JAY HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- JAY HOSPITAL INC (EIN 59-2425149)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-14
- IRS object ID
- 201402269349301705
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
- Affiliated Group Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-14T09:58:31-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 592425149 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jay Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % KEITH STRICKLING | InCareOfName |
| Name Control | JAYH | NameControl |
| Phone | 8504344714 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | POST OFFICE BOX 17500 | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | PENSACOLA | City |
| State | FL | State |
| ZIP Code | 32522 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ELEANOR MCGEE | Name |
| Title | VP FIN/CONTROLLER | Title |
| Phone | 8504344714 | Phone |
| Date Signed | 2014-08-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Michael T Hutchins | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1717 N E ST STE 320 | AddressLine1 |
| City | PENSACOLA | City |
| State | FL | State |
| ZIP Code | 32501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 13795483 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.ebaptisthealthcare.org/JayHospital | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | FL | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 166 | TotalNbrEmployees |
| Total Nbr Volunteers | 24 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 9010 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 13326343 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 12106721 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 9929 | InvestmentIncomePriorYear |
| Investment Income Current Year | 795 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 408646 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1671171 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 13744918 | TotalRevenuePriorYear |
| Total Revenue Current Year | 13787697 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 14000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 14400 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5795135 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5551742 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8548125 | OtherExpensePriorYear |
| Other Expenses Current Year | 8891817 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 14357260 | TotalExpensesPriorYear |
| Total Expenses Current Year | 14457959 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -612342 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -670262 | RevenuesLessExpensesCY |
| Total Assets BOY | 5410583 | TotalAssetsBOY |
| Total Assets EOY | 6384329 | TotalAssetsEOY |
| Total Liabilities BOY | 2257597 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3901605 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3152986 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2482724 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 11347031 | Expense |
| Grants | 0 | Grants |
| Revenue | 13716811 | Revenue |
| Description | GENERAL AND SPECIALIZED HEALTH CARE SERVICES INCLUDING INPATIENT, PRIMARY CARE, LONG TERM AND OUTPATIENT HEALTHCARE SERVICES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 16745 | Expense |
| Grants | 14400 | Grants |
| Revenue | 0 | Revenue |
| Description | COMMUNITY BENEFIT OUTREACH ACTIVITIES CONDUCTED BY THE ORGANIZATION INCLUDING HEALTH EDUCATION SEMINARS, HEALTH FAIRS, AND DONATIONS TO OTHER NON-PROFIT ENTITIES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 11363776 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 166 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KEITH STRICKLING | NamePerson |
| Telephone Number | 8506758024 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14114 ALABAMA STREET | AddressLine1 |
| City | Jay | City |
| State | FL | State |
| ZIP Code | 32565 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Ronald E Jackson | ||||||||
| CHAIRMAN | 1.0 | 1.0 | X | X | 0 | 0 | 0 | |
| Larry K Hicks | ||||||||
| VICE CHAIRMAN | 1.0 | 1.0 | X | X | 0 | 0 | 0 | |
| Ricky W Smith | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| David Kellen MD | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| James L Lonquist MD | ||||||||
| MEMBER | 1.0 | 41.0 | X | 0 | 499459 | 46864 | ||
| Adm Robert Kelly | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| John Hosman | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| Kim Jernigan DMD | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| Michael J Mazenko | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| Thomas F Owens | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| Margaret T Stopp | ||||||||
| SECRETARY-TREASURER | 1.0 | 1.0 | X | X | 0 | 0 | 0 | |
| Milton F Usry PhD | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| John J Baehr III MD | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| John M Kizziah | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| Kelli Wells MD | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| Reverend LuTimothy May | ||||||||
| Member | 1.0 | 1.0 | X | |||||
| Frank White | ||||||||
| Member | 1.0 | 1.0 | X | |||||
| LUTHER TAYLOR | ||||||||
| MEMBER | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| Mike Hutchins | ||||||||
| VP/ADMINISTRATOR | 50.0 | 0.0 | X | 211207 | 0 | 24945 | ||
| Kerry Vermillion | ||||||||
| SR VP FINANCE/CFO | 4.0 | 46.0 | X | 0 | 499027 | 74991 | ||
| Melanie Styles | ||||||||
| LABORATORY MANAGER | 40.0 | 0.0 | 103584 | 0 | 16243 | X | ||
| Daniel Sheppard | ||||||||
| Pharmacist | 40.0 | 0.0 | 115043 | 0 | 20544 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 429834 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 998486 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 183587 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| Mark Elder MD | |
| Physician Services | 153366 |
| Jeff Kelley MD | |
| Physician Services | 270239 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| All Other Contributions | 9010 | AllOtherContributions |
| Total Contributions | 9010 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 12106721 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12106721 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 12106721 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 795 | TotalRevenueColumn |
| Exclusion | $795 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 31835 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 7786 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 24049 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24049 | TotalRevenueColumn |
| Exclusion | $24,049 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA SALES | 722210 | 30323 | $30,323 | |
| MEDICAL RECORDS | 541900 | 6262 | $6,262 | |
| CLINICAL IT STIMULUS REBATE | 900099 | 1610090 | 1610090 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 447 | TotalRevenueColumn |
| Exclusion | $447 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1647122 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13787697 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13716811 | RelatedOrExemptFunctionIncome |
| Exclusion | $61,876 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14400 | Total |
| Program Services | 14400 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 218775 | Total |
| Program Services | 172210 | ProgramServices |
| Management And General | 46565 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4422184 | Total |
| Program Services | 3841923 | ProgramServices |
| Management And General | 580261 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59607 | Total |
| Program Services | 51596 | ProgramServices |
| Management And General | 8011 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 535151 | Total |
| Program Services | 466317 | ProgramServices |
| Management And General | 68834 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 316025 | Total |
| Program Services | 273552 | ProgramServices |
| Management And General | 42473 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1541088 | Total |
| Management And General | 1541088 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48855 | Total |
| Management And General | 48855 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1374141 | Total |
| Program Services | 1051085 | ProgramServices |
| Management And General | 323056 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24756 | Total |
| Program Services | 22356 | ProgramServices |
| Management And General | 2400 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 166641 | Total |
| Program Services | 125389 | ProgramServices |
| Management And General | 41252 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22246 | Total |
| Program Services | 21633 | ProgramServices |
| Management And General | 613 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 211390 | Total |
| Program Services | 184482 | ProgramServices |
| Management And General | 26908 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56083 | Total |
| Program Services | 11336 | ProgramServices |
| Management And General | 44747 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10253 | Total |
| Program Services | 300 | ProgramServices |
| Management And General | 9953 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39208 | Total |
| Management And General | 39208 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 634273 | Total |
| Program Services | 539132 | ProgramServices |
| Management And General | 95141 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94433 | Total |
| Management And General | 94433 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 3648825 | 3648825 | |
| MEDICAL SUPPLIES | 710677 | 710677 | |
| INDIGENT ASSESSMENT | 135543 | 135543 | |
| FOOD COSTS | 84989 | 78614 | 6375 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88416 | Total |
| Program Services | 14406 | ProgramServices |
| Management And General | 74010 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14457959 | Total |
| Program Services | 11363776 | ProgramServices |
| Management And General | 3094183 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10492 | BOY |
| EOY | 10477 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1571079 | BOY |
| EOY | 1051840 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 157635 | BOY |
| EOY | 141170 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73273 | BOY |
| EOY | 54494 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 12737191 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8747852 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3322789 | BOY |
| EOY | 3989339 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 275315 | BOY |
| EOY | 1137009 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5410583 | BOY |
| EOY | 6384329 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 866956 | BOY |
| EOY | 886358 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 508575 | BOY |
| EOY | 424434 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 882066 | BOY |
| EOY | 2590813 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2257597 | BOY |
| EOY | 3901605 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3152986 | BOY |
| EOY | 2482724 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3152986 | BOY |
| EOY | 2482724 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5410583 | BOY |
| EOY | 6384329 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -670262 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Belongs To Affiliated Group | X | OrgBelongsToAffiliatedGroup |
Total Grassroots Lobbying TotalGrassrootsLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 0 | FilingOrganizationsTotals |
| Affiliated Group Totals | 0 | AffiliatedGroupTotals |
Total Direct Lobbying TotalDirectLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 3746 | FilingOrganizationsTotals |
| Affiliated Group Totals | 117438 | AffiliatedGroupTotals |
Total Lobbying Expenditures TotalLobbyingExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 3746 | FilingOrganizationsTotals |
| Affiliated Group Totals | 117438 | AffiliatedGroupTotals |
Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 14454213 | FilingOrganizationsTotals |
| Affiliated Group Totals | 692097311 | AffiliatedGroupTotals |
Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 14457959 | FilingOrganizationsTotals |
| Affiliated Group Totals | 692214749 | AffiliatedGroupTotals |
Lobbying Nontaxable LobbyingNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 872898 | FilingOrganizationsTotals |
| Affiliated Group Totals | 6371523 | AffiliatedGroupTotals |
Grassroots Nontaxable GrassrootsNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 218225 | FilingOrganizationsTotals |
| Affiliated Group Totals | 1592881 | AffiliatedGroupTotals |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx |
Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 1000000 | CurrentYearMinus3 |
| Current Year Minus2 | 1000000 | CurrentYearMinus2 |
| Current Year Minus1 | 1000000 | CurrentYearMinus1 |
| Current Year | 1000000 | CurrentYear |
| Total | 4000000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Lobbying Ceiling | $6,000,000 | LobbyingCeilingAmount |
Total Lobbying Expenditures2 TotalLobbyingExpenditures2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 192223 | CurrentYearMinus3 |
| Current Year Minus2 | 216698 | CurrentYearMinus2 |
| Current Year Minus1 | 213915 | CurrentYearMinus1 |
| Current Year | 117438 | CurrentYear |
| Total | 740274 | Total |
Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 250000 | CurrentYearMinus3 |
| Current Year Minus2 | 250000 | CurrentYearMinus2 |
| Current Year Minus1 | 250000 | CurrentYearMinus1 |
| Current Year | 250000 | CurrentYear |
| Total | 1000000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grassroots Ceiling | $1,500,000 | GrassrootsCeilingAmount |
Grassroots Lobbying Expenditures GrassrootsLobbyingExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 0 | CurrentYearMinus3 |
| Current Year Minus2 | 0 | CurrentYearMinus2 |
| Current Year Minus1 | 0 | CurrentYearMinus1 |
| Current Year | 0 | CurrentYear |
| Total | 0 | Total |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 62193 | OtherCostOrOtherBasis |
| Book Value | 62193 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 977439 | OtherCostOrOtherBasis |
| Depreciation | 180621 | Depreciation |
| Book Value | 796818 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4602208 | OtherCostOrOtherBasis |
| Depreciation | 3037177 | Depreciation |
| Book Value | 1565031 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6913298 | OtherCostOrOtherBasis |
| Depreciation | 5508328 | Depreciation |
| Book Value | 1404970 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 182053 | OtherCostOrOtherBasis |
| Depreciation | 21726 | Depreciation |
| Book Value | 160327 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3989339 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM AFFILIATES | 0 |
| DUE FROM THIRD PARTIES | 1093259 |
| PHYSICIAN GUARANTEE | 43750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1137009 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD PARTIES | $0 |
| ASSET RETIREMENT OBLIGATION | $125,118 |
| DUE TO AFFILIATES | $2,465,695 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2590813 | TotalOfAmounts |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | UNCERTAIN TAX POSITIONS DISCLOSURE | Identifier |
| Return Reference | SCHEDULE D, PART X, LINE 2 | ReturnReference |
| Explanation | 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, 2013 and 2012. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 288046 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 288046 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02660 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1583056 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1333541 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 249515 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02310 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1871102 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1333541 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 537561 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04970 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 87 | PersonsServed |
| Total Community Benefit Expense | 2345 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2345 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14400 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14400 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 87 | PersonsServed |
| Total Community Benefit Expense | 16745 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16745 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 87 | PersonsServed |
| Total Community Benefit Expense | 1887847 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1333541 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 554306 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05120 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $721,191 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2076002 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3628840 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1552838 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14114 ALABAMA STREET | AddressLine1 |
| City | JAY | City |
| State | FL | State |
| ZIP Code | 32565 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Financial Assistance at Cost | 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. The cost of unreimbursed medicaid was computed using the cost report. |
| Total Expenses | Part I, Ln 7 Col(f) | Bad debt expense in the amount of $3,648,825 was subtracted from total expenses per Form 990, Part IX, Line 25 for purposes of calculating the percentage for Line 7, column (f). |
| Bad Debt Expense and costing methodology | Part III, Line 2 and Line 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 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. |
| Medicare shortfall and costing methodology | Part III, Line 8 | THE MEDICARE SHORTFALL WAS NOT INCLUDED IN THE COMMUNITY BENEFIT COST, AND THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE ORGANIZATION'S 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. |
| Debt Collection Policy | Part III, Line 9b | For patients who are financially or medically indigent (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): a)Patients are deemed financially indigent if their income is below 200% of FPL. If a patient makes between 200% and 400% of the FPL, then they may only receive a partial write-off. b)Patients may be deemed medically indigent if their household medical expenses exceed 25% of the annual household income regardless of income level. 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. |
| CHNA Community Input | Part V, Section B, Line 3 | 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. Senior leadership from Baptist Health Care and its affiliates (including Jay Hospital), Sacred Heart Health System, the Florida Department of Health-Escambia County and the University of West Florida also 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. The results were also shared with and reviewed by the Florida Department of Health-Santa Rosa County. 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. In December 2012, a Community Forum was held to share and discuss the results of the assessment with the public. Approximately 75 people representing community constituencies attended the Forum. In addition, the Forum was recorded for public viewing on the PFAHC website. In May 2013, a Community Health Summit was held to involve the key organizations and community leaders whose participation is essential to the development of plans to effectively improve the health status of residents of Escambia and Santa Rosa Counties. Jay Hospital representatives participated in the Summit. |
| CHNA Hospital Facilities Involved | Part V, Section B, Line 4 | The following licensed hospitals were involved in the CHNA process during the tax year: Baptist Hospital, Gulf Breeze Hospital, Jay Hospital, Sacred Heart Hospital. |
| NEEDS ASSESSMENT | 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: http://www.ebaptisthealthcare.org/ContentDocuments/Community/CHNA-2012_Jay .pdf |
| Patient education of eligibility for assistance | Part VI, Line 3 | ALL 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 ON ITS INTERNET WEBSITE. |
| COMMUNITY INFORMATION | Part VI, Line 4 | JAY HOSPITAL, INC. OPERATES IN SANTA ROSA COUNTY, FLORIDA. APPROXIMATELY 161,000 INDIVIDUALS RESIDE IN THIS COUNTY, 11.1% OF WHICH LIVE BELOW POVERTY LEVEL. WHEN CONSIDERING THESE FACTORS, MORE THAN 18,000 RESIDENTS COULD BE ELIGIBLE TO QUALIFY FOR CHARITY CARE. APPROXIMATELY 31.5% OF JAY HOSPITAL'S PATIENTS DURING FY2013 WERE UNINSURED OR WERE MEDICAID RECIPIENTS. THREE HOSPITALS, INCLUDING JAY HOSPITAL, ARE LOCATED IN SANTA ROSA COUNTY. |
| Promotion of community health | 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. |
| Affiliated health care system | 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: -ANDREWS RESEARCH & EDUCATION INSTITUTE, LLC - LEADS MEDICAL RESEARCH AND EDUCATION INITIATIVES -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 -ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPITALS, INC. - OPERATES ATMORE HOSPITAL -LAKEVIEW CENTER, INC. AND AFFILIATES - PROVIDE BEHAVIORAL HEALTH AND SUPPORT SERVICES -THE BAPTIST MANOR, INC. - PROVIDES HEALTH CARE SERVICES TO THE ELDERLY AND OTHER PATIENTS |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Santa Rosa Community Clinic | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5520 Stewart Street | AddressLine1 |
| City | Milton | City |
| State | FL | State |
| ZIP Code | 32570 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 311746599 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 12500 | AmountOfCashGrant |
| Purpose Of Grant | Healthcare Assistance | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Schedule I, Part I, Line 2 | Identifier |
| Explanation | Within one year, the organization requests documentation from the recipient regarding proper use of funds provided for indigent patients. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| James L Lonquist MD | ||||||||||||||
| MEMBER | 0 | 482288 | 0 | 0 | 0 | 17171 | 0 | 22500 | 0 | 24364 | 0 | 546323 | 0 | 0 |
| Mike Hutchins | ||||||||||||||
| VP/ADMINISTRATOR | 148102 | 0 | 31984 | 0 | 31121 | 0 | 4287 | 0 | 20658 | 0 | 236152 | 0 | 0 | 0 |
| Kerry Vermillion | ||||||||||||||
| SR VP FINANCE/CFO | 0 | 386351 | 0 | 86490 | 0 | 26186 | 0 | 53718 | 0 | 21273 | 0 | 574018 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Employer Contribution to 457(f) executive retirement benefit plan | Part I, Line 4b | Kerry Vermillion $47,893 |
| COMPENSATION FROM RELATED ORGANIZATIONS | PART II | THE RELATED COMPENSATION REPORTED ON FORM 990, PART VII, SECTION A & SCHEDULE J, PART II WAS PAID BY THE FOLLOWING RELATED ORGANIZATIONS: -BAPTIST HEALTH CARE CORPORATION -LANGHORNE CARDIOLOGY CONSULTANTS, INC. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | 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. |
| MEMBERS | 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. |
| MEMBERS MAY ELECT MEMBERS OF THE GOVERNING BODY | 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 member 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 interests 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 |
| GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERS OR STOCKHOLDERS | 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 member 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 interests 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 REVIEW PROCESS | 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 PROVIDED ELECTRONICALLY TO 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 PRINCIPLE OFFICE. |
| MONITORING OF CONFLICT OF INTEREST POLICY | 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 QUESTIONNAIRE. 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. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD UTILIZES INDEPENDENT COMPENSATION STUDIES THAT REFLECT THE CURRENT MARKET VALUE OF SPECIFIC KEY MANAGMENT POSITIONS AS BENCHMARK DATA. ALL COMPENSATION OF KEY INDIVIDUALS MUST BE APPROVED BY THE COMPENSATION COMMITTEE. |
| AVAILABILITY OF DOCUMENTS | 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| BAPTIST HEALTH CARE CORPORATION | ||||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592425151 | HEALTHCARE | FL | 501(c)(3) | 11c | 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) | 9 | LCI | true |
| ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPIT | ||||||||||
| 401 MEDICAL PARK DRIVE | ATMORE | AL | 36502 | 631143638 | HEALTHCARE | AL | 501(c)(3) | 3 | BHC | 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) | 9 | LCI | true |
| LAKEVIEW VILLA INC | ||||||||||
| 1221 WEST LAKEVIEW AVE | PENSACOLA | FL | 32501 | 592842486 | LOW COST HOUS | FL | 501(c)(3) | 9 | LCI | true |
| THE BAPTIST MANOR INC | ||||||||||
| 10095 HILLVIEW RD | PENSACOLA | FL | 32514 | 592455515 | HEALTHCARE | FL | 501(c)(3) | 9 | BHC | true |
| ANDREWS RESEARCH & EDUCATION INSTITUTE | ||||||||||
| 1040 GULF BREEZE PARKWAY | GULF BREEZE | FL | 32561 | 263263612 | RESEARCH | FL | 501(c)(3) | 9 | BHC | true |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | Code VCodeVAmount | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BAPTIST MEDICAL PARK SURGERY CENTER LLC | ||||||||||||||
| 9400 UNIVERSITY PKWY | PENSACOLA | FL | 32514 | 593535262 | AMBULATORY SURGER | FL | NA | NONE | 0 | 0 | false | $0 | false | 0.00000 |
| ENDOSCOPY CENTER OF GULF BREEZE LLC | ||||||||||||||
| 1116 GULF BREEZE PKWY | GULF BREEZE | FL | 32561 | 432086670 | AMBULATORY SURGER | FL | BHI | NONE | 0 | 0 | false | $0 | false | 0.00000 |
| PHYSICIANS LABORATORIES | ||||||||||||||
| 14 WEST JORDAN STREET STE A | PENSACOLA | FL | 32501 | 590879739 | LABORATORY SVCS | FL | NA | NONE | 0 | 0 | false | $0 | false | 0.00000 |
| ANDREWS INSTITUTE ASC LLC | ||||||||||||||
| 1040 GULF BREEZE PKWY | GULF BREEZE | FL | 32561 | 352274952 | AMBULATORY SURGER | FL | BHI | NONE | 0 | 0 | false | $0 | false | 0.00000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BAPTIST HEALTH VENTURES INC | ||||||||||||
| 1717 NORTH E ST | PENSACOLA | FL | 32501 | 592415910 | ADMINISTRATIVE | FL | BHV | C CORP | 0 | 0 | 0.00000 | true |
| BAPTIST URGENT CARE INC | ||||||||||||
| 1717 NORTH E ST | PENSACOLA | FL | 32501 | 593622226 | MEDICAL SERVICES | FL | BHV | C CORP | 0 | 0 | 0.00000 | true |
| PENSACOLA POB INC | ||||||||||||
| 1717 NORTH E ST | PENSACOLA | FL | 32501 | 592462399 | LEASING AGENT | FL | BHV | C CORP | 0 | 0 | 0.00000 | true |
| MOBILE DIAGNOSTICS INC | ||||||||||||
| 1717 NORTH E ST | PENSACOLA | FL | 32501 | 592864191 | MEDICAL SERVICES | FL | BHV | C CORP | 0 | 0 | 0.00000 | true |
| MEDICAL PROFESSIONAL AGENCY INC | ||||||||||||
| 1717 NORTH E ST | PENSACOLA | FL | 32501 | 592555835 | MEDICAL SERVICES | FL | BHV | C CORP | 0 | 0 | 0.00000 | true |
| THE TOWERS PHARMACY INC | ||||||||||||
| 1717 NORTH E ST | PENSACOLA | FL | 32501 | 592667929 | RETAIL SALES | FL | BHV | C CORP | 0 | 0 | 0.00000 | true |
| LANGHORNE CARDIOLOGY CONSULTANTS INC | ||||||||||||
| 1717 NORTH E ST | PENSACOLA | FL | 32501 | 592874324 | MEDICAL SERVICES | FL | BHI | C CORP | 0 | 0 | 0.00000 | true |
| LAKEVIEW ASSOCIATED ENTERPRISES INC | ||||||||||||
| 1221 W LAKEVIEW AVE | PENSACOLA | FL | 32501 | 611711170 | FRANCHISING | FL | LCI | C CORP | 0 | 0 | 0.00000 | true |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Baptist Hospital Inc | ||
| D | 2465695 | FMV |
| Baptist Hospital Inc | ||
| M | 76003 | FMV |
Affiliated Group Schedule AffiliatedGroupSchedule
Affiliated Schedule AffiliatedSchedule (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Total Grassroots LobbyingTotalGrassrootsLobbying | Total Direct LobbyingTotalDirectLobbying | Total Lobbying ExpendituresTotalLobbyingExpenditures | Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures | Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures | Lobbying NontaxableLobbyingNontaxableAmount | Grassroots NontaxableGrassrootsNontaxableAmount | Tot Lobbying Grassroot Minus NontxTotLobbyingGrassrootMinusNontx | Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx | Share Of Excess Lobbying ExpendtrsShareOfExcessLobbyingExpendtrs | Electing OrgElectingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANDREWS RESEARCH & EDUCATION | |||||||||||||||
| 1040 GULF BREEZE PARKWAY | GULF BREEZE | FL | 32561 | 263263612 | 0 | 0 | 0 | 2824975 | 2824975 | $291,249 | $72,812 | 0 | 0 | 0 | |
| BAPTIST HEALTH CARE CORPORAT | |||||||||||||||
| PO BOX 17500 | PENSACOLA | FL | 325227500 | 592425151 | 0 | 54064 | 54064 | 43616454 | 43670518 | $1,000,000 | $250,000 | 0 | 0 | 0 | X |
| BAPTIST HEALTH CARE FOUNDATI | |||||||||||||||
| PO BOX 17500 | PENSACOLA | FL | 325227500 | 590192265 | 0 | 0 | 0 | 1810315 | 1810315 | $240,516 | $60,129 | 0 | 0 | 0 | X |
| BAPTIST HOSPITAL INC | |||||||||||||||
| PO BOX 17500 | PENSACOLA | FL | 325227500 | 590657322 | 0 | 53052 | 53052 | 417942982 | 417996034 | $1,000,000 | $250,000 | 0 | 0 | 0 | |
| CMHC HERNANDEZ HOUSE INC | |||||||||||||||
| 1221 W LAKEVIEW AVENUE | PENSACOLA | FL | 325011836 | 592041794 | 0 | 0 | 0 | 184387 | 184387 | $36,877 | $9,219 | 0 | 0 | 0 | |
| ESCAMBIA COUNTY ALABAMA COMM | |||||||||||||||
| PO BOX 17500 | PENSACOLA | FL | 325227500 | 631143638 | 0 | 6576 | 6576 | 22804294 | 22810870 | $1,000,000 | $250,000 | 0 | 0 | 0 | |
| JAY HOSPITAL INC | |||||||||||||||
| PO BOX 17500 | PENSACOLA | FL | 325227500 | 592425149 | 0 | 3746 | 3746 | 14454213 | 14457959 | $872,898 | $218,225 | 0 | 0 | 0 | |
| LAKEVIEW PLACE INC | |||||||||||||||
| 1221 W LAKEVIEW AVENUE | PENSACOLA | FL | 325011836 | 592804577 | 0 | 0 | 0 | 138455 | 138455 | $27,691 | $6,923 | 0 | 0 | 0 | |
| LAKEVIEW VILLA INC | |||||||||||||||
| 1221 W LAKEVIEW AVENUE | PENSACOLA | FL | 325011836 | 592842486 | 0 | 0 | 0 | 221846 | 221846 | $44,369 | $11,092 | 0 | 0 | 0 | |
| THE BAPTIST MANOR INC | |||||||||||||||
| PO BOX 17500 | PENSACOLA | FL | 325227500 | 592455515 | 0 | 0 | 0 | 14158456 | 14158456 | $857,923 | $214,481 | 0 | 0 | 0 | |
| LAKEVIEW CENTER INC | |||||||||||||||
| 1221 W LAKEVIEW AVENUE | PENSACOLA | FL | 325011836 | 590737872 | 0 | 0 | 0 | 173940934 | 173940934 | $1,000,000 | $250,000 | 0 | 0 | 0 | |