2023-11-13T16:01:10-06:00 2022-12-31 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-01-01 636001820 JACKSON HOSPITAL AND CLINIC INC JACK 3342938000 1725 PINE STREET 1200 MONTGOMERY AL 36106 BENJAMIN WELLS VICE PRESIDENT / CFO 3342938000 2023-11-13 1 BENJAMIN WELLS 999009999 0 AMY BIBBY P00445891 8282542254 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOE B RILEY 1725 PINE STREET 1200 MONTGOMERY AL 36106 332930397 0 X WWW.JACKSON.ORG X 1946 AL JACKSON HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION COMMITTED TO IMPROVING THE HEALTH OF ALL MEMBERS OF OUR COMMUNITY BY PROVIDING SUPERIOR, PATIENT-CENTERED AND COST-EFFECTIVE CARE IN A SAFE, COMPASSIONATE ENVIRONMENT. 11 9 2802 40 0 0 3501206 15825 293154342 324749499 8929662 2238807 3090102 5926266 308675312 332930397 85217 69027 0 0 147956604 164134648 0 0 78594 161931293 177136627 309973114 341340302 -1297802 -8409905 237401026 245636738 130099161 157073900 107301865 88562838 X JACKSON HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION COMMITTED TO IMPROVING THE HEALTH OF ALL MEMBERS OF OUR COMMUNITY BY PROVIDING SUPERIOR, PATIENT-CENTERED AND COST-EFFECTIVE CARE IN A SAFE, COMPASSIONATE ENVIRONMENT. 0 0 293551132 69027 325718450 JACKSON HOSPITAL OPERATES A GENERAL ACUTE CARE HOSPITAL THAT PROVIDES CERTAIN TERTIARY SERVICES SUCH AS NEUROLOGY AND NEUROSURGERY, CARDIOLOGY (INCLUDING CARDIAC CATHERIZATION AND CARDIOVASCULAR SURGERY) AND ONCOLOGY. JACKSON HOSPITAL IS LICENSED FOR 344 BEDS THAT INCLUDE 30 INTENSIVE CARE BEDS AND 22 OBSTETRIC BEDS. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS.THE INPATIENT ANCILLARY AND SUPPORT SERVICES OFFERED BY JACKSON HOSPITAL ARE AS FOLLOWS; ACUTE DIALYSIS, BLOOD BANK. CARDIAC CATHETERIZATION LABORATORY, NUCLEAR MEDICINE, NURSERY (LEVEL II), PHARMACY, PHYSICAL THERAPY, POST ANESTHESIA CARE, RESPIRATORY CARE, ELECTROCARDIOLOGY, INTENSIVE CARE, LABOR AND DELIVERY, MRI, CARDIOVASCULAR SURGERY, CARDIOVASCULAR LABORATORY, CLINICAL AND ANATOMICAL LABORATORY, COMPUTERIZED TOMOGRAPHY, CORONARY CARE, DIAGNOSTIC RADIOLOGY, SURGICAL FACILITIES AND ULTRASOUND. THE OUTPATIENT ANCILLARY AND SUPPORT SERVICES OFFERED BY JACKSON HOSPITAL ARE AS FOLLOWS; BLOOD BANK, CARDIAC CATHETERIZATION LABORATORY, EMERGENCY DEPARTMENT, ENDOSCOPY, LITHOTRIPSY, DIABETES TREATMENT CENTER, PAIN MANAGEMENT, PHYSICAL THERAPY, RESPIRATORY CARE, SLEEP LAB, ELECTROCARDIOLOGY, MRI, CARDIOVASCULAR LABORATORY, CLINICAL LABORATORY, COMPUTERIZED TOMOGRAPHY, DIAGNOSTIC RADIOLOGY, AMBULATORY SURGERY, ULTRASOUND AND WOUND CARE CENTER. FOR THE 12 MONTHS ENDING DECEMBER 31, 2022, JACKSON HOSPITAL HAD 12,101 ADMISSIONS, 75,938 PATIENT DAYS, 969 DELIVERIES, 22,138 TOTAL SURGERIES AND 53,080 EMERGENCY DEPARTMENT VISITS. 293551132 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 96 0 1 2802 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BEN WELLS 3342938816 1725 PINE STREET SUITE 1200 MONTGOMERY AL 36106 X KEITH KARST BOARD MEMBER 1.00 X 0 0 0 DAVID THRASHER MD BOARD MEMBER 1.00 X 0 0 0 GEORGE W THOMPSON III BOARD MEMBER 1.00 X 0 0 0 LEMUEL GORDEN MD SECRETARY (PHYSICIAN) 40.00 X X 408210 0 0 EDWARD CROWELL CHAIRMAN 1.00 X X 0 0 0 WILBUR HUFMAN BOARD MEMBER 1.00 X 0 0 0 GEORGE WAKEFIELD MD BOARD MEMBER 1.00 X 0 0 0 RENE' A LLERA MD BOARD MEMBER 1.00 X 0 0 0 JO PARR BOARD MEMBER 1.00 X 0 0 0 PATRICK G RYAN MD BOARD MEMBER (PHYSICIAN) 40.00 X 77000 0 0 W KEN UPCHURCH III BOARD MEMBER 1.00 X 0 0 0 STEVEN BARRINGTON MD BOARD MEMBER (PHYSICIAN) 40.00 X 264500 0 0 JOE B RILEY PRESIDENT/CEO 40.00 X 675540 0 38510 MICHAEL JAMES VICE PRESIDENT/COO 40.00 X 367443 0 35530 BENJAMIN WELLS VICE PRESIDENT /CFO 40.00 X 358190 0 32987 JAN HILL VICE PRESIDENT /CNO 40.00 X 234886 0 33610 CRAIG MOMANY AVP OF FINANCE 40.00 X 187876 0 23363 DAVID RALSTON AVP OF REVENUE CYCLE 40.00 X 200683 0 36610 GINA ANDERSON VICE PRESIDENT/CQ AND INTEGRATION 40.00 X 258856 0 9610 MARK LAUTEREN AVP/CIO 40.00 X 204249 0 38687 KWAN STEPHEN PHYSICIAN 40.00 X 1501403 0 36610 AGGARWAL HIMANSHU PHYSICIAN 40.00 X 1303581 0 54487 RICHARDSON BRIAN PHYSICIAN 40.00 X 1102196 0 51070 CLARK LATOYA S PHYSICIAN 40.00 X 971615 0 54320 PATEL HIREN G PHYSICIAN 40.00 X 1195171 0 48508 9311399 0 493902 304 0 1 0 MONTGOMERY ANESTHESIA ASSOCIATES 7956 VAUGHN ROAD 165 MONTGOMERY AL 36105 ANESTESIA SERVICES 3648330 RICHARD SAMPLE L PO BOX 1709 MILLBROOK AL 36054 ED PHYSICIAN SERVICES 581080 PATEL URMIL SURESH MD 9204 AUTUMN BROOKE WAY MONTGOMERY AL 36117 ED PHYSICIAN SERVICES 504880 PEADEN MICHAEL W MD 644 BURT MILL ROAD TALLASEE AL 36078 ED PHYSICIAN SERVICES 473553 FARAH MAHER 9533 FENDALL HALL CIRCLE MONTGOMERY AL 36117 ED PHYSICIAN SERVICES 470188 25 15825 15825 NET PATIENT SERVICE 621400 319895287 319895287 SURGERY CENTER REVENUES 621400 3062239 3062239 IMAGING CENTER REVENUES 621400 1089969 1089969 HOME HEALTH SERVICES 621610 681307 681307 ANCILLIARY SERVICES 621610 20697 20697 324749499 1158027 1158027 968951 0 968951 968951 968951 1080780 0 1080780 1080780 1080780 OTHER 900099 3641730 3641730 CAFETERIA 722514 1229020 1229020 COMMISSION INCOME 900099 47452 47452 39113 39113 4957315 332930397 325718450 0 7196122 X 69027 69027 142429881 125433466 16928214 68201 817951 720343 97216 392 12127248 10680082 1441359 5807 8759568 7714273 1041101 4194 368276 368276 382815 382815 57152245 50936276 6215969 851575 851575 17114113 7446234 9667879 3449522 3449522 5298497 5298497 152127 141378 10749 129719 129719 4300207 4300207 10838002 10838002 6254867 6254867 SUPPLIES 55706019 49910732 5795287 BAD DEBT EXPENSE 13714539 13714539 MISCELLANEOUS EXPENSE 735963 93209 642754 RECRUITMENT 688141 688141 341340302 293551132 47710576 78594 6473755 10225457 54631232 74291999 12354833 11862640 2029210 1854176 275719203 194806622 85872697 80912581 54398849 38687227 10167957 11744172 11472493 16058486 237401026 245636738 49097585 61126407 1552188 1565531 69612139 66468983 449298 11799298 9387951 16113681 130099161 157073900 X 107301865 88562838 107301865 88562838 237401026 245636738 X -8409905 -7969928 -2359195 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 17000 0 0 17000 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE ALABAMA HOSPITAL ASSOCIATION. EACH YEAR, A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TOWARDS LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES. FOR 2022, THE APPROXIMATE AMOUNTS OF MEMBERSHIP DUES ALLOCATED TO THESE EXPENDITURES WERE APPROXIMATELY $ 8,000 FOR AHA AND $ 9,000 FOR ALABAMA HOSPITAL ASSOCIATION. 1644606 8144235 9788841 73609053 53922128 19686925 31334471 22953988 8380483 156115433 114361970 41753463 4871405 3568536 1302869 80912581 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 2525258 INTEREST IN JACKSON HOPSITAL FOUNDATION 3599139 RIGHT OF USE ASSETS 9934089 16058486 ACCRUED INTEREST 2086235 PENSION LIABILITY -58906 UNAMORTIZED BOND PREMIUM 3758251 LEASES PAYABLE 5472842 LEASE LIABILITY 4855259 16113681 X PART X, LINE 2: THE ORGANIZATION FILES A CONSOLIDATED FINANCIAL STATEMENT WITH ITS SUBSIDIARIES. THE FOLLOWING FOOTNOTE REFERENCES ENTITIES WHOSE ACTIVITY IS NOT REPORTED ON THE FORM 990 FOR JACKSON HOSPITAL AND CLINIC, INC. "THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3); ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AS LIMITED LIABILITY COMPANIES, THE SURGERY CENTER AND IMAGING CENTER'S TAXABLE INCOME OR LOSS IS ALLOCATED TO THE MEMBERS AND IS INCLUDED IN THE CALCULATION OF THEIR TAXABLE INCOME. ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR INCOME TAXES. THE ORGANIZATION DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2022 AND 2021." 1 1 1 X 0 1 1 1 0 0 8800228 8800228 0.02690 32537516 30459282 2078234 0.00630 41337744 30459282 10878462 0.03320 220465 220465 0.00070 220465 220465 0.00070 41558209 30459282 11098927 0.03390 1 13714539 9188741 105467290 120709656 -15242366 X 1 1 1 JACKSON IMAGING CENTER LLC RADIOLOGY PROCEDURES 0.67000 0.33000 2 JACKSON SURGERY CENTER LLC OUTPATIENT SURGERY 0.54130 0.43410 3 JMS HEALTH SERVICES PATIENT SERVICES 0.50000 1 1 JACKSON HOSPITAL AND CLINIC 1725 PINE STREET MONTGOMERY AL 361061117 X X X DISPROPORTIONATE SHARE HOSPITAL JACKSON HOSPITAL & CLINIC 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X HTTPS://WWW.JACKSON.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 22 1 HTTPS://WWW.JACKSON.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 300.000000000000 X X X 1 1 X X X X 1 X SEE DISCLOSURE X SEE DISCLOSURE X SEE DISCLOSURE X X X X X X 1 X 0 X X X X 1 X 0 0 JACKSON HOSPITAL & CLINIC PART V, SECTION B, LINE 5: THIS CHNA INCLUDES INFORMATION FROM THE FOLLOWING SOURCES:-INPUT FROM PERSONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY SERVED BY JACKSON HOSPITAL-IDENTIFYING FEDERAL, REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES, WITH CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY JACKSON HOSPITALCONSULTATION OR INPUT FROM OTHER PERSONS LOCATED IN AND/OR SERVING JACKSON HOSPITAL'S COMMUNITY, SUCH AS:-HEALTHCARE COMMUNITY ADVOCATES-NONPROFIT ORGANIZATIONS-ACADEMIC EXPERTS-LOCAL GOVERNMENT OFFICIALS-COMMUNITY-BASED ORGANIZATIONS, INCLUDING ORGANIZATIONS FOCUSED ON ONE OR MORE HEALTH ISSUES-HEALTHCARE PROVIDERS, INCLUDING COMMUNITY HEALTH CENTERS AND OTHER PROVIDERS FOCUSING ON MEDICALLY UNDERSERVED POPULATIONS, LOW-INCOME PERSONS, MINORITY GROUPS OR THOSE WITH NEEDS ARISING FROM CHRONIC DISEASE JACKSON HOSPITAL & CLINIC PART V, SECTION B, LINE 11: 1 CHONIC CONDITIONSHEART DISEASE IS THE LEADING CAUSE OF DEATH IN ELMORE, AUTAUGA, AND MONTGOMERY COUNTIES. THE CHRONIC LOWER RESPIRATORY DISEASEMORTALITY RATE IN AUTAUGA COUNTY IS SIGNIFICANTLY HIGHER THAN THE RATE IN THE OVERALL STATE OF ALABAMATHE HYPERTENSION HOSPITALIZATION RATES IN ELMORE, AUTAUGA, AND MONTGOMERY COUNTIES ARE HIGHER THAN THE OVERALL RATE IN ALABAMA CANCER WAS THE SECOND MOST COMMONLY MENTIONED HEALTH CONCERN DURING COMMUNITY PHONE SURVEYS. RESPONDENTS FELT THAT THE CONCERN IS GETTING WORSE OVER TIME THE BREAST CANCER INCIDENCE RATE IS HIGHER IN ELMORE, AUTAUGA, AND MONTGOMERY COUNTIES WHEN COMPARED TO ALABAMA. THE COLORECTAL CANCER MORTALITY.2 DIABETESTHE DIABETES MORTALITY RATE IN MONTGOMERY COUNTY IS SIGNIFICANTLY HIGHER THAN THE RATE IN ALABAMA. DURING COMMUNITY LEADER INTERVIEWS, INTERVIEWEES NOTED DIABETES AS ONE OF THEIR MAIN HEALTH CONCERNS. THE MOST COMMONLY MENTIONED HEALTH CONCERN DURING COMMUNITY PHONE SURVEYS WAS DIABETES. RESPONDENTS FEEL THAT THE CONCERN IS GETTING WORSE OVER TIME.3 OBESITYTHE PREVALENCE OF OBESITY IN MONTGOMERY MSA IS SLIGHTLY HIGHER THAN THE PERCENTAGE STATEWIDE. ACCESS TO HEALTHY FOODS IN AUTAUGA AND MONTGOMERY COUNTIES IS SIGNIFICANTLY LIMITED COMPARED TO THE REST OF THE STATE. OBESITY/BEING OVERWEIGHT WAS ONE OF THE MOST COMMONLY MENTIONED HEALTH CONCERN BY PHONE SURVEY PARTICIPANTS. PHYSICAL INACTIVITY IN ELMORE COUNTY IS HIGHER THAN THE ENTIRE STATE OF ALABAMA. THE PERCENTAGE OF OBESE AND OVERWEIGHT INDIVIDUALS IS SIGNIFICANTLY HIGHER THAN THOSE OF NORMAL WEIGHT.MATERNAL & CHILD HEALTHTHE TEEN BIRTH RATE IN MONTGOMERY COUNTY IS HIGHER THAN THE STATE RATE. THE INFANT MORTALITY RATE IS HIGHER IN MONTGOMERY COUNTY WHEN COMPARED TO THE RATE IN ALABAMA. WOMEN IN AUTAUGA, ELMORE, AND MONTGOMERY COUNTIES ARE LESS LIKELY TO RECEIVE PRENATAL CARE IN THE FIRST TRIMESTER OF THEIR PREGNANCY WHEN COMPARED TO OTHER WOMEN IN ALABAMA. WOMEN IN MONTGOMERY COUNTY ARE LESS LIKELY TO RECEIVE ADEQUATE PRENATAL CARE DURING THE COURSE OF THEIR PREGNANCY WHEN COMPARED TO WOMEN IN ALABAMA. INFANTS IN AUTAUGA AND MONTGOMERY COUNTIES ARE MORE LIKELY TO BE CONSIDERED LOW BIRTHWEIGHT BIRTHS WHEN COMPARED TO INFANTS IN ALABAMA. JACKSON HOSPITAL & CLINIC PART V, SECTION B, LINE 13H: ALL SELF-PAY PATIENTS RECEIVE A 78% DISCOUNT SO THAT THEY ARE ONLY BILLED FOR 22% OF TOTAL CHARGES. IN ADDITION, FINANCIAL ASSISTANCE WILL BE PROVIDED TO THOSE WHOSE INCOME IS AT OR BELOW THE FPG OF 100%. ADDITIONAL CONSIDERATIONS ARE INSURANCE/COVERAGE STATUS. PART V, SECTION B, LINE 16A: WEBSITE FOR FAP:HTTP://WWW.JACKSON.ORG/MEDIA/1244/FINANCIAL-ASSISTANCE-POLICY-REVISED-6-28-16.PDF PART V, SECTION B, LINE 16B: FAP APPLICATION WEBSITE:HTTP://WWW.JACKSON.ORG/MEDIA/1242/FINANCIAL-ASSISTANCE-APPLICATION-REV-7-19-16.PDF PART V, SECTION B, LINE 16C: PLS WEBSITE:HTTP://WWW.JACKSON.ORG/PATIENT-RESOURCES/PATIENTS-VISITORS/FINANCIAL-SERVICES-BILLING/FINANCIAL-ASSISTANCE-PROGRAM/ 3 1 - JACKSON CLINIC FAMILY MEDICINE CENTER 1111 OLIVE STREET MONTGOMERY AL 36106 FAMILY MEDICINE/OUTPATIENT 2 - JACKSON SURGERY CENTER 1725 PARK PLACE MONTGOMERY AL 36106 OUTPATIENT SURGERY 3 - JACKSON IMAGING CENTER 1825 PARK PLACE MONTGOMERY AL 36106 MEDICAL IMAGING PART I, LINE 3C: ALL SELF-PAY PATIENTS RECEIVE A 78% DISCOUNT SO THAT THEY ARE ONLY BILLED FOR 22% OF TOTAL CHARGES. IN ADDITION, FINANCIAL ASSISTANCE WILL BE PROVIDED