2017-05-12T12:38:39-04:00 2016-06-30 990 2015-07-01 270898372 WELLMONT MEDICAL ASSOCIATES INC WELL 4232308200 1905 AMERICAN WAY KINGSPORT TN 37660 TODD J DOUGAN CFO 4232308200 2017-05-12 2015 2021-01-29 14:40:06Z TODD J DOUGAN 1905 AMERICAN WAY KINGSPORT TN 37660 74162222 false X WWW.WELLMONT.ORG X 2008 TN WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION. 19 0 889 0 7086 5358 72229456 73910127 -23057 0 1691695 140384 73905180 74055869 0 0 74914469 78914748 0 0 27656826 25037167 102571295 103951915 -28666115 -29896046 7358030 27200685 7678595 9306961 -320565 17893724 X WE DELIVER SUPERIOR HEALTH CARE WITH COMPASSION. false false 100156508 73910127 WELLMONT MEDICAL ASSOCIATES, INC. IS PHYSICIAN-LED AND PROFESSIONALLY MANAGED. FROM ITS BOARD OF DIRECTORS AND LEADERSHIP TEAM MEMBERS TO THE PROVIDERS WHO CARE FOR PATIENTS EVERY DAY, WELLMONT MEDICAL ASSOCIATES, INC.'S COMMITMENT TO PHYSICIAN LEADERSHIP IS CLEAR. WELLMONT MEDICAL ASSOCIATES, INC., A NON-PROFIT HEALTHCARE PROVIDER, DELIVERS EXCEPTIONAL CARE TO PATIENTS IN THE TRI-CITIES REGION OF NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. BASED IN KINGSPORT, TENNESSEE, AS WELL AS LOCATIONS EXPANDING FROM SNEEDVILLE, TENNESSEE, TO MARION, VIRGINIA, WELLMONT MEDICAL ASSOCIATES, INC. OFFERS THE LATEST IN TECHNOLOGICAL ADVANCES TO ENSURE PATIENTS RECEIVE SUPERIOR CARE. (CON'T ON SCHEDULE O) 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. 100156508 true true false false false false false false false false true false false false false false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 68 0 true 889 true false false false false false false false false false false false false X 19 0 false false false false true true true true true true false true true true true true true true true false TN X TODD J DOUGAN 4232308200 1905 AMERICAN WAY KINGSPORT TN 37660 X BARTON A HOVE EX-OFFICIO B 1.00 39.00 X 0 1382592 38571 PAUL JETT MD PHYSICIAN/DI 40.00 X 1172600 0 31499 GIRENDRA HOSKERE PHYSICIAN/DI 40.00 X 873420 0 23938 IBRAHIM NAKHOUL MD PHYSICIAN/DI 40.00 X 651564 0 29012 MAURICE NIDA DO DIRECTOR/CHA 40.00 X X 527261 0 27754 MARTA WAYT MD DIRECTOR 40.00 X 467797 0 19046 STEPHEN COMBS MD EX-OFFICIO B 40.00 X X 460014 0 27672 DAVID L BRASH EX-OFFICIO B 1.00 39.00 X X 0 458177 26070 DAVID THOMPSON MD CHIEF ADM ME 40.00 X X 458018 0 18282 PARMINDERJIT SINGH MD PHYSICIAN/DI 40.00 X 440368 0 18223 MIHIR PATEL MD DIRECTOR 40.00 X 405537 0 22766 KIM ONESKO TERMED 12216 EX-OFFICIO B 40.00 X X 361035 0 17102 LENITA THIBAULT MD DIRECTOR 40.00 X 338825 0 15969 CLINTON SUTHERLAND PHYSICIAN/DI 40.00 X 305633 0 20771 LANDON COMBS MD SECRETARY\TR 40.00 X X 301665 0 20741 MANSOOR TANWIR PHYSICIAN/DI 40.00 X 280692 0 22846 DAVID ASTIN MD DIRECTOR 40.00 X 231001 0 17112 TERESA VANCE NP/DIRECTOR 40.00 X 133963 0 13051 ROGER MOWEN EX-OFFICIO B 1.00 X 0 0 0 KAREN J WILLIAMS EXEC DIRECTO 40.00 X 203431 0 11572 WILLIAM BRAD HALE EXEC DIR FIN 40.00 X 66685 0 9839 DANIEL KRENK MD PHYSICIAN 40.00 X 839605 0 35512 PERRIE RYAN MD PHYSICIAN 40.00 X 808978 0 31682 HARSHA VARDHANA MD PHYSICIAN 40.00 X 751325 0 31202 ADEL EL ABBASSI PHYSICIAN 40.00 X 676613 0 0 DENNIS AGUIRRE PHYSICIAN 40.00 X 659072 0 30389 JAMES BECKNER MD DIRECTOR 40.00 X 573130 0 30362 SUE PRILL MD DIRECTOR 40.00 X 480388 0 26538 KELLY OGGERO MD PHYSICIAN/DI X 446874 0 24216 AMANDA DOVE MD DIRECTOR,WES 40.00 X 331939 0 8971 MONIKA KARAKATTU MD PHYSICIAN/DI X 161267 0 16480 MARGARET DENARVAEZ TERMED 91614 WHS PRESIDEN X 0 146211 0 MARK KADOWAKI MD TRM 41315 DIRECTOR X 119076 0 4992 ANILKUMAR TUMKUR MD TRM 121814 DIRECTOR X 10226 0 726 PAUL KRAMER MD PHYSICIAN X 652728 0 30180 ASHEESH SHIPSTONE MD PHYSICIAN X 651793 0 32017 EDWIN MCELROY M D PHYSICIAN X 592744 0 30294 ROBERT SAUNDERS M D PHYSICIAN X 568424 0 28265 16003691 1986980 793662 175 true true false BLUE RIDGE RADIOLOGY PC 3053 WEST STATE STREET BRISTOL TN 37620 PROFESSIONAL SV 492217 WATAUGA ORTHOPAEDICS PLC 2410 SUSANNAH STREET DALLAS TX 75397 MEDICAL CARE 290222 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 PHYSICIAN SVCS 235848 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PHSICIAN SVS 195188 ALL IN ONE CORPORAL CLEAN INC PO BOX 3337 CRS JOHNSON CITY TN 37602 PROFESSIONAL SV 190458 9 5358 5358 PATIENT SERVICE REVENUE-NET 621990 71489726 71489726 CAPITATION & HUMANA REVENUE 621990 1912432 1912432 BILLING REVENUE 621990 489809 489809 SALE OF DEPARTMENT SERVICES 621990 18160 18160 73910127 89681 106353 -16672 -16672 -16672 MISCELLANEOUS REVENUE 621990 88150 88150 MEDICAL DIRECTORSHIP 621990 61066 61066 MEANINGFUL USE REVENUE 611710 7840 7840 157056 74055869 74067183 -16672 7678638 7044936 633702 62229438 60336712 1892726 1300107 1276448 23659 4237384 4255266 -17882 3469181 3448939 20242 1370223 1158498 211725 2332983 2252973 80010 2484 2484 906662 856631 50031 6259059 5809476 449583 186345 150814 35531 183662 183662 1816988 1786655 30333 541268 519711 21557 MSO ALLOCATIONS 6706254 6706254 DRUGS & MEDICAL SUPPLIES 2736374 2736374 PHYSICIAN GUARANTEE & INT 883536 883536 DUES AND MEMBERSHIPS 571804 285214 286590 539525 461925 77600 103951915 100156508 3795407 0 204511 25257 -8160283 11433384 966321 975100 131521 198945 27798818 14520275 12925760 13278543 1290200 1289456 7358030 27200685 7678595 9306961 7678595 9306961 X -320565 17893724 -320565 17893724 7358030 27200685 -29896046 48110335 X false true X true false X 55725 38508 7086 5358 106677 13594208 667540667 66564675 73921151 74067183 895687884 13594208 667596392 66603183 73928237 74072541 895794561 895794561 45201 153831 156801 89681 445514 45201 153831 156801 89681 445514 13639409 667596392 66757014 74085038 74162222 896240075 0.99950 0.99960 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28688 28688 7383369 2756741 4626628 8221906 2487400 5734506 10027246 7294892 2732354 2137609 1981242 156367 13278543 X true true false false false false false false true false false BARTON A HOVE EX-OFFICIO BRD MBR 798729 520000 63863 28581 9990 1421163 PAUL JETT MD PHYSICIAN/DIRECTOR 664282 394777 113541 21509 9990 1204099 GIRENDRA HOSKERE PHYSICIAN/DIRECTOR 381287 318067 174066 23938 897358 IBRAHIM NAKHOUL MD PHYSICIAN/DIRECTOR 534890 115447 1227 19867 9145 680576 MAURICE NIDA DO DIRECTOR/CHAIR 266330 90744 170187 15739 12015 555015 MARTA WAYT MD DIRECTOR 271737 75793 120267 15249 3797 486843 STEPHEN COMBS MD EX-OFFICIO BRD MBR 367049 36745 56220 15657 12015 487686 DAVID L BRASH EX-OFFICIO BRD MEMBR 341357 116250 570 14955 11115 484247 DAVID THOMPSON MD CHIEF ADM MED OFFCR 319934 138084 9067 9215 476300 PARMINDERJIT SINGH MD PHYSICIAN/DIRECTOR 250060 23125 167183 6676 11547 458591 MIHIR PATEL MD DIRECTOR 243689 22250 139598 10751 12015 428303 KIM ONESKO TERMED 12216 EX-OFFICIO BRD MBR 309791 42020 9224 12837 4265 378137 LENITA THIBAULT MD DIRECTOR 337551 1274 13152 2817 354794 CLINTON SUTHERLAND PHYSICIAN/DIRECTOR 255792 12650 37191 11437 9334 326404 LANDON COMBS MD SECRETARY\TREASURER 215308 86357 11121 9620 322406 MANSOOR TANWIR PHYSICIAN/DIRECTOR 265238 12264 3190 10831 12015 303538 DAVID ASTIN MD DIRECTOR 198255 19256 13490 7975 9137 248113 KAREN J WILLIAMS EXEC DIRECTOR WMA OP 185083 17993 355 7307 4265 215003 DANIEL KRENK MD PHYSICIAN 693692 145913 23497 12015 875117 PERRIE RYAN MD PHYSICIAN 444560 364098 320 23013 8669 840660 HARSHA VARDHANA MD PHYSICIAN 462560 288421 344 21500 9702 782527 ADEL EL ABBASSI PHYSICIAN 385499 104852 186262 676613 DENNIS AGUIRRE PHYSICIAN 484243 122938 51891 22224 8165 689461 JAMES BECKNER MD DIRECTOR 506800 66330 20372 9990 603492 SUE PRILL MD DIRECTOR 366044 79930 34414 17304 9234 506926 KELLY OGGERO MD PHYSICIAN/DIRECTOR 423351 23523 16051 8165 471090 AMANDA DOVE MD DIRECTOR,WEST REGION 214957 73517 43465 6010 2961 340910 MONIKA KARAKATTU MD PHYSICIAN/DIRECTOR 158895 2372 6490 9990 177747 MARGARET DENARVAEZ TERMED 91614 WHS PRESIDENT & CEO 136339 9872 146211 MARK KADOWAKI MD TRM 41315 DIRECTOR 119076 2402 2590 124068 ANILKUMAR TUMKUR MD TRM 121814 DIRECTOR 10226 421 305 10952 PAUL KRAMER MD PHYSICIAN 543229 59025 50474 22015 8165 682908 ASHEESH SHIPSTONE MD PHYSICIAN 540888 110905 22027 9990 683810 EDWIN MCELROY M D PHYSICIAN 561229 31515 20304 9990 623038 ROBERT SAUNDERS M D PHYSICIAN 512911 55513 19579 8686 596689 SCHEDULE J, PAGE 1, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES DURING THE FISCAL YEAR ENDED JUNE 30, 2016, WELLMONT HEALTH SYSTEM PROVIDED A COUNTRY CLUB MEMBERSHIP TO BARTON A. HOVE. THE AMOUNT IS INCLUDED IN TAXABLE COMPENSATION. SCHEDULE J, PAGE 1, PART I, LINE 6B INCENTIVE COMPENSATION IS BASED ON MEETING BUDGETED OPERATING MARGIN GOALS. SCHEDULE J, PART III PART I, LINE 4A - SEVERANCE PAYMENT MARGARET DENARVAEZ, FORMER CEO OF WELLMONT HEALTH SYSTEM, ENTERED INTO A CONFIDENTIAL SEPARATION AGREEMENT AND GENERAL RELEASE (THE "AGREEMENT") AS OF SEPTEMBER 16, 2014. THERE WERE OTHER PAYMENTS FOR EARNED INCENTIVE COMPENSATION AND REIMBURSEMENT OF RELOCATION COSTS THAT ARE NOT CONSIDERED "SEVERANCE". 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 WELLMONT HEALTH SYSTEM 1905 AMERICAN WAY KINGSPORT TN 37660 621636465 HEALTHCARE TN 501C3 3 NA false WELLMONT HAWKINS CTY MEM HOSPITAL 1905 AMERICAN WAY KINGSPORT TN 37660 621816368 HEALTHCARE TN 501C3 3 WHS false WELLMONT CARDIOLOGY SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 263557623 HEALTHCARE TN 501C3 9 WHS false WELLMONT FOUNDATION INC 1905 AMERICAN WAY KINGSPORT TN 37660 581594191 HEALTHCARE TN 501C3 7 WHS false WELLMONT MADISON HOUSE 1905 AMERICAN WAY KINGSPORT TN 37660 621308216 HEALTHCARE TN 501C3 9 WHS false WELLMONT WEXFORD HOUSE 1905 AMERICAN WAY KINGSPORT TN 37660 581859039 HEALTHCARE TN 501C3 9 WHS false WELLMONT SLEEP SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 273777167 HEALTHCARE TN 501C3 3 WHS false WELLMONT IMAGING SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 861103148 HEALTHCARE TN 501C3 11A WHS false SAPLING GROVE AMBULATORY SURGERY 220 MEDICAL PARK BOULEVARD BRISTOL TN 37620 204450153 HEALTHCARE TN N/A false false HOLSTON VALLEY AMBULATORY SURGERY 103 WEST STONE DRIVE KINGSPORT TN 37660 621816864 HEALTHCARE TN N/A false false HOLSTON VALLEY IMAGING CENTER 103 WEST STONE DRIVE KINGSPORT TN 37660 202043285 HEALTHCARE TN N/A false false WELLMONT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621320035 PHYS SVCS TN N/A false MCOT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621325938 MED SVCS TN N/A false WELLMONT MALL PHARMACY INC 1905 AMERICAN WAY KINGSPORT TN 37660 621565006 MED SVCS TN N/A false WELLMONT PHYSICIANS SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 621567353 PHYS SVCS TN N/A false WELLMONT HEALTH SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 621254373 HEALTHCARE TN N/A false WPS PROVIDERS INC 1905 AMERICAN WAY KINGSPORT TN 37660 625564642 PHYS SVCS TN N/A false WELLMONT INTEGRATED NETWORK LLC 1905 AMERICAN WAY KINGSPORT TN 37660 455443060 MED SVS TN N/A false false false true false false false false false true true false true false false false false false false false WELLMONT HEALTH SYSTEM C 16903504 CAPITAL CONTRIBUTION WELLMONT HEALTH SYSTEM I 50000 ASSET TRANSFERS WELLMONT HEALTH SYSTEM J 1435400 LEASE AGREEMENT WELLMONT HEALTH SYSTEM L 70218 SERVICE AGREEMENT SCHEDULE R PART V, LINE 2 RELATED ORGANIZATION TRANSACTIONS WITH WELLMONT FOUNDATION, WELLMONT CARDIOLOGY SERVICES, AND WELLMONT HEALTH SYSTEM DURING THE FISCAL YEAR ENDED JUNE 30, 2016 THAT DID NOT MEET THE 50,000 THRESHOLD AMOUNT FOR SEPARATE DISCLOSURE. ORGANIZATION TRANS TYPE AMOUNT METHOD DETERMINATION WELLMONT FOUNDATION C 20,698 NEED WELLMONT CARDIOLOGY SERV J 18,810 LEASE AGREEMENT WELLMONT HEALTH SYSTEM L 5,015 INVOICES