2025-05-07T15:47:23-05:00 2024-06-30 990 2023-07-01 621636465 Wellmont Health System WELL 4233023467 311 Princeton Road Suite 1 Johnson City TN 376012080 Shane Hilton BH EVP & CFO 4233023467 2025-05-07 1 Non-Paid Preparer P03077501 2023 2025-03-06 01:10:19Z Alan Levine BH PresCEO 303 Med Tech Prkwy Johnson City TN 37604 859096810 0 X balladhealth.org X 1996 TN Honor those we serve by delivering the best possible care. 4 0 4015 223 67077 0 1757486 2585954 833003272 847869552 382294 1366593 5300881 5090630 840443933 856912729 1144652 1441838 0 0 289132967 302903430 0 0 0 523489837 522995593 813767456 827340861 26676477 29571868 442212331 469564946 166716520 162866469 275495811 306698477 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 684680834 1441838 849063511 See Schedule O 684680834 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 X 0 0 1 4015 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 1 1 TN VA X Shane Hilton 4233023467 303 Med Tech Pwy JC TN 37604 Alan Levine BH PresCEO Director/Chair 1.00 64.00 X X 0 1983279 264516 Marvin Eichorn BH EVPCAO Director 1.00 64.00 X X 0 1073543 50738 Eric Deaton BH EVPCOO Director 1.00 64.00 X X 0 1121767 123774 Julie Bennett CLOGovnc Offcr Director/Secretary 1.00 64.00 X X 0 567016 57811 Lynn Krutak end June 2024 BH EVP/CFO 1.00 64.00 X 0 994596 120642 Shane Hilton begin Jan 2024 BH EVP/CFO 1.00 64.00 X 0 630028 100190 Chris Miller COO BRMC 45.00 0.00 X 312807 0 41791 Robert Kennedy COO HVMC 45.00 0.00 X 269410 0 37991 Chad Couch Pres/CEO NE Mkt 45.00 0.00 X 670212 0 102764 Shannon Showalter CEO Wise County 24.00 21.00 X 0 368116 47618 Rebecca Beck CEO HVMC 45.00 0.00 X 478955 0 40315 Robert Bender CFO BRMC 36.00 9.00 X 0 341543 42654 Stephen Sawyer end Dec 2023 CFO 23.00 22.00 X 0 263848 34255 Bobbie Murphy Regional CNO 45.00 0.00 X 325674 0 29484 John Jeter CEO BRMC/JMH 23.00 22.00 X 0 494855 48168 James Price MD Physician 40.00 0.00 X 524878 0 48010 Christopher Yeary MD Physician 40.00 0.00 X 503814 0 11913 Elie Nader MD Physician 40.00 0.00 X 420525 0 41188 John Morehead MD Physician 40.00 0.00 X 425074 0 21325 Brian Newberry MD Physician 40.00 0.00 X 364935 0 38886 Andrew Wampler BH Gen Cnsl Former Officer 1.00 54.00 X 0 398602 62837 Tim Belisle Former Officer 0.00 0.00 X 0 162508 2542 Dale Clark CEO SCCH Former CEO Wise County 0.00 45.00 X 0 374759 26799 Lisa Smithgall Former Key Employee/CNE 0.00 55.00 X 0 586458 82904 4296284 9360918 1479115 262 1 1 0 0 381179 2204775 2585954 Patient Revenue 622110 846349726 846349726 Rent to Exempt Affiliates 621511 1179637 1179637 Wellness Program Revenue 900099 340189 340189 847869552 399055 399055 48523 48523 3750441 1808023 1942418 1942418 1942418 88587 1206486 0 376058 88587 830428 919015 830428 62560 26027 Cafeteria/Vending 722514 2626803 2626803 Trauma Center Funding 900099 230192 230192 Facility & Const Mgmt Rev 900099 132993 132993 158224 346 4517 153361 3148212 856912729 849063511 67077 5196187 X 1441838 1441838 2887724 2887724 245452326 192543624 52908702 7322156 5691592 1630564 32614863 18376690 14238173 14626361 13953539 672822 310096 782 309314 13029 10651 2378 212922878 170334715 42588163 455989 27257 428732 5574739 5336355 238384 11614544 9616815 1997729 12410769 12025329 385440 675702 588016 87686 13776670 13585344 191326 27644847 26958376 686471 4448155 4306401 141754 Medical Supplies 180448972 180448972 Support Services 23784296 2166675 21617621 Maintenance 19167681 18952428 215253 Dietary 3952900 3952900 5794326 4362535 1431791 827340861 684680834 142660027 0 56426 56425 52249 71202 152155 161523 78115942 99059219 11937435 12008888 18325646 18863511 9170577 6606607 958884797 715960942 252048634 242923855 37626739 37626739 34726528 52186977 442212331 469564946 75007284 75545515 300411 460675 71466129 67428820 5821138 5315304 14121558 14116155 166716520 162866469 X 275451665 306576673 44146 121804 275495811 306698477 442212331 469564946 X 29571868 196930 1433868 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 29209 0 0 0 29209 0 Part II-B, Line 1: Wellmont Health System had lobbying expenses of $29,209 which represents the portion of dues paid to various organizations attributable to direct lobbying, including Tennessee Hospital Association and Virginia Hospital and Healthcare Association. 107181 16028718 16135899 549208676 391107972 158100704 8687543 5198862 3488681 356883438 303261860 53621578 27969241 16392248 11576993 242923855 2011 Interest Fund-AWUIL 17201 Intermediate Fixed Income 5382465 Inv Fund Val - Intermediate Fixed Income -485778 Due from Affiliates 47273089 52186977 Due to 3rd Party Payors 3851007 Due to Payor Stimulus Reserve 474865 Defined Pension Payable LT 5150748 Operating Lease Obligation ST 1988470 Operating Lease Obligation LT 2341151 Other Reserves 309914 14116155 X Part X, Line 2: Wellmont Health System 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 X 1 X 225.000000000000 1 X 450.000000000000 1 1 0 1 1 17660719 17660719 0.02130 128806553 95239121 33567432 0.04060 146467272 95239121 51228151 0.06190 6378613 80409 6298204 0.00760 19476180 9006306 10469874 0.01270 48019531 21200661 26818870 0.03240 1718455 73878 1644577 0.00200 1369998 1369998 0.00170 76962777 30361254 46601523 0.05640 223430049 125600375 97829674 0.11830 5233 5233 0.00000 2200 2200 0.00000 7433 7433 0.00000 1 37708053 1885403 143838308 134364443 9473865 X 1 1 5 1 Holston Valley Medical Center 130 W Ravine Road Kingsport TN 37660 balladhealth.org 0000000133 X X X X A 2 Bristol Regional Medical Center 1 Medical Park Boulevard Bristol TN 37620 balladhealth.org 0000000131 X X X X Mental Health A 3 Lonesome Pine Hospital 1990 Holston Avenue Big Stone Gap VA 24219 balladhealth.org H 1915 X X X X A 4 Norton Community Hospital 100 15th Street NW Norton VA 24273 balladhealth.org H 1879 X X X X A 5 Hancock County Hospital 1519 Main Street Sneedville TN 37869 balladhealth.org 0000000165 X X A Facility Reporting Group - A 0 0 1 X X X X X X X X X X 24 1 1 0 1 X balladhealth.org/locations X 1 25 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 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Holston