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Governance Register
US nonprofit · EIN 452386864 · Kingsport, TNiSource and licenceOrganisation record IRS Exempt Organizations Business Master File (EIN 452386864) - NTEE activity code, address.Board and officers IRS Form 990 annual filings, Part VII (directors, trustees, officers, key employees), read year by year to observe tenure.Latest return IRS Form 990 series e-file data - 990EZ for the year to 31 December 2024: assets, liabilities, staff, website, telephone, pay.Finances by year IRS Form 990 e-file data - total revenue and total expenses by tax year.Renewal outlook Computed by Governance Register from the observed filing history and filed revenue (us-approach-v4-clean). Not a statement that the organisation is recruiting.Exemption status IRS Automatic Revocation of Exemption List (posted to 13 October 2026).Licence US Federal Government public domain.How we handle data
Exemption recognised again: the IRS automatically revoked this organisation’s exemption on 15 May 2014, and its IRS ruling date is now 1 August 2014 (a later recognition). Source: IRS Automatic Revocation of Exemption List, posted to 13 October 2026.

Holston Valley Medical Center Medical Staff Fund's network

4 peoplei4 people on this map.The large node is the subject of this page. Solid lines are what the register itself records (4). Form 990 filings give names without a person identifier; SEC insider filings carry a CIK.

The board

4 listediTime on the board is observed from the annual filings: the IRS files no appointment date, so the bar counts years from the first filing the person appears on - a lower bound, not a filed start date. Names are exactly as filed. The IRS publishes no person identifier, so this edition does not yet link a person across organisations.Tenure and departures are observed across annual filings. Observed tenure is a lower bound - a member may have joined before the first year on record.
NameRole as filedSinceOn the board
Evan Kulbacki MD (also filed as Evan Kulbacki)Prior President2018
8 yrs
Kevin Cornwell MD (also filed as Kevin Cornwell)President2022
4 yrs
Lauren PY MDSecretary/Treasurer2024
2 yrs
Stephanie Hart MDPresident-Elect2023
3 yrs
Under 5 years5 to 6 years6 years or more

Pay and hours

year to 31 December 2024iFrom Part VII of the Form 990: compensation reported for each officer, director, trustee, key employee and highest-paid staff member, and the average hours a week they report. Most board members are unpaid; a blank means nothing was reported. Pay from related organisations is shown separately.
NameTitle as filedHours a weekPay from the organisationRelated organisationsOther
Kevin Cornwell MDPresident5$11k
Stephanie Hart MDPresident-Elect3$3k
Lauren Py MDSecretary/Treasurer1$2k
Evan Kulbacki MDPrior President1$2k

About

Legal name
Holston Valley Medical Center Medical Staff Fund
EIN
452386864
Address
130 West Ravine Road, Kingsport, TN, 37660-3837
State
Tennessee
Activity (NTEE)
N50 Recreation and sports
IRS classification
501(c)07 (tax-exempt under section 501(c)(3) where shown)
Classified purpose
Recreation & Sports
Size band
4 (IRS master file code)
IRS ruling date
1 August 2014
Status
Code 01 (unconditional exemption)
Form 990 filings on record
6, latest 2024

Most connected

Longest observed on the filings

≥8years on the filingsEvan Kulbacki MD
≥4years on the filingsKevin Cornwell MD
≥3years on the filingsStephanie Hart MD
≥2years on the filingsLauren PY MD

Latest return

year to 31 December 2024iFigures from the newest Form 990 or 990-EZ in the IRS e-file releases of 2025 and 2026, for the year ending 31 December 2024. US dollars, as filed.
Total assets
$441k
Total liabilities
$0
Net assets or fund balances
$441k

Filed finances

1 yeariTotals as filed on the IRS Form 990 (revenue and expenses), by tax year.
Tax yearTotal revenueTotal expensesSurplus or deficit
2024$104k$30k$74k

As filed on the IRS Form 990. US dollars.