SMYTH COUNTY COMMUNITY HOSPITAL: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: SMYTH COUNTY COMMUNITY HOSPITAL (EIN 54-0794913)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2019-05-10
IRS object ID: 201921309349300617
Schema version: 2017v2.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-05-10T08:16:26-05:00	ReturnTs
Tax Period End	2018-06-30	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2017-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	540794913	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SMYTH COUNTY COMMUNITY HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	SMYT	BusinessNameControlTxt
Phone	2763781202	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1021 W OAKLAND AVENUE SUITE 103	AddressLine1Txt
City	JOHNSON CITY	CityNm
State Abbreviation	TN	StateAbbreviationCd
ZIP	37604	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	JAMES TYLER	PersonNm
Person Title	SCCH CEO	PersonTitleTxt
Phone	2763781202	PhoneNum
Signature	2019-05-10	SignatureDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	151.102.241.104	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-05-10	IPDt
IP Tm	08:16:26	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	87E77A894FBEAE8A07458463D987FBB2F40DF0C9	AtSubmissionCreationDeviceId
At Submission Filing Device Id	39095CF110B0C8EE9B5E629A9826572B753F4624	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Address Change	Yes (X)	AddressChangeInd
Principal Officer	JAMES TYLER	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	P O BOX 880	AddressLine1Txt
City	MARION	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24354	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$49,757,113	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	BALLADHEALTH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1961	FormationYr
Legal Domicile State	VA	LegalDomicileStateCd
Activity Or Mission	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	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	2	TotalEmployeeCnt
Total Volunteers	69	TotalVolunteersCnt
Total Gross UBI	$31,286	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$13,232	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$28,488	PYContributionsGrantsAmt
CY Contributions Grants	$28,717	CYContributionsGrantsAmt
PY Program Service Revenue	$44,014,919	PYProgramServiceRevenueAmt
CY Program Service Revenue	$47,653,157	CYProgramServiceRevenueAmt
PY Investment Income	$1,045,065	PYInvestmentIncomeAmt
CY Investment Income	$1,512,686	CYInvestmentIncomeAmt
PY Other Revenue	$425,902	PYOtherRevenueAmt
CY Other Revenue	$397,671	CYOtherRevenueAmt
PY Total Revenue	$45,514,374	PYTotalRevenueAmt
CY Total Revenue	$49,592,231	CYTotalRevenueAmt
PY Grants And Similar Paid	$22,397	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$21,140	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$21,556,086	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$20,942,606	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$24,479,322	PYOtherExpensesAmt
CY Other Expenses	$25,478,420	CYOtherExpensesAmt
PY Total Expenses	$46,057,805	PYTotalExpensesAmt
CY Total Expenses	$46,442,166	CYTotalExpensesAmt
PY Revenues Less Expenses	-$543,431	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$3,150,065	CYRevenuesLessExpensesAmt
Total Assets BOY	$102,355,794	TotalAssetsBOYAmt
Total Assets EOY	$104,938,742	TotalAssetsEOYAmt
Total Liabilities BOY	$21,168,446	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$19,992,938	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$81,187,348	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$84,945,804	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	OUR MISSION: HONOR THOSE WE SERVE BY DELIVERING THE BEST POSSIBLE CARE	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$30,948,325	ExpenseAmt
Grant	$21,140	GrantAmt
Revenue	$39,374,077	RevenueAmt
Desc	SMYTH COUNTY COMMUNITY HOSPITAL (SCCH) HAS A 55-PLUS YEAR HISTORY OF PROVIDING HEALTHCARE SERVICES WITHIN THE COMMUNITY OF MARION, VIRGINIA. SCCH IS A 44-BED COMMUNITY-BASED HOSPITAL THAT OFFERS BOTH ACUTE CARE AND INPATIENT REHABILITATION CARE. THE HOSPITAL PROVIDES COMPREHENSIVE OUTPATIENT SERVICES AND A VARIETY OF OUTREACH PROGRAMS SUCH AS HOMECARE. ADDITIONALLY, SCCH HAS A 109-BED NURSING CARE FACILITY, FRANCIS MARION MANOR HEALTH AND REHABILITATION (FMM). FMM PROVIDES BOTH SKILLED-LEVEL AND NURSING FACILITY-LEVEL HEALTH CARE SERVICES. (CONTINUED ON SCHEDULE O) (CONTINUED) OUR MEMBERSHIP CONSISTS OF MOUNTAIN STATES HEALTH ALLIANCE (MAJORITY OWNER) AND SMYTH COUNTY COMMUNITY FOUNDATION. IN FEBRUARY 2018, MOUNTAIN STATES HEALTH ALLIANCE (MSHA) AND WELLMONT HEALTH SYSTEM (WHS) MERGED TO FORM BALLAD HEALTH, A TAX-EXEMPT ENTITY AND PARENT COMPANY OF MSHA AND WHS. BALLAD OPERATES 3,293 LICENSED BEDS IN 21 HOSPITALS, AN OUTPATIENT ADDICTION TREATMENT FACILITY, LONG-TERM CARE FACILITIES, HOME CARE AND HOSPICE SERVICES, RETAIL PHARMACIES, OUTPATIENT SERVICES AND A COMPREHENSIVE MEDICAL MANAGEMENT CORPORATION. FOR THE YEAR ENDING JUNE 30, 2018, SCCH RECORDED 1,372 INPATIENT HOSPITAL ADMISSIONS AND 284 NURSING HOME ADMISSIONS. THERE WERE 74,951 OUTPATIENT VISITS, 16,459 EMERGENCY VISITS AND 10,891 HOME HEALTH VISITS. SCCH SUBSIDIZED A PHYSICIAN CLINIC LOCATED IN A RURAL, MEDICALLY UNDERSERVED AREA. THE CLINIC ALLOWS RESIDENTS TO RECEIVE QUALITY CARE WITHOUT HAVING TO TRAVEL OUTSIDE OF THEIR HOME AREA. THIS IS ESPECIALLY IMPORTANT FOR ELDERLY RESIDENTS AND OTHERS THAT REQUIRE FAMILY OR FRIENDS TO PROVIDE TRANSPORTATION TO PHYSICIAN APPOINTMENTS. OUR COST DURING THE YEAR TO SUBSIDIZE THE CLINIC WAS 77,863. THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC) ISSUED A PRESS RELEASE DATED APRIL 11, 2018 STATING THAT THE UNITED STATES COULD SEE A SHORTAGE OF UP TO 120,000 PHYSICIANS BY 2030. THE U.S. POPULATION IS ESTIMATED TO GROW BY NEARLY 11%, WITH THOSE OVER AGE 65 INCREASING 50% BY 2030. MUCH OF THE INCREASED DEMAND COMES FROM A GROWING, AGING POPULATION. THE AGING POPULATION WILL ALSO AFFECT PHYSICIAN SUPPLY SINCE ONE-THIRD OF ALL CURRENTLY ACTIVE DOCTORS WILL BE OLDER THAN 65 IN THE NEXT DECADE AND LIKELY TO RETIRE. THE AAMC POINTS OUT THAT DATA CONDUCTED IN 2017 INDICATED THAT AN ADDITIONAL 31,600 PHYSICIANS WOULD HAVE BEEN NEEDED IF UNDERSERVED POPULATIONS UTILIZED THE SAME HEALTH CARE SERVICES AS INSURED INDIVIDUALS. THE DATA LOOKED AT PEOPLE IN NON-METROPOLITAN AREAS AND PEOPLE WITHOUT INSURANCE COMPARED TO PEOPLE LIVING IN METROPOLITAN AREAS. FURTHERMORE, THE STUDY INDICATED NEARLY HALF OF THE SHORTAGE WAS IN THE SOUTH. SCCH SPENT 329,279 DURING FY18 TO RECRUIT AND RETAIN PHYSICIANS. SCCH RECRUITMENT EFFORTS ARE BASED ON DOCUMENTED COMMUNITY NEED. SCCH IS LOCATED IN A MUA (MEDICALLY UNDERSERVED AREA), AS DESIGNATED BY THE U.S. HEALTH RESOURCES & SERVICES ADMINISTRATION (HRSA). MUA DESIGNATION INDICATES AN AREA AS: HAVING TOO FEW PRIMARY CARE PROVIDERS, HAVING A HIGH INFANT MORTALITY, A HIGH POVERTY RATE OR A HIGH ELDERLY POPULATION. SCCH, ALONG WITH THE SMYTH COUNTY HOSPITAL HEALTHTRUST AND THE SMYTH COUNTY HEALTH DEPARTMENT, HOSTED THEIR SECOND ANNUAL FREE HEALTH FAIR FOR LOCAL LAW ENFORCEMENT AGENTS IN THE COUNTY. THE ALL-DAY EVENT PROVIDED OFFICERS A VARIETY OF SCREENINGS FREE OF CHARGE, INCLUDING LAB WORK, VISION, SLEEP, VARIOUS VACCINATIONS INCLUDING FLU SHOTS, BLOOD PRESSURE AND BMI CHECKS, AND MORE. GUESTS WERE ABLE TO SPEND TIME WITH HEALTH CARE PROVIDERS AND ASK QUESTIONS ABOUT THEIR RESULTS OR OTHER HEALTH CONCERNS. HEALTH EDUCATION CLASSES WERE PROVIDED THROUGHOUT THE YEAR. FOR EXAMPLE, WE OFFER CPR CLASSES FOR LOCAL BUSINESSES AND AGENCIES AND A JOINT CLASS IS OFFERED FOR PEOPLE WITH HIP AND KNEE PAIN. DURING THE YEAR SCCH HOSTED TWO CHAMBER OF COMMERCE BREAKFASTS. AT THE FIRST BREAKFAST A SURGEON PROVIDED EDUCATION ON BREAST CANCER/BREAST CANCER AWARENESS AND AT THE SECOND BREAKFAST A CARDIOLOGIST PROVIDED EDUCATION ON CARDIOVASCULAR HEALTH. IN AUGUST 2018, SCCH HOSTED THE FIRST MEETING OF THE SOUTHWESTERN CHAPTER OF THE VIRGINIA NURSES ASSOCIATION (VNA). NURSES FROM ACROSS SOUTHWEST VIRGINIA ATTENDED. THE EVENT WAS OPEN TO MEMBERS AS WELL AS NONMEMBERS, BOTH RNS AND LPNS. GUESTS INCLUDED REPRESENTATIVES FROM THE VNA, A DELEGATE FOR THE 5TH DISTRICT OF VIRGINIA, AND A NURSE EDUCATOR AND CO-LEAD OF THE NURSING TASK FORCE AND COALITION FOR NURSES ON BOARDS FOR THE STATE OF VIRGINIA. ATTENDEES WERE PROVIDED UPDATES ON NURSING ACTIVITIES ACROSS THE STATE, UPCOMING CONFERENCES AND SCHOLARSHIP OPPORTUNITIES, UPDATES ON LEGISLATION AND BILLS RELATED TO HEALTH CARE AND NURSING, AND AN INTERACTIVE PROGRAM FOCUSED ON HARNESSING NURSING PERSPECTIVES AND THE VALUE OF NURSES ON BOARDS. SEVERAL SCCH TEAM MEMBERS WERE SELECTED LAST YEAR TO SERVE AS OFFICERS FOR THE SOUTHWESTERN CHAPTER OF THE VNA. IN OCTOBER 2018, SCCH HOSTED A LEGISLATIVE RECEPTION SPONSORED BY THE SOUTHWEST CHAPTER OF THE VNA AND THE VIRGINIA COUNCIL OF NURSE PRACTITIONERS (VCNP). THE EVENT BROUGHT TOGETHER SEVERAL LEGISLATORS AND THEIR REPRESENTATIVES TO TALK ABOUT HEALTHCARE REFORM, FOCAL POINTS FOR THE UPCOMING SESSION AND THEIR POSITION ON VIRGINIA NURSING'S PUBLIC POLICY PLATFORM. MUCH OF THE FOCUS OF THE EVENING WAS TARGETED AT POPULATION HEALTH, PRACTICE AUTHORITY IN THE STATE OF VIRGINIA, EDUCATION RESOURCES TO SUPPORT LOCAL COLLEGES, ESPECIALLY THOSE WITH NURSING PROGRAMS, CURRENT LEGISLATION AROUND THE CARE OF PSYCHIATRIC PATIENTS AND ITS IMPACT ON THE ACUTE CARE SETTING, AND THE OPIOID CRISIS. ATTENDEES CAME FROM ACROSS SOUTHWEST VIRGINIA AND REPRESENTED A VASTLY DIVERSE NURSING POPULATION FROM COLLEGE DEANS TO NURSING STUDENTS TO NURSES WITH THE STATE HOSPITAL AND CORRECTIONAL FACILITIES, AS WELL AS CHIEF NURSING OFFICERS FROM THE REGION, LONG-TERM CARE PROVIDERS, AND ACUTE-CARE NURSES FROM HOME HEALTH AND HOSPITALS. AS WE NOTED ON SCCH'S FY17 FORM 990, MSHA IS ONE OF ONLY 32 ORGANIZATIONS IN THE COUNTRY SELECTED TO BE PART OF THE U.S. CENTERS FOR MEDICARE & MEDICAID SERVICES' (CMS) NEW INITIATIVE, ACCOUNTABLE HEALTH COMMUNITIES (AHC), AIMED AT IMPROVING THE HEALTH OF MEDICARE AND MEDICAID BENEFICIARIES. THE NEW CMS PROGRAM IS DESIGNED TO INTEGRATE CARE FOR HEALTH-RELATED SOCIAL NEEDS INTO USUAL CARE BY IMPLEMENTING SYSTEMATIC SCREENING, REFERRAL, AND PATIENT NAVIGATION SERVICES FOR NEEDS SUCH AS FOOD INSECURITY, HOUSING INSTABILITY, SAFETY, TRANSPORTATION NEEDS, AND UTILITY ASSISTANCE. MOUNTAIN STATES SERVES AS THE BRIDGE ORGANIZATION FOR THE PROJECT LOCALLY, LEADING A COLLABORATIVE OF MULTIPLE ORGANIZATIONS AND CLINICAL DELIVERY SITES TO BRING NEEDED SERVICES TO BENEFICIARIES RESIDING IN SOUTHWEST VIRGINIA. THE FIRST STEPS IN IMPLEMENTING THE AHC COOPERATIVE AGREEMENT WERE COMPLETED DURING FY18. SIX FULL-TIME TEAM MEMBERS WERE HIRED, WHOSE POSITIONS ARE FINANCED BY THE FEDERAL FUNDS, (3 NAVIGATORS, 1 LEAD NAVIGATOR, 1 SCREENING AND REFERRAL SPECIALIST, AND 1 PROGRAM MANAGER), WHILE THREE FULL-TIME AND ONE PART-TIME NAVIGATOR POSITIONS REMAINED OPEN AS OF 6/30/18. IN ADDITION, MSHA ADMINISTRATIVE TEAM MEMBERS PROVIDED MORE THAN 700 HOURS OF THEIR TIME TO THIS INITIATIVE. WHEN FULLY IMPLEMENTED, OVER 50 UNITS AT CLINICAL DELIVERY SITES IN SOUTHWEST VIRGINIA, INCLUDING SMYTH COUNTY COMMUNITY HOSPITAL, AND NORTHEAST TENNESSEE WILL HAVE A SCREENING PROCESS IN PLACE TO IDENTIFY HEALTH-RELATED SOCIAL NEEDS. PATIENTS THAT SCREEN POSITIVE FOR HEALTH- RELATED SOCIAL NEEDS ARE GIVEN A "COMMUNITY REFERRAL SUMMARY", WHICH CONTAINS CONTACT AND PROGRAM INFORMATION FOR RELEVANT RESOURCES THAT ASSIST WITH THE NEEDS IDENTIFIED BY THE SCREENING. DURING FY18, EDUCATION AND PILOT TESTING FOR SCREENING PROCESSES OCCURRED AT 17 PRIMARY CARE PHYSICIAN OFFICES, TEN EMERGENCY DEPARTMENTS, THREE INPATIENT LABOR AND DELIVERY UNITS, THREE INPATIENT PSYCHIATRY UNITS, AND ONE INTENSIVE OUTPATIENT PSYCHIATRY UNIT. DURING THE FALL OF 2017 AND WINTER OF 2018, A PROCESS WAS TESTED USING A DATA SYSTEM DEVELOPED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN TOTAL, 2,547 HEALTH-RELATED SOCIAL NEEDS SCREENINGS OF VIRGINIA MEDICARE AND MEDICAID BENEFICIARIES WERE COMPLETED USING THE SYSTEM. DURING THIS PILOT TESTING, A NUMBER OF OPERATIONAL OBSTACLES WERE IDENTIFIED, INCLUDING DUPLICATIVE DATA ENTRY TASKS, LENGTHY LOG-IN STEPS, AND MANUAL CREATION OF THE COMMUNITY REFERRAL SUMMARIES. DATA ENTRY TIME TOOK TOO LONG, SO MOUNTAIN STATES TRANSITIONED FROM THE CMS DATA SYSTEM TO AN INTERNALLY-PRODUCED SYSTEM. THIS TRANSITION IMPROVED OPERATIONAL EFFICIENCY BY AT LEAST FIVE-FOLD. PATIENT NAVIGATORS WERE TRAINED IN DISCIPLINES SUCH AS MENTAL HEALTH FIRST AID, INTERPERSONAL COMMUNICATION, AND MANY OTHER RELATED TOPICS. THE NAVIGATORS WERE DEPLOYED TO WORK FROM FIVE VIRGINIA COMMUNITY SERVICES BOARDS IN OUR SERVICE AREA. NAVIGATORS WORK FROM COMMUNITY SERVICES BOARDS TO IMPROVE THE REFERRAL PROCESS, AS WE EXPECT A LARGE NUMBER OF BEHAVIORAL HEALTH-RELATIVE NEEDS TO BE IDENTIFIED DURING NAVI	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$7,702,901	ExpenseAmt
Revenue	$8,716,187	RevenueAmt
Desc	FRANICS MARION MANOR HEALTH AND REHABILITATION (FMM), PROVIDES BOTH SKILLED-LEVEL AND NURSING FACILITY-LEVEL HEALTH CARE SERVICES. THERE WERE 284 ADMISSIONS AND 32,970 PATIENT DAYS DURING FY18.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$38,651,226	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
IRP Document	64	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	2	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	VA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	TN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	LYNN KRUTAK	PersonNm
Phone	4233023374	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	303 MED TECH PARKWAY SUITE 300	AddressLine1Txt
City	JOHNSON CITY	CityNm
State Abbreviation	TN	StateAbbreviationCd
ZIP	37604	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
TONY KECK
MSHA EVP, CP	0.10	54.90	Yes (X)	$0	$458,610	$65,584
BRIAN MILLER DO
DIRECTOR	44.00		Yes (X)	$0	$406,372	$26,423
STAN HICKSON
VP, PRES. SW	3.25	41.75	Yes (X)	$0	$383,274	$20,856
ERIC SACKNOFF MD
DIRECTOR	30.00		Yes (X)	$0	$297,200	$28,745
JOHN JETER
TREAS./CFO	5.20	39.80	Yes (X)	$0	$211,825	$29,199	Yes (X)
ANDY BLEVINS
VICE CHAIR	0.20		Yes (X)	$0	$0	$0	Yes (X)
AMANDA CURRIN
CHAIR	0.30		Yes (X)	$0	$0	$0	Yes (X)
CHELSEA HAMMAN MD
DIRECTOR	0.20		Yes (X)	$0	$0	$0
BRYAN HAYNES
DIRECTOR	0.20		Yes (X)	$0	$0	$0
PAUL HOLCOMBE
DIRECTOR	0.30		Yes (X)	$0	$0	$0
GARY PEACOCK
SECRETARY	0.30	6.80	Yes (X)	$0	$0	$0	Yes (X)
DR SCOTT RICHARDS
DIRECTOR	0.20		Yes (X)	$0	$0	$0
DR MIKE ROBINSON
DIRECTOR	0.20		Yes (X)	$0	$0	$0
JAMES TYLER
SCCH CEO	45.00			$0	$266,692	$24,543	Yes (X)
BELDON FLEMING
PHARMACY MGR	45.00			$0	$148,107	$31,898		Yes (X)
LORI MARTIN
ADMINISTRATO	45.00			$0	$124,677	$25,720		Yes (X)
GREGORY RINEHARDT
REHAB THER.	40.00			$0	$110,224	$16,541		Yes (X)
LINDA WHITE
FORMER SCCH		45.00		$0	$340,317	$43,915			Yes (X)
CATHY MAINE
FORMER SCCH		40.00		$0	$129,500	$11,565			Yes (X)

Field	Value	IRS element (for citing)
Tot Reportable Comp Rltd Org	$2,876,798	TotReportableCompRltdOrgAmt
Total Other Compensation	$324,989	TotalOtherCompensationAmt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
VIRGINIA HIGHLANDS ANESTHESIA
PO BOX 1476	ABINGDON	VA	24212	ANESTHESIA SVCS	$872,467
COVE CREEK EMERGENCY PHYSICIANS
1001 GALAXY WAY SUITE 400	CONCORD	CA	94520	ER PHYS SVCS	$810,167
RELIANT POST-ACUTE CARE
6860 DALLAS PARKWAY SUITE 550	PLANO	TX	75024	PHYSICAL THER.	$804,871
CROTHALL SERVICES EAST TN
13028 COLLECTIONS CENTER DRIVE	CHICAGO	IL	60693	LINEN SERVICES	$214,273
VEP MSHA ED INC
1990 N CALIFORNIA BLVD SUITE 400	WALNUT CREEK	CA	94596	EMER SVCS FEES	$174,167

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	13	CntrctRcvdGreaterThan100KCnt
Related Organizations	$15,063	RelatedOrganizationsAmt
Government Grants	$6,500	GovernmentGrantsAmt
All Other Contributions	$7,154	AllOtherContributionsAmt
Total Contributions	$28,717	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICES	622110	$47,365,401	$47,365,401
WELLNESS PROGRAMS	622110	$246,321	$246,321
P/S ORDINARY INCOME	541900	$111,790	$111,790
LAB OUTREACH INCOME	621500	$19,391		$19,391
EARLY EXT. OF DEBT	900099	-$89,746	-$89,746

Field	Value	IRS element (for citing)
Total Program Service Revenue	$47,653,157	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,013,504	TotalRevenueColumnAmt
Related Or Exempt Func Income	$379,800	RelatedOrExemptFuncIncomeAmt
Exclusion	$633,704	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$202,833	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$162,791	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$40,042	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$40,042	TotalRevenueColumnAmt
Exclusion	$40,042	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$487,993	SecuritiesAmt
Other	$13,280	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$2,091	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$487,993	SecuritiesAmt
Other	$11,189	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$499,182	TotalRevenueColumnAmt
Related Or Exempt Func Income	$11,189	RelatedOrExemptFuncIncomeAmt
Exclusion	$487,993	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
VENDOR SETTLEMENT	900099	$291,581	$291,581
REVENUE FROM PARENT	900099	$46,118		$46,118
CAFETERIA SALES	722514	$8,035	$8,035

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$11,895	TotalRevenueColumnAmt
Unrelated Business Revenue	$11,895	UnrelatedBusinessRevenueAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$357,629	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$49,592,231	TotalRevenueColumnAmt
Related Or Exempt Func Income	$48,070,873	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$31,286	UnrelatedBusinessRevenueAmt
Exclusion	$1,461,355	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$21,140	TotalAmt
