2019-05-10T09:10:47-05:00 2018-06-30 990 2017-07-01 620476282 MOUNTAIN STATES HEALTH ALLIANCE MOUN 4233023374 1021 W OAKLAND AVENUE SUITE 103 JOHNSON CITY TN 37604 LYNN KRUTAK EVP/CFO 4233023374 2018-10-03 151.102.241.104 2019-05-10 09:10:47 CD P 87E77A894FBEAE8A07458463D987FBB2F40DF0C9 39095CF110B0C8EE9B5E629A9826572B753F4624 2017 2019-02-21 02:37:17Z X JOHNSON CITY MEDICAL CENTER ALAN LEVINE 303 MED TECH PARKWAY SUITE 300 JOHNSON CITY TN 37604 730166966 false X WWW.BALLADHEALTH.ORG X 1945 TN OUR MISSION: HONOR THOSE WE SERVE BY DELIVERING THE BEST POSSIBLE CARE. OUR VISION: TO BUILD A LEGACY OF SUPERIOR HEALTH BY LISTENING TO AND CARING FOR THOSE WE SERVE. 11 9 8004 1181 1678278 538987 2851553 2818566 716841391 704253585 15838583 16903072 5414293 5510600 740945820 729485823 1009333 978764 0 295310931 309858627 0 880811 409686609 417612646 706006873 728450037 34938947 1035786 1581000029 1534285953 1045335789 992458877 535664240 541827076 X OUR MISSION: HONOR THOSE WE SERVE BY DELIVERING THE BEST POSSIBLE CARE. false false 609235239 978764 704224059 SINCE 1998, MSHA HAS BEEN BRINGING THE NATION'S BEST HEALTH CARE CLOSE TO HOME TO SERVE THE RESIDENTS OF NORTHEAST TENNESSEE, SOUTHWEST VIRGINIA, SOUTHEASTERN KENTUCKY AND WESTERN NORTH CAROLINA. THE 1,899-BED NOT-FOR- PROFIT HEALTH CARE ORGANIZATION BASED IN JOHNSON CITY, TENNESSEE OPERATES A FAMILY OF 12 HOSPITALS SERVING A 29-COUNTY REGION. MSHA OFFERS A LARGE TERTIARY HOSPITAL WITH A LEVEL 1 TRAUMA CENTER, A DEDICATED CHILDREN'S HOSPITAL AND AN INPATIENT BEHAVIORAL HEALTH HOSPITAL; SEVERAL COMMUNITY HOSPITALS; TWO CRITICAL ACCESS HOSPITALS; THREE LONG-TERM CARE FACILITIES, HOME CARE AND HOSPICE SERVICES, RETAIL PHARMACIES, OUTPATIENT SERVICES, AND A COMPREHENSIVE MEDICAL MANAGEMENT CORPORATION. THIS FORM 990 INCLUDES (CONTINUED) 609235239 true true false true false false false false false false true false true false true true false true false false false false false false false false true true true false true true false false false false false true false false true true false false false false false true true true false false true 613 0 true 8004 true true true false false false false false false false false false X 11 9 false false true false true false false true true false false true true true true true true true true true true TN VA X LYNN KRUTAK 4233023374 303 MED TECH PARKWAY SUITE 300 JOHNSON CITY TN 37604 ALAN LEVINE PRESIDENT/CE 34.90 20.10 X X 1296102 0 183940 BARBARA ALLEN CHAIR 1.00 2.80 X X 0 0 0 JULIE BENNETT DIRECTOR 0.10 1.40 X 0 0 0 MICHAEL CHRISTIAN TREASURER 3.30 0.10 X X 0 0 0 ROBERT FEATHERS VICE CHAIR 3.70 0.10 X X 0 0 0 JOANNE GILMER SECRETARY 3.30 3.10 X X 0 0 0 DAVID GOLDEN DIRECTOR 0.50 1.90 X 0 0 0 DAVID LESTER VICE CHAIR 0.50 2.50 X X 0 0 0 DAVID MAY MD DIRECTOR 1.00 2.00 X 0 0 0 BRENDEN MCSHEEHY DIRECTOR 1.80 3.10 X 0 0 0 DAVID MOULTON MD DIRECTOR 2.80 0.10 X 0 0 0 SCOTT NISWONGER DIRECTOR 0.40 1.60 X 0 0 0 BRIAN NOLAND DIRECTOR 0.40 1.60 X 0 0 0 GARY PEACOCK TREASURER 1.00 6.10 X X 0 0 0 BERT SMITH MD DIRECTOR 1.80 0.60 X 0 0 0 DOUG SPRINGER SECRETARY 0.20 1.60 X X 0 0 0 RICK STOREY DIRECTOR 1.00 1.40 X 0 0 0 GRANT SUMMERS DIRECTOR 1.80 0.10 X 0 0 0 CLEM WILKES JR PAST CHAIR DIRECTOR 3.30 0.10 X X 0 0 0 KEITH WILSON DIRECTOR 0.20 1.60 X 0 0 0 MARVIN EICHORN EVP/COO 41.70 13.30 X 749129 0 42742 LYNN KRUTAK EVP/CFO 49.00 6.00 X 587884 0 88257 DAWN TRIMBLE VP/CEO WASHI 45.00 X 559125 0 43321 SHANE HILTON SVP MKT. FIN 46.50 3.50 X 396092 0 58587 MONTY MCLAURIN VP/CEO NW MK 35.50 9.50 X 386782 0 54704 LINDA WHITE VP & CEO, FW 45.00 X 340317 0 43915 RICHARD BOONE VP/CFO WASHI 45.00 X 332949 0 25992 LEMMIE TAYLOR VP/CEO SE MK 45.00 X 275491 0 50057 MORGAN MAY JCMC CNO 45.00 X 209702 0 30957 STEVE SAWYER AVP/CFO NW M 26.00 19.00 X 203148 0 31777 MORRIS SELIGMAN MD EVP & CMO 54.50 0.50 X 670741 0 60897 ANTHONY KECK EVP POP. HLT 54.90 0.10 X 458610 0 65584 CLAY RUNNELS MD VP SVC LINE 44.00 1.00 X 435873 0 35287 MARK WILKINSON MD VP/CMO 45.00 X 418280 0 35310 PAUL MERRYWELL CIO 45.00 X 387395 0 38725 TONY BENTON VP/COO WASH. X 115772 0 7702 7823392 897754 255 true true false CERNER HEALTH SERVICES INC P O BOX 959167 SAINT LOUIS MO 631959167 CONSULTING 8051954 ANESTHESIA & PAIN CONSULTANTS 1009 LARK STREET SUITE 2 JOHNSON CITY TN 37604 ANESTHESIA SVCS 4810166 VIGILANCE ANESTHESIA SOLUTIONS P O BOX 645293 CINCINNATI OH 452645293 ANESTHESIA SVCS 2830550 CROTHALL SERVICES EAST TENNESSEE 13028 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LAUNDRY SVCS 2816346 ADVISORY BOARD COMPANY 2445 M STREET NW WASHINGTON DC 20037 DATA SVCS/CONSU 2776286 116 980874 1334334 503358 2818566 PATIENT REVENUE 622110 706397154 706397154 WELLNESS REVENUE 622110 5262419 5262419 P/S ORDINARY INCOME 541900 1274620 1274620 LAB OUTREACH INCOME 621500 802509 802509 LOSS ON DEBT RETIREMENT 900099 -9483117 -9483117 704253585 11035093 11035093 57857 57857 1070940 618051 452889 452889 151347 301542 5839648 33566 63092 5839648 -29526 5810122 -29526 5839648 VENDOR SETTLEMENT 900099 2826139 2826139 DAY CARE 624410 992716 992716 DIETARY, SECURITY, ENGIN, ETC 900099 859449 859449 379407 724422 -345015 5057711 729485823 703421550 1678278 21567429 X 978764 978764 7745948 258033 7487915 239055605 225567239 12923981 564385 11715435 11119159 568454 27822 33918633 33345082 565129 8422 17423006 15812997 1578898 31111 2854429 939 2853490 631027 781 608308 21938 142702 142702 924625 924625 122181934 108240642 13932946 8346 5054397 133209 4907459 13729 5885892 4865820 1000681 19391 17220602 15412497 1808105 13702113 10407402 3224527 70184 1949594 1439658 505553 4383 35728891 1117 35727774 45721225 21760961 23958983 1281 1097993 1097993 MEDICAL SUPPLIES & DRUGS 138876706 138876706 REPAIRS & MAINTENANCE 16892857 16078297 737468 77092 DUES & SUBSCRIPTIONS 5722747 2486114 3233520 3113 RETENTION & RECRUITMENT 1595934 685646 910103 185 1428978 1621474 -221925 29429 728450037 609235239 118333987 880811 62507823 10808245 6331382 5506817 308342 443373 103319561 112430519 11535908 11977590 19597279 18827128 17983101 18615225 7401767 6994594 1142791307 647112272 489197719 495679035 320692082 334991957 338744993 339717493 145025185 145025185 58354887 33268792 1581000029 1534285953 125337834 100285014 6511099 4513039 877932035 150252709 8190000 27364821 737408115 1045335789 992458877 X 535395968 541800639 268272 26437 535664240 541827076 1581000029 1534285953 X 1035786 416190 4710860 X X false true X true false X false false false false false true 104848 true 512237 false false 617085 false SCHEDULE C, PART IV BALLAD HEALTH'S COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR DIRECTOR ATTENDED THE FOLLOWING LEGISLATIVE CONFERENCES: -PREMIER FEDERAL AFFAIRS NETWORK MEETING -AMERICAN HOSPITAL ASSOCIATION ANNUAL MEETING -TENNESSEE HOSPITAL ASSOCIATION LEGISLATIVE ADVOCACY DAY -TENNESSEE PUBLIC & TEACHING HOSPITALS ASSOCIATION ANNUAL MEETING THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR DEPARTMENTAL STAFF ALSO CONTACTED CONGRESSIONAL OFFICES CONCERNING THE FOLLOWING ISSUES: -OPPOSED ADDITIONAL CUTS IN MEDICARE/MEDICAID -SUPPORTED REAUTHORIZATION AND FUNDING OF CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION -SUPPORTED AREA WAGE INDEX REFORM -SUPPORTED MEDICARE DEPENDENT HOSPITAL AND LOW-VOLUME DESIGNATIONS -SUPPORTED CHILDREN'S HEALTH INSURANCE PROGRAM FUNDING -OPPOSED CUTS TO 340B PROGRAM THE COMMUNITY AND GOVERNMENT RELATIONS VICE PRESIDENT AND/OR DEPARTMENT DIRECTOR RESPONDED VIA LETTER, PHONE, OR IN PERSON TO THE FOLLOWING TENNESSEE AND VIRGINIA LEGISLATIVE ISSUES: SUPPORTED THE FOLLOWING ISSUES: -CERTIFICATE OF NEED (TN)/CERTIFICATE OF PUBLIC NEED (VA) REFORM -CONTINUATION OF HOSPITAL ASSESSMENT FEE IN TENNESSEE -FUNDING FOR PERINATAL CENTERS IN TENNESSEE -MENTAL HEALTH FUNDING FOR INPATIENT PSYCHIATRIC CARE-TENNESSEE -ADEQUATE TENNCARE FUNDING IN TENNESSEE AND MEDICAID EXPANSION IN VIRGINIA -CONTINUATION OF MAINTENANCE OF CERTIFICATE REQUIREMENTS FOR PHYSICIAN PRIVILEGES -MINOR MODIFICATION TO CONFIDENTIALITY REQUIREMENTS FOR HOSPITAL COOPERATIVE AGREEMENT -HOSPITAL REPORTING REQUIREMENTS FOR SURPRISE BILLING 38869446 38869446 549577106 223652748 325924358 963135 675053 288082 546749488 417784837 128964651 6632132 4999634 1632498 495679035 INVESTMENT IN JMH 132000000 C INVESTMENT IN BRMMC 100310432 C INVESTMENT IN SCCH 71400494 C INVESTMENT IN ISHN 37015787 C INVESTMENT IN PREMIER,NET OF RESERVE 55000 C INVESTMENT IN MSJC -1064220 C 339717493 DUE TO AFFILIATES 714431878 EST. FAIR VALUE OF INT. RATE SWAPS 8949730 DUE TO THIRD-PARTY PAYORS 6179768 PROFESSIONAL LIABILITIES & OTHER 3720530 LONG TERM COMPENSATION PAYABLE 2626209 CONTRIBUTIONS PAYABLE 1500000 737408115 X SCHEDULE D, PAGE 3, PART X "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 HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR BALLAD AND ITS TAX-EXEMPT SUBSIDIARIES. BALLAD'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. BALLAD HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2018. AT JUNE 30, 2018, TAX RETURNS FOR MSHA AND WHS FOR 2015 THROUGH 2017 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE." true true X true X 2.250000000000 true X 4.500000000000 true true true false false 11526651 11526651 0.01580 117471911 94047830 23424081 0.03220 128998562 94047830 34950732 0.04800 4615211 716125 3899086 0.00540 13139548 3172978 9966570 0.01370 9792095 6998519 2793576 0.00380 279404 138617 140787 0.00020 829224 829224 0.00110 28655482 11026239 17629243 0.02420 157654044 105074069 52579975 0.07220 55000 55000 0.00010 34120 34120 2375 2375 500 500 100 100 92095 92095 0.00010 true 79808597 30327267 160969415 159374525 1594890 X true true MED'L SPEC OF JC LLC MEDICAL SERVICES 0.51000 0.49000 7 1 JOHNSON CITY MEDICAL CENTER 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 BALLADHEALTH.ORG/LOCATIONSHOSPITALS 00000121 X X X X X X MENTAL HEALTH A 2 INDIAN PATH MEDICAL CENTER 2000 BROOKSIDE DRIVE KINGSPORT TN 37660 BALLADHEALTH.ORG/LOCATIONSHOSPITALS 00000134 X X X X A 3 FRANKLIN WOODS COMMUNITY HOSPITAL 300 MED TECH PARKWAY JOHNSON CITY TN 37604 BALLADHEALTH.ORG/LOCATIONSHOSPITALS 00000123 X X X X A 4 SYCAMORE SHOALS HOSPITAL 1501 W ELK AVENUE ELIZABETHTON TN 37643 BALLADHEALTH.ORG/LOCATIONSHOSPITALS 00000012 X X X A 5 RUSSELL COUNTY MEDICAL CENTER 58 CAROLL STREET LEBANON VA 24266 BALLADHEALTH.ORG/LOCATIONSHOSPITALS H 1892 X X X A 6 JOHNSON COUNTY COMMUNITY HOSPITAL 16901 S SHADY STREET MOUNTAIN CITY TN 37683 BALLADHEALTH.ORG/LOCATIONSHOSPITALS 00000039 X X X A 7 UNICOI COUNTY MEMORIAL HOSPITAL 100 GREENWAY CIRCLE ERWIN TN 37650 BALLADHEALTH.ORG/LOCATIONSHOSPITALS 00000119 X X X A A 123456 false false true X X X X X X X X X X 18 true true false true X BALLADHEALTH.ORG/LOCATIONSHOSPITALS X true 19 false true false true X 225.000000000000 450.000000000000 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 true X false false GROUP A, FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 3E DURING FY18, MSHA HOSPITALS WERE OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES WERE ESTABLISHED FOR ALL MSHA HOSPITALS' CHNAS AND PRIORITIES WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 FOR MSHA'S HOSPITALS) CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. JOHNSON CITY MEDICAL CENTER'S CHNA WAS CONDUCTED WITH FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH). FWCH IS LOCATED IN THE SAME SERVICE AREA AS JOHNSON CITY MEDICAL CENTER SO THE TWO HOSPITALS' COMMUNITY DEMOGRAPHICS AND HEALTH NEEDS ARE THE SAME. JOHNSON CITY MEDICAL CENTER INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL, A BEHAVIORAL HEALTH FACILITY. THE WASHINGTON COUNTY CHNA COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE JCMC/FWCH GROUP'S 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, THE WASHINGTON COUNTY REPRESENTATIVES IDENTIFIED THE TOP FOCUS AREAS. FOUR KEY PRIORITIES WERE IDENTIFIED: -SMOKING -SUBSTANCE ABUSE AND MENTAL HEALTH -OBESITY -EARLY INTERVENTION: VACCINATIONS, SCREENINGS, THIRD-GRADE READING LEVEL FOR 3RD GRADERS, AND DIABETES COUNSELING GROUP A, FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 5 AS PART OF THE FY18 BALLAD HEALTH CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN EACH COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. JCMC INCLUDES WOODRIDGE HOSPITAL, ITS BEHAVIORAL HEALTH FACILITY, AND NISWONGER CHILDREN'S HOSPITAL. BECAUSE JCMC AND FRANKLIN WOODS COMMUNITY HOSPITAL SERVE THE SAME COMMUNITY, THE TWO HOSPITALS CONDUCTED THE FY18 CHNA TOGETHER. THE JCMC/FWCH FOCUS GROUP MEMBERS WERE REPRESENTED BY WASHINGTON COUNTY HEALTH DEPARTMENT, JOHNSON CITY MAYOR'S OFFICE, EAST TENNESSEE STATE UNIVERSITY COMMUNITY HEALTH CENTER, BALLAD HEALTH EMPLOYEES, MEMBERS OF THE WASHINGTON COUNTY FOUNDATION BOARD, MEMBERS OF THE WASHINGTON COUNTY COMMUNITY BOARD, AND MEMBERS OF THE WASHINGTON COUNTY MEDICAL EXECUTIVE COMMITTEE. LOW INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS WERE REPRESENTED BY WASHINGTON COUNTY HEALTH DEPARTMENT AND EAST TENNESSEE STATE UNIVERSITY (ETSU) COMMUNITY HEALTH CENTER. ETSU'S COMMUNITY HEALTH CENTER IS AN INTERDISCIPLINARY FACILITY FOR THE DELIVERY OF PRIMARY HEALTH CARE SERVICES AND EDUCATION OF ETSU COLLEGE OF NURSING STUDENTS. THE HEALTH CENTER PROVIDES HEALTH CARE TO THE UNINSURED, UNDERINSURED, TENNCARE ENROLLEES, A GROWING HISPANIC POPULATION AND MEDICALLY INDIGENT INDIVIDUALS. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY. GROUP A, FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA THIS FISCAL YEAR. THE HOSPITALS WITHIN THE MSHA FEIN (INCLUDED IN THIS FORM 990) INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL. A SPEARATE FORM 990 IS FILED FOR EACH MSHA HOSPITAL THAT IS A SEPARATE FEIN ENTITY. GROUP A, FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 11 DURING THE YEAR, JOHNSON CITY MEDICAL CENTER CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. JCMC'S PRIMARY AREAS OF FOCUS INCLUDED: DIABETES, OBESITY/PHYSICAL ACTIVITY, HEART DISEASE AND SUBSTANCE/DRUG ABUSE. 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. THE HOSPITAL AND MSHA'S CORPORATE DEPARTMENTS ALSO LEND SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. JOHNSON CITY MEDICAL CENTER, ALONG WITH MSHA'S OTHER HOSPITALS, HAS BEEN DILIGENT IN ITS GOAL TO ENSURE APPROPRIATE PRESCRIBING OF OPIOIDS AND A REDUCTION IN OPIOIDS IN OUR REGION. THE RESULT IS A SIGNIFICANT REDUCTION IN PRESCRIBING RATES. OPIOID DOSES ADMINISTERED AT MSHA'S HOSPITALS WERE REDUCED BY MORE THAN 40 PERCENT. OUR EMERGENCY DEPARTMENT PRESCRIBING RATES ARE NOW 26 PERCENT BELOW THE NATIONAL AVERAGE. JCMC'S NISWONGER CHILDREN'S HOSPITAL LAUNCHED FAMILIES THRIVE THIS YEAR. THIS NEW PROGRAM IS PART OF OUR NEONATAL ABSTINENCE SYNDROME (NAS) PROGRAM FOR BABIES WHO ARE EXPOSED TO ADDICTIVE SUBSTANCES BEFORE BIRTH. THE FAMILY THRIVE PROGRAM PROVIDED COUNSELING FOR ADDICTION RECOVERY, TOOLS FOR PARENTING SKILLS AND CONNECTIONS TO OTHER COMMUNITY SERVICES THAT CAN ASSIST FAMILIES AFTER THE BABY LEAVES THE HOSPITAL. THE GOAL IS TO PROVIDE ADDICTED MOTHERS WITH TREATMENT PLANS FOR NARCOTIC RECOVERY IF THEY ARE NOT IN A PROGRAM ALREADY. NEARLY 30 PERCENT OF THE BABIES IN OUR NEONATAL INTENSIVE CARE UNIT SUFFER FROM NEONATAL ABSTINENCE SYNDROME. JCMC OPENED A NEW CDU (CLINICAL DECISION UNIT) THIS YEAR. THE CDU IS AN EXTENSION OF THE EMERGENCY DEPARTMENT SPECIALLY DESIGNED TO SERVE PATIENTS NEEDING BEHAVIORAL HEALTH CARE. SOME OF THESE PATIENTS MAY BE TRANSITIONED TO INPATIENT PSYCHIATRIC CARE WHILE OTHERS WILL BE DISCHARGED TO OUTPATIENT SERVICE ONCE STABILIZED. JOHNSON CITY MEDICAL CENTER'S HEALTH RESOURCES CENTER (HRC) PROVIDES NUMEROUS HEALTH SCREENINGS THROUGHOUT THE YEAR, A WIDE RANGE OF FREE HEALTH EDUCATION CLASSES, MOST OF WHICH TARGET HEALTH NEED PRIORITIES IDENTIFIED IN THE HOSPITAL'S CHNA. FOR EXAMPLE, MANY CLASSES AND ACTIVITIES FOCUS ON HEALTHY EATING, OBESITY, HEART HEALTH AND DIABETES, ALL DIRECTLY RELATED TO OUR FY15 CHNA. THIS YEAR, THE HRC PROVIDED INDIVIDUAL NUTRITION EDUCATION SESSIONS AND OUTREACH SERVICES THAT CONNECTED TO ALMOST 8,000 RESIDENTS. IN ADDITION, THE HRC HAD MORE THAN 12,000 VISITS TO ITS OFFICE DURING FY18. JCMC OFFERS NUMEROUS SUPPORT GROUPS FOR VARIOUS CHRONIC CONDITIONS. OUR PARISH NURSE PROGRAM OFFERS HEALTH EDUCATION WITHIN PLACES OF WORSHIP. THE NURSES ALSO CONDUCT HEALTH SCREENINGS THAT DETECT HEALTH ISSUES THAT NEED ATTENTION. OUR CHILDREN'S HOSPITAL PROVIDES MANY ACTIVITIES THROUGHOUT THE YEAR TO ENGAGE COMMUNITY CHILDREN AND THEIR FAMILIES IN PHYSICAL ACTIVITIES. IN ADDITION, THE HOSPITAL SUPPORTS MORNING MILE, A PARTNERSHIP WITH LOCAL ELEMENTARY AND MIDDLE SCHOOLS TO OFFER EXERCISE IN THE MORNINGS BEFORE CLASSES BEGIN. HEART DISEASE WAS A PRIORITY STATED IN THE FY15 CHNA. JCMC OPERATES A FREE CONGESTIVE HEALTH FAILURE CLINIC TO HELP PATIENTS MANAGE THEIR DISEASE. THE CLINIC IS STAFFED BY A NURSE PRACTITIONER WORKING WITH CARDIOLOGISTS TO EVALUATE AND PROVIDE EDUCATION TO HELP PATIENTS IMPROVE THEIR CARDIAC FUNCTION AND LESSEN THE LIKELIHOOD OF ACUTE EPISODES OF HEART FAILURE. PATIENTS WHO TAKE ADVANTAGE OF THE FREE HEART FAILURE CLINIC HAVE A LOWER HOSPITAL READMISSION RATE. JCMC MADE FINANCIAL CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS PROVIDING COMMUNITY SERVICES THAT SUPPORT THE HOSPITAL'S CHNA. JCMC CONTRIBUTIONS BENEFITED AN ORGANIZATION THAT FOCUSED ON HEALTHY EATING FOR CHILDREN, AN ORGANIZATION WORKING TO UNDERSTAND LONG-TERM EFFECTS OF NEONATAL ABSTINENCE SYNDROME, DONATIONS TO FUND PHYSICAL ACTIVITIES FOR CHILDREN AT A LOCAL FAIR, A DONATION TO A FOOD PANTRY THAT PROVIDES FOOD FOR KIDS DURING THE SUMMER, AND A SIGNIFICANT DONATION TO AN ORGANIZATION THAT PROVIDES ACCESS TO HEALTH CARE FOR LOW INCOME RESIDENTS IN APPALACHIA. THE MSHA ENTITY INCLUDES THE HOSPITALS REPORTED IN THIS FORM 990, A HOME HEALTH AGENCY AND ITS CORPORATE DEPARTMENTS. MOST OF THE CHARITABLE DONATIONS MADE DURING THE YEAR ARE REPORTED IN A CORPORATE DEPARTMENT RATHER THAN BY ONE OF THE HOSPITALS. MORE DETAIL OF MSHA'S TOTAL CHARITABLE DONATIONS DURING THE YEAR IS REPORTED IN THE CORE FORM OF THE FORM 990 - PART III PROGRAM SERVICE ACCOMPLISHMENTS. FREE MEDICATIONS WERE PROVIDED TO SOME LOW-INCOME PATIENTS AT THE TIME OF THEIR DISCHARGE. THE HOSPITAL ALSO PROVIDED FREE LAB SERVICES TO A NONPROFIT CLINIC THAT PROVIDES PRIMARY HEALTH CARE SERVICES AND ENGAGES IN MANY OUTREACH CONTACTS EACH YEAR TO INDIVIDUALS ON THE STREET, IN SHELTERS AND IN FARM WORKER CAMPS. GROUP A, FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 13H BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY. GROUP A, FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 3E DURING FY18, MSHA HOSPITALS WERE OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES WERE ESTABLISHED FOR ALL MSHA HOSPITALS' CHNAS AND PRIORITIES WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 FOR MSHA'S HOSPITALS) CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. THE INDIAN PATH MEDICAL CENTER COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE IPMC GROUP'S MEMBERS COMPLETED A SURVEY RELATIVE TO WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR SPECIFIC COMMUNITY OVER THE NEXT THREE YEARS. AFTER THE INITIAL FOCUS GROUP, THE HOSPITAL'S COMMUNITY BOARD WAS INVOLVED TO DISCUSS THE SELECTED HEALTH PRIORITIES AND TO GIVE INPUT ON ANY ADDITIONAL PRIORITIES. AFTER ALL THE DETAILS AND DATA COLLECTION WAS COMPLETE, THE HOSPITAL COMMUNITY BOARD VOTED TO APPROVE THE SELECTED PRIORITIES. FOUR KEY PRIORITIES WERE IDENTIFIED: - SMOKING - SUBSTANCE ABUSE AND MENTAL HEALTH - OBESITY - EARLY INTERVENTION: VACCINATIONS AND THIRD-GRADE READING LEVEL FOR 3RD GRADERS GROUP A, FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 5 AS PART OF THE BALLAD HEALTH FY18 CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN EACH COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. INDIAN PATH MEDICAL CENTER'S FOCUS GROUP MEMBERS WERE REPRESENTED BY SULLIVAN COUNTY DEPARTMENT OF EDUCATION, HEALTHY KINGSPORT, HEALTH RESOURCES CENTER - KINGSPORT, SULLIVAN COUNTY HEALTH DEPARTMENT, KINGSPORT BOARD OF MAYOR & ALDERMAN, KINGSPORT CHAMBER OF COMMERCE, UNITED WAY, GIRLS INC., MEMBERS OF IPMC FOUNDATION BOARD, AND MEMBERS OF IPMC COMMUNITY BOARD. THE HEALTH RESOURCES CENTER, SULLIVAN COUNTY HEALTH DEPARTMENT, UNITED WAY OF KINGSPORT, AND GIRLS INC. OF KINGSPORT REPRESENTED LOW-INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS. ALSO, BETWEEN THE FOUNDATION BOARD AND THE COMMUNITY BOARD, THERE ARE A NUMBER OF INDIVIDUALS THAT SIT ON EACH OF THESE BOARDS THAT REPRESENT LOW INCOME, MINORITY POPULATIONS, AND MEDICALLY UNDERSERVED. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY. GROUP A, FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL. GROUP A, FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 11 DURING THE YEAR, INDIAN PATH MEDICAL CENTER CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. IPMC'S PRIMARY AREAS OF FOCUS INCLUDED: DIABETES, OBESITY, CANCER, HEART DISEASE AND SUBSTANCE/NEONATAL ABSTINENCE SYNDROME. 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. THE HOSPITAL ALSO LENDS SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. TO BETTER MANAGE CERTAIN HEART DISEASE PATIENTS, THE HOSPITAL IMPLEMENTED DISEASE MANAGERS AND A TRANSITIONAL CARE CLINIC. BOTH PROGRAMS FACILITATE CARE FOR PATIENTS THAT MAY LACK THE NECESSARY RESOURCES TO PROPERLY TREAT THEIR CONDITIONS. IN RECOGNITION OF THE SIGNIFICANT ROLE PRESCRIPTION DRUGS PLAY IN SUBSTANCE ABUSE, THE HOSPITAL AND HEALTH SYSTEM HAVE DEVELOPED AND IMPLEMENTED PROGRAMS TO REDUCE OPIATE PRESCRIBING. THE CHNA CONTINUES TO ENCOURAGE PROGRAMMATIC INVESTMENTS MADE BY THE HOSPITAL SUCH AS THE INTRODUCTION OF LOW-DOSE CT LUNG SCREENING FOR CANCER TO DETECT CANCER EARLIER. 579 FREE LUNG SCREENING SCANS WERE PROVIDED DURING FY18. INDIAN PATH'S HEALTH RESOURCES CENTER (HRC) PROVIDES NUMEROUS HEALTH SCREENINGS THROUGHOUT THE YEAR, A WIDE RANGE OF FREE HEALTH EDUCATION CLASSES, MOST OF WHICH TARGET HEALTH NEED PRIORITIES IDENTIFIED IN THE HOSPITAL'S CHNA. THIS YEAR, THE HRC PROVIDED INDIVIDUAL NUTRITION EDUCATION SESSIONS AND OUTREACH SERVICES THAT CONNECTED TO MORE THAN 15,000 COMMUNITY MEMBERS. IN ADDITION, THE HRC HAD ALMOST 12,000 VISITS TO ITS OFFICE DURING FY18. IPMC ALSO OFFERS NUMEROUS SUPPORT GROUPS FOR VARIOUS CHRONIC CONDITIONS. ONE EXAMPLE IS OUR BETTER BREATHERS CLUB THAT MEETS MONTHLY. THE HOSPITAL'S LAB DEPARTMENT PROVIDED FREE LAB TESTING FOR TWO LOCAL NONPROFIT ORGANIZATIONS. ONE NONPROFIT SERVES TWO RURAL IMPOVERISHED COUNTIES IN EAST TENNESSEE BY PROVIDING FOOD, HEALTH SCREENINGS, A DENTAL CLINIC, AND OTHER ESSENTIAL SERVICES. THE OTHER NONPROFIT OFFERS MEDICAL CARE TO PERSONS WITH INCOMES 150% OR BELOW THE POVERTY LEVEL. INDIAN PATH IS VERY ACTIVE IN THE COMMUNITY. ONE EXAMPLE OF THAT IS THE MUCH-ANTICIPATED ANNUAL 9-DAY FUN FEST FESTIVAL IN KINGSPORT. EVERY YEAR, INDIAN PATH IS VERY INVOLVED IN THE FESTIVAL, OFFERING MANY ACTIVITIES FOR CHILDREN THAT INVOLVE PHYSICAL ACTIVITY. OVER 1,000 CHILDREN PARTICIPATED IN OUR FUN FEST ACTIVITIES THIS YEAR DESPITE NEAR RECORD HIGH TEMPERATURES. INDIAN PATH PROVIDED FREE MEDICATIONS TO SOME LOW-INCOME PATIENTS AT THEIR TIME OF DISCHARGE. GROUP A, FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 13H BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY. GROUP A, FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 3E DURING FY18, MSHA HOSPITALS WERE OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES WERE ESTABLISHED FOR ALL MSHA HOSPITALS' CHNAS AND PRIORITIES WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 FOR MSHA'S HOSPITALS) CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. FRANKLIN WOODS COMMUNITY HOSPITAL'S CHNA WAS CONDUCTED WITH JOHNSON CITY MEDICAL CENTER. THE HOSPITALS ARE LOCATED IN THE SAME SERVICE AREA SO THEIR COMMUNITY DEMOGRAPHICS AND HEALTH NEEDS ARE THE SAME. THE WASHINGTON COUNTY CHNA COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE FWCH/JCMC GROUP'S 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, THE WASHINGTON COUNTY REPRESENTATIVES IDENTIFIED THE TOP FOCUS AREAS. FOUR KEY PRIORITIES WERE IDENTIFIED: - SMOKING - SUBSTANCE ABUSE AND MENTAL HEALTH - OBESITY - EARLY INTERVENTION: VACCINATIONS, SCREENINGS, THIRD-GRADE READING LEVEL FOR 3RD GRADERS, AND DIABETES COUNSELING GROUP A, FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 5 AS PART OF THE BALLAD HEALTH FY18 CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN EACH COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. BECAUSE FRANKLIN WOODS COMMUNITY HOSPITAL AND JOHNSON CITY MEDICAL CENTER SERVE THE SAME COMMUNITY, THE TWO HOSPITALS CONDUCTED THE FY18 CHNA TOGETHER. THE FWCH/JCMC FOCUS GROUP MEMBERS WERE REPRESENTED BY WASHINGTON COUNTY HEALTH DEPARTMENT, JOHNSON CITY MAYOR'S OFFICE, EAST TENNESSEE STATE UNIVERSITY COMMUNITY HEALTH CENTER, JOHNSON CITY COMMUNITY HEALTH CENTER, BALLAD HEALTH EMPLOYEES, WASHINGTON COUNTY FOUNDATION BOARD MEMBERS, WASHINGTON COMMUNITY BOARD MEMBERS, AND WASHINGTON COUNTY MEDICAL EXECUTIVE COMMITTEE MEMBERS. LOW INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS WERE REPRESENTED BY WASHINGTON COUNTY HEALTH DEPARTMENT AND EAST TENNESSEE STATE UNIVERSITY (ETSU) COMMUNITY HEALTH CENTER. ETSU'S COMMUNITY HEALTH CENTER IS AN INTERDISCIPLINARY FACILITY FOR THE DELIVERY OF PRIMARY HEALTH CARE SERVICES AND EDUCATION OF ETSU COLLEGE OF NURSING STUDENTS. THE HEALTH CENTER PROVIDES HEALTH CARE TO THE UNINSURED, UNDERINSURED, TENNCARE ENROLLEES, A GROWING HISPANIC POPULATION AND MEDICALLY INDIGENT INDIVIDUALS. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY. GROUP A, FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL. GROUP A, FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 13H BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY. GROUP A, FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 3E DURING FY18, MSHA HOSPITALS WERE OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES WERE ESTABLISHED FOR ALL MSHA HOSPITALS' CHNAS AND PRIORITIES WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 FOR MSHA'S HOSPITALS) CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. THE SYCAMORE SHOALS HOSPITAL COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE SSH GROUP'S MEMBERS COMPLETED A SURVEY RELATIVE TO WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR SPECIFIC COMMUNITY OVER THE NEXT THREE YEARS. AFTER THE INITIAL FOCUS GROUP, THE HOSPITAL'S COMMUNITY BOARD WAS INVOLVED TO DISCUSS THE SELECTED HEALTH PRIORITIES AND TO GIVE INPUT ON ANY ADDITIONAL PRIORITIES. AFTER ALL THE DETAILS AND DATA COLLECTION WAS COMPLETE, THE HOSPITAL COMMUNITY BOARD VOTED TO APPROVE THE SELECTED PRIORITIES. FOUR KEY PRIORITIES WERE IDENTIFIED: - SMOKING - SUBSTANCE ABUSE AND MENTAL HEALTH - OBESITY - EARLY INTERVENTION - VACCINATIONS, SCREENINGS AND DIABETES COUNSELING GROUP A, FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 5 AS PART OF THE BALLAD HEALTH FY18 CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN EACH COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. SYCAMORE SHOALS HOSPITAL'S FOCUS GROUP MEMBERS WERE REPRESENTED BY SIGNATURE HEALTHCARE, CARTER COUNTY HEALTH DEPARTMENT, CARTER COUNTY EMS, SYCAMORE SHOALS HOSPITAL TEAM MEMBERS, PRIMARY CARE (A MEDICAL PRACTICE), MEMBERS OF THE SSH FOUNDATION BOARD, AND MEMBERS OF THE SSH COMMUNITY BOARD. LOW- INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS WERE REPRESENTED BY CARTER COUNTY HEALTH DEPARTMENT. ALSO, BETWEEN THE FOUNDATION BOARD AND THE COMMUNITY BOARD, THERE ARE A NUMBER OF INDIVIDUALS THAT SIT ON EACH OF THESE BOARDS THAT REPRESENT LOW INCOME, MINORITY POPULATIONS, AND MEDICALLY UNDERSERVED. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY. GROUP A, FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL. GROUP A, FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 11 DURING THE YEAR, SYCAMORE SHOALS HOSPITAL CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. SSH'S PRIMARY AREAS OF FOCUS INCLUDED: DIABETES, OBESITY, SMOKING, AND SUBSTANCE ABUSE. 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. THE HOSPITAL ALSO LENDS SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. SYCAMORE SHOALS HOSPITAL, ALONG WITH MSHA'S OTHER HOSPITALS, HAS BEEN DILIGENT IN ITS GOAL TO ENSURE APPROPRIATE PRESCRIBING OF OPIOIDS AND A REDUCTION IN OPIOIDS IN OUR REGION. THE RESULT IS A SIGNIFICANT REDUCTION IN PRESCRIBING RATES. OPIOID DOSES ADMINISTERED AT MSHA'S HOSPITALS WERE REDUCED BY MORE THAN 40 PERCENT. OUR EMERGENCY DEPARTMENT PRESCRIBING RATES ARE NOW 26 PERCENT BELOW THE NATIONAL AVERAGE. OUR HOSPITAL PROVIDED AN RN TO WORK WITH AND ROLE MODEL PROFESSIONAL BEHAVIORS AND LIFE SKILLS TO YOUNG WOMEN IN THE COMMUNITY THAT ARE IN RECOVERY FROM DRUG AND/OR ALCOHOL ABUSE. THE RN WORKED WITH THE PARTICIPANTS ON HEALTH, WELLNESS, CAREER OPPORTUNITIES, AND HYGIENE. THE PROGRAM'S GOAL IS TO ASSIST THE WOMEN IN RE-ENTERING SOCIETY AS DRUG/ALCOHOL FREE CITIZENS AND TO BOOST THEIR SELF-CONFIDENCE. THE HOSPITAL HOSTED EVENTS TO ENCOURAGE PHYSICAL ACTIVITY DURING THE 3-DAY COVERED BRIDGE FESTIVAL IN ELIZABETHTON. SSH HOSTED A 5K RUN AND A 3K WALK. SSH PARTNERED WITH ELIZABETHTON AND CARTER COUNTY CHAMBER OF COMMERCE AND SPECTRUM COMMUNICATION TO ORGANIZE, PROMOTE AND HOLD THE RUN AND WALK EVENTS. SSH IMPLEMENTED THE MORNING MILE PROGRAM IN ELEMENTARY SCHOOLS AS ONE MEANS TO HELP REDUCE OBESITY IN CHILDREN BY ENCOURAGING PHYSICAL ACTIVITY. NOW, THE PROGRAM HAS EXPANDED TO INCLUDE THE LOCAL HIGH SCHOOL, A MIDDLE SCHOOL, AND THREE ELEMENTARY SCHOOLS. THE HOSPITAL ALSO MADE DONATIONS TO A LOCAL BOYS & GIRLS CLUB, AN ORGANIZATION THAT PROVIDES AFTER SCHOOL PROGRAMS THAT ENCOURAGE PHYSICAL ACTIVITY. THE HOSPITAL PROVIDES SMOKING CESSATION COUNSELING TO ALL PATIENTS THAT HAVE BEEN ADMITTED AS AN INPATIENT, SEEN IN THE EMERGENCY DEPARTMENT OR IN AMBULATORY SURGERY. PATIENT EDUCATION IS PROVIDED THROUGH SEVERAL AVENUES INCLUDING IN-HOSPITAL EDUCATION, A TOLL FREE NUMBER FOR INFORMATION AND ADDITIONAL COUNSELING, WRITTEN MATERIAL GIVEN TO PATIENTS AND NICOTINE GUM. THE HOSPITAL PROVIDES COMMUNITY EDUCATION ON SMOKING CESSATION THROUGH EVENTS AND LOCAL SCHOOLS. THE HOSPITAL HAS FOUND IT IS MOST EFFECTIVE TO LEVERAGE PHYSICIANS TO PROVIDE EDUCATION ON SMOKING CESSATION. A DOCTOR MADE PRESENTATIONS TO LOCAL ROTARY AND KIWANIS CLUBS ABOUT THE IMPORTANCE OF GOOD HEALTH, INCLUDING NOT SMOKING, AND TIED IN THE ECONOMIC IMPACT TO THE LOCAL ECONOMY THROUGH COMMUNITY HEALTH IMPROVEMENTS. A CARDIOLOGIST AND A PULMONOLOGIST SPOKE TO LOCAL GROUPS ABOUT THE NEGATIVE HEALTH IMPACTS OF SMOKING AND THE LOCAL SMOKING CESSATION RESOURCES AVAILABLE. DIABETIC EDUCATION AND SUPPORT WAS OFFERED TO THE COMMUNITY THROUGH QUARTERLY MEETINGS. THE HOSPITAL PARTNERED WITH LILLY TO PROVIDE EDUCATIONAL PROGRAMS OPEN TO THE PUBLIC AT NO COST. THE MEETINGS OFFERED PARTICIPANTS THE OPPORTUNITY TO LEARN MORE ABOUT HOW TO MANAGE THEIR CONDITION THROUGH LIFESTYLE MEDICATION, DIET AND EXERCISE. WITH FUNDING FROM OUR FOUNDATION, WE PROVIDED GLUCOMETERS AND TESTING STRIPS TO PATIENTS WHO COULD NOT AFFORD TO MAKE THE PURCHASES. DONATIONS WERE MADE TO ORGANIZATIONS THAT SUPPORT DISEASES PREVALENT IN OUR AREA SUCH AS CANCER AND HEART DISEASE. FREE MEDICATIONS WERE PROVIDED TO SOME LOW-INCOME PATIENTS AT THE TIME OF THEIR DISCHARGE. GROUP A, FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 13H BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY. GROUP A, FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 3E DURING FY18, MSHA HOSPITALS WERE OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES WERE ESTABLISHED FOR ALL MSHA HOSPITALS' CHNAS AND PRIORITIES WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 FOR MSHA'S HOSPITALS) CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. THE RUSSELL COUNTY MEDICAL CENTER COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE RCMC GROUP'S MEMBERS COMPLETED A SURVEY RELATIVE TO WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR SPECIFIC COMMUNITY OVER THE NEXT THREE YEARS. AFTER THE INITIAL FOCUS GROUP, THE HOSPITAL'S COMMUNITY BOARD WAS INVOLVED TO DISCUSS THE SELECTED HEALTH PRIORITIES AND TO GIVE INPUT ON ANY ADDITIONAL PRIORITIES. AFTER ALL THE DETAILS AND DATA COLLECTION WAS COMPLETE, THE HOSPITAL COMMUNITY BOARD VOTED TO APPROVE THE SELECTED PRIORITIES FOUR KEY PRIORITIES WERE IDENTIFIED: - SMOKING - PHYSICAL ACTIVITY/OBESITY - SCREENINGS FOR DIABETES AND CANCER - SUBSTANCE ABUSE GROUP A, FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 5 AS PART OF THE BALLAD HEALTH FY18 CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN EACH COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. RUSSELL COUNTY MEDICAL CENTER'S FOCUS GROUP MEMBERS WERE REPRESENTED BY VIRGINIA COOPERATIVE EXTENSION, RUSSELL COUNTY HEALTH COALITION, CUMBERLAND MOUNTAIN COMMUNITY SERVICES, RUSSELL COUNTY HEALTH DEPARTMENT - CUMBERLAND PLATEAU, RUSSELL COUNTY MEDICAL CENTER FOUNDATION BOARD, UNITED WAY OF SOUTHWEST VIRGINIA, APPALACHIAN AGENCY SENIOR CITIZENS, AND RUSSELL COUNTY MEDICAL CENTER COMMUNITY BOARD. LOW-INCOME, MINORITY POPULATIONS AND MEDICALLY UNDERSERVED WERE REPRESENTED BY CUMBERLAND PLATEAU HEALTH DEPARTMENT, UNITED WAY OF SOUTHWEST VIRGINIA, AND RUSSELL COUNTY HEALTH COALITION. ALSO, BETWEEN THE FOUNDATION BOARD AND THE COMMUNITY BOARD, THERE ARE A NUMBER OF INDIVIDUALS THAT SIT ON EACH OF THESE BOARDS THAT REPRESENT LOW INCOME, MINORITY POPULATIONS, AND MEDICALLY UNDERSERVED. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY. GROUP A, FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL. GROUP A, FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 11 DURING THE YEAR, RUSSELL COUNTY MEDICAL CENTER CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. RCMC'S PRIMARY AREAS OF FOCUS INCLUDED: OBESITY, HEART DISEASE, CANCER AND SUBSTANCE ABUSE. 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. THE HOSPITAL ALSO LENDS SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. SIMILAR TO MANY OF MOUNTAIN STATES HEALTH ALLIANCE'S HOSPITALS, RUSSELL COUNTY, VIRGINIA IS A MEDICALLY UNDERSERVED AND RURAL POPULATION. AND SIMILAR TO OUR SISTER HOSPITALS, OUR COMMUNITY HAS HIGH RATES OF OBESITY, CANCER, CARDIOVASCULAR DISEASE AND SUBSTANCE ABUSE. THE HOSPITAL PROVIDED FUNDING FOR THE PURCHASE OF DRUG TAKE-BACK BOXES THAT WERE PLACED IN THREE LOCATIONS IN THE COUNTY. THESE BOXES HELP TO LIMIT THE AVAILABILITY OF UNUSED PRESCRIPTION DRUGS THAT CAN BE ABUSED. THE HOSPITAL PARTNERED WITH RUSSELL COUNTY PREVENTION COALITION TO HOST AN AFTER GRADUATION PARTY WITH A GOAL OF PREVENTING DRUG AND ALCOHOL USE. RUSSELL COUNTY PREVENTION COALITION'S MISSION IS TO PROMOTE WELLNESS WITHIN RUSSELL COUNTY. THE ORGANIZATION WORKS TO REDUCE TOBACCO USE (INCLUDING E-CIGARETTES) AND REDUCE UNDERAGE ALCOHOL AND DRUG ABUSE. THE HOSPITAL ALSO PROVIDED FINANCIAL SUPPORT TO THIS ORGANIZATION. RUSSELL COUNTY MEDICAL CENTER'S CLEARVIEW BEHAVIORAL HEALTH CENTER OFFERS MENTAL AND BEHAVIORAL HEALTH CARE FOR PEOPLE IN CRISIS SITUATIONS AT A SIGNIFICANT FINANCIAL LOSS TO THE HOSPITAL. THERE IS NOT ANOTHER INPATIENT MENTAL HEALTH FACILITY IN OUR AREA. OUR HOSPITAL AND OUR FOUNDATION CONTINUE TO HOLD THE ANNUAL HOLIDAY HEALTH CELEBRATION TO EDUCATE THE PUBLIC ON A VARIETY OF HEALTH TOPICS AND PERFORM HEALTH SCREENINGS. WE ALSO ESTABLISHED A CELEBRATE WOMEN NIGHT OF HOPE TO SUPPORT FUNDING AND EDUCATION FOR CANCER PREVENTION AND TREATMENT. A NEW SERVICE ADDED THIS YEAR IS OUR LOW-DOSE LUNG SCREENINGS TO ENABLE EARLY DETECTION OF LUNG CANCER. WE PROVIDED FREE LOW-DOSE CT SCANS TO A NUMBER OF PATIENTS. THE HOSPITAL CONTINUED ITS PRACTICE OF PROVIDING MEDICATIONS AND SUPPLIES TO AREA RESCUE SQUADS THIS YEAR. GROUP A, FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 13H BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY. GROUP A, FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 3E DURING FY18, MSHA HOSPITALS WERE OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES WERE ESTABLISHED FOR ALL MSHA HOSPITALS' CHNAS AND PRIORITIES WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 FOR MSHA'S HOSPITALS) CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. THE JOHNSON COUNTY COMMUNITY HOSPITAL COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE JCCH GROUP'S MEMBERS COMPLETED A SURVEY RELATIVE TO WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR SPECIFIC COMMUNITY OVER THE NEXT THREE YEARS. AFTER THE INITIAL FOCUS GROUP, THE HOSPITAL'S COMMUNITY BOARD WAS INVOLVED TO DISCUSS THE SELECTED HEALTH PRIORITIES AND TO GIVE INPUT ON ANY ADDITIONAL PRIORITIES. AFTER ALL THE DETAILS AND DATA COLLECTION WAS COMPLETE, THE HOSPITAL COMMUNITY BOARD VOTED TO APPROVE THE SELECTED PRIORITIES. THREE KEY PRIORITIES WERE IDENTIFIED: - SMOKING - SUBSTANCE ABUSE/MENTAL HEALTH - OBESITY GROUP A, FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 5 AS PART OF THE CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN EACH COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. JOHNSON COUNTY COMMUNITY HOSPITAL'S FOCUS GROUP MEMBERS WERE REPRESENTED BY JOHNSON COUNTY HEALTH DEPARTMENT, JOHNSON COUNTY EMERGENCY MEDICAL SERVICES, EAST TENNESSEE STATE UNIVERSITY'S MOUNTAIN CITY EXTENDED HOURS CLINIC, JOHNSON COUNTY COMMUNITY HOSPITAL TEAM MEMBERS, MEMBERS OF JOHNSON COUNTY COMMUNITY HOSPITAL FOUNDATION BOARD, AND MEMBERS OF JOHNSON COUNTY COMMUNITY HOSPITAL COMMUNITY BOARD. JOHNSON COUNTY HEALTH DEPARTMENT AND THE ETSU AFTER HOURS CLINIC REPRESENTED LOW INCOME, MEDICALLY UNDERSERVED AND MINORITY POPULATIONS. JOHNSON COUNTY'S MAU (MEDICALLY UNDERSERVED AREA) IS 100% ACCORDING TO THE U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES HEALTH RESOURCES & SERVICES ADMINISTRATION. ALSO, BETWEEN THE FOUNDATION BOARD AND THE COMMUNITY BOARD, THERE ARE A NUMBER OF INDIVIDUALS THAT SIT ON EACH OF THESE BOARDS THAT REPRESENT LOW INCOME, MINORITY POPULATIONS, AND MEDICALLY UNDERSERVED. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY. GROUP A, FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL. GROUP A, FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 11 DURING THE YEAR, JOHNSON COUNTY COMMUNITY HOSPITAL CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. JCCH'S PRIMARY AREAS OF FOCUS INCLUDED: DIABETES, OBESITY, SMOKING AND CANCER. 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. THE HOSPITAL ALSO LENDS SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. OUR RURAL COMMUNITY SUFFERS FROM HIGHER RATES OF DIABETES, CANCER, OBESITY AND TOBACCO USE. AND, OUR ISOLATED AREA POSES A CHALLENGE TO ACCESS TO HEALTH CARE. IN RESPONSE TO THE UNIQUE CHALLENGES OF RURAL LIFE, EAST TENNESSEE STATE UNIVERSITY OPERATES AN EXTENDED HOURS CLINIC LOCATED INSIDE OUR HOSPITAL, WITH THE HOSPITAL PROVIDING SOME FINANCIAL SUPPORT. THE CLINIC TREATS ACUTE AND CHRONIC CONDITIONS AND IS OPEN 6 DAYS A WEEK. THE HOSPITAL ALSO PROVIDES TELEMEDICINE SERVICES FOR SOME SPECIALTIES, FURTHER IMPROVING ACCESS TO MEDICAL SPECIALISTS. OUR HOSPITAL OPERATES AN EMERGENCY DEPARTMENT AT A FINANCIAL LOSS. WE ALSO PROVIDE A MUCH-NEEDED OUTPATIENT BEHAVIORAL HEALTH PROGRAM FOR OLDER ADULTS, WHICH ALSO OPERATES AT A LOSS. JCCH HAS FORMED PARTNERSHIPS WITH A NUMBER OF OTHER ORGANIZATIONS, SUCH AS GOJOCO TO FOCUS ON INCREASING PHYSICAL ACTIVITY, REDUCING TOBACCO USE, AND IMPROVING NUTRITION - THREE OF THE PRIMARY BEHAVIORS THAT DRIVE POOR HEALTH AND ADVERSE HEALTH OUTCOMES IN OUR REGION. GOJOCO IS A JOHNSON COUNTY-WIDE INITIATIVE TO IMPROVE THE HEALTH OF RESIDENTS. WE ALSO PARTNERED WITH A.C.T.I.O.N. COALITION TO PROMOTE SCHOOL EDUCATION WITH THE SAME GOAL TO PREVENT TOBACCO AND SUBSTANCE USE. WE SPONSORED HEALTH TOPICS ON LOCAL RADIO AND SUPPORTED HEALTH FAIRS AND COMMUNITY EVENTS AND WE PROVIDED INPATIENT AND OUTPATIENT SMOKING CESSATION COUNSELING. GROUP A, FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 13H BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY. GROUP A, FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 3E DURING FY18, MSHA HOSPITALS WERE OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES WERE ESTABLISHED FOR ALL MSHA HOSPITALS' CHNAS AND PRIORITIES WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 FOR MSHA'S HOSPITALS) CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. THE UNICOI COUNTY MEMORIAL HOSPITAL COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE UCMH GROUP'S MEMBERS COMPLETED A SURVEY RELATIVE TO WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR SPECIFIC COMMUNITY OVER THE NEXT THREE YEARS. AFTER THE INITIAL FOCUS GROUP, THE HOSPITAL'S COMMUNITY BOARD WAS INVOLVED TO DISCUSS THE SELECTED HEALTH PRIORITIES AND TO GIVE INPUT ON ANY ADDITIONAL PRIORITIES. AFTER ALL THE DETAILS AND DATA COLLECTION WAS COMPLETE, THE HOSPITAL COMMUNITY BOARD VOTED TO APPROVE THE SELECTED PRIORITIES. FOUR KEY PRIORITIES WERE IDENTIFIED: - OBESITY - BEHAVIORAL/MENTAL HEALTH - SMOKING - EARLY INTERVENTION; SCREENING RATES (MAMMOGRAPHY, COLORECTAL CANCER AND LUNG CANCER) AND THIRD GRADE READING LEVEL FOR THIRD-GRADERS GROUP A, FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 5 AS PART OF THE BALLAD HEALTH FY18 CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN EACH COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. UNICOI COUNTY MEMORIAL HOSPITAL'S FOCUS GROUP MEMBERS WERE REPRESENTED BY UNICOI COUNTY DEPARTMENT OF EDUCATION, UNICOI COUNTY CHAMBER OF COMMERCE, UNICOI COUNTY HEALTH DEPARTMENT, TOWN OF ERWIN, TELAMON HEAD START, YMCA, UNICOI COUNTY MEMORIAL HOSPITAL TEAM MEMBERS, AND THE UNICOI COUNTY MEMORIAL HOSPITAL'S BOARD. UNICOI COUNTY HEALTH DEPARTMENT, YMCA OF ERWIN, AND TELAMON HEAD START REPRESENTED LOW-INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS. ALSO, BETWEEN THE FOUNDATION BOARD AND THE COMMUNITY BOARD, THERE ARE A NUMBER OF INDIVIDUALS THAT SIT ON EACH OF THESE BOARDS THAT REPRESENT LOW INCOME, MINORITY POPULATIONS, AND MEDICALLY UNDERSERVED. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY. GROUP A, FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL. GROUP A, FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 11 DURING THE YEAR, UNICOI COUNTY MEMORIAL HOSPITAL CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. UCMH'S PRIMARY AREAS OF FOCUS INCLUDED: DIABETES, OBESITY, CANCER, AND SUBSTANCE ABUSE. 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. THE HOSPITAL ALSO LENDS SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. SIMILAR TO MSHA'S ENTIRE SERVICE AREA, UNICOI COUNTY HAS A HIGH RATE OF DIABETES, OBESITY, CANCER, AND SUBSTANCE ABUSE. ONE DIFFERENCE BETWEEN OUR COMMUNITY AND A MORE ISOLATED HOSPITAL, SUCH AS OUR SISTER HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, IS THAT OUR RESIDENTS GENERALLY HAVE GOOD ACCESS TO HEALTHCARE TREATMENT RESOURCES. UCMH IS INVOLVED WITH THE MORNING MILE - A PROGRAM THAT ENCOURAGES PHYSICAL ACTIVITY THROUGH PARTNERSHIP WITH LOCAL SCHOOLS. MORNING MILE'S GOAL IS TO REDUCE CHILDHOOD OBESITY, WHILE IMPROVING GRADES AND DECREASING ABSENTEEISM. KIDS ENGAGED WITH MORNING MILE ARE ABLE TO EXERCISE BEFORE CLASSES BEGIN WHICH HAS SHOWN TO REDUCE STRESS AND IMPROVE MOOD. PARTNERSHIPS ARE FORMED WITH OTHER ORGANIZATIONS, INCLUDING THE LOCAL CHAMBER OF COMMERCE AND LITTLE LEAGUE WITH THE SAME GOAL OF INCREASING PHYSICAL ACTIVITY. SUPPORTING OUR CHNA, A FOCUS ON CANCER RATES WITHIN OUR COMMUNITY LED TO OUR CANCER NAVIGATOR PROGRAM WHICH PROVIDES SUPPORT FOR PATIENTS NEEDING TRANSPORTATION TO DOCTOR VISITS AND TREATMENTS AS WELL AS PRESCRIPTION NEEDS. THE HOSPITAL ALSO PROVIDED FINANCIAL SUPPORT TO A LOCAL NONPROFIT THAT BENEFITS CANCER PATIENTS. WE CONTINUE TO WORK CLOSELY WITH LOCAL SUBSTANCE ABUSE AND MENTAL HEALTH PROVIDERS. UNICOI COUNTY FAR EXCEEDS THE STATE AVERAGE IN DRUG DEATHS. GROUP A, FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 13H BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY. 11 JCMC AMBULATORY SURGERY CENTER 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 LICENSED AMBULATORY SURGERY CENTER MOUNTAIN STATES IMAGING CENTER 301 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 LICENSED OUTPATIENT DIAGNOSTIC CENTER INDIAN PATH TRANSITIONAL CARE 2000 BROOKSIDE DRIVE KINGSPORT TN 37660 LICENSED SKILLED NURSING FACILITY MEDICAL CNTR HOME CARE-JOHNSON CITY 509 MED TECH PARKWAY SUITE 200 JOHNSON CITY TN 37604 LICENSED HOME HEALTH AGENGY MEDICAL CNTR HOME CARE-KINGSPORT 2020 BROOKSIDE DRIVE 28 KINGSPORT TN 37660 LICENSED HOME HEALTH AGENCY RUSSELL CO MEDICAL CNTR HOME HLTH 116 FLANNAGAN AVENUE LEBANON VA 24266 LICENSED HOME HEALH AGENCY MEDICAL CENTER HOSPICE 509 MED TECH PARKWAY SUITE 300 JOHNSON CITY TN 37604 LICENSED HOSPICE AGENCY JOHNSON COUNTY HOME HEALTH 1987 SOUTH SHADY STREET MOUNTAIN CITY TN 37683 LICENSED HOME HEALTH AGENCY RUSSELL COUNTY MEDICAL CNTR HOSPICE 116 FLANNAGAN AVENUE LEBANON VA 24266 LICENSED HOSPICE AGENCY UNICOI COUNTY LONG TERM CARE 100 GREENWAY CIRCLE UNICOI TN 37650 LICENSED LONG TERM CARE FACILITY DICKENSON CO HOME HEALTH & HOSPICE 312 HOSPITAL DRIVE SUITES 1A 1B CLINTWOOD VA 24228 LICENSED HOME HEALTH AGENCY PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE FINANCIAL ASSISTANCE APPROVAL CAN APPLY TO AN ASSORTMENT OF PATIENTS SUCH AS THOSE WHO HAVE EXHAUSTED THEIR TENNCARE/MEDICAID BENEFITS, THOSE WHO QUALIFIED FOR TENNCARE/MEDICAID AFTER THE DATE OF SERVICE, DECEASED PATIENTS WITH NO ESTATE OR ASSETS, UNINSURED PATIENTS, AND UNDERINSURED PATIENTS. WHILE BALLAD HEALTH'S QUALIFICATIONS FOR FINANCIAL ASSISTANCE IS BASED ON FEDERAL POVERTY GUIDELINES, ASSET VALUES MAY ALSO BE USED TO DETERMINE ELIGIBILITY. UNIQUE CIRCUMSTANCES MAY BE ASSESSED ON A CASE-BY-CASE BASIS. CHARITY APPROVAL COVERS ALL DATES OF SERVICE FOR THE PATIENT WHEN THEY ARE APPROVED AND THERE IS NO LIMITATION OR CAP ON THE AMOUNT OF CHARITY THAT A PATIENT MAY RECEIVE. BALLAD HEALTH HOSPITALS DO NOT STOP APPROVING FINANCIAL ASSISTANCE FOR PATIENT ACCOUNTS IF A HOSPITAL'S CHARITY WRITE-OFFS EXCEED THE HOSPITAL'S CHARITY BUDGET. OUR HOSPITALS' CHARITY WRITE-OFFS EXCEEDED BUDGET BY 8,735,103 THIS YEAR. ALL BALLAD HEALTH HOSPITALS PROVIDE AN UNINSURED DISCOUNT; THE CURRENT UNINSURED DISCOUNT IS 80% WITH THE EXCEPTION OF CRITICAL ACCESS HOSPITALS THAT PROVIDE 58%. 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 - COSTING METHODOLOGY EXPLANATION 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. OUR COST ACCOUNTING SYSTEM WAS USED TO DETERMINE LOSSES FROM TENNCARE AND MEDICAID REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH, A SMALL PHYSICIAN CLINIC AND UCMH - WE USED THE COST TO CHARGE RATIO FOR THEIR DATA BECAUSE THESE ARE SMALLER DIVISIONS NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS OR EXPENSES SPECIFIC TO A COMMUNITY HEALTH EVENT, WITH NO ADDITIONAL OVERHEAD INCLUDED IN THE COST. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF INTERNSHIPS (PRIMARILY INTERNAL MEDICINE RESIDENTS, NURSING, PHARMACY, AND THERAPY STUDENTS) WITH SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING IN A HOSPITAL SETTING. OUR MEDICARE-APPROVED PROGRAMS INCLUDE MEDICAL RESIDENTS, PHARMACY AND PASTORAL CARE AT JCMC AND IPMC AND A CERTIFIED NURSE ASSISTANT PROGRAM AT UCMH. FOR THESE PROGRAMS, MEDICARE-APPROVED COSTS AND MEDICARE REIMBURSEMENT COMES FROM FILED MEDICARE COST REPORTS. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT (OD) MAINTAINS RECORDS FOR THE NON-MEDICARE PROGRAMS. OD 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 HER/HIS 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. THERE ARE THREE EXCEPTIONS WHERE WE DO NOT USE OUR COST ACCOUNTING SYSTEM. WE HAVE A SMALL CLINIC INSIDE JCCH, A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL. JCCH SUBSIDIZES THE CLINIC AND WE USE THE CLINIC'S DEPARTMENTAL OPERATING REPORT TO COMPUTE THE CLINIC'S COMMUNITY BENEFIT (21,070). THE SECOND EXCEPTION IS A PALLIATIVE CARE PROGRAM. FOR THIS PROGRAM, WE USE THE DEPARTMENT'S OPERATING REPORT. THE THIRD EXCEPTION RELATES TO LOW-DOSE CT SCANS FOR LUNG CANCER. PATIENT CHARGES FOR THIS SCREENING EVENT WERE WRITTEN-OFF AS AN ADMINISTRATIVE ADJUSTMENT (NOT AS CHARITY). WE USED THE COST TO CHARGE RATIO TO DETERMINE THE COST OF THE FREE SCANS. THE SCANS WERE PERFORMED IN SUPPORT OF OUR CANCER CHNA PRIORITY. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY OR TENNCARE/MEDICAID ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITALS 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 IS REPORTED USING THE RESEARCH DEPARTMENT'S ACTUAL EXPENSES AND NO OVERHEAD PROVISION IS INCLUDED. LINE 7I CASH AND IN-KIND CONTRIBUTIONS INCLUDE CASH DISBURSEMENTS AND IN-KIND DONATIONS OF MEDICATIONS TO LOCAL NONPROFIT RESCUE SQUADS AND FIRE DEPARTMENTS. IN-KIND DONATIONS OF MEDICATIONS ARE BASED ON OUR ACTUAL COST FOR THESE ITEMS. PART II - COMMUNITY BUILDING ACTIVITIES MSHA LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR MSHA TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. WE DO NOT CAPTURE COSTS ASSOCIATED WITH TEAM MEMBERS THAT SERVE ON OTHER NONPROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. COMMUNITY BUILDING REPORTED ON THIS RETURN INCLUDES CHARITABLE CONTRIBUTIONS TO NONPROFITS DIRECTED TO PROVIDING ASSISTANCE TO LOW INCOME FAMILIES, MENTORING PROGRAMS FOR CHILDREN, TUTORING FOR ADULTS TO IMPROVE LITERACY SKILLS, ECONOMIC DEVELOPMENT PROJECTS, AND OTHER PROGRAMS SPECIFIC TO CHILDREN. MSHA, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, PROVIDE SPACE, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. MOST OF THESE ORGANIZATIONS WORK TO IMPROVE THE LIVES OF COMMUNITY MEMBERS THAT HAVE LIMITED, OR NO, FINANCIAL RESOURCES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY SELF-PAY BALANCES INCLUDE ACCOUNTS AFTER PAYMENTS AND CONTRACTUAL ADJUSTMENTS (DISCOUNTS) HAVE BEEN APPLIED FROM ALL THIRD-PARTY PAYERS SUCH AS MEDICARE, TENNCARE, COMMERCIAL INSURERS, AND OTHERS - GENERALLY LEAVING THE PATIENT RESPONSIBLE FOR ANY REMAINING DEDUCTIBLE AND/OR CO-PAYMENT. OTHER SELF-PAY ACCOUNTS ARE FROM PATIENTS WITH NO INSURANCE OR OTHER THIRD-PARTY COVERAGE. UNDER BALLAD HEALTH'S SELF-PAY POLICY, ANY PATIENT WHO HAS NO INSURANCE AND IS INELIGIBLE FOR ANY GOVERNMENT ASSISTANCE PROGRAM RECEIVED A 71% DISCOUNT UNTIL FEBRUARY 1, 2018, AT WHICH TIME THE UNINSURED DISCOUNT INCREASED TO 80%. 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, MSHA 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 COLLECTIVITY OF RECEIVABLES. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE OUR PRIMARY EXTERNAL COLLECTION AGENCY ESTIMATES THAT 38% OF MSHA'S 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 INDIVIDUAL'S 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 INDIVIDUAL'S PROPENSITY TO PAY SCORE. JUST UNDER 83% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS PROCESSED DURING FY18 RECEIVED A FULL DISCOUNT (COMPLETE WRITE-OFF). AN ADDITIONAL 12% RECEIVED A PARTIAL DISCOUNT, RESULTING IN AN OVERALL APPROVAL RATE OF 95% FOR COMPLETED APPLICATIONS. THEREFORE, ONLY 5% 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. INCOMPLETE APPLICATIONS ARE RETURNED TO PATIENTS ALONG WITH A NOTICE OF MISSING INFORMATION. THE NOTICE ALSO PROVIDES A CONTACT PHONE NUMBER PATIENTS MAY CALL FOR ASSISTANCE IN COMPLETING THE APPLICATION. ALL SELF-PAY PATIENTS RECEIVE FOLLOW UP CALLS EVERY 21 DAYS FROM A COMPANY MSHA PAYS TO PROCESS CHARITY CARE APPLICATIONS FOR UNINSURED PATIENTS AND TO OFFER PATIENTS ENROLLMENT ASSISTANCE IN TENNCARE (TN) OR MEDICAID (VA). 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. MSHA 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. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS BALLAD HEALTH'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PAGES 13-14 THAT DESCRIBES BAD DEBT. MSHA IS INCLUDED IN THE JUNE 30, 2018 AUDITED FINANCIAL STATEMENTS OF BALLAD HEALTH. THE AUDITED FINANCIAL STATEMENTS ARE FOR THE FIVE MONTHS ENDING AFTER THE FEBRUARY 1, 2018 MERGER OF MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM (ATTACHED). PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE REPORTED USING MSHA'S FILED MEDICARE COST REPORTS (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS TRANSPORTATION OF A PATIENT AND COMFORT ITEMS THAT INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED AND TO FEDERALLY RECOGNIZED MEDICALLY UNDERSERVED AREAS. A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE, LEAVING THE HOSPITAL TO ABSORB THE LOSS. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS SUCH AS THOSE NOTED ABOVE, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. WHILE WE AGREE THAT COSTS SUCH AS MARKETING TO ATTRACT PATIENTS AND LOBBYING ARE REASONABLE TO EXCLUDE, IT DOES NOT SEEM REASONABLE TO EXCLUDE RECRUITMENT OF PHYSICIANS AND BASIC ITEMS SUCH AS A TELEVISION AND PHONE IN PATIENT ROOMS. 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 - COLLECTION PRACTICES EXPLANATION REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GUIDELINES, WHILE ALLOWING FOR UNIQUE FINANCIAL CIRCUMSTANCES - FOR EXAMPLE, MEDICALLY INDIGENT PATIENTS WITH CATASTROPHIC MEDICAL COSTS THAT WOULD THREATEN THE PATIENT'S HOUSEHOLD FINANCIAL VIABILITY. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT'S ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED. ALL BALLAD HEALTH HOSPITALS COMPLY WITH IRS 501(R) REGULATORY GUIDELINES. 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 HOSPITALS' 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 TENNCARE OR MEDICAID. 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 AGENCY REASONABLE 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 DURING FY18. 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 BALLAD HEALTH 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 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 DEPARTMENT 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 TENNCARE OR MEDICAID, FEDERAL DISABILITY AND OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. ADDITIONALLY, IF A PATIENT OR COMMUNITY RESIDENT EXPRESSES AN INTEREST IN THE ACA-HEALTHCARE EXCHANGE, 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 MSHA SERVES THE HEALTHCARE NEEDS OF 29 APPALACHIAN COUNTIES IN TENNESSEE, SOUTHWEST VIRGINIA, KENTUCKY, AND NORTH CAROLINA. ALL OF THE COUNTIES MSHA SERVES ARE FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS. MSHA'S LARGEST HOSPITAL, JOHNSON CITY MEDICAL CENTER, IS A TERTIARY REFERRAL CENTER AND LEVEL ONE TRAUMA CENTER. ALL OF MSHA'S WHOLLY OWNED HOSPITALS ARE LOCATED IN FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS. OUR HOSPITALS' INPATIENT DISCHARGES DURING FY18, TRACKED BY ZIP CODE, INDICATE A MEDICALLY UNDERSERVED RANGE FROM 89.2% (RUSSELL COUNTY MEDICAL CENTER) TO 100% (JOHNSON COUNTY COMMUNITY HOSPITAL). MEDICALLY UNDERSERVED AREAS ARE DESIGNATED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. SHORTAGE AREAS ARE IDENTIFIED THROUGH ANALYSIS OF PHYSICIAN TO POPULATION RATIOS DEPENDING ON WHETHER AN AREA IS CONSIDERED TO HAVE A HIGH NEED. CRITERIA USED TO DETERMINE HIGH NEED ARE POVERTY RATES, THE PERCENT OF THE POPULATION OVER AGE 65, INFANT MORTALITY RATES AND FERTILITY RATES. MSHA OPERATES 2 CRITICAL ACCESS HOSPITALS: WHOLLY-OWNED JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH) IN TENNESSEE AND MAJORITY-OWNED DICKENSON COUNTY COMMUNITY HOSPITAL IN VIRGINIA. MANY RURAL RESIDENTS MUST TRAVEL A GREATER DISTANCE TO ACCESS DIFFERENT POINTS OF THE HEALTH CARE DELIVERY SYSTEM. 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 VECHICLE MILES TRAVELED OCCUR IN RURAL AREAS, ALMOST HALF OF CRASH DEATHS OCCUR THERE. WITHIN OUR COUNTIES IN MSHA'S SERVICE AREA, UNINTENTIONAL INJURY DEATHS ARE MUCH HIGHER THAN THE STATEWIDE RATES. FOR EXAMPLE, IN TENNESSEE, THE UNICOI COUNTY RATE IS 23% HIGHER AND JOHNSON COUNTY RATE IS 15% HIGHER. IN VIRGINIA, RUSSELL COUNTY'S RATE IS 54% HIGHER THAN THE STATEWIDE RATE. A CDC (CENTERS FOR DISEASE CONTROL AND PREVENTION) STUDY DEMONSTRATED THERE IS A SIGNIFICANT GAP IN HEALTH BETWEEN RURAL AND URBAN AMERICANS. THE CDC NOTED THAT DEMOGRAPHIC, ENVIRONMENTAL, ECONOMIC, AND SOCIAL FACTORS MAY PUT RURAL RESIDENTS AT HIGHER RISK OF DEATH. RESIDENTS IN RURAL AREAS TEND TO BE OLDER AND SICKER THAN THEIR URBAN COUNTERPARTS. THEY HAVE HIGHER RATES OF CIGARETTE SMOKING, HIGH BLOOD PRESSURE AND OBESITY. RURAL RESIDENTS ALSO REPORT LESS LEISURE-TIME PHYSICAL ACTIVITY AND LOWER SEATBELT USE. THEY HAVE HIGHER RATES OF POVERTY, LESS ACCESS TO HEALTHCARE, AND ARE LESS LIKELY TO HAVE HEALTH INSURANCE. THE CDC STUDY FOUND THAT UNINTENTIONAL INJURY DEATHS WERE SIGNIFICANTLY HIGHER IN RURAL AREAS, PARTLY DUE TO A GREATER RISK OF MOTOR VEHICLE CRASHES AND OPIOID OVERDOSES. THE CDC BELIEVES THE GAPS IN HEALTH BETWEEN RURAL AND URBAN CAN BE ADDRESSED BY: -SCREENING PATIENTS FOR HIGH BLOOD PRESSURE -INCREASING CANCER PREVENTION AND EARLY DETECTION -ENCOURAGING PHYSICAL ACTIVITY AND HEALTHY EATING -PROMOTING SMOKING CESSATION - CIGARETTE SMOKING IS THE LEADING CAUSE OF PREVENTABLE DISEASE DEATH IN THE U.S. -PROMOTING MOTOR VEHICLE SAFETY -ENGAGING PROVIDERS IN SAFER PRESCRIBING OF OPIOIDS FOR PAIN AND EDUCATING CITIZENS ON THE RISKS OF OPIOIDS WHILE OUR AREA HAS GENERALLY UNFAVORABLE HEALTH STATISTICS, THERE ARE FAR FEWER PRIMARY CARE PHYSICIANS PER RESIDENT IN SOME OF OUR COUNTIES THAN THE STATE'S AVERAGE. FOR EXAMPLE, IN CARTER COUNTY, OUR RATIO OF POPULATION TO PRIMARY CARE PHYSICIANS IS 79% HIGHER THAN THE STATE'S AVERAGE AND UNICOI'S RATIO IS 85% HIGHER. BOTH OF THESE COUNTIES ARE MORE THAN DOUBLE THE RATIO OF U.S. TOP PERFORMERS ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS. 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 EDUCATIONAL, 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 THE OVERALL HEALTH STANDING FOR COUNTIES INCLUDED IN THE MSHA SERVICE AREA. 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. RELATIVE TO OBESITY AND PHYSICAL ACTIVITY LEVELS, MANY OF OUR COUNTIES HAVE HIGH LEVELS OF OBESITY COMBINED WITH HIGH LEVELS OF PHYSICAL INACTIVITY AS SHOWN BELOW. -THE PERCENTAGES OF ADULT OBESITY: JOHNSON COUNTY 30%, UNICOI COUNTY 35%, CARTER COUNTY 35%, SULLIVAN COUNTY 32% AND RUSSELL COUNTY 30%. THE ADULT OBESITY RATE FOR U.S. TOP PERFORMERS IS 26% ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS. -THE PERCENTAGES OF PHYSICAL INACTIVITY: CARTER COUNTY 33%, SULLIVAN COUNTY 31%, UNICOI COUNTY 30%, JOHNSON COUNTY 35%, AND RUSSELL COUNTY 29%. THE PHYSICAL INACTIVITY RATE FOR U.S. TOP PERFORMERS IS 20% ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS. THE HEALTH STATUS OF THE POPULATION IN MSHA'S SERVICE AREA IS GENERALLY POOR. OUR SERVICE AREA EXTENDS TO SOME OF THE POOREST RURAL COUNTIES IN THE REGION WITH A POVERTY RATE OF ALMOST 30% IN SOME AREAS. THE CENSUS BUREAU ESTIMATES COUNTY MEDIAN HOUSEHOLD INCOMES ARE: JOHNSON COUNTY - 32,994; CARTER COUNTY - 34,625 AND UNICOI COUNTY - 36,576, AVERAGING APPROXIMATELY 29% BELOW THE STATE OF TENNESSEE MEDIAN HOUSEHOLD INCOME. SOME OF THE MOST WELL-OFF COUNTIES IN MSHA'S SERVICE AREA STILL HAVE A MEDIAN HOUSEHOLD INCOME LOWER THAN THE STATE AVERAGE. FOR INSTANCE, WASHINGTON COUNTY'S MEDIAN HOUSEHOLD INCOME IS 10.3% BELOW THE STATE OF TENNESSEE'S AND SULLIVAN COUNTY'S IS 15.3% BELOW. CHILDREN IN POVERTY IN SOME AREAS EXCEEDS 30%. FOR EXAMPLE, THE PERCENTAGE OF CHILDREN LIVING IN POVERTY IN JOHNSON COUNTY IS 33%, CARTER COUNTY IS 30%, UNICOI COUNTY IS 27% AND RUSSELL COUNTY IS 24%. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF UNICOI COUNTY IS 45.9, JOHNSON COUNTY IS 45.7, AND CARTER COUNTY IS 44.4, ALL SIGNIFICANTLY OLDER THAN THE MEDIAN AGE OF 38.6 IN TENNESSEE. ALL OF OUR COMMUNITIES HAVE A LARGE ELDERLY POPULATION, FAR EXCEEDING THAT OF THE COUNTRY. PERSONS 65 YEARS AND OLDER IN THE COUNTIES MSHA'S HOSPITALS ARE LOCATED IN RANGE FROM 17.6% TO 22.7% COMPARED TO 15.4% FOR THE U.S. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH MSHA IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. MSHA'S LEADERSHIP REMAINS MINDFUL OF MANAGING THE ALLIANCE'S 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. MSHA HAS SEVERAL HOSPITALS WITH MEDICARE-APPROVED HEALTH PROFESSION EDUCATION PROGRAMS. IN ADDITION, OUR HOSPITALS SERVE AS TRAINING SITES FOR MANY TYPES OF HEALTH PROFESSIONS: NURSING, PHARMACY, PSYCHOLOGY, LAB, RESPIRATORY THERAPY, EMT, PUBLIC HEALTH, ETC. STUDENTS FROM NUMEROUS COLLEGES, UNIVERSITIES, AND PROGRAMS RECEIVE TRAINING AND EXPERIENCE IN OUR HOSPITALS. WE DEVOTE RESOURCES TO HEALTH CONFERENCES FOR LOCAL HEALTH PROFESSIONALS, OPERATE TWO HEALTH RESOURCE CENTERS CONVENIENTLY LOCATED IN A SHOPPING MALL AND OUR WELLNESS CENTER; PROVIDE FOR MEDIA COVERAGE TO EDUCATE OUR RESIDENTS ON HEALTH ISSUES; OFFER EVENTS TO THE PUBLIC THAT COMBINE FUN ACTIVITIES WITH HEALTH EDUCATION; AND MANY OTHER PROGRAMS FOCUSED ON IMPROVING THE HEALTH OF OUR RESIDENTS. WHILE WE OPERATE HOSPITALS IN PREDOMINANTLY LOW-INCOME, RURAL AND ISOLATED AREAS, WE CONTINUE TO OFFER SERVICES THAT OPERATE AT A LOSS TO MSHA BECAUSE RESIDENTS WOULD OTHERWISE NEED TO LEAVE THEIR HOME TOWN OR COUNTY TO RECEIVE NEEDED CARE. MOUNTAIN STATES MERGED WITH WELLMONT HEALTH SYSTEM IN FEBRUARY 2018 TO FORM BALLAD HEALTH HEALTHCARE SYSTEM, BALLAD HEALTH'S BOARD OF DIRECTORS ASSUMED BOARD RESPONSIBILITIES FOR BOTH MOUNTAIN STATES AND WELLMONT. MOUNTAIN STATES AND WELLMONT STILL EXIST AS LEGAL ENTITIES AND CONTINUE TO OPERATE MULTIPLE HOSPITALS. MSHA'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREAS. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY MSHA. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM AS NOTED EARLIER, MSHA MERGED WITH WELLMONT HEALTH SYSTEM (WHS) TO FORM BALLAD HEALTH. BALLAD HEALTH IS THE PARENT COMPANY, SOLE MEMBER OF BOTH MSHA AND WHS. FOLLOWING THE MERGER, MSHA AND WHS CONTINUE TO EXIST AS SEPARATE LEGAL ENTITIES, EACH OPERATING MULTIPLE HOSPITALS. MOUNTAIN STATE'S MERGER WITH WELLMONT OPENS UP MANY OPPORTUNITIES NOT PREVIOUSLY AVAILABLE TO TWO COMPETING HEALTH SYSTEMS. COLLABORATION STARTED POST-MERGER AND WE EXPECT TO SEE FUTURE PROGRESS TOWARDS IMPROVING EFFICIENCIES WITHIN OUR NEW HEALTH SYSTEM, ACTIVITIES CONSISTENT WITH BALLAD HEALTH'S POPULATION HEALTH INITIATIVE, SHARING BEST PRACTICE QUALITY IMPROVEMENTS, AND OTHER BENEFITS RELATED TO OPERATING AS ONE RATHER THAN OPERATING IN A COMPETITIVE ENVIRONMENT. A NEW CLINICAL COUNCIL WAS FORMED IMMEDIATELY FOLLOWING THE MERGER. THE COUNCIL INCLUDES PHYSICIANS NOMINATED FROM THE LEADERSHIP OF ALL BALLAD HOSPITALS. NEAR THE END OF FY18, THE COUNCIL EMBARKED ON A CAMPAIGN TO REDUCE HOSPITAL ACQUIRED C. DIFF BY 30%, WITH AN ULTIMATE GOAL OF ZERO C. DIFF INFECTIONS. A NEW COMMUNITY BENEFIT AND POPULATION HEALTH COMMITTEE OF THE BOARD WAS ESTABLISHED AND VARIOUS OTHER INFRASTRUCTURES WERE ESTABLISHED PRIOR TO THE END OF FY18. ACROSS MSHA'S HOSPITALS, THERE WERE MANY PROJECTS, PROGRAMS, AND COLLABORATIVE EFFORTS THAT TOOK PLACE DURING THE YEAR. SOME EXAMPLES INCLUDE: -OPIOID PRESCRIBING REDUCTION ACROSS ALL MSHA HOSPITALS -OUR NURSE NAVIGATOR PROGRAM ACROSS ALL MSHA HOSPITALS TO ASSIST CANCER PATIENTS -A NEW STORYTELLING PROGRAM SHOWN TO RELAX AND ENCOURAGE PATIENTS WAS ESTABLISHED AT THREE HOSPITALS -THE NEW BABY BOX UNIVERSITY PROGRAM WAS IMPLEMENTED AT ALL MSHA BIRTHING CENTERS, PROMOTING PARENTING EDUCATION AND SAFE SLEEP FOR BABIES -MSHA'S GRANT DEPARTMENT OBTAINED FUNDING FOR BOTH WHOLLY OWNED AND MAJORITY OWNED HOSPITALS TO ASSIST WITH VARIOUS PATIENT HEALTH AND SAFETY PROGRAMS -MSHA HOSPITALS SHARED SUCCESSFUL ACHIEVEMENTS FROM VALUE OPTIMIZATION TEAM PROJECTS -TELEMEDICINE TO BRING SPECIALTY PHYSICIAN RESOURCES TO SMALLER FACILITIES MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY AND NORTH CAROLINA. EACH HOSPITAL IS FULLY ACCREDITED BY THE JOINT COMMISSION, WITH THE EXCEPTION OF JCCH. JCCH RECEIVES CERTIFICATION THROUGH THE STATE OF TENNESSEE SINCE IT IS A CRITICAL ACCESS HOSPITAL. MSHA, BASED IN JOHNSON CITY, TENNESSEE INCLUDES 8 WHOLLY-OWNED HOSPITALS (7 OF WHICH ARE INCLUDED IN THIS FORM 990). MSHA'S NEWEST HOSPITAL, LAUGHLIN MEMORIAL HOSPITAL, FILES A SEPARATE FORM 990. IN ADDITION TO ITS WHOLLY-OWNED HOSPITALS, MSHA HAS MAJORITY OWNERSHIP IN 4 HOSPITALS LOCATED IN SOUTHWEST VIRGINIA, EACH OF WHICH FILE SEPARATE RETURNS. IN ADDITION TO OUR ACUTE CARE HOSPITALS, OUR SYSTEM INCLUDES SUCH SERVICES AS: PRIMARY/SPECIALTY PHYSICIAN PRACTICES, EMERGENCY DEPARTMENTS, OCCUPATIONAL MEDICINE, REHABILITATION, OUTREACH LABORATORY, MENTAL HEALTH, NEONATAL INTENSIVE CARE, A NACHARI-AFFILIATED CHILDREN'S HOSPITAL, RENAL DIALYSIS, ST. JUDE'S TRI-CITIES AFFILIATE ONCOLOGY CLINIC, INPATIENT/OUTPATIENT SURGERY, SKILLED NURSING, LONG-TERM CARE, HOME HEALTH, AND MORE. WITH THESE ADDITIONAL FACILITIES AND SERVICES, MSHA EXTENDS A HIGHLY EFFECTIVE HEALTH CARE DELIVERY SYSTEM. SINCE OUR SYSTEM IS BOTH HORIZONTALLY AND VERTICALLY INTEGRATED, PATIENTS CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. MSHA'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, IS AT THE CORE OF OUR SYSTEM OFFERING FULL-SERVICE TERTIARY CARE. MSHA IS THE SOLE MEMBER OF BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (BRMMC). MSHA EXTENDS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THROUGH BRMMC TO INCLUDE MULTIPLE PRIMARY AND SPECIALTY CARE PATIENT ACCESS CENTERS AND NUMEROUS OUTPATIENT CARE SITES, INCLUDING URGENT CARE CENTERS, OCCUPATIONAL MEDICINE SERVICES, A SAME DAY SURGERY CENTER AND REHABILITATION. MSHA PARTNERED WITH EAST TENNESSEE STATE UNIVERSITY TO OPERATE OVERMOUNTAIN RECOVERY, AN OPIOID RECOVERY FACILITY LOCATED IN GRAY, TENNESSEE. MSHA IS THE OWNER OF INTEGRATED SOLUTIONS HEALTH NETWORK, LLC. (ISHN). ISHN OPERATES ANEWCARE COLLABORATIVE, THE REGION'S FIRST ACCOUNTABLE CARE ORGANIZATION, BRINGING TOGETHER COMMUNITY HEALTH CARE PROVIDERS TO PROVIDE BETTER OUTCOMES AND IMPROVED PATIENT SATISFACTION AT A LOWER COST. MSHA COUNTY-SPECIFIC OPERATIONS ARE GOVERNED BY A COMMUNITY BOARD OF DIRECTORS. COUNTY BOARDS REPORT TO A SYSTEM LEVEL BOARD OF DIRECTORS. ALL BOARDS ARE PRIMARILY COMPOSED OF LOCAL COMMUNITY RESIDENTS. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT TENNESSEE, VIRGINIA 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 CERTIFICATE OF PUBLIC ADVANTAGE (COPA) IN TENNESSEE AND A COOPERATIVE AGREEMENT (CA) IN VIRGINIA AS OBLIGATED BY AGREEMENTS BETWEEN BALLAD AND THE TWO STATES TO ALLOW MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM TO MERGE. true AMERICAN CANCER SOCIETY 2513 WESLEY STREET JOHNSON CITY TN 37601 640329009 501C3 16050 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION 208 SUNSET DRIVE SUITE 113 JOHNSON CITY TN 37604 135613797 501C3 10275 PROGRAM SUPPORT APPALACHIAN MOUNTAIN PROJECT ACCESS 809 S ROAN STREET SUITE 4 JOHNSON CITY TN 37601 262102040 501C3 179589 HEALTH ACCESS BARTER THEATRE PO BOX 867 ABINGDON VA 24212 546000120 501C3 9580 SPONSORSHIP BOYS & GIRLS CLUB OF GREENEVILLE PO BOX 1977 GREENEVILLE TN 37644 621706248 501C3 7500 AFTER SCHOOL PROG. CASA OF NORTHEAST TENNESSEE PO BOX 1021 JOHNSON CITY TN 37605 450515257 501C3 10000 CHILD PROTECTION COALITION FOR KIDS INC PO BOX 3156 JOHNSON CITY TN 37602 621765487 501C3 5500 AFTER SCHOOL PROG. EAST TENNESSEE STATE UNIVERSITY P O BOX 70732 JOHNSON CITY TN 37614 626021046 501C3 49065 HEALTH RESEARCH FRIENDS IN NEED HEALTH CENTER 1105 W STONE DR KINGSPORT TN 37660 621541637 501C3 13400 HEALTH & DENTAL CARE FRONTIER HEALTH FOUNDATION PO BOX 8293 GRAY TN 37615 461432508 501C3 47400 MENTAL HEALTH GOOD SAMARITAN MINISTRY 100 NORTH ROAN STREET JOHNSON CITY TN 37601 621233320 501C3 5500 ASSIST LOW-INCOME GOVERNOR'S FNDTN FOR HLTH&WELLNESS 511 UNION STREET SUITE 720 NASHVILLE TN 37219 453635908 501C3 25000 HEALTHIER TENNESSEE HEALING HANDS HEALTH CENTER 245 MIDWAY MEDICAL PARK BRISTOL TN 37620 621677000 501C3 14370 MEDICAL & DENTAL JDRF - EAST TN CHAPTER 4700 RUTLEDGE PIKE KNOXVILLE TN 37914 231907729 501C3 6000 PROGRAM SUPPORT SUSAN KOMEN BREAST CANCER FNDTN P O BOX 5835 KINGSPORT TN 37663 841689067 501C3 30000 PROGRAM SUPPORT MILLIGAN COLLEGE PO BOX 189 MILLIGAN COLLEGE TN 37682 620535755 501C3 13410 HEALTH PROF. EDUC. K-PLAY SPORTS COUNCILMIRACLE FIELD 400 CLINCHFIELD STREET SUITE 100 KINGSPORT TN 37660 412045125 501C3 216474 ADAPTIVE PLAYGROUND PROVIDENCE ACADEMY 2788 CARROLL CREEK ROAD JOHNSON CITY TN 37615 621564142 501C3 7380 MEDICAL/SOCIAL SVCS. SCIENCE HILL HIGH SCHOOL 1509 JOHN EXUM PARKWAY JOHNSON CITY TN 37604 626000320 501C3 5500 SPORTS PROGRAMS SECOND HARVEST FOOD BANK 127 DILLON COURT GRAY TN 37615 621303822 501C3 52500 FOOD PANTRIES RONALD MCDONALD HOUSE CHARITIES 418 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 621578123 501C3 5600 PROGRAM SUPPORT TN STATE COLLAB ON REFORMING EDUC 1207 18TH AVENUE SUITE 326 NASHVILLE TN 37212 263670335 501C3 30000 TN SCORE PROGRAM UNITED WAY OF SWVA 1096 OLE BERRY DRIVE ABINGDON VA 24210 540718860 501C3 31600 ECONOMIC DEVEL. UNIVERSITY OF VA AT WISE FNDTN PO BOX 400201 CHARLOTSVILLE VA 229044201 546001796 501C3 43708 NURSING PROGRAM UP & AT EM INC PO BOX 44 JOHNSON CITY TN 376050044 473088983 501C3 6000 HEALTHY JOHNSON CITY 25 SCHEDULE I, PAGE 1, PART I, LINE 2 DONATION REQUESTS THAT WILL BE EXPENSED AT THE CORPORATE DIVISION REQUIRE TWO LEVELS OF APPROVAL, WITH FINAL REVIEW BY EITHER THE VP OF MARKETING OR PRESIDENT & CEO OF BALLAD HEALTH. DONATIONS THAT WILL BE EXPENSED BY ONE OF OUR HOSPITALS REQUIRES FINAL APPROVAL BY THE INDIVIDUAL HOSPITAL'S CEO. ALL REQUESTS ARE NOW REQUIRED TO USE THE ONLINE APPLICATION FORM. THE ONLINE FORM PROVIDES CONSISTENCY AMONG APPLICANTS AND GIVES US THE INFORMATION WE NEED TO MAKE A VETTED FUNDING DECISION. SOME OF THE INFORMATION WE REQUIRE FROM APPLICANTS INCLUDES: -IF THE APPLICANT IS REQUESTING FUNDING FOR A SPECIFIC EVENT OR PROGRAM, THE DATE, LOCATION, TIME ARE REQUIRED -DESCRIPTION OF THE EVENT/PROGRAM -APPLICANT'S OTHER SOURCES OF INCOME -EVENT/PROGRAM BUDGET -HOW THE EVENT/PROGRAM SUPPORTS BALLAD HEALTH'S MISSION -WHO WILL BENEFIT FROM OUR CONTRIBUTION -WHAT WILL THE EVENT/PROGRAM ACCOMPLISH -HOW WILL THE EVENT/PROGRAM MEASURE ITS ACCOMPLISHMENTS -APPLICANT ORGANIZATION'S MISSION STATEMENT -YEAR THE APPLICANT ORGANIZATION WAS FOUNDED -NUMBER OF PEOPLE SERVED ANNUALLY BY THE APPLICANT -APPLICANT'S WEBSITE -TAX STATUS OF THE APPLICANT AND FEDERAL TAXPAYER ID NUMBER WITH FEW EXCEPTIONS, DONATIONS TO NATIONAL ORGANIZATIONS ARE HANDLED AT THE CORPORATE LEVEL, WHICH PREVENTS MULTIPLE CONTRIBUTIONS BEING MADE TO THE SAME NATIONAL ORGANIZATION AND ALLOWS ADDITIONAL CONTRIBUTION DOLLARS TO BE USED FOR REGION-SPECIFIC REQUESTS. DONATIONS FROM OUR HOSPITALS ARE ALMOST ENTIRELY DIRECTED TO LOCAL NONPROFIT ORGANIZATIONS. BALLAD HEALTH'S SOCIAL RESPONSIBILITY COMMITTEE IS COMPRISED OF COMMUNITY, VOLUNTEER AND BUSINESS LEADERS AS WELL AS THE PRESIDENT & CEO, CHIEF OPERATING OFFICER AND OTHER LEADERS FROM ACROSS THE SYSTEM. COMMITTEE MEMBERS WERE SELECTED SO THAT MEMBERSHIP EXPERTISE INCLUDES PUBLIC HEALTH, HEALTH PROFESSIONS EDUCATION, KNOWLEDGE OF OTHER RESOURCES AVAILABLE TO CHARITABLE ORGANIZATIONS, AND INDIVIDUALS WITH HANDS-ON COMMUNITY VOLUNTEER EXPERIENCE. SOME OF THE ROUTINE ACTIVITIES OF THE COMMITTEE DURING QUARTERLY MEETINGS INCLUDE: QUARTERLY REVIEW OF THE SOCIAL RESPONSIBILITY SCORECARD; A MEASUREMENT OF ACTUAL ACCOMPLISHMENTS IN THE YEAR COMPARED TO TARGETS SET AT THE BEGINNING OF THE YEAR REVIEW OF CHARITABLE CONTRIBUTION GIVING FOR THE PREVIOUS QUARTER OPPORTUNITY FOR LOCAL TAX-EXEMPT ORGANIZATIONS TO PRESENT TO THE COMMITTEE PROGRAMS THEY OFFER, ACHIEVEMENTS, AND FUNDING NEEDS THE COMMITTEE MAY OR MAY NOT RECOMMEND BALLAD HEALTH FUNDING OF PROGRAMS SOMETIMES, BALLAD HEALTH DEPARTMENTS WILL BRING PROPOSALS FOR NEW PROGRAMS TO BENEFIT A SPECIFIC POPULATION, SUCH AS CHILDREN X true true X X X X true true false false false false false false false ALAN LEVINE PRESIDENT/CEO 944348 277123 74631 161337 22603 1480042 48912 MARVIN EICHORN EVP/COO 576562 128590 43977 18900 23842 791871 LYNN KRUTAK EVP/CFO 479306 104168 4410 71503 16754 676141 DAWN TRIMBLE VP/CEO WASHINGTON CO 467879 69259 21987 22766 20555 602446 SHANE HILTON SVP MKT. FIN. OPS. 328389 63529 4174 35389 23198 454679 MONTY MCLAURIN VP/CEO NW MKT. 301780 36465 48537 31532 23172 441486 15920 LINDA WHITE VP & CEO, FWCH/WR 264066 72552 3699 25335 18580 384232 RICHARD BOONE VP/CFO WASHINGTON CO 286227 43095 3627 10271 15721 358941 LEMMIE TAYLOR VP/CEO SE MKT. 217035 51268 7188 29443 20614 325548 MORGAN MAY JCMC CNO 178787 26640 4275 11125 19832 240659 STEVE SAWYER AVP/CFO NW MKT. 177000 17273 8875 9343 22434 234925 MORRIS SELIGMAN MD EVP & CMO 515569 115743 39429 43438 17459 731638 ANTHONY KECK EVP POP. HLTH. OFF. 370812 81021 6777 49071 16513 524194 CLAY RUNNELS MD VP SVC LINE MGMT 358675 69101 8097 12731 22556 471160 MARK WILKINSON MD VP/CMO 355554 44377 18349 12735 22575 453590 PAUL MERRYWELL CIO 305899 58643 22853 20872 17853 426120 TONY BENTON VP/COO WASH. COUNTY 25687 90085 1392 6310 123474 SCHEDULE J, PAGE 1, PART I, LINE 1B UNLESS EXPRESSLY APPROVED BY BALLAD HEALTH'S 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, BALLAD HEALTH'S INTERNAL AUDIT VALIDATES ALL CHARTER TRAVEL WAS FOR VALID BUSINESS PURPOSES AND IN COMPLIANCE WITH BALLAD'S SENIOR EXECUTIVE TRAVEL AND BUSINESS REIMBURSEMENT POLICY. SCHEDULE J, PAGE 1, PART I, LINE 4 ALAN LEVINE 0 147,837 0 LYNN KRUTAK 0 50,200 0 DAWN TRIMBLE 0 12,649 0 SHANE HILTON 0 17,507 0 MONTY MCLAURIN 0 16,160 0 LINDA WHITE 0 7,074 0 LEMMIE TAYLOR 0 11,535 0 MORRIS SELIGMAN, M.D. 0 27,747 0 ANTHONY KECK 0 38,493 0 PAUL MERRYWELL 0 8,305 0 TONY BENTON 69,615 0 0 SCHEDULE J, PART III THE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA): ALAN LEVINE, LYNN KRUTAK, DAWN TRIMBLE, SHANE HILTON, MONTY MCLAURIN, LINDA WHITE, LEMMIE TAYLOR, MORRIS SELIGMAN, M.D., ANTHONY KECK AND PAUL MERRYWELL. 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 MSHA 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. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) 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. A HLTH & EDU FACIL BD 2012A&B&C CITY OF JOHNSON CITY 621464028 478271JV2 2012-09-18 94745050 CONSTRUCTION & EQUIP. false false false A 37880000 95337514 1889665 89474759 2016 false false true true A false false true true false false false true A false false false true true false false false true A true SCHEDULE K - DATE REBATE COMPUTATION PERFORMED HLTH & EDU. FACIL. BD. 2012A&B&C 11/28/17 SCHEDULE K - ADDITIONAL INFORMATION HLTH & EDU. FACIL. BD. 2012A&B&C CONSTRUCT AND EQUIP SURGERY CENTER AT JOHNSON CITY MEDICAL CENTER; CONSTRUCT AND EQUIP HOSPITAL FACILITIES, INCLUDING REFINANCING OF TAXABLE INDEBTEDNESS RELATING THERETO 1. COMMENT ON PART I, LINE A. IN 2012, WHEN THE BONDS REFERENCED IN SCHEDULE K WERE ISSUED, MOUNTAIN STATES HEALTH ALLIANCE OWNED AND/OR OPERATED HOSPITALS IN A NUMBER OF DIFFERENT LOCATIONS BOTH IN TENNESSEE AND IN VIRGINIA. AS A RESULT, MOUNTAIN STATES HEALTH ALLIANCE UTILIZED CONDUIT GOVERNMENTAL BOND ISSUERS IN MULTIPLE JURISDICTIONS IN ORDER TO FINANCE IMPROVEMENTS TO ITS HOSPITAL FACILITIES. IN 2012, MOUNTAIN STATES HEALTH ALLIANCE WAS THE CONDUIT BORROWER OF TAX-EXEMPT BONDS ISSUED BY MULTIPLE ISSUERS IN TENNESSEE AND VIRGINIA. FOR FEDERAL TAX PURPOSES, EVEN THOUGH DIFFERENT GOVERNMENT ISSUERS WERE INVOLVED, THESE MULTIPLE ISSUES IN EACH YEAR WERE REQUIRED TO BE TREATED, AND WERE TREATED, AS A SINGLE "ISSUE" BECAUSE THEY MET THE SINGLE "ISSUE" TEST UNDER THE APPLICABLE FEDERAL TAX REGULATIONS. THEREFORE, MULTIPLE ISSUERS ARE LISTED UNDER LINE A BECAUSE THE BONDS THAT WERE ISSUED WERE PART OF A SINGLE "ISSUE" FOR FEDERAL TAX PURPOSES. ADDITIONAL ISSUER EIN: 54-1276910 ADDITIONAL CUSIPS: 478271JWO; 977220AA0 2. COMMENT ON PART II, LINE 3. LINE 3 FOR THE LISTED BOND ISSUES DOES NOT MATCH THE APPLICABLE ISSUE PRICE FOR SUCH BOND ISSUE BECAUSE OF INTEREST EARNINGS EARNED ON THE PROCEEDS OF SUCH BONDS. 3. SCHEDULE K, PART II, LINES 10-12. THE USES OF PROCEEDS LISTED IN LINES 10-12 OF PART II ARE NOT EQUAL TO THE TOTAL PROCEEDS OF THE ISSUE LISTED IN PART II, LINE 3 BECAUSE A PORTION OF THE PROCEEDS OF THE LISTED BOND ISSUE BECAME TRANSFERRED PROCEEDS OF A CURRENT REFUNDING ISSUE OF THE LISTED BOND ISSUE (AND THEREFORE WERE NO LONGER WERE PROCEEDS OF THE LISTED BOND ISSUE). THEREFORE, SUCH TRANSFERRED PROCEEDS WERE NOT SPENT WHILE CONSIDERED PROCEEDS OF THE BONDS, AND ARE THEREFORE NOT INCLUDED ON LINES 10-12. DENNIS VONDERFECHT RETIRED CEO SPLIT LIFE INSUR.;INCL. PRIOR YRS X 7205125 8295295 false true true MARVIN EICHORN KEY EMPLOYEE SPLIT LIFE INSUR.;INCL. PRIOR YRS X 1750000 2485735 false true true MARVIN EICHORN KEY EMPLOYEE SPLIT LIFE INSUR.;INCL. PRIOR YRS X 458410 653445 false true true MARVIN EICHORN KEY EMPLOYEE SPLIT LIFE INSUR.;INCL. PRIOR YRS X 304332 304332 false true true MARVIN EICHORN KEY EMPLOYEE SPLIT LIFE INSUR.;INCL. PRIOR YRS X 296183 238783 false true true 11977590 MATTHEW MARTIN FAMILY MEMBER 30901 SEE PART V false CLEM WILKES III FAMILY MEMBER 256788 SEE PART V false BROOKE HAMILTON FAMILY MEMBER 330541 SEE PART V false SCOTT PETERS FAMILY MEMBER 68317 SEE PART V false WORKSPACE INTERIORS VENDOR 427826 SEE PART V false DAVID MAY MD VENDOR 2891029 SEE PART V false SCHEDULE L, PART V SCHEDULE L, PART IV, COL. D - ADDITIONAL INFORMATION (1) JOANNE GILMER, MSHA DIRECTOR, IS A FAMILY MEMBER OF MATTHEW MARTIN, AN EMPLOYEE OF MSHA. (2) CLEM WILKES, JR., MSHA DIRECTOR, IS A FAMILY MEMBER OF CLEM WILKES, III, AN EMPLOYEE OF MSHA. (3) CLEM WILKES, JR., MSHA DIRECTOR, IS A FAMILY MEMBER OF BROOKE HAMILTON, AN EMPLOYEE OF MSHA. (4) LEMMIE TAYLOR, MSHA KEY EMPLOYEE, IS A FAMILY MEMBER OF SCOTT PETERS, AN EMPLOYEE OF MSHA. (5) ROBERT FEATHERS, MSHA DIRECTOR, IS THE OWNER OF WORKSPACE INTERIORS, INC., WHICH PROVIDES COMMERCIAL FURNISHINGS AND DESIGN SERVICES TO MSHA. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH. (6) DAVID MAY, M.D., MSHA DIRECTOR, OWNS 50% OF VIGILANCE ANESTHESIA SOLUTIONS, PC, WHICH PROVIES ANESTHESIA SERVICES TO MSHA. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH. FORM 990, PAGE 1, ITEM C NISWONGER CHILDREN'S HOSPITAL; FRANKLIN WOODS COMMUNITY HOSPITAL; INDIAN PATH MEDICAL CENTER; SYCAMORE SHOALS HOSPITAL; WOODRIDGE HOSPITAL; JOHNSON COUNTY COMMUNITY HOSPITAL; RUSSELL COUNTY MEDICAL CENTER; UNICOI COUNTY MEMORIAL HOSPITAL FORM 990, PART III SEVEN OF OUR WHOLLY-OWNED HOSPITALS; ANOTHER WHOLLY-OWNED HOSPITAL AND FOUR MAJORITY OWNED HOSPITALS FILE SEPARATE RETURNS. MSHA IS SOLE SHAREHOLDER OF BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (BRMMC), A FOR-PROFIT ENTITY THAT OWNS AND MANAGES PHYSICIAN PRACTICES AND PROVIDES OTHER HEALTH CARE SERVICES TO PATIENTS IN TENNESSEE AND VIRGINIA. IN ADDITION, BRMMC OWNS AND MANAGES REAL ESTATE. MSHA IS THE OWNER OF INTEGRATED SOLUTIONS HEALTH NETWORK (ISHN). ISHN IS A REGIONAL HEALTH SOLUTIONS COMPANY HEADQUARTERED IN JOHNSON CITY, TENNESSEE. ISHN IS AN EXPANSIVE NETWORK OF PROVIDERS SERVING RESIDENTS OF BOTH NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA AND CONSISTS OF APPROXIMATELY 3,350 PHYSICIANS IN NORTHEAST TENNESSEE, SOUTHWEST VIRGINIA, AND WESTERN NORTH CAROLINA; OVER 470 PROVIDER GROUPS, 600 PRIMARY CARE PHYSICIANS, MORE THAN 2,600 SPECIALISTS, AND MORE THAN 2,700 ALLIED HEALTH PROVIDERS. ISHN CONSISTS OF 21 HOSPITALS, 30 SKILLED NURSING FACILITIES, 12 ORTHOTIC/ PROSTHETIC PROVIDERS, 34 DURABLE MEDICAL EQUIPMENT PROVIDERS, 9 HOME HEALTH PROVIDERS, 4 HOSPICE PROVIDERS, 13 LABORATORY PROVIDERS, 6 REHABILITATION FACILITIES AND 9 AMBULATORY SURGICAL CENTERS. ISHN CREATED ANEWCARE COLLABORATIVE, AN ACCOUNTABLE CARE ORGANIZATION, TO BEGIN PARTICIPATING IN THE MEDICARE SHARED SAVINGS PROGRAM (MSSP) IN 2012. ITS NETWORK OF PROVIDERS IS ORGANIZED TO DELIVER ON THE TENETS OF INSTITUTE FOR HEALTHCARE IMPROVEMENT'S TRIPLE AIM: IMPROVING THE HEALTH OF THE POPULATION, IMPROVING THE PATIENT EXPERIENCE OF CARE, AND REDUCING THE PER CAPITA COST OF HEALTH CARE. BUILDING OFF THE SUCCESS OF THE MSSP, AND FULLY RECOGNIZING THE SHIFT TO VALUE-BASED CARE, ANEWCARE PARTNERS WITH BALLAD HEALTH TO OFFER INNOVATIVE IMPROVEMENTS TO ITS CARE DELIVERY MODEL IN ORDER TO PROVIDE HIGH QUALITY COST AND EFFECTIVE CARE TO THOSE POPULATIONS IT IS PRIVILEGED TO SERVE. SPECIFIC TO THE HOSPITALS INCLUDED IN THIS FORM 990, WE RECORDED 45,927 INPATIENT ADMISSIONS. WE PROVIDED FOR 702,080 OUTPATIENT VISITS, 164,967 EMERGENCY VISITS AND 105,231 HOME HEALTH VISITS. 3,233 BABIES WERE BORN IN OUR FACILITIES THIS YEAR. IN APRIL 2015, MSHA AND WELLMONT HEALTH SYSTEM (WELLMONT) ANNOUNCED THEIR INTENT TO MERGE. WELLMONT OPERATES SEVEN HOSPITALS AND NUMEROUS OUTPATIENT CARE SITES IN NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. IN SEPTEMBER 2017, TENNESSEE DEPARTMENT OF HEALTH OFFICIALS GRANTED THE TWO ORGANIZATIONS THE CERTIFICATE OF PUBLIC ADVANTAGE (COPA) AND THE SOUTHWEST VIRGINIA HEALTH AUTHORITY UNANIMOUSLY RECOMMENDED APPROVAL OF THE COOPERATIVE AGREEMENT IN VIRGINIA. THE MERGER, DISCUSSED IN MORE DETAIL BELOW, WAS FINALIZED WITH A CLOSE DATE OF FEBRUARY 1, 2018. MSHA BECAME THE SOLE MEMBER OF LAUGHLIN MEMORIAL HOSPITAL ON JUNE 30, 2017. LAUGHLIN IS A NONPROFIT LOCATED IN GREENEVILLE, TENNESSEE. MSHA AND LAUGHLIN HAVE ENJOYED A DECADES-LONG RELATIONSHIP AND THE MERGER WILL ALLOW LAUGHLIN TO EXPAND SERVICES INTO AREAS WHERE THEY ARE MOST NEEDED. LAUGHLIN REMAINS A SEPARATE LEGAL ENTITY; THUS, FILING A SEPARATE FORM 990. WASHINGTON COUNTY, TN: JOHNSON CITY MEDICAL CENTER (JCMC), MSHA'S FLAGSHIP FACILITY: -A 585-BED REGIONAL TERTIARY REFERRAL CENTER - JCMC OPERATES A 432-BED ACUTE HOSPITAL; A 69-BED CHILDREN'S HOSPITAL AND AN 84-BED BEHAVIORAL HEALTH HOSPITAL -TEACHING HOSPITAL AFFILIATED WITH JAMES H. & CECILE C. QUILLEN COLLEGE OF MEDICINE AT EAST TENNESSEE STATE UNIVERSITY (ETSU) -THE SECOND HOSPITAL BUILT IN TENNESSEE -LEVEL I TRAUMA CENTER - ONE OF ONLY SIX IN TENNESSEE -HOME OF THE REGIONAL CANCER CENTER -JCMC WAS RANKED BY U.S. NEWS AND WORLD REPORT AS ONE OF THE TOP 10 HOSPITALS IN TENNESSEE IN 2017. -NISWONGER CHILDREN'S HOSPITAL (NSCH) IS A 69-BED CHILDREN'S HOSPITAL WITHIN A HOSPITAL AND IS LOCATED ON THE CAMPUS OF JOHNSON CITY MEDICAL CENTER. IT IS THE REGION'S ONLY DEDICATED HOSPITAL FOR CHILDREN THAT PROVIDES COMPREHENSIVE SERVICES WITH ACCESS TO MORE THAN 20 PEDIATRIC SUBSPECIALTIES. -NSCH SERVES MORE THAN 200,000 CHILDREN IN A FOUR-STATE, 29-COUNTY REGION. THE CHILDREN'S HOSPITAL IS STAFFED BY PEDIATRIC EXPERTS WHO KNOW, LOVE AND CARE ABOUT CHILDREN AND THEIR FAMILIES. -THE ST. JUDE TRI-CITIES AFFILIATE CLINIC AT NISWONGER CHILDREN'S HOSPITAL IS A PARTNERSHIP AMONG THE ST. JUDE CHILDREN'S RESEARCH HOSPITAL, ETSU AND NISWONGER CHILDREN'S HOSPITAL. IT WAS ESTABLISHED IN 1999, AND IS AN OUTPATIENT CLINIC STAFFED BY PEDIATRIC HEMATOLOGY- ONCOLOGY PHYSICIANS, A NURSE PRACTITIONER, IN ADDITION TO MANY OTHER CLINIC SUPPORT TEAM MEMBERS. THE TRI-CITIES AFFILIATE IS PART OF THE ST. JUDE MISSION TO EXTEND THE PROTOCOL-STRUCTURED TREATMENT AND RESEARCH AT ST. JUDE THROUGH CLINICAL, RESEARCH AND ACADEMIC PARTNERSHIPS WITH PEDIATRIC PROGRAMS. THE CLINIC RECEIVES MORE THAN 6,000 OUTPATIENT VISITS AND FOLLOWS 2,800 CHILDREN WITH MALIGNANCIES, ALSO TREATING MANY CHILDREN WITH CONGENITAL BLEEDING DISORDERS AND A VARIETY OF OTHER HEMATOLOGICAL PROBLEMS. THE FIRST REGIONAL HEMOPHILIA PROGRAM, A STATE SPONSORED PROGRAM FOR CONGENITAL BLEEDING DISORDERS, IS HOUSED IN THE ST. JUDE TRI-CITIES AFFILIATE AND HAS QUARTERLY CLINICS FOR CHILDREN AND ADULTS WITH HEMOPHILIA. THE ST. JUDE TRI-CITIES AFFILIATE CLINIC AT NISWONGER CHILDREN'S HOSPITAL IS ONE OF ONLY EIGHT CLINICS IN THE NATION THAT ARE PART OF THE ST. JUDE DOMESTIC AFFILIATE PROGRAM. -NSCH IS THE ONLY CHILDREN'S HOSPITAL IN THE REGION AFFILIATED WITH THE CHILDREN'S HOSPITAL ASSOCIATION. -NSCH'S NEONATAL INTENSIVE CARE (NICU) WORKS IN CONJUNCTION WITH ONE OF ONLY FIVE STATE-DESIGNATED PERINATAL CENTERS IN TENNESSEE. THE NICU IS DESIGNATED AS LEVEL III AND IS THE REGIONAL REFERRAL CENTER FOR NEONATAL PATIENTS. -NSCH IS HOME TO THE REGION'S ONLY PEDIATRIC EMERGENCY DEPARTMENT, OFFERING 24-HOUR EMERGENCY CARE BY SPECIALLY TRAINED PERSONNEL FOCUSED ON PROVIDING CARE TO PATIENTS FROM BIRTH TO 18 YEARS OF AGE. -NSCH PARTNERS WITH WINGS AIR RESCUE TO PROVIDE A SPECIALTY CREW FOR OUR NEONATAL POPULATIONS THAT REQUIRE ISOLETTE TRANSPORTS. -THE NORTHEAST TENNESSEE REGIONAL PERINATAL CENTER LOCATED AT JCMC IS ONE OF FIVE STATE-DESIGNATED TERTIARY CENTERS FOR HIGH-RISK MATERNAL FETAL CARE. STATE DESIGNATION IS BASED ON GUIDELINES FOR THE SERVICE PROVISIONS AND DESIGNATIONS OF LEVELS OF CARE GOVERNED AND REVIEWED BY A STATE APPOINTED COMMITTEE THROUGH TENNESSEE DEPARTMENT OF HEALTH. -WOODRIDGE HOSPITAL IS AN 84-BED INPATIENT BEHAVIORAL HEALTH HOSPITAL AND A SERVICE OF JOHNSON CITY MEDICAL CENTER THAT SERVES A WIDE REGION IN NORTHEAST TENNESSEE AS WELL AS SEVERAL COUNTIES IN SOUTHWEST VIRGINIA. WOODRIDGE IS THE ONLY DEDICATED INPATIENT BEHAVIORAL HEALTH HOSPITAL IN THE REGION, PROVIDING MENTAL HEALTH AND CHEMICAL DEPENDENCY SERVICES FOR ADULTS, ADOLESCENTS, AND CHILDREN AGES 6 AND OLDER. THE HOSPITAL PROVIDES A 24/7 INTERVENTION HELPLINE. WOODRIDGE RECEIVED THE GUARDIAN OF EXCELLENCE AWARD FROM PRESS GANEY ASSOCIATES, INC. FOR THREE CONSECUTIVE YEARS. FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH) FWCH IS AN 80-BED HOSPITAL AND WAS THE FIRST "LEADERSHIP IN ENERGY AND ENVIRONMENTAL DESIGN" (LEED) CERTIFIED HOSPITAL IN TENNESSEE AND HAS SET THE PRECEDENT FOR ENVIRONMENTALLY FRIENDLY DESIGNS. THE HOSPITAL WAS NAMED ONE OF SOLIANT HEALTH'S 2016 MOST BEAUTIFUL HOSPITALS. FRANKLIN WOODS WAS THE FIRST HOSPITAL IN TENNESSEE TO EARN PERINATAL CARE CERTIFICATION FROM THE JOINT COMMISSION. THE HOSPITAL ACHIEVED THE PATHWAY TO EXCELLENCE DESIGNATION BY THE AMERICAN NURSES CREDENTIALING CENTER (ANCC), WHICH IDENTIFIES THE HOSPITAL AS ONE OF THE BEST PLACES TO WORK FOR NURSES. SULLIVAN COUNTY, TN: INDIAN PATH MEDICAL CENTER (IPMC) IPMC IS A 261-BED HOSPITAL THAT PROVIDES ADVANCED SERVICES, INCLUDING 24/7 INTERVENTIONAL CARDIAC CATHETERIZATIONS, AN ACCREDITED JOINT REPLACEMENT PROGRAM AND A DEDICATED SPINE CENTER. THE IPMC CAMPUS OFFERS A SATELLITE REGIONAL CANCER CENTER OFFICE, A SLEEP CENTER FOR BOTH ADULTS AND CHILDREN, A FULL RANGE OF SURGICAL SERVICES, A FAMILY BIRTH CENTER AND MANY OTHER SERVICE LINES. IPMC'S PRIMARY STROKE CENTER RECEIVED ADVANCED CERTIFICATION FROM THE JOINT COMMISSION (TJC). THE HOSPITAL'S CHEST PAIN CENTER IS ALSO CERTIFIED BY TJC. THE JOINT COMMISSION IS AN INDEPENDENT, NOT-FOR-PROFIT ORGANIZATION THAT ACCREDITS AND CERTIFIES NEARLY 21,000 HEALTH CARE ORGANIZATIONS AND PROGRAMS IN THE UNITED STATES. TJC ACCREDITATION AND CERTIFICATION IS RECOGNIZED NATIONWIDE AS A SYMBOL OF QUALITY. CARTER COUNTY, TN: SYCAMORE SHOALS HOSPITAL (SSH) SSH IS A 121-BED FACILITY THAT OFFERS COMPLETE INPATIENT AND OUTPATIENT SURGICAL SERVICES INCLUDING GENERAL SURGERY, SURGICAL ONCOLOGY, ORTHOPEDICS (INCLUDING HAND AND EXTREMITIES), PLASTIC SURGERY AND GYNECOLOGICAL SURGERY. SSH ALSO OFFERS A CERTIFIED CHEST PAIN AND HEART FAILURE PROGRAM, A CERTIFIED ACUTE STROKE-READY PROGRAM AND NEW LEAF SENIOR CARE OFFERS INPATIENT PSYCHIATRIC TREATMENT TO ADULTS 55 AND OLDER. THE SSH CAMPUS INCLUDES A REGIONAL CANCER CENTER OFFICE, AN OUTPATIENT REHABILITATION CLINIC, AND COMPREHENSIVE PRIMARY CARE AND SPECIALIST CARE. SYCAMORE SHOALS HOSPITAL'S CHEST PAIN CENTER AND HE FORM 990, PAGE 6, PART VI, LINE 4 MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM MERGED ON FEBRUARY 1, 2018 TO FORM BALLAD HEALTH, A TAX-EXEMPT HEALTHCARE DELIVERY SYSTEM. AT TIME OF MERGER, THE BALLAD HEALTH BOARD OF DIRECTORS BECAME THE DIRECTORS OF MOUNTAIN STATES HEALTH ALLIANCE AND DIRECTORS OF WELLMONT HEALTH SYSTEM. BALLAD HEALTH IS THE SOLE MEMBER OF MOUNTAIN STATES AND WELLMONT. THE BOARD IS COMPRISED OF 11 MEMBERS TO INCLUDE BALLAD HEALTH'S PRESIDENT AND CEO, EAST TENNESSEE STATE UNIVERSITY'S PRESIDENT AND 9 MEMBERS CHOSEN BY MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM. BALLAD HEALTH'S PRESIDENT AND CEO SERVES AS THE BOARD'S EXECUTIVE CHAIR. IN THE SELECTION OF DIRECTORS, CONSIDERATION WAS GIVEN TO THE INCLUSION OF A VARIETY OF BUSINESS, HEALTH-RELATED, AND CONSUMER PERSPECTIVES AMONG THE VARIOUS MEMBERS OF THE BOARD OF DIRECTORS, WITH A GOAL OF ACHIEVING (I) A GEOGRAPHIC AND DEMOGRAPHIC DIVERSITY AMONG THE MEMBERS AND (II) A MIX OF COMPETENCIES, SKILLS AND PERSPECTIVES. FORM 990, PAGE 6, PART VI, LINE 6 MOUNTAIN STATES HEALTH ALLIANCE IS ORGANIZED AS A TENNESSEE NON-STOCK, NONPROFIT ORGANIZATION WITH ITS SOLE MEMBER BEING BALLAD HEALTH. FORM 990, PAGE 6, PART VI, LINE 11B THE EXECUTIVE VICE-PRESIDENT/CFO OF THE BALLAD HEALTH HEALTHCARE SYSTEM REVIEWED MOUNTAIN STATES HEALTH ALLIANCE'S FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO THE RETURN BEING FILED WITH THE IRS. THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW. FORM 990, PAGE 6, PART VI, 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, INCLUDING MSHA 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, PAGE 6, PART VI, LINE 15A BALLAD HEALTH'S BOARD OF DIRECTORS ALSO SERVES AS THE BOARD OF DIRECTORS FOR MOUNTAIN STATES HEALTH ALLIANCE. THE BOARD'S EXECUTIVE COMMITTEE REVEIWED AND APPROVED THE COMPENSATION OF ALAN LEVINE, BALLAD HEALTH AND MSHA'S PRESIDENT AND CEO, THIS YEAR. DATA OBTAINED BY AN INDEPENDENT, OUTSIDE CONSULTING FIRM WAS USED TO DETERMINE HIS PAY SO THAT IT IS COMPARABLE TO LIKE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS AND REFLECTIVE OF THE MANY ADDITIONAL HOURS HE DEVOTED THIS YEAR TO THE MERGER OF MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM. FORM 990, PAGE 6, PART VI, LINE 15B THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED AND APPROVED COMPENSATION FOR ALL MSHA EXECUTIVES AT THE VICE-PRESIDENT LEVEL AND ABOVE THIS YEAR. DATA OBTAINED BY AN INDEPENDENT, OUTSIDE CONSULTING FIRM WAS USED TO DETERMINE EXECUTIVE PAY SO THAT IT REMAINS COMPARABLE TO LIKE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. FORM 990, PAGE 6, PART VI, 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 VII, OFFICERS, KEY EMPLOYEES, & HIGHEST PAID COMPENSATION: CERTAIN EXECUTIVES OF THE ORGANIZATION, SUCH AS THE HEALTH SYSTEM'S CEO, EVP/CFO, EVP/COO. ETC. PROVIDE SERVICES TO SOME OR ALL OF THE ORGANIZATIONS RELATED TO MSHA. FORM 990, PART IX, LINE 11G PHYSICIAN FEES 27,568,242 0 0 HOSPITAL SUPPORTED CLINICS 33,555,355 0 0 HOSPITAL BASED PROVIDERS 916,333 0 0 DIETARY SERVICES 9,341,853 0 0 CONSULTING SERVICES 0 6,485,615 0 ENVIRONMENTAL SERVICES 8,353,967 0 0 LAUNDRY SERVICES 2,758,367 0 0 COLLECTION SERVICES 0 4,673,708 0 RETAIL PHARMACY 694,370 0 0 LABORATORY SERVICES 2,717,070 0 0 CONTRACT LABOR 9,700,318 0 0 PATIENT RESOURCE SERVICES 1,208,365 0 0 TRANSCRIPTION SERVICES 0 667,799 0 PHYSICIAN RECRUITMENT 890,976 0 0 LITHOTRIPSY 838,000 0 0 ENGINEERING SERVICES 0 1,492,338 0 HOSPICE 27,119 0 0 SKILLED NURSING SERVICES 1,495,680 0 0 OTHER 8,174,627 613,486 8,346 TOTAL 108,240,642 13,932,946 8,346 FORM 990, PART XI, LINE 9 CUMMULATIVE EFFECT OF CHANGE IN ACCTG. PRINCIPLE 7,206,855 TEMPORARILY RESTRICTED GRANTS -396,616 ADDITIONAL PAID IN CAPITAL -717,365 PARTNERSHIP ORDINARY INCOME - NOT ON BOOKS -1,334,580 PARTNERSHIP INTEREST INCOME - NOT ON BOOKS -26,526 PARTNERSHIP CAPITAL CONTRIBUTIONS - NOT ON BOOKS 168,694 EMPLOYER PROVIDED PARKING - NOT ON BOOKS -189,602 TOTAL 4,710,860 FORM 990, PAGE 12, PART XII, LINE 2C BALLAD HEALTH (BALLAD) 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. THE INDIVIDUALS SERVING AS THE BOARD OF DIRECTORS OF BALLAD ALSO SERVE AS THE BOARD OF DIRECTORS OF WHS AND MSHA. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF BALLAD INCLUDE WHS, MSHA AND THEIR SUBSIDIARIES AND AFFILIATES WHICH WERE PREVIOUSLY INCLUDED IN EITHER WHS OR MSHA AUDITED CONSOLIDATED FINANCIAL STATEMENTS. BALLAD HAS AN AUDIT COMMITTEE WHICH ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR. MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD SUITE 101 JOHNSON CITY TN 37604 581418862 FUNDRAISER TN 501C3 12A MSHA true MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 581418345 SUPP. ORG. TN 501C3 12A MSHA true SMYTH COUNTY COMMUNITY HOSPITAL 245 MEDICAL PARK DRIVE MARION VA 24354 540794913 HOSPITAL VA 501C3 3 MSHA true 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 MED. SERV. VA 501C3 12A JMH false BALLAD HEALTH 303 MED TECH PARKWAY SUITE 220 JOHNSON CITY TN 37604 611771290 SUPP. ORG. TN 501C3 12B NA false EAST TN HEALTHCARE HOLDINGS INC 203 GRAY COMMONS CIRCLE GRAY TN 37615 815475903 OPIOID TRT TN 501C3 3 MSHA true WELLMONT HEALTH SYSTEM 1905 AMERICAN WAY KINGSPORT TN 37660 621636465 HOSP. SYS. TN 501C3 3 BALLAD false WELLMONT HAWKINS CO MEMORIAL HOSP 851 LOCUST STREET ROGERSVILLE TN 37857 621816368 HOSPITAL TN 501C3 3 WHS false TAKOMA REGIONAL HOSPITAL INC 401 TAKOMA AVENUE GREENEVILLE TN 37743 510603966 HOSPITAL TN 501C3 3 WHS false TAKOMA REGIONAL HOSPITAL FDN INC 1905 AMERICAN WAY KINGSPORT TN 37660 471334302 FUNDRAISER TN 501C3 7 WHS false WELLMONT CARDIOLOGY SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 263557623 MED. SERV. TN 501C3 10 WHS false WELLMONT MEDICAL ASSOCIATES 1905 AMERICAN WAY KINGSPORT TN 37660 270898372 MED. SERV. TN 501C3 7 WHS false WELLMONT FOUNDATION 1905 AMERICAN WAY KINGSPORT TN 37660 581594191 FUNDRAISER TN 501C3 7 WHS false WELLMONT MADISON HOUSE 1905 AMERICAN WAY KINGSPORT TN 37660 621308216 ASST. LIV. TN 501C3 10 WHS false WELLMONT WEXFORD HOUSE 1905 AMERICAN WAY KINGSPORT TN 37660 581859039 NSG. HOME TN 501C3 10 WHS false WELLMONT IMAGING SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 861103148 HEALTHCARE TN 501C3 12A WHS false WELLMONT SLEEP SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 273777167 MED. SERV. TN 501C3 3 WHS false LAUGHLIN MEMORIAL HOSPITAL INC 1420 TUSCULUM BOULEVARD GREENEVILLE TN 37745 620701119 HOSPITAL TN 501C3 3 MSHA true LAUGHLIN HEALTHCARE FOUNDATION 1420 TUSCULUM BOULEVARD GREENEVILLE TN 37745 582105493 FUNDRAISER TN 501C3 12A MSHA true EMMAUS COMMUNITY HEALTHCARE PLLC 6070 HWY 11E PINEY FLATS TN 37686 200577483 MED. SERV. TN N/A false false MEDICAL SPECIALISTS OF JC LLC 2528 WESLEY STREET SUITE 2 JOHNSON CITY TN 37601 272199037 MED. SERV. TN MSHA EXCLUDED -313137 205925 false false 0.51000 EAST TN AMBULATORY SURGERY CNTR 701 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 621787537 MED. SERV. TN NA false false GREENEVILLE PHYSICIAN SERVICES LLC 1905 AMERICAN WAY KINGSPORT TN 37660 455070419 MED. SERV. TN LMH RELATED -1272 81046 false false 0.25000 BLUE RIDGE MEDICAL MANAGEMENT CORP 1905 AMERICAN WAY KINGSPORT TN 37660 621490616 MED. SERV. TN MSHA C CORP 142889792 227942654 1.00000 false MEDISERVE MEDICAL EQUIPMENT 1905 AMERICAN WAY KINGSPORT TN 37660 621212286 DME TN BRMMC C CORP 2347845 6153763 1.00000 false MOUNTAIN STATES PROPERTIES 1905 AMERICAN WAY KINGSPORT TN 37660 621845895 PROP. MGMT TN BRMMC C CORP 13068978 146948683 1.00000 false MOUNTAIN STATES PHYSICIAN GROUP 1905 AMERICAN WAY KINGSPORT TN 37660 621700412 MED. SERV. TN BRMMC C CORP 71133432 7348810 1.00000 false COMMUNITY HOME CARE INC 1490 PARK AVENUE NW SUITE B NORTON VA 24273 541453810 DME VA NCH C CORP 204711 449302 0.50100 false WILSON PHARMACY INC PO BOX 5289 JOHNSON CITY TN 37604 620329587 PHARMACY TN BRMMC C CORP 4881618 4846544 1.00000 false CRESTPOINT HEALTH INSURANCE COMPANY 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 620381170 INSURANCE TN ISHN C CORP 111913 12957142 1.00000 false INTEGRATED SOLUTIONS HEALTH NETWORK 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 621711997 HLTH NETWK TN MSHA C CORP 1514232 14913726 1.00000 false WELLMONT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621320035 MED. SERV. TN N/A false MCOT INC 1905 AMERICAN WAY KINGSPORT TN 37660 621325938 BUS. SERV. TN N/A false MEDICAL MALL PHARMACY INC 1905 AMERICAN WAY KINGSPORT TN 37660 621565006 MED. SERV. TN N/A false WELLMONT PHYSICIAN SERVICES 1905 AMERICAN WAY KINGSPORT TN 37660 621567353 MED. SERV. TN N/A false WPS PROVIDERS INC 1905 AMERICAN WAY KINGSPORT TN 37660 205564642 MED. SERV. TN N/A false WELLMONT HEALTH SERVICES INC 1905 AMERICAN WAY KINGSPORT TN 37660 621254373 MED. SERV. TN N/A false WELLMONT INSURANCE CO SPC LTD 1905 AMERICAN WAY KINGSPORT TN 37660 981195624 INSURANCE N/A false NOLICHUCKEY MANAGEMENT SVCS INC 1420 TUSCULUM BOULEVARD GREENEVILLE TN 37745 621776681 MED. SERV. TN LMH C CORP 4161858 801596 1.00000 false true true true true false false true true false true true true true true true true true true true ABINGTON PHYSICAN PARTNERS L 165413 COST BLUE RIDGE MEDICAL MANAGEMENT CORP A 528677 FMV BLUE RIDGE MEDICAL MANAGEMENT CORP G 392424 FMV BLUE RIDGE MEDICAL MANAGEMENT CORP L 8231835 FMV BLUE RIDGE MEDICAL MANAGEMENT CORP M 42156021 FMV BLUE RIDGE MEDICAL MANAGEMENT CORP O 186419 COST BLUE RIDGE MEDICAL MANAGEMENT CORP P 730785 COST BLUE RIDGE MEDICAL MANAGEMENT CORP Q 32835150 COST BLUE RIDGE MEDICAL MANAGEMENT CORP R 1023672 CASH BLUE RIDGE MEDICAL MANAGEMENT CORP S 1528644 CASH DICKENSON COMMUNITY HOSPITAL L 1107129 COST DICKENSON COMMUNITY HOSPITAL P 61160 COST DICKENSON COMMUNITY HOSPITAL Q 779593 COST INTEGRATED SOLUTIONS HEALTH NETWORK A 126082 FMV INTEGRATED SOLUTIONS HEALTH NETWORK L 177414 FMV INTEGRATED SOLUTIONS HEALTH NETWORK M 135520 FMV INTEGRATED SOLUTIONS HEALTH NETWORK Q 3104700 COST JOHNSTON MEMORIAL HOSPITAL L 14890876 COST JOHNSTON MEMORIAL HOSPITAL P 87680 COST JOHNSTON MEMORIAL HOSPITAL Q 41175789 COST JOHNSTON MEMORIAL HOSPITAL R 128193 CASH MEDISERVE MEDICAL EQUIP K 205837 FMV MEDISERVE MEDICAL EQUIP L 199011 FMV MEDISERVE MEDICAL EQUIP O 99457 COST MEDISERVE MEDICAL EQUIP Q 3985221 COST MOUNTAIN STATES AUXILIARY P 65210 COST MOUNTAIN STATES AUXILIARY Q 1079504 COST MOUNTAIN STATES FOUNDATION C 980274 CASH MOUNTAIN STATES PROPERTIES K 1967995 FMV MOUNTAIN STATES PROPERTIES M 323023 FMV MOUNTAIN STATES PROPERTIES O 451076 COST MOUNTAIN STATES PROPERTIES Q 7165367 COST NORTON COMMUNITY HOSPITAL D 20524914 CASH NORTON COMMUNITY HOSPITAL L 6768781 COST NORTON COMMUNITY HOSPITAL O 1394709 COST NORTON COMMUNITY HOSPITAL P 305421 COST NORTON COMMUNITY HOSPITAL Q 25360466 COST NORTON COMMUNITY HOSPITAL R 817642 CASH SMYTH COUNTY COMMUNITY HOSPITAL D 15271960 CASH SMYTH COUNTY COMMUNITY HOSPITAL L 4811614 COST SMYTH COUNTY COMMUNITY HOSPITAL Q 13366116 COST WILSON PHARMACY A 58333 FMV WILSON PHARMACY M 160606 FMV WILSON PHARMACY O 248745 COST WILSON PHARMACY Q 10482697 COST