2011-05-12T07:44:31-05:00 2010-06-30 Pershing Yoakley & Associates P C One Cherokee Mills 2220 Sutherland Knoxville TN 379192363 990 2009-07-01 620476282 MOUNTAIN STATES HEALTH ALLIANCE MOUN 4234311013 400 NORTH STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 MARVIN EICHORN 4234311013 2011-05-12 1 DEBORAH O ERNSBERGER 8656730844 2009 2016-02-24 21:20:13Z Johnson City Medical Center DENNIS VONDERFECHT 701 NSTATE OF FRANKLIN RD Ste 1 JOHNSON CITY TN 37604 701975767 0 X www.msha.com X 1945 TN PLEASE SEE SCHEDULE O - PART I, LINE 1, MISSION AND SIGNIFICANT ACTIVITIES. 14 8 8698 1464 4102501 207227 3633909 3938777 658812783 674850480 15033623 16043398 6512402 6999981 683992717 701832636 460751 301136 0 276505647 287264466 0 1500104 369535487 370493266 646501885 658058868 37490832 43773768 1529066198 1530090739 1349056846 1311074327 180009352 219016412 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 537083477 301136 674850480 Mountain States Health Alliance (MSHA) was created in September 1998 as a private, locally owned, tax-exempt, regional healthcare system. MSHA is a 1,221 bed tertiary-care and referral hospital system, the region's largest by bed count and volumes. For the year ending June 30, 2010, MSHA recorded 47,209 inpatient admissions, and provided for 747,043 outpatient visits, including 165,260 emergency visits and 95,493 home health visits. The Alliance is composed of 10 hospitals, an outpatient surgery center, an outpatient radiation oncology center, an outpatient diagnostic center and two outpatient rehabilitation therapy centers. It also has services for home health, durable medical equipment, infusion therapy, hospice and parish nursing. 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 10 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 JMH, NCH, DCH and SCCH are partially owned entities, their data are excluded from this document and each of the 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 to the 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 - Home of the region's only organ transplant program - one of only six in Tennessee- 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- 2001-2010 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-licensed hospitals: Niswonger Children's Hospital at JCMC, the region's only NACHRI-affiliated children's hospital; James H. & Cecile C. Quillen Rehabilitation Hospital (CARF-accredited); and Woodridge Hospital for behavioral health services.North Side Hospital and Johnson City Specialty Hospital, each separately licensed, are also located in Washington County. 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 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. Other recognitions received by MSHA include the Verispan top 100 Integrated Hospital Networks designation and the 2008 Most Wired Hospitals and Healthcare Networks by Hospital and Healthcare Networks magazine.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. - 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 ResearchMSHA 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 $4,172,639 to the residency program in FY10.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. In FY10, MSHA incurred an expense of $37,818 to coordinate and orient these health care professional students. Also receiving clinical experience at MSHA were 1,326 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 $2,716,207. MSHA provided a clinical setting for another 963 students training in health-related programs such as radiology, pharmacy, laboratory, physical therapy and other allied-health disciplines. These additional clinical students cost MSHA $728,534. MSHA provided assistance to 363 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 $8,233. 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 FY10 cost of providing this service was $297,874. 537083477 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 0 0 1 932 0 1 8698 1 1 1 0 0 0 0 0 0 0 0 14 8 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 VA X MARVIN EICHORN 4234311017 400 N STATE OF FRANKLIN RD JOHNSON CITY TN 37604 DENNIS VONDERFECHT 60.00 X X 964066 0 40201 CAMERON PERRY 1.00 X 0 0 0 WILLIAM WALKER MD 1.00 X 0 577986 1928 BARBARA ALLEN 1.00 X 0 0 0 JEFF FARROW MD 1.00 X 35713 0 0 JOHN CAMPBELL 1.00 X 0 0 0 SANDRA BROOKS MD 1.00 X 0 0 0 DON JEANES 2.00 X 0 0 0 MAUREEN MACIVER 1.00 X 0 0 0 GARY PEACOCK 1.00 X 0 0 0 CLEM WILKES JR 1.00 X 0 0 0 Robert FEATHERS 2.00 X 0 0 0 BILL HAWKINS JR 1.00 X 0 0 0 MIKE CHRISTIAN 1.00 X 0 0 0 MARVIN EICHORN 60.00 X 649704 0 213607 DALE CLAYTORE 55.00 X 205724 0 10656 JOHN DOYLE 55.00 X 200804 0 30897 ANN FLEMING 60.00 X 427191 0 59477 CANDACE JENNINGS 60.00 X 379905 0 54298 LYNN KRUTAK 58.00 X 234263 0 30184 MONTY MCLAURIN 46.00 X 345168 0 52598 CINDY SALYER 40.00 X 251254 0 40467 JOHN MELTON 3.40 X 2205600 0 15133 SHANE HILTON 50.00 X 176949 0 28519 KENNETH MARSHALL MD 40.00 X 451033 0 21731 STEVE KILGORE 60.00 X 297288 0 45268 JAMIE PARSONS 50.00 X 281728 0 28304 CHAO LEE MD 50.00 X 310545 0 14168 KATHRYN WILHOIT 60.00 X 264734 0 35105 7681669 577986 722541 146 0 1 0 HOSPITAL HOUSEKEEPING SYSTEMS 322 CONGRESS AVENUE AUSTIN TX 78701 HOUSEKEEPING SERVICES/MGMT 3381643 PEPPER CONSTRUCTION COMPANY OF INDIANA L 1850 W 15TH STREET INDIANAPOLIS IN 46202 CONSTRUCTION 2928377 ADVANTAGE RN 4184 RELIABLE PARKWAY CHICAGO IL 60686 STAFFING AGENCY 1989468 TRAVEL NURSE SOLUTIONS LLC 3750 CORPORATE WOODS DRIVE BIRMINGHAM AL 35242 STAFFING AGENCY 1483511 CDSS ENTERPRISES 635 TOLL BRANCH ROAD JOHNSON CITY TN 37601 CONSTRUCTION 1123648 34 2339424 1428005 171348 3938777 PATIENT SERVICES 621500 672200303 670070746 2129557 WELLNESS PROGRAMS 621990 4229251 4229251 P/S PROG. SERV. INCOME 561000 1449659 1362711 86948 LOSS ON LTD RETIREMENT 900099 -3028733 -3028733 674850480 14123757 152 14123605 339830 339830 423695 140107 283588 283588 283588 1543695 39140 3024 1543695 36116 1579811 1579811 CAFETERIA SALES 722210 3929282 3929282 DIET/SECur/engin/OTHER 541900 956293 1011147 -54854 JCMC DAYCARE 624410 956121 956121 874697 874697 6716393 701832636 672633975 4102501 21157383 301136 301136 6072398 6072398 224097635 211195081 12242249 660305 11835925 11361314 439098 35513 28178615 27421769 713732 43114 17079893 15444370 1601282 34241 232389 232389 1474842 1474842 345299 6679 325171 13449 35240 35240 921188 921188 83722456 63612751 19853204 256501 2822113 2162437 637583 22093 9497514 7763561 1438671 295282 10269378 9309886 959492 12376788 10538044 1774891 63853 1768635 1261526 475892 31217 284845 217954 66071 820 41417948 16370 41401578 55577812 27027243 28542833 7736 1418464 16637 1401827 MEDICAL SUPPLIES & DRUG 129702248 129407850 293492 906 TAXES - UBIT 65000 65000 REPAIRS & MAINTENANCE 13401647 12958124 430637 12886 BAD DEBTS 3821964 3819759 2205 RECRUITMENT & RETENTION 1524671 1010471 513940 260 -187175 2230515 -2439618 21928 658058868 537083477 119475287 1500104 191283991 208449573 288879 189220 87441027 84415992 3643645 4579735 98414951 20219171 13908048 14609053 7002378 4368028 834022717 370371063 394242703 463651654 137081332 152089704 282350254 282350254 154365082 143276118 159043908 151892237 1529066198 1530090739 74107505 76082572 20765454 20092072 610470055 626569957 389886147 400096949 4342306 3114607 249485379 185118170 1349056846 1311074327 X 179553523 218490539 455829 525873 180009352 219016412 1529066198 1530090739 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 273954 0 0 273954 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR THE COMMUNITY & GOVERNMENT RELATIONS MANAGERS 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 CONFERENCE THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR THE COMMUNITY & GOVERNMENT RELATIONS MANAGERS HAVE ALSO SENT LETTERS AND MADE CALLS TO A CONGRESSIONAL OFFICE CONCERNING THE FOLLOWING ISSUES: - HEALTH REFORM - SUPPORTED ADEQUATE MEDICAID PAYMENTS TO CHILDREN'S PROVIDERS - REAUTHORIZATION OF THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - SAFEGUARDING GRADUATE MEDICAL EDUCATION - OPPOSED CUTS TO INDIRECT MEDICAL EDUCATION AND LAWS CHANGING THE TAX EXEMPT STATUS FOR NOT-FOR-PROFIT HOSPITALS TO FUND PROPOSED HEALTH CARE REFORM - SUPPORTED NEEDED CHANGES RELATED TO HEALTH INFORMATION TECHNOLOGY (HIT) INCENTIVE PAYMENTS INCLUDING MEANINGFUL USE CRITERIA - SUPPORTED THE CONTINUATION OF TENNESSEE'S FEDERAL DSH PAYMENT - PARTICIPATED IN EFFORT TO REAUTHORIZE FEDERAL TRAUMA FUNDING UP TO $200 MILLION THE FOLLOWING ARE EXAMPLES OF STATE OF TENNESSEE AND VIRGINIA LEGISLATION THAT THE COMMUNITY & GOVERNMENT RELATIONS ASSISTANT VICE PRESIDENT AND/OR THE COMMUNITY & GOVERNMENT RELATIONS MANAGERS AND DIRECTOR RESPONDED TO BY LETTER, CALL OR IN PERSON: - OPPOSED PAYMENT RATE REDUCTIONS - TENNCARE AND VIRGINIA MEDICAID - SUPPORTED CONTINUATION OF CON (COPN) - SUPPORTED THE CONTINUATION OF SAFETY NET FUNDING, INCLUDING TENNESSEE'S TRAUMA FUND - OPPOSED LEGISLATION TO REPEAL TENNESSEE'S HELMET REQUIREMENT FOR MOTORCYCLISTS - SUPPORTED PASSAGE OF MENTAL HEALTH GRANT FOR WOODRIDGE HOSPITAL - SUPPORTED EFFORTS THAT RESTORED FUNDING TO TENNESSEE'S PERINATAL CENTERS, THE GOVERNOR'S OFFICE ON CHILDCARE COORDINATION AND THE COORDINATED SCHOOL HEALTH PROGRAM - WORKED CLOSELY WITH THE COMMISSIONER OF FINANCE AND ADMINISTRATION IN HIS SUCCESSFUL EFFORT TO OBTAIN $13 MILLION IN FIRST TIME MONIES TO FUND HEALTH INFORMATION TECHNOLOGY INITIATIVES ACROSS THE STATE - INVOLVED IN ADVOCATING FOR AN EXTRA $10 MILLION IN THE TENNESSEE BUDGET FOR CRITICAL ACCESS HOSPITALS, INCLUDING JCCH. THE FUNDING WAS INCLUDED IN THE BUDGET, DEPENDENT ON THE EXTENSION OF THE ENHANCED FMAP. 28449100 28449100 425267056 113981335 311285721 770639 352320 418319 379535922 256037408 123498514 463651654 INVESTMENT IN BRMMC 100273634 C INVESTMENT IN ISHN 1784120 C INVESTMENT IN PREMIER 192500 C INVESTMENT IN SCCH 48100000 C INVESTMENT IN JMH 132000000 C 282350254 AWUL - CURRENT 6763171 AWUL - UNDER BOND INDENTURE AGREEMENTS 113355234 DEFERRED CHARGES AND OTHER 23879227 LONG TERM COMPENSATION INVESTMENT 7894605 151892237 ACCRUED INTEREST 15550017 OTHER LONG-TERM LIABILITIES 6672623 ACCRUED SALARIES, ABSENCES, & W/H 31604489 CALL OPTION LIABILITY 89650437 ESTIMATED FAIR VALUE OF INT. RATE SWAP 33657579 DUE TO THIRD PARTY PAYORS 7983025 185118170 Part X: Description of Uncertain Tax Positions Under FIN 48: MOUNTAIN STATES HEALTH ALLIANCE (MSHA) IS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MSHA DOES FILE FORM 990T TO REPORT UNRELATED BUSINESS INCOME (UBI) AND PAYS ALL FEDERAL AND STATE TAXES ASSOCIATED WITH UBI. MSHA COMPLIES WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARD CODIFICATION (ASC) 740, INCOME TAXES. THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2010. AS SUCH, NO INTEREST OR PENALTIES ARE RECOGNIZED IN THE FINANCIAL STATEMENTS RELATED TO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 1 X 1 1 1 0 1 1 10245255 10245255 0.01570 14306147 9379265 4926882 0.00750 73153528 49372561 23780967 0.03630 97704930 58751826 38953104 0.05950 5134349 5134349 0.00780 10017117 2353686 7663431 0.01170 16838664 16838664 0.02570 450976 450976 0.00070 254033 254033 0.00040 32695139 2353686 30341453 0.04630 130400069 61105512 69294557 0.10580 28725 28725 0.00000 3225 3225 0.00000 832 832 0.00000 224 224 0.00000 199291 199291 0.00030 40526 40526 0.00010 272823 272823 0.00040 1 16796337 10077802 190127886 192702548 -2574662 X 1 1 INDIAN PATH MEDICAL CENTER

2000 BROOKSIDE DRIVE KINGSPORT TN 37660

X X X X INDIAN PATH TRANSITIONAL

2000 BROOKSIDE DRIVE KINGSPORT TN 37660

SKILLED NURSING JOHNSON CITY MEDICAL CENTER

400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604

X X X X X X REHABILITATION & MENTAL HEALTH HOSPITALS JCMC AMBULATORY SURGERY

400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604

X AMBUL. SURG. CNTR JOHNSON CITY SPECIALTY HOSPITAL

203 E WATAUGA AVENUE JOHNSON CITY TN 37601

X X JOHNSON COUNTY COMMUNITY HOSPITAL

1901 S SHADY STREET MOUNTAIN CITY TN 37683

X X X JOHNSON COUNTY HOME HEALTH

1987 S SHADY STREET MOUNTAIN CITY TN 37683

HOME HEALTH MEDICAL CENTER HOME CARE - JOHNSON CITY

101 MED TECH PKWY STE 100 JOHNSON CITY TN 37604

HOME HEALTH MEDICAL CENTER HOME CARE - KINGSPORT

2020 BROOKSIDE DRIVE 28 KINGSPORT TN 37660

HOME HEALTH MEDICAL CENTER HOSPICE

101 MED TECH PKWY STE 100 JOHNSON CITY TN 37604

HOSPICE MOUNTAIN STATES DIAGNOSTIC CENTER

1 PROFESSIONAL PARK DRIVE 16 JOHNSON CITY TN 37604

LICENSED OP DIAGNOSTIC CENTER NORTH SIDE HOSPITAL

401 PRINCETON ROAD JOHNSON CITY TN 37602

X X X PRINCETON TRANSITIONAL

401 PRINCETON ROAD JOHNSON CITY TN 37602

SKILLED NURSING RUSSELL COUNTY MEDICAL CENTER

58 CARROLL STREET LEBANON VA 24266

X X X RUSSELL CO MEDICAL CENTER HOME HEALTH

116 FLANNAGAN AVENUE LEBANON VA 24266

HOME HEALTH RUSSELL COUNTY MEDICAL CENTER HOSPICE

116 FLANNAGAN AVENUE LEBANON VA 24266

HOSPICE SYCAMORE SHOALS HOSPITAL

1501 W ELK AVENUE ELIZABETHTON TN 37643

X X X FRANKLIN TRANSITIONAL

2511 WESLEY STREET JOHNSON CITY TN 37601

SKILLED NURSING MTN STATES IMAGING CNTR AT MED TECH PARK

301 MED TECH PKWY STE 100 JOHNSON CITY TN 37604

LICENSED OP DIAGNOSTIC CENTER 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 $59,577 for the twelve months ending June, 2010. The specialty clinic includes cardiology, OB/GYN, general surgery, vascular surgery, neurology, 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.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 the 12-month reporting period, the clinic had 10,900 outpatient visits and incurred unreimbursed expenses of $527,710. Part I, Line 7f: Bad Debt expense of $3,821,964 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 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 2010, 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 and Changes in Net Assets 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. 16% of those patients approved for financial assistance were Bad Debt transfers. We find it unreasonable to apply either of these percentages to our bad debt population as there are many additional variables that must be considered. 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 JMH'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, JMH 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 JMH 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 2010, 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. 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 MedAssist to work with self-paying patients who have limited financial resources. MedAssist determines a patient's eligibility in medical coverage options and assists with their enrollment. MSHA bears the cost for the MedAssist 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 5: 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, rotary 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 their 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 for a federally underserved area is reported in Community Building and makes up the majority of the total expense reported on Schedule H, Part II. 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 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 14 hospitals. 10 facilities are wholly-owned and 4 are majority owned. This Form 990 encompasses 10 wholly-owned facilities: 9 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 in this reporting FEIN, 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. VA 1 ETSU FOUNDATION PO BOX 70721 JOHNSON CITY TN 37614 237092731 501(C)(3) 30000 SUPPORT CLINIC DEDICATED TO IMPROVING THE HEALTH OF UNINSURED AND UNDERINSURED PEOPLE ETSU 807 UNIVERSITY PKWY JOHNSON CITY TN 37614 626021046 501(C)(3) 10250 2200 FMV DONATION OF MEDICAL EQUIPMENT EQUIPMENT DONATION TO BENEFIT THE FIT KIDS PROGRAM CARESPARK PO BOX 657 125 BROAD STREET KINGSPORT TN 37662 202694144 501(C)(3) 50000 SUPPORT DEVELOPMENT OF SHARED HEALTH INFORMATION TO IMPROVE PATIENT CARE TENNESSEE TECHNOLOGY CENTER 1500 ARNEY STREET ELIZABETHTON TN 37643 621113186 501(C)(3) 25000 SUPPORT HEALTH PROFESSION EDUCATION SUSAN KOMEN BREAST CANCER FOUNDATION POBOX 5835 KINGSPORT TN 37663 841689067 501(C)(3) 25000 BREAST CANCER RESEARCH AMERICAN HEART ASSOCIATION 1101 NORTHCHASE PKWY STE 1 MARIETTA GA 30067 135613797 501(C)(3) 10700 SUPPORT HEART HEALTH RESEARCH AND EDUCATION GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ADADEMY AVE DANVILLE PA 17822 232164794 501(C)(3) 10000 SUPPORT INNOVATIVE RESEARCH FOR SPECIALIZED TREATMENT OPTIONS WELLMONT FOUNDATION INC 1905 AMERICAN WAY STE 102 KINGSPORT TN 37660 581594191 501(C)(3) 15000 DONATION FOR HAITI EARTHQUAKE RELIEF HANDS ON REGIONAL MUSEUM 315 E MAIN STREET KINGSPORT TN 37601 621282542 501(C)(3) 12000 SUPPORT TO LOCAL INTERACTIVE CHILDREN'S MUSEUM JOHNSON CITY PARKS AND RECREATION PO BOX 1535 JOHNSON CITY TN 37605 383731893 501(C)(3) 5000 152 DONATION FOR CONSTRUCTION OF A VETERANS MEMORIAL COALITION FOR KIDS PO BOX 3156 JOHNSON CITY TN 37602 621765487 501(C)(3) 5000 2562 ACTUAL COST PROVIDED PRINT SERVICES FOR NEWSLETTER AFTER SCHOOL TUTORING AND MENTORING PROGRAM FOR KIDS 11 0 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 FY10, 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 630093 0 260107 0 73866 0 17150 0 23051 0 1004267 0 0 0 WILLIAM WALKER MD 0 549042 0 27765 0 1179 0 0 0 1928 0 579914 0 0 MARVIN EICHORN 420689 0 171393 0 57622 0 187084 0 26523 0 863311 0 0 0 DALE CLAYTORE 161081 0 42308 0 2335 0 8053 0 2603 0 216380 0 0 0 JOHN DOYLE 184620 0 6625 0 9559 0 11983 0 18914 0 231701 0 0 0 ANN FLEMING 294561 0 110625 0 22005 0 39321 0 20156 0 486668 0 0 0 CANDACE JENNINGS 284204 0 84870 0 10831 0 31792 0 22506 0 434203 0 0 0 LYNN KRUTAK 182942 0 50362 0 959 0 11433 0 18751 0 264447 0 0 0 MONTY MCLAURIN 253486 0 81353 0 10329 0 24719 0 27879 0 397766 0 0 0 CINDY SALYER 180720 0 61029 0 9505 0 20722 0 19745 0 291721 0 0 0 JOHN MELTON 134138 0 48326 0 2023136 0 3571 0 11562 0 2220733 0 0 0 SHANE HILTON 157468 0 9625 0 9856 0 10314 0 18205 0 205468 0 0 0 KENNETH MARSHALL MD 37572 0 59427 0 354034 0 1527 0 20204 0 472764 0 0 0 STEVE KILGORE 219768 0 71101 0 6419 0 24801 0 20467 0 342556 0 0 0 JAMIE PARSONS 193130 0 70895 0 17703 0 20306 0 7998 0 310032 0 0 0 CHAO LEE MD 310545 0 0 0 0 0 0 0 14168 0 324713 0 0 0 KATHRYN WILHOIT 174117 0 63031 0 27586 0 15716 0 19389 0 299839 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 4a 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, 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. Supplemental Information Part III Part ii: JOHN MELTON, SENIOR VICE PRESIDENT, RECEIVED A DISABILITY INSURANCE PAYMENT OF $2,022,088, WHICH WAS INCLUDED IN HIS TAXABLE INCOME FROM MSHA. HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 621464028 2010-05-27 16000000 ACQUIRE HOSPITAL EQUIPMENT 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 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 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 HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 621464028 478271HJ1 2007-12-14 140930000 CONSTRUCT & EQUIP HOSP FACILITIES, REFUND BONDS ISSUED 3/18/94 & 4/12/06 0 0 14679978 14679978 45000 1275039 0 0 0 1 44816060 18355842 26460217 3474644 1 0 0 1 55112561 12156318 42956238 2481706 57043762 0 0 0 1 624760 624760 1953563 4473649 103874142 0 0 0 1 1172457 1172457 1903195 29888340 1 0 0 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00010 0.00010 1 0 0 1 0 1 0.00000 0.00010 0.00010 1 0 0 1 0 1 0.00000 0.00010 0.00010 1 0 0 1 0 1 0.00000 0.00010 0.00010 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 RABOBANK INTERNATIONAL 1 1 0 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 25245326 18053000 7192326 2383533 122694950 1 1 0 1 0 0 1 0 1 0.00000 0.00010 0.00010 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 4579735 CLEM WILKES III FAMILY MEMBER OF CLEM WILKES, JR., MSHA BOARD treasurer. 43172 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. 467225 DR. SANDRA BROOKS, MEMBER OF THE MSHA BOARD OF DIRECTORS, IS An owner IN and serves as vice president of WATAUGA PATHOLOGY ASSOCIATES, P.C., WHICH PROVIDES MEDICAL SERVICES TO MSHA. 0 PULMONARY ASSOCIATES OF EAST TENNESSEE PC PROVIDER OF MEDICAL SERVICES TO MSHA. 96299 DR. JEFF FARROW, MEMBER OF THE MSHA BOARD OF DIRECTORS, IS An owner IN PULMONARY ASSOCIATES OF EAST TENNESSEE, P.C., WHICH PROVIDES MEDICAL SERVICES TO MSHA. 0 PAULA CLAYTORE FAMILY MEMBER OF DALE CLAYTORE, MSHA KEY EMPLOYEE. 201835 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. 1169549 ROBERT FEATHERS, vice chair OF THE MSHA BOARD OF DIRECTORS, IS OWNER OF WORKSPACE INTERIORS, INC., WHICH PROVIDES COMMERCIAL FURNISHING PRODUCTS TO MSHA. DURING FY10, MSHA COMPLETED CONSTRUCTION OF OUR NEW HOSPITAL, FRANKLIN WOODS COMMUNITY HOSPITAL. MSHA PURCHASED FURNISHINGS FROM WORKSPACE INTERIORS, INC. FOR THE NEW HOSPITAL. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH BASED UPON AN INDEPENDENT BIDDING PROCESS. ONLY INDEPENDENT, DISINTERESTED MEMBERS OF THE BOARD REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF CONSTRUCTION CONTRACTS, WHICH INCLUDE FURNISHINGS RELATED TO NEW CONSTRUCTION. 0 Form 990, Part I, Item C Doing Business As JOhnson City Specialty Hospital JOhnson county community hospital North side Hospital Russell County Medical Center Sycamore shoals hospital Indian Path Medical Center Woodridge Hospital for Behavioral Health Services Form 990, Part VI, Section A, line 6 THE CORPORATION IS ORGANIZED AS A TENNESSEE NOT-FOR-PROFIT MEMBERSHIP CORPORATION. FOR THE PAYMENT OF $100, AND APPROVAL BY THE BOARD OF DIRECTORS, AN INDIVIDUAL MAY BECOME A MEMBER OF THE CORPORATION. Form 990, Part VI, Section A, line 7a THE MEMBERS OF THE CORPORATION ANNUALLY ELECT MEMBERS OF 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 MEMBERSHIP AS WELL. 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. FORM 990, PART VII, SECTION A, officer, Key employee & highest paid compensation: 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. MSHA BOARD MEMBER, DR. JEFF FARROW, HAS FORM 990 REPORTABLE COMPENSATION DERIVED FROM MEDICAL SERVICES HE PROVIDES TO A MSHA HOSPITAL. HE DOES NOT RECEIVE COMPENSATION FOR HIS SERVICES AS A MSHA BOARD MEMBER. DR. WILLIAM WALKER, MSHA BOARD MEMBER, HAS REPORTABLE COMPENSATION AND BENEFITS PAID 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 MOUNTAIN STATES HEALTH ALLIANCE. THESE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS. FORM 990, PART XI, LINE 2C, Audit committee: The audit committee's oversight and selection processes did not change during the tax year. 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 2. 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. 3. Comment on Schedule K, Part II, Line 6. 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. 4. 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. 5. 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. 6. Comment on Schedule K, Part IV, Line 5. The bond issues described in Lines E and F 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 Lines D and E 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 E and Line F have become transferred proceeds of the Series 2010 Bonds (and are reported under the appropriate lines for the Series 2010 Bonds). form 990, part i, line i, mission & significant activities: MOUNTAIN STATES HEALTH ALLIANCE (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. NEAR THE END OF FY10, MSHA COMPLETED CONSTRUCTION OF A NEW REPLACEMENT HOSPITAL, FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH), A CERTIFIED "GREEN" FACILITY AND THE FIRST "GREEN" HOSPITAL IN THE STATE OF TENNESSEE. FWCH OPENED IN EARLY FY11 AND WILL REPLACE NORTH SIDE AND SPECIALTY HOSPITALS IN JOHNSON CITY. IN ADDITION TO THE COMPLETION OF FWCH DURING FY10, CONSTRUCTION ON A REPLACEMENT HOSPITAL FOR JOHNSTON MEMORIAL HOSPITAL WAS ONGOING THROUGHOUT THE REPORTING PERIOD AND DESIGN WORK WAS STARTED ON A REPLACEMENT FACILITY FOR SMYTH COUNTY COMMUNITY HOSPITAL AS WELL. BOTH HOSPITALS 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. MSHA HAS MADE TREMENDOUS FINANCIAL INVESTMENTS TO NURSING PROGRAMS AT EAST TENNESSEE STATE UNIVERSITY AND LOCAL COLLEGES IN OUR REGION. EACH PROGRAM WAS TARGETED TO INCREASE THE NUMBER OF RN STUDENTS AND GRADUATES. MSHA'S NURSING SCHOLARSHIP PROGRAM HAS BEEN SO SUCCESSFUL THAT IN FY10, MSHA WAS ABLE TO ELIMINATE CONTRACT RNS, PRODUCING A LABOR SAVINGS OF $9 MILLION WHILE PROVIDING EXCELLENT NURSE CARE AT THE BEDSIDE. 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. IN FEBRUARY 2010, MSHA WAS FORMALLY RECOGNIZED BY THE TENNESSEE CENTER FOR PERFORMANCE EXCELLENCE AS THE RECIPIENT OF THE 2009 EXCELLENCE AWARD. MSHA PREVIOUSLY RECEIVED THIS RECOGNITION IN 2005, THUS MAKING MSHA THE ONLY HEALTHCARE ORGANIZATION IN TENNESSEE TO RECEIVE THIS RECOGNITION TWICE. TWO MSHA HOSPITALS, INDIAN PATH MEDICAL CENTER AND NORTH SIDE HOSPITAL, RECEIVED THE QUEST PROJECT'S QUALITY OF CARE TOP PERFORMER AWARDS IN ALL 5 FOCUS AREAS: 1) EVIDENCE BASED CARE; 2) MORTALITY REDUCTION; 3) COST OF CARE; 4) REDUCTION OF HARM; AND 5) PATIENT EXPERIENCE. 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. Form 990, Part I, Line 6, VOLUNTEERS: Mountain States Health Alliance Auxiliary (Auxiliary) supports the numerous hospitals within the Mountain States Health Alliance (MSHA) system. The Auxiliary is a very active organization that constantly looks for and solicits recommendations on activities that will 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 1,464 on page 1, line 6, we actually have closer to 3,500 volunteers. We only keep precise records for the active members who work regularly scheduled hours. For example, our volunteers that do needlework, sewing, etc. in their home are not counted. Our active volunteers served 194,497 hours during FY10. Our volunteers give much to MSHA and the communities MSHA serves. Survey results from an evaluation completed by our volunteers indicate that 100% would recommend volunteering at a MSHA hospital to their friends. Some of the activities provided by the Auxiliary volunteers during FY10 are reported below: Musical Entertainment. Taped concerts and performances by local individuals and groups. The tapes are played on a newly developed 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 gives out 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 gardener volunteers at JCMC, IPMC, and Princeton Transitional Care. Literary Arts. A reading program is provided for the patients at Niswonger Children's Hospital. Culinary Arts. Volunteers bake and deliver cookies daily to JCMC 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 stocking. 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. Volunteers 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 1,094 patients and family members. Courtesy carts and a van are operated by volunteers 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 7 days a week from 9 a.m. to 7 p.m. 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. Prior to opening in the summer of 2010, the Auxiliary volunteer team assisted FWCH in several ways. The Auxiliary assisted with recruitment efforts through radio advertisement, website support, recruitment fairs, presentations to community groups, and placement of flyers throughout our service areas. Volunteers served as mock patients in diagnostic imaging to prepare FWCH staff for actual patients. The Navigator Program was staffed by Auxiliary volunteers to assist with pre-opening and opening events and tours to the general public. Equipment has been purchased by the Auxiliary to provide cookie baking for this hospital and will be operational once approval is received from the fire marshal. Various other equipment was purchased for this new hospital to promote continuing volunteer services. Also, pet therapy volunteers have been trained and a year round junior volunteer program is just taking off. form 990, part iii, line 4a, statement of program service accomplishments (continued): MSHA also 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 individual 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. MSHA also partners with A.D.A.M. to provide the Health Encyclopedia. This service is one of the most respected and credible online medical resources in the world and offers access to 4,000 articles on health and wellness and covers more than 1,500 medical topics. 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 44th and Virginia ranked 21st in terms of health status. Some of the overwhelming health issues in our service area include: 1. High prevalence of obesity 2. High infant mortality 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 2010, MSHA incurred a loss of $10,245,255 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 FY10, the unreimbursed cost of services provided to this patient population was $2,574,662 (Medicare, based on Medicare allowable costs), $4,926,881 (Medicaid) and $23,780,966 (TennCare). Bad Debt: MSHA provides an increasing level of service to self-pay patients for which it receives little or no payment. During FY10, bad debts resulted in unreimbursed costs of $16,796,337. 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 by 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. 51% of their patients are from trauma scenes, with others being cardiac, OB, pediatric and medical. During FY09, Wings transported 1,540 patients and made 9 search and rescue flights at a net operating loss of $817,335 to MSHA. Ask-A-Nurse Medical Call Center is a 24-hour toll-free medical information line. Experienced registered nurses answer calls and provide invaluable 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 FY10, Ask-A-Nurse handled 57,507 calls including 4,355 physician referrals. MSHA incurred an expense of $615,325 to provide this service at no cost to the community. During FY10, MSHA opened the doors of 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. The site has its own pharmacy, a part-time pharmacist, a full-time pharmacy tech and a social worker/receptionist. The local Dispensary of Hope will be 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 FY10, MSHA incurred unreimbursed expenses of $201,099 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 25,208 visits to their office and performed 2,016 health screenings. The HRC also hosted more than 7,940 attendees who participated in monthly health education programs. The HRC also provides outreach services where they screened an additional 3,498 community members. The uncompensated cost of HRC was $373,448. 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 FY10, CHAWS provided 1,146 screenings with an unreimbursed expense of $286,412. Based on community needs, MSHA incurred an expense of $198,868 to recruit physicians into clinical/geographical areas that were federally designated as medically underserved. MSHA incurred an additional expense of $1,687,521 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 $59,577 in FY10. The specialty clinic includes gastrointestinal, OB/GYN, general surgery, podiatry 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 more than 40% of their patients. During FY10, the clinic had 10,900 outpatient visits. During FY10, Riverside Clinic incurred unreimbursed expenses of $527,715. form 990, part iii, line 4a, statement of program service accomplishments (continued): MSHA has partnered with the company MedAssist to work with self-paying patients who have limited financial resources. During FY10, MedAssist representatives were available at all MSHA facilities for daily interaction and financial screening of patients. MedAssist representatives were able to determine governmental medical assistance (TennCare or Medicaid) eligibility, and to help with the application process and follow-up. During FY10, 4,334 potentially eligible patients took advantage of MedAssist's help, and of those patients who applied for TennCare or Virginia Medicaid coverage, 2,382 (55%) were approved for coverage. Once a person is approved for TennCare or Medicaid through the MedAssist program offered through MSHA, they retain coverage for future medical care. MedAssist is compensated by MSHA. During FY10, MSHA's cost for this program was $732,865. MSHA worked with GOJO, the makers of Purell, to implement a hand sanitizer program. MSHA provided 3,000 bags of Purell alcohol gel to hundreds of elementary, middle schools and high schools in our region. This initiative was a proactive measure by MSHA against the 2009-2010 flu season in an attempt to improve school attendance by lowering absenteeism due to illness. In the schools where they aggressively implemented the gel units and measured the absenteeism, double digit improvements were recorded. During FY10, MSHA re-supplied our local schools systems with hand sanitizer at an expense of $10,283. 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 $50,000 to CareSpark. CareSpark was established in 2005 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 $25,000 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, Kingsport Tomorrow Inc., 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 FY10 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 FY10, 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 - $50,000 - ETSU Foundation - $30,000 - Tennessee Technology Center - $25,000 - Susan G. Komen Breast Cancer Foundation - $25,000 - Wellmont Foundation Inc. - $15,000 - East Tennessee State University - $12,450 - American Heart Association - $10,700 - Geisinger Health System Foundation - $10,000 - Johnson City Parks & Recreation - $5,152 - Children's Advocacy Center - $1,000 - American Cancer Society - $1,212 - March of Dimes - $1,037 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 - $16,727 - Hands On! Regional Museum - $12,000 - Johnson City Public Library - $500 - Carter County Imagination Library - $500 - Coalition for Kids - $1,240 - Boys to Men - $1,032 - Girls Inc. - $536 One MSHA response to the region's high incidence rate of childhood obesity was to contribute $10,250 to East Tennessee State University's Fit Kids program. MSHA contributes annually to local chapters of several national nonprofit organizations whose research focuses on those diseases and conditions most prevalent in the region. FY10: - Susan G. Komen Breast Cancer Foundation - $25,000 - American Heart Association - $10,700 - American Cancer Society - $1,212 - March of Dimes - $1,037 - United Way - $1,357 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. form 990, part iii, line 4a, statement of program service accomplishments (continued): Among initiatives and ongoing services that promote community health and social wellbeing 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 FY09, 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 FY10, 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 FY10 MSHA spent $18,615 on coordinating the HEAL program and hosting the symposium and paid 20 of the 25 grants, or $40,000. MSHA's total FY10 cost: $58,615. 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. Programs for the community at large MSHA's Congestive Heart Failure Program is a multidisciplinary effort disease management program involving physicians, Cardiovascular Services, Home Health, Ask-A-Nurse Call Center and other hospital support groups. By integrating its call center into a telehealth program for congestive heart failure patients, MSHA's program has become a leader in disease management and was named the "Best Collaboration in Disease Management in the Nation" by the Disease Management Association of America. Of the 82 program participants in FY10, 54% had no Emergency Department visits or hospital admissions for any reason and 85% had no CHF admission after enrollment into the program. The FY10 unreimbursed cost to MSHA was $51,900. 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 $54,403. 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 FY10 cost for the Parish Nurse program was $60,685. 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 RNs 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 $911,861 during FY10. 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 $33,508. We feel sure this amount is underreported due to the difficulty in tracking team members' many activities. In FY10, local health departments solicited help from MSHA to assist with H1N1 vaccination. MSHA was able to coordinate a response to this request by providing nurses to administer shots. The cost of providing vaccination assistance was $14,601. 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 FY10, the cost associated with the Clinic's lab testing was $63,516 and the cost of diagnostic imaging services was $17,291. These expenses are included in MSHA's Charity write-offs. During FY10, 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. There are currently 1,878 members. 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 FY10, MSHA incurred a net operating loss of $82,879 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. form 990, part iii, line 4a, statement of program service accomplishments (continued): 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 $60,162. 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 FY10 unreimbursed cost to provide the educational courses to the public was $139,876. 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. During FY10, Wings Air Rescue made 139 training runs to area Emergency Medical Service facilities to perform training of EMS crews. 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