Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 07-01-2013 , 2013, and ending 06-30-2014
BCheck if applicable:
CName of organization
JOHNSTON MEMORIAL HOSPITAL INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
16000 JOHNSTON MEMORIAL DR
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ABINGDON, VA24211
D Employer identification number

54-0544705
E Telephone number

G Gross receipts $ 128,796,681
F Name and address of principal officer:
SEAN MCMURRAY
16000 JOHNSTON MEMORIAL DR
ABINGDON,VA24211
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
HTTP://WWW.MSHA.COM/JMH
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1917
M State of legal domicile: VA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: JOHNSTON MEMORIAL HOSPITAL (JMH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 242
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 132,455
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 23,485
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 54,039 101,108
9 Program service revenue (Part VIII, line 2g) ......... 126,824,002 119,469,249
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,913,544 7,163,382
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,570,450 1,472,331
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 134,362,035 128,206,070
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 116,677 280,949
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) 53,104,147 49,011,100
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 63,865,533 69,605,077
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 117,086,357 118,897,126
19 Revenue less expenses. Subtract line 18 from line 12....... 17,275,678 9,308,944
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 323,314,314 335,681,718
21 Total liabilities (Part X, line 26)............. 53,919,883 54,271,755
22 Net assets or fund balances. Subtract line 21 from line 20..... 269,394,431 281,409,963
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: JOHNSTON MEMORIAL HOSPITAL (JMH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 92,403,416 including grants of $ 280,949 ) (Revenue $ 120,090,523 )
JOHNSTON MEMORIAL HOSPITAL, INC. (JMH) IS A 116-BED NOT-FOR-PROFIT HOSPITAL LOCATED IN ABINGDON, VIRGINIA AND A MEMBER OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA). JMH IS THE SOLE MEMBER OF ABINGDON PHYSICIAN PARTNERS, A TAX EXEMPT ORGANIZATION, ORGANIZED TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF THE HOSPITAL. DURING 2013, JMH CREATED JMH EMERGENCY PHYSICIANS, ORGANIZED TO PROVIDE EMERGENCY ROOM PHYSICIANS FOR THE HOSPITAL. (CONTINUED ON SCHEDULE O) JMH OFFERS A FULL ARRAY OF MEDICAL SERVICES THROUGH HIGHLY TRAINED PHYSICIANS AND SUPPORT STAFF, PROUDLY SERVING SOUTHWEST VIRGINIA SINCE 1917. OUR GOAL IS TO BE A LEADER IN IMPROVING THE HEALTH AND QUALITY OF LIFE IN THE COMMUNITY, BY WORKING TOGETHER AS A TEAM DEDICATED TO EXCELLENCE. DURING FY14, WE EXPERIENCED 7,109 ADMISSIONS, WITH ALMOST 24,000 PATIENT DAYS. THERE WERE AN ADDITIONAL 4,760 OBSERVATION DAYS. OUR OUTPATIENT VISITS WERE JUST UNDER 146,000. THERE WERE 39,161 VISITS TO OUR EMERGENCY DEPARTMENT, WITH 5,403 RESULTING IN AN INPATIENT STAY. ALMOST 6,900 SURGERIES WERE PERFORMED DURING THE YEAR AND WE DELIVERED 752 BABIES. DURING FY14, JMH IMPLEMENTED AN ONLINE TOOL CALLED OWL (ONLINE WELLNESS LINK). OWL PROVIDES INPATIENTS WITH BETTER ACCESS TO THEIR HEALTH CARE INFORMATION SO THEY CAN VIEW A PORTION OF THEIR HEALTH RECORD ONLINE, INCLUDING: - A CONTINUITY OF CARE DOCUMENT WHICH PROVIDES A SUMMARY OF THE HOSPITAL VISIT - CURRENT MEDICATIONS - ALLERGIES AND ADVERSE REACTIONS - PAST MEDICAL HISTORY - CERTAIN LABORATORY AND RADIOLOGY RESULTS THE OWL PORTAL ALSO ALLOWS JMH CAREGIVERS TO EXCHANGE HEALTHCARE INFORMATION, WHICH HAS LED TO SAFER, MORE QUALTIY-ORIENTED AND STREAMLINED CARE FOR OUR PATIENTS. JMH SIGNED A NON-PROFIT BLOOD CENTER TENANT TO A ONE YEAR LEASE FOR ONLY 1. THE ANNUAL FAIR MARKET VALUE OF THE LEASE IS 32,770. THE FMV FOR THE EIGHT MONTHS FALLING WITHIN FY14 IS 21,846. BLOOD ASSURANCE IS A NON-PROFIT FULL SERVICE REGIONAL BLOOD CENTER SERVING 51 COUNTIES AND MORE THAN 70 HEALTHCARE FACILITIES IN VIRGINIA, TENNESSEE, NORTH CAROLINA, ALABAMA, AND GEORGIA. THE MISSION OF BLOOD ASSURANCE IS TO PROVIDE A SAFE AND ADEQUATE SUPPLY OF BLOOD AND BLOOD COMPONENTS IN A COST EFFECTIVE MANNER TO EVERY AREA PATIENT IN NEED. JMH IS COMMITTED TO PROVIDING COMPREHENSIVE MEDICAL EDUCATION TO AID IN PATIENT RECOVERY AND DISEASE MANAGEMENT. WE OFFER MANY CLASSES AND SUPPORT GROUPS, SUCH AS: CPR AND LIFE SAVING CLASSES; CARDIAC CARE; TOTAL JOINT; CANCER EDUCATION; PRENATAL PARENTING; AND, OTHERS. THE JMH CENTER FOR COMPREHENSIVE WOUND CARE IS ONE OF ONLY A FEW FACILITIES IN THE REGION THAT OFFERS HYPERBARIC OXYGEN THERAPY-THE DELIVERY OF OXYGEN AT LEVELS HIGHER THAN ATMOSPHERIC PRESSURE IN A CHAMBER SETTING THAT STIMULATES THE HEALING PROCESS. OUR TRAINED STAFF FOLLOW A TEAM APPROACH TO WOUND HEALING. AFTER AN INITIAL EVALUATION, EACH PATIENT RECEIVES A COMPREHENSIVE INDIVIDUALIZED PLAN DESIGNED TO HELP DIFFICULT-TO-HEAL WOUNDS. JMH STAFF STRIVE TO ADDRESS THE UNDERLYING CAUSE OF THE PROBLEM, CONTROL INFECTION, AND IMPROVE THE OVERALL HEALTH OF OUR PATIENTS. THE JMH DIABETES EDUCATION CENTER HAS ASSISTED PATIENTS IN DIABETES CARE SINCE 1999. DR. ANDREW RHINEHART, DIRECTOR OF THE CENTER, WAS AWARDED RECOGNITION, BY THE PRESTIGIOUS NATIONAL COMMITTEE FOR QUALITY ASSURANCE DIABETES RECOGNITION PROGRAM, A PRIVATE, NONPROFIT ORGANIZATION DEDICATED TO IMPROVING HEALTH CARE QUALITY. DR. RHINEHART IS BOARD-CERTIFIED IN ADVANCED DIABETES MANAGEMENT AND WAS THE FIRST PHYSICIAN IN THE U.S. TO GAIN THESE CREDENTIALS. HE BECAME ONE OF THE FIRST PHYSICIANS TO EARN DISTINCTION AS A CERTIFIED DIABETES TECHNOLOGY CLINICIAN, THE HIGHEST PROFESSIONAL CREDENTIAL THAT RECOGNIZES A PHYSICIAN AS AN EXPERT IN USING TECHNOLOGY TO MANAGE DIABETES. A STAFF OF CERTIFIED DIABETES EDUCATORS ASSISTS HIM AT THE DIABETES CARE CENTER. MOUNTAIN STATES REHABILITATION AT JMH HAS BEEN AWARDED AN OUTCOMES EXCELLENCE CERTIFICATE FROM FOCUS ON THERAPEUTIC OUTCOMES, INC. (FOTO), A NATIONWIDE OUTCOMES DATABASE AND REPORTING SERVICE FOR HEALTHCARE PROVIDERS ACROSS THE COUNTRY TO RECOGNIZE EXCELLENCE IN PATIENT OUTCOMES SUSTAINED OVER TIME. NATIONALLY, ONLY ABOUT 12 PERCENT OF NEARLY 3,000 ELIGIBLE CLINICS RECEIVED THIS AWARD OVER THE LAST YEAR. JMH RANKS HIGH COMPARED TO OTHER CLINICS IN THE FOTO NETOWRK WITH ITS PATIENTS ACHIEVING SIGNIFICANTLY HIGHER FUNCTIONAL IMPROVEMENTS, IN FEWER VISITS, AND WITH HIGHER PATIENT SATISFACTION. JMH HAS USED FOTO SINCE 2010 AS A WAY TO OBJECTIVELY TRACK PATIENTS' FUNCTIONAL OUTCOMES. PARTICIPATING IN THIS NATION-WIDE SYSTEM IS ANOTHER EXAMPLE OF JMH'S COMMITMENT TO PROVIDING EFFICIENT AND OUTSTANDING PATIENT CARE. FOTO HAS THE FIRST FUNCTIONAL HEALTH STATUS MEASURE APPROVED FOR PHYSICAL REHABILITATION BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES' LIST OF APPROVED QUALITY MEASURES IN NATIONAL QUALITY MEASURES CLEARINGHOUSE. THE HEAL (HEALTHLY EATING ACTIVE LIVING) APPALACHIA PROGRAM, WHICH BATTLES CHILDHOOD OBESITY IN OUR REGION, WAS SELECTED AS A 2014 INDUCTEE INTO THE FIRST LADY OF VIRGINIA'S OPPORTUNITY HALL OF FAME. THIS HONOR RELATES TO HEAL APPALACHIA'S WORK IN SOUTHWEST VIRGINIA. HEAL APPALACHIA IS A COLLABORATIVE EFFORT OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA) AND EAST TENNESSEE STATE UNIVERSITY. IT WAS CREATED TO BUILD MOMENTUM IN THE FIGHT AGAINST CHILDHOOD OBESITY IN SOUTHERN APPALACHIA. JMH SUPPORTS OTHER LOCAL NON-PROFIT ORGANIZATIONS THAT PROVIDE HEALTHCARE SERVICES TO OUR RESIDENTS. WE DONATE MEDICATIONS AND SUPPLIES TO AREA RESCUE SQUADS AND FIRE DEPARTMENTS. THESE DRUG AND SUPPLY DONATIONS EXCEEDED 13,000 IN FY14. WE PROVIDED FINANCIAL ASSISTANCE TO A LOCAL COLLEGE FOR ITS NURSING PROGRAM. DURING FY14, WE CONTRIBUTED OVER 75,000 TO THE PROGRAM. MANY OTHER DONATIONS WERE MADE TO SUPPORT OUR SCHOOLS, MARCH OF DIMES, ETC. WITH HEALTHCARE INSURANCE COVERAGE CHANGING RAPIDLY, PATIENT PAYMENT RESPONSIBILTY IS INCREASING AT A RATE OF 5 TO 6 PERCENT EACH YEAR. MOUNTAIN STATES INTRODUCED A NEW PAYMENT OPTION LAST YEAR THAT OFFERS MORE FLEXIBILITY TO OUR PATIENTS - THE ABILITY TO SPREAD PAYMENTS OVER A 36-MONTH PERIOD WITH NO INTEREST CHARGED. OF COURSE, FOR PATIENTS THAT ARE UNABLE TO PAY THEIR ACCOUNT BALANCES, PATIENT RESPRESENTATIVES ARE AVAILABLE TO DISCUSS FINANCIAL ASSISTANCE PROGRAMS. JMH HAS PARTNERED WITH THE COMPANY FIRSTSOURCE SOLUTIONS USA TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. DURING FY14, FIRSTSOURCE REPRESENTATIVES WERE AVAILABLE AT JMH TO ASSIST PATIENTS. THE REPRESENTATIVES WERE ABLE TO DETERMINE GOVERNMENTAL MEDICAL ASSISTANCE (MEDICAID OR TENNCARE) ELIGIBILITY, AND TO HELP WITH THE APPLICATION PROCESS AND FOLLOW-UP. ONCE A PERSON IS APPROVED FOR MEDICAID OR TENNCARE THROUGH THE PROGRAM OFFERED THROUGH JMH, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. 636 PATIENTS WERE APPROVED FOR GOVERNMENTAL ASSISTANCE DURING THE YEAR. FIRSTSOURCE IS COMPENSATED BY JMH. DURING FY14, JMH'S COST FOR THIS PROGRAM WAS 88,193. DURING FY14, JMH'S BOARD OF DIRECTORS VOTED TO PARTNER WITH THE EDWARD VIA COLLEGE OF OSTEOPATHIC MEDICINE (VCOM) TO ESTABLISH A RESIDENCY PROGRAM IN ABINGDON. THE AGREEMENT IS EXPECTED TO PLACE UP TO NINE RESIDENTS AT JMH IN THE FIRST YEAR, WITH THE NUMBER POTENTIALLY INCREASING DURING THE INITIAL FIVE YEARS OF THE PROGRAM. VCOM WILL PROVIDE SUPPORT PERSONNEL AND OTHER RESOURCES DURING THE FIVE-YEAR START-UP PHASE. JMH BELIEVES PRIMARY CARE PHYSICIANS ARE PARTICULARLY NEEDED IN THE REGION, ESPECIALLY WITH THE INFLUX OF NEW PATIENTS EXPECTED TO COME AS MORE PEOPLE OBTAIN HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT. VCOM SPECIALIZES IN TRAINING PHYSICIANS FOR PRIMARY CARE; HOSPITAL OFFICIALS BELIEVE THE PARTNERSHIP IS A NATURAL FIT. JMH SERVES AS A CLINICAL TRAINING HOSPITAL FOR HEALTH PROFESSIONAL EDUCATION STUDENTS. WE HAVE DEDICATED STAFF THAT WORK WITH REGIONAL COLLEGES AND UNIVERSITIES TO COORDINATE THE PLACEMENT OF HEALTHCARE PROFESSIONAL STUDENTS AS PART OF THEIR EDUCATIONAL CURRICULUM. IN ADDITION TO CLINICAL TRAINING, THE HEALTHCARE STUDENTS ENTERING OUR SYSTEM ARE REQUIRED TO HAVE ORIENTATION AND COMPUTER TRAINING. PARTICIPANTS RECEIVING CLINICAL EXPERIENCE AT JMH DURING FY14 INCLUDED 349 NURSING STUDENTS FROM VARIOUS COLLEGES, UNIVERSITIES AND PROGRAMS. THIS NURSING CLINICAL EXPERIENCE REQUIRED EXTENSIVE JMH NURSING STAFF INVOLVEMENT. THE CLINICAL SETTING AND HANDS-ON INSTRUCTION COST JMH 724,962. JMH PROVIDED A CLINICAL SETTING FOR ANOTHER 174 STUDENTS TRAINING IN HEALTH-RELATED PROGRAMS SUCH AS RADIOLOGY, PHARMACY, PHYSICAL THERAPY, EMT/PARAMEDIC AND OTHER ALLIED-HEALTH DISCIPLINES. THESE ADDITIONAL CLINICAL STUDENTS COST JMH 173,134. BASED ON COMMUNITY NEEDS, JMH INCURRED EXPENSE OF 311,375 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. MSHA'S VALUE OPTIMIZATION SYSTEM (VOS) GOAL IS TO ACCELERATE ACHIEVEMENT OF PATIENT CENTERED CARE TO MEET THE PATIENT'S
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 expensesMediumBullet92,403,416
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
133
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
VA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletJOHN L JETER16000 JOHNSTON MEMORIAL DRABINGDONVA24211 (276) 258-1000
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) DENNIS VONDERFECHT........................................................................
TRUSTEE
 9.00
.......................51.00 		X           0 1,058,195 68,381
(2) ANN FLEMING........................................................................
TREASURER
 13.00
.......................47.00 		X           0 753,909 73,411
(3) PAUL ARMSTRONG MD........................................................................
TRUSTEE
 3.00
.......................37.00 		X           0 465,440 36,131
(4) JIM GARDNER MD........................................................................
TRUSTEE
 13.00
.......................27.00 		X           0 227,657 26,193
(5) KATHY MITCHELL MD........................................................................
TRUSTEE
 13.00
.......................   		X           0 0 0
(6) MICHAEL SPIEGLER........................................................................
SECRETARY
 10.00
.......................   		X           0 0 0
(7) GARY PEACOCK........................................................................
TRUSTEE
 8.00
.......................5.00 		X           0 0 0
(8) OTEY DUDLEY........................................................................
TRUSTEE
 12.00
.......................   		X           0 0 0
(9) HUGH FERGUSON........................................................................
CHAIR
 13.00
.......................   		X           0 0 0
(10) TOM FOWLKES........................................................................
TRUSTEE
 6.00
.......................4.50 		X           0 0 0
(11) RACHEL FOWLKES EDD........................................................................
TRUSTEE
 11.00
.......................   		X           0 0 0
(12) JOANNE GILMER........................................................................
VICE-CHAIR
 13.00
.......................6.00 		X           0 0 0
(13) KATHI LOWE........................................................................
TRUSTEE
 7.00
.......................   		X           0 0 0
(14) BILL HAYTER........................................................................
TRUSTEE
 13.00
.......................   		X           0 0 0
(15) BARBARA ALLEN........................................................................
TRUSTEE
 4.00
.......................7.00 		X           0 0 0
(16) ERIC MILLER........................................................................
TRUSTEE
 13.00
.......................   		X           0 0 0
(17) SEAN MCMURRAY........................................................................
CEO
 50.00
.......................5.00 		    X       0 309,946 49,800
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) JOHN JETER........................................................................
CFO
 45.00
.......................10.00 		    X       0 153,530 23,574
(19) KELLY CARTER MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   0 341,868 32,346
(20) DAVID SIMMONS MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   0 330,402 30,693
(21) SAMUEL MELTON MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   0 317,898 12,982
(22) MATHEW DYE MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   0 308,669 34,070
(23) JACQUELYN EARLY MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   0 302,185 30,861














1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet   4,569,699 418,442
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet  
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
VIRGINIA HIGHLANDS ANESTHESIAPO BOX 1476ABINGDONVA24212 ANESTHESIA 3,065,965
ABINGDON PHYSICIANS ASC GROUP613 CAMPUS DRIVE SUITE 300ABINGDONVA24210 SURG. CTR. MGMT 742,999
EXECUTIVE HEALTH RESOURCES15 CAMPUS BOULEVARD SUITE 200NEWTOWN SQUAREPA19073 PT.RESOURCE MGT 453,663
CROTHALL SERVICES EAST TN955 CHESTERBROOK BLVD STE 300WAYNEPA19087 LINEN SERVICES 389,538
MEDIAS INCPO BOX 10452BLACKSBURGVA240620452 SLEEP STUDIES 377,864
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet22
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 22,811
e Government grants (contributions)1e 64,674
f All other contributions, gifts, grants, and
similar amounts not included above1f 		13,623
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 101,108
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 621110 116,952,245 116,952,245    
b WELLNESS PROGRAMS 621110 1,998,265 1,998,265    
c P/S PREMIER AND ISHN 621110 244,615 244,615    
d RENT TO EXEMPT AFFILIATES 621110 147,760     147,760
e LABORATORY 621500 132,455   132,455  
f All other program service revenue . -6,091     -6,091
g Total. Add lines 2a–2f........MediumBullet 119,469,249
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 2,055,268     2,055,268
4 Income from investment of tax-exempt bond proceeds..MediumBullet 3,038     3,038
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 697,046  
b Less: rental expenses 590,611  
c Rental income or (loss) 106,435  
d Net rental income or (loss).......MediumBullet 106,435     106,435
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 4,457,858 647,218
b Less: cost or other basis and sales expenses    
c Gain or (loss) 4,457,858 647,218
d Net gain or (loss)..........MediumBullet 5,105,076 621,274   4,483,802
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..MediumBullet      
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...MediumBullet        
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..MediumBullet        
Miscellaneous Revenue Business Code
11a CAFETERIA & VENDING 722210 636,413     636,413
b PREMIER IPO VENDOR INCENTIVE 900099 504,135     504,135
c MANAGEMENT FEES 561000 180,921     180,921
d All other revenue .... 44,427     44,427
e Total. Add lines 11a–11d ...... MediumBullet 1,365,896
12 Total revenue. See Instructions......MediumBullet 128,206,070 119,816,399 132,455 8,156,108
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
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 21 280,949 280,949
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 .... 557,980   557,980  
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 40,586,280 33,944,178 6,642,102  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,426,982 1,208,802 218,180  
9 Other employee benefits ....... 3,986,003 3,956,825 29,178  
10 Payroll taxes ........... 2,453,855 2,289,057 164,798  
11 Fees for services (non-employees):        
a Management ...... 102,806   102,806  
b Legal ......... 12,319   12,319  
c Accounting ........... 116,514   116,514  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 231,721   231,721  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 24,064,058 20,423,322 3,640,736  
12 Advertising and promotion .... 275,887 8,559 267,328  
13 Office expenses ....... 1,220,779 975,994 244,785  
14 Information technology ...... 776,525 768,146 8,379  
15 Royalties ..        
16 Occupancy ........... 2,318,275 1,658,692 659,583  
17 Travel ............ 222,743 189,463 33,280  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 43,874 41,855 2,019  
20 Interest ........... 560,130   560,130  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 11,801,342 4,917,860 6,883,482  
23 Insurance .............. 997,468 21,963 975,505  
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 18,374,666 18,374,666    
b MANAGEMENT FEES TO PARENT 4,727,688   4,727,688  
c REPAIRS AND MAINTENANCE 2,955,073 2,872,718 82,355  
d ALL OTHER 785,810 470,367 315,443  
e All other expenses 17,399   17,399  
25 Total functional expenses. Add lines 1 through 24e 118,897,126 92,403,416 26,493,710 0
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 11,763,287 1 11,263,537
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 20,851,685 4 20,502,390
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
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 ............. 3,140,677 7 2,501,943
8 Inventories for sale or use .............. 2,990,250 8 2,954,107
9 Prepaid expenses and deferred charges .......... 875,233 9 851,748
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 255,685,379
b Less: accumulated depreciation ..... 10b 88,439,688 177,110,911 10c 167,245,691
11 Investments—publicly traded securities .......... 105,055,305 11 130,127,592
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13 199,510
14 Intangible assets ............... 35,200 14 35,200
15 Other assets. See Part IV, line 11 ........... 1,491,766 15  
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 323,314,314 16 335,681,718
Liabilities 17 Accounts payable and accrued expenses ......... 11,747,745 17 11,358,879
18 Grants payable .................   18  
19 Deferred revenue ................   19 2,084,434
20 Tax-exempt bond liabilities ............. 40,701,627 20 38,218,067
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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   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.................... 1,470,511 25 2,610,375
26 Total liabilities. Add lines 17 through 25......... 53,919,883 26 54,271,755
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 269,395,885 27 281,409,482
28 Temporarily restricted net assets ........... -1,454 28 481
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 269,394,431 33 281,409,963
34 Total liabilities and net assets/fund balances ........ 323,314,314 34 335,681,718
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
128,206,070
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
118,897,126
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
9,308,944
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
269,394,431
5
Net unrealized gains (losses) on investments ...............
5
3,324,700
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-618,112
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
281,409,963
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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.
right arrow 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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
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)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (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
Yes No Yes No Yes No
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
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) right arrow (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) right arrow (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).  
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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
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) right arrow (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) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet 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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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
JOHNSTON MEMORIAL HOSPITAL INC
  		Employer identification number

54-0544705
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


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(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
JOHNSTON MEMORIAL HOSPITAL INC
  		Employer identification number

54-0544705
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
JOHNSTON MEMORIAL HOSPITAL INC
  		Employer identification number

54-0544705
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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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:  
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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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

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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ......................................

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


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)
No
Yes
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
7,051
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
7,051
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
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."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
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 IV PART II-B, LINE 1 PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION THAT ARE ATTRIBUTABLE TO DIRECT LOBBYING.
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .......................................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   6,414,992 6,414,992
b Buildings ................   148,392,946 23,025,328 125,367,618
c Leasehold improvements ............   6,087,656 1,521,441 4,566,215
d Equipment ................   93,864,257 63,629,978 30,234,279
e Other .................   925,528 262,941 662,587
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 167,245,691
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
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  
OTHER LONG-TERM LIABILITIES 1,126,666
CAPITAL LEASE OBLIGATIONS 773,821
DUE TO THIRD-PARTY 496,450
DUE TO AFFILIATES 213,438





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 2,610,375
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

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 FOOTNOTES FROM JOHNSTON MEMORIAL HOSPITAL'S JUNE 30, 2014 CONSOLIDATED AUDITED FINANCIAL STATEMENTS INCLUDE THE FOLLOWING TEXT: "THE HOSPITAL AND APP ARE CLASSIFIED AS ORGANIZATIONS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. JMH ER IS ORGANIZED AS A LIMITED LIABILITY CORPORATION AND IS CONSIDERED A DISREGARDED ENTITY FOR TAX PURPOSES. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AT JUNE 30, 2014, TAX RETURNS FOR FISCAL YEARS 2010 THROUGH 2013 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2014 AND 2013. AS SUCH, NO INTEREST OR PENALTIES ARE RECOGNIZED IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RELATED TO UNRECOGNIZED TAX BENEFITS."
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: .........
3b
Yes
 
%
c
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.
4
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"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
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? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
 
No
b
If "Yes," did the organization make it available to the public? ..............
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) .. 		    2,679,061   2,679,061 2.250 %
b Medicaid (from Worksheet 3,
column a) .... 		    18,385,487 14,633,630 3,751,857 3.160 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    21,064,548 14,633,630 6,430,918 5.410 %
Other Benefits
     175,428   175,428 0.150 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    898,097   898,097 0.760 %
g Subsidized health services
(from Worksheet 6) .. 		    3,634,927 2,612,826 1,022,101 0.860 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    184,634   184,634 0.160 %
j Total. Other Benefits ..     4,893,086 2,612,826 2,280,260 1.920 %
k Total. Add lines 7d and 7j .     25,957,634 17,246,456 8,711,178 7.330 %
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     3,575   3,575  
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     3,575   3,575  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
16,035,231
3
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. ......
3
12,026,423
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
37,453,513
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
40,349,827
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-2,896,314
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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.......................

9b

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 % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
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?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 JOHNSTON MEMORIAL HOSPITAL INC
16000 JOHNSTON MEMORIAL DRIVE
ABINGDON,VA24211
HTTP://WWW.MSHA.COM/JMH 		X X         X      
Schedule H (Form 990) 2013
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)
JOHNSTON MEMORIAL HOSPITAL INC
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) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 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 .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 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):
a
b
c
d
e
f
g
h
i
7 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 ........ 7   No
8a 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)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c 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
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
b
c
d
e
f
g
h
i
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
b
c
d
e
f
g
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
b
c
d
e
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
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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.
a
b
c
d
21 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? ............................ 21   No
If "Yes," explain in Part VI.
22 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? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
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, JOHNSTON MEMORIAL HOSPITAL, INC. - PART V, LINE 3 MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING JMH) 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, JOHNSTON MEMORIAL HOSPITAL, INC. - 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. JMH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER, FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 1, JOHNSTON MEMORIAL HOSPITAL, INC. - 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, SOME OF MSHA FACILITIES WERE UNABLE TO ADDRESS ISSUES THAT WERE IDENTIFIED.
FACILITY 1, JOHNSTON MEMORIAL HOSPITAL, INC. - 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 NEGOIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
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?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2013
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, JOHNSTON MEMORIAL HOSPITAL, INC. - PART V, LINE 3 MSHA MET WITH TEN FOCUS GROUPS EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES (INCLUDING JMH) 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, JOHNSTON MEMORIAL HOSPITAL, INC. - 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. JMH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER, FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 1, JOHNSTON MEMORIAL HOSPITAL, INC. - 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, SOME OF MSHA FACILITIES WERE UNABLE TO ADDRESS ISSUES THAT WERE IDENTIFIED.
FACILITY 1, JOHNSTON MEMORIAL HOSPITAL, INC. - 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 NEGOIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE.
Schedule H (Form 990) 2013
Additional Data


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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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number
54-0544705
Part I
General Information on Grants and Assistance
1
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? ....................................
2
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		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) BARTER THEATRE
PO BOX 867
ABINGDON,VA24212 		54-6000120 501C3 18,800       SPONSORSHIP
(2) JOHN S BATTTLE HIGH SCHOOL
21264 BATTLE HILL DRIVE
BRISTOL,VA24202 		54-1604035 501C3 16,296       FOOTBALL SCOREBOARD
(3) JOHNSTON MEMORIAL HOSP AUXILIARY
16000 JOHNSTON MEMORIAL DRIVE
ABINGDON,VA24211 		54-0917478 501C3 40,000       GENERAL SUPPORT
(4) MARCH OF DIMES
PO BOX 799-2700 S ROAN ST 430
JOHNSON CITY,TN37605 		13-1846366 501C3 5,200       GENERAL SPONSORSHIP
(5) SALTVILLE RESCUE SQUAD
126 BATTLEGROUND AVENUE
SALTSVILLE,VA24370 		31-1638300 501C3   5,719     DRUG BOX REFILLS
(6) VHCC EDUCATIONAL FOUNDATION
PO BOX 828
ABINGDON,VA24212 		52-1225133 501C3 36,155       FUND NURSING PROGRAM
(7) VIRGINIA HIGHLANDS COMM COLLEGE
P O BOX 828
ABINGDON,VA24212 		54-1268289 501C3 128,914       FUND NURSING PROGRAM
(8) WASHINGTON COUNTY PUBLIC SCHOOLS
812 THOMPSON DRIVE
ABINGDON,VA24210 		54-6001671 501C3 7,250       SPONSORSHIP
(9) WILLIAM KING MUSEUM
PO BOX 2256
ABINGDON,VA24210 		54-1144120 501C3 10,000       SPONSORSHIP






2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
9
3
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

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 FUNDING MAY BE PROVIDED TO LOCAL 501(C)(3) ORGANIZATIONS WHOSE FOCUS IS ON HEALTH AND EDUCATION. FOR MANY YEARS, JMH HAS MADE DONATIONS OF MEDICATIONS TO AREA NON-PROFIT EMERGENCY MEDICAL SERVICE COMPANIES. WE ARE PROVIDING ASSISTANCE TO A LOCAL COLLEGE TO HELP FUND AN INSTRUCTOR FOR ITS NURSING PROGRAM. ADDITIONAL DONATIONS ARE MADE TO THE UNITED WAY, LOCAL SCHOOLS, AND THE LOCAL ARTS. 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, INCLUDING JMH, 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 CNHA, ETC.
Schedule I (Form 990) 2013


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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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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....
1b
 
 
2
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? ..
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)DENNIS VONDERFECHTTRUSTEE (i)
(ii)		  
780,241 		 
236,094 		 
41,860 		 
40,000 		 
28,381 		 
1,126,576 		 
 
(2)ANN FLEMINGTREASURER (i)
(ii)		  
383,151 		 
87,911 		 
282,847 		 
55,452 		 
17,959 		 
827,320 		 
242,724
(3)PAUL ARMSTRONG MDTRUSTEE (i)
(ii)		  
348,063 		 
116,939 		 
438 		 
18,051 		 
18,080 		 
501,571 		 
 
(4)JIM GARDNER MDTRUSTEE (i)
(ii)		  
174,206 		 
52,888 		 
563 		 
9,255 		 
16,938 		 
253,850 		 
 
(5)SEAN MCMURRAYCEO (i)
(ii)		  
266,258 		 
38,619 		 
5,069 		 
28,438 		 
21,362 		 
359,746 		 
 
(6)JOHN JETERCFO (i)
(ii)		  
149,322 		 
3,930 		 
278 		 
5,473 		 
18,101 		 
177,104 		 
 
(7)KELLY CARTER MDPHYSICIAN (i)
(ii)		  
262,640 		 
23,472 		 
55,756 		 
11,840 		 
20,506 		 
374,214 		 
 
(8)DAVID SIMMONS MDPHYSICIAN (i)
(ii)		  
255,033 		 
23,619 		 
51,750 		 
10,701 		 
19,992 		 
361,095 		 
 
(9)SAMUEL MELTON MDPHYSICIAN (i)
(ii)		  
269,189 		 
45,509 		 
3,200 		 
  		 
12,982 		 
330,880 		 
 
(10)MATHEW DYE MDPHYSICIAN (i)
(ii)		  
223,744 		 
20,019 		 
64,906 		 
12,094 		 
21,976 		 
342,739 		 
 
(11)JACQUELYN EARLY MDPHYSICIAN (i)
(ii)		  
219,337 		 
23,379 		 
59,469 		 
12,026 		 
18,835 		 
333,046 		 
 
Schedule J (Form 990) 2013

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 4 ANN FLEMING 0 39,222 0 SEAN MCMURRAY 0 13,524 0 SAMUEL MELTON, M.D. 0 13,050 0
SCHEDULE J, PART III PART I, LINE 3: SALARY AND BENEFITS FOR JMH'S CEO ARE SUBJECT TO THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) COMPENSATION COMMITTEE PROCESS, WHEREBY THE MSHA CEO RECOMMENDS THE SALARY AND IT IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE, BASED UPON MARKET DATA, MADE AVAILABLE BY THIRD PARTY CONSULTANTS. THE COMPENSATION COMMITTEE HAS FINAL APPROVAL OF MSHA'S CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR THE JMH CEO. WE USE AN OUTSIDE, INDEPENDENT CONSULTING FIRM TO PROVIDE CONSULTATION ON EXECUTIVE PAY AS WELL AS OUR EXECUTIVE PAY AT RISK PLAN. PART I, LINE 4B: ANN FLEMING, SEAN MCMURRAY, AND SAMUEL MELTON PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). 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


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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet 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.
SchKMediumBulletInformation 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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number
54-0544705
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
Yes No Yes No Yes No
A 2011 HOSPITAL FACILITY INVEST BOND
INDUSTRIAL DEV AUTHORITY OF SMYTH 		54-1758381   11-16-2011 24,870,000 REFINANCE CANCER CTR.   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 3,535,000      
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 24,870,000      
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 238,423      
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . .        
11 Other spent proceeds . . . . . . . . . . . . . . 24,631,577      
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2012
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X              
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . 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            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2013
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              
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              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   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 . . SchKMediumBullet        
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 . . . . . . . SchKMediumBullet        
6 Total of lines 4 and 5 . . . . . . . . . . . . .        
7 Does the bond issue meet the private security or payment test? . . . . .   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              
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? . . . . . . . . . . . . .   X            
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              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . . X              
c No rebate due? . . . . . . . .   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              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2013
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            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . 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 2011 HOSPITAL FACILITY INVEST. BOND (LINE A) REFINANCE OF CANCER TREATMENT CENTER AND REFINANCING OF SERIES 1998 BONDS PART III, LINES 8B & 8C: A PORTION OF THE BONDS ISSUED IN 1998 THAT WAS REFUNDED WITH A PORTION OF THE REPORTED BOND ISSUE FINANCED HOSPITAL IMPROVEMENTS FOR A FACILITY THAT BECAME OUTMODED AND OBSOLETE. THE OBSOLETE FACILITY WAS SUBSEQUENTLY SOLD FOR A MINIMAL AMOUNT (LESS THAN 5% OF THE PROCEEDS OF THE BONDS). BASED ON THE AVAILABLE RECORDS, IT IS NOT POSSIBLE TO GIVE A PRECISE AMOUNT OF THE 1998 BOND PROCEEDS THAT WERE USED TO FINANCE THE PROPERTY THAT WAS DISPOSED. BECAUSE THE AMOUNT OF PRIVATE PAYMENTS WAS LESS THAN THE PERMITTED THRESHOLD, NO REMEDIAL ACTION WAS REQUIRED. PART IV, LINE 2C: THE 2011 BOND ISSUE HAS NO ARBITRAGE REBATE DUE SO THERE HAS BEEN NO REBATE COMPUTATION PERFORMED.
Schedule K (Form 990) 2013

Additional Data


Software ID:  
Software Version:  

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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
Return Reference Explanation
FORM 990 - ORGANIZATION'S MISSION JOHNSTON MEMORIAL HOSPITAL (JMH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.
FORM 990, PAGE 2, PART III, LINE 4A JMH OFFERS A FULL ARRAY OF MEDICAL SERVICES THROUGH HIGHLY TRAINED PHYSICIANS AND SUPPORT STAFF, PROUDLY SERVING SOUTHWEST VIRGINIA SINCE 1917. OUR GOAL IS TO BE A LEADER IN IMPROVING THE HEALTH AND QUALITY OF LIFE IN THE COMMUNITY, BY WORKING TOGETHER AS A TEAM DEDICATED TO EXCELLENCE. DURING FY14, WE EXPERIENCED 7,109 ADMISSIONS, WITH ALMOST 24,000 PATIENT DAYS. THERE WERE AN ADDITIONAL 4,760 OBSERVATION DAYS. OUR OUTPATIENT VISITS WERE JUST UNDER 146,000. THERE WERE 39,161 VISITS TO OUR EMERGENCY DEPARTMENT, WITH 5,403 RESULTING IN AN INPATIENT STAY. ALMOST 6,900 SURGERIES WERE PERFORMED DURING THE YEAR AND WE DELIVERED 752 BABIES. DURING FY14, JMH IMPLEMENTED AN ONLINE TOOL CALLED OWL (ONLINE WELLNESS LINK). OWL PROVIDES INPATIENTS WITH BETTER ACCESS TO THEIR HEALTH CARE INFORMATION SO THEY CAN VIEW A PORTION OF THEIR HEALTH RECORD ONLINE, INCLUDING: - A CONTINUITY OF CARE DOCUMENT WHICH PROVIDES A SUMMARY OF THE HOSPITAL VISIT - CURRENT MEDICATIONS - ALLERGIES AND ADVERSE REACTIONS - PAST MEDICAL HISTORY - CERTAIN LABORATORY AND RADIOLOGY RESULTS THE OWL PORTAL ALSO ALLOWS JMH CAREGIVERS TO EXCHANGE HEALTHCARE INFORMATION, WHICH HAS LED TO SAFER, MORE QUALTIY-ORIENTED AND STREAMLINED CARE FOR OUR PATIENTS. JMH SIGNED A NON-PROFIT BLOOD CENTER TENANT TO A ONE YEAR LEASE FOR ONLY 1. THE ANNUAL FAIR MARKET VALUE OF THE LEASE IS 32,770. THE FMV FOR THE EIGHT MONTHS FALLING WITHIN FY14 IS 21,846. BLOOD ASSURANCE IS A NON-PROFIT FULL SERVICE REGIONAL BLOOD CENTER SERVING 51 COUNTIES AND MORE THAN 70 HEALTHCARE FACILITIES IN VIRGINIA, TENNESSEE, NORTH CAROLINA, ALABAMA, AND GEORGIA. THE MISSION OF BLOOD ASSURANCE IS TO PROVIDE A SAFE AND ADEQUATE SUPPLY OF BLOOD AND BLOOD COMPONENTS IN A COST EFFECTIVE MANNER TO EVERY AREA PATIENT IN NEED. JMH IS COMMITTED TO PROVIDING COMPREHENSIVE MEDICAL EDUCATION TO AID IN PATIENT RECOVERY AND DISEASE MANAGEMENT. WE OFFER MANY CLASSES AND SUPPORT GROUPS, SUCH AS: CPR AND LIFE SAVING CLASSES; CARDIAC CARE; TOTAL JOINT; CANCER EDUCATION; PRENATAL PARENTING; AND, OTHERS. THE JMH CENTER FOR COMPREHENSIVE WOUND CARE IS ONE OF ONLY A FEW FACILITIES IN THE REGION THAT OFFERS HYPERBARIC OXYGEN THERAPY-THE DELIVERY OF OXYGEN AT LEVELS HIGHER THAN ATMOSPHERIC PRESSURE IN A CHAMBER SETTING THAT STIMULATES THE HEALING PROCESS. OUR TRAINED STAFF FOLLOW A TEAM APPROACH TO WOUND HEALING. AFTER AN INITIAL EVALUATION, EACH PATIENT RECEIVES A COMPREHENSIVE INDIVIDUALIZED PLAN DESIGNED TO HELP DIFFICULT-TO-HEAL WOUNDS. JMH STAFF STRIVE TO ADDRESS THE UNDERLYING CAUSE OF THE PROBLEM, CONTROL INFECTION, AND IMPROVE THE OVERALL HEALTH OF OUR PATIENTS. THE JMH DIABETES EDUCATION CENTER HAS ASSISTED PATIENTS IN DIABETES CARE SINCE 1999. DR. ANDREW RHINEHART, DIRECTOR OF THE CENTER, WAS AWARDED RECOGNITION, BY THE PRESTIGIOUS NATIONAL COMMITTEE FOR QUALITY ASSURANCE DIABETES RECOGNITION PROGRAM, A PRIVATE, NONPROFIT ORGANIZATION DEDICATED TO IMPROVING HEALTH CARE QUALITY. DR. RHINEHART IS BOARD-CERTIFIED IN ADVANCED DIABETES MANAGEMENT AND WAS THE FIRST PHYSICIAN IN THE U.S. TO GAIN THESE CREDENTIALS. HE BECAME ONE OF THE FIRST PHYSICIANS TO EARN DISTINCTION AS A CERTIFIED DIABETES TECHNOLOGY CLINICIAN, THE HIGHEST PROFESSIONAL CREDENTIAL THAT RECOGNIZES A PHYSICIAN AS AN EXPERT IN USING TECHNOLOGY TO MANAGE DIABETES. A STAFF OF CERTIFIED DIABETES EDUCATORS ASSISTS HIM AT THE DIABETES CARE CENTER. MOUNTAIN STATES REHABILITATION AT JMH HAS BEEN AWARDED AN OUTCOMES EXCELLENCE CERTIFICATE FROM FOCUS ON THERAPEUTIC OUTCOMES, INC. (FOTO), A NATIONWIDE OUTCOMES DATABASE AND REPORTING SERVICE FOR HEALTHCARE PROVIDERS ACROSS THE COUNTRY TO RECOGNIZE EXCELLENCE IN PATIENT OUTCOMES SUSTAINED OVER TIME. NATIONALLY, ONLY ABOUT 12 PERCENT OF NEARLY 3,000 ELIGIBLE CLINICS RECEIVED THIS AWARD OVER THE LAST YEAR. JMH RANKS HIGH COMPARED TO OTHER CLINICS IN THE FOTO NETOWRK WITH ITS PATIENTS ACHIEVING SIGNIFICANTLY HIGHER FUNCTIONAL IMPROVEMENTS, IN FEWER VISITS, AND WITH HIGHER PATIENT SATISFACTION. JMH HAS USED FOTO SINCE 2010 AS A WAY TO OBJECTIVELY TRACK PATIENTS' FUNCTIONAL OUTCOMES. PARTICIPATING IN THIS NATION-WIDE SYSTEM IS ANOTHER EXAMPLE OF JMH'S COMMITMENT TO PROVIDING EFFICIENT AND OUTSTANDING PATIENT CARE. FOTO HAS THE FIRST FUNCTIONAL HEALTH STATUS MEASURE APPROVED FOR PHYSICAL REHABILITATION BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES' LIST OF APPROVED QUALITY MEASURES IN NATIONAL QUALITY MEASURES CLEARINGHOUSE. THE HEAL (HEALTHLY EATING ACTIVE LIVING) APPALACHIA PROGRAM, WHICH BATTLES CHILDHOOD OBESITY IN OUR REGION, WAS SELECTED AS A 2014 INDUCTEE INTO THE FIRST LADY OF VIRGINIA'S OPPORTUNITY HALL OF FAME. THIS HONOR RELATES TO HEAL APPALACHIA'S WORK IN SOUTHWEST VIRGINIA. HEAL APPALACHIA IS A COLLABORATIVE EFFORT OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA) AND EAST TENNESSEE STATE UNIVERSITY. IT WAS CREATED TO BUILD MOMENTUM IN THE FIGHT AGAINST CHILDHOOD OBESITY IN SOUTHERN APPALACHIA. JMH SUPPORTS OTHER LOCAL NON-PROFIT ORGANIZATIONS THAT PROVIDE HEALTHCARE SERVICES TO OUR RESIDENTS. WE DONATE MEDICATIONS AND SUPPLIES TO AREA RESCUE SQUADS AND FIRE DEPARTMENTS. THESE DRUG AND SUPPLY DONATIONS EXCEEDED 13,000 IN FY14. WE PROVIDED FINANCIAL ASSISTANCE TO A LOCAL COLLEGE FOR ITS NURSING PROGRAM. DURING FY14, WE CONTRIBUTED OVER 75,000 TO THE PROGRAM. MANY OTHER DONATIONS WERE MADE TO SUPPORT OUR SCHOOLS, MARCH OF DIMES, ETC. WITH HEALTHCARE INSURANCE COVERAGE CHANGING RAPIDLY, PATIENT PAYMENT RESPONSIBILTY IS INCREASING AT A RATE OF 5 TO 6 PERCENT EACH YEAR. MOUNTAIN STATES INTRODUCED A NEW PAYMENT OPTION LAST YEAR THAT OFFERS MORE FLEXIBILITY TO OUR PATIENTS - THE ABILITY TO SPREAD PAYMENTS OVER A 36-MONTH PERIOD WITH NO INTEREST CHARGED. OF COURSE, FOR PATIENTS THAT ARE UNABLE TO PAY THEIR ACCOUNT BALANCES, PATIENT RESPRESENTATIVES ARE AVAILABLE TO DISCUSS FINANCIAL ASSISTANCE PROGRAMS. JMH HAS PARTNERED WITH THE COMPANY FIRSTSOURCE SOLUTIONS USA TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. DURING FY14, FIRSTSOURCE REPRESENTATIVES WERE AVAILABLE AT JMH TO ASSIST PATIENTS. THE REPRESENTATIVES WERE ABLE TO DETERMINE GOVERNMENTAL MEDICAL ASSISTANCE (MEDICAID OR TENNCARE) ELIGIBILITY, AND TO HELP WITH THE APPLICATION PROCESS AND FOLLOW-UP. ONCE A PERSON IS APPROVED FOR MEDICAID OR TENNCARE THROUGH THE PROGRAM OFFERED THROUGH JMH, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. 636 PATIENTS WERE APPROVED FOR GOVERNMENTAL ASSISTANCE DURING THE YEAR. FIRSTSOURCE IS COMPENSATED BY JMH. DURING FY14, JMH'S COST FOR THIS PROGRAM WAS 88,193. DURING FY14, JMH'S BOARD OF DIRECTORS VOTED TO PARTNER WITH THE EDWARD VIA COLLEGE OF OSTEOPATHIC MEDICINE (VCOM) TO ESTABLISH A RESIDENCY PROGRAM IN ABINGDON. THE AGREEMENT IS EXPECTED TO PLACE UP TO NINE RESIDENTS AT JMH IN THE FIRST YEAR, WITH THE NUMBER POTENTIALLY INCREASING DURING THE INITIAL FIVE YEARS OF THE PROGRAM. VCOM WILL PROVIDE SUPPORT PERSONNEL AND OTHER RESOURCES DURING THE FIVE-YEAR START-UP PHASE. JMH BELIEVES PRIMARY CARE PHYSICIANS ARE PARTICULARLY NEEDED IN THE REGION, ESPECIALLY WITH THE INFLUX OF NEW PATIENTS EXPECTED TO COME AS MORE PEOPLE OBTAIN HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT. VCOM SPECIALIZES IN TRAINING PHYSICIANS FOR PRIMARY CARE; HOSPITAL OFFICIALS BELIEVE THE PARTNERSHIP IS A NATURAL FIT. JMH SERVES AS A CLINICAL TRAINING HOSPITAL FOR HEALTH PROFESSIONAL EDUCATION STUDENTS. WE HAVE DEDICATED STAFF THAT WORK WITH REGIONAL COLLEGES AND UNIVERSITIES TO COORDINATE THE PLACEMENT OF HEALTHCARE PROFESSIONAL STUDENTS AS PART OF THEIR EDUCATIONAL CURRICULUM. IN ADDITION TO CLINICAL TRAINING, THE HEALTHCARE STUDENTS ENTERING OUR SYSTEM ARE REQUIRED TO HAVE ORIENTATION AND COMPUTER TRAINING. PARTICIPANTS RECEIVING CLINICAL EXPERIENCE AT JMH DURING FY14 INCLUDED 349 NURSING STUDENTS FROM VARIOUS COLLEGES, UNIVERSITIES AND PROGRAMS. THIS NURSING CLINICAL EXPERIENCE REQUIRED EXTENSIVE JMH NURSING STAFF INVOLVEMENT. THE CLINICAL SETTING AND HANDS-ON INSTRUCTION COST JMH 724,962. JMH PROVIDED A CLINICAL SETTING FOR ANOTHER 174 STUDENTS TRAINING IN HEALTH-RELATED PROGRAMS SUCH AS RADIOLOGY, PHARMACY, PHYSICAL THERAPY, EMT/PARAMEDIC AND OTHER ALLIED-HEALTH DISCIPLINES. THESE ADDITIONAL CLINICAL STUDENTS COST JMH 173,134. BASED ON COMMUNITY NEEDS, JMH INCURRED EXPENSE OF 311,375 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. MSHA'S VALUE OPTIMIZATION SYSTEM (VOS) GOAL IS TO ACCELERATE ACHIEVEMENT OF PATIENT CENTERED CARE TO MEET THE PATIENT'S EXPECTATIONS OF HIGH QUALITY, HIGH SATISFACTION AND EFFICIENT CARE. DURING FY14, A VOS RAPID IMPROVEMENT EVENT TEAM DEVELOPED STANDARD WORK PROCESSES TO IMPROVE PATIENT FLOW AT JMH AND TO REDUCE THE AVERAGE LENGTH OF STAY BY 5%. THE TEAM CREATED A VISUAL MANAGEMENT TOOL OF THE ESTIMATED DISCHARGE DATE FOR PATIENT CARE CLINICIANS IN ORDER TO IDENTIFY BARRIERS TO DISCHARGING PATIENTS IN A TIMELY MANNER AND HELP STAFF FOCUS ON REDUCING LENGTH OF STAY
FORM 990, PART V LINE 2A: W-2 EMPLOYEES JOHNSTON MEMORIAL HOSPITAL (JMH) TEAM MEMBERS ARE PAID BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). JMH REIMBURSES MSHA FOR ALL SALARY AND BENEFITS AND THE EXPENSE IS RECORDED ON JMH'S BOOKS.
FORM 990, PAGE 6, PART VI, LINE 6 THE CORPORATION IS ORGANIZED AS A VIRGINIA NON-STOCK, NON-PROFIT CORPORATION WITH TWO MEMBERS: MOUNTAIN STATES HEALTH ALLIANCE, WHICH MAINTAINS A 50.1% INTEREST AND JOHNSTON MEMORIAL HEALTHCARE FOUNDATION, WHICH MAINTAINS A 49.9% INTEREST.
FORM 990, PAGE 6, PART VI, LINE 7A THERE ARE TWO CLASSES OF MEMBERS, AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE JOHNSTON MEMORIAL HOSPITAL CLASS IS ELECTED BY THE JOHNSTON MEMORIAL HEALTHCARE FOUNDATION'S BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT.
FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN DECISIONS OF THE BOARD ARE PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS, ETC. NO ORDINARY DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL.
FORM 990, PAGE 6, PART VI, LINE 11B THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS 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, INCLUDING JOHNSTON MEMORIAL HOSPITAL'S CEO. 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, OTHER SENIOR EXECUTIVES RECEIVE COMPENSATION AND BENEFITS THAT COMPLY WITH MSHA'S SALARY POLICY. COMPENSATION FOR EACH OF THEM IS SET AT A MARKET PERCENTILE SPECIFIC TO HIS/HER 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 INDEBTNESS OF THE COMPANY ON A QUARTERLY BASIS.
FORM 990, PART IX, LINE 11G HOSPITAL BASED PROVIDERS 5,095,262 0 0 HOSPITAL SUPPORTED CLINICS 7,108,164 0 0 PHYSICIAN FEES 5,781,157 0 0 COLLECTION SERVICE FEES 0 817,885 0 JANITORIAL & LINEN FEES 0 683,095 0 DIALYSIS SERVICES 210,044 0 0 HYPERBARIC SERVICES 151,160 0 0 SLEEP DIAGNOSTICS SERVICES 360,203 0 0 NUC. MED./ONCOLOGY /RADIOLOGY 253,496 0 0 LABORATORY TESTS 611,225 0 0 AMBULATORY SURGERY CENTER 273,964 0 0 ENGINEERING SERVICES 0 214,981 0 DIETARY 0 1,213,399 0 TRANSCRIPTION & CODING 0 611,402 0 OTHER FEES 578,647 99,974 0
FORM 990, PART XI, LINE 9 ELIMINATION OF INTERCOMPANY REC/PAY -353,185 P/S INCOME NOT ON BOOKS -238,524 P/S INTEREST INCOME NOT ON BOOKS -2,413 P/S CAPITAL GAIN NOT ON BOOKS -25,944 P/S CHARITABLE CONTRIBUTIONS NOT ON BOOKS 19 CHANGES IN TEMPORARILY RESTRICTED NET ASSETS 1,935 TOTAL TO FORM 990, PART XI, LINE 9 -618,112
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:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach 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
JOHNSTON MEMORIAL HOSPITAL INC
 
Employer identification number

54-0544705
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
(1) JMH EMERGENCY PHYSICIANS LLC
16000 JOHNSTON MEMORIAL DRIVE
ABINGDON,VA24211
45-4786385 		MED. SERV. VA 3,578,213 1,105,906 JMH
 










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?
Yes No
(1) JOHNSTON MEMORIAL HEALTHCARE FND

16000 JOHNSTON MEMORIAL DRIVE

ABINGDON,VA24211
26-2870970 		SUPPORT VA 501C3 11B NA
 
 
No
(2) ABINGDON PHYSICIAN PARTNERS

16000 JOHNSTON MEMORIAL DRIVE

ABINGDON,VA24211
20-5485346 		MED. SERV. VA 501C3 11A JMH
 
 
No
(3) MOUNTAIN STATES HEALTH ALLIANCE

400 N STATE OF FRANKLIN ROAD

JOHNSON CITY,TN37604
62-0476282 		HOSPITAL TN 501C3 3 NA
 
 
No
(4) MOUNTAIN STATES FOUNDATION

2335 KNOB CREEK ROAD SUITE 101

JOHNSON CITY,TN37604
58-1418862 		FUNDRAISER TN 501C3 11A MSHA
 
 
No
(5) APPALACHIAN EMERGENCY PHYSICIANS

1021 W OAKLAND AVENUE SUITE 207

JOHNSON CITY,TN37604
80-0592504 		MED. SERV. VA 501C3 11A NA
 
 
No
(6) AUXILIARY TO JOHNSTON MEMORIAL HOSP

1600 JOHNSTON MEMORIAL DRIVE

ABINGDON,VA24211
54-0917478 		SUPPORT VA 501C3 11A NA
 
 
No
(7) MSHA AUXILIARY

400 N STATE OF FRANKLIN ROAD

JOHNSON CITY,TN37604
58-1418345 		SUPPORT TN 501C3 11A MSHA
 
 
No
(8) NORTON COMMUNITY HOSPITAL

100 15TH STREET NW

NORTON,VA24273
54-0566029 		HOSPITAL VA 501C3 3 NA
 
 
No
(9) DICKENSON COMMUNITY HOSPITAL

ONE HOSPITAL DRIVE

CLINTWOOD,VA24228
77-0599553 		HOSPITAL VA 501C3 3 NCH
 
 
No
(10) SMYTH COUNTY COMMUNITY HOSPITAL

245 MEDICAL PARK DRIVE

MARION,VA24354
54-0794913 		HOSPITAL VA 501C3 3 MSHA
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
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
Yes No Yes No
(1) INTEGRATED SOLUTIONS HEALTH NETWORK

509 MED TECH PARKWAY SUITE 100
JOHNSON CITY,TN37604
62-1711997 		INVESTMENT TN NA
  		EXCLUDED 643     No     No  
(2) EMMAUS COMMUNITY HEALTHCARE PLLC

6070 HWY 11E
PINEY FLATS,TN37686
20-0577483 		MED. SERV. TN NA
  		EXCLUDED       No     No  
(3) MEDICAL SPECIALISTS OF JC LLC

2528 WESLEY STREET SUITE 2
JOHNSON CITY,TN37601
27-2199037 		MED. SERV. TN NA
  		EXCLUDED       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?
Yes No
(1) BLUE RIDGE MEDICAL MANAGEMENT CORP

1021 W OAKLAND AVENUE SUITE 207
JOHNSON CITY,TN37604
62-1711997 		MED. SERV. TN NA
  		C CORP         No
(2) MEDISERVE MED EQUIP OF KINGSPORT

1021 W OAKLAND AVE SUITE 207
JOHNSON CITY,TN37604
62-1212286 		DME TN NA
  		C CORP         No
(3) MOUNTAIN STATES PROPERTIES

1021 W OAKLAND AVE SUITE 207
JOHNSON CITY,TN37604
62-1845895 		PROP. MGMT TN NA
  		C CORP         No
(4) MOUNTAIN STATES PHYSICIAN GRP INC

1021 W OAKLAND AVENUE SUITE 207
JOHNSON CITY,TN37604
62-1700412 		MED. SERV. TN NA
  		C CORP         No
(5) COMMUNITY HOME CARE INC

1460 PARK AVENUE
NORTON,VA24273
54-1453810 		DME VA NCH
  		C CORP         No
(6) SOUTHWEST COMMUNITY HEALTH SERVICES

PO BOX 880
MARION,VA24354
54-1460695 		MED. SERV. VA SCCH
  		C CORP         No
(7) WILSON PHARMACY INC

P O BOX 5289
JOHNSON CITY,TN37604
62-0329587 		PHARMACY TN NA
  		C CORP         No
(8) CRESTPOINT HEALTH INSURANCE CO INC

509 MED TECH PARKWAY SUITE 100
JOHNSON CITY,TN37604
62-0381170 		INSURANCE TN ISHN
  		C CORP         No
Schedule R (Form 990) 2013
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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
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 		(d)
Method of determining amount involved
(1) APPALACHIAN PHYSICIAN PARTNERS

 B 353,185  
(2) APPALACHIAN PHYSICIAN PARTNERS

 J 775,542  




Schedule R (Form 990) 2013
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
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


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