MOUNTAIN STATES HEALTH ALLIANCE: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: MOUNTAIN STATES HEALTH ALLIANCE (EIN 62-0476282)
Tax period: 2009-07-01 to 2010-06-30
Filed: 2011-05-12
IRS object ID: 201131329349300713
Schema version: 2009v1.7
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-05-12T07:44:31-05:00	Timestamp
Tax Period End Date	2010-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Pershing Yoakley & Associates P C	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	One Cherokee Mills 2220 Sutherland	AddressLine1
City	Knoxville	City
State	TN	State
ZIP Code	379192363	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2009-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	620476282	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	MOUNTAIN STATES HEALTH ALLIANCE	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	MOUN	NameControl
Phone	4234311013	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	400 NORTH STATE OF FRANKLIN ROAD	AddressLine1
City	JOHNSON CITY	City
State	TN	State
ZIP Code	37604	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	MARVIN EICHORN	Name
Title	SR VP/CFO	Title
Phone	4234311013	Phone
Date Signed	2011-05-12	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	DEBORAH O ERNSBERGER	Name
Phone	8656730844	Phone

Field	Value	IRS element (for citing)
Tax Year	2009	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	Johnson City Medical Center	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	DENNIS VONDERFECHT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	701 NSTATE OF FRANKLIN RD Ste 1	AddressLine1
City	JOHNSON CITY	City
State	TN	State
ZIP Code	37604	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	701975767	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c	X	Organization501c
Web Site	www.msha.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1945	YearFormation
State Legal Domicile	TN	StateLegalDomicile
Activity Or Mission Description	PLEASE SEE SCHEDULE O - PART I, LINE 1, MISSION AND SIGNIFICANT ACTIVITIES.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	8	NbrIndependentVotingMembers
Total Nbr Employees	8698	TotalNbrEmployees
Total Nbr Volunteers	1464	TotalNbrVolunteers
Total Gross UBI	4102501	TotalGrossUBI
Net Unrelated Business Txbl Income	207227	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	3633909	ContributionsGrantsPriorYear
Contributions Grants Current Year	3938777	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	658812783	ProgramServiceRevenuePriorYear
Program Service Revenue CY	674850480	ProgramServiceRevenueCY
Investment Income Prior Year	15033623	InvestmentIncomePriorYear
Investment Income Current Year	16043398	InvestmentIncomeCurrentYear
Other Revenue Prior Year	6512402	OtherRevenuePriorYear
Other Revenue Current Year	6999981	OtherRevenueCurrentYear
Total Revenue Prior Year	683992717	TotalRevenuePriorYear
Total Revenue Current Year	701832636	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	460751	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	301136	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	276505647	SalariesEtcPriorYear
Salaries Etc Current Year	287264466	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	1500104	TotalFundrsngExpCurrentYear
Other Expense Prior Year	369535487	OtherExpensePriorYear
Other Expenses Current Year	370493266	OtherExpensesCurrentYear
Total Expenses Prior Year	646501885	TotalExpensesPriorYear
Total Expenses Current Year	658058868	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	37490832	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	43773768	RevenuesLessExpensesCY
Total Assets BOY	1529066198	TotalAssetsBOY
Total Assets EOY	1530090739	TotalAssetsEOY
Total Liabilities BOY	1349056846	TotalLiabilitiesBOY
Total Liabilities EOY	1311074327	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	180009352	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	219016412	NetAssetsOrFundBalancesEOY
Mission Description	MOUNTAIN STATES HEALTH ALLIANCE IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	537083477	Expense
Grants	301136	Grants
Revenue	674850480	Revenue
Description	Mountain States Health Alliance (MSHA) was created in September 1998 as a private, locally owned, tax-exempt, regional healthcare system. MSHA is a 1,221 bed tertiary-care and referral hospital system, the region's largest by bed count and volumes. For the year ending June 30, 2010, MSHA recorded 47,209 inpatient admissions, and provided for 747,043 outpatient visits, including 165,260 emergency visits and 95,493 home health visits. The Alliance is composed of 10 hospitals, an outpatient surgery center, an outpatient radiation oncology center, an outpatient diagnostic center and two outpatient rehabilitation therapy centers. It also has services for home health, durable medical equipment, infusion therapy, hospice and parish nursing. MSHA entities, in concert with the Mountain States Healthcare Network of 54 affiliated hospitals and nursing homes, provide an integrated, comprehensive continuum of care to residents across a widespread, predominantly rural 29-county area of Appalachia. The service area includes parts of Northeast Tennessee, Southwest Virginia, Southeast Kentucky and Western North Carolina. All 10 MSHA hospitals are located in Northeast Tennessee and Southwest Virginia. Johnson City Medical Center, the company's flagship facility, is home to many of the region's critically needed programs. MSHA also has a majority ownership in Smyth County Community Hospital (SCCH), located in Marion, VA, Norton Community Hospital (NCH), located in Norton, VA, Dickenson Community Hospital (DCH), located in Clintwood, VA, and Johnston Memorial Hospital (JMH), located in Abingdon, VA. Because JMH, NCH, DCH and SCCH are partially owned entities, their data are excluded from this document and each of the hospitals file a separate Form 990. Washington County, TN: Johnson City Medical Center (JCMC) Flagship Facility: - Teaching Hospital Affiliated with Quillen College of Medicine at East Tennessee State University (ETSU)- Level I Trauma Center - one of only six in Tennessee - Home of the Regional Cancer Center- Home to the Niswonger Children's Hospital which also offers the St. Jude Tri-Cities Affiliate Clinic, one of only six such clinics in the country, working with the Memphis facility to treat pediatric patients in our region - Home of the region's only organ transplant program - one of only six in Tennessee- Home of the region's only state-designated Perinatal Center - one of only five in Tennessee- Home of the region's first and largest air ambulance fleet, Wings Air Rescue- First hospital in Tennessee awarded Magnet status for nursing excellence by American Nurses Credentialing Center- 2001-2010 Consumer's Choice Award for the region through an independent survey conducted by the National Research Council: Best Overall Quality, Best Doctors, Best Nurses, Most Personalized Care and Having the Best ReputationOther JCMC-licensed hospitals: Niswonger Children's Hospital at JCMC, the region's only NACHRI-affiliated children's hospital; James H. & Cecile C. Quillen Rehabilitation Hospital (CARF-accredited); and Woodridge Hospital for behavioral health services.North Side Hospital and Johnson City Specialty Hospital, each separately licensed, are also located in Washington County. Sullivan County, TN: Indian Path Medical CenterCarter County, TN: Sycamore Shoals HospitalJohnson County, TN: Johnson County Community Hospital, a federally designated critical access hospital located in one of Tennessee's poorest counties, a medically underserved areaRussell County, VA: Russell County Medical Center MSHA was awarded the Governor's Excellence Award by the Tennessee Center for Performance Excellence in 2009. MSHA was also the recipient of this esteemed award in 2005 and is the first healthcare recipient to be recognized twice, and only the second organization in the history of TNCPE to be recognized at this top level more than once. Other recognitions received by MSHA include the Verispan top 100 Integrated Hospital Networks designation and the 2008 Most Wired Hospitals and Healthcare Networks by Hospital and Healthcare Networks magazine.Audit and Compliance Practices: MSHA is governed by a Board of Directors, whose members are from the communities MSHA serves. The corporate board includes a longstanding Audit and Compliance Committee. All auditors and compliance specialists, internal and external, report directly to the Audit and Compliance Committee as a way to ensure the audit and compliance process is independent. - MSHA's Compliance Plan ensures the organization conducts business in an appropriate manner and in accordance with local, state and federal laws and regulations. The plan addresses fiscal accountability and transparency of operations through the review and use of independent audits by external auditors and rating agencies. - Upon employment, MSHA team members receive a copy of the booklet Code of Ethics and Business Conduct, detailing required standards of behavior. Yearly, team members receive refresher education on their obligations under the Code of Ethics and Business Conduct. - Annually, department directors, executive officers and board members are required to sign MSHA's Conflict of Interest policy. By signing this policy, they affirm their knowledge and understanding of the policy and also have the opportunity to disclose any conflict of interest they may have. All team members are required by policy to immediately disclose situations that may constitute conflicts of interest when they arise. - MSHA is fully compliant with regulatory and legal requirements, and its hospitals are accredited by The Joint Commission. - MSHA has a no-retaliation and no-retribution policy for the protection of individuals who, in good faith, report legal or ethical concerns. Team members are required to report concerns to appropriate persons for investigation or follow-up. AlertLine is a confidential, risk-free hotline for reporting suspected illegal behavior, ethical violations or safety risks and is available to all team members via a toll-free number. Medical Education and ResearchMSHA provides clinical experience to medical students and residents of the James H. Quillen College of Medicine at ETSU. MSHA contributed an unreimbursed cost amount of $4,172,639 to the residency program in FY10.MSHA facilities serve as clinical training areas for health professional education students. MSHA has dedicated staff to work with regional colleges and universities to coordinate the placement of health care professional students as part of their educational curriculum. Many of the health care students entering our system are required to have orientation and computer training. In FY10, MSHA incurred an expense of $37,818 to coordinate and orient these health care professional students. Also receiving clinical experience at MSHA were 1,326 nursing students from various colleges, universities and programs. This nursing clinical experience required extensive MSHA nursing staff involvement at five MSHA facilities. The clinical setting and hands-on instruction cost MSHA $2,716,207. MSHA provided a clinical setting for another 963 students training in health-related programs such as radiology, pharmacy, laboratory, physical therapy and other allied-health disciplines. These additional clinical students cost MSHA $728,534. MSHA provided assistance to 363 high school and college students who were considering a healthcare career path by allowing them to observe licensed MSHA clinical professionals. The shadowing of clinical staff by these students cost MSHA $8,233. MSHA's Learning Resource Center (LRC) is a medical library that provides access to medical databases, various paper publications and facilitates inter-library journal loans to increase library resources. The LRC subscribes to several online medical databases as well as printed medical education materials. The LRC is primarily utilized by medical residents, pharmacy and nursing students. This service is also used by other health profession education students, physicians and staff, and is open to the community. The FY10 cost of providing this service was $297,874.	Description
Total Program Service Expense	537083477	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Balance Sheet Amounts Reported	1	BalanceSheetAmountsReported
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	1	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	932	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	8698	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	8	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	1	LocalChapters
Policies Reference Chapters	1	PoliciesReferenceChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	VA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	MARVIN EICHORN	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	4234311017	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	400 N STATE OF FRANKLIN RD	AddressLine1
City	JOHNSON CITY	City
State	TN	State
ZIP Code	37604	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
DENNIS VONDERFECHT
PRESIDENT/CEO	60.00	X	X	964066	0	40201
CAMERON PERRY
DIRECTOR	1.00	X		0	0	0
WILLIAM WALKER MD
DIRECTOR	1.00	X		0	577986	1928
BARBARA ALLEN
SECRETARY	1.00	X		0	0	0
JEFF FARROW MD
DIRECTOR	1.00	X		35713	0	0
JOHN CAMPBELL
Director	1.00	X		0	0	0
SANDRA BROOKS MD
Director	1.00	X		0	0	0
DON JEANES
DIRECTOR	2.00	X		0	0	0
MAUREEN MACIVER
CHAIR	1.00	X		0	0	0
GARY PEACOCK
DIRECTOR	1.00	X		0	0	0
CLEM WILKES JR
TREASURER	1.00	X		0	0	0
Robert FEATHERS
VICE CHAIR	2.00	X		0	0	0
BILL HAWKINS JR
DIRECTOR	1.00	X		0	0	0
MIKE CHRISTIAN
DIRECTOR	1.00	X		0	0	0
MARVIN EICHORN
SR VP/CFO	60.00		X	649704	0	213607
DALE CLAYTORE
AVP	55.00			205724	0	10656	X
JOHN DOYLE
AVP/CFO IPMC	55.00			200804	0	30897	X
ANN FLEMING
SR VP	60.00			427191	0	59477	X
CANDACE JENNINGS
SR VP/CEO WASHINGTON CO.	60.00			379905	0	54298	X
LYNN KRUTAK
AVP/CFO	58.00			234263	0	30184	X
MONTY MCLAURIN
VP/CEO IPMC	46.00			345168	0	52598	X
CINDY SALYER
VP CARDIO/PULMONARY	40.00			251254	0	40467	X
JOHN MELTON
SR VP/CEO	3.40			2205600	0	15133	X
SHANE HILTON
CFO-TN	50.00			176949	0	28519	X
KENNETH MARSHALL MD
SR VP/CMO	40.00			451033	0	21731		X
STEVE KILGORE
PRESIDENT/CEO BRMMC	60.00			297288	0	45268		X
JAMIE PARSONS
VP H/R	50.00			281728	0	28304		X
CHAO LEE MD
PHYSICIAN	50.00			310545	0	14168		X
KATHRYN WILHOIT
CNO	60.00			264734	0	35105		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	7681669	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	577986	TotalReportableCompFrmRltdOrgs
Total Other Compensation	722541	TotalOtherCompensation
Number Individuals GT100 K	146	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
HOSPITAL HOUSEKEEPING SYSTEMS
322 CONGRESS AVENUE	AUSTIN	TX	78701	HOUSEKEEPING SERVICES/MGMT	3381643
PEPPER CONSTRUCTION COMPANY OF INDIANA L
1850 W 15TH STREET	INDIANAPOLIS	IN	46202	CONSTRUCTION	2928377
ADVANTAGE RN
4184 RELIABLE PARKWAY	CHICAGO	IL	60686	STAFFING AGENCY	1989468
TRAVEL NURSE SOLUTIONS LLC
3750 CORPORATE WOODS DRIVE	BIRMINGHAM	AL	35242	STAFFING AGENCY	1483511
CDSS ENTERPRISES
635 TOLL BRANCH ROAD	JOHNSON CITY	TN	37601	CONSTRUCTION	1123648

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	34	NumberOfContractorsGT100K
Related Organizations	2339424	RelatedOrganizations
Government Grants	1428005	GovernmentGrants
All Other Contributions	171348	AllOtherContributions
Total Contributions	3938777	TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICES	621500	672200303	670070746	2129557
WELLNESS PROGRAMS	621990	4229251	4229251
P/S PROG. SERV. INCOME	561000	1449659	1362711	86948
LOSS ON LTD RETIREMENT	900099	-3028733	-3028733

Field	Value	IRS element (for citing)
Total Program Service Revenue	674850480	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	14123757	TotalRevenueColumn
Unrelated Business Revenue	152	UnrelatedBusinessRevenue
Exclusion	$14,123,605	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	339830	TotalRevenueColumn
Exclusion	$339,830	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	423695	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	140107	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	283588	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	283588	TotalRevenueColumn
Exclusion	$283,588	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	1543695	Securities
Other	39140	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	3024	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	1543695	Securities
Other	36116	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	1579811	TotalRevenueColumn
Exclusion	$1,579,811	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount	Unrelated Business RevenueUnrelatedBusinessRevenue
CAFETERIA SALES	722210	3929282	$3,929,282
DIET/SECur/engin/OTHER	541900	956293	-$54,854	1011147
JCMC DAYCARE	624410	956121	$956,121

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	874697	TotalRevenueColumn
Unrelated Business Revenue	874697	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Other Revenue	6716393	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	701832636	TotalRevenueColumn
Related Or Exempt Function Income	672633975	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	4102501	UnrelatedBusinessRevenue
Exclusion	$21,157,383	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	301136	Total
Program Services	301136	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	6072398	Total
Management And General	6072398	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	224097635	Total
Program Services	211195081	ProgramServices
Management And General	12242249	ManagementAndGeneral
Fundraising	660305	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	11835925	Total
Program Services	11361314	ProgramServices
Management And General	439098	ManagementAndGeneral
Fundraising	35513	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	28178615	Total
Program Services	27421769	ProgramServices
Management And General	713732	ManagementAndGeneral
Fundraising	43114	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	17079893	Total
Program Services	15444370	ProgramServices
Management And General	1601282	ManagementAndGeneral
Fundraising	34241	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	232389	Total
Management And General	232389	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	1474842	Total
Management And General	1474842	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	345299	Total
Program Services	6679	ProgramServices
Management And General	325171	ManagementAndGeneral
Fundraising	13449	Fundraising

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	35240	Total
Management And General	35240	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	921188	Total
Management And General	921188	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	83722456	Total
Program Services	63612751	ProgramServices
Management And General	19853204	ManagementAndGeneral
Fundraising	256501	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	2822113	Total
Program Services	2162437	ProgramServices
Management And General	637583	ManagementAndGeneral
Fundraising	22093	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	9497514	Total
Program Services	7763561	ProgramServices
Management And General	1438671	ManagementAndGeneral
Fundraising	295282	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	10269378	Total
Program Services	9309886	ProgramServices
Management And General	959492	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	12376788	Total
Program Services	10538044	ProgramServices
Management And General	1774891	ManagementAndGeneral
Fundraising	63853	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	1768635	Total
Program Services	1261526	ProgramServices
Management And General	475892	ManagementAndGeneral
Fundraising	31217	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	284845	Total
Program Services	217954	ProgramServices
Management And General	66071	ManagementAndGeneral
Fundraising	820	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	41417948	Total
Program Services	16370	ProgramServices
Management And General	41401578	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	55577812	Total
Program Services	27027243	ProgramServices
Management And General	28542833	ManagementAndGeneral
Fundraising	7736	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1418464	Total
Program Services	16637	ProgramServices
Management And General	1401827	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
MEDICAL SUPPLIES & DRUG	129702248	129407850	293492	906
TAXES - UBIT	65000		65000
REPAIRS & MAINTENANCE	13401647	12958124	430637	12886
BAD DEBTS	3821964	3819759	2205
RECRUITMENT & RETENTION	1524671	1010471	513940	260

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	-187175	Total
Program Services	2230515	ProgramServices
Management And General	-2439618	ManagementAndGeneral
Fundraising	21928	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	658058868	Total
Program Services	537083477	ProgramServices
Management And General	119475287	ManagementAndGeneral
Fundraising	1500104	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	191283991	BOY
EOY	208449573	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	288879	BOY
EOY	189220	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	87441027	BOY
EOY	84415992	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	3643645	BOY
EOY	4579735	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	98414951	BOY
EOY	20219171	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	13908048	BOY
EOY	14609053	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	7002378	BOY
EOY	4368028	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	834022717	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	370371063	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	394242703	BOY
EOY	463651654	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	137081332	BOY
EOY	152089704	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	282350254	BOY
EOY	282350254	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	154365082	BOY
EOY	143276118	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	159043908	BOY
EOY	151892237	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	1529066198	BOY
EOY	1530090739	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	74107505	BOY
EOY	76082572	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	20765454	BOY
EOY	20092072	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	610470055	BOY
EOY	626569957	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	389886147	BOY
EOY	400096949	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	4342306	BOY
EOY	3114607	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	249485379	BOY
EOY	185118170	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1349056846	BOY
EOY	1311074327	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	179553523	BOY
EOY	218490539	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	455829	BOY
EOY	525873	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	180009352	BOY
EOY	219016412	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1529066198	BOY
EOY	1530090739	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	1	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	1	DirectContactLegislators
Direct Contact Legislators	$273,954	DirectContactLegislatorsAmount
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	0	OtherActivities
Total Lobbying Expenditures IIB	273954	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Part II-B, Line 1i:	Identifier
Return Reference	Explanation of Other Lobbying Activities:	ReturnReference
Explanation	THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR THE COMMUNITY & GOVERNMENT RELATIONS MANAGERS ATTENDED THE FOLLOWING LEGISLATIVE CONFERENCES: - PREMIER FEDERAL AFFAIRS NETWORK MEETINGS - AMERICAN HOSPITAL ASSOCIATION ANNUAL MEETING - TENNESSEE HOSPITAL ASSOCIATION LEGISLATIVE ADVOCACY DAY - TENNESSEE HOSPITAL ASSOCIATION ANNUAL MEETING - HOSPITAL ALLIANCE OF TENNESSEE ANNUAL MEETING - NACHRI VIP ADVOCACY DAY - TNPATH ANNUAL MEETING - VHHA CONFERENCE THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR THE COMMUNITY & GOVERNMENT RELATIONS MANAGERS HAVE ALSO SENT LETTERS AND MADE CALLS TO A CONGRESSIONAL OFFICE CONCERNING THE FOLLOWING ISSUES: - HEALTH REFORM - SUPPORTED ADEQUATE MEDICAID PAYMENTS TO CHILDREN'S PROVIDERS - REAUTHORIZATION OF THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - SAFEGUARDING GRADUATE MEDICAL EDUCATION - OPPOSED CUTS TO INDIRECT MEDICAL EDUCATION AND LAWS CHANGING THE TAX EXEMPT STATUS FOR NOT-FOR-PROFIT HOSPITALS TO FUND PROPOSED HEALTH CARE REFORM - SUPPORTED NEEDED CHANGES RELATED TO HEALTH INFORMATION TECHNOLOGY (HIT) INCENTIVE PAYMENTS INCLUDING MEANINGFUL USE CRITERIA - SUPPORTED THE CONTINUATION OF TENNESSEE'S FEDERAL DSH PAYMENT - PARTICIPATED IN EFFORT TO REAUTHORIZE FEDERAL TRAUMA FUNDING UP TO $200 MILLION THE FOLLOWING ARE EXAMPLES OF STATE OF TENNESSEE AND VIRGINIA LEGISLATION THAT THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR THE COMMUNITY & GOVERNMENT RELATIONS MANAGERS AND DIRECTOR RESPONDED TO BY LETTER, CALL OR IN PERSON: - OPPOSED PAYMENT RATE REDUCTIONS - TENNCARE AND VIRGINIA MEDICAID - SUPPORTED CONTINUATION OF CON (COPN) - SUPPORTED THE CONTINUATION OF SAFETY NET FUNDING, INCLUDING TENNESSEE'S TRAUMA FUND - OPPOSED LEGISLATION TO REPEAL TENNESSEE'S HELMET REQUIREMENT FOR MOTORCYCLISTS - SUPPORTED PASSAGE OF MENTAL HEALTH GRANT FOR WOODRIDGE HOSPITAL - SUPPORTED EFFORTS THAT RESTORED FUNDING TO TENNESSEE'S PERINATAL CENTERS, THE GOVERNOR'S OFFICE ON CHILDCARE COORDINATION AND THE COORDINATED SCHOOL HEALTH PROGRAM - WORKED CLOSELY WITH THE COMMISSIONER OF FINANCE AND ADMINISTRATION IN HIS SUCCESSFUL EFFORT TO OBTAIN $13 MILLION IN FIRST TIME MONIES TO FUND HEALTH INFORMATION TECHNOLOGY INITIATIVES ACROSS THE STATE - INVOLVED IN ADVOCATING FOR AN EXTRA $10 MILLION IN THE TENNESSEE BUDGET FOR CRITICAL ACCESS HOSPITALS, INCLUDING JCCH. THE FUNDING WAS INCLUDED IN THE BUDGET, DEPENDENT ON THE EXTENSION OF THE ENHANCED FMAP.	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	28449100	OtherCostOrOtherBasis
Book Value	28449100	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	425267056	OtherCostOrOtherBasis
Depreciation	113981335	Depreciation
Book Value	311285721	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	770639	OtherCostOrOtherBasis
Depreciation	352320	Depreciation
Book Value	418319	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	379535922	OtherCostOrOtherBasis
Depreciation	256037408	Depreciation
Book Value	123498514	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	463651654	TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (5 entries)

DescriptionDescription	Book ValueBookValue	Method Of ValuationMethodOfValuation
INVESTMENT IN BRMMC	100273634	C
INVESTMENT IN ISHN	1784120	C
INVESTMENT IN PREMIER	192500	C
INVESTMENT IN SCCH	48100000	C
INVESTMENT IN JMH	132000000	C

Field	Value	IRS element (for citing)
Total Of Book Value Program Related	282350254	TotalOfBookValueProgramRelated

Other Assets OtherAssets (4 entries)

DescriptionDescription	Book ValueBookValue
AWUL - CURRENT	6763171
AWUL - UNDER BOND INDENTURE AGREEMENTS	113355234
DEFERRED CHARGES AND OTHER	23879227
LONG TERM COMPENSATION INVESTMENT	7894605

Field	Value	IRS element (for citing)
Total Book Value Other Assets	151892237	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescription	AmountAmount
ACCRUED INTEREST	$15,550,017
OTHER LONG-TERM LIABILITIES	$6,672,623
ACCRUED SALARIES, ABSENCES, & W/H	$31,604,489
CALL OPTION LIABILITY	$89,650,437
ESTIMATED FAIR VALUE OF INT. RATE SWAP	$33,657,579
DUE TO THIRD PARTY PAYORS	$7,983,025

Field	Value	IRS element (for citing)
Total Of Amounts	185118170	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Part X:	Identifier
Return Reference	Description of Uncertain Tax Positions Under FIN 48:	ReturnReference
Explanation	MOUNTAIN STATES HEALTH ALLIANCE (MSHA) IS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MSHA DOES FILE FORM 990T TO REPORT UNRELATED BUSINESS INCOME (UBI) AND PAYS ALL FEDERAL AND STATE TAXES ASSOCIATED WITH UBI. MSHA COMPLIES WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARD CODIFICATION (ASC) 740, INCOME TAXES. THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2010. AS SUCH, NO INTEREST OR PENALTIES ARE RECOGNIZED IN THE FINANCIAL STATEMENTS RELATED TO UNCERTAIN TAX POSITIONS.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10245255	TotalCommunityBenefitExpense
Net Community Benefit Expense	10245255	NetCommunityBenefitExpense
Percent Of Total Expense	0.01570	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	14306147	TotalCommunityBenefitExpense
Direct Offsetting Revenue	9379265	DirectOffsettingRevenue
Net Community Benefit Expense	4926882	NetCommunityBenefitExpense
Percent Of Total Expense	0.00750	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	73153528	TotalCommunityBenefitExpense
Direct Offsetting Revenue	49372561	DirectOffsettingRevenue
Net Community Benefit Expense	23780967	NetCommunityBenefitExpense
Percent Of Total Expense	0.03630	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	97704930	TotalCommunityBenefitExpense
Direct Offsetting Revenue	58751826	DirectOffsettingRevenue
Net Community Benefit Expense	38953104	NetCommunityBenefitExpense
Percent Of Total Expense	0.05950	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	5134349	TotalCommunityBenefitExpense
Net Community Benefit Expense	5134349	NetCommunityBenefitExpense
Percent Of Total Expense	0.00780	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10017117	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2353686	DirectOffsettingRevenue
Net Community Benefit Expense	7663431	NetCommunityBenefitExpense
Percent Of Total Expense	0.01170	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	16838664	TotalCommunityBenefitExpense
Net Community Benefit Expense	16838664	NetCommunityBenefitExpense
Percent Of Total Expense	0.02570	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Total Community Benefit Expense	450976	TotalCommunityBenefitExpense
Net Community Benefit Expense	450976	NetCommunityBenefitExpense
Percent Of Total Expense	0.00070	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	254033	TotalCommunityBenefitExpense
Net Community Benefit Expense	254033	NetCommunityBenefitExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	32695139	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2353686	DirectOffsettingRevenue
Net Community Benefit Expense	30341453	NetCommunityBenefitExpense
Percent Of Total Expense	0.04630	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	130400069	TotalCommunityBenefitExpense
Direct Offsetting Revenue	61105512	DirectOffsettingRevenue
Net Community Benefit Expense	69294557	NetCommunityBenefitExpense
Percent Of Total Expense	0.10580	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	28725	TotalCommunityBuildingExpense
Net Community Building Expense	28725	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	3225	TotalCommunityBuildingExpense
Net Community Building Expense	3225	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	832	TotalCommunityBuildingExpense
Net Community Building Expense	832	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Total Community Building Expense	224	TotalCommunityBuildingExpense
Net Community Building Expense	224	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	199291	TotalCommunityBuildingExpense
Net Community Building Expense	199291	NetCommunityBuildingExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Total Community Building Expense	40526	TotalCommunityBuildingExpense
Net Community Building Expense	40526	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	272823	TotalCommunityBuildingExpense
Net Community Building Expense	272823	NetCommunityBuildingExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$16,796,337	BadDebtExpenseAmount
Amount Attributable To	10077802	AmountAttributableTo
Amount Reimbursed By Medicare	190127886	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	192702548	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-2574662	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV (19 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital	General Medical And SurgicalGeneralMedicalAndSurgical	Teaching HospitalTeachingHospital	Er24 HoursEr24Hours	OtherOther	Childrens HospitalChildrensHospital	Research FacilityResearchFacility	Critical Access HospitalCriticalAccessHospital
INDIAN PATH MEDICAL CENTER
2000 BROOKSIDE DRIVE	KINGSPORT	TN	37660	X	X	X	X
INDIAN PATH TRANSITIONAL
2000 BROOKSIDE DRIVE	KINGSPORT	TN	37660					SKILLED NURSING
JOHNSON CITY MEDICAL CENTER
400 N STATE OF FRANKLIN ROAD	JOHNSON CITY	TN	37604	X	X	X	X	REHABILITATION & MENTAL HEALTH HOSPITALS	X	X
JCMC AMBULATORY SURGERY
400 N STATE OF FRANKLIN ROAD	JOHNSON CITY	TN	37604		X			AMBUL. SURG. CNTR
JOHNSON CITY SPECIALTY HOSPITAL
203 E WATAUGA AVENUE	JOHNSON CITY	TN	37601	X	X
JOHNSON COUNTY COMMUNITY HOSPITAL
1901 S SHADY STREET	MOUNTAIN CITY	TN	37683	X			X				X
JOHNSON COUNTY HOME HEALTH
1987 S SHADY STREET	MOUNTAIN CITY	TN	37683					HOME HEALTH
MEDICAL CENTER HOME CARE - JOHNSON CITY
101 MED TECH PKWY STE 100	JOHNSON CITY	TN	37604					HOME HEALTH
MEDICAL CENTER HOME CARE - KINGSPORT
2020 BROOKSIDE DRIVE 28	KINGSPORT	TN	37660					HOME HEALTH
MEDICAL CENTER HOSPICE
101 MED TECH PKWY STE 100	JOHNSON CITY	TN	37604					HOSPICE
MOUNTAIN STATES DIAGNOSTIC CENTER
1 PROFESSIONAL PARK DRIVE 16	JOHNSON CITY	TN	37604					LICENSED OP DIAGNOSTIC CENTER
NORTH SIDE HOSPITAL
401 PRINCETON ROAD	JOHNSON CITY	TN	37602	X	X		X
PRINCETON TRANSITIONAL
401 PRINCETON ROAD	JOHNSON CITY	TN	37602					SKILLED NURSING
RUSSELL COUNTY MEDICAL CENTER
58 CARROLL STREET	LEBANON	VA	24266	X	X		X
RUSSELL CO MEDICAL CENTER HOME HEALTH
116 FLANNAGAN AVENUE	LEBANON	VA	24266					HOME HEALTH
RUSSELL COUNTY MEDICAL CENTER HOSPICE
116 FLANNAGAN AVENUE	LEBANON	VA	24266					HOSPICE
SYCAMORE SHOALS HOSPITAL
1501 W ELK AVENUE	ELIZABETHTON	TN	37643	X	X		X
FRANKLIN TRANSITIONAL
2511 WESLEY STREET	JOHNSON CITY	TN	37601					SKILLED NURSING
MTN STATES IMAGING CNTR AT MED TECH PARK
301 MED TECH PKWY STE 100	JOHNSON CITY	TN	37604					LICENSED OP DIAGNOSTIC CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Costing Method Used	Part I, Line 7: A cost to charge ratio was derived from the Schedule H applicable worksheets, including Worksheet 2, Ratio of Patient Care Cost to Charges.	CostingMethodUsed
Subsidized Health Services Expln	Part I, Line 7g: JOHNSON COUNTY COMMUNITY HOSPITAL, A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL, operates a Physician Specialty Clinic, which incurred an operating loss of $59,577 for the twelve months ending June, 2010. The specialty clinic includes cardiology, OB/GYN, general surgery, vascular surgery, neurology, oncology, podiatry and other specialty services. This continues to be a valuable resource to the residents of the area by aiding with transportation issues (other offices are more than an hour away), resolving access limitations for specialty services, and providing relief to the special health problems of a largely elderly population.Russell county medical center operates a rural health clinic located in St Paul, VA, on the border of Wise and Russell counties. Riverside Clinic first opened in 1991 to provide primary care services to this elderly underserved population. The clinic's largest payor is Medicare, which accounts for more than 40% of their patients. During the the 12-month reporting period, the clinic had 10,900 outpatient visits and incurred unreimbursed expenses of $527,710.	SubsidizedHealthServicesExpln
Percent Of Total Expense Expln	Part I, Line 7f: Bad Debt expense of $3,821,964 is included in the Statement of Functional Expenses on Form 990, part IX, line 25, but has been subtracted for purposes of calculating percentages on part 1, line 7, column f.	PercentOfTotalExpenseExpln
Bad Debt Footnote	Part III, Line 4: Worksheet A was used for Part III, lines 2 and 3 in determining bad debt at cost. MSHA follows the Healthcare Financial Management Association's Principles and Practices Board issued Statement 15: Valuation and Financial Statement Presentation of Charity Care and Bad Debts by Institutional Healthcare Providers ("the Statement"). The Statement provides guidance on collectability criteria and emphasizes revenue recognition only when collections are reasonably assured. To further explain MSHA's reporting of bad debt expense, MSHA's financial statements account for Bad Debt in two locations. First, a deduction from revenue line item called "Contra-Revenue" contains the majority of MSHA's self-pay estimated bad debt. For fiscal year 2010, 95% of total bad debt was moved to this line. This percentage is simply an estimate of what Patient Financial Services anticipates will not be collected after all debt collection efforts have been exhausted. This estimate is based on historical information. The remaining 5% of bad debt is recorded in the expense section appropriately called "Bad Debt."The footnotes to the audited financial statements states "Current operations include a provision for bad debts in the Consolidated Statements of Operations and Changes in Net Assets estimated based upon the age of the patient accounts receivable, prior experience and any unusual circumstances (such as local, regional or national economic conditions) which affect the collectability of receivables, including management's assumptions about conditions it expects to exist and courses of action it expects to take."Regarding line 3, it is implausible to determine the amount of MSHA's Bad Debt expense associated with those clients who may have met the criteria set forth in our financial assistance policy without having a completed financial assessment. We are unable to determine our patient's financial circumstances unless a completed financial assessment form is voluntarily provided to us. We can assert that more than 90% of our patients who have provided completed financial assessment forms have been approved for at least partial financial assistance. 16% of those patients approved for financial assistance were Bad Debt transfers. We find it unreasonable to apply either of these percentages to our bad debt population as there are many additional variables that must be considered. Our Vice President of Patient Financial Services conservatively estimates that 60% of total bad debt expense was assumed attributable to clients potentially eligible for financial assistance.	BadDebtFootnote
Shortfall As Community Benefit	Part III, Line 8: Medicare allowable costs were reported using JMH's filed Medicare Cost Report (C/R). The C/R uses a cost to charge ratio based on a step down method. In caring for the patient, there are several services that are considered non-allowable such as: transportation of a patient, comfort items to include a television, magazines, or a telephone. Additional non-allowable costs include the recruitment of physicians, physician guarantees and a portion of the Bad Debt (30%) associated with the care of the patient. Medicare losses, including some non-allowable costs, should be counted as a community benefit as this is the cost of care for serving the aging population. As a not-for-profit organization, we exist to identify and respond to the health care needs of the community and the individual while maintaining a high level of health care services without losses. Since losses do occur through the CMS system of reimbursement, these losses are a cost of doing business for our community and should be considered a community benefit. As a participating provider in the Medicare program, JMH is required to provide the full regimen of care for our Medicare population. There are a number of care regimens that are compensated by the Medicare program at levels below our cost. Therefore it is only logical to allow JMH to report these uncompensated services as a community benefit on this document. By making this change, non-profit providers will be encouraged to sustain important care delivery models for our aging population in spite of the fact it is sometimes economically injurious.	ShortfallAsCommunityBenefit
Debt Collection Policy	Part III, Line 9b: MSHA follows a strong collection program that communicates financial responsibility to the patient prior to service. Collection practices apply to all patients, charity and non-charity. In routine circumstances when it is determined that a patient has not responded to requests for payment, an account can be referred to an outside collection agency for collection assistance. MSHA ensures that outside collection agencies follow hospital billing and collection guidelines. Once a delinquent patient account has been submitted to an outside collection agency it can be retracted if it is determined that the patient is eligible for financial assistance. All requests for financial assistance must be accompanied by a completed financial assessment form and supporting documentation.	DebtCollectionPolicy
General Explanation	Part VI, Line 8: MSHA submits Community Benefit data to the Virginia Health and Hospital Association (VHHA) and the Hospital Alliance of Tennessee (HAT). VHHA combines data from all sources to demonstrate the Community Benefits provided by both for-profit and not-for-profit hospitals and health systems to the state of Virginia. HAT provides its members and Tennessee legislators with Community Benefit data in an effort to provide a clear picture of not-for-profit health system's investment in the communities they serve.	GeneralExplanation
Needs Assessment	Part VI, Line 2: During fiscal year 2008 and fiscal year 2009, MSHA conducted the largest community health needs assessment in its history in an effort to profile the health of the residents within the local region. The assessment focused on state, regional, and county specific data collection. This assessment also included primary data collected through approximately 50 one-on-one interviews. Those interviewed were individuals from around the region which included local and state government officials, health department representatives, physicians, general public, local industry, civic organizations, education officials, and community resource groups. This information was collected, and then analyzed, and a summary of the findings was listed in an effort to obtain a more detailed snapshot specific to each county located throughout the MSHA service area. This information was reviewed by MSHA's Strategic Planning Team along with Government Relations and Quality Departments. The MSHA steering committee identified childhood obesity as the health disparity targeted for improvement. During fiscal year 2009, MSHA began collaborative efforts with East Tennessee State University's College of Public Health to develop the MSHA-ETSU Obesity Collaborative Committee. The focus of this committee is to pull together many partners and organizations in collaboration to reduce the level of childhood obesity throughout Northeast Tennessee and Southwest Virginia. During fiscal year 2010, the committee offered 25 seed grants of $2,000 each to local community organizations such as churches, community groups, schools, and employers that want to explore obesity reduction efforts.In addition to the grants program, an annual symposium is provided free to the region and available to residents and community groups. National, regional, and local experts share information on trends regarding childhood obesity and proven community-based strategies to reduce the prevalence.	NeedsAssessment
Patient Education Assistance	Part VI, Line 3: MSHA provides communication of financial assistance on its web site and on posters placed in prominent areas such as Admitting areas, Emergency Departments and patient payment (cashier) locations. Printed educational materials including financial assistance contact information are also provided in the patient's admitting paperwork. Posters and reference materials are written in both English and Spanish. Admitting staff are trained to educate patients on MSHA's Financial Assistance Policy. MSHA also has Financial Counselors which communicate the patient's financial responsibility prior to service as well as provide education on MSHA's financial assistance policy. These counselors also help uninsured patients determine sources of payment for medical bills and help patients determine eligibility for programs such as TennCare or Medicaid. In addition, MSHA contracts with the company MedAssist to work with self-paying patients who have limited financial resources. MedAssist determines a patient's eligibility in medical coverage options and assists with their enrollment. MSHA bears the cost for the MedAssist program.	PatientEducationAssistance
Community Information	Part VI, Line 4: MSHA serves the healthcare needs of 29 Appalachian counties in Tennessee, Southwest Virginia, Kentucky and North Carolina. Some of the counties MSHA serves are federally designated medically underserved areas. MSHA operates 2 critical access hospitals, Dickenson Community Hospital in Virginia and Johnson County Community Hospital in Tennessee. These two facilities operate in federally designated medically underserved areas. The health status of the population in MSHA's service area is generally poor. The service area extends to some of the poorest rural counties in the region with a poverty rate of almost 30%. Some of the most well off counties in MSHA's service area still have a median household income lower than state and national averages. Rural service area counties share common challenges of:1. High rates of uninsured2. High prevalence of obesity3. High prevalence of diabetes	CommunityInformation
Community Building Activities	Part VI, Line 5: MSHA leaders support and encourage all employees to volunteer time, money, and skills to community service projects and charitable organizations. Senior leaders and board members set a positive example for MSHA employees by serving voluntarily on committees and managing boards of local service and nonprofit organizations. Many also serve as members and consultants on professional committees and task forces that affect regional development in health care, and education. Employees served the Boys & Girls Club, Kiwanis Clubs, rotary clubs, Susan G. Komen Breast Cancer Foundation, Economic Development Steering Committee for Washington County, the Tennessee Valley Corridor, Junior Achievement, Salvation Army, American Heart Association, Hands On! Museum, Kingsport Tomorrow Inc., Carter County Tomorrow, Appalachian Mountain Project Access, Washington County Emergency Medical Services, Appalachian Regional Coalition on Homelessness, Washington County Veteran's Memorial Committee of the Johnson City Parks and Recreation Foundation, Eating Disorders Coalition of Tennessee, Johnson City Symphony Orchestra, Dawn of Hope, United Way, Chamber of Commerce Boards, and many others. Some of these employees devoted two weeks of normal work time to outside charitable activities. MSHA provides sponsorships and offers assistance with coordination, advocacy, and publicity; provides space; or contributes supplies to support community organizations for their program activities. MSHA provides staff at their expense to local agencies, community advisory boards, councils, and other organizations to assist with leadership programs, planning, committee participation, and assistance with special events. Examples include American Red Cross blood drives, Imagination Library Steering Committee, Ronald McDonald House Board, United Way Board, and others. Physician recruitment for a federally underserved area is reported in Community Building and makes up the majority of the total expense reported on Schedule H, Part II. Without MSHA's dedication to rural health, there would not be an adequate number of physicians to serve this patient population. MSHA supports the economic development of the region by providing financial support as well as paid employee's time to serve on economic development boards. Evidence shows that a healthy economy relates to a healthier population.	CommunityBuildingActivities
Other Information	Part VI, Line 6: The majority of MSHA's governing body is comprised of persons who reside in the organization's primary service area. Only two employees are on the MSHA Board of Directors: the CEO paid by MSHA and a physician who is paid by a related organization. Physicians that request privileges who are qualified and credentialed are extended privileges by MSHA.MSHA is dedicated to operating our facilities efficiently so that waste is minimized and surpluses may be applied to maintaining adequate facilities and equipment for the care for our patients. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary.	OtherInformation
Affiliated Health Care System	Part VI, Line 7: Mountain States Health Alliance (MSHA) provides care to people in 29 counties in Tennessee, Virginia, Kentucky, and North Carolina. Each hospital is fully accredited, most by The Joint Commission. MSHA is integrated both vertically and horizontally and is the largest regional healthcare system with 14 hospitals. 10 facilities are wholly-owned and 4 are majority owned. This Form 990 encompasses 10 wholly-owned facilities: 9 facilities in Tennessee and 1 in Virginia. Each facility in this form 990 is accredited by The Joint Commission with the exception of JCCH. JCCH receives certification through the State of Tennessee since it is a critical access hospital. In addition to the wholly-owned hospitals in this reporting FEIN, MSHA also has majority ownership in 4 hospitals in Southwest Virgina. In addition to our acute care hospitals, our system also includes such services as: primary / specialty physician practices, urgent care centers, emergency departments, occupational medicine, rehabilitation, transplant, outreach laboratory, mental health, neonatal intensive care, a NACHRI affiliated children's hospital, renal dialysis, St. Jude's oncology, inpatient / outpatient surgery, skilled nursing, home health, air ambulance transport, an organ transplant department, and more. With these additional facilities and services, MSHA extends a highly effective health care delivery system. Since our system is both horizontally and vertically integrated, patients can be efficiently moved along an integrated, comprehensive continuum of care as their health status dictates. Our flagship facility, Johnson City Medical Center is at the core of our system offering full service tertiary care. In addition to our hospitals, MSHA is the sole member of Blue Ridge Medical Management Corporation (BRMMC). MSHA extends an integrated healthcare delivery system through BRMMC to include multiple primary and specialty care patient access centers and numerous outpatient care sites, including urgent care centers, occupational medicine services, a same day surgery center, and outpatient rehabilitation. MSHA county-specific operations are governed by a Community Board of Directors. County Boards report to a system level Board of Directors. All boards are primarily composed of local community residents.	AffiliatedHealthCareSystem
Reports Filed With States	VA	ReportsFiledWithStates

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (11 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance
ETSU FOUNDATION
PO BOX 70721	JOHNSON CITY	TN	37614	237092731	501(C)(3)	30000	SUPPORT CLINIC DEDICATED TO IMPROVING THE HEALTH OF UNINSURED AND UNDERINSURED PEOPLE
ETSU
807 UNIVERSITY PKWY	JOHNSON CITY	TN	37614	626021046	501(C)(3)	10250	EQUIPMENT DONATION TO BENEFIT THE FIT KIDS PROGRAM	2200	FMV	DONATION OF MEDICAL EQUIPMENT
CARESPARK
PO BOX 657 125 BROAD STREET	KINGSPORT	TN	37662	202694144	501(C)(3)	50000	SUPPORT DEVELOPMENT OF SHARED HEALTH INFORMATION TO IMPROVE PATIENT CARE
TENNESSEE TECHNOLOGY CENTER
1500 ARNEY STREET	ELIZABETHTON	TN	37643	621113186	501(C)(3)	25000	SUPPORT HEALTH PROFESSION EDUCATION
SUSAN KOMEN BREAST CANCER FOUNDATION
POBOX 5835	KINGSPORT	TN	37663	841689067	501(C)(3)	25000	BREAST CANCER RESEARCH
AMERICAN HEART ASSOCIATION
1101 NORTHCHASE PKWY STE 1	MARIETTA	GA	30067	135613797	501(C)(3)	10700	SUPPORT HEART HEALTH RESEARCH AND EDUCATION
GEISINGER HEALTH SYSTEM FOUNDATION
100 NORTH ADADEMY AVE	DANVILLE	PA	17822	232164794	501(C)(3)	10000	SUPPORT INNOVATIVE RESEARCH FOR SPECIALIZED TREATMENT OPTIONS
WELLMONT FOUNDATION INC
1905 AMERICAN WAY STE 102	KINGSPORT	TN	37660	581594191	501(C)(3)	15000	DONATION FOR HAITI EARTHQUAKE RELIEF
HANDS ON REGIONAL MUSEUM
315 E MAIN STREET	KINGSPORT	TN	37601	621282542	501(C)(3)	12000	SUPPORT TO LOCAL INTERACTIVE CHILDREN'S MUSEUM
JOHNSON CITY PARKS AND RECREATION
PO BOX 1535	JOHNSON CITY	TN	37605	383731893	501(C)(3)	5000	DONATION FOR CONSTRUCTION OF A VETERANS MEMORIAL	152
COALITION FOR KIDS
PO BOX 3156	JOHNSON CITY	TN	37602	621765487	501(C)(3)	5000	AFTER SCHOOL TUTORING AND MENTORING PROGRAM FOR KIDS	2562	ACTUAL COST	PROVIDED PRINT SERVICES FOR NEWSLETTER

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	11	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Procedure for Monitoring Grants in the U.S.:	Identifier
Return Reference	Part I, Line 2:	ReturnReference
Explanation	Schedule I, Part I, Line 2: MSHA ADHERED TO THE FOLLOWING CRITERIA FOR OUR CONTRIBUTIONS TO ORGANIZATIONS IN THE REGION: HEALTHCARE: THE ORGANIZATION ENHANCED OR IMPROVED ACCESS FOR THE UNINSURED OR UNDERINSURED POPULATION OR SUPPORTED A PROGRAM TO IMPROVE THE HEALTH OF OUR CHILDREN (I.E., CHILDHOOD OBESITY PREVENTION). EDUCATION: THE ORGANiZATION PROVIDED A PROGRAM TO IMPROVE EDUCATION OF THE CHILDREN IN OUR REGION ALL THE WAY TO COLLEGE AGE STUDENTS (RN NURSING PROGRAMS). QUALITY OF LIFE: THE ORGANIZATION OFFERED PROGRAMS TO ENHANCE THE QUALITY OF LIFE WHICH IS IMPORTANT IN THE RECRUITMENT EFFORTS OF BUSINESSES IN THE REGION AS WE WORK TO ATTRACT AND RETAIN THE BEST TALENT. FOR THE SUPPORTED PROGRAMS, METRICS WERE ESTABLISHED TO DETERMINE THE SUCCESS (OR FAILURE) OF EACH PROGRAM TO WHICH MSHA CONTRIBUTES. AS THE DEPRESSED ECONOMIC SITUATION CONTINUED DURING FY10, THE CRITERIA USED IN THE DECISION MAKING PROCESS FOR MAJOR DONATIONS WAS REVISED TO SUPPORT THOSE PROGRAMS WHICH FOCUSED ON HEALTH AND WELLNESS INITIATIVES, PARTICULARLY THOSE FIGHTING CHILDHOOD OBESITY.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
First Class Or Charter Travel	X	FirstClassOrCharterTravel
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DENNIS VONDERFECHT
630093	0	260107	0	73866	0	17150	0	23051	0	1004267	0	0	0
WILLIAM WALKER MD
0	549042	0	27765	0	1179	0	0	0	1928	0	579914	0	0
MARVIN EICHORN
420689	0	171393	0	57622	0	187084	0	26523	0	863311	0	0	0
DALE CLAYTORE
161081	0	42308	0	2335	0	8053	0	2603	0	216380	0	0	0
JOHN DOYLE
184620	0	6625	0	9559	0	11983	0	18914	0	231701	0	0	0
ANN FLEMING
294561	0	110625	0	22005	0	39321	0	20156	0	486668	0	0	0
CANDACE JENNINGS
284204	0	84870	0	10831	0	31792	0	22506	0	434203	0	0	0
LYNN KRUTAK
182942	0	50362	0	959	0	11433	0	18751	0	264447	0	0	0
MONTY MCLAURIN
253486	0	81353	0	10329	0	24719	0	27879	0	397766	0	0	0
CINDY SALYER
180720	0	61029	0	9505	0	20722	0	19745	0	291721	0	0	0
JOHN MELTON
134138	0	48326	0	2023136	0	3571	0	11562	0	2220733	0	0	0
SHANE HILTON
157468	0	9625	0	9856	0	10314	0	18205	0	205468	0	0	0
KENNETH MARSHALL MD
37572	0	59427	0	354034	0	1527	0	20204	0	472764	0	0	0
STEVE KILGORE
219768	0	71101	0	6419	0	24801	0	20467	0	342556	0	0	0
JAMIE PARSONS
193130	0	70895	0	17703	0	20306	0	7998	0	310032	0	0	0
CHAO LEE MD
310545	0	0	0	0	0	0	0	14168	0	324713	0	0	0
KATHRYN WILHOIT
174117	0	63031	0	27586	0	15716	0	19389	0	299839	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part I, Line 1a	BOARD MEMBERS AND TEAM MEMBERS OF MSHA ARE NOT PERMITTED TO travel FIRST-CLASS with the exception of MSHA's CEO. As SANCTIONED BY MSHA'S BOARD OF DIRECTORS, MSHA'S CEO is permitted to travel first-class when the flight's duration is GREATER THAN TWO HOURS. DUE TO THE LENGTH OF SUCH FLIGHTS, THE BOARD BELIEVES IT IS IN THE BEST INTEREST OF MSHA FOR THE CEO TO travel FIRST-CLASS. CHARTER TRAVEL IS LIMITED TO MSHA BUSINESS TRIPS THAT INCLUDE NUMEROUS TRAVELERS AND WHICH CAN BE JUSTIFIED BASED UPON FINANCIAL AND/OR ESSENTIAL TIME SAVINGS. CHARTER FLIGHTS MUST BE APPROvED BY THE CEO PRIOR TO BOOKING THE FLIGHT.
Part I, Line 4a	THE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MSHA: ANN FLEMING, CANDACE JENNINGS, MONTY MCLAURIN, CINDY SALYER, STEVE KILGORE, AND JAMIE PARSONS. THE 457(F) PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE." IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIEs OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON" OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24 MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION.
Part III	Part ii: JOHN MELTON, SENIOR VICE PRESIDENT, RECEIVED A DISABILITY INSURANCE PAYMENT OF $2,022,088, WHICH WAS INCLUDED IN HIS TAXABLE INCOME FROM MSHA.	Supplemental Information

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (5 entries)

Issuer EINIssuerEIN	Date IssuedDateIssued	Issue PriceIssuePrice	Description Of PurposeDescriptionOfPurpose	DefeasedDefeased	On Behalf Of IssuerOnBehalfOfIssuer	CUSIP NumberCUSIPNumber
HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN
621464028	2010-05-27	16000000	ACQUIRE HOSPITAL EQUIPMENT	0	0
HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN
621464028	2010-04-29	205877528	PARTIAL REFUNDING OF BONDS ISSUED 12/14/07 AND 2/20/2008	0	0	478271JH3
INDUSTRIAL DEVELOPMENT AUTHORITY OF WASHINGTON COUNTY VA
521324605	2009-03-31	124301533	CONSTRUCT & EQUIP HOSPITAL FACILITIES, INCLUD'G REFINANCING OF TAXABLE DEBT	0	0	938740CF2
HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN
621464028	2008-02-20	127000000	ACQUIRE,CONSTRUCT & EQUIP HOSP FACILITIES,INCLUD'G REFINANCING TAXABLE DEBT	0	0	478271HL6
HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN
621464028	2007-12-14	140930000	CONSTRUCT & EQUIP HOSP FACILITIES, REFUND BONDS ISSUED 3/18/94 & 4/12/06	0	0	478271HJ1

Form990 Schedule K Part II Form990ScheduleKPartII (5 entries)

Total ProceedsTotalProceeds	Amount UnspentAmountUnspent	Issuance Costs From ProceedsIssuanceCostsFromProceeds	Capital ExpendituresCapitalExpenditures	Current RefundingCurrentRefunding	Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind	Amount In Reserve FundAmountInReserveFund	Working Capital ExpendituresWorkingCapitalExpenditures
14679978	14679978	45000	1275039	0	1
44816060	26460217	3474644		1	1	18355842
55112561	42956238	2481706	57043762	0	1	12156318
624760	624760	1953563	103874142	0	1		4473649
1172457	1172457	1903195	29888340	1	1

Form990 Schedule K Part III Form990ScheduleKPartIII (5 entries)

Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty	Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged	Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI	Total Private Business UseTotalPrivateBusinessUse	Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
1	1	0.00000	0.00000	1
1	1	0.00010	0.00010	1
1	1	0.00010	0.00010	1
1	1	0.00010	0.00010	1
1	1	0.00010	0.00010	1

Form990 Schedule K Part IV Form990ScheduleKPartIV (5 entries)

Form8038 T FiledForm8038TFiled	Variable Rate IssueVariableRateIssue	Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds	Gross Proceeds Invested In GICGrossProceedsInvestedInGIC	Gross Proceeds InvestedGrossProceedsInvested	Exception To RebateExceptionToRebate	Business Name Line2NameOfGICProvider/BusinessNameLine2	Regulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied
(no name)
0	0	0	0	0	1
(no name)
0	0	0	0	0	0
(no name)
0	0	0	0	0	0
(no name)
0	1	0	0	0	0
RABOBANK
0	1	0	1	1	0	INTERNATIONAL	1

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	621464028	IssuerEIN
CUSIP Number	478271GX1	CUSIPNumber
Date Issued	2006-02-14	DateIssued
Issue Price	178614171	IssuePrice
Description Of Purpose	CONSTRUCT & EQUIP HOSPITAL FACILITIES, INCLUDING REFINANCING TAXABLE DEBT	DescriptionOfPurpose
Defeased	0	Defeased
On Behalf Of Issuer	0	OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Total Proceeds	25245326	TotalProceeds
Amount In Reserve Fund	18053000	AmountInReserveFund
Amount Unspent	7192326	AmountUnspent
Issuance Costs From Proceeds	2383533	IssuanceCostsFromProceeds
Capital Expenditures	122694950	CapitalExpenditures
Current Refunding	1	CurrentRefunding
Advance Refunding	1	AdvanceRefunding
Final Allocation Made	0	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	1	MngmentCntrctBondFinancdPrprty
Any Research Agreements	0	AnyResearchAgreements
Bond Counsel Routinely Engaged	1	BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00010	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00010	TotalPrivateBusinessUse
Post Issuance Compliance Procdrs	1	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	0	Form8038TFiled
Variable Rate Issue	0	VariableRateIssue
Hedge Identified In Books And Recds	0	HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC	1	GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

Field	Value	IRS element (for citing)
Business Name Line1	JP MORGAN CHASE	BusinessNameLine1
Business Name Line2	BANK NA	BusinessNameLine2

Field	Value	IRS element (for citing)
Regulatory Safe Harbor Satisfied	0	RegulatorySafeHarborSatisfied
Gross Proceeds Invested	1	GrossProceedsInvested
Exception To Rebate	0	ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable (3 entries)

Purpose Of LoanPurposeOfLoan	Loan From OrganizationLoanFromOrganization	Original PrincipalOriginalPrincipalAmount	Balance DueBalanceDue	DefaultDefault	Approved By BoardApprovedByBoard	Written AgreementWrittenAgreement
DENNIS VONDERFECHT
SPLIT DOLLAR LIFE INSUR. LOAN	X	$2,705,125	2705125	0	1	1
DENNIS VONDERFECHT
SPLIT DOLLAR LIFE INSUR. LOAN	X	$900,000	938520	0	1	1
DENNIS VONDERFECHT
SPLIT DOLLAR LIFE INSUR. LOAN	X	$900,000	936090	0	1	1

Field	Value	IRS element (for citing)
Total Balance Due	4579735	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
CLEM WILKES III
FAMILY MEMBER OF CLEM WILKES, JR., MSHA BOARD treasurer.	43172	CLEM WILKES, JR., treasurer OF THE MSHA BOARD OF DIRECTORS, IS A FAMILY MEMBER OF CLEM WILKES, III, AN EMPLOYEE OF MSHA.	0
WATAUGA PATHOLOGY ASSOCIATES PC
PROVIDER OF MEDICAL SERVICES TO MSHA.	467225	DR. SANDRA BROOKS, MEMBER OF THE MSHA BOARD OF DIRECTORS, IS An owner IN and serves as vice president of WATAUGA PATHOLOGY ASSOCIATES, P.C., WHICH PROVIDES MEDICAL SERVICES TO MSHA.	0
PULMONARY ASSOCIATES OF EAST TENNESSEE PC
PROVIDER OF MEDICAL SERVICES TO MSHA.	96299	DR. JEFF FARROW, MEMBER OF THE MSHA BOARD OF DIRECTORS, IS An owner IN PULMONARY ASSOCIATES OF EAST TENNESSEE, P.C., WHICH PROVIDES MEDICAL SERVICES TO MSHA.	0
PAULA CLAYTORE
FAMILY MEMBER OF DALE CLAYTORE, MSHA KEY EMPLOYEE.	201835	DALE CLAYTORE, A KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF PAULA CLAYTORE, AN EMPLOYEE OF MSHA.	0
WORKSPACE INTERIORS INC
PROVIDER OF COMMERCIAL FURNISHINGS TO MSHA.	1169549	ROBERT FEATHERS, vice chair OF THE MSHA BOARD OF DIRECTORS, IS OWNER OF WORKSPACE INTERIORS, INC., WHICH PROVIDES COMMERCIAL FURNISHING PRODUCTS TO MSHA. DURING FY10, MSHA COMPLETED CONSTRUCTION OF OUR NEW HOSPITAL, FRANKLIN WOODS COMMUNITY HOSPITAL. MSHA PURCHASED FURNISHINGS FROM WORKSPACE INTERIORS, INC. FOR THE NEW HOSPITAL. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH BASED UPON AN INDEPENDENT BIDDING PROCESS. ONLY INDEPENDENT, DISINTERESTED MEMBERS OF THE BOARD REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF CONSTRUCTION CONTRACTS, WHICH INCLUDE FURNISHINGS RELATED TO NEW CONSTRUCTION.	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (17 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Form 990, Part I, Item C	Doing Business As	JOhnson City Specialty Hospital JOhnson county community hospital North side Hospital Russell County Medical Center Sycamore shoals hospital Indian Path Medical Center Woodridge Hospital for Behavioral Health Services
Form 990, Part VI, Section A, line 6		THE CORPORATION IS ORGANIZED AS A TENNESSEE NOT-FOR-PROFIT MEMBERSHIP CORPORATION. FOR THE PAYMENT OF $100, AND APPROVAL BY THE BOARD OF DIRECTORS, AN INDIVIDUAL MAY BECOME A MEMBER OF THE CORPORATION.
Form 990, Part VI, Section A, line 7a		THE MEMBERS OF THE CORPORATION ANNUALLY ELECT MEMBERS OF THE BOARD OF DIRECTORS.
Form 990, Part VI, Section A, line 7b		CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO TENNESSEE STATUTE, SUBJECT TO APPROVAL BY THE MEMBERSHIP AS WELL. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL.
Form 990, Part VI, Section B, line 11		MSHA'S FORM 990 WAS REVIEWED BY MSHA'S BOARD OF DIRECTORS PRIOR TO SUBMITTING THE RETURN TO THE IRS. MSHA'S CFO AND SENIOR VICE-PRESIDENT PRESIDED OVER THE BOARD REVIEW. THE BOARD MEMBERS WERE PROVIDED ELECTRONIC ACCESS TO THE FORM 990 AND SCHEDULES PRIOR TO THE IN-PERSON REVIEW TO ALLOW MEMBERS ADEQUATE TIME TO LOOK OVER THE RETURN.
Form 990, Part VI, Section B, line 12c		ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT OF THE CORPORATION FORWARDS THE POLICY AND THE CONFLICT OF INTEREST DISCLOSURE FORMS TO ALL COVERED PERSONS. EACH PERSON IS REQUIRED TO PROVIDE A COMPLETED DISCLOSURE FORM, NOTING ANY CONFLICTS OR ATTESTING THEY HAVE "NONE", AND THEN FORWARD THOSE BACK TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT, AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION.
Form 990, Part VI, Section B, line 15		THE COMPENSATION COMMITTEE, WHICH IS THE EXECUTIVE COMMITTEE OF THE MSHA BOARD, OBTAINS THE SERVICES OF AN OUTSIDE AND INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM COMPENSATION SURVEYS AND WITH ADVICE WHEN THE COMMITTEE MAKES RECOMMENDATIONS ON PAY AND BENEFITS FOR THE CEO OF MSHA. THE BOARD ALSO APPROVES PAY AND BENEFITS FOR THE CFO. THE COMPENSATION COMMITTEE REVIEWS AND HAS FINAL APPROVAL OF CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR ALL OTHER EXECUTIVES.
Form 990, Part VI, Section C, line 19		GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY AND ANNUAL BASIS.
FORM 990, PART VII, SECTION A,	officer, Key employee & highest paid compensation:	lYNN KRUTAK, CFO AND MSHA KEY EMPLOYEE, IS PAID BY MSHA. BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (BRMMC) REIMBURSES MSHA FOR 50% OF KRUTAK'S SALARY AND BENEFITS. MSHA IS THE SOLE MEMBER OF BRMMC. KRUTAK DEVOTES AN EQUAL AMOUNT OF TIME BETWEEN MSHA AND BRMMC. STEVE KILGORE, REPORTABLE AS A HIGHEST COMPENSATED EMPLOYEE, IS PAID BY MSHA AND HIS SALARY AND BENEFITS ARE FULLY REIMBURSED TO MSHA BY BRMMC. MSHA BOARD MEMBER, DR. JEFF FARROW, HAS FORM 990 REPORTABLE COMPENSATION DERIVED FROM MEDICAL SERVICES HE PROVIDES TO A MSHA HOSPITAL. HE DOES NOT RECEIVE COMPENSATION FOR HIS SERVICES AS A MSHA BOARD MEMBER. DR. WILLIAM WALKER, MSHA BOARD MEMBER, HAS REPORTABLE COMPENSATION AND BENEFITS PAID BRMMC. DR. WALKER IS A CARDIOVASCULAR THORACIC SURGEON IN A MEDICAL PRACTICE OWNED BY BRMMC. HE DOES NOT RECEIVE COMPENSATION FOR HIS MSHA BOARD SERVICE. CERTAIN EXECUTIVES OF THE ORGANIZATiON, SUCH AS THE CEO AND SR VP/CFO, PROVIDE SERVICES TO SOME OR ALL OF THE ORGANIZATIONS RELATED TO MOUNTAIN STATES HEALTH ALLIANCE. THESE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS.
FORM 990, PART XI, LINE 2C,	Audit committee:	The audit committee's oversight and selection processes did not change during the tax year.
Schedule K Supplental Information		1. Comment on Schedule K, Part I, Lines B, C, D, and E. Mountain States Health Alliance owns and/or operates hospitals in a number of different locations both in Tennessee and in Virginia. As a result, Mountain States Health Alliance must utilize conduit governmental bond issuers in a number of jurisdictions in order to finance improvements to its hospital facilities. In 2007, 2008, 2009 and 2010, Mountain States Health Alliance was the conduit borrower of tax-exempt bonds issued by multiple issuers in Tennessee and Virginia. For federal tax purposes, even though different government issuers were involved, these multiple issues in each year were required to be treated, and were treated, as a single "issue" because they met the single "issue" test under the applicable federal tax regulations. Therefore, multiple issuers are listed under lines B, C, D and E because the bonds that were issued were part of a single "issue" for federal tax purposes. 2. Comment on Schedule K, Part II, Line 2. Certain proceeds of the bond issues listed in lines B, C, and F are deposited in reasonably required reserve funds, the size of each of which complies with federal tax regulations. The amounts shown on Line 2 of Part II of Schedule K include proceeds held in those funds. These lines also include a small amount of investment earnings relative to these funds that had not yet been moved as of the end of the applicable reporting period to another fund to be used to pay debt service, as is permitted under the applicable bond documents. Line 2 of Part II of Schedule K for the bond issue described in line F also includes certain monies held in a bona fide debt service fund. 3. Comment on Schedule K, Part II, Line 6. The bond issue described in line D of Part I financed a small amount of working capital expenditures. These working capital expenditures directly related to the capital expenditures that were financed with the proceeds of the bonds. Therefore the proceeds of these bonds could be allocated to such working capital expenditures pursuant to Section 1.148-6(d)(3)(v) of the Treasury Regulations. 4. Comments on Schedule K, Part IV, Line 1. As of the reporting date of the 990, the only arbitrage rebate calculation that was required related to the bonds described in Line F of Part I (the Series 2006 Bonds). Mountain States Health Alliance retained a rebate calculation agent to calculate whether any arbitrage rebate was due with respect to those bonds, and there was negative arbitrage rebate liability in a significant amount. Therefore, no Form 8038-T was required to be filed with respect to that bond issue. 5. Comment on Schedule K, Part IV, Line 4d. Part IV, Line 4d relative to the bond issue described on Line F shows that the regulatory safe harbor for establishing fair market value of the GIC described in Line 4a was not satisfied. Due to market conditions at the time, Mountain States Health Alliance did not receive three bids for this GIC. However, the yield on the GIC was so substantially below the yield on the relevant bonds that there was no doubt that the yield on the GIC did not exceed the appropriate yield on the relevant bonds. 6. Comment on Schedule K, Part IV, Line 5. The bond issues described in Lines E and F of Part I financed significant capital improvements to hospital facilities. There have been unexpected delays in the construction and equipping of certain of these hospital facilities, and therefore not all of the bond proceeds were spent within the three-year temporary period relative to construction projects. However, Mountain States Health Alliance has yield restricted these proceeds after the end of the applicable temporary period and/or will be making a yield reduction payment with respect to those proceeds, if required. Portions of the bond issues described in Lines D and E were partially refunded by the bonds described in Line B (the Series 2010 Bonds), so some of the proceeds of the bonds described in Line E and Line F have become transferred proceeds of the Series 2010 Bonds (and are reported under the appropriate lines for the Series 2010 Bonds).
form 990, part i, line i,	mission & significant activities:	MOUNTAIN STATES HEALTH ALLIANCE (MSHA) IS COMMITTED TO OUR MISSION OF BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN THE 29-COUNTY AREA WE SERVE, HELPING THEM ATTAIN THEIR HIGHEST LEVEL OF HEALTH. MSHA DELIVERS THIS CARE THROUGH THE PHILOSOPHY OF PATIENT-CENTERED CARE, AND THE DEVELOPMENT OF COMPREHENSIVE STRATEGIC PLANNING AND IMPLEMENTATION. NEAR THE END OF FY10, MSHA COMPLETED CONSTRUCTION OF A NEW REPLACEMENT HOSPITAL, FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH), A CERTIFIED "GREEN" FACILITY AND THE FIRST "GREEN" HOSPITAL IN THE STATE OF TENNESSEE. FWCH OPENED IN EARLY FY11 AND WILL REPLACE NORTH SIDE AND SPECIALTY HOSPITALS IN JOHNSON CITY. IN ADDITION TO THE COMPLETION OF FWCH DURING FY10, CONSTRUCTION ON A REPLACEMENT HOSPITAL FOR JOHNSTON MEMORIAL HOSPITAL WAS ONGOING THROUGHOUT THE REPORTING PERIOD AND DESIGN WORK WAS STARTED ON A REPLACEMENT FACILITY FOR SMYTH COUNTY COMMUNITY HOSPITAL AS WELL. BOTH HOSPITALS ARE LOCATED IN VIRGINIA AND MAJORITY OWNED BY MSHA. MSHA OFFERS UNIQUE SERVICES TO THE BROAD COMMUNITY WITH OUR NISWONGER CHILDREN'S HOSPITAL. THROUGH NISWONGER CHILDREN'S HOSPITAL, THE ST. JUDE CHILDREN'S HOSPITAL AFFILIATE CLINIC, WE PROVIDE THE REGION'S ONLY CHILDREN'S EMERGENCY DEPARTMENT. NISWONGER CHILDREN'S ALSO PROVIDES AN N.I.C.U., WHICH IS THE STATE DESIGNATED PERINATAL CENTER FOR THIS REGION. MSHA OFFERS THE LARGEST AIR AMBULANCE SERVICE IN THE REGION WITH WINGS AIR RESCUE COVERING THE ENTIRE 29-COUNTY SERVICE AREA. MSHA HAS MADE TREMENDOUS FINANCIAL INVESTMENTS TO NURSING PROGRAMS AT EAST TENNESSEE STATE UNIVERSITY AND LOCAL COLLEGES IN OUR REGION. EACH PROGRAM WAS TARGETED TO INCREASE THE NUMBER OF RN STUDENTS AND GRADUATES. MSHA'S NURSING SCHOLARSHIP PROGRAM HAS BEEN SO SUCCESSFUL THAT IN FY10, MSHA WAS ABLE TO ELIMINATE CONTRACT RNS, PRODUCING A LABOR SAVINGS OF $9 MILLION WHILE PROVIDING EXCELLENT NURSE CARE AT THE BEDSIDE. TO MEET ITS MISSION CLINICALLY, MSHA IS INVOLVED IN NUMEROUS QUALITY INITIATIVES AROUND THE UNITED STATES, BENCHMARKING AND IMPROVING PATIENT OUTCOMES AT OUR ACUTE CARE FACILITIES. THESE EFFORTS HAVE GENERATED NATIONAL, STATE AND REGIONAL RECOGNITIONS AS MSHA CONTINUES TO IMPROVE ITS PROCESSES AND OUTCOMES. IN FEBRUARY 2010, MSHA WAS FORMALLY RECOGNIZED BY THE TENNESSEE CENTER FOR PERFORMANCE EXCELLENCE AS THE RECIPIENT OF THE 2009 EXCELLENCE AWARD. MSHA PREVIOUSLY RECEIVED THIS RECOGNITION IN 2005, THUS MAKING MSHA THE ONLY HEALTHCARE ORGANIZATION IN TENNESSEE TO RECEIVE THIS RECOGNITION TWICE. TWO MSHA HOSPITALS, INDIAN PATH MEDICAL CENTER AND NORTH SIDE HOSPITAL, RECEIVED THE QUEST PROJECT'S QUALITY OF CARE TOP PERFORMER AWARDS IN ALL 5 FOCUS AREAS: 1) EVIDENCE BASED CARE; 2) MORTALITY REDUCTION; 3) COST OF CARE; 4) REDUCTION OF HARM; AND 5) PATIENT EXPERIENCE. OUR MISSION DIRECTS THE SYSTEM TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION. AS A RESULT, MSHA FINANCIALLY SUPPORTS MANY NON-PROFIT ORGANIZATIONS COMMITTED TO MEDICAL ASSISTANCE TO THE UNINSURED/UNDERINSURED AS WELL AS PROGRAMS TO IMPROVE THE OVERALL HEALTH AND WELLNESS OF OUR REGION.
Form 990, Part I, Line 6,	VOLUNTEERS:	Mountain States Health Alliance Auxiliary (Auxiliary) supports the numerous hospitals within the Mountain States Health Alliance (MSHA) system. The Auxiliary is a very active organization that constantly looks for and solicits recommendations on activities that will benefit MSHA hospitals, patients and their families, and the community. Since MSHA has numerous hospitals of varying size and services, the opportunity to provide assistance is tremendous and the Auxiliary often tailors its activities to the unique needs within a specific hospital. Although we report active volunteers of 1,464 on page 1, line 6, we actually have closer to 3,500 volunteers. We only keep precise records for the active members who work regularly scheduled hours. For example, our volunteers that do needlework, sewing, etc. in their home are not counted. Our active volunteers served 194,497 hours during FY10. Our volunteers give much to MSHA and the communities MSHA serves. Survey results from an evaluation completed by our volunteers indicate that 100% would recommend volunteering at a MSHA hospital to their friends. Some of the activities provided by the Auxiliary volunteers during FY10 are reported below: Musical Entertainment. Taped concerts and performances by local individuals and groups. The tapes are played on a newly developed volunteer music channel at Johnson City Medical Center (JCMC). A musical events calendar is maintained on the intranet for all hospitals and in the daily "MSHA Moment" - an informational communication to all team members. Sunday afternoon musical performances are given at 5 MSHA hospitals. A harmonica player walks the halls and provides harmonica music. He will go in any patient room when the patient/patient family requests and he gives out free harmonicas with bedside lessons especially for children at our Niswonger Children's Hospital. These harmonica lessons are also helpful to heart patients who are having trouble using their breathing device. Visual Arts. The Auxiliary prepares a rotating art exhibit at JCMC and Indian Path Medical Center (IPMC). We have certified master gardener volunteers at JCMC, IPMC, and Princeton Transitional Care. Literary Arts. A reading program is provided for the patients at Niswonger Children's Hospital. Culinary Arts. Volunteers bake and deliver cookies daily to JCMC and IPMC. Volunteers arrive early each morning to bake the cookies. The cookies are wrapped and delivered to Surgery, ICU, Heart Cath, and ER waiting rooms. A variety of snacks and meals are delivered to Norton Community Hospital family kitchens. Goody basket deliveries are made to JCMC's ICU waiting room. Creative Arts. Volunteers from area church groups make quilts and personal care kits for ER patients at IPMC. Volunteers create coloring books for waiting areas. All newborns receive hand-knitted or crocheted baby hats and many receive blankets and/or booties. All babies born during December receive a handmade, over-sized Christmas stocking. Volunteers begin working on the stockings in the summer and complete over 400 stockings. The babies are often sent home nestled in the stocking. Volunteers make IV covers, soft caps for oncology patients, and heatable baby positioning pads. Special entertainment for children includes volunteer clowns and Santa. Both Santa and the clowns make monthly visits. Volunteers make pillows for bariatric patients. Community Involvement. Volunteers are available 7 days a week, 24 hours a day for Niswonger Children's Hospital NICU. This program's purpose is to hold and comfort babies in the NICU and is aptly called the NICU "Cuddler Program". The Auxiliary maintains a program for heart patients called "Mended Hearts". Mended Hearts has 19 trained volunteers to visit with cardiac patients before and after open heart surgery every day. They also have monthly support meetings with programs on heart health and offer another class every six weeks to the Cardiac Rehab program. This program served 1,094 patients and family members. Courtesy carts and a van are operated by volunteers to transport patients and visitors to any door at JCMC. JCMC is a large hospital with multiple entry points and parking can be a good distance away from the facility. This transport program has been very well received by our patients and their visitors. The carts and van operate 7 days a week from 9 a.m. to 7 p.m. Franklin Woods Community Hospital (FWCH). FWCH is a brand-new MSHA hospital. We are very proud of this new facility, which is a certified "green" hospital. Prior to opening in the summer of 2010, the Auxiliary volunteer team assisted FWCH in several ways. The Auxiliary assisted with recruitment efforts through radio advertisement, website support, recruitment fairs, presentations to community groups, and placement of flyers throughout our service areas. Volunteers served as mock patients in diagnostic imaging to prepare FWCH staff for actual patients. The Navigator Program was staffed by Auxiliary volunteers to assist with pre-opening and opening events and tours to the general public. Equipment has been purchased by the Auxiliary to provide cookie baking for this hospital and will be operational once approval is received from the fire marshal. Various other equipment was purchased for this new hospital to promote continuing volunteer services. Also, pet therapy volunteers have been trained and a year round junior volunteer program is just taking off.
form 990, part iii, line 4a,	statement of program service accomplishments (continued):	MSHA also provides access to several online health information services. My Health News allows access to health information topics and services that matter to the user. This service sends up-to-date information from national health resources tailored to individual needs. MSHA provides access to KidsHealth, a service that provides practical parenting information and news. This service also provides homework help for kids and straight talk answers for teens. MSHA also partners with A.D.A.M. to provide the Health Encyclopedia. This service is one of the most respected and credible online medical resources in the world and offers access to 4,000 articles on health and wellness and covers more than 1,500 medical topics. MSHA provides CME and CEU opportunities with MedNewsPlus for physicians and nurses free of charge. The service is open to any physician or nurse in the region and offers CME and CEU credits. MSHA also provides links to helpful health- related sites on the internet. Patient Care Services Data shows that the health status of MSHA's service area is generally poor. MSHA's service area consists of counties in Tennessee and Southwest Virginia. Among the 50 states, Tennessee ranked 44th and Virginia ranked 21st in terms of health status. Some of the overwhelming health issues in our service area include: 1. High prevalence of obesity 2. High infant mortality 3. High rate of cigarette smoking 4. Poor air quality 5. Low rate of diabetic care 6. High rate of uninsured 7. Low level of education 8. High rate of deaths due to cardiovascular conditions, cancer and diabetes Given this health profile, MSHA exists to identify and respond to the healthcare needs of all individuals and communities in the region and to assist them in attaining their highest possible level of health. MSHA lives its mission to bring loving care to health care in our region. MSHA operates on a non-discriminatory basis, providing quality health care to all patients regardless of race, religion, gender, ethnicity, disability, age or ability to pay. Charity and Unreimbursed Costs Charity Care: While reimbursement for healthcare services rendered is critical to the operation and sustainability of the organization, MSHA recognizes its obligation to provide care to individuals who cannot afford essential medical services, including emergency care. A patient is classified as a charity patient by reference to established policies of MSHA and guidelines outlined by the federal government. However, financial assistance decisions are not solely based on income. Unique financial circumstances are weighed with verified patient assets which can determine financial assistance eligibility. It is not until after verification of income and assets that a decision as to the amount of write-off will be made. In fiscal year 2010, MSHA incurred a loss of $10,245,255 attributable to the provision of free care to indigent patients. Governmental Program Enrollees: MSHA provides care to persons covered by governmental programs, including Medicare and Medicaid and State-funded TennCare. In FY10, the unreimbursed cost of services provided to this patient population was $2,574,662 (Medicare, based on Medicare allowable costs), $4,926,881 (Medicaid) and $23,780,966 (TennCare). Bad Debt: MSHA provides an increasing level of service to self-pay patients for which it receives little or no payment. During FY10, bad debts resulted in unreimbursed costs of $16,796,337. Promote Community Health MSHA offers many reduced-price or free services and programs year-round in care settings that it established to accommodate the widely scattered, aging and socioeconomically disadvantaged population. Such programs serve bona fide community health needs and result in financial losses to the organization. Wings Air Rescue (Wings), the region's only emergency medical helicopter service, is considered by MSHA to be a regional asset. Licensed by the state of Tennessee and the Commonwealths of Kentucky and Virginia, Wings provided air transport of critically ill and injured patients to the closest tertiary facilities, including non-MSHA facilities. 51% of their patients are from trauma scenes, with others being cardiac, OB, pediatric and medical. During FY09, Wings transported 1,540 patients and made 9 search and rescue flights at a net operating loss of $817,335 to MSHA. Ask-A-Nurse Medical Call Center is a 24-hour toll-free medical information line. Experienced registered nurses answer calls and provide invaluable health information. They manage physician-approved patient triage services; make individual callbacks for pediatric and adult patients with serious symptoms; and coordinate patient transports and emergency department access. In FY10, Ask-A-Nurse handled 57,507 calls including 4,355 physician referrals. MSHA incurred an expense of $615,325 to provide this service at no cost to the community. During FY10, MSHA opened the doors of a satellite Dispensary of Hope. The Dispensary of Hope provides prescription drugs to those who may not have otherwise been able to afford needed medications. The site has its own pharmacy, a part-time pharmacist, a full-time pharmacy tech and a social worker/receptionist. The local Dispensary of Hope will be staffed, in part, by volunteer pharmacists from the community and will serve as a training site for the Bill Gatton College of Pharmacy at East Tennessee State University. During FY10, MSHA incurred unreimbursed expenses of $201,099 for this program. The Health Resources Center (HRC) is a community outreach service provided by MSHA. The HRC is conveniently located in the region's largest shopping mall. The HRC offers free classes, blood pressure checks, informational materials and resources as well as a number of other services in an effort to meet community members' basic health and health education needs. The HRC had 25,208 visits to their office and performed 2,016 health screenings. The HRC also hosted more than 7,940 attendees who participated in monthly health education programs. The HRC also provides outreach services where they screened an additional 3,498 community members. The uncompensated cost of HRC was $373,448. MSHA's Community Health and Wellness Screening Center (CHAWS) works with local schools and businesses as well as individual community members to provide onsite health education programs, perform health assessments and offer healthy lifestyle counseling. In FY10, CHAWS provided 1,146 screenings with an unreimbursed expense of $286,412. Based on community needs, MSHA incurred an expense of $198,868 to recruit physicians into clinical/geographical areas that were federally designated as medically underserved. MSHA incurred an additional expense of $1,687,521 to recruit physicians into other areas serviced by MSHA. Johnson County Community Hospital (JCCH) is a federally designated critical access hospital. This facility is located in one of Tennessee's poorest counties and provides emergency, inpatient and outpatient care to the county's residents, many of whom are over 65 years old. JCCH continues to be designated as a physician shortage area for many specialties. JCCH operates a Physician Specialty Clinic, which incurred an operating loss of $59,577 in FY10. The specialty clinic includes gastrointestinal, OB/GYN, general surgery, podiatry and other specialty services. This continues to be a valuable resource to the residents of the area by aiding with transportation issues (other physician offices are located more than an hour away), resolving access limitations for specialty services, and providing relief to the special health problems of a largely elderly population. Rural life often includes hazardous occupations such as farming, which increases the risk for chronic respiratory diseases and cancer-related illnesses caused by fertilization and other chemicals. This rural population has a higher incidence of cardiovascular disease due to diet and genetic predisposition. Given these factors, rural hospitals must remain flexible and diverse in their facilities and the services they offer the community. MSHA remains firm in the belief that financially supporting the services of JCCH and the specialty clinic to assist residents in attaining a high level of health continues to be a core value of our business and community support. MSHA operates a rural health clinic located in St Paul, VA, on the border of Wise and Russell counties. Riverside Clinic first opened in 1991 to provide primary care services to this elderly, underserved population. The clinic's largest payor is Medicare, which accounts for more than 40% of their patients. During FY10, the clinic had 10,900 outpatient visits. During FY10, Riverside Clinic incurred unreimbursed expenses of $527,715.
form 990, part iii, line 4a,	statement of program service accomplishments (continued):	MSHA has partnered with the company MedAssist to work with self-paying patients who have limited financial resources. During FY10, MedAssist representatives were available at all MSHA facilities for daily interaction and financial screening of patients. MedAssist representatives were able to determine governmental medical assistance (TennCare or Medicaid) eligibility, and to help with the application process and follow-up. During FY10, 4,334 potentially eligible patients took advantage of MedAssist's help, and of those patients who applied for TennCare or Virginia Medicaid coverage, 2,382 (55%) were approved for coverage. Once a person is approved for TennCare or Medicaid through the MedAssist program offered through MSHA, they retain coverage for future medical care. MedAssist is compensated by MSHA. During FY10, MSHA's cost for this program was $732,865. MSHA worked with GOJO, the makers of Purell, to implement a hand sanitizer program. MSHA provided 3,000 bags of Purell alcohol gel to hundreds of elementary, middle schools and high schools in our region. This initiative was a proactive measure by MSHA against the 2009-2010 flu season in an attempt to improve school attendance by lowering absenteeism due to illness. In the schools where they aggressively implemented the gel units and measured the absenteeism, double digit improvements were recorded. During FY10, MSHA re-supplied our local schools systems with hand sanitizer at an expense of $10,283. MSHA also gifts the land lease to the Ronald McDonald House at a fair market value of $60,000. The Ronald McDonald House is located on the campus of Niswonger Children's Hospital and Johnson City Medical Center. MSHA contributed $50,000 to CareSpark. CareSpark was established in 2005 to explore ways to share health information securely, efficiently and cost-effectively. CareSpark was initiated by volunteers with the Community Health Improvement Partnership, who had been working together for more than a decade through the local non-profit citizen organization, Kingsport Tomorrow, to develop collaborative processes to improve health within the community. MSHA contributed $30,000 to the ETSU Foundation to support the Johnson City Downtown Clinic. The Johnson City Downtown Clinic was originally established to serve the needs of the local homeless population in Johnson City and has expanded over the past nearly 15 years to include the uninsured, underinsured, TennCare enrollees, a growing Hispanic population, and medically indigent individuals. MSHA contributed $25,000 to Susan G. Komen Breast Care Foundation. Susan G. Komen is the global leader of the breast cancer movement and the world's largest grassroots network of breast cancer survivors and activists. Community Contributions As the second largest employer in the region, MSHA is one of the area's principle benefactors and has made corporate citizenship an integral part of its culture. From system-wide initiatives to individual efforts of caring team members, its aim is to enrich the communities that the organization serves. MSHA's commitment includes financial contributions, in-kind (non-cash) contributions and leadership resources within three broad categories of giving: 1) Direct contributions that support community healthcare needs and those nonprofit agencies that advocate the health and well-being of community members; 2) MSHA-run and MSHA-supported programs that contribute to the health and well-being of area residents; and 3) Education/training; both as a community citizen and as an employer. 1.) Direct Contributions - In-Kind and Cash MSHA leaders support and encourage all team members to volunteer time, money and skills to community service projects and charitable organizations. Senior leaders and board members set a positive example for MSHA team members, serving voluntarily on committees and managing boards of local service and nonprofit organizations. Many also serve as members and consultants on professional committees and task forces that affect regional development in health care and education. Team members served the Boys & Girls Club, Kiwanis Clubs, Rotary Clubs, Susan G. Komen Breast Cancer Foundation, Economic Development Steering Committee for Washington County, Junior Achievement, Salvation Army, American Heart Association, Hands On! Museum, Kingsport Tomorrow Inc., Appalachian Mountain Project Access, Washington County Emergency Medical Services, Washington County Veteran's Memorial Committee of the Johnson City Parks and Recreation Foundation, Eating Disorders Coalition of Tennessee, Johnson City Symphony Orchestra, Dawn of Hope, United Way, Chamber of Commerce Boards, and many others. Although MSHA did not fully monitor these activities during FY10 to tabulate the total financial cost, the amount would be significant since some of these team members devoted two weeks of normal work time to outside charitable activities. Summary List of Charitable Giving: In FY10, MSHA provided cash and in-kind support to numerous health and human service agencies, including, but not limited to, the following recipients. Major programs are described in more detail in the sections that follow. - CareSpark - $50,000 - ETSU Foundation - $30,000 - Tennessee Technology Center - $25,000 - Susan G. Komen Breast Cancer Foundation - $25,000 - Wellmont Foundation Inc. - $15,000 - East Tennessee State University - $12,450 - American Heart Association - $10,700 - Geisinger Health System Foundation - $10,000 - Johnson City Parks & Recreation - $5,152 - Children's Advocacy Center - $1,000 - American Cancer Society - $1,212 - March of Dimes - $1,037 MSHA, in collaboration with area health agencies and providers, may offer assistance with coordination, advocacy and publicity; provide space; or contribute supplies to support groups for their program activities. MSHA values social responsibility and is committed to community health and health education. Annually, MSHA makes generous monetary donations to area health and human service agencies whose programs are specifically designed to provide for the healthcare needs of the homeless, indigent and underserved populations. Throughout the year, MSHA makes contributions to local schools and organizations that provide educational and social support for young people. Some of the contributions to youth programs include: - Regional County and City Schools - $16,727 - Hands On! Regional Museum - $12,000 - Johnson City Public Library - $500 - Carter County Imagination Library - $500 - Coalition for Kids - $1,240 - Boys to Men - $1,032 - Girls Inc. - $536 One MSHA response to the region's high incidence rate of childhood obesity was to contribute $10,250 to East Tennessee State University's Fit Kids program. MSHA contributes annually to local chapters of several national nonprofit organizations whose research focuses on those diseases and conditions most prevalent in the region. FY10: - Susan G. Komen Breast Cancer Foundation - $25,000 - American Heart Association - $10,700 - American Cancer Society - $1,212 - March of Dimes - $1,037 - United Way - $1,357 2.) Community Programs Demographic studies and a customer market needs analysis, performed annually during strategic planning, indicate the necessity of having a wide array of free and price-reduced services that are well-situated for easy access from rural, mountainous areas. MSHA has given high priority to investments in community outreach, and as a result, has established councils and departments whose focus is to translate findings into viable healthcare programs both for the community at large and for populations with special needs.
form 990, part iii, line 4a,	statement of program service accomplishments (continued):	Among initiatives and ongoing services that promote community health and social wellbeing are disease management, wellness programs, health-related education sessions by MSHA nurses, staff physicians, nutritionists, and other specialists; health screenings and support. MSHA also offers special programs for youth, the elderly, the disabled and the medically underserved. During FY09, MSHA continued the largest community health needs assessment in its history in an effort to profile the health of the residents within the local region. This assessment specifically focused on MSHA's 13-county core service area, which includes, but is not limited to, all the counties in which MSHA has a facility. The seven Tennessee counties included in this needs assessment were: Carter County, Greene County, Hawkins County, Johnson County, Sullivan County, Unicoi County and Washington County. The other six Virginia counties are located in Southwest Virginia. After analyzing the many health disparities in the region, MSHA chose childhood obesity as its health priority. MSHA collaborated with East Tennessee State University's College of Public Health to develop the MSHA-ETSU Obesity Collaborative. The focus of this collaborative is to pull together many partners and organizations to reduce the level of childhood obesity throughout Northeast Tennessee and Southwest Virginia. MSHA provided the funding and coordination, while ETSU worked on research efforts. This initiative provided funding for up to 25 micro-grants of $2,000 each to local community organizations such as churches, community groups, schools and employers that want to explore childhood obesity reduction efforts. In FY10, MSHA and ETSU named the Obesity Collaborative "HEAL Appalachia" - HEAL, standing for "Healthy Eating Active Living." MSHA received over 100 applications for the micro-grants. The applicants awarded the grants were announced at a regional health symposium focusing on obesity. During FY10 MSHA spent $18,615 on coordinating the HEAL program and hosting the symposium and paid 20 of the 25 grants, or $40,000. MSHA's total FY10 cost: $58,615. The HEAL Appalachia committee will evaluate local program grant recipients as to their ability to make a measurable impact on the level of childhood obesity throughout the region. This committee will then make recommendations to executive leadership as to how MSHA should continue to direct financial support for successful programs. Programs for the community at large MSHA's Congestive Heart Failure Program is a multidisciplinary effort disease management program involving physicians, Cardiovascular Services, Home Health, Ask-A-Nurse Call Center and other hospital support groups. By integrating its call center into a telehealth program for congestive heart failure patients, MSHA's program has become a leader in disease management and was named the "Best Collaboration in Disease Management in the Nation" by the Disease Management Association of America. Of the 82 program participants in FY10, 54% had no Emergency Department visits or hospital admissions for any reason and 85% had no CHF admission after enrollment into the program. The FY10 unreimbursed cost to MSHA was $51,900. In addition to the health screenings and support groups offered through the Health Resources Center, described above, a variety of screenings, support groups, health education, and health fairs were provided at a cost of more than $54,403. These activities include providing community health education on such topics as orthopedics, pre- and post- natal, nutrition, sleep disorders, behavioral health issues, cardiovascular health, and many others. In addition to health education, MSHA provided free blood pressure screenings and colorectal screenings, for specific populations as well as physicals for pee-wee and high school football players in Johnson County. The Hospice Program offers extended 13-month bereavement support rather than the required 12-month period, thus supporting families during the anniversary month of the patient's death, which can be a challenging time. Also provided is a Celebration of Life program for families of former hospice patients and the community at large. The Parish Nurse Program is sponsored by MSHA's Home Health organization, with goals of recruiting area churches and registered nurses to the program and providing participants with education about parish nursing. Parish nursing is an amalgam of social work, good neighboring and nursing. It supports, educates and counsels those with healthcare needs from within their places of worship. A few of the services provided by parish nurses are blood drives, flu shots, health screenings, health fairs and monthly blood pressure clinics. Several of the nurses are certified to teach CPR and First Aid at no cost to participants. MSHA provides the Parish Nurse Program with coordinators, sponsored orientation, monthly educational programs and other support functions. Currently, there are 26 churches participating in Tennessee and six in Southwest Virginia with parish nurses on staff. MSHA's FY10 cost for the Parish Nurse program was $60,685. The Respond Department at Woodridge Hospital (WH) offer assessments and referrals for individuals dealing with mental health issues and substance abuse. Professional staff includes behavioral health counselors and RNs who are available 24 hours a day, seven days a week to answer calls from the community concerning treatment. Throughout the assessment process, Respond collaborates with a psychiatrist to determine the most appropriate level of care. The Respond Department at WH incurred unreimbursed costs of $911,861 during FY10. MSHA provided staff to local agencies, councils and other charitable organizations to assist with leadership programs, planning, service on steering committees and participation with special events. Examples include American Red Cross blood drives, Healthy Babies Day, the American Cancer Society leadership council and others at a cost to MSHA of $33,508. We feel sure this amount is underreported due to the difficulty in tracking team members' many activities. In FY10, local health departments solicited help from MSHA to assist with H1N1 vaccination. MSHA was able to coordinate a response to this request by providing nurses to administer shots. The cost of providing vaccination assistance was $14,601. Programs for Special Populations Due to the use of emergency departments as walk-in clinics by the poor and underserved, MSHA has helped establish and finance alternative care settings such as the ETSU College of Nursing's Downtown Clinic in Johnson City, TN. The Downtown Clinic is dedicated to serving the primary needs of the homeless, indigent and uninsured populations, providing them with free laboratory testing and assistance with their diagnosis and treatments. MSHA gifts the clinic rent, which is valued at a discounted $35,000 annually. MSHA has an agreement with the Downtown Clinic to process their lab specimens as well as provide some diagnostic imaging services to clinic patients at no cost to the patient or the clinic. In FY10, the cost associated with the Clinic's lab testing was $63,516 and the cost of diagnostic imaging services was $17,291. These expenses are included in MSHA's Charity write-offs. During FY10, MSHA also contributed an additional $30,000 contribution to assist with the Clinic's operations. MSHA's service area comprises a stable, aging population, so the organization has established a number of programs to serve the needs of senior citizens. An example of a senior program is the Pinnacle Club - a community outreach program for service-area seniors that offers monthly health-related events and fellowship opportunities at Johnson City Medical Center, Indian Path Medical Center, Russell County Medical Center and Sycamore Shoals Hospital. Benefits include health screenings, free annual lab screenings, and discounted first-time enrollment fees at our Wellness Center and Franklin Fitness Center. There are currently 1,878 members. The club sponsors health fairs, the Senior Expo, and monthly educational luncheons in Kingsport, Johnson City, and Elizabethton, TN, and in Lebanon, VA. The club also provides free notary services, socials, travel opportunities and discounts through numerous vendors. During FY10, MSHA incurred a net operating loss of $82,879 attributable to its support of the program. 3) Education and Training Community Health Educational Programs MSHA provided a variety of wellness and health information to help educate area residents about community-specific health issues. Information was provided through printed materials, speaking engagements, radio and television interviews, and health fairs and expos.
form 990, part iii, line 4a,	statement of program service accomplishments (continued):	MSHA accepted invitations to speak on health-related topics at various community organizations and schools. A variety of topics were presented such as skin care, stress management, nutrition, weight management, preventive care measures, care of aging parents and others. Youth education programs were presented to students ranging from kindergarten to college and were designed to promote safety at play; age-appropriate health issues; illness and injury prevention techniques; nutrition; and the dangers of tobacco, alcohol and drug use. Dietitians gave talks, provided food demonstrations to various groups and visited area schools to discuss nutrition. Home Health, Hospice and Parish Nursing also provided numerous speaking engagements. The cost of providing these speaking engagements was approximately $60,162. MSHA's American Heart Association (AHA) Training Center offered several courses to healthcare providers and to the public in an effort to expand the outreach of the American Heart Association and MSHA in promoting wellness and saving lives. Programs include: Advanced Cardiac Life Support, Basic Cardiac Life Support, Pediatric Advanced Life Support, First Aid and Life Support Instructor training. The FY10 unreimbursed cost to provide the educational courses to the public was $139,876. Important to the efficient and safe operation of the air ambulance is a clear understanding of how to clear and prepare landing zones and appropriate methods for communicating with air helicopter pilots at accident scenes and transport sites. During FY10, Wings Air Rescue made 139 training runs to area Emergency Medical Service facilities to perform training of EMS crews.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Direct Controlling Entity NADirectControllingEntityNA
DICKENSON COMMUNITY HOSPITAL
PO BOX 1440 HOSPITAL DRIVE	CLINTWOOD	VA	24228	770599553	HOSPITAL	VA	501(C)(3)	LINE 3	NORTON COMMUNITY HOSPITAL
MOUNTAIN STATES FOUNDATION
2335 KNOB CREEK ROAD STE 101	JOHNSON CITY	TN	37604	581418862	FUNDRAISING FOR MSHA HOSPITALS	TN	501(C)(3)	LINE 11A		N/A
MSHA AUXILIARY
400 N STATE OF FRANKLIN ROAD	JOHNSON CITY	TN	37604	581418345	SUPPORTING ORGANIZATION TO MSHA HOSPITALS	TN	501(C)(3)	LINE 11A		N/A
SMYTH COUNTY COMMUNITY HOSPITAL
565 RADIO HILL ROAD	MARION	VA	24354	540794913	HOSPITAL	VA	501(C)(3)	LINE 3		N/A
NORTON COMMUNITY HOSPITAL
100 15TH STREET NW	NORTON	VA	24273	540566029	HOSPITAL	VA	501(C)(3)	LINE 3		N/A
JOHNSTON MEMORIAL HOSPITAL
351 COURT STREET NW	ABINGDON	VA	24210	540544705	HOSPITAL	VA	501(C)(3)	LINE 3		N/A
ABINGDON PHYSICIAN PARTNERS
351 COURT STREET NW	ABINGDON	VA	24210	205485346	MEDICAL SERVICES	VA	501(C)(3)	LINE 11A	JOHNSTON MEMORIAL HOSPITAL

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	General Or Managing PartnerGeneralOrManagingPartner
INTEGRATED SOLUTIONS HEALTH NETWORK LLC
400 N STATE OF FRANKLIN RD	JOHNSON CITY	TN	37604	621711997	INVESTMENT COMPANY	TN	N/A	(D)	7186	2229938	0	0
EMMAUS COMMUNITY HEALTHCARE PLLC
6070 HWY 11E	PINEY FLATS	TN	37686	200577483	MEDICAL SERVICES	TN	N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Business Name Line1DirectControllingEntityName/BusinessNameLine1
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
1021 W OAKLAND AVE STE 207	JOHNSON CITY	TN	37604	621490616	PHYSICIAN OFFICES	TN	N/A	C	59122424	188408632	1.00000
MEDISERVE MEDICAL EQUIPMENT OF KINGSPORT
1021 W OAKLAND AVE STE 103	JOHNSON CITY	TN	37604	621212286	DURABLE MEDICAL EQUIPMENT CO.	TN		C	4504773	3698034	1.00000	BLUE RIDGE MEDICAL MGMT CORP
MOUNTAIN STATES PROPERTIES
1021 W OAKLAND AVE STE 207	JOHNSON CITY	TN	37604	621845895	PROPERTY MANAGEMENT	TN		C	12637251	147225234	1.00000	BLUE RIDGE MEDICAL MGMT CORP
BLUE RIDGE PHYSICIAN GROUP
1019 W OAKLAND AVE STE 5	JOHNSON CITY	TN	37604	621700412	HEALTHCARE SERVICES	TN		C	28664168	3115353	1.00000	BLUE RIDGE MEDICAL MGMT CORP
COMMUNITY HOME CARE INC
1460 PARK AVENUE	NORTON	VA	24273	541453810	MEDICAL EQUIP. SALES & RENTAL	VA		C	325299	336250	0.50100	NORTON COMMUNITY HOSPITAL
COMMUNITY PHYSICIANS SERV CORP
100 15TH STREET NW	NORTON	VA	24273	541641446	MEDICAL SERVICES	VA		C	27385	4994	0.50100	NORTON COMMUNITY HOSPITAL
SOUTHWEST COMMUNITY HEALTH SERV
565 RADIO HILL RD PO BOX 880	MARION	VA	24354	541460695	MEDICAL SERVICES	VA		C	338242	895562	0.80000	SMYTH CO COMMUNITY HOSPITAL

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	1	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	1	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	1	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	1	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	1	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	1	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (29 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved
MOUNTAIN STATES PROPERTIES
G	4952775
MOUNTAIN STATES PROPERTIES
J	1550138
MOUNTAIN STATES PROPERTIES
K	280937
MOUNTAIN STATES PROPERTIES
N	53164
MOUNTAIN STATES PROPERTIES
O	58752
MOUNTAIN STATES PROPERTIES
P	504170
MEDISERVE
J	205325
MEDISERVE
P	398461
SMYTH COUNTY COMMUNITY HOSPITAL
A	717517
SMYTH COUNTY COMMUNITY HOSPITAL
K	2988762
SMYTH COUNTY COMMUNITY HOSPITAL
Q	3143999
DICKENSON COMMUNITY HOSPITAL
K	392804
JOHNSTON MEMORIAL HOSPITAL
B	4571429
JOHNSTON MEMORIAL HOSPITAL
K	3998831
JOHNSTON MEMORIAL HOSPITAL
O	68700
JOHNSTON MEMORIAL HOSPITAL
P	326906
JOHNSTON MEMORIAL HOSPITAL
Q	1688162
MOUNTAIN STATES FOUNDATION
B	780502
MOUNTAIN STATES FOUNDATION
C	2319016
BLUE RIDGE MEDICAL MGMT CORP
G	64070
BLUE RIDGE MEDICAL MGMT CORP
K	4200738
BLUE RIDGE MEDICAL MGMT CORP
L	17624563
BLUE RIDGE MEDICAL MGMT CORP
N	210568
BLUE RIDGE MEDICAL MGMT CORP
P	6716791
MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY
O	106396
MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY
P	160865
NORTON COMMUNITY HOSPITAL
K	1303051
INTEGRATED SOLUTIONS HEALTH NETWORK LLC
L	113442
INTEGRATED SOLUTIONS HEALTH NETWORK LLC
P	206926