The contract was included in a cache of tens of thousands of internal Americore documents, dealing with all aspects of the business, which changed hands in the course of one of the many private disputes related to the company. POLITICO, which first began reporting on Jim Biden’s Americore involvement in 2019, recently obtained the cache, and this article draws on hundreds of the documents within it.

Jim Biden’s representatives declined to respond to questions about whether he has a relationship with Fountain Health.

As relations deepened between Fountain Health and Americore in the summer of 2017, Jim Biden grew closer to White. He saw even more potential in struggling rural hospitals than the value contained in their real estate.

In addition to cancer treatment, he believed he could help Americore land contracts from the Veterans Affairs Department, an area rife with federal subsidies, and from labor groups, political allies of his older brother with whom he had built longstanding business ties over the decades, according to emails and the former Americore executives.

A few weeks after Fountain concluded the deal with Ellwood City Hospital in Pennsylvania, Jim Biden took O’Connor, an army veteran who served as Joe Biden’s government-provided doctor during the Obama administration, to meet with the hospital’s president, Beverly Annarumo.

“You and your team clearly share our vision, and I look forward to seeing you again in coming months,” O’Connor, who now serves as Biden’s White House physician, wrote to Annarumo later that week. Annarumo did not respond to requests for comment.

The White House did not respond to requests to interview O’Connor. The physician, who also lists an affiliation with the George Washington University’s medical school, did not respond to an email sent to him through the university’s website.

As the summer wore on, plans for a health care empire continued apace.

On July 12, Joey Langston emailed Jim Biden, Keaton Langston, White and two others to schedule a “meeting for Fountain Health partners” the next week.

“Jim will report to the group the results of his discussions earlier today with a contact at [Blue Cross Blue Shield],” he wrote. “There will also be discussion about how to proceed with the Union contacts that have been made by Jim and Keaton, within the last two weeks.”

The partners’ meeting had to be put off so that White and Jim Biden could attend a meeting in Ellwood City, where Americore’s hospital acquisition faced review by the state.

Once the acquisition was completed, Joey Langston wrote in another email to Jim Biden and others, Fountain could dramatically increase the samples it sent to Ellwood City for lab testing.

But before the deal could close, it needed to be reviewed by the office of Pennsylvania’s attorney general. At the time, that was Josh Shapiro, who, as the Democratic nominee for that post in 2016, had campaigned alongside Joe Biden.

Approval was no guarantee. Americore’s efforts to acquire a hospital in southwest Virginia were encountering resistance: Local authorities had learned about financial problems in Pineville, where the hospital had just failed to make payroll, and about one of White’s previous ventures in Canada, in which investors had been saddled with losses.

In Pennsylvania, the company had a leg up. With his roots in Scranton, and his three decades representing neighboring Delaware, Joe Biden had earned the honorific of Pennsylvania’s “ third senator,” and an endorsement from a Biden could help ease concerns about Americore’s trustworthiness.

On a Thursday afternoon in July, Shapiro’s office held a hearing at the hospital to solicit feedback on the proposed takeover. In a show of support, Jim Biden accompanied White, who noted the presence of his new ally. “We also have Jim Biden here as one of our strategic partners,” White said, according to a transcript of the hearing obtained under Pennsylvania’s Right-to-Know Law. “Very familiar person I’m sure.”

In the weeks that followed, Shapiro recommended the approval of Americore’s acquisition of the hospital, which began going by the name Ellwood City Medical Center, according to a September 2017 order issued by Lawrence County judge David Acker that greenlit the takeover.

Representatives for the attorney general’s office directed requests for more information about the approval to the state’s public records process, where a request for documents remains pending. Representatives for Shapiro, who now serves as governor, did not respond to requests for comment.

Americore’s bid enjoyed support from some local stakeholders, and it is unclear what role Jim Biden’s help played in the approval.

His appearance at the Ellwood City hearing had been a rare sign of visible support. As a personal business bio he sent Grant White a few days after the hearing made clear, he preferred to operate in the background.

“Jim has been advising his brother in relation to implementing the Cancer Moonshot, his nephew Beau Biden’s legacy foundation and other Biden family projects,” the bio states. “Through the years, Jim has personally met and has maintained relationships with many key governmental and business leaders throughout the world. He remains the closest personal advisor to his brother. He prides himself in maintaining a low business and political profile.”

Big Brother

In private, Jim Biden was less shy, especially when it came to invoking his older brother.

Several former Americore executives said Joe Biden was central to Jim Biden’s ambitions for the company.

One said that Jim Biden explained to him “His brother was very interested in rural health care and very interested in veterans’ health care and it was something he really wanted to get behind.”

In fact, Jim Biden told the executive, if Americore successfully demonstrated a model for revitalizing rural health care, Joe Biden could run on it in 2020. “This would help his brother get elected if it were to take off and go,” the former executive explained.

Another former executive said that Jim Biden spoke of plans — which did not come to pass — to give Joe Biden equity in Americore.

The plans were part of broader discussions about Jim Biden taking an equity stake of his own in the company, this person said.

A third former executive said that White and Jim Biden spoke of plans to put Joe Biden on Americore’s board.

None of them recalled any indication that Joe Biden ever did involve himself in the company, though his younger brother also invoked him in the course of wooing potential business partners and acquisition targets outside of Americore.

One person on the receiving end of Jim Biden’s health care pitch recalled a phone call in which Jim Biden said he was sitting in a car next to his brother Joe. Joe Biden has said that he never discussed business with his brother.

Previously, an executive who was suing Jim Biden told POLITICO that in a call with the maker of an oral health care rinse he had offered to have the product promoted by the Biden Cancer Initiative. At the time, a spokesman for Jim Biden dismissed that allegation as “pure fantasy.”

The newly obtained email sent to another potential business partner confirms that Joe Biden at times was featured in Jim Biden’s pitch. “This would be a perfect platform to expose my Brothers team to [your] protocol,” he wrote to Jonathan Brenner, the CEO of Tampa-area health care firm Medicus. Brenner did not respond to requests for comment.

While Joe Biden has said he never discussed business with Jim Biden, he did have a chance to meet Americore’s CEO.

In September of 2017, White attended a fundraiser for the Beau Biden Foundation, a nonprofit dedicated to fighting child abuse, alongside Jim Biden. At the event at the Wilmington Country Club, White met Joe Biden, though there is no indication they discussed business.

The next month, White met Jim and Hunter Biden for lunch at the Mandarin Oriental Hotel in Manhattan. The trio discussed the possibility that Americore could land an investment from associates of Jim and Hunter Biden affiliated with CEFC, a Chinese energy firm, according to a person familiar with the conversation.

Tracy Schmaler, a communications consultant who has been fielding media inquiries on behalf of Hunter Biden’s legal team, did not respond to a request for information about the encounter.

In November, Jim and Hunter’s plans with the Chinese businessmen were upended when one of them, Patrick Ho, was arrested by the FBI for bribing government officials in Chad and Uganda.

As he looked elsewhere for investment capital, Jim Biden enlisted the help of more relatives.

Emails also show that his son, Jamie Biden — a creative type known for his turn as a long-haired DJ in the Hamptons — pitched in, helping to create a video presentation about Americore intended to entice investors.

Jim Biden’s wife, Sara Biden, an attorney and a partner in Jim’s consulting firm, Lion Hall Group, was more involved. She helped prepare investor presentations and for a time was given her own Americore email address, according to emails obtained by POLITICO.

Neither Jamie Biden nor Sara Biden responded to requests for comment.