SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
2019
Open to Public Inspection
Name of the organization
JACKSON HOSPITAL AND CLINIC INC
 
Employer identification number

63-6001820
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) 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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
 
No
%
c
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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    9,505,718   9,505,718 3.740 %
b Medicaid (from Worksheet 3, column a) . . . . .     21,331,352 11,692,675 9,638,677 3.790 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     30,837,070 11,692,675 19,144,395 7.530 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .     74,850   74,850 0.030 %
g Subsidized health services (from Worksheet 6) . . . .     370,785   370,785 0.150 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     445,635   445,635 0.180 %
k Total. Add lines 7d and 7j .     31,282,705 11,692,675 19,590,030 7.710 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
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            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
17,190,407
3
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. ......
3
11,547,537
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
47,893,628
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
56,312,604
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-8,418,976
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(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 % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
11 JACKSON IMAGING CENTER LLC
  		RADIOLOGY PROCEDURES 67.000 %   33.000 %
22 JACKSON SURGERY CENTER LLC
  		OUTPATIENT SURGERY 54.130 %   43.410 %
33 JMS HEALTH SERVICES
  		PATIENT SERVICES 50.000 %    
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 JACKSON HOSPITAL AND CLINIC
1725 PINE STREET
MONTGOMERY,AL361061117 		X X         X   DISPROPORTIONATE SHARE HOSPITAL  
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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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)
JACKSON HOSPITAL & CLINIC
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): 		1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 19
5 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 ................. 5 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.................................. 6a   No
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.JACKSON.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
JACKSON HOSPITAL & CLINIC
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE DISCLOSURE
b
SEE DISCLOSURE
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Billing and Collections
JACKSON HOSPITAL & CLINIC
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
JACKSON HOSPITAL & CLINIC
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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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
JACKSON HOSPITAL & CLINIC PART V, SECTION B, LINE 5: THIS CHNA INCLUDES INFORMATION FROM THE FOLLOWING SOURCES:-INPUT FROM PERSONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY SERVED BY JACKSON HOSPITAL-IDENTIFYING FEDERAL, REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES, WITH CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY JACKSON HOSPITALCONSULTATION OR INPUT FROM OTHER PERSONS LOCATED IN AND/OR SERVING JACKSON HOSPITAL'S COMMUNITY, SUCH AS:-HEALTHCARE COMMUNITY ADVOCATES-NONPROFIT ORGANIZATIONS-ACADEMIC EXPERTS-LOCAL GOVERNMENT OFFICIALS-COMMUNITY-BASED ORGANIZATIONS, INCLUDING ORGANIZATIONS FOCUSED ON ONE OR MORE HEALTH ISSUES-HEALTHCARE PROVIDERS, INCLUDING COMMUNITY HEALTH CENTERS AND OTHER PROVIDERS FOCUSING ON MEDICALLY UNDERSERVED POPULATIONS, LOW-INCOME PERSONS, MINORITY GROUPS OR THOSE WITH NEEDS ARISING FROM CHRONIC DISEASE
JACKSON HOSPITAL & CLINIC PART V, SECTION B, LINE 11: 1 CHONIC CONDITIONSHEART DISEASE IS THE LEADING CAUSE OF DEATH IN ELMORE, AUTAUGA, AND MONTGOMERY COUNTIES. THE CHRONIC LOWER RESPIRATORY DISEASEMORTALITY RATE IN AUTAUGA COUNTY IS SIGNIFICANTLY HIGHER THAN THE RATE IN THE OVERALL STATE OF ALABAMATHE HYPERTENSION HOSPITALIZATION RATES IN ELMORE, AUTAUGA, AND MONTGOMERY COUNTIES ARE HIGHER THAN THE OVERALL RATE IN ALABAMA CANCER WAS THE SECOND MOST COMMONLY MENTIONED HEALTH CONCERN DURING COMMUNITY PHONE SURVEYS. RESPONDENTS FELT THAT THE CONCERN IS GETTING WORSE OVER TIME THE BREAST CANCER INCIDENCE RATE IS HIGHER IN ELMORE, AUTAUGA, AND MONTGOMERY COUNTIES WHEN COMPARED TO ALABAMA. THE COLORECTAL CANCER MORTALITY.2 DIABETESTHE DIABETES MORTALITY RATE IN MONTGOMERY COUNTY IS SIGNIFICANTLY HIGHER THAN THE RATE IN ALABAMA. DURING COMMUNITY LEADER INTERVIEWS, INTERVIEWEES NOTED DIABETES AS ONE OF THEIR MAIN HEALTH CONCERNS. THE MOST COMMONLY MENTIONED HEALTH CONCERN DURING COMMUNITY PHONE SURVEYS WAS DIABETES. RESPONDENTS FEEL THAT THE CONCERN IS GETTING WORSE OVER TIME.3 OBESITYTHE PREVALENCE OF OBESITY IN MONTGOMERY MSA IS SLIGHTLY HIGHER THAN THE PERCENTAGE STATEWIDE. ACCESS TO HEALTHY FOODS IN AUTAUGA AND MONTGOMERY COUNTIES IS SIGNIFICANTLY LIMITED COMPARED TO THE REST OF THE STATE. OBESITY/BEING OVERWEIGHT WAS ONE OF THE MOST COMMONLY MENTIONED HEALTH CONCERN BY PHONE SURVEY PARTICIPANTS. PHYSICAL INACTIVITY IN ELMORE COUNTY IS HIGHER THAN THE ENTIRE STATE OF ALABAMA. THE PERCENTAGE OF OBESE AND OVERWEIGHT INDIVIDUALS IS SIGNIFICANTLY HIGHER THAN THOSE OF NORMAL WEIGHT.MATERNAL & CHILD HEALTHTHE TEEN BIRTH RATE IN MONTGOMERY COUNTY IS HIGHER THAN THE STATE RATE. THE INFANT MORTALITY RATE IS HIGHER IN MONTGOMERY COUNTY WHEN COMPARED TO THE RATE IN ALABAMA. WOMEN IN AUTAUGA, ELMORE, AND MONTGOMERY COUNTIES ARE LESS LIKELY TO RECEIVE PRENATAL CARE IN THE FIRST TRIMESTER OF THEIR PREGNANCY WHEN COMPARED TO OTHER WOMEN IN ALABAMA. WOMEN IN MONTGOMERY COUNTY ARE LESS LIKELY TO RECEIVE ADEQUATE PRENATAL CARE DURING THE COURSE OF THEIR PREGNANCY WHEN COMPARED TO WOMEN IN ALABAMA. INFANTS IN AUTAUGA AND MONTGOMERY COUNTIES ARE MORE LIKELY TO BE CONSIDERED LOW BIRTHWEIGHT BIRTHS WHEN COMPARED TO INFANTS IN ALABAMA.
JACKSON HOSPITAL & CLINIC PART V, SECTION B, LINE 13H: ALL SELF-PAY PATIENTS RECEIVE A 78% DISCOUNT SO THAT THEY ARE ONLY BILLED FOR 22% OF TOTAL CHARGES. IN ADDITION, FINANCIAL ASSISTANCE WILL BE PROVIDED TO THOSE WHOSE INCOME IS AT OR BELOW THE FPG OF 100%. ADDITIONAL CONSIDERATIONS ARE INSURANCE/COVERAGE STATUS.
PART V, SECTION B, LINE 16A: WEBSITE FOR FAP:HTTP://WWW.JACKSON.ORG/MEDIA/1244/FINANCIAL-ASSISTANCE-POLICY-REVISED-6-28-16.PDF
PART V, SECTION B, LINE 16B: FAP APPLICATION WEBSITE:HTTP://WWW.JACKSON.ORG/MEDIA/1242/FINANCIAL-ASSISTANCE-APPLICATION-REV-7-19-16.PDF
PART V, SECTION B, LINE 16C: PLS WEBSITE:HTTP://WWW.JACKSON.ORG/PATIENT-RESOURCES/PATIENTS-VISITORS/FINANCIAL-SERVICES-BILLING/FINANCIAL-ASSISTANCE-PROGRAM/
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
Page 9
Schedule H (Form 990) 2019
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?3
Name and address Type of Facility (describe)
1 1 - JACKSON CLINIC FAMILY MEDICINE CENTER
1111 OLIVE STREET
MONTGOMERY,AL36106 		FAMILY MEDICINE/OUTPATIENT
2 2 - JACKSON SURGERY CENTER
1725 PARK PLACE
MONTGOMERY,AL36106 		OUTPATIENT SURGERY
3 3 - JACKSON IMAGING CENTER
1825 PARK PLACE
MONTGOMERY,AL36106 		MEDICAL IMAGING
4
5
6
7
8
9
10
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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: ALL SELF-PAY PATIENTS RECEIVE A 78% DISCOUNT SO THAT THEY ARE ONLY BILLED FOR 22% OF TOTAL CHARGES. IN ADDITION, FINANCIAL ASSISTANCE WILL BE PROVIDED TO THOSE WHOSE INCOME IS AT OR BELOW THE FPG OF 100%. ADDITIONAL CONSIDERATIONS ARE INSURANCE/COVERAGE STATUS.
PART I, LN 7 COL(F): THE AMOUNT LISTED ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $17,190,407 THAT HAS BEEN REMOVED FOR PURPOSES OF CALCULATING PERCENT OF TOTAL EXPENSE ON PART I, LINE 7, COLUMN (F).
PART III, LINE 3: THE ORGANIZATION ESTIMATES APPROXIMATELY 67.2% OF ITS BAD DEBT WOULD QUALIFY FOR FINANCIAL ASSISTANCE IF PATIENTS WENT THROUGH THE APPLICATION PROCESS. THIS ESTIMATE IS BASED OF PATIENT POPULATION.
PART III, LINE 4: RECEIVABLES FROM PATIENTS, INSURANCE COMPANIES, AND THIRD-PARTY CONTRACTUAL AGENCIES ARE RECORDED AT REGULAR PATIENT SERVICE CHARGE RATES. A MAJORITY OF THE COMPANY'S PATIENTS ARE INSURED BY CERTAIN THIRD PARTY INSURERS (PRINCIPALLY BLUE CROSS, MEDICARE, AND MEDICAID) BASED ON CONTRACTUAL AGREEMENTS WHICH GENERALLY RESULT IN THE COMPANY COLLECTING LESS THAN THE ESTABLISHED CHARGE RATES. FINAL DETERMINATION OF PAYMENTS UNDER THESE AGREEMENTS IS SUBJECT TO REVIEW BY APPROPRIATE AUTHORITIES. ADEQUATE ALLOWANCES ARE PROVIDED FOR DOUBTFUL ACCOUNTS, CONTRACTUAL ADJUSTMENTS AND OTHER UNCERTAINTIES. CREDIT LOSSES HAVE HISTORICALLY BEEN WITHIN MANAGEMENT'S EXPECTATIONS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBTS IF SUBSEQUENTLY COLLECTED.
PART III, LINE 8: THE ORGANIZATION USED ITS MEDICARE COST REPORT TO CALCULATE ALLOWABLE COSTS OF CARE RELATED TO MEDICARE FOR PURPOSES OF PART III, LINE 6.
PART III, LINE 9B: THE ORGANIZATION QUALIFIES PATIENTS FOR ITS CHARITY CARE POLICY AT TIME OF DISCHARGE. DISCOUNTS ON SELF-PAY PATIENTS ARE APPLIED USING A NON-FINANCIAL MEASURE, SO ACCOUNTS IN BAD DEBTS ARE NOT LIKELY ELIGIBILE FOR FURTHER FINANCIAL ASSISTANCE AFTER HAVING THEIR FINAL BILLS ISSUED. THE HOSPITAL PRIMARILY USES A THIRD-PARTY TO HANDLE BAD DEBT COLLECTIONS, AND ROUTINELY REEVALUATES ITS BAD DEBT ACCOUNTS TO DETERMINE PATIENTS THAT QUALIFY UNDER THE ORGANIZATION'S CHARITY CARE POLICY.
PART VI, LINE 2: HOSPITAL PERFORMS A COMMUNITY HEALTH ASSESSMENT EVERY 3 YEARS. INCORPORATING KEY COMMUNITY STAKEHOLDS IN THE PROCESS. HOSPITAL ALSO WORKS CLOSELY WITH PHYSICIAN & PHYSICIAN GROUPS WITHIN KEY COMMITTEES TO DISCUSS SERVICE LINE NEEDS FOR THEIR ASSOCIATED SPECIALTIES. HOSPITAL ALSO RELIES ON VARIOUS DATA POINTS REGARDING KEY DEMOGRAPHIC DATA AND HEALTH NEEDS.
PART VI, LINE 3: FINANCIAL ASSISTANCE ARE AVAILABLE ON COMPANY WEBSITE, BILLING STATEMENTS, ON-SITE FINANCIAL CONSELOURS AND THEN MEDICIAD ELLIGIBILITY AND SSI/DISSABILITY COUNCELORS.
PART VI, LINE 4: JACKSON HOSPITAL'S PRIMARY SERVICE AREA IS COMPRISED OF MONTGOMERY, ELMORE, AND AUTAUGA COUNTIES, LOCATED IN THE EASTERN CENTRAL PART OF THE STATE OF ALABAMA. THE SECONDARY SERVICE AREA IS COMPRISED OF BULLOCK, BUTLER, CRENSHAW, DALLAS, LOWNDES, MACON, AND PIKE COUNTRIES. JACKSON HOSPITAL IS ADJACENT TO I-85 AND NEAR THE INTERSECTION OF I-65 AND I-85, PROVIDING FOR EASY ACCESS FROM THE PRIMARY AND SECONDARY SERVICE AREAS. MAJOR PRIMARY SERVICE AREA EMPLOYERS ARE MAXWELL AIR FORCE BASE, STATE OF ALABAMA, HYUNDAI MOTOR MANUFACTURING ALABAMA, ALFA INSURANCE COMPANIES, ALABAMA STATE UNIVERSITY, AUBURN UNIVERSITY MONTGOMERY AND CITY OF MONTGOMERY.
PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES, INDEPENDENT CONTRACTORS, NOR A FAMILY MEMBER OF AN EMPLOYEE OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO MOST OF ITS DEPARTMENTS. IN ADDITION, SURPLUS FUNDS ARE REINVESTED IN THE HOSPITAL THROUGH THE PURCHASE OF TECHNOLOGY, PROPERTY, AND PLANT EQUIPMENT.
PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.
PART VI, LINE 7, REPORTS FILED WITH STATES AL
Schedule H (Form 990) 2019
Additional Data


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