2023-05-11T17:25:48-05:00 2022-06-30 990 2021-07-01 621636465 Wellmont Health System WELL 4233023374 311 Princeton Road Suite 1 Johnson City TN 376012080 Lynn Krutak BH EVP & CFO 4233023374 2023-05-11 Lynn Krutak 999009999 P03077501 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X Alan Levine BH PresCEO 303 Med Tech Prkwy Johnson City TN 37604 846872227 0 X balladhealth.org X 1996 TN Honor those we serve by delivering the best possible care. 4 0 5174 159 217702 0 8254754 5636854 787243254 830486020 1174093 1497464 10833509 7903429 807505610 845523767 11054278 2977668 0 0 252155586 284584999 0 0 0 452308787 510261667 715518651 797824334 91986959 47699433 476937664 438048848 283552967 206999216 193384697 231049632 X Honor those we serve by delivering the best possible care.Ballad Health is dedicated to improving the health of the 29-county Appalachian Highlands region. 0 0 663833257 2977668 833874923 See Schedule O 663833257 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 386 0 1 5174 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 TN VA X Lynn Krutak 4233023374 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Alan Levine BH PresCEO Director 1.00 64.00 X X 0 4083029 240343 Marvin Eichorn BH EVPCAO Director 1.00 64.00 X X 0 1154466 43904 Tim Belisle BH EVPGen Cnsl Director 1.00 64.00 X X 0 670583 87406 Eric Deaton BH EVPCOO Director 1.00 64.00 X X 0 1021443 104184 Lynn Krutak BH EVP/CFO 1.00 64.00 X 0 956968 104263 Stephen Sawyer CFO NW Region 24.00 21.00 X 0 264736 38251 Robert Bender CFO NE Mkt 36.00 9.00 X 323525 0 40452 Rebecca Beck VP/COO HVMC 45.00 0.00 X 314562 0 36825 Theresa Trivette VP/Pt Care Svcs HVMC 45.00 0.00 X 177637 0 19309 Bobbie Murphy VP/Pt Care Svcs BRMC 45.00 0.00 X 238961 0 25023 Linda White end 61822 VP/Pres NW Mkt 39.00 5.00 X 546749 0 60387 Chris Miller VP/COO BRMC 45.00 0.00 X 261481 0 31580 Andrew Wampler end 121721 BH VP/Oper Excellence 44.00 0.00 X 439652 0 22613 Chad Couch Pres/CEO NE Mkt 44.00 0.00 X 543542 0 43284 Robert Kennedy AVP/COO Wise County 22.00 23.00 X 0 246988 30117 Dale Clark Interim VP/CEO Wise Cnty 22.00 23.00 X 0 324658 26898 Shannon Showalter VP/CEO Wise County 24.00 21.00 X 0 188139 12476 David Pryputniewicz MD Staff Physician 40.00 0.00 X 757214 0 33593 James Price MD Staff Physician 40.00 0.00 X 612333 0 41837 Elizabeth Jackson MD Staff Physician 39.00 0.00 X 585113 0 31875 Raj Vishal Staff Physician 40.00 0.00 X 484024 0 35331 Jon Taveau MD Staff Physician 40.00 0.00 X 914232 0 32093 Mark Leonard VP end 1020 Former CEO Wise County 0.00 0.00 X 0 152254 10915 Lisa Smithgall Former Key Employee/CNE 0.00 55.00 X 0 538248 72060 6199025 9601512 1225019 237 1 1 0 Bristol Anesthesia Services PC PO Box 7 Bristol TN 37621 Anesthesiology Svcs 4532640 East Tennessee State University PO Box 70732 Johnson City TN 37614 Med Supp/Gen Acad Svcs 2332582 AYA Healthcare Inc Department 3519 PO Box 123519 Dallas TX 753123519 Healthcare Staffing Svcs 2056916 Medical Solutions LLC 1010 N 102nd Street Suite 300 Omaha NE 68114 Healthcare Staffing Svcs 1872745 Trustaff Travel Nurses LLC PO Box 63-8231 Cincinnati OH 452638231 Healthcare Staffing Svcs 1778369 55 451979 5154387 30488 5636854 Patient Revenue 622110 815314836 815314836 CARES Act Revenue 900099 13561428 13561428 Wellness Program Revenue 900099 1608819 1608819 Lab Outreach Income 621500 14026 14026 Rent to Exempt Affiliates 621511 -13089 -13089 830486020 687899 378383 309516 689 689 3512808 1337861 2174947 2174947 15990 2158957 203678 615797 0 10599 203678 605198 808876 605198 187686 15992 Cafeteria/Vending 722514 2680089 2680089 Support Services 900099 2419348 2419348 Trauma Center Funding 900099 218079 218079 410966 410966 5728482 845523767 833874923 217702 5794288 X 2977668 2977668 3222586 361271 2861315 231376708 186269586 45107122 6421076 5138512 1282564 29059419 18102437 10956982 14505210 13378189 1127021 356190 238 355952 34759 26841 7918 214269247 167459848 46809399 422880 12429 410451 5747447 5359892 387555 11537090 9073152 2463938 12239582 11928668 310914 529080 472228 56852 5249604 4969704 279900 31404686 30331257 1073429 2323944 2216121 107823 Medical Supplies 180948045 180948045 Maintenance 19243175 19037974 205201 Support Services 18284449 18284449 Dues & Subscriptions 1805687 1206394 599293 5865802 4562803 1302999 797824334 663833257 133991077 0 309109 59457 1287378 135157 94462169 88104399 8143835 8006167 14757439 15258839 12740235 10607180 939288938 677046655 278526848 262242283 37626739 37626739 30371290 14721249 476937664 438048848 91475867 80351432 425 82834655 77303607 6560843 6282332 102681177 43061845 283552967 206999216 X 193375705 231002142 8992 47490 193384697 231049632 476937664 438048848 X 47699433 -1175297 -8859201 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 1 58486 0 0 0 58486 0 Part II-B, Line 1: Wellmont Health System had lobbying expenses of $58,486 which represents the portion of dues paid to various organizations, including Tennessee Hospital Association and Virginia Hospital and Healthcare Association, attributable to direct lobbying. 107181 16130483 16237664 539033474 364394254 174639220 8774940 4293176 4481764 345770478 292250807 53519671 29472382 16108418 13363964 262242283 Due to 3rd Party Payors 793063 Due to Payor Medicare Adv Pmts ST 22777182 Due to Payor Stimulus Reserve 86032 Defined Pension Payable LT 7898466 Operating Lease Obligation ST 3077789 Operating Lease Obligation LT 5874718 Other Reserves 2554595 43061845 X Part X, Line 2: Wellmont Health System is included in the audited consolidated financial statements of Ballad Health. The footnote explanation relative to income taxes reads: "Ballad is classified as an organization exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. As such, no provision for federal income taxes is included in the accompanying consolidated financial statements. Taxable subsidiaries are discussed in Note K. No significant uncertain tax positions exist at June 30, 2022 and 2021. Tax returns for 2019 through 2021 are subject to examination by the Internal Revenue Service." 1 1 X 1 X 225.000000000000 1 X 450.000000000000 1 1 0 1 1 7397665 0 7397665 0.00930 107982313 84309172 23673141 0.02970 0 0 0.00000 115379978 84309172 31070806 0.03900 3336580 87811 3248769 0.00410 16864313 7777466 9086847 0.01140 14486170 10334842 4151328 0.00520 914130 37352 876778 0.00110 2202324 0 2202324 0.00280 37803517 18237471 19566046 0.02460 153183495 102546643 50636852 0.06360 5000 0 5000 0.00000 38000 0 38000 0.00000 36250 0 36250 0.00000 1000 0 1000 0.00000 511867 0 511867 0.00060 592117 592117 0.00060 1 17721390 6556914 171510250 161146821 10363429 X 1 1 1 Rehabilitation Hospital of Bristol LLC Medical Services 0.25000 6 1 Holston Valley Medical Center 130 W Ravine Road Kingsport TN 37660 balladhealth.org 0000000133 X X X X A 2 Bristol Regional Medical Center 1 Medical Park Boulevard Bristol TN 37620 balladhealth.org 0000000131 X X X X Mental Health A 3 Lonesome Pine Hospital 1990 Holston Avenue Big Stone Gap VA 24219 balladhealth.org H 1915 X X X X A 4 Norton Community Hospital 100 15th Street NW Norton VA 24273 balladhealth.org H 1879 X X X X A 5 Hancock County Hospital 1519 Main Street Sneedville TN 37869 balladhealth.org 0000000165 X X A 6 Mountain View Regional Hospital 310 3rd Street NE Norton VA 24273 balladhealth.org H 1930 X A Facility Reporting Group - A 0 0 1 X X X X X X X X X X 21 1 1 0 1 X balladhealth.org/locations#hospitals X 1 22 0 1 0 1 X 225.000000000000 450.000000000000 X X X X X 1 1 X X X X 1 X balladhealth.org X balladhealth.org X balladhealth.org X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Holston Valley Medical Center, - Facility 2: Bristol Regional Medical Center, - Facility 3: Lonesome Pine Hospital, - Facility 4: Norton Community Hospital, - Facility 5: Hancock County Hospital, - Facility 6: Mountain View Regional 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 the community. Ballad Health hospitals, including WHS hospitals, conducted their fifth CHNA last year 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 Sullivan County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Sullivan County. For Bristol Regional Medical Center and Holston Valley Medical Center, the three priority areas for future improvement efforts that were selected by key stakeholders in Sullivan County, TN are substance abuse, Adverse Childhood Experiences (ACEs), and housing. Analysis of secondary data for Hancock County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Hancock County. For Hancock County Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Hancock County, TN are education, mental health, and Adverse Childhood Experiences (ACEs).Analysis of secondary data for Wise County, VA, findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Wise County. For Lonesome Pine Hospital, Mountain View Regional Hospital and Norton Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Wise County are substance abuse, chronic disease, and access to care. 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 Bristol Regional Medical Center and Holston Valley Medical Center, 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 Hancock County Hospital there were seven focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Hancock 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 Lonesome Pine Hospital, Mountain View Regional Hospital and Norton Community Hospital, there were fifteen focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Wise County, 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 assessment 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 plan that was completed fall 2021. Facility Reporting Group - A Part V, Section B, line 6a: Each hospital within Ballad Health completed a CHNA. WHS's CHNA was conducted with all Ballad Health hospitals at that time to include: Bristol Regional Medical Center, Hancock County Hospital, Hawkins County Memorial Hospital, Greeneville Community Hospital, Holston Valley Medical Center, Johnson City Medical Center (includes Niswonger Children's Hospital and Woodridge Hospital), Franklin Woods Community Hospital, Indian Path Community Hospital, Lonesome Pine Hospital (including Mountain View campus), Johnson County Community Hospital, Johnston Memorial Hospital, Norton Community Hospital, Dickenson Community Hospital, Russell County Hospital, Smyth County Community Hospital, Sycamore Shoals Hospital, and Unicoi County Hospital. Facility Reporting Group - A Part V, Section B, line 11: During the year, WHS focused on its CHNA priorities as identified in its FY21 CHNA report. WHS's primary areas of focus included: substance abuse, Adverse Childhood Experiences (ACEs), and housing. 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 WHS hospital's CHNA. WHS continued its practice of providing medications and supplies to area rescue squads this year. Facility Reporting Group - A Part V, Section B, line 13h: Ballad Health's financial assistance policy allows for some exceptions to strictly adhering to federal poverty guidelines when awarding financial assistance. Unique circumstances may be weighed and assessed for financial assistance consideration on a case-by-case basis. Also, there are some services where financial assistance may be provided outside of federal poverty guidelines. These are noted in the Ballad Health's financial assistance policy. Part I, Line 3c: Financial assistance approval can apply to an assortment of patients such as those who have exhausted their Medicaid/Tenncare benefits, those who qualified for Medicaid/TennCare after the date of service, deceased patients with no estate or assets, uninsured patients, and underinsured patients. While Ballad Health's qualifications for financial assistance is based on federal poverty guidelines, asset values may also be used to determine 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 (charity care) cost. WHS's cost accounting system was used to determine losses from Tenncare and Medicaid reported on line 7b. Line 7e community health improvement includes costs that are taken directly from departmental operating reports or expenses specific to a community health event, with no additional overhead included in the cost. Line 7f health professions education is comprised of internships (primarily internal medicine residents, nursing, pharmacy, and therapy students) with schools and universities, allowing their health profession students to receive hands-on training in a hospital setting. WHS's Medicare-approved programs include medical residents, pharmacy and pastoral care. For these programs, Medicare-approved costs and Medicare reimbursement comes from filed Medicare cost reports. The Ballad Health Organizational Development Department (OD) maintains records for the non-Medicare programs. Only labor costs are included for WHS team members that provide training (no overhead is applied) and only a percentage of team members' time is attributed to actual training. For line 7g subsidized health care services, WHS's cost accounting system is used because WHS has established, standard costing reports for these services. There is an exception where WHS does not use the cost accounting system. The exception relates to low-dose CT scans for lung cancer. Patient charges for this screening were written-off as an administrative adjustment (not as charity). The cost to charge ratio was used to determine the cost of the free scans. WHS is careful to ensure no double counting of cost. Although there are other service lines within WHS hospitals that lose money, WHS does not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7h research represents WHS's expense allocation from Ballad Health for research. Line 7i cash and in-kind contributions includes cash disbursements and in-kind donations of medications to local nonprofit rescue squads and fire departments. In-kind donations of medications are based on actual cost for these items. Part II, Community Building Activities: WHS leaders support and encourage all team members to volunteer time, money and skills to community service projects and charitable organizations. Senior leaders and board members set a positive example for WHS team members, serving voluntarily on committees and boards of local service and nonprofit organizations. Some also serve as members and consultants on professional committees and task forces that affect regional development in healthcare and education. WHS does not capture costs associated with team members that serve on other nonprofit boards or provide services to other nonprofits.WHS, in collaboration with area health agencies and providers, 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.Line 1 - Physical Improvements and HousingNorton Community Hospital provided support totaling $5,000 to the Southwest Regional Recreation Authority to build an indoor/outdoor playground in the community. Line 2 - Economic DevelopmentBallad Health provided program support to the following organizations: - Downtown Kingsport Association $5,000 Economic development - ETSU Foundation $25,000 Noland Family First scholarship program for low-income individuals - University of Virginia College at Wise Fnd $8,000 Economic forum Line 3 - Community SupportBristol Regional Medical Center provided program support - YWCA of NETN/SWVA $5,000 2022 Tribute to Women Holston Valley Medical Center provided program support to the following organization: - Kingsport Chamber Foundation $1,250 Tri-Cities JuneTeenth Silver Ballad Health provided program support to the following organizations: - Appalachian Literacy Initiative $10,000 - Greater Kingsport Family YMCA $10,000 - Mate Inspiration for Innovation $10,000 Promote STEM education for studentsLine 4 - Environmental ImprovementsHolston Valley Medical Center provided program support to the following organization: - Boone Lake Association $1,000 23rd Boone Lake CleanupLine 8 - Workforce DevelopmentBallad Health provided program support to Streamworks, Inc. totaling $511,867 to promote STEM education for students throughout the Appalachian Highlands. Part III, Line 2: Self-pay balances include accounts after payments and contractual adjustments (discounts) have been applied from all third-party payers such as Medicare, TennCare, commercial insurers, and others - generally leaving the patient responsible for any remaining deductible and/or co-payment. Other self-pay accounts are from patients with no insurance or other third-party coverage. Under Ballad Health's system-wide self-pay policy, any patient who has no insurance and is ineligible for any government assistance program receives an 85% discount. Many self-pay patients will further qualify for financial assistance (sometimes referred to as charity care) if they provide the financial information needed to deem them eligible or upon determination of presumptive charity eligibility.After the normal collection process has indicated an account is uncollectible, WHS writes the account off to bad debt. The hospital's overall self-pay accounts receivable balance is evaluated on an ongoing basis to evaluate the age of accounts receivable, historical write-offs and recoveries and any unusual instances (such as local, regional or national economic conditions) which affect the collectability of receivables. Part III, Line 3: WHS's primary external collection agency historically estimated that approximately 37% of WHS's bad debt would have qualified for financial assistance if patients had provided a financial assistance application and required documentation. Pursuant to the merger, WHS has begun to score accounts using a presumptive eligibility tool. This tool utilizes various data points for a proprietary algorithm operated by an outside vendor to provide an individual's score which is then relied upon to assign presumptive charity eligibility. There are many instances of patients with large account balances and no health insurance coverage that WHS believes would qualify for financial assistance. Although patients are encouraged to apply for assistance, many will not do so. WHS would prefer for patients to submit completed financial assistance applications given that historical data clearly indicates that most uninsured patients and many underinsured patients will qualify for financial assistance under WHS's program. Without a completed application or approval through the presumptive charity eligibility review, these are recorded as bad debt instead of charity care. Part III, Line 4: Ballad Health's audited financial statements include a footnote on page 14 that describes bad debt. WHS is included in the June 30, 2022 audited financial statements of Ballad Health (attached). Part III, Line 8: Excluding Medicare losses reported in Part I subsidized health, the Part III Medicare allowable costs are reported using WHS's filed Medicare cost report (C/R). The C/R uses a cost to charge ratio based on a step-down allocation methodology. WHS 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 the 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. WHS hospitals provide assistance to help underinsured and uninsured patients determine sources of payment for medical bills and to help patients determine eligibility for programs such as TennCare or Medicaid.After insurance benefit verification, WHS hospitals bill insurance carriers. If the insurance carrier denies payment of the service/procedure as non-covered or the patient has exceeded their maximum benefits, the service/procedure will qualify for the uninsured discount.Financial counselors are available to discuss financial assistance with patients and their families. WHS hospitals provided a number of payment options:- a pre-service discount may be offered- a discount in excess of established discounting rates may be granted for catastrophic high dollar accounts- WHS hospitals accept all non-contracted and out-of-network payers and will make attempts to work with these payers regarding appropriate reimbursement and billing to their members- as part of Ballad Health's commitments to the State of Tennessee and Commonwealth of Virginia to form Ballad Health, not-in-network discounts are applied per policies in place for WHS hospitals- payment arrangements are available so long as the account is not with a collection agencyReasonable efforts are made to determine if a patient is eligible for financial assistance - see Schedule H, Part VI, line 3 for information on how patients are informed about Ballad Health's financial assistance policy. Part VI, Line 2: 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, WHS communicates with and provides education to patients through various avenues regarding governmental assistance programs and hospital financial assistance. Various educational and application documents related to obtaining financial assistance are widely available at WHS hospitals and all documents are available on the Ballad Health website. Printed financial assistance educational materials are part of each registration packet and posters are displayed in highly visible areas of the hospitals. The financial assistance policy and documents are available in emergency departments and admitting areas. WHS is also happy to mail all documents to patients and offers a plain language summary. All of the documents are available in English and Spanish. Financial assistance information is available during pre-registration, registration and/or during financial counseling. WHS offers governmental program eligibility representatives to assist patients in securing eligibility for TennCare or Medicaid, federal disability and other governmental assistance programs. Additionally, if a patient or community resident expresses an interest in the Affordable Care Act healthcare exchange, WHS representatives have the qualifications and experience to assist them through the entire process. Financial counselors offer financial assistance applications to patients who do not qualify for governmental assistance programs and are unable to pay for some or all of their healthcare.All patient billing statements have verbiage discussing financial assistance along with contact information. The last letter to the patient displays the plain language summary. In all oral correspondences with a patient, if it is identified the patient cannot meet payment requirements on their account, financial assistance is discussed as an option. Applicants are notified of financial assistance determination in writing. Part VI, Line 4: WHS serves the healthcare needs of 29 Appalachian counties in Northeast Tennessee, Southwest Virginia, Southeast Kentucky, and Northwest North Carolina. All of the counties WHS serves are federally designated as medically underserved areas. WHS's largest hospital, Holston Valley Medical Center, is a tertiary referral center and one of the nation's 50 top cardiovascular hospitals. Medically underserved areas are designated by the U.S. Department of Health and Human Services. Shortage areas are identified through analysis of physician to population ratios depending on whether an area is considered to have a high need. Criteria used to determine high need are poverty rates, the percent of the population over age 65, infant mortality rates and fertility rates. WHS operates 1 critical access hospital: Hanock County Hospital in Tennessee. Additionally, according to the 2021 County Health Rankings, counties where WHS hospitals are located ranked poorly for both health outcomes and health factors. Part VI, Line 5: WHS is dedicated to operating efficiently so that waste is minimized. WHS's leadership remains mindful of managing limited resources so that adequate facilities and equipment are available for the care of their patients. Surplus funds are invested into improving treatment options for patients through new technologies, recruiting physicians and trained staff in shortage areas, and improving WHS facilities. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary. WHS has several hospitals with Medicare-approved health profession education programs. In addition, WHS hospitals serve as training sites for many types of health professions: nursing, pharmacy, psychology, lab, respiratory therapy, EMT, public health, etc. Students from several colleges, universities, and programs receive training and hands-on experience in WHS hospitals. WHS resources are devoted to health conferences for local health professionals and offer other programs focused on improving the health of residents. While WHS operates in a predominantly low-income, rural and isolated areas, WHS continues to offer services that operate at a loss because residents would otherwise need to leave their hometown or county to receive needed care.Wellmont Health System merged with Mountain States Health Alliance in February 2018 to form Ballad Health healthcare system. WHS and Mountain States Health Alliance still exist as legal entities and continue to operate multiple hospitals. WHS's governing body is comprised of persons who reside in the organization's primary service areas.Physicians that request privileges who are qualified and credentialed are extended privileges by WHS. Part VI, Line 6: WHS's merger with Mountain States Health Alliance opened up many opportunities not previously available to two competing health systems. Collaboration started post-merger and Ballad Health continues to see progress towards improving efficiencies within our health system, activities consistent with Ballad Health's population health initiative, sharing best practice quality improvements, and other benefits related to operating as one rather than operating in a competitive environment. A new clinical council was formed immediately following the merger. The council includes physicians nominated from the leadership of all Ballad hospitals. A new Community Benefit and Population Health Committee of the board was established and various other infrastructures have been established since the merger.WHS is a Tennessee non-profit corporation and a premier provider of healthcare services in Northeast Tennessee and Southwest Virginia. WHS includes nine hospitals (six included in this return), an integrated physician network, and several ambulatory sites. WHS hospitals offer a broad scope of services ranging from community based acute care to highly specialized tertiary services including a trauma center, comprehensive heart care, and cancer care.WHS owns and operates an integrated health care delivery system providing inpatient, outpatient, and other health care services at multiple locations in Northeast Tennessee and Southwest Virginia. Currently, WHS owns and operates eight acute care hospital facilities and one critical access hospital. The acute care facilities owned by WHS include Holston Valley Medical Center in Kingsport, Tennessee, Bristol Regional Medical Center in Bristol, Tennessee, Lonesome Pine Hospital in Big Stone Gap, Virginia, Mountain View Regional Hospital in Norton, Virginia, Dickenson Community Hospital in Clintwood, Virginia, Hawkins County Memorial Hospital in Rogersville, Tennessee, Takoma Regional Hospital, Inc. d/b/a Greeneville Community Hospital in Greeneville, Tennessee, and the critical access hospital, Hancock County Hospital in Sneedville, Tennessee.Across WHS's hospitals, there were many projects, programs and collaborative efforts that took place during the year. Some examples include:- Opioid prescribing reduction across all WHS hospitals- WHS hospitals shared successful achievements from value optimization team projectsSince the Ballad Health system is both horizontally and vertically integrated, patients can be efficiently moved along an integrated, comprehensive continuum of care as their health dictates. If needed, patients can be moved to one of Ballad Health's tertiary care facilities providing advanced treatment options.Hospitals in the Ballad Health system work closely with one another to share expertise and resources. Part VI, Line 7, Reports Filed With States TN,VA Part VI, Additional Information Ballad Health is required to report community benefit estimates on a quarterly basis with the states of Tennessee and Virginia. The reporting includes all of Ballad Health's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad Health operates under a Cooperative Agreement (CA) in Virginia and a Certificate of Public Advantage (COPA) in Tennessee as obligated by agreements between Ballad Health and the two states to allow Mountain States Health Alliance and Wellmont Health System to merge. 1 Appalachian Literacy Initiative PO Box 3283 Bristol TN 37620 824755919 501c3 10000 0 Program support Appalachian Music Heritage Fndtn PO Box 304 Marion VA 24354 261571577 501c3 8000 0 Program support Children's Advocacy Center of Sullivan Co PO Box 867 Blountville TN 37617 621232172 501c3 20000 0 Program support Dobyns Bennett High School Band Boosters Club PO Box 7265 Kingsport TN 37660 237170169 501c3 20000 0 Program support Downtown Kingsport Association 229 Broad Street Kingsport TN 37660 812175094 501c3 5000 0 Program support East Tenn State Univ Fndtn PO Box 70721 Johnson City TN 37614 237092731 501c3 51231 0 Rural research program East Tenn State Univ Fndtn PO Box 70721 Johnson City TN 37614 237092731 501c3 25000 0 Noland Family First Generation Scholarship Program East Tenn State Univ Research Fndtn 2109 W Market St Johnson City TN 37604 550788917 501c3 25000 0 Program support Evan B Hartsell Foundation 10144 Arbor Run Dr Unit 89 Tampa FL 33647 850678297 501c3 10000 0 College scholarships for individuals with physical disabilities For Our Kids Project 1808 Verona Road Henrico VA 23229 872713060 501c3 12000 0 Program support for families of children born with disabilities Greater Kingsport Family YMCA 1840 Meadowview Parkway Kingsport TN 37660 581564232 501c3 10000 0 Program support King University 1350 King College Road Bristol TN 37620 581363100 501c3 50000 0 School of Nursing patient simulators Kingsport Chamber Foundation 400 Clinchfield St Ste 100 Kingsport TN 37660 581453565 501c3 42660 0 Sponsorships/Renovation Project K-Play Sports Council Inc 400 Clinchfield St Ste 100 Kingsport TN 37660 412045125 501c3 6705 0 Sponsorship - adaptive sports complex for children with disabilities Mate Inspiration for Innovation 980 Freemont Street Monterey CA 93940 814389131 501c3 10000 0 Program support - encourage students in STEM academics Paramount Foundation Inc 518 State Street Bristol TN 37620 581837080 501c3 20000 0 Restoration program support Second Harvest Food Bank 127 Dillon Court Gray TN 37615 621303822 501c3 26000 0 Program support Southwest Regional Recreation Authority 11325 Norton Coeburn Road Coeburn VA 24230 300501475 501c3 5000 0 Indoor/Outdoor playground sponsorship Streamworks Inc 122 Pickens Road Kingsport TN 37663 832552649 501c3 511867 0 Program support-STEM education Tennessee Medical Foundation Inc 216 Centerview Dr Ste 304 Brentwood TN 37027 620541813 501c3 5000 0 Program support-health professionals with substance abuse disorders Tusculum University PO Box 5100 Greeneville TN 37744 620484185 501c3 35000 0 Program support United Way of East Tn Highlands 1907 N Roan Street Johnson City TN 37601 626001105 501c3 7500 0 Helping Heroes fund United Way of Southwest Virginia 1096 Old Berry Drive Abingdon VA 24210 540718860 501c3 25000 0 SWVA Trauma Informed Community Network Grant Univ of Va College at Wise Foundation 1 College Ave Wise VA 24293 541638774 501c3 8000 0 Event sponsorship - Economic Forum Virginia Center for Health Innovation 3831 Westerre Pkwy Ste 5 Henrico VA 23233 800796077 501c3 10000 0 Program support Va Polytechnic Inst & State Univ 201 Southgate Center Blacksburg VA 24061 546001805 501c3 240000 0 Project ALS: Improve access to health care Zoll Medical Corporation PO Box 27028 New York NY 10087 042711626 1639171 0 Purchase monitors donated to local EMS providers 26 1 Part I, Line 2: The Community Benefit and Population Health Committee for Ballad Health is comprised of members from Tennessee and Virginia. Committee members have various perspectives on community health improvement and work to develop an understanding of population health, philanthropy, community benefit obligations and the role Ballad Health plays in health access improvement. The senior leadership for Ballad Health, including the President and CEO and COO, attend the meetings. Among the responsibilities of the committee is ensuring charitable contributions comply with Ballad Health Board policies. All requests are submitted electronically with the required information to determine eligibility. After the committee has reviewed requests, various levels of approval are required, including the Ballad Health CEO or Ballad Health Board, based on the level of commitment. Applicants requesting funding for a specific event or program should include the following information: - 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 Part II, Line 1(a): Grant reported in Part II, Line 1(a) to Zoll Medical Corporation represents the purchase of heart monitors that were provided at no charge to various non-profit Emergency Medical Service providers in our service area. 1 1 0 0 0 0 0 0 0 Alan Levine BH PresCEO Director 0 1328603 0 1687893 0 1066533 0 216552 0 23791 0 4323372 0 1002170 Marvin Eichorn BH EVPCAO Director 0 738294 0 347261 0 68911 0 17100 0 26804 0 1198370 0 0 Eric Deaton BH EVPCOO Director 0 656895 0 334180 0 30368 0 83012 0 21172 0 1125627 0 0 Lynn Krutak BH EVP/CFO 0 638754 0 299081 0 19133 0 80962 0 23301 0 1061231 0 0 Jon Taveau MD Staff Physician 467793 0 914 0 445525 0 17100 0 14993 0 946325 0 0 0 David Pryputniewicz MD Staff Physician 445669 0 500 0 311045 0 18600 0 14993 0 790807 0 0 0 Tim Belisle BH EVPGen Cnsl Director 0 444154 0 202357 0 24072 0 61801 0 25605 0 757989 0 0 James Price MD Staff Physician 599616 0 500 0 12217 0 12443 0 29394 0 654170 0 0 0 Elizabeth Jackson MD Staff Physician 532554 0 52372 0 187 0 17080 0 14795 0 616988 0 0 0 Lisa Smithgall Former Key Employee/CNE 0 377014 0 156307 0 4927 0 53375 0 18685 0 610308 0 0 Linda White end 61822 VP/Pres NW Mkt 402700 0 141893 0 2156 0 37714 0 22673 0 607136 0 0 0 Chad Couch Pres/CEO NE Mkt 398896 0 134666 0 9980 0 18114 0 25170 0 586826 0 0 0 Raj Vishal Staff Physician 450434 0 30500 0 3090 0 9256 0 26075 0 519355 0 0 0 Andrew Wampler end 121721 BH VP/Oper Excellence 293071 0 108548 0 38033 0 0 0 22613 0 462265 0 15569 0 Robert Bender CFO NE Mkt 239398 0 82864 0 1263 0 15768 0 24684 0 363977 0 0 0 Dale Clark Interim VP/CEO Wise Cnty 0 237312 0 75182 0 12164 0 19112 0 7786 0 351556 0 0 Rebecca Beck VP/COO HVMC 228461 0 81586 0 4515 0 16730 0 20095 0 351387 0 0 0 Stephen Sawyer CFO NW Region 0 191230 0 55111 0 18395 0 12667 0 25584 0 302987 0 0 Chris Miller VP/COO BRMC 191169 0 65760 0 4552 0 12061 0 19519 0 293061 0 0 0 Robert Kennedy AVP/COO Wise County 0 188789 0 52797 0 5402 0 9387 0 20730 0 277105 0 0 Bobbie Murphy VP/Pt Care Svcs BRMC 171583 0 65643 0 1735 0 0 0 25023 0 263984 0 0 0 Shannon Showalter VP/CEO Wise County 0 166524 0 500 0 21115 0 0 0 12476 0 200615 0 0 Theresa Trivette VP/Pt Care Svcs HVMC 175559 0 0 0 2078 0 7569 0 11740 0 196946 0 0 0 Mark Leonard VP end 1020 Former CEO Wise County 0 0 0 0 0 152254 0 0 0 10915 0 163169 0 0 Part I, Lines 4a-b The following executives listed in Schedule J, Part II participated in a 457(f) retirement plan provided by Ballad Health(BH). The 457(f) plan is a nonqualified tax-deferred compensation plan available to a select group of key executives for the intent of supporting retention and to offer a competitive total retirement program. Account balances have a "substantial risk of forfeiture". In addition to creditor risk, substantial risk of forfeiture is created through default risk if the participant's employment with Ballad Health is terminated prior to age 65. However, the 457(f) plan contains a non-compete provision that provides the account balance to be paid in a lump sum after the executive satisfies the two-year non-compete period. This provision applies to employer contributions if the executive has provided eligible service for six or more years. The executive will receive the entire account balance if he/she becomes disabled, dies or if the executive terminates for "good reason or is involuntarily terminated without "good cause" within a 24-month period after a change-of-control occurs. Distributions from this plan are subject to federal, state, and local taxes on the entire account balance upon distribution. Additionally, during the year a one-time acceleration of the supplemental executive retirement plan occurred for the CEO in the amount of $1,002,170. This amount was taxable in the year accelerated and is included in total compensation for purposes of reporting. Alan Levine $199,452 Eric Deaton $65,950 Lynn Krutak $63,862 Tim Belisle $44,703 Lisa Smithgall $36,419 Linda White $20,460 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. Mark Leonard $152,254 Andrew Wampler $2,421 A The Health Educational & Housing Facilities Board of Sullivan County TN 621256662 865293AF1 2016-09-01 180420000 Construction @ HVMC 0 0 0 B The Health Educational & Housing Facilities Board of Sullivan County TN 621256662 865293AH7 2016-04-20 73240000 Refund 2006A Bond 0 0 0 A 180420000 18977995 180420000 2011 1 0 1 1 B 16215000 73240000 73240000 2011 1 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 A 0 0 0 1 0 0 1 Massachusetts Mutual Life 29.800000000000 1 0 1 B 0 0 1 0 0 0 0 0 1 A 1 B 1 Schedule K, Part II, Lines 10-12 The uses of proceeds listed in Line 11 of Part II does not equal the total gross proceeds of the issue listed in Part II, Line 3 and 4 because amounts in the original reserve fund created in 2006 would be considered transferred proceeds of the 2006 issue, but were not sale proceeds of the reissuance bonds in 2016. Schedule K, Part IV, Arbitrage Line 2c - Date Rebate Computation Performed: The Health, Educational & Housing Facilities Board of Sullivan County, TN 06C 10/31/2016 Jacob R Krutak Family Member 21278 See Part V 0 Part IV Business Transactions Involving Interested Persons: Jacob R. Krutak, Surgical Tech II at Bristol Regional Medical Center, is a family member of Lynn Krutak, EVP and CFO of Ballad Health. His last date of employment with Ballad Health was December 13, 2021. Part III, Line 4a 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 is publicly available on the website of the Tennessee Department of Health, at https://www.tn.gov/health/health-program -areas/health-planning/certificate-of-public-advantage.html. The Cooperative Agreement is available on the website of the Virginia Department of Health, at https://www.vdh.virginia.gov/licensure- and-certification/cooperative-agreement/. Form 990 for Mountain States Health Alliance (MSHA) includes eight wholly owned hospitals including a children's hospital and a behavioral health hospital; two others, also wholly owned by MSHA, each file a separate return. Form 990 for Wellmont Health System (WHS) includes six wholly owned hospitals, including two tertiary hospitals, while three wholly owned hospitals file separate returns. In addition to the acute care hospitals, WHS wholly owns or has ownership interest in a nursing home, an assisted living facility, physician practice organizations, ambulatory surgery centers and other health care businesses. Specific to the hospitals included in this Form 990, services were provided to: 34,819 inpatients 520,626 outpatient visits 120,790 emergency visits 1,547 deliveries 19,995 surgeries SULLIVAN COUNTY, TN: BRISTOL REGIONAL MEDICAL CENTER (BRMC) - 348-bed tertiary hospital located in Bristol, Tennessee has served the community since 1925. - Provides cardiac and neurological care, diabetes treatment, emergency and trauma (Level III) care, inpatient and outpatient hospice care, oncology, occupational health, outpatient, psychiatric, rehabilitation, surgical and women's health services. - Centers of Excellence include the Ballad CVA Heart Institute, J.D. and Lorraine Nicewonder Cancer Center, Deborah H. Quillen Birthing Center, Primary Stroke Center, and the Leaonard Family Comprehensive Breast Center. - The J.D. Nicewonder Family Pediatric Emergency Department is part of a regional system of care for children, including pediatric surgery, trauma and Level III NICU services at Niswonger Children's Hospital in Johnson City. - Ridgeview Pavilion, a service of BRMC, is a 28-bed inpatient behavioral health center serving a wide region in Northeast Tennessee and Southwest Virginia providing short-term crisis intervention, medication assessment and stabilization. - Quantros named BRMC as the No. 1 hospital in Tennessee and among the top 100 in the nation for medical excellence in neurological care in its 2023 CareChexawards. BRMC was also named in the top 10% of hospitals in the nation for patient safety in spinal surgery, pulmonary care, and gastrointestinal hemorrhage. BRMC was also named in the top 100 hospitals in the nation for patient safety in gallbladder removal. - U.S. News recognized BRMC in 2023 with "high performing distinctions for heart attack care and treatment, heart failure care and treatment, stroke care, colon cancer surgery, pulmonary disease care, and in care for kidney failure patients. - BRMC has received the American College of Cardiology's NCDR Chest Pain MI Registry Platinum Performance Achievement Award for 2022. SULLIVAN COUNTY, TN: HOLSTON VALLEY MEDICAL CENTER (HVMC) - 505-bed tertiary hospital located in Kingsport, Tennessee has served the community since 1935. - Provides diagnostic imaging, surgical, neuroscience, rehabilitation, women's health, outpatient services, emergency and trauma (Level III) care. - Centers of Excellence include the Ballad CVA Heart Institute, the Christine LaGuardia Phillips Cancer Center, Comprehensive Breast Cancer Center, Advanced Primary Stroke center, and Every Step joint replacement center. - Named by U.S. News' annual "Best Hospital" study as the ninth-ranked hospital in the state of Tennessee and "high performing distinction for knee replacement procedures, heart attack care and treatment, heart failure and treatment, transcatheter aortic valve replacement, care of stroke patients, pulmonary disease care and inpatient care for kidney failure patients. - Quantros named HVMC in the top 100 hospitals in the nation for medical excellence in interventional carotid care in its 2023 CareChex awards. HVMC was also recognized in the top 10% of hospitals in the nation for medical excellence in gallbladder removal and in the top 10% of hospitals in the State of Tennessee for general surgery. - Holston Valley has received the American Heart Association's (AHA) GoldPlus Get With the Guidelines Stroke quality achievement award for its commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines, ultimately leading to more lives saved and reduced disability. HANCOCK COUNTY, TN: HANCOCK COUNTY HOSPITAL (HCH) - 10-bed federally designated critical access hospital located in Sneedville, Tennessee opened in 2005 through a partnership with the Hancock County Commission. - Provides inpatient and outpatient acute care, emergency care, radiology, laboratory, respiratory therapy and physical therapy services. WISE COUNTY, VA: LONESOME PINE HOSPITAL (LPH) - 60-bed community hospital located in Big Stone Gap, Virginia has served the community since 1973. - Provides emergency care, medical, and oncology services. - Southwest Virginia Cancer Center in Norton, Virginia and Ballad Cancer Institute in Bristol, Virginia serve medical and radiation oncology patients as part of LPH operations. - Quantros named LPH in the top 10% of hospitals in the nation for medical excellence in heart attack treatment and sepsis care in its 2023 CareChex awards. WISE COUNTY, VA: NORTON COMMUNITY HOSPITAL (NCH) - 120-bed acute care facility located in Norton, Virginia serving the community since 1949. On February 28, 2021 NCH merged into WHS and still does business under the name "Norton Community Hospital". - Provides a wide array of services including primary care, surgical pulmonology, urology, obstetrics, emergency, radiology, and laboratory services. - Accredited by the American Osteopathic Association ("AOA") and was the first AOA accredited teaching facility in Virginia. - Quantros named NCH in the top 10% of hospitals in the nation for medical excellence in women's health in its 2023 CareChex awards. - Healthgrades named NCH as a Five-Star Recipeint for C-Section and for Hysterectomy Delivery for 2 Years in a Row (2021-2022). - U.S. News recognized NCH as "high-performing" in pneumonia care. WISE COUNTY, VA: MOUNTAIN VIEW REGIONAL HOSPITAL (MVRH) - 44-bed facility is dual-certified and specializes in skilled and long-term care located in Norton, Virginia. Novel Coronavirus (COVID-19) Public Health Emergency In March 2020, Ballad Health (Ballad) executed its disaster plan in response to the COVID-19 pandemic. This plan included the activation of its Corporate Emergency Operations Command (CEOC) to coordinate efforts across the system and around the region to rapidly plan for and execute an ongoing response to the issues resulting from the COVID-19 pandemic. Throughout 2021, Ballad continued to battle against COVID-19 as new variants emerged, such as the Delta and Omicron variants. As these variants spread through the Ballad service area, Ballad's emergency rooms experienced significant surges. In addition to caring for patients within the hospital's walls, Ballad also supported the community through testing and vaccination efforts. In 2021 alone, Ballad conducted almost 300,000 tests and delivered over 88,000 total doses of COVID-19 vaccines. In September 2021, Ballad expanded its Safe at Home program, which was designed to provide at-home COVID-19 care to include patients presenting at Ballad urgent care and primary care locations and those visiting Ballad hospitals. Launched in November 2020, the program aimed to prevent hospital overcrowding and conserve inpatient beds during current and expected COVID-19 surges. Eligible patients in the Safe at Home program were equipped with a pulse oximeter and thermometer to monitor their vitals at home and ensure they receive timely and appropriate care if their condition worsened. The program also involved regular interactions with Ballad's clinical team members via phone calls. In April of 2021, Ballad launched the region's first Center for Post-COVID Care, an innovative approach to COVID-19 care that creates an access point to comprehensive clinical care for patients struggling with post-COVID symptoms. Through the Center for Post-COVID Care, Ballad offers a full spectrum of services, including care navigation and case management, for post-COVID patients. The health system is also fostering research and learning opportunities and collaborating with other leading institutions to understand post-COVID care and increase awareness among healthcare providers, patients, and community members of this condition. In April 2022, Ballad closed its Corporate Emergency Operations Center. Ballad continues to vigilantly monitor COVID-19 and its variants in its service area and will respond accordingly. 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 June 2022, the Tennessee Department of Health highlighted that despite the significant changes for population health across the United States during the COVID-19 pandemic, the 11 Tennessee counties served by Ballad in "the COPA region performed better, and [were] shown to be healthier, than peer counties in 50 percent of population health" measures and that drug overdoses have decreased considerably in the region since the merger. The region also outperforms peer counties on all vaccination measures for children and adults. The overall cost of healthcare was reduced due to the reduction of preventable hospitalizations in adults 65 and older by almost half. The merger has reduced unnecessary administrative overhead costs and eliminated unnecessary duplication of high-cost services reducing the overall cost of care for the Appalachian Highlands. In the Tennessee Department of Health report covering the period of July 1, 2020 to June 30, 2021, the department noted that as a combined health system, Ballad Health was able to respond to the COVID-19 pandemic "in ways that would not have been possible with two separate health systems" to ensure the deployment of staff, beds and personal protective equipment met the needs of the community and served as a trusted voice in the region for COVID-19 information. 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. Since its inception, the program has screened 182,000 individuals on Medicare or Medicaid 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. The health system continued to address the cost of care in the region. For example, Ballad successfully managed the care of thousands of COVID-19 patients in their homes through the "Safe at Home" program. The program served 5,654 patients and saved millions of dollars in potential hospitalization costs and freed up hospital capacity for the most seriously ill patients. Based on the strength of this program, Ballad's Hospital at Home waiver was approved by the Centers for Medicare and Medicaid Services (CMS) for Ballad's Bristol Regional Medical Center, Holston Valley Medical Center and Johnson City Medical Center. This waiver will allow Ballad to provide hospital-level care at home for Medicare patients who traditionally qualify for hospital admission. Early results from similar programs around the country indicate high patient satisfaction and quality outcomes at a lower cost than traditional inpatient hospitalization. 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. Forbes recognized Ballad as The Best Employers for Diversity in 2020. CHARITABLE CONTRIBUTIONS - From its inception in February of 2018, Ballad Health made significant contributions to the community it serves totaling over $29 million to date in direct contributions and other community health improvement initiatives. A few examples from fiscal year 2022 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. This program has seen dramatic growth over the years and surpassed 10,000 patients cared for in fiscal year 2022. 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. Ballad's chair of clinical research and medical director of the interventional and diagnostic catheterization labs led a new clinical trial in the United States for a potentially groundbreaking new carotid stent. The cardiovascular program at Holston Valley has performed as the No. 1 or No. 2 enroller in the United States and globally in at least 30 top research 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. - Ballad has achieved seven EPIC Gold Stars. Form 990, Part VI, Section A, line 6 Wellmont Health System is a Tennessee non-stock, nonprofit organization with Ballad Health as its sole member. Form 990, Part VI, Section A, line 7a Ballad Health has the authority to appoint Wellmont Health System board members. The President and CEO of Ballad Health serves as the President and CEO for Wellmont Health System. Form 990, Part VI, Section A, line 7b Decisions of the Wellmont Health System Board of Directors are subject to approval by the Ballad Health Board of Directors. Form 990, Part VI, Section B, line 11b The Ballad Health Tax Department prepares and reviews the Form 990. During preparation other functional areas within the organization provide information and support to complete an accurate return. The return is reviewed by the organization's EVP/CFO and is provided in electronic form to all members of the Board of Directors prior to being filed with the IRS. Form 990, Part VI, Section B, line 12c Ballad Health has a conflict of interest policy for all members of the Board of Directors, the Executive Chair/President, Executive Vice Presidents, Senior Vice Presidents, and Vice Presidents, and applies to all Ballad Health organizations. All persons covered by this policy are required to complete a conflict of interest disclosure form on an annual basis. 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. 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 34,224,572. Fundraising expenses 0. Total expenses 34,224,572. Consulting Fees: Program service expenses 247,597. Management and general expenses 474,524. Fundraising expenses 0. Total expenses 722,121. Contract Labor: Program service expenses 61,573,340. Management and general expenses 2,783,453. Fundraising expenses 0. Total expenses 64,356,793. Dietary Services: Program service expenses 10,593,925. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,593,925. Environmental Services: Program service expenses 7,158,828. Management and general expenses 19,914. Fundraising expenses 0. Total expenses 7,178,742. Hospital Supported Clinics: Program service expenses 47,599,989. Management and general expenses 0. Fundraising expenses 0. Total expenses 47,599,989. Laboratory Services: Program service expenses 2,756,952. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,756,952. Laundry: Program service expenses 1,974,137. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,974,137. Other: Program service expenses 6,676,522. Management and general expenses 9,306,936. Fundraising expenses 0. Total expenses 15,983,458. Physician Fees: Program service expenses 28,878,558. Management and general expenses 0. Fundraising expenses 0. Total expenses 28,878,558. Form 990, Part XI, line 9: Alternative Investment Income Not on Books -187,686. Closing of Wellmont Collections, Inc. & Highlands Wellmont Health Network -17,496. Intercompany Transfers -9,471,217. Pension Plan Adjustment 1,096,426. RHB Net Assets Transferred to BRMMC -317,726. Temporarily Restricted Grants 38,498. 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