2021-05-14T06:11:31-07:00 2020-06-30 990 2019-07-01 611771290 Ballad Health BALL 4233023374 1021 W Oakland Avenue Suite 103 Johnson City TN 37604 Lynn Krutak BH EVP & CFO 2021-05-14 2019 2022-09-23 18:48:47Z Alan Levine PresidentCEO 303 Med Tech Parkway Ste 300 Johnson City TN 37604 63010501 false X balladhealth.org X 2015 TN Our mission: Honor those we serve by delivering the best possible care.Our vision: To build a legacy of superior health by listening to and caring for those we serve. 11 10 2578 21 299238 45724 911075 2025330 8072731 9932992 33308699 45008980 3263964 -570910 45556469 56396392 1000887 29610 0 12302330 21962628 0 194506 59985743 126628329 73288960 148620567 -27732491 -92224175 1975165200 2037115071 1312231001 1420522936 662934199 616592135 Honor those we serve by delivering the best possible care. false false 108665538 29610 15319266 See Schedule O 108665538 true true false true false false false false false false true false true false true true false true false false false false false false false false false false false true true false false false false false true false false false false false false false false false true true true false false true 369 0 true 2578 true true true false false false false false false 0 false false false false false true false X 11 10 false false false false false false false true true false false true true true true true true true true true true TN VA X Lynn Krutak 4233023374 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Alan Levine PresidentCEO Executive Chair 54.00 6.00 X X 2155621 0 214799 Marvin Eichorn EVP/CAO 52.80 7.20 X 1097890 0 42535 Lynn Krutak EVP/CFO 58.40 1.60 X 929458 0 96545 Barton Hove Former Officer - 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UBIT 138500 138500 Medical Supplies 138499 138499 -7861932 33253748 -41117933 2253 148620567 108665538 39760523 194506 78779665 8059 37404447 314541361 475776 228403 14093336 11977590 4565659 0 8515916 23247208 714005 2262000 7041518 19585480 575829211 329894736 222885867 245934475 673963918 775123176 90687616 18938691 435513957 448424068 133326592 133326592 274125706 36589190 1975165200 2037115071 68986492 91008482 2856305 359026 1040412920 1176741601 165740185 24542975 34235099 127870852 1312231001 1420522936 X 662917532 616210175 16667 381960 662934199 616592135 1975165200 2037115071 X -92224175 -10634659 56516770 X false true X true true true X X X 2 Mountain States Health Alliance 620476282 3 true 0 0 Wellmont Health System 621636465 3 true 0 0 2 0 true false false false false false false false false false false false false false false true RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 57576 true 664222 false false 721798 false false Part II-B, Line 1i - Other Activities Description Ballad Health had lobbying expenses of $57,576 which represents the portion of dues paid to Tennessee Public & Teaching Hospital Association, Tennessee Business Roundtable, Tennessee Chamber & Commerce Industry and Virginia Hospital and Healthcare Association.The remaining expenditures were incurred for lobbyist registrations,sponsorship of legislative events and consulting.Representatives of Ballad Healths Community & Government Relations department attended the following legislative conferences:Premier Federal Affairs Network meetingAmerica's Essential Hospitals Policy meetingTennessee Hospital Association Legislative Advocacy Day Tennessee Public & Teaching Hospitals Association annual meetingParticipated in CHA Public Policy Sub CommitteeRepresentatives of Ballad Healths Community & Government Relations department also contacted congressional offices concerning the following issues:Opposed any cuts in Medicare/MedicaidSupported area wage index permanent fix (introduced Save Rural Hospital Act)Supported the continuance of Medicare Dependent Hospital and Low-Volume designationsOpposed cuts to 340b Program and changes in eligibility resulting from the pandemicSupported a reasonable remedy for surprise billingMonitored progress of the TN Medicaid Block GrantSupported Provider Financial Relief Efforts for COVID related expenses and revenue lossesRepresentatives of Ballad Healths Community & Government Relations department responded via letter, phone, or in person to the following Tennessee and Virginia legislative issues:Certificate of Need reform(TN)/Certificate of Public Need (VA) reformContinuation of monitoring of Hospital Assessment Fee in Tennessee and VirginiaMental health funding for inpatient psychiatric care-Tennessee and overall behavioral health funding in VirginiaAdequate TennCare funding in Tennessee Limited hospital reporting requirements for surprise billingAdvocated for TANF (Temporary Assistance for Needy Families) Funding in Tennessee to support residential treatment center for mothers with substance use disorders and their young children 30139435 30139435 72400741 20874768 51525973 4457988 2416525 2041463 364091206 305606071 58485135 104739841 997372 103742469 245934475 448424068 Capital Lease CP 1138458 Capital Lease LT 5938528 Contributions Payable 850000 COVID-19 FICA Loan 1589837 Due to 3rd Parties - MCare PHE Acc 3485 Due to 3rd Party Payors -19155 Due to Affiliates 4122575 Long-term Compensation Payable 2966109 LT-DT 3rd Parties -Mcare PHE Accel/Adv 15669 Operatig Lease-LT Portion 2647807 Operating Lease-Current Portion 1493539 Reserve - Other 97727676 Retiree Health Care Benefit 1504305 Retirement Obligations 6824791 SWAPS 1067228 127870852 X Part X : FIN48 Footnote "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, 2020. Tax returns for 2017 through 2019 are subject to examination by the Internal Revenue Service." X true true X X X X true true true false false false false false false Alan Levine PresidentCEO Executive Chair 1217727 805887 132007 192278 22521 2370420 101488 Anthony Keck EVP/CPHO 436718 228079 6777 59684 19775 751033 Barton Hove Former Officer - Retired 12563 967590 980153 Clay Runnels MD EVP/Chief Phy Exec 432441 122757 4425 33425 23903 616951 Eric Deaton EVP/COO 517462 235353 28028 68002 18616 867461 Lisa Smithgall SVP/Chief Nursing Executive 362677 150386 8067 53895 16843 591868 Lynn Krutak EVP/CFO 618283 304398 6777 77960 18585 1026003 Marvin Eichorn EVP/CAO 715309 346798 35783 16759 25776 1140425 Melissa Carr SVP Financial Management 306254 134028 3276 49157 14554 507269 Monty McLaurin CEO NW Mkt. 389780 137469 44713 37303 24190 633455 Morris Seligman MD Former EVP & CMO 567374 2291 569665 Pam Austin SVP & CIO 288185 100525 13365 20988 10223 433286 Shana Tate SVP 277803 123339 3358 44277 942 449719 Shane Hilton SVP, CFO Market Operations 366177 157650 3642 53986 23922 605377 Steve Kilgore BHMA SVP 447286 186725 28132 62149 25594 749886 Tim Belisle EVP General Counsel 426412 250526 15016 63565 24190 779709 Todd Dougan Former Officer - Retired 14379 333707 2291 350377 Part I, Line 1a: Relevant information in regards to selections on 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, Line 4: Participated or recieved pay from an equity based compensation arrangement 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 participants 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 $175,519Lynn Krutak $61,200Eric Deaton $51,002Tim Belisle $42,840Tony Keck $42,840Steve Kilgore $45,390Melissa Carr $30,000Monty McLaurin $20,000Clay Runnels, MD $16,490Shane Hilton $37,230Lisa Smithgall $34,500Shana Tate $27,600Pam Austin $2,635The following executives received change-of-control payments. Payments were reported as taxable income with appropriate tax withheld and remitted to the IRS. Morris Seligman, MD $56,583Todd Dougan $322,094Wellmont Health System established a Rabbi Trust to benefit Barton Hove, former President & CEO of Wellmont Health system. Mr. Hove terminated his employment with Wellmont Health System effective January 31, 2018 which triggered the initiation of payments under the Rabbi Trust Agreement totaling $967,590. In accordance with Section 2. (e) of the Agreement, Mr. Hove is to be paid a monthly amount of $80,633, per the Agreement Payment Schedule. A Hth & Edu Facil Bd 2018 830682499 396649EX9 2018-06-06 820526657 Assets & Capital Improvements false false false A 13775000 820542471 9240 820535798 2019 false false false true A false false true true false false false true A false true true false false false false true A true Part VI 1.Part II, Line 10. Pursuant to Section 1.150 - 1(a)(2)(ii) of the Treasury Regulations, the proceeds of the Bonds were used to acquire the assets of Mountain States Health Alliance and Wellmont Health System, and such expenditures would be treated as capital expenditures, and not the refunding of prior debt. M Eichorn Officer split$life X 2808925 4565659 false true false 4565659 Form 990, Part VI, Line 11b: Form 990 Review Process 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, Line 12c: Explanation of Monitoring and Enforcement of Conflicts 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, Line 15a: Compensation Review & Approval Process - CEO, Top Management The executive committee serves as the compensation committee of Ballad Health's Board of Directors. The compensation plan for Alan Levine, Ballad Health's President and CEO, was reviewed and approved by the executive committee. An outside and independent compensation consultant was used to determine his compensation and benefits. Studies and surveys were used to ensure his pay is comparable to like positions at similarly situated organizations. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The executive committee reviewed and approved compensation for all Ballad Health executives at the vice-president level and above during FY20 using the same methodology used to determine the CEO's compensation. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available 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. Other Changes In Net Assets Or Fund Balances - Other Decreases Ballad Health Ventures = -$1075000 Other Changes In Net Assets Or Fund Balances - Other Decreases Captive = -$3523097 Other Changes In Net Assets Or Fund Balances - Other Decreases Change in Fair Value of Interest Rate Swap = -$12010666 Other Changes In Net Assets Or Fund Balances - Other Increases Elimination of Intercompany Receivables/Payables = $XXX-XX-XXXX Other Changes In Net Assets Or Fund Balances - Other Increases Foundation PTO = $471935 Other Changes In Net Assets Or Fund Balances - Other Increases HVASC = $471578 Other Changes In Net Assets Or Fund Balances - Other Decreases NCH Note = -$41342975 Other Changes In Net Assets Or Fund Balances - Other Increases SGASC = $8874 Other Changes In Net Assets Or Fund Balances - Other Increases SGASC Dist = $390000 Other Changes In Net Assets Or Fund Balances - Other Decreases SGASC Eq Dist = -$6454 Other Changes In Net Assets Or Fund Balances - Other Decreases SGASC tax pmt to City of Bristol = -$5427 Other Changes In Net Assets Or Fund Balances - Other Increases T/F LMSHA Corp BS = $29957633 Other Changes In Net Assets Or Fund Balances - Other Decreases T/F LWHS Corp BS = -$31813271 Other Changes In Net Assets Or Fund Balances - Other Increases Temporarily Restricted Grants = $365293 IMPROVING ACCESS TO HEALTHCARE SERVICES RE-IMAGINE RURAL HEALTHCARE - Since 2010, more than 130 rural hospitals have closed in the United States, according to the North Carolina Rural Health Research Program. Compared to other states, Tennessee ranks second worst in the nation, with 14 rural hospital closures between 2010 and 2020. A key benefit of Ballad Health, however, has been the retention of hospitals in rural communities of the Appalachian Highlands bucking the national trend. In fact, every community in the region with a hospital prior to the merger creating Ballad Health continues to be served by a hospital, even in the face of millions of dollars of annual operating losses in many of those hospitals. Before 2018, four hospitals in Northeast Tennessee and three hospitals in Southwest Virginia were reporting ongoing annual operating losses, with several at risk of closure, in addition to one hospital that closed in Lee County, Virginia, in 2013. REOPENING HOSPITAL IN LEE COUNTY, VA - Ballad Health has submitted an application to the Centers for Medicare and Medicaid to designate Lee County Community Hospital as a Critical Access Hospital. Significant progress was made during 2020 to repurpose the closed facility into a modern Critical Access Hospital to serve patients in a rural area despite impacts of the COVID-19 pandemic. While the new hospital is renovated, Ballad Health has opened a new urgent care center adjacent to the future hospital to provide residents in the area with immediate access to care.GREENE COUNTY, TN CONSOLIDATION AND NEW SERVICES- During the 2018 fiscal year, the two hospitals in Greene County, Laughlin Memorial and Takoma Regional, saw combined operating losses of $11 million, with cumulative two-year losses totaling nearly $25 million. As competing hospitals in the community, both hospitals were failing financially. With Ballad Healths creation, both hospitals were consolidated into one, with the Laughlin Memorial campus being renamed Greeneville Community Hospital. The former Takoma Regional Hospital campus is now being converted into a new service for the region Strong Futures, a residential facility for women who are pregnant and suffer from substance abuse disorders. Under this new model, Greeneville Community Hospital, the newly consolidated acute care hospital, has reversed its losses and is becoming financially sustainable. CREATED SINGLE COORDINATED REGIONAL TRAUMA SYSTEM - One of the most significant ways Ballad Health has been able to comply with the provisions of the Certificate of Public Advantage and Cooperative Agreement, which required avoidance of duplication of services where appropriate, was the consolidation of the two Level I trauma centers operating in the region and the subsequent creation of a coordinated regional trauma system. In approving this move in advance, the State of Tennessee relied upon the evidence published in multiple respected studies which found higher volume trauma centers lead to improved outcomes. The move toward a single coordinated trauma system followed the guidance of the American College of Surgeons (ACS), which verifies trauma centers, and Ballad Health is seeking verification of its Level I trauma center. When verified, it will be the first time the Appalachian Highlands will have had its Level I trauma center verified by the ACS.CONSOLIDATED REGIONAL PERINATAL CENTER - Tennessee law requires a regionalized system of care for high-risk newborns. The result of this law is a policy in Tennessee that recognizes five regional perinatal centers. Niswonger Childrens Hospital at Johnson City Medical Center is the designated center for regional perinatal care for the Appalachian Highlands. Prior to the merger, perinatal care in the Appalachian Highlands did not meet the goals of the state, with two NICUs that were not coordinated and shared volumes. Ballad Health immediately took steps to correct this after the merger, leading to a more sustainable and coordinated system of care for neonates, while also reducing the costs associated with maintaining two lower-volume units. After this consolidation, Ballad Health partnered with ETSUs Quillen College of Medicine, which provides ongoing expert neonatology coverage for the hospital, ensuring Ballad Health has neonatology provider coverage 24 hours per day. With more than 25 pediatric specialists to provide support for the Perinatal Center, this is the first time every newborn in the region has access to such highly specialized care.EXPANDED ACCESS TO PEDIATRIC SPECIALTIES - With financial support from Ballad Health and the State of Tennessee, the ETSU Quillen College of Medicine was able to successfully recruit pediatric surgeons to support the Niswonger Childrens Hospital. Our partners at ETSUs Quillen College of Medicine also provide 24/7 neonatology coverage for the NICU, and more than 25 pediatric specialists provide support as well. Ballad Health now proudly meets the highest standards for regional perinatal care, something that was not thought possible prior to the merger creating Ballad Health.PARTNERSHIP WITH ETSU TO CREATE FELLOWSHIP PROGRAM IN ADDICTION MEDICINE - Ballad Health and East Tennessee State University formed a partnership to create a new fellowship program in addiction medicine. As part of its commitment to expand education and training in the region, Ballad Health will fund any unreimbursed costs of the fellowship program which, over a 10-year period, could cost more than $2.5 million. With accreditation to the Accreditation Council for Graduate Medical Education, ETSU has a goal of accepting its first fellows by July 2020.ESTABLISHMENT OF CENTER FOR RURAL HEALTH RESEARCH Tennessee Governor Bill Lee announced the creation of a new Center for Rural Health Research that will be housed at the College of Public Health at East Tennessee State University. In addition to state funding, Ballad Health has committed to contributing more than $15 million during the next 10 years to the Center. The goal of the Center will be to work with Ballad Health, local healthcare delivery partners, national experts and the leadership of ETSU Health to identify new mechanisms to improve health in rural and nonurban communities. Specific emphasis will be placed on strategies that disrupt inter-generational cycles of behaviors that contribute to poor health outcomes, which ultimately can affect college and career-readiness.RECRUITMENT OF NEW PHYSICIANS TO RURAL SOUTHWEST VIRGINIA - Ballad Health provided the necessary resources to recruit new specialists to serve our region, many of whom were recruited to private practices not owned by Ballad Health. The addition of specialists is helping to improve access to care in rural communities. For instance, Wise County in Virginia now benefits from an orthopedist, a cardiologist and several other physicians and providers. Wythe County, in Virginia, a community not served by a Ballad Health hospital, benefits from a cardiologist recruited by Ballad Health. Throughout the region, new physicians and advanced practitioners, recruited and funded by Ballad Health, are serving the region from trauma care to pediatrics, from Wythe County, Virginia to Hancock County, Tennessee. IMPROVING HEALTHCARE QUALITY QUALITY METRICS - Ballad Healths Board of Directors has adopted a zero-harm culture for the organization, and processes have commenced to institutionalize this objective. This focused effort on quality improvement significantly benefitted patients. While quality measures can vary from month to month, and Ballad Health cautions about deriving conclusions based on data at one point in time, some positive trends have emerged, including: Clostridioides difficile (C. diff) decreased by 44% compared to the baseline, Catheter-associated urinary tract infections (CAUTI) decreased by 41% compared to last fiscal year and decreased by 4% compared to baseline, Iatrogenic Pneumothorax rate decreased by 66% compared to the baseline, In-hospital fall with hip fracture rate decreased by 50% compared to the baseline, Postoperative acute kidney injury (AKI) decreased by 50% compared to the baseline, Postoperative wound dehiscence rate decreased by 28% compared to the baseline, Postoperative respiratory failure rate decreased by 60% compared to the baseline, Sepsis bundle compliance remains an all-time high of more than 64%, putting Ballad Health as one of the top performers in the nation in this domain. Prior to the impacts of COVID-19, Ballad Health improved performance in 13 of the 17 Quality Targeted Measures that Tennessee and Virginia use to measure quality of care delivered to patients for the 2020 fiscal year. Ballad Health ranked above the 90th percentile of health systems in Hospital Compare during that time in five of the 17 Quality Targeted Measures. PARTICIPATION IN THE MEDICAID TRANSFORMATION PROJECT - Ballad Health and a group of the nations leading health systems joined forces to identify ways to better care for some of the nations most vulnerable populations through the Medicaid Transformation Project. The project is a national effort to transform healthcare and address social determinants of health for the nearly 75 million Americans who rely on Medicaid. The work focused on four keys areas of opportunity: Behavioral health, child and maternal health, substance use disorder and avoidable emergency department visits. PARTICIPATION IN THE HIGH-VALUE CARE COLLABORATIVE - Ballad Health was chosen for a national initiative called The High-Value Care Collaborative, a partnership of the American Hospital Association, the American Board of Internal Medicine Foundations Choosing Wisely campaign, and the Costs of Care organization, that brings together participants to improve efficiency in healthcare, decrease cost and improve quality. During the past year, Ballad Health and other participants in the program adopted strategies to reduce unnecessary cost and deliver evidence-based care that has been demonstrated to reduce the burden on patients. IMPROVING THE COMMUNITY'S HEALTHCARE STATUS ACCOUNTABLE CARE COMMUNITY ACHIEVEMENTS - To help address the broader needs of the community at large, Ballad Health has convened the nations largest accountable care community (ACC), spanning two states with more than 300 participating organizations in 21 counties throughout the Appalachian Highlands.Through five months of regional focus groups and stakeholder meetings, the ACC selected four priority areas to influence through its work: substance abuse, tobacco use, overweight and obesity, childhood trauma and resiliency.The ACC leadership council has agreed that the most impactful way to address the four priority areas is by focusing on interventions that benefit children and families. To reflect this commitment toward youth, the group chose the name STRONG ACC (Striving Toward Resilience and Opportunity for the Next Generation) and is organizing activities into four categories: STRONG Starts (conception through kindergarten), STRONG Youth (kindergarten through 12 years old), STRONG Teens (13 to 18 years old) and STRONG Families (adults and caregivers).CREATION OF NEW BALLAD HEALTH BEHAVIORAL SERVICES DIVISION - To achieve success in a value-based healthcare environment and to achieve the goals for improved access to behavioral services for the region, Ballad Health created the Behavioral Health Services Division. CREATION OF THE BALLAD HEALTH INNOVATION CENTER - Ballad Health created The Innovation Center to serve as a hub for development of partnerships and collaborations that can bring to market life-saving initiatives and other technologies and services that can improve the human condition. COMMUNITY RESOURCES - Ballad Health parish nurses work with individual congregations to help people in religious communities improve their health, prevent illness and injury and ease suffering associated with any health crisis. The parish nurse acts as counselor, educator and healthcare provider by identifying needs of the congregation, coordinating health screenings, providing educational programs, supplying health literature and referring congregants to supportive health services where appropriate. Also, the parish nurse maintains an active visitation program to parishioners who are homebound, hospitalized or in nursing homes. Currently, there are dozens of churches in Northeast Tennessee and Southwest Virginia that are serviced by the Ballad Health parish nurse program. Ballad Healths Nurse Connect is a toll-free line that connects community members with experienced nurses around the clock. The nurses provide expert medical advice anytime, day or night, make referrals to a primary care provider with a location and hours convenient to the community member and referrals to a physician specialist when they need advanced local medical care. They also provide health information and resources, including health screenings and immunizations, and make referrals to urgent care clinics to see a doctor near the community member the same day. Ballad Healths Marsh Regional Blood Center supplies the blood needs of 28 hospitals and 5 rescue aircraft across Northeast Tennessee and Southwest Virginia. This is accomplished through our collection facilities in Kingsport, Johnson City, Bristol, and 650 mobile blood drives at local high schools, businesses, and colleges each year. Marsh conducts blood drives with 49 high schools and 21 colleges & vocational schools throughout Northeast Tennessee and Southwest Virginia.CHARITABLE CONTRIBUTIONS- From its inception in February of 2018, Ballad Health made significant contributions to the community it serves totaling nearly $9 million to date. A few examples from fiscal year 2020 include: contribution towards the Center for Rural Health and Research and establishment of the Ballad Health Institute focusing on Trauma Informed Care, annual support for medical and dental care to working uninsured or underinsured, Isaiah 117 House support to provide physical and emotional support for children awaiting foster care placement, full body scanner for Sullivan County Main Jail Facility to improve safety and security for the Sullivan County Sheriffs Office. INVESTMENTS COMMON ELECTRONIC HEALTH RECORD - Ballad Health made additional progress in FY20 toward establishing a common clinical platform and electronic health record (EHR). An implementation plan was developed to include infrastructure enhancements to support the expansion. This investment of over $200 million will allow patient information to be shared immediately at the point of service regardless of where a patient enters the Ballad Health system, providing clinical staff with information to better manage patients in the emergency room, clinics, acute and post-acute settings. In the midst of, and despite the global health pandemic, on June 1, Ballad Health successfully completed the first major milestone in a journey to create a common and interoperable health technology platform. Ballad Health launched the ambulatory portion of the electronic health records system, Epic, in physician clinics, previously part of the Mountain States Health Alliance system. This effort was completed with Ballad Health achieving 100 percent compliance with the Key Operating Indicators indicative of a successful conversion. The new platform will provide patients and their doctors with new options for access, care and security of patient records unprecedented in Ballad Healths service area. Ballad Health implemented the acute care phase of the transition on October 1, 2020 concluding a multi-year effort to transition to a single patient record platform. With this accomplishment, Ballad Health expects to optimize its connectivity to consumers, improving the patient experience dramatically. CHARITY CARE CONTRIBUTIONS - For 2020, Ballad Health provided more than $60 million in free care, cost that is not reimbursed by any payer nor recovered from the patient who qualifies for charity assistance. Following the merger, Ballad Health increased the threshold for patients to qualify for charity care from 200% of the federal poverty level to 225% of the federal poverty level, and provides significant discounts for people up to 450% of the federal poverty level. ACCOUNTABLE CARE ORGANIZATION SAVINGS - Ballad Health was among the first health systems to implement and successfully demonstrate that value-based care led to reduced costs through its Accountable Care Organization (ACO), AnewCare Collaborative. Value-based care means payments for healthcare are based on the quality of care provided and in the reduction of the total cost of care. Since the United States Centers for Medicare and Medicaid Services established the shared savings program six years ago, AnewCare has been one of only 18 ACOs in the nation to generate savings for taxpayers each year saving taxpayers more than $25million since inception.MEDICAL EDUCATION - Ballad Health continues to offer free Certified Nursing Assistant (CNA) classes, which are open to the public. The CNA courses are approved and regulated by either the Tennessee State Board of Nursing or the Virginia Board of Nursing (Smyth County Community Hospital). The training opportunity can lead to job opportunities for those who complete the program. 62 percent of the students trained by Ballad Health are hired upon graduation. Ballad Health offers the course free of charge and participants who successfully complete the course meet criteria to sit for the state certification examination. The program includes classroom sessions followed by clinical experience. Clinical hours are conducted at various Ballad Health facilities. RESEARCH the Ballad Health research department serves as the central office for multi-specialty research oversight to our healthcare system. In addition to providing full spectrum support for studies generated and managed by the research department, the department provides oversight for studies generated by external groups. The research department has participated in several large-scale, multi-center trials with a high subject retention rate and sponsor/monitoring rating. Oversight services include administrative, legal, regulatory support, internal service arrangement and financial management. In addition, since teaching and continuing education play a large role within the organization, research staff participate in conferences/webinars and conduct a monthly research orientation session. The department maintains reportable metrics and financial reports on a quarterly basis. The focus for principal investigators is mostly in therapeutic areas such as oncology, neuro/trauma/ortho, pharmacology, endocrinology, pediatrics, and cardiology. A variety of studies include different designs that may include, but are not limited to, pharmaceutical/investigational trials, retrospective medical chart reviews and registry studies. The research department is dedicated to: providing consistent oversight and management of clinical research performed at all Ballad Health facilities,ensuring regulatory compliance and fiscal responsibility, andcreating a research culture across Ballad Health facilities OTHER NOTABLE EVENTS AND AWARDS Ballad Health, ETSU partner to launch Strong BRAIN Institute to study adverse childhood experiences. The Strong BRAIN (Building Resilience through ACEs-Informed Networking) Institute will facilitate the development and dissemination of evidence-based practices that prevent, reduce or mitigate the negative effects of Adverse Childhood Events (ACEs) on health and health disparities. The institute will also work to inform the citizenry and workforce in the Appalachian Highlands on the importance of being trauma informed. Established through a five-year gift from Ballad Health to ETSU, the Strong BRAIN Institute will be guided by an advisory board comprised of ETSU experts, Ballad Health experts and community members.Ballad Health announced that Dr. Michael Chernew, the Leonard D. Schaeffer Professor of Health Care Policy and the Director of the Healthcare Markets and Regulation Lab at Harvard Medical School, will lead an independent study to evaluate hospital competition in small rural markets, and how service offerings and expenses are affected by rural hospital closures and mergers. This latest announcement follows on a partnership between Tennessee Gov. Bill Lee, the Tennessee Legislature and Ballad Health last July to create the Center for Rural Health Research at ETSU a multidisciplinary institute for research impacting rural health. Over a 10-year period, Ballad Healths $15 million contribution commitment was matched with nearly $10 million by the governor and Tennessee legislature.Harvard University and UnitedHealthcare recognized Ballad Health as one of four healthcare organizations leading the way towards a 3D model for value-based care.In response to the COVID-19 Pandemic, Ballad Health partnered with the Mayo Clinic to conduct research into convalescent plasma as an experimental treatment. Ballad Health was recognized by Forbes magazine as being a top employer for diversity and inclusion. In its annual Best Employers for Diversity list, Ballad Health ranked 29th in the entire nation and were fifth among employers in the Healthcare and Social industry.Holston Valley Medical Center was selected as one of only two medical facilities in the United States as a demonstration site for the Leipzig Interventional Course (LINC) 2020 conference. LINC is an interdisciplinary live course designed to provide a global platform that facilitates discussion of vascular patients by integrating colleagues of different specialties who are performing endovascular intervention.Holston Valley Medical Center was recognized as one of the nations 50 Top Cardiovascular Hospitals by IBM Watson Health.Two Ballad Health hospitals, Franklin Woods Community Hospital and Bristol Regional Medical Center, earned the Tennessee Department of Healths BEST for Babies award for their efforts to improve infant care and reduce infant mortality.Norton Community Hospitals inpatient rehabilitation department was recognized for the 13th straight year as among the top 10 percent in the nation for functional patient outcomes.Dr. Amit Vashist, Chief Clinical Officer for Ballad Health, was named to the physician leaders to know by Beckers Hospital Review for the second year in a row. Eric Deaton, Chief Operating Officer for Ballad Health, was named to the Leadership Tennessee 2019-2020 class. Leadership Tennessee is a program that brings leaders from across the state together to engage in collaborative, non-partisan dialogue on issues of statewide importance. PART lll, Program Service Accomplishments Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). The two healthcare systems came together on February 1, 2018 as a result of a merger approved by both Tennessee and Virginia Departments of Health. Ballad Health operates under a Certificate of Public Advantage (COPA) in Tennessee and a Cooperative Agreement (CA) in Virginia. Pursuant to the COPA and CA, MSHA and WHS are required to fulfill the obligations, commitments and covenants set forth in the COPA. Such obligations include that Ballad Health shall meet, over the ten-year period beginning July 1, 2018, established minimum spending criteria on initiatives for expanded access to healthcare services, health research and graduate medical education, population health improvement, and a region-wide health information exchange. The full text of the COPA can be found on the Tennessee Department of Health's website, while the CA can be found on the Virginia Department of Health's website.Ballad Health is a healthcare delivery system serving 1.2 million residents from 29 counties in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeastern Kentucky. Ballad Health operates 3,030 licensed beds and 21 hospitals, including a dedicated children's hospital, community hospitals, three 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. Form 990 for MSHA includes seven wholly-owned hospitals including a childrens hospital and a behavioral health hospital; four others, majority owned by MSHA, each file a separate return. Form 990 for WHS includes five wholly-owned hospitals; two others, also wholly-owned, each file a separate return. 2019 Novel Coronavirus (COVID-19) Public Health EmergencyThe United States Secretary of Health and Human Services declared a Public Health Emergency on January 31, 2020 due to confirmed cases of the 2019 Novel Coronavirus (COVID-19). On March 10, 2020 Ballad Health executed its disaster plan in response to the COVID-19 pandemic. This included the activation of its Corporate Emergency Operations Command (CEOC) to coordinate efforts across the system and around the region to rapidly plan for, and execute, ongoing response to the issues resulting from the COVID-19 pandemic. The policy establishing the CEOC is established and authorized by the Board of Directors, and follows guidelines established by the Federal Emergency Management Agency (FEMA) and the CDC. CEOC is led by an incident commander appointed by the Chief Executive Officer in this instance the Chief Operating Officer. The CEOC is composed of key leaders overseeing essential functions of the health system, including logistics, supply chain, communications, operations, finance, government relations and clinical services. The CEOC acts as the clearinghouse for all organizational planning and decision-making related to the event, and continues its responsibilities under the oversight of, and until discontinued by, the Chief Executive Officer. The Chief Executive Officer, who also serves as Chair of the Board of Directors, keeps the Board of Directors apprised of issues on an ongoing basis and ensures compliance with the Boards delegations of authority pursuant to Ballad Healths policies.Effective March 23, 2020, Ballad Health complied with federal and state guidance to cease all non-emergent, elective procedures. Beyond the deferral of these procedures and diagnostic testing, Ballad Health experienced a decline in other types of medical treatment similar to that experienced by most health systems and physician organizations physician practice, urgent care and other routine medical service visits declined precipitously.Comparing the fourth quarter of 2020 to the prior year, Ballad Health saw a 22.6% decline in acute discharges, a 29.3% decline in surgeries performed in hospital settings; a 26.9% decrease in inpatient surgeries; a 30.6% decrease in outpatient surgeries; and a 34.7% decrease in emergency department visits. Due to these unique circumstances and the material adverse effect COVID-19 imposed on the health system, the Tennessee Department of Health and the Virginia Department of Health temporarily suspended certain provisions of the COPA and the CA, respectively, providing flexibility for Ballad Health to plan for, and respond to, the various issues related to the pandemic.During the 2020 fiscal year, Ballad Healths total expenses decreased by 1.4%, or $29 million, when compared to the prior year. Cost reduction efforts also resulted in almost $50 million in savings for the fourth quarter of 2020.In May 2020, Ballad Health partnered with Premier, Inc., on a new program to ensure our team members and patients are always protected through the availability of personal protective equipment, such as gloves, gowns and masks. This program focused on investing in domestic manufacturers to enhance supply chains for essential medical products and PPE. 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