APPALACHIAN EMERGENCY PHYSICIANS: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- APPALACHIAN EMERGENCY PHYSICIANS (EIN 80-0592504)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-12
- IRS object ID
- 201531329349301438
- Schema version
- 2013v4.0
- 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 | 2015-05-12T09:43:09-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621517792 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERSHING YOAKLEY & ASSOCIATES PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE CHEROKEE MILLS 2220 SUTHERLAND | AddressLine1 |
| Address Line2 | AVE | AddressLine2 |
| City | KNOXVILLE | City |
| State | TN | State |
| ZIP Code | 379192363 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 800592504 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | APPALACHIAN EMERGENCY PHYSICIANS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | APPA | BusinessNameControlTxt |
| Phone | 8049679604 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 W OAKLAND AVENUE SUITE 207 | AddressLine1 |
| City | JOHNSON CITY | City |
| State | TN | State |
| ZIP Code | 37604 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK WILKINSON MD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 8049679604 | PhoneNum |
| Signature | 2015-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DEBORAH O ERNSBERGER | PreparerPersonNm |
| PTIN | P00364912 | PTIN |
| Phone | 8656730844 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK WILKINSON MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 W OAKLAND AVENUE SUITE 207 | AddressLine1 |
| City | JOHNSON CITY | City |
| State | TN | State |
| ZIP Code | 37604 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,084,214 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EMERGENCY PHYSICIANS SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $7,270,966 | PYContributionsGrantsAmt |
| CY Contributions Grants | $9,501,269 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,163,040 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,582,945 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $29,434,006 | PYTotalRevenueAmt |
| CY Total Revenue | $30,084,214 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,470,040 | PYOtherExpensesAmt |
| CY Other Expenses | $30,084,213 | CYOtherExpensesAmt |
| PY Total Expenses | $29,470,040 | PYTotalExpensesAmt |
| CY Total Expenses | $30,084,213 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$36,034 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,418,747 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,292,687 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,454,781 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,328,720 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$36,034 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$36,033 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | APPALACHIAN EMERGENCY PHYSICIANS IS ORGANIZED AND OPERATED FOR CHARITABLE PURPOSES, WHICH INCLUDE THE PROVISION OF EMERGENCY PHYSICIAN SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,913,680 | ExpenseAmt |
| Revenue | $20,582,945 | RevenueAmt |
| Desc | - APPALACHIAN EMERGENCY PHYSICIANS ("AEP") IS A VIRGINIA NONSTOCK CORPORATION THAT IS ORGANIZED AND OPERATED FOR CHARITABLE PURPOSES, WHICH INCLUDE THE PROVISION OF EMERGENCY PHYSICIAN SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. AEP HAS NO MEMBERS AND IS GOVERNED BY ITS BOARD OF DIRECTORS.- AEP HAS A CLOSE CONNECTION WITH MOUNTAIN STATES HEALTH ALLIANCE ("MSHA"), WHICH IS A NONPROFIT TENNESSEE CORPORATION THAT IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAXATION UNDER IRC SECTION 501(C)(3). MSHA OWNS AND OPERATES SEVERAL ACUTE CARE HOSPITAL FACILITIES AND OTHER HEALTHCARE FACILITIES WITHIN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. MSHA HAS ENCOUNTERED PROBLEMS IN SECURING COMPREHENSIVE PHYSICIAN COVERAGE FOR ITS HOSPITALS WITHIN THE FIELD OF EMERGENCY MEDICINE. MSHA HELPED TO FACILITATE THE FORMATION OF AEP TO CONTRACT WITH MSHA-AFFILIATED ACUTE CARE HOSPITALS FOR PHYSICIAN COVERAGE. AS WITH ALL MSHA-AFFILIATED HOSPITALS, AEP WILL ENSURE THAT PATIENTS ARE TREATED FOR MEDICALLY NECESSARY CONDITIONS REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, IN A MANNER CONSISTENT WITH MSHA'S CHARITY CARE PROGRAM. IN RECOGNIZING THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES, AEP WILL NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. MSHA'S CHARITY CARE POLICY HAS BEEN ADOPTED BY THE AEP BOARD.- AEP IS ORGANIZED AND OPERATED AS AN EMERGENCY PHYSICIAN DEVELOPMENT SERVICE. SPECIFICALLY, AEP WILL (I) RECRUIT AND CONTRACT WITH A STABLE BASE OF PHYSICIANS AND MID-LEVEL PROVIDERS (E.G., NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS) TO SUPPORT THE LEVEL OF EMERGENCY MEDICAL CARE REQUIRED FOR MSHA ACUTE CARE HOSPITAL FACILITIES; (II) CREATE A VEHICLE FOR FUTURE COLLABORATION BETWEEN MSHA HOSPITALS AND THEIR MEDICAL STAFFS; AND (III) STABILIZE THE PROVISION OF EMERGENCY CARE THROUGH EXISTING PHYSICIAN PRACTICES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. AEP PROVIDES EMERGENCY MEDICINE PROFESSIONAL COVERAGE BY CONTRACT FOR THE FOLLOWING MSHA HOSPITALS:JOHNSON CITY MEDICAL CENTER (TN)FRANKLIN WOODS COMMUNITY HOSPITAL (TN)NISWONGER CHILDREN'S HOSPITAL (TN CHILDREN'S HOSPITAL)INDIAN PATH MEDICAL CENTER (TN)SYCAMORE SHOALS HOSPITAL (TN)JOHNSON COUNTY COMMUNITY HOSPITAL (TN)UNICOI COUNTY MEMORIAL HOSPITAL (TN)NORTON COMMUNITY HOSPITAL (VA)DICKENSON COMMUNITY HOSPITAL (VA)RUSSELL COUNTY MEDICAL CENTER (VA), ANDSMYTH COUNTY COMMUNITY HOSPITAL (VA).- EACH OF THESE HOSPITAL FACILITIES IS EITHER WHOLLY OR PARTIALLY OWNED BY MSHA. MSHA IS A NONPROFIT HEALTH SYSTEM BASED IN JOHNSON CITY, TENNESSEE. MSHA IS TAX-EXEMPT UNDER IRC SECTION 501(C)(3) AND FORMED AEP IN AN EFFORT TO ENSURE THAT EACH OF THE AFOREMENTIONED HOSPITALS WOULD HAVE COMPREHENSIVE AND CONTINUOUS PHYSICIAN COVERAGE FOR ITS RESPECTIVE EMERGENCY DEPARTMENT. SUCH SERVICES ARE PROVIDED BY AEP IN AN EFFORT TO COMPLEMENT MSHA'S PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY.- MEDICAL SERVICES WOULD BE PROVIDED TO INDIVIDUALS PRESENTING TO THE EMERGENCY DEPARTMENT OF ONE OF THE AFOREMENTIONED HOSPITAL FACILITIES AND WOULD BE BASED UPON EMERGENCY MEDICAL NEED. AEP FOLLOWS THE INDIGENT CARE POLICIES AND PROCEDURES ADOPTED BY MSHA AND EACH OF THE AFOREMENTIONED HOSPITAL FACILITIES FOR THE TREATMENT OF PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY.- AS SUCH SERVICES ARE MADE AVAILABLE TO THE GENERAL PUBLIC, AEP MAY INCIDENTALLY PROVIDE EMERGENCY SERVICES TO OFFICERS, DIRECTORS, EMPLOYEES AND INDEPENDENT CONTRACTORS, HOWEVER, SUCH INDIVIDUALS WOULD NOT BE TREATED DIFFERENTLY THAN OTHER PATIENTS AND SUCH SERVICES WOULD ONLY BE MADE AVAILABLE IN THE NORMAL COURSE OF AEP'S BUSINESS OPERATIONS. | Desc |
| Total Program Service Expenses | $29,913,680 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 102 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEVIN JIA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4239155102 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 W OAKLAND AVE SUITE 207 | AddressLine1 |
| City | JOHNSON CITY | City |
| State | TN | State |
| ZIP Code | 37604 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| MARK WILKINSON MD | ||||||||
| PRESIDENT | 2.00 | 55.00 | Yes (X) | Yes (X) | $0 | $371,159 | $37,078 | |
| CANDACE JENNINGS | ||||||||
| SECRETARY/MSHA SVP | 2.00 | 55.00 | Yes (X) | Yes (X) | $0 | $523,529 | $85,889 | |
| ANN FLEMING | ||||||||
| DIRECTOR/MSHA SVP | 1.00 | 55.00 | Yes (X) | $0 | $753,909 | $73,411 | ||
| BERT SMITH MD | ||||||||
| DIRECTOR | 1.00 | 55.00 | Yes (X) | $0 | $397,140 | $22,368 | ||
| TY PUTNAM MD | ||||||||
| DIRECTOR | 1.00 | 55.00 | Yes (X) | $0 | $471,052 | $14,860 | ||
| TODD JONES | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN GOODSON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BILL MILLER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CLAY RUNNELS MD | ||||||||
| FORMER PRESIDENT | 0.00 | 55.00 | $0 | $374,857 | $35,560 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,891,646 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $269,166 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MOUNTAIN STATES EMERGENCY PHYSICIANS LL | |||||
| PO BOX 674579 | DETROIT | MI | 482674579 | MANAGEMENT & BILLING SERVICES | $2,774,899 |
| SOUTHWEST VIRGINIA EMERGENCY PHYSICIANS | |||||
| PO BOX 674579 | DETROIT | MI | 482674580 | MANAGEMENT & BILLING SERVICES | $1,465,485 |
| KENT SWRIGHT MD | |||||
| 1235 AUSTIN SPRINGS ROAD | PINEY FLATS | TN | 37686 | PHYSICIAN SERVICES | $417,455 |
| GARIK T MISENAR MD | |||||
| 3044 HIGHLAND GROVE DRIVE | JOHNSON CITY | TN | 37615 | PHYSICIAN SERVICES | $404,183 |
| JAMES H BURLESON | |||||
| 2545 ESSEX DRIVE | KINGSPORT | TN | 37660 | PHYSICIAN SERVICES | $394,808 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 62 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $9,187,156 | RelatedOrganizationsAmt |
| All Other Contributions | $314,113 | AllOtherContributionsAmt |
| Total Contributions | $9,501,269 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $20,582,945 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,582,945 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,582,945 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,084,214 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,582,945 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,985 | TotalAmt |
| Program Services | $28,985 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,975 | TotalAmt |
| Program Services | $17,975 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,323,110 | TotalAmt |
| Program Services | $27,323,110 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,835 | TotalAmt |
| Management And General | $80,835 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,420 | TotalAmt |
| Management And General | $64,420 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,456 | TotalAmt |
| Program Services | $32,456 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,423 | TotalAmt |
| Program Services | $22,423 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,794 | TotalAmt |
| Management And General | $14,794 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $390 | TotalAmt |
| Management And General | $390 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,525,665 | TotalAmt |
| Program Services | $1,525,665 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $663,285 | $663,285 | |
| RECRUITMENT | $275,882 | $275,882 | |
| LICENSES & DUES | $17,695 | $17,695 | |
| REPAIRS & MAINTENANCE | $16,298 | $6,204 | $10,094 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,084,213 | TotalAmt |
| Program Services | $29,913,680 | ProgramServicesAmt |
| Management And General | $170,533 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $348,820 | BOYAmt |
| EOY | $1,111,819 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,348,078 | BOYAmt |
| EOY | $1,740,672 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $224,934 | BOYAmt |
| EOY | $89,600 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $650,000 | BOYAmt |
| EOY | $650,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $846,915 | BOYAmt |
| EOY | $700,596 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,418,747 | BOYAmt |
| EOY | $4,292,687 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,098,648 | BOYAmt |
| EOY | $4,105,094 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $356,027 | BOYAmt |
| EOY | $223,626 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $106 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,454,781 | BOYAmt |
| EOY | $4,328,720 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$36,034 | BOYAmt |
| EOY | -$36,033 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$36,034 | BOYAmt |
| EOY | -$36,033 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,418,747 | BOYAmt |
| EOY | $4,292,687 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | 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 Minus3 Years | $2,347,737 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,727,789 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,270,966 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,501,268 | CurrentTaxYearAmt |
| Total | $24,847,760 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $14,125,152 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,654,182 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $22,163,040 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,582,945 | CurrentTaxYearAmt |
| Total | $78,525,319 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $16,472,889 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,381,971 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,434,006 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,084,213 | CurrentTaxYearAmt |
| Total | $103,373,079 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $103,373,079 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $1,644 | CurrentTaxYearMinus3YearsAmt |
| Total | $1,644 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $1,644 | CurrentTaxYearMinus3YearsAmt |
| Total | $1,644 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $16,474,533 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,381,971 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,434,006 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,084,213 | CurrentTaxYearAmt |
| Total | $103,374,723 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | Yes (X) | First5Years509Ind |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER RECEIVABLES | Desc |
| Book Value | $700,596 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $700,596 | TotalBookValueOtherAssetsAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | Yes (1) | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK WILKINSON MD | ||||||||||||||
| PRESIDENT | $0 | $332,573 | $0 | $34,304 | $0 | $4,282 | $0 | $10,940 | $0 | $26,138 | $0 | $408,237 | $0 | $0 |
| CANDACE JENNINGS | ||||||||||||||
| SECRETARY/MSHA SVP | $0 | $419,157 | $0 | $85,228 | $0 | $19,144 | $0 | $60,753 | $0 | $25,136 | $0 | $609,418 | $0 | $0 |
| ANN FLEMING | ||||||||||||||
| DIRECTOR/MSHA SVP | $0 | $383,151 | $0 | $87,911 | $0 | $282,847 | $0 | $55,452 | $0 | $17,959 | $0 | $827,320 | $0 | $0 |
| BERT SMITH MD | ||||||||||||||
| DIRECTOR | $0 | $307,421 | $0 | $62,736 | $0 | $26,983 | $0 | $4,869 | $0 | $17,499 | $0 | $419,508 | $0 | $0 |
| TY PUTNAM MD | ||||||||||||||
| DIRECTOR | $0 | $438,452 | $0 | $32,000 | $0 | $600 | $0 | $13,200 | $0 | $1,660 | $0 | $485,912 | $0 | $0 |
| CLAY RUNNELS MD | ||||||||||||||
| FORMER PRESIDENT | $0 | $337,665 | $0 | $34,304 | $0 | $2,888 | $0 | $10,927 | $0 | $24,633 | $0 | $410,417 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE FOLLOWING PROCESS IS UTILIZED BY MOUNTAIN STATES HEALTH ALLIANCE ("MSHA"), THE RELATED ORGANIZATION FROM WHICH REPORTABLE COMPENSATION IS DISCLOSED ON SCHEDULE J, PART II: THE MSHA COMPENSATION COMMITTEE, WHICH IS THE EXECUTIVE COMMITTEE OF THE MSHA BOARD, OBTAINS THE SERVICES OF AN OUTSIDE AND INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM COMPENSATION SURVEYS AND WITH ADVICE WHEN THE COMMITTEE APPROVES PAY AND BENEFITS FOR MSHA EXECUTIVES. |
| PART I, LINES 4B-C | THE FOLLOWING EXECUTIVES LISTED IN J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE ("MSHA"): ANN FLEMING AND CANDACE JENNINGS. THE 457(F) RETIREMENT PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN). THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON" OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24 MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: ANN FLEMING $39,222 CANDACE JENNINGS $42,847 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE TAX RETURN IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND THEN SUBMITTED TO INTERNAL MANAGEMENT FOR INTERNAL REVIEW. COPIES ARE AVAILABLE TO THE ENTIRE BOARD FOR REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C | EVERY COVERED PERSON AS DEFINED BY THE CONFLICTS OF INTEREST POLICY ADOPTED BY THE BOARD OF DIRECTORS SHALL BE SUBJECT TO THAT POLICY. AS PART OF SAID POLICY, EVERY COVERED PERSON SHALL COMPLETE A CONFLICTS OF INTEREST DISCLOSURE STATEMENT IN ACCORDANCE WITH THE REQUIREMENT OF THE CONFLICTS OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | AEP DOES NOT COMPENSATE ITS DIRECTORS OR OFFICERS. AEP HAS ENTERED INTO PROFESSIONAL SERVICE CONTRACTS WITH PHYSICIANS TO ASSIST AEP IN PROVIDING EMERGENCY SERVICE COVERAGE TO HOSPITALS. THESE AGREEMENTS MAY INCLUDE FIXED RATES AND BONUSES BASED ON PRODUCTIVITY OR ACHIEVING QUALITY, PATIENT SATISFACTION SCORES OR OTHER QUALITY METRICS. THE METHODOLOGY OR AMOUNT OF THE BONUS IS FIXED AND SET IN ADVANCE WITHIN EACH CONTRACT. BONUS FORMULAS ARE BASED UPON REACHED PRE-DETERMINED AND OBJECTIVELY VERIFIABLE PERFORMANCE METRICS. IN ADDITION TO ADDRESSING EXCESS BENEFIT, PRIVATE INUREMENT AND PRIVATE BENEFIT CONCERNS, AEP'S COMPENSATION ARRANGEMENTS ARE STRUCTURED IN A MANNER TO COMPLY WITH APPLICABLE FRAUD AND ABUSE LAWS THAT APPLY TO HEALTH CARE PROVIDERS. AEP HAS NEGOTIATED EACH OF ITS COMPENSATION ARRANGEMENTS AT ARM'S LENGTH. THE AGREEMENTS INCLUDE COMMERCIALLY REASONABLE TERMS AND CONDITIONS WITH A COMPENSATION ARRANGEMENT THAT IS CONSISTENT WITH FAIR MARKET VALUE FOR THE SERVICES RENDERED. THE TERMS AND CONDITIONS OF SUCH ARRANGEMENTS HAVE BEEN, ARE AND WILL CONTINUE TO BE SET THROUGH GOOD FAITH NEGOTIATIONS AMONG THE RELEVANT PARTIES IN AN EFFORT TO BE CONSISTENT WITH SIMILAR ARRANGEMENTS FOR OTHER HEALTH CARE PROVIDERS PROVIDING SIMILAR SERVICES IN SIMILAR SPECIALTIES WITHIN SOUTHWESTERN VIRGINIA AND NORTHEASTERN TENNESSEE. NATIONAL PHYSICIAN COMPENSATION SURVEY DATA (E.G., MGMA PHYSICIAN COMPENSATION SURVEY) AND OTHER OBJECTIVE COMPARABLE DATA HAS BEEN AND WILL CONTINUE TO BE USED AS THE BASIS FOR SETTING PHYSICIAN COMPENSATION ARRANGEMENTS. AEP ALSO UTILIZES THE SERVICES OF NATIONALLY-RECOGNIZED VALUATION FIRMS TO EVALUATE CERTAIN PROPOSED COMPENSATION ARRANGEMENTS TO ENSURE THAT THEY ARE CONSISTENT WITH FAIR MARKET VALUE AND ARE COMMERCIALLY REASONABLE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CONFLICT OF INTEREST POLICY, IN ADDITION TO OTHER GOVERNING POLICIES, IS AVAILABLE UPON REQUEST. ALL CORPORATE POLICIES AND CORPORATE FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST. |
| FORM 990, PART VII, SECTION A, | BOARD OF DIRECTORS MEMBERS CANDACE JENNINGS, ANN FLEMING, BERT SMITH, M.D., TY PUTNAM, M.D., FORMER PRESIDENT CLAY RUNNELS, M.D., AND PRESIDENT MARK WILKINSON, M.D. RECEIVE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS DERIVED FROM SERVICES THEY PROVIDED AS EMPLOYEES. AEP DOES NOT COMPENSATE ITS DIRECTORS OR OFFICERS. |
| FORM 990, PART IX, LINE 11G | CONSULTING FEES: PROGRAM SERVICE EXPENSES 1,603. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,603. MEDICAL DIRECTOR & PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 22,569,263. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,569,263. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,876,162. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,876,162. MANAGEMENT FEES: PROGRAM SERVICE EXPENSES -123,918. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -123,918. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MOUNTAIN STATES HEALTH ALLIANCE | |||||||||||
| 400 N STATE OF FRANKLIN ROAD | JOHNSON CITY | TN | 37604 | 620476282 | HOSPITAL SYSTEM | TN | 501(C)(3) | LINE 3 | N/A | 0 | |
| DICKENSON COMMUNITY HOSPITAL INC | |||||||||||
| ONE HOSPITAL DRIVE | CLINTWOOD | VA | 24228 | 770599553 | HOSPITAL | VA | 501(C)(3) | LINE 3 | 0 | NORTON COMMUNITY HOSPITAL | |
| MOUNTAIN STATES HOSPITAL ALLIANCE AUXILIARY INC | |||||||||||
| 400 N STATE OF FRANKLIN ROAD | JOHNSON CITY | TN | 37604 | 581418345 | SUPPORTING ORGANIZATION TO MSHA HOSPITALS | TN | 501(C)(3) | LINE 11A, I | 0 | MOUNTAIN STATES HEALTH ALLIANCE | |
| SMYTH COUNTY COMMUNITY HOSPITAL | |||||||||||
| 565 RADIO HILL ROAD | MARION | VA | 24354 | 540794913 | HOSPITAL | VA | 501(C)(3) | LINE 3 | 0 | MOUNTAIN STATES HEALTH ALLIANCE | |
| NORTON COMMUNITY HOSPITAL | |||||||||||
| 100 15TH STREET NW | NORTON | VA | 24273 | 540566029 | HOSPITAL | VA | 501(C)(3) | LINE 3 | N/A | 0 | |
| JOHNSTON MEMORIAL HOSPITAL INC | |||||||||||
| 16000 JOHNSTON MEMORIAL DRIVE | ABINGDON | VA | 24211 | 540544705 | HOSPITAL | VA | 501(C)(3) | LINE 3 | N/A | 0 | |
| ABINGDON PHYSICIAN PARTNERS | |||||||||||
| 16000 JOHNSTON MEMORIAL DRIVE | ABINGDON | VA | 24211 | 205485346 | MEDICAL SERVICES | VA | 501(C)(3) | LINE 11A, I | 0 | JOHNSTON MEMORIAL HOSPITAL INC | |
| MOUNTAIN STATES FOUNDATION | |||||||||||
| 2335 KNOB CREEK ROAD STE 101 | JOHNSON CITY | TN | 37604 | 581418862 | FUNDRAISING FOR MSHA HOSPITALS | TN | 501(C)(3) | LINE 11A, I | 0 | MOUNTAIN STATES HEALTH ALLIANCE | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| INTEGRATED SOLUTIONS HEALTH NETWORK LLC | |||||||
| 509 MED TECH PARKWAY STE 100 | JOHNSON CITY | TN | 37604 | 621711997 | INVESTMENT COMPANY | TN | N/A |
| EMMAUS COMMUNITY HEALTHCARE LLC | |||||||
| 6070 HWY 11E | PINEY FLATS | TN | 37686 | 200577483 | MEDICAL SERVICES | TN | N/A |
| MEDICAL SPECIALISTS OF JOHNSON CITY LLC | |||||||
| 2528 WESLEY STREET SUITE 2 | JOHNSON CITY | TN | 37601 | 272199037 | MEDICAL SERVICES | TN | N/A |
| EAST TENN AMBULATORY SURGERY CENTER LLC | |||||||
| 701 MED TECH PARKWAY STE 100 | JOHNSON CITY | TN | 37604 | 621787337 | MEDICAL SERVICES | TN | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BLUE RIDGE MEDICAL MANAGEMENT CORPORATION | |||||||||
| 1021 W OAKLAND AVE STE 207 | JOHNSON CITY | TN | 37604 | 621490616 | PHYSICIAN OFFICES | TN | N/A | C | 0 |
| MEDISERVE MEDICAL EQUIPMENT OF KINGSPORT INC | |||||||||
| 1021 W OAKLAND AVE STE 207 | JOHNSON CITY | TN | 37604 | 621212286 | DURABLE MEDICAL EQUIPMENT CO. | TN | N/A | C | 0 |
| MOUNTAIN STATES PROPERTIES INC | |||||||||
| 1021 W OAKLAND AVE STE 207 | JOHNSON CITY | TN | 37604 | 621845895 | PROPERTY MANAGEMENT | TN | N/A | C | 0 |
| MOUNTAIN STATES PHYSICIAN GROUP INC | |||||||||
| 1021 W OAKLAND AVE STE 207 | JOHNSON CITY | TN | 37604 | 621700412 | HEALTHCARE SERVICES | TN | N/A | C | 0 |
| COMMUNITY HOME CARE INC | |||||||||
| 1460 PARK AVENUE | NORTON | VA | 24273 | 541453810 | MEDICAL EQUIP. SALES & RENTAL | VA | N/A | C | 0 |
| SOUTHWEST COMMUNITY HEALTH SERVICES INC | |||||||||
| PO BOX 880 | MARION | VA | 24354 | 541460695 | MEDICAL SERVICES | VA | N/A | C | 0 |
| CRESTPOINT HEALTH INSURANCE COMPANY INC | |||||||||
| 509 MED TECH PARKWAY STE 100 | JOHNSON CITY | TN | 37604 | 620381170 | INSURANCE | TN | N/A | C | 0 |
| WILSON PHARMACY INC | |||||||||
| PO BOX 5289 | JOHNSON CITY | TN | 37602 | 620329587 | PHARMACY | TN | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |