BALLAD HEALTH FOUNDATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- BALLAD HEALTH FOUNDATION (EIN 58-1594191)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-17
- IRS object ID
- 202121379349304687
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-05-17T12:52:20-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621517792 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PYA P C | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2220 SUTHERLAND AVE | AddressLine1Txt |
| City | KNOXVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37919 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581594191 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BALLAD HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BALL | BusinessNameControlTxt |
| Phone | 4233023131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 W OAKLAND AVE SUITE 2 | AddressLine1Txt |
| City | JOHNSON CITY | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 376042357 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JACK SIMPSON | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 4232308550 | PhoneNum |
| Signature | 2021-05-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DEBORAH O ERNSBERGER | PreparerPersonNm |
| PTIN | P00364912 | PTIN |
| Phone | 8656730844 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TODD NORRIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 W OAKLAND AVE SUITE 2 | AddressLine1Txt |
| City | JOHNSON CITY | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 376042357 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,186,882 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | BALLADHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Activity Or Mission | BALLAD HEALTH FOUNDATION'S PRIMARY PURPOSE IS TO BUILD RELATIONSHIPS WITH OTHERS TO FULFILL THE MISSION AND VISION OF BALLAD HEALTH THROUGH PHILANTHROPY. WORKING TOGETHER AROUND A COMMON SET OF OBJECTIVES, WE CAN TRANSFORM OUR COMMUNITY'S HEALTH AND WELL-BEING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 16 | TotalEmployeeCnt |
| Total Volunteers | 353 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,793,058 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,900,227 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,372,089 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,125,922 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$411 | PYOtherRevenueAmt |
| CY Other Revenue | -$405,007 | CYOtherRevenueAmt |
| PY Total Revenue | $5,164,736 | PYTotalRevenueAmt |
| CY Total Revenue | $5,621,142 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,226,311 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,180,239 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $910,610 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $822,204 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $347,989 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,421,872 | PYOtherExpensesAmt |
| CY Other Expenses | $967,521 | CYOtherExpensesAmt |
| PY Total Expenses | $7,558,793 | PYTotalExpensesAmt |
| CY Total Expenses | $4,969,964 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,394,057 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $651,178 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $51,428,843 | TotalAssetsBOYAmt |
| Total Assets EOY | $51,336,210 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,995,237 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,574,142 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $45,433,606 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $45,762,068 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | BALLAD HEALTH FOUNDATION'S PRIMARY PURPOSE IS TO BUILD RELATIONSHIPS WITH OTHERS TO FULFILL THE MISSION AND VISION OF BALLAD HEALTH THROUGH PHILANTHROPY. WORKING TOGETHER AROUND A COMMON SET OF OBJECTIVES, WE CAN TRANSFORM OUR COMMUNITY'S HEALTH AND WELL-BEING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,180,239 | ExpenseAmt |
| Grant | $3,180,239 | GrantAmt |
