2019-02-14T13:07:30-07:00 2018-03-31 990 2017-04-01 362448028 JACKSON PARK HOSPITAL FOUNDATION JACK 7531 Stony Island Chicago IL 60649 William Dorsey MD Chairman/CEO 7739477500 2019-02-11 65.42.145.126 2017 2019-02-21 02:37:17Z William Dorsey MD 7531 Stony Island Chicago IL 60649 70004114 0 X 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 1 890 0 0 0 147048 154720 58571802 37354353 27666 60707 31678576 32434334 90425092 70004114 0 0 0 0 43940811 43636073 0 0 0 38455043 41828470 82395854 85464543 8029238 -15460429 146583721 135831973 25530175 30505892 121053546 105326081 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 0 12161173 0 14239494 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, obstetrics, labor and delivery and hospice In 2017 the hospital served 5,289 acute care admissions which amounted to 20,318 patient days 3595877 0 2661167 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 2017 Jackson Park Hospital served 2,068 inpatient behavioral medicine patients which amounted to 8,359 patient days 7089026 0 3546911 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 2017 the hospital served 27,467 emergency patients 57447965 0 49556542 See Schedule O , Statement 2 57447965 0 49556542 80294041 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 60 0 1 890 1 0 0 0 0 0 1 1 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 Nelson Vasquez 7739477989 7531 Stony Island Chicago IL 60649 James Clark Director 2 0 X 0 0 0 Lakshmi Dodda MD Director 25 15 X 193358 101611 13025 William Dorsey MD Chairman/CEO 40 0 X X 717980 0 6863 Siddiq Hasan MD Director 10.00 30 X 123513 305668 0 Harshad Mehta MD Director 40 0 X 143277 0 13985 Bangalore Murthy MD Director 25.00 15 X 162980 71604 17942 Haroon Olomi MD Director 4 36 X 87211 209916 13025 Surrenthia Parker MD Director 4.00 38 X 51316 425436 0 Merritt Hasbrouck President 40 0 X 906485 0 210 G Randall Smith Executive Vice President 40 0 X 613846 0 17942 M Patrica Simon Senior Vice President Quality & Compliance 40 0 X 229168 0 12686 Barry Mandell Vice President Special Projects 40 0 X 201111 0 17942 Nelson Vasquez Vice President Finance 40 0 X 218987 0 17942 Matthew Malters MD Physician 2 38 X 23424 663494 0 Caryn Carranza MD Physician 0 40 X 0 416867 0 Pratap Kumar MD Physician 0 40 X 0 302700 0 Thodur Ranganathan MD Physician 40.00 0 X 247413 0 17915 James Nunn MD Physician 0 40 X 0 244115 0 3920069 2741411 149477 84 0 1 1 EBT Trust Health Care Service Corporation 25550 Network Place Chicago IL 606731255 Health Insurance 3769829 Northern Illinois Clinical Laboratory 306 E Era Drive Northbrook IL 60062 Clinical Laboratory Services 1713475 White Cap Nursing Inc 2600 Michigan Ave Chicago IL 60616 Temporary Nurse Staffing 1636852 Mckesson 6111 N River Road Rosemont IL 60018 Technology Services 1223305 Cardinal Health 7000 Cardinal Place Dublin OH 43017 Medical Supplies 940377 64 0 0 154720 0 0 0 0 154720 Net Patient Service Revenue 622110 37354353 37354353 0 0 0 0 0 0 37354353 60707 60707 0 0 0 0 0 0 0 0 0 0 543296 0 0 0 543296 0 543296 543296 0 0 0 0 128145 Provider Tax Proceeds 622110 26857737 26857737 0 0 Miscellanous Income 622110 5033301 5033301 0 0 0 0 0 0 31891038 70004114 69849394 0 0 X 4278957 4278957 32547563 32547563 391320 391320 3804159 3804159 2614074 2614074 762370 762370 129175 129175 1218896 1218896 1922748 1922748 466662 466662 3126514 3126514 2014235 2014235 32187870 32187870 0 0 85464543 80294041 5170502 0 7579150 8436790 0 0 0 0 112705949 101146585 0 0 0 0 12275 0 975581 979184 287075 415045 92948763 68581470 24536616 24367293 0 0 0 0 0 0 0 0 487075 487076 146583721 135831973 9763203 12446204 0 0 0 0 0 0 0 0 0 0 10043778 12005202 0 0 5723194 6054486 25530175 30505892 X 121053546 105326081 0 0 0 0 121053546 105326081 146583721 135831973 X -15460429 0 0 0 0 -267036 X 0 1 1 0 X 2482024 0 2482024 56286456 0 40502078 15784378 0 0 0 0 34180283 0 28079392 6100891 0 0 0 0 24367293 0 Pension Liability 592106 Professional Liability 5462380 6054486 X 70004114 0 0 0 0 0 70004114 0 0 0 70004114 85464543 0 0 0 0 0 85464543 0 0 0 85464543 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, 2018. 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. Annual Gala 128145 0 128145 0 0 0 0 0 0 Annual Golf Outing 26575 0 26575 0 0 0 0 0 0 0 154720 0 154720 0 0 0 0 0 0 0 154720 1 1 1 X 1 X 1 1 1 0 1 1 3549240 0 0 3549240 0 0 0 4105503 10120956 0 0 14226459 0 0 0 0 0 17775699 0 0 0 1 3986794 3986794 17562555 17562555 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 1 0 1 X X X X X X X X X 17 1 0 0 1 X jacksonparkhospital.org X 1 17 1 jacksonparkhospital.org 0 0 1 X 200 200 X X X X X X 1 1 X X X 1 X jacksonparkhospital.org X jacksonparkhospital.org X X X X X 1 X 0 X X X 1 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 In November 2017 the hospital implemented free transportation to members of our community that do not have transportation to the hospital or its medical providers Schedule H, Part I, Line 7 Charity Care Cost is based is based on the total cost to charge ratio derived from the hospitals 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 ratio 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 inpatients and outpatients The hospital prepared its community health needs assessment using a professional company experienced in assisting hospitals in this process Together we confirmed the need for education and other interventions for diabetes, asthma and behavioral medicine The hospital has responded to these needs through the development of several community education programs and specialty clinics The hospital also implemented free transportation for patients who are unable to keep appointments with their primary care providers 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 encompass 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 January 2018, the hospital began a outreach program for senior patients This senior program will manage the primary healthcare needs and match the patient with a 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 X X X 0 0 0 0 0 0 0 0 0 William Dorsey MD Chairman/CEO 705980 0 0 0 12000 0 0 0 6863 0 724843 0 Merritt Hasbrouck President 894485 0 0 0 12000 0 0 0 210 0 906695 0 0 0 G Randall Smith Executive Vice President 601846 0 0 0 12000 0 0 0 17942 0 631788 0 0 0 James Clark Director 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Lakshmi Dodda MD Director 193358 101611 0 0 0 0 0 0 13025 0 206383 101611 0 0 Siddiq Hasan MD Director 123513 305668 0 0 0 0 0 0 0 0 123513 305668 0 0 Harshad Mehta MD Director 143277 0 0 0 0 0 0 0 13985 0 157262 0 0 0 Bangalore Murthy MD Director 162980 71604 0 0 0 0 0 0 17942 0 180922 71604 0 0 Haroon Olomi MD Director 87211 209916 0 0 0 0 0 0 13025 0 100236 209916 0 0 Surrenthia Parker MD Director 51316 425436 0 0 0 0 0 0 0 0 51316 425436 0 0 M Patrica Simon Senior Vice President Quality & Compliance 229168 0 0 0 0 0 0 0 12686 0 241854 0 0 0 Barry Mandell Vice President Special Projects 201111 0 0 0 0 0 0 0 17942 0 219053 0 0 0 Nelson Vasquez Vice President Finance 218987 0 0 0 0 0 0 0 17942 0 236929 0 0 0 Matthew Malters MD Physician 23424 663494 0 0 0 0 0 0 0 0 23424 663494 0 Caryn Carranza MD Physician 0 416867 0 0 0 0 0 0 0 0 0 416867 0 0 Pratap Kumar MD Physician 0 302700 0 0 0 0 0 0 0 0 0 302700 0 0 Thodur Ranganathan MD Physician 247413 0 0 0 0 0 0 0 17915 0 265328 0 0 0 James Nunn MD Physician 0 244115 0 0 0 0 0 0 0 0 0 244115 0 0 Schedule J, Part I, Line 3 Jackson Park Hospital Foundation has a compensation The Chairman of the Board reviews the compensation of senior management and key employees on an annual basis Bangalore Murthy MD Director 742343 Temporary Nurse Staffing 0 Bangalore Murthy MD Director 314406 Medical Education 0 Bamgalore Murthy MD Director 86922 Medical Education Billing 0 Form 990, Part VI, Section B, Line 11b The Management and the Chairman of the Audit Committee review the return prior to its release Form 990, Part VI, Section B, Line 12c All officers, directors or trustees and key employees are required to complete a conflict of interest disclosure annually and submit it to the Senior Vice President of Quality And Compliance This process was completed in February 2018 Form 990, Part VI, Section B, Line 15 Jackson Park Hospital Foundation has a 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 24e Other expenses include the provider tax, contract labor, supplies and professional fees Form 990, Part XI, Line 9 Pension plan change 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 0