PONTOTOC HEALTH SERVICES INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
PONTOTOC HEALTH SERVICES INC (EIN 64-0751410)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-08-11
IRS object ID
201502239349302020
Schema version
2013v4.0
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

FieldValueIRS element (for citing)
Return2015-08-11T16:23:18-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1190 E Capitol Street Ste 500AddressLine1
CityJacksonCity
StateMSState
ZIP Code392012190ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN640751410EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pontotoc Health Services IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of% JOE REPPERTInCareOfNm
Business Name ControlPONTBusinessNameControlTxt
Phone6623773977PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1830 South Gloster StreetAddressLine1
Address Line2SuiteAddressLine2
CityTupeloCity
StateMSState
ZIP Code38801ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOE REPPERTPersonNm
Person TitleTREASURERPersonTitleTxt
Phone6623773977PhoneNum
Signature2015-08-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonPenny Wood CPAPreparerPersonNm
PTINP00328157PTIN
Phone6623773977PhoneNum
Preparation2015-08-15PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJoe ReppertPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1830 South Gloster StreetAddressLine1
CityTupeloCity
StateMSState
ZIP Code38801ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$18,904,828GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.nmhs.net/pontotoc/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1987FormationYr
Legal Domicile StateDELegalDomicileStateCd
Activity Or MissionPontotoc Health Services, Inc. operates a 25 bed hospital and a 44 25 bed hospital and a 44 bed nursing home located in Pontotoc, Mississippi.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee216TotalEmployeeCnt
Total Volunteers78TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$43,122PYContributionsGrantsAmt
CY Contributions Grants$111,834CYContributionsGrantsAmt
PY Program Service Revenue$18,223,221PYProgramServiceRevenueAmt
CY Program Service Revenue$18,329,834CYProgramServiceRevenueAmt
PY Investment Income$10,113PYInvestmentIncomeAmt
CY Investment Income$627CYInvestmentIncomeAmt
PY Other Revenue$433,285PYOtherRevenueAmt
CY Other Revenue$462,533CYOtherRevenueAmt
PY Total Revenue$18,709,741PYTotalRevenueAmt
CY Total Revenue$18,904,828CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$10,122,182PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,302,431CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$10,876,774PYOtherExpensesAmt
CY Other Expenses$11,559,936CYOtherExpensesAmt
PY Total Expenses$20,998,956PYTotalExpensesAmt
CY Total Expenses$20,862,367CYTotalExpensesAmt
PY Revenues Less Expenses-$2,289,215PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,957,539CYRevenuesLessExpensesAmt
Total Assets BOY$8,973,839TotalAssetsBOYAmt
Total Assets EOY$8,822,175TotalAssetsEOYAmt
Total Liabilities BOY$3,968,609TotalLiabilitiesBOYAmt
Total Liabilities EOY$7,044,059TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,005,230NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,778,116NetAssetsOrFundBalancesEOYAmt
MissionPONTOTOC 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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$19,874,749ExpenseAmt
Revenue$18,373,754RevenueAmt
DescNMMC-Pontotoc serves Pontotoc County and the surrounding area. In fiscal year 2014, there were 376 inpatient admissions, 9,793 emergency department visits, and 4,905 outpatient 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

FieldValueIRS element (for citing)
DescOne 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 charity care policy states that NMMC-Pontotoc will provide necessary hospital services to patients free of charge with household income levels based on the median income for Mississippi compared to the median income nationally. The Mississippi Adjusted Poverty Guidelines is approximately 77% of the federal poverty rate. The policy further provides patients with household income levels above the Mississippi Adjusted Poverty Guidelines will be liable for no more than the amount that their household income exceeds the applicable federal poverty guidelines. 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 $750,696 in fiscal year 2014. Based on the gross charges provided to charity patients compared to total hospital gross charges, 1.9% of all services in fiscal year 2014 were provided on a charity basis. The net cost of charity care provided by NMMC-Pontotoc was approximately $301,000 in fiscal year 2014. 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
FieldValueIRS element (for citing)
Total Program Service Expenses$19,874,749TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document7IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee216EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJOE REPPERTPersonNm
Phone6623773977PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1830 SOUTH GLOSTER STREETAddressLine1
CityTupeloCity
StateMSState
ZIP Code38801ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Mark Bourne
Director1.00.0Yes (X)
Tommy Patterson
Director1.00.0Yes (X)
Ernie Wright
Director1.00.0Yes (X)
Phyllis High
Director1.00.0Yes (X)
Teresa Montgomery
Director1.00.0Yes (X)
Jerry Robbins
Director1.00.0Yes (X)
Julie Henry
Director1.00.0Yes (X)
Bruce Toppin
Secretary1.039.0Yes (X)$0$319,681$8,961
Joe Reppert
Treasurer1.039.0Yes (X)$0$584,935$9,228
Rodger Brown
President4.036.0Yes (X)$0$400,883$8,628
Fred B Hood
Administrator40.00.0$135,975$0$6,862Yes (X)
Melissa Lindsey
Pharmacist40.00.0$121,065$0$5,897Yes (X)
Brad J Bowlin
Physician40.00.0$330,051$0$10,428Yes (X)
Teresa L Fitts
Nurse Practitioner40.00.0$118,423$0$2,515Yes (X)
Robert Jones
Former Treasurer0.040.0$0$194,798$7,889Yes (X)
Timothy H Moore
Former President5.035.0$0$214,088$7,040Yes (X)
Gerald Wages
Former President0.08.0$0$123,958$2,464Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$705,514TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,838,343TotReportableCompRltdOrgAmt
Total Other Compensation$69,912TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
Correct Care
17438 Hard Hat DriveCOVINGTONLA70435ER Physician Fees$682,585
North Mississippi Medical Clinics
830 S Gloster StTUPELOMS38801Physician Fees$372,741
North MS Emergency Services
830 South Gloster StreetTUPELOMS38801ER Physician Fees$122,827
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$111,834GovernmentGrantsAmt
All Other Contributions$0AllOtherContributionsAmt
Total Contributions$111,834TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net Patient Service Revenue900099$18,321,320$18,321,320
Related Rental Income900099$8,514$8,514
FieldValueIRS element (for citing)
Total Program Service Revenue$18,329,834TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$627TotalRevenueColumnAmt
Exclusion$627ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Employee Drugs900099$376,385$376,385
CAFETERIA REVENUE900099$43,920$43,920
REBATE INCOME900099$27,316$27,316

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,912TotalRevenueColumnAmt
Exclusion$14,912ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$462,533OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,904,828TotalRevenueColumnAmt
Related Or Exempt Func Income$18,373,754RelatedOrExemptFuncIncomeAmt
Exclusion$419,240ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,644,782TotalAmt
Program Services$6,011,354ProgramServicesAmt
Management And General$633,428ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$303,952TotalAmt
Program Services$303,952ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,881,345TotalAmt
Program Services$1,881,345ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$472,352TotalAmt
Program Services$428,654ProgramServicesAmt
Management And General$43,698ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$219,010TotalAmt
Management And General$219,010ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,910TotalAmt
Management And General$1,910ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$29,577TotalAmt
Management And General$29,577ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,815,379TotalAmt
Program Services$2,815,379ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$14,567TotalAmt
Program Services$14,567ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$304,837TotalAmt
Program Services$304,837ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$195,050TotalAmt
Program Services$195,050ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$273,938TotalAmt
Program Services$273,938ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$9,108TotalAmt
Program Services$9,108ProgramServicesAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$25,454TotalAmt
Program Services$25,454ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,054,367TotalAmt
Program Services$1,054,367ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$59,995TotalAmt
Management And General$59,995ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
Bad Debt Expense$4,604,141$4,604,141
MEDICAL SUPPLIES$1,394,343$1,394,343
Taxes and Licenses$242,334$242,334
REPAIRS & MAINTENANCE$102,660$102,660

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$213,266TotalAmt
Program Services$213,266ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$20,862,367TotalAmt
Program Services$19,874,749ProgramServicesAmt
Management And General$987,618ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$765BOYAmt
EOY$765EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$350,298BOYAmt
EOY$516,821EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,930,940BOYAmt
EOY$3,431,058EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$245,847BOYAmt
EOY$230,913EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$14,535,087LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$10,248,493LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,059,857BOYAmt
EOY$4,286,594EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$386,132BOYAmt
EOY$356,024EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,973,839BOYAmt
EOY$8,822,175EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,231,721BOYAmt
EOY$3,640,738EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,736,888BOYAmt
EOY$3,403,321EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,968,609BOYAmt
EOY$7,044,059EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,897,686BOYAmt
EOY$1,664,431EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$107,544BOYAmt
EOY$113,685EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,005,230BOYAmt
EOY$1,778,116EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,973,839BOYAmt
EOY$8,822,175EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$1,957,539ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$1,269,575OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$60,613OtherCostOrOtherBasisAmt
Book Value$60,613BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,956,443OtherCostOrOtherBasisAmt
Depreciation$3,711,528DepreciationAmt
Book Value$1,244,915BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,387,123OtherCostOrOtherBasisAmt
Depreciation$6,416,675DepreciationAmt
Book Value$2,970,448BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$130,908OtherCostOrOtherBasisAmt
Depreciation$120,290DepreciationAmt
Book Value$10,618BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,286,594TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Due to Related Parties$2,919,321
DUE TO THIRD PARTY PAYORS$484,000
FieldValueIRS element (for citing)
Total Liability$3,403,321TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$14,315,880TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$4,604,141OtherRevenueAmt
Revenue Not Reported-$4,604,141RevenueNotReportedAmt
Revenue Subtotal$18,920,021RevenueSubtotalAmt
Other Revenues Not Included-$15,193OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$15,193RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$18,904,828TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$16,273,419TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$15,193OtherExpensesIncludedAmt
Expenses Not Reported$15,193ExpensesNotReportedAmt
Expenses Subtotal$16,258,226ExpensesSubtotalAmt
Other Expenses Not Included$4,604,141OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$4,604,141ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$20,862,367TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part X, Line 2:The System applies Financial Accounting Standards Board (FASB) Acocunting Standards Codification (ASC) Topic 740 for Income Taxes ("Topic 740"), which clarifies the accounting for uncertainty in income tax positions and provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There has been no impact on the System's financial statements as a result of Topic 740.
Part XI, Line 2d:Bad debt expense is netted with revenue on the financial statements but included in expenses on the return.
Part XI, Line 4b:Rental expenses are netted with rental income on the return but included in expenses on the financial statements.
Part XII, Line 2d:Rental expenses are netted with rental income on the return but included in expenses on the financial statements.
Part XII, Line 4b:Bad debt expense is netted with revenue on the financial statements but included in expenses on the return.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other77.FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CarefalseFPGReferenceDiscountedCareInd
Free Care Medically IndigentfalseFreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$300,928TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$300,928NetCommunityBenefitExpnsAmt
Total Expense0.01850TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,856,318TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,654,797DirectOffsettingRevenueAmt
Net Community Benefit Expns-$1,798,479NetCommunityBenefitExpnsAmt

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,157,246TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,654,797DirectOffsettingRevenueAmt
Net Community Benefit Expns-$1,497,551NetCommunityBenefitExpnsAmt
Total Expense0.01850TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,157,246TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,654,797DirectOffsettingRevenueAmt
Net Community Benefit Expns-$1,497,551NetCommunityBenefitExpnsAmt
Total Expense0.01850TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$4,604,141BadDebtExpenseAmt
Reimbursed By Medicare$5,000,611ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$4,891,949CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$108,662MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pontotoc Health Services IncBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1176 South Main StreetAddressLine1
CityPontotocCity
StateMSState
ZIP Code38863ZIPCode
FieldValueIRS element (for citing)
Website Addresshttp://www.nmhs.net/pontotoc/WebsiteAddressTxt
State License16-091StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Pontotoc Health Services IncBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
OtherYes (X)OtherInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs AddressedfalseAllNeedsAddressedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (true)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care77.FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CarefalseFPGUsedDetermEligDscntCareInd
Explained BasisYes (true)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Insurance StatusYes (X)InsuranceStatusInd
Uninsured DiscountYes (X)UninsuredDiscountInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Attached To InvoiceYes (X)AttachedToInvoiceInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Posted In Admission OfficeYes (X)PostedInAdmissionOfficeInd
Available On RequestYes (X)AvailableOnRequestInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pontotoc Health Services Nursing HomeBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1176 South Main StreetAddressLine1
CityPontotocCity
StateMSState
ZIP Code38863ZIPCode
FieldValueIRS element (for citing)
FacilityLong Term Acute Care FacilityFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (19 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3c:Pontotoc Health Services, Inc. does not use the Federal Poverty Guidelines to determine eligibility for discounted care. The Federal Poverty Guidelines are used only for free care. Discounted care is given to anyone regardless of income level if they do not have insurance. Pontotoc Health Services will provide its prevalent managed care discount to any patient that meets Pontotoc Health Services' definition of uninsured (an individual having no third party coverage by commercial third party insurer, an ERISA plan, Medicare, Medicaid, SCHIP, Champus or other coverage for all or part of their bill).
Part I, Line 6a:Pontotoc Health Services' 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, MS, and Hamilton AL; North Mississippi Medical Clinics, a regional network of more than 36 primary and specialty clinics; and nursing homes. NMHS offers a comprehensive portfolio of managed care plans.
Part I, Line 7, Column (f):Bad Debt Expense of $4,604,141 was included in total expense on Form 990, Part IX, Line 25, Column (A), but was subtracted from total expense for purposes of calculating the percentage of total expense in column (F).
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 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. Bad debt expense reported in Part III Line 2 matches the amount of bad debt expense reported on Pontotoc Health Services' audited financial statements. Pontotoc Health Services (PHS) follows the Catholic Health Association guidelines and does not include bad debt in any community benefit amounts. PHS, however, 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.
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 $618,791 and total costs were $593,828 for a net surplus of $24,963. When combined with the surplus reported on Line 7, the net surplus from all Medicare programs is $133,625.
Part III, Line 9b:Pontotoc Health Services does not pursue collection of amounts determined to qualify as charity care.
Part V, Line 1j:A description of health indicators that affect the overall health of the community enabling access to health care.
Part V, Line 3:Telephone and mail surveys involving various people in the community were conducted and the findings were summarized in the CHNA report. Pontotoc Health Services' Community Health Department also works closely with the local and state departments of health, which has resulted in several projects concerning obesity and smoking cessation.
Part V, Line 4:Pontotoc Health Services is part of the North Mississippi Health Services' diversified regional healthcare system. North Mississippi Health Services operates five 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, and Marion Regional Medical Center.
Part V, Line 5c:http://www.nmhs.net/documents/NMMC2013Report-PontotocCounty.pdf
Part V, Line 7:There were numerous health needs identified in the CHNA report as the state of Mississippi ranks last in the U.S. regarding overall health. It is not financially feasible for Pontotoc Health Services to address each of the needs identified. Instead, Pontotoc Health Services has prioritized and addressed the needs that cause the biggest concern for the community. Currently, Pontotoc Health Services is addressing the most pressing needs of obesity (including child hood obesity), smoking cessation, and diabetes.
Part V, Line 11:Pontotoc Health Services, Inc. does not use the Federal Poverty Guidelines to determine eligibility for discounted care. The Federal Poverty Guidelines are used only for free care. Discounted care is given to anyone regardless of income level if they do not have insurance. Pontotoc Health Services will provide its prevalent managed care discount to any patient that meets Pontotoc Health Services' definition of uninsured (an individual having no third party coverage by commercial third party insurer, an ERISA plan, Medicare, Medicaid, SCHIP, Champus or other coverage for all or part of their bill).
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 30,000 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 2013 census, age demographics for the service area show that approximately 26% of the population is under 18 years of age, approximately 60% is between 18 and 64 years of age and that 14% is 65 or older. Caucasians make up 78% of the service area's population while African Americans make up 15% and Hispanics and others make up 7%. Median household income for 2009-2013 was $39,899 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: 39.98% Medicare, 16.96% Medicaid, 24.67% private insurance with 18.39% 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, four 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. The community benefit report is available online at nmhs.net.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
Bruce Toppin
Secretary$0$246,286$0$66,246$0$7,149$0$4,833$0$4,128$0$328,642
Joe Reppert
Treasurer$0$420,953$0$145,378$0$18,604$0$5,100$0$4,128$0$594,163
Robert Jones
Former Treasurer$0$190,523$0$88$0$4,187$0$3,761$0$4,128$0$202,687
Timothy H Moore
Former President$0$182,000$0$1,211$0$30,877$0$4,334$0$2,706$0$221,128
Brad J Bowlin
Physician$329,805$0$30$0$216$0$5,100$0$5,328$0$340,479$0
Gerald Wages
Former President$0$64,272$0$59,686$0$0$0$2,464$0$0$0$126,422
Rodger Brown
President$0$255,650$0$73,213$0$72,020$0$5,100$0$3,528$0$409,511

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 4b:FormAndLineReferenceDesc
ExplanationParticipant: Joe Reppert $17,704 Rodger Brown $44,575 Terms & Conditions: North Mississippi Health Services, Inc. (NMHS) Adopted the management deferred annuity plan (the Plan) on October 1, 1998. Participants in the plan are designated by the compensation committee of the board of directors of NMHS. At the beginning of each plan year, NMHS shall pay a contribution, less witholding for taxes, to the participant's annuity contract, which is a deferred annuity contract selected, owned, and controlled by the participant. The contribution is determined by multiplying the participant's compensation in the preceding plan year by a percentage set forth in appendix b of the plan. A participant is terminated from the plan on the earliest of: (1) the date the board determines the employee is no longer a participant; (2) the date the participant retires; (3) the date that the participant dies; or (4) the date the participant no longer is employed by NMHS for reasons other than retirement or death.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 Treasurer 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, The Hay Group, is used to help establish the compensation of the CEO, Executive Director, other officers, and key employees. The firm presents their independent analysis, which contains comparability data, to the Compensation Committee of North Mississippi Health Services, Inc. In addition to this, the VP of Human Resources obtains another independent analysis from another compensation consulting firm in order to verify the information provided by The Hay Group. The compensation of the individuals are then approved by the Compensation Committee. The salaries of NMHS' CEO and senior leadership 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 (1,275,718) Increase in interest in net assets of affiliated foundation 6,141 Other Changes 2 Total other changes in net assets or fund balance = (1,269,575)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationInd
North MS Management Services Inc
830 S Gloster StreetTupeloMS38801640762694Mgmt & AdminDE501(c)(3)11-INMHSfalse
North MS Health Services Inc
830 S Gloster StreetTupeloMS38801640653269Mgmt ServicesDE501(c)(3)11-IINMHSfalse
Clay County Medical Corporation
830 S Gloster StreetTupeloMS38801640668465HospitalDE501(c)(3)3NMHSfalse
Tishomingo Health Services Inc
830 S Gloster StreetTupeloMS38801640741047HospitalDE501(c)(3)3NMHSfalse
North MS Medical Center Inc
830 S Gloster StreetTupeloMS38801640662976HospitalDE501(c)(3)3NMHSfalse
North MS Medical Clinics Inc
830 S Gloster StreetTupeloMS38801640787918Med ClinicsDE501(c)(3)3NMHSfalse
Tupelo Service Finance Inc
844 Cliff Gookin BlvdTupeloMS38801640508308CollectionsDE501(c)(3)3NMHSfalse
Webster Health Services Inc
830 S Gloster StreetTupeloMS38801640819193HospitalDE501(c)(3)3NMHSfalse
Marion Regional Medical Center Inc
830 S Gloster StreetTupeloMS38801640926753HospitalDE501(c)(3)3NMHSfalse
North MS Emergency Services Inc
830 S Gloster StreetTupeloMS38801640780130ER PhysiciansDE501(c)(3)9NMHSfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Entity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
North MS Health Link Inc
830 S Gloster StreetTupeloMS38801640715886Medical ServicesDENMHSC Corpfalse
North MS Enterprises Inc
830 S Gloster StreetTupeloMS38801640658059Medical ServicesDENMHSC Corpfalse
Professional Practice Management Inc
830 S Gloster StreetTupeloMS38801721390014Med Serv MgmtDENMMCIC Corpfalse
Acclaim Inc
830 S Gloster StreetTupeloMS38801721356116Hlth Care ClaimsDEHealthlinkC Corpfalse
North MS Support Services Inc
830 S Gloster StreetTupeloMS38801260718275Support ServicesDENMHSC Corpfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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