2022-08-09T13:10:38-05:00 2021-09-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2020-10-01 273274203 ANDERSON PHYSICIAN ALLIANCE INC ANDE 6015536000 2124 14TH STREET MERIDIAN MS 39301 STEVEN BROWN VP OF FINANCE 6015536000 2022-08-09 1 STEVEN BROWN 999009999 AMY BIBBY P00445891 8282542254 2022-08-09 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEVEN BROWN 2124 14TH STREET MERIDIAN MS 39301 5053669 0 X WWW.ANDERSONREGIONAL.ORG X 2010 MS ANDERSON PHYSICIAN ALLIANCE, INC. OFFERS FAMILY PRACTICE AND SPECIALTY CLINICS TO PROVIDE QUALITY HEALTHCARE FOR EAST MISSISSIPPI AND WEST ALABAMA. 5 0 63 0 0 0 0 0 4053900 5053666 12 3 112 0 4054024 5053669 0 0 0 0 3899489 5489614 0 0 0 1851290 1821636 5750779 7311250 -1696755 -2257581 1089622 2357545 31645895 35163272 -30556273 -32805727 X SEE SCHEDULE O:ANDERSON PHYSICIAN ALLIANCE, INC. IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES. THE SPECIFIC PURPOSES AND OBJECTIVES OF THE CORPORATION SHALL INCLUDE BUT NOT BE LIMITED TO EMPLOYING PHYSICIANS AND OTHER MEDICAL PERSONNEL TO CARRY OUT THE PURPOSES AND OBJECTIVES OF ANDERSON REGIONAL MEDICAL CENTER, AS FOLLOWS:1.) TO ESTABLISH AND MAINTAIN AN INSTITUTION OR INSTITUTIONS, WITHIN OR WITHOUT THE STATE WHERE INCORPORATED, WITH PERMANENT FACILITIES TO PROVIDE DIAGNOSIS AND TREATMENT FOR PATIENTS2.) TO CARRY ON ANY EDUCATION ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED, OR TO THE PROMOTION OF HEALTH3.) TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED4.) TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY 0 0 7035465 5052690 SEE SCHEDULE O:ANDERSON PHYSICIAN ALLIANCE, INC. OFFERS FAMILY PRACTICE AND SPECIALTY CLINICS TO PROVIDE QUALITY HEALTHCARE FOR EAST MISSISSIPPI AND WEST ALABAMA. THE PHYSICIANS, NURSE PRACTITIONERS AND STAFF FOCUS ON PRIMARY HEALTHCARE NEEDS OF THE COMMUNITY.ANDERSON EAR, NOSE & THROAT CENTER DIAGNOSES, TREATS AND MANAGES PATIENTS WITH DISORDERS AND CONDITIONS OF THE EAR, NOSE AND THROAT REGION, AND RELATED AREAS OF THE HEAD AND NECK.AT ANDERSON NEUROLOGY CENTERTREATS DISORDERS THAT AFFECT THE BRAIN, SPINAL CORD AND NERVES. DIAGNOSES COMPLEX CONDITIONS THROUGH DETAILED HISTORY AND PHYSICAL EXAMINATION, INCLUDING TESTING OF MENTAL STATUS, VISION, SPEECH, STRENGTH, SENSATION, COORDINATION, REFLEXES, AND GAIT. ANDERSON UROLOGY CLINIC OF MERIDIANTREATS A WIDE VARIETY OF CONDITIONS THAT AFFECT THE URINARY SYSTEM AND THE MALE REPRODUCTIVE SYSTEM.ANDERSON CARDIAC SURGICAL ASSOCIATESOFFERS A WEALTH OF KNOWLEDGE AND EXPERIENCE, MODERN SURGICAL EQUIPMENT, ADVANCED TECHNIQUES, AND HIGH-QUALITY CARE FOR COMPLEX OPEN HEART AND VASCULAR SURGERIES. PEDIATRIC HOSPITALISTSTHE PEDIATRIC HOSPITALIST PARTNERS WITH PRIMARY