2012-08-10T09:05:40-05:00 2011-09-30 BKD LLP 190 E Capitol Street Ste 500 Jackson MS 392012190 990 2010-10-01 640741047 Tishomingo Health Services Inc TISH 6623773977 830 South Gloster Street Tupelo MS 38801 Joe Reppert 2012-08-15 Penny Wood CPA 6019486700 2010 2016-02-24 21:20:13Z Joe Reppert 830 South Gloster Street Tupelo MS 38801 19962948 false X www.nmhs.net/iuka/ X 1986 DE Tishomingo Health Services, Inc. operates a 48 bed acute care hospital located in Iuka, Mississippi. 5 5 190 7 0 0 45913 284774 16194976 19213520 769 524 399995 464130 16641653 19962948 0 0 0 0 9007522 9751370 0 0 0 9718011 10387879 18725533 20139249 -2083880 -176301 10799256 11802740 4653922 7055002 6145334 4747738 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. false false 19075635 19280226 NMMC-Iuka serves Tishomingo County and the surrounding area. In fiscal year 2011, there were over 900 inpatient admissions, over 10,100 emergency department visits, and over 10,800 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. NMMC-Iuka is the only hospital in Mississippi to have received these national awards for clinical excellence and patient satisfaction. 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. 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 71% 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 $917,000 in fiscal year 2011. Based on the gross charges provided to charity patients compared to total hospital gross charges, 2% of all services in fiscal year 2011 were provided on a charity basis. The net cost of charity care provided by NMMC-Iuka was approximately $320,000 in fiscal year 2011. 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. 19075635 true true false false false false false false false true false false false true true true true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false false true 11 0 true 190 true false false false false false false false false false false X 5 5 false false false false true true true true true false false false true true true true true true true false X JOE REPPERT 6623773977 SOUTH GLOSTER STREET Tupelo MS 38801 X John T Castleberry Jr 1.0 X 0 0 0 Charles Evans 1.0 X 0 0 0 Tim Wigginton 1.0 X 0 0 0 Thomas E Day 1.0 X 0 0 0 John B Moore 1.0 X 0 0 0 Larry Bonds 1.0 X 0 0 0 Steve McAnally 1.0 X 0 0 0 Gerald Wages 1.0 X 0 632782 8862 Bruce Toppin 1.0 X 0 294160 8380 Joe Reppert 1.0 X 0 502301 9005 Fred A Truesdale Jr 40.0 X 113817 0 5631 Layne Harris 40.0 X 102596 0 5596 Robert Jones 0.0 X 0 177522 7047 216413 1606765 44521 2 true true false 4MD2 Inc 1028 Highland Lakes Trace BIRMINGHAM AL 35242 ER Physician Fees 765308 Siemens Medical Solutions Dept at 40065 ATLANTA GA 311920065 X-ray Services 444127 Medicomp PO Box 426 MAGEE MS 39111 Rehab Services 389792 Alliance Imaging Inc PO Box 96485 CHICAGO IL 60693 MRI Services 240967 4 330 244750 39694 284774 Net Patient Service Revenue 900099 19210240 19210240 Related Rental Revenue 900099 3280 3280 19213520 524 524 0 0 0 0 0 0 Employee Drugs 900099 358581 358581 Cafeteria Revenue 900099 66706 66706 Rebate Income 900099 19824 19824 19019 19019 464130 19962948 19280226 0 397948 0 0 0 0 0 0 6663206 6073276 589930 394608 394608 2238636 2238636 454920 422873 32047 363295 363295 10692 10692 45297 45297 0 0 0 1598002 1598002 17851 17851 2251329 2251329 209783 209783 0 345545 345545 29057 29057 0 28786 28786 0 0 640103 640103 22353 22353 Bad Debt Expense 4418345 4418345 Recruitment Expense 105910 105910 Repairs and Maintenance 91054 91054 Collection Fees 59411 59411 Dues and Subscriptions 53372 53372 97694 97694 20139249 19075635 1063614 0 810 810 568160 749412 2816559 3802364 219760 241625 16605080 9901082 7132864 6703998 61103 304531 10799256 11802740 2319046 3905164 2334876 3149838 4653922 7055002 X 6100325 4702722 45009 45016 6145334 4747738 10799256 11802740 X -176301 -1221295 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 162278 162278 9284300 3926913 5357387 6944690 5839350 1105340 213812 134819 78993 6703998 0 Due to Related Parties 3149838 3149838 19962948 20139249 -176301 -1221295 -1221295 -1397596 19962948 19962948 19962948 20139249 20139249 20139249 Part X, Line 2: The Hospital 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 Hospital's financial statements as a result of Topic 740. Part XI, Line 8: Pension-related changes other than net periodic pension cost <1,221,302> Increase in interest in net assets of affiliated foundation 7 true true X true X 71. false false true false true true 319573 0 319573 0.02030 1467689 1928767 -461078 0.02930 0 0 0 0.00000 1787262 1928767 -141505 0.00900 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 1787262 1928767 -141505 0.00900 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 false 1539147 0 5308707 6839862 -1531155 X true true 1 1 Tishomingo Health Services

1777 Curtis Drive Iuka MS 38852

X Tishomingo Health Services 1 1 TishomingoIuka Wellness Center

619 Battle Ground Drive Iuka MS 38852

Wellness Center 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 6a: Tishomingo Health Services' community benefit information is included in the community benefit report of its parent company, North Mississippi Health Services, Inc. North Mississippi Health Services (NMHS) is a diversified regional health care organization, which serves 24 counties in north Mississippi and northwest Alabama from headquarters in Tupelo, MS. The NMHS organization covers a broad range of acute diagnostic and therapeutic services, offered through North Mississippi Medical Center in Tupelo; a community hospital system with locations in Eupora, Iuka, Pontotoc, West Point, MS, and Hamilton AL; North Mississippi Medical Clinics, a regional network of more than 30 primary and specialty clinics; and nursing homes. NMHS offers a comprehensive portfolio of managed care plans. Part I, Line 7g: Not Applicable Part I, Line 7, column (f): Bad Debt Expense of $4,418,345 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. The bad debt expense at cost in Part III Line 2 was calculated using the cost to charge ratio from Worksheet 2. 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 $1,192,262 and total costs were $1,884,355 for a net shortfall of $692,093. When combined with the shortfall reported on Line 7, the net shortfall from all Medicare programs is $2,223,248. 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 our internal and external stakeholders across the entire service area including Tishomingo County. The information gathered through several qualitative survey questions is used to determine our community's needs for the entire service area as well as the local service area for each hospital such as 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 2010 census, age demographics for the service area show that approximately 23% of the population is under 18 years of age, approximately 59% is between 18 and 64 years of age and that 18% is 65 or older. Caucasians make up 92% of the service area's population while African Americans make up 3% and Hispanics and others make up 5%. Median household income of $33,674 for the service area 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: 56.76% Medicare, 11.37% Medicaid, and 19.58% private insurance with 12.29% 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. The community benefit report is available online at nmhs.net. X X X X X false true false false false false false false false Gerald Wages 0 269225 0 139878 0 223679 0 4900 0 3962 0 641644 Bruce Toppin 0 222406 0 65303 0 6451 0 4900 0 3480 0 302540 Joe Reppert 0 379320 0 106433 0 16548 0 4900 0 4105 0 511306 Robert Jones 0 172080 0 1177 0 4265 0 3567 0 3480 0 184569 Part I, Line 4b: Participants: Gerald Wages $213,346 Joe Reppert $15,738 Terms & Conditions: North Mississippi Health Services, Inc. (NMHS) Adopted the management deferred annuity plan (the Plan) on October 1, 1998. Participants in the plan are designated by the compensation committee of the board of directors of NMHS. At the beginning of each plan year, NMHS shall pay a contribution, less witholding for taxes, to the participant's annuity contract, which is a deferred annuity contract selected, owned, and controlled by the participant. The contribution is determined by multiplying the participant's compensation in the preceding plan year by a percentage set forth in appendix b of the plan. A participant is terminated from the plan on the earliest of: (1) the date the board determines the employee is no longer a participant; (2) the date the participant retires; (3) the date that the participant dies; or (4) the date the participant no longer is employed by NMHS for reasons other than retirement or death. Form 990, Page 6, Part VI, Section A, Line 6: 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 5: Pension-related changes other than net periodic pension cost: <1,221,302> Increase in interest in net assets of Affiliated Foundation: 7 Total other changes in net assets or fund balance = <1,221,295> HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gerald Wages TITLE:President HOURS:39 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bruce Toppin TITLE:Secretary HOURS:39 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Joe Reppert TITLE:Treasurer HOURS:39 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert Jones TITLE:Former Treasurer HOURS:40 North MS Management Services Inc 830 S Gloster Street Tupelo MS 38801 640762694 Mgmt & Admin DE 501(c)(3) 11-I NA North MS Health Services Inc 830 S Gloster Street Tupelo MS 38801 640653269 Mgmt Services DE 501(c)(3) 11-II NA Clay County Medical Corporation 830 S Gloster Street Tupelo MS 38801 640668465 Hospital DE 501(c)(3) 3 NA North MS Medical Center Inc 830 S Gloster Street Tupelo MS 38801 640662976 Hospital DE 501(c)(3) 3 NA Pontotoc Health Services Inc 830 S Gloster Street Tupelo MS 38801 640751410 Hospital DE 501(c)(3) 3 NA North MS Medical Clinics Inc 830 S Gloster Street Tupelo MS 38801 640787918 Med Clinics DE 501(c)(3) 3 NA Tupelo Service Finance Inc 844 Cliff Gookin Blvd Tupelo MS 38801 640508308 Collections DE 501(c)(3) 3 NA Webster Health Services Inc 830 S Gloster Street Tupelo MS 38801 640819193 Hospital DE 501(c)(3) 3 NA Marion Regional Medical Center Inc 830 S Gloster Street Tupelo MS 38801 640926753 Hospital DE 501(c)(3) 3 NA North MS Emergency Services Inc 830 S Gloster Street Tupelo MS 38801 640780130 ER Physicians DE 501(c)(3) 9 NA North MS Health Link Inc 830 S Gloster Street Tupelo MS 38801 640715886 Medical Services DE NA C Corp North MS Enterprises Inc 830 S Gloster Street Tupelo MS 38801 640658059 Medical Services DE NA C Corp Professional Practice Management Inc 830 S Gloster Street Tupelo MS 38801 721390014 Med Serv Mgmt DE NA C Corp Acclaim Inc 830 S Gloster Street Tupelo MS 38801 721356116 Hlth Care Claims DE NA C Corp North MS Support Services Inc 830 S Gloster Street Tupelo MS 38801 260718275 Support Services DE NA C Corp false false false false false false false false false false false true false true true true true true