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PEMISCOT COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
PEMISCOT COUNTY MEMORIAL HOSPITAL (EIN 43-6004544)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-11-13
IRS object ID
201513179349304356
Schema version
2014v5.0
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

FieldValueIRS element (for citing)
Return2015-11-13T11:42:21-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationMOStateAbbreviationCd
ZIP658062523ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN436004544EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PEMISCOT MEMORIAL HEALTH SYSTEMSBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% JULIE HANKINSInCareOfNm
Business Name ControlPEMIBusinessNameControlTxt
Phone5733593623PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 489AddressLine1Txt
CityHAYTICityNm
State AbbreviationMOStateAbbreviationCd
ZIP63851ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKERRY NOBLEPersonNm
Person TitleCHIEF EXECUTIVE OFFICERPersonTitleTxt
Phone5733593623PhoneNum
Signature2015-09-24SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBrian D ToddPreparerPersonNm
PTINP00422601PTIN
Phone4178658701PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKERRY NOBLEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 489AddressLine1Txt
CityHAYTICityNm
State AbbreviationMOStateAbbreviationCd
ZIP63851ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$43,078,249GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PEMISCOT.ORGWebsiteAddressTxt
Type Of Organization OtherYes (X)TypeOfOrganizationOtherInd
Other Organization DscPOL SUBOtherOrganizationDsc
Formation1949FormationYr
Legal Domicile StateMOLegalDomicileStateCd
Activity Or MissionTHE PRIMARY PURPOSE OF PEMISCOT MEMORIAL HEALTH SYSTEMS IS TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY REGARDLESS OF ABILITY TO PAY.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee661TotalEmployeeCnt
Total Volunteers5TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$630,795PYContributionsGrantsAmt
CY Contributions Grants$770,389CYContributionsGrantsAmt
PY Program Service Revenue$43,479,212PYProgramServiceRevenueAmt
CY Program Service Revenue$42,288,551CYProgramServiceRevenueAmt
PY Investment Income$20,819PYInvestmentIncomeAmt
CY Investment Income$12,852CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$6,457CYOtherRevenueAmt
PY Total Revenue$44,130,826PYTotalRevenueAmt
CY Total Revenue$43,078,249CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$22,510,033PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$21,455,660CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$24,814,614PYOtherExpensesAmt
CY Other Expenses$23,483,828CYOtherExpensesAmt
PY Total Expenses$47,324,647PYTotalExpensesAmt
CY Total Expenses$44,939,488CYTotalExpensesAmt
PY Revenues Less Expenses-$3,193,821PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,861,239CYRevenuesLessExpensesAmt
Total Assets BOY$11,576,133TotalAssetsBOYAmt
Total Assets EOY$9,933,015TotalAssetsEOYAmt
Total Liabilities BOY$10,297,225TotalLiabilitiesBOYAmt
Total Liabilities EOY$11,073,544TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,278,908NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$1,140,529NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPEMISCOT MEMORIAL HEALTH SYSTEMS IS COMMITTED TO PROVIDE AN ORGANIZED SYSTEM OF HEALTHCARE SERVICES TO ALL PERSONS WITHIN OUR SERVICE AREA WITHOUT REGARD TO AGE, SEX, RACE, COLOR, NATIONAL ORIGIN, CREED, FINANCIAL STATUS, PHYSICAL OR MENTAL CHALLENGE. SEE SCHEDULE O.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$41,909,417ExpenseAmt
Revenue$42,288,551RevenueAmt
DescPROVIDING QUALITY HEALTH CARE TO THE COMMUNITY THROUGH THE OPERATION OF A HOSPITAL, TWO LONG-TERM CARE FACILITIES, RURAL HEALTH CLINICS AND ADOLESCENT, ADULT, AND GERIATRIC PSYCHIATRIC UNITS.Desc
Total Program Service Expenses$41,909,417TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingYes (true)CreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document50IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee661EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJULIE HANKINSPersonNm
Phone5733593623PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1946 EAST REEDAddressLine1Txt
CityHAYTICityNm
State AbbreviationMOStateAbbreviationCd
ZIP63851ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
RUSSELL GILMORE
CHAIRMAN2.00.0Yes (X)Yes (X)$0$0$0
TIMOTHY GARDNER
TREASURER2.00.0Yes (X)Yes (X)$0$0$0
WILLIAM E BROOKS
VICE CHAIRMAN2.00.0Yes (X)Yes (X)$0$0$0
DELILA SWINGER
SECRETARY2.00.0Yes (X)Yes (X)$0$0$0
STEPHEN REID
MEMBER2.00.0Yes (X)$0$0$0
KERRY NOBLE
CEO30.00.0Yes (X)$151,356$0$8,778
MARK DAVIS
COO40.00.0Yes (X)$75,995$0$4,408
ABDULLAH ARSHAD
PHYSICIAN40.00.0$855,704$0$26,548Yes (X)
BABATUNDE OLADIRAN
PHYSICIAN40.00.0$505,489$0$30,329Yes (X)
JOSEPH KULPEKSA
PHYSICIAN40.00.0$290,094$0$17,406Yes (X)
GHAITH KHAIR
PHYSICIAN40.00.0$225,088$0$13,505Yes (X)
ERICA SCHEFFER
PHYSICIAN40.00.0$205,276$0$12,317Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,309,002TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$113,291TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K16IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

ServicesServicesDescCompensationCompensationAmt
HOSPITAL HOUSEKEEPING SYSTEMS
DIETARY MANAGEMENT$531,306
J M ANESTHESIA
ANESTHESIA COVERAGE$453,100
AFFINITY HEALTHCARE
MANAGEMENT$263,950
DATA SYSTEMS MANAGEMENT
MANAGEMENT$131,255
AMERICAN ESOTERIC LAB
LAB SERVICES$124,516
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K6CntrctRcvdGreaterThan100KCnt
Government Grants$770,389GovernmentGrantsAmt
Total Contributions$770,389TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621400$41,039,123$41,039,123
MEDICAL RECORDS621400$41,140$41,140
CAFETERIA722514$105,307$105,307
MISCELLANEOUS900099$677,981$677,981
EHR INCENTIVE REVENUE621400$425,000$425,000
FieldValueIRS element (for citing)
Total Program Service Revenue$42,288,551TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,852TotalRevenueColumnAmt
Exclusion$12,852ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$6,457RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$6,457RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,457TotalRevenueColumnAmt
Exclusion$6,457ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$43,078,249TotalRevenueColumnAmt
Related Or Exempt Func Income$42,288,551RelatedOrExemptFuncIncomeAmt
Exclusion$19,309ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$240,537TotalAmt
Management And General$240,537ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$17,567,508TotalAmt
Program Services$16,192,964ProgramServicesAmt
Management And General$1,374,544ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$418,015TotalAmt
Program Services$370,800ProgramServicesAmt
Management And General$47,215ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,902,021TotalAmt
Program Services$1,698,885ProgramServicesAmt
Management And General$203,136ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,327,579TotalAmt
Program Services$1,177,629ProgramServicesAmt
Management And General$149,950ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$70,149TotalAmt
Management And General$70,149ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$143,568TotalAmt
Management And General$143,568ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,454,435TotalAmt
Program Services$4,083,922ProgramServicesAmt
Management And General$370,513ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$14,268TotalAmt
Program Services$12,656ProgramServicesAmt
Management And General$1,612ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$690,537TotalAmt
Program Services$614,501ProgramServicesAmt
Management And General$76,036ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$796,444TotalAmt
Program Services$706,486ProgramServicesAmt
Management And General$89,958ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$95,025TotalAmt
Program Services$47,291ProgramServicesAmt
Management And General$47,734ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$212,334TotalAmt
Program Services$188,534ProgramServicesAmt
Management And General$23,800ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,147,756TotalAmt
Program Services$1,018,117ProgramServicesAmt
Management And General$129,639ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$285,760TotalAmt
Program Services$285,760ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT$9,870,356$9,870,356
MEDICAL SUPPLIES & DRUGS$3,600,284$3,600,284
FRA EXPENSE$1,778,055$1,778,055
REPAIRS & MAINTENANCE$232,866$222,826$10,040

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$91,991TotalAmt
Program Services$40,351ProgramServicesAmt
Management And General$51,640ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$44,939,488TotalAmt
Program Services$41,909,417ProgramServicesAmt
Management And General$3,030,071ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,405BOYAmt
EOY$2,405EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$921,386BOYAmt
EOY$321,216EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$541,028BOYAmt
EOY$616,814EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,646,453BOYAmt
EOY$3,837,214EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$317,560BOYAmt
EOY$307,819EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$165,487BOYAmt
EOY$71,247EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$29,131,940LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$24,503,846LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,391,722BOYAmt
EOY$4,628,094EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$590,092BOYAmt
EOY$148,206EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$11,576,133BOYAmt
EOY$9,933,015EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,080,473BOYAmt
EOY$5,933,414EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$495,000BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$20,663BOYAmt
EOY$18,479EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$3,701,089BOYAmt
EOY$5,036,896EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$84,755EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$10,297,225BOYAmt
EOY$11,073,544EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,278,908BOYAmt
EOY-$1,140,529EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,278,908BOYAmt
EOY-$1,140,529EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$11,576,133BOYAmt
EOY$9,933,015EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,861,239ReconcilationRevenueExpnssAmt
Prior Period Adjustments-$558,198PriorPeriodAdjustmentsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedfalseFSAuditedInd
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
Agent Trustee EtcfalseAgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (true)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$137,742OtherCostOrOtherBasisAmt
Book Value$137,742BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,374,787OtherCostOrOtherBasisAmt
Depreciation$12,155,605DepreciationAmt
Book Value$219,182BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$16,210,049OtherCostOrOtherBasisAmt
Depreciation$12,293,105DepreciationAmt
Book Value$3,916,944BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$409,362OtherCostOrOtherBasisAmt
Depreciation$55,136DepreciationAmt
Book Value$354,226BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,628,094TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO THIRD PARTYDesc
Amt$84,755Amt
FieldValueIRS element (for citing)
Total Liability$84,755TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART IV, LINE 2BFormAndLineReferenceDesc
ExplanationRESIDENT TRUST FUND: THE ORGANIZATION HOLDS RESIDENT FUNDS THAT HAVE BEEN SET ASIDE FROM MEDICAID FOR PERSONAL EXPENSES OF PATIENTS. FAMILY MEMBERS AND PATIENTS MAY ALSO MAKE ADDITIONAL DEPOSITS INTO THE ACCOUNTS FOR ADDITIONAL EXPENSES, AS AVAILABLE AND NECESSARY.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentfalseFreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,215,874TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,215,874NetCommunityBenefitExpnsAmt
Total Expense0.06320TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,985,268TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,717,029DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,268,239NetCommunityBenefitExpnsAmt
Total Expense0.06470TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,201,142TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,717,029DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,484,113NetCommunityBenefitExpnsAmt
Total Expense0.12790TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$179,924TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$179,924NetCommunityBenefitExpnsAmt
Total Expense0.00510TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$179,924TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$179,924NetCommunityBenefitExpnsAmt
Total Expense0.00510TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,381,066TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,717,029DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,664,037NetCommunityBenefitExpnsAmt
Total Expense0.13300TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$400TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$400NetCommunityBenefitExpnsAmt

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,163TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,163NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$93TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$93NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,656TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,656NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$9,870,356BadDebtExpenseAmt
Bad Debt Expense Attributable$2,892,014BadDebtExpenseAttributableAmt
Reimbursed By Medicare$11,078,626ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$9,872,702CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$1,205,924MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnfalseFinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PEMISCOT MEMORIAL HEALTH SYSTEMSBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1946 EAST REEDAddressLine1Txt
CityHAYTICityNm
State AbbreviationMOStateAbbreviationCd
ZIP63851ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.PEMISCOT.ORGWebsiteAddressTxt
State License15-57StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PEMISCOT MEMORIAL HEALTH SYSTEMSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLwww.pemiscot.org/CHNA_Report.pdfOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt14ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedYes (true)StrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Medicare RatesYes (X)MedicareRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, LINE 5COMMUNITY INPUT: INTERVIEWS WITH THREE STAKEHOLDERS WERE CONDUCTED OVER A ONE-DAY PERIOD IN DECEMBER 2014 OVER THE PHONE. STAKEHOLDERS WERE DETERMINED BASED ON THEIR: A) SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, B) THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY OR C) THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. ALL INTERVIEWS WERE CONDUCTED USING A STANDARD QUESTIONNAIRE. A COPY OF THE INTERVIEW INSTRUMENT IS INCLUDED IN THE APPENDICES OF THE CHNA. A SUMMARY OF THEIR OPINIONS IS REPORTED WITHOUT JUDGING THE TRUTHFULNESS OR ACCURACY OF THEIR REMARKS. COMMUNITY LEADERS PROVIDED COMMENTS ON THE FOLLOWING ISSUES: -HEALTH AND QUALITY OF LIFE FOR RESIDENTS OF THE PRIMARY COMMUNITY IN RELATION TO THE CURRENT STRATEGIES IMPLEMENTED -THOUGHTS ON HOW CURRENT PROGRAMS ARE IMPROVING HEALTH AND QUALITY OF LIFE FOR RESIDENTS OF THE PRIMARY COMMUNITY OR IDENTIFYING PROGRAMS DONE BY OTHERS THAT ADDRESS SIMILAR NEEDS -OPINIONS REGARDING AND NEW NEEDS OR HEALTH ISSUES THAT AFFECT PEMISCOT COUNTY RESIDENTS AND THE TYPES OF SERVICES THAT ARE IMPORTANT FOR ADDRESSING THESE NEW ISSUES -COLLABORATION EFFORTS WITH OTHER AGENCIES/HOSPITALS THIS TECHNIQUE DOES NOT PROVIDE A QUANTITATIVE ANALYSIS OF THE LEADERS' OPINIONS, BUT REVEALS SOME OF THE FACTORS AFFECTING THE VIEWS AND SENTIMENTS ABOUT OVERALL HEALTH AND QUALITY OF LIFE WITHIN THE COMMUNITY. REPRESENTATIVES FROM THE COMMUNITY WHO WERE INCLUDED IN THE KEY INFORMANT INTERVIEW PROCESS WORKED FOR 2 PUBLIC HEALTH AGENCIES AND 1 MEDICAL ORGANIZATION. THESE HEALTH CARE AND NONHEALTH CARE PROFESSIONALS PROVIDED INSIGHT INTO THE HEALTH STATUS OF THE HOSPITAL THROUGH AN 11-QUESTION INTERVIEW.
SCHEDULE H, PART V, LINE 11ADDRESSING SIGNIFICANT NEEDS: THE MOST SIGNIFICANT/PREVALENT NEEDS IDENTIFIED IN THE ORGANIZATIONS MOST RECENT CHNA WERE AS FOLLOWS: - LACK OF HEALTH EDUCATION/NUTRITION KNOWLEDGE - ADULT SMOKING - ADULT OBESITY - LACK OF PREVENTATIVE MEASURE - HEART DISEASE - PRIMARY CARE PHYSICIANS - HEALTHY BEHAVIORS AND LIFESTYLES - UNINSURED - PHYSICAL INACTIVITY - DIABETIC SCREEN RATE - CANCER - STROKE/CEREBROVASCULAR DISEASE - LIMITED ACCESS TO HEALTHY FOODS THE ORGANIZATION WILL ADDRESS THESE NEEDS THROUGH PROGRAMS DESIGNED TO FOCUS ON THREE SPECIFIC AREAS: PREVENTATIVE HEALTH EDUCATION AND HEALTHY LIVING, UNINSURED/ACCESS TO CARE, AND PRIMARY CARE PROVIDERS. A TOTAL OF 26 HEALTH NEEDS WERE IDENTIFIED. THE ORGANIZATION CHOSE TO FOCUS ITS EFFORTS ON NEEDS THAT WERE OF THE HIGHEST PRIORITY, AFFECTED THE GREATEST NUMBER OF PEOPLE, PRODUCED THE MOST SERIOUS CONSEQUENCES IF NOT ADDRESSED, AND IMPACTED VULNERABLE GENERATIONS.
FieldValueIRS element (for citing)
Facility10FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
PEMISCOT MEMORIAL NURSING HOME
946 EAST REEDHAYTIMO63851LONG-TERM CARE FACILITY
CARUTHERSVILLE NURSING CENTER
500 TRUMAN BLVDCARUTHERSVILLEMO63830SKILLED NURSING FACILITY
PEMISCOT PRIMARY CARE CENTER
907 EAST REEDHAYTIMO63851OUTPATIENT PHYSICIAN CLINIC
DOCTOR'S CLINIC
106 WEST 12CARUTHERSVILLEMO63830OUTPATIENT PHYSICIAN CLINIC
WOMEN'S PRIMARY CARE CENTER
701 EAST LINCOLNHAYTIMO63851OUTPATIENT PHYSICIAN CLINIC
PEMISCOT CONVENIENT CARE CLINIC
946 EAST REEDHAYTIMO63851OUTPATIENT PHYSICIAN CLINIC
PORTAGEVILLE PRIMARY CARE CENTER
314 EAST MAINPORTAGEVILLEMO63873OUTPATIENT PHYSICIAN CLINIC
BOOTHEEL PRIMARY CARE - CARUTHERSVILLE
1502 WARD AVENUECARUTHERSVILLEMO63830OUTPATIENT PHYSICIAN CLINIC
BOOTHEEL PRIMARY CARE - HAYTI
310 EAST MAINHAYTIMO63851OUTPATIENT PHYSICIAN CLINIC
BOOTHEEL PRIMARY CARE - STEELE
213 5 WALNUTSTEELEMO63877OUTPATIENT PHYSICIAN CLINIC

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7, COLUMN FPERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990, WAS REDUCED BY BAD DEBT EXPENSE OF $9,870,356.
SCHEDULE H, PART I, LINE 7COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 6. WORKSHEET 3 USED ACTUAL COST METHODS FROM THE ORGANIZATION'S COST REPORT.
SCHEDULE H, PART IICOMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION PROVIDED COMMUNITY SUPPORT THROUGH AN R-3 PARTY AND TRUNK OR TREAT, WHICH CONTRIBUTED TO YOUTH DEVELOPMENT AND SUPPORT. THE ORGANIZATION PARTICIPATED IN THE HAYTI JOB FAIR TO PROMOTE WORKFORCE DEVELOPMENT. MEMBERS OF THE ORGANIZATION'S MANAGEMENT ARE MEMBERS OF THE HAYTI ROTARY AND THE DUES ASSOCIATED WITH THIS MEMBERSHIP ARE REPORTED AS ECONOMIC DEVELOPMENT.
SCHEDULE H, PART III, SECTION A, LINE 2BAD DEBT EXPENSE: LINE 2 WAS CALCULATED USING THE BAD DEBT EXPENSE PER THE REVIEWED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION A, LINE 3BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: THE ORGANIZATION HAS ESTIMATED THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY FOR LINE 3 BASED ON CENSUS DATA SHOWING 29.3% OF THE POPULATION IN ITS SERVICE AREA FALLING BELOW THE FEDERAL POVERTY GUIDELINES.
SCHEDULE H, PART III, SECTION A, LINE 4BAD DEBT EXPENSE FOOTNOTE: A FOOTNOTE TO THE FINANCIAL STATEMENTS READS NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. LAWS AND REGULATIONS GOVERNING THE MEDICARE AND MEDICAID PROGRAMS ARE EXTREMELY COMPLEX AND SUBJECT TO INTERPRETATION; AS A RESULT THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.
SCHEDULE H, PART III, SECTION B, LINE 8COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
SCHEDULE H, PART VI, LINE 2NEEDS ASSESSMENT: GENERAL NEEDS ASSESSMENT IS PERFORMED BY THE BOARD OF DIRECTORS AND MANAGEMENT, WHO REGULARLY MEET WITH LOCAL PROVIDERS TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES FOR ADDRESSING THESE NEEDS. APPROPRIATE PROGRAMS ARE IMPLEMENTED AS A RESULT.
SCHEDULE H, PART VI, LINE 3PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PATIENTS ARE ASKED UPON ADMISSION IF THEY WOULD LIKE TO APPLY FOR ASSISTANCE. A CASEWORKER MAKES IN-ROOM VISITS TO THOSE WHO APPLY AND ASSISTS IN ENROLLMENT IN ANY PROGRAMS FOR WHICH THE PATIENT QUALIFIES.
SCHEDULE H, PART VI, LINE 4COMMUNITY INFORMATION: THE HOSPITAL SERVES PEMISCOT, EASTERN DUNKLIN, AND SOUTHERN NEW MADRID COUNTIES OF SOUTHEAST MISSOURI. PEMISCOT COUNTY'S MEDIAN HOUSEHOLD INCOME WAS $28,889 WHEN LAST MEASURED IN 2013, WITH 29.3% PERSONS LIVING BELOW THE POVERTY LEVEL.
SCHEDULE H, PART VI, LINE 5PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL SENDS EMPLOYEES TO WORK AT LOCAL HEALTH FAIRS, INCLUDING CHECKING BLOOD PRESSURE AND BASIC LAB WORK. ONE DOCTOR HAS STARTED A NEW PROGRAM TO ADDRESS TEEN PREGNANCY. THE HOSPITAL ALSO PROVIDES EMPLOYEES TO ADMINISTER FLU SHOTS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KERRY NOBLE
CEO$151,356$0$0$0$0$0$0$0$8,778$0$160,134$0$0$0
ABDULLAH ARSHAD
PHYSICIAN$457,727$0$397,977$0$0$0$0$0$26,548$0$882,252$0$0$0
BABATUNDE OLADIRAN
PHYSICIAN$505,489$0$0$0$0$0$0$0$30,329$0$535,818$0$0$0
JOSEPH KULPEKSA
PHYSICIAN$290,094$0$0$0$0$0$0$0$17,406$0$307,500$0$0$0
GHAITH KHAIR
PHYSICIAN$225,088$0$0$0$0$0$0$0$13,505$0$238,593$0$0$0
ERICA SCHEFFER
PHYSICIAN$205,276$0$0$0$0$0$0$0$12,317$0$217,593$0$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 1ORGANIZATION'S MISSION: DEMAND FOR EXPANSION OF EXISTING OR INITIATION OF NEW PROGRAMS AND SERVICES ARE EVALUATED ON AN ONGOING BASIS RESULTING IN INCREMENTAL IMPROVEMENTS IN THE DEGREE OF QUALITY OF SERVICES RENDERED IN DIRECT RESPONSE TO THE CHANGING HEALTHCARE NEEDS OF THE COMMUNITY. PEMISCOT MEMORIAL HEALTH SYSTEMS STRIVES TO WORK IN COLLABORATION WITH LOCAL, STATE AND FEDERAL ORGANIZATIONS TO ENSURE ACCESS TO PRIMARY CARE FOR ALL RESIDENTS WITH SPECIAL EMPHASIS ON PREVENTATIVE HEALTH AND WELLNESS. WE DILIGENTLY WORK TO MAINTAIN OUR FINANCIAL STRENGTH IN ORDER THAT WE REMAIN A PROMINENT PROVIDER OF MEDICAL SERVICES FOR THE REGION.
FORM 990, PART IV, LINE 20BAUDITED FINANCIAL STATEMENTS: THE ORGANIZATION IS ATTACHING THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2012, AS THESE ARE THE MOST RECENT AUDITED FINANCIAL STATEMENTS. THE 2014 FINANCIAL STATEMENTS ARE REVIEWED FINANCIAL STATEMENTS RATHER THAN AUDITED FINANCIAL STATEMENTS.
FORM 990, PART VI, SECTION A, LINES 6 & 7AMEMBERS: ANY VACANCY ON THE BOARD IS FILLED BY APPOINTMENT BY THE PEMISCOT COUNTY COURT. THE APPOINTEE HOLDS THE OFFICE UNTIL THE NEXT ELECTION, OR WHEN THE SUCCESSOR IS ELECTED.
FORM 990, PART VI, SECTION B, LINE 11BREVIEW OF FORM 990: THE FORM IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM USING INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT AND MANAGEMENT. FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT A REGULAR SCHEDULED BOARD MEETING FOLLOWING THE FILING OF THE RETURN.
FORM 990, PART VI, SECTION B, LINES 15A & 15BCOMPENSATION REVIEW: THE COMPENSATION OF THE CEO AND COO IS REVIEWED AND APPROVED BY THE BOARD AND DOCUMENTED IN THE MINUTES. THE BOARD USES MHA EXECUTIVE SURVEY DATA TO COMPARE COMPENSATION TO LIKE ORGANIZATIONS.
FORM 990, PART VI, SECTION C, LINE 19DOCUMENT AVAILABILITY: GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST.