Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
MOUNTAIN STATES HEALTH ALLIANCE |
620476282 | Yes | 81,730 | 1,018 | ||
| (B)
NORTON COMMUNITY HOSPITAL |
540566029 | Yes | 10,200 | 25 | ||
Total 2
|
91,930 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART IV, LINE 1 | THE AUXILIARY'S BYLAWS DO NOT LIST EACH SUPPORTED ORGANIZATION BY NAME. HOWEVER, ARTICLE II ("PURPOSE") OF THE BYLAWS STATE "MOUNTAIN STATES AUXILIARY IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, RELIGIOUS, EDUCATIONAL AND SCIENTIFIC PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1954, AS AMENDED. SPECIFICALLY, MOUNTAIN STATES AUXILIARY IS ORGANIZED TO RENDER SERVICE TO MOUNTAIN STATES HEALTH ALLIANCE AND ITS PATIENTS AND TO ASSIST MOUNTAIN STATES HEALTH ALLIANCE IN PROMOTING THE HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH THE OBJECTIVES ESTABLISHED BY THE INSTITUTION. |
| PART IV, LINE 5A | PRIOR TO THE AUXILIARY'S AMEDNED BYLAWS, THE AUXILIARY SUPPORTED MOUNTAIN STATES HEALTH ALLIANCE'S ("MSHA") WHOLLY OWNED HOSPITALS, BUT NOT ITS MAJORITY OWNED HOSPITALS. PURSUENT TO THE AMENDED BYLAWS BEING APPROVED IN FY15, THE AUXILIARY'S OPERATIONS WERE EXPANDED TO INCLUDE TAX EXEMPT ORGANIZATIONS AFFILIATED OR OPERATED BY MSHA AND TO ESTABLISH SEPARATE DIVISIONS. DURING THE YEAR, THREE OF MSHA'S MAJORITY OWNED HOSPITALS TRANSFERRED THEIR AUXILIARY OPERATIONS TO MOUNTAIN STATES AUXILIARY TO TAKE ADVANTAGE OF COMMON INTERESTS, COORDINATED FUNDRAISING, MOUNTAIN STATES' EXPERTISE IN DEVELOPING HOSPITAL VOLUNTEER PROGRAMS, AND TO COORDINATE ADMINISTRATIVE FUNCTIONS SUCH AS ACCOUNTING. FOR EXAMPLE, THE AUXILIARY ESTABLISHED A SEPARATE DIVISION FOR SMYTH COUNTY COMMUNITY HOSPITAL, A MSHA MAJORITY OWNED (80%) FACILITY LOCATED IN VIRGINIA. THE AUXILIARY ADDED THREE DIVISIONS DURING FY15, PROVIDING SERVICES TO THE FOLLOWING MSHA MAJORITY OWNED HOSPITALS: SMYTH COUNTY COMMUNITY HOSPITAL - EIN 54-0794913 NORTON COMMUNITY HOSPITAL - EIN 54-0566029 DICKENSON COMMUNITY HOSPITAL - EIN 77-0599553 THE AUTHORITY UNDER WHICH THE BYLAWS WERE AMENDED REQUIRED AN AFFIRMATIVE VOTE OF TWO-THIRDS OF THE MEMBERS OF THE AUXILIARY'S BOARD OF DIRECTORS AS WELL AS APPROVAL BY MOUNTAIN STATES HEALTH ALLIANCE'S BOARD OF DIRECTORS. |
| PART IV, LINE 5B | REFERENCE NARRATIVE IN PART IV, LINE 5A (ABOVE). |
| PART IV, LINE 6 | MSHA AUXILIARY PROVIDED SMALL DOLLAR CONTRIBUTIONS TO A FEW OTHER 501(C)(3) ORGANIZATIONS THAT DO NOT MEET THE CRITERIA IN LINES 6A-6C. FOR EXAMPLE, 1,500 WAS DONATED TO A 501(C)(3) ORGANIZATION THAT SUPPORTS THE ELDERLY. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | (CONT'D) HOME VOLUNTEERS, NOT REFLECTED IN OUR "ACTIVE" VOLUNTEER COUNT REPORTED ON LINE 6 OF PART I, CONSIST OF VOLUNTEERS WHO KNIT, CROCHET AND SEW BABY CAPS, BLANKETS, BOOTIES, AND BABY-SIZED CHRISTMAS STOCKINGS, ALL FOR NEWBORNS. THESE GROUPS ALSO PROVIDE LAP BLANKETS, HATS FOR CANCER PATIENTS AND CHILD-FRIENDLY QUILTS FOR EACH PEDIATRIC SURGERY PATIENT AT NISWONGER CHILDREN'S HOSPITAL AS WELL AS COMFORT ITEMS FOR PATIENTS, INCLUDING EMERGENCY ROOM PATIENTS. THESE VOLUNTEERS MAY WORK INDIVIDUALLY OR AS PART OF A GROUP, MEETING IN SOMEONE'S HOME. THE VOLUNTEERS WITHIN THE AUXILIARY ARE A TEAM OF PEOPLE DEDICATED TO HIGH-QUALITY, PATIENT-CENTERED CARE. IT IS OUR BELIEF THAT WORKING TOGETHER AS A TEAM, SHARING A COMMON OBJECTIVE OF EXCELLENT SERVICE, IS WHAT HAS EARNED MSHA FACILITIES THE RECOGINITION OF BEING PART OF THE FINEST HEALTH CARE SYSTEM IN OUR REGION. WE ARE COMMITTED TO PROVIDING SERVICES TO PATIENTS IN A CARING, LOVING, AND RESPECTFUL WAY. VOLUNTEERS ARE HELPING MSHA TO MEET THE NEEDS OF ALL OUR PATIENTS AND THEIR FAMILIES IN AN ENVIRONMENT OF CARE, UNDERSTANDING AND COMPASSION. THERE ARE MANY DIFFERENT SERVICE AND SPECIAL PROJECT OPPORTUNITIES FOR VOLUNTEERS THROUGHOUT MSHA'S SERVICE AREAS. THE MSHA VOLUNTEER AND AUXILIARY RESOURCES DEPARTMENT WORKS VERY CLOSELY WITH VOLUNTEERS TO ENSURE APPROPRIATE VOLUNTEER PLACEMENT SO THAT EACH VOLUNTEER MAY PROVIDE SERVICE IN AN AREA THAT IS A GOOD MATCH FOR HIM/HER. AUXILIARY VOLUNTEERS HAVE THE SAME ONBOARDING PROCESS AS PAID TEAM MEMBERS; INCLUDING, BUT NOT LIMITED TO, REQUIRED IMMUNIZATIONS, ORIENTATION, BACKGROUND CHECKS AND UNIT/DEPARTMENT TRAINING WHERE THEY WILL BE ASSIGNED. ANNUAL EVALUATIONS ARE CONDUCTED TO ENSURE A CONSISTENT PROVISION OF QUALITY SERVICE TO PATIENTS, VISITORS, AND TEAM MEMBERS. VOLUNTEERS WORK THROUGHOUT THE YEAR TO ASSIST HOSPITAL STAFF, PATIENTS AND PATIENT FAMILIES. SOME OF THE SERVICES PROVIDED BY AUXILIARY VOLUNTEERS DURING FY15 INCLUDE: PATIENT AMBASSADOR PROGRAMS CONSIST OF TRAINED VOLUNTEERS VISITING WITH PATIENTS AND/OR FAMILIES, HANDLING THEIR CONCERNS, OR FORWARDING A CONCERN ON TO APPROPRIATE PERSONS. THIS PROGRAM ALSO RECOGNIZES TEAM MEMBERS RECEIVING COMPLIMENTS BY PATIENTS AND VISITORS. AMBASSADORS CAN ANSWER MOST NON-MEDICAL QUESTIONS. THE PROGRAM IS PROVIDED AT JOHNSON CITY MEDICAL CENTER, INDIAN PATH MEDICAL CENTER, AND FRANKLIN WOODS COMMUNITY HOSPITAL. MENDED HEARTS PROGRAM (JCMC AND IPMC). MENDED HEARTS IS AFFILIATED WITH THE AMERICAN COLLEGE OF CARDIOLOGISTS. THE PROGRAM'S MISSION IS DEDICATED TO "INSPIRING HOPE AND IMPROVING THE QUALITY OF LIFE FOR HEART PATIENTS AND THEIR FAMILIES THROUGH ONGOING PEER-TO-PEER SUPPORT". FREE MONTHLY PROGRAMS WITH RELEVANT SPEAKERS, USUALLY WITH A HEART-HEALTHY MEAL PROVIDED, ARE AVAILABLE FOR PERSONS WITH A HISTORY OF HEART PROBLEMS. THE PROGRAM SUPPORTS THE PATIENT AND FAMILY THROUGH HOSPITALIZATION, REHABILITATION AND BEYOND. THE PROGRAM HAS 25 TRAINED AND ACCREDITED VOLUNTEERS, REFERRED TO AS "HEART VISITORS". THE HEART VISITORS ARE THERE EVERY DAY TO ANSWER QUESTIONS FOR CARDIAC PATIENTS AND THEIR FAMILIES, RELIEVING SOME OF THEIR ANXIETY. IN FY15, HEART VISITORS BEGAN VISITING PATIENTS HAVING HEART CATHETERIZATIONS, DISTRIBUTING A PACKET OF INFORMATION PROVIDED BY THE NATIONAL MENDED HEART ORGANIZATION. THE MENDED LITTLE HEARTS PROGRAM FOR NISWONGER CHILDREN'S HOSPITAL WAS ESTABLISHED THIS YEAR TO SUPPORT FAMILIES OF CHILDREN WITH HEART RELATED ISSUES. A COORDINATOR MEETS WITH THIS SUPPORT GROUP MONTHLY TO COVER VARIOUS TOPICS OF INTEREST, WHILE CHILDCARE IS PROVIDED CLOSE-BY. EACH YEAR, THE NATIONAL MENDED HEARTS ORGANIZATION HONORS ONE VOLUNTEER FROM ACROSS THE COUNTRY WHO HAS DEMONSTRATED OUTSTANDING SERVICE IN SUPPORT OF THE MENDED HEARTS' MISSION OVER THE COURSE OF THAT PERSON'S MEMBERSHIP. DURING FY15, THE 62ND MENDED HEARTS ANNUAL NATIONAL EDUCATION & TRAINING CONFERENCE HONORED LYNN FRIERSON, MSHA AUXILIARY BOARD PRESIDENT AND ORGANIZER OF MSHA'S MENDED HEARTS PROGRAMS, WITH THE COVETED VOLUNTEER OF THE YEAR AWARD. THE CRITERIA FOR THE AWARD INCLUDE LENGTH OF SERVICE PARTICIPATION ON NATIONAL BOARDS, COMMITTEES AND TASK FORCES; AND OTHER ACHIEVEMENTS THAT ADVANCE THE PROGRAM'S MISSION. COURTESY CARTS (AT JCMC, NISWONGER CHILDREN'S HOSPITAL, AND FWCH) DELIVER PATIENTS, STAFF AND VISITORS TO/FROM THEIR CARS AND ANY DOOR OF THE HOSPITALS. A RED DIRECT-LINE PHONE IS IN THE JCMC AND FWCH LOBBIES FOR PERSONS TO CALL FOR PICK UP. THIS PROGRAM IS ESPECIALLY BENEFICIAL FOR ANYONE WITH LIMITED MOBILITY OR DURING BAD WEATHER. THE PATIENT VOLUME AT FWCH HAS SIGNIFICANTLY INCREASED, CREATING A PARKING CHALLENGE AND MAKING THE COURTESY CARTS ESPECIALLY HELPFUL FOR THOSE WHO MUST PARK FURTHER AWAY. SURGERY WAITING AREAS (AT IPMC, FWCH, AND SCCH) ARE STAFFED BY VOLUNTEERS. THE VOLUNTEERS KEEP FAMILIES INFORMED ABOUT THE STATUS OF PATIENTS, ARRANGE PRIVATE MEETINGS WITH THE PHYSICIAN AND FAMILY MEMBERS, AND STRIVE TO MEET ANY IMMEDIATE NEED THAT A VOLUNTEER CAN PROVIDE SUCH AS DIRECTIONS, PHONE NUMBERS, SNACKS, ETC. FRESH BAKED COOKIES ARE BAKED AND DELIVERED AT NO CHARGE TO WAITING AREAS BY VOLUNTEERS (AT JCMC, NICH, FWCH, IPMC, AND SSH). VISUAL ARTS PROGRAM (JCMC AND IPMC) ROTATES ART EXHIBITS BY LOCAL ARTISTS, WHICH ARE DISPLAYED IN MAIN HALLWAYS OF JCMC AND IPMC. AUXILIARY-OPERATED GIFT SHOPS (ALL MSHA HOSPITALS) PROVIDE MERCHANDISE FOR PATIENTS, VISITORS AND TEAM MEMBERS. THE GIFT SHOP VOLUNTEERS NOT ONLY SELL MERCHANDISE; BUT, MORE OFTEN THAN NOT, PROVIDE A LISTENING EAR TO FAMILY MEMBERS NEEDING TO VERBALIZE CONCERNS ABOUT THEIR HOSPITALIZED FAMILY MEMBERS. JUNIOR VOLUNTEER PROGRAM (AT JCMC, FWCH, IPMC, SSH, JMH, AND UCMH) IS A SUMMER EDUCATIONAL/VOLUNTEER PROGRAM FOR HIGH SCHOOL STUDENTS TO ASSIST THEM IN DETERMINING IF THEY HAVE AN INTEREST IN HEALTHCARE CAREERS. AT JCMC THE AUXILIARY MEETS WITH PATIENTS PRIOR TO DISCHARGE, PRIMARILY TO IDENTIFY IF EDUCATIONAL NEEDS WERE MET. VOLUNTEERS ASSIST IN THE CANCER TREATMENT CENTERS (AT IPMC, JCMC, AND JMH) BY PROVIDING DIVERSIONARY ACTIVITIES FOR CHEMO PATIENTS SUCH AS ART THERAPY, GAMES, ETC., OR JUST PROVIDING COMPANY FOR THEM. THE AUXILIARY PROVIDES WEEKLY ASSISTANCE FOR THE HEALTHCARE RESOURCE CENTER(HRC)IN THE KINGSPORT TOWN CENTER. THE HRC IS AN OUTREACH SERVICE OF MSHA THAT OFFERS HEALTH PROGRAMS AND SCREENINGS DESIGNED TO HELP INDIVIDUALS LIVE HEALTHIER LIVES. THE HRC STAFFS EXPERIENCED REGISTERED NURSES AND OTHER HEALTH PROFESSIONS THAT HELP ANSWER MEDICAL QUESTIONS AND DISTRIBUTE LITERATURE THAT PROVIDE UP-TO-DATE HEALTH INFORMATION FOR THE COMMUNITY. IN 2015, MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY RECEIVED THE PRESTIGIOUS FAITH IN THE FUTURE AWARD FROM CENTURY LINK (IN THE HEALTHCARE CATEGORY). THE AWARD RECOGNIZES BUSINESSES THAT DEMONSTRATE A COMMITMENT TO THE FUTURE OF THEIR BUSINESS, THEIR EMPLOYEES, THEIR COMMUNITY, AND THE REGION. THE AWARD NOMINATION NOTED THAT THE AUXILIARY MEMBERS INSPIRE BY EXAMPLE WITH THEIR VOLUNTEERISM, AND THEY QUITE OFTEN SERVE AS THE FIRST AND LAST PERSON FROM MOUNTAIN STATES THAT OUR PATIENTS SEE DURING HOSPITAL STAYS. VOLUNTEER CHAPLAINS: THE STAFF OF THE SPIRITUAL AND PASTORAL CARE DEPARTMENT ENDEAVORS TO AFFIRM AND RESPECT EACH PERSON, TO BE INCLUSIVE OF ALL, AND TO APPROACH DIVERSE RELIGIOUS CONVICTIONS WITH SENSITIVITY. OUR EMPLOYED CHAPLAINS ARE SUPPLEMENTED BY A HIGH-QUALITY CORPS OF VOLUNTEER CHAPLAINS COMPOSED OF REPRESENTATIVES OF VARIOUS DENOMINATIONS IN OUR AREA. IN SELECTING THESE PERSONS, WE SEEK PEOPLE WHO WILL ADHERE TO OUR CODE OF ETHICS AND WILL ATTEMPT TO RELATE TO THE PATIENT'S PARTICULAR RELIGIOUS/SPIRITUAL UNDERSTANDING AND NOT PROSELYTIZE OR COERCE. EACH VOLUNTEER CHAPLAIN PARTICIPATING IN THE MSHA SPIRITUAL AND PASTORAL CARE DEPARTMENT GOES THROUGH A RIGOROUS INTERVIEW AND TRAINING REGIMEN FOUND IN OUR GUIDE TO CLINICAL PRACTICE. THIS 57-PAGE DOCUMENT ORIENTS INDIVIDUALS TO PASTORAL CARE AND MOUNTAIN STATES HEALTH ALLIANCE FACILITIES. VOLUNTEER CHAPLAINS WORK IN THE HOSPITALS THROUGHOUT MSHA. THEY PROVIDE PASTORAL CARE VISITATION AND SUPPORT TO PATIENTS, FAMILIES OF PATIENTS AND TEAM MEMBERS. WHERE IMPLEMENTED, OUR CHAPLAIN PROGRAMS ARE ON-CALL, 24 HOURS A DAY, 7 DAYS A WEEK. AT OUR LARGER HOSPITALS, WE HAVE SPIRITUAL CARE VOLUNTEERS WHO PROVIDE SCHEDULED COVERAGE AND DAILY VISITATIONS FOR ADDED SUPPORT AND PRESENCE. DURING FY15, WE ESTABLISHED A VOLUNTEER CHAPLAIN PROGRAM AT UNICOI COUNTY MEMORIAL HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, AND SMYTH COUNTY COMMUNITY HOSPITAL (SCCH). AT SCCH, A SPIRITUAL CARE TEAM COMPOSED OF FELLOW SCCH TEAM MEMBERS WAS ESTABLISHED. THESE TEAM MEMBERS PROVIDE SUPPORT TO PATIENTS AND FAMILIES WAITING FOR THEIR OWN PASTOR OR OUR VOLUNTEER CHAPLAINS TO ARRIVE. THE TEAM HAS RECEIVED TRAINING RELATIVE TO THE PURPOSE AND FUNCTION OF SPIRITUAL CARE. AT JUNE 30, 2015, MOUNTAIN STATES HEALTH ALLIANCE HAD 137 VOLUNTEER CHAPLAINS. DURING 2015, OUR VOLUNTEER CHAPLAINS PROVIDED 15,223 HOURS OF SUPPORT AND MADE 33,269 CONTACTS. IN ADDITION TO THE MAN |
| FORM 990, PAGE 6, PART VI, LINE 4 | MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY ("AUXILIARY") AMENDED ITS BYLAWS DURING FY15. THE ONLY SIGNIFICANT CHANGE WAS TO EXPAND THE OPERATIONS OF THE AUXILIARY TO INCLUDE SEPARATE DIVISIONS FOR THE VARIOUS HEALTHCARE FACILITIES AFFILIATED WITH OR OPERATED BY MOUNTAIN STATES HEALTH ALLIANCE AND TO DESIGNATE AUXILIARY BOARD OF DIRECTOR CHANGES, INCLUDING ADDING DIRECTORS FROM EACH DIVISION OF THE AUXILIARY. THE AMENDED BYLAWS DEFINE THE RULES OF THE SEPARATE DIVISIONS, SUCH AS: NUMBER OF BOARD DIRECTORS TO SERVE ON THE AUXILIARY BOARD, ROLES AND DUTIES OF DIRECTORS, RULES AND PROCEDURES FOR BOARD MEETINGS, ETC. |
| FORM 990, PAGE 6, PART VI, LINE 11B | PRIOR TO FILING THE FORM 990 WITH THE IRS, THE COMPLETED RETURN WAS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE AUXILIARY'S BOARD OF DIRECTORS. COPIES OF THE RETURN WERE ALSO PROVIDED FOR ABSENT BOARD MEMBERS. THE REVIEW WAS CONDUCTED BY A MOUNTAIN STATES HEALTH ALLIANCE SENIOR TAX ACCOUNTANT. THE EXECUTIVE COMMITTEE IS COMPRISED OF INDIVIDUALS WITH LONG TENURE WITH THE AUXILIARY SO THEY ARE VERY FAMILIAR WITH THE FORM 990. |
| 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(INCLUDING THE AUXILIARY). 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 AUXILIARY IS LED BY A DIRECTOR OF MOUNTAIN STATES HEALTH ALLIANCE AND UNDERGOES THE SAME EMPLOYMENT REQUIREMENTS OF ANY DIRECTOR LEVEL TEAM MEMBER. SINCE THE DIRECTOR IS NOT A VICE-PRESIDENT OR IN A SENIOR LEADERSHIP POSITION, HER COMPENSATION AND BENEFITS ARE CONSISTENT WITH OTHER MHSA NON-EXECUTIVE POSITIONS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN TEMPORARILY RESTRICTED ASSETS -26,142 |
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