2019-08-15T08:40:26-05:00 2018-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2017-10-01 592425149 Jay Hospital Inc % KEITH STRICKLING JAYH 8504344714 POST OFFICE BOX 17500 PENSACOLA FL 32522 MICHAEL GLEASON SVP/CFO 8504697643 2019-08-15 true Michael J Engle P00482834 8162216300 167.68.126.162 43372220192275000010 2019-08-15 P 8EF1097B0777C414CCA6378D7E1DA964BB9E7854 355CC2E4B6E27E32DAADC48E1CA8D97843AD7DA8 2017 2019-02-21 02:37:17Z BRYON SCOTT RAYNES 1717 N E ST STE 320 PENSACOLA FL 32501 12221242 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. 13 13 164 31 19546 1435 0 0 12035097 11676109 5855 2029 256696 536672 12297648 12214810 14100 14800 0 0 6778040 6839632 0 0 0 8317827 9570318 15109967 16424750 -2812319 -4209940 3709020 3710947 8149101 12360968 -4440081 -8650021 X SEE SCHEDULE O false false 12421344 11676109 GENERAL AND SPECIALIZED HEALTH CARE SERVICES INCLUDING INPATIENT, PRIMARY CARE, LONG TERM AND OUTPATIENT HEALTHCARE SERVICES. 14800 14800 COMMUNITY BENEFIT OUTREACH ACTIVITIES CONDUCTED BY THE ORGANIZATION INCLUDING HEALTH EDUCATION SEMINARS, HEALTH FAIRS, AND DONATIONS TO OTHER NON-PROFIT ENTITIES. 12436144 true false 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 false true false false false false false false false false false false false false false true true true false false true X 3 0 true 164 true true true false false false false false false false false false X 13 13 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 X Ronald E Jackson CHAIRMAN 1.0 2.0 X X 0 0 0 KIM JERNIGAN DMD VICE CHAIRMAN/BOARD MEMBER 1.0 2.0 X X 0 0 0 Ricky W Smith SECRETARY 1.0 1.0 X X 0 0 0 MICHAEL J MAZENKO TREASURER 1.0 1.0 X X 0 0 0 LUTHER TAYLOR MEMBER/VICE CHAIRMAN 1.0 2.0 X X 0 0 0 JOHN HEER MEMBER 1.0 1.0 X 0 0 0 JOHN BAEHR MD MEMBER-TERM ENDED 3/18 1.0 1.0 X 0 0 0 ADM ROBERT KELLY MEMBER 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 MARTHA SAUNDERS PHD MEMBER-TERM ENDED 03/18 1.0 2.0 X 0 0 0 DOUG SPRAGUE MEMBER 1.0 1.0 X 0 0 0 KARA CARDONA MEMBER-TERM START 04/18 1.0 1.0 X 0 0 0 REV LONNIE WESLEY MEMBER 1.0 1.0 X 0 0 0 STEPHANIE WHITE MEMBER 1.0 1.0 X 0 0 0 MICHAEL HUTCHINS VP/ADMINISTRATOR 40.0 0.0 X 246319 0 25505 MICHAEL GLEASON SVP/CFO 5.0 45.0 X 0 712013 131591 BYRON SCOTT RAYNES PRESIDENT-JHI/EXEC VP-BHC 10.0 40.0 X 0 617622 127096 DANIEL D SHEPPARD PHARMACIST 40.0 0.0 X 123006 0 28566 GEORGIA W AGRAIT NURSE PRACTITIONER 40.0 0.0 X 102225 0 11628 KEITH STRICKLING CONTROLLER 40.0 0.0 X 106010 0 28811 KARIN PARDUE PHYSICIAN 40.0 0.0 X 159645 0 25157 GREG W PETTY NURSE PRACTITIONER 40.0 0.0 X 104218 0 11403 841423 1329635 389757 6 false true false Mark Elder DO 2946 GREYSTONE DR PACE FL 32571 Physician Services 268307 JEFF KELLY MD PO BOX 1 JAY FL 32565 PHYSICIAN SERVICES 104740 2 0 NET PATIENT SERVICE REVENUE 621990 11676109 11656563 19546 11676109 868 868 0 0 22050 6432 15618 0 15618 15618 1161 1161 1161 1161 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722210 27317 27317 MEDICAL RECORDS 541900 3130 3130 MISCELLANEOUS REVENUE 900099 490607 490607 490607 490607 521054 12214810 11656563 19546 538701 14800 14800 0 0 0 277562 222050 55512 0 5451538 4963751 487787 171453 155211 16242 549417 497368 52049 389662 352748 36914 2349930 140009 2209921 2080 2080 0 0 0 0 1529613 1169865 359748 1717 1717 180729 126915 53814 12395 12395 0 273966 247517 26449 40350 10189 30161 0 192 192 263892 263892 0 451418 383705 67713 158453 158453 BAD DEBT EXPENSE 3242658 3242658 MEDICAL SUPPLIES 667246 667246 INDIGENT ASSESSMENT 114906 114906 FOOD COSTS 100825 99939 886 179948 13155 166793 16424750 12436144 3988606 0 57345 66462 0 0 0 0 820796 881239 0 0 0 0 0 0 134487 131395 63828 63516 12397805 9829470 2632564 2568335 0 0 0 0 0 0 0 0 0 0 3709020 3710947 712369 855855 0 0 0 0 0 0 0 0 0 0 378377 338104 0 0 7058355 11167009 8149101 12360968 X -4440081 -8650021 0 0 0 0 -4440081 -8650021 3709020 3710947 -4209940 X false true X true false X X 2607 249769 2607 249769 16422143 943235397 16424750 943485166 971238 1000000 242810 1367478 1000000 1000000 1000000 1000000 4000000 6000000 84612 232507 246919 249769 813807 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 62193 62193 1182808 176381 1006427 4591085 3593821 997264 6385338 6023045 362293 176381 36223 140158 2568335 0 DUE TO THIRD PARTIES 905297 ASSET RETIREMENT OBLIGATION 134591 DUE TO AFFILIATES 10127121 11167009 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. ASC Topic 740 provides guidance for recognition threshold and measurement attributes for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. There were no material uncertain tax positions as of September 30, 2018 and 2017. true true X true X false true true true false true true 741365 741365 0.05620 2153663 1643388 510275 0.03870 2895028 1643388 1251640 0.09490 8 14800 14800 0.00110 8 14800 14800 0.00110 8 2909828 1643388 1266440 0.09600 false 3242658 924158 4163331 6176588 -2013257 X true true 1 1 JAY HOSPITAL 14114 ALABAMA STREET JAY FL 32565 100048 X X X JAY HOSPITAL 1 false false true X X X X X X X X X 15 true true true true X ebaptisthealthcare.org/community/CHNA X true 15 true www.ebaptisthealthcare.org/community/CHNA false true X 200. 0. 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 Partnership for a Healthy Community (PFAHC), a nonprofit tax-exempt organization whose mission is to sponsor community health status assessments for the two counties and to support and promote collaborative initiatives that address priority health problems. Collaborating partners in the completion of this report include representatives from the Florida Departments of Health in Escambia and Santa Rosa Counties, Baptist Health Care and its affiliates (including Jay Hospital), Sacred Heart Health System, Escambia Community Clinics (a federally qualified health center) and the University of West Florida. With the Florida Department of Health as a partner, the Mobilizing for Action through Planning and Partnerships (MAPP) process was utilized to conduct the CHNA. The MAPP process is a community-driven strategic planning process for improving community health and is comprised of four individual assessments. In August 2015, twenty-two diverse stakeholders, representing the Northwest Florida Partnership for a Healthy Community, Baptist Health Care and its affiliates (including Jay Hospital), Sacred Heart Health System, the Florida Department of Health-Escambia, Florida Department of Health-Santa Rosa, Escambia and Santa Rosa Community Clinics, Santa Rosa Medical Center, Santa Rosa School District, Healthy Start of Santa Rosa County, SMI Consultants, United Way of Escambia County, the University of West Florida, Ascendant Healthcare Partners, Interfaith Ministries/Good Samaritan Clinic, non-profit organizations and others, served as members of a PFAHC workgroup that designed the CHNA process, assimilated the results and provided recommendations to the PFAHC's Board of Directors. PFAHC's Board of Directors provided oversight and input throughout the development of the assessment and establishment of priority health needs by way of discussions at Board meetings. These directors included representatives from the County's Department of Health and other organizations representing the broad interest of the community. SCHEDULE H, Part V, Section B, Line 6a Baptist Health Care (Jay Hospital's parent company), Sacred Heart Health System, and Escambia Community Clinics, a federally qualified health center, were lead organizations and funders of the CHNA process. Senior leadership from Baptist Health Care, Sacred Heart Health System, the Florida Department of Health-Escambia, Florida Department of Health-Santa Rosa, Escambia and Santa Rosa Community Clinics, Santa Rosa Medical Center and Interfaith Ministries/Good Samaritan Clinic also served as members of a PFAHC workgroup that designed the CHNA process, assimilated the results and provided recommendations to the Partnership Board of Directors. SCHEDULE H, Part V, Section B, Line 6b Non-hospital stakeholders, including the University of West Florida, Santa Rosa School District, Healthy Start of Santa Rosa County, SMI Consultants, United Way of Escambia County, Ascendant Health Care Partners, as well as several non-profit and other organizations were part of the diverse PFAHC workgroup that designed the CHNA process, assimilated the results and provided recommendations to the Partnership Board of Directors. SCHEDULE H, Part V, Section B, Line 11 The Partnership completed this process with a holistic review of the data gathered in each of the assessments to identify overarching themes and health issues. The issues were discussed by the Partnership Board of Directors who represents a diverse group of community partners from each county. The discussion affirmed that the health issues selected in 2012 continue to be primary community health concerns. As such, the Board adopted as the 2016 Community Health Priorities for the communities of Escambia and Santa Rosa Counties the following health priorities: - Tobacco Use - Healthiest Weight - Access to Care Jay Hospital, working through its parent company, Baptist Health Care, in collaboration with other hospitals in the system, 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. Baptist Health Care affiliate hospitals and their partners organized work groups around each of the three health improvement priorities and provided broad community leadership, as well as commitment of resources to accomplish the following goals and achieve collective impact: Tobacco Use: - Implement community based tobacco cessation program by hosting on-site tobacco cessation classes - Participate in collaborative efforts lead by the Partnership for a Healthy Community to reduce tobacco use. Healthy Weight: - Because of limited resources, Jay Hospital will not address this priority beyond its involvement in the collaborative efforts lead by the Partnership for a Healthy Community. Access to Care: - Increase access to health education by providing opportunities for community health education - Develop passive education tool to improve understanding of access to care - Participate in collaborative efforts lead by the Partnership for a Healthy Community to increase access to health care. Healthy Community to increase access to health care. 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 FEDERAL POVERTY GUIDELINES 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 $3,242,658 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, LINES 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 WITH THE POLICY 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 THE ORGANIZATION'S COMMUNITY BENEFIT. APPROXIMATELY 28.5% OF JAY HOSPITAL'S PATIENTS QUALIFY FOR FREE OR DISCOUNTED CARE. HOWEVER, IT IS NOT KNOWN HOW MUCH OF THE ORGANIZATION'S BAD DEBT EXPENSE WOULD BE INCLUDED AS COMMUNITY BENEFIT HAD THOSE PATIENTS COMPLETED THE FINANCIAL ASSISTANCE PROCESS, THOUGH IT IS BELIEVED THAT SOME PORTION WOULD QUALIFY FOR FINANCIAL ASSISTANCE. ASSISTANCE. 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 ORGANIZATIONS 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 PATIENTS 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 AND FINANCIAL ASSITANCE APPLICATIONS ON ITS INTERNET WEBSITE. SCHEDULE H, PART VI, LINE 4 JAY HOSPITAL, INC. OPERATES IN SANTA ROSA COUNTY, FLORIDA. APPROXIMATELY 179,000 INDIVIDUALS RESIDE IN THIS COUNTY, 10.2% OF WHICH LIVE BELOW POVERTY LEVEL. WHEN CONSIDERING THESE FACTORS, MORE THAN 18,000 RESIDENTS COULD BE ELIGIBLE TO QUALIFY FOR CHARITY CARE. APPROXIMATELY 28.5% OF JAY HOSPITAL'S PATIENTS DURING FY2018 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 HOSPITAL - 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) 12500 Healthcare Assistance 1 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 167461 0 41689 0 37169 0 10773 0 14732 0 271824 0 0 0 MICHAEL GLEASON SVP/CFO 0 536076 0 140919 0 35018 0 112304 0 19287 0 843604 0 0 DANIEL D SHEPPARD PHARMACIST 122566 0 0 0 440 0 3212 0 25354 0 151572 0 0 0 KARIN PARDUE PHYSICIAN 0 0 159645 0 0 0 0 0 25157 0 184802 0 0 0 BYRON SCOTT RAYNES PRESIDENT-JHI/EXEC VP-BHC 0 494373 0 101582 0 21667 0 96599 0 30497 0 744718 0 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 - BYRON (SCOTT) RAYNES SCHEDULE J, PART I, LINE 4B ACCRUED -------- MICHAEL GLEASON $104,688 MICHAEL HUTCHINS $6,436 BYRON (SCOTT) RAYNES $86,316 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 ORGANIZATION: -BAPTIST HEALTH CARE CORPORATION 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 55-BED ACUTE CARE 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 V, LINE 1A ALL 1099'S ARE ISSUED ON THE ORGANIZATION'S BEHALF BY BAPTIST HEALTH CARE CORPORATION, THE SOLE MEMBER AND RELATED 501 (C)(3) TAX EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 MICHAEL GLEASON, MICHAEL HUTCHINS, AND BYRON (SCOTT) RAYNES HAVE A BUSINESS RELATIONSHIP. THE BUSINESS RELATIONSHIP IS AN EMPLOYER/EMPLOYEE RELATIONSHIP AT RELATED TAX-EXEMPT ORGANIZATIONS. RONALD E. JACKSON, KIM JERNIGAN, D.M.D., MARTHA SAUNDERS, PH.D., AND LUTHER TAYLOR HAVE A BUSINESS RELATIONSHIP WITH MICHAEL GLEASON. RONALD E. JACKSON, KIM JERNIGAN, D.M.D., MARTHA SAUNDERS, PH.D., AND LUTHER TAYLOR ARE BOARD MEMBERS OF BAPTIST HEALTH CARE CORPORATION AND MICHAEL GLEASON IS AN EMPLOYED OFFICER OF BAPTIST HEALTH CARE CORPORATION. RONALD E. JACKSON, KIM JERNIGAN, D.M.D., RICKY W. SMITH, MICHAEL J. MAZENKO, LUTHER TAYOLR, JOHN HEER, JOHN BAEHR, M.D., ADM. ROBERT KELLY, JOHN M. KIZZAH, THOMAS F. OWENS, MARTHA SAUNDERS, PH.D., DOUG SPRAGUE, KARA CARDONA, REV. LONNIE WESLEY, STEPHANIE WHITE, AND BYRON (SCOTT) RAYNES HAVE A BUSINESS RELATIONSHIP. ALL EXCEPT BYRON (SCOTT) RAYNNES ARE BOARD MEMBERS OF BAPTIST HOSPITAL, INC. WHERE MR. RAYNES IS AN EMPLOYEE. 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 11 AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. 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, LINE 15A 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 MEMBER CHANGED THEIR POSITION WITHIN THE BOARD DURING THE TAX YEAR AS A RESULT OF THE TIMING OF BOARD MEMBER ELECTIONS: 10/01/17 - 03/31/18 04/01/18 - 09/30/18 KIM JERNIGAN, D.M.D. VICE CHAIRMAN BOARD MEMBER LUTHER TAYLOR BOARD MEMBER VICE CHAIRMAN 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 ABLE FORCES INC 1221 WEST LAKEVIEW AVE PENSACOLA FL 32501 270881311 VOC TRAINING VA 501(C)(3) 10 GCE true BAPTIST MEDICAL PARK SURGERY CENTER LLC 9400 UNIVERSITY PKWY PENSACOLA FL 32514 593535262 AMBULATORY SURG. FL NA N/A ANDREWS INSTITUTE ASC LLC 1040 GULF BREEZE PKWY GULF BREEZE FL 32561 352274952 AMBULATORY SURG. FL NA N/A LIGHTHOUSE HEALTH PLAN LLC 1717 NORTH E STREET STE 320 PENSACOLA FL 32501 823182832 HEALTH INS. 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