2021-08-10T08:33:17-05:00 2020-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2019-10-01 592425149 JAY HOSPITAL INC % KEITH STRICKLING JAYH 8504344714 POST OFFICE BOX 17500 PENSACOLA FL 32522 MICHAEL GLEASON SVP/CFO 8504697643 2021-08-16 true Michael J Engle P00482834 8162216300 2019 2022-09-23 18:48:47Z Michael T Hutchins 1717 N E ST STE 320 PENSACOLA FL 32501 11239372 false X www.ebaptisthealthcare.org/JayHospital X 1983 FL DEDICATED TO MEETING THE HEALTHCARE NEEDS IN THE JAY, CENTURY, FLOMATON AND SURROUNDING COMMUNITIES IN THE NORTHWEST FLORIDA-SOUTH ALABAMA AREA. 12 12 155 23 49828 7848 50000 5000 12122955 10927196 32096 353 436599 295583 12641650 11228132 13300 13158 0 0 7543923 7818126 0 0 0 9050794 7458766 16608017 15290050 -3966367 -4061918 4060215 3765804 1650879 4086238 2409336 -320434 X SEE SCHEDULE O false true 11501963 0 10877368 GENERAL AND SPECIALIZED HEALTH CARE SERVICES INCLUDING INPATIENT, PRIMARY CARE, LONG TERM AND OUTPATIENT HEALTHCARE SERVICES. 13158 13158 0 COMMUNITY BENEFIT OUTREACH ACTIVITIES CONDUCTED BY THE ORGANIZATION INCLUDING HEALTH EDUCATION SEMINARS, HEALTH FAIRS, AND DONATIONS TO OTHER NON-PROFIT ENTITIES. 11515121 true false false true false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true X 1 0 true 155 true true true false false false false false false false false false false false X 12 12 true false false false true true true true true false false true true true true true true true true false X KEITH STRICKLING 8506758024 14114 ALABAMA STREET Jay FL 32565 MICHAEL GLEASON SVP/CFO 5.0 45.0 X 0 608067 115764 BYRON SCOTT RAYNES PRESIDENT-JHI/EXEC VP-BHC 10.0 40.0 X 0 580549 127040 KARIN PARDUE PHYSICIAN 40.0 0.0 X 305375 0 27624 MICHAEL HUTCHINS VP/ADMINISTRATOR 40.0 0.0 X 228721 0 27506 DANIEL D SHEPPARD PHARMACIST 40.0 0.0 X 125097 0 28487 KEITH STRICKLING CONTROLLER 40.0 0.0 X 108956 0 28465 KATHRYN R HUNT PHYSICIAN 40.0 0.0 X 120325 0 0 PURUSHOTTAM GARG PHYSICIAN 40.0 0.0 X 108333 0 0 Ronald E Jackson MEMBER/CHAIRMAN 1.0 2.0 X X 0 0 0 KIM JERNIGAN DMD MEMBER 1.0 1.0 X 0 0 0 Ricky W Smith MEMBER/SECRETARY 1.0 1.0 X X 0 0 0 MICHAEL J MAZENKO MEMBER/TREASURER 1.0 1.0 X X 0 0 0 LUTHER TAYLOR ENDED 33120 MEMBER/VICE CHAIRMAN 1.0 2.0 X X 0 0 0 JOHN HEER MEMBER 1.0 2.0 X 0 0 0 ADM ROBERT KELLY MEMBER (ENDED 3/31/20) 1.0 1.0 X 0 0 0 JOHN M KIZZIAH MEMBER 1.0 1.0 X 0 0 0 THOMAS F OWENS MEMBER 1.0 1.0 X 0 0 0 DOUG SPRAGUE MEMBER 1.0 1.0 X 0 0 0 KARA CARDONA MEMBER/VICE CHAIR 1.0 1.0 X X 0 0 0 STEPHANIE WHITE MEMBER (ENDED 3/31/20) 1.0 1.0 X 0 0 0 DAVID HAWKINS MEMBER 1.0 1.0 X 0 0 0 SHIRLEY HENDERSON MEMBER 1.0 1.0 X 0 0 0 BRIAN WYER MEMBER (STARTED 4/1/21) 1.0 1.0 X 0 0 0 996807 1188616 354886 8 false true false Mark Elder DO 2946 GREYSTONE DR PACE FL 32571 Physician Services 206088 ALLIANCE HEALTHCARE SERVICES PO BOX 735714 DALLAS TX 75373 MEDICAL IMAGING 222474 2 5000 5000 NET PATIENT SERVICE REVENUE 621990 10599063 10549235 49828 COVID-19 RECOVERIES 621990 328133 328133 10927196 455 455 0 0 12575 11138 1437 0 1437 1437 0 102 -102 -102 -102 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722210 13001 13001 MEDICAL RECORDS 541900 3115 3115 MISCELLANEOUS REVENUE 900099 278030 278030 278030 278030 294146 11228132 10877368 49828 295936 13158 13158 0 0 0 251864 201491 50373 0 6313921 5752350 561571 164391 149102 15289 642705 582933 59772 445245 403834 41411 2360014 171575 2188439 5826 5826 0 0 0 0 1240271 910330 329941 578 578 217787 149270 68517 19649 19566 83 0 321396 292837 28559 27720 7031 20689 0 0 0 0 358651 304853 53798 223717 223717 BAD DEBT EXPENSE 1661881 1661881 MEDICAL SUPPLIES 680696 680696 INDIGENT ASSESSMENT 104609 104609 FOOD COSTS 90046 89037 1009 145925 19990 125935 15290050 11515121 3774929 0 114407 82746 0 0 0 0 1424045 1137374 0 0 0 0 0 0 151811 174055 48576 22725 13014396 10665492 2321376 2348904 0 0 0 0 0 0 0 0 0 0 4060215 3765804 798457 1087786 0 0 0 0 0 0 0 0 0 0 257462 257462 0 0 594960 2740990 1650879 4086238 X 2409336 -320434 0 0 2409336 -320434 4060215 3765804 X -4061918 1332148 X false true X true false X X 3301 190875 3301 190875 15286749 1060280694 15290050 1060471569 914503 1000000 228626 1318119 1000000 1000000 1000000 1000000 4000000 6000000 246919 249769 212140 190875 899703 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 62193 62193 1182808 176381 1006427 4591085 3770854 820231 7001929 6671183 330746 176381 47074 129307 2348904 0 DUE TO THIRD PARTIES 2349230 ASSET RETIREMENT OBLIGATION 140915 LEASE OBLIGATION 250845 2740990 X FORM 990, SCHEDULE D, PART XIII Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 740, Income Taxes, prescribes the accounting for uncertainty in income tax positions recognized in financial statements. 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X X X X X X true true X X X true X See Section C X See Section C X See Section C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 The CHNA process was facilitated by The Live Well Partnership (Live Well), a nonprofit organization whose mission is to sponsor community health status assessments for Escambia and Santa Rosa Counties in Florida and to support and promote collaborative initiatives that address identified health priorities. An effort was made to involve individuals from many different sectors of the local economy in developing this CHNA. The Live Well Board of Directors, which includes health providers, social service organizations and business interests formed the backbone of the CHNA process. A Steering Committee, consisting of the Live Well Board and other community organizations, was established to provide guidance and input throughout data gathering and analysis. The Steering Committee provided input on their perceptions of health and health services, reviewed health outcomes, narrowed the focus to the top four priorities in each county, and approved this report. Below is a roster of both the CHNA Planning Committee and CHNA Steering Committee. CHNA Planning Committee - responsible for planning, data collection/analysis, communication and report writing . Brett Aldridge, Baptist Health Care . Myesha Arrington, Community Health Northwest Florida . Amy Barron, Sacred Heart Health System . Nora Bailey, Live Well Partnership . Paula Bides, Ascension Florida . John Clark, Council on Aging . Carter Craddock, Baptist Health Care . Denice Curtis, University of West Florida, College of Health . Matt Dobson, Florida Department of Health - Santa Rosa . Krystle Fernandez, Baptist Health Care . John Hartman, University of West Florida, College of Health . Michelle Hill, Florida Department of Health - Santa Rosa . Bethany Miller, Sacred Heart Health System . Kimberly Pace, Florida Department of Health - Escambia . Ann Papadelias - Community Health Northwest Florida . Sandra Park-O'Hara, Florida Department of Health - Santa Rosa . Patrick Shehee - Florida Department of Health - Escambia . Chandra Smiley, Community Health Northwest Florida . Daudet Tshiswaka, University of West Florida, College of Health . Versilla Turner, Florida Department of Health - Escambia . Debra Vinci, University of West Florida, College of Health CHNA Steering Committee - responsible for guiding the CHNA process, reviewing data, providing feedback and setting priorities . Achieve Escambia . Ascension Florida . Baptist Health Care . Baptist Hospital . Children's Home Society of Florida . Community Health Northwest Florida . Community Drug & Alcohol Council . Council on Aging of Northwest Florida . Covenant Care . Emerald Coast Utility Authority . Escambia County School District . Ever'man Cooperative Grocery & Caf . Feeding the Gulf Coast . FL Department of Children & Families . FL Dept of Health - Escambia . FL Dept of Health - Santa Rosa . Good Samaritan Clinic . Gulf Breeze Hospital . Gulf Coast African American Chamber . Health & Hope Clinic . Jay Hospital . J L Maygarden Company . Lakeview Center . Live Well Partnership . Manna Food Pantries . Open Doors NW FL . Pensacola Bay Baptist Association . Pensacola News Journal . Sacred Heart Health System . Santa Rosa County . Santa Rosa County School District . Santa Rosa Medical Center . Town of Century . United Way of Escambia . University of West Florida . Walmart . Waterfront Mission . YMCA of Northwest Florida SCHEDULE H, Part V, Section B, Line 6a The CHNA process was facilitated by The Live Well Partnership (Live Well), a nonprofit organization whose mission is to sponsor community health status assessments for Escambia and Santa Rosa Counties in Florida and to support and promote collaborative initiatives that address identified health priorities. The CHNA Planning Committee and Steering Committee included representation from Baptist Health Care and its affiliates (including both Baptist and Gulf Breeze Hospital), Ascension Sacred Heart and Santa Rosa Medical Center. SCHEDULE H, Part V, Section B, Line 6b Non-hospital stakeholder members of the CHNA Planning Committee and Steering Committee included representatives from the Florida Departments of Health in Escambia and Santa Rosa Counties, Community Health Northwest Florida (a federally qualified health center), the University of West Florida as well as a variety of community organizations including business, social service organizations, school districts, local utility companies, county government, to name a few. SCHEDULE H, Part V, Section B, Line 11 Baptist Health Care recognized that sustained community health improvement happens when organizations from all sectors of the community landscape take ownership of the community's health and work together for improvement. While health providers can lead the charge, all sectors of the community must be engaged and committed to alignment of resources across sectors to better serve families. Following the completion of the 2019 CHNA, Baptist worked with other community partners who had together formed the Live Well Partnership for Healthy Communities to begin working toward an expanded, more comprehensive model for approaching health and wellness in the community. There are two parts in this enhanced collaborative approach: 1. Expansion of the former approach to a true cross-sector collective impact effort that engages others outside of the traditional health provider partners. Health partner meetings led to a convening of cross- sector community leaders to determine if there was an interest among other sectors to engage in this work. With over 75 thought leaders from the community in attendance at a convening in April of 2019, the response was overwhelmingly positive for moving forward with this new approach to health and wellness in the community. Learning from the efforts of Achieve Escambia, a collective impact effort focused on educational outcomes, the group began the process to launch Achieve Healthy EscaRosa, with a purpose of working together to improve the health and well-being of Escambia and Santa Rosa counties so that all can thrive. The Mission of this new organization is to unite and align resources to achieve a healthy community where all can thrive. The Vision is a community where everyone lives well and thrives. 2. Convening community partners in focus groups for each prioritized areas of focus from the 2019 CHNA. The health departments have led the charge on the implementation of these sessions with the purpose of gaining additional insights from partners and developing strategic goals and objectives to truly "move the needle" toward improvement in these areas of focus. In late 2019, in light of additional insights from the community, to be more aligned with the Florida Community Health Improvement Plan (CHIP), and to be more effective with community health improvement efforts, the partners determined it was imperative to align the prioritized areas of focus across counties. Therefore, the updated, aligned prioritized focus areas are: Diabetes Mental health (including substance abuse as a component) Child health (including infant health as a component) Multiple focus group sessions for each of these focus areas were held in 2019 with hundreds of stakeholders attending the sessions. Feedback has been gathered to identify underlying causes, community concerns and promising practices that can be considered in Community Health Improvement Plans. Achieve Healthy EscaRosa creation hosted a community convening in February of 2020, during which hundreds of community members were introduced to the priority focus areas and other health metrics through a data walk. Participants were encouraged to engage in the effort. Input received at the convening was incorporated into a plan for the formal creation of Achieve Healthy EscaRosa (AHER.) AHER has now become the governing body for the implementation of community health improvement actions as well as future CHNAs in this community. With University of West Florida serving as the backbone convener and fiscal agent for AHER, nearly 60 partners in the community have begun engaging in the work of this collective impact effort. Baptist Health Care serves as a leader and convener of these efforts, and is actively engaged in multiple ways in this enhanced approached to health and wellness in the communities we serve. Jennifer Grove, VP External Relations of Baptist Health Care, serves as the Chair of Achieve Healthy EscaRosa, and various other team members participate in the Data, Communications, and CHNA Committees of AHER. SCHEDULE H, PART V, SECTION C, LINE 16A-C THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY CAN BE FOUND AT THE FOLLOWING WEB ADDRESS: https://www.ebaptisthealthcare.org/PatientFinancialResources 1 CENTURY MEDICAL CENTER 8401 N CENTURY BLVD CENTURY FL 32535 PRIMARY CARE PRACTICE SCHEDULE H , PART I, LINE 3C IN ADDITION TO THE FPG THE ORGANIZATION USES AN ASSET TEST, MEDICAL INDINGENCY, INSURANCE/UNDERINSURANCE STATUS, AND RESIDENCY IN DETERMINING FREE OR DISCOUNTED CARE. SCHEDULE H, PART I, LINE 7 The costing methodology used in determining the amount reported on Line 7 is the cost to charge ratio calculated pursuant to the IRS schedule H worksheet 2 instructions. SCHEDULE H, PART I, LINE 7, COLUMN (F) BAD DEBT EXPENSE IN THE AMOUNT OF $1,661,881 WAS SUBTRACTED FROM TOTAL EXPENSES PER FORM 990, PART IX, LINE 25 FOR PURPOSES OF CALCULATING THE PERCENTAGE FOR LINE 7, COLUMN (F). SCHEDULE H, PART III, LINE 2 AND 4 THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORT HAS BEEN FOLLOWED IN ACCORDANCE FOR UNCOLLECTIBLE PATIENT ACCOUNTS, AND SUBSEQUENT RECOVERIES ARE ADDED. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. THE HOSPITAL PROVIDES SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE, SUCH SERVICES ARE NOT REPORTED AS NET REVENUE. THE HOSPITAL'S CHARITY CARE POLICY UTILIZES THE GENERALLY RECOGNIZED FEDERAL POVERTY INCOME LEVELS. FOR PATIENTS WHO DO NOT APPLY OR DO NOT QUALIFY, THE UNCOLLECTED AMOUNTS ARE RECOGNIZED AS BAD DEBT EXPENSE. ESTIMATED COST OF BAD DEBT IS BASED ON THE RATIO OF COST TO CHARGES AS DETERMINED BY HOSPITAL SPECIFIC DATA. SCHEDULE H, PART III, LINE 3 BAD DEBT IS NOT INCLUDED AS PART OF JAY HOSPITAL'S COMMUNITY BENEFIT. APPROXIMATELY 26.6% OF JAY HOSPITAL'S PATIENTS QUALIFY FOR FREE OR DISCOUNTED CARE. THIS MEANS THAT APPROXIMATELY $442,060, OR 26.6%, OF JAY'S HOSPITAL'S BAD DEBT EXPENSE COULD BE INCLUDED AS COMMUNITY BENEFIT HAD THOSE INDIVIDUALS GONE THROUGH THE FINANCIAL ASSISTANCE PROCESS. SCHEDULE H, PART III, LINE 8 THE MEDICARE SHORTFALL WAS NOT INCLUDED IN THE COMMUNITY BENEFIT COST, AND THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE ENTIRE COST OF PROVIDING CARE TO MEDICARE PATIENTS CAUSING THE ORGANIZATION TO USE OTHER SURPLUS FUNDS TO COVER THE SHORTFALL. HOWEVER, THE ORGANIZATION PROVIDES CARE TO MEDICARE PATIENTS REGARDLESS OF THIS SHORTFALL, WHICH RELIEVES THE STATE AND FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR THE CARE OF MEDICARE BENEFICIARIES. SCHEDULE H, PART III, LINE 9B PATIENTS ARE DEEMED FINANCIALLY INDIGENT IF (A) THEY ARE UNINSURSED OR UNDERINSURED AND (B) THEIR INCOME IS BELOW 200% OF FPL (BASED UPON THE PATIENT'S HOUSEHOLD INCOME AS DEFINED ANNUALLY BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES IN THE FEDERAL REGISTER AS THE FEDERAL POVERTY LEVEL (FPL) GUIDELINES). IF A PATIENT IS FOUND TO BE FINANCIALLY INDIGENT OR MEDICALLY INDIGENT, APPROPRITE FINANCIAL ASSISTANCE DISCOUNTS ARE APPLIED TO THE PATIENT'S ACCOUNT. FOR ANY PATIENT THAT QUALIFIES UNDER THE ORGANIZATION'S CHARITY CARE POLICY, THE PATIENT ACCOUNT IS WRITTEN OFF AS CHARITY CARE AND THE ORGANIZATION DOES NOT PURSUE ANY COLLECTIONS. SCHEDULE H, PART VI, LINE 2 Part of the organization's mission is to improve the quality of life for people and communities served. In response to this mission, the organization helps ensure that all citizens are afforded access to health care by investing in community health, and by participating in and leading collaborative, community-wide partnerships. Free health screenings, support groups, education seminars, and other programs that are offered focus on areas that have been identified through internal studies and external sources as critical health concerns in the surrounding communities. A full copy of the hospital's Community Health Needs Assessment can be accessed using the following website: https://www.ebaptisthealthcare.org/community/CHNA SCHEDULE H, PART VI, LINE 3 JAY EMPLOYEES WORKING IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS AREAS HAVE BEEN TRAINED TO BE FULLY VERSED IN ALL FINANCIAL ASSISTANCE-RELATED POLICIES, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND BE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE REPRESENTATIVES. FOR NON-EMERGENCY PURPOSES, EVERY FILE FOR A PATIENT THAT HAS PRE-SCHEDULED AN OFFICE VISIT OR PROCEDURE IS REVIEWED BEFORE THE PATIENT ARRIVES AT THE HOSPITAL. A FINANCIAL COUNSELOR IS ASSIGNED TO THAT PATIENT IF IT IS DETERMINED THAT THE INDIVIDUAL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ETC. ALSO, WHEN A PATIENT RECEIVES A BILL, THE ORGANIZATION INCLUDES PAPERWORK EXPLAINING THAT FINANCIAL ASSISTANCE IS AVAILABLE. JAY HOSPITAL HAS POSTED MULTILINGUAL NOTICES OF FINANCIAL ASSISTANCE POLICIES IN THE EMERGENCY DEPARTMENT. SAID NOTICES HAVE BEEN PUBLISHED IN ENGLISH AND SPANISH, AND HAVE BEEN MADE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. JAY HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS FOR APPLYING FOR ASSISTANCE. ALSO, JAY HOSPITAL HAS POSTED A SUMMARY OF ITS CURRENT CHARITY CARE POLICY ON ITS INTERNET WEBSITE. SCHEDULE H, PART VI, LINE 4 JAY HOSPITAL, INC. OPERATES IN SANTA ROSA COUNTY, FLORIDA. APPROXIMATELY 184,000 INDIVIDUALS RESIDE IN THIS COUNTY, 9.8% OF WHICH LIVE BELOW POVERTY LEVEL. WHEN CONSIDERING THESE FACTORS, MORE THAN 18,000 RESIDENTS COULD BE ELIGIBLE TO QUALIFY FOR CHARITY CARE. APPROXIMATELY 26.6% OF JAY HOSPITAL'S PATIENTS DURING FY2020 WERE UNINSURED OR WERE MEDICAID RECIPIENTS. THREE HOSPITALS, INCLUDING JAY HOSPITAL, ARE LOCATED IN SANTA ROSA COUNTY. SCHEDULE H, PART VI, LINE 5 THE ORGANIZATION DOES NOT LIMIT MEDICAL STAFF PRIVILEGES TO THE ORGANIZATION'S EMPLOYED PHYSICIANS BUT EXTENDS THOSE PRIVILEGES TO QUALIFIED PHYSICIANS FOR MOST AREAS OF SERVICE. THE ORGANIZATION'S BOARD OF DIRECTORS PRIMARILY CONSISTS OF COMMUNITYLEADERS AND RESIDENTS WHO ARE INDEPENDENT OF THE ORGANIZATION. THE ORGANIZATION STRIVES TO EDUCATE ALL BOARD MEMBERS REGARDING THE HEALTH NEEDS OF THE COMMUNITY AND HOW THESE NEEDS RELATE TO THE ORGANIZATION'S MISSION AND VALUES. THE ORGANIZATION SEEKS TO STRATEGICALLY ALLOCATE AVAILABLE FUNDS TO BENEFIT THE SURROUNDING COMMUNITIES. FOCUS AREAS INCLUDE INCREASING THE TYPES OF CARE TO BE PROVIDED TO THE COMMUNITY, IMPROVING THE QUALITY OF PATIENT CARE, AND FURTHERING MEDICAL EDUCATION AND RESEARCH. SCHEDULE H, PART VI, LINE 6 ALTHOUGH THE ORGANIZATION MAY OPERATE IN DIFFERENT SERVICE AREAS WHEN COMPARED TO ITS AFFILIATES, ALL AFFILIATES WORK COLLABORATIVELY TO ENSURE THAT THE NEEDS OF THE COMMUNITIES ARE BEING ADDRESSED. THE ORGANIZATION PARTICIPATES IN MANY FREE HEALTH SCREENINGS, SUPPORT GROUPS, EDUCATION SEMINARS, AND HEALTH FAIRS THAT BENEFIT ALL COMMUNITIES WITHIN THE SYSTEM AND ARE NOT LIMITED TO THE COMMUNITIES IN WHICH THE ORGANIZATION OPERATES. AFFILIATED ENTITIES INCLUDE: - BAPTIST HEALTH CARE CORPORATION: PARENT ORGANIZATION PROVIDING STRATEGIC MANAGEMENT AND SUPPORT SERVICES - BAPTIST HOSPITAL, INC.: OPERATES BAPTIST HOSPITAL AND GULF BREEZE HOSPITALS - BAPTIST HEALTH CARE FOUNDATION, INC.: PROVIDES FINANCIAL AND FUNDRAISING ASSISTANCE FOR ALL AFFILIATES - LAKEVIEW CENTER, INC. AND AFFILIATES: PROVIDE BEHAVIORAL HEALTH AND PROTECTIVE SERVICES, LOW-COST HOUSING, AS WELL AS VOCATIONAL SERVICES AND EMPLOYMENT FOR PEOPLE WITH DISABILITIES. - BAPTIST URGENT CARE, LLC.:DELIVER AMBULATORY ARE IN A DEDICATED MEDICAL FACILITY OUTSIDE OF A TRADITIONAL EMERGENCY ROOM. true Santa Rosa Community Clinic 5520 Stewart Street Milton FL 32570 311746599 501(c)(3) 11458 Healthcare 1 0 Schedule I, Part I, Line 2 Within one year, the organization requests documentation from the recipient regarding proper use of funds provided for indigent patients. X true true X X X X X false true false false false false false false false MICHAEL HUTCHINS VP/ADMINISTRATOR 173510 0 13713 0 41498 0 11141 0 16365 0 256227 0 0 MICHAEL GLEASON SVP/CFO 0 568394 0 0 0 39673 0 94762 0 21002 0 723831 0 DANIEL D SHEPPARD PHARMACIST 124707 0 0 0 390 0 1597 0 26890 0 153584 0 0 KARIN PARDUE PHYSICIAN 287947 0 17290 0 138 0 0 0 27624 0 332999 0 0 BYRON SCOTT RAYNES PRESIDENT-JHI/EXEC VP-BHC 0 558554 0 0 0 21995 0 93691 0 33349 0 707589 0 SCHEDULE J, PART I, LINE 1A THE FOLLOWING OFFICERS/KEY EMPLOYEES RECEIVED TAX GROSS-UP PAYMENTS THAT WERE INCLUDED IN THEIR W-2 TAXABLE WAGES: --MICHAEL HUTCHINS SCHEDULE J, PART I, LINE 4B CONTRIBUTIONS ----------- MICHAEL GLEASON $87,762 MICHAEL HUTCHINS $5,877 BYRON (SCOTT) RAYNES $83,848 SCHEDULE J, PART II THE RELATED COMPENSATION REPORTED ON FORM 990, PART VII, SECTION A & SCHEDULE J, PART II WAS PAID BY THE FOLLOWING RELATED ORGANIZATIONS: --BAPTIST HEALTH CARE CORPORATION --BAPTIST HOSPITAL FORM 990, PART III, LINE 1 HELPING PEOPLE THROUGHOUT LIFE'S JOURNEY: JAY HOSPITAL'S PRIMARY MISSION IS DEDICATED TO MEETING THE HEALTHCARE NEEDS IN THE JAY, CENTURY, FLOMATON, AND SURROUNDING COMMUNITIES IN THE NORTHWEST FLORIDA-SOUTH ALABAMA AREA. JAY HOSPITAL IS A 49-BED ACUTE FACILITY AND PART OF AN INTEGRATED NETWORK OF AFFILIATED ORGANIZATIONS. JAY HOSPITAL AND ITS AFFILIATED ORGANIZATIONS ARE COMMITTED TO PROVIDING A BROAD RANGE OF GENERAL AND SPECIALIZED HEALTH CARE SERVICES INCLUDING INPATIENT, PRIMARY CARE, LONG TERM AND OUTPATIENT HEALTHCARE SERVICES. QUALITY MEDICAL CARE IS PROVIDED TO ALL PERSONS REQUIRING IMMEDIATE TREATMENT REGARDLESS OF THEIR ABILITY TO PAY. FORM 990, PART III, LINE 3 Like other healthcare providers, jAY Hospital experienced significant operational changes due to the COVID-19 pandemic. This included the mandatory suspension of elective procedures from March 2020 to May 2020, extreme increases in the cost of personal protective equipment, temporary alterations to facilities, staffing challenges, the rapid implementation of telehealth and staff telecommuting, and changes in safety protocols to protect patients, the staff and the community. During the pandemic, our organization followed the emerging and rapidly changing guidance of the CDC and other health experts to serve the needs of COVID-19 patients through inpatient care, outpatient care, telehealth, and COVID-19 testing and vaccine clinics. FORM 990, PART V, LINE 1A MOST 1099'S ARE ISSUED ON THE ORGANIZATION'S BEHALF BY BAPTIST HOSPITAL INC. (EIN: 59-0657322), A RELATED TAX EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 MICHAEL GLEASON AND BRYON (SCOTT) RAYNES HAVE A BUSINESS RELATIONSHIP. ALL RELATIONSHIPS ARE EMPLOYER/EMPLOYEE RELATIONSHIPS AT RELATED TAX EXEMPT ORGANIZATIONS. RONALD E. JACKSON AND LUTHER TAYLOR HAVE A BUSINESS RELATIONSHIP WITH MICHAEL GLEASON. RONALD E. JACKSON AND LUTHER TAYLOR ARE BOARD MEMBERS OF BAPTIST HEALTH CARE CORPORATION AND MICHAEL GLEASON IS AN OFFICER OF BAPTIST HEALTH CARE CORPORATION, CREATING AN EMPLOYER/EMPLOYEE RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 BAPTIST HEALTH CARE CORPORATION, A FLORIDA CORPORATION NOT-FOR-PROFIT, IS THE SOLE MEMBER OF JAY HOSPITAL,INC. BAPTIST HEALTH CARE CORPORATION HAS THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF JAY HOSPITAL,INC. FORM 990, PART VI, SECTION A, LINE 7A BAPTIST HEALTH CARE CORPORATION, BEING THE SOLE MEMBER OF JAY HOSPITAL, INC. HAS THE RIGHT TO ELECT THE GOVERNING BODY OF JAY HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING SHALL REQUIRE APPROVAL BY THE BAPTIST HEALTH CARE CORPORATION, THE SOLE MEMBER, BOARD OF DIRECTORS: A. ELECTION OF THE DIRECTORS OF THE CORPORATION AT THE ANNUAL MEETING OF THE MEMBERS FROM AMONG THOSE PERSONS NOMINATED BY THE BAPTIST HEALTH CARE CORPORATION NOMINATING COMMITTEE. B. REMOVAL OF A DIRECTOR OF THE CORPORATION WITH OR WITHOUT CAUSE WHENEVER SUCH ACTION WOULD BE IN THE BEST INTEREST OF THE CORPORATION C. ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE. D. APPOINTMENT OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION E. ANY CONTRACT OR PURCHASE ORDER IN EXCESS OF $1,000,000 IN ADVANCE F. THE INCURRENCE BY THE CORPORATION OF ANY INDEBTEDNESS IN EXCESS OF $1,000,000 BEFORE SUCH INDEBTEDNESS IS CONTRACTED AND BEFORE EVIDENCE OF SUCH INDEBTEDNESS IS ISSUED G. ANNUAL CAPITAL AND OPERATING BUDGETS OF THE CORPORATION H. TRANSFER ASSETS BY THE CORPORATION DURING ANY FISCAL YEAR OF ASSETS EXCEEDING $100,000 IN NET VALUE FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY A FLORIDA LICENSED CPA WHO IS AN EMPLOYEE OF A RELATED TAX-EXEMPT ORGANIZATION, BAPTIST HEALTH CARE, INC., AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM.THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S MANAGEMENT PERSONNEL HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN MADE AVAILABLE TO THE EXECUTIVE COMPENSATION COMMITTEE AND ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990 WITH THE IRS. ALL BOARD MEMBERS ARE INFORMED THAT A PAPER COPY OF THE FORM 990 IS AVAILABLE AT THE ORGANIZATION'S PRINCIPAL OFFICE. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND OFFICERS RECEIVE CORRESPONDENCE EACH YEAR THAT MUST BE COMPLETED AND SIGNED. THE CORRESPONDENCE INCLUDES A CONFLICTS OF INTEREST QUESTIONAIRE. OFFICERS AND KEY STAFF ALSO RECEIVE AN ATTESTATION FORM THAT MUST BE SIGNED CONFIRMING THAT THEY WILL DISCLOSE ANY CONFLICTS THAT VIOLATE THE ORGANIZATION'S POLICY. THE BOARD REVIEWS ALL CONFLICTS AND DETERMINES IF FURTHER ACTIONS NEED TO BE TAKEN. FORM 990, PART VI, SECTION B, LINES 15A & B EACH YEAR, THE COMPENSATION COMMITTEE OF THE BAPTIST HEALTH CARE CORPORATION BOARD UTILIZES INDEPENDENT COMPENSATION STUDIES THAT REFLECT THE CURRENT MARKET VALUE OF SPECIFIC KEY MANAGEMENT POSITIONS AS BENCHMARK DATA. ALL COMPENSATION OF KEY INDIVIDUALS MUST BE APPROVED BY THE BAPTIST HEALTH CARE COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS ALL GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND THE ANNUAL FINANCIAL STATEMENTS ON FILE IN THE ACCOUNTING AND ADMINISTRATION DEPARTMENTS. ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING BOARD MEMBERS CHANGED THEIR POSITION WITHIN THE BOARD DURING THE TAX YEAR AS A RESULT OF THE TIMING OF BOARD MEMBER ELECTIONS: 10/01/19 - 03/31/20 04/01/20 - 09/30/20 LUTHER TAYLOR VICE CHAIR (TERM ENDED 3/31/20) KARA CARDONA MEMBER VICE CHAIR FORM 990, PART XI, LINE 9 EQUITY TRANSFER $1,332,148 BAPTIST HEALTH CARE CORPORATION 1717 N E STREET PENSACOLA FL 32501 592425151 HEALTHCARE FL 501(c)(3) 12c NA false BAPTIST HEALTH CARE FOUNDATION 1717 N E STREET PENSACOLA FL 32501 590192265 FUNDRAISING FL 501(c)(3) 7 BHC true BAPTIST HOSPITAL INC 1000 WEST MORENO STREET PENSACOLA FL 32501 590657322 HEALTHCARE FL 501(c)(3) 3 BHC true CMHC HERNANDEZ HOUSE INC 1221 WEST LAKEVIEW AVE PENSACOLA FL 32501 592041794 LOW COST HOUS FL 501(c)(3) 10 LCI true LAKEVIEW CENTER INC 1221 WEST LAKEVIEW AVENUE PENSACOLA FL 32501 590737872 HEALTHCARE FL 501(c)(3) 7 BHC true LAKEVIEW PLACE INC 1221 WEST LAKEVIEW AVE PENSACOLA FL 32501 592804577 LOW COST HOUS FL 501(c)(3) 10 LCI true LAKEVIEW VILLA INC 1221 WEST LAKEVIEW AVE PENSACOLA FL 32501 592842486 LOW COST HOUS FL 501(c)(3) 10 LCI true GLOBAL CONNECTIONS TO EMPLOYMENT INC 1221 WEST LAKEVIEW AVE PENSACOLA FL 32501 472592811 VOC TRAINING FL 501(C)(3) 7 LCI true CHAUTAUQUA OFFICES OF PSYCHOTHERAPY AND 1221 WEST LAKEVIEW AVE PENSACOLA FL 32501 591469145 COUNSELING FL 501(C)(3) 7 LCI true BAPTIST MEDICAL PARK SURGERY CENTER LLC 9400 UNIVERSITY PKWY PENSACOLA FL 32514 593535262 AMBULATORY SURGER FL NA N/A ANDREWS INSTITUTE ASC LLC 1040 GULF BREEZE PKWY GULF BREEZE FL 32561 352274952 AMBULATORY SURGER FL NA N/A LIGHTHOUSE HEALTH PLAN LLC 1717 NORTH E STREET STE 320 PENSACOLA FL 32501 823182832 HEALTH INS. 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