2023-05-12T14:27:57-05:00 2022-06-30 990 2021-07-01 270898372 Wellmont Medical Associates Inc WELL 4233023374 311 Princeton Road Suite 1 Johnson City TN 376012080 Chase Wilson VP/COO-BHMA 4233023374 2023-05-12 Chase Wilson 999009999 P03077501 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Chase Wilson 1905 American Way Kingsport TN 37660 129481755 0 X balladhealth.org X 2008 TN Honor those we serve by delivering the best possible care. 4 0 1008 0 0 0 1173649 70448 118507895 124931584 14433 17515 166783 4432161 119862760 129451708 0 0 0 0 86661498 86679172 0 0 0 35801499 41648361 122462997 128327533 -2600237 1124175 20328734 18025626 23109479 19811991 -2780745 -1786365 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 116248106 124901537 Wellmont Medical Associates, Inc. (WMA) is physician-led and professionally managed. From the WMA board of directors and leadership team members to the providers who care for patients every day, WMA's commitment to physician leadership is clear.WMA, a non-profit healthcare provider, delivers exceptional care to patients in the Tri-Cities region of Northeast Tennessee and Southwest Virginia. Based in Kingsport, Tennessee, as well as locations expanding from Sneedville, Tennessee, to Marion, Virginia, WMA offers the latest in technological advances to ensure patients receive superior care. Medical services provided by Wellmont Medical Associates include:- Primary care- OB/GYN- Surgery- Oncology- Outpatient and urgent care centers- Neurology- Pulmonology- Spine and rehabilitation- Behavioral health- Sleep center- Occupational medicine- Physical therapy- Pain management- Palliative medicine- HospitalistsWMA is dedicated to improving the community's access to quality, affordable healthcare, educating the region's caregivers, improving the health status of the communities and contributing to the overall quality of life in the areas served.In fiscal year 2022, WMA had 630,936 patient encounters.Recognizing some patients cannot afford essential medical services, WMA incurred a loss of $1,357,781 attributable to the provision of charity care in fiscal year 2022.Additionally, WMA provided care to people covered by Medicare, Medicaid, TennCare and Champus at a loss. Due to mandated reductions in Medicare funding and declining reimbursement from TennCare, the shortfall between reimbursement and the cost of providing care to these patients totaled $24,476,980.It is WMA's obligation to support the causes that improve the quality of life in the region. WMA sponsored educational, community-based programs on healthy lifestyles, risk factor identification and options for diagnosis and treatment. Programs included:- Lectures about asthma to area elementary schools- Providing a free clinic in Church Hill, Tennessee- Providing free medical care through the Remote Area Medical clinic- Supporting The Health Wagon in Wise, Virginia- Teaching at Lincoln Memorial University-DeBusk College of Osteopathic Medicine- Teaching at the University of Virginia's College at Wise- Working with Appalachian Mountain Project Access- Working with Friends In Need, a local nonprofit that provides primary care and dental care to the uninsured and underinsured as well as full-time college studentsWMA also participated in a number of health fairs and community screenings. Employees gave their time to area nonprofit organizations, which included the United Way and the East Tennessee affiliate of Susan G. Komen for the Cure. 116248106 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 85 0 1 1008 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Lynn Krutak 4233023374 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Eric Deaton BH EVP/COO 0.10 64.90 X X 0 1021443 104184 Alan Levine BH President & CEO/Chair 0.10 64.90 X X 0 4083029 240343 Tim Belisle BH EVP & Gen Counsel 0.10 64.90 X X 0 670583 87406 Marvin Eichorn BH EVP/CAO 0.10 64.90 X X 0 1154466 43904 Chase Wilson BHMA COO/CFO 40.50 4.50 X 279940 0 38130 Mark Patterson MD BH SVP BHMA Pres/CEO 54.50 0.50 X 716186 0 86766 Lynn Krutak BH EVP & CFO 0.10 64.90 X 0 956968 104263 Stephen Combs MD VP/CMO Medical Services 45.00 0.00 X 595951 0 25131 Girendra Hoskere MD Physician 40.00 0.00 X 739915 0 15135 Daniel Krenk MD Physician 40.00 0.00 X 738004 0 43576 Paul Kramer MD Physician 40.00 0.00 X 735290 0 38356 Paul Jett MD Physician 40.00 0.00 X 1001957 0 38911 Joseph Frye II MD Physician 40.00 0.00 X 759447 0 38521 Marta Wayt MD Former Officer/Chairman 39.90 0.10 X 482780 0 26937 Leanne Cox end 102020 Former Officer VP/BHMA CFO 0.00 40.00 X 0 105169 31799 Howard Herrell MD Former Officer Sec/Treas 0.00 40.00 X 0 433511 42472 David Thompson MD Former Officer/Vice Chair/CAMO 40.00 0.00 X 290096 0 25513 Landon Combs MD Former Officer 40.00 0.00 X 254509 0 33336 Karen Williams Former Key Employee 0.00 40.00 X 0 190309 32974 6594075 8615478 1097657 214 1 1 0 LocumTenenscom LLC PO Box 405547 Atlanta GA 30384 Medical Staffing 721051 Pain Medicine Associates PC 101 MedTech Parkway Suite 200 Johnson City TN 37604 Medical Staffing 470168 Tri-City Pulmonary Medicine LLC 305 Huntington Way Johnson City TN 37604 Physician Services 377156 Powell River Emergency Group PO Box 677979 Dallas TX 75267 Contract Physician Services 309606 Blue Ridge Radiology PC 3053 West State Street Bristol TN 37620 Radiology Services 301438 6 70448 70448 Net Patient Revenue 621990 80187133 80187133 Hospital Support 621990 36889723 36889723 CARES Act Revenue 900099 3517849 3517849 Performance Bonuses/Cap 621990 2784218 2784218 Wellness Programs 621990 924775 924775 627886 627886 124931584 47562 47562 6464 0 6464 6464 6464 30047 -30047 -30047 -30047 Gain on Settlement 900099 4143019 4143019 Medical Records 900099 151400 151400 Medical Director Fees 621990 90483 90483 40795 40795 4425697 129451708 124901537 0 4479723 668576 668576 73896806 73557384 339422 2148166 2135778 12388 6185924 6171415 14509 3779700 3746409 33291 65 65 10627596 10356275 271321 17226 17226 928743 906739 22004 7080060 6918942 161118 268279 240483 27796 56942 56942 1536731 1374298 162433 213448 211197 2251 Support Services 9980738 9980738 Medical Supplies 8603367 8603367 Maintenance 790027 787382 2645 Dues & Subscriptions 509771 141589 368182 1035368 1022615 12753 128327533 116248106 12079427 0 63661 62040 5849545 2478571 12500 106146 66170 1440316 713872 4376625 5666790 27707101 21380387 6728725 6326714 1289456 1289456 461760 1422013 20328734 18025626 13704156 13077249 1201302 1095229 8204021 5639513 23109479 19811991 X -2780745 -1786365 -2780745 -1786365 20328734 18025626 X 1124175 -129795 X 0 1 X 1 1 1 X 1888 0 0 1173649 70448 1245985 149020081 157985364 123132961 118596010 124901536 673635952 137073 60558 160834 90791 4425697 4874953 0 0 0 0 0 0 0 0 0 0 149159042 158045922 123293795 119860450 129397681 679756890 0 0 0 679756890 101010 90328 61638 32778 54026 339780 0 0 0 0 0 101010 90328 61638 32778 54026 339780 0 0 0 0 0 149260052 158136250 123355433 119893228 129451707 680096670 0.99950 0.99940 0.00050 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2139011 1132048 1006963 11103495 6713637 4389858 14181077 13478643 702434 283518 56059 227459 6326714 Other Receivables 1050532 Due from Affiliates 371481 1422013 Operating Lease Obligation ST 2399592 Operating Lease Obligation LT 3370404 Due to 3rd Party Payors 60185 Due to Payor Medicare Adv Pmts ST -190668 5639513 X Part X, Line 2: Wellmont Medical Associates 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." X 0 0 0 1 0 0 0 0 0 0 0 Alan Levine BH President & CEO/Chair 0 1328603 0 1687893 0 1066533 0 216552 0 23791 0 4323372 0 1002170 Marvin Eichorn BH EVP/CAO 0 738294 0 347261 0 68911 0 17100 0 26804 0 1198370 0 0 Eric Deaton BH EVP/COO 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 Paul Jett MD Physician 280821 0 714449 0 6687 0 13584 0 25327 0 1040868 0 0 0 Mark Patterson MD BH SVP BHMA Pres/CEO 494284 0 205450 0 16452 0 60534 0 26232 0 802952 0 0 0 Joseph Frye II MD Physician 365946 0 341873 0 51628 0 13049 0 25472 0 797968 0 0 0 Daniel Krenk MD Physician 692353 0 31750 0 13901 0 21526 0 22050 0 781580 0 0 0 Paul Kramer MD Physician 577362 0 155154 0 2774 0 16928 0 21428 0 773646 0 0 0 Tim Belisle BH EVP & Gen Counsel 0 444154 0 202357 0 24072 0 61801 0 25605 0 757989 0 0 Girendra Hoskere MD Physician 489626 0 246392 0 3897 0 14870 0 265 0 755050 0 0 0 Stephen Combs MD VP/CMO Medical Services 448261 0 133160 0 14530 0 17211 0 7920 0 621082 0 0 0 Marta Wayt MD Former Officer/Chairman 379770 0 83616 0 19394 0 16479 0 10458 0 509717 0 0 0 Howard Herrell MD Former Officer Sec/Treas 0 357950 0 64814 0 10747 0 17100 0 25372 0 475983 0 0 Chase Wilson BHMA COO/CFO 216688 0 63133 0 119 0 13770 0 24360 0 318070 0 0 0 David Thompson MD Former Officer/Vice Chair/CAMO 285012 0 500 0 4584 0 0 0 25513 0 315609 0 0 0 Landon Combs MD Former Officer 246057 0 500 0 7952 0 15207 0 18129 0 287845 0 0 0 Karen Williams Former Key Employee 0 183318 0 4321 0 2670 0 11721 0 21253 0 223283 0 0 Leanne Cox end 102020 Former Officer VP/BHMA CFO 0 102060 0 500 0 2609 0 6886 0 24913 0 136968 0 0 Part I, Line 1a Discretionary Spending WMA provided a monthly vehicle allowance to Stephen Combs, M.D., for travel expenses during the fiscal year ended June 30, 2022. The amount is included in taxable compensation. Part I, Line 1b As part of Dr. Stephen Combs' employment agreement for assuming the WMA CMO position, he receives $400 a month to provide for his personal auto usage. As CMO, Dr. Combs is required to attend numerous medical staff meetings, executive business meetings, serve on various committees and is responsible for various other clinical duties. He travels to multiple locations in East Tennessee and Southwest Virginia in performance of these responsibilities. The agreement was approved by the Wellmont Health System CEO. Part I, Line 4b 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. 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 Lynn Krutak $63,862 Tim Belisle $44,703 Mark Patterson $43,434 Landon Combs MD Family Member 273240 See Part V 0 Part IV Business Transactions Involving Interested Persons: Landon Combs, M.D., an employee and former officer of WMA, is a family member of Stephen Combs, M.D, key employee of WMA. Form 990, Part VI, Section A, line 6 The business and affairs of Wellmont Medical Associates, Inc. (WMA) are governed by Wellmont Health System's Board of Directors. WMA's board of directors is designated by Wellmont Health System, the sole member of WMA. In addition to such rights of approval and consent as may be reserved to the sole member of WMA pursuant to applicable law, transactions of the following matters by WMA require the prior approval of Wellmont Health System: (A) Implementation of WMA's annual budget, (B) Incurring any loan or other indebtedness for borrowed money, (C) Acquisition of any equipment or personal property for a purchase price in excess of $50,000 or the acquisition of any real estate, regardless of purchase price, (D) The undertaking of certain contractual commitments, (E) Entering into any plan of merger or consolidation, (F) Acquisition of substantially all of the assets of any other legal entity, and (G) Institution of any litigation by or on behalf of WMA. Form 990, Part VI, Section A, line 7a Wellmont Health System (WHS) is WMA's sole member. The board of directors of Ballad Health, WHS's parent organization, serves as WHS's board of directors and is responsible for appointing the directors of WMA's board. Form 990, Part VI, Section A, line 7b Certain decisions of the board are, pursuant to charter, subject to approval of the members. No ordinary, day-to-day decisions are subject to member approval. 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 VP/COO 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 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. 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 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 XI, line 9: Closing Adjustment-Highlands Wellmont Health Network, Inc. 476. Intercompany Transfers -130,271. Mountain States Health Alliance 303 Med Tech Parkway Suite 220 Johnson City TN 37604 620476282 Hospital System TN 501c3 Line_3_Hospital_Coop BALLAD HEALTH 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 Abingdon Physician Partners 16000 Johnston Memorial Drive Abingdon VA 24211 205485346 Medical Services VA 501c3 12a JMH 0 Ballad Health 303 Med Tech Parkway Suite 220 Johnson City TN 37604 611771290 Supporting Organization TN 501c3 12b N/A 0 East TN Healthcare Holdings Inc 203 Gray Commons Circle Gray TN 37615 815475903 Opioid Treatment TN 501c3 Line_3_Hospital_Coop MSHA 0 Wellmont Health System 1905 American Way Kingsport TN 37660 621636465 Hospital System TN 501c3 Line_3_Hospital_Coop BALLAD HEALTH 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 Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City TN 37604 581594191 Fundraiser TN 501c3 Line_7_Organization_ BALLAD HEALTH 0 Wellmont Madison House 2000 Greenway Street Kingsport TN 37660 621308216 Assisted Living TN 501c3 Line_10_Organization WHS 0 Wellmont Wexford House 2421 North John B Dennis Highway Kingsport TN 37660 581859039 Nursing Home TN 501c3 Line_10_Organization WHS 0 Wellmont Imaging Services Inc 1905 American Way Kingsport TN 37660 861103148 Healthcare TN 501c3 12a WHS 0 Rehabilitation Hospital of Bristol LLC 103 North Street Bristol VA 24201 205612001 Medical Services VA N/A N/A 0 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 Tennessee Ambulatory Surgery Center 701 Med Tech Parkway Suite 100 Johnson City TN 37604 621787537 Medical Services TN N/A N/A 0 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 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 Group 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 Nolichuckey Management 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 1 1 1 1 0 1 1 1 0 0