2026-05-15T08:49:16+00:00 2025-06-30 135565207 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2024-07-01 640303091 St Dominic - Jackson Memorial Hospital STDO 6012006570 969 LAKELAND DRIVE JACKSON MS 392164699 SAM SCOTT TREASURER 2026-05-15 true RYAN HOOKS P00746825 2253444000 2026-05-15 2024 2025-03-06 01:10:19Z FMOL Health St Dominic SAM SCOTT 969 LAKELAND DRIVE JACKSON MS 392164699 639357649 false X WWW.STDOM.COM X 1946 MS TO PROVIDE FOR THE CARE OF THE ILL, INJURED, OR DISABLED PERSONS, AND TO PROVIDE FOR RESEARCH, EDUCATION, AND FOR THE ENHANCEMENT OF HEALTH OF THOSE IN THE COMMUNITY. 14 9 3647 159 1055292 0 5887832 4309197 571485465 588110718 4935860 16591402 14594470 9596519 596903627 618607836 374475 840987 0 234930911 234777000 0 0 0 345926188 350669034 581231574 586287021 15672053 32320815 567488528 593286461 281525687 283282541 285962841 310003920 INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI 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 false false 445446207 840987 589189936 THE ST. DOMINIC - JACKSON MEMORIAL HOSPITAL PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES TO ITS PATIENTS. IN THE CURRENT YEAR, SERVICES WERE PROVIDED FOR 124,603 PATIENT DAYS, 49,373 EMERGENCY ROOM VISITS, AND 22,122 INPATIENT DISCHARGES. THE MEDICAL CENTER IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. ADDITIONAL COSTS WERE INCURRED FOR PARTICIPATION IN PROGRAMS WHICH, IN SOME CASES, PAY AMOUNTS LESS THAN THE COST OF PROVIDING SERVICES. THE HOSPITAL ALSO SERVES THE COMMUNITY IN NUMEROUS WAYS, SUCH AS ASSISTING IN EDUCATING THE COMMUNITY REGARDING HEALTH-RELATED ISSUES. 445446207 true true false true false false false false false false true true false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false false true true true true false false true 0 0 3647 true true true false false false false false false false false false true false X 14 9 false false false false true true true true true false false false true true true true true true true true true false X SAM SCOTT 6012006570 969 LAKELAND DRIVE JACKSON MS 392164699 Jeff Fletcher Chair 0.5 0 X X 0 0 0 Jeremy Tinnerello Market President 0.5 41.5 X X 0 638943 108960 Johnny Donaldson Vice Chair 0.5 0 X X 0 0 0 Sister Mary Trinita Eddington OP Secretary 0.8 40.5 X X 0 0 0 Bishop Joseph Kopacz Board Member 0.5 0 X 0 0 0 David Carroll MD Board Member 0.5 5.0 X 54515 0 0 Evert Kuiper FMOLHS President & CEO 1.0 40.0 X 0 1188036 24496 Marcelo Ruvinsky MD Board Member 0.5 0 X 0 0 0 Rebekah Moulder MD Board Member/Physician 40.0 0 X 651935 0 19242 Rick Guynes MD Board Member 0.5 0 X 0 0 0 Sister Dorothea Sondgeroth OP Board Member 0.5 40.5 X 0 0 0 Sister Karina Dickey OP Board Member 0.5 0 X 0 0 0 Stewart Gentry Board Member 0.5 0 X 0 0 0 Samuel Scott Treasurer 1.0 41.5 X 0 487114 36405 David Estorge VP, Rural Strategy 1.0 40.0 X 0 421042 80465 Kay McRee Sr Director Foundation 40.0 1.0 X 249264 0 27560 Teri Dyess VP, Chief Medical Officer 40.0 0 X 589250 0 53883 Tracey Smithson VP, CNO 40.0 0 X 406649 0 26747 Bryan Gaspard MD Physician 40.0 0 X 1140307 0 47792 D Paul Seago MD VP Chief Medical Officer 40.0 0.5 X 1197288 0 39284 David Theodoro MD Physician 40.0 0 X 1325161 0 38804 P Kerr MD Physician 40.0 0 X 1206026 0 40177 Ruth Fredericks MD Physician 40.0 0 X 1116803 0 28337 Kristin Wolkart Former Market Pres/FMOLHS CNO 0.0 40.0 X 0 1063272 146654 7937198 3798407 718806 449 true true false RELIAS EMERGENCY MED SPECIALISTS OF ST DOMINIC LLC PO BOX 31037 CHARLOTTE NC 28231 Revenue Cycle Services 7167366 PHYSICIANS ANESTHESIA GROUP PA PO BOX 3749 JACKSON MS 39207 Professional Services 7022674 TRIMEDX INC PO BOX 636129 CINCINNATI OH 45263 Biomed Services 6276933 JACKSON HEART CLINIC PA PO BOX 5169 JACKSON MS 39296 Professional Fee Services 3891875 MISSISSIPPI BLOOD SERVICES 115 TREE STREET FLOWOOD MS 39232 Blood Services 2770773 85 2714142 123287 1471768 4309197 PATIENT SERVICE REVENUE 621400 575556671 575556671 Other Program Service 900099 1915630 860338 1055292 Lab 621500 684058 684058 340 B Revenue 621400 8074462 8074462 Cafeteria 722514 2029281 2029281 -149384 -149384 0 0 588110718 5884203 5884203 5471275 38547 5432728 0 5432728 5432728 31418465 20711266 10707199 0 10707199 10707199 Pension related changes 900099 4163791 4163791 0 0 0 0 4163791 618607836 589189936 1055292 24053411 840987 840987 1404328 1313609 90719 196259026 183580692 12678334 8419227 7895551 523676 15011881 14078142 933739 13682538 12831484 851054 90016935 41556148 48460787 538974 126821 412153 87850 20671 67179 45813 45813 272296 64071 208225 49935370 5817677 44117693 0 2412845 280373 2132472 23415835 7712047 15703788 1527635 177511 1350124 13966221 11519144 2447077 298185 34649 263536 130 15 115 753594 42428 711166 18802943 14189429 4613514 4442056 966052 3476004 MEDICAL SUPPLIES EXPENSE 141621156 141621156 PURCHASED SERVICES 1984211 230565 1753646 REPAIRS & MAINTENANCE 546985 546985 0 0 0 0 586287021 445446207 140840814 0 10341739 23432699 40420394 55475420 58014322 58643499 0 0 0 0 118635 354394 14940473 14316858 1515524 1824794 309209464 93159552 233612736 216049912 169324342 187172935 11237362 10854501 9774035 8090745 18188966 17070704 567488528 593286461 59550024 59126426 29594 0 0 0 221946069 224156115 281525687 283282541 X 277499044 289609877 8463797 20394043 285962841 310003920 567488528 593286461 X 32320815 3892327 -12172063 X false true true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 40000 false true 5813 45813 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY PART II-B, LINE 1G: ST. DOMINIC JACKSON MEMORIAL HOSPITAL PAID A LOBBYING CONSULTANT WHO HAD DIRECT CONTACT WITH LEGISLATORS TO DISCUSS VARIOUS PUBLIC POLICY ISSUES AND LEGISLATIVE MATTERS. LINE 1i: ST. DOMINIC JACKSON MEMORIAL HOSPITAL PAYS DUE TO VARIOUS ORGANIZATIONS, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING. 34739440 34739440 195765727 46274908 149490819 70252241 43721265 26530976 8452056 3163379 5288677 216049912 Closely-held equity interests Financial derivatives FND DEPR - FMOL PORTFOLIO 187172935 F 187172935 Federal Income Taxes NET DUE TO/FROM AFFILIATES 28197786 OPERATING LEASE - LT 1833766 SELF INSURANCE LIABILITY LT 29610907 RETIREMENT PAYABLE LONG TERM 71628202 OBLIGATION OPERATING- ST 4171875 INVETSEMENTS HELD AT FMOLHS 85576042 FINANCE LEASE PAYABLE 3137537 224156115 X 0 0 0 0 0 0 0 0 0 0 0 0 Schedule D, Part X, Line 2 FIN 48 (ASC 740) 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 RESERVE FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. true true true X 275 false 10181453 1632390 8549063 0.01458 71829453 71829453 0 0.0 0 0.0 0 0 82010906 73461843 8549063 0.01458 521626 99 521527 0.00089 1548 1548 0.00000 3686784 134528 3552256 0.00606 0 0.0 263000 78650 184350 0.00031 0 0 4472958 213277 4259681 0.00727 0 0 86483864 73675120 12808744 0.02185 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 17873985 126703306 132510980 -5807674 X true true JACKSON HEART & VASCULAR CENTER CARDIOVASCULAR CLINIC 0.2 0.047 0.753 1 1 ST DOMINIC-JACKSON MEMORIAL HOSPITAL 969 LAKELAND DRIVE JACKSON MS 392164699 HTTP://WWW.STDOM.COM/14-031 14-031 X X X ST DOMINIC-JACKSON MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 24 true false false true X https://www.fmolhs.org/-/media/files/about-us/chna/fmol-chna-stdominics-2025-20pg-fin-singles.pdf https://www.fmolhs.org/-/media/files/about-us/chna/fmol-chna-stdominics-2025-20pg-fin-singles.pdf X true 24 false true false true X 275.0 0.0 X X X X X true true X X X true X HTTPS://WWW.FMOLHS.ORG/PATIENTS-GUESTS/PATIENTS-RESOURCES/FINANCIAL-ASSISTANCE-POLICY X HTTPS://WWW.FMOLHS.ORG/PATIENTS-GUESTS/PATIENTS-RESOURCES/FINANCIAL-ASSISTANCE-POLICY X HTTPS://WWW.FMOLHS.ORG/PATIENTS-GUESTS/PATIENTS-RESOURCES/FINANCIAL-ASSISTANCE-POLICY X 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 Facility , 1 Facility , 1 - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL:. Input from persons who represent the broad interests of the community served was taken into account throughout the Community Health Needs Assessment (CHNA) process conducted by St. Dominic Hospital. Input was obtained from community stakeholders, including community partners and healthcare providers serving vulnerable populations, through surveys administered in late spring and early summer 2024 and through targeted interviews with external community representatives. As part of this process, St. Dominic's interviewed Brianna McField, MPh, Community Health Director for the Mississippi Department of Health, whose role specifically represents medically underserved, lowincome, and minority populations on a fulltime basis. Additional external stakeholder input was obtained from community and economic development leaders, including Angelique Rawls, Executive Vice President of the Greater Jackson Chamber Partnership. Feedback from these representatives echoed survey results identifying challenges related to social determinants of health, such as poverty, access to care, transportation, and the need for trusted and affordable healthcare services. This qualitative input was reviewed alongside quantitative data from recognized public health sources and was incorporated into the identification and prioritization of significant community health needs reflected in the CHNA. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL:. DURING THE CURRENT YEAR, St. DOMINIC'S HOSPITAL (sdh) CONTINUED TO ADDRESS THE FOLLOWING PRIORITY AREAS IDENTIFIED DURING THE PRIOR CHNA: HOmelessness, Crisis care programs for mental health, affordable healthcare services for people or families with low income, Domestic Violence Resources. Housing for all incomes/ages, Counseling services for depression or anxiety, Job readiness, post-addictions treatment support programs, Counseling services for adolescents / children, and Prescription assistance. THE HOSPITAL ALSO CONDUCTED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IDENTIFIED THE FOLLOWING PRIORITY AREAS: ACCESS TO CARE AND WOMEN'S HEALTH. DURING THE CURRENT YEAR, TO ADDRESS THE PRIORITY AREAS LISTED ABOVE, THE HOSPITAL DID THE FOLLOWING: SDH PARTNERED WITH ST. VINCENT DEPAUL PHARMACY TO OPEN A FREE PHARMACY DEDICATED TO SERVING VULNERABLE POPULATIONS IN JACKSON AND THE SURROUNDING AREAS. SDH PROVIDES THE SPACE FREE OF CHARGE FOR THE PHARMACY TO HELP OFFSET THE COST OF OPERATIONS. SDH CONTINUED TO PROVIDE THE FREE SISTER TRINITA COMMUNITY HEALTH CLINIC TO PATIENTS IN THE SAME BUILDING AS STEWPOT COMMUNITY SERVICES, WHICH INCLUDES SERVICES SUCH AS A CLOTHING CLOSET, FREE MEAL PROGRAMS, A FOOD PANTRY, A STREET OUTREACH PROGRAM, A LEGAL CLINIC, HeARTworks ART PROGRAM, AND DAILY CHAPEL SERVICES. FINANCIAL CONTRAINTS COMPELLED SDH TO CLOSE ITS FREESTANDING BEHAVIORAL HEALTH SERVICES IN 2023. HOWEVER, SDH SOUGHT A BEHAVIORAL HEALTH PROVIDER TO LEASE THE SPACE. OCEANS HEALTHCARE OPENED EARLY IN 2025. WHILE OCEANS CANNOT ACCOMMODATE THE SAME VOLUME OF INDIGENT PATIENTS AS SDH DID, IT NONETHELESS PROVIDES MUCH NEEDED BEHAVIORAL HEALTH SERVICES TO THE COMMUNITY. SDH TIED ITS COMMUNITY CONTRIBUTIONS TO ITS CHNA FINDINGS TO FUND CONTRIBUTIONS THAT FURTHERED THE WORK OF ITS CHNA GOALS AND OBJECTIVES AS WELL WITH A WELL-DEFINED PROCESS OF VETTING EACH REQUEST FOR DONATIONS TO DETERMINE IF THE DONATION MET THE NEEDS OF THE COMMUNITY AS DEFINED BY THE CHNA. In June 2025, SDH announced its adoption of the InVision Pathology Imaging System, an infrared imaging technology designed to better identify lymph nodes in surgical specimens during cancer treatment. The goal is to better assess the stage of cancer in patients. St. Dominic Health is utilizing the technology for all cancers that involve lymph node analysis as part of the staging process, including breast, colon, small bowel, stomach (gastric), and pancreatic cancers. In a recent study of 104 patients, the InVision Pathology Imaging System was shown to increase lymph node detection in 86.5% of cases and led to staging changes in 3.8% of cases, with no added risk to patients. According to the American Joint Cancer Committee (AJCC), the number of lymph nodes examined is correlated with the survival rate of cancer patients. SDH PROVIDED Workforce Development/Primary and Secondary Workforce Exposure TO A TOTAL OF 255 INDIVIDUALS IN THE CURRENT YEAR. TWO HUNDRED INDIVIDUALS WERE REACHED THROUGH THE JSU TRIO Bash, A federally funded educational support program, AND 55 WERE REACHED THROUGH THE Lanier High School WORKFORCE DEVELOPMENT Careers Presentation. Through thoughtful partnerships and expansion of educational opportunities, sdh is leading the future for careers in healthcare. fmol health has dedicated funds for development of programs for high schoolers to adulthood that supports both the broader community and those living in poverty as they pursue educational goals. Key relationships with high schools in local parishes provide entry pathways to careers in bedside care and ancillary roles. The commitment to workforce development solutions continues in partnership with the area's higher education institutions. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL:. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: 1. THE PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL; 2. STATE-FUNDED PRESCRIPTION PROGRAMS; 3. HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT; 4. PATIENTS' CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCE PROGRAMS; 5. PATIENT ELIGIBLE FOR FOOD STAMPS; 6. MEDICAID ELIGIBLE PATIENT; 7. PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY; 8. PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL:. REGISTRATION PERSONNEL REFER UNINSURED AND/OR LOW-INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. 35 ST DOMINIC'S HOSPITAL MEDICINE 971 LAKELAND DRIVE SUITE 1453 JACKSON MS 39216 HOSPITALIST CLINIC ST DOMINIC'S NEUROSURGERY ASSOCIATES 971 LAKELAND DRIVE SUITE 657 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S NEUROCARE 971 LAKELAND DRIVE SUITE 557 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S VASCULAR AND ENDOVASCULAR 971 LAKELAND DRIVE SUITE 1250 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S EAR NOSE & THROAT SURGICA 970 LAKELAND DRIVE SUITE 40 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S INTERNAL MEDICINE GROUP 971 LAKELAND DRIVE SUITE 250 JACKSON MS 39216 PHYSICIAN CLINIC STDOMINIC'S FAMILY MEDICINE OF MADISON 106 HIGHLAND WAY 103 MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S INTERNAL MEDICINE MADISON 106 HIGHLAND WAY 200 MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S CARDIOVASCULAR SURGERY 971 LAKELAND DRIVE SUITE 657 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S PAIN MANAGEMENT CENTER 971 LAKELAND DRIVE SUITE 1159 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S GYNECOLOGIC ONCOLOGY 971 LAKELAND DRIVE SUITE 750 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S UROLOGY 971 LAKELAND DRIVE SUITE 360 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S INFECTIOUS DISEASE 971 LAKELAND DRIVE SUITE 954 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S PSYCHIATRIC ASSOCIATES 890 LAKELAND DRIVE JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S RHEUMATOLOGY 106 HIGHLAND WAY SUITE 200 MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF BRANDON 1297 WEST GOVERNMENT STREET BRANDON MS 39042 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF CLINTON 728 CLINTON PARKWAY SUITE B CLINTON MS 39056 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF FLOWOOD 1050 RIVER OAKS DRIVE FLOWOOD MS 39232 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF DOGWOOD 205A BELLE MEADE POINTE FLOWOOD MS 39232 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF MAGEE 360 SIMPSON HWY 149 SUITE 220 MAGEE MS 39111 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF JACKSON 890 LAKELAND DRIVE JACKSON MS 39056 PHYSICIAN CLINIC ST DOMINIC'S MARTIN SURGICAL ASSOCIATES 971 LAKELAND DRIVE SUITE 211 JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MED OF PELAHATCHIE 610 2ND STREET PELAHATCHIE MS 39145 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE OF RALEIGH 342 MAGNOLIA DRIVE RALEIGH MS 39153 PHYSICIAN CLINIC ST DOMINIC'S FAMILY MEDICINE GLUCKSTADT 286 CALHOUN STATION PARKWAY MADISON MS 39110 PHYSICIAN CLINIC ST DOMINIC'S COUMADIN CLINIC 890 LAKELAND DRIVE JACKSON MS 39056 PHYSICIAN CLINIC ST DOMINIC'S CHRONIC CARE CLINIC 969 LAKELAND DRIVE JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-TELEMEDIC 969 LAKELAND DRIVE JACKSON MS 39216 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-MAGEE 360 SIMPSON HWY 149 SUITE 370 MAGEE MS 39111 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-CLEVELAND 810 E SUNFLOWER ROAD CLEVELAND MS 38732 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-KOSCIUSKO 332 HIGHWAY 12 WEST KOSCIUSKO MS 39090 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-PELAHATCH 610 2ND STREET PELAHATCHIE MS 39145 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-VICKSBURG 4204 CLAY STREET VICKSBURG MS 39180 PHYSICIAN CLINIC ST DOMINIC'S OUTREACH PROGRAM-BROOKHAVE 427 HWY 51 N BROOKHAVEN MS 39601 PHYSICIAN CLINIC ST DOMINIC'S INTERNAL MEDICINE CLINIC 112 SOUTH LAKE CIRCLE CANTON MS 39046 PHYSICIAN CLINIC Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULLY-DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. FULLY-DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS IF MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: 1) PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOPSITAL; 2) STATE-FUNDED PRESCRIPTION PROGRAMS; 3) HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT; 4) PATIENT'S CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCE PROGRAMS; 5) PATIENT ELIGIBLE FOR FOOD STAMPS; 6) MEDICAID ELIGIBLE PATIENT; 7) PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY; 8) PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A COST TO CHARGE RATIO WAS USED TO CALCULATE PART I, LINE 7A AND 7B. THE COST TO CHARGE RATIO WAS DERIVED FROM IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. THE COST TO CHARGE RATIO IS APPLIED TO GROSS CHARGES RELATED TO CHARITY CARE AND CARE COVERED BY MEDICAID AND OTHER GOVERNMENT PROGRAMS. FOR PART I, LINES 7E THROUGH 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND THE MEDICARE COST REPORT LESS DIRECT OFFSESTTING REVENUE, WHERE APPLICABLE. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED IN PART III, LINE 2 AS BAD DEBT EXPENSE MATCHES THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON THE HOSPITAL'S INTERNAL FINANCIAL STATEMENTS. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND REPORTED AT NET REALIZABLE VALUE. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTABLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance ST. DOMINIC HOSPITAL HAS A BOARD APPROVED COLLECTION POLICY AND HAS WRITTEN CONTRACTS IN PLACE WITH ITS COLLECTION AGENCIES SO THE APPROPRIATE COLLECTION ACTIVITIES ARE FOLLOWED. THE COLLECTION AGENCIES THAT ST. DOMINIC USES ARE FULLY INFORMED ABOUT THE HOSPITAL'S FINANCIAL AID POLICY AND ASSIST IN EDUCATING ITS PATIENTS. THEY ROUTINELY SEND FINANCIAL AID APPLICATIONS TO PATIENTS AND REFER THOSE PATIENTS BACK TO THE HOSPITAL'S FINANCIAL COUNSELORS WHEN APPROPRIATE. Schedule H, Part V, Section B, Line 16a FAP website - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL: Line 16a URL: HTTPS://WWW.FMOLHS.ORG/PATIENTS-GUESTS/PATIENTS-RESOURCES/FINANCIAL-ASSISTANCE-POLICY; Schedule H, Part V, Section B, Line 16b FAP Application website - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL: Line 16b URL: HTTPS://WWW.FMOLHS.ORG/PATIENTS-GUESTS/PATIENTS-RESOURCES/FINANCIAL-ASSISTANCE-POLICY; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. DOMINIC-JACKSON MEMORIAL HOSPITAL: Line 16c URL: HTTPS://WWW.FMOLHS.ORG/PATIENTS-GUESTS/PATIENTS-RESOURCES/FINANCIAL-ASSISTANCE-POLICY; Schedule H, Part VI, Line 2 Needs assessment St. DominicJackson Memorial Hospital assesses the health care needs of the community it serves through a process that integrates community input with analysis of quantitative public health data. In conducting the Community Health Needs Assessment (CHNA), the hospital collected input from community stakeholders, including community partners and healthcare providers serving vulnerable populations, through surveys administered in late spring and early summer 2024, as well as targeted interviews with internal and external stakeholders. Community input was compared with statistical data obtained from recognized sources such as the U.S. Census Bureau and other public health data sources to identify health disparities, social determinants of health, and service gaps affecting residents of Hinds, Madison, and Rankin Counties. The resulting qualitative and quantitative data were reviewed and analyzed to identify significant community health needs, which informed the prioritization of needs and the development of implementation strategies reflected in the CHNA. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance ST. DOMINIC HOSPITAL WORKS TO EDUCATE ITS PATIENTS AND COMMUNITY OF ASSISTANCE OPTIONS BY: 1) POSTING SIGNAGE IN THE EMERGENCY ROOM AND OTHER REGISTRATION AREAS INFORMING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. 2) PROVIDING BROCHURES IN THE WAITING ROOMS AND AT THE REGISTRATION DESKS THAT EXPLAIN THE BILLING AND COLLECTION PROCESS AS WELL AS INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND PHONE NUMBERS TO CALL FOR ASSISTANCE. 3) CONTRACTING AND PAYING AN AGENCY TO MEET WITH ALL UNINSURED PATIENTS TO ASSIST THEM IN APPLYING FOR FEDERAL AND STATE ASSISTANCE (I.E. MEDICAID, DISABILITY, ETC.). 4) PROVIDING FINANCIAL COUNSELORS TO MEET WITH PATIENTS. THESE COUNSELORS FULLY UNDERSTAND THE HOSPITAL'S CHARITY POLICY AND ARE AVAILABLE TO ASSIST WITH THE APPLICATIONS, SET UP INTEREST FREE PAYMENT PLANS AND OFFER ADVICE ON PUBLIC ASSISTANCE THAT MAY BE AVAILABLE. 5) STAFFING PATIENT REPRESENTATIVES TO ANSWER QUESTIONS AND ASSIST PATIENTS AS NEEDED. 6) EDUCATING THE EARLY-OUT AND BAD DEBT COLLECTION AGENCIES ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES SO THEY CAN ASSIST PATIENTS WHOM THEY FIND MIGHT HAVE FINANCIAL NEED. Schedule H, Part VI, Line 4 Community information COMMUNITY INFORMATION: ST. DOMINIC HOSPITAL IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN JACKSON, MISSISSIPPI, IN HINDS COUNTY. FOR PURPOSES OF THE CHNA, St. DominicJackson Memorial Hospital defines its community as consisting primarily of Hinds County, Madison County, and Rankin County in central Mississippi, which together comprise the hospital's tricounty service area based on patient origin data. This area includes a combined population of more than 480,000 residents and reflects a diverse mix of urban, suburban, and rural communities. The population served includes children, workingage adults, and a significant elderly population, with individuals age 65 and older accounting for approximately 16-17 percent of residents across the three counties. Demographically, the service area is racially and ethnically diverse, particularly in Hinds County, where Black or African American residents represent a majority of the population, alongside White residents, Hispanic or Latino populations, and other minority groups across the tricounty region. The community also includes medically underserved, lowincome, and minority populations who experience health disparities related to income, education, access to care, and social determinants of health. St. Dominic does not define its community to exclude any population based on ability to pay or insurance status and considers all residents of this tricounty area-including vulnerable and underserved populations-as part of the community it serves. Schedule H, Part VI, Line 5 Promotion of community health INSPIRED BY THE TEACHINGS OF JESUS CHRIST AND THE WITNESS OF OUR FOUNDING DOMINICAN SISTERS, WE PROVIDE COMPASSIONATE CARE AND HOPE AS A HEALING MINISTRY OF THE CATHOLIC CHURCH. ST. DOMINIC APPLIES THIS MISSION BY CONDUCTING NEEDS ASSESSMENTS, PUBLISHING THE RESULTS, ESTABLISHING GOALS AND STRATEGIES TO HELP RESOLVE IDENTIFIED ISSUES AND SEEKING OPPORTUNITIES TO WORK WITH THE COMMUNITY. ST. DOMINIC HOSPITAL IMPROVES THE HEALTH OF THE COMMUNITIES IT IS PRIVILEGED TO SERVE IN MANY WAYS THAT EXTEND FAR BEYOND THE HEALING MINISTRY OF BEDSIDE CARE. THROUGH APPROACHES SUCH AS OPEN MEDICAL STAFF POLICIES, UNIQUE TECHNOLOGY INNOVATIONS FOR BETTER OUTCOMES, AND DIVERSITY, EQUITY, AND INCLUSION STRATEGIES FOCUSED ON EVERY ASPECT OF HEALTH CARE FROM THE BEDSIDE TO THE PURCHASING DOCK TO EACH PATIENT WHO WALKS THROUGH OUR DOORS, THE HOSPITAL CONTINUOUSLY EXPANDS ITS DEFINITION OF WHAT IT MEANS TO HAVE A "COMMUNITY IMPACT." THE HOSPITAL ALSO INVOLVES MEMBERS OF ITS COMMUNITY IN ITS GOVERNANCE SO THAT IT MAINTAINS THE FOCUS ON THE NEEDS OF ITS COMMUNITY. SDH PROVIDES A NEONATAL INTENSIVE CARE UNIT, EMERGENCY DEPARTMENT, AND ADVANCED COMPREHENSIVE STROKE CENTER (WHICH IS JOINT COMMISSION CERTIFIED). SDH IS ALSO A CENTER OF EXCELLENCE FOR COMPLEX HEART PROCEDURES AND IS PART OF THE MISSISSIPPI HEART AND VASCULAR INSTITUTE. THE CENTER IS THE ONLY ONE OF ITS KIND IN THE NATION. THE HOSPITAL ALSO PROVIDES 16 URGENT CARE CLINICS, A FREESTANDING CANCER CENTER, AND A WOUND HEALING CENTER, AS WELL AS AN OUTPATIENT REHABILIATION AND HAND MANAGEMENT PROGRAM. SDH's Comprehensive Cancer Program is one of the top cancer treatment providers in central Mississippi and is known throughout the area for outstanding adult patient care and exceptionally skilled oncologists. SDH is the only hospital in the state to receive the Outstanding Achievement Award by the Commission on Cancer (CoC) of the American College of Surgeons multiple times. sdh continues to be accredited through the Commission on Cancer every three years. SDH's Maternal & Newborn Care Center emphasizes a team approach to care with physicians, nurses and educators working together to meet the total needs of the patient and the entire family. It offers services and programs not only during a patient's hospital stay but also classes and resources to assist with the family transition before and after birth. SDH is officially designated as a Baby-Friendly hospital by Baby-Friendly USA, meaning SDH is adhering to the highest standards of care for breastfeeding mothers and their babies. SDH offers digital mammography and other breast diagnostic technology with the Center for Women's Health and SDH's Madison Medical Imaging. SDH focuses on comfort and a relaxing environment that houses some of the most advanced technology available for detecting breast cancer. The Mississippi Heart & Vascular Institute (MHVI) at SDH is the top provider of cardiac, vascular and venous services in Central Mississippi. Since 1974, this leading institute has provided the most advanced treatment options available to patients. In 2023, MHVI launched the nation's first Center of Excellence for Complex Heart Procedures, bringing new, minimally invasive treatment options to patients experiencing cardiac total occlusion. SDH's physicians are nationally known for using the most advanced technology and procedures and for their clinical excellence in delivering patient care. SDH's Joint Center program provides comprehensive pre-operative and post-operative services for patients undergoing total hip and total knee replacement. The program involves a multi-disciplinary team of specialists, which includes doctors, nurses, physical therapists, occupational therapists, pharmacists, social services and nurse case managers. As a Blue Cross Blue Shield Distinction Center of Excellence for knee and hip replacement, SDH IS IDENTIFIED as a hospital that delivers the highest level of specialty care in these areas - demonstrating better outcomes and fewer readmissions. SDH is one of 600 hospitals across the nation to receive this designation. SDH is certified as Mississippi's first Comprehensive Stroke Center by The Joint Commission. SDH first earned The Joint Commission's Gold Seal of Approval and the American Stroke Association's Heart-Check mark for Comprehensive Stroke Certification in 2016. SDH's Comprehensive Stroke Center offers rapid diagnosis, high-tech intervention, expert care and intensive rehabilitation in a caring, compassionate setting. sdh'S mission to respect life in all stages is fulfilled through the quality care provided to residents of St. Catherine's Village. St. Catherine's Village is a freestanding, not-for-profit, all-inclusive Continuing Care Retirement Community providing services to individuals over 62 years of age, of all faiths and races. Created in 1988, St. Catherine's Village extends the SDH healing ministry to the special needs of older adults. St. Catherine's is Mississippi's first retirement community offering the security of Life Care and is the only community of its kind in Mississippi to earn accreditation by Commission on Rehabilitation Facilities-Continuing Care Accreditation (CARF-CCAC). This seal of approval signifies that St. Catherine's Village exceeds the standards of excellence established by CARF's Continuing Care Accreditation Commission. in august 2024, sdh announced a major advancement in healthcare with the implementation of the IntelliSep test in its emergency department. This innovative diagnostic tool allows for the early detection and treatment of sepsis in Mississippi. Sepsis is a leading cause of mortality in hospitals across the nation and prior to the development of the IntelliSep technology there was no objective test to determine if a patient was septic. Sepsis, a condition triggered by the body's response to infection, can rapidly lead to organ failure if not promptly identified and treated. The IntelliSep test uses a standard blood sample to analyze white blood cell responses, delivering results in under 10 minutes. This early detection enables healthcare providers to intervene sooner, reducing inpatient stays by an average of 1.28 days and ICU stays by 2.24 days, while also saving approximately $1,429 per patient and resulting in a 20% reduction in mortality of septic patients. sdh is much more than a hospital. outreach programs and services extend the ministry into the community so that specific needs can be addressed: The sdh Community Health Clinic provides free healthcare services for the homeless and underserved in Jackson's inner city. In addition to primary health care services, the clinic provides a variety of educational programs for children, adolescents and adults in an effort to promote disease prevention and safety among this segment of the population. THE MAJORITY OF THE GOVERNING BODY OF SDH IS COMPRISED OF INDIVIDUALS FROM A BROAD CROSS-SECTION OF THE COMMUNITY WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. SDH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF THE HOSPITAL DEPARTMENTS AS NEEDED. SURPLUS FUNDS ARE APPLIED TO IMPROVEMENTS IN PATIENT CARE AREAS THROUGH INVESTMENT IN CLINICAL TECHNOLOGY, MEDICAL INFORMATION TECHNOLOGY, AND CONTINUED TRAINING OF CLINICAL STAFF. Schedule H, Part VI, Line 6 Affiliated health care system ST. DOMINIC JACKSON MEMORIAL HOSPITAL (SDH) IS A NOT-FOR-PROFIT, NON-STOCK MEMBER CORPORATION OF WHICH FRANCISACN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC (FMOL) IS THE SOLE MEMBER. SDH IS PART OF THE FMOL HEALTH SYSTEM WHICH INCLUDES SEVERAL HOSPITAL AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATES OF LOUISIANA AND MISSISSIPPI. SDH SERVES THE COMMUNITY IN HINDS COUNTY AND SURROUNDING COUNTIES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF LOURDES REGIONAL MEDICAL CENTER ST. FRANCIS MEDICAL CENTER OUR LADY OF THE LAKE ASSUMPTION HOSPITAL OUR LADY OF THE ANGELS HOSPITAL OUR LADY OF THE LAKE HOSPITAL true AMERICAN HEART ASSOCIATION 250 Williams Street Atlanta GA 30303 135613797 501(C)(3) 20000 GENERAL SUPPORT 100 BLACK MEN OF JACKSON INC 5360 Highland Drive Jackson MS 39286 640817928 501(C)(3) 15000 GENERAL SUPPORT CATHOLIC CHARITIES INC 850 East River Place Jackson MS 39201 640466850 501(C)(3) 63850 GENERAL SUPPORT AMERICAN CANCER SOCIETY INC 250 Williams Street Atlanta GA 30303 131788491 501(C)(3) 20000 GENERAL SUPPORT CENTER FOR VIOLENCE PREVENTION Po Box 6279 Pearl MS 39288 581959108 501(C)(3) 20000 ASSISTING VICTIMS OF VIOLENCE, ASSAULT, AND HUMAN TRAFFICKING REAL CHRISTIAN FOUNDATION PO Box 180059 RICHLAND MS 39218 640885750 501(C)(3) 10000 Improve quality of life for understved rural MS population through Christian ministries JACKSON HEART FOUNDATION PO BOX 5021 Jackson MS 39296 582232550 501(C)(3) 10000 promote heart health and wellness MISSION MISSISSIPPI PO BOX 22655 Jackson MS 39225 640824240 501(C)(3) 30000 promote relationships across racial and denominational STEWPOT COMMUNITY SERVICES 1100 WEST CAPITOL ST Jackson MS 39203 640655566 501(C)(3) 13000 community assistance through ministries and support OVARIAN CANCER RESEARCH FUND INC 45 ROCKEFELLER PLAZA 20TH FLOOR NEW YORK NY 10111 133806788 501(C)(3) 15000 Ovarian Cancer research 10 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds THE HOSPITAL HAS A CONTRIBUTIONS COMMITTEE, WHICH IS A SUB-COMMITTEE OF THE BOARD, THAT OVERSEES THE HOSPITAL'S GIVING. THEY MONITOR THE REQUESTS AND OVERSEE ALL GIFTS. false true false false false false false false false Jeremy Tinnerello Market President 0 493820 0 126655 0 18468 0 80950 0 28010 0 747903 0 0 Evert Kuiper FMOLHS President & CEO 0 993312 0 166877 0 27847 0 17250 0 7246 0 1212532 0 0 Rebekah Moulder MD Board Member/Physician 625645 0 25000 0 1290 0 17250 0 1992 0 671177 0 0 0 Kristin Wolkart Former Market Pres/FMOLHS CNO 0 540315 0 517539 0 5418 0 123599 0 23055 0 1209926 0 0 Samuel Scott Treasurer 0 344295 0 137728 0 5091 0 16688 0 19717 0 523519 0 0 David Estorge VP, Rural Strategy 0 315132 0 103091 0 2819 0 49276 0 31189 0 501507 0 0 Kay McRee Sr Director Foundation 222914 0 26250 0 100 0 12834 0 14726 0 276824 0 0 0 Tracey Smithson VP, CNO 302289 0 99269 0 5091 0 14560 0 12187 0 433396 0 0 0 Teri Dyess VP, Chief Medical Officer 478224 0 107325 0 3701 0 17250 0 36633 0 643133 0 0 0 Ruth Fredericks MD Physician 633380 0 476301 0 7122 0 17250 0 11087 0 1145140 0 0 0 Bryan Gaspard MD Physician 1139466 0 0 0 841 0 17250 0 30542 0 1188099 0 0 0 P Kerr MD Physician 1204736 0 0 0 1290 0 11577 0 28600 0 1246203 0 0 0 D Paul Seago MD VP Chief Medical Officer 1124359 0 70518 0 2411 0 17250 0 22034 0 1236572 0 0 0 David Theodoro MD Physician 1321460 0 0 0 3701 0 17250 0 21554 0 1363965 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE FMOL HEALTH SYSTEM 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 REIVEWS COMPENSATION PACKAGES AND APPRROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan LINES 4A-B: FMOLHS MAINTAINS TWO UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDE 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 ON PART VII, SECTION A RECEIVED A PAYMENT FROM THE PLANS IN THE CURRENT YEAR. Schedule J, Part I, Line 4a A BOARD MEMBER, AN OFFICER, AND A FORMER OFFICER WHO IS CURRENTLY EMPLOYED BY A RELATED ORGANIZATION, ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE OLY 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 THE RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS EITHER 24 OR 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. Form 990, Part III, Line 1 DESCRIPTION OF ORGANIZATION MISSION: TALENTS TO CREATE A SPIRIT OF HEALING - WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY 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, Line 15 OUR BOARD OF DIRECTORS DESIGNATES AN EXECUTIVE COMMITTEE MADE UP OF INDEPENDENT BOARD MEMBERS TO REVIEW AND SET THE COMPENSATION ANNUALLY OF OUR OFFICERS AND KEY EMPLOYEES. THE EXECUTIVE COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY AN OUTSIDE CONSULTING FIRM. THE EXECUTIVE COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE EXECUTIVE COMMITTEE. THE COMPENSATION FOR THE CEO OF ST. DOMINIC JACKSON MEMORIAL HOSPITAL IS SET BY THE COMPENSATION COMMITTEE OF FMOL HEALTH SYSTEM (A RELATED TAX-EXEMPT ORGANIZATION) ACCORDING TO THEIR PAY PRACTICES WHICH ARE SIMILAR TO THOSE DESCRIBED ABOVE. Form 990, Part VI, Line 6 Classes of members or stockholders FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM (FMOLHS) IS THE SOLE MEMBER OF ST. DOMINIC JACKSON MEMORIAL HOSPITAL. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL'S SOLE MEMBER, FMOLHS, INC., HAS THE AUTHORITY TO APPROVE THE ELECTION OF THE PRESIDENT/CEO, THE CHAIR OF THE BOARD OF DIRECTORS AND THE VICE-CHAIR OF THE BOARD OF DIRECTORS OF THE HOSPITAL AND ALL OTHER DIRECTORS AND OFFICERS OF THE HOSPITAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE RESERVED POWER TO THE MEMBER, FMOLHS, 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 BYLAWS 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, LEAASE, 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, Line 11b Review of form 990 by governing body THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE OF THE BOARD PRIOR TO FILING. A FULL COPY, AS APPROVED BY THE FINANCE COMMITTEE, IS PROVIDED TO THE BOARD. Form 990, Part VI, Line 12c Conflict of interest policy ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST FORM ANNUALLY. THE PRESIDENT REVIEWS THE FORMS, AND ANY CONFLICTS ARE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD. PERSONS WITH CONFLICTS OF INTERESTS DO NOT VOTE OR USE HIS OR HER INFLUENCE ON THE MATTER AND ARE EXCLUDED FROM THE COUNT IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part VIII, Line 2f Other Program Service Revenue Income from Equity Investees - Total Revenue: -149384, Related or Exempt Function Revenue: -149384, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Capital transfers - -12011069; Prior Period Adjustment - -160994; Total - -12172063; SECTION 1.263(A)-3(N) - BOOK CONFORMITY ELECTION: ST. DOMINIC JACKSON MEMORIAL HOSPITAL IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2025. SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION: ST. DOMINIC JACKSON MEMORIAL HOSPITAL 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 ENDED JUNE 30, 2025. 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 OR LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). ST DOMINIC MEDICAL ASSOCIATES 969 LAKELAND DRIVE JACKSON MS 39216 261969846 HEALTHCARE MS 32686977 10597845 SDJMH ST DOMINIC HOSPITAL MEDICINE LLC 969 LAKELAND DRIVE JACKSON MS 39216 814908606 HEALTHCARE MS 0 0 SDJMH ST DOMINIC HEALTH & WELLNESS LLC 969 LAKELAND DRIVE JACKSON MS 39216 823234006 HEALTHCARE MS 125549 -477789 SDJMH Central Mississippi Imaging LLC dba Southern Diagnostic Imaging 1037 North Flowood Drive Flowood MS 39232 640928442 HEALTHCARE MS 2166960 3837037 SDJMH MEA PRIMARY CARE PLUS LLC 308 CORPORATE DRIVE RIDGELAND MS 39211 814502721 HEALTHCARE MS 0 0 SDJMH HEALTH CARE CENTERS IN SCHOOLS 5000 HENNESSY BLVD BATON ROUGE LA 70808 721443935 HEALTHCARE LA 501(c)(3) 10 OLOL false COMMUNITY HEALTH SERVICES - ST DOMINIC 969 LAKELAND DRIVE JACKSON MS 39216 640884870 HEALTH PROGRAM MS 501(c)(3) 10 SDJMH true ST DOMINIC - HEALTH SERVICES FOUNDATION 969 LAKELAND DRIVE JACKSON MS 39216 431992975 FUNDRAISING MS 501(c)(3) 7 SDJMH true ST CATHERINE'S VILLAGE INC 969 LAKELAND AND DRIVE JACKSON MS 39216 640714997 RET HOME MS 501(c)(3) 10 SDJMH true LOURDES IMAGING DEVELOPMENT LLC 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 208326287 REAL ESTATE LA NA false false PARK PLACE SURGERY CENTER LLC 4811 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 721404092 HEALTHCARE LA NA false false CONVENIENT CARE LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 721439481 HEALTHCARE LA NA false false PERKINS PLAZA AMBULATORY SURGERY CENTER LLC 7145 PERKINS ROAD BATON ROUGE LA 70808 481264699 HEALTHCARE LA NA false false SURGICAL SPECIALTY CENTER OF BATON ROUGE LLC 8080 BLUEBONNET BLVD BATON ROUGE LA 70810 263120962 HEALTHCARE LA NA false false ST ELIZABETH-MARY BIRD PERKINS CANCER CENTER LLC 4950 ESSEN LANE BATON ROUGE LA 70809 260628752 HEALTHCARE LA NA false false NORTHEAST LA CANCER INSTITUTE LLC 411 CALYPSO STREET MONROE LA 71201 721329499 HEALTHCARE LA NA false false LHCG-XIII LLC dba Lourdes Home Health 901 S HUGH WALLIS ROAD LAFAYETTE LA 70508 208068308 HEALTHCARE LA NA false false LOURDES AFTER HOURS LLC 7777 HENNESSY BLVD SUITE 1004-202 BATON ROUGE LA 70809 201367299 HEALTHCARE LA NA false false LAKE URGENT CARE ASCENSION LLC (LUCA) 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 352463092 HEALTHCARE LA NA false false ST FRANCIS URGENT CARE LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 474013731 HEALTHCARE LA NA false false GAMMA KNIFE OF LOUISIANA LLC 4950 ESSEN LANE BATON ROUGE LA 70809 811827194 HEALTHCARE LA NA false false PINNACLE CARE HOLDINGS LLC 5627 S SHERWOOD FOREST BLVD BATON ROUGE LA 70816 821637627 HEALTHCARE LA NA false false LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 943419282 HEALTHCARE LA NA false false FREMAUX OFFICE MM LLC 3500 NORTH CAUSEWAY BOULEVARD STE 600 METAIRIE LA 70002 843084552 HEALTHCARE LA NA false false OLOL Pontchartrain Surgery Center LLC 4200 ESSEN LANE BATON ROUGE LA 70809 461379031 HEALTHCARE LA NA false false Lake Surgical Hospital (Slidell) LLC 1700 LINDBERG DR SLIDELL LA 70458 474228147 HEALTHCARE LA NA false false PREMIER HEALTH HOLDINGS LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 472665226 HEALTHCARE LA NA false false Perkins Plaza Development LLC 5000 HENNESSY BLVD BATON ROUGE LA 70808 882998457 REAL ESTATE LA NA false false Jackson Heart & Vascular Center LLC 969 LAKELAND DRIVE JACKSON MS 39216 870947298 HEALTHCARE MS ST DOMINIC JACKSON Related 343654 -121583 false true Cardiovascular and Arrythmia Center LLC (CVAC) PO Box 82063 BATON ROUGE LA 70884 861438331 HEALTHCARE LA NA false false Cardiovascular and Arrythmia Management LLC (CVAM) PO Box 82063 BATON ROUGE LA 70884 HEALTHCARE LA NA false false TRACTION SPORTS MANAGEMENT LLC 9222 BURBANK DRIVE BATON ROUGE LA 70820 822247999 HEALTHCARE LA NA false false Highland Medical Arts PO Box 55769 Jackson MS 39296 743073171 HEALTHCARE MS ST DOMINIC JACKSON Related 1007729 9368285 false true LOUISE INSURANCE COMPANY PO BOX 1051 CJ KY11102 INSURANCE CJ FMOL C Corporation false FRANCISICAN HEALTH & WELLNESS SERVICES INC 4200 ESSEN LANE BATON ROUGE LA 70809 455492379 HEALTHCARE LA FMOL C Corporation false FMOL HEALTH SYSTEM HOLDINGS INC 4200 ESSEN LANE BATON ROUGE LA 70809 454405024 INVESTMENT LA FMOL C Corporation false ST DOMINIC MADISON HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON MS 39216 202870254 HEALTHCARE MS SDJMH C Corporation 2811737 17128702 1 true ST DOMINIC INTEGRATED SERVICES INC 969 LAKELAND DRIVE JACKSON MS 39216 271493623 INVESTMENTS MS SDJMH C Corporation 0 3631592 1 true LAFAYETTE SURGICARE INC C/O C T CORPORATION SYSTEM 3867 PLAZA TOWER DR BATON ROUGE LA 70816 943419282 HEALTHCARE LA LOURDES C Corporation false NMC OPERATING COMPANY LLC DBA SPINE HOSPITAL OF LOUISIANA 10105 PARK ROWE CIRCLE STE 250 BATON ROUGE LA 70810 270059959 HEALTHCARE LA OLOL S Corporation false false false true true false false false false false true true false true true true true true true true JACKSON HEART & VASCULAR CENTER LLC S 100000 FMV ST CATHERINE'S VILLAGE D 12177787 FMV ST DOMINIC HEALTH SERVICES FOUNDATION C 2712142 FMV