WELLMONT MEDICAL ASSOCIATES INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- WELLMONT MEDICAL ASSOCIATES INC (EIN 27-0898372)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-11
- IRS object ID
- 201631329349300118
- 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 | 2016-05-11T07:17:09-05:00 | 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 | 270898372 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLMONT MEDICAL ASSOCIATES INC | BusinessNameLine1Txt |
| 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 | 2016-05-11 | 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 | $74,105,569 | 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 | 2008 | FormationYr |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Activity Or Mission | WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 880 | TotalEmployeeCnt |
| Total Gross UBI | $80,143 | TotalGrossUBIAmt |
| PY Contributions Grants | $38,508 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,086 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $65,388,372 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $72,229,456 | CYProgramServiceRevenueAmt |
| CY Investment Income | -$23,057 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,176,302 | PYOtherRevenueAmt |
| CY Other Revenue | $1,691,695 | CYOtherRevenueAmt |
| PY Total Revenue | $66,603,182 | PYTotalRevenueAmt |
| CY Total Revenue | $73,905,180 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $65,572,700 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $74,914,469 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,973,727 | PYOtherExpensesAmt |
| CY Other Expenses | $27,656,826 | CYOtherExpensesAmt |
| PY Total Expenses | $93,546,427 | PYTotalExpensesAmt |
| CY Total Expenses | $102,571,295 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$26,943,245 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$28,666,115 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | -$20,436,727 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,358,030 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,506,517 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,678,595 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$26,943,244 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$320,565 | 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 | $97,913,725 | ExpenseAmt |
| Revenue | $73,817,951 | RevenueAmt |
| Desc | WELLMONT MEDICAL ASSOCIATES, INC. IS PHYSICIAN-LED AND PROFESSIONALLY MANAGED. FROM ITS BOARD OF DIRECTORS AND LEADERSHIP TEAM MEMBERS TO THE PROVIDERS WHO CARE FOR PATIENTS EVERY DAY, WELLMONT MEDICAL ASSOCIATES, INC.'S COMMITMENT TO PHYSICIAN LEADERSHIP IS CLEAR. WELLMONT MEDICAL ASSOCIATES, INC., A NON-PROFIT HEALTHCARE PROVIDER, DELIVERS EXCEPTIONAL CARE TO PATIENTS IN THE TRI-CITIES REGION OF NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. BASED IN KINGSPORT, TENNESSEE, AS WELL AS LOCATIONS EXPANDING FROM SNEEDVILLE, TENNESSEE, TO MARION, VIRGINIA, WELLMONT MEDICAL ASSOCIATES, INC. OFFERS THE LATEST IN TECHNOLOGICAL ADVANCES TO ENSURE PATIENTS RECEIVE SUPERIOR CARE. (CON'T ON SCHEDULE O) WE ARE DEDICATED TO 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. IN FISCAL YEAR 2015, WE HAD 399,465 OFFICE VISITS AND 138,570 HOSPITAL/NURSING HOME VISITS AND PATIENT ENCOUNTERS OF 538,035. REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, WELLMONT MEDICAL ASSOCIATES, INC. TREATS ALL PATIENTS FOR MEDICALLY NECESSARY CONDITIONS. RECOGNIZING THAT SOME PATIENTS CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, WE PROVIDED CARE FOR INDIGENT PATIENTS INCURRING COSTS OF 1,227,430. ADDITIONALLY, WE PROVIDED CARE TO PERSONS COVERED BY MEDICARE, MEDICAID, TENNCARE AND CHAMPUS AT LESS THAN COST. DUE TO MANDATED REDUCTIONS IN MEDICARE FUNDING FROM THE BALANCED BUDGET ACT AND DECLINING REIMBURSEMENT FROM TENNCARE, THE SHORTFALL BETWEEN RECEIPTS AND THE COST OF PROVIDING CARE TO THESE PATIENTS TOTALED 35,089,640. OVERALL, WE RETURNED MORE THAN 33,862,210 IN BENEFITS TO OUR REGION. IT IS OUR OBLIGATION TO SUPPORT THE CAUSES THAT IMPROVE THE QUALITY OF LIFE IN OUR REGION. WE SPONSORED EDUCATIONAL, COMMUNITY-BASED PROGRAMS ON HEALTHY LIFESTYLES, RISK FACTOR IDENTIFICATION AND OPTIONS FOR DIAGNOSIS AND TREATMENT. PROGRAMS INCLUDED: - LECTURES ABOUT ASTHMA TO AREA ELEMENTARY SCHOOLS - WORKING WITH FRIENDS IN NEED, WHICH PROVIDES ON-SITE PRIMARY CARE - PROVIDING FREE MEDICAL CARE THROUGH REMOTE AREA MEDICAL CLINIC - WORKING WITH APPALACHIAN MOUNTAIN PROJECT ACCESS - TEACHING AT LINCOLN MEMORIAL UNIVERSITY-DEBUSK COLLEGE OF OSTEOPATHIC MEDICINE - TEACHING AT UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE - PROVIDING A FREE CLINIC IN CHURCH HILL, TENNESSEE - THE HEALTH WAGON IN WISE, VIRGINIA WE ALSO PARTICIPATED IN A NUMBER OF HEALTH FAIRS AND COMMUNITY SCREENINGS. EMPLOYEES GAVE THEIR TIME TO AREA NONPROFIT ORGANIZATIONS, WHICH INCLUDED THE UNITED WAY AND THE TRI-CITIES AFFILIATE OF SUSAN G. KOMEN FOR THE CURE. THEY ALSO DONATED AS PART OF WELLMONT'S EMPLOYEE GIVING CAMPAIGN TO FUNDS SUCH AS THE WELLMONT CANCER INSTITUTE PATIENT ASSISTANCE FUND, EMPLOYEE EMERGENCY FUND AND MANY OTHERS. | Desc |
| Total Program Service Expenses | $97,913,725 | 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 | 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 | Yes (true) | 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 | 74 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 880 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| 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 |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 19 | 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 |
| States Where Copy Of Return Is Fld | TN | StatesWhereCopyOfReturnIsFldCd |
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (34 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 | ||||||||
| WHS PRESIDEN | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $2,554,461 | $65,341 | |
| PAUL JETT MD | ||||||||
| PHYSICIAN/DI | 40.00 | Yes (X) | $645,410 | $0 | $9,142 | |||
| IBRAHIM NAKHOUL MD | ||||||||
| PHYSICIAN/DI | 40.00 | Yes (X) | $576,863 | $0 | $27,302 | |||
| ANILKUMAR TUMKUR MD TRM 121814 | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $563,797 | $0 | $26,855 | |||
| JAMES BECKNER MD | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $548,836 | $0 | $29,084 | |||
| JASON BRAZEE MD TERMED 2715 | ||||||||
| CHIEF ADM ME | 40.00 | Yes (X) | Yes (X) | $454,688 | $0 | $26,317 | ||
| MAURICE NIDA DO | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $439,765 | $0 | $25,570 | |||
| KELLY OGGERO MD | ||||||||
| PHYSICIAN/DI | 40.00 | Yes (X) | $435,704 | $0 | $12,150 | |||
| DAVID THOMPSON MD | ||||||||
| EX-OFFICIO B | 40.00 | Yes (X) | Yes (X) | $433,561 | $0 | $8,407 | ||
| SUE PRILL MD | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $429,608 | $0 | $25,492 | |||
| STEPHEN COMBS MD | ||||||||
| EX-OFFICIO B | 40.00 | Yes (X) | Yes (X) | $423,602 | $0 | $26,658 | ||
| BARTON A HOVE | ||||||||
| EX-OFFICIO B | 1.00 | 39.00 | Yes (X) | $0 | $394,913 | $16,374 | ||
| MIHIR PATEL MD | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $382,627 | $0 | $22,252 | |||
| LENITA THIBAULT MD | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $373,622 | $0 | $18,208 | |||
| MARTA WAYT MD | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $371,129 | $0 | $16,518 | |||
| MARK KADOWAKI MD TRM 41315 | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $369,621 | $0 | $16,615 | |||
| DAVID L BRASH | ||||||||
| EX-OFFICIO B | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $319,658 | $21,654 | |
| KIM ONESKO | ||||||||
| EX-OFFICIO B | 40.00 | Yes (X) | Yes (X) | $310,043 | $0 | $14,492 | ||
| LANDON COMBS MD | ||||||||
| SECRETARY\TR | 40.00 | Yes (X) | Yes (X) | $284,379 | $0 | $20,919 | ||
| AMANDA DOVE MD | ||||||||
| DIRECTOR,WES | 40.00 | 0.00 | Yes (X) | $238,318 | $0 | $4,107 | ||
| DAVID ASTIN MD | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $232,283 | $0 | $17,116 | |||
| JOSEPH SMIDDY MD RES 91814 | ||||||||
| VICE CHAIR | 40.00 | Yes (X) | Yes (X) | $227,593 | $0 | $12,427 | ||
| MONIKA KARAKATTU MD | ||||||||
| PHYSICIAN/DI | 40.00 | Yes (X) | $217,952 | $0 | $18,213 | |||
| PARMINDERJIT SINGH MD | ||||||||
| PHYSICIAN/DI | 40.00 | Yes (X) | $215,635 | $0 | $4,965 | |||
| KIMBERLY ROLLER MD | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $5,504 | $0 | $722 | |||
| MARISSA VITO CRUZ MD | ||||||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | ||||
| ROGER MOWEN | ||||||||
| EX-OFFICIO B | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KAREN J WILLIAMS | ||||||||
| EXEC DIRECTO | 40.00 | Yes (X) | $173,325 | $0 | $10,266 | |||
| WILLIAM C WILSON TERMED 6515 | ||||||||
| VP FINANCE A | 40.00 | Yes (X) | $137,150 | $0 | $14,980 | |||
| DANIEL KRENK MD | ||||||||
| PHYSICIAN | 40.00 | $812,366 | $0 | $32,845 | Yes (X) | |||
| PAUL KRAMER MD | ||||||||
| PHYSICIAN | 40.00 | $731,383 | $0 | $30,630 | Yes (X) | |||
| GIRENDRA HOSKERE MD | ||||||||
| PHYSICIAN | 40.00 | $721,186 | $0 | $27,734 | Yes (X) | |||
| HARSHA VARDHANA MD | ||||||||
| PHYSICIAN | 40.00 | $606,949 | $0 | $27,491 | Yes (X) | |||
| PERRIE RYAN MD | ||||||||
| PHYSICIAN | 40.00 | $568,932 | $0 | $26,358 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $11,931,831 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,269,032 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $657,204 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 167 | 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 |
|---|---|---|---|---|---|
| EMERGENCY CARE PHYSICIANS INC | |||||
| 3633 HONEYWOOD DRIVE | JOHNSON CITY | TN | 37604 | MEDICAL CARE | $1,021,766 |
| BARTON ASSOCIATES INC | |||||
| PO BOX 417844 | BOSTON | MA | 02241 | MEDICAL SVS | $651,945 |
| COMPHEALTH INC | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | PHSICIAN SVS | $418,388 |
| BLUE RIDGE RADIOLOGY PC | |||||
| 3053 WEST STATE STREET | BRISTOL | TN | 37620 | PROFESSIONAL SV | $324,779 |
| WATAUGA ORTHOPAEDICS PLC | |||||
| 2410 SUSANNAH STREET | JOHNSON CITY | TN | 376011748 | MEDICAL CARE | $313,387 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $7,086 | RelatedOrganizationsAmt |
| Total Contributions | $7,086 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE-NET | 621990 | $70,785,314 | $70,785,314 | |
| CAPITATION & HUMANA REVENUE | 621990 | $835,844 | $835,844 | |
| BILLING REVENUE | 621990 | $499,155 | $499,155 | |
| UNRELATED BUSINESS TAX INCOME | 541700 | $80,143 | $80,143 | |
| DIAGNOSTIC INTERPRETATIONS | 621990 | $29,000 | $29,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $72,229,456 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $156,801 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $156,801 | RealAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $20,531 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $43,588 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$23,057 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$23,057 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$23,057 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEANINGFUL USE REVENUE | 621990 | $707,333 | $707,333 |
| MEDICAL DIRECTORSHIP | 621990 | $542,000 | $542,000 |
| MISCELLANEOUS REVENUE | 611710 | $442,362 | $442,362 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,691,695 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $73,905,180 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $73,817,951 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $80,143 | UnrelatedBusinessRevenueAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,428,350 | TotalAmt |
| Program Services | $6,757,492 | ProgramServicesAmt |
| Management And General | $670,858 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,009,051 | TotalAmt |
| Program Services | $57,300,539 | ProgramServicesAmt |
| Management And General | $1,708,512 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,236,042 | TotalAmt |
| Program Services | $1,188,322 | ProgramServicesAmt |
| Management And General | $47,720 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,964,349 | TotalAmt |
| Program Services | $3,688,350 | ProgramServicesAmt |
| Management And General | $275,999 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,276,677 | TotalAmt |
| Program Services | $3,156,031 | ProgramServicesAmt |
| Management And General | $120,646 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,562,048 | TotalAmt |
| Program Services | $1,421,678 | ProgramServicesAmt |
| Management And General | $140,370 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,935,106 | TotalAmt |
| Program Services | $2,861,959 | ProgramServicesAmt |
| Management And General | $73,147 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,438 | TotalAmt |
| Program Services | $3,884 | ProgramServicesAmt |
| Management And General | $26,554 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $928,939 | TotalAmt |
| Program Services | $869,189 | ProgramServicesAmt |
| Management And General | $59,750 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,569,801 | TotalAmt |
| Program Services | $6,211,556 | ProgramServicesAmt |
| Management And General | $358,245 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,517 | TotalAmt |
| Program Services | $144,981 | ProgramServicesAmt |
| Management And General | $34,536 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,709 | TotalAmt |
| Program Services | $165,400 | ProgramServicesAmt |
| Management And General | $1,309 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,930,846 | TotalAmt |
| Program Services | $1,809,006 | ProgramServicesAmt |
| Management And General | $121,840 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $733,501 | TotalAmt |
| Program Services | $590,760 | ProgramServicesAmt |
| Management And General | $142,741 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MSO ALLOCATIONS | $7,045,877 | $7,045,877 | |
| DRUGS & MEDICAL SUPPLIES | $2,589,894 | $2,589,894 | |
| PHYSICIAN GUARANTEE & INT | $1,285,141 | $1,275,141 | $10,000 |
| DUES AND MEMBERSHIPS | $708,937 | $220,554 | $488,383 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $990,072 | TotalAmt |
| Program Services | $613,112 | ProgramServicesAmt |
| Management And General | $376,960 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,571,295 | TotalAmt |
| Program Services | $97,913,725 | ProgramServicesAmt |
| Management And General | $4,657,570 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,242 | BOYAmt |
| EOY | $204,511 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$35,211,956 | BOYAmt |
| EOY | -$8,160,283 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,342,086 | BOYAmt |
| EOY | $966,321 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $382,224 | BOYAmt |
| EOY | $131,521 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $25,636,555 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,710,795 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,746,210 | BOYAmt |
| EOY | $12,925,760 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,303,467 | BOYAmt |
| EOY | $1,290,200 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$20,436,727 | BOYAmt |
| EOY | $7,358,030 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,446,986 | BOYAmt |
| EOY | $7,678,595 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,531 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,506,517 | BOYAmt |
| EOY | $7,678,595 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$26,943,244 | BOYAmt |
| EOY | -$320,565 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$26,943,244 | BOYAmt |
| EOY | -$320,565 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$20,436,727 | BOYAmt |
| EOY | $7,358,030 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$28,666,115 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $55,288,794 | 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $55,725 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $38,508 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,086 | CurrentTaxYearAmt |
| Total | $101,319 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,657,332 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,594,208 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $667,540,667 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $66,564,675 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $73,921,151 | CurrentTaxYearAmt |
| Total | $824,278,033 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,657,332 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,594,208 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $667,596,392 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $66,603,183 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $73,928,237 | CurrentTaxYearAmt |
| Total | $824,379,352 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $824,379,352 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,759 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $45,201 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $153,831 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $156,801 | CurrentTaxYearAmt |
| Total | $359,592 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,759 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $45,201 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $153,831 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $156,801 | CurrentTaxYearAmt |
| Total | $359,592 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,661,091 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,639,409 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $667,596,392 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $66,757,014 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $74,085,038 | CurrentTaxYearAmt |
| Total | $824,738,944 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99960 | PublicSupportCY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 | $28,688 | OtherCostOrOtherBasisAmt |
| Book Value | $28,688 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,425,548 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,288,281 | DepreciationAmt |
| Book Value | $4,137,267 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,701,080 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,901,191 | DepreciationAmt |
| Book Value | $5,799,889 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,489,709 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,591,945 | DepreciationAmt |
| Book Value | $2,897,764 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,991,530 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,929,378 | DepreciationAmt |
| Book Value | $62,152 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,925,760 | TotalBookValueLandBuildingsAmt |
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 (31 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 | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARGARET DENARVAEZ TERMED 91614 | ||||||||||||
| WHS PRESIDENT & CEO | $544,420 | $265,980 | $1,744,061 | $58,432 | $6,909 | $2,619,802 | ||||||
| PAUL JETT MD | ||||||||||||
| PHYSICIAN/DIRECTOR | $529,571 | $25,000 | $90,839 | $9,142 | $654,552 | |||||||
| IBRAHIM NAKHOUL MD | ||||||||||||
| PHYSICIAN/DIRECTOR | $515,246 | $60,437 | $1,180 | $8,862 | $604,165 | $18,440 | ||||||
| ANILKUMAR TUMKUR MD TRM 121814 | ||||||||||||
| DIRECTOR | $517,139 | $46,658 | $8,862 | $590,652 | $17,993 | |||||||
| JAMES BECKNER MD | ||||||||||||
| DIRECTOR | $487,040 | $61,796 | $9,620 | $577,920 | $19,464 | |||||||
| JASON BRAZEE MD TERMED 2715 | ||||||||||||
| CHIEF ADM MED OFFICR | $423,500 | $2,400 | $28,788 | $8,407 | $481,005 | $17,910 | ||||||
| MAURICE NIDA DO | ||||||||||||
| DIRECTOR | $253,076 | $29,279 | $157,410 | $11,570 | $465,335 | $14,000 | ||||||
| KELLY OGGERO MD | ||||||||||||
| PHYSICIAN/DIRECTOR | $400,498 | $35,206 | $8,407 | $447,854 | $3,743 | |||||||
| DAVID THOMPSON MD | ||||||||||||
| EX-OFFICIO BRD MBR | $288,751 | $66,310 | $78,500 | $8,407 | $441,968 | |||||||
| SUE PRILL MD | ||||||||||||
| DIRECTOR | $352,487 | $42,835 | $34,286 | $8,697 | $455,100 | $16,795 | ||||||
| STEPHEN COMBS MD | ||||||||||||
| EX-OFFICIO BRD MBR | $329,466 | $38,066 | $56,070 | $11,570 | $450,260 | $15,088 | ||||||
| BARTON A HOVE | ||||||||||||
| EX-OFFICIO BRD MBR | $315,138 | $50,000 | $29,775 | $6,754 | $9,620 | $411,287 | ||||||
| MIHIR PATEL MD | ||||||||||||
| DIRECTOR | $224,889 | $55,600 | $102,138 | $11,282 | $404,879 | $10,970 | ||||||
| LENITA THIBAULT MD | ||||||||||||
| DIRECTOR | $347,483 | $24,951 | $1,188 | $3,126 | $391,830 | $15,082 | ||||||
| MARTA WAYT MD | ||||||||||||
| DIRECTOR | $233,279 | $33,428 | $104,422 | $3,184 | $387,647 | $13,334 | ||||||
| MARK KADOWAKI MD TRM 41315 | ||||||||||||
| DIRECTOR | $359,999 | $9,622 | $9,057 | $386,236 | $7,558 | |||||||
| DAVID L BRASH | ||||||||||||
| EX-OFFICIO BRD MEMBR | $277,473 | $41,832 | $353 | $12,034 | $9,620 | $341,312 | ||||||
| KIM ONESKO | ||||||||||||
| EX-OFFICIO BRD MBR | $260,866 | $40,003 | $9,174 | $4,107 | $324,535 | $10,385 | ||||||
| LANDON COMBS MD | ||||||||||||
| SECRETARY\TREASURER | $206,325 | $78,054 | $9,620 | $305,298 | $11,299 | |||||||
| AMANDA DOVE MD | ||||||||||||
| DIRECTOR,WEST REGION | $183,997 | $15,276 | $39,045 | $4,107 | $242,425 | |||||||
| DAVID ASTIN MD | ||||||||||||
| DIRECTOR | $182,708 | $27,520 | $22,055 | $8,983 | $249,399 | $8,133 | ||||||
| JOSEPH SMIDDY MD RES 91814 | ||||||||||||
| VICE CHAIR | $227,593 | $6,272 | $240,020 | $6,155 | ||||||||
| MONIKA KARAKATTU MD | ||||||||||||
| PHYSICIAN/DIRECTOR | $195,504 | $12,069 | $10,379 | $9,620 | $236,165 | $8,593 | ||||||
| PARMINDERJIT SINGH MD | ||||||||||||
| PHYSICIAN/DIRECTOR | $154,749 | $6,250 | $54,636 | $4,965 | $220,600 | |||||||
| KAREN J WILLIAMS | ||||||||||||
| EXEC DIRECTOR WMA OP | $155,946 | $17,128 | $251 | $3,544 | $183,591 | $6,722 | ||||||
| WILLIAM C WILSON TERMED 6515 | ||||||||||||
| VP FINANCE AND OPERA | $118,521 | $18,565 | $64 | $9,620 | $152,130 | $5,360 | ||||||
| DANIEL KRENK MD | ||||||||||||
| PHYSICIAN | $812,186 | $180 | $9,960 | $845,211 | $22,885 | |||||||
| PAUL KRAMER MD | ||||||||||||
| PHYSICIAN | $520,180 | $160,846 | $50,357 | $8,407 | $762,013 | $22,223 | ||||||
| GIRENDRA HOSKERE MD | ||||||||||||
| PHYSICIAN | $455,243 | $219,898 | $46,045 | $7,032 | $748,920 | $20,702 | ||||||
| HARSHA VARDHANA MD | ||||||||||||
| PHYSICIAN | $425,000 | $181,777 | $172 | $9,165 | $634,440 | $18,326 | ||||||
| PERRIE RYAN MD | ||||||||||||
| PHYSICIAN | $407,500 | $161,162 | $270 | $8,407 | $595,290 | $17,951 | ||||||
Supplemental Information Detail SupplementalInformationDetail (4 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 BARTON A. HOVE AND MARGARET D. DENARVAEZ. THESE AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. |
| SCHEDULE J, PAGE 1, PART I, LINE 4 | MARGARET DENARVAEZ (TERMED 9/16/14) 1,745,528 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". PART 1, LINE 4B - NONQUALIFIED RETIREMENT PLAN WELLMONT HEALTH SYSTEM HAS AN EXECUTIVE RETIREMENT PROGRAM THAT INCLUDED MARGARET DENARVAEZ 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 L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| THE HEART CENTER PARTNERSHIP | |||
| BOARD OVERLAP | $163,233 | LEASE AGREEMENT | false |
| TRI-STATE PROFESSIONAL SUITES OWNER | |||
| BOARD OVERLAP | $72,297 | LEASE AGREEMENT | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | SCHEDULE L, PART IV, LINE 1, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: WELLMONT HEALTH SYSTEM (LESSEE), WHICH IS THE SOLE MEMBER OF THE CORPORATION, WELLMONT MEDICAL ASSOCIATES, ENTERED INTO A LEASE AGREEMENT WITH THE HEART CENTER PARTNERSHIP (LESSOR) ON APRIL 30, 2010 TO LEASE 49,481 RENTABLE SQUARE FEET IN THE BUILDING KNOWN AS THE HEART CENTER,LOCATED AT 2050 MEADOWVIEW PARKWAY, KINGSPORT, TENNESSEE 37660 FOR A TEN YEAR TERM WITH RENEWABLE TERMS IN SIX MONTH INCREMENTS, OF WHICH, WELLMONT MEDICAL ASSOCIATES LEASES 4,205 RENTABLE SQUARE FEET ON THE SECOND FLOOR. THE AGREEMENT PROVIDES FOR THE LESSEE'S PURCHASE RIGHT OF FIRST REFUSAL AND A MULTI-LESSEE RIGHT OF FIRST OFFER. THERE ARE CURRENTLY 37 PHYSICIANS EMPLOYED BY WELLMONT CARDIOLOGY SERVICES OF WHICH, 25 ARE SENIOR PHYSICIANS THAT ARE THE CURRENT PARTNERS OF THE HEART CENTER PARTNERSHIP,AS IS TIM ATTEBERY, PRESIDENT OF HOLSTON VALLEY MEDICAL CENTER, WHICH IS WELLMONT HEALTH SYSTEM'S LARGEST HOSPITAL. THE HEART CENTER PARTNERSHIP IS NOT OWNED BY WELLMONT HEALTH SYSTEM, WELLMONT CARDIOLOGY SERVICES, OR ANY AFFILIATED ENTITIES. THE 25 PHYSICIAN PARTNERS MENTIONED IN THE LEASE AGREEMENT ARE AS FOLLOWS: DAVID C. BECKNER, M.D. JOHN F. BERRY, M.D. JOHN R. BERTUSO, M.D. GERALD G. BLACKWELL, M.D. MARK A. BORSCH, M.D. THOMAS M. BULLE, M.D. JONATHAN W. BURRESS, M.D. LARRY H. COX, M.D. STANLEY A. GALL, JR., M.D. DAVID TYLER GREENFIELD, M.D. PIERRE ISTFAN, M.D. GREGORY K. JONES, M.D. CHRISTOPHER J. KENNEDY, M.D. ROBERT KEITH KRAMER, M.D. HERBERT D. LADLEY, M.D. MARC W. MAYHEW, M.D. JAMES J. MERRILL, M.D. WILLIAM M. MESSERSCHMIDT, M.D. DAVID CHRISTOPHER METZGER, M.D. ARUN RAO, M.D. PABITRA K. SAHA, M.D. DANIEL E. SIMPSON, M.D. HARRISON D. TURNER, M.D. FREDDIE M. WILLIAMS, M.D. MARCUS WILLIAMS, M.D. SCHEDULE L, PART IV, LINE 2, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: WELLMONT HEALTH SYSTEM (LESSEE), WHICH IS THE SOLE MEMBER OF THE CORPORATION, WELLMONT MEDICAL ASSOCIATES, ENTERED INTO A LEASE AGREEMENT WITH TRI-STATE PROFESSIONAL SUITES OWNERS ASSOCIATION, INC. (LESSOR), ON OCTOBER 11, 2011 TO LEASE 23,503 RENTABLE SQUARE FEET IN THE BUILDING KNOWN AS TRI-STATE PROFESSIONAL SUITES, LOCATED AT 2428 KNOB CREEK ROAD, UNIT 1, JOHNSON CITY, TN, 37601 FOR A TWELVE YEAR TERM WITH RENEWABLE TERMS IN SIX MONTH INCREMENTS, OF WHICH, WELLMONT MEDICAL ASSOCIATES SUBLEASES FROM WELLMONT CARDIOLOGY SERVICES 2,633 SQUARE FEET OF RENTABLE SPACE. THE AGREEMENT PROVIDES FOR THE LESSEE'S PURCHASE RIGHT OF FIRST REFUSAL. TRI- STATE PROFESSIONAL SUITES OWNERS ASSOCIATION, INC. SOLD THE BUILDING ON JANUARY 23, 2015. THE 4 PARTNERS ARE AS FOLLOWS: HAROLD ALISON, M.D. JOSEPH BAILEY, M.D. MARK CHANG, M.D. COLLIER JORDAN, M.D. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | WE ARE DEDICATED TO 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. IN FISCAL YEAR 2015, WE HAD 399,465 OFFICE VISITS AND 138,570 HOSPITAL/NURSING HOME VISITS AND PATIENT ENCOUNTERS OF 538,035. REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, WELLMONT MEDICAL ASSOCIATES, INC. TREATS ALL PATIENTS FOR MEDICALLY NECESSARY CONDITIONS. RECOGNIZING THAT SOME PATIENTS CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, WE PROVIDED CARE FOR INDIGENT PATIENTS INCURRING COSTS OF 1,227,430. ADDITIONALLY, WE PROVIDED CARE TO PERSONS COVERED BY MEDICARE, MEDICAID, TENNCARE AND CHAMPUS AT LESS THAN COST. DUE TO MANDATED REDUCTIONS IN MEDICARE FUNDING FROM THE BALANCED BUDGET ACT AND DECLINING REIMBURSEMENT FROM TENNCARE, THE SHORTFALL BETWEEN RECEIPTS AND THE COST OF PROVIDING CARE TO THESE PATIENTS TOTALED 35,089,640. OVERALL, WE RETURNED MORE THAN 33,862,210 IN BENEFITS TO OUR REGION. IT IS OUR OBLIGATION TO SUPPORT THE CAUSES THAT IMPROVE THE QUALITY OF LIFE IN OUR REGION. WE SPONSORED EDUCATIONAL, COMMUNITY-BASED PROGRAMS ON HEALTHY LIFESTYLES, RISK FACTOR IDENTIFICATION AND OPTIONS FOR DIAGNOSIS AND TREATMENT. PROGRAMS INCLUDED: - LECTURES ABOUT ASTHMA TO AREA ELEMENTARY SCHOOLS - WORKING WITH FRIENDS IN NEED, WHICH PROVIDES ON-SITE PRIMARY CARE - PROVIDING FREE MEDICAL CARE THROUGH REMOTE AREA MEDICAL CLINIC - WORKING WITH APPALACHIAN MOUNTAIN PROJECT ACCESS - TEACHING AT LINCOLN MEMORIAL UNIVERSITY-DEBUSK COLLEGE OF OSTEOPATHIC MEDICINE - TEACHING AT UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE - PROVIDING A FREE CLINIC IN CHURCH HILL, TENNESSEE - THE HEALTH WAGON IN WISE, VIRGINIA WE ALSO PARTICIPATED IN A NUMBER OF HEALTH FAIRS AND COMMUNITY SCREENINGS. EMPLOYEES GAVE THEIR TIME TO AREA NONPROFIT ORGANIZATIONS, WHICH INCLUDED THE UNITED WAY AND THE TRI-CITIES AFFILIATE OF SUSAN G. KOMEN FOR THE CURE. THEY ALSO DONATED AS PART OF WELLMONT'S EMPLOYEE GIVING CAMPAIGN TO FUNDS SUCH AS THE WELLMONT CANCER INSTITUTE PATIENT ASSISTANCE FUND, EMPLOYEE EMERGENCY FUND AND MANY OTHERS. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE BUSINESS AND AFFAIRS OF WELLMONT MEDICAL ASSOCIATES, 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 EXPLANATION. |
| FORM 990, PAGE 6, PART VI, LINE 7B | SEE FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION. |
| FORM 990, PAGE 6, PART VI, LINE 9 | MARGARET DENARVAEZ (TERMED 9/16/14) 1905 AMERICAN WAY KINGSPORT, TN 37660 WILLIAM C. WILSON (TERMED 6/5/15) 1905 AMERICAN WAY KINGSPORT, TN 37660 |
| FORM 990, PAGE 6, PART VI, LINE 11B | WELLMONT MEDICAL ASSOCIATES, INC.'S FORM 990 IS REVIEWED BY THE SENIOR VICE PRESIDENT OF FINANCE, THE CORPORATE CONTROLLER, AND THE MANAGER OF ACCOUNTING OF WELLMONT HEALTH SYSTEM, AND THE BOARD OF DIRECTORS OF WELLMONT MEDICAL ASSOCIATES, 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 MEDICAL ASSOCIATES, 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 | DAVID THOMPSON, M.D. RECEIVES NO COMPENSATION FOR SERVING AS CHAIR OF THE BOARD OF DIRECTORS OF WELLMONT MEDICAL ASSOCIATES. THE COMPENSATION THAT DAVID THOMPSON, M.D. RECEIVES AS A PHYSICIAN OF WELLMONT MEDICAL ASSOCIATES IS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM BOARD OF DIRECTORS. WELLMONT HEALTH SYSTEM USES ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE COMPENSATION OF DAVID THOMPSON, M.D. 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 BOARD OF DIRECTORS. BARTON A. HOVE IS ALSO A BOARD MEMBER OF WELLMONT CARDIOLOGY SERVICES. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. 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 CARDIOLOGY SERVICES. 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. |
| FORM 990, PAGE 6, PART VI, LINE 15B | WELLMONT MEDICAL ASSOCIATES USES ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE COMPENSATION OF STEPHEN COMBS, M.D., CHIEF EXECUTIVE MEDICAL OFFICER, KIM ONESKO, CHIEF ADMINISTRATIVE OFFICER, JASON BRAZEE, M.D.,CHIEF ADMINISTRATIVE MEDICAL OFFICER, KAREN J. WILLIAMS, EXECUTIVE DIRECTOR WMA OPERATIONS, AND WILLIAM C. WILSON, VICE PRESIDENT OF FINANCE AND OPERATIONS. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. |
| FORM 990, PAGE 6, PART VI, LINE 19 | WELLMONT MEDICAL ASSOCIATES, 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, PAGE 7, PART VII | AVERAGE HOURS PER WEEK THE SECRETARY AND VARIOUS BOARD MEMBERS SERVE IN A DIFFERENT CAPACITY FOR SEVERAL RELATED ORGANIZATIONS. THE MAJORITY OF THEIR TIME IS DEVOTED TO A RELATED ORGANIZATION (GREATER THAN 38 HOURS PER WEEK). HOWEVER, BOARD MEMBERS WHO ARE PHYSICIANS HAVE DEDICATED AN AVERAGE OF 40 HOURS PER WEEK TO WELLMONT MEDICAL ASSOCIATES, INC. |
| FORM 990, PART XI, LINE 9 | INTERCOMPANY RESOLUTION 26,943,241 INTERCOMPANY-HOSPITAL ALLOCATIONS 28,345,548 ROUNDING 5 |
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 |
|---|---|---|---|---|---|---|---|---|---|---|
| WELLMONT HEALTH SYSTEM | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621636465 | HEALTHCARE | TN | 501C3 | 3 | NA | false |
| WELLMONT HAWKINS CTY MEM HOSPITAL | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621816368 | HEALTHCARE | TN | 501C3 | 3 | WHS | false |
| WELLMONT CARDIOLOGY SERVICES | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 263557623 | HEALTHCARE | TN | 501C3 | 9 | 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 | 581859039 | HEALTHCARE | TN | 501C3 | 9 | WHS | false |
| WELLMONT SLEEP SERVICES | ||||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 273777167 | HEALTHCARE | TN | 501C3 | 3 | 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 |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| HOLSTON VALLEY IMAGING CENTER | |||||||||
| 103 WEST STONE DRIVE | KINGSPORT | TN | 37660 | 202043285 | HEALTHCARE | TN | N/A | false | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 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 |
| WELLMONT MALL PHARMACY INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621565006 | MED SVCS | TN | N/A | false |
| WELLMONT PHYSICIANS SERVICES INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621567353 | PHYS SVCS | TN | N/A | false |
| WELLMONT HEALTH SERVICES INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 621254373 | HEALTHCARE | TN | N/A | false |
| WPS PROVIDERS INC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 625564642 | PHYS SVCS | TN | N/A | false |
| WELLMONT INTEGRATED NETWORK LLC | ||||||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | 455443060 | MED SVS | 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 | false | 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 | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | 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 | false | 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 (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WELLMONT HEALTH SYSTEM | ||
| C | $26,943,241 | CAPITAL CONTRIBUTION |
| WELLMONT HEALTH SYSTEM | ||
| I | $167,734 | ASSET TRANSFERS |
| WELLMONT HEALTH SYSTEM | ||
| J | $55,313 | LEASE AGREEMENT |
| WELLMONT HEALTH SYSTEM | ||
| K | $1,466,772 | LEASE AGREEMENT |
| WELLMONT HEALTH SYSTEM | ||
| L | $545,532 | SERVICE AGREEMENT |
| WELLMONT HEALTH SYSTEM | ||
| M | $111,231 | SERVICE AGREEMENTS |
| WELLMONT CARDIOLOGY SERVICES | ||
| K | $79,864 | LEASE AGREEMENT |
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 HAWKINS COUNTY MEMORIAL HOSPITAL, INC. AND WELLMONT WEXFORD HOUSE, TOTALED 45,178 DURING THE FISCAL YEAR ENDED JUNE 30, 2015, AND DID NOT MEET THE 50,000 THRESHOLD AMOUNT FOR SEPARATE DISCLOSURE. ORGANIZATION TRANS TYPE AMOUNT METHOD DETERMINATION WELLMONT FOUNDATION C 28,785 NEED WELLMONT HAWKINS COUNTY M 7,870 SERVICE AGREEMENTS MEMORIAL HOSPITAL, INC. WELLMONT WEXFORD HOUSE L 8,523 INVOICES | ExplanationTxt |