[efile GRAPHIC print DO NOT PROCESS [As Filed Data -] DLN: 93495226022767 990 Return of Organization Exempt From Income Tax JoMe aT 36520087 Form x 2015 Crs poe Under section 501(c), 527, oF 4947(a)(1) of the Internal Revenue Code (except private foundations) Do not enter social secuty numbers on this form as it may be made public > Information about Form 990 and ts instructions 1s at winy IRS gou/Torm990, ‘for the 2015 calendar year, or tax year beginning 40-01-2015 —, and ending 09-30-2016 rca faotsie Yor Hass Meal Ces We [ems exnae se wrisTy ouxe 64-0787918 TFintel naa Fina Totephone number dunftmnesed | RERERE ERTS Bae a Baar Hea Frenened rum (662) 377-3978 Trookaton penne] ERGY gate © BOWE GRDEY, TF OTOH DRT SE F Name and aderess ofprincipalofice’ SHARON NOBLES 830 South Glo Tupelo, MS 38801 Ts this a group return for subordinates? Proves & No Hib) Are all subordinates Pres ne T Tewevematatins Fy soxeyay [7 sou) ( ) ser 0) asuais) «527 trcluced? eee 2 a ee 3 Website: > www amhs net/elnies php Street ach alist (see instructions) He) Group exemption aumber ® K Form of orgamzation FY Corporation [~ Trust [~ Assaaaton [~ other TTS POSe summer ‘rely descnbe the organisations mation or mort agnfcant actives North issasipl Medial Chncs, Ine operates 90 medica ics located nnath Misisipp1 : 5 | 2 check ns box » [tthe organaation @iscontnaea ts operations or claporea of more than 25% ofite net assets 3 x2 | 2 Number otvoting members ofthe governing body (Pa VI line 3a) 3 $ | 4 number otinependent voting members ofthe governing body PartVI,Ine 38). ss ee Dw 4 © | 5 total number of dividuals employed in calendar year 2015 (PartV, line 2a) 3 B04 | 6 rotatsumper orvotnteers estimate necessary) é 4 27m Total unrelated business revenue rom Part Vit, column (), tine 12 7 A b_Net unrelated business taxable income fom Form 990-1, ine 24 7 Prior Vear curent Year Contnbutons and grants (PaRLVIIE tne th). we we : 1391455 23,500 2 Program service revenue (Part VIE, line 20) s+ ew ee 7 75,091,519] 56,209,412 § |10 investment income (Part VIII, column (A), lines 3,4, and 74 } 3.957] © Jaa Other revenue (Part VIIT, column (A), lines 5, 64, Be, 9e, 10¢, and 116) 1,559,866] 22 Total revenue~add ines @ trough L! (must equal Part VIE, column (A) ine Sanaa uh 33 Grants and similar amounts pad (Park IX, column (A) mes 1-3) =~ a 44 Benes pad oor for members (Pat 1x, column (A) ie 4) a ni og [28 Selegssotercompansoten,empye berets Pat D4 column (a) nes a caaonsar £ | s60rroiessionattuncaisng fees (Part X,column A). le tte). sv es a a & | & raattuntaing exene (ran % coumn 0), ne 25) mD 47 Other expenses (Part 1K, column (A), ines 18-186, 11-246) «| 50865,757] 1979283 48 Total expenses Adeines 13-17 (must equal Par 1, column (A) hie 25) 97,637 666 71,261,830 19 _Revenveless exsenses Subtract ine 18 from ine 12... a 19,590,969 12,736,537 sf Jsoiming of current Your] End of Year ee $8 |20 total assets (Pare x, he 16) wo766.A58 3233085 Bl 21 totatvapies (arex,ine26) . Poe. 32,871,577 15,670,265 Bo | 22 net assets ord paances Subtract ine 21 fom line 20 7,915,261 16,659,920 Signature Block Under penalfies of perjury, I declare that | have examined this return, nchiding accompanying schedules and statements, and tothe best oF my knowledge and belie, itis true, correct, and complete Declaration of preparer (other than officer) 1s based on all information of whieh preparer has any knowedge Nan overseer Co Mans Overtest CPA ar9-0p-as| cheer [~ | pora7a004 Paid seF-empioyed Pee = —_. Wes ony) ckeon, MS_392012190 May the IRS discuss this return with the preparer shown above? (see instructions) Wes [No For Paperwork Reduction Act Notice, see the separate instructions. Cat No 112827 Form990(2015)Form 990 (2015) Page 2 ‘Statement of Program Service Accomplishments (Check Schedule O contains a response or note to any line mths Part IL r T Brieliy describe the organdation’s mission NORTH MISSISSIPPI MEDICAL CLINICS, INC (CLINICS) OWNS AND OPERATES 30 PRIMARY CARE AND INTERNAL MEDICINE MISSISSIPPI HEALTH SERVICES (NMHS) ORGANIZATION THE MISSION OF NMHS IS TO CONTINUOUSLY IMPROVE THE HEALTH OF THE PEOPLE OF OUR REGION CLINICS WORKS TO ACHIEVE THIS CORPORATE MISSION TO IMPROVE THE HEALTH OF THE PEOPLE OF THIS REGION BY PROVIDING CONVE! 2 Did the organization undertake any significant program services during the year which were not listed on the pnor Farm 990 ar 990. oe Se ao + Pves ine 1f*¥es," descnbe these new services on Schedule 0 3 _Did the organization cease conducting, ar make significant changes in how it conducts, any program services? ves no If "Yes," descnbe these changes on Schedule O 4 pesenbe the organization's program service accomplishments for each of ts three largest program services, as measured by expenses Section $01 (c)(3) and 501 (c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reperted ae code rors HOHE wang ga oFe 7 (Revenue & se2004i2) “a (code Yepesas § vrcuaing ans oFs Vikevenue S| 7 ae (code Yespensas § vecuaing gris oFs ViRevenue S| y “44 Other program services (Describe m Schedule 0) (Expenses $ Including grants of {Revenue $ D “de __ Total program service expenses $5,530 316 eeeForm 990 (2015) Page Checklist of Required Schedules Yes | No A. Is the organization descnbed in section 504 (c)(3) or 4947(a)(1) (other than a prwvate foundation)? IF "Yes," Yes complete scneauleAD ee 2. 1s the organization required to complete Schedule B, Schedule af Contributors (see structions)? . =. 2 Ne 3. Did the organization engage in director indirect political campaign activities on behalf of arin opposition to No candidates for public office? If "Yes," complete ScheduleG Ptl se ee ee ee ee ee LB 4 Section 503(c)(3) organizations. Did the organzation engage in lobbying actwities, or have a section S041(h) election in effect during the tax year? 1 "¥es," complete ScheduleC, Patil. + et et ee et ee 4 No 5 15 the organization a section $01(c4), 504 (c}(5), oF $03 (c)(6) organvzation that receives membershup dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? 7 Te "Yes," complete ScheduleG, PatIT es eee et 5 2 6 id the organization maintain any donor advised funds or any simular funds or accounts for which donors have the hight to provide advice on the distidutian ar investment of amounts in Such funds or accounts? 1 "¥es,"complete ScheduleD, Pat WD... 6 ae 7 Did the organization receive or hold a conservation easement, including easements to preserve open space, ho the environment, histone land areas, or historic structures? If "Yes," complete Schedule, Partin)... | 7 8 id the organization maintain collections of works of at, histoncal treasures, or other similar assets? a 11 "¥es,"complete ScheduleD, Pat WD... ee 8 9 Did the organization report an amount in Part X, ne 21 for escrow or custodial account lability, serve as ‘custodian for amounts not listed in Part X, of provide credit counseling, debt management, credit repait, oF debt ho negotiation services It "Yes,"camplete Schedule D,fatV%J. 2... ee ee ee LB 40 Did the orgamzation, directly or through a related organization, hold assets in temporarily restricted endowments,| 10 No Permanent endowments, or quast-endowments? If "Yes," complete Schedule D, Patv 3). . ss «+ AL Ifthe organization's answer to any ofthe following questions 15 "Yes," then complete Schedule D, Parts VE, VI, VIIT, 1x, oF X as applicable {id the orgamzation report an amount far land, buildings, and equipment in Part X, line 107 y. 10 "Yes," complete ScheduleD, Pat VI De ee ee ee [tte YE 'b_ Did the organization report an amount far investments other securities in Part X, ine 12 that 1s 59% or more of ho Its total assets reported in Part X, ine 167 If "Yes," complete Schedule D, Part VII 9... . - we a1b {© Did the organization report an amount for investments program celated in Part X, line 13 that 16 5% or more of a its total assets reported in Part X, line 167 IF "Yes,"complete ScheduleD, Patil J... - . . - (Ae 0 4. Did the organization report an amount far other assets in Part X, line 15 that 1s 5% or more ofits total assets ves reported in Part x, line 167 It "Yas," complate Schedule D, Part IX. 6 ee ee ew ww ee La © id the organization report an amount for other abilties in Part X, line 25? If “Yes,” complete Schedule b, Pax [ae] yo f Did the organization's separate or consolidated financial statements for the tax year include a footnote that en addresses the organrzation’ abi 16 "Yes," complete Schedule D, Part X 42a Did the organization obtain separate, independent audited financial statements for the tax year? It "Yes," complete Schedule 0, Parts x1 andxit . . os ee LR No. fr uncertain tax positions under FIN 48 (ASC 740)? 'b Was the organization included 1n consolidated, independent audited financial statements forthe tax year? 11 "¥es,"and ifthe organization answered "No" to me 12a, then completing Schedule, Parts XI and XII 1s optinat “tJ 428 | Yes 13. 1s the organization a school described in section 1 70(0)(1)(A un)? If "Yes," complete Schedule E 3 ho {4a Did the organization maintain an office, employees, or agents outside of the United States? . . . . . [aga No bid the orgamzation have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service actwities outside the United States, or aggregate foreign investments valued at $100,000 armore? If Yee," complete Schedule f, Parts Tand IV. 0. ee sw ss 4b No 15 Did the orgamzation report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or h for any foreign organization? It "Yes," complete Schedule, Parts iT and IV... ss 3 10 16 Did the organization report on Part 1X, column (A), line 3, more than $5,000 of aggregate grants or other h assistance to or for foreign individuals? If "Yes, "camplete Schedule Pats III andIV. 16 2 47 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Parl 47. No 1X, column (A), lines 6 and 112” IF "Yes," complete Schedule G, Part I (See instructions) +» 48 Did the organization report more than $5,000 total of fundraising event gross income and contributions on Part VIII lines 1 and 8a? TF "Yes," complete Schedule G,PutI set se te et ete 18 No 39 bid the organization report more than $15,000 of gross income from gaming actwities on Part VEIt, ine 9a7 1F [4g h ‘Yes,"complete ScheduleG, Pat vse ee ee te 2 20a Did the organization operate one or more hospital facilities? IF "Yas," complete Schedule... a aa 1 °¥ 5" to line 208, did the organization attach a copy ofits audited financial statements £o this return? bi 20a, did the organization at py of ts audited fi statements to this ret ‘0b TESForm 990 (2015) paged FAME Checklist of Required Schedules (continued) 21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization oF A Ne domestic government an Part IX, column (A), line 2? f "Yes, "complete Schedule, Parts Tardis. ++ 22 Did the organzation report more than $5,000 of grants ar other assistance to or for domestic mnaividuals on Part | 9p h 1X, column (A), line 2? F "Yes," complete Schedule, alts f andi. ses ws 2 23. Did the organization answer "Yes" to Part VII, Section A, line 3, 4, oF § about compensation ofthe organization's v. Current and former officers, directors, trustees, key employees, and highest compensated employees? If "ves," | 23 | Yes complete Schedule ve ee SD 24a. Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000, as of the last day of the year, that mas sued after December 31, 2002? If "Yes,"answer ines 240 through 34d h ‘nd complete Schedule K TF"No,"gotolme25a- s+ ss we ee a 2a 2 1b id the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . . a 2ab Did the organization maintain an escrow account other than a efunding escrow at any time during the year tadetease any tax-exempt bonds? eee 2ae Did the organization act as an "an behalf of esuer for bonds outstanding at any time during tre year? . «| 29g 25a. Section 501(€)(3), 501(¢)(4), and 501(¢)(29) organizations. Did tne organizatton engage in an excess Deneft transaction wth a disqvaliied person dung the year? IF "Yes," | ag 1h complete Schedule, PTT ee ee 2 bb 1s the organization aware that it engaged in an excess Denefit transaction with a cisqualfied person in a prior Year, and thatthe transaction has not been reported on any of the organization's prior Forms 990 or 990°E2? | 256 No Ir "¥es,"complete Schedule, Put. vse tn tt te eh ee 26 Did the organization report any amount an Part X, line S, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? | 26 [0 1 "Yes," complete Schedule UCIT vv ete te te te ee 27 Did the organization provide a grant or other assistance to an officer, director, trustee, Key employee, substantial Contributor or employee thereof, @ grant selection committee member, or to a.35% controlieg entity or farmly | 27 No member of any of these persons? If "Yes," complete Schedule, Part Ili. a 28 was the organization a party to a business transaction with one of the folloming parties (see Schedule L, Part 1V instructions for applicable fling thresholds, conditions, and exceptions} A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule , pative Coe tn eae ae ea na b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Parte et ee ee ee ee en te 2b No An entity of which a current of former officer, cirector, trustee, or key employee (ora Family member thereof) was an officer, airector, trustee, or director indirect owner? If "Yes," complete Schedule, Part IV... « 20 No 29 Did the organization recewve more than $25,000 1n non-cash contnbutions? If "Yes," complete Schedule . . | 99 No 30 Did the organization receive contributions of art histoncal treasures, or other similar assets, or qualified conservation contributions? If "Yes,"complete Schedule. ee ee ee ee 30 ne 31 bid the organization liqucate, terminate, or dissolve and cease operations? If “Yes," complete Schedule N, art! - a No 32 pid the organization sell, exchange, dispose of, oF transfer more than 25% of is net assets? h IF "Yes," complete Schedule N, Pat IT wy we we fi 2 0 33. Did the organzation own 100% of an entity cisregarced as separate from the organization under Regulations y. sections 301 7701-2 and 301 7701-37 If "Yes,"complete Schedule, Part 2 + 2 we 33 | Yee 34, Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Pa 11. HH ert¥. | ay | y, and Pa VED et = 35a _Did the organization have a controlled entity within the meaning of section $12(b}(13)? ae es) b IP Yes'to line 354, did the organization receive any payment from ar engage in any transaction with @ controlled entity mthin the meaning of section $12(b\13)? JF "vas," camplate Schedule R, Part V, ine 2... oes) 36 Section 501(c)(3) organizations. 014 the organization make any transfers to an exempt non-charitable relgted ho organization? Jf "Yes," complete Schedule R, Part V,iine2 . . «1 + we ee @ 36 137 bid the organization conduct more than S‘% of ts activities through an entity that isnot 2 related organization h and that 1s treated as a partnership for federal income tax purposes? If "Yes,” complete Schedule R, Par VI 7 io 38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? y. Note, All Form 990 filers are required to complete Schedules. vv + vs ses 3a | ves reneeForm 990 (2015), Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule O contains 2 response or note to any ine inthis PartV.. ss te » Gross receipts, ncluded on Form 990, Part VIII, ine 12, for public use or club [0b u 1b Gross income from other sources (D0 not net amounts due or paid to other sources 12 Enter the number reported in Box 3 of Form 1096 Enter-0- ifnot applicable . | ta 43 Enter the number of Forms W-2G included inline ta Enter -0-fnot applicable | ab 2 id the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to praewinners? vs ee ee ee te ee et Enter the number of employees reported on Form W-3, Transmittal of Wage and ‘Tax Statements, fled for the calendar year ending with or within the year covered bythisreturn eee ee ee Le 804 fat least one is reported on ine 2a, did the organization file all required federal employment tax returns? Note.t' the sum of lines La and 2a 1s greater than 250, you may be required to e-fle (see mstructions) Did the organization have unrelated ousiness gross income af $1,000 or more dunng the year? . No 1F°¥e," has i led a Form 990-T for this year?JF "No" tole 2b, provide an explanation in Schedule... 2b At any time during the celendar year, did the organization have an interest in, of signature or other authority over, 2 financial account in a foreign country (such as @ bank account, securities account, or other financial account)? . e No 1FYes," enter the name ofthe foreign country See instructions for fling requirements for FINCEN Form 114, Report of Foreign Bank and Financial Accounts (rBaR) Was the organvzation a party to a prohibited tax shelter transaction at any time during the tax year. « We Did any taxable party natty the organvzation that it was oF 1s @ party to a prohibited tax shelter transaction?” No 1F*Yes," to line Sa or Sb, did the organization file Form 8886-17... ee ee Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization soliit any contributions that were not tax ceductible as chantable contributions? . ely |e |e No 1f*¥es," did the organization include with every solieitation an express statement that such contributions oF gifts werenottax deductible? eve ee ee ee et te ne en e Organizations that may receive deductible contributions under section 170(¢). Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and fservices] provided oltre payor 2a fers ger eat ee feat h- reareterea vel ares Friat 7 If *¥5," dd the organization notiy the donor ofthe value of the goods or services provided?» . id the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required tl fle Form 82827 2 ee ee nnn re No 1f*Yes," indicate the number of Forms #282 fled dunngthe year... | 7 Did the orgamzation receive any funds, diectly er ineirectly, to pay premiums on 2 personal benefit contract? Je No id the organization, dunng the year, pay premiums, directly orindiracty, on a personal benef contract? . No 1 the organization received a contnbution of qualified intellectual property, did the organization hile Form 8999 as| re cs ara Rat a Nar nea A 7a If the organization received a contnbution of cars, boats, airplanes, or other vehicles, did the organization file a Form1098-c?. oe eee ee es ao ™ ‘Sponsoring organizations maintaining donor advised funds. Did e dorer advised fund maintained by the spansoring organization have excess business holdings at any time dunngthe year? svt ete ee ten tne tet een id the sponsoring organization make any taxable distnbutions under section 49667... id the sponsoring organization make a distr ution to a donor, donor adviser, or related person? . . slele Section 501(c)(7) organizations. Enter Inrtiation fees and capital contnbutions included on Part VIII, line 12... | 40a facilities Section 501(c)(42) organizations. Enter Gross income from members orsharsholders ss 2 ses [ata against amounts due arreceived fromthe). s+ se ee es LAR Section 4947(a)(3) non-exempt charitable trusts.ts the organization fling Form 990 in leu of Form 10417 120 1f*¥5," enter the amount of tax-exempt interest received or accrued dunng the year 32 Section 501(c)(28) qualified nonprofit health insurance issuers. 15 the organization licensee to 1ssue qualified health plans in more than one state?Nate. See the instructions for additional information the organization must report on Schedule 0 Enter the amount of reserves the organization 1s required to maintain by he states Inwwhich the organization is licensed to issue qualified health plans... 336 Enter the amount of reserves on hand... se ee we ee Lae Did the organization receive any payments for ndaor tanning services dunng the taxyear?. ~~ aaa No 1F"¥95," has it filed a Form 720 to report these payments?/f "No," provide an explanation in Schedule. « sab Form 990 (2015)Form 990 (2015) Page 6 Governance, Management, and Disclosure For each "Yes" response to ines 2 through 7b below, and for a "No” response to lines 8a, 8b, or 10D below, desenbe the circumstances, processes, or changes in Schedule O. See instructions. Check it Schedule O contame response ornotetoanyinernths Pat. ws ss Section A. Governing Gody and Management Yes | No 4a Enter the number of voting members ofthe governing body at the end ofthetax — | 4, 7 year If there are matenal diferences 1n voting nights among members ofthe governing body, or ithe governing body delegated broad authorty to an executive committee or similar committee, explain in Seredule 0 'b Enter the number of voting members included in line La, above, whe are ngependent » 4 2 Did any ofcer, director, trustee, or key employee have a family relationship of business relationship with any other officer, diector, trustee, or key employee? vv ee ee et ee ee ee ee LR No 3 Did the organzation delegate control over management duties customarily performed by or under the direct 3 ho supervision of oficers, directors or trustees, or key employaes toa management company or other person? 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was ia ee a RB 4 No 5 Did the organization become aware during the year of significant diversion ofthe organization's assets? « 5 No 6 Did the orgamzation have members or stockholders? . ss ee ee ee ee ee ee [6 vee 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members ofthe governing body? vw ee we ee ee ee we | Pa | Yes bb Are any governance decisions of the organization reserved to (or subject to approval by) members, stockhalders,| 7b | Yes for persons other than the governingbody? vs ste tt te et ee te en 18 Did the organization contemporaneously document the meetings held or wnitten actions undertaken during the year By the following Ini ne governing body apart Yareat tat ie Ver ge at gear een ae eee sa | ves b Each committee with authority to act on behalf ofthe governing body? . ss ss ss ss ss «| Bb] Yes 9 1s there any officer, ditector, trustee, of key employee listed n Part VI, Section A, who cannot be reached at the| organization's mailing address? IP "Yes," provide the naries and addresses in Schedule O : ° No Section B. Policies (Thys Section 8 requests formation about polices not required by the Internal Revenue Code.) Yer. 0a Did the organization have local chapters, branches, orattlates? . ss ee ee ee [ate No b 1F*¥es," did the organization have wntten policies and procedures governing the activities of such chapters, affliates, and branches to ensure their operations are consistent with the organization's exempt purposes? 0b {1a Has the organization provided a complete copy ofthis Form 990 to all members of ts governing body before them ef Aa No b Describe in Schedule O the process, any, used by the organization to review this Form990. 5. 2a Did the organization have a written conflict of interest policy? If "No," gotoline 13, ao : ia | vee b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give Nsetoconficts? sv te te te et ee ee te te ee [4b | Yes © Did the organization regularly and consistently moniter and enforce compliance with the policy? If "Yes," describe InSchedule Ohow this Was done vv ye et ee te et tte ee ane | ves 13 Didthe organization have a written whistleblower policy? ss + + ee ee ee ee w+ [a | Yes 44 Did the organization have a written document retention and destruction policy? . . ss ss ss « [44] Yer 15 Did the process for determining compensation of the following persons include a review and approval by Independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? The organization's CEO, Executive Director, ortop management oficial. . . - . . +. + + + {aBa| Yes b Other oficers orkey employees of the erganzation » ee eee ee ee we we ee api) ves 1f*Ye5" to line 159 oF 15b, descnbe the process in Schedule O (see instructions) 46a Did the organization invest in, contnbute assets to, or participate n a Joint venture or similar arrangement with a taxable entity dunng the year”. ot Of Sere [368 No 1b 1f "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in mnt venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? . ves tte tes Ley ‘Section €. Disclosure 7 List the States with which a copy ofthis Form 990 15 required to be flea 48 Section 6104 requires an organization to make its Form 1023 (or 1024 i applicable), 990, and 990-1 (SOAle) Gis only) avatladle for public inspection Indicate how you made these available Check all that apply own website [Another's website [Upon request [Other (explain in Schedule 0) 49 Describe in Schedule O whether (and if 50, how) the organization made its governing documents, conflict of Interest policy, and financral statements available tothe public during the tax year 20 State the name, address, and telephone number ofthe person who possesses the organization's books and records PRRISTY DUKE €30 SOUTH GLOSTER STREET. Tupelo, MS 38801 (662) 377-2977 eeeForm 990 (2015) page 7 [ZIERZN compensation of Officers, Directors Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check Schedule 0 contams a response of note to any ine inthis Part VIL. or Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 3a Complete ts table for all persons requved tobe listed Report compensation forthe calendar year encing wth or within the organization tax year # Lista of the organization’ current officers, directors, trustees (whether individuals or organvzations), regardless of amount ‘of compensation Enter -0- im columns (0), (E), and {F) ifn compensation was paid (© List al ofthe organization’ current key employees, ifany See instructions for definition af "key employee # List the organization’ five current highest compensated employees (other than an officer, director, trustee or key employee) who received reportable compensation (Box 5 af Form W-2 and/or Box 7 of Form 1093-MISC) of more than $100,000 from the organization and any related organizations List all ofthe organization’ former oficers, Key employees, or highest compensated employees who received more than $100,000 ‘of reportable compensation from the organization and any related organizations List al ofthe organization’ former directors or trustees that received, n the capacity as a former director or trustee of the organization, more than $10,000 ofrepertable compensation from the organization and any related organizations List persons inthe following order individual trustees or directors, institutional trustees, officers, key employees, highest compensated employees, and former such persons check ths box ifreither the organization nor any related orgamization compensated any current officer, rector, or truste “ Oy © © ©) io) Name'and Title average | Position (donotcheck | Reporeable | Reportable | estimated ours per more than one box, unless | compensation | compensation | amount of weet fist "person's bot anoftcer | tromene. | tromrelates. | other anyrours | ‘andadrectorfrustec) | organization | organizations | compensation Grretotea = STEEP ive z/i099- | (we2/1099- | ~ fromthe organizations [2 3] 5/818 (BS |Z] misc) Misc) ‘organization veiow |22/ 3/2 fe (Sz [2 ‘and related dotted tine) [BE] 2 |* | = |E organizations z ae g (yoo Robeson ) Renny Young MB (Sy aren Knavey WO Genk bes HO Obed ter (@) ere Topp (By eseph a Reper (10) Charles M King bchForm 990 (2015) EEMEWE Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Page 8 “ @) © ©) © ° Name and Title Average | Position (donot check Reportable Reportable Estimated hours per [more than one box, unless | compensation | compensation | amount of other week (ist | "person is both an officer ‘rom the from elated | compensation any hours | ‘anda dvectorftrustee) | organization (W- | organizations (W-] from the forrelated STE EE Tp] tsetse |272099-misc) | organizavon ond *pelow 212 le FE |2 organizations dotted tine) eB" |g eS |F e| |e 3 =| [8/3 Sub-Total Se eae _ € Total from continuation sheets to Part VIT, Section A » Total (add fines tb and te) paneseera err ae) Se ua Ear 2 Total number of dividuals (including but not hited fo those listed above) who received more than $100,000 of reportable compensation from the organization ® 160 3 Did the organization ist ary former officer, director or trustee, Key employee, ar highest compensated employee online 1a? If Yes,"complete Schedule }forsuch mdwvidual vss +e ve ew ee ew Lg ma 4 Forany individual listed on line 12, 18 the sum of reportable compensation and other compensation from the organization an related organizations greater than $150,000" If "Yes," complete Schedule I er such 5 bid any person sted on line 1a receive or accrue compensation from any unrelated organization oF individual for services renderee to the organtzation?If "Yes," complete Schedule far such persen ss + +s + + + | g na ‘Section 8. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of Compensation fom the organization Report compensation fr the calendar year ending with or within the organization's tax year a @, © ‘Compheat ivan Sannces inmeath Tense, Jransapn See Total number of adependent contractors (including bik Rot imted to those leted above) who received more than $100,000 of compensation from the organization P26 ceeeeeeeeeeeeeeeForm 990 (2015) Page ® ‘Statement of Revenue Check Schedule © contams aresgonse ornate oarylne mths PatViII 2) a 7) G o oralitenue | reitaor | unites | nelere rem, | business. | excluded tom est ia Federmed campagne 7 ge BET b wemterhodues ss 2. ab ge — GE] c rundronmgevens os. te ae S| ¢ einecorsencatons . . «4a BF | 5 covmmentenms tombe) te m0 Be |e mamas om guy at 25) 1 sancummataess BB |g Sennm commer nce me Eo iets. BE] n raadsinesio 0 oes ase BE | 6 rota ses nes 1034 : y Tanmant Code : 2a _Net Pabent Service Revenue 200099} 135,414,880] 35,414,680 E | ine toottome = ac Ee 2]. § |e Mamermogansencereene & g Total.Addiines2a-2f . . 1 1 ee a 36,209,412] 3 —nvesiment income (nelodng drwdends teres, _ and other similaramounts). - - se ee 3,767) 376 4 emer mrenranet wr ermel end rene 1 4 3B Rote ee 7 eal OE 2 Grose rete ban al ¢ kenugeme 7 | aay 4. Weteotal neon areas] se : (secon ee za cs snout comune ‘seo nese ay b tam autor te wea crea) a7 @ Netgamor (oss) yyy and | % cross income om undrasna : vents (nt nea 5 oo 5 Siconmmoters ported ontne te) é Steraivsine iB Fj 7 3 Db Less cwrect expenses . »| € Netincome or oss) fom arising eveRIS TP d 5 on come tom gamiog acten Secretive > Less cuectenpenses ss. b Netincome or oss} am giming atges 7 F » 108 ross sales of ventory ess fetes and allowances » Less costotgoods sold. sb €_Netincome of oss) tom sales ot meany 7 d Toreenreoor Revenue oe Tis REBATE INCOME ay staan ssean ‘Other Miscellaneous Revenue 900099) 371,983] 371,383) © Clinical Trial Revenue ‘s00088} 144,738] 194,798 Blotterrevense © Ta ara Taal Adding Lei ee. — 12 Totalreveve, see Instrutons Total See Instructs >| 58,545,293) 56,209,412] 2,242,361] Form 990 (2015)Form 990 (2015) Statement of Funetional Expenses ‘Section $07 (€)(3) and 501 (€]/4) organizations must complete all columns Allether organwations must Complete column (Al Page 10 (Check if Schedule © contains a response or note fo any line inthis Part IX. cn Bootes ere tes, a a 7b, 8b, 9b, and 0b of Part VIII. ‘expenses | general expanses | _expenaay Scustameieein cea ; ieeeneraet reported in colurnn (8) jont costs from a combined ‘edvcatianal campaign and fundrarsing solicitation Check here ® [-iffollowing SOP $8-2 (ASC 958-720) rnForm 990 (2015) Page 11 HES falance Sheet Check Schedule © contams a response ornote to anyline nthe PaRtK we ee ee ee w eo sepnning ot year endityear 2 savings and temporaryeash investments Tsu] 2 251080 3 Pledges and grants recenable,net se we vee om a 5 Loans andotherrecewables trom cuenta former oficers,crectors, trustees, key employees, and highest compensated employees, Complete Parti of Sore eee eee ee eeeee eee eee as ° «Loans and sther receivables from other disqulied persons (as dened under section 4338(0(1)), persons descned insection @958(O(0), 20 Centntutng employers and sponsonng organaations of secon $03(6)9) Voluntary employees’ beneficiary erganatvons (see instructions) Complete Par 2 Torsenewtet $ os 0 ie Notes andioans recewableynet 6... ee oz a 2 inventones raters vee ee ee wae 8 Tae 9 Prepa expenses and defered charges sv ee ee ee ae ma] 9 waar 40 Land, bugs, and equipment cost or other basis Complete Pat VI ef Schedule D 10 a4 0 b Less accumulates depreciation... 0b ae00 zoa0n26) 10. tnstes7 11 investments—publcly traded secummies ss 5. yy of a8 o 12. Investmentsothersecunties See ParIV linet ee = oa 3 23° Investments—program-related See PartV,ine 11» v= + a as o we inangileassets we ee alse o 15. otherassets See PartiV.tne ii. « a a ECO aeons 16 Total asseteAAdd ines 1 through 15 (mustequaline 34) vs ss To. 0] a6 230.108 47 Aecounts payable and accrued expenses =. = 2 vr vw aras03) 47 Tn 361 18 Gromspoyable of a ° 19 beferedreverse of 49 o 20 Taw-cnempthonétabiites al 20 o 2A Escrow or custodial account lablty Complete Port 1V of Schedule D of at 3 & |22 Loans and ather payables to current and former oficets, directors trustees, A Kev employees, nghest compensated employees and dstuaned 3 persons Complete PartITofScheduleL . . . ee ee ee 2 o Jas secued mortgages and notes payable to uneated thd pares. a2 o 24 Unsecured notes and lans payable tounrelated thd partes «+ + a] 30 o 25 other uate (ncluting federal income tax, payables to related thd partes, fnd other labities not clade on ines 17-24) Complete Part X of ScheculeD 26 Total lates Add Ines 17 thowgh2s vv vv ss ss wana] 26 ieerozee Organization tat follow SFAS 347 (ASC958), check here Py and complete 2 tines 27 trough 2, and lines 33 and 3 B Jae vemporanyrestnctednetassets weasel 20 18.8 E |29 rermanentyestactednet assets vv vw ww wwe al 29 o é Organizations that donot follow SFAS 147 (ASC 958), check here [~ and 3 Complete lines 30 through 3 ¢ 30 Capital stock or trust principal, or current funds noe we 30 $ |spatd-morcaptal surplus, orfand, bulding orequipment tind. sss a & [aa netamned earings, endowment, accumulated come, or other nds 3 B [an rowinetassets ortundbatances se ee Tosa] 33 eae 24 Total abies and nt assete/tnd balances =v = + + = Toxrene| 34 2.80108 eeeForm 990 (2015) Reconcilliation of Net Assets Page 12 Check # Schedule O contains a response or note toanyline mths PatXI . . - . +. - + +. ss A Total revenue (must equal Part VITI, column (A), 12) . + ew ee ee 1 58,545,203 2 Total expenses (must equal Part Ix, column (A), line 25) ome oa os 2 71,281,830 3 Revenue less expenses Subtractline 2frominet . 6 ee ee 2 -12,736,537 4 Net assets or fund balances at beginning of year (must equal Part x, line 33, column (A) «+ 4 7,915,261 5 Net unrealized gains (losses) on investments ©. 2 2 eee ee ee 5 © Donated services anduse offaciities 6 6. ee ee 6 7 Investmentexpenses . 6 2. 2 ee z 1B Prorpenod achustments s - 6 ee ee e 9 Other changes in net assets ot fund balances (explain im Schedule)... os ° 21,481,196 10 Net assets or fund balances at end of year Combine lines 3 through 9 (must equal Part X, ine 33, column (8), 10 16,659,920 Financial Statements and Reporting check i Schedule O contains a response arnote to anyineinths Pan Xl... ss Accounting method used to prepare the Form 950 Fcash accrual other: Ifthe organization changed its method of accounting from a pri year or checked “Other,” éxplain im Schedule 0 Were the organization’ financial statements compiled or reviewed by an independent accountant? If-¥es,"check 2 60x below to indicate whether the financial statements forthe year were compiled or reviewed on a separate basis, consol fated basis, or both F-separate basis [Consolidated basis Both consolidated and separate basis Were the organization’ financial statements audited by an independent accountant? 1F'¥es,/check a box below to indicate whether the financial statements forthe year were audited on a separate basis, consoligated basis, or bath [separate basis [FConscldatedbasis [Bath consolidated and separate basis 1f*¥e5," to hne 2a oF 20, does the organrzation have a committee that assumes responsibilty for oversight ofthe audit, review, ar compilation ots financial statements and selection of an independent accountant? 1fthe organization changed either Its oversight pracess or selection process during the tax year, explain in Schedule 0 [As a result ofa federal anard, was the organization required to undergo an audit or audits as set forth inthe Single Audit Act and OMB Circular A-133? IF"¥e5," did the organization undergo the required audit oF audits? Ifthe organization did not undergo the Fequired audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits Yer da No 2 | ves 2c | ves aa No 2b Form 5502015)Additional Data Software 1D: Software Version: EIN: 64-0787918, Name: North Mississippi Medical Clinics Inc Form 990, Part I11, Line 4a a (code Y eapesas 6 GS SDO GIS wang gs of Y Revenues 3505, ) Cine sve te 2¢countaen north Masesipp ang northwest Alabama that make up the NHS sre area_In fecal year 2086, Cl served the population of {he tea wth 435,17) wets ta he physoane. The omannaton operates 7) agonal primary ar ana tera) medics nckForm 990, Part III, Line 4b > (Code Yeas § vnc aes ViRevene S| 7 (ne of the primary ways Cince serves the communty by providing care ts venous populations fr which eens no compensation or ecewves compensation at ‘ates sgnfcandy less than eaablahed ates The bard of rectors of Chnes het extabiahed» palsy under winch the eeganastionprodes caer witout carpe 12 heady members of community” The chant cae okey sates tat Cine wl provide necessary serves fo pallens fe of charge with Housel income level, Based on the medion neome for Mussspocarpared to the median sname nalonaiy. The Vsstspp Austad Povey Guleles approximately 75% of te federal povery rte The poly futher odes pabante wh househols nome levels above the Mase: Adjusted Poverty Coidanas willbe able for pa more than he smoune that ther pousehels come excaeds the apoteable feral poverty guidlines Tne poley apptes to reduls whe reste Me county where the Ssppieabierine'slocetna,Peverta fom ous the county may sto be gamed chacty care base onthe jedoment of Cimcs menagamertaepering on et Indvidulcreumatancat Th ply aba rages the pabert ta coperata ‘uly wit Cie Teguest for norton wth whch to vey the patent egy Faoving that gate, lines matin acods to ny ehd momor te ave of tnformation about schedule A (Porm 990 oF 990-£2) and Its Instructions at Deparment of he twanirs 200 /forms90. bul Revene servo Name of the organization Cres paved Employer identification number s4.07879%8 [EEEER_ Reason for Public Charity Status (Al orgenitatons must complete this part.) See instructors The otanzatons nota prvate foundation Because ts (Forlnes 1 trough 11, check only one box} 1 [7A church, convantion of churches, or assoctation of churches described in section 470(6)(4)(A)(1)- 2 [7A school described in section 170(b)(1)(A)(H).(Attach Schedule € (Form 890 oF 980-£z)) 3 [YA nospital ora cooperative hospital service organization describe in sectlon 470(b)(41)(A (IN). 4 FF A medical research organization operated in conyunction with @ hespital described in section 170(b)(4)(A)( Ii). Enter the hospitals name, city, and state 5 [-_Anorganzation operated for tie Benett ofa college ov university Owned or opeTated by a Governmental unt described n section 470(b)(1)(A){iv). (Complete Part 11 ) 6 [7A federsi, state, oF local government or governmental unit described in section 470(b)(4)(A)(¥). 7 [- Ancrganization that normally eceives a substantial part of ts support fram a governmental uni or from the general public Gescribed in section 170(b)(2)(A) (wi). (Complete Part I} 8 _ Acommunity trust cescribes in section 470(B)(4)(A)(wi) (Complete Part IT ) 9 F_ Anorganization that normally receives (1) more than 331/3% ofits support from contributions, membership fees, and gross eceipts from activities related to its exempt functions —subyect to certain exceptions, and (2) Ao more than 331/3% ofits support ffom gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975, Seesection 509(a)(2). (Complete Part III ) 10 Anarganization organized and operated exclusively to test for pubic salety See section 509(a)(4). 11 Anerganzation organized and operated exclusively for the benetit of, to perform the functions of, orto carry out the purpases of fone oF more publicly supported organizations described in section §09(a){1) oF section 509(a)(2) See section 509(a)(3).c heck the box in lines 113 through 114 that describes the type of supporting organization and complete lines ite, 121, and 1ig 2 Type. A supporting organization operated, supervised, or controlled by ts supported organization(s), typicaly by giving the supported organization(s) the power to regularly appoint or elect a majority ofthe directors or trustees of the supporting organization You must complete Part IV, Sections A and 8. b Type .a supporting organization supervised or controled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s) You ‘must complete Part 1V, Sections A and C. [Type dit functionally integrated. A supporting organization operated in connection wth, and functionally integrated with, is supported organization(s) (see instructions) You must complete Part TV, Sections A, D, and E 4 [Type 11K non-functionally integrated. A supporting organization operated in connection with ts supported organization(s) that is not functionally integrated The organization genetaly must satisfy a distnbution requirement and an attentiveness requirement (See instructions) You must complete Part IV, Sections A and D, and Part V. © [Check this box ifthe organization received a wtten cetermination rom the IRS that tis a Type I, Type 11, Type III functionally tegrated, or Type III nen-funetionally integrated supporting organization Enter the number of supported organizations . er q Provide the following information about the supported organreation(s} oO ne oD) ™ o oy Name of supported organization Type of Is the organization Amount of Amount ot ther organzation | listed n yourgoverning | monetary support | support (see (escribed on lines document? (ee mstructions) | instructions) 1-9 above (see structions) Yes No Total For Paperwork Reduction Act Notice, se the Instructions for Form 990 or 99062, Cat No 112956 ‘Schadule A (Form 990 or 990-£Z) 2015.Schedule A (Form 990 or 990-EZ) 2015 Page 2 ‘Support Schedule for Organizations Described in Sections 170(b)(1)(A)(Wv) and 170(b)(A)(A)(vi) (Complete only f you checked the box on line 5, 7, or 8 of Pare | or f the organizaton failed to quaify under Pare II, If the organization fails to qualify under the tests listed below, please complete Part II. ‘Section A. Public Support Calendar year : : en ene port | wore | erois [mora | ce201s | enter 2 Gifts, grants, contributions, and membership fes recewvea (00 not nclude any unusual grants ) 2. Taxrevenves levied forthe argorizatin’s benefit ad ether aid to or expended on ts behalt 3 Thevalue of services or facies fumed by 2 governmental unt to the organization wathout charge 4 Total, Add lines 1 through 2 5 The portion of total contributions by each person (other than a governmental unt or pubitely Supported organzeion)incided aniine 1 that exceeds 25 ofthe mount shown online 21, column o 6 Public suppor. subtaet ine from ine Saction 6. Total Support Calendar year 2011 2012 (2013 2044 22015 ata (or fiscal year beginning in) & ce ce Ss & 7 Amounts from tine 4 8 Gross income from interest, dividends, payments received on Secunties loans, rents, royalties 9 Netincome ftom untelated business activites, whether oF not the Business is regularly 20 Otherincome Do not clude gain or oss from the sale of Gapital assets (Explain n Part wt) 31, Total support. Aca lines 7 through 0 12° Gross receipts fom related actwies, ele (Bee matUCTORS) Fy 33 First five years the Form 990 is forthe organization's fst Second, thd, fourth oF ft tax year as 2 section SOT (E13 organation, check ths box and stop here aC Section €. Computation of Public Support Percentage F4_Pubiec support percentage for 2015 (ine 6, column (f) divided by he Ta, Coun a 25 Public suppor percentage for 2014 Schedule A, Par Il, line 14 15 the box on line 13, and line 14 15 33 1/3% oF more, Check this bax ed organization a b 33.1/2% support test—2044.1 the organization did not check a box an line 13 oF L6a, and line 15 16 33 1/2% or more, check this box and stop here. The organization qualifies as a publicly supported organization > 17a 10%-facts-and-circumstances test—2015. the organization did net check a box on line 13, 16a, oF 16b, and line 14 is 1096 oF more, and ithe organization meets the facts-and-circumstances test, check this box and step here. Explain ‘in Part VI how the erganrzation meets the cfacts-and-evrcumstances" test The organization qualifies 3¢ a publicly supported organzation or b 0%efacts-and-circumstances test—2014.f the organization dis not check a box on line 13, 16a, 168, oF 17, an line 15 15 10% armore, and irthe orgamzation meets the “facts-and-circumstances” test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances” test. The erganization qualifies as a publicly 16333 1/3% support test—2015.1f the organization did not che: {and stop here. The organization qualifies as a publicly suppar’ supported organization mr 18 Private foundation.I! the organization did not check a box on line 13, 162, 16b, 17, oF 178, check this box ane see Instructions: > eTSchedule A (Form 990 or 990-EZ) 2015 Page 3 EXMIETEE Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part IT, If the organization fails to qualify under the tests listed below, please complete Part II.) ‘Section A. Public Support Calender year ; eee G01: | ew2012 | coors | @aore | cerors | enrotl 1 Gite, grants, conthbutons, and membership fees received (00 hot include any “unusual grants *) 2 Grose receipts fom admissions, Dertormed, or facies furshed In-any acuity that is relates to the organizations tax-exempt purpose 3 Gross receipts ftom activites business under section 513 4 Tax revenues levied for the organization's beneht and either Bald to or expended an t's bell 5 Thevalue ofservices oracles {urmshea by a governmental unt tothe orgamizetion without charge 6 Total, Add lines 1 chrough S 7a Amounts included on lines 1,2, and 3 received from disqualiied persons bb Amounts inluded on ines 2 and 3 rece fram other than dqualed persons that excees the greater of $5,000 oF 135 of the amount on ine 13 forthe year € Addiines 72 and7® {8 Public support. (Subtract ne 7¢ fromline ‘Section B. Total Support Calendar year ayo 2012 2013 2044 22015 Total (or fiscal year begining in) cw @ a & we cai ‘Amounts from ine 6 202 Gross income fom terest, dividends, payments received on Secunties ans, rents, royalties and income from simular sources b Unrelated business taxable sneome less section 511 taxes) fTom businesses acquires ater Add ines 108 and 105 11 Netincome tom unveated inne 10b, whether or not the business 1s regulary cared on 42, Othermeome Do natinclude gain or loss from the sate of Capital assets (Explain m Part vt) 13. Total support. (Add lines 9,1 3i,end2 } 14 Fits five years the Form 990 15 fOrthe organizations frat second, Hw, Tourth or AR ax year aya section SOITENS) organization, check this box and stop here > Section C. Computation of Public Support Percentage TS Public suppor percentage for 7015 (ine 8, column (9 awided by Une 13, column) 5 16 Public support percentage from 2014 Schedule A, Part HI, hne 15 36 ‘Section D. Computation of Investment Income Percentage T7 Investment income percentage for 2085 [ine 10c, column ) aviced by ine T3, coumn TH) 7 48 Investment income percentage trom 2014 Schedule A, Part IIL, ne 17 18 198 33:1/3% support tests2035.ithe organization didnot check the Box on line 14, and line 15 © more than 33 1/9%, ana ine 17 Te noe more than 33 1/38, check this box and stop here. The organization qualifies as 2 publicly supperted organization > bb 331/39 support tests—2014.f te organaation did not check 2 box on line 14 orline 193, and hne 26 vs more than 33 1/38 and ine 18 15 not mare than 33 1/38, check this box and stop here. Te organization qualities as @ publicly supperted organization > 20 private foundation the organization dd not check a Box on ine 14, 192, oF 19b, check this Box and see insteuctions >r ‘Schedule A (Form: Eo)‘Schedule A (Form 990 or 990-£Z) 2015 paged Supporting Organizations (Complete only you checked a box online 11 of Part Ifyou checked 13a of Par I, complete Sectans A and Ifyou checkea Tarrant, Compete Sectors A and © If youchecked Ihc af Part, complete Sectons'A,D, and Ifyou checked 11d of Part Lcomplete Sections A and D,and complete Part V Section A. All Supporting Organizations Yes | No 1. Are all ofthe organization’s supported organizations listed by name in the organization’: governing documents? IF "No," describe n Part VE how the supported organizations are designated If designated by class or purpose, eccrine the designation IF historic and continuing relationship, explain a 2. Did the organization have any supported organveation that does not have an IRS determination of status under section $09(a)(L) or (2)? 1F-"Yes," explain im Pare VE how the organization determined thatthe supported organrzation was described in section |_2 509(a)(1) oF (2) 3a. id the organization have a supported organization described in section 501 (c)(4), (5), oF 6)? IF "Yes, "answer (b) and (c) below 3a bb Did the organization confirm that each supported organization qualified under section 501{¢)(4), (5), oF (6) and satisfied the public support tests under section 509(2)(2)? 11 "Yes," describe m Pare VE when and how the organization made the determination € Did the organization ensure that al support to such organizations was used exclusively for section £70(c)(21(8) purposes? 11 "Yes," explain in Part VE what controls he organization put m place to ensure such use 44a Was any supported organization not organized in the United States ("foreign Supported organization)? If Vas" and if you checked {1a ar 11b 1m Part I, answar (b) and (c) below a bb Did the organization have ultimate contral ané discretion in deciding whether to make grants to the foreign Supported organization? In Yes," describe i Part VI how the eiganizatin had such contral and discretion despite being controlled er supervised| Dy or 1 connection with ts supparted erganvzations {€ Did the organization support any foreign supported organization that does not have an IRS determination under sections §01(€)(3) and 509(a)(2) oF (2)? 11 "Yes," explain in Part VI what controls the organization used to ensure that all suppart tothe foreign supported organization wes used exclusively for section 170(¢)(2)(8) purposes 5a. Did the organization add, substitute, or remove any supported organizations during the tax year? 11 "es, answer (b) and (c) below (i applicable) Also, provide detail in Part VI, including (1) the names and EIN humbers ofthe supported organizations added, substituted, or removed, ()) he reasans for each such actin, (i) the Buthonty under the organization's argantaing document authorizing such actien, and (iv) how the action Was, accomplished (such as by amendment tothe organizing document) 4b bb Type I or Type If only. Was any added or substituted supported organization part ofa class already designated in the organization's organizing document? Sb {¢ Substitutions oniy. Was the substitution the result ofan event beyond the organization's control? g 6 Did the organization provide support (hether in the form of grants oF the provision of services or facilities) to Anyone other tnan (a) i's supparted organizations, (b) individuais that are part of the charitable class Denefited by {ane of more af ts supported organizations, or (c)ather supporting organizations that also support or benefit one or more ofthe filing organization’: supportad organizations? If "Yes, "provide detail m Part VI. 6 7 Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contnbutor (defined in IRC 4958(c)(3}C)), 2 family member of a substantial contnbutor or a 35-percent controlled entity, wth regard to a substantial contnbutor? If “Yes,” camplete Part of Schadulel (Ferm 990) 2 8 Did the organization make a loan toa disqualified person (a5 defined in section 4958) not described inline 77 11 "Yes," complete Part If of Schedule L (Form 990) 8 98 Was the organization controled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers ané organizations described in section S09 (a)(2) or (2))? 1F"¥es," provide detain Pare VE. oa bb Did one or more disqualified persons (as defined in ine 9(a)) hold a controling interest in any entity in which the: supporting organization had an interest? If "Yes," provide deta in Part VI. 9 Dida disqualified person (as defined in line 9{a)) have an ownership interest in, or derive any personal benefit, from, assets in nhich the supporting organization also had an interest? If “Ves,” plovide deta! m Part VE. = loa was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(1) (regarsing certain Type {1 supporting organzations, ang all Type III non-functionally integrated supporting organizations) 7 "Ves," answer b below 300 bb Did the organization have any excess business holdings in the tax year? (Use Schedule G, Form 4720, to determine Whether the erganrzation had excess business holdings) 0b 41 Has the organization accepted a gift or contribution trom any of the following persons? ‘9 A person who directly or indirectly contrals, either alone or together with persons described in (b) and (c) below, the governing boay of a supported organization? tia A family member of a person described in (a) above? Fry € A 359% controlled entity of a person described in (a) oF (b) above7It "Yes" to, v, orc, providedetai im pat vi | ae ree‘Schedule A (Form 990 of 990-£Z) 2015 Page 5 TEX7_ Supporting Organizations (continued) ‘Section B. Type I Supporting Organizations 1 Did the directors, trustees, oF membersinp of one oF more supported organrzations have the power to regularly appoint or elect at least 2 majority ofthe organization ditectors or trustees at all times dunng the tax year? 11a" describe in Part VE how the supported organization(s) effectively ope'ated, supervised, or controlled the ‘organieation®s activities If the organieation id more than one supported organization, describe hew the powers £0 ‘appoint and/or emove directors or trustees mere allocated among the supported organvzations and what conditions or Festnictions, if any, applied to Such powers during the tax year a 2.__Did the organization operate for the benefit of any supported organization other than the supported organtzation(s that operated, supervised, or controlled the supporting organization? Ir "Yes," explain im Part VE hou providing such benefit carried out the purposes ofthe supported organization(s) that operated, supervised or controlled the supparting organization ‘Section €. Type 11 Supporting Organizations Yes | No A. Were @ mayonty ofthe organization’ directors or trustees during the tax year also @ majonty of the directors or trustees of each of the organveation’s supported organization(s? 11", describe n Bart VE how control ar management of the Supporting evoanrzation was vested inthe same persons that controled or managed the supparted organizaten(s) 1 ‘Section D. All Type III Supporting Organizations 1. Did the organization provide to each of ts supported organizations, by the last day of the fith month of the organization's tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) copy of the Form 990 that was mast recently filed as of the date of notification, and (3) copies of the organization's governing dacuments in effect on the date of notification, ta the extent not previously proviced?| 2 2 Were any of the organization’ officers, directors, or trustees either (1) appointed or elected by the supported organization(s) of (i) serving on the governing body ofa supported organization? 1F "No," explain m Pare VE how the organization mamntained a cose and cantinucus working relatianstyp with the A Supported organization(s) 3. By reason of the relationship descnbed in (2), did the organization's supported organizations have a significant voice m the organization’ investment policies and in girecting the use of the organigation’ income or assets at alltumes during the tax year? Ir "Yes," describe m Part VE the rte the organtzation’s supported ot ganizatiens played in this regard 3 ‘Section E. Type II Functionally- Integrated Supporting Organizations 1. Check the box next fa the method that the organization used to satisty the Integral Part Test curing the year (see instructions) ‘a [The organization satisfied the Activities Test Complete line 2 below 1b [F—_The organization is the parent of each of ts supported organizations Complete line 3 below © [7 The organization supported a governmental entity Describe in Part VI how you supported 2 government entity (see instructions) 2 Actites Test_Answer (a) and (b) below. Yes | No 22 Did substantially all of the organvzation’s activites during the tax year directly further the exempt purposes ofthe supported organization(s) to which the organization was responsive? 11 "Yes," then n Bart VE identify those supported organizations and explain how these activites directly furthered ther exempt purposes, how the arganization wae responsive fo those supported arganizatons, and how the organization determined that these activites constituted substantially al f 1 activities 2a bb Did the activities descnbed in (a) constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? 1 "Yes," explain in Part VE the reasons for the erganrzatin’s position that Its Supported argantzation(s) would have ‘engaged in these actvitias but far ens organizations involvement 2b 3 Parent of Supported Organizations __ Answer (a) and (b) below. 2 Did the organization have the power to regularly appoint or elect a mayonty ofthe oficers, directors, or trustees of each of the supported organizations? Provide details Part VI Ed bb Did the organization exercise a substantial degree of direction over the policies, programs and activities of each ofits supported organizations? if "Yes," describein Fart VI the role played by the organization 1n ths regard 3b ee!Schedule A (Form 990 or 990-EZ) 2035 Page 6 MEHR Type 111 Non-Functionally Integrated 509(a)(3) Supporting Organizations: YT Check here i the organisation satisied the Integral Part Test as a qualifying trust on Nov 20,1570 See instructions: Al other Type 111 non-functionally itegrated supporting organizations must complete Sections A through E Cc Section A - Adjusted Net Income (#9 Prox Year eptonad, Net short-term capital gain Recoveries of pnor-year distributions Other gross income (see instructions) Add tines 4 through 3 Deprectation and depletion Portion of operating expenses paid or incurreé for production or collection of gross income or for management, conservation, or maintenance of property held for praduetion of income (see instructions: Other expenses (see instructions) Adjusted Net Income (subtract lines 5, 6 and 7 from ne 4) Section B - Minimum Asset Amount (ay enor Year eptonal, Aggregate fair market value ofall non-exempt-use assets (see instructions for short tax year or assets held for part of year) 1 Average monthly value of secunties te Average monthly cash balances wb Fair market value of other non-exempt-use assets 1c Total (add lines 12, 1b, and 1¢) FA {explain in detail in Part V1) Acquisition indebtedness appicable to non-exempt use assets 3 Subtract line 2 from ine 14 cash deemed held for exempt use Enter 1-1/2%6 of ine 3 (for greater Net value of non-exempt-use assets (subtract line 4 from line 3) Multiply tine 5 by 035 Recoveres of prior-year aistnbutions Minimum Asset Amount (add line 7 to line 6) Section C - Distributable Amount Cine Year Adusted net income for pnor year (from Section A, ine B, Column A) Enter 85% of line 1 Minimum asset amount for prior year (rom Section @, line &, Column A) Enter greater of ine 2 oF line 3 ncome tax imposed in aior year Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) ‘ 7 Check here ifthe current year is the organization's first as a non-functionally-integrated Type TI Supporting organization (eee instructions) [~ eeeSchedule A (Form 990 or 990-EZ) 2035 Page 7 KEEN Type 111 Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued) ‘Section D - Distributions 4_Amounts pard to supported organizations to accomplish exempt purposes 2 Amounts patd to perform activity that directly furthers exempt purposes of supported organizations, 1n excess of meame from actity 3_ Administrative expenses paid to accomplish exempt purposes of supported organtzations 4 Amounts paid to acquire exemptuse assets 5 Qualified set-aside amounts (prior IRS approval required) 6 Other distributions (descnbe n Part VI) See instructions 7_ Total annual distributions. Acd lines 1 through 6 8 Distnbutions to attentive supportes organizations to which the organization 1s responsive (provide details in Part vi) See mstiuctions 9 bistnbutable amount for 2015 fram Section C, line 6 10 _Line 8 amount divided by Line 8 amount Section E - Distribution Allocations (see 0 G instructions) Excess Distributions Underdistributions, re-2015 a Distributable Amount for 2015 T Distributable amount fer 2015 from Section ©, bine 6 2 Underdistnbutions, any, for years pror to 2015 (reasonable cause required--see instructions) 3 Excess distributions carryover, any, to 2025, ny ‘@ From ola) # Total of ines Ja through © ‘9 Applied to underdistributions of pnor years Th Applied to 2015 distributable amount ¥ Carryover from 2010 not applied (see instructions} Remainder subtract ines 39, 3h, and 31 from SP % Distributions for 2015 from Section D, me 7 "Applied to undereistributions of pror years 'b Applied to 2015 distnburable amount © Remainder Subtract lines 4a and 4b from 4 3 Remaining undercistributions for years prior to 2015, any Subtract lines 39 and 4a from line 2 (ifamount greater than zero, see instructions) @ Ramaning underdistnbutions for 2015 Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instruction 7 Excess distributions carryover to 2016. Ada lines 3yand 4c ‘B_Breakdonn of me 7 Excess from 2015 From 2014, 7 yy ‘Schedule A (Form 990 or 990-EZ) (7015)Schedule A (Form 990 or 990-EZ) 2025 [ZERZ Supplemental Information. Provide the explanations required by Part II, line 10; Part Il, ine 17a or 179; Part II, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 92, 9b, 9¢, 11a, 11b, and 11¢; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, ines 2 and 3; Pert IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line Le; Part V Section D, lines 5, 6, and 8; and Part V, Secuon E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions) Page 8 Facts And Circumstances Test Schedule A (Form 990 or 990-EZ) 2015.[efile GRAPHIC print DO NOT PROCESS [As Filed Data -] DLN: 93495226022767 SCHEDULE D Supplemental Financial Statements 2 0 15 (Form 990) > complete if the organization answered “Yes,” on Form 980, rT art IV, line 6 7, 8,9, 20, 11a, 11b, 116, 184, 13¢, 181, 120, oF 12D, '» Attach to Form 990. Treasuy Information about Schedule D (Form 960) and its instructions is at wwwirs.gov/tormoso. [ieee ‘Name of the organization Employer Identification number 64-0787918 ‘Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts, Complete if the organization answered "Yes" on Form 990, Part IV, line 6. (a) Donor advised funds (b)Funds end other accounts 1 Total number at end of year 2 Aggregate value of contributions te (during yea") 3 Aggregate value of grants from (during year) 4 Agaregate value at end of year Did the orgameation inform all donors and donor advisors in writing thatthe assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal contral? Pres Co {6 bid the orgamzation inform all grantees, donors, and donor advisors in wting that grant funds can be lused only for charitable purposes and not for the benefit of the donor ar dont advisor, or for any ather purpose conferring impermissible private benefit? [ver [no Conservation Easements. Complete if tne organization answered "Yes" on Form 990, Part IV, line 7 1 Purpose(s) of conservation easements held by the organization (check all that apply) [Preservation of land for public use (e g recreation or education) [7 Preservation ofan histoncally important land area TF Protection of natural habitat TT Preservation ofa certified histone structure TF Preservation of open space 2 Complete limes 2a through 2¢ ifthe organization held a qualified conservation contnbution inthe form of a conservation easement on the last day ofthe tax year Held at the End of the Year bb Total acreage restricted by conservation easements 2 ‘€ Number of conservation easements on a certified histone structure included in (a) ze 1d Number of conservation easements included in (c) acquired after 8/17/06, and not on @ histone structure listed inthe National Register 2a 3 Number of conservation easements modifie, transferred, released, extinguished, or terminated by the organization dunng the tax year >, 4 Number of states where property subject to conservation easement is located P. oes the organization have a written policy regarding the periodie monitoring, inspection, handling of ‘lolations, and enforcement of the conservation easements it olds? ves [No 6 _Stafand volunteer hours devoted to monitoring, nspecting, handling of violations, and enforcing conservation easements during the year » 7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year ms 18 Does each conservation easement reported on line 2(8) above satisty the requirements of section 170(h)(4) (Bj(s ane section 170(h}¢4 (B)(u)> Pves [No 9 InPare XI11, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and mclude, applicable, the text of tne footnote to the organization’ financial statement that describes the organization's accounting for conservation easements [EIEEIH Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets, Complete if the organization answered "Yes" on Form 990, Part 1V, line 8. ta Ifthe organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historieal treasures, or other similar assets held for public exhibition, education, or research in furtherance of public Service, provide, in Part XII], the text of the footnote to its financial statements that describes these Cems bb Ifthe organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other siilar assets held for public exhibition, education, or research in furtherance of public Service, provide the following amounts relating to these items () revenue included on Form 999, Part VIII, ine 1 ms (0 Assets included in Form 990, Pact X bs 2 _ Ifthe organization received or held works of art, histoncal treasures, or other similar assets for financial gain, provide the fallowng amounts required to be reported under SPAS 116 {ASC 958) relating to these items Revenue included on Form 890, Part VIET ine ms Assets includes in Form 990, Part X oa For Paperwork Reduction Act Notice, cee the Instructions for Form 990. Ss eo oorSchedule (Form 390) 2015 Page 2 ‘Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets conned} 3 Using the organization’ acquisition, accession, and other records, check any of the following that are a significant use of ts colleezion items (check all that apply) 2 Public exhibition 4 TH Loanorexchange programs © scholarly research © other © 7 Preservation for future generations 4 Provige a descnption of the organzations collections and explain how they further the organvzatian’s exempt purpose in Part xUtT 5 During the year, did the organization solicit or recerve donations of art, historical treasures or other similar assets to be sold to fase funds rather than to be mamntained a part of the organization's collection? Eves [No Escrow and Custodial Arrangements. Complete the organization answered "Yes" on Form 990, Part 1V, lie 9, or reported an amount on Form 990, Part X, line 21. {421s the organization an agent, trustee, custodian or other intermediary for contributions or other assets not tncluded on Form 990, Part X? [ves No b_1F°¥es," explain the arrangement in Part XI11 and complete the following table ‘Amount © Beginning balance Fa 4 Additions during the year a © bistnbutions dunng the year te # ending balance at 2a__ Did the organization include an amount on Form 990, Part X, line 21, for escrowor custadial account lability? [ves [No b _irsves,* explain the arrangement in Part XIII Check here ifthe explanation has been provided in Part IIT... . - . o Endowment Funds. Compiete ive organization answered "Yes" to Form 990, Part IV, ine 10. {@icurer yar [—tb¥oryoar —[b (ive yn back | Vie years tak | (aurea ta Beginning ofyearbalance .. Contnbutions © Netinvestment earnings, gains, and losses Grants orscholarships . - . = | Other expenditures for fciities and programs f Administrative expenses 9 End of year balance 2 Provide the estimated percentage of the current year end balance (Iie 19, column (a)) held as Board designated or quasi-endowment ® Permanent endowment Temporarily restricted endowment ® The percentages on ines 2a, 2b, and 2c should equal 100% 3a Are there endowment funds not n the possession af the organization that are held and administered for the organization by Yes | No (unrelated organizations ©. ee ati) ip related organzations » . se ee Sati 1b 1f*¥es" on 3a{i), are the related organtzations listed as required on Schedule? - eee ee ee LBB 4 _ Describe in Part XIII the intended uses of the organization's endowment funds Land, Buildings, and Equipment. Compete ifthe organization answered Yes" to Form 990, Pert IV, line 11a.See Form 990, Part x, line 10 Deseripuian of property Cost or thera | coat crater bans| (e)ocpresaten | eM iiivesement (tier ve ca cand 395,153 3395.59, bb Busldings € Leasehold improvements. vee ee 572,685 546,695] 23.980 @equpmet 2 2. ee e728 396,060 3232.68 fe other Pi era aaa PEO Ae 1,262,485 877.09] 294,696 {Yotal, Ada ines 1a trough Le (Column (@) must equal Form 900, Part, ealumn (B),imel\e)) vss 730,657 rsSchedule 0 (Form 990) 2015 Page 3 [EMXU Investments—other Securities. Complete if the organwation answered Yes" on Form 990, Parvlv, line 11D. See Form 990, Part xX, line 12. (a) Deseniption of secu ay oF category (H)Book value (Method of valuation {including name of security) Cost of end-of-year market value (@yfinancial cenvaiwes (2)Closely-Feld equity iterests (aother erat (Column (0) mst equal Frm 90, Par, ct (8) ine 12 > Investments—Program Related, Complete if the organization answered 'Yes' on Form 990, Part IV, line 11¢.See Form 990, Part X, line 13 (@) Descaption of investment (b) Book val (€) Method of valuation Cost or end-of-year market value FIMEN Other Assets. complete the organization answered Yes on Form 990, Par iv, ine 11d See Form990, Pam x une 15 (a) Desenption (b) Book value 3515362 85,436, (i) Deferred Comp Trust Fund (2) Int mn Net Assets of AM Frid Total (Column (0) must equal Fam 990, Part X cal (8) ine 1S) 5 > 3801798 ‘Other Liabilities. Complete if tne organization answered Yes on Form 990, Partiv, ime Iie or 1if See Form 990, Part x, line 25 x {@) Description of lability () Book value Federal income taxes 0 Due to Arhinates 5123.404 “etek (ou (6) rst equal Frm 990, Part X ol (@) ine 25) > 523,408 2. Liabilty for uncertain tax positions in PaFt XIII, provide the text ofthe footnote to the organization's nancial statements that reports the ‘organization's liability for uncertain tax positions under FIN 48 (ASC 740) Check here ifthe text of the feotnate has been provided in Part xu “Schedule D (Form 990) 2015Schedule 0 (Form 990) 2015 Page 4 Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete i the orgatizaton ensnered Yes" on form 990, Par Iv, ine 122 Total revere, gains, and other support per audited financial statements a Amounts included an line 1 but nat on Form 990, Part VIII, line 12 2 Net unreatized gains (losses) on investments 2a © Recoveries of pnor year grants 2 other (Desenbe im Part xI1T ) 2d @ Adé nes 2a through 2d 2. 3 Subtract line 28 from line 4 5 Paes 3 Amounts included an Form 990, Part VIIL, line 12, but not on line 2 Investment expenses not incluced on Form 990, Part VIIL, ime 7 4a Other (Desende in P ) a Ado ines 4a and 4b ae 5 Total revenue Add lines 3and 4e,(This must equal Form 990, Partt,line12) + + _.[s Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered ‘Yes’ on Form 990, Part IV, line 12a, Total expenses and losses per audited fnancial statements z [Amounts included an line 1 but not on Form 990, Patt IX, ine 25 '@ Donated services and use of facilities 2a b_Pnor year adjustments 2 € Other losses 2e 4 Other (Descnbe in Part XIIE ) 2d © Addlines 2a through 2d. 2e 3 Subtract line 2e from line 4 3 4 Amounts included on Form 990, Part IX, line 25, but not on ine 4: Investment expenses not included on Form 990, Part VIIE, line 7b 4a Other (Descnbe in Part XIIT ) a © Adgines 4a and 4b a 5 5 Total expenses Add lines 3 and ae, (This must equal Form 990, Part [ETIEGIA suppiemental tnformation Provide the descriptions required fr Part II, lines 3,5, and 9, Pai II, lines 1a and 4, Part v, ines 1b and 2b, PartV, line 4, Part, ine 2, Part XI, lines 2 and 4b, and Part XII, lines 2d and4D Also complete this part to provice any additional information Return Reference Explanation See Additional Data Table “Schedule D (Form 990) 2015.‘Schedule D (Form 990) 2015 Pave 5 a ‘Supplemental Information (continued) Return Reference Explanation ‘Schedule b (Form 990) 2015Additional Data Software ID: Software Version: EIN: 64-0787918, Name: North Mississippi Medical Clinics Inc Supplemental Information Return Reference Explanation Part x, Line 2 The Company applies Financial Accounting Standards Board (FASB) Accounting Standards Coait reation (NSC) Topic 740 for Income Taxes ("Topic 740"), which clanties the accounting for Uncertainty in income tax provisions and provides guidance on when tax positions are reco ‘onized in an entity's financial statements and how the values ofthese positions are deter mined There has been no impact on the Company's financial statements a a result of TopicGRAPHIC pri Schedule 3 (Form 990) Department ofthe ‘Compensation Information For certain Officers, Directors, Trustees, Key Employees, and Highest ‘Compensated Employees > complete if the organization answered "Yes" on Form 990, Part 1V, line 23. > Attach to Form 990. >> Information about Schedule 3 (Form 990) and its instructions is at www.irs.gov/form990. Name of the organization Employer identification number BEDEED auestions negaraing compensation 9 it DO NOT PROCESS TAs Filed Data -] DLN: 93493226022787| Check the appropiate box(es) ifthe organization provided any ofthe following to or fora person listed on Form 990, Part VIL, Section A, line 12 Complete Part III to provide any relevant information regarcing these Items IT Ftst-class or charter travel TT Housing allowance or residence for personal use Travel for companions IT Payments for business use of personal residence TF Tax wemnication and gross-up payments TT Health or social club dues or intiation fees FF piscretionary spending account TH Personal services (e 9, maid, cnautfeur, chet) Hany of the boxes inline 1a are checked, did the organization follow a wntten policy regarding payment or Feimbursement or provision of allot the expenses described above? If-No," complete Part III to explain Did the organization require substantiation prior ta reimbursing or allowing expenses incurred by all directors, trustees, ofcers, including the CEO /Executwve Director, regarding the items checked inline 1a? Indicate which, 1fany, ofthe following the fling organization used to establish the compensation of the organvzation’s CEO /Executive Director Check all that apply Do rot check any boxes for methods Used by a related orgamzation to establish compensation al the CEO /Executive Ditectar, but explain in Part ILL Compensation committee FY warten employment contract FZ Independent compensation consultan TF Form 990 of other organizations TY Compensetion survey or study Fy Approval by the board or compensation committee During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respes fora related organization to the fling organization Receive a severance payment or change-of-contral payment? Participate in, or receive payment from, supplemental nongualified retirement plan? Participate in, oF receive payment from, an equity-based compensation arrangement? IF*¥e5" to any of ines 4a-c, list the persons and provide the applicable amounts for each item in Part IIT ‘only 504(c)(3), 504(c)(4), and 504(c)(29) organizations must complete lines 5-9. For persons listed on Form 990, Part VIL, Section A, line 1a, did the organization pay or accrue any compensation contingent on the revenues of he organization? Any related organization? 1f*¥e5," on line 5a oF Sb, describe in Part IIL Fr persons listed on Form 990, Part VIL, Section A, line 1a, did the organization pay or accrue any compensation contingent on the net earnings of he organization? Any related organization? 1f*¥e5," on line 6a oF 6b, describe in Patt IIT For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fnxed payments not deseribed mn ines § and 6? If*Yes," describe in Part L Were any amounts reported on Form 990, Part VII, paid or accured pursuant toa contract that was Subject to the inital contract exception described in Regulations section 53 4958-4(a){3)? If "Yes," describe inpare tT 1f*¥e5" on line 8, did the organrzation also follow the rebuttable presumption procedure descabed in Regulations saction $1 4958-6(¢)? Yes | No I | | | I | » 2 | | I | “ No # | Yes 3b No ob No z No 8 No s For Paperwork Reduction Act Notice, cee the Instructions for Form 990. SeSchedule 1 (Form 990) 2025 age 2 Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use dupicate copies 1 addiuonal space 6 needed Foreach individual whose compensation must be reported on Schedule ), report compensation from the organaation on row i) and fom related organizations, described wn the instructions, on row (i) De not list any individuals that are rot listed on Form 980, Part VI Note. The sum of columns (B)(:)-(in) far each bsted individual must equal the ratal amount of Form 990, Part VIL, Section A, line La, applicable column () and (E) amounts for that inchvicual (A) Name and Title See Acciuonal Data Table (B) Breakdown of W-2 and/or 1099-MISC compensation fase (9 comperaston ol in ther eperabie (©) Retrement and other deferrea compensation (0) Nontaxable benefits [ce Toxal or columns] nr (0) (F) Compensation in| column(s) reported, 2s deferred on prior Schedule) (Form 590) 2015Schedule } (Form 990) 2035, [EGET] Supplemental information Provide the information, explanation, oF Gescrou Page 3 (one required for Part 1 Hines 13,10, 3,49, 4b, 4c, Sa; Sb, 6a, 6b, 7, and 8, and for Parti Also complete ths part for any addiuonal miomation Return Reference Explanation Parl Line ab Participant Joseph A Reppert $37,890 Terms & Conditions North Mississippi Health Services, Ine (NMHS) Adopted the management Geferred annuity pian (the Plan) on October 1, 1998 Participants 1n the plan are designated by the compensation committee of the board of directors of NMHS At the eginning of each plan year, AMHS snall pay a contribution, less mitholaing for taxes, tothe participant's annulty contract, whichis 9 deferred annuity lcontract selected, ovmed, and controlled by the participant: The contribution 1s determined by multipying the participant's compensation in the preceding pian year by a percentage set forth n appendix b ofthe plan A participant is terminated from the plan on the earliest of (1) the date the board determines Ihe employee 1s no longer a participant, (2) te date the participant retire, (3) the date that the participant dies, or (4) the date the participant no longer i employed by NHS for reasons other than retirement or death Schedule) (Form 990) 2015Additional Data Form 990, Schedule J, Part II - Officers, Directors, Trustees, Key Employ. Software ID: Software Version: EIN: 64-0787918 Name: North Mississipp: Medical Clinics Inc 3s, and Highest Compensated Employees (@) Name and Title (8) Breakdown of W-2 and/or 1099-NISC compensation (©) Rewwement and (P) Nontaxable _[(e) Total of columns] (F) Compensation in 7 ca a other deferred benefits 10-0) column (8) Base Bonus & other compensation ieee ees [compensation incentive reportable ‘en pros Form 990 compensation __| compensation Toon baat o} 270 854] 62,103 10,835 0] 4400 305,312 | 9 ol Ql Tae Tampa a] ol | 266,951] a 4400 356,119] Tioson A RapeATERSI a] Ol cs} 408,17 155,797 5.300| | ° aso] 634,062 Seanes Kaori o} a79;087| ore 991,332] co} Ql . oe o| “Wa sears a] 334499] 185,053 842,302 eo] —y ° o| ‘robe DanalavPhvsaa al 627985 185,083 19,584 5.880) 838,492 eo] Ql o oa ol o| ‘iamer CHarny HODGor al ro eo] a Teak Des ROD al 131,601 339,696] oo] Ql a } ° o| Baie tevemaFinoc a] 327 883] 210,350 860,993] eo] | a | ° o| Beard FoauaenPrvaase al 378,228] 235,057] 836,275| | o| ol fiSCHEDULE O Supplemental Information to Form 990 or 990-EZ (Form 990 or 990-EZ) ‘Complete to provide information for responses to specific questions on Form 980 oF 990-£2 or to provide any additional information > Attach to Form 990 or 990-E2. > Information about Schedule O (Form 990 oF 990-E2) and its instructions is at Twwveirs gov/torm990, Department of the Treasury [efile GRAPHIC print - DO NOT PROCESS [As Filed Data - | DLN: 93493226022787) 2015 Cre Ec Name of the orgameation Employé 990 Schedule 0, Supplemental Information Tdentification numbe Return Explanation Reference Form 990, Page | North Mssissipp1 Medical Cines, ne 1s @ not-for-profit, nonstock, membershwp corporat 6,Part VL |1on of w hich North Mississippi Heath Services, Inc ss the sole member and has sole votn Section A, Line | g contro! 6990 Schedule 0, Supplemental Information Return Reference Form 990, Page 6, Part VI Section A, Line Ta ‘The Governance Committee of North Missssipp1 Health Services, nc. (NWHS), which s made up of past Charmen, nomnate candidates forthe Board These candxlates are then approved by the Board of NVHS990 Schedule 0, Supplemental Information Return Reference Form 990, Page 6, Part Vi Section A, Line 7 “The Board of North Mississippi Heath Services, lnc approves all transactions that exceed $1 mllon990 Schedule 0, Supplemental Information Return Reference Explanation Form 990, Page 6, Part VI Secton B, Lne 1b ‘The Form 990 goes through @ review process in the Accounting Department The accountant fo + each facity reviews the return for reasonableness and accuracy Altotals are ted to the audt reports, and al amounts are cross-referenced to schedules or other parts of th €@ actual return Once the accountant review's, the Accounting Supervisor and the Drector 0 Accountng reviews. The Supervisor does a detailed review by checkng the return for the ‘same teme thatthe accountant checked for Then the Drector does a more high evel revi ‘ew , reading the return for reasonableness and companing pror year amounts to current year ‘amounts Finally, the VP of Finance review s the return for reasonableness The returns ar «then sent tothe Executwe VPrTreasurer to be reviewed The Treasurer signs the return 3 nid then sent to the RS990 Schedule 0, Supplemental Information Return Reference Explanation Form 990, Page 6, Part Vi Section B, Line toe ‘ANANNUAL CONFLICT OF INTEREST QUESTIONNAIRE IS REGURED TO BE COMPLETED BY ALL OFFERS A. ND DRECTORS OF THE ORGANZATION THE QUESTIONNAIRE IS REVIEWED BY NORTH MSSISSIPAHEALT H SERVICES, INC'S COMPLIANCE OFFICER AND CONFLICT COMMITTEE. THE CONFLICT COMMITTEE REVIE WS CONFLICT TRANSACTIONS AND MAKES RECOMVENDA TIONS TO THE BOARD OF DIRECTORS REGARDING CON FLICT TRANSACTIONS IN ACCORDANCE WITH THE ORGANZATIONSS CONFLICT OF INTEREST POLICY ALL MEMBERS OF THE CONFLICT CONBATTEE ARE PROHBITED FROM ENGAGNG IN TRANSACTIONS WITH THE OR GANZATION OR ITS AFFLIATES DURING THER TENURE ON THE CONFLICT COMMITTEE AND ONE YEAR AF TER THER SERVICE CONCLUDES990 Schedule 0, Supplemental Information Return Reference Explanation Form 990, Page 6, Part VI Secton B, Lne 15aab ‘An independent compensation consuitng frm, The Hay Group, used to help establish the ‘compensation ofthe C=O, Executive Drector, other officer, and key employees The frmp resents ther ndependent analysis, w hich contans comparabilty data o the Compensation CConrnttee of North Mississippi Heath Services, Inc in adctton to this, the VPof Human Resources obtains another independent analysis from ancther compensation consuiting frm inorder to verty the mforration provided by The Hay Group The compensation ofthe ind viduals are then approved by the Compensation Committee The indiviiual whose compensation 's beng discussed s not present dunng the discussion or approval of ther compensation ‘The discussions and decisions regarding the comsensaton are documented the mnutes 0 { the meetngs Compensation of these individuals is approved annually990 Schedule 0, Supplemental Information Return Reference Form 990, Page 6, Part Vi ‘Section C, Line 19 ‘The governing documents, confbct of nterest poley, and financial staterments are avaliab le to the publ upon request A consoldated statement of operations is avalable on the lorganzations website990 Schedule 0, Supplemental Information Return Reference Explanation Form 990, Page 12, Part Xi, Line 9 Transfer of captal fromeubsdianes of NUS $6,618,630 Tranefer of Capral rom NVIVC to MUN! $14,860,440 orease m interest n net assets of affitated foundation $2,117 To tal other changes in Net Assets or Fund Balance = $21 481,196SCHEDULE R Related Organizations and Unrelated Partnerships (Form 990) > complete ifthe organization answered "Yes" on Form 90, Pat BV ine 2,34 356, 26, or 37, 2015 Ty fener teen » attach to Form 990, Information about Schedule R (Form 990) and its instructions is at www.lrs.gov/form9S0. peeneetend Name ofthe organization Trapoyer lentication number Noh anes Mes ines HEEGEME tentification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33 N sd 14 Em (4 doped) of red Pama gt dance ( Tou End-otfoor ase (4 Shea regarded enty may guste cate | rotamer at Gy oak Weasnpp Case od Cs rF war Tae [ONT ‘Identification of Related Tax-Exempt Organizations Complete if te organization answered "Ves" on Form 95 lor more related tax-exempt organizations during the tax year, TV, ine 34 because had one a) o @, @ @ ©. @ Nome, address and Eh oF rlted opanzaton Prmaryactwty | Legal donnie (ate | exempt Cade eacton_ | Publ cet sat Orect artling fsactem'a1246) ‘Sloreigncouney) epeenter omy 15) convalled ent? [ye [Ro Sie Adcnoral Oa SS a aT E SSSchedule R (Form 990) 2015 Page 2 Identification of Related Organizations Taxable as a Partnership Complete ifthe organization answered "Yes" on Form 990, Part IV, ine 34 because had one or more relsted organisations treated as 4 parmnerstvp during the tax year, oy oe] @ @, w ww m7 @ o o Name, sear, and EN of lonmaypactviy] tsamt | Ovex | Prodommnant | share of | ssc ot fospronranate] coos ust | contra or] pores Tasted craton esa] containg |main| cannot tener | foregn ‘excluded from schedule «4 econ ‘eae {fom 1065 [XTELA Identitication of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered 34 because it had one or more related organizations treated as a corporation or trust during the tax year. /es* on Form 990, Part IV, line @ w @ @, @ @ cy ® w ame, aces, a Prmary acoty soa! rect sorting | Type ef enety | stareet total [share atend-of| percentage | sacoon siz Teste orgeneaton cml ney |(Ceor, Secor] meame ior one 03) county rt) tty? ‘Gwen WS Heath one re Neda! Servcee ve jeans oor Ne Tupelo, He 38001 (Gorn HE Ener he Medal Servcos OE jeans econ e (ymenagement ine ° “e ” ° “ (fect Be Fis Care Cams Te Jreatrane Corp cs Tort MS Suppor Sarva [separ sewees 0 yas mor 7 cine ‘Schadule R (Form 990) 2015‘Schedule R (Form 990) 2015 Page 3 Transactions With Related Organizations Complete the organization answered Yes" on Form 990, Pert IV, line 34, 35b, or 36. Note. Complete ine i any entitys listedin Parts II, fl, orIV ofthis schedule Yes | No 4 During the tax year, did the orgramzation engage in any of the following transactions with one oF more related organtzations listed in Parts 11-1V7 a Receipt of (I) interest, (Wannuities, (Iljoyalties, or{lvyrent from a controlled entity, 6 se ss et ee te faa Re GR, grant, or capital contribution to related organization(s) = ee ee cy No € Gift, grant, or capital contribution rom related organveation(s) «6 se eee ee ie | ves Loans or loan guarantees to orforrelated organization(s). 6 ee eee faa No fe Loans of loan guarantees by related organization(s) lie [ Yes f Dividends from related organization(s) 2 eee a No 9 Sale of assets to relates organization(s). «- oe os ce 0 no bh Purchase of assets from related organization(s) © 2-2 ve ee fan No 1 Exchange of assets wit related organization(s)» +s 6 ee ee a No J) Lease offacilties, equipment, or other assets to related organvzation(s) © © 2 ee ee a K Lease offaciities, equipment, or other assets from related organization(s)» ee eee ee lak [ves 1 Performance of services or membership or fundraising solicitations for related organization(s) a We 1m Performance of services or membership or fundraising Solictations by related organization(S) «sss vs ee ee im] ves fn Sharing of facilities, equipment, mailing lists, or other assets with related organvzation(s) = 2 2 2 ee ee ee i We Shanng of pard employees with related organization(s) © ee eee iio | Yes Reimbursement paid to related organization(s) orexpensess 5 eee ee lip | Yes 4. Reimbursement paid by elated organization(s) forexpenses © ee ee ee iia] Yes Other transfer of cash or property to related organization(s)... es ee os Se a [ves '§ Othertranster of cash or property rom related organization(s). 2. ee ee is | ves 12_fthe answer to any ofthe abave is "Ves," see the instructions for information on whe must complete this ling, including covered relationships and transaction thveshalds @ @ © @ Name of rated organzaton seanentoon peut void Metiod of termina amount volved type (ss) Wp atecconal Parte Hamagenan ne 3 Tanase fie Paar ‘ayprtereanal Prarie Hanapemant he = Taina fae aa vT “Schedule A (Form 990) 2015Schedule R (Form 990) 2025, Pane 4 Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37, Provide the following information for each entily taxed a a partnership through which the arganvzation conducted more than five percent afte activities (measured by total alaets OF TOSS revenue) t ‘organization ‘See instructions regarding exclusion for certain investment partnerships one, sauean’ a tv ao) wa, | ac al o_) ,@ wm @ @ w. ess end EN of entity mary acct eernant | we iparmes | sit | tet | owroptene | cage un | cei or | recon (emer | (mistes, | s01tes0) | neame | same Bon'20" | ‘panne cunty)fexetaed trom ms ae (Foon ios) SSSchedule R (Form 990) 2015 Page 5 EERE supplemental tnformation Provide additional mformation for responses to questions on Schedule R (see instructions) Return Reference Par v, Line 2, Column (@) |Methoa of determining amounts for vansacons descabed mine 1q and 1s CeVtain routine management, nancial, and accounting services are provided joy North Missiesipp! Medical Clinics, Inc (Clinics) torts related aftihates Additionally, thre-party services are provided by related affiates for Clinics Jamounts reported on Line 2, colume (¢) for this transaction type are at fair market value and are comparable to transactions between two or more: Junrelated parties dealing at arm's length Shaduieh ron SoOy DOTSAdditional Data Software Version: Software 1D: EIN: 64-0787918 Name: North Mississipp: Medical Clinics Inc Form 990, Schedule R, Part II - Identification of Related Tax-Exempt Organizations (@) Name, adéress, and EIN of related organization ) Primary actwity ©. Legal domicile {state lor foreign country) @ Exempt Code © Public chanty status (ofseetion 501(¢) e wo rect controlling centty (a) section $12 (x13) controlled entity? Yes North MS Management Services Inc 830 5 Gloster Street Tupelo, MS 38801 04:0762698 Mame & Raman DE Boren) hat Innis No North MS Health Services Ine 830 5 Gloster Street Tupelo, MS 38801 64:0653269 Iam Services DE sore) haar Inwas Clay County Medical Corporation 8305 Gloster Street Tupelo, MS 38801 6410668465 Hospital DE sore) wns ‘Tishomingo Health Services Inc 830 § Gloster Street Tupelo, MS 38801, 04-0741087 IHospreal DE Boren) [ens No Pontatoe Health Services Ine 830 § Gloster Street Tupelo, MS 38601 64'0751410 Hosp DE sore Iswas North MS Medical Center Ine 830 § Gloster Street Tupelo, MS 38801 6410662976 IHospreal DE Isorrere) Inns We Tupelo Service Finance Ine 830 South Gloster Street Tupelo, MS 38801, 64-0508308 [conections DE Bore) lens Ne Webster Health Services Ine 830 5 Gloster street Tupelo, MS 38801 64"0819193 IHospreal DE sore) Inws Manion Regional Medical Center Ine 830 5 Gloster street Tupelo, MS 38801 6410926753 Hospital DE sore) es We North MS Emergency Services Inc 830 5 Gloster street Tupelo, MS 38801, 94-0780130 JER Physicians DE sore Inwas