PONTOTOC HEALTH SERVICES INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PONTOTOC HEALTH SERVICES INC (EIN 64-0751410)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-14
- IRS object ID
- 201402269349301275
- Schema version
- 2012v2.3
- 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) |
|---|---|---|
| Timestamp | 2014-08-14T09:49:41-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 190 E Capitol Street Ste 500 | AddressLine1 |
| City | Jackson | City |
| State | MS | State |
| ZIP Code | 392012190 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 640751410 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pontotoc Health Services Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % JOE REPPERT | InCareOfName |
| Name Control | PONT | NameControl |
| Phone | 6623773977 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 South Gloster Street | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | Tupelo | City |
| State | MS | State |
| ZIP Code | 38801 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOE REPPERT | Name |
| Title | TREASURER | Title |
| Phone | 6623773977 | Phone |
| Date Signed | 2014-08-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Penny Wood CPA | Name |
| Phone | 6019486700 | Phone |
| Date Prepared | 2014-08-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Joe Reppert | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 South Gloster Street | AddressLine1 |
| City | Tupelo | City |
| State | MS | State |
| ZIP Code | 38801 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 18709741 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.nmhs.net/pontotoc/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1987 | YearFormation |
| State Legal Domicile | DE | StateLegalDomicile |
| Activity Or Mission Description | Pontotoc Health Services, Inc. operates a 25 bed hospital and a 44 bed nursing home located in Pontotoc, Mississippi. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 216 | TotalNbrEmployees |
| Total Nbr Volunteers | 82 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 3275734 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 43122 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17695929 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 18223221 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -20232 | InvestmentIncomePriorYear |
| Investment Income Current Year | 10113 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 595040 | OtherRevenuePriorYear |
| Other Revenue Current Year | 433285 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21546471 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18709741 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10058478 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10122182 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10439138 | OtherExpensePriorYear |
| Other Expenses Current Year | 10876774 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 20497616 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20998956 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1048855 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2289215 | RevenuesLessExpensesCY |
| Total Assets BOY | 10162586 | TotalAssetsBOY |
| Total Assets EOY | 8973839 | TotalAssetsEOY |
| Total Liabilities BOY | 5704876 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3968609 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4457710 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5005230 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 20085023 | Expense |
| Revenue | 18266388 | Revenue |
| Description | NMMC-Pontotoc serves Pontotoc County and the surrounding area. In fiscal year 2013, there were 479 inpatient admissions, 10,373 emergency department visits, and 4,913 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. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | 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 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 74% 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 $524,177 in fiscal year 2013. Based on the gross charges provided to charity patients compared to total hospital gross charges, 1.5% of all services in fiscal year 2013 were provided on a charity basis. The net cost of charity care provided by NMMC-Pontotoc was approximately $237,000 in fiscal year 2013. 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 20085023 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 6 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 216 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JOE REPPERT | NamePerson |
| Telephone Number | 6623773977 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 SOUTH GLOSTER STREET | AddressLine1 |
| City | Tupelo | City |
| State | MS | State |
| ZIP Code | 38801 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| Mark Bourne | |||||||||
| Director | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Tommy Patterson | |||||||||
| Director | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Ernie Wright | |||||||||
| Director | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Phyllis High | |||||||||
| Director | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Teresa Montgomery | |||||||||
| Director | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Jerry Robbins | |||||||||
| Director | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Julie Henry | |||||||||
| Director | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Bruce Toppin | |||||||||
| Secretary | 1.0 | 39.0 | 0 | 342260 | 8840 | X | |||
| Joe Reppert | |||||||||
| Treasurer | 1.0 | 39.0 | 0 | 630943 | 8840 | X | |||
| Timothy H Moore | |||||||||
| President (Oct-Jul) | 6.0 | 34.0 | 0 | 205105 | 6742 | X | |||
| Rodger Brown | |||||||||
| President (Jul-Sept) | 6.0 | 34.0 | 423957 | 8456 | X | ||||
| Samuel Mansour | |||||||||
| Physician | 40.0 | 0.0 | 320386 | 0 | 8840 | X | |||
| Fred B Hood | |||||||||
| Administrator | 40.0 | 0.0 | 140653 | 0 | 6882 | X | |||
| Melissa Lindsey | |||||||||
| Pharmacist | 40.0 | 0.0 | 117697 | 0 | 5752 | X | |||
| Brad J Bowlin | |||||||||
| Physician | 40.0 | 0.0 | 319549 | 0 | 10040 | X | |||
| Teresa L Fitts | |||||||||
| Nurse Practitioner | 40.0 | 0.0 | 122644 | 0 | 2420 | X | |||
| Robert Jones | |||||||||
| Former Treasurer | 0.0 | 40.0 | 195924 | 7659 | X | ||||
| Gerald Wages | |||||||||
| Former President | 0.0 | 40.0 | 214043 | 3846 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1020929 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2012232 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 78317 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| North Mississippi Medical Clinics | |||||
| 830 South Gloster Street | TUPELO | MS | 38801 | Physician Fees | 427035 |
| Keystone Healthcare | |||||
| Crescent Center | MEMPHIS | TN | 38119 | ER Physician Fees | 362831 |
| North MS Emergency Services | |||||
| 830 South Gloster Street | TUPELO | MS | 38801 | ER Physician Fees | 119893 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Government Grants | 43122 | GovernmentGrants |
| Total Contributions | 43122 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient Service Revenue | 900099 | 18206035 | 18206035 |
| Related Rental Income | 900099 | 17186 | 17186 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 18223221 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 613 | TotalRevenueColumn |
| Exclusion | $613 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 9500 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 9500 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9500 | TotalRevenueColumn |
| Exclusion | $9,500 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| Employee Drugs | 900099 | 372838 | $372,838 | |
| Medicare part D Revenue | 900099 | 11822 | $11,822 | |
| Cafeteria Revenue | 900004 | 43167 | 43167 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5458 | TotalRevenueColumn |
| Exclusion | $5,458 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 433285 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18709741 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18266388 | RelatedOrExemptFunctionIncome |
| Exclusion | $400,231 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6918192 | Total |
| Program Services | 6290606 | ProgramServices |
| Management And General | 627586 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 764921 | Total |
| Program Services | 764921 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1931449 | Total |
| Program Services | 1931449 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 507620 | Total |
| Program Services | 449273 | ProgramServices |
| Management And General | 58347 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 195495 | Total |
| Management And General | 195495 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6361 | Total |
| Management And General | 6361 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32063 | Total |
| Management And General | 32063 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2365890 | Total |
| Program Services | 2365890 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23370 | Total |
| Program Services | 23370 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 542495 | Total |
| Program Services | 542495 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180816 | Total |
| Program Services | 180816 | ProgramServices |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 270094 | Total |
| Program Services | 270094 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14905 | Total |
| Program Services | 14905 | ProgramServices |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26314 | Total |
| Program Services | 26314 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1031132 | Total |
| Program Services | 1031132 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -5919 | Total |
| Management And General | -5919 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Bad Debt Expense | 4542442 | 4542442 |
| MEDICAL SUPPLIES | 1140626 | 1140626 |
| Taxes and Licenses | 220318 | 220318 |
| REPAIRS & MAINTENANCE | 88728 | 88728 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 201644 | Total |
| Program Services | 201644 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20998956 | Total |
| Program Services | 20085023 | ProgramServices |
| Management And General | 913933 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 765 | BOY |
| EOY | 765 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 388952 | BOY |
| EOY | 350298 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3094177 | BOY |
| EOY | 2930940 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 227621 | BOY |
| EOY | 245847 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14253983 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9194126 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5731121 | BOY |
| EOY | 5059857 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 719950 | BOY |
| EOY | 386132 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10162586 | BOY |
| EOY | 8973839 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4695470 | BOY |
| EOY | 2231721 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1009406 | BOY |
| EOY | 1736888 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5704876 | BOY |
| EOY | 3968609 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4356982 | BOY |
| EOY | 4897686 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100728 | BOY |
| EOY | 107544 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4457710 | BOY |
| EOY | 5005230 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10162586 | BOY |
| EOY | 8973839 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2289215 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 2836735 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 60613 | OtherCostOrOtherBasis |
| Book Value | 60613 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4950001 | OtherCostOrOtherBasis |
| Depreciation | 3468000 | Depreciation |
| Book Value | 1482001 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9106019 | OtherCostOrOtherBasis |
| Depreciation | 5606637 | Depreciation |
| Book Value | 3499382 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 137350 | OtherCostOrOtherBasis |
| Depreciation | 119489 | Depreciation |
| Book Value | 17861 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5059857 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Due to Related Parties | $1,614,888 |
| DUE TO THIRD PARTY PAYORS | $122,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1736888 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 14178480 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -4542442 | OtherRevenues |
| Revenue Not Rptd F990 | -4542442 | RevenueNotRptdF990 |
| Revenue Subtotal | 18720922 | RevenueSubtotal |
| Other Revenues Not Included | -11181 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -11181 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 18709741 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 16467695 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 11181 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 11181 | ExpensesNotRptdF990 |
| Expenses Subtotal | 16456514 | ExpensesSubtotal |
| Other Expenses Not Included | 4542442 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 4542442 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20998956 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part X, Line 2: | The Hospital 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 Hospital'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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 74. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | false | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 237007 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 237007 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01440 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2894169 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4646879 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1752710 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3131176 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4646879 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1515703 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01440 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3131176 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4646879 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1515703 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01440 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $4,542,442 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 4729582 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4567043 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 162539 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pontotoc Health Services Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 176 South Main Street | AddressLine1 |
| City | Pontotoc | City |
| State | MS | State |
| ZIP Code | 38863 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pontotoc Health Services Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Other | X | Other |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 74. | FPGFreePercent |
| Uses FPG Discounted | false | UsesFPGDiscounted |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pontotoc Health Services Nursing Home | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 176 South Main Street | AddressLine1 |
| City | Pontotoc | City |
| State | MS | State |
| ZIP Code | 38863 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | Long Term Acute Care Facility | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 30 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 $4,542,442 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 $877,691 and total costs were $695,648 for a net surplus of $182,043. When combined with the surplus reported on Line 7, the net surplus from all Medicare programs is $344,582. | |
| 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: | The CHNA report was not posted on Pontotoc Health Services' website by 9/30/2013. However, the report has since been posted to the website at http://www.nmhs.net/communityreport.php. | |
| 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: | 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. | Needs Assessment |
| Part VI, Line 3: | 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. | Patient education of eligibility for assistance |
| Part VI, Line 4: | 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 2010 census, age demographics for the service area show that approximately 27% of the population is under 18 years of age, approximately 60% is between 18 and 64 years of age and that 13% is 65 or older. Caucasians make up 81% of the service area's population while African Americans make up 15% and Hispanics and others make up 4%. Median household income for 2007-2011 was $38,574 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: 40.47% Medicare, 16.93% Medicaid, 24.09% private insurance with 18.51% uninsured. | Community information |
| Part VI, Line 5: | 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. | Promotion of community health |
| Part VI, Line 6: | 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 30 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. | Affiliated health care system |
| Part VI, Line 7: | 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. | State filing of community benefit report |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bruce Toppin | ||||||||||||
| Secretary | 0 | 238114 | 0 | 97237 | 0 | 6909 | 0 | 5000 | 0 | 3840 | 0 | 351100 |
| Joe Reppert | ||||||||||||
| Treasurer | 0 | 406866 | 0 | 206154 | 0 | 17923 | 0 | 5000 | 0 | 3840 | 0 | 639783 |
| Samuel Mansour | ||||||||||||
| Physician | 301956 | 0 | 398 | 0 | 18032 | 0 | 5000 | 0 | 3840 | 0 | 329226 | 0 |
| Robert Jones | ||||||||||||
| Former Treasurer | 184227 | 6216 | 5481 | 3819 | 3840 | 203583 | ||||||
| Timothy H Moore | ||||||||||||
| President (Oct-Jul) | 0 | 147989 | 0 | 39643 | 0 | 17473 | 0 | 3462 | 0 | 3280 | 0 | 211847 |
| Brad J Bowlin | ||||||||||||
| Physician | 314640 | 0 | 4693 | 0 | 216 | 0 | 5000 | 0 | 5040 | 0 | 329589 | 0 |
| Gerald Wages | ||||||||||||
| Former President | 77207 | 109934 | 26902 | 3558 | 288 | 217889 | ||||||
| Rodger Brown | ||||||||||||
| President (Jul-Sept) | 246866 | 107501 | 69590 | 5000 | 3456 | 432413 | ||||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part I, Line 4b: | Identifier |
| Explanation | Participant: Joe Reppert $17,023 Rodger Brwon $42,861 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. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| 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 5: | Pension-related changes other than net periodic pension cost 2,829,919 Increase in interest in net assets of affiliated foundation 6,816 Total other changes in net assets or fund balance = 2,836,735 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| North MS Management Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640762694 | Mgmt & Admin | DE | 501(c)(3) | 11-I | NA | false |
| North MS Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640653269 | Mgmt Services | DE | 501(c)(3) | 11-II | NA | false |
| Clay County Medical Corporation | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640668465 | Hospital | DE | 501(c)(3) | 3 | NA | false |
| Tishomingo Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640741047 | Hospital | DE | 501(c)(3) | 3 | NA | false |
| North MS Medical Center Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640662976 | Hospital | DE | 501(c)(3) | 3 | NA | false |
| North MS Medical Clinics Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640787918 | Med Clinics | DE | 501(c)(3) | 3 | NA | false |
| Tupelo Service Finance Inc | ||||||||||
| 844 Cliff Gookin Blvd | Tupelo | MS | 38801 | 640508308 | Collections | DE | 501(c)(3) | 3 | NA | false |
| Webster Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640819193 | Hospital | DE | 501(c)(3) | 3 | NA | false |
| Marion Regional Medical Center Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640926753 | Hospital | DE | 501(c)(3) | 3 | NA | false |
| North MS Emergency Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640780130 | ER Physicians | DE | 501(c)(3) | 9 | NA | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| North MS Health Link Inc | ||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640715886 | Medical Services | DE | NA | C Corp |
| North MS Enterprises Inc | ||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640658059 | Medical Services | DE | NA | C Corp |
| Professional Practice Management Inc | ||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 721390014 | Med Serv Mgmt | DE | NA | C Corp |
| Acclaim Inc | ||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 721356116 | Hlth Care Claims | DE | NA | C Corp |
| North MS Support Services Inc | ||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 260718275 | Support Services | DE | NA | C Corp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
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