CARE PEDIATRICIANS AND OTHER SUB-SPECIALISTS AND NURSE PRACTITIONERS TO PROVIDE COMPREHENSIVE, FAMILY CENTERED CARE DURING AN ACUTE HOSPITALIZATION.THE PURVIS CLINICFROM PUBERTY THROUGH CHILD-BEARING YEARS, MENOPAUSE AND BEYOND, THE PRACTICE PROVIDES PERSONAL AND HIGH QUALITY CARE FOR WOMEN. WOMEN'S MEDICAL CENTER OF MERIDIANTHE WOMEN'S MEDICAL CENTER OF MERIDIAN SERVE PATIENTS RANGING IN AGE FROM ADOLESCENCE TO ELDERLY, BELIEVING ALL ARE ENTITLED TO THE VERY BEST IN HEALTHCARE, UTILIZING STATE-OF-THE-ART MEDICAL TREATMENT AND SURGICAL PROCEDURES. 7035465 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 63 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X STEVEN BROWN 6015536647 2124 14TH STREET MERIDIAN MS 39301 X GEORGE D FARR JR DIRECTOR (CHAIRMAN) 1.00 50.00 X X 0 190142 47287 WANDA B COOPER DIRECTOR (SECRETARY) 1.00 50.00 X X 0 221493 9517 SHAWN C ANDERSON DIRECTOR 1.00 5.00 X X 0 22000 0 STEVEN W BROWN DIRECTOR 1.00 50.00 X X 0 238797 59015 THURMAN K EVERETT DIRECTOR 1.00 X X 0 357437 49768 CODY B AULL PHYSICIAN 40.00 X 603395 0 38037 ZAINEB DAUD PHYSICIAN 40.00 X 263371 0 0 DAVID A GEER PHYSICIAN 40.00 X 451957 0 18723 DANIEL J MCKIEVER JR PHYSICIAN 40.00 X 257205 0 12955 RONNY PURVIS PHYSICIAN 40.00 X 483430 0 12298 2059358 1029869 247600 11 0 1 0 LARAIB TABBA 127C AIRPARK DRIVE PHILADELPHIA MS 39350 CONTRACT PHYSICIAN SERVICES 230171 NTT DATA SERVICES LLC POB 534118 ATLANTA GA 303534118 EMR - BILLING SOFTWARE 111168 2 NET PATIENT 621990 5043550 5043550 PROVIDER RELIEF FUNDS 900099 10116 10116 5053666 3 3 5053669 5053666 0 3 5037649 4840134 197515 33053 30896 2157 202849 196337 6512 216063 213286 2777 602600 596457 6143 1123 1123 150668 118961 31707 469311 469239 72 26728 25762 966 1120 1120 103781 83437 20344 159134 159134 MEDICAL SUPPLIES 196492 195619 873 BAD DEBT EXPENSE 110679 103960 6719 7311250 7035465 275785 0 10213 12787 394514 458894 26667 26667 3113874 1254677 658228 1859197 1089622 2357545 211882 333104 31434013 34830168 31645895 35163272 X -30556273 -32805727 -30556273 -32805727 1089622 2357545 -2257581 8127 0 X X 0 1 X 1 1 1 X 160000 160000 1953238 358752 1594486 29777 28458 1319 970859 867467 103392 1859197 DUE TO AFFILIATES 34671416 MEDICARE ACCELERATED PAYMENT 158752 34830168 X PART X, LINE 2: ANDERSON PHYSICIAN ALLIANCE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3); ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION FOR INCOME TAXES. ANDERSON PHYSICIAN ALLIANCE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2021 AND 2020. X 0 0 X X X X X 0 1 0 0 0 0 0 0 0 CODY B AULL PHYSICIAN 594813 0 7686 0 896 0 5600 0 32437 0 641432 0 0 0 RONNY PURVIS PHYSICIAN 465222 0 15277 0 2931 0 0 0 12298 0 495728 0 0 0 DAVID A GEER PHYSICIAN 442045 0 0 0 9912 0 5600 0 13123 0 470680 0 0 0 THURMAN K EVERETT DIRECTOR 0 342934 0 0 0 14503 0 49768 0 0 0 407205 0 0 STEVEN W BROWN DIRECTOR 0 236699 0 0 0 2098 0 41228 0 17787 0 297812 0 0 DANIEL J MCKIEVER JR PHYSICIAN 200994 0 56211 0 0 0 0 0 12955 0 270160 0 0 0 ZAINEB DAUD PHYSICIAN 263371 0 0 0 0 0 0 0 0 0 263371 0 0 0 GEORGE D FARR JR DIRECTOR (CHAIRMAN) 0 188295 0 0 0 1847 0 32967 0 14320 0 237429 0 0 WANDA B COOPER DIRECTOR (SECRETARY) 0 212785 0 0 0 8708 0 2600 0 6917 0 231010 0 0 PART I, LINE 1A EXECUTIVE TEAM MEMBERS ARE OFFERED FREE MEMBERSHIPS TO ANDERSON HEALTH AND FITNESSS CENTER. WANDA COOPER, GEORGE DENTON FARR, AND JOHN ANDERSON RECEIVED FREE MEMBERSHIPS. PART I, LINE 3 THE ORGANIZATION IS A SUBSIDIARY OF ANDERSON REGIONAL MEDICAL CENTER (ARMC). OFFICERS AND DIRECTORS OF ANDERSON PHYSICIAN ALLIANCE ARE COMPENSATED BY ARMC. AS SUCH APA FOLLOWS THE POLICIES OF ARMC. ARMC HAS A DESIGNATED THREE PERSON COMMITTEE AND HAS AN OUTSIDE CONTRACTED ORGANIZATION TO STUDY AND RECOMMEND COMPENSATION FOR EXECUTIVES. PART I, LINE 4B ARMC PROVIDES TO CERTAIN EXECUTIVES AN IRS SEC. 457(F), NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. THE PURPOSE OF THIS PLAN IS TO OFFER PARTICIPATING EXECUTIVES TAXABLE DEFERRED COMPENSATION BENEFITS TO SUPPLEMENT SUCH EXECUTIVE'S RETIREMENT UNDER ARMC'S TAX-QUALIFIED RETIREMENT PLAN. THE PLAN SHALL BE UNFUNDED FOR TAX PURPOSES AND FOR PURPOSE OF TITLE I OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1975 ("ERISA"). SEE COMPENSATION SECTION FOR DETAIL INFORMATION ON PERSONS AND AMOUNTS. FORM 990, PART VI, SECTION A, LINE 1 UNLESS PROHIBITED OR LIMITED BY THE ARTICLES OF INCORPORATION OR THESE BYLAWS, THE BOARD OF DIRECTORS MAY CREATE AN EXECUTIVE COMMITTEE AND ONE OR MORE THAN OTHER COMMITTEES OF THE BOARD AND APPOINT MEMBERS OF THE BOARD OF DIRECTORS TO SERVE ON THEM. FORM 990, PART VI, SECTION A, LINE 2 GEORGE DENTON FARR AND SHAWN ANDERSON ARE FIRST COUSINS. JOHN ANDERSON AND SHAWN ANDERSON ARE UNCLE AND NEPHEW. FORM 990, PART VI, SECTION A, LINE 6 ANDERSON REGIONAL MEDICAL CENTER (ARMC) IS THE SOLE MEMBER OF ANDERSON PHYSICIAN ALLIANCE, INC. FORM 990, PART VI, SECTION A, LINE 7A ANDERSON REGIONAL MEDICAL CENTER HAS THE POWER (1) TO APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS, (2) TO EXERCISE ALL VOTING RIGHTS OF THE MEMBERS FORM 990, PART VI, SECTION A, LINE 7B ANDERSON REGIONAL MEDICAL CENTER HAS THE POWER (1) TO APRROVE APA'S PHYSICIAN COMPENSATION MODELS, PHYSICIAN COMPENSATION AND PHYSICIAN COMPENSATION POLICIES, (2) TO APPROVE PHYSICIAN EMPLOYMENT AGREEMENTS, AND (3) TO INITIATE AND/OR APPROVE VARIOUS OTHER ACTIONS AND POLICIES AS ENUMERATED IN APA'S CERTIFICATE OF INCORPORATION AND BYLAWS, AND AS REQUIRED BY STATE LAW. FORM 990, PART VI, SECTION B, LINE 11B EACH BOARD MEMBER WAS PROVIDED A COPY OF THE FORM 990. THE BOARD MEMBERS WERE ASKED TO REVIEW THE FORM AND SUBMIT QUESTIONS AND COMMENTS PROIR TO THE FORM 990 BEING FINALIZED. AFTER REVIEW, THE FINALIZED FORM 990 WAS PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND REQUESTS ALL BOARD MEMBERS TO ANNUALLY DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION IS A SUBSIDIARY OF ANDERSON REGIONAL MEDICAL CENTER (ARMC). OFFICERS AND DIRECTORS OF ANDERSON PHYSICIAN ALLIANCE ARE COMPENSATED BY ARMC. AS SUCH APA FOLLOWS THE POLICIES OF ARMC. ARMC HAS A DESIGNATED THREE PERSON COMMITTEE AND HAS AN OUTSIDE CONTRACTED ORGANIZATION TO STUDY AND RECOMMEND COMPENSATION FOR EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE MADE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VI, LINE 1: INDEPENDENCE OF VOTING BOARD MEMBERS: THE ORGANIZATION IS A SUBSIDIARY OF ANDERSON REGIONAL MEDICAL CENTER, A 501(C)(3) ORGANIZATION. THE BOARD OF DIRECTORS OF THIS ORGANIZATION FAILS TO HAVE A MAJORITY OF INDEPENDENT BOARD MEMBERS PER THE DEFINITION PROVIDED BY THE IRS. PLEASE NOTE, HOWEVER, THAT THE SOLE MEMBER ORGANIZATION HAS A FIFTY PERCENT INDEPENDENT BOARD OF DIRECTORS, AND THROUGH ITS MEMBERSHIP PROVIDES GOVERNANCE OVERSIGHT OVER THE FILING ORGANIZATION. PLEASE SEE THE RESPONSES TO FORM 990, PART VI, LINES 6 THROUGH 7B FOR DETAILS ON THE SOLE MEMBER AND ITS AUTHORITY. FORM 990; PART XII; LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ANDERSON REGIONAL MEDICAL CENTER 2124 14TH STREET MERIDIAN MS 39301 640362400 HEALTHCARE MS 501(C)(3) LINE 3 N/A 0 MEDICAL SUPPORT AND DEVELOPMENT ORGANIZATION 122 WOODMONT WAY RIDGELAND MS 39157 640722433 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 12C, III-FI ANDERSON REGIONAL MEDICAL CENTER 0 ANDERSON SUPPORT AND DEVELOPMENT FOUNDATION 7651 POPLAR SPRINGS DR MERIDIAN MS 39305 640730109 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 12D, III-O ANDERSON REGIONAL MEDICAL CENTER 0 MIRACLES OF GRACE FOUNDATION 1827 SUNRISE LANE TOOMSUBA MS 39364 640730366 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 12C, III-FI ANDERSON REGIONAL MEDICAL CENTER 0 CARE CONSISTENCY FOUNDATION INC 7761 MEADOW CIRCLE MERIDIAN MS 39305 640730846 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 12D, III-O ANDERSON REGIONAL MEDICAL CENTER 0 EAST MISSISSIPPI ENDOSCOPY CENTER 1926 23RD AVENUE MERIDIAN MS 39301 440884792 HEALTHCARE MS N/A 0 0 ARMC HOSPITAL PROF & GEN LLFT 512 22ND AVENUE MERIDIAN MS 39301 206131090 TRUST MS N/A T 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0