APPALACHIAN EMERGENCY PHYSICIANS: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- APPALACHIAN EMERGENCY PHYSICIANS (EIN 80-0592504)
- Tax period
- 2017-07-01 to 2017-09-30
- Filed
- 2019-03-11
- IRS object ID
- 201900709349300210
- Schema version
- 2017v2.3
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-03-11T08:49:39-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 800592504 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | APPALACHIAN EMERGENCY PHYSICIANS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | APPA | BusinessNameControlTxt |
| Phone | 4233023374 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 MED TECH PARKWAY SUITE 220 | AddressLine1Txt |
| City | JOHNSON CITY | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37604 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOSH PUHR MD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 4233023374 | PhoneNum |
| Signature | 2019-03-11 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 151.102.241.104 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-03-11 | IPDt |
| IP Tm | 08:49:39 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 87E77A894FBEAE8A07458463D987FBB2F40DF0C9 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 39095CF110B0C8EE9B5E629A9826572B753F4624 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | JOSH PUHR MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 MED TECH PARKWAY SUITE 220 | AddressLine1Txt |
| City | JOHNSON CITY | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37604 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $590,236 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EMERGENCY PHYSICIANS SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,506,110 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $590,236 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $23,506,110 | PYTotalRevenueAmt |
| CY Total Revenue | $590,236 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $796,623 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,750 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,709,495 | PYOtherExpensesAmt |
| CY Other Expenses | $836,037 | CYOtherExpensesAmt |
| PY Total Expenses | $23,506,118 | PYTotalExpensesAmt |
| CY Total Expenses | $843,787 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$8 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$253,551 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $875,572 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $911,613 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$36,041 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE EMERGENCY PHYSICIANS SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | Yes (true) | SignificantChangeInd |
| Expense | $163,472 | ExpenseAmt |
| Revenue | $590,236 | RevenueAmt |
| Desc | APPALACHIAN EMERGENCY PHYSICIANS ("AEP") WAS A VIRGINIA NONSTOCK CORPORATION THAT WAS ORGANIZED AND OPERATED FOR CHARITABLE PURPOSES, WHICH INCLUDED THE PROVISION OF EMERGENCY PHYSICIAN SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. AEP HAD NO MEMBERS AND WAS GOVERNED BY ITS BOARD OF DIRECTORS. (CONTINUED ON SCHEDULE O) | Desc |
| Total Program Service Expenses | $163,472 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | Yes (true) | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 91 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LYNN KRUTAK | PersonNm |
| Phone | 4233023374 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 MED TECH PARKWAY SUITE 300 | AddressLine1Txt |
| City | JOHNSON CITY | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37604 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| MARVIN EICHORN MSHA EVPCOO | ||||||||
| DIRECTOR | 1.00 | 54.00 | Yes (X) | $0 | $749,129 | $42,742 | ||
| MORRRIS SELIGMAN MD MSHA EVPCMO | ||||||||
| DIRECTOR | 0.50 | 54.50 | Yes (X) | $0 | $670,741 | $60,897 | ||
| CLAY RUNNELS MD MSHA VP | ||||||||
| DIRECTOR | 1.00 | 44.00 | Yes (X) | $0 | $435,873 | $35,287 | ||
| SHANE HILTON SVP MARKET OPERATIONS | ||||||||
| DIRECTOR | 1.00 | 44.00 | Yes (X) | $0 | $396,092 | $58,587 | ||
| JOSH PUHR MD | ||||||||
| PRESIDENT | 56.00 | Yes (X) | $254,182 | $0 | $0 | Yes (X) | ||
| MELISSA POWELL MD | ||||||||
| DIRECTOR | 0.80 | 40.00 | Yes (X) | $0 | $247,200 | $0 | ||
| TODD JONES | ||||||||
| SECRETARY | 0.60 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| STEVE GOODSON | ||||||||
| CHAIR | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| BILL MILLER | ||||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | |||
| MATT MOODY DO | ||||||||
| FORMER DIREC | 27.00 | $140,918 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $395,100 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,499,035 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $197,513 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MOUNTAIN STATES ER PHYSICIANS LLP | |||||
| PO BOX 677979 | DALLAS | TX | 752677979 | MGMT. SERVICES | $1,877,599 |
| SWVA EMERGENCY PHYSICIANS LLP | |||||
| PO BOX 677979 | DALLAS | TX | 752677979 | MGMT. SERVICES | $539,882 |
| SYMMETRIC REVENUE SOLUTIONS | |||||
| PO BOX 677979 | DALLAS | TX | 752677979 | BILLING/CODING | $384,528 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | PHYSICIAN SVCS. | $253,839 |
| LIPSCOMB LAURA MD | |||||
| 543 CHEROKEE MOUNTAIN ROAD | JONESBOROUGH | TN | 37659 | PHYSICIAN SVCS. | $189,900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 36 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $590,236 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $590,236 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $590,236 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $590,236 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $590,236 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,750 | TotalAmt |
| Program Services | $7,750 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,567 | TotalAmt |
| Program Services | $8,567 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,067 | TotalAmt |
| Program Services | $147,067 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,060 | TotalAmt |
| Management And General | $30,060 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| GOODWILL IMPAIRMENT | $650,000 | $650,000 | |
| MEALS | $255 | $255 | |
| PRE-EMPLOYMENT PHYSICALS | $63 | $63 | |
| LICENSES & PERMITS | $25 | $25 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $843,787 | TotalAmt |
| Program Services | $163,472 | ProgramServicesAmt |
| Management And General | $680,315 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,549 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,023 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $650,000 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $875,572 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $832,050 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,563 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $911,613 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$36,041 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$36,041 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $875,572 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$253,551 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $289,592 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,084,214 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,762,811 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $29,638,857 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,506,110 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $590,236 | CurrentTaxYearAmt |
| Total | $112,582,228 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,084,214 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,762,811 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $29,638,857 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,506,110 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $590,236 | CurrentTaxYearAmt |
| Total | $112,582,228 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,997,059 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,796,967 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,534,073 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,316,933 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,092 | CurrentTaxYearAmt |
| Total | $26,650,124 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,997,059 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,796,967 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,534,073 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,316,933 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,092 | CurrentTaxYearAmt |
| Total | $26,650,124 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $85,932,104 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,084,214 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,762,811 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $29,638,857 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,506,110 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $590,236 | CurrentTaxYearAmt |
| Total | $112,582,228 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.76330 | PublicSupportCY509Pct |
| Public Support PY509 | 0.77060 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|
| MARVIN EICHORN MSHA EVPCOO | |||||||||
| DIRECTOR | $576,562 | $128,590 | $43,977 | $18,900 | $23,842 | $791,871 | |||
| MORRRIS SELIGMAN MD MSHA EVPCMO | |||||||||
| DIRECTOR | $515,569 | $115,743 | $39,429 | $43,438 | $17,459 | $731,638 | |||
| CLAY RUNNELS MD MSHA VP | |||||||||
| DIRECTOR | $358,675 | $69,101 | $8,097 | $12,731 | $22,556 | $471,160 | |||
| SHANE HILTON SVP MARKET OPERATIONS | |||||||||
| DIRECTOR | $328,389 | $63,529 | $4,174 | $35,389 | $23,198 | $454,679 | |||
| JOSH PUHR MD | |||||||||
| PRESIDENT | $253,104 | $1,078 | $254,182 | ||||||
| MELISSA POWELL MD | |||||||||
| DIRECTOR | $210,000 | $26,685 | $10,515 | $247,200 | |||||
| MATT MOODY DO | |||||||||
| FORMER DIRECTOR | $119,918 | $21,000 | $140,918 | ||||||
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 4 | MORRRIS SELIGMAN, M.D., MSHA EVP/CMO 0 27,747 0 SHANE HILTON, SVP MARKET OPERATIONS 0 17,507 0 |
| SCHEDULE J, PART III | PART I, LINE 4B: EXPLANATION: THE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART LL PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE ("MSHA"): MORRIS SELIGMAN, M.D. AND SHANE HILTON. THE 457(F) RETIREMENT PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE'. IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR 6 OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN). THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON- OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24 MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | CASH | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2018-06-30 | DistributionDt |
| Fair Market Value Of Asset | -$805,415 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | BOOK VALUE | MethodOfFMVDeterminationTxt |
| EIN | 620476282 | EIN |
| Person | MOUNTAIN STATES HEALTH ALLIANCE | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 N STATE OF FRANKLIN ROAD | AddressLine1Txt |
| City | JOHNSON CITY | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37604 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | false | DirectorOfSuccessorInd |
| Employee Of Successor | false | EmployeeOfSuccessorInd |
| Owner Of Successor | false | OwnerOfSuccessorInd |
| Receive Compensation | false | ReceiveCompensationInd |
| Assets Distributed | Yes (true) | AssetsDistributedInd |
| Required To Notify AG | Yes (true) | RequiredToNotifyAGInd |
| Liabilities Paid | Yes (true) | LiabilitiesPaidInd |
| Bonds Outstanding | false | BondsOutstandingInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 3 | AEP WAS ESTABLISHED TO FULFILL A NEED FOR EMERGENCY PROVIDER SERVICES AND STABILIZE COVERAGE OF EMERGENCY SERVICES AT MOUNTAIN STATES HEALTH ALLIANCE (MSHA) HOSPITALS IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE WHEN THE NEED FOR SUCH COVERAGE HAD BEEN UNABLE TO BE FULFILLED BY OTHER EMERGENCY MEDICINE PROVIDERS IN THE COMMUNITY. AS A REGIONAL PROVIDER OF EMERGENCY MEDICINE SERVICES, AEP ALSO EXPERIENCED SOME DIFFICULTY IN MAINTAINING A SUFFICIENT NUMBER OF PROVIDERS TO FULLY STAFF THE MSHA HOSPITALS WITHOUT UTILIZING LOCUM TENENS (TEMPORARY) PROVIDERS. MSHA DETERMINED THAT CONTRACTING WITH A NATIONAL PROVIDER OF EMERGENCY MEDICINE SERVICES WOULD LIKELY MAKE A LARGER POOL OF PROVIDERS AVAILABLE TO FULFILL THE COVERAGE NEEDS OF ITS FACILITIES AND TERMINATED ITS CONTRACTS WITH AEP. BECAUSE THE MSHA HOSPITALS WERE AEP'S ONLY CLIENTS, AEP DETERMINED THAT IT WAS IN THE BEST INTEREST OF THE ORGANIZATION TO CEASE OPERATIONS, WIND UP ITS BUSINESS AND TERMINATE ITS CORPORATE ENTITY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | WE WERE UNABLE TO REVIEW THE FINAL RETURN WITH BOARD MEMBERS PRIOR TO FILING WITH THE IRS. THE FINAL RETURN WAS PROVIDED TO BOARD MEMBERS WE COULD REACH. |
| FORM 990, PAGE 6, PART VI, LINE 12C | EXPLANATION: EVERY COVERED PERSON AS DEFINED BY THE CONFLICT OF INTEREST POLICY ADOPTED BY THE BOARD OF DIRECTORS WERE SUBJECT TO THAT POLICY. AS PART OF SAID POLICY, EVERY COVERED PERSON COMPLETED A CONFLICT OF INTEREST DISCLOSURE STATEMENT IN ACCORDANCE WITH THE REQUIREMENT OF THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | EXPLANATION: AEP HAD ENTERED INTO PROFESSIONAL SERVICE CONTRACTS WITH PHYSICIANS TO ASSIST AEP IN PROVIDING EMERGENCY SERVICE COVERAGE TO HOSPITALS. THESE AGREEMENTS INCLUDED FIXED RATES AND BONUSES BASED ON PRODUCTIVITY OR ACHIEVING QUALITY, PATIENT SATISFACTION SCORES OR OTHER QUALITY METRICS. THE METHODOLOGY OR AMOUNT OF THE BONUS WAS FIXED AND SET IN ADVANCE WITHIN EACH CONTRACT. BONUS FORMULAS ARE BASED UPON REACHED PREDETERMINED AND OBJECTIVELY VERIFIABLE PERFORMANCE METRICS. IN ADDITION TO ADDRESSING EXCESS BENEFIT, PRIVATE INUREMENT AND PRIVATE BENEFIT CONCERNS, AEP'S COMPENSATION ARRANGEMENTS WERE STRUCTURED IN A MANNER TO COMPLY WITH APPLICABLE FRAUD AND ABUSE LAWS THAT APPLY TO HEALTH CARE PROVIDERS. AEP HAD NEGOTIATED EACH OF ITS COMPENSATION ARRANGEMENTS AT ARM'S LENGTH. THE AGREEMENTS INCLUDE COMMERCIALLY REASONABLE TERMS AND CONDITIONS WITH A COMPENSATION ARRANGEMENT THAT IS CONSISTENT WITH FAIR MARKET VALUE FOR THE SERVICES RENDERED. THE TERMS AND CONDITIONS OF SUCH ARRANGEMENTS WERE ARE SET THROUGH GOOD FAITH NEGOTIATIONS AMONG THE RELEVANT PARTIES IN AN EFFORT TO BE CONSISTENT WITH SIMILAR ARRANGEMENTS FOR OTHER HEALTH CARE PROVIDERS PROVIDING SIMILAR SERVICES IN SIMILAR SPECIALTIES WITHIN SOUTHWESTERN VIRGINIA AND NORTHEASTERN TENNESSEE. NATIONAL PHYSICIAN COMPENSATION SURVEY DATA (E.G. MGMA PHYSICIAN COMPENSATION SURVEY) AND OTHER OBJECTIVE COMPARABLE DATA WAS USED AS THE BASIS FOR SETTING PHYSICIAN COMPENSATION ARRANGEMENTS. AEP ALSO UTILIZED THE SERVICES OF NATIONALLY-RECOGNIZED VALUATION FIRMS TO EVALUATE COMPENSATION ARRANGEMENTS TO ENSURE THAT THEY WERE CONSISTENT WITH FAIR MARKET VALUE AND WERE COMMERCIALLY REASONABLE. IN ADDITION TO COMPENSATION RECEIVED FOR PROVISION OF PHYSICIAN SERVICES, AEP'S PRESIDENT, JOSH PUHR, RECEIVES PAY AS AN INDEPENDENT CONTRACTOR FOR HIS DUTIES AND RESPONSIBILITIES AS PRESIDENT. |
| FORM 990, PAGE 6, PART VI, LINE 15B | FORMER DIRECTOR MOODY, RECEIVED COMPENSATION FROM AEP AS AN INDEPENDENT CONTRACTOR FOR PROVISION OF PHYSICIAN SERVICES TO HOSPITALS SERVICED BY AEP. HIS CONTRACT, SIMILAR TO PUHR'S, FOLLOWED THE SAME PROCESS USED FOR AEP PHYSICIAN CONTRACTS THAT IS DESCRIBED FOR PART VI, LINE 15A. |
| FORM 990, PAGE 6, PART VI, LINE 19 | EXPLANATION: THE CONFLICT OF INTEREST POLICY, IN ADDITION TO OTHER GOVERNING POLICIES, IS AVAILABLE UPON REQUEST. ALL CORPORATE POLICIES AND CORPORATE FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A - COMPENSATION OF DIRECTORS AND OFFICERS EXPLANATION: AEP DOES NOT COMPENSATE ITS OFFICERS AND DIRECTORS EXCEPT AS FOLLOWS: PRESIDENT/DIRECTOR PUHR AND FORMER DIRECTOR MOODY WERE PAID BY AEP FOR PHYSICIAN SERVICES THEY PROVIDE TO HOSPITALS. IN ADDITIO, PUHR RECEIVES ADDITIONAL COMPENSATION, AS APPROVED BY THE BOARD, FOR HIS SERVICES TO THE ORGANIZATION AS PRESIDENT. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES 47,582 0 0 COLLECTION SERVICE FEES 99,485 0 0 TOTAL 147,067 0 0 |
| FORM 990, PART XI, LINE 9 | TRANSFER CASH TO MSHA -805,415 TRANSFER ACCOUNTS PAYABLE TO MSHA 1,194,920 PRIOR PERIOD ADJUSTMENT -99,913 TOTAL 289,592 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| MOUNTAIN STATES HEALTH ALLIANCE | ||||||||||
| 303 MED TECH PARKWAY SUITE 220 | JOHNSON CITY | TN | 37604 | 620476282 | HOSP. SYS. | TN | 501C3 | 3 | NA | false |
| MOUNTAIN STATES FOUNDATION | ||||||||||
| 2335 KNOB CREEK ROAD SUITE 101 | JOHNSON CITY | TN | 37604 | 581418862 | FUNDRAISER | TN | 501C3 | 12A | MSHA | false |
| MSHA AUXILIARY | ||||||||||
| 400 N STATE OF FRANKLIN ROAD | JOHNSON CITY | TN | 37604 | 581418345 | SUPP. ORG. | TN | 501C3 | 12A | MSHA | false |
| SMYTH COUNTY COMMUNITY HOSPITAL | ||||||||||
| 245 MEDICAL PARK DRIVE | MARION | VA | 24354 | 540794913 | HOSPITAL | VA | 501C3 | 3 | NA | false |
| NORTON COMMUNITY HOSPITAL | ||||||||||
| 100 15TH STREET NW | NORTON | VA | 24273 | 540566029 | HOSPITAL | VA | 501C3 | 3 | NA | false |
| DICKENSON COMMUNITY HOSPITAL | ||||||||||
| 312 HOSPITAL DRIVE | CLINTWOOD | VA | 24228 | 770599553 | HOSPITAL | VA | 501C3 | 3 | NCH | false |
| JOHNSTON MEMORIAL HOSPITAL | ||||||||||
| 16000 JOHNSTON MEMORIAL DRIVE | ABINGDON | VA | 24211 | 540544705 | HOSPITAL | VA | 501C3 | 3 | NA | false |
| ABINGDON PHYSICIAN PARTNERS | ||||||||||
| 16000 JOHNSTON MEMORIAL DRIVE | ABINGDON | VA | 24211 | 205485346 | MED. SERV. | VA | 501C3 | 12A | JMH | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| INTEGRATED SOLUTIONS HEALTH NETWORK | |||||||||||
| 509 MED TECH PARKWAY SUITE 100 | JOHNSON CITY | TN | 37604 | 621711997 | INVESTMENT | TN | N/A | false | false | ||
| EMMAUS COMMUNITY HEALTHCARE LLC | |||||||||||
| 6070 HWY 11E | PINEY FLATS | TN | 37686 | 200577483 | MED. SERV. | TN | false | false | NA | N/A | |
| MEDICAL SPECIALISTS OF JC LLC | |||||||||||
| 2528 WESLEY STREET SUITE 2 | JOHNSON CITY | TN | 37601 | 272199037 | MED. SERV. | TN | false | false | NA | ||
| EAST TN AMBULATORY SURGERY CNTR | |||||||||||
| 701 MED TECH PARKWAY SUITE 100 | JOHNSON CITY | TN | 37604 | 621787537 | MED. SERV. | TN | false | false | NA | ||
| GREENEVILLE PHYSICIAN SERVICES LLC | |||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 455070419 | MED. SERV. | TN | false | false | NA | ||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BLUE RIDGE MEDICAL MANAGEMENT CORP | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621490616 | MED. SERV. | TN | MSHA | C CORP | false |
| MEDISERVE MEDICAL EQUIPMENT | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621212286 | DME | TN | BRMMC | C CORP | false |
| MOUNTAIN STATES PROPERTIES | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621845895 | PROP. MGMT | TN | BRMMC | C CORP | false |
| MOUNTAIN STATES PHYSICIAN GROUP | |||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621700412 | MED. SERV. | TN | BRMMC | C CORP | false |
| COMMUNITY HOME CARE INC | |||||||||
| 1490 PARK AVENUE NW SUITE B | NORTON | VA | 24273 | 541453810 | DME | VA | NCH | C CORP | false |
| WILSON PHARMACY INC | |||||||||
| PO BOX 5289 | JOHNSON CITY | TN | 37604 | 620329587 | PHARMACY | TN | BRMMC | C CORP | false |
| CRESTPOINT HEALTH INSURANCE COMPANY | |||||||||
| 509 MED TECH PARKWAY SUITE 100 | JOHNSON CITY | TN | 37604 | 620381170 | INSURANCE | TN | ISHN | C CORP | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |