TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(1) SISTER KATHLEEN ANNE TAIT OP...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(2) WILLIAM BROWN...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(3) SISTER KRISTIN REVER OP...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(4) SISTER KATHLEEN GALLAGHER OP...................................................................... BOARD MEMBER	0.75 ................. 1.00	X	0	0
(5) MONSIGNOR ELVIN SUNDS...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(6) SISTER DOROTHEA SONDGEROTH OP...................................................................... BOARD MEMBER	0.75 ................. 41.50	X	0	0
(7) SISTER KARINA DICKEY OP...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(8) D PAUL SEAGO MD...................................................................... BOARD MEMBER/PHYSICIAN	40.00 ................. 0.50	X	817,663	20,028
(9) SISTER ROSE MIRIAM SCHULTE OP...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(10) DUANE A O'NEILL...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(11) REBEKAH MOULDER MD...................................................................... BOARD MEMBER/PHYSICIAN	40.00 ................. 0.00	X	548,919	2,676
(12) REGINALD MARTIN MD...................................................................... BOARD MEMBER/PHYSICIAN	40.00 ................. 0.00	X	368,126	25,571
(13) EDDIE MALONEY...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(14) RICK GUYNES MD...................................................................... BOARD MEMBER	40.00 ................. 0.00	X	0	0
(15) RUTH FREDERICKS MD...................................................................... BOARD MEMBER/PHYSICIAN	40.00 ................. 0.00	X	876,871	10,482
(16) SISTER M THECLA KUHNLINE OP...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0
(17) JIMMY JONES MD...................................................................... BOARD MEMBER	0.75 ................. 0.00	X	0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) WILL MCCRANEY MD........................................................................ BOARD MEMBER	0.75 .......................0.00	X					0	0	0
(19) JEFF FLETCHER........................................................................ CHAIR	0.75 .......................0.00	X	X				0	0	0
(20) LESTER DIAMOND........................................................................ PRESIDENT (THRU 03/2021)	2.00 .......................40.00	X	X				0	1,135,918	113,444
(21) SISTER M TRINITA EDDINGTON OP........................................................................ SECRETARY	0.75 .......................40.25	X	X				0	0	0
(22) JOHNNY DONALDSON........................................................................ VICE CHAIR	0.75 .......................0.00	X	X				0	0	0
(23) SAMUEL SCOTT........................................................................ SVP, CFO	0.75 .......................41.00		X				0	594,049	26,582
(24) WILLIAM MORGAN........................................................................ COO	40.00 .......................0.00			X			622,038	0	37,444
(25) DAVID HENRY........................................................................ VP CLINICAL OPERATIONS	40.00 .......................0.00			X			334,304	0	33,905
(26) KEITH VAN CAMP........................................................................ VP INFORMATION TECHNOLOGY	40.00 .......................0.00			X			506,089	0	11,789
(27) DAVID SINCLAIR........................................................................ VP NETWORK ADMIN	40.00 .......................0.00			X			427,715	0	32,015
(28) JOHN LANCON........................................................................ PHYSICIAN	40.00 .......................0.00				X		1,315,650	0	28,310
(29) BRYAN A GASPARD........................................................................ PHYSICIAN	40.00 .......................0.00				X		973,230	0	25,610
(30) PB KERR........................................................................ PHYSICIAN	40.00 .......................0.00				X		963,315	0	25,610
(31) RONALD KENNEDY........................................................................ PHYSICIAN	40.00 .......................0.00				X		841,692	0	12,994
(32) ZACHARY K BALDWIN........................................................................ PHYSICIAN	40.00 .......................0.00				X		813,760	0	25,610
(33) CLAUDE HARBARGER........................................................................ FORMER PRESIDENT SDHS	0.00 .......................0.00					X	0	439,241	0

(A) Name and business address	(B) Description of services	(C) Compensation
ALLIED EMERGENCY SERVICES PC PO BOX 2120 RIDGELAND,MS39158	EMERGENCY ROOM DOCTO	7,490,988
FLAGSTAR CONSTRUCTION COMPANY 2006 ASPEN CV BRANDON,MS39042	VARIOUS CONSTRUCTION	7,212,661
NTHRIVE INC PO BOX 676188 DALLAS,TX752676188	PATIENT FINANCIAL SV	6,248,613
PHYSICIANS ANESTHESIA GROUP PA 971 LAKELAND DRIVE JACKSON,MS39207	ANESTHESIA SERVICE A	4,832,584
CERNER CORPORATION PO BOX 959156 ST LOUIS,MO63195	INFORMATION TECHNOLO	4,609,078
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 59

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2020

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. 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 ....................... right arrow

33 1/3% support test—2019. 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2020. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2019. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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 ....... right arrow

33 1/3% support tests—2019. 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 .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2020

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2020

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2020

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Part I Contributors	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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization ST DOMINIC - JACKSON MEMORIAL HOSPITAL		Employer identification number 64-0303091

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization ST DOMINIC - JACKSON MEMORIAL HOSPITAL			Employer identification number 64-0303091
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2020)

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2020

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 SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ...................................................................................................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable 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) 2020

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

25,284

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

25,284

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	ST. DOMINIC-JACKSON MEMORIAL HOSPITAL PAID DUES TO THE MISSISSIPPI HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. THE MISSISSIPPI HOSPITAL ASSOCIATION REPORTS THAT 8.89% OF THE $162,822 OF DUES PAID WERE RELATED TO LOBBYING ACTIVITIES. AMERICAN HOSPITAL ASSOCIATION REPORTS THAT 25.56% OF THE $42,288 OF DUES PAID WERE RELATED TO LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB 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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2020

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII 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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on 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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .......................

3a(i)

(ii) Related organizations .......................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. 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 .....	14,930,000		14,930,000
b	Buildings ....	181,871,777	12,924,569	168,947,208
c	Leasehold improvements
d	Equipment ....	50,442,602	19,666,619	30,775,983
e	Other .....	138,880	30,468	108,412
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				214,761,603

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3) Other (A) IMPROVEMENT TRUST FUND	31,561,936	F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	31,561,936

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	112,377,981
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	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 XIII.) ...........	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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ............	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 XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART X, LINE 2:

FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVE FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED.

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining eligibility for free or discounted care.

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"? . . . . . . . . . . . . .

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	14,315,511	8,728,096	5,587,415	1.080 %
b	Medicaid (from Worksheet 3, column a) . . . . .	59,611,975	69,113,003	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	88,439	59,015	29,424	0.010 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	74,015,925	77,900,114	5,616,839	1.090 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	90,979		90,979	0.020 %
f	Health professions education (from Worksheet 5) . . .	107,520		107,520	0.020 %
g	Subsidized health services (from Worksheet 6) . . . .	17,937,853	16,086,224	1,851,629	0.360 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,534,075		2,534,075	0.490 %
j	Total. Other Benefits . .	20,670,427	16,086,224	4,584,203	0.890 %
k	Total. Add lines 7d and 7j .	94,686,352	93,986,338	10,201,042	1.980 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	100,000	100,000	0.020 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	100,000	100,000	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,371,423

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

1,554,163

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

139,214,323

Enter Medicare allowable costs of care relating to payments on line 5.....

108,418,129

Subtract line 6 from line 5. This is the surplus (or shortfall)........

30,796,194

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

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 .........................

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 ST DOMINIC ASC	OUTPATIENT SURGERY CENTER	46.300 %	53.700 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	ST DOMINIC-JACKSON MEMORIAL HOSPITAL 969 LAKELAND DRIVE JACKSON,MS392164699 HTTP://WWW.STDOM.COM/ 14-031	X	X	X

Schedule H (Form 990) 2020

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	ST DOMINIC-JACKSON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ST DOMINIC-JACKSON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 350.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	ST DOMINIC-JACKSON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	ST DOMINIC-JACKSON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2020

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL	PART V, SECTION B, LINE 5: AS PART OF THE COMMUNITY NEEDS ASSESSMENT, ST. DOMINIC HOSPITAL REACHED OUT TO AN EXPANSIVE AND HIGHLY DIVERSE GROUP OF INDIVIDUALS TO PARTICIPATE IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) LEADERSHIP TEAM AND TO CONTRIBUTE INSIGHT FROM COMMUNITY SERVICE ORGANIZATIONS. EACH MEMBER PROVIDED PROJECT INSIGHT, FEEDBACK REGARDING PERCEPTIONS OF AREA HEALTH NEEDS, DATA EVALUATION, AND OTHER GUIDANCE DURING THE CHNA DEVELOPMENT PROCESS. THESE INDIVIDUALS OFFERED A BREADTH OF COMMUNITY HEALTH VISION, KNOWLEDGE, AND POWER TO IMPACT THE WELL-BEING OF THE SERVICE AREA. INFORMATION WAS GATHERED ABOUT THE LARGER COMMUNITY USING SECONDARY RESEARCH, DISCUSSION GROUPS AND COMMUNITY SURVEYS.
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL	PART V, SECTION B, LINE 11: ST. DOMINIC'S BUILT UPON WHAT IT LEARNED IN ITS PRECEDING CHNAS AND USED THAT INFORMATION TO CONDUCT A NEW AND MORE EXTENSIVE NEEDS ASSESSMENT. THE RESULTS OF THE NEW ASSESSMENT WERE LATER PUBLISHED WITHIN THE 2019-2021 COMMUNITY HEALTH NEEDS ASSESSMENT AND CAN BE FOUND ONLINE AT: HTTPS://WWW.STDOM.COM/ASSETS/DOCUMENTS/WP-2019/01/CHNA_2019-2021.PDF.THE OVERARCHING GOAL OF BOTH ASSESSMENTS WAS TO IDENTIFY AND RESPOND TO COMMUNITY HEALTH NEEDS, IMPROVE ACCESS AND IMPROVE HEALTH STATUS - ESPECIALLY FOR THE MOST VULNERABLE AND UNDERSERVED IN THE COMMUNITY. IT IS INTEGRAL TO ST. DOMINIC'S FOCUS TO ESTABLISH COMMUNITY AND PROVIDE SERVICE, SETTING AN EXAMPLE TO OTHERS IN COMMUNITY SERVICE.ST. DOMINIC HOSPITAL'S OVERALL APPROACH TO COMMUNITY BENEFIT IS TO TARGET THE INTERSECTION OF DOCUMENTED UNMET COMMUNITY HEALTH NEEDS AND THE ORGANIZATION'S KEY STRENGTHS AND MISSION COMMITMENTS. SPECIFICALLY, MEMBERS OF THE TASK FORCE THAT LED THE DEVELOPMENT OF THE ASSESSMENTIDENTIFIED PRIORITY HEALTH ISSUES IN ST. DOMINIC'S SERVICE AREA BASED ON ITS REVIEW OF DEMOGRAPHIC INFORMATION, FOCUS GROUP FEEDBACK AND THE RESULTS OF COMMUNITY SURVEYS. THOSE IDENTIFIED PRESSING ISSUES FOR 2020-2021 ARE:- ACCESS TO AFFORDABLE HEALTH CARE;- MENTAL HEALTH AND SUBSTANCE ABUSE; AND- LIFESTYLE RELATED CONDITIONS.IN 2021, AS IT DID IN PRIOR YEARS, ST. DOMINIC'S INTEGRATED ITS COMMITMENT TO COMMUNITY SERVICE INTO ITS MANAGEMENT AND GOVERNANCE STRUCTURES AS WELL AS ITS STRATEGIC AND OPERATIONAL PLANS. IN 2020 AND 2021 THE HOSPITAL'S STRATEGIC PLAN CONTAINED A GOAL AND STRATEGIES SPECIFICALLY DIRECTED AT ALLOCATING RESOURCES TO MEET THE NEEDS OF THE COMMUNITY IN RESPONSE TO THE IDENTIFIED FOCUS AREAS IN THE NEEDS ASSESSMENT. THE OVERARCHING GOAL INDICATED, "GROW OUR SERVICES AND ADOPT INNOVATIVE STRATEGIES TO MEET COMMUNITY HEALTH NEEDS." FOLLOWING ARE WAYS IN WHICH THAT STRATEGY WAS IMPLEMENTED AS WELL AS WAYS OTHER IDENTIFIED NEEDS WERE MET IN 2020 AND 2021.ACCESS TO CARE - SERVED OVER 9,067 VULNERABLE CHILDREN AND MATURE ADULTS THROUGHOUT THE STATE FROM JULY 2020 - JUNE 2021 THROUGH THE CARE-A-VAN PROGRAM. RECORDED 100 REFERRALS FOR FOLLOW UP CARE AND GAVE 8,245 COVID VACCINATIONS. THE MOBILE SCREENING SERVICE HOSTED BY ST. DOMINIC'S TRAVELED TO SCHOOLS TO PROVIDE SCREENING AND EDUCATIONAL PROGRAMS.BEHAVIORAL OR MENTAL HEALTH - STEERED SCREENING OR EDUCATION ACTIONS IN COMMUNITIES THROUGHOUT THE STATE, MANY THROUGH VIRTUAL MEANS. THE NUMBER OF REFERRAL DEVELOPMENT CONTACTS RECORDED FROM JULY 2020 JUNE 2021 WAS 4675, OR AN AVERAGE OF 390 PER MONTH. ST. DOMINIC'S ALSO EXPANDED ITS TELEMEDICINE OFFERINGS TO ENCOMPASS BEHAVIORAL HEALTH AND ASSIST OUTLYING COMMUNITIES WITH LIMITED PERSONNEL AND RESOURCES TO CONDUCT PROPER ASSESSMENTS. OUR PHYSICIAN, LOCATION AND SCHEDULING OF TELEPSYCHIATRY CONTINUED SINCE THE FIRST OUTPATIENT PSYCHIATRY APPOINTMENTS HELD IN PRIOR OCTOBER. ST. DOMINIC'S BEHAVIORAL HEALTH PARTNERED WITH OTHER SENIOR CARE AGENCIES TO PROMOTE SENIOR CARE SERVICES ACROSS THE STATE AND PARTICIPATED IN COMMUNITY OUTREACH PROGRAMS WHERE BHS CLINICAL STAFF SPOKE TO SMALLER AUDIENCES IN AGENCIES AND COMMUNITY SETTINGS, SOMETIMES VIRTUALLY TO ADHERE TO COVID GUIDELINES.
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL	PART V, SECTION B, LINE 20E: THE HOSPITAL PROACTIVELY SCREENS PATIENTS FOR FINANCIAL ASSISTANCE ELIGIBILITY IF THERE IS AN INDICATION THAT THE PATIENT MAY QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY.
PART V, SECTION A, LINES 7A &10	HTTPS://WWW.STDOM.COM/ASSETS/DOCUMENTS/WP-2019/01/CHNA_2019-2021.PDF
PART V, SECTION B, LINE 16 A, B, C	THE FAP, FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY OF THE FAP ARE AVAILABLE AT:HTTPS://WWW.STDOM.COM/PATIENTS-AND-VISITORS/PATIENT-GUIDE/FINANCIAL-ASSISTANCE

Schedule H (Form 990) 2020

Page 9

Part VFacility Information (continued)

Section D. 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?35
Name and address		Type of Facility (describe)
1	1 - ST DOMINIC'S HOSPITAL MEDICINE 971 LAKELAND DRIVE SUITE 1453 JACKSON,MS39216	HOSPITALIST CLINIC
2	2 - ST DOMINIC'S NEUROSURGERY ASSOCIATES 971 LAKELAND DRIVE SUITE 657 JACKSON,MS39216	PHYSICIAN CLINIC
3	3 - ST DOMINIC'S NEUROCARE 971 LAKELAND DRIVE SUITE 557 JACKSON,MS39216	PHYSICIAN CLINIC
4	4 - ST DOMINIC'S VASCULAR AND ENDOVASCULAR 971 LAKELAND DRIVE SUITE 1250 JACKSON,MS39216	PHYSICIAN CLINIC
5	5 - ST DOMINIC'S EAR NOSE & THROAT SURGICA 970 LAKELAND DRIVE SUITE 40 JACKSON,MS39216	PHYSICIAN CLINIC
6	6 - ST DOMINIC'S INTERNAL MEDICINE GROUP 971 LAKELAND DRIVE SUITE 250 JACKSON,MS39216	PHYSICIAN CLINIC
7	7 - STDOMINIC'S FAMILY MEDICINE OF MADISON 106 HIGHLAND WAY 103 MADISON,MS39110	PHYSICIAN CLINIC
8	8 - ST DOMINIC'S INTERNAL MEDICINE MADISON 106 HIGHLAND WAY 200 MADISON,MS39110	PHYSICIAN CLINIC
9	9 - ST DOMINIC'S CARDIOVASCULAR SURGERY 971 LAKELAND DRIVE SUITE 657 JACKSON,MS39216	PHYSICIAN CLINIC
10	10 - ST DOMINIC'S PAIN MANAGEMENT CENTER 971 LAKELAND DRIVE SUITE 1159 JACKSON,MS39216	PHYSICIAN CLINIC
11	11 - ST DOMINIC'S GYNECOLOGIC ONCOLOGY 971 LAKELAND DRIVE SUITE 750 JACKSON,MS39216	PHYSICIAN CLINIC
12	12 - ST DOMINIC'S UROLOGY 971 LAKELAND DRIVE SUITE 360 JACKSON,MS39216	PHYSICIAN CLINIC
13	13 - ST DOMINIC'S INFECTIOUS DISEASE 971 LAKELAND DRIVE SUITE 954 JACKSON,MS39216	PHYSICIAN CLINIC
14	14 - ST DOMINIC'S PSYCHIATRIC ASSOCIATES 890 LAKELAND DRIVE JACKSON,MS39216	PHYSICIAN CLINIC
15	15 - ST DOMINIC'S RHEUMATOLOGY 106 HIGHLAND WAY SUITE 200 MADISON,MS39110	PHYSICIAN CLINIC
16	16 - ST DOMINIC'S FAMILY MEDICINE OF BRANDON 1297 WEST GOVERNMENT STREET BRANDON,MS39042	PHYSICIAN CLINIC
17	17 - ST DOMINIC'S FAMILY MEDICINE OF CLINTON 728 CLINTON PARKWAY SUITE B CLINTON,MS39056	PHYSICIAN CLINIC
18	18 - ST DOMINIC'S FAMILY MEDICINE OF FLOWOOD 1050 RIVER OAKS DRIVE FLOWOOD,MS39232	PHYSICIAN CLINIC
19	19 - ST DOMINIC'S FAMILY MEDICINE OF DOGWOOD 205A BELLE MEADE POINTE FLOWOOD,MS39232	PHYSICIAN CLINIC
20	20 - ST DOMINIC'S FAMILY MEDICINE OF MAGEE 360 SIMPSON HWY 149 SUITE 220 MAGEE,MS39111	PHYSICIAN CLINIC
21	21 - ST DOMINIC'S FAMILY MEDICINE OF JACKSON 890 LAKELAND DRIVE JACKSON,MS39056	PHYSICIAN CLINIC
22	22 - ST DOMINIC'S MARTIN SURGICAL ASSOCIATES 971 LAKELAND DRIVE SUITE 211 JACKSON,MS39216	PHYSICIAN CLINIC
23	23 - ST DOMINIC'S FAMILY MED OF PELAHATCHIE 610 2ND STREET PELAHATCHIE,MS39145	PHYSICIAN CLINIC
24	24 - ST DOMINIC'S FAMILY MEDICINE OF RALEIGH 342 MAGNOLIA DRIVE RALEIGH,MS39153	PHYSICIAN CLINIC
25	25 - ST DOMINIC'S FAMILY MEDICINE GLUCKSTADT 286 CALHOUN STATION PARKWAY MADISON,MS39110	PHYSICIAN CLINIC
26	26 - ST DOMINIC'S COUMADIN CLINIC 890 LAKELAND DRIVE JACKSON,MS39056	PHYSICIAN CLINIC
27	27 - ST DOMINIC'S CHRONIC CARE CLINIC 969 LAKELAND DRIVE JACKSON,MS39216	PHYSICIAN CLINIC
28	28 - ST DOMINIC'S OUTREACH PROGRAM-TELEMEDIC 969 LAKELAND DRIVE JACKSON,MS39216	PHYSICIAN CLINIC
29	29 - ST DOMINIC'S OUTREACH PROGRAM-MAGEE 360 SIMPSON HWY 149 SUITE 370 MAGEE,MS39111	PHYSICIAN CLINIC
30	30 - ST DOMINIC'S OUTREACH PROGRAM-CLEVELAND 810 E SUNFLOWER ROAD CLEVELAND,MS38732	PHYSICIAN CLINIC
31	31 - ST DOMINIC'S OUTREACH PROGRAM-KOSCIUSKO 332 HIGHWAY 12 WEST KOSCIUSKO,MS39090	PHYSICIAN CLINIC
32	32 - ST DOMINIC'S OUTREACH PROGRAM-PELAHATCH 610 2ND STREET PELAHATCHIE,MS39145	PHYSICIAN CLINIC
33	33 - ST DOMINIC'S OUTREACH PROGRAM-VICKSBURG 4204 CLAY STREET VICKSBURG,MS39180	PHYSICIAN CLINIC
34	34 - ST DOMINIC'S OUTREACH PROGRAM-BROOKHAVE 427 HWY 51 N BROOKHAVEN,MS39601	PHYSICIAN CLINIC
35	35 - ST DOMINIC'S INTERNAL MEDICINE CLINIC 112 SOUTH LAKE CIRCLE CANTON,MS39046	PHYSICIAN CLINIC

