JACKSON HOSPITAL & CLINIC INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- JACKSON HOSPITAL & CLINIC INC (EIN 63-6001820)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-10-17
- IRS object ID
- 201132919349300113
- Schema version
- 2010v3.4
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-10-17T11:34:48-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 636001820 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON HOSPITAL AND CLINIC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JACK | NameControl |
| Phone | 3342938000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET NO 1200 | AddressLine1 |
| City | MONTGOMERY | City |
| State | AL | State |
| ZIP Code | 361061117 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DONALD HENDERSON | Name |
| Title | PRESIDENT / CEO | Title |
| Phone | 3342938000 | Phone |
| Date Signed | 2011-10-18 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DONALD HENDERSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET NO 1200 | AddressLine1 |
| City | MONTGOMERY | City |
| State | AL | State |
| ZIP Code | 361061117 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 181771632 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.JACKSON.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | AL | StateLegalDomicile |
| Activity Or Mission Description | COMMUNITY NOT-FOR-PROFIT 344 BED HOSPITAL SERVING MONTGOMERY AND ALABAMA RIVER REGION | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1739 | TotalNbrEmployees |
| Total Nbr Volunteers | 106 | TotalNbrVolunteers |
| Total Gross UBI | 204947 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 164925 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 12050 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 65778 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 148530408 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 171671051 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2143217 | InvestmentIncomePriorYear |
| Investment Income Current Year | 5360390 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -936681 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4674413 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 149748994 | TotalRevenuePriorYear |
| Total Revenue Current Year | 181771632 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 81528 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 74125 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 56731713 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 67597583 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 477630 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 89679114 | OtherExpensePriorYear |
| Other Expenses Current Year | 102072211 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 146492355 | TotalExpensesPriorYear |
| Total Expenses Current Year | 169743919 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3256639 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 12027713 | RevenuesLessExpensesCY |
| Total Assets BOY | 217788957 | TotalAssetsBOY |
| Total Assets EOY | 226168830 | TotalAssetsEOY |
| Total Liabilities BOY | 131566614 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 128898676 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 86222343 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 97270154 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE SUPERIOR HEALTHCARE IN A SAFE, COMPASSIONATE ENVIRONMENT WHILE FULFILLING OUR CHARITABLE OBLIGATION AS A NOT-FOR-PROFIT ORGANIZATION. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 142163054 | Expense |
| Grants | 74125 | Grants |
| Revenue | 171974024 | Revenue |
| Description | JACKSON HOSPITAL AND CLINIC, INC. IS A COMMUNITY NOT-FOR-PROFIT HOSPITAL SERVING MONTGOMERY AND THE ALABAMA RIVER REGION LICENSED FOR 344 BEDS, INCLUDING 30 INTENSIVE CARE BEDS AND 22 OBSTETRIC BEDS. OUR COMPREHENSIVE HEALTHCARE SERVICES INCLUDE CARDIAC, CANCER, NEUROSCIENCES, ORTHOPEDICS AND WOMEN'S AND CHILDREN'S CARE, ALONG WITH 24-HOUR EMERGENCY SERVICES. IT RANKS AMONG THE LARGEST HOSPITALS IN ALABAMA AND IS WIDELY RECOGNIZED FOR PROVIDING EXCELLENCE IN CARE. EVEN WITH OUR LEADING-EDGE TECHNOLOGY AND FACILITIES, WE REMAIN TRUE TO OUR MISSION OF PROVIDING SUPERIOR PERSONAL HEALTHCARE IN A SAFE, COMPASSIONATE ENVIRONMENT WHILE FULFILLING OUR COMMITMENT AS A CHARITABLE ORGANIZATION. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PLEASE SEE SCHEDULE O FOR DETAILS ON SOME OF OUR COMMUNITY HEALTH PROGRAMS AND SERVICES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 142163054 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 1 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 46 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1739 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETER C VERRECCHIA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3342938820 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET SUITE 1200 | AddressLine1 |
| City | MONTGOMERY | City |
| State | AL | State |
| ZIP Code | 36106 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| JIM L RIDLING | |||||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |||
