JEFFERSON DAVIS COMMUNITY HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: JEFFERSON DAVIS COMMUNITY HOSPITAL (EIN 72-1379812)
Tax period: 2010-08-01 to 2011-07-31
Filed: 2012-06-12
IRS object ID: 201221649349300447
Schema version: 2010v3.7
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-06-12T16:17:29-05:00	Timestamp
Tax Period End Date	2011-07-31	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	2010-08-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	721379812	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Prentiss Regional Hospital and	BusinessNameLine1
Business Name Line2	Extended Care Facility Inc	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	PREN	NameControl
Phone	6017924276	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	Post Office Box 1288	AddressLine1
City	Prentiss	City
State	MS	State
ZIP Code	394741288	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Reggie Magee	Name
Title	President	Title
Date Signed	2012-06-15	DateSigned

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Penny Wood CPA	Name
Phone	6019486700	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	Jefferson Davis Community Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Reggie Magee	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1102 Rose Street	AddressLine1
City	Prentiss	City
State	MS	State
ZIP Code	39474	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	13017519	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1997	YearFormation
State Legal Domicile	MS	StateLegalDomicile
Activity Or Mission Description	Prentiss Regional Hospital & Extended Care Facility, Inc. D/B/A Jefferson Davis Community Hospital (The Hospital) is an acute care hospital located in Prentiss, MS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	7	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	7	NbrIndependentVotingMembers
Total Nbr Employees	253	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	21630	ContributionsGrantsPriorYear
Contributions Grants Current Year	8815	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	12762497	ProgramServiceRevenuePriorYear
Program Service Revenue CY	12671914	ProgramServiceRevenueCY
Investment Income Prior Year	-57596	InvestmentIncomePriorYear
Investment Income Current Year	72	InvestmentIncomeCurrentYear
Other Revenue Prior Year	289461	OtherRevenuePriorYear
Other Revenue Current Year	336718	OtherRevenueCurrentYear
Total Revenue Prior Year	13015992	TotalRevenuePriorYear
Total Revenue Current Year	13017519	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	5889506	SalariesEtcPriorYear
Salaries Etc Current Year	5043946	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	7846610	OtherExpensePriorYear
Other Expenses Current Year	7180969	OtherExpensesCurrentYear
Total Expenses Prior Year	13736116	TotalExpensesPriorYear
Total Expenses Current Year	12224915	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-720124	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	792604	RevenuesLessExpensesCY
Total Assets BOY	5160132	TotalAssetsBOY
Total Assets EOY	3985857	TotalAssetsEOY
Total Liabilities BOY	3602676	TotalLiabilitiesBOY
Total Liabilities EOY	1744225	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1557456	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	2241632	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	PRENTISS REGIONAL HOSPITAL & EXTENDED CARE FACILITY, INC. D/B/A JEFFERSON DAVIS COMMUNITY HOSPITAL, (THE HOSPITAL) LOCATED IN PRENTISS, MS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES PRIMARILY FOR LOCAL RESIDENTS AND RESIDENTS OF THE SURROUNDING AREA. THE HOSPITAL IS LICENSED FOR 25 ACUTE CARE BEDS, 10 GERIATRIC PSYCHIATRIC UNIT BEDS, AND 60 NURSING HOME BEDS. THE HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT A REDUCED CHARGE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	true	SignificantChange
Expense	8491871	Expense
Revenue	12678622	Revenue
Description	Inpatient, outpatient, and emergency care services	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Description	The hospital provides medical care without charge or at a reduced charge to patients who meet certain criteria under its charity care policy. The amount of charges foregone for services and supplies furnished under the Hospital's charity care policy aggregated approximately $19,000 during fiscal year 2011. Charges foregone are netted against patient service revenue to arrive at net patient service revenue and are not reported as functional expenses on the tax return.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	1764218	Expense
Description	The Hospital grants credit without collateral to its patients. Charges deemed uncollectible during fiscal year 2011 were approximately $1,764,218.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	10256089	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
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	true	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	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	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	9	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	253	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	true	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	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	CHARLIE PHILLIPS	NamePerson
Telephone Number	6017924276	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1102 ROSE STREET	AddressLine1
City	Prentiss	City
State	MS	State
ZIP Code	39474	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
Jack Berry
Trustee	1.0	X	1277	0	0
Keith Bridges
Trustee	1.0	X	1100	0	0
Kathy Cloyd
Trustee	1.0	X	1100	0	0
Willis Graves
Trustee	1.0	X	1315	0	0
Lola Bass
Trustee	1.0	X	1425	0	0
Ralph Fortenberry
Trustee	1.0	X	1177	0	0
Reggie Magee
President	1.0	X	1064	0	0
Lee McCall
CEO	40.0		97198	0	11483	X
Paul Black
CFO	40.0		84000	0	0	X
Mary Curtis
Interim Administrator	40.0		72708	0	0	X
Earl Mahaffey MD
Clinic Physician	40.0		157429	0	6442		X
Joe Taylor
Nurse Practitioner	40.0		185114	0	7123		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	604907	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	25048	TotalOtherCompensation
Number Individuals GT100 K	2	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	true	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Correct Care
17438 Hard Hat Drive	COVINGTON	LA	70435	ER Physician	616637
Healthcare Services Group
3220 Tillman Drive	BENSALEM	PA	19020	Housekeeping	476622
Valley
PO Box 5454	JACKSON	MS	392885454	Food Services	347300
Physical Rehab Management Inc
1106 Pointe Cove	BRANDON	MS	39042	Physical Therapy	315809

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	4	NumberOfContractorsGT100K
Government Grants	8815	GovernmentGrants
Total Contributions	8815	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENUE	900099	12577320	12577320
RELATED RENTAL INCOME	900099	94594	94594

Field	Value	IRS element (for citing)
Total Program Service Revenue	12671914	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	72	TotalRevenueColumn
Exclusion	$72	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

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

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
MISCELLANEOUS REVENUE	900099	86107	$86,107
CAFETERIA REVENUE	722210	6708		6708
WELLNESS CENTER REVENUE	713940	37279	$37,279

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	206624	TotalRevenueColumn
Exclusion	$206,624	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	336718	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	13017519	TotalRevenueColumn
Related Or Exempt Function Income	12678622	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$330,082	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	97449	Total
Management And General	97449	ManagementAndGeneral

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	4189392	Total
Program Services	3704752	ProgramServices
Management And General	484640	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	39301	Total
Program Services	35438	ProgramServices
Management And General	3863	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	388847	Total
Program Services	339401	ProgramServices
Management And General	49446	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	328957	Total
Program Services	285111	ProgramServices
Management And General	43846	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	36880	Total
Management And General	36880	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	166874	Total
Management And General	166874	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	2625627	Total
Program Services	2475865	ProgramServices
Management And General	149762	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	11104	Total
Management And General	11104	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1270968	Total
Program Services	991184	ProgramServices
Management And General	279784	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	50173	Total
Program Services	2868	ProgramServices
Management And General	47305	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	158260	Total
Program Services	158260	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	11421	Total
Program Services	5113	ProgramServices
Management And General	6308	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	2740	Total
Program Services	1635	ProgramServices
Management And General	1105	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	118350	Total
Program Services	118350	ProgramServices

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	284083	Total
Program Services	284083	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	261304	Total
Management And General	261304	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT EXPENSE	1764218	1764218
TAXES AND LICENSES	315246	697	314549
REPAIRS AND MAINTENANCE	85298	85298
DUES AND SUBSCRIPTIONS	17871	3816	14055
BANK FEES	552		552

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	12224915	Total
Program Services	10256089	ProgramServices
Management And General	1968826	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	138192	BOY
EOY	394618	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	46000	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	1417834	BOY
EOY	326698	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	108896	BOY
EOY	0	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	30119	BOY
EOY	0	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	7446450	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	5001765	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2728768	BOY
EOY	2444685	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	690323	BOY
EOY	819856	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	5160132	BOY
EOY	3985857	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1533429	BOY
EOY	12474	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	1144979	BOY
EOY	973762	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	924268	BOY
EOY	757989	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3602676	BOY
EOY	1744225	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1557456	BOY
EOY	2241632	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1557456	BOY
EOY	2241632	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	5160132	BOY
EOY	3985857	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	792604	ReconcilationRevenueExpenses
Reconcilation Other Changes	-108428	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited
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

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	97900	OtherCostOrOtherBasis
Book Value	97900	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3454482	OtherCostOrOtherBasis
Depreciation	1494460	Depreciation
Book Value	1960022	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	38629	OtherCostOrOtherBasis
Depreciation	35223	Depreciation
Book Value	3406	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3805975	OtherCostOrOtherBasis
Depreciation	3427528	Depreciation
Book Value	378447	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	49464	OtherCostOrOtherBasis
Depreciation	44554	Depreciation
Book Value	4910	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	2444685	TotalOfBookValueLandBuildings
Financial Derivatives		FinancialDerivatives
Closely Held Equity Interests		CloselyHeldEquityInterests

Other Securities OtherSecurities

Field	Value	IRS element (for citing)
Description	INVESTMENT IN HPIC	Description
Book Value	819856	BookValue
Method Of Valuation	C	MethodOfValuation

Field	Value	IRS element (for citing)
Total Of Book Value Securities	819856	TotalOfBookValueSecurities
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
THIRD-PARTY PAYOR SETTLEMENTS	$412,980
DUE TO FGH	$345,009

Field	Value	IRS element (for citing)
Total Of Amounts	757989	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Schedule D, Part X, Line 2:	Identifier
Explanation	Management has evaluated the company's income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements.	Explanation

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	false	FPGReferenceFreeCare
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	false	AmountsBudgetedForCharityCare
Annual Community Benefit Report	false	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	11428	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	11428	NetCommunityBenefitExpense
Percent Of Total Expense	0.00110	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2895151	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1979983	DirectOffsettingRevenue
Net Community Benefit Expense	915168	NetCommunityBenefitExpense
Percent Of Total Expense	0.08750	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2906579	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1979983	DirectOffsettingRevenue
Net Community Benefit Expense	926596	NetCommunityBenefitExpense
Percent Of Total Expense	0.08860	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2906579	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1979983	DirectOffsettingRevenue
Net Community Benefit Expense	926596	NetCommunityBenefitExpense
Percent Of Total Expense	0.08860	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	false	BadDebtExpenseReported
Bad Debt Expense	$1,050,744	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	4195885	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4149644	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	46241	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	false	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	Prentiss Regional Hospital & ECF	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	1102 Rose Street	AddressLine1
City	Prentiss	City
State	MS	State
ZIP Code	39474	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Prentiss Regional Hospital & ECF	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
Part I, Line 7, Column f:	Bad debt expense of $1,764,218 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:	The cost-to-charge ratio per the organization's cost report was used to determine the amounts reported in Part I, Line 7a and b.
Part III, Line 4:	The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Hospital bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific cirmcumstances of the account. The Hospital offers a charity assistance application to patients upon admission. Accounts of patients who choose not to apply for charity care but who are unable to pay their medical bills are ultimately written off as bad debt based on the Hospital's bad debt policy. This policy does not include provisions for those patients who are known to qualify for charity care but do not apply for the assistance. The Hospital is unable to quantify the amount of bad debt that is related to patients who would qualify for charity care if applied for, but consider a majority of bad debt to consist of these accounts. The organization's bad debt expense at cost was calculated using the cost-to-charge ratio per the organization's cost report.
Part III, Line 8:	The Hospital uses its medicare cost report to determine the amount reported on Schedule H, Part III, Line 6.
Part V:	All health care facilities operated by the hospital are reported in Schedule H, Part V. The organization does not operate facilities that are not required to be licensed, registered or similarly recognized as a health care facility under state law.
Part VI, Line 2:	The Hospital assesses the needs of the community it serves by engaging in community programs, conducting and participating in community meetings, through dialogue with constituents, and by receiving feedback through evaluations of its services.	Needs Assessment
Part VI, Line 3:	Patients are informed about their eligibility for government and charity care assistance during the registration process.	Patient Education of eligibility for assistance
Part VI, Line 4:	The Hospital serves Jefferson Davis County, a rural area located in south central Mississippi with a population of approximately 12,000 and median household income of approximatley $27,000.	Community Information
Part VI, Line 5:	The Hospital educates and informs community members of various programs and services which increases community accessibility and involvement in healthcare programs offered by the Hospital.	Promotion of community health
Part VI, Line 6:	The organization is not part of an affiliated health care system.	Affiliated health care system
Part VI, Line 7:	The organization does not file a community benefit report with the state of Mississippi as there is no requirement to do so.	State filing of community benefit report

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	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 (4 entries)

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
Paul Black
84000	0	0	0	0	0	0	0	0	0	84000	0
Mary Curtis
72708	0	0	0	0	0	0	0	0	0	72708	0
Earl Mahaffey MD
157429	0	0	0	0	0	3120	0	3322	0	163871	0
Joe Taylor
185114	0	0	0	0	0	2496	0	4627	0	192237	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	Schedule J, Part II:	Identifier
Explanation	Paul Black, CFO, was paid $84,000 by Rural Health Management, Inc., an unrelated organization, for services rendered to the hospital. Mary Curtis, Interim Administrator, was paid $72,708 by Curtis Management, Inc., an unrelated organization, for services rendered to the hospital.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifier	ExplanationExplanation
Form 990, Page 2, Part III, Line 3:	As of July 1, 2011, Prentiss Regional Hospital & Extended Care Facility, Inc. d/b/a Jefferson Davis Community Hospital (the Hospital) entered into a five year lease agreement with Forrest County General Hospital (FGH). As a result of this agreement, the Hospital subleased the assets previously under lease by the Hospital from Jefferson Davis County as well as personal property owned by the Hospital outside the lease with the County to FGH (this includes the main hospital facilities). During the lease term, FGH will operate and manage the Hospital.
Form 990, Page 3, Part IV, Line 12:	The Hospital obtained separate, independent audited financial statements for the period ending June 30,2011. The Hospital was then part of a consolidated, independent audited financial statement for the period ending September 30, 2011, the year end of a related entity, Forrest County General Hospital. The Form 990 reports activity through July 31, 2011, the Hospital's current fiscal year end.
Form 990, Page 3, Part IV, Line 20b:	The Hospital entered into a lease agreement with Forrest County General Hospital (FGH) as of July 1, 2011. In accordance with generally accepted auditing standards, Hospital activity occuring after June 30, 2011 will be included in the audited financial statements of FGH. Therefore, the Hospital's audited financial statements attached to the Form 990 are as of June 30, 2011.
Form 990, Page 6, Part VI, Section A, Line 3:	As a result of the lease agreement described in Part III, Line 3, FGH manages the day-to-day operations of the Hospital.
Form 990, Page 6, Part VI, Section B, Line 11B:	The Form 990 is reviewed by the Hospital's CEO and CFO prior to filing with the IRS.
Form 990, Page 6, Part VI, Section B, Line 12:	Annual disclosure forms are required to be completed by all board members, officers, and highest compensated employees. The questionnaires are reviewed by the organization's CEO and any persons with conflicts of interest are prohibited from participating in the board's deliberations and decisions in the transaction in which the conflict exists.
Form 990, Page 6, Part VI, Section B, Line 15:	Compensation of top management officials and other officers of the organization is determined by the Board of Directors based on comparability data received from salary surveys conducted by the Mississippi Hospital Association.
Form 990, Page 6, Part VI, Section C, Line 19:	The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.
Form 990, Page 12, Part XI, Line 5:	Transfer of assets to Forrest County General Hospital <108,428>
Form 990, Page 12, Part XII, Line 2B:	The organization's financial statements were audited by an independent auditor. However, due to the lease agreement with Forrest County General Hospital (FGH), the financial statements of the organization were audited through June 30, 2011, and not July 31, 2011, the organization's fiscal year end. Activity for the month of July 2011 is included in a consolidated financial statement of FGH. Since all information reported on the organization's 2010 Form 990 was not included in the organization's separate audited financial statement, Line 2b is being answered "no."