JAY HOSPITAL INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- JAY HOSPITAL INC (EIN 59-2425149)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-14
- IRS object ID
- 201142269349300119
- Schema version
- 2009v1.7
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
- Affiliated Group Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-14T20:57:02-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERSHING YOAKLEY & ASSOCIATES PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 PORTLAND STREET | AddressLine1 |
| City | KNOXVILLE | City |
| State | TN | State |
| ZIP Code | 379192363 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 592425149 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JAYH | NameControl |
| Phone | 8504344714 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | POST OFFICE BOX 17500 | AddressLine1 |
| City | PENSACOLA | City |
| State | FL | State |
| ZIP Code | 325227500 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kerry Vermillion | Name |
| Title | SR VP Finance/CFO | Title |
| Phone | 8504692337 | Phone |
| Date Signed | 2011-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | W EDWARD PHILLIPS | Name |
| Phone | 8656730844 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Michael T Hutchins | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1717 N E ST STE 320 | AddressLine1 |
| City | PENSACOLA | City |
| State | FL | State |
| ZIP Code | 32501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16970680 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.EBAPTISTHEALTHCARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | FL | StateLegalDomicile |
| Activity Or Mission Description | Jay Hospital's primary mission is dedicated to meeting the healthcare needs in the Jay, Century, Flomaton, and surrounding communities in the Northwest Florida-South Alabama area. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 184 | TotalNbrEmployees |
| Total Nbr Volunteers | 20 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 103929 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15369257 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16342656 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 222962 | InvestmentIncomePriorYear |
| Investment Income Current Year | 320201 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 30897 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 15696148 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16693754 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 14826 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 12500 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5829490 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6220303 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8980839 | OtherExpensePriorYear |
| Other Expenses Current Year | 9615622 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 14825155 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15848425 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 870993 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 845329 | RevenuesLessExpensesCY |
| Total Assets BOY | 18104276 | TotalAssetsBOY |
| Total Assets EOY | 6462589 | TotalAssetsEOY |
| Total Liabilities BOY | 2786304 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2581152 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 15317972 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3881437 | NetAssetsOrFundBalancesEOY |
| Mission Description | Jay Hospital's primary mission is dedicated to meeting the healthcare needs in the Jay, Century, Flomaton, and surrounding communities in the Northwest Florida-South Alabama area. 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12837302 | Expense |
| Revenue | 16342656 | Revenue |
| Description | GENERAL AND SPECIALIZED HEALTH CARE SERVICES INCLUDING INPATIENT, PRIMARY CARE, LONG TERM AND OUTPATIENT HEALTHCARE SERVICES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 19162 | Expense |
| Grants | 12500 | Grants |
| Description | COMMUNITY BENEFIT OUTREACH ACTIVITIES CONDUCTED BY THE ORGANIZATION INCLUDING HEALTH EDUCATION SEMINARS, PARTICIPATION IN "RELAY FOR LIFE," HEALTH FAIRS, AND HIGH SCHOOL SPORTS PHYSICALS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 12856464 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 184 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Keith Strickling | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8506758024 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14114 ALabama Street | AddressLine1 |
| City | Jay | City |
| State | FL | State |
| ZIP Code | 32565 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| OLIVER M DARDEN | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MILTON F USRY | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LARRY K HICKS | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RONALD E JACKSON | |||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| RICKY M SMITH | |||||||
| SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| VAN E MANSKER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BARRY C HOWARD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JAMES L LONQUIST MD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN M KIZZIAH | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN J BAEHR III MD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| KIM JERNIGAN DMD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL MAZENKO | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| THOMAS F OWENS | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MARGARET T STOPP | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL T HUTCHINS | |||||||
| VP/ADMINISTRATOR | 40.00 | 0 | 202845 | 18330 | X | ||
| KERRY VERMILLION | |||||||
| SR VP FINANCE/CFO | 40.00 | 0 | 393158 | 62544 | X | ||
| DANIEL SHEPPARD | |||||||
| PHARMACIST | 40.00 | 127047 | 0 | 22931 | X | ||
| GREG PETTY | |||||||
| PT CLINICAL COORDINATOR | 40.00 | 100460 | 0 | 7561 | X | ||
| MELANIE STYLES | |||||||
| LABORATORY MANAGER | 40.00 | 114985 | 0 | 19113 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 342492 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 596003 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 130479 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Mark Elder DO | |||||
| 2946 Greystone Drive | Pace | FL | 32571 | Physician Services | 311260 |
| John-Stewart Michael Smith MD | |||||
| PO Box 181 | Jay | FL | 32565 | Physician Services | 253788 |
| Jeff Kelley MD | |||||
| PO Box 1 | Jay | FL | 32565 | Physician Services | 227359 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| NET PATIENT REVENUE | 621990 | 16272566 | 16272566 | |
| CAFETERIA SALES | 722210 | 32089 | $32,089 | |
| NET RENTAL INCOME | 531390 | 15421 | 15421 | |
| MISCELLANEOUS | 900099 | 15175 | $15,175 | |
| MEDICAL RECORDS | 541900 | 7405 | $7,405 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16342656 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 262129 | TotalRevenueColumn |
| Exclusion | $262,129 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 334998 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 276926 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 58072 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 58072 | TotalRevenueColumn |
| Exclusion | $58,072 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Hurricane Gain | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 30897 | TotalRevenueColumn |
| Exclusion | $30,897 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 30897 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16693754 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16287987 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $405,767 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12500 | Total |
| Program Services | 12500 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5102272 | Total |
| Program Services | 4532788 | ProgramServices |
| Management And General | 569484 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108002 | Total |
| Program Services | 91802 | ProgramServices |
| Management And General | 16200 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 646920 | Total |
| Program Services | 549882 | ProgramServices |
| Management And General | 97038 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 363109 | Total |
| Program Services | 346758 | ProgramServices |
| Management And General | 16351 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1359218 | Total |
| Management And General | 1359218 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25934 | Total |
| Management And General | 25934 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15917 | Total |
| Management And General | 15917 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1608682 | Total |
| Program Services | 1461039 | ProgramServices |
| Management And General | 147643 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26883 | Total |
| Program Services | 186 | ProgramServices |
| Management And General | 26697 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1351868 | Total |
| Program Services | 1231204 | ProgramServices |
| Management And General | 120664 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34351 | Total |
| Program Services | 30772 | ProgramServices |
| Management And General | 3579 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 241941 | Total |
| Program Services | 200951 | ProgramServices |
| Management And General | 40990 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38251 | Total |
| Program Services | 13599 | ProgramServices |
| Management And General | 24652 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3087 | Total |
| Program Services | 3087 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30218 | Total |
| Program Services | 30218 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 689678 | Total |
| Program Services | 586226 | ProgramServices |
| Management And General | 103452 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 273389 | Total |
| Management And General | 273389 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 3497049 | 3497046 | 3 |
| FOOD COSTS | 124918 | 119975 | 4943 |
| INDIGENT ASSESSMENT | 112453 | 112453 | |
| COLLECTION FEES | 85659 | 0 | 85659 |
| SPORTS MEDICINE PROGRAM | 25117 | 25117 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71009 | Total |
| Program Services | 10861 | ProgramServices |
| Management And General | 60148 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15848425 | Total |
| Program Services | 12856464 | ProgramServices |
| Management And General | 2991961 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136046 | BOY |
| EOY | 27965 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1643065 | BOY |
| EOY | 1818071 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 179156 | BOY |
| EOY | 184465 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72547 | BOY |
| EOY | 62829 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11193658 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6921266 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4796468 | BOY |
| EOY | 4272392 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11276994 | BOY |
| EOY | 96867 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18104276 | BOY |
| EOY | 6462589 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1180380 | BOY |
| EOY | 1512496 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 729493 | BOY |
| EOY | 660758 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 876431 | BOY |
| EOY | 407898 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2786304 | BOY |
| EOY | 2581152 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15217972 | BOY |
| EOY | 3881437 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100000 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15317972 | BOY |
| EOY | 3881437 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18104276 | BOY |
| EOY | 6462589 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Belongs To Affiliated Group | X | OrgBelongsToAffiliatedGroup |
Total Direct Lobbying TotalDirectLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 192223 | AffiliatedGroupTotals |
Total Lobbying Expenditures TotalLobbyingExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 192223 | AffiliatedGroupTotals |
Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 589479900 | AffiliatedGroupTotals |
Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 589672123 | AffiliatedGroupTotals |
Lobbying Nontaxable LobbyingNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 1000000 | AffiliatedGroupTotals |
Grassroots Nontaxable GrassrootsNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 250000 | AffiliatedGroupTotals |
Tot Lobbying Grassroot Minus Non Tx TotLobbyingGrassrootMinusNonTx
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 0 | AffiliatedGroupTotals |
Tot Lobby Expend Mns Lobbying Nontx TotLobbyExpendMnsLobbyingNontx
| Field | Value | IRS element (for citing) |
|---|---|---|
| Affiliated Group Totals | 0 | AffiliatedGroupTotals |
Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 1000000 | CurrentYearMinus3 |
| Current Year Minus2 | 1000000 | CurrentYearMinus2 |
| Current Year Minus1 | 1000000 | CurrentYearMinus1 |
| Current Year | 1000000 | CurrentYear |
| Total | 4000000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Lobbying Ceiling | $6,000,000 | LobbyingCeilingAmount |
Total Lobbying Expenditures2 TotalLobbyingExpenditures2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 372157 | CurrentYearMinus3 |
| Current Year Minus2 | 282417 | CurrentYearMinus2 |
| Current Year Minus1 | 186922 | CurrentYearMinus1 |
| Current Year | 192223 | CurrentYear |
| Total | 1033719 | Total |
Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 250000 | CurrentYearMinus3 |
| Current Year Minus2 | 250000 | CurrentYearMinus2 |
| Current Year Minus1 | 250000 | CurrentYearMinus1 |
| Current Year | 250000 | CurrentYear |
| Total | 1000000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grassroots Ceiling | $1,500,000 | GrassrootsCeilingAmount |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 100000 | BeginningOfYearBalance |
| Other Expenditures | 100000 | OtherExpenditures |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | 100000 | Contributions |
| End Of Year Balance | 100000 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 62193 | OtherCostOrOtherBasis |
| Book Value | 62193 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 977439 | OtherCostOrOtherBasis |
| Depreciation | 139376 | Depreciation |
| Book Value | 838063 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4743328 | OtherCostOrOtherBasis |
| Depreciation | 2529988 | Depreciation |
| Book Value | 2213340 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5302066 | OtherCostOrOtherBasis |
| Depreciation | 4241039 | Depreciation |
| Book Value | 1061027 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 108632 | OtherCostOrOtherBasis |
| Depreciation | 10863 | Depreciation |
| Book Value | 97769 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4272392 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Due To Third Parties | $289,101 |
| Asset Retirement Obligation | $118,797 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 407898 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | Funds were used for the purchase of Capital Equipment. |
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 740, Income Taxes, prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC Topic 740 provides guidance for recognition threshold and measurement attributes for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 424407 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 424407 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03440 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1518067 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1119448 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 398619 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03230 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1942474 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1119448 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 823026 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06670 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 665 | PersonsServed |
| Total Community Benefit Expense | 6295 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6295 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12500 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 12500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 665 | PersonsServed |
| Total Community Benefit Expense | 18795 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 18795 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 665 | PersonsServed |
| Total Community Benefit Expense | 1961269 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1119448 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 841821 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06820 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 400 | PersonsServed |
| Total Community Building Expense | 367 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 367 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 400 | PersonsServed |
| Total Community Building Expense | 367 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 367 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $858,869 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 3643130 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4723496 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1080366 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jay Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14114 Alabama Street | AddressLine1 |
| City | Jay | City |
| State | FL | State |
| ZIP Code | 32565 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: The costing methodology used in determining the amount reported on Line 7 is the cost to charge ratio calculated pursuant to the IRS schedule H worksheet 2 instructions.The cost of unreimbursed medicaid was computed using the cost report. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: Bad debt expense in the amount of $3,497,049 was subtracted from total expenses per Form 990, Part IX, Line 25 for purposes of calculating the percentage for Line 7, column (f). | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: The costing methodology used in determining the cost of bad debt is the cost to charge ratio calculated pursuant to the IRS schedule H worksheet 2 instructions. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The Medicare costs shown on Line 6 were computed using the organization's Medicare cost report for the period. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: For patients who are financially or medically indigent (based upon the patient's household income as defined annually by the U.S. Department of Health and Human Services in the Federal Register as the Federal Poverty Level (FPL) guidelines):a)Patients are deemed financially indigent if their income is below 200% of FPL. If a patient makes between 200% and 400% of the FPL, then they may only receive a partial write-off.b)Patients may be deemed medically indigent if their household medical expenses exceed 25% of the annual household income regardless of income level. For any patient that qualifies under the organization's charity care policy, the patient account is written off as charity care and the organization does not pursue any collections. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Although 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. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: For non-ER purposes, every file for a patient that has pre-scheduled an office visit, surgery, etc. 