| WILBUR HUFHAM | |||||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |||
| WILLIAM M JORDAN MD | |||||||||
| SECRETARY / TREASURER | 1.00 | X | X | 0 | 0 | 0 | |||
| ROGER S DUGGAR MD | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| E KYLE KYSER | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| CHARLOTTE MUSSAFER | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| JAMES T MCLAUGHLIN MD | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| GEORGE M HANDEY MD | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| KEITH KARST | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| W KEN UPCHURCH III | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| JOHN A WILLIAMS MD | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| DONALD HENDERSON | |||||||||
| PRESIDENT / CEO | 40.00 | X | 548826 | 0 | 15499 | ||||
| PETER VERRECCHIA | |||||||||
| VP OF FINANCE | 40.00 | X | 253882 | 0 | 4502 | ||||
| VICTORIA JONES | |||||||||
| VICE PRESIDENT | 40.00 | X | 237319 | 0 | 63067 | ||||
| RICHARD CALDWELL | |||||||||
| VP OF PROFESSIONAL SERVICES | 40.00 | 282882 | 0 | 8412 | X | ||||
| LARRY SHERBETT | |||||||||
| AVP OF FINANCE | 40.00 | 183880 | 0 | 5899 | X | ||||
| CYNTHIA DIXON | |||||||||
| VP OF PATIENT CARE | 40.00 | 178374 | 0 | 10238 | X | ||||
| JANET MCQUEEN | |||||||||
| VP OF MARKETING & DEVELOPMENT | 40.00 | 154215 | 0 | 5348 | X | ||||
| SHELLY HENRIKSON | |||||||||
| VP OF PATIENT CARE | 40.00 | 124467 | 0 | 929 | X | ||||
| CYNTHIA WALKER | |||||||||
| AVP OF PERFORMANCE INPROVEMENT | 40.00 | 125349 | 0 | 1692 | X | ||||
| MARGARET VEREB MD | |||||||||
| PHYSICIAN | 40.00 | 371771 | 0 | 14440 | X | ||||
| JAMES MRACEK MD | |||||||||
| PHYSICIAN | 40.00 | 349622 | 0 | 8186 | X | ||||
| ROBERT HARRIS MD | |||||||||
| PHYSICIAN | 40.00 | 287345 | 0 | 9972 | X | ||||
| DONALD MARSHALL MD | |||||||||
| PHYSICIAN | 40.00 | 202014 | 0 | 65949 | X | ||||
| WILLIAM D JONES MD | |||||||||
| PHYSICIAN | 40.00 | 181722 | 0 | 9976 | X | ||||
| EDWARD SCHOLL | |||||||||
| FORMER VP OF FINANCE | 40.00 | 158803 | 0 | 3841 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3390655 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 225329 | TotalOtherCompensation |
| Number Individuals GT100 K | 44 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| LIFESOUTH COMMUNITY BLOOD CENTERS INC | |||||
| PO BOX 830469 | BIRMINGHAM | AL | 35283 | BLOOD PRODUCTS | 2278987 |
| JACKSON MED SOUTH | |||||
| PO BOX 689 | JASPER | AL | 35502 | SLEEP LAB STUDIES | 1605633 |
| MONTGOMERY ANESTHESIA ASSOC PC | |||||
| PO BOX 230725 | MONTGOMERY | AL | 26123 | ANESTHESIA SERVICES | 1596000 |
| PROASSURANCE INDEMNITY CO | |||||
| 13060 COLLECTION CENTER DR | CHICAGO | IL | 60693 | MALPRACTICE PREMIUMS | 1415651 |
| DIVERSIFIED CLINICAL SERVICES | |||||
| PO BOX 636981 | CINCINNATI | OH | 45263 | WOUND CARE SERVICES | 902519 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 27 | NumberOfContractorsGT100K |
| Related Organizations | 65778 | RelatedOrganizations |
| Total Contributions | 65778 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT SERVICE | 621400 | 169601246 | 169533143 | 68103 |
| SURGERY CENTER REVENUE | 621400 | 1184476 | 1184476 | |
| IMAGING CENTER REVENUE | 621400 | 867971 | 867971 | |
| ANCILLIARY SERVICES | 900099 | 17358 | 17358 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 171671051 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5360390 | TotalRevenueColumn |
| Exclusion | $5,360,390 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 2560153 | GrossSalesOfInventory |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2560153 | TotalRevenueColumn |
| Exclusion | $2,560,153 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| CAFETERIA | 722210 | 1332336 | $1,332,336 | ||
| JOINT VENTURE | 900099 | 507920 | 371076 | 136844 | |
| COFFEE SHOP | 722210 | 87421 | $87,421 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 186583 | TotalRevenueColumn |
| Exclusion | $186,583 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2114260 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 181771632 | TotalRevenueColumn |
| Related Or Exempt Function Income | 171974024 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 204947 | UnrelatedBusinessRevenue |
| Exclusion | $9,526,883 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74125 | Total |
| Program Services | 74125 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2101721 | Total |
| Management And General | 2101721 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54369068 | Total |
| Program Services | 43670799 | ProgramServices |
| Management And General | 10302714 | ManagementAndGeneral |
| Fundraising | 395555 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1645180 | Total |
| Program Services | 1321456 | ProgramServices |
| Management And General | 311755 | ManagementAndGeneral |
| Fundraising | 11969 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5499731 | Total |
| Program Services | 4417542 | ProgramServices |
| Management And General | 1042176 | ManagementAndGeneral |
| Fundraising | 40013 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3981883 | Total |
| Program Services | 3198363 | ProgramServices |
| Management And General | 754550 | ManagementAndGeneral |
| Fundraising | 28970 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78323 | Total |
| Management And General | 78323 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 270144 | Total |
| Management And General | 270144 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17207788 | Total |
| Program Services | 14389609 | ProgramServices |
| Management And General | 2818179 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 417668 | Total |
| Management And General | 417668 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6207816 | Total |
| Program Services | 3210885 | ProgramServices |
| Management And General | 2995999 | ManagementAndGeneral |
| Fundraising | 932 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3408401 | Total |
| Management And General | 3408401 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3645656 | Total |
| Program Services | 3645656 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 277999 | Total |
| Program Services | 244556 | ProgramServices |
| Management And General | 33252 | ManagementAndGeneral |
| Fundraising | 191 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5215331 | Total |
| Program Services | 5215331 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10933742 | Total |
| Program Services | 10933742 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1588564 | Total |
| Program Services | 1588564 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 38316541 | 36114652 | 2201889 |
| BAD DEBT EXPENSE | 13956997 | 13956997 | |
| UBI TAXES | 210256 | 210256 | |
| MISCELLANEOUS EXPENSE | 181376 | 180777 | 599 |
| RECRUITMENT | 155609 | 155609 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169743919 | Total |
| Program Services | 142163054 | ProgramServices |
| Management And General | 27103235 | ManagementAndGeneral |
| Fundraising | 477630 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5459721 | BOY |
| EOY | 7465172 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7942472 | BOY |
| EOY | 7246887 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28782115 | BOY |
| EOY | 24904068 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 536978 | BOY |
| EOY | 511142 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4037286 | BOY |
| EOY | 3995157 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1971241 | BOY |
| EOY | 2223512 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 243028837 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 132924308 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 116605835 | BOY |
| EOY | 110104529 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44264004 | BOY |
| EOY | 64637011 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 3255322 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8189305 | BOY |
| EOY | 1826030 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 217788957 | BOY |
| EOY | 226168830 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11662287 | BOY |
| EOY | 13887276 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 106925000 | BOY |
| EOY | 104960000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12979327 | BOY |
| EOY | 10051400 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 131566614 | BOY |
| EOY | 128898676 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86222343 | BOY |
| EOY | 97270154 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86222343 | BOY |
| EOY | 97270154 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 217788957 | BOY |
| EOY | 226168830 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 12027713 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -979902 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1644606 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 5851770 | OtherCostOrOtherBasis |
| Book Value | 7496376 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 93263284 | OtherCostOrOtherBasis |
| Depreciation | 38301685 | Depreciation |
| Book Value | 54961599 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2432493 | OtherCostOrOtherBasis |
| Depreciation | 1884179 | Depreciation |
| Book Value | 548314 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 138172538 | OtherCostOrOtherBasis |
| Depreciation | 92738444 | Depreciation |
| Book Value | 45434094 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1664146 | OtherCostOrOtherBasis |
| Book Value | 1664146 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 110104529 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated (4 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN JACKSON MED SOUTH | 796665 | F |
| INVESTMENT IN IMAGING CENTER | 1031269 | F |
| INVESTMENT IN SURGERY CENTER | 1223877 | F |
| INVESTMENT IN OAK PARK HIGHLAND | 203511 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 3255322 | TotalOfBookValueProgramRelated |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 734944 |
| BOND DISCOUNT AND ISSUANCE COSTS | 1091086 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1826030 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED INTEREST | $1,732,985 |
| PENSION LIABILITY | $6,048,634 |
| UNAMORTIZED BOND PREMIUM | $2,269,781 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 10051400 | TotalOfAmounts |
| Total Revenue | 181771632 | TotalRevenue |
| Total Expenses | 169743919 | TotalExpenses |
| Excess Or Deficit For Year | 12027713 | ExcessOrDeficitForYear |
| Other | -$979,902 | OtherAmount |
| Total Adjustments | -979902 | TotalAdjustments |
| Excess Or Deficit Per FS | 11047811 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 178585468 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -853857 | OtherRevenues |
| Revenue Not Rptd F990 | -853857 | RevenueNotRptdF990 |
| Revenue Subtotal | 179439325 | RevenueSubtotal |
| Other Revenues Not Included | 2332307 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 2332307 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 181771632 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 167537657 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | -2206262 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | -2206262 | ExpensesNotRptdF990 |
| Expenses Subtotal | 169743919 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 169743919 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE ORGANIZATION FILES A CONSOLIDATED FINANCIAL STATEMENT WITH ITS SUBSIDIARIES. THE FOLLOWING FOOTNOTE REFERENCES ENTITIES WHOSE ACTIVITY IS NOT REPORTED ON THE FORM 990 FOR JACKSON HOSPITAL AND CLINIC, INC. "THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3); ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. JACKSON IMAGING CENTER, LLC AND JACKSON SURGERY CENTER, LLC ARE LIMITED LIABILITY COMPANIES. AS SUCH, THEY ARE NOT TAXABLE ENTITIES, AND ELEMENTS OF INCOME AND EXPENSE FLOW THROUGH AND ARE TAXED TO THE MEMBERS. ACCORDINGLY, THERE IS NO PROVISION FOR INCOME TAXES FOR THESE ENTITIES. THE COMPANY HAS ADOPTED THE GUIDANCE RELATING TO REPORTING POSSIBLE UNCERTAINTY IN INCOME TAXES. THIS GUIDANCE REQUIRES ENTITIES TO ASSESS ANY UNCERTAIN TAX POSITIONS FOR THE LIKELIHOOD THAT THEY WOULD BE OVERTURNED UPON INTERNAL REVENUE SERVICE EXAMINATION OR UPON EXAMINATION BY STATE TAXING AUTHORITIES. THE COMPANY DETERMINED THAT IT DOES NOT HAVE ANY POSITIONS THAT IT WOULD BE UNABLE TO SUBSTANTIATE. THE COMPANY HAS FILED TAX RETURNS FOR ALL YEARS FROM INCEPTION THROUGH 2009. UNDER STATUTE, THE HOSPITAL IS SUBJECT TO IRS AND STATE TAXING AUTHORITY REVIEW FOR TAX YEARS 2007 THROUGH 2009." |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | BOOK TO TAX DIFFERENCE ON JOINT VENTURE -126,045. UNFUNDED PENSION LOSS -853,857. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | UNFUNDED PENSION LOSS -853,857. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BOOK TO TAX DIFFERENCE ON JOINT VENTURE 126,045. INTEREST ON FUNDED DEPRECIATION 2,206,262. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | INTEREST ON FUNDED DEPRECIATION -2,206,262. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7975481 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7975481 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05120 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19390284 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21376039 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1985755 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 27365765 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21376039 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5989726 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05120 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15107 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1740 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13367 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2224306 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2224306 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01430 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 43475 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 43475 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2282888 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1740 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2281148 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01470 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 29648653 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21377779 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8270874 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06590 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $2,941,295 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 62704875 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 54015020 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 8689855 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| 1 JACKSON IMAGING CENTER LLC | ||
| RADIOLOGY PROCEDURES | 0.67000 | 0.33000 |
| 2 JACKSON SURGERY CENTER LLC | ||
| OUTPATIENT SURGERY | 0.51000 | 0.49000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON HOSPITAL AND CLINIC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET | AddressLine1 |
| City | MONTGOMERY | City |
| State | AL | State |
| ZIP Code | 361061117 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | DISPROPORTIONATE SHARE HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA FOR 2010 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| JACKSON CLINIC FAMILY MEDICINE CENTER | ||||
| 1111 OLIVE STREET | MONTGOMERY | AL | 36106 | FAMILY MEDICINE/OUTPATIENT |
| JACKSON SURGERY CENTER | ||||
| 1725 PARK PLACE | MONTGOMERY | AL | 36106 | OUTPATIENT SURGERY |
| JACKSON IMAGING CENTER | ||||
| 1825 PARK PLACE | MONTGOMERY | AL | 36106 | MEDICAL IMAGING |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: FOR INDIVIDUALS THAT DO NOT QUALIFY FOR FREE CARE UNDER OUR CHARITY CARE POLICY, JACKSON HOSPITAL DISCOUNTS SELF-PAY ACCOUNTS BY 30% AT THE TIME OF PATIENT DISCHARGE. | ||
| PART I, LINE 7G: JACKSON HOSPITAL HAS SEVERAL HEALTH PROGRAMS OPERATED AT A LOSS FOR THE BENEFIT OF THE COMMUNITY. THESE DEPARTMENTS, INCLUDED ON PART I, LINE 7(G) ARE: EMERGENCY ROOM - $ 1,902,477 DIABETES SERVICES - 4,937 OBSTETRICS - 316,892 TOTAL $ 2,224,306 | ||
| PART I, L7 COL(F): THE AMOUNT LISTED ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $ 13,956,997 THAT HAS BEEN REMOVED FOR PURPOSES OF CALCULATING PERCENT OF TOTAL EXPENSE ON PART I, LINE 7, COLUMN (F). | ||
| PART III, LINE 4: WORKSHEET 2 OF THE 2010 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE BAD DEBT EXPENSE AT COST FOR PURPOSES OF PART III, LINE 2.RECEIVABLES FROM PATIENTS, INSURANCE COMPANIES, AND THIRD-PARTY CONTRACTUAL AGENCIES ARE RECORDED AT REGULAR PATIENT SERVICE CHARGE RATES. A MAJORITY OF THE COMPANY'S PATIENTS ARE INSURED BY CERTAIN THIRD PARTY INSURERS (PRINCIPALLY BLUE CROSS, MEDICARE, AND MEDICAID) BASED ON CONTRACTUAL AGREEMENTS WHICH GENERALLY RESULT IN THE COMPANY COLLECTING LESS THAN THE ESTABLISHED CHARGE RATES. FINAL DETERMINATION OF PAYMENTS UNDER THESE AGREEMENTS IS SUBJECT TO REVIEW BY APPROPRIATE AUTHORITIES. ADEQUATE ALLOWANCES ARE PROVIDED FOR DOUBTFUL ACCOUNTS, CONTRACTUAL ADJUSTMENTS AND OTHER UNCERTAINTIES. CREDIT LOSSES HAVE HISTORICALLY BEEN WITHIN MANAGEMENT'S EXPECTATIONS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBTS IF SUBSEQUENTLY COLLECTED. | ||
| PART III, LINE 8: THE ORGANIZATION USED ITS MEDICARE COST REPORT TO CALCULATE ALLOWABLE COSTS OF CARE RELATED TO MEDICARE FOR PURPOSES OF PART III, LINE 6. | ||
| PART III, LINE 9B: THE ORGANIZATION QUALIFIES PATIENTS FOR ITS CHARITY CARE POLICY AT TIME OF DISCHARGE. DISCOUNTS ON SELF-PAY PATIENTS ARE APPLIED USING A NON-FINANCIAL MEASURE, SO ACCOUNTS IN BAD DEBTS ARE NOT LIKELY ELIGIBILE FOR FURTHER FINANCIAL ASSISTANCE AFTER HAVING THEIR FINAL BILLS ISSUED. THE HOSPITAL PRIMARILY USES A THIRD-PARTY TO HANDLE BAD DEBT COLLECTIONS, AND ROUTINELY REEVALUATES ITS BAD DEBT ACCOUNTS TO DETERMINE PATIENTS THAT QUALIFY UNDER THE ORGANIZATION'S CHARITY CARE POLICY. | ||
| PART VI, LINE 3: THE HOSPITAL PROVIDES SIGNAGE IN AND AROUND THE EMERGENCY ROOM STATING THE CONTACT INFORMATION FOR FINANCIAL ASSISTANCE REPRESENTATIVES. "YOU MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE TERMS AND CONDITIONS THE HOSPITAL OFFERS TO QUALIFIED PATIENTS. FOR ADDITIONAL INFORMATION, CONTACT THE HOSPITAL FINANCIAL ASSISTANCE REPRESENTATIVE AT 334-293-6970."IN ADDITION, A REPRESENTATIVE VISITS EACH SELF-PAY INPATIENT, AND AN APPLICATION FORM FOR ASSISTANCE IS COMPLETED AT THAT TIME. EACH PRIVATE PAY PATIENT IS INTERVIEWED TO DETERMINE QUALIFICATION BASED ON NATIONAL POVERTY GUIDELINES FOR FINANCIAL ASSISTANCE. BASED ON THIS DETERMINATION, A DECISION IS MADE AS TO ELIGIBILTY FOR FINANCIAL ASSISTANCE. | ||
| PART VI, LINE 4: JACKSON HOSPITAL'S PRIMARY SERVICE AREA IS COMPRISED OF MONTGOMERY, ELMORE, AND AUTAUGA COUNTIES, LOCATED IN THE EASTERN CENTRAL PART OF THE STATE OF ALABAMA. THE SECONDARY SERVICE AREA IS COMPRISED OF BULLOCK, BUTLER, CRENSHAW, DALLAS, LOWNDES, MACON, AND PIKE COUNTRIES. JACKSON HOSPITAL IS ADJACENT TO I-85 AND NEAR THE INTERSECTION OF I-65 AND I-85, PROVIDING FOR EASY ACCESS FROM THE PRIMARY AND SECONDARY SERVICE AREAS. MAJOR PRIMARY SERVICE AREA EMPLOYERS ARE MAXWELL AIR FORCE BASE, STATE OF ALABAMA, HYUNDAI MOTOR MANUFACTURING ALABAMA, ALFA INSURANCE COMPANIES, ALABAMA STATE UNIVERSITY, AUBURN UNIVERSITY MONTGOMERY AND CITY OF MONTGOMERY. | ||
| PART VI, LINE 6: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES, INDEPENDENT CONTRACTORS, NOR A FAMILY MEMBER OF AN EMPLOYEE OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO MOST OF ITS DEPARTMENTS. IN ADDITION, SURPLUS FUNDS ARE REINVESTED IN THE HOSPITAL THROUGH THE PURCHASE OF TECHNOLOGY, PROPERTY, AND PLANT EQUIPMENT. | ||
| AL | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| AUBURN UNIVERSITY FOUNDATION | |||||||
| 317 SOUTH COLLEGE STREET | AUBURN | AL | 368495170 | 636022422 | 501(C)(3) | 5000 | OPERATION SUPPORT |
| MONTGOMERY AREA CHAMBER OF COMMERCE | |||||||
| 41 COMMERCE STREET | MONTGOMERY | AL | 36101 | 630039380 | 501(C)(6) | 25000 | OPERATION SUPPORT |
| MONTGOMERY AREA COMMUNITY WELLNESS COALITION | |||||||
| 3060 MOBILE HIGHWAY | MONTGOMERY | AL | 36108 | 300092712 | 501(C)(3) | 11500 | OPERATION SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE PRESIDENT/CEO PROVIDES OVERSIGHT TO THE GRANTS PROVIDED BY THE ORGANIZATION AND REPORTS USAGE TO THE BOARD OF DIRECTORS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DONALD HENDERSON | |||||||||||||
| 393938 | 0 | 115900 | 0 | 38988 | 0 | 9800 | 0 | 5699 | 0 | 564325 | 0 | 0 | 0 |
| PETER VERRECCHIA | |||||||||||||
| 189643 | 0 | 42025 | 0 | 22214 | 0 | 0 | 0 | 4502 | 0 | 258384 | 0 | 0 | 0 |
| VICTORIA JONES | |||||||||||||
| 158185 | 0 | 39565 | 0 | 39569 | 0 | 61212 | 0 | 1855 | 0 | 300386 | 0 | 0 | 0 |
| RICHARD CALDWELL | |||||||||||||
| 201398 | 0 | 41820 | 0 | 39664 | 0 | 6704 | 0 | 1708 | 0 | 291294 | 0 | 0 | 0 |
| LARRY SHERBETT | |||||||||||||
| 142409 | 0 | 30671 | 0 | 10800 | 0 | 4968 | 0 | 931 | 0 | 189779 | 0 | 0 | 0 |
| CYNTHIA DIXON | |||||||||||||
| 108124 | 0 | 33825 | 0 | 36425 | 0 | 5367 | 0 | 4871 | 0 | 188612 | 0 | 0 | 0 |
| JANET MCQUEEN | |||||||||||||
| 106390 | 0 | 25567 | 0 | 22258 | 0 | 4116 | 0 | 1232 | 0 | 159563 | 0 | 0 | 0 |
| MARGARET VEREB MD | |||||||||||||
| 283674 | 0 | 72219 | 0 | 15878 | 0 | 8667 | 0 | 5773 | 0 | 386211 | 0 | 0 | 0 |
| JAMES MRACEK MD | |||||||||||||
| 198637 | 0 | 150835 | 0 | 150 | 0 | 6667 | 0 | 1519 | 0 | 357808 | 0 | 0 | 0 |
| ROBERT HARRIS MD | |||||||||||||
| 254266 | 0 | 32499 | 0 | 580 | 0 | 8667 | 0 | 1305 | 0 | 297317 | 0 | 0 | 0 |
| DONALD MARSHALL MD | |||||||||||||
| 148294 | 0 | 16424 | 0 | 37296 | 0 | 5777 | 0 | 60172 | 0 | 267963 | 0 | 0 | 0 |
| WILLIAM D JONES MD | |||||||||||||
| 161154 | 0 | 20000 | 0 | 568 | 0 | 5333 | 0 | 4643 | 0 | 191698 | 0 | 0 | 0 |
| EDWARD SCHOLL | |||||||||||||
| 0 | 0 | 0 | 0 | 158803 | 0 | 0 | 0 | 3841 | 0 | 162644 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | THE HOSPITAL PROVIDED INITIAL DUES AND MONTHLY DUES FOR A COUNTRY CLUB MEMBERSHIP FOR THE PRESIDENT/CEO. |
| PART I, LINES 4A-B | FORMER KEY EMPLOYEE EDWARD SCHOLL WAS COMPENSATED IN 2010 UNDER A SEVERANCE AGREEMENT THAT BEGAN PRIOR TO THE TAX YEAR IN APRIL 2009 AND ENDED SEPTEMBER 30, 2010. ALL AMOUNTS LISTED AS COMPENSATION TO EDWARD SCHOLL WERE PAID UNDER THIS AGREEMENT. THERE WERE NO ADDITIONAL TERMS OR CONDITIONS TO THE ARRANGEMENT. PLEASE SEE PART II FOR COMPENSATION DETAILS. THE HOSPITAL ESTABLISHED THE JACKSON HOSPITAL 457(F) DEFERRED COMPENSATION PLAN (THE "457(F) PLAN") EFFECTIVE JANUARY 1, 2008 (AMENDED MARCH 1, 2008), FOR THE EXCLUSIVE BENEFIT OF CERTAIN EMPLOYEES AND THEIR BENEFICIARIES. THE 457(F) PLAN (ALONG WITH THE RELATED RABBI TRUST) IS INTENDED TO BE A FUNDED NONQUALIFIED INELIGIBLE DEFERRED COMPENSATION PLAN ESTABLISHED PURSUANT TO SECTION 409A OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. THE PRIMARY PURPOSE OF THE 457(F) PLAN IS TO ATTRACT AND RETAIN QUALIFIED HIGHLY COMPENSATED EXECUTIVE OR MANAGERIAL PERSONNEL BY PROVIDING FOR A DEFERRAL OF COMPENSATION TO A LATER DATE. FOR 2010, THE FOLLOWING INDIVIDUAL ACCRUED AMOUNTS UNDER THIS PLAN: VICTORIA JONES - $ 54,886 PLEASE SEE PART II, COLUMN (C). |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEDICAL CLINIC BOARD OF THE CITY OF MONTGOMERY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 630881546 | IssuerEIN |
| CUSIP Number | 013058CG9 | CUSIPNumber |
| Date Issued | 2006-12-05 | DateIssued |
| Issue Price | 113221823 | IssuePrice |
| Description Of Purpose | REFUNDING, CAPITAL ACQUISITION | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 5615000 | AmountRetired |
| Total Proceeds | 115784596 | TotalProceeds |
| Amount In Reserve Fund | 7170460 | AmountInReserveFund |
| Issuance Costs From Proceeds | 1260470 | IssuanceCostsFromProceeds |
| Capital Expenditures | 6203213 | CapitalExpenditures |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 1 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 1 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MONTGOMERY CARDIOLOGY ASSOCIATES | |||
| PRACTICE OWNED IN PART BY BOARD MEMBER JOHN WILLIAMS | 104765 | PAYMENT TO INTERESTED PERSON FOR MEDICAL SERVICES RENDERED (EKG READINGS AND ECHO STUDIES) | 0 |
| MONTGOMERY CARDIOLOGY ASSOCIATES | |||
| PRACTICE OWNED IN PART BY BOARD MEMBER JOHN WILLIAMS | 122078 | OFFICE SPACE RENTAL PAID BY INTERESTED PERSON | 0 |
| PRIMARY CARE INTERNISTS | |||
| PRACTICE OWNED IN PART BY BOARD MEMBER JAMES MCLAUGHLIN | 89633 | PAYMENT TO INTERESTED PERSON FOR MEDICAL SERVICES RENDERED (EKG READINGS) | 0 |
| PRIMARY CARE INTERNISTS | |||
| PRACTICE OWNED IN PART BY BOARD MEMBER JAMES MCLAUGHLIN | 78680 | OFFICE SPACE RENTAL PAID BY INTERESTED PERSON | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICE STATEMENT | FORM 990, PART III, LINE 4A | WE BELIEVE THAT JACKSON HOSPITAL PLAYS A VITAL ROLE IN HELPING TO MAINTAIN THE HEALTH OF OUR COMMUNITY THROUGH THE PROVISION OF FREE HEALTHCARE SERVICES, RESEARCH AND EDUCATIONAL PROGRAMS, AND COMMUNITY INVOLVEMENT AND FINANCIAL SUPPORT. SOME OF OUR COMMUNITY HEALTH IMPROVEMENT SERVICES AND RESEARCH PROJECTS INCLUDE: COLORECTAL CANCER HEALTH SCREENING - TAKE-HOME COLORECTAL CANCER EXAM KITS AS WELL AS EDUCATIONAL MATERIALS WERE DISTRIBUTED EVERY TUESDAY THROUGHOUT THE MONTH OF MARCH IN HONOR OF COLORECTAL CANCER AWARENESS MONTH. COMMUNITY HEALTH FAIRS - JACKSON HOSPITAL PARTICIPATED IN VARIOUS COMMUNITY HEALTH FAIRS THROUGHOUT THE YEAR. THE FAIRS OFFERED FLU VACCINES, BLOOD PRESSURE CHECKS, GLUCOSE CHECKS, CHOLESTEROL CHECKS, AND GENERAL HEALTH EDUCATION. SPORTS MEDICINE PHYSICALS - AS A RESULT OF THIS GREAT EFFORT BY JACKSON HOSPITAL EMPLOYEES, APPROXIMATELY 1,400 MALE AND FEMALE ATHLETES HAD THE OPPORTUNITY TO PARTICIPATE IN INTER-SCHOLASTIC SPORTS DURING THE SCHOOL YEAR. THIS FREE COMMUNITY SERVICE EVENT HELPED THOUSANDS OF PARENTS, TWENTY-FIVE SCHOOLS, AND HUNDREDS OF COACHES. NONE OF THIS COULD HAVE BEEN DONE WITHOUT THE VOLUNTEER EFFORTS OF OVER 100 INDIVIDUALS WHO GAVE OF THEIR TIME TO SHOW CENTRAL ALABAMA HOW JACKSON HOSPITAL LIVES UP TO ITS REPUTATION AS A CARING HOSPITAL THAT PROVIDES SUPERIOR HEALTHCARE IN A SAFE, COMPASSIONATE ENVIRONMENT. RESEARCH PROJECTS: - MENTOR SILICONE GEL-FILLED BREAST IMPLANT ADJUNCT CLINICAL STUDY - MCGHAN/INAMED MEDICAL CORPORATION SILICONE-FILLED BREAST IMPLANT ADJUNCT CLINICAL STUDY - A POST-APPROVAL INVESTIGATION OF THE PRESTIGE CERVICAL DISC DEVICE AT A SINGLE LEVEL FOR SYMPTOMATIC CERVICAL DISC DISEASE - MEDTRONIC SOFAMOR DANEK: A PROSPECTIVE, MULTICENTER, CONTROLLED CLINICAL TRIAL OF AN ARTIFICIAL CERVICAL DISC LOW PROFILE AT A SINGLE LEVEL FOR SYMPTOMATIC CERVICAL DISC DISEASE - BANKING PHASE (PHASE 2): ESTABLISHMENT OF A COLLECTION AND STORAGE CENTER FOR CLINICAL RESEARCH ON TRANSPLANTATION OF UMBILICAL CORD STEM AND PROGENITOR CELLS - A RANDOMIZED, DOUBLE-BLIND, MULTICENTER STUDY OF THE SAFETY AND EFFICACY OF RX-3341 COMPARED WITH CEFAZOLIN FOR THE PREVENTION OF SURGICAL SITE INFECTIONS FOLLOWING CORONARY ARTERY BYPASS GRAFT SURGERY - A PHASE II, MULTICENTER, RANDOMIZED, OPEN LABEL, COMPARATIVE STUDY TO EVALUATE THE SAFETY AND EFFICACY OF RX-1741 VERSUS LINEZOLID IN THE OUTPATIENT TREATMENT OF ADULTS WITH UNCOMPLICATED SKIN AND SKIN STRUCTURE INFECTION - PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL TO EVALUATE THE EFFICACY AND SAFETY OF FAROPENEM MEDOXOMIL 600MG P.O. BID FOR 7 DAYS IN THE TREATMENT OF ACUTE BACTERIAL SINUSITIS CASH AND IN-KIND DONATIONS - JACKSON HOSPITAL BELIEVES IN GIVING BACK TO THE COMMUNITY. IN THE PAST YEAR, THE HOSPITAL DONATED FUNDS AND SERVICES TO THE FOLLOWING ORGANIZATIONS: - AFA CHAPTER 102 - AMERICAN CANCER SOCIETY - AMERICAN DIABETES ASSOCIATION - ARTHRITIS FOUNDATION - AUBURN UNIVERSITY SCHOOL OF NURSING - ELMORE COUNTY ECONOMIC DEVELOPMENT AUTHORITY - HOSPICE OF MONTGOMERY - MADD - MONTGOMERY AUTAUGA ELMORE MEDICAL ALLIANCE - MARCH OF DIMES - MONTGOMERY AREA CHAMBER OF COMMERCE - MONTGOMERY DRAGON BOAT RACE & FESTIVAL - NIGERIAN AMERICAN COMMUNITY SOUTH CENTRAL ALABAMA - PARTNERS IN EDUCATION WOMEN EMPOWERMENT PROGRAM DURING 2010, THE HOSPITAL RECRUITED FIVE NEW SPECIALISTS, AN ENDOCRINOLOGIST, UROLOGIST, VASCULAR SURGEON, FAMILY PRACTICE PHYSICIAN, AND NEUROLOGIST TO MEET THE NEEDS OF THE COMMUNITY. THESE SPECIALTIES WERE IDENTIFIED USING THE STATE HEALTH PLAN, ALABAMA DEPARTMENT OF PUBLIC HEALTH AND MEMBERSHIP OF JACKSON HOSPITALS MEDICAL STAFF. THE ALABAMA DEPARTMENT OF PUBLIC HEALTH HAD TO APPROVE THE NEED FOR THE ENDOCRINOLOGIST AND VASCULAR SURGEON DUE TO THEIR J-1 VISA STATUS. JACKSON HOSPITAL WAS ABLE TO PROVE THE MONTGOMERY AREA WAS UNDERSERVED IN THOSE AREAS. THE ENDOCRINOLOGIST, VASCULAR SURGEON AND UROLOGIST BEGAN PRACTICE IN AUGUST 2011. JACKSON HOSPITAL CONTINUES TO RECRUITMENT NEUROLOGIST AND FAMILY PRACTICE PHYSICIANS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS FOUR CLASSES OF MEMBERS: ACTIVE MEMBERS, SENIOR ACTIVE MEMBERS, ASSOCIATE MEMBERS, AND COMMUNITY MEMBERS. ACTIVE MEMBERS - TO QUALIFY AS AN ACTIVE MEMBER, AN APPLICANT MUST: BE ACTIVE IN THE PRACTICE OF MEDICINE, BE A MEMBER OF THE ACTIVE MEDICAL STAFF OF THE HOSPITAL, HAVE SERVED AS AN ASSOCIATE MEMBER FOR NOT LESS THAN THREE YEARS, HAVE DEMONSTRATED INTEREST IN AND ADHERENCE TO THE OBJECTIVES OF THE ORGANIZATION, AND BE IN COMPLIANCE WITH ALL OTHER PROVISIONS FROM TIME TO TIME ADOPTED BY THE BOARD RELATING TO MEMBERSHIP. SENIOR ACTIVE MEMBERS - ACTIVE MEMBERS THAT HAVE RETIRED FROM ACTIVE PRACTICE BUT EXPRESS A DESIRE TO CONTINUE TO PARTICIPATE IN THE OBJECTIVES OF THE ORGANIZATION. ASSOCIATE MEMBERS - TO QUALIFY AS AN ASSOCIATE MEMBER, AN APPLICANT MUST: BE ACTIVE IN THE PRACTICE OF MEDICINE, HAVE SERVED AS A MEMBER OF THE MEDICAL STAFF OF THE HOSPITAL FOR NOT LESS THAN TWO YEARS, HAVE DEMONSTRATED INTEREST IN AND ADHERENCE TO THE OBJECTIVES OF THE ORGANIZATION, AND BE IN COMPLIANCE WITH ALL OTHER PROVISIONS FROM TIME TO TIME ADOPTED BY THE BOARD RELATING TO MEMBERSHIP. COMMUNITY MEMBERS - A COMMUNITY MEMBER MUST BE A CITIZEN OF THE UNITED STATES OF NOT LESS THAN 21 YEARS OF AGE AND A PERMANENT RESIDENT OF MONTGOMERY COUNTY, ALABAMA, OR ANY OTHER COUNTY WITHIN THE STATE WHICH IS WITHIN THE SERVICE AREA OF THE HOSPITAL AND SHALL POSSESS SUCH ADDITIONAL QUALIFICATIONS AS SHALL BE SET FORTH FROM TIME TO TIME BY THE BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 7A | ACTIVE MEMBERS HAVE THE EXCLUSIVE RIGHT TO VOTE ON THE APPROVAL OF THE ADMISSION OF ANY PERSON AS AN ACTIVE OR ASSOCIATE MEMBER OF THE NON-PROFIT CORPORATION. COMMUNITY MEMBERS ARE PERMITTED TO PARTICIPATE IN THE ELECTION OF THE MEMBERS OF THE BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL VOTING RIGHTS OF MEMBERS ACCRUING TO MEMBERS GENERALLY, UNDER THE ALABAMA NONPROFIT CORPORATION ACT OR UNDER THE RESTATED ARTICLES OF INCORPORATION, ARE RESERVED TO THE ACTIVE MEMBERS, EXCEPT FOR THE PARTICIPATION OF COMMUNITY MEMBERS IN THE ELECTION OF MEMBERS OF THE BOARD OF TRUSTEES AND EXCEPT IN THOSE INSTANCES WHERE THE BOARD OF TRUSTEES, IN ITS DISCRETION, DESIRES TO REFER A PARTICULAR MATTER TO THE MEMBERSHIP AS A WHOLE OR TO ANY RESTRICTED CLASS OR CLASSES FOR CONSIDERATION AND ADVICE AS PROVIDED HEREIN, PROVIDED, HOWEVER, THAT NO CLASS OF MEMBERS OTHER THAN ACTIVE MEMBERS SHALL, BY SUCH PROCEDURE, BE GIVEN THE RIGHT TO VOTE ON ANY MATTER REQUIRING THE VOTE OR APPROVAL OF MEMBERS GENERALLY UNDER THE ALABAMA NONPROFIT CORPORATION ACT OR THE VOTE OF ACTIVE MEMBERS UNDER THE RESTATED ARTICLES OF INCORPORATION. THE MATTERS UPON WHICH THE ACTIVE MEMBERS SHALL HAVE THE EXCLUSIVE RIGHT TO VOTE ARE THOSE MATTERS GENERALLY RESERVED TO MEMBERS IN THE ALABAMA NONPROFIT CORPORATION ACT AS IT MAY EXIST FROM TIME TO TIME, INCLUDING, WITHOUT LIMITATION, THE FOLLOWING: - THE LIQUIDATION, DISSOLUTION, OR REORGANIZATION OF THE CORPORATION, - THE SALE, EXCHANGE, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTIES OF THE CORPORATION, BUT NOT THE POWER TO MORTGAGE OR CONVEY SUCH PROPERTY SOLELY FOR THE PURPOSE OF SECURING ANY INDEBTEDNESS OR OTHER OBLIGATIONS OF THE CORPORATION, WHICH THE BOARD OF TRUSTEES, ACTING ALONE, SHALL HAVE AND EXERCISE, - THE APPROVAL OF THE AMENDMENT OF THE RESTATED ARTICLES OF INCORPORATION, - THE APPROVAL OF THE ADMISSION OF ANY PERSON AS AN ACTIVE OR ASSOCIATE MEMBER OF THE CORPORATION. SUCH MATTERS SHALL BE SUBMITTED FOR VOTE OF THE ACTIVE MEMBERS UPON RECOMMENDATION OF THE BOARD OF TRUSTEES. NO ACTION UPON ANY SUCH MATTERS SHALL BE TAKEN BY THE ACTIVE MEMBERS (OR ANY OTHER MEMBER ENTITLED TO VOTE) WITHOUT NOTICE OF SUCH PURPOSE BEING GIVEN PRIOR TO THE MEETING, OTHER THAN THE ELECTION OF THE BOARD OF TRUSTEES WHICH SHALL OCCUR AT EACH ANNUAL MEETING WITHOUT REQUIREMENT OF FURTHER NOTICE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY HOSPITAL MANAGEMENT. THE RETURN IS PROVIDED TO THE BOARD FOR REVIEW AND IS AN AGENDA ITEM AT A REGULARLY SCHEDULED BOARD MEETING AND OPEN FOR DISCUSSION PRIOR TO FILING WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION UPDATES ITS CONFLICT OF INTEREST POLICY ANNUALLY FOR KEY HOSPITAL EMPLOYEES AND BOARD MEMBERS TO PROVIDE INFORMATION ON ANY POTENTIAL CONFLICTS OF INTEREST. THE UPDATES OF THE POLICY FORMS ARE REVIEWED BY HOSPITAL ADMINISTRATION. IN THE EVENT OF A POTENTIAL CONFLICT OF INTEREST, A BOARD MEMBER WILL ABSTAIN FROM VOTING ON MATTERS PERTAINING TO THE CONFLICT. | |
| FORM 990, PART VI, SECTION B, LINE 15 | AN OUTSIDE INDEPENDENT CONSULTING FIRM REVIEWS THE COMPENSATION OF THE PRESIDENT/CEO AND VICE PRESIDENT POSITIONS EVERY TWO YEARS TO ENSURE COMPENSATION IS COMPARABLE TO THAT OF SIMILAR ORGANIZATIONS. THE BOARD EXECUTIVE COMMITTEE REVIEWS THE CONSULTANT'S RECOMMENDATIONS AND APPROVES THE COMPENSATION AND ANY CHANGES TO THE COMPENSATION FOR HOSPITAL OFFICERS. THE EXECUTIVE COMMITTEE IS COMPOSED OF INDEPENDENT PERSONS FROM THE BOARD OF TRUSTEES, INCLUDING THE BOARD CHAIRMAN, VICE CHAIRMAN, SECRETARY, AND TWO OTHER BOARD MEMBERS. THE COMMITTEE DETERMINES COMPENSATION BASED ON BENCHMARKS SET BY THE COMMITTEE AND COMPARED TO DATA PROVIDED BY THE CONSULTANT. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PLEASE SEE PART VI, LINE 20. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PLEASE SEE PART VI, LINE 20. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | BOOK TO TAX DIFFERENCE ON JOINT VENTURE -126,045. UNFUNDED PENSION LOSS -853,857. TOTAL TO FORM 990, PART XI, LINE 5: -979,902. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OAK PARK HIGHLAND LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 PINE STREET | AddressLine1 |
| City | MONTGOMERY | City |
| State | AL | State |
| ZIP Code | 36106 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 260752650 | EIN |
| Primary Activities | REAL ESTATE | PrimaryActivities |
| Legal Domicile State | AL | LegalDomicileState |
| Total Income | 0 | TotalIncome |
| EOY Assets | 203512 | EOYAssets |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JACKSON IMAGING CENTER LLC | |||||||||||||
| 1825 PARK PLACE | MONTGOMERY | AL | 36106 | 260339264 | MEDICAL IMAGING | AL | N/A | RELATED | 799627 | 4961111 | 0 | 0 | 0.67000 |
| JACKSON SURGERY CENTER LLC | |||||||||||||
| 1725 PARK PLACE | MONTGOMERY | AL | 36106 | 204173305 | OUTPATIENT SURGERY | AL | N/A | RELATED | 1235648 | 7710866 | 0 | 0 | 0.51750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| JACKSON IMAGING CENTER LLC | ||
| R | 335000 | CASH |
| JACKSON SURGERY CENTER LLC | ||
| R | 1284000 | CASH |
| JACKSON IMAGING CENTER LLC | ||
| A | 47102 | CASH |
| JACKSON SURGERY CENTER LLC | ||
| A | 97960 | CASH |
Comments