JEFFERSON DAVIS COMMUNITY HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- JEFFERSON DAVIS COMMUNITY HOSPITAL (EIN 72-1379812)
- Tax period
- 2009-08-01 to 2010-07-31
- Filed
- 2011-03-09
- IRS object ID
- 201100689349300630
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-03-09T19:05:18-05:00 | Timestamp |
| Tax Period End Date | 2010-07-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 190 E Capitol Street Suite 500 | AddressLine1 |
| City | Jackson | City |
| State | MS | State |
| ZIP Code | 392012190 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-08-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 721379812 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prentiss Regional Hospital and | BusinessNameLine1 |
| Business Name Line2 | Extended Care Facility Inc | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PREN | NameControl |
| Phone | 6017924276 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Post Office Box 1288 | AddressLine1 |
| City | Prentiss | City |
| State | MS | State |
| ZIP Code | 394741288 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Lee McCall | Name |
| Title | CEO | Title |
| Date Signed | 2011-03-15 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Penny Wood CPA | Name |
| Phone | 6019486700 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jefferson Davis Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Lee McCall | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1102 Rose Street | AddressLine1 |
| City | Prentiss | City |
| State | MS | State |
| ZIP Code | 39474 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 13199680 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.jdchnet.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | MS | StateLegalDomicile |
| Activity Or Mission Description | Prentiss Regional Hospital & Extended Care Facility, Inc. D/B/A Jefferson Davis Community Hospital, (The Hospital) is an acute care hospital located in Prentiss, MS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 277 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 25000 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 21630 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 14738568 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 12762497 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 462 | InvestmentIncomePriorYear |
| Investment Income Current Year | -57596 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 452814 | OtherRevenuePriorYear |
| Other Revenue Current Year | 289461 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 15216844 | TotalRevenuePriorYear |
| Total Revenue Current Year | 13015992 | 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 | 6681257 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5889506 | 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 | 8476718 | OtherExpensePriorYear |
| Other Expenses Current Year | 7846610 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15157975 | TotalExpensesPriorYear |
| Total Expenses Current Year | 13736116 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 58869 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -720124 | RevenuesLessExpensesCY |
| Total Assets BOY | 6100495 | TotalAssetsBOY |
| Total Assets EOY | 5160132 | TotalAssetsEOY |
| Total Liabilities BOY | 3822915 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3602676 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2277580 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1557456 | NetAssetsOrFundBalancesEOY |
| Mission Description | Prentiss Regional Hospital & Extended Care Facility, Inc. D/B/A Jefferson Davis Community Hospital, (the Hospital) located in Prentiss, MS is a not-for-profit acute care hospital that provides inpatient, outpatient, and emergency care services primarily for local residents and residents of the surrounding area. The Hospital is licensed for 25 acute care beds, 10 geriatric psychiatric unit beds, and 60 nursing home beds. The Hospital provides medical care without charge or at a reduced charge to patients who meet certain criteria under its charity care policy. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 9422692 | Expense |
| Revenue | 12815935 | Revenue |
| Description | Inpatient, outpatient, and emergency care services | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | The hospital provides medical care without charge or at a reduced charge to patients who meet certain criteria under its charity care policy. The amount of charges foregone for services and supplies furnished under the Hospital's charity care policy aggregated $82,634 during fiscal year 2010. Charges foregone are netted against patient service revenue to arrive at net patient service revenue and are not reported as functional expenses on the tax return. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2311270 | Expense |
| Description | The Hospital grants credit without collateral to its patients. Charges deemed uncollectible during fiscal year 2010 were approximately $2,311,270. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 11733962 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 277 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PAUL BLACK | NamePerson |
| Telephone Number | 6017921136 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1102 ROSE STREET | AddressLine1 |
| City | Prentiss | City |
| State | MS | State |
| ZIP Code | 39474 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 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 |
|---|---|---|---|---|---|---|---|
| Jack Berry | |||||||
| Trustee | 1.0 | X | 11189 | 0 | 0 | ||
| Keith Bridges | |||||||
| Trustee | 1.0 | X | 1200 | 0 | 0 | ||
| Kathy Cloyd | |||||||
| Trustee | 1.0 | X | 1200 | 0 | 0 | ||
| Willis Graves | |||||||
| Trustee | 1.0 | X | 1315 | 0 | 0 | ||
| Lola Bass | |||||||
| Trustee | 1.0 | X | 1315 | 0 | 0 | ||
| Ralph Fortenberry | |||||||
| Trustee | 1.0 | X | 1284 | 0 | 0 | ||
| Reggie Magee | |||||||
| Trustee | 1.0 | X | 1277 | 0 | 0 | ||
| Lee McCall | |||||||
| CEO | 40.0 | 87716 | 0 | 12113 | X | ||
| Paul Black | |||||||
| CFO | 40.0 | 34200 | 0 | 0 | X | ||
| Mary Curtis | |||||||
| Compliance Officer | 40.0 | 69800 | 0 | 0 | X | ||
| Earl Mahaffey MD | |||||||
| Clinic Physician | 40.0 | 165392 | 0 | 6962 | X | ||
| Joe Taylor | |||||||
| Nurse Practitioner | 48.0 | 160012 | 0 | 6338 | X | ||
| Roy Evans MD | |||||||
| Clinic Physician | 40.0 | 145208 | 0 | 5462 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 681108 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 30875 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | true | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Correct Care | |||||
| 17438 Hard Hat Drive | COVINGTON | LA | 70435 | ER Physician | 435188 |
| Healthcare Services Group Inc | |||||
| 3220 Tillman Drive | BENSALEM | PA | 19020 | Housekeeping | 279553 |
| Physical Rehab Management Inc | |||||
| 1106 Pointe Cove | BRANDON | MS | 39042 | Physical Therapy | 223636 |
| The Summit Health Rehab Services I | |||||
| PO Box 2377 | MCCOMB | MS | 39649 | Physical Therapy | 166097 |
| GAR Management | |||||
| 1590 Cooper Road | PEARL | MS | 39208 | GPU Management | 120000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Government Grants | 21630 | GovernmentGrants |
| Total Contributions | 21630 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Revenue | 900099 | 12706970 | 12706970 |
| RELATED RENTAL INCOME | 900099 | 55527 | 55527 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 12762497 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5 | TotalRevenueColumn |
| Exclusion | $5 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 126087 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 183688 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -57601 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -57601 | TotalRevenueColumn |
| Exclusion | -$57,601 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| Miscellaneous Revenue | 900099 | 60535 | $60,535 | |
| Cafeteria Revenue | 722210 | 53438 | 53438 | |
| Wellness Center Revenue | 713940 | 65599 | $65,599 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 109889 | TotalRevenueColumn |
| Exclusion | $109,889 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 289461 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13015992 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12815935 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $178,427 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99828 | Total |
| Management And General | 99828 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4919261 | Total |
| Program Services | 4373623 | ProgramServices |
| Management And General | 545638 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50444 | Total |
| Program Services | 44063 | ProgramServices |
| Management And General | 6381 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 436833 | Total |
| Program Services | 392157 | ProgramServices |
| Management And General | 44676 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 383140 | Total |
| Program Services | 334675 | ProgramServices |
| Management And General | 48465 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16999 | Total |
| Management And General | 16999 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80685 | Total |
| Management And General | 80685 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2352729 | Total |
| Program Services | 2125834 | ProgramServices |
| Management And General | 226895 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7855 | Total |
| Management And General | 7855 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1564801 | Total |
| Program Services | 1296248 | ProgramServices |
| Management And General | 268553 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39905 | Total |
| Program Services | 3175 | ProgramServices |
| Management And General | 36730 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209738 | Total |
| Program Services | 209738 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24908 | Total |
| Program Services | 11153 | ProgramServices |
| Management And General | 13755 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3873 | Total |
| Program Services | 3223 | ProgramServices |
| Management And General | 650 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 195992 | Total |
| Program Services | 195992 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 357508 | Total |
| Program Services | 357508 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 262374 | Total |
| Management And General | 262374 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt Expense | 2311270 | 2311270 | |
| Taxes and Licenses | 404015 | 74146 | 329869 |
| Repairs and Maintenance | 651 | 651 | |
| Dues and Subscriptions | 13307 | 506 | 12801 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13736116 | Total |
| Program Services | 11733962 | ProgramServices |
| Management And General | 2002154 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107527 | BOY |
| EOY | 138192 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17160 | BOY |
| EOY | 46000 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2012053 | BOY |
| EOY | 1417834 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118349 | BOY |
| EOY | 108896 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78081 | BOY |
| EOY | 30119 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7446450 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4717682 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3186891 | BOY |
| EOY | 2728768 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 580434 | BOY |
| EOY | 690323 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6100495 | BOY |
| EOY | 5160132 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1633821 | BOY |
| EOY | 1533429 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1303234 | BOY |
| EOY | 1144979 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 885860 | BOY |
| EOY | 924268 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3822915 | BOY |
| EOY | 3602676 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2277580 | BOY |
| EOY | 1557456 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2277580 | BOY |
| EOY | 1557456 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6100495 | BOY |
| EOY | 5160132 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 97900 | OtherCostOrOtherBasis |
| Book Value | 97900 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3454482 | OtherCostOrOtherBasis |
| Depreciation | 1411800 | Depreciation |
| Book Value | 2042682 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38629 | OtherCostOrOtherBasis |
| Depreciation | 34019 | Depreciation |
| Book Value | 4610 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3707635 | OtherCostOrOtherBasis |
| Depreciation | 3130580 | Depreciation |
| Book Value | 577055 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 147804 | OtherCostOrOtherBasis |
| Depreciation | 141283 | Depreciation |
| Book Value | 6521 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2728768 | TotalOfBookValueLandBuildings |
| Financial Derivatives | FinancialDerivatives | |
| Closely Held Equity Interests | CloselyHeldEquityInterests |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENT IN HPIC | Description |
| Book Value | 690323 | BookValue |
| Method Of Valuation | C | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 690323 | TotalOfBookValueSecurities |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Third-Party Payor Settlements | Description |
| Amount | $924,268 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 924268 | TotalOfAmounts |
| Total Revenue | 13015992 | TotalRevenue |
| Total Expenses | 13736116 | TotalExpenses |
| Excess Or Deficit For Year | -720124 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -720124 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 13073593 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 13073593 | RevenueSubtotal |
| Other Revenues Not Included | -57601 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -57601 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 13015992 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 13793717 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 57601 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 57601 | ExpensesNotRptdF990 |
| Expenses Subtotal | 13736116 | ExpensesSubtotal |
| Total Expenses Per Form990 | 13736116 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Schedule D, Part X, Line 2: | Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. |
| Schedule D, Part XII, Line 4b: | Loss on sale of assets reported as expense on the financial statements but included as revenue on the Form 990 |
| Schedule D, Part XIII, Line 2d: | Losses on sale of assets reported as expenses on the financial statements but included as revenue on the Form 990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | false | FPGReferenceFreeCare |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 47170 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 47170 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00410 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3326266 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 807464 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2518802 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.21940 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3373436 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 807464 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2565972 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.22350 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3373436 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 807464 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2565972 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.22350 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $1,331,523 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 4813646 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4813646 | CostOfCareReimbursedByMedicare |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | false | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (3 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| Rural Health | ||
| Management Services | 0.50000 | |
| Curtis Management | ||
| Management Services | 0.50000 | |
| GAR Management | ||
| Management Services | 1.00000 | |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prentiss Regional Hospital & ECF | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1102 Rose Street | AddressLine1 |
| City | Prentiss | City |
| State | MS | State |
| ZIP Code | 39474 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | The costing methodology used to calculate the amounts in Part I, Line 7 is a ratio of patient care cost to charges and includes all patient segments. Worksheets 1, 2, and 3 were used to determine the amounts reported in Part I, Line 7a and b. | CostingMethodUsed |
| Percent Of Total Expense Expln | Bad debt expense of $2,311,270 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). | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Hospital bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific cirmcumstances of the account. The Hospital offers a charity assistance application to patients upon admission. Accounts of patients who choose not to apply for charity care but who are unable to pay their medical bills are ultimately written off as bad debt based on the Hospital's bad debt policy. This policy does not include provisions for those patients who are known to qualify for charity care but do not apply for the assistance. The Hospital is unable to quantify the amount of bad debt that is related to patients who would qualify for charity care if applied for, but consider a majority of bad debt to consist of these accounts. The costing methodology used to report the organization's bad debt expense at cost is a ratio of patient care cost to charges using Worksheet 2 of the instructions. | BadDebtFootnote |
| Shortfall As Community Benefit | The Hospital uses its medicare cost report to determine the amount reported on Schedule H, Part III, Line 6. | ShortfallAsCommunityBenefit |
| Number Of Facility Type Expln | All health care facilities operated by the hospital are reported in Schedule H, Part V. The organization does not operate facilities that are not required to be licensed, registered or similarly recognized as a health care facility under state law. | NumberOfFacilityTypeExpln |
| Needs Assessment | The Hospital assesses the needs of the community it serves by engaging in community programs, conducting and participating in community meetings, through dialogue with constituents, and by receiving feedback through evaluations of its services. | NeedsAssessment |
| Patient Education Assistance | Patients are informed about their eligibility for government and charity care assistance during the registration process. | PatientEducationAssistance |
| Community Information | The Hospital serves Jefferson Davis County, a rural area located in south central Mississippi with a population of approximately 12,000 and median household income of approximatley $27,000. | CommunityInformation |
| Community Building Activities | The Hospital educates and informs community members of various programs and services which increases community accessibility and involvement in healthcare programs offered by the Hospital. | CommunityBuildingActivities |
| Other Information | A majority of the organization's governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization, nor family members thereof. | OtherInformation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Paul Black | |||||||||||
| 34200 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 34200 | 0 |
| Mary Curtis | |||||||||||
| 69800 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 69800 | 0 |
| Earl Mahaffey MD | |||||||||||
| 165392 | 0 | 0 | 0 | 0 | 0 | 3120 | 0 | 3842 | 0 | 172354 | 0 |
| Joe Taylor | |||||||||||
| 160012 | 0 | 0 | 0 | 0 | 0 | 2496 | 0 | 3842 | 0 | 166350 | 0 |
| Roy Evans MD | |||||||||||
| 145208 | 0 | 0 | 0 | 0 | 0 | 1620 | 0 | 3842 | 0 | 150670 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Schedule J, Part II: | Identifier |
| Explanation | Paul Black, CFO, was paid approximately $34,200 by Rural Health Management, Inc., an unrelated organization, for services to the Hospital. Mary Curtis, Compliance Officer, was paid $69,800 by Curtis Management, Inc., an unrelated organization, for services rendered to the Hospital. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Page 6, Part VI, Section B, Line 11A: | The Form 990 is reviewed by the organization's CEO and CFO prior to filing with the IRS. |
| Form 990, Page 6, Part VI, Section B, Line 12: | Annual disclosure forms are required to be completed by all board members, officers, and highest compensated employees. The questionnaires are reviewed by the organization's CEO and any persons with conflicts of interest are prohibited from participating in the board's deliberations and decisions in the transaction in which the conflict exists. |
| Form 990, Page 6, Part VI, Section B, Line 15: | Compensation of top management officials and other officers of the organization is determined by the board of directors based on comparability data received from salary surveys conducted by the Mississippi Hospital Association. |
| Form 990, Page 6, Part VI, Section C, Line 19: | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |