2011-05-13T15:36:56-05:00 2010-06-30 LARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2009-07-01 710329353 Jefferson Hospital Association Inc JEFF 8705417100 1600 west 40th street Pine bluff AR 71603 BRYAN JACKSON 8705417100 2011-05-12 1 3149254300 2009 2016-02-24 21:20:13Z walter johnson 1600 west 40th street Pine bluff AR 71603 199136177 0 X www.JRMC.org X 1959 AR Health Care Service Provider 15 6 2254 133 267470 -58830 1099033 645225 191428147 189590548 2004285 2285079 7593794 6455843 202125259 198976695 1163790 685020 0 80602022 84385904 16000 0 159482 114216470 102679472 195998282 187750396 6126977 11226299 202619663 215609044 59690966 60177727 142928697 155431317 Jefferson 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. 0 0 168752440 685020 189597873 Jefferson 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. 168752440 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 1 218 0 1 2254 1 1 1 0 0 0 0 0 0 0 0 0 0 15 6 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Jeremy Jeffery 8705415985 1600 West 40th Street Pine Bluff AR 71603 Kline Annette 1.00 X 0 0 0 Morgan Chuck 1.00 X 0 0 0 Roaf DDS Clifton 1.00 X 0 0 0 Brown David 1.00 X X 0 0 0 Atkinson Drew 1.00 X X 0 0 0 Copeland Ed 1.00 X 0 0 0 Anthony Frank 1.00 X 0 0 0 Roberson MD George 1.00 X 67400 0 0 Campbell MD James A 1.00 X 0 0 0 Boast Jerrel 1.00 X X 0 0 0 Forestiere MD Lee 1.00 X 35812 0 0 Casteel Marty 1.00 X 0 0 0 Atiq MD Omar 1.00 X X 27500 0 0 Coleman MD Doug 1.00 X X 0 0 0 Makris George 1.00 X 0 0 0 Atkinson Robert P 40.00 X X 675863 0 23008 Johnson Walter 40.00 X X 437647 0 21970 Harbuck Thomas 40.00 X 565384 0 24300 VanGenderen Nathan 40.00 X 298914 0 21222 Thomas Brian 40.00 X 0 0 0 Holman Brock 40.00 X 125952 0 14220 Hickman Louise 40.00 X 251646 0 20007 Alnasif MD Ali 40.00 X 329286 0 17176 Imran MD Adil 40.00 X 338284 0 18232 Alsebai MD Tamer 40.00 X 264361 0 26631 Pearce MD Malcolm 40.00 X 222809 0 23407 Scott M Daryl 40.00 X 211353 0 19713 3852211 0 229886 46 0 1 0 EMURGENT CARE INC 8 SHACKLEFORD PLAZA SUITE 207 LITTLE ROCK AR 72211 PHYSICIAN SERVICES 3707676 REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 631502096 THERAPY SERVICES 3021148 SODEXHO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 NUTRITIONAL SERVICES 2449663 UAMS-AHEC 4010 Mulberry St Pine bluff AR 71603 PhysICIAN SERVICES 1958476 jefferson anesthesiology PO Box 1272 Pine bluff AR 71613 professional services 1361660 51 131638 207600 305987 645225 PATIENT SERVICE REVENU 621400 189590548 189590548 189590548 2285079 2285079 470415 470415 470415 470415 0 131638 159482 -159482 -159482 OP Pharmacy and Gift S 446110 1345916 1345916 CAFETERIA 722320 988300 988300 WELLNESS CENTER 713940 854889 854889 2955805 7325 267470 2681010 6144910 198976695 189597873 267470 8466127 477420 477420 207600 207600 1682323 181055 1501268 69305895 62168236 7137659 2330590 2046641 283949 5625109 4909135 715974 5441987 4778958 663029 1199062 1198361 701 127106 127106 220361 220361 23605 23605 27701357 25388340 2250167 62850 170461 93269 77192 33844364 31663060 2084672 96632 938022 914045 23977 2814302 2615841 198461 156713 73228 83485 208412 132440 75972 1622080 1560549 61531 1598203 1590512 7691 9523594 9162330 361264 2508938 1238955 1269983 PROVISION FOR BAD DEBTS 18197042 18197042 LICENSE/tAXES 1392045 25024 1367021 DUES & FEES 420211 120594 299617 MINOR EQUIPMENT 9412 9089 323 OTHER MISCELLANEOUS 4182 716 3466 187750396 168752440 18838474 159482 31721853 45985632 24988459 21038766 9050645 8245334 5707340 5153372 2274004 2484947 193975651 131390701 62173363 62584950 38536215 40695325 28167784 29420718 202619663 215609044 29569331 30029231 2041048 2973178 27769688 26755618 310899 419700 59690966 60177727 X 142928697 155431317 142928697 155431317 202619663 215609044 X 0 1 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23605 23605 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A PORTION OF DUES PAID TO ARKANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING EXPENSES. 4805853 4805853 82611092 50163658 32447434 106558706 81227043 25331663 62584950 1917419 C Cash and Short-Term Investments 6279889 F U.S. Treasury and Government Agency Obligations 18526573 F Corporate Obligations 2464762 F Equity Securities and Mutual Funds 11120989 F Accrued Investment Income 167125 F Held by Trustee Under Indenture Agreement 218568 F 40695325 dEFERRED FINANCING COSTS 368881 457 PLAN - FMV ASSET 419700 Due From Affiliates 28632137 29420718 457 Plan - Liability 419700 419700 Part X: Description of Uncertain Tax Positions Under FIN 48: THE 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. Bob ATKINSON GALA 71400 71400 5497 39342 16430 83340 Fundraising-Wee Care Fundraisers 33463 33463 14873 104863 104863 5497 39342 16430 98213 159482 -159482 1 1 X 1 X 1 X 1 1 1 0 1 1 22148 8626259 8626259 0.04590 26507 1257925 1257925 0.00670 48655 9884184 9884184 0.05260 94 56282 361191 72805 288386 0.00150 13 45026 5103528 2042876 3060652 0.01630 3 10028 1990945 1204630 786315 0.00420 121 491952 491952 0.00260 231 111336 7947616 3320311 4627305 0.02460 231 159991 17831800 3320311 14511489 0.07720 53 275719 164018 1300 162718 0.00090 1 2 10917 10917 0.00010 54 275721 174935 1300 173635 0.00100 1 6229557 60753213 57594655 3158558 X 1 1 Jefferson Surgery Center PLLC Ambulatory Surgery Center 0.62500 0.01000 0.36500 Jefferson Regional Medical Center

1600 W 40th Ave Pine Bluff AR 71603

X X X X Part 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. Part 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. Part 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. Part I, Line 6b: The organization makes its annual community benefit report available upon request. 1 AR COMMUNITY FOUNDATION 1400 W MARKHAMUNION STA STE 206 little rock AR 722012519 521055743 501(c)(3) 50000 0 community endowment (honoring bob atkinson) SEABROOK 6808 S HAZEL pine bluff AR 71603 581641894 501(c)(3) 26900 0 capital sponsorship PINE BLUFF COUNTRY CLUB PO BOX 6809 pine bluff AR 71611 710141610 501(c)(7) 122500 0 sponsorship for club renovations and centennial partner program. UNITED WAY OF SE AR PO BOX 8702 pine bluff AR 71611 710236869 501(c)(3) 37500 0 pledge of support for 2009. JEFFERSON COMPREHENSIVE CARE SYSTEM INC PO BOX 1285 pine bluff AR 71613 710433902 501(c)(3) 50000 0 area physician recruitment and retention contribution. COMMITTEE AGAINST SPOUSAL ABUSE (CASA) PO BOX 6705 pine bluff AR 716116705 710562152 501(c)(3) 10000 0 pledge of support. AR AFFILIATE OF SUSAN G KOMEN FOR THE CURE 904 AUTUMN RD STE 500 little rock AR 72211 710724439 501(c)(3) 5000 0 race for the cure sponsor. GREATER PINE BLUFF CHAMBER OF COMMERCE PO BOX 5069 pine bluff AR 71611 710765850 501(C)(6) 36540 0 partners in progress pledge of support. CITY OF PINE BLUFF GENERAL FUND-ATTNSAMPSON 200 EAST 8TH pine bluff AR 71601 716009954 Government 13247 0 support for davis hospital site project. UAPB - ATHLETIC DEPT 1200 N UNIVERSITY DRMAIL SLOT 4891 pine bluff AR 71601 716010030 Government 50000 0 sponsorship for baseball complex. PINE BLUFF SCHOOL DIST CO FRANK ANTHONY 512 SOUTH PINE ST pine bluff AR 71601 716020519 government 36125 0 Various sponsorship. UAMS FOUNDATION FOR ALS RESEARCH 4301 W MARKHAM ST SLT 716 little rock AR 72205 716046242 government 5000 0 sponsorship for als program. 10 2 PELL GRANT - U.S. Department of Education 57 148179 0 N/A N/A WIA Adult Program - U.S. Department of Labor 20 53843 0 N/A N/A WIA Dislocated Worker - U.S. Department of Labor 2 5578 0 N/A N/A Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. X 0 1 X X X X X X 0 1 0 0 0 0 0 1 0 Atkinson Robert P 370897 0 103178 0 201788 0 11040 0 14536 0 701439 0 0 0 Johnson Walter 240848 0 53199 0 143600 0 10810 0 12972 0 461429 0 0 0 Harbuck Thomas 272974 0 130188 0 162222 0 11040 0 15369 0 591793 0 0 0 VanGenderen Nathan 178871 0 42123 0 77920 0 11062 0 12513 0 322489 0 0 0 Hickman Louise 140580 0 34550 0 76516 0 10066 0 11141 0 272853 0 0 0 Alnasif MD Ali 312560 0 0 0 16726 0 11040 0 8053 0 348379 0 0 0 Imran MD Adil 338140 0 0 0 144 0 8100 0 12647 0 359031 0 0 0 Alsebai MD Tamer 216731 0 36473 0 11157 0 10966 0 17098 0 292425 0 0 0 Pearce MD Malcolm 190569 0 18000 0 14240 0 10326 0 14421 0 247556 0 0 0 Scott M Daryl 129708 0 19395 0 62250 0 9116 0 11703 0 232172 0 0 0 Part I, Line 1a Country Club dues are maintained by the organization and utilized by specified employees of the organization. Part I, Line 1b There is no written policy regarding payment of those specific dues. Part I, Line 4a Robert 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 7 The 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. Central Moloney see schedule O. see sch. o 0 Cindy Forestiere see schedule O. see sch. o 0 Richard Morgan see schedule O. see sch. o 0 Simmons First Nat'l Bank see schedule O. see sch. o 0 Form 990, Part VI, Section A, line 2 Chuck 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 6 The organization has a membership consisting of 30 Jefferson County Arkansas residents. Form 990, Part VI, Section A, line 7a The 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 11 A 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 12c The 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 15 The 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 19 although 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 2c The organization's policy regarding oversight of audit is consistent with the prior year. Form 990, Part XI, Line 3b As 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 A The 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 Business transactions involving interested persons: (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 Fees JEFFERSON SURGERY CENTER PLLC 1600 W 40th Street PINE BLUFF AR 71602 710810564 AMB Surgery AR N/A related 124042 1008740 0 0 JRMC Development Corp 1600 W 40th Street Pine Bluff AR 71602 710664723 Practice Office Space Sold and Leased To PHysicians and other third parties AR N/A C -2148001 -4743877 1.00000 Jefferson Management Services Inc 1600 W 40th Street pine Bluff AR 71602 710582753 Physician Practice Management AR N/A C 128889 -3778719 1.00000 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 1 jefferson surgery center pllc K 1760892 Jefferson surgery center pllc R 1722231 JRMC Development Corporation A 1399237 JRMC Development Corporation F 251643 JRMC Development Corporation J 440698 JRMC Development Corporation K 259258 JRMC Development Corporation R 263119 Jefferson Management Services Inc K 252799 Jefferson Management Services Inc R 379074