2025-04-22T14:10:11-05:00 2024-06-30 990 2023-07-01 621308216 Wellmont Madison 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 902160 0 X balladhealth.org X 1989 TN Honor those we serve by delivering the best possible care. 4 0 28 1 0 0 2064 60 876901 889804 0 0 18247 12296 897212 902160 0 0 0 0 1015654 978354 0 0 0 527860 528880 1543514 1507234 -646302 -605074 569717 595043 102806 733206 466911 -138163 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 1353022 0 889804 See Schedule O 1353022 1 0 0 0 0 0 0 0 0 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 28 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 Michele Rusek Sr Dir L/T Care 5.00 35.00 X 0 154548 31622 Mark Chappell CFO HH MH CFO 0.10 44.90 X 0 179734 37699 Lynn Krutak BH EVPCFO (End June 2024) 0.10 64.90 X 0 994595 120642 Shane Hilton BH EVPCFO (Beg. Jan. 2024) 0.10 64.90 X 0 630028 100190 Andrew Wampler BH Gen Gnsl Former Officer 0.00 55.00 X 0 398602 62837 Tim Belisle Former Officer 0.00 0.00 X 0 162508 2542 0 7265621 852370 0 1 1 0 0 60 60 Patient Care Revenue 623990 889804 889804 889804 Cable Revenue 900099 7250 7250 Cafeteria/Vending 722514 2400 2400 Laundry Services 900099 1664 1664 982 982 12296 902160 889804 0 12296 814476 737510 76966 15542 14050 1492 95158 73803 21355 53178 53118 60 1797 1797 71957 63550 8407 51952 51913 39 46349 40366 5983 68127 68127 1126 1126 48201 48201 13935 13298 637 Maintenance 94803 94803 Food Service 82694 82694 Support Services 39273 39273 Medical Supplies 5046 5046 3620 3620 1507234 1353022 154212 0 347 -1193 164436 282525 3604415 3290704 361912 313711 43022 0 569717 595043 102519 112913 287 2095 0 618198 102806 733206 X 466911 -138163 466911 -138163 569717 595043 -605074 0 X 0 1 X 1 1 1 X 48758 252 752 2064 60 51886 1048475 686856 796216 879453 889804 4300804 23935 12471 11232 15695 12296 75629 1121168 699579 808200 897212 902160 4428319 0 534074 398445 328150 537100 431080 2228849 534074 398445 328150 537100 431080 2228849 2199470 1121168 699579 808200 897212 902160 4428319 0.49670 0.48340 0.00000 0.00000 X 40000 40000 3434257 3163314 270943 95082 92314 2768 35076 35076 0 313711 Due to Affiliates 618198 618198 X Part X, Line 2: Wellmont Madison 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 Gnsl Former Officer 0 311946 0 79268 0 7388 0 45089 0 17748 0 461439 0 0 Mark Chappell CFO HH MH CFO 0 139304 0 32881 0 7549 0 8998 0 28701 0 217433 0 0 Michele Rusek Sr Dir L/T Care 0 152283 0 0 0 2265 0 9040 0 22582 0 186170 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 Shane Hilton $50,175 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 $161,641 Form 990, Part III, Line 4a - Program Service Accomplishments Wellmont Madison House is the region's only healthcare system-affiliated assisted living residence, adult day care center and short-term overnight care program. Wellmont Madison House is a 29 bed facility with 27 Team Members. Wellmont Madison House offers adult day care services that feature hourly, half- and full-day options, overnight respite care for mid-life adults with chronic conditions and assisted living services to senior adults who require access to 24-hour personal care. The facility's team members frequently provide education about dementia and aging options during community events and health fairs. There are a wide range of activities for residents to enjoy including shopping trips and community outings. Other activities and events include a Halloween party where children from the neighborhood and community can interact with residents and a Veteran's Day service available to the community to commemorate the veterans or people who have served in armed services. For the year ended June 30, 2024, Wellmont Madison House provided services to 22 individuals. Form 990, Part V, line 1a Ballad Health (BH), Wellmont Madison House's (MH) parent organization, filed Form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. MH reimburses BH for all expenses related to vendor payments and the expenses are recorded on MH's books. Form 990, Part VI, Section A, line 6 Wellmont Health System is the sole member of Wellmont Madison 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 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. The Senior Director, Long Term Care 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. 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. 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 East TN Healthcare Holdings Inc 203 Gray Commons Circle Gray TN 37615 815475903 Opioid Treatment TN 501c3 Line 10 MSHA 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 Gre 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 Wexford House 2421 North John B Dennis Highway Kingsport TN 37660 581859039 Nursing Home TN 501c3 Line_10_Organization WHS 0 Ballad Health Center for Early Learning 400 N State of Franklin Road Johnson City TN 37604 923891827 Child Day Care Services TN 501c3 Line_10_Organization BALLAD 0 Wellmont Imaging Services Inc 400 N State of Franklin Road 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 Street Suite 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 Street Suite 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 Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman CJ KY1-1203 981195624 Insurance CJ 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 Ballad Ventures LLC 400 N State of Franklin Road Johnson City TN 37604 844214681 Investments TN N/A C 0 Ballad Health Development Corporation 400 N State of Franklin Road 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