2017-05-12T07:58:53-04:00 2016-06-30 990 2015-07-01 620476282 MOUNTAIN STATES HEALTH ALLIANCE MOUN 4233023374 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37601 LYNN KRUTAK SVP/CFO 4233023374 2017-05-11 2015 2021-01-29 14:40:06Z JOHNSON CITY MEDICAL CENTER ALAN LEVINE 303 MED TECH PARKWAY STE 300 JOHNSON CITY TN 37604 737236154 false X WWW.MOUNTAINSTATESHEALTH.COM X 1945 TN MOUNTAIN STATES HEALTH ALLIANCE (MSHA) 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. 12 7 8620 1561 1892160 658079 1268900 3520559 693631193 708190056 22153666 19402926 9431964 5616520 726485723 736730061 1816780 843424 0 298141980 299232233 0 1274159 393805378 411468902 693764138 711544559 32721585 25185502 1615714180 1547756754 1141215270 1060941339 474498910 486815415 X MOUNTAIN STATES HEALTH ALLIANCE (MSHA) 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. false false 588781553 843424 708299656 SEE ATTACHED DOCUMENT: MSHA - PROGRAM SERVICE ACCOMPLISHMENTS. 588781553 true true false true false false false false false false true false true false true true false true false false false false false false false false true true true false true true true false false false false true false false true true false false false false false true true true false false true 625 0 true 8620 true true true false false false false false false false false false X 12 7 false false false false false false false true true false true true true true true true true true true true true true VA X LYNN KRUTAK 4233023374 303 MED TECH PARKWAY JOHNSON CITY TN 37604 ALAN LEVINE PRESIDENT & 53.00 2.00 X X 1148777 0 168236 JEFF FARROW MD DIRECTOR 4.00 X 76700 0 0 SANDRA BROOKS MD DIRECTOR 5.00 X 3000 0 0 CLEM WILKES JR PAST CHAIR 9.00 X 0 0 0 GARY PEACOCK DIRECTOR 8.00 3.50 X 0 0 0 RICK STOREY DIRECTOR 6.00 X 0 0 0 LINDA GARCEAU DIRECTOR 5.00 X 0 0 0 JOANNE GILMER SECRETARY 6.00 4.00 X X 0 0 0 DAVID MAY MD DIRECTOR 7.00 X 0 0 0 ROBERT FEATHERS VICE CHAIR 9.00 X X 0 0 0 MICHAEL CHRISTIAN TREASURER 6.00 X X 0 0 0 BARBARA ALLEN CHAIR 10.00 X X 0 0 0 MARVIN EICHORN EVP/COO 46.00 9.00 X 747271 0 39264 LYNN KRUTAK SVP/CFO 49.00 1.00 X 565182 0 83557 DAWN TRIMBLE VP/CEO WASH. 45.00 X 548528 0 42704 SHANE HILTON VP/CFO-MKT O 41.00 4.00 X 406667 0 55701 TONY BENTON VP/COO WASH. 45.00 X 366169 0 36094 MONTY MCLAURIN VP/CEO NW MK 35.80 9.20 X 357781 0 52277 RICHARD BOONE VP/CFO WASH. 45.00 X 347845 0 17368 LINDA WHITE VP & CEO, FW 45.00 X 325783 0 46302 LEMMIE TAYLOR VP/CEO SE MK 45.00 X 250530 0 46687 DRU MALCOLM VP & CNO JCM 45.00 X 230005 0 21901 STEVE SAWYER AVP/CFO NW M 45.00 X 211868 0 24929 MORRIS SELIGMAN MD EVP & CMO 52.50 2.50 X 648239 0 82572 ANN FLEMING MSHA CONSULT 40.00 X 452992 0 5529 ANTHONY KECK SVP/CHIEF DE 54.50 0.50 X 451023 0 47064 CLAY RUNNELS MD VP HOSP. PRG 44.00 1.00 X 441373 0 34093 MARK WILKINSON MD VP/CMO 45.00 X 411004 0 33711 DALE CLAYTORE FMR. KEY EMP 45.00 X 275301 0 13212 PAT NIDAY FMR. KEY EMP 45.00 X 208073 0 25061 RHONDA MANN FMR. KEY EMP X 130559 0 8869 8604670 885131 247 true true false ANESTHESIA PAIN CONSULTANTS PO BOX 3727 JOHNSON CITY TN 376023727 ANESTHESIA SVCS 5539123 CERNER HEALTH SERVICES INC C/O US BANK PO BOX 959167 ST LOUIS MO 631959167 IT MAINT. CONTR 5419467 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 SVC. CONTRACT 3570256 SODEXO INC PO BOX 905374 CHARLOTTE NC 282905374 LAUNDRY SVCS 3557044 VIGILANCE ANESTHESIA SOLUTIONS LOCKBOX005293 PO BOX 645293 CINCINNATI OH 452645293 ANESTHESIA SVCS 3027713 137 1884309 844227 792023 3520559 PATIENT REVENUE 622110 697098318 697098318 WELLNESS PROGRAMS 622110 8991091 8991091 P/S INCOME ISHN & MSJC 900099 1047259 1047259 LAB UBI REVENUE 621511 1040112 1040112 RENTAL TO EXEMPT AFFILIATE 531120 13276 13276 708190056 15046231 15046231 28374 28374 887683 477324 410359 410359 292801 117558 4218721 138369 28769 4218721 109600 4328321 109600 4218721 CAFE' SALES 722514 3419849 3419849 VENDOR SETTLEMENT 900099 2531516 2531516 DAY CARE 624410 987271 987271 -1732475 559247 -2291722 5206161 736730061 707259544 1892160 24057798 X 843424 843424 6101532 49263 6052269 230562012 217132919 12496297 932796 11022244 10536901 440077 45266 33840776 33230796 601733 8247 17705669 16093759 1555071 56839 4906380 38432 4867948 797574 4800 772778 19996 197914 197914 1053041 1053041 121032136 104312860 16711361 7915 3780857 645948 3124654 10255 7379494 6285251 1085252 8991 16232219 14353275 1878944 13665388 10457348 3141106 66934 2083409 1478495 603176 1738 41499691 41499691 40532548 20303608 20227659 1281 1357699 1183 1356516 MEDICAL SUPPLIES & DRUGS 132692717 132692717 REPAIRS & MAINTENANCE 16474875 15814286 591727 68862 DUES & SUBSCRIPTIONS 4033886 1747352 2283767 2767 TAXES - UBIT 223748 223748 3525326 2561022 922032 42272 711544559 588781553 121488847 1274159 62262670 42140274 3714306 212728 305041 111027708 105638499 10680656 11094226 24321103 19370927 16971892 17330502 5197148 6448512 1077573395 587779895 499468501 489793500 312855173 296888356 335649496 337772493 145025185 145025185 92041920 72234933 1615714180 1547756754 68353826 115088906 11354761 7666818 966918770 904388726 16314872 12140000 78273041 21656889 1141215270 1060941339 X 474227931 486418331 270979 397084 474498910 486815415 1615714180 1547756754 X 25185502 -9700992 -3168005 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false true 118164 true 420610 false false 538774 false SCHEDULE C, PART II-B, LINE 1 MSHA'S COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR THE DEPARTMENT'S MANAGER OR DIRECTOR ATTENDED THE FOLLOWING LEGISLATIVE CONFERENCES: - PREMIER FEDERAL AFFAIRS NETWORK MEETING - AMERICAN HOSPITAL ASSOCIATION ANNUAL MEETING - TENNESSEE HOSPITAL ASSOCIATION LEGISLATIVE ADVOCACY DAY - HOSPITAL ALLIANCE OF TENNESSEE ANNUAL MEETING - TENNESSEE PUBLIC & TEACHING HOSPITALS ASSOCIATION ANNUAL MEETING - VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION LEGISLATIVE ISSUES CONFERENCE THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR DEPARTMENTAL STAFF ALSO CONTACTED CONGRESSIONAL OFFICES CONCERNING THE FOLLOWING ISSUES: - SUPPORTED PERMANENT DISPROPORTIONATE SHARE HOSPITAL FOR THE STATE OF TENNESSEE - SUPPORTED SUSTAINABLE GROWTH RATE REFORM - OPPOSED ADDITIONAL CUTS IN MEDICARE/MEDICAID - SUPPORTED REAUTHORIZATION AND FUNDING OF CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION - SUPPORTED FEDERAL FUNDING FOR TRAUMA CARE - SUPPORTED CONTINUATION OF GRADUATE MEDICAL EDUCATION FUNDING - SUPPORTED AREA WAGE INDEX REFORM - SUPPORTED STUDY OF CHRONIC CARE FOR MEDICARE RECIPIENTS - SUPPORTED CHANGES TO 2 MIDNIGHT RULE - SUPPORTED RECOVERY AUDIT CONTRACTOR REFORM - SUPPORTED MEDICARE DEPENDENT HOSPITAL AND LOW-VOLUME DESIGNATIONS THE COMMUNITY & GOVERNMENT RELATIONS VICE PRESIDENT AND/OR DEPARTMENTAL DIRECTOR RESPONDED VIA LETTER, PHONE, OR IN PERSON TO SUPPORT THE FOLLOWING TENNESSEE AND VIRGINIA LEGISLATIVE ISSUES: - CERTIFICATE OF NEED(TN)/CERTIFICATE OF PUBLIC NEED (VA) REFORM - CONTINUATION OF HOSPITAL ASSESSMENT FEE IN TENNESSEE - FUNDING FOR PERINATAL CENTERS IN TENNESSEE - MENTAL HEALTH FUNDING FOR INPATIENT PSYCHIATRIC CARE - TENNESSEE - ADEQUATE MEDICAID FUNDING IN VIRGINIA AND TENNESSEE - LESS BURDENSOME LICENSURE REQUIREMENTS FOR GRADUATES OF FORIEGN MEDICAL SCHOOLS - HELMET REQUIREMENT FOR MOTORCYCLISTS 40130439 40130439 517893933 190498964 327394969 946017 597798 348219 510550686 391860357 118690329 8052320 4822776 3229544 489793500 INVESTMENT IN JMH 132000000 C INVESTMENT IN BRMMC 100310432 C INVESTMENT IN SCCH 69400494 C INVESTMENT IN ISHN 37015787 C INVESTMENT IN PREMIER 370000 C PREMIER RESERVE -260000 C INVESTMENT IN MSJC -1064220 C 337772493 OTHER LONG-TERM LIABILITIES 8682124 DUE TO THIRD-PARTY PAYERS 8492014 EST. FAIR VALUE OF INT. RATE SWAP 4482751 21656889 X SCHEDULE D, PAGE 3, PART X "THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3)OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR 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, 2016 AND 2015. AT JUNE 30, 2016, TAX RETURNS FOR 2013 THROUGH 2015 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE." true true X true X true X true true false false 9994337 9994337 0.01400 117108591 87410733 29697858 0.04170 127102928 87410733 39692195 0.05580 5164468 861256 4303212 0.00600 15606066 3127302 12478764 0.01750 11004322 7256922 3747400 0.00530 285418 47301 238117 0.00030 707247 707247 0.00100 32767521 11292781 21474740 0.03020 159870449 98703514 61166935 0.08600 8500 8500 2500 2500 11260 11260 300 300 680 680 23240 23240 true 90803811 63562668 163659931 166141839 -2481908 X true true MED'L SPEC OF JC LLC MEDICAL SERVICES 0.51000 0.49000 7 1 JOHNSON CITY MEDICAL CENTER 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 00000121 X X X X X X MENTAL HEALTH 2 INDIAN PATH MEDICAL CENTER 2000 BROOKSIDE DRIVE KINGSPORT TN 37660 00000134 X X X X 3 FRANKLIN WOODS COMMUNITY HOSPITAL 300 MED TECH PARKWAY JOHNSON CITY TN 37604 00000123 X X X X 4 SYCAMORE SHOALS HOSPITAL 1501 W ELK AVENUE ELIZABETHTON TN 37643 00000012 X X X 5 RUSSELL COUNTY MEDICAL CENTER 58 CARROLL STREET LEBANON VA 24266 H 1892 X X X 6 JOHNSON COUNTY COMMUNITY HOSPITAL 16901 S SHADY STREET MOUNTAIN CITY TN 37683 00000039 X X X 7 UNICOI COUNTY MEMORIAL HOSPITAL 100 GREENWAY CIRCLE ERWIN TN 37650 00000119 X X X JOHNSON CITY MEDICAL CENTER 1 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false INDIAN PATH MEDICAL CENTER 2 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false FRANKLIN WOODS COMMUNITY HOSPITAL 3 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false SYCAMORE SHOALS HOSPITAL 4 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false RUSSELL COUNTY MEDICAL CENTER 5 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false JOHNSON COUNTY COMMUNITY HOSPITAL 6 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false UNICOI COUNTY MEMORIAL HOSPITAL 7 false false true X X X X X X X X 15 true true false true X WWW.MOUNTAINSTATESHEALTH.COM X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X WWWMOUNTAINSTATESHEALTHCOM X X X X X true X true X X X X true X false false FACILITY 1, JOHNSON CITY MEDICAL CENTER - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). THE 13 HOSPITALS ARE COMPRISED OF: 7 LICENSED HOSPITALS THAT ARE INCLUDED IN THIS RETURN, 2 HOSPITALS THAT ARE LICENSED UNDER ONE OF THE 7 AND ARE INCLUDED IN THIS RETURN, AND 4 MSHA HOSPITALS THAT FILE SEPARATE RETURNS. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NONPROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO JCMC, THE GROUP CONSISTED OF REPRESENTATIVES FROM THE WASHINGTON COUNTY HEALTH DEPARTMENT, FRONTIER HEALTH, ETSU COLLEGE OF NURSING, ETSU JOHNSON CITY COMMUNITY HEALTH CENTER, ETSU COLLEGE OF PUBLIC HEALTH, WASHINGTON COUNTY COMMISSION, NORTHEAST TENNESSEE REGIONAL HEALTH DEPARTMENT, WASHINGTON COUNTY/JOHNSON CITY EMERGENCY MEDICAL SERVICES, UNITED WAY, PROJECT ACCESS, CHAMBER OF COMMERCE, FAMILIES FREE, CITY OF JOHNSON CITY, AND CENTER ON AGING AND HEALTH. 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 THE WASHINGTON COUNTY COMMUNITY 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, JOHNSON CITY MEDICAL CENTER - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL) AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE ALL LOCATED IN WASHINGTON COUNTY, TENNESSEE SO JCMC AND FWCH SHARED THE SAME COMMUNITY GROUP. JCMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: 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, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 1, JOHNSON CITY MEDICAL CENTER - 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 HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. JCMC PROVIDES A SIGNIFICANT NUMBER OF PUBLIC SERVICE ANNOUNCEMENTS AND PARTNERS WITH THE LOCAL TELEVISION STATIONS TO INCREASE COMMUNITY AWARENESS ON THE PREVALENCE OF NEONATAL ABSTINENCE SYNDROME. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. SSH WORKS WITH RED LEGACY RECOVERY COUNSELING TO PROVIDE SUPPORT FOR YOUNG WOMEN AND MOTHERS RECOVERING FROM SUBSTANCE ABUSE. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA TO SUPPORT THEIR IMPLEMENTATION PLANS. FACILITY 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). THE 13 HOSPITALS ARE COMPRISED OF: 7 LICENSED HOSPITALS THAT ARE INCLUDED IN THIS RETURN, 2 HOSPITALS THAT ARE LICENSED UNDER ONE OF THE 7 AND ARE INCLUDED IN THIS RETURN, AND 4 MSHA HOSPITALS THAT FILE SEPARATE RETURNS. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NONPROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO IPMC, THE GROUP CONSISTED OF REPRESENTATIVES FROM HEALTHY KINGSPORT, KINGSPORT CITY SCHOOLS, UNITED WAY OF GREATER KINGSPORT, SULLIVAN COUNTY HEALTH DEPARTMENT, IPMC HEALTH RESOURCE CENTER, SULLIVAN COUNTY DEPARTMENT OF EDUCATION, KINGSPORT CHAMBER OF COMMERCE, AND KINGSPORT BOARD OF MAYOR AND ALDERMAN. 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 IPMC'S SULLIVAN COUNTY COMMUNITY 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 2, INDIAN PATH MEDICAL CENTER - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL) AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE ALL LOCATED IN WASHINGTON COUNTY, TENNESSEE. IPMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, JOHNSON CITY MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 2, INDIAN PATH MEDICAL CENTER - 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 HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. JCMC PROVIDES A SIGNIFICANT NUMBER OF PUBLIC SERVICE ANNOUNCEMENTS AND PARTNERS WITH THE LOCAL TELEVISION STATIONS TO INCREASE COMMUNITY AWARENESS ON THE PREVALENCE OF NEONATAL ABSTINENCE SYNDROME. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. SSH WORKS WITH RED LEGACY RECOVERY COUNSELING TO PROVIDE SUPPORT FOR YOUNG WOMEN AND MOTHERS RECOVERING FROM SUBSTANCE ABUSE. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA TO SUPPORT THEIR IMPLEMENTATION PLANS. FACILITY 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). THE 13 HOSPITALS ARE COMPRISED OF: 7 LICENSED HOSPITALS THAT ARE INCLUDED IN THIS RETURN, 2 HOSPITALS THAT ARE LICENSED UNDER ONE OF THE 7 AND ARE INCLUDED IN THIS RETURN, AND 4 MSHA HOSPITALS THAT FILE SEPARATE RETURNS. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NONPROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO FWCH, THE GROUP CONSISTED OF REPRESENTATIVES FROM THE WASHINGTON COUNTY HEALTH DEPARTMENT, FRONTIER HEALTH, ETSU COLLEGE OF NURSING, ETSU JOHNSON CITY COMMUNITY HEALTH CENTER, ETSU COLLEGE OF PUBLIC HEALTH, WASHINGTON COUNTY COMMISSION, NORTHEAST TENNESSEE REGIONAL HEALTH DEPARTMENT, WASHINGTON COUNTY/JOHNSON CITY EMERGENCY MEDICAL SERVICES, UNITED WAY, PROJECT ACCESS, CHAMBER OF COMMERCE, FAMILIES FREE, CITY OF JOHNSON CITY, AND CENTER ON AGING AND HEALTH. 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 THE WASHINGTON COUNTY COMMUNITY 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 3, FRANKLIN WOODS COMMUNITY HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL) AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE ALL LOCATED IN WASHINGTON COUNTY, TENNESSEE SO FWCH AND JCMC SHARED THE SAME COMMUNITY GROUP. FWCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER, 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, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 3, FRANKLIN WOODS 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 HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. JCMC PROVIDES A SIGNIFICANT NUMBER OF PUBLIC SERVICE ANNOUNCEMENTS AND PARTNERS WITH THE LOCAL TELEVISION STATIONS TO INCREASE COMMUNITY AWARENESS ON THE PREVALENCE OF NEONATAL ABSTINENCE SYNDROME. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. SSH WORKS WITH RED LEGACY RECOVERY COUNSELING TO PROVIDE SUPPORT FOR YOUNG WOMEN AND MOTHERS RECOVERING FROM SUBSTANCE ABUSE. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA HOSPITALS TO SUPPORT THEIR IMPLEMENTATION PLANS. FACILITY 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). THE 13 HOSPITALS ARE COMPRISED OF: 7 LICENSED HOSPITALS THAT ARE INCLUDED IN THIS RETURN, 2 HOSPITALS THAT ARE LICENSED UNDER ONE OF THE 7 AND ARE INCLUDED IN THIS RETURN, AND 4 MSHA HOSPITALS THAT FILE SEPARATE RETURNS. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NONPROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO SSH, THE GROUP CONSISTED OF REPRESENTATIVES FROM ELIZABETHTON CITY SCHOOLS, CARTER COUNTY SCHOOLS, UNITED HEALTHCARE, UT-CARTER COUNTY EXTENSION, CENTER ON AGING AND HEALTH, CARTER COUNTY GOVERNOR'S OFFICE, COORDINATED SCHOOL HEALTH, BABE BREASTFEEDING COALITION, PROJECT ACCESS AND CARTER COUNTY HEALTH DEPARTMENT. 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 SSH'S CARTER COUNTY COMMUNITY 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 4, SYCAMORE SHOALS HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL) AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE ALL LOCATED IN WASHINGTON COUNTY, TENNESSEE. SSH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON CITY MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 4, SYCAMORE SHOALS 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 HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. JCMC PROVIDES A SIGNIFICANT NUMBER OF PUBLIC SERVICE ANNOUNCEMENTS AND PARTNERS WITH THE LOCAL TELEVISION STATIONS TO INCREASE COMMUNITY AWARENESS ON THE PREVALENCE OF NEONATAL ABSTINENCE SYNDROME. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. SSH WORKS WITH RED LEGACY RECOVERY COUNSELING TO PROVIDE SUPPORT FOR YOUNG WOMEN AND MOTHERS RECOVERING FROM SUBSTANCE ABUSE. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA HOSPITALS TO SUPPORT THEIR IMPLEMENTATION PLANS. FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). THE 13 HOSPITALS ARE COMPRISED OF: 7 LICENSED HOSPITALS THAT ARE INCLUDED IN THIS RETURN, 2 HOSPITALS THAT ARE LICENSED UNDER ONE OF THE 7 AND ARE INCLUDED IN THIS RETURN, AND 4 MSHA HOSPITALS THAT FILE SEPARATE RETURNS. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NONPROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO RCMC, THE GROUP CONSISTED OF REPRESENTATIVES FROM THE CUMBERLAND PLATEAU HEALTH DISTRICT, VIRGINIA DEPARTMENT OF HEALTH, DANTE EMERGENCY MEDICAL SERVICES, TOWN OF LEBANON, RUSSELL COUNTY DEPARTMENT OF SOCIAL SERVICES, AND RUSSELL COUNTY YMCA. 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 RUSSELL COUNTY MEDICAL CENTER'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 5, RUSSELL COUNTY MEDICAL CENTER - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL) AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE ALL LOCATED IN WASHINGTON COUNTY, TENNESSEE. RCMC'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, JOHNSON CITY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 5, RUSSELL COUNTY MEDICAL CENTER - 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 HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. JCMC PROVIDES A SIGNIFICANT NUMBER OF PUBLIC SERVICE ANNOUNCEMENTS AND PARTNERS WITH THE LOCAL TELEVISION STATIONS TO INCREASE COMMUNITY AWARENESS ON THE PREVALENCE OF NEONATAL ABSTINENCE SYNDROME. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. SSH WORKS WITH RED LEGACY RECOVERY COUNSELING TO PROVIDE SUPPORT FOR YOUNG WOMEN AND MOTHERS RECOVERING FROM SUBSTANCE ABUSE. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA HOSPITALS TO SUPPORT THEIR IMPLEMENTATION PLANS. FACILITY 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). THE 13 HOSPITALS ARE COMPRISED OF: 7 LICENSED HOSPITALS THAT ARE INCLUDED IN THIS RETURN, 2 HOSPITALS THAT ARE LICENSED UNDER ONE OF THE 7 AND ARE INCLUDED IN THIS RETURN, AND 4 MSHA HOSPITALS THAT FILE SEPARATE RETURNS. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NONPROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO JCCH, THE GROUP CONSISTED OF REPRESENTATIVES FROM JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSON COUNTY HEALTH DEPARTMENT, JOHNSON COUNTY RESCUE AND EMERGENCY MEDICAL SERVICES, ETSU COLLEGE OF NURSING AT MOUNTAIN CITY EXTENDED HOURS, AND JOHNSON COUNTY SCHOOLS. 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 JOHNSON COUNTY COMMUNITY HOSPITAL'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 6, JOHNSON COUNTY COMMUNITY HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL) AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE ALL LOCATED IN WASHINGTON COUNTY, TENNESSEE. JCCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON CITY MEDICAL CENTER, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 6, JOHNSON COUNTY 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 HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. JCMC PROVIDES A SIGNIFICANT NUMBER OF PUBLIC SERVICE ANNOUNCEMENTS AND PARTNERS WITH THE LOCAL TELEVISION STATIONS TO INCREASE COMMUNITY AWARENESS ON THE PREVALENCE OF NEONATAL ABSTINENCE SYNDROME. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. SSH WORKS WITH RED LEGACY RECOVERY COUNSELING TO PROVIDE SUPPORT FOR YOUNG WOMEN AND MOTHERS RECOVERING FROM SUBSTANCE ABUSE. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA HOSPITALS TO SUPPORT THEIR IMPLEMENTATION PLANS. FACILITY 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES LOCATED WITHIN THE CORE COUNTIES OF MSHA FACILITIES (16 COUNTIES). THE 13 HOSPITALS ARE COMPRISED OF: 7 LICENSED HOSPITALS THAT ARE INCLUDED IN THIS RETURN, 2 HOSPITALS THAT ARE LICENSED UNDER ONE OF THE 7 AND ARE INCLUDED IN THIS RETURN, AND 4 MSHA HOSPITALS THAT FILE SEPARATE RETURNS. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NONPROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO UCMH, THE GROUP CONSISTED OF REPRESENTATIVES FROM THE UNICOI COUNTY CHAMBER OF COMMERCE, BANK OF TENNESSEE, UNICOI COUNTY FAMILY YMCA, KEESECKER/STEEL RAILS, CENTER ON AGING AND HEALTH, UETHDA HEAD START, TELEMON HEAD START, AND UNICOI COUNTY HEALTH DEPARTMENT. 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 THE UNICOI COUNTY COMMUNITY 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 7, UNICOI COUNTY MEMORIAL HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS THAT ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL) AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE ALL LOCATED IN WASHINGTON COUNTY, TENNESSEE. UCMH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSON CITY MEDICAL CENTER, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 7, UNICOI COUNTY MEMORIAL 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 HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. JCMC PROVIDES A SIGNIFICANT NUMBER OF PUBLIC SERVICE ANNOUNCEMENTS AND PARTNERS WITH THE LOCAL TELEVISION STATIONS TO INCREASE COMMUNITY AWARENESS ON THE PREVALENCE OF NEONATAL ABSTINENCE SYNDROME. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. SSH WORKS WITH RED LEGACY RECOVERY COUNSELING TO PROVIDE SUPPORT FOR YOUNG WOMEN AND MOTHERS RECOVERING FROM SUBSTANCE ABUSE. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JCCH MEETS WITH THE LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA HOSPITALS TO SUPPORT THEIR IMPLEMENTATION PLANS. 10 JCMC AMBULATORY SURGERY CENTER 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 LICENSED AMBULATORY SURGERY CENTER MOUNTAIN STATES IMAGING CENTER 301 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 LICENSED OUTPATIENT DIAGNOSTIC CENTER INDIAN PATH TRANSITIONAL CARE 2000 BROOKSIDE DRIVE KINGSPORT TN 37660 LICENSED SKILLED NURSING FACILITY MEDICAL CNTR HOME CARE-JOHNSON CITY 101 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 LICENSED HOME HEALTH AGENCY MEDICAL CNTR HOME CARE-KINGSPORT 2020 BROOKSIDE DRIVE 28 KINGSPORT TN 37660 LICENSED HOME HEALTH AGENCY RUSSELL CO MEDICAL CNTR HOME HLTH 116 FLANNAGAN AVENUE LEBANON VA 24266 LICENSED HOME HEALTH AGENCY MEDICAL CENTER HOSPICE 101 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 LICENSED HOSPICE AGENCY JOHNSON COUNTY HOME HEALTH 1987 SOUTH SHADY STREET MOUNTAIN CITY TN 37683 LICENSED HOME HEALTH AGENCY RUSSELL COUNTY MEDICAL CNTR HOSPICE 116 FLANNAGAN AVENUE LABANON VA 24266 LICENSED HOSPICE AGENCY UNICOI COUNTY LONG TERM CARE 100 GREENWAY CIRCLE UNICOI TN 37650 LICENSED LONG TERM CARE FACILITY 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 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. AS REQUIRED BY TENNESSEE LAW, ALL PATIENTS WITH NO FORM OF THIRD-PARTY PAYER COVERAGE RECEIVE A DISCOUNT OF 67%, WITH THE EXCEPTION OF OUR CRITICAL ACCESS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH). JCCH PROVIDES UNINSURED PATIENTS A 58% DISCOUNT. BOTH THE 67% AND THE 58% DISCOUNTS ARE CALCULATED ACCORDING TO TENNESSEE LAW AND THE DISCOUNTS ARE UPDATED ANNUALLY. MSHA EXTENDS THESE DISCOUNTS TO OUR VIRGINIA HOSPITALS AS WELL. PART I, LINE 6A - RELATED ORGANIZATION INFORMATION MSHA'S COMMUNITY BENEFIT REPORT WAS COMPLETED IN FY15. OUR NEXT COMMUNITY BENEFIT REPORT WILL BE ISSUED DURING FY17. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE COST TO CHARGE RATIO (WORKSHEET 2 "RATIO OF PATIENT CARE COST TO CHARGES") WAS USED TO CALCULATE LINE 7A FINANCIAL ASSISTANCE (CHARITY CARE) COST. OUR COST ACCOUNTING SYSTEM WAS USED TO DETERMINE LOSSES FROM MEDICAID AND TENNCARE REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH, A SMALL PHYSICIAN CLINIC AND UCMH - WE USED THE COST TO CHARGE RATIO FOR THEIR DATA BECAUSE THESE ARE SMALLER DIVISIONS NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS, WITH NO ADDITIONAL OVERHEAD INCLUDED IN THE COST. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF INTERNSHIPS (PRIMARILY INTERNAL MEDICINE RESIDENTS, NURSING, PHARMACY, AND THERAPY STUDENTS) WITH SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING. MEDICAL RESIDENT, PHARMACY AND PASTORAL CARE COSTS AND REIMBURSEMENTS ARE TAKEN FROM JCMC AND IPMC MEDICARE COST REPORTS. FWCH'S CERTIFIED NURSE ASSISTANT PROGRAM COST AND REIMBURSEMENT COMES FROM ITS MEDICARE COST REPORT. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT KEEPS DETAILED RECORDS OF HOURS SPENT ON THE OTHER TYPES OF STUDENTS' ACTIVITIES, THE NUMBER OF STUDENTS THAT ROTATE THROUGH OUR HOSPITALS, ETC. INFORMATION IS MAINTAINED FOR EACH HOSPITAL UNIT THAT PARTICIPATES. WE ONLY INCLUDE LABOR COSTS AND WE ONLY ASSUME A PERCENTAGE OF OUR TEAM MEMBERS' TIME IS DEVOTED TO THESE STUDENTS. FOR LINE 7G SUBSIDIZED HEALTH CARE SERVICES, WE USE OUR COST ACCOUNTING SYSTEM BECAUSE WE HAVE ESTABLISHED, STANDARD COSTING REPORTS FOR THESE SERVICES. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND TENNCARE/MEDICAID ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITALS THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE. WE INCLUDE A PHYSICIAN SPECIALTY CLINIC OPERATED BY JCCH, A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL. THIS CONTINUES TO BA A VALUABLE RESOURCE TO THE RESIDENTS OF THE AREA BY AIDING WITH TRANSPORTATION ISSUES (OTHER PHYSICIAN OFFICES ARE MORE THAN AN HOUR AWAY), RESOLVING ACCESS LIMITATIONS FOR SPECIALTY SERVICES, AND PROVIDING RELIEF TO THE SPECIAL HEALTH PROBLEMS OF A LARGELY ELDERLY POPULATION. THE CLINIC INCURRED A LOSS OF 29,004 DURING FY16 THAT IS INCLUDED IN LINE 7G. LINE 7H RESEARCH IS REPORTED USING THE RESEARCH DEPARTMENT'S ACTUAL EXPENSES AND NO OVERHEAD PROVISION IS INCLUDED. LINE 7I CASH AND IN-KIND CONTRIBUTIONS INCLUDE CASH DISBURSEMENTS AND IN-KIND DONATIONS OF MEDICATIONS TO LOCAL NONPROFIT RESCUE SQUADS AND FIRE DEPARTMENTS. IN-KIND DONATIONS OF MEDICATIONS ARE BASED ON OUR ACTUAL COST FOR THESE ITEMS. PART II - COMMUNITY BUILDING ACTIVITIES MSHA LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR MSHA TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. WE DO NOT CAPTURE COSTS ASSOCIATED WITH TEAM MEMBERS THAT SERVE ON OTHER NONPROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. COMMUNITY BUILDING REPORTED ON THIS RETURN INCLUDES CHARITABLE CONTRIBUTIONS TO NONPROFITS DIRECTED TO PROVIDING ASSISTANCE TO HOMELESS AND LOW INCOME FAMILIES, SUPPORT FOR A LOCAL PARK, A LITERACY PROGRAM FOR ADULTS, A SCHOOL FOR AT-RISK CHILDREN, AN ECONOMIC DEVELOPMENT PROJECT, AND OTHER SERVICES SPECIFIC TO CHILDREN. MSHA, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION; ADVOCACY; PROVIDE SPACE; OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. 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. AFTER THE NORMAL COLLECTION PROCESS HAS INDICATED AN ACCOUNT IS UNCOLLECTIBLE, MSHA WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO GATHER HISTORICAL INFORMATION TO APPLY TO THE CURRENT BALANCE. IN OTHER WORDS, THE HOSPITAL EVALUATES PAST COLLECTION HISTORY ON ACCOUNTS WRITTEN OFF TO BAD DEBT AND APPLIES THE HISTORICAL UNPAID RATE TO THE CURRENT SELF-PAY ACCOUNTS RECEIVABLE BALANCE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE MSHA'S PATIENT FINANCIAL SERVICES MANAGEMENT ESTIMATES THAT 70% OF BAD DEBT EXPENSE IS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. WE BASE THIS PERCENTAGE ON THE COMPOSITION OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS WITH NO FORM OF INSURANCE OR THIRD-PARTY COVERAGE, WHICH REPRESENTS THE MAJORITY OF BAD DEBT ACCOUNTS. WE ALSO ESTIMATE A MUCH SMALLER PERCENTAGE OF LIKELY CHARITY-ELIGIBLE ACCOUNTS TO ACCOUNTS WITH BALANCES AFTER INSURANCE/THIRD-PARTY COVERAGE HAS PAID (E.G. REMAINING DEDUCTIBLE AND CO-PAYMENT BALANCES). IT IS IMPLAUSIBLE TO DETERMINE WITH EXACTITUDE THE AMOUNT OF MSHA'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 95% OF OUR PATIENTS WHO COMPLETED OUR FINANCIAL ASSISTANCE APPLICATION WERE APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE. IN FACT, 83% OF COMPLETED APPLICATIONS RECEIVED A COMPLETE WRITE-OFF OF ALL CHARGES (FREE CARE). ANOTHER 12% RECEIVED A PARTIAL DISCOUNT. DURING FY16, ONLY 5% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS WERE DENIED. UNFORTUNATELY, 33% OF SUBMITTED APPLICATIONS ARE INCOMPLETE. WE RETURN INCOMPLETE APPLICATIONS TO PATIENTS ALONG WITH A NOTICE OF MISSING INFORMATION. THE NOTICE ALSO PROVIDES A CONTACT PHONE NUMBER PATIENTS MAY CALL. WE HAVE MANY INSTANCES OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE ARE SURE WOULD QUALIFY FOR CHARITY CARE. ALTHOUGH HOSPITAL TEAM MEMBERS ENCOURAGE THESE INDIVIDUALS TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION, MANY WILL NOT DO SO. OUR TEAM MEMBERS VOLUNTEER TO ASSIST PATIENTS WITH COMPLETION OF THE APPLICATION. MSHA WOULD PREFER FOR PATIENTS TO SUBMIT COMPLETED FINANCIAL ASSISTANCE APPLICATIONS GIVEN HISTORICAL DATA THAT MANY WOULD QUALIFY FOR THIS PROGRAM. WITHOUT A COMPLETED APPLICATION, MSHA MUST REPORT AN UNPAID ACCOUNT AS BAD DEBT INSTEAD OF CHARITY. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE TEXT OF MSHA'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE APPEARS ON PAGE 13 IN OUR MOST RECENT AUDITED FINANCIAL STATEMENTS (ATTACHED). PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE REPORTED USING MSHA'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 ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED. 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. AS A NONPROFIT ORGANIZATION, WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITY AND THE INDIVIDUAL WHILE MAINTAINING A HIGH LEVEL OF HEALTH CARE SERVICES WITHOUT LOSSES. SINCE LOSSES DO OCCUR THROUGH THE CMS SYSTEM OF REIMBURSEMENT, THESE LOSSES ARE A COST OF DOING BUSINESS FOR OUR COMMUNITY AND SHOULD BE CONSIDERED A COMMUNITY BENEFIT. 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 MSHA 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. MSHA RECOGNIZES ITS OBLIGATION TO PROVIDE QUALITY HEALTH CARE TO THOSE WHO ARE UNABLE TO PAY. MSHA CHARITY GUIDELINES ARE BASED ON 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. 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 2016, TENNESSEE IS RANKED 44TH, WHILE VIRGINIA'S OVERALL HEALTH RANKING MOVED UP TO 19TH. HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE SOME OF MSHA FACILITIES ARE 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, NON-PROFIT 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 NON-PROFITS 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). RANKINGS BY FACILITY: -JCMC AND FWCH WERE GIVEN A HEALTH STATUS RANKING OF 5.3 -IPMC WAS GIVEN A HEALTH STATUS RANKING OF 3.6 -SSH WAS GIVEN A HEALTH STATUS RANKING OF 4.7 -JCCH WAS GIVEN A HEALTH STATUS RANKING OF 5.14 -UCMH WAS GIVEN A HEALTH STATUS RANKING OF 4.9 -RCMC WAS GIVEN A HEALTH STATUS RANKING OF 5.0 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. TENNESSEE RANKS 45TH FOR CARDIOVASCULAR DEATHS, CANCER DEATHS (43RD FOR SMOKING), AND FOR DIABETES. VIRGINIA RANKS 25TH FOR CARDIOVASCULAR DEATHS, 23RD FOR CANCER DEATHS AND 28TH FOR DIABETES. COUNTY HEALTH RANKINGS FOR COUNTIES INCLUDED IN THE MSHA SERVICE AREA: THE PERCENTAGE OF CHILDREN LIVING IN POVERTY: JOHNSON COUNTY 35%, CARTER COUNTY 33%, UNICOI COUNTY 29%, AND RUSSELL COUNTY 25% PERCENTAGE OF PHYSICAL INACTIVITY: UNICOI COUNTY 35%, RUSSELL COUNTY 29%, JOHNSON COUNTY 36%, AND CARTER COUNTY 34% PERCENTAGE OF ADULT OBESITY: RUSSELL COUNTY 31%, JOHNSON COUNTY 30%, UNICOI COUNTY 32%, AND CARTER COUNTY 30% 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 MSHA SERVES THE HEALTHCARE NEEDS OF 29 APPALACHIAN COUNTIES IN TENNESSEE, SOUTHWEST VIRGINIA, KENTUCKY, AND NORTH CAROLINA. SOME OF THE COUNTIES MSHA SERVES ARE FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS. MSHA'S LARGEST HOSPITAL, JOHNSON CITY MEDICAL CENTER, IS A TERTIARY REFERRAL CENTER AND LEVEL ONE TRAUMA CENTER. JCMC'S INPATIENT POPULATION AT ANY TIME WILL HISTORICALLY DRAW NEARLY 50% OF ITS PATIENTS FROM MEDICALLY UNDERSERVED AREAS. SYCAMORE SHOALS HOSPITAL DRAWS A SIGNIFICANT NUMBER OF PATIENTS FROM JOHNSON AND CARTER COUNTIES, BOTH OF WHICH ARE LISTED ON THE TENNESSEE DEPARTMENT OF HEALTH'S WEBSITE AS MEDICALLY UNDERSERVED AREAS. UNICOI COUNTY MEMORIAL HOSPITAL IS LISTED AS A WHOLE-COUNTY MEDICALLY UNDERSERVED AREA ON THE TENNESSEE HEALTH DEPARTMENT'S WEBSITE. RUSSELL COUNTY MEDICAL CENTER IS DESIGNATED BY THE STATE OF VIRGINIA AS A WHOLE- COUNTY HEALTH PROFESSIONAL SHORTAGE AREA. MSHA OPERATES 2 CRITICAL ACCESS HOSPITALS: JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH) IN TENNESSEE AND MAJORITY-OWNED DICKENSON COMMUNITY HOSPITAL IN VIRGINIA. THE HEALTH STATUS OF THE POPULATION IN MSHA'S SERVICE AREA IS GENERALLY POOR. OUR SERVICE AREA EXTENDS TO SOME OF THE POOREST RURAL COUNTIES IN THE REGION WITH A POVERTY RATE OF ALMOST 30% IN SOME AREAS (ALL PEOPLE IN POVERTY), WHILE CHILDREN IN POVERTY IN SOME AREAS EXCEEDS 30%. SOME OF THE MOST WELL-OFF COUNTIES IN MSHA'S SERVICE AREA STILL HAVE A MEDIAN HOUSEHOLD INCOME LOWER THAN STATE AND NATIONAL AVERAGES. OUR COMMUNITIES HAVE A LARGE ELDERLY POPULATION, FAR EXCEEDING THAT OF THE COUNTRY. PERSONS 65 YEARS AND OLDER IN THE COUNTIES OUR HOSPITALS ARE LOCATED IN RANGE FROM 17.4% TO 22.1% COMPARED TO 14.9% FOR THE U.S. MUCH OF OUR SERVICE AREA IS RURAL. RURAL SERVICE AREA COUNTIES SHARE COMMON CHALLENGES OF: 1. HIGH RATES OF UNINSURED 2. HIGH PREVALENCE OF OBESITY 3. HIGH PREVALENCE OF DIABETES 4. HIGH PREVALENCE OF CANCER 5. HIGH PREVALENCE OF POOR CARDIAC HEALTH PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH MSHA IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. MSHA'S LEADERSHIP REMAINS MINDFUL OF MANAGING THE ALLIANCE'S LIMITED RESOURCES SO THAT ADEQUATE FACILITIES AND EQUIPMENT ARE AVAILABLE FOR THE CARE OF OUR PATIENTS. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. SURPLUS FUNDS ARE INVESTED INTO IMPROVING TREATMENT OPTIONS FOR OUR PATIENTS THROUGH NEW TECHNOLOGIES, RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS, AND IMPROVING OUR FACILITIES. MSHA HAS SEVERAL HOSPITALS WITH MEDICARE-APPROVED HEALTH PROFESSION EDUCATION PROGRAMS. IN ADDITION, OUR HOSPITALS SERVE AS TRAINING SITES FOR MANY TYPES OF HEALTH PROFESSIONS: NURSING, PHARMACY, PSYCHOLOGY, LAB, RESPIRATORY THERAPY, EMT, PUBLIC HEALTH, ETC. STUDENTS FROM NUMEROUS COLLEGES, UNIVERSITIES, AND PROGRAMS RECEIVE TRAINING AND EXPERIENCE IN OUR HOSPITALS. WE DEVOTE RESOURCES TO HEALTH CONFERENCES FOR LOCAL HEALTH PROFESSIONALS, OPERATE TWO HEALTH RESOURCE CENTERS LOCATED IN SHOPPING MALLS, PROVIDE FOR MEDIA COVERAGE TO EDUCATE OUR RESIDENTS ON HEALTH ISSUES, OFFER EVENTS TO THE PUBLIC THAT COMBINE FUN ACTIVITIES WITH HEALTH EDUCATION, AND MANY OTHER PROGRAMS FOCUSED ON IMPROVING THE HEALTH OF OUR RESIDENTS. WHILE WE OPERATE HOSPITALS IN PREDOMINANTLY LOW-INCOME, RURAL AREAS, WE CONTINUE TO OFFER SERVICES THAT OPERATE AT A LOSS TO MSHA BECAUSE RESIDENTS WOULD OTHERWISE NEED TO LEAVE THEIR HOME TOWN OR COUNTY TO RECEIVE NEEDED CARE. THE MAJORITY OF MSHA'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY MSHA. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY AND NORTH CAROLINA. EACH HOSPITAL IS FULLY ACCREDITED BY THE JOINT COMMISSION, WITH THE EXCEPTION OF JCCH. JCCH RECEIVES CERTIFICATION THROUGH THE STATE OF TENNESSEE SINCE IT IS A CRITICAL ACCESS HOSPITAL. MSHA, BASED IN JOHNSON CITY, TENNESSEE IS THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. NINE FACILITIES ARE WHOLLY-OWNED FACILITIES: 8 FACILITIES IN TENNESSEE AND 1 IN VIRGINIA. IN ADDITION TO THE WHOLLY-OWNED HOSPITALS REPORTED WITHIN THIS FORM 990, MSHA ALSO HAS MAJORITY OWNERSHIP IN 4 HOSPITALS IN SOUTHWEST VIRGINIA. IN ADDITION TO OUR ACUTE CARE HOSPITALS, OUR SYSTEM INCLUDES SUCH SERVICES AS: PRIMARY/SPECIALTY PHYSICIAN PRACTICES, EMERGENCY DEPARTMENTS, OCCUPATIONAL MEDICINE, REHABILITATION, OUTREACH LABORATORY, MENTAL HEALTH, NEONATAL INTENSIVE CARE, A NACHRI-AFFILIATED CHILDREN'S HOSPITAL, RENAL DIALYSIS, ST. JUDE'S ONCOLOGY, INPATIENT/OUTPATIENT SURGERY, SKILLED NURSING, LONG- TERM CARE, HOME HEALTH, AND MORE. WITH THESE ADDITIONAL FACILITIES AND SERVICES, MSHA EXTENDS A HIGHLY EFFECTIVE HEALTH CARE DELIVERY SYSTEM. SINCE OUR SYSTEM IS BOTH HORIZONTALLY AND VERTICALLY INTEGRATED, PATIENTS CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. OUR FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER IS AT THE CORE OF OUR SYSTEM OFFERING FULL-SERVICE TERTIARY CARE. IN ADDITION TO OUR HOSPITALS, MSHA IS THE SOLE MEMBER OF BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (BRMMC). MSHA EXTENDS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THROUGH BRMMC TO INCLUDE MULTIPLE PRIMARY AND SPECIALTY CARE PATIENT ACCESS CENTERS AND NUMEROUS OUTPATIENT CARE SITES, INCLUDING URGENT CARE CENTERS, OCCUPATIONAL MEDICINE SERVICES, A SAME DAY SURGERY CENTER AND REHABILITATION. MSHA IS A 99.9% SHAREHOLDER OF INTEGRATED SOLUTIONS HEALTH NETWORK, LLC. (ISHN). IN 2012, ISHN CREATED ANEWCARE COLLABORATIVE, THE REGION'S FIRST ACCOUNTABLE CARE ORGANIZATION, BRINGING TOGETHER COMMUNITY HEALTH CARE PROVIDERS TO PROVIDE BETTER OUTCOMES AND IMPROVED PATIENT SATISFACTION AT A LOWER COST. MSHA COUNTY-SPECIFIC OPERATIONS ARE GOVERNED BY A COMMUNITY BOARD OF DIRECTORS. COUNTY BOARDS REPORT TO A SYSTEM LEVEL BOARD OF DIRECTORS. ALL BOARDS ARE PRIMARILY COMPOSED OF LOCAL COMMUNITY RESIDENTS. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT TENNESSEE, VIRGINIA true AMERICAN CANCER SOCIETY 250 WILLIAMS STREET NW SUITE 400 ATLANTA GA 30303 131788491 501C3 10575 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION PO BOX 50015 PRESCOTT AZ 863045015 135613797 501C3 23750 PROGRAM SUPPORT APPALACHIAN MOUNTAIN PROJECT ACCESS 809 SOUTH ROAN STREET SUITE 4 JOHNSON CITY TN 37601 262102040 501C3 318461 HEALTH ACCESS BARTER THEATRE PO BOX 867 ABINGDON VA 24212 546000120 501C3 19800 SPONSORSHIP CITY OF JOHNSON CITY 601 E MAIN ST JOHNSON CITY TN 37601 626000320 501C3 20000 WALKING TRAIL, ETC. EAST TENNESSEE STATE UNIVERSITY PO BOX 70732 JOHNSON CITY TN 37614 626021046 501C3 120815 HLTH RESEARCH/PHARM FRIENDS IN NEED HEALTH CENTER 1105 W STONE DRIVE KINGSPORT TN 37660 621541637 501C3 15000 HEALTH & DENTAL CARE GOV'S FNDTN FOR HEALTH & WELLNESS PO BOX 198198 NASHVILLE TN 37219 453635908 501C3 50000 HEALTH INITIATIVE ISHN CONTRIBUTIONS K-1 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 621711997 501C3 39987 K-1 P/S CHAR. CONTR. KINGSPORT CHAMBER FOUNDATION 151 EAST MAIN STREET KINGSPORT TN 37660 581453565 501C3 45000 HEALTHY KPT PRGRM MILLIGAN COLLEGE PO BOX 189 MILLIGAN COLLEGE TN 37682 620535755 501C3 27021 HEALTH PROF. EDUC. MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD SUITE 101 JOHNSON CITY TN 37604 581418862 501C3 5675 LOCAL HLTH PROGRAMS PUBLIC GOOD PROJECTS THE 120 E 23RD ST 5TH FLOOR NEW YORK NY 10010 462717584 501C3 25000 HLTH & WELLNESS PROG SPEEDWAY CHILDREN'S CHARITIES 151 SPEEDWAY BOULEVARD BRISTOL TN 37620 561331429 501C3 7500 PROGRAM SUPPORT SUSAN KOMEN BREAST CANCER FOUND PO BOX 5835 KINGSPORT TN 37663 841689067 501C3 10200 PROGRAM SUPPORT TWEETSIE TRAIL CONSERVANCY 106 E WATAUGA AVENUE JOHNSON CITY TN 37605 473257873 501C3 20000 WALKING TRAIL 15 SCHEDULE I, PAGE 1, PART I, LINE 2 DONATION REQUESTS THAT WILL BE EXPENSED AT THE CORPORATE DIVISION REQUIRE TWO LEVELS OF APPROVAL, WITH FINAL REVIEW BY MSHA'S PRESIDENT. DONATIONS THAT WILL BE EXPENSED BY ONE OF OUR HOSPITALS REQUIRES FINAL APPROVAL BY THE INDIVIDUAL HOSPITAL'S CEO. DURING PART OF THE YEAR, WE ENCOURAGED DONATION REQUESTS TO BE COMPLETED USING OUR ONLINE DONATION APPLICATION FORM, BUT WE ACCEPTED DONATION REQUESTS IN THE FORM OF LETTERS WHEN AN ADEQUATE EXPLANATION FOR THE REQUEST WAS PROVIDED IN THE LETTER. IN ORDER TO IMPROVE THE OVERALL EFFICIENCY OF CONTRIBUTION REQUEST EVALUATION, WE CHANGED OUR PROCESS SO THAT 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 APPLICANTS OTHER SOURCES OF INCOME EVENT/PROGRAM BUDGET HOW THE EVENT/PROGRAM SUPPORTS MSHA'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 THE CORPORATE LEVEL, WHICH PREVENTS MULTIPLE CONTRIBUTIONS BEING MADE TO THE SAME NATIONAL ORGANIZATION AND ALLOWS ADDITIONAL CONTRIBUTION DOLLARS TO BE USED FOR REGION-SPECIFIC REQUESTS. DONATIONS MADE BY OUR HOSPITALS ARE ALMOST ENTIRELY DIRECTED TO LOCAL NONPROFIT ORGANIZATIONS. MSHA'S SOCIAL RESPONSIBILITY COMMITTEE 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, MSHA'S PRESIDENT AND CEO, 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 THIS YEAR, THE COMMITTEE BEGAN WORK TO DEVELOP A SOCIAL RESPONSIBILITY BUSINESS PLAN 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 FUNDING OF PROGRAMS SOMETIMES, MSHA DEPARTMENTS WILL BRING PROPOSALS FOR NEW PROGRAMS TO BENEFIT A SPECIFIC POPULATION, SUCH AS CHILDREN X X true true X X X true true false false false false false true false ALAN LEVINE PRESIDENT & CEO 874179 259087 15511 148440 23586 1317013 8050 MARVIN EICHORN EVP/COO 571412 134090 41769 18550 24504 786535 LYNN KRUTAK SVP/CFO 456385 102076 6721 68271 19075 648739 DAWN TRIMBLE VP/CEO WASH. CO. 461672 74581 12275 22613 23768 591232 SHANE HILTON VP/CFO-MKT OPS 330385 65889 10393 34851 24494 462368 TONY BENTON VP/COO WASH. CO MKT 297908 57995 10266 16377 23235 402263 MONTY MCLAURIN VP/CEO NW MKT 299200 41814 16767 31753 24057 410058 RICHARD BOONE VP/CFO WASH. CO. 286877 55282 5686 19855 365213 LINDA WHITE VP & CEO, FWCH/WR 261240 54065 10478 28850 20812 372085 LEMMIE TAYLOR VP/CEO SE MKT 210069 32960 7501 27809 21616 297217 DRU MALCOLM VP & CNO JCMC/WR 184967 39238 5800 15040 8208 251906 STEVE SAWYER AVP/CFO NW MKT 175344 18495 18029 8934 17994 236797 MORRIS SELIGMAN MD EVP & CMO 504955 111446 31838 67725 18637 730811 ANN FLEMING MSHA CONSULTANT 12172 440820 926 4997 458521 34425 ANTHONY KECK SVP/CHIEF DEV. OFC. 361624 84485 4914 34596 14884 498087 CLAY RUNNELS MD VP HOSP. PRGM. SERV. 360527 76336 4510 13624 24225 475466 MARK WILKINSON MD VP/CMO 357769 48716 4519 13603 23855 444715 DALE CLAYTORE FMR. KEY EMPL., VP 220202 41242 13857 13212 2776 288513 PAT NIDAY FMR. KEY EMPL., AVP 163326 25956 18791 9299 17888 233134 RHONDA MANN FMR. KEY EMPL., VP 130559 8869 139428 SCHEDULE J, PAGE 1, PART I, LINE 1B BOARD MEMBERS AND TEAM MEMBERS OF MSHA ARE NOT PERMITTED TO TRAVEL FIRST- CLASS WITH THE EXCEPTION OF MSHA'S CEO. AS SANCTIONED BY MSHA'S BOARD OF DIRECTORS, MSHA'S CEO IS PERMITTED TO TRAVEL FIRST-CLASS WHEN THE FLIGHT'S DURATION IS GREATER THAN TWO HOURS. DUE TO THE LENGTH OF SUCH FLIGHTS, THE BOARD BELIEVES IT IS IN THE BEST INTEREST OF MSHA FOR THE CEO TO TRAVEL FIRST-CLASS. CHARTER TRAVEL IS LIMITED TO MSHA BUSINESS TRIPS THAT INCLUDE NUMEROUS TRAVELERS AND WHICH CAN BE JUSTIFIED BASED UPON FINANCIAL AND/OR ESSENTIAL TIME SAVINGS. CHARTER FLIGHTS MUST BE APPROVED BY THE CEO PRIOR TO BOOKING THE FLIGHT. ALTHOUGH MSHA DOES NOT GENERALLY GROSS-UP PAYMENTS TO COVER A TEAM MEMBER'S TAX LIABILITY, MSHA'S BOARD OF DIRECTORS APPROVED BONUSES FOR MR. LEVINE, MR. EICHORN, MS. KRUTAK, MR. SELIGMAN, AND MR. KECK AT THE END OF CALENDAR YEAR 2015 TO EXPRESS APPRECIATION FOR THE EXTREME HOURS THEY DEVOTED DURING THE YEAR TO A SIGNIFICANT MERGER PROJECT. THE BOARD WANTED EACH EXECUTIVE TO RECEIVE A NET CHECK: 2,500 FOR MR. LEVINE AND 2,000 FOR THE OTHER FOUR. SCHEDULE J, PAGE 1, PART I, LINE 4 ALAN LEVINE 0 128,250 0 LYNN KRUTAK 0 43,990 0 DAWN TRIMBLE 0 22,613 0 SHANE HILTON 0 16,331 0 MONTY MCLAURIN 0 14,905 0 LINDA WHITE 0 12,840 0 LEMMIE TAYLOR 0 10,442 0 MORRIS SELIGMAN, M.D. 0 48,783 0 ANN FLEMING 386,014 0 0 ANTHONY KECK 0 34,596 0 RHONDA MANN 130,559 0 0 SCHEDULE J, PAGE 1, PART I, LINE 7 MSHAS BOARD OF DIRECTORS APPROVED BONUSES FOR MR. LEVINE, MR. EICHORN, MS. KRUTAK, MR. SELIGMAN, AND MR. KECK AT THE END OF CALENDAR YEAR 2015 TO EXPRESS APPRECIATION FOR THE ADDITIONAL HOURS THEY DEVOTED DURING THE YEAR TO A SIGNIFICANT MERGER PROJECT. THE BOARD APPROVED FOR EACH EXECUTIVE TO RECEIVE A NET CHECK: 2,500 FOR MR. LEVINE AND 2,000 FOR THE OTHER FOUR EXECUTIVES. SCHEDULE J, PART III THE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA): ALAN LEVINE, MORRIS SELIGMAN, LYNN KRUTAK, ANTHONY KECK, DAWN TRIMBLE, SHANE HILTON, MONTY MCLAURIN, LINDA WHITE, AND LEMMIE TAYLOR. THE 457(F) PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON- COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON- OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24-MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. A HLTH & EDU FACIL BD 2011A&B&C&D OF THE CITY OF JOHNSON CITY TN 621464028 478271JS9 2011-10-19 195840000 CONSTRUCTION & EQUIP. false false false B HLTH & EDU FACIL BD 2010A&B 621464028 478271JH3 2010-04-29 205877528 PARTIAL REFUNDING false false false C HLTH & EDU FACIL BD 2009A&B&C 621464028 478271HT9 2009-03-31 124301533 CONSTRUCTION & EQUIP. false false false D HLTH & EDU FACIL BD 2006A 621464028 478271GX1 2006-02-14 178614171 CONSTRUCTION & EQUIP. true false false A 123555000 195841283 2353905 158517509 34166556 2016 true false true true B 40100000 206160210 3474644 202685565 true false true true C 10350000 125828347 2481706 100727095 22440435 179111 2014 false false true true D 173030000 185648913 2383533 101295664 81969716 2011 true true true true A false false true true false false true 0.00020 true true B false false true true false false true 0.00020 true true C false false true true false false false true D false false true true false false true 0.00130 true true A false false false true true false false false true B false false false true false false false true true C false false false true false false false true true D false false false true false false false true true A true B true C true D true SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION HLTH & EDU. FACIL. BD. 2011A&B&C&D (PAGE 1 - LINE A) CONSTRUCT AND EQUIP HOSPITAL FACILITIES,INCLUDING REFINANCING TAXABLE DEBT RELATING THERETO, REFUND BONDS ISSUED 12/01/2001; REFINANCING LOANS AND EQUIPMENT LEASES. HLTH & EDU. FACIL. BD. 2010A&B (PAGE 1 - LINE B) PARTIAL REFUNDING OF BONDS ISSUED 12/14/2007 (2007A) AND (2007C) AND 2/20/2008 (2008A). HLTH & EDU. FACIL. BD. 2009A&B&C (PAGE 1 - LINE C) CONSTRUCT AND EQUIP HOSPITAL FACILITIES,INCLUDING REFINANCING OF TAXABLE INDEBTEDNESS RELATING THERETO. HLTH & EDU. FACIL. BD. 2006A (PAGE 1 - LINE D) CONSTRUCT AND EQUIP HOSPITAL FACILITIES,INCLUDING REFINANCING TAXABLE DEBT RELATING THERETO, AND COST OF INTEREST RATE HEDGE, REFUND BONDS ISSUED 3/28/01, 7/01/03, 7/08/04, 11/23/04, 9/7/05 AND 11/23/05. HLTH & EDU. FACIL. BD. 2012A&B&C (PAGE 2 - LINE A) CONSTRUCT AND EQUIP SURGERY CENTER AT JCMC; CONSTRUCT AND EQUIP HOSPITAL FACILITIES, INCLUDING REFINANCING OF INDEBTEDNESS RELATING THERETO. HLTH & EDU. FACIL. BD. 2013A&C&D&E (PAGE 2 - LINE B) CONSTRUCT & EQUIP HOSPITAL FACILITIES, INCLUDING REFINANCING OF INDEBTEDNESS RELATING THERETO, REFUND BONDS ISSUED 2/20/08, 10/19/11 & 9/18/12 HLTH & EDU. FACIL. BD. 2016A (PAGE 2 - LINE C) REFUNDING OF 2006A BOND. HOSPITAL CONSTRUCTION AND EQUIPMENT, INCLUDING REFINANCING DEBT AND COST OF INTEREST RATE HEDGE. SCHEDULE K - DATE REBATE COMPUTATION PERFORMED HLTH & EDU. FACIL. BD. 2011A&B&C&D 04/29/16 HLTH & EDU. FACIL. BD. 2010A&B 02/25/16 HLTH & EDU. FACIL. BD. 2009A&B&C 03/21/14 HLTH & EDU. FACIL. BD. 2006A 03/08/16 SCHEDULE K - ADDITIONAL INFORMATION HLTH & EDU. FACIL. BD. 2011A&B&C&D SCHEDULE K PART VI: 1.COMMENT ON SCHEDULE K, PART I, LINES A, B, C, E AND F. MOUNTAIN STATES HEALTH ALLIANCE OWNS AND/OR OPERATES HOSPITALS IN A NUMBER OF DIFFERENT LOCATIONS BOTH IN TENNESSEE AND IN VIRGINIA. AS A RESULT, MOUNTAIN STATES HEALTH ALLIANCE MUST UTILIZE CONDUIT GOVERNMENTAL BOND ISSUERS IN A NUMBER OF JURISDICTIONS IN ORDER TO FINANCE IMPROVEMENTS TO ITS HOSPITAL FACILITIES. IN 2009, 2010, 2011, 2012 AND 2013, MOUNTAIN STATES HEALTH ALLIANCE WAS THE CONDUIT BORROWER OF TAX-EXEMPT BONDS ISSUED BY MULTIPLE ISSUERS IN TENNESSEE AND VIRGINIA. FOR FEDERAL TAX PURPOSES, EVEN THOUGH DIFFERENT GOVERNMENT ISSUERS WERE INVOLVED, THESE MULTIPLE ISSUES IN EACH YEAR WERE REQUIRED TO BE TREATED, AND WERE TREATED, AS A SINGLE "ISSUE" BECAUSE THEY MET THE SINGLE "ISSUE" TEST UNDER THE APPLICABLE FEDERAL TAX REGULATIONS. THEREFORE, MULTIPLE ISSUERS ARE LISTED UNDER LINES A, B, C, E AND F BECAUSE THE BONDS THAT WERE ISSUED WERE PART OF A SINGLE "ISSUE" FOR FEDERAL TAX PURPOSES. 2.COMMENT ON SCHEDULE K, PART II. LINE 3 FOR EACH THE LISTED BOND ISSUES DOES NOT MATCH THE APPLICABLE ISSUE PRICE FOR EACH SUCH BOND ISSUE BECAUSE OF INTEREST EARNINGS EARNED ON THE PROCEEDS OF EACH SERIES OF BONDS. 3.COMMENT ON SCHEDULE K, PART II, LINE 9 THROUGH 11. THE INSTRUCTIONS ARE UNCLEAR AS TO WHETHER AMOUNTS USED TO REFINANCE SHORT-TERM TAXABLE LOANS INCURRED TO TEMPORARILY FINANCE ELIGIBLE COSTS SHOULD BE SHOWN AS CAPITAL EXPENDITURES AND WORKING CAPITAL (LINES 9 AND 10) OR AS OTHER SPENT PROCEEDS (LINE 11). BASED UPON A REVIEW OF OTHER 990 FILINGS, IT APPEARS THAT MOST REPORTING ENTITIES HAVE LISTED THE APPLICATION OF PROCEEDS FOR SUCH PURPOSE UNDER OTHER SPENT PROCEEDS (LINE 11). THIS FILING TAKES THAT APPROACH. 4.COMMENT ON SCHEDULE K, PART II, LINE 12. IT IS UNCLEAR UNDER THE INSTRUCTIONS WHETHER TRANSFERRED PROCEEDS SHOULD BE TREATED AS OTHER UNSPENT PROCEEDS FOR REPORTING PURPOSES ON LINE 12. AS AN ABUNDANCE OF CAUTION, TRANSFERRED PROCEEDS HAVE BEEN INCLUDED ON LINE 12 FOR EACH ISSUE (BEING THOSE ISSUES LISTED ON LINES E AND F UNDER PART I) TO THE EXTENT APPLICABLE. 5.COMMENT ON SCHEDULE K, PART III, LINE 8C. A VERY SMALL AMOUNT OF EQUIPMENT THAT WAS FINANCED OR REFINANCED WITH THE PROCEEDS OF THE BONDS DESCRIBED IN LINES A, B, D AND F WAS DISPOSED OF DURING THE 2015 FISCAL YEAR. NO REMEDIAL ACTION WAS REQUIRED PURSUANT TO SECTIONS 1.141-12 AND 1.145-2 OF THE TREASURY REGULATIONS BECAUSE THE DISPOSITION OF SUCH EQUIPMENT DID NOT RESULT IN THE PRIVATE BUSINESS USE TEST THRESHOLD BEING EXCEEDED. THEREFORE, SUCH REGULATIONS WERE INAPPLICABLE. HOWEVER, AS A PRECAUTION, AND TO INSURE THAT BOND PROCEEDS WERE ALLOCATED TO ASSETS OWNED BY A 501(C)(3) ORGANIZATION, MOUNTAIN STATES HEALTH ALLIANCE ALLOCATED FROM THE PROCEEDS OF THE SALE OF THE FINANCED EQUIPMENT AND OTHER EQUIPMENT, AN AMOUNT EQUAL TO THE DEPRECIATED BOOK VALUE OF SUCH FINANCED EQUIPMENT TO NEW EQUIPMENT ACQUIRED DURING THE FISCAL YEAR BY MOUNTAIN STATES HEALTH ALLIANCE. 6.COMMENT ON SCHEDULE K, PART IV, LINES 1 AND 2. PRIOR TO JUNE 30, 2016, THE REPORTING DATE OF THE 990, THE ONLY ARBITRAGE REBATE CALCULATIONS THAT WERE REQUIRED RELATED TO THE BONDS DESCRIBED IN LINES A, B, C AND D OF PART I (THE SERIES 2006, 2009, 2010 AND 2011 BONDS). MOUNTAIN STATES HEALTH ALLIANCE RETAINED A REBATE CALCULATION AGENT TO CALCULATE WHETHER ANY ARBITRAGE REBATE WAS DUE WITH RESPECT TO THOSE BONDS, AND THERE WAS NEGATIVE ARBITRAGE REBATE LIABILITY IN A SIGNIFICANT AMOUNT. THEREFORE, NO FORM 8038-T WAS REQUIRED TO BE FILED WITH RESPECT TO THOSE BOND ISSUES. 7.COMMENT ON SCHEDULE K, PART IV, LINE 6. CERTAIN OF THE BOND ISSUES LISTED HAD PROCEEDS OR TRANSFERRED PROCEEDS OF PRIOR BOND ISSUES THAT FINANCED SIGNIFICANT CAPITAL IMPROVEMENTS TO HOSPITAL FACILITIES OR PROCEEDS. THERE WERE UNEXPECTED DELAYS IN THE CONSTRUCTION AND EQUIPPING OF CERTAIN OF THESE HOSPITAL FACILITIES, AND THEREFORE NOT ALL OF SUCH PROCEEDS WERE SPENT WITHIN THE THREE-YEAR TEMPORARY PERIOD RELATIVE TO CONSTRUCTION PROJECTS. HOWEVER, MOUNTAIN STATES HEALTH ALLIANCE HAS YIELD RESTRICTED THESE PROCEEDS AFTER THE END OF THE APPLICABLE TEMPORARY PERIOD AND/OR WILL BE MAKING A YIELD REDUCTION PAYMENT WITH RESPECT TO THOSE PROCEEDS, IF REQUIRED. DENNIS VONDERFECHT SPLIT LIFE INSUR.LOAN,INCL.PR.YRS X 7205125 8295295 false true true MARVIN EICHORN SPLIT DOLLAR LIFE INSURANCE LOAN X 1750000 1785735 false true true MARVIN EICHORN SPLIT DOLLAR LIFE INSURANCE LOAN X 458410 470081 false true true MARVIN EICHORN SPLIT DOLLAR LIFE INSURANCE LOAN X 304332 304332 false true true MARVIN EICHORN SPLIT DOLLAR LIFE INSURANCE LOAN X 296183 238783 false true true 11094226 WORKSPACE INTERIORS INC VENDOR 406215 SEE PART V false SCOTT PETERS FAMILY MEMBER 58221 SEE PART V false PAULA CLAYTORE FAMILY MEMBER 280059 SEE PART V false MATTHEW MARTIN FAMILY MEMBER 27348 SEE PART V false CLEM WILKES III FAMILY MEMBER 182250 SEE PART V false SCHEDULE L, PART V (1) ROBERT FEATHERS, VICE CHAIR OF THE MSHA BOARD OF DIRECTORS, IS OWNER OF WORKSPACE INTERIORS,INC. WHICH PROVIDES COMMERCIAL FURNISHINGS AND DESIGN SERVICES TO MSHA. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH. (2) LEMMIE TAYLOR, KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF SCOTT PETERS, AN EMPLOYEE OF MSHA. (3) DALE CLAYTORE, FORMER KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF PAULA CLAYTORE, AN EMPLOYEE OF MSHA. (4) JOANNE GILMER, SECRETARY OF THE MSHA BOARD OF DIRECTORS, IS A FAMILY MEMBER OF MATTHEW MARTIN, AN EMPLOYEE OF MSHA. (5) CLEM WILKES, JR., PAST CHAIR OF THE MSHA BOARD OF DIRECTORS, IS A FAMILY MEMBER OF CLEM WILKES III, AN EMPLOYEE OF MSHA. FORM 990, PAGE 1, ITEM C NISWONGER CHILDREN'S HOSPITAL; FRANKLIN WOODS COMMUNITY HOSPITAL; INDIAN PATH MEDICAL CENTER; SYCAMORE SHOALS HOSPITAL; WOODRIDGE HOSPITAL FOR BEHAVIORAL HEALTH SERVICES; JOHNSON COUNTY COMMUNITY HOSPITAL; RUSSELL COUNTY MEDICAL CENTER; UNICOI COUNTY MEMORIAL HOSPITAL FORM 990 - ORGANIZATION'S MISSION MOUNTAIN STATES HEALTH ALLIANCE (MSHA) 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 6, PART VI, LINE 11B THE CFO/SENIOR VP REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING AND 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. 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. ANY CONFLICTED PERSON SHALL BE EXCLUDED FROM MEETINGS DURING DISCUSSION OF THE MATTER THAT GIVES RISE TO THE POTENTIAL CONFLICT. A CONFLICTED BOARD DIRECTOR WILL NOT VOTE ON THE MATTER THAT GIVES RISE TO THE POTENTIAL CONFLICT. IN ADDITION, IF A CONFLICTED PERSON HAS A FINANCIAL INTEREST IN A TRANSACTION OR ARRANGEMENT THAT MIGHT INVOLVE PERSONAL FINANCIAL GAIN OR LOSS FOR HIM/HER, THE BOARD OR BOARD COMMITTEE MAY APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. IN ORDER TO APPROVE THE TRANSACTION, THE BOARD OR COMMITTEE MUST FIND BY THE MAJORITY VOTE OF THE BOARD MEMBERS, WITHOUT COUNTING THE VOTE OF A CONFLICTED PERSON, THAT THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT; THE PROPOSED TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION; AND, AFTER REASONABLE INVESTIGATION, THE BOARD OR BOARD COMMITTEE HAS DETERMINED THAT THE CORPORATION CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES; THE CONFLICTED PERSON WILL NOT BE PRESENT FOR THE DISCUSSION OR VOTE REGARDING THE TRANSACTION OR ARRANGEMENT; AND THE TRANSACTION OR ARRANGEMENT MUST BE APPROVED BY A MAJORITY VOTE OF THE BOARD MEMBERS, NOT INCLUDING ANY CONFLICTED PERSONS. ANY PERSON HAVING A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND DISCLOSURE FORM ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION. FAILURE TO COMPLY WITH MSHA'S CONFLICT OF INTEREST POLICY CONSTITUTES GROUNDS FOR REMOVAL FROM OFFICE, IN THE CASE OF THE GOVERNING BODY; AND, IN THE CASE OF TEAM MEMBERS, TERMINATION OF EMPLOYMENT. FORM 990, PAGE 6, PART VI, LINE 15A THE EXECUTIVE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE OF MSHA'S BOARD OF DIRECTORS. THE COMPENSATION FOR ALAN LEVINE, MSHA'S PRESIDENT AND CEO, WAS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE DURING FY16. DATA OBTAINED BY AN INDEPENDENT, OUTSIDE CONSULTING FIRM WAS USED TO DETERMINE HIS PAY SO THAT IT IS COMPARABLE TO LIKE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. FORM 990, PAGE 6, PART VI, LINE 15B THE EXECUTIVE COMMITTEE ALSO REVIEWED AND APPROVED COMPENSATION FOR ALL MSHA OFFICERS AND KEY EMPLOYEES DURING FY16. DATA OBTAINED BY AN INDEPENDENT, OUTSIDE CONSULTING FIRM WAS USED TO DETERMINE THEIR PAY SO THAT IT IS COMPARABLE TO LIKE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY BASIS. FORM 990, PART VII, OFFICERS, KEY EMPLOYEES, & HIGHEST PAID COMPENSATION: CERTAIN EXECUTIVES OF THE ORGANIZATION, SUCH AS THE HEALTH SYSTEM'S CEO, SVP/CFO, EVP/COO, ETC. PROVIDE SERVICES TO SOME OR ALL OF THE ORGANIZATIONS RELATED TO MSHA. FORM 990, PART IX, LINE 11G PHYSICIAN FEES 25,908,256 0 0 HOSPITAL SUPPORTED CLINICS 37,396,704 0 0 HOSPITAL BASED PROVIDERS 2,811,887 0 0 DIETARY SERVICES 7,994,710 0 0 CONSULTING SERVICES 0 10,901,223 0 ENVIRONMENTAL SERVICES 5,278,588 0 0 LAUNDRY SERVICES 2,505,808 0 0 COLLECTION SERVICES 0 3,574,021 0 RETAIL PHARMACY 516,595 0 0 LABORATORY SERVICES 3,580,554 0 0 CONTRACT LABOR 6,063,440 0 0 PATIENT RESOURCE SERVICES 769,933 0 0 TRANSCRIPTION SERVICES 0 1,125,272 0 PHYSICIAN LOAN FORGIVENESS 819,883 0 0 LITHOTRIPSY 807,091 0 0 ENGINEERING SERVICES 0 934,260 0 OTHER FEES 9,859,411 176,585 7,915 FORM 990, PART XI, LINE 9 PARTNERSHIP CHARITABLE CONTRIBUTION NOT ON BOOKS 39,987 PARTNERSHIP ORDINARY INCOME NOT ON BOOKS -1,047,259 TEMPORARILY RESTRICTED GRANTS 126,105 CHANGE IN FAIR VALUE OF DERIVATIVES -2,286,838 TOTAL -3,168,005 DICKENSON COMMUNITY HOSPITAL ONE HOSPITAL DRIVE CLINTWOOD VA 24228 770599553 HOSPITAL VA 501C3 3 NCH false MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD STE 101 JOHNSON CITY TN 37604 581418862 FUNDRAISER TN 501C3 11A MSHA false MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 581418345 SUPPORT TN 501C3 11A MSHA false SMYTH COUNTY COMMUNITY HOSPITAL 245 MEDICAL PARK DRIVE MARION VA 24354 540794913 HOSPITAL VA 501C3 3 MSHA false NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON VA 24273 540566029 HOSPITAL VA 501C3 3 NA false 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 11A JMH false APPALACHIAN EMERGENCY PHYSICIANS 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 800592504 MED. SERV VA 501C3 11A NA false NEWCO INC 211 COMMERCE ST STE 800 NASHVILLE TN 372011817 611771290 SUPP. ORG TN 501C3 11B NA false INTEGRATED SOLUTIONS HEALTH NETWORK 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 621711997 INVESTMENT TN MSHA EXCLUDED 1267377 18322097 false false EMMAUS COMMUNITY HEALTHCARE LLC 6070 HWY 11E PINEY FLATS TN 37686 200577483 MED. SERV. TN NA false false MEDICAL SPECIALISTS OF JC LLC 2528 WESLEY STREET SUITE 2 JOHNSON CITY TN 37601 272199037 MED. SERV. TN MSHA EXCLUDED -110474 -229826 false false EAST TN AMBULATORY SURGERY CNTR 701 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 621787537 MED. SERV. TN NA false false BLUE RIDGE MEDICAL MANAGEMENT CORP 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 621490616 MED. SERV. TN MSHA C CORP 133192077 224925179 1.00000 false MEDISERVE MEDICAL EQUIPMENT 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY TN 37604 621212286 DME TN BRMMC C CORP 4552162 5474210 1.00000 false MOUNTAIN STATES PROPERTIES 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY TN 37604 621845895 PROP. MGMT TN BRMMC C CORP 12940616 139683467 1.00000 false MOUNTAIN STATES PHYSICIAN GROUP 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY TN 37604 621700412 MED. SERV. TN BRMMC C CORP 71424586 7830478 1.00000 false COMMUNITY HOME CARE INC 1460 PARK AVENUE NORTON VA 24273 541453810 DME VA NCH C CORP 273802 433578 0.50100 false WILSON PHARMACY INC PO BOX 5289 JOHNSON CITY TN 37604 620329587 PHARMACY TN BRMMC C CORP 4947092 6523997 1.00000 false CRESTPOINT HEALTH INSURANCE COMPANY 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY TN 37604 620381170 INSURANCE TN ISHN C CORP 43290387 16926956 0.99830 false true true true true false false true true false true true true true true true true true true true APP L 154213 BLUE RIDGE MEDICAL MANAGEMENT CORP M 38598999 BLUE RIDGE MEDICAL MANAGEMENT CORP O 369187 BLUE RIDGE MEDICAL MANAGEMENT CORP P 47259 BLUE RIDGE MEDICAL MANAGEMENT CORP Q 36242975 BLUE RIDGE MEDICAL MANAGMENT CORP R 130994 BLUE RIDGE MEDICAL MANAGMENT CORP L 7756551 BLUE RIDGE MEDICAL MANAGMENT CORP S 56172 DICKENSON COMMUNITY HOSPITAL L 1037024 DICKENSON COMMUNITY HOSPITAL Q 334576 HEALTHPLUS A 53370 HEALTHPLUS L 63744 HEALTHPLUS M 184309 HEALTHPLUS O 336326 HEALTHPLUS Q 18139964 ISHN A 216049 ISHN B 1161000 ISHN D 6433000 ISHN L 191548 ISHN M 3793800 ISHN Q 8151409 JOHNSTON MEMORIAL HOSPITAL L 12669625 JOHNSTON MEMORIAL HOSPITAL R 111464 MEDISERVE K 140714 MEDISERVE L 66299 MEDISERVE Q 5125451 MOUNTAIN STATES FOUNDATION C 1875556 MOUNTAIN STATES PROPERTIES K 1901149 MOUNTAIN STATES PROPERTIES M 206584 MOUNTAIN STATES PROPERTIES O 494366 MOUNTAIN STATES PROPERTIES Q 5983797 MSHA AUXILIARY P 84176 MSHA AUXILIARY Q 1545515 NORTON COMMUNITY HOSPITAL D 20985500 NORTON COMMUNITY HOSPITAL L 5994190 NORTON COMMUNITY HOSPITAL O 308063 NORTON COMMUNITY HOSPITAL P 148518 NORTON COMMUNITY HOSPITAL Q 29523047 NORTON COMMUNITY HOSPITAL R 286230 SMYTH COUNTY COMMUNITY HOSPITAL D 15832228 SMYTH COUNTY COMMUNITY HOSPITAL L 4655541 SMYTH COUNTY COMMUNITY HOSPITAL Q 14570756