MERCY HOSPITAL JEFFERSON: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MERCY HOSPITAL JEFFERSON (EIN 43-0687077)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-11
IRS object ID
201122239349302322
Schema version
2009v1.4
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)
Timestamp2011-08-11T14:21:10-00:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1211 N Broadway Ste 600AddressLine1
CitySt LouisCity
StateMOState
ZIP Code631022733ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN430687077EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jefferson Memorial Hospital AssociationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlJEFFNameControl
Phone6369331136Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 350AddressLine1
CityCrystal CityCity
StateMOState
ZIP Code63019ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJames MuehlhauserName
TitleCEOTitle
Phone6369331103Phone
Date Signed2011-08-11DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDonna Larson CPAName
Phone3142315544Phone
Date Prepared2011-08-11DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Jefferson Regional Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonJames MuehlhauserNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 350AddressLine1
CityCrystal CityCity
StateMOState
ZIP Code63019ZIPCode
FieldValueIRS element (for citing)
Gross Receipts134755760GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.jhsmo.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1953YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionJefferson Regional Medical Center is a community based integrated healthcare system. The hospital consists of a 236-bed licensed facility which provides a full range of diagnostic, preventative and healthcare services along with 24 hour emergency room care. These services are provided on a non-discriminatory basis.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees1630TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI301859TotalGrossUBI
Net Unrelated Business Txbl Income-265146NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year411884ContributionsGrantsPriorYear
Contributions Grants Current Year423757ContributionsGrantsCurrentYear
Program Service Revenue Prior Year133051311ProgramServiceRevenuePriorYear
Program Service Revenue CY130031967ProgramServiceRevenueCY
Investment Income Prior Year932308InvestmentIncomePriorYear
Investment Income Current Year1058601InvestmentIncomeCurrentYear
Other Revenue Prior Year1120151OtherRevenuePriorYear
Other Revenue Current Year1454952OtherRevenueCurrentYear
Total Revenue Prior Year135515654TotalRevenuePriorYear
Total Revenue Current Year132969277TotalRevenueCurrentYear
Grants And Similar Amnts CY158138GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year61316924SalariesEtcPriorYear
Salaries Etc Current Year64755615SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year169925TotalFundrsngExpCurrentYear
Other Expense Prior Year66331944OtherExpensePriorYear
Other Expenses Current Year61831588OtherExpensesCurrentYear
Total Expenses Prior Year127648868TotalExpensesPriorYear
Total Expenses Current Year126745341TotalExpensesCurrentYear
Revenues Less Expenses Prior Year7866786RevenuesLessExpensesPriorYear
Revenues Less Expenses CY6223936RevenuesLessExpensesCY
Total Assets BOY117144396TotalAssetsBOY
Total Assets EOY134837141TotalAssetsEOY
Total Liabilities BOY44967677TotalLiabilitiesBOY
Total Liabilities EOY63067052TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY72176719NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY71770089NetAssetsOrFundBalancesEOY
Mission DescriptionNoneMissionDescription
Significant New Program ServicestrueSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense96513785Expense
Revenue121267381Revenue
DescriptionJefferson Regional Medical Center consists of a 236-bed licensed facility which provides a wide range of services. In fiscal year 2010 the following services were provided - 11,992 admissions, 44,948 patient days, 535 deliveries, 32,779 Emergency Room visits, 2,294 inpatient surgeries including 84 open hearts, 4,079 minor and ambulatory surgery procedures and 64,014 referred outpatient procedures. It is the policy of Jefferson Regional Medical Center to provide uncompensated care to patients in need of financial assistance in accordance with the hospitals established guidelines and without regard to race, religion, sex, age or national origin. Charity and uncompensated care for the year totaled 14,120,829. Jefferson Regional Medical Center is committed to providing educational programs to the community. Free seminars and presentations are provided on a wide variety of health issues which impact patients and their families. Free services are also offered to the community such as lipid, cholesterol, bone density and glucose screenings as well as hearing and memory screenings. Jefferson Regional Medical Center works closely with other community organizations such as the American Red Cross, the American Heart Association and the American Cancer Society.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense6131955Expense
Revenue6731576Revenue
DescriptionJefferson Regional Medical Center is further complimented by the Supportive Care Service Departments which provide home care services. The Home Health agency provided 17,045 visits and the Hospice agency provided 23,128 days of service for the fiscal year.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3817430Expense
Revenue1919874Revenue
DescriptionJefferson Physician Network was added to the healthcare system in fiscal year 2009. The network employs physicians to further our services throughout the hospital and community. At the end of the fiscal year, there were 12 physicians which made up the network, which included physicians in family practice, endocrinology, rheumatology, hospitalists and wound care. The Physician Network is to expand with the recruiting of more physicians in the future.Description
FieldValueIRS element (for citing)
Total Program Service Expense106463170TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgtrueTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096116NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1630NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJames MuehlhauserNamePerson
Telephone Number6369331104TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 350AddressLine1
CityCrystal CityCity
StateMOState
ZIP Code63019ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Lloyd Ford Jr
President CEO040.00XX499650020252
James Muehlhauser
CFO040.00X233209019200
Beverly Johnson
VP Patient Care Svcs040.00X20523905595
Blake Temple
VP of Business Development040.00X20484405997
Jerome Ladous
VP of Operations040.00X182381012522
Timothy Pigg
VP Facilities/Support Svcs040.00X120839011683
Daniel Cox
Physician040.0032870709100X
Eric Hale
CRNA040.0017345504938X
Lawrence Billy
Physician040.0016355805430X
Frank Krewett
Physician040.00161526010212X
Tina Smith
CRNA040.0015612305783X
Lindell Carter
Board President000.50X000
Bill McKenna
Board Vice President000.50X000
Tonda Breeze
Board Secretary000.50X000
Ron Ravenscraft
Board Treasurer000.50X000
Kenneth Kilian MD
Board Member000.50X1070000
Martha Reed MD
Board Member000.50X2963400
Jeff Draves MD
Board Member000.50X000
Dennis Gannon
Board Member000.50X000
Timothy Patterson
Board Member000.50X000
Jack King
Board Member000.50X000
Benjamin Albano MD
Board Member000.50X000
Roy Burnside
Board Member000.50X000
Stoke Wischmeier
Board Member000.50X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org2469865TotalReportableCompFromOrg
Total Other Compensation110712TotalOtherCompensation
Number Individuals GT100 K27NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
RehabCare Group Inc
PO Box 502096St LouisMO631502096Therapists1693267
Sodexo Inc & Affiliates
4880 Paysphere CircleChicagoIL60674Dietary Services1386704
Siemens Med Solutions USA
51 Valley Stream ParkwayMalvernPA19355Software support services1354592
Acuity Anesthesiology LLC
1734 Clarkson Road Suite 147ChesterfieldMO63017Anesthesiologists941667
Brockmiller Construction Inc
PO Box 387FarmingtonMO63640Construction707686
FieldValueIRS element (for citing)
Number Of Contractors GT100 K45NumberOfContractorsGT100K
Fundraising Events60785FundraisingEvents
Government Grants46615GovernmentGrants
All Other Contributions316357AllOtherContributions
Total Contributions423757TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Lab Services621500113136111936$1,200
Net Patient Service Revenue621110127754695127754695
Net Patient Service Revenue for physician offices62111021641362164136
FieldValueIRS element (for citing)
Total Program Service Revenue130031967TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1056916TotalRevenueColumn
Exclusion$1,056,916ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1324085Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1362276Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-38191Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-38191TotalRevenueColumn
Exclusion-$38,191ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other8609Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other6924Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other1685Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1685TotalRevenueColumn
Exclusion$1,685ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events35379GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events60785CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses35379FundraisingDirectExpenses
Gross Income Gaming7637GrossIncomeGaming
Gaming Direct Expenses5981GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column1656TotalRevenueColumn
Exclusion$1,656ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory459167GrossSalesOfInventory
Cost Of Goods Sold375923CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column83244TotalRevenueColumn
Unrelated Business Revenue2064UnrelatedBusinessRevenue
