2024-05-10T14:45:37-05:00 2023-06-30 FORVIS LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2022-07-01 710329353 Jefferson Hospital Association Inc % JEREMY JEFFERY JEFF 8705417100 1600 West 40th Avenue Pine Bluff AR 71603 Jeremy Jeffery SVP AND CFO 8705417100 2024-05-15 true Jeremy Jeffery 999009999 Jeanette Verrelli P00742631 9727028262 2 2022 2023-04-26 12:10:37Z JEFFERSON REGIONAL MEDICAL CENTER BRIAN THOMAS 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 262880176 false X WWW.JRMC.ORG X 1959 AR JEFFERSON HOSPITAL ASSOCIATION, INC. PROVIDES A WIDE RANGE OF HEALTH CARE SERVICES TO PATIENTS FROM JEFFERSON COUNTY AND SURROUNDING AREAS IN SOUTHEAST ARKANSAS. 19 11 2069 30 1000 0 13876933 1379362 212508578 225186942 7092827 4823920 3453771 3193813 236932109 234584037 465964 476642 0 0 110386902 112779215 0 0 0 123694720 130772421 234547586 244028278 2384523 -9444241 272744607 256362575 78025444 66105659 194719163 190256916 X JEFFERSON REGIONAL'S MISSION IS IMPROVING HEALTH THROUGH EXCELLENCE AND COMPASSION WITH A VISION TO BE THE HEALTHCARE PROVIDER AND EMPLOYER OF CHOICE FOR SOUTHEAST ARKANSAS. false false 215384528 476642 227195453 Jefferson Regional opened its doors in 1908 as Davis Hospital, with a mission to meet the healthcare needs of Pine Bluff and Southeast Arkansas. More than 100 years later, that mission is unchanged. As Jefferson County's only general acute care hospital, Jefferson Regional is licensed for 300 acute care beds and participates in Medicaid/Arkansas Health and Opportunity For Me, Medicare, Champus, Tricare, Tricare East and/or other government-sponsored healthcare programs. SEE SCH O FOR MORE INFORMATION. 215384528 true true false true false false false false false false true false false false true false false true false false false false false false false false true true true true true false false false false false false true false false false false false true true true true false false true 246 0 true 2069 true true true false false false false false false false false false false false X 19 11 true false true false true true false true true false false true true true true true true true true true true CA X JEREMY JEFFERY 8705417100 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 X J ACOSTA - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 F ANTHONY - SEE SCH O DIRECTOR Retired: 09/22 1.0 0.0 X 0 0 0 D BRIDGFORTH - SEE SCH O TREASURER 1.0 0.0 X X 0 0 0 D BROWN - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 M CASTEEL - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 M ECKERT - SEE SCH O DIRECTOR 40.0 0.0 X 0 0 0 JB MAYS - SEE SCH O DIRECTOR 40.0 0.0 X 0 0 0 S PITTILLO - SEE SCH O CHAIRMAN 1.0 0.0 X X 0 0 0 D ROBINSON - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 A SANDERS - SEE SCH O Director Effective: 09/22 1.0 0.0 X 0 0 0 F TROTTER III - SEE SCH O VICE CHAIRMAN 1.0 0.0 X X 0 0 0 S WRIGHT - SEE SCH O DIRECTOR 1.0 0.0 X 0 0 0 B THOMAS - SEE SCH O PRESIDENT & CEO 40.0 0.0 X X 0 0 0 L ALEXANDER - SEE SCH O Director 1.0 0.0 X 0 0 0 D ATKINSON - SEE SCH O Director 1.0 0.0 X 0 0 0 A CAHILL - SEE SCH O Director 40.0 0.0 X 0 0 0 A Kline - SEE SCH O Director 1.0 0.0 X 0 0 0 G Makris - SEE SCH O Director 1.0 0.0 X 0 0 0 T Middleton - SEE SCH O Director 1.0 0.0 X 0 0 0 C Morgan - SEE SCH O Director 1.0 0.0 X 0 0 0 P AUSTIN - SEE SCH O SVP & COO 40.0 0.0 X 0 0 0 L HICKMAN - SEE SCH O VP & CCO 40.0 0.0 X 0 0 0 B JACKSON - SEE SCH O VP & CAO 40.0 2.0 X 0 0 0 J JEFFERY - SEE SCH O SVP & CFO 40.0 0.0 X 0 0 0 M Powell - SEE SCH O VP & CNO 40.0 0.0 X 0 0 0 G BIRK - SEE SCH O PHYSICIAN 40.0 0.0 X 0 0 0 R BURRELL - SEE SCH O PHYSICIAN 40.0 0.0 X 0 0 0 J FAKOURI - SEE SCH O Physician 40.0 0.0 X 0 0 0 J Shah - SEE SCH O Physician 40.0 0.0 X 0 0 0 T Simon - SEE SCH O Physician 40.0 0.0 X 0 0 0 0 0 0 203 false true false Lifepoint Rehabilitation LLC PO BOX 502096 ST LOUIS MO 63150 THERAPY & REHAB SVCS 3860759 SODEXO INC AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICES 2759061 QUALIVIS LLC DEPT 3847 PO BOX 123847 DALLAS TX 75312 HEALTHCARE STAFFING 9820817 CDI Contractors LLC 3000 CANTRELL RD LITTLE ROCK AR 72202 Construction svcs 4446119 Maxim Healthcare Services Inc 12558 Collections Ctr Dr CHICAGO IL 60693 Healthcare Staffing 2262422 82 545636 614177 219549 1379362 PATIENT SERVICE REVENUE 621110 201717365 201717365 OTHER OPERATING REVENUE 900099 1307579 1307579 JOINT VENTURE INCOME 621500 270051 270051 MEDICAL OFFICE RENTAL 531120 889316 889316 PHARMACY REVENUE 446110 19877833 19877833 1124798 1124798 225186942 3518619 3518619 0 0 18490 1000 18490 1000 19490 1000 18490 29584846 28279448 97 1305398 -97 1305301 1305301 0 0 0 0 0 0 317739 16594 301145 301145 CAFETERIA 722320 1165812 1165812 WELLNESS CENTER 713490 426318 426318 ALL OTHER MISC REVENUE 900099 1281048 1281048 1281048 1281048 2873178 234584037 227195453 1000 6008222 X 89250 89250 387392 387392 0 0 4667920 1594096 3073824 324753 178026 146727 94654022 83653606 11000416 2967261 2541228 426033 3540989 3392920 148069 6624270 5658380 965890 5286943 4619876 667067 176410 18976 157434 198601 198601 34262 34262 0 0 51210251 44130830 7079421 210199 13348 196851 6500722 4362734 2137988 2432836 2048446 384390 0 4157016 3889276 267740 179094 131168 47926 0 59916 59916 1080942 1006492 74450 0 10745063 10004993 740070 3283910 3070157 213753 BAD DEBT EXPENSE 466917 466917 MEDICAL SUPPLIES 40734704 40734704 DUES/FEES 663091 297870 365221 LICENSE & TAXES 3276535 2986119 290416 75009 47808 27201 244028278 215384528 28643750 0 3293380 0 929855 3345973 0 0 26129671 28235345 0 0 0 0 273334 373334 6002113 6610684 3274730 2844593 297697890 210862363 85069042 86835527 131781232 111140495 2063918 2228246 0 0 4739213 4253555 9188119 10494823 272744607 256362575 42110394 40146301 0 0 757300 53906 0 0 0 0 0 0 11917841 21385665 0 0 23239909 4519787 78025444 66105659 X 194719163 190256916 0 0 194719163 190256916 272744607 256362575 X -9444241 5245287 -263293 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false false false true 34262 34262 false Form 990, Schedule C, Part II-B, Line 1i LOBBYING ACTIVITIES: DURING THE FISCAL YEAR, MEMBERS OF JRMC'S STAFF HAD OCCASIONAL CONTACT WITH LEGISLATORS. ADDITIONALLY, JRMC CONTRIBUTED TO ORGANIZATIONS THAT UNDERTOOK LOBBYING ACTIVITIES DURING THE YEAR. JRMC ESTIMATES THE TOTAL AMOUNT OF DUES USED FOR LOBBYING ACTIVITIES AT $34,262. 6958885 6958885 128445410 94351747 34093663 1881077 1616206 264871 148786914 114894410 33892504 11625604 11625604 86835527 0 457 PLAN LIABILITY 3528601 FINANCING LEASE LIABILITY 468386 OPERATING LEASE LIABILITY 522800 4519787 SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X true X true true true false true true 3393 2689034 2689034 0.01100 11348 28699222 24426316 4272906 0.01750 14741 31388256 24426316 6961940 0.02850 14 550 5301393 3534840 1766553 0.00720 10 66413822 52179817 14234005 0.05830 476642 382242 94400 0.00040 24 550 72191857 56096899 16094958 0.06590 24 15291 103580113 80523215 23056898 0.09440 3 1020 1495 1495 0.00010 61 4948 39253 39253 0.00020 10 794 3315 3315 0.00010 74 6762 44063 44063 0.00040 true 3150129 52357675 42039199 10318476 X true true 1 1 JEFFERSON REGIONAL MEDICAL CENTER 1600 W 40TH AVENUE PINE BLUFF AR 71603 WWW.JRMC.ORG AR4213 X X X X JEFFERSON REGIONAL MEDICAL CENTER false false true X X X X X X X X X 21 true false false true X SEE PART V, SECTION C X true 21 true SEE PART V, SECTION C false true X 150. 300. X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 CONSULTING REPRESENTATIVES OF THE COMMUNITY: The Community Health Needs Assessment Toolkit developed by the National Center for Rural Health Works at Oklahoma State University, Center for Rural Health and Oklahoma Office of Rural Health was utilized as a guide for the CHNA facilitation process. The hospital created a Steering committee made up of officers of Jefferson Regional Medical Center and Officers of the Arkansas Rural Health Partnership and a community advisory committee made up of 28 community members. Due to the size of the service area, the steering committee chose to conduct their assessment through a focus group of community leaders and individuals in health-related fields. Approximately 28 individuals from the community were selected for invitation to the focus group, or community advisory committee, by the Jefferson Regional staff steering committee. Those accepting the invitation in which 23 attended the advisory committee's first meeting. A few additional advisory committee members, who were unable to attend the first meeting, joined the second meeting after being briefed. The individuals who participated in the meetings were from various organizations such as: Jefferson Regional Medical Center, local physicians, Simmons Bank, Relyance Bank, Strong Manufacturing, Arkansas Community Foundation, Pine Bluff City Council, Jefferson County District Court, SEARK College, Southeast Arkansas Behavioral Health Care System, various other businesses and retirees. In addition to the focus group, 138 surveys were completed by members of the community. SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS ADDRESSED AND NOT ADDRESSED: THE ORGANIZATION IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE 2021 CHNA THROUGH THE EXECUTION OF ITS CHNA IMPLEMENTATION STRATEGY THAT WAS CREATED OCTOBER 13, 2022. All needs identified within the assessment are being addressed in the implementation strategy. FOR ADDITIONAL INFORMATION, SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. SCHEDULE H, PART V, SECTION B, LINES 7 & 10 CHNA AND IMPLEMENTATION STRATEGY: THE CHNA AND IMPLEMENTATION STRATEGY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: https://www.jrmc.org/about/community-health-needs-assessment/ SCHEDULE H, PART V, SECTION B, LINES 16A, 16B & 16C FINANCIAL ASSISTANCE POLICY: THE FAP, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: https://www.jrmc.org/patients-visitors/billing-insurance/financial-assista nce 22 HEALTHWORKS 4201 S Mulberry St Suite A PINE BLUFF AR 71603 PHYSICIAN CLINIC PINE BLUFF SPECIALTY CLINIC 1601 W 40TH AVE SUITE 202A PINE BLUFF AR 71603 PHYSICIAN CLINIC CARDIOLOGY ASSOCIATES 1601 W 40TH AVE SUITE 301 PINE BLUFF AR 71603 PHYSICIAN CLINIC ENDOCRINOLOGY OF SOUTH ARKANSAS 7500 DOLLARWAY RD Suite 404 WHITE HALL AR 71603 PHYSICIAN CLINIC SOUTH ARKANSAS ORTHOPEADICS CENTER 1609 W 40TH AVE SUITE 501 PINE BLUFF AR 71603 PHYSICIAN CLINIC OBGYN ASSOCIATES OF S AR 1609 W 40TH AVE STE 300 PINE BLUFF AR 71603 PHYSICIAN CLINIC SURGICAL ASSOCIATES OF SOUTHEAST AR 1609 W 40TH AVE SUITE 403 PINE BLUFF AR 71603 PHYSICIAN CLINIC FAMILY HEALTH ASSOC OF SOUTH ARKANSAS 4747 DUSTY LAKE DRIVE SUITE G2 PINE BLUFF AR 71603 PHYSICIAN CLINIC GI ASSOC OF SOUTH ARKANSAS 1609 W 40TH AVE SUITE 401 PINE BLUFF AR 71603 PHYSICIAN CLINIC I-530 IMAGING 4747 DUSTY LAKE DR PINE BLUFF AR 71603 OP IMAGING JRMC OUTPATIENT PHYSICAL THERAPY 1600 W HOLLAND AVE WHITE HALL AR 71602 OP THERAPY JRMC URGENT CARE CENTER 4201 S MULBERRY ST PINE BLUFF AR 71603 WALK-IN CLINIC JEFFERSON REGIONAL CANCER CENTER 1609 W 40TH AVE STE 205 PINE BLUFF AR 71603 PHYSICIAN CLINIC FAMILY HEALTH ASSOC OF SOUTH ARKANSAS 1801 W 40TH AVE STE 6A PINE BLUFF AR 71603 PHYSICIAN CLINIC FAMILY HEALTH ASSOC OF SOUTH ARKANSAS 1600 W HOLLAND STE 202 PINE BLUFF AR 71603 PHYSICIAN CLINIC Rheumatology Associates 4747 Dusty Lake Dr Suite G1 Pine Bluff AR 71603 physician clinic Radiation Oncology 1609 W 40th Ave Suite 111 PINE BLUFF AR 71603 PHYSICIAN CLINIC MONTICELLO MEDICAL CLINIC I 906 Roberts Dr Monticello AR 71665 Physician Clinic Monticello Medical Clinic II 733 Roberts Dr Monticello AR 71665 Physician Clinic MMC - Crossett Clinic 201 Fairview Suite A Crossett AR 71635 Physician Clinic Ear Nose and Throat Assoc 1801 w 40th Suite 1B Pine Bluff AR 71603 Physician Clinic Nephrology Associates 1801 W 40th Suite 1b Pine Bluff AR 71603 physician clinic SCHEDULE H, PART III, SECTION A, LINE 2 PROVISION FOR UNCOLLECTIBLE ACCOUNTS METHODOLOGY: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09 DURING THE YEAR ENDED JUNE 30, 2022. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. THEREFORE, BAD DEBT EXPENSE RELATED TO PATIENT ACCOUNTS WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2023. HOWEVER, THE HOSPITAL INTERNALLY TRACKS ACCOUNT ACTIVITY CONSISTENT WITH HISTORICAL PRACTICES AND THE AMOUNT THAT WOULD HAVE BEEN ATTRIBUTED TO BAD DEBT UNDER PREVIOUS ACCOUNTING POLICY HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE: THE HOSPITAL HAS PROCESSES IN PLACE TO IDENTIFY THOSE PATIENTS THAT WOULD QUALIFY FOR FINANCIAL ASSISTANCE. THOSE ACCOUNTS ARE WRITTEN OFF TO CHARITY. THE HOSPITAL ALSO USES PRESUMPTIVE ELIGIBILITY TO IDENTIFY THOSE PATIENTS WHO HAVE NOT COMPLETED AN APPLICATION AND THOSE PATIENTS ARE CONSIDERED FOR ASSISTANCE AS WELL. MANAGEMENT DOESN'T BELIEVE THAT ANY OF THE BAD DEBT WOULD BE ATTRIBUTABLE TO THOSE FAP-ELIGIBLE PATIENTS. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: NOT APPLICABLE DUE TO THE ADOPTION OF ASU TOPIC 606 REVENUE FROM CONTRACTS WITH CUSTOMERS. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: THE ORGANIZATION DETERMINES ALLOWABLE COSTS ASSOCIATED WITH MEDICARE PAYMENTS BY UTILIZING AMOUNTS REPORTED ON THE MEDICARE COST REPORT. Medicare revenue was computed from Worksheet E, less GME & Allied health reimbursement (considered separately). Medicare allowable cost was computed from worksheet D-1. As a safety Net Hospital, the organization provides care to all patients regardless of source of Payment; therefore, costs to provide care to Medicare patients should be considered community benefit to the extent costs exceed Medicare reimbursement. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTIONS POLICY: PATIENT ACCOUNTS QUALIFYING FOR free or discounted care WOULD NOT INTENTIONALLY BE PLACED WITH A DEBT COLLECTION SERVICE. FROM TIME TO TIME, INFORMATION THAT RESULTS IN THE DETERMINATION OF ASSISTANCE QUALIFICATION IS OBTAINED SUBSEQUENT TO A PATIENT'S ACCOUNT BEING PLACED WITH A DEBT COLLECTION AGENCY. THE ORGANIZATION'S COLLECTION AGENCY POLICY REQUIRES CONTRACTED COLLECTION AGENTS, IN ADDITION TO MANY OTHER PRUDENT PROCEDURES, TO INFORM THE DEBTOR OF THE APPROPRIATE HOSPITAL FINANCIAL ASSISTANCE PROFESSIONAL TO CONTACT IF THE COLLECTION AGENT IS MADE AWARE OF A PATIENT'S FINANCIAL HARDSHIP. THE COLLECTION AGENT IS ALSO REQUIRED TO NOTIFY THE ORGANIZATION OF THE PATIENT'S FINANCIAL HARDSHIP SO THE ORGANIZATION CAN ASSIST THE PATIENT IN ACCESSING THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAMS. SCHEDULE H, PART VI, LINE 2 Needs Assessment: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILTY FOR ASSISTANCE: A FINANCIAL COUNSELOR INITIATES A FINANCIAL SCREENING ON ALL INPATIENTS, OBSERVATION PATIENTS AND OUTPATIENTS OCCUPYING A BED HAVING NO INSURANCE INDICATED ON THEIR ACCOUNT. THIS PROCESS INCLUDES SCREENING FOR free or discounted care, MEDICAID COVERAGE AND OTHER THIRD PARTY COVERAGE. OUTPATIENTS RECEIVE A FINANCIAL ASSISTANCE GUIDE SHEET SUMMARIZING ASSISTANCE OFFERED BY JRMC AT THE TIME OF REGISTRATION. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THIS IS NOT APPLICABLE FOR FISCAL YEAR 2023. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NO COMMUNITY BENEFIT REPORT WAS FILED WITH THE STATE FOR FISCAL YEAR 2023. SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -MEDICAL INDIGENCY -INSURANCE STATUS -UNDERINSURANCE STATUS SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: JRMC PERSONNEL SERVED ON THE BOARDS OF A NUMBER OF LOCAL VOLUNTEER AND BUSINESS ORGANIZATIONS THAT PROMOTED GENERAL COMMUNITY DEVELOPMENT AND HEALTH BY PROVIDING HEALTH EDUCATION AND VOLUNTEER SUPPORT. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: The organization computes the cost of providing care through the use of cost accounting methodologies and assumptions derived from the Medicare cost report. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES: THE EXPENSES REPORTED ON THIS LINE ARE FROM COSTS ASSOCIATED WITH VARIOUS PHYSICIAN CLINICS REPORTED ON PART V, SECTION D THAT PROVIDE SERVICES TO THE COMMUNITY THAT WOULD NOT OTHERWISE BE AVAILABLE. true UNITED WAY OF SOUTH EAST ARKANSAS PO BOX 8702 Pine Bluff AR 71611 710236869 501(C)(3) 30765 2022 CAMPAIGN PLEDGE Go Forward Pine Bluff Inc PO BOX 6316 PINE BLUFF AR 71611 821412910 501(C)(3) 75000 LONG-TERM PLEDGE Pine Bluff Country Club 1100 W 46th Ave Pine Bluff AR 71603 710141610 501(C)(7) 8769 REVITALIZATION Arts & Science Center 701 S Main St Pine Bluff AR 71601 510447372 501(C)(3) 6775 Sponsorship Greater Pine Bluff Chamber of Commerce PO Box 5069 Pine Bluff AR 71611 710765850 501(C)(6) 5810 Sponsorship 3 2 FEDERAL PELL GRANTS 79 348062 JSN SCHOLARSHIPS 8 5150 ACADEMIC CHALLENGE 11 17750 Arkansas Rehabilitation Services 6 16430 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: JEFFERSON HOSPITAL ASSOCIATION, INC. MAINTAINED RECORDS TO SUBSTANTIATE THE AMOUNT OF THE GRANTS OR ASSISTANCE, THE GRANTEES' ELIGIBILITY FOR THE GRANTS OR ASSISTANCE, AND THE SELECTION CRITERIA USED TO AWARD GRANTS OR ASSISTANCE. FORM 990, PART IX, LINES 1 & 2 & SCHEDULE I, PARTS II & III DIFFERENCE BETWEEN SCHEDULE I & STATEMENT OF FUNCTIONAL EXPENSES: THE ORGANIZATION IS REPORTING THE CONTRIBUTIONS PAID ON SCHEDULE I, WHICH IS NOT NECESSARILY ON THE ACCRUAL BASIS BECAUSE THE ORGANIZATION RECORDS LONG-TERM PLEDGES AT THEIR NPV AND RECORDS ACCRETION OF INTEREST OVER TIME. THE PLEDGES, WHEN PAID, ARE A REDUCTION OF THIS LIABILITY AND NOT CURRENT YEAR EXPENSE WHICH MAY CAUSE A DIFFERENCE BETWEEN AMOUNT REPORTED ON FORM 990, PART IX AND SCHEDULE I, PARTS II & III. X X false true X X X X false true false false false false false true false SCHEDULE J, PART I, LINE 1A DESCRIPTION OF BENEFITS: THE FOLLOWING BENEFITS ARE INCLUDED IN THE TAXABLE COMPENSATION OF THE RECIPIENTS. - TAX GROSS-UP PAYMENTS ARE INCLUDED IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IDENTIFIED BELOW. - COUNTRY CLUB MEMBERSHIPS ARE MAINTAINED BY THE ORGANIZATION FOR THE USE OF SPECIFIC EMPLOYEES AS DESIGNATED BY THE BOARD OF DIRECTORS. SCHEDULE J, PART I, LINE 1B WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT: THERE IS NO WRITTEN POLICY REGARDING PROVISION OF COUNTRY CLUB MEMBERSHIPS. THE BOARD OF DIRECTORS DESIGNATES WHICH EMPLOYEES MAY USE MEMBERSHIPS MAINTAINED BY THE ORGANIZATION. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: THE ORGANIZATION PROVIDES DEFINED MEMBERS OF MANAGEMENT A NON-FIXED PERFORMANCE BASED INCENTIVE PLAN. THE PLAN'S COMPONENTS ARE ESTABLISHED AND EVALUATED BY THE ORGANIZATION'S EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP PLAN REPORTED IN W-2 DEFERRED COMPENSATION --------------------------- ----------------- ---------------------- PETER AUSTIN $38,443 $43,882 LOUISE HICKMAN $97,300 NONE BRYAN JACKSON $86,329 NONE JEREMY JEFFERY $59,721 $9,165 BRIAN THOMAS $281,721 NONE SCHEDULE J, PART II COMPENSATION TABLE: COMPENSATION INFORMATION REQUIRED IN FORM 990, PART VII, SECTION A AND SCHEDULE J, PART II IS PROVIDED IN A TABLE ATTACHED TO THE TAX RETURN DOCUMENT FOLLOWING SCHEDULE R. THE AMOUNTS ARE INCLUDED IN THE ATTACHMENT. ELIZABETH BRIDGFORTH HARTZ SEE SUPPLEMENTAL INFO SEE SUPPLEMENTAL INFO false VERONICA ALEXANDER SEE SUPPLEMENTAL INFO SEE SUPPLEMENTAL INFO false RUTH ANN NUTT SEE SUPPLEMENTAL INFO SEE SUPPLEMENTAL INFO false RICHARD MORGAN SEE SUPPLEMENTAL INFO SEE SUPPLEMENTAL INFO false FORM 990, SCHEDULE L, PART IV, COLUMNS B, C, & D (A) NAME OF PERSON: ELIZABETH BRIDGFORTH HARTZ (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF DAVID BRIDGFORTH (JHA TREASURER) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC (A) NAME OF PERSON: RUTH ANN NUTT (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF AMY CAHILL (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC (A) NAME OF PERSON: VERONICA ALEXANDER (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF LAURENCE ALEXANDER (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC (A) NAME OF PERSON: RICHARD MORGAN (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF CHUCK MORGAN (JHA DIRECTOR) (C) TRANSACTION AMOUNTS REPORTED ARE GREATER THAN $10,000 (D) DESCRIPTION OF TRANSACTION: EMPLOYEE OF JRMC FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS: CONTINUED FROM PART III... Jefferson Regional's governing board is comprised of individuals who are business leaders in our community. Approximately 80 percent of Jefferson Regional Medical Center's patients originate from the primary service area (Jefferson, Cleveland and Lincoln counties) with 20 percent originating from the secondary service area (Arkansas, Ashley, Bradley, Chicot, Dallas, Desha, Drew and Grant counties). Offering a variety of diverse programs and services, Jefferson Regional's medical staff features most major specialties including cardiology, general surgery, critical care, gastroenterology, orthopaedics, neurology, cancer care, endocrinology, obstetrics/gynecology, radiology, psychiatry, otolaryngology, and urgent and emergency care. Jefferson Regional also actively participates in teaching programs for medical students and residents, as well as students in allied health fields. In addition, our physicians can be seen in surrounding communities, conducting satellite clinics on a regular basis to care for patients in rural areas. The Jefferson Regional Emergency Department and the Urgent Care Walk-In Clinic are open seven days-a-week to provide immediate care for different levels of emergencies, regardless of the patient's ability to pay. Jefferson Regional Healthworks, an occupational health clinic, offers a wide range of services to area businesses including pre-employment testing and laboratory services. Jefferson Regional also operates dozens of additional clinics, some providing specialized care such as the Wound Care Center, and others offering family medical services. The Jefferson Regional Jones-Dunkin Cancer Center provides cancer care for patients all in one convenient location - from screening and diagnosis to therapy and beyond. Services include physician visits, an infusion center, a radiation oncology center, a breast center, imaging services, on site lab and pharmacy, care coordination, and financial navigation. With community service and education as a significant part of our mission, Jefferson Regional provides financial sponsorships within the community and offers free health screenings and educational events each year. We will continue to strive to accomplish our mission, "Improving health through excellence and compassionvision, "To be the healthcare provider and employer of choice for Southeast Arkansas." FORM 990, PART VI, SECTION A, LINE 1A DELEGATION OF AUTHORITY: AN EXECUTIVE COMMITTEE MAY BE ELECTED BY THE BOARD OF DIRECTORS TO CONSIST OF NOT LESS THAN THREE DIRECTORS. THE COMMITTEE IS ABLE TO EXERCISE ALL AUTHORITY OF THE BOARD DURING INTERVALS BETWEEN MEETINGS OF THE BOARD WITH RESPECT TO THE AFFAIRS OF THE CORPORATION, BUT SHALL BE SUBJECT TO THE CONTROL AND DIRECTION OF THE FULL BOARD. THE COMMITTEE SHALL ALSO CONDUCT AN EVALUATION OF THE CHIEF EXECUTIVE OFFICER ANNUALLY FOR THE FULL BOARD OF DIRECTORS TO REVIEW. FORM 990, PART VI, SECTION A, LINE 2 RELATIONSHIPS OF OFFICERS, DIRECTORS, AND TRUSTEES: H. Ford Trotter (JHA Director) and David Brown (JHA Director) have a business relationship. JANICE ACOSTA (JHA DIRECTOR) CHUCK MORGAN (JHA DIRECTOR) ANNETTE KLINE (JHA DIRECTOR) AND SCOTT PITTILLO (JHA CHAIR) HAVE A BUSINESS RELATIONSHIP. Marty Casteel (JHA Director), George Makris (JHA Director) and Daniel Robinson (JHA Director) have a business relationship. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS: THE ORGANIZATION HAS A MEMBERSHIP CONSISTING OF 30 JEFFERSON COUNTY ARKANSAS RESIDENTS. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT MEMBERS OF GOVERNING BODY: THE MEMBERSHIP OF THE ORGANIZATION HAS THE RESPONSIBILITY OF ELECTING THE BOARD OF DIRECTORS AT THE ANNUAL MEMBERSHIP MEETING. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990: THE FORM 990 AND FORM 990-T ARE PREPARED AND REVIEWED UNDER THE DIRECTION OF THE CHIEF FINANCIAL OFFICER. FINAL DRAFTS OF THE RETURNS ARE PRESENTED TO THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS, WHICH IS DESIGNATED BY THE BOARD OF DIRECTORS TO FULFILL THE FIDUCIARY RESPONSIBILITY OF THE GOVERNING BODY TO REVIEW THE RETURNS BEFORE THEY ARE FILED WITH THE IRS. AFTER ANY FINAL REVISIONS ARE MADE BASED UPON THE GOVERNANCE COMMITTEE'S REVIEW, A FINAL VERSION IS POSTED TO AN INTERNAL SECURE WEBSITE WITH A LINK E-MAILED TO EACH VOTING MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C PROCESS TO MONITOR AND ENFORCE COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE ORGANIZATION REQUIRES NOT ONLY AN ANNUAL CONFLICT OF INTEREST DISCLOSURE, BUT ALSO DISCLOSURE WHEN SITUATIONS SUBSEQUENT TO THE ANNUAL DISCLOSURE DEVELOP THAT WOULD POTENTIALLY PLACE THE INDIVIDUAL IN A CONFLICT OF INTEREST. IN THOSE SITUATIONS, IMMEDIATE DISCLOSURE IS REQUIRED. THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS CONDUCTS THE ANNUAL REVIEW OF CONFLICT OF INTEREST DISCLOSURES. IN THE EVENT THE GOVERNANCE COMMITTEE DETERMINES THAT A CONFLICT EXISTS, LEGAL COUNSEL IS CONSULTED. IF LEGAL COUNSEL DETERMINES THAT A CONFLICT EXISTS, THE PERSON IS INFORMED AND THE MATTER IS REPORTED TO THE BOARD FOR ACTION. ANY DIRECTOR OR OFFICER WHOSE TRANSACTIONS ARE BEING REVIEWED WOULD ABSENT HIMSELF/HERSELF FROM THE REVIEW. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION OF CEO AND OTHER OFFICERS: THE COMPENSATION COMMITTEE MOST RECENTLY ENGAGED A THIRD-PARTY GLOBAL HUMAN CAPITAL CONSULTING FIRM, KORN FERRY HAY GROUP IN NOVEMBER 2021 TO PERFORM A COMPENSATION REVIEW FOR SELECT OFFICERS OF THE ORGANIZATION AND PREVIOUSLY IN OCTOBER 2019 TO PERFORM A TOTAL COMPENSATION REVIEW. THE COMPENSATION COMMITTEE UTILIZES THESE REVIEWS IN CONCERT WITH A DEFINED EXECUTIVE COMPENSATION POLICY TO DEVELOP AND MAINTAIN A TOTAL COMPENSATION PACKAGE THAT IS REASONABLE AS COMPARED TO SIMILAR POSITIONS AT NON-PROFIT HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY. THE DELIBERATIONS AND DECISIONS OF THE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED AND A SUMMARY REPORT IS MADE TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND OTHER DOCUMENTS TO ALL WHO REQUEST ONE OR MORE OF THE ITEMS. FORM 990, PART VII, SECTION A & SCHEDULE J, PART II COMPENSATION TABLE: COMPENSATION INFORMATION REQUIRED IN FORM 990, PART VII, SECTION A AND SCHEDULE J, PART II IS PROVIDED IN A TABLE ATTACHED TO THE TAX RETURN DOCUMENT FOLLOWING SCHEDULE R. THE AMOUNTS ARE INCLUDED IN THE ATTACHMENT. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: Contributions of or for Acquisition of Property 127,098 Release of Net Assets from Restrictions (390,391) -------------- TOTAL $(263,293) FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: DURING THE YEAR, THE ASSOCIATION AMENDED ITS BYLAWS TO CHANGE DIRECTOR COUNT, TERM LIMITS, VOTING RIGHTS, AND RESIDENCY REQUIREMENTS. FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:21357719 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:21715196 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:6015597 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES TOTAL FEES:2121739 JEFFERSON REGIONAL ANESTHESIA 1600 W 40TH AVE PINE BLUFF AR 71603 831984365 ANESTHESIA AR 1334885 313685 JHA ARKANSAS RURAL HEALTH PARTNERSHIP CIN 1600 W 40TH AVE PINE BLUFF AR 71603 830694507 POP HEALTH AR 350375 466795 JHA DELTA ASSURANCE LLC 1600 W 40TH AVE PINE BLUFF AR 71603 873657892 INSURANCE AR 1124798 1826492 JHA JEFFERSON REGIONAL MED CENTER FOUNDATION 1600 W 40TH AVE PINE BLUFF AR 71603 821820277 SUPPORT AR 501(C)(3) 12, TYPE I JHA true Jefferson Regional R&B Hospital LLC 330 Seven Springs Way Brentwood TN 37027 872820909 Rehab hospital TN JHA related 0 0 false 0 false 0.60000 JEFFERSON MANAGEMENT SERVICES INC 1600 W 40TH AVE PINE BLUFF AR 71603 710582753 PHYS PRACTICE AR JHA C-CORPORATION 0 3417 1.00000 true JHA HEALTH AFFILIATES INC 1600 W 40TH AVE PINE BLUFF AR 71603 710766959 REAL EST RENT AR JHA C-CORPORATION -29386 497655 1.00000 true false false true false false false false false false false false true false false false false false false true JEFFERSON REGIONAL MED CENTER FOUNDATION L 85515 G/L ACTIVITY JEFFERSON REGIONAL MED CENTER FOUNDATION C 545636 G/L Activity