2023-05-12T11:15:46-05:00 2022-06-30 990 2021-07-01 205485346 Abingdon Physician Partners ABIN 2762582800 311 Princeton Road Suite 1 Johnson City TN 376012080 John Jeter VP, CEO 2762582861 2023-05-12 John Jeter 999009999 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X John Jeter 16000 Johnston Memorial Drive Abingdon VA 24211 13338326 0 X www.balladhealth.org X 2006 VA Our mission: Honor those we serve by delivering the best possible care 4 0 120 0 0 0 70755 33036 13882984 13280444 244 15592 4211 6796 13958194 13335868 0 0 0 0 9529775 8928361 0 0 0 3678810 4541567 13208585 13469928 749609 -134060 3256381 2959735 4036373 2426743 -779992 532992 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 13460893 13302727 Abingdon Physician Partners (APP) was created to augment Johnston Memorial Hospital's exempt purpose of responding to the healthcare needs of individuals and communities in its service area. To promote the general health and welfare of the communities served, the corporation has more than 10 primary care, general surgery, orthopedic, gynecology, and oncology clinics.Multiple APP clinics also serve as outpatient teaching locations for family medicine and internal medicine residency programs. 13460893 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 1 120 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 VA X Lynn Krutak 4233023374 303 Med Tech Prkwy Ste 300 Johnson City TN 37604 John Jeter VP/CEO JMH/BRMC/APP 0.50 44.50 X X 0 432983 38431 Mark Patterson MD BHMA SVP Director, Through Nov. 2021 0.50 54.50 X 0 716186 86766 David H Smith MD Director, Through Nov. 2021 40.00 0.00 X 193199 0 36494 Karl Kindig Chairman, Through Nov. 2021 0.50 0.00 X X 0 0 0 James Gardner MD Director, Through Nov. 2021 40.00 0.00 X 4405 0 0 Alan Levine BH PresCEO Director, Beg. Nov. 2021 1.00 64.00 X X 0 4083029 240343 Marvin Eichorn BH EVPCAO Director, Beg. Nov. 2021 1.00 64.00 X X 0 1154466 43904 Eric Deaton BH EVPCOO Director, Beg. Nov. 2021 1.00 64.00 X X 0 1021443 104184 Tim Belisle BH EVPGen Cnsl Director, Beg. Nov. 2021 1.00 64.00 X X 0 670583 87406 Edward Pryor AVP/CFO JMH/APP 0.50 44.50 X 0 102116 8035 Lynn Krutak BH EVP/CFO 1.00 64.00 X 0 956968 104263 William Cummins MD Physician 40.00 0.00 X 401599 0 34239 Matthew Dorn MD Physician 40.00 0.00 X 383142 0 41417 Timothy Davis MD Physician 40.00 0.00 X 417313 0 40426 Amy Hitchcock MD Physician 40.00 0.00 X 327697 0 16013 Adrienne Griffin MD Physician 40.00 0.00 X 313119 0 17964 Edward Hickson VPPres SWMkt Former Officer 0.00 45.00 X 0 660570 37119 Carl Kilgore BH SVP Retail Former Officer 0.00 55.00 X 0 667536 92580 Justin Ivory Former CFO - JMH/APP 0.00 40.00 X 0 104629 16577 2040474 10570509 1046161 24 1 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Med Staffing Svcs 402741 1 33036 33036 Net Patient Revenue 621110 6684983 6684983 Hospital Support 621110 5926458 5926458 CARES Act Revenue 900099 405533 405533 Medical Educ. Training 621110 225064 225064 Performance Bonuses 621110 38406 38406 13280444 60 60 17990 2458 15532 15532 15532 Misc 900099 4751 4751 Tax Refund 900099 2000 2000 Medical Records 900099 45 45 6796 13335868 13302727 0 105 X 156523 156523 7410634 7410634 231400 231400 687124 687124 442680 442680 3503 3503 2621748 2621748 63022 55793 7229 846645 845222 1423 371833 371450 383 656 656 Medical Supplies 485168 485168 Maintenance 131378 131378 Licenses & Permits 13881 13881 Miscellaneous 3733 3733 13469928 13460893 9035 0 464106 174275 1017516 1491393 82588 35354 89261 39187 3848587 2663689 1545658 1184898 34628 34628 22624 0 3256381 2959735 1760742 1645519 2275631 781224 4036373 2426743 X -779992 532992 -779992 532992 3256381 2959735 X -134060 1447044 X 0 1 X 1 1 1 X X 1 Johnston Memorial Hospital 540544705 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 290915 157656 133259 243021 241299 1722 3314651 2264734 1049917 1184898 Due to Affiliates 742037 Operating Lease Obligation ST 12044 Operating Lease Obligation LT 27143 781224 X Part X, Line 2: Abingdon Physician Partners is included in the audited consolidated financial statements of Ballad Health. The footnote explanation relative to income taxes reads: "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, 2022 and 2021. Tax returns for 2019 through 2021 are subject to examination by the Internal Revenue Service." 1 1 0 0 0 0 0 0 0 Alan Levine BH PresCEO Director, Beg. Nov. 2021 0 1328603 0 1687893 0 1066533 0 216552 0 23791 0 4323372 0 1002170 Marvin Eichorn BH EVPCAO Director, Beg. Nov. 2021 0 738294 0 347261 0 68911 0 17100 0 26804 0 1198370 0 0 Eric Deaton BH EVPCOO Director, Beg. Nov. 2021 0 656895 0 334180 0 30368 0 83012 0 21172 0 1125627 0 0 Lynn Krutak BH EVP/CFO 0 638754 0 299081 0 19133 0 80962 0 23301 0 1061231 0 0 Mark Patterson MD BHMA SVP Director, Through Nov. 2021 0 494284 0 205450 0 16452 0 60534 0 26232 0 802952 0 0 Carl Kilgore BH SVP Retail Former Officer 0 464334 0 183773 0 19429 0 64464 0 28116 0 760116 0 0 Tim Belisle BH EVPGen Cnsl Director, Beg. Nov. 2021 0 444154 0 202357 0 24072 0 61801 0 25605 0 757989 0 0 Edward Hickson VPPres SWMkt Former Officer 0 256355 0 165100 0 239115 0 14934 0 22185 0 697689 0 0 John Jeter VP/CEO JMH/BRMC/APP 0 314926 0 110719 0 7338 0 17251 0 21180 0 471414 0 0 Timothy Davis MD Physician 391600 0 20500 0 5213 0 17028 0 23398 0 457739 0 0 0 William Cummins MD Physician 320140 0 69572 0 11887 0 15984 0 18255 0 435838 0 0 0 Matthew Dorn MD Physician 370629 0 500 0 12013 0 17080 0 24337 0 424559 0 0 0 Amy Hitchcock MD Physician 308733 0 500 0 18464 0 0 0 16013 0 343710 0 0 0 Adrienne Griffin MD Physician 292450 0 500 0 20169 0 5065 0 12899 0 331083 0 0 0 David H Smith MD Director, Through Nov. 2021 190495 0 500 0 2204 0 12000 0 24494 0 229693 0 0 0 Justin Ivory Former CFO - JMH/APP 0 101777 0 2750 0 102 0 0 0 16577 0 121206 0 0 Part I, Lines 4a-b 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 Ballad Health 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. Additionally, during the year a one-time acceleration of the supplemental executive retirement plan occurred for the CEO in the amount of $1,002,170. This amount was taxable in the year accelerated and is included in total compensation for purposes of reporting. Alan Levine $199,452 Eric Deaton $ 65,950 Tim Belisle $ 44,703 Mark Patterson $ 43,434 Lynn Krutak $ 63,862 Carl Kilgore $ 47,364 The following executive received a change-of-control payment. The payment was reported as taxable income with appropriate tax withheld and remitted to the IRS. Edward Hickson $237,700 Form 990, Part VI, Section A, line 3 Line 3 explanation - The corporation contracted with Blue Ridge Medical Management Corporation, a for-profit corporation, to perform management duties such as accounting, payroll, budgeting, financial operations, and management responsibilities. Form 990, Part VI, Section A, line 6 Line 6 explanation - The corporation is organized as a Virginia non-stock, nonprofit organization with Johnston Memorial Hospital, a Section 501(c)(3) organization, as the sole member. Form 990, Part VI, Section A, line 7a Line 7a explanation - There is a single class of member, Johnston Memorial Hospital. Form 990, Part VI, Section A, line 7b Line 7b explanation - Certain decisions of the board are, pursuant to charter and Virginia statute, subject to approval of the members. These decisions include: dissolution of the corporation; merger of the corporation; non-ordinary course of business sale of assets, etc. No ordinary, day-to-day decisions are subject to member approval. Form 990, Part VI, Section B, line 11b Line 11b Explanation - The Ballad Health Tax Department prepares and reviews the Form 990. During preparation other functional areas within the orgainzation provide information and support to complete an accurate return. The return is reviewed by the organization's CEO and is provided in electronic form to all members of the Board of Directors prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Ballad Health has a conflict of interest policy for all members of the Board of Directors, the Executive Chair/President, Executive Vice Presidents, Senior Vice Presidents, and Vice Presidents, and applies to all Ballad Health organizations, including Abingdon Physician Partners. All persons covered by this policy are required to complete a conflict of interest disclosure form on an annual basis. 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. Form 990, Part VI, Section B, line 15 Line 15a - Compensation Process for Top Official 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. 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 CEO evaluates the data and, if appropriate, makes necessary adjustments. Any adjustments to Senior Vice Presidents or above are reviewed by the Board of Directors Executive Compensation Committee. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics categorized by; Quality, Service and Safety; Access to Care; Financial Stewardship, and any other metrics approved from time to time by the Board of Directors. 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 the 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 Environmental Services: Program service expenses 17,322. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,322. Laundry Services: Program service expenses 3,066. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,066. Collection Services: Program service expenses 274,474. Management and general expenses 0. Fundraising expenses 0. Total expenses 274,474. Credentialing Fees: Program service expenses 47,298. Management and general expenses 0. Fundraising expenses 0. Total expenses 47,298. Contract Labor: Program service expenses 2,182,510. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,182,510. Other: Program service expenses 97,078. Management and general expenses 0. Fundraising expenses 0. Total expenses 97,078. Form 990, Part XI, line 9: Intercompany Debt Forgiveness 1,447,044. Mountain States Health Alliance 303 Med Tech Parkway Suite 220 Johnson City TN 37604 620476282 Hospital System TN 501C3 Line_3_Hospital_Coop BALLAD 0 MSHA Auxiliary 400 N State of Franklin Road Johnson City TN 37604 581418345 Supporting Organization TN 501C3 12a MSHA 0 Smyth County Community Hospital 245 Medical Park Drive Marion VA 24354 540794913 Hospital VA 501C3 Line_3_Hospital_Coop MSHA 0 Dickenson Community Hospital 312 Hospital Drive Clintwood VA 24228 770599553 Hospital VA 501C3 Line_3_Hospital_Coop WHS 0 Johnston Memorial Hospital 16000 Johnston Memorial Drive Abingdon VA 24211 540544705 Hospital VA 501C3 Line_3_Hospital_Coop MSHA 0 Johnston Memorial Healthcare Fdn 851 French Moore Jr Blvd Ste 110 Abingdon VA 24210 262870970 Fundraiser VA 501C3 12b N/A 0 Ballad Health 303 Med Tech Parkway Suite 220 Johnson City TN 37604 611771290 Supporting Organization TN 501C3 12b N/A 0 Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City TN 37604 581594191 Fundraiser TN 501C3 Line_7_Organization_ BALLAD 0 Wellmont Health System 1905 American Way Kingsport TN 37660 621636465 Hospital System TN 501C3 Line_3_Hospital_Coop BALLAD 0 Wellmont Hawkins Co Memorial Hosp 851 Locust Street Rogersville TN 37857 621816368 Hospital TN 501C3 Line_3_Hospital_Coop WHS 0 Takoma Regional Hospital Inc DBA GCH 1420 Tusculum Boulevard Greeneville TN 37745 510603966 Hospital TN 501C3 Line_3_Hospital_Coop WHS 0 Wellmont Cardiology Services 1905 American Way Kingsport TN 37660 263557623 Medical Services TN 501C3 Line_10_Organization WHS 0 Wellmont Medical Associates 1905 American Way Kingsport TN 37660 270898372 Medical Services TN 501C3 Line_7_Organization_ WHS 0 Wellmont Madison House 2000 Greenway Street Kingsport TN 37660 621308216 Assisted Living TN 501C3 Line_10_Organization WHS 0 Wellmont Wexford House 2421 N John B Dennis Hwy Kingsport TN 37660 581859039 Nursing Home TN 501C3 Line_10_Organization WHS 0 Wellmont Imaging Services Inc 400 N State of Franklin Road Johnson City TN 37604 861103148 Healthcare TN 501C3 12a WHS 0 Emmaus Community Healthcare PLLC 6419 Bristol Hwy Piney Flats TN 37686 200577483 Medical Services TN N/A N/A 0 0 Medical Specialists of JC LLC 2528 Wesley Street Suite 2 Johnson City TN 37601 272199037 Medical Services TN N/A N/A 0 0 East TN Ambulatory Surgery Center 701 Med Tech Parkway Suite 100 Johnson City TN 37604 621787537 Medical Services TN N/A N/A 0 0 Rehabilitation Hospital of Bristol LLC 103 North Street Britol VA 24201 205612001 Medical Services VA N/A N/A 0 0 Blue Ridge Medical Management Corp 1905 American Way Kingsport TN 37660 621490616 Medical Services TN N/A C 0 Mediserve Medical Equipment 1905 American Way Kingsport TN 37660 621212286 Durable Medical Equipment TN N/A C 0 Mountain States Properties 1905 American Way Kingsport TN 37660 621845895 Property Management TN N/A C 0 Mountain States Physician Grp 1905 American Way Kingsport TN 37660 621700412 Medical Services TN N/A C 0 Community Home Care Inc 1490 Park Avenue NW Suite B Norton VA 24273 541453810 Durable Medical Equipment VA N/A C 0 Wilson Pharmacy Inc PO Box 5289 Johnson City TN 37604 620329587 Pharmacy TN N/A C 0 Wellmont Inc 1905 American Way Kingsport TN 37660 621320035 Medical Services TN N/A C 0 Wellmont Physician Services 1905 American Way Kingsport TN 37660 621567353 Medical Services TN N/A C 0 WPS Providers Inc 1905 American Way Kingsport TN 37660 205564642 Medical Services TN N/A C 0 Wellmont Health Services Inc 1905 American Way Kingsport TN 37660 621254373 Medical Services TN N/A C 0 Nolichuckey Mgmt Svcs Inc 1420 Tusculum Boulevard Greeneville TN 37745 621776681 Medical Services TN N/A C 0 Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman CJ KY1-1203 981195624 Insurance CJ N/A C 0 Ballad Ventures LLC 400 N State of Franklin Road Johnson City TN 37604 844214681 Investments TN N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 1