2017-07-17T16:16:44-05:00 2016-08-31 BKD LLP 190 E Capitol Street Ste 500 Jackson MS 392012190 990 2015-09-01 452896080 BAPTIST MEDICAL CENTER - LEAKE INC % AMELIA H CONNER BAPT 6019685130 1225 North State Street Jackson MS 39202 WILLIAM F THOMPSON CORP VP 6019683080 2017-07-15 true Dustin W Taylor CPA P01250644 6019486700 2017-07-15 2015 2021-01-29 14:40:06Z DAVID JACKSON PO BOX 909 CARTHAGE MS 39051 23018159 false X MBHS.ORG X 2011 MS BAPTIST MEDICAL CENTER - LEAKE IS A 25-BED CRITICAL ACCESS HOSPITAL LOCATED IN CARTHAGE, MS, OFFERING A COMPREHENSIVE RANGE OF SERVICES TO PATIENTS. 6 1 339 27 0 24518 31104 20678150 22571475 4945 1820 483033 413760 21190646 23018159 8850 4800 0 0 8682320 9426966 0 0 0 14041588 17178892 22732758 26610658 -1542112 -3592499 30870772 31263225 29587038 32987812 1283734 -1724587 THE MISSION OF BAPTIST MEDICAL CENTER - LEAKE (BAPTIST LEAKE) IS TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING EXCELLENT HEALTH CARE SERVICES BY CONTINUALLY IMPROVING THE QUALITY OF PATIENT CARE AND UTILIZING RESOURCES EFFICIENTLY AND EFFECTIVELY. false false 24895852 4800 23013812 BAPTIST LEAKE OFFERS ACUTE CARE AND SWING BED, AS WELL AS MRI, VASCULAR ULTRASOUND, ECHOCARDIOGRAPHY, WOUND CARE AND PODIATRY SERVICES. BAPTIST LEAKE'S LEVEL IV EMERGENCY ROOM IS STAFFED BY QUALIFIED PHYSICIANS AND ANCILLARY STAFF. FAMILY HEALTH CARE SERVICES ARE OFFERED FROM THREE CLINIC LOCATIONS IN WALNUT GROVE, MS AND CARTHAGE, MS, A 44-BED SKILLED NURSING HOME WHICH CLOSED OPERATIONS ON APRIL 30, 2016. A SENIOR LIFE INTENSIVE OUTPATIENT PROGRAM PROVIDES SUPPORT AND TREATMENT FOR ADULTS OVER AGE 55 WITH EMOTIONAL OR MENTAL DIFFICULTIES. A SWING BED PROGRAM OFFERS A MUCH NEEDED SERVICE FOR PATIENTS WHO NO LONGER NEED ACUTE HOSPITAL CARE, BUT DO NEED SKILLED NURSING OR THERAPY CARE TO COMPLETE THEIR RECOVERY. BAPTIST LEAKE RECORDED 26,641 HOSPITAL PATIENT VISITS DURING ITS 2016 FISCAL YEAR. THIS CONSISTED OF 868 INPATIENT ADMISSIONS WITH 6,680 DAYS OF CARE PROVIDED, 15,681 OUTPATIENT VISITS, AND 10,092 EMERGENCY ROOM VISITS. IN ADDITION, BAPTIST LEAKE RECORDED 10,463 DAYS OF CARE TO ITS NURSING HOME RESIDENTS. FINALLY, THE THREE PRIMARY CARE CLINICS PROVIDED SERVICES ON 26,611 OCCASIONS. ALTHOUGH EQUITABLE PAYMENT FOR SERVICES IS ESSENTIAL TO THE ORGANIZATION'S FINANCIAL VIABILITY, BAPTIST LEAKE RECOGNIZES THAT NOT ALL INDIVIDUALS POSSESS THE RESOURCES REQUIRED TO REIMBURSE THE HOSPITAL FOR ALL SERVICES PROVIDED. KEEPING ITS COMMITMENT TO THE COMMUNITY, BAPTIST LEAKE PROVIDES FREE CARE AND SUBSIDIZED CARE WITHIN EXISTING RESOURCES WHERE THE NEED FOR SUCH CARE EXISTS. FOR FISCAL YEAR 2016, TRADITIONAL CHARITY CARE CHARGES FOREGONE BASED ON ESTABLISHED RATES WERE APPROXIMATELY $319,500 AND DISCOUNTS PROVIDED TO UNINSURED PATIENTS BASED ON ESTABLISHED RATES WERE APPROXIMATELY $1,001,016. ALL OF 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. 24895852 true false false false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false true false false false false false true true false false false true 92 0 339 true false false false false false false false false false false X 6 1 false false false false true true true true true false false true true true true true true true true false X AMELIA H CONNER 6012671221 1100 HWY 16E CARTHAGE MS 39051 WILLIAM B GRETE CORP VP - GENERAL COUNSEL 6.0 34.0 X X 0 392470 47867 BOBBIE K WARE VP - CHIEF NURSING OFFICER 6.0 34.0 X X 0 358517 29288 MICHAEL K STEVENS VP - BUSINESS DEVELOPMENT 4.0 36.0 X X 0 253619 42903 CHRIS ANDERSON PRESIDENT & CEO 4.0 36.0 X X 0 651793 165315 WILLIAM F THOMPSON CORP VP - CFO 4.0 36.0 X X 0 348599 90750 ARTHUR SKIP JERNIGAN DIRECTOR 1.0 0.0 X 0 0 0 DARYL WEAVER CEO 40.0 0.0 X 0 181361 24855 DAVID JACKSON CFO - COMMUNITY HOSPITALS 20.0 20.0 X 101922 127698 0 MICHAEL D MAPLES CORP VP- CHIEF MEDICAL OFFICER 4.0 36.0 X 0 359605 104720 LEE ANN FOREMAN VP HUMAN RESOURCES 4.0 36.0 X 0 205396 58583 WILLIAM LOGAN PHYSICIAN 40.0 0.0 X 171245 0 0 WILLIAM D PERRY MD PHYSICIAN 40.0 0.0 X 349043 0 0 CHARLES M HARDIN NURSE PRACTITIONER 40.0 0.0 X 145369 0 0 ANGELA ATKINSON NURSE PRACTITIONER 40.0 0.0 X 115529 0 0 LINDA PICKERING NURSE PRACTITIONER 40.0 0.0 X 105157 0 0 RUSSELL W YORK FORMER CFO 8.0 32.0 X 0 118400 0 988265 2997458 564281 6 true true false CORRECT CARE INC 1111 NORTH CAUSEWAY BLVD MANDEVILLE LA 70471 PHYSICIAN FEES/HOSPI 1567879 BRASFIELD GORRIE LLC PO BOX 11407 BIRMINGHAM AL 352460351 CONSTRUCTION 1395269 WOUND CARE SPECIALISTS PO BOX 71849 CHICAGO IL 606941849 MEDICAL SERVICES 582175 PERFORMANCE THERAPY 921 WEST BEACON STREET PHILADELPHIA MS 39350 PHYSICAL THERAPY SVC 362745 MEDICAL PRACTICE SOLUTIONS 1600 NORTH STATE ST SUITE 400 JACKSON MS 39202 BILLING/MGMT SERVICE 237056 10 31104 31104 Net Patient Service Revenue 900099 22464319 22464319 Related Rental Revenue 900099 107156 107156 22571475 1820 1820 0 0 0 0 0 0 0 0 0 Food Sales 722320 2527 2527 Other Revenue 900099 411233 411233 413760 23018159 22982708 4347 4800 4800 0 0 0 50648 50648 0 7852843 7852843 183915 183915 804644 804644 534916 534916 1647792 1171362 476430 16020 16020 8190 8190 0 0 0 3588204 3270452 317752 57666 21935 35731 1151802 1007379 144423 0 0 369122 355497 13625 18260 9214 9046 0 28956 13811 15145 831062 831062 0 2731696 2498687 233009 2732250 2732250 Bad Debt Expense 1959954 1959954 Medical Supplies 847935 847935 Taxes and Licenses 617232 490548 126684 Repairs and Maintenance 505964 266386 239578 66787 38262 28525 26610658 24895852 1714806 0 1823324 741985 0 0 0 0 2494862 2022616 0 0 0 0 0 0 184115 165028 120336 154312 29755824 6800785 25533407 22955039 0 0 0 0 0 0 0 0 714728 5224245 30870772 31263225 1259462 1335112 0 0 0 0 0 0 0 0 0 0 0 0 26270200 27260200 2057376 4392500 29587038 32987812 X 1283734 -1724587 0 0 0 0 1283734 -1724587 30870772 31263225 X -3592499 584178 X false true X true false X 2648413 2648413 20521017 2770754 17750263 6586394 4030031 2556363 22955039 DUE FROM THIRD-PARTY PAYORS 1617000 Other Receivables 109465 ASSETS LIMITED AS TO USE 3497780 5224245 0 Professional Liab Ins Reserve 2943500 DUE TO THIRD-PARTY PAYORS 699000 DUE TO RELATED ENTITY 750000 4392500 Schedule D, Part X, Line 2: 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. true true X true X true X true true true false true true 990651 990651 0.04020 3207499 3099775 107724 0.00440 4198150 3099775 1098375 0.04460 14800 14800 0.00060 1042773 260248 782525 0.03170 12600 12600 0.00050 1070173 260248 809925 0.03280 5268323 3360023 1908300 0.07740 7200 7200 0.00030 7200 7200 0.00030 true 1959954 533107 10699801 10733335 -33534 X true true 1 1 BAPTIST MEDICAL CENTER - LEAKE 310 ELLIS STREET CARTHAGE MS 39051 SEE SECTION C 13-187 X X X X BAPTIST MEDICAL CENTER - LEAKE 1 false false true X X X X X X X X X 15 true false false true X SEE SECTION C X true 15 true SEE SECTION C false true X 100 199. X X X false true X X X true X SEE SECTION C X SEE SECTION C X X X true X false X X true X false false Part V, Section A, Line 1: http://www.mbhs.org/locations/baptist-medical-center-leake/ Part V, Section B, Line 5: The hospital engaged an independent consulting firm, the Solutions Group, to conduct surveys among specific area stakeholders including businesses and healthcare providers and governmental agencies. The firm also completed surveys of the community citizens at large. Part V, Section B, Line 7a: A COPY OF THE CHNA IS LOCATED AT: https://www.mbhs.org/locations/baptist-medical-center-leake/community-heal th-needs/ Part V, Section B, Line 10a: https://www.mbhs.org/locations/baptist-medical-center-leake/community-heal th-needs/ Part V, Section B, Line 11: Baptist Medical Center Leake does not have the resources to address each community health need identified through the CHNA. BMCL expends all of its resources providing care and services typically associated with critical access hospitals. Part V, Section B, Line 13h: The Hospital reserves the right to provide additional assistance to any patient determined to be in financial need. Part V, Section B, Line 16a&b: https://mbhs.patientcompass.com/RA/General/BillingPolicies/_FinancialAssis tance Part V, Section B, Line 16i: If at any time during the admission, discharge, billing, or collection process a patient informs the hospital representative that they are unable to pay their bill, then the patient will be referred to a payment coordinator who will inform them of the availability of financial assistance/charity care for those who qualify and offer the patient the opportunity to complete an application. Part V, Section B, Line 22d: ADJUSTMENTS DETERMINED ON A CASE-BY-CASE BASIS ARE MADE TO STATED CHARGES FOR ALL UNINSURED PATIENTS OTHER THAN THOSE WHO QUALIFY FOR CHARITY CARE (THOSE WITH INCOME LEVELS LESS THAN 100% OF FPG) OR THOSE WHO QUALIFY FOR A PRORATED DISCOUNT (THOSE WITH INCOME LEVELS 101%-199% OF FPG). Part I, Line 3c: BAPTIST MEDICAL CENTER - LEAKE, INC. (BAPTIST - LEAKE) USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. IF THE PATIENT'S INCOME LEVEL IS 0-100% OF THE FEDERAL POVERTY LEVEL, AN ADJUSTMENT OF 100% OF THE HOSPITAL'S STATED CHARGES WILL BE MADE. IF THE PATIENT'S INCOME LEVEL IS 101-199% OF THE FEDERAL POVERTY LEVEL, A DISCOUNT WILL APPLY. THE DISCOUNT WILL BE PRO-RATED BASED ON THE PATIENT'S GROSS FAMILY INCOME AS A PERCENTAGE OF THE FPL. PATIENTS WHOSE FAMILY GROSS INCOME IS EQUAL TO OR GREATER THAN 200% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT A DISCOUNTED RATE. Part I, Line 4: The financial assistance and charity care policy of Baptist - Leake does not specifically provide for free or discounted care to the "medically indigent." However, the hospital reserves the right to provide additional assistance to any patient determined to be in financial need Part I, Line 6a: A description of the organization's programs and services that promote the health of the community served is included in the footnotes to the organization's audited financial statements. Baptist - Leake is part of a consolidated financial statement, which includes the activities of its parent company, Mississippi Baptist Health Systems, and subsidiaries. Part I, Line 7G: N/A Part I, Line 7, Column (f): Bad debt expense of $1,959,954 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 medicaid cost report was used to determine the amounts reported on Part I, Line 7b. The amounts reported on Part I, Line 7a were determined by using a cost to charge ratio, which was calculated using information from the medicaid cost report as adjusted for amounts included elsewhere on line 7b. Line 7a includes costs for providing charity care only. However, during the fiscal year ending August 31, 2016, Baptist - Leake provided discounts of $1,001,016 to uninsured individuals receiving care as well. The estimated cost based on the cost to charge ratio used for Line 7a was $750,962, which is 3.05% of total expense. Baptist - Leake feels that providing services to the uninsured and offering these discounts is an important part in keeping its commitment to the community, and therefore, should be included as a cost of providing community benefit. Part II: Baptist - Leake is involved in the community in many ways by offering volunteer help and health information to the county residents. Volunteer services include employee involvement in numerous events and board member service on various committees, including: Leake County Chamber of Commerce, Carthage Main Street, Leake County Health Network (Network of healthcare providers and businesses that offer numerous health information events for Leake County residents), Carthage Rotary Club, Leake County Health Foundation (Raises funds for local residents battling terminal illnesses needing assistance), Keep Leake Beautiful, and Leake County Schools Career Center Advisory Board. Baptist - Leake shows its support for the community by also sponsoring numerous community activities and events. Sponsorships include sponsor of the Leake County Sheriff's Rodeo, the local city park baseball/softball program, sponsor of the Leake County 4-H program livestock show, sponsor of the Life Time Achievement Award given at the Leake County Chamber of Commerce Banquet, sponsor of the local volunteer fire department banquet and fundraiser to help offset cost of equipment, sponsor of the Baptist Medical Center Leake Heart of MS 5K Run, sponsor of the Leake County D.A.R.E. program, and sponsor of the local Fashion Advantage Fashion Show. Baptist - Leake supports local schools in numerous ways, including support of numerous area scholarships, yearbook support, and support of athletic programs. Baptist - Leake was also the sponsor of the local high school rodeo and hosted 17 high school seniors in the Leake County Chamber of Commerce "Career for a Day" program. Baptist - Leake hosted Health Science students from the local high school on a tour of both Baptist - Leake and Jackson and provided an information session on health care. The students were also offered shadowing opportunities in various areas of Baptist - Leake. Baptist - Leake works with the Special Education Department of Leake County Schools in an ongoing volunteer program, helping teach the students life skills. This includes mock interviews to help students with their interview skills. Baptist - Leake also provided free physicals for area special need students to participate in the Special Olympics. Baptist - Leake participates in health fairs at local businesses and industries in the county offering free screenings to their associates. Over 500 employees are screened each year. Baptist - Leake also provided free health screenings to over 400 senior citizens at the Leake County Senior Citizens Day. In addition, Baptist - Leake provided health programs for local churches, businesses, and civic clubs. Baptist - Leake provides facility, lab needs, and staff for a charity clinic held once a month which offers health care to over 150 local residents. Baptist - Leake also offers discount health care to the Leake County Detention Center inmates. Baptist - Leake supports the women of Leake County in hosting "Go Red for Women" day, offering heart healthy snacks and heart healthy tips, and sponsoring the "Be Your Best Self Essay" scholarship at the Leake County Distinguished Young Woman program. Baptist - Leake Extended Care Facility hosted over 500 children for trick or treat on Halloween night. Over 30 employees volunteered for the event. In the town of Walnut Grove, Baptist - Leake sponsored the new fitness trail and the South of the River Roux festival. Baptist - Leake started a volunteer program with 27 members. These retired individuals answer the hospital switch board and help patients and visitors with directions throughout the facility. Baptist - Leake provides a health related article to the local newspaper each month. Part III, Lines 2-4: The amount reported in Part III, Line 2 as bad debt expense matches the amount of bad debt expense reported on Baptist - Leake's audited financial statements. To estimate the amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy for line 3, Baptist - Leake used research based on Kaisar Foundation studies of uninsured rates in Leake County compared to Mississippi along with Census Bureau publications regarding various levels of poverty rates in Leake County. However, bad debt amounts have not been included in community benefit. Baptist - Leake's audited financial statements do not include a footnote specifically discussing bad debt expense, accounts receivable, or allowance for doubtful accounts. However, Baptist - Leake reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients, and other. Baptist - Leake provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluations and specific circumstances of the account. 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. Charity care arises from a deliberate policy by a health care organization to forego payment for certain services provided to low income patients. Hospital participation in Medicare is voluntary. Medicare shortfalls occur when the payments received by Medicare are less than the costs of providing care to Medicare patients. Payment rates for Medicare are currently set below the cost of providing care resulting in underpayment. The organization must bridge the gap created by government underpayments. A majority of Baptist - Leake's patients are Medicare patients. The organization feels that providing care for the elderly and poor is an essential part of the community benefit standard and as such, any Medicare underpayments represent the real cost of serving its community and should count as quantifiable community benefit for tax compliance purposes. Part III, Line 9b: Patients may apply for financial assistance to cover all or part of their hospital bills. Baptist - Leake does not pursue collection of amounts determined to qualify as charity care. However, the collection policy is the same for all patients once the charity or financial discount has been applied. Part VI, Line 2: Needs Assessment Mississippi Baptist Health Systems, Inc., the parent company of Baptist Medical Center - Leake, Inc., assesses the health care needs of the community it serves primarily by performing consumer surveys each month. The surveys are conducted on a random selection of consumers from the 17 counties in the Baptist Health Systems service area and measure Baptist Health Systems' performance against other major hospitals in the area, as well as provide information on utilization of health services, satisfaction with health care services, and public perception of Baptist Health Systems as a whole. Baptist Health Systems engages New South Research to conduct the surveys via telephone and also conducts surveys of participants following community seminars and educational classes. Part VI, Line 3: Patient education of eligibility for assistance Baptist - Leake has representatives from the Mississippi Division of Medicaid on campus once per month to assist patients with obtaining coverage. Also, there are general customer service personnel available. Information containing a financial assistance statement is given to each patient upon admission or during pre-admission, is posted at each registration booth, and is also available online. If at any time during the admission, discharge, billing, or collection process a patient informs a hospital representative that they are unable to pay their bill and need financial assistance, then the patient is referred to a payment coordinator who informs the patient of the availability of financial assistance/charity care for those who qualify and offers the patient the opportunity to complete an application. Part VI, Line 4: Community Information Baptist - Leake's primary service area consists of Leake County, which is located in central Mississippi. Leake County consists of approximately 24,000 people. Age demographics for the area show that approximately 26% of the population is under 18 years of age, approximately 59% is between 18 and 64 years of age and that 15% is 65 or older. Median household income of $33,452 for Leake County is below the overall average for Mississippi and significantly less than the nationwide average. Insurance coverage is lacking for much of the population with between 25-27% estimated to be uninsured. Part VI, Line 5: Promotion of community health Mississippi Baptist Health Systems (MBHS) is the parent company of an affiliated healthcare group (Baptist). Baptist - Leake is part of that group. Baptist is committed to involvement in the community and organizes various programs and activities which are offered to the public in order to promote community health. Baptist offers a multitude of low or no cost screenings to the community including heart, lung, and mammogram screenings. These low-cost screening packages help people determine if their health is headed in the right direction and provides the information necessary to make important lifestyle decisions at an affordable price. In addition, MBHS operates Baptist Health Line, which offers physician referrals, hospital services referrals, scheduling of classes for hospital services, and the health information library. Baptist Health Line professionals also offer Baptist's risk assessment tools, including the heart test, the health test, the women's health check, the diabetes test, and the cancer test. A number of educational classes on a wide variety of health topics are also offered to the community at no cost. In keeping with MBHS's foundation and tradition in the Christian healing ministry, Baptist offers pastoral care for patients and visitors. Baptist has a team of chaplains, each assigned to a different area of the hospital, to minister and bring comfort and care to patients. The Pastoral Care Department offers many services including patient visitation, chapel services, memorial services, counseling sessions, prayer, scripture reading, and answering emergency calls. In addition to the programs and services offered, Baptist also supports its local community through financial donations. MBHS operates the Carry the Mission program through a committee of employees of the hospital willing to volunteer their time to serve. Carry the Mission is funded by employee donations, which are matched by Baptist at 50 cents for every dollar raised. MBHS splits the funds raised through Carry the Mission to support different areas in the community: 40% goes to local nonprofits and groups that meet the established criteria, 40% goes to Baptist employees experiencing unexpected financial difficulties, and 20% goes to support the Baptist Health Foundation. Through this program, MBHS is able to support a wide range of groups in the community. Part VI, Line 6: Affiliated health care system Baptist - Leake is part of an affiliated health care system. Mississippi Baptist Health Systems (MBHS) is the holding company for several nonprofit entities to which it provides various management and support services. In addition to Baptist - Leake, MBHS is the parent company to Mississippi Baptist Medical Center, a 638 bed tertiary medical center, Mississippi Hospital for Restorative Care, a 25 bed long term acute care hospital, Baptist Medical Center - Attala, a 25 bed critical access hospital, Baptist Medical Center - Yazoo, a 25 bed critical access hospital, and the Medical Foundation of Central Mississippi, a network of primary care and specialty physicians. Through various partnership relationships, MBHS also provides home health care and adult day care services. Part VI, Line 7: State filing of community benefit report Baptist Medical Center - Leake, Inc. does not file a community benefit report with the state of Mississippi as there is no requirement to do so. X X X false true false false false false false false false WILLIAM B GRETE CORP VP - GENERAL COUNSEL 0 374470 0 0 18000 0 10200 0 37667 0 440337 0 0 BOBBIE K WARE VP - CHIEF NURSING OFFICER 0 357917 0 0 0 600 0 8019 0 21269 0 387805 0 0 WILLIAM LOGAN PHYSICIAN 171245 0 0 0 0 0 0 0 0 0 171245 0 0 0 MICHAEL K STEVENS VP - BUSINESS DEVELOPMENT 0 253619 0 0 0 0 0 0 0 42903 0 296522 0 0 RUSSELL W YORK FORMER CFO 0 15857 0 0 0 102543 0 0 0 0 0 118400 0 56063 DARYL WEAVER CEO 0 181361 0 0 0 0 0 7556 0 17299 0 206216 0 0 DAVID JACKSON CFO - COMMUNITY HOSPITALS 101922 127698 0 0 0 0 0 0 0 0 101922 127698 0 0 MICHAEL D MAPLES CORP VP- CHIEF MEDICAL OFFICER 0 359005 0 0 0 600 0 67038 0 37682 0 464325 0 0 CHRIS ANDERSON PRESIDENT & CEO 0 651193 0 0 0 600 0 134457 0 30858 0 817108 0 0 LEE ANN FOREMAN VP HUMAN RESOURCES 0 204796 0 0 0 600 0 37621 0 20962 0 263979 0 0 WILLIAM F THOMPSON CORP VP - CFO 0 347999 0 0 0 600 0 61423 0 29327 0 439349 0 0 WILLIAM D PERRY MD PHYSICIAN 231860 0 93120 0 24063 0 0 0 0 0 349043 0 0 0 PART I, LINE 4B: PARTICIPANTS: MICHAEL D. MAPLES $59,774 CHRIS ANDERSON $124,054 WILLIAM F. THOMPSON $50,823 LEE ANN FOREMAN $29,701 Terms and Conditions: Baptist Health Systems, Inc. established the Baptist Health Systems, Inc. Supplemental Executive Retirement Plan, a nonqualified, unfunded deferred compensation plan effective July 1, 2010, for the benefit of certain management or highly-compensated employees of Baptist Health Systems, Inc. Participants are chosen by the Chairman's Council of the Board (the Council) of Baptist Health Systems, Inc. The purpose of the plan is to enhance the ability of Baptist Health Systems, Inc. to attract and retain qualified management personnel with a market-competitive supplemental retirement benefit for a select group of management or highly compensated employees on a tax-deferred basis. Baptist Health Systems, Inc. will contribute to each participant's plan an annual amount equal to a percentage of the participant's base salary commencing in 2010 and continuing each year thereafter until the year in which the participant separates from employment. An applicable percentage of either 17.5% or 15% of base salary will be contributed to each participant's plan (or such other percentage as the Council determines). The vested accrued balance or employer contribution (plus earnings or losses) will be paid for any event requiring such payment other than death, as soon as administratively feasible but no later than the last day of the calendar year in which the event occurs. If the event that results in the payment of the benefit is death, the balance will be paid as soon as the Board obtains satisfactory proof of death, but no later than the 15th day of the third month following the end of the calendar year in which the Participant dies. Certain participants who remain in continuous employment have a non-forfeitable right to receive the employer contribution made in a plan year as of the first day of the plan year that is five years from the first day of the Plan year in which such contribution was made. However, if such participant has attained a specified age, the participant shall have a non-forfeitable right to receive any future employer contributions along with earnings or losses that have not vested and an immediate non-forfeitable right to receive any future employer contributions as of the date such contributions are made. New participants other than those specifically identified in the Plan have a non-forfeitable right to receive their accrued balance based on a vesting schedule as described in the Plan document. Otherwise, a participant shall have a non-forfeitable right to receive his accrued balance upon his separation from service on account of death, disability, or upon involuntary separation from service without cause if such separation occurs prior to the completion of the five year period described above, prior to attaining the age specified above, or prior to the applicable vesting schedule described above. MEDICAL PRACTICE SOLUTIONS SEE PART V 288164 SEE PART V false PART IV, LINE (1) COLUMNS (B) & (D): OFFICERS, WILLIAM F. THOMPSON, WILLIAM B. GRETE, CHRIS ANDERSON, AND MICHAEL K. STEVENS, ARE BOARD MEMBERS OF MEDICAL PRACTICE SOLUTIONS, A RELATED ENTITY. FORM 990, PAGE 6, PART VI, SECTION A, LINE 6: BAPTIST MEDICAL CENTER - LEAKE, INC. IS A NOT-FOR-PROFIT, NONSTOCK, MEMBERSHIP CORPORATION OF WHICH MISSISSIPPI BAPTIST HEALTH SYSTEMS, INC. IS THE SOLE MEMBER AND HAS SOLE VOTING CONTROL. Form 990, Page 6, Part VI, Section A, Line 7a: The board of Baptist Medical Center - Leake, Inc. is appointed by Mississippi Baptist Health Systems, Inc. Form 990, Page 6, Part VI, Section A, Line 7b: The board of Mississippi Baptist Health Systems approves all major capital expenditures. Form 990, Page 6, Part VI, Section B, Line 11B: AN ELECTRONIC COPY OF THE FORM 990 IS DISTRIBUTED VIA EMAIL. ALL BOARD MEMBERS/DIRECTORS HAVE THE OPPORTUNITY TO REVIEW THE FORM PRIOR TO FILING WITH THE IRS. Form 990, Page 6, Part VI, Section B, Line 12c: The compliance committee of the governing body meets quarterly to review all compliance issues. 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 A&b: An independent compensation consulting firm, the Hay group, conducts annual surveys to help establish the compensation of the organization's top management officials, officers and key employees. The chairman's council functions as the compensation committee of the board. The Hay Group presents their findings and recommendations to the council for their consideration and action. The council approves the salaries and benefit package for all senior management. The Hay Group maintains minutes of the Chairman's council meetings where compensation and benefits are discussed and approvals made. Form 990, Page 6, Part VI, Section C, Line 19: The organization's governing documents, conflict of interest policy and financial statements are available to the public upon request. FORM 990, PAGE 12, PART XI, LINE 9: TRANSFER FROM MISSISSIPPI BAPTIST HEALTH SYSTEMS, INC. 584,178 MS Hospital for Restorative Care Inc 1225 North State Street Jackson MS 39202 640833383 Hospital MS 501(c)(3) 3 MBHS true Medical Foundation of Central MS 1225 North State Street Jackson MS 39202 753068151 Clinics MS 501(C)(3) 3 MBHS true MS Baptist Health Systems Inc 1225 North State Street Jackson MS 39202 640306253 Holding Co. MS 501(C)(3) 11B-II NA false MS Baptist Medical Center Inc 1225 North State Street Jackson MS 39202 640881013 Hospital MS 501(C)(3) 3 MBHS false BAPTIST MEDICAL CENTER- YAZOO INC 1225 NORTH STATE STREET JACKSON MS 39202 640844470 HOSPITAL MS 501(C)(3) 3 MBHS false MJMH IMPROVEMENT CORPORATION 1225 NORTH STATE STREET JACKSON MS 39202 800812322 HOLDING CO. MS 501(C)(3) 11A-I MBHS true BAPTIST OUTPATIENT IMAGING LLC 1225 North State Street Jackson MS 39202 452968057 MEDICAL SERVICES MS MBHS false MS Baptist Medical Enterprises Inc 1225 North State Street Jackson MS 39202 640776164 Investments MS MBHS C Corp false Medical Practice Solutions 1225 North State Street Jackson MS 39202 640833731 Med Consulting MS MBME C Corp false MS Real Estate Enterprises Inc 1225 North State Street Jackson MS 39202 640746856 Investments MS MBME C Corp false HEALTHCARE FINANCIAL SERVICES INC 1225 NORTH STATE STREET JACKSON MS 39202 640847789 FINANCIAL SVC MS MBME C CORP false false false true false true false false false false true true false false false true false false false false