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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 55,725 | 38,508 | 7,086 | 5,358 | 106,677 | |
| 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...... | 13,594,208 | 667,540,667 | 66,564,675 | 73,921,151 | 74,067,183 | 895,687,884 |
| 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. | 13,594,208 | 667,596,392 | 66,603,183 | 73,928,237 | 74,072,541 | 895,794,561 |
| 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.) | 895,794,561 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 13,594,208 | 667,596,392 | 66,603,183 | 73,928,237 | 74,072,541 | 895,794,561 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 45,201 | 153,831 | 156,801 | 89,681 | 445,514 | |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 45,201 | 153,831 | 156,801 | 89,681 | 445,514 | |
| 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.).. | 13,639,409 | 667,596,392 | 66,757,014 | 74,085,038 | 74,162,222 | 896,240,075 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| 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, PAGE 2, PART III, LINE 4A | WE ARE DEDICATED TO IMPROVING OUR COMMUNITY'S ACCESS TO QUALITY, AFFORDABLE HEALTH CARE, EDUCATING OUR REGION'S CAREGIVERS, IMPROVING THE HEALTH STATUS OF OUR COMMUNITIES AND CONTRIBUTING TO THE OVERALL QUALITY OF LIFE IN THE AREAS WE SERVE. IN FISCAL YEAR 2016, WE HAD 440,371 OFFICE VISITS AND 140,403 HOSPITAL/NURSING HOME VISITS AND PATIENT ENCOUNTERS OF 580,774. REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, WELLMONT MEDICAL ASSOCIATES, INC. TREATS ALL PATIENTS FOR MEDICALLY NECESSARY CONDITIONS. RECOGNIZING THAT SOME PATIENTS CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, WE PROVIDED CARE FOR INDIGENT PATIENTS INCURRING COSTS OF 1,093,838. ADDITIONALLY, WE PROVIDED CARE TO PERSONS COVERED BY MEDICARE, MEDICAID, TENNCARE AND CHAMPUS AT LESS THAN COST. DUE TO MANDATED REDUCTIONS IN MEDICARE FUNDING FROM THE BALANCED BUDGET ACT AND DECLINING REIMBURSEMENT FROM TENNCARE, THE SHORTFALL BETWEEN RECEIPTS AND THE COST OF PROVIDING CARE TO THESE PATIENTS TOTALED 36,342,176. OVERALL, WE RETURNED MORE THAN 35,248,338 IN BENEFITS TO OUR REGION. IT IS OUR OBLIGATION TO SUPPORT THE CAUSES THAT IMPROVE THE QUALITY OF LIFE IN OUR REGION. WE SPONSORED EDUCATIONAL, COMMUNITY-BASED PROGRAMS ON HEALTHY LIFESTYLES, RISK FACTOR IDENTIFICATION AND OPTIONS FOR DIAGNOSIS AND TREATMENT. PROGRAMS INCLUDED: - LECTURES ABOUT ASTHMA TO AREA ELEMENTARY SCHOOLS - WORKING WITH FRIENDS IN NEED, WHICH PROVIDES ON-SITE PRIMARY CARE - PROVIDING FREE MEDICAL CARE THROUGH REMOTE AREA MEDICAL CLINIC - WORKING WITH APPALACHIAN MOUNTAIN PROJECT ACCESS - TEACHING AT LINCOLN MEMORIAL UNIVERSITY-DEBUSK COLLEGE OF OSTEOPATHIC MEDICINE - TEACHING AT UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE - PROVIDING A FREE CLINIC IN CHURCH HILL, TENNESSEE - THE HEALTH WAGON IN WISE, VIRGINIA WE ALSO PARTICIPATED IN A NUMBER OF HEALTH FAIRS AND COMMUNITY SCREENINGS. EMPLOYEES GAVE THEIR TIME TO AREA NONPROFIT ORGANIZATIONS, WHICH INCLUDED THE UNITED WAY AND THE TRI-CITIES AFFILIATE OF SUSAN G. KOMEN FOR THE CURE. THEY ALSO DONATED AS PART OF WELLMONT'S EMPLOYEE GIVING CAMPAIGN TO FUNDS SUCH AS THE WELLMONT CANCER INSTITUTE PATIENT ASSISTANCE FUND, EMPLOYEE EMERGENCY FUND AND MANY OTHERS. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE BUSINESS AND AFFAIRS OF WELLMONT MEDICAL ASSOCIATES, INC. (THE CORPORATION) SHALL BE GOVERNED EXCLUSIVELY BY THE BOARD OF DIRECTORS. THE CORPORATION'S BOARD OF DIRECTORS IS DESIGNATED BY WELLMONT HEALTH SYSTEM, THE SOLE MEMBER OF THE CORPORATION. IN ADDITION TO SUCH RIGHTS OF APPROVAL AND CONSENT AS MAY BE RESERVED TO THE SOLE MEMBER OF THE CORPORATION PURSUANT TO APPLICABLE LAW, TRANSACTIONS OF THE FOLLOWING MATTERS BY THE CORPORATION SHALL REQUIRE THE PRIOR APPROVAL OF WELLMONT HEALTH SYSTEM, THE SOLE MEMBER OF THE CORPORATION: (A) IMPLEMENTATION OF CORPORATION'S ANNUAL BUDGET, (B) INCURRING ANY LOAN OR OTHER INDEBTEDNESS FOR BORROWED MONEY, (C) ACQUISITION OF ANY EQUIPMENT OR PERSONAL PROPERTY FOR A PURCHASE PRICE IN EXCESS OF 50,000 OR THE ACQUISITION OF ANY REAL ESTATE, REGARDLESS OF PURCHASE PRICE, (D) THE UNDERTAKING OF CERTAIN CONTRACTUAL COMMITMENTS, (E) ENTERING INTO ANY PLAN OF MERGER OR CONSOLIDATION, (F) ACQUISITION OF SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER LEGAL ENTITY, AND (G) INSTITUTION OF ANY LITIGATION BY OR ON BEHALF OF CORPORATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | SEE FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION. |
| FORM 990, PAGE 6, PART VI, LINE 7B | SEE FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION. |
| FORM 990, PAGE 6, PART VI, LINE 9 | MARGARET DENARVAEZ (TERMED 9/16/14) 1905 AMERICAN WAY KINGSPORT, TN 37660 JOSEPH SMIDDY, M.D. (TERMED 9/18/14) 1905 AMERICAN WAY KINGSPORT, TN 37660 JASON BRAZEE, M.D. (TERMED 2/7/15) 1905 AMERICAN WAY KINGSPORT, TN 37660 KIM ONESKO (TERMED 12/2/16) 1905 AMERICAN WAY KINGSPORT, TN 37660 WILLIAM C. WILSON (TERMED 6/5/15) 1905 AMERICAN WAY KINGSPORT, TN 37660 |
| FORM 990, PAGE 6, PART VI, LINE 11B | WELLMONT MEDICAL ASSOCIATES, INC.'S FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER, THE CORPORATE CONTROLLER, AND THE MANAGER OF ACCOUNTING OF WELLMONT HEALTH SYSTEM, AND THE BOARD OF DIRECTORS OF WELLMONT MEDICAL ASSOCIATES, INC. PRIOR TO FILING. ANY QUESTIONS OR COMMENTS ARISING FROM THE INITIAL REVIEW ARE ADDRESSED TO ENSURE THE RETURN IS COMPLETE AND ACCURATE. ANY CHANGES OR CORRECTIONS ARE IDENTIFIED, REVISED IN THE RETURN, AND REVIEWED BY THE INDIVIDUALS LISTED ABOVE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT. ANY POTENTIAL CONFLICTS ARE DISCUSSED WITH THE COMPLIANCE AND AUDIT SERVICES DEPARTMENT, AS THEY ARISE. WELLMONT MEDICAL ASSOCIATES, INC.'S OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE GOVERNED BY WELLMONT HEALTH SYSTEM'S CONFLICT OF INTEREST POLICY. WELLMONT HEALTH SYSTEM ALSO HAS A POLICY ON BUSINESS PRACTICES THAT DISCUSSES CONFLICT OF INTEREST AND INFORMS THE WORKFORCE TO DISCLOSE ANY ISSUES TO THE COMPLIANCE AND AUDIT SERVICES DEPARTMENT, FOR RESOLUTION. WELLMONT HEALTH SYSTEM ALSO USES A HOTLINE THAT ALLOWS ANONYMOUS REPORTING OF POSSIBLE CONFLICT OF INTEREST SITUATIONS FOR INVESTIGATION BY THE COMPLIANCE AND AUDIT SERVICES DEPARTMENT. |
| FORM 990, PAGE 6, PART VI, LINE 15A | MAURICE NIDA, M.D. RECEIVES NO COMPENSATION FOR SERVING AS CHAIR OF THE BOARD OF DIRECTORS OF WELLMONT MEDICAL ASSOCIATES. THE COMPENSATION THAT MAURICE NIDA, M.D. RECEIVES AS A PHYSICIAN OF WELLMONT MEDICAL ASSOCIATES IS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM BOARD OF DIRECTORS. WELLMONT HEALTH SYSTEM USES ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE COMPENSATION OF MAURICE NIDA, M.D. THE COMPENSATION OF BARTON A. HOVE, THE PRESIDENT AND CEO OF WELLMONT HEALTH SYSTEM, IS REVIEWED, APPROVED AND DOCUMENTED BY THE WELLMONT HEALTH SYSTEM HUMAN RESOURCES COMMITTEE AND BOARD OF DIRECTORS. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. THE LAST COMPENSATION DELIBERATION AND REVIEW PROCESS FOR BARTON A. HOVE WAS COMPLETED AND APPROVED BY THE BOARD OF DIRECTORS OF WELLMONT HEALTH SYSTEM ON MARCH 20, 2015. |
| FORM 990, PAGE 6, PART VI, LINE 15B | WELLMONT MEDICAL ASSOCIATES USES ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE COMPENSATION OF STEPHEN COMBS, M.D., CHIEF EXECUTIVE MEDICAL OFFICER, KIM ONESKO, CHIEF ADMINISTRATIVE OFFICER, DAVID THOMPSON, M.D.,CHIEF ADMINISTRATIVE MEDICAL OFFICER, KAREN J. WILLIAMS, EXECUTIVE DIRECTOR WMA OPERATIONS, AND BRAD HALE, EXECUTIVE DIRECTOR OF FINANCE. IN ADDITION, THESE BODIES USE COMPARABILITY DATA TO DETERMINE THE APPROPRIATE COMPENSATION. ALL COMPENSATION DELIBERATIONS AND REVIEWS ARE CONTEMPORANEOUSLY DOCUMENTED. |
| FORM 990, PAGE 6, PART VI, LINE 19 | WELLMONT MEDICAL ASSOCIATES, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. WELLMONT HEALTH SYSTEM'S AUDITED FINANCIAL STATEMENTS AND QUARTERLY UNAUDITED FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE. |
| FORM 990, PAGE 7, PART VII | AVERAGE HOURS PER WEEK THE SECRETARY AND VARIOUS BOARD MEMBERS SERVE IN A DIFFERENT CAPACITY FOR SEVERAL RELATED ORGANIZATIONS. THE MAJORITY OF THEIR TIME IS DEVOTED TO A RELATED ORGANIZATION (GREATER THAN 38 HOURS PER WEEK). HOWEVER, BOARD MEMBERS WHO ARE PHYSICIANS HAVE DEDICATED AN AVERAGE OF 40 HOURS PER WEEK TO WELLMONT MEDICAL ASSOCIATES, INC. |
| FORM 990, PART XI, LINE 9 | INTERCOMPANY RESOLUTION 16,903,504 INTERCOMPANY-HOSPITAL ALLOCATIONS 31,206,831 TOTAL 48,110,335 |
| Software ID: | |
| Software Version: |