| Desc | BALLAD HEALTH FOUNDATION EXISTS TO SUPPORT BALLAD HEALTH'S MISSION OF SERVICE TO THE PEOPLE OF THE APPALACHIAN HIGHLANDS REGION. DURING THE 12 MONTH FISCAL YEAR ENDED JUNE 30, 2020, THE FOUNDATION FUNDED $1,838,993 IN CAPITAL PROJECTS AT BALLAD HEALTH FACILITIES THROUGHOUT THE APPALACHIAN HIGHLANDS REGION. OF THESE PROJECTS, $1,391,863 WERE RELATED TO PEDIATRIC CARE OR HEALTH INITIATIVES. AMONG THE MORE NOTABLE PEDIATRIC PROJECTS FUNDED WAS THE COMPLETION OF THE J.D. NICEWONDER PEDIATRIC EMERGENCY DEPARTMENT AT BRISTOL REGIONAL MEDICAL CENTER, AN ADAPTIVE PLAYGROUND FOR USE BY PATIENTS AND FAMILIES WHO ARE AT NISWONGER CHILDREN'S HOSPITAL, AND A VENTILATOR FOR PEDIATRIC PATIENTS WHO ARE BEING TRANSPORTED BY HELICOPTER. THE FOUNDATION ALSO PROVIDED FUNDING FOR RENOVATIONS ON THE THIRD FLOOR OF SYCAMORE SHOALS HOSPITAL, THE COMPLETION OF A HEALING GARDEN AT JOHNSON CITY MEDICAL CENTER, DIAGNOSTIC EQUIPMENT FOR WOMEN IN SMYTH COUNTY, FURNISHINGS AND DECOR FOR THE GREENEVILLE COMMUNITY HOSPITAL CAFETERIA, AND A NUMBER OF PIECES OF PATIENT TRANSPORT EQUIPMENT IN DICKENSON COUNTY. DURING THE SAME TIME PERIOD OVER $196,000 WAS PROVIDED TO SUPPORT EDUCATIONAL PROGRAMMING FOR PATIENTS AT NISWONGER CHILDREN'S HOSPITAL, $116,899 WAS PROVIDED TO SUPPORT THE HEALTH SYSTEM'S POPULATION HEALTH OBJECTIVES, AND THE FOUNDATION SUPPORTED THE HEALTH SYSTEM'S PARISH NURSING PROGRAM WITH $22,602. FINALLY, THROUGHOUT THE YEAR THE FOUNDATION PROVIDED $503,835 TO SUPPORT TEAM MEMBERS AND PATIENTS WITH BASIC NEEDS AND WOMEN WHO COULD NOT OTHERWISE AFFORD BREAST CANCER SCREENINGS PROGRAMS. | Desc |
| Total Program Service Expenses | $3,180,239 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 74 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 16 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | TN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMANTHA BRUCE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4233023131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 W OAKLAND AVE SUITE 2 | AddressLine1Txt |
| City | JOHNSON CITY | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 376042357 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| BOB CANTLER | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| TED FIELDS | ||||||||
| VICE CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LYNN KRUTAK | ||||||||
| TRUSTEE/ BH EVP & CFO | 0.50 | Yes (X) | Yes (X) | $0 | $929,458 | $96,545 | 59.50 | |
| NORRIS SNEED | ||||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JACK SIMPSON | ||||||||
| PRESIDENT | 40.00 | Yes (X) | Yes (X) | $113,622 | $0 | $12,019 | ||
| ANGELA ARP | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| KAY BUNN | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| GREG COX | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| HEIDI DULEBOHN | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| SHAWN HOLLINGER | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| ANTHONY KECK | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $671,574 | $79,459 | 59.50 | ||
| MICHELE KING | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| JULIE LICH | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| TODD NORRIS | ||||||||
| TRUSTEE | 40.00 | Yes (X) | $0 | $470,542 | $74,055 | 10.00 | ||
| TODD DOUGAN | ||||||||
| FORMER OFFICER | 0.00 | $0 | $348,086 | $0 | Yes (X) | |||
| BARTON HOVE | ||||||||
| FORMER OFFICER | 0.00 | $0 | $980,153 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $113,622 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,399,813 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $262,078 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $964,950 | FundraisingAmt |
| Related Organizations | $39,500 | RelatedOrganizationsAmt |
| All Other Contributions | $3,895,777 | AllOtherContributionsAmt |
| Noncash Contributions | $52,044 | NoncashContributionsAmt |
| Total Contributions | $4,900,227 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $830,542 | TotalRevenueColumnAmt |
| Exclusion | $830,542 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $312,880 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $17,500 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $312,880 | SecuritiesAmt |
| Other | -$17,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $295,380 | TotalRevenueColumnAmt |
