2019-03-11T08:49:39-05:00 2017-09-30 990 2017-07-01 800592504 APPALACHIAN EMERGENCY PHYSICIANS APPA 4233023374 303 MED TECH PARKWAY SUITE 220 JOHNSON CITY TN 37604 JOSH PUHR MD PRESIDENT 4233023374 2019-03-11 151.102.241.104 2019-03-11 08:49:39 CD P 87E77A894FBEAE8A07458463D987FBB2F40DF0C9 39095CF110B0C8EE9B5E629A9826572B753F4624 2017 2019-02-21 02:37:17Z X X JOSH PUHR MD 303 MED TECH PARKWAY SUITE 220 JOHNSON CITY TN 37604 590236 false X N/A X 2010 VA TO PROVIDE EMERGENCY PHYSICIANS SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. X 9 3 0 0 0 23506110 590236 0 0 23506110 590236 0 0 796623 7750 0 0 22709495 836037 23506118 843787 -8 -253551 875572 0 911613 0 -36041 0 X TO PROVIDE EMERGENCY PHYSICIANS SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. false true 163472 590236 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) 163472 true false false false false false false false false false false false false false false false false false false false false false false false false false false false false true false false false false false false false false false false true false false true false false false true 91 0 true 0 false false false false false false false false false false X 9 3 false false false false false false false true true false false true true true true true true false false false VA X LYNN KRUTAK 4233023374 303 MED TECH PARKWAY SUITE 300 JOHNSON CITY TN 37604 MARVIN EICHORN MSHA EVPCOO DIRECTOR 1.00 54.00 X 0 749129 42742 MORRRIS SELIGMAN MD MSHA EVPCMO DIRECTOR 0.50 54.50 X 0 670741 60897 CLAY RUNNELS MD MSHA VP DIRECTOR 1.00 44.00 X 0 435873 35287 SHANE HILTON SVP MARKET OPERATIONS DIRECTOR 1.00 44.00 X 0 396092 58587 JOSH PUHR MD PRESIDENT 56.00 X X 254182 0 0 MELISSA POWELL MD DIRECTOR 0.80 40.00 X 0 247200 0 TODD JONES SECRETARY 0.60 X X 0 0 0 STEVE GOODSON CHAIR 3.00 X X 0 0 0 BILL MILLER DIRECTOR 0.30 X 0 0 0 MATT MOODY DO FORMER DIREC 27.00 X 140918 0 0 395100 2499035 197513 2 true true false MOUNTAIN STATES ER PHYSICIANS LLP PO BOX 677979 DALLAS TX 752677979 MGMT. SERVICES 1877599 SWVA EMERGENCY PHYSICIANS LLP PO BOX 677979 DALLAS TX 752677979 MGMT. SERVICES 539882 SYMMETRIC REVENUE SOLUTIONS PO BOX 677979 DALLAS TX 752677979 BILLING/CODING 384528 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SVCS. 253839 LIPSCOMB LAURA MD 543 CHEROKEE MOUNTAIN ROAD JONESBOROUGH TN 37659 PHYSICIAN SVCS. 189900 36 NET PATIENT REVENUE 621110 590236 590236 590236 590236 590236 X 7750 7750 8567 8567 147067 147067 30060 30060 GOODWILL IMPAIRMENT 650000 650000 MEALS 255 255 PRE-EMPLOYMENT PHYSICALS 63 63 LICENSES & PERMITS 25 25 843787 163472 680315 0 10549 215023 650000 875572 0 832050 79563 911613 0 X -36041 -36041 0 875572 0 -253551 289592 X false false false X 30084214 28762811 29638857 23506110 590236 112582228 30084214 28762811 29638857 23506110 590236 112582228 7997059 6796967 5534073 6316933 5092 26650124 7997059 6796967 5534073 6316933 5092 26650124 85932104 30084214 28762811 29638857 23506110 590236 112582228 0.76330 0.77060 0.00000 0.00000 X false true false false false false false false false MARVIN EICHORN MSHA EVPCOO DIRECTOR 576562 128590 43977 18900 23842 791871 MORRRIS SELIGMAN MD MSHA EVPCMO DIRECTOR 515569 115743 39429 43438 17459 731638 CLAY RUNNELS MD MSHA VP DIRECTOR 358675 69101 8097 12731 22556 471160 SHANE HILTON SVP MARKET OPERATIONS DIRECTOR 328389 63529 4174 35389 23198 454679 JOSH PUHR MD PRESIDENT 253104 1078 254182 MELISSA POWELL MD DIRECTOR 210000 26685 10515 247200 MATT MOODY DO FORMER DIRECTOR 119918 21000 140918 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. CASH 2018-06-30 -805415 BOOK VALUE 620476282 MOUNTAIN STATES HEALTH ALLIANCE 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 501(C)(3) false false false false true true true false 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 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 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 NA N/A false false MEDICAL SPECIALISTS OF JC LLC 2528 WESLEY STREET SUITE 2 JOHNSON CITY TN 37601 272199037 MED. SERV. TN NA false false EAST TN AMBULATORY SURGERY CNTR 701 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 621787537 MED. SERV. TN NA false false GREENEVILLE PHYSICIAN SERVICES LLC 1905 AMERICAN WAY KINGSPORT TN 37660 455070419 MED. SERV. TN NA false false 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 false false false false false false false false false false false false true false false true false true false