Schedule H (Form 990) 2020

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
PART I, LINE 3C:	ST. DOMINIC HOSPITAL HAS A DISCOUNT POLICY THAT IS BASED ON FEDERAL POVERTY GUIDELINES WITH A SLIDING SCALE THAT OFFERS DISCOUNTS RANGING FROM 20% TO 100%. IN ADDITION, ST. DOMINIC OFFERS A 68% DISCOUNT OFF GROSS CHARGES TO ALL UNINSURED PATIENTS.
PART I, LINE 6A:	THE COMMUNITY BENEFIT REPORT FOR ST. DOMINIC HOSPITAL IS CONSOLIDATED WITH THE PARENT ORGANIZATION, ST. DOMINIC HEALTH SERVICES, INC. THE REPORT IS AVAILABLE AT HTTPS://WWW.STDOM.COM/ABOUT-US/COMMUNITY-BENEFIT-AND-NEEDS/.
PART I, LINE 7:	ST. DOMINIC HOSPITAL USED A COST-TO-CHARGE RATIO BASED ON WORKSHEET 2 PROVIDED IN THE FORM 990, SCHEDULE H INSTRUCTIONS.
PART I, LINE 7G:	ST. DOMINIC HOSPITAL DID NOT INCLUDE LOSSES ON ITS OWNED PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. IN ORDER TO MEET THE NEEDS OF THE COMMUNITY IT SERVES, ST. DOMINIC CONTINUES ITS MINISTRY IN VARIOUS SERVICE LINES THAT ARE NOT PROFITABLE TO THE ORGANIZATION. EXAMPLES OF THESE SERVICES INCLUDE BUT ARE NOT LIMITED TO THE EMERGENCY DEPARTMENT AND BEHAVIORAL HEALTH SERVICES.
PART II, COMMUNITY BUILDING ACTIVITIES:	ST. DOMINIC PROVIDES SIGNIFICANT SUPPORT TO ITS COMMUNITY THROUGH A VARIETY OF WAYS INCLUDING FREE HEALTH SCREENINGS AT LOCAL SCHOOLS, PARTICIPATION IN VARIOUS NON-PROFIT BOARDS AS WELL AS FINANCIAL SUPPORT THROUGH CASH DONATIONS.
PART III, LINE 2:	THE AMOUNT REPORTED IN PART III, LINE 2 AS BAD DEBT EXPENSE MATCHES THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON THE HOSPITAL'S INTERNAL FINANCIAL STATEMENTS.
PART III, LINE 3:	ST. DOMINIC HOSPITAL FREQUENTLY HAS PATIENT ACCOUNTS THAT ARE INTITIALLY WRITTEN OFF AS A BAD DEBT EXPENSE, BUT LATER (THROUGH A SCREENING PROCESS) IT IS DETERMINED THAT THE PATIENT DOES QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE PERCENTAGE OF ACCOUNTS IS ESTIMATED TO BE 44 PERCENT. THE PERCENTAGE IS DETERMINED UTILIZING AN INTERNAL REPORT OF ACCOUNTS WRITTEN OFF AS A BAD DEBT EXPENSE IN ONE YEAR AND CLASSIFIED AS CHARITY IN A SUBSEQUENT YEAR.
PART III, LINE 4:	THE BAD DEBT FOOTNOTE IS ON PAGES 14-16 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 9B:	ST. DOMINIC HOSPITAL HAS A BOARD APPROVED COLLECTION POLICY AND HAS WRITTEN CONTRACTS IN PLACE WITH ITS COLLECTION AGENCIES SO THE APPROPRIATE COLLECTION ACTIVITIES ARE FOLLOWED. THE COLLECTION AGENCIES THAT ST. DOMINIC USES ARE FULLY INFORMED ABOUT THE HOSPITAL'S FINANCIAL AID POLICY AND ASSIST IN EDUCATING ITS PATIENTS. THEY ROUTINELY SEND FINANCIAL AID APPLICATIONS TO PATIENTS AND REFER THOSE PATIENTS BACK TO THE HOSPITAL'S FINANCIAL COUNSELORS WHEN APPROPRIATE.
PART VI, LINE 2:	ST. DOMINIC HOSPITAL ASSESSES THE COMMUNITY IT SERVES THROUGH VARIOUS SOURCES WHICH INCLUDE:1) ANALYSIS OF THE PAYOR SOURCE AND DISEASE CATEGORIES OF PATIENTS TREATED AT ST. DOMINIC HOSPITAL WITH PARTICULAR ANALYSIS DONE ON PATIENTS PRESENTING TO ITS EMERGENCY DEPARTMENT;2) FEEDBACK FROM THE BOARD MEMBERS WHO REPRESENT THE COMMUNITY IT SERVES;3) REQUESTS MADE FROM THE COMMUNITY; AND4) PUBLIC HEALTH INFORMATION.
PART VI, LINE 3:	ST. DOMINIC HOSPITAL WORKS TO EDUCATE ITS PATIENTS AND COMMUNITY OF ASSISTANCE OPTIONS BY:1) POSTING SIGNAGE IN THE EMERGENCY ROOM AND OTHER REGISTRATION AREAS INFORMING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE.2) PROVIDING BROCHURES IN THE WAITING ROOMS AND AT THE REGISTRATION DESKS THAT EXPLAIN THE BILLING AND COLLECTION PROCESS AS WELL AS INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND PHONE NUMBERS TO CALL FOR ASSISTANCE.3) CONTRACTING AND PAYING AN AGENCY TO MEET WITH ALL UNINSURED PATIENTS TO ASSIST THEM IN APPLYING FOR FEDERAL AND STATE ASSISTANCE (I.E. MEDICAID, DISABILITY, ETC.).4) PROVIDING FINANCIAL COUNSELORS TO MEET WITH PATIENTS. THESE COUNSELORS FULLY UNDERSTAND THE HOSPITAL'S CHARITY POLICY AND ARE AVAILABLE TO ASSIST WITH THE APPLICATIONS, SET UP INTEREST FREE PAYMENT PLANS AND OFFER ADVICE ON PUBLIC ASSISTANCE THAT MAY BE AVAILABLE.5) STAFFING PATIENT REPRESENTATIVES TO ANSWER QUESTIONS AND ASSIST PATIENTS AS NEEDED.6) EDUCATION THE EARLY-OUT AND BAD DEBT COLLECTION AGENCIES ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES SO THEY CAN ASSIST PATIENTS WHOM THEY FIND MIGHT HAVE FINANCIAL NEED.
PART VI, LINE 4:	ST. DOMINIC JACKSON MEMORIAL HOSPITAL SERVCES THE HINDS, MADISON, AND RANKIN TRI-COUNTY AREA OF MISSISSIPPI. HINDS COUNTY INCLUDES 239.497 RESIDENTS, NEARLY HALF OF THE SERVICES AREA POPULATION. THE COUNTY'S RACIAL MAKEUP IS PREDOMINATELY (71.7%) AFRICAN AMERICAN. IN ADDITION, RESIDENTS HAVE A MUCH LOWER MEDIAN HOUSEHOLD INCOME COMPARED TO MADISON AND RANKIN COUNTIES AND A HIGHER PERCENTAGE WHO INDICATE THAT THEY HAVE A POOR OR FAIR HEALTH STATUS. THESE TWO INDICATORS OFTEN COORELATE WITH A HIGHER LEVEL OF COMMUNITY HEALTH NEEDS. MADISON COUNTY RESIDENTS TEND TO HAVE HIGHER HOUSEHOLD INCOME AND BETTER HEALTH STATUS COMPARED TO HINDS COUNTY. THE COUNTY IS RACIALLY DIVERSE, WITH NEARLY 40% OF ITS RESIDENTS BEING AFRICAN AMERICAN. RANKIN COUNTRY IS THE LEAST RACIALLY DIVERSE COUNTY IN THE ST. DOMINIC'S SERVICE AREA, AS ONLY ON OF FIVE RESIDENTS (19%) ARE AFRICAN AMERICAN. RANKIN AND MADISON COUNTIES HAVE FEWER PEOPLE LIVING IN POVERTY THAN HINDS COUNTRY (6.4% AND 9.3% COMPARED TO HINDS' 25%).
PART VI, LINE 5:	INSPIRED BY THE TEACHINGS OF JESUS CHRIST AND THE WITNESS OF OUR FOUNDING DOMINICAN SISTERS, WE PROVIDE COMPASSIONATE CARE AND HOPE AS A HEALING MINISTRY OF THE CATHOLIC CHURCH. ST. DOMINIC APPLIES THIS MISSION BY CONDUCTING NEEDS ASSESSMENTS, PUBLISHING THE RESULTS, ESTABLISHING GOALS AND STRATEGIES TO HELP RESOLVE IDENTIFIED ISSUES AND SEEKING OPPORTUNITIES TO WORK WITH THE COMMUNITY. THE HOSPITAL INVOLVES MEMBERS OF ITS COMMUNITY IN ITS GOVERNANCE SO THAT IT MAINTAINS THE FOCUS ON THE NEEDS OF ITS COMMUNITY. THE HOSPITAL HAS AN OPEN MEDICAL STAFF.
PART VI, LINE 6:	ST. DOMINIC HEALTH SERVICES, INC. IS THE PARENT ORGANIZATION OF A SYSTEM THAT INCLUDES ST. DOMINIC - JACKSON MEMORIAL HOSPITAL (A 571-BED ACUTE CARE FACILITY), ST. CATHERINE'S VILLAGE (A CONTINUING CARE RETIREMENT COMMUNITY), ST. DOMINIC HEALTH SERVICES FOUNDATION (A FUNDRAISING/GRANT FOCUSED ENTITY) AND ST. DOMINIC MADISON HEALTH SERVICES, INC. (A MEDICAL OFFICE BUILDING AND FITNESS CENTER). IN ADDITION, ST. DOMINIC HEALTH SERVICES OPERATES COMMUNITY HEALTH SERVICES - ST. DOMINIC, INC., WHICH INCORPORATES THE OUTREACHES SERVICES OF THE CLUB AT ST. DOMINIC'S, NEW DIRECTIONS FOR OVER 55, ST. DOMINIC COMMUNITY HEALTH CLINIC, MADISON SCHOOL NURSE PROGRAM AND THE CARE-A-VAN SCREENING PROGRAM. AS A WHOLE, ALL OF THE SERVICES, ENTITIES AND HOSPITAL ARE COLLECTIVELY REFERRED TO AS ST. DOMINIC'S. ST DOMINIC'S SEEKS TO GIVE TIME, TALENTS, AND RESOURCES TO MAKE THE COMMUNITIES SERVED BY THE ORGANIZATION BETTER PLACES TO LIVE. THE ST. DOMINIC'S FAMILY OF CAREGIVERS NOT ONLY SERVES PATIENTS, BUT ALSO CONTRIBUTES TO AN ATMOSPHERE OF CARE AND COMPASSION FOR THOSE OUTSIDE THE HOSPITAL'S WALLS. ST. DOMINIC STRIVES TO NOT ONLY PROVIDE CARE FOR THE SICK BUT ALSO TO OFFER EDUCATION AND WELLNESS SERVICES TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND HELP ELIMINATE RISK FACTORS FOR MORE SERIOUS HEALTH PROBLEMS. ONLY JULY 1, 2019, ST. DOMINIC HEALTH SERVICES ENTERED INTO A SHARED MISSION AGREEMENT WITH FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM (FMOLHS) TO INTEGRATE THE TWO CATHOLIC MINISTRIES. AS CONSIDERATION FOR THE ACQUISITION, FMOLHS WILL CONTRIBUTE SUPPORT PAYMENTS OVER SEVEN YEAR FOR SDHS' ONGOING MINISTRIES.
PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORTST. DOMINIC HOSPITAL (CONSOLIDATED WITH ST. DOMINIC HEALTH SERVICES, INC.) PREPARES ANNUALLY A COMMUNITY BENEFIT REPORT WHICH IS DISTRIBUTED TO KEY MEMBERS OF THE LOCAL COMMUNITY AND STATE GOVERNMENT. HOWEVER, THERE ARE CURRENTLY NO REQUIREMENTS TO DO SO IN THE STATE OF MISSISSIPPI.

Schedule H (Form 990) 2020

Additional Data

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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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number
64-0303091

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) AMERICAN CANCER SOCIETY 250 WILLIAMS STREET ATLANTA,GA30303	13-1788491	501 (C)(3)	25,000	GENERAL SUPPORT
(2) AMERICAN HEART ASSOCIATION 4830 MCWILLIE CIRCLE JACKSON,MS39206	13-5613797	501 (C)(3)	50,000	GENERAL SUPPORT
(3) BOY SCOUTS OF AMERICA 855 RIVERSIDE DR JACKSON,MS39202	64-0303071	501 (C)(3)	16,000	GENERAL SUPPORT
(4) CATHOLIC CHARITIES 850 EAST RIVER PLACE JACKSON,MS39201	64-0466850	501 (C)(3)	163,000	GENERAL SUPPORT
(5) CATHOLIC DIOCESE OF JACKSON PO BOX 2248 JACKSON,MS392252248	64-0303073	501 (C)(3)	28,500	GENERAL SUPPORT
(6) CENTER FOR THE PREVENTION OF VIOLENCE PO BOX 6279 PEARL,MS39288	58-1959108	501 (C)(3)	35,000	GENERAL SUPPORT
(7) COMMUNITY HEALTH SERVICES 970 LAKELAND DR JACKSON,MS39216	64-0884870	501 (C)(3)	175,000	GENERAL SUPPORT
(8) HOPE HOUSE OF HOSPITALITY 786 EAST NORTHSIDE DRIVE JACKSON,MS39206	64-0622022	501 (C)(3)	15,000	GENERAL SUPPORT
(9) HOSPICE MINISTRIES 45 TOWNE CENTER BLVD RIDGELAND,MS39157	64-0789919	501 (C)(3)	50,000	GENERAL SUPPORT
(10) JUNIOR LEAGUE OF JACKSON 805 RIVERSIDE DRIVE JACKSON,MS39202	64-6011106	501 (C)(3)	10,000	GENERAL SUPPORT
(11) LEXINGTON MEDICAL CLINIC 22741 HIGHWAY 12 LEXINGTON,MS39095	20-0378262	501 (C)(3)	25,000	GENERAL SUPPORT
(12) MISSION FIRST INC PO BOX 250 JACKSON,MS39205	64-0797107	501 (C)(3)	20,000	GENERAL SUPPORT
(13) MISSION MISSISSIPPI PO BOX 22655 JACKSON,MS39225	64-0824240	501 (C)(3)	35,000	GENERAL SUPPORT
(14) MISSISSIPPI HOUSING PARTNERSHIP PO BOX 22987 JACKSON,MS39225	64-0816305	501 (C)(3)	7,500	GENERAL SUPPORT
(15) MS CHILDREN'S MUSEUM PO BOX 55409 JACKSON,MS392965409	64-0850010	501 (C)(3)	20,000	GENERAL SUPPORT
(16) MS SYMPHONY ORCHESTRA PO BOX 2052 JACKSON,MS39225	64-0273405	501 (C)(3)	20,800	GENERAL SUPPORT
(17) NEWK'S CARES 2680 CRANE RIDGE DRIVE JACKSON,MS39216	27-0705547	501 (C)(3)	50,000	GENERAL SUPPORT
(18) OPERATION SHOESTRING 1711 BAILEY AVENUE JACKSON,MS39283	64-0471554	501 (C)(3)	45,000	GENERAL SUPPORT
(19) REAL CHRISTIAN FOUNDATION PO BOX 180059 RICHLAND,MS39218	64-0885750	501 (C)(3)	35,000	GENERAL SUPPORT
(20) REFILL CAFE 136 SOUTH ADAMS STREET JACKSON,MS39203	83-2814994	501 (C)(3)	15,000	GENERAL SUPPORT
(21) SISTERS IN BIRTH 5839 PEAR ORCHARD RD JACKSON,MS39211	81-2072883	501 (C)(3)	15,000	GENERAL SUPPORT
(22) SOUTHERN CHRISTIAN SERVICES 860 EAST RIVER PLACE SUITE 104 JACKSON,MS39202	64-0758344	501 (C)(3)	25,000	GENERAL SUPPORT
(23) ST JOSEPH CATHOLIC SCHOOL PO BOX 2027 MADISON,MS391302027	64-0339825	501 (C)(3)	55,000	GENERAL SUPPORT
(24) ST RICHARD CATHOLIC SCHOOL 100 HOLLY DRIVE JACKSON,MS39206	46-1541862	501 (C)(3)	5,700	GENERAL SUPPORT
(25) TUTWILER COMMUNITY EDUCATION CENTER INC PO BOX 448 TUTWILER,MS38963	58-1887449	501 (C)(3)	25,000	GENERAL SUPPORT
(26) ST DOMINIC HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON,MS39216	64-0714999	501 (C)(3)	1,500,000	GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2020

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant
(1) SCHOLARSHIP/TUITION REIMBURSEMENT	50	7,256
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	THE HOSPITAL HAS A CONTRIBUTIONS COMMITTEE, WHICH IS A SUB-COMMITTEE OF THE BOARD, THAT OVERSEES THE HOSPITAL'S GIVING. THEY MONITOR THE REQUESTS AND OVERSEE ALL GIFTS.

Schedule I (Form 990) 2020

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used 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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on 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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2020

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 on 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 (E) amounts for that individual.

(A) Name and Title		(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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JOHN LANCON PHYSICIAN	(i) (ii)	1,315,650 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	28,310 ------------- 0	1,343,960 ------------- 0	0 ------------- 0
2LESTER DIAMOND PRESIDENT (THRU 03/2021)	(i) (ii)	0 ------------- 691,308	0 ------------- 0	0 ------------- 444,610	0 ------------- 84,758	0 ------------- 28,686	0 ------------- 1,249,362	0 ------------- 346,858
3BRYAN A GASPARD PHYSICIAN	(i) (ii)	973,230 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	25,610 ------------- 0	998,840 ------------- 0	0 ------------- 0
4PB KERR PHYSICIAN	(i) (ii)	963,315 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	25,610 ------------- 0	988,925 ------------- 0	0 ------------- 0
5RUTH FREDERICKS MD BOARD MEMBER/PHYSICIAN	(i) (ii)	876,871 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	10,482 ------------- 0	887,353 ------------- 0	0 ------------- 0
6RONALD KENNEDY PHYSICIAN	(i) (ii)	841,692 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	12,994 ------------- 0	854,686 ------------- 0	0 ------------- 0
7ZACHARY K BALDWIN PHYSICIAN	(i) (ii)	813,760 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	25,610 ------------- 0	839,370 ------------- 0	0 ------------- 0
8D PAUL SEAGO MD BOARD MEMBER/PHYSICIAN	(i) (ii)	817,663 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	20,028 ------------- 0	837,691 ------------- 0	0 ------------- 0
9WILLIAM MORGAN COO	(i) (ii)	543,349 ------------- 0	0 ------------- 0	78,689 ------------- 0	8,885 ------------- 0	28,559 ------------- 0	659,482 ------------- 0	14,869 ------------- 0
10SAMUEL SCOTT SVP, CFO	(i) (ii)	0 ------------- 516,351	0 ------------- 0	0 ------------- 77,698	0 ------------- 7,762	0 ------------- 18,820	0 ------------- 620,631	0 ------------- 35,767
11REBEKAH MOULDER MD BOARD MEMBER/PHYSICIAN	(i) (ii)	548,919 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	2,676 ------------- 0	551,595 ------------- 0	0 ------------- 0
12KEITH VAN CAMP VP INFORMATION TECHNOLOGY	(i) (ii)	407,498 ------------- 0	0 ------------- 0	98,591 ------------- 0	8,885 ------------- 0	2,904 ------------- 0	517,878 ------------- 0	75,289 ------------- 0
13DAVID SINCLAIR VP NETWORK ADMIN	(i) (ii)	353,190 ------------- 0	0 ------------- 0	74,525 ------------- 0	6,425 ------------- 0	25,590 ------------- 0	459,730 ------------- 0	44,905 ------------- 0
14CLAUDE HARBARGER FORMER PRESIDENT SDHS	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 439,241	0 ------------- 0	0 ------------- 0	0 ------------- 439,241	0 ------------- 0
15REGINALD MARTIN MD BOARD MEMBER/PHYSICIAN	(i) (ii)	368,126 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	25,571 ------------- 0	393,697 ------------- 0	0 ------------- 0
16DAVID HENRY VP CLINICAL OPERATIONS	(i) (ii)	284,357 ------------- 0	0 ------------- 0	49,947 ------------- 0	8,417 ------------- 0	25,488 ------------- 0	368,209 ------------- 0	31,358 ------------- 0

Schedule J (Form 990) 2020

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	THE ST. DOMINIC HEALTH SERVICES INC. BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REIVEWS COMPENSATION PACKAGES AND APPRROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE.
PART I, LINES 4A-B	EFFECTIVE FOR THE PLAN YEAR BEGINNING 1/1/2013, THE EXECUTIVE COMPENSATION COMMITTEE ADOPTED A NON-QUALIFIED RESTORATION PLAN THAT PROVIDES 5% OF PAY FOR SALARY IN EXCESS OF THE IRS LIMIT (CODE SECTION 401(A)(17)). PAYOUTS ARE INCLUDED IN FORM W-2 BOX 5 WAGES AND REFLECTED IN OTHER REPORTABLE COMPENSATION. IN THE CURRENT YEAR, PAYMENTS WERE MADE TO THE FOLLOWING INDIVIDUALS: LESTER DIAMOND - 31,327 DAVID W. SINCLAIR - 4,134 WILLIAM MORGAN - 15,892 SAMUEL SCOTT - 16,368 KEITH VAN CAMP - 8,184 SDHS MAINTAINS AN UNFUNDED DEFERRED COMPENSATION PLAN WHICH MEETS THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLAN PROVIDES FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLAN IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL BY SDHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENT FROM THE PLAN IN THE CURRENT YEAR: LESTOR DIAMOND 413,283 SAMUEL SCOTT 61,330 DAVID SINCLAIR 70,391 WILLIAM MORGAN 62,797 DAVID HENRY 49,947 KEITH VAN CAMP 90,407 FMOLHS MAINTAINS THREE UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDE FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLANS IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. NONE OF THE INDIVIDUALS ON PART VII RECEIVED PAYMENTS IN THE CURRENT YEAR.
PART I, QUESTION 4A	A FORMER DIRECTOR IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY CHANGE OF CONTROL. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS/HER AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 24 MONTHS. CLAUDE HARBARGER RECEIVED A SEVERANCE PAYMENT OF $439,241 IN THE CURRENT YEAR. AN OFFICER IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYEMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 12 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR.

Schedule J (Form 990) 2020

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

Return Reference	Explanation
FORM 990, PART III - PROGRAM SERVICE, LINE 4A	ST. DOMINIC HOSPITAL IS A 571-BED ACUTE CARE FACILITY IN JACKSON, MS. AS PART OF ITS HEALING MINISTRY, ST. DOMINIC'S IS ONE OF THE LARGEST EMPLOYERS IN THE AREA, AND THOSE EMPLOYEES, AS WELL AS HOSPITAL OPERATIONS, SIGNIFICANTLY HELP TO SUPPORT THE LOCAL ECONOMY. IN FISCAL YEAR 2021, ST. DOMINIC HOSPITAL PROVIDED OVER $1.7 BILLION (CHARGES) IN HOSPITAL SERVICES TO PATIENTS THROUGHOUT THE CENTRAL REGION OF MISSISSIPPI, AND EMPLOYED OVER 2,700 PEOPLE. ST. DOMINIC HOSPITAL'S MEDICAL STAFF OF NEARLY 500 LEADING PHYSICIANS AND SPECIALISTS MAKES ST. DOMINIC'S ONE OF THE MOST COMPREHENSIVE HOSPITALS IN MISSISSIPPI. THESE PHYSICIANS AND STAFF MEMBERS HAVE PLAYED AN INTEGRAL ROLE IN DEVELOPING HIGHLY REGARDED CLINICAL PROGRAMS AND SERVICES. SOME OF THOSE KEY SERVICES INCLUDE THE MISSISSIPPI HEART AND VASCULAR INSTITUTE, STROKE SERVICES, WOMEN'S SERVICES, BEHAVIORAL HEALTH SERVICES, AND THE CANCER CENTER (AND CANCER SERVICES AS A WHOLE). MISSISSIPPI HEART AND VASCULAR INSTITUTE IN 1974, ST. DOMINIC'S ESTABLISHED A CENTER FOR COMPREHENSIVE CARDIAC CARE. THEN KNOWN AS THE MISSISSIPPI HEART INSTITUTE THE NAME HAS SINCE BEEN REVISED TO MISSISSIPPI HEART AND VASCULAR INSTITUTE (MHVI) TO SHOW ST. DOMINIC'S ONGOING COMMITMENT TO EXPERTISE AND CARE OF THE ENTIRE CIRCULATORY SYSTEM. MANY OF ST. DOMINIC'S HEART AND VASCULAR PHYSICIANS ARE NATIONALLY KNOWN FOR USING THE MOST ADVANCED TECHNOLOGY AND PROCEDURES AND FOR THEIR CLINICAL EXCELLENCE IN DELIVERING PATIENT CARE. SERVICES OFFERED RANGE FROM MINIMALLY INVASIVE CARDIAC TREATMENTS TO TRADITIONAL OPEN-HEART SURGERY TO COMPLICATED AND VERY SPECIALIZED VALVE REPAIRS. IN FISCAL YEAR 2021 HEART AND VASCULAR SERVICE VOLUMES CONTINUED TO CLIMB COMPARED TO PRIOR YEARS. MUCH OF THESE INCREASES CAN BE ATTRIBUTED TO ST. DOMINIC'S EFFORTS TO OFFER OUTREACH SERVICES TO THE BROADER COMMUNITY. ST. DOMINIC'S CLINICAL OUTREACH, FIRST ESTABLISHED IN 2013, PROVIDES SCREENINGS, SPECIALTY CLINIC HUBS AND OTHER HEALTH SERVICES TO INDIVIDUALS IN BOTH THE JACKSON AREA AND IN OUTLYING COMMUNITIES. THE PROGRAM IS MADE UP OF TWO PARTS: SCREENINGS, WHICH ENCOMPASSES THE HEALTHY HEART SCREENING PROGRAM, LUNG CANCER SCREENING PROGRAM, AND COMMUNITY SCREENING EVENTS, AND OUTREACH, WHICH INCLUDES TELEMEDICINE AND SPECIALTY CLINICS IN RURAL AREAS. PATIENTS WHO SCHEDULE AN APPOINTMENT WITH THE HEALTHY HEART PROGRAM RECEIVE A (HOSPITAL SUBSIDIZED) HEART RISK ASSESSMENT FOR $99. UP TO 18 PATIENTS A DAY CAN BE SEEN AT TWO LOCATIONS. THE HEALTHY HEART PROGRAM STAFF CONDUCTED A TOTAL OF 1,862 SCREENINGS IN FISCAL YEAR 2021. CLINICAL OUTREACH ALSO AIMS TO SPREAD ITS MINISTRY FURTHER BY PROVIDING SERVICES TO COMMUNITIES ACROSS THE STATE TO AUGMENT EXISTING MEDICAL RESOURCES. THE PROGRAM HAS SPECIALTY CLINIC HUB SITES IN INDIANOLA, KOSCIUSKO, MAGEE, PELAHATCHIE, CLEVELAND, BROOKHAVEN, AND VICKSBURG. AT THESE LOCATIONS, NEUROLOGY, CARDIOLOGY, AND PSYCHIATRY PHYSICIANS SEE PATIENTS VIA FACE-TO-FACE ENCOUNTERS ONCE OR TWICE EACH MONTH, ALLOWING PATIENTS TO RECEIVE MEDICAL SERVICES WITHOUT THE NEED TO TRAVEL TO SEE A SPECIALIST. ALL LOCATIONS ALSO OFFER TELE-MEDICINE CLINICS WHERE PHYSICIANS REMAIN AT ST. DOMINIC'S AND THE PATIENTS REMAIN IN THEIR LOCAL COMMUNITY TO RECEIVE CONSULTATIONS AND CARE. CLINICAL OUTREACH ALSO OFFERS LUNG CANCER SCREENINGS TO PATIENTS WHO MEET CRITERIA. THE LUNG NAVIGATOR PLAYS A KEY ROLE IN ENSURING THAT PATIENTS MEET CRITERIA, ARE SCREENED, AND FOLLOW UP OF ANY CONCERNING REPORTS. THE LUNG SCREENING MUST BE DONE ANNUALLY IF NOT SOONER. IN FISCAL YEAR 2021, 362 PATIENTS WERE SCREENED. COMPRESHENSIVE STROKE CENTER ST. DOMINIC'S COMPREHENSIVE STROKE CENTER OFFERS RAPID DIAGNOSIS, HIGH-TECH INTERVENTION, EXPERT CARE AND INTENSIVE REHABILITATION IN A CARING, COMPASSIONATE SETTING. ST. DOMINIC'S IS CAPABLE OF DELIVERING THE FULL SPECTRUM OF CARE TO SERIOUSLY ILL PATIENTS WITH STROKE AND CEREBROVASCULAR DISEASE. THE CHIEF COMPONENT OF THE PROGRAM IS A HIGHLY COLLABORATIVE, EXPERTLY SKILLED TEAM OF CLINICAL PROFESSIONALS WHO DIRECT AND PROVIDE EVIDENCE-BASED CARE FOR EVERY STROKE PATIENT. THE PROGRAM PROVIDES CARE TO THE ADULT POPULATION OF CENTRAL MISSISSIPPI AND OUTLYING RURAL AREAS. IN JUNE 2020, ST. DOMINIC HOSPITAL RECEIVED THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES TARGET: STROKE GOLD PLUS WITH HONOR ROLL ELITE QUALITY ACHIEVEMENT AWARD. IN 2021. ST. DOMINIC HOSPITAL RECEIVED THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES TARGET: STROKE GOLD PLUS WITH HONOR ROLL ELITE/ADVANCED THERAPY QUALITY ACHIEVEMENT AWARD. THE AWARD RECOGNIZES THE HOSPITAL'S COMMITMENT TO ENSURING STROKE PATIENTS RECEIVE THE MOST APPROPRIATE TREATMENT ACCORDING TO NATIONALLY RECOGNIZED, RESEARCH-BASED GUIDELINES BASED ON THE LATEST SCIENTIFIC EVIDENCE. ST. DOMINIC'S HAS WORKED TO EXTEND THIS EXPERTISE TO AREAS OUTSIDE OF THE JACKSON AREA. ST. DOMINIC'S TELE-STROKE NETWORK LINKS SEVEN HOSPITALS IN RURAL AREAS WITH STROKE NEUROLOGISTS AT ST. DOMINIC'S WHO CAN PROVIDE SPECIALIZED, URGENT CARE FOR THOSE SUSPECTED OF HAVING A STROKE. IN FISCAL YEAR 2021, ST. DOMINIC'S TREATED 2,900 STROKE PATIENTS, 2/3 OF WHOM WERE TRANSFERRED IN FROM OUTLYING, RURAL HOSPITALS. WOMEN'S SERVICES ST. DOMINIC'S MATERNAL AND NEWBORN CARE CENTER EMPHASIZES A TEAM APPROACH TO CARE WITH PHYSICIANS, NURSES AND EDUCATORS WORKING TOGETHER TO MEET THE TOTAL NEEDS OF THE PATIENT AND THE ENTIRE FAMILY. ST. DOMINIC'S OFFERS SERVICES AND PROGRAMS NOT ONLY DURING A PATIENT'S HOSPITAL STAY, BUT ALSO CLASSES AND RESOURCES TO ASSIST WITH THE FAMILY TRANSITION LONG BEFORE AND LONG AFTER THE BIRTH OF A BABY. SERVICES INCLUDE PRENATAL CARE, LABOR AND DELIVERY, NEWBORN CARE, DIGITAL MAMMOGRAPHY, WELLNESS CHECKS, LACTATION CONSULTATIONS, GYNECOLOGICAL SURGERIES AND A WIDE ARRAY OF CLASSES. IN FISCAL YEAR 2021, ST. DOMINIC'S WOMEN'S SERVICES WORKED WITH FAMILIES TO DELIVER OVER 1,600 BABIES. BEHAVIORAL HEALTH SERVICES FOR ST. DOMINIC'S, THE TREATMENT OF BEHAVIORAL HEALTH CONDITIONS HAS BEEN A PRIORITY SINCE THE INCEPTION OF ITS BEHAVIORAL HEALTH PROGRAM. ST. DOMINIC'S BEHAVIORAL HEALTH SERVICES PROVIDES QUALITY AND COMPASSIONATE TREATMENT TO ADULT INDIVIDUALS AND THEIR FAMILIES SUFFERING FROM MENTAL ILLNESS. BOARD CERTIFIED PSYCHIATRISTS, SOCIAL WORKERS AND OTHER THERAPISTS WORK TOGETHER WITHIN A MULTI-DISCIPLINARY TEAM TO MEET THE INDIVIDUALIZED NEEDS OF EACH PATIENT. ONE OF THE SPECIALTY PSYCHIATRIC UNITS AT ST. DOMINIC'S, THE OAKES, PROVIDES COMPASSIONATE CARE FOR SENIOR ADULT PATIENTS IN A SECURE AND THERAPEUTIC ENVIRONMENT. THE OAKES USES PROVEN METHODS TO HELP PATIENTS, SUCH AS SOCIAL GROUP INTERACTION, REALITY ORIENTATION, SENSORY STIMULATION, RECREATION AND SELF-EXPRESSION. ST. DOMINIC'S BEHAVIORAL HEALTH SERVICES FACILITY COMPLETED IN 2013 CAN ACCOMMODATE PATIENTS IN NEED OF PSYCHIATRIC INPATIENT SERVICES IN THE METRO AREA. THE TWO-STORY, STATE-OF-THE-ART FACILITY CONTAINS 78,000 SQUARE FEET AND 77 PRIVATE ROOMS. SEPARATE UNITS WITHIN THE FACILITY HAVE INDIVIDUAL GROUP MEETING AND DINING AREAS. ST. DOMINIC'S BEHAVIORAL HEALTH SERVICES CONTINUED TO REACH OUT TO THE COMMUNITY TO ASSIST INDIVIDUALS IN IDENTIFYING MENTAL HEALTH ISSUES AND PROVIDE DIRECTION TO RECEIVE THE APPROPRIATE LEVEL OF CARE NEEDED EVEN DURING THE HEIGHT OF THE PANDEMIC. FROM JULY 1, 2020 JUNE 2021, BEHAVIORAL HEALTH SERVICES PROVIDED SCREENING MATERIALS, INCLUDING DEPRESSION, ANXIETY, AND RELATED MENTAL HEALTH ISSUES TO MORE THAN 1,200 PEOPLE THROUGHOUT MULTIPLE VIRTUAL COMMUNITY EVENTS AND IN RURAL HEALTH CENTER LOCATIONS. COVID-19 AND MENTAL HEALTH RELATED NEWSLETTERS WERE DISTRIBUTED ELECTRONICALLY TO OVER 150 INDIVIDUALS IN 2021. ALSO, MORE COLLABORATIVE EFFORTS AND PARTNERSHIPS WERE ESTABLISHED WITHIN THE COMMUNITY TO DEVELOP A COORDINATED APPROACH TO ADDRESSING ISSUES SURROUNDING MENTAL HEALTH IN THE COMMUNITY. TELE-PHYCHIATRY BECAME A WAY TO MEET THE NEEDS OF THOSE IN NEED IN OUR RURAL COMMUNITIES AND THOSE WHO WE NEEDED TO RACH DURING COVID OUTBREAKS. EFFORTS TO REDUCE THE STIGMAS ASSOCIATED WITH MENTAL HEALTH WERE ALSO A FOCUS IN MARKETING AND SOCIAL MEDIA COVERAGE, WITH SPECIFIC FOCUS ON DEPRESSION AND THE IMPACT OF COVID-19. ST. DOMINIC'S BEHAVIORAL HEALTH SERVICES STAFF SERVED IN LEADERSHIP ROLES AND PARTICIPATED IN MANY COMMUNITY EVENTS IN THE JACKSON AND THE SURROUNDING AREAS TO EDUCATE THE PUBLIC ON MENTAL HEALTH, AS WELL AS MENTAL ILLNESS.
FORM 990, PART III, LINE 4A	CANCER CENTER AND CANCER SERVICES ST. DOMINIC'S CANCER SERVICES ARE A LEADER IN COMMUNITY OUTREACH AND CANCER EDUCATION. THE COMPREHENSIVE PROGRAM WAS RECOGNIZED IN 2018, FOR THE THIRD TIME, WITH AN OUTSTANDING ACHIEVEMENT AWARD BY THE COMMISSION ON CANCER (COC) OF THE AMERICAN COLLEGE OF SURGEONS. ST. DOMINIC'S IS THE ONLY HOSPITAL IN THE STATE OF MISSISSIPPI TO HAVE RECEIVED THIS AWARD THREE TIMES. ST. DOMINIC'S IS ONE OF A SELECT GROUP OF 24 ACCREDITED CANCER PROGRAMS IN THE UNITED STATES TO RECEIVE THIS NATIONAL HONOR FOR CANCER SURVEYS PERFORMED IN 2018. ST. DOMINIC'S ALSO RECEIVED THE THREE-YEAR ACCREDITATION FOR THE 2009, 2014, AND 2018 SURVEYS. TO EARN THIS VOLUNTARY ACCREDITATION, ST. DOMINIC'S CANCER SERVICES IS REQUIRED TO MEET OR EXCEED QUALITY CARE STANDARDS AS OUTLINED BY THE COC, BE EVALUATED EVERY THREE YEARS THROUGH A SURVEY PROCESS AND MAINTAIN LEVELS OF EXCELLENCE IN THE DELIVERY OF COMPREHENSIVE PATIENT-CENTERED CARE. THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC) IS A CONSORTIUM OF NATIONAL, PROFESSIONAL ORGANIZATIONS FOCUSED ON BREAST HEALTH AND DEDICATED TO THE IMPROVEMENT OF QUALITY OUTCOMES OF PATIENTS OF DISEASES OF THE BREAST THROUGH EVIDENCE-BASED STANDARDS AND PROFESSIONAL EDUCATION. ST. DOMINIC'S IS ONE OF TWO PROGRAMS ACCREDITED BY THE NAPBC IN MISSISSIPPI AND WAS FIRST ACCREDITED THROUGH THE NAPBC IN 2011. ST. DOMINIC'S WAS SELECTED IN 2017 BY THE OVARIAN CANCER RESEARCH ALLIANCE TO RECEIVE A GRANT TO KICK OFF THE WOMAN-TO-WOMAN PATIENT SUPPORT PROGRAM THAT PAIRS GYNECOLOGIC CANCER PATIENTS WITH TRAINED AND SUPERVISED SURVIVOR VOLUNTEERS TO PROVIDE ONE-ON-ONE MENTORING AND SUPPORT. THE PROGRAM CONTINUES TO GROW FROM THAT INITIAL $50,000 GRANT. AN INTEGRAL PART OF ST. DOMINIC'S CANCER SERVICES IS THE FREESTANDING CANCER CENTER, WHICH PROVIDES EASY ACCESS TO A LARGE VARIETY OF SERVICES AS WELL AS CONVENIENT PARKING. TREATMENTS AT THE CENTER INCLUDE MEDICAL CANCER THERAPY AND RADIATION THERAPY. IN 2021, 31,000 RADIATION THERAPY PROCEDURES AND 16,500 OUTPATIENT INFUSIONS WERE CONDUCTED. ST. DOMINIC'S ALSO ACQUIRED THE DIGNICAP SCALP COOLING SYSTEM IN APRIL 2019 TO MINIMIZE HAIR LOSS FROM CHEMOTHERAPY. POSITIVE RESULTS FROM THE MULTI-CENTER FDA CLINICAL TRIAL, PUBLISHED IN FEBRUARY 2017 BY THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (JAMA), INDICATE THAT SEVEN OUT OF TEN PATIENTS USING THE DIGNICAP SYSTEM KEPT AT LEAST 50 PERCENT OF THEIR HAIR. FDA-CLEARED SINCE 2015, THE DIGNICAP SCALP COOLING SYSTEM MINIMIZES HAIR LOSS FROM CERTAIN CHEMOTHERAPY TREATMENTS FOR WOMEN AND MEN WITH SOLID TUMOR CANCERS SUCH AS THOSE ASSOCIATED WITH BREAST, OVARIAN, UTERINE, PROSTATE AND OTHER TISSUES.
FORM 990, PART III - PROGRAM SERVICE, LINE 4B	THE HOSPITAL IS AN ACTIVE, CARING MEMBER OF THE COMMUNITY IT SERVES. IN CARRYING OUT ITS HEALING MINISTRY, THE BOARD OF DIRECTORS HAS ESTABLISHED A POLICY UNDER WHICH THE HOSPITAL PROVIDES CARE TO THE NEEDY MEMBERS OF ITS COMMUNITY. FOLLOWING THAT POLICY, THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICIES. THE DIRECT AND INDIRECT COSTS ASSOCIATED WITH THESE SERVICES CANNOT BE IDENTIFIED TO SPECIFIC CHARITY CARE PATIENTS. THEREFORE, MANAGEMENT ESTIMATED THE COSTS OF THESE SERVICES BY CALCULATING A COST TO GROSS CHARGE RATIO AND MULTIPLYING IT BY THE CHARGES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS MEETING THE HOSPITAL'S CHARITY CARE GUIDELINES. THE ESTIMATED COST OF CHARGES FOREGONE, BASED ON THE COST TO CHARGE RATIO, WAS APPROXIMATELY $14,316,000. THE FOREGONE CHARGES ARE NETTED AGAINST PATIENT SERVICE REVENUE TO ARRIVE AT NET PATIENT SERVICE REVENUE AS REFLECTED AS PROGRAM SERVICE REVENUE ON PART VIII OF FORM 990 IN ORDER TO BE CONSISTENT WITH FINANCIAL STATEMENT REPORTING AND ARE NOT REPORTED AS FUNCTIONAL EXPENSES ON THE FORM 990. THE HOSPITAL ALSO PROVIDES HEALTH CARE SERVICES TO A SIGNIFICANT PORTION OF THE UNINSURED POPULATION IN THE SURROUNDING COMMUNITY. WHILE A PORTION OF THESE PATIENTS MAY ULTIMATELY QUALIFY FOR COVERAGE UNDER THE MEDICAID PROGRAM OR THE CHARITY CARE POLICY DISCUSSED ABOVE, THE HOSPITAL IS UNABLE TO COLLECT A SIGNIFICANT PORTION OF THESE ACCOUNTS. CHARGES DEEMED UNCOLLECTIBLE WERE APPROXIMATELY $49,477,000.
FORM 990, PART III - PROGRAM SERVICE, LINE 4C	THE HOSPITAL SERVES THE COMMUNITY IN NUMEROUS WAYS. SOME EXAMPLES INCLUDE ASSISTING IN EDUCATING THE COMMUNITY REGARDING HEALTH-RELATED ISSUES. THE HOSPITAL PARTICIPATES IN NUMEROUS HEALTH FAIRS AND GIVES PRESENTATIONS TO VARIOUS SCHOOLS AND INDUSTRIES REGARDING SUCH ISSUES AS DRUG ABUSE AND SAFETY IN THE WORKPLACE. THE HOSPITAL HAS SPONSORED ANNUAL CHOLESTEROL AND CANCER SCREENINGS UPON WHICH THE TESTS ARE MADE AVAILABLE TO THE PUBLIC FOR A NOMINAL FEE AND THE MAJORITY OF THE COSTS INCURRED ARE ABSORBED BY THE HOSPITAL. THE HOSPITAL ALSO ORGANIZES EMPLOYEE PARTICIPATION IN FUNDRAISING FOR ORGANIZATIONS, SUCH AS THE UNITED WAY, STEWPOT MINISTRIES AND JUNIOR ACHIEVEMENT, AMONG OTHERS. IN ADDITION, THE HOSPITAL GAVE NEARLY $1,034,000 DURING FISCAL YEAR 2021 IN CHARITABLE CORPORATE DONATIONS TO VARIOUS AREA COMMUNITY SERVICE ORGANIZATIONS. ALTHOUGH THE HOSPITAL HAS ESTIMATED THE COST OF EACH OF THESE EFFORTS TO SERVE THE JACKSON, MISSISSIPPI METROPOLITAN AREA, MANAGEMENT AND THE BOARD OF DIRECTORS BELIEVE THAT SUCH COSTS REPRESENT ONLY ONE FACET OF THE MANY WAYS THE HOSPITAL SERVES THE GREATER JACKSON COMMUNITY. THE ABOVE EXAMPLES RELATE ONLY TO CERTAIN MEASURABLE BENEFITS THAT THE HOSPITAL PROVIDES TO ITS SERVICE AREA AND IS NOT INTENDED TO MEASURE ALL SUCH COMMUNITY BENEFITS, MANY OF WHICH ARE INTANGIBLE IN NATURE OR OTHERWISE NOT QUANTIFIABLE.
FORM 990, PART VI, SECTION A, LINE 6	ST. DOMINIC HEALTH SERVICES, INC. IS THE SOLE MEMBER OF ST. DOMINIC JACKSON MEMORIAL HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A	THE BOARD OF DIRECTORS OF ST. DOMINIC- JACKSON MEMORIAL HOSPITAL'S SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC., HAS THE AUTHORITY TO APPROVE THE ELECTION OF THE PRESIDENT/CEO, THE CHAIR OF THE BOARD OF DIRECTORS AND THE VICE-CHAIR OF THE BOARD OF DIRECTORS OF THE HOSPITAL AND ALL OTHER DIRECTORS AND OFFICERS OF THE HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7B	THE RESERVED POWER TO THE MEMBER, ST. DOMINIC HEALHT SERVICES, INC., ARE AS FOLLOWS: I. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION. II. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION. III. TO AMEND, ALTER, MODIFY, OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. IV. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES. V. TO DISSOLVE AND TO DISTRIBUTE ASSETS OF THE CORPORATION. VI. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. VII. TO ACQUIRE, PURCHASE, SELL, LEAASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF THE CORPORATION. VIII. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION. IX. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION. X. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION. XI. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION. XII. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B	AFTER PREPARATION OF THE FORM 990 BY KPMG LLP, MANAGEMENT REVIEWED THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BOARD BEFORE IT WAS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST FORM ANNUALLY. THE PRESIDENT REVIEWS THE FORMS, AND ANY CONFLICTS ARE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD. PERSONS WITH CONFLICTS OF INTERESTS DO NOT VOTE OR USE HIS OR HER INFLUENCE ON THE MATTER AND ARE EXCLUDED FROM THE COUNT IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW.
FORM 990, PART VI, SECTION B, LINE 15	OUR BOARD OF DIRECTORS DESIGNATES AN EXECUTIVE COMMITTEE MADE UP OF INDEPENDENT BOARD MEMBERS TO REVIEW AND SET THE COMPENSATION ANNUALLY OF OUR OFFICERS AND KEY EMPLOYEES. THE EXECUTIVE COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY AN OUTSIDE CONSULTING FIRM. THE EXECUTIVE COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE EXECUTIVE COMMITTEE. THE COMPENSATION FOR THE CEO OF ST. DOMINIC JACKSON MEMORIAL HOSPITAL IS SET BY THE COMPENSATION COMMITTEE OF ST. DOMINIC HEALTH SERVICES (A RELATED TAX-EXEMPT ORGANIZATION) ACCORDING TO THEIR PAY PRACTICES WHICH ARE SIMILAR TO THOSE DESCRIBED ABOVE.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SECTION 1.263(A)-3(N) - BOOK CONFORMITY ELECTION ST. DOMINIC JACKSON MEMORIAL HOSPITAL IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2021. SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION ST. DOMINIC JACKSON MEMORIAL HOSPITAL HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDED JUNE 30, 2021. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OR LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I).
FORM 990, PART XI, LINE 9:	CAPITAL TRANSFERS -6,777,507. OTHER BOOK/TAX DIFFERENCES -5,354,788.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

ST DOMINIC - JACKSON MEMORIAL HOSPITAL

Employer identification number

64-0303091

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) 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
(1) ST DOMINIC MEDICAL ASSOCIATES 969 LAKELAND DRIVE JACKSON,MS39216 26-1969846	HEALTHCARE	MS	46,120,618	18,071,157	SDJMH
(2) ST DOMINIC HOSPITAL MEDICINE LLC 969 LAKELAND DRIVE JACKSON,MS39216 81-4908606	HEALTHCARE	MS	9,025,019	3,290,280	SDJMH

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 entity?
(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	Yes	No
(1)ST BERNARD HEALTH FUND 4200 ESSEN LANE BATON ROUGE,LA70809 20-4685614	HEALTHCARE	LA	501(C)(3)	LINE 12A, I	FMOL		No
(2)HEALTH CARE CENTERS IN SCHOOLS 5000 HENNESSY BLVD BATON ROUGE,LA70808 72-1443935	HEALTHCARE	LA	501(C)(3)	LINE 10 - A	OLOL		No
(3)ST DOMINIC HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON,MS39216 64-0714999	HOLDING CO	MS	501(C)(3)	LINE 12C, III - FI	FMOLHS		No
(4)COMMUNITY HEALTH SERVICES - ST DOMINIC 969 LAKELAND DRIVE JACKSON,MS39216 64-0884870	HEALTH PROGRA	MS	501(C)(3)	LINE 10 - A	SDHS		No
(5)ST DOMINIC - HEALTH SERVICES FOUNDATION 969 LAKELAND DRIVE JACKSON,MS39216 43-1992975	FUNDRAISING	MS	501(C)(3)	LINE 7 - AN	SDHS		No
(6)ST CATHERINE'S VILLAGE INC 969 LAKELAND AND DRIVE JACKSON,MS39216 64-0714997	RET HOME	MS	501(C)(3)	LINE 10 - A	SDHS		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2020

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) LOURDES IMAGING DEVELOPMENT LLC 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE,LA70508 20-8326287	REAL ESTATE	LA	N/A	N/A				No			No
(2) PARK PLACE SURGERY CENTER LLC 4811 AMBASSADOR CAFFERY PKWY LAFAYETTE,LA70508 72-1404092	HEALTHCARE	LA	N/A	N/A				No			No
(3) BRPT LAKE REHABILITATION CENTERS LLC 175 S ENGLISH STATION RD STE 218 LOUISVILLE,KY40245 72-1506100	HEALTHCARE	LA	N/A	N/A				No			No
(4) CONVENIENT CARE LLC 10319 JEFFERSON HIGHWAY BATON ROUGE,LA70809 72-1439481	HEALTHCARE	LA	N/A	N/A				No			No
(5) SURGICAL SPECIALTY CENTER OF BATON ROUGE LLC 8080 BLUEBONNET BLVD BATON ROUGE,LA70810 26-3120962	HEALTHCARE	LA	N/A	N/A				No			No
(6) ST ELIZABETH-MARY BIRD PERKINS CANCER CENTER LLC 4950 ESSEN LANE BATON ROUGE,LA70809 26-0628752	HEALTHCARE	LA	N/A	N/A				No			No
(7) NORTHEAST LA CANCER INSTITUTE LLC 411 CALYPSO STREET MONROE,LA71201 72-1329499	HEALTHCARE	LA	N/A	N/A				No			No
(8) LHCG-XIII LLC DBA LOURDES HOME HEALTH 901 S HUGH WALLIS ROAD LAFAYETTE,LA70508 20-8068308	HEALTHCARE	LA	N/A	N/A				No			No
(9) LOURDES AFTER HOURS LLC 7777 HENNESSY BLVD SUITE 1004-202 BATON ROUGE,LA70809 20-1367299	HEALTHCARE	LA	N/A	N/A				No			No
(10) LAKE URGENT CARE ASCENSION LLC 10319 JEFFERSON HIGHWAY BATON ROUGE,LA70809 35-2463092	HEALTHCARE	LA	N/A	N/A				No			No
(11) OLOLUSP SURGERY CENTER LLC 15305 DALLAS PKWY STE 1600 LB 28 ADDISON,TX75001 35-2457810	HEALTHCARE	TX	N/A	N/A				No			No
(12) ST FRANCIS URGENT CARE LLC 10319 JEFFERSON HIGHWAY BATON ROUGE,LA70809 47-4013731	HEALTHCARE	LA	N/A	N/A				No			No
(13) GAMMA KNIFE OF LOUISIANA LLC 4950 ESSEN LANE BATON ROUGE,LA70809 81-1827194	HEALTHCARE	LA	N/A	N/A				No			No
(14) LHCG LXVII LLC 901 S HUGH WALLIS ROAD LAFAYETTE,LA70508 47-4283509	HEALTHCARE	LA	N/A	N/A				No			No
(15) PREMIER HEALTH HOLDINGS LLC 10319 JEFFERSON HIGHWAY BATON ROUGE,LA70809 47-2665226	HEALTHCARE	LA	N/A	N/A				No			No
(16) PINNACLE CARE HOLDINGS LLC 5627 S SHERWOOD FOREST BLVD BATON ROUGE,LA70816 82-1637627	HEALTHCARE	LA	N/A	N/A				No			No
(17) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP C/O C T CORPORATION SYSTEM 3867 PLA BATON ROUGE,LA70816 94-3419282	HEALTHCARE	LA	N/A	N/A				No			No
(18) HIGHLAND MEDICAL ARTS LLC PO BOX 55769 JACKSON,MS39296 74-3073171	MED BUILDING	MS	N/A	N/A				No			No
(19) FREMAUX OFFICE MM LLC 3500 NORTH CAUSEWAY BOULEVARD STE 6 METAIRIE,LA70002 84-3084552	HEALTHCARE	LA	N/A	N/A				No			No
(20) FREMAUX MOB LLC 3500 NORTH CAUSEWAY BOULEVARD STE 6 METAIRIE,LA70002	MED BLDG	LA	N/A	N/A				No			No
(21) SHP MANAGING MEMBER LLC 7015 HIGHWAY 190 E SERVICE ROAD STE COVINGTON,LA70433 83-2168844	HEALTHCARE	LA	N/A	N/A				No			No
(22) OLOL PONTCHARTRAIN SURGERY CENTER LLC 4200 ESSEN LANE BATON ROUGE,LA70809 46-1379031	HEALTHCARE	LA	N/A	N/A				No			No
(23) LAKE SURGICAL HOSPITAL (SLIDELL) LLC 1700 LINDBERG DR SLIDELL,LA70458 47-4228147	HEALTHCARE	LA	N/A	N/A				No			No
(24) PREMIER HEALTH HOLDINGS LLC 10319 JEFFERSON HIGHWAY BATON ROUGE,LA70809 47-2665226	HEALTHCARE	LA	N/A	N/A				No			No

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) LOUISE INSURANCE COMPANY PO BOX 1051 CAYMAN ISLANDS KY1-1102 CJ	INSURANCE	CJ	FMOL	C				Yes
(2) FMOL HEALTH SYSTEM HOLDINGS INC 4200 ESSEN LANE BATON ROUGE,LA70809 45-4405024	INVESTMENT	LA	FMOL	C				Yes
(3) ST DOMINIC MADISON HEALTH SERVICES INC 969 LAKELAND DRIVE JACKSON,MS39216 20-2870254	HEALTHCARE	MS	SDHS	C				Yes
(4) FIRST INTERMED CORPORATION 308 CORPORATE DRIVE RIDGELAND,MS39157 64-0824796	MEDICAL SERVICES	MS	SDHS	C				Yes
(5) ST DOMINIC INTEGRATED SERVICES INC 969 LAKELAND DRIVE JACKSON,MS39216 27-1493623	INVESTMENTS	MS	SDJMH	C				Yes
(6) LAFAYETTE SURGICARE INC C/O C T CORP SYSTEM 3867 PLAZA TOWE BATON ROUGE,LA70816	HEALTHCARE	LA	LOURDES	C				Yes

Schedule R (Form 990) 2020

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2020

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2020

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2020

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE FOR THE CARE OF THE ILL, INJURED, OR DISABLED PERSONS, AND TO PROVIDE FOR RESEARCH, EDUCATION, AND FOR THE ENHANCEMENT OF HEALTH OF THOSE IN THE COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	4,362
6	Total number of volunteers (estimate if necessary) .............	6	261
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	609,495
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	12,536,961	49,243,178
9	Program service revenue (Part VIII, line 2g) .........	495,371,318	525,283,460
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	953,969	8,870,762
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,541,326	8,633,917
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	513,403,574	592,031,317
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,275,686	2,523,206
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)	234,963,334	247,519,837
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	297,894,593	269,299,712
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	535,133,613	519,342,755
19	Revenue less expenses. Subtract line 18 from line 12.......	-21,730,039	72,688,562
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	456,520,111	502,151,354
21	Total liabilities (Part X, line 26).............	233,727,811	213,774,579
22	Net assets or fund balances. Subtract line 21 from line 20.....	222,792,300	288,376,775

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 416,807,806 including grants of $ ) (Revenue $ 526,499,679 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ 15,472,527 including grants of $ ) (Revenue $ )
	SEE SCHEDULE O

4c	(Code: ) (Expenses $ 2,523,206 including grants of $ 2,523,206 ) (Revenue $ )
	SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses434,803,539

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	9,409,372	2,169,208	432,070

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	6,373,643
e	Government grants (contributions)		1e	42,859,535

f	All other contributions, gifts, grants, and similar amounts not included above		1f	10,000

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		49,243,178

		Business Code
2a	PATIENT SERVICE REVENUE	621990	519,329,706	519,329,706
b	CAFETERIA SALES	722516	2,331,671			2,331,671
c	COOR CARE INCENTIVE	621900	1,132,542	1,132,542
d	CHILD CARE INCOME	624410	1,099,481		609,495	489,986
e	RETAIL SALES	453000	860,107			860,107
f	All other program service revenue.		529,953	529,953
g	Total. Add lines 2a–2f .....		525,283,460

3 Investment income (including dividends, interest, and othersimilar amounts) ......			8,069,043			8,069,043
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		4,653,370	6a
b	Less: rental expenses		1,526,931	6b
c	Rental income or (loss)		3,126,439	6c
d	Net rental income or (loss).......			3,126,439			3,126,439
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		4,647,182	7a
b	Less: cost or other basis and sales expenses		3,845,463	7b
c	Gain or (loss)		801,719	7c
d	Net gain or (loss).........			801,719			801,719
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	PENSION RELATED CHANGES		990009	5,507,478	5,507,478
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			5,507,478
12	Total revenue. See instructions.....			592,031,317	526,499,679	609,495	15,678,965

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,515,950	2,515,950
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	7,256	7,256
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	219,541,771	177,228,629	42,313,142
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	14,022,662	11,320,020	2,702,642
10	Payroll taxes ...........	13,955,404	11,265,725	2,689,679
11	Fees for services (non-employees):
a	Management ......	27,293,368	23,378,664	3,914,704
b	Legal .........	3,247,834	3,133,702	114,132
c	Accounting ...........	61,000	46,096	14,904
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	37,449,264	34,489,697	2,959,567
12	Advertising and promotion ....	1,150,041	869,680	280,361
13	Office expenses .......	10,501,993	7,936,126	2,565,867
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	12,077,300	9,126,552	2,950,748
17	Travel ............	88,734	67,054	21,680
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	5,225	3,948	1,277
20	Interest ...........	784,384		784,384
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	17,061,894	430,222	16,631,672
23	Insurance ...	4,169,146	3,150,532	1,018,614
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL & OTHER SUPPLIE	132,587,817	132,587,817
b	REPAIRS & MAINTENANCE	20,791,344	15,711,564	5,079,780
c	MISCELLANEOUS EXPENSES	2,030,368	1,534,305	496,063
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	519,342,755	434,803,539	84,539,216	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			124,277,290	1	117,018,469
2	Savings and temporary cash investments .........				2	0
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			67,331,301	4	75,326,090
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6	0
7	Notes and loans receivable, net ...........				7	0
8	Inventories for sale or use ............			14,016,194	8	15,422,662
9	Prepaid expenses and deferred charges ......			8,025,660	9	22,543,161
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	247,383,259
b	Less: accumulated depreciation	10b	32,621,656	207,082,669	10c	214,761,603
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			19,241,160	12	31,561,936
13	Investments—program-related. See Part IV, line 11 ..			7,419,942	13	7,846,405
14	Intangible assets ...............				14	7,361,321
15	Other assets. See Part IV, line 11 ...........			9,125,895	15	10,309,707
16	Total assets. Add lines 1 through 15 (must equal line 33)...			456,520,111	16	502,151,354

17	Accounts payable and accrued expenses .....	51,513,885	17	58,236,879
18	Grants payable ...		18
19	Deferred revenue .........	63,541,494	19	30,610,778
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	14,985,961	23	12,548,941
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	103,686,471	25	112,377,981
26	Total liabilities. Add lines 17 through 25..	233,727,811	26	213,774,579

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	222,792,300	27	288,376,775
28	Net assets with donor restrictions ...........		28	0
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	222,792,300	32	288,376,775
33	Total liabilities and net assets/fund balances ........	456,520,111	33	502,151,354