| Exclusion | $295,380 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $143,233 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $964,950 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $548,240 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$405,007 | TotalRevenueColumnAmt |
| Exclusion | -$405,007 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,621,142 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $720,915 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,986,192 | TotalAmt |
| Program Services | $2,986,192 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,047 | TotalAmt |
| Program Services | $194,047 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $822,204 | TotalAmt |
| Management And General | $822,204 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,201 | TotalAmt |
| Management And General | $37,201 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,764 | TotalAmt |
| Management And General | $88,991 | ManagementAndGeneralAmt |
| Fundraising | $116,773 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,302 | TotalAmt |
| Fundraising | $74,302 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,692 | TotalAmt |
| Management And General | $81,692 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,701 | TotalAmt |
| Management And General | $10,701 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $341,651 | $341,651 | |
| DONOR RECOGNITION | $94,371 | $94,371 | |
| SPECIAL EVENTS | $51,291 | $51,291 | |
| SUPPLIES | $18,900 | $18,900 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,648 | TotalAmt |
| Management And General | $40,396 | ManagementAndGeneralAmt |
| Fundraising | $11,252 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,969,964 | TotalAmt |
| Program Services | $3,180,239 | ProgramServicesAmt |
| Management And General | $1,441,736 | ManagementAndGeneralAmt |
| Fundraising | $347,989 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,520,067 | BOYAmt |
| EOY | $14,399,695 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,056,011 | BOYAmt |
| EOY | $1,695,284 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $396,720 | BOYAmt |
| EOY | $220,770 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,689 | BOYAmt |
| EOY | $77,146 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $144,327 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $114,998 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,966 | BOYAmt |
| EOY | $29,329 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,872,848 | BOYAmt |
| EOY | $32,596,676 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,496,542 | BOYAmt |
| EOY | $2,317,310 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,428,843 | BOYAmt |
| EOY | $51,336,210 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,385 | BOYAmt |
| EOY | $53,489 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $367,550 | BOYAmt |
| EOY | $122,300 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,506,302 | BOYAmt |
| EOY | $5,398,353 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,995,237 | BOYAmt |
| EOY | $5,574,142 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,851,596 | BOYAmt |
| EOY | $10,194,348 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,582,010 | BOYAmt |
| EOY | $35,567,720 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,433,606 | BOYAmt |
| EOY | $45,762,068 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,428,843 | BOYAmt |
| EOY | $51,336,210 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $651,178 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$494,382 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $171,666 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,614,415 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,775,347 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,920,331 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,793,058 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,900,227 | CurrentTaxYearAmt |
| Total | $23,003,378 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,614,415 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,775,347 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,920,331 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,793,058 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,900,227 | CurrentTaxYearAmt |
| Total | $23,003,378 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $23,003,378 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $746,523 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $569,330 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $750,532 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,080,704 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $830,542 | CurrentTaxYearAmt |
| Total | $3,977,631 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,350 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,700 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,950 | CurrentTaxYearMinus2YearsAmt |
| Total | $13,000 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $797 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $94,336 | CurrentTaxYearMinus1YearAmt |
| Total | $95,133 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $27,089,142 | TotalSupportAmt |
| Public Support CY170 | 0.84920 | PublicSupportCY170Pct |
| Public Support PY170 | 0.83180 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,840,295 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$513,678 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,326,617 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,308,437 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $531,858 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,840,295 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,320,023 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$11,586 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,308,437 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,320,884 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$861 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,320,023 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,322,831 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$1,947 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,320,884 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,780 | OtherCostOrOtherBasisAmt |
| Book Value | $4,780 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,145 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,069 | DepreciationAmt |
| Book Value | $76 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $138,402 | OtherCostOrOtherBasisAmt |
| Depreciation | $113,929 | DepreciationAmt |
| Book Value | $24,473 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $29,329 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $5,193,353 |
| ANNUITY PAYABLE | $205,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,398,353 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $6,731,805 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$134,543 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $215,894 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $1,066,513 | OtherRevenueAmt |
| Revenue Not Reported | $1,147,864 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,583,941 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $37,201 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $37,201 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $5,621,142 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $6,056,736 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $215,894 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $908,079 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,123,973 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,932,763 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $37,201 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $37,201 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,969,964 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE FOUNDATION IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ADDITION, THE FOUNDATION HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A "PRIVATE FOUNDATION" WITHIN THE MEANING OF SECTION 509(A) OF THE IRC. THE FOUNDATION HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2020 THAT WOULD REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. AT JUNE 30, 2020, INFORMATIONAL TAX RETURNS FOR MOUNTAIN STATES FOUNDATION, WELLMONT FOUNDATION, AND LAUGHLIN HEALTHCARE FOUNDATION FOR FISCAL YEARS 2017 THROUGH 2018 ARE ELIGIBLE FOR EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE INFORMATIONAL TAX RETURN FOR THE FOUNDATION FOR FISCAL YEAR 2019 IS ALSO ELIGIBLE FOR EXAMINATION. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES NETTED WITH REVENUES 548,240. NET ASSETS TRANSFERRED FROM AFFILIATE 518,273. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES NETTED WITH REVENUES 548,240. UNREALIZED LOSS RECORDED AS AN EXPENSE FOR AUDIT 359,839. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENTS | Event1Nm |
