Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2011 and ending 09-30-2012
BCheck if applicable:
CName of organization
JUPITER MEDICAL CENTER INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1210 South Old Dixie Highway
 
Room/suite
City or town, state or country, and ZIP + 4
Jupiter, FL33458
D Employer identification number

59-1460239
E Telephone number

G Gross receipts $ 188,551,056
F Name and address of principal officer:
JOHN D COURIS
1210 SOUTH OLD DIXIE HIGHWAY
JUPITER,FL33458
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.JUPITERMED.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1976
M State of legal domicile: FL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: JUPITER MEDICAL CENTER IS A NOT-FOR-PROFIT COMMUNITY MEDICAL CENTER OFFERING STATE-OF-THE-ART TECHNOLOGY AND WORLD-CLASS HEALTHCARE PROFESSIONALS. JMC HAS OVER 520 PHYSICIANS ON OUR MEDICAL STAFF AS WELL AS APPROXIMATELY 1,500 EMPLOYEES AND OVER 700 VOLUNTEERS ACROSS ALL AFFILIATED ORGANIZATIONS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 16
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 1,529
6 Total number of volunteers (estimate if necessary) .... 6 450
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a -4,683
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 7,685,922 7,192,724
9 Program service revenue (Part VIII, line 2g) ......... 178,040,901 175,032,297
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 39,531 661,504
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,146,862 5,120,211
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 188,913,216 188,006,736
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 71,068
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 75,284,539 78,902,971
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 103,504,859 99,686,604
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 178,789,398 178,660,643
19 Revenue less expenses. Subtract line 18 from line 12....... 10,123,818 9,346,093
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 164,866,980 166,194,249
21 Total liabilities (Part X, line 26)............. 88,541,287 83,214,809
22 Net assets or fund balances. Subtract line 21 from line 20..... 76,325,693 82,979,440
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: THE MISSION OF JUPITER MEDICAL CENTER IS TO DELIVER EXCELLENT AND COMPASSIONATE HEALTHCARE ADVANCING THE WELL-BEING OF THE PEOPLE WE SERVE, REGARDLESS OF THEIR ABILITY TO PAY. CERTAIN SERVICES ARE PROVIDED AT A LOSS OR AT NO PAYMENT THROUGH THE HOSPITAL'S CHARITY CARE, MEDICARE AND MEDICAID PROGRAMS.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 147,912,020 including grants of $ 71,068 ) (Revenue $ 179,415,724 )
JUPITER MEDICAL CENTER, INC. OFFERS SEVERAL SERVICES TO BENEFIT THE COMMUNITY, INCLUDING CARDIOPULMONARY REHABILITATION, THE ELLA MILBANK FOSHAY CANCER CENTER, GI LAB, SLEEP DISORDERS CENTER, OUTPATIENT LAB, HEALTH AND REHABILITATION CENTER, THE KRISTIN HOKE BREAST PROGRAM INCLUDING THE MARGARET W. NIEDLAND BREAST CENTER, OBSTETRICS, WOUND CARE, OUTPATIENT IMAGING, AND VASCULAR LAB. THE MEDICAL CENTER ALSO OFFERS A SURGICAL WEIGHT LOSS PROGRAM, CARDIOLOGY SERVICES, PEDIATRIC THERAPY, OUTPATIENT REHABILITATION, PAIN MANAGEMENT AND RESPIRATORY SERVICES. (CONTINUED ON SCHEDULE O)
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 147,912,020
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
125
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,529
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
16
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
16
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
DALE HOCKING
1210 SOUTH OLD DIXIE HIGHWAY
JUPITER,FL33458
(561) 263-2234
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JOSEPH R TADDEO
CHAIRMAN
 10.00 X   X       0 0 0
(2) MARK L CORRY MD
SECRETARY
 10.00 X   X       0 0 0
(3) PAUL CHIAPPARONE
VICE CHAIRMAN
 10.00 X   X       0 0 0
(4) S BARRIE GODOWN CPA
TREASURER
 10.00 X   X       0 0 0
(5) ANN SCHWARTZ
TRUSTEE
 5.00 X           0 0 0
(6) DOUGLAS BROWN
TRUSTEE
 5.00 X           0 0 0
(7) ERNIE CANTELMO
TRUSTEE
 5.00 X           0 0 0
(8) HERBERT BAUM
TRUSTEE
 5.00 X           0 0 0
(9) JACK WATERMAN DO
TRUSTEE
 5.00 X           0 0 0
(10) JAMES MULLEN MD
TRUSTEE
 5.00 X           0 0 0
(11) JENNIFER DOSS
TRUSTEE
 5.00 X           0 0 0
(12) KAREN GOLONKA
TRUSTEE
 5.00 X           0 0 0
(13) MARTIN DYTRYCH CPA
TRUSTEE
 5.00 X           0 0 0
(14) R NEILL BORLAND MD
TRUSTEE
 5.00 X           0 0 0
(15) RICHARD J KATZ JR
TRUSTEE
 5.00 X           0 0 0
(16) RYAN SIMOVITCH MD
TRUSTEE
 5.00 X           0 0 0
(17) BETSY HEARTFIELD
VP LONG TERM CARE & PAVILION ADMINISTRATOR
 10.00     X       155,367 0 18,429
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) CATHY BUSH
VP OF MARKETING
 40.00     X       130,450 0 13,391
(19) DALE HOCKING
VP FINANCE AND CFO - PARTIAL YEAR
 40.00     X       0 0 0
(20) ERIC JOLLY
INTERIM VP FINANCE AND CFO
 40.00     X       110,667 0 28,535
(21) J MICHAEL FEHR
VP CIO
 40.00     X       219,890 0 37,829
(22) JOHN D COURIS
PRESIDENT & CEO
 40.00     X       524,813 0 37,668
(23) JOHN WOLF
VP HUMAN RESOURCES - PARTIAL YEAR
 40.00     X       189,627 0 29,294
(24) PETER GLOGGNER
VP HUMAN RESOURCES - PARTIAL YEAR
 40.00     X       7,120 0 0
(25) STEPHEN J GRIGSBY
VP FINANCE & CFO - PARTIAL YEAR
 40.00     X       270,708 0 30,045
(26) STEVEN SEELEY
VP CNO
 40.00     X       122,047 0 2,502
(27) TERESA F WENTZ
VP CAO AND ADMIN SERV
 40.00     X       215,207 0 17,696
(28) MARK A SIMS MD
PHYSICIAN - PARTIAL YEAR
 40.00         X   0 486,792 12,515
(29) PEDRO MENDEZ-CORREA
PHYSICIST
 40.00         X   180,988 0 26,076
(30) SEAN MILLER
HOSPITALIST
 40.00         X   0 186,851 26,786
(31) THOMAS A DAVIS
DIRECTOR PHARMACY
 40.00         X   159,747 0 17,547
(32) TODD BRADFORD
PHYSICIAN
 40.00         X   0 374,616 26,663
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,286,631 1,048,259 324,976
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet51
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
FENSTER & COHEN PA
1391 SAWGRASS CORPORATE PKWY
SUNRISE,FL33323 		LEGAL SERVICES 475,000
CARLTON FIELDS PA
PO BOX 3239
TAMPA,FL33601 		LEGAL SERVICES 333,580
MCDERMOTT WILL AND EMORY LLP
PO BOX 6043
CHICAGO,IL60680 		LEGAL SERVICES 251,340
BUSH & COMPANY LLC
102 CLUB DRIVE
PALM BEACH GARDENS,FL33418 		MARKETING SERVICES 184,054
CHAN ACCOUNTING
231 S BERNISTON SUITE 300
ST LOUIS,MO63105 		INTERNAL AUDIT SERVICES 152,639
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet7
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 7,172,724
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		20,000
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 7,192,724
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 900,099 174,534,386 174,534,386    
b CLINIC SERVICES 621,110 497,911 497,911    
c
d
e
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 175,032,297
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 437,280     437,280
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 929,213  
b Less: rental expenses 544,320  
c Rental income or (loss) 384,893 0
d Net rental income or (loss).......MediumBullet 384,893   -4,683 389,576
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   224,224
b Less: cost or other basis and sales expenses 0  
c Gain or (loss) 0 224,224
d Net gain or (loss)..........MediumBullet 224,224     224,224
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a MEDICAID/MEDICARE INCENTIVE PAYMENTS 900,099 2,775,413 2,775,413    
b PARTNERSHIP SHARE OF INCOME - JOSC 621,400 809,041 809,041    
c CAFETERIA 722,100 351,891     351,891
d All other revenue .... 798,973 798,973 0 0
e Total. Add lines 11a–11d ......MediumBullet 4,735,318
12 Total revenue. See Instructions....MediumBullet 188,006,736 179,415,724 -4,683 1,402,971
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 71,068 71,068
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,005,086 1,002,543 1,002,543  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 61,379,888 49,319,596 12,060,292  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,985,839 1,595,649 390,190  
9 Other employee benefits ....... 8,948,350 7,190,124 1,758,226  
10 Payroll taxes ........... 4,583,808 3,683,154 900,654  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 2,137,369   2,137,369  
c Accounting ........... 348,132   348,132  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 35,065   35,065  
g Other .......... 13,915,708 10,450,279 3,465,429  
12 Advertising and promotion .... 637,473   637,473  
13 Office expenses ....... 4,376,640 3,282,480 1,094,160  
14 Information technology ...... 3,304,309 2,697,085 607,224  
15 Royalties .. 0      
16 Occupancy ........... 6,571,591 5,543,961 1,027,630  
17 Travel ............ 91,649 91,649    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 2,140,707 1,514,646 626,061  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 11,243,395 7,955,206 3,288,189  
23 Insurance .............. 2,805,872 2,478,276 327,596  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL AND OTHER SUPPLIES 37,526,085 37,526,085    
b FOOD AND NUTRITION 1,568,670 1,568,670    
c PROVISION FOR BAD DEBT 9,314,978 9,314,978    
d INDIGENT CARE ASSESSMENT 1,983,775 1,983,775    
e
f All other expenses 1,685,186 642,796 1,042,390 0
25 Total functional expenses. Add lines 1 through 24f 178,660,643 147,912,020 30,748,623 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 12,695,530 2 15,146,438
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 23,037,030 4 28,090,087
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 3,718,259 8 3,774,796
9 Prepaid expenses and deferred charges ............ 2,052,905 9 2,793,393
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 232,412,490
b Less: accumulated depreciation. ..... 10b 141,288,930 87,030,818 10c 91,123,560
11 Investments—publicly traded securities .......... 16,290,611 11 13,081,159
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 2,423,341 13 2,515,051
14 Intangible assets ......... 10,887,322 14 8,217,452
15 Other assets. See Part IV, line 11 ........... 6,731,164 15 1,452,313
16 Total assets. Add lines 1 through 15 (must equal line 34)... 164,866,980 16 166,194,249
Liabilities 17 Accounts payable and accrued expenses . 20,676,374 17 23,225,004
18 Grants payable ..........   18  
19 Deferred revenue .......... 24,055 19 0
20 Tax-exempt bond liabilities .......... 39,126,453 20 36,197,845
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 9,546,964 23 8,598,250
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 19,167,441 25 15,193,710
26 Total liabilities. Add lines 17 through 25..... 88,541,287 26 83,214,809
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 76,325,693 27 82,979,440
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 76,325,693 33 82,979,440
34 Total liabilities and net assets/fund balances ..... 164,866,980 34 166,194,249
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
188,006,736
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
178,660,643
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
9,346,093
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
76,325,693
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-2,692,346
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
82,979,440
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID: 11000230
Software Version: v2011.1.0
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID: 11000230
Software Version: v2011.1.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
JUPITER MEDICAL CENTER INC
  		Employer identification number

59-1460239
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
JUPITER MEDICAL CENTER INC
  		Employer identification number

59-1460239
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
JUPITER MEDICAL CENTER INC
  		Employer identification number

59-1460239
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID: 11000230
Software Version: v2011.1.0
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
9,109
j
Total. Add lines 1c through 1i ...............................
9,109
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 THE ORGANIZATION PAYS DUES TO PROFESSIONAL ORGANIZATIONS AND MEMBERSHIP ASSOCIATIONS, SUCH AS THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF DUES ARE IDENTIFIED BY THESE ORGANIZATIONS AS HAVING BEEN SPENT ON LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID: 11000230
Software Version: v2011.1.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 18,277,283 17,532,381 11,034,876 12,111,242
b Contributions ........   993,800 5,243,570 63,490
c Net investment earnings, gains, and losses ... 3,739,664 -244,774 1,253,935 -540,012
d Grants or scholarships .....     0 0
e Other expenditures for facilities
and programs ........ 		  4,124 0 599,844
f Administrative expenses ....     0 0
g End of year balance ...... 22,016,947 18,277,283 17,532,381 11,034,876
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet84.880 %
b
Permanent endowment SchDMd Bullet12.950 %
c
Temporarily restricted endowment SchDMd Bullet2.170 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   5,595,546 5,595,546
b Buildings ................   81,109,928 34,706,934 46,402,994
c Leasehold improvements ............   6,095,940 4,738,291 1,357,649
d Equipment ................   131,028,240 101,843,705 29,184,535
e Other .................   8,582,836   8,582,836
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 91,123,560
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
SELF INSURANCE LIABILITIES 7,801,442
INDIGENT CARE TAX 3,053,811
LEASE FINANCING OBLIGATION 3,960,422
CAPITAL LEASE OBLIGATIONS 354,456
DEPOSITS 23,579




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 15,193,710
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Intended uses of endowment funds Schedule D, Part V, Line 4 ENDOWMENT FUNDS ARE HELD BY JUPITER MEDICAL CENTER FOUNDATION, INC. (A RELATED ORGANIZATION). THE FUNDS ARE HELD TO SUPPORT HEALTHCARE SERVICES FOR THOSE IN GREATEST NEED AND FOR FUTURE PHYSICAL PLANT AND EQUIPMENT EXPENDITURES TO EXPAND SERVICES OFFERED. THE FUNDS ARE INTENDED TO SUPPORT THE PROGRAMS AND MISSION OF JUPITER MEDICAL CENTER, INC. AND JUPITER MEDICAL CENTER PAVILION, INC.
FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 JUPITER MEDICAL CENTER INC. IS INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS. BELOW IS THE TEXT OF THE FIN 48 FOOTNOTE FROM THOSE FINANCIAL STATEMENTS. THE INTERNAL REVENUE SERVICE HAS DETERMINED ON AUGUST 2, 1973, THAT THE HOSPITAL, THE PAVILION, THE FOUNDATION AND THE PHYSICIANS GROUP ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). ACCORDINGLY, NO INCOME TAXES HAVE BEEN PROVIDED FOR THESE ENTITIES. ASC TOPIC 740, INCOME TAXES, PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 PROVIDES GUIDANCE FOR RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTES FOR THE FINANCIAL RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THERE WERE NO UNCERTAIN TAX POSITIONS RECORDED IN THE CONOLIDATED FINANCIAL STATEMENTS AT SEPTEMBER 30, 2012 OR 2011. THE CENTER HAS A 60.2% INVESTMENT INTEREST IN AN AMBULATORY SURGERY CENTER AT SEPTEMBER 30, 2012 WHICH MAY BE DEEMED TO OPERATE IN A FOR-PROFIT MANNER. HOWEVER, THE CENTER BELIEVES, THROUGH ITS MEMBERSHIP AGREEMENT, IT HAS DOCUMENTATION TO SUPPORT THE INTEREST IN THIS INVESTMENT BY THE HOSPITAL CAUSING IT TO BE RELATED TO ITS EXEMPT PURPOSE. AS A RESULT, THE CENTER HAS NOT RECORDED INCOME TAXES PAYABLE OR AN INCOME TAX PROVISION RELATING TO THE INCOME FROM THIS INVESTMENT. THERE ARE NO SIGNIFICANT DEFERRED INCOME TAX ASSETS OR LIABILITIES.
Schedule D (Form 990) 2011

Additional Data


Software ID: 11000230
Software Version: v2011.1.0




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    3,341,700 0 3,341,700 1.970 %
b Medicaid (from Worksheet 3, column a) .....     8,051,151 3,383,991 4,667,160 2.760 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     1,133,367 522,818 610,549 0.360 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		0 0 12,526,218 3,906,809 8,619,409 5.090 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    206,805 94,546 112,259 0.070 %
f Health professions education
(from Worksheet 5) .. 		    0 0 0 0 %
g Subsidized health services
(from Worksheet 6) .. 		    0 0 0 0 %
h Research (from Worksheet 7)     287,430 72,450 214,980 0.130 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     71,068 0 71,068 0.040 %
jTotal Other Benefits ... 0 0 565,303 166,996 398,307 0.240 %
kTotal. Add lines 7d and 7j. .. 0 0 13,091,521 4,073,805 9,017,716 5.330 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and training for community members         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 0 0 0 0 0 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
9,314,978
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
62,239,526
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
76,560,000
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-14,320,474
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1JUPITER OUTPATIENT SURGERY CENTER LLC
  		OUTPATIENT SURGERY CENTER 60.5 % 0 % 39.5 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 JUPITER MEDICAL CENTER
1210 SOUTH OLD DIXIE HIGHWAY
JUPITER,FL33458 		X           X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):  

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?....... 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14    
15 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 DDid the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16    
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address Type of Facility (describe)
1 JUPITER OUTPATIENT SURGERY CENTER
2055 MILITARY TRAIL SUITE 100
JUPITER,FL33458 		AMBULATORY SURGICAL CENTER
2 JUPITER MED CENTER CLINICAL LABORATORY
1210 SOUTH OLD DIXIE HIGHWAY
JUPITER,FL33458 		CLINICAL LABORATORY
3 JUPITER MEDICAL CENTER BLOOD GAS
1210 SOUTH OLD DIXIE HIGHWAY
JUPITER,FL33458 		CLINICAL LABORATORY
4
5
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 THE HOSPITAL UTILIZED THE COST TO CHARGE RATIO FOR THE INFORMATION IN PART I, LINE 7.
Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 9,314,978
Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 JUPITER MEDICAL CENTER, INC. IS INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS. BELOW IS THE TEXT OF FOOTNOTE REGARDING BAD DEBT EXPENSE: THE CENTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS REMAINED CONSISTENT WITH PRIOR YEAR EXPERIENCE AT APPROXIMATELY 100% OF SELF-PAY ACCOUNTS RECEIVABLE. THE CENTER'S PROVISION FOR BAD DEBT DECREASED FROM APPROXIMATELY $15,752,000 FOR FISCAL YEAR 2011 TO $9,482,000 FOR FISCAL YEAR 2012. THE CENTER'S SELF-PAY PATIENTS HAVE EXPERIENCED SIMILAR ECONOMIC DIFFICULTIES IN BOTH FISCAL YEARS, HOWEVER THE CENTER WAS ABLE TO CAPTURE MORE CHARITY CARE IN FISCAL YEAR 2012, THROUGH ITS PRESUMPTIVE AND TRADITIONAL CHARITY MODELS, AS THOSE WITH THE INABILITY TO PAY CONTINUED TO HAVE LESS FINANCIAL RESOURCES AND LOWER CREDIT SCORES. THE CENTER HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES. THE CENTER DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS. COSTING METHODOLOGY BAD DEBT EXPENSE IS REPORTED AT GROSS CHARGES IN PART III, LINE 2.
Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 JUPITER MEDICAL CENTER, INC. PROVIDES SERVICES UNDER GOVERNMENTAL PROGRAMS AS A COMMUNITY BENEFIT AND AS PART OF ITS MISSION; IN MANY CASES, THIS RESULTS IN ACCEPTING PAYMENT FOR THOSE SERVICES AT LESS THAN COST. JUPITER MEDICAL CENTER, INC. UTILIZES THE MEDICARE COST REPORT TO REPORT THE TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS.
Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b JUPITER MEDICAL CENTER HAS A COLLECTIONS POLICY WHICH IS FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE, WHICH INCLUDES REVIEW OF TRADITIONAL CHARITY CARE INFORMATION, INCLUDING SUBMITTED TAX RETURNS, SOURCES OF INCOME, AVAILABLE CREDIT AND OTHER DEMOGRAPHIC INFORMATION. IN ADDITION TO OUR TRADITIONAL CHARITY CARE METHODOLOGY, JMC HAS INSTITUTED A CHARITY CARE POLICY WHICH ALLOWS FOR WRITE OFF OF ACCOUNT BALANCES WITHOUT A PATIENT APPLICATION FOR CARE BASED UPON REVIEW OF AVAILABLE CONSUMER CREDIT SCORES AND CERTAIN DEMOGRAPHIC INFORMATION GATHERED AT THE TIME OF REGISTRATION. ALL COLLECTION ACTIVITY CEASES ON CHARITY CARE PATIENT ENCOUNTERS.
FINANCIAL ASSISTANCE POLICY PART V, SECTION B, LINE 13 THE ORGANIZATION IS IN THE PROCESS OF REVISING THE FINANCIAL ASSISTANCE POLICY. UPON REVISION OF THE FINANCIAL ASSISTANCE POLICY, THE POLICY WILL BE POSTED ON THE HOSPITAL'S WEBSITE, ATTACHED TO ALL BILLING INVOICES, POSTED IN THE HOSPITAL'S EMERGENCY AND WAITING ROOMS, POSTED IN THE HOSPITAL'S ADMISSIONS OFFICES AND ALSO PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY. THE POLICY WILL ALSO BE AVAILABLE UPON REQUEST.
Means used to determine amounts billed Schedule H, Part V Section B, Line 19d (1) JUPITER MEDICAL CENTER - JUPITER MEDICAL CENTER OFFERS FREE OR DISCOUNTED CARE TO ALL INDIVIDUALS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE AMOUNT BILLED TO THOSE INDIVIDUALS IS DISCOUNTED BASED ON SEVERAL FACTORS INCLUDING INCOME LEVEL, ASSET LEVEL, INSURANCE STATUS AND MEDICAL INDIGENCY. IF A PATIENT DOES NOT QUALIFY FOR MEDICAID OR MEDICARE AND DOES NOT HAVE INSURANCE, THEY ARE REQUIRED TO PAY GROSS CHARGES. HOWEVER, MOST SELF-PAY PATIENTS QUALIFY FOR DISCOUNTED OR FREE CARE. THEREFORE VERY FEW PATIENTS ARE ACTUALLY BILLED GROSS CHARGES. THE HOSPITAL OFFERS THE OPTION TO PAY $550 TO ANYONE WHO COMES INTO THE EMERGENCY ROOM FOR A VISIT IF THEY ARE UNINSURED AND PAY THAT SAME DAY. THE MEDICAL CENTER PROVIDES THE PROMPT-PAY DISCOUNTED PAYMENT AMOUNT TO ALLOW AN UNINSURED PATIENT WHO WOULD NOT QUALIFY FOR FINANCIAL ASSISTANCE THE OPPORTUNITY TO EXPERIENCE A SIGNIFICANT DISCOUNT.;
Gross Charges for Medical Care Schedule H, Part V Section B, Line 21 (1) JUPITER MEDICAL CENTER - THE HOSPITAL UTILIZES GROSS CHARGES IN BILLING PATIENTS WITHOUT INSURANCE FOR ELECTIVE (NON-EMERGENCY OR OTHER MEDICALLY NECESSARY) CARE.;
Needs assessment. Schedule H, Part VI, Line 2 JUPITER MEDICAL CENTER IS IN THE PROCESS OF CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT - AS REQUIRED BY IRC SECTION 501(R).
Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 WHEN JUPITER MEDICAL CENTER REGISTERS A PATIENT, INSURANCE/GUARANTOR INFORMATION IS SOUGHT. IF A PATIENT DOES NOT HAVE INSURANCE, JMC EMPLOYS FINANCIAL COUNSELORS WHO ARE TRAINED IN HELPING PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FEDERAL, HILL-BURTON PROGRAM, STATE OF FLORIDA MEDICAID ASSISTANCE, LOCAL PALM BEACH COUNTY HEALTH DISTRICT CARE ALONG WITH ADVISING ON CHARITY CARE UNDER JMC'S FINANCIAL ASSISTANCE POLICIES, AMONG OTHERS. FINANCIAL COUNSELORS ADVISE THE PATIENT ON COMPLETION OF PAPERWORK NECESSARY TO RECEIVE ASSISTANCE. IN ADDITION, JMC HAS PARTNERED WITH A FINANCING INSTITUTION TO PROVIDE PATIENTS OF ADDITIONAL MEANS THE ABILITY TO FINANCE PATIENT CARE AT A 0% INTEREST RATE PROVIDED THAT PAYMENTS ARE MADE OVER A 12 MONTH PERIOD.
Community information. Schedule H, Part VI, Line 4 ACCORDING TO THE AMERICAN COMMUNITY SURVEY 2006-2008 ESTIMATES, THE TOTAL POPULATION FOR JUPITER MEDICAL CENTER'S SERVICE AREA IS APPROXIMATELY 79,746. 80% OF THE POPULATION WITHIN THE TOWN OF JUPITER IS WHITE. HISPANICS MAKE UP 14.6%, ASIANS ACCOUNT FOR 2% AND AFRICAN AMERICANS COMPRISE 1.7% OF THE POPULATION. 58.5% OF JUPITER'S POPULATION IS BETWEEN THE AGES OF 20 AND 64. 18.1% OF THE POPULATION ARE BETWEEN THE AGES OF 5-19, AND INDIVIDUALS OVER 65 YEARS OF AGE ACCOUNT FOR 17% OF THE POPULATION. ALMOST 64% OF THE HOUSEHOLDS IN JUPITER ARE FAMILY HOUSEHOLDS. OF THOSE, 50% ARE MARRIED COUPLES AND 20% OF THOSE HAVE CHILDREN UNDER 18 LIVING IN THEM. JUPITER HAS 8.3% OF ITS HOUSEHOLDS HEADED BY FEMALES WITH NO HUSBAND. THE DATA FOR THE SURROUNDING ZIP CODES THAT COMPRISE JUPITER MEDICAL CENTER'S SERVICE AREA IS SIMILAR AS FEMALES HEAD 7.4% OF THE HOUSEHOLDS AND 4.4% OF THOSE HAVE CHILDREN UNDER THE AGE OF 18 LIVING IN THEM. 43% OF FAMILIES IN JUPITER AND ITS SURROUNDING ZIP CODES HAVE GRANDPARENTS LIVING IN THE HOME THAT ARE RESPONSIBLE FOR THEIR OWN GRANDCHILDREN. 89% OF JUPITER RESIDENTS ARE HIGH SCHOOL GRADUATES AND 32% HAVE A BACHELOR'S DEGREE OR HIGHER. ONLY 4% OF THE POPULATION HAVE LESS THAN A NINTH GRADE EDUCATION AND ONLY 6.6% HAVE ATTENDED HIGH SCHOOL BUT NOT RECEIVED A DIPLOMA. NEARLY 6% OF ALL PEOPLE LIVING IN JUPITER HAVE INCOME LEVELS BELOW THE FEDERAL POVERTY LEVEL IN 2006-2008. 10.3% OF THE JUPITER POPULATION WAS LIVING AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL IN 2005. 4% OF FAMILIES ARE LIVING BELOW THE POVERTY LEVEL AND 8.3% OF THOSE FAMILIES HAVE CHILDREN UNDER THE AGE OF 5. NEARLY 5% OF THAT POPULATION HAD INCOME BELOW THE 1999 FEDERAL POVERTY LEVEL AND 4.7% OF THOSE INDIVIDUALS HAD CHILDREN UNDER THE AGE OF 18. THE MEDIAN INCOME FOR JUPITER FAMILIES IS $81,039 AND FOR NON-FAMILIES ITS $44,003. MEDIAN EARNINGS FOR FEMALE, YEAR-ROUND WORKERS IN JUPITER ARE $44,139 AND IS 15.6% LESS THAN THAT OF MALES. 56% OF HOUSES WITH MORTGAGES IN JUPITER HAVE MONTHLY OWNER COSTS OF $2,000 OR MORE; THE GROSS RENT AS A PERCENTAGE OF HOUSEHOLD INCOME (GRAPI) IS STEEP, AND 35% OF THOSE WHO RENT IN JUPITER PAY 35% OR MORE OF THEIR MONTHLY INCOME ON RENT. OF THE POPULATION AGES 21-64, 17% HAVE A DISABILITY AND OF THOSE, 68.3% OF THEM ARE EMPLOYED. 6% OF THE POPULATION AGES 5-19 HAVE A DISABILITY. A TARGET POPULATION OF POTENTIAL USERS OF A FEDERALLY QUALIFIED HEALTH CARE CENTER DOES EXIST IN JUPITER. THESE USERS ARE COMPRISED OF THE 10.3% OF THE POPULATION WHICH IS LIVING AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, FEMALE-HEADED HOUSEHOLDS WITH CHILDREN EARNING 15.6% LESS THAN THEIR MALE COUNTERPARTS, THE 25% OF THE SCHOOL-AGED CHILDREN THAT ARE ELIGIBLE FOR FREE AND REDUCED LUNCHES, NON-ENGLISH SPEAKING DAY LABORERS AND THE 10,000 NON-INSURED AND MEDICAID PATIENTS UTILIZING THE JUPITER MEDICAL CENTER FOR PRIMARY CARE SERVICES.
Promotion of community health Schedule H, Part VI, Line 5 JMC'S GOVERNING BODY IS COMPRISED OF PERSONS AND PHYSICIANS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS, NOR FAMILY MEMBERS THEREOF. JMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS SERVICE LINES. TO THE EXTENT THAT JMC HAS SURPLUS FUNDS, JMC CONSTANTLY LOOKS AT COMMUNITY NEEDS IN ORDER TO DETERMINE WHAT SERVICE LINE SHOULD BE EXPANDED AND EQUIPMENT REINVESTMENTS SHOULD BE MADE TO BETTER SERVE OUR PRIMARY SERVICE AREA. THE ORGANIZATION OFFERS MEDICAL EDUCATION TO THE COMMUNITY AND HAS SEVERAL ONGOING MEDICAL RESEARCH STUDIES.
Affiliated health care system Schedule H, Part VI, Line 6 JUPITER MEDICAL CENTER, INC IS AN AFFILIATE OF JUPITER MEDICAL CENTER PAVILION, INC AND JUPITER MEDICAL CENTER PHYSICIANS GROUP, INC. TOGETHER WITH JUPITER MEDICAL CENTER FOUNDATION, INC, THE ORGANIZATION IS FOCUSED ON PROVIDING HIGH QUALITY, COMMUNITY CENTERED HEALTHCARE IN A COST-EFFECTIVE AND COMPASSIONATE MANNER. AS A NON-PROFIT ORGANIZATION, WE RECOGNIZE RESPONSIBILITY FOR THE HEALTH OF OUR COMMUNITY. TOGETHER, THESE ORGANIZATIONS PROVIDE A CONTINUUM OF CARE TO THE COMMUNITY FROM PRIMARY CARE OF PATIENTS THROUGH TO HOSPITAL AND ANCILLARY CARE SERVICES, LONG-TERM, RESIDENTIAL AND REHABILITATION CARE. WE CONSTANTLY REVIEW THE HEALTHCARE NEEDS OF OUR COMMUNITY IN ORDER TO ENSURE THE ORGANIZATION IS RESPONDING TO AND MEETING THE NEEDS OF THE COMMUNITY.
Schedule H (Form 990) 2011
Additional Data


Software ID: 11000230
Software Version: v2011.1.0
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number
59-1460239
Part I
General Information on Grants and Assistance
1
Does the organization maintain 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 the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) NPB CHAMBER OF COMMERCE800 N US HWY 1
JUPITER,FL33477 		59-1001660 501(C)(6) 7,243 0 N/A N/A SPONSORSHIP
(2) KOMEN RACE FOR THE CURE5005 LBJ FREEWAY
SUITE 250
DALLAS,TX75244 		75-1835298 501(C)(3) 7,500 0 N/A N/A KIDS FOR THE CURE SPONSORSHIP
(3) AMERICAN CANCER SOCIETY250 WILLIAMS STREET NW
ATLANTA,GA30303 		13-1788491 501(C)(3) 25,000 0 N/A N/A SPONSORSHIP


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
1
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE ORGANIZATION GIVES GRANT FUNDS TO SPONSOR THE PROGRAMS OF VARIOUS NONPROFIT ORGANIZATIONS IN THE COMMUNITY. THE FUNDS CAN BE USED FOR THE GENERAL PROGRAMS OF THESE ORGANIZATIONS.
Schedule I (Form 990) 2011


Additional Data


Software ID: 11000230
Software Version: v2011.1.0


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) TODD BRADFORD (i)
(ii)		 0
329,616 		0
45,000 		0
0 		0
0 		0
26,663 		0
401,279 		0
0
(2) BETSY HEARTFIELD (i)
(ii)		 140,183
0 		14,916
0 		268
0 		3,050
0 		15,379
0 		173,796
0 		0
0
(3) PEDRO MENDEZ-CORREA (i)
(ii)		 180,988
0 		0
0 		0
0 		3,636
0 		22,440
0 		207,064
0 		0
0
(4) MARK A SIMS MD (i)
(ii)		 0
486,792 		0
0 		0
0 		0
0 		0
12,515 		0
499,307 		0
0
(5) JOHN WOLF (i)
(ii)		 165,716
0 		22,012
0 		1,899
0 		20,393
0 		8,901
0 		218,921
0 		0
0
(6) J MICHAEL FEHR (i)
(ii)		 193,822
0 		25,626
0 		442
0 		4,591
0 		33,238
0 		257,719
0 		0
0
(7) STEPHEN J GRIGSBY (i)
(ii)		 243,506
0 		27,202
0 		0
0 		5,204
0 		24,841
0 		300,753
0 		0
0
(8) JOHN D COURIS (i)
(ii)		 405,931
0 		110,475
0 		8,407
0 		4,505
0 		33,163
0 		562,481
0 		0
0
(9) TERESA F WENTZ (i)
(ii)		 187,512
0 		27,294
0 		401
0 		4,328
0 		13,368
0 		232,903
0 		0
0
(10) THOMAS A DAVIS (i)
(ii)		 149,708
0 		9,833
0 		206
0 		3,230
0 		14,317
0 		177,294
0 		0
0
(11) SEAN MILLER (i)
(ii)		 0
166,851 		0
20,000 		0
0 		0
2,623 		0
24,163 		0
213,637 		0
0





Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Health or social club dues or initiation fees Schedule J, Part I, Line 1a THE PRESIDENT/CEO RECEIVES THE BENEFIT OF A GOLF CLUB MEMBERSHIP WHICH IS PAID BY THE ORGANIZATION. THE MEMBERSHIP IS USED FOR BUSINESS PURPOSES, THEREFORE IT IS NOT TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUAL.
Non-fixed payments Schedule J, Part I, Line 7 SOME OF THE INTERESTED PERSONS RECEIVED PERFORMANCE BONUSES THAT WERE NOT BASED ON A FIXED FORMULA.
Schedule J (Form 990) 2011

Additional Data


Software ID: 11000230
Software Version: v2011.1.0
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number
59-1460239
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY
  		52-1297505   08-07-2009 13,000,000 REFINANCE DEBT AND VARIOUS CAPITAL IMPROVEMENTS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 3,189,253      
2 Amount of bonds legally defeased . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . 13,087,369      
4 Gross proceeds in reserve funds . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . 0      
8 Credit enhancement from proceeds . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . 13,087,369      
11 Other spent proceeds . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .   X            
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X              
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X              
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.0000%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.0000%   %   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.0000%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . X              
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X            
2 Is the bond issue a variable rate issue?   X            
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X            
b Name of provider . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X            
6 Did the bond issue qualify for an exception to rebate? . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

Additional Data


Software ID: 11000230
Software Version: v2011.1.0

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Identifier Return Reference Explanation
PROGRAM SERVICE ACCOMPLISHMENT FORM 990, PART III, LINE 4A (CONTINUED FROM PART III) IN ADDITION, JMC CONTINUALLY IMPLEMENTS NEW TECHNOLOGY AND SERVICES TO MEET THE COMMUNITY'S NEEDS. THE MEDICAL CENTER CONSISTS OF 163 PRIVATE ACUTE CARE HOSPITAL BEDS AND 120 LONG-TERM CARE BEDS, PROVIDES A BROAD RANGE OF SERVICES WITH SPECIALTY CONCENTRATIONS IN CANCER CARE, ORTHOPEDICS/SPINE, EMERGENCY SERVICES, CARDIAC SERVICES, WOMEN'S AND CHILDREN'S SERVICES, MINIMALLY-INVASIVE SURGICAL PROCEDURES, INCLUDING A ROBOTIC SURGERY PROGRAM, ADVANCED DIAGNOSTICS, AND REHABILITATION. JUPITER MEDICAL CENTER IS AFFILIATED WITH THE UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE. THE MEDICAL CENTER HAS APPROXIMATELY 1,500 EMPLOYEES, 520 PHYSICIANS AND 450 VOLUNTEERS. FOR THE YEAR ENDING SEPTEMBER 30, 2012, THE MEDICAL CENTER HAD 10,243 ADMISSIONS, 1,084 BIRTHS, 30,053 EMERGENCY ROOM VISITS, 124,611 OUTPATIENT VISITS, AND 6,488 SURGERIES. OVER THE YEARS, JUPITER MEDICAL CENTER HAS GAINED A REPUTATION AS A WORLD-CLASS MEDICAL FACILITY, KNOWN FOR ITS EXCELLENT, COMPASSIONATE CARE.
Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION, EXCEPT AS SUCH AUTHORITY IS LIMITED BY FLORIDA STATUTE. THE EXECUTIVE COMMITTEE SHALL: (I) CONSIST OF SIX TRUSTEES, AT LEAST ONE OF WHICH SHALL BE A PHYSICIAN MEMBER AND (II) HAVE THE PRESIDENT OF THE CORPORATION AS AN EX-OFFICIO, NON-VOTING, SEVENTH COMMITTEE MEMBER.
Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE VP OF FINANCE AND CFO REVIEWS THE FORM 990 PRIOR TO ITS FINALIZATION. ACCESS TO THE FINAL DRAFT OF THE FORM 990 IS PROVIDED ELECTRONICALLY TO EVERY MEMBER OF THE BOARD OF DIRECTORS BEFORE IT IS FILED.
Conflict of interest policy Form 990, Part VI, Section B, Line 12c THE ORGANIZATION MAINTAINS A CORPORATE COMPLIANCE PROGRAM THAT MONITORS FOR POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. ON AN ANNUAL BASIS, ALL DEPARTMENTAL MANAGERS THROUGH ORGANIZATION SENIOR MANAGEMENT AND ALL MEMBERS OF THE GOVERNING BODY ARE REQUIRED TO SIGN A STATEMENT TO DISCLOSE POTENTIAL CONFLICTS. THE STATEMENTS ARE REVIEWED IN DETAIL BY THE CEO AND THE CORPORATE COMPLIANCE DIRECTOR. IF ANY CONFLICT DOES EXIST, THE INDIVIDUAL WITH THE CONFLICT IS PROHIBITED FROM PARTICIPATING IN THE TRANSACTION OR VOTING ON MATTERS RELATED TO THE CONFLICT. IN ADDITION, IN ORDER TO REGULARLY MONITOR AND ENFORCE THE CONFLICT OF INTEREST POLICY, THE BOARD CHAIR ASKS THE VOTING MEMBERS OF THE GOVERNING BODY TO DISCLOSE ANY CONFLICTS OF INTEREST AT THE START OF EACH BOARD MEETING.
Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE COMPENSATION COMMITTEE OF THE BOARD OF JUPITER MEDICAL CENTER, INC. REVIEWS SURVEY DATA, FINANCIAL ABILITY OF THE ORGANIZATION, AND ACCOMPLISHMENT OF GOALS TO DETERMINE THE AMOUNT OF COMPENSATION OF THE PRESIDENT & CEO. COMPENSATION IS THEN APPROVED BY THE BOARD OF JUPITER MEDICAL CENTER, INC. THE DELIBERATIONS AND DECISIONS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED IN THE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN THE YEAR ENDED SEPTEMBER 30, 2012.
Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b THE COMPENSATION COMMITTEE OF THE BOARD OF JUPITER MEDICAL CENTER, INC. REVIEWS AND APPROVES THE COMPENSATION OF THE OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE REVIEWS SURVEY DATA, FINANCIAL ABILITY OF THE ORGANIZATION, AND ACCOMPLISHMENT OF GOALS IN ORDER TO DETERMINE THE COMPENSATION OF THE TOP OFFICIALS. COMPENSATION IS THEN APPROVED BY THE BOARD OF JUPITER MEDICAL CENTER, INC. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN THE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN THE YEAR ENDED SEPTEMBER 30, 2012.
Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH THE STATE OF FLORIDA BECAUSE THEY ARE FILED WITH THE AGENCY FOR HEALTH CARE ADMINISTRATION. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE FOR REVIEW UPON REQUEST AT HOSPITAL ADMINISTRATION.
Average number of hours devoted per week to related organization Form 990, Part VII, Section A, Column B BETSY HEARTFIELD - BETSY HEARTFIELD SERVES AS AN OFFICER FOR JUPITER MEDICAL CENTER, INC. SHE ALSO WORKS APPROXIMATELY 40 HOURS/WEEK FOR JUPITER MEDICAL CENTER PAVILION, INC (A RELATED ORGANIZATION). STEPHEN J. GRIGSBY - STEPHEN J. GRIGSBY SERVES AS AN OFFICER FOR JUPITER MEDICAL CENTER, INC. HE ALSO WORKS APPROXIMATELY 1 HOUR/WEEK FOR JUPITER MEDICAL CENTER PHYSICIANS GROUP, INC., 5 HOURS/WEEK FOR JUPITER MEDICAL CENTER PAVILION, INC. AND 2 HOURS/WEEK FOR JUPITER MEDICAL CENTER FOUNDATION, INC. (ALL RELATED ORGANIZATIONS). TERESA F WENTZ - TERESA WENTZ SERVES AS AN OFFICER FOR JUPITER MEDICAL CENTER, INC. SHE ALSO WORKS APPROXIMATELY 5 HOURS/WEEK FOR JUPITER MEDICAL CENTER PHYSICIANS GROUP, INC. (A RELATED ORGANIZATION).
Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -22476; LOSS ON IMPAIRMENT OF GOODWILL - -2669870;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID: 11000230
Software Version: v2011.1.0
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JUPITER MEDICAL CENTER INC
 
Employer identification number

59-1460239
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) JUPITER MEDICAL CENTER FOUNDATION INC

1210 SOUTH OLD DIXIE HIGHWAY

JUPITER,FL33458
65-0132406 		SUPPORTING ORGANIZATION FL 501(C)(3) 11 - Type I JUPITER MEDICAL CENTER INC
 
Yes
 
(2) JUPITER MEDICAL CENTER PAVILION INC

1230 SOUTH OLD DIXIE HIGHWAY

JUPITER,FL33458
59-2452576 		REHABILITATION HOSPITAL FL 501(C)(3) 9 JUPITER MEDICAL CENTER INC
 
Yes
 
(3) JUPITER MEDICAL CENTER PHYSICIANS GROUP INC

1210 SOUTH OLD DIXIE HIGHWAY

JUPITER,FL33458
26-3187119 		PHYSICIAN OFFICES FL 501(C)(3) 9 JUPITER MEDICAL CENTER INC
 
Yes
 








For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) JUPITER OUTPATIENT SURGERY CENTER LLC

2055 N MILITARY TRAIL SUITE 100
JUPITER,FL33458
65-0925020 		SURGERY CENTER FL JUPITER MEDICAL CENTER INC
  		RELATED 1,079,951 1,724,747   No 0   No 60.5 %
(2) TTB PARTNERS LTD

2300 GLADES ROAD SUITE 100E
BOCA RATON,FL33431
65-0945554 		LAND RENTAL FL NA
  		RELATED 236,333 2,337,582   No 0   No 51 %










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) TTB PARTNERS LTD

 A 236,830 FMV
(2) TTB PARTNERS LTD

 R 234,600 FMV
(3) JUPITER OUTPATIENT SURGERY CENTER LLC

 A 1,067,033 FMV
(4) JUPITER OUTPATIENT SURGERY CENTER LLC

 R 931,398 FMV
(5) JUPITER MEDICAL CENTER FOUNDATION INC

 C 7,172,724 FMV
(6) JUPITER MEDICAL CENTER PAVILION INC

 P 136,104 FMV
(7) JUPITER MEDICAL CENTER FOUNDATION INC

 P 157,884 FMV
(8) JUPITER MEDICAL CENTER PAVILION INC

 E 5,346,827 FMV
(9) JUPITER MEDICAL CENTER FOUNDATION INC

 D 645,729 FMV
(10) JUPITER MEDICAL CENTER PHYSICIANS GROUP INC

 D 4,374,522 FMV
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID: 11000230
Software Version: v2011.1.0