2014-08-15T11:16:06-05:00 2013-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-10-01 273274203 ANDERSON PHYSICIAN ALLIANCE INC ANDE 6015536000 2124 14TH STREET MERIDIAN MS 39301 A KEITH HEARTSILL 6015536000 2014-08-15 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z A KEITH HEARTSILL 2124 14TH STREET MERIDIAN MS 39301 6489437 0 X WWW.JARMC.ORG X 2010 MS ANDERSON PHYSICIAN ALLIANCE, INC. OFFERS FAMILY PRACTICE AND SPECIALTY CLINICS TO PROVIDE QUALITY HEALTHCARE FOR EAST MISSISSIPPI AND WEST ALABAMA. 3 1 138 0 0 0 0 0 6653066 6374350 427 -2059 46812 115052 6700305 6487343 0 0 0 0 7558542 6564023 0 0 0 4481747 3574168 12040289 10138191 -5339984 -3650848 2721683 1421162 12631438 14981765 -9909755 -13560603 X SEE SCHEDULE O:ANDERSON PHYSICIAN ALLIANCE, INC. IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES. THE SPECIFIC PURPOSES AND OBJECTIVES OF THE CORPORATION SHALL INCLUDE BUT NOT BE LIMITED TO EMPLOYING PHYSICIANS AND OTHER MEDICAL PERSONNEL TO CARRY OUT THE PURPOSES AND OBJECTIVES OF ANDERSON REGIONAL MEDICAL CENTER, AS FOLLOWS:1.) TO ESTABLISH AND MAINTAIN AN INSTITUTION OR INSTITUTIONS, WITHIN OR WITHOUT THE STATE WHERE INCORPORATED, WITH PERMANENT FACILITIES TO PROVIDE DIAGNOSIS AND TREATMENT FOR PATIENTS2.) TO CARRY ON ANY EDUCATION ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED, OR TO THE PROMOTION OF HEALTH3.) TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED4.) TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY 0 0 8626504 0 6374350 SEE SCHEDULE O:ANDERSON PHYSICIAN ALLIANCE, INC. OFFERS FAMILY PRACTICE AND SPECIALTY CLINICS TO PROVIDE QUALITY HEALTHCARE FOR EAST MISSISSIPPI AND WEST ALABAMA.ANDERSON PHYSICIAN ALLIANCE, INC. OPERATES 5 PRIMARY CARE CLINICS IN THE EAST MISSISSIPPI AND WEST ALABAMA AREA. THE PHYSICIANS, NURSE PRACTITIONERS AND STAFF FOCUS ON PRIMARY HEALTHCARE NEEDS OF THE COMMUNITY.THE CLINICS IN MISSISSIPPI INCLUDE:ANDERSON FAMILY MEDICAL CENTER - RIVERBIRCHANDERSON FAMILY MEDICAL CENTER - AIRPARK (PHILADELPHIA, MS)ANDERSON FAMILY MEDICAL CENTER - ENTERPRISE (ENTERPRISE, MS)THE ALABAMA CLINICS INCLUDE:ANDERSON FAMILY MEDICAL CENTER - BUTLER (BUTLER, ALABAMA)ANDERSON FAMILY MEDICAL CENTER - LIVINGSTON (LIVINGSTON, AL) ANDERSON PHYSICIAN ALLIANCE, INC. OPERATES 7 MEDICAL SPECIALTY CLINICS INCLUDING:ANDERSON ARTHRITIS AND RHEUMATOLOGY, FOCUSES ON PROVIDING PATIENTS WITH ASSISTANCE IN ACHIEVING A HIGHER QUALITY OF LIFE THROUGH AGGRESSIVE ATTENTION TO RHEUMATOLOGIC DISEASE AND ARTHRITIC CONDITIONS. THE CLINIC SPECIALIZES IN THE DIAGNOSIS AND TREATMENT OF RHEUMATOID ARTHRITIS, LUPUS AND MIXED CONNECTIVE TISSUE DISEASES, SJORGENS SYNDROME, MYOSITIS, VACUITIES AND OSTEOARTHRITIS.ANDERSON INFECTIOUS DISEASE CENTER OFFERS TREATMENT IN THE DIAGNOSIS AND TREATMENT OF INFECTIOUS DISEASES. THE