Form 990, Part XI, Line 3bAs of the date of filing of this return, the OMB Circular A-133 Audit required for the taxable year is in process.
Schedule G, Part II, Column AThe Atkinson Gala was held to raise funds to establish a community endowment with the Arkansas Community Foundation (a 501 (c) 3 non-profit organization). The Association incurred costs for the event and solicited sponsorship for the event to defray the costs totaling $71,400. Proceeds from ticket sales were paid directly to the Arkansas Community Foundation and are not shown as income on this return. Those ticket sales totaled $45,000.
Schedule L, Part IV, Columns B, C, & D(A) Name of Person: Central Moloney (B) Relationship between interested person and organization: Entity in which Ed Copeland and Chuck Morgan, JHA Directors, are officers. (C) Transaction amounts are reported as greater than $100,000 (D) Description of Transaction: Healthcare Payments (A) Name of person: Cindy Forestiere (B) Relationship between interested person and organization: Family member of Lee Forestiere, JHA Director. (C) Transaction amounts are reported as greater than $10,000 (D) Description of transaction: Employee of Jefferson regional medical center (A) Name of person: Richard Morgan (B) Relationship between interested person and organization: Family member of chuck morgan, JHA Director. (C) Transaction amounts are reported as greater than $10,000 (D) Description of transaction: employee of jefferson regional medical center. (A) Name of Person: Simmons First Nat'l Bank (B) Relationship between interested person and organization: Entity in which marty casteel, clinton roaf and george makris, jha directors, are officers. (C) Transaction amounts are reported as greater than $100,000 (D) Description of transaction: Bank/Trustee FeesBusiness transactions involving interested persons:

Schedule R IRS990ScheduleR

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1JEFFERSON SURGERY CENTER PLLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11600 W 40th StreetAddressLine1
CityPINE BLUFFCity
StateARState
ZIP Code71602ZIPCode
FieldValueIRS element (for citing)
EIN710810564EIN
Primary ActivityAMB SurgeryPrimaryActivity
Legal Domicile StateARLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Predominant Income TyperelatedPredominantIncomeType
Share Of Total Income124042ShareOfTotalIncome
Share Of EOY Assets1008740ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
JRMC Development Corp
1600 W 40th StreetPine BluffAR71602710664723Practice Office Space Sold and Leased To PHysicians and other third partiesARN/AC-2148001-47438771.00000
Jefferson Management Services Inc
1600 W 40th Streetpine BluffAR71602710582753Physician Practice ManagementARN/AC128889-37787191.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org1SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
jefferson surgery center pllc
K1760892
Jefferson surgery center pllc
R1722231
JRMC Development Corporation
A1399237
JRMC Development Corporation
F251643
JRMC Development Corporation
J440698
JRMC Development Corporation
K259258
JRMC Development Corporation
R263119
Jefferson Management Services Inc
K252799
Jefferson Management Services Inc
R379074