2022-05-09T11:59:35-05:00 2021-06-30 990 2020-07-01 611771290 Ballad Health BALL 4233023374 1021 W Oakland Avenue Suite 103 Johnson City TN 37604 Lynn Krutak BH EVP & CFO 4233023374 2022-05-09 Lynn Krutak 999009999 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z Alan LevinePresCEO 303 Med Tech Pkwy Ste 300 Johnson City TN 37604 72410750 0 X balladhealth.org X 2015 TN Our mission: Honor those we serve by delivering the best possible care. 11 10 2664 0 21831 18748 2025330 8853151 9932992 15427011 45008980 48569618 -570910 -6779789 56396392 66069991 29610 0 0 0 21962628 16033975 0 0 222480 126628329 71080701 148620567 87114676 -92224175 -21044685 2037115071 2205229549 1420522936 1355496733 616592135 849732816 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 100423543 0 18718052 See Schedule O Ballad Health (BH) is an integrated community health improvement organization serving 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina and Southeast Kentucky. Our system of 21 hospitals, including a dedicated children's hospital, post-acute care and behavioral health services, and a large multi-specialty group physician practice works closely with an active independent medical community and community stakeholders to improve the health and well-being of more than 1 million people. By leading in the adoption of value-based payments, addressing health-related social needs, funding clinical and health systems research and committing to long-term investments in strong children and families in our region, Ballad Health is striving to become a national model for rural health and healthcare. Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). The two healthcare systems came together on February 1, 2018 as a result of a merger approved by both Tennessee and Virginia Departments of Health. Ballad Health operates under a Certificate of Public Advantage (COPA) in Tennessee and a Cooperative Agreement (CA) in Virginia. Pursuant to the COPA and CA, MSHA and WHS are required to fulfill the obligations, commitments and covenants set forth in the COPA. Such obligations include that Ballad Health shall meet, over the ten-year period beginning July 1, 2018, established minimum spending criteria on initiatives for expanded access to healthcare services, health research and graduate medical education, population health improvement, and a region-wide health information exchange. The full text of the COPA can be found on the Tennessee Department of Health's website, while the CA can be found on the Virginia Department of Health's website.Form 990 for MSHA includes seven wholly-owned hospitals including a children's hospital and a behavioral health hospital; four others, majority owned by MSHA, each file a separate return. Form 990 for WHS includes five wholly-owned hospitals; two others, also wholly-owned, each file a separate return. 2019 Novel Coronavirus (COVID-19) Public Health Emergency:The United States Secretary of Health and Human Services declared a Public Health Emergency (PHE) on January 31, 2020 due to confirmed cases of the 2019 Novel Coronavirus (COVID-19). On March 10, 2020 Ballad Health executed its disaster plan in response to the COVID-19 pandemic. This 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, ongoing response to the issues resulting from the COVID-19 pandemic. The policy establishing the CEOC is established and authorized by the Board of Directors, and follows guidelines established by the Federal Emergency Management Agency (FEMA) and the CDC. CEOC is led by an incident commander appointed by the Chief Executive Officer in this instance the Chief Operating Officer. The CEOC is composed of key leaders overseeing essential functions of the health system, including logistics, supply chain, communications, operations, finance, government relations and clinical services. The CEOC acts as the clearinghouse for all organizational planning and decision-making related to the event, and continues its responsibilities under the oversight of, and until discontinued by, the Chief Executive Officer. The Chief Executive Officer, who also serves as Chair of the Board of Directors, keeps the Board of Directors apprised of issues on an ongoing basis and ensures compliance with the Board's delegations of authority pursuant to Ballad Health's policies.During fiscal year 2021, CEOC continued to manage activities related to the PHE which included frequent communications to internal parties, news media, and the public. These communications included providing data related to the prevalence of the virus in the community, hospital capacity and constraints, and other timely information related to the progression of the pandemic. Upon release of vaccines, communications and efforts progressed to include the distribution of vaccination to eligible individuals. This was through newly established Ballad Health vaccination centers, outpatient clinics, supporting community partners, and other mobile outreach efforts. Ballad Health administered almost 88,000 vaccine doses through these efforts during the fiscal year starting with the delivery of the first dose in the service region on December 15, 2020. The system also discharged over 6,500 patients diagnosed with COVID-19 and referred an additional 1,600 patients from Emergency Departments into the "Safe at Home" program. Through the "Safe at Home" program and other measures, the healthcare system focused on delivery of care to patients in the most convenient and appropriate environment for their condition. These measures reduced hospital stays for patients in need of monitoring while conserving hospital beds for patients in need. Ballad Health also focused on supporting patients recovering from COVID-19 through the Center for Post-COVID Care and other COVID-19 support groups. This innovative approach creates an access point to comprehensive clinical care for those struggling with post-COVID symptoms. Through the Center for Post-COVID Care, Ballad Health provides a full spectrum of services, including care navigation and care management. The health system also fosters research and learning opportunities and collaborates with other leading institutions to understand post-COVID care and increase awareness to healthcare providers, patients and community members of this Long COVID condition. 100423543 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 379 0 1 2664 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 TN VA X Lynn Krutak 4233023374 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Alan Levine PresidentCEO Executive Chair 59.00 6.00 X X 2837324 0 224600 Barbara Allen End 1021 Director 4.00 X 0 0 0 Julie Bennett Director 4.00 X 0 0 0 Doug Springer MD Secretary 4.00 X X 0 0 0 David Lester Vice Chair 4.00 X X 0 0 0 David May MD Director 4.00 X 0 0 0 Scott Niswonger Director 4.00 X 0 0 0 Brian Noland Director 4.00 X 0 0 0 Gary Peacock Treasurer 4.00 1.00 X X 0 0 0 David Golden Director 4.00 X 0 0 0 Keith Wilson Director 4.00 X 0 0 0 Aldo Noseda Beg 1021 Director 4.00 X 0 0 0 Marvin Eichorn EVP/CAO 57.80 7.20 X 1313705 0 44243 Lynn Krutak EVP/CFO 63.40 1.60 X 1107634 0 99395 Eric Deaton EVP/COO 58.60 6.40 X 1039919 0 94315 Shane Hilton SVP CFO Market Operations 53.00 2.00 X 647926 0 81399 Melissa Carr SVP Financial Management 54.80 0.20 X 409510 0 57734 Lisa Smithgall SVP Chief Nursing Executiv 55.00 X 619140 0 70249 Pam Austin SVP CIO 55.00 X 419491 0 59406 Shana Tate SVP End 620 Revenue Cycle 27.50 X 228179 0 8606 Tim Belisle EVP General Counsel 59.00 6.00 X 779407 0 86025 Anthony Keck EVP/CPHO 64.40 0.60 X 774362 0 82066 Steve Kilgore BHMA SVP 54.30 0.70 X 810551 0 90587 Clay Runnels MD EVP/Chief Phy Exec 65.00 X 778006 0 94084 Deborah Dover SVP CHRO 41.00 14.00 X 676344 0 67944 12441498 0 1160653 154 0 1 0 Ensemble RCM LLC 13620 Reese BLVD E Suite 200 Huntsville NC 28078 Rev Cycle Mgmt. 27202129 Impact Advisors LLC PO Box 379 Naperville IL 605560379 IT Pro. Adv. Svcs. 12013441 Data Blue LLC 5300 Virginia Way Brentwood TN 37027 IT Maint. Svcs. 6589890 Anesthesia Pain Consultants 1009 Lark St Suite 2 Johnson City TN 37604 Anesthesia Svcs. 4492500 Virginia Highlands Anesthesia PC PO Box 1476 Abingdon VA 24212 Anesthesia Svcs. 4172145 51 82020 8486227 284904 8853151 Regional Blood Center 622110 9486335 9486335 Wellness Programs 622110 4835417 4835417 Rent Related Exempt Orgs 531120 1105259 1105259 15427011 19859002 19859002 1034772 1034772 146477 21831 273797 0 -127320 21831 -105489 21831 -127320 27639301 6103505 0 6066962 27639301 36543 27675844 36543 27639301 IPO Settlement 900099 3254498 3254498 Laundry Services 900099 2025394 2025394 Air Transport 900099 760580 760580 -12714772 -12714772 -6674300 66069991 18718052 21831 38476957 X 11012770 11012770 3850251 894371 2750000 205880 219857 13416 206441 438097 17024 405645 15428 513000 31303 481697 1619784 33800 1585984 644724 644724 902041 902041 2151455 987599 1163856 18460983 8648897 9812086 2050427 590627 1459800 4787580 3149259 1637559 762 5214430 2159310 3055120 5585020 2346068 3238952 565741 298739 267002 11690696 10787853 902843 43741148 33671431 10069717 1085219 528585 556634 Taxes - UBIT 88546 40646 47900 Maintenance 38632314 24230788 14401526 Dues & Subscriptions 3764993 2081254 1683739 Population Health 3163767 3163767 -73068167 6748806 -79817383 410 87114676 100423543 -13531347 222480 8059 8726917 314541361 304846349 475776 1752519 14093336 1397208 4565659 4565659 23247208 29876296 2262000 8885856 19585480 21634558 627861005 371640001 245934475 256221004 775123176 927900240 18938691 18941004 448424068 448729709 133326592 133326592 36589190 38425638 2037115071 2205229549 91008482 114696786 359026 284185 1176741601 1158577182 24542975 22317393 127870852 59621187 1420522936 1355496733 X 616210175 849335967 381960 396849 616592135 849732816 2037115071 2205229549 X -21044685 118962652 135222714 X 0 1 X 1 1 1 X X X 2 Mountain States Health Alliance 620476282 3 1 0 0 Wellmont Health System 621636465 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 56340 1 869847 0 0 926187 0 Part II-B, Line 1: Ballad Health had lobbying expenses of $56,340 which represents the portion of dues paid to numerous organizations, including Tennessee Business Roundtable, Tennessee Chamber of Commerce & Industry, Tennessee Association of Mental Health Organizations, Kingsport Chamber Government Relations, attributable to lobbying. Representatives of Ballad Health's Community & Government Relations department attended the following legislative conferences: *Premier Federal Affairs Network meeting *America's Essential Hospitals Policy meeting *Tennessee Hospital Association Legislative Advocacy Day *Tennessee Public & Teaching Hospitals Association annual meeting *Participated in Children's Hospital Association Public Policy Sub-Committee Representatives of Ballad Health's Community & Government Relations department also contacted congressional offices concerning the following issues: *Opposed any cuts in Medicare/Medicaid *Supported area wage index permanent fix (introduced Save Rural Hospital Act) *Supported the continuance of Medicare Dependent Hospital and Low-Volume designations *Opposed cuts to 340B program and changes in eligibility resulting from the pandemic *Supported a reasonable remedy for "surprise" billing *Monitored progress of the TN Medicaid Block Grant *Supported Provider Financial Relief Efforts for COVID related expenses and revenue losses Representatives of Ballad Health's Community & Government Relations department responded via letter, phone, or in person to the following Tennessee and Virginia legislative issues and supported the following: *Certificate Of Need reform (TN)/Certificate Of Public Need (VA) reform *Continuation and monitoring of hospital assessment fee in Tennessee and Virginia *Mental health funding for inpatient psychiatric care in Tennessee and overall behavioral health funding in Virginia *Adequate TennCare funding in Tennessee *Limited hospital reporting requirements for surprise billing *Advocated for Temporary Assistance for Needy Families funding to support residential treatment center for mothers with substance use disorders and their young children in Tennessee 33216073 33216073 106606132 38889843 67716289 4493708 2718935 1774773 474522055 328364449 146157606 9023037 1666774 7356263 256221004 Investment - BRMMC 100310432 C Investment - MSHA 125042522 C Investment - JMH 132000000 C Investment - SCCH 72400494 C Investment - Consortia 400000 C Investment - Health South 546482 C Investment - Premier 18724952 C Investment - MSJC -1064220 C Investment - PRAM HLDG 260529 C Investment - DePre HLDG 108518 C 448729709 Reserve - Other 8466832 Retirement Obligations 3664605 Retiree Health Care Benefit 1458544 Long-term Compensation Payable 4499957 Contributions Payable 18194151 Operating Lease-Current Portion 1715512 Operatig Lease-LT Portion 4525242 COVID-19 FICA Loan 1967014 SWAPS 729895 Due to Affiliates 14399435 59621187 X Part X, Line 2: FASB ASC740 Footnote: "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, 2021. Tax returns for 2018 through 2020 are subject to examination by the Internal Revenue Service." X 1 1 X X X X 1 1 1 0 0 0 0 0 0 Alan Levine PresidentCEO Executive Chair 1105435 0 1577573 0 154316 0 203351 0 21249 0 3061924 0 122199 0 Marvin Eichorn EVP/CAO 701564 0 576630 0 35511 0 17300 0 26943 0 1357948 0 0 0 Lynn Krutak EVP/CFO 606603 0 494254 0 6777 0 79271 0 20124 0 1207029 0 0 0 Eric Deaton EVP/COO 577023 0 447591 0 15305 0 73799 0 20516 0 1134234 0 0 0 Steve Kilgore BHMA SVP 441644 0 340511 0 28396 0 63262 0 27325 0 901138 0 0 0 Clay Runnels MD EVP/Chief Phy Exec 474281 0 289754 0 13971 0 68948 0 25136 0 872090 0 0 0 Tim Belisle EVP General Counsel 418179 0 345978 0 15250 0 60679 0 25346 0 865432 0 0 0 Anthony Keck EVP/CPHO 421607 0 345978 0 6777 0 60598 0 21468 0 856428 0 0 0 Deborah Dover SVP CHRO 368187 0 281321 0 26836 0 55076 0 12868 0 744288 0 0 0 Shane Hilton SVP CFO Market Operations 361853 0 279296 0 6777 0 56155 0 25244 0 729325 0 0 0 Lisa Smithgall SVP Chief Nursing Executiv 344915 0 262405 0 11820 0 52096 0 18153 0 689389 0 0 0 Pam Austin SVP CIO 304716 0 106794 0 7981 0 48461 0 10945 0 478897 0 0 0 Melissa Carr SVP Financial Management 300742 0 105416 0 3352 0 47003 0 10731 0 467244 0 0 0 Shana Tate SVP End 620 Revenue Cycle 133809 0 0 0 94370 0 7986 0 620 0 236785 0 0 0 Part I, Line 1a Unless expressly approved by the Ballad Health Executive Chair/President, first-class transportation is generally not permitted. The Executive Chair/President may utilize first class travel for flights of a long duration. The Vice Chair/Lead Independent Director of the Board of Directors reviews and determines approval for expense reimbursement requests made by the Executive Chair/President. Charter flights must be approved in advance by the Executive Chair/President and are limited to business trips that can be justified based on financial savings, essential time savings and meeting logistics. On an annual basis, the Internal Audit Department of Ballad Health validates all charter travel was for valid business purposes and in compliance with the Ballad Health senior executive travel and business reimbursement policy. Part I, Lines 4a-c The following executives listed in Schedule J, Part II participated in a 457(f) retirement plan provided by Ballad Health (BH). The 457(f) plan is a nonqualified tax-deferred compensation plan available to a select group of key executives for the intent of supporting retention and to offer a competitive total retirement program. Account balances have a "substantial risk of forfeiture". In addition to creditor risk, substantial risk of forfeiture is created through default risk if the participant's employment with BH is terminated prior to age 65. However, the 457(f) plan contains a non-compete provision that provides the account balance to be paid in a lump sum after the executive satisfies the two-year non-compete period. This provision applies to employer contributions if the executive has provided eligible service for six or more years. The executive will receive the entire account balance if he/she becomes disabled, dies or if the executive terminates for "good reason or is involuntarily terminated without "good cause" within a 24-month period after a change-of-control occurs. Distributions from this plan are subject to federal, state, and local taxes on the entire account balance upon distribution. Alan Levine $186,051 Lynn Krutak $61,972 Eric Deaton $56,507 Tim Belisle $43,383 Tony Keck $43,383 Steve Kilgore $45,962 Melissa Carr $30,077 Clay Runnels, MD $49,677 Shane Hilton $37,701 Lisa Smithgall $34,871 Pam Austin $31,702 Deborah Dover $37,974 A Hlth & Edu Facil Bd 2018 830682499 396649EX9 2018-06-06 820526657 Assets & Capital Improvements 0 0 0 A 29980000 820545037 9240 820535798 2019 0 0 0 1 A 0 0 1 1 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 Part II, Line 10 Pursuant to Section 1.150 - 1(a)(2)(ii) of the Treasury Regulations, the proceeds of the Bonds were used to acquire the assets of Mountain States Health Alliance and Wellmont Health System, and such expenditures would be treated as capital expenditures, and not the refunding of prior debt. Additional CUSIP#: 396649EY7 M Eichorn Officer SPLIT X 2808925 4565659 0 1 0 4565659 Part ll, Line 10 Form 990, Part III, Program Service Accomplishments (continued): IMPROVING THE COMMUNITY'S HEALTH STATUS: ACCOUNTABLE CARE COMMUNITY ACHIEVEMENTS - To help address the broader needs of the community at large, Ballad Health has convened the nation's largest accountable care community (ACC), spanning two states with more than 300 participating organizations in 21 counties throughout the Appalachian Highlands. Through five months of regional focus groups and stakeholder meetings, the ACC selected four priority areas to influence through its work: substance abuse, tobacco use, overweight and obesity, childhood trauma and resiliency. The ACC leadership council has agreed that the most impactful way to address the four priority areas is by focusing on interventions that benefit children and families. To reflect this commitment toward youth, the group chose the name STRONG (Striving Toward Resilience and Opportunity for the Next Generation) Accountable Care Community and is organizing activities into four categories: STRONG Starts (conception through kindergarten), STRONG Youth (kindergarten through 12 years old), STRONG Teens (13 to 18 years old) and STRONG Families (adults and caregivers). In May, Ballad Health announced it would invest $2 million in 21 regional, community-based organizations to support strategies aimed at improving children's health outcomes in the region, including providing social support services and navigation for women suffering from addiction, preventing food insecurity, parenting and resiliency training and keeping youth from dropping out of school. The work these community organizations are doing will help ensure that children and families reach their full potential. Ballad Health and the region's STRONG Accountable Care Community unveiled a new partnership and coordinated care network with Unite Us that will enhance community members' health and well-being. The partnership, announced in June, will join Ballad Health with the Unite Tennessee and Unite Virginia networks. These networks connect people with unmet health and social service needs, such as housing, food, transportation and employment. Within Ballad Health, specially trained staff now conduct health related social needs screenings for gaps in care, such as food and housing insecurity, transportation challenges or other obstacles. The Unite Us technology helps staff connect families with community organizations committed to resolving those issues. The network, however, is not dependent on Ballad Health. Participating organizations also now use the system to refer clients to each other even if the people they're referring aren't Ballad Health patients. CREATION OF NEW BALLAD HEALTH BEHAVIORAL SERVICES DIVISION - To achieve success in a value-based healthcare environment and to achieve the goals for improved access to behavioral services for the region, Ballad Health created the Behavioral Health Services Division. CREATION OF THE BALLAD HEALTH INNOVATION CENTER - Ballad Health created The Innovation Center to serve as a hub for development of partnerships and collaborations that can bring to market life-saving initiatives and other technologies and services that can improve the human condition. COMMUNITY RESOURCES - Ballad Health parish nurses work with individual congregations to help people in religious communities improve their health, prevent illness and injury and ease suffering associated with any health crisis. The parish nurse acts as counselor, educator and healthcare provider by identifying needs of the congregation, coordinating health screenings, providing educational programs, supplying health literature and referring congregants to supportive health services where appropriate. Also, the parish nurse maintains an active visitation program to parishioners who are homebound, hospitalized or in nursing homes. Currently, there are dozens of churches in Northeast Tennessee and Southwest Virginia that are serviced by the Ballad Health parish nurse program. Ballad Health's Nurse Connect is a toll-free line that connects community members with experienced nurses around the clock. The nurses provide expert medical advice anytime, day or night, make referrals to a primary care provider with a location and hours convenient to the community member and referrals to a physician specialist when they need advanced local medical care. They also provide health information and resources, including health screenings and immunizations, and make referrals to urgent care clinics to see a doctor near the community member the same day. Ballad Health's Marsh Regional Blood Center supplies the blood needs of 25 medical facilities, all regional cancer centers, and local rescue aircraft across the Appalachian Highlands. This is accomplished through our collection facilities in Kingsport, Johnson City, Bristol, and mobile blood drives. CHARITABLE CONTRIBUTIONS- From its inception in February of 2018, Ballad Health made significant contributions to the community it serves totaling over $27 million to date in direct contributions and other community health improvement initiatives. A few examples from fiscal year 2021 include: contribution towards Center for Rural Health and Research Fund, contribution towards Strong BRAIN Institute, support for Milligan University's Addiction Counseling Program, support towards a Medical / Legal Partnership to improve access to health care and patient health. IMPROVING ACCESS TO HEALTHCARE SERVICES: RE-IMAGINE RURAL HEALTHCARE - Since 2010, more than 136 rural hospitals have closed in the United States, according to the North Carolina Rural Health Research Program. Compared to other states, Tennessee ranks worst in the nation, with 16 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. REOPENING HOSPITAL IN LEE COUNTY, VA - Ballad Health took significant strides towards reopening Lee County Community Hospital as a Critical Access Hospital despite impacts of the COVID-19 pandemic. During renovations of the hospital, Ballad Health staffed a new urgent care center to provide residents in the area with immediate access to care. All preparation work and renovations were completed during fiscal year 2021 in order to meet the July 1, 2021 grand reopening date. This 10-bed modern medical facility will serve the community in rural Southwest Virginia and Southeast Kentucky. GREENE COUNTY, TN CONSOLIDATION AND NEW SERVICES- During the 2018 fiscal year, the two hospitals in Greene County, Laughlin Memorial and Takoma Regional, saw combined operating losses of $11 million, with cumulative two-year losses totaling nearly $25 million. As competing hospitals in the community, both hospitals were failing financially. With Ballad Health's creation, both hospitals were consolidated into one, with the Laughlin Memorial campus being renamed Greeneville Community Hospital. Ballad Health continues to identify ways to reduce unnecessary administrative and overhead cost, improve quality, eliminate unnecessary duplication of high-cost services, and seek better supply pricing all of which further reduced the overall cost of care for patients in the Appalachian Highlands. Ballad Health has utilized the savings it has created and invested them into a population health infrastructure, Epic electronic medical record platform, provider recruitment, academics and training. STRONG Futures - In early 2021, Ballad Health announced a major investment into serving the specialized needs of pregnant women, babies and families who suffer from the pain of addiction. Ballad Health STRONG Futures is housed in the former Takoma Regional Hospital in Greeneville and provides residential and other care for pregnant women and mothers who suffer from addiction or need other behavioral health services. The program provides a range of residential and intensive outpatient behavioral health services that help ensure the strongest-possible new beginnings for women and their children. The program is unique in that children may live with the mother during treatment. Programs for financial stability, educational classes and fathers are also offered. STRONG Futures serves community members in Carter, Cocke, Greene, Hamblen, Hancock, Hawkins, Johnson, Sullivan, Unicoi and Washington counties. The STRONG Futures program has served 147 families, impacting over 800 individuals. Form 990, Part III, Program Service Accomplishments (continued): EXPANDED ACCESS TO RURAL COMMUNITIES - In addition to opening new hospitals in rural communities, Ballad Health has focused on expansion of access to other healthcare services. Ballad Health opened a new urgent care center in Banner Elk, North Carolina. This center provides convenient access to residents who previously were required to travel excessive distances for care. This clinic also serves as a convenient resource for students, faculty, and staff of a nearby college. CREATED SINGLE COORDINATED REGIONAL TRAUMA SYSTEM - One of the most significant ways Ballad Health has been able to comply with the provisions of the Certificate of Public Advantage and Cooperative Agreement, which required avoidance of duplication of services where appropriate, was the consolidation of the two Level I trauma centers operating in the region and the subsequent creation of a coordinated regional trauma system. In approving this move in advance, 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. The result of this law is a policy in Tennessee that 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, perinatal care in the Appalachian Highlands did not meet the goals of the state, with two NICUs that were not coordinated and shared volumes. Ballad Health immediately took steps to correct this after the merger, leading to 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, which provides ongoing expert neonatology coverage for the hospital, ensuring Ballad Health has neonatology provider coverage 24 hours per day. With more than 25 pediatric specialists to provide support for the Perinatal Center, this is the first time every newborn in the region has access to such highly specialized care. 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 the 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 RURAL SOUTHWEST VIRGINIA - 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, in Virginia now benefits from an orthopedist, a cardiologist and several other physicians and providers. Wythe County, in 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. CREATION OF APPALACHIAN HIGHLANDS CARE NETWORK - Unveiled a major, coordinated effort to increase healthcare access for low-income uninsured people, aiming to reduce health disparity and inequity. The new Appalachian Highlands Care Network is designed to bridge gaps, improve health and reduce avoidable healthcare cost and utilization. The program includes all Ballad Health hospitals, outpatient services and physician practices, along with a regional network of non-Ballad Health care providers and primary care services offered through regional safety-net clinics, health departments and federally-qualified health centers. The new network was adapted from Appalachian Mountain Project Access, part of a national model of care that has served parts of the Appalachian Highlands, mainly Washington County, Tennessee, for many years. In addition to more than $75 million Ballad Health spends annually providing access to care for people with serious financial limitations through uncompensated care, charity care and unreimbursed Medicaid, the health system is also making significant investments into Project Access across the health system's entire 21-county service area the entire Appalachian Highlands. LAUNCH OF NISWONGER CHILDREN'S NETWORK - Unveiled philanthropic investment of nearly $60 million into a comprehensive, regional system of care for children, families and the future of the Appalachian Highlands. The Niswonger Children's Network is a regional system of healthcare and community services marking a new phase in high standards of care and well-being for children, regardless of where they live, across Northeast Tennessee and Southwest Virginia. Form 990, Part III, Program Service Accomplishments (continued): IMPROVING HEALTHCARE QUALITY: QUALITY METRICS - Ballad Health continues to make headway in its aim of being a zero-harm, top-decile health system by improving the quality of care delivered to patients by reducing hospital-acquired infection rates and improving other key indicators related to quality care. The State of Tennessee established a scoring system in the COPA to measure key indicators related to quality care and compares those scores to a baseline figure established prior to the merger. In 2021, seven of our quality measures performed among the top decile in the country, the most in the health system's history. Those metrics included in-hospital fall with hip fracture rate, post-operative sepsis rate and perioperative hemorrhage or hematoma rate, among others. These quality metrics were achieved during a time when COVID-19 had a terrible impact on hospital operations, while associated infections and complications have deteriorated nationally. FOCUS ON QUALITY - Ballad Health launched a series of initiatives, including the work of the Clinical Council, implementation of systemwide tiered safety huddles and bold and ambitious initiatives like "30 in 90" reducing infections by 30% over 90 days that target hospital-acquired infections like Clostridioides difficile (C. diff), Catheter-associated Urinary Tract Infections (CAUTI), surgical site infections and others. Not only did Ballad Health achieve its goal of reducing the number of C. diff cases by 30% within 90 days, the reduction in C. diff cases has continued as Ballad Health has now reduced C. diff cases by 70% since the program's inception. As part of Ballad Health's systemwide initiative to improve safety and reduce harm, Ballad Health has continued its tiered-safety huddle program throughout the pandemic, which continues to grow in popularity among frontline caregivers. Any issues identified during those huddles are elevated to hospital leadership. If hospital leadership cannot resolve the issue, the issue is further elevated to the market level and then to the corporate level. Using this approach, Ballad Health can improve outcomes and enhance safety by rapidly deploying resources to support and solve safety issues as they arise. PARTICIPATION IN THE MEDICAID TRANSFORMATION PROJECT - Ballad Health and a group of the nation's leading health systems joined forces to identify ways to better care for some of the nation's most vulnerable populations. The project is a national effort to transform healthcare and address social determinants of health for the nearly 75 million Americans who rely on Medicaid. The work focused on four keys areas of opportunity: behavioral health, child and maternal health, substance use disorder and avoidable emergency department visits. PARTICIPATION IN THE HIGH-VALUE CARE COLLABORATIVE - Ballad Health was chosen for a national initiative, The High-Value Care Collaborative, a partnership of the American Hospital Association, the American Board of Internal Medicine Foundation's Choosing Wisely campaign, and the Costs of Care organization. The High-Value Care Collaborative brings together participants to improve efficiency, decrease cost and improve quality in healthcare. During the past year, Ballad Health and other participants in the program adopted strategies to reduce unnecessary cost and deliver evidence-based care that has been demonstrated to reduce the burden on patients. INVESTMENTS: COMMON ELECTRONIC HEALTH RECORD - Ballad Health continued building on prior progress around a common electronic medical record. An implementation plan was developed to include infrastructure enhancements to support the expansion. This investment of over $200 million will allow patient information to be shared immediately at the point of service regardless of where a patient enters the Ballad Health system, providing clinical staff with information to better manage patients in the emergency room, clinics, acute and post-acute settings. In the midst of, and despite the global health pandemic, on October 1, Ballad Health successfully completed the acute care phase of the transition. This new common platform will provide patients and their doctors with new options for access, care and security of patient records unprecedented in Ballad Health's service area. This concluded a multi-year effort to transition to a single patient record platform. With this accomplishment, Ballad Health expects to optimize its connectivity to consumers, improving the patient experience dramatically. Ballad Health's conversion to a single technology platform, is just the first of many steps the system is taking as part of its digital transformation journey. Last year, Ballad Health launched an app for patients, giving them direct access to new services, including real-time scheduling, digital access to health information, price transparency and better coordination between providers, regardless of their location. More than 150,000 Ballad Health patients use the Ballad Health app, with thousands joining each month. CHARITY CARE CONTRIBUTIONS - For 2021, Ballad Health provided more than $80 million in free care, cost that is not reimbursed by any payer nor recovered from the patient who qualifies for charity assistance. Following the merger, Ballad Health increased the threshold for patients to qualify for charity care from 200% of the federal poverty level to 225% of the federal poverty level and provides significant discounts for people up to 450% of the federal poverty level. ACCOUNTABLE CARE ORGANIZATION SAVINGS - Ballad Health was among the first health systems to implement and successfully demonstrate that value-based care led to reduced costs through its Accountable Care Organization (ACO), AnewCare Collaborative. Value-based care means payments for healthcare are based on the quality of care provided and in the reduction of the total cost of care. Since the United States Centers for Medicare and Medicaid Services established the shared savings program six years ago, AnewCare has been one of only 18 ACOs in the nation to generate savings for taxpayers each year saving taxpayers more than $60 million since inception. MEDICAL EDUCATION - Ballad Health continues to offer free Certified Nursing Assistant (CNA) classes, which are open to the public. The CNA courses are approved and regulated by either the Tennessee State Board of Nursing or the Virginia Board of Nursing. The training opportunity can lead to career opportunities for those who complete the program. Ballad Health offers the course free of charge and participants who successfully complete the course meet criteria to sit for the state certification examination. The program includes classroom sessions followed by clinical experience. Clinical hours are conducted at various Ballad Health facilities. RESEARCH the Ballad Health research department serves as the central source of oversight for multi-specialty research. In addition to providing full spectrum support for research studies at Ballad Health, the department also provides oversight for studies generated externally. Teaching and continuing education play a large role at Ballad Health and research staff participate in conferences/webinars and conduct a monthly research orientation sessions. The research department has participated in several large-scale, multi-center trials with a high subject retention rate and sponsor/monitoring rating. Oversight services include administrative, legal, regulatory support, internal service arrangement and financial management. The department maintains reportable metrics and financial reports on a quarterly basis. The focus for principal investigators is mostly in therapeutic areas such as oncology, neuro/trauma/ortho, pharmacology, endocrinology, pediatrics, and cardiology. A variety of studies include different designs that may include, but are not limited to, pharmaceutical/investigational trials, retrospective medical chart reviews and registry studies. The research department is dedicated to: *providing consistent oversight and management of clinical research performed at all Ballad Health facilities, *ensuring regulatory compliance and fiscal responsibility, and *creating a research culture across Ballad Health facilities Form 990, Part III, Program Service Accomplishments (continued): OTHER NOTABLE EVENTS AND AWARDS: *Recognized by Forbes Magazine as being a top employer for diversity and inclusion ranked 29th in the entire nation and fifth among employers in the "Healthcare and Social" industry. *Earned the College of Healthcare Information Management Executives (CHIME) Digital Health Most Wired recognition. *Smyth County Community Hospital earned CMS 5 Star rating for patient experience. *Ballad Health provided support to build the Miracle League Field at Brickyard Park in Kingsport, TN that provides opportunities for children and adults with both mental and physical disabilities to play baseball on a safe, smooth, cushioned field. It is the only field of its kind in Northeast Tennessee. *Received its Accreditation/Department of Distinction from the International Association for Healthcare Security & Safety (IAHSS). *Partnered with East Tennessee State University (ETSU) to launch Strong BRAIN Institute to study adverse childhood experiences. The Strong BRAIN (Building Resilience through Adverse Childhood Events -Informed Networking) Institute facilitates the development and dissemination of evidence-based practices that prevent, reduce or mitigate the negative effects of Adverse Childhood Events (ACEs) on health and health disparities. The Institute will also work to inform the citizenry and workforce in the Appalachian Highlands on the importance of being trauma informed. Established through a five-year gift from Ballad Health to ETSU, the Strong BRAIN Institute will be guided by an advisory board comprised of ETSU experts, Ballad Health experts and community members. *Recognized by Harvard University and UnitedHealthcare as one of four healthcare organizations leading the way towards a 3D model for value-based care. *Partnered with Mayo Clinic, in response to the COVID-19 Pandemic to conduct research into convalescent plasma as an experimental treatment. 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 Part VI, Line 15a Compensation Process for Top Official: The executive compensation committee serves as the compensation oversight committee of Ballad Health's Board of Directors. The executive compensation committee is comprised of members who are determined to be independent and whom are not reliant upon any business relationship with Ballad Health for income or compensation. The compensation plan for Alan Levine, Ballad Health's Chairman, President and CEO, was reviewed and approved by the executive compensation committee and then by the Ballad Health Board of Directors in accordance with the Board's compensation policy and practice. The Board of Directors relies upon the advice of an independent and experienced compensation consultant with knowledge about pay practices for comparable positions within the industry, and who has access to broad data, studies and surveys in order to ensure the compensation falls within competitive and appropriate ranges for the position. Part VI, Line 15b Compensation Process for Officers & Key Employees: The executive committee reviewed and approved compensation for all Ballad Health executives at the vice-president level and above during FY21 using the same methodology used to determine the CEO's compensation. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics approved by the Ballad Health Board of Directors which include Quality of Care, Access to Care, Cost Management, etc. 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 COVID - 19: Program service expenses 1,206,210. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,206,210. Consulting: Program service expenses 0. Management and general expenses 1,340,301. Fundraising expenses 0. Total expenses 1,340,301. Contract Labor: Program service expenses 1,762,877. Management and general expenses 472,118. Fundraising expenses 0. Total expenses 2,234,995. Mars Julia Davis Collection Center: Program service expenses 2,027,507. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,027,507. COPA Compliance: Program service expenses 0. Management and general expenses 789,172. Fundraising expenses 0. Total expenses 789,172. Other: Program service expenses 3,652,303. Management and general expenses 7,210,495. Fundraising expenses 0. Total expenses 10,862,798. Form 990, Part XI, line 9: Change in Fair Value of interest Rate Swap 4,145,652. Elimination of Intercompany Rec/Pay 135,859,436. Other Acquisition -4,797,264. Temp. Restricted Grants 14,890. 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