PHYSICIAN AND NURSE PRACTITIONERS EXTENSIVE TRAINING GUIDES PATIENTS IN THE TREATMENT OF INFECTIONS, INCLUDING THOSE CAUSED BY BACTERIA, VIRUSES, FUNGI, PARASITES AND HUMAN IMMUNODEFICIENCY VIRUS, THE CAUSE OF AIDS.ANDERSON NEUROLOGY CENTER FOCUSES ON THE DIAGNOSIS AND TREATMENT OF ALZHEIMER'S DISEASE, PARKINSON'S DISEASE, STROKE AND NEUROLOGICAL DISORDERS.ANDERSON ENDOCRINOLOGY CENTER PROVIDES TREATMENT OF DIABETES, THYROID DISEASE, METABOLIC DISORDERS, CHOLESTEROL DISORDERS AND ENDOCRINE DISORDERS.ANDERSON UROLOGY CENTER OF MERIDIAN PROVIDES UROLOGIC CARE SPECIALIZING IN OVERACTIVE BLADDER, KIDNEY STONES, AND URINARY TRACT INFECTIONS. SURGICAL TREATMENTS INCLUDE: MINIMALLY INVASIVE PROSTATECTOMY SURGERY USING THE DAVINCI SURGICAL ROBOT.ANDERSON PREMIER WOMEN'S CLINIC PROVIDES QUALITY CARE TO WOMEN IN MERIDIAN AND THE SURROUNDING COMMUNITIES. THE DEDICATED PHYSICIAN'S AND STAFF TAKE PRIDE IN PROVIDING A GENUINE CONCERNED ENVIRONMENT FOR WOMEN FROM ADOLESCENCE, TO CHILD BEARING YEARS AND THROUGH MATERNITY.ANDERSON CHILDREN'S MEDICAL CLINIC IS DEVOTED TO PROVIDING THE HIGHEST QUALITY CARE FOR NEWBORNS, YOUNG CHILDREN AND ADOLESCENTS SEVEN DAYS A WEEK.EFFECTIVE JUNE 2013, THE FOLLOWING CLINIC DEPARTMENTS WERE MOVED FROM THE ANDERSON PHYSICIAN ALLIANCE, INC. TO ANDERSON REGIONAL MEDICAL CENTER:ANDERSON FAMILY MEDICAL CENTER - RIVERBIRCHANDERSON FAMILY MEDICAL CENTER - AIRPARK (PHILADELPHIA, MS)ANDERSON FAMILY MEDICAL CENTER - ENTERPRISE (ENTERPRISE, MS)ANDERSON CHILDREN'S MEDICAL CLINICTHESE CLINICS ARE OPERATED AS RURAL HEALTH CLINICS UNDER ANDERSON REGIONAL MEDICAL CENTER SOUTH HOSPITAL FACILITY.EFFECTIVE JANUARY 2014, ANDERSON FAMILY MEDICAL CENTER - BUTLER (BUTLER, ALABAMA) CLINIC CEASED OPERATIONS AS AN ANDERSON PHYSICIAN ALLIANCE, INC. CLINIC. 8626504 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 32 0 1 138 1 0 0 0 0 0 0 0 0 0 0 X 3 1 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X A KEITH HEARTSILL 6015536000 2124 14TH STREET MERIDIAN MS 39301 JOHN ANDERSON 1.00 X X 0 192172 52703 WANDA COOPER 1.00 X X 0 195485 53143 PHILLIP BROOKS 1.00 X 0 15682 0 LELAND RAY HUMPHREYS 1.00 X 0 426219 128773 MARK T PHILLIPS 40.00 X 490458 0 64584 JESSE P PENICO 40.00 X 484630 0 33128 JIMMY V WOLFE 40.00 X 343730 0 20374 DREW M HUFFMAN 40.00 X 332935 0 23736 LINDA M DALES 40.00 X 306267 0 51552 1958020 829558 427993 15 0 1 0 MED 3000 HEALTH SOLUTIONS 5 E ALVON ROAD SUITE 7 WHITE SULPHUR SPRINGS WV 24986 BILLING SERVICES 131776 1 NET PATIENT 621990 6366449 6366449 OTHER OPERATING REVENU 621990 7901 7901 6374350 35 35 2094 -2094 -2094 -2094 MISCELLANEOUS REVENUE 900099 115052 115052 115052 6487343 6374350 0 112993 X 57282 57282 5763962 5027442 736520 83509 72943 10566 339872 296870 43002 319398 278987 40411 1147549 500528 647021 57465 56825 640 