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. For ER patients, the organization has signs in the emergency room explaining that financial assistance is available. Also, when patients receive their bill, the organization includes paperwork explaining that financial assistance is available. Starting in FY2011 and going forward, the organization will be increasing the awareness of the financial assistance availability to all patients. Examples may include posting the charity care policy on the website, disclosing on each bill that financial assistance is available, etc. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Jay Hospital, Inc. operates in Santa Rosa County, Florida. Approximately 151,000 individuals reside in this county, 11.4% of which live below poverty level. When considering these factors, more than 17,000 residents could be eligible to qualify for charity care. Currently, approximately 30.2% of Jay Hospital patients are uninsured or are Medicaid recipients. Three hospitals, including Jay Hospital, are located in Santa Rosa County. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: The program included in Part II includes Jay's participation in Relay for Life activities that took place during normal business hours by paid staff (before the actual event occurred). Jay Hospital was in charge of the whole event, coordinating teams in the community, etc. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: - The organization does not limit medical staff privileges to the organization's employed physicians but extends those privileges to qualified physicians for most areas of service. - The organization's Board of Directors primarily consists of 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. - Overall, 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. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: Although the organization may operate in different service areas when compared to its affiliates, all affiliates work collaboratively to ensure that the needs of the communities are being addressed. The organization participates in many free health screenings, support groups, education seminars, and health fairs that benefit all communities within the system and are not limited to the communities in which the organization operates. Affiliated entities include:Baptist Health Care Corporation - Parent Organization providing strategic management and support services.Baptist Hospital, Inc. - Operates Baptist Hospital and Gulf Breeze HospitalBaptist Health Care Foundation - provides financial and fundraising assistance for all affiliatesEscambia County Alabama Community Hospitals, Inc. - operates Atmore HospitalBaptist Manor, Inc. - provides health care services to the elderly and other patients.Lakeview Center,Inc. and affiliates - provide behavioral health and support services | AffiliatedHealthCareSystem |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Santa Rosa Community Clinic | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5520 Stewart Street | AddressLine1 |
| City | Milton | City |
| State | FL | State |
| ZIP Code | 32570 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 311746599 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 12500 | AmountOfCashGrant |
| Purpose Of Grant | Health Care Assistance for uninsured and/or underinsured patients | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Within one year, the organization requests documentation from the recipient regarding proper use of funds provided for indigent patients. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL T HUTCHINS | |||||||||||||
| 0 | 185247 | 0 | 0 | 0 | 17598 | 0 | 5648 | 0 | 12682 | 0 | 221175 | 0 | 0 |
| KERRY VERMILLION | |||||||||||||
| 0 | 291470 | 0 | 84328 | 0 | 17360 | 0 | 46253 | 0 | 16291 | 0 | 455702 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 4b: | ReturnReference |
| Explanation | Employer Contribution to 457(f) executive retirement benefit plan: Kerry Vermillion $38,625 | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Radiology Associates of Pensacola | |||
| Radiology Assoc. of Pensacola provides medical services to Jay Hospital. | 156790 | John J. Baehr, III, M.D., Jay Hospital, Inc. board member, is the president of Radiology Associates of Pensacola. During the 2009 tax year, Jay Hospital, Inc. paid Radiology Associates for various contract medical services. All transactions were arm's length and at fair market value. | 0 |
| Branch Banking Trust BBT | |||
| BB&T services Jay Hospital, Inc.'s business loans. | 159955 | Thomas F. Owens, Jay Hospital, Inc. board member, is an officer and senior vice president of BB&T. All transactions were arm's length and at fair market value. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | Baptist Health Care Corporation is the sole member of the organization. |
| Form 990, Part VI, Section A, line 7a | Baptist Health Care Corporation appoints the Board of Directors of the Organization. |
| Form 990, Part VI, Section A, line 7b | Baptist Health Care Corporation must approve any changes to the bylaws or articles and the appointment of the Chief Exective Officer. |
| Form 990, Part VI, Section B, line 11 | Information was provided to an independent accounting firm for the preparation of the return. A draft of the return was then provided to management personnel for review. All voting board members received an electronic copy of the Form 990 for review before filing anything with the IRS. Also, the board members were informed that a paper copy of the Form 990 was available at the organization's principal office. |
| Form 990, Part VI, Section B, line 12c | Board Members and officers receive correspondence each year that must be completed and signed. The correspondence includes a Conflicts of Interest 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. |
| Form 990, Part VI, Section B, line 15 | The Compensation Committee of the organization's independent Board utilizes independent compensation studies that reflect the current market value of specific key management positions as benchmark data. All compensation of key individuals must be approved by the Compensation Committee. |
| Form 990, Part VI, Section C, line 19 | The organization has all governing documents, the conflict of interest policy, and the annual financial statements on file in the accounting and administration departments. These documents are available upon request. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (17 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Total IncomeTotalIncome | EOY AssetsEOYAssets |
|---|---|---|---|---|---|---|---|---|---|
| ATMORE COMMUNITY HOME CARE LLC | |||||||||
| 611 E LAUREL STREET | ATMORE | AL | 36502 | 205472065 | HOME HEALTH CARE SERVICES | AL | N/A | ||
| ANDREWS INSTITUTE REHABILITATION LLC | |||||||||
| 1040 GULF BREEZE PARKWAY | GULF BREEZE | FL | 32561 | 261307826 | REHABILITATION SERVICES | FL | N/A | ||
| BAPTIST HOSPITAL NORTH FAMILY PRACTICE LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 262977061 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| BAPTIST HOSPITAL PRIMARY CARE LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 261423323 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| BAPTIST MEDICAL GROUP ORTHOPEDIC PRACTICE LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 270950931 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| BAPTIST MEDICAL GROUP LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 264800380 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| BAPTIST PHYSICAN ASSOCIATES LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 200737321 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| BAPTIST PHYSICIAN ENTERPRISE LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 270288317 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| BAPTIST MEDICAL GROUP - OBGYN LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 273238217 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| PATHWAYS FOR CHANGE LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 271628254 | CHRISTIAN COUNSELING SERVICES | FL | N/A | 0 | 0 |
| AI LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 202137733 | REAL ESTATE | FL | N/A | 0 | 0 |
| ANDREWS INSTITUTE MEDICAL PARK LLC | |||||||||
| 1040 GULF BREEZE PKWY | GULF BREEZE | FL | 32561 | 204428528 | REAL ESTATE | FL | N/A | 0 | 0 |
| BAPTIST LEADERSHIP GROUP LLC | |||||||||
| 119 W GARDEN STREET | PENSACOLA | FL | 32502 | 271028631 | CONSULTING SERVICES | FL | N/A | 0 | 0 |
| BAPTIST PHYSICIAN PARTNERS LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 260386167 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| BAPTIST PHYSICIANS GROUP LLC | |||||||||
| 1717 NORTH E STREET | PENSACOLA | FL | 32501 | 743018052 | PHYSICIAN SERVICES | FL | N/A | 0 | 0 |
| Andrews-Paulos Research & Education Institute | |||||||||
| 1040 GULF BREEZE PARKWAY | gULF BREEZE | FL | 32561 | 263263612 | Research | FL | N/A | 0 | 0 |
| Behavioral Health Solutions LLC | |||||||||
| 1221 West Lakeview Ave | PENSACOLA | FL | 32501 | 205421098 | Mental Health Support services | FL | N/A | 0 | 0 |
Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| BAPTIST HEALTH CARE CORPORATION | |||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592425151 | COORDINATION OF HEALTH CARE SERVICES/ RESOURCE ALLOCATION | FL | 501(c)(3) | Line 11c, III-FI | N/A |
| BAPTIST HEALTH CARE FOUNDATION | |||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 590192265 | FINANCIAL AND FUNRAISING ASSISTANCE FOR HEALTH CARE RELATED SERVICES | FL | 501(c)(3) | Line 7 | N/A |
| BAPTIST HOSPITAL INC | |||||||||
| 1000 WEST MORENO STREET | PENSACOLA | FL | 32501 | 590657322 | HOSPITAL | FL | 501(c)(3) | Line 3 | N/A |
| CMHC HERNANDEZ HOUSE INC | |||||||||
| 1221 WEST LAKEVIEW AVENUE | PENSACOLA | FL | 32501 | 592041794 | PROVISION OF LOW COST HOUSING TO MENTALLY ILL PERSONS | FL | 501(c)(3) | Line 9 | N/A |
| ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPITALS INC | |||||||||
| 401 MEDICAL PARK DRIVE | ATMORE | AL | 36502 | 631143638 | HOSPITAL | AL | 501(c)(3) | Line 3 | N/A |
| LAKEVIEW CENTER INC | |||||||||
| 1221 WEST LAKEVIEW AVENUE | PENSACOLA | FL | 32501 | 590737872 | BEHAVIORAL HEALTH SERVICES | FL | 501(c)(3) | Line 7 | N/A |
| LAKEVIEW PLACE INC | |||||||||
| 1221 WEST LAKEVIEW AVENUE | PENSACOLA | FL | 32501 | 592804577 | PROVISION OF LOW COST HOUSING TO MENTALLY ILL PERSONS | FL | 501(c)(3) | Line 9 | N/A |
| LAKEVIEW VILLA INC | |||||||||
| 1221 WEST LAKEVIEW AVENUE | PENSACOLA | FL | 32501 | 592842486 | PROVISION OF LOW COST HOUSING TO MENTALLY ILL PERSONS | FL | 501(c)(3) | Line 9 | N/A |
| THE BAPTIST MANOR INC | |||||||||
| 10095 HILLVIEW ROAD | PENSACOLA | FL | 32514 | 592455515 | HEALTH CARE SERVICES | FL | 501(c)(3) | Line 9 | N/A |
| Global Connections for Employment Inc | |||||||||
| 1221 WEST LAKEVIEW AVENUE | pENSACOLA | FL | 32501 | 260441675 | Employment support services | FL | 501(c)(3) | Line 9 | N/A |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| BAPTIST MEDICAL PARK SURGERY CENTER LLC | |||||||
| PO BOX 17500 | PENSACOLA | FL | 32522 | 593535262 | SURGERY CENTER | FL | N/A |
| ENDOSCOPY CENTER OF GULF BREEZE LLC | |||||||
| 1116 GULF BREEZE PARKWAY | GULF BREEZE | FL | 32561 | 432086670 | ENDOSCOPY | FL | N/A |
| Baptist Imaging Center LLC | |||||||
| 5330 N Davis Highway | Pensacola | FL | 32503 | 261373637 | Diagnostic Testing and Imaging | FL | N/A |
| Physicians Laboratories | |||||||
| 14 W Jordan Street | Pensacola | FL | 32501 | 590879739 | laboratory services | DE | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| BAPTIST HEALTH VENTURES INC | ||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592415910 | ADMINISTRATIVE AND SUPPORT SERVICES | FL | N/A | C |
| BAPTIST URGENT CARE INC | ||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 593622226 | MEDICAL SERVICES | FL | N/A | C |
| PENSACOLA POB INC | ||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592462399 | REAL ESTATE LEASING | FL | N/A | C |
| MOBILE DIAGNOSTICS INC | ||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592864191 | DIAGNOSTIC SERVICE | FL | N/A | C |
| MEDICAL PROFESSIONAL AGENCY INC | ||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592555835 | MEDICAL SERVICES | FL | N/A | C |
| THE TOWERS PHARMACY INC | ||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592667929 | RETAIL SALES | FL | N/A | C |
| LANGHORNE CARDIOLOGY CONSULTANTS INC | ||||||||
| 1717 N E STREET | PENSACOLA | FL | 32501 | 592874324 | MEDICAL SERVICES | FL | N/A | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Affiliated Group Schedule AffiliatedGroupSchedule
Affiliated Schedule AffiliatedSchedule (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Total Grassroots LobbyingTotalGrassrootsLobbying | Total Direct LobbyingTotalDirectLobbying | Total Lobbying ExpendituresTotalLobbyingExpenditures | Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures | Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures | Lobbying NontaxableLobbyingNontaxableAmount | Grassroots NontaxableGrassrootsNontaxableAmount | Tot Lobbying Grassroot Minus NontxTotLobbyingGrassrootMinusNontx | Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx | Share Of Excess Lobbying ExpendtrsShareOfExcessLobbyingExpendtrs | Electing OrgElectingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lakeview Villa Inc | |||||||||||||||
| 1221 W Lakeview Avenue | Pensacola | FL | 325011836 | 592842486 | 0 | 0 | 0 | 136025 | 136025 | $27,205 | $6,801 | 0 | 0 | 0 | |
| Lakeview Place Inc | |||||||||||||||
| 1221 W Lakeview Avenue | Pensacola | FL | 325011836 | 592804577 | 0 | 0 | 0 | 75666 | 75666 | $15,133 | $3,783 | 0 | 0 | 0 | |
| CMHC Hernandez House Inc | |||||||||||||||
| 1221 W Lakeview Avenue | Pensacola | FL | 325011836 | 592041794 | 0 | 0 | 0 | 46997 | 46997 | $9,399 | $2,350 | 0 | 0 | 0 | |
| Escambia County Alabama Community Hospitals Inc | |||||||||||||||
| PO Box 17500 | Pensacola | FL | 325227500 | 631143638 | 0 | 0 | 0 | 19920312 | 19920312 | $1,000,000 | $250,000 | 0 | 0 | 0 | |
| Jay Hospital Inc | |||||||||||||||
| PO Box 17500 | Pensacola | FL | 325227500 | 592425149 | 0 | 0 | 0 | 15848425 | 15848425 | $942,421 | $235,605 | 0 | 0 | 0 | |
| The Baptist Manor Inc | |||||||||||||||
| PO Box 17500 | Pensacola | FL | 325227500 | 592455515 | 0 | 0 | 0 | 14635084 | 14635084 | $881,754 | $220,439 | 0 | 0 | 0 | |
| Baptist Health Care Foundation Inc | |||||||||||||||
| PO Box 17500 | Pensacola | FL | 325227500 | 590192265 | 0 | 0 | 0 | 1421480 | 1421480 | $217,148 | $54,287 | 0 | 0 | 0 | |
| Baptist Health Care Corporation | |||||||||||||||
| PO Box 17500 | Pensacola | FL | 325227500 | 592425151 | 0 | 192223 | 192223 | 37289080 | 37481303 | $1,000,000 | $250,000 | 0 | 0 | 0 | X |
| Lakeview Center Inc | |||||||||||||||
| 1221 W Lakeview Avenue | Pensacola | FL | 325011836 | 590737872 | 0 | 0 | 0 | 136837912 | 136837912 | $1,000,000 | $250,000 | 0 | 0 | 0 | |
| Baptist Hospital Inc | |||||||||||||||
| PO Box 17500 | Pensacola | FL | 325227500 | 590657322 | 0 | 0 | 0 | 363268919 | 363268919 | $1,000,000 | $250,000 | 0 | 0 | 0 | |