PONTOTOC HEALTH SERVICES INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PONTOTOC HEALTH SERVICES INC (EIN 64-0751410)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-12
- IRS object ID
- 202222249349302202
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-12T12:19:59-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3667 | AddressLine1Txt |
| City | LITTLE ROCK | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 722033667 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 640751410 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pontotoc Health Services Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % KRISTY DUKE | InCareOfNm |
| Business Name Control | PONT | BusinessNameControlTxt |
| Phone | 6623773978 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 South Gloster Street | AddressLine1Txt |
| City | Tupelo | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38801 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHARON NOBLES | PersonNm |
| Person Title | CHIEF FINANCIAL OFF. | PersonTitleTxt |
| Phone | 6623773978 | PhoneNum |
| Signature | 2022-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SHARON | PersonFirstNm |
| Person Last | NOBLES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Amber Sherrill CPA | PreparerPersonNm |
| PTIN | P00748683 | PTIN |
| Phone | 5013721040 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SHARON NOBLES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 South Gloster Street | AddressLine1Txt |
| City | Tupelo | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $29,444,991 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.nmhs.net/pontotoc/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1987 | FormationYr |
| Legal Domicile State | DE | LegalDomicileStateCd |
| Activity Or Mission | Pontotoc Health Services, Inc. operates a 25 bed hospital and a 44 bed nursing home located in Pontotoc, Mississippi. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 317 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,097,647 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,819,698 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,846,669 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $27,377,122 | CYProgramServiceRevenueAmt |
| PY Investment Income | $27,026 | PYInvestmentIncomeAmt |
| CY Investment Income | $38,176 | CYInvestmentIncomeAmt |
| PY Other Revenue | $348,041 | PYOtherRevenueAmt |
| CY Other Revenue | $209,995 | CYOtherRevenueAmt |
| PY Total Revenue | $30,319,383 | PYTotalRevenueAmt |
| CY Total Revenue | $29,444,991 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $16,050,564 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,161,360 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,160,256 | PYOtherExpensesAmt |
| CY Other Expenses | $8,801,626 | CYOtherExpensesAmt |
| PY Total Expenses | $28,210,820 | PYTotalExpensesAmt |
| CY Total Expenses | $26,962,986 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,108,563 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,482,005 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,143,071 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,119,690 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,984,970 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,264,077 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,158,101 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,855,613 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PONTOTOC HEALTH SERVICES, INC. OPERATES A 25 BED HOSPITAL AND A 44 BED NURSING HOME LOCATED IN PONTOTOC, MISSISSIPPI CALLED NORTH MISSISSIPPI MEDICAL CENTER-PONTOTOC(NMMC-PONTOTOC). NMMC-PONTOTOC IS PART OF THE NORTH MISSISSIPPI HEALTH SERVICES (NMHS) ORGANIZATION. THE MISSION OF NMHS IS TO CONTINUOUSLY IMPROVE THE HEALTH OF THE PEOPLE OF OUR REGION. NMMC-PONTOTOC WORKS TO ACHIEVE THIS CORPORATE MISSION TO IMPROVE THE HEALTH OF THE PEOPLE OF THIS REGION BY PROVIDING CONVENIENTLY ACCESSIBLE, COST-EFFECTIVE HEALTH CARE OF THE HIGHEST QUALITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $26,359,601 | ExpenseAmt |
| Revenue | $27,377,122 | RevenueAmt |