| Gross Receipts Event1 | $683,854 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $612,288 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $71,566 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $60,922 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $35,169 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $59,326 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $131,925 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $50,760 | OtherDirectExpensesEvent1Amt |
| Event2 | NIGHT OF HOPE AND MIRACLES | Event2Nm |
| Gross Receipts Event2 | $212,070 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $169,350 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $42,720 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $19,151 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $36,693 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $3,500 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $13,908 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 8 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $212,259 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $183,312 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $28,947 | GrossRevenueOtherEventsAmt |
| Non Cash Prizes Other Events | $13,472 | NonCashPrizesOtherEventsAmt |
| Rent Fclty Costs Other Events | $4,691 | RentFcltyCostsOtherEventsAmt |
| Food And Beverage Other Events | $11,377 | FoodAndBeverageOtherEventsAmt |
| Entertainment Other Events | $15,925 | EntertainmentOtherEventsAmt |
| Oth Direct Expnss Other Events | $91,421 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $1,108,183 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $964,950 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $143,233 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $74,394 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $59,011 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $107,396 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $151,350 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $156,089 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $548,240 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$405,007 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| UNITED WAY BRISTOL TNVA | |||||||
| 315 8TH ST | BRISTOL | TN | 37620 | 620476656 | 501(C)(3) | $22,502 | LITERACY INITIATIVES |
| UNITED WAY GREENE CO | |||||||
| 115 ACADEMY ST | GREENEVILLE | TN | 37743 | 626015767 | 501(C)(3) | $12,922 | LITERACY INITIATIVES |
| UNITED WAY ELIZABETHTONCARTER CO | |||||||
| 527 E ELK AVE | ELIZABETHTON | TN | 37643 | 621104204 | 501(C)(3) | $18,213 | LITERACY INITIATIVES |
| UNITED WAY GREATER KINGSPORT | |||||||
| 301 LOUIS STREET SUITE 201 | KINGSPORT | TN | 37660 | 620481461 | 501(C)(3) | $40,781 | LITERACY INITIATIVES |
| UNITED WAY SOUTHWEST VA | |||||||
| PO BOX 644 | ABINGDON | VA | 24212 | 540718860 | 501(C)(3) | $37,225 | LITERACY INITIATIVES |
| UNITED WAY OF EAST TN HIGHLANDS | |||||||
| PO BOX 4039 | JOHNSON CITY | TN | 37602 | 626001105 | 501(C)(3) | $30,908 | LITERACY INITIATIVES |
| PROJECT FIT AMERICA | |||||||
| PO BOX 308 | BOYES HOT SPRINGS | CA | 95416 | 363730823 | 501(C)(3) | $15,390 | FITNESS PROGRAM |
| MISSION DENTAL VIRGINIA INC | |||||||
| 15325 LEE HWY | BRISTOL | VA | 242027401 | 833820038 | 501(C)(3) | $41,000 | NET PROCEEDS JMH EVENTS |
| THE NISWONGER FOUNDATION | |||||||
| PO BOX 1508 | GREENEVILLE | TN | 37744 | 621871605 | 501(C)(3) | $6,500 | BCTG SCHOLARSHIPS |
| LIFETIME WELLNESS CENTER | |||||||
| 200 MEDTECH PARKWAY SUITE 200 | JOHNSON CITY | TN | 37604 | 320185801 | $13,111 | STEPPING OUT HEALTHY CAMP 2019, AFTER-SCHOOL HEARTS AND MIND PROGRAM | |
| MOUNTAIN EMPIRE COMMUNITY COLLEGE | |||||||
| 3441 MOUNTAIN EMPIRE ROAD | BIG STONE GAP | VA | 24219 | 541268294 | 115 | $6,500 | MECC NURSING PROGRAM AND MECC LPN CLASS |
| BALLAD HEALTH | |||||||
| 1019 W OAKLAND AVE STE 1 | JOHNSON CITY | TN | 37604 | 611771290 | 501(C)(3) | $2,712,078 | $1,832,284 FOR CAPITAL NEEDS AND $879.794 FOR MISCELLANEOUS OTHER PROJECTS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 11 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| SCHOLARSHIPS | 21 | $47,000 |
| EMPLOYEE ASSSISTANCE | 113 | $147,047 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. VARIOUS PROCEDURES ARE IN PLACE DEPENDING ON GRANT TYPE, INCLUDING REQUIREMENTS TO SUBMIT APPLICATIONS FOR REVIEW AND APPROVAL. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LYNN KRUTAK | ||||||||||||||
| TRUSTEE/ BH EVP & CFO | $0 | $618,283 | $0 | $304,398 | $0 | $6,777 | $0 | $77,960 | $0 | $18,585 | $0 | $1,026,003 | $0 | $0 |
| ANTHONY KECK | ||||||||||||||
| TRUSTEE | $0 | $436,718 | $0 | $228,079 | $0 | $6,777 | $0 | $59,684 | $0 | $19,775 | $0 | $751,033 | $0 | $0 |
| TODD NORRIS | ||||||||||||||
| TRUSTEE | $0 | $324,839 | $0 | $143,113 | $0 | $2,590 | $0 | $54,320 | $0 | $19,735 | $0 | $544,597 | $0 | $0 |
| TODD DOUGAN | ||||||||||||||
| FORMER OFFICER | $0 | $14,379 | $0 | $0 | $0 | $333,707 | $0 | $0 | $0 | $0 | $0 | $348,086 | $0 | $0 |
| BARTON HOVE | ||||||||||||||
| FORMER OFFICER | $0 | $0 | $0 | $12,563 | $0 | $967,590 | $0 | $0 | $0 | $0 | $0 | $980,153 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | DURING FISCAL YEAR ENDED JUNE 30, 2020, BALLAD HEALTH PROVIDED A COUNTRY CLUB MEMBERSHIP TO BARTON HOVE, A FORMER OFFICER OF THE BALLAD HEALTH FOUNDATION. THESE AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. | ExplanationTxt |
Schedule M IRS990ScheduleM
Works Of Art WorksOfArtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $6,031 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | MISCELLANEOUS ITEMS | 1 | $34,596 | ESTIMATED VALUE |
| Yes (X) | CHARITY AUCTION ITEMS | 54 | $11,417 | ESTIMATED VALUE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE BUSINESS AND AFFAIRS OF BALLAD HEALTH FOUNDATION ARE GOVERNED EXCLUSIVELY BY THE BOARD OF TRUSTEES. THE FOUNDATION'S BOARD OF TRUSTEES IS DESIGNATED BY BALLAD HEALTH, THE SOLE MEMBER OF THIS CORPORATION. IN ADDITION TO SUCH RIGHTS OF APPROVAL AND CONSENT AS MAY BE RESERVED TO THE SOLE MEMBER OF THE FOUNDATION PURSUANT TO APPLICABLE LAW, TRANSACTIONS OF THE FOLLOWING MATTERS BY THE FOUNDATION SHALL REQUIRE THE PRIOR APPROVAL OF BALLAD HEALTH: (A) IMPLEMENTATION OF FOUNDATION'S ANNUAL BUDGET, (B) INCURRING ANY LOAN OR OTHER INDEBTEDNESS FOR BORROWED MONEY, (C) ACQUISITION OF ANY EQUIPMENT OR PERSONAL PROPERTY FOR A PURCHASE PRICE IN EXCESS OF $50,000 OR THE ACQUISITION OF ANY REAL ESTATE, REGARDLESS OF PURCHASE PRICE, (D) THE UNDERTAKING OF CERTAIN CONTRACTUAL COMMITMENTS, (E) ENTERING INTO ANY PLAN OR MERGER OR CONSOLIDATION, (F) ACQUISITION OF SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER LEGAL ENTITY, AND (G) INSTITUTION OF ANY LITIGATION BY OR ON BEHALF OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | BALLAD HEALTH IS BALLAD HEALTH FOUNDATION'S SOLE MEMBER. THE BOARD OF DIRECTORS OF BALLAD HEALTH IS RESPONSIBLE FOR APPOINTING THE DIRECTORS OF THE FOUNDATION'S BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS SUBJECT TO APPROVAL OF MEMBERS SEE FORM 990, PART VI, SECTION A, LINE 6 FOR EXPLANATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE BALLAD HEALTH FOUNDATION PRESIDENT REVIEWED THE BALLAD HEALTH FOUNDATION FORM 990 WITH ITS BOARD OF TRUSTEES PRIOR TO FILING. THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE FOUNDATION IS PART OF BALLAD HEALTH WHICH HAS A CONFLICT OF INTEREST POLICY FOR ALL MEMBERS OF THE BOARD OF DIRECTORS, THE EXECUTIVE CHAIR/PRESIDENT, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND VICE PRESIDENTS, AND APPLIES TO ALL BALLAD HEALTH ORGANIZATIONS. ALL PERSONS COVERED BY THIS POLICY ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS. SHOULD A CONFLICT ARISE, IT IS THE RESPONSIBILITY OF THE CONFLICTED INDIVIDUAL TO UPDATE HIS OR HER DISCLOSURE IMMEDIATELY. ALL MEETINGS OF THE BOARD OR BOARD COMMITTEES HAVE A STANDING