2024-05-01T09:36:33-05:00 2023-06-30 990 2022-07-01 540794913 Smyth County Community Hospital SMYT 4233023467 311 Princeton Road Suite 1 Johnson City TN 376012080 Dale Clark SCCH CEO 4233023467 2024-05-01 Dale Clark 999009999 1 P03077501 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Dale Clark 245 Medical Park Dr Marion VA 24354 46487791 0 X www.balladhealth.org X 1961 VA Honor those we serve by delivering the best possible care 4 0 2 24 80931 33612 174234 143211 53330076 45889838 1560597 36826 412614 265849 55477521 46335724 37930 17225 0 0 19527644 18871779 0 0 0 28336783 28607950 47902357 47496954 7575164 -1161230 59602575 58619963 24072546 20229893 35530029 38390070 X Honor those we serve by delivering the best possible care.Ballad Health is dedicated to improving the health of the 29-county Appalachian Highlands region. 0 0 32513340 17225 41537999 See Schedule O 6277752 4272908 See Schedule O 38791092 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 2 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 VA TN X Shane Hilton 4233023467 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Eric Deaton BH EVPCOO Director 1.00 64.00 X X 0 1268808 106688 Tim Belisle BH EVPGen Cnsl Director, Secretary End July 2022 1.00 64.00 X X 0 827127 56231 Alan Levine BH PresCEO Director, Chair 1.00 64.00 X X 0 3557360 247091 Marvin Eichorn BH EVPCAO Director 1.00 64.00 X X 0 3107146 45520 Julie Bennett CLOGovnc Offcr Director, Secretary Start April 2023 1.00 64.00 X X 0 0 0 Andrew Wampler BH Gen Cnsl Director, Secretary End April 2023 1.00 49.00 X X 0 207386 40760 Lynn Krutak BH EVP/CFO 1.00 64.00 X 0 1209478 109728 Robert Bender CFO, BH Northern Region 5.00 40.00 X 0 317730 38666 Dale Clark VP, CEO - SCCH 45.00 0.00 X 320228 0 21276 Trista K Ruff Assoc. Admin./CNO - SCCH 40.00 0.00 X 159993 0 30216 Joseph Boothe Registered Nurse 40.00 0.00 X 226876 0 35558 Beldon Fleming Pharmacy Manager 40.00 0.00 X 165475 0 36237 Gregory Rinehardt Rehab Therapy Mgr 40.00 0.00 X 129574 0 26826 Patricia Debusk Physical Therapist 40.00 0.00 X 119389 0 28422 Kelley Gray Physical Therapist 40.00 0.00 X 114160 0 6919 John Jeter VPCEO BRMCJMH Former Officer 0.00 45.00 X 0 432429 40617 1235695 10927464 870755 14 1 1 0 0 135126 8085 143211 Patient Revenue 622110 45671965 45671965 CARES Act Revenue 621111 82355 82355 Lab Outreach Revenue 621500 80931 80931 Occupational Medicine 622110 52279 52279 Wellness Programs 622110 2308 2308 45889838 34826 34826 219741 152067 67674 67674 67674 2000 0 2000 2000 2000 Cafeteria/Vending 722514 169295 169295 Other Revenue 900099 28880 28880 198175 46335724 45810907 80931 300675 X 17225 17225 634532 634532 14925746 11952301 2973445 377812 310955 66857 2005885 1235011 770874 927804 861465 66339 734 734 12383586 10099474 2284112 18810 1625 17185 307706 276741 30965 760388 704937 55451 1304147 1283089 21058 52924 49966 2958 390451 386500 3951 3688510 3331152 357358 -221310 -234435 13125 Taxes - UBIT 2000 2000 Medical Supplies 6931003 6931003 Maintenance 1290375 1275657 14718 Support Services 1197994 1197994 500632 308426 192206 47496954 38791092 8705862 0 1652 1650 78710 25446 5150271 4811562 21848 0 977952 980466 527930 415054 118007046 71150256 48812532 46856790 2670406 2219891 1361274 3309104 59602575 58619963 4488759 3763929 15271960 15271960 164264 136147 4147563 1057857 24072546 20229893 X 35527529 38387570 2500 2500 35530029 38390070 59602575 58619963 X -1161230 -450515 4471786 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3148 0 0 0 3148 0 Part II-B, Line 1: Smyth County Community Hospital had lobbying expenses of $3,148 which represents the portion of dues paid to various organizations attributable to direct lobbying, including Virginia Hospital and Healthcare Association and Virginia Health Care Association. 2084648 2084648 57805665 19544295 38261370 63400 63400 0 57255513 50869858 6385655 797820 672703 125117 46856790 Due from Third Party Payors -468386 Other Receivables 1313005 Due from Affiliates 2464485 3309104 Due to Third Party Payors 470908 Professional Liabilities Reserve 353253 Operating Lease Obligation ST 53655 Operating Lease Obligation LT 119541 Due to Payor Stimulus Reserve 60500 1057857 X Part X, Line 2: Smyth County Community Hospital is included in the audited consolidated financial statements of Ballad Health. The footnote explanation relative to income taxes reads: "Ballad is classified as an organization exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. As such, no provision for federal income taxes is included in the accompanying consolidated financial statements. Taxable subsidiaries are discussed in Note K. No significant uncertain tax positions exist at June 30, 2023 and 2022. Tax returns for 2020 through 2022 are subject to examination by the Internal Revenue Service." 1 1 X 1 X 225.000000000000 1 X 450.000000000000 1 1 0 1 1 677016 677016 0.01430 9229079 13962204 0 0.00000 9906095 13962204 677016 0.01430 94909 5375 89534 0.00190 440009 4589 435420 0.00920 1539980 1117820 422160 0.00890 67616 3343 64273 0.00140 8525 8525 0.00020 2151039 1131127 1019912 0.02160 12057134 15093331 1696928 0.03590 100 100 0.00000 100 100 0.00000 1 1913248 95662 11089334 10211841 877493 X 1 1 1 1 Smyth County Community Hospital 45 Medical Park Drive Marion VA 24354 balladhealth.org H 1902 X X X Smyth County Community Hospital 1 0 0 1 X X X X X X X X X X 21 1 1 0 1 X balladhealth.org/locations X 1 22 0 1 0 1 X 225.000000000000 450.000000000000 X X X X X 1 1 X X X X 1 X balladhealth.org X balladhealth.org X balladhealth.org X X X X X X 1 X 0 X X X X 1 X 0 0 Smyth County Community Hospital Part V, Section B, Line 3j: To understand each community's individual needs, Ballad Health conducted a Community Health Needs Assessment (CHNA) for each Ballad hospital to profile the health of the residents within its service area. Throughout the CHNA process, high priority was given to determining the health disparities and available resources within each community. Community members from each county met with Ballad representatives to discuss current health priorities and identify potential solutions. Priorities established for our CHNA were determined by the most significant health needs of the community. Ballad Health hospitals, including Smyth County Community Hospital, conducted their fifth CHNA with board approval and publication occurring at the end of FY21.For FY21 CHNAs, Ballad Health utilized a mixed-methods approach for primary and secondary data collection to gather regional information to inform the 2021 community health needs assessments. The secondary data collection entailed the compilation of secondary data pertaining to agreed-upon metrics and indicators from an array of verified sources. The primary data collection component involved both a key stakeholder survey and key stakeholder focus groups. Findings from both research methods were used to prioritize the needs of the community served by each Ballad Health facility and determine priority focus areas for future improvement efforts. Analysis of secondary data for Smyth County, findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Smyth County. For Smyth County Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Smyth County are substance abuse, mental health, and Adverse Childhood Experiences (ACEs). Smyth County Community Hospital Part V, Section B, Line 5: The community health needs assessment process was guided by the Mobilizing for Action Through Planning and Partnerships (MAPP) model, with an understanding that aspects of the model may have to be adapted due to the purpose of the assessment for Ballad Health and constraints related to the COVID-19 pandemic. In coordination with the MAPP model, concepts from both Community-Based Participatory Research (CBPR) and the Arkansas Center for Health Improvement (ACHI) Community Health Assessment Toolkit were also utilized for the assessments. Following guidance from the MAPP model, a Key Stakeholder Survey was designed with the primary aim of identifying the most-pressing community issues. In aligning with principles of CBPR, the key stakeholder survey was designed to allow key stakeholders to frame community issues in their own words through the use of open-ended questions. In addition to the identification of community issues, the key stakeholder survey was also designed to discern why survey respondents believed the community issues they selected had the greatest effect on the overall health and wellbeing of their community. Questions related to ideas and suggestions for improvement efforts, gauging the success of efforts after the previous community health needs assessments, and community struggles related to the COVID-19 pandemic were also included in the survey. Independent focus groups were conducted for each Ballad Health facility in order to provide specific and unique information for each community being served. The MAPP model and questions from the key stakeholder survey were used to guide the development and construction of the focus groups. Because the key stakeholder survey primarily dealt with the identification of community issues, the focus groups were primarily designed to prioritize community issues identified through the key stakeholder survey and discuss actionable items around how to best address these community issues. Questions related to root causes of community issues, the current state of resources to address community issues, needed resources to initiate improvement efforts and be successful, and community struggles related to the COVID-19 pandemic were also included in the focus group facilitation guide. The key stakeholder focus groups were conducted virtually via WebEx and were one hour and thirty minutes in length.For Smyth County Community Hospital there were eight focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Smyth County, VA which included: the school system, businesses, government, the health care system, health departments, faith-based organizations, and a diverse group of community-based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders. Activities associated with the June 2021 assessments took place from summer of 2020 through the spring of 2021. The assessment activity including focus groups & surveys were used to develop the hospital implementation plans that were completed fall 2021. Smyth County Community Hospital Part V, Section B, Line 6a: Each hospital within Ballad Health completed a CHNA. SCCH's CHNA was conducted with all Ballad Health hospitals at that time to include: Bristol Regional Medical Center, Hancock County Hospital, Hawkins County Memorial Hospital, Greeneville Community Hospital, Holston Valley Medical Center, Johnson City Medical Center (includes Niswonger Children's Hospital and Woodridge Hospital), Franklin Woods Community Hospital, Indian Path Community Hospital, Lonesome Pine Hospital (including Mountain View campus), Johnson County Community Hospital, Johnston Memorial Hospital, Norton Community Hospital, Dickenson Community Hospital, Russell County Hospital, Smyth County Community Hospital, Sycamore Shoals Hospital, and Unicoi County Hospital. Smyth County Community Hospital Part V, Section B, Line 11: During the year, Smyth County Community Hospital focused on its CHNA priorities as identified in its FY21 CHNA report. SCCH's primary areas of focus included: substance abuse, mental health, and Adverse Childhood Experiences (ACEs). Many additional community needs exist in our region. It is fiscally impossible for a hospital to address every health need in a community, which is why the CHNA process is used to identify and prioritize areas of focus. A thoughtful CHNA evaluates overall community health needs to determine which ones the hospital can best influence in a positive way. Consideration is given to other organizations in the hospital's geographic area that already offer services addressing specific health needs. In some cases, it is best to simply support an identified health need through a financial donation to another nonprofit organization skilled in certain areas: teen pregnancy, dental health, fighting homelessness, etc. Hospitals also lend support to other nonprofit organizations by serving on their boards, committees, and assisting with fundraising efforts. Ballad Health made financial contributions to other nonprofit organizations providing community services that support the hospital's CHNA. SCCH continued its practice of providing medications and supplies to area rescue squads this year Smyth County Community Hospital Part V, Section B, Line 13h: Ballad Health's financial assistance policy allows for some exceptions to strictly adhering to federal poverty guidelines when awarding financial assistance. Unique circumstances may be weighed and assessed for financial assistance consideration on a case-by-case basis. Also, there are some services where financial assistance may be provided outside of federal poverty guidelines. These are noted in Ballad Health's financial assistance policy. 1 1 - Francis Marion Manor Health & Rehab 100 Francis Marion Lane Marion VA 24354 Hospital Based Nursing Home (SNF/NF) Part I, Line 3c: Financial assistance approval can apply to an assortment of patients such as those who have exhausted their Medicaid/TennCare benefits, those who qualified for Medicaid/TennCare after the date of service, deceased patients with no estate or assets, uninsured patients, and underinsured patients. While Ballad Health's qualifications for financial assistance is based on federal poverty guidelines, asset values may also be used to determine financial assistance eligibility. Unique circumstances may be assessed on case-by-case basis. Charity approval covers current or active patient balances when they are approved and there is no limitation or cap on the amount of charity that a patient may receive. Ballad Health hospitals do not stop approving financial assistance for patient accounts if a hospital's charity write-offs exceed the hospital's charity budget.All Ballad Health hospitals provide an uninsured discount. The current uninsured discount for Critical Access Hospitals (CAH's) is 77% and for all other hospitals or physician practices it is 85%. In addition to the uninsured discount, many patients will further qualify for additional financial assistance. All patients seeking financial assistance must submit an application for financial assistance and submit documents in support of the information on the application, unless specifically excluded according to policy guidelines. Medicaid eligible patients will qualify for 100% financial assistance and not be required to complete the required documentation when: a) Medicaid eligibility requirements are met after the service is provided, b) non-covered charges occur on a Medicaid eligible encounter, or c) benefits have been exhausted. Deceased patients with no estate also qualify for 100% financial assistance.Financial assistance determinations may be retroactive for all outstanding balances. In addition, Ballad Health offers a number of programs with special discounts such as lactation consultation services, oncology treatment regimens, enrollment in various community programs and prescription drugs filled post-discharge. Part I, Line 7: The cost to charge ratio (worksheet 2 "ratio of patient care cost to charges") was used to calculate line 7a financial assistance at cost, which includes charity and uninsured discounts. Due to Virginia Medicaid supplemental funding in FY23, SCCH did not incur a Medicaid loss. Line 7e community health improvement includes costs that are taken directly from departmental operating reports or expenses specific to a community health event, with no additional overhead included in the cost. Line 7f health professions education is comprised of internships (primarily nursing, pharmacy, and therapy students) with local schools and universities, allowing their health profession students to get hands-on training in a hospital setting. Another source of health professions education reported on line 7f is our Medicare-approved CNA, "Certified Nursing Assistant", program. The CNA program cost and reimbursement information comes from our filed Medicare cost report, adhering to IRS 990 instructions. For line 7g subsidized health care services, we use our cost accounting system because we have established, standard costing reports for these services. We are careful to ensure no double counting of cost. Although we have other service lines within our hospital that lose money, we do not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7h research represents SCCH's expense allocation from Ballad Health for research. Line 7i cash and in-kind contributions include cash disbursements and in-kind donations of medications to local nonprofit rescue squads and fire departments. In-kind donations of medications are based on our actual cost for these items. Part II, Community Building Activities: SCCH leaders support and encourage all team members to volunteer time, money and skills to community service projects and charitable organizations. Senior leaders and board members set a positive example for SCCH team members, serving voluntarily on committees and boards of local service and nonprofit organizations. Some also serve as members and consultants on professional committees and task forces that affect regional development in healthcare and education. We do not capture costs associated with team members that serve on other nonprofit boards or provide services to other nonprofits.SCCH, in collaboration with area health agencies and providers, may offer assistance with coordination, advocacy, or contribute supplies to support groups for their program activities that serve to assist special populations within our area. Most of these organizations work to improve the lives of community members that have limited, or no, financial resources.In FY23 SCCH contributed to the Phillip Michael Smythe Foundation's education scholarship fund for Emory & Henry College. Part III, Line 2: Self-pay balances include accounts after payments and contractual adjustments (discounts) have been applied from all third-party payors such as Medicare, Medicaid, commercial insurers, and others - generally leaving the patient responsible for any remaining deductible and/or co-payment. Other self-pay accounts are from patients with no insurance or other third-party coverage. Under Ballad Health's system-wide self-pay policy, any patient who has no insurance and is ineligible for any government assistance program received an 85% discount. Many self-pay patients will further qualify for financial assistance (sometimes referred to as charity care) if they provide the financial information that we need to deem them eligible or upon determination of presumptive charity eligibility.After the normal collection process has indicated an account is uncollectible, SCCH writes the account off to bad debt. The hospital's overall self-pay accounts receivable balance is evaluated on an ongoing basis to evaluate the age of accounts receivable, historical write-offs and recoveries and any unusual instances (such as local, regional or national economic conditions) which affect the collectability of receivables. Part III, Line 3: Ballad Health estimates that approximately 5% of SCCH's bad debt would have qualified for financial assistance if patients had provided our hospital with a financial assistance application and required documentation. Pursuant to the merger, SCCH has begun to score accounts using a presumptive eligibility tool. This tool utilizes various data points for a proprietary algorithm operated by an outside vendor to provide an individual's score. There are many instances of patients with account balances and no health insurance coverage that SCCH believes would qualify for financial assistance. Although patients are encouraged to apply for assistance, many will not do so. SCCH would prefer for patients to submit completed financial assistance applications given that historical data clearly indicates that most uninsured patients and many underinsured patients will qualify for financial assistance under SCCH's program. Without a completed application, these are recorded as bad debt instead of charity care. Part III, Line 4: Ballad Health's audited financial statements include a footnote on page 14 that describes bad debt. SCCH is included in the June 30, 2023 audited financial statements of Ballad Health (attached). Part III, Line 8: Excluding Medicare losses reported in Part I subsidized health, the Part III Medicare allowable costs are reported using SCCH's filed Medicare cost report (C/R). The C/R uses a cost to charge ratio based on a step-down allocation methodology.Ballad Health believes Medicare losses should be allowed as a reportable community benefit, similar to governmental programs such as Medicaid. As a participating provider in the Medicare program, hospitals are required to provide the full regimen of care for the Medicare population. There are a number of care regimens that are compensated by the Medicare program at levels below cost. Therefore, it is only logical to allow hospitals to report these uncompensated services as a community benefit. By making this change, nonprofit providers will be encouraged to continue important care delivery models for our aging population in spite of the fact it may be economically injurious. Part III, Line 9b: Requests for financial assistance are evaluated using established guidelines, while allowing for unique financial circumstances - for example, medically indigent patients with catastrophic medical costs that would threaten the patient's household financial viability.When a patient requests financial assistance or when an application has been received, the patient's account is placed in a hold status to prevent further collection activities until financial assistance eligibility is determined. All Ballad Health hospitals comply with IRS 501(r) regulatory guidelines.The Ballad Health collection policy clearly states that all patients are treated equally - with dignity and respect. Ballad Health ensures that outside collection agencies used by our hospitals adhere to Ballad Health billing and collection guidelines. The collection program includes communicating expected financial responsibility prior to service. Ballad Health hospitals provide assistance to help underinsured and uninsured patients determine sources of payment for medical bills and to help patients determine eligibility for programs such as Medicaid or TennCare.After insurance benefit verification, Ballad Health bills insurance carriers. If the insurance carrier denies payment of the service/procedure as non-covered or the patient has exceeded their maximum benefits, the service/procedure will qualify for the uninsured discount.Financial counselors are available to discuss financial assistance with patients and their families. Ballad Health hospitals provide a number of payment options:- a pre-service discount may be offered- a discount in excess of established discounting rates may be granted for catastrophic high dollar accounts- the hospital accepts all non-contracted and out-of-network payors and will make attempts to work with these payors regarding appropriate reimbursement and billing to their members-as part of Ballad Health's commitments to the State of Tennessee and Commonwealth of Virginia to form Ballad Health, not-in-network discounts are applied per policies in place for Ballad Health hospitals- payment arrangements are available so long as the account is not with a collection agencyReasonable efforts are made to determine if a patient is eligible for financial assistance - see Schedule H, Part VI, line 3 for information on how patients are informed about our financial assistance policy. Part VI, Line 2: Focusing on population health improvement and associated priority metrics allows Ballad Health to further engage the efforts of its hospitals in partnership with communities in our service areas. It has helped Ballad to better identify health disparities that appear across the individual communities and has helped Ballad to prioritize issues that are most important in each hospital's community. Engaging local community organizations expands partnerships so that organizations work together more to address community health needs. Ballad Health uses a comprehensive process to gather input for and continues to evolve its population health plan. Because our hospitals are located in a region with many chronic disease challenges and high levels of health-related social risks, Ballad Health's goal is to target population health issues to make lasting improvements. Ballad conducts ongoing interviews, focus groups and meetings with external groups, including the regional health departments, United Way agencies, chambers of commerce, schools and community organizations, the regional accountable care community leadership council, as well as internal groups such as our population health and community benefit committee of the Ballad Health board of directors, the Ballad Health population health clinical committee, social needs council, grant advisory committees and our hospital community boards in the creation and on-going implementation of its population health plan. Part VI, Line 3: Consistent with the Ballad Health financial assistance policy, SCCH communicates with and provides education to our patients through various avenues regarding governmental assistance programs and hospital financial assistance. Various educational and application documents related to obtaining financial assistance are widely available at SCCH and all documents are available on the Ballad Health website. Printed financial assistance educational materials are part of each registration packet and posters are displayed in highly visible areas of the hospital. SCCH's financial assistance policy and documents are available in our Emergency Department and admitting areas. SCCH is also happy to mail all documents to patients and offers a plain language summary. All documents are available in English and Spanish. Financial assistance information is available during pre-registration, registration and/or during financial counseling. We offer governmental program eligibility representatives to assist patients in securing eligibility for Medicaid or TennCare, federal disability and other governmental assistance programs. Additionally, if a patient or community resident expresses an interest in the ACA healthcare exchange, our representatives have the qualifications and experience to assist them through the entire process. Our financial counselors offer financial assistance applications to patients who do not qualify for governmental assistance programs and are unable to pay for some or all of their healthcare.All patient billing statements have verbiage discussing financial assistance along with contact information. Our last letter to the patient displays the plain language summary. In all oral correspondences with a patient, if it is identified the patient cannot meet payment requirements on their account, financial assistance is discussed as an option.Applicants are notified of financial assistance determination in writing Part VI, Line 4: Smyth County Community Hospital, located in Marion, Virginia, primarily serves Smyth and Wythe Counties in Southwest Virginia. Smyth County has a population of 29,893. The population projections for Smyth County over the next five years show that the county will likely experience a slight decline in population overall. However, the age 65+ population for Smyth County is projected to experience the most population change over the next five years, as it moves from 23.3% of the total population in 2021 to 25.8% of the population in 2026. The aging population of the county presents opportunities for earlier identification and better management of health conditions that oftentimes affect elderly populations in rural areas.Additionally, the median household income for Smyth County is $41,000 which ranks well below the average for the state of Virginia at $72,600. Other demographic factors influencing health status in the county also includes education levels. A large portion of Smyth County residents do not have an education past high school (54.7%). The remaining portion of the population reports having some college/associates degree (31.3%) or a bachelor's degree or greater (14.0%). Additionally, a large portion of Smyth County (13.0%) adult residents do not have health insurance, which is higher than the Virginia state average (12.0%).According to the 2021 County Health Rankings, Smyth County, where SCCH is located, is ranked among the least healthy counties in Virginia. Smyth County is ranked 112th in Virginia for health outcomes and 102nd for health factors out of 133 counties/cities. Smyth County also ranked 108th in health behaviors, due to higher than desired rates of adult obesity, physical inactivity, adult smoking, and alcohol-impaired driving deaths. As for social and economic factors, Smyth County ranks 105th due to high rates of children in poverty and higher unemployment rates. Part VI, Line 5: SCCH is dedicated to operating efficiently so that waste is minimized. SCCH's leadership remains mindful of managing limited resources so that adequate facilities and equipment are available for the care of our patients. Surplus funds are invested into improving treatment options for our patients through new technologies, recruiting physicians and trained staff in shortage areas, and improving our facilities. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary. SCCH serves as a training site for many types of health professions: nursing, pharmacy, psychology, lab, respiratory therapy, EMT, public health, etc. Students from several colleges receive training and hands-on experience in our hospital. We devote resources to health conferences for local health professionals and offer other programs focused on improving the health of our residents. We provide free drugs and medical supplies to local nonprofit emergency response organizations. While we operate in a predominantly low-income, rural area, we continue to offer services that operate at a loss because Smyth County residents would otherwise need to leave their hometown or county to receive needed care.Physicians that request privileges who are qualified and credentialed are extended privileges by SCCH. Part VI, Line 6: Smyth County Community Hospital is a member of Ballad Health. The merger of Mountain States Health Alliance and Wellmont Health System in 2018 to form Ballad Health opened up many opportunities not previously available to two competing health systems. Collaboration started post-merger and Ballad Health continues to see progress towards improving efficiencies within our health system, activities consistent with Ballad Health's population health initiative, sharing best practice quality improvements, and other benefits related to operating as one rather than operating in a competitive environment. A clinical council was formed immediately following the merger. The council includes physicians nominated from the leadership of all Ballad hospitals. A Community Benefit and Population Health Committee of the board was established, and various other infrastructures have been established since the merger. Across Ballad's hospitals, there were many projects, programs and collaborative efforts that took place during the year. Part VI, Line 7, Reports Filed With States VA,TN Part VI, Additional Information Ballad Health is required to report community benefit estimates on a quarterly basis with the states of Tennessee and Virginia. The reporting includes all of Ballad's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad operates under a Cooperative Agreement (CA) in Virginia and a Certificate of Public Advantage (COPA) in Tennessee as obligated by agreements between Ballad and the two states to allow Mountain States Health Alliance and Wellmont Health System to merge. 1 0 0 Part I, Line 2: The Ballad Health Community Benefit and Population Health Committee is a collective group of members from both Tennessee and Virginia. These members bring a variety of insights into community health improvement, striving to cultivate an understanding of population health, philanthropy, community benefit obligations, and the integral role that Ballad Health plays in enhancing health access. Senior leadership of Ballad Health, including the President and CEO and the COO, are present at these meetings. One of the committee's key duties is to ensure that charitable donations are in line with the policies set by the Ballad Health Board. All applications for assistance are submitted digitally, complete with the necessary information to assess eligibility. Following a thorough review of these applications by the committee, approval must be obtained from various levels, including the Ballad Health CEO or the Ballad Health Board, depending on the level of commitment required. For those seeking funding for a specific event or program, the application should include the following details: -Mission statement of organization -Year organization was founded -Tax status and federal taxpayer ID number -Website -Description of the event/program -Event/program budget -Other sources of income -Impact of the event/program on the health of residents in our region -Beneficiaries of contribution -Number of people served annually -Event/program accomplishments -Measure of accomplishments 1 1 0 0 0 0 0 0 0 Alan Levine BH PresCEO Director, Chair 0 1351717 0 2162808 0 42835 0 218859 0 28232 0 3804451 0 0 Marvin Eichorn BH EVPCAO Director 0 752788 0 598921 0 1755437 0 17400 0 28120 0 3152666 0 0 Eric Deaton BH EVPCOO Director 0 720293 0 530155 0 18360 0 84013 0 22675 0 1375496 0 0 Lynn Krutak BH EVP/CFO 0 682629 0 520077 0 6772 0 82332 0 27396 0 1319206 0 0 Tim Belisle BH EVPGen Cnsl Director, Secretary End July 2022 0 277977 0 310583 0 238567 0 29779 0 26452 0 883358 0 0 John Jeter VPCEO BRMCJMH Former Officer 0 340640 0 83783 0 8006 0 17859 0 22758 0 473046 0 0 Robert Bender CFO, BH Northern Region 0 249949 0 65374 0 2407 0 15261 0 23405 0 356396 0 0 Dale Clark VP, CEO - SCCH 249748 0 62956 0 7524 0 13152 0 8124 0 341504 0 0 0 Joseph Boothe Registered Nurse 221896 0 3216 0 1764 0 13892 0 21666 0 262434 0 0 0 Andrew Wampler BH Gen Cnsl Director, Secretary End April 2023 0 202835 0 1250 0 3301 0 30762 0 9998 0 248146 0 0 Beldon Fleming Pharmacy Manager 160177 0 1250 0 4048 0 10232 0 26005 0 201712 0 0 0 Trista K Ruff Assoc. Admin./CNO - SCCH 138150 0 21587 0 256 0 8651 0 21565 0 190209 0 0 0 Gregory Rinehardt Rehab Therapy Mgr 125429 0 1250 0 2895 0 7936 0 18890 0 156400 0 0 0 Part I, Lines 4a-b The following executives participated in a 457(f) retirement plan provided by Ballad Health. The 457(f) plan is a nonqualified tax-deferred compensation plan available to a select group of key executives for the intent of supporting retention and to offer a competitive total retirement program. Account balances have a "substantial risk of forfeiture". In addition to creditor risk, substantial risk of forfeiture is created through default risk if the participant's employment with Ballad Health is terminated prior to age 65. However, the 457(f) plan contains a non-compete provision that provides the account balance to be paid in a lump sum after the executive satisfies the two-year non-compete period. This provision applies to employer contributions if the executive has provided eligible service for six or more years. The executive will receive the entire account balance if he/she becomes disabled, dies or if the executive terminates for "good reason or is involuntarily terminated without "good cause" within a 24-month period after a change-of-control occurs. Distributions from this plan are subject to federal, state, and local taxes on the entire account balance upon distribution. Alan Levine $201,459 Eric Deaton $ 66,613 Lynn Krutak $ 64,932 Tim Belisle $ 22,233 Andrew Wampler $ 18,111 The following executive received a change-of-control payment. The payment was reported as taxable income with appropriate tax withheld and remitted to the IRS. Tim Belise $179,601 Form 990, Part III, Line 4a: Program Service Accomplishments Smyth County Community Hospital's (SCCH) membership consists of Mountain States Health Alliance. SCCH is also a member of the Ballad Health network. Ballad Health (Ballad) is an integrated healthcare delivery system consisting of 21 hospitals in Northeast Tennessee and Southwest Virginia, including a Level 1 Trauma Center, dedicated children's hospital, several community hospitals, three critical access hospitals, a behavioral health hospital, an addiction treatment facility, long-term care facilities, home care and hospice services, retail pharmacies, outpatient services and a comprehensive medical management corporation. Ballad works closely with an active independent medical community and community stakeholders to improve the health and well-being of over one million people in 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky. Ballad is a Tennessee non-profit corporation and is the main provider of healthcare services in Northeast Tennessee and Southwest Virginia. Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). On February 1, 2018, Ballad was formed through a merger of two legacy systems, Mountain States Health Alliance and Wellmont Health System. Ballad was formed under state-action immunity in compliance with federal antitrust law, to create a healthier region and keep healthcare local. The action approving the merger was officially taken through the agreements made between Ballad and the State of Tennessee in the Certificate of Public Advantage (the "COPA") and the Letter Authorizing the Cooperative Agreement (the "CA") in Virginia. Pursuant to the COPA and CA, Ballad must fulfill certain obligations, commitments, and covenants. Tennessee and Virginia, through their respective health departments, supervise specific aspects of Ballad's operations under certain conditions of the COPA and the CA. The COPA and amendments is publicly available on the website of the Tennessee Department of Health, at https://www.tn.gov/health/health-program -areas/health-planning/certificate-of-public-advantage.html. The Cooperative Agreement is available on the website of the Virginia Department of Health, at https://www.vdh.virginia.gov/licensure- and-certification/cooperative-agreement/. Smyth County Community Hospital (SCCH), located in Marion, Virginia, has served the community for over 45 years. The 44-bed, LEED certified facility opened in 2012. SCCH provides a full range of acute inpatient and outpatient services, including general surgery, urology, ear nose and throat, orthopedics, cardiology, oncology, and skilled nursing. Nursing home services are provided at Francis Marion Manor, a 109-bed long term care facility. SCCH maintained a five-star patient experience rating for the second straight year and achieved a five-star overall rating in 2021 from Centers for Medicare and Medicaid Services. SCCH is one of only eight hospitals in Virginia to receive a five-star overall rating. Quantros named SCCH in the top 10% of hospitals in the nation for medical excellence in major bowel procedures and sepsis care in its 2023 CareChex awards. Healthgrades named SCCH as a Five-Star Recipient for Treatment of Sepsis for 9 Years in a Row (2015-2023). U.S. News recognized SCCH as "high-performing" in care for hip-fracture patients. SCCH serves the populations of Smyth and Wythe Counties in Southwest Virginia. Specific to the hospitals included in this Form 990, services were provided to: 1,063 hospital inpatients 55,188 outpatient visits 18,004 emergency visits 29 nursing home admissions SCCH subsidizes the Glade Springs Family Medicine Rural Health Clinic and the Family Medicine Practice in Rural Retreat, Virginia. These practices are located in rural, medically underserved areas and allow residents to receive quality care without having to travel outside of their home area. This is especially important for elderly residents and others that require family or friends to provide transportation to physician appointments. FOCUSING ON QUALITY EMPHASIZING ZERO-HARM THROUGH TIERED SAFETY HUDDLES - As part of Ballad Health's systemwide initiative to improve safety and reduce harm, Ballad Health continued its tiered safety huddle program throughout the pandemic. Each day, frontline team members across the Ballad Health organization begin their morning with huddles focused on clinical quality and safety. These huddles provide an organized manner for team members to express opportunities to improve safety and quality and strive towards becoming a zero-harm institution. Any issues identified during those huddles are elevated to hospital leadership. If hospital leadership needs help to resolve the problem, the issue is further elevated to the market and corporate levels. Using this approach, Ballad Health can improve outcomes and enhance safety by rapidly deploying resources to support and solve safety issues as they arise. LAUNCH OF IBM/WATSON TOP HEALTH SYSTEM JOURNEY - Since the merger in 2018, one of Ballad Health's priorities has been to instill a zero-harm culture and become one of the highest-performing health systems in America for the quality of care it delivers to patients. After a rigorous review of the various systems for measuring that success, Ballad Health leaders chose IBM/Watson because it provided measurable, achievable, and valid guideposts for the health system. To help lead Ballad Health on this journey to become a top health system in the nation, health system leaders formed the IBM/Watson Top 15 Health System Task Force, comprised of stakeholders from multiple departments of Ballad Health. IBM/Watson identifies the 15 top-performing health systems in the nation based on four key performance domains: inpatient outcomes, extended outcomes, operational efficiency, and patient experience. Dr. Amit Vashist, Ballad Health's chief clinical officer, who leads the IBM/Watson top health system journey, stated, "We looked far and wide at various methodologies to identify the most appropriate benchmarks to measure ourselves against, and we ultimately chose IBM/Watson because it included an ideal blend of metrics and measures that are truly meaningful and appealed to our frontline clinicians, such as hospital-acquired conditions, ED throughput, readmissions, mortality, costs of care and length of stay." CLINICAL COUNCIL - A unique feature of Ballad Health is the establishment of a robust and diverse Clinical Council, comprised of about 30 physicians. The physicians were nominated by the leadership of all Ballad Health hospitals, the health system's medical group and independently practicing community physicians. The Council's members also include pharmacists, advanced practice providers and nurses. The Council reports directly to the Quality Committee of the Ballad Health Board of Directors. The council aims to ensure excellence in clinical care through physician engagement and leadership and is charged with guiding Ballad Health's transformation into a community health improvement system. As a result of the council's efforts, several important quality measures are now performing among the top-decile health systems in America. CONTINUED PUBLIC ADVANTAGE Ballad's compliance with each of the COPA and CA is supervised by Tennessee and Virginia respectively. Ballad is in compliance with all terms of the COPA and CA. Each year since the creation of Ballad, the State of Tennessee and Commonwealth of Virginia have independently confirmed the public advantage created by the unification of the hospitals in the rural region. In the latest report dated March 2023, the Tennessee Department of Health highlighted "Over the life of the COPA, improvement was seen in Ballad Health's service area for most of the Access Sub-Index measures. Significant improvements were seen in preventive health measures such as primary care provider and prenatal care in the first trimester. Improvement was also achieved by Ballad Health in all five screening measures, with the most significant improvement occurring in rates of Colorectal Cancer Screenings and Diabetes and Prediabetes Screenings". TDH also recognizes that Ballad Health continued to invest in standing up and implementing many of its Population Health, Behavioral Health, Children's Health, Rural Health, and Health Research and Graduate Medical Education programs proposed under the system's three-year Spending Plans, even as it prioritized its response to COVID-19. In the Tennessee Department of Health report covering the period of July 1, 2021 to June 30, 2022, the department noted that as a combined health system, "Ballad Health's continued handling of the pandemic and the fact that all of Ballad Health's 21 hospitals, including its many vulnerable rural hospitals, remained open through the year are acknowledged by TDH as two of the system's greatest successes during FY22". In each year before the COVID-19 pandemic, Ballad Health also maintained one of the nation's most successful Accountable Care Organizations, which has been highlighted by the Centers for Medicare and Medicaid Services as one of a handful of organizations that have produced savings for taxpayers in each year since the program's creation, while making high-quality scores. ENVIRONMENTAL, SOCIAL, AND GOVERNANCE (ESG) Ballad Health is committed to being a responsible and concerned citizen of the communities of the service area where it operates and is driven by its mission: "honor those we serve by delivering the best possible care." Ballad continues to deploy initiatives intended to improve the overall health and well-being of the over one million people living in its service area. ENVIRONMENTAL - Environmental stewardship and preserving the environment is important to Ballad and is demonstrated in the following practices: - Environmentally responsible supply chain - Encourage the recycling of materials and minimization of waste - Encourage the reduction of energy usage - Incorporate environmentally preferable alternatives when designing new construction SOCIAL - Social commitments are an integral part of Ballad's mission, vision, and values. By working and collaborating with others in the communities in which it serves, Ballad works "to build a legacy of superior health by listening to and caring for those we serve". Ballad provides direct and in-kind support to improve access to care and deliver healthy lifestyle services, education, and activities. The community health programs are designed to improve access and quality of care, strengthen community outreach and partnerships, decrease healthcare costs, and assist in the reduction of health care disparities in the region. Ballad has opened two new rural hospitals in the past five years. Ballad offers extensive education and outreach programs throughout the community at little or no cost to participants. Program areas include: - Community events, such as health fairs, screenings, flu shots, health and safety education, support groups, stroke education, baby and child health, and medical libraries - Children's resources, such as the Morning Mile Program, B.E.A.R. Buddies, car seat safety, and Families Thrive. - Heart and Soul, senior health, and well-being programs. - General health resources, individual health, nutrition, and safety education. - Regular health education speakers covering a wide range of topics. The following are some of the programs designed to improve healthcare equity and availability: Ballad as a Community Health Improvement Organization: Ballad's goal is to ensure the sustainability of rural healthcare services while improving the health and well-being of the region as a whole. In the short-term, Ballad will address health related social needs to improve access to care, reduce inequity, and empower individuals to adopt healthy behaviors and manage health conditions. In the long-term, Ballad will address social drivers of health to provide a community level foundation for permanent regional health improvement through multi-sector collective impact. Ballad is taking an intergenerational approach to focus on children's health initiatives to give kids a strong start in life, as well as assisting adults with overcoming obstacles to health and self-sufficiency. Ballad is on a journey to universalize social needs screening and prioritized navigation resources throughout the system using embedded Epic tools combined with the UniteUs referral management platform. These efforts are informed and supported by a multi-departmental team called the Social Needs Council which has accountability to the system Population Health Council, the Chief Population Health Officer, and ultimately the board Population Health and Social Responsibility Committee. STRONG Accountable Care Community: Driving Community Level Action and Change: The STRONG Accountable Care Community is a regional collective impact model focusing on community level strategies across a life course model that includes a multi-generation approach to parenting support and family self-sufficiency. Established in 2018, the STRONG Accountable Care Community (STRONG ACC), sponsored by Ballad, is a 350 organization, multi-sector model serving the same geographic footprint as Ballad and additional contiguous counties. The STRONG ACC has adopted the "Five Conditions of Collective Impact": a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support. Ballad is providing backbone support and investing in the STRONG ACC because the health system believes the collective impact model is necessary to accelerate, leverage, and sustain community level change. The STRONG ACC is also using the UniteUs platform for a "no wrong door" approach to social needs across hundreds of networked organizations. The organization is also creating an Early Care and Education Plan for all of Northeast Tennessee and Southwest Virginia. For more information, visit https://www.strongacc.org/. Accountable Health Communities ("AHC"): When Ballad was awarded the Accountable Health Communities grant from the Centers for Medicare and Medicaid Services in 2017, the system acted on its vision to universalize social needs screening and navigation. Health related social needs create major barriers to health for some individuals. Within Ballad Health, Unite Tennessee and Unite Virginia will allow specially trained staff to conduct health-related social needs screenings for gaps in care, such as food and housing insecurity, transportation challenges or other obstacles. It will then connect those families with community organizations committed to resolving those issues. The network, however, is not dependent on Ballad Health. Participating organizations will also be able to refer clients to each other even if the people they're referring aren't Ballad Health patients. Since its inception, the program has screened 319,349 individuals and identified 50,000 distinct needs, working with nearly 2,000 regional organizations to successfully connect individuals to services which provide food, housing, transportation, safety support, and utilities among other needs. AHC has provided 29,681 community referrals and navigation for 7,573 patients. The program has revealed new information about the extent of social needs within Ballad's patient environment and informed the goal to scale social needs screening and navigation services throughout the organization. Appalachian Highlands Care Network: Appalachian Highlands Care Network, started in 2020, is Ballad's program to serve low-income, uninsured people of the region through a realignment of charity care dollars. The goals of the Appalachian Highlands Care Network are to identify low-income uninsured people, enroll them in the program, and serve them to improve quality of care, increase access to care, and reduce avoidable cost of care. Patients in the program receive free needed medical care from Ballad and a network of other providers. This includes ensuring all patients have a source of primary care and are screened and navigated to social need resources, provided with medical care coordination, and assisted through care management services. Ballad partners significantly with Appalachian Mountain Project Access, the region's free and reduced cost clinics and health departments, and hundreds of regional social support agencies to break down barriers to medical care, improve chronic conditions like diabetes, and address social needs. To date, the program has enrolled more than 4,800 individuals. STRONG Starts: Ballad believes safe, stable, nurturing environments for children are essential to optimal early development and later success in life. Started in 2021, STRONG Starts is aimed at improving birth outcomes and reducing the negative impact of chronic stress for mothers, babies and families. The birth of a new baby is a pivotal time for a mother and her family. No one should feel alone or unsupported during this time. Ballad seeks to connect with every expectant mother as early in her pregnancy as possible to ensure access to early prenatal care - all in partnership with the region's obstetric providers. As the life situation and pregnancy experience for every woman is different, Ballad will build supportive relationships aligned with the unique circumstances of every woman and family. With embedded staff in the region's obstetric practices and hospital birthing centers, these relationships begin early. Staff will help families connect with community resources for issues from food/housing insecurity to parenting resources to education/job training. To date, the program has screened more than 7,300 women and served nearly 3,000 through the course of their pregnancies. The program continues into the post-natal and early stage of life. Ballad staff assist those in the program through kindergarten entry with a whole-family approach. This ongoing relationship will help with evolving needs and the transition in healthcare from the obstetric environment to the pediatric environment. Ballad works with regional pediatricians to ensure they can refer children and families into the program. The developmental milestones of children will be assessed so early supports can be provided, and Ballad assist with connections to community resources as children grow, including programs which support resiliency and early learning environments. Ballad seeks to further support the safety, stability, and self-sufficiency of families and to help ensure children enter kindergarten developmentally, socially, and emotionally ready to learn. This first experience with the educational system is foundational, as it sets the tone for later success with grade level reading, math proficiency, and the academic discipline needed to ensure high school graduation and college and career readiness. These benchmarks are predictors of later economic and health outcomes which can reshape the life trajectory, health, and well-being for children and families for generations to come. To date, this section of the program has served more than 2,000 families. In addition to these programs, Ballad invests significant funding annually to support partnering organizations, Community Health Improvement Sites, who provide aligned services and mutually serve the populations mentioned above. These services include free health services, care coordination, housing supports, substance use and recovery, social needs support, maternal/child supports, early learning and literacy improvement initiatives, and women's health services. Ballad also provides a host of other services to vulnerable populations including free cancer screenings, mobile health services, health fairs, children's resources, and health education programs notably through a network of faith community nurses. GOVERNANCE Governance is overseen by the Ballad Board of Directors and ongoing ESG work through the following committees: - Audit and Compliance - environmental and sustainability performance - Community Benefit & Population Health - social and community goals and performance - Executive Compensation - human capital; diversity, equity, and inclusion; and pay equity goals and performance - Governance - governance goals and performance - Quality - equity of care, patient safety and quality of care goals and performance Ballad has a conflict-of-interest policy and plans to align reporting with the Sustainability Accounting Standards Board's topics for disclosure and other reporting frameworks in the coming years. Ballad has leader diversity with 30% of CEOs being females and 33% of Executive Vice Presidents being females. CHARITABLE CONTRIBUTIONS - From its inception in February of 2018, Ballad Health made significant contributions to the community it serves totaling over $30 million to date in direct contributions and other community health improvement initiatives. A few examples include: Support for Speedway Children's Charities, aid to Feeding Southwest Virginia, provision of new EKG equipment to regional emergency medical services, and investments in regional programs for schoolchildren. IMPROVING ACCESS TO HEALTHCARE SERVICES RE-IMAGINE RURAL HEALTHCARE - Our region has a variety of health, economic and other issues that, when combined, present a unique and challenging environment for healthcare access and outcomes. These unique challenges were reaffirmed in a 2017 report issued by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthier Kentucky (Health Disparities in Appalachia), which found that the health outcomes in the greater Appalachian region are worse than those experienced in the United States as a whole in 7 of the 10 leading causes of death: heart disease, cancer, chronic obstructive pulmonary disease (COPD), injury, stroke, diabetes and suicide. The region also faces economic challenges, with performance on incomes, poverty rates, unemployment rates and postsecondary education lagging the national level. This is relevant because, as the study notes, socioeconomic and health outcomes are often interrelated, if not interdependent. Since 2010, more than 151 rural hospitals have closed in the United States, according to the North Carolina Rural Health Research Program. Compared to other states, Tennessee ranks amongst the worst in the nation, with 15 rural hospital closures since 2005. In the region served by Ballad Health, however, it is a different story. Every community in the region with a hospital prior to the merger creating Ballad Health continues to be served by a hospital. In fact, in the middle of the pandemic, Ballad Health opened the country's newest rural hospital. In July 2021, Ballad Health followed through on its promise to the residents of Lee County, Virginia, and reopened Lee County Community Hospital in Pennington Gap. CREATED SINGLE COORDINATED REGIONAL TRAUMA SYSTEM - A critical success factor of the COPA and CA is avoidance of duplication of hospital resources. Ballad Health consolidated two Level I trauma centers operating within 25 miles of each other and subsequently created a coordinated regional trauma system. In approving this move in advance of the merger, the State of Tennessee relied upon the evidence published in multiple respected studies which found higher volume trauma centers lead to improved outcomes. The move toward a single coordinated trauma system followed the guidance of the American College of Surgeons (ACS), which verifies trauma centers. The Tennessee Department of Health, after conducting a rigorous review of the trauma program at Johnson City Medical Center, issued its Level I Trauma Center Reverification Site Visit Report. The report found the hospital "has demonstrated an outstanding commitment to care for the injured patient." Further, the survey resulted in zero deficiencies, a first for trauma care in the region. CONSOLIDATED REGIONAL PERINATAL CENTER - Tennessee law requires a regionalized system of care for high-risk newborns. As a result of this law, Tennessee recognizes five regional perinatal centers. Niswonger Children's Hospital at Johnson City Medical Center is the designated center for regional perinatal care for the Appalachian Highlands. Prior to the merger, two neonatal intensive care units (NICUs) existed and were not coordinated. After the merger, Ballad Health immediately took steps to consolidate the NICUs to achieve a more sustainable and coordinated system of care for neonates, while also reducing the costs associated with maintaining two lower-volume units. After this consolidation, Ballad Health partnered with ETSU's Quillen College of Medicine to provide ongoing expert neonatology coverage for the hospital 24 hours per day. As a result of the merger and NICU consolidation, every newborn in the region has access to more than 25 pediatric specialists at the regional Perinatal Center. EXPANDED ACCESS TO PEDIATRIC SPECIALTIES - With financial support from Ballad Health and the State of Tennessee, the ETSU Quillen College of Medicine was able to successfully recruit pediatric surgeons to support Niswonger Children's Hospital. Our partners at ETSU's Quillen College of Medicine also provide 24/7 neonatology coverage for the NICU. Ballad Health now proudly meets the highest standards for regional perinatal care, something that was not thought possible prior to the merger creating Ballad Health. PARTNERSHIP WITH ETSU TO CREATE FELLOWSHIP PROGRAM IN ADDICTION MEDICINE - Ballad Health and East Tennessee State University formed a partnership to create a new fellowship program in addiction medicine. As part of its commitment to expand education and training in the region, Ballad Health will fund any unreimbursed costs of the fellowship program which, over a 10-year period, could cost more than $2.5 million. ESTABLISHMENT OF CENTER FOR RURAL HEALTH RESEARCH - Tennessee Governor Bill Lee announced the creation of a new Center for Rural Health Research that will be housed at the College of Public Health at East Tennessee State University. In addition to state funding, Ballad Health has committed to contributing more than $15 million during the next 10 years to the Center. The goal of the Center will be to work with Ballad Health, local healthcare delivery partners, national experts and the leadership of ETSU Health to identify new mechanisms to improve health in rural and nonurban communities. Specific emphasis will be placed on strategies that disrupt inter-generational cycles of behaviors that contribute to poor health outcomes, which ultimately can affect college and career-readiness. RECRUITMENT OF NEW PHYSICIANS TO THE APPALACHIAN HIGHLANDS - Ballad Health provided the necessary resources to recruit new specialists to serve our region, many of whom were recruited to private practices not owned by Ballad Health. The addition of specialists is helping to improve access to care in rural communities. For instance, Wise County, Virginia now benefits from an orthopedist, a cardiologist and several other physicians and providers. Wythe County, Virginia, a community not served by a Ballad Health hospital, benefits from a cardiologist recruited by Ballad Health. Throughout the region, new physicians and advanced practitioners, recruited and funded by Ballad Health, are serving the region - from trauma care to pediatrics, from Wythe County, Virginia to Hancock County, Tennessee. OTHER NOTABLE EVENTS AND AWARDS - Ballad has invested significantly across the region specifically in academic and community institutions that serve the people in the service area. Examples of this investment are shown through the continuum of service from the offering of observation opportunities to students of all ages within our clinical facilities, to providing experts to lecture to school children on a broad variety of healthcare topics. The commitment to giving back extends to direct investment in regional educational partners. Some key examples of this include the Appalachian Highlands Center for Nursing Advancement, The Center for Rural Health Research, the STRONG BRAIN Institute, and the Gatton College of Pharmacy Center for Pharmacy, Education, Outreach, and Advocacy. The work of these centers at ETSU focuses on some of the leading issues facing the service area, from the development and support of the next evolution of nursing as a profession, to understanding the unique challenges facing our public health, to the scourge of adverse childhood experiences, to access and intervention at the community pharmacy, Ballad is committed to understanding and addressing the significant issues facing the service area. - Ballad is also engaged in funding the development of new and expanded healthcare training programs across the region. Ballad has granted support of programs in Nursing and Allied Health. From a new BSN program in Southwest Virginia at Emory & Henry College, to a new program in Ultrasonography at Southwest Virginia Community College, we are supporting programs large and small. We have expanded the Medical-legal partnership we have in the Appalachian Highlands to include all of the Ballad facilities as well as many of the outpatient clinics. This one-of-a-kind program partners Ballad with Virginia Tech and the Appalachian School of Law together to address the challenges of access to social supports for the poorest members of the Service Area. Ballad is a sponsor of a residency in Advanced Education Graduate Dentistry in Southwest Virginia. The endemic problem of poor oral hygiene across service area accounts for loss of economic opportunity, loss of self-esteem, and profound impacts on the health of individuals suffering from missing or diseased teeth. - Ballad's research department serves as the central office for multi-specialty research oversight in the System. In addition to providing full spectrum support for studies generated and managed by the research department, the department provides oversight for studies generated by external groups. The research department has participated in several large-scale, multi-center trials with subject retention at nearly 100%. Oversight services include administrative, legal, regulatory support, internal service arrangement and financial management. Ballad is a world leader in cardiovascular clinical trials. - Received its Accreditation/Department of Distinction from the International Association for Healthcare Security & Safety (IAHSS) - Recognized by Harvard University and UnitedHealthcare as one of four healthcare organizations leading the way towards a 3D model for value-based care - Earned the College of Healthcare Information Management Executives (CHIME) Digital Health Most Wired. - After the creation of a regional and coordinated system of trauma care nearly two years prior, in July 2021, a Tennessee Department of Health survey concluded the trauma program serving the Appalachian Highlands provides "outstanding commitment to care for the injured patient and found zero deficiencies at the Level I Trauma Center at Johnson City Medical Center, a first for trauma care in the region. As a result of the regional and coordinated system of trauma care, Ballad decreased mortality by 40% and reduced the cost of care by approximately $3 million. Form 990, Part IV, line 24a and Part X, line 20 - Tax Exempt Bonds The tax exempt bond liability reflects the portion of bonds issued by Mountain States Health Alliance, SCCH's sole member, on behalf of SCCH for capital needs. SCCH pays all costs related to this portion of the bond issue. Form 990, Part V, line 1a For CY22 Ballad Health (BH), SCCH's parent organization, filed Form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. SCCH reimburses BH for all expenses related to vendor payments and the expenses are recorded on SCCH's books. Form 990, Part V, line 2a - Number of Employees Ballad Health (BH), SCCH's parent organization, processes payroll for SCCH. SCCH reimburses BH for all salary and benefits related to our team members and the expense is recorded on SCCH's books. SCCH operates a rural health clinic. Under current Centers for Medicare and Medicaid Services (CMS) regulations governing staffing at a rural health clinic, at least one mid-level provider (nurse practitioner, physician assistant, etc.) must be a W-2 employee of the clinic. Therefore, SCCH pays two mid-level providers directly (rather than BH paying these team members' salary with SCCH reimbursing Ballad Health). The number of SCCH team members that received reportable compensation in excess of $100,000 was 14. Form 990, Part VI, Section A, line 6 Mountain States Health Alliance is the sole member of Smyth County Community Hospital. Form 990, Part VI, Section A, line 7a There is a single class of member, Mountain States Health Alliance. Form 990, Part VI, Section A, line 7b Certain decisions of the board are, pursuant to charter and Virginia statute, subject to approval of the member. These decisions include: dissolution of the corporation; merger of the corporation; non-ordinary course of business sale of assets, etc. No ordinary, day-to-day decisions are subject to member approval. Form 990, Part VI, Section B, line 11b The Ballad Health Tax Department prepares and reviews the Form 990. During preparation other functional areas within the organization provide information and support to complete an accurate return. The return is reviewed by the organization's EVP/CFO and is provided in electronic form to all members of the Board of Directors prior to being filed with the IRS. Form 990, Part VI, Section B, line 12c Ballad Health policy requires Board of Directors and Board Committee members, the Executive Chair/President, and Executive Vice Presidents to complete a conflict of interest disclosure statement on an annual basis. Ballad Health policy also requires team members to complete an annual acknowledgement that they have read and understand the conflict of interest policy and they will complete a conflict of interest disclosure statement if they have a conflict of interest. Should a conflict arise, it is the responsibility of the conflicted individual to update his or her disclosure immediately. All meetings of the board or board committees have a standing agenda item first on the agenda titled "Conflicts of Interest". If a member of the board or board committee has a conflict of interest involving any issue on the board agenda, he or she must declare the conflict of interest during the period allotted for disclosure. If any issue arises during a meeting in which the board member has a conflict of interest, he or she must immediately declare the conflict. While each member of the board or board committee is responsible for disclosing conflicts of interest, it is also the responsibility of any board member aware of a conflict which has not been disclosed to ensure the board is made aware. The presiding officer of a board or board committee meeting may ask a conflicted member to excuse themselves from the meeting during the discussion related to the issue with which the conflict of interest applies. Under no circumstances shall a member vote on a matter that gives rise to a potential conflict. This applies to all Ballad Health organizations. Form 990, Part VI, Section B, line 15 Line 15a - Compensation Process for Top Officials The executive compensation committee serves as the compensation oversight committee of Ballad Health's Board of Directors. The executive compensation committee is comprised of members who are determined to be independent and whom are not reliant upon any business relationship with Ballad Health for income or compensation. The compensation plan for Alan Levine, Ballad Health's Chairman, President and CEO, was reviewed and approved by the executive compensation committee and then by the Ballad Health Board of Directors in accordance with the Board's compensation policy and practice. The Board of Directors relies upon the advice of an independent and experienced compensation consultant with knowledge about pay practices for comparable positions within the industry, and who has access to broad data, studies and surveys in order to ensure the compensation falls within competitive and appropriate ranges for the position. Line 15b - Compensation Process for Top Officers On an annual basis, Ballad Health's Human Resources (H/R) Department evaluates compensation for all executives at a position level of Assistant Vice President and above. H/R's evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on this comparable data, Ballad Health's CEO evaluates the data and, if appropriate, makes necessary adjustments. Any adjustments to Senior Vice Presidents or above are reviewed by the Board of Directors Executive Compensation Committee. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics categorized by; Quality, Service and Safety; Access to Care; Financial Stewardship, and any other metrics approved from time to time by the Board of Directors. Form 990, Part VI, Section C, line 19 Governing documents and conflict of interest policy are made available upon request to the appropriate parties requesting them. Financial statements are made available upon request to appropriate parties requesting them, and they are made available to those parties who own indebtedness of the company on a quarterly basis. Form 990, Part IX, line 11g Collection Services: Program service expenses 0. Management and general expenses 1,697,092. Fundraising expenses 0. Total expenses 1,697,092. Consulting Fees: Program service expenses 0. Management and general expenses 72,637. Fundraising expenses 0. Total expenses 72,637. Contract Labor: Program service expenses 1,564,247. Management and general expenses 473,685. Fundraising expenses 0. Total expenses 2,037,932. Dietary Services: Program service expenses 982,982. Management and general expenses 0. Fundraising expenses 0. Total expenses 982,982. Environmental Services: Program service expenses 790,832. Management and general expenses 0. Fundraising expenses 0. Total expenses 790,832. Hospital Supported Clinics: Program service expenses 3,854,212. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,854,212. Laboratory Services: Program service expenses 110,685. Management and general expenses 0. Fundraising expenses 0. Total expenses 110,685. Laundry Services: Program service expenses 168,504. Management and general expenses 0. Fundraising expenses 0. Total expenses 168,504. Long-Term Care Services: Program service expenses 970,971. Management and general expenses 0. Fundraising expenses 0. Total expenses 970,971. Other: Program service expenses 685,472. Management and general expenses 40,698. Fundraising expenses 0. Total expenses 726,170. Physician Fees: Program service expenses 918,636. Management and general expenses 0. Fundraising expenses 0. Total expenses 918,636. Rehabilitation Services: Program service expenses 52,933. Management and general expenses 0. Fundraising expenses 0. Total expenses 52,933. Form 990, Part XI, line 9: Temporarily Restricted Grants Intercompany Fund Transfer 4,440,321. Acquisition 31,465. Abingdon Physician Partners 16000 Johnston Memorial Drive Abingdon VA 24211 205485346 Medical Services VA 501C3 12a JMH 0 Ballad Health 303 Med Tech Parkway Suite 300 Johnson City TN 37604 611771290 Supporting Organization TN 501C3 12b N/A 0 Ballad Health Center for Early Learning 400 N State of Franklin Road Johnson City TN 37604 923891827 Child Day Care Services TN 501C3 Line_10_Organization BALLAD HEALTH 0 Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City TN 37604 581594191 Fundraiser TN 501C3 Line_7_Organization_ BALLAD HEALTH 0 Dickenson Community Hospital 312 Hospital Drive Clintwood VA 24228 770599553 Hospital VA 501C3 Line_3_Hospital_Coop WHS 0 East TN Healthcare Holdings Inc 203 Gray Commons Circle Ste 110 Gray TN 37615 815475903 Opioid Treatment TN 501C3 Line_3_Hospital_Coop MSHA 0 Johnston Memorial Hospital 16000 Johnston Memorial Drive Abingdon VA 24211 540544705 Hospital VA 501C3 Line_3_Hospital_Coop MSHA 0 Mountain States Health Alliance 303 Med Tech Parkway Suite 300 Johnson City TN 37604 620476282 Hospital System TN 501C3 Line_3_Hospital_Coop BALLAD HEALTH 0 MSHA Auxiliary 400 N State of Franklin Road Johnson City TN 37604 581418345 Supporting Organization TN 501C3 12a MSHA 0 Takoma Reg'l Hosp Inc dba GCH 1420 Tusculum Boulevard Greeneville TN 37745 510603966 Hospital TN 501C3 Line_3_Hospital_Coop WHS 0 Wellmont Cardiology Services 303 Med Tech Parkway Ste 220B Johnson City TN 37604 263557623 Medical Services TN 501C3 Line_10_Organization WHS 0 Wellmont Hawkins Co Memorial Hosp Inc 851 Locust Street Rogersville TN 37857 621816368 Hospital TN 501C3 Line_3_Hospital_Coop WHS 0 Wellmont Health System 303 Med Tech Parkway Suite 300 Johnson City TN 37604 621636465 Hospital System TN 501C3 Line_3_Hospital_Coop BALLAD HEALTH 0 Wellmont Imaging Services Inc 400 N State of Franklin Road Johnson City TN 37604 861103148 Healthcare TN 501C3 12a WHS 0 Wellmont Madison House 2000 Greenway Street Kingsport TN 37660 621308216 Assisted Living TN 501C3 Line_10_Organization WHS 0 Wellmont Medical Associates 303 Med Tech Parkway Ste 220B Johnson City TN 37604 270898372 Medical Services TN 501C3 Line_7_Organization_ WHS 0 Wellmont Wexford House 2421 N John B Dennis Hwy Kingsport TN 37660 581859039 Nursing Home TN 501C3 Line_10_Organization WHS 0 East Tennessee Ambulatory Surgery Center 701 Med Tech Prkwy Suite 100 Johnson City TN 37604 621787537 Medical Services TN N/A 0 0 Emmaus Community Healthcare PLLC 6419 Bristol Highway Piney Flats TN 37686 200577483 Medical Servives TN N/A 0 0 Medical Specialists of JC LLC 2528 Wesley St Ste 2 Johnson City TN 37601 272199037 Medical Services TN N/A 0 0 Quality Improvement Ptrs LLC 2528 Wesley St Ste 2 Johnson City TN 37601 861932106 Healthcare TN N/A 0 0 Ballad Health Development Corporation 400 N State of Franklin Rd Johnson City TN 37604 883118592 Investments TN N/A C 0 Ballad Ventures LLC 400 N State of Franklin Rd Johnson City TN 37604 844214681 Investments TN N/A C 0 Blue Ridge Medical Management Corp 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621490616 Medical Services TN N/A C 0 Community Home Care Inc 1490 Park Avenue NW Suite B Norton VA 24273 541453810 Durable Medical Equipment VA N/A C 0 Mediserve Medical Equipment 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621212286 Durable Medical Equipment TN N/A C 0 Mountain States Physician Grp 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621700412 Medical Services TN N/A C 0 Mountain States Properties 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621845895 Property Management TN N/A C 0 Nolichuckey Management Svcs Inc 1420 Tusculum Boulevard Greeneville TN 37745 621776681 Medical Services TN N/A C 0 Wellmont Health Services Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621254373 Medical Services TN N/A C 0 Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman CJ KY1-1203 981195624 Insurance CJ N/A C 0 Wellmont Physician Services Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621567353 Medical Services TN N/A C 0 Wellmont Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621320035 Medical Services TN N/A C 0 Wilson Pharmacy Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 620329587 Pharmacy TN N/A C 0 WPS Providers Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 205564642 Medical Services TN N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1