302399 286420 15979 555012 555012 10805 6227 4578 25946 25946 38933 38933 366679 366679 309215 309215 MEDICAL SUPPLIES 563372 550402 12970 BAD DEBT EXPENSE 196793 196793 10138191 8626504 1511687 0 2446 2200 274488 553696 584695 353333 50381 113510 759062 361965 1809673 397097 0 1326 2721683 1421162 883559 721430 11747879 14260335 12631438 14981765 X -9909755 -13560603 -9909755 -13560603 2721683 1421162 -3650848 0 X 0 1 X 1 0 X 759062 361965 397097 397097 DUE TO AFFILIATES 14260335 14260335 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ANDERSON PHYSICIAN ALLIANCE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3); ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. ANDERSON PHYSICIAN ALLIANCE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013 AND 2012. YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010, REMAIN SUBJECT TO EXAMINIATION BY FEDERAL AND STATE TAX AUTHORITIES. 0 1 0 0 0 0 0 0 0 JOHN ANDERSON 0 190695 0 0 0 1477 0 39800 0 12903 0 244875 0 0 WANDA COOPER 0 193011 0 0 0 2474 0 39823 0 13320 0 248628 0 0 LELAND RAY HUMPHREYS 0 411741 0 0 0 14478 0 113447 0 15326 0 554992 0 0 MARK T PHILLIPS 450153 0 38415 0 1890 0 46631 0 17953 0 555042 0 0 0 JESSE P PENICO 345801 0 137281 0 1548 0 16675 0 16453 0 517758 0 0 0 JIMMY V WOLFE 343133 0 0 0 597 0 1250 0 19124 0 364104 0 0 0 DREW M HUFFMAN 216874 0 115744 0 317 0 5749 0 17987 0 356671 0 0 0 LINDA M DALES 304287 0 0 0 1980 0 40750 0 10802 0 357819 0 0 0 PART I, LINE 4B ARMC PROVIDES CERTAIN EXEUCTIVES AN IRC SEC 457(F), NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) PLAN: - LELAND RAY HUMPHREYS $67,257 - JOHN ANDERSON 34,755 - WANDA COOPER 33,257 CASEY CHESTNUTT HAARALA FAMILY RELATIONSHIP WITH A BOARD MEMBER 57282 CLINIC MANAGER OF THE ORGANIZATION 0 FORM 990, PART VI, SECTION A, LINE 1 UNLESS PROHIBITED OR LIMITED BY THE ARTICLES OF INCORPORATION OR THESE BYLAWS, THE BOARD OF DIRECTORS MAY CREATE AN EXECUTIVE COMMITTEE AND ONE OR MORE THAN OTHER COMMITTEES OF THE BOARD AND APPOINT MEMBERS OF THE BOARD OF DIRECTORS TO SERVE ON THEM. FORM 990, PART VI, SECTION A, LINE 3 MEDICAL MANAGEMENT SERVICES IS RESPONSIBLE FOR THE DAILY MANAGEMENT OPERATIONS OF THE APA CLINICS AND APA BUSINESS OFFICE INCLUDING PERFOMRING BUDGETS AND EXPENSE APPROVAL. MEDICAL MANAGEMENT SERVICES RECOMMENDS STAFFING PERSONNAL TO THE FACILITY BUT THE FACILITY HAS THE FINAL APPROVAL FOR ALL HIRING AND FIRING OF EMPLOYEES INCLUDING PHYSICIANS. FORM 990, PART VI, SECTION A, LINE 6 ANDERSON REGIONAL MEDICAL CENTER (ARMC) IS THE SOLE MEMBER OF ANDERSON PHYSICIAN ALLIANCE, INC. FORM 990, PART VI, SECTION A, LINE 7A ANDERSON REGIONAL MEDICAL CENTER HAS THE POWER (1) TO APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS, (2) TO EXERCICE ALL VOTING RIGHTS OF THE MEMBERS FORM 990, PART VI, SECTION A, LINE 7B ANDERSON REGIONAL MEDICAL CENTER HAS THE POWER (1) TO APRROVE APA'S PHYSICIAN COMPENSATION MODELS, PHYSICIAN COMPENSATION AND PHYSICIAN COMPENSATION POLICIES, (2) TO APPROVE PHYSICIAN EMPLOYMENT AGREEMENTS, AND (3) TO INITIATE AND/OR APPROVE VARIOUS OTHER ACTIONS AND POLICIES AS ENUMERATED IN APA'S CERTIFICATE OF INCORPORATION AND BYLAWS, AND AS REQUIRED BY STATE LAW. FORM 990, PART VI, SECTION B, LINE 11 EACH BOARD MEMBER WAS PROVIDED A COPY OF THE FORM 990. THE BOARD MEMBERS WERE ASKED TO REVIEW THE FORM AND SUBMIT QUESTIONS AND COMMENTS PROIR TO THE FORM 990 BEING FINALIZED. AFTER REVIEW, THE FINALIZED FORM 990 WAS PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND REQUESTS ALL BOARD MEMBERS TO ANNUALLY DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST. THE BOARD OF ARMC HAS A DESIGNATED THREE (3) PERSON COMMITTEE OF INDEPENDENT BOARD MEMBERS TO REVIEW AND APPROVE COMPENSATION. THE BOARD ALSO HAD A CONTRACT FOR PROFESSIONAL SERVICES WITH MERCER UNTIL JULY 1, 2013 AND CURRENTLY USES SULLIVAN COTTER TO STUDY AND RECOMMEND COMPENSATION FOR THE CEO, THE VICE PRESIDENTS, AND THE DIRECTORS OF THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE MADE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,900. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,900. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 493,628. MANAGEMENT AND GENERAL EXPENSES 647,021. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,140,649. ANDERSON REGIONAL MEDICAL CENTER 2124 14TH STREET MERIDIAN MS 39301 640362400 HEALTHCARE MS 501(C)(3) LINE 3 N/A 0 MEDICAL SUPPORT AND DEVELOPMENT ORGANIZATION 122 WOODMONT WAY RIDGELAND MS 39157 640722433 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11C, III-FI ANDERSON REGIONAL MEDICAL CENTER 0 ANDERSON SUPPORT AND DEVELOPMENT FOUNDATION 7651 POPLAR SPRINGS DR MERIDIAN MS 39305 640730109 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11D, III-O ANDERSON REGIONAL MEDICAL CENTER 0 MIRACLES OF GRACE FOUNDATION 1827 SUNRISE LANE TOOMSUBA MS 39364 640730366 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11C, III-FI ANDERSON REGIONAL MEDICAL CENTER 0 CARE CONSISTENCY FOUNDATION INC 7761 MEADOW CIRCLE MERIDIAN MS 39305 640730846 SUPPORTING ORGANIZATION MS 501(C)(3) LINE 11D, III-O ANDERSON REGIONAL MEDICAL CENTER 0 ANDERSON HOSPITAL PROVIDERS INC 2124 14TH STREET MERIDIAN MS 39301 461305481 PHYSICIAN BILLING MS 501(C)(3) LINE 3 ANDERSON REGIONAL MEDICAL CENTER 0 EAST MISSISSIPPI ENDOSCOPY CENTER 1926 23RD AVENUE MERIDIAN MS 39301 440884792 HEALTHCARE MS N/A JARMC LEVERAGE LLC 2124 14TH STREET MERIDIAN MS 39301 272284311 INVESTMENTS MS N/A ARMC HOSPITAL PROF & GEN LLFT 512 22ND AVENUE MERIDIAN MS 39301 206131090 TRUST MS N/A T 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0