2021-05-14T06:06:57-05:00 2020-06-30 BKD LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2019-07-01 710329353 Jefferson Hospital Association Inc % JEREMY JEFFERY JEFF 8705417100 1600 West 40th Avenue Pine Bluff AR 71603 JEREMY JEFFERY VP AND CFO 8705417100 2021-05-17 true Jeanette Verrelli P00742631 9727028262 2019 2022-09-23 18:48:47Z Jefferson Regional Medical Center BRIAN THOMAS 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 260708030 false X WWW.JRMC.ORG X 1959 AR JEFFERSON HOSPITAL ASSOCIATION,INC. PROVIDES A WIDE RANGE OF HEALTH CARE SERVICES TO PATIENTS FROM JEFFERSON COUNTY AND SURROUNDING AREAS IN SOUTHEAST ARKANSAS. 13 9 2163 50 5114 0 743630 14183715 185767717 187326944 5028866 6530323 2905632 2573578 194445845 210614560 507450 2308739 0 0 98497640 100531409 0 0 0 102608231 118217038 201613321 221057186 -7167476 -10442626 270623412 293824793 67419473 101844850 203203939 191979943 X JEFFERSON REGIONAL'S MISSION IS IMPROVING HEALTH THROUGH EXCELLENCE & COMPASSION WITH A VISION TO BE THE HEALTHCARE PROVIDER AND EMPLOYER OF CHOICE FOR SOUTHEAST ARKANSAS. false false 192669641 2308739 188894277 Jefferson Regional opened its doors in 1908 as Davis Hospital, with a mission to meet the healthcare needs of Pine Bluff and Southeast Arkansas. More than 100 years later, that mission is unchanged. As Jefferson Countys only general acute care hospital, Jefferson Regional is licensed for 300 acute care beds (currently operates an available 276 beds) and participates in Medicaid/Arkansas Works, Medicare, Champus, Tricare, Tricare East and/or other government-sponsored healthcare programs. SEE SCH O FOR MORE INFORMATION. 192669641 true true false true false false false false false false true false false false true false false true false false false false false false false false true true true true true false false false false false false true true false false false false true true true true false false true 232 0 2163 true true true false false false false false false false false false false false X 13 9 true false false false true true false true true false false true true true true true true true true true true CA IL NC X JEREMY JEFFERY 8705417100 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 X J ACOSTA - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 F ANTHONY - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 D ATKINSON - SEE SCH O SECRETARY 1.0 0.0 X X 0 0 0 D BRIDGFORTH - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 D BROWN - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 JA CAMPBELL - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 M CASTEEL - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 M ECKERT - SEE SCH O DIRECTOR 40.0 0.0 X 0 0 0 A KLINE - SEE SCH O chairman 1.0 0.0 X X 0 0 0 JB MAYS - SEE SCH O DIRECTOR 40.0 0.0 X 0 0 0 S PITTILLO - SEE SCH O VICE CHAIRMAN 1.0 0.0 X X 0 0 0 A SANDERS - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 H TROTTER III - SEE SCH O DIRECTOR/TREASURER 1.0 0.0 X X 0 0 0 P AUSTIN - SEE SCH O VP & COO 40.0 0.0 X 0 0 0 L HICKMAN - SEE SCH O VP & CNO 40.0 0.0 X 0 0 0 B JACKSON - SEE SCH O VP & CAO 40.0 2.0 X 0 0 0 B THOMAS - SEE SCH O PRESIDENT & CEO 40.0 2.0 X 0 0 0 J JEFFERY - SEE SCH O VP & CFO 40.0 0.0 X 0 0 0 T HARBUCK - SEE SCH O FORMER EXECUTIVE VP 0.0 0.0 X X 0 0 0 W JOHNSON - SEE SCH O FORMER DIR/PRES & CEO 0.0 0.0 X X 0 0 0 M ALI - SEE SCH O PHYSICIAN 40.0 0.0 X 0 0 0 G BIRK - SEE SCH O PHYSICIAN 40.0 0.0 X 0 0 0 R BURRELL - SEE SCH O PHYSICIAN 40.0 0.0 X 0 0 0 K MOHAMMAD - SEE SCH O PHYSICIAN 40.0 0.0 X 0 0 0 A POLLARD - SEE SCH O PHYSICIAN 40.0 0.0 X 0 0 0 0 0 0 129 true true false REHAB CARE GROUP INC PO Box 502096 ST LOUIS MO 631502096 THERAPY & REHAB SVCS 3519973 CERNER HEALTH SVC INC PO BOX 959156 ST LOUIS MO 631959156 IT SUPPORT 2945956 SODEXO INC AFFILIATES PO BOX 536922 ATLANTA GA 303536922 FOOD SERVICES 2607603 SOUTHEAST ARKANSAS HOSPITALISTS LLP PO BOX 677979 DALLAS TX 752677979 PROFESSIONAL SERVICE 2121000 ALLSCRIPTS HEALTHCARE 24630 NETWORK PLACE CHICAGO IL 606731246 IT SUPPORT 1647491 90 13161266 1022449 14183715 Patient Service Revenue 621110 170893316 170893316 EHR Incentive 900099 2400 2400 Joint Venture Income 621500 969204 966490 2714 Medical Office Rental 531120 1101048 1101048 Pharmacy Revenue 446110 14360976 14360976 187326944 6530323 6530323 0 0 38418 2400 38418 2400 40818 2400 38418 50080941 50080941 0 0 0 0 0 0 0 317434 12529 304905 304905 Outside/Pathology Lab 900099 13018 13018 Cafeteria 722320 967827 967827 Wellness Center 713490 428002 428002 819008 819008 2227855 210614560 188889163 5114 7536568 X 87561 87561 2221178 2221178 0 0 2890092 634106 2255986 495657 97987 397670 81641003 72942500 8698503 2050542 1777131 273411 7215281 6409755 805526 6238834 5410504 828330 4803202 4258910 544292 250418 16118 234300 262453 262453 33816 33816 0 0 45097412 35489454 9607958 590250 70830 519420 5690165 4159412 1530753 1860725 1527655 333070 0 3497622 3580320 -82698 125899 93274 32625 0 88214 76345 11869 883394 822550 60844 0 10870783 10122054 748729 4107354 3960704 146650 BAD DEBT -136984 -136984 MEDICAL SUPPLIES 36158731 36158731 DUES & FEES 599991 177861 422130 LICENSE & TAXES 2926844 2704953 221891 506749 6732 500017 221057186 192669641 28387545 0 6377 125482 0 34807424 0 0 34044860 34786714 0 0 0 0 375961 429148 3779030 4744506 2124222 2827995 258610559 183058119 77962972 75552440 142565906 129461921 2797057 2858847 0 0 0 0 6967027 8230316 270623412 293824793 35009314 42387844 0 0 70486 34355 16688857 0 0 0 0 0 0 13694241 0 0 15650816 45728410 67419473 101844850 X 203203939 191979943 0 0 203203939 191979943 270623412 293824793 -10442626 -781370 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 4432 false true 33816 38248 false Form 990, Schedule C, Part II-B, Line 1i LOBBYING ACTIVITIES: DURING THE FISCAL YEAR, MEMBERS OF JRMC'S STAFF HAD OCCASIONAL CONTACT WITH LEGISLATORS. ADDITIONALLY, JRMC CONTRIBUTED TO ORGANIZATIONS THAT UNDERTOOK LOBBYING ACTIVITIES DURING THE YEAR. JRMC ESTIMATES THE TOTAL AMOUNT OF DUES USED FOR LOBBYING ACTIVITIES AT $33,816. 6795018 6795018 113473142 85465928 28007214 1841991 1490697 351294 126896673 96101494 30795179 9603735 9603735 75552440 0 457 Plan 2497556 ADVANCES FROM 3RD PARTY PAYERS 30808479 Capital Lease Obligation 1107224 Line of Credit 9699954 Due to Affiliates 235286 DEFERRED PAYROLL TAX 1379911 45728410 SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X true X true true true false true true 7579 4001857 4001857 0.01830 14781 34672530 24787109 9885421 0.04510 22360 38674387 24787109 13887278 0.06340 4 625 1610 1610 0.00000 17 4738557 2389636 2348921 0.01070 7 35316732 31058553 4258179 0.01940 342587 253276 89311 0.00040 28 625 40399486 33701465 6698021 0.03050 28 22985 79073873 58488574 20585299 0.09390 24 1721 14565 14565 0.00010 24 1721 14565 14565 0.00010 true 2576313 59719907 51728513 7991394 X true true 1 1 JEFFERSON REGIONAL MEDICAL CENTER 1600 W 40TH AVENUE PINE BLUFF AR 71603 WWW.JRMC.ORG AR4213 X X X X JEFFERSON REGIONAL MEDICAL CENTER false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X true 19 true SEE PART V, SECTION C false true X 150. 300. X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, 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 CONSULTING REPRESENTATIVES OF THE COMMUNITY: The Community Health Needs Assessment Toolkit developed by the National Center for Rural Health Works at Oklahoma State University, Center for Rural Health and Oklahoma Office of Rural Health was utilized as a guide for the CHNA facilitation process. The hospital created a Steering committee made up of officers of Jefferson Regional Medical Center and Officers of the Arkansas Rural Health Partnership. Due to the size of the service area, the steering committee chose to conduct their assessment through a focus group of community leaders and individuals in health-related fields. Approximately 60 Individuals from the community were selected for invitation to the focus group, or community advisory committee, by the Jefferson Regional Medical Center staff steering committee. Over 20 individuals who participated in the focus group were from various organizations such as: Jefferson Regional Medical Center, local physicians, Relyance Bank, Strong Manufacturing, Oudin Properties, Trotter Auto Group, Go Forward Pine Bluff, First Arkansas Insurance, Greater Mt. Calvary Baptist Church, Reed Architectural Firm, various other businesses and retirees. In addition to the focus group, 84 surveys were completed by members of the community. SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS ADDRESSED AND NOT ADDRESSED: THE ORGANIZATION IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE 2018 CHNA THROUGH THE EXECUTION OF ITS CHNA IMPLEMENTATION STRATEGY THAT WAS UPDATED IN October OF 2019. All needs identified within the assessment are being addressed in the implementation strategy. FOR ADDITIONAL INFORMATION, SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. SCHEDULE H, PART V, SECTION B, LINES 7 & 10 CHNA AND IMPLEMENTATION STRATEGY: THE CHNA AND IMPLEMENTATION STRATEGY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: https://www.jrmc.org/about/community-health-needs-assessment/ SCHEDULE H, PART V, SECTION B, LINES 16A, 16B & 16C FINANCIAL ASSISTANCE POLICY: THE FAP, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: https://www.jrmc.org/patients-visitors/billing-insurance/financial-assista nce 22 HEALTHWORKS 4747 DUSTY LAKE DR STE 101 PINE BLUFF AR 71603 PHYSICIAN CLINIC PINE BLUFF SPECIALTY CLINIC 1601 W 40TH AVE SUITE 301 PINE BLUFF AR 71603 PHYSICIAN CLINIC CARDIOLOGY ASSOCIATES 1601 W 40TH AVE SUITE 301 PINE BLUFF AR 71603 PHYSICIAN CLINIC ENDOCRINOLOGY OF SOUTH ARKANSAS 7500 DOLLARWAY RD WHITE HALL AR 71603 PHYSICIAN CLINIC SOUTH ARKANSAS ORTHOPEADICS CENTER 1609 W 40TH AVE SUITE 501 PINE BLUFF AR 71603 PHYSICIAN CLINIC OBGYN ASSOCIATES OF S AR 1609 W 40TH AVE STE 201 PINE BLUFF AR 71603 PHYSICIAN CLINIC SURGICAL ASSOCIATES OF SOUTHEAST AR 1609 W 40TH AVE SUITE 403 PINE BLUFF AR 71603 PHYSICIAN CLINIC FAMILY HEALTH ASSOC OF SOUTH ARKANSAS 4747 DUSTY LAKE DRIVE PINE BLUFF AR 71603 PHYSICIAN CLINIC GI ASSOC OF SOUTH ARKANSAS 1609 W 40TH AVE SUITE 202 PINE BLUFF AR 71603 PHYSICIAN CLINIC PAIN SPECIALISTS OF SOUTH ARKANSAS 1609 W 40TH AVE SUITE 312 PINE BLUFF AR 71603 PHYSICIAN CLINIC Jefferson Regional Neurology Clinic 1609 W 40TH AVE SUITE 207 PINE BLUFF AR 71603 PHYSICIAN CLINIC CHILDREN'S CLINIC OF SOUTH ARKANSAS 1420 W 43RD AVE PINE BLUFF AR 71603 PHYSICIAN CLINIC I-530 IMAGING 4747 DUSTY LAKE DR PINE BLUFF AR 71603 OP IMAGING JRMC OUTPATIENT PHYSICAL THERAPY 1600 W HOLLAND AVE WHITE HALL AR 71602 OP THERAPY JRMC URGENT CARE CENTER 4201 S MULBERRY ST PINE BLUFF AR 71603 WALK-IN CLINIC SURGICAL ASSOCIATES OF SOUTHEAST AR 1801 W 40TH AVE STE 7 PINE BLUFF AR 76103 PHYSICIAN CLINIC OBGYN ASSOCIATES OF SOUTH AR 1609 W 40TH AVE STE 402 PINE BLUFF AR 76103 PHYSICIAN CLINIC JEFFERSON REGIONAL CANCER CENTER 1609 W 40TH AVE STE 205 PINE BLUFF AR 71603 PHYSICIAN CLINIC OBGYN ASSOCIATES OF SOUTH AR 1609 W 40TH AVE STE 204 PINE BLUFF AR 71603 PHYSICIAN CLINIC FAMILY HEALTH ASSOC OF SOUTH ARKANSAS 1801 W 40TH AVE STE 6A PINE BLUFF AR 71603 PHYSICIAN CLINIC FAMILY HEALTH ASSOC OF SOUTH ARKANSAS 1600 W HOLLAND STE 202 PINE BLUFF AR 71603 PHYSICIAN CLINIC JEFFERSON REGIONAL CANCER CENTER 4310 S MULBERRY ST PINE BLUFF AR 71603 PHYSICIAN CLINIC SCHEDULE H, PART III, SECTION A, LINE 2 PROVISION FOR UNCOLLECTIBLE ACCOUNTS METHODOLOGY: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. THEREFORE, BAD DEBT EXPENSE RELATED TO PATIENT ACCOUNTS WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2020. HOWEVER, THE HOSPITAL INTERNALLY TRACKS ACCOUNT ACTIVITY CONSISTENT WITH HISTORICAL PRACTICES AND THE AMOUNT THAT WOULD HAVE BEEN ATTRIBUTED TO BAD DEBT UNDER PREVIOUS ACCOUNTING POLICY HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE: THE HOSPITAL HAS PROCESSES IN PLACE TO IDENTIFY THOSE PATIENTS THAT WOULD QUALIFY FOR FINANCIAL ASSISTANCE. THOSE ACCOUNTS ARE WRITTEN OFF TO CHARITY. THE HOSPITAL ALSO USES PRESUMPTIVE ELIGIBILITY TO IDENTIFY THOSE PATIENTS WHO HAVE NOT COMPLETED AN APPLICATION AND THOSE PATIENTS ARE CONSIDERED FOR ASSISTANCE AS WELL. MANAGEMENT DOESN'T BELIEVE THAT ANY OF THE BAD DEBT WOULD BE ATTRIBUTABLE TO THOSE FAP-ELIGIBLE PATIENTS. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: NOT APPLICABLE DUE TO THE ADOPTION OF ASU TOPIC 606 REVENUE FROM CONTRACTS WITH CUSTOMERS. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: THE ORGANIZATION DETERMINES ALLOWABLE COSTS ASSOCIATED WITH MEDICARE PAYMENTS BY UTILIZING AMOUNTS REPORTED ON THE MEDICARE COST REPORT. Medicare revenue was computed from Worksheet E, less GME & Allied health reimbursement (considered separately). Medicare allowable cost was computed from worksheet D-1. As a safety Net Hospital, the organization provides care to all patients regardless of source of Payment; therefore, costs to provide care to Medicare patients should be considered community benefit to the extent costs exceed Medicare reimbursement. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTIONS POLICY: PATIENT ACCOUNTS QUALIFYING FOR free or discounted care WOULD NOT INTENTIONALLY BE PLACED WITH A DEBT COLLECTION SERVICE. FROM TIME TO TIME, INFORMATION THAT RESULTS IN THE DETERMINATION OF ASSISTANCE QUALIFICATION IS OBTAINED SUBSEQUENT TO A PATIENT'S ACCOUNT BEING PLACED WITH A DEBT COLLECTION AGENCY. THE ORGANIZATION'S COLLECTION AGENCY POLICY REQUIRES CONTRACTED COLLECTION AGENTS, IN ADDITION TO MANY OTHER PRUDENT PROCEDURES, TO INFORM THE DEBTOR OF THE APPROPRIATE HOSPITAL FINANCIAL ASSISTANCE PROFESSIONAL TO CONTACT IF THE COLLECTION AGENT IS MADE AWARE OF A PATIENT'S FINANCIAL HARDSHIP. THE COLLECTION AGENT IS ALSO REQUIRED TO NOTIFY THE ORGANIZATION OF THE PATIENT'S FINANCIAL HARDSHIP SO THE ORGANIZATION CAN ASSIST THE PATIENT IN ACCESSING THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAMS. SCHEDULE H, PART VI, LINE 2 Needs Assessment: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILTY FOR ASSISTANCE: A FINANCIAL COUNSELOR INITIATES A FINANCIAL SCREENING ON ALL INPATIENTS, OBSERVATION PATIENTS AND OUTPATIENTS OCCUPYING A BED HAVING NO INSURANCE INDICATED ON THEIR ACCOUNT. THIS PROCESS INCLUDES SCREENING FOR free or discounted care, MEDICAID COVERAGE AND OTHER THIRD PARTY COVERAGE. OUTPATIENTS RECEIVE A FINANCIAL ASSISTANCE GUIDE SHEET SUMMARIZING ASSISTANCE OFFERED BY JRMC AT THE TIME OF REGISTRATION. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THIS IS NOT APPLICABLE FOR FISCAL YEAR 2020. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NO COMMUNITY BENEFIT REPORT WAS FILED WITH THE STATE FOR FISCAL YEAR 2020. SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -MEDICAL INDIGENCY -INSURANCE STATUS -UNDERINSURANCE STATUS SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: JRMC PERSONNEL SERVED ON THE BOARDS OF A NUMBER OF LOCAL VOLUNTEER AND BUSINESS ORGANIZATIONS THAT PROMOTED GENERAL COMMUNITY DEVELOPMENT AND HEALTH BY PROVIDING HEALTH EDUCATION AND VOLUNTEER SUPPORT. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: The organization computes the cost of providing care through the use of cost accounting methodologies and assumptions derived from the Medicare cost report. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES: THE EXPENSES REPORTED ON THIS LINE ARE FROM COSTS ASSOCIATED WITH VARIOUS PHYSICIAN CLINICS REPORTED ON PART V, SECTION D THAT PROVIDE SERVICES TO THE COMMUNITY THAT WOULD NOT OTHERWISE BE AVAILABLE. true UNITED WAY OF SOUTH EAST ARKANSAS PO BOX 8702 PINE BLUFF AR 71603 710236869 501(C)(3) 26250 2019 CAMPAIGN PLEDGE AR HOSPITAL EDUCATION & RESEARCH TRUST 419 NATURAL RESOURCES DR LITTLE ROCK AR 72205 710392458 501(C)(3) 17608 2019 AHERT DONATION PINE BLUFF COUNTRY CLUB PO BOX 6809 PINE BLUFF AR 71603 710141610 501(C)(7) 7000 IRRIGATION SYSTEM & EVENT SPONSORSHIP 2 1 FEDERAL PELL GRANTS 49 177337 WIA ADULT PROGRAM GRANTS 8 26991 STATE GO GRANTS 3 10500 STATE OF AR - REHABILITATION 9 16574 JSN SCHOLARSHIPS 10 8250 Academic Challenge 10 13625 State of AR - DCWP 928 1966152 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: JEFFERSON HOSPITAL ASSOCIATION, INC. MAINTAINED RECORDS TO SUBSTANTIATE THE AMOUNT OF THE GRANTS OR ASSISTANCE, THE GRANTEES' ELIGIBILITY FOR THE GRANTS OR ASSISTANCE, AND THE SELECTION CRITERIA USED TO AWARD GRANTS OR ASSISTANCE. FORM 990, PART IX, LINES 1 & 2 & SCHEDULE I, PARTS II & III DIFFERENCE BETWEEN SCHEDULE I & STATEMENT OF FUNCTIONAL EXPENSES: THE ORGANIZATION IS REPORTING THE CONTRIBUTIONS PAID ON SCHEDULE I, WHICH IS NOT NECESSARILY ON THE ACCRUAL BASIS BECAUSE THE ORGANIZATION RECORDS LONG-TERM PLEDGES AT THEIR NPV AND RECORDS ACCRETION OF INTEREST OVER TIME. THE PLEDGES, WHEN PAID, ARE A REDUCTION OF THIS LIABILITY AND NOT CURRENT YEAR EXPENSE WHICH MAY CAUSE A DIFFERENCE BETWEEN AMOUNT REPORTED ON FORM 990, PART IX AND SCHEDULE I, PARTS II & III. X X false true X X X X true true false false false false false true false J ACOSTA - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 F ANTHONY - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 D ATKINSON - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 D BRIDGFORTH - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 D BROWN - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JA CAMPBELL - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 M CASTEEL - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 M ECKERT - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 A KLINE - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JB MAYS - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 S PITTILLO - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 A SANDERS - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 H TROTTER III - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C MORGAN - SEE SCH O G MARKIS - SEE SCH O P AUSTIN - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 L HICKMAN - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 B JACKSON - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 B THOMAS - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 M ALI - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 G BIRK - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 R BURRELL - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 J JEFFERY - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 T HARBUCK - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 W JOHNSON - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 K MOHAMMAD - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 A POLLARD - SEE SCH O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE J, PART I, LINE 1A DESCRIPTION OF BENEFITS: THE FOLLOWING BENEFITS ARE INCLUDED IN THE TAXABLE COMPENSATION OF THE RECIPIENTS. - TAX GROSS-UP PAYMENTS ARE INCLUDED IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IDENTIFIED BELOW. - COUNTRY CLUB MEMBERSHIPS ARE MAINTAINED BY THE ORGANIZATION FOR THE USE OF SPECIFIC EMPLOYEES AS DESIGNATED BY THE BOARD OF DIRECTORS. SCHEDULE J, PART I, LINE 1B WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT: THERE IS NO WRITTEN POLICY REGARDING PROVISION OF COUNTRY CLUB MEMBERSHIPS. THE BOARD OF DIRECTORS DESIGNATES WHICH EMPLOYEES MAY USE MEMBERSHIPS MAINTAINED BY THE ORGANIZATION. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: THE ORGANIZATION PROVIDES DEFINED MEMBERS OF MANAGEMENT A NON-FIXED PERFORMANCE BASED INCENTIVE PLAN. THE PLAN'S COMPONENTS ARE ESTABLISHED AND EVALUATED BY THE ORGANIZATION'S EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS: Mr. Harbuck and Mr. Johnson received severance payments in accordance with the terms of employment agreements between them and the Association. THOMAS HARBUCK $102,981 WALTER JOHNSON $178,063 SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP PLAN REPORTED IN W-2 DEFERRED COMPENSATION --------------------------- ----------------- ---------------------- LOUISE HICKMAN $ 78,576 $NONE BRIAN THOMAS $ 99,019 $NONE BRYAN G. JACKSON $ 74,922 $NONE PETER AUSTIN $ NONE $51,774 Jeremy Jeffery $ NONE $30,967 Eckert Michelle MD PA See Supplemental Info See Supplemental Info false Dr Joann Mays PLLC SEE SUPPLEMENTAL INFO SEE SUPPLEMENTAL INFO false MICHAEL ACOSTA SEE SUPPLEMENTAL INFO SEE SUPPLEMENTAL INFO false ELIZABETH BRIDGFORTH HARTZ SEE SUPPLEMENTAL INFO SEE SUPPLEMENTAL INFO false FORM 990, SCHEDULE L, PART IV, COLUMNS B, C, & D (A) NAME OF PERSON: Eckert, Michelle MD PA (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: Michelle Eckert (JHA DIRECTOR) IS the OWNER OF the PA. (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $100,000 (D) DESCRIPTION OF TRANSACTION: CONTRACTED PHYSICIAN SERVICES (A) NAME OF PERSON: Dr. Joann Mays PLLC (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: JOANN MAYS (JHA DIRECTOR) IS the OWNER OF the PLLC. (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $100,000 (D) DESCRIPTION OF TRANSACTION: CONTRACTED PEDIATRIC SERVICES (A) NAME OF PERSON: Michael Acosta (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JANICE ACOSTA (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC (A) NAME OF PERSON: ELIZABETH BRIDGFORTH HARTZ (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF DAVID BRIDGFORTH (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS: CONTINUED FROM PART III... Jefferson Regional's governing board is comprised of individuals who are Local business leaders, community leaders, and health care providers. Approximately 65 percent of Jefferson Regional's patients originate from the primary service area (Jefferson, Cleveland and Lincoln counties) with 35 percent originating from the secondary service area (Arkansas, Ashley, Bradley, Chicot, Dallas, Desha, Drew and Grant counties). Offering a variety of diverse programs and services, Jefferson Regional's medical staff features most major specialties including cardiology, general surgery, critical care, gastroenterology, orthopedics, spinal surgery, neurology, cancer care, endocrinology, obstetrics/gynecology, radiology, psychiatry, urgent and emergency care. Jefferson Regional also actively participates in teaching programs for medical students and residents, as well as students in allied health fields. In addition, our physicians can be seen in surrounding communities, conducting satellite clinics on a regular basis to care for patients in rural areas. The Jefferson Regional Emergency Department and the Urgent Care Walk-In Clinic are open seven days-a-week to provide immediate care for different levels of emergencies, regardless of the patient's ability to pay. Jefferson Regional Healthworks, an occupational health clinic, offers a wide range of services to area businesses including pre-employment testing, laboratory services, and inpatient and outpatient rehabilitation (occupational, physical and speech therapy). Jefferson Regional also operates dozens of additional clinics, some providing specialized care such as the Wound Care Center, and others offering family medical services. Our commitment to bring innovative programs and services to southeast Arkansas is evident. During fiscal year 2020, Jefferson Regional invested $7.6 million in capital additions and improvements to our planning, budgeting and spending with the goal of continuing to provide state-of-the-art technologies in a caring environment. With community service and education as a significant part of our mission, Jefferson Regional provides financial sponsorships within the community and offers free health screenings and educational events each year. We Will continue to strive to accomplish our Mission, "Improving health through excellence and compassionVision, "To be the healthcare provider and employer of choice for Southeast Arkansas." FORM 990, PART VI, SECTION A, LINE 1A DELEGATION OF AUTHORITY: AN EXECUTIVE COMMITTEE MAY BE ELECTED BY THE BOARD OF DIRECTORS TO CONSIST OF NOT LESS THAN THREE DIRECTORS. THE COMMITTEE IS ABLE TO EXERCISE ALL AUTHORITY OF THE BOARD DURING INTERVALS BETWEEN MEETINGS OF THE BOARD WITH RESPECT TO THE AFFAIRS OF THE CORPORATION, BUT SHALL BE SUBJECT TO THE CONTROL AND DIRECTION OF THE FULL BOARD. THE COMMITTEE SHALL ALSO CONDUCT AN EVALUATION OF THE CHIEF EXECUTIVE OFFICER ANNUALLY FOR THE FULL BOARD OF DIRECTORS TO REVIEW. FORM 990, PART VI, SECTION A, LINE 2 RELATIONSHIPS OF OFFICERS, DIRECTORS, AND TRUSTEES: H. Ford Trotter (JHA Director) and David Brown (JHA Director) have a business relationship. Annette Kline (JHA Chair) and Scott Pittillo (JHA Vice chair) have a business relationship. Janice Acosta (JHA Director) and Scott Pittillo (JHA VICE CHAIR) have a business relationship. Annette Kline (JHA Chair) and Janice Acosta (JHA Director) have a business relationship. Archie Sanders (JHA Director) and Scott Pittillo (JHA Vice Chair) have a business relationship. Archie Sanders (JHA Director) and Annette Kline (JHA Chair) have a business relationship. Archie Sanders (JHA Director) and Janice Acosta (JHA Director) have a business relationship. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS: THE ORGANIZATION HAS A MEMBERSHIP CONSISTING OF 30 JEFFERSON COUNTY ARKANSAS RESIDENTS. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT MEMBERS OF GOVERNING BODY: THE MEMBERSHIP OF THE ORGANIZATION HAS THE RESPONSIBILITY OF ELECTING THE BOARD OF DIRECTORS AT THE ANNUAL MEMBERSHIP MEETING. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990: THE FORM 990 AND FORM 990-T ARE PREPARED AND REVIEWED UNDER THE DIRECTION OF THE CHIEF FINANCIAL OFFICER. FINAL DRAFTS OF THE RETURNS ARE PRESENTED TO THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS, WHICH IS DESIGNATED BY THE BOARD OF DIRECTORS TO FULFILL THE FIDUCIARY RESPONSIBILITY OF THE GOVERNING BODY TO REVIEW THE RETURNS BEFORE THEY ARE FILED WITH THE IRS. AFTER ANY FINAL REVISIONS ARE MADE BASED UPON THE GOVERNANCE COMMITTEE'S REVIEW, A FINAL VERSION IS POSTED TO AN INTERNAL SECURE WEBSITE WITH A LINK E-MAILED TO EACH VOTING MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C PROCESS TO MONITOR AND ENFORCE COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE ORGANIZATION REQUIRES NOT ONLY AN ANNUAL CONFLICT OF INTEREST DISCLOSURE, BUT ALSO DISCLOSURE WHEN SITUATIONS SUBSEQUENT TO THE ANNUAL DISCLOSURE DEVELOP THAT WOULD POTENTIALLY PLACE THE INDIVIDUAL IN A CONFLICT OF INTEREST. IN THOSE SITUATIONS, IMMEDIATE DISCLOSURE IS REQUIRED. THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS CONDUCTS THE ANNUAL REVIEW OF CONFLICT OF INTEREST DISCLOSURES. IN THE EVENT THE GOVERNANCE COMMITTEE DETERMINES THAT A CONFLICT EXISTS, LEGAL COUNSEL IS CONSULTED. IF LEGAL COUNSEL DETERMINES THAT A CONFLICT EXISTS, THE PERSON IS INFORMED AND THE MATTER IS REPORTED TO THE BOARD FOR ACTION. ANY DIRECTOR OR OFFICER WHOSE TRANSACTIONS ARE BEING REVIEWED WOULD ABSENT HIMSELF/HERSELF FROM THE REVIEW. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION OF CEO AND OTHER OFFICERS: THE COMPENSATION COMMITTEE MOST RECENTLY ENGAGED A THIRD-PARTY GLOBAL HUMAN CAPITAL CONSULTING FIRM, KORN FERRY HAY GROUP IN OCTOBER 2019 TO PERFORM A TOTAL COMPENSATION REVIEW THAT WAS PREVIOUSLY CONDUCTED IN SEPTEMBER 2018. THE COMPENSATION COMMITTEE UTILIZES THIS REVIEW IN CONCERT WITH A DEFINED EXECUTIVE COMPENSATION POLICY TO DEVELOP AND MAINTAIN A TOTAL COMPENSATION PACKAGE THAT IS REASONABLE AS COMPARED TO SIMILAR POSITIONS AT NON-PROFIT HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY. THE DELIBERATIONS AND DECISIONS OF THE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED AND A SUMMARY REPORT IS MADE TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND OTHER DOCUMENTS TO ALL WHO REQUEST ONE OR MORE OF THE ITEMS. FORM 990, PART VII, SECTION A & SCHEDULE J, PART II COMPENSATION TABLE: COMPENSATION INFORMATION REQUIRED IN FORM 990, PART VII, SECTION A AND SCHEDULE J, PART II IS PROVIDED IN A TABLE IDENTIFIED AS ATTACHMENT 3 AND ATTACHED TO THE TAX RETURN DOCUMENT FOLLOWING SCHEDULE R. THE TABLES WITHIN THE RETURN ARE POPULATED WITH ZERO BECAUSE OF THE ELECTRONIC FILING REQUIREMENT, AND THE CORRECT AMOUNTS ARE INCLUDED IN THE ATTACHMENT. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:15565222 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:2685291 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:16654760 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:2475692 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES TOTAL FEES:7716447 JEFFERSON REGIONAL ANESTHESIA 1600 W 40TH AVE PINE BLUFF AR 71603 831984365 ANESTHESIA AR 2452721 3720526 JHA ARKANSAS RURAL HEALTH PARTNERSHIP CIN 1600 W 40TH AVE PINE BLUFF AR 71603 830694507 POP HEALTH AR 208563 347424 JHA JEFFERSON REGIONAL MED CENTER FOUNDATION 1600 W 40TH AVE PINE BLUFF AR 71603 821820277 SUPPORT AR 501(C)(3) 12, TYPE I JHA true JEFFERSON MANAGEMENT SERVICES INC 1600 W 40TH AVE PINE BLUFF AR 71603 710582753 PHYS PRACTICE MGM AR JHA C-CORPORATION 0 690247 1.00000 true JHA HEALTH AFFILIATES INC 1600 W 40TH AVE PINE BLUFF AR 71603 710766959 REAL EST RENTAL AR JHA C-CORPORATION 0 671099 1.00000 true false false false false false false false false false false false true false false false false false false true JEFFERSON MANAGEMENT SERVICES INC L 182547 G/L ACTIVITY JEFFERSON MANAGEMENT SERVICES INC S 225000 G/L ACTIVITY JEFFERSON REGIONAL MED CENTER FOUNDATION L 294023 G/L ACTIVITY