2026-05-13T08:29:17-05:00 2025-06-30 990 2024-07-01 611771290 Ballad Health BALL 4233023467 311 Princeton Road Suite 1 Johnson City TN 376012080 Shane Hilton BH EVP & CFO 4233023467 2026-05-13 0 1 2024 2025-03-06 01:10:19Z Alan Levine PresCEO 303 Med Tech Pkwy Johnson City TN 37604 130596553 0 X balladhealth.org X 2015 TN Honor those we serve by delivering the best possible care. 11 9 2394 0 24592 21233 5699232 11043877 10078195 14327992 62098153 100341703 3122650 4526698 80998230 130240270 4710714 2007011 0 0 5820937 9439048 0 0 342109 75192741 83830954 85724392 95277013 -4726162 34963257 1954168188 1973498062 1310333210 1322629513 643834978 650868549 X Honor those we serve by delivering the best possible care.Ballad Health is dedicated to improving the health of the 29-county Appalachian Highlands region. 0 0 239566694 2007011 16960500 See Schedule O 239566694 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 1203 0 1 2394 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 TN VA X Shane Hilton 4233023467 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Alan Levine PresidentCEO Executive Chair 57.00 8.00 X X 3848876 0 286146 Marta Wayt MD BHMA Director 5.00 35.00 X 0 445434 30487 Aldo Noseda Director 5.00 0.00 X 0 0 0 Keith Wilson Director 5.00 0.00 X 0 0 0 David Golden Director 5.00 0.00 X 0 0 0 Dr Brian Noland Director, Vice Chair 5.00 0.00 X X 0 0 0 Scott Niswonger Director 5.00 0.00 X 0 0 0 David May MD Director 5.00 0.00 X 0 0 0 David Lester Director, Treasurer 5.00 0.00 X X 0 0 0 Martin Kent Director 5.00 0.00 X 0 0 0 Michael J Quillen Director 5.00 0.00 X 0 0 0 Shane Hilton EVP Chief Financial Officer 57.00 8.00 X 988163 0 113059 Eric Deaton EVP Chief Operating Officer 57.00 8.00 X 1747698 0 137400 Marvin Eichorn EVP Chief Administrative Officer 57.00 8.00 X 1445711 0 53543 Julie Bennett CLOGovnc Offcr Director, Secretary 57.00 8.00 X 976689 0 102286 Anthony Keck EVP Chief Transformation Officer 64.00 1.00 X 996815 0 110024 Pam Austin SVP Chief Information Officer 55.00 0.00 X 764221 0 79619 Lisa Smithgall SVP Chief Nursing Executive 55.00 0.00 X 628794 0 92266 Amit Vashist MD Chief Clinical Officer 55.00 0.00 X 847756 0 81164 Clay Runnels MD EVP Chief Physician Executive 64.00 1.00 X 1375526 0 131128 Steve Kilgore SVP Retail & Physician Svcs. 55.00 0.00 X 1651089 0 104672 Deborah Dover SVP Chief Human Resources Officer 55.00 0.00 X 779824 0 82108 Bradley Price SVP Regional Ops & Svc. Line Dev. 55.00 0.00 X 736224 0 90464 Lynn Krutak Former Officer 57.00 8.00 X 1101262 0 76184 Shana Tate VP Financial Mgmt Former Key Employee 40.00 0.00 X 365817 0 49886 Melissa Carr Sr Dir Treasury Former Key Employee 40.00 0.00 X 132197 0 18724 Tim Belisle Former Officer 0.00 0.00 X 448129 0 0 18834791 445434 1639160 305 1 1 0 Ensemble Health Partners 11511 Reed Hartman Hwy Cincinnati OH 45241 Rev Cycle Mgmt 101364124 East Tennessee State University P O Box 70732 Johnson City TN 37614 Resident & Acad Svcs 29085353 Medical Education Assistance Corp PO Box 699 Mountain Home TN 376840699 Medical Education Svcs 24886626 Paragon Anesthesia PC 10415 Wallace Alley St Kingsport TN 37663 Anesthesia Svcs 20313345 American Anesthesiology of TN PC 1305 Walt Whitman Rd Melville NY 11747 Anesthesia Svcs 19675724 169 107056 4468386 6468435 11043877 Wellness Programs 900099 11130963 11130963 Rent Related Exempt Orgs 531120 3197029 3197029 14327992 31949473 31949473 438529 438529 272173 24592 0 0 272173 24592 296765 24592 272173 67854196 455788 0 356283 67854196 99505 67953701 99505 67854196 Prior Year Refund/Recoveries 900099 1535591 1535591 Health Information Technology 900099 997412 997412 Daycare 900099 608823 608823 1088107 1088107 4229933 130240270 16960500 24592 102211301 X 2007011 2007011 13461005 13461005 -4995354 88190804 -93503563 317405 232806 3783046 -3549240 -1000 503179 15298109 -14819251 24321 237412 6295226 -6057814 3185863 65001 3120862 557299 557299 1080614 1080614 2280715 1296894 983821 15077427 7656355 7421072 4182969 820501 3362468 8031373 6161459 1869914 11936245 5371310 6564935 3783048 1926868 1856180 3616526 1384072 2232454 10861042 10529976 331066 53536292 43139345 10396947 2000074 1137595 862479 Taxes - UBIT 64421 36632 27789 Maintenance 36333440 27016448 9316992 Dues & Subscriptions 11757671 5916381 5841290 Population Health 2926205 2926205 -87380270 8607456 -95989109 1383 95277013 239566694 -144631790 342109 1294967 1244568 39248611 45577486 1313081 2827083 -1891792 -15327 5007341 5007341 31253867 39283534 976790 5816674 22497809 22321338 714185932 523880339 210586908 190305593 1246748258 1270809807 16869690 17229526 225352954 225352954 133326592 133326592 21583112 14410893 1954168188 1973498062 99403534 90851683 179238 148664 1076768030 1052022818 6458725 1212255 127523683 178394093 1310333210 1322629513 X 638270212 647271090 5564766 3597459 643834978 650868549 1954168188 1973498062 X 34963257 18738807 -46668493 X 0 1 X 1 1 1 X X X 3 Mountain States Health Alliance 620476282 3 1 0 0 Wellmont Health System 621636465 3 1 0 0 Early Learning Center 923891827 10 1 0 0 3 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Part I, Line 12g, Column (vi) Ballad Health is the parent organization that provides management services to its supported organizations. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 8484 1 1296901 0 0 1305385 0 Part II-B, Line 1: Ballad Health had lobbying expenses of $8,494 which represents the portion of dues paid to various organizations attributable to lobbying, including Tennessee Business Leadership Council and Tennessee Chamber of Commerce and Industry. Representatives of Ballad Health participated in the following legislative Events: -Tennessee Hospital Association Legislative Advocacy Day -Tennessee Public & Teaching Hospitals Association annual meeting -Participated in THA Government Affairs Sub-Committee Representatives of Ballad Health's Community & Government Relations department also contacted congressional offices concerning the following issues: -Opposed any cuts in Medicare/Medicaid -Supported area wage index permanent fix (introduced Save Rural Hospital Act) -Supported the continuance of Medicare Dependent Hospital and low-volume designations -Opposed cuts to 340B program -Supported a reasonable remedy for "surprise" billing -Supported legislation to protect hospital eligibility in the 340B Program -Supported the extension of Medicare Sequester Relief -Oppose effort to extend site neutrality payment policies -Supported Telehealth Flexibility Extension Representative of Ballad Health's Community & Government Relations department responded via letter, phone, or in person to the following Tennessee and Virginia legislative issues: Supported the following issues: -Certificate Of Need reform (TN)/Certificate Of Public Need (VA) reform -Continuation and monitoring of hospital assessment fee in Tennessee and Virginia -Mental health funding for inpatient psychiatric care-Tennessee and overall behavioral health funding in Virginia -Adequate TennCare funding in Tennessee -Limited hospital reporting requirements for surprise billing -Oppose repeal of COPA -Corporate practice of medicine -Health care worker protection policies 38612668 38612668 116310384 53116545 63193839 4346020 3453785 892235 548933558 462999920 85933638 5983302 4310089 1673213 190305593 Investment - BRMMC 100310432 C Investment - MSHA 125042522 C 225352954 Asset Retirement Obligations 4120070 Contributions Payable 5529194 Due to Affiliates 146301133 Due to Payor Stimulus Reserve 3918278 Due to 3rd Parties -19156 Long-term Compensation Payable 7325621 Operating Lease Obligation LT 4351874 Operating Lease Obligation ST 1185260 Professional Liabilities Reserve -27878 Retiree Health Care Benefit 796926 SWAPS 4912771 178394093 X Part X, Line 2: "Ballad is classified as an organization exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. As such, no provision for federal income taxes is included in the accompanying consolidated financial statements. Taxable subsidiaries are discussed in Note K. No significant uncertain tax positions exist at June 30, 2025 and 2024. Tax returns for 2022 through 2024 are subject to examination by the Internal Revenue Service." 1 Appalachian Highlands Economic Development Partnership 10431 Wallace Alley Street Kingsport TN 37663 920465383 501C3 100000 0 2025 Collaborative Partner for economic development Bristol Trainstation Foundation 4523 Bristol Highway Johnson City TN 37601 522185216 501C3 7500 0 Kids' Christmas Event Sponsorship Cardinal Productions Inc P O Box 4455 Roanoke VA 24017 871532828 501C3 25000 0 Build & sustain news organizations that report untold stories of SWVA & Southside VA Dobyns-Bennett Band Boosters Club P O Box 7265 Kingsport TN 37660 237170169 501C3 35000 0 Provide quality musical education through academic, community and competitive activities East Tennessee Foundation 520 W Summit Hill Drive Ste 1101 Knoxville TN 37902 620807696 501C3 10000 0 Kingsport's Best Presenting Sponsor 2025 ETSU Foundation P O Box 70721 Johnson City TN 37604 237092731 501C3 125000 0 Donation designated to Athletics First TN Development District 3211 North Roan Street Johnson City TN 37601 620759446 501C3 50000 0 Region. A.H.E.A.D. - small business recovery relief Governor's Early Literacy Fdn 710 James Robertson Parkway Nashville TN 37243 201115704 501C3 20000 0 Support of Governor's Early Learning Program - 20th Anniversary Greater Kingsport Family YMCA 1840 Meadowview Parkway Kingsport TN 37660 581564232 501C3 0 1287401 Book Donation of 3 Acres of Vacant Lant International Storytelling Center 100 West Main Street Jonesborough TN 37659 621014756 501C3 8500 0 2024 Festival Jeremiah School P O Box 6024 Johnson City TN 37602 473649152 501C3 25000 0 Tuition-econ. challenged students, emergency fund, emotional/nutritional support Junior Achievement of Tri-Cities TNVA 330 Broad Street Suite 1 Kingsport TN 37660 620757847 501C3 25000 0 Junior Achievement Hall of Fame Kingsport Chamber Foundation 400 Clinchfield Street Ste 100 Kingsport TN 37660 581453565 501C3 85000 0 Healthy Kingsport and Sponsorship of Fun Fest and Juneteenth Leadership Tennessee 718 Thompson Ln Ste 108-141 Nashville TN 37604 872004805 501C3 25000 0 2024 Campaign: foster non-partisan dialogue on issues of state importance Milligan University P O Box 750 Milligan College TN 37682 620535755 501C3 63500 0 Athletics Program Sponsorship including scoreboard & Inauguration of President Waers Morrison School 400 Edgewater Lane Bristol VA 24201 541053329 501C3 25000 0 Education Sponsorship for students with learning disabilities. Music for All 39 W Jackson Place Suite 150 Indianapolis IN 46225 363413042 501C3 20000 0 2024 Bands of America East Tennessee Regional Championship Sponsor Streamworks Inc 122 Pickens Rd Kingsport TN 376633284 832552649 501C3 7257 0 2025 Sponsorship of STEM education throughout Appalachian Highlands Tennessee State Collaborative on Reforming Education (SCORE) 1207 18th Ave Suite 326 Nashville TN 37212 263670335 501C3 25000 0 Catalyze transformative change in TN Education so that all students can achieve success Visit Johnson City Foundation Inc 302 Buffalo Street Johnson City TN 37604 352795354 501C3 10000 0 Meet the Mountains Festival 20 Part I, Line 2: The Ballad Health Community Benefit and Population Health Committee is a collective group of members from both Tennessee and Virginia. These members bring a variety of insights into community health improvement, striving to cultivate an understanding of population health, community benefit obligations, and the integral role that Ballad Health plays in enhancing health access. Senior leadership of Ballad Health, including the President and CEO and the COO, are present at these meetings. One of the committee's key duties is to ensure that charitable donations are in line with the policies set by the Ballad Health Board. All applications for assistance are completed with the necessary information to assess eligibility, and reviewed and approved by an administrative committee which includes members from the Community Benefit and Population Health Committee. In addition, community health improvement applications and recommendations are reviewed by the Community Benefit and Population Health Committee annually. Following a thorough review of all applications, approval must be obtained from various levels, including the Ballad Health CEO or the Ballad Health Board, depending on the level of commitment required. For those seeking funding for a specific event or program, the application should include the following details: -Mission statement of organization -Year organization was founded -Tax status and federal taxpayer ID number -Website -Description of the event/program -Event/program budget -Other sources of income -Impact of the event/program on the health of residents in our region -Beneficiaries of contribution -Number of people served annually -Event/program accomplishments -Measure of accomplishments X 1 1 X X X X 0 1 1 0 0 0 0 0 0 Alan Levine PresidentCEO Executive Chair 1520581 0 2128611 0 199684 0 253530 0 32616 0 4135022 0 0 0 Eric Deaton EVP Chief Operating Officer 894611 0 604644 0 248443 0 110198 0 27202 0 1885098 0 0 0 Steve Kilgore SVP Retail & Physician Svcs. 508344 0 323696 0 819049 0 72018 0 32654 0 1755761 0 782346 0 Clay Runnels MD EVP Chief Physician Executive 797671 0 541155 0 36700 0 100731 0 30397 0 1506654 0 0 0 Marvin Eichorn EVP Chief Administrative Officer 805288 0 598349 0 42074 0 20040 0 33503 0 1499254 0 0 0 Lynn Krutak Former Officer 414747 0 526405 0 160110 0 53781 0 22403 0 1177446 0 0 0 Anthony Keck EVP Chief Transformation Officer 563999 0 385795 0 47021 0 77565 0 32459 0 1106839 0 0 0 Shane Hilton EVP Chief Financial Officer 615030 0 366316 0 6817 0 80643 0 32416 0 1101222 0 0 0 Julie Bennett CLOGovnc Offcr Director, Secretary 564044 0 403122 0 9523 0 78804 0 23482 0 1078975 0 0 0 Amit Vashist MD Chief Clinical Officer 521762 0 300503 0 25491 0 68307 0 12857 0 928920 0 0 0 Deborah Dover SVP Chief Human Resources Officer 449422 0 276686 0 53716 0 66918 0 15190 0 861932 0 0 0 Pam Austin SVP Chief Information Officer 458150 0 288335 0 17736 0 66148 0 13471 0 843840 0 0 0 Bradley Price SVP Regional Ops & Svc. Line Dev. 440981 0 271255 0 23988 0 64283 0 26181 0 826688 0 0 0 Lisa Smithgall SVP Chief Nursing Executive 472618 0 136871 0 19305 0 68259 0 24007 0 721060 0 0 0 Marta Wayt MD BHMA Director 0 420344 0 21195 0 3895 0 19992 0 10495 0 475921 0 0 Tim Belisle Former Officer 0 0 0 0 448129 0 0 0 0 0 448129 0 0 0 Shana Tate VP Financial Mgmt Former Key Employee 293254 0 70798 0 1765 0 18034 0 31852 0 415703 0 0 0 Melissa Carr Sr Dir Treasury Former Key Employee 130919 0 0 0 1278 0 8052 0 10672 0 150921 0 0 0 Part I, Line 1a Unless expressly approved by the Ballad Health Executive Chair/President, first-class transportation is generally not permitted. The Executive Chair/President may utilize first class travel for flights of a long duration. The Vice Chair/Lead Independent Director of the Board of Directors reviews and determines approval for expense reimbursement requests made by the Executive Chair/President. Charter flights must be approved in advance by the Executive Chair/President and are limited to business trips that can be justified based on financial savings, essential time savings and meeting logistics. On an annual basis, the Internal Audit Department of Ballad Health validates all charter travel was for valid business purposes and in compliance with the Ballad Health senior executive travel and business reimbursement policy. Part I, Lines 4b-c The following executives listed in Schedule J, Part II participated in a 457(f) retirement plan provided by Ballad Health (BH). 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 BH 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. 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. Alan Levine $233,490 Eric Deaton $90,158 Lynn Krutak $38,666 Tony Keck $57,525 Julie Bennett $56,613 Steve Kilgore $51,978 Clay Runnels, MD $80,691 Shane Hilton $60,603 Lisa Smithgall $47,625 Pam Austin $46,300 Amit Vashist, MD $48,254 Debbie Dover $45,370 Bradley Price $44,483 Upon meeting the Substantial Risk of Forfeiture provisions of the Ballad Health 457(f) Plan mentioned above, the following former executive received his deferred compensation plan balance during the year. Timothy Belisle $448,129 A Health & Educational Facil Bd 2018 830682499 396649EX9 2018-06-06 820526657 Assets & Capital Improvements 0 0 0 B Health & Educational Facil Bd 2022 621464028 478271KE8 2022-06-16 128145000 Capital&Debt Refd 0 0 0 C Health & Educational Facil Bd 2022B 621464028 478271KDO 2022-07-07 121855000 Refund the 2018C Bonds 0 0 0 D Health & Educational Facil Bd 2023A & 2022B 621464028 478271KR9 2023-05-18 208262134 Refund the 2018A Bonds 0 0 0 A 357350000 820545037 9240 820535798 2022 0 0 0 1 B 3695000 128254941 520000 71250000 56450485 34456 2022 1 0 0 1 C 121855000 1190000 120665000 74892 1 0 0 1 D 13565000 208262134 1803579 45000000 161458555 76654 2023 1 0 0 1 A 0 0 1 1 0 0.00990 0.00990 0 1 0.01790 1 1 B 0 0 1 1 0 0.00990 0.00990 0 0 1 C 0 0 1 1 0 0.00990 0.00990 0 1 0.01790 1 1 D 0 0 1 1 0 0.00990 0.00990 0 1 0.01790 1 1 A 0 0 0 1 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: Health & Educational Facil Bd. 2018 Date the Rebate Computation was Performed: 08/23/2023 Schedule K, Part II, Proceeds, Line 3: Line 3 for the 2018A, B and C Bonds and 2022A and C Bonds and 2023A and B Bonds does not match the applicable issue price for such bond issues because of interest earnings earned on the proceeds of such bonds. Schedule K, Part II, Proceeds, Line 10: Pursuant to Section 1.150 1(a)(2)(ii) of the Treasury Regulations, the proceeds of the Bonds were used to acquire the assets of Mountain States Health Alliance and Wellmont Health System, and such expenditures are treated as capital expenditures, and not the refunding of prior debt. Schedule K, Part III, Private Business Use, Line 8(c): Pursuant to the remedial action regulations, the proceeds from the sale of certain nursing home assets that were bond financed are being reallocated to qualified expenditures. Such reallocation will be completed within the 2-year time frame proscribed by the applicable Treasury Regulations. M Eichorn Officer SPLIT X 2808925 5007341 0 1 0 5007341 Stephen G Stanley Family Member 138240 See Part V 0 Part IV, Supplemental Information (1) Pam Austin, SVP and CIO of Ballad Health, is a family member of Stephen G. Stanley, an employee of Ballad Health. Part III, Program Service Accomplishments Ballad Health (Ballad) is an integrated healthcare delivery system consisting of 20 hospitals in Northeast Tennessee and Southwest Virginia, including a Level 1 Trauma Center, dedicated children's hospital, several community hospitals, four critical access hospitals, a behavioral health hospital, an addiction treatment facility, long-term care facilities, home care and hospice services, retail pharmacies, outpatient services and a comprehensive medical management corporation. Ballad works closely with an active independent medical community and community stakeholders to improve the health and well-being of over one million people in 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky. Ballad is a Tennessee non-profit corporation and is the main provider of healthcare services in Northeast Tennessee and Southwest Virginia. Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). On February 1, 2018, Ballad was formed through a merger of two legacy systems, Mountain States Health Alliance and Wellmont Health System. Ballad was formed under state-action immunity in compliance with federal antitrust law, to create a healthier region and keep healthcare local. The action approving the merger was officially taken through the agreements made between Ballad and the State of Tennessee in the Certificate of Public Advantage (the "COPA") and the Letter Authorizing the Cooperative Agreement (the "CA") in Virginia. Pursuant to the COPA and CA, Ballad must fulfill certain obligations, commitments, and covenants. Tennessee and Virginia, through their respective health departments, supervise specific aspects of Ballad's operations under certain conditions of the COPA and the CA. The COPA and amendments are publicly available on the website of the Tennessee Department of Health, at https://www.tn.gov/health/copa.html. The Cooperative Agreement is available on the website of the Virginia Department of Health, at https://www.vdh.virginia.gov/licensure- and-certification/cooperative-agreement/. Form 990 for Wellmont Health System (WHS) includes five wholly owned hospitals, including two tertiary hospitals, while three wholly owned hospitals file separate returns. In addition to the acute care hospitals, WHS wholly owns or has ownership interest in a nursing home, an assisted living facility, physician practice organizations, ambulatory surgery centers and other health care businesses. Form 990 for Mountain States Health Alliance (MSHA) includes eight wholly owned hospitals including a tertiary hospital, a children's hospital and a behavioral health hospital; two others, wholly owned by MSHA, each file a separate return. MSHA is sole shareholder of Blue Ridge Medical Management Corporation (BRMMC), a for-profit entity that owns and manages physician practices and real estate and provides other health care services to patients in Tennessee and Virginia. MSHA is the sole member of Integrated Solutions Health Network, LLC (ISHN). ISHN, also included in this Form 990, is a regional health solutions company headquartered in Johnson City, Tennessee. ISHN is an expansive network of providers serving residents of Northeast Tennessee and Southwest Virginia and consists of provider groups, primary care physicians, specialists, and allied health providers. Ballad Health is in its seventh full year of operation under active supervision by the State of Tennessee and the Commonwealth of Virginia. Fiscal Year 2025 was marked by resilience, innovation, and a deepened commitment to improving health outcomes across Northeast Tennessee and Southwest Virginia. Throughout the period, Ballad Health continued to maintain and expand access to essential care and services, delivering high quality care, and reducing the cost of care for the people we are entrusted to serve. Over the past seven years, Ballad Health has made significant strides in regional healthcare. The organization successfully reopened a previously closed hospital in Southwest Virginia, invested capital in critical infrastructure, expanded services where needed, and consolidated others where appropriate. We met the challenges of a global pandemic that claimed thousands of lives in our region and severely disrupted hospital operations. We coordinated care in the wake of Hurricane Helene and its devastating aftermath and worked closely with both the Tennessee Department of Health and Virginia Department of Health to respond to the evolving needs of the region. Notable examples include investments in mental health services, the opening of high-quality childcare centers, the creation of the Quillen Center for Urological Services, and the launch of a new dental clinic that has served thousands of uninsured Virginians. Ballad Health has achieved these milestones while navigating national challenges, often responding faster and more effectively than other well-regarded hospitals and health systems. Similarly, our emergency department performance outpaces other peer hospitals on publicly reported metrics. Furthermore, a recent independent evaluation of physician access revealed that, while the rest of the nation has experienced a decline in physician supply, Ballad Health's rural region has either maintained or improved access in many specialties. In FY25, Ballad Health continued to demonstrate its commitment to improving the health of the Appalachian Highlands region through investments in its people, COPA Plan spending commitments, and capital. These investments included: - Partnering with the Tennessee Center for Nursing Advancement, the ETSU Research Corporation, East Tennessee State University (ETSU) College of Nursing, and StoryCollab on the Nursing Narrative Initiative. This project highlights the voices and experiences of nurses across the region, aiming to inspire future professionals and support current staff through storytelling and reflection. Additionally, investing in Ballad Health team members by launching B Excellent to strengthen our culture through continuous learning, skill-building, and team member engagement. - More than $65 million in new investments for rural health, behavioral health, children's health, population health, health research and graduate medical education, and health information exchange. - Capital spend of over $128 million, the highest level in our history. This included investments in new diagnostic and treatment technology, equipment upgrades, facility improvements, information technology, and the continued expansion of Niswonger Children's Hospital. Hurricane Helene Hurricane Helene tragically struck on September 27, 2024, causing catastrophic flooding throughout the Appalachian Highlands. Floodwater from Hurricane Helene permanently destroyed Unicoi County Hospital and caused significant disruption to several other facilities. At Greeneville Community Hospital, Sycamore Shoals Hospital, Johnson County Hospital and Laughlin Healthcare services had to be suspended and patients relocated due to flood-related damage and safety concerns. Thanks to Ballad Health's integrated system, coordinated emergency response, and the dedication of our team members, all patients were safely evacuated to other facilities. In response, Ballad Health quickly established a 24/7 advanced urgent care clinic in Erwin, Tennessee, to ensure continued access to critical healthcare services for the community. Strengthening Rural Access Through Strategic Workforce Planning Ballad Health is taking a proactive approach to protecting care in rural Appalachia. To guide this effort, Ballad Health engaged a nationally recognized healthcare consulting firm to conduct a detailed provider needs assessment. This process closely examines the supply and demand for physicians and advanced practice providers in the region and helps guide recruitment where shortages are most severe, and ensures we meet federal requirements. Nationally, the projected shortage of primary care physicians by 2030 ranges from 27,300 to 40,300, according to the Association of American Medical Colleges (AAMC) and other workforce studies. This makes Ballad Health's forward-looking strategy especially critical for rural regions. Since 2018, Ballad Health has recruited more than 800 providers to help close important gaps across the region. Between 2022 and 2025, general primary care adequacy improved from 62% to 72%, and 8 of 12 specialties also showed measurable progress. Ballad Health's access and quality metrics now outperform many national peers. Only 1% of emergency room patients leave before being seen, compared to 6 to 8% at other emergency rooms. Discharge times are up to 100 minutes faster than leading academic medical centers and sepsis care compliance ranks among the best in the country. Quality of Care - Recognition from Independent Organizations: Ballad Health hospitals achieved national recognition for quality and safety from several respected national organizations, including U.S. News & World Report, the American Medical Association, and the American Heart Association. The Blue Cross and Blue Shield Association designated multiple Ballad Health hospitals as "Blue Distinction Centers" in service areas such as cardiology, hip and knee replacement, and maternity care. In addition, they highlight only five hospitals in Tennessee as "Blue Distinction Centers in Quality and Value" for cardiology services, with two of the five hospitals being Ballad Health facilities. Leading Innovation in Physician Well-Being Ballad Health Medical Associates has earned bronze-level national recognition from the American Medical Association as a Joy in Medicine Health System organization for taking meaningful steps to address physician burnout and promote well-being across the Appalachian Highlands. Ballad Health Medical Associates is the only organization in Tennessee to receive Joy in Medicine recognition for the 2025-2026 cycle, with only four organizations in Virginia achieving this distinction. Cardiovascular Excellence Continues to Set National Standards Holston Valley Medical Center continues to lead the nation in cardiovascular care, cementing Ballad Health's reputation as a destination for exceptional cardiac treatment. For 2025, Healthgrades named Holston Valley one of America's 50 Best Hospitals for Vascular Surgery for the sixth consecutive year and ranked it No. 1 in Tennessee for vascular surgery. Holston Valley also earned the Vascular Surgery Excellence Award and received five-star ratings for several critical procedures, including abdominal aorta repair, carotid surgery (achieving this distinction for the 16th year in a row), and peripheral vascular bypass. Holston Valley and Bristol Regional Medical Center earned the Platinum Performance Achievement Award from the American College of Cardiology (ACC) for excellence in heart attack care through the chest pain - MI Registry. Johnston Memorial Hospital received the Silver Performance Achievement Award, recognizing its commitment to evidence-based care and improved outcomes for patients experiencing acute myocardial infarction. These honors reflect the dedication of Ballad Health's clinical teams to consistently deliver high-quality, guideline-driven care that improves survival rates and long-term outcomes for heart patients across the Appalachian Highlands. This recognition reflects Ballad Health's commitment to creating a supportive and efficient work environment for physicians and advanced practice providers, an essential strategy for improving care quality and access in rural communities. These results show Ballad Health's commitment to listening to our communities, recruiting where it matters most, and building the strong healthcare workforce the Appalachian Highlands relies on. Recognition Spanning Our Entire Health System U.S. News & World Report 2025-2026 National and Regional Distinctions: - Holston Valley Medical Center was named a "Best Regional Hospital and ranked No. 9 in Tennessee, earning "high performing distinctions in 10 different clinical areas. - Bristol Regional Medical Center, Indian Path Community Hospital, and Johnson City Medical Center were recognized for excellence in cardiac, pulmonary, and surgical care. - Specific clinical honors include high-performance ratings in hip fracture and hip replacement care, gynecological cancer treatment, aortic valve surgery, abdominal aortic aneurysm repair, pacemaker implantation, pneumonia care, spinal fusion, colon cancer surgery, transcatheter aortic valve replacement, and diabetes care. Charity Care Update Ballad Health maintained increased patient eligibility for charity care at 225% of the federal poverty guidelines (up from 200% before the merger in 2018). In FY25, Ballad Health provided over $65 million for charity care, the highest since its formation. Notably, the weighted average median household income in the region is approximately $51,000 with some communities falling below that level. Ballad Health's threshold for free charity care for a family of 2.5 people is approximately $54,000 based on 225% of the Federal Poverty Level. This positions Ballad Health as having one of the most generous charity care policies in the nation. Ballad Health continued its efforts to reduce the number of preventable hospitalizations and emergency department visits. Ballad Health also remained committed to advancing value-based initiatives, such as the Appalachian Highlands Care Network (AHCN). The AHCN connects uninsured patients and their families with free or low-cost clinics, dental services, financial counseling, and preventative care services. The AHCN is recognized as a national model for partnership programs between a health system and local organizations, outpatient clinics and providers working together to deliver a more supportive system of care for the uninsured population. These efforts to provide cost efficient care benefit the taxpayers, patients, and hospitals. By the end of the period, the AHCN had enrolled over 11,100 uninsured individuals, demonstrating its growing impact across the Appalachian Highlands. Progress in Target Areas Ballad Health achieved improvements in the target areas of expanding access to care, improving quality of care, and lowering the cost of care. I. Access to Care & Population Health Access to Care Metrics: Ballad Health achieved improvements in 20 of 25 access measures over the pre-merger baseline. Notable areas of improvement since FY24 include appropriate emergency department wait times, asthma emergency department visits, diabetes screening, and rate of SBIRT administration during emergency department visits. The virtual urgent care platform is available 24/7 and accessible via smartphone or internet, and Ballad Health is the only regional provider offering this service. II. Improving Quality of Care, Patient Experience & Staff Experience a. Quality of Care Metrics: Ballad Health publishes its quality data on its website. The currently reported baselines are pre-COVID. Notable highlights include the following: i. Ballad Health improved in 10 of the 17 target measures for FY25 using the pre-COVID baselines. ii. Emergency Department throughput metrics have shown improvement. Notably, OP22 Left Without Being Seen decreased by 33.8% compared to FY24. The median time from ED arrival to transport for admitted patients and the ED2b ED Decision to Transport (ED1) also improved. iii. Ballad Health implemented a standardized mortality case review process, supported by predictive analytic tools to help caregivers identify and act on early signs of deterioration. These efforts contributed to measurable reductions in mortality from FY23 to FY25, across various conditions, including Heart Failure (25%), Pneumonia (18%), and Sepsis (14%). iv. Among the hospital infection indicators, Ballad Health is performing as expected or meeting the measure in all but one measure when using the Centers for Disease Control and Prevention's recommended adjustment methodology accounting for differences in patient population. b. Clinical Council: The Clinical Council (the Council) is aligned with the Ballad Health Board of Directors and the Board's Quality, Service and Safety Committee (QSSC). During FY25, the Council was comprised of 27 physicians from many backgrounds and specialties. Of those physicians, nearly half were independent. The Council continued to assist in establishing key quality and patient safety priorities with consideration to risk, volume, propensity for problems (including incidence, prevalence, and severity), impact on health outcomes, patient safety and quality across all areas of care. Key accomplishments in FY25 included: i. enhancements in electronic health record workflows, ii. standardization of a variety of high-value care initiatives, iii. implementation of projects for provider wellbeing and workforce support, iv. updates to medication use processes, and v. improvements to children's and women's care standards. c. Patient Experience: In the aggregate, 90% of patients surveyed by Press-Ganey, the nation's most credible firm for tracking patient and employee experience, would recommend Ballad Health's hospitals. In some Ballad Health hospitals, that number reaches as high as 97%. While emergency department wait times remain a concern, it should be noted that the metrics for Ballad Health outperform national averages, and some of America's, Tennessee's, and Virginia's most well-respected health systems in areas such as patients who leave without being seen, time from presentation to discharge, and sepsis care. III. Lowering Cost of Care Ballad Health and community physicians continue to reduce the cost of care to patients, employers, and government payors through value-based care. a. Price Transparency: Ballad Health continued to meet the Centers for Medicare & Medicaid Services hospital price transparency requirements under section 2718(e) of the Public Health Service Act. As such, Ballad Health's gross charges, discounted cash prices, payer-specific negotiated rates, and de-identified minimum and maximum negotiated rates for all hospital items and services as well as a consumer-friendly estimator tool and other pricing information are publicly available on its website. b. Cost-Efficiency Measures: According to countyhealthrankings.org, Ballad Health and community physicians have reduced preventable hospitalizations in our region by 50% since 2017. This has resulted in over $200 million of annual recurring savings to taxpayers, employers, and patients. Our region's preventable hospitalization rate is as low, or lower than, communities like Nashville - a stunning result given the magnitude of resources available in those communities. In FY25, Ballad Health saw more than $45 million (for projects greater than $200,000) in savings due to cost-efficiency measures taken across the areas of contract labor, supplies, and pharmacy efficiency. Through the work of the AHCN, Ballad Health has helped reduce preventable hospitalizations for the uninsured population, reducing the cost to taxpayers of charity care, and improving patient safety by avoidance of hospitalization. Form 990, Part V, line 1a Ballad Health (BH) filed Form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. Each subsidiary reimburses BH for all expenses related to vendor payments and the expenses are recorded on each individual entity's books. Form 990, Part VI, Section B, line 11b The Ballad Health Tax Department prepares and reviews the Form 990. During preparation other functional areas within the organization provide information and support to complete an accurate return. The return is reviewed by the organization's EVP/CFO and is provided in electronic form to all members of the Board of Directors prior to being filed with the IRS. Form 990, Part VI, Section B, line 12c Ballad Health policy requires Board of Directors and Board Committee members, the Executive Chair/President, and Executive Vice Presidents to complete a conflict of interest disclosure statement on an annual basis. Ballad Health policy also requires team members to complete an annual acknowledgement that they have read and understand the conflict of interest policy and they will complete a conflict of interest disclosure statement if they have a conflict of interest. Should a conflict arise, it is the responsibility of the conflicted individual to update his or her disclosure immediately. All meetings of the board or board committees have a standing agenda item first on the agenda titled "Conflicts of Interest". If a member of the board or board committee has a conflict of interest involving any issue on the board agenda, he or she must declare the conflict of interest during the period allotted for disclosure. If any issue arises during a meeting in which the board member has a conflict of interest, he or she must immediately declare the conflict. While each member of the board or board committee is responsible for disclosing conflicts of interest, it is also the responsibility of any board member aware of a conflict which has not been disclosed to ensure the board is made aware. The presiding officer of a board or board committee meeting may ask a conflicted member to excuse themselves from the meeting during the discussion related to the issue with which the conflict of interest applies. Under no circumstances shall a member vote on a matter that gives rise to a potential conflict. This applies to all Ballad Health organizations. Form 990, Part VI, Section B, line 15 Line 15a Compensation Process for Top Officials The executive compensation committee serves as the compensation oversight committee of Ballad Health's Board of Directors. The executive compensation committee is comprised of members who are determined to be independent and whom are not reliant upon any business relationship with Ballad Health for income or compensation. The compensation plan for Alan Levine, Ballad Health's Chairman, President and CEO, was reviewed and approved by the executive compensation committee and then by the Ballad Health Board of Directors in accordance with the Board's compensation policy and practice. The Board of Directors relies upon the advice of an independent and experienced compensation consultant with knowledge about pay practices for comparable positions within the industry, and who has access to broad data, studies and surveys in order to ensure the compensation falls within competitive and appropriate ranges for the position. Part VI, Line 15b Compensation Process for Officers On an annual basis, Ballad Health's Human Resources (H/R) Department evaluates compensation for all executives at a position level of Assistant Vice President and above. H/R's evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on this comparable data, Ballad Health's President & CEO evaluates the data and submits his recommendations to Ballad Health's Board of Directors for their final review and approval. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics approved by the Ballad Health Board of Directors which include Quality of Care, Access to Care, Cost Management, etc. Form 990, Part VI, Section C, line 19 Governing documents and conflict of interest policy are made available upon request to the appropriate parties requesting them. Financial statements are made available upon request to appropriate parties requesting them, and they are made available to those parties who own indebtedness of the company on a quarterly basis. Form 990, Part IX, line 11g Consulting Fees: Program service expenses 4,320,434. Management and general expenses 5,833,616. Fundraising expenses 0. Total expenses 10,154,050. Contract Labor: Program service expenses 0. Management and general expenses 565,278. Fundraising expenses 0. Total expenses 565,278. Marsh Julia Davis Collection Center: Program service expenses 1,830,377. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,830,377. Environmental Services: Program service expenses 97,614. Management and general expenses 29,026. Fundraising expenses 0. Total expenses 126,640. Physician Fees: Program service expenses 125,082. Management and general expenses 0. Fundraising expenses 0. Total expenses 125,082. Other: Program service expenses 1,282,848. Management and general expenses 993,152. Fundraising expenses 0. Total expenses 2,276,000. Form 990, Part XI, line 9: Change in Fair Value of interest Rate Swap -769,938. Transfers related to Self-Insurance Plan (Captive) -695,849. Temp. Restricted Grants -1,967,307. Closeout Balance Sheet Bristol Surgery Center -2,132,770. Intercompany Transfers -41,102,629. 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