| Desc | NMMC-Pontotoc serves Pontotoc County and the surrounding area. In fiscal year 2021, there were 567 inpatient admissions, 8,840 emergency department visits, 42,843 outpatient visits, 32,171 rural health clinic visits, and 565 hospital based clinic visits. NMMC-Pontotoc uses Press Ganey, the largest patient satisfaction survey company in the nation, that works with more than 7,000 healthcare facilities. Randomly selected patients are asked about their experience with inpatient, outpatient, ER, and long term care services. The hospital offers paramedic-level ambulance service and 24-hour physician coverage in its Emergency Department. Radiology services include x-ray, computed tomography (CT) and ultrasound. Area residents can stay close to home and take advantage of the Mobile Mammography Unit on designated days each month at NMMC-Pontotoc. The 44-bed nursing home offers a variety of rehabilitation services and amenities to residents. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | One of the primary ways NMMC-Pontotoc serves the community is by providing care to various populations for which it receives no compensation or receives compensation at rates significantly less than established rates. The board of directors of NMMC-Pontotoc has established a policy under which the hospital provides care, without charge, to needy members of its community. THE FINANCIAL ASSISTANCE POLICY STATES THAT NMMC-PONTOTOC WILL PROVIDE EMERGENCY AND MEDICALLY NECESSARY INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO PATIENTS FREE OF CHARGE WITH HOUSEHOLD INCOME LEVELS AT OR BELOW 150% OF THE FEDERAL POVERTY LEVEL. The policy applies to individuals who reside in Pontotoc County. Patients from outside the county may also be granted charity care based on the judgment of NMMC-Pontotoc management depending on their individual circumstances. The policy also requires the patient to cooperate fully with NMMC-Pontotoc's request for information with which to verify the patient's eligibility. 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 forgone for services and supplies furnished under its charity care policy. Charges forgone, based on established rates, totaled approximately $1,993,863 in fiscal year 2021. Based on the gross charges provided to charity patients compared to total hospital gross charges, 6.96% of all services in fiscal year 2021 were provided on a charity basis. The net cost of charity care provided by NMMC-Pontotoc was approximately $1,754,896 in fiscal year 2021. The total cost estimate is based on the ratio of costs to charges for NMMC-Pontotoc. All the foregone charges mentioned above 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 tax return. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $26,359,601 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 23 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 317 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KRISTY DUKE | PersonNm |
| Phone | 6623773977 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 SOUTH GLOSTER STREET | AddressLine1Txt |
| City | Tupelo | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Key EmployeeKeyEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|---|
| Michael S Spees | |||||||||
| President & CEO | 0.5 | 39.5 | Yes (X) | $0 | $1,113,747 | $23,249 | |||
| Sharon Nobles | |||||||||
| Treasurer & CFO | 1.0 | 39.0 | Yes (X) | $0 | $540,231 | $12,156 | |||
| Brad J Bowlin | |||||||||
| Physician | 40.0 | 0.0 | $440,936 | $0 | $14,966 | Yes (X) | |||
| Bruce Toppin | |||||||||
| Secretary | 1.0 | 39.0 | Yes (X) | $0 | $383,500 | $12,233 | |||
| Justin Smith | |||||||||
| Physician | 40.0 | 0.0 | $299,398 | $0 | $9,510 | Yes (X) | |||
| Curtis Glidewell | |||||||||
| Physician | 40.0 | 0.0 | $288,133 | $0 | $9,318 | Yes (X) | |||
| Corey N Brown | |||||||||
| Physician | 40.0 | 0.0 | $283,794 | $0 | $5,922 | Yes (X) | |||
| Stephen Montgomery | |||||||||
| Physician | 40.0 | 0.0 | $247,308 | $0 | $15,988 | Yes (X) | |||
| Leslia D Carter | |||||||||
| Administrator | 40.0 | 0.0 | $173,931 | $0 | $7,037 | Yes (X) | |||
| Sidra P Winter | |||||||||
| Director | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Mariam B Clark PhD | |||||||||
| Director | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Conwell Duke | |||||||||
| Chairman | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| David High | |||||||||
| Director | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Mike McGregor | |||||||||
| Director | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Mitch Montgomery | |||||||||
| Director | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Scott Uithoven | |||||||||
| Director | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,733,500 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,037,478 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $110,379 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RELIAS EMERGENCY MED | |||||
| PO BOX 7058 | TUPELO | MS | 38802 | ER/HOSPITALIST PROV | $761,964 |
| SMG HOLDING LLC | |||||
| 300 CONSHOHOCKEN ST RD STE 450 | CONSHOHOCKEN | PA | 19428 | IOP MANAGEMENT FEES | $350,476 |
| TRILOGY HEALTHCARE SOLUTIONS | |||||
| 911 FLYNT DRIVE | FLOWOOD | MS | 39232 | BILLING/COLLECTION | $233,197 |
| CROTHALL HEALTHCARE | |||||
| 13028 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | HOUSEKEEPING SERVICE | $102,094 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,809,920 | GovernmentGrantsAmt |
| All Other Contributions | $9,778 | AllOtherContributionsAmt |
| Total Contributions | $1,819,698 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Revenue | 622110 | $27,361,520 | $27,361,520 |
| Related Rental Income | 531120 | $15,602 | $15,602 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $27,377,122 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,059 | TotalRevenueColumnAmt |
| Exclusion | $2,059 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $36,117 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $36,117 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,117 | TotalRevenueColumnAmt |
| Exclusion | $36,117 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Employee Drugs | 446110 | $209,984 | $209,984 |
| Rebate Income | 900099 | $11 | $11 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $209,995 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,444,991 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,377,122 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $248,171 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,741 | TotalAmt |
| Management And General | $187,741 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,206,764 | TotalAmt |
| Program Services | $14,206,764 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $690,285 | TotalAmt |
| Program Services | $690,285 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,102,063 | TotalAmt |
| Program Services | $2,102,063 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $974,507 | TotalAmt |
| Program Services | $917,161 | ProgramServicesAmt |
| Management And General | $57,346 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,032 | TotalAmt |
| Management And General | $166,032 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,448 | TotalAmt |
| Management And General | $5,448 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,405 | TotalAmt |
| Management And General | $28,405 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,923,311 | TotalAmt |
| Program Services | $2,923,311 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,426 | TotalAmt |
| Program Services | $12,426 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,926 | TotalAmt |
| Program Services | $299,926 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $396,263 | TotalAmt |
| Program Services | $396,263 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $712,930 | TotalAmt |
| Program Services | $712,930 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,056 | TotalAmt |
| Program Services | $27,056 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,942 | TotalAmt |
| Program Services | $37,942 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $287,285 | TotalAmt |
| Program Services | $287,285 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,413 | TotalAmt |
| Management And General | $158,413 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $2,980,974 | $2,980,974 |
| TAXES AND LICENSES | $345,443 | $345,443 |
| Collection Fees | $141,424 | $141,424 |
| REPAIRS AND MAINTENANCE | $141,056 | $141,056 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,292 | TotalAmt |
| Program Services | $137,292 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,962,986 | TotalAmt |
| Program Services | $26,359,601 | ProgramServicesAmt |
| Management And General | $603,385 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,590 | BOYAmt |
| EOY | $2,590 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,336,252 | BOYAmt |
| EOY | $1,598,754 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,874,188 | BOYAmt |
| EOY | $1,372,029 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $363,584 | BOYAmt |
| EOY | $392,287 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,093 | BOYAmt |
| EOY | $74,992 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,088,696 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $16,873,520 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,605,479 | BOYAmt |
| EOY | $2,215,176 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,913,885 | BOYAmt |
| EOY | $16,463,862 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,143,071 | BOYAmt |
| EOY | $22,119,690 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,783,371 | BOYAmt |
| EOY | $7,014,245 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,201,599 | BOYAmt |
| EOY | $6,249,832 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,984,970 | BOYAmt |
| EOY | $13,264,077 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,028,110 | BOYAmt |
| EOY | $8,718,900 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,991 | BOYAmt |
| EOY | $136,713 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,158,101 | BOYAmt |
| EOY | $8,855,613 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,143,071 | BOYAmt |
| EOY | $22,119,690 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,482,005 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $2,215,507 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $60,613 | OtherCostOrOtherBasisAmt |
| Book Value | $60,613 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,471,730 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,952,239 | DepreciationAmt |
| Book Value | $519,491 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,234,962 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,766,356 | DepreciationAmt |
| Book Value | $1,468,606 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $321,391 | OtherCostOrOtherBasisAmt |
| Depreciation | $154,925 | DepreciationAmt |
| Book Value | $166,466 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,215,176 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due From Third Party Payor | $275,197 |
| Deferred Compensation | $875,621 |
| Interest in Assets of Aff. Fnd | $136,713 |
| Other Receivables | $47,232 |
| Due from Affiliates | $14,870,803 |
| RIGHT OF USE LEASES | $258,296 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $16,463,862 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Related Parties | $214,579 |
| Due to Third Party Payors | $5,776,958 |
| LEASE LIABILITY | $258,295 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,249,832 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $29,620,351 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $175,360 | OtherRevenueAmt |
| Revenue Not Reported | $175,360 | RevenueNotReportedAmt |
| Revenue Subtotal | $29,444,991 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $29,444,991 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $27,138,346 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $27,138,346 | ExpensesSubtotalAmt |
| Other Expenses Not Included | -$175,360 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | -$175,360 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,962,986 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | MANAGEMENT HAS EVALUATED ITS INCOME TAX POSITIONS UNDER GUIDANCE INCLUDED IN ASC 740. BASED ON ITS REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| Part XI, Line 2d: | Pension cost included in revenue on financial statements but expenses on the return: 175,360 Total Line 2d: 175,360 |
| Part XII, Line 4b: | Pension cost included in revenue on financial statements but expenses on the return: (175,360) Total Line 4b: (175,360) |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,754,896 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,754,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06510 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,178,882 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,378,054 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,933,778 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,378,054 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,754,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06510 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,933,778 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,378,054 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,754,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06510 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Reimbursed By Medicare | $11,750,058 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,550,717 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $199,341 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pontotoc Health Services Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 176 South Main Street | AddressLine1Txt |
| City | Pontotoc | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38863 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.nmhs.net/pontotoc/ | WebsiteAddressTxt |
| State License | 16-091 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pontotoc Health Services Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE SECTION C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, SECTION B, LINE 5: | Information for the CHNA report was gathered by conducting interviews with individuals representing community health and public service organizations, medical professionals, hospital administration, and other hospital staff members. Consultation or input was also requested from persons who represented the broad interests of the community served, which included those with special knowledge of or expertise in public health; healthcare community advocates; Community-based organizations, including organizations focused on one or more health issues; Private Business Leaders with an understanding of the general and diverse community needs, who also provide a financial and economic perspective; Patient/family advisory councils. |
| PART V, SECTION B, LINE 6A: | Pontotoc Health Services is part of the North Mississippi Health Services' diversified regional healthcare system. North Mississippi Health Services operates six community hospitals in addition to Pontotoc Health Services. The CHNA included Pontotoc Health Services, Clay County Medical Corporation, North Mississippi Medical Center, Webster Health Services, Tishomingo Health Services, Monroe Health Services, and Marion Regional Medical Center. |
| PART V, SECTION B, LINE 7B: | https://www.nmhs.net/about-us/community-benefit/ PART V, SECTION B, LINE 10A: https://www.nmhs.net/about-us/community-benefit/ |
| PART V, SECTION B, LINE 11: | THE NEEDS OF THE COMMUNITY GO BEYOND THE RESOURCES OF THE ORGANIZATION WITH THE NON-EXPANSION OF MEDICAID IN THE STATE AND THE REDUCTION IN MEDICAID PAYMENTS AS WELL AS A SIGNIFICANT INCREASE IN UNINSURED. THE ORGANIZATION FOCUSES ON PROVIDING ACCESS TO BASIC HEALTHCARE NEEDS INCLUDING: - BLOOD PRESSURE SCREENING AND TREATMENT, - OBESITY TREATMENT, - DIABETES SCREENING AND TREATMENT, - IMMUNIZATIONS, AND - CHILDREN'S HEALTH BY PLACEMENT OF NURSES IN LOCAL SCHOOLS. |
| PART V, SECTION B, LINE 13h: | The Hospital's eligibility criteria also included the following: - Service type provided to patient, - Patient's relationship to physicians, - Patient's eligibility for financial assistance under another city, county, state, federal or other assistance program that supersedes the FAP, - Whether or not the patient's charges resulted from a work-related incident, - Whether or not the patient's charges resulted from an auto accident, and - Whether the patient is in the custody of a correctional facility |
| PART V, SECTION B, LINE 16A, 16B, & 16C | https://www.nmhs.net/patient-family-information/financial-assistance/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Pontotoc Health Services Nursing Home | ||||
| 176 South Main Street | Pontotoc | MS | 38863 | Long Term Acute Care Facility |
| Pontotoc Outpatient Counseling | ||||
| 185 North Main Street | Pontotoc | MS | 38863 | Outpatient Counseling |
| Pontotoc Medical Clinic | ||||
| 345 HWY 15 NORTH | Pontotoc | MS | 38863 | Rural Health clinic |
| ECRU MEDICAL CLINIC | ||||
| 202 MAIN STREET | ECRU | MS | 38841 | RURAL HEALTH CLINIC |
| NEW ALBANY MEDICAL CLINIC | ||||
| 400 DOCTORS DRIVE | NEW ALBANY | MS | 38652 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | WEBSTER HEALTH SERVICES, INC. USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE CARE. IF THE PATIENT'S INCOME LEVEL IS 0-150% OF THE FEDERAL POVERTY LEVEL (FPL), AN ADJUSTMENT OF 100% OF THE HOSPITAL'S STATED CHARGES WILL BE MADE. FOR PATIENTS WHOSE FAMILY GROSS INCOME IS EQUAL TO OR GREATER THAN 200% OF THE FPL, THE HOSPITAL MAY OFFER DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE. Part I, Line 6a: Pontotoc Health Services, Inc. community benefit information is included in the community benefit report of its parent company, North Mississippi Health Services, Inc. North Mississippi Health Services (NMHS) is a diversified regional health care organization, which serves 24 counties in north Mississippi and northwest Alabama from headquarters in Tupelo, MS. The NMHS organization covers a broad range of acute diagnostic and therapeutic services, offered through North Mississippi Medical Center in Tupelo; a community hospital system with locations in Eupora, Iuka, Pontotoc, West Point, Amory, MS, and Hamilton AL; North Mississippi Medical Clinics, a regional network of 27 primary and specialty clinics; and nursing homes. NMHS offers a comprehensive portfolio of managed care plans. |
| Part I, Line 7: | A cost to charge ratio was used for the amounts reported in the table for Line 7. The cost to charge ratio for Line 7 was calculated using Worksheet 2. |
| Part III, Line 2-4: | Pontotoc Health Services' financial statements do not include a footnote specifically concerning bad debt. Bad debt is shown as a separate line item on the face of the income statement. The amount of bad debt booked each year is based on a review of outstanding receivables and their age from date of service. The older the account, the higher the reserve percentage used to estimate bad debt. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluations and specific circumstances of the account. Pontotoc Health Services (PHS) follows the Catholic Health Association guidelines and does not include bad debt in any community benefit amounts. PHS believes that some portion of bad debt results from patients who could qualify for charity care but has no way of making an estimate of the amount and therefore has answered "zero" for Part III Line 3. THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2021. |
| Part III, Line 8: | The ratio of cost to charges used in the calculation of costs for Medicare was taken from the Medicare Cost Report. Lines 5, 6, & 7 do not include certain Medicare programs and costs and thus do not reflect all of the organization's revenues and costs associated with its participation in Medicare programs. Additional revenues and costs not reported on Lines 5, 6, & 7 include those associated with the organization's Medicare outpatient lab, ambulance and therapy services. Total revenues from these activities were $195,224 and total costs were $278,684 for a net shortfall of $83,460. When combined with the surplus reported on Line 7, the net surplus from all Medicare programs is $115,881. |
| Part III, Line 9b: | Pontotoc Health Services does not pursue collection of amounts determined to qualify as charity care. For patients who qualify for charity care or financial assistance and who are cooperating in good faith to resolve their discounted hospital bills, the hospitals may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts. |
| Part VI, Line 2: | Needs Assessment Pontotoc Health Services utilizes varied but complimentary methods to assess the health care needs of the community it serves. Pontotoc Health Services and Pontotoc County are included in the North Mississippi Health Services Community Health Assessment which is performed every three years and provides information on health status, utilization of health services, healthy beliefs and satisfaction with health care services. The North Mississippi Health Services Community Health Assessment covers the 24 county service area including Pontotoc County and provides information by county. In addition, the North Mississippi Health Services Community Relations Facilitator conducts routine visits with our internal and external stakeholders across the entire service area including Pontotoc County. The information gathered through several qualitative survey questions is used to determine our community's needs for the entire service area as well as the local service area for each hospital such as Pontotoc Health Services. |
| Part VI, Line 3: | Patient education of eligibility for assistance Explanations of the Pontotoc Health Services charity care policy are communicated in a variety of forms including signage at all admission and registration areas, on the web site, on bills and statements, and in admission packets. Financial counselors assist the patient and responsible parties with determining eligibility for government programs, primarily Medicaid, and charity care status. The patient can apply for charity care at any time from the date of service through the collection process and once qualified and approved all collection efforts are stopped. |
| Part VI, Line 4: | Community information Pontotoc Health Services serves more than 31,000 people in Pontotoc County, MS and the surrounding area. The population for the service area is projected to remain essentially flat over the next five years. According to the 2021 census, age demographics for the service area show that approximately 26% of the population is under 18 years of age, approximately 59% is between 18 and 64 years of age and that 15% is 65 or older. Caucasians make up 76% of the service area's population while African Americans make up 16% and Hispanics and others make up 8%. Median household income for 2016-2020 was $48,980 for the service area, which is above the overall average for Mississippi but significantly less than the nationwide average. The patient population for Pontotoc Health Services is covered by insurance or is uninsured as follows: 43.44% Medicare, 8.40% Medicare advantage, 7.00% Medicaid, 8.62% MS CAN, 20.28% private insurance with 12.26% uninsured. |
| Part VI, Line 5: | Promotion of community health Pontotoc Health Services has a commitment to a wide variety of community health outreach activities, which are coordinated by the community health coordinator and are staffed by Pontotoc Health Services employees who volunteer their time to help with these events and activities. The community health coordinator assists in educating the community on health-related issues by organizing and presenting various health fairs and seminars. These events are held at local businesses, schools and community organizations and address a variety of health-related topics. In addition, the hospital sponsors cholesterol, blood pressure, vision, memory, and heart-risk screening events, through which tests are made available to the public for a nominal fee or at no charge with the majority of the costs incurred absorbed by the hospital. |
| Part VI, Line 6: | Affiliated health care system As noted above, Pontotoc Health Services (PHS) is part of North Mississippi Health Services (NMHS). NMHS operates North Mississippi Medical Center, five other community hospitals in addition to PHS, as well as, North Mississippi Medical Clinics, which operates more than 36 medical clinics. Some of these facilities operate at an ongoing financial loss and NMHS provides operating funds in the form of working capital loans that have no set repayment date. These working capital loans have historically been converted to capital transfers in many cases, and therefore, the loans are forgiven such that the facility never makes repayment. NMHS does this in order to provide access to a variety of services across the service area and is an intentional part of its business model. The Community Health department that is part of NMMC coordinates a variety of community health activities across the service area as well. |
| Part VI, Line 7: | State filing of community benefit report Pontotoc Health Services does not file a community benefit report with the state of Mississippi as there is no requirement to do so. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bruce Toppin | ||||||||||||||
| Secretary | $335,135 | $15 | $48,350 | $0 | $3,567 | $0 | $8,666 | $0 | $395,733 | $0 | $0 | |||
| Brad J Bowlin | ||||||||||||||
| Physician | $10,797 | $0 | $4,169 | $0 | $455,902 | $0 | $0 | $0 | $421,047 | $15 | $19,874 | |||
| Michael S Spees | ||||||||||||||
| President & CEO | $966,324 | $25 | $147,398 | $0 | $17,100 | $0 | $6,149 | $0 | $1,136,996 | $0 | $0 | |||
| Leslia D Carter | ||||||||||||||
| Administrator | $2,318 | $0 | $4,719 | $0 | $180,968 | $0 | $0 | $0 | $171,534 | $15 | $2,382 | |||
| Sharon Nobles | ||||||||||||||
| Treasurer & CFO | $538,926 | $15 | $1,290 | $0 | $5,700 | $0 | $6,456 | $0 | $552,387 | $0 | $0 | |||
| Stephen Montgomery | ||||||||||||||
| Physician | $10,422 | $0 | $5,566 | $0 | $263,296 | $0 | $0 | $0 | $208,108 | $37,555 | $1,645 | |||
| Justin Smith | ||||||||||||||
| Physician | $4,962 | $0 | $4,548 | $0 | $308,908 | $0 | $0 | $0 | $223,488 | $75,711 | $199 | |||
| Curtis Glidewell | ||||||||||||||
| Physician | $5,010 | $0 | $4,308 | $0 | $297,451 | $0 | $0 | $0 | $213,801 | $74,133 | $199 | |||
| Corey N Brown | ||||||||||||||
| Physician | $0 | $0 | $5,922 | $0 | $289,716 | $0 | $0 | $0 | $246,082 | $20,000 | $17,712 | |||
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | NORTH MISSISSIPPI HEALTH SERVICES (NMHS) ESTABLISHES THE PAY OF THE CEO AND COMPENSATES HIM. NMHS USES THE FOLLOWING METHODS FOR ESTABLISHING THE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| PART I, LINE 4B: | The following people participated in or received payment from a supplemental nonqualified retirement plan: Michael Shane Spees - $93,057 Bruce Toppin - $37,995 |
| PART I, LINE 7 | PHYSICIAN BONUSES ARE ALL CONTINGENT INCOME DEPENDING UPON EITHER THE NUMBER OF SERVICES PROVIDED OR THE QUALITY OF PERFORMANCE PERFORMED. ALL ARE SPECIFIED IN THEIR CONTRACTS. ANY OTHER INCENTIVES ARE PAID OUT AS CONTINGENT INCOME ALSO BASED ON QUALITY AND FINANCIAL PERFORMANCE METRICS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Page 6, Part VI, Section A, Line 6: | Pontotoc Health Services, Inc. is a not-for-profit, nonstock, membership corporation of which North Mississippi Health Services, Inc. is the sole member and has sole voting control. |
| Form 990, Page 6, Part VI, Section A, Line 7a: | The Governance Committee of North Mississippi Health Services, Inc., which is made up of past Chairmen, nominate candidates for the Board. These candidates are then approved by the Board of North Mississippi Health Services, Inc. |
| Form 990, Page 6, Part VI, Section A, Line 7b: | The Board of North Mississippi Health Services, Inc. approves all transactions that exceed $1 million. |
| Form 990, Page 6, Part VI, Section b, Line 11b: | The Form 990 goes through a review process in the Accounting Department. The accountant for each facility reviews the returns for reasonableness and accuracy. All totals are tied to the audit reports, and all amounts are cross referenced to schedules or other parts of the actual return. Once the accountant reviews the return, the Accounting Supervisor and the Director of Accounting reviews. The Supervisor does a detailed review by checking the return for the same items that the accountant checked for. The Director then does a higher level review, reading the return for reasonableness and comparing prior year amounts to current year amounts. Finally, the Vice President of Finance reviews the return for reasonableness. The returns are then sent to the Executive VP/Treasurer to be reviewed. The Chief Financial Officer signs the return and it is then sent to the IRS. |
| Form 990, Page 6, Part VI, Section B, Line 12c: | An annual conflict of interest questionnaire is required to be completed by all officers and directors of the organization. The questionnaire is reviewed by North Mississippi Health Services, Inc.'s compliance officer and Conflict Committee. The Conflict Committee reviews conflict transactions and makes recommendations to the board of directors regarding conflict transactions in accordance with the organization's conflict of interest policy. All members of the Conflict Committee are prohibited from engaging in transactions with the organization or its affiliates during their tenure on the Conflict Committee and one year after their service concludes. |
| Form 990, Page 6, Part VI, Section B, Line 15 a&b: | AN INDEPENDENT COMPENSATION CONSULTING FIRM, KORN FERRY, IS USED TO HELP ESTABLISH THE COMPENSATION OF THE SENIOR EXECUTIVES. THE FIRM PRESENTS THEIR INDEPENDENT ANALYSIS, WHICH CONTAINS COMPARABILITY DATA, TO THE COMPENSATION COMMITTEE OF NORTH MISSISSIPPI HEALTH SERVICES, INC. (NMHS). THE COMPENSATION OF THE INDIVIDUALS ARE THEN APPROVED BY THE COMPENSATION COMMITTEE. THE SALARIES OF NMHS' SENIOR EXECUTIVES ARE THEN REVIEWED BY THE NMHS BOARD OF DIRECTORS. THE INDIVIDUAL WHOSE COMPENSATION IS BEING DISCUSSED IS NOT PRESENT DURING THE DISCUSSION OR APPROVAL OF THEIR COMPENSATION. THE DISCUSSIONS AND DECISIONS REGARDING THE COMPENSATION ARE DOCUMENTED IN THE MINUTES OF THE MEETINGS. COMPENSATION OF THESE INDIVIDUALS IS APPROVED ANNUALLY. |
| Form 990 Page 6, Part VI, Section C, Line 19: | The governing documents, conflict of interest policy, and financial statements are available to the public upon request. A consolidated statement of operations is available on the organization's website. |
| Form 990, Page 12, Part XI, Line 9: | Pension-related changes other than net periodic pension cost: 1,178,290 Increase in interest in net assets of affiliated foundation: 6,722 Contributed Capital: 1,030,495 Total other changes in net assets or fund balance = 2,215,507 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:2923311 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| North MS Management Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640762694 | Mgmt & Admin | DE | 501(c)(3) | 12-I | NMHS | Yes (true) |
| North MS Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640653269 | Mgmt Services | DE | 501(c)(3) | 12-II | NA | false |
| Clay County Medical Corporation | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640668465 | Hospital | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| Tishomingo Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640741047 | Hospital | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| North MS Medical Center Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640662976 | Hospital | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| North MS Medical Clinics Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640787918 | Med Clinics | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| Tupelo Service Finance Inc | ||||||||||
| 830 S GLOSTER STREET | Tupelo | MS | 38801 | 640508308 | Collections | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| Webster Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640819193 | Hospital | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| Marion Regional Medical Center Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640926753 | Hospital | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| North MS Emergency Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640780130 | ER Physicians | DE | 501(c)(3) | 10 | NMHS | Yes (true) |
| Monroe Health Services | ||||||||||
| 830 South Gloster Street | Tupelo | MS | 38801 | 320583236 | Hospital | DE | 501(c)(3) | 3 | NMHS | Yes (true) |
| Health Care Foundation of North MS | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640914704 | FUNDRAISING | DE | 501(C)(3) | 7 | NMHS | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | UBI Code VUBICodeVAmt | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| North MS Ambulatory | ||||||||||||||
| Surgery Center LLC | Tupelo | MS | 38801 | 200145190 | Ambulatory Surg | MS | NA | NONE | $0 | $0 | false | $0 | false | 0.00000 |
| Medical Imaging | ||||||||||||||
| LLC | Tupelo | MS | 38801 | 770647210 | Medical Imaging | MS | NA | NONE | $0 | $0 | false | $0 | false | 0.00000 |
| Cntr for Digestive | ||||||||||||||
| Health LLC | Tupelo | MS | 38801 | 201606438 | Digestive Care | MS | NA | NONE | $0 | $0 | false | $0 | false | 0.00000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| North MS Health Link Inc | ||||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640715886 | Medical Services | DE | NA | C Corp | $0 | $0 | 0.00000 | Yes (true) |
| North MS Enterprises Inc | ||||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640658059 | Medical Services | DE | NA | C Corp | $0 | $0 | 0.00000 | Yes (true) |
| Professional Practice Management Inc | ||||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 721390014 | Med Serv Mgmt | DE | NA | C Corp | $0 | $0 | 0.00000 | Yes (true) |
| Acclaim Inc | ||||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 721356116 | Hlth Care Claims | DE | NA | C Corp | $0 | $0 | 0.00000 | Yes (true) |
| North MS Support Services Inc | ||||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 260718275 | Support Services | DE | NA | C Corp | $0 | $0 | 0.00000 | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Comments