2020-07-15T14:49:45-07:00 2019-06-30 990 2018-07-01 510603966 Takoma Regional Hospital Inc dba Greeneville Community Hospital TAKO 4233023374 1021 W Oakland Avenue Suite 103 Johnson City TN 37604 Tammy Albright CEO-GCH 2020-07-15 2018 2020-09-23 17:36:50Z X Tammy Albright 1420 Tusculum Boulevard Greeneville TN 37743 58288740 false false X balladhealth.org X 2006 TN Mission: Honor those we serve by delivering the best possible care. Vision: To build a legacy of superior health by listening to and caring for those we serve. 4 0 597 92 9466 7619 346073 41233 57036021 57380162 46440 186196 3310992 597438 60739526 58205029 2100 21175 0 34912746 40133525 0 0 29807269 33457199 64722115 73611899 -3982589 -15406870 32494699 169822344 3656439 18801170 28838260 151021174 X Honor those we serve by delivering the best possible care. false false 61182416 21175 57502506 See Schedule O 61182416 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false false false false true false false false true 26 0 true 597 true true true false false false false false false 0 false false false false false false false false false false false false X 4 0 false false false false true true true true true false false true true true true true true false false false TN VA X Lynn Krutak 4233023374 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Alan Levine BH President CEO President 1.00 59.00 X X 0 2032246 193444 Marvin Eichorn BH EVPCAO Director 1.00 59.00 X 0 1011865 36694 Tim BelisleBH EVPGen Counsel Sec./Treas. 1.00 59.00 X X 0 577064 79532 Eric Deaton BH EVPCOO Director 1.00 59.00 X 0 570270 42955 Tammy Albright CEO-GCH 30.00 15.00 X 227202 0 30915 Judith Clark end 81818 CFO-GCH 40.00 0.00 X 90212 0 26160 Lindsay Haun start 81918 CFO-GCH 0.00 40.00 X 0 81017 19020 Chris Miller start 20319 COO-GCH 40.00 0.00 X 0 147026 24149 Joseph Kretschmar MD Physician 40.00 0.00 X 587259 0 42422 William Bridges MD Physician 40.00 0.00 X 528297 0 40697 Jami Goodwin MD Physician 40.00 0.00 X 408728 0 35702 Beth Bulawa MD Physician 40.00 0.00 X 405633 0 41688 Howard Herrell MD Physician 40.00 0.00 X 397589 0 38151 Barton Hove Former Officer-Retired 0.00 0.00 X 0 1296774 17936 Todd Dougan Former Officer-Retired 0.00 10.00 X 0 488595 18367 Gary Miller Former Officer 0.00 50.00 X 0 347667 30404 2644920 6552524 718236 41 true true false Solstas Lab Partners PO Box 751337 Charlotte NC 28275 Lab Services 383199 1 41233 41233 340B Program 900099 5738180 5738180 Hospital Patient Revenue 900099 50973686 50973686 P/S Business Income 541900 117156 117156 Rent to T/E Affiliates 900099 25802 25802 Wellness Programs 900099 525338 525338 57380162 73318 73318 0 0 301241 74736 226505 226505 226505 121853 8975 112878 112878 112878 0 0 0 Cafeteria & Vending 722514 202406 202406 Gift Shop/Hair Salon 900099 19243 19243 Revenue From Parent 900099 132606 132606 16678 9466 7212 370933 58205029 57493040 9466 661290 X 21175 21175 0 0 0 487331 487331 0 31790199 29386759 2403440 958040 827857 130183 4982755 3662260 1320495 1915200 1882466 32734 0 15366 2132 13234 0 0 0 3413 2796 617 13251460 9988106 3263354 99194 1718 97476 1089685 999579 90106 901813 324067 577746 0 3208989 3086420 122569 118529 103679 14850 0 0 25260 25260 0 1800523 1713697 86826 -345087 -354856 9769 Medical Supplies 7263413 7263413 Management Fees 3455431 3455431 Maintenance 1329842 1321998 7844 Taxes - UBIT 14146 11589 2557 1225222 937561 287661 73611899 61182416 12429483 0 3662160 8512545 0 0 10166678 25540292 0 0 799101 35899 1269767 3426715 124468 632599 48500957 9137867 13964561 39363090 0 0 916245 2507964 2507964 88886995 32494699 169822344 3043192 12855880 297513 259146 613247 5388631 3656439 18801170 X 28838260 151021174 28838260 151021174 32494699 169822344 X -15406870 541 137589243 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 1023 false false false 1023 false false Part II-B, Line 1i - Other Activities Description Takoma Regional Hospital, Inc. had lobbying expenses of $1,023 which represents the portion of dues paid to Tennessee Hospital Association attributable to direct lobbying. 5686171 5686171 29059850 2254594 26805256 11845416 6124470 5720946 1909520 758803 1150717 39363090 AWUIL 542871 Due from Affiliates 87184632 LT Comp Investments 1104799 Other Current Receivables 54693 88886995 Due to Third Party Payors 3816898 Pharmacy, Medical, Worker's Comp 1359985 Reserve for Professional Liab. 211748 5388631 X Part X : FIN48 Footnote Takoma Regional Hospital, Inc. 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, 2019. Tax returns for 2016 through 2018 are subject to examination by the Internal Revenue Service." true true X true X 225.000000000 true X 450.000000000 true true false false false false 1313435 1313435 0.01780 8431523 4040253 4391270 0.05970 9744958 4040253 5704705 0.07750 186208 13301 172907 0.00230 137380 137380 0.00190 3236 2208 1027 7500 7500 0.00010 334324 15509 318814 0.00430 10079282 4055762 6023519 0.08180 18697 18697 0.00030 18697 18697 0.00030 true 1222508 452328 11854106 15874146 -4020040 X true true Greeneville Phy Svcs LLC Medical Services 0.75000 0.25000 2 1 Greeneville Comm Hosp-East 1420 Tusculum Boulevard Greeneville TN 37745 balladhealth.org/locations 0000000054 X X X A 2 Greeneville Comm Hosp-West 401 Takoma Boulevard Greeneville TN 37743 balladhealth.org/locations 0000000054 X X X A A false false true X X X X X X X X X X 19 true true false true X balladhealth.org/locations#hospitals X true 16 false true false true X 225.0000 450.0000 X X X true true X X X X true X balladhealth.org X balladhealth.org X balladhealth.org X X X X X X true X false X X X X true X false false Facility: A - Part V, Section B, Line 3j Facility/Group A includes the following hospital campuses:Greeneville Community Hospital-East and Greeneville Community Hospital-WestDuring FY19, Takoma Regional Hospital, Inc. d/b/a Greeneville Community Hospital operated under the FY16 CHNA approved by its board of directors at the end of FY15. Priorities established for our CHNA were determined by the most significant health needs of the community. GCH conducted their FY19 CHNA this tax reporting period with board approval and publication occurring during late FY19. For the FY18 CHNA, Ballad Health and its hospitals and entities agreed to focus on an index of 25 active population health index measures (plus an additional 31 measures for monitoring). The population health index itself is based on the focus areas outlined in the previous FY15 CHNA and align with national health improvement efforts, such as Healthy People 2020. Wellmont Health System and its hospitals, Mountain States Health Alliance and its hospitals, focused on the same population health index measures determined by Ballad Health, our health system's parent, when completing their individual FY19 CHNA's.To understand each communitys 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.The CHNA community members for each facility evaluated measures that make up Ballad Healths population health index and a few additional measures related to access to health screenings. The groups members completed a survey relative to what health priorities should be a focus for their specific community over the next three years. After all the details and data collection was complete and interviews with various focus groups were complete, representatives identified four top focus areas:-Smoking-Physical activity/obesity -Substance abuse/mental health-Maternal/infant health Facility: A - Part V, Section B, Line 5 Information for the CHNA assessment was gathered from a variety of sources, including:- Physician needs assessment- Community health facility assessment- Mental health needs assessment- Publicly available population and demographic information- Publicly available population health information, including America's Health Rankings and the County Health Rankings- State and regional health department data- The Southwest Virginia Health Authority's Blueprint for Health Enabled Prosperity- The ETSU, Wellmont, Mountain States Community Work Group Project- Other studiesSignificant information was gleaned from a process conducted by the ETSU College of Public Health and supported by both Wellmont Health System and Mountain States Health Alliance. Community workgroups were formed, involving a cross section of subject matter experts to assess regional health needs, including those of underserved people, families, children and those suffering from mental health and substance abuse challenges. Regional meetings were also held which included representatives of the community at large, patients and minorities or agencies serving them.Findings from this work were taken into account in both the assessment and implementation plan. The information was then collated and assessed to determine the greatest unmet health needs facing our region. Strategies to address these needs were then developed, utilizing internal resources and partnerships with other health care organizations and physicians. Facility: A - Part V, Section B, Line 6a The community health needs assessment conducted by Greeneville Community Hospital (GCH) was based upon the hospital's involvement and enrichment of those who live within Greene County, Tennessee. The primary service area is shared by GCH-East (Laughlin Memorial Hospital) and GCH-West (Takoma Regional Hospital, Inc.) and thus the community health needs assessment was completed in cooperation with both hospitals. Facility: A - Part V, Section B, Line 11 Key findings noted during the FY16 CHNA were the low rankings of the counties we serve in several categories related to health and wellness, including prevalence of chronic disease management, tobacco use, diet and exercise, as well as a need for expanded and enhanced mental health services. They also emphasized the vulnerability of our underinsured and uninsured populations, and that if our communities are to thrive, we must focus on encouraging healthy children and families.Greeneville Community Hospital operates a diabetes treatment center. The center offers diabetes services and free educational programs. Dietitians, nurses and certified diabetes educators teach about topics such as preparing nutritious meals, tracking blood sugar, reducing diabetes' long-term effects, and other diabetes related topics.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.To help meet these needs, Greeneville Community Hospital will continue to strengthen our partnerships and continuum of care opportunities with area health departments, Federally Qualified Health Centers, and Frontier Health, the region's leading provider of behavioral health services. Facility: A - Part V, Section B, Line 13h The Ballad Health financial assistance policy allows for some exceptions to strictly adhering to federal poverty guidelines when awarding financial assistance. Unique circumstances may be weighed and assessed for financial assistance consideration on a case-by-case basis. Also, there are some services where financial assistance may be provided outside of federal poverty guidelines. These are noted in Ballad Health's financial assistance policy. Ballad Health Medical Associates FKA Takoma Med Assoc 438 E Vann Road Greeneville TN 37743 Physician services Laughlin Healthcare Center 801 E McKee Street Greeneville TN 37743 Nursing home BHMA OBGYN & Womens Health-Greeneville 1021 Coolidge Street Suite 2 Greeneville TN 37743 Outpatient clinic Greeneville Occupational Medicine 1021 Coolidge Street Suite 4 Greeneville TN 37743 Outpatient clinic BHMA Pediatrics-Greeneville FKA KidsFirst Pediatrics 5000 Monarch Pointe Greeneville TN 37745 Outpatient clinic Takoma Center for Sleep Disorders 1024 Coolidge Street Greeneville TN 37743 Outpatient clinic Takoma Outpatient Rehabilitation 108 W Summers Street Greeneville TN 37743 Rehabilitation services Takoma Outpatient Rehabilitation 1321 Tusculum Boulevard Greeneville TN 37743 Rehabilitation services BHMA Behavioral Health-Greeneville 303 Takoma Avenue Greeneville TN 37743 Behavioral health services BHMA General Surgery-Greeneville West 1404 Tusculum Boulevard MOB 3 Suite Greeneville TN 37745 Surgical services Greeneville Community Hospital Outpatient Therapy Svcs 1404 Tusculum Boulevard MOB 3 Suite Greeneville TN 37745 Outpatient clinic Wound Care Center Greeneville Community Hospital 1406 Tusculum Boulevard MOB 2 Suite Geeneville TN 37745 Outpatient clinic BHMA Family and Internal Medicine 1021 Coolidge Street Suite 3 Greeneville TN 37743 Outpatient clinic Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) 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 Healths 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 hospitals charity write-offs exceed the hospitals charity budget.All Ballad Health hospitals provide an uninsured discount; the current uninsured discount is 77%. 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 our 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, we have 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 - Explanation of Costing Methodology 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 and line 7b TennCare and Medicaid losses. 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 nursing, pharmacy, and therapy students) with schools and universities, allowing their health profession students to get hands-on training in a hospital setting. The Ballad Health Clinical Education Department (CE) maintains records for the non-Medicare programs. CE keeps records of the number of students receiving training at our hospitals and the amount of hours the students spend at our hospitals. Hours may differ based on the school and the type of program (RN, radiology, lab, etc.). The number of team members that provide training to students will also vary based on where the student is training. For example, an RN trainer on a medical floor may have 3 or 4 students under his/her direction, while an RN trainer in a specialty area such as ICU or the ER may be training one-on-one with a single student. We only include labor costs for our hospital team members that provide training (i.e. no overhead is applied) and we only attribute a percentage of our team members time to actual training. For line 7g subsidized health care services, we use our cost accounting system because we have established standard costing reports for these services. We are careful to ensure no double counting of cost. Although we have other service lines within our hospital that lose money, we do not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7h research represents GCH's expense allocation from Ballad Health for research. Line 7i cash and in-kind contributions include cash disbursements and an in-kind donation of land to local nonprofit organizations. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense Self-pay balances include accounts after payments and contractual adjustments (discounts) have been applied from all third-party payers such as Medicare, Medicaid, commercial insurers, and others - generally leaving the patient responsible for any remaining deductible and/or co-payment. Other self-pay accounts are from patients with no insurance or other third-party coverage. Under Ballad Healths system-wide self-pay policy, any patient who has no insurance and is ineligible for any government assistance program received a 74% discount until September 30, 2018, at which time the uninsured discount increased to 77%. Many self-pay patients will further qualify for financial assistance (sometimes referred to as charity care) if they provide the financial information we need to deem them eligible.After the normal collection process has indicated an account is uncollectible, GCH 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 - Methodology of Estimated Amount & Rationale for Including in Community Benefit Our primary external collection agency estimates that 37% of GCHs bad debt would likely qualify for financial assistance if patients had provided our hospitals with a financial assistance application and required documentation. The agency based their likely eligible for charity assumption on individuals with a low score. An individuals score is based on an algorithm that includes data points such as FICO credit score, property value, years at current residence, number of times an individual has moved and an individuals propensity to pay score. Just over 41% of completed financial assistance applications processed during FY19 received a full discount (complete write-off). An additional 10% received a partial discount, resulting in an overall approval rate of 51% for completed applications. Therefore, 49% of completed financial assistance applications were denied. Unfortunately, many patients either do not submit an application for financial assistance or do not provide a complete application. A letter is sent to the patient outlining missing information on incomplete applications. The letter also provides a contact phone number patients may call for assistance in completing the application. All self-pay patients receive follow up calls from a company WHS pays to process charity care applications for uninsured patients and to offer patients enrollment assistance in Medicaid (VA) or TennCare (TN). The follow up calls are as follows: every 31 days, 31-60 days up to 3 calls are made, after 60 days up to 2 additional calls are made. Our financial counselors follow up with patients that have a balance after insurance has paid. We have many instances of patients with large account balances and no health insurance coverage that we believe 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 will qualify for financial assistance under our program. Without a completed application, we have no choice other than to record an unpaid account as bad debt instead of charity care. Part III, Line 4 - Bad Debt Expense Ballad Healths audited financial statements include a footnote on page 13 that describes bad debt. GCH is included in the June 30, 2019 audited financial statements of Ballad Health (attached). Part III, Line 8 - Explanation Of Shortfall As Community Benefit Excluding Medicare losses reported in Part I subsidized health, the Part III Medicare loss is reported using GCH's filed Medicare cost report (C/R). The C/R uses a cost to charge ratio based on a step-down allocation methodology. We believe Medicare losses should be allowed as a reportable community benefit, similar to governmental programs such as Medicaid. As a participating provider in the Medicare program, hospitals are required to provide the full regimen of care for the Medicare population. There are a number of care regimens that are compensated by the Medicare program at levels below cost. Therefore, it is only logical to allow hospitals to report these uncompensated services as a community benefit. By making this change, nonprofit providers will be encouraged to continue important care delivery models for our aging population in spite of the fact it may be economically injurious. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients 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 patients 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.Our collection policy clearly states that all patients are treated equally - with dignity and respect. We ensure that outside collection agencies used by our hospitals adhere to our billing and collection guidelines. Our collection program includes communicating expected financial responsibility prior to service. Our 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 Medicaid or TennCare.After insurance benefit verification, our 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. Our hospitals provide a number of payment options:- a pre-service discount may be offered- a discount in excess of established discounting rates may be granted for catastrophic high dollar accounts- our 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- 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 our financial assistance policy. Part VI, Line 2 - Needs Assessment Focusing on 25 active population health index measures 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 will expand partnerships so that organizations work together more to address community health needs.Ballad Health developed a comprehensive process to gather input for and draft a population health plan last year. An executive steering team was established, aided by national experts with experience in large-scale population health improvement. Because our hospitals are located in a region with many chronic disease challenges, Ballad Health's goal is to target population health issues to make lasting improvements. Ballad conducted approximately 150 interviews and held 40 meetings with external groups, including the regional health departments, United Way agencies, chambers of commerce, schools and community organizations, the regional accountable care community steering committee, as well as internal groups such as our population health and social responsibility committee of the Ballad Health board of directors, the Ballad Health population health clinical committee, and our hospital community boards. Part VI, Line 3 - Patient Education of Eligibility for Assistance Consistent with the Ballad Health financial assistance policy, GCH communicates with and provides education to our patients through various avenues regarding governmental assistance programs and hospital financial assistance. Various educational and application documents related to obtaining financial assistance are widely available at WHS and all documents are available on the Ballad Health website. Printed financial assistance educational materials are part of each registration packet and posters are displayed in highly visible areas of the hospital. Our financial assistance policy and documents are available in our emergency departments and admitting areas. We are also happy to mail all documents to patients. We offer a plain language summary and all of our documents are available in English and Spanish. Financial assistance information is available during pre-registration, registration and/or during financial counseling. We offer governmental program eligibility representatives to assist patients in securing eligibility for Medicaid or TennCare, federal disability and other governmental assistance programs. Additionally, if a patient or community resident expresses an interest in the ACA healthcare exchange, our representatives have the qualifications and experience to assist them through the entire process. Our 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. Our 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 - Community Information Greeneville Community Hospital campuses are located in Greeneville, Tennessee (Greene County) on the eastern border of the state. The county is primarily rural, and the population is estimated by the U.S. Census Bureau to be 68,808. The latest census bureau data estimates the median age of residents of Greene County is 44.5 which is older than the median age of 38.9 in Tennessee. 21.3% of Greene County residents are 65 or older compared to 16% for the state. The population projections for Greene County over the next five years indicate that the county will likely experience little to no population growth overall. However, the age 65+ population for Greene county is projected to experience the most population change over the next five years. The aging population of the county presents opportunities for earlier identification and better management of health conditions that oftentimes affect elderly populations.The bureau estimates Greene County median household income at $40,100 ($34,296 for the town of Greeneville) compared to the State of Tennessee's median income of $51,300. 34.7% of Greene County's children live in poverty compared to 21% statewide.Greene County is almost 65.2% rural compared with the statewide rural rate of 33.6%. This is a significant contributing factor in influencing health outcomes in a population. Many rural residents must travel a greater distance to access different points of the health care delivery system; however, due to geographic distance, sometimes extreme weather conditions, lack of public transportation and challenging roads, rural residents may be limited, and in some instances, even prohibited from accessing health care services. Although 19% of people in the U.S. live in rural areas and 30% of the vehicle miles traveled occur in rural areas, almost half of crash deaths occur there. While our area has generally unfavorable health statistics, there are far fewer primary care physicians per resident in our county than the state's average. Our county's ratio of population to primary care physicians is 1,670:1 compared to the state's average of 1,390:1. In other words, we have 20% more residents per physician than the overall state rate. Our county's ratio of population of mental health providers is 1,150:1 compared to the state's average of 700:1. This is over 64% more residents per mental health provider than the overall state rate. Recruiting physicians to rural areas is often challenging due to a myriad of factors, such as geography, economics, culture and education. Geographically, rural communities are often far removed from suburban and urban centers that provide access to education, cultural and economic opportunities. These limitations influence the relocation decision of the physician candidate and his/her spouse/children to locate to a rural area.A number of factors contribute to a unique and challenging environment that influence overall health standing in our county. According to the Robert Wood Johnson Foundation's county health rankings, 36% of the adults in Greene County are obese. Obesity increases the risk for many health conditions such as coronary heart disease, type 2 diabetes, hypertension, stroke, cancer, sleep apnea and respiratory problems, and osteoarthritis. Evidence indicates physical activity, independent of its effect on weight, has substantial benefits for health. Our county's inactivity rate of 34% is 26% higher than the statewide rate and resident's access to exercise opportunities is 39% less than the state. According to the 2019 County Health Rankings, Greene County is ranked 50 out of 95 in Tennessee for health outcomes and 52 in health behaviors. As for social and economic factors, Greene County ranks 47 primarily due to high rates of children in poverty and above average unemployment rates. Part VI, Line 4 - Community Building Activities GCH 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 GCH 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. We do not capture costs associated with team members that serve on other nonprofit boards or provide services to other nonprofits.Part II, Community Building Activities, Line 3 - Community SupportGCH promoted the health of the communities it serves through various community building activities in FY19. Some examples include:Boys & Girls Club of Greeneville & Greene County offered a safe place for kids, positive programs and provided caring adults to supervise the youth of our community. Net community building expense was $8,800. A donation of $6,250 was given to Greene Leaf, a program of the Greene County Local Educational Advancement Foundation, for a technology campaign. Their mission is to serve as an advocate for creating a premier educational environment for the students of Greene County, Tennessee. Several GCH team members support local nonprofits by attending quarterly meetings of the Healthy TN Community and Community EMS Board meetings. Net community building expense was $2,022.United Way provides transportation assistance for cancer patients who cannot afford to get to frequent treatments and might miss treatments and support with nutritional supplement they could not otherwise afford and provides financial assistance to Greene County residents who sruggle with speech and hearing disorders as they seek treatment. United Way also supports four other specific programs to promote early childhood reading and education, learning health education to support better health through education. Net community building expense was $1,500. Part VI, Line 5 - Promotion of Community Health GCH is dedicated to operating efficiently so that waste is minimized. GCHs leadership remains mindful of managing limited resources so that adequate facilities and equipment are available for the care of our patients. Surplus funds are invested into improving treatment options for our patients through new technologies, recruiting physicians and trained staff in shortage areas, and improving our facilities. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary.GCH campuses have Medicare-approved health profession education programs. In addition, GCH campuses 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 our hospitals. We devote resources to health conferences for local health professionals and offer other programs focused on improving the health of our residents. While we operate in a predominantly low-income, rural area, we continue to offer services that operate at a loss to GCH because residents would otherwise need to leave their home town or county to receive needed care.Physicians that request privileges who are qualified and credentialed are extended privileges by GCH. Part VI, Line 6 - Affilated Health Care System Greeneville Community Hospital is a two campus hospital in Greeneville, Tennessee which includes Greeneville Community Hospital-East and Greeneville Community Hospital-West and one of the hospitals within the Ballad Health system. Ballad Health operates a family of 21 hospitals, including three tertiary care facilities, a dedicated children's hospital, 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.Patients benefit from GCH's affiliation with a healthcare system where they can be efficiently moved along an integrated, comprehensive continuum of care as their health status dictates. If needed, patients can be moved to one of Ballad Health's tertiary care facilities providing advanced treatment options.Wellmont Health Systems merger with Mountain States Health Alliance opened up many opportunities not previously available to two competing health systems. Collaboration started post-merger and we continue to see progress towards improving efficiencies within our health system, activities consistent with Ballad Healths 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 physician 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.Across GCH campuses, there were many projects, programs and collaborative efforts that took place during the year. Some examples include:- A plan was approved to adopt an integrated technology platform bringing all of our hospitals and points of service together as an integrated system- Opioid prescribing reduction across all WHS hospitals- WHS hospitals shared successful achievements from value optimization team projectsSince our 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 - States Filing of Community Benefit Report TN VA Part VI - Additional Information Ballad Health is required to report community benefit estimates on a quarterly basis with the states of Tennessee and Virginia. The reporting includes all of Ballad's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad operates under a Cooperative Agreement (CA) in Virginia and a Certificate of Public Advantage (COPA) in Tennessee as obligated by agreements between Ballad Health and the two states to allow Wellmont Health System and Mountain States Health Alliance to merge. true Boys & Girls Club PO Box 1977 Greeneville TN 37744 621706248 501c3 8800 0 Sponsorship Greene LEAF PO Box 1253 Greeneville TN 37744 454418460 501c3 6250 0 Technology campaign 2 0 Grantmaker's Description of How Grants are Used 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 false true false false false false false false false false Alan Levine BH President CEO President 1101957 750000 180289 172174 21270 2225690 150202 Barton Hove Former Officer-Retired 246667 161333 888774 9467 8469 1314710 Beth Bulawa MD Physician 310677 57662 37294 18646 23042 447321 Chris Miller start 20319 COO-GCH 144738 2288 8931 15218 171175 Eric Deaton BH EVPCOO Director 497063 40165 33042 26522 16433 613225 Gary Miller Former Officer 301352 39377 6938 18235 12169 378071 Howard Herrell MD Physician 390943 6646 17064 21087 435740 Jami Goodwin MD Physician 369549 19517 19662 16734 18968 444430 Joseph Kretschmar MD Physician 293487 287364 6408 19673 22749 629681 Marvin Eichorn BH EVPCAO Director 678984 300000 32881 12241 24453 1048559 Tammy Albright CEO-GCH 212627 13630 945 11201 19714 258117 Tim BelisleBH EVPGen Counsel Sec./Treas. 400672 161656 14736 56640 22892 656596 Todd Dougan Former Officer-Retired 446194 35385 7016 6061 12306 506962 William Bridges MD Physician 308912 182891 36494 18365 22332 568994 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Wellmont Health System is Takoma Regional Hospital, Inc.'s (TRH) sole member. The board of directors of Ballad Health, Wellmont's parent organization, serves as Wellmont's board of directors and is responsible for appointing the directors of TRH's board.Takoma Regional Hospital's Board of Directors are responsible for:- Development and establishment of the organization's policies and strategic plan,- Development and approval of the organization's annual capital and operating budgets,- Regular review of the organization's financial performance,- Annual review of medical staff competency standards, and- Regular review of the organization's Corporate Compliance Plan. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Following the merger of Takoma Regional Hospital, Inc.'s sole member, Wellmont Health System, and Mountain States Health Alliance in February 2018 to form Ballad Health, the newly appointed Ballad Health Board of Directors assumed board responsibilities for Wellmont and Mountain States. Both Wellmont and Mountain States remain separate legal entities. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders Certain decisions of the board are, pursuant to charter, subject to approval of the member. No ordinary, day-to-day decisions are subject to member approval. Form 990, Part VI, Line 11b: Form 990 Review Process The President of Greeneville Community Hospital reviewed the Takoma Regional Hospital, Inc.'s Form 990 with the Board of Directors prior to filing. The return was made available to each board member in an electonic format prior to the review. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts 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, including Takoma Regional Hospital, Inc. 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 delcare 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 delcare the conflict. While each member of the board or board committees are 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, Line 19: Other Organization Documents Publicly Available 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. Other Changes In Net Assets Or Fund Balances - Other Increases Acquisition of Laughlin Memorial Hospital (eff. 4/1/19) = $63352051 Other Changes In Net Assets Or Fund Balances - Other Increases Intercompany debt forgiveness = $74368823 Other Changes In Net Assets Or Fund Balances - Other Decreases Premier Healthcare partnership income-not on books = -$126622 Other Changes In Net Assets Or Fund Balances - Other Decreases Premier Healthcare partnership interest income-not on books = -$5009 AWARDS AND RECOGNITIONS All the GCH campuses are accredited by The Joint Commission (TJC). TJC is an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States. TJC is the nations largest standard-setting and accrediting body in health care. Joint Commission surveyors visit accredited health care organizations a minimum of once every 39 months to evaluate standards compliance. All regular Joint Commission accreditation survey visits are unannounced. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects on an organization's commitment to meeting certain performance standards.GCH is also accredited by the Commission on Cancer, a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MSQUIP) achieving a Low Acuity Center accreditation, and American Academy of Sleep Medicine (AASM) achieving H-3 reaccreditation. The security, safety & emergency management force at both Ballad Health and GCH has been recognized by Security magazine as part of the 2018 Security 500 rankings. Security magazine remarked: We are recognizing your organization for your safety and security policies and efforts to keep patients, staff and visitors safe. Our team has been monitoring your work in this area, and we wanted to recognize you. CHARITY AND OTHER UNREIMBURSED COSTS While reimbursement for healthcare services rendered is critical to the operation and sustainability of the organization, GCH recognizes its obligation to provide care to individuals who cannot afford essential medical services, including emergency care. GCH accepts all patients regardless of their ability to pay. A patient is classified as a charity patient when they meet the established policies of Ballad Health and guidelines outlined by the federal government. However, financial assistance decisions are not solely based on income. Unique financial circumstances are weighed with verified patient assets which can determine financial assistance eligibility. It is not until after verification of income and assets that a decision regarding the amount of financial assistance can be made. In fiscal year 2019, GCH incurred a loss of $1,313,435 attributable to the provision of charity care. This amount does not include the costs associated with accounts classified as bad debt. TENNCARE/MEDICAID: GCH provides care to persons covered by governmental programs, such as TennCare (Tennessee residents) and Medicaid. GCH incurred a loss of $4,391,270 providing care to this population of patients during the year.UNINSURED DISCOUNT: Uninsured patients received a 74% discount through September 30, 2018, at which time the uninsured discount increased to 77%. The uninsured discount is applied to all uninsured patients at GCH. Certain elective procedures are not eligible for the uninsured discount. The uninsured discount is calculated each year in accordance with Tennessee regulations and without regard to a patient's income or assets. Although the uninsured discount is not required by the Commonwealth of Virginia, Ballad Health applies the same discount to hospitals located in Virginia. The approximate cost of this discount in FY19, using a cost to charge ratio, was $1,951,632 for the hospitals included in this Form 990 return. COMMUNITY CONTRIBUTIONS As the largest employer in the region, Ballad Health is one of the areas principal benefactors and has made corporate citizenship an integral part of its culture. From system-wide initiatives to GCH campuses and individual efforts of caring team members, the aim is to enrich the communities that it serves. GCHs commitment includes direct financial contributions that support community healthcare needs and those non-profit agencies that advocate the health and well-being of community members.In FY19, GCH made donations to numerous health and human service organizations, social and well-being non-profits, and others within the service area.Donations to local organizations provide health care, work to increase access to health care and/or conduct research with the aim of improving health, or promote a healthy community included: - American Cancer Society, Inc.- Greene Leaf- United Way of Greeneville- YMCA of Greene County, TNThroughout the year, GCH makes contributions to local schools and organizations that provide educational, health, and social support to youth. Many of the donations to benefit young people are restricted to services focusing on healthy eating and physical activities, after school and summer programs providing at-risk children a safe environment, and literacy programs. Studies show a correlation between literacy and medical compliance/overall health. Some of the contributions to youth programs included:- Mosheim Middle School- Tusculum Athletics, Inc.- Boys & Girls Club of Greeneville and Greene County GCH also makes financial contributions to local nonprofits that provide social, economic and well-being benefits to communities served. A strong social and economic community attracts talented health care professionals and enhances the lives of community members. Some of the donations to these organizations during the year include:- Greene County EMS - $500 in-kind land donation (net book value) located at 1024 Coolidge Street, Greeneville, TN The board of directors and senior management of Ballad Health encourage team members to devote time to local community service projects, task forces, committees, boards, volunteer programs, and other charitable organizations that benefit our communities. Team members, within reason, are allowed to serve on these outside activities as representatives of GCH. Team members serve on local chamber of commerce boards as a healthcare representative, local county economic boards, participate in school health programs, assist charitable organizations with fundraising activities, speak at local clubs/churches/groups on healthcare topics, provide assistance to local organizations at Thanksgiving and Christmas, provide health education and/or first aid at local festivals, and many other predominantly health related activities. COMMUNITY RESOURCES Ballad Health supports its parish nurse program, which is designed to provide holistic ministry and special promotion services within the faith community. The parish nurse program assists individuals in gaining optimal mental, physical and spiritual health by complementing the ministry provided by pastors and other lay ministers. Some of the services and programs provided include screenings for blood pressure, cholesterol, diabetes, glaucoma and overall fitness, classes for all age groups offered on health related issues (nutrition, exercise, parenting, care for elderly parents, stress management, CPR), hospital, nursing home and home visits for assessment of health care needs, referrals to appropriate community resources and the creation of health tips in congregational newsletters, bulletin boards and other forms of communication. In FY19, WHSs parish nurse program provided 649 home visits, accompanied community members to 1,772 clinic visits and visited community members while in the hospital or nursing home on 933 occasions. The program offered 243 blood pressure screening clinics, 412 glucose screenings, 80 health fairs and one blood drive, resulting in identification and referral of 296 people with abnormal results to physician services. The program offered health education to parishioners through 329 educational sessions, 233 newsletter articles, 22 church bulletin articles and 110 bulletin board displays. The cost for GCH to provide this program was $3,140.In FY19, Ballad Health made a major change regarding air ambulance services. Ballad selected Med-Trans, locally known as Wings Air Rescue, to continue to operate four full-time bases in Elizabethton, TN, Greeneville, TN, Jenkins, KY and Marion, VA plus a base at Bristol Motor Speedway, which is active during race events. Licensed in Tennessee, Ballad Health One air ambulance provides transport of critically ill and injured patients to one of the closest tertiary hospitals in the region. Ballad Health also provided staffing, physicians, and medical supplies to the Commonwealth of Virginia for the Virginia State Polices Med Flight air ambulance service. VSP Med Flight will continue to maintain its base in Abingdon, VA. The contribution from GCH for the air ambulance services, especially critical in rural areas, was $29,090.Ballad Health offers to the community Nurse Connection, a 24-hour toll-free health information line supported by registered nurses who provide nurse triage with medically approved triage guidelines, health information and education, registration for classes and screenings, and referrals to external resources such as Poison Control and crisis intervention. The direct cost of Nurse Connection was $7,721 this year for GCH.GCH, in collaboration with area health agencies and providers, helps with coordination, advocacy and publicity, provides space, or contributes to support groups for their program activities.A leadership committee representing 24 regional organizations, along with more than 150 community stakeholder groups, has created the regions first Accountable Care Community, a collaborative group whose goal is to transform the health of a region spanning 21 counties in Northeast Tennessee and Southwest Virginia. A partnership of Ballad Health, Healthy Kingsport and the United Way of Southwest Virginia serves as the backbone of the Accountable Care Community, which uses the collective impact model to align the efforts of all sectors of a community or region to accomplish shared objectives. The Accountable Care Community will focus on supportive systems, programs and environments that nurture strong children and families to help them develop the key characteristics to succeed in life. The goals of the Accountable Care Community are to see more children succeed in school, go on to college,and have productive careers, and to enable families to succeed in overcoming generational barriers. Our area is sometimes referred to as the "diabetes belt" due to the high number of residents with diabetes. Our Diabetes Treatment Centers are accredited by the American Diabetes Association. Self-management classes, offered free of charge, are taught by specially trained registered nurses, dietitians and certified diabetes educators. For those who prefer one-on-one counseling instead of classes, the center will accommodate for that.Diabetes Treatment Center staff are also involved with hospital inpatients to help control patient blood sugar levels, assist with medication management and take advantage of a person's inpatient stay to provide diabetes education. DTC staff provide health coaching at businesses in Greene County, Tennessee, present health information to community groups, and participate in health fairs. Team members also educate teachers in various school districts about care for their students with diabetes. Our Diabetes Expo draws upwards of 300 community members each year to learn about diabetes and receive free screenings, including foot, eye, kidney, and glucose. The best way to keep our communities healthy is to provide them with the latest information about their health. GCH strives to provide information about everything from disease and injury prevention to the latest treatments and technologies available to coping with disease and its symptoms. Some of our programs during FY19 include:- Nutrition presentations were provided by our dietitian on topics such as tips for healthy eating, how to read food labels, with information pamphlets provided to participants and diabetes care management- Numerous presentations were provided to senior citizens including breast cancer diagnosis, heart health and nutrition learning sessions from our dietitianGCH team members participated in health fairs, such as:- Derby Day for Foundation - Health Fair for New Mothers- Winter Wellness Fair GCH team members are engaged in a myriad of community activities. Some examples during FY2019 include:- Two team members participated in the B.E.A.R. Buddies Reading Program - Our Director of Radiology spoke to senior citizens about breast cancer diagnosis- Four team members represent the hospital on the Healthy Tennessee Community subcommittee of the Greene County Health Council for our area- Team members assisted with the March of Dimes Community Walk Hospital meeting space is open to local organizations that support community health and wellness. Some examples include community health needs assessment committee meetings and various support groups such as diabetes, stroke, breast cancer and cancer support groups. Some of the Healthy Tennessee Community committee meetings were also held at GCH. Form 990, Part III, Line 4a - Program Service Accomplishments Greeneville Community Hospital is an acute care hospital in Greeneville, Tennessee and one of the hospitals within the Ballad Health system. Ballad Health is an integrated healthcare system serving 29 counties of Northeast Tennessee, Southwest Virginia, Northwest North Carolina and Southeast Kentucky. Ballad Health was created upon the merger of two large regional health systems, Wellmont Health System and Mountain States Health Alliance, on February 1, 2018. Through rigorous state oversight, these two competitors have been granted the ability to merge into an integrated healthcare delivery system with a simple and concise mission: to improve the health of the people we serve. On April 1, 2019, Takoma Regional Hospital, Inc. acquired neighboring Laughlin Memorial Hospital (LMH) and both facilities began doing business as Greeneville Community Hospital (GCH) with East (formerly Laughlin Memorial Hospital) and West (formerly Takoma Regional Hospital, Inc.) campuses. GCH is one hospital with two distinct campuses and part of the Ballad Health system. Greeneville Community Hospital East in Greeneville, Tennessee, is committed to providing the highest quality medical services and diagnostic medical equipment for their patients. Greeneville Community Hospital West in Greeneville, Tennessee, is providing award-winning care that is recognized nationally for quality and patient safety.By working in collaboration with each other under the umbrella of Ballad Health, the hospital campuses had a significant opportunity to better organize their services to the community by allowing each campus to specialize in specific types of services. Concentrating patient volume for certain services in one unit or facility can improve the quality of care offered and also reduces the cost of care. Significant duplication of inpatient services existed prior to the combination, creating unnecessary and duplicative cost. Through the merger that created Ballad Health, we pledged to the community and our regional employers to reduce unnecessary costs by organizing our resources in a way that makes the most sense for the community. Consolidation of services in Greene County, TN was discussed publicly prior to the merger and was pre-approved by state officials in our COPA agreement.Specific to the hospitals included in this Form 990, services were provided to: 2,172 inpatients 266,496 outpatient visits 100,430 patient encounters 20,131 emergency room visits 414 deliveries 2,002 surgical casesGREENEVILLE, TN: GREENEVILLE COMMUNITY HOSPITAL EAST (GCHE) 140-bed acute care hospital Formerly known as Laughlin Memorial Hospital Operates a 90-bed skilled nursing facility known as Laughlin Healthcare Center Services include acute inpatient services, including inpatient surgery, same-day surgery, endoscopy, ICU/PCU and obstetrics, including labor and deliveryGREENEVILLE, TN: GREENEVILLE COMMUNITY HOSPITAL WEST (GCHW) 100-bed acute care hospital through April 2019, decreasing to 27 licensed beds Formerly known as Takoma Regional Hospital, Inc. Services include inpatient rehabilitation care, psychiatric care, diagnostic imaging, outpatient laboratory services and sleep lab Form 990, Part VI, Line 15a Compensation Process for Top Officials The compensation plan for GCH's Board President and Ballad Health's President and CEO, Alan Levine, was reviewed and approved by the executive committee. An outside and independent compensation consultant was used to determine his compensation and benefits. Studies and surveys were used to ensure his pay is comparable to like positions at similarly situated organizations. 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. The review includes GCH's CEO. H/R's evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on this comparable data, Ballad Health's President & CEO evaluates the data and submits his recommendations to Ballad Health's Board of Directors for their final review and approval. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics set in advance of the pay year. Established metrics include: communication with patients, patient evidence-based care scores and patient safety, value based purchasing, etc. Form 990, Part VI, Line 15b - Compensation Process for Officers Similar to GCH's CEO, other GCH officers receive compensation that complies with Ballad Health's salary policy. Their pay is set at a market percentile specific to their positions. IMPROVING HEALTHCARE QUALITY QUALITY METRICS - Ballad Healths Board of Directors has adopted a zero-harm culture for the organization, and processes have commenced to institutionalize this objective. This focused effort on quality improvement significantly benefited patients. Specific examples include: zero infections for abdominal hysterectomy cases across the system; 47 percent reduction in pressure injury rate; 42 percent reduction in clostridium difficile infections; 39 percent reduction in iatrogenic pneumothorax rate; and 13 percent reduction in central line bloodstream infections.During FY19, there has been a 10 percent reduction in the hospital readmission rate over the prior year, and a 25 percent reduction among legacy hospitals since 2015 as evidence that physician and administrative partnership is resulting in lower cost and lower risk to patients. Ballad Health achieved the lowest readmission rate in either legacy health systems histories. ONGOING QUALITY IMPROVEMENT PROGRAMS RECEIVE PRAISE FROM NATIONAL EXPERTS - Ballad Health has instituted a comprehensive quality improvement program system-wide based on the FOCUS PDCA modela model designed to empower team members to identify opportunities for improvement and measurably implement those opportunities. These efforts are organic and driven by staff at all levels. The Ballad Health approach to quality improvement was recently praised by national experts who facilitate and assess organizational commitment to quality. For instance, in the past year, a total of 130 quality improvement projects across the system qualified at various levels of improvement for recognition, with 42 national judges evaluating the projects and awarding recognition for the results. Examples of improvement projects include: a 50 percent reduction in hospital-acquired Clostridium difficile (C.diff) across all hospitals within three months. IMPROVING THE COMMUNITY'S HEALTH STATUS Greeneville Community Hospital (GCH) is one of only 29 organizations in the country participating in the Centers for Medicare & Medicaid Services (CMS) new initiative, Accountable Health Communities Model (referred to as AHC Program), aimed at improving the health of eligible Medicare and Medicaid beneficiaries. The AHC Program is designed to integrate care for health-related social needs into usual care by implementing systematic screening, referral, and patient navigation services for needs such as food insecurity, housing instability, safety, transportation needs, and utility assistance. GCH serves as the Bridge Organization for the AHC Program locally, leading a collaborative of multiple organizations and clinical delivery sites to bring needed services to beneficiaries residing in Southwest Virginia. Full implementation of the AHC Program was achieved during FY19. Nine full-time team members, (six Navigators, one Lead Navigator, one Screening and Referral Specialist, and one Program Manager) salaries are reimbursed by federal funding. Two part-time Navigator positions remain open. Fifty-two locations in Southwest Virginia and Northeast Tennessee serve as clinical delivery sites and the capability to identify health-related social needs. Patients screening positive for health-related social needs receive a Community Referral Summary. The Community Referral Summary contains contact and program information for relevant resources to assist with the needs identified by the screening. Since formal go-live of the AHC Program on November 17, 2018 and through June 30, 2019, 61,705 screenings have been offered, 35,544 screenings answered, 9,050 needs identified, 5,030 Community Referral Summaries given, and 2,142 patients navigated to care. The above stats are inclusive of the Ballad Health hospitals in Virginia plus three hospitals in Northeast Tennessee located close to Southwest Virginia. Greeneville Community Hospital also created a data system for the screening, referral, and navigation services in lieu of the CMS AHC Data System. The internal data system improved operational efficiency by at least five-fold. Patient Navigators have been re-deployed from five Virginia Community Services Boards to hospital emergency departments and primary care offices in the Ballad Health service area. This redeployment allows the Navigators to establish initial contact with a patient and complete a personal interview and action plan related to the health-related social needs identified by the patient. Laptops and cell phones were purchased for the Navigators to provide the ability to work at the clinical delivery sites and from other locations, as needed. INVESTMENTS COMMON ELECTRONIC HEALTH RECORD - Ballad Health made progress in FY19 toward establishing a common clinical platform and electronic health record (EHR). An implementation plan was developed to include infrastructure enhancements to support the expansion. A common EHR across the new health system will allow patient information to be shared immediately at the point of service regardless of where a patient enters the Ballad system, providing clinical staff with information to better manage patients in the emergency room, clinics, acute and post-acute settings. MEDICAL EDUCATION GCH participates in Ballad Healths Nurse Intern II program, overseen by Ballad Healths Clinical Education team. The program pairs each nurse intern with a registered nurse (RN) preceptor on a designated hospital unit. The interns work with their preceptor to gain valuable clinical skills to assist in the transition from nursing student to licensed nurse. The interns are under no obligation to work for Ballad Health although many of them choose to do so. Interns who complete the program become a Nurse Intern III and advance to a Nurse Intern IV upon graduation and move to RN status upon passing of the NCLEX (National Council Licensure Examination). GCH continues to offer free Certified Nursing Assistant (CNA) classes open to the public. The program includes classroom sessions followed by clinical experience. There is no requirement for participants to work for Greeneville Community Hospital upon completion of the program. The training opportunity often leads to job opportunities for graduates of the program. In FY19, over 93 percent of the graduates were hired by GCH. GCH facilities serve as clinical training areas for health professional education students. Dedicated staff work with regional colleges and universities, as part of the educational curriculum, to coordinate the placement of healthcare professional students. Health care students training in GCH facilities are required to complete orientation and computer training.Included in the number receiving clinical training at GCH, 23 nursing students from various colleges, universities and programs received training. This nursing clinical experience required extensive involvement by GCH nursing staff. The cost of the clinical setting and hands-on instruction to GCH was $33,003.GCH provided a clinical training setting for another 79 students in health-related programs, such as biomedical engineering, radiology, pharmacy, respiratory therapy, physician assistant, nurse practitioner, laboratory, occupational therapy, social work, public health, EMT/paramedic, and other allied-health disciplines. The cost of clinical training for these additional students was $83,493. OTHER ACCOMPLISHMENTS Ballad Healths grants and awards department works throughout the year writing grant applications to benefit communities throughout the large service area. Some examples of this reporting period include: Awarded a grant for Car Seats and Teen Driver Safety to provide car seats to people in the community and to educate teen drivers on safe driving habits (such as don't text and drive). Received a grant that provides funding (in addition to our Ballad Health Cancer Patient Assistance Fund) for 75 additional patients to overcome barriers to breast cancer treatment through meeting their basic needs and/or improving their quality of life (i.e. rent/mortgage, groceries, utilities, transportation vouchers, gas cards, etc.). The Cancer Navigation program provides a single point of contact to help patients coordinate their care and understand their treatment plan. The Navigators often determine obstacles, such as the need for financial assistance, that keep patients from receiving treatment. The Komen/Virginia Blue Ridge Mobile Mammography grant was utilized to provide mammograms to women who may otherwise not receive them due to cost or access issues, along with helping to arrange financial assistance for additional diagnostic studies and further treatment, where applicable. Patients needing additional studies and treatment were assisted by our Cancer Navigators if they did not have a primary care provider.GCH continues the Value Optimization System (VOS). The goal of the system is to accelerate achievement of patient-centered care to meet patients expectations of high quality, high satisfaction, and efficient care. Each VOS team meets over an intense four-day period to identify waste/inefficiencies, develop an improved work plan, and then implement the plan immediately. The results are referred to as value streams. PROGRAMS FOR SPECIAL POPULATIONS GCH partnered with Bolder Outreach Solutions to assist patients without insurance. Representatives were available for these patients at all GCH campuses in order to determine sources of possible governmental medical assistance (TennCare or Medicaid) and to assist in the application process and follow-up. 338 patients were approved for coverage during FY19. GCH incurred expense of $24,487 during FY19 to provide this service. Ballad Health and a group of the nations leading health systems are joining forces to identify ways to better care for some of the nations most vulnerable populations. The Medicaid Transformation 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 will focus on five key areas of opportunity, four of which have been identified: behavioral health, child and maternal health, substance use disorder and avoidable emergency department visits. WHS hospitals will be able to improve care for all vulnerable populations based on solutions/best practices provided by this project. PROGRAMS TO IMPROVE CHILDHOOD LITERACY Since 2014, Ballad Healths Niswonger Childrens Hospital has reached outside the hospital walls and into the community to improve child literacy through the B.E.A.R. Buddies reading program, which pairs volunteer mentors with elementary school students who need a boost in their reading skills. When five new schools recently requested to join the program, Ballad Health Chairman and CEO Alan Levine issued a call to Ballad Health team members to help fill the gap. To date, 100 volunteers for the 2020 school year have signed up.Ballad Health is committed to promoting strong starts for kids and reading achievement is an essential element that every child needs in order to be positioned for future health and success. Ballad Health partnered with seven United Way organizations from Southwest Virginia and Northeast Tennessee to pilot an initiative to increase grade-level reading and improve reading proficiency for children in the region. The partnership will have a huge impact on the community as the United Way organizations work together with local schools to improve childhood literacy across the region. Ballad Health is participating in a new initiative called STRONG Kids, which stands for Striving Toward Resiliency and Opportunities for the Next Generation, that brings together and assists regional organizations that support children. The program will enable Ballad Health, Niswonger Childrens Hospital and the Bristol chapter of Speedway Childrens Charities to share ideas and best practices that will help children in the region reach their potential through expanded opportunities in health, education and economic vitality. The partnership is designed to bring a new level of support to these organizations that are on the front lines serving children. RESEARCH The Ballad Health clinical research department serves as the central office for multi-specialty research oversight to Ballad Health. 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 a high subject retention rate and a great sponsor/monitoring rating. Oversight services include administrative, regulatory support, and internal service arrangement. In addition, since teaching and continuing education play a large role within the organization, research staff participated in conferences/webinars. 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 WHS facilities,- ensuring regulatory compliance and fiscal responsibility, and- creating a research culture across the health system.During FY19, the unreimbursed expenses of the research department were $1,027. Wellmont Health System 1905 American Way Kingsport TN 37660 621636465 Hospital System TN 501c3 3 BALLAD false Wellmont Hawkins Co Memorial Hosp 851 Locust Street Rogersville TN 37857 621816368 Hospital TN 501c3 3 WHS false Wellmont Cardiology Services 1905 American Way Kingsport TN 37660 263557623 Medical Services TN 501c3 10 WHS false Wellmont Medical Associates 1905 American Way Kingsport TN 37660 270898372 Medical Services TN 501c3 7 WHS false Wellmont Sleep Services 1905 American Way Kingsport TN 37660 273777167 Medical Services TN 501c3 3 WHS false Ballad Health Foundation Inc 1019 West Oakland Ave Suite 2 Johnson City TN 37604 581594191 Fundraiser TN 501c3 7 BALLAD false Wellmont Madison House 2000 Greenway Street Kingsport TN 37660 621308216 Assisted Living TN 501c3 10 WHS false Wellmont Wexford House 2421 N John B Dennis Hwy Kingsport TN 37660 581859039 Nursing Home TN 501c3 10 WHS false Wellmont Imaging Services Inc 1905 American Way Kingsport TN 37660 861103148 Healthcare TN 501c3 12a WHS false Mountain States Health Alliance 303 Med Tech Parkway Suite 220 Johnson City TN 37604 620476282 Hospital System TN 501c3 3 BALLAD false MSHA Auxiliary 400 N State of Franklin Road Johnson City TN 37604 581418345 Supporting Organization TN 501c3 12a MSHA false Smyth County Community Hospital 245 Medical Park Drive Marion VA 24354 540794913 Hospital VA 501c3 3 MSHA false Norton Community Hospital 100 15th Street NW Norton VA 24273 540566029 Hospital VA 501c3 3 NA false Dickenson Community Hospital 312 Hospital Drive Clintwood VA 24228 770599553 Hospital VA 501c3 3 NCH false Johnston Memorial Hospital 16000 Johnston Memorial Drive Abingdon VA 24211 540544705 Hospital VA 501c3 3 NA false Abingdon Physician Partners 16000 Johnston Memorial Drive Abingdon VA 24211 205485346 Medical Services VA 501c3 12a JMH false Ballad Health 303 Med Tech Parkway Suite 220 Johnson City TN 37604 611771290 Supporting Organization TN 501c3 12b NA false East TN Healthcare Holdings Inc 203 Gray Commons Circle Gray TN 37615 815475903 Opioid Treatment TN 501c3 3 MSHA false Laughlin Memorial Hospital Inc 1420 Tusculum Boulevard Greeneville TN 37745 620701119 Hospital TN 501c3 3 MSHA false Laughlin Healthcare Foundation 1420 Tusculum Boulevard Greeneville TN 37745 582105493 Fundraiser TN 501c3 12a MSHA false Sapling Grove Ambulatory Surgery Center 220 Medical Park Boulevard Bristol TN 37620 204450153 Medical Services TN WHS false false Holston Valley Ambulatory Surgery Center 103 West Stone Drive Kingsport TN 37660 621816864 Medical Services TN WHS false false Greeneville Physician Services LLC 1905 American Way Kingsport TN 37660 455070419 Medical Services TN WHS Excluded -40 239784 false false 0.75000 Wellmont Inc 1905 American Way Kingsport TN 37660 621320035 Medical Services TN WHS C false Wellmont Collections Inc 2004 American Way Suite 101 Kingsport TN 37660 621325938 Business Services TN NA C false Medical Mall Pharmacy Inc 1905 American Way Kingsport TN 37660 621565006 Medical Services TN NA C false Wellmont Physician Services 1905 American Way Kingsport TN 37660 621567353 Medical Services TN NA C false WPS Providers Inc 1905 American Way Kingsport TN 37660 205564642 Medical Services TN NA C false Wellmont Health Services Inc 1905 American Way Kingsport TN 37660 621254373 Medical Services TN NA C false Blue Ridge Medical Management Corp 1905 American Way Kingsport TN 37660 621490616 Medical Services TN MSHA C false Mediserve Medical Equipment 1905 American Way Kingsport TN 37660 621212286 Durable Medical Equipment TN BRMMC C false Mountain States Properties 1905 American Way Kingsport TN 37660 621845895 Property Management TN BRMMC C false Mountain States Physician Grp 1905 American Way Kingsport TN 37660 621700412 Medical Services TN BRMMC C false Community Home Care Inc 1490 Park Avenue NW Suite B Norton VA 24273 541453810 Durable Medical Equipment VA NCH C false Wilson Pharmacy Inc PO Box 5289 Johnson City TN 37604 620329587 Pharmacy TN BRMMC C false Crestpoint Health Insurance Company 509 Med Tech Parkway Suite 100 Johnson City TN 37604 620381170 Insurance TN ISHN C false Integrated Solutions Health Network 509 Med Tech Parkway Suite 100 Johnson City TN 37604 621711997 Health Network TN MSHA C false Nolichuckey Management Svcs Inc 1420 Tusculum Boulevard Greeneville TN 37745 621776681 Medical Services TN LMH C false Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman CJ KY1-1203 981195624 Insurance CJ NA C false false false true false false false false false false true true true true true true true false false false