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 | |||||
| Total | ||||||
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...... | 16,472,889 | 27,381,971 | 29,434,006 | 30,084,214 | 28,762,811 | 132,135,891 |
| 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. | 16,472,889 | 27,381,971 | 29,434,006 | 30,084,214 | 28,762,811 | 132,135,891 |
| 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. | 1,853,503 | 4,632,509 | 5,799,266 | 7,997,059 | 6,796,967 | 27,079,304 |
| c | Add lines 7a and 7b.. | 1,853,503 | 4,632,509 | 5,799,266 | 7,997,059 | 6,796,967 | 27,079,304 |
| 8 | Public support (Subtract line 7c from line 6.) | 105,056,587 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 16,472,889 | 27,381,971 | 29,434,006 | 30,084,214 | 28,762,811 | 132,135,891 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,644 | 1,644 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,644 | 1,644 | ||||
| 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.).. | 16,474,533 | 27,381,971 | 29,434,006 | 30,084,214 | 28,762,811 | 132,137,535 |
| 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 |
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|
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) |
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|
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. |
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| 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 |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
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 - ORGANIZATION'S MISSION | APPALACHIAN EMERGENCY PHYSICIANS IS ORGANIZED AND OPERATED FOR CHARITABLE PURPOSES, WHICH INCLUDE THE PROVISION OF EMERGENCY PHYSICIAN SERVICES TO ACUTE CARE HOSPITAL FACILITIES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. |
| FORM 990, PAGE 2, PART III, LINE 4A | APPALACHIAN EMERGENCY PHYSICIANS HELPS TO FULFILL A NEED IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE FOR ACUTE CARE FACILITIES THAT HAVE ENCOUNTERED PROBLEMS IN SECURING COMPREHENSIVE PHYSICIAN COVERAGE WITHIN THE FIELD OF EMERGENCY MEDICINE. AEP WILL ENSURE THAT PATIENTS ARE TREATED FOR MEDICALLY NECESSARY CONDITIONS REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, IN A MANNER CONSISTENT WITH THE PATIENT FINANCIAL ASSISTANCE PROGRAM APPLICABLE FOR EACH RESPECTIVE HOSPITAL WHERE AEP PROVIDES EMERGENCY SERVICES. IN RECOGNIZING THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES, AEP WILL NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR PATIENT FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY FOR EACH RESPECTIVE HOSPITAL FACILITY SERVICED BY AEP HAS BEEN ADOPTED BY THE AEP BOARD WITH RESPECT TO SERVICES AT THE RESPECTIVE FACILITY. AEP IS ORGANIZED AND OPERATED AS AN EMERGENCY PHYSICIAN DEVELOPMENT SERVICE. SPECIFICALLY, AEP WILL (I) RECRUIT AND CONTRACT WITH A STABLE BASE OF PHYSICIANS AND MID-LEVEL PROVIDERS (E.G. NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS) TO SUPPORT THE LEVEL OF EMERGENCY MEDICAL CARE REQUIRED FOR MSHA ACUTE CARE HOSPITAL FACILITIES; (II) CREATE A VEHICLE FOR FUTURE COLLABORATION BETWEEN MSHA HOSPITALS AND THEIR MEDICAL STAFFS; AND (III) STABILIZE THE PROVISION OF EMERGENCY CARE THROUGH EXISTING PHYSICIAN PRACTICES IN SOUTHWEST VIRGINIA AND NORTHEAST TENNESSEE. AEP PROVIDES EMERGENCY MEDICINE PROFESSIONAL COVERAGE BY CONTRACT FOR THE FOLLOWING HOSPITALS: JOHNSON CITY MEDICAL CENTER (TN) FRANKLIN WOODS COMMUNITY HOSPITAL (TN) NISWONGER CHILDREN'S HOSPITAL (TN) INDIAN PATH MEDICAL CENTER (TN) SYCAMORE SHOALS HOSPITAL (TN) JOHNSON COUNTY COMMUNITY HOSPITAL (TN) UNICOI COUNTY MEMORIAL HOSPITAL (TN) NORTON COMMUNITY HOSPITAL (VA) DICKENSON COMMUNITY HOSPITAL (VA) RUSSELL COUNTY MEDICAL CENTER (VA), AND SMYTH COUNTY COMMUNITY HOSPITAL (VA) EACH OF THESE HOSPITAL FACILITIES IS EITHER WHOLLY OR PARTIALLY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). MSHA IS A NONPROFIT HEALTH SYSTEM BASED IN JOHNSON CITY, TN. MSHA IS TAX-EXEMPT UNDER IRC SECTION 501(C)(3). WHILE SOME MSHA REPRESENTATIVES ARE ON AEP'S GOVERNING BOARD, MSHA AND ITS AFFILIATES DO NOT CONTROL AEP'S BOARD OR THE MANNER IN WHICH AEP IS OPERATED, MANAGED, OR GOVERNED. MEDICAL SERVICES ARE PROVIDED TO INDIVIDUALS PRESENTING TO THE EMERGENCY DEPARTMENT OF ONE OF THE AFOREMENTIONED HOSPITAL FACILITIES AND ARE BASED UPON EMERGENCY MEDICAL NEED. AEP FOLLOWS THE PATIENT FINANCIAL ASSISTANCE POLICIES AND PROCEDURES ADOPTED BY EACH OF THE AFOREMENTIONED HOSPITAL FACILITIES FOR THE TREATMENT OF PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY. AS SUCH SERVICES ARE MADE AVAILABLE TO THE GENERAL PUBLIC, AEP MAY INCIDENTALLY PROVIDE EMERGENCY SERVICES TO OFFICERS, DIRECTORS, EMPLOYEES AND INDEPENDENT CONTRACTORS. HOWEVER, SUCH INDIVIDUALS WOULD NOT BE TREATED DIFFERENTLY THAN OTHER PATIENTS AND SUCH SERVICES WOULD ONLY BE MADE AVAILABLE IN THE NORMAL COURSE OF AEP'S BUSINESS OPERATIONS. |
| FORM 990, PAGE 6, PART VI, LINE 4 | CHANGES TO THE BYLAWS WERE MADE TO INCREASE THE NUMBER OF MAXIMUM DIRECTORS FROM 5 TO 9. |
| FORM 990, PAGE 6, PART VI, LINE 11B | AEP'S TAX PREPARER REVIEWED THE FORM 990 WITH AEP'S BOARD MEMBERS PRIOR TO FILING THE RETURN WITH THE IRS. BOARD MEMBERS RECEIVED A COPY OF THE FORM 990 PRIOR TO THE REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 12C | EXPLANATION: EVERY COVERED PERSON AS DEFINED BY THE CONFLICT OF INTEREST POLICY ADOPTED BY THE BOARD OF DIRECTORS SHALL BE SUBJECT TO THAT POLICY. AS PART OF SAID POLICY, EVERY COVERED PERSON SHALL COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT IN ACCORDANCE WITH THE REQUIREMENT OF THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | EXPLANATION: AEP HAS ENTERED INTO PROFESSIONAL SERVICE CONTRACTS WITH PHYSICIANS TO ASSIST AEP IN PROVIDING EMERGENCY SERVICE COVERAGE TO HOSPITALS. THESE AGREEMENTS MAY INCLUDE FIXED RATES AND BONUSES BASED ON PRODUCTIVITY OR ACHIEVING QUALITY,PATIENT SATISFACTION SCORES OR OTHER QUALITY METRICS. THE METHODOLOGY OR AMOUNT OF THE BONUS IS FIXED AND SET IN ADVANCE WITHIN EACH CONTRACT. BONUS FORMULAS ARE BASED UPON REACHED PRE- DETERMINED AND OBJECTIVELY VERIFIABLE PERFORMANCE METRICS. IN ADDITION TO ADDRESSING EXCESS BENEFIT, PRIVATE INUREMENT AND PRIVATE BENEFIT CONCERNS, AEP'S COMPENSATION ARRANGEMENTS ARE STRUCTURED IN A MANNER TO COMPLY WITH APPLICABLE FRAUD AND ABUSE LAWS THAT APPLY TO HEALTH CARE PROVIDERS. AEP HAS NEGOTIATED EACH OF ITS COMPENSATION ARRANGEMENTS AT ARM'S LENGTH. THE AGREEMENTS INCLUDE COMMERCIALLY REASONABLE TERMS AND CONDITIONS WITH A COMPENSATION ARRANGEMENT THAT IS CONSISTENT WITH FAIR MARKET VALUE FOR THE SERVICES RENDERED. THE TERMS AND CONDITIONS OF SUCH ARRANGEMENTS HAVE BEEN, ARE AND WILL CONTINUE TO BE SET THROUGH GOOD FAITH NEGOTIATIONS AMONG THE RELEVANT PARTIES IN AN EFFORT TO BE CONSISTENT WITH SIMILAR ARRANGEMENTS FOR OTHER HEALTH CARE PROVIDERS PROVIDING SIMILAR SERVICES IN SIMILAR SPECIALTIES WITHIN SOUTHWESTERN VIRGINIA AND NORTHEASTERN TENNESSEE. NATIONAL PHYSICIAN COMPENSATION SURVEY DATA (E.G. MGMA PHYSICIAN COMPENSATION SURVEY) AND OTHER OBJECTIVE COMPARABLE DATA HAS BEEN AND WILL CONTINUE TO BE USED AS THE BASIS FOR SETTING PHYSICIAN COMPENSATION ARRANGEMENTS. AEP ALSO UTILIZES THE SERVICES OF NATIONALLY-RECOGNIZED VALUATION FIRMS TO EVALUATE CERTAIN PROPOSED COMPENSATION ARRANGEMENTS TO ENSURE THAT THEY ARE CONSISTENT WITH FAIR MARKET VALUE AND ARE COMMERCIALLY REASONABLE. IN ADDITION TO COMPENSATION RECEIVED FOR PROVISION OF PHYSICIAN SERVICES, AN ADDENDUM WAS ADDED TO THE CURRENT PRESIDENT'S WRITTEN CONTRACT AS AN INDPENDENT CONTRACTOR THAT DESCRIBES HIS DUTIES AND RESPONSIBILITIES AS PRESIDENT AS WELL AS HIS COMPENSATION FOR THE ADDITIONAL RESPONSIBILITIES AS PRESIDENT. THE ADDENDUM WAS APPROVED BY AEP'S BOARD AND THE COMPENSATION WAS DEEMED REASONABLE BY AN OUTSIDE AND INDEPENDENT VALUATION FIRM. |
| FORM 990, PAGE 6, PART VI, LINE 15B | EXPLANATION: DIRECTOR MOODY RECEIVES COMPENSATION FROM AEP AS AN INDEPENDENT CONTRACTOR FOR HIS PROVISION OF PHYSICIAN SERVICES TO HOSPITALS SERVICED BY AEP. HE AND DIRECTOR/PRESIDENT PUHR ARE THE ONLY TWO DIRECTORS/OFFICERS PAID BY AEP. |
| FORM 990, PAGE 6, PART VI, LINE 19 | EXPLANATION: THE CONFLICT OF INTEREST POLICY, IN ADDITION TO OTHER GOVERNING POLICIES, IS AVAILABLE UPON REQUEST. ALL CORPORATE POLICIES AND CORPORATE FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A - COMPENSATION OF DIRECTORS AND OFFICERS EXPLANATION: AEP DOES NOT COMPENSATE ITS OFFICERS AND DIRECTORS EXCEPT AS FOLLOWS: PRESIDENT/DIRECTOR PUHR AND DIRECTOR MOODY ARE PAID BY AEP FOR PHYSICIAN SERVICES THEY PROVIDE TO HOSPITALS. IN ADDITION, PUHR RECEIVES ADDITIONAL COMPENSATION, AS APPROVED BY THE BOARD, FOR HIS SERVICES TO THE ORGANIZATION AS PRESIDENT. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES 22,469,038 0 0 MANAGEMENT & BILLING SERVICES 4,365,977 0 0 CONSULTING 0 7,548 0 |
| Software ID: | |
| Software Version: |