TISHOMINGO HEALTH SERVICES INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- TISHOMINGO HEALTH SERVICES INC (EIN 64-0741047)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-11
- IRS object ID
- 201622249349302872
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-11T16:26:47-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 190 E Capitol Street Ste 500 | AddressLine1Txt |
| City | Jackson | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 392012190 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 640741047 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tishomingo Health Services Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % KRISTY DUKE | InCareOfNm |
| Business Name Control | TISH | BusinessNameControlTxt |
| Phone | 6623773977 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 South Gloster Street | AddressLine1Txt |
| City | Tupelo | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38801 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOE REPPERT | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 6623773977 | PhoneNum |
| Signature | 2016-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Megan H Mills CPA | PreparerPersonNm |
| PTIN | P01250504 | PTIN |
| Phone | 6019486700 | PhoneNum |
| Preparation | 2016-08-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-12-15 16:53:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Joe Reppert | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 South Gloster Street | AddressLine1Txt |
| City | Tupelo | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,787,054 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.nmhs.net/iuka/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | DE | LegalDomicileStateCd |
| Activity Or Mission | Tishomingo Health Services, Inc. operates a 48 bed acute care hospital located in Iuka, Mississippi. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 183 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,220,428 | PYContributionsGrantsAmt |
| CY Contributions Grants | $752,501 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,688,807 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,495,389 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,514 | PYInvestmentIncomeAmt |
| CY Investment Income | -$13,855 | CYInvestmentIncomeAmt |
| PY Other Revenue | $502,873 | PYOtherRevenueAmt |
| CY Other Revenue | $537,605 | CYOtherRevenueAmt |
| PY Total Revenue | $18,413,622 | PYTotalRevenueAmt |
| CY Total Revenue | $19,771,640 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,395,609 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,620,556 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,864,236 | PYOtherExpensesAmt |
| CY Other Expenses | $10,734,387 | CYOtherExpensesAmt |
| PY Total Expenses | $20,259,845 | PYTotalExpensesAmt |
| CY Total Expenses | $21,354,943 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,846,223 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,583,303 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,942,727 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,596,592 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,407,812 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,981,363 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $534,915 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,384,771 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TISHOMINGO HEALTH SERVICES, INC. OPERATES A 48 BED ACUTE CARE HOSPITAL LOCATED IN IUKA, MISSISSIPPI CALLED NORTH MISSISSIPPI MEDICAL CENTER-IUKA (NMMC-IUKA). NMMC-IUKA 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-IUKA WORKS TO ACHIEVE THIS CORPORATE MISSION TO IMPROVE THE HEALTH OF THE PEOPLE OF THIS REGION BY PROVIDING CONVENIENTLY ACCESSIBLE, COST-EFFECTIVE HEALTH CARE OF THE HIGHEST QUALITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $20,409,731 | ExpenseAmt |
| Revenue | $18,566,548 | RevenueAmt |
| Desc | NMMC-Iuka serves Tishomingo County and the surrounding area. In fiscal year 2015, there were 862 inpatient admissions, 9,524 emergency department visits, and 12,067 outpatient visits. NMMC-Iuka 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. Inpatient care includes 24 hour direct patient care with multi-disciplinary services, including: nursing, radiology, laboratory, ultrasonography, nuclear medicine, CT, magnetic resonance imaging (MRI), physical therapy, occupational therapy, respiratory therapy, food and nutritional services, and social services. The hospital also has 10 certified swing beds for patients who need extended care based on availability and resources. NMMC-Iuka offers 24-hour emergency services and paramedic-level ambulance services. Outpatient services include physical therapy, occupational therapy, laboratory, radiology, respiratory care, infusion, wound care and cardiac monitoring. NMMC-Iuka is the recipient of two VHA Leadership Awards, honoring the hospital for meeting or exceeding national performance standards for clinical care and quality. VHA serves more than 1,400 not-for-profit hospitals and more than 24,000 non-acute health care organizations nationwide. NMMC-Iuka was one of only 38 VHA member organizations to receive a 2009 Leadership Award for Clinical Excellence. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | One of the primary ways NMMC-Iuka 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 the NMMC-Iuka 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-Iuka 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 Tishomingo County. Patients from outside the county may also be granted charity care based on the judgment of NMMC-Iuka management depending on their individual circumstances. The policy also requires the patient to cooperate fully with NMMC-Iuka'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 $765,936 in fiscal year 2015. Based on the gross charges provided to charity patients compared to total hospital gross charges, 1.45% of all services in fiscal year 2015 were provided on a charity basis. The net cost of charity care provided by NMMC-Iuka was approximately $238,000 in fiscal year 2015. The total cost estimate is based on the ratio of costs to charges for NMMC-Iuka. All of the forgone charges mentioned above are netted against patient service revenue to arrive at net patient service revenue as reflected as program service revenue on Part VIII of Form 990 in order to be consistent with financial statement reporting and are not reported as functional expenses on the tax return. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $20,409,731 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 183 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KRISTY DUKE | PersonNm |
| Phone | 6623773977 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 SOUTH GLOSTER STREET | AddressLine1Txt |
| City | Tupelo | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38801 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| James F Tennyson | |||||||||
| Director | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Thomas E Day | |||||||||
| Director | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Larry Bonds | |||||||||
| Director | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Steve McAnally | |||||||||
| Director | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Gary Matthews | |||||||||
| Director | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Bruce Toppin | |||||||||
| Secretary | 1.0 | 39.0 | $0 | $342,625 | $9,304 | Yes (X) | |||
| Joseph A Reppert | |||||||||
| Treasurer | 1.0 | 39.0 | $0 | $619,075 | $9,328 | Yes (X) | |||
| Michael S Spees | |||||||||
| President | 1.0 | 39.0 | $0 | $1,235,484 | $5,328 | Yes (X) | |||
| Fred A Truesdale Jr | |||||||||
| Administrator | 40.0 | 0.0 | $136,890 | $0 | $6,202 | Yes (X) | |||
| Layne Harris | |||||||||
| Pharmacist | 40.0 | 0.0 | $122,837 | $0 | $6,665 | Yes (X) | |||
| Thomas S Draper | |||||||||
| Physician | 40.0 | 0.0 | $258,798 | $0 | $12,251 | Yes (X) | |||
| Shelby C Howell | |||||||||
| Physician | 40.0 | 0.0 | $213,266 | $0 | $10,630 | Yes (X) | |||
| Walter G Mayfield | |||||||||
| Physician | 40.0 | 0.0 | $233,678 | $0 | $600 | Yes (X) | |||
| Rodger Brown | |||||||||
| Former President | 4.0 | 36.0 | $0 | $415,383 | $8,728 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $965,469 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,612,567 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $69,036 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Medicomp | |||||
| 119 S E Street PO Box 426 | MAGEE | MS | 39111 | Rehab Services | $584,576 |
| Correct Care Inc | |||||
| 1111 North Causeway Blvd | MANDEVILLE | LA | 70471 | ER Physician Svc | $416,765 |
| Alliance Healthcare Services | |||||
| PO Box 96485 | CHICAGO | IL | 606936485 | MRI Services | $260,943 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $752,501 | GovernmentGrantsAmt |
| Total Contributions | $752,501 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Revenue | 900099 | $18,490,839 | $18,490,839 |
| Related Rental Revenue | 900099 | $4,550 | $4,550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,495,389 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,559 | TotalRevenueColumnAmt |
| Exclusion | $1,559 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $15,414 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$15,414 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$15,414 | TotalRevenueColumnAmt |
| Exclusion | -$15,414 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Employee Drugs | 900099 | $416,546 | $416,546 | |
| Cafeteria Revenue | 900099 | $71,159 | $71,159 | |
| REBATE INCOME | 900099 | $42,485 | $42,485 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,415 | TotalRevenueColumnAmt |
| Exclusion | $7,415 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $537,605 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,771,640 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,566,548 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $452,591 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,472,016 | TotalAmt |
| Program Services | $6,904,881 | ProgramServicesAmt |
| Management And General | $567,135 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $484,485 | TotalAmt |
| Program Services | $484,485 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,142,745 | TotalAmt |
| Program Services | $2,142,745 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $521,310 | TotalAmt |
| Program Services | $480,117 | ProgramServicesAmt |
| Management And General | $41,193 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,778 | TotalAmt |
| Management And General | $304,778 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,538 | TotalAmt |
| Management And General | $1,538 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,966 | TotalAmt |
| Management And General | $31,966 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,739,511 | TotalAmt |
| Program Services | $1,739,511 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,787 | TotalAmt |
| Program Services | $12,787 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600,200 | TotalAmt |
| Program Services | $600,200 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $230,560 | TotalAmt |
| Program Services | $230,560 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $367,217 | TotalAmt |
| Program Services | $367,217 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,943 | TotalAmt |
| Program Services | $25,943 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,423 | TotalAmt |
| Program Services | $33,423 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,008,501 | TotalAmt |
| Program Services | $1,008,501 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$1,398 | TotalAmt |
| Management And General | -$1,398 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Bad Debt Expense | $4,404,484 | $4,404,484 |
| MEDICAL SUPPLIES | $1,644,899 | $1,644,899 |
| Repairs and Maintenance | $111,341 | $111,341 |
| DUES AND SUBSCRIPTIONS | $75,698 | $75,698 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,939 | TotalAmt |
| Program Services | $142,939 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,354,943 | TotalAmt |
| Program Services | $20,409,731 | ProgramServicesAmt |
| Management And General | $945,212 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $810 | BOYAmt |
| EOY | $810 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $553,178 | BOYAmt |
| EOY | $415,920 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,095,393 | BOYAmt |
| EOY | $3,390,576 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $289,392 | BOYAmt |
| EOY | $288,315 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,634,896 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,257,649 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,888,841 | BOYAmt |
| EOY | $7,377,247 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,113 | BOYAmt |
| EOY | $123,724 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,942,727 | BOYAmt |
| EOY | $11,596,592 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,120,963 | BOYAmt |
| EOY | $4,791,877 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,286,849 | BOYAmt |
| EOY | $8,189,486 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,407,812 | BOYAmt |
| EOY | $12,981,363 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $488,193 | BOYAmt |
| EOY | -$1,434,736 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,722 | BOYAmt |
| EOY | $49,965 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $534,915 | BOYAmt |
| EOY | -$1,384,771 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,942,727 | BOYAmt |
| EOY | $11,596,592 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,583,303 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$336,383 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $162,278 | OtherCostOrOtherBasisAmt |
| Book Value | $162,278 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,275,800 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,857,490 | DepreciationAmt |
| Book Value | $4,418,310 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,042,125 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,325,200 | DepreciationAmt |
| Book Value | $2,716,925 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $154,693 | OtherCostOrOtherBasisAmt |
| Depreciation | $74,959 | DepreciationAmt |
| Book Value | $79,734 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,377,247 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Related Parties | Desc |
| Amt | $8,189,486 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,189,486 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $15,367,156 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$4,404,484 | OtherRevenueAmt |
| Revenue Not Reported | -$4,404,484 | RevenueNotReportedAmt |
| Revenue Subtotal | $19,771,640 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $19,771,640 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $16,950,459 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $16,950,459 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $4,404,484 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $4,404,484 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $21,354,943 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The System applies Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 740 ("Topic 740") for Income Taxes, which clarifies the accounting for uncertainty in income tax positions and provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There has been no impact on the System's financial statements as a result of Topic 740. |
| Part XI, Line 2d: | Bad debt expense included in patient revenue on the financial statements is included in expense on the return. |
| Part XII, Line 4b: | Bad debt expense included in patient revenue on the financial statements is included in expense on the return. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 75. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | false | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $238,267 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $238,267 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,097,655 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,158,627 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$1,060,972 | NetCommunityBenefitExpnsAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,335,922 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,158,627 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$822,705 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,335,922 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,158,627 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$822,705 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,404,484 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,034,445 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,231,016 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,196,571 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tishomingo Health Services | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1777 Curtis Drive | AddressLine1Txt |
| City | Iuka | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38852 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.nmhs.net/iuka/ | WebsiteAddressTxt |
| State License | 13-221 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tishomingo Health Services | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE SECTION C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 75. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0. | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, SECTION B, LINE 3J: | A DESCRIPTION OF HEALTH INDICATORS THAT AFFECT THE OVERALL HEALTH OF THE COMMUNITY ENABLING ACCESS TO HEALTH CARE. |
| PART V, SECTION B, LINE 5: | TELEPHONE AND MAIL SURVEYS INVOLVING VARIOUS PEOPLE IN THE COMMUNITY WERE CONDUCTED AND THE FINDINGS WERE SUMMARIZED IN THE CHNA REPORT. TISHOMINGO HEALTH SERVICES' COMMUNITY HEALTH DEPARTMENT ALSO WORKS CLOSELY WITH THE LOCAL AND STATE DEPARTMENTS OF HEALTH, WHICH HAS RESULTED IN SEVERAL PROJECTS CONCERNING OBESITY AND SMOKING CESSATION. |
| PART V, SECTION B, LINE 6A: | Tishomingo Health Services is part of the North Mississippi Health Services' diversified regional healthcare system. North Mississippi Health Services operates five community hospitals in addition to Tishomingo Health Services. The CHNA included Tishomingo Health Services, Clay County Medical Corporation, Pontotoc Health Services, Webster Health Services, North Mississippi Medical Center, and Marion Regional Medical Center. |
| PART V, SECTION B, LINE 7B: | http://www.nmhs.net/documents/NMMC2013Report-TishomingoCounty.pdf |
| PART V, SECTION B, LINE 11: | THE NEEDS OF THE COMMUNITY GO BEYOND THE RESOURCES OF THE ORGANIZATION WITH THE NON-EXPANSION OF MEDICAID IN THE STATE AND THE REDUCTION IN MEDICAID PAYMENTS AS WELL AS A SIGNIFICANT INCREASE IN UNINSURED. THE ORGANIZATION FOCUSES ON PROVIDING ACCESS TO BASIC HEALTHCARE NEEDS INCLUDING: - BLOOD PRESSURE SCREENING AND TREATMENT, - OBESITY TREATMENT, - DIABETES SCREENING AND TREATMENT, - IMMUNIZATIONS, AND - CHILDREN'S HEALTH BY PLACEMENT OF NURSES IN LOCAL SCHOOLS. |
| PART V, SECTION B, LINE 13H: | SERVICE TYPE AND PATIENT RELATIONSHIP TO PHYSICIANS |
| PART V, SECTION B, LINE 16A&C: | HTTP://WWW.NMHS.NET/CHARITY_CARE_POLICY.PHP |
| PART V, SECTION B, LINE 22D: | THE ORGANIZATION USES THE LOOK-BACK METHOD TO DETERMINE AMOUNTS GENERALLY BILLED. FAP-ELIGIBLE INDIVIDUALS ARE CHARGED NO MORE THAN THE AMOUNTS GENERALLY BILLED TO PATIENTS WHO HAVE INSURANCE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TishomingoIuka Wellness Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 619 Battle Ground Drive | AddressLine1Txt |
| City | Iuka | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 38852 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Wellness Center | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Tishomingo 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. Tishomingo Health Services will provide its prevalent managed care discount to any patient that meets Tishomingo Health Services' definition of uninsured (an individual having no third party coverage by commercial third party insurer, an ERISA plan, Medicare, Medicaid, SCHIP, Champus or other coverage for all or part of their bill). |
| Part I, Line 7g: | Not Applicable |
| Part I, Line 7, column (f): | Bad Debt Expense of $4,404,484 was included in total expense on Form 990, Part IX, Line 25, Column (A), but was subtracted from total expense for purposes of calculating the percentage of total expense in column (F). |
| Part I, Line 7: | A cost to charge ratio was used for the amounts reported in the table for Line 7. The cost to charge ratio for Line 7 was calculated using Worksheet 2. |
| Part III, Line 4: | Tishomingo Health Services' financial statements do not include a footnote specifically concerning bad debt. Bad debt is shown as a separate line item on the face of the income statement. The amount of bad debt booked each year is based on a review of outstanding receivables and their age from date of service. The older the account, the higher the reserve percentage used to estimate bad debt. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluations and specific circumstances of the account. Bad debt expense reported in Part III Line 2 matches bad debt expense reported in Tishomingo Health Services' audited financial statements. Tishomingo Health Services (THS) follows the Catholic Health Association guidelines and does not include bad debt in any community benefit amounts. THS, however, believes that some portion of bad debt results from patients who could qualify for charity care but has no way of making an estimate of the amount and therefore has answered "zero" for Part III Line 3. |
| Part III, Line 8: | The ratio of cost to charges used in the calculation of costs for Medicare was taken from the Medicare Cost Report. Lines 5, 6, & 7 do not include certain Medicare programs and costs and thus do not reflect all of the organization's revenues and costs associated with its participation in Medicare programs. Additional revenues and costs not reported on Lines 5, 6, & 7 include those associated with the organization's Medicare outpatient lab, ambulance and therapy services. Total revenues from these activities were $1,094,319 and total costs were $1,661,218 for a net shortfall of $566,899. When combined with the shortfall reported on Line 7, the net shortfall from all Medicare programs is $2,763,470. |
| Part III, Line 9b: | Tishomingo Health Services does not pursue collection of amounts determined to qualify as charity care. |
| Part VI, Line 2: | Needs Assessment Tishomingo Health Services utilizes varied but complimentary methods to assess the health care needs of the community it serves. Tishomingo Health Services and Tishomingo 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 Tishomingo County and provides information by county. In addition, the North Mississippi Health Services Community Relations Facilitator conducts routine visits with its internal and external stakeholders across the entire service area including Tishomingo County. The information gathered through several qualitative survey questions is used to determine its community's needs for the entire service area as well as the local service area for each hospital such as Tishomingo Health Services. |
| Part VI, Line 3: | Patient Eligibility for Assistance Explanations of the Tishomingo Health Services charity care policy are communicated in a variety of forms including signage at all admission and registration areas, on the web site, on bills and statements, and in admission packets. Financial counselors assist the patient and responsible parties with determining eligibility for government programs, primarily Medicaid, and charity care status. The patient can apply for charity care at any time from the date of service through the collection process and once qualified and approved all collection efforts are stopped. |
| Part VI, Line 4: | Community Information Tishomingo Health Services serves more than 19,000 people in Tishomingo County, MS and the surrounding area. The population for the service area is projected to remain essentially flat over the next five years. According to the 2015 census, age demographics for the service area show that approximately 22% of the population is under 18 years of age, approximately 58% is between 18 and 64 years of age and that 20% is 65 or older. Caucasians make up 93% of the service area's population while African Americans make up 3% and Hispanics and others make up 4%. Median household income for 2010-2014 was $34,499 for the service area, which is below the overall average for Mississippi and significantly less than the nationwide average. The patient population for Tishomingo Health Services is covered by insurance or is uninsured as follows: 51.64% Medicare, 6.72% Medicaid, and 29.95% private insurance with 11.69% being uninsured. |
| Part VI, Line 5: | Promotion of Community Health Tishomingo 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 Tishomingo Health Services employees who volunteer their time to help with these events and activities. The community health coordinator assists in educating the community on health-related issues by organizing and presenting various health fairs and seminars. These events are held at local businesses, schools and community organizations and address a variety of health-related topics. In addition, the hospital sponsors cholesterol, blood pressure, vision, memory, and heart-risk screening events, through which tests are made available to the public for a nominal fee or at no charge with the majority of the costs incurred absorbed by the hospital. |
| Part VI, Line 6: | Affiliated Health Care System As noted above, Tishomingo Health Services (THS) is part of North Mississippi Health Services (NMHS). NMHS operates North Mississippi Medical Center, four other community hospitals in addition to THS, 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. |
| Part VI, Line 7: | State filing of community benefit report Tishomingo Health Services does not file a community benefit report with the state of Mississippi as there is no requirement to do so. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bruce Toppin | ||||||||||||||
| Secretary | $0 | $246,286 | $0 | $88,204 | $0 | $8,135 | $0 | $5,176 | $0 | $4,128 | $0 | $351,929 | $0 | $0 |
| Joseph A Reppert | ||||||||||||||
| Treasurer | $0 | $419,530 | $0 | $160,356 | $0 | $39,189 | $0 | $5,200 | $0 | $4,128 | $0 | $628,403 | $0 | $0 |
| Thomas S Draper | ||||||||||||||
| Physician | $253,025 | $0 | $5,413 | $0 | $360 | $0 | $7,092 | $0 | $5,159 | $0 | $271,049 | $0 | $0 | $0 |
| Shelby C Howell | ||||||||||||||
| Physician | $197,747 | $0 | $4,813 | $0 | $10,706 | $0 | $4,410 | $0 | $6,220 | $0 | $223,896 | $0 | $0 | $0 |
| Rodger Brown | ||||||||||||||
| Former President | $0 | $255,649 | $0 | $85,863 | $0 | $73,871 | $0 | $5,200 | $0 | $3,528 | $0 | $424,111 | $0 | $0 |
| Michael S Spees | ||||||||||||||
| President | $0 | $807,607 | $0 | $255,015 | $0 | $172,862 | $0 | $0 | $0 | $5,328 | $0 | $1,240,812 | $0 | $0 |
| Walter G Mayfield | ||||||||||||||
| Physician | $229,616 | $0 | $3,702 | $0 | $360 | $0 | $0 | $0 | $600 | $0 | $234,278 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4b: | FormAndLineReferenceDesc |
| Explanation | Participants: Michael S. Spees $18,632 Rodger Brown $46,358 Joseph A. Reppert $36,823 Terms & Conditions: North Mississippi Health Services, Inc. (NMHS) Adopted the management deferred annuity plan (the Plan) on October 1, 1998. Participants in the plan are designated by the compensation committee of the board of directors of NMHS. At the beginning of each plan year, NMHS shall pay a contribution, less witholding for taxes, to the participant's annuity contract, which is a deferred annuity contract selected, owned, and controlled by the participant. The contribution is determined by multiplying the participant's compensation in the preceding plan year by a percentage set forth in appendix b of the plan. A participant is terminated from the plan on the earliest of: (1) the date the board determines the employee is no longer a participant; (2) the date the participant retires; (3) the date that the participant dies; or (4) the date the participant no longer is employed by NMHS for reasons other than retirement or death. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Page 6, Part VI, Section A, Line 6: | Tishomingo 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. (NMHS), which is made up of past Chairmen, nominate candidates for the Board. These candidates are then approved by the Board of NMHS. |
| Form 990, Page 6, Part VI, Section A, Line 7b: | The Board of North Mississippi Health Services, Inc. approves all transactions that exceed $1 million. |
| Form 990, Page 6, Part VI, Section B, Line 11b: | The Form 990 goes through a review process in the Accounting Department. The accountant for each facility reviews the returns for reasonableness and accuracy. All totals are tied to the audit reports, and all amounts are cross-referenced to schedules or other parts of the actual return. Once the accountant reviews, the 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. Then the Director does a more high level review, reading the return for reasonableness and comparing prior year amounts to current year amounts. Finally, the VP of Finance reviews the return for reasonableness. The returns are then sent to the Executive VP/Treasurer to be reviewed. The Treasurer signs the return and it is then sent to the IRS. |
| Form 990, Page 6, Part VI, Section B, Line 12c: | An annual conflict of interest questionnaire is required to be completed by all officers and directors of the organization. The questionnaire is reviewed by North Mississippi Health Services, Inc.'s compliance officer and Conflict Committee. The Conflict Committee reviews conflict transactions and makes recommendations to the board of directors regarding conflict transactions in accordance with the organization's conflict of interest policy. All members of the Conflict Committee are prohibited from engaging in transactions with the organization or its affiliates during their tenure on the Conflict Committee and one year after their service concludes. |
| Form 990, Page 6, Part VI, Section B, Line 15 a&b: | An independent compensation consulting firm, The Hay Group, is used to help establish the compensation of the CEO, Executive Director, other officers, and key employees. The firm presents their independent analysis, which contains comparability data, to the Compensation Committee of North Mississippi Health Services, Inc. In addition to this, the VP of Human Resources obtains another independent analysis from another compensation consulting firm in order to verify the information provided by The Hay Group. The compensation of the individuals are then approved by the Compensation Committee. The salaries of NMHS' CEO and senior leadership are then reviewed by the NMHS Board of Directors. The individual whose compensation is being discussed is not present during the discussion or approval of their compensation. The discussions and decisions regarding the compensation are documented in the minutes of the meetings. Compensation of these individuals is approved annually. |
| Form 990, Page 6, Part VI, Section C, Line 19: | The governing documents, conflict of interest policy, and financial statements are available to the public upon request. A consolidated statement of operations is available on the organization's website. |
| Form 990, Page 12, Part XI, Line 9: | Pension-related changes other than net periodic pension cost: (338,460) Increase in interest in net assets of Affiliated Foundation: 2,077 Total other changes in net assets or fund balance = (336,383) |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| North MS Management Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640762694 | Mgmt & Admin | DE | 501(c)(3) | 11-I | NMHS | false |
| North MS Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640653269 | Mgmt Services | DE | 501(c)(3) | 11-II | NMHS | false |
| Clay County Medical Corporation | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640668465 | Hospital | DE | 501(c)(3) | 3 | NMHS | false |
| North MS Medical Center Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640662976 | Hospital | DE | 501(c)(3) | 3 | NMHS | false |
| Pontotoc Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640751410 | Hospital | DE | 501(c)(3) | 3 | NMHS | false |
| North MS Medical Clinics Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640787918 | Med Clinics | DE | 501(c)(3) | 3 | NMHS | false |
| Tupelo Service Finance Inc | ||||||||||
| 844 Cliff Gookin Blvd | Tupelo | MS | 38801 | 640508308 | Collections | DE | 501(c)(3) | 3 | NMHS | false |
| Webster Health Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640819193 | Hospital | DE | 501(c)(3) | 3 | NMHS | false |
| Marion Regional Medical Center Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640926753 | Hospital | DE | 501(c)(3) | 3 | NMHS | false |
| North MS Emergency Services Inc | ||||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640780130 | ER Physicians | DE | 501(c)(3) | 9 | NMHS | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| North MS Health Link Inc | |||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640715886 | Medical Services | DE | NMHS | C Corp | false |
| North MS Enterprises Inc | |||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 640658059 | Medical Services | DE | NMHS | C Corp | false |
| Professional Practice Management Inc | |||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 721390014 | Med Serv Mgmt | DE | NMMCI | C Corp | false |
| Acclaim Inc | |||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 721356116 | Hlth Care Claims | DE | Healthlink | C Corp | false |
| North MS Support Services Inc | |||||||||
| 830 S Gloster Street | Tupelo | MS | 38801 | 260718275 | Support Services | DE | NMHS | C Corp | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |