2025-04-22T14:42:36-05:00 2024-06-30 990 2023-07-01 581859039 Wellmont Wexford House WELL 4233023467 311 Princeton Road Suite 1 Johnson City TN 376012080 Michele Rusek Senior Director 4233023467 2025-04-22 1 Non-Paid Preparer P03077501 2023 2025-03-06 01:10:19Z Michele Rusek 2421 N John B Dennis Hwy Kingsport TN 37660 10019935 0 X balladhealth.org X 1989 TN Honor those we serve by delivering the best possible care. 4 0 135 3 0 0 24975 156474 9121958 9861675 45 -3221 3406 1344 9150384 10016272 0 0 0 0 7063661 7162987 0 0 0 6079228 6986790 13142889 14149777 -3992505 -4133505 12017543 11048130 1541388 4705480 10476155 6342650 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 11840741 0 9858460 See Schedule O 11840741 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 135 1 0 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 X Shane Hilton 4233023467 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Eric Deaton BH EVPCOO Director 0.10 64.90 X X 0 1121768 123773 Alan Levine BH PresCEO Director, Chair 0.10 64.90 X X 0 1983279 264516 Marvin Eichorn BH EVPCAO Director 0.10 64.90 X X 0 1073543 50738 Julie Bennett CLOGovnc Offcr Director, Secretary 0.10 64.90 X X 0 567016 57811 Mark Chappell CFO HH WH CFO 0.10 44.90 X 0 179734 37699 Shane Hilton BH EVPCFO (Beg. Jan. 2024) 0.10 64.90 X 0 630028 100190 Michele Rusek Sr Dir L/T Care 35.00 5.00 X 154548 0 31622 Lynn Krutak BH EVPCFO (End June 2024) 0.10 64.90 X 0 994595 120642 Melissa Barton LPN 40.00 X 137135 0 0 Kristie Tyndall LPN, Unit Manager 40.00 X 109489 0 21220 Pamela Poff LPN, Long Term Care 40.00 X 123200 0 16048 Kristina Mullins LPN, Long Term Care 40.00 X 100773 0 0 Andrew Wampler BH Gen Cnsl Former Officer 0.00 55.00 X 0 398602 62837 Tim Belisle Former Officer 0.00 0.00 X 0 162508 2542 625145 7111073 889638 5 1 1 0 0 156474 156474 Patient Revenue 623000 9861675 9861675 9861675 6 6 436 3663 -3227 -3227 -3227 Cafeteria/Vending 900099 1229 1229 Medical Records 900099 103 103 Support Services 900099 12 12 1344 10016272 9858460 0 1338 X 196238 196238 5719995 4774900 945095 82504 73725 8779 777197 548733 228464 387053 349027 38026 2289 2289 2741653 2486399 255254 8362 8362 164945 108502 56443 254491 193701 60790 318179 289778 28401 -167 247 -414 506643 462326 44317 443623 403772 39851 122865 118414 4451 Nsg Home Assessment Tax 1015789 1015789 Medical Supplies 498149 498149 Support Services 355013 355013 Maintenance 234194 218169 16025 320762 299110 21652 14149777 11840741 2309036 0 2876 2876 5413 0 867358 894872 58215 76965 41767 10062 6978283 4590231 2835338 2388052 7622979 7622979 583597 52324 12017543 11048130 1241298 1255864 34629 42737 265461 3406879 1541388 4705480 X 10476155 6342650 10476155 6342650 12017543 11048130 -4133505 0 X 0 1 X 1 1 1 X 431349 24975 156474 612798 15972650 14022439 11593640 9122969 9861686 60573384 44695 16466 18507 2395 1332 83395 16017345 14470254 11612147 9150339 10019492 61269577 0 147225 253816 208438 430278 572084 1611841 147225 253816 208438 430278 572084 1611841 59657736 33 45 6 84 33 45 6 84 16017345 14470287 11612147 9150384 10019498 61269661 0.97370 0.98070 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 505992 505992 5298398 3574288 1724110 990143 848932 141211 183750 167011 16739 2388052 Due to Payor Stimulus Reserve 265461 Due to Affiliates 3159997 Due to 3rd Party Payors -18579 3406879 X Part IV, Line 2b: The patient trust liability account is monies owned by the residents of Wellmont Wexford House to be used for personal expenses. The residents' social security checks and other personal funds are deposited to Wellmont Wexford House Truist Bank account, solely used for the residents'. Checks are written from this account by Ballad Health Accounts Payable department via check requests submitted by Wellmont Wexford House business office manager for residents' personal expenses. The patient trust liability account is monitored closely by the State of Tennessee to ensure disbursements are in compliance with state law. Part X, Line 2: Wellmont Wexford House 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, 2024 and 2023. Tax returns for 2021 through 2023 are subject to examination by the Internal Revenue Service." 1 1 0 0 0 0 0 0 0 Alan Levine BH PresCEO Director, Chair 0 1451380 0 495018 0 36881 0 233996 0 30520 0 2247795 0 0 Eric Deaton BH EVPCOO Director 0 851884 0 253329 0 16555 0 98731 0 25042 0 1245541 0 0 Marvin Eichorn BH EVPCAO Director 0 782057 0 240415 0 51071 0 19805 0 30933 0 1124281 0 0 Lynn Krutak BH EVPCFO (End June 2024) 0 751346 0 230794 0 12455 0 90747 0 29895 0 1115237 0 0 Shane Hilton BH EVPCFO (Beg. Jan. 2024) 0 492543 0 130683 0 6802 0 69984 0 30206 0 730218 0 0 Julie Bennett CLOGovnc Offcr Director, Secretary 0 463475 0 100000 0 3541 0 41515 0 16296 0 624827 0 0 Andrew Wampler BH Gen Cnsl Former Officer 0 311946 0 79268 0 7388 0 45089 0 17748 0 461439 0 0 Mark Chappell CFO HH WH CFO 0 139304 0 32881 0 7549 0 8998 0 28701 0 217433 0 0 Michele Rusek Sr Dir L/T Care 152283 0 0 0 2265 0 9040 0 22582 0 186170 0 0 0 Tim Belisle Former Officer 0 0 0 0 0 162508 0 0 0 2542 0 165050 0 0 Part I, Lines 4a-b The following executives listed in Schedule J, Part II participated in a 457(f) retirement plan provided by Ballad Health (BH). 