TY 2013 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DENNIS VONDERFECHT........................................................................ CEO	51.00 .......................9.00	X	X		1,058,195	0	68,381
(2) JEFF FARROW MD........................................................................ DIRECTOR	4.00 .......................	X			36,835	475	0
(3) CLEM WILKES JR........................................................................ CHAIR	8.00 ........................50	X			0	0	0
(4) GARY PEACOCK........................................................................ DIRECTOR	5.00 .......................8.00	X			0	0	0
(5) SANDRA BROOKS MD........................................................................ DIRECTOR	4.50 .......................1.00	X			0	0	0
(6) RICK STOREY........................................................................ DIRECTOR	5.00 .......................	X			0	0	0
(7) THOMAS FOWLKES........................................................................ DIRECTOR	4.50 .......................6.00	X			0	0	0
(8) LINDA GARCEAU........................................................................ DIRECTOR	5.00 .......................	X			0	0	0
(9) JOANNE GILMER........................................................................ VICE CHAIR	6.00 .......................13.00	X			0	0	0
(10) DAVID MAY MD........................................................................ DIRECTOR	5.50 .......................	X			0	0	0
(11) ROBERT FEATHERS........................................................................ PAST CHAIR	6.00 ........................50	X			0	0	0
(12) MICHAEL CHRISTIAN........................................................................ TREASURER	4.50 .......................	X			0	0	0
(13) BARBARA ALLEN........................................................................ SECRETARY	7.00 .......................4.00	X			0	0	0
(14) ALAN LEVINE........................................................................ PRESIDENT &	60.00 .......................	X	X		0	0	0
(15) MARVIN EICHORN........................................................................ SENIOR VP/CF	59.00 .......................1.00		X		626,635	0	47,303
(16) ANN FLEMING........................................................................ SR. VP	45.00 .......................15.00			X	753,909	0	73,411
(17) CANDACE JENNINGS........................................................................ SR. VP TN OP	60.00 .......................			X	523,529	0	85,889

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) DAVID NICELY........................................................................ VP/CEO WASHI	55.00 .......................	X			342,553	54,931
(19) MONTY MCLAURIN........................................................................ VP/IPMC CEO	55.00 .......................	X			317,642	57,151
(20) TONY BENTON........................................................................ INTERIM CEO	55.00 .......................	X			299,304	37,624
(21) SHANE HILTON........................................................................ VP/TN CFO	55.00 .......................	X			286,898	38,039
(22) LYNN KRUTAK........................................................................ VP/CORP. CFO	55.00 .......................	X			265,010	36,445
(23) PATRICK BOLANDER........................................................................ JCMC CFO	55.00 .......................	X			206,144	28,052
(24) STEVE SAWYER........................................................................ IPMC CFO	.......................55.00	X			153,220	21,317
(25) MORRIS SELIGMAN MD........................................................................ SR. VP/CMO	60.00 .......................		X		533,796	84,703
(26) BERT SMITH MD........................................................................ VP HOSP. PRG	55.00 .......................		X		395,458	22,368
(27) DOUGLAS EDEMA........................................................................ VP PRES./CEO	55.00 .......................		X		391,873	36,180
(28) STEVE KILGORE........................................................................ PRESIDENT BR	54.00 .......................1.00		X		377,168	55,429
(29) MARK WILKINSON........................................................................ CMO	55.00 .......................		X		371,159	37,078
(30) DALE CLAYTORE........................................................................ VP	55.00 .......................			X	233,706	13,560
(31) PAT NIDAY........................................................................ FORMER CNO W	55.00 .......................			X	191,046	39,977

(A) Name and business address	(B) Description of services	(C) Compensation
SKANSKA USA BUILDING INC, 5000 MERIDIAN BLVD SUITE 100FRANKLINTN37067	CONSTRUCTION	27,432,371
ANESTHESIA PAIN CONSULTANTS, STE 4 1113 SUNSET DR PO BOX 3727JOHNSON CITYTN376023727	PHYSICIAN SVCS.	4,571,599
PREMIER ANESTHESIA SERVICES, PO BOX 4653JOHNSON CITYTN376024653	PHYSICIAN SVCS.	2,845,186
PHILIPS HEALTHCARE, PO BOX 100355ATLANTAGA30384	EQUIPMENT SVCS.	2,695,286
CROTHALL SERVICES EAST TN, 13028 COLLECTIONS CENTER DRIVECHICAGOIL60693	LAUNDRY SVCS.	2,674,201
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 108

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	705,491	705,491
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	5,535,708	38,163	5,497,545
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	227,756,974	215,290,820	11,677,610	788,544
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,821,500	9,365,543	421,656	34,301
9	Other employee benefits .......	34,490,957	31,001,196	3,480,662	9,099
10	Payroll taxes ...........	17,917,601	15,610,114	2,262,804	44,683
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,606,661		1,606,661
c	Accounting ...........	312,624	5,100	288,404	19,120
d	Lobbying ...........	147,043	147,043
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	966,844		966,844
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	93,864,907	83,187,817	10,670,853	6,237
12	Advertising and promotion ....	2,312,231	121,029	2,183,296	7,906
13	Office expenses .......	6,415,775	6,258,731	139,107	17,937
14	Information technology ......	20,867,730	12,775,200	8,092,530
15	Royalties ..
16	Occupancy ...........	14,843,361	11,311,738	3,466,484	65,139
17	Travel ............	1,850,759	1,347,658	501,750	1,351
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	81,434	61,345	19,465	624
20	Interest ...........	42,471,912		42,471,912
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	43,713,910	24,394,217	19,314,751	4,942
23	Insurance ..............	2,714,095	2,114	2,711,981
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	123,908,206	123,590,299	317,907
b	REPAIRS & MAINTENANCE	15,117,008	14,004,298	1,071,399	41,311
c	DUES & SUBSCRIPTIONS	3,927,018	1,533,282	2,390,539	3,197
d	UBI TAXES	77,000		77,000
e	All other expenses	2,947,111	2,085,141	818,279	43,691
25	Total functional expenses. Add lines 1 through 24e	674,373,860	552,836,339	120,449,439	1,088,082
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	53,114,956	2	78,251,832
3	Pledges and grants receivable, net ...........	96,609	3	99,629
4	Accounts receivable, net .............	117,265,071	4	111,736,791
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		8,492,454	5	8,988,974
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............	17,189,476	7	29,866,592
8	Inventories for sale or use ..............	15,873,411	8	15,723,351
9	Prepaid expenses and deferred charges ..........	4,850,577	9	4,344,835
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,043,477,462
b	Less: accumulated depreciation .....	10b	516,925,448	517,908,210	10c	526,552,014
11	Investments—publicly traded securities ..........	285,653,065	11	261,766,810
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....	313,693,918	13	324,481,069
14	Intangible assets ...............	144,707,541	14	144,707,541
15	Other assets. See Part IV, line 11 ...........	120,631,703	15	96,741,552
16	Total assets. Add lines 1 through 15 (must equal line 34)......	1,599,476,991	16	1,603,260,990
	17	Accounts payable and accrued expenses .........	69,022,047	17	63,659,832
18	Grants payable .................		18
19	Deferred revenue ................	2,130,026	19	1,273,627
20	Tax-exempt bond liabilities .............	882,984,693	20	981,126,646
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	145,411,405	23	25,846,994
24	Unsecured notes and loans payable to unrelated third parties ....	2,319,713	24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	100,026,944	25	94,938,811
26	Total liabilities. Add lines 17 through 25.........	1,201,894,828	26	1,166,845,910
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	397,408,151	27	436,180,033
28	Temporarily restricted net assets ...........	174,012	28	235,047
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	397,582,163	33	436,415,080
34	Total liabilities and net assets/fund balances ........	1,599,476,991	34	1,603,260,990

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2012. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2012. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization MOUNTAIN STATES HEALTH ALLIANCE

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization MOUNTAIN STATES HEALTH ALLIANCE

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2013

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2013

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Yes

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

258,825

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

258,825

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1	THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR THE DEPARTMENT'S MANAGER OR DIRECTOR ATTENDED THE FOLLOWING LEGISLATIVE CONFERENCES: - PREMIER FEDERAL AFFAIRS NETWORK MEETING - AMERICAN HOSPITAL ASSOCIATION ANNUAL MEETING - TENNESSEE HOSPITAL ASSOCIATION LEGISLATIVE ADVOCACY DAY - HOSPITAL ALLIANCE OF TENNESSEE ANNUAL MEETING - TENNESSEE PUBLIC & TEACHING HOSPITALS ASSOCIATION ANNUAL MEETING - VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION LEGISLATIVE ISSUES CONFERENCE THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR DEPARTMENTAL STAFF ALSO CONTACTED CONGRESSIONAL OFFICES CONCERNING THE FOLLOWING ISSUES: - SUPPORT FOR PROVISIONS TO EXPAND INSURANCE COVERAGE (HEALTH INSURANCE EXCHANGES AND MEDICAID EXPANSION) - SUPPORT FOR INITIATIVES TO IMPROVE PAYMENT DELIVERY REDESIGN; SUCH AS ACCOUNTABLE CARE ORGANIZATION DEVELOPMENT - SUPPORT FOR CONTINUATION OF TENNESSEE MEDICAID DISPROPORTIONATE SHARE HOSPITAL PAYMENTS - OPPOSITION TO ADDITIONAL CUTS IN MEDICARE/MEDICAID - SUPPORT FOR REAUTHORIZATION AND FUNDING OF CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION - SUPPORT FEDERAL FUNDING FOR TRAUMA CARE - SUPPORT CONTINUATION OF GRADUATE MEDICAL EDUCATIONAL FUNDING - SUPPORT OF STATE MEDICAID PROVIDER TAX PROVISIONS - SUPPORT CHANGES TO MEDICARE WAGE INDEX - SUPPORT CHANGES TO TWO MIDNIGHT RULE - SUPPORT RECOVERY AUDIT CONTRACTOR REFORM - SUPPORT OF MEDICARE DEPENDENT HOSPITAL AND LOW-VOLUME DESIGNATIONS THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR THE DEPARTMENTAL DIRECTOR RESPONDED VIA LETTER, PHONE, OR IN PERSON TO THE FOLLOWING TENNESSEE AND VIRGINIA LEGISLATIVE ISSUES: - MEDICAID EXPANSION - TENNESSEE AND VIRGINIA - STRONG CERTIFICATE OF NEED PROGRAMS IN TENNESSEE AND VIRGINIA - CONTINUATION OF HOSPITAL ASSESSMENT FEE IN TENNESSEE - FUNDING FOR PERINATAL CENTERS IN TENNESSEE - SAFETY NET FUNDING FOR PROJECT ACCESS - STABLE MEDICAID RATES IN VIRGINIA - LEGISLATION THAT ADDRESSES DRUG ADDICTED PREGNANT WOMEN AND THEIR BABIES (NEONATAL ABSTINENCE SYNDROME) - HELMET REQUIREMENT FOR MOTORCYCLISTS

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1

THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR THE DEPARTMENT'S MANAGER OR DIRECTOR ATTENDED THE FOLLOWING LEGISLATIVE CONFERENCES: - PREMIER FEDERAL AFFAIRS NETWORK MEETING - AMERICAN HOSPITAL ASSOCIATION ANNUAL MEETING - TENNESSEE HOSPITAL ASSOCIATION LEGISLATIVE ADVOCACY DAY - HOSPITAL ALLIANCE OF TENNESSEE ANNUAL MEETING - TENNESSEE PUBLIC & TEACHING HOSPITALS ASSOCIATION ANNUAL MEETING - VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION LEGISLATIVE ISSUES CONFERENCE THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR DEPARTMENTAL STAFF ALSO CONTACTED CONGRESSIONAL OFFICES CONCERNING THE FOLLOWING ISSUES: - SUPPORT FOR PROVISIONS TO EXPAND INSURANCE COVERAGE (HEALTH INSURANCE EXCHANGES AND MEDICAID EXPANSION) - SUPPORT FOR INITIATIVES TO IMPROVE PAYMENT DELIVERY REDESIGN; SUCH AS ACCOUNTABLE CARE ORGANIZATION DEVELOPMENT - SUPPORT FOR CONTINUATION OF TENNESSEE MEDICAID DISPROPORTIONATE SHARE HOSPITAL PAYMENTS - OPPOSITION TO ADDITIONAL CUTS IN MEDICARE/MEDICAID - SUPPORT FOR REAUTHORIZATION AND FUNDING OF CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION - SUPPORT FEDERAL FUNDING FOR TRAUMA CARE - SUPPORT CONTINUATION OF GRADUATE MEDICAL EDUCATIONAL FUNDING - SUPPORT OF STATE MEDICAID PROVIDER TAX PROVISIONS - SUPPORT CHANGES TO MEDICARE WAGE INDEX - SUPPORT CHANGES TO TWO MIDNIGHT RULE - SUPPORT RECOVERY AUDIT CONTRACTOR REFORM - SUPPORT OF MEDICARE DEPENDENT HOSPITAL AND LOW-VOLUME DESIGNATIONS THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR THE DEPARTMENTAL DIRECTOR RESPONDED VIA LETTER, PHONE, OR IN PERSON TO THE FOLLOWING TENNESSEE AND VIRGINIA LEGISLATIVE ISSUES: - MEDICAID EXPANSION - TENNESSEE AND VIRGINIA - STRONG CERTIFICATE OF NEED PROGRAMS IN TENNESSEE AND VIRGINIA - CONTINUATION OF HOSPITAL ASSESSMENT FEE IN TENNESSEE - FUNDING FOR PERINATAL CENTERS IN TENNESSEE - SAFETY NET FUNDING FOR PROJECT ACCESS - STABLE MEDICAID RATES IN VIRGINIA - LEGISLATION THAT ADDRESSES DRUG ADDICTED PREGNANT WOMEN AND THEIR BABIES (NEONATAL ABSTINENCE SYNDROME) - HELMET REQUIREMENT FOR MOTORCYCLISTS

Schedule C (Form 990 or 990EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	50,465,142		50,465,142
b	Buildings ................	518,039,628	170,607,620	347,432,008
c	Leasehold improvements ............	950,676	528,730	421,946
d	Equipment ................	474,022,016	345,789,098	128,232,918
e	Other .................
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				526,552,014

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) INVESTMENT IN JMH	132,000,000	C
(2) INVESTMENT IN BRMMC	100,273,634	C
(3) INVESTMENT IN SCCH	67,400,494	C
(4) INVESTMENT IN ISHN	25,579,937	C
(5) INVESTMENT IN OTHER	-772,996	F




Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	324,481,069

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) AWUL-UNDER BOND INDENTURE AGREEMENT				43,890,111
(2) AWUL - CURRENT				25,028,568
(3) DEFERRED CHARGES AND OTHER				14,755,160
(4) LONG TERM COMPENSATION INVESTMENT				13,067,713





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				96,741,552

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
ACCRUED SALARIES, ABSENCES & W/H		45,491,008
ACCRUED INTEREST		18,527,828
EST. FAIR VALUE OF INT. RATE SWAP		10,665,808
OTHER LONG-TERM LIABILITIES		10,324,133
DUE TO THIRD-PARTY PAYERS		9,930,034




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		94,938,811
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PAGE 3, PART X	THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2014 AND 2013. AT JUNE 30, 2014, TAX RETURNS FOR 2010 THROUGH 2013 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.

Return Reference

Explanation

SCHEDULE D, PAGE 3, PART X

THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2014 AND 2013. AT JUNE 30, 2014, TAX RETURNS FOR 2010 THROUGH 2013 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

If "Yes," did the organization make it available to the public? ..............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	16,107,968		16,107,968	2.390 %
b	Medicaid (from Worksheet 3, column a) ....	22,007,589	17,414,212	4,593,377	0.680 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	78,916,606	59,293,227	19,623,379	2.910 %
d	Total Financial Assistance and Means-Tested Government Programs .	117,032,163	76,707,439	40,324,724	5.980 %
Other Benefits		4,528,009	595,650	3,932,359	0.580 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	4,528,009	595,650	3,932,359	0.580 %
f	Health professions education (from Worksheet 5) ..	11,534,585	3,168,169	8,366,416	1.240 %
g	Subsidized health services (from Worksheet 6) ..	24,141,775	14,904,595	9,237,180	1.370 %
h	Research (from Worksheet 7)	258,391	31,886	226,505	0.030 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	468,791		468,791	0.070 %
j	Total. Other Benefits ..	40,931,551	18,700,300	22,231,251	3.300 %
k	Total. Add lines 7d and 7j .	157,963,714	95,407,739	62,555,975	9.280 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing	8,062	8,062
2	Economic development
3	Community support	17,635	17,635
4	Environmental improvements
5	Leadership development and training for community members	1,000	1,000
6	Coalition building	2,420	2,420
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	29,117	29,117

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

85,394,567

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

65,753,817

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

174,151,296

Enter Medicare allowable costs of care relating to payments on line 5.....

175,918,898

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-1,767,602

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1MED'L SPEC OF JC LLC	MEDICAL SERVICES	51.000 %	49.000 %
2EMMAUS COMM HLTHCR	MEDICAL SERVICES	75.000 %	25.000 %
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2013

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?7 Name, address, primary website address, and state license number									Other (Describe)
1	JOHNSON CITY MEDICAL CENTER 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604	X	X	X	X		X	X	REHABILITATION & MENTAL HEALTH
2	INDIAN PATH MEDICAL CENTER 2000 BROOKSIDE DRIVE KINGSPORT,TN37660	X	X		X			X
3	FRANKLIN WOODS COMMUNITY HOSPITAL 300 MED TECH PARKWAY JOHNSON CITY,TN37604	X	X					X
4	SYCAMORE SHOALS HOSPITAL 1501 W ELK AVENUE ELIZABETHTON,TN37643	X	X					X
5	RUSSELL COUNTY MEDICAL CENTER 58 CARROLL STREET LEBANON,VA24266	X	X					X
6	JOHNSON COUNTY COMMUNITY HOSPITAL 16901 S SHADY STREET MOUNTAIN CITY,TN37683	X				X		X
7	UNICOI COUNTY MEMORIAL HOSPITAL 100 GREENWAY CIRCLE ERWIN,TN37650	X	X					X

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	JOHNSON CITY MEDICAL CENTER
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MSHA.COM/JCMC

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	INDIAN PATH MEDICAL CENTER
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MSHA.COM/IPMC

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	FRANKLIN WOODS COMMUNITY HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MSHA.COM/FWCH

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	SYCAMORE SHOALS HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MSHA.COM/SSH

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	RUSSELL COUNTY MEDICAL CENTER
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MSHA.COM/RCMC

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	JOHNSON COUNTY COMMUNITY HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MSHA.COM/JCCH

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	UNICOI COUNTY MEMORIAL HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MSHA.COM/UCMH

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

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Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

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Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. JCMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, JCMC WAS UNABLE TO ADDRESS ISSUES RELATED TO END-OF-LIFE CARE THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. IPMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, JCMC, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, IPMC WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE AND BEHAVIORAL HEALTH THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN. DUE TO LACK OF RESOURCES, FWCH WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE AND END-OF-LIFE CARE THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. FWCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JCMC, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. SSH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JCMC, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. RCMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE:FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, JCMC, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, RCMC WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE AND CHILD MALNOURISHMENT THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. JCCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JCMC, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, JCCH WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 50% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 3	DURING MAY 2013, THE MSHA STRATEGIC PLANNING DEPARTMENT WITH ASSISTANCE FROM LEADERSHIP OF UCMH, HOSTED A LUNCHEON IN ORDER TO CONNECT WITH COMMUNITY MEMBERS OF UNICOI COUNTY. UCMH'S HOSPITAL ADMINISTRATION IDENTIFIED INDIVIDUALS IN THE COMMUNITY WHO WERE CONSIDERED PUBLIC HEALTH OFFICIALS OR COMMUNITY LEADERS. THE 10 INTERVIEWEES FROM UNICOI COUNTY IN ATTENDANCE WERE A LOCAL PHYSICIAN, REPRESENTATION FROM UNICOI COUNTY SCHOOLS, NON-PROFIT DIRECTORS, HEALTH DEPARTMENT OFFICIALS, MINORITY GROUP LEADERS, AND UCMH LEADERSHIP. THE ORGANIZATIONS THAT WERE REPRESENTED WERE: TELAMON MIGRANT HEAD START; UNICOI COUNTY; UNICOI COUNTY HEALTH DEPARTMENT; UNICOI COUNTY SCHOOLS; UNICOI MEDICAL ASSOCIATES; TOWN OF ERWIN; UNICOI COUNTY CHAMBER OF COMMERCE; UNICOI COUNTY MEMORIAL HOSPITAL; UNICOI COUNTY FAMILY YMCA; AND UNICOI VALLEY INTERNAL MEDICINE.
FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 4	MOUNTAIN STATES HEALTH ALLIANCE ASSISTED UCMH WITH ITS CHNA COMPLETION. THIS TOOK PLACE PRIOR TO UCMH JOINING MSHA. FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 6G: FOUR TOP HEALTH PRIORITIES WERE IDENTIFIED BY UNICOI COUNTY COMMUNITY MEMBERS. THESE PRIORITIES INCLUDE: OBESITY, CANCER, DIABETES, AND HEART DISEASE. BY UTILIZING EFFECTIVE MEASURES, AVAILABLE RESOURCES AND COMMUNITY MEMBER INVOLVEMENT, COUNTY-SPECIFIC PLANS HAVE BEEN DEVELOPED AND IMPLEMENTED WHICH FOCUS ON PREVENTING THE GROWTH OF THE FOUR IDENTIFIED HEALTH OUTCOMES. HOWEVER, IT IS APPARENT THAT IT TAKES MORE THAN JUST RESOURCES AND AN IMPLEMENTATION PLAN TO CHALLENGE THESE HEALTH PRIORITIES. UCMH IS NEVERTHELESS, COMMITTED TO SEEING CHANGE TAKE PLACE WITHIN THE COMMUNITY IT SERVES. THE 10 INTERVIEWEES AGREED ALL OF THE FOUR HEALTH PRIORITIES COULD BE POSITIVELY IMPACTED BY ADDRESSING THE OBESITY ISSUE AS IT IS A HEALTH RISK FACTOR FOR EACH OF THESE DISEASES. THE COMMUNITY MEMBERS WHO WERE SURVEYED PROVIDED HELPFUL IDEAS AS TO HOW TO BEGIN FORMULATING A PLAN TO IMPROVE THE HEALTH PRIORITIES WITHIN THE COMMUNITY. TO ENHANCE EXISTING RESOURCES, THE PARTICIPANTS STRESSED THE SIGNIFICANCE OF INCREASING PUBLIC AWARENESS OF BOTH ADDRESSING ONE'S HEALTH NEEDS AND THE AVAILABILITY OF HEALTH CARE OPTIONS WITHIN THE COUNTY. ADDITIONAL SUGGESTIONS AS TO HOW UCMH CAN IMPROVE THE PREVIOUSLY IDENTIFIED HEALTH PRIORITIES ARE: 1. EDUCATION CLASSES AND EVENTS TO PROVIDE AWARENESS TO THE COMMUNITY CONCERNING HEALTH ISSUES; 2. PROVIDE ACCESS TO A NUTRITIONIST/DIETICIAN; AND 3. EDUCATIONAL CAMPAIGNS TO ENCOURAGE ANNUAL CHECK-UPS WITH YOUR LOCAL PHYSICIAN.
FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?11
Name and address		Type of Facility (describe)
1	JCMC AMBULATORY SURGERY CENTER 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604	LICENSED AMBULATORY SURGERY CENTER
2	MOUNTAIN STATES IMAGING CENTER 301 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604	LICENSED OUTPATIENT DIAGNOSTIC CENTER
3	PRINCETON TRANSITIONAL CARE 401 PRINCETON ROAD JOHNSON CITY,TN37601	LICENSED SKILLED NURSING FACILITY
4	INDIAN PATH TRANSITIONAL CARE 2000 BROOKSIDE DRIVE KINGSPORT,TN37660	LICENSED SKILLED NURSING FACILITY
5	MEDICAL CNTR HOME CARE-JOHNSON CITY 101 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604	LICENSED HOME HEALTH AGENCY
6	MEDICAL CNTR HOME CARE-KINGSPORT 2020 BROOKSIDE DRIVE 28 KINGSPORT,TN37660	LICENSED HOME HEALTH AGENCY
7	RUSSELL CO MEDICAL CNTR HOME HLTH 116 FLANNAGAN AVENUE LEBANON,VA24266	LICENSED HOME HEALTH AGENCY
8	MEDICAL CENTER HOSPICE 101 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604	LICENSED HOSPICE AGENCY
9	JOHNSON COUNTY HOME HEALTH 1987 SOUTH SHADY STREET MOUNTAIN CITY,TN37683	LICENSED HOME HEALTH AGENCY
10	RUSSELL COUNTY MEDICAL CNTR HOSPICE 116 FLANNAGAN AVENUE LABANON,VA24266	LICENSED HOSPICE AGENCY
11	UNICOI COUNTY LONG TERM CARE 100 GREENWAY CIRCLE UNICOI,TN37650	LICENSED LONG TERM CARE FACILITY

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. JCMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, JCMC WAS UNABLE TO ADDRESS ISSUES RELATED TO END-OF-LIFE CARE THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. IPMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, JCMC, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, IPMC WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE AND BEHAVIORAL HEALTH THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN. DUE TO LACK OF RESOURCES, FWCH WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE AND END-OF-LIFE CARE THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. FWCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JCMC, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL.
FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. SSH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JCMC, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL.
FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. RCMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE:FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, JCMC, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, RCMC WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE AND CHILD MALNOURISHMENT THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 3	MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING ALL OF THE HOSPITALS INCLUDED IN THIS 990, WITH THE EXCEPTION OF UNICOI COUNTY MEMORIAL HOSPITAL, WHICH JOINED MSHA DURING THIS FISCAL YEAR) LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY'S IMPLEMENTATION PLAN.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 4	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. JCCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JCMC, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 7	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2012. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, JCCH WAS UNABLE TO ADDRESS ISSUES RELATED TO SUBSTANCE ABUSE/PRESCRIPTION DRUG ABUSE THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 50% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 3	DURING MAY 2013, THE MSHA STRATEGIC PLANNING DEPARTMENT WITH ASSISTANCE FROM LEADERSHIP OF UCMH, HOSTED A LUNCHEON IN ORDER TO CONNECT WITH COMMUNITY MEMBERS OF UNICOI COUNTY. UCMH'S HOSPITAL ADMINISTRATION IDENTIFIED INDIVIDUALS IN THE COMMUNITY WHO WERE CONSIDERED PUBLIC HEALTH OFFICIALS OR COMMUNITY LEADERS. THE 10 INTERVIEWEES FROM UNICOI COUNTY IN ATTENDANCE WERE A LOCAL PHYSICIAN, REPRESENTATION FROM UNICOI COUNTY SCHOOLS, NON-PROFIT DIRECTORS, HEALTH DEPARTMENT OFFICIALS, MINORITY GROUP LEADERS, AND UCMH LEADERSHIP. THE ORGANIZATIONS THAT WERE REPRESENTED WERE: TELAMON MIGRANT HEAD START; UNICOI COUNTY; UNICOI COUNTY HEALTH DEPARTMENT; UNICOI COUNTY SCHOOLS; UNICOI MEDICAL ASSOCIATES; TOWN OF ERWIN; UNICOI COUNTY CHAMBER OF COMMERCE; UNICOI COUNTY MEMORIAL HOSPITAL; UNICOI COUNTY FAMILY YMCA; AND UNICOI VALLEY INTERNAL MEDICINE.
FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 4	MOUNTAIN STATES HEALTH ALLIANCE ASSISTED UCMH WITH ITS CHNA COMPLETION. THIS TOOK PLACE PRIOR TO UCMH JOINING MSHA. FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 6G: FOUR TOP HEALTH PRIORITIES WERE IDENTIFIED BY UNICOI COUNTY COMMUNITY MEMBERS. THESE PRIORITIES INCLUDE: OBESITY, CANCER, DIABETES, AND HEART DISEASE. BY UTILIZING EFFECTIVE MEASURES, AVAILABLE RESOURCES AND COMMUNITY MEMBER INVOLVEMENT, COUNTY-SPECIFIC PLANS HAVE BEEN DEVELOPED AND IMPLEMENTED WHICH FOCUS ON PREVENTING THE GROWTH OF THE FOUR IDENTIFIED HEALTH OUTCOMES. HOWEVER, IT IS APPARENT THAT IT TAKES MORE THAN JUST RESOURCES AND AN IMPLEMENTATION PLAN TO CHALLENGE THESE HEALTH PRIORITIES. UCMH IS NEVERTHELESS, COMMITTED TO SEEING CHANGE TAKE PLACE WITHIN THE COMMUNITY IT SERVES. THE 10 INTERVIEWEES AGREED ALL OF THE FOUR HEALTH PRIORITIES COULD BE POSITIVELY IMPACTED BY ADDRESSING THE OBESITY ISSUE AS IT IS A HEALTH RISK FACTOR FOR EACH OF THESE DISEASES. THE COMMUNITY MEMBERS WHO WERE SURVEYED PROVIDED HELPFUL IDEAS AS TO HOW TO BEGIN FORMULATING A PLAN TO IMPROVE THE HEALTH PRIORITIES WITHIN THE COMMUNITY. TO ENHANCE EXISTING RESOURCES, THE PARTICIPANTS STRESSED THE SIGNIFICANCE OF INCREASING PUBLIC AWARENESS OF BOTH ADDRESSING ONE'S HEALTH NEEDS AND THE AVAILABILITY OF HEALTH CARE OPTIONS WITHIN THE COUNTY. ADDITIONAL SUGGESTIONS AS TO HOW UCMH CAN IMPROVE THE PREVIOUSLY IDENTIFIED HEALTH PRIORITIES ARE: 1. EDUCATION CLASSES AND EVENTS TO PROVIDE AWARENESS TO THE COMMUNITY CONCERNING HEALTH ISSUES; 2. PROVIDE ACCESS TO A NUTRITIONIST/DIETICIAN; AND 3. EDUCATIONAL CAMPAIGNS TO ENCOURAGE ANNUAL CHECK-UPS WITH YOUR LOCAL PHYSICIAN.
FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 20D	UNINSURED PATIENTS RECEIVE A 63% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOTIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.

Schedule H (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number
62-0476282

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) AMERICAN CANCER SOCIETY 250 WILLIAMS STREET NW SUITE 400 ATLANTA,GA30303	13-1788491	501C3	26,774			PROGRAM SUPPORT
(2) AMERICAN HEART ASSOCIATION 208 SUNSET DRIVE JOHNSON CITY,TN37604	13-5613797	501C3	62,500	463	PRINTING	MULTI-EVENT SPONSOR
(3) APPALACHIAN MOUNTAIN PROJECT ACCESS 809 SOUTH ROAN STREET SUITE 4 JOHNSON CITY,TN37601	26-2102040	501C3	116,964			HEALTH ACCESS
(4) BARTER THEATRE PO BOX 867 ABINGDON,VA24212	54-6000120	501C3	18,800			CONTRIBUTION
(5) BOYS & GIRLS CLUB OF KINGSPORT PO BOX 784 213 LEE STREET KINGSPORT,TN37662	62-0481370	501C3	62,000			FITNESS PROGRAMS
(6) EAST TENNESSEE STATE UNIVERSITY PO BOX 70732 JOHNSON CITY,TN37614	62-6021046	501C3	20,000			SUPPORT FIT KIDS
(7) FAMILY PROMISE PO BOX 205 JOHNSON CITY,TN37605	62-1808323	501C3		5,462	PRINTING	NEWSLETTERS
(8) FRIENDS IN NEED HEALTH CENTER 1105 W STONE DRIVE KINGSPORT,TN37660	62-1541637	501C3	10,000	62	PRINTING	DENTAL CARE
(9) GOV'S FNDTN FOR HEALTH & WELLNESS PO BOX 198198 NASHVILLE,TN37219	45-3635908	501C3	25,000			HEALTH INITIATIVE
(10) HANDS ON REGIONAL MUSEUM 315 EAST MAIN STREET JOHNSON CITY,TN37601	62-1282542	501C3	7,500			HEALTH PROGRAM
(11) ISHN CONTRIBUTIONS K-1 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604	62-1711997	501C3	61,028			K-1 P/S CHAR. CONTR.
(12) JC PARKS & RECREATION FOUNDATION 4137 BRISTOL HIGHWAY JOHNSON CITY,TN37601	38-3731893	501C3	5,000	824	PRINTING	SPONSORSHIP
(13) JOHNSON CITY SYMPHONY ORCHESTRA PO BOX 533 JOHNSON CITY,TN37605	62-0910261	501C3		7,246	PRINTING	PRINT PROGRAMS
(14) MARCH OF DIMES PO BOX 799 2700 S ROAN ST 430 JOHNSON CITY,TN37605	13-1846366	501C3	15,000			MARCH FOR BABIES
(15) MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD SUITE 101 JOHNSON CITY,TN37604	58-1418862	501C3	56,390			LOCAL HEALTH PROGRAM
(16) ST MARY'S CATHOLIC CHURCH 2211 EAST LAKEVIEW DRIVE JOHNSON CITY,TN37601	62-0507470	501C3	11,710			CHILDHOOD OBESITY
(17) SYCAMORE SHOALS ST HISTORIC AREA 1651 WEST ELK AVENUE ELIZABETHTON,TN37643	62-6011445	501C3		5,592	PRINTING	2014 EVENT BOOK
(18) TOWN OF JONESBOROUGH 123 BOONE STREET JONESBOROUGH,TN37659	62-6000322	501C3		21,318	PRINTING	VARIOUS PROGRAMS
(19) VIRGINIA HIGHALNDS COMM COLLEGE PO BOX 828 ABINGDON,VA24212	54-1268289	501C3	30,000			NURSING PROGRAM

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2013

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

SCHEDULE I, PAGE 1, PART I, LINE 2

MOST DONATION REQUESTS ARE MADE THROUGH AN APPLICATION PROCESS WHERE THE APPLICANT DESCRIBES HOW THE MONEY WILL BE USED, HOW IT BENEFITS THE COMMUNITY, HOW OUR DONATION WILL CORRELATE WITH HEALTH NEEDS IDENTIFIED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND THE AGREEMENT THAT THE DONEE WILL PROVIDE FOLLOW-UP OF HOW OUR DONATION WAS USED (WHO BENEFITED, ETC.). NOT ALL OF OUR DONATIONS ARE RESTRICTED TO OUR CHNA, BUT MANY ARE. MSHA'S SOCIAL RESPONSIBILITY COMMITTEE REVIEWS MOST DONATION REQUESTS TO DETERMINE WHICH REQUESTS MSHA WILL FUND. THERE ARE MANY FACTORS THAT ARE CONSIDERED DURING THE REVIEW PROCESS BY THE COMMITTEE, SUCH AS OUR BUDGET CONSTRAINTS, IF THE APPLICANT HAS ALREADY RECEIVED A DONATION FROM A MSHA FACILITY, HOW THE REQUESTING ORGANIZATION FITS WITH OUR CHNA, ETC. 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 RESIDENTS IN OUR REGION ALL THE WAY TO COLLEGE AGE STUDENTS (SUCH AS A NURSING PROGRAM). QUALITY OF LIFE: THE ORGANIZATION SUPPORTED 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.

Schedule I (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2013

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)DENNIS VONDERFECHTCEO	(i) (ii)	780,241	236,094	41,860	40,000	28,381	1,126,576
(2)MARVIN EICHORNSENIOR VP/CFO	(i) (ii)	467,818	104,240	54,577	24,139	23,164	673,938
(3)ANN FLEMINGSR. VP	(i) (ii)	383,151	87,911	282,847	55,452	17,959	827,320	242,724
(4)CANDACE JENNINGSSR. VP TN OPERATIONS	(i) (ii)	419,157	85,228	19,144	60,753	25,136	609,418
(5)DAVID NICELYVP/CEO WASHINGTON CO	(i) (ii)	296,697	37,743	8,113	28,014	26,917	397,484
(6)MONTY MCLAURINVP/IPMC CEO	(i) (ii)	263,158	39,707	14,777	28,734	28,417	374,793
(7)TONY BENTONINTERIM CEO WASH. CO	(i) (ii)	239,245	51,354	8,705	16,273	21,351	336,928
(8)SHANE HILTONVP/TN CFO	(i) (ii)	208,263	68,171	10,464	15,045	22,994	324,937
(9)LYNN KRUTAKVP/CORP. CFO	(i) (ii)	220,630	41,691	2,689	17,952	18,493	301,455
(10)PATRICK BOLANDERJCMC CFO	(i) (ii)	182,716	15,905	7,523	3,847	24,205	234,196
(11)STEVE SAWYERIPMC CFO	(i) (ii)	137,425	7,708	8,087	4,278	17,039	174,537
(12)MORRIS SELIGMAN MDSR. VP/CMO	(i) (ii)	429,033	92,121	12,642	58,911	25,792	618,499
(13)BERT SMITH MDVP HOSP. PRGM.	(i) (ii)	305,739	62,736	26,983	4,869	17,499	417,826
(14)DOUGLAS EDEMAVP PRES./CEO MSPG	(i) (ii)	298,019	61,739	32,115	12,398	23,782	428,053
(15)STEVE KILGOREPRESIDENT BRMMC	(i) (ii)	305,723	59,559	11,886	32,848	22,581	432,597
(16)MARK WILKINSONCMO	(i) (ii)	332,573	34,304	4,282	10,940	26,138	408,237
(17)DALE CLAYTOREVP	(i) (ii)	177,276	36,009	20,421	10,636	2,924	247,266
(18)PAT NIDAYFORMER CNO WASH. CO.	(i) (ii)	149,917	24,209	16,920	7,985	31,992	231,023

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PAGE 1, 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.
SCHEDULE J, PAGE 1, PART I, LINE 4	ANN FLEMING 0 39,222 0 CANDACE JENNINGS 0 42,847 0 DAVID NICELY 0 15,208 0 MONTY MCLAURIN 0 13,653 0 MORRIS SELIGMAN, M.D. 0 43,541 0 STEVE KILGORE 0 15,550 0
SCHEDULE J, PART III	THE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA): ANN FLEMING, CANDACE JENNINGS, MONTY MCLAURIN, MORRIS SELIGMAN, DAVID NICELY, AND STEVE KILGORE. 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.

Schedule J (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number
62-0476282

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	HLTH & EDU FACIL BD 2011A&B&C&D OF THE CITY OF JOHNSON CITY TN	62-1464028	478271JS9	10-19-2011	195,840,000	CONSTRUCTION & EQUIP.		X		X		X
B	HLTH & EDU FACIL BD 2010A&B	62-1464028	478271JH3	04-29-2010	205,877,528	PARTIAL REFUNDING		X		X		X
C	HLTH & EDU FACIL BD 2009A&B&C	62-1464028	478271HT9	03-31-2009	124,301,533	CONSTRUCTION & EQUIP.		X		X		X
D	HLTH & EDU FACIL BD 2006A	62-1464028	478271GX1	02-14-2006	178,614,171	CONSTRUCTION & EQUIP.		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	118,910,000		24,545,000		4,970,000		5,295,000
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	195,840,938		206,153,584		125,776,987		185,261,811
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	2,353,905		3,474,644		2,481,706		2,383,533
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	157,897,796				100,727,095		101,295,664
11 Other spent proceeds . . . . . . . . . . . . . .	34,166,505		201,278,521		17,687,636		64,674,434
12 Other unspent proceeds . . . . . . . . . . . . . .	619,419		1,400,419		4,880,548		16,908,180
13 Year of substantial completion . . . . . . . . . . . .	2014				2014		2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X		X			X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X		X	X
16 Has the final allocation of proceeds been made? . . . . . . . .		X		X	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2013

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .
6 Total of lines 4 and 5 . . . . . . . . . . . . .
7 Does the bond issue meet the private security or payment test? . . . . .		X		X		X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .	X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .	X		X			X		X
b Exception to rebate? . . . . . . . .		X		X		X		X
c No rebate due? . . . . . . . .		X		X	X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X	X
b Name of provider . . . . . . . . .	MERRILL LYNCH PIERCE FENNER & SMITH INC						PIERCE FENNER & SMITH INC PIERCE FENNER & SMITH INC
c Term of hedge . . . . . . . . . .	0.200000000000						0.200000000000
d Was the hedge superintegrated? . . . .		X						X
e Was the hedge terminated? . . . . . .		X						X

Schedule K (Form 990) 2013

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X	X
b Name of provider . . . . . . . . .	JP MORGAN CHASE BANK NA						JP MORGAN CHASE BANK NA
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .		X						X
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X	X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION	HLTH & EDU. FACIL. BD. 2011A&B&C&D (LINE A) CONSTRUCT AND EQUIP HOSPITAL FACILITIES,INCLUDING REFINANCING TAXABLE DEBT RELATING THERETO, REFUND BONDS ISSUED 12/01/2001; REFINANCING LOANS AND EQUIPMENT LEASES. HLTH & EDU. FACIL. BD. 2010A&B (LINE B) PARTIAL REFUNDING OF BONDS ISSUED 12/14/2007 (2007A) AND (2007C) AND 2/20/2008 (2008A). HLTH & EDU. FACIL. BD. 2009A&B&C (LINE C) CONSTRUCT AND EQUIP HOSPITAL FACILITIES,INCLUDING REFINANCING OF TAXABLE INDEBTEDNESS RELATING THERETO. HLTH & EDU. FACIL. BD. 2006A (LINE E) CONSTRUCT AND EQUIP HOSPITAL FACILITIES,INCLUDING REFINANCING TAXABLE DEBT RELATING THERETO, AND COST OF INTEREST RATE HEDGE, REFUND BONDS ISSUED 3/28/01, 7/01/03, 7/08/04, 11/23/04, 9/7/05 AND 11/23/05. HLTH & EDU. FACIL. BD. 2012A&B&C (LINE F) CONSTRUCT AND EQUIP SURGERY CENTER AT JCMC; CONSTRUCT AND EQUIP HOSPITAL FACILITIES, INCLUDING REFINANCING OF INDEBTEDNESS RELATING THERETO. HLTH & EDU. FACIL. BD. 2013A&C&D&E (LINE G) CONSTRUCT & EQUIP HOSPITAL FACILITIES, INCLUDING REFINANCING OF INDEBTEDNESS RELATING THERETO, REFUND BONDS ISSUED 2/20/08, 10/19/11 & 9/18/12
SCHEDULE K - DATE REBATE COMPUTATION PERFORMED	HLTH & EDU. FACIL. BD. 2009A&B&C 03/21/14 HLTH & EDU. FACIL. BD. 2006A 02/17/10
SCHEDULE K - ADDITIONAL INFORMATION	HLTH & EDU. FACIL. BD. 2006A SCHEDULE K PART VI: 1.COMMENT ON SCHEDULE K, PART I, LINES A, B, C, E, AND F. MOUNTAIN STATES HEALTH ALLIANCE OWNS AND/OR OPERATES HOSPITALS IN A NUMBER OF DIFFERENT LOCATIONS BOTH IN TENNESSEE AND IN VIRGINIA. AS A RESULT, MSHA MUST UTILIZE CONDUIT GOVERNMENTAL BOND ISSUERS IN A NUMBER OF JURISDICTIONS IN ORDER TO FINANCE IMPROVEMENTS TO ITS HOSPITAL FACILITIES. IN 2009, 2010, 2011, 2012 AND 2013, MSHA 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 A, B, C, E AND F BECAUSE THE BONDS THAT WERE ISSUED WERE PART OF A SINGLE "ISSUE" FOR FEDERAL TAX PURPOSES. 2. COMMENT ON SCHEDULE K, PART II. LINE 3 EACH OF THE LISTED BOND ISSUES DO NOT MATCH THE APPLICABLE ISSUE PRICE BECAUSE OF INTEREST EARNINGS EARNED ON THE SALE PROCEEDS OF EACH BOND SERIES. 3. COMMENT ON SCHEDULE K, PART II, LINES 9 THROUGH 11. THE INSTRUCTIONS ARE UNCLEAR AS TO WHETHER AMOUNTS USED TO REFINANCE SHORT-TERM TAXABLE LOANS INCURRED TO TEMPORARILY FINANCE ELIGIBLE COSTS SHOULD BE SHOWN AS CAPITAL EXPENDITURES AND WORKING CAPITAL (LINES 9 AND 10) OR AS OTHER SPENT PROCEEDS (LINE 11). BASED UPON A REVIEW OF OTHER 990 FILINGS, IT APPEARS THAT MOST REPORTING ENTITIES HAVE LISTED THE APPLICATION OF PROCEEDS FOR SUCH PURPOSE UNDER OTHER SPENT PROCEEDS (LINE 11). THIS FILING TAKES THAT APPROACH. 4. COMMENT ON SCHEDULE K, PART II, LINE 12. IT IS UNCLEAR UNDER THE INSTRUCTIONS WHETHER TRANSFERRED PROCEEDS SHOULD BE TREATED AS OTHER UNSPENT PROCEEDS FOR REPORTING PURPOSES ON LINE 12. AS AN ABUNDANCE OF CAUTION, TRANSFERRED PROCEEDS HAVE BEEN INCLUDED ON LINE 12 FOR EACH ISSUE (BEING THOSE ISSUES LISTED ON LINES A, E AND F UNDER PART I) TO THE EXTENT APPLICABLE. ALSO, DURING ITS 2013 FISCAL YEAR, MSHA WAS ABLE TO REMOVE THE REQUIREMENT THAT CERTAIN DEBT SERVICE RESERVE FUNDS BE MAINTAINED. AS A RESULT, MSHA WAS ABLE TO TRANSFER PROCEEDS FROM DEBT SERVICE RESERVE FUNDS FOR CERTAIN ISSUES TO BOND SINKING FUNDS FOR THOSE ISSUES TO PAY PRINCIPAL ON THE ISSUE AND TO REDUCE THE AMOUNT OF TAX-EXEMPT BONDS OUTSTANDING IN THE MARKET. AS A RESULT, UNSPENT PROCEEDS HAVE INCREASED FOR CERTAIN ISSUES WHILE SUCH FUNDS ARE HELD IN THE BOND SINKING FUNDS, AND THE AMOUNTS PREVIOUSLY HELD IN DEBT SERVICE RESERVE FUNDS FOR SUCH ISSUES HAVE BEEN REDUCED. MSHA IS USING SUCH PROCEEDS TO PAY PRINCIPAL AS QUICKLY ON THOSE ISSUES AS THE BOND DOCUMENTS PERMIT. 5. COMMENT ON SCHEDULE K, PART IV, LINE 1. PRIOR TO JUNE 30, 2014, THE REPORTING DATE OF THE 990, THE ONLY ARBITRAGE REBATE CALCULATIONS THAT WERE REQUIRED RELATED TO THE BONDS DESCRIBED IN LINES C AND D OF PART I (THE SERIES 2006 AND 2009 BONDS). MSHA 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 THOSE BOND ISSUES. 6. COMMENT ON SCHEDULE K, PART IV, LINE 5D. PART IV, LINE 5D RELATIVE TO THE BOND ISSUE DESCRIBED ON LINE D SHOWS THAT THE REGULATORY SAFE HARBOR FOR ESTABLISHING FAIR MARKET VALUE OF THE GIC DESCRIBED IN LINE 5A WAS NOT SATISFIED. DUE TO MARKET CONDITIONS AT THE TIME, MSHA 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. 7. COMMENT ON SCHEDULE K, PART IV, LINE 6. THE BOND ISSUES DESCRIBED IN LINES A, B, C, E AND F OF PART I HAVE TRANSFERRED PROCEEDS OF PRIOR BOND ISSUES THAT FINANCED SIGNIFICANT CAPITAL IMPROVEMENTS TO HOSPITAL FACILITIES OR PROCEEDS THAT ARE TO BE USED FOR SUCH PURPOSES. THERE HAVE BEEN UNEXPECTED DELAYS IN THE CONSTRUCTION AND EQUIPPING OF CERTAIN OF THESE HOSPITAL FACILITIES, AND THEREFORE NOT ALL OF SUCH PROCEEDS WERE SPENT WITHIN THE THREE-YEAR TEMPORARY PERIOD RELATIVE TO CONSTRUCTION PROJECTS. HOWEVER, MSHA 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. ALSO, THE PROCEEDS HELD IN THE BOND SINKING FUNDS AS DESCRIBED IN COMMENT 4 ABOVE ARE NO LONGER ELIGIBLE FOR ANY TEMPORARY PERIOD AND WILL BE INVESTED AT A RESTRICTED YIELD OR WILL BE SUBJECT TO A YIELD REDUCTION PAYMENT.

Schedule K (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) DENNIS VONDERFECHT		SPLIT LIFE INSUR.LOAN,INCL.PR.YRS		X	7,205,125	7,395,295		No	Yes		Yes
(2) MARVIN EICHORN		SPLIT DOLLAR LIFE INSURANCE LOAN		X	700,000	710,710		No	Yes		Yes
(3) MARVIN EICHORN		SPLIT DOLLAR LIFE INSURANCE LOAN		X	304,332	304,332		No	Yes		Yes
(4) MARVIN EICHORN		SPLIT LIFE INSUR.LOAN,INCL.PR.YRS		X	296,183	296,183		No	Yes		Yes
(5) MARVIN EICHORN		SPLIT DOLLAR LIFE INSURANCE LOAN		X	183,364	282,454		No	Yes		Yes

Total ...... $						8,988,974

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2013

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) WATAUGA PATHOLOGY ASSOC PC	M.D. SERVICES	410,197	SEE PART V		No
(2) PULMONARY ASSOCIATES OF EAST TENN	M.D. SERVICES	42,125	SEE PART V		No
(3) WORKSPACE INTERIORS INC	VENDOR	1,205,384	SEE PART V		No
(4) MATTHEW MARTIN	FAMILY MEMBER	27,783	SEE PART V		No
(5) MITCH HATHAWAY	FAMILY MEMBER	97,491	SEE PART V		No
(6) SYCAMORE SHOALS ANESTHESIA ASSOC	M.D. SERVICES	819,996	SEE PART V		No
(7) CLEM WILKES III	FAMILY MEMBER	71,145	SEE PART V		No
(8) PAULA CLAYTORE	FAMILY MEMBER	270,782	SEE PART V		No
(9) JAMES TEIXEIRA	FAMILY MEMBER	77,016	SEE PART V		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

SCHEDULE L, PART V

(1) SANDRA BROOKS, M.D., MSHA BOARD MEMBER, IS A PARTNER WITH OWNERSHIP INTEREST IN WATAUGA PATHOLOGY ASSOCIATES, P.C., WATAUGA PATHOLOGY ASSOCIATES, P.C. PROVIDES MEDICAL SERVICES TO MSHA. (2) DR. JEFF FARROW, MSHA BOARD MEMBER, IS A KEY EMPLOYEE OF PULMONARY ASSOCIATES OF EAST TENNESSEE P.C. AND HAS AN OWNERSHIP IN THE PROFESSIONAL CORPORATION. PULMONARY ASSOCIATES OF EAST TENNESSEE P.C. PROVIDES MEDICAL SERVICES TO MSHA. (3) ROBERT FEATHERS, PAST CHAIR OF THE MSHA BOARD OF DIRECTORS, IS OWNER OF WORKSPACE INTERIORS,INC. WHICH PROVIDES COMMERCIAL FURNISHINGS AND DESIGN SERVICES TO MSHA. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH. (4) JOANNE GILMER, VICE CHAIR OF THE MSHA BOARD OF DIRECTORS, IS A FAMILY MEMBER OF MATTHEW MARTIN, AN EMPLOYEE OF MSHA. (5) JOANNE GILMER, VICE CHAIR OF THE MSHA BOARD OF DIRECTORS, IS A FAMILY MEMBER OF MITCH HATHAWAY, AN EMPLOYEE OF MSHA. (6) DR. DAVID MAY, MSHA BOARD MEMBER, SERVES AS BOARD CHAIR FOR SYCAMORE SHOALS ANESTHESIA ASSOCIATES, P.C., AND HAS AN OWNERSHIP SHARE IN THE PROFESSIONAL CORPORATION. SYCAMORE SHOALS ANESTHESIA ASSOCIATES, P.C. PROVIDES MEDICAL SERVICES TO MSHA. (7) CLEM WILKES, JR., CHAIR OF THE MSHA BOARD OF DIRECTORS, IS A FAMILY MEMBER OF CLEM WILKES III, AN EMPLOYEE OF MSHA. (8) DALE CLAYTORE, FORMER KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF PAULA CLAYTORE, AN EMPLOYEE OF MSHA. (9) PAT NIDAY, FORMER KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF JAMES TEIXEIRA, AN EMPLOYEE OF MSHA.

Schedule L (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Return Reference	Explanation
FORM 990, PAGE 1, ITEM C	NISWONGER CHILDREN'S HOSPITAL; QUILLEN REHABILITATION HOSPITAL; FRANKLIN WOODS COMMUNITY HOSPITAL; INDIAN PATH MEDICAL CENTER; SYCAMORE SHOALS HOSPITAL; WOODRIDGE HOSPITAL FOR BEHAVIORAL HEALTH SERVICES; JOHNSON COUNTY COMMUNITY HOSPITAL; RUSSELL COUNTY MEDICAL CENTER; UNICOI COUNTY MEMORIAL HOSPITAL
FORM 990 - ORGANIZATION'S MISSION	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. SEE ATTACHED NARRATIVE-PROGRAM SERVICE ACCOMPLISHMENTS.
FORM 990, PAGE 6, PART VI, LINE 11B	THE CFO AND SENIOR VP REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING AND THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW.
FORM 990, PAGE 6, PART VI, LINE 12C	ANNUALLY, THE CORPORATE AUDIT AND COMPLIANCE DEPARTMENT OF MSHA FORWARDS THE CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO ALL MSHA MANAGEMENT TEAM MEMBERS AND BOARD MEMBERS. EMPLOYEES AND BOARD MEMBERS MUST NOTE ANY CONFLICTS OR ATTEST THEY HAVE "NONE", AND RETURN THE FORM TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED 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, PAGE 6, PART VI, LINE 15A	THE CEO'S COMPENSATION AND BENEFITS ARE SUBJECT TO THE EXECUTIVE COMPENSATION POLICY OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE POLICY WAS ESTABLISHED BY MSHA'S BOARD OF DIRECTORS AND IS ALLIGNED WITH THE MSHA MISSION, VISION, AND VALUES, SUPPORTING THE ACHIEVEMENT OF THE HEALTH SYSTEM'S STRATEGIC PLANS AND ANNUAL GOALS AND OBJECTIVES. THE POLICY ENSURES THAT MSHA'S EXECUTIVE COMPENSATION IS COMPLIANT WITH THE LEGAL, REGULATORY, AND STATUTORY ENVIRONMENT AFFECTING COMPENSATION. MSHA'S PRESIDENT AND CEO MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE OF THE MSHA BOARD FOR ALL ELEMENTS OF COMPENSATION FOR THE SENIOR MANAGEMENT TEAM. THE BOARD OF DIRECTORS MONITORS THE PERFORMANCE OF THE SENIOR MANAGEMENT TEAM ON AN ONGOING BASIS, BUT AT LEAST ANNUALLY.
FORM 990, PAGE 6, PART VI, LINE 15B	SIMILAR TO THE CEO'S COMPENSATION, THE CFO RECEIVES COMPENSATION AND BENEFITS THAT COMPLY WITH MSHA'S SALARY POLICY. HIS PAY IS SET AT A MARKET PERCENTILE SPECIFIC TO HIS POSITION.
FORM 990, PAGE 6, PART VI, 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 BASIS.
FORM 990, PAGE 7, PART VII	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. DR. DOUGLAS EDEMA AND STEVE KILGORE, REPORTABLE AS HIGHEST COMPENSATED EMPLOYEES, ARE PAID BY MSHA AND THEIR SALARY AND BENEFITS ARE FULLY REIMBURSED TO MSHA BY BRMMC. CERTAIN EXECUTIVES OF THE ORGANIZATION, SUCH AS THE CEO AND SR VP/CFO, PROVIDE SERVICES TO SOME OR ALL OF THE ORGANIZATIONS RELATED TO MSHA.
FORM 990, PART IX, LINE 11G	PHYSICIAN FEES 24,631,544 0 0 DIETARY SERVICES 8,064,179 0 0 CONSULTING SERVICES 0 5,006,726 0 ENVIRONMENTAL SERVICES 4,346,007 0 0 LAUNDRY SERVICES 3,904,673 0 0 COLLECTION SERVICES 3,436,975 0 0 RETAIL PHARMACY 2,590,687 0 0 LABORATORY SERVICES 2,442,224 0 0 CONTRACT LABOR 1,797,398 0 0 PATIENT RESOURCE SERVICES 1,147,985 0 0 TRANSCRIPTION SERVICES 995,139 0 0 PHYSICIAN LOAN FORGIVENESS 656,530 0 0 OTHER FEES 29,174,476 5,664,127 6,237
FORM 990, PART XI, LINE 9	PARTNERSHIP CHARITABLE CONTRIBUTION NOT ON BOOKS 61,028 PARTNERSHIP GAIN NOT ON BOOKS -108,586 CHANGE IN FAIR VALUE OF DERIVATIVES -2,789,699 P/S ORDINARY INCOME/LOSS-NOT ON BOOKS -3,485,375 P/S INTEREST INCOME-NOT ON BOOKS -16,033 TRSFR OF UCMH INVSTMT. TO BRMMC -36,795 TEMPORARILY RESTRICTED GRANTS -61,035 TOTAL TO FORM 990, PART XI, LINE 9 -6,314,425

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE

Employer identification number

62-0476282

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) DICKENSON COMMUNITY HOSPITAL ONE HOSPITAL DRIVE CLINTWOOD,VA24228 77-0599553	HOSPITAL	VA	501C3	3	NCH		No
(2) MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD STE 101 JOHNSON CITY,TN37604 58-1418862	FUNDRAISER	TN	501C3	11A	MSHA		No
(3) MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604 58-1418345	SUPPORT	TN	501C3	11A	MSHA		No
(4) SMYTH COUNTY COMMUNITY HOSPITAL 245 MEDICAL PARK DRIVE MARION,VA24354 54-0794913	HOSPITAL	VA	501C3	3	MSHA		No
(5) NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON,VA24273 54-0566029	HOSPITAL	VA	501C3	3	NA		No
(6) JOHNSTON MEMORIAL HOSPITAL 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 54-0544705	HOSPITAL	VA	501C3	3	NA		No
(7) ABINGDON PHYSICIAN PARTNERS 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 20-5485346	MED. SERV.	VA	501C3	11A	JMH		No
(8) APPALACHIAN EMERGENCY PHYSICIANS 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY,TN37604 80-0592504	MED. SERV	VA	501C3	11A	NA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) INTEGRATED SOLUTIONS HEALTH NETWORK 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1711997	INVESTMENT	TN	MSHA	EXCLUDED	2,122,481	12,484,859		No			No	99.830 %
(2) EMMAUS COMMUNITY HEALTHCARE LLC 6070 HWY 11E PINEY FLATS,TN37686 20-0577483	MED. SERV.	TN	BRMMC BRMMC					No			No
(3) MEDICAL SPECIALISTS OF JC LLC 2528 WESLEY STREET SUITE 2 JOHNSON CITY,TN37601 27-2199037	MED. SERV.	TN	MSHA	EXCLUDED	-213,548	298,823		No			No	51.000 %
(4) EAST TN AMBULATORY SURGERY CNTR 701 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1787537	MED. SERV.	TN	BRMMC					No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) BLUE RIDGE MEDICAL MANAGEMENT CORP 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY,TN37604 62-1490616	MED. SERV.	TN	MSHA	C CORP	111,802,020	234,434,921	100.000 %		No
(2) MEDISERVE MEDICAL EQUIPMENT 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1212286	DME	TN	BRMMC	C CORP	4,499,229	4,640,641	100.000 %		No
(3) MOUNTAIN STATES PROPERTIES 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1845895	PROP. MGMT	TN	BRMMC	C CORP	14,098,045	147,365,408	100.000 %		No
(4) MOUNTAIN STATES PHYSICIAN GROUP 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1700412	MED. SERV.	TN	BRMMC	C CORP	64,194,747	7,270,764	100.000 %		No
(5) COMMUNITY HOME CARE INC 1460 PARK AVENUE NORTON,VA24273 54-1453810	DME	VA	NCH	C CORP	391,958	495,203	50.100 %		No
(6) SOUTHWEST COMMUNITY HEALTH SERV PO BOX 880 MARION,VA24354 54-1460695	MED. SERV.	VA	SCCH	C CORP	76,200	592,392	80.000 %		No
(7) WILSON PHARMACY INC PO BOX 5289 JOHNSON CITY,TN37604 62-0329587	PHARMACY	TN	BRMMC	C CORP	4,350,967	5,666,405	100.000 %		No
(8) CRESTPOINT HEALTH INSURANCE COMPANY 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-0381170	INSURANCE	TN	ISHN	C CORP	4,906,389	7,945,232	99.830 %		No

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved
(1) MSHA AUXILIARY	P	104,826
(2) MSHA AUXILIARY	Q	859,493
(3) BLUE RIDGE MEDICAL MANAGMENT CORP	A	76,703
(4) BLUE RIDGE MEDICAL MANAGMENT CORP	G	120,724
(5) BLUE RIDGE MEDICAL MANAGMENT CORP	H	272,220
(6) BLUE RIDGE MEDICAL MANAGMENT CORP	L	419,838
(7) BLUE RIDGE MEDICAL MANAGEMENT CORP	M	31,202,130
(8) BLUE RIDGE MEDICAL MANAGEMENT CORP	O	265,230
(9) BLUE RIDGE MEDICAL MANAGEMENT CORP	P	3,839,569
(10) BLUE RIDGE MEDICAL MANAGEMENT CORP	Q	22,395,030
(11) HEALTHPLUS	G	3,632,525
(12) HEALTHPLUS	J	52,387
(13) HEALTHPLUS	L	181,190
(14) HEALTHPLUS	M	546,218
(15) HEALTHPLUS	P	75,640
(16) HEALTHPLUS	Q	12,552,650
(17) HEALTHPLUS	S	803,018
(18) MEDISERVE	K	220,973
(19) MEDISERVE	L	148,129
(20) MEDISERVE	P	214,778
(21) MEDISERVE	Q	3,382,559
(22) MOUNTAIN STATES PROPERTIES	G	2,211,449
(23) MOUNTAIN STATES PROPERTIES	K	1,087,854
(24) MOUNTAIN STATES PROPERTIES	L	315,609
(25) MOUNTAIN STATES PROPERTIES	O	254,250
(26) MOUNTAIN STATES PROPERTIES	P	157,048
(27) MOUNTAIN STATES PROPERTIES	Q	5,467,192
(28) MOUNTAIN STATES PROPERTIES	R	531,453
(29) MOUNTAIN STATES FOUNDATION	B	56,390
(30) MOUNTAIN STATES FOUNDATION	C	3,510,166
(31) NORTON COMMUNITY HOSPITAL	D	21,242,680
(32) NORTON COMMUNITY HOSPITAL	L	5,607,930
(33) NORTON COMMUNITY HOSPITAL	O	1,069,529
(34) NORTON COMMUNITY HOSPITAL	P	175,984
(35) NORTON COMMUNITY HOSPITAL	Q	4,477,436
(36) DICKENSON COMMUNITY HOSPITAL	L	834,997
(37) ISHN	A	21,781
(38) ISHN	B	11,181,720
(39) ISHN	L	297,641
(40) ISHN	M	3,470,413
(41) ISHN	O	76,381
(42) ISHN	Q	6,758,215
(43) SMYTH COUNTY COMMUNITY HOSPITAL	D	14,744,509
(44) SMYTH COUNTY COMMUNITY HOSPITAL	L	4,388,161
(45) SMYTH COUNTY COMMUNITY HOSPITAL	Q	50,381
(46) JOHNSTON MEMORIAL HOSPITAL	L	11,025,472
(47) JOHNSTON MEMORIAL HOSPTIAL	O	871,908
(48) JOHNSTON MEMORIAL HOSPITAL	P	57,248
(49) JOHNSTON MEMORIAL HOSPITAL	R	180,921
(50) APP	M	1,171,864

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most 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. SEE ATTACHED NARRATIVE-PROGRAM SERVICE ACCOMPLISHMENTS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	8,659
6	Total number of volunteers (estimate if necessary) .............	6	2,619
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	916,236
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	222,370

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,474,339	4,260,554
9	Program service revenue (Part VIII, line 2g) .........	674,372,724	670,231,172
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	31,675,503	28,617,401
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	9,360,388	4,204,431
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	717,882,954	707,313,558
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	405,051	705,491
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	305,057,437	295,522,740
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,088,082
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	376,841,250	378,145,629
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	682,303,738	674,373,860
19	Revenue less expenses. Subtract line 18 from line 12.......	35,579,216	32,939,698
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,599,476,991	1,603,260,990
21	Total liabilities (Part X, line 26).............	1,201,894,828	1,166,845,910
22	Net assets or fund balances. Subtract line 21 from line 20.....	397,582,163	436,415,080

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 552,836,339 including grants of $ 705,491 ) (Revenue $ 675,626,593 )
	SEE ATTACHED DOCUMENT: MSHA - PROGRAM SERVICE ACCOMPLISHMENTS FOR GUIDESTAR READERS, OUR PROGRAM SERVICE ACCOMPLISHMENTS MAY BE FOUND AT THE END.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses552,836,339

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	7,364,080	475	837,838

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		3,515,325
e	Government grants (contributions)1e		667,665

f	All other contributions, gifts, grants, and similar amounts not included above1f		77,564

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			4,260,554
			Business Code
2a	PATIENT REVENUE-OTHER		622110	648,737,836	648,737,836
b	WELLNESS PROGRAMS		622110	18,193,332	18,193,332
c	P/S INCOME PREMIER-ISHN-MSJC		900099	3,107,986	3,136,588	-28,602
d	LAB UBI REVENUE		621500	177,267		177,267
e	RENTAL TO EXEMPT AFFILIATE		531120	14,751	14,751
f	All other program service revenue .
g	Total. Add lines 2a–2f........			670,231,172
3	Investment income (including dividends, interest, and other similar amounts).......			13,157,320		21,781	13,135,539
4	Income from investment of tax-exempt bond proceeds..			227,071			227,071
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	213,236
b	Less: rental expenses	83,196
c	Rental income or (loss)	130,040
d	Net rental income or (loss).......			130,040		42,772	87,268
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	9,837,589	5,517,039
b	Less: cost or other basis and sales expenses		121,618
c	Gain or (loss)	9,837,589	5,395,421
d	Net gain or (loss)..........			15,233,010	5,395,421		9,837,589
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	CAFE' SALES		722210	3,943,462			3,943,462
b	PREMIER IPO VENDOR INCENTIVE		900099	2,202,302			2,202,302
c	DAY CARE		624410	1,080,183			1,080,183
d	All other revenue ....			-3,151,556		703,018	-3,854,574
e	Total. Add lines 11a–11d ......			4,074,391
12	Total revenue. See Instructions......			707,313,558	675,477,928	916,236	26,658,840


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............				1
2	Savings and temporary cash investments .........			53,114,956	2	78,251,832
3	Pledges and grants receivable, net ...........			96,609	3	99,629
4	Accounts receivable, net .............			117,265,071	4	111,736,791
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				8,492,454	5	8,988,974
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............			17,189,476	7	29,866,592
8	Inventories for sale or use ..............			15,873,411	8	15,723,351
9	Prepaid expenses and deferred charges ..........			4,850,577	9	4,344,835
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,043,477,462
b	Less: accumulated depreciation .....	10b	516,925,448	517,908,210	10c	526,552,014
11	Investments—publicly traded securities ..........			285,653,065	11	261,766,810
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....			313,693,918	13	324,481,069
14	Intangible assets ...............			144,707,541	14	144,707,541
15	Other assets. See Part IV, line 11 ...........			120,631,703	15	96,741,552
16	Total assets. Add lines 1 through 15 (must equal line 34)......			1,599,476,991	16	1,603,260,990
17	Accounts payable and accrued expenses .........			69,022,047	17	63,659,832
18	Grants payable .................				18
19	Deferred revenue ................			2,130,026	19	1,273,627
20	Tax-exempt bond liabilities .............			882,984,693	20	981,126,646
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			145,411,405	23	25,846,994
24	Unsecured notes and loans payable to unrelated third parties ....			2,319,713	24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			100,026,944	25	94,938,811
26	Total liabilities. Add lines 17 through 25.........			1,201,894,828	26	1,166,845,910
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			397,408,151	27	436,180,033
28	Temporarily restricted net assets ...........			174,012	28	235,047
29	Permanently restricted net assets ...........				29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			397,582,163	33	436,415,080
34	Total liabilities and net assets/fund balances ........			1,599,476,991	34	1,603,260,990