AGENDA ITEM FIRST ON THE AGENDA TITLED "CONFLICTS OF INTEREST." IF A MEMBER OF THE BOARD OR BOARD COMMITTEE HAS A CONFLICT OF INTEREST INVOLVING ANY ISSUE ON THE BOARD AGENDA, HE OR SHE MUST DECLARE THE CONFLICT OF INTEREST DURING THE PERIOD ALLOTTED FOR DISCLOSURE. IF ANY ISSUE ARISES DURING A MEETING IN WHICH THE BOARD MEMBER HAS A CONFLICT OF INTEREST, HE OR SHE MUST IMMEDIATELY DECLARE THE CONFLICT. WHILE EACH MEMBER OF THE BOARD OR BOARD COMMITTEE IS RESPONSIBLE FOR DISCLOSING CONFLICTS OF INTEREST, IT IS ALSO THE RESPONSIBILITY OF ANY BOARD MEMBER AWARE OF A CONFLICT WHICH HAS NOT BEEN DISCLOSED TO ENSURE THE BOARD IS MADE AWARE. THE PRESIDING OFFICER OF A BOARD OR BOARD COMMITTEE MEETING MAY ASK A CONFLICTED MEMBER TO EXCUSE THEMSELVES FROM THE MEETING DURING THE DISCUSSION RELATED TO THE ISSUE WITH WHICH THE CONFLICT OF INTEREST APPLIES. UNDER NO CIRCUMSTANCE SHALL A MEMBER VOTE ON A MATTER THAT GIVES RISE TO A POTENTIAL CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | ON AN ANNUAL BASIS, BALLAD HEALTH'S HUMAN RESOURCES (H/R) DEPARTMENT EVALUATES COMPENSATION FOR ALL EXECUTIVES AT A POSITION LEVEL OF ASSISTANT VICE PRESIDENT AND ABOVE. H/R'S EVALUATION IS BASED ON MARKET DATA OBTAINED FROM INDEPENDENT THIRD-PARTY CONSULTANTS FOR POSITIONS WITH SIMILAR RESPONSIBILITIES AT SIMILARLY SITUATED ORGANIZATIONS. BASED ON THIS COMPARABLE DATA, BALLAD HEALTH'S PRESIDENT & CEO EVALUATES THE DATA AND SUBMITS HIS RECOMMENDATIONS TO BALLAD HEALTH'S BOARD OF DIRECTORS FOR THEIR FINAL REVIEW AND APPROVAL. IN ADDITION, BALLAD HEALTH OFFERS AN INCENTIVE PLAN TO EXECUTIVES BASED ON TARGETED ACHIEVEMENT METRICS SET IN ADVANCE OF THE PAY YEAR. ESTABLISHED METRICS INCLUDE: QUALITY AND ACCESS MEASURES, EVIDENCE-BASED CARE SCORES, AND VALUE BASED PURCHASING, ETC. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO THE APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. |
| FORM 990, PART XI, LINE 9: | TRANSFER FROM AFFILIATE 518,273. LONESOME PINE HOSPITAL FUND -346,607. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (18 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MOUNTAIN STATES HEALTH ALLIANCE | |||||||||||
| 303 MED TECH PARKWAY SUITE 220 | JOHNSON CITY | TN | 37604 | 620476282 | HOSPITAL SYSTEM | TN | 501(C)(3) | LINE 3 | BALLAD HEALTH | 0 | |
| MSHA AUXILIARY | |||||||||||
| 400 N STATE OF FRANKLIN ROAD | JOHNSON CITY | TN | 37604 | 581418345 | SUPPORTING ORGANIZATION | TN | 501(C)(3) | LINE 12A, I | MOUNTAIN STATES HEALTH ALLIANCE | 0 | |
| SMYTH COUNTY COMMUNITY HOSPITAL | |||||||||||
| 245 MEDICAL PARK DRIVE | MARION | VA | 24354 | 540794913 | HOSPITAL | VA | 501(C)(3) | LINE 3 | MOUNTAIN STATES HEALTH ALLIANCE | 0 | |
| NORTON COMMUNITY HOSPITAL | |||||||||||
| 100 15TH STREET NW | NORTON | VA | 24273 | 540566029 | HOSPITAL | VA | 501(C)(3) | LINE 3 | MOUNTAIN STATES HEALTH ALLIANCE | 0 | |
| DICKENSON COMMUNITY HOSPITAL | |||||||||||
| 312 HOSPITAL DRIVE | CLINTWOOD | VA | 24228 | 770599553 | HOSPITAL | VA | 501(C)(3) | LINE 3 | NORTON COMMUNITY HOSPITAL | 0 | |
| JOHNSTON MEMORIAL HOSPITAL | |||||||||||
| 16000 JOHNSTON MEMORIAL DRIVE | ABINGDON | VA | 24211 | 540544705 | HOSPITAL | VA | 501(C)(3) | LINE 3 | 0 | N/A | |
| ABINGDON PHYSICIAN PARTNERS | |||||||||||
| 16000 JOHNSTON MEMORIAL DRIVE | ABINGDON | VA | 24211 | 205485346 | MEDICAL SERVICES | VA | 501(C)(3) | LINE 12A, I | JOHNSTON MEMORIAL HOSPITAL INC | 0 | |
| BALLAD HEALTH | |||||||||||
| 303 MED TECH PARKWAY SUITE 220 | JOHNSON CITY | TN | 37604 | 611771290 | SUPPORTING ORGANIZATION | TN | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| EAST TN HEALTHCARE HOLDINGS INC | |||||||||||
| 203 GRAY COMMONS CIRCLE | GRAY | TN | 37615 | 815475903 | OPIOID TREATMENT | TN | 501(C)(3) | LINE 3 | MOUNTAIN STATES HEALTH ALLIANCE | 0 | |
| WELLMONT HEALTH SYSTEM | |||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621636465 | HOSPITAL SYSTEM | TN | 501(C)(3) | LINE 3 | BALLAD HEALTH | 0 | |
| WELLMONT HAWKINS CO MEMORIAL HOSP | |||||||||||
| 851 LOCUST STREET | ROGERSVILLE | TN | 37857 | 621816368 | HOSPITAL | TN | 501(C)(3) | LINE 3 | WELLMONT HEALTH SYSTEM | 0 | |
| TAKOMA REGIONAL HOSPITAL INC DBA GREENEVILLE COMMUNITY HOSPITAL | |||||||||||
| 1420 TUSCULUM BOULEVARD | GREENEVILLE | TN | 37745 | 510603966 | HOSPITAL | TN | 501(C)(3) | LINE 3 | WELLMONT HEALTH SYSTEM | 0 | |
| WELLMONT CARDIOLOGY SERVICES | |||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 263557623 | MEDICAL SERVICES | TN | 501(C)(3) | LINE 10 | WELLMONT HEALTH SYSTEM | 0 | |
| WELLMONT MEDICAL ASSOCIATES | |||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 270898372 | MEDICAL SERVICES | TN | 501(C)(3) | LINE 7 | WELLMONT HEALTH SYSTEM | 0 | |
| WELLMONT MADISON HOUSE | |||||||||||
| 2000 GREENWAY STREET | KINGSPORT | TN | 37660 | 621308216 | ASSISTED LIVING | TN | 501(C)(3) | LINE 10 | WELLMONT HEALTH SYSTEM | 0 | |
| WELLMONT WEXFORD HOUSE | |||||||||||
| 2421 N JOHN B DENNIS HWY | KINGSPORT | TN | 37660 | 581859039 | NURSING HOME | TN | 501(C)(3) | LINE 10 | WELLMONT HEALTH SYSTEM | 0 | |
| WELLMONT IMAGING SERVICES INC | |||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 861103148 | HEALTHCARE | TN | 501(C)(3) | LINE 12A, I | WELLMONT HEALTH SYSTEM | 0 | |
| WELLMONT SLEEP SERVICES | |||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 273777167 | MEDICAL SERVICES | TN | 501(C)(3) | LINE 3 | WELLMONT HEALTH SYSTEM | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| SAPLING GROVE AMBULATORY SURGERY CENTER | |||||||
| 220 MEDICAL PARK BOULEVARD | BRISTOL | TN | 37620 | 204450153 | MEDICAL SERVICES | TN | N/A |
| HOLSTON VALLEY AMBULATORY SURGERY CENTER | |||||||
| 103 WEST STONE DRIVE | KINGSPORT | TN | 37660 | 621816864 | MEDICAL SERVICES | TN | N/A |
| GREENEVILLE PHYSICIAN SERVICES LLC | |||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 455070419 | MEDICAL SERVICES | TN | N/A |
| EMMAUS COMMUNITY HEALTHCARE PLLC | |||||||
| 6070 HWY 11E | PINEY FLATS | TN | 37686 | 200577483 | MEDICAL SERVICES | TN | N/A |
| MEDICAL SPECIALISTS OF JC LLC | |||||||
| 2528 WESLEY STREET SUITE 2 | JOHNSON CITY | TN | 37601 | 272199037 | MEDICAL SERVICES | TN | N/A |
| EAST TN AMBULATORY SURGERY CENTER | |||||||
| 701 MED TECH PARKWAY SUITE 100 | JOHNSON CITY | TN | 37604 | 621787537 | MEDICAL SERVICES | TN | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BLUE RIDGE MEDICAL MANAGEMENT CORP | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621490616 | MEDICAL SERVICES | TN | N/A | C | 0 |
| MEDISERVE MEDICAL EQUIPMENT | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621212286 | DURABLE MEDICAL EQUIPMENT CO. | TN | N/A | C | 0 |
| MOUNTAIN STATES PROPERTIES | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621845895 | PROPERTY MANAGEMENT | TN | N/A | C | 0 |
| MOUNTAIN STATES PHYSICIAN GROUP | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621700412 | MEDICAL SERVICES | TN | N/A | C | 0 |
| COMMUNITY HOME CARE INC | |||||||||
| 1490 PARK AVENUE NW SUITE B | NORTON | VA | 24273 | 541453810 | DURABLE MEDICAL EQUIPMENT CO. | VA | N/A | C | 0 |
| WILSON PHARMACY INC | |||||||||
| PO BOX 5289 | JOHNSON CITY | TN | 37604 | 620329587 | PHARMACY | TN | N/A | C | 0 |
| CRESTPOINT HEALTH INSURANCE COMPANY | |||||||||
| 509 MED TECH PARKWAY SUITE 100 | JOHNSON CITY | TN | 37604 | 620381170 | INSURANCE | TN | N/A | C | 0 |
| WELLMONT INC | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621320035 | MEDICAL SERVICES | TN | N/A | C | 0 |
| WELLMONT COLLECTIONS INC | |||||||||
| 2004 AMERICAN WAY SUITE 101 | KINGSPORT | TN | 37660 | 621325938 | BUSINESS SERVICES | TN | N/A | C | 0 |
| MEDICAL MALL PHARMACY INC | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621565006 | MEDICAL SERVICES | TN | N/A | C | 0 |
| WELLMONT PHYSICIAN SERVICES | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621567353 | MEDICAL SERVICES | TN | N/A | C | 0 |
| WPS PROVIDERS INC | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 205564642 | MEDICAL SERVICES | TN | N/A | C | 0 |
| WELLMONT HEALTH SERVICES INC | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621254373 | MEDICAL SERVICES | TN | N/A | C | 0 |
| NOLICHUCKEY MANAGEMENT SVCS INC | |||||||||
| 1420 TUSCULUM BOULEVARD | GREENEVILLE | TN | 37745 | 621776681 | MEDICAL SERVICES | TN | N/A | C | 0 |
| BALLAD VENTURES LLC | |||||||||
| 400 N STATE OF FRANKLIN RD | JOHNSON CITY | TN | 37604 | 844214681 | INVESTMENTS | TN | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |