2011-08-11T10:34:06-05:00 2010-09-30 BKD LLP 190 E Capitol Street Suite 500 Jackson MS 392012190 990 2009-10-01 640751410 Pontotoc Health Services Inc PONT 6623773977 830 South Gloster Street Tupelo MS 38801 Joe Reppert 2011-08-15 Penny Wood CPA 6019486700 2009 2016-02-24 21:20:13Z Joe Reppert 830 South Gloster Street Tupelo MS 38801 18527714 false X www.nmhs.net/pontotoc/ X 1987 DE Pontotoc Health Services, Inc. operates a 25 bed hospital and a 44 bed nursing home located in Pontotoc, Mississippi. 4 4 224 17 0 0 55475 31006 16694823 17734249 1156 1192 700097 761267 17451551 18527714 0 0 0 0 8942301 9043130 0 0 0 9579934 10106844 18522235 19149974 -1070684 -622260 8330437 7972155 1680226 2290119 6650211 5682036 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. false false 18108379 17769644 NMMC-Pontotoc serves Pontotoc County and the surrounding area. In fiscal year 2010, there were over 600 inpatient admissions, over 12,700 emergency department visits, and over 5,100 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. 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 75% 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 $1,569,000 in fiscal year 2010. Based on the gross charges provided to charity patients compared to total hospital gross charges, 5% of all services in fiscal year 2010 were provided on a charity basis. The net cost of charity care provided by NMMC-Pontotoc was approximately $728,000 in fiscal year 2010. 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. 18108379 true true false false false false false false false true true false false false false false false false false false true false false true false false false false false false false false false false false false false true false false false true 8 0 true 224 true false false false false false false false false false 4 4 false false false false true true true true true false false false true true true true true true true false X JOE REPPERT 6623773977 830 SOUTH GLOSTER STREET Tupelo MS 38801 Conwell Duke 1.0 X 0 0 0 Bill Jackson 1.0 X 0 0 0 Marsha Reeder 1.0 X 0 0 0 Jerry Robbins 1.0 X 0 0 0 Wayne Stokes 1.0 X 0 0 0 Gerald Wages 1.0 X 0 848369 8020 Bruce Toppin 1.0 X 0 298009 8020 Joe Reppert 1.0 X 0 452988 2860 Samuel Mansour 40.0 X 388728 0 8020 Fred B Hood 40.0 X 122440 0 5597 Melissa Lindsey 40.0 X 112667 0 2249 Robert Jones X 0 223281 6430 623835 1822647 41196 3 true true false Keystone Emergency 3150 Lenox Park Blvd Ste 109 MEMPHIS TN 38115 ER Physician Fees 601826 North MS Emergency Services 830 South Gloster Street TUPELO MS 38801 ER Physician Fees 201926 4MD2 Inc 1028 Highland Lakes Trace BIRMINGHAM AL 35242 ER Physician Fees 164992 Pontotoc Family Medical Clinic 345 Highway 15 North PONTOTOC MS 38863 Swingbed Phys. Fees 100876 4 30537 469 31006 Net Patient Service Revenue 900099 17712514 17712514 Related Rental Income 900099 21735 21735 17734249 1192 1192 0 0 0 0 0 0 Employee Drugs 900099 494127 494127 Medicare part D Revenue 900099 208180 208180 Cafeteria Income 900004 35395 35395 23565 23565 761267 18527714 17769644 0 727064 0 0 0 0 0 0 6534243 5885341 648902 286936 286936 1757183 1757183 464768 418188 46580 229487 229487 0 39562 39562 0 0 0 2026209 2026209 16168 16168 1791629 1791629 169328 169328 0 284762 284762 11898 11898 0 32129 32129 0 0 679562 679562 77064 77064 Bad Debt Expense 4218626 4218626 Taxes and Licenses 209649 209649 Other Expenses 114224 114224 Repairs & Maintenance 54473 54473 Collection Fees 53220 53220 98854 98854 19149974 18108379 1041595 0 665 665 433477 771887 3450852 2995820 171364 234923 10912121 7300212 3550731 3611909 723348 356951 8330437 7972155 1532957 2016914 147269 273205 1680226 2290119 X 6568868 5592706 81343 89330 6650211 5682036 8330437 7972155 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 60613 60613 4777624 2669905 2107719 5952742 4526568 1426174 121142 103739 17403 3611909 0 Due to Related Parties 273205 273205 18527714 19149974 -622260 -345915 -345915 -968175 18545124 18545124 -17410 -17410 18527714 19167384 17410 17410 19149974 19149974 Schedule D, Part X, Line 2: Management has evaluated their 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. Schedule D, Part XI, Line 8: Pension-related changes other than net periodic pension cost <$353,902> Increase in interest in net assets of affiliated foundation $7,987 Schedule D, Part XII, Line 4b: Rental expenses are netted with rental income on the return but included in expenses on the financial statements. Schedule D, Part XIII, Line 2d: Rental expenses are netted with rental income on the return but included in expenses on the financial statements. true true X true X 75. false false true true false true true 691999 691999 0.04630 3100635 4510853 -1410218 0.09430 3792634 4510853 -718219 0.04800 3792634 4510853 -718219 0.04800 false 1860683 0 4729654 4533955 195699 X true true Pontotoc Health Services Inc

176 South Main Street Pontotoc MS 38863

X X Pontotoc Health Services Nursing Home

176 South Main Street Pontotoc MS 38863

Long Term Acute Care Facility 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). 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. 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. Not Applicable Bad Debt Expense of $4,218,626 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). 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. The bad debt expense at cost in Part III Line 2 was calculated using the cost to charge ratio from Worksheet 2. 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. 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 $605,609 and total costs were $463,748 for a net surplus of $141,861. When combined with the surplus reported on Line 7, the net surplus from all Medicare programs is $337,560. Pontotoc Health Services does not pursue collection of amounts determined to qualify as charity care. 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. 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. Pontotoc Health Services serves more than 29,000 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. 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 of $38,518 for the service area 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: 42.30% Medicare, 20.82% Medicaid, 18.15% private insurance with 18.73% uninsured. Not Applicable How the organization's hospitals further its exempt purpose by promoting the health of the community: 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. 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. States Community Benefit Report Filed: 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. X X X X X false true false false false false false false false Gerald Wages 0 444917 0 177119 0 226333 0 4900 0 3120 0 856389 Bruce Toppin 0 224620 0 66958 0 6431 0 4900 0 3120 0 306029 Robert Jones 0 173881 0 47898 0 1502 0 3310 0 3120 0 229711 Samuel Mansour 369246 0 18450 0 1032 0 4900 0 3120 0 396748 0 Joe Reppert 0 336586 0 96866 0 19536 0 0 0 2860 0 455848 Part I, Line 4b: Participants: Gerald Wages $208,380 Joseph A. Reppert $8,461 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. 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 11A: 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. (NMHS). 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 7, Part VII, Column(E): Estimate of average hours worked per week devoted to related organization: Gerald Wages 1 hr Tishomingo Health Services, Inc. 1 hr Clay County Medical Corporation 1 hr Webster Health Services, Inc. 1 hr Marion Regional Medical Center 35 hrs North Mississippi Health Services, Inc. Bruce Toppin 1 hr North Mississippi Medical Clinics, Inc. 1 hr Tupelo Service Finance 1 hr Tishomingo Health Services, Inc. 1 hr Clay County Medical Corporation 1 hr Webster Health Services, Inc. 1 hr Marion Regional Medical Center 1 hr North Mississippi Medical Center, Inc. 1 hr North Mississippi Emergency Services, Inc. 1 hr North Mississippi Management Services, Inc. 30 hrs North Mississippi Health Services, Inc. Robert Jones 1 hr Clay County Medical Corporation 39 hrs Webster Health Services, Inc. Joe Reppert 1 hr North Mississippi Medical Clinics, Inc. 1 hr Tupelo Service Finance 1 hr Tishomingo Health Services, Inc. 1 hr Clay County Medical Corporation 1 hr Webster Health Services, Inc. 1 hr Marion Regional Medical Center 1 hr North Mississippi Medical Center, Inc. 1 hr North Mississippi Emergency Services, Inc. 1 hr North Mississippi Management Services, Inc. 30 hrs North Mississippi Health Services, Inc. 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