2025-05-15T14:06:21-05:00 2024-06-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2023-07-01 431992975 ST DOMINIC HEALTH SERVICES FOUNDATION INC STDO 6012006951 969 LAKELAND DRIVE JACKSON MS 391264699 SAM SCOTT TREASURER 6012006951 2025-05-15 1 0 RYAN HOOKS P00746825 2253444000 2023 2025-03-06 01:10:19Z SAM SCOTT 969 LAKELAND DRIVE JACKSON MS 391264699 3748175 0 X WWW.STDOM.COM X 2002 MS SUPPORTS ST. DOMINIC HEALTH SERVICES & AFFILIATES THROUGH FUNDRAISING & GIVING INITIATIVES 22 20 0 20 0 0 776943 1540243 0 0 357127 337647 0 0 1134070 1877890 1275423 2003784 0 0 0 0 0 0 194149 216464 310447 1491887 2314231 -357817 -436341 23584067 24967349 1405287 1347594 22178780 23619755 X SEE SCHEDULE O 0 0 2003784 2003784 0 ST. DOMINIC HEALTH SERVICES FOUNDATION, INC. FACILITATES FUNDRAISING IN SUPPORT OF THE MISSION OF ST. DOMINIC HEALTH SERVICES AND ITS AFFILIATES, ST. CATHERINE'S VILLAGE, COMMUNITY HEALTH SERVICES AND ST. DOMINIC JACKSON MEMORIAL HOSPITAL. GRANTS ARE MADE TO PROMOTE THE WELFARE OF THESE ORGANIZATIONS AND INCREASE THEIR USEFULNESS TO THE JACKSON, MISSISSIPPI COMMUNITY THEY SERVE. 2003784 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 22 20 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SAM SCOTT 6012006951 969 LAKELAND DRIVE JACKSON MS 392164699 AMY BOTELER BOARD MEMBER 0.50 0.00 X 0 0 0 BARTON LAMPTON BOARD MEMBER 0.50 0.00 X 0 0 0 BRIAN JOHNSON BOARD MEMBER 0.50 0.00 X 0 0 0 C RALPH DANIEL III MD BOARD MEMBER 0.50 0.00 X 0 0 0 CHARLES POSTON BOARD MEMBER 0.50 0.00 X 0 0 0 CHERYL SHERRY RULA BOARD MEMBER 0.50 0.00 X 0 0 0 D PAUL SEAGO MD BOARD MEMBER/PHYSICIAN 0.50 40.00 X 0 1108105 36770 DICKENS Q FOURNET VICE CHAIR 0.50 0.00 X X 0 0 0 DOUG RALSTON CHAIR 0.50 0.00 X X 0 0 0 JAMES HOUSE III MD BOARD MEMBER 0.50 0.00 X 0 0 0 JEREMY TINNERELLO MARKET PRESIDENT (START 11/2023) 0.50 41.00 X X 0 117252 267 JULIE HERLIHY IMMEDIATE PAST CHAIR 0.50 0.00 X X 0 0 0 KENNY WILLIAMSON BOARD MEMBER 0.50 0.00 X 0 0 0 LARRY RATZLAFF BOARD MEMBER 0.50 0.00 X 0 0 0 MATT JAMES BOARD MEMBER 0.50 0.00 X 0 0 0 RITA MARTINSON SECRETARY 0.50 0.00 X X 0 0 0 SAMANTHA MOORE BOARD MEMBER 0.50 0.00 X 0 0 0 SCOTT KASHMAN MARKET PRESIDENT (UNTIL 7/2023) 0.50 42.00 X X 0 295199 16104 SHIRLEY TUCKER BOARD MEMBER 0.50 0.00 X 0 0 0 SISTER DOROTHEA SONDGEROTH BOARD MEMBER 0.50 40.75 X 0 0 0 TRISH DUNCAN BOARD MEMBER 0.50 0.00 X 0 0 0 TRUDY LIPSCOMB BOARD MEMBER 0.50 0.00 X 0 0 0 W HIBBETT NEEL BOARD MEMBER 0.50 0.00 X 0 0 0 KRISTEN WOLKART INTERIM MKT PRESIDENT:7/2023-11/2023 0.50 42.75 X 0 740802 117217 KAY MCREE EXECUTIVE DIRECTOR 1.00 40.00 X 0 216752 23990 SAM SCOTT SVP, CFO 0.50 41.75 X 0 434391 33974 0 2912501 228322 0 0 1 0 0 1540243 108860 1540243 373122 373122 1834810 1870285 -35475 -35475 -35475 1877890 0 0 337647 2003784 2003784 34060 34060 88331 82190 6141 195 195 186938 48 186890 776 776 MEDICAL SUPPLIES 147 147 2314231 2003784 116298 194149 6734558 6046963 1944212 1911433 15000 15000 15000 14890297 16993953 23584067 24967349 5100 5550 1400187 1342044 1405287 1347594 X 7647253 8273368 14531527 15346387 22178780 23619755 23584067 24967349 X -436341 1990696 -113380 X 0 1 X 1 0 X 1973905 3125330 1629443 776943 1540243 9045864 1973905 3125330 1629443 776943 1540243 9045864 2582324 6463540 54037 143898 119271 214932 373122 905260 9951124 0.64950 0.71690 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14538416 3964876 838712 3913078 15428926 14906739 784009 542516 1694848 14538416 16140982 2150275 -154861 3229657 14906739 18534970 3100029 1128528 6622545 16140982 16584393 1991323 57589 98335 18534970 1.00000 0 0 15000 15000 15000 INVESTMENTS HELD BY FMOLHS 16993953 F 16993953 DUE TO/FROM AFFILIATES 1342044 1342044 X 4310047 1990696 588901 2579597 1730450 34060 113380 147440 1877890 2869072 588901 588901 2280171 34060 34060 2314231 PART X, LINE 2: ASC 740 (FIN 48) FOOTNOTE FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAPITAL TRANSFERS 113,380. PART X, LINE 2: THE ENDOWMENT FUNDS SUPPORT SPECIFIC PROJECTS, PROGRAMS AND ENTITIES WITHIN ST. DOMINIC'S AND ST. CATHERINE'S VILLAGE. 1 ST DOMINIC JACKSON MEMORIAL HOSPITAL 969 LAKELAND DRIVE JACKSON MS 39202 640303091 501(C)(3) 1913655 0 GENERAL ASSISTANCE ST CATHERINE'S VILLAGE 200 DOMINICAN DRIVE MADISON MS 39110 640714997 501(C)(3) 65202 0 GENERAL ASSISTANCE DOMINICAN SISTERS OF SPRINGFIELD 12377 W MONROE ST SPRINGFIELD IL 62704 501(C)(3) 16025 0 GENERAL ASSISTANCE 3 0 PART I, LINE 2: THE FOUNDATION ONLY GIVES GRANTS TO ITS OWN RELATED ORGANIZATIONS. GRANTS ARE MONITORED BY VIRTUE OF THE ORGANIZATIONS HAVING THE SAME OFFICERS. 0 1 0 0 0 0 0 0 0 D PAUL SEAGO MD BOARD MEMBER/PHYSICIAN 0 891805 0 178870 0 37430 0 16500 0 20270 0 1144875 0 0 KRISTEN WOLKART INTERIM MKT PRESIDENT:7/2023-11/2023 0 493260 0 244790 0 2752 0 96776 0 20441 0 858019 0 0 SAM SCOTT SVP, CFO 0 334566 0 94413 0 5412 0 15315 0 18659 0 468365 0 0 SCOTT KASHMAN MARKET PRESIDENT (UNTIL 7/2023) 0 293628 0 0 0 1571 0 0 0 16104 0 311303 0 0 KAY MCREE EXECUTIVE DIRECTOR 0 201355 0 15397 0 0 0 11162 0 12828 0 240742 0 0 PART I, LINE 3: THE FMOL HEALTH SYSTEM INC. BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE. PART I, LINE 4A: TWO OFFICERS AND ONE BOARD MEMBER ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 12 OR 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. PART I, LINE 4B: FMOLHS MAINTAINS TWO UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDES FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLANS IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. NO ONE LISTED IN PART VII, SECTION A RECEIVED A PAYMENT IN THE CURRENT YEAR. X 3 108860 FMV 0 1 0 PART I, COLUMN (B): PART I, LINE 9, COLUMN B THE FIGURES REPORTED IN PART I, LINE 9, COLUMN B REPRESENT THE NUMBER OF DONATION OCCURANCES. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: INSPIRED BY THE VISION OF ST. FRANCIS AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING - WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMULITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. FORM 990, PART VI, SECTION A, LINE 6 ST. DOMINIC HEALTH SERVICES, INC. WAS THE SOLE MEMBER OF THE FOUNDATION. ON 3/31/24, ST. DOMINIC HEALTH SERVICES INC. MERGED INTO ST. DOMINIC JACKSON MEMORIAL HOSPITAL (SDJMH). SDJMH IS NOW THE SOLE MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE FOUNDATION'S SOLE MEMBER, ST. DOMINIC JACKSON MEMORIAL HOSPITAL, INC., HAVE THE AUTHORITY TO APPROVE THE ELECTION OF THE CHAIR OF THE BOARD, THE VICE-CHAIR OF THE BOARD, THE PRESIDENT OF THE FOUNDATION, AND ALL OTHER DIRECTORS AND OFFICERS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B THE RESERVED POWERS TO FMOL HEALTH SYSTEM, INC. ARE AS FOLLOWS: I. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION. II. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION. III. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BY LAWS OF THE CORPORATION. IV. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES. V. TO DISSOLVE AND TO DISTRIBUTE ASSETS OF THE CORPORATION. VI. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. VII. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF THE CORPORATION. VIII. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION. IX. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION. X. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION. XI. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION. XII. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B AFTER PREPARATION AND REVIEW OF FORM 990 BY KPMG LLP, THE TAXPAYER'S TAX ADVISORS, ONE OR MORE MEMBERS OF SENIOR MANAGEMENT REVIEWS THE RETURN. GOVERNING BODY IS PROVIDED A COPY OF THE RETURN ELECTRONICALLY PRIOR TO THE FILING DATE AND IS GIVEN AN OPPORTUNITY TO REVIEW AND PROVIDE COMMENTS TO MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND OFFICERS RECEIVE A COPY OF THE POLICY AND FORM FOR REPORTING EACH YEAR AT THE FIRST MEETING OF THE YEAR. FORMS ARE REVIEWED BY THE PRESIDENT AND ANY CONFLICTS SHARED WITH THE BOARD CHAIR. PERSONS WITH CONFLICTS OF INTERESTS ABSTAIN FROM ANY DECISIONS WHERE THE CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION DOES NOT COMPENSATE ANY OFFICERS OR EMPLOYEES. ALL COMPENSATION IS PAID BY THE FOUNDATION'S SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SECTION 1.263(A)-3(N) ELECTION - BOOK CONFORMITY ELECTION: ST. DOMINIC HEALTH SERVICES FOUNDATION, INC. IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THOSE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2024. SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION: ST. DOMINIC HEALTH SERVICES FOUNDATION, INC. HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDING JUNE 30, 2024. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OF LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). FORM 990, PART XI, LINE 9: CAPITAL TRANSFERS -113,380. 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