2024-05-15T11:50:34-05:00 2023-06-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2022-07-01 640884870 COMMUNITY HEALTH SERVICES - ST DOMINIC COMM 6012006951 969 LAKELAND DRIVE JACKSON MS 392164699 SAM SCOTT CFO 6012006951 2024-05-14 1 SAM SCOTT XXX-XX-XXXX 0 RYAN HOOKS P00746825 2253444000 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SAM SCOTT 969 LAKELAND DRIVE JACKSON MS 392164699 580134 0 X WWW.STDOM.COM X 1996 MS COMMUNITY HEALTH SERVICES PROVIDES COMMUNITY HEALTH PROGRAMS, INCLUDING THE CLUB AT ST. DOMINIC, NEW DIRECTIONS, CARE-A-VAN, AND COMMUNITY OUTREACH. 6 5 45 5 0 0 1412246 0 670365 580134 0 0 0 0 2082611 580134 54 0 0 0 1479191 820821 0 0 0 747429 774977 2226674 1595798 -144063 -1015664 408545 246800 1120864 1974783 -712319 -1727983 X COMMUNITY HEALTH SERVICES - ST. DOMINIC, INC. (CHS) SHARES THE MISSION STATEMENT OF ITS SOLE CORPORATE MEMBER - ST. DOMINIC HEALTH SERVICES. INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING - WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILIDGED TO SERVE. 0 0 688395 576759 THE CLUB AT ST. DOMINIC'S (THE CLUB) - THE CLUB IS A MEDICAL FITNESS FACILITY PROVIDING A FULL SPECTRUM OF INTEGRATED WELLNESS PROGRAMS AND A WELL-EQUIPPED FITNESS CENTER. THE STAFF PROVIDE FREE EDUCATIONAL PROGRAMS AND WELLNESS SCREENINGS IN THE COMMUNITY AS WELL AS OFFER MEMBERSHIPS BASED ON INCOME FOR A NUMBER OF AT RISK GROUPS. THE CLUB HAD 1,255 MEMBERS AND 920 WELLNESS CONTACTS. 219480 0 COMMUNITY HEALTH CLINIC - THE CLINIC IS LOCATED ADJACENT TO STEWPOT, THE CLOTHES CLOSET, AND THE FOOD BANK. EACH OF THESE PROVIDES SERVICES TO THE UNDERSERVED POPULATIONS OF JACKSON, MS. THE CLINIC PROVIDES PRIMARY CARE SERVICES AND REFERRALS FOR THE HOMELESS, INDIGENT, AND UNINSURED INDIVIDUALS. COVID PRESENTED SOME CHALLENGES, HOWEVER, THE CLINIC PROVIDED SERVICES FOR 1,440 PATIENT CARE VISITS. 84086 3375 NEW DIRECTIONS - REALIZING THAT OUR POPULATION IS AN AGING ONE, ST. DOMINIC'S CREATED A WELLNESS PROGRAM TO MEET THE UNIQUE NEEDS OF MATURE ADULTS. THE PROGRAM IS BUILT ON THE PREMISE THAT SOCIAL INTERACTION, ENRICHMENT OPPORTUNITIES, AND WELLNESS EDUCATION HELP PROMOTE HEALTHY, ACTIVE LIFESTYLES AMONG SENIORS. NEW DIRECTIONS HAD 35,957 SOCIAL CONTACTS THAT FOCUSED ON SOCIAL INTERACTION, ENRICHMENT OPPORTUNITIES, AND WELLNESS EDUCATION. 146221 CARE-A-VAN - CARE-A-VAN IS A MOBILE HEALTH SCREENING PROGRAM. BY USING A MOBILE CLINIC, COMMUNITY HEALTH SERVICES - ST DOMINIC, INC (CHS) CAN TAKE HEALTH SCREENING TO THE MOST VULNERABLE POPULATIONS. THE CLINIC VISITS SENIOR CENTERS, DAYCARE CENTERS, ELEMENTARY SCHOOLS, AS WELL AS COMMUNITY-WIDE WELLNESS FAIRS IN RURAL AND UNDESERVED AREAS OF THE METRO JACKSON AREA. COMMUNITY OUTREACH - CHS CONTINUES ITS MISSION THROUGH COLLABORATING AND NETWORKING WITH COMMUNITY AGENCIES, PROVIDERS, BUSINESS LEADERS AND OTHER GROUPS. THERE ARE MORE THAN 100 COMMUNITY PARTNERS WITH WHICH IT SHARES INFORMATION AND RESOURCES. CHS SEEKS TO CONTINUE TO IDENTIFY AND NURTURE PARTNERS TO MEET THE GROWING NEEDS OF THE COMMUNITIES SERVED.THE COST FOR THESE OUTREACH EFFORTS CONSISTS OF THE DIRECT COSTS FOR THE SERVICES OF THE COMMUNITY LIAISON WHO LEADS THIS PROGRAM. 146221 1138182 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 45 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SAM SCOTT 6012006951 969 LAKELAND DRIVE JACKSON MS 39216 LAQUITA BROWN CHAIR 0.50 0.00 X X 0 0 0 JENNY CRUTCHFIELD DIRECTOR 0.50 0.00 X 0 0 0 SUMAN K DAS MD VICE CHAIR 0.50 0.00 X X 0 0 0 SISTER MARY TRINITA EDDINGTON SECRETARY 36.00 5.25 X X 0 0 0 SCOTT KASHMAN MARKET PRESIDENT (THRU 6/2023) 0.50 42.00 X X 0 610569 97937 GLENDA SUTHERLAND BOARD MEMBER 0.50 0.00 X 0 0 0 KRISTIN WOLKART INTERIM MARKET PRES (START 6/2023) 0.50 40.00 X X 0 575846 115578 SAMUEL SCOTT SVP, CFO, TREASURER 0.50 41.75 X 0 484817 32087 MARY WATKINS NURSE PRACTITIONER 40.00 0.00 X 121280 0 17074 LESTER DIAMOND FORMER PRESIDENT - SDHS 0.00 0.00 X 0 531654 0 121280 2202886 262676 1 1 1 0 0 THE CLUB AT ST. DOMINI 713940 572539 572539 OTHER REVENUE 900099 7595 7595 580134 580134 580134 0 0 746274 488460 257814 20933 13702 7231 -5995 -3924 -2071 59609 39016 20593 33502 33502 43464 19973 23491 21678 9962 11716 74865 40875 33990 528652 525366 3286 842 387 455 7063 -4312 11375 MEDICAL SUPPLIES 56087 4622 51465 REPAIRS & MAINTENANCE 8824 4055 4769 1595798 1138182 457616 0 314071 172993 3170 3164 111171 40528 70643 70643 20661 408545 246800 156113 53284 40860 87053 923891 1834446 1120864 1974783 X -712319 -1727983 -712319 -1727983 408545 246800 -1015664 0 X X 0 1 X 1 0 X 1086160 1672656 1567095 1412246 0 5738157 469537 668906 571366 670365 580134 2960308 1555697 2341562 2138461 2082611 580134 8698465 986160 1597656 1380097 1312030 5275943 0 986160 1597656 1380097 1312030 5275943 3422522 1555697 2341562 2138461 2082611 580134 8698465 0.39350 0.36420 0.00000 0.00000 X 111171 40528 70643 70643 NET DUE TO/FROM AFFILIATES 1277538 OTHER LONG TERM LIABILITIES 556908 1834446 X 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 RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. 1 1 0 0 0 0 0 0 0 SCOTT KASHMAN MARKET PRESIDENT (THRU 6/2023) 0 499303 0 108077 0 3189 0 70852 0 27085 0 708506 0 0 KRISTIN WOLKART INTERIM MARKET PRES (START 6/2023) 0 440832 0 131783 0 3231 0 95636 0 19942 0 691424 0 0 LESTER DIAMOND FORMER PRESIDENT - SDHS 0 0 0 0 0 531654 0 0 0 0 0 531654 0 0 SAMUEL SCOTT SVP, CFO, TREASURER 0 321567 0 157491 0 5759 0 14175 0 17912 0 516904 0 0 PART I, LINE 3 THE PRESIDENT IS PAID BY FMOLHS HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION. THE ST. DOMINIC HEALTH SERVICES, INC. BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE CEO'S COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE. PART I, LINES 4A-4B PART I, LINE 4A: TWO OFFICERS AND ONE DIRECTOR ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION FOR EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. A FORMER OFFICER IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION FOR EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 24 MONTHS. LESTER DIAMOND RECEIVED A SEVERANCE PAYMENT OF $531,654 DURING THE CURRENT YEAR. PART I, LINE 4B: 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. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. FORM 990, PART VI, SECTION A, LINE 6 ST DOMINIC HEALTH SERVICES, INC IS THE SOLE MEMBER OF COMMUNITY HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF COMMUNITY HEALTH SERVICES' (CHS) SOLE MEMBER, ST DOMINIC HEALTH SERVICES, INC, HAS THE AUTHORITY TO APPROVE THE ELECTION OF THE CHAIR OF THE BOARD, THE VICE-CHAIR OF THE BOARD AND ALL OTHER DIRECTORS AND OFFICERS OF CHS. FORM 990, PART VI, SECTION A, LINE 7B THE RESERVED POWER TO THE MEMBER, ST. DOMINIC HEALTH 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, LEASE, 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 CHARGE 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 AND REVIEW OF FORM 990 BY KPMG LLP, THE TAXPAYER'S TAX ADVISORS, ONE OR MORE MEMBERS OF SENIOR MANAGEMENT REVIEWS THE RETURN. A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND OFFICERS RECEIVE A COPY OF THE POLICY AND FORM FOR REPORTING EACH YEAR AT THE FIRST MEETING OF THE YEAR. FORMS ARE REVIEWED BY THE PRESIDENT AND ANY CONFLICTS SHARED WITH THE BOARD CHAIR. PERSONS WITH CONFLICTS OF INTERESTS ABSTAIN FROM ANY DECISIONS WHERE THE CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 COMMUNITY HEALTH SERVICES - ST. DOMINIC, INC. DOES NOT COMPENSATE ANY OFFICERS OR EMPLOYEES. ALL COMPENSATION IS PAID BY THE ORGANIZATION'S SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC. 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. FORM 990, PART XII, LINE 2C THE FINANCE COMMITTEE OF ST. DOMINIC HEALTH SERVICES, INC. (SDHS; SOLE MEMBER OF THE ORGANIZATION) MEETS QUARTERLY AND IS CHARGED WITH REVIEWING THE BUDGET, CURRENT PERFORMANCE, THE AUDIT, AND THE FORM 990. THE FINANCE COMMITTEE MAKES RECOMMENDATIONS THAT ARE THEN TAKEN TO THE FULL SDHS BOARD FOR FINAL APPROVAL. SECTION 1.263(A)-3(N) - BOOK CONFORMITY ELECTION COMMUNITY HEALTH SERVICES - ST. DOMINIC, INC. IS MAKING THE ELECTION UNDER TREAS. REG. SECTION 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, 2023. SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION COMMUNITY HEALTH SERVICES - ST. DOMINIC, INC. 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 ENDING JUNE 30, 2023. 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). 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