Program Services	$21,140	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$348,418	TotalAmt
Management And General	$348,418	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$16,284,682	TotalAmt
Program Services	$14,343,007	ProgramServicesAmt
Management And General	$1,941,675	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$542,657	TotalAmt
Program Services	$475,229	ProgramServicesAmt
Management And General	$67,428	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,656,001	TotalAmt
Program Services	$2,096,780	ProgramServicesAmt
Management And General	$559,221	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,110,848	TotalAmt
Program Services	$1,036,086	ProgramServicesAmt
Management And General	$74,762	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$14,365	TotalAmt
Management And General	$14,365	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$103,394	TotalAmt
Management And General	$103,394	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,012	TotalAmt
Management And General	$1,012	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$66,723	TotalAmt
Management And General	$66,723	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$10,139,889	TotalAmt
Program Services	$9,386,383	ProgramServicesAmt
Management And General	$753,506	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$105,835	TotalAmt
Program Services	$7,604	ProgramServicesAmt
Management And General	$98,231	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$378,814	TotalAmt
Program Services	$317,765	ProgramServicesAmt
Management And General	$61,049	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,129,162	TotalAmt
Program Services	$1,046,818	ProgramServicesAmt
Management And General	$82,344	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,041,421	TotalAmt
Program Services	$923,161	ProgramServicesAmt
Management And General	$118,260	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$150,589	TotalAmt
Program Services	$125,962	ProgramServicesAmt
Management And General	$24,627	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$303,686	TotalAmt
Management And General	$303,686	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,714,397	TotalAmt
Program Services	$1,743,082	ProgramServicesAmt
Management And General	$1,971,315	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$63,797	TotalAmt
Program Services	$988	ProgramServicesAmt
Management And General	$62,809	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Management And GeneralManagementAndGeneralAmt	Program ServicesProgramServicesAmt
UBIT	$550	$550
MEDICAL SUPPLIES & DRUGS	$5,798,120		$5,798,120
REPAIRS & MAINTENANCE	$1,047,250	$39,407	$1,007,843
MANAGEMENT FEES	$1,022,637	$957,770	$64,867

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$396,779	TotalAmt
Program Services	$256,391	ProgramServicesAmt
Management And General	$140,388	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$46,442,166	TotalAmt
Program Services	$38,651,226	ProgramServicesAmt
Management And General	$7,790,940	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part X	Yes (X)	InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$2,995,833	BOYAmt
EOY	$2,612,195	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$5,889,660	BOYAmt
EOY	$7,116,952	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$182,279	BOYAmt
EOY	$1,038,876	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$843,148	BOYAmt
EOY	$935,174	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$320,155	BOYAmt
EOY	$224,581	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$119,390,027	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$62,150,137	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$60,613,223	BOYAmt
EOY	$57,239,890	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$30,416,420	BOYAmt
EOY	$34,769,664	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$717,011	BOYAmt
EOY	$717,011	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$378,065	BOYAmt
EOY	$284,399	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$102,355,794	BOYAmt
EOY	$104,938,742	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$4,239,278	BOYAmt
EOY	$3,201,980	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$678,706	BOYAmt
EOY	$470,432	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$15,558,741	BOYAmt
EOY	$15,271,960	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$691,721	BOYAmt
EOY	$1,048,566	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$21,168,446	BOYAmt
EOY	$19,992,938	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$81,184,938	BOYAmt
EOY	$84,945,804	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,410	BOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$81,187,348	BOYAmt
EOY	$84,945,804	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$102,355,794	BOYAmt
EOY	$104,938,742	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$3,150,065	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$719,161	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$110,770	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (true)	GrantsOtherOrganizationsInd
Grants Other Organizations	$2,177	GrantsOtherOrganizationsAmt
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	false	OtherActivitiesInd
Total Lobbying Expenditures	$2,177	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE C, PART II-B, LINE 1	FormAndLineReferenceDesc
Explanation	SCCH HAD LOBBYING EXPENSES OF 2,177 WHICH REPRESENTS THE PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION AND NATIONAL RURAL HEALTH ASSOCIATION ATTRIBUTABLE TO DIRECT LOBBYING.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,121,878	OtherCostOrOtherBasisAmt
Book Value	$2,121,878	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$57,449,106	OtherCostOrOtherBasisAmt
Depreciation	$12,390,288	DepreciationAmt
Book Value	$45,058,818	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$72,169	OtherCostOrOtherBasisAmt
Depreciation	$69,254	DepreciationAmt
Book Value	$2,915	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$58,814,054	OtherCostOrOtherBasisAmt
Depreciation	$49,031,633	DepreciationAmt
Book Value	$9,782,421	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$932,820	OtherCostOrOtherBasisAmt
Depreciation	$658,962	DepreciationAmt
Book Value	$273,858	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$57,239,890	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
PHARMACY, MEDICAL & WORKERS COMP.	$623,432
RESERVE FOR PROFESSIONAL LIABILITIES	$424,369
OTHER LONG-TERM LIABILITIES	$765

Field	Value	IRS element (for citing)
Total Liability	$1,048,566	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE D, PAGE 3, PART X	FormAndLineReferenceDesc
Explanation	"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 HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR BALLAD AND ITS TAX-EXEMPT SUBSIDIARIES. BALLAD'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. BALLAD HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2018. AT JUNE 30, 2018, TAX RETURNS FOR MSHA AND WHS FOR 2015 THROUGH 2017 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE."	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	2.250000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Discounted Care Other	4.500000000000	DiscountedCareOtherPct

Field	Value	IRS element (for citing)
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	false	ExpensesExceedBudgetInd
Annual Community Bnft Report	false	AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$367,097	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$367,097	NetCommunityBenefitExpnsAmt
Total Expense	0.00790	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,304,059	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,666,864	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,637,195	NetCommunityBenefitExpnsAmt
Total Expense	0.03530	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,671,156	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,666,864	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,004,292	NetCommunityBenefitExpnsAmt
Total Expense	0.04320	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$365,187	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$338	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$364,849	NetCommunityBenefitExpnsAmt
Total Expense	0.00790	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$667,115	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,492	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$654,623	NetCommunityBenefitExpnsAmt
Total Expense	0.01410	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,995,204	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,524,957	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,470,247	NetCommunityBenefitExpnsAmt
Total Expense	0.03170	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,890	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$9,890	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,037,396	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,537,787	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,499,609	NetCommunityBenefitExpnsAmt
Total Expense	0.05380	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,708,552	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,204,651	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,503,901	NetCommunityBenefitExpnsAmt
Total Expense	0.09700	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,737,731	BadDebtExpenseAmt
Bad Debt Expense Attributable	$1,800,338	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$14,720,664	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$15,322,549	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$601,885	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SMYTH COUNTY COMMUNITY HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	45 MEDICAL PARK DRIVE	AddressLine1Txt
City	MARION	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24354	ZIPCd

Field	Value	IRS element (for citing)
Website Address	BALLADHEALTH.ORG/LOCATIONSHOSPITALS	WebsiteAddressTxt
State License	H 1902	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	SMYTH COUNTY COMMUNITY HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
Other	Yes (X)	OtherInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	false	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	BALLADHEALTH.ORG/LOCATIONSHOSPITALS	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	19	ImplementationStrategyAdptYr
Strategy Posted Website	false	StrategyPostedWebsiteInd
Strategy Attached	Yes (true)	StrategyAttachedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	225.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	450.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	BALLADHEALTH.ORG	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	BALLADHEALTH.ORG	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	BALLADHEALTH.ORG	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 3E	DURING FY18, SCCH WAS OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES ESTABLISHED FOR THE CHNA WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS, INCLUDING SCCH, CONDUCTED THEIR THIRD CHNA THIS TAX REPORTING PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNA, BALLAD HEALTH AND ITS HOSPITALS AND ENTITIES AGREED TO FOCUS ON AN INDEX OF 25 ACTIVE POPULATION HEALTH INDEX MEASURES (PLUS AN ADDITIONAL 31 MEASURES FOR MONITORING). THE POPULATION HEALTH INDEX ITSELF IS BASED ON THE FOCUS AREAS OUTLINED IN THE PREVIOUS FY15 CHNA AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. THE SMYTH COUNTY CHNA COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENINGS. THE SMYTH COUNTY GROUP'S MEMBERS COMPLETED A SURVEY RELATIVE TO WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR SPECIFIC COMMUNITY OVER THE NEXT THREE YEARS. AFTER ALL THE DETAILS AND DATA COLLECTION WAS COMPLETE AND INTERVIEWS WITH VARIOUS FOCUS GROUPS WERE COMPLETE, THE SMYTH COUNTY REPRESENTATIVES IDENTIFIED THE TOP FOCUS AREAS. FOUR KEY PRIORITIES WERE IDENTIFIED: -CHILD ABUSE -OBESITY -MENTAL HEALTH -SUBSTANCE ABUSE
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 5	AS PART OF THE FY18 BALLAD HEALTH CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN SCCH'S COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. THE SCCH FOCUS GROUP MEMBERS WERE REPRESENTED BY MOUNT ROGERS COMMUNITY SERVICES BOARD, MOUNT ROGERS HEALTH DISTRICT, EMORY & HENRY SCHOOL OF HEALTH SCIENCES, SMYTH COUNTY SHERIFF'S DEPARTMENT, MARION POLICE DEPARTMENT, SMYTH COUNTY SCHOOL BOARD, SMYTH COUNTY CIRCUIT COURT, SMYTH COUNTY DEPARTMENT OF SOCIAL SERVICES, MEMBERS OF THE SCCH HEALTH TRUST BOARD AND MEMBERS OF THE SCCH COMMUNITY HOSPITAL BOARD. LOW INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS WERE REPRESENTED BY MOUNT ROGERS HEALTH DEPARTMENT, VIRGINIA DEPARTMENT OF HEALTH, SMYTH COUNTY SCHOOLS AND SMYTH COUNTY DEPARTMENT OF SOCIAL SERVICES. ALSO, BETWEEN THE FOUNDATION BOARD AND THE COMMUNITY BOARD, THERE ARE A NUMBER OF INDIVIDUALS THAT SIT ON THESE BOARDS THAT REPRESENT LOW INCOME, MINORITY POPULATIONS, AND MEDICALLY UNDERSERVED. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM SMYTH COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY.
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 6A	EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. SCCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL, AND UNICOI COUNTY MEMORIAL HOSPITAL.
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 11	DURING THE YEAR, SCCH CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. SCCH'S PRIMARY AREAS OF FOCUS INCLUDED: SMOKING, SUBSTANCE ABUSE, OBESITY, CARDIOVASCULAR DISEASE AND MENTAL HEALTH. MANY ADDITIONAL COMMUNITY NEEDS EXIST IN OUR REGION. IT IS FISCALLY IMPOSSIBLE FOR A HOSPITAL TO ADDRESS EVERY HEALTH NEED IN A COMMUNITY, WHICH IS WHY THE CHNA PROCESS IS USED TO IDENTIFY AND PRIORITIZE AREAS OF FOCUS. A THOUGHTFUL CHNA EVALUATES OVERALL COMMUNITY HEALTH NEEDS TO DETERMINE WHICH ONES THE HOSPITAL CAN BEST INFLUENCE IN A POSITIVE WAY. CONSIDERATION IS GIVEN TO OTHER ORGANIZATIONS IN THE HOSPITAL'S GEOGRAPHIC AREA THAT ALREADY OFFER SERVICES ADDRESSING SPECIFIC HEALTH NEEDS. IN SOME CASES, IT IS BEST TO SIMPLY SUPPORT AN IDENTIFIED HEALTH NEED THROUGH A FINANCIAL DONATION TO ANOTHER NONPROFIT ORGANIZATION SKILLED IN CERTAIN AREAS: TEEN PREGNANCY, DENTAL HEALTH, FIGHTING HOMELESSNESS, ETC. HOSPITALS ALSO LEND SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. SCCH PARTNERED WITH QUIT NOW VIRGINIA, A 24/7 COACHING PROGRAM TO ENSURE SUCCESS WITH SMOKING CESSATION. THEY OFFER A TEXT MESSAGING, EMAIL, AND PHONE CALL SYSTEM DELIVERY TO INDIVIDUALS THAT ARE INTERESTED IN SMOKING CESSATION LITERATURE, GUIDANCE, AND SUPPORT DURING THEIR RECOVERY PERIOD. THIS IS A FREE PROGRAM OFFERED TO ANYONE INTERESTED. WE ALSO HELD LECTURES ON SMOKING CESSATION, SMOKING DANGERS AND CARDIOVASCULAR HEALTH THROUGHOUT OUR COMMUNITY. BELOW ARE THE LISTED DATES, LOCATIONS AND SUBJECTS COVERED: 2-20-17 HOLSTON HIGH SCHOOL - NICOTINE 3-14-17 NORTHWOOD HIGH SCHOOL - NICOTINE, SMOKING CESSATION 2-20-17 VIRGINIA HIGH SCHOOL - DANGERS OF NICOTINE 1-31-17 PATRICK HENRY HIGH SCHOOL - DANGERS OF NICOTINE 2-18-16 CEDAR BLUFF BAPTIST CHURCH - CARDIOVASCULAR HEALTH, SMOKING CESSATION 6-2-16 CEDAR BLUFF BAPTIST CHURCH - AED TRAINING, DANGERS OF NICOTINE SCCH, ALONG WITH MSHA'S OTHER HOSPITALS, HAS BEEN DILIGENT IN ITS GOAL TO ENSURE APPROPRIATE PRESCRIBING OF OPIOIDS AND A REDUCTION IN OPIOIDS IN OUR REGION. THE RESULT IS A SIGNIFICANT REDUCTION IN PRESCRIBING RATES. OPIOID DOSES ADMINISTERED AT MSHA'S HOSPITALS WERE REDUCED BY MORE THAN 40 PERCENT. SCCH OBTAINED A HEALTH RESOURCES AND SERVICES ADMINISTRATION RURAL HEALTH OPIOID PROGRAM (RHOP) GRANT IN CONJUNCTION WITH A COMMUNITY BASED CONSORTIUM COMPOSED OF HEALTH CARE PROVIDERS. THE PURPOSE OF RHOP IS TO PROMOTE RURAL HEALTH CARE SERVICES OUTREACH BY EXPANDING THE DELIVERY OF OPIOID RELATED HEALTH CARE SERVICES TO RURAL COMMUNITIES. THE GOAL IS TO REDUCE MORBIDITY AND MORTALITY RELATED TO OPIOID OVERDOSES IN RURAL COMMUNITIES THROUGH THE DEVELOPMENT OF BROAD COMMUNITY CONSORTIUMS TO PREPARE INDIVIDUALS WITH OPIOID-USE DISORDER (OUD) TO START TREATMENT, IMPLEMENT CARE COORDINATION PRACTICES TO ORGANIZE PATIENT CARE ACTIVITIES, AND SUPPORT INDIVIDUALS IN RECOVERY THROUGH THE ENHANCEMENT OF BEHAVIORAL COUNSELLING AND PEER SUPPORT ACTIVITIES. THROUGH THE VIRGINIA DEPARTMENT OF HEALTH, SCCH HAS IMPLEMENTED A COMPREHENSIVE HARM REDUCTION PROGRAM (CHR). THE CHR IS A SET OF PUBLIC HEALTH STRATEGIES INTENDED TO REDUCE THE NEGATIVE IMPACT OF DRUG USE INCLUDING HIV, HEPATITIS C, OTHER INFECTIONS, OVERDOSE AND DEATH AMONG PEOPLE WHO ARE UNABLE OR NOT READY TO STOP USING DRUGS. CHR INCLUDES THE DISTRIBUTION OF STERILE AND DISPOSAL OF USED HYPODERMIC NEEDLES AND SYRINGES, EDUCATION, REFERRAL TO DRUG TREATMENT, TESTING, AND AN ARRAY OