SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
MISSISSIPPI PROFESSIONALS HEALTH
PROGRAM
Employer identification number

64-0629295
Return Reference Explanation
FORM 990 - ORGANIZATION'S MISSION THE MISSISSIPPI PROFESSIONALS HEALTH PROGRAM IS MISSISSIPPI'S IMPAIRED HEALTHCARE PROFESSIONALS PROGRAM AND WILL BECOME ONE OF THE NATION'S PREMIER ORGANIZATIONS THAT PROMOTE RESEARCH, EDUCATION, PREVENTION, EARLY IDENTIFICATION, INTERVENTION, TREATMENT AND REHABILITATION OF DOCTORS WHO MAY BE IMPAIRED OR AT RISK OF IMPAIRMENT BECAUSE OF CHEMICAL DEPENDENCY, PSYCHIATRIC ILLNESS OR OTHER POTENTIALLY IMPAIRING CONDITIONS. WE WILL IDENTIFY, INTERVENE UPON, TREAT AND REHABILITATE CHEMICALLY DEPENDENT HEALTHCARE PROFESSIONALS WITH COMPASSION, DIGNITY AND RESPECT. WE WILL EDUCATE THE PUBLIC AND THE HEALTHCARE PROFESSION OF OUR STATE ABOUT CHEMICAL DEPENDENCY. WE WILL EXPAND THE BODY OF BASIC KNOWLEDGE ABOUT CHEMICAL DEPENDENCY THROUGH RESEARCH. WE WILL ACTIVELY SEEK METHODS TO PREVENT CHEMICAL DEPENDENCY. WE WILL PURSUE ADEQUATE FUNDING AND RESOURCES TO ENABLE US TO COMPLETE THIS MISSION.
FORM 990, PAGE 2, PART III, LINE 4A WE WILL ACTIVELY SEEK METHODS TO PREVENT CHEMICAL DEPENDENCY. WE WILL PURSUE ADEQUATE FUNDING AND RESOURCES TO ENABLE US TO COMPLETE THIS MISSION.
FORM 990, PAGE 6, PART VI, LINE 2 CHARMAIN KANOSKY MPHP BOARD OF DIRECTORS DIRECTOR DIRECTORS BUSINESS BLAKE BELL MPHP BOARD OF DIRECTORS DIRECTOR DIRECTORS BUSINESS
FORM 990, PAGE 6, PART VI, LINE 11B 990 REVIEWED BY MANAGEMENT OF ORGANIZATION WITH PREPARING CPA.
FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY, A QUESTIONAIRE IS CIRCULATED TO THE BOARD IN ORDER TO ACCUMULATE INFORMATION ON INTERESTS THAT COULD GIVE RISE TO CONFLICTS.
FORM 990, PAGE 6, PART VI, LINE 15A BOARD APPROVES MEDICAL DIRECTOR PAY
FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS , CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

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