TY 2015 Form 990

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE
AUXILIARY

Employer identification number

58-1418345

Part I

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

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

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

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

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............. 4

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 (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)
(i)Name of supported organization	(ii) EIN		Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(A) MOUNTAIN STATES HEALTH ALLIANCE	620476282	3	Yes		59,245	8,806
(B) NORTON COMMUNITY HOSPITAL	540566029	3	Yes		6,757	1,339
(C) SMYTH COUNTY COMMUNITY HOSPITAL	540794913	3	Yes		0	1,263
(D) DICKENSON COUNTY COMMUNITY HOSPITAL	770599553	3	Yes		1,343	0
Total 4					67,345	11,408

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 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.

Section B. Total Support

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.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

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

Section A. Public Support

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

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Yes

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

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

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Yes

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
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)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
PART IV, SECTION A, 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, SECTION A, LINE 6	MSHA AUXILIARY PROVIDED SMALL DOLLAR CONTRIBUTIONS TO A FEW OTHER 501(C)(3) ORGANIZATIONS THAT DO NOT MEET THE CRITERIA IN LINES 6(I)-6(III). FOR EXAMPLE, 2,500 WAS DONATED TO A 501(C)(3) ORGANIZATION THAT SUPPORTS THE ELDERLY.

Return Reference

Explanation

PART IV, SECTION A, 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, SECTION A, LINE 6

MSHA AUXILIARY PROVIDED SMALL DOLLAR CONTRIBUTIONS TO A FEW OTHER 501(C)(3) ORGANIZATIONS THAT DO NOT MEET THE CRITERIA IN LINES 6(I)-6(III). FOR EXAMPLE, 2,500 WAS DONATED TO A 501(C)(3) ORGANIZATION THAT SUPPORTS THE ELDERLY.

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE
AUXILIARY

Employer identification number

58-1418345

Part I

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

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

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

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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

Part V

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

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on 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 ...
b	Buildings	294,352	164,678	129,674
c	Leasehold improvements	168,520	115,052	53,468
d	Equipment ...	423,569	335,942	87,627
e	Other ...
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				270,769

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

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

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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 (losses) 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' on 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	LINE 2: MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY IS INCLUDED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE FOOTNOTE EXPLANATION RELATIVE TO INCOME TAXES READS: "THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2016 AND 2015. AT JUNE 30, 2016, TAX RETURNS FOR 2013 THROUGH 2015 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE."

Return Reference

Explanation

SCHEDULE D, PAGE 3, PART X

LINE 2: MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY IS INCLUDED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE FOOTNOTE EXPLANATION RELATIVE TO INCOME TAXES READS: "THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2016 AND 2015. AT JUNE 30, 2016, TAX RETURNS FOR 2013 THROUGH 2015 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE."

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

Complete if the organization answered "Yes," on 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

2015

Open to Public
Inspection

Name of the organization
MOUNTAIN STATES HEALTH ALLIANCE
AUXILIARY

Employer identification number
58-1418345

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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) MOUNTAIN STATES HEALTH ALLIANCE 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604	62-0476282	501C3	59,245	8,806		MAGAZINES	GENERAL SUPPORT
(2) NORTON COMMUNITY HOSPITAL 100 15TH ST NW NORTON,VA24273	54-0566029	501C3	6,757	1,339		MAGAZINES	GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)

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	MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY'S PRIMARY ROLE IS TO SUPPORT THE HOSPITALS WITHIN MOUNTAIN STATES HEALTH ALLIANCE. AS SUCH, THE AUXILIARY'S DONATIONS ARE DIRECTED TO THE SPECIFIC NEEDS OF THE HOSPITALS. IN MOST CASES, THE DONATIONS ARE TO FUND PATIENT CARE NEEDS OR VISITOR AREAS SUCH AS WAITING ROOMS.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ 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

2015

Open to Public
Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE
AUXILIARY

Employer identification number

58-1418345

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 1, CONSIST OF VOLUNTEERS WHO KNIT, CROCHET, 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 QUIILTS FOR EACH PEDIATRIC SURGERY PATIENT AT NISWONGER CHILDREN'S HOSPITAL (NICH) 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. IN ADDITION, VOLUNTEERS AT IPMC COLLECT PACKAGED SNACKS, COLORING AND PUZZLE BOOKS FROM CIVIC GROUPS AND CHURCHES FOR ER, SURGERY WAITING, AND ICU FAMILY MEMBERS. THE VOLUNTEERS WITHIN THE AUXILIARY ARE TEAMS 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 RECOGNITION 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 SERVICE AND SPECIAL PROJECT OPPORTUNITIES FOR VOLUNTEERS THROUGHOUT MSHA'S SERVICE AREAS. THE LEADERSHIP WITHIN MSHA VOLUNTEER AND AUXILIARY RESOURCES DEPARTMENTS WORK 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. THIS PAST YEAR, PAPERLESS PROCESSES HAVE BEGUN SO POTENTIAL VOLUNTEERS CAN DO THE PRELIMINARY WORK ON LINE. ORIENTATION IS CONDUCTED ON-SITE. VOLUNTEERS WORK THROUGHOUT THE YEAR TO ASSIST HOSPITAL STAFF, PATIENTS AND PATIENT FAMILIES. SOME OF THE SERVICES PROVIDED BY AUXILIARY VOLUNTEERS DURING FY16 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 (JCMC), INDIAN PATH MEDICAL CENTER (IPMC), AND FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH). IPMC'S EMERGENCY AMBASSADOR PROGRAM IS NOW STAFFED FIVE DAYS A WEEK WITH ADULT VOLUNTEERS AND HAS BEGUN STAFFING IN THE EVENINGS WITH COLLEGE AND MEDICAL SCHOOL STUDENT VOLUNTEERS. 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. THEY VISIT PATIENTS HAVING HEART CATHETERIZATIONS, DISTRIBUTING A PACKET OF INFORMATION PROVIDED BY THE NATIONAL ORGANIZATION. THE MENDED LITTLE HEARTS PROGRAM AT NISWONGER CHILDREN'S HOSPITAL WAS ESTABLISHED 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 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. LAST YEAR THE 62ND MENDED HEARTS ANNUAL NATIONAL EDUCATION & TRAINING CONFERENCE HONORED LYNN FRIERSON, MSHA AUXILIARY BOARD PAST CHAIR AND ORGANIZER OF MSHA'S MENDED HEARTS PROGRAMS, WITH THE COVETED VOLUNTEER OF THE YEAR AWARD. THE CRITERIA FOR THE AWARD INCLUDES LENGTH OF SERVICE PARTICIPATION ON NATIONAL BOARDS, COMMITTEES AND TASK FORCES; AND OTHER ACHIEVEMENTS THAT ADVANCE THE PROGRAM'S MISSION. FURTHER, MS. FRIERSON, HAS BEEN HONORED BY BEING REQUESTED TO ORGANIZE AND COORDINATE THE UPCOMING NATIONAL CONFERENCE IN 2017. THIS IS AN EXTREMELY HIGH HONOR. COURTESY CARTS (AT JCMC, NICH, 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 BETWEEN PHYSICIANS 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. THE 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. VOLUNTEERS ASSIST IN THE CANCER TREATMENT CENTERS (AT IPMC AND JCMC) 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 2016, MOUNTAIN STATES HEALTH ALLIANCE AWARDED FOUR VOLUNTEERS WITH THE COVETED SERVANTS HEART AWARD FOR THEIR OUTSTANDING SERVICE TO PATIENTS AND FAMILIES. VOLUNTEERS DO NOT TEND TO LET ANYONE KNOW OF ALL THE SERVICE THEY PROVIDE DAY IN AND DAY OUT. ONE OF THE VOLUNTEERS HONORED IS A RETIRED PHYSICIAN WHO VOLUNTEERS WITH THE PET THERAPY PROGRAM; ANOTHER IS A JCMC/FWCH PATIENT AMBASSADOR WHO FULFILLS THE SMALL NEEDS OF THE PATIENTS THAT AREN'T HEALTH RELATED BUT ARE IMPORTANT TO THE PATIENT AND FAMILY. ANOTHER VOLUNTEER DRIVES THE COURTESY CART AT JCMC AND LISTENS TO THE NEEDS OF THE FAMILY MEMBERS SHE IS ESCORTING AND ENSURES THEY GET TO THE RIGHT PLACE. AS A FIRST FOR FWCH, AN EXCEPTIONAL VOLUNTEER WHO ASSISTS ADMITTING, WON THE PRESTIOUS AWARD. THE NOMINATIONS SUBMITTED FOR THIS AWARD GOES THOUGH AN EXTENSIVE REVIEW PROCESS WITH A MULTIDISCIPLANARY MSHA TEAM SELECTING THE OVERALL WINNERS ON A POINTS SYSTEM. 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 CORP 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 EACH 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 IMPLEM
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 990 WERE MADE AVAILABLE PRIOR TO THE REVIEW. 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 MSHA 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	XFER FUNDS FROM SCCH AUX(WHEN COMBINED W/MSHA AUX) 110,118 XFER FUNDS FROM NCH AUX (WHEN COMBINED W/MSHA AUX) 6,557 CHANGE IN TEMPORARILY RESTRICTED ASSETS -6,555 TOTAL 110,120

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MOUNTAIN STATES HEALTH ALLIANCE
AUXILIARY

Employer identification number

58-1418345

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)MOUNTAIN STATES HEALTH ALLIANCE 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604 62-0476282	HOSP. SYS.	TN	501C3	3	NA		No
(2)MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD JOHNSON CITY,TN37604 58-1418862	FUNDRAISER	TN	501C3	11A	MSHA		No
(3)SMYTH COUNTY COMMUNITY HOSPITAL 245 MEDICAL PARK DRIVE MARION,VA24354 54-0794913	HOSPITAL	VA	501C3	3	MSHA		No
(4)NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON,VA24273 54-0566029	HOSPITAL	VA	501C3	3	NA		No
(5)DICKENSON COMMUNITY HOSPITAL PO BOX 1440 HOSPITAL DRIVE CLINTWOOD,VA24228 77-0599553	HOSPITAL	VA	501C3	3	NCH		No
(6)JOHNSTON MEMORIAL HOSPITAL 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 54-0544705	HOSPITAL	VA	501C3	3	NA		No
(7)ABINGDON PHYSICIAN PARTNERS 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 20-5485346	MED. SERV.	VA	501C3	3	JMH		No
(8)NEWCO INC 211 COMMERCE ST STE 800 NASHVILLE,TN372011817 61-1771290	SUPP. ORG	TN	501C3	11B	NA		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) INTEGRATED HEALTH SOLUTIONS NETWORK 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1711997	INVESTMENT	TN	NA				No			No
(2) EMMAUS COMMUNITY HEALTHCARE LLC 6070 HWY 11E PINEY FLATS,TN37686 20-0577483	MED. SERV.	TN	NA				No			No
(3) EAST TN AMBULATORY SURGERY CENTER 701 MED TECH PARKWAY JOHNSON CITY,TN37604 62-1787537	MED. SERV.	TN	NA				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	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) BLUE RIDGE MEDICAL MGMT CORP 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1490616	PHY. OFF.	TN	NA	C CORP				No
(2) MEDISERVE MED EQUIP OF KINGSPORT 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1212286	DME	TN	NA	C CORP				No
(3) MOUNTAIN STATES PROPERTIES 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1845895	PROP. MGMT	TN	NA	C CORP				No
(4) MOUNTAIN STATES PHYSICIAN GROUP 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1700412	MED. SERV.	TN	NA	C CORP				No
(5) COMMUNITY HOME CARE INC 14600 PARK AVENUE NORTON,VA24273 54-1453810	DME	VA	NA	C CORP				No
(6) WILSON PHARMACY INC PO BOX 880 JOHNSON CITY,TN37604 62-0329587	PHARMACY	TN	NA	C CORP				No

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

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) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO RENDER SERVICES TO MOUNTAIN STATES HEALTH ALLIANCE AND ITS RELATED HOSPITALS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	8
6	Total number of volunteers (estimate if necessary) .............	6	1,670
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	35,221	402
9	Program service revenue (Part VIII, line 2g) .........		0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,544	3,169
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	559,414	684,732
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	596,179	688,303
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	101,241	98,970
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)	254,304	292,828
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	126,789	139,504
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	482,334	531,302
19	Revenue less expenses. Subtract line 18 from line 12.......	113,845	157,001
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,674,953	1,789,129
21	Total liabilities (Part X, line 26).............	292,730	132,897
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,382,223	1,656,232

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 506,804 including grants of $ 98,970 ) (Revenue $ 572,143 )
	THE PURPOSE OF THE ORGANIZATION IS TO RENDER SERVICES TO MOUNTAIN STATES HEALTH ALLIANCE (MSHA) AND ITS RELATED HOSPITALS; ITS PATIENTS, GUESTS, AND TEAM MEMBERS, WHILE ASSISTING MSHA IN PROMOTING THE HEALTH AND WELFARE OF THE COMMUNITY SERVED, AND TO FUNCTION AS AN ADVISORY BOARD TO THE MSHA VOLUNTEER AND AUXILIARY RESOURCES LEADERSHIP TEAM. (CONTINUED ON SCHEDULE O) (CONT'D) HOME VOLUNTEERS, NOT REFLECTED IN OUR "ACTIVE" VOLUNTEER COUNT REPORTED ON LINE 6 OF PART 1, CONSIST OF VOLUNTEERS WHO KNIT, CROCHET, 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 QUIILTS FOR EACH PEDIATRIC SURGERY PATIENT AT NISWONGER CHILDREN'S HOSPITAL (NICH) 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. IN ADDITION, VOLUNTEERS AT IPMC COLLECT PACKAGED SNACKS, COLORING AND PUZZLE BOOKS FROM CIVIC GROUPS AND CHURCHES FOR ER, SURGERY WAITING, AND ICU FAMILY MEMBERS. THE VOLUNTEERS WITHIN THE AUXILIARY ARE TEAMS 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 RECOGNITION 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 SERVICE AND SPECIAL PROJECT OPPORTUNITIES FOR VOLUNTEERS THROUGHOUT MSHA'S SERVICE AREAS. THE LEADERSHIP WITHIN MSHA VOLUNTEER AND AUXILIARY RESOURCES DEPARTMENTS WORK 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. THIS PAST YEAR, PAPERLESS PROCESSES HAVE BEGUN SO POTENTIAL VOLUNTEERS CAN DO THE PRELIMINARY WORK ON LINE. ORIENTATION IS CONDUCTED ON-SITE. VOLUNTEERS WORK THROUGHOUT THE YEAR TO ASSIST HOSPITAL STAFF, PATIENTS AND PATIENT FAMILIES. SOME OF THE SERVICES PROVIDED BY AUXILIARY VOLUNTEERS DURING FY16 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 (JCMC), INDIAN PATH MEDICAL CENTER (IPMC), AND FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH). IPMC'S EMERGENCY AMBASSADOR PROGRAM IS NOW STAFFED FIVE DAYS A WEEK WITH ADULT VOLUNTEERS AND HAS BEGUN STAFFING IN THE EVENINGS WITH COLLEGE AND MEDICAL SCHOOL STUDENT VOLUNTEERS. 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. THEY VISIT PATIENTS HAVING HEART CATHETERIZATIONS, DISTRIBUTING A PACKET OF INFORMATION PROVIDED BY THE NATIONAL ORGANIZATION. THE MENDED LITTLE HEARTS PROGRAM AT NISWONGER CHILDREN'S HOSPITAL WAS ESTABLISHED 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 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. LAST YEAR THE 62ND MENDED HEARTS ANNUAL NATIONAL EDUCATION & TRAINING CONFERENCE HONORED LYNN FRIERSON, MSHA AUXILIARY BOARD PAST CHAIR AND ORGANIZER OF MSHA'S MENDED HEARTS PROGRAMS, WITH THE COVETED VOLUNTEER OF THE YEAR AWARD. THE CRITERIA FOR THE AWARD INCLUDES LENGTH OF SERVICE PARTICIPATION ON NATIONAL BOARDS, COMMITTEES AND TASK FORCES; AND OTHER ACHIEVEMENTS THAT ADVANCE THE PROGRAM'S MISSION. FURTHER, MS. FRIERSON, HAS BEEN HONORED BY BEING REQUESTED TO ORGANIZE AND COORDINATE THE UPCOMING NATIONAL CONFERENCE IN 2017. THIS IS AN EXTREMELY HIGH HONOR. COURTESY CARTS (AT JCMC, NICH, 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 BETWEEN PHYSICIANS 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. THE 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. VOLUNTEERS ASSIST IN THE CANCER TREATMENT CENTERS (AT IPMC AND JCMC) 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 2016, MOUNTAIN STATES HEALTH ALLIANCE AWARDED FOUR VOLUNTEERS WITH THE COVETED SERVANTS HEART AWARD FOR THEIR OUTSTANDING SERVICE TO PATIENTS AND FAMILIES. VOLUNTEERS DO NOT TEND TO LET ANYONE KNOW OF ALL THE SERVICE THEY PROVIDE DAY IN AND DAY OUT. ONE OF THE VOLUNTEERS HONORED IS A RETIRED PHYSICIAN WHO VOLUNTEERS WITH THE PET THERAPY PROGRAM; ANOTHER IS A JCMC/FWCH PATIENT AMBASSADOR WHO FULFILLS THE SMALL NEEDS OF THE PATIENTS THAT AREN'T HEALTH RELATED BUT ARE IMPORTANT TO THE PATIENT AND FAMILY. ANOTHER VOLUNTEER DRIVES THE COURTESY CART AT JCMC AND LISTENS TO THE NEEDS OF THE FAMILY MEMBERS SHE IS ESCORTING AND ENSURES THEY GET TO THE RIGHT PLACE. AS A FIRST FOR FWCH, AN EXCEPTIONAL VOLUNTEER WHO ASSISTS ADMITTING, WON THE PRESTIOUS AWARD. THE NOMINATIONS SUBMITTED FOR THIS AWARD GOES THOUGH AN EXTENSIVE REVIEW PROCESS WITH A MULTIDISCIPLANARY MSHA TEAM SELECTING THE OVERALL WINNERS ON A POINTS SYSTEM. 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 CORP 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 EACH PATIENT'S PARTICULAR RELIGIOUS/SPIRITUAL UNDERSTANDING AND NOT PROSELYTIZE OR COERCE. EACH VOLUNTEER CHAPLAIN PARTICIPATING IN THE MSHA SPIRITUAL AND PASTORAL CARE DEPARTMENT GOES

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 expenses506,804

(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
(A) Name and Title
(1) LYNNIS HORNSBY...................................................................... PRESIDENT	35.00 ................. 15.00	X	X	0	100,429	11,587
(2) LYNN FRIERSON...................................................................... PAST CHAIR	10.00 .................	X		0	0	0
(3) LORETTA PEEKS...................................................................... TREASURER	3.50 .................	X	X	0	0	0
(4) RONALD TAYLOR...................................................................... ASST. TREASU	2.00 .................	X	X	0	0	0
(5) NANCY JEWELL...................................................................... SECRETARY	11.50 .................	X	X	0	0	0
(6) FRANCES ADAMS...................................................................... CHAIR	7.50 .................	X		0	0	0
(7) PATSY SORAH...................................................................... DIRECTOR	4.50 .................	X		0	0	0
(8) IDA COOK...................................................................... DIRECTOR	6.50 .................	X		0	0	0
(9) MARYANNE LAUGHLIN...................................................................... DIRECTOR	5.75 .................	X		0	0	0
(10) NANCY TAYLOR...................................................................... DIRECTOR	3.50 .................	X		0	0	0
(11) ALANE LOVERN...................................................................... DIRECTOR	5.50 .................	X		0	0	0
(12) JUDY BRADLEY...................................................................... DIRECTOR	4.50 .................	X		0	0	0
(13) ANN HERNDON...................................................................... DIRECTOR	4.50 .................	X		0	0	0
(14) GLORIA MOUTON...................................................................... DIRECTOR	4.50 .................	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	100,429	11,587

(A) Name and business address	(B) Description of services	(C) Compensation





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

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	402

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		402

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			3,169			3,169
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a		1,103,421
b	Less: cost of goods sold ..b		531,278
c	Net income or (loss) from sales of inventory..			572,143	572,143
Business Code			Miscellaneous Revenue
11a	COMMISSIONS		900099	112,589			112,589
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			112,589
12	Total revenue. See Instructions......			688,303	572,143		115,758

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	98,970	98,970
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 ....
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	254,672	254,672
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	20,940	20,940
10	Payroll taxes ...........	17,216	17,216
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........	2,695		2,695
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	8,172	8,172
12	Advertising and promotion ....	1,597	1,597
13	Office expenses .......	32,819	12,818	20,001
14	Information technology ......
15	Royalties ..	19,575	19,575
16	Occupancy ...........
17	Travel ............	2,688	2,688
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	2,947	2,947
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	50,370	50,370
23	Insurance ...
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	MAINTENANCE & REPAIRS	9,522	9,522
b	COMMUNITY DONATIONS	3,795	3,795
c	DUES & SUBSCRIPTIONS	1,294		1,294
d	LICENSES & PERMITS	315	315
e	All other expenses	3,715	3,207	508
25	Total functional expenses. Add lines 1 through 24e	531,302	506,804	24,498	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			501,663	1	263,551
2	Savings and temporary cash investments .........			273,835	2	9,021
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			194,978	4	161,442
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 ....				7
8	Inventories for sale or use ........			406,088	8	587,434
9	Prepaid expenses and deferred charges ......			2,303	9	7,540
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	886,441
b	Less: accumulated depreciation	10b	615,672	292,649	10c	270,769
11	Investments—publicly traded securities .				11	487,810
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			3,437	15	1,562
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,674,953	16	1,789,129

17	Accounts payable and accrued expenses .....	289,147	17	132,897
18	Grants payable ...		18
19	Deferred revenue .........	3,583	19
20	Tax-exempt bond liabilities .........		20
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		25
26	Total liabilities. Add lines 17 through 25..	292,730	26	132,897

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	1,365,458	27	1,646,022
28	Temporarily restricted net assets ...........	16,765	28	10,210
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	1,382,223	33	1,656,232
34	Total liabilities and net assets/fund balances ........	1,674,953	34	1,789,129