PEMISCOT COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: PEMISCOT COUNTY MEMORIAL HOSPITAL (EIN 43-6004544)
Tax period: 2010-01-01 to 2010-12-31
Filed: 2011-11-15
IRS object ID: 201103199349306240
Schema version: 2010v3.4
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	2011-11-15T13:55:11-06:00	Timestamp
Tax Period End Date	2010-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

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	2010-01-01	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	2011-11-15	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

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

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Address Change	X	AddressChange
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	45059813	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	782	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	742021	ContributionsGrantsPriorYear
Contributions Grants Current Year	523370	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	48499626	ProgramServiceRevenuePriorYear
Program Service Revenue CY	44076922	ProgramServiceRevenueCY
Investment Income Prior Year	40869	InvestmentIncomePriorYear
Investment Income Current Year	27500	InvestmentIncomeCurrentYear
Other Revenue Prior Year	308312	OtherRevenuePriorYear
Other Revenue Current Year	432021	OtherRevenueCurrentYear
Total Revenue Prior Year	49590828	TotalRevenuePriorYear
Total Revenue Current Year	45059813	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	25134834	SalariesEtcPriorYear
Salaries Etc Current Year	24573780	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	24139692	OtherExpensePriorYear
Other Expenses Current Year	23524448	OtherExpensesCurrentYear
Total Expenses Prior Year	49274526	TotalExpensesPriorYear
Total Expenses Current Year	48098228	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	316302	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-3038415	RevenuesLessExpensesCY
Total Assets BOY	18512470	TotalAssetsBOY
Total Assets EOY	16452665	TotalAssetsEOY
Total Liabilities BOY	7752224	TotalLiabilitiesBOY
Total Liabilities EOY	8730834	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	10760246	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	7721831	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	45836000	Expense
Revenue	44043654	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	45836000	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
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	0	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
Number Of Employees	782	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
GEORGE BYERS
VICE PRESIDENT	2.00	X	0	0	0
LEE WIGGINTON
TREASURER	2.00	X	0	0	0
GINNY BRASWELL
SECRETARY	2.00	X	0	0	0
BOBBY KHOURIE
MEMBER	2.00	X	0	0	0
KERRY NOBLE
CHIEF EXECUTIVE OFFICER	40.00		205454	0	9245	X
LARRY DAVIS
CHIEF OPERATING OFFICER	40.00		72568	0	3266	X
ABDULLAH ARSHAD
PHYSICIAN	40.00		473461	0	21306		X
RALPH KELLEY
PHYSICIAN	40.00		233911	0	10526		X
B UNGERLEIDER
PHYSICIAN	40.00		225525	0	10149		X
BABATUNDE OLADIRAN
PHYSICIAN	40.00		248802	0	11196		X
GENEROSO GUZMAN
PHYSICIAN	40.00		200908	0	9041		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1660629	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	74729	TotalOtherCompensation
Number Individuals GT100 K	16	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	1249567
HARDIN'S SYSCO FOOD SERVICES
PO BOX 18872	MEMPHIS	TN	38181	FOOD	744647
JIM PANG MD
8134 COUNTRY VILLAGE DR SUITE 102	CORDOVA	TN	38016	PHYSICIAN	670627
CARDINAL HEALTH
PO BOX 70539	CHICAGO	IL	60673	MEDICAL SUPPLIES	602692
EXTENDED ENTERPRISES INC
PO BOX 393	HAYTI	MO	63851	BILLING SERVICES	535762

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	24	NumberOfContractorsGT100K
Government Grants	523370	GovernmentGrants
Total Contributions	523370	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PATIENT SERVICES	Description
Business Code	621400	BusinessCode
Total Revenue Column	44076922	TotalRevenueColumn
Related Or Exempt Function Income	44043654	RelatedOrExemptFunctionIncome
Exclusion	$33,268	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	44076922	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	27500	TotalRevenueColumn
Exclusion	$27,500	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
MISCELLANEOUS	900099	237385	$237,385
CAFETERIA	722210	99657	$99,657
MEDICAL RECORDS	519100	74200	$74,200

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	20779	TotalRevenueColumn
Exclusion	$20,779	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	432021	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	45059813	TotalRevenueColumn
Related Or Exempt Function Income	44043654	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$492,789	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	290532	Total
Program Services	271783	ProgramServices
Management And General	18749	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	18904222	Total
Program Services	17684272	ProgramServices
Management And General	1219950	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	671943	Total
Program Services	627171	ProgramServices
Management And General	44772	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	3392121	Total
Program Services	3166101	ProgramServices
Management And General	226020	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1314962	Total
Program Services	1227345	ProgramServices
Management And General	87617	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	49221	Total
Management And General	49221	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	90056	Total
Management And General	90056	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	584608	Total
Program Services	494286	ProgramServices
Management And General	90322	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	565454	Total
Program Services	508909	ProgramServices
Management And General	56545	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	174991	Total
Program Services	165670	ProgramServices
Management And General	9321	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	156930	Total
Program Services	141237	ProgramServices
Management And General	15693	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1094634	Total
Program Services	985171	ProgramServices
Management And General	109463	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	572939	Total
Program Services	559739	ProgramServices
Management And General	13200	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT EXPENSE	8601768	8601768
OUTSIDE SERVICES	3767658	3666493	101165
MEDICAL SUPPLIES	2446552	2446552
FRA EXPENSE	2391232	2391232
EQUIPMENT RENTAL AND MA	1110345	1064081	46264

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1918060	Total
Program Services	1834190	ProgramServices
Management And General	83870	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	48098228	Total
Program Services	45836000	ProgramServices
Management And General	2262228	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	134263	BOY
EOY	404832	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	10505458	BOY
EOY	7628290	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	276886	BOY
EOY	278089	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	141045	BOY
EOY	106073	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	25248094	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	18699997	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	6045989	BOY
EOY	6548097	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1406424	BOY
EOY	1484879	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	18512470	BOY
EOY	16452665	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	4061102	BOY
EOY	3793801	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	2115000	BOY
EOY	1735000	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	1576122	BOY
EOY	3202033	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	7752224	BOY
EOY	8730834	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	10760246	BOY
EOY	7721831	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	10760246	BOY
EOY	7721831	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	18512470	BOY
EOY	16452665	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-3038415	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	0	FederalGrantAuditRequired

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	10401913	OtherCostOrOtherBasis
Depreciation	6636674	Depreciation
Book Value	3765239	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	14184770	OtherCostOrOtherBasis
Depreciation	12008187	Depreciation
Book Value	2176583	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	116807	OtherCostOrOtherBasis
Book Value	116807	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	6548097	TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescription	Book ValueBookValue
ACCRUED COUNTY TAX REVENUE	457199
ASSETS WHOSE USE IS LIMITED	897445
BOND UNDERWRITER FEES, NET	37101
OTHER RESERVES	76021
CASH HELD FOR RESIDENTS	17113

Field	Value	IRS element (for citing)
Total Book Value Other Assets	1484879	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescription	AmountAmount
CAPITAL LEASE PAYABLE	$2,209,680
ESTIMATED THIRD PART SETTLEMENT	$938,917
LEGAL SETTLEMENT PAYABLE	$36,323
RESIDENT TRUST FUND	$17,113

Field	Value	IRS element (for citing)
Total Of Amounts	3202033	TotalOfAmounts
Total Revenue	45059813	TotalRevenue
Total Expenses	48098228	TotalExpenses
Excess Or Deficit For Year	-3038415	ExcessOrDeficitForYear
Total Adjustments	0	TotalAdjustments
Excess Or Deficit Per FS	-3038415	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	45059813	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	45059813	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	45059813	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	48098228	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	48098228	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	48098228	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	2944985	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2552808	DirectOffsettingRevenue
Net Community Benefit Expense	392177	NetCommunityBenefitExpense
Percent Of Total Expense	0.00820	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	8339531	TotalCommunityBenefitExpense
Direct Offsetting Revenue	7357505	DirectOffsettingRevenue
Net Community Benefit Expense	982026	NetCommunityBenefitExpense
Percent Of Total Expense	0.02040	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	11284516	TotalCommunityBenefitExpense
Direct Offsetting Revenue	9910313	DirectOffsettingRevenue
Net Community Benefit Expense	1374203	NetCommunityBenefitExpense
Percent Of Total Expense	0.02860	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	166010	TotalCommunityBenefitExpense
Net Community Benefit Expense	166010	NetCommunityBenefitExpense
Percent Of Total Expense	0.00350	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	166010	TotalCommunityBenefitExpense
Net Community Benefit Expense	166010	NetCommunityBenefitExpense
Percent Of Total Expense	0.00350	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	11450526	TotalCommunityBenefitExpense
Direct Offsetting Revenue	9910313	DirectOffsettingRevenue
Net Community Benefit Expense	1540213	NetCommunityBenefitExpense
Percent Of Total Expense	0.03210	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$3,993,227	BadDebtExpenseAmount
Amount Attributable To	1397629	AmountAttributableTo
Amount Reimbursed By Medicare	12195274	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	11963754	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	231520	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 - HORNERSVILLE
207 BESSIE	HORNERSVILLE	MO	63855	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 6: 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)
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
205454	0	0	0	0	0	9245	0	0	0	214699	0	0	0
ABDULLAH ARSHAD
473461	0	0	0	0	0	21306	0	0	0	494767	0	0	0
RALPH KELLEY
233911	0	0	0	0	0	10526	0	0	0	244437	0	0	0
B UNGERLEIDER
225525	0	0	0	0	0	10149	0	0	0	235674	0	0	0
BABATUNDE OLADIRAN
248802	0	0	0	0	0	11196	0	0	0	259998	0	0	0
GENEROSO GUZMAN
200908	0	0	0	0	0	9041	0	0	0	209949	0	0	0

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	27892	CAPITAL LEASE	0
EXTENDED HEALTH SERVICES
ENTITY MORE THAN 35% OWNED BY BOARD PRESIDENT	535987	INDEPENDENT CONTRACTOR	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11	FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING ON NOVEMBER 18, 2011. THIS IS THREE DAYS AFTER THE FILING DEADLINE.
	COMPENSATION FOR EXISTING OFFICERS AND KEY EMPLOYEES IS COMPARED WITH MO HOSPITAL ASSOCIATION SALARY SURVEY DATA.
	FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST.	FORM 990, PART VI, SECTION C, LINE 19