2020-12-08T13:51:54-07:00 2020-03-31 990 2019-04-01 362448028 JACKSON PARK HOSPITAL FOUNDATION JACK 7739477500 7531 Stony Island Avenue Chicago IL 60649 William Dorsey MD Chairman/CEO 7739477500 2020-12-08 2019 2022-09-23 18:48:47Z William Dorsey MD 7531 South Stony Island Chicago IL 60649 85579723 0 X www.jacksonparkhospital.org X 1960 IL The Mission of the physicians, Staff and Board of Directors of the organization is to provide compassionate care and high quality healthcare services to meet the needs of the patients and communities we serve. 8 1 829 0 0 0 146683 3120779 15543392 46558622 209065 117839 39656422 35782483 55555562 85579723 0 0 0 0 45296520 44600031 0 0 0 37909644 34672390 83206164 79272421 -27650602 6307302 113295304 106434592 35933980 34504905 77361324 71929687 X The mission of the physicians, staff and Board of Directors of the organization is to provide compassionate and high quality healthcare services to meet the needs of the patients and communities we serve. 0 1 45166236 66086063 Jackson Park Hospital Foundation provides inpatient and outpatient medical care to Chicago's south side communities regardless of the patient's ability to pay Inpatient services including medical surgical, ICU and hospice In 2019 the hospital served 3,593 acute care admissions which amounted to 16,052 patient days. 16125430 13852798 Jackson Park Hospital Foundation provides inpatient and outpatient behavioral medicine services to the greater Chicagoland area Jackson park Hospital is one of the few hospitals in Chicago that continues to provide behavioral medicine to its community In 2019 Jackson Park Hospital served 2,629 inpatient behavioral medicine patients which amounted to 11,075 patient days 7988004 12552495 Jackson park Hospital Provides basic emergency room services to its community 24 hours a day 7 days a week regardless of the patients ability to pay in 2019 the hospital served 24,001 emergency patients 2398643 0 See Schedule O , Statement 2 Medical Education 2398643 0 0 71678313 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 84 0 1 829 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 X 8 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IL X X Nelson Vasquez 7739477989 7531 Stony Island Chicago IL 60649 Matthew Malters MD Physician 2 38 X 23276 681866 11084 William Dorsey MD Chairman/CEO 40 X X 704992 0 11084 G Randall Smith Executive Vice President 40 0 X 604406 0 29079 Merritt Hasbrouck President 40 0 X 607087 0 12226 Surrenthia Parker MD Director 4 36 X 49521 389983 29079 Siddiq Hasan MD Director 4 36 X 122196 280196 29079 Caryn Carranza MD Physician 0 40 X 0 379497 0 Ruksana Sajid-Nazneen MD Physician 25 15 X 156856 141786 29079 Lakshmi Dodda MD Director 25 15 X 195087 96313 29079 Joseph D'Silva MD Physician 0 40 X 0 314400 0 Jayesh Madhani MD Physician 2 38 X 71400 210196 29079 Bangalore Murthy MD Director 25 15 X 161745 65637 29079 Haroon Olomi MD Director 4 36 X 16970 209996 29079 Nelson Vasquez Vice President Finance 40 0 X 219335 0 29079 Harshad Mehta MD Director 40 X 205780 0 19052 M Patrica Simon Senior Vice President Quality & Compliance 40 0 X 185236 0 19052 Barry Mandell Vice President Special Projects 40 0 X 170087 0 29079 Danny Rollins VP of Ancillary Services 40 0 X 186641 0 9526 Thomas Pankow Chief Information Officer 40 0 X 136618 0 0 James Clark Director 2 X 0 0 0 3817233 2769870 372814 73 0 1 1 Powers & Sons Construction 2636 West 15th Avenue Gary IN 46404 Construction 3660398 EBP Trust 1501 North Plano Road Suite 100 Richardson TX 75081 Health Insurace 3318614 Simple Laboratories 5960 North Milwaukee Avenue Chicago IL 60646 Lab Services 2540970 White Cap Nursing 2600 South Michigan Avenue Chicago IL 60616 Temporary Nurse Staff 1629712 Amerisource Bergen PO Box 27550 Chicago IL 60653 Drug Supplies 1532825 58 0 0 0 0 2989152 131627 0 3120779 46558622 46558622 0 0 46558622 117839 117839 0 0 0 0 0 0 0 0 0 0 292938 0 0 0 292938 0 292938 292938 0 0 0 0 0 Provider Tax Proceeds 622110 33521547 33521547 0 0 Other Income 622000 246094 246094 0 0 Other Revenue 622000 1721904 1721904 0 0 0 0 0 0 35489545 85579723 82458944 0 0 X 3817233 0 3817233 0 33385588 33385588 1117139 1117139 3613445 3209100 404345 2666626 2666626 790769 790769 292821 292821 15654164 15378744 275420 7884543 6903329 981214 1214565 1214565 653638 613372 40266 3231586 3032512 199074 1013502 0 1013502 3936802 3366569 570233 79272421 71678313 7594108 0 8003082 0 1015925 78558780 73899067 1152092 1310960 196479 148624 98924730 74389405 24897795 24535325 5871 5032657 487076 486163 113295304 106434592 15394609 11803336 13187258 5777799 7352113 16923770 35933980 34504905 X 77361324 71929687 0 0 77361324 71929687 113295304 106434592 6307302 0 0 0 -11738939 0 X X 0 1 X 1 1 0 X 2482024 0 2482024 61225175 0 43769138 17456037 3178 0 0 3178 35214353 0 30620267 4594086 0 0 0 0 24535325 0 Pension Liability 1083928 Professional Liability 5746283 Other Liabilities 10093559 16923770 X Schedule D, Part X, Line 2 Uncertain tax positions U. S. GAAP requires management to evaluate uncertain tax positions taken by the Corporation. The financial statement effects of a tax position are recognized when a position is more likely than not, based on technical merits, to be sustained by the examination by the Internal Revenue Service. The Corporation has evaluated tax positions taken or expected to be taken to determine whether the tax positions are more likely than not to be sustained by the applicable taxing authority and has determined that it currently does not have any uncertain tax positions as of March 31, 2020. The Corporation has recognized no interest or penalties related to uncertain tax positions. The Corporation is subject to routine audits by taxing jurisdictions, however, there are currently no audits for any tax periods in progress. Management believes it is no longer subject to income tax examinations for years prior to 2013. 1 1 1 X 1 X 1 1 1 0 1 1 1992149 0 0 1992149 0 0 0 2398644 7567738 0 0 9966382 0 0 0 0 0 11958531 0 0 0 1 7567738 7567738 15805470 15805470 0 X 1 1 1 1 Jackson Park Hospital Foundation 7531 Stony Island Chicago IL 60649 jacksonparkhospital.org 0001115 X X X X Jackson Park Hospital Foundation 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X jacksonparkhospital.org X 1 18 1 jacksonparkhospital.org 0 0 1 X 200 200 1 1 X X X 1 X jacksonparkhospital.org X jacksonparkhospital.org X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Jackson Park Hospital Foundation Focus groups were conducted with members of our community. Schedule H, Part V, Section B, Line 11-Jackson Park Hospital Foundation The hospital implemented a senior program that included free transportation to older adults 55+. Due to the ongoing pandemic, the expansion of community based programs were suspended. Because of the large negative financial impact the O.B. product line was having on the hospital operations, it was closed in August 2019. Schedule H, Part I, Line 7 Charity Care Cost is based on the total cost to charge ratio derived from the Medicare Cost Report for services provided to patients. Schedule H, Part III, Section A, Line 4 The cost of bad debt expense is based on the cost to charge derived from the hospitals Medicare Cost Report Schedule H, Part III, Section B, Line 8 There is no shortfall between Medicare reimbursement and the hospitals cost. Schedule H, Part III, Section C, Line 9b The hospital has a presumptive eligibility policy as required by the State of Illinois. Schedule H, Part VI, Line 2 Jackson Park Hospital Foundation outreach and assessment of its community health by evaluating which health conditions and diseases are prevalent among its inpatient and outpatients. The hospital prepared its community health needs assessment using a professional company experienced in assisting hospitals in the process. Together we confirmed the need for education and other inventions for diabetes, asthma, and behavioral medicine. The hospital has responded to these needs through the development of several community programs and specialty clinics. The hospital implemented free transportation for patients who are unable to keep appointments with their primary care provider or consultant. Schedule H, Part VI, Line 3 The hospital has contracted with a third party named First Source to assist any patient through the financial application process to qualify for Medicaid, Medicare, and the Affordable Care Act. This same company will also assist a patient and or family through the hospitals charity application process. Schedule H, Part VI, Line 4 Jackson Park Hospitals primary service area is 60649,60621,60637,60619 and 60617. Our primary care area for behavioral patients is much broader and encompasses the City of Chicago. The average income in the hospitals primary service area is approximately 53% of the State of Illinois average. Schedule H, Part VI, Line 5 In addition to various education programs within the hospital, the hospital has begun regular education and outreach programs at local grocery stores and banks in 2019. The hospital began an outreach program for senior patients. This senior program will manage the primary healthcare needs and match the patient with the physician. Schedule H, Part VI, Line 7 Jackson park Hospital prepares and submits an annual Community Benefits report to the Attorney General of the State of Illinois. This report is also made available to the public upon request. X 0 0 0 0 0 0 0 0 0 Lakshmi Dodda MD Director 195087 96313 0 0 0 0 0 0 29079 0 224166 96313 0 0 William Dorsey MD Chairman/CEO 704992 0 0 0 0 0 0 0 11084 0 716076 0 0 0 Siddiq Hasan MD Director 122196 280196 0 0 0 0 0 0 29079 0 151275 280196 0 0 Harshad Mehta MD Director 205780 0 0 0 0 0 0 0 19052 0 224832 0 0 0 Bangalore Murthy MD Director 161745 65637 0 0 0 0 0 0 29079 0 190824 65637 0 0 Haroon Olomi MD Director 16970 209996 0 0 0 0 0 0 29079 0 46049 209996 0 0 Surrenthia Parker MD Director 49251 389983 0 0 0 0 0 0 29079 0 78330 389983 0 0 Merritt Hasbrouck President 607087 0 0 0 0 0 0 0 12226 0 619313 0 0 0 G Randall Smith Executive Vice President 604406 0 0 0 0 0 0 0 29079 0 633485 0 0 0 M Patrica Simon Senior Vice President Quality & Compliance 185236 0 0 0 0 0 0 0 19052 0 204288 0 0 0 Barry Mandell Vice President Special Projects 170087 0 0 0 0 0 0 0 29079 0 199166 0 0 0 Nelson Vasquez Vice President Finance 219335 0 0 0 0 0 0 0 29079 0 248414 0 0 0 Thomas Pankow Chief Information Officer 136618 0 0 0 0 0 0 0 0 0 136618 0 0 0 Matthew Malters MD Physician 23276 681866 0 0 0 0 0 0 11084 0 34360 681866 0 0 Caryn Carranza MD Physician 0 379497 0 0 0 0 0 0 0 0 0 379497 0 0 Joseph D'Silva MD Physician 0 314400 0 0 0 0 0 0 0 0 0 314400 0 0 Jayesh Madhani MD Physician 71400 210196 0 0 0 0 0 0 29079 0 100479 210196 0 0 Ruksana Sajid-Nazneen MD Physician 156856 141786 0 0 0 0 0 0 29079 0 185935 141786 0 Danny Rollins VP of Ancillary Services 186641 0 0 0 0 0 0 0 9526 0 196167 0 0 0 Bangalore Murthy MD Director 621138 Temporary Staffing 0 Bangalore Murthy MD Director 725 Medical Education 0 Bangalore Murthy MD Director 71604 Medical Education Billing 0 Form 990, Part III, Line 3 Due to growing operating losses, the O.B. product line was closed in August 2019 Form 990, Part VI, Section B, Line 11b Several individuals review the 990 before it is submitted. This includes Assistant VP of Finance, VP of Finance, Executive VP, President, and CEO Form 990, Part VI, Section B, Line 12c The Compliance Officer reviews policies on annual basis. Form 990, Part VI, Section B, Line 15 Jackson Park Hospital Foundation has an audit/compensation committee. The Chairman of the Audit/Compensation committee reviews the compensation of senior management and key employees on an annual basis. Form 990, Part VI, Section C, Line 19 Jackson Park Hospital Foundation makes its Community Health Needs Assessment available on its own website and by appointment with its Vice President of Finance. The Conflict of Interest Policy, Community Benefit Report, Form 990 and Financial Statements are available to the public by appointment with its Vice President of Finance or its Senior Vice President of Quality and Compliance. Form 990, Part IX, Line 11g Contract Labor, Purchased Services, and Professional Fees Form 990, Part XII, Line 3b We have an extension until February 15, 2021. The Friedell Clinic SC 7531 Stony Island Chicago IL 60649 363290656 Primary Health Care IL Jackson Park Hospital Foundation C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 We have an extension until February 15, 2021.