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.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
EAST JEFFERSON GENERAL HOSPITAL
Employer identification number
72-0692834
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
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
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.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
EAST JEFFERSON GENERAL HOSPITAL
Employer identification number
72-0692834
Return Reference
Explanation
ORGANIZATIONS MISSION
FORM 990, PART III, LINE 1 OUR MISSION AT EAST JEFFERSON GENERAL HOSPITAL, A NONPROFIT COMMUNITY HEALTH SYSTEM IS TO PROVIDE PERSONALIZED AND DEPENDABLE HEALTH CARE AND HEALTH RELATED SERVICES TO INDIVIDUALS, PHYSICIANS AND BUSINESSES CONSISTENT WITH QUALITY MEDICAL AND ETHICAL STANDARDS TO IMPROVE THE HEALTH STATUS OF THOSE WE SERVE IN THE EAST BANK OF JEFFERSON PARISH AND SURROUNDING COMMUNITIES. WE PRACTICE A HOLISTIC APPROACH TO HEALTH CARE THAT RECOGNIZES EACH PERSON'S NEED FOR PHYSICAL, EMOTIONAL, AND SPIRITUAL WELL-BEING. WE DELIVER OUR CARE TO ALL RACES, CREEDS, NATIONALITIES, SEXES, AGES, AND SOCIO-ECONOMIC GROUPS. IN PURSUING OUR MISSION, WE COMMIT TO THESE GUIDING PRINCIPLES: - TO DELIVER QUALITY CARE AND SERVICES AT A PRICE WHICH REPRESENTS VALUE TO OUR CUSTOMERS; - TO UPHOLD THE BASIC RIGHTS AND RESPONSIBILITIES OF PATIENTS AND TO ENCOURAGE ACTIVE PARTICIPATION IN THEIR CARE; - TO WORK IN HARMONY WITH PHYSICIANS, RECOGNIZING OUR MUTUAL RESPONSIBILITY TO MEET THE NEEDS OF OUR PATIENTS; - TO TREAT EACH OTHER, AS MEMBERS OF THE EJGH FAMILY, WITH FAIRNESS AND DIGNITY AND TO STRIVE TO ACHIEVE THE HIGHEST LEVEL OF PERSONAL GROWTH AND DEVELOPMENT IN AN ATMOSPHERE THAT RECOGNIZES CREATIVITY AND INNOVATION; - TO FULFILL OUR CIVIC RESPONSIBILITY BY PARTICIPATING IN COMMUNITY ACTIVITIES AND BY SUPPORTING LOCAL COMMERCE AS A MAJOR EMPLOYER AND HEALTH RESOURCE; AND - TO MANAGE, INDIVIDUALLY AND COLLECTIVELY, OUR TIME, EQUIPMENT AND SUPPLIES TO ASSURE FULFILLMENT OF OUR MISSION. ALL REVENUES GENERATED BY THE HOSPITAL ARE IN FURTHERANCE OF OUR EXEMPT PURPOSE. IN ADDITION, EJGH PROVIDES A FREE AND BELOW COST CARE PROGRAM ON ITS OWN, 911 AMBULANCE SERVICE AT NO CHARGE, VARIOUS CONTRIBUTIONS TO PARISH PROGRAMS SUCH AS PRISON MEDICAL UNIT, COMMUNITY EDUCATION, COMPREHENSIVE EARLY DETECTION PROGRAMS, FACILITIES FOR VARIOUS COMMUNITY GROUPS, AND NUMEROUS OTHER SERVICES TO THE COMMUNITY. THE PROGRAM SERVICE REVENUE GENERATED ALLOWS US TO PROVIDE QUALITY, DEPENDABLE HEALTH CARE IN OUR COMMUNITY.
OTHER PROGRAM SERVICES
FORM 990, PART III, LINE 4D: SPECIALTY CARE AND OTHER: INCLUDES SERVICES SUCH AS PSYCHIATRY, REHABILITATION, AND SKILLED NURSING FACILITIES. IT ALSO INCLUDES CONVENIENCE SERVICES SUCH AS CAFETERIA, VENDING, AND WELLNESS FACILITIES. IN 2013, THERE WERE 10,208 PSYCHIATRIC DAYS, 5,825 REHAB PATIENT DAYS, AND 13,396 SKILLED NURSING FACILITY DAYS, 75,955 RADIOLOGY PROCEDURES, 74,769 CARDIOLOGY NON-INVASIVE PROCEDURES, 21,498 SURGICAL HOURS, 245 OPEN HEART SURGERIES, AND 10,724 ENDOSCOPY PROCEDURES.
MEMBERS WITH POWER TO ELECT MEMBERS OF THE GOVERNING BODY
FORM 990, PART VI, LINE 7A MEMBERS OF THE JEFFERSON PARISH COUNCIL APPOINT OR APPROVE EACH OF THE 10 MEMBERS OF THE BOARD OF DIRECTORS.
GOVERNANCE DECISIONS OF THE ORGANIZATION RESERVED TO MEMBERS
FORM 990, PART VI, LINE 7B THE JEFFERSON PARISH COUNCIL SHALL, BY ORDINANCE OR RESOLUTION, ENTER INTO ALL CONTRACTS WITH ALL ARCHITECTS, ENGINEERS AND CONTRACTORS IN CONNECTION WITH PLANT ALTERATIONS OF OR ADDITIONS TO THE HOSPITAL, PROVIDED, HOWEVER, THAT NOTHING HEREIN TO THE CONTRARY SHALL PREVENT THE BOARD FROM RECOMMENDING TO THE COUNCIL THE ENGAGEMENT OF AN ARCHITECT, ENGINEER OR CONTRACTOR FOR THE PERFORMANCE OF PROFESSIONAL SERVICES AS DEFINED IN THE CODE OF THE PARISH, SO LONG AS SUCH RECOMMENDATION IS IN ACCORDANCE WITH THE PARISH CONTRACT PROCEDURES SET FORTH IN THE CODE OR ORDINANCE; AND THE JEFFERSON PARISH COUNCIL SHALL BY ORDINANCE OR RESOLUTION, ENTER INTO CONTRACTS FOR SPECIAL COUNSEL, FINANCIAL CONSULTANTS, ECONOMIC OR FINANCIAL MANAGERS FOR AND/OR INVOLVING THE HOSPITAL, INVESTMENT TEAMS IN CONJUNCTION WITH ANY BOND ISSUE OF THE HOSPITAL, AND INVESTMENT MANAGERS FOR THE HOSPITAL PROVIDED HOWEVER, THAT THE BOARD MAY SELECT AND EXECUTE CONTRACTS WITH CONSULTANTS AS IT DEEMS APPROPRIATE; AND EACH INSURANCE POLICY GOVERNING THE HOSPITAL, ITS PROPERTIES AND ACTIVITIES SHALL COMPLY WITH THE REQUIREMENTS OF THE PROGRAM OF INSURANCE ADOPTED BY THE JEFFERSON PARISH COUNCIL; AND THE BOARD MAY, WITH THE APPROVAL OF THE JEFFERSON PARISH COUNCIL, ENTER INTO SUCH CONTRACTS AND AGREEMENTS WITH THE UNITED STATES OF AMERICA OR WITH LOUISIANA OR ANY STATE OR ANY AGENCY OR INSTRUMENTALITY THEREOF NECESSARY TO PROCURE AIDS OR GRANTS TO ASSIST IN CARRYING OUT THE PURPOSES OF THE BOARD; AND ANY AGREEMENT, MEMORANDUM OF UNDERSTANDING, AND/OR CONTRACT THAT BINDS THE HOSPITAL TO ANY FUTURE ACTION, THE EFFECT OF WHICH SHALL CONSTITUTE A MERGER, SALE OR CONSOLIDATION OF THE HOSPITAL AND ITS PROPERTY AND/OR EQUIPMENT OR THAT WOULD EFFECT A SIMILAR CHANGE IN THE OPERATIONS OF THE HOSPITAL SHALL REQUIRE THE PRIOR APPROVAL OF THE JEFFERSON PARISH COUNCIL.
PROCESS USED TO REVIEW FORM 990
FORM 990, PART VI, LINE 11B: EJGH USES AN EXTERNAL, INDEPENDENT CPA FIRM TO REVIEW THE FORM 990 PRIOR TO FILING. ADDITIONALLY, THE CONTROLLER OF EJGH REVIEWS THE FORM PRIOR TO SIGNING AND EXPRESSES ANY CONCERNS TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS.
MONITORING AND ENFORCEMENT OF CONFLICT OF INTEREST POLICY
FORM 990, PART VI, LINE 12C: EJGH REQUIRES BOARD MEMBERS AND OFFICERS OF THE ORGANIZATION TO COMPLETE A CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. THE FORM IS MONITORED, UPDATED, AND REVISED ON A YEARLY BASIS BY THE INTERNAL AUDITOR. MONITORING AND ENFORCING THE CONFLICT OF INTEREST STATEMENT IS PERFORMED BY THE INTERNAL AUDITING DEPARTMENT. THEY MONITOR THE STATEMENTS AND ENFORCE THE RULES RELATED TO THE CONFLICT OF INTEREST STATEMENTS.
PROCESS OF DETERMINING COMPENSATION OF OFFICERS AND OTHER KEY EMPLOYEES
IN THE ORGANIZATION FORM 990, PART VI, LINE 15: EJGH'S HUMAN RESOURCES DEPARTMENT CONDUCTS COMPARABILITY SURVEYS ON A PERIODIC BASIS AND USES THIRD-PARTY INDEPENDENT DATA TO SET LEVELS OF ALL OF THE TOP MANAGERS AND KEY EMPLOYEES. THE RESULTS OF THE PROCESS IS PRESENTED TO THE BOARD OF DIRECTORS WHICH DETERMINE THE APPROPRIATE LEVEL OF COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER. ALL OTHER OFFICERS AND KEY EMPLOYEES ARE NOT PRESENTED TO THE BOARD, BUT FOLLOW THE SAME PROCESS FOR DETERMINING REASONABLENESS. SURVEYS WERE LAST PERFORMED IN JULY, 2011.
AVAILABILITY OF DOCUMENTS
FORM 990, PART VI, LINE 19: EJGH MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON A REQUEST BASIS. WHEN A REQUEST IS MADE FOR ONE OR MORE OF THE ABOVE POLICIES, THEY ARE PROVIDED TO THE INDIVIDUAL MAKING THE REQUEST.
PROGRAM SERVICE REVENUE
FORM 990, PART VIII, LINES 2A - 2G: THE PROGRAM SERVICE REVENUE GENERATED ALLOWS US TO PROVIDE QUALITY, DEPENDABLE HEALTH CARE IN OUR COMMUNITY. IN 2013, OUR KEY PATIENT VOLUMES WERE: 19,551 ADMISSIONS, 97,936 PATIENT DAYS OF SERVICE, 3,626 NEWBORN PATIENT DAYS, 50,752 EMERGENCY ROOM VISITS, 21,498 SURGICAL HOURS, AND 75,955 RADIOLOGY PROCEDURES. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G PROGRAM EXPENSES M&G EXPENSES TOTAL ----------------------------------------------------------------------- CONTRACT LABOR $ 1,944,286 486,071 2,430,357 MEDICAL DIRECTOR FEES $ 1,266,466 316,617 1,583,083 PURCHASED MEDICAL SERVICES $13,149,578 3,287,394 16,436,972 MAINTENANCE CONTRACT $ 2,443,727 610,932 3,054,659 RENTAL EXPENSE $ 1,737,222 434,305 2,171,527 PURCHASED SERVICES $18,882,361 4,720,590 23,602,951 UTILITIES $ 3,367,925 841,981 4,209,906 INTERGOVERNMENTAL TRANSFERS $ 5,734,782 1,433,695 7,168,477 OTHER $ 2,077,765 519,443 2,597,208 ----------------------------------------------------------------------- TOTAL $50,604,112 12,651,028 63,255,140
FORM 990, PART XI, LINE 9 RECONCILIATION OF NET ASSETS
TRANSFERS TO JEFFERSON PARISH ($1,481,326) ADOPTION OF GASB NO. 61 ($4,240,032) OTHER $179,753 --------------- ($5,541,605)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.