2012-05-22T09:21:48-05:00 2011-06-30 990 2010-07-01 621636465 WELLMONT HEALTH SYSTEM WELL 4232308200 1905 AMERICAN WAY KINGSPORT TN 37660 TODD J DOUGAN 4232308200 2012-05-22 2012-05-22 2010 2016-02-24 21:20:13Z TODD J DOUGAN 1905 AMERICAN WAY KINGSPORT TN 37660 851785997 false X WWW.WELLMONT.ORG X 1996 TN WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION. 14 11 5470 793 151530 -3190 2385595 3106229 601472119 651047190 7814832 9545103 10322525 9646203 621995071 673344725 1065798 697055 0 249808413 254579570 0 0 337180801 387366874 588055012 642643499 33940059 30701226 906473724 939337117 609622506 576621565 296851218 362715552 X WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION. false false 617478652 697055 651047190 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 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 CONTINUING 617478652 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true true false false false false false true false false false false false false false false true true true true false false true 392 0 true 5470 true true true false false false false true true false false false false false false X 14 11 false false false false false false false true true false false true true true true true true true true true false TN X TODD J DOUGAN 4232308512 1905 AMERICAN WAY KINGSPORT TN 37660 X ROBERT F BURGIN - THROUGH 073110 40.00 X X 398362 0 0 DAVID THOMPSON MD 40.00 X 339447 0 8701 PIERRE ISTFAN MD 40.00 X 322540 0 23654 JULIE P BENNETT 6.00 X X 0 0 0 MARVIN CAMERON 6.00 X 0 0 0 DAVE CROCKETT 6.00 X X 0 0 0 WAYNE J KENNEDY 6.00 X 0 0 0 E WAYNE KIRK 6.00 X X 0 0 0 RAVEN KRICKBAUM 6.00 X 0 0 0 ROGER L LEONARD 6.00 X 0 0 0 ROGER K MOWEN 6.00 X 0 0 0 THOMAS F PUGH MD 6.00 X 0 0 0 T ARTHUR BUDDY SCOTT JR 6.00 X X 0 0 0 GLEN SKIP SKINNER 6.00 X 0 0 0 DOUGLAS J SPRINGER MD 6.00 X 0 0 0 JOHN WILLIAMS 6.00 X 0 0 0 MARGARET DENARVAEZ-080110-PRESENT 40.00 X 758395 0 1602 ELIZABETH WARD 40.00 X 576536 0 7876 J DALE SARGENT MD-THROUGH 2611 40.00 X 347647 0 25077 MICHAEL BUNDY - THROUGH 4811 40.00 X 303798 0 25746 GARY D MILLER - THROUGH 122010 40.00 X 293006 0 25218 HAMLIN J WILSON 40.00 X 292529 0 20888 ALICE POPE 40.00 X 261151 0 23307 PATRICK KANE - THROUGH 63011 40.00 X 260199 0 23018 TODD J DOUGAN 40.00 X 235448 0 22359 KENT PETTY - 3110 TO PRESENT 40.00 X 183432 0 8242 VIRGINIA FRANK - 9710 TO PRESENT 40.00 X 117388 0 1595 TRACEY P MOFFATT-4911 TO PRESENT 40.00 X 0 0 0 JOHN HOWARD - 040111-PRESENT 40.00 X 0 0 0 BARTHOLEMEW A HOVE 40.00 X 407011 0 31190 RON PREWITT 40.00 X 308032 0 22028 DAVID L BRASH 40.00 X 292505 0 26276 FRED PELLE 2.00 X 246426 0 22843 BLAINE DOUGLAS - THROUGH 7910 40.00 X 187071 0 15700 JORGE LODEIRO MD 40.00 X 868851 0 45233 EDWIN A MCELROY MD 40.00 X 751291 0 40350 ROBERT HARRIS MD-THROUGH 103110 40.00 X 693896 0 7755 MALCOLM R MATTHEWS MD-TO 5311 40.00 X 658009 0 40434 MARCO DASILVA MD 40.00 X 648596 0 40711 9751566 509803 226 false true false SPECTRUM LABORATORY 4380 FEDERAL DRIVE GREENSBORO NC 27410 LAB SERVICES 13180693 ROBINS & MORTON GROUP 5500 MARYLAND WAY SUITE 100 BRENTWOOD TN 37027 CONTRACTING 10000943 HOLSTON ANESTHESIA ASSOCIATION 135 W RAVINE STREET KINGSPORT TN 37662 MEDICAL SERVICE 7468099 HIGHLANDS PATHOLOGY CONSULTANTS SPC 10368 WALLACE ALLEY 18 KINGSPORT TN 37663 MEDICAL SERVICE 1934507 EMERGENCY COVERAGE CORP PO BOX 634850 CINCINNATI OH 45263 PHYSICIAN SERVI 1545498 51 2892953 209350 3926 3106229 NET PATIENT REVENUE 621990 451576370 451576370 PHARMACY REVENUE 621990 186556496 186556496 BLOOD REVENUE 621990 12076273 12076273 ADMINISTRATIVE REVENUE 561000 838051 838051 651047190 7765025 7765025 6553454 2346555 4206899 4206899 4206899 157265095 20609700 156173958 19920759 1091137 688941 1780078 1780078 CAFETERIA VENDING 722210 2954366 2954366 MISCELLANEOUS REVENUE 900099 1825279 1825279 GIFT SHOP REVENUE 453220 508129 508129 151530 151530 5439304 673344725 651047190 151530 19039776 697055 697055 6421728 6421728 189475107 188924404 550703 8496802 7815138 681664 35675815 35407720 268095 14510118 14051779 458339 238200 238200 1156956 1059350 97606 807349 787001 20348 143581 143581 274817 274817 108446465 98108578 10337887 1000994 592665 408329 139711020 138276733 1434287 8371446 8361712 9734 21945311 21898751 46560 1384659 1146017 238642 32596 30356 2240 20142495 20136901 5594 41535435 40039838 1495597 4016007 4016007 PROVISION FOR BAD DEBTS 33729806 33705914 23892 PHYSICIAN RECRUITMENT 2330326 413222 1917104 MISC EXPENSE 1012708 777599 235109 DUES AND MEMBERSHIPS 724101 241397 482704 BOOKS AND PUBLICATIONS 362602 333917 28685 642643499 617478652 25164847 0 19280 17919 28821001 29872126 97840693 100500580 29514 14706814 15064889 6425709 6525891 886796805 454343156 425483782 432453649 303622399 321289188 20120565 18988817 4778521 8745924 4654960 5848620 906473724 939337117 59772029 52916367 430070000 438747592 119780477 84957606 609622506 576621565 X 296851218 362715552 296851218 362715552 906473724 939337117 30701226 35163108 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 143581 143581 642499918 642643499 1000000 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 91230 68925 96271 143581 400007 250000 250000 250000 250000 1000000 1500000 false false false false false false false false false false false false false false false false false false false false false false false false 1307181 32663799 33970980 519444184 204694980 314749204 2395334 474747 1920587 330986307 249173429 81812878 432453649 OTHER LT LIABILITIES 24218069 OTHER CURRENT LIABILITIES 18760892 CAPITAL LEASE OBLIGATIONS 16102252 SWAP LIABILITY 11588215 POST RETIREMENT BENEFITS 7762743 DEFINED BENEFITS PENSION LIABILITY 6525435 TAXABLE BOND LIABILITIES 84957606 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X THE 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. true true X true X true X 1.50000 true true false true true 17239015 17239015 0.02680 68091287 51748934 16342353 0.02540 85330302 51748934 33581368 0.05230 476 28811 5728028 5728028 0.00890 18 135 8731418 3556874 5174544 0.00810 11 81414 15500 65914 0.00010 273 2775 697055 697055 0.00110 778 31721 15237915 3572374 11665541 0.01820 778 31721 100568217 55321308 45246909 0.07040 6 199 199 122 882 20317 2630 17687 1 1025 1025 8 36 1424 1424 30 590 934 934 38 860 34755 34755 0.00010 13 997 997 218 2368 59651 2630 57021 0.00010 false 10025120 162869585 160898845 1970740 true true HOLSTON VALLEY IMAG RADIOLOGY SERVICES 0.75000 0.25000 HOLSTON VALLEY AMB SURGERY SERVICES 0.52000 0.48000 SAPLING GROVE AMB SURGICAL SERVICES 0.65000 0.35000 6 1 BRISTOL REGIONAL MEDICAL CENTER

1 MEDICAL PARK BLVD BRISTOL TN 37620

X X X 2 HOLSTON VALLEY MEDICAL CENTER

130 RAVINE ROAD KINGSPORT TN 37660

X X X 3 LONESOME PINE HOSPITAL

1990 HOLTON AVENUE BIG STONE GAP VA 24219

X X X 4 HANCOCK COUNTY HOSPITAL

1519 MAIN STREET SNEEDVILLE TN 37869

X X X 5 MOUNTAIN VIEW REGIONAL MEDICAL CENT

310 3RD STREET NE NORTON VA 24273

X X 6 LEE REGIONAL MEDICAL CENTER

PO BOX 589 127 HEALTH CARE DRIVE PENNINGTON GAP VA 24277

X X BRISTOL REGIONAL MEDICAL CENTER 1 true true 100.0 true 150.0 true X X X X X X X true true X X X X true X X X X X true X X X X X X X X true X false false HOLSTON VALLEY MEDICAL CENTER 2 true true 100.0 true 150.0 true X X X X X X X true true X X X X true X X X X X true X X X X X X X X true X false false LONESOME PINE HOSPITAL 3 true true 100.0 true 150.0 true X X X X X X X true true X X X X true X X X X X true X X X X X X X X true X false false HANCOCK COUNTY HOSPITAL 4 true true 100.0 true 150.0 true X X X X X X X true true X X X X true X X X X X true X X X X X X X X true X false false MOUNTAIN VIEW REGIONAL MEDICAL CENT 5 true true 100.0 true 150.0 true X X X X X X X true true X X X X true X X X X X true X X X X X X X X true X false false LEE REGIONAL MEDICAL CENTER 6 true true 100.0 true 150.0 true X X X X X X X true true X X X X true X X X X X true X X X X X X X X true X false false SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G PART 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 EXPENSE PART I LINE 7 COLUMN F THE 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 EXPLANATION PART I LINE 7 RATIO 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 ASSESSMENT PART VI WELLMONT 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 ASSISTANCE PART VI WELLMONT 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 INFORMATION PART VI WELLMONT 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 PURPOSE PART VI WELLMONT 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 INFORMATION PART VI WELLMONT 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 FILED PART VI TENNESSEE VIRGINIA ADDITIONAL INFORMATION PART VI PART 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 15E PART V LINE 15E WELLMONT BRISTOL REGIONAL MEDICAL CENTER S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES BRISTOL REGIONAL MEDICAL CENTER LINE NUMBER 1 PART V LINE 16E PART V LINE 16E WELLMONT BRISTOL REGIONAL MEDICAL CENTER S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES HOLSTON VALLEY MEDICAL CENTER LINE NUMBER 2 PART V LINE 15E PART V LINE 15E WELLMONT HOLSTON VALLEY MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES HOLSTON VALLEY MEDICAL CENTER LINE NUMBER 2 PART V LINE 16E PART V LINE 16E WELLMONT HOLSTON VALLEY MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES LONESOME PINE HOSPITAL LINE NUMBER 3 PART V LINE 15E PART V LINE 15E WELLMONT LONESOME PINE HOSPITAL S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES LONESOME PINE HOSPITAL LINE NUMBER 3 PART V LINE 16E PART V LINE 16E WELLMONT LONESOME PINE HOSPITAL S OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES HANCOCK COUNTY HOSPITAL LINE NUMBER 4 PART V LINE 15E PART V LINE 15E WELLMONT HANCOCK COUNTY HOSPITALS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES HANCOCK COUNTY HOSPITAL LINE NUMBER 4 PART V LINE 16E PART V LINE 16E WELLMONT HANCOCK COUNTY HOSPITALS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES MOUNTAIN VIEW REGIONAL MEDICAL CENT LINE NUMBER 5 PART V LINE 15E PART V LINE 15E WELLMONT MOUNTAIN VIEW REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES MOUNTAIN VIEW REGIONAL MEDICAL CENT LINE NUMBER 5 PART V LINE 16E PART V LINE 16E WELLMONT MOUNTAIN VIEW REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES LEE REGIONAL MEDICAL CENTER LINE NUMBER 6 PART V LINE 15E PART V LINE 15E WELLMONT LEE REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES LEE REGIONAL MEDICAL CENTER LINE NUMBER 6 PART V LINE 16E PART V LINE 16E WELLMONT LEE REGIONAL MEDICAL CENTERS OTHER ACTIONS INCLUDE GARNISHMENT OF WAGES true APPALACHIAN COLLEGE OF PHARMACY CON 1060 DRAGON RD OAKWOOD VA 24631 260069167 501 10000 SPONSORSHIP AMERICAN CANCER SOCIETY 508 PRINCETON RD SUITE 102 JOHNSON CITY TN 37601 640329099 501 18000 RELAY FOR LIFE SPONS AMERICAN HEART ASSOCIATION PO BOX 4002900 DES MOINES IA 50340 135613797 501 35000 GO RED FOR WOMEN SPO BARTER THEATRE FOUNDATION PO BOX 867 ABINDGON VA 24212 546000120 501 20000 CORPORATE SPONSORSHI CROSSROADS MEDICAL MISSION PO BOX 16852 BRISTOL VA 242096852 542038877 501 12500 CORPORATE SPONSOR FISCHER ROSS GROUP INC 2 SOUND VIEW DR SUITE 100 GREENWICH CT 06830 205111271 COR 17500 JOAN LUNDEN TALENT FRIENDS IN NEED HEALTH CENTER 1105 WEST STONE DR KINGSPORT TN 37660 621541637 501 151500 UNINSURED HEALTHCARE FUN FEST KINGSPORT TN 151 EAST MAIN ST KINGSPORT TN 37660 620446834 501 12140 FUN FEST SPONSORSHIP KINGSPORT CHAMBER OF COMMERCE 151 EAST MAIN ST KINGSPORT TN 37662 620446834 501 24655 ANNUAL SPONSORSHIP KINGSPORT TOMORROW 301 LOUIS ST SUITE 303 KINGSPORT TN 37660 581941002 501 10000 ANNUAL HEALTHCARE SY KOMEN TRI-CITIES AFFILIATE PO BOX 5835 KINGSPORT TN 37663 841689067 501 50000 RACE FOR THE CURE SP MARCH OF DIMES 2313 BROWNS MILL RD SUITE 3 JOHNSON CITY TN 37604 131846366 501 9500 SIGNATURE CHEF ADDIT RHYTHM & ROOTS REUNION PO BOX 1927 BRISTOL VA 24203 721526206 501 8000 GOLD SPONSORSHIP FOR SYMPHONY OF THE MOUNTAINS 1200 E CENTER ST KINGSPORT TN 37660 620534228 501 35000 WELLMONT HOLIDAY CON TENNESSEE CHAMBER OF COMMERCE 611 COMMERCE ST SUITE 3030 NASHVILLE TN 37203 621236022 501 6000 ANNUAL SPONSORSHIP WATAUGA SPORTS MEDICINE FOUNDATION PO BOX 2267 JOHNSON CITY TN 37605 621586264 PLC 40000 ATHLETE OF THE WEEK WCYB PO BOX 601063 CHARLOTTE NC 28260 540467002 COR 18084 GO RED FOR WOMEN MED PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 ALL 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. X X X X true true X X X X false true false false false true false false true true ROBERT F BURGIN - THROUGH 073110 380843 17519 398362 DAVID THOMPSON MD 285736 39316 14395 8701 348148 PIERRE ISTFAN MD 274151 48118 271 17147 6507 346194 MARGARET DENARVAEZ-080110-PRESENT 269230 489165 1602 759997 ELIZABETH WARD 414980 161317 239 7876 584412 J DALE SARGENT MD-THROUGH 2611 286098 60775 774 18989 6088 372724 MICHAEL BUNDY - THROUGH 4811 252456 51180 162 16363 9383 329544 GARY D MILLER - THROUGH 122010 240935 51180 891 15715 9503 318224 HAMLIN J WILSON 240935 51180 414 15715 5173 313417 ALICE POPE 223439 37532 180 14513 8794 284458 PATRICK KANE - THROUGH 63011 207376 43930 8893 13506 9512 283217 TODD J DOUGAN 192798 42650 12847 9512 257807 KENT PETTY - 3110 TO PRESENT 177694 5738 8242 191674 BARTHOLEMEW A HOVE 336293 62896 7822 21678 9512 438201 RON PREWITT 253318 53940 774 16526 5502 330060 DAVID L BRASH 240935 51300 270 15995 10281 318781 FRED PELLE 206795 38677 954 13331 9512 269269 BLAINE DOUGLAS - THROUGH 7910 186564 507 9935 5765 202771 JORGE LODEIRO MD 712000 156002 849 36083 9150 914084 EDWIN A MCELROY MD 587738 163283 270 30838 9512 791641 ROBERT HARRIS MD-THROUGH 103110 693030 866 7755 701651 MALCOLM R MATTHEWS MD-TO 5311 476494 180207 1308 30922 9512 698443 MARCO DASILVA MD 481054 166768 774 30430 10281 689307 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A AIRPLANE 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 ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 6A INCENTIVE 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 8 ON 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 INFORMATION SCHEDULE J, PART III WELLMONT 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. SULLIVAN CNTY TENN HEALTH EDL & HSG 621256662 865293AC8 2006-11-02 200000000 RENOVATION/CONSTRUCTION OF HOLSTON VALLEY false false false VIRGINIA SMALL BUSINESS FING AUTH H 541300845 928101AC8 2007-07-31 55000000 PURCHASE OF HOSPITALS false false false SULLIVAN CNTY TENN HEALTH EDL & HSG 621256662 865292DY9 2003-06-01 59100000 REFUND OF PREVIOUSLY ISSUED BOND false false false SULLIVAN CNTY TENN HEALTH EDL & HSG 621256662 865292DZ6 2005-12-13 70620000 REFUND OF PREVIOUSLY ISSUED BOND false false false 207055314 18977995 2164568 187573513 12534857 2011 false false false true 55658570 5464590 1026366 49167614 2007 false false true true 67546371 5300282 2184358 2003 false true true true 71923735 266958 126950 2005 false true true true false false false false true true false false false false true true false false false false true true false false false false true false false false false true MERRILL LYNCH 4.0 true false false false false false false false false false false false false false false false true true LEHMAN BROTHERS 10.8 false false false false false SULLIVAN CNTY TENN HEALTH EDL & HSG 621256662 865293AC8 2006-11-02 200000000 RENOVATION/CONSTRUCTION OF HOLSTON VALLEY false false false VIRGINIA SMALL BUSINESS FING AUTH H 541300845 928101AC8 2007-07-31 55000000 PURCHASE OF HOSPITALS false false false SULLIVAN CNTY TENN HEALTH EDL & HSG 621256662 865292DY9 2003-06-01 59100000 REFUND OF PREVIOUSLY ISSUED BOND false false false SULLIVAN CNTY TENN HEALTH EDL & HSG 621256662 865292DZ6 2005-12-13 70620000 REFUND OF PREVIOUSLY ISSUED BOND false false false 207055314 18977995 2164568 187573513 12534857 2011 false false false true 55658570 5464590 1026366 49167614 2007 false false true true 67546371 5300282 2184358 2003 false true true true 71923735 266958 126950 2005 false true true true false false false false true true false false false false true true false false false false true true false false false false true false false false false true MERRILL LYNCH 4.0 true false false false false false false false false false false false false false false false true true LEHMAN BROTHERS 10.8 false false false false false JOHN HOWARD RELOCATION ASSISTANCE X 31250 29514 false true true 29514 ADDITIONAL INFORMATION SCHEDULE L PART V THE 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 2011 ADDITIONAL INFORMATION FORM 990 FORM 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 990 FORM 990, PAGE 6, PART VI, LINE 11B WELLMONT 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 POLICY FORM 990, PAGE 6, PART VI, LINE 12C OFFICERS, 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 OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE 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 OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE 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 EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 WELLMONT 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 METHOD FORM 990, PAGE 7, PART VII PARENT ORGANIZATION HAS FILED A CONSOLIDATED RETURN WELLMONT HEALTH MANAGEMENT SERVICES LLC 1905 AMERICAN WAY KINGSPORT TN 37660 621825259 HEALTHCARE TN WHS WELLMONT HAWKINS CO MEMORIAL HOSPI 1905 AMERICAN WAY KINGSPORT TN 37660 621816368 HEALTHCARE TN 501C3 3 NA true WELLMONT MADISON HOUSE 1905 AMERICAN WAY KINGSPORT TN 37660 621308216 HEALTHCARE TN 501C3 9 WHS true WELLMONT FOUNDATION 1905 AMERICAN WAY KINGSPORT TN 37660 581594191 HEALTHCARE TN 501C3 7 WHS true TAKOMA REGIONAL HOSPITAL 401 TAKOMA AVE GREENVILLE TN 37734 510603966 HEALTHCARE TN 501C3 3 WHS true WELLMONT CARDIOLOGY SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 263557623 HEALTHCARE TN 501C3 3 WHS true WELLMONT IMAGING SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 861103148 HEALTHCARE TN 501C3 11A WHS true WELLMONT MEDICAL ASSOCIATES 1905 AMERICAN WAY KINGSPORT TN 37660 270898372 HEALTHCARE TN 501C3 3 WHS true WELLMONT SLEEP SERVICES 1906 AMERICAN WAY KINGSPORT TN 37660 HEALTHCARE TN 501C3 3 WHS true HOLSTON VALLEY IMAGING CENTER 103 WEST STONE DRIVE KINGSPORT TN 37660 TN WHS IMAGING RELATED false false 0.75000 SAPLING GROVE AMBULATORY SURGERY 220 MEDICAL PARK BOULEVARD BRISTOL TN 37620 TN WHS RELATED 615822 4532492 false false 0.65000 HOLSTON VALLEY AMBULATORY SURGERY 103 WEST STONE DRIVE KINGSPORT TN 37660 TN WHS RELATED 1098698 1895900 false false 0.52000 HOLSTON VALLEY IMAGING CENTER 103 WEST STONE DRIVE KINGSPORT TN 37660 TN WHS IMAGING RELATED false false 0.75000 SAPLING GROVE AMBULATORY SURGERY 220 MEDICAL PARK BOULEVARD BRISTOL TN 37620 TN WHS RELATED 615822 4532492 false false 0.65000 HOLSTON VALLEY AMBULATORY SURGERY 103 WEST STONE DRIVE KINGSPORT TN 37660 TN WHS RELATED 1098698 1895900 false false 0.52000 WELLMONT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621320035 PHYS. SVCS TN WHS C CORP -15105870 -50166284 1.00000 MCOT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621325938 MED. SVCS. TN N/A MEDICAL LAUNDRY OF TRI-CITIES MEDICAL LAUNDRY OF TRI-CITIES 1905 AMERICAN WAY KINGSPORT TN 37660 621482226 MED. SVCS. TN N/A MEDICAL MALL PHARMACY INC 1905 AMERICAN WAY KINGSPORT TN 37660 621565006 MED. SVCS. TN N/A WELLMONT PHYSICIAN SERVICES WELLMONT PHYSICIAN SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 621567353 PHYS. SVCS TN N/A WELLMONT HEALTH SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 621254373 HEALTHCARE TN N/A WPS PROVIDERS INC 1905 AMERICAN WAY KINGSPORT TN 37660 205564642 PHYS. SVCS TN N/A WELLMONT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621320035 PHYS. SVCS TN WHS C CORP -15105870 -50166284 1.00000 MCOT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621325938 MED. SVCS. TN N/A MEDICAL LAUNDRY OF TRI-CITIES MEDICAL LAUNDRY OF TRI-CITIES 1905 AMERICAN WAY KINGSPORT TN 37660 621482226 MED. SVCS. TN N/A MEDICAL MALL PHARMACY INC 1905 AMERICAN WAY KINGSPORT TN 37660 621565006 MED. SVCS. TN N/A WELLMONT PHYSICIAN SERVICES WELLMONT PHYSICIAN SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 621567353 PHYS. SVCS TN N/A WELLMONT HEALTH SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 621254373 HEALTHCARE TN N/A WPS PROVIDERS INC 1905 AMERICAN WAY KINGSPORT TN 37660 205564642 PHYS. SVCS TN N/A false true true false false false false false true false true true true true false true false true HOLSTON VALLEY AMBULATORY SURGERY C I 854332 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC I 824189 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC P 607651 COST MCOT INC L 2017149 COLLECTION AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC I 92750 LEASE AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC L 2020989 FMV MEDICAL MALL PHARMACY INC L 71996 COST SAPLING GROVE AMBULATORY SURGE R 975000 DISTRIBUTION WELLMONT CARDIOLOGY SERVICES L 362589 MANAGEMENT AGREEMENT WELLMONT FOUNDATION C 3325105 NEED WELLMONT HAWKINS COUNTY MEMORIAL HO B 893279 INTERCOMPANY TRANSFER WELLMONT HAWKINS COUNTY MEMORIAL HO I 190632 LEASE AGREEMENT WELLMONT HAWKINS COUNTY MEMORIAL HO K 2167859 SUPPORT SERVICES WELLMONT MADISON HOUSE B 122833 INTERCOMPANY TRANSFER WELLMONT PHYSICIAN SERVICES INC I 1284739 LEASE AGREEMENT WELLMONT PHYSICIAN SERVICES INC L 135238 SERVICE AGREEMENT WELLMONT FOUNDATION B 122063 NEED WELLMONT MEDICAL ASSOCIATES L 285000 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES K 2896947 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES F 350850 NET BOOK VALUE HOLSTON VALLEY AMBULATORY SURGERY C R 906360 DISTRIBUTION HOLSTON VALLEY AMBULATORY SURGERY C I 854332 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC I 824189 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC P 607651 COST MCOT INC L 2017149 COLLECTION AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC I 92750 LEASE AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC L 2020989 FMV MEDICAL MALL PHARMACY INC L 71996 COST SAPLING GROVE AMBULATORY SURGE R 975000 DISTRIBUTION WELLMONT CARDIOLOGY SERVICES L 362589 MANAGEMENT AGREEMENT WELLMONT FOUNDATION C 3325105 NEED WELLMONT HAWKINS COUNTY MEMORIAL HO B 893279 INTERCOMPANY TRANSFER WELLMONT HAWKINS COUNTY MEMORIAL HO I 190632 LEASE AGREEMENT WELLMONT HAWKINS COUNTY MEMORIAL HO K 2167859 SUPPORT SERVICES WELLMONT MADISON HOUSE B 122833 INTERCOMPANY TRANSFER WELLMONT PHYSICIAN SERVICES INC I 1284739 LEASE AGREEMENT WELLMONT PHYSICIAN SERVICES INC L 135238 SERVICE AGREEMENT WELLMONT FOUNDATION B 122063 NEED WELLMONT MEDICAL ASSOCIATES L 285000 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES K 2896947 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES F 350850 NET BOOK VALUE HOLSTON VALLEY AMBULATORY SURGERY C R 906360 DISTRIBUTION HOLSTON VALLEY AMBULATORY SURGERY C I 854332 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC I 824189 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC P 607651 COST MCOT INC L 2017149 COLLECTION AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC I 92750 LEASE AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC L 2020989 FMV MEDICAL MALL PHARMACY INC L 71996 COST SAPLING GROVE AMBULATORY SURGE R 975000 DISTRIBUTION WELLMONT CARDIOLOGY SERVICES L 362589 MANAGEMENT AGREEMENT WELLMONT FOUNDATION C 3325105 NEED WELLMONT HAWKINS COUNTY MEMORIAL HO B 893279 INTERCOMPANY TRANSFER WELLMONT HAWKINS COUNTY MEMORIAL HO I 190632 LEASE AGREEMENT WELLMONT HAWKINS COUNTY MEMORIAL HO K 2167859 SUPPORT SERVICES WELLMONT MADISON HOUSE B 122833 INTERCOMPANY TRANSFER WELLMONT PHYSICIAN SERVICES INC I 1284739 LEASE AGREEMENT WELLMONT PHYSICIAN SERVICES INC L 135238 SERVICE AGREEMENT WELLMONT FOUNDATION B 122063 NEED WELLMONT MEDICAL ASSOCIATES L 285000 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES K 2896947 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES F 350850 NET BOOK VALUE HOLSTON VALLEY AMBULATORY SURGERY C R 906360 DISTRIBUTION HOLSTON VALLEY AMBULATORY SURGERY C I 854332 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC I 824189 LEASE AGREEMENT HOLSTON VALLEY IMAGING CENTER INC P 607651 COST MCOT INC L 2017149 COLLECTION AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC I 92750 LEASE AGREEMENT MEDICAL LAUNDRY OF TRI-CITIES INC L 2020989 FMV MEDICAL MALL PHARMACY INC L 71996 COST SAPLING GROVE AMBULATORY SURGE R 975000 DISTRIBUTION WELLMONT CARDIOLOGY SERVICES L 362589 MANAGEMENT AGREEMENT WELLMONT FOUNDATION C 3325105 NEED WELLMONT HAWKINS COUNTY MEMORIAL HO B 893279 INTERCOMPANY TRANSFER WELLMONT HAWKINS COUNTY MEMORIAL HO I 190632 LEASE AGREEMENT WELLMONT HAWKINS COUNTY MEMORIAL HO K 2167859 SUPPORT SERVICES WELLMONT MADISON HOUSE B 122833 INTERCOMPANY TRANSFER WELLMONT PHYSICIAN SERVICES INC I 1284739 LEASE AGREEMENT WELLMONT PHYSICIAN SERVICES INC L 135238 SERVICE AGREEMENT WELLMONT FOUNDATION B 122063 NEED WELLMONT MEDICAL ASSOCIATES L 285000 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES K 2896947 SERVICES AGREEMENT WELLMONT CARDIOLOGY SERVICES F 350850 NET BOOK VALUE HOLSTON VALLEY AMBULATORY SURGERY C R 906360 DISTRIBUTION WELLMONT 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 ANNU