Norton Community Hospital: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: Norton Community Hospital (EIN 54-0566029)
Tax period: 2016-07-01 to 2017-06-30
Filed: 2018-04-30
IRS object ID: 201811209349300531
Schema version: 2016v3.1
Source: Download XML · Original 990 at ProPublica

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

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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-04-30T10:39:40-04:00	ReturnTs
Tax Period End	2017-06-30	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	540566029	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	NORTON COMMUNITY HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	NORT	BusinessNameControlTxt
Phone	2766799600	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1106 W MARKET STREET	AddressLine1Txt
City	JOHNSON CITY	CityNm
State Abbreviation	TN	StateAbbreviationCd
ZIP	37604	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	MARK LEONARD	PersonNm
Person Title	NCH/DCH CEO	PersonTitleTxt
Phone	2766799600	PhoneNum
Signature	2018-04-26	SignatureDt

Filing Security Information FilingSecurityInformation

Field	Value	IRS element (for citing)
At Submission Creation Device Id	EBA7F521928E27B6E9DB4326061FED7B51503225	AtSubmissionCreationDeviceId
At Submission Filing Device Id	EBA7F521928E27B6E9DB4326061FED7B51503225	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	MARK LEONARD	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	100 15TH STREET NW	AddressLine1Txt
City	NORTON	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24273	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$65,005,591	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.BALLADHEALTH.ORG/NCH	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1949	FormationYr
Legal Domicile State	VA	LegalDomicileStateCd
Activity Or Mission	NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	4	VotingMembersIndependentCnt
Total Employee	599	TotalEmployeeCnt
Total Volunteers	46	TotalVolunteersCnt
Total Gross UBI	$138,028	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$39,839	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$123,976	PYContributionsGrantsAmt
CY Contributions Grants	$98,297	CYContributionsGrantsAmt
PY Program Service Revenue	$64,684,469	PYProgramServiceRevenueAmt
CY Program Service Revenue	$63,392,952	CYProgramServiceRevenueAmt
PY Investment Income	$879,993	PYInvestmentIncomeAmt
CY Investment Income	$983,073	CYInvestmentIncomeAmt
PY Other Revenue	$433,267	PYOtherRevenueAmt
CY Other Revenue	$494,900	CYOtherRevenueAmt
PY Total Revenue	$66,121,705	PYTotalRevenueAmt
CY Total Revenue	$64,969,222	CYTotalRevenueAmt
PY Grants And Similar Paid	$32,811	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$64,675	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$35,997,567	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$35,591,617	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$1,139	CYTotalFundraisingExpenseAmt
PY Other Expenses	$26,098,553	PYOtherExpensesAmt
CY Other Expenses	$26,493,911	CYOtherExpensesAmt
PY Total Expenses	$62,128,931	PYTotalExpensesAmt
CY Total Expenses	$62,150,203	CYTotalExpensesAmt
PY Revenues Less Expenses	$3,992,774	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$2,819,019	CYRevenuesLessExpensesAmt
Total Assets BOY	$95,001,591	TotalAssetsBOYAmt
Total Assets EOY	$96,531,232	TotalAssetsEOYAmt
Total Liabilities BOY	$40,777,394	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$38,253,781	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$54,224,197	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$58,277,451	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$52,982,115	ExpenseAmt
Grant	$64,675	GrantAmt
Revenue	$63,529,273	RevenueAmt
Desc	NORTON COMMUNITY HOSPITAL (NCH) IS LOCATED IN NORTON, VIRGINIA. OUR 129-BED ACUTE-CARE FACILITY HAS SERVED SOUTHWEST VIRGINIA AND SOUTHEASTERN KENTUCKY SINCE 1949. AS THE LARGEST HEALTHCARE FACILITY IN THE COALFIELD REGION, NCH PROVIDES A WIDE ARRAY OF SERVICES THROUGH HIGHLY TRAINED PHYSICIANS AND SUPPORT STAFF. NCH IS THE SOLE OWNER OF DICKENSON COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN CLINTWOOD, VIRGINIA. NCH IS A SUBSIDIARY OF MOUNTAIN STATES HEALTH ALLIANCE. (CONT'D ON SCHEDULE O) (CONT'D) NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 170,800 TOWARDS EFFORTS TO RECRUIT PHYSICIANS TO OUR COMMUNITY AND RETAIN THEM. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S. ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. IN MANY CASES, RECRUITMENT IS DUE TO PHYSICIAN RETIREMENT. FY17 RECRUITMENT EXPENSE AT NCH IS COMPRISED OF PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A TEMPORARY LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. LOAN FORGIVENESS IS AN INCENTIVE FOR PHYSICIANS TO STAY IN OUR AREA PROVIDING HEALTH SERVICES TO THE COMMUNITY. PHYSICIAN LOANS ARE FORGIVEN OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY. DURING FY17, OUR RECRUITMENT ACTIVITIES WERE DIRECTED TOWARD SPECIALTY AREAS SUCH AS CARDIOLOGY, GENERAL SURGERY, OB, ORTHOPEDIC SURGERY, UROLOGY, FAMILY PRACTICE, HOSPITALISTS, AND A NURSE PRACTITIONER. MSHA'S RECRUITMENT DEPARTMENT RECRUITS ON BEHALF OF ALL ITS HOSPITALS AND THE COSTS ASSOCIATED WITH RECRUITMENT FOR A PARTICULAR HOSPITAL ARE EXPENSED TO THE RECRUITING HOSPITAL. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED NEARLY 12,000 BLACK LUNG PROCEDURES THIS YEAR. WITH FINANCIAL ASSISTANCE FROM A USDA RURAL DEVELOPMENT GRANT, MOUNTAIN STATES HEALTH ALLIANCE (MSHA) ESTABLISHED A TELEMEDICINE NETWORK CONNECTING ICU DOCTORS AT JOHNSON CITY MEDICAL CENTER (MSHA'S FLAGSHIP HOSPITAL) WITH THE SYSTEM'S SIX RURAL HOSPITALS, INCLUDING NORTON COMMUNITY HOSPITAL. MOUNTAIN STATES ALREADY PRACTICES TELEMEDICINE FOR PEDIATRICS, EMERGENCY ROOM AND PSYCHIATRICS, PROVIDING A HIGH-QUALITY, LIVE VIDEO AND AUDIO LINK BETWEEN A PROVIDER AT ONE FACILITY AND A PATIENT AND PROVIDER AT ANOTHER FACILITY. THE NEW USDA GRANT IS SPECIFICALLY FOR THE INTENSIVE CARE UNIT, ALLOWING SPECIALISTS AT JCMC TO CONDUCT REAL-TIME CONSULTATIONS WITH PATIENTS AND CAREGIVERS IN THE ICU AT OUR RURAL HOSPITALS. MANY PATIENTS IN RURAL TOWNS DO NOT HAVE CARS OR DISPOSABLE INCOME TO SPEND ON GAS, MEALS OR LODGING TO COME TO JCMC FOR CARE, SO TELEMEDICINE BRINGS THE CARE TO THEM. THIS NEW SERVICE IS PROJECTED TO SERVE ABOUT 5,000 PATIENTS PER YEAR. THE USDA GRANT IS ONE OF THE USDA'S DISTANCE LEARNING AND TELEMEDICINE PROJECTS. MSHA'S TRIUMPH CANCER NAVIGATOR PROGRAM CELEBRATED ITS ONE-YEAR ANNIVERSARY DURING FY17. THE PROGRAM HAS EXPANDED ITS SCOPE TO INCLUDE MORE MSHA HOSPITALS AND NOW INCLUDES NORTON COMMUNITY HOSPITAL. IN ADDITION, THE NAVIGATION PROGRAM EXPANDED TO COVER ALL TYPES OF CANCER. THE PROGRAM IS DESIGNED TO SUPPORT CANCER PATIENTS AND THEIR FAMILIES, ADVOCATE FOR THE PATIENT, AND TO HELP COORDINATE THE PATIENT'S CARE THROUGHOUT THE CONTINUUM OF TREATMENT - FROM DIAGNOSIS TO SURVIVORSHIP. THERE IS NO CHARGE FOR THESE SERVICES REGARDLESS OF WHETHER A PATIENT CHOOSES TO RECEIVE THEIR TREATMENT AT A MSHA FACILITY OR A DIFFERENT PROVIDER. THOSE THAT JOIN THE PROGRAM RECEIVE ONE-ON-ONE ASSISTANCE FROM SPECIALLY TRAINED ONCOLOGY PROFESSIONALS. OUR CANCER NAVIGATORS COMMUNICATE WITH THE PATIENT'S DOCTOR, WILL COORDINATE TRANSPORTATION, SET UP APPOINTMENT REMINDERS AND PROVIDE EMOTIONAL SUPPORT FOR BOTH THE PATIENT AND THE PATIENT'S FAMILY. OUR NAVIGATORS WILL ALSO COORDINATE SUPPORT SERVICES SUCH AS TREATMENT PLANNING, PROSTHESIS SELECTION, NUTRITION COUNSELING, AND IDENTIFICATION OF RESOURCES FOR SPIRITUAL CARE, FINANCIAL ASSISTANCE AND OTHER NEEDS. OUR NAVIGATORS PARTICIPATE IN COMMUNITY EVENTS SUCH AS HEALTH FAIRS, CANCER EDUCATION EVENTS, AND CANCER SUPPORT GROUPS. THEY VISIT PHYSICIAN OFFICES, SENIORS' GROUPS, ATTEND MEETINGS WITH LOCAL BUSINESS ORGANIZATIONS, AND THEY WORK WITH MANY OTHER ORGANIZATIONS TO EXPLAIN THE NAVIGATION PROGRAM AND PROVIDE CANCER AWARENESS/EDUCATION THROUGHOUT THE COMMUNITY. THE PROGRAM HAS MADE AN IMPACT, WITH THE TRIUMPH PROGRAM RECEIVING A PATIENT SATISFACTION SCORE OF 93. OUR HOSPITAL'S TRIUMPH CANCER NAVIGATOR RECOGNIZED A NEED IN OUR COMMUNITY FOR SOME CANCER PATIENTS STRUGGLING WITH THEIR ILLNESS, WHILE ALSO DEALING WITH FINANCIAL WORRIES SO OUR NAVIGATOR CAME UP WITH THE IDEA FOR A FUNDRAISER. WORKING WITH MOUNTAIN STATES FOUNDATION, TWO "SOUP AND PAINT" EVENTS BROUGHT TEAM MEMBERS AND COMMUNITY MEMBERS TOGETHER TO ENJOY WARM SOUP AND A CRAFT PROJECT FOR A GOOD CAUSE. A LOCAL PAINTING INSTRUCTOR DONATED HER TIME FOR THE TWO EVENTS. MONEY RAISED PROVIDED FINANCIAL ASSISTANCE TO CANCER PATIENTS FOR THINGS LIKE GAS VOUCHERS, TAXI FARES, NON-COVERED MEDICATIONS, NUTRITIONAL EXPENSES, AND PERSONAL CARE ITEMS. DEPENDING ON PATIENTS' GREATEST NEEDS, IMPORTANT BILLS SUCH AS UTILITIES HAVE BEEN COVERED. THE UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE HOSTED AN INAUGURAL GIRLS DAY IN STEM-H FOR SIXTH-GRADE GIRLS IN THE REGION TO SHOW THE YOUNG GIRLS THAT CAREERS IN SCIENCE, TECHNOLOGY, ENGINEERING, MATHEMATICS AND HEALTH (S-T- E-M-H) ARE NOT JUST FOR MEN. DURING THE EVENT, NORTON COMMUNITY HOSPITAL PROVIDED DEMONSTRATIONS AND ACTIVITIES DESIGNED TO SPARK AN INTEREST IN MATH AND SCIENCE AND PERHAPS INTRODUCE THE GIRLS TO THE POSSIBILITY OF PURSUING CAREERS IN THE HEALTH CARE FIELD. OUR TEAM MEMBER ACTIVITIES AND PRESENTATIONS COVERED THE AREAS OF PHARMACY, OCCUPATIONAL AND PHYSICAL THERAPY, LABORATORY TECHNOLOGY, AND EMERGENCY SERVICES. STUDIES SHOW THAT YOUNG GIRLS BEGIN TO LOSE INTEREST IN STEM-H FIELDS OF STUDY JUST BEFORE THEY REACH HIGH SCHOOL. THE NUMBERS DROP AGAIN IN HIGH SCHOOL AND IN COLLEGE. ACCORDING TO THE UNITED STATES DEPARTMENT OF COMMERCE, WOMEN CONSTITUTE SLIGHTLY MORE THAN HALF OF COLLEGE EDUCATED WORKERS BUT MAKE UP ONLY 25 PERCENT OF COLLEGE EDUCATED STEM WORKERS. IN AN EFFORT TO RECRUIT MORE STUDENTS INTO THE HEALTH CARE FIELD, TEAM MEMBERS FROM NORTON COMMUNITY HOSPITAL PARTICIPATED IN A HEALTH CARE CAREER EXPO FOR EIGHTH-GRADE STUDENTS WHO HAD EXPRESSED AN INTEREST IN HEALTH CARE CAREERS. THE STUDENTS WERE ABLE TO ROTATE THROUGH THREE HEALTH CAREER SCENARIOS TO GET A TASTE OF A JOB IN HEALTH CARE. THE FIRST SCENARIO GAVE THE STUDENTS THE OPPORTUNITY TO "GOWN UP" FOR SURGERY, WITH INSTRUCTIONS ON SURGICAL INSTRUMENTS AND THE IMPORTANCE OF A STERILE ENVIRONMENT. THE STUDENTS WITNESSED THE REPAIR OF A "BANANAPLASTY", WITH OUR CNO SURGICALLY REPAIRING A PARTIALLY PEELED BANANA. THE STUDENTS GOT TO WITNESS TYPES OF STITCHES USED IN SURGICAL CASES AND THE TYPES OF INSTRUMENTS INVOLVED. THE SECOND SCENARIO PROVIDED INFORMATION RELATED TO A CAREER IN PHARMACY WITH OUR PHARMACY DIRECTOR WALKING THE STUDENTS THROUGH THE EDUCATIONAL REQUIREMENTS AND PROCESSES INVOLVED WITH PURSUING PHARMACY DEGREES AND FACILITATED A VERY COMPETITIVE ROUND OF PHARMACY BINGO WHICH INTRODUCED STUDENTS TO MEDICAL TERMINOLOGY RELATED TO PHARMACY. IN THE THIRD SCENARIO, STUDENTS WERE TAUGHT ABOUT HEART AND LUNG FUNCTIONS. STUDENTS VIEWED THEIR OWN HEART RHYTHMS WHILE LEARNING ABOUT EKG PATTERNS. THEY LISTENED TO BREATH SOUNDS AND RESPIRATIONS ON A PEDIATRIC MANIKIN AND HOW TO USE A DINAMAP FOR MONITORING BLOOD PRESSURE AND CHECKING PULSE OXIMETRY READINGS. THE STUDENTS WERE ALSO TAUGHT HOW TO MANUALLY CHECK BLOOD PRESSURE READINGS. NORTON COMMUNITY HOSPITAL PARTNERED WITH DICKENSON COMMUNITY HOSPITAL, RIDGEVIEW MIDDLE SCHOOL AND SOUTHWEST VIRGINIA AREA HEALTH EDUCATION CENTER TO PUT THE PROGRAM TOGETHER. FUTURE PROGRAMS ARE BEING PLANNED FOR DIFFERENT AGE GROUPS. NCH OPERATES A PHYSICIAN CLINIC THAT IS LOCATED IN A RURAL, LOW-INCOME AREA. THE CLINIC IS STAFFED PRIMARILY WITH MEDICAL RESIDENTS. WITHOUT THE CLINIC, COMMUNITY MEMBERS WOULD NOT HAVE ACCESS TO PRIMARY CARE. NCH'S SUBSIDY OF THE CLINIC THIS YEAR EXCEEDED 626,000. AFTER COMPLETING AN EXT	Desc
Total Program Service Expenses	$52,982,115	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	Yes (true)	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	124	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	599	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	4	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	VA	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	ROWENA BLACK	PersonNm
Phone	2764391031	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	100 15TH STREET NW	AddressLine1Txt
City	NORTON	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24273	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
MARVIN EICHORN MSHA EVPCOO
DIRECTOR	0.50	54.50	Yes (X)	$0	$590,395	$39,746
MONTY MCLAURIN VPCEO NW MKT
VICE-CHAIR	9.00	36.00	Yes (X)	$0	$565,441	$54,906	Yes (X)
MATTHEW CUSANO MD
PHYSICIAN &	41.00	0.50	Yes (X)	$351,087	$0	$30,123
SHANE HILTON VPCFO MKT OPER
DIRECTOR	2.00	43.00	Yes (X)	$0	$339,387	$58,849
TOM TULL MSHA VP
DIRECTOR	1.00	44.00	Yes (X)	$0	$170,651	$24,339
CHARLES WARD
CHAIR	1.00	0.50	Yes (X)	$21,445	$0	$0	Yes (X)
ROBERT LEONARD
SECRETARY/TR	1.00	1.00	Yes (X)	$12,560	$0	$0	Yes (X)
JAMES MANICURE
DIRECTOR	0.50	1.10	Yes (X)	$8,172	$0	$0
BUFORD STURGILL
DIRECTOR	0.50	0.50	Yes (X)	$6,833	$0	$0
BILL WAMPLER
DIRECTOR	1.00	0.50	Yes (X)	$3,765	$0	$0
CHARLES SLEMP
DIRECTOR	0.50	0.50	Yes (X)	$1,260	$0	$0
ERNIE WARD
DIRECTOR	1.00	1.00	Yes (X)	$1,260	$0	$0
VALERIE LAWSON
DIRECTOR	1.00	0.50	Yes (X)	$840	$0	$0
MARK LEONARD
NCH/DCH CEO	39.00	6.00		$0	$256,280	$46,006	Yes (X)
KEVIN MORRISON
NCH/DCH CFO	39.00	6.00		$0	$117,853	$14,896	Yes (X)
VISHAL RAJ MD
PHYSICIAN	40.00			$503,584	$0	$17,950		Yes (X)
DARYL PIERCE MD
PHYSICIAN	40.00			$419,554	$0	$15,545		Yes (X)
MICHAEL GREEN MD
PHYSICIAN	40.00			$380,309	$0	$6,497		Yes (X)
RUBYE WASHINGTON-MOORE MD
PHYSICIAN	40.00			$313,874	$0	$30,681		Yes (X)
BERNIE SERGENT MD
PHYSICIAN	40.00			$292,489	$0	$29,107		Yes (X)
STEPHEN SAWYER AVPCFO NW MKT
IPMC CFO/FMR	0.00	45.00		$0	$189,714	$30,666			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$2,317,032	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,229,721	TotReportableCompRltdOrgAmt
Total Other Compensation	$399,311	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	32	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
VIRGINIA HIGHLANDS ANESTHESIA
PO BOX 1476	ABINGDON	VA	24212	ANESTHESIA SERV	$846,819
WEATHERBY LOCUMS INC
PO BOX 972633	DALLAS	TX	753972633	PHYSICIAN FEES	$606,315
ARAMARK SERVICES INC
615 MCCALLIE AVENUE	CHATTANOOGA	TN	37403	DIETARY SERV	$558,428
DAVIS BROTHERS NURSERY INC
122 BASSWOOD ROAD	ROSE HILL	VA	24281	LANDSCAPING	$242,238
GRC CONSTRUCTION SERVICES
130 REGIONAL PARK DRIVE	KINGSPORT	TN	37660	CONSTRUCTION	$209,224

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	9	CntrctRcvdGreaterThan100KCnt
Related Organizations	$81,053	RelatedOrganizationsAmt
Government Grants	$6,500	GovernmentGrantsAmt
All Other Contributions	$10,744	AllOtherContributionsAmt
Total Contributions	$98,297	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT REVENUE	621110	$62,394,052	$62,394,052
WELLNESS PROGRAMS	621110	$981,061	$981,061
LABORATORY REVENUE	621511	$17,839		$17,839

Field	Value	IRS element (for citing)
Total Program Service Revenue	$63,392,952	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$643,994	TotalRevenueColumnAmt
Exclusion	$643,994	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$221,663	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$36,369	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$185,294	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$185,294	TotalRevenueColumnAmt
Unrelated Business Revenue	$22,823	UnrelatedBusinessRevenueAmt
Exclusion	$162,471	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$332,643	SecuritiesAmt
Other	$6,436	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$332,643	SecuritiesAmt
Other	$6,436	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$339,079	TotalRevenueColumnAmt
Related Or Exempt Func Income	$6,436	RelatedOrExemptFuncIncomeAmt
Exclusion	$332,643	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
WELLNESS CENTER	713940	$97,366	$97,366
PRECEPTOR PAYMENTS	900099	$82,925		$82,925
REVENUE FROM PARENT	900099	$49,960		$49,960

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$79,355	TotalRevenueColumnAmt
Exclusion	$79,355	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$309,606	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$64,969,222	TotalRevenueColumnAmt
Related Or Exempt Func Income	$63,514,434	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$138,028	UnrelatedBusinessRevenueAmt
Exclusion	$1,218,463	ExclusionAmt

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

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$64,675	TotalAmt
Program Services	$64,675	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,016,328	TotalAmt
Program Services	$423,492	ProgramServicesAmt
Management And General	$592,836	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$27,036,017	TotalAmt
Program Services	$24,976,165	ProgramServicesAmt
Management And General	$2,059,852	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,124,787	TotalAmt
Program Services	$1,046,274	ProgramServicesAmt
Management And General	$78,513	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$4,713,173	TotalAmt
Program Services	$4,102,778	ProgramServicesAmt
Management And General	$610,395	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,701,312	TotalAmt
Program Services	$1,655,327	ProgramServicesAmt
Management And General	$45,985	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$262,129	TotalAmt
Program Services	$248,537	ProgramServicesAmt
Management And General	$13,592	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$277,635	TotalAmt
Management And General	$277,635	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$50,004	TotalAmt
Management And General	$50,004	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$86,131	TotalAmt
Management And General	$86,131	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$7,390,506	TotalAmt
Program Services	$6,277,609	ProgramServicesAmt
Management And General	$1,112,897	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$231,108	TotalAmt
Program Services	$32,848	ProgramServicesAmt
Management And General	$198,260	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$652,685	TotalAmt
Program Services	$571,550	ProgramServicesAmt
Management And General	$81,135	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,407,628	TotalAmt
Program Services	$1,380,655	ProgramServicesAmt
Management And General	$26,973	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,024,632	TotalAmt
Program Services	$870,432	ProgramServicesAmt
Management And General	$154,200	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$327,668	TotalAmt
Program Services	$311,462	ProgramServicesAmt
Management And General	$15,067	ManagementAndGeneralAmt
Fundraising	$1,139	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$292,370	TotalAmt
Management And General	$292,370	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$4,418,812	TotalAmt
Program Services	$2,741,383	ProgramServicesAmt
Management And General	$1,677,429	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$512,922	TotalAmt
Program Services	$122,645	ProgramServicesAmt
Management And General	$390,277	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$5,867,711	$5,867,711
MANAGEMENT FEES TO PARENT	$1,778,643	$758,646	$1,019,997
REPAIRS & MAINTENANCE	$1,185,772	$1,146,810	$38,962
UBI TAXES	$6,381		$6,381

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$721,174	TotalAmt
Program Services	$383,116	ProgramServicesAmt
Management And General	$338,058	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$62,150,203	TotalAmt
Program Services	$52,982,115	ProgramServicesAmt
Management And General	$9,166,949	ManagementAndGeneralAmt
Fundraising	$1,139	FundraisingAmt

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

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$7,369,839	BOYAmt
EOY	$2,714,701	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$9,496,254	BOYAmt
EOY	$9,843,893	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$62,692	BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,436,665	BOYAmt
EOY	$1,317,625	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$485,218	BOYAmt
EOY	$253,685	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$102,948,111	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$55,825,056	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$49,861,960	BOYAmt
EOY	$47,123,055	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$26,107,697	BOYAmt
EOY	$35,086,412	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$181,266	BOYAmt
EOY	$191,861	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$95,001,591	BOYAmt
EOY	$96,531,232	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$7,118,549	BOYAmt
EOY	$6,101,019	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$20,985,500	BOYAmt
EOY	$20,708,048	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$12,673,345	BOYAmt
EOY	$11,444,714	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$40,777,394	BOYAmt
EOY	$38,253,781	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$54,096,792	BOYAmt
EOY	$58,203,041	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$127,405	BOYAmt
EOY	$74,410	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$54,224,197	BOYAmt
EOY	$58,277,451	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$95,001,591	BOYAmt
EOY	$96,531,232	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$2,819,019	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$1,883,372	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$649,137	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

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

Contributor US Address ContributorUSAddress

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

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

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (true)	GrantsOtherOrganizationsInd
Grants Other Organizations	$2,811	GrantsOtherOrganizationsAmt
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	false	OtherActivitiesInd
Total Lobbying Expenditures	$2,811	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE C, PART II-B, LINE 1	FormAndLineReferenceDesc
Explanation	NCH HAD LOBBYING EXPENSES OF 2,811 WHICH REPRESENTS THE PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION AND TO NATIONAL RURAL HEALTH ASSOCIATION ATTRIBUTABLE TO DIRECT LOBBYING.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,111,034	OtherCostOrOtherBasisAmt
Book Value	$2,111,034	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$52,150,123	OtherCostOrOtherBasisAmt
Depreciation	$21,866,468	DepreciationAmt
Book Value	$30,283,655	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$282,116	OtherCostOrOtherBasisAmt
Depreciation	$209,193	DepreciationAmt
Book Value	$72,923	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$47,112,123	OtherCostOrOtherBasisAmt
Depreciation	$33,292,178	DepreciationAmt
Book Value	$13,819,945	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,292,715	OtherCostOrOtherBasisAmt
Depreciation	$457,217	DepreciationAmt
Book Value	$835,498	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$47,123,055	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
PENSION BENEFITS	$9,202,152
DUE TO AFFILIATES	$1,256,919
RESERVE-PROF. LIABILITY SELF-INSUR	$985,643

Field	Value	IRS element (for citing)
Total Liability	$11,444,714	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE D, PAGE 3, PART X	FormAndLineReferenceDesc
Explanation	"THE ALLIANCE 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 THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2017 AND 2016. AT JUNE 30, 2017, TAX RETURNS FOR 2014 THROUGH 2016 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE."	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	false	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$790,535	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$790,535	NetCommunityBenefitExpnsAmt
Total Expense	0.01270	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,351,717	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$9,807,888	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,543,829	NetCommunityBenefitExpnsAmt
Total Expense	0.07310	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$15,142,252	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$9,807,888	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,334,364	NetCommunityBenefitExpnsAmt
Total Expense	0.08580	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$255,841	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$255,841	NetCommunityBenefitExpnsAmt
Total Expense	0.00410	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,496,731	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,601,495	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,895,236	NetCommunityBenefitExpnsAmt
Total Expense	0.03050	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,951,007	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$620,646	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,330,361	NetCommunityBenefitExpnsAmt
Total Expense	0.02140	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$39,175	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$39,175	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,742,754	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,222,141	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,520,613	NetCommunityBenefitExpnsAmt
Total Expense	0.05660	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,885,006	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,030,029	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,854,977	NetCommunityBenefitExpnsAmt
Total Expense	0.14250	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$8,007,203	BadDebtExpenseAmt
Bad Debt Expense Attributable	$6,005,402	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$16,875,422	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$16,028,859	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$846,563	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

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

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	NORTON COMMUNITY HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	100 15TH STREET NW	AddressLine1Txt
City	NORTON	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24273	ZIPCd

Field	Value	IRS element (for citing)
Website Address	BALLADHEALTH.ORG/NCH	WebsiteAddressTxt
State License	H 1879	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Teaching Hospital	Yes (X)	TeachingHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	NORTON COMMUNITY HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	15	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	false	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	BALLADHEALTH.ORG/NCH	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	false	StrategyPostedWebsiteInd
Strategy Attached	Yes (true)	StrategyAttachedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	BALLADHEALTH.ORG	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	BALLADHEALTH.ORG	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	BALLADHEALTH.ORG	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 5	MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES, INCLUDING NCH. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 5 TO 18 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S PERCEIVED HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS, AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE FACILITY COMMUNITY BOARDS (SUCH AS NCH'S BOARD) WERE PRESENTED THIS INFORMATION AND SHARED THEIR THOUGHTS AS WELL ON THE HEALTH NEEDS TO PRIORITIZE. THE SPECIFIC NEEDS FOR EACH COUNTY WERE THEN ADDRESSED IN THE RESPECTIVE FACILITY IMPLEMENTATION PLAN WHICH WAS ADOPTED SEVERAL MONTHS LATER.
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 6A	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. NCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 11	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2015. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2014 AND 2015. DUE TO LIMITED RESOURCES, EACH FACILITY PRIORITIZED FOUR TO FIVE HEALTH PRIORITIES ON WHICH TO FOCUS AND DEVELOP IMPLEMENTATION PLANS TO IMPACT. THERE WERE SEVEN COMMON HEALTH PRIORITIES SELECTED BY THE VARIOUS 11 FACILITIES, BUT NOT ALL FACILITIES SELECTED THE SAME AREAS. THE SEVEN ARE OBESITY, SUBSTANCE/PRESCRIPTION DRUG ABUSE, DIABETES, CANCER, HEART DISEASE, SMOKING AND MENTAL HEALTH. ALL OF THESE ARE SIGNIFICANT ISSUES FOR ALL 11 FACILITIES, BUT EACH CHOSE TO PRIORITIZE ON A DIFFERENT SET SO THEY COULD TARGET THEIR EFFORTS AND BE MORE EFFECTIVE WITH LIMITED RESOURCES. FOR EXAMPLE, WHILE NEARLY ALL THE FACILITIES IDENTIFIED OBESITY (11 OF 11) AND SUBSTANCE/PRESCRIPTION DRUG ABUSE (10 OF 11), ONLY CERTAIN FACILITIES ELECTED TO FOCUS ON SOME NUMBER OF THE OTHER FIVE COMMON HEALTH PRIORITIES. WHILE MENTAL HEALTH IS CLEARLY A SIGNIFICANT ISSUE FOR ALL 11 FACILITIES, ONLY THREE ARE FOCUSED ON IT DUE TO LIMITED RESOURCES. THE SAME IS TRUE WITH SMOKING WHERE ONLY 5 OF THE 11 FACILITIES ARE FOCUSED ON IT, BUT IT IS AN ISSUE FOR ALL FACILITIES. SIX OF THE 11 FACILITIES SELECTED CANCER; 6 OF THE 11 SELECTED HEART DISEASE; AND 9 OF THE 11 CHOSE DIABETES. ANOTHER WAY TO STATE THIS IS BY FACILITY. FOR EXAMPLE, WHILE CANCER AND MENTAL HEALTH ARE PREVALENT CHALLENGES FOR JCMC'S PRIMARY SERVICE AREA, THE HOSPITAL ELECTED NOT TO FOCUS ON THOSE DUE TO LIMITED TIME, FUNDING, PERSONNEL AND OTHER RESOURCES NEEDED TO EFFECTUATE CHANGE. UCMH FELT IT WAS UNABLE TO ADDRESS HEART DISEASE, SMOKING, AND MENTAL HEALTH ISSUES IN ITS PRIMARY SERVICE AREA. SOME FACILITIES IDENTIFIED ISSUES SUCH AS TRANSPORTATION AND EDUCATION AS BARRIERS TO GOOD HEALTH, BUT WERE ALSO UNABLE TO SET ASIDE SUFFICIENT RESOURCES TO MEANINGFULLY IMPACT THOSE CHALLENGES. AFTER THE FACILITIES SELECTED A REASONABLE NUMBER OF HEALTH PRIORITIES THEY FELT THEY COULD ADEQUATELY IMPACT, AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF NOVEMBER AND DECEMBER 2015. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. THE FACILITIES CONTINUE TO CONDUCT ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, NCH WORKS WITH LOCAL PHYSICIANS TO PROVIDE A SUPPORT PROGRAM FOR PREGNANT WOMEN WITH SUBSTANCE ABUSE ISSUES. IN COLLABORATION WITH ANOTHER NONPROFIT, WE PROVIDED FREE COLONOSCOPIES TO LOW INCOME COMMUNITY MEMBERS. WE ALSO PROVIDED NUMEROUS PUBLIC HEALTH EDUCATIONAL INFORMATION BY PARTNERING WITH LOCAL MEDIA OUTLETS TO COVER TOPICS SUCH AS WOMEN'S HEALTH, LUNG CANCER, AND A MEDICATION ASSISTANCE PROGRAM. SEVERAL MSHA FACILITIES, INCLUDING NCH, PARTICIPATE IN THE MSHA TRIUMPH CANCER NAVIGATOR PROGRAM WHICH HELPS COORDINATE CARE FOR CANCER PATIENTS FREE OF CHARGE TO ALL PATIENTS, REGARDLESS OF WHETHER THEY CHOOSE TO RECEIVE THEIR TREATMENT AT A MSHA FACILITY.

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 MEDICAID BENEFITS, THOSE WHO QUALIFIED FOR MEDICAID AFTER THE DATE OF SERVICE, DECEASED PATIENTS WITH NO ESTATE OR ASSETS, UNINSURED PATIENTS, AND UNDERINSURED PATIENTS. MSHA/NCH CHARITY QUALIFICATION IS BASED ON FEDERAL POVERTY GUIDELINES BUT ALSO USES ASSET VALUES TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. 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 THEY CAN RECEIVE. MSHA ALWAYS ATTEMPTS TO FULFILL ITS OBLIGATION TO PROVIDE FINANCIAL ASSISTANCE TO THOSE PATIENTS WITHOUT THE ABILITY TO PAY. THE MAJORITY OF MSHA HOSPITALS ARE LOCATED IN TENNESSEE AND PURSUANT TO TENNESSEE LAW ALL PATIENTS WITHOUT THIRD-PARTY PAYER COVERAGE RECEIVE A DISCOUNT OF 70%, WITH THE EXCEPTION OF CRITICAL ACCESS HOSPITALS THAT RECEIVE 58%. THIS IS A CALCULATED DISCOUNT THAT IS UPDATED ON AN ANNUAL BASIS. ALTHOUGH VIRGINIA DOES NOT HAVE A LAW THAT REQUIRES HOSPITALS TO PROVIDE DISCOUNTS TO UNINSURED PATIENTS, MSHA EXTENDS THESE UNINSURED DISCOUNTS TO ITS VIRGINIA HOSPITALS AS WELL, INCLUDING NCH.
PART I, LINE 6A - RELATED ORGANIZATION INFORMATION	MOUNTAIN STATES HEALTH ALLIANCE, NCH'S MAJORITY OWNER, PREPARED A COMMUNITY BENEFIT REPORT THAT INCLUDED NCH DURING THE TAX YEAR. THE REPORT WAS MADE AVAILABLE TO THE PUBLIC.
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 COST. OUR COST ACCOUNTING SYSTEM PROVIDED MEDICAID/TENNCARE LOSSES REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH AND OUR PHYSICIAN CLINIC. WE USED COST TO CHARGE RATIOS FOR HOME HEALTH AND OUR PHYSICIAN CLINIC BECAUSE THEIR DATA ARE 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 (NURSING, PHARMACY, EMT, RESPIRATORY THERAPY, PUBLIC HEALTH, PHYSICAL/OCCUPATIONAL THERAPY, AND STUDENTS FROM OTHER ALLIED HEALTH PROGRAMS) WITH SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING AT A HOSPITAL AS PART OF THEIR EDUCATION AND TRAINING. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT KEEPS DETAILED RECORDS OF HOURS SPENT ON THESE STUDENT ACTIVITIES, THE NUMBER OF STUDENTS THAT ROTATE THROUGH OUR HOSPITAL, ETC. INFORMATION IS MAINTAINED FOR EACH HOSPITAL UNIT THAT PARTICIPATES. WE ONLY INCLUDE LABOR RELATED COSTS AND WE ONLY ASSUME A PERCENTAGE OF OUR INVOLVED TEAM MEMBERS' TIME ARE DEVOTED TO THESE STUDENTS. NCH PARTICIPATES IN A MEDICARE-APPROVED INTERNAL MEDICINE RESIDENT PROGRAM. COSTS AND REIMBURSEMENT FOR THE MEDICAL RESIDENT PROGRAM ARE TAKEN FROM THE HOSPITAL'S FILED MEDICARE COST REPORT. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USED OUR COST ACCOUNTING SYSTEM TO DETERMINE COMMUNITY BENEFIT EXPENSE. THERE ARE TWO EXCEPTIONS WHERE WE DO NOT USE OUR COST ACCOUNTING SYSTEM. WE HAVE A PHYSICIAN CLINIC IN A RURAL, LOW INCOME AREA THAT IS SUBSIDIZED BY THE HOSPITAL. NCH OWNS AND OPERATES THE CLINIC AND SUBSIDIZES THE CLINIC'S LOSSES (626,926). THE OTHER EXCEPTION RELATES TO CLINICAL SERVICES WE PROVIDE TO LOCAL NONPROFITS (73,177). FOR THESE, WE APPLIED THE 990 COMPUTED COST TO CHARGE RATIO. FOR MANY YEARS, NCH HAS PROVIDED FREE CLINICAL SERVICES TO ORGANIZATIONS THAT WORK WITH HOMELESS OR LOW INCOME INDIVIDUALS. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND MEDICAID/TENNCARE 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 HOSPITAL THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE OR SERVICES THAT ARE READILY AVAILABLE FROM OTHER FOR-PROFIT PROVIDERS IN OUR SERVICE AREA.
PART II - COMMUNITY BUILDING ACTIVITIES	NCH 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 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 NON PROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. NCH, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN 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 POSTED FROM ALL THIRD-PARTY PAYERS- 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. ALL UNINSURED PATIENTS RECEIVE A 70% UNINSURED DISCOUNT AND MANY SELF-PAY PATIENTS WILL QUALIFY FOR 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, NCH WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO GATHER HISTORICAL INFORMATION TO APPLY TO THE CURRENT RECEIVABLE BALANCE. ANOTHER CONSIDERATION WHEN ESTIMATING BAD DEBT EXPENSE IS UNUSUAL CIRCUMSTANCES (SUCH AS LOCAL, REGIONAL OR NATIONAL ECONOMIC CONDITIONS) WHICH AFFECT THE COLLECTABILITY OF RECEIVABLES.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE	OUR REIMBURSEMENT DEPARTMENT ESTIMATES THAT 75% OF BAD DEBT EXPENSE AT NCH IS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, EITHER A FULL OR PARTIAL WRITE-OFF OF CHARGES. THIS ESTIMATE IS BASED ON THE COMPOSITION OF BAD DEBTS ATTRIBUTABLE TO PEOPLE WITH NO FORM OF INSURANCE OR OTHER THIRD-PARTY COVERAGE, WHICH REPRESENTS THE MAJORITY OF BAD DEBT ACCOUNTS. WE ALSO ESTIMATE A MUCH SMALLER PERCENTAGE OF LIKELY CHARITY-ELIGIBLE ACCOUNTS TO PEOPLE WITH BALANCES AFTER INSURANCE/THIRD- PARTY COVERAGE HAS PAID (E.G. DEDUCTIBLES AND CO-PAYMENT BALANCES). IT IS IMPLAUSIBLE TO DETERMINE WITH EXACTITUDE THE AMOUNT OF NCH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETED FINANCIAL ASSESSMENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSISTANCE FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT 84.6% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS PROCESSED DURING FY17 RECEIVED A FULL DISCOUNT (COMPLETE WRITE-OFF). AN ADDITIONAL 11.2% RECEIVED A PARTIAL DISCOUNT, RESULTING IN AN OVERALL APPROVAL RATE OF 95.8% FOR COMPLETED APPLICATIONS. DURING FY17, ONLY 4.2% 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 7 DAYS FROM A COMPANY NCH PAYS TO PROCESS CHARITY CARE APPLICATIONS FOR UNINSURED PATIENTS AND TO OFFER PATIENTS ENROLLMENT ASSISTANCE IN MEDICAID. 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 ARE SURE 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 HISTORICAL DATA CLEARLY INDICATES THAT MOST UNINSURED PATIENTS WILL QUALIFY FOR FINANCIAL ASSISTANCE UNDER OUR PROGRAM. WITHOUT A COMPLETED APPLICATION, WE HAVE NO CHOICE OTHER THAN TO REPORT AN UNPAID ACCOUNT AS BAD DEBT INSTEAD OF CHARITY CARE.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS	THE TEXT OF NCH'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE APPEARS ON PAGES 13 AND 14 IN OUR MOST RECENT AUDITED FINANCIAL STATEMENTS (ATTACHED).
PART III, LINE 8 - MEDICARE EXPLANATION	MEDICARE ALLOWABLE COSTS ARE REPORTED USING NCH'S FILED MEDICARE COST REPORT (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 TO INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS AND PHYSICIAN GUARANTEES ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED. ALSO, A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE. 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 TELEVISIONS IN PATIENT ROOMS. ALTHOUGH NCH DID NOT SUSTAIN A MEDICARE LOSS THIS YEAR, WE STRONGLY FEEL HOSPITALS THAT DO SUSTAIN OVERALL MEDICARE LOSSES SHOULD BE ALLOWED TO REPORT LOSSES IN PART I AS A COMMUNITY BENEFIT, SIMILAR TO OTHER 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, NON-PROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES ECONOMICALLY INJURIOUS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION: NCH HAS ESTABLISHED A STRONG COMMITMENT TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES WE SERVE. ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GENERAL 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. NORTON COMMUNITY HOSPITAL RECOGNIZES ITS OBLIGATION TO PROVIDE QUALITY HEALTHCARE TO THOSE WHO ARE UNABLE TO PAY. NCH CHARITY GUIDELINES ARE BASED ON THE NATIONAL POVERTY GUIDELINES. HOWEVER, FINANCIAL ASSISTANCE IS NOT BASED SOLELY ON INCOME. UNIQUE FINANCIAL CIRCUMSTANCES ARE CONSIDERED, WHICH CAN CHANGE THE CATEGORY OF ELIGIBILITY. IN ADDITION, CHARITY DETERMINATION MAY BE RETROACTIVE FOR ALL DATES OF SERVICE. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED. ALL MSHA HOSPITALS ADHERE TO IRS REGULATORY GUIDELINES SET FORTH IN 501(R). A COPY OF OUR CREDIT AND COLLECTION POLICY MAY BE FOUND ONLINE OR OBTAINED IN PRINT VERSION FREE OF CHARGE.
PART VI, LINE 2 - NEEDS ASSESSMENT	MSHA INCLUDED AMERICA'S HEALTH RANKINGS (AHR) IN ITS ASSESSMENT IN ORDER TO BETTER DEFINE THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. IN 2017, VIRGINIA'S OVERALL HEALTH RANKING REMAINED AT 19TH, WHILE TENNESSEE MOVED FROM 44TH TO 45TH. HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE NCH IS LOCATED) CLOSELY RESEMBLES THE HEALTH RANKINGS FOR TENNESSEE. AMERICA'S HEALTH RANKINGS ARE BASED ON A SERIES OF MEASURES INCLUDING SEVERAL HEALTH OUTCOMES AND HEALTH FACTORS. A SURVEY WAS GIVEN TO 106 INDIVIDUALS REPRESENTING THE TEN COUNTIES IN WHICH MSHA OWNS A FACILITY. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH LEADERS, NONPROFIT DIRECTORS, SCHOOL NURSES AND OFFICIALS, AND BUSINESS LEADERS. A SURVEY WAS GIVEN TO EACH INDIVIDUAL SEEKING FEEDBACK REGARDING AVAILABLE RESOURCES IN EACH AREA, THE PERCEIVED HEALTH STATUS, HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. THE MAJORITY OF RESPONSES SUGGESTED FOCUSING ON EDUCATION IN ORDER TO PROMOTE HEALTHY HABITS AND INCREASED ACCESS TO RESOURCES. OTHER RESPONSES INCLUDED: MAKE PHYSICAL EDUCATION A REQUIREMENT AS PART OF SCHOOL CURRICULUM, IMPROVE NATURAL TRAILS AND WALKWAYS, INCREASE COMMUNITY SUPPORT FOR SMOKE-FREE AREAS, PARTNER WITH LOCAL FARMER'S MARKETS, SHARE HEALTH INFORMATION BETWEEN PHARMACIES, NETWORK WITH SMALL BUSINESSES AND NONPROFITS IN ORDER TO AVOID DUPLICATING RESOURCES, AND PROVIDE EARLY SCREENINGS FOR THE UNINSURED OR UNDERINSURED. OVERALL, THE COMMUNITY MEMBERS GAVE MSHA'S CORE SERVICE AREA A HEALTH STATUS RANKING OF 4.55 OUT OF 10 (1 BEING THE LOWEST, 10 BEING THE HIGHEST). NCH WAS GIVEN A HEALTH STATUS RANKING OF 3.6. AMONG THE 106 PARTICIPANTS, THE AREAS OF OBESITY, CANCER, HEART DISEASE, SMOKING, SUBSTANCE/PRESCRIPTION DRUG ABUSE, AND DIABETES WERE THE TOP HEALTH PRIORITIES IN OUR REGION. ACCORDING TO THE MOST RECENT AHR REPORTS, VIRGINIA AND TENNESSEE BOTH SAW AN INCREASE IN DIABETES AND OBESITY WITHIN THE PAST TEN YEARS. VIRGINIA RANKS 25TH FOR CARDIOVASCULAR DEATHS, 24TH FOR CANCER DEATHS AND 23RD FOR DIABETES.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	MOUNTAIN STATES HEALTH ALLIANCE COMMUNICATES WITH AND EDUCATES OUR PATIENTS THROUGH VARIOUS AVENUES FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND HOSPITAL FINANCIAL ASSISTANCE. EDUCATION IS PROVIDED TO PATIENTS THROUGH SIGNAGE AND FINANCIAL ASSISTANCE BROCHURES AT ALL HOSPITAL AND AMBULATORY ADMISSION LOCATIONS. FINANCIAL ASSISTANCE APPLICATIONS AND PLAIN LANGUAGE SUMMARIES ARE PROVIDED TO PATIENTS SHOULD THEY REQUEST ONE DURING THEIR PRE- REGISTRATION, REGISTRATION OR FINANCIAL COUNSELING PROCESS. OUR GOVERNMENTAL PROGRAM ELIGIBILITY REPRESENTATIVES ASSIST PATIENTS IN SECURING ELIGIBILITY FOR 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. FINANCIAL COUNSELORS OFFER FINANCIAL ASSISTANCE APPLICATIONS TO PATIENTS WHO DO NOT QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND ARE UNABLE TO PAY FOR THE COST OF THEIR HEALTHCARE. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE ON OUR WEBSITE TO INCLUDE THE FINANCIAL ASSISTANCE APPLICATION, POLICY AND PLAIN LANGUAGE SUMMARY IN BOTH ENGLISH AND SPANISH. ALL PATIENT STATEMENTS HAVE VERBIAGE DISCUSSING FINANCIAL ASSISTANCE ALONG WITH THE CONTACT INFORMATION. OUR LAST LETTER TO THE PATIENT DISPLAYS THE PLAIN LANGUAGE SUMMARY. IN ALL ORAL CORRESPONDENCES WITH THE PATIENT, IF IT IS IDENTIFIED THEY CANNOT MEET THE PAYMENT REQUIREMENTS ON THEIR ACCOUNT, FINANCIAL ASSISTANCE IS DISCUSSED AS AN OPTION.
PART VI, LINE 4 - COMMUNITY INFORMATION	NCH IS LOCATED IN NORTON, WISE COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. SOUTHWEST VIRGINIA (SWVA) IS LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION AND HAS A HIGH RATE OF UNINSURED ADULTS. ACCORDING TO U.S. CENSUS BUREAU ESTIMATES, NORTON HAS A POPULATION OF APPROXIMATELY 3,978, WHILE WISE COUNTY'S POPULATION IS 40,074. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF WISE COUNTY IS 40.0 WHICH IS OLDER THAN THE MEDIAN AGE OF 37.8 IN VIRGINIA. 16.2% OF WISE COUNTY'S RESIDENTS ARE 65 OR OLDER COMPARED TO 14.2% FOR THE STATE. THE BUREAU ESTIMATES WISE COUNTY MEDIAN HOUSEHOLD INCOME AT 36,352 COMPARED TO 66,149 FOR THE STATE OF VIRGINIA. 31% OF WISE COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 15% STATEWIDE. WISE COUNTY'S HEALTH OUTCOMES RANK 124 OUT OF 134 IN THE STATE. WISE COUNTY IS ALMOST 57% RURAL COMPARED WITH THE STATEWIDE RURAL RATE OF 24.5%. THIS FACTOR IS A SIGNIFICANT CONTRIBUTING FACTOR IN INFLUENCING HEALTH OUTCOMES IN A POPULATION. MANY RURAL RESIDENTS MUST TRAVEL A GREATER DISTANCE TO ACCESS DIFFERENT POINTS OF THE HEALTH CARE DELIVERY SYSTEM; HOWEVER, DUE TO GEOGRAPHIC DISTANCE, SOMETIMES EXTREME WEATHER CONDITIONS, LACK OF PUBLIC TRANSPORTATION AND CHALLENGING ROADS, RURAL RESIDENTS MAY BE LIMITED, AND IN SOME INSTANCES, EVEN PROHIBITED FROM ACCESSING HEALTH CARE SERVICES. MORE THAN 50% OF VEHICLE CRASH-RELATED FATALITIES OCCUR IN RURAL AREAS, EVEN THOUGH LESS THAN ONE-THIRD OF MILES TRAVELED IN A VEHICLE OCCUR THERE AND THERE IS AN ADDITIONAL 22% RISK OF INJURY-RELATED DEATHS IN RURAL COMMUNITIES. WITHIN OUR OWN COUNTY, INJURY DEATHS ARE ALMOST DOUBLE THE STATEWIDE RATE. AND, WHILE OUR AREA HAS GENERALLY UNFAVORABLE HEALTH STATISTICS, THERE ARE FAR FEWER PRIMARY CARE PHYSICIANS PER RESIDENT IN OUR COUNTY THAN THE STATE'S AVERAGE. OUR COUNTY'S RATIO OF POPULATION TO PRIMARY CARE PHYSICIANS IS 2,100:1 COMPARED TO THE STATE'S AVERAGE OF 1,320:1. IN OTHER WORDS, WE HAVE 40% MORE RESIDENTS PER PHYSICIAN THAN THE STATE'S AVERAGE. IT IS DIFFICULT TO RECRUIT PHYSICIANS TO A RURAL AREA SUCH AS OURS. A NUMBER OF FACTORS CONTRIBUTE TO A UNIQUE AND CHALLENGING ENVIRONMENT THAT INFLUENCE OVERALL HEALTH STANDING IN OUR COUNTY. ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS, 31% OF THE ADULTS IN NCH'S HOME COUNTY ARE OBESE. OBESITY INCREASES THE RISK FOR MANY HEALTH CONDITIONS SUCH AS CORONARY HEART DISEASE, TYPE 2 DIABETES, HYPERTENSION, STROKE, CANCER, SLEEP APNEA AND RESPIRATORY PROBLEMS, AND OSTEOARTHRITIS. EVIDENCE INDICATES PHYSICAL ACTIVITY, INDEPENDENT OF ITS EFFECT ON WEIGHT, HAS SUBSTANTIAL BENEFITS FOR HEALTH. OUR COUNTY'S INACTIVITY RATE OF 35% IS ALMOST 67% HIGHER THAN THE STATEWIDE RATE. WISE COUNTY'S ADULT SMOKING RATE IS ALMOST 24% HIGHER THAN THAT OF VIRGINIA'S AVERAGE.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	NCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. NCH'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. NCH HAS A MEDICARE-APPROVED INTERNAL MEDICINE RESIDENCY EDUCATION PROGRAM. IN ADDITION, OUR HOSPITAL SERVES AS A TRAINING SITE FOR MANY OTHER TYPES OF HEALTH PROFESSIONS SUCH AS NURSING, PHARMACY, RESPIRATORY THERAPY, AND OTHER ALLIED HEALTH PROGRAMS. WE PROVIDE FOR MEDIA COVERAGE TO EDUCATE OUR COMMUNITY ON HEALTH ISSUES, PROVIDE FREE CLINICAL CARE TO LOW INCOME INDIVIDUALS IN COLLABORATION WITH OTHER NONPROFIT ORGANIZATIONS, AND PROVIDE FREE DRUGS AND SUPPLIES TO LOCAL NONPROFIT EMERGENCY RESPONSE ORGANIZATIONS. WE ALSO PROVIDED FUNDING TO A LOCAL UNIVERSITY FOR NURSING STUDENT SCHOLARSHIPS THIS YEAR. NCH OWNS DICKENSON COUNTY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN THE APPALACHIAN MOUNTAINS. DICKENSON IS 100% RURAL ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S 2017 COUNTY HEALTH RANKINGS REPORT. DICKENSON COUNTY'S MEDIAN HOUSEHOLD INCOME IS ONLY 47% OF THE MEDIAN STATEWIDE INCOME AND THE COUNTY'S HEALTH OUTCOMES RANK 122 OUT OF 134 IN THE STATE. DCH OPERATES AT A SUBSTANTIAL FINANCIAL LOSS AND RELIES ON NCH TO SUBSIDIZE ITS OPERATIONS. NCH'S CAPITAL CONTRIBUTION TO DCH WAS JUST UNDER 2.9 MILLION. THE MAJORITY OF NCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. MANY OF OUR BOARD MEMBERS ARE NOT CONSIDERED INDEPENDENT, PER IRS FORM 990 INSTRUCTIONS. FOUR WERE EMPLOYED BY NCH'S MAJORITY OWNER, MOUNTAIN STATES HEALTH ALLIANCE. TWO MEMBERS ARE NOT CONSIDERED INDEPENDENT BECAUSE THEY HAD A FAMILY MEMBER EMPLOYED BY NCH DURING THE YEAR (IN NON-MANAGERIAL POSITIONS). TWO LACK INDEPENDENCE BECAUSE THEY RECEIVED 1099 REPORTABLE COMPENSATION EXCEEDING 10,000 FOR HEALTH INSURANCE PAID BY NCH. ANOTHER BOARD MEMBER IS NOT INDEPENDENT BECAUSE HE WAS EMPLOYED BY NCH. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY NCH.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	NCH IS A 129-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 13- MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. NCH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE, THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. NCH SERVES AS THE COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM NCH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. IF NEED BE, PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	VIRGINIA

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	UNIVERSITY OF VIRGINIA AT WISE	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1 COLLEGE AVE	AddressLine1Txt
City	WISE	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24293	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	541638774	RecipientEIN
IRC Section	501C3	IRCSectionDesc
Cash Grant	$56,000	CashGrantAmt
Purpose Of Grant	NRSG. & ATHL. PROGMS	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE I, PAGE 1, PART I, LINE 2	FormAndLineReferenceDesc
Explanation	NCH CHARITABLE DONATIONS REQUIRE FINAL APPROVAL BY THE CEO. IN ORDER TO IMPROVE THE OVERALL EFFICIENCY OF CONTRIBUTION REQUEST EVALUATION, ALL REQUESTS ARE NOW REQUIRED TO BE COMPLETED USING THE ONLINE APPLICATION FORM. THE ONLINE FORM PROVIDES CONSISTENCY AMONG APPLICANTS AND GIVES US THE INFORMATION WE NEED IN ORDER TO MAKE A FULLY 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, AND TIME ARE REQUIRED DESCRIPTION OF THE EVENT/PROGRAM APPLICANT'S OTHER SOURCES OF INCOME EVENT/PROGRAM BUDGET HOW THE EVENT/PROGRAM SUPPORTS NCH'S MISSION WHO WILL BENEFIT FROM OUR CONTRIBUTION WHAT WILL THE EVENT/PROGRAM ACCOMPLISH 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 MSHA'S 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 MSHA HOSPITALS, INCLUDING NCH, ARE ALMOST ENTIRELY DIRECTED TO LOCAL NONPROFIT ORGANIZATIONS. MSHA'S SOCIAL RESPONSIBILITY COMMITTEE, WHICH PROVIDES SYSTEM-WIDE GUIDANCE, IS COMPRISED OF COMMUNITY LEADERS INCLUDING THE DEAN OF A LOCAL UNIVERSITY, THE PRESIDENT OF A LOCAL COLLEGE, UNITED WAY OF WASHINGTON COUNTY'S PRESIDENT, COMMUNITY VOLUNTEERS, BUSINESS LEADERS, MOUNTAIN STATES FOUNDATION'S PRESIDENT, AND OTHERS. 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 MSHA CORPORATE/HOSPITAL FUNDING OF PROGRAMS SOMETIMES, MSHA DEPARTMENTS WILL BRING PROPOSALS FOR NEW PROGRAMS TO BENEFIT A SPECIFIC POPULATION, SUCH AS CHILDREN	ExplanationTxt

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Bonus Related OrganizationsBonusRelatedOrganizationsAmt
MARVIN EICHORN MSHA EVPCOO
DIRECTOR	$558,459	$31,936	$18,200	$24,493	$630,141
MONTY MCLAURIN VPCEO NW MKT
VICE-CHAIR	$296,329	$269,112	$32,670	$24,986	$620,347	$108,669
MATTHEW CUSANO MD
PHYSICIAN & DIRECTOR							$261,135	$41,364	$48,588	$8,171	$22,881	$381,210
SHANE HILTON VPCFO MKT OPER
DIRECTOR	$322,719	$4,103	$36,871	$24,815	$398,236								$12,565
TOM TULL MSHA VP
DIRECTOR	$159,956	$10,695	$13,784	$12,214	$194,990
MARK LEONARD
NCH/DCH CEO	$247,334	$8,946	$26,216	$22,333	$302,286
VISHAL RAJ MD
PHYSICIAN							$455,901	$20,812	$26,871		$19,053	$521,534
DARYL PIERCE MD
PHYSICIAN							$417,374		$2,180		$16,667	$435,099
MICHAEL GREEN MD
PHYSICIAN							$364,749		$15,560	$5,653	$1,880	$386,806
RUBYE WASHINGTON-MOORE MD
PHYSICIAN							$273,951	$18,500	$21,423	$7,962	$23,706	$344,555
BERNIE SERGENT MD
PHYSICIAN							$177,971	$67,560	$46,958	$7,802	$22,215	$321,596
STEPHEN SAWYER AVPCFO NW MKT
IPMC CFO/FMR NCH CFO	$174,936	$14,778	$9,539	$22,803	$220,380

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

SCHEDULE J, PAGE 1, PART I, LINE 4

MONTY MCLAURIN, VP/CEO NW MKT 0 15,920 0 SHANE HILTON, VP/CFO MKT OPER. 0 17,247 0 MARK LEONARD 0 13,214 0

SCHEDULE J, PART III

PART I, LINE 4B MONTY MCLAURIN, SHANE HILTON, AND MARK LEONARD PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE(MSHA). 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.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
JAMIE FLEMING
FAMILY MEMBER	$37,881	FAMILY MBR OF BD MBR	false
DEBBIE WARD
FAMILY MEMBER	$72,050	FAMILY MBR OF BD MBR	false

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE L, PART V	FormAndLineReferenceDesc
Explanation	BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: 1(A) NAME OF PERSON: JAMIE FLEMING 1(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JAMES MANICURE, NORTON COMMUNITY HOSPITAL (NCH)BOARD MEMBER 1(D) DESCRIPTION OF TRANSACTION: JAMES MANICURE, BOARD MEMBER OF NCH, IS A FAMILY MEMBER OF JAMIE FLEMING, AN EMPLOYEE OF NCH. 2(A) NAME OF PERSON: DEBBIE WARD 2(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF ERNIE WARD, NORTON COMMUNITY HOSPITAL (NCH)BOARD MEMBER 2(D) DESCRIPTION OF TRANSACTION: ERNIE WARD, BOARD MEMBER OF NCH, IS A FAMILY MEMBER OF DEBBIE WARD, AN EMPLOYEE OF NCH.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSION	NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.
FORM 990, PAGE 2, PART III, LINE 4A	(CONT'D) NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 170,800 TOWARDS EFFORTS TO RECRUIT PHYSICIANS TO OUR COMMUNITY AND RETAIN THEM. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S. ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. IN MANY CASES, RECRUITMENT IS DUE TO PHYSICIAN RETIREMENT. FY17 RECRUITMENT EXPENSE AT NCH IS COMPRISED OF PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A TEMPORARY LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. LOAN FORGIVENESS IS AN INCENTIVE FOR PHYSICIANS TO STAY IN OUR AREA PROVIDING HEALTH SERVICES TO THE COMMUNITY. PHYSICIAN LOANS ARE FORGIVEN OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY. DURING FY17, OUR RECRUITMENT ACTIVITIES WERE DIRECTED TOWARD SPECIALTY AREAS SUCH AS CARDIOLOGY, GENERAL SURGERY, OB, ORTHOPEDIC SURGERY, UROLOGY, FAMILY PRACTICE, HOSPITALISTS, AND A NURSE PRACTITIONER. MSHA'S RECRUITMENT DEPARTMENT RECRUITS ON BEHALF OF ALL ITS HOSPITALS AND THE COSTS ASSOCIATED WITH RECRUITMENT FOR A PARTICULAR HOSPITAL ARE EXPENSED TO THE RECRUITING HOSPITAL. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED NEARLY 12,000 BLACK LUNG PROCEDURES THIS YEAR. WITH FINANCIAL ASSISTANCE FROM A USDA RURAL DEVELOPMENT GRANT, MOUNTAIN STATES HEALTH ALLIANCE (MSHA) ESTABLISHED A TELEMEDICINE NETWORK CONNECTING ICU DOCTORS AT JOHNSON CITY MEDICAL CENTER (MSHA'S FLAGSHIP HOSPITAL) WITH THE SYSTEM'S SIX RURAL HOSPITALS, INCLUDING NORTON COMMUNITY HOSPITAL. MOUNTAIN STATES ALREADY PRACTICES TELEMEDICINE FOR PEDIATRICS, EMERGENCY ROOM AND PSYCHIATRICS, PROVIDING A HIGH-QUALITY, LIVE VIDEO AND AUDIO LINK BETWEEN A PROVIDER AT ONE FACILITY AND A PATIENT AND PROVIDER AT ANOTHER FACILITY. THE NEW USDA GRANT IS SPECIFICALLY FOR THE INTENSIVE CARE UNIT, ALLOWING SPECIALISTS AT JCMC TO CONDUCT REAL-TIME CONSULTATIONS WITH PATIENTS AND CAREGIVERS IN THE ICU AT OUR RURAL HOSPITALS. MANY PATIENTS IN RURAL TOWNS DO NOT HAVE CARS OR DISPOSABLE INCOME TO SPEND ON GAS, MEALS OR LODGING TO COME TO JCMC FOR CARE, SO TELEMEDICINE BRINGS THE CARE TO THEM. THIS NEW SERVICE IS PROJECTED TO SERVE ABOUT 5,000 PATIENTS PER YEAR. THE USDA GRANT IS ONE OF THE USDA'S DISTANCE LEARNING AND TELEMEDICINE PROJECTS. MSHA'S TRIUMPH CANCER NAVIGATOR PROGRAM CELEBRATED ITS ONE-YEAR ANNIVERSARY DURING FY17. THE PROGRAM HAS EXPANDED ITS SCOPE TO INCLUDE MORE MSHA HOSPITALS AND NOW INCLUDES NORTON COMMUNITY HOSPITAL. IN ADDITION, THE NAVIGATION PROGRAM EXPANDED TO COVER ALL TYPES OF CANCER. THE PROGRAM IS DESIGNED TO SUPPORT CANCER PATIENTS AND THEIR FAMILIES, ADVOCATE FOR THE PATIENT, AND TO HELP COORDINATE THE PATIENT'S CARE THROUGHOUT THE CONTINUUM OF TREATMENT - FROM DIAGNOSIS TO SURVIVORSHIP. THERE IS NO CHARGE FOR THESE SERVICES REGARDLESS OF WHETHER A PATIENT CHOOSES TO RECEIVE THEIR TREATMENT AT A MSHA FACILITY OR A DIFFERENT PROVIDER. THOSE THAT JOIN THE PROGRAM RECEIVE ONE-ON-ONE ASSISTANCE FROM SPECIALLY TRAINED ONCOLOGY PROFESSIONALS. OUR CANCER NAVIGATORS COMMUNICATE WITH THE PATIENT'S DOCTOR, WILL COORDINATE TRANSPORTATION, SET UP APPOINTMENT REMINDERS AND PROVIDE EMOTIONAL SUPPORT FOR BOTH THE PATIENT AND THE PATIENT'S FAMILY. OUR NAVIGATORS WILL ALSO COORDINATE SUPPORT SERVICES SUCH AS TREATMENT PLANNING, PROSTHESIS SELECTION, NUTRITION COUNSELING, AND IDENTIFICATION OF RESOURCES FOR SPIRITUAL CARE, FINANCIAL ASSISTANCE AND OTHER NEEDS. OUR NAVIGATORS PARTICIPATE IN COMMUNITY EVENTS SUCH AS HEALTH FAIRS, CANCER EDUCATION EVENTS, AND CANCER SUPPORT GROUPS. THEY VISIT PHYSICIAN OFFICES, SENIORS' GROUPS, ATTEND MEETINGS WITH LOCAL BUSINESS ORGANIZATIONS, AND THEY WORK WITH MANY OTHER ORGANIZATIONS TO EXPLAIN THE NAVIGATION PROGRAM AND PROVIDE CANCER AWARENESS/EDUCATION THROUGHOUT THE COMMUNITY. THE PROGRAM HAS MADE AN IMPACT, WITH THE TRIUMPH PROGRAM RECEIVING A PATIENT SATISFACTION SCORE OF 93. OUR HOSPITAL'S TRIUMPH CANCER NAVIGATOR RECOGNIZED A NEED IN OUR COMMUNITY FOR SOME CANCER PATIENTS STRUGGLING WITH THEIR ILLNESS, WHILE ALSO DEALING WITH FINANCIAL WORRIES SO OUR NAVIGATOR CAME UP WITH THE IDEA FOR A FUNDRAISER. WORKING WITH MOUNTAIN STATES FOUNDATION, TWO "SOUP AND PAINT" EVENTS BROUGHT TEAM MEMBERS AND COMMUNITY MEMBERS TOGETHER TO ENJOY WARM SOUP AND A CRAFT PROJECT FOR A GOOD CAUSE. A LOCAL PAINTING INSTRUCTOR DONATED HER TIME FOR THE TWO EVENTS. MONEY RAISED PROVIDED FINANCIAL ASSISTANCE TO CANCER PATIENTS FOR THINGS LIKE GAS VOUCHERS, TAXI FARES, NON-COVERED MEDICATIONS, NUTRITIONAL EXPENSES, AND PERSONAL CARE ITEMS. DEPENDING ON PATIENTS' GREATEST NEEDS, IMPORTANT BILLS SUCH AS UTILITIES HAVE BEEN COVERED. THE UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE HOSTED AN INAUGURAL GIRLS DAY IN STEM-H FOR SIXTH-GRADE GIRLS IN THE REGION TO SHOW THE YOUNG GIRLS THAT CAREERS IN SCIENCE, TECHNOLOGY, ENGINEERING, MATHEMATICS AND HEALTH (S-T- E-M-H) ARE NOT JUST FOR MEN. DURING THE EVENT, NORTON COMMUNITY HOSPITAL PROVIDED DEMONSTRATIONS AND ACTIVITIES DESIGNED TO SPARK AN INTEREST IN MATH AND SCIENCE AND PERHAPS INTRODUCE THE GIRLS TO THE POSSIBILITY OF PURSUING CAREERS IN THE HEALTH CARE FIELD. OUR TEAM MEMBER ACTIVITIES AND PRESENTATIONS COVERED THE AREAS OF PHARMACY, OCCUPATIONAL AND PHYSICAL THERAPY, LABORATORY TECHNOLOGY, AND EMERGENCY SERVICES. STUDIES SHOW THAT YOUNG GIRLS BEGIN TO LOSE INTEREST IN STEM-H FIELDS OF STUDY JUST BEFORE THEY REACH HIGH SCHOOL. THE NUMBERS DROP AGAIN IN HIGH SCHOOL AND IN COLLEGE. ACCORDING TO THE UNITED STATES DEPARTMENT OF COMMERCE, WOMEN CONSTITUTE SLIGHTLY MORE THAN HALF OF COLLEGE EDUCATED WORKERS BUT MAKE UP ONLY 25 PERCENT OF COLLEGE EDUCATED STEM WORKERS. IN AN EFFORT TO RECRUIT MORE STUDENTS INTO THE HEALTH CARE FIELD, TEAM MEMBERS FROM NORTON COMMUNITY HOSPITAL PARTICIPATED IN A HEALTH CARE CAREER EXPO FOR EIGHTH-GRADE STUDENTS WHO HAD EXPRESSED AN INTEREST IN HEALTH CARE CAREERS. THE STUDENTS WERE ABLE TO ROTATE THROUGH THREE HEALTH CAREER SCENARIOS TO GET A TASTE OF A JOB IN HEALTH CARE. THE FIRST SCENARIO GAVE THE STUDENTS THE OPPORTUNITY TO "GOWN UP" FOR SURGERY, WITH INSTRUCTIONS ON SURGICAL INSTRUMENTS AND THE IMPORTANCE OF A STERILE ENVIRONMENT. THE STUDENTS WITNESSED THE REPAIR OF A "BANANAPLASTY", WITH OUR CNO SURGICALLY REPAIRING A PARTIALLY PEELED BANANA. THE STUDENTS GOT TO WITNESS TYPES OF STITCHES USED IN SURGICAL CASES AND THE TYPES OF INSTRUMENTS INVOLVED. THE SECOND SCENARIO PROVIDED INFORMATION RELATED TO A CAREER IN PHARMACY WITH OUR PHARMACY DIRECTOR WALKING THE STUDENTS THROUGH THE EDUCATIONAL REQUIREMENTS AND PROCESSES INVOLVED WITH PURSUING PHARMACY DEGREES AND FACILITATED A VERY COMPETITIVE ROUND OF PHARMACY BINGO WHICH INTRODUCED STUDENTS TO MEDICAL TERMINOLOGY RELATED TO PHARMACY. IN THE THIRD SCENARIO, STUDENTS WERE TAUGHT ABOUT HEART AND LUNG FUNCTIONS. STUDENTS VIEWED THEIR OWN HEART RHYTHMS WHILE LEARNING ABOUT EKG PATTERNS. THEY LISTENED TO BREATH SOUNDS AND RESPIRATIONS ON A PEDIATRIC MANIKIN AND HOW TO USE A DINAMAP FOR MONITORING BLOOD PRESSURE AND CHECKING PULSE OXIMETRY READINGS. THE STUDENTS WERE ALSO TAUGHT HOW TO MANUALLY CHECK BLOOD PRESSURE READINGS. NORTON COMMUNITY HOSPITAL PARTNERED WITH DICKENSON COMMUNITY HOSPITAL, RIDGEVIEW MIDDLE SCHOOL AND SOUTHWEST VIRGINIA AREA HEALTH EDUCATION CENTER TO PUT THE PROGRAM TOGETHER. FUTURE PROGRAMS ARE BEING PLANNED FOR DIFFERENT AGE GROUPS. NCH OPERATES A PHYSICIAN CLINIC THAT IS LOCATED IN A RURAL, LOW-INCOME AREA. THE CLINIC IS STAFFED PRIMARILY WITH MEDICAL RESIDENTS. WITHOUT THE CLINIC, COMMUNITY MEMBERS WOULD NOT HAVE ACCESS TO PRIMARY CARE. NCH'S SUBSIDY OF THE CLINIC THIS YEAR EXCEEDED 626,000. AFTER COMPLETING AN EXTENSIVE APPLICATION PROCESS, NORTON COMMUNITY HOSPITAL'S INTERNAL MEDICINE RESIDENCY PROGRAM ACHIEVED ACCREDITATION BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME). ACGME SETS STANDARDS FOR U.S. MEDICAL EDUCATION (RESIDENCY AND FELLOWSHIP) PROGRAMS AND THE INSTITUTIONS THAT SPONSOR THEM. ACCREDITATION DECISIONS ARE BASED ON EVALUATION AND REVIEW OF PUBLISHED ACCREDITATION QUALITY STANDARDS. NCH TAKES GREAT PRIDE IN TRAINING YOUNG PHYSICIANS FOR OUR RURAL, PREDOMINANTLY LOW-INCOME AND
FORM 990, PAGE 6, PART VI, LINE 6	THE CORPORATION IS ORGANIZED AS A VIRGINIA, NON-STOCK, NONPROFIT CORPORATION. MOUNTAIN STATES HEALTH ALLIANCE IS THE 50.1% MEMBER OF NORTON COMMUNITY HOSPITAL,INC. COMMUNITY HEALTHCARE FOUNDATION, INC. IS THE 49.9% MEMBER OF NORTON COMMUNITY HOSPITAL, INC.
FORM 990, PAGE 6, PART VI, LINE 7A	THERE ARE TWO CLASSES OF MEMBERS AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE NORTON COMMUNITY HOSPITAL CLASS IS ELECTED BY THE COMMUNITY HEALTHCARE FOUNDATION BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT.
FORM 990, PAGE 6, PART VI, LINE 7B	CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY, DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL.
FORM 990, PAGE 6, PART VI, LINE 11B	THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN 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	ANNUALLY, THE CORPORATE AUDIT AND COMPLIANCE DEPARTMENT OF MSHA FORWARDS THE CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO ALL MSHA MANAGEMENT TEAM MEMBERS AND BOARD MEMBERS INCLUDING THOSE AT NCH. EMPLOYEES AND BOARD MEMBERS MUST NOTE ANY CONFLICTS OR ATTEST THEY HAVE "NONE", AND RETURN THE FORM TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION.
FORM 990, PAGE 6, PART VI, LINE 15A	ON AN ANNUAL BASIS, MOUNTAIN STATE HEALTH ALLIANCE'S HUMAN RESOURCE (H/R) DEPARTMENT EVALUATES COMPENSATION FOR ALL EXECUTIVES AT A POSITION LEVEL OF ASSISTANT VICE PRESIDENT AND ABOVE. THE REVIEW INCLUDES NCH/DCH'S CEO. H/R'S EVALUATION IS BASED ON MARKET DATA OBTAINED FROM INDEPENDENT THIRD- PARTY CONSULTANTS FOR POSITIONS WITH SIMILAR RESPONSIBILITIES AT SIMILARLY SITUATED ORGANIZATIONS. BASED ON THIS COMPARABLE DATA, MOUNTAIN STATE'S PRESIDENT & CEO EVALUATES THE DATA AND SUBMITS HIS RECOMMENDATIONS TO MOUNTAIN STATE'S BOARD OF DIRECTORS FOR THEIR FINAL REVIEW AND APPROVAL. IN ADDITION, MOUNTAIN STATES OFFERS AN INCENTIVE PLAN TO EXECUTIVES BASED ON TARGETED ACHIEVEMENT METRICS SET IN ADVANCE OF THE PAY YEAR. ESTABLISHED METRICS INCLUDE: COMMUNICATION WITH PATIENTS, PATIENT EVIDENCE-BASED CARE SCORES AND PATIENT SAFETY, VALUE-BASED PURCHASING, ETC. THESE SAME METRICS ARE USED FOR ALL EMPLOYEES THROUGHOUT MSHA, WITH ONLY A SMALL NUMBER OF EXCEPTIONS FOR OUR COMPANIES THAT DO NOT PROVIDE DIRECT PATIENT CARE.
FORM 990, PAGE 6, PART VI, LINE 15B	SIMILAR TO NCH/DCH'S CEO, NCH'S CFO RECEIVES COMPENSATION THAT COMPLIES WITH MOUNTAIN STATE'S SALARY POLICY AND UNDERGOES THE SAME REVIEW AND APPROVAL PROCESS BY MOUNTAIN STATE'S BOARD OF DIRECTORS AS THE CEO, AS DESCRIBED IN 15A. ONE PHYSICIAN SERVES ON NCH'S BOARD. HIS COMPENSATION RELATES TO MEDICAL SERVICES HE PROVIDES TO NCH.
FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO 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 - RELATED ORGANIZATIONS DIRECTOR COMPENSATION: NORTON COMMUNITY HOSPITAL'S BOARD OF DIRECTORS, MARVIN EICHORN, SHANE HILTON, MONTY MCLAURIN, AND TOM TULL RECEIVE COMPENSATION FOR SERVICES PROVIDED TO RELATED ORGANIZATIONS AND DO NOT RECEIVE COMPENSATION FOR SERVICES AS A NCH BOARD MEMBER.
FORM 990, PART IX, LINE 11G	HOSPITAL SUPPORTED CLINICS 1,227,335 0 0 HOSPITAL BASED PROVIDERS 2,244,244 0 0 PHYSICIAN FEES 1,694,780 0 0 LINEN & ENVIRONMENTAL SERV. 721,878 0 0 CONTRACT LABOR 138,248 68,039 0 COLLECTION FEES 0 384,334 0 CONSULTING FEES 0 224,294 0 TRANSCRIPTION 0 92,640 0 ENGINEERING SERVICES 0 194,001 0 VARIOUS EXPENSES 251,124 149,589 0 TOTAL 6,277,609 1,112,897 0
FORM 990, PART X	PART IV, LINE 24A AND PART X, LINE 20 - TAX EXEMPT BOND LIABILITY THE TAX EXEMPT BOND LIABILITY REFLECTS THE PORTION OF BONDS ISSUED BY MOUNTAIN STATES HEALTH ALLIANCE, NCH'S MAJORITY OWNER, ON BEHALF OF NCH FOR CAPITAL NEEDS. NCH PAYS ALL COSTS RELATED TO THIS PORTION OF THE BOND ISSUE.
FORM 990, PART XI, LINE 9	CHANGE IN TEMP. RESTRICTED GRANTS -52,994 ELIMINATION OF INTERCOMPANY REC/PAY -2,889,117 PENSION PLAN ADJUSTMENT 2,292,974 TOTAL -649,137

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NORTON COMMUNITY PHYSICIAN SVCS LLC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	96 15TH ST NW	AddressLine1Txt
City	NORTON	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24273	ZIPCd

Field	Value	IRS element (for citing)
EIN	260868690	EIN
Primary Activities	MED. SERV.	PrimaryActivitiesTxt
Legal Domicile State	VA	LegalDomicileStateCd
Total Income	$8,051,855	TotalIncomeAmt
End Of Year Assets	$3,166,566	EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

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

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
MOUNTAIN STATES HEALTH ALLIANCE
400 N STATE OF FRANKLIN RD	JOHNSON CITY	TN	37604	620476282	HOSP. SYS.	TN	501C3	3	NA	false
DICKENSON COMMUNITY HOSPITAL
ONE 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
SMYTH COUNTY COMMUNITY HOSPITAL
245 MEDICAL PARK DRIVE	MARION	VA	24354	540794913	HOSPITAL	VA	501C3	3	MSHA	false
COMMUNITY HEALTHCARE FOUNDATION
100 15TH STREET NW	NORTON	VA	24273	542002314	SUPPORT	VA	501C3	12A	NA	false
MOUNTAIN STATES FOUNDATION
2335 KNOB CREEK ROAD SUITE 101	JOHNSON CITY	TN	37604	581418862	FUNDRAISER	TN	501C3	12A	MSHA	false
MOUNTAIN STATES HEALTH ALLIANCE AUX
400 N STATE OF FRANKLIN RD	JOHNSON CITY	TN	37604	581418345	SUPP. ORG.	TN	501C3	12A	MSHA	false
APPALACHIAN EMERGENCY PHYSICIANS
1021 W OAKLAND AVENUE STE 207	JOHNSON CITY	TN	37604	800592504	MED. SERV	TN	501C3	12A	NA	false

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd
INTEGRATED SOLUTIONS HLTH NTWK INC
509 MED TECH PARKWAY SUITE 100	JOHNSON CITY	TN	37604	621711997	INVESTMENT	TN	NA	false	false
EMMAUS COMMUNITY HEALTHCARE PLLC
6070 HWY 11E	PINEY FLATS	TN	37686	200577483	MED. SERV.	TN	NA	false	false
MEDICAL SPECIALISTS OF J C LLC
2528 WESLEY STREET SUITE 2	JOHNSON CITY	TN	37604	272199037	MED. SERV.	TN	NA	false	false
EAST TN AMBULATORY SURGERY CTR
701 MED TECH PARKWAY	JOHNSON CITY	TN	37604	621787537	MED. SERV.	TN	NA	false	false

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Controlled OrganizationControlledOrganizationInd
COMMUNITY HOME CARE INC
1460 PARK AVENUE	NORTON	VA	24273	541453810	DME	VA	NA	C CORP	$435,595	$840,643	false
BLUE RIDGE MEDICAL MANAGEMENT CORP
1021 W OAKLAND AVENUE SUITE 207	JOHNSON CITY	TN	37604	621490616	MED. SERV.	TN	NA	C CORP			false
MEDISERVE MED EQUIP OF KINGSPORT
1021 W OAKLAND AVENUE SUITE 207	JOHNSON CITY	TN	37604	621212286	DME	TN	NA	C CORP			false
MOUNTAIN STATES PROPERTIES
1021 W OAKLAND AVENUE SUITE 207	JOHNSON CITY	TN	37604	621845895	PROP MGMT	TN	NA	C CORP			false
MOUNTAIN STATES PHYSICIAN GROUP
1021 W OAKLAND AVENUE SUITE 207	JOHNSON CITY	TN	37604	621700412	HEALTHCARE	TN	NA	C CORP			false
WILSON PHARMACY INC
P O BOX 5289	JOHNSON CITY	TN	37602	620329587	PHARMACY	TN	NA	C CORP			false
CRESTPOINT HEALTH INSURANCE COMPANY
509 MED TECH PARKWAY SUITE 100	JOHNSON CITY	TN	37604	620381170	INSURANCE	TN	NA	C CORP			false

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

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt
COMMUNITY HOME CARE INC
A	$26,900
DICKENSON COMMUNITY HOSPITAL
B	$2,889,117
DICKENSON COMMUNITY HOSPITAL
O	$945,435
DICKENSON COMMUNITY HOSPITAL
Q	$1,760,381
COMMUNITY HOME CARE INC
Q	$58,511