MOUNTAIN STATES HEALTH ALLIANCE: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization: MOUNTAIN STATES HEALTH ALLIANCE (EIN 62-0476282)
Tax period: 2022-07-01 to 2023-06-30
Filed: 2024-05-14
IRS object ID: 202411359349309566
Schema version: 2022v5.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2024-05-14T15:38:03-05:00	ReturnTs
Tax Period End	2023-06-30	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2022-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	620476282	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Mountain States Health Alliance	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	MOUN	BusinessNameControlTxt
Phone	4233023467	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	311 Princeton Road Suite 1	AddressLine1Txt
City	Johnson City	CityNm
State Abbreviation	TN	StateAbbreviationCd
ZIP	376012080	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Shane Hilton	PersonNm
Person Title	BH EVP/CFO	PersonTitleTxt
Phone	4233023367	PhoneNum
Signature	2024-05-14	SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Shane	PersonFirstNm
Person Last	Hilton	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Field	Value	IRS element (for citing)
IRS Responsible Prty Info Curr	Yes (1)	IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
PTIN	P03077501	PTIN

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2022	TaxYr
Build TS	2023-04-26 12:10:37Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Alan Levine BH PresCEO	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	303 Med Tech Prkwy	AddressLine1Txt
City	Johnson City	CityNm
State Abbreviation	TN	StateAbbreviationCd
ZIP	37604	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$975,386,021	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	balladhealth.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1945	FormationYr
Legal Domicile State	TN	LegalDomicileStateCd
Activity Or Mission	Honor those we serve by delivering the best possible care.	ActivityOrMissionDesc
Voting Members Governing Body	4	VotingMembersGoverningBodyCnt
Voting Members Independent	0	VotingMembersIndependentCnt
Total Employee	6817	TotalEmployeeCnt
Total Volunteers	206	TotalVolunteersCnt
Total Gross UBI	$457,352	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$206,855	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$11,065,205	PYContributionsGrantsAmt
CY Contributions Grants	$18,006,238	CYContributionsGrantsAmt
PY Program Service Revenue	$899,832,195	PYProgramServiceRevenueAmt
CY Program Service Revenue	$950,636,535	CYProgramServiceRevenueAmt
PY Investment Income	$18,290	PYInvestmentIncomeAmt
CY Investment Income	$233,313	CYInvestmentIncomeAmt
PY Other Revenue	$8,185,688	PYOtherRevenueAmt
CY Other Revenue	$6,020,461	CYOtherRevenueAmt
PY Total Revenue	$919,101,378	PYTotalRevenueAmt
CY Total Revenue	$974,896,547	CYTotalRevenueAmt
PY Grants And Similar Paid	$3,286,642	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$1,064,386	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$324,864,142	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$345,719,307	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$548,121,007	PYOtherExpensesAmt
CY Other Expenses	$610,993,352	CYOtherExpensesAmt
PY Total Expenses	$876,271,791	PYTotalExpensesAmt
CY Total Expenses	$957,777,045	CYTotalExpensesAmt
PY Revenues Less Expenses	$42,829,587	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$17,119,502	CYRevenuesLessExpensesAmt
Total Assets BOY	$541,592,959	TotalAssetsBOYAmt
Total Assets EOY	$532,273,583	TotalAssetsEOYAmt
Total Liabilities BOY	$120,528,162	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$104,530,311	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$421,064,797	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$427,743,272	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$797,210,592	ExpenseAmt
Grant	$1,064,386	GrantAmt
Revenue	$950,237,440	RevenueAmt
Desc	See Schedule O	Desc
Total Program Service Expenses	$797,210,592	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	6817	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	4	GoverningBodyVotingMembersCnt
Independent Voting Member	0	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	0	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	TN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	VA	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Shane Hilton	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	4233023467	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	303 Med Tech Parkway	AddressLine1Txt
City	Johnson City	CityNm
State Abbreviation	TN	StateAbbreviationCd
ZIP	37604	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Alan Levine BH PresCEO
Director, Chair	1.00	64.00	Yes (X)	Yes (X)	$0	$3,557,360	$247,091
Eric Deaton BH EVPCOO
Director	1.00	64.00	Yes (X)	Yes (X)	$0	$1,268,808	$106,688
Marvin Eichorn BH EVPCAO
Director	1.00	64.00	Yes (X)	Yes (X)	$0	$3,107,146	$45,520
Tim Belisle BH EVPGen Cnsl
Director, Secretary End July 2022	1.00	64.00	Yes (X)	Yes (X)	$0	$827,127	$56,231
Andrew Wampler BH Gen Cnsl
Director, Secretary End April 2023	1.00	49.00	Yes (X)	Yes (X)	$0	$207,386	$40,760
Julie Bennett CLOGovnc Offcr
Director, Secretary Start April 2023	1.00	64.00	Yes (X)	Yes (X)	$0	$0	$0
Lynn Krutak
BH EVP/CFO	1.00	64.00		Yes (X)	$0	$1,209,478	$109,728
Frank Canova
Regional CFO	44.00	1.00		Yes (X)	$191,083	$0	$9,482
Kenneth Shafer
VP/CEO - JCMC	45.00	0.00			$414,450	$0	$36,326	Yes (X)
Lemmie Taylor
VP/CEO - SSH	45.00	0.00			$317,823	$0	$52,415	Yes (X)
Lisa Carter
Reg'l Pres - Southern Mkt	45.00	0.00			$645,666	$0	$54,706	Yes (X)
Melanie Stanton
VP/CEO - FWCH	45.00	0.00			$364,120	$0	$38,876	Yes (X)
Morgan May
VP/Reg'l CNO	45.00	0.00			$276,536	$0	$21,270	Yes (X)
Brandy Lawson
Lead Resp Therapist FWCH	40.00	0.00			$225,212	$0	$20,606		Yes (X)
David Wild MD
VP/Reg'l CMO	45.00	0.00			$238,555	$0	$13,883		Yes (X)
Corinne Allen
MultiFac Dir - Pharm Svcs	40.00	0.00			$210,282	$0	$33,983		Yes (X)
Dwight Owens
Admin/COO - IPCH	40.00	0.00			$290,043	$0	$37,622		Yes (X)
Greta Morrison
AVP, Admin/CNO - RCH	40.00	0.00			$198,219	$0	$36,193		Yes (X)
Joshua McFall Fmr Key Empl
CFO - Acute Services	0.00	40.00			$0	$455,393	$61,297			Yes (X)
Linda White Fmr Offcr
VP/Pres - NW Mkt	0.00	45.00			$0	$363,355	$29,806			Yes (X)
Chase Wilson Fmr Key Empl
CFO Greene Co	0.00	40.00			$0	$296,185	$40,312			Yes (X)
Eric Carroll Fmr HComp
CEO Greene Co	0.00	40.00			$0	$286,231	$33,164			Yes (X)
Clay Runnels MD Fmr Offcr
BH EVP/Chief Phys Exec	0.00	65.00			$0	$1,095,491	$98,857			Yes (X)
Mark Wilkinson MD Fmr HComp
BH VP/CMIO	0.00	45.00			$0	$548,999	$44,284			Yes (X)
Matthew Loos Fmr HComp
BH VP/CAO	0.00	45.00			$0	$507,157	$46,822			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,371,989	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$13,730,116	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,315,922	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	379	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Related Organizations	$15,238,519	RelatedOrganizationsAmt
Government Grants	$2,430,720	GovernmentGrantsAmt
All Other Contributions	$336,999	AllOtherContributionsAmt
Total Contributions	$18,006,238	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
Patient Revenue	622110	$949,242,160	$949,242,160
Diabetes Program Revenue	900099	$640,692	$640,692
Lab Outreach Revenue	621500	$407,341		$407,341
CARES Act Revenue	900099	$246,657	$246,657
O/P Rehabilitation Revenue	900099	$99,685	$99,685

Field	Value	IRS element (for citing)
Total Program Service Revenue	$950,636,535	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$261,726	TotalRevenueColumnAmt
Exclusion	$261,726	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$868,551	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$417,988	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$450,563	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$450,563	TotalRevenueColumnAmt
Unrelated Business Revenue	$50,011	UnrelatedBusinessRevenueAmt
Exclusion	$400,552	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$43,073	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$71,486	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	-$28,413	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$28,413	TotalRevenueColumnAmt
Related Or Exempt Func Income	-$28,413	RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
Cafeteria/Vending	722514	$2,711,236	$2,711,236
Network Mgt Services	900099	$1,867,860	$1,867,860
Daycare	624410	$263,976	$263,976

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$726,826	TotalRevenueColumnAmt
Related Or Exempt Func Income	$36,659	RelatedOrExemptFuncIncomeAmt
Exclusion	$690,167	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$5,569,898	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$974,896,547	TotalRevenueColumnAmt
Related Or Exempt Func Income	$950,237,440	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$457,352	UnrelatedBusinessRevenueAmt
Exclusion	$6,195,517	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$1,064,386	TotalAmt
Program Services	$1,064,386	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,857,840	TotalAmt
Program Services	$339,808	ProgramServicesAmt
Management And General	$2,518,032	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$278,329,140	TotalAmt
Program Services	$220,991,030	ProgramServicesAmt
Management And General	$57,338,110	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$7,115,024	TotalAmt
Program Services	$5,698,739	ProgramServicesAmt
Management And General	$1,416,285	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$40,619,842	TotalAmt
Program Services	$23,982,182	ProgramServicesAmt
Management And General	$16,637,660	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$16,797,461	TotalAmt
Program Services	$15,929,063	ProgramServicesAmt
Management And General	$868,398	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$341,663	TotalAmt
Management And General	$341,663	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$239,770,039	TotalAmt
Program Services	$186,588,300	ProgramServicesAmt
Management And General	$53,181,739	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$611,382	TotalAmt
Program Services	$86,908	ProgramServicesAmt
Management And General	$524,474	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$5,301,912	TotalAmt
Program Services	$4,848,305	ProgramServicesAmt
Management And General	$453,607	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$13,409,501	TotalAmt
Program Services	$12,001,549	ProgramServicesAmt
Management And General	$1,407,952	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$12,346,661	TotalAmt
Program Services	$12,303,191	ProgramServicesAmt
Management And General	$43,470	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$1,252,321	TotalAmt
Program Services	$1,184,613	ProgramServicesAmt
Management And General	$67,708	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$25,478,424	TotalAmt
Program Services	$25,334,782	ProgramServicesAmt
Management And General	$143,642	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$32,753,925	TotalAmt
Program Services	$31,623,523	ProgramServicesAmt
Management And General	$1,130,402	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$3,617,310	TotalAmt
Program Services	$3,512,281	ProgramServicesAmt
Management And General	$105,029	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical Supplies	$222,440,554	$222,440,554
Support Services	$23,227,484	$1,951,466	$21,276,018
Maintenance	$22,399,028	$21,914,135	$484,893
Lease - Equipment	$2,432,622	$2,385,129	$47,493

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$5,610,526	TotalAmt
Program Services	$3,030,648	ProgramServicesAmt
Management And General	$2,579,878	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$957,777,045	TotalAmt
Program Services	$797,210,592	ProgramServicesAmt
Management And General	$160,566,453	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$13,797	BOYAmt
EOY	$0	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$247,772	BOYAmt
EOY	$205,869	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$172,025	BOYAmt
EOY	$75,845	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$99,587,487	BOYAmt
EOY	$115,072,479	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$12,937,884	BOYAmt
EOY	$13,938,037	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$20,187,849	BOYAmt
EOY	$20,177,149	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$3,573,367	BOYAmt
EOY	$4,669,516	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$1,022,970,002	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$663,660,679	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$356,694,008	BOYAmt
EOY	$359,309,323	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$13,141,003	BOYAmt
EOY	$13,141,003	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$35,037,767	BOYAmt
EOY	$5,684,362	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$541,592,959	BOYAmt
EOY	$532,273,583	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$78,960,736	BOYAmt
EOY	$79,365,380	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$11,689,902	BOYAmt
EOY	$7,498,677	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$61,266	BOYAmt
EOY	$48,120	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$29,816,258	BOYAmt
EOY	$17,618,134	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$120,528,162	BOYAmt
EOY	$104,530,311	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$421,051,078	BOYAmt
EOY	$427,549,663	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$13,719	BOYAmt
EOY	$193,609	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$421,064,797	BOYAmt
EOY	$427,743,272	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$541,592,959	BOYAmt
EOY	$532,273,583	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$17,119,502	ReconcilationRevenueExpnssAmt
Prior Period Adjustments	-$413,733	PriorPeriodAdjustmentsAmt
Other Changes In Net Assets	-$10,027,294	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (1)	GrantsOtherOrganizationsInd
Grants Other Organizations	$119,874	GrantsOtherOrganizationsAmt
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	0	OtherActivitiesInd
Total Lobbying Expenditures	$119,874	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Mountain States Health Alliance had lobbying expenses of $119,874 which represents the portion of dues paid to various organizations attributable to direct lobbying, including Tennessee Hospital Association and Virginia Hospital and Healthcare Association.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$22,219,663	OtherCostOrOtherBasisAmt
Book Value	$22,219,663	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$535,787,366	OtherCostOrOtherBasisAmt
Depreciation	$276,936,968	DepreciationAmt
Book Value	$258,850,398	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,841,819	OtherCostOrOtherBasisAmt
Depreciation	$3,763,742	DepreciationAmt
Book Value	$1,078,077	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$441,607,337	OtherCostOrOtherBasisAmt
Depreciation	$376,914,314	DepreciationAmt
Book Value	$64,693,023	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$18,513,817	OtherCostOrOtherBasisAmt
Depreciation	$6,045,655	DepreciationAmt
Book Value	$12,468,162	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$359,309,323	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDesc	AmtAmt
Due to 3rd Party Payors	-$116,436
Operating Lease Obligation ST	$475,883
Operating Lease Obligation LT	$583,971
Professional Liabilities Reserve	$9,970,556
Due to Payor Stimulus Reserve	$2,270,500
Deferred Income	$4,433,660

Field	Value	IRS element (for citing)
Total Liability	$17,618,134	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part X, Line 2:	FormAndLineReferenceDesc
Explanation	Mountain States Health Alliance is included in the audited consolidated financial statements of Ballad Health. The footnote explanation relative to income taxes reads: "Ballad is classified as an organization exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. As such, no provision for federal income taxes is included in the accompanying consolidated financial statements. Taxable subsidiaries are discussed in Note K. No significant uncertain tax positions exist at June 30, 2023 and 2022. Tax returns for 2020 through 2022 are subject to examination by the Internal Revenue Service."	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	225.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Discounted Care Other	450.000000000000	DiscountedCareOtherPct

Field	Value	IRS element (for citing)
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$32,407,277	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$32,407,277	NetCommunityBenefitExpnsAmt
Total Expense	0.03380	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$262,462,381	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$232,453,189	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$30,009,192	NetCommunityBenefitExpnsAmt
Total Expense	0.03130	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$294,869,658	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$232,453,189	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$62,416,469	NetCommunityBenefitExpnsAmt
Total Expense	0.06510	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,412,985	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$697,290	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,715,695	NetCommunityBenefitExpnsAmt
Total Expense	0.00280	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$17,746,563	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,125,618	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$13,620,945	NetCommunityBenefitExpnsAmt
Total Expense	0.01420	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$22,781,237	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$19,016,296	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,764,941	NetCommunityBenefitExpnsAmt
Total Expense	0.00390	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,381,364	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$68,289	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,313,075	NetCommunityBenefitExpnsAmt
Total Expense	0.00140	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$942,886	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$942,886	NetCommunityBenefitExpnsAmt
Total Expense	0.00100	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$46,265,035	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$23,907,493	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$22,357,542	NetCommunityBenefitExpnsAmt
Total Expense	0.02330	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$341,134,693	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$256,360,682	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$84,774,011	NetCommunityBenefitExpnsAmt
Total Expense	0.08840	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$250,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$250,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$29,241	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$29,241	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$30,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$30,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$309,241	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$309,241	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$54,136,080	BadDebtExpenseAmt
Bad Debt Expense Attributable	$2,706,804	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$159,278,530	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$147,351,516	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$11,927,014	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

Field	Value	IRS element (for citing)
Business Name Line1	1 Med Spec of JC LLC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Primary Activities	Medical Services	PrimaryActivitiesTxt
Org Profit Or Ownership	0.51000	OrgProfitOrOwnershipPct
Physicians Profit Or Ownership	0.49000	PhysiciansProfitOrOwnershipPct

Field	Value	IRS element (for citing)
Hospital Facilities	8	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (8 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Childrens HospitalChildrensHospitalInd	Teaching HospitalTeachingHospitalInd	Research FacilityResearchFacilityInd	Emergency Room24 HrsEmergencyRoom24HrsInd	OtherOtherDesc	Facility Reporting GroupFacilityReportingGroupCd	Critical Access HospitalCriticalAccessHospitalInd
Johnson City Medical Center
1	400 N State of Franklin Rd	Johnson City	TN	37604	balladhealth.org	00000121	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Mental Health	A
Indian Path Community Hospital
2	2000 Brookside Drive	Kingsport	TN	37660	balladhealth.org	00000134	Yes (X)	Yes (X)		Yes (X)		Yes (X)		A
Franklin Woods Community Hospital
3	300 Med Tech Parkway	Johnson City	TN	37604	balladhealth.org	00000123	Yes (X)	Yes (X)				Yes (X)		A
Sycamore Shoals Hospital
4	1501 W Elk Avenue	Elizabethton	TN	37643	balladhealth.org	00000012	Yes (X)	Yes (X)				Yes (X)	Mental Health	A
Russell County Hospital
5	58 Carroll Street	Lebanon	VA	24266	balladhealth.org	H 1892	Yes (X)	Yes (X)				Yes (X)	Mental Health	A
Johnson County Community Hospital
6	1901 S Shady Street	Mountain City	TN	37683	balladhealth.org	00000039	Yes (X)	Yes (X)				Yes (X)		A	Yes (X)
Unicoi County Hospital
7	2030 Temple Hill Road	Erwin	TN	37650	balladhealth.org	00000119	Yes (X)	Yes (X)				Yes (X)		A
Lee County Community Hospital
8	127 Health Care Drive	Pennington Gap	VA	24277	balladhealth.org	H 1940	Yes (X)	Yes (X)				Yes (X)		A	Yes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Facility Reporting Group - A	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
Other	Yes (X)	OtherInd
CHNA Conducted	21	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	balladhealth.org/locations	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	22	ImplementationStrategyAdptYr
Strategy Posted Website	0	StrategyPostedWebsiteInd
Strategy Attached	Yes (1)	StrategyAttachedInd
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	225.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	450.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	balladhealth.org	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	balladhealth.org	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	balladhealth.org	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part V, Section B	Facility Reporting Group A
Facility Reporting Group A consists of:	- Facility 1: Johnson City Medical Center, - Facility 2: Indian Path Community Hospital, - Facility 3: Franklin Woods Community Hospital, - Facility 4: Sycamore Shoals Hospital, - Facility 5: Russell County Hospital, - Facility 6: Johnson County Community Hospital, - Facility 7: Unicoi County Hospital, - Facility 8: Lee County Community Hospital
Facility Reporting Group - A Part V, Section B, line 3j:	To understand each community's individual needs, Ballad Health conducted a Community Health Needs Assessment (CHNA) for each Ballad hospital to profile the health of the residents within its service area. Throughout the CHNA process, high priority was given to determining the health disparities and available resources within each community. Community members from each county met with Ballad representatives to discuss current health priorities and identify potential solutions. Priorities established for the CHNAs were determined by the most significant health needs of each community. Ballad Health hospitals, including MSHA hospitals, conducted their fifth CHNA with board approval and publication occurring at the end of FY21. For FY21 CHNAs, Ballad Health utilized a mixed-methods approach for primary and secondary data collection to gather regional information to inform the 2021 community health needs assessments. The secondary data collection entailed the compilation of secondary data pertaining to agreed-upon metrics and indicators from an array of verified sources. The primary data collection component involved both a key stakeholder survey and key stakeholder focus groups. Findings from both research methods were used to prioritize the needs of the community served by each Ballad Health facility and determine priority focus areas for future improvement efforts. Analysis of secondary data for Washington County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Washington County. For Johnson City Medical Center, Franklin Woods Community Hospital, Niswonger Children's Hospital, and Woodridge Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Washington County are substance abuse, mental health, and Adverse Childhood Experiences (ACEs). Analysis of secondary data for Sullivan County, findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Sullivan County. For Indian Path Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Sullivan County, TN are substance abuse, mental health, and transportation. Analysis of secondary data for Carter County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Carter County. For Sycamore Shoals Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Carter County, TN are substance abuse, mental health, Adverse Childhood Experiences (ACEs), and transportation.Analysis of secondary data for Unicoi County, findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Unicoi County. For Unicoi County Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Unicoi County, TN are education, mental health, and Adverse Childhood Experiences (ACEs). Analysis of secondary data for Russell County, VA findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Russell County. For Russell County Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Russell County, VA are substance abuse, mental health, and poverty.Analysis of secondary data for Johnson County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Johnson County. For Johnson County Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Johnson County, TN are substance abuse, mental health, and Adverse Childhood Experiences (ACEs).
Facility Reporting Group - A Part V, Section B, line 5:	The community health needs assessment process was guided by the Mobilizing for Action Through Planning and Partnerships (MAPP) model, with an understanding that aspects of the model may have to be adapted due to the purpose of the assessment for Ballad Health and constraints related to the COVID-19 pandemic. In coordination with the MAPP model, concepts from both Community-Based Participatory Research (CBPR) and the Arkansas Center for Health Improvement (ACHI) Community Health Assessment Toolkit were also utilized for the assessments. Following guidance from the MAPP model, a Key Stakeholder Survey was designed with the primary aim of identifying the most-pressing community issues. In aligning with principles of CBPR, the key stakeholder survey was designed to allow key stakeholders to frame community issues in their own words through the use of open-ended questions. In addition to the identification of community issues, the key stakeholder survey was also designed to discern why survey respondents believed the community issues they selected had the greatest effect on the overall health and wellbeing of their community. Questions related to ideas and suggestions for improvement efforts, gauging the success of efforts after the previous community health needs assessments, and community struggles related to the COVID-19 pandemic were also included in the survey. Independent focus groups were conducted for each Ballad Health facility in order to provide specific and unique information for each community being served. The MAPP model and questions from the key stakeholder survey were used to guide the development and construction of the focus groups. Because the key stakeholder survey primarily dealt with the identification of community issues, the focus groups were primarily designed to prioritize community issues identified through the key stakeholder survey and discuss actionable items around how to best address these community issues. Questions related to root causes of community issues, the current state of resources to address community issues, needed resources to initiate improvement efforts and be successful, and community struggles related to the COVID-19 pandemic were also included in the focus group facilitation guide. The key stakeholder focus groups were conducted virtually via WebEx and were one hour and thirty minutes in length.For Johnson City Medical Center, Niswonger Children's Hospital, Franklin Woods Community Hospital, and Woodridge Hospital there were thirty-five focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Washington County, TN which included: the school system, businesses, government, the health care system, health departments, faith-based organizations, and a diverse group of community-based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders. For Indian Path Community Hospital there were eighteen focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Sullivan County, TN which included: the school system, businesses, government, the health care system, health departments, faith-based organizations, and a diverse group of community-based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Sycamore Shoals Community Hospital there were ten focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Carter County, TN which included: the school system, businesses, government, the health care system, health departments, faith-based organizations, and a diverse group of community-based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Unicoi County Hospital there were six focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Unicoi County, TN which included: the school system, businesses, government, the health care system, health departments, faith-based organizations, and a diverse group of community-based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Russell County Community Hospital there were nine focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Russell County, VA which included: the school system, businesses, government, the health care system, health departments, faith-based organizations, and a diverse group of community-based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Johnson County Community Hospital, there were seven focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Johnson County, TN which included: the school system, businesses, government, the health care system, health departments, faith-based organizations, and a diverse group of community-based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders. Activities associated with the June 2021 assessments took place from summer of 2020 through the spring of 2021. The assessment activity including focus groups & surveys were used to develop the hospital implementation plans that were completed fall 2021.
Facility Reporting Group - A Part V, Section B, line 6a:	Each hospital within Ballad Health completed a CHNA. MSHA's CHNAs were conducted with all Ballad Health hospitals at that time to include: Bristol Regional Medical Center, Hancock County Hospital, Hawkins County Memorial Hospital, Greeneville Community Hospital, Holston Valley Medical Center, Johnson City Medical Center (includes Niswonger Children's Hospital and Woodridge Hospital), Franklin Woods Community Hospital, Indian Path Community Hospital, Lonesome Pine Hospital (including Mountain View campus), Johnson County Community Hospital, Johnston Memorial Hospital, Norton Community Hospital, Dickenson Community Hospital, Russell County Hospital, Smyth County Community Hospital, Sycamore Shoals Hospital, and Unicoi County Hospital.
Facility Reporting Group - A Part V, Section B, line 11:	During the year, MSHA focused on its CHNA priorities as identified in its FY21 CHNA report. MSHA's primary areas of focus included: substance abuse, mental health, and Adverse Childhood Experiences (ACEs). Many additional community needs exist in our region. It is fiscally impossible for a hospital to address every health need in a community, which is why the CHNA process is used to identify and prioritize areas of focus. A thoughtful CHNA evaluates overall community health needs to determine which ones the hospital can best influence in a positive way. Consideration is given to other organizations in the hospital's geographic area that already offer services addressing specific health needs. In some cases, it is best to simply support an identified health need through a financial donation to another nonprofit organization skilled in certain areas: teen pregnancy, dental health, fighting homelessness, etc. Hospitals also lend support to other nonprofit organizations by serving on their boards, committees, and assisting with fundraising efforts. Ballad Health made financial contributions to other nonprofit organizations providing community services that support MSHA hospitals' CHNAs.
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 Ballad Health's financial assistance policy.

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - MSHA dba BH Homecare-Johnson City
509 Med Tech Parkway Ste 200	Johnson City	TN	37604	Licensed Home Health Agency
2 - MSHA dba BH Homecare-Abingdon
611 Campus Dr Ste 300	Abingdon	VA	24210	Licensed Home Health Agency
3 - MSHA dba BH Homecare-Greeneville
1410 Tusculum Blvd Ste 1600	Greeneville	TN	37745	Licensed Home Health Agency
4 - MSHA dba BH Homecare-Norton
96 15th St NW Ste 104A	Norton	VA	24273	Licensed Home Health Agency
5 - MSHA dba BH Hospice-Bristol
280 Steeles Road	Bristol	TN	37620	Licensed Hospice Agency
6 - MSHA dba BH Hospice-Abingdon
611 Campus Dr Ste 500	Abingdon	VA	24210	Licensed Hospice Agency

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 for Critical Access Hospitals (CAH's) is 77% and for all other hospitals or physician practices it is 85%. In addition to the uninsured discount, many patients will further qualify for additional financial assistance. All patients seeking financial assistance must submit an application for financial assistance and submit documents in support of the information on the application, unless specifically excluded according to policy guidelines. Medicaid eligible patients will qualify for 100% financial assistance and not be required to complete the required documentation when: a) Medicaid eligibility requirements are met after the service is provided, b) non-covered charges occur on a Medicaid eligible encounter, or c) benefits have been exhausted. Deceased patients with no estate also qualify for 100% financial assistance.Financial assistance determinations may be retroactive for all outstanding balances. In addition, Ballad Health offers a number of programs with special discounts such as lactation consultation services, oncology treatment regimens, enrollment in various community programs and prescription drugs filled post-discharge.
Part I, Line 7:	The cost to charge ratio (worksheet 2 "ratio of patient care cost to charges") was used to calculate line 7a financial assistance at cost, which includes charity and uninsured discounts. MSHA's cost accounting system was used to determine losses from Tenncare and Medicaid reported on line 7b, with the exception of home health and a small physician clinic. A cost to charge ratio was used for their data because these are smaller divisions not available in MSHA's cost accounting software. 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. MSHA'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 maintains records for the non-Medicare programs. Only labor costs are included for MSHA 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, MSHA's cost accounting system is used because MSHA has established, standard costing reports for these services. There are exceptions where MSHA does not use the cost accounting system. A small clinic inside Johnson County Community Hospital (JCCH), a federally designated critical access hospital, is subsidized by JCCH and the clinic's departmental operating report is used to compute the clinic's community benefit. The second exception is a palliative care program. For this program, the department's operating report is used. MSHA is careful to ensure no double counting of cost. Although there are other service lines within MSHA hospitals that lose money, MSHA does not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7h research represents MSHA'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:	MSHA 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 MSHA 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. MSHA does not capture costs associated with team members that serve on other nonprofit boards or provide services to other nonprofits.MSHA, in collaboration with area health agencies and providers, may offer assistance with coordination, advocacy, or contribute supplies to support groups for their program activities that serve to assist special populations within the area. Most of these organizations work to improve the lives of community members that have limited, or no, financial resources.During FY23 MSHA provided $250,000 to the Appalachian Highlands Economic Development Partnership; $23,741 of community support to the local Boys & Girls Club, community school supplies programs and Farm to Table Program that supports local farmers; $25,000 to the Summit Leadership Foundation Youth Leadership Program and $5,000 to local Chamber of Commerce leadership programs; and $5,500 to the Lee County Sheriff's Department Test Alert System.
Part III, Line 2:	Self-pay balances include accounts after payments and contractual adjustments (discounts) have been applied from all third-party payors such as Medicare, 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 received an 85% discount. Many self-pay patients will further qualify for financial assistance (sometimes referred to as charity care) if they provide the financial information needed to deem them eligible or upon determination of presumptive charity eligibility. After the normal collection process has indicated an account is uncollectible, MSHA 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 MSHA's bad debt would have qualified for financial assistance if patients had provided a financial assistance application and required documentation. Pursuant to the merger, MSHA 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 MSHA believes would qualify for financial assistance. Although patients are encouraged to apply for assistance, many will not do so. MSHA 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 our program. Without a completed application, these are recorded as bad debt instead of charity care.
Part III, Line 4:	Ballad Health's audited financial statements include a footnote on page 14 that describes bad debt. MSHA is included in the June 30, 2023 audited financial statements of Ballad Health (attached).
Part III, Line 8:	Excluding Medicare losses reported in Part I subsidized health, the Part III Medicare allowable costs are reported using MSHA's filed Medicare cost report (C/R). The C/R uses a cost to charge ratio based on a step-down allocation methodology. MSHA believes Medicare losses should be allowed as a reportable community benefit, similar to governmental programs such as Medicaid. As a participating provider in the Medicare program, hospitals are required to provide the full regimen of care for the Medicare population. There are a number of care regimens that are compensated by the Medicare program at levels below cost. Therefore, it is only logical to allow hospitals to report these uncompensated services as a community benefit. By making this change, nonprofit providers will be encouraged to continue important care delivery models for our aging population in spite of the fact it may be economically injurious.
Part III, Line 9b:	Requests for financial assistance are evaluated using established guidelines, while allowing for unique financial circumstances - for example, medically indigent patients with catastrophic medical costs that would threaten the patient's household financial viability. When a patient requests financial assistance or when an application has been received, the patient's account is placed in a hold status to prevent further collection activities until financial assistance eligibility is determined. All Ballad Health hospitals comply with IRS 501(r) regulatory guidelines.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. MSHA 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, MSHA 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. MSHA hospitals provide a number of payment options:- a pre-service discount may be offered- a discount in excess of established discounting rates may be granted for catastrophic high dollar accounts- MSHA hospitals accept all non-contracted and out-of-network payors and will make attempts to work with these payors regarding appropriate reimbursement and billing to their members- as part of Ballad Health's commitments to the State of Tennessee and Commonwealth of Virginia to form Ballad Health, not-in-network discounts are applied per policies in place for MSHA hospitals- payment arrangements are available as 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 the Ballad Health financial assistance policy.
Part VI, Line 2:	Focusing on population health improvement and associated priority metrics allows Ballad Health to further engage the efforts of its hospitals in partnership with communities in our service areas. It has helped Ballad to better identify health disparities that appear across the individual communities and has helped Ballad to prioritize issues that are most important in each hospital's community. Engaging local community organizations expands partnerships so that organizations work together more to address community health needs. Ballad Health uses a comprehensive process to gather input for and continues to evolve its population health plan. Because our hospitals are located in a region with many chronic disease challenges and high levels of health-related social risks, Ballad Health's goal is to target population health issues to make lasting improvements. Ballad conducts ongoing interviews, focus groups and meetings with external groups, including the regional health departments, United Way agencies, chambers of commerce, schools and community organizations, the regional accountable care community leadership council, as well as internal groups such as our population health and community benefit committee of the Ballad Health board of directors, the Ballad Health population health clinical committee, social needs council, grant advisory committees and our hospital community boards in the creation and on-going implementation of its population health plan.
Part VI, Line 3:	Consistent with the Ballad Health financial assistance policy, MSHA 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 MSHA 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. Our financial assistance policy and documents are available in emergency departments and admitting areas. MSHA is also happy to mail all documents to patients and offers a plain language summary. All documents are available in English and Spanish. Financial assistance information is available during pre-registration, registration and/or during financial counseling. MSHA 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 ACA-healthcare exchange, MSHA 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:	MSHA serves the healthcare needs of 29 Appalachian counties in Northeast Tennessee, Southwest Virginia, Southeast Kentucky, and Northwest North Carolina. All of the counties MSHA serves are federally designated as medically underserved areas. MSHA's largest hospital, Johnson City Medical Center, is a tertiary referral center and level one trauma center. 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. MSHA operates 2 critical access hospitals: Johnson County Community Hospital in Tennessee and Lee County Community Hospital in Virginia.Additionally, according to the 2021 County Health Rankings, counties where MSHA hospitals are located ranked poorly for both health outcomes and health factors.
Part VI, Line 5:	MSHA is dedicated to operating efficiently so that waste is minimized. MSHA's leadership remains mindful of managing limited resources so that adequate facilities and equipment are available for the care of patients. Surplus funds are invested into improving treatment options for patients through new technologies, recruiting physicians and trained staff in shortage areas, and improving MSHA facilities. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary. MSHA has several hospitals with Medicare-approved health profession education programs. In addition, MSHA hospitals serve as training sites for many types of health professions: nursing, pharmacy, psychology, lab, respiratory therapy, EMT, public health, etc. Students from numerous colleges, universities, and programs receive training and experience in MSHA hospitals. MSHA resources are devoted to health conferences for local health professionals, two health resources centers conveniently located in a shopping mall and a wellness center; provide for media coverage to educate residents on health issues; offer events to the public that combine fun activities with health education; and many other programs focused on improving the health of area residents. While MSHA operates hospitals in predominantly low-income, rural and isolated areas, MSHA continues to offer services that operate at a loss because residents would otherwise need to leave their hometown or county to receive needed care. Mountain States merged with Wellmont Health System in February 2018 to form Ballad Health healthcare system. Mountain States and Wellmont still exist as legal entities and continue to operate multiple hospitals. MSHA'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 MSHA.
Part VI, Line 6:	Mountain State's merger with Wellmont opened up many opportunities not previously available to two competing health systems. Collaboration started post-merger and Ballad Health continues to see progress towards improving efficiencies within our health system, activities consistent with Ballad Health's population health initiative, sharing best practice quality improvements, and other benefits related to operating as one rather than operating in a competitive environment. A clinical council was formed immediately following the merger. The council includes physicians nominated from the leadership of all Ballad hospitals. A Community Benefit and Population Health Committee of the board was established, and various other infrastructures have been established since the merger. Across MSHA's hospitals, there were many projects, programs, and collaborative efforts that took place during the year. MSHA provides care to people in 29 counties in Tennessee, Virginia, Kentucky and North Carolina. Each hospital is fully accredited by The Joint Commission, with the exception of Johnson County Community Hospital and Lee County Community Hospital. JCCH and LCCH receive certification through the states of Tennessee and Virginia since they are critical access hospitals. MSHA, based in Johnson City, Tennessee includes 8 wholly owned hospitals which are included in this Form 990. In addition, MSHA owns 2 hospitals located in Southwest Virginia, each of which file separate returns. In addition to acute care hospitals, the system includes such services as:Primary/specialty physician practices, emergency departments, occupational medicine, rehabilitation, outreach laboratory, mental health, neonatal intensive care, a NACHARI-affiliated children's hospital, renal dialysis, St. Jude's Oncology, inpatient/outpatient surgery, skilled nursing, long-term care, home health, and more. With these additional facilities and services, MSHA extends a highly effective health care delivery system. Since our system is both horizontally and vertically integrated, patients can be efficiently moved along an integrated, comprehensive continuum of care as their health status dictates. MSHA's flagship facility, Johnson City Medical Center is at the core of the system offering full-service tertiary care. In addition to MSHA hospitals, MSHA is the sole member of Blue Ridge Medical Management Corporation (BRMMC). MSHA extends an integrated healthcare delivery system through BRMMC to include multiple primary and specialty care patient access centers and numerous outpatient care sites, including urgent care centers, occupational medicine services, a same day surgery center and rehabilitation.MSHA partners with East Tennessee State University to operate Overmountain Recovery, an opioid addiction recovery facility located in Gray, Tennessee.MSHA is the sole member of Integrated Solutions Health Network, LLC. (ISHN). ISHN operates Anewcare Collaborative, the region's first accountable care organization, bringing together community health care providers to provide better outcomes and improved patient satisfaction at a lower cost.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's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad operates under a Cooperative Agreement (CA) in Virginia and a Certificate of Public Advantage (COPA) in Tennessee as obligated by agreements between Ballad and the two states to allow Mountain States Health Alliance and Wellmont Health System to merge.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Non Cash AssistanceNonCashAssistanceAmt	Purpose Of GrantPurposeOfGrantTxt
Appalachian School of Law
1169 Edgewater Drive	Grundy	VA	24614	541743079	501c3	$260,000	$0	Improve Access to Healthcare Program
East Tennessee State University
PO Box 70732	Johnson City	TN	37614	626021046	501c3	$470,000	$0	College of Pharmacy
East Tennessee State University Foundation
PO Box 70721	Johnson City	TN	37614	237092731	501c3	$32,775	$0	Center for Nursing Excellence
East Tennessee State University Foundation
PO Box 70721	Johnson City	TN	37614	237092731	501c3	$134,010	$0	Research
Kingsport Chamber Foundation
400 Clinchfield St Ste 100	Kingsport	TN	37660	581453565	501c3	$13,750	$0	Program Sponsorships
Southern Appalachian Ronald McDonald House Charities
418 N State of Franklin Rd	Johnson City	TN	37604	621578123	501c3	$8,000	$0	Program support

Field	Value	IRS element (for citing)
Total501c3 Org	6	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	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	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	Yes (1)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (24 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Alan Levine BH PresCEO
Director, Chair	$0	$1,351,717	$0	$2,162,808	$0	$42,835	$0	$218,859	$0	$28,232	$0	$3,804,451	$0	$0
Marvin Eichorn BH EVPCAO
Director	$0	$752,788	$0	$598,921	$0	$1,755,437	$0	$17,400	$0	$28,120	$0	$3,152,666	$0	$0
Eric Deaton BH EVPCOO
Director	$0	$720,293	$0	$530,155	$0	$18,360	$0	$84,013	$0	$22,675	$0	$1,375,496	$0	$0
Lynn Krutak
BH EVP/CFO	$0	$682,629	$0	$520,077	$0	$6,772	$0	$82,332	$0	$27,396	$0	$1,319,206	$0	$0
Clay Runnels MD Fmr Offcr
BH EVP/Chief Phys Exec	$0	$626,281	$0	$450,791	$0	$18,419	$0	$72,852	$0	$26,005	$0	$1,194,348	$0	$0
Tim Belisle BH EVPGen Cnsl
Director, Secretary End July 2022	$0	$277,977	$0	$310,583	$0	$238,567	$0	$29,779	$0	$26,452	$0	$883,358	$0	$0
Lisa Carter
Reg'l Pres - Southern Mkt	$421,628	$0	$211,924	$0	$12,114	$0	$29,940	$0	$24,766	$0	$700,372	$0	$0	$0
Mark Wilkinson MD Fmr HComp
BH VP/CMIO	$0	$424,870	$0	$108,231	$0	$15,898	$0	$18,150	$0	$26,134	$0	$593,283	$0	$0
Matthew Loos Fmr HComp
BH VP/CAO	$0	$396,819	$0	$103,742	$0	$6,596	$0	$18,246	$0	$28,576	$0	$553,979	$0	$0
Joshua McFall Fmr Key Empl
CFO - Acute Services	$0	$359,547	$0	$94,810	$0	$1,036	$0	$34,586	$0	$26,711	$0	$516,690	$0	$0
Kenneth Shafer
VP/CEO - JCMC	$331,343	$0	$80,954	$0	$2,153	$0	$14,702	$0	$21,624	$0	$450,776	$0	$0	$0
Melanie Stanton
VP/CEO - FWCH	$282,891	$0	$72,725	$0	$8,504	$0	$15,740	$0	$23,136	$0	$402,996	$0	$0	$0
Linda White Fmr Offcr
VP/Pres - NW Mkt	$0	$220,967	$0	$125,400	$0	$16,988	$0	$16,253	$0	$13,553	$0	$393,161	$0	$0
Lemmie Taylor
VP/CEO - SSH	$244,069	$0	$64,896	$0	$8,858	$0	$27,619	$0	$24,796	$0	$370,238	$0	$0	$0
Chase Wilson Fmr Key Empl
CFO Greene Co	$0	$229,756	$0	$66,225	$0	$204	$0	$14,416	$0	$25,896	$0	$336,497	$0	$0
Dwight Owens
Admin/COO - IPCH	$233,629	$0	$49,162	$0	$7,252	$0	$14,582	$0	$23,040	$0	$327,665	$0	$0	$0
Eric Carroll Fmr HComp
CEO Greene Co	$0	$225,992	$0	$59,099	$0	$1,140	$0	$13,760	$0	$19,404	$0	$319,395	$0	$0
Morgan May
VP/Reg'l CNO	$220,672	$0	$54,838	$0	$1,026	$0	$0	$0	$21,270	$0	$297,806	$0	$0	$0
David Wild MD
VP/Reg'l CMO	$212,523	$0	$500	$0	$25,532	$0	$0	$0	$13,883	$0	$252,438	$0	$0	$0
Andrew Wampler BH Gen Cnsl
Director, Secretary End April 2023	$0	$202,835	$0	$1,250	$0	$3,301	$0	$30,762	$0	$9,998	$0	$248,146	$0	$0
Brandy Lawson
Lead Resp Therapist FWCH	$222,512	$0	$1,250	$0	$1,450	$0	$13,579	$0	$7,027	$0	$245,818	$0	$0	$0
Corinne Allen
MultiFac Dir - Pharm Svcs	$194,867	$0	$9,538	$0	$5,877	$0	$12,892	$0	$21,091	$0	$244,265	$0	$0	$0
Greta Morrison
AVP, Admin/CNO - RCH	$161,535	$0	$31,519	$0	$5,165	$0	$10,445	$0	$25,748	$0	$234,412	$0	$0	$0
Frank Canova
Regional CFO	$163,711	$0	$10,500	$0	$16,872	$0	$0	$0	$9,482	$0	$200,565	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Lines 4a-b	FormAndLineReferenceDesc
Explanation	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 $201,459 Eric Deaton $ 66,613 Lynn Krutak $ 64,932 Clay Runnels $ 55,452 Tim Belisle $ 22,233 Joshua McFall $ 18,615 Andrew Wampler $ 18,111 Lisa Carter $ 16,333 Linda White $ 10,176 Lemmie Taylor $ 12,436 The following executive received a change-of-control payment. The payment was reported as taxable income with appropriate tax withheld and remitted to the IRS. Tim Belise $179,601	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	Laura Levine	PersonNm

Field	Value	IRS element (for citing)
Relationship Description	Family Member	RelationshipDescriptionTxt
Transaction	$41,096	TransactionAmt
Transaction	See Part V	TransactionDesc
Sharing Of Revenues	0	SharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part IV, Supplemental Information	FormAndLineReferenceDesc
Explanation	Alan Levine, President and CEO of the Ballad Health/Mountain States Health Alliance Board of Directors, is a family member of Laura Levine, an employee of Mountain States Health Alliance.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (25 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part III, Program Service Accomplishments	Ballad Health (Ballad) is an integrated healthcare delivery system consisting of 21 hospitals in Northeast Tennessee and Southwest Virginia, including a Level 1 Trauma Center, dedicated children's hospital, several community hospitals, three critical access hospitals, a behavioral health hospital, an addiction treatment facility, long-term care facilities, home care and hospice services, retail pharmacies, outpatient services and a comprehensive medical management corporation. Ballad works closely with an active independent medical community and community stakeholders to improve the health and well-being of over one million people in 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky. Ballad is a Tennessee non-profit corporation and is the main provider of healthcare services in Northeast Tennessee and Southwest Virginia. Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). On February 1, 2018, Ballad was formed through a merger of two legacy systems, Mountain States Health Alliance and Wellmont Health System. Ballad was formed under state-action immunity in compliance with federal antitrust law, to create a healthier region and keep healthcare local. The action approving the merger was officially taken through the agreements made between Ballad and the State of Tennessee in the Certificate of Public Advantage (the "COPA") and the Letter Authorizing the Cooperative Agreement (the "CA") in Virginia. Pursuant to the COPA and CA, Ballad must fulfill certain obligations, commitments, and covenants. Tennessee and Virginia, through their respective health departments, supervise specific aspects of Ballad's operations under certain conditions of the COPA and the CA. The COPA and amendments 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 Mountain States Health Alliance (MSHA) includes eight wholly owned hospitals including a tertiary hospital, a children's hospital and a behavioral health hospital; two others, wholly owned by MSHA, each file a separate return. MSHA is sole shareholder of Blue Ridge Medical Management Corporation (BRMMC), a for-profit entity that owns and manages physician practices and real estate and provides other health care services to patients in Tennessee and Virginia. MSHA is the sole member of Integrated Solutions Health Network, LLC (ISHN). ISHN, also included in this Form 990, is a regional health solutions company headquartered in Johnson City, Tennessee. ISHN is an expansive network of providers serving residents of Northeast Tennessee and Southwest Virginia and consists of provider groups, primary care physicians, specialists, and allied health providers. Specific to the hospitals included in this Form 990, services were provided to: 40,689 inpatients 590,225 outpatient visits 177,233 emergency visits 3,373 deliveries 24,120 surgeries 88,765 home health visits
WASHINGTON COUNTY, TN: JOHNSON CITY MEDICAL CENTER (JCMC)	- Located in Johnson City, Tennessee and serving the community since 1911. The 585-bed regional tertiary referral center has 416 beds dedicated to acute care, 85 beds for children and 84-beds for behavioral. - Provides a wide array of acute care services, including a complete range of cardiovascular, neurology, oncology, surgical and rehabilitation services. JCMC is a comprehensive, acute-care teaching hospital affiliated with James H. & Cecile C. Quillen College of Medicine at East Tennessee State University (ETSU). - Region's only Level I trauma center, one of only five in Tennessee, with 24/7 orthopedic traumatologist specialist coverage. - Region's only safety net hospital. - Regional Cancer Center at JCMC has relationships with Harvard, Duke, and Vanderbilt universities. - Quantros named JCMC in the top 10% of hospitals in the nation for patient safety in overall medical care, trauma care, heart attack and heart failure treatment, stroke care, hip fracture treatment and major neurological surgery in its 2023 CareChex awards. JCMC was also recognized among the top 100 hospitals and top 10% of hospitals in the nation for medical excellence in hip fracture care. - U.S. News recognized JCMC as "high performing" for knee replacement procedures, heart attack care and treatment, heart failure care and treatment, and care of stroke patients. - Niswonger Children's Hospital (NsCH) is a hospital within a hospital located on the campus of JCMC. NsCH is the only children's hospital in northeast Tennessee and serves more than 200,000 children in the four state, 29-county region. NsCH has more than 20 pediatric subspecialties providing specialty care through a pediatric emergency room and 85 inpatient beds, including a 16-bed neonatal abstinence syndrome unit. The Level III designated neonatal intensive care unit is only one of five state-designated tertiary centers for high-risk maternal fetal care in Tennessee and is the regional referral center for neonatal patents. A Ronald McDonald House is located on the campus and provides services to the pediatric patients and family members. In October 1999, a clinical affiliation was entered with St. Jude's Children's Research Hospital to provide pediatric cancer and other catastrophic disease treatment services. The affiliation with St. Jude's in one of only eight in the country. The First Regional Hemophilia Program, a state sponsored program for congenital bleeding disorders, is housed in the St. Jude affiliate clinic and provides programs for both children and adults with hemophilia. - Woodridge Hospital, a free-standing 84-bed behavioral health hospital located across the street from JCMC, provides mental health and chemical dependency services for adults, adolescents, and children in Northeast Tennessee and Southwest Virginia. Woodridge is the only dedicated inpatient behavioral health hospital in the region and provides a 24/7 intervention helpline. In 2023, Woodridge opened a new access point for behavioral healthcare with a 24/7 walk-in behavioral crisis clinic for patients experiencing behavioral health emergencies, such as suicidal or homicidal ideation, acute psychosis, auditory and/or visual hallucinations and other extreme mental or emotional crises.
WASHINGTON COUNTY, TN: FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH)	- 80-bed acute care hospital located in Johnson City, Tennessee and providing services since 2010. - Provides specialty and subspecialty care, including general acute medical, maternity, comprehensive diagnostic imaging, emergency services and advanced surgical services, including minimally invasive robotic surgery. - FWCH was the first "Leadership Energy and Environmental Design" (LEED) certified hospital in Tennessee. - U.S. News recognized FWCH as "high-performing" for pulmonary disease care. - Healthgrades recognized FWCH as a Five-Star Recipient for Treatment of Sepsis in 2023.
SULLIVAN COUNTY, TN: INDIAN PATH COMMUNITY HOSPITAL (IPCH)	- 239-bed acute care hospital located in Kingsport, Tennessee serving the community since 1984. - Provides general medical and surgical services, including the Center for Women and Babies, various outpatient services, including advanced services such as the lung nodule clinic, a regional cancer center, and a sleep center. - IPCH opened the third Niswonger Children's Network Pediatric Emergency department in 2023, strengthening the system of care for children by joining Niswonger Children's Hospital in Johnson City and the J.D. Nicewonder Family Pediatric Emergency Department at Bristol Regional Medical Center. - Quantros named IPCH in the top 10% of hospitals in the nation for patient safety in overall surgical care, medical excellence in general surgery, patient safety in gastrointestinal care in its 2023 CareChex awards. IPCH was also named in the top 10% in the State of Tennessee for patient safety in general surgery. - U.S. News recognized IPCH as "high-performing" in pneumonia care in 2023.
CARTER COUNTY, TN: SYCAMORE SHOALS HOSPITAL (SSH)	- 121-bed acute care facility located in Elizabethton, Tennessee providing services to the community since 1955. - Provides inpatient, geropsychiatric, and outpatient care for medical and surgical patients. - Quantros named SSH in the top 10% in the nation for medical excellence in gallbladder removal in its 2023 CareChex awards and in the top 10% of hospitals in the State of Tennessee for gastrointestinal hemorrhage.
JOHNSON COUNTY, TN: JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH)	- Federally designated critical access hospital located in Mountain City, Tennessee serving residents of upper Northeast Tennessee, parts of western North Carolina and Southwest Virginia since 1998. - Provides inpatient, emergency and outpatient care along with cardiac rehabilitation, diagnostic, and physical therapy services.
RUSSELL COUNTY, VA: RUSSELL COUNTY HOSPITAL (RCH)	- 78-bed Medicare dependent hospital located in Lebanon, Virginia. - Included in the 78-bed complement, is a 20-bed inpatient psychiatric unit. RCH offers a full array of primary care services and some specialty services, including a cancer center.
UNICOI COUNTY, TN: UNICOI COUNTY HOSPITAL (UCH)	- 10-bed acute care hospital, located in Erwin, Tennessee and providing services since 2018. - Provides general acute inpatient, emergency, cardiology, diagnostic imaging, sleep lab, and rehabilitation services.
LEE COUNTY, VA: LEE COUNTY COMMUNITY HOSPITAL (LCCH)	- 10-bed critical access hospital located in Pennington Gap, Virginia providing services since 2021 to residents of Southwest Virginia and Southeast Kentucky. - LCCH was specially designed to meet the needs of its community, with acute and emergency services, diagnostic radiology and lab services, outpatient cardiology and additional rotating clinics for specialty care and telehealth access. FOCUSING ON QUALITY
EMPHASIZING ZERO-HARM THROUGH TIERED SAFETY HUDDLES - As part of Ballad	Health's systemwide initiative to improve safety and reduce harm, Ballad Health continued its tiered safety huddle program throughout the pandemic. Each day, frontline team members across the Ballad Health organization begin their morning with huddles focused on clinical quality and safety. These huddles provide an organized manner for team members to express opportunities to improve safety and quality and strive towards becoming a zero-harm institution. Any issues identified during those huddles are elevated to hospital leadership. If hospital leadership needs help to resolve the problem, the issue is further elevated to the market and corporate levels. Using this approach, Ballad Health can improve outcomes and enhance safety by rapidly deploying resources to support and solve safety issues as they arise. LAUNCH OF IBM/WATSON TOP HEALTH SYSTEM JOURNEY - Since the merger in 2018, one of Ballad Health's priorities has been to instill a zero-harm culture and become one of the highest-performing health systems in America for the quality of care it delivers to patients. After a rigorous review of the various systems for measuring that success, Ballad Health leaders chose IBM/Watson because it provided measurable, achievable, and valid guideposts for the health system. To help lead Ballad Health on this journey to become a top health system in the nation, health system leaders formed the IBM/Watson Top 15 Health System Task Force, comprised of stakeholders from multiple departments of Ballad Health. IBM/Watson identifies the 15 top-performing health systems in the nation based on four key performance domains: inpatient outcomes, extended outcomes, operational efficiency, and patient experience. Dr. Amit Vashist, Ballad Health's chief clinical officer, who leads the IBM/Watson top health system journey, stated, "We looked far and wide at various methodologies to identify the most appropriate benchmarks to measure ourselves against, and we ultimately chose IBM/Watson because it included an ideal blend of metrics and measures that are truly meaningful and appealed to our frontline clinicians, such as hospital-acquired conditions, ED throughput, readmissions, mortality, costs of care and length of stay." CLINICAL COUNCIL - A unique feature of Ballad Health is the establishment of a robust and diverse Clinical Council, comprised of about 30 physicians. The physicians were nominated by the leadership of all Ballad Health hospitals, the health system's medical group and independently practicing community physicians. The Council's members also include pharmacists, advanced practice providers and nurses. The Council reports directly to the Quality Committee of the Ballad Health Board of Directors. The council aims to ensure excellence in clinical care through physician engagement and leadership and is charged with guiding Ballad Health's transformation into a community health improvement system. As a result of the council's efforts, several important quality measures are now performing among the top-decile health systems in America. CONTINUED PUBLIC ADVANTAGE Ballad's compliance with each of the COPA and CA is supervised by Tennessee and Virginia respectively. Ballad is in compliance with all terms of the COPA and CA. Each year since the creation of Ballad, the State of Tennessee and Commonwealth of Virginia have independently confirmed the public advantage created by the unification of the hospitals in the rural region. In the latest report dated March 2023, the Tennessee Department of Health highlighted "Over the life of the COPA, improvement was seen in Ballad Health's service area for most of the Access Sub-Index measures. Significant improvements were seen in preventive health measures such as primary care provider and prenatal care in the first trimester. Improvement was also achieved by Ballad Health in all five screening measures, with the most significant improvement occurring in rates of Colorectal Cancer Screenings and Diabetes and Prediabetes Screenings". TDH also recognizes that Ballad Health continued to invest in standing up and implementing many of its Population Health, Behavioral Health, Children's Health, Rural Health, and Health Research and Graduate Medical Education programs proposed under the system's three-year Spending Plans, even as it prioritized its response to COVID-19. In the Tennessee Department of Health report covering the period of July 1, 2021 to June 30, 2022, the department noted that as a combined health system, "Ballad Health's continued handling of the pandemic and the fact that all of Ballad Health's 21 hospitals, including its many vulnerable rural hospitals, remained open through the year are acknowledged by TDH as two of the system's greatest successes during FY22". In each year before the COVID-19 pandemic, Ballad Health also maintained one of the nation's most successful Accountable Care Organizations, which has been highlighted by the Centers for Medicare and Medicaid Services as one of a handful of organizations that have produced savings for taxpayers in each year since the program's creation, while making high-quality scores.
ENVIRONMENTAL, SOCIAL, AND GOVERNANCE (ESG)	Ballad Health is committed to being a responsible and concerned citizen of the communities of the service area where it operates and is driven by its mission: "honor those we serve by delivering the best possible care." Ballad continues to deploy initiatives intended to improve the overall health and well-being of the over one million people living in its service area. ENVIRONMENTAL - Environmental stewardship and preserving the environment is important to Ballad and is demonstrated in the following practices: - Environmentally responsible supply chain - Encourage the recycling of materials and minimization of waste - Encourage the reduction of energy usage - Incorporate environmentally preferable alternatives when designing new construction SOCIAL - Social commitments are an integral part of Ballad's mission, vision, and values. By working and collaborating with others in the communities in which it serves, Ballad works "to build a legacy of superior health by listening to and caring for those we serve". Ballad provides direct and in-kind support to improve access to care and deliver healthy lifestyle services, education, and activities. The community health programs are designed to improve access and quality of care, strengthen community outreach and partnerships, decrease healthcare costs, and assist in the reduction of health care disparities in the region. Ballad has opened two new rural hospitals in the past five years. Ballad offers extensive education and outreach programs throughout the community at little or no cost to participants. Program areas include: - Community events, such as health fairs, screenings, flu shots, health and safety education, support groups, stroke education, baby and child health, and medical libraries - Children's resources, such as the Morning Mile Program, B.E.A.R. Buddies, car seat safety, and Families Thrive. - Heart and Soul, senior health, and well-being programs. - General health resources, individual health, nutrition, and safety education. - Regular health education speakers covering a wide range of topics. The following are some of the programs designed to improve healthcare equity and availability: Ballad as a Community Health Improvement Organization: Ballad's goal is to ensure the sustainability of rural healthcare services while improving the health and well-being of the region as a whole. In the short-term, Ballad will address health related social needs to improve access to care, reduce inequity, and empower individuals to adopt healthy behaviors and manage health conditions. In the long-term, Ballad will address social drivers of health to provide a community level foundation for permanent regional health improvement through multi-sector collective impact. Ballad is taking an intergenerational approach to focus on children's health initiatives to give kids a strong start in life, as well as assisting adults with overcoming obstacles to health and self-sufficiency. Ballad is on a journey to universalize social needs screening and prioritized navigation resources throughout the system using embedded Epic tools combined with the UniteUs referral management platform. These efforts are informed and supported by a multi-departmental team called the Social Needs Council which has accountability to the system Population Health Council, the Chief Population Health Officer, and ultimately the board Population Health and Social Responsibility Committee. STRONG Accountable Care Community: Driving Community Level Action and Change: The STRONG Accountable Care Community is a regional collective impact model focusing on community level strategies across a life course model that includes a multi-generation approach to parenting support and family self-sufficiency. Established in 2018, the STRONG Accountable Care Community (STRONG ACC), sponsored by Ballad, is a 350 organization, multi-sector model serving the same geographic footprint as Ballad and additional contiguous counties. The STRONG ACC has adopted the "Five Conditions of Collective Impact": a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support. Ballad is providing backbone support and investing in the STRONG ACC because the health system believes the collective impact model is necessary to accelerate, leverage, and sustain community level change. The STRONG ACC is also using the UniteUs platform for a "no wrong door" approach to social needs across hundreds of networked organizations. The organization is also creating an Early Care and Education Plan for all of Northeast Tennessee and Southwest Virginia. For more information, visit https://www.strongacc.org/. Accountable Health Communities ("AHC"): When Ballad was awarded the Accountable Health Communities grant from the Centers for Medicare and Medicaid Services in 2017, the system acted on its vision to universalize social needs screening and navigation. Health related social needs create major barriers to health for some individuals. Within Ballad Health, Unite Tennessee and Unite Virginia will allow specially trained staff to conduct health-related social needs screenings for gaps in care, such as food and housing insecurity, transportation challenges or other obstacles. It will then connect those families with community organizations committed to resolving those issues. The network, however, is not dependent on Ballad Health. Participating organizations will also be able to refer clients to each other even if the people they're referring aren't Ballad Health patients. Since its inception, the program has screened 319,349 individuals and identified 50,000 distinct needs, working with nearly 2,000 regional organizations to successfully connect individuals to services which provide food, housing, transportation, safety support, and utilities among other needs. AHC has provided 29,681 community referrals and navigation for 7,573 patients. The program has revealed new information about the extent of social needs within Ballad's patient environment and informed the goal to scale social needs screening and navigation services throughout the organization. Appalachian Highlands Care Network: Appalachian Highlands Care Network, started in 2020, is Ballad's program to serve low-income, uninsured people of the region through a realignment of charity care dollars. The goals of the Appalachian Highlands Care Network are to identify low-income uninsured people, enroll them in the program, and serve them to improve quality of care, increase access to care, and reduce avoidable cost of care. Patients in the program receive free needed medical care from Ballad and a network of other providers. This includes ensuring all patients have a source of primary care and are screened and navigated to social need resources, provided with medical care coordination, and assisted through care management services. Ballad partners significantly with Appalachian Mountain Project Access, the region's free and reduced cost clinics and health departments, and hundreds of regional social support agencies to break down barriers to medical care, improve chronic conditions like diabetes, and address social needs. To date, the program has enrolled more than 4,800 individuals.
STRONG Starts: Ballad believes safe, stable, nurturing environments	for children are essential to optimal early development and later success in life. Started in 2021, STRONG Starts is aimed at improving birth outcomes and reducing the negative impact of chronic stress for mothers, babies and families. The birth of a new baby is a pivotal time for a mother and her family. No one should feel alone or unsupported during this time. Ballad seeks to connect with every expectant mother as early in her pregnancy as possible to ensure access to early prenatal care - all in partnership with the region's obstetric providers. As the life situation and pregnancy experience for every woman is different, Ballad will build supportive relationships aligned with the unique circumstances of every woman and family. With embedded staff in the region's obstetric practices and hospital birthing centers, these relationships begin early. Staff will help families connect with community resources for issues from food/housing insecurity to parenting resources to education/job training. To date, the program has screened more than 7,300 women and served nearly 3,000 through the course of their pregnancies. The program continues into the post-natal and early stage of life. Ballad staff assist those in the program through kindergarten entry with a whole-family approach. This ongoing relationship will help with evolving needs and the transition in healthcare from the obstetric environment to the pediatric environment. Ballad works with regional pediatricians to ensure they can refer children and families into the program. The developmental milestones of children will be assessed so early supports can be provided, and Ballad assist with connections to community resources as children grow, including programs which support resiliency and early learning environments. Ballad seeks to further support the safety, stability, and self-sufficiency of families and to help ensure children enter kindergarten developmentally, socially, and emotionally ready to learn. This first experience with the educational system is foundational, as it sets the tone for later success with grade level reading, math proficiency, and the academic discipline needed to ensure high school graduation and college and career readiness. These benchmarks are predictors of later economic and health outcomes which can reshape the life trajectory, health, and well-being for children and families for generations to come. To date, this section of the program has served more than 2,000 families. In addition to these programs, Ballad invests significant funding annually to support partnering organizations, Community Health Improvement Sites, who provide aligned services and mutually serve the populations mentioned above. These services include free health services, care coordination, housing supports, substance use and recovery, social needs support, maternal/child supports, early learning and literacy improvement initiatives, and women's health services. Ballad also provides a host of other services to vulnerable populations including free cancer screenings, mobile health services, health fairs, children's resources, and health education programs notably through a network of faith community nurses.
Governance	Governance is overseen by the Ballad Board of Directors and ongoing ESG work through the following committees: - Audit and Compliance - environmental and sustainability performance - Community Benefit & Population Health - social and community goals and performance - Executive Compensation - human capital; diversity, equity, and inclusion; and pay equity goals and performance - Governance - governance goals and performance - Quality - equity of care, patient safety and quality of care goals and performance Ballad has a conflict-of-interest policy and plans to align reporting with the Sustainability Accounting Standards Board's topics for disclosure and other reporting frameworks in the coming years. Ballad has leader diversity with 30% of CEOs being females and 33% of Executive Vice Presidents being females. CHARITABLE CONTRIBUTIONS - From its inception in February of 2018, Ballad Health made significant contributions to the community it serves totaling over $30 million to date in direct contributions and other community health improvement initiatives. A few examples include: Support for Speedway Children's Charities, aid to Feeding Southwest Virginia, provision of new EKG equipment to regional emergency medical services, and investments in regional programs for schoolchildren. IMPROVING ACCESS TO HEALTHCARE SERVICES RE-IMAGINE RURAL HEALTHCARE - Our region has a variety of health, economic and other issues that, when combined, present a unique and challenging environment for healthcare access and outcomes. These unique challenges were reaffirmed in a 2017 report issued by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthier Kentucky (Health Disparities in Appalachia), which found that the health outcomes in the greater Appalachian region are worse than those experienced in the United States as a whole in 7 of the 10 leading causes of death: heart disease, cancer, chronic obstructive pulmonary disease (COPD), injury, stroke, diabetes and suicide. The region also faces economic challenges, with performance on incomes, poverty rates, unemployment rates and postsecondary education lagging the national level. This is relevant because, as the study notes, socioeconomic and health outcomes are often interrelated, if not interdependent. Since 2010, more than 151 rural hospitals have closed in the United States, according to the North Carolina Rural Health Research Program. Compared to other states, Tennessee ranks amongst the worst in the nation, with 15 rural hospital closures since 2005. In the region served by Ballad Health, however, it is a different story. Every community in the region with a hospital prior to the merger creating Ballad Health continues to be served by a hospital. In fact, in the middle of the pandemic, Ballad Health opened the country's newest rural hospital. In July 2021, Ballad Health followed through on its promise to the residents of Lee County, Virginia, and reopened Lee County Community Hospital in Pennington Gap. CREATED SINGLE COORDINATED REGIONAL TRAUMA SYSTEM - A critical success factor of the COPA and CA is avoidance of duplication of hospital resources. Ballad Health consolidated two Level I trauma centers operating within 25 miles of each other and subsequently created a coordinated regional trauma system. In approving this move in advance of the merger, the State of Tennessee relied upon the evidence published in multiple respected studies which found higher volume trauma centers lead to improved outcomes. The move toward a single coordinated trauma system followed the guidance of the American College of Surgeons (ACS), which verifies trauma centers. The Tennessee Department of Health, after conducting a rigorous review of the trauma program at Johnson City Medical Center, issued its Level I Trauma Center Reverification Site Visit Report. The report found the hospital "has demonstrated an outstanding commitment to care for the injured patient." Further, the survey resulted in zero deficiencies, a first for trauma care in the region. CONSOLIDATED REGIONAL PERINATAL CENTER - Tennessee law requires a regionalized system of care for high-risk newborns. As a result of this law, Tennessee recognizes five regional perinatal centers. Niswonger Children's Hospital at Johnson City Medical Center is the designated center for regional perinatal care for the Appalachian Highlands. Prior to the merger, two neonatal intensive care units (NICUs) existed and were not coordinated. After the merger, Ballad Health immediately took steps to consolidate the NICUs to achieve a more sustainable and coordinated system of care for neonates, while also reducing the costs associated with maintaining two lower-volume units. After this consolidation, Ballad Health partnered with ETSU's Quillen College of Medicine to provide ongoing expert neonatology coverage for the hospital 24 hours per day. As a result of the merger and NICU consolidation, every newborn in the region has access to more than 25 pediatric specialists at the regional Perinatal Center. EXPANDED ACCESS TO PEDIATRIC SPECIALTIES - With financial support from Ballad Health and the State of Tennessee, the ETSU Quillen College of Medicine was able to successfully recruit pediatric surgeons to support Niswonger Children's Hospital. Our partners at ETSU's Quillen College of Medicine also provide 24/7 neonatology coverage for the NICU. Ballad Health now proudly meets the highest standards for regional perinatal care, something that was not thought possible prior to the merger creating Ballad Health. PARTNERSHIP WITH ETSU TO CREATE FELLOWSHIP PROGRAM IN ADDICTION MEDICINE - Ballad Health and East Tennessee State University formed a partnership to create a new fellowship program in addiction medicine. As part of its commitment to expand education and training in the region, Ballad Health will fund any unreimbursed costs of the fellowship program which, over a 10-year period, could cost more than $2.5 million. ESTABLISHMENT OF CENTER FOR RURAL HEALTH RESEARCH - Tennessee Governor Bill Lee announced the creation of a new Center for Rural Health Research that will be housed at the College of Public Health at East Tennessee State University. In addition to state funding, Ballad Health has committed to contributing more than $15 million during the next 10 years to the Center. The goal of the Center will be to work with Ballad Health, local healthcare delivery partners, national experts and the leadership of ETSU Health to identify new mechanisms to improve health in rural and nonurban communities. Specific emphasis will be placed on strategies that disrupt inter-generational cycles of behaviors that contribute to poor health outcomes, which ultimately can affect college and career-readiness. RECRUITMENT OF NEW PHYSICIANS TO THE APPALACHIAN HIGHLANDS - Ballad Health provided the necessary resources to recruit new specialists to serve our region, many of whom were recruited to private practices not owned by Ballad Health. The addition of specialists is helping to improve access to care in rural communities. For instance, Wise County, Virginia now benefits from an orthopedist, a cardiologist and several other physicians and providers. Wythe County, Virginia, a community not served by a Ballad Health hospital, benefits from a cardiologist recruited by Ballad Health. Throughout the region, new physicians and advanced practitioners, recruited and funded by Ballad Health, are serving the region - from trauma care to pediatrics, from Wythe County, Virginia to Hancock County, Tennessee.
OTHER NOTABLE EVENTS AND AWARDS	- Ballad has invested significantly across the region specifically in academic and community institutions that serve the people in the service area. Examples of this investment are shown through the continuum of service from the offering of observation opportunities to students of all ages within our clinical facilities, to providing experts to lecture to school children on a broad variety of healthcare topics. The commitment to giving back extends to direct investment in regional educational partners. Some key examples of this include the Appalachian Highlands Center for Nursing Advancement, The Center for Rural Health Research, the STRONG BRAIN Institute, and the Gatton College of Pharmacy Center for Pharmacy, Education, Outreach, and Advocacy. The work of these centers at ETSU focuses on some of the leading issues facing the service area, from the development and support of the next evolution of nursing as a profession, to understanding the unique challenges facing our public health, to the scourge of adverse childhood experiences, to access and intervention at the community pharmacy, Ballad is committed to understanding and addressing the significant issues facing the service area. - Ballad is also engaged in funding the development of new and expanded healthcare training programs across the region. Ballad has granted support of programs in Nursing and Allied Health. From a new BSN program in Southwest Virginia at Emory & Henry College, to a new program in Ultrasonography at Southwest Virginia Community College, we are supporting programs large and small. We have expanded the Medical-legal partnership we have in the Appalachian Highlands to include all of the Ballad facilities as well as many of the outpatient clinics. This one-of-a-kind program partners Ballad with Virginia Tech and the Appalachian School of Law together to address the challenges of access to social supports for the poorest members of the service area. Ballad is a sponsor of a residency in Advanced Education Graduate Dentistry in Southwest Virginia. The endemic problem of poor oral hygiene across service area accounts for loss of economic opportunity, loss of self-esteem, and profound impacts on the health of individuals suffering from missing or diseased teeth. - Ballad's research department serves as the central office for multi-specialty research oversight in the System. In addition to providing full spectrum support for studies generated and managed by the research department, the department provides oversight for studies generated by external groups. The research department has participated in several large-scale, multi-center trials with subject retention at nearly 100%. Oversight services include administrative, legal, regulatory support, internal service arrangement and financial management. Ballad is a world leader in cardiovascular clinical trials. - Received its Accreditation/Department of Distinction from the International Association for Healthcare Security & Safety (IAHSS) - Recognized by Harvard University and UnitedHealthcare as one of four healthcare organizations leading the way towards a 3D model for value-based care - Earned the College of Healthcare Information Management Executives (CHIME) Digital Health Most Wired. - After the creation of a regional and coordinated system of trauma care nearly two years prior, in July 2021, a Tennessee Department of Health survey concluded the trauma program serving the Appalachian Highlands provides "outstanding commitment to care for the injured patient and found zero deficiencies at the Level I Trauma Center at Johnson City Medical Center, a first for trauma care in the region. As a result of the regional and coordinated system of trauma care, Ballad decreased mortality by 40% and reduced the cost of care by approximately $3 million.
Part IV, Line 24a and Part X, Line 20 - Tax Exempt Bonds	The tax exempt bond liability reflects the portion of bonds issued by Ballad Health, MSHA's parent organization, on behalf of MSHA for capital needs. MSHA pays all costs related to this portion of the bond issue.
Form 990, Part V, line 1a	For CY22 Ballad Health (BH), MSHA's parent organization, filed Form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. MSHA reimburses BH for all expenses related to vendor payments and the expenses are recorded on MSHA's books.
Form 990, Part VI, Section A, line 6	Line 6 explanation - Mountain States Health Alliance is a Tennessee non-stock, nonprofit organization with Ballad Health as its sole member.
Form 990, Part VI, Section A, line 7a	Line 7a explanation - Ballad Health has the authority to appoint Mountain States Health Alliance board members. The President and CEO of Ballad Health serves as the President and CEO for Mountain States Health Alliance.
Form 990, Part VI, Section A, line 7b	Line 7b explanation - Decisions of the Mountain States Health Alliance Board of Directors are subject to approval by the Ballad Health Board of Directors.
Form 990, Part VI, Section B, line 11b	Line 11b Explanation - 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 37,679,543. Fundraising expenses 0. Total expenses 37,679,543. Consulting Fees: Program service expenses 5,882. Management and general expenses 1,787,980. Fundraising expenses 0. Total expenses 1,793,862. Contract Labor: Program service expenses 44,652,683. Management and general expenses 7,696,241. Fundraising expenses 0. Total expenses 52,348,924. Dietary Services: Program service expenses 12,323,466. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,323,466. Environmental Services: Program service expenses 9,958,887. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,958,887. Hospital Supported Clinics: Program service expenses 62,298,215. Management and general expenses 0. Fundraising expenses 0. Total expenses 62,298,215. Laboratory Services: Program service expenses 5,669,136. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,669,136. Laundry Services: Program service expenses 3,141,895. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,141,895. Other: Program service expenses 10,352,177. Management and general expenses 6,017,975. Fundraising expenses 0. Total expenses 16,370,152. Physician Fees: Program service expenses 38,185,959. Management and general expenses 0. Fundraising expenses 0. Total expenses 38,185,959.
Form 990, Part XI, line 9:	Temporarily Restricted Grants -47,523. Intercompany Transfers -9,979,771.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Integrated Solutions Health Network LLC
509 Med Tech Parkway Suite 100	Johnson City	TN	37604	621711997	Health Network	TN	$3,665,665	$375,655	MSHA
AnewCare Collaborative LLC
509 Med Tech Parkway Suite 100	Johnson City	TN	37604	453232366	Accountable Care Organization	TN	$111	$101,672	ISHN

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
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		0	N/A
Ballad Health Center for Early Learning
400 N State of Franklin Road	Johnson City	TN	37604	923891827	Child Day Care Services	TN	501C3	Line_10_Organization	BALLAD HEALTH	0
Ballad Health Foundation
1019 West Oakland Ave Suite 2	Johnson City	TN	37604	581594191	Fundraiser	TN	501C3	Line_7_Organization_	BALLAD HEALTH	0
Dickenson Community Hospital
312 Hospital Drive	Clintwood	VA	24228	770599553	Hospital	VA	501C3	Line_3_Hospital_Coop	WHS	0
East TN Healthcare Holdings Inc
203 Gray Commons Circle	Gray	TN	37615	815475903	Opioid Treatment	TN	501C3	Line_3_Hospital_Coop	MSHA	Yes (1)
Johnston Memorial Hospital
16000 Johnston Memorial Drive	Abingdon	VA	24211	540544705	Hospital	VA	501C3	Line_3_Hospital_Coop	MSHA	Yes (1)
MSHA Auxiliary
400 N State of Franklin Road	Johnson City	TN	37604	581418345	Supporting Organization	TN	501C3	12a	MSHA	Yes (1)
Smyth County Community Hospital
245 Medical Park Drive	Marion	VA	24354	540794913	Hospital	VA	501C3	Line_3_Hospital_Coop	MSHA	Yes (1)
Takoma Regional Hospital Inc DBA GCH
1420 Tusculum Boulevard	Greeneville	TN	37745	510603966	Hospital	TN	501C3	Line_3_Hospital_Coop	WHS	0
Wellmont Cardiology Services
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	263557623	Medical Services	TN	501C3	Line_10_Organization	WHS	0
Wellmont Hawkins Co Memorial Hosp Inc
851 Locust Street	Rogersville	TN	37857	621816368	Hospital	TN	501C3	Line_3_Hospital_Coop	WHS	0
Wellmont Health System
303 Med Tech Parkway Suite 300	Johnson City	TN	37604	621636465	Hospital System	TN	501C3	Line_3_Hospital_Coop	BALLAD HEALTH	0
Wellmont Imaging Services Inc
400 N State of Franklin Road	Johnson City	TN	37604	861103148	Healthcare	TN	501C3	12a	WHS	0
Wellmont Madison House
2000 Greenway Street	Kingsport	TN	37660	621308216	Assisted Living	TN	501C3	Line_10_Organization	WHS	0
Wellmont Medical Associates
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	270898372	Medical Services	TN	501C3	Line_7_Organization_	WHS	0
Wellmont Wexford House
2421 N John B Dennis Hwy	Kingsport	TN	37660	581859039	Nursing Home	TN	501C3	Line_10_Organization	WHS	0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct
Emmaus Community Healthcare PLLC
6419 Bristol Hwy	Piney Flats	TN	37686	200577483	Medical Services	TN	N/A	0	0
Medical Specialists of JC LLC
2528 Wesley St Ste 2	Johnson City	TN	37601	272199037	Medical Services	TN		0	0	MSHA	Excluded	-$52,449	$213,535	0.51000
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

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (14 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	CountryForeignAddress/CountryCd	Foreign PostalForeignAddress/ForeignPostalCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
Ballad Health Development Corporation
400 N State of Franklin Rd	Johnson City	TN	37604	883118592	Investments	TN	N/A	C	0
Ballad Ventures LLC
400 N State of Franklin Rd	Johnson City	TN	37604	844214681	Investments	TN	N/A	C	0
Blue Ridge Medical Management Corp
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	621490616	Medical Services	TN		C	0	MSHA	$130,822,830	$222,578,705	1.00000
Community Home Care Inc
1490 Park Avenue NW Suite B	Norton	VA	24273	541453810	Durable Medical Equipment	VA	N/A	C	0
Mediserve Medical Equipment
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	621212286	DME	TN		C	0	BRMMC	$2,393,682	$5,246,943	1.00000
Mountain States Physician Grp
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	621700412	Medical Services	TN		C	0	BRMMC	$48,476,560	$3,834,249	1.00000
Mountain States Properties
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	621845895	Property Management	TN		C	0	BRMMC	$13,098,551	$125,501,757	1.00000
Nolichuckey Mgmt Svcs Inc
1420 Tusculum Blvd	Greeneville	TN	37745	621776681	Medical Services	TN	N/A	C	0
Wellmont Health Services Inc
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	621254373	Medical Services	TN	N/A	C	0
Wellmont Insurance Co SPC LTD
				981195624	Insurance		N/A	C	0					PO Box 30600	Grand Cayman	CJ	KY1-1203	CJ
Wellmont Physician Services Inc
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	621567353	Medical Services	TN	N/A	C	0
Wellmont Inc
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	621320035	Medical Services	TN	N/A	C	0
Wilson Pharmacy Inc
PO Box 5289	Johnson City	TN	37604	620329587	Pharmacy	TN		C	0	BRMMC	$4,489,436	$7,887,170	1.00000
WPS Providers Inc
303 Med Tech Parkway Ste 220B	Johnson City	TN	37604	205564642	Medical Services	TN	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	Yes (1)	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (23 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Wilson Pharmacy Inc
A	$46,252	FMV
Blue Ridge Medical Management Corp
A	$467,025	FMV
Mountain States Properties
K	$588,424	FMV
Mediserve Medical Equipment
K	$15,960	FMV
Johnston Memorial Hospital
K	$42,606	FMV
Abingdon Physician Partners
L	$43,357	Cost
Blue Ridge Medical Management Corp
L	$281,279	FMV
Blue Ridge Medical Management Corp
M	$98,267	FMV
Abingdon Physician Partners
O	$136,679	Cost
Johnston Memorial Hospital
O	$13,508	Cost
Mountain States Properties
P	$4,260	Cost
Johnston Memorial Hospital
P	$141,378	Cost
Abingdon Physician Partners
P	$1,134	Cost
Wilson Pharmacy Inc
P	$9,161	Cost
Johnston Memorial Hospital
Q	$720,017	Cost
East Tennessee Healthcare Holdings
Q	$530	Cash
Blue Ridge Medical Management Corp
Q	$10,754	Cost
Mediserve Medical Equipment
Q	$820	Cost
Smyth County Community Hospital
Q	$127,360	Cash
Wilson Pharmacy Inc
Q	$840	Cost
Blue Ridge Medical Management Corp
R	$54,037,369	Cash
Abingdon Physician Partners
R	$305,668	Cash
Smyth County Community Hospital
R	$1,034	Cash