Valley Medical Center, - Facility 2: Bristol Regional Medical Center, - Facility 3: Lonesome Pine Hospital, - Facility 4: Norton Community Hospital, - Facility 5: Hancock County Hospital Facility Reporting Group - A Part V, Section B, line 3j: The Community Health Needs Assessment report also included information related to other findings from the data collection process. Special topics such as Adverse Childhood Experiences, Access, Child Health, and others were also detailed. The report also included extensive data appendices further describing the community and health and social related outcomes. Facility Reporting Group - A Part V, Section B, line 5: To assess the health of those living in our service area, Ballad Health utilized the Mobilizing for Action through Planning and Partnerships (MAPP 2.0) framework. This comprehensive assessment was conducted from summer 2023 through spring 2024 and included all Ballad Health hospitals. We gathered primary data through surveys with community partners and members, as well as stakeholder meetings. There was broad representation from multi-sector community partners such as, but not exclusively, health departments, academic institutions, community-based organizations, faith-based organizations, justice systems, behavioral health organizations, clinical providers, governmental agencies, emergency personnel, and social services. There was also special focus on including vulnerable and marginalized populations input. Additionally, we compiled secondary data from national, state, regional and county sources. This thorough approach helps us understand and address the unique health needs of our communities. Throughout the community health needs assessment process, we focused on identifying health priorities and disparities within each community. Community members ranked the top three health issues in their area, providing valuable local insights. Combining these perspectives with county, state and national data gives us a comprehensive view of the region's health. This foundation helps us develop effective solutions to improve health outcomes for all. Facility Reporting Group - A Part V, Section B, line 6a: The comprehensive assessment was conducted from summer 2023 through spring 2024 and included all Ballad Health hospitals (Bristol Regional Medical Center, Dickenson Community Hospital, Franklin Woods Community Hospital, Greeneville Community Hospital, Hancock County Hospital, Hawkins County Memorial Hospital, Holston Valley Medical Center, Indian Path Community Hospital, Johnson City Medical Center, Johnson County Community Hospital, Johnston Memorial Hospital, Lee County Community Hospital, Lonesome Pine Hospital, Niswonger Children's Hospital, Norton Community Hospital, Russell County Hospital, Smyth County Community Hospital, Sycamore Shoals Hospital, Unicoi County Hospital, and Woodridge Hospital). Facility Reporting Group - A Part V, Section B, line 11: Phase 3 of the MAPP 2.0 framework focuses on the continuous improvement of the community. As part of this phase, presentations on Ballad Health's Community Health Needs Assessment (CHNA) process were provided to each of the hospital boards to promote engagement and secure buy-in ahead of the development of Community Health Improvement Plans (CHIPs). These presentations aimed to ensure that hospital leadership fully understood the CHNA process and were committed to the subsequent steps. The CHIPs were developed by each facility based on the CHNA findings and involve collaboration between hospital leadership and community partners in their design and implementation. Each CHIP outlines specific, actionable strategies tailored to address the priority health issues identified in the CHNA. These strategies include measurable objectives, timelines, and assigned responsibilities to ensure accountability and progress tracking.Recognizing the complexity of the identified health issues, Ballad Health emphasizes the importance of collaboration, ensuring that all partners have a seat at the table. This inclusive approach is essential for addressing the multifaceted health challenges that no single entity can manage alone. By fostering strong partnerships and collective action, Ballad Health aims to create effective and sustainable health improvement strategies for the community. Furthermore, the CHIPs will include regular progress reviews and updates to adapt to emerging needs and challenges. This dynamic process ensures that the plans remain relevant and effective over time, continually improving health outcomes in the community. Through these comprehensive and collaborative efforts, Ballad Health is committed to making meaningful and lasting improvements in community health. Facility Reporting Group - A 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 the Ballad Health's financial assistance policy. 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 a 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 is 85% for all acute facilities and 77% for all critical access facilities. 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. WHS's cost accounting system was used to determine losses from Tenncare and Medicaid reported on line 7b. 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 internal medicine residents, nursing, pharmacy, and therapy students) with schools and universities, allowing their health profession students to receive hands-on training in a hospital setting. WHS's Medicare-approved programs include medical residents, pharmacy and pastoral care. For these programs, Medicare-approved costs and Medicare reimbursement comes from filed Medicare cost reports. The Ballad Health Organizational Development Department (OD) maintains records for the non-Medicare programs. Only labor costs are included for WHS team members that provide training (no overhead is applied) and only a percentage of team members' time is attributed to actual training. For line 7g subsidized health care services, WHS's cost accounting system is used because WHS has established standard costing reports for these services. Although there are other service lines within WHS hospitals that incur losses, WHS does not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7g also includes $20,627,728 of actual cost WHS incurred that is attributable to physician clinics. Services are being subsidized at these clinics in order to maintain access and service in rural areas and would otherwise be unavailable to the community or below the community's need if not provided. WHS is careful to ensure no double counting of costs. Line 7h research represents WHS's expense allocation from Ballad Health for research. Line 7i cash and in-kind contributions includes cash disbursements and in-kind donations of medications to local nonprofit rescue squads and fire departments. In-kind donations of medications are based on actual cost for these items. Part II, Community Building Activities: WHS 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 WHS 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. WHS does not capture costs associated with team members that serve on other nonprofit boards or provide services to other nonprofits.WHS, in collaboration with area health agencies and providers, offers assistance with coordination, advocacy, or contribute supplies to support groups for their program activities that serve to assist special populations within the area. Most of these organizations work to improve the lives of community members that have limited, or no, financial resources.Line 3 - Community SupportBristol Regional Medical Center, Holston Valley Medical Center and Norton Community Hospital provided support to the Boys & Girls Club of The Mountain Empire, St. Paul's Episcopal Church, THS After Prom, Inc. and the Town of Wise for community building projects.Line 5 - Leadership Development & Training For Community MembersHolston Valley Medical Center provided tuition support for a Radiology Administration team member to participate in the Leadership Kingsport Class of 2024 sponsored by the Kingsport Chamber Foundation. Part III, Line 2: Self-pay balances include accounts after payments and contractual adjustments (discounts) have been applied from all third-party payers such as Medicare, TennCare/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 receives an 85% discount, with the exception of critical access hospitals, where it is 77%. Many self-pay patients will further qualify for financial assistance (sometimes referred to as charity care) if they provide the financial information needed to deem them eligible or upon determination of presumptive charity eligibility.After the normal collection process has indicated an account is uncollectible, WHS writes the account off to bad debt. The 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 WHS's bad debt would have qualified for financial assistance if patients had provided a financial assistance application and required documentation. Pursuant to the merger, WHS 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 which is then relied upon to assign presumptive charity eligibility. There are many instances of patients with large account balances and no health insurance coverage that WHS believes would qualify for financial assistance. Although patients are encouraged to apply for assistance, many will not do so. WHS 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 WHS's program. Without a completed application or approval through the presumptive charity eligibility review, 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. WHS is included in the June 30, 2024 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 WHS's filed Medicare cost report (C/R). The C/R uses a cost to charge ratio based on a step-down allocation methodology. 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.Ballad Health's collection policy clearly states that all patients are treated equally - with dignity and respect. Ballad Health ensures that outside collection agencies adhere to Ballad Health billing and collection guidelines. The collection program includes communicating expected financial responsibility prior to service. WHS 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 TennCare or Medicaid.After insurance benefit verification, WHS hospitals bill 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. WHS hospitals provided 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- WHS hospitals accept all non-contracted and out-of-network payers and will make attempts to work with these payers 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 WHS 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 Ballad Health's financial assistance policy. Part VI, Line 2: Ballad Health and its hospitals have pledged to improve the health of our service area counties by focusing on access, quality and population health measures. These metrics enable Ballad Health to collaborate with our communities and address the region's health disparities and access challenges. Through the Community Health Needs Assessment (CHNA) process, we have gained valuable insights into the health disparities within our communities and prioritized the most pressing issues in each hospital's service area. This collaborative approach helps us educate and drive meaningful change, ensuring better health outcomes for all.The community health needs assessment identified chronic disease, behavioral and mental health, and obesity and overweight as the top three health priorities for the hospital service area. These issues emerged as the most pressing health concerns based on data from various sources, including local perspectives and community surveys. Addressing these critical areas allows us to focus efforts on improving overall health outcomes and quality of life in the region. Part VI, Line 3: Consistent with the Ballad Health financial assistance policy, WHS communicates with and provides education to 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 WHS 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 hospitals. The financial assistance policy and documents are available in emergency departments and admitting areas. WHS is also happy to mail all documents to patients and offers a plain language summary. All of the documents are available in English and Spanish. Financial assistance information is available during pre-registration, registration and/or during financial counseling. WHS offers governmental program eligibility representatives to assist patients in securing eligibility for TennCare or Medicaid, federal disability and other governmental assistance programs. Additionally, if a patient or community resident expresses an interest in the Affordable Care Act healthcare exchange, WHS representatives have the qualifications and experience to assist them through the entire process. 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. The 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: WHS serves the healthcare needs of 29 Appalachian counties in Northeast Tennessee, Southwest Virginia, Southeast Kentucky, and Northwest North Carolina. All of the counties WHS serves are federally designated as medically underserved areas. WHS's largest hospital, Holston Valley Medical Center, is a tertiary referral center and one of the nation's 50 top cardiovascular hospitals. Medically underserved areas are designated by the U.S. Department of Health and Human Services. Shortage areas are identified through analysis of physician to population ratios depending on whether an area is considered to have a high need. Criteria used to determine high need are poverty rates, the percent of the population over age 65, infant mortality rates and fertility rates. WHS operates 1 critical access hospital: Hancock County Hospital in Tennessee. Additionally, according to County Health Rankings, counties where WHS hospitals are located consistently rank poorly for both health outcomes and health factors. Part VI, Line 5: WHS is dedicated to operating efficiently so that waste is minimized. WHS's leadership remains mindful of managing limited resources so that adequate facilities and equipment are available for the care of their patients. Surplus funds are invested into improving treatment options for patients through new technologies, recruiting physicians and trained staff in shortage areas, and improving WHS facilities. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary. WHS has several hospitals with Medicare-approved health profession education programs. In addition, WHS hospitals serve as training sites for many types of health professions: nursing, pharmacy, psychology, lab, respiratory therapy, EMT, public health, etc. Students from several colleges, universities, and programs receive training and hands-on experience in WHS hospitals. WHS resources are devoted to health conferences for local health professionals and offer other programs focused on improving the health of residents. While WHS operates in a predominantly low-income, rural and isolated areas, WHS continues to offer services that operate at a loss because residents would otherwise need to leave their hometown or county to receive needed care.Wellmont Health System merged with Mountain States Health Alliance in February 2018 to form Ballad Health healthcare system. WHS and Mountain States Health Alliance still exist as legal entities and continue to operate multiple hospitals. WHS's governing body is comprised of persons who reside in the organization's primary service areas.Physicians that request privileges who are qualified and credentialed are extended privileges by WHS. Part VI, Line 6: WHS's merger with Mountain States Health Alliance 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 new clinical council was formed immediately following the merger. The council includes physicians nominated from the leadership of all Ballad hospitals. A new Community Benefit and Population Health Committee of the board was established and various other infrastructures have been established since the merger.WHS is a Tennessee non-profit corporation and a premier provider of healthcare services in Northeast Tennessee and Southwest Virginia. WHS includes nine hospitals (six included in this return), an integrated physician network, and several ambulatory sites. WHS hospitals offer a broad scope of services ranging from community based acute care to highly specialized tertiary services including a trauma center, comprehensive heart care, and cancer care.WHS owns and operates an integrated health care delivery system providing inpatient, outpatient, and other health care services at multiple locations in Northeast Tennessee and Southwest Virginia. Currently, WHS owns and operates eight acute care hospital facilities and one critical access hospital. The acute care facilities owned by WHS include Holston Valley Medical Center in Kingsport, Tennessee, Bristol Regional Medical Center in Bristol, Tennessee, Lonesome Pine Hospital in Big Stone Gap, Virginia, Dickenson Community Hospital in Clintwood, Virginia, Hawkins County Memorial Hospital in Rogersville, Tennessee, Takoma Regional Hospital, Inc. d/b/a Greeneville Community Hospital in Greeneville, Tennessee, and the critical access hospital, Hancock County Hospital in Sneedville, Tennessee.Across WHS's hospitals, there were many projects, programs and collaborative efforts that took place during the year. Some examples include:- Opioid prescribing reduction across all WHS hospitals- WHS hospitals shared successful achievements from value optimization team projectsSince the Ballad Health system is both horizontally and vertically integrated, patients can be efficiently moved along an integrated, comprehensive continuum of care as their health dictates. If needed, patients can be moved to one of Ballad Health's tertiary care facilities providing advanced treatment options.Hospitals in the Ballad Health system work closely with one another to share expertise and resources. Part VI, Line 7, Reports Filed With States TN,VA 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 Health's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad Health operates under a Cooperative Agreement (CA) in Virginia and a Certificate of Public Advantage (COPA) in Tennessee as obligated by agreements between Ballad Health and the two states to allow Mountain States Health Alliance and Wellmont Health System to merge. 1 Barter Theatre PO Box 867 Abingdon VA 24212 546000120 501c3 9550 0 Program Support Bristol Tennessee City Schools 615 Martin Luther King Jr Blvd Bristol TN 37620 620646808 501c3 10000 0 Sponsor Power of Play 5K Clintwood Volunteer Rescue Squad P O Box 484 Clintwood VA 24228 541096326 501c3 0 7958 Cost EMS supplies Donate supplies Crossroads Medical Mission P O Box 16852 Bristol VA 24209 542038877 501c3 9400 0 Healthcare for underinsured & uninsured Emory & Henry College PO Box 950 Emory VA 24327 540505892 501c3 16882 0 Program Support-College of Nursing Healing Hands Health Center 245 Midway Medical Park Bristol TN 37620 621677000 501c3 8350 0 Program Support Josie King Foundation PO Box 16337 Baltimore MD 21210 261118580 501c3 20000 0 Patient safety tools education Kingsport Chamber Foundation 400 Clinchfield St Ste 100 Kingsport TN 37660 581453565 501c3 10000 0 Program Support-Healthy Kingsport Milligan University P O Box 750 Milligan College TN 37682 620535755 501c3 972950 0 Sponsor health sciences simulation lab Netvets Group 400 Clinchfield Street Kingsport TN 37660 883912598 501c3 15000 0 Program Sponsor-veterans support Norton Rescue Squad Inc 1710 Main Avenue SW Norton VA 24273 521358372 501c3 0 5968 Cost EMS supplies Donate supplies Second Harvest Food Bank 127 Dillon Court Gray TN 37615 621303822 501c3 25000 0 Program Support Southwest Va Higher Education Fndtn 1 Partnership Circle PO Box 1987 Abingdon VA 24212 800232306 501c3 100000 0 SWVA Regional Simulation Lab for Nursing & Allied Health Southwest Virginia Comm College Fndtn PO Box SWCC Richlands VA 24641 541269325 501c3 54648 0 SWVA Diagnostic Medical Sonography Program University of Virginia at Wise Foundation P O Box 40021 Charlottsville VA 229044201 546001796 501c3 24996 0 Athletics Program Virginia Breast Cancer Fndtn 2821 Emerywood Pkwy Ste 203 Richmond VA 23294 541633519 501c3 20000 0 Program Support YWCA of Bristol 106 State Street Bristol TN 37620 620488044 501c3 6300 0 Tribute to Women - Healthcare Zoll Medical Corporation PO Box 27028 New York NY 10087 042711626 44643 0 Purchase monitors donated to local EMS providers 17 1 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 1451380 0 495018 0 36881 0 233996 0 30520 0 2247795 0 0 Eric Deaton BH EVPCOO Director 0 851884 0 253329 0 16554 0 98732 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 end June 2024 BH EVP/CFO 0 751346 0 230794 0 12456 0 90747 0 29895 0 1115238 0 0 Chad Couch Pres/CEO NE Mkt 509905 0 152859 0 7448 0 72795 0 29969 0 772976 0 0 0 Shane Hilton begin Jan 2024 BH EVP/CFO 0 492543 0 130683 0 6802 0 69984 0 30206 0 730218 0 0 Lisa Smithgall Former Key Employee/CNE 0 458966 0 120029 0 7463 0 61022 0 21882 0 669362 0 0 Julie Bennett CLOGovnc Offcr Director/Secretary 0 463475 0 100000 0 3541 0 41515 0 16296 0 624827 0 0 James Price MD Physician 509661 0 0 0 15217 0 17800 0 30210 0 572888 0 0 0 John Jeter CEO BRMC/JMH 0 397392 0 91799 0 5664 0 19444 0 28724 0 543023 0 0 Rebecca Beck CEO HVMC 389141 0 87958 0 1856 0 16413 0 23902 0 519270 0 0 0 Christopher Yeary MD Physician 369769 0 124858 0 9187 0 0 0 11913 0 515727 0 0 0 Elie Nader MD Physician 399540 0 20000 0 985 0 17747 0 23441 0 461713 0 0 0 Andrew Wampler BH Gen Cnsl Former Officer 0 311946 0 79268 0 7388 0 45089 0 17748 0 461439 0 0 John Morehead MD Physician 406174 0 15167 0 3733 0 0 0 21325 0 446399 0 0 0 Shannon Showalter CEO Wise County 0 302747 0 63619 0 1750 0 18772 0 28846 0 415734 0 0 Brian Newberry MD Physician 261398 0 32427 0 71110 0 13970 0 24916 0 403821 0 0 0 Dale Clark CEO SCCH Former CEO Wise County 0 294272 0 66251 0 14236 0 17752 0 9047 0 401558 0 0 Robert Bender CFO BRMC 0 268882 0 70038 0 2623 0 16643 0 26011 0 384197 0 0 Bobbie Murphy Regional CNO 257315 0 64000 0 4359 0 0 0 29484 0 355158 0 0 0 Chris Miller COO BRMC 246631 0 62847 0 3329 0 15412 0 26379 0 354598 0 0 0 Robert Kennedy COO HVMC 220195 0 45031 0 4184 0 13694 0 24297 0 307401 0 0 0 Stephen Sawyer end Dec 2023 CFO 0 212138 0 37192 0 14518 0 12947 0 21308 0 298103 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 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 $214,191 Eric Deaton $78,933 Lynn Krutak $70,942 Chad Couch $51,971 Shane Hilton $50,175 Lisa Smithgall $42,507 Julie Bennett $41,515 Andrew Wampler $25,902 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 Belisle $161,640 A The Health Educational & Housing Facilities Board of Sullivan County TN 621256662 865293AF1 2016-09-01 180420000 Construction @ HVMC 0 0 0 B The Health Educational & Housing Facilities Board of Sullivan County TN 621256662 865293AH7 2016-04-20 73240000 Refund 2006A Bond 0 0 0 A 25640000 180420000 180420000 2011 1 0 1 1 B 26020000 73240000 73240000 2011 1 0 1 1 A 0 0 1 1 0 0.01000 0.01000 0 0 1 B 0 1 1 1 0 0.02000 0.02000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: The Health, Educational & Housing Facilities Board of Sullivan Date the Rebate Computation was Performed: 10/31/2021 Schedule K, Part I, Bond Issues: (f) Description of Purpose: Both of the listed bond issues were amended in 2016. Although such issues might not be treated as reissued under applicable regulations, the issuer took a conservative position and filed Form 8038 upon the assumption that the bond issues may be treated as reissued. Therefore, for purposes of this Schedule, the listed bond issues are treated as reissued when amended in 2016 and are being treated as refundings for purposes of this form. Schedule K, Part III,Private Business Use: Line 5, Column A and B: A Series 2006C Reissued - less than 1% B Series 2011 Reissued - less than 2% Line 6, Column A and B: A Series 2006C Reissued - less than 1% B Series 2011 Reissued - less than 2% Part III, Line 4a Program Service Accomplishments Ballad Health (Ballad) is an integrated healthcare delivery system consisting of 20 hospitals in Northeast Tennessee and Southwest Virginia, including a Level 1 Trauma Center, dedicated children's hospital, several community hospitals, four 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 are 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/. Form 990 for Wellmont Health System (WHS) includes five wholly owned hospitals, including two tertiary hospitals, while three wholly owned hospitals file separate returns. In addition to the acute care hospitals, WHS wholly owns or has ownership interest in a nursing home, an assisted living facility, physician practice organizations, ambulatory surgery centers and other health care businesses. Specific to the hospitals included in this Form 990, services were provided to: 33,042 inpatients 501,314 outpatient visits 126,923 emergency visits 1,814 deliveries 21,413 surgeries SULLIVAN COUNTY, TN: BRISTOL REGIONAL MEDICAL CENTER (BRMC) - 348-bed tertiary hospital located in Bristol, Tennessee has served the community since 1925. - Provides cardiac and neurological care, diabetes treatment, emergency and trauma (Level III) care, inpatient and outpatient hospice care, oncology, occupational health, outpatient, psychiatric, rehabilitation, surgical and women's health services. - Centers of Excellence include the Ballad CVA Heart Institute, J.D. and Lorraine Nicewonder Cancer Center, Deborah H. Quillen Birthing Center, Primary Stroke Center, and the Leonard Family Comprehensive Breast Center. - The J.D. Nicewonder Family Pediatric Emergency Department is part of a regional system of care for children, including pediatric surgery, trauma and Level III NICU services at Niswonger Children's Hospital in Johnson City. - Ridgeview Pavilion, a service of BRMC, is a 28-bed inpatient behavioral health center serving a wide region in Northeast Tennessee and Southwest Virginia providing short-term crisis intervention, medication assessment and stabilization. - Quantros named BRMC as the No. 1 hospital in Tennessee and among the top 100 in the nation for medical excellence in neurological care in its 2023 CareChex awards. BRMC was also named in the top 10% of hospitals in the nation for patient safety in spinal surgery, pulmonary care, and gastrointestinal hemorrhage. BRMC was also named in the top 100 hospitals in the nation for patient safety in gallbladder removal. - U.S. News recognized BRMC in 2023 with "high-performing distinctions for heart attack care and treatment, heart failure care and treatment, stroke care, colon cancer surgery, pulmonary disease care, and in care for kidney failure patients. SULLIVAN COUNTY, TN: HOLSTON VALLEY MEDICAL CENTER (HVMC) - 505-bed tertiary hospital located in Kingsport, Tennessee has served the community since 1935. - Provides diagnostic imaging, surgical, neuroscience, rehabilitation, women's health, outpatient services, emergency and trauma (Level III) care. - Centers of Excellence include the Ballad CVA Heart Institute, the Christine LaGuardia Phillips Cancer Center, Comprehensive Breast Cancer Center, Advanced Primary Stroke Center, and Every Step joint replacement center. - Named by U.S. News' annual "Best Hospital" study as the ninth-ranked hospital in the State of Tennessee and "high-performing distinction for knee replacement procedures, heart attack care and treatment, heart failure and treatment, transcatheter aortic valve replacement, care of stroke patients, pulmonary disease care and inpatient care for kidney failure patients. - Quantros named HVMC in the top 100 hospitals in the nation for medical excellence in interventional carotid care in its 2023 CareChex awards. HVMC was also recognized in the top 10% of hospitals in the nation for medical excellence in gallbladder removal and in the top 10% of hospitals in the State of Tennessee for general surgery. HANCOCK COUNTY, TN: HANCOCK COUNTY HOSPITAL (HCH) - 10-bed federally designated critical access hospital located in Sneedville, Tennessee opened in 2005 through a partnership with the Hancock County Commission. - Provides inpatient and outpatient acute care, emergency care, radiology, laboratory, respiratory therapy and physical therapy services. WISE COUNTY, VA: LONESOME PINE HOSPITAL (LPH) - 60-bed community hospital located in Big Stone Gap, Virginia has served the community since 1973. - Provides emergency care, medical, and oncology services. - Southwest Virginia Cancer Center in Norton, Virginia and Ballad Cancer Institute in Bristol, Virginia serve medical and radiation oncology patients as part of LPH operations. - Quantros named LPH in the top 10% of hospitals in the nation for medical excellence in heart attack treatment and sepsis care in its 2023 CareChex awards. WISE COUNTY, VA: NORTON COMMUNITY HOSPITAL (NCH) - 120-bed acute care facility located in Norton, Virginia serving the community since 1949. On February 28, 2021, NCH merged with WHS and still does business under the name "Norton Community Hospital". - Provides a wide array of services including primary care, surgical pulmonology, urology, obstetrics, emergency, radiology, and laboratory services. - Accredited by the American Osteopathic Association ("AOA") and was the first AOA accredited teaching facility in Virginia. - Quantros named NCH in the top 10% of hospitals in the nation for medical excellence in women's health in its 2023 CareChex awards. - Healthgrades named NCH as a Five-Star Recipient for C-Section and Hysterectomy Delivery for 2 Years in a Row (2021-2022). - U.S. News recognized NCH as "high-performing" in pneumonia care. In FY24, Ballad Health continued to demonstrate its commitment to improving the health of the Appalachian Highlands region through investments in its people, COPA Plan spending commitments, and capital. These investments include: - Over $67 million in new investments for rural health, behavioral health, children's health, population health, health research and graduate medical education, and health information exchange. - Capital spend of over $91 million, investing in information technology, new diagnostic and treatment technology, facility upgrades and the continued expansion of Niswonger Children's Hospital. Quality of Care - Recognition from Independent Organizations: Ballad Health hospitals were named among the top performers in the nation by multiple respected national organizations, such as U.S. News & World Report, Quantros Inc's CareChex awards, and the American Heart Association. Noted areas of excellence for specific hospitals included overall hospital care, trauma and orthopedic care, cardiovascular care, neurological care, surgical care, pulmonary care, and gastrointestinal care. Additionally, zero deficiencies were found across all Ballad Health trauma centers by state surveyors. Their report found that Johnson City Medical Center "demonstrated an outstanding commitment to care for the injured patient." Blue Cross and Blue Shield of America has designated Ballad Hospitals as "Blue Centers of Distinction" in services such as cardiology and maternity care. In fact, Blue Cross highlights only five hospitals in Tennessee as "Blue Centers of Distinction in Quality and Value" for cardiology services, with two of the five hospitals being Ballad Health facilities. Charity Care: Ballad Health maintained increased patient eligibility for charity care at 225% of the federal poverty guidelines (up from 200% before the merger in 2018). Ballad Health spent over $106 million in FY24 for Charity and Unreimbursed TennCare and Medicaid, the most ever as a merged entity. Notably, the weighted average median household income in the region is approximately $46,800 (lower in some communities), while Ballad Health's threshold for free charity care for a family of 2.5 people is approximately $52,000 (225% of the Federal Poverty Level) indicating one of the most generous charity care policies in the nation. Additionally, continued efforts by Ballad Health to provide care to chronic uninsured and underinsured patients had the desired result in reducing the cost of care, lowering charity care costs, and savings to employers, payers, and individuals who help subsidize the cost of charity care through state and federal programs. Reducing the number of preventable hospitalizations and emergency room visits results in lower costs of charity care and improves patient safety. This is a benefit of efforts by Ballad Health to initiate value-based initiatives, such as the Appalachian Highlands Care Network (AHCN). The AHCN connects uninsured patients and their families with free or low-cost clinics, dental services, financial counseling, and preventative care services. The AHCN is a national model for partnership programs between a health system and local organizations, outpatient clinics and providers that are working together to deliver a better, more supportive system of care for the uninsured population. These efforts reduce the cost of charity care - which benefits taxpayers, patients, and hospitals. The AHCN had over 8,500 uninsured enrollees by the end of the reporting period. Expanding Access to Care and Population Health: - Access to Care Metrics: Ballad Health achieved results over the pre-merger baseline for 21 of 25 access measures. Notable areas of improvement included appropriate emergency department wait times, asthma emergency department visits, antidepressant medication management for both acute and continuation phase, engagement of alcohol or drug treatment and rate of SBIRT administration during emergency department visits. Notably, while officially rolled out in FY24, with the FY23 investment in technology, anyone with access to a smart phone or the internet can now access Ballad Health's urgent care from anywhere in the region or world. Ballad Health is the only provider in the region which currently provides this service. - Population Health Measures: Ballad Health achieved all Process Measures (15 out of 15) for FY24. Ballad Health also exceeded its FY24 Population Health Plan Spend commitment of $11 million with an additional $7 million investment over its required spend. Improving Quality of Care, Patient Experience & Staff Experience: Quality data in almost every hospital in the nation declined during the pandemic. According to Premier - the nation's largest aggregator of quality data for hospitals, "Ballad Health's quality has recovered faster than any of the thousands of hospitals in its database." Quality of Care Metrics: Ballad Health publishes its quality data in accordance with the COPA requirements on its website. Notable highlights include the following: - Ballad Health improved results in 11 of the 17 target measures for FY24 compared to FY23. - Ballad Health improved in 8 out of the 10 patient experience monitoring measures for FY24 compared to FY23. - Among the hospital infection indicators, Ballad Health is performing better than expected or meeting the measure in all but one measure when using the Centers for Disease Control and Prevention's recommended adjustment methodology accounting for differences in patient population. Clinical Council: The Clinical Council (the Council) is aligned with the Ballad Health Board of Directors and the Board's Quality Service and Safety Committee (QSSC). During FY24, the Council was comprised of 30 physicians from many backgrounds and specialties. Of those physicians, 16 were employed by Ballad Health. The Council continued to assist in establishing key quality and patient safety priorities with consideration to risk, volume, propensity for problems (including incidence, prevalence, and severity), impact on health outcomes, patient safety and quality across all areas of care. Key accomplishments in FY24 included: - improvements in the usage of electronic health records, - standardization of a variety of high-value care initiatives, - updates to medication use processes, and - improvements to children's and women's care standards. Patient Experience: In the aggregate, 90% of patients surveyed by Press-Ganey, the nation's most credible patient data firm which tracks patient and employee experience, would recommend Ballad Health's hospitals. In some Ballad Health hospitals, as many as 98% of patients would recommend their hospital. While wait times, specifically for the emergency department, are too long as a result of staffing shortages, it should be noted that the metrics for Ballad Health's tertiary hospitals outperform national averages, and some of America's, Tennessee's, and Virginia's most well-respected health systems in areas such as patients who leave without being seen, time from presentation to discharge, and sepsis care. Workforce and Career Development: Ballad Health has added programs and enhanced existing programs since its last report, reflecting a significant investment in workforce development resources to equip Ballad Health team members to deliver the best experience for patients and each other. These programs include the return of in-person orientation, onboarding programs for new leaders as well as tiered leadership programs, the healthcare advisory program, and tuition reimbursement and scholarships. Lowering Cost of Care Ballad Health and community physicians continue to reduce the cost of care to patients, employers and government payors through value-based care. Price Transparency: Ballad Health continued to meet the Centers for Medicare & Medicaid Services hospital price transparency requirements under section 2718(e) of the Public Health Service Act. As such, Ballad Health's gross charges, discounted cash prices, payer-specific negotiated rates, and de-identified minimum and maximum negotiated rates for all hospital items and services as well as a consumer- friendly estimator tool and other pricing information are publicly available on its website. Cost-Efficiency Measures: According to countyhealthrankings.org, Ballad Health and community physicians have reduced preventable hospitalizations in our region by 50% since 2017. This has resulted in over $200 million of savings to taxpayers, employers, and patients. Our region's preventable hospitalization rate is as low, or lower than, communities like Nashville - a stunning result given the magnitude of resources available in those communities. In FY24, Ballad Health saw more than $50.3 million (for projects greater than $200,000) in savings due to cost-efficiency measures taken across the areas of labor, and contract consolidation, productivity, and supplies. Partnership & Research Highlights Ballad Health has made progress toward its involvement with its academic and community partners and its research goals. Highlights include receiving a grant from the Bloomberg Foundation to develop the Ballad Health Academy, a multifaceted academic partnership with East Tennessee State University's (ETSU) Center for Rural Health and Research, as well as continuing studies with Harvard Medical School's Department of Health Care Policy. Non-academic research included work with the Health Resources and Services Administration's (HRSA) efforts to combat opioid usage in rural communities, and the Centers for Medicaid and Medicare Services (CMS) Accountable Health Communities. Ballad Health also funded a myriad of initiatives across a broad spectrum of research. 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 of 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 are referring aren't Ballad Health 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. 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. 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 can 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. 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. 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 it's 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 V, line 1a Ballad Health (BH), WHS's parent organization, filed Form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. WHS reimburses BH for all expenses related to vendor payments and the expenses are recorded on WHS's books. Form 990, Part VI, Section A, line 6 Wellmont Health System is a Tennessee non-stock, nonprofit organization with Ballad Health as its sole member. Form 990, Part VI, Section A, line 7a Ballad Health has the authority to appoint Wellmont Health System board members. The President and CEO of Ballad Health serves as the President and CEO for Wellmont Health System. Form 990, Part VI, Section A, line 7b Decisions of the Wellmont Health System Board of Directors are subject to approval by the Ballad Health Board of Directors. 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 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. 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 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 33,996,415. Fundraising expenses 0. Total expenses 33,996,415. Consulting Fees: Program service expenses 324,640. Management and general expenses 253,289. Fundraising expenses 0. Total expenses 577,929. Contract Labor: Program service expenses 30,459,100. Management and general expenses 6,721,098. Fundraising expenses 0. Total expenses 37,180,198. Dietary Services: Program service expenses 9,042,508. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,042,508. Environmental Services: Program service expenses 8,783,761. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,783,761. Hospital Supported Clinics: Program service expenses 60,681,136. Management and general expenses 0. Fundraising expenses 0. Total expenses 60,681,136. Laboratory Services: Program service expenses 2,741,968. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,741,968. Laundry: Program service expenses 2,691,274. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,691,274. Other: Program service expenses 12,079,216. Management and general expenses 1,617,361. Fundraising expenses 0. Total expenses 13,696,577. Physician Fees: Program service expenses 43,531,112. Management and general expenses 0. Fundraising expenses 0. Total expenses 43,531,112. Form 990, Part XI, line 9: Alternative Investment Income Not on Books -62,560. Intercompany Transfers 0. Pension Plan Adjustment 1,418,770. Temporarily Restricted Grants 77,658. 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