WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC (EIN 62-1816368)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-09
- IRS object ID
- 201611309349301371
- Schema version
- 2014v6.0
- 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 | 2016-05-09T11:52:30-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 621816368 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLMONT HAWKINS COUNTY MEMORIAL | BusinessNameLine1Txt |
| Business Name Line2 | HOSPITAL INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WELL | BusinessNameControlTxt |
| Phone | 4232308200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1905 AMERICAN WAY | AddressLine1Txt |
| City | KINGSPORT | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37660 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD J DOUGAN | PersonNm |
| Person Title | SR. VP OF FINANCE | PersonTitleTxt |
| Phone | 4232308200 | PhoneNum |
| Signature | 2016-05-09 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TODD J DOUGAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1905 AMERICAN WAY | AddressLine1Txt |
| City | KINGSPORT | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37660 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $61,758,648 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WELLMONT.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Activity Or Mission | WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 255 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $28,800 | PYContributionsGrantsAmt |
| CY Contributions Grants | $21,590 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $48,855,566 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $61,128,864 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $941,099 | PYOtherRevenueAmt |
| CY Other Revenue | $598,292 | CYOtherRevenueAmt |
| PY Total Revenue | $49,825,465 | PYTotalRevenueAmt |
| CY Total Revenue | $61,748,746 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $394 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,390,916 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,537,196 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $36,724,326 | PYOtherExpensesAmt |
| CY Other Expenses | $38,709,382 | CYOtherExpensesAmt |
| PY Total Expenses | $45,115,636 | PYTotalExpensesAmt |
| CY Total Expenses | $47,246,578 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,709,829 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $14,502,168 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,070,143 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,048,922 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,171,228 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,225,268 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,898,915 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,823,654 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $36,495,951 | ExpenseAmt |
| Revenue | $61,552,280 | RevenueAmt |
| Desc | WELLMONT HEALTH SYSTEM PREPARES A CONSOLIDATED COMMUNITY BENEFIT REPORT, WHICH INCLUDES THE ACTIVITIES OF ALL ITS OPERATIONS AND AFFILIATES. IN CONTRAST, AN INTERNAL REVENUE SERVICE (IRS) FORM 990 IS FILED FOR EACH TAX EXEMPT CORPORATION (7 SEPARATE FORM 990S), AND THERE IS NO SUCH IRS FORM FOR THE TAXABLE CORPORATIONS. IN ADDITION, THE IRS INSTRUCTIONS TO FORM 990 HAVE SPECIFIC DEFINITIONS, METHODS AND WORKSHEETS TO CALCULATE THE COMMUNITY BENEFITS TO BE INCLUDED ON THE FORM 990. AS A RESULT, THERE ARE SIGNIFICANT DIFFERENCES BETWEEN THE COMMUNITY BENEFITS REPORTED IN THE CONSOLIDATED COMMUNITY BENEFIT REPORT AND THE VARIOUS FORM 990S. THERE ARE ALSO FUNDS AND SERVICES THAT ARE PROVIDED THAT DO NOT MEET THE SPECIFIC DEFINITIONS OF THE IRS INSTRUCTIONS, SUCH AS (CON'T ON SCHEDULE O) CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS THAT DO NOT MEET THE DEFINITION OF "RESTRICTED TO ONE OR MORE OF THE ACTIVITIES DESCRIBED IN THE TABLE IN PART I, LINE 7" OF SCHEDULE H-HOSPITALS. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. IS A PUBLIC TRUST. THIS HOSPITAL, LIKE THE OTHER WELLMONT HEALTH SYSTEM FACILITIES OF WHICH IT IS A MEMBER, WAS BORN OF ITS COMMUNITY'S COMMITMENT TO PROVIDE SUPERIOR HEALTH CARE FOR ITS CITIZENS. IT IS OUR MISSION TO DELIVER SUPERIOR HEALTH CARE WITH COMPASSION TO THE PEOPLE WE SERVE, AND IT IS OUR VISION TO DELIVER THE BEST HEALTH CARE ANYWHERE. CONSISTENT WITH THIS MISSION, WE HAVE WORKED TOWARD IMPROVING OUR COMMUNITY'S ACCESS TO QUALITY, AFFORDABLE HEALTH CARE, EDUCATING OUR REGION'S CAREGIVERS, IMPROVING THE HEALTH STATUS OF OUR COMMUNITIES AND CONTRIBUTING TO THE OVERALL QUALITY OF LIFE IN THE AREAS WE SERVE. OVERALL, WE RETURNED MORE THAN 5,375,558 IN BENEFITS TO OUR COMMUNITY IN FISCAL YEAR 2015, INCLUDING 5,337,825 OF UNREIMBURSED COSTS FOR INDIGENT AND MEDICAID PATIENTS AND 37,733 FOR OTHER COMMUNITY ACTIVITIES. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. IS A 50-BED FACILITY IN ROGERSVILLE, TENNESSEE. WE PROVIDE A WIDE VARIETY OF SERVICES, INCLUDING EMERGENCY CARE, PHYSICAL, STROKE AND OCCUPATIONAL THERAPIES, SURGERY, INTERMEDIATE MEDICAL CARE, OUTPATIENT SPECIALTY CLINICS, LABORATORY SERVICES, AUDIOLOGY SERVICES, CARDIOVASCULAR SERVICES, RESPIRATORY THERAPY, SLEEP EVALUATIONS AND TREATMENT, INFUSION, SPINE REHABILITATION SERVICES AND DIAGNOSTIC IMAGING. IN MARCH 2014, HAWKINS COUNTY MEMORIAL OPENED A SECOND INFUSION CENTER IN JOHNSON CITY, TENNESSEE. THE INFUSION CENTERS IN HAWKINS COUNTY AND JOHNSON CITY OFFER PATIENTS CONVENIENT ACCESS TO CANCER SERVICES IN A HEALING ENVIRONMENT. AMENITIES IN THE INFUSION CENTERS INCLUDE HEATED CHAIRS AND MASSAGES. IN FISCAL YEAR 2015, WE PROVIDED SERVICES TO 981 INPATIENTS, HAD 509 INPATIENT AND OUTPATIENT SURGICAL CASES, AND HAD 16,329 EMERGENCY ROOM VISITS. WE ARE MINDFUL OF OUR RESPONSIBILITIES AS ONE OF HAWKINS COUNTY'S LARGEST COMPANIES. HUNDREDS OF FAMILIES COUNT ON US FOR THEIR LIVELIHOODS. OUR AREA RELIES ON US AS A DRIVER OF ECONOMIC DEVELOPMENT. IT IS OUR DUTY AS A CORPORATE CITIZEN TO SUPPORT THOSE ENDEAVORS AND CAUSES THAT IMPROVE THE QUALITY OF LIFE IN OUR REGION. AND WE ALSO RECOGNIZE IT IS OUR RESPONSIBILITY TO CARE FOR THOSE IN NEED - REGARDLESS OF THEIR ABILITY TO PAY. IT IS OUR COMMITMENT - INDEED, IT IS IMPLICIT IN OUR MISSION - TO SUPPORT THE CAUSES AND DEVELOP THE INITIATIVES THAT WILL PROPEL OUR COMMUNITY TOWARD A BETTER, BRIGHTER, HEALTHIER AND MORE VIBRANT FUTURE. REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. TREATS ALL PATIENTS FOR MEDICALLY NECESSARY CONDITIONS. RECOGNIZING SOME PATIENTS CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, WE PROVIDED CARE FOR INDIGENT PATIENTS, WRITING OFF 5,168,559 OF CHARGES AND INCURRING COSTS OF 861,339. WE SUPPORT AND ENCOURAGE OUR EMPLOYEES TO GIVE THEIR TIME TO AREA NOT-FOR- PROFIT ORGANIZATIONS, WHICH INCLUDED THE AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY, THE ROGERSVILLE HERITAGE ASSOCIATION, CIVIC GROUPS SUCH AS KIWANIS AND ROTARY, VARIOUS UNITED WAY AGENCIES AND THE ROGERSVILLE AREA CHAMBER OF COMMERCE AND ITS PROGRAMS. MANY OF OUR EMPLOYEES ALSO SERVE IN COMMUNITY RESCUE SQUADS. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. WILL SUCCEED IN OUR MISSION BY CONTINUALLY REINVESTING IN OUR MOST PRECIOUS RESOURCE - OUR PEOPLE. TO THAT END, WE PROVIDED ON-THE-JOB TRAINING TO NURSING CANDIDATES. THIS PROGRAM UTILIZES NURSING STAFF THAT HAVE COMPLETED A DEGREE BUT NOT YET PASSED BOARD CERTIFICATION. THIS PROVIDES INVALUABLE EXPERIENCE FOR NEW NURSES, WHO ARE SUPERVISED BY BOARD-CERTIFIED NURSES. WE ALSO PROVIDED EDUCATIONAL OPPORTUNITIES TO STUDENTS IN OTHER MEDICAL DISCIPLINES, SUCH AS RADIOLOGY. FOREWARNED IS FOREARMED. THE BEST WAY TO KEEP OUR COMMUNITIES HEALTHY IS TO PROVIDE THEM WITH THE LATEST INFORMATION ABOUT THEIR HEALTH. WE STRIVE TO PROVIDE INFORMATION ABOUT EVERYTHING FROM DISEASE AND INJURY PREVENTION TO THE LATEST TREATMENTS AND TECHNOLOGIES AVAILABLE TO COPING WITH DISEASE AND ITS SYMPTOMS. OUR TOTAL COMMUNITY BENEFIT FOR COMMUNITY HEALTH IMPROVEMENT SERVICES HAD A DIRECT COST OF 4,531. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. PROVIDED IN-KIND SERVICES AT A DIRECT COST OF 32,301. IN-KIND SERVICES INCLUDED CONFERENCE ROOM SPACE DONATED TO NON-PROFIT COMMUNITY GROUPS SUCH AS ALCOHOLICS ANONYMOUS, HAWKINS COUNTY CHAMBER OF COMMERCE AND THE ROTARY CLUB. OTHER IN-KIND SERVICES PROVIDED WERE RESTOCKING SUPPLIES OF EMS VEHICLES. | Desc |
| Total Program Service Expenses | $36,495,951 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | 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 | Yes (true) | 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 | Yes (true) | 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 | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| 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 | false | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 255 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| 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 | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | 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 | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | Yes (true) | 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 | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD J DOUGAN | PersonNm |
| Phone | 4232308200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1905 AMERICAN WAY | AddressLine1Txt |
| City | KINGSPORT | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37660 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MARGARET DENARVAEZ TERMED 91614 | ||||||||
| PRESIDENT/WH | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $2,554,461 | $65,341 | |
| TRACEY P MOFFATT TERMED 10314 | ||||||||
| TREASURER/WH | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $575,375 | $21,418 | |
| ALICE POPE | ||||||||
| SEC/EVP & CF | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $479,861 | $27,467 | |
| BARTON A HOVE | ||||||||
| PRESIDENT/WH | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $394,913 | $16,374 | |
| GARY D MILLER | ||||||||
| TREAS/SR VP | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $346,188 | $16,104 | |
| FRED PELLE TRF 32315 TO HVMC | ||||||||
| PRES/CEO COM | 32.00 | 8.00 | Yes (X) | $66,411 | $267,406 | $21,490 | ||
| ROBERT MATTHEW TAVENNER TM 2615 | ||||||||
| CHIEF ADMIN | 10.00 | 30.00 | Yes (X) | $44,469 | $133,407 | $14,519 | ||
| SHERRI IVES TERMED 71114 | ||||||||
| VP OF PATIEN | 10.00 | 30.00 | Yes (X) | $37,483 | $112,450 | $7,616 | ||
| REBECCA BECK | ||||||||
| PRESIDENT-WH | 32.00 | 8.00 | Yes (X) | $0 | $100,856 | $15,746 | ||
| REGINA DAY | ||||||||
| FINANCE DIRE | 10.00 | 30.00 | Yes (X) | $24,205 | $72,615 | $5,108 | ||
| GEORGIA SHUCK | ||||||||
| PHARMACIST | 40.00 | $118,462 | $0 | $5,212 | Yes (X) | |||
| ALEXANDER GEORGE | ||||||||
| PHARMACIST | 40.00 | $105,699 | $0 | $8,769 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $396,729 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,037,532 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $225,164 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | 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 | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| SOLSTAS LAB PARTNERS | ||||||
| 1201 COLLEGEVILLE ROAD | COLLEGEVILLE | PA | 19426 | MEDICAL SERVICE | $791,684 | |
| MEDSTREAM ANESTHESIA | ||||||
| 82 PATTON AVENUE | ASHEVILLE | NC | 28801 | MEDICAL SERVICE | $317,100 | SUITE 510 |
| NEW MILLENIUM HEALTHCARE | ||||||
| 555 MT CARMEL ROAD | MOSHEIM | TN | 37818 | MRI SCANS | $277,750 | |
| SODEXO INC & AFFLILIATES | ||||||
| P O BOX 536922 | ATLANTA | GA | 30353 | DIETARY MGMT | $198,677 | |
| UT SURGICAL ASSOCIATES | ||||||
| 1437 WEST MORRIS BLVD | MORRISTOWN | TN | 37813 | MEDICAL SERVICE | $175,000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $21,590 | RelatedOrganizationsAmt |
| Total Contributions | $21,590 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT CARE REVENUE - NET | 621990 | $61,126,724 | $61,126,724 |
| PHYSICAL THERAPY REVENUE | 621990 | $2,140 | $2,140 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $61,128,864 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,507 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,902 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $15,605 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,605 | TotalRevenueColumnAmt |
| Exclusion | $15,605 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| MEANINGFUL USE FUNDS | 900099 | $421,970 | $421,970 | |
| MISCELLANEOUS REVENUE | 900099 | $98,331 | $98,331 | |
| CAFETERIA/ VENDING REVENUE | 900099 | $60,940 | $60,940 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,446 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,446 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $582,687 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,748,746 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $61,552,280 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $174,876 | ExclusionAmt |
| 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 | $193,016 | TotalAmt |
| Management And General | $193,016 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,767,606 | TotalAmt |
| Program Services | $6,686,733 | ProgramServicesAmt |
| Management And General | $80,873 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,054 | TotalAmt |
| Program Services | $178,014 | ProgramServicesAmt |
| Management And General | $1,040 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $897,774 | TotalAmt |
| Program Services | $872,531 | ProgramServicesAmt |
| Management And General | $25,243 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $499,746 | TotalAmt |
| Program Services | $485,233 | ProgramServicesAmt |
| Management And General | $14,513 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,567,313 | TotalAmt |
| Program Services | $2,291,886 | ProgramServicesAmt |
| Management And General | $10,275,427 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $919,202 | TotalAmt |
| Program Services | $865,169 | ProgramServicesAmt |
| Management And General | $54,033 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $897,464 | TotalAmt |
| Program Services | $897,464 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,770 | TotalAmt |
| Program Services | $25,970 | ProgramServicesAmt |
| Management And General | $6,800 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $294,280 | TotalAmt |
| Program Services | $294,280 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,192,917 | TotalAmt |
| Program Services | $1,133,271 | ProgramServicesAmt |
| Management And General | $59,646 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,554 | TotalAmt |
| Program Services | $150,554 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $20,927,094 | $20,927,094 | |
| PROVISION FOR BAD DEBTS | $1,659,659 | $1,659,659 | |
| MISCELLANEOUS EXPENSE | $68,129 | $28,093 | $40,036 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,246,578 | TotalAmt |
| Program Services | $36,495,951 | ProgramServicesAmt |
| Management And General | $10,750,627 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $306,848 | BOYAmt |
| EOY | $57,372 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,704,568 | BOYAmt |
| EOY | $18,709,560 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,028,469 | BOYAmt |
| EOY | $1,044,712 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,674 | BOYAmt |
| EOY | $48,015 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,218,616 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,029,353 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,920,584 | BOYAmt |
| EOY | $7,189,263 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,070,143 | BOYAmt |
| EOY | $27,048,922 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,171,228 | BOYAmt |
| EOY | $6,225,268 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,171,228 | BOYAmt |
| EOY | $6,225,268 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,898,915 | BOYAmt |
| EOY | $20,823,654 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,898,915 | BOYAmt |
| EOY | $20,823,654 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,070,143 | BOYAmt |
| EOY | $27,048,922 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $14,502,168 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$10,577,429 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,500 | OtherCostOrOtherBasisAmt |
| Book Value | $30,500 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,407,376 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,552,018 | DepreciationAmt |
| Book Value | $2,855,358 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,616,082 | OtherCostOrOtherBasisAmt |
| Depreciation | $688,955 | DepreciationAmt |
| Book Value | $2,927,127 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,716,107 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,398,515 | DepreciationAmt |
| Book Value | $1,317,592 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $448,551 | OtherCostOrOtherBasisAmt |
| Depreciation | $389,865 | DepreciationAmt |
| Book Value | $58,686 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,189,263 | TotalBookValueLandBuildingsAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $861,339 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $861,339 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01820 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,515,916 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,039,430 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,476,486 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09470 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,377,255 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,039,430 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,337,825 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11300 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 471 | ActivitiesOrProgramsCnt |
| Persons Served | 477 | PersonsServedCnt |
| Total Community Benefit Expns | $4,531 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,531 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 302 | ActivitiesOrProgramsCnt |
| Persons Served | 346 | PersonsServedCnt |
| Total Community Benefit Expns | $901 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $901 | NetCommunityBenefitExpnsAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 162 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $32,301 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $32,301 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 935 | ActivitiesOrProgramsCnt |
| Persons Served | 823 | PersonsServedCnt |
| Total Community Benefit Expns | $37,733 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $37,733 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 935 | ActivitiesOrProgramsCnt |
| Persons Served | 823 | PersonsServedCnt |
| Total Community Benefit Expns | $9,414,988 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,039,430 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,375,558 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11380 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $276,582 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $12,080,685 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,739,408 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $341,277 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLMONT HAWKINS CO MEM HOSPINC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 851 LOCUST STREET | AddressLine1Txt |
| City | ROGERSVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37857 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLMONT HAWKINS CO MEM HOSPINC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.WELLMONT.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.WELLMONT.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Explained Basis | false | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWWWELLMONTORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWWWELLMONTORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWWWELLMONTORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, WELLMONT HAWKINS CO MEM HOSP,INC - PART V, LINE 5 | INFORMATION FOR THE CHNA ASSESSMENT WAS GATHERED FROM A VARIETY OF SOURCES, INCLUDING: - INTERVIEWS WITH PATIENTS - INTERVIEWS WITH KEY COMMUNITY LEADERS AND STAKEHOLDERS, INCLUDING REPRESENTATIVE OF UNDERSERVED POPULATIONS AND AREAS WITH HEALTHCARE DISPARITIES - INTERVIEWS WITH LEADERS AND STAFF IN OTHER HEALTHCARE ORGANIZATIONS OR CIVIC ORGANIZATIONS WITH A SHARED MISSION TO POSITIVELY IMPACT THE HEALTH STATUS OF THE COMMUNITY - PHYSICIAN NEEDS ASSESSMENT - COMMUNITY HEALTH FACILITY ASSESSMENT - MENTAL HEALTH NEEDS ASSESSMENT - DIALYSIS AND DENTAL NEEDS ASSESSMENT - PUBLICLY AVAILABLE POPULATION AND DEMOGRAPHIC INFORMATION - PUBLICLY AVAILABLE POPULATION HEALTH INFORMATION THE INFORMATION WAS THEN COLLATED AND ASSESSED TO DETERMINE THE GREATEST UNMET HEALTH NEEDS FACING OUR REGION. STRATEGIES TO ADDRESS THESE NEEDS WERE THEN DEVELOPED, UTILIZING INTERNAL RESOURCES AND PARTNERSHIPS WITH OTHER HEALTHCARE ORGANIZATIONS AND PHYSICIANS. SEVERAL COMMUNITY LEADERS PARTICIPATED IN THE CHNA THROUGH PERSONAL INTERVIEWS, SURVEYS AND OTHER MEANS. THEIR FEEDBACK WAS INVALUABLE IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITIES WE SERVE AND DEVELOPING ACTIONS PLANS TO ENSURE THOSE NEEDS WERE MET. THE TIME, TALENT AND INSIGHT OF ELECTED REPRESENTATIVES AND LEADERS OF BUSINESSES, MUNICIPALITIES AND ORGANIZATIONS LISTED BELOW WERE GREATLY APPRECIATED. - ADVANCED HOME CARE - BELIEVE IN BRISTOL - BILL GATTON AUTOMOTIVE GROUP - BRISTOL COMPRESSORS INTERNATIONAL - BRISTOL TENNESEE CITY SCHOOLS - VIRGINIA STATE SENATOR BILL CARRICO - CHILTERN INTERNATIONAL - CITY OF BRISTOL, TN - CITY OF BRISTOL, VA - CITY OF KINGSPORT, TN - CITY OF NORTON, VA - CITY OF NORTON SCHOOL SYSTEM - CITY OF ROGERSVILLE, TN - CITY OF SNEEDVILLE, TN - DICKENSON COUNTY CHAMBER OF COMMERCE - DOMTAR - DR. GLENN E. VANCE, JR., DDS - ELECTRO-MECHANICAL CORPORATION - FIRST TENNESSEE BANK - FRIENDS IN NEED HEALTHCARE, INC. - FRONTIER HEALTH - US REPRESENTATIVE MORGAN GRIFFITH - HANCOCK MANOR NURSING HOME - HAWKINS COUNTY GAS UTILITY - HAWKINS AND HANCOCK COUNTY HEALTH DEPARTMENTS - HEALING HANDS HEALTH CENTER - THE HEALTH WAGON - HUNTER, SMITH & DAVIS, ATTORNEYS AT LAW - INDUSTRIAL DEVELOPMENT AUTHORITY OF DICKENSON COUNTY - KVAT FOOD STORES - KAVANAUGH CALL CENTER GROUP - VIRGINIA STATE DELEGATE TERRY KILGORE - KINGSPORT AREA CHAMBER OF COMMERCE - KINGSPORT OFFICE OF SMALL BUSINESS DEVELOPMENT & ENTREPRENEURSHIP - LANDMARK REALTY, INC. - LEE COUNTY, VA. - MEADOWVIEW CONFERENCE RESORT & CONVENTION CENTER - VIRGINIA STATE DELEGATE JAMES "WILL" MOREFIELD - MOUNTAIN EMPIRE OLDER CITIZENS, INC. - NASH AND POWERS INSURANCE SERVICES - NORTON INDUSTRIAL DEVELOPMENT AUTHORITY - OAK HILL CEMETERY - VIRGINIA STATE DELEGATE ISRAEL O'QUINN - PHARMACEUTICAL PRODUCT DEVELOPMENT - VIRGINIA STATE SENATOR PHILLIP PUCKETT - TENNESSEE LT. GOVERNOR RON RAMSEY - THE REGIONAL EYE CENTER - THE ROBINETTE COMPANY - RURAL HEALTH SERVICES CONSORTIUM - SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS, INC. - STRONGWELL CORPORATION - SULLIVAN COUNTY, TN - SULLIVAN COUNTY REGIONAL HEALTH DEPARTMENT - SULLIVAN COUNTY SCHOOL SYSTEM - TELE-OPTICS, INC. - TOWN OF ABINGDON, VA - TOWN OF BIG STONE GAP, VA - TOWN OF PENNINGTON GAP, VA - TOWN OF JONESVILLE, VA - TRISUMMIT BANK - UNIVERSAL FIBERS - UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE - VIRGINIA CITY HYBRID ENERGY CENTER - VIRGINIA DEPARTMENT OF HEALTH - CUMBERLAND PLATEAU HEALTH DISTRICT - VIRGINIA DEPARTMENT OF HEALTH - LENOWISCO DISTRICT - WCYB-TV - WELLMONT MEDICAL ASSOCIATES - WISE COUNTY CHAMBER OF COMMERCE - WISE COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY - WISE COUNTY, VA - YWCA BRISTOL |
| FACILITY 1, WELLMONT HAWKINS CO MEM HOSP,INC - PART V, LINE 6A | - BRISTOL REGIONAL MEDICAL CENTER - HOLSTON VALLEY MEDICAL CENTER - LONESOME PINE HOSPITAL - HANCOCK COUNTY HOSPITAL - MOUNTAIN VIEW REGIONAL MEDICAL CENTER |
| FACILITY 1, WELLMONT HAWKINS CO MEM HOSP,INC - PART V, LINE 11 | KEY FINDINGS NOTED DURING THE CHNA WERE LACK OF SUFFICIENT PSYCHIATRIC HEALTH AND DENTAL CARE. THESE FINDINGS FALL OUTSIDE THE CORE BUSINESS AND MISSON OF WELLMONT HEALTH SYSTEM. TO HELP MEET THESE NEEDS, WELLMONT HEALTH SYSTEM WILL CONTINUE TO STRENGTHEN OUR PARTNERSHIPS AND CONTINUUM OF CARE OPPORTUNITIES WITH AREA HEALTH DEPARTMENTS, FEDERALLY QUALIFIED HEALTH CENTERS AND FRONTIER HEALTH, THE REGION'S LEADING PROVIDER OF BEHAVIORAL HEALTH SERVICES. |
| FACILITY 1, WELLMONT HAWKINS CO MEM HOSP,INC - PART V, LINE 22D | WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. FOLLOWS TENNESSEE STATUTE WHICH IS 175% OF AVERAGE COST FOR ITS HOSPITALS. |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | BAD DEBT EXPENSE OF 1,659,659 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A, BUT WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN. PART I, LINE 7 - FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST FOR WORKSHEET 2, THE RATIO OF PATIENT CARE COST-TO-CHARGES WAS USED TO DETERMINE THE COSTS FOR AMOUNTS IN LINES 7A AND 7B, COLUMN C. THE COSTS INCLUDED IN THE COST-TO-CHARGE RATIO INCLUDED THE COSTS FROM ALL PATIENT SEGMENTS. ACTUAL COSTS FROM THE GENERAL LEDGER WERE USED FOR AMOUNTS IN LINES 7F AND 7I, COLUMN C. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | THE COST REPORTED ON LINE 2 IS CALCULATED AS THE BAD DEBT EXPENSE FROM THE GENERAL LEDGER TIMES THE RATIO OF COST TO CHARGES AS CALCULATED ON WORKSHEET 2. THERE ARE NO AMOUNTS REPORTED ON LINE 3. DISCOUNTS ON PATIENT ACCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE. PAYMENTS ON PATIENT ACCOUNTS THAT HAVE PREVIOUSLY BEEN WRITTEN OFF AS BAD DEBT ARE USED TO REDUCE BAD DEBT EXPENSE. A THIRD PARTY VENDOR IS USED TO HELP DETERMINE THE AMOUNT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE POLICY. TEXT OF NOTE TO FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: NET PATIENT SERVICE REVENUE IS REPORTED ON THE ACCRUAL BASIS IN THE PERIOD IN WHICH SERVICES ARE PROVIDED AT THE ESTIMATED NET REALIZABLE AMOUNTS EXPECTED TO BE COLLECTED. NET PATIENT SERVICE REVENUE INCLUDES AMOUNTS ESTIMATED BY MANAGEMENT TO BE REIMBURSABLE BY PATIENTS AND VARIOUS THIRD-PARTY PAYORS UNDER PROVISIONS OF REIMBURSEMENT FORMULAS IN EFFECT, INCLUDING RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS. ESTIMATED RETROACTIVE ADJUSTMENTS ARE ACCRUED IN THE PERIOD RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL AND OTHER SETTLEMENTS ARE DETERMINED. WELLMONT PROVIDES CARE TO PATIENTS WHO MEET CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE WELLMONT DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE. PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF BOTH AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. THE CONTRACTUAL ALLOWANCE REPRESENTS THE DIFFERENCE BETWEEN ESTABLISHED BILLING RATES AND ESTIMATED REIMBURSEMENT FROM MEDICARE, TENNCARE, MEDICAID, AND OTHER THIRD-PARTY PAYMENT PROGRAMS. WELLMONT'S POLICY DOES NOT REQUIRE COLLATERAL OR OTHER SECURITY FOR PATIENT ACCOUNTS RECEIVABLE. WELLMONT ROUTINELY OBTAINS ASSIGNMENT OF, OR IS OTHERWISE ENTITLED TO RECEIVE, PATIENT BENEFITS PAYABLE UNDER HEALTH INSURANCE PROGRAMS, PLANS, OR POLICIES. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | LINE NUMBER 1, PART VI, LINE 2 WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. EXAMINES THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES BY CONDUCTING PHYSICIAN NEEDS ASSESSMENTS FOR ITS HOSPITALS. AS PART OF THIS EFFORT, WELLMONT REVIEWS ITS SERVICE AREA AND DEMOGRAPHICS, EXAMINES PHYSICIAN DEMOGRAPHICS AND CONDUCTS FOCUS GROUPS. IT MAKES A DETERMINATION OF PHYSICIAN NEED WHILE CALCULATING ITS PHYSICIAN SURPLUSES AND DEFICITS AND HIGHLIGHTING ITS RECRUITMENT PRIORITIES AND PLANS. WELLMONT ANNUALLY DETERMINES ITS PRIMARY, SECONDARY AND TERTIARY MARKETS THROUGH THE USE OF COUNTY-BY-COUNTY ANALYSIS TO IDENTIFY THE FOLLOWING CUSTOMER GROUPS: PATIENTS AND POTENTIAL PATIENTS, COMMUNITY/EMPLOYER GROUPS AND LOCAL PHYSICIANS. THE HEALTH SYSTEM ALSO RELIES ON THE EXPERTISE OF CONSULTANTS TO PERIODICALLY REVIEW ALL FACETS OF OPERATIONS AND MAKE RECOMMENDATIONS FOR CHANGES. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | LINE NUMBER 1, PART VI, LINE 3 WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. PROACTIVELY INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY BY POSTING THE POLICY ON ITS WEBSITE AS WELL AS POSTING THE POLICY AT POINTS OF REGISTRATION IN THE HOSPITAL. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. USES PROGRAM ELIGIBILITY SPECIALISTS WHO CONTACT THE UNINSURED PATIENT POPULATION. THESE SPECIALISTS DISCUSS THE VARIOUS GOVERNMENTAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE TO PATIENTS IN ORDER TO DETERMINE IF THE PATIENT WOULD QUALIFY FOR ANY OF THESE PROGRAMS. THE SPECIALISTS WILL WORK WITH THE PATIENTS TO COMPLETE ANY NECESSARY APPLICATIONS AND WILL HELP THEM THROUGH THE QUALIFICATION PROCESS. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | LINE NUMBER 1, PART VI, LINE 4 WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC.'S PRIMARY SERVICE AREA IS HAWKINS AND HANCOCK COUNTIES OF TENNESSEE. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. IS THE ONLY HOSPITAL IN HAWKINS COUNTY AND ITS SISTER FACILITY, HANCOCK COUNTY HOSPITAL IS THE ONLY HOSPITAL IN HANCOCK COUNTY. THE DEMOGRAPHICS OF THESE COUNTIES ARE AS FOLLOWS: HAWKINS - POPULATION 56,735; MEDIAN HOUSEHOLD INCOME 37,357. HANCOCK - POPULATION 6,657; MEDIAN HOUSEHOLD INCOME 23,892. APPROXIMATELY 22.6% OF OUR PATIENTS ARE MEDICAID RECIPIENTS AND 8.3% ARE UNINSURED, AND HAWKINS COUNTY IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | LINE NUMBER 1, PART VI, LINE 5 THE MEDICAL STAFF OF WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC., LIKE ALL WELLMONT HEALTH SYSTEM HOSPITALS, IS OPEN TO ALL QUALIFIED PHYSICIANS, EXCEPT FOR SOME OF ITS HOSPITAL BASED DEPARTMENTS, SUCH AS ANESTHESIOLOGY, EMERGENCY MEDICINE, PATHOLOGY, AND RADIOLOGY. ANY SURPLUS OF REVENUES AND GAINS IN EXCESS OF EXPENSES AND LOSSES FOR WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC., LIKE ALL WELLMONT HEALTH SYSTEM HOSPITALS, IS USED TO FURTHER THE WELLMONT HEALTH SYSTEM MISSION AND VISION, WHICH ARE "WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION- AND "WE WILL DELIVER THE BEST HEALTH CARE ANYWHERE". THIS WOULD INCLUDE IMPROVEMENTS IN FACILITIES AS WELL AS OPERATIONS FOR PATIENT CARE. |
| PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM | LINE NUMBER 1, PART VI, LINE 6 WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL IS AN AFFILIATE OF WELLMONT HEALTH SYSTEM. WELLMONT HEALTH SYSTEM ("WELLMONT") IS A TENNESSEE NON-PROFIT CORPORATION BASED IN KINGSPORT, TENNESSEE AND A PREMIER PROVIDER OF HEALTHCARE SERVICES IN NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. WELLMONT WAS FORMED IN JULY 1996 WITH THE MERGER OF BRISTOL MEMORIAL HOSPITAL IN BRISTOL, TENNESSEE AND HOLSTON VALLEY MEDICAL CENTER IN KINGSPORT, TENNESSEE. WELLMONT HAS GROWN TO INCLUDE FIVE ADDITIONAL HOSPITALS, AN INTEGRATED PHYSICIAN NETWORK AND SEVERAL AMBULATORY SITES. WELLMONT HOSPITALS OFFER A BROAD SCOPE OF SERVICES RANGING FROM COMMUNITY-BASED ACUTE CARE TO HIGHLY SPECIALIZED TERTIARY SERVICES INCLUDING TWO TRAUMA CENTERS, COMPREHENSIVE HEART CARE AND CANCER CARE CENTERS. WELLMONT OWNS AND OPERATES AN INTEGRATED HEALTH CARE DELIVERY SYSTEM PROVIDING INPATIENT, OUTPATIENT AND OTHER HEALTH CARE SERVICES AT MULTIPLE LOCATIONS IN NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. CURRENTLY, WELLMONT OWNS AND OPERATES FIVE ACUTE CARE HOSPITAL FACILITIES AND ONE CRITICAL ACCESS HOSPITAL WITH A TOTAL OF 1,091 LICENSED BEDS AND, THROUGH A JOINT VENTURE, PARTNERS TO OPERATE AN ADDITIONAL ACUTE CARE HOSPITAL FACILITY WITH 100 LICENSED BEDS. THE ACUTE CARE FACILITIES OWNED BY WELLMONT INCLUDE HOLSTON VALLEY MEDICAL CENTER, BRISTOL REGIONAL MEDICAL CENTER, MOUNTAIN VIEW REGIONAL MEDICAL CENTER IN NORTON, VIRGINIA, LONESOME PINE HOSPITAL IN BIG STONE GAP, VIRGINIA, WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL IN ROGERSVILLE, TENNESSEE AND THE CRITICAL ACCESS HOSPITAL, HANCOCK COUNTY HOSPITAL IN SNEEDVILLE, TENNESSEE. WELLMONT ALSO, DIRECTLY OR INDIRECTLY, CONTROLS, OWNS OR IS AFFILIATED WITH VARIOUS NONPROFIT AND FOR-PROFIT CORPORATIONS AND OTHER ORGANIZATIONS THAT CURRENTLY PROVIDE HEALTH CARE AND HEALTH CARE-RELATED SERVICES THROUGHOUT THE SERVICE AREA. IN ADDITION TO THE HOSPITAL CAMPUSES AND AMBULATORY CARE CENTERS DESCRIBED ABOVE, WELLMONT ALSO OPERATES MEDICAL CLINICS, AMBULATORY SURGERY CENTERS, COMPREHENSIVE CANCER CARE CENTERS, AND IMAGING FACILITIES. |
| PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT | TENNESSEE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Severance Payment | Yes (true) | 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 | Yes (true) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 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 | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARGARET DENARVAEZ TERMED 91614 | ||||||||||||
| PRESIDENT/WHS CEO | $544,420 | $265,980 | $1,744,061 | $58,432 | $6,909 | $2,619,802 | ||||||
| TRACEY P MOFFATT TERMED 10314 | ||||||||||||
| TREASURER/WHS COO | $334,601 | $230,000 | $10,774 | $18,100 | $3,318 | $596,793 | ||||||
| ALICE POPE | ||||||||||||
| SEC/EVP & CFO | $383,559 | $87,632 | $8,670 | $15,897 | $11,570 | $507,328 | ||||||
| BARTON A HOVE | ||||||||||||
| PRESIDENT/WHS CEO | $315,138 | $50,000 | $29,775 | $6,754 | $9,620 | $411,287 | ||||||
| GARY D MILLER | ||||||||||||
| TREAS/SR VP GEN COUN | $287,236 | $57,296 | $1,656 | $12,920 | $3,184 | $362,292 | ||||||
| FRED PELLE TRF 32315 TO HVMC | ||||||||||||
| PRES/CEO COMM DIV | $233,418 | $26,860 | $7,128 | $9,547 | $7,770 | $284,723 | $55,173 | $8,953 | $2,285 | $2,323 | $1,850 | $70,584 |
| ROBERT MATTHEW TAVENNER TM 2615 | ||||||||||||
| CHIEF ADMIN OFFICER | $119,426 | $12,034 | $1,947 | $3,674 | $7,215 | $144,296 | $39,809 | $4,011 | $649 | $1,225 | $2,405 | $48,099 |
| SHERRI IVES TERMED 71114 | ||||||||||||
| VP OF PATIENT CARE | $94,489 | $11,864 | $6,097 | $5,712 | $118,162 | $31,496 | $3,955 | $2,032 | $1,904 | $39,387 | ||
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 1A | CHARTER TRAVEL AND TRAVEL FOR COMPANIONS WELLMONT HEALTH SYSTEM PROVIDED AIRPLANE TRAVEL FOR ITS EXECUTIVES THROUGH A PARTIAL OWNERSHIP OF AN AIRPLANE. IN SEPTEMBER 2014, WELLMONT HEALTH SYSTEM SOLD ITS OWNERSHIP INTEREST IN THE AIRPLANE. ON OCCASION, TRAVEL WAS PROVIDED FOR EXECUTIVES AND THEIR COMPANIONS FOR PERSONAL USE. WELLMONT HEALTH SYSTEM FOLLOWED IRS GUIDELINES AND INCLUDED THE APPROPRIATE AMOUNTS IN THEIR TAXABLE COMPENSATION. HEALTH OR SOCIAL CLUB DUES DURING THE FISCAL YEAR ENDED JUNE 30, 2015, WELLMONT HEALTH SYSTEM PROVIDED COUNTRY CLUB MEMBERSHIPS TO MARGARET DENARVAEZ, BARTON A. HOVE, AND TRACEY P. MOFFATT. THESE AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. |
| SCHEDULE J, PAGE 1, PART I, LINE 3 | WELLMONT HEALTH SYSTEM USES ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE COMPENSATION OF ALL PERSONS LISTED ON FORM 990, PART VII, SECTION A AS MORE FULLY DESCRIBED IN SCHEDULE O. |
| SCHEDULE J, PAGE 1, PART I, LINE 4 | MARGARET DENARVAEZ (TERMED 9/16/14) 1,745,538 0 0 TRACEY P. MOFFATT (TERMED 10/3/14) 275,000 0 0 |
| SCHEDULE J, PAGE 1, PART I, LINE 6B | INCENTIVE COMPENSATION IS BASED ON MEETING BUDGETED OPERATING MARGIN GOALS. |
| SCHEDULE J, PART III | PART I, LINE 4A - SEVERANCE PAYMENT MARGARET DENARVAEZ, FORMER CEO OF WELLMONT HEALTH SYSTEM, ENTERED INTO A CONFIDENTIAL SEPARATION AGREEMENT AND GENERAL RELEASE (THE "AGREEMENT") AS OF SEPTEMBER 16, 2014. THE TERMS OF THIS AGREEMENT INCLUDED THE PAYMENT OF 1,745,538 FOR ITEMS WHICH ARE CONSIDERED "SEVERANCE", INCLUDING PAYMENT IN LIEU OF A NOTICE PERIOD, EARLY TERMINATION CLAUSE, RELEASE OF CLAIMS, AND REIMBURSEMENT OF HEALTH INSURANCE PREMIUMS FOLLOWING TERMINATION. THERE WERE OTHER PAYMENTS FOR EARNED INCENTIVE COMPENSATION, ACCRUED VACATION, AND REIMBURSEMENT OF RELOCATION COSTS THAT ARE NOT CONSIDERED "SEVERANCE". TRACEY P. MOFFATT, FORMER COO OF WELLMONT HEALTH SYSTEM, ENTERED INTO A CONFIDENTIAL SEPARATION AGREEMENT AND MUTUAL RELEASE (THE "AGREEMENT") AS OF OCTOBER 3, 2014. THE TERMS OF THIS AGREEMENT INCLUDED THE PAYMENT OF 275,000 FOR ITEMS WHICH ARE CONSIDERED "SEVERANCE", INCLUDING PAYMENT FOR RELEASE OF CLAIMS. PART I, LINE 4B: WELLMONT HEALTH SYSTEM HAS AN EXECUTIVE RETIREMENT PROGRAM THAT INCLUDED ALICE POPE FOR THE FISCAL YEAR ENDING JUNE 30, 2015. THIS PROGRAM HAS A TARGET BENEFIT OF 60% OF THE HIGHEST THREE YEAR AVERAGE SALARY (LESS EMPLOYER PROVIDER BENEFITS) AND THE EXECUTIVE MUST HAVE TWENTY YEARS OF SERVICE TO RECEIVE THE FULL BENEFIT. THE EXECUTIVE MAY RETIRE EARLY AT AGE 60 AND RECEIVE REDUCED BENEFITS. THERE WERE NO PAYMENTS MADE UNDER THIS PROGRAM FOR THE FISCAL YEAR ENDING JUNE 30, 2015. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS THAT DO NOT MEET THE DEFINITION OF "RESTRICTED TO ONE OR MORE OF THE ACTIVITIES DESCRIBED IN THE TABLE IN PART I, LINE 7" OF SCHEDULE H-HOSPITALS. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. IS A PUBLIC TRUST. THIS HOSPITAL, LIKE THE OTHER WELLMONT HEALTH SYSTEM FACILITIES OF WHICH IT IS A MEMBER, WAS BORN OF ITS COMMUNITY'S COMMITMENT TO PROVIDE SUPERIOR HEALTH CARE FOR ITS CITIZENS. IT IS OUR MISSION TO DELIVER SUPERIOR HEALTH CARE WITH COMPASSION TO THE PEOPLE WE SERVE, AND IT IS OUR VISION TO DELIVER THE BEST HEALTH CARE ANYWHERE. CONSISTENT WITH THIS MISSION, WE HAVE WORKED TOWARD IMPROVING OUR COMMUNITY'S ACCESS TO QUALITY, AFFORDABLE HEALTH CARE, EDUCATING OUR REGION'S CAREGIVERS, IMPROVING THE HEALTH STATUS OF OUR COMMUNITIES AND CONTRIBUTING TO THE OVERALL QUALITY OF LIFE IN THE AREAS WE SERVE. OVERALL, WE RETURNED MORE THAN 5,375,558 IN BENEFITS TO OUR COMMUNITY IN FISCAL YEAR 2015, INCLUDING 5,337,825 OF UNREIMBURSED COSTS FOR INDIGENT AND MEDICAID PATIENTS AND 37,733 FOR OTHER COMMUNITY ACTIVITIES. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. IS A 50-BED FACILITY IN ROGERSVILLE, TENNESSEE. WE PROVIDE A WIDE VARIETY OF SERVICES, INCLUDING EMERGENCY CARE, PHYSICAL, STROKE AND OCCUPATIONAL THERAPIES, SURGERY, INTERMEDIATE MEDICAL CARE, OUTPATIENT SPECIALTY CLINICS, LABORATORY SERVICES, AUDIOLOGY SERVICES, CARDIOVASCULAR SERVICES, RESPIRATORY THERAPY, SLEEP EVALUATIONS AND TREATMENT, INFUSION, SPINE REHABILITATION SERVICES AND DIAGNOSTIC IMAGING. IN MARCH 2014, HAWKINS COUNTY MEMORIAL OPENED A SECOND INFUSION CENTER IN JOHNSON CITY, TENNESSEE. THE INFUSION CENTERS IN HAWKINS COUNTY AND JOHNSON CITY OFFER PATIENTS CONVENIENT ACCESS TO CANCER SERVICES IN A HEALING ENVIRONMENT. AMENITIES IN THE INFUSION CENTERS INCLUDE HEATED CHAIRS AND MASSAGES. IN FISCAL YEAR 2015, WE PROVIDED SERVICES TO 981 INPATIENTS, HAD 509 INPATIENT AND OUTPATIENT SURGICAL CASES, AND HAD 16,329 EMERGENCY ROOM VISITS. WE ARE MINDFUL OF OUR RESPONSIBILITIES AS ONE OF HAWKINS COUNTY'S LARGEST COMPANIES. HUNDREDS OF FAMILIES COUNT ON US FOR THEIR LIVELIHOODS. OUR AREA RELIES ON US AS A DRIVER OF ECONOMIC DEVELOPMENT. IT IS OUR DUTY AS A CORPORATE CITIZEN TO SUPPORT THOSE ENDEAVORS AND CAUSES THAT IMPROVE THE QUALITY OF LIFE IN OUR REGION. AND WE ALSO RECOGNIZE IT IS OUR RESPONSIBILITY TO CARE FOR THOSE IN NEED - REGARDLESS OF THEIR ABILITY TO PAY. IT IS OUR COMMITMENT - INDEED, IT IS IMPLICIT IN OUR MISSION - TO SUPPORT THE CAUSES AND DEVELOP THE INITIATIVES THAT WILL PROPEL OUR COMMUNITY TOWARD A BETTER, BRIGHTER, HEALTHIER AND MORE VIBRANT FUTURE. REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. TREATS ALL PATIENTS FOR MEDICALLY NECESSARY CONDITIONS. RECOGNIZING SOME PATIENTS CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, WE PROVIDED CARE FOR INDIGENT PATIENTS, WRITING OFF 5,168,559 OF CHARGES AND INCURRING COSTS OF 861,339. WE SUPPORT AND ENCOURAGE OUR EMPLOYEES TO GIVE THEIR TIME TO AREA NOT-FOR- PROFIT ORGANIZATIONS, WHICH INCLUDED THE AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY, THE ROGERSVILLE HERITAGE ASSOCIATION, CIVIC GROUPS SUCH AS KIWANIS AND ROTARY, VARIOUS UNITED WAY AGENCIES AND THE ROGERSVILLE AREA CHAMBER OF COMMERCE AND ITS PROGRAMS. MANY OF OUR EMPLOYEES ALSO SERVE IN COMMUNITY RESCUE SQUADS. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. WILL SUCCEED IN OUR MISSION BY CONTINUALLY REINVESTING IN OUR MOST PRECIOUS RESOURCE - OUR PEOPLE. TO THAT END, WE PROVIDED ON-THE-JOB TRAINING TO NURSING CANDIDATES. THIS PROGRAM UTILIZES NURSING STAFF THAT HAVE COMPLETED A DEGREE BUT NOT YET PASSED BOARD CERTIFICATION. THIS PROVIDES INVALUABLE EXPERIENCE FOR NEW NURSES, WHO ARE SUPERVISED BY BOARD-CERTIFIED NURSES. WE ALSO PROVIDED EDUCATIONAL OPPORTUNITIES TO STUDENTS IN OTHER MEDICAL DISCIPLINES, SUCH AS RADIOLOGY. FOREWARNED IS FOREARMED. THE BEST WAY TO KEEP OUR COMMUNITIES HEALTHY IS TO PROVIDE THEM WITH THE LATEST INFORMATION ABOUT THEIR HEALTH. WE STRIVE TO PROVIDE INFORMATION ABOUT EVERYTHING FROM DISEASE AND INJURY PREVENTION TO THE LATEST TREATMENTS AND TECHNOLOGIES AVAILABLE TO COPING WITH DISEASE AND ITS SYMPTOMS. OUR TOTAL COMMUNITY BENEFIT FOR COMMUNITY HEALTH IMPROVEMENT SERVICES HAD A DIRECT COST OF 4,531. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. PROVIDED IN-KIND SERVICES AT A DIRECT COST OF 32,301. IN-KIND SERVICES INCLUDED CONFERENCE ROOM SPACE DONATED TO NON-PROFIT COMMUNITY GROUPS SUCH AS ALCOHOLICS ANONYMOUS, HAWKINS COUNTY CHAMBER OF COMMERCE AND THE ROTARY CLUB. OTHER IN-KIND SERVICES PROVIDED WERE RESTOCKING SUPPLIES OF EMS VEHICLES. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE BUSINESS AND AFFAIRS OF WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. (THE CORPORATION) SHALL BE GOVERNED EXCLUSIVELY BY THE BOARD OF DIRECTORS. THE CORPORATION'S BOARD OF DIRECTORS IS DESIGNATED BY WELLMONT HEALTH SYSTEM, THE SOLE MEMBER OF THE CORPORATION. IN ADDITION TO SUCH RIGHTS OF APPROVAL AND CONSENT AS MAY BE RESERVED TO THE SOLE MEMBER OF THE CORPORATION PURSUANT TO APPLICABLE LAW, TRANSACTIONS OF THE FOLLOWING MATTERS BY THE CORPORATION SHALL REQUIRE THE PRIOR APPROVAL OF WELLMONT HEALTH SYSTEM, THE SOLE MEMBER OF THE CORPORATION: A) IMPLEMENTATION OF CORPORATION'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 OF 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 CORPORATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | SEE FORM 990, PART VI, SECTION A, LINE 6 FOR EXPLANATION. |
| FORM 990, PAGE 6, PART VI, LINE 7B | SEE FORM 990, PART VI, SECTION A, LINE 6 FOR EXPLANATION. |
| FORM 990, PAGE 6, PART VI, LINE 9 | SHERRI IVES (TERMED 7/11/14) 1905 AMERICAN WAY KINGSPORT, TN 37660 TRACEY P. MOFFATT (TERMED 10/3/14) 1905 AMERICAN WAY KINGSPORT, TN 37660 MARGARET DENARVAEZ (TERMED 9/16/14) 1905 AMERICAN WAY KINGSPORT, TN 37660 |
| FORM 990, PAGE 6, PART VI, LINE 11B | WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC.'S FORM 990 IS REVIEWED BY THE SENIOR VICE PRESIDENT OF FINANCE, THE CORPORATE CONTROLLER, AND THE MANAGER OF ACCOUNTING FOR WELLMONT HEALTH SYSTEM, AND THE BOARD OF DIRECTORS OF WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. PRIOR TO FILING. ANY QUESTIONS OR COMMENTS ARISING FROM THE INITIAL REVIEW ARE ADDRESSED TO ENSURE THE RETURN IS COMPLETE AND ACCURATE. ANY CHANGES OR CORRECTIONS ARE IDENTIFIED, REVISED IN THE RETURN, AND REVIEWED BY THE INDIVIDUALS LISTED ABOVE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT. ANY POTENTIAL CONFLICTS ARE DISCUSSED WITH THE COMPLIANCE AND AUDIT SERVICES DEPARTMENT AS THEY ARISE. WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC.'S OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE GOVERNED BY WELLMONT HEALTH SYSTEM'S CONFLICT OF INTEREST POLICY. WELLMONT HEALTH SYSTEM ALSO HAS A POLICY ON BUSINESS PRACTICES THAT DISCUSSES CONFLICT OF INTEREST AND INFORMS THE WORKFORCE TO DISCLOSE ANY ISSUES TO THE COMPLIANCE AND AUDIT SERVICES DEPARTMENT, FOR RESOLUTION. WELLMONT HEALTH SYSTEM ALSO USES A HOTLINE THAT ALLOWS ANONYMOUS REPORTING OF POSSIBLE CONFLICT OF INTEREST SITUATIONS FOR INVESTIGATION BY THE COMPLIANCE AND AUDIT SERVICES DEPARTMENT. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE COMPENSATION OF BARTON A. HOVE, THE PRESIDENT AND CEO OF WELLMONT HEALTH SYSTEM, IS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM HUMAN RESOURCES COMMITTEE AND THE BOARD OF DIRECTORS. BARTON A. HOVE IS ALSO ON THE BOARD OF DIRECTORS OF WELLMONT FOUNDATION, INC. THE LAST COMPENSATION DELIBERATION AND REVIEW PROCESS FOR BARTON A. HOVE WAS COMPLETED AND APPROVED BY THE BOARD OF DIRECTORS OF WELLMONT HEALTH SYSTEM ON MARCH 20, 2015. THE COMPENSATION OF MARGARET D. DENARVAEZ, THE FORMER PRESIDENT AND CEO OF WELLMONT HEALTH SYSTEM THROUGH SEPTEMBER 16, 2014, IS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM HUMAN RESOURCES COMMITTEE AND THE BOARD OF DIRECTORS. MARGARET D. DENARVAEZ IS ALSO ON THE BOARD OF DIRECTORS OF WELLMONT FOUNDATION, INC. THE LAST COMPENSATION DELIBERATION AND REVIEW PROCESS FOR MARGARET D. DENARVAEZ WAS COMPLETED NOVEMBER 29, 2012, AND APPROVED BY THE BOARD OF DIRECTORS OF WELLMONT HEALTH SYSTEM ON DECEMBER 4, 2012. FRED PELLE IS THE PRESIDENT AND CEO OF WELLMONT COMMUNITY HOSPITAL DIVISION THAT INCLUDES WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. FRED PELLE'S COMPENSATION IS PAID BY WELLMONT HEALTH SYSTEM THROUGH INTERCOMPANY TRANSACTIONS. WELLMONT HEALTH SYSTEM USES ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE COMPENSATION OF FRED PELLE. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. THE LAST COMPENSATION DELIBERATION AND REVIEW PROCESS FOR MARGARET DENARVAEZ WAS COMPLETED NOVEMBER 29, 2012 AND APPROVED BY THE BOARD OF DIRECTORS OF WELLMONT HEALTH SYSTEM ON DECEMBER 4, 2012. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE COMPENSATION OF TRACEY P. MOFFATT, THE CHIEF OPERATIONS OFFICER OF WELLMONT HEALTH SYSTEM, IS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS. TRACEY P. MOFFATT IS ALSO THE TREASURER OF WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. THIS PROCESS IN COMPLETED ON AN ANNUAL BASIS. THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED THE SALARY AND MARKET COMPENSATION DATA FOR TRACEY P. MOFFATT ON NOVEMBER 29, 2012. |
| FORM 990, PAGE 6, PART VI, LINE 19 | WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. WELLMONT HEALTH SYSTEM'S AUDITED FINANCIAL STATEMENTS AND QUARTERLY UNAUDITED FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE. |
| FORM 990, PART IX, LINE 11G | FEES FOR SERVICES 2,291,886 13,523 0 SUPPORT SERVICES 0 9,198,996 0 TN COVERAGE FEES 0 1,062,908 0 |
| FORM 990, PART XI, LINE 9 | CAPITAL DISTRIBUTION 3,585,497 INTERCOMPANY TRANSACTIONS 6,991,930 ROUNDING 2 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| WELLMONT HEALTH SYSTEM | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621636465 | HEALTHCARE | TN | 501C3 | 3 | WHS | false |
| WELLMONT CARDIOLOGY SERVICES | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 263557623 | HEALTHCARE | TN | 501C3 | 3 | WHS | false |
| WELLMONT MEDICAL ASSOCIATES INC | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 270898372 | HEALTHCARE | TN | 501C3 | 7 | WHS | false |
| WELLMONT INTEGRATED NETWORK LLC | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37664 | 455443060 | HEALTHCARE | TN | 501C3 | 3 | WHS | false |
| WELLMONT SLEEP SERVICES | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 273777167 | HEALTHCARE | TN | 501C3 | 3 | WHS | false |
| WELLMONT FOUNDATION INC | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 581594191 | HEALTHCARE | TN | 501C3 | 7 | WHS | false |
| WELLMONT MADISON HOUSE | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621308216 | HEALTHCARE | TN | 501C3 | 9 | WHS | false |
| WELLMONT WEXFORD HOUSE | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 581589039 | HEALTHCARE | TN | 501C3 | 9 | WHS | false |
| WELLMONT IMAGING SERVICES INC | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 861103148 | HEALTHCARE | TN | 501C3 | 11A | WHS | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|
| HOLSTON VALLEY IMAGING CENTER | |||||||||
| 103 WEST STONE DRIVE | KINGSPORT | TN | 37660 | 202043285 | HEALTHCARE | TN | N/A | false | false |
| SAPLING GROVE AMBULATORY SURGERY | |||||||||
| 220 MEDICAL PARK BOULEVARD | BRISTOL | TN | 37620 | 204450153 | HEALTHCARE | TN | N/A | false | false |
| HOLSTON VALLEY AMBULATORY SURGERY | |||||||||
| 103 WEST STONE DRIVE | KINGSPORT | TN | 37660 | 621816864 | HEALTHCARE | TN | N/A | false | false |
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 | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|
| WELLMONT INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621320035 | PHYS SVCS | TN | N/A | false |
| MCOT INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621325938 | MED SVCS | TN | N/A | false |
| MEDICAL LAUNDRY OF TRI-CITIES INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621482226 | MED SVCS | TN | N/A | false |
| MEDICAL MALL PHARMACY INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621565006 | MED SVCS | TN | N/A | false |
| WELLMONT PHYSICIAN SERVICES INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621567353 | PHYS SVCS | TN | N/A | false |
| WPS PROVIDERS INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 205564642 | PHYS SVCS | TN | N/A | false |
| WELLMONT HEALTH SERVICES INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621254373 | HEALTHCARE | TN | N/A | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | 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 | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WELLMONT HEALTH SYSTEM | ||
| B | $3,585,497 | CAPITAL CONTRIBUTION |
| WELLMONT HEALTH SYSTEM | ||
| K | $257,705 | LEASE AGREEMENT |
| WELLMONT HEALTH SYSTEM | ||
| M | $90,464 | SERVICE AGREEMENTS |
| WELLMONT HEALTH SYSTEM | ||
| M | $85,544 | INVOICES |
| WELLMONT HEALTH SYSTEM | ||
| M | $9,198,996 | CORPORATE SUPPORT SERVICE |
| WELLMONT HEALTH SYSTEM | ||
| O | $348,498 | SALARY ALLOCATION |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R | FormAndLineReferenceDesc |
| Explanation | PART V, LINE 2: RELATED ORGANIZATION TRANSACTIONS WITH WELLMONT FOUNDATION, WELLMONT MADISON HOUSE AND WELLMONT MEDICAL ASSOCIATES TOTALED 31,479 DURING THE FISCAL YEAR ENDED JUNE 30, 2015 AND DID NOT MEET THE 50,000 THRESHOLD AMOUNT FOR SEPARATE DISCLOSURE. TRANS ORGANIZATION TYPE AMOUNT METHOD DETERMINATION WELLMONT FOUNDATION C 21,590 NEED WELLMONT MADISON HOUSE O 2,019 SALARY ALLOCATION WELLMONT MEDICAL ASSOCIATES L 7,870 INVOICES | ExplanationTxt |