2012-05-08T08:11:19-05:00 2011-06-30 PERSHING YOAKLEY & ASSOCIATES P C ONE CHEROKEE MILLS 2220 SUTHERLAND KNOXVILLE TN 379192363 990 2010-07-01 620476282 MOUNTAIN STATES HEALTH ALLIANCE MOUN 4233023372 400 NORTH STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 MARVIN EICHORN 4233023372 2012-04-30 1 DEBORAH O ERNSBERGER 8656730844 2010 2016-02-24 21:20:13Z JOHNSON CITY MEDICAL CENTER DENNIS VONDERFECHT 701 NSTATE OF FRANKLIN RD STE 1 JOHNSON CITY TN 37604 729709747 0 X WWW.MSHA.COM X 1945 TN PLEASE SEE SCHEDULE O - PART I, LINE 1, MISSION AND SIGNIFICANT ACTIVITIES. 13 7 8870 1759 3543768 174903 3938777 3143661 674850480 703882320 16043398 15682301 6999981 6648445 701832636 729356727 301136 357333 0 0 287264466 301399812 0 0 1534772 370493266 377644976 658058868 679402121 43773768 49954606 1530090739 1573869411 1311074327 1268238796 219016412 305630615 X MOUNTAIN STATES HEALTH ALLIANCE 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. 0 0 548973782 357333 704105247 MOUNTAIN STATES HEALTH ALLIANCE (MSHA) WAS CREATED IN SEPTEMBER 1998 AS A PRIVATE, LOCALLY OWNED, TAX-EXEMPT, REGIONAL HEALTHCARE SYSTEM. MSHA IS A 1,200 BED TERTIARY-CARE AND REFERRAL HOSPITAL SYSTEM, THE REGION'S LARGEST BY BED COUNT AND VOLUMES. FOR THE YEAR ENDING JUNE 30, 2011, MSHA RECORDED 48,180 INPATIENT ADMISSIONS, AND PROVIDED FOR 720,772 OUTPATIENT VISITS, INCLUDING 145,390 EMERGENCY VISITS AND 94,251 HOME HEALTH VISITS. THE ALLIANCE IS COMPOSED OF 8 HOSPITALS, AN OUTPATIENT SURGERY CENTER, AN OUTPATIENT RADIATION ONCOLOGY CENTER, TWO OUTPATIENT DIAGNOSTIC CENTERS AND TWO OUTPATIENT REHABILITATION THERAPY CENTERS. IT ALSO HAS SERVICES FOR HOME HEALTH, DURABLE MEDICAL EQUIPMENT, INFUSION THERAPY, HOSPICE AND PARISH NURSING. FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH) LICENSED FOR 80 BEDS, OPENED IN JULY 2010, REPLACING OPERATIONS AT NORTH SIDE HOSPITAL (NSH) AND JOHNSON CITY SPECIALTY HOSPITAL (JCSH). NSH AND JCSH WERE LICENSED FOR 91 BEDS AND 23 BEDS, RESPECTIVELY, PRIOR TO THE OPENING OF FWCH AND A TOTAL OF 64 BEDS WERE TRANSFERRED WITHIN THE ALLIANCE.MSHA ENTITIES, IN CONCERT WITH THE MOUNTAIN STATES HEALTHCARE NETWORK OF 54 AFFILIATED HOSPITALS AND NURSING HOMES, PROVIDE AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE TO RESIDENTS ACROSS A WIDESPREAD, PREDOMINANTLY RURAL 29-COUNTY AREA OF APPALACHIA. THE SERVICE AREA INCLUDES PARTS OF NORTHEAST TENNESSEE, SOUTHWEST VIRGINIA, SOUTHEAST KENTUCKY AND WESTERN NORTH CAROLINA. ALL 8 MSHA HOSPITALS ARE LOCATED IN NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. JOHNSON CITY MEDICAL CENTER, THE COMPANY'S FLAGSHIP FACILITY, IS HOME TO MANY OF THE REGION'S CRITICALLY NEEDED PROGRAMS. MSHA ALSO HAS A MAJORITY OWNERSHIP IN SMYTH COUNTY COMMUNITY HOSPITAL (SCCH) LOCATED IN MARION, VA, NORTON COMMUNITY HOSPITAL (NCH), LOCATED IN NORTON, VA, DICKENSON COMMUNITY HOSPITAL (DCH), LOCATED IN CLINTWOOD, VA, AND JOHNSTON MEMORIAL HOSPITAL (JMH), LOCATED IN ABINGDON, VA. BECAUSE SCCH, NCH, DCH AND JMH ARE PARTIALLY OWNED ENTITIES, THEIR DATA ARE EXCLUDED FROM THIS DOCUMENT AND EACH OF THESE HOSPITALS FILE A SEPARATE FORM 990. WASHINGTON COUNTY, TN: JOHNSON CITY MEDICAL CENTER (JCMC) FLAGSHIP FACILITY: - TEACHING HOSPITAL AFFILIATED WITH QUILLEN COLLEGE OF MEDICINE AT EAST TENNESSEE STATE UNIVERSITY (ETSU)- LEVEL I TRAUMA CENTER - ONE OF ONLY SIX IN TENNESSEE - HOME OF THE REGIONAL CANCER CENTER- HOME OF THE REGION'S ONLY ORGAN TRANSPLANT PROGRAM - ONE OF ONLY SIX IN TENNESSEE- HOME TO NISWONGER CHILDREN'S HOSPITAL, WHICH ALSO OFFERS THE ST. JUDE TRI-CITIES AFFILIATE CLINIC, ONE OF ONLY SIX SUCH CLINICS IN THE COUNTRY, WORKING WITH THE MEMPHIS FACILITY TO TREAT PEDIATRIC PATIENTS IN OUR REGION. AND, THE REGION'S ONLY NACHRI-AFFILIATED CHILDREN'S HOSPITAL- HOME OF THE REGION'S ONLY STATE-DESIGNATED PERINATAL CENTER - ONE OF ONLY FIVE IN TENNESSEE- HOME OF THE REGION'S FIRST AND LARGEST AIR AMBULANCE FLEET, WINGS AIR RESCUE- FIRST HOSPITAL IN TENNESSEE AWARDED MAGNET STATUS FOR NURSING EXCELLENCE BY AMERICAN NURSES CREDENTIALING CENTER- 2001-2011 CONSUMER'S CHOICE AWARD FOR THE REGION THROUGH AN INDEPENDENT SURVEY CONDUCTED BY THE NATIONAL RESEARCH COUNCIL: BEST OVERALL QUALITY, BEST DOCTORS, BEST NURSES, MOST PERSONALIZED CARE AND HAVING THE BEST REPUTATIONOTHER JCMC HOSPITALS; JAMES H. & CECILE C. QUILLEN REHABILITATION HOSPITAL (CARF-ACCREDITED) AND WOODRIDGE HOSPITAL FOR BEHAVIORAL HEALTH SERVICES.FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH) OPENED ITS DOORS IN THE SUMMER OF 2010 AS A REPLACEMENT HOSPITAL FOR 2 AGING WASHINGTON COUNTY FACILITIES. FWCH WAS THE FIRST "LEED" CERTIFIED HOSPITAL IN TENNESSEE AND HAS SET THE PRECEDENT FOR ENVIRONMENTALLY FRIENDLY DESIGNS. SULLIVAN COUNTY, TN: INDIAN PATH MEDICAL CENTERCARTER COUNTY, TN: SYCAMORE SHOALS HOSPITALJOHNSON COUNTY, TN: JOHNSON COUNTY COMMUNITY HOSPITAL, A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL LOCATED IN ONE OF TENNESSEE'S POOREST COUNTIES, A MEDICALLY UNDERSERVED AREARUSSELL COUNTY, VA: RUSSELL COUNTY MEDICAL CENTER MSHA WAS AWARDED THE GOVERNOR'S EXCELLENCE AWARD BY THE TENNESSEE CENTER FOR PERFORMANCE EXCELLENCE (TNCPE) IN 2009. MSHA WAS ALSO THE RECIPIENT OF THIS ESTEEMED AWARD IN 2005 AND IS THE FIRST HEALTHCARE RECIPIENT TO BE RECOGNIZED TWICE, AND ONLY THE SECOND ORGANIZATION IN THE HISTORY OF TNCPE TO BE RECOGNIZED AT THIS TOP LEVEL MORE THAN ONCE. THREE MSHA HOSPITALS WERE RECOGNIZED AS TOP PERFORMERS ON KEY QUALITY MEASURES AS DEFINED BY THE JOINT COMMISSION, THE LEADING ACCREDITOR OF HEALTH CARE ORGANIZATIONS IN THE UNITED STATES. FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER AND RUSSELL COUNTY MEDICAL CENTER WERE RECOGNIZED BY THE JOINT COMMISION BASED ON DATA REPORTED ABOUT EVIDENCE-BASED CLINICAL PROCESSES THAT ARE SHOWN TO IMPROVE CARE FOR CERTAIN CONDITIONS, INCLUDING HEART ATTACK, HEART FAILURE, PNEUMONIA, SURGICAL CARE AND CHILDREN'S ASTHMA. THESE THREE HOSPITALS ARE AMONG ONLY 405 U.S. HOSPITALS EARNING THE DISTINCTION OF "TOP PERFORMER ON KEY QUALITY MEASURES". JOHNSON CITY MEDICAL CENTER (JCMC) WAS RECOGNIZED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES AND THE SOCIETY OF CRITICAL CARE MEDICINE WITH AN OUTSTANDING LEADERSHIP AWARD FOR THE HOSPITAL'S ACHIEVEMENT IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA. JCMC WAS ONE OF ONLY SIX HOSPITALS IN THE NATION RECOGNIZED FOR OUTSTANDING LEADERSHIP IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA (VAP). THE VAP RATE AT JCMC IS NOW ONE-THIRD OF WHAT IS TYPICALLY FOUND IN HOSPITALS OF A SIMILAR SIZE AND PATIENT POPULATION. ICU TEAMS AT JCMC BEGAN A PROJECT IN 2006 DESIGNED TO TARGET VAP INFECTIONS. THE OUTSTANDING LEADERSHIP AWARD REQUIRES A HOSPITAL TO REACH THEIR INFECTION TARGETS FOR 25 MONTHS OR MORE. FOR THE SECOND YEAR IN A ROW, JOHNSON CITY MEDICAL CENTER HAS BEEN AWARDED TWO GOLD MEDALS BY THE AMERICAN HEART ASSOCIATION, WHILE TWO OTHER MSHA FACILITIES EACH RECEIVED THEIR FIRST AHA GOLD AWARDS. THESE AHA AWARDS WERE SPOTLIGHTED IN THE JULY 2010 EDITION OF U.S. NEWS AND WORLD REPORT. JCMC RECEIVED ITS SECOND GOLD IN TREATMENT OF BOTH HEART FAILURE AND CORONARY ARTERY DISEARSE IN AS MANY YEARS. JCMC WAS THE ONLY HOSPITAL IN TENNESSEE TO ACHIEVE THE HONOR OF TWO GOLDS OVER A TWO-YEAR PERIOD IN THESE CATEGORIES. IPMC AND SSH EACH RECEIVED THEIR FIRST GOLD AWARDS IN THE TREATMENT OF HEART FAILURE. TO ACHIEVE A GOLD AWARD, A HOSPITAL MUST MEET OR EXCEED BEST PRACTICE GUIDELINES WITH A MINIMUM 85% COMPLIANCE FOR AT LEAST 24 MONTHS. MSHA FACILITIES HAVE STEADILY IMPROVED IN THE AHA'S RANKINGS OVER THE YEARS AND WERE THE ONLY HOSPITALS IN THE REGION TO RECEIVE THIS RECOGNITION. A DOCUMENTARY ON THE HISTORY OF JOHNSON CITY MEDICAL CENTER WON GOLD IN THE MARCOM AWARDS, AN INTERNATIONAL COMPETITION FOR INDIVIDUALS AND COMPANIES INVOLVED IN THE CONCEPT, WRITING AND DESIGN OF PRINT, VISUAL, AUDIO AND WEB MATERIALS. THERE WERE MORE THAN 6,000 ENTRIES THROUGHOUT THE UNITED STATES, CANADA AND OTHER COUNTRIES IN THE 2011 COMPETITION. THE DOCUMENTARY FOCUSED ON 100 YEARS OF HEALTH CARE AT JCMC. AUDIT AND COMPLIANCE PRACTICES: MSHA IS GOVERNED BY A BOARD OF DIRECTORS, WHOSE MEMBERS ARE FROM THE COMMUNITIES MSHA SERVES. THE CORPORATE BOARD INCLUDES A LONGSTANDING AUDIT AND COMPLIANCE COMMITTEE. ALL AUDITORS AND COMPLIANCE SPECIALISTS, INTERNAL AND EXTERNAL, REPORT DIRECTLY TO THE AUDIT AND COMPLIANCE COMMITTEE AS A WAY TO ENSURE THE AUDIT AND COMPLIANCE PROCESS IS INDEPENDENT. - MSHA'S COMPLIANCE PLAN ENSURES THE ORGANIZATION CONDUCTS BUSINESS IN AN APPROPRIATE MANNER AND IN ACCORDANCE WITH LOCAL, STATE AND FEDERAL LAWS AND REGULATIONS. THE PLAN ADDRESSES FISCAL ACCOUNTABILITY AND TRANSPARENCY OF OPERATIONS THROUGH THE REVIEW AND USE OF INDEPENDENT AUDITS BY EXTERNAL AUDITORS AND RATING AGENCIES. - UPON EMPLOYMENT, MSHA TEAM MEMBERS RECEIVE A COPY OF THE BOOKLET "CODE OF ETHICS AND BUSINESS CONDUCT", DETAILING REQUIRED STANDARDS OF BEHAVIOR. YEARLY, TEAM MEMBERS RECEIVE REFRESHER EDUCATION ON THEIR OBLIGATIONS UNDER THE CODE OF ETHICS AND BUSINESS CONDUCT. - ANNUALLY, DEPARTMENT DIRECTORS, EXECUTIVE OFFICERS AND BOARD MEMBERS ARE REQUIRED TO SIGN MSHA'S CONFLICT OF INTEREST POLICY. BY SIGNING THIS POLICY, THEY AFFIRM THEIR KNOWLEDGE AND UNDERSTANDING OF THE POLICY AND ALSO HAVE THE OPPORTUNITY TO DISCLOSE ANY CONFLICT OF INTEREST THEY MAY HAVE. ALL TEAM MEMBERS ARE REQUIRED BY POLICY TO IMMEDIATELY DISCLOSE SITUATIONS THAT MAY CONSTITUTE CONFLICTS OF INTEREST WHEN THEY ARISE. - MSHA IS FULLY COMPLIANT WITH REGULATORY AND LEGAL REQUIREMENTS, AND ITS HOSPITALS ARE ACCREDITED BY THE JOINT COMMISSION. 548973782 1 1 0 1 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 719 0 1 8870 1 1 1 0 0 0 0 0 0 0 0 0 X 13 7 0 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 VA X MARVIN EICHORN 4233023372 400 N STATE OF FRANKLIN RD JOHNSON CITY TN 37604 X DENNIS VONDERFECHT 60.00 X X 855625 0 42464 WILLIAM WALKER MD 0.80 X 0 612004 1615 BARBARA ALLEN 2.10 X 0 0 0 JOHN CAMPBELL 0.60 X 0 0 0 SANDRA BROOKS MD 1.30 X 0 0 0 MAUREEN MACIVER 2.20 X 0 0 0 GARY PEACOCK 1.10 X 0 0 0 CLEM WILKES JR 1.60 X 0 0 0 ROBERT FEATHERS 1.60 X 0 0 0 BILL HAWKINS 1.10 X 0 0 0 MIKE CHRISTIAN 1.30 X 0 0 0 JOANNE GILMER 1.50 X 0 0 0 DAVID MAY 1.30 X 0 0 0 MARVIN EICHORN 60.00 X 597053 0 209233 DALE CLAYTORE 55.00 X 216997 0 11406 ANN FLEMING 55.00 X 442795 0 65589 CANDACE JENNINGS 55.00 X 458976 0 71955 LYNN KRUTAK 55.00 X 242859 0 30312 MONTY MCLAURIN 55.00 X 324458 0 54124 CINDY SALYER 55.00 X 232182 0 41464 SHANE HILTON 55.00 X 193587 0 31422 PAT NIDAY 55.00 X 156116 0 27602 BRAD NURKIN 55.00 X 244706 0 20237 STEVE KILGORE 55.00 X 339311 0 52799 JAMIE PARSONS 50.00 X 253987 0 30442 CHAO LEE MD 50.00 X 309360 0 25655 TONY BENTON JR 50.00 X 238984 0 28792 MORRIS SELIGMAN 50.00 X 485251 0 69030 5592247 612004 814141 164 0 1 0 HOSPITAL HOUSEKEEPING SYSTEMS 322 CONGRESS AVENUE AUSTIN TX 78701 HOUSEKEEPING SERVICES/MGMT 3899360 CREDIT BUREAU COLLECTIONS PO BOX 5187 KINGSPORT TN 37663 COLLECTION SERVICES 1053429 MILLIGAN COLLEGE PO BOX 750 MILLIGAN COLLEGE TN 37682 EDUCATIONAL 801069 HANCOCK DANIEL JOHNSON & NAGLE PO BOX 72050 RICHMOND VA 232552050 LEGAL SERVICES 724381 AVANTAS WORK STRATEGIES 1128 JOHN GALT BLVD STE 400 OMAHA NE 68134 SCHEDULING SYSTEM 688140 36 1957949 947756 237956 3143661 PATIENT SERVICES 621500 700421164 698661352 1759812 WELLNESS PROGRAMS 621990 3231669 3231669 P/S PROG. SERV. INCOME 561000 229487 225554 3933 703882320 14059273 7768 14051505 13232 13232 302737 289918 12819 12819 13871 -1052 1403969 268929 63102 1403969 205827 1609796 222929 1386867 CAFETERIA SALES 722210 3932816 3932816 JCMC DAYCARE 624410 970799 970799 DIET/SECUR/ENGIN/OTHER 541900 953931 980304 -26373 778080 778080 6635626 729356727 702341504 3543768 20327794 357333 357333 4701600 4701600 233797106 223583109 9528935 685062 9763324 9582668 151295 29361 35048014 30903153 4064436 80425 18089768 16140576 1911865 37327 1481288 70 1481218 252600 5441 227519 19640 15666 15666 909566 909566 78751295 60834645 17708514 208136 3065167 2407402 645067 12698 8682390 6842387 1703754 136249 11401755 10286180 1115575 14429955 11969854 2395897 64204 2291207 1637251 615980 37976 359432 297108 61719 605 42206499 8154 42198345 61675549 30249046 31418807 7696 627063 15885 611178 MEDICAL SUPPLIES & DRUG 126183544 126032884 146030 4630 TAXES - UBIT 7800 7800 REPAIRS & MAINTENANCE 14046240 13466849 529169 50222 OTHER 5377696 2923554 2293658 160484 BAD DEBTS 4097305 18145 4079160 1782959 1396422 386480 57 679402121 548973782 128893567 1534772 208449573 94236272 189220 196903 84415992 96082434 4579735 5517265 20219171 94585775 14609053 15564585 4368028 3217335 887338436 417725411 463651654 469613025 152089704 257416902 282350254 282266093 143276118 143276118 151892237 111896704 1530090739 1573869411 76082572 66520793 20092072 19167490 626569957 620629456 400096949 382866923 3114607 185118170 179054134 1311074327 1268238796 X 218490539 305570637 525873 59978 219016412 305630615 1530090739 1573869411 X 49954606 36659597 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 248878 0 0 248878 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR THE COMMUNITY & GOVERNMENT RELATIONS MANAGER AND/OR DIRECTOR ATTENDED THE FOLLOWING LEGISLATIVE CONFERENCES: - PREMIER FEDERAL AFFAIRS NETWORK MEETINGS - AMERICAN HOSPITAL ASSOCIATION ANNUAL MEETING - TENNESSEE HOSPITAL ASSOCIATION LEGISLATIVE ADVOCACY DAY - TENNESSEE HOSPITAL ASSOCIATION ANNUAL MEETING - HOSPITAL ALLIANCE OF TENNESSEE ANNUAL MEETING - NACHRI VIP ADVOCACY DAY - TNPATH ANNUAL MEETING - VHHA LEGISLATIVE ISSUES CONFERENCE, SPRING CONFERENCE ANNUAL MEETING - ASSOCIATION OF AMERICAN MEDICAL COLLEGES GOVERNMENT RELATIONS MEETING THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR DEPARTMENTAL STAFF ALSO CONTACTED CONGRESSIONAL OFFICES CONCERNING THE FOLLOWING ISSUES: - SUPPORT FOR EXTENSION OF ENHANCED FEDERAL MATCH ASSISTANCE PROGRAM - SUPPORT AFFORDABLE CARE ACT PROVISIONS TO EXPAND INSURANCE COVERAGE TO THE UNINSURED - SUPPORT FOR INITIATIVES TO IMPROVE PAYMENT DELIVERY REDESIGN SUCH AS ACO REGULATIONS - SUPPORT FOR CONTINUATION OF TENNESSEE MEDICAID DSH - CONTRIBUTED TO MSHA'S COMMENTS REGARDING PROPOSED ACO REGULATIONS - OPPOSITION TO HOSPITAL CUTS IN PROPOSED IPPS RULE (CODING OFFSET) - OPPOSITION TO ADDITIONAL CUTS IN MEDICARE/MEDICAID - SUPPORT FOR REAUTHORIZATION OF CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION - CONTINUED WORK WITH THE NATIONAL FOUNDATION FOR TRAUMA CARE TO SECURE FEDERAL FUNDING - SUPPORT FOR AN INCREMENTAL AND REALISTIC TIMETABLE THAT RECOGNIZES FLEXIBLE CRITERIA FOR THE MEDICARE EHR INCENTIVE PROGRAM - SUPPORT FOR GRADUATE MEDICAL EDUCATION THE COMMUNITY AND GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR DEPARTMENTAL STAFF RESPONDED VIA LETTER, PHONE, OR IN PERSON TO THE FOLLOWING TENNESSEE AND VIRGINIA LEGISLATIVE ISSUES: - SUPPORT FOR CONTINUATION OF HOSPITAL ASSESSMENT FEE IN TENNESSEE - SUPPORT FOR CONTINUATION OF TENNESSEE'S APPROPRIATION FOR CARE OF UNINSURED MENTALLY ILL PATIENTS - SUPPORT FOR RESTORATION OF FUNDING FOR PERINATAL CENTERS IN TENNESSEE - SUPPORT FOR CONTINUATION OF SAFETY NET FUNDING FOR PROJECT ACCESS - SUPPORT FOR LEGISLATION TO ENSURE THAT MEDICAID RATES REMAIN UNCHANGED IN VIRGINIA - SUPPORT FOR A BUDGET AMENDMENT THAT REINSTATED SUPPLEMENTAL PAYMENTS TO JCMC'S NICU FOR ITS HIGH VIRGINIA MEDICAID VOLUME - OPPOSED A CERTIFICATE OF NEED BILL IN TENNESSEE THAT WOULD HAVE SEVERELY WEAKENED THE CON PROCESS - SUPPORTED TORT REFORM LEGISLATION IN TENNESSEE 34838122 34838122 443078534 127384695 315693839 856198 379181 477017 408565582 289961535 118604047 469613025 INVESTMENT IN BRMMC 100273634 C INVESTMENT IN ISHN 1843937 C INVESTMENT IN OTHER 48522 C INVESTMENT IN SCCH 48100000 C INVESTMENT IN JMH 132000000 C 282266093 AWUL - CURRENT 7628257 AWUL - UNDER BOND INDENTURE AGREEMENTS 71689876 DEFERRED CHARGES AND OTHER 22473469 LONG TERM COMPENSATION INVESTMENT 10105102 111896704 ACCRUED INTEREST 19607249 OTHER LONG-TERM LIABILITIES 6895891 ACCRUED SALARIES, ABSENCES, & W/H 40176880 CALL OPTION LIABILITY 92044033 EST. FAIR VALUE OF INT. RATE SWAP 7782969 DUE TO THIRD PARTY PAYORS 12547112 179054134 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: MOUNTAIN STATES HEALTH 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. TAXABLE ENTITIES ACCOUNT FOR INCOME TAXES IN ACCORDANCE WITH FASB ASC 740, "INCOME TAXES". THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2011 AND 2010. 1 1 X 1 X 1 X 380.000000000000 1 1 1 0 1 1 13141846 13141846 0.01950 15382326 11993765 3388561 0.00500 73485181 50198122 23287059 0.03450 102009353 62191887 39817466 0.05900 6281105 1021002 5260103 0.00780 9860820 2652458 7208362 0.01070 17494050 5593591 11900459 0.01760 472920 472920 0.00070 248259 248259 0.00040 34357154 9267051 25090103 0.03720 136366507 71458938 64907569 0.09620 26206 26206 0.00000 359 359 0.00000 2139245 2139245 0.00320 82635 82635 0.00010 2248445 2248445 0.00330 1 19031222 11418733 201775707 207565036 -5789329 X 1 1 1 MEDICAL SPECIALISTS OF JOHNSON CITY LLC MEDICAL SERVICES 0.51000 0.49000 2 EMMAUS COMMUNITY HEALTHCARE PLLC MEDICAL SERVICES 0.75000 0.25000 6 1 JOHNSON CITY MEDICAL CENTER

400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604

X X X X X X REHABILITATION & MENTAL HEALTH HOSPITALS 2 INDIAN PATH MEDICAL CENTER

2000 BROOKSIDE DRIVE KINGSPORT TN 37660

X X X X 3 FRANKLIN WOODS COMMUNITY HOSPITAL

300 MED TECH PARKWAY JOHNSON CITY TN 37604

X X X 4 SYCAMORE SHOALS HOSPITAL

1501 W ELK AVENUE ELIZABETHTON TN 37643

X X X 5 RUSSELL COUNTY MEDICAL CENTER

58 CARROLL STREET LEBANON VA 24266

X X X 6 JOHNSON COUNTY COMMUNITY HOSPITAL

1901 S SHADY STREET MOUNTAIN CITY TN 37683

X X X JOHNSON CITY MEDICAL CENTER 1 INDIAN PATH MEDICAL CENTER 2 FRANKLIN WOODS COMMUNITY HOSPITAL 3 SYCAMORE SHOALS HOSPITAL 4 RUSSELL COUNTY MEDICAL CENTER 5 JOHNSON COUNTY COMMUNITY HOSPITAL 6 11 JCMC AMBULATORY SURGERY CENTER

400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604

LICENSED AMBULATORY SURGERY CENTER MOUNTAIN STATES IMAGING CENTER

301 MED TECH PARKWAY STE 100 JOHNSON CITY TN 37604

LICENSED OUTPATIENT DIAGNOSTIC CENTER FRANKLIN TRANSITIONAL CARE

400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604

LICENSED SKILLED NURSING FACILITY MOUNTAIN STATES DIAGNOSTIC CENTER

1 PROFESSIONAL PARK DRIVE 16 JOHNSON CITY TN 37604

LICENSED OUTPATIENT DIAGNOSTIC CENTER INDIAN PATH TRANSITIONAL CARE

2000 BROOKSIDE DRIVE KINGSPORT TN 37660

LICENSED SKILLED NURSING FACILITY MED CENTER HOME CARE - JOHNSON CITY

101 MED TECH PARKWAY STE 100 JOHNSON CITY TN 37604

LICENSED HOME HEALTH AGENCY MEDICAL CENTER HOME CARE - KINGSPORT

2020 BROOKSIDE DRIVE 28 KINGSPORT TN 37660

LICENSED HOME HEALTH AGENCY RUSSELL CO MED CENTER HOME HEALTH

116 FLANNAGAN AVE LEBANON VA 24266

LICENSED HOME HEALTH AGENCY MEDICAL CENTER HOSPICE

10101 MED TECH PARKWAY STE 100 JOHNSON CITY TN 37604

LICENSED HOSPICE AGENCY JOHNSON COUNTY HOME HEALTH

1987 S SHADY STREET MOUNTAIN CITY TN 37683

LICENSED HOME HEALTH AGENCY RUSSELL COUNTY MEDICAL CENTER HOSPICE

116 FLANNAGAN AVE LEBANON VA 24266

LICENSED HOSPICE AGENCY PART I, LINE 7: A COST TO CHARGE RATIO WAS DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PART I, LINE 7G: JOHNSON COUNTY COMMUNITY HOSPITAL, A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL, OPERATES A PHYSICIAN SPECIALTY CLINIC, WHICH INCURRED AN OPERATING LOSS OF $59,254 FOR THE TWELVE MONTHS ENDING JUNE, 2011. THE SPECIALTY CLINIC INCLUDES CARDIOLOGY, ORTHOPEDICS, GENERAL SURGERY, VASCULAR SURGERY, NEPHROLOGY, ONCOLOGY, PODIATRY AND OTHER SPECIALTY SERVICES. THIS CONTINUES TO BE A VALUABLE RESOURCE TO THE RESIDENTS OF THE AREA BY AIDING WITH TRANSPORTATION ISSUES (OTHER 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 SPECIALTY CLINIC REPORTED 2,227 VISITS DURING THE YEAR.RUSSELL COUNTY MEDICAL CENTER OPERATES A RURAL HEALTH CLINIC LOCATED IN ST PAUL, VA, ON THE BORDER OF WISE AND RUSSELL COUNTIES. RIVERSIDE CLINIC FIRST OPENED IN 1991 TO PROVIDE PRIMARY CARE SERVICES TO THIS ELDERLY UNDERSERVED POPULATION. THE CLINIC'S LARGEST PAYOR IS MEDICARE, WHICH ACCOUNTS FOR MORE THAN 40% OF THEIR PATIENTS. DURING THE 12-MONTH REPORTING PERIOD, THE CLINIC HAD 10,101 OUTPATIENT VISITS AND INCURRED UNREIMBURSED EXPENSES OF $399,460. PART I, L7 COL(F): BAD DEBT EXPENSE OF $4,097,305 IS INCLUDED IN THE STATEMENT OF FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, BUT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING PERCENTAGES ON PART 1, LINE 7, COLUMN F. PART II: MSHA LEADERS SUPPORT AND ENCOURAGE ALL EMPLOYEES TO VOLUNTEER TIME, MONEY, AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR MSHA EMPLOYEES BY SERVING VOLUNTARILY ON COMMITTEES AND MANAGING BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. MANY ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTH CARE, AND EDUCATION. EMPLOYEES SERVED THE BOYS & GIRLS CLUB, KIWANIS CLUBS, SUSAN G. KOMEN BREAST CANCER FOUNDATION, ECONOMIC DEVELOPMENT STEERING COMMITTEE FOR WASHINGTON COUNTY, THE TENNESSEE VALLEY CORRIDOR, JUNIOR ACHIEVEMENT, SALVATION ARMY, AMERICAN HEART ASSOCIATION, HANDS ON! MUSEUM, KINGSPORT TOMORROW INC., CARTER COUNTY TOMORROW, APPALACHIAN MOUNTAIN PROJECT ACCESS, WASHINGTON COUNTY EMERGENCY MEDICAL SERVICES, APPALACHIAN REGIONAL COALITION ON HOMELESSNESS, WASHINGTON COUNTY VETERAN'S MEMORIAL COMMITTEE OF THE JOHNSON CITY PARKS AND RECREATION FOUNDATION, EATING DISORDERS COALITION OF TENNESSEE, JOHNSON CITY SYMPHONY ORCHESTRA, DAWN OF HOPE, UNITED WAY, CHAMBER OF COMMERCE BOARDS, AND MANY OTHERS. SOME OF THESE EMPLOYEES DEVOTED TWO WEEKS OF NORMAL WORK TIME TO OUTSIDE CHARITABLE ACTIVITIES. MSHA PROVIDES SPONSORSHIPS AND OFFERS ASSISTANCE WITH COORDINATION, ADVOCACY, AND PUBLICITY; PROVIDES SPACE; OR CONTRIBUTES SUPPLIES TO SUPPORT COMMUNITY ORGANIZATIONS FOR THEIR PROGRAM ACTIVITIES. MSHA PROVIDES STAFF AT ITS EXPENSE TO LOCAL AGENCIES, COMMUNITY ADVISORY BOARDS, COUNCILS, AND OTHER ORGANIZATIONS TO ASSIST WITH LEADERSHIP PROGRAMS, PLANNING, COMMITTEE PARTICIPATION, AND ASSISTANCE WITH SPECIAL EVENTS. EXAMPLES INCLUDE AMERICAN RED CROSS BLOOD DRIVES, IMAGINATION LIBRARY STEERING COMMITTEE, RONALD MCDONALD HOUSE BOARD, UNITED WAY BOARD, AND OTHERS. PHYSICIAN RECRUITMENT IS REPORTED IN COMMUNITY BUILDING AND INCLUDES EXPENSE TO REPLACE PHYSICIANS RETIRING OR LEAVING OUR SERVICE AREAS, INCLUDING RECRUITMENT TO ONE OF OUR FEDERALLY DESIGNATED UNDERSERVED COMMUNITIES. WITHOUT MSHA'S DEDICATION TO RURAL HEALTH, THERE WOULD NOT BE AN ADEQUATE NUMBER OF PHYSICIANS TO SERVE THIS PATIENT POPULATION. MSHA SUPPORTS THE ECONOMIC DEVELOPMENT OF THE REGION BY PROVIDING FINANCIAL SUPPORT AS WELL AS PAID EMPLOYEE'S TIME TO SERVE ON ECONOMIC DEVELOPMENT BOARDS. EVIDENCE SHOWS THAT A HEALTHY ECONOMY RELATES TO A HEALTHIER POPULATION. PART III, LINE 4: WORKSHEET A WAS USED FOR PART III, LINES 2 AND 3 IN DETERMINING BAD DEBT AT COST. MSHA FOLLOWS THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION'S PRINCIPLES AND PRACTICES BOARD ISSUED STATEMENT 15: VALUATION AND FINANCIAL STATEMENT PRESENTATION OF CHARITY CARE AND BAD DEBTS BY INSTITUTIONAL HEALTHCARE PROVIDERS ("THE STATEMENT"). THE STATEMENT PROVIDES GUIDANCE ON COLLECTABILITY CRITERIA AND EMPHASIZES REVENUE RECOGNITION ONLY WHEN COLLECTIONS ARE REASONABLY ASSURED. TO FURTHER EXPLAIN MSHA'S REPORTING OF BAD DEBT EXPENSE, MSHA'S FINANCIAL STATEMENTS ACCOUNT FOR BAD DEBT IN TWO LOCATIONS. FIRST, A DEDUCTION FROM REVENUE LINE ITEM CALLED "CONTRA-REVENUE" CONTAINS THE MAJORITY OF MSHA'S SELF-PAY ESTIMATED BAD DEBT. FOR FISCAL YEAR 2011, 95% OF TOTAL BAD DEBT WAS MOVED TO THIS LINE. THIS PERCENTAGE IS SIMPLY AN ESTIMATE OF WHAT PATIENT FINANCIAL SERVICES ANTICIPATES WILL NOT BE COLLECTED AFTER ALL DEBT COLLECTION EFFORTS HAVE BEEN EXHAUSTED. THIS ESTIMATE IS BASED ON HISTORICAL INFORMATION. THE REMAINING 5% OF BAD DEBT IS RECORDED IN THE EXPENSE SECTION APPROPRIATELY CALLED "BAD DEBT."THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENTS STATES "CURRENT OPERATIONS INCLUDE A PROVISION FOR BAD DEBTS IN THE CONSOLIDATED STATEMENTS OF OPERATIONS ESTIMATED BASED UPON THE AGE OF THE PATIENT ACCOUNTS RECEIVABLE, PRIOR EXPERIENCE AND ANY UNUSUAL CIRCUMSTANCES (SUCH AS LOCAL, REGIONAL OR NATIONAL ECONOMIC CONDITIONS) WHICH AFFECT THE COLLECTABILITY OF RECEIVABLES, INCLUDING MANAGEMENT'S ASSUMPTIONS ABOUT CONDITIONS IT EXPECTS TO EXIST AND COURSES OF ACTION IT EXPECTS TO TAKE."REGARDING LINE 3, IT IS IMPLAUSIBLE TO DETERMINE THE AMOUNT OF MSHA'S BAD DEBT EXPENSE ASSOCIATED WITH THOSE CLIENTS 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 PATIENT'S FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSESSMENT FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT MORE THAN 90% OF OUR PATIENTS WHO HAVE PROVIDED COMPLETED FINANCIAL ASSESSMENT FORMS HAVE BEEN APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE. OUR VICE PRESIDENT OF PATIENT FINANCIAL SERVICES CONSERVATIVELY ESTIMATES THAT 60% OF TOTAL BAD DEBT EXPENSE WAS ASSUMED ATTRIBUTABLE TO CLIENTS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE REPORTED USING MSHA'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP DOWN METHOD. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS: TRANSPORTATION OF A PATIENT, COMFORT ITEMS TO INCLUDE A TELEVISION, MAGAZINES, OR A TELEPHONE. ADDITIONAL NON-ALLOWABLE COSTS INCLUDE THE RECRUITMENT OF PHYSICIANS, PHYSICIAN GUARANTEES AND A PORTION OF THE BAD DEBT (30%) ASSOCIATED WITH THE CARE OF THE PATIENT. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. AS A NOT-FOR-PROFIT 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, MSHA IS REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR OUR MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW OUR COST. THEREFORE IT IS ONLY LOGICAL TO ALLOW MSHA TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT ON THIS DOCUMENT. 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: MSHA FOLLOWS A STRONG COLLECTION PROGRAM THAT COMMUNICATES FINANCIAL RESPONSIBILITY TO THE PATIENT PRIOR TO SERVICE. COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY AND NON-CHARITY. IN ROUTINE CIRCUMSTANCES WHEN IT IS DETERMINED THAT A PATIENT HAS NOT RESPONDED TO REQUESTS FOR PAYMENT, AN ACCOUNT CAN BE REFERRED TO AN OUTSIDE COLLECTION AGENCY FOR COLLECTION ASSISTANCE. MSHA ENSURES THAT OUTSIDE COLLECTION AGENCIES FOLLOW HOSPITAL BILLING AND COLLECTION GUIDELINES. ONCE A DELINQUENT PATIENT ACCOUNT HAS BEEN SUBMITTED TO AN OUTSIDE COLLECTION AGENCY IT CAN BE RETRACTED IF IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL REQUESTS FOR FINANCIAL ASSISTANCE MUST BE ACCOMPANIED BY A COMPLETED FINANCIAL ASSESSMENT FORM AND SUPPORTING DOCUMENTATION. PART VI, LINE 8: MSHA SUBMITS COMMUNITY BENEFIT DATA TO THE VIRGINIA HEALTH AND HOSPITAL ASSOCIATION (VHHA) AND THE HOSPITAL ALLIANCE OF TENNESSEE (HAT). VHHA COMBINES DATA FROM ALL SOURCES TO DEMONSTRATE THE COMMUNITY BENEFITS PROVIDED BY BOTH FOR-PROFIT AND NOT-FOR-PROFIT HOSPITALS AND HEALTH SYSTEMS TO THE STATE OF VIRGINIA. HAT PROVIDES ITS MEMBERS AND TENNESSEE LEGISLATORS WITH COMMUNITY BENEFIT DATA IN AN EFFORT TO PROVIDE A CLEAR PICTURE OF NOT-FOR-PROFIT HEALTH SYSTEM'S INVESTMENT IN THE COMMUNITIES THEY SERVE. PART VI, LINE 2: DURING FISCAL YEAR 2008 AND FISCAL YEAR 2009, MSHA CONDUCTED THE LARGEST COMMUNITY HEALTH NEEDS ASSESSMENT IN ITS HISTORY IN AN EFFORT TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN THE LOCAL REGION. THE ASSESSMENT FOCUSED ON STATE, REGIONAL, AND COUNTY SPECIFIC DATA COLLECTION. THIS ASSESSMENT ALSO INCLUDED PRIMARY DATA COLLECTED THROUGH APPROXIMATELY 50 ONE-ON-ONE INTERVIEWS. THOSE INTERVIEWED WERE INDIVIDUALS FROM AROUND THE REGION WHICH INCLUDED LOCAL AND STATE GOVERNMENT OFFICIALS, HEALTH DEPARTMENT REPRESENTATIVES, PHYSICIANS, GENERAL PUBLIC, LOCAL INDUSTRY, CIVIC ORGANIZATIONS, EDUCATION OFFICIALS, AND COMMUNITY RESOURCE GROUPS. THIS INFORMATION WAS COLLECTED, AND THEN ANALYZED, AND A SUMMARY OF THE FINDINGS WAS LISTED IN AN EFFORT TO OBTAIN A MORE DETAILED SNAPSHOT SPECIFIC TO EACH COUNTY LOCATED THROUGHOUT THE MSHA SERVICE AREA. THIS INFORMATION WAS REVIEWED BY MSHA'S STRATEGIC PLANNING TEAM ALONG WITH GOVERNMENT RELATIONS AND QUALITY DEPARTMENTS. THE MSHA STEERING COMMITTEE IDENTIFIED CHILDHOOD OBESITY AS THE HEALTH DISPARITY TARGETED FOR IMPROVEMENT. DURING FISCAL YEAR 2009, MSHA BEGAN COLLABORATIVE EFFORTS WITH EAST TENNESSEE STATE UNIVERSITY'S COLLEGE OF PUBLIC HEALTH TO DEVELOP THE MSHA-ETSU OBESITY COLLABORATIVE COMMITTEE. THE FOCUS OF THIS COMMITTEE IS TO PULL TOGETHER MANY PARTNERS AND ORGANIZATIONS IN COLLABORATION TO REDUCE THE LEVEL OF CHILDHOOD OBESITY THROUGHOUT NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. DURING FISCAL YEAR 2011, THE COMMITTEE OFFERED 25 SEED GRANTS OF $2,000 EACH TO LOCAL COMMUNITY ORGANIZATIONS SUCH AS CHURCHES, COMMUNITY GROUPS, SCHOOLS, AND EMPLOYERS THAT WANT TO EXPLORE OBESITY REDUCTION EFFORTS.IN ADDITION TO THE GRANTS PROGRAM, AN ANNUAL SYMPOSIUM IS PROVIDED FREE TO THE REGION AND AVAILABLE TO RESIDENTS AND COMMUNITY GROUPS. NATIONAL, REGIONAL, AND LOCAL EXPERTS SHARE INFORMATION ON TRENDS REGARDING CHILDHOOD OBESITY AND PROVEN COMMUNITY-BASED STRATEGIES TO REDUCE THE PREVALENCE.MOUNTAIN STATES HEALTH ALLIANCE DOCUMENTED ITS CORPORATE RESPONSIBILITY PROGRAMS, PARTNERSHIPS, AND ACTIVITIES FOR COMMUNITY BENEFIT AND SOCIAL RESPONSIBILITY IN THE 2011 SOCIAL RESPONSIBILITY PLAN (THE PLAN). THE PLAN PROVIDES THE STRATEGIC DIRECTION OF SOCIAL RESPONSIBILITY FOR THE ORGANIZATION. MSHA CREATED A SOCIAL RESPONSIBILITY COMMITTEE TO ENSURE A STRATEGIC COMMITMENT TO THE ORGANIZATION'S SOCIAL RESPONSIBILITY THROUGH NEEDS PRIORITIZED FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IDENTIFIES SEVERAL PRIORITIES TO FOCUS THE ORGANIZATION'S COMMUNITY BENEFIT, COMMUNITY BUILDING AND OTHER INITIATIVES TO IMPACT THE HEALTH OF INDIVIDUALS AND COMMUNITIES WITHIN THE DEFINED SERVICE AREA. THE COMMITTEE MEETS ON A QUARTERLY BASIS AND INCLUDES MSHA BOARD MEMBERS; THE DEAN OF PUBLIC HEALTH AT EAST TENNESSEE STATE UNIVERSITY; THE PRESIDENT AND CEO OF UNITED WAY OF WASHINGTON COUNTY, TENNESSEE; MSHA'S CEO AND OTHER EXECUTIVES AS WELL AS OTHER COMMUNITY LEADERS. THE FOUNDATION OF MSHA'S SOCIAL RESPONSIBILITY IS THE CHNA TO PRIORITIZE FUTURE HEALTH IMPROVEMENT INITIATIVES TO BE COMPLETED IN COLLABORATION WITH LOCAL RESOURCES. THE PROJECT FULLY SUPPORTS THE MSHA MISSION 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". THE ASSESSMENT FOCUSES ON MSHA'S THIRTEEN CORE COUNTIES. ACTIVITIES ASSOCIATED WITH THE DEVELOPMENT OF THIS ASSESSMENT INCLUDE STATE, REGIONAL AND COUNTY-SPECIFIC SECONDARY DATA COLLECTION AND PRIMARY DATA OBTAINED THROUGH OVER 56 SURVEYS WITH INDIVIDUALS FROM THE LOCAL COMMUNITIES. PART VI, LINE 3: MSHA PROVIDES COMMUNICATION OF FINANCIAL ASSISTANCE ON ITS WEB SITE AND ON POSTERS PLACED IN PROMINENT AREAS SUCH AS ADMITTING AREAS, EMERGENCY DEPARTMENTS AND PATIENT PAYMENT (CASHIER) LOCATIONS. PRINTED EDUCATIONAL MATERIALS INCLUDING FINANCIAL ASSISTANCE CONTACT INFORMATION ARE ALSO PROVIDED IN THE PATIENT'S ADMITTING PAPERWORK. POSTERS AND REFERENCE MATERIALS ARE WRITTEN IN BOTH ENGLISH AND SPANISH. ADMITTING STAFF ARE TRAINED TO EDUCATE PATIENTS ON MSHA'S FINANCIAL ASSISTANCE POLICY. MSHA ALSO HAS FINANCIAL COUNSELORS WHICH COMMUNICATE THE PATIENT'S FINANCIAL RESPONSIBILITY PRIOR TO SERVICE AS WELL AS PROVIDE EDUCATION ON MSHA'S FINANCIAL ASSISTANCE POLICY. THESE COUNSELORS ALSO HELP UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS TENNCARE OR MEDICAID. IN ADDITION, MSHA CONTRACTS WITH THE COMPANY FIRSTSOURCE SOLUTIONS USA TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. FIRSTSOURCE SOLUTIONS USA DETERMINES A PATIENT'S ELIGIBILITY IN MEDICAL COVERAGE OPTIONS AND ASSISTS WITH THEIR ENROLLMENT. MSHA BEARS THE COST FOR THE FIRSTSOURCE SOLUTIONS USA PROGRAM. PART VI, LINE 4: 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 MEDICALLY UNDERSERVED AREAS. MSHA OPERATES 2 CRITICAL ACCESS HOSPITALS, DICKENSON COMMUNITY HOSPITAL IN VIRGINIA AND JOHNSON COUNTY COMMUNITY HOSPITAL IN TENNESSEE. THESE TWO FACILITIES OPERATE IN FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS. THE HEALTH STATUS OF THE POPULATION IN MSHA'S SERVICE AREA IS GENERALLY POOR. THE SERVICE AREA EXTENDS TO SOME OF THE POOREST RURAL COUNTIES IN THE REGION WITH A POVERTY RATE OF ALMOST 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. RURAL SERVICE AREA COUNTIES SHARE COMMON CHALLENGES OF:1. HIGH RATES OF UNINSURED2. HIGH PREVALENCE OF OBESITY3. HIGH PREVALENCE OF DIABETES PART VI, LINE 6: THE MAJORITY OF MSHA'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. ONLY TWO EMPLOYEES ARE ON THE MSHA BOARD OF DIRECTORS: THE CEO PAID BY MSHA AND A PHYSICIAN WHO IS PAID BY A RELATED ORGANIZATION. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY MSHA.MSHA IS DEDICATED TO OPERATING OUR FACILITIES EFFICIENTLY SO THAT WASTE IS MINIMIZED AND SURPLUSES MAY BE APPLIED TO MAINTAINING ADEQUATE FACILITIES AND EQUIPMENT FOR THE CARE FOR OUR PATIENTS. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. PART VI, LINE 7: MOUNTAIN STATES HEALTH ALLIANCE (MSHA) PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. EACH HOSPITAL IS FULLY ACCREDITED, MOST BY THE JOINT COMMISSION. MSHA IS INTEGRATED BOTH VERTICALLY AND HORIZONTALLY AND IS THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. 9 FACILITIES ARE WHOLLY-OWNED AND 4 ARE MAJORITY OWNED. THIS FORM 990 ENCOMPASSES 9 WHOLLY-OWNED FACILITIES: 8 FACILITIES IN TENNESSEE AND 1 IN VIRGINIA. EACH FACILITY IN THIS FORM 990 IS 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. IN ADDITION TO THE WHOLLY-OWNED HOSPITALS WITHIN THIS REPORTING FEDERAL EMPLOYER IDENTIFICATION NUMBER, MSHA ALSO HAS MAJORITY OWNERSHIP IN 4 HOSPITALS IN SOUTHWEST VIRGINA. IN ADDITION TO OUR ACUTE CARE HOSPITALS, OUR SYSTEM ALSO INCLUDES SUCH SERVICES AS: PRIMARY / SPECIALTY PHYSICIAN PRACTICES, URGENT CARE CENTERS, EMERGENCY DEPARTMENTS, OCCUPATIONAL MEDICINE, REHABILITATION, TRANSPLANT, OUTREACH LABORATORY, MENTAL HEALTH, NEONATAL INTENSIVE CARE, A NACHRI AFFILIATED CHILDREN'S HOSPITAL, RENAL DIALYSIS, ST. JUDE'S ONCOLOGY, INPATIENT / OUTPATIENT SURGERY, SKILLED NURSING, HOME HEALTH, AIR AMBULANCE TRANSPORT, AN ORGAN TRANSPLANT DEPARTMENT, 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 OUTPATIENT REHABILITATION. 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. REPORTS FILED WITH STATES PART VI, LINE 7 VA 1 ETSU 807 UNIVERSITY PKWY JOHNSON CITY TN 37614 626021046 501(C)(3) 20450 214 COST PRINT SUPPLIES FOR MEDICAL SYMPOSIUM SUPPORT FIT KIDS PROGRAM CARESPARK PO BOX 657 125 BROAD STREET KINGSPORT TN 37662 202694144 501(C)(3) 53027 SUPPORT DEVELOPMENT OF SHARED HEALTH INFORMATION TO IMPROVE PATIENT CARE SUSAN KOMEN BREAST CANCER FOUNDATION POBOX 5835 KINGSPORT TN 37663 841689067 501(C)(3) 25164 196 COST PRINT SUPPLIES FOR FUNDRAISING BROCHURE BREAST CANCER RESEARCH HANDS ON REGIONAL MUSEUM 315 E MAIN STREET JOHNSON CITY TN 37601 621282542 501(C)(3) 7500 SUPPORT LOCAL INTERACTIVE CHILDREN'S MUSEUM CITY OF JOHNSON CITY 601 E MAIN STREET JOHNSON CITY TN 37601 626000320 115 9500 2290 COST PRINT SUPPLIES SPONSOR ECONOMIC DEVELOPMENT AND OTHER PROGRAMS/EVENTS COALITION FOR KIDS PO BOX 3156 JOHNSON CITY TN 37602 621765487 501(C)(3) 2000 6560 COST PRINT SERVICES AND POSTAGE GRANT TO COMBAT CHILDHOOD OBESITY BOYS AND GIRLS CLUB OF KINGSPORT PO BOX 784 213 LEE STREET KINGSPORT TN 37662 620481370 501(C)(3) 20000 GENERAL SUPPORT CROSSROADS MEDICAL MISSION PO BOX 16852 BRISTOL VA 24209 542038877 501(C)(3) 12500 SUPPORT REMOTE AREA MEDICAL CARE LINCOLN THEATRE 117 E MAIN STREET PO BOX 664 MARION VA 24354 541477479 501(C)(3) 12500 SUPPORT PERFORMING ARTS ETSU FOUNDATION PO BOX 70721 JOHNSON CITY TN 37614 237092731 501(C)(3) 51500 81 COST PRINT MEDICAL SYMPOSIUM BROCHURE SUPPORT INDIGENT CLINIC AND FIT KIDS PROGRAM RUSSELL COUNTY CAREER & TECHNOLOGY PO BOX 849 304 CAREER TECH DRIVE LEBANON VA 24266 546001591 501(C)(3) 17474 COST MEDICAL SUPPLIES SUPPORT HEALTH PROFESSIONS EDUCATION 11 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MSHA ADHERED TO THE FOLLOWING CRITERIA FOR OUR CONTRIBUTIONS TO ORGANIZATIONS IN THE REGION: HEALTHCARE: THE ORGANIZATION ENHANCED OR IMPROVED ACCESS FOR THE UNINSURED OR UNDERINSURED POPULATION OR SUPPORTED A PROGRAM TO IMPROVE THE HEALTH OF OUR CHILDREN (I.E., CHILDHOOD OBESITY PREVENTION). EDUCATION: THE ORGANIZATION PROVIDED A PROGRAM TO IMPROVE EDUCATION OF THE CHILDREN IN OUR REGION ALL THE WAY TO COLLEGE AGE STUDENTS (RN NURSING PROGRAMS). QUALITY OF LIFE: THE ORGANIZATION OFFERED PROGRAMS TO ENHANCE THE QUALITY OF LIFE WHICH IS IMPORTANT IN THE RECRUITMENT EFFORTS OF BUSINESSES IN THE REGION AS WE WORK TO ATTRACT AND RETAIN THE BEST TALENT. FOR THE SUPPORTED PROGRAMS, METRICS WERE ESTABLISHED TO DETERMINE THE SUCCESS (OR FAILURE) OF EACH PROGRAM TO WHICH MSHA CONTRIBUTES. AS THE DEPRESSED ECONOMIC SITUATION CONTINUED DURING FY11, THE CRITERIA USED IN THE DECISION MAKING PROCESS FOR MAJOR DONATIONS WAS REVISED TO SUPPORT THOSE PROGRAMS WHICH FOCUSED ON HEALTH AND WELLNESS INITIATIVES, PARTICULARLY THOSE FIGHTING CHILDHOOD OBESITY. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 DENNIS VONDERFECHT 639736 0 141752 0 74137 0 19600 0 22864 0 898089 0 0 0 WILLIAM WALKER MD 0 512691 0 98124 0 1189 0 0 0 1615 0 613619 0 0 MARVIN EICHORN 422229 0 115646 0 59178 0 188316 0 20917 0 806286 0 0 0 DALE CLAYTORE 171000 0 28881 0 17116 0 8550 0 2856 0 228403 0 0 0 ANN FLEMING 328461 0 72944 0 41390 0 48481 0 17108 0 508384 0 0 0 CANDACE JENNINGS 354039 0 91919 0 13018 0 51539 0 20416 0 530931 0 0 0 LYNN KRUTAK 200939 0 39904 0 2016 0 13403 0 16909 0 273171 0 0 0 MONTY MCLAURIN 253584 0 60997 0 9877 0 26340 0 27784 0 378582 0 0 0 CINDY SALYER 179548 0 35558 0 17076 0 20422 0 21042 0 273646 0 0 0 SHANE HILTON 179001 0 9129 0 5457 0 11090 0 20332 0 225009 0 0 0 PAT NIDAY 143084 0 8820 0 4212 0 6000 0 21602 0 183718 0 0 0 BRAD NURKIN 193067 0 0 0 51639 0 9808 0 10429 0 264943 0 0 0 STEVE KILGORE 270098 0 62796 0 6417 0 30631 0 22168 0 392110 0 0 0 JAMIE PARSONS 198788 0 46144 0 9055 0 20134 0 10308 0 284429 0 0 0 CHAO LEE MD 308922 0 0 0 438 0 9692 0 15963 0 335015 0 0 0 TONY BENTON JR 179605 0 47651 0 11728 0 11100 0 17692 0 267776 0 0 0 MORRIS SELIGMAN 392982 0 53556 0 38713 0 40385 0 28645 0 554281 0 0 0 PART I, LINE 1A 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. PART I, LINE 4B THE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MSHA: ANN FLEMING, CANDACE JENNINGS, MONTY MCLAURIN, CINDY SALYER, BRAD NURKIN, MORRIS SELIGMAN,STEVE KILGORE, AND JAMIE PARSONS. 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. HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 621464028 2010-05-27 16000000 ACQUIRE HOSPITAL EQUIPMENT 0 0 0 HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 621464028 478271JH3 2010-04-29 205877528 PARTIAL REFUNDING OF BONDS ISSUED 12/14/07 AND 2/20/2008 0 0 0 INDUSTRIAL DEVELOPMENT AUTHORITY OF WASHINGTON COUNTY VA 521324605 938740CF2 2009-03-31 124301533 CONSTRUCT & EQUIP HOSPITAL FACILITIES, INCLUD'G REFINANCING OF TAXABLE DEBT 0 0 0 HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 621464028 478271HL6 2008-02-20 127000000 ACQUIRE,CONSTRUCT & EQUIP HOSP FACILITIES,INCLUD'G REFINANCING TAXABLE DEBT 0 0 0 1989299 7121143 45000 8835764 7121143 0 0 0 1 18340116 18340116 3476394 21469689 1 0 0 1 18570379 12131763 2481706 94192104 6438617 0 0 0 1 59900000 1745703 2719265 1953563 324975 4473649 105490018 926968 0 0 0 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 SCHEDULE K SUPPLENTAL INFORMATION 1. COMMENT ON SCHEDULE K, PART I, LINES B, C, D, AND E. 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 2007, 2008, 2009 AND 2010, 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 B, C, D AND E 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. THE INSTRUCTIONS REQUEST THE TOTAL AMOUNT OF BOND PROCEEDS "AS OF THE END OF THE 12-MONTH PERIOD". BECAUSE A SUBSTANTIAL AMOUNT OF THE PROCEEDS OF EACH ISSUE WAS SPENT AS OF THE END OF THE REPORTING PERIOD, THE TOTAL PROCEEDS AS OF THE END OF SUCH PERIOD WILL NECESSARILY BE LESS THAN THE ISSUE PRICE. 3. COMMENT ON SCHEDULE K, PART II, LINE 4. CERTAIN PROCEEDS OF THE BOND ISSUES LISTED IN LINES B, C, AND F ARE DEPOSITED IN REASONABLY REQUIRED RESERVE FUNDS, THE SIZE OF EACH OF WHICH COMPLIES WITH FEDERAL TAX REGULATIONS. THE AMOUNTS SHOWN ON LINE 2 OF PART II OF SCHEDULE K INCLUDE PROCEEDS HELD IN THOSE FUNDS. THESE LINES ALSO INCLUDE A SMALL AMOUNT OF INVESTMENT EARNINGS RELATIVE TO THESE FUNDS THAT HAD NOT YET BEEN MOVED AS OF THE END OF THE APPLICABLE REPORTING PERIOD TO ANOTHER FUND TO BE USED TO PAY DEBT SERVICE, AS IS PERMITTED UNDER THE APPLICABLE BOND DOCUMENTS. LINE 2 OF PART II OF SCHEDULE K FOR THE BOND ISSUE DESCRIBED IN LINE F ALSO INCLUDES CERTAIN MONIES HELD IN A BONA FIDE DEBT SERVICE FUND. 4. COMMENT ON SCHEDULE K, PART II, LINE 9. THE BOND ISSUE DESCRIBED IN LINE D OF PART I FINANCED A SMALL AMOUNT OF WORKING CAPITAL EXPENDITURES. THESE WORKING CAPITAL EXPENDITURES DIRECTLY RELATED TO THE CAPITAL EXPENDITURES THAT WERE FINANCED WITH THE PROCEEDS OF THE BONDS. THEREFORE THE PROCEEDS OF THESE BONDS COULD BE ALLOCATED TO SUCH WORKING CAPITAL EXPENDITURES PURSUANT TO SECTION 1.148-6(D)(3)(V) OF THE TREASURY REGULATIONS. 5. COMMENTS ON SCHEDULE K, PART IV, LINE 1. AS OF THE REPORTING DATE OF THE 990, THE ONLY ARBITRAGE REBATE CALCULATION THAT WAS REQUIRED RELATED TO THE BONDS DESCRIBED IN LINE F OF PART I (THE SERIES 2006 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 THAT BOND ISSUE. 6. COMMENT ON SCHEDULE K, PART IV, LINE 4D. PART IV, LINE 4D RELATIVE TO THE BOND ISSUE DESCRIBED ON LINE F SHOWS THAT THE REGULATORY SAFE HARBOR FOR ESTABLISHING FAIR MARKET VALUE OF THE GIC DESCRIBED IN LINE 4A WAS NOT SATISFIED. DUE TO MARKET CONDITIONS AT THE TIME, MOUNTAIN STATES HEALTH ALLIANCE DID NOT RECEIVE THREE BIDS FOR THIS GIC. HOWEVER, THE YIELD ON THE GIC WAS SO SUBSTANTIALLY BELOW THE YIELD ON THE RELEVANT BONDS THAT THERE WAS NO DOUBT THAT THE YIELD ON THE GIC DID NOT EXCEED THE APPROPRIATE YIELD ON THE RELEVANT BONDS. 7. COMMENT ON SCHEDULE K, PART IV, LINE 5. THE BOND ISSUES DESCRIBED IN LINES C AND D OF PART I FINANCED SIGNIFICANT CAPITAL IMPROVEMENTS TO HOSPITAL FACILITIES. THERE HAVE BEEN UNEXPECTED DELAYS IN THE CONSTRUCTION AND EQUIPPING OF CERTAIN OF THESE HOSPITAL FACILITIES, AND THEREFORE NOT ALL OF THE BOND 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. PORTIONS OF THE BOND ISSUES DESCRIBED IN LINE D AS WELL AS BOND ISSUES ISSUED IN 2007 WERE PARTIALLY REFUNDED BY THE BONDS DESCRIBED IN LINE B (THE SERIES 2010 BONDS), SO SOME OF THE PROCEEDS OF THE BONDS DESCRIBED IN LINE C HAVE BECOME TRANSFERRED PROCEEDS OF THE SERIES 2010 BONDS (AND ARE REPORTED UNDER THE APPROPRIATE LINES FOR THE SERIES 2010 BONDS). 8. COMMENT ON PART V. MOUNTAIN STATES HEALTH ALLIANCE HAS EXECUTED DETAILED TAX CERTIFICATES REQUIRING TAX COMPLIANCE THAT ARE INTENDED TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED. MOUNTAIN STATES HEALTH ALLIANCE HAS ALSO RECENTLY ADOPTED SEPARATE PROCEDURES FOR SUCH PURPOSES. HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 621464028 478271GX1 2006-02-14 178614171 CONSTRUCT & EQUIP HOSPITAL FACILITIES, INCLUDING REFINANCING TAXABLE DEBT 0 0 0 3395000 17303000 17463000 2383533 127559187 2011 1 1 1 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 JP MORGAN CHASE BANK NA 0 1 0 DENNIS VONDERFECHT SPLIT DOLLAR LIFE INSUR. LOAN X 2705125 2705125 0 1 1 DENNIS VONDERFECHT SPLIT DOLLAR LIFE INSUR. LOAN X 900000 938520 0 1 1 DENNIS VONDERFECHT SPLIT DOLLAR LIFE INSUR. LOAN X 900000 936090 0 1 1 DENNIS VONDERFECHT SPLIT DOLLAR LIFE INSUR. LOAN X 900000 937530 0 1 1 5517265 CLEM WILKES III FAMILY MEMBER OF CLEM WILKES, JR., MSHA BOARD TREASURER 49200 CLEM WILKES, JR., TREASURER OF THE MSHA BOARD OF DIRECTORS, IS A FAMILY MEMBER OF CLEM WILKES, III, AN EMPLOYEE OF MSHA. 0 WATAUGA PATHOLOGY ASSOCIATES PC PROVIDER OF MEDICAL SERVICES TO MSHA 320674 DR. SANDRA BROOKS, MEMBER OF THE MSHA BOARD OF DIRECTORS, SERVES AS VICE PRESIDENT OF WATAUGA PATHOLOGY ASSOCIATES, P.C. AND HAS AN OWNERSHIP IN THE PROFESSIONAL CORPORATION. WATAUGA PATHOLOGY ASSOCIATES, P.C. PROVIDES MEDICAL SERVICES TO MSHA. 0 PAULA CLAYTORE FAMILY MEMBER OF DALE CLAYTORE, MSHA KEY EMPLOYEE 245953 DALE CLAYTORE, A KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF PAULA CLAYTORE, AN EMPLOYEE OF MSHA. 0 WORKSPACE INTERIORS INC PROVIDER OF COMMERCIAL FURNISHINGS TO MSHA 267026 ROBERT FEATHERS, CHAIRMAN OF THE MSHA BOARD OF DIRECTORS, IS OWNER OF WORKSPACE INTERIORS, INC., WHICH PROVIDES COMMERCIAL FURNISHING PRODUCTS TO MSHA. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH. 0 REBEKAH HILTON FAMILY MEMBER OF SHANE HILTON, MSHA KEY EMPLOYEE 33447 SHANE HILTON, A KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF REBEKAH HILTON, AN EMPLOYEE OF MSHA. 0 JAMES TEIXEIRA FAMILY MEMBER OF PAT NIDAY, MSHA KEY EMPLOYEE 49611 PAT NIDAY, A KEY EMPLOYEE OF MSHA, IS A FAMILY MEMBER OF JAMES TEIXEIRA, AN EMPLOYEE OF MSHA. 0 MITCHELL HATHAWAY FAMILY MEMBER OF JOANNE GILMER, MSHA BOARD MEMBER 94743 JOANNE GILMER, MSHA BOARD SECRETARY, IS A FAMILY MEMBER OF MITCHELL HATHAWAY, AN EMPLOYEE OF MSHA. 0 SYCAMORE SHOALS ANESTHESIA ASSOCIATES PC PROVIDER OF MEDICAL SERVICES TO MSHA 845445 DR. DAVID MAY, MSHA BOARD MEMBER, SERVES AS BOARD CHAIR OF SYCAMORE SHOALS ANESTHESIA ASSOCIATES, P.C. AND HAS AN OWNERSHIP IN THE PROFESSIONAL CORPORATION. SYCAMORE SHOALS ANESTHESIA ASSOCIATES, P.C. PROVIDES MEDICAL SERVICES TO MSHA. 0 SCHEDULE L, PART II, LOANS TO AND FROM INTERESTED PERSONS: THE FIRST LINE ON PART II IS THE ORIGINAL LOAN AMOUNT FOR A SPLIT DOLLAR LIFE INSURANCE PLAN, WHILE THE ADDITIONAL LINES ARE ANNUAL PREMIUM FUNDINGS AND INTEREST. DOING BUSINESS AS FORM 990, PART I, ITEM C SYCAMORE SHOALS HOSPITAL INDIAN PATH MEDICAL CENTER WOODRIDGE HOSPITAL FOR BEHAVIORAL HEALTH SERVICES FRANKLIN WOODS COMMUNITY HOSPITAL JOHNSON COUNTY COMMUNITY HOSPITAL NISWONGER CHILDREN'S HOSPITAL RUSSELL COUNTY MEDICAL CENTER FORM 990, PART VI, SECTION A, LINE 4 THE MEMBERSHIP OF THE MSHA CORPORATION VOTED TO AMEND THE CHARTER OF THE CORPORATION TO CREATE TWO CLASSES OF MEMBERS, A & B. THE CLASS A MEMBERS ARE WHAT IS TRADITIONALLY CONSIDERED MEMBERS, HAVING THE ABILITY TO ELECT OFFICERS AND VOTE ON CERTAIN ACTIONS OF THE CORPORATION. ALL EXISTING MEMBERS AUTOMATICALLY BECOME CLASS A MEMBERS, AND WILL REMAIN CLASS A MEMBERS SO LONG AS THEY PARTICIPATE IN TWO EDUCATIONAL SESSIONS ANNUALLY OFFERED BY THE CORPORATION. PERSONS DESIRING TO BECOME NEW CLASS A MEMBERS MUST CONTRIBUTE $500 UPON APPLICATION, CONTRIBUTE $100 ANNUALLY THEREAFTER, AND PARTICIPATE IN THE TWO ANNUAL EDUCATION SESSIONS. CLASS B MEMBERS ARE ANY FORMER CLASS A MEMBERS WHO FAILED TO MAINTAIN THE REQUIREMENTS OF CLASS A MEMBERSHIP, OR ANYONE APPLYING TO BECOME A CLASS B MEMBER AND CONTRIBUTING $100 AT APPLICATION. CLASS B MEMBERS HAVE NO VOTE, BUT CAN ATTEND AND PARTICIPATE IN THE MEETINGS AND EDUCATION SESSIONS OF THE CLASS A MEMBERSHIP, BUT ARE NOT REQUIRED TO. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS MEMBERS AS FULLY DESCRIBED IN RESPONSE TO NUMBER 4 ABOVE. FORM 990, PART VI, SECTION A, LINE 7A THE CLASS A MEMBERS ANNUALLY ELECT MEMBERS TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO TENNESSEE STATUTE, SUBJECT TO APPROVAL BY THE CLASS A MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 MSHA'S FORM 990 WAS REVIEWED BY MSHA'S BOARD OF DIRECTORS PRIOR TO SUBMITTING THE RETURN TO THE IRS. MSHA'S CFO AND SENIOR VICE-PRESIDENT PRESIDED OVER THE BOARD REVIEW. THE BOARD MEMBERS WERE PROVIDED ELECTRONIC ACCESS TO THE FORM 990 AND SCHEDULES PRIOR TO THE IN-PERSON REVIEW TO ALLOW MEMBERS ADEQUATE TIME TO LOOK OVER THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT OF THE CORPORATION FORWARDS THE POLICY AND THE CONFLICT OF INTEREST DISCLOSURE FORMS TO ALL COVERED PERSONS. EACH PERSON IS REQUIRED TO PROVIDE A COMPLETED DISCLOSURE FORM, NOTING ANY CONFLICTS OR ATTESTING THEY HAVE "NONE", AND THEN FORWARD THOSE BACK TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT, AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE, WHICH IS THE EXECUTIVE COMMITTEE OF THE MSHA BOARD, OBTAINS THE SERVICES OF AN OUTSIDE AND INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM COMPENSATION SURVEYS AND WITH ADVICE WHEN THE COMMITTEE MAKES RECOMMENDATIONS ON PAY AND BENEFITS FOR THE CEO OF MSHA. THE BOARD ALSO APPROVES PAY AND BENEFITS FOR THE CFO. THE COMPENSATION COMMITTEE REVIEWS AND HAS FINAL APPROVAL OF CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR ALL OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, 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 AND ANNUAL BASIS. OFFICER, KEY EMPLOYEE & HIGHEST PAID COMPENSATION: FORM 990, PART VII, SECTION A LYNN KRUTAK, CFO AND MSHA KEY EMPLOYEE, IS PAID BY MSHA. BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (BRMMC) REIMBURSES MSHA FOR 50% OF KRUTAK'S SALARY AND BENEFITS. MSHA IS THE SOLE MEMBER OF BRMMC. KRUTAK DEVOTES AN EQUAL AMOUNT OF TIME BETWEEN MSHA AND BRMMC. STEVE KILGORE, REPORTABLE AS A HIGHEST COMPENSATED EMPLOYEE, IS PAID BY MSHA AND HIS SALARY AND BENEFITS ARE FULLY REIMBURSED TO MSHA BY BRMMC. DR. WILLIAM WALKER, MSHA BOARD MEMBER, HAS REPORTABLE COMPENSATION AND BENEFITS PAID BY BRMMC. DR. WALKER IS A CARDIOVASCULAR THORACIC SURGEON IN A MEDICAL PRACTICE OWNED BY BRMMC. HE DOES NOT RECEIVE COMPENSATION FOR HIS MSHA BOARD SERVICE. CERTAIN EXECUTIVES OF THE ORGANIZATION, SUCH AS THE CEO AND SR VP/CFO, PROVIDE SERVICES TO SOME OR ALL OF THE ORGANIZATIONS RELATED TO MSHA. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PSHP CHARITABLE CONTRIBUTIONS NOT ON BOOKS 19,300. PSHP PORTFOLIO EXPENSES NOT ON BOOKS 3. TEMPORARILY RESTRICTED GRANTS 59,978. CHANGE IN FAIR VALUE OF DERIVATIVES 36,801,826. PARTNERSHIP INCOME NOT ON BOOKS -229,487. PSHP INTEREST INCOME NOT ON BOOKS -9,125. PSHP CAPITAL LOSSES NOT ON BOOKS 17,102. TOTAL TO FORM 990, PART XI, LINE 5: 36,659,597. MISSION & SIGNIFICANT ACTIVITIES: FORM 990, PART I, LINE 1 MSHA IS COMMITTED TO OUR MISSION OF BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN THE 29-COUNTY AREA WE SERVE, HELPING THEM ATTAIN THEIR HIGHEST LEVEL OF HEALTH. MSHA DELIVERS THIS CARE THROUGH THE PHILOSOPHY OF PATIENT-CENTERED CARE, AND THE DEVELOPMENT OF COMPREHENSIVE STRATEGIC PLANNING AND IMPLEMENTATION. MSHA OPENED A NEW REPLACEMENT HOSPITAL IN EARLY FY11, FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH), A CERTIFIED "GREEN" FACILITY AND THE FIRST "GREEN" HOSPITAL IN THE STATE OF TENNESSEE. FWCH REPLACED NORTH SIDE AND SPECIALTY HOSPITALS IN JOHNSON CITY. CONSTRUCTION ON A REPLACEMENT HOSPITAL FOR JOHNSTON MEMORIAL HOSPITAL (JMH) WAS COMPLETED DURING FY11 AND THE HOSPITAL OPENED DURING THE YEAR. CONSTRUCTION WAS STARTED ON A REPLACEMENT FACILITY FOR SMYTH COUNTY COMMUNITY HOSPITAL (SCCH) AS WELL, WHICH WILL OPEN DURING FY12. BOTH JMH AND SCCH ARE LOCATED IN VIRGINIA AND MAJORITY OWNED BY MSHA. MSHA OFFERS UNIQUE SERVICES TO THE BROAD COMMUNITY WITH OUR NISWONGER CHILDREN'S HOSPITAL. THROUGH NISWONGER CHILDREN'S HOSPITAL, THE ST. JUDE CHILDREN'S HOSPITAL AFFILIATE CLINIC, WE PROVIDE THE REGION'S ONLY CHILDREN'S EMERGENCY DEPARTMENT. NISWONGER CHILDREN'S ALSO PROVIDES AN N.I.C.U., WHICH IS THE STATE DESIGNATED PERINATAL CENTER FOR THIS REGION. MSHA OFFERS THE LARGEST AIR AMBULANCE SERVICE IN THE REGION WITH WINGS AIR RESCUE COVERING THE ENTIRE 29-COUNTY SERVICE AREA. TO MEET ITS MISSION CLINICALLY, MSHA IS INVOLVED IN NUMEROUS QUALITY INITIATIVES AROUND THE UNITED STATES, BENCHMARKING AND IMPROVING PATIENT OUTCOMES AT OUR ACUTE CARE FACILITIES. THESE EFFORTS HAVE GENERATED NATIONAL, STATE AND REGIONAL RECOGNITIONS AS MSHA CONTINUES TO IMPROVE ITS PROCESSES AND OUTCOMES. MORE NARRATIVE INFORMATION IS PROVIDED ABOUT OUR HEALTH SYSTEM IN PART III AND SCHEDULE H. OUR MISSION DIRECTS THE SYSTEM TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION. AS A RESULT, MSHA FINANCIALLY SUPPORTS MANY NON-PROFIT ORGANIZATIONS COMMITTED TO MEDICAL ASSISTANCE TO THE UNINSURED/UNDERINSURED AS WELL AS PROGRAMS TO IMPROVE THE OVERALL HEALTH AND WELLNESS OF OUR REGION. VOLUNTEERS: FORM 990, PART I, LINE 6 MOUNTAIN STATES HEALTH ALLIANCE AUXILIARY (AUXILIARY) SUPPORTS THE NUMEROUS HOSPITALS WITHIN THE MSHA SYSTEM. THE AUXILIARY IS AN ACTIVE ORGANIZATION THAT CONSTANTLY LOOKS FOR AND SOLICITS RECOMMENDATIONS ON ACTIVITIES TO BENEFIT MSHA HOSPITALS, PATIENTS AND THEIR FAMILIES, AND THE COMMUNITY. SINCE MSHA HAS NUMEROUS HOSPITALS OF VARYING SIZE AND SERVICES, THE OPPORTUNITY TO PROVIDE ASSISTANCE IS TREMENDOUS AND THE AUXILIARY OFTEN TAILORS ITS ACTIVITIES TO THE UNIQUE NEEDS WITHIN A SPECIFIC HOSPITAL. ALTHOUGH WE REPORT ACTIVE VOLUNTEERS OF 1,759 ON PAGE 1, LINE 6, THE ACTUAL NUMBER OF VOLUNTEERS IS MUCH HIGHER. WE KEEP PRECISE RECORDS ONLY FOR THOSE ACTIVE MEMBERS WHO WORK REGULARLY SCHEDULED HOURS. FOR EXAMPLE, OUR VOLUNTEERS WHO SEW AND DO NEEDLEWORK, ETC. INSIDE THEIR HOMES ARE NOT COUNTED. OUR ACTIVE VOLUNTEERS SERVED 145,423 HOURS DURING FISCAL YEAR 2011. ALL OF OUR ACTIVE VOLUNTEERS RECEIVE ORIENTATION AND ONGOING TRAINING; AND, ALL RECEIVE AN ANNUAL EVALUATION TO PROMOTE STAKEHOLDER SAFETY, ADHERENCE TO INTERNAL COMPLIANCE STANDARDS, AND TO ENSURE A CONSISTENT PROVISION OF QUALITY SERVICE TO PATIENTS, VISITORS, AND TEAM MEMBERS. SOME OF THE ACTIVITIES PROVIDED BY THE AUXILIARY VOLUNTEERS DURING FISCAL YEAR 2011 ARE REPORTED BELOW: MUSICAL ENTERTAINMENT, TAPED CONCERTS AND PERFORMANCES BY LOCAL STUDENTS, CHURCHES AND COMMUNITY GROUPS ARE PLAYED ON A VOLUNTEER MUSIC CHANNEL AT JOHNSON CITY MEDICAL CENTER (JCMC). A MUSICAL EVENTS CALENDAR IS MAINTAINED ON THE INTRANET FOR ALL HOSPITALS AND IN THE DAILY "MSHA MOMENT" - AN INFORMATIONAL COMMUNICATION TO ALL TEAM MEMBERS. SUNDAY AFTERNOON MUSICAL PERFORMANCES ARE GIVEN AT 5 MSHA HOSPITALS. A HARMONICA PLAYER WALKS THE HALLS AND PROVIDES HARMONICA MUSIC. HE WILL GO IN ANY PATIENT ROOM WHEN THE PATIENT/PATIENT FAMILY REQUESTS AND HE OFFERS FREE HARMONICAS WITH BEDSIDE LESSONS ESPECIALLY FOR CHILDREN AT OUR NISWONGER CHILDREN'S HOSPITAL. THESE HARMONICA LESSONS ARE ALSO HELPFUL TO HEART PATIENTS WHO ARE HAVING TROUBLE USING THEIR BREATHING DEVICE. VISUAL ARTS. THE AUXILIARY PREPARES A ROTATING ART EXHIBIT AT JCMC AND INDIAN PATH MEDICAL CENTER (IPMC). WE HAVE CERTIFIED MASTER GARDNER VOLUNTEERS AT JCMC, WOODRIDGE HOSPITAL, AND QUILLEN REHAB HOSPITAL. DIRECTION CARDS WERE DEVELOPED FOR JCMC AND FRANKLIN WOODS COMMUNITY HOSPITAL DURING THE YEAR. LITERARY ARTS. A READING PROGRAM IS PROVIDED FOR THE PATIENTS AT NISWONGER CHILDREN'S HOSPITAL. CULINARY. VOLUNTEERS BAKE AND DELIVER COOKIES DAILY TO JCMC, FWCH, AND IPMC. VOLUNTEERS ARRIVE EARLY EACH MORNING TO BAKE THE COOKIES. THE COOKIES ARE WRAPPED AND DELIVERED TO SURGERY, ICU, HEART CATH, AND ER WAITING ROOMS. A VARIETY OF SNACKS AND MEALS ARE DELIVERED TO NORTON COMMUNITY HOSPITAL FAMILY KITCHENS. GOODY BASKET DELIVERIES ARE MADE TO JCMC'S ICU WAITING ROOM. CREATIVE ARTS. VOLUNTEERS FROM AREA CHURCH GROUPS MAKE QUILTS AND PERSONAL CARE KITS FOR ER PATIENTS AT IPMC. VOLUNTEERS CREATE COLORING BOOKS FOR WAITING AREAS. ALL NEWBORNS RECEIVE HAND-KNITTED OR CROCHETED BABY HATS AND MANY RECEIVE BLANKETS AND/OR BOOTIES. ALL BABIES BORN DURING DECEMBER RECEIVE A HANDMADE, OVER-SIZED CHRISTMAS STOCKING. VOLUNTEERS BEGIN WORKING ON THE STOCKINGS IN THE SUMMER AND COMPLETE OVER 400 STOCKINGS. THE BABIES ARE OFTEN SENT HOME NESTLED IN THE STOCKINGS. VOLUNTEERS MAKE IV COVERS, SOFT CAPS FOR ONCOLOGY PATIENTS, AND HEATABLE BABY POSITIONING PADS. SPECIAL ENTERTAINMENT FOR CHILDREN INCLUDES VOLUNTEER CLOWNS AND SANTA. BOTH SANTA AND THE CLOWNS MAKE MONTHLY VISITS TO NISWONGER CHILDREN'S HOSPITAL. VOLUNTEERS ALSO MAKE PILLOWS FOR BARIATRIC PATIENTS. COMMUNITY INVOLVEMENT. VOLUNTEERS ARE AVAILABLE 7 DAYS A WEEK, 24 HOURS A DAY FOR NISWONGER CHILDREN'S HOSPITAL NICU. THIS PROGRAM'S PURPOSE IS TO HOLD AND COMFORT BABIES IN THE NICU AND IS APTLY CALLED THE NICU CUDDLER PROGRAM. THE AUXILIARY MAINTAINS A PROGRAM FOR HEART PATIENTS CALLED MENDED HEARTS. MENDED HEARTS HAS 19 TRAINED VOLUNTEERS TO VISIT WITH CARDIAC PATIENTS BEFORE AND AFTER OPEN HEART SURGERY EVERY DAY. THEY ALSO HAVE MONTHLY SUPPORT MEETINGS WITH PROGRAMS ON HEART HEALTH AND OFFER ANOTHER CLASS EVERY SIX WEEKS TO THE CARDIAC REHAB PROGRAM. THIS PROGRAM SERVED 761 PATIENTS AND FAMILY MEMBERS DURING THE YEAR. COURTESY CARTS AND A VAN OPERATED BY VOLUNTEERS ARE PROVIDED TO TRANSPORT PATIENTS AND VISITORS TO ANY DOOR AT JCMC. JCMC IS A LARGE HOSPITAL WITH MULTIPLE ENTRY POINTS AND PARKING CAN BE A GOOD DISTANCE AWAY FROM THE FACILITY. THIS TRANSPORT PROGRAM HAS BEEN VERY WELL RECEIVED BY OUR PATIENTS AND THEIR VISITORS. THE CARTS AND VAN OPERATE THREE SHIFTS DAILY AND ONE TO TWO SHIFTS ON WEEKENDS. FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH). FWCH IS A BRAND-NEW MSHA HOSPITAL. WE ARE VERY PROUD OF THIS NEW FACILITY, WHICH IS A CERTIFIED "GREEN" HOSPITAL. SINCE OPENING IN THE SUMMER OF 2010, THE AUXILIARY VOLUNTEER TEAM EXPANDED ITS VOLUNTEER SERVICE OPERATIONS TO INCLUDE THIS NEW HOSPITAL. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) FORM 990, PART III, LINE 4A - MSHA HAS A NO-RETALIATION AND NO-RETRIBUTION POLICY FOR THE PROTECTION OF INDIVIDUALS WHO, IN GOOD FAITH, REPORT LEGAL OR ETHICAL CONCERNS. TEAM MEMBERS ARE REQUIRED TO REPORT CONCERNS TO APPROPRIATE PERSONS FOR INVESTIGATION OR FOLLOW-UP. "ALERTLINE" IS A CONFIDENTIAL, RISK-FREE HOTLINE FOR REPORTING SUSPECTED ILLEGAL BEHAVIOR, ETHICAL VIOLATIONS OR SAFETY RISKS AND IS AVAILABLE TO ALL TEAM MEMBERS VIA A TOLL-FREE NUMBER. MEDICAL EDUCATION AND RESEARCH MSHA PROVIDES CLINICAL EXPERIENCE TO MEDICAL STUDENTS AND RESIDENTS OF THE JAMES H. QUILLEN COLLEGE OF MEDICINE AT ETSU. MSHA CONTRIBUTED AN UNREIMBURSED COST AMOUNT OF $3,877,766 TO THE RESIDENCY PROGRAM IN FY11. MSHA FACILITIES SERVE AS CLINICAL TRAINING AREAS FOR HEALTH PROFESSIONAL EDUCATION STUDENTS. MSHA HAS DEDICATED STAFF TO WORK WITH REGIONAL COLLEGES AND UNIVERSITIES TO COORDINATE THE PLACEMENT OF HEALTH CARE PROFESSIONAL STUDENTS AS PART OF THEIR EDUCATIONAL CURRICULUM. MANY OF THE HEALTH CARE STUDENTS ENTERING OUR SYSTEM ARE REQUIRED TO HAVE ORIENTATION AND COMPUTER TRAINING. ALSO RECEIVING CLINICAL EXPERIENCE AT MSHA WERE 1,298 NURSING STUDENTS FROM VARIOUS COLLEGES, UNIVERSITIES AND PROGRAMS. THIS NURSING CLINICAL EXPERIENCE REQUIRED EXTENSIVE MSHA NURSING STAFF INVOLVEMENT AT FIVE MSHA FACILITIES. THE CLINICAL SETTING AND HANDS-ON INSTRUCTION COST MSHA $2,307,917. MSHA PROVIDED A CLINICAL SETTING FOR ANOTHER 1,162 STUDENTS TRAINING IN HEALTH-RELATED PROGRAMS SUCH AS RADIOLOGY, PHARMACY, LABORATORY, PHYSICAL THERAPY AND OTHER ALLIED-HEALTH DISCIPLINES. THESE ADDITIONAL CLINICAL STUDENTS COST MSHA $1,022,679. MSHA PROVIDED ASSISTANCE TO 383 HIGH SCHOOL AND COLLEGE STUDENTS WHO WERE CONSIDERING A HEALTHCARE CAREER PATH BY ALLOWING THEM TO OBSERVE LICENSED MSHA CLINICAL PROFESSIONALS. THE SHADOWING OF CLINICAL STAFF BY THESE STUDENTS COST MSHA $8,686. MSHA'S LEARNING RESOURCE CENTER (LRC) IS A MEDICAL LIBRARY THAT PROVIDES ACCESS TO MEDICAL DATABASES, VARIOUS PAPER PUBLICATIONS AND FACILITATES INTER-LIBRARY JOURNAL LOANS TO INCREASE LIBRARY RESOURCES. THE LRC SUBSCRIBES TO SEVERAL ONLINE MEDICAL DATABASES AS WELL AS PRINTED MEDICAL EDUCATION MATERIALS. THE LRC IS PRIMARILY UTILIZED BY MEDICAL RESIDENTS, PHARMACY AND NURSING STUDENTS. THIS SERVICE IS ALSO USED BY OTHER HEALTH PROFESSION EDUCATION STUDENTS, PHYSICIANS AND STAFF, AND IS OPEN TO THE COMMUNITY. THE FY11 COST OF PROVIDING THIS SERVICE WAS $306,197. MARKETING - MSHA PROVIDES ACCESS TO SEVERAL ONLINE HEALTH INFORMATION SERVICES. "MY HEALTH NEWS" ALLOWS ACCESS TO HEALTH INFORMATION TOPICS AND SERVICES THAT MATTER TO THE USER. THIS SERVICE SENDS UP-TO-DATE INFORMATION FROM NATIONAL HEALTH RESOURCES TAILORED TO THE INDIVIDUAL'S NEEDS. MSHA PROVIDES ACCESS TO "KIDSHEALTH", A SERVICE THAT PROVIDES PRACTICAL PARENTING INFORMATION AND NEWS. THIS SERVICE ALSO PROVIDES HOMEWORK HELP FOR KIDS AND STRAIGHT TALK ANSWERS FOR TEENS. NEW TO THE MSHA WEB SITE IS "ITRIAGE", A LINK THAT ALLOWS THE USER TO CHECK FOR A WIDE ARRAY OF SYMPTOMS AND CAUSES/TREATMENTS, DISEASES AND CONDITION INFORMATION, EXPLANATIONS OF VARIOUS MEDICAL PROCEDURES, AND AN APP IS AVAILABLE FOR DOWNLOADING. MSHA PROVIDES CME AND CEU OPPORTUNITIES WITH "MEDNEWSPLUS" FOR PHYSICIANS AND NURSES FREE OF CHARGE. THE SERVICE IS OPEN TO ANY PHYSICIAN OR NURSE IN THE REGION AND OFFERS CME AND CEU CREDITS. MSHA ALSO PROVIDES LINKS TO HELPFUL HEALTH-RELATED SITES ON THE INTERNET. PATIENT CARE SERVICES DATA SHOWS THAT THE HEALTH STATUS OF MSHA'S SERVICE AREA IS GENERALLY POOR. MSHA'S SERVICE AREA CONSISTS OF COUNTIES IN TENNESSEE AND SOUTHWEST VIRGINIA. AMONG THE 50 STATES, TENNESSEE RANKED 42ND AND VIRGINIA RANKED 22ND IN TERMS OF HEALTH STATUS. SOME OF THE OVERWHELMING HEALTH ISSUES IN OUR SERVICE AREA INCLUDE: 1. HIGH PREVALENCE OF OBESITY 2. POOR CARDIOVASCULAR HEALTH 3. HIGH RATE OF CIGARETTE SMOKING 4. POOR AIR QUALITY 5. LOW RATE OF DIABETIC CARE 6. HIGH RATE OF UNINSURED 7. LOW LEVEL OF EDUCATION 8. HIGH RATE OF DEATHS DUE TO CARDIOVASCULAR CONDITIONS, CANCER AND DIABETES GIVEN THIS HEALTH PROFILE, MSHA EXISTS TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF ALL INDIVIDUALS AND COMMUNITIES IN THE REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. MSHA LIVES ITS MISSION TO BRING LOVING CARE TO HEALTH CARE IN OUR REGION. MSHA OPERATES ON A NON-DISCRIMINATORY BASIS, PROVIDING QUALITY HEALTH CARE TO ALL PATIENTS REGARDLESS OF RACE, RELIGION, GENDER, ETHNICITY, DISABILITY, AGE OR ABILITY TO PAY. CHARITY AND UNREIMBURSED COSTS CHARITY CARE: WHILE REIMBURSEMENT FOR HEALTHCARE SERVICES RENDERED IS CRITICAL TO THE OPERATION AND SUSTAINABILITY OF THE ORGANIZATION, MSHA RECOGNIZES ITS OBLIGATION TO PROVIDE CARE TO INDIVIDUALS WHO CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, INCLUDING EMERGENCY CARE. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO ESTABLISHED POLICIES OF MSHA AND GUIDELINES OUTLINED BY THE FEDERAL GOVERNMENT. HOWEVER, FINANCIAL ASSISTANCE DECISIONS ARE NOT SOLELY BASED ON INCOME. UNIQUE FINANCIAL CIRCUMSTANCES ARE WEIGHED WITH VERIFIED PATIENT ASSETS WHICH CAN DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. IT IS NOT UNTIL AFTER VERIFICATION OF INCOME AND ASSETS THAT A DECISION AS TO THE AMOUNT OF WRITE-OFF WILL BE MADE. IN FISCAL YEAR 2011, MSHA INCURRED A LOSS OF $13,141,846 ATTRIBUTABLE TO THE PROVISION OF FREE CARE TO INDIGENT PATIENTS. GOVERNMENTAL PROGRAM ENROLLEES: MSHA PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, INCLUDING MEDICARE AND MEDICAID AND STATE-FUNDED TENNCARE. IN FY11, THE UNREIMBURSED COST OF SERVICES PROVIDED TO THIS PATIENT POPULATION WAS $5,789,329 (MEDICARE, BASED ON MEDICARE ALLOWABLE COSTS), $3,388,560 (MEDICAID) AND $23,287,060 (TENNCARE). BAD DEBT: MSHA PROVIDES AN INCREASING LEVEL OF SERVICE TO SELF-PAY PATIENTS FOR WHICH IT RECEIVES LITTLE OR NO PAYMENT. DURING FY11, BAD DEBTS RESULTED IN UNREIMBURSED COSTS OF $11,418,733. PROMOTE COMMUNITY HEALTH MSHA OFFERS MANY REDUCED-PRICE OR FREE SERVICES AND PROGRAMS YEAR-ROUND IN CARE SETTINGS THAT IT ESTABLISHED TO ACCOMMODATE THE WIDELY SCATTERED, AGING AND SOCIOECONOMICALLY DISADVANTAGED POPULATION. SUCH PROGRAMS SERVE BONA FIDE COMMUNITY HEALTH NEEDS AND RESULT IN FINANCIAL LOSSES TO THE ORGANIZATION. WINGS AIR RESCUE (WINGS), THE REGION'S ONLY EMERGENCY MEDICAL HELICOPTER SERVICE, IS CONSIDERED BY MSHA TO BE A REGIONAL ASSET. LICENSED IN THE STATE OF TENNESSEE AND THE COMMONWEALTHS OF KENTUCKY AND VIRGINIA, WINGS PROVIDED AIR TRANSPORT OF CRITICALLY ILL AND INJURED PATIENTS TO THE CLOSEST TERTIARY FACILITIES, INCLUDING NON-MSHA FACILITIES. 74% OF THEIR PATIENTS ARE FROM TRAUMA SCENES TO TERTIARY CARE CENTERS, WITH OTHERS BEING CARDIAC, OB, PEDIATRIC AND MEDICAL. DURING FY11, WINGS TRANSPORTED 1,591 PATIENTS AND MADE 11 SEARCH AND RESCUE FLIGHTS AT A NET OPERATING LOSS OF $740,905 TO MSHA. NURSE LINK MEDICAL CALL CENTER IS A 24-HOUR TOLL-FREE MEDICAL INFORMATION LINE. EXPERIENCED REGISTERED NURSES ANSWER CALLS AND PROVIDE INVALUABLE CONFIDENTIAL HEALTH INFORMATION. THEY MANAGE PHYSICIAN-APPROVED PATIENT TRIAGE SERVICES; MAKE INDIVIDUAL CALLBACKS FOR PEDIATRIC AND ADULT PATIENTS WITH SERIOUS SYMPTOMS; AND COORDINATE PATIENT TRANSPORTS AND EMERGENCY DEPARTMENT ACCESS. IN FY11, NURSE LINK HANDLED 52,359 CALLS INCLUDING 3,410 PHYSICIAN REFERRALS. MSHA INCURRED AN EXPENSE OF $560,241 TO PROVIDE THIS SERVICE AT NO COST TO THE COMMUNITY. DURING FY11, MSHA OPERATED A SATELLITE DISPENSARY OF HOPE. THE DISPENSARY OF HOPE PROVIDES PRESCRIPTION DRUGS TO THOSE WHO MAY NOT HAVE OTHERWISE BEEN ABLE TO AFFORD NEEDED MEDICATIONS. DURING FY11, THE DISPENSARY FILLED 12,358 PRESCRIPTIONS FOR 2,792 PEOPLE WHOM OTHERWISE COULD NOT HAVE AFFORDED THEM. THE SITE HAS ITS OWN PHARMACY, A FULL TIME PHARMACIST, A FULL-TIME PHARMACY TECH AND A SOCIAL WORKER/RECEPTIONIST. THE LOCAL DISPENSARY OF HOPE IS STAFFED, IN PART, BY VOLUNTEER PHARMACISTS FROM THE COMMUNITY AND WILL SERVE AS A TRAINING SITE FOR THE BILL GATTON COLLEGE OF PHARMACY AT EAST TENNESSEE STATE UNIVERSITY. DURING FY11, MSHA INCURRED UNREIMBURSED EXPENSES OF $194,980 FOR THIS PROGRAM. THE HEALTH RESOURCES CENTER (HRC) IS A COMMUNITY OUTREACH SERVICE PROVIDED BY MSHA. THE HRC IS CONVENIENTLY LOCATED IN THE REGION'S LARGEST SHOPPING MALL. THE HRC OFFERS FREE CLASSES, BLOOD PRESSURE CHECKS, INFORMATIONAL MATERIALS AND RESOURCES AS WELL AS A NUMBER OF OTHER SERVICES IN AN EFFORT TO MEET COMMUNITY MEMBERS' BASIC HEALTH AND HEALTH EDUCATION NEEDS. THE HRC HAD 25,565 VISITS TO THEIR OFFICE AND PERFORMED 1,698 HEALTH SCREENINGS. THE HRC ALSO HOSTED MORE THAN 7,802 ATTENDEES WHO PARTICIPATED IN MONTHLY HEALTH EDUCATION PROGRAMS. THE HRC ALSO PROVIDES OUTREACH SERVICES WHERE THEY SCREENED AN ADDITIONAL 5,489 COMMUNITY MEMBERS. THE UNCOMPENSATED COST OF HRC WAS $388,247. PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) FORM 990, PART III, LINE 4A SOME OF THE FREE CLASSES AND SUPPORT GROUPS OFFERED TO THE PUBLIC BY MSHA INCLUDE: SMOKING SESSATION PROGRAMS; NURTITION AND COOKING CLASSES; EDUCATIONAL SESSIONS ON THE DANGERS OF RECREATIONAL DRUGS SUCH AS BATH SALTS AND SYNTHETIC MARIJUANA; CPR CLASSES; RELAXATION TRAINING; SAFE BABYSITTING TRAINING; BALANCE AND FALLS PREVENTION; WEIGHT LOSS; EXERCISE PROGRAMS, ETC. MSHA'S COMMUNITY HEALTH AND WELLNESS SCREENING CENTER (CHAWS) WORKS WITH LOCAL SCHOOLS AND BUSINESSES AS WELL AS INDIVIDUAL COMMUNITY MEMBERS TO PROVIDE ONSITE HEALTH EDUCATION PROGRAMS, PERFORM HEALTH ASSESSMENTS AND OFFER HEALTHY LIFESTYLE COUNSELING. IN FY11, CHAWS PROVIDED 983 SCREENINGS WITH AN UNREIMBURSED EXPENSE OF $351,985. IN OCTOBER OF 2010, MSHA INTRODUCED THE HEART COACH. THE HEART COACH IS A MOBILE CARDIOVASCULAR SCREENING CENTER WHICH IS OFFERED IN EAST TENNESSEE AND SOUTHWEST VIRGINIA. DURING FY11, THE HEART COACH PROVIDED 2,721 CARDIOVASCULAR SCREENINGS. 183 OF THESE SCREENINGS HAD ABNORMAL RESULTS FOR CARDIOVASCULAR ISSUES AND 202 ABNORMAL RESULTS FOR OTHER ISSUES (GLUCOSE, BLOOD PRESSURE, ETC.). THE STAFF OF THE HEART COACH WAS ABLE TO PROVIDE REFERRALS FOR FOLLOW UP APPROPRIATE TO EACH MEDICAL CONDITION. IN FY11, THE HEART COACH HAD UNREIMBURSED EXPENSES OF $170,752. BASED ON COMMUNITY NEEDS, MSHA INCURRED AN EXPENSE OF $150,215 TO RECRUIT PHYSICIANS INTO CLINICAL/GEOGRAPHICAL AREAS THAT WERE FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED. MSHA INCURRED AN ADDITIONAL EXPENSE OF $1,989,030 TO RECRUIT PHYSICIANS INTO OTHER AREAS SERVICED BY MSHA. JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH) IS A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL. THIS FACILITY IS LOCATED IN ONE OF TENNESSEE'S POOREST COUNTIES AND PROVIDES EMERGENCY, INPATIENT AND OUTPATIENT CARE TO THE COUNTY'S RESIDENTS, MANY OF WHOM ARE OVER 65 YEARS OLD. JCCH CONTINUES TO BE DESIGNATED AS A PHYSICIAN SHORTAGE AREA FOR MANY SPECIALTIES. JCCH OPERATES A PHYSICIAN SPECIALTY CLINIC, WHICH INCURRED AN OPERATING LOSS OF $59,254 IN FY11. THE SPECIALTY CLINIC INCLUDES GENERAL SURGERY, PODIATRY, CARDIOLOGY AND OTHER SPECIALTY SERVICES. THIS CONTINUES TO BE A VALUABLE RESOURCE TO THE RESIDENTS OF THE AREA BY AIDING WITH TRANSPORTATION ISSUES (OTHER PHYSICIAN OFFICES ARE LOCATED MORE THAN AN HOUR AWAY), RESOLVING ACCESS LIMITATIONS FOR SPECIALTY SERVICES, AND PROVIDING RELIEF TO THE SPECIAL HEALTH PROBLEMS OF A LARGELY ELDERLY POPULATION. RURAL LIFE OFTEN INCLUDES HAZARDOUS OCCUPATIONS SUCH AS FARMING, WHICH INCREASES THE RISK FOR CHRONIC RESPIRATORY DISEASES AND CANCER- RELATED ILLNESSES CAUSED BY FERTILIZATION AND OTHER CHEMICALS. THIS RURAL POPULATION HAS A HIGHER INCIDENCE OF CARDIOVASCULAR DISEASE DUE TO DIET AND GENETIC PREDISPOSITION. GIVEN THESE FACTORS, RURAL HOSPITALS MUST REMAIN FLEXIBLE AND DIVERSE IN THEIR FACILITIES AND THE SERVICES THEY OFFER THE COMMUNITY. MSHA REMAINS FIRM IN THE BELIEF THAT FINANCIALLY SUPPORTING THE SERVICES OF JCCH AND THE SPECIALTY CLINIC TO ASSIST RESIDENTS IN ATTAINING A HIGH LEVEL OF HEALTH CONTINUES TO BE A CORE VALUE OF OUR BUSINESS AND COMMUNITY SUPPORT. MSHA OPERATES A RURAL HEALTH CLINIC LOCATED IN ST PAUL, VA ON THE BORDER OF WISE AND RUSSELL COUNTIES. RIVERSIDE CLINIC FIRST OPENED IN 1991 TO PROVIDE PRIMARY CARE SERVICES TO THIS ELDERLY, UNDERSERVED POPULATION. THE CLINIC'S LARGEST PAYOR IS MEDICARE, WHICH ACCOUNTS FOR 36% OF THEIR PATIENTS. DURING FY11, THE CLINIC HAD 10,101 OUTPATIENT VISITS. DURING FY11, RCMC PROVIDED A $399,460 SUBSIDY TO SUPPORT THE CLINIC'S OPERATIONS. MSHA HAS PARTNERED WITH THE COMPANY FIRSTSOURCE SOLUTIONS TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. DURING FY11, FIRSTSOURCE REPRESENTATIVES WERE AVAILABLE AT ALL MSHA FACILITIES FOR DAILY INTERACTION AND FINANCIAL SCREENING OF PATIENTS. FIRSTSOURCE REPRESENTATIVES WERE ABLE TO DETERMINE GOVERNMENTAL MEDICAL ASSISTANCE (TENNCARE OR MEDICAID) ELIGIBILITY, AND TO HELP WITH THE APPLICATION PROCESS AND FOLLOW-UP. DURING FY11, 4,339 POTENTIALLY ELIGIBLE PATIENTS TOOK ADVANTAGE OF FIRST SOURCE'S HELP, AND OF THOSE PATIENTS WHO APPLIED FOR TENNCARE OR VIRGINIA MEDICAID COVERAGE, 2,580 (60%) WERE APPROVED FOR COVERAGE. ONCE A PERSON IS APPROVED FOR TENNCARE OR MEDICAID THROUGH THE FIRSTSOURCE PROGRAM OFFERED THROUGH MSHA, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. FIRSTSOURCE IS COMPENSATED BY MSHA. DURING FY11, MSHA'S COST FOR THIS PROGRAM WAS $755,834. MSHA ALSO GIFTS THE LAND LEASE TO THE RONALD MCDONALD HOUSE AT A FAIR MARKET VALUE OF $60,000. THE RONALD MCDONALD HOUSE IS LOCATED ON THE CAMPUS OF NISWONGER CHILDREN'S HOSPITAL AND JOHNSON CITY MEDICAL CENTER. MSHA CONTRIBUTED $53,027 TO CARESPARK. CARESPARK WAS ESTABLISHED TO EXPLORE WAYS TO SHARE HEALTH INFORMATION SECURELY, EFFICIENTLY AND COST-EFFECTIVELY. CARESPARK WAS INITIATED BY VOLUNTEERS WITH THE COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP, WHO HAD BEEN WORKING TOGETHER FOR MORE THAN A DECADE THROUGH THE LOCAL NON-PROFIT CITIZEN ORGANIZATION, KINGSPORT TOMORROW, TO DEVELOP COLLABORATIVE PROCESSES TO IMPROVE HEALTH WITHIN THE COMMUNITY. MSHA CONTRIBUTED $30,000 TO THE ETSU FOUNDATION TO SUPPORT THE JOHNSON CITY DOWNTOWN CLINIC. THE JOHNSON CITY DOWNTOWN CLINIC WAS ORIGINALLY ESTABLISHED TO SERVE THE NEEDS OF THE LOCAL HOMELESS POPULATION IN JOHNSON CITY AND HAS EXPANDED OVER THE PAST NEARLY 15 YEARS TO INCLUDE THE UNINSURED, UNDERINSURED, TENNCARE ENROLLEES, A GROWING HISPANIC POPULATION, AND MEDICALLY INDIGENT INDIVIDUALS. MSHA CONTRIBUTED $25,360 TO SUSAN G. KOMEN BREAST CARE FOUNDATION. SUSAN G. KOMEN IS THE GLOBAL LEADER OF THE BREAST CANCER MOVEMENT AND THE WORLD'S LARGEST GRASSROOTS NETWORK OF BREAST CANCER SURVIVORS AND ACTIVISTS. COMMUNITY CONTRIBUTIONS AS THE SECOND LARGEST EMPLOYER IN THE REGION, MSHA IS ONE OF THE AREA'S PRINCIPLE BENEFACTORS AND HAS MADE CORPORATE CITIZENSHIP AN INTEGRAL PART OF ITS CULTURE. FROM SYSTEM-WIDE INITIATIVES TO INDIVIDUAL EFFORTS OF CARING TEAM MEMBERS, ITS AIM IS TO ENRICH THE COMMUNITIES THAT THE ORGANIZATION SERVES. MSHA'S COMMITMENT INCLUDES FINANCIAL CONTRIBUTIONS, IN-KIND (NON-CASH) CONTRIBUTIONS AND LEADERSHIP RESOURCES WITHIN THREE BROAD CATEGORIES OF GIVING: 1) DIRECT CONTRIBUTIONS THAT SUPPORT COMMUNITY HEALTHCARE NEEDS AND THOSE NONPROFIT AGENCIES THAT ADVOCATE THE HEALTH AND WELL-BEING OF COMMUNITY MEMBERS; 2) MSHA-RUN AND MSHA-SUPPORTED PROGRAMS THAT CONTRIBUTE TO THE HEALTH AND WELL-BEING OF AREA RESIDENTS; AND 3) EDUCATION/TRAINING; BOTH AS A COMMUNITY CITIZEN AND AS AN EMPLOYER. 1.) DIRECT CONTRIBUTIONS - IN-KIND AND CASH 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 MANAGING BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. MANY ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTH CARE AND EDUCATION. TEAM MEMBERS SERVED THE BOYS & GIRLS CLUB, KIWANIS CLUBS, ROTARY CLUBS, SUSAN G. KOMEN BREAST CANCER FOUNDATION, ECONOMIC DEVELOPMENT STEERING COMMITTEE FOR WASHINGTON COUNTY, JUNIOR ACHIEVEMENT, SALVATION ARMY, AMERICAN HEART ASSOCIATION, HANDS ON! MUSEUM, APPALACHIAN MOUNTAIN PROJECT ACCESS, WASHINGTON COUNTY EMERGENCY MEDICAL SERVICES, WASHINGTON COUNTY VETERAN'S MEMORIAL COMMITTEE OF THE JOHNSON CITY PARKS AND RECREATION FOUNDATION, EATING DISORDERS COALITION OF TENNESSEE, JOHNSON CITY SYMPHONY ORCHESTRA, DAWN OF HOPE, UNITED WAY, CHAMBER OF COMMERCE BOARDS, AND MANY OTHERS. ALTHOUGH MSHA DID NOT FULLY MONITOR THESE ACTIVITIES DURING FY11 TO TABULATE THE TOTAL FINANCIAL COST, THE AMOUNT WOULD BE SIGNIFICANT SINCE SOME OF THESE TEAM MEMBERS DEVOTED TWO WEEKS OF NORMAL WORK TIME TO OUTSIDE CHARITABLE ACTIVITIES. SUMMARY LIST OF CHARITABLE GIVING: IN FY11, MSHA PROVIDED CASH AND IN-KIND SUPPORT TO NUMEROUS HEALTH AND HUMAN SERVICE AGENCIES, INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING RECIPIENTS. MAJOR PROGRAMS ARE DESCRIBED IN MORE DETAIL IN THE SECTIONS THAT FOLLOW. - CARESPARK - $50,027 - ETSU FOUNDATION - $51,581 - SUSAN G. KOMEN BREAST CANCER FOUNDATION - $25,360 - EAST TENNESSEE STATE UNIVERSITY - $20,664 - BOYS AND GIRLS CLUB OF KINGSPORT - $20,000 - CROSSROADS MEDICAL MISSION - $12,500 - LINCOLN THEATRE - $12,500 - COALITION FOR KIDS - $8,560 - CITY OF JOHNSON CITY - $9,541 - RUSSELL COUNTY CAREER AND TECHNOLOGY CENTER - $17,474 - HANDS ON! REGIONAL MUSEUM - $7,500 - RUSSELL COUNTY AMBULANCE - $4,074 - RUSSELL COUNTY CAREER & TECHNOLOGY CENTER - $17,474 - SECOND HARVEST FOOD BANK - $4,583 - TENNESSEE CENTER FOR PERFORMANCE EXCELLENCE - $4,150 - THE SALVATION ARMY - $1,768 - UMOJA UNITY FESTIVAL - $2,237 - ECUMENICAL FAITH IN ACTION - $1,000 - FIRST TENNESSEE HUMAN RESOURCE AGENCY - $1,000 - GOD OF SECOND CHANCE MISSION - $1,000 PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) FORM 990, PART III, LINE 4A - MOUNTAIN STATES FOUNDATION - $2,665 - GOOD SAMARITAN MISITRY - $1,759 MSHA, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY AND PUBLICITY; PROVIDE SPACE; OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES. MSHA VALUES SOCIAL RESPONSIBILITY AND IS COMMITTED TO COMMUNITY HEALTH AND HEALTH EDUCATION. ANNUALLY, MSHA MAKES GENEROUS MONETARY DONATIONS TO AREA HEALTH AND HUMAN SERVICE AGENCIES WHOSE PROGRAMS ARE SPECIFICALLY DESIGNED TO PROVIDE FOR THE HEALTHCARE NEEDS OF THE HOMELESS, INDIGENT AND UNDERSERVED POPULATIONS. THROUGHOUT THE YEAR, MSHA MAKES CONTRIBUTIONS TO LOCAL SCHOOLS AND ORGANIZATIONS THAT PROVIDE EDUCATIONAL AND SOCIAL SUPPORT FOR YOUNG PEOPLE. SOME OF THE CONTRIBUTIONS TO YOUTH PROGRAMS INCLUDE: - REGIONAL COUNTY AND CITY SCHOOLS - $19,340 - ETSU FIT KIDS PROGRAM - $30,750 - HANDS ON! REGIONAL MUSEUM - $7,500 - CARTER COUNTY IMAGINATION LIBRARY - $1,000 - COALITION FOR KIDS - $8,560 - BOYS AND GIRLS CLUB OF KINGSPORT - $20,000 - BOYS SCOUTS OF AMERICA - $1,000 - WARRIORS PARK BOUNDLESS PLAYGROUND - $1,050 - JASON WHITTON SCORE FOUNDATION - $2,300 - KERMIT TIPTON SCHOLARSHIP FOUNDATION - $2,500 - CASA FOR KIDS - $622 - CITY YOUTH BALLET - $408 - ETSU SCHOLARSHIP PROGRAM - $1,000 MSHA CONTRIBUTES ANNUALLY TO LOCAL CHAPTERS OF SEVERAL NATIONAL NONPROFIT ORGANIZATIONS WHOSE RESEARCH FOCUSES ON THOSE DISEASES AND CONDITIONS MOST PREVALENT IN THE REGION. FY11: - SUSAN G. KOMEN BREAST CANCER FOUNDATION - $25,360 - AMERICAN CANCER SOCIETY - $2,401 - MARCH OF DIMES - $1,225 - UNITED WAY - $1,357 - VARIOUS ORGANIZATION FOCUSED ON CHILDHOOD OBESITY - $66,750 - JOHNSTON MEMORIAL HOSPTIAL - $1,000 - KEYSTONE DENTAL CARE, INC. - $651 - CROSSROADS MEDICAL MISSION - $12,000 2.) COMMUNITY PROGRAMS DEMOGRAPHIC STUDIES AND A CUSTOMER MARKET NEEDS ANALYSIS, PERFORMED ANNUALLY DURING STRATEGIC PLANNING, INDICATE THE NECESSITY OF HAVING A WIDE ARRAY OF FREE AND PRICE-REDUCED SERVICES THAT ARE WELL-SITUATED FOR EASY ACCESS FROM RURAL, MOUNTAINOUS AREAS. MSHA HAS GIVEN HIGH PRIORITY TO INVESTMENTS IN COMMUNITY OUTREACH, AND AS A RESULT, HAS ESTABLISHED COUNCILS AND DEPARTMENTS WHOSE FOCUS IS TO TRANSLATE FINDINGS INTO VIABLE HEALTHCARE PROGRAMS BOTH FOR THE COMMUNITY AT LARGE AND FOR POPULATIONS WITH SPECIAL NEEDS. AMONG INITIATIVES AND ONGOING SERVICES THAT PROMOTE COMMUNITY HEALTH AND SOCIAL WELL-BEING ARE DISEASE MANAGEMENT, WELLNESS PROGRAMS, HEALTH-RELATED EDUCATION SESSIONS BY MSHA NURSES, STAFF PHYSICIANS, NUTRITIONISTS, AND OTHER SPECIALISTS; HEALTH SCREENINGS AND SUPPORT. MSHA ALSO OFFERS SPECIAL PROGRAMS FOR YOUTH, THE ELDERLY, THE DISABLED AND THE MEDICALLY UNDERSERVED. DURING FY11, MSHA CONTINUED THE LARGEST COMMUNITY HEALTH NEEDS ASSESSMENT IN ITS HISTORY IN AN EFFORT TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN THE LOCAL REGION. THIS ASSESSMENT SPECIFICALLY FOCUSED ON MSHA'S 13-COUNTY CORE SERVICE AREA, WHICH INCLUDES, BUT IS NOT LIMITED TO, ALL THE COUNTIES IN WHICH MSHA HAS A FACILITY. THE SEVEN TENNESSEE COUNTIES INCLUDED IN THIS NEEDS ASSESSMENT WERE: CARTER COUNTY, GREENE COUNTY, HAWKINS COUNTY, JOHNSON COUNTY, SULLIVAN COUNTY, UNICOI COUNTY AND WASHINGTON COUNTY. THE OTHER SIX VIRGINIA COUNTIES ARE LOCATED IN SOUTHWEST VIRGINIA. AFTER ANALYZING THE MANY HEALTH DISPARITIES IN THE REGION, MSHA CHOSE CHILDHOOD OBESITY AS ITS HEALTH PRIORITY. MSHA COLLABORATED WITH EAST TENNESSEE STATE UNIVERSITY'S COLLEGE OF PUBLIC HEALTH TO DEVELOP THE MSHA-ETSU OBESITY COLLABORATIVE. THE FOCUS OF THIS COLLABORATIVE IS TO PULL TOGETHER MANY PARTNERS AND ORGANIZATIONS TO REDUCE THE LEVEL OF CHILDHOOD OBESITY THROUGHOUT NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. MSHA PROVIDED THE FUNDING AND COORDINATION, WHILE ETSU WORKED ON RESEARCH EFFORTS. THIS INITIATIVE PROVIDED FUNDING FOR UP TO 25 MICRO-GRANTS OF $2,000 EACH TO LOCAL COMMUNITY ORGANIZATIONS SUCH AS CHURCHES, COMMUNITY GROUPS, SCHOOLS AND EMPLOYERS THAT WANT TO EXPLORE CHILDHOOD OBESITY REDUCTION EFFORTS. IN FY11, MSHA AND ETSU NAMED THE OBESITY COLLABORATIVE "HEAL APPALACHIA" - HEAL, STANDING FOR "HEALTHY EATING ACTIVE LIVING". MSHA RECEIVED OVER 100 APPLICATIONS FOR THE MICRO-GRANTS. THE APPLICANTS AWARDED THE GRANTS WERE ANNOUNCED AT A REGIONAL HEALTH SYMPOSIUM FOCUSING ON OBESITY. DURING FY11 MSHA SPENT $34,004 ON COORDINATING THE HEAL PROGRAM AND HOSTING THE SYMPOSIUM AND PAID 18 OF THE 25 GRANTS, OR $36,000. MSHA'S TOTAL FY11 COST: $70,004. THE HEAL APPALACHIA COMMITTEE WILL EVALUATE LOCAL PROGRAM GRANT RECIPIENTS AS TO THEIR ABILITY TO MAKE A MEASURABLE IMPACT ON THE LEVEL OF CHILDHOOD OBESITY THROUGHOUT THE REGION. THIS COMMITTEE WILL THEN MAKE RECOMMENDATIONS TO EXECUTIVE LEADERSHIP AS TO HOW MSHA SHOULD CONTINUE TO DIRECT FINANCIAL SUPPORT FOR SUCCESSFUL PROGRAMS. IN ADDITION TO THE HEAL APPALACHIA GRANTS AND SYMPOSIUM, MSHA DONATED $30,750 TO ETSU'S FIT KIDS PROGRAM, ANOTHER PROGRAM WITH A FOCUS ON REDUCING CHILDHOOD OBESITY AND IMPROVING THE HEALTH OF CHILDREN. PROGRAMS FOR THE COMMUNITY AT LARGE IN ADDITION TO THE HEALTH SCREENINGS AND SUPPORT GROUPS OFFERED THROUGH THE HEALTH RESOURCES CENTER, DESCRIBED ABOVE, A VARIETY OF SCREENINGS, SUPPORT GROUPS, HEALTH EDUCATION, AND HEALTH FAIRS WERE PROVIDED AT A COST OF MORE THAN $23,000. THESE ACTIVITIES INCLUDE PROVIDING COMMUNITY HEALTH EDUCATION ON SUCH TOPICS AS ORTHOPEDICS, PRE- AND POST- NATAL, NUTRITION, SLEEP DISORDERS, BEHAVIORAL HEALTH ISSUES, CARDIOVASCULAR HEALTH, AND MANY OTHERS. IN ADDITION TO HEALTH EDUCATION, MSHA PROVIDED FREE BLOOD PRESSURE SCREENINGS AND COLORECTAL SCREENINGS, FOR SPECIFIC POPULATIONS AS WELL AS PHYSICALS FOR PEE-WEE AND HIGH SCHOOL FOOTBALL PLAYERS IN JOHNSON COUNTY. THE HOSPICE PROGRAM OFFERS EXTENDED 13-MONTH BEREAVEMENT SUPPORT RATHER THAN THE REQUIRED 12-MONTH PERIOD, THUS SUPPORTING FAMILIES DURING THE ANNIVERSARY MONTH OF THE PATIENT'S DEATH, WHICH CAN BE A CHALLENGING TIME. ALSO PROVIDED IS A CELEBRATION OF LIFE PROGRAM FOR FAMILIES OF FORMER HOSPICE PATIENTS AND THE COMMUNITY AT LARGE. THE PARISH NURSE PROGRAM IS SPONSORED BY MSHA'S HOME HEALTH ORGANIZATION, WITH GOALS OF RECRUITING AREA CHURCHES AND REGISTERED NURSES TO THE PROGRAM AND PROVIDING PARTICIPANTS WITH EDUCATION ABOUT PARISH NURSING. PARISH NURSING IS AN AMALGAM OF SOCIAL WORK, GOOD NEIGHBORING AND NURSING. IT SUPPORTS, EDUCATES AND COUNSELS THOSE WITH HEALTHCARE NEEDS FROM WITHIN THEIR PLACES OF WORSHIP. A FEW OF THE SERVICES PROVIDED BY PARISH NURSES ARE BLOOD DRIVES, FLU SHOTS, HEALTH SCREENINGS, HEALTH FAIRS AND MONTHLY BLOOD PRESSURE CLINICS. SEVERAL OF THE NURSES ARE CERTIFIED TO TEACH CPR AND FIRST AID AT NO COST TO PARTICIPANTS. MSHA PROVIDES THE PARISH NURSE PROGRAM WITH COORDINATORS, SPONSORED ORIENTATION, MONTHLY EDUCATIONAL PROGRAMS AND OTHER SUPPORT FUNCTIONS. CURRENTLY, THERE ARE 26 CHURCHES PARTICIPATING IN TENNESSEE AND SIX IN SOUTHWEST VIRGINIA WITH PARISH NURSES ON STAFF. MSHA'S FY11 COST FOR THE PARISH NURSE PROGRAM WAS $60,211. THE RESPOND DEPARTMENT AT WOODRIDGE HOSPITAL (WH) OFFER ASSESSMENTS AND REFERRALS FOR INDIVIDUALS DEALING WITH MENTAL HEALTH ISSUES AND SUBSTANCE ABUSE. PROFESSIONAL STAFF INCLUDES BEHAVIORAL HEALTH COUNSELORS AND RN'S WHO ARE AVAILABLE 24 HOURS A DAY, SEVEN DAYS A WEEK TO ANSWER CALLS FROM THE COMMUNITY CONCERNING TREATMENT. THROUGHOUT THE ASSESSMENT PROCESS, RESPOND COLLABORATES WITH A PSYCHIATRIST TO DETERMINE THE MOST APPROPRIATE LEVEL OF CARE. THE RESPOND DEPARTMENT AT WH INCURRED UNREIMBURSED COSTS OF $708,633 DURING FY11. MSHA PROVIDED STAFF TO LOCAL AGENCIES, COUNCILS AND OTHER CHARITABLE ORGANIZATIONS TO ASSIST WITH LEADERSHIP PROGRAMS, PLANNING, SERVICE ON STEERING COMMITTEES AND PARTICIPATION WITH SPECIAL EVENTS. EXAMPLES INCLUDE AMERICAN RED CROSS BLOOD DRIVES, HEALTHY BABIES DAY, THE AMERICAN CANCER SOCIETY LEADERSHIP COUNCIL AND OTHERS AT A COST TO MSHA OF $26,565. WE FEEL SURE THIS AMOUNT IS UNDERREPORTED DUE TO THE DIFFICULTY IN TRACKING TEAM MEMBERS' MANY ACTIVITIES. PROGRAMS FOR SPECIAL POPULATIONS DUE TO THE USE OF EMERGENCY DEPARTMENTS AS WALK-IN CLINICS BY THE POOR AND UNDERSERVED, MSHA HAS HELPED ESTABLISH AND FINANCE ALTERNATIVE CARE SETTINGS SUCH AS THE ETSU COLLEGE OF NURSING'S DOWNTOWN CLINIC IN JOHNSON CITY, TN. THE DOWNTOWN CLINIC IS DEDICATED TO SERVING THE PRIMARY NEEDS OF THE HOMELESS, INDIGENT AND UNINSURED POPULATIONS, PROVIDING THEM WITH FREE LABORATORY TESTING AND ASSISTANCE WITH THEIR DIAGNOSIS AND TREATMENTS. MSHA GIFTS THE CLINIC RENT, WHICH IS VALUED AT A DISCOUNTED $35,000 ANNUALLY. MSHA HAS AN AGREEMENT WITH THE DOWNTOWN CLINIC TO PROCESS THEIR LAB SPECIMENS AS WELL AS PROVIDE SOME DIAGNOSTIC IMAGING SERVICES TO CLINIC PATIENTS AT NO COST TO THE PATIENT OR THE CLINIC. IN FY11, THE COST ASSOCIATED WITH THE CLINIC'S LAB TESTING WAS $63,860 AND THE COST OF DIAGNOSTIC IMAGING SERVICES WAS $10,428. THESE EXPENSES ARE INCLUDED IN MSHA'S CHARITY WRITE-OFFS. PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) FORM 990, PART III, LINE 4A DURING FY11, MSHA ALSO CONTRIBUTED AN ADDITIONAL $30,000 CONTRIBUTION TO ASSIST WITH THE CLINIC'S OPERATIONS. MSHA'S SERVICE AREA COMPRISES A STABLE, AGING POPULATION, SO THE ORGANIZATION HAS ESTABLISHED A NUMBER OF PROGRAMS TO SERVE THE NEEDS OF SENIOR CITIZENS. AN EXAMPLE OF A SENIOR PROGRAM IS THE PINNACLE CLUB A COMMUNITY OUTREACH PROGRAM FOR SERVICE-AREA SENIORS THAT OFFERS MONTHLY HEALTH-RELATED EVENTS AND FELLOWSHIP OPPORTUNITIES AT JOHNSON CITY MEDICAL CENTER, INDIAN PATH MEDICAL CENTER, RUSSELL COUNTY MEDICAL CENTER AND SYCAMORE SHOALS HOSPITAL. BENEFITS INCLUDE HEALTH SCREENINGS, FREE ANNUAL LAB SCREENINGS, AND DISCOUNTED FIRST-TIME ENROLLMENT FEES AT OUR WELLNESS CENTER AND FRANKLIN FITNESS CENTER. THE CLUB SPONSORS HEALTH FAIRS, THE SENIOR EXPO, AND MONTHLY EDUCATIONAL LUNCHEONS IN KINGSPORT, JOHNSON CITY, AND ELIZABETHTON, TN, AND IN LEBANON, VA. THE CLUB ALSO PROVIDES FREE NOTARY SERVICES, SOCIALS, TRAVEL OPPORTUNITIES AND DISCOUNTS THROUGH NUMEROUS VENDORS. DURING FY11, MSHA INCURRED A NET OPERATING LOSS OF $51,651 ATTRIBUTABLE TO ITS SUPPORT OF THE PROGRAM. 3) EDUCATION AND TRAINING COMMUNITY HEALTH EDUCATIONAL PROGRAMS MSHA PROVIDED A VARIETY OF WELLNESS AND HEALTH INFORMATION TO HELP EDUCATE AREA RESIDENTS ABOUT COMMUNITY-SPECIFIC HEALTH ISSUES. INFORMATION WAS PROVIDED THROUGH PRINTED MATERIALS, SPEAKING ENGAGEMENTS, RADIO AND TELEVISION INTERVIEWS, AND HEALTH FAIRS AND EXPOS. MSHA ACCEPTED INVITATIONS TO SPEAK ON HEALTH-RELATED TOPICS AT VARIOUS COMMUNITY ORGANIZATIONS AND SCHOOLS. A VARIETY OF TOPICS WERE PRESENTED SUCH AS SKIN CARE, STRESS MANAGEMENT, NUTRITION, WEIGHT MANAGEMENT, PREVENTIVE CARE MEASURES, CARE OF AGING PARENTS AND OTHERS. YOUTH EDUCATION PROGRAMS WERE PRESENTED TO STUDENTS RANGING FROM KINDERGARTEN TO COLLEGE AND WERE DESIGNED TO PROMOTE SAFETY AT PLAY; AGE-APPROPRIATE HEALTH ISSUES; ILLNESS AND INJURY PREVENTION TECHNIQUES; NUTRITION; AND THE DANGERS OF TOBACCO, ALCOHOL AND DRUG USE. DIETITIANS GAVE TALKS, PROVIDED FOOD DEMONSTRATIONS TO VARIOUS GROUPS AND VISITED AREA SCHOOLS TO DISCUSS NUTRITION. HOME HEALTH, HOSPICE AND PARISH NURSING ALSO PROVIDED NUMEROUS SPEAKING ENGAGEMENTS. THE COST OF PROVIDING THESE SPEAKING ENGAGEMENTS WAS APPROXIMATELY $62,027. MSHA'S AMERICAN HEART ASSOCIATION (AHA) TRAINING CENTER OFFERED SEVERAL COURSES TO HEALTHCARE PROVIDERS AND TO THE PUBLIC IN AN EFFORT TO EXPAND THE OUTREACH OF THE AMERICAN HEART ASSOCIATION AND MSHA IN PROMOTING WELLNESS AND SAVING LIVES. PROGRAMS INCLUDE: ADVANCED CARDIAC LIFE SUPPORT, BASIC CARDIAC LIFE SUPPORT, PEDIATRIC ADVANCED LIFE SUPPORT, FIRST AID AND LIFE SUPPORT INSTRUCTOR TRAINING. THE FY11 UNREIMBURSED COST TO PROVIDE THE EDUCATIONAL COURSES TO THE PUBLIC WAS $211,155. IMPORTANT TO THE EFFICIENT AND SAFE OPERATION OF THE AIR AMBULANCE IS A CLEAR UNDERSTANDING OF HOW TO CLEAR AND PREPARE LANDING ZONES AND APPROPRIATE METHODS FOR COMMUNICATING WITH AIR HELICOPTER PILOTS AT ACCIDENT SCENES AND TRANSPORT SITES. WINGS AIR RESCUE MADE MORE THAN 100 TRAINING RUNS TO AREA EMERGENCY MEDICAL SERVICE FACILITIES TO PERFORM TRAINING OF EMS CREWS. 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