2015-08-11T10:31:34-05:00 2014-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2013-10-01 273274203 ANDERSON PHYSICIAN ALLIANCE INC ANDE 6015536000 2124 14TH STREET MERIDIAN MS 39301 G EDWARD TUCKER JR CEO/PRESIDENT 6015536000 2015-08-11 1 AMY BIBBY P00445891 8282542254 2013 2016-02-25 16:41:14Z G EDWARD TUCKER JR 2124 14TH STREET MERIDIAN MS 39301 4375569 0 X WWW.JARMC.ORG X 2010 MS ANDERSON PHYSICIAN ALLIANCE, INC. OFFERS FAMILY PRACTICE AND SPECIALTY CLINICS TO PROVIDE QUALITY HEALTHCARE FOR EAST MISSISSIPPI AND WEST ALABAMA. 3 0 120 0 0 0 0 0 6374350 4337744 -2059 21 115052 37804 6487343 4375569 0 0 0 0 6564023 4897709 0 0 0 3574168 2098594 10138191 6996303 -3650848 -2620734 1421162 1203950 14981765 17385287 -13560603 -16181337 X SEE SCHEDULE O:ANDERSON PHYSICIAN ALLIANCE, INC. IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES. THE SPECIFIC PURPOSES AND OBJECTIVES OF THE CORPORATION SHALL INCLUDE BUT NOT BE LIMITED TO EMPLOYING PHYSICIANS AND OTHER MEDICAL PERSONNEL TO CARRY OUT THE PURPOSES AND OBJECTIVES OF ANDERSON REGIONAL MEDICAL CENTER, AS FOLLOWS:1.) TO ESTABLISH AND MAINTAIN AN INSTITUTION OR INSTITUTIONS, WITHIN OR WITHOUT THE STATE WHERE INCORPORATED, WITH PERMANENT FACILITIES TO PROVIDE DIAGNOSIS AND TREATMENT FOR PATIENTS2.) TO CARRY ON ANY EDUCATION ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED, OR TO THE PROMOTION OF HEALTH3.) TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED4.) TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY 0 0 5880540 0 4337744 SEE SCHEDULE O:ANDERSON PHYSICIAN ALLIANCE, INC. OFFERS FAMILY PRACTICE AND SPECIALTY CLINICS TO PROVIDE QUALITY HEALTHCARE FOR EAST MISSISSIPPI AND WEST ALABAMA.ANDERSON PHYSICIAN ALLIANCE, INC. OPERATES PRIMARY CARE CLINICS IN THE EAST MISSISSIPPI AND WEST ALABAMA AREA. THE PHYSICIANS, NURSE PRACTITIONERS AND STAFF FOCUS ON PRIMARY HEALTHCARE NEEDS OF THE COMMUNITY.ANDERSON FAMILY MEDICAL CENTER - LIVINGSTON (LIVINGSTON, AL) ANDERSON PHYSICIAN ALLIANCE, INC. OPERATES 6 MEDICAL SPECIALTY CLINICS INCLUDING:ANDERSON ARTHRITIS AND RHEUMATOLOGY, FOCUSES ON PROVIDING PATIENTS WITH ASSISTANCE IN ACHIEVING A HIGHER QUALITY OF LIFE THROUGH AGGRESSIVE ATTENTION TO RHEUMATOLOGIC DISEASE AND ARTHRITIC CONDITIONS. THE CLINIC SPECIALIZES IN THE DIAGNOSIS AND TREATMENT OF RHEUMATOID ARTHRITIS, LUPUS AND MIXED CONNECTIVE TISSUE DISEASES, SJORGENS SYNDROME, MYOSITIS, VACUITIES AND OSTEOARTHRITIS.ANDERSON INFECTIOUS DISEASE CENTER OFFERS TREATMENT IN THE DIAGNOSIS AND TREATMENT OF INFECTIOUS DISEASES. THE PHYSICIAN AND NURSE PRACTITIONERS EXTENSIVE TRAINING GUIDES PATIENTS IN THE TREATMENT OF INFECTIONS, INCLUDING THOSE CAUSED BY BACTERIA, VIRUSES, FUNGI, PARASITES AND HUMAN IMMUNODEFICIENCY VIRUS, THE CAUSE OF AIDS.ANDERSON NEUROLOGY CENTER FOCUSES ON THE DIAGNOSIS AND TREATMENT OF ALZHEIMER'S DISEASE, PARKINSON'S DISEASE, STROKE AND NEUROLOGICAL DISORDERS.ANDERSON ENDOCRINOLOGY CENTER PROVIDES TREATMENT OF DIABETES, THYROID DISEASE, METABOLIC DISORDERS, CHOLESTEROL DISORDERS AND ENDOCRINE DISORDERS.ANDERSON UROLOGY CENTER OF MERIDIAN PROVIDES UROLOGIC CARE SPECIALIZING IN OVERACTIVE BLADDER, KIDNEY STONES, AND URINARY TRACT INFECTIONS. SURGICAL TREATMENTS INCLUDE: MINIMALLY INVASIVE PROSTATECTOMY SURGERY USING THE DAVINCI SURGICAL ROBOT.ANDERSON PREMIER WOMEN'S CLINIC PROVIDES QUALITY CARE TO WOMEN IN MERIDIAN AND THE SURROUNDING COMMUNITIES. THE DEDICATED PHYSICIAN'S AND STAFF TAKE PRIDE IN PROVIDING A GENUINE CONCERNED ENVIRONMENT FOR WOMEN FROM ADOLESCENCE, TO CHILD BEARING YEARS AND THROUGH MATERNITY.EFFECTIVE JUNE 2013, THE FOLLOWING CLINIC DEPARTMENTS WERE MOVED FROM THE ANDERSON PHYSICIAN ALLIANCE, INC. TO ANDERSON REGIONAL MEDICAL CENTER:ANDERSON FAMILY MEDICAL CENTER - RIVERBIRCHANDERSON FAMILY MEDICAL CENTER - AIRPARK (PHILADELPHIA, MS)ANDERSON FAMILY MEDICAL CENTER - ENTERPRISE (ENTERPRISE, MS)ANDERSON CHILDREN'S MEDICAL CLINICTHESE CLINICS ARE OPERATED AS RURAL HEALTH CLINICS UNDER ANDERSON REGIONAL MEDICAL CENTER SOUTH HOSPITAL FACILITY.EFFECTIVE JANUARY 2014, ANDERSON FAMILY MEDICAL CENTER - BUTLER (BUTLER, ALABAMA) CLINIC CEASED OPERATIONS AS AN ANDERSON PHYSICIAN ALLIANCE, INC. CLINIC. 5880540 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 31 0 1 120 1 0 0 0 0 0 0 0 0 0 0 X 3 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X G EDWARD TUCKER JR 6015536000 2124 14TH STREET MERIDIAN MS 39301 JOHN ANDERSON CHAIRMAN 1.00 50.00 X X 0 207348 53256 WANDA COOPER SECRETARY/TREASURER 1.00 51.00 X X 0 191052 53301 PHILLIP BROOKS DIRECTOR 1.00 4.00 X 0 14622 0 LELAND RAY HUMPHREYS PRESIDENT 1.00 50.00 X 0 441599 136346 RICHARD HIGHTOWER PRESIDENT 1.00 X 0 43078 0 MARK T PHILLIPS PHYSICIAN 40.00 X 497499 0 64478 ROBERT E DILWORTH PHYSICIAN 40.00 X 355856 0 25173 JIMMY V WOLFE PHYSICIAN 40.00 X 291888 0 16895 SILVIA A BEVILACQUA PHYSICIAN 40.00 X 320765 0 14798 LINDA M DALES PHYSICIAN 40.00 X 296812 0 55824 1762820 897699 420071 14 0 1 0 DELL MARKETING LP PO BOX 534118 ATLANTA GA 303534118 IT SERVICES 409456 1 NET PATIENT 621990 4212313 4212313 OTHER OPERATING REVENU 621990 125431 125431 4337744 21 21 MISCELLANEOUS REVENUE 900099 37804 37804 37804 4375569 4337744 0 37825 X 48629 48629 4382535 3805653 576882 19616 17062 2554 217255 188971 28284 229674 199773 29901 856017 451319 404698 34766 32885 1881 191081 163954 27127 19846 19846 7124 1993 5131 17992 17992 8422 8422 104788 104788 165939 165939 MEDICAL SUPPLIES 467700 428395 39305 BAD DEBT EXPENSE 224919 224919 6996303 5880540 1115763 0 2200 2200 553696 405504 353333 314129 113510 44529 871096 466755 397097 404341 1326 33247 1421162 1203950 721430 903878 14260335 16481409 14981765 17385287 X -13560603 -16181337 -13560603 -16181337 1421162 1203950 -2620734 0 X 0 1 X 1 0 X 871096 466755 404341 404341 DUE TO AFFILIATES 16481409 16481409 X PART X, LINE 2: ANDERSON PHYSICIAN ALLIANCE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3); ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. ANDERSON PHYSICIAN ALLIANCE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2014 AND 2013. YEARS ENDING ON OR AFTER SEPTEMBER 30, 2011, REMAIN SUBJECT TO EXAMINIATION BY FEDERAL AND STATE TAX AUTHORITIES. 0 1 0 0 0 0 0 0 0 JOHN ANDERSON CHAIRMAN 0 204587 0 0 0 2761 0 39948 0 13308 0 260604 0 0 WANDA COOPER SECRETARY/TREASURER 0 186941 0 0 0 4111 0 39681 0 13620 0 244353 0 0 LELAND RAY HUMPHREYS PRESIDENT 0 427678 0 0 0 13921 0 121020 0 15326 0 577945 0 0 MARK T PHILLIPS PHYSICIAN 495497 0 0 0 2002 0 45525 0 18953 0 561977 0 0 0 ROBERT E DILWORTH PHYSICIAN 352960 0 0 0 2896 0 24802 0 371 0 381029 0 0 0 JIMMY V WOLFE PHYSICIAN 290574 0 0 0 1314 0 3750 0 13145 0 308783 0 0 0 SILVIA A BEVILACQUA PHYSICIAN 320360 0 0 0 405 0 1275 0 13523 0 335563 0 0 0 LINDA M DALES PHYSICIAN 294832 0 0 0 1980 0 41971 0 13853 0 352636 0 0 0 PART I, LINE 4B ARMC PROVIDES CERTAIN EXEUCTIVES AN IRC SEC 457(F), NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) PLAN: - LELAND RAY HUMPHREYS $75,495 - JOHN ANDERSON 35,940 - WANDA COOPER 33,896 CASEY CHESTNUTT HAARALA FAMILY RELATIONSHIP WITH A BOARD MEMBER 48629 CLINIC MANAGER OF THE ORGANIZATION 0 FORM 990, PART VI, SECTION A, LINE 1 UNLESS PROHIBITED OR LIMITED BY THE ARTICLES OF INCORPORATION OR THESE BYLAWS, THE BOARD OF DIRECTORS MAY CREATE AN EXECUTIVE COMMITTEE AND ONE OR MORE THAN OTHER COMMITTEES OF THE BOARD AND APPOINT MEMBERS OF THE BOARD OF DIRECTORS TO SERVE ON THEM. FORM 990, PART VI, SECTION A, LINE 3 MEDICAL MANAGEMENT SERVICES IS RESPONSIBLE FOR THE DAILY MANAGEMENT OPERATIONS OF THE APA CLINICS AND APA BUSINESS OFFICE INCLUDING PERFOMRING BUDGETS AND EXPENSE APPROVAL. MEDICAL MANAGEMENT SERVICES RECOMMENDS STAFFING PERSONNAL TO THE FACILITY BUT THE FACILITY HAS THE FINAL APPROVAL FOR ALL HIRING AND FIRING OF EMPLOYEES INCLUDING PHYSICIANS. FORM 990, PART VI, SECTION A, LINE 6 ANDERSON REGIONAL MEDICAL CENTER (ARMC) IS THE SOLE MEMBER OF ANDERSON PHYSICIAN ALLIANCE, INC. FORM 990, PART VI, SECTION A, LINE 7A ANDERSON REGIONAL MEDICAL CENTER HAS THE POWER (1) TO APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS, (2) TO EXERCICE ALL VOTING RIGHTS OF THE MEMBERS FORM 990, PART VI, SECTION A, LINE 7B ANDERSON REGIONAL MEDICAL CENTER HAS THE POWER (1) TO APRROVE APA'S PHYSICIAN COMPENSATION MODELS, PHYSICIAN COMPENSATION AND PHYSICIAN COMPENSATION POLICIES, (2) TO APPROVE PHYSICIAN EMPLOYMENT AGREEMENTS, AND (3) TO INITIATE AND/OR APPROVE VARIOUS OTHER ACTIONS AND POLICIES AS ENUMERATED IN APA'S CERTIFICATE OF INCORPORATION AND BYLAWS, AND AS REQUIRED BY STATE LAW. FORM 990, PART VI, SECTION B, LINE 11 EACH BOARD MEMBER WAS PROVIDED A COPY OF THE FORM 990. THE BOARD MEMBERS WERE ASKED TO REVIEW THE FORM AND SUBMIT QUESTIONS AND COMMENTS PROIR TO THE FORM 990 BEING FINALIZED. AFTER REVIEW, THE FINALIZED FORM 990 WAS PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND REQUESTS ALL BOARD MEMBERS TO ANNUALLY DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF ARMC HAS A DESIGNATED THREE (3) PERSON COMMITTEE OF INDEPENDENT BOARD MEMBERS TO REVIEW AND APPROVE COMPENSATION. THE BOARD ALSO HAD A CONTRACT FOR PROFESSIONAL SERVICES WITH MERCER UNTIL JULY 1, 2013 AND CURRENTLY USES SULLIVAN COTTER TO STUDY AND RECOMMEND COMPENSATION FOR THE CEO, THE VICE PRESIDENTS, AND THE DIRECTORS OF THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE MADE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 102,976. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,976. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 348,343. MANAGEMENT AND GENERAL EXPENSES 401,698. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 750,041. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,000. ANDERSON REGIONAL MEDICAL CENTER 2124 14TH STREET MERIDIAN MS 39301 640362400 HEALTHCARE MS 501(C)(3) LINE 3 N/A 0 MEDICAL SUPPORT AND DEVELOPMENT ORGANIZATION 122 WOODMONT WAY RIDGELAND MS 39157 640722433 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11C, III-FI ANDERSON REGIONAL MEDICAL CENTER 0 ANDERSON SUPPORT AND DEVELOPMENT FOUNDATION 7651 POPLAR SPRINGS DR MERIDIAN MS 39305 640730109 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11D, III-O ANDERSON REGIONAL MEDICAL CENTER 0 MIRACLES OF GRACE FOUNDATION 1827 SUNRISE LANE TOOMSUBA MS 39364 640730366 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11C, III-FI ANDERSON REGIONAL MEDICAL CENTER 0 CARE CONSISTENCY FOUNDATION INC 7761 MEADOW CIRCLE MERIDIAN MS 39305 640730846 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11D, III-O ANDERSON REGIONAL MEDICAL CENTER 0 ANDERSON HOSPITAL PROVIDERS INC 2124 14TH STREET MERIDIAN MS 39301 461305481 PHYSICIAN BILLING MS 501(C)(3) LINE 3 ANDERSON REGIONAL MEDICAL CENTER 0 ANDERSON ANESTHESIA PROVIDERS 2124 14TH STREET MERIDIAN MS 39301 464069816 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 3 ANDERSON REGIONAL MEDICAL CENTER 0 EAST MISSISSIPPI ENDOSCOPY CENTER 1926 23RD AVENUE MERIDIAN MS 39301 440884792 HEALTHCARE MS N/A JARMC LEVERAGE LLC 2124 14TH STREET MERIDIAN MS 39301 272284311 INVESTMENTS MS N/A ARMC HOSPITAL PROF & GEN LLFT 512 22ND AVENUE MERIDIAN MS 39301 206131090 TRUST MS N/A T 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1