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WELLMONT HEALTH SYSTEM: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
WELLMONT HEALTH SYSTEM (EIN 62-1636465)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-22
IRS object ID
201231439349300108
Schema version
2010v3.7
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

FieldValueIRS element (for citing)
Timestamp2012-05-22T09:21:48-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN621636465EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WELLMONT HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWELLNameControl
Phone4232308200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11905 AMERICAN WAYAddressLine1
CityKINGSPORTCity
StateTNState
ZIP Code37660ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTODD J DOUGANName
TitleSR. VP OF FINANCETitle
Phone4232308200Phone
Date Signed2012-05-22DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Date Prepared2012-05-22DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTODD J DOUGANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11905 AMERICAN WAYAddressLine1
CityKINGSPORTCity
StateTNState
ZIP Code37660ZIPCode
FieldValueIRS element (for citing)
Gross Receipts851785997GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WELLMONT.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileTNStateLegalDomicile
Activity Or Mission DescriptionWE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees5470TotalNbrEmployees
Total Nbr Volunteers793TotalNbrVolunteers
Total Gross UBI151530TotalGrossUBI
Net Unrelated Business Txbl Income-3190NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2385595ContributionsGrantsPriorYear
Contributions Grants Current Year3106229ContributionsGrantsCurrentYear
Program Service Revenue Prior Year601472119ProgramServiceRevenuePriorYear
Program Service Revenue CY651047190ProgramServiceRevenueCY
Investment Income Prior Year7814832InvestmentIncomePriorYear
Investment Income Current Year9545103InvestmentIncomeCurrentYear
Other Revenue Prior Year10322525OtherRevenuePriorYear
Other Revenue Current Year9646203OtherRevenueCurrentYear
Total Revenue Prior Year621995071TotalRevenuePriorYear
Total Revenue Current Year673344725TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1065798GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY697055GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year249808413SalariesEtcPriorYear
Salaries Etc Current Year254579570SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year337180801OtherExpensePriorYear
Other Expenses Current Year387366874OtherExpensesCurrentYear
Total Expenses Prior Year588055012TotalExpensesPriorYear
Total Expenses Current Year642643499TotalExpensesCurrentYear
Revenues Less Expenses Prior Year33940059RevenuesLessExpensesPriorYear
Revenues Less Expenses CY30701226RevenuesLessExpensesCY
Total Assets BOY906473724TotalAssetsBOY
Total Assets EOY939337117TotalAssetsEOY
Total Liabilities BOY609622506TotalLiabilitiesBOY
Total Liabilities EOY576621565TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY296851218NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY362715552NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionWE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense617478652Expense
Grants697055Grants
Revenue651047190Revenue
DescriptionWELLMONT HEALTH SYSTEM PREPARES A CONSOLIDATED COMMUNITY BENEFIT REPORT WHICH INCLUDES THE ACTIVITIES OF ALL ITS OPERATIONS AND AFFILIATES. IN CONTRAST, AN IRS FORM 990 IS FILED FOR EACH TAX-EXEMPT CORPORATION (7 SEPARATE FORM 990S), AND THERE IS NO SUCH IRS FORM FOR THE TAXABLE CORPORATIONS. IN ADDITION, THE IRS INSTRUCTIONS TO FORM 990 HAVE SPECIFIC DEFINITIONS, METHODS, AND WORKSHEETS TO CALCULATE THE COMMUNITY BENEFITS TO BE INCLUDED ON THE FORM 990. AS A RESULT, THERE ARE SIGNIFICANT DIFFERENCES BETWEEN THE COMMUNITY BENEFITS REPORTED IN THE CONSOLIDATED COMMUNITY BENEFIT REPORT AND THE VARIOUS FORM 990S. FOR EXAMPLE, THERE ARE SIGNIFICANT LOSSES INCURRED IN THE TAXABLE CORPORATIONS THAT CANNOT BE REFLECTED IN THE VARIOUS FORM 990S, THE LARGEST OF WHICH ARE THE COSTS AND REVENUES ASSOCIATED WITH THE PHYSICIANS AND OTHER PROVIDERS WITHIN THESE CORPORATIONS WHO PROVIDE INDISPENSIBLE SERVICES TO PATIENTS OF WELLMONT HEALTH SYSTEM. THERE ARE ALSO FUNDS AND SERVICES THAT ARE PROVIDED THAT DO NOT MEET THE SPECIFIC DEFINITIONS OF THE IRS INSTRUCTIONS, SUCH AS CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS THAT DO NOT MEET THE DEFINITION OF "RESTRICTED TO ONE OR MORE OF THE ACTIVITIES DESCRIBED IN THE TABLE IN PART I, LINE 7" OF SCHEDULE H. JIK WELLMONT HEALTH SYSTEM IS A PUBLIC TRUST. FROM KINGSPORT TO BRISTOL, FROM SNEEDVILLE TO NORTON, THE MEMBER HOSPITALS OF OUR ORGANIZATION WERE BORN OF THEIR COMMUNITIES' COMMITMENT TO SUPERIOR HEALTH CARE FOR THEIR CITIZENS. WE OFFER A VAST ARRAY OF MEDICAL SERVICES AND RESOURCES FOR THOUSANDS OF PATIENTS IN NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. IN 2011, WE PROVIDED SERVICES TO 52,309 PATIENTS IN A BED, 189,463 EMERGENCY ROOM VISITS, 214,864 OUTPATIENT REGISTRATIONS (EXCLUDING ER), 2,056 NEWBORN DELIVERIES, 23,151 SURGERIES, AND 250,103 PHYSICIAN OFFICE VISITS. WELLMONT IS A TENNESSEE NOT-FOR-PROFIT CORPORATION. SIX TAX-EXEMPT COMMUNITY BASED HOSPITALS - BRISTOL REGIONAL MEDICAL CENTER (BRISTOL, TENN.), HOLSTON VALLEY MEDICAL CENTER (KINGSPORT, TENN.), LONESOME PINE HOSPITAL (BIG STONE GAP, VA.), HANCOCK COUNTY HOSPITAL (SNEEDVILLE, TENN.), MOUNTAIN VIEW REGIONAL MEDICAL CENTER (NORTON, VA.) AND LEE REGIONAL MEDICAL CENTER (PENNINGTON GAP, VA.) - ARE INCLUDED IN THIS CORPORATION. BUT EVEN AS OUR SERVICE AREA SPANS MULTIPLE STATES AND OUR REVENUE IS REPORTED IN THE HUNDREDS OF MILLIONS OF DOLLARS, WE REMAIN A COMMUNITY-OWNED HEALTH SYSTEM. IT IS OUR MISSION TO DELIVER SUPERIOR HEALTH CARE WITH COMPASSION TO THE PEOPLE WE SERVE. IT IS OUR VISION TO DELIVER THE BEST HEALTH CARE ANYWHERE. CONSISTENT WITH THIS MISSION, WE HAVE WORKED TOWARD IMPROVING OUR COMMUNITY'S ACCESS TO QUALITY, AFFORDABLE HEALTH CARE, EDUCATING OUR REGION'S CAREGIVERS, IMPROVING THE HEALTH STATUS OF OUR COMMUNITIES AND CONTRIBUTING TO THE OVERALL QUALITY OF LIFE IN THE AREAS WE SERVE. OVERALL, WE RETURNED MORE THAN 45,246,909 IN BENEFITS TO OUR REGION, INCLUDING 33,581,368 OF COSTS FOR INDIGENT PATIENTS AND UNCOMPENSATED CARE FOR OTHER PATIENTS AND 11,665,541 FOR OTHER COMMUNITY ACTIVITIES OUTLINED BELOW. WELLMONT HEALTH SYSTEM IS IN COMPLIANCE WITH IRS GUIDELINES FOR FORM 990 SCHEDULE H REPORTING PURPOSES AND THE AMOUNTS REFLECTED ABOVE ARE NOT INCLUSIVE OF RESOURCES DESCRIBED IN WELLMONT HEALTH SYSTEM'S COMMUNITY BENEFIT REPORT AS THE ABOVE AMOUNTS ARE REPORTED ON SCHEDULE H. WE ARE MINDFUL OF OUR RESPONSIBILITIES AS ONE OF THE REGION'S LARGEST EMPLOYERS. 5,439 FAMILIES COUNT ON US FOR THEIR LIVELIHOODS. CITIES AND COUNTIES THROUGHOUT OUR SERVICE AREA RELY ON US AS A DRIVER OF ECONOMIC DEVELOPMENT. IT IS OUR DUTY AS A CORPORATE CITIZEN TO SUPPORT THOSE ENDEAVORS AND CAUSES THAT IMPROVE THE QUALITY OF LIFE IN OUR REGION. AND WE ALSO RECOGNIZE IT IS OUR RESPONSIBILITY TO CARE FOR THOSE IN NEED - REGARDLESS OF THEIR ABILITY TO PAY. IT IS OUR COMMITMENT - INDEED, IT IS OUR MISSION - TO SUPPORT THE CAUSES AND DEVELOP THE INITIATIVES THAT WILL PROPEL OUR COMMUNITIES TOWARD A BETTER, BRIGHTER, HEALTHIER AND MORE VIBRANT FUTURE. SERVING THE UNDERSERVED REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, WELLMONT HEALTH SYSTEM'S HOSPITALS TREAT ALL PATIENTS FOR MEDICALLY NECESSARY CONDITIONS. RECOGNIZING THAT SOME PATIENTS CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, WELLMONT PROVIDED CARE FOR INDIGENT PATIENTS, WRITING OFF 33,747,861 OF CHARGES AND INCURRING COST OF 10,025,120. WELLMONT HEALTH SYSTEM IS IN COMPLIANCE WITH IRS GUIDELINES FOR FORM 990 SCHEDULE H REPORTING PURPOSES AND THE AMOUNTS REFLECTED ABOVE ARE NOT INCLUSIVE OF RESOURCES DESCRIBED IN WELLMONT HEALTH SYSTEM'S COMMUNITY BENEFIT REPORT AS THE ABOVE AMOUNTS ARE REPORTED ON SCHEDULE H. OTHER RECENT INITIATIVES INCLUDE: OUR HEALTH SYSTEM, IN CONJUNCTION WITH A GRANT FROM SUSAN G. KOMEN FOR THE CURE TRI-CITIES, WAS ABLE TO FUND THE COST OF MAMMOGRAMS FOR SEVERAL HUNDRED WOMEN WHO WERE UNDERINSURED OR UNINSURED. PROJECT ACCESS TO BREAST CARE IS DESIGNED TO REACH WOMEN WHO LIVE IN HAWKINS, SULLIVAN, WASHINGTON, JOHNSON, UNICOI, HANCOCK, CARTER AND GREENE COUNTIES IN TENNESSEE AND WOMEN IN SCOTT COUNTY, VA. TO QUALIFY, WOMEN MUST BE BETWEEN THE AGES OF 35 AND 49 AND EITHER BE UNINSURED AND FINANCIALLY UNABLE TO PAY FOR A MAMMOGRAM OR INSURED AND HAVE A HIGH DEDUCTIBLE AND/OR CO-PAY THAT MAKES IT FINANCIALLY DIFFICULT TO OBTAIN A MAMMOGRAM. HOLSTON VALLEY MEDICAL CENTER PROVIDED FINANCIAL SUPPORT OF 289,334 TO FRIENDS IN NEED WHICH INCLUDED CASH CONTRIBUTIONS TOTALING 150,000 AND DRUGS AND SUPPLIES AT A DIRECT COST OF 139,334. THE KINGSPORT-BASED CLINIC PROVIDES PRIMARY HEALTH CARE TO THE WORKING POOR AND THOSE WITHOUT INSURANCE COVERAGE. BRISTOL REGIONAL MEDICAL CENTER RECRUITED DR. DAVE ARNOLD TO SERVE AS MEDICAL DIRECTOR OF HEALING HANDS HEALTH CENTER IN BRISTOL, TENN. DR. ARNOLD'S SALARY AND BENEFITS ARE PAID BY WELLMONT PHYSICIAN SERVICES, A TAXABLE SUBSIDIARY OF WELLMONT HEALTH SYSTEM. BRISTOL REGIONAL PROVIDES SUPPLIES AND OTHER VARIOUS ITEMS VALUED AT 15,749 FOR THE HEALTH CENTER, WHICH PROVIDES QUALITY HEALTH CARE TO THE WORKING POOR. THE WELLMONT FOUNDATION FUNDED THE PURCHASE OF SEVERAL HUNDRED INFANT CAR SEATS FOR NEWBORNS WHOSE FAMILIES COULDN'T AFFORD THEM. TRAINING AND EDUCATING OUR HEALTHCARE PROFESSIONALS WELLMONT HEALTH SYSTEM WILL NOT SUCCEED IN OUR MISSION WITHOUT CONTINUALLY REINVESTING IN OUR MOST PRECIOUS RESOURCE - OUR PEOPLE. TO THAT END, WE SUPPORTED THE EDUCATION AND TRAINING OF HEALTH CARE PROFESSIONALS AT A DIRECT COST OF 5,330,059. RECENT INITIATIVES INCLUDE: WELLMONT HEALTH SYSTEM PROVIDED AND PARTICIPATED IN SEVERAL FORMAL TRAINING PROGRAMS FOR HEALTH PROFESSIONALS, INCLUDING EAST TENNESSEE STATE UNIVERSITY'S INTERNSHIP AND RESIDENCY PROGRAMS. OUR CONTRIBUTIONS TOTALED 4,949,763 IN SUPPORT OF THE SCHOOL'S JAMES H. QUILLEN COLLEGE OF MEDICINE RESIDENCY PROGRAM. ADDITIONALLY, OUR HOSPITALS PROVIDE TRAINING FOR 50 PERCENT OF THE PHYSICIAN RESIDENTS IN THIS PROGRAM. WELLMONT HEALTH SYSTEM CONTINUES TO WELCOME OSTEOPATHIC MEDICAL STUDENTS FROM LINCOLN MEMORIAL UNIVERSITY'S DEBUSK COLLEGE OF OSTEOPATHIC MEDICINE. THE STUDENTS PERFORM CLINICAL ROTATIONS IN WELLMONT HOSPITALS AS THEY MOVE TOWARD BECOMING THE NEXT GENERATION OF DOCTORS. THE STUDENTS, WHO RECEIVE FREE HOUSING ON THE CAMPUS OF MOUNTAIN VIEW REGIONAL MEDICAL CENTER, COMPLETE THEIR CORE CLINICAL ROTATIONS IN WELLMONT'S MOUNTAIN REGION HOSPITALS - MOUNTAIN VIEW REGIONAL, LONESOME PINE HOSPITAL AND LEE REGIONAL MEDICAL CENTER. THE STUDENTS PERFORM SUBSPECIALTY ROTATIONS AT HOLSTON VALLEY MEDICAL CENTER AND BRISTOL REGIONAL MEDICAL CENTER AND PRIMARY CORE ROTATIONS AT HAWKINS COUNTY MEMORIAL HOSPITAL. WELLMONT HEALTH SYSTEM AND LINCOLN MEMORIAL UNIVERSITY'S DEBUSK COLLEGE OF OSTEOPATHIC MEDICINE AGAIN PARTNERED IN 2011 TO CREATE THE WELLMONT ORTHOPEDIC RESIDENCY PROGRAM AT HOLSTON VALLEY MEDICAL CENTER, ONE OF JUST 33 SUCH PROGRAMS IN THE COUNTRY TO HELP TRAIN THE NEXT GENERATION OF SPECIALTY PHYSICIANS. CLINICIANS AT WELLMONT'S BRISTOL REGIONAL MEDICAL CENTER CAN NOW ENHANCE THEIR SKILLS IN A STATE-OF-THE-ART SIMULATION LABORATORY. ESTABLISHED IN PARTNERSHIP WITH EAST TENNESSEE STATE UNIVERSITY, THE LAB SIMULATES REAL-LIFE PATIENT CARE SITUATIONS USING A SPECIALLY DESIGNED MANNEQUIN THAT FEATURES A LIFELIKE HEARTBEAT, BREATHING SOUNDS AND A PULSE. WELLMONT HEALTH SYSTEM HAS EXERTED TREMENDOUS EFFORT TO ACHIEVE MEANINGFUL USE OF AN ELECTRONIC HEALTH RECORD. THIS NATIONAL MANDATE CREATES TREMENDOUS EFFICIENCIES FOR CAREGIVERS, ENHANCES PATIENT CARE AND ULTIMATELY IMPROVES PATIENT SAFETY BY REDUCING THE POTENTIAL FOR ERRORS ASSOCIATED WITH PAPER DOCUMENTATION AS WELL AS INCREASING THE SECURITY AND SHARING OF DATA AMONG PROVIDERS. THE COST OF IMPLEMENTATION OF THE ELECTRONIC HEALTH RECORD IN 2011 WAS 2,410,854, IN ADDITION TO SIGNIFICANT TRAINING AND EDUCATION FOR STAFF, AT A DIRECT COST OF 133,049. WELLMONT HEALTH SYSTEM HAS PUBLICLY SUPPORTED THE IDEA OF A MEDICAL SCHOOL AT KING COLLEGE TO PROVIDE ADDITIONAL PHYSICIANS TO OUR REGION. WELLMONT HEALTH SYSTEM HAS MADE AVAILABLE CONTINUINGDescription
Total Program Service Expense617478652TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPtrueLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096392NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees5470NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledTNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTODD J DOUGANNamePerson
Telephone Number4232308512TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11905 AMERICAN WAYAddressLine1
CityKINGSPORTCity
StateTNState
ZIP Code37660ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (39 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
ROBERT F BURGIN - THROUGH 073110
INT. PRES. &40.00XX39836200
DAVID THOMPSON MD
BOARD MEMBER40.00X33944708701
PIERRE ISTFAN MD
BOARD MEMBER40.00X322540023654
JULIE P BENNETT
SECRETARY6.00XX000
MARVIN CAMERON
EX-OFFICIO B6.00X000
DAVE CROCKETT
CHAIRMAN6.00XX000
WAYNE J KENNEDY
EX-OFFICIO B6.00X000
E WAYNE KIRK
TREASURER6.00XX000
RAVEN KRICKBAUM
BOARD MEMBER6.00X000
ROGER L LEONARD
BOARD MEMBER6.00X000
ROGER K MOWEN
BOARD MEMBER6.00X000
THOMAS F PUGH MD
BOARD MEMBER6.00X000
T ARTHUR BUDDY SCOTT JR
VICE CHAIRMA6.00XX000
GLEN SKIP SKINNER
BOARD MEMBER6.00X000
DOUGLAS J SPRINGER MD
BOARD MEMBER6.00X000
JOHN WILLIAMS
BOARD MEMBER6.00X000
MARGARET DENARVAEZ-080110-PRESENT
PRESIDENT &40.00X75839501602
ELIZABETH WARD
EXECUTIVE VP40.00X57653607876
J DALE SARGENT MD-THROUGH 2611
CHIEF MED. O40.00X347647025077
MICHAEL BUNDY - THROUGH 4811
SR. VP-OPERA40.00X303798025746
GARY D MILLER - THROUGH 122010
SR. VP-GEN C40.00X293006025218
HAMLIN J WILSON
SR. VP-HUMAN40.00X292529020888
ALICE POPE
SR. VP-FINAN40.00X261151023307
PATRICK KANE - THROUGH 63011
SR. VP-MARKE40.00X260199023018
TODD J DOUGAN
SR. VP-FINAN40.00X235448022359
KENT PETTY - 3110 TO PRESENT
CHIEF INFORM40.00X18343208242
VIRGINIA FRANK - 9710 TO PRESENT
PRESIDENT-HV40.00X11738801595
TRACEY P MOFFATT-4911 TO PRESENT
SR. VP-OPERA40.00X000
JOHN HOWARD - 040111-PRESENT
WPS PRES&GEN40.00X000
BARTHOLEMEW A HOVE
PRESIDENT-BR40.00407011031190X
RON PREWITT
PRESIDENT-LR40.00308032022028X
DAVID L BRASH
REGIONAL VP-40.00292505026276X
FRED PELLE
PRESIDENT-HC2.00246426022843X
BLAINE DOUGLAS - THROUGH 7910
PRESIDENT-HV40.00187071015700X
JORGE LODEIRO MD
40.00868851045233X
EDWIN A MCELROY MD
40.00751291040350X
ROBERT HARRIS MD-THROUGH 103110
40.0069389607755X
MALCOLM R MATTHEWS MD-TO 5311
40.00658009040434X
MARCO DASILVA MD
40.00648596040711X
FieldValueIRS element (for citing)
Total Reportable Comp From Org9751566TotalReportableCompFromOrg
Total Other Compensation509803TotalOtherCompensation
Number Individuals GT100 K226NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SPECTRUM LABORATORY
4380 FEDERAL DRIVEGREENSBORONC27410LAB SERVICES13180693
ROBINS & MORTON GROUP
5500 MARYLAND WAY SUITE 100BRENTWOODTN37027CONTRACTING10000943
HOLSTON ANESTHESIA ASSOCIATION
135 W RAVINE STREETKINGSPORTTN37662MEDICAL SERVICE7468099
HIGHLANDS PATHOLOGY CONSULTANTS SPC
10368 WALLACE ALLEY 18KINGSPORTTN37663MEDICAL SERVICE1934507
EMERGENCY COVERAGE CORP
PO BOX 634850CINCINNATIOH45263PHYSICIAN SERVI1545498
FieldValueIRS element (for citing)
Number Of Contractors GT100 K51NumberOfContractorsGT100K
Related Organizations2892953RelatedOrganizations
Government Grants209350GovernmentGrants
All Other Contributions3926AllOtherContributions
Total Contributions3106229TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE621990451576370451576370
PHARMACY REVENUE621990186556496186556496
BLOOD REVENUE6219901207627312076273
ADMINISTRATIVE REVENUE561000838051838051
FieldValueIRS element (for citing)
Total Program Service Revenue651047190TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7765025TotalRevenueColumn
Exclusion$7,765,025ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real6553454Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2346555Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real4206899Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column4206899TotalRevenueColumn
Exclusion$4,206,899ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities157265095Securities
Other20609700Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities156173958Securities
Other19920759Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1091137Securities
Other688941Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1780078TotalRevenueColumn
Exclusion$1,780,078ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA VENDING7222102954366$2,954,366
MISCELLANEOUS REVENUE9000991825279$1,825,279
GIFT SHOP REVENUE453220508129$508,129

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column151530TotalRevenueColumn
Unrelated Business Revenue151530UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue5439304TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column673344725TotalRevenueColumn
Related Or Exempt Function Income651047190RelatedOrExemptFunctionIncome
Unrelated Business Revenue151530UnrelatedBusinessRevenue
Exclusion$19,039,776ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total697055Total
Program Services697055ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total6421728Total
Management And General6421728ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total189475107Total
Program Services188924404ProgramServices
Management And General550703ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total8496802Total
Program Services7815138ProgramServices
Management And General681664ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total35675815Total
Program Services35407720ProgramServices
Management And General268095ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total14510118Total
Program Services14051779ProgramServices
Management And General458339ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total238200Total
Program Services238200ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1156956Total
Program Services1059350ProgramServices
Management And General97606ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total807349Total
Program Services787001ProgramServices
Management And General20348ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total143581Total
Program Services143581ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total274817Total
Program Services274817ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total108446465Total
Program Services98108578ProgramServices
Management And General10337887ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1000994Total
Program Services592665ProgramServices
Management And General408329ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total139711020Total
Program Services138276733ProgramServices
Management And General1434287ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total8371446Total
Program Services8361712ProgramServices
Management And General9734ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total21945311Total
Program Services21898751ProgramServices
Management And General46560ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1384659Total
Program Services1146017ProgramServices
Management And General238642ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total32596Total
Program Services30356ProgramServices
Management And General2240ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total20142495Total
Program Services20136901ProgramServices
Management And General5594ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total41535435Total
Program Services40039838ProgramServices
Management And General1495597ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total4016007Total
Program Services4016007ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROVISION FOR BAD DEBTS337298063370591423892
PHYSICIAN RECRUITMENT23303264132221917104
MISC EXPENSE1012708777599235109
DUES AND MEMBERSHIPS724101241397482704
BOOKS AND PUBLICATIONS36260233391728685

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total642643499Total
Program Services617478652ProgramServices
Management And General25164847ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY19280BOY
EOY17919EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY28821001BOY
EOY29872126EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY97840693BOY
EOY100500580EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY29514EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY14706814BOY
EOY15064889EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6425709BOY
EOY6525891EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis886796805LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec454343156LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY425483782BOY
EOY432453649EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY303622399BOY
EOY321289188EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY20120565BOY
EOY18988817EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY4778521BOY
EOY8745924EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4654960BOY
EOY5848620EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY906473724BOY
EOY939337117EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY59772029BOY
EOY52916367EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY430070000BOY
EOY438747592EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY119780477BOY
EOY84957606EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY609622506BOY
EOY576621565EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY296851218BOY
EOY362715552EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY296851218BOY
EOY362715552EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY906473724BOY
EOY939337117EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses30701226ReconcilationRevenueExpenses
Reconcilation Other Changes35163108ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
Form1120 Pol FiledfalseForm1120PolFiled

Total Direct Lobbying TotalDirectLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals143581FilingOrganizationsTotals

Total Lobbying Expenditures TotalLobbyingExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals143581FilingOrganizationsTotals

Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals642499918FilingOrganizationsTotals

Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals642643499FilingOrganizationsTotals

Lobbying Nontaxable LobbyingNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals1000000FilingOrganizationsTotals

Grassroots Nontaxable GrassrootsNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals250000FilingOrganizationsTotals
FieldValueIRS element (for citing)
Form4720 FiledfalseForm4720Filed

Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus31000000CurrentYearMinus3
Current Year Minus21000000CurrentYearMinus2
Current Year Minus11000000CurrentYearMinus1
Current Year1000000CurrentYear
Total4000000Total
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmount

Total Lobbying Expenditures2 TotalLobbyingExpenditures2

FieldValueIRS element (for citing)
Current Year Minus391230CurrentYearMinus3
Current Year Minus268925CurrentYearMinus2
Current Year Minus196271CurrentYearMinus1
Current Year143581CurrentYear
Total400007Total

Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus3250000CurrentYearMinus3
Current Year Minus2250000CurrentYearMinus2
Current Year Minus1250000CurrentYearMinus1
Current Year250000CurrentYear
Total1000000Total
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmount
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax
Substantially All Dues NondeductfalseSubstantiallyAllDuesNondeduct
Only In House LobbyingfalseOnlyInHouseLobbying
Agree To Carryover Prior YearfalseAgreeToCarryoverPriorYear

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1307181InvestmentCostOrOtherBasis
Other Cost Or Other Basis32663799OtherCostOrOtherBasis
Book Value33970980BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis519444184OtherCostOrOtherBasis
Depreciation204694980Depreciation
Book Value314749204BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2395334OtherCostOrOtherBasis
Depreciation474747Depreciation
Book Value1920587BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis330986307OtherCostOrOtherBasis
Depreciation249173429Depreciation
Book Value81812878BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings432453649TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescriptionAmountAmount
OTHER LT LIABILITIES$24,218,069
OTHER CURRENT LIABILITIES$18,760,892
CAPITAL LEASE OBLIGATIONS$16,102,252
SWAP LIABILITY$11,588,215
POST RETIREMENT BENEFITS$7,762,743
DEFINED BENEFITS PENSION LIABILITY$6,525,435
TAXABLE BOND LIABILITIES
FieldValueIRS element (for citing)
Total Of Amounts84957606TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationTHE WELLMONT HEALTH SYSTEM ENTITIES ARE PRIMARILY CLASSIFIED AS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) AS ENTITIES DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED FOR THESE ENTITIES IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE OPERATIONS OF WELLMONT HEALTH SYSTEM ARE SUBJECT TO STATE AND FEDERAL INCOME TAXES WHICH ARE ACCOUNTED FOR IN ACCORDANCE WITH ASC 740, INCOME TAXES; HOWEVER, SUCH AMOUNTS ARE NOT MATERIAL.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage1.50000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense17239015TotalCommunityBenefitExpense
Net Community Benefit Expense17239015NetCommunityBenefitExpense
Percent Of Total Expense0.02680PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense68091287TotalCommunityBenefitExpense
Direct Offsetting Revenue51748934DirectOffsettingRevenue
Net Community Benefit Expense16342353NetCommunityBenefitExpense
Percent Of Total Expense0.02540PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense85330302TotalCommunityBenefitExpense
Direct Offsetting Revenue51748934DirectOffsettingRevenue
Net Community Benefit Expense33581368NetCommunityBenefitExpense
Percent Of Total Expense0.05230PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs476NumberOfActivitiesOrPrograms
Persons Served28811PersonsServed
Total Community Benefit Expense5728028TotalCommunityBenefitExpense
Net Community Benefit Expense5728028NetCommunityBenefitExpense
Percent Of Total Expense0.00890PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs18NumberOfActivitiesOrPrograms
Persons Served135PersonsServed
Total Community Benefit Expense8731418TotalCommunityBenefitExpense
Direct Offsetting Revenue3556874DirectOffsettingRevenue
Net Community Benefit Expense5174544NetCommunityBenefitExpense
Percent Of Total Expense0.00810PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs11NumberOfActivitiesOrPrograms
Total Community Benefit Expense81414TotalCommunityBenefitExpense
Direct Offsetting Revenue15500DirectOffsettingRevenue
Net Community Benefit Expense65914NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs273NumberOfActivitiesOrPrograms
Persons Served2775PersonsServed
Total Community Benefit Expense697055TotalCommunityBenefitExpense
Net Community Benefit Expense697055NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs778NumberOfActivitiesOrPrograms
Persons Served31721PersonsServed
Total Community Benefit Expense15237915TotalCommunityBenefitExpense
Direct Offsetting Revenue3572374DirectOffsettingRevenue
Net Community Benefit Expense11665541NetCommunityBenefitExpense
Percent Of Total Expense0.01820PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs778NumberOfActivitiesOrPrograms
Persons Served31721PersonsServed
Total Community Benefit Expense100568217TotalCommunityBenefitExpense
Direct Offsetting Revenue55321308DirectOffsettingRevenue
Net Community Benefit Expense45246909NetCommunityBenefitExpense
Percent Of Total Expense0.07040PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Total Community Building Expense199TotalCommunityBuildingExpense
Net Community Building Expense199NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs122NumberOfActivitiesOrPrograms
Persons Served882PersonsServed
Total Community Building Expense20317TotalCommunityBuildingExpense
Direct Offsetting Revenue2630DirectOffsettingRevenue
Net Community Building Expense17687NetCommunityBuildingExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense1025TotalCommunityBuildingExpense
Net Community Building Expense1025NetCommunityBuildingExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served36PersonsServed
Total Community Building Expense1424TotalCommunityBuildingExpense
Net Community Building Expense1424NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs30NumberOfActivitiesOrPrograms
Persons Served590PersonsServed
Total Community Building Expense934TotalCommunityBuildingExpense
Net Community Building Expense934NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs38NumberOfActivitiesOrPrograms
Persons Served860PersonsServed
Total Community Building Expense34755TotalCommunityBuildingExpense
Net Community Building Expense34755NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Total Community Building Expense997TotalCommunityBuildingExpense
Net Community Building Expense997NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs218NumberOfActivitiesOrPrograms
Persons Served2368PersonsServed
Total Community Building Expense59651TotalCommunityBuildingExpense
Direct Offsetting Revenue2630DirectOffsettingRevenue
Net Community Building Expense57021NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$10,025,120BadDebtExpenseAmount
Amount Reimbursed By Medicare162869585AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare160898845CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1970740MedicareSurplusOrShortfall
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (3 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
HOLSTON VALLEY IMAG
RADIOLOGY SERVICES0.750000.25000
HOLSTON VALLEY AMB
SURGERY SERVICES0.520000.48000
SAPLING GROVE AMB
SURGICAL SERVICES0.650000.35000
FieldValueIRS element (for citing)
Number Of Hospital Facilities6NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (6 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalTeaching HospitalTeachingHospitalEr24 HoursEr24HoursCritical Access HospitalCriticalAccessHospitalAddress Line2Address/AddressLine2
BRISTOL REGIONAL MEDICAL CENTER
11 MEDICAL PARK BLVDBRISTOLTN37620XXX
HOLSTON VALLEY MEDICAL CENTER
2130 RAVINE ROADKINGSPORTTN37660XXX
LONESOME PINE HOSPITAL
31990 HOLTON AVENUEBIG STONE GAPVA24219XXX
HANCOCK COUNTY HOSPITAL
41519 MAIN STREETSNEEDVILLETN37869XXX
MOUNTAIN VIEW REGIONAL MEDICAL CENT
5310 3RD STREET NENORTONVA24273XX
LEE REGIONAL MEDICAL CENTER
6PO BOX 589PENNINGTON GAPVA24277XX127 HEALTH CARE DRIVE

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (6 entries)

Hospital Facility NumberHospitalFacilityNumberEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeFPG Free PercentFPGFreePercentUses FPG DiscountedUsesFPGDiscountedFPG Discount PercentFPGDiscountPercentExplains BasisExplainsBasisIncome LevelIncomeLevelAsset LevelAssetLevelMedical IndigencyMedicalIndigencyInsurance StatusInsuranceStatusUninsured DiscountUninsuredDiscountMedicaid MedicareMedicaidMedicareState RegulationStateRegulationExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresPosted On WebsitePostedOnWebsitePosted In Emergency RoomPostedInEmergencyRoomPosted In Admission OfficePostedInAdmissionOfficeAvailable On RequestAvailableOnRequestActions On NonpaymentActionsOnNonpaymentPermit Report To Credit AgencyPermitReportToCreditAgencyPermit LawsuitPermitLawsuitPermit Lien On ResidencePermitLienOnResidencePermit Body AttachmentPermitBodyAttachmentPermit Other ActionsPermitOtherActionsCollection ActivitiesCollectionActivitiesReport To Credit AgencyReportToCreditAgencyLawsuitLawsuitLien On ResidenceLienOnResidenceBody AttachmentBodyAttachmentOther ActionsOtherActionsNotify Upon AdmissionNotifyUponAdmissionNotify Before DischargeNotifyBeforeDischargeDocumented DeterminationDocumentedDeterminationNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyUsed Other MethodUsedOtherMethodAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
BRISTOL REGIONAL MEDICAL CENTER
1truetrue100.0true150.0trueXXXXXXXtruetrueXXXXtrueXXXXXtrueXXXXXXXXtrueXfalsefalse
HOLSTON VALLEY MEDICAL CENTER
2truetrue100.0true150.0trueXXXXXXXtruetrueXXXXtrueXXXXXtrueXXXXXXXXtrueXfalsefalse
LONESOME PINE HOSPITAL
3truetrue100.0true150.0trueXXXXXXXtruetrueXXXXtrueXXXXXtrueXXXXXXXXtrueXfalsefalse
HANCOCK COUNTY HOSPITAL
4truetrue100.0true150.0trueXXXXXXXtruetrueXXXXtrueXXXXXtrueXXXXXXXXtrueXfalsefalse
MOUNTAIN VIEW REGIONAL MEDICAL CENT
5truetrue100.0true150.0trueXXXXXXXtruetrueXXXXtrueXXXXXtrueXXXXXXXXtrueXfalsefalse
LEE REGIONAL MEDICAL CENTER
6truetrue100.0true150.0trueXXXXXXXtruetrueXXXXtrueXXXXXtrueXXXXXXXXtrueXfalsefalse

Form990 Schedule H Part VI Form990ScheduleHPartVI (22 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUBSIDIZED HEALTH SERVICES EXPLANATIONPART I LINE 7GPART I LINE 6A WELLMONT HEALTH SYSTEM PREPARES A CONSOLIDATED COMMUNITY BENEFIT REPORT WHICH INCLUDES THE ACTIVITIES OF ALL ITS OPERATIONS AND AFFILIATES IN CONTRAST AN IRS FORM 990 IS FILED FOR EACH TAX EXEMPT CORPORATION 7 SEPARATE FORM 990S AND THERE IS NO SUCH IRS FORM FOR THE TAXABLE CORPORATIONS IN ADDITION THE IRS INSTRUCTIONS TO FORM 990 HAVE SPECIFIC DEFINITIONS METHODS AND WORKSHEETS TO CALCULATE THE COMMUNITY BENEFITS TO BE INCLUDED ON THE FORM 990 AS A RESULT THERE ARE SIGNIFICANT DIFFERENCES BETWEEN THE COMMUNITY BENEFITS REPORTED IN THE CONSOLIDATED COMMUNITY BENEFIT REPORT AND THE VARIOUS FORM 990S FOR EXAMPLE THERE ARE SIGNIFICANT LOSSES INCURRED IN THE TAXABLE CORPORATIONS THAT CANNOT BE REFLECTED IN THE VARIOUS FORM 990S THE LARGEST OF WHICH ARE THE COSTS AND REVENUES ASSOCIATED WITH THE PHYSICIANS AND OTHER PROVIDERS WITHIN THESE CORPORATIONS WHO PROVIDE INDISPENSABLE SERVICES TO PATIENTS OF WELLMONT HEALTH SYSTEM THERE ARE ALSO FUNDS AND SERVICES THAT ARE PROVIDED THAT DO NOT MEET THE SPECIFIC DEFINITIONS OF THE IRS INSTRUCTIONS SUCH AS CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS THAT DO NOT MEET THE DEFINITION OF RESTRICTED TO ONE OR MORE OF THE ACTIVITIES DESCRIBED IN THE TABLE IN PART I LINE 7
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEPART I LINE 7 COLUMN FTHE BAD DEBT EXPENSE OF 33729806 WAS INCLUDED ON FORM 990 PART IX LINE 25 COL A BUT WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN
COSTING METHODOLOGY EXPLANATIONPART I LINE 7RATIO OF PATIENT CARE COSTTOCHARGES WAS USED TO DETERMINE THE COSTS FOR AMOUNTS IN LINE 7A AND 7B COL C BY FACILITY THE COSTS INCLUDED IN THE COSTTOCHARGE RATIO INCLUDED THE COSTS FROM ALL PATIENT SEGMENTS ACTUAL COSTS FROM THE GENERAL LEDGER WERE USED FOR AMOUNTS IN LINE 7F AND 7I COLC
NEEDS ASSESSMENTPART VIWELLMONT HEALTH SYSTEM EXAMINES THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES BY CONDUCTING PHYSICIAN NEEDS ASSESSMENTS FOR ITS HOSPITALS AS PART OF THIS EFFORT WELLMONT REVIEWS ITS SERVICE AREA AND DEMOGRAPHICS EXAMINES PHYSICIAN DEMOGRAPHICS AND CONDUCTS FOCUS GROUPS IT MAKES A DETERMINATION OF PHYSICIAN NEED WHILE CALCULATING ITS PHYSICIAN SURPLUSES AND DEFICITS AND HIGHLIGHTING ITS RECRUITMENT PRIORITIES AND PLANS WELLMONT ANNUALLY DETERMINES ITS PRIMARY SECONDARY AND TERTIARY MARKETS THROUGH THE USE OF COUNTYBYCOUNTY ANALYSIS TO IDENTIFY THE FOLLOWING CUSTOMER GROUPS PATIENTS AND POTENTIAL PATIENTS COMMUNITYEMPLOYER GROUPS AND LOCAL PHYSICIANS THE HEALTH SYSTEM ALSO RELIES ON THE EXPERTISE OF CONSULTANTS TO PERIODICALLY REVIEW ALL FACETS OF OPERATIONS AND MAKE RECOMMENDATIONS FOR CHANGES
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VIWELLMONT HEALTH SYSTEM PROACTIVELY INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY BY POSTING THE POLICY ON ITS WEB SITE AS WELL AS POSTING THE POLICY AT POINTS OF REGISTRATION IN THE HOSPITALS WELLMONT HEALTH SYSTEM USES PROGRAM ELIGIBILITY SPECIALISTS WHO CONTACT THE UNINSURED PATIENT POPULATION THESE SPECIALISTS DISCUSS THE VARIOUS GOVERNMENTAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE TO PATIENTS IN ORDER TO DETERMINE IF THE PATIENT WOULD QUALIFY FOR ANY OF THESE PROGRAMS THE SPECIALISTS WILL WORK WITH THE PATIENTS TO COMPLETE ANY NECESSARY APPLICATIONS AND WILL HELP THEM THROUGH THE QUALIFICATION PROCESS
COMMUNITY INFORMATIONPART VIWELLMONT HEALTH SYSTEMS SERVICE AREA IS DEFINED BY MANAGEMENT AT THE COUNTY LEVEL BASED ON PATIENT ACTIVITY AND LOCATIONS OF OUR CAMPUSES THE PRIMARY SERVICE AREA PSA INCLUDES THE TENNESSEE COUNTIES OF SULLIVAN HAWKINS AND HANCOCK AND THE VIRGINIA COUNTIES OF WASHINGTON WISE LEE AND SCOTT THE SECONDARY SERVICE AREA SSA IS DEFINED AS WASHINGTON GREENE CARTER JOHNSON AND UNICOI COUNTIES OF TENNESSEE AND RUSSELL BUCHANAN SMYTH TAZEWELL DICKENSON AND WYTHE COUNTIES OF VIRGINIA THE DEMOGRAPHICS OF THESE AREAS ARE AS FOLLOWS PSA POPULATION 365567 MEDIAN HOUSEHOLD INCOME 37319 SSA POPULATION 461210 MEDIAN HOUSEHOLD INCOME 35861 APPROXIMATELY 211 OF OUR PATIENTS ARE MEDICAID RECIPIENTS AND 107 ARE UNINSURED AND 2 OF THE PSA COUNTIES ARE DESIGNATED AS MEDICALLY UNDERSERVED AREAS HAWKINS COUNTY TENNESSEE AND LEE COUNTY VIRGINIA
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VIWELLMONT HEALTH SYSTEMS HOSPITALS AND OTHER HEALTHCARE FACILITIES FURTHER THEIR EXEMPT PURPOSE BY PROVIDING MILLIONS IN UNCOMPENSATED CARE AND OTHER CHARITABLE DONATIONS IN FISCAL YEAR 20102011 WELLMONT PROVIDED 74738000 IN UNCOMPENSATED CARE THE HEALTH SYSTEM ALSO DONATED 1023420 TO COMMUNITY ORGANIZATIONS SUCH AS THE AMERICAN HEART ASSOCIATION UNITED WAY SUSAN G KOMEN FOR THE CURE AND THE AMERICAN CANCER SOCIETY WELLMONT PROVIDED NEARLY 5820139 FOR COMMUNITY HEALTH AND OUTREACH AND 5330059 FOR TRAINING AND EDUCATION OF HEALTHCARE PROFESSIONALS EMPLOYEES PHYSICIANS AND VOLUNTEERS DONATED IN EXCESS OF 102900 HOURS OF COMMUNITY SERVICE
AFFILIATED HEALTH CARE INFORMATIONPART VIWELLMONT HEALTH SYSTEMWELLMONT IS A TENNESSEE NONPROFIT CORPORATION BASED IN KINGSPORT TENNESSEEAND A PREMIER PROVIDER OF HEALTHCARE SERVICES IN NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA WELLMONT WAS FORMED IN JULY 1996 WITH THE MERGER OF BRISTOL MEMORIAL HOSPITAL IN BRISTOL TENNESSEE AND HOLSTON VALLEY MEDICAL CENTER IN KINGSPORT TENNESSEE OVER THE PAST 15 YEARS WELLMONT HAS GROWN TO INCLUDE SIX ADDITIONAL HOSPITALS AN INTEGRATED PHYSICIAN NETWORK AND SEVERAL AMBULATORY SITES WELLMONT HOSPITALS OFFER A BROAD SCOPE OF SERVICES RANGING FROM COMMUNITY BASED ACUTE CARE TO HIGHLY SPECIALIZED TERTIARY SERVICES INCLUDING TWO TRAUMA CENTERS COMPREHENSIVE HEART CARE AND CANCER CARE WELLMONT OWNS AND OPERATES AN INTEGRATED HEALTH CARE DELIVERY SYSTEM PROVIDING INPATIENT OUTPATIENT AND OTHER HEALTH CARE SERVICES AT MULTIPLE LOCATIONS IN NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA CURRENTLY WELLMONT OWNS AND OPERATES SIX ACUTE CARE HOSPITAL FACILITIES AND ONE CRITICAL ACCESS HOSPITAL WITH A TOTAL OF 1253 LICENSED BEDS AND THROUGH A JOINT VENTURE PARTNERS TO OPERATE AN ADDITIONAL ACUTE CARE HOSPITAL FACILITY WITH 100 LICENSED BEDS THE ACUTE CARE FACILITIES OWNED BY WELLMONT INCLUDE HOLSTON VALLEY MEDICAL CENTER BRISTOL REGIONAL MEDICAL CENTER MOUNTAIN VIEW REGIONAL MEDICAL CENTER IN NORTON VIRGINIA LEE REGIONAL MEDICAL CENTER IN PENNINGTON GAP VIRGINIA LONESOME PINE HOSPITAL IN BIG STONE GAP VIRGINIA HAWKINS COUNTY MEMORIAL HOSPITAL IN ROGERSVILLE TENNESSEE AND THE CRITICAL ACCESS HOSPITAL HANCOCK COUNTY HOSPITAL IN SNEEDVILLE TENNESSEE WELLMONT IS THE MAJORITY PARTNER WITH ADVENTIST HEALTH SYSTEM AT TAKOMA REGIONAL HOSPITAL AN ACUTE CARE HOSPITAL IN GREENEVILLE TENNESSEE WELLMONT ALSO DIRECTLY OR INDIRECTLY CONTROLS OWNS OR IS AFFILIATED WITH VARIOUS NONPROFIT AND FORPROFIT CORPORATIONS AND OTHER ORGANIZATIONS THAT CURRENTLY PROVIDE HEALTH CARE AND HEALTH CARERELATED SERVICES THROUGHOUT THE SERVICE AREA IN ADDITION TO THE HOSPITAL CAMPUSES AND AMBULATORY CARE CENTERS DESCRIBED ABOVE WELLMONT ALSO OPERATES MEDICAL CLINICS AMBULATORY SURGERY CENTERS COMPREHENSIVE CANCER CARE CENTERS AND IMAGING FACILITIES
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILEDPART VITENNESSEE VIRGINIA
ADDITIONAL INFORMATIONPART VIPART III LINE 4 THE COST REPORTED ON LINE 2 IS CALCULATED AS THE BAD DEBT EXPENSE FROM THE GENERAL LEDGER TIMES THE RATIO OF COST TO CHARGES AS CALCULATED ON WORKSHEET 2 BY FACILITY THERE ARE NO AMOUNTS REPORTED ON LINE 3 DISCOUNTS ON PATIENT ACCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE PAYMENTS ON PATIENT ACCOUNTS THAT HAVE BEEN PREVIOUSLY WRITTEN OFF AS BAD DEBT ARE USED TO REDUCE BAD DEBT EXPENSE A THIRD PARTY VENDOR IS USED TO HELP DETERMINE THE AMOUNT THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY COULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE POLICY TEXT OF NOTE TO FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE NET PATIENT SERVICE REVENUE IS REPORTED ON THE ACCRUAL BASIS IN THE PERIOD IN WHICH SERVICES ARE PROVIDED AT THE NET REALIZABLE AMOUNTS EXPECTED TO BE COLLECTED NET PATIENT SERVICE REVENUE INCLUDES AMOUNTS ESTIMATED BY MANAGEMENT TO BE REIMBURSABLE BY PATIENTS AND VARIOUS THIRDPARTY PAYORS UNDER PROVISIONS OF REIMBURSEMENT FORMULAS IN EFFECT INCLUDING RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS ESTIMATED RETROACTIVE ADJUSTMENTS ARE ACCRUED IN THE PERIOD RELATED SERVICES ARE RENDERED AND ADJUSTED IN PERIODS AS FINAL AND OTHER SETTLEMENTS ARE DETERMINED WELLMONT PROVIDES CARE TO PATIENTS WHO MEET CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES BECAUSE WELLMONT DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE THEY ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF BOTH AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS THE CONTRACTUAL ALLOWANCE REPRESENTS THE DIFFERENCE BETWEEN ESTABLISHED BILLING RATES AND ESTIMATED REIMBURSEMENT FROM MEDICARE TENNCARE MEDICAID AND OTHER THIRDPARTY PAYMENT PROGRAMS WELLMONTS POLICY DOES NOT REQUIRE COLLATERAL OR OTHER SECURITY FOR PATIENT ACCOUNTS RECEIVABLE WELLMONT ROUTINELY OBTAINS ASSIGNMENT OF OR IS OTHERWISE ENTITLED TO RECEIVE PATIENT BENEFITS PAYABLE UNDER HEALTH INSURANCE PROGRAMS PLANS OR POLICIES THE MEDICARE COST REPORT COST FINDING METHODOLOGY AND COST TO CHARGE RATIOS WERE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 LINE 7 IS A SURPLUS SO IT IS NOT INCLUDED AS COMMUNITY BENEFIT THE IRS INSTRUCTIONS FOR SCHEDULE H PART III SECTION B LINES 57 SPECIFICALLY INDICATE TO INCLUDE ONLY THOSE APPLICABLE COSTS AND MEDICARE REIMBURSEMENTS THAT ARE REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT FOR THE YEAR THIS REPORTING DOES NOT TAKE INTO ACCOUNT THOSE COSTS AND REVENUES ASSOCIATED WITH PHYSICIANS WHO ARE TREATING MEDICARE PATIENTS AT HOSPITALOWNED CLINIC AND PHYSICIAN PRACTICE SITES ACCORDINGLY THE RESULT OF TREATING MEDICARE PATIENTS FROM A FINANCIAL PERSPECTIVE MAY DIFFER AS REPORTED FOR FINANCIAL REPORTING PURPOSES AND COMMUNITY BENEFIT REPORTING PURPOSES FROM THE SURPLUS OR SHORTFALL SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H PART III LINE 9B A THIRDPARTY VENDOR WAS USED BEGINNING IN FISCAL YEAREND 6302010 TO IDENTIFY PATIENTS WHO HAD BEEN SENT TO A COLLECTION AGENCY BUT WHO LIKELY WOULD QUALIFY FOR CHARITY CARE THESE PATIENTS ACCOUNTS ARE THEN WRITTEN OFF AS CHARITY CARE
BRISTOL REGIONAL MEDICAL CENTER LINE NUMBER 1 PART V LINE 15EPART V LINE 15EWELLMONT BRISTOL REGIONAL MEDICAL CENTER S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
BRISTOL REGIONAL MEDICAL CENTER LINE NUMBER 1 PART V LINE 16EPART V LINE 16EWELLMONT BRISTOL REGIONAL MEDICAL CENTER S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
HOLSTON VALLEY MEDICAL CENTER LINE NUMBER 2 PART V LINE 15EPART V LINE 15EWELLMONT HOLSTON VALLEY MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
HOLSTON VALLEY MEDICAL CENTER LINE NUMBER 2 PART V LINE 16EPART V LINE 16EWELLMONT HOLSTON VALLEY MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
LONESOME PINE HOSPITAL LINE NUMBER 3 PART V LINE 15EPART V LINE 15EWELLMONT LONESOME PINE HOSPITAL S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
LONESOME PINE HOSPITAL LINE NUMBER 3 PART V LINE 16EPART V LINE 16EWELLMONT LONESOME PINE HOSPITAL S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
HANCOCK COUNTY HOSPITAL LINE NUMBER 4 PART V LINE 15EPART V LINE 15EWELLMONT HANCOCK COUNTY HOSPITALS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
HANCOCK COUNTY HOSPITAL LINE NUMBER 4 PART V LINE 16EPART V LINE 16EWELLMONT HANCOCK COUNTY HOSPITALS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
MOUNTAIN VIEW REGIONAL MEDICAL CENT LINE NUMBER 5 PART V LINE 15EPART V LINE 15EWELLMONT MOUNTAIN VIEW REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
MOUNTAIN VIEW REGIONAL MEDICAL CENT LINE NUMBER 5 PART V LINE 16EPART V LINE 16EWELLMONT MOUNTAIN VIEW REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
LEE REGIONAL MEDICAL CENTER LINE NUMBER 6 PART V LINE 15EPART V LINE 15EWELLMONT LEE REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES
LEE REGIONAL MEDICAL CENTER LINE NUMBER 6 PART V LINE 16EPART V LINE 16EWELLMONT LEE REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (17 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrantAddress Line2AddressUS/AddressLine2
APPALACHIAN COLLEGE OF PHARMACY CON
1060 DRAGON RDOAKWOODVA2463126006916750110000SPONSORSHIP
AMERICAN CANCER SOCIETY
508 PRINCETON RDJOHNSON CITYTN3760164032909950118000RELAY FOR LIFE SPONSSUITE 102
AMERICAN HEART ASSOCIATION
PO BOX 4002900DES MOINESIA5034013561379750135000GO RED FOR WOMEN SPO
BARTER THEATRE FOUNDATION
PO BOX 867ABINDGONVA2421254600012050120000CORPORATE SPONSORSHI
CROSSROADS MEDICAL MISSION
PO BOX 16852BRISTOLVA24209685254203887750112500CORPORATE SPONSOR
FISCHER ROSS GROUP INC
2 SOUND VIEW DRGREENWICHCT06830205111271COR17500JOAN LUNDEN TALENTSUITE 100
FRIENDS IN NEED HEALTH CENTER
1105 WEST STONE DRKINGSPORTTN37660621541637501151500UNINSURED HEALTHCARE
FUN FEST KINGSPORT TN
151 EAST MAIN STKINGSPORTTN3766062044683450112140FUN FEST SPONSORSHIP
KINGSPORT CHAMBER OF COMMERCE
151 EAST MAIN STKINGSPORTTN3766262044683450124655ANNUAL SPONSORSHIP
KINGSPORT TOMORROW
301 LOUIS STKINGSPORTTN3766058194100250110000ANNUAL HEALTHCARE SYSUITE 303
KOMEN TRI-CITIES AFFILIATE
PO BOX 5835KINGSPORTTN3766384168906750150000RACE FOR THE CURE SP
MARCH OF DIMES
2313 BROWNS MILL RDJOHNSON CITYTN376041318463665019500SIGNATURE CHEF ADDITSUITE 3
RHYTHM & ROOTS REUNION
PO BOX 1927BRISTOLVA242037215262065018000GOLD SPONSORSHIP FOR
SYMPHONY OF THE MOUNTAINS
1200 E CENTER STKINGSPORTTN3766062053422850135000WELLMONT HOLIDAY CON
TENNESSEE CHAMBER OF COMMERCE
611 COMMERCE STNASHVILLETN372036212360225016000ANNUAL SPONSORSHIPSUITE 3030
WATAUGA SPORTS MEDICINE FOUNDATION
PO BOX 2267JOHNSON CITYTN37605621586264PLC40000ATHLETE OF THE WEEK
WCYB
PO BOX 601063CHARLOTTENC28260540467002COR18084GO RED FOR WOMEN MED

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATESIdentifier
Return ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2ReturnReference
ExplanationALL REQUESTS FOR CHARITABLE ASSISTANCE ARE REVIEWED BY THE SENIOR VICE PRESIDENT OF MARKETING COMMUNICATIONS. THE REQUEST FOR GRANT FUNDS IS EVALUATED ON THE BASIS OF THE FOLLOWING ITEMS: THE DEGREE TO WHICH THE REQUEST SUPPORTS WELLMONT HEALTH SYSTEM'S MISSION, REPRESENTATION OF WELLMONT HEALTH SYSTEM AS A GOOD CORPORATE CITIZEN, AND THE ANNUAL BUDGET. THE SENIOR VICE PRESIDENT THEN MAKES A DETERMINATION OF APPROVAL FOR ALL REQUESTS AND THE REQUEST IS SENT DIRECTLY TO ACCOUNTS PAYABLE FOR PAYMENT. WELLMONT HEALTH SYSTEM MAKES MINIMAL GRANTS (LESS THAN 5,000 PER ENTITY) THROUGHOUT THE YEAR. THE USE OF THESE GRANT FUNDS IS NOT MONITORED BY WELLMONT HEALTH SYSTEM AS THESE GRANTS ARE MADE IN GENERAL SUPPORT OF THE GRANT RECIPIENT.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptiontrueInitialContractException
Rebuttable Presumption ProceduretrueRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (23 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgBonus Filing OrgBonusFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrg
ROBERT F BURGIN - THROUGH 073110
38084317519398362
DAVID THOMPSON MD
28573614395348148393168701
PIERRE ISTFAN MD
27415127134619448118650717147
MARGARET DENARVAEZ-080110-PRESENT
2692304891657599971602
ELIZABETH WARD
4149802395844121613177876
J DALE SARGENT MD-THROUGH 2611
28609877437272460775608818989
MICHAEL BUNDY - THROUGH 4811
25245616232954451180938316363
GARY D MILLER - THROUGH 122010
24093589131822451180950315715
HAMLIN J WILSON
24093541431341751180517315715
ALICE POPE
22343918028445837532879414513
PATRICK KANE - THROUGH 63011
207376889328321743930951213506
TODD J DOUGAN
19279825780742650951212847
KENT PETTY - 3110 TO PRESENT
17769457381916748242
BARTHOLEMEW A HOVE
336293782243820162896951221678
RON PREWITT
25331877433006053940550216526
DAVID L BRASH
240935270318781513001028115995
FRED PELLE
20679595426926938677951213331
BLAINE DOUGLAS - THROUGH 7910
18656450720277157659935
JORGE LODEIRO MD
712000849914084156002915036083
EDWIN A MCELROY MD
587738270791641163283951230838
ROBERT HARRIS MD-THROUGH 103110
6930308667016517755
MALCOLM R MATTHEWS MD-TO 5311
4764941308698443180207951230922
MARCO DASILVA MD
4810547746893071667681028130430

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FRINGE OR EXPENSE EXPLANATIONSCHEDULE J, PAGE 1, PART I, LINE 1AAIRPLANE TRAVEL AND TRAVEL FOR COMPANIONS WELLMONT HEALTH SYSTEM PROVIDED AIRPLANE TRAVEL FOR ITS EXECUTIVES THROUGH A PARTIAL OWNERSHIP OF AN AIRPLANE. ON OCCASION, TRAVEL WAS PROVIDED FOR EXECUTIVES AND THEIR COMPANIONS FOR PERSONAL USE. WELLMONT HEALTH SYSTEM FOLLOWED IRS GUIDELINES AND INCLUDED THE APPROPRIATE AMOUNTS IN THEIR TAXABLE COMPENSATION. HOUSING ALLOWANCE WELLMONT HEALTH SYSTEM OFFERED A HOUSING ALLOWANCE FOR JOHN HOWARD, SR. VP OF LEGAL AFFAIRS, DURING THE FISCAL YEAR ENDED JUNE 30, 2011. THE HOUSING ALLOWANCE PAID TO THE EXECUTIVE WAS INCLUDED IN HIS TAXABLE COMPENSATION. HEALTH OR SOCIAL CLUB DUES DURING THE FISCAL YEAR ENDED JUNE 30, 2011, WELLMONT HEALTH SYSTEM PROVIDED COUNTRY CLUB MEMBERSHIPS TO MARGARET DENARVAEZ, PRESIDENT AND CEO, BART HOVE, PRESIDENT OF BRISTOL REGIONAL MEDICAL CENTER, JOHN HOWARD, SR. VP OF LEGAL AFFAIRS, PATRICK KANE, SR. VP OF MARKETING AND COMMUNICATIONS, AND TRACEY MOFFATT, SR. VP OF OPERATIONS. THESE AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION.
COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATIONSCHEDULE J, PAGE 1, PART I, LINE 6AINCENTIVE COMPENSATION IS PARTIALLY BASED ON MEETING BUDGETED OPERATING MARGIN GOALS.
PURSUANT TO CONTRACT PER REGS. SECTION 53.4958-4(A)(3)SCHEDULE J, PAGE 1, PART I, LINE 8ON AUGUST 1, 2010, MARGARET D. DENARVAEZ BECAME THE PRESIDENT AND CEO OF WELLMONT HEALTH SYSTEM. AS PART OF HER EMPLOYMENT CONTRACT, WHICH WAS REVIEWED, APPROVED AND DOCUMENTED BY WELLMONT HEALTH SYSTEM'S PERSONNEL COMMITTEE AND ALSO THE BOARD OF DIRECTORS, NONE OF WHICH HAD A CONFLICT OF INTEREST WITH RESPECT TO THE EMPLOYMENT CONTRACT, HER FORMER RESIDENCE WAS TO BE PURCHASED BY WELLMONT HEALTH SYSTEM FOR THE GREATER OF A FIXED PAYMENT AMOUNT OR ITS APPRAISED VALUE. THREE INDEPENDENT APPRAISALS WERE OBTAINED TO SUBSTANTIATE THE FAIR MARKET VALUE OF THE HOUSE. THE DIFFERENCE BETWEEN THE PURCHASE PRICE OF THE HOUSE AND THE APPRAISED FAIR MARKET VALUE OF THE HOUSE WAS INCLUDED IN THE 2010 FORM W-2 OF MARGARET D. DENARVAEZ. ADDITIONALLY, PRIOR TO DECEMBER 31, 2010, WELLMONT HEALTH SYSTEM RECEIVED AN INTERMEDIATE SANCTION REVIEW CONDUCTED BY AN INDEPENDENT COMPANY FOR THE CEO POSITION WHICH DETERMINED THAT THE COMPENSATION RATE WAS IN THE COMPETITIVE RANGE AND IN COMPLIANCE WITH SECTION 4958 OF THE INTERNAL REVENUE CODE.
OTHER ADDITIONAL INFORMATIONSCHEDULE J, PART IIIWELLMONT HEALTH SYSTEM HAS AN EXECUTIVE RETIREMENT PROGRAM THAT INCLUDED MARGARET DENARVAEZ, JOHN HOWARD AND ELIZABETH WARD FOR THE FISCAL YEAR ENDING JUNE 30, 2011. THIS PROGRAM HAS A TARGET BENEFIT OF 60% OF THE HIGHEST THREE YEAR AVERAGE SALARY (LESS EMPLOYER PROVIDER BENEFITS) AND THE EXECUTIVE MUST HAVE TWENTY YEARS OF SERVICE TO RECEIVE THE FULL BENEFIT. THE EXECUTIVE MAY RETIRE EARLY AT AGE 60 AND RECEIVE REDUCED BENEFITS. THERE WERE NO PAYMENTS MADE UNDER THIS PROGRAM FOR THE FISCAL YEAR ENDING JUNE 30, 2011.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
SULLIVAN CNTY TENN HEALTH EDL & HSG
621256662865293AC82006-11-02200000000RENOVATION/CONSTRUCTION OF HOLSTON VALLEYfalsefalsefalse
VIRGINIA SMALL BUSINESS FING AUTH H
541300845928101AC82007-07-3155000000PURCHASE OF HOSPITALSfalsefalsefalse
SULLIVAN CNTY TENN HEALTH EDL & HSG
621256662865292DY92003-06-0159100000REFUND OF PREVIOUSLY ISSUED BONDfalsefalsefalse
SULLIVAN CNTY TENN HEALTH EDL & HSG
621256662865292DZ62005-12-1370620000REFUND OF PREVIOUSLY ISSUED BONDfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapital ExpendituresCapitalExpenditures
207055314189779952164568187573513125348572011falsefalsefalsetrue
55658570546459010263662007falsefalsetruetrue49167614
67546371530028221843582003falsetruetruetrue
719237352669581269502005falsetruetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsetruetrue
falsefalsefalsefalsetruetrue
falsefalsefalsefalsetruetrue
falsefalsefalsefalsetruefalse

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminated
MERRILL LYNCH
falsefalsefalsetrue4.0truefalsefalse
(no name)
falsefalsefalsefalsefalsefalse
(no name)
falsefalsefalsefalsefalsefalse
LEHMAN BROTHERS
falsetruetruefalsefalsefalse10.8falsefalse

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
SULLIVAN CNTY TENN HEALTH EDL & HSG
621256662865293AC82006-11-02200000000RENOVATION/CONSTRUCTION OF HOLSTON VALLEYfalsefalsefalse
VIRGINIA SMALL BUSINESS FING AUTH H
541300845928101AC82007-07-3155000000PURCHASE OF HOSPITALSfalsefalsefalse
SULLIVAN CNTY TENN HEALTH EDL & HSG
621256662865292DY92003-06-0159100000REFUND OF PREVIOUSLY ISSUED BONDfalsefalsefalse
SULLIVAN CNTY TENN HEALTH EDL & HSG
621256662865292DZ62005-12-1370620000REFUND OF PREVIOUSLY ISSUED BONDfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapital ExpendituresCapitalExpenditures
207055314189779952164568187573513125348572011falsefalsefalsetrue
55658570546459010263662007falsefalsetruetrue49167614
67546371530028221843582003falsetruetruetrue
719237352669581269502005falsetruetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsetruetrue
falsefalsefalsefalsetruetrue
falsefalsefalsefalsetruetrue
falsefalsefalsefalsetruefalse

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminated
MERRILL LYNCH
falsefalsefalsetrue4.0truefalsefalse
(no name)
falsefalsefalsefalsefalsefalse
(no name)
falsefalsefalsefalsefalsefalse
LEHMAN BROTHERS
falsetruetruefalsefalsefalse10.8falsefalse

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonJOHN HOWARDNamePerson
Purpose Of LoanRELOCATION ASSISTANCEPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$31,250OriginalPrincipalAmount
Balance Due29514BalanceDue
DefaultfalseDefault
Approved By BoardtrueApprovedByBoard
Written AgreementtrueWrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due29514TotalBalanceDue

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierADDITIONAL INFORMATIONIdentifier
Return ReferenceSCHEDULE L PART VReturnReference
ExplanationTHE TERMS OF MR HOWARDS EMPLOYMENT OFFER INCLUDING RELOCATION ALLOWANCE AND TEMPORARY HOUSING WAS APPROVED BY THE WELLMONT HEALTH SYSTEMS PERSONNEL COMMITTEE OF THE BOARD OF DIRECTORS AT ITS MEETING HELD JANUARY 27 2011Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ADDITIONAL INFORMATIONFORM 990FORM 990, PART X, BALANCE SHEET CERTAIN BALANCE SHEET ACCOUNTS HAVE BEEN RECLASSIFIED FOR BETTER COMPARISON TO THE CURRENT YEAR FINANCIAL STATEMENTS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BWELLMONT HEALTH SYSTEM'S FORM 990 IS REVIEWED BY THREE INDIVIDUALS OF WELLMONT HEALTH SYSTEM (THE SENIOR VICE PRESIDENT OF FINANCE, THE CORPORATE CONTROLLER, AND THE MANAGER OF ACCOUNTING) AND THE BOARD OF DIRECTORS OF WELLMONT HEALTH SYSTEM. ANY QUESTIONS OR COMMENTS ARISING FROM THE INITIAL REVIEW ARE ADDRESSED TO ENSURE THE RETURN IS COMPLETE AND ACCURATE.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12COFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT THAT IS RECEIVED AND REVIEWED BY GENERAL COUNSEL. WELLMONT HEALTH SYSTEM ALSO HAS A POLICY ON BUSINESS PRACTICES THAT DISCUSSES CONFLICT OF INTEREST AND INFORMS THE WORKFORCE TO DISCLOSE ANY ISSUES TO THE SENIOR VICE PRESIDENT, COMPLIANCE AND AUDIT SERVICES, FOR RESOLUTION. WELLMONT HEALTH SYSTEM ALSO USES A HOTLINE THAT ALLOWS ANONYMOUS REPORTING OF POSSIBLE CONFLICT OF INTEREST SITUATIONS FOR INVESTIGATION BY THE SENIOR VICE PRESIDENT, COMPLIANCE AND AUDIT SERVICES.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE COMPENSATION OF MARGARET DENARVAEZ, THE PRESIDENT AND CEO (08/01/10 TO PRESENT) OF WELLMONT HEALTH SYSTEM IS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM PERSONNEL COMMITTEE AND BOARD OF DIRECTORS. THE COMPENSATION OF ROBERT BURGIN, THE PRESIDENT AND CEO (INTERIM - 02/01/10 TO 07/31/10) OF WELLMONT HEALTH SYSTEM, WAS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM PERSONNEL COMMITTEE AND THE BOARD OF DIRECTORS. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED THE SALARY AND MARKET COMPENSATION DATA FOR MARGARET DENARVAEZ IMMEDIATELY PRIOR TO TENDERING HER OFFER OF EMPLOYMENT. THE LAST COMPENSATION DELIBERATION AND REVIEW PROCESS FOR MARGARET DENARVAEZ WAS COMPLETED MARCH 15, 2011.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BTHE COMPENSATION OF THE OTHER OFFICERS AND KEY EMPLOYEES OF WELLMONT HEALTH SYSTEM ARE REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM PERSONNEL COMMITTEE AND BOARD OF DIRECTORS. OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION HAVE WRITTEN EMPLOYMENT CONTRACTS AND COMPENSATION IS BASED ON SURVEYS/STUDIES AND THEN APPROVED BY THE WELLMONT HEALTH SYSTEM CEO. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. THIS PROCESS IN COMPLETED ON AN ANNUAL BASIS. THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED THE SALARY AND MARKET COMPENSATION DATA FOR THE FOLLOWING OTHER OFFICERS AND KEY EMPLOYEES ON AUGUST 26, 2010. WELLMONT HEALTH SYSTEM EXECUTIVE VP AND CFO - ELIZABETH WARD WELLMONT HEALTH SYSTEM SR. VP OF OPERATIONS - MICHAEL BUNDY WELLMONT HEALTH SYSTEM SR. VP OF HUMAN RESOURCES - HAMLIN J. WILSON WELLMONT HEALTH SYSTEM SR. VP GENERAL COUNSEL - GARY D. MILLER WELLMONT HEALTH SYSTEM CHIEF MEDICAL OFFICER - DALE SARGENT, M.D. WELLMONT HEALTH SYSTEM SR. VP OF MARKETING AND COMMUNICATIONS - PATRICK KANE BRISTOL REGIONAL MEDICAL CENTER PRESIDENT - BARTHOLOMEW A. HOVE HOLSTON VALLEY MEDICAL CENTER PRESIDENT - VIRGINIA FRANK HAWKINS COUNTY MEMORIAL HOSPITAL PRESIDENT - FRED PELLE REGIONAL VP VIRGINIA DIVISION - DAVID L. BRASH THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED THE SALARY AND MARKET COMPENSATION DATA FOR THE FOLLOWING OTHER OFFICERS AND KEY EMPLOYEES, IMMEDIATELY PRIOR TO TENDERING THEIR OFFERS OF EMPLOYMENT. WELLMONT HEALTH SYSTEM SR. VP OF OPERATIONS - TRACEY P. MOFFAT WELLMONT PHYSICIAN SERVICES PRESIDENT AND WELLMONT HEALTH SERVICES GENERAL COUNSEL - JOHN HOWARD WELLMONT HEALTH SYSTEM USES ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE COMPENSATION OF THE FOLLOWING OTHER OFFICERS AND KEY EMPLOYEES. WELLMONT HEALTH SYSTEM SR. VP OF FINANCE - ALICE POPE WELLMONT HEALTH SYSTEM SR. VP OF FINANCE - TODD J. DOUGAN WELLMONT HEALTH SYSTEM CHIEF INFORMATION OFFICER - KENT PETTY LEE REGIONAL MEDICAL CENTER PRESIDENT - RON PREWITT
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19WELLMONT HEALTH SYSTEM'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT AVAILABLE TO THE PUBLIC. WELLMONT HEALTH SYSTEM'S AUDITED FINANCIAL STATEMENTS AND QUARTERLY UNAUDITED FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE.
GROUP RETURN METHODFORM 990, PAGE 7, PART VIIPARENT ORGANIZATION HAS FILED A CONSOLIDATED RETURN

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1WELLMONT HEALTH MANAGEMENTBusinessNameLine1
Business Name Line2SERVICES LLCBusinessNameLine2

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11905 AMERICAN WAYAddressLine1
CityKINGSPORTCity
StateTNState
ZIP Code37660ZIPCode
FieldValueIRS element (for citing)
EIN621825259EIN
Primary ActivitiesHEALTHCAREPrimaryActivities
Legal Domicile StateTNLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1WHSBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
WELLMONT HAWKINS CO MEMORIAL HOSPI
1905 AMERICAN WAYKINGSPORTTN37660621816368HEALTHCARETN501C33NAtrue
WELLMONT MADISON HOUSE
1905 AMERICAN WAYKINGSPORTTN37660621308216HEALTHCARETN501C39WHStrue
WELLMONT FOUNDATION
1905 AMERICAN WAYKINGSPORTTN37660581594191HEALTHCARETN501C37WHStrue
TAKOMA REGIONAL HOSPITAL
401 TAKOMA AVEGREENVILLETN37734510603966HEALTHCARETN501C33WHStrue
WELLMONT CARDIOLOGY SERVICES
1905 AMERICAN WAYKINGSPORTTN37660263557623HEALTHCARETN501C33WHStrue
WELLMONT IMAGING SERVICES INC
1905 AMERICAN WAYKINGSPORTTN37660861103148HEALTHCARETN501C311AWHStrue
WELLMONT MEDICAL ASSOCIATES
1905 AMERICAN WAYKINGSPORTTN37660270898372HEALTHCARETN501C33WHStrue
WELLMONT SLEEP SERVICES
1906 AMERICAN WAYKINGSPORTTN37660HEALTHCARETN501C33WHStrue

Form990 Schedule R Part III Form990ScheduleRPartIII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Business Name Line2DirectControllingEntityName/BusinessNameLine2Predominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnershipBusiness Name Line2NameOfRelatedOrg/BusinessNameLine2Share Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssets
HOLSTON VALLEY IMAGING CENTER
103 WEST STONE DRIVEKINGSPORTTN37660TNWHSIMAGINGRELATEDfalsefalse0.75000
SAPLING GROVE AMBULATORY
220 MEDICAL PARK BOULEVARDBRISTOLTN37620TNWHSRELATEDfalsefalse0.65000SURGERY6158224532492
HOLSTON VALLEY AMBULATORY
103 WEST STONE DRIVEKINGSPORTTN37660TNWHSRELATEDfalsefalse0.52000SURGERY10986981895900
HOLSTON VALLEY IMAGING CENTER
103 WEST STONE DRIVEKINGSPORTTN37660TNWHSIMAGINGRELATEDfalsefalse0.75000
SAPLING GROVE AMBULATORY
220 MEDICAL PARK BOULEVARDBRISTOLTN37620TNWHSRELATEDfalsefalse0.65000SURGERY6158224532492
HOLSTON VALLEY AMBULATORY
103 WEST STONE DRIVEKINGSPORTTN37660TNWHSRELATEDfalsefalse0.52000SURGERY10986981895900

Form990 Schedule R Part IV Form990ScheduleRPartIV (14 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipDirect Controlling Entity NADirectControllingEntityNABusiness Name Line2NameOfRelatedOrg/BusinessNameLine2
WELLMONT INC
1905 AMERICAN WAYKINGSPORTTN37660621320035PHYS. SVCSTNWHSC CORP-15105870-501662841.00000
MCOT INC
1905 AMERICAN WAYKINGSPORTTN37660621325938MED. SVCS.TNN/A
MEDICAL LAUNDRY OF TRI-CITIES
1905 AMERICAN WAYKINGSPORTTN37660621482226MED. SVCS.TNN/AMEDICAL LAUNDRY OF TRI-CITIES
MEDICAL MALL PHARMACY INC
1905 AMERICAN WAYKINGSPORTTN37660621565006MED. SVCS.TNN/A
WELLMONT PHYSICIAN SERVICES
1905 AMERICAN WAYKINGSPORTTN37660621567353PHYS. SVCSTNN/AWELLMONT PHYSICIAN SERVICES
WELLMONT HEALTH SERVICES INC
1905 AMERICAN WAYKINGSPORTTN37660621254373HEALTHCARETNN/A
WPS PROVIDERS INC
1905 AMERICAN WAYKINGSPORTTN37660205564642PHYS. SVCSTNN/A
WELLMONT INC
1905 AMERICAN WAYKINGSPORTTN37660621320035PHYS. SVCSTNWHSC CORP-15105870-501662841.00000
MCOT INC
1905 AMERICAN WAYKINGSPORTTN37660621325938MED. SVCS.TNN/A
MEDICAL LAUNDRY OF TRI-CITIES
1905 AMERICAN WAYKINGSPORTTN37660621482226MED. SVCS.TNN/AMEDICAL LAUNDRY OF TRI-CITIES
MEDICAL MALL PHARMACY INC
1905 AMERICAN WAYKINGSPORTTN37660621565006MED. SVCS.TNN/A
WELLMONT PHYSICIAN SERVICES
1905 AMERICAN WAYKINGSPORTTN37660621567353PHYS. SVCSTNN/AWELLMONT PHYSICIAN SERVICES
WELLMONT HEALTH SERVICES INC
1905 AMERICAN WAYKINGSPORTTN37660621254373HEALTHCARETNN/A
WPS PROVIDERS INC
1905 AMERICAN WAYKINGSPORTTN37660205564642PHYS. SVCSTNN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (84 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
HOLSTON VALLEY AMBULATORY SURGERY C
I854332LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
I824189LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
P607651COST
MCOT INC
L2017149COLLECTION AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
I92750LEASE AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
L2020989FMV
MEDICAL MALL PHARMACY INC
L71996COST
SAPLING GROVE AMBULATORY SURGE
R975000DISTRIBUTION
WELLMONT CARDIOLOGY SERVICES
L362589MANAGEMENT AGREEMENT
WELLMONT FOUNDATION
C3325105NEED
WELLMONT HAWKINS COUNTY MEMORIAL HO
B893279INTERCOMPANY TRANSFER
WELLMONT HAWKINS COUNTY MEMORIAL HO
I190632LEASE AGREEMENT
WELLMONT HAWKINS COUNTY MEMORIAL HO
K2167859SUPPORT SERVICES
WELLMONT MADISON HOUSE
B122833INTERCOMPANY TRANSFER
WELLMONT PHYSICIAN SERVICES INC
I1284739LEASE AGREEMENT
WELLMONT PHYSICIAN SERVICES INC
L135238SERVICE AGREEMENT
WELLMONT FOUNDATION
B122063NEED
WELLMONT MEDICAL ASSOCIATES
L285000SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
K2896947SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
F350850NET BOOK VALUE
HOLSTON VALLEY AMBULATORY SURGERY C
R906360DISTRIBUTION
HOLSTON VALLEY AMBULATORY SURGERY C
I854332LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
I824189LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
P607651COST
MCOT INC
L2017149COLLECTION AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
I92750LEASE AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
L2020989FMV
MEDICAL MALL PHARMACY INC
L71996COST
SAPLING GROVE AMBULATORY SURGE
R975000DISTRIBUTION
WELLMONT CARDIOLOGY SERVICES
L362589MANAGEMENT AGREEMENT
WELLMONT FOUNDATION
C3325105NEED
WELLMONT HAWKINS COUNTY MEMORIAL HO
B893279INTERCOMPANY TRANSFER
WELLMONT HAWKINS COUNTY MEMORIAL HO
I190632LEASE AGREEMENT
WELLMONT HAWKINS COUNTY MEMORIAL HO
K2167859SUPPORT SERVICES
WELLMONT MADISON HOUSE
B122833INTERCOMPANY TRANSFER
WELLMONT PHYSICIAN SERVICES INC
I1284739LEASE AGREEMENT
WELLMONT PHYSICIAN SERVICES INC
L135238SERVICE AGREEMENT
WELLMONT FOUNDATION
B122063NEED
WELLMONT MEDICAL ASSOCIATES
L285000SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
K2896947SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
F350850NET BOOK VALUE
HOLSTON VALLEY AMBULATORY SURGERY C
R906360DISTRIBUTION
HOLSTON VALLEY AMBULATORY SURGERY C
I854332LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
I824189LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
P607651COST
MCOT INC
L2017149COLLECTION AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
I92750LEASE AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
L2020989FMV
MEDICAL MALL PHARMACY INC
L71996COST
SAPLING GROVE AMBULATORY SURGE
R975000DISTRIBUTION
WELLMONT CARDIOLOGY SERVICES
L362589MANAGEMENT AGREEMENT
WELLMONT FOUNDATION
C3325105NEED
WELLMONT HAWKINS COUNTY MEMORIAL HO
B893279INTERCOMPANY TRANSFER
WELLMONT HAWKINS COUNTY MEMORIAL HO
I190632LEASE AGREEMENT
WELLMONT HAWKINS COUNTY MEMORIAL HO
K2167859SUPPORT SERVICES
WELLMONT MADISON HOUSE
B122833INTERCOMPANY TRANSFER
WELLMONT PHYSICIAN SERVICES INC
I1284739LEASE AGREEMENT
WELLMONT PHYSICIAN SERVICES INC
L135238SERVICE AGREEMENT
WELLMONT FOUNDATION
B122063NEED
WELLMONT MEDICAL ASSOCIATES
L285000SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
K2896947SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
F350850NET BOOK VALUE
HOLSTON VALLEY AMBULATORY SURGERY C
R906360DISTRIBUTION
HOLSTON VALLEY AMBULATORY SURGERY C
I854332LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
I824189LEASE AGREEMENT
HOLSTON VALLEY IMAGING CENTER INC
P607651COST
MCOT INC
L2017149COLLECTION AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
I92750LEASE AGREEMENT
MEDICAL LAUNDRY OF TRI-CITIES INC
L2020989FMV
MEDICAL MALL PHARMACY INC
L71996COST
SAPLING GROVE AMBULATORY SURGE
R975000DISTRIBUTION
WELLMONT CARDIOLOGY SERVICES
L362589MANAGEMENT AGREEMENT
WELLMONT FOUNDATION
C3325105NEED
WELLMONT HAWKINS COUNTY MEMORIAL HO
B893279INTERCOMPANY TRANSFER
WELLMONT HAWKINS COUNTY MEMORIAL HO
I190632LEASE AGREEMENT
WELLMONT HAWKINS COUNTY MEMORIAL HO
K2167859SUPPORT SERVICES
WELLMONT MADISON HOUSE
B122833INTERCOMPANY TRANSFER
WELLMONT PHYSICIAN SERVICES INC
I1284739LEASE AGREEMENT
WELLMONT PHYSICIAN SERVICES INC
L135238SERVICE AGREEMENT
WELLMONT FOUNDATION
B122063NEED
WELLMONT MEDICAL ASSOCIATES
L285000SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
K2896947SERVICES AGREEMENT
WELLMONT CARDIOLOGY SERVICES
F350850NET BOOK VALUE
HOLSTON VALLEY AMBULATORY SURGERY C
R906360DISTRIBUTION

Reasonable Cause Explanation ReasonableCauseExplanation

FieldValueIRS element (for citing)
ExplanationWELLMONT HEALTH SYSTEM REQUESTED THE INTERNAL REVENUE SERVICE'S APPROVAL OF A ONE-TIME EXTENSION TO MAY 15, 2012 FOR OUR FORM 990 RETURN. THE ORIGINAL REQUEST FOR THE FIRST EXTENSION WAS INADVERTENTLY FILED ONE DAY AFTER THE REQUIRED DUE DATE OF NOVEMBER 15, 2011. AS A COST SAVING INITIATIVE, WE BROUGHT THE RETURN PREPARATION IN-HOUSE AND PURCHASED ULTRATAX SOFTWARE TO ASSIST WITH THE FILING. UNFORTUNATELY, WE ATTEMPTED TO FILE THE REQUEST FOR EXTENSION ELECTRONICALLY WITH THE NEW SOFTWARE, BUT WE WERE UNSUCCESSFUL AFTER MUCH EFFORT. THEREFORE, WE HURRIEDLY FILED THE EXTENSION MANUALLY. IN THE MEANTIME, ONE OF OUR RELATED ORGANIZATIONS FILED AN ORIGINAL REQUEST FOR A FIRST EXTENSION ON THE SAME DAY THAT WELLMONT HEALTH SYSTEM FILED AN ORIGINAL REQUEST FOR A FIRST EXTENSION, AND WAS GRANTED AN EXTENSION. WELLMONT HEALTH SYSTEM HAS TAKEN ACTIONS TO ENSURE THAT ALL FUTURE FILINGS WILL BE TIMELY BY PROPERLY INSTALLING AND PROVIDING TRAINING ON THE ULTRATAX SOFTWARE SYSTEM. A CORPORATE ANNUExplanation