JACKSON PARK HOSPITAL FOUNDATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- JACKSON PARK HOSPITAL FOUNDATION (EIN 36-2448028)
- Tax period
- 2010-04-01 to 2011-03-31
- Filed
- 2012-03-30
- IRS object ID
- 201220909349300432
- Schema version
- 2010v3.7
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-30T10:44:37-05:00 | Timestamp |
| Tax Period End Date | 2011-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MITCHELL & TITUS LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE BATTERY PARK PLAZA | AddressLine1 |
| City | NEW YORK | City |
| State | NY | State |
| ZIP Code | 10004 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362448028 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson Park Hospital Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JACK | NameControl |
| Phone | 7739477989 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 SOUTH STONY ISLAND Avenue | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60649 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mr William OP Dorsey MD | Name |
| Title | Chairman of the Audit Committee | Title |
| Date Signed | 2012-03-30 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN BAIARDI | Name |
| Phone | 2127094500 | Phone |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Merritt Hasbrouck | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 South Stony Island Avenue | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60649 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 123815759 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.jacksonparkhospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1912 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 977 | TotalNbrEmployees |
| Total Nbr Volunteers | 8 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 467457 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 43990 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 106046224 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 117179840 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 22781 | InvestmentIncomePriorYear |
| Investment Income Current Year | 4035 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 6122727 | OtherRevenuePriorYear |
| Other Revenue Current Year | 6587894 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 112659189 | TotalRevenuePriorYear |
| Total Revenue Current Year | 123815759 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 39489900 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 40147997 | 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 | 60335472 | OtherExpensePriorYear |
| Other Expenses Current Year | 76382071 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 99825372 | TotalExpensesPriorYear |
| Total Expenses Current Year | 116530068 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 12833817 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 7285691 | RevenuesLessExpensesCY |
| Total Assets BOY | 93455032 | TotalAssetsBOY |
| Total Assets EOY | 105711225 | TotalAssetsEOY |
| Total Liabilities BOY | 24829027 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 29359725 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 68626005 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 76351500 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE COMPASSIONATE AND HIGH QUALITY HEALTHCARE SERVICES TO MEET THE NEEDS OF THE PATIENTS AND COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 32374275 | Expense |
| Revenue | 79103440 | Revenue |
| Description | Acute inpatient hospital services. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5464423 | Expense |
| Revenue | 18274037 | Revenue |
| Description | Emergency Room services. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2769989 | Expense |
| Revenue | 12574187 | Revenue |
| Description | Inpatient behavorial medicine services. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 72452925 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 7228176 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 113061612 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| 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 | false | 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 | false | 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 | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | false | ScheduleORequired |
| Number Forms Transmitted With1096 | 153 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 977 | 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 | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | 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 | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | 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 |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | NELSON VASQUEZ | NamePerson |
| Telephone Number | 7739477989 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 SOUTH STONY ISLAND AVENUE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60649 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Dr Arol Augsburger | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| James I Clark III | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| Dr Lakshmi Dodda | ||||||||
| Physician | 40.0 | X | 274970 | 0 | 0 | |||
| Dr William O Dorsey III | ||||||||
| Chairman of the Board of Direc | 40.0 | X | 131840 | 0 | 0 | |||
| Dr Harshad Mehta | ||||||||
| Director | 40.0 | X | 40900 | 0 | 0 | |||
| Dr Joyce R Miller | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| Kay L Murray | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| Dr Bangalore R Murthy | ||||||||
| Director | 40.0 | X | 149027 | 0 | 0 | |||
| Dr Haroon Olomi | ||||||||
| Director | 40.0 | X | 98427 | 0 | 0 | |||
| Dinah Ramirez | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| Alderman Todd Stroger | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| Michael Wilczynski | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| Dr Emra Brooks Williams | ||||||||
| Director | 2.0 | X | 0 | 0 | 0 | |||
| Merritt Hasbrouck | ||||||||
| President | 40.0 | 490133 | 0 | 0 | X | |||
| G Randall Smith | ||||||||
| Executive Vice President | 40.0 | 488843 | 0 | 0 | X | |||
| Margo Brooks-Pugh | ||||||||
| Vice President | 40.0 | 125434 | 0 | 0 | X | |||
| Alvin L Kruse | ||||||||
| Secetary | 2.0 | 0 | 0 | 0 | X | |||
| James M Schraidt | ||||||||
| Assistant Secretary | 2.0 | 0 | 0 | 0 | X | |||
| Edward J Silha | ||||||||
| COO | 40.0 | 216024 | 0 | 0 | X | |||
| Nelson Vasquez | ||||||||
| VP of Finance | 40.0 | 216931 | 0 | 0 | X | |||
| Thodur Ranganathan | ||||||||
| Physician | 40.0 | 442326 | 0 | 0 | X | |||
| Rose Ette | ||||||||
| Registered Nurse | 79.0 | 177637 | 0 | 0 | X | |||
| Chioma Uche | ||||||||
| Registered Nurse | 69.0 | 170410 | 0 | 0 | X | |||
| Gloria Ifebueme | ||||||||
| Registered Nurse | 60.0 | 138882 | 0 | 0 | X | |||
| Onyekachi Abuwa | ||||||||
| Registered Nurse | 61.0 | 145223 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3307007 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| NICL Laboratories | |||||
| 306 Era Drive | NORTHBROOK | IL | 60062 | Pathology & Lab MGT | 3458954 |
| Cardinal Health | |||||
| PO Box 70539 | CHICAGO | IL | 60673 | Medical Products | 831056 |
| Emcare | |||||
| 7032 Collection Center Drive | CHICAGO | IL | 60693 | EMERG MED PHYSICIANS | 1443547 |
| Rush Nursing Agency | |||||
| 7501 South Stony Island | CHICAGO | IL | 60649 | Nurse Staffing | 1744092 |
| Amerisourcebergen | |||||
| 1001 West Taylor Road | ROMEOVILLE | IL | 60446 | DRUGS FOR PNT CARE | 1477488 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| All Other Contributions | 43990 | AllOtherContributions |
| Total Contributions | 43990 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 611710 | 100462891 | 100462891 |
| PROVIDER TAX PROCEEDS | 621500 | 16716949 | 16716949 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 117179840 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4035 | TotalRevenueColumn |
| Exclusion | $4,035 | 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 |
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 | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICAL SCHOOL BILLINGS | 900099 | 3617142 | 3617142 |
| AUXILIARY INCOME | 900099 | 1670616 | 1670616 |
| RADIOLOGY PHYSICIANS | 900099 | 318786 | 318786 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 981350 | TotalRevenueColumn |
| Related Or Exempt Function Income | 981350 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 6587894 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 123815759 | TotalRevenueColumn |
| Related Or Exempt Function Income | 123767734 | RelatedOrExemptFunctionIncome |
| Exclusion | $4,035 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
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 | 2064017 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 2064017 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
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 | 29550185 | Total |
| Program Services | 29550185 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8533795 | Total |
| Program Services | 8533795 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 990587 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 990587 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 241352 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 241352 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 172500 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 172500 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
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 | 19779672 | Total |
| Program Services | 19779672 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9845928 | Total |
| Program Services | 9845928 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2018356 | Total |
| Program Services | 2018356 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 243069 | Total |
| Program Services | 243069 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1929298 | Total |
| Program Services | 1929298 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2117351 | Total |
| Program Services | 2117351 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| PROVISION FOR BAD DEBTS | 31783037 | 31783037 | 0 | 0 |
| PROVIDER TAX EXPENSES | 7131636 | 7131636 | 0 | 0 |
| PENSION EXPENSE | 129285 | 129285 | 0 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116530068 | Total |
| Program Services | 113061612 | ProgramServices |
| Management And General | 3468456 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6937276 | BOY |
| EOY | 11854003 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66033613 | BOY |
| EOY | 72192367 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 815193 | BOY |
| EOY | 837204 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 430644 | BOY |
| EOY | 2091150 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 67458891 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 49359626 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18709386 | BOY |
| EOY | 18099265 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 528920 | BOY |
| EOY | 637236 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93455032 | BOY |
| EOY | 105711225 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10655571 | BOY |
| EOY | 11157567 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3013973 | BOY |
| EOY | 7193210 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4340709 | BOY |
| EOY | 3649736 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6818774 | BOY |
| EOY | 7359212 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24829027 | BOY |
| EOY | 29359725 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68626005 | BOY |
| EOY | 75911696 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 439804 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68626005 | BOY |
| EOY | 76351500 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93455032 | BOY |
| EOY | 105711225 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 7285691 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 439804 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
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) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | true | DirectContactLegislators |
| Direct Contact Legislators | $174,000 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 174000 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2482024 | OtherCostOrOtherBasis |
| Book Value | 2482024 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 40985555 | OtherCostOrOtherBasis |
| Depreciation | 31575906 | Depreciation |
| Book Value | 9747945 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 21782410 | OtherCostOrOtherBasis |
| Depreciation | 17542892 | Depreciation |
| Book Value | 4844963 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 962250 | OtherCostOrOtherBasis |
| Depreciation | 240828 | Depreciation |
| Book Value | 1024333 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 18099265 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | SELF-INSURANCE LIABILITY | Description |
| Amount | $7,359,212 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 7359212 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Accounting for Uncertainty in Income Taxes | Identifier |
| Return Reference | Schedule D, Part X | ReturnReference |
| Explanation | On March 31, 2010, the Corporations adopted the requirements of Financial Accounting Standards Board (FASB) Accounting Standards Update (ASU) 2009-06 regarding uncertain tax positions. ASU 2009-06 defines how uncertain tax positions should be recognized, measured, presented, and disclosed in the financial statements. It requires entities to recognize a tax benefit from an uncertain tax position only if it is more likely than not that the position is sustainable, based solely on its technical merits and consideration of the relevant taxing authority's widely understood administrative practices and precedents. The Corporations have evaluated tax positions taken or expected to be taken to determine whether the tax positions are more likely than not to be sustained by the applicable taxing authority, and have determined that they currently do not have any uncertain tax positions. | 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 |
| Pcent200 D | X | Pcent200D |
| 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 | 14411685 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 14411685 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17030 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 45319325 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14570777 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 30748548 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.36240 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 59731010 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14570777 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 45160233 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.53270 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3025968 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 470966 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2555002 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03020 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | -99990980 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | -91633790 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -8357190 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09880 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | -96965012 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | -91162824 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -5802188 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06860 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | -37234002 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | -76592047 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 39358045 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.46410 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $8,029,730 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 26868010 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 27206785 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -338775 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| 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 | JACKSON PARK HOSPITAL FOUNDATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 South Stony Island | AddressLine1 |
| City | chicago | City |
| State | IL | State |
| ZIP Code | 60649 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSON PARK HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | false | UsesFPGDiscounted |
| Explains Basis | false | ExplainsBasis |
| Explains Application Method | true | ExplainsApplicationMethod |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | false | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Schedule H, Part III, Line 4 | The amount of bad debt expense at cost is based on worksheet 2 in the instructions to schedule H. The basis for this costing methodology is operating expenses adjusted by non-patient care activities, Medicare provider taxes, and community benefit expense divided by gross patient charges. |
| Form 990, Schedule H, Part III, Line 8 | The shortfall should be treated as a community benefit because the amount represents the difference between the hospitals cost and amounts received from both Medicaid and Medicare. |
| Form 990, Schedule H, Part III, Line 9b | Patients who are known to qualify for charity care or financial assistance are placed into their own financial class in our business system. This insures they are not billed or placed into collections. |
| Form 990, Schedule H, Part VI, Line 1 | Form 990, Schedule H, Part I, Line 3c - Charity Care is based on 200% of the Federal Poverty Income Guidelines. Form 990, Schedule H, Part I, Line 6a - Jackson Park Hospital files an annual community benefit report with the Illinois Attorney Generals Office. Form 990, Schedule H, Part V, Line 19d - Jackson Park Hospital uses its policy for charity assistance in determining amounts billed to patients who do not have insurance. |
| Form 990, Schedule H, Part VI, Line 2 | The hospital has not completed a needs assessment for our community. In 2012, the hospital will participate with the Metropolitan Chicago Health Care Council on completing a needs assessment. |
| Form 990, Schedule H, Part VI, Line 3 | The hospital contracts with a third party named FirstSource to educate and assist all of our patients upon admission or treatment in our emergency room as to enrollment into state and federal programs. If a patient is not eligible for a federal or state program, FirstSource will assist the patient with our charity care application and submit it to management for approval. |
| Form 990, Schedule H, Part VI, Line 4 | Jackson Park Hospital is a full service community hospital providing medical surgical, obstetric, intensive care and acute mental illness care to our community. The hospital is located in the economically challenged south side of Chicago. The hospital is very dependent on state funded programs to sustain its day to day operations. Medicaid accounts for 37% of the hospitals revenues and self pay patients accounted for 19% of revenues. |
| Form 990, Schedule H, Part VI, Line 5 | The hospital sponsors a school based medical clinic at one of our local high schools. In addition, the hospital sponsors various screening programs at community events. |
| Form 990, Schedule H, Part VI, Line 6 | n/a |
| Form 990, Schedule H, Part VI, Line 7 | Jackson Park Hospital files an annual community benefit report with the Illinois Attorney Generals Office. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | 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 (8 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr Lakshmi Dodda | |||||||||||||
| 274970 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 274970 | 0 | 286465 | 0 |
| Merritt Hasbrouck | |||||||||||||
| 342586 | 0 | 143846 | 0 | 3701 | 0 | 0 | 0 | 0 | 0 | 490133 | 0 | 442360 | 0 |
| G Randall Smith | |||||||||||||
| 342586 | 0 | 143846 | 0 | 2411 | 0 | 0 | 0 | 0 | 0 | 488843 | 0 | 440920 | 0 |
| Edward J Silha | |||||||||||||
| 149202 | 0 | 63598 | 0 | 3224 | 0 | 0 | 0 | 0 | 0 | 216024 | 0 | 278886 | 0 |
| Nelson Vasquez | |||||||||||||
| 190195 | 0 | 25396 | 0 | 1340 | 0 | 0 | 0 | 0 | 0 | 216931 | 0 | 187958 | 0 |
| Thodur Ranganathan | |||||||||||||
| 441148 | 0 | 0 | 0 | 1178 | 0 | 0 | 0 | 0 | 0 | 442326 | 0 | 269200 | 0 |
| Rose Ette | |||||||||||||
| 177506 | 0 | 0 | 0 | 131 | 0 | 0 | 0 | 0 | 0 | 177637 | 0 | 169381 | 0 |
| Chioma Uche | |||||||||||||
| 170410 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 170410 | 0 | 137490 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Line 11A | The Chairman of The Board and Audit Committee along with the senior management team reviews the Form 990 prior to its filing. |
| Form 990, Part VI, Line 12c | All officers, directors or trustees, and key employees are required to complete a conflict of interest disclosure form every three years. Jackson Park Hospital Foundation is scheduled to complete this procedure in its fiscal year 2011. |
| Form 990, Part VI, Line 15a & B | 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, Line 19 | Jackson Park Hospital Foundations 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 III, Line 4d | Salaries/Purchased Services/Professional Fees/Utilities/Insurance/Other Supplies |
| REASONABLE CAUSE STATEMENT | THIS RETURN IS BEING FILED BETWEEN MARCH 1, 2012, AND MARCH 30, 2012, AS DIRECTED BY THE IRS IN NOTICE 2012-4, BECAUSE ELECTRONIC FILING WAS NOT AVAILABLE JANUARY 1, 2012 THROUGH FEBRUARY 29, 2012. WE REQUEST THAT PENALTIES BE WAIVED BECAUSE IT WOULD BE INEQUITABLE TO IMPOSE A PENALTY ON US DUE TO THE UNUSUAL CIRCUMSTANCES REQUIRING US TO DELAY THE FILING OF THIS RETURN. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Foundation For Jackson Park Hospital | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 South Stony Island | AddressLine1 |
| City | chicago | City |
| State | IL | State |
| ZIP Code | 60649 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270029181 | EIN |
| Primary Activities | healthcare | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 11 | ExemptCodeSection |
| Public Charity Status | 501(c)(3) | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | na | BusinessNameLine1 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Friedell Clinic | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7531 South Stony Island | AddressLine1 |
| City | chicago | City |
| State | IL | State |
| ZIP Code | 60649 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363290656 | EIN |
| Primary Activity | healthcare sv | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | na | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | c corp. | TypeOfEntity |
| Share Of Total Income | 100 | ShareOfTotalIncome |
| Share Of EOY Assets | 100 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| 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 | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | 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 (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| friedell clinic | |
| n | 91157 |
| Jackson Park Foundation | |
| c | 26000 |
| Medical Staff | |
| c | 10000 |