TO THOSE WHOSE INCOME IS AT OR BELOW THE FPG OF 100%. ADDITIONAL CONSIDERATIONS ARE INSURANCE/COVERAGE STATUS. PART I, LN 7 COL(F): THE AMOUNT LISTED ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $13,714,539 THAT HAS BEEN REMOVED FOR PURPOSES OF CALCULATING PERCENT OF TOTAL EXPENSE ON PART I, LINE 7, COLUMN (F). PART III, LINE 3: THE ORGANIZATION ESTIMATES APPROXIMATELY 67.2% OF ITS BAD DEBT WOULD QUALIFY FOR FINANCIAL ASSISTANCE IF PATIENTS WENT THROUGH THE APPLICATION PROCESS. THIS ESTIMATE IS BASED OF PATIENT POPULATION. PART III, LINE 4: RECEIVABLES FROM PATIENTS, INSURANCE COMPANIES, AND THIRD-PARTY CONTRACTUAL AGENCIES ARE RECORDED AT REGULAR PATIENT SERVICE CHARGE RATES. A MAJORITY OF THE COMPANY'S PATIENTS ARE INSURED BY CERTAIN THIRD PARTY INSURERS (PRINCIPALLY BLUE CROSS, MEDICARE, AND MEDICAID) BASED ON CONTRACTUAL AGREEMENTS WHICH GENERALLY RESULT IN THE COMPANY COLLECTING LESS THAN THE ESTABLISHED CHARGE RATES. FINAL DETERMINATION OF PAYMENTS UNDER THESE AGREEMENTS IS SUBJECT TO REVIEW BY APPROPRIATE AUTHORITIES. ADEQUATE ALLOWANCES ARE PROVIDED FOR DOUBTFUL ACCOUNTS, CONTRACTUAL ADJUSTMENTS AND OTHER UNCERTAINTIES. CREDIT LOSSES HAVE HISTORICALLY BEEN WITHIN MANAGEMENT'S EXPECTATIONS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBTS IF SUBSEQUENTLY COLLECTED. PART III, LINE 8: THE ORGANIZATION USED ITS MEDICARE COST REPORT TO CALCULATE ALLOWABLE COSTS OF CARE RELATED TO MEDICARE FOR PURPOSES OF PART III, LINE 6. PART III, LINE 9B: THE ORGANIZATION QUALIFIES PATIENTS FOR ITS CHARITY CARE POLICY AT TIME OF DISCHARGE. DISCOUNTS ON SELF-PAY PATIENTS ARE APPLIED USING A NON-FINANCIAL MEASURE, SO ACCOUNTS IN BAD DEBTS ARE NOT LIKELY ELIGIBILE FOR FURTHER FINANCIAL ASSISTANCE AFTER HAVING THEIR FINAL BILLS ISSUED. THE HOSPITAL PRIMARILY USES A THIRD-PARTY TO HANDLE BAD DEBT COLLECTIONS, AND ROUTINELY REEVALUATES ITS BAD DEBT ACCOUNTS TO DETERMINE PATIENTS THAT QUALIFY UNDER THE ORGANIZATION'S CHARITY CARE POLICY. PART VI, LINE 2: HOSPITAL PERFORMS A COMMUNITY HEALTH ASSESSMENT EVERY 3 YEARS. INCORPORATING KEY COMMUNITY STAKEHOLDS IN THE PROCESS. HOSPITAL ALSO WORKS CLOSELY WITH PHYSICIAN & PHYSICIAN GROUPS WITHIN KEY COMMITTEES TO DISCUSS SERVICE LINE NEEDS FOR THEIR ASSOCIATED SPECIALTIES. HOSPITAL ALSO RELIES ON VARIOUS DATA POINTS REGARDING KEY DEMOGRAPHIC DATA AND HEALTH NEEDS. PART VI, LINE 3: FINANCIAL ASSISTANCE ARE AVAILABLE ON COMPANY WEBSITE, BILLING STATEMENTS, ON-SITE FINANCIAL CONSELOURS AND THEN MEDICIAD ELLIGIBILITY AND SSI/DISSABILITY COUNCELORS. PART VI, LINE 4: JACKSON HOSPITAL & CLINIC INC, SERVES THE GREATER RIVER REGION. DUE TO CHALLENGES ASSOCIATED WITH OVERALL EDUCATION, HEALTH LITERACY TRAILS PEERS COMPARED TO OTHER STATES. JACKSON HAS EXPANDED IN SURROUNDING COMMUNITIES TO HAVE A GREATER IMPACT IN IMPROVING HEALTH EDUCATION AND OUTCOMES. CHRONIC CONDITIONS AND COMORBIDITIES ARE HIGH THROUGHOUT THE AREA. JACKSON SERVES A DIVERSE COMMUNITY. PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES, INDEPENDENT CONTRACTORS, NOR A FAMILY MEMBER OF AN EMPLOYEE OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO MOST OF ITS DEPARTMENTS. IN ADDITION, ANY SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION TO EXPAND HEALTH SERVICES AND SERVICE LINES. HOSPITAL HAS A PHARMACY RESIDENCY PROGRAM AND IS CURRENTLY IN THE PROCESS OF ESTABLISHING A FAMILY PRACTICE RESIDENCY PROGRAM. PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES AL 1 PART I, LINE 2: THE ORGANIZATION WORKS WITH LOCAL COMMUNITY ORGANIZATIONS AND LOCAL CHAPTERS OF NATIONAL ORGANIZATION. THE ORGANIZATION EVALUATES REQUESTS FOR FUNDS PRIOR TO DISBURSEMENTS. NO ORGANIZATION RECEIVED GRANTS IN EXCESS OF 5,000. X 1 1 X X X X X X 0 0 0 0 0 1 0 0 0 KWAN STEPHEN PHYSICIAN 1501403 0 0 0 0 0 27000 0 9610 0 1538013 0 0 0 AGGARWAL HIMANSHU PHYSICIAN 650000 0 653581 0 0 0 41000 0 13487 0 1358068 0 0 0 PATEL HIREN G PHYSICIAN 500000 0 695171 0 0 0 35021 0 13487 0 1243679 0 0 0 RICHARDSON BRIAN PHYSICIAN 631365 0 470831 0 0 0 37583 0 13487 0 1153266 0 0 0 CLARK LATOYA S PHYSICIAN 315145 0 656470 0 0 0 40833 0 13487 0 1025935 0 0 0 JOE B RILEY PRESIDENT/CEO 625400 0 50140 0 0 0 26000 0 12510 0 714050 0 0 0 LEMUEL GORDEN MD SECRETARY (PHYSICIAN) 408210 0 0 0 0 0 0 0 0 0 408210 0 0 0 MICHAEL JAMES VICE PRESIDENT/COO 310000 0 57443 0 0 0 25920 0 9610 0 402973 0 0 0 BENJAMIN WELLS VICE PRESIDENT /CFO 307000 0 51190 0 0 0 19500 0 13487 0 391177 0 0 0 JAN HILL VICE PRESIDENT /CNO 200000 0 34886 0 0 0 24000 0 9610 0 268496 0 0 0 GINA ANDERSON VICE PRESIDENT/CQ AND INTEGRATION 220000 0 38856 0 0 0 0 0 9610 0 268466 0 0 0 STEVEN BARRINGTON MD BOARD MEMBER (PHYSICIAN) 264500 0 0 0 0 0 0 0 0 0 264500 0 0 0 MARK LAUTEREN AVP/CIO 204249 0 0 0 0 0 25200 0 13487 0 242936 0 0 0 DAVID RALSTON AVP OF REVENUE CYCLE 200683 0 0 0 0 0 27000 0 9610 0 237293 0 0 0 CRAIG MOMANY AVP OF FINANCE 187876 0 0 0 0 0 9876 0 13487 0 211239 0 0 0 PART I, LINE 1A THE HOSPITAL PAID MONTHLY DUES FOR A COUNTRY CLUB MEMBERSHIP AND ALSO PROVIDES A CAR ALLOWANCE FOR THE PRESIDENT/CEO. THESE BENEFITS WERE INCLUDED IN THE CEO'S TAXABLE COMPENSATION. PART I, LINE 6 EXECUTIVE BONUS CALCULATIONS INCLUDE A METRIC FOR NET EARNINGS. INCLUDED IN THE EXECUTIVE BONUS CALUCATION IS A METRIC FOR EARNINGS. NO BONUS WAS ACCRUED AND PAID FOR 2021 YEAR. BONUS FOR 2020 WAS ACCRUED FOR IN 2020 AND PAID IN 2021. A THE MEDICAL CLINIC BOARD OF THE CITY OF MONTGOMERY ALABAMA 630888154 613058CZ7 2016-01-14 92697442 REFUNDING, CAPITAL ACQUISITION 0 0 0 A 17325000 92697442 933990 479556 2016 1 1 1 1 A 1 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 A 0 EDITH JAMES FAMILY MEMBER OF OFFICER MICHAEL JAMES, COO 91224 COMPENSATION 0 CHANDLER RILEY SON OF CEO 31168 IMAGING TECH 0 FORM 990, PART IV LINE 20C AT THE TIME OF FILING THE 2022 AUDITED FINANCIAL STATEMENTS HAD NOT BEEN ISSUED, THEREFORE, THE ORGANIZATION IS ATTACHING ITS MOST RECENT AUDITED FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS FOUR CLASSES OF MEMBERS: ACTIVE MEMBERS, SENIOR ACTIVE MEMBERS, ASSOCIATE MEMBERS, AND COMMUNITY MEMBERS. ACTIVE MEMBERS - TO QUALIFY AS AN ACTIVE MEMBER, AN APPLICANT MUST: BE ACTIVE IN THE PRACTICE OF MEDICINE, BE A MEMBER OF THE ACTIVE MEDICAL STAFF OF THE HOSPITAL, HAVE SERVED AS AN ASSOCIATE MEMBER FOR NOT LESS THAN THREE YEARS, HAVE DEMONSTRATED INTEREST IN AND ADHERENCE TO THE OBJECTIVES OF THE ORGANIZATION, AND BE IN COMPLIANCE WITH ALL OTHER PROVISIONS FROM TIME TO TIME ADOPTED BY THE BOARD RELATING TO MEMBERSHIP. SENIOR ACTIVE MEMBERS - ACTIVE MEMBERS THAT HAVE RETIRED FROM ACTIVE PRACTICE BUT EXPRESS A DESIRE TO CONTINUE TO PARTICIPATE IN THE OBJECTIVES OF THE ORGANIZATION. ASSOCIATE MEMBERS - TO QUALIFY AS AN ASSOCIATE MEMBER, AN APPLICANT MUST: BE ACTIVE IN THE PRACTICE OF MEDICINE, HAVE SERVED AS A MEMBER OF THE MEDICAL STAFF OF THE HOSPITAL FOR NOT LESS THAN TWO YEARS, HAVE DEMONSTRATED INTEREST IN AND ADHERENCE TO THE OBJECTIVES OF THE ORGANIZATION, AND BE IN COMPLIANCE WITH ALL OTHER PROVISIONS FROM TIME TO TIME ADOPTED BY THE BOARD RELATING TO MEMBERSHIP. COMMUNITY MEMBERS - A COMMUNITY MEMBER MUST BE A CITIZEN OF THE UNITED STATES OF NOT LESS THAN 21 YEARS OF AGE AND A PERMANENT RESIDENT OF MONTGOMERY COUNTY, ALABAMA, OR ANY OTHER COUNTY WITHIN THE STATE WHICH IS WITHIN THE SERVICE AREA OF THE HOSPITAL AND SHALL POSSESS SUCH ADDITIONAL QUALIFICATIONS AS SHALL BE SET FORTH FROM TIME TO TIME BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 7A ACTIVE MEMBERS HAVE THE EXCLUSIVE RIGHT TO VOTE ON THE APPROVAL OF THE ADMISSION OF ANY PERSON AS AN ACTIVE OR ASSOCIATE MEMBER OF THE NON-PROFIT CORPORATION. COMMUNITY MEMBERS ARE PERMITTED TO PARTICIPATE IN THE ELECTION OF THE MEMBERS OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B ALL VOTING RIGHTS OF MEMBERS ACCRUING TO MEMBERS GENERALLY, UNDER THE ALABAMA NONPROFIT CORPORATION ACT OR UNDER THE RESTATED ARTICLES OF INCORPORATION, ARE RESERVED TO THE ACTIVE MEMBERS, EXCEPT FOR THE PARTICIPATION OF COMMUNITY MEMBERS IN THE ELECTION OF MEMBERS OF THE BOARD OF TRUSTEES AND EXCEPT IN THOSE INSTANCES WHERE THE BOARD OF TRUSTEES, IN ITS DISCRETION, DESIRES TO REFER A PARTICULAR MATTER TO THE MEMBERSHIP AS A WHOLE OR TO ANY RESTRICTED CLASS OR CLASSES FOR CONSIDERATION AND ADVICE AS PROVIDED HEREIN, PROVIDED, HOWEVER, THAT NO CLASS OF MEMBERS OTHER THAN ACTIVE MEMBERS SHALL, BY SUCH PROCEDURE, BE GIVEN THE RIGHT TO VOTE ON ANY MATTER REQUIRING THE VOTE OR APPROVAL OF MEMBERS GENERALLY UNDER THE ALABAMA NONPROFIT CORPORATION ACT OR THE VOTE OF ACTIVE MEMBERS UNDER THE RESTATED ARTICLES OF INCORPORATION. THE MATTERS UPON WHICH THE ACTIVE MEMBERS SHALL HAVE THE EXCLUSIVE RIGHT TO VOTE ARE THOSE MATTERS GENERALLY RESERVED TO MEMBERS IN THE ALABAMA NONPROFIT CORPORATION ACT AS IT MAY EXIST FROM TIME TO TIME, INCLUDING, WITHOUT LIMITATION, THE FOLLOWING: - THE LIQUIDATION, DISSOLUTION, OR REORGANIZATION OF THE CORPORATION, - THE SALE, EXCHANGE, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTIES OF THE CORPORATION, BUT NOT THE POWER TO MORTGAGE OR CONVEY SUCH PROPERTY SOLELY FOR THE PURPOSE OF SECURING ANY INDEBTEDNESS OR OTHER OBLIGATIONS OF THE CORPORATION, WHICH THE BOARD OF TRUSTEES, ACTING ALONE, SHALL HAVE AND EXERCISE, - THE APPROVAL OF THE AMENDMENT OF THE RESTATED ARTICLES OF INCORPORATION, - THE APPROVAL OF THE ADMISSION OF ANY PERSON AS AN ACTIVE OR ASSOCIATE MEMBER OF THE CORPORATION. SUCH MATTERS SHALL BE SUBMITTED FOR VOTE OF THE ACTIVE MEMBERS UPON RECOMMENDATION OF THE BOARD OF TRUSTEES. NO ACTION UPON ANY SUCH MATTERS SHALL BE TAKEN BY THE ACTIVE MEMBERS (OR ANY OTHER MEMBER ENTITLED TO VOTE) WITHOUT NOTICE OF SUCH PURPOSE BEING GIVEN PRIOR TO THE MEETING, OTHER THAN THE ELECTION OF THE BOARD OF TRUSTEES WHICH SHALL OCCUR AT EACH ANNUAL MEETING WITHOUT REQUIREMENT OF FURTHER NOTICE. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY HOSPITAL MANAGEMENT. THE RETURN WAS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING WITH THE IRS. THE BOARD REVIEWED THE FORM 990 AT A SUBSEQUENT BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION UPDATES ITS CONFLICT OF INTEREST POLICY ANNUALLY FOR KEY HOSPITAL EMPLOYEES AND BOARD MEMBERS TO PROVIDE INFORMATION ON ANY POTENTIAL CONFLICTS OF INTEREST. THE UPDATES OF THE POLICY FORMS ARE REVIEWED BY HOSPITAL ADMINISTRATION. IN THE EVENT OF A POTENTIAL CONFLICT OF INTEREST, A BOARD MEMBER WILL ABSTAIN FROM VOTING ON MATTERS PERTAINING TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AN OUTSIDE INDEPENDENT CONSULTING FIRM REVIEWS THE COMPENSATION OF OFFICERS EVERY TWO YEARS TO ENSURE COMPENSATION IS COMPARABLE TO THE MARKET. THE HOSPITAL EXECUTIVE COMMITTEE REVIEWS THE RECOMMENDATIONS OF THE OUTSIDE CONSULTING COMPANY AND APPROVES THE COMPENSATION AND ANY CHANGES TO THE COMPENSATION OF OFFICERS. THE EXECUTIVE COMMITEE IS COMPOSED OF MEMBERS OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PLEASE SEE PART VI, LINE 20. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PLEASE SEE PART VI, LINE 20. FORM 990, PART VII, SECTION A, LINE 1A: BOARD MEMBER COMPENSATION: THE COMPENSATION PAID TO BOARD MEMBERS LEMUEL GORDEN, PATRICK RYAN, AND STEVEN BARRINGTON WERE FOR MEDICAL SERIVCES, NOT FOR THEIR POSITIONS AS BOARD MEMBERS. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 20,066,952. MANAGEMENT AND GENERAL EXPENSES 120,629. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,187,581. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 19,610,038. MANAGEMENT AND GENERAL EXPENSES 4,422,336. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,032,374. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 9,907,873. MANAGEMENT AND GENERAL EXPENSES 176,216. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,084,089. BILLING SERVICES: PROGRAM SERVICE EXPENSES 1,351,413. MANAGEMENT AND GENERAL EXPENSES 1,496,788. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,848,201. FORM 990, PART XI, LINE 9: RESTATEMENT OF AUDITED FINANCIAL STATEMENTS -2,359,195. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OAK PARK HIGHLAND LLC 1725 PINE STREET MONTGOMERY AL 36106 260752650 REAL ESTATE AL 0 0 JACKSON HOSPITAL AND CLINIC INC HOSPICE OF MONTGOMERY INC 1111 HOLLOWAY PARK MONTGOMERY AL 36117 630768381 MEDICAL SERVICES AL 501(C)(3) LINE 7 JACKSON HOSPITAL AND CLINIC INC 0 JACKSON IMAGING CENTER LLC 1825 PARK PLACE MONTGOMERY AL 36106 260339264 MEDICAL IMAGING AL JACKSON HOSPITAL AND CLINIC INC RELATED 4135996 6339360 0 0 0.67000 JACKSON SURGERY CENTER LLC 1725 PARK PLACE MONTGOMERY AL 36106 204173305 OUTPATIENT SURGERY AL JACKSON HOSPITAL AND CLINIC INC RELATED 10578806 8385223 0 0 0.60250 JACKSON HEALTH INC 1725 PINE STREET MONTGOMERY AL 36106 471701457 PHYSICIAN PRACTICES AL JACKSON HOSPITAL AND CLINIC INC C 1.00000 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0