APPALACHIAN EMERGENCY PHYSICIANS: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- APPALACHIAN EMERGENCY PHYSICIANS (EIN 80-0592504)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-13
- IRS object ID
- 201401339349305020
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-05-13T16:01:12-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 621517792 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERSHING YOAKLEY & ASSOCIATES PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 800592504 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | APPALACHIAN EMERGENCY PHYSICIANS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | APPA | NameControl |
| Phone | 8049679604 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | C STEVEN KILGORE | Name |
| Title | PRESIDENT | Title |
| Phone | 8049679604 | Phone |
| Date Signed | 2014-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEBORAH O ERNSBERGER | Name |
| PTIN | P00364912 | PTIN |
| Phone | 8656730844 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | C STEVEN KILGORE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 29434006 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2010 | YearFormation |
| State Legal Domicile | VA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE EMERGENCY PHYSICIANS SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 5727789 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 7270966 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 21654182 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 22163040 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27381971 | TotalRevenuePriorYear |
| Total Revenue Current Year | 29434006 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 27381971 | OtherExpensePriorYear |
| Other Expenses Current Year | 29470040 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 27381971 | TotalExpensesPriorYear |
| Total Expenses Current Year | 29470040 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 0 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -36034 | RevenuesLessExpensesCY |
| Total Assets BOY | 2931798 | TotalAssetsBOY |
| Total Assets EOY | 4418747 | TotalAssetsEOY |
| Total Liabilities BOY | 2931798 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4454781 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 0 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -36034 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 29289243 | Expense |
| Revenue | 22163040 | Revenue |
| Description | - 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). NORTON COMMUNITY HOSPITAL (VA). DICKENSON COMMUNITY HOSPITAL (VA). RUSSELL COUNTY MEDICAL CENTER (VA), AND. SMYTH 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. | Description |
| Total Program Service Expense | 29289243 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 96 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | VA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REBECCA V SIMERLY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4239155165 | TelephoneNumber |
Address US AddressUS
| 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 | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| CANDACE JENNINGS | |||||||
| SECRETARY/MSHA SVP | 2.00 | 40.00 | X | X | 0 | 504935 | 31650 |
| ANN FLEMING | |||||||
| DIRECTOR/MSHA SVP | 1.00 | 40.00 | X | 0 | 426280 | 21553 | |
| CLAY RUNNELS MD | |||||||
| DIRECTOR | 5.00 | 40.00 | X | 0 | 378217 | 24832 | |
| BERT SMITH MD | |||||||
| DIRECTOR | 1.00 | 40.00 | X | 0 | 375394 | 15791 | |
| TY PUTNAM MD | |||||||
| DIRECTOR | 1.00 | 40.00 | X | 0 | 473554 | 680 | |
| TODD JONES | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| STEPHEN GODSON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| BILL MILLER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| C STEVEN KILGORE | |||||||
| PRESIDENT/BRMMC PRESIDENT | 2.00 | 40.00 | X | 0 | 379828 | 54871 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2538208 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 149377 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MOUNTAIN STATES EMERGENCY PHYSICIANS LL | |||||
| PO BOX 674579 | DETROIT | MI | 482674579 | MANAGEMENT & BILLING SERVICES | 3581721 |
| SOUTHWEST VIRGINIA EMERGENCY PHYSICIANS | |||||
| PO BOX 674579 | DETROIT | MI | 482674580 | MANAGEMENT & BILLING SERVICES | 1465143 |
| RBE PLLC | |||||
| 599 S MEADOW LARK LANE | MARION | VA | 24354 | PHYSICIANS SERVICES | 528652 |
| JOHN R HOLLAND MD | |||||
| 3500 CIMARRON DRIVE | JOHNSON CITY | TN | 37601 | PHYSICIANS SERVICES | 436826 |
| CHRISTOPHER S SMITH MD | |||||
| 1233 RESERVE PLACE | JOHNSON CITY | TN | 37615 | PHYSICIANS SERVICES | 408283 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 57 | NumberOfContractorsGT100K |
| Related Organizations | 6766827 | RelatedOrganizations |
| All Other Contributions | 504139 | AllOtherContributions |
| Total Contributions | 7270966 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 22163040 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22163040 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 22163040 | TotalProgramServiceRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29434006 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22163040 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11137 | Total |
| Program Services | 11137 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6000 | Total |
| Program Services | 6000 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26621373 | Total |
| Program Services | 26621373 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86945 | Total |
| Management And General | 86945 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63029 | Total |
| Management And General | 63029 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12401 | Total |
| Program Services | 12401 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21304 | Total |
| Program Services | 21304 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21239 | Total |
| Management And General | 21239 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 390 | Total |
| Management And General | 390 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1592537 | Total |
| Program Services | 1592537 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 721776 | 721776 | |
| RECRUITMENT | 263249 | 263249 | |
| LICENSES & DUES | 30780 | 30780 | |
| REPAIRS & MAINTENANCE | 17880 | 8686 | 9194 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29470040 | Total |
| Program Services | 29289243 | ProgramServices |
| Management And General | 180797 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29931 | BOY |
| EOY | 348820 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2132264 | BOY |
| EOY | 2348078 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 119603 | BOY |
| EOY | 224934 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 650000 | BOY |
| EOY | 650000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 846915 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2931798 | BOY |
| EOY | 4418747 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2449814 | BOY |
| EOY | 4098648 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 481984 | BOY |
| EOY | 356027 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 106 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2931798 | BOY |
| EOY | 4454781 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | -36034 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | -36034 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2931798 | BOY |
| EOY | 4418747 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -36034 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 2347737 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5727789 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7270966 | CurrentTaxYear |
| Total | 15346492 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 14125152 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 21654182 | CurrentTaxYearMinus1Year |
| Current Tax Year | 22163040 | CurrentTaxYear |
| Total | 57942374 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 16472889 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 27381971 | CurrentTaxYearMinus1Year |
| Current Tax Year | 29434006 | CurrentTaxYear |
| Total | 73288866 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 73288866 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 1644 | CurrentTaxYearMinus2Years |
| Total | 1644 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 1644 | CurrentTaxYearMinus2Years |
| Total | 1644 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 16474533 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 27381971 | CurrentTaxYearMinus1Year |
| Current Tax Year | 29434006 | CurrentTaxYear |
| Total | 73290510 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | X | First5Years509 |
| Public Support Percentage509 | 1.00000 | PublicSupportPercentage509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER RECEIVABLES | Description |
| Book Value | 846915 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 846915 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO AFFILIATE | Description |
| Amount | $106 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 106 | TotalOfAmounts |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 1 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CANDACE JENNINGS | ||||||||||||||
| SECRETARY/MSHA SVP | 0 | 402118 | 0 | 82014 | 0 | 20803 | 0 | 12500 | 0 | 19150 | 0 | 536585 | 0 | 0 |
| ANN FLEMING | ||||||||||||||
| DIRECTOR/MSHA SVP | 0 | 351697 | 0 | 51836 | 0 | 22747 | 0 | 12500 | 0 | 9053 | 0 | 447833 | 0 | 0 |
| CLAY RUNNELS MD | ||||||||||||||
| DIRECTOR | 0 | 328822 | 0 | 46387 | 0 | 3008 | 0 | 6738 | 0 | 18094 | 0 | 403049 | 0 | 0 |
| BERT SMITH MD | ||||||||||||||
| DIRECTOR | 0 | 262174 | 0 | 70336 | 0 | 42884 | 0 | 2968 | 0 | 12823 | 0 | 391185 | 0 | 0 |
| TY PUTNAM MD | ||||||||||||||
| DIRECTOR | 0 | 436913 | 0 | 36000 | 0 | 641 | 0 | 0 | 0 | 680 | 0 | 474234 | 0 | 0 |
| C STEVEN KILGORE | ||||||||||||||
| PRESIDENT/BRMMC PRESIDENT | 0 | 301393 | 0 | 59898 | 0 | 18537 | 0 | 30396 | 0 | 24475 | 0 | 434699 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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, CANDACE JENNINGS, AND STEVEN KILGORE. 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 $35,925 CANDACE JENNINGS $41,057 STEVEN KILGORE $15,396 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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, CLAY RUNNELS, M.D., BERT SMITH, M.D., TY PUTNAM, M.D., AND PRESIDENT STEVEN KILGORE RECEIVE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS DERIVED FROM SERVICES THEY PROVIDED AS EMPLOYEES. AEP DOES NOT COMPENSATE ITS DIRECTORS OR OFFICERS. | DIRECTOR COMPENSATION: |
| FORM 990, PART IX, LINE 11G | CONSULTING FEES: PROGRAM SERVICE EXPENSES 14,247. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,247. MEDICAL DIRECTOR & PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 21,901,308. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,901,308. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,910,510. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,910,510. MANAGEMENT FEES: PROGRAM SERVICE EXPENSES -204,692. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -204,692. | OTHER FEES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | 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 | 0 | MOUNTAIN STATES HEALTH ALLIANCE | |
| JOHNSTON MEMORIAL HOSPITAL INC | |||||||||||
| 16000 JOHNSTON MEMORIAL DRIVE | ABINGDON | VA | 24211 | 540544705 | HOSPITAL | VA | 501(C)(3) | LINE 3 | 0 | MOUNTAIN STATES HEALTH ALLIANCE | |
| 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 | |
| MOUNTIAN 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 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| INTEGRATED SOLUTIONS HEALTH NETWORK LLC | |||||||
| 400 N STATE OF FRANKLIN ROAD | 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 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| 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 | |||||||||
| 208 SUNSET DRIVE SUITE 101 | 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 Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |