2015-10-02T17:34:24-07:00 2015-03-31 990 2014-04-01 362448028 JACKSON PARK HOSPITAL FOUNDATION JACK 7739477989 7531 Stony Island Avenue Chicago IL 60649 William Dorsey MD Chairman/CEO 7739477989 2015-10-02 2014 2016-02-25 16:41:14Z William Dorsey MD 7531 Stony Island Chicago IL 60649 90110886 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 and high quality healthcare services to meet the needs of the patients and communities we serve. 10 3 815 0 0 0 4017411 288954 66263748 62683102 37102 9903 25846007 27128927 96164268 90110886 0 0 0 0 40041696 43925028 0 0 0 47260921 40713656 87302617 84638684 8861651 5472202 127240624 134477606 26016819 27976753 101223805 106500853 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 80341774 90110886 Jackson Park Hospital Foundation provides inpatient and outpatient medical care and behavioral medicine services to Chicago's south side communities regardless of the patients ability to pay. Jackson Park Hospital serves a economically challenged community with high rates of foreclosures, unemployment, violence and some of the worst health indices in the City of Chicago. Jackson Park Hospital itself is challenged to stay viable in such a poorly resourced area. However, Jackson Park Hospital works to deploy its limited resources in ways that most appropriately meets the needs of our community. 0 0 0 80341774 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 815 1 0 0 0 0 0 0 X 10 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Nelson Vasquez 7739477989 7531 Stony Island Chicago IL 60649 Dr Arol Augsburger Director 2 X 0 0 0 Bangalore Murthy MD Director 22 18.00 X 155202 137718 17084 Sameera T Qureshi MD Director 4 36 X 27431 135954 17181 James Nunn MD Director 8 32 X 66859 341694 16610 James Clark III Director 2 X 0 0 0 Haroon Olomi MD Director 4 36 X 80117 200857 15256 Lakshmi Dodda MD Director 36 4 X 201242 97189 15304 Dr Erma Brooks Williams Director 2 0 X 0 0 0 William Dorsey MD Chairman / CEO 40 0 X X 621806 0 9039 Harshad Mehta MD Director 40 0 X 125667 0 13635 Merritt Hasbrouck President 40 0 X 524687 0 3120 G Randall Smith Executive Vice President 40 0 X 515393 0 19604 Nelson Vasquez VP Finance 40 0 X 207879 0 20275 Barry Mandell VP Special Projects 40 0 X 162202 0 19842 Patricia Simon VP Quality and Compliance 40 0 X 157397 0 13704 Thodur Ranganathan MD Physician 40 0 X 220239 0 17181 Rose Ette RN Registered Nurse 60 0 X 205891 0 13407 Bayo B Agbolade Registered Nurse 60 0 X 172628 0 0 Raylene M Swinock Registered Nurse 60 0 X 170135 0 4945 Georgina Lubben MD Physician 38 2 X 131793 33692 264 3746568 947104 216451 43 0 1 0 McKesson 5995 Windward Parkway Alpharetta GA 30005 Healthcare IT Services and Systems 1491759 EMCARE INC 7032 Collection Center Chicago IL 60693 Provides Emergency Room Physicians 1477913 Rush Nursing Services 7501 Stony Island Chicago IL 60649 Temporary Nurse Staff 1272548 Northern Illinois Clinical Laboratory 306 E Era Drive Northbrook IL 60062 Laboratory Services 3381222 Crystal Care Dept 4501 Boca Raton FL 33431 Temporary Nursing Staff 1140857 20 0 0 0 0 0 288954 0 288954 Inpatient, Outpatient and emergency services 622110 62683102 62683102 0 0 0 0 0 0 62683102 9903 9903 0 0 0 0 0 0 0 0 0 0 74825 0 0 0 74825 0 74825 74825 0 0 0 0 0 27054102 27054102 0 0 27054102 90110886 89821932 0 0 X 0 0 0 0 0 0 0 0 6251192 3125596 3125596 0 0 0 0 0 30411768 30411768 0 0 337027 337027 0 0 4481091 4481091 0 0 2443950 2443950 0 0 575000 287500 287500 0 1473376 736688 736688 0 294252 147126 147126 0 0 0 0 0 0 0 0 0 0 0 33258188 33258188 0 0 0 0 0 0 0 0 0 0 1718711 1718711 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 498140 498140 0 0 0 0 0 0 2744030 2744030 0 0 151959 151959 0 0 84638684 80341774 4296910 0 6695550 7038442 0 0 0 0 92288855 99685167 0 0 0 0 0 0 954944 808734 468445 27501 85014681 58734296 26196000 26280385 0 0 0 0 0 0 0 0 636830 637377 127240624 134477606 10997861 11828226 0 0 0 0 0 0 0 0 0 0 8755356 10090981 0 0 6263602 6057546 26016819 27976753 X 101223805 106500853 0 0 0 0 101223805 106500853 127240624 134477606 X 5472202 -2200 0 0 0 -192954 X 0 1 X 1 0 X 2482024 0 2482024 52257828 0 58734296 -6476468 0 0 0 0 30274829 0 0 30274829 0 0 0 0 26280385 Pension Liability 704797 Professional Liability 5352749 6057546 90110886 0 0 0 0 0 90110886 0 0 0 90110886 84638684 0 0 0 0 0 84638684 0 0 0 84638684 1 1 X 1 X 1 X 1 1 1 0 1 1 4094723 4094723 0.0484 0 0 4094723 0 4094723 0.0484 3650376 3650376 0.0431 8757585 8757585 0.1035 0 0 12407961 0 12407961 0.1466 0 0 16502684 0 16502684 0.1950 1 5466014 2733007 21131123 21131123 0 X 0 1 1 Jackson Park Hospital Foundation 7531 Stony Island Chicago IL 60649 www.jacksonparkhospital.org 0001115 X X X X Behavioral Medicine Jackson Park Hospital Foundation 1 0 0 1 X X X X X X 14 1 0 1 1 X 0 0 1 X 200 200 X X X X X X 1 1 X X X X 1 X X X X X 0 X 1 X X X 1 0 0 Schedule H, Part V, Section B, Line 5-Jackson Park Hospital Foundation Through the Metropolitan Chicago Healthcare Council, focus groups were held in our primary zip codes. Our education and outreach programs were designed to meet the needs of the community. Schedule H, Part V, Section B, Line 6b-Jackson Park Hospital Foundation The Metropolitan Chicago Healthcare Council Schedule H, Part V, Section B, Line 11-Jackson Park Hospital Foundation Jackson Park Hospital believes that it is meeting the needs of the community through its education and outreach programs Schedule H, Part I, Line 7 The hospital determined the cost of services provided by using the Medicare cost to charge ratio (worksheet C, Part 1, PPS Inpatient Ratios). Schedule H, Part I, Line 7, Column f The hospital reported a total of $16,186,005 in bad debts Schedule H, Part III, Section A, Line 4 Schedule H, Part III, Section A, Line 4 - In July 2011, the FASB issued ASU 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debt, and the Allowance for Doubtful Accounts for Certain Health Care Entities. ASU 2011-07 amends Accounting Standards Codification 954, Health Care Entities, to provide financial statement users with greater transparency about a health care entity's net patient service revenue, which is sometimes grossed up and recognized at the time the services are rendered regardless of whether the entity expects to collect that amount, and the related allowance for doubtful accounts. ASU 2011-07 provides information to assist financial statement users in assessing an entity's sources of net patient service revenue and related changes in its allowance for doubtful accounts. It requires health care entities that recognize significant amounts of patient service revenue at the time the services are rendered, even though they do not assess the patient's ability to pay, to present the provision for bad debts related to patient service revenue as a deduction from patient service revenue (net of contractual allowances and discounts) on their statement of operations. For non-public entities, ASU 2011-07 is effective for the first annual period ending after December 15, 2012 and interim and annual periods thereafter, with early adoption permitted. The Corporation adopted this new standard in fiscal year 2013. Schedule H, Part III, Section B, Line 8 The hospital reported actual cash collections from Medicare from its annual cost report Schedule H, Part VI, Line 2 Jackson Park Hospital Foundation begins outreach and assessment of its community health by evaluating which health conditions and diseases are prevalent among its inpatient and outpatients. The hospital also purchased community health information services from the Metropolitan Chicago Health Care Council which included focus groups with-in our primary care area. Together, they confirm 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. Schedule H, Part VI, Line 3 The hospital has contracted with a third party that assist any patient through the application process of Medicaid, Medicare and the affordable care act. This same company will also assist a patient and or family through the hospital's charity care application. Schedule H, Part VI, Line 4 Jackson Park Hospital's primary service area is 60649,60620,60617 and 60628. Our primary care service area for behavioral patients is much broader and encompass the City of Chicago. The average income in the hospital's primary service area is approximately 46% of the State of Illinois average. Schedule H, Part VI, Line 5 In addition to various education programs with-in the hospital. The hospital has begun regular education and outreach programs at the local grocery store and banks. Schedule H, Part VI, Line 7 Jackson Park Hospital Foundation prepares and submits an annual Community Benefit Report to the Attorney General of the State of Illinois. This report is also made available to the general public upon request. X X X X X 0 0 0 0 0 0 0 0 0 Merritt Hasbrouck President 524687 0 0 0 0 0 0 0 3120 0 527807 0 528595 0 G Randall Smith Executive Vice President 515393 0 0 0 0 0 0 0 19604 0 534997 0 535255 0 William Dorsey MD Chairman / CEO 621806 0 0 0 0 0 0 0 9039 0 630845 0 614148 0 Lakshmi Dodda MD Director 201242 97189 0 0 0 0 0 0 15304 0 216546 97189 210354 0 Harshad Mehta MD Director 125667 0 0 0 0 0 0 0 13635 0 139302 0 129381 0 Bangalore Murthy MD Director 155202 137718 0 0 0 0 0 0 17084 0 172286 137718 178528 137718 Haroon Olomi MD Director 80117 200857 0 0 0 0 0 0 15256 0 95373 200857 108686 200649 James Nunn MD Director 66859 341694 0 0 0 0 0 0 16610 0 83469 341694 91409 341694 Nelson Vasquez VP Finance 207879 0 0 0 0 0 0 0 20275 0 228154 0 212067 0 Patricia Simon VP Quality and Compliance 157397 0 0 0 0 0 0 0 13704 0 171101 0 154214 0 Barry Mandell VP Special Projects 162202 0 0 0 0 0 0 0 19842 0 182044 0 160897 0 Thodur Ranganathan MD Physician 220239 0 0 0 0 0 0 0 17181 0 237420 0 261073 0 Rose Ette RN Registered Nurse 205891 0 0 0 0 0 0 0 13407 0 219298 0 228512 0 Bayo B Agbolade Registered Nurse 172628 0 0 0 0 0 0 0 0 0 172628 0 0 0 Raylene M Swinock Registered Nurse 170135 0 0 0 0 0 0 0 4945 0 175080 0 0 0 Georgina Lubben MD Physician 131793 33692 0 0 0 0 0 0 264 0 132057 33692 131623 33657 Sameera T Qureshi MD Director 27431 135954 0 0 0 0 0 0 17181 0 44612 135954 81554 24178 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 form every three years. This process was completed in 2014. Form 990, Part VI, Section B, Line 15 Jackson Park Hospital Foundation has a compensation committee. The Chairman of the board 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 990, conflict of interest policy, community benefit report and financial statements available to the public by appointment with its vice president of finance. Form 990, Part IX, Line 11g Other expense items such as contract labor and purchased services $12,954,658, supplies $9,362,013, Professional fees $3,401,759, utilities $1,686,816, and provider tax expense $7,703,035 Form 990, Part XI, Line 9 Pension plan losses and expenses during 2015 The Friedell Clinic SC 7531 Stony Island Avenue Chicago IL 60649 363290656 Primary Health Care IL C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 There was a delay in completing the audited statements