Exclusion$81,180ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Building Svc Management Fee621110248345187859$60,486
Cafe Vending722210753266$753,266
Therapy Audio90009958441$58,441

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column348191TotalRevenueColumn
Exclusion$348,191ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1408243TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column132969277TotalRevenueColumn
Related Or Exempt Function Income129918831RelatedOrExemptFunctionIncome
Unrelated Business Revenue301859UnrelatedBusinessRevenue
Exclusion$2,324,830ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total158138Total
Program Services158138ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1550850Total
Program Services216173ProgramServices
Management And General1334677ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total51137266Total
Program Services43854156ProgramServices
Management And General7175188ManagementAndGeneral
Fundraising107922Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1689458Total
Program Services1415950ProgramServices
Management And General273508ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6627490Total
Program Services5531400ProgramServices
Management And General1068457ManagementAndGeneral
Fundraising27633Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3750551Total
Program Services3164202ProgramServices
Management And General578554ManagementAndGeneral
Fundraising7795Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total495905Total
Program Services495455ProgramServices
Management And General450ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total219502Total
Management And General219502ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total72569Total
Management And General72569ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total11589984Total
Program Services8714957ProgramServices
Management And General2873398ManagementAndGeneral
Fundraising1629Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total934851Total
Program Services24519ProgramServices
Management And General907693ManagementAndGeneral
Fundraising2639Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total25312101Total
Program Services24388300ProgramServices
Management And General917853ManagementAndGeneral
Fundraising5948Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total978109Total
Program Services36885ProgramServices
Management And General941224ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2350468Total
Program Services2091483ProgramServices
Management And General258985ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total546794Total
Program Services457472ProgramServices
Management And General88121ManagementAndGeneral
Fundraising1201Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total77327Total
Program Services64877ProgramServices
Management And General12450ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1750484Total
Program Services1468656ProgramServices
Management And General281828ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total6607321Total
Program Services5541343ProgramServices
Management And General1065978ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total700345Total
Program Services9388ProgramServices
Management And General690957ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Recruiting787923132187655736
Minor Equipment16422311035353870
Guest Meals Special Events6542776514057418014957
Bad Debts85035398503539

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total85866Total
Program Services18597ProgramServices
Management And General67068ManagementAndGeneral
Fundraising201Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total126745341Total
Program Services106463170ProgramServices
Management And General20112246ManagementAndGeneral
Fundraising169925Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY19461904BOY
EOY18604302EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY16011913BOY
EOY18766396EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY15288842BOY
EOY16297211EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY10372242BOY
EOY16379101EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2305244BOY
EOY2365380EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2818154BOY
EOY5052731EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis151173734LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec102866578LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY42341935BOY
EOY48307156EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY5413368BOY
EOY5359989EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3130794BOY
EOY3704875EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY117144396BOY
EOY134837141EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY15247976BOY
EOY18821319EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY27537400BOY
EOY37635000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2182301BOY
EOY6610733EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY44967677BOY
EOY63067052EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY71923967BOY
EOY71505065EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY152752BOY
EOY165024EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY100000BOY
EOY100000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY72176719BOY
EOY71770089EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY117144396BOY
EOY134837141EOY
FieldValueIRS element (for citing)
Method Of Accounting OtherXMethodOfAccountingOther
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Pertcentage1700.00000PublicSupportPertcentage170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

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)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$11,613GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB11613TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FSfalseIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance22878750BeginningOfYearBalance
Contributions143208Contributions
Investment Earnings Or Losses2910001InvestmentEarningsOrLosses
End Of Year Balance25931959EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance22353994BeginningOfYearBalance
Contributions178727Contributions
Investment Earnings Or Losses346029InvestmentEarningsOrLosses
End Of Year Balance22878750EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.99000BoardDesignatedEOYBalance
Term Endowment EOY Balance0.01000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1406489InvestmentCostOrOtherBasis
Other Cost Or Other Basis6563748OtherCostOrOtherBasis
Book Value3105451BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis13003030InvestmentCostOrOtherBasis
Other Cost Or Other Basis48613777OtherCostOrOtherBasis
Depreciation39562535Depreciation
Book Value22054272BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis633989OtherCostOrOtherBasis
Depreciation38211Depreciation
Book Value595778BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis8175682InvestmentCostOrOtherBasis
Other Cost Or Other Basis67491892OtherCostOrOtherBasis
Depreciation57367764Depreciation
Book Value18299810BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4835127OtherCostOrOtherBasis
Depreciation583282Depreciation
Book Value4251845BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings48307156TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Amounts due to affiliates-JPN$5,399,858
Amounts due to affiliates-ICH$1,066,474
Amounts due to affiliates-Land Co$144,400
Rounding$1
FieldValueIRS element (for citing)
Total Of Amounts6610733TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
VLine 4The endowment funds are to be used for various capital projects.
X2Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Vegas GalaNameOfEvent1
Gross Receipts Event164006GrossReceiptsEvent1
Charitable Contributions Event136733CharitableContributionsEvent1
Gross Revenue Event127273GrossRevenueEvent1
Rent Facility Costs Event11593RentFacilityCostsEvent1
Food And Beverage Event110485FoodAndBeverageEvent1
Entertainment Event115195EntertainmentEvent1
Name Of Event2Golf TournamentNameOfEvent2
Gross Receipts Event228970GrossReceiptsEvent2
Charitable Contributions Event222796CharitableContributionsEvent2
Gross Revenue Event26174GrossRevenueEvent2
Rent Facility Costs Event24780RentFacilityCostsEvent2
Food And Beverage Event21394FoodAndBeverageEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events3188GrossReceiptsOtherEvents
Charitable Contrib Other Events1256CharitableContribOtherEvents
Gross Revenue Other Events1932GrossRevenueOtherEvents
Other Direct Expenses Other Events1932OtherDirectExpensesOtherEvents
Gross Receipts Total96164GrossReceiptsTotal
Charitable Contributions Total60785CharitableContributionsTotal
Gross Revenue Total Events35379GrossRevenueTotalEvents
Rent Facility Costs Total Events6373RentFacilityCostsTotalEvents
Food And Beverage Total Events11879FoodAndBeverageTotalEvents
Entertainment Total Events15195EntertainmentTotalEvents
Other Direct Expenses Total Events1932OtherDirectExpensesTotalEvents
Direct Expense Summary Events35379DirectExpenseSummaryEvents

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3198759TotalCommunityBenefitExpense
Net Community Benefit Expense3198759NetCommunityBenefitExpense
Percent Of Total Expense0.02710PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense20421877TotalCommunityBenefitExpense
Direct Offsetting Revenue16176226DirectOffsettingRevenue
Net Community Benefit Expense4245651NetCommunityBenefitExpense
Percent Of Total Expense0.03590PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense23620636TotalCommunityBenefitExpense
Direct Offsetting Revenue16176226DirectOffsettingRevenue
Net Community Benefit Expense7444410NetCommunityBenefitExpense
Percent Of Total Expense0.06300PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served4801PersonsServed
Total Community Benefit Expense12731TotalCommunityBenefitExpense
Net Community Benefit Expense12731NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense36911TotalCommunityBenefitExpense
Net Community Benefit Expense36911NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense156969TotalCommunityBenefitExpense
Net Community Benefit Expense156969NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served4801PersonsServed
Total Community Benefit Expense206611TotalCommunityBenefitExpense
Net Community Benefit Expense206611NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served4801PersonsServed
Total Community Benefit Expense23827247TotalCommunityBenefitExpense
Direct Offsetting Revenue16176226DirectOffsettingRevenue
Net Community Benefit Expense7651021NetCommunityBenefitExpense
Percent Of Total Expense0.06470PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense35063TotalCommunityBuildingExpense
Net Community Building Expense35063NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense464860TotalCommunityBuildingExpense
Net Community Building Expense464860NetCommunityBuildingExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense499923TotalCommunityBuildingExpense
Net Community Building Expense499923NetCommunityBuildingExpense
Percent Of Total Expense0.00400PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$3,069,778BadDebtExpenseAmount
Amount Attributable To2261709AmountAttributableTo
Amount Reimbursed By Medicare54834199AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare57139011CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2304812MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part V Form990ScheduleHPartV (8 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalOtherOther
Jefferson Regional Medical Center
PO Box 350Crystal CityMO63019X
Jefferson Regional Hospice
5 Industrial DrFestusMO63028Hospice services
Jeffrson Multi-Specialty Group
1400 Highway 61 SouthCrystal CityMO63019Outpatient physician clinic
Jefferson Memorial Surgical Partners LLC
PO Box 350Crystal CityMO63019Outpatient surgery
Jefferson Regional Home Care
5 Industrial DrFestusMO63028Home care services
Jeffrson Memorial Hospital Rehabilitation Unit
PO Box 350Crystal CityMO63019Rehabilitation services
Jefferson Memorial Hospital Psychiatric Unit
PO Box 350Crystal CityMO63019Psychiatric services
Jefferson Regional Outpatient Facilities LLC
1400 Highway 61 SouthCrystal CityMO63019Urgent care services

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedThe costs reported in the table in Part I, Line 7 used a ratio of patient care costs to charges computed in Worksheet 2 of the form instructions. This methodology was used for all patient segments.CostingMethodUsed
Percent Of Total Expense ExplnThe organization had bad debt expense in the amount of 8,526,797 reported on Part IX, line 25, however, it has been subtracted for purposes of calculating the percentage in this column.PercentOfTotalExpenseExpln
Bad Debt FootnoteThe organization reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The organization provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the organization bills third-party payers directly and bills the patient when the patients liability is determined. Patient accounts receivable are due in full when billed. 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 BenefitThe organizations shortfall on line 7 represents unreimbursed Medicare services provided to members of the community who might otherwise not be able to afford adequate health care services.ShortfallAsCommunityBenefit
Debt Collection PolicyJefferson Regional Medical Center continues to offer and process financial assistance to patients who are identified as candidiates throughout the debt collection process. All collection agency letters and bills state financial assistance is available. Collection agency representatives also communicate the availability of financial assistance to patients as they recognize a financial need. They notify the Medical Center of these patients. We then follow up on these accounts and send a financial assistance packet to the patient.DebtCollectionPolicy
Needs AssessmentJefferson Regional Medical Center is currently conducting a 2-year comprehensive community health needs assessment of certain cities and towns in its primary service area. The overall goal of the assessment is to provide Jefferson Regional with the ability to clarify the health needs and priorities of the communities it serves. The project will consist of two phases. Phase I, consists of a thorough review of existing data from the Missouri Dept. of Public Health. The anticipated completion of Phase I is December 2011. In Phase II, a comprehensive community survey will be distributed to a random sample of 2,400 households in our primary area. In addition, a series of community interviews will be conducted to help determine leading health needs and priorities. This is expected to be completed by April 2012. The final report will provide a needs assessment prepared from all the data collected in both phases of the project.NeedsAssessment
Patient Education AssistanceJefferson Regional Medical Center business partner, Firstsource Solutions USA, LLC, representatives visit self-pay inpatients, patients with minimal insurance benefits and other referred patients including Emergency Department and outpatients to assist with Medicaid eligibility, SSI, W/C, TPL, Crime Victims, VA, Champus, COBRA, medical hardship cases, and others. If no potential eligibility for third party payment is determined, the patient is provided with a financial assistance packet and an explanation of the financial assistance process. Our Financial Assistance Coordinator also assists patients with any help they may need in completing required paperwork and follow up. Informational posters regarding the availability of financial assistance are displayed on every level of the facility near main entrance locations, registration areas, the Emergency Department, each individual emergency treatment room and the Patient Accounts department cashiering office. Business cards for the Financial Assistance Coordinator are available at all registration areas and are given to potential applicants by registration personnel and during in-house visits. All medical center patient account letters and bills, as well as collection agency letters and bills, state the availability of financial assistance. Brightly colored inserts are enclosed with the first self-pay collection letter informing patients of the availability of financial assistance. Patient Accounts department information along with financial assistance information and applications are available on the Jefferson Regional Medical Center website. Patient Account Representatives communicate the availability of financial assistance and explain eligibility criteria upon learning of patient financial need. Financial Assistance Program in-services are provided to Admitting and Social Services staff. Also, new employees are informed of the Financial Assistance Program during orientation. Financial assistance announcements/reminders are made periodically during Leadership meetings and via our Medical Center Employee Newsletter.PatientEducationAssistance
Community InformationAs one of the fastest growing counties in Missouri, Jefferson County benefits from its proximity to the amenities of St. Louis combined with the semi-rural atmosphere of small town living. Located in the Twin Cities of Crystal City and Festus, Jefferson Regional Medical Center reaches beyond the city limits to the neighboring communities of DeSoto, Herculaneum, Hillsboro and Pevely, along with many other smaller towns and villages. The hospital also serves nearby Ste. Genevieve and St. Francois counties. Positioned near the intersection of Interstate 55 and US Highways 61 and 67, Jefferson Regional is at the primary hub for southern Jefferson County and is easily accessible from the St. Louis area as well as southeastern Missouri. According to 2010 U.S. Census data, Jefferson County as a whole grew more than 10 percent, adding 20,634 residents for a total population of 218,733. Crystal City and Festus recorded growth percentages of 14 and 20 percent respectively, while other nearby cities - with smaller base populations - grew even more dramatically including Hillsboro at 68 percent, Pevely with 46 percent and Herculaneum at 24 percent. The populations are based on Census Designated Place which does not necessarily correspond with Postal ZIP Code or municipal boundaries. Most Jefferson County residents - about 73 percent - live outside of the city limits in unincorporated areas of the county. Still those cities are the primary centers of commerce and community, with the majority of businesses, churches, and schools located within the city limits. Founded as a company town around the glass factory that was built on the banks of the Mississippi River in the mid 1800s, Crystal City celebrated its centennial in 2011, marking 100 years of incorporation. Jefferson Regional owes significant gratitude to the glass factory and the community of Crystal City for the fund-raising drive that built the community hospital in 1957. The City of DeSoto is a railroad town and the largest city in Jefferson County south of the hospital. With 6,400 residents, according to the 2010 census, it also played a significant role in the fund-raising drive that built the hospital. The City of Festus is the largest community in southern Jefferson County with a 2010 population of 11,602. In combination with the three adjacent communities of Crystal City, Herculaneum and Pevely the population within a five-mile radius of Jefferson Regional Medical Center is more than 25,000. Demographically, as a whole, Jefferson Countys population is less than 5 percent non-white with very small ethnic communities located primarily in the cities of Crystal City, DeSoto and Festus. About 11 percent of the county population is over age 65 with the highest percentages occuring in the hospitals primary service area 17.3 percent in Crystal City, 13.5 percent in DeSoto, 13.8 percent in Festus, 15.4 percent in Herculaneum, 11 percent in Hillsboro and 10.8 percent in Pevely. The median income for the five-city base excluding Hillsboro is 46,652, while the median income countywide is 53,939. A total of 84.6 percent of persons age 25 and older are high school graduates and 16.8 percent have a bachelors degree or higher education.CommunityInformation
Community Building ActivitiesAs the areas largest employer, Jefferson Regional Medical Center is committed to community building activities including collaborative efforts that focus on health education, access to care, and commercial development. The hospital hosts community residents and participates in health fair activities that bring critical healthcare information to the communities it serves. Events held on the Medical Center campus, at local businesses, and in school settings include multiple healthcare providers offering information and screenings in a health fair format. The annual Family Health Fair held at Jefferson Regional attracts hundreds of area residents each year and provides low-cost, full-lipid panel screenings, free health assessments, and discount-priced childrens bicycle helmets. In the fall of 2009 when concern about H1N1 flu virus was peaking, Jefferson Regional donated portable hand sanitizer containers for the students in every elementary school in southern Jefferson County. The Medical Center offers free transportation for area residents visiting the hospital for appointments. A VIP Care service coordinates the transportation and offers a lounge area for patients to wait between appointments and tests. Patients health can be monitored during their stay in the VIP Care lounge, all at no charge. During the October 1, 2009 through September 30, 2010 reporting period, Jefferson Regional maintained its affiliation with Iron County Hospital, helping the fledgling facility continue to meet the healthcare needs of its area while a new owner was being sought. Jefferson Regional recruited staff and a physician group to serve the residents of Iron County. In Jefferson county, Jefferson Regional opened a new urgent care center and recruited additional physicians and needed specialists including endocrinologists, a rheumatologist, and orthopedic surgeons. Jefferson Regional is a firm supporter of community organizations, especially the area public and private schools, and the chamber of commerce organizations. With representatives on the boards of these organizations and involved in civic clubs throughout the community, Jefferson Regional is dedicated to promoting community building and the health of the communities it serves.CommunityBuildingActivities

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
American Heart Association
460 North Lindbergh BlvdSt LouisMO63141135613797501c386250general support
YMCA of Jefferson County
1303 YMCA DriveFestusMO63028430653616501c35420general support
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierIIdentifier
Return Reference2ReturnReference
ExplanationThe organization awards assistance to preapproved local charity based organizations. The amounts of 5,000Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Lloyd Ford Jr
34717114088011598122508002519901
James Muehlhauser
206447190007762118547346252409
Beverly Johnson
16709926461116795595210834
Blake Temple
1734582653948485997210842
Jerome Ladous
15306426651266691793343194903
Daniel Cox
3287079100337807
Eric Hale
172335112034951443178393
Lawrence Billy
16201015485430168988
Frank Krewett
1518867851179081672045171739
Tina Smith
154043208031722611161906

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuer
Health and Educational Facilities Authority of the State of Missouri
43117896660635RN452004-05-2737340504Various capital projectsfalsefalse
Health and Educational Facilities Authority of the State of Missouri
43117896660635RU472005-04-277410212Various capital projectsfalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount In Reserve FundAmountInReserveFundAmount DefeasedAmountDefeasedIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
370726925558528151243262800002006truetruetruetrue
744000471548626784517037482010truefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsetrue

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Clarence Temple MD
Father of B Temple-VP of Business Development392319Employed physicianfalse
Benjamin Albano Jr MD
Son of B Albano Sr-Board Member45378Employed physician/independent contrfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990 III2Merged JMH Diversified Health Care into The Jefferson Memorial Hospital Association.
Form 990 V7bThe organization supplies the information if requested by the donor. The organization will be implementing the necessary procedures to ensure notifications are provided in the future for donations.
Form 990 VI2Board members Lindell Carter and Tonda Breeze have a business relationship.
Form 990 VI6Under the Articles of Incorporation, Article VI states that the Corporation shall have one member, Jefferson Health System.
Form 990 VI7aIn establishing new bylaws, Jefferson Memorial Hospital Associations members of the initial board shall be reduced to nine members, as members leave the board and are not to be replaced. Once the Board of Directors are reduced to nine members, members shall be appointed as necessary by the sole member, Jefferson Health System, from among its 15 member Board of Directors.
Form 990 VI7bJefferson Health System, as the sole member of Jefferson Memorial Hospital Association shall maintain certain reserved powers of decisions over the sale of assets, long-term debt over a certain dollar amount, all decisions dealing with the assets and debts and any other decisions reserved for the Member. Jefferson Memorial Hospital Associations Board of Directors shall report to the Board of Directors of Jefferson Health System.
Form 990 VI11AThe completed tax forms 990 and its related schedules are reviewed by both the Chief Accounting Officer and the Chief Financial Officer. The final tax return is presented to the board of directors at their monthly board meeting, where they are reviewed and discussed as needed.
Form 990 VI12cJefferson Memorial Hospital Association requires all board members and senior management to complete an annual Conflict of Interest Questionnaire, which should disclose all potential and existing conflicts of interest. An annual report summarizing the comments from the questionnaire is approved by the board. As conflicts arise, members are required to disclose or abstain from voting and excuse themselves for the discussion.
Form 990 VI15Executive compensation is reviewed annually by an outside contracted individual who is responsible for bringing recommendations to the financial committee and then to the full board. This procedure establishes salary limits as well as annual strategic goals and related bonuses.
Form 990 VI19The organization makes its financial statements available to the public upon request.
Form 990 XI1The corporation uses the modified accrual method of accounting.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsDirect Controlling Entity NADirectControllingEntityNA
Jefferson Hospital Company ICH LLC
1400 Highway 61 SouthCrystal CityMO63019263754189Management companyMO187859192482N/A
Jefferson Physician Network
1400 Highway 61 SouthCrystal CityMO63019263753905Physician officesMO21713872060175N/A

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionDirect Controlling Entity NADirectControllingEntityNAPublic Charity StatusPublicCharityStatus
Jefferson Land Company Inc
P O Box 350Crystal CityMO63019431330360Title holding companyMO501c2N/A
JMH Diversified Health Care
P O Box 350Crystal CityMO63019431657255Ambulance servicesMO501c3N/A9
Jefferson Health System
1400 Highway 61 SouthCrystal CityMO63019263920271Supporting organizationMO501c4N/A

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Jefferson Memorial Surgical Partners LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 350AddressLine1
CityCrystal CityCity
StateMOState
ZIP Code63019ZIPCode
FieldValueIRS element (for citing)
EIN431803975EIN
Primary ActivityOutpatient surgeryPrimaryActivity
Legal Domicile StateMOLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Predominant Income TypeRelatedPredominantIncomeType
Share Of Total Income-81862ShareOfTotalIncome
Share Of EOY Assets599862ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnertrueGeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Apothecary Services IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 350AddressLine1
CityCrystal CityCity
StateMOState
ZIP Code63019ZIPCode
FieldValueIRS element (for citing)
EIN431627267EIN
Primary ActivityRetail PharmacyPrimaryActivity
Legal Domicile StateMOLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityC CorpTypeOfEntity
Share Of Total Income816837ShareOfTotalIncome
Share Of EOY Assets504430ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (14 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Apothecary Services Inc
r933257
Apothecary Services Inc
p1850000
Apothecary Services Inc
n480006
Apothecary Services Inc
o2361270
Jefferson Memorial Surgical Partners LLC
o69828
JMH Diversified Health Care
r5664956
JMH Diversified Health Care
p168490
JMH Diversified Health Care
a34500
JMH Diversified Health Care
d74600
JMH Diversified Health Care
o295903
JMH Diversified Health Care
n115396
Jefferson Health System
n326916
Jefferson Health System
p73797
Jefferson Health System
q401649

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