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 BH 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 $214,191 Eric Deaton $78,933 Lynn Krutak $70,942 Shane Hilton $50,175 Julie Bennett $41,515 Andrew Wampler $25,902 The following executives received a change-of-control payment. The payment was reported as taxable income with appropriate tax withheld and remitted to the IRS. Tim Belisle $161,641 Form 990, Part III, Line 4a - Program Service Accomlishments Wellmont Wexford House (WWH) is a CMS rated 5 Star 174-bed skilled and long-term care facility. Our team of professional caregivers has a goal to provide each resident with high-quality healthcare in a comfortable home-like environment. Their expertise ensures effective medical services for skilled and rehabilitative nursing care, including inpatient and outpatient physical therapy, speech therapy and occupational therapy, residential custodial care, respite and hospice care. During fiscal year 2024, WWH served 268 residents and provided 38,452 days of care. Serving the residents of Sullivan County and surrounding communities, our licensed and certified nursing facility is recognized by The Joint Commission as a healthcare leader, providing short-term and long-term medical care and rehabilitation. WWH earned the Joint Commission's Gold Seal of Approval for accreditation and recertification in March 2023 with a March 31, 2026, expiration. The facility achieved that designation by complying with national standards for advanced post-acute rehabilitation services, healthcare quality and patient and resident safety in nursing home care. With the aligning of Ballad Health's organizations, WWH enhances the continuum of care the region's patients receive. It results in a seamless transition from one healthcare setting to another, while retaining the same quality throughout the care process. Special attention is given to the personal needs of each resident. Social, religious, recreational and educational programs, along with other amenities, are provided so each resident can lead a fulfilling life and experience as much personal freedom as possible. Services at WWH include nursing and healthcare programs that offer a wide range of individualized care such as respiratory care, therapeutic management, restorative therapies, nutritional counseling, and recreational activities, as well as convalescent nursing care for the acutely ill. Residents also have onsite access to diagnostic services such as Sleep Studies, Ultrasound, Echo, X-ray and EKG. Motivational programs emphasize the rehabilitation of each resident to their maximum level of functioning. Other medical services offered include enteral nutritional and tube feeding, Foley catheter care, colostomy, urostomy, nephrostomy care, ventilator care, IV access care and therapy/antibiotics, pain management, diabetes care, wound care, lab services, orthopedic rehabilitation, incontinence care, and dental and vision care. WWH has been recognized as a five-star facility by the Centers for Medicare and Medicaid Services and has garnered a near perfect score from Tennessee Department of Health inspectors. WWH was also rated among the best long term care facilities in Tennessee for 2023 and 2024 by Newsweek. Form 990, Part V, Line 1a Ballad Health (BH), WWH's parent organization, filed form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. WWH reimburses BH for all expenses related to vendor payments and the expenses are recorded on WWH's books. Form 990, Part VI, Section A, line 6 Wellmont Health System is the sole member of Wellmont Wexford House. Form 990, Part VI, Section A, line 7a There is a single class of member, Wellmont Health System. Form 990, Part VI, Section A, line 7b Certain decisions of the board are, pursuant to charter, subject to approval of the members. 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 Senior Director 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 Form 990, Part VI, Line 15a - Compensation Process for Top Official 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. Form 990, Part VI, Line 15b - Compensation Process for 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 President & 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. Wellmont Wexford House's Senior Director receives compensation that complies with Ballad Health's salary policy. Her pay is set at a market percentile specific to her position as Senior Director of Wellmont Wexford House. 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 Dietary Services: Program service expenses 881,636. Management and general expenses 0. Fundraising expenses 0. Total expenses 881,636. Contract Labor: Program service expenses 596,027. Management and general expenses 35,400. Fundraising expenses 0. Total expenses 631,427. IP Physical Therapy: Program service expenses 176,273. Management and general expenses 0. Fundraising expenses 0. Total expenses 176,273. IP Occupational Therapy: Program service expenses 200,867. Management and general expenses 0. Fundraising expenses 0. Total expenses 200,867. Environmental Services: Program service expenses 400,771. Management and general expenses 0. Fundraising expenses 0. Total expenses 400,771. IP Speech Therapy: Program service expenses 88,542. Management and general expenses 0. Fundraising expenses 0. Total expenses 88,542. Facilities & Construction Management Services: Program service expenses 0. Management and general expenses 184,820. Fundraising expenses 0. Total expenses 184,820. Physician Fees: Program service expenses 43,000. Management and general expenses 0. Fundraising expenses 0. Total expenses 43,000. Other: Program service expenses 99,283. Management and general expenses 35,034. Fundraising expenses 0. Total expenses 134,317. Mountain States Health Alliance 303 Med Tech Parkway Suite 300 Johnson City TN 37604 620476282 Hospital System TN 501c3 Line_3_Hospital_Coop BALLAD 0 Ballad Health Auxiliary 400 N State of Franklin Road Johnson City TN 37604 581418345 Supporting Organization TN 501c3 12a BALLAD 0 Smyth County Community Hospital 245 Medical Park Drive Marion VA 24354 540794913 Hospital VA 501c3 Line_3_Hospital_Coop MSHA 0 Dickenson Community Hospital Inc 312 Hospital Drive Clintwood VA 24228 770599553 Hospital VA 501c3 Line_3_Hospital_Coop WHS 0 Johnston Memorial Hospital Inc 16000 Johnston Memorial Drive Abingdon VA 24211 540544705 Hospital VA 501c3 Line_3_Hospital_Coop MSHA 0 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 Wellmont Health System 303 Med Tech Parkway Suite 300 Johnson City TN 37604 621636465 Hospital System TN 501c3 Line_3_Hospital_Coop BALLAD 0 Wellmont Hawkins Co Memorial Hosp Inc 851 Locust Street Rogersville TN 37857 621816368 Hospital TN 501c3 Line_3_Hospital_Coop WHS 0 Takoma Regional Hospital 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 Medical Associates Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 270898372 Medical Services TN 501c3 Line 10 WHS 0 Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City TN 37604 581594191 Fundraiser TN 501c3 Line_7_Organization_ BALLAD 0 Wellmont Madison House 2000 Greenway Street Kingsport TN 37660 621308216 Assisted Living TN 501c3 Line_10_Organization WHS 0 East TN Healthcare Holdings Inc 203 Gray Commons Circle Gray TN 37615 815475903 Opioid Treatment TN 501c3 Line 10 MSHA 0 Ballad Health Center for Early Learning 400 N State of Franklin Rd Johnson City TN 37604 923891827 Child Day Care Services TN 501c3 Line_10_Organization BALLAD 0 Wellmont Imaging Services Inc 400 N State of Franklin Rd Johnson City TN 37604 861103148 Healthcare TN 501c3 Line 12a, I WHS 0 Emmaus Community Healthcare PLLC 6419 Bristol Hwy Piney Flats TN 37686 200577483 Medical Services 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 East Tennessee Ambulatory Surgery Center 701 Med Tech Parkway Suite 100 Johnson City TN 37604 621787537 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 Wellmont Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621320035 Medical Services TN 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 WPS Providers Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 205564642 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 Blue Ridge Medical Management Corp 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621490616 Medical Services TN N/A C 0 Mediserve Medical Equipment of Kingsport Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621212286 Durable Medical Equipment TN N/A C 0 Mountain States Properties Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621845895 Property Management TN N/A C 0 Mountain States Physician Group Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621700412 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 Wilson Pharmacy Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 620329587 Pharmacy TN N/A C 0 Nolichuckey Management Svcs Inc 1420 Tusculum Boulevard Greeneville TN 37745 621776681 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 Ballad Ventures LLC 400 N State of Franklin Rd Johnson City TN 37604 844214681 Investments TN N/A C 0 Ballad Health Development Corporation 400 N State of Franklin Rd Johnson City TN 37604 883118592 Investments TN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0