PEMISCOT COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: PEMISCOT COUNTY MEMORIAL HOSPITAL (EIN 43-6004544)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-08-30
IRS object ID: 201232439349300408
Schema version: 2011v1.2
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
Form 990
Schedule A
Schedule D
Schedule H
Schedule J
Schedule K
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-08-30T10:23:58-05:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	621804252	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	WATKINS UIBERALL PLLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1661 AARON BRENNER DR STE 300	AddressLine1
City	MEMPHIS	City
State	TN	State
ZIP Code	38120	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	436004544	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	PEMISCOT MEMORIAL HEALTH SYSTEMS	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	PEMI	NameControl
Phone	5733593415	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 489	AddressLine1
City	HAYTI	City
State	MO	State
ZIP Code	63851	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	KERRY NOBLE	Name
Title	CEO	Title
Phone	5733593415	Phone
Date Signed	2012-08-02	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	B COBENE WATKINS	Name
PTIN	P00083192	PTIN
Phone	9017612720	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	KERRY NOBLE	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	PO BOX 489	AddressLine1
City	HAYTI	City
State	MO	State
ZIP Code	63851	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	46123964	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.PEMISCOT.ORG	WebSite
Type Of Organization Other	X	TypeOfOrganizationOther
Year Formation	1949	YearFormation
State Legal Domicile	MO	StateLegalDomicile
Activity Or Mission Description	THE PRIMARY PURPOSE OF PEMISCOT MEMORIAL HEALTH SYSTEM IS TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY REGARDLESS OF ABILITY TO PAY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	5	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	4	NbrIndependentVotingMembers
Total Nbr Employees	701	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	523370	ContributionsGrantsPriorYear
Contributions Grants Current Year	1088152	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	44076922	ProgramServiceRevenuePriorYear
Program Service Revenue CY	42403894	ProgramServiceRevenueCY
Investment Income Prior Year	27500	InvestmentIncomePriorYear
Investment Income Current Year	31653	InvestmentIncomeCurrentYear
Other Revenue Prior Year	432021	OtherRevenuePriorYear
Other Revenue Current Year	2600265	OtherRevenueCurrentYear
Total Revenue Prior Year	45059813	TotalRevenuePriorYear
Total Revenue Current Year	46123964	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	24573780	SalariesEtcPriorYear
Salaries Etc Current Year	23137083	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	23524448	OtherExpensePriorYear
Other Expenses Current Year	22124728	OtherExpensesCurrentYear
Total Expenses Prior Year	48098228	TotalExpensesPriorYear
Total Expenses Current Year	45261811	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-3038415	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	862153	RevenuesLessExpensesCY
Total Assets BOY	16452665	TotalAssetsBOY
Total Assets EOY	18220136	TotalAssetsEOY
Total Liabilities BOY	8730834	TotalLiabilitiesBOY
Total Liabilities EOY	9636152	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	7721831	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	8583984	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	PEMISCOT 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. 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(S). 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.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	43178363	Expense
Revenue	42374826	Revenue
Description	PROVIDING QUALITY HEALTH CARE TO THE COMMUNITY THROUGH THE OPERATION OF A HOSPITAL, TWO LONGTERM CARE FACILITIES, RURAL HEALTH CLINICS AND ADOLESCENT, ADULT, AND GERIATRIC PSYCHIATRIC UNITS.	Description
Total Program Service Expense	43178363	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	1	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	67	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	701	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	5	NbrVotingGoverningBodyMembers
Number Independent Voting Members	4	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	0	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	0	ConflictOfInterestPolicy
Whistleblower Policy	0	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	0	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MO	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	CARRIE BYERS	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	5733593415	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	946 EAST REED	AddressLine1
City	HAYTI	City
State	MO	State
ZIP Code	63851	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
GLENN HAYNES
PRESIDENT	2.00	X	0	0	0
LEE WIGGINTON
TREASURER	2.00	X	0	0	0
BOBBY KHOURIE
VICE PRESIDENT	2.00	X	0	0	0
CAROL TILLMAN
SECRETARY	2.00	X	0	0	0
JOHNNY HARMON
MEMBER	2.00	X	0	0	0
KERRY NOBLE
CHIEF EXECUTIVE OFFICER	40.00		216481	0	11906	X
JACK PENNINGTON
CHIEF OPERATING OFFICER	40.00		3644	0	200	X
ABDULLAH ARSHAD
PHYSICIAN	40.00		469781	0	25838		X
RALPH KELLEY
PHYSICIAN	40.00		230229	0	12663		X
J KULPEKSA
PHYSICIAN	40.00		169562	0	9326		X
BABATUNDE OLADIRAN
PHYSICIAN	40.00		250504	0	13778		X
GENEROSO GUZMAN
PHYSICIAN	40.00		201364	0	11075		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1541565	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	84786	TotalOtherCompensation
Number Individuals GT100 K	15	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
AMERI SOURCE BERGEN
24663 NETWORK PLACE	CHICAGO	IL	60673	PHARMACY	1307289
HARDIN'S SYSCO FOOD SERVICES
PO BOX 18872	MEMPHIS	TN	38181	FOOD	854031
JIM PANG MD
8134 COUNTRY VILLAGE DR SUITE 102	CORDOVA	TN	38016	PHYSICIAN	627567
CARDINAL HEALTH
PO BOX 70539	CHICAGO	IL	60673	MEDICAL SUPPLIES	598133
EXTENDED ENTERPRISES INC
PO BOX 393	HAYTI	MO	63851	BILLING SERVICES	572564

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	35	NumberOfContractorsGT100K
Government Grants	1087652	GovernmentGrants
All Other Contributions	500	AllOtherContributions
Total Contributions	1088152	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PATIENT SERVICES	Description
Business Code	621400	BusinessCode
Total Revenue Column	42403894	TotalRevenueColumn
Related Or Exempt Function Income	42374826	RelatedOrExemptFunctionIncome
Exclusion	$29,068	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	42403894	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	31653	TotalRevenueColumn
Exclusion	$31,653	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
MISCELLANEOUS	900099	2421114	$2,421,114
CAFETERIA	722210	96619	$96,619
MEDICAL RECORDS	519100	65508	$65,508

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	17024	TotalRevenueColumn
Exclusion	$17,024	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	2600265	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	46123964	TotalRevenueColumn
Related Or Exempt Function Income	42374826	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$2,660,986	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	232231	Total
Program Services	218294	ProgramServices
Management And General	13937	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	18514682	Total
Program Services	17403550	ProgramServices
Management And General	1111132	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	838118	Total
Program Services	785676	ProgramServices
Management And General	52442	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	2279012	Total
Program Services	2136410	ProgramServices
Management And General	142602	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1273040	Total
Program Services	1193384	ProgramServices
Management And General	79656	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	62647	Total
Management And General	62647	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	44288	Total
Management And General	44288	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	536228	Total
Program Services	462005	ProgramServices
Management And General	74223	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	569916	Total
Program Services	512924	ProgramServices
Management And General	56992	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	45748	Total
Program Services	41024	ProgramServices
Management And General	4724	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	184963	Total
Program Services	166467	ProgramServices
Management And General	18496	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1116402	Total
Program Services	1004762	ProgramServices
Management And General	111640	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	512591	Total
Program Services	501251	ProgramServices
Management And General	11340	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT EXPENSE	7290684	7290684
OUTSIDE SERVICES	3882365	3730662	151703
MEDICAL SUPPLIES	2587786	2587786
FRA EXPENSE	2426303	2426303

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	2864807	Total
Program Services	2717181	ProgramServices
Management And General	147626	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	45261811	Total
Program Services	43178363	ProgramServices
Management And General	2083448	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	2405	BOY
EOY	2405	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	404832	BOY
EOY	1806772	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	7628290	BOY
EOY	6484446	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	278089	BOY
EOY	323599	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	106073	BOY
EOY	204503	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	26588304	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	19806280	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	6548097	BOY
EOY	6782024	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1484879	BOY
EOY	2616387	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	16452665	BOY
EOY	18220136	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	3793801	BOY
EOY	3951334	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	1735000	BOY
EOY	1340000	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
EOY	277389	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	3202033	BOY
EOY	4067429	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	8730834	BOY
EOY	9636152	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	7721831	BOY
EOY	8583984	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	7721831	BOY
EOY	8583984	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	16452665	BOY
EOY	18220136	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	862153	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	135242	OtherCostOrOtherBasis
Book Value	135242	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	10587573	OtherCostOrOtherBasis
Depreciation	6585421	Depreciation
Book Value	4002152	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	409362	OtherCostOrOtherBasis
Depreciation	55136	Depreciation
Book Value	354226	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	15288356	OtherCostOrOtherBasis
Depreciation	13165723	Depreciation
Book Value	2122633	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	167771	OtherCostOrOtherBasis
Book Value	167771	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	6782024	TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescription	Book ValueBookValue
ACCRUED COUNTY TAX REVENUE	514906
ACCRUED DSH FUNDS	1152457
ASSETS WHOSE USE IS LIMITED	906600
BOND UNDERWRITER FEES, NET	26983
CASH HELD FOR RESIDENTS	15441

Field	Value	IRS element (for citing)
Total Book Value Other Assets	2616387	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescription	AmountAmount
ACCRUED DSH RECOUPMENT	$1,444,290
CAPITAL LEASE PAYABLE	$2,023,905
ESTIMATED THIRD PARTY SETTLEMENT	$547,470
LEGAL SETTLEMENT PAYABLE	$36,323
RESIDENT TRUST FUND	$15,441

Field	Value	IRS element (for citing)
Total Of Amounts	4067429	TotalOfAmounts
Total Revenue	46123964	TotalRevenue
Total Expenses	45261811	TotalExpenses
Excess Or Deficit For Year	862153	ExcessOrDeficitForYear
Excess Or Deficit Per FS	862153	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	46123964	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	46123964	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	46123964	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	45261811	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	45261811	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	45261811	TotalExpensesPerForm990

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	0	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	0	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2842057	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1763187	DirectOffsettingRevenue
Net Community Benefit Expense	1078870	NetCommunityBenefitExpense
Percent Of Total Expense	0.02380	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	7670179	TotalCommunityBenefitExpense
Direct Offsetting Revenue	7127380	DirectOffsettingRevenue
Net Community Benefit Expense	542799	NetCommunityBenefitExpense
Percent Of Total Expense	0.01200	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10512236	TotalCommunityBenefitExpense
Direct Offsetting Revenue	8890567	DirectOffsettingRevenue
Net Community Benefit Expense	1621669	NetCommunityBenefitExpense
Percent Of Total Expense	0.03580	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	256430	TotalCommunityBenefitExpense
Net Community Benefit Expense	256430	NetCommunityBenefitExpense
Percent Of Total Expense	0.00570	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4211	TotalCommunityBenefitExpense
Net Community Benefit Expense	4211	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	260641	TotalCommunityBenefitExpense
Net Community Benefit Expense	260641	NetCommunityBenefitExpense
Percent Of Total Expense	0.00580	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10772877	TotalCommunityBenefitExpense
Direct Offsetting Revenue	8890567	DirectOffsettingRevenue
Net Community Benefit Expense	1882310	NetCommunityBenefitExpense
Percent Of Total Expense	0.04160	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$3,468,713	BadDebtExpenseAmount
Amount Attributable To	1214050	AmountAttributableTo
Amount Reimbursed By Medicare	11625751	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	11422379	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	203372	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	0	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	PEMISCOT MEMORIAL HEALTH SYSTEMS	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	946 EAST REED	AddressLine1
City	HAYTI	City
State	MO	State
ZIP Code	63851	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	PEMISCOT MEMORIAL HEALTH SYSTEMS	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	100.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	200.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	1	ActionsOnNonpayment
Permit Report To Credit Agency	X	PermitReportToCreditAgency
Permit Lawsuit	X	PermitLawsuit
Permit Lien On Residence	X	PermitLienOnResidence
Collection Activities	0	CollectionActivities
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	1	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	10	NumberOfOtherFacilities

Other Facilities OtherFacilities (10 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
PEMISCOT MEMORIAL NURSING HOME
946 EAST REED	HAYTI	MO	63851	LONG-TERM CARE FACILITY
CARUTHERSVILLE NURSING CENTER
500 TRUMAN BLVD	CARUTHERSVILLE	MO	63830	SKILLED NURSING FACILITY
PEMISCOT PRIMARY CARE CENTER
907 EAST REED	HAYTI	MO	63851	OUTPATIENT PHYSICIAN CLINIC
DOCTOR'S CLINIC
106 WEST 12	CARUTHERSVILLE	MO	63830	OUTPATIENT PHYSICIAN CLINIC
WOMEN'S PRIMARY CARE CENTER
701 EAST LINCOLN	HAYTI	MO	63851	OUTPATIENT PHYSICIAN CLINIC
PEMISCOT CONVENIENT CARE CLINIC
946 EAST REED	HAYTI	MO	63851	OUTPATIENT PHYSICIAN CLINIC
PORTAGEVILLE PRIMARY CARE CENTER
712 NORTH HIGHWAY 61	PORTAGEVILLE	MO	63873	OUTPATIENT PHYSICIAN CLINIC
BOOTHEEL PRIMARY CARE - CARUTHERSVILLE
1502 WARD AVENUE	CARUTHERSVILLE	MO	63830	OUTPATIENT PHYSICIAN CLINIC
BOOTHEEL PRIMARY CARE - HAYTI
223 SOUTH 3RD	HAYTI	MO	63851	OUTPATIENT PHYSICIAN CLINIC
BOOTHEEL PRIMARY CARE - STEELE
213 S WALNUT	STEELE	MO	63877	OUTPATIENT PHYSICIAN CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)

ExplanationExplanation	IdentifierIdentifier
PART III, LINE 4: 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.COST TO CHARGE RATIO IS USED TO DETERMINE THE REPORTED AMOUNTS.
PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE TAKEN FROM THE HOSPITAL'S COST REPORT.
PART V, SECTION B, LINE 19D: THE HOSPITAL FACILITY USES 130% OF THE MEDICARE RATE.	PEMISCOT MEMORIAL HEALTH SYSTEMS
PART V, SECTION B, LINE 21: PRIVATE PAY PATIENTS ARE CHARGED AT GROSS CHARGES. IF THE PATIENT QUALIFIES FOR THE SLIDING FEE SCALES, THE CHARGES ARE DISCOUNTED ACCORDINGLY. ALSO, DISCOUNTS APPLY FOR PAYING WITHIN 30/60/90 DAYS AND FOR PAYING WITHIN THE TERMS OF A FINANCING AGREEMENT WITH THE HOSPITAL. THE AMOUNT CHARGED IS EQUAL TO GROSS CHARGES ONLY IF THE PATIENT IS MORE THAN 60 DAYS DELINQUENT ON A PAYMENT PLAN.	PEMISCOT MEMORIAL HEALTH SYSTEMS
PART VI, LINE 2: GENERAL NEEDS ASSESSMENT IS PERFORMED BY THE BOARD OF DIRECTORS AND MANAGEMENT. APPROPRIATE PROGRAMS ARE IMPLEMENTED AS A RESULT.
PART VI, LINE 3: 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.
PART VI, LINE 4: THE HOSPITAL SERVES PEMISCOT, EASTERN DUNKLIN, AND SOUTHERN NEW MADRID COUNTIES OF SOUTHEAST MISSOURI. PEMISCOT COUNTY'S MEDIAN HOUSEHOLD INCOME WAS $27,188 WHEN LAST MEASURED IN 2008, WITH 31.7% OF PERSONS BELOW THE FEDERAL POVERTY LEVEL.
PART VI, LINE 5: 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

Field	Value	IRS element (for citing)
Club Dues Or Fees	X	ClubDuesOrFees
Written Policy Re T And E Expenses	0	WrittenPolicyReTAndEExpenses
Substantiation Required	0	SubstantiationRequired
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KERRY NOBLE
216481	0	0	0	0	0	11906	0	0	0	228387	0	0	0
ABDULLAH ARSHAD
469781	0	0	0	0	0	25838	0	0	0	495619	0	0	0
RALPH KELLEY
230229	0	0	0	0	0	12663	0	0	0	242892	0	0	0
J KULPEKSA
169562	0	0	0	0	0	9326	0	0	0	178888	0	0	0
BABATUNDE OLADIRAN
250504	0	0	0	0	0	13778	0	0	0	264282	0	0	0
GENEROSO GUZMAN
201364	0	0	0	0	0	11075	0	0	0	212439	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Return Reference	PART I, LINE 1A	ReturnReference
Explanation	HAYTI ROTARY CLUB DUES WERE PAID ON BEHALF OF THE OFFICERS AT $200.00 PER QUARTER.	Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	PEMISCOT COUNTY MISSOURI	BusinessNameLine1

Field	Value	IRS element (for citing)
Date Issued	2004-06-01	DateIssued
Issue Price	4265000	IssuePrice
Description Of Purpose	REFUND OUTSTANDING BOND ISSUES	DescriptionOfPurpose
Defeased	0	Defeased
On Behalf Of Issuer	0	OnBehalfOfIssuer
Pool Financing	0	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Total Proceeds	4265000	TotalProceeds
Amount In Reserve Fund	426500	AmountInReserveFund
Refunding Escrow	4776317	RefundingEscrow
Issuance Costs From Proceeds	101185	IssuanceCostsFromProceeds
Current Refunding	1	CurrentRefunding
Advance Refunding	0	AdvanceRefunding
Final Allocation Made	1	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	0	MngmentCntrctBondFinancdPrprty
Any Research Agreements	0	AnyResearchAgreements
Post Issuance Compliance Procdrs	0	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	0	Form8038TFiled
Variable Rate Issue	0	VariableRateIssue
Hedge Identified In Books And Recds	0	HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGIC
Gross Proceeds Invested	0	GrossProceedsInvested
Exception To Rebate	0	ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
GLENN HAYNES
PRESIDENT	33792	CAPITAL LEASE	0
EXTENDED HEALTH SERVICES
ENTITY MORE THAN 35% OWNED BY BOARD PRESIDENT	576163	INDEPENDENT CONTRACTOR	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

Return ReferenceReturnReference	ExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11	FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING FOLLOWING THE FILING OF THE RETURN.
	COMPENSATION FOR EXISTING OFFICERS AND KEY EMPLOYEES IS COMPARED WITH MO HOSPITAL ASSOCIATION SALARY SURVEY DATA.
FORM 990, PART VI, SECTION C, LINE 19	FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST.