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JAY HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
JAY HOSPITAL INC (EIN 59-2425149)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-15
IRS object ID
201242289349303184
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-15T14:41:15-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1
CityKansas CityCity
StateMOState
ZIP Code641062246ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN592425149EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jay Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlJAYHNameControl
Phone8504344714Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1POST OFFICE BOX 17500AddressLine1
CityPENSACOLACity
StateFLState
ZIP Code32522ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKERRY VERMILLIONName
TitleSr VP Finance/CFOTitle
Date Signed2012-08-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMichael J EngleName
Phone8162216300Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael T HutchinsNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11717 N E ST STE 320AddressLine1
CityPENSACOLACity
StateFLState
ZIP Code32501ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16822342GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.EBAPTISTHEALTHCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1983YearFormation
State Legal DomicileFLStateLegalDomicile
Activity Or Mission DescriptionJay 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 Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees184TotalNbrEmployees
Total Nbr Volunteers20TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16342656ProgramServiceRevenuePriorYear
Program Service Revenue CY16730653ProgramServiceRevenueCY
Investment Income Prior Year320201InvestmentIncomePriorYear
Investment Income Current Year3263InvestmentIncomeCurrentYear
Other Revenue Prior Year30897OtherRevenuePriorYear
Other Revenue Current Year74396OtherRevenueCurrentYear
Total Revenue Prior Year16693754TotalRevenuePriorYear
Total Revenue Current Year16808312TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year12500GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY15687GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6220303SalariesEtcPriorYear
Salaries Etc Current Year6569763SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year9615622OtherExpensePriorYear
Other Expenses Current Year10338971OtherExpensesCurrentYear
Total Expenses Prior Year15848425TotalExpensesPriorYear
Total Expenses Current Year16924421TotalExpensesCurrentYear
Revenues Less Expenses Prior Year845329RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-116109RevenuesLessExpensesCY
Total Assets BOY6462591TotalAssetsBOY
Total Assets EOY6291988TotalAssetsEOY
Total Liabilities BOY2581154TotalLiabilitiesBOY
Total Liabilities EOY2526660TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3881437NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3765328NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSee Schedule OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense13794490Expense
Grants0Grants
Revenue16730653Revenue
DescriptionGENERAL AND SPECIALIZED HEALTH CARE SERVICES INCLUDING INPATIENT, PRIMARY CARE, LONG TERM AND OUTPATIENT HEALTHCARE SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense27063Expense
Grants15687Grants
Revenue0Revenue
DescriptionCOMMUNITY BENEFIT OUTREACH ACTIVITIES CONDUCTED BY THE ORGANIZATION INCLUDING HEALTH EDUCATION SEMINARS, HEALTH FAIRS, AND DONATIONS TO OTHER NON-PROFITS.Description
FieldValueIRS element (for citing)
Total Program Service Expense13821553TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees184NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKEITH STRICKLINGNamePerson
Telephone Number8506758024TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line114114 ALABAMA STREETAddressLine1
CityJayCity
StateFLState
ZIP Code32565ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Ronald E Jackson
CHAIRMAN1.0XX000
Larry K Hicks
VICE CHAIRMAN1.0XX000
Ricky W Smith
SECRETARY/TREASURER1.0XX000
Barry C Howard
MEMBER1.0X000
James L Lonquist MD
MEMBER1.0X000
Van E Mansker
MEMBER1.0X000
John Hosman
MEMBER1.0X000
Kim Jernigan DMD
MEMBER1.0X000
Michael J Mazenko
MEMBER1.0X000
Thomas F Owens
MEMBER1.0X000
Margaret T Stopp
MEMBER1.0X000
Milton F Usry PhD
MEMBER1.0X000
John J Baehr III MD
MEMBER1.0X000
John M Kizziah
MEMBER1.0X000
Kelli Wells MD
MEMBER1.0X000
Mike Hutchins
VP/ADMINISTRATOR40.0X197785035831
Kerry Vermillion
SR VP FINANCE/CFO4.0X037681578643
Daniel Sheppard
Pharmacist40.0121000024839X
FieldValueIRS element (for citing)
Total Reportable Comp From Org318785TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs376815TotalReportableCompFrmRltdOrgs
Total Other Compensation139313TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
Mark Elder DO
Physician Services270228
John-Stewart Michael Smith MD
Physician Services241772
Jeff Kelley MD
Physician Services239804
David C Smith MD
Physician Services117934
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REVENUEDescription
Business Code621990BusinessCode
Total Revenue Column16730653TotalRevenueColumn
Related Or Exempt Function Income16730653RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue16730653TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7371TotalRevenueColumn
Exclusion$7,371ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real30200Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real8522Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real21678Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column21678TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1400Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other5508Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-4108Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-4108TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA SALES72221033611$33,611
MEDICAL RECORDS54190010431$10,431
MISCELLANEOUS REVENUE9000998676$8,676
FieldValueIRS element (for citing)
Total Other Revenue52718TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column16808312TotalRevenueColumn
Related Or Exempt Function Income16730653RelatedOrExemptFunctionIncome
Exclusion$60,089ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total15687Total
Program Services15687ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total220268Total
Program Services191897ProgramServices
Management And General28371ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5123966Total
Program Services4464119ProgramServices
Management And General659847ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total145718Total
Program Services126953ProgramServices
Management And General18765ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total698220Total
Program Services608308ProgramServices
Management And General89912ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total381591Total
Program Services332451ProgramServices
Management And General49140ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1405983Total
Program Services12366ProgramServices
Management And General1393617ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total16929Total
Management And General16929ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total15000Total
Management And General15000ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1694616Total
Program Services1344630ProgramServices
Management And General349986ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total8932Total
Program Services4500ProgramServices
Management And General4432ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total169906Total
Program Services115120ProgramServices
Management And General54786ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total60153Total
Program Services56808ProgramServices
Management And General3345ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total216746Total
Program Services193900ProgramServices
Management And General22846ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total52804Total
Program Services13384ProgramServices
Management And General39420ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total3537Total
Management And General3537ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total26607Total
Management And General26607ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total668020Total
Program Services567817ProgramServices
Management And General100203ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total105632Total
Management And General105632ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE44338714433871
MEDICAL SUPPLIES10586161058616
INDIGENT ASSESSMENT145518145518
FOOD COSTS1307821254415341
COLLECTION FEES9114891148

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total34171Total
Program Services10167ProgramServices
Management And General24004ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total16924421Total
Program Services13821553ProgramServices
Management And General3102868ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY34865BOY
EOY29863EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1850667BOY
EOY1434685EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY184465BOY
EOY180645EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY62830BOY
EOY76217EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis11546089LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7600420LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4272392BOY
EOY3945669EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY57372BOY
EOY624909EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6462591BOY
EOY6291988EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1512496BOY
EOY1091575EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY660758BOY
EOY587231EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY407900BOY
EOY847854EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2581154BOY
EOY2526660EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3881437BOY
EOY3765328EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3881437BOY
EOY3765328EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6462591BOY
EOY6291988EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-116109ReconcilationRevenueExpenses
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Org Belongs To Affiliated GroupXOrgBelongsToAffiliatedGroup

Total Grassroots Lobbying TotalGrassrootsLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals0AffiliatedGroupTotals

Total Direct Lobbying TotalDirectLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals216698AffiliatedGroupTotals

Total Lobbying Expenditures TotalLobbyingExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals216698AffiliatedGroupTotals

Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals16924421FilingOrganizationsTotals
Affiliated Group Totals632951444AffiliatedGroupTotals

Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals16924421FilingOrganizationsTotals
Affiliated Group Totals633168142AffiliatedGroupTotals

Lobbying Nontaxable LobbyingNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals996221FilingOrganizationsTotals
Affiliated Group Totals6400219AffiliatedGroupTotals

Grassroots Nontaxable GrassrootsNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals249055FilingOrganizationsTotals
Affiliated Group Totals1600056AffiliatedGroupTotals
FieldValueIRS element (for citing)
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx

Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus31000000CurrentYearMinus3
Current Year Minus21000000CurrentYearMinus2
Current Year Minus11000000CurrentYearMinus1
Current Year1000000CurrentYear
Total4000000Total
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmount

Total Lobbying Expenditures2 TotalLobbyingExpenditures2

FieldValueIRS element (for citing)
Current Year Minus3282417CurrentYearMinus3
Current Year Minus2186922CurrentYearMinus2
Current Year Minus1192223CurrentYearMinus1
Current Year216698CurrentYear
Total878260Total

Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus3250000CurrentYearMinus3
Current Year Minus2250000CurrentYearMinus2
Current Year Minus1250000CurrentYearMinus1
Current Year250000CurrentYear
Total1000000Total
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmount

Grassroots Lobbying Expenditures GrassrootsLobbyingExpenditures

FieldValueIRS element (for citing)
Current Year0CurrentYear
Total0Total

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis62193OtherCostOrOtherBasis
Book Value62193BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis977439OtherCostOrOtherBasis
Depreciation161339Depreciation
Book Value816100BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4561275OtherCostOrOtherBasis
Depreciation2701347Depreciation
Book Value1859928BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5763129OtherCostOrOtherBasis
Depreciation4737734Depreciation
Book Value1025395BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis182053OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value182053BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3945669TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionDUE FROM AFFILIATESDescription
Book Value624909BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets624909TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO THIRD PARTIES$727,173
ASSET RETIREMENT OBLIGATION$120,681
FieldValueIRS element (for citing)
Total Of Amounts847854TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierUNCERTAIN TAX POSITIONS DISCLOSUREIdentifier
Return ReferenceSCHEDULE D, PART X, LINE 2ReturnReference
ExplanationFinancial 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, 2011 and 2010.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense270173TotalCommunityBenefitExpense
Net Community Benefit Expense270173NetCommunityBenefitExpense
Percent Of Total Expense0.01600PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2021877TotalCommunityBenefitExpense
Direct Offsetting Revenue985572DirectOffsettingRevenue
Net Community Benefit Expense1036305NetCommunityBenefitExpense
Percent Of Total Expense0.06120PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2292050TotalCommunityBenefitExpense
Direct Offsetting Revenue985572DirectOffsettingRevenue
Net Community Benefit Expense1306478NetCommunityBenefitExpense
Percent Of Total Expense0.07720PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Persons Served237PersonsServed
Total Community Benefit Expense11863TotalCommunityBenefitExpense
Net Community Benefit Expense11863NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs9NumberOfActivitiesOrPrograms
Total Community Benefit Expense15200TotalCommunityBenefitExpense
Net Community Benefit Expense15200NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs14NumberOfActivitiesOrPrograms
Persons Served237PersonsServed
Total Community Benefit Expense27063TotalCommunityBenefitExpense
Net Community Benefit Expense27063NetCommunityBenefitExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs14NumberOfActivitiesOrPrograms
Persons Served237PersonsServed
Total Community Benefit Expense2319113TotalCommunityBenefitExpense
Direct Offsetting Revenue985572DirectOffsettingRevenue
Net Community Benefit Expense1333541NetCommunityBenefitExpense
Percent Of Total Expense0.07880PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$959,635BadDebtExpenseAmount
Amount Reimbursed By Medicare4080888AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5069467CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-988579MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Jay HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line114114 Alabama StreetAddressLine1
CityJayCity
StateFLState
ZIP Code32565ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Jay HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Financial Assistance at CostPart I, Line 7The 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 ExpensesPart I, Ln 7 Col(f)Bad debt expense in the amount of $4,433,871 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 methodologyPart III, Line 4THE 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 ASSESS 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 methodologyPart III, Line 8The Medicare costs shown on Line 6 were computed using the organization's Medicare cost report for the period.
Debt Collection PolicyPart III, Line 9bFor 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.
Needs assessmentPart VI, Line 2Although an official community health needs assessment has not yet been completed for the reporting fiscal year, the organization identifies the needs in surrounding communities through internal analysis as well as external sources, including statistics from local health departments, county reports, the state of florida, and statistics from various healthcare market experts. Part of the organization's mission is to improve the qualify 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.
Patient education of eligibility for assistancePart VI, Line 3All 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 patients receives a bill, the organization includes paperwork explaining that financial assistance is available. Jay Hospital has posted multilingual notices of financial assistance policies in several prominent locations within Jay's facilities including, but not limited to, the Emergency Departments, Patient Financial Services office, waiting rooms for purposes of admissions, and the inpatient and outpatient registration areas. 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 informationPart VI, Line 4Jay Hospital, Inc. operates in Santa Rosa County, Florida. Approximately 151,000 individuals reside in this county, 9.8% of which live below poverty level. When considering these factors, more than 15,000 residents could be eligible to qualify for charity care. Approximately 31.0% of Jay Hospital's patients during FY2011 were uninsured or were Medicaid recipients. Three hospitals, including Jay Hospital, are located in Santa Rosa County.
Promotion of community healthPart VI, Line 5The 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 community leaders 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 systemPart VI, Line 6Although 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-Paulos 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 Baptist Manor, Inc. - provides health care services to the elderly and other patients. Lakeview Center, Inc. and affiliates - provide behavioral health and support services

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Santa Rosa Community ClinicBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15520 Stewart StreetAddressLine1
CityMiltonCity
StateFLState
ZIP Code32570ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient311746599EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant12500AmountOfCashGrant
Purpose Of GrantHealthcare AssistancePurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSchedule I, Part I, Line 2Identifier
ExplanationWithin one year, the organization requests documentation from the recipient regarding proper use of funds provided for indigent patients.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Mike Hutchins
148903031930016952072740285570233616000
Kerry Vermillion
0311060050315015440050171028472045545800

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierEmployer Contribution to 457(f) executive retirement benefit planIdentifier
Return ReferencePart I, Line 4bReturnReference
ExplanationKerry Vermillion $40,556Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1JAY 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.
MEMBERSFORM 990, PART VI, SECTION A, LINE 6BAPTIST 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 BODYFORM 990, PART VI SECTION A, LINE 7BTHE 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 STOCKHOLDERSFORM 990, PART VI SECTION A, LINE 7BTHE 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 PROCESSFORM 990, PART VI, SECTION B, LINE 11AN 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 POLICYFORM 990, PART VI, SECTION B, LINE 12CBOARD 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 REVIEWFORM 990, PART VI, SECTION B, LINE 15THE 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 DOCUMENTSFORM 990, PART VI, SECTION C, LINE 19THE 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.
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Kerry Vermillion TITLE:SR VP FINANCE/CFO HOURS:46

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
BAPTIST HEALTH CARE CORPORATION
1717 N E STREETPENSACOLAFL32501592425151HEALTHCAREFL501(C)(3)11NA
BAPTIST HEALTH CARE FOUNDATION
1717 N E STREETPENSACOLAFL32501590192265FUNDRAISINGFL501(C)(3)7BHC
BAPTIST HOSPITAL INC
1000 WEST MORENO STREETPENSACOLAFL32501590657322HEALTH CAREFL501(C)(3)3BHC
CMHC HERNANDEZ HOUSE INC
1221 WEST LAKEVIEW AVEPENSACOLAFL32501592041794LOW COST HOUSFL501(C)(3)9LCI
ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPIT
401 MEDICAL PARK DRIVEATMOREAL36502631143638HEALTH CAREAL501(C)(3)3BHC
LAKEVIEW CENTER INC
1221 WEST LAKEVIEW AVENUEPENSACOLAFL32501590737872HEALTH CAREFL501(C)(3)7BHC
LAKEVIEW PLACE INC
1221 WEST LAKEVIEW AVEPENSACOLAFL32501592804577LOW COST HOUSFL501(C)(3)9LCI
LAKEVIEW VILLA INC
1221 WEST LAKEVIEW AVEPENSACOLAFL32501592842486LOW COST HOUSFL501(C)(3)9LCI
THE BAPTIST MANOR INC
10095 HILLVIEW RDPENSACOLAFL32514592455515HEALTH CAREFL501(C)(3)9BHC
GLOBAL CONNECTIONS FOR EMPLOYMENT INC
1221 WEST LAKEVIEW AVEPENSACOLAFL32501260441675EMPLOYMENT SVFL501(C)(3)9BHC
ANDREWS-PAULOS RESEARCH & EDUCATION INST
1040 GULF BREEZE PARKWAYGULF BREEZEFL32561263263612REASEARCHFL501(C)(3)9BHC

Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
BAPTIST MEDICAL PARK SURGERY CENTER LLC
9400 UNIVERSITY PKWYPENSACOLAFL32514593535262AMBULATORY SURGERFLNANONE00false$0false0.00000
ENDOSCOPY CENTER OF GULF BREEZE LLC
1116 GULF BREEZE PKWYGULF BREEZEFL32561432086670AMBULATORY SURGERFLNANONE00false$0false0.00000
PHYSICIANS LABORATORIES
14 WEST JORDAN STREET STE APENSACOLAFL32501590879739LABORATORY SERVICFLNANONE00false$0false0.00000
BAPTIST IMAGING CENTER LLC
5330 N DAVIS HWYPENSACOLAFL32503261373637DIAGNOSTIC TESTINFLNANONE00false$0false0.00000
ANDREWS INSTITUTE ASC LLC
1040 GULF BREEZE PKWYGULF BREEZEFL32561352274952AMBULATORY SURGERFLNANONE00false$0false0.00000

Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
BAPTIST HEALTH VENTURES INC
1717 NORTH E STPENSACOLAFL32501592415910ADMINISTRATIVE ANFLNAC CORP000.00000
BAPTIST URGENT CARE INC
1717 NORTH E STPENSACOLAFL32501593622226MEDICAL SERVICESFLNAC CORP000.00000
PENSACOLA POB INC
1717 NORTH E STPENSACOLAFL32501592462399LEASING AGENTFLNAC CORP000.00000
MOBILE DIAGNOSTICS INC
1717 NORTH E STPENSACOLAFL32501592864191MEDICAL SERVICESFLNAC CORP000.00000
MEDICAL PROFESSIONAL AGENCY INC
1717 NORTH E STPENSACOLAFL32501592555835MEDICAL SERVICESFLNAC CORP000.00000
THE TOWERS PHARMACY INC
1717 NORTH E STPENSACOLAFL32501592667929RETAIL SALESFLNAC CORP000.00000
LANGHORNE CARDIOLOGY CONSULTANTS INC
1717 NORTH E STPENSACOLAFL32501592874324MEDICAL SERVICESFLNAC CORP000.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Affiliated Group Schedule AffiliatedGroupSchedule

Affiliated Schedule AffiliatedSchedule (11 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINElecting OrgElectingOrgTotal Grassroots LobbyingTotalGrassrootsLobbyingTotal Direct LobbyingTotalDirectLobbyingTotal Lobbying ExpendituresTotalLobbyingExpendituresOther Exempt Purpose ExpendituresOtherExemptPurposeExpendituresTotal Exempt Purpose ExpendituresTotalExemptPurposeExpendituresLobbying NontaxableLobbyingNontaxableAmountGrassroots NontaxableGrassrootsNontaxableAmountTot Lobbying Grassroot Minus NontxTotLobbyingGrassrootMinusNontxTot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontxShare Of Excess Lobbying ExpendtrsShareOfExcessLobbyingExpendtrs
LAKEVIEW CENTER INC
1221 W LAKEVIEW AVENUEPENSACOLAFL325011836590737872X014721472146112387146113859$1,000,000$250,000000
ANDREWS-PAULOS RESEARCH & ED
1040 GULF BREEZE PARKWAYGULF BREEZEFL3256126326361200015225471522547$226,127$56,532000
BAPTIST HEALTH CARE CORPORAT
PO BOX 17500PENSACOLAFL325227500592425151X01932981932983655309136746389$1,000,000$250,000000
BAPTIST HEALTH CARE FOUNDATI
PO BOX 17500PENSACOLAFL325227500590192265X00020518122051812$252,591$63,148000
BAPTIST HOSPITAL INC
PO BOX 17500PENSACOLAFL325227500590657322X01432014320393775723393790043$1,000,000$250,000000
CMHC HERNANDEZ HOUSE INC
1221 W LAKEVIEW AVENUEPENSACOLAFL325011836592041794X0005221152211$10,442$2,611000
ESCAMBIA COUNTY ALABAMA COMM
PO BOX 17500PENSACOLAFL325227500631143638X0760876082135708621364694$1,000,000$250,000000
JAY HOSPITAL INC
PO BOX 17500PENSACOLAFL325227500592425149X0001692442116924421$996,221$249,055000
LAKEVIEW PLACE INC
1221 W LAKEVIEW AVENUEPENSACOLAFL325011836592804577X0007995679956$15,991$3,998000
LAKEVIEW VILLA INC
1221 W LAKEVIEW AVENUEPENSACOLAFL325011836592842486X000151576151576$30,315$7,579000
THE BAPTIST MANOR INC
PO BOX 17500PENSACOLAFL325227500592455515X0001437063414370634$868,532$217,133000