2011-10-17T11:34:48-05:00 2010-12-31 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-01-01 636001820 JACKSON HOSPITAL AND CLINIC INC JACK 3342938000 1725 PINE STREET NO 1200 MONTGOMERY AL 361061117 DONALD HENDERSON 3342938000 2011-10-18 AMY BIBBY 8282542254 2010 2016-03-07 17:11:31Z DONALD HENDERSON 1725 PINE STREET NO 1200 MONTGOMERY AL 361061117 181771632 0 X WWW.JACKSON.ORG X 1946 AL COMMUNITY NOT-FOR-PROFIT 344 BED HOSPITAL SERVING MONTGOMERY AND ALABAMA RIVER REGION 11 9 1739 106 204947 164925 12050 65778 148530408 171671051 2143217 5360390 -936681 4674413 149748994 181771632 81528 74125 0 0 56731713 67597583 0 0 477630 89679114 102072211 146492355 169743919 3256639 12027713 217788957 226168830 131566614 128898676 86222343 97270154 X TO PROVIDE SUPERIOR HEALTHCARE IN A SAFE, COMPASSIONATE ENVIRONMENT WHILE FULFILLING OUR CHARITABLE OBLIGATION AS A NOT-FOR-PROFIT ORGANIZATION. 0 0 142163054 74125 171974024 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. PLEASE SEE SCHEDULE O FOR DETAILS ON SOME OF OUR COMMUNITY HEALTH PROGRAMS AND SERVICES. 142163054 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 46 0 1 1739 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X PETER C VERRECCHIA 3342938820 1725 PINE STREET SUITE 1200 MONTGOMERY AL 36106 JIM L RIDLING 1.00 X X 0 0 0 WILBUR HUFHAM 1.00 X X 0 0 0 WILLIAM M JORDAN MD 1.00 X X 0 0 0 ROGER S DUGGAR MD 1.00 X 0 0 0 E KYLE KYSER 1.00 X 0 0 0 CHARLOTTE MUSSAFER 1.00 X 0 0 0 JAMES T MCLAUGHLIN MD 1.00 X 0 0 0 GEORGE M HANDEY MD 1.00 X 0 0 0 KEITH KARST 1.00 X 0 0 0 W KEN UPCHURCH III 1.00 X 0 0 0 JOHN A WILLIAMS MD 1.00 X 0 0 0 DONALD HENDERSON 40.00 X 548826 0 15499 PETER VERRECCHIA 40.00 X 253882 0 4502 VICTORIA JONES 40.00 X 237319 0 63067 RICHARD CALDWELL 40.00 X 282882 0 8412 LARRY SHERBETT 40.00 X 183880 0 5899 CYNTHIA DIXON 40.00 X 178374 0 10238 JANET MCQUEEN 40.00 X 154215 0 5348 SHELLY HENRIKSON 40.00 X 124467 0 929 CYNTHIA WALKER 40.00 X 125349 0 1692 MARGARET VEREB MD 40.00 X 371771 0 14440 JAMES MRACEK MD 40.00 X 349622 0 8186 ROBERT HARRIS MD 40.00 X 287345 0 9972 DONALD MARSHALL MD 40.00 X 202014 0 65949 WILLIAM D JONES MD 40.00 X 181722 0 9976 EDWARD SCHOLL 40.00 X 158803 0 3841 3390655 0 225329 44 1 1 0 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 27 65778 65778 NET PATIENT SERVICE 621400 169601246 169533143 68103 SURGERY CENTER REVENUE 621400 1184476 1184476 IMAGING CENTER REVENUE 621400 867971 867971 ANCILLIARY SERVICES 900099 17358 17358 171671051 5360390 5360390 2560153 2560153 2560153 CAFETERIA 722210 1332336 1332336 JOINT VENTURE 900099 507920 371076 136844 COFFEE SHOP 722210 87421 87421 186583 186583 2114260 181771632 171974024 204947 9526883 74125 74125 2101721 2101721 54369068 43670799 10302714 395555 1645180 1321456 311755 11969 5499731 4417542 1042176 40013 3981883 3198363 754550 28970 78323 78323 270144 270144 17207788 14389609 2818179 417668 417668 6207816 3210885 2995999 932 3408401 3408401 3645656 3645656 277999 244556 33252 191 5215331 5215331 10933742 10933742 1588564 1588564 SUPPLIES 38316541 36114652 2201889 BAD DEBT EXPENSE 13956997 13956997 UBI TAXES 210256 210256 MISCELLANEOUS EXPENSE 181376 180777 599 RECRUITMENT 155609 155609 169743919 142163054 27103235 477630 5459721 7465172 7942472 7246887 28782115 24904068 536978 511142 4037286 3995157 1971241 2223512 243028837 132924308 116605835 110104529 44264004 64637011 3255322 8189305 1826030 217788957 226168830 11662287 13887276 106925000 104960000 12979327 10051400 131566614 128898676 X 86222343 97270154 86222343 97270154 217788957 226168830 X 12027713 -979902 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1644606 5851770 7496376 93263284 38301685 54961599 2432493 1884179 548314 138172538 92738444 45434094 1664146 1664146 110104529 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 3255322 OTHER RECEIVABLES 734944 BOND DISCOUNT AND ISSUANCE COSTS 1091086 1826030 ACCRUED INTEREST 1732985 PENSION LIABILITY 6048634 UNAMORTIZED BOND PREMIUM 2269781 10051400 181771632 169743919 12027713 -979902 -979902 11047811 178585468 -853857 -853857 179439325 2332307 2332307 181771632 167537657 -2206262 -2206262 169743919 0 169743919 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. 1 1 1 X 0 1 1 0 1 1 7975481 0 7975481 0.05120 19390284 21376039 -1985755 0.00000 27365765 21376039 5989726 0.05120 15107 1740 13367 0.00010 2224306 2224306 0.01430 43475 43475 0.00030 2282888 1740 2281148 0.01470 29648653 21377779 8270874 0.06590 0 2941295 62704875 54015020 8689855 X 1 1 1 JACKSON IMAGING CENTER LLC RADIOLOGY PROCEDURES 0.67000 0.33000 2 JACKSON SURGERY CENTER LLC OUTPATIENT SURGERY 0.51000 0.49000 1 1 JACKSON HOSPITAL AND CLINIC

1725 PINE STREET MONTGOMERY AL 361061117

X X X DISPROPORTIONATE SHARE HOSPITAL NA FOR 2010 1 3 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 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. REPORTS FILED WITH STATES PART VI, LINE 7 AL 1 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 2 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 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 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). THE MEDICAL CLINIC BOARD OF THE CITY OF MONTGOMERY 630881546 013058CG9 2006-12-05 113221823 REFUNDING, CAPITAL ACQUISITION 0 0 0 5615000 115784596 7170460 1260470 6203213 2007 0 1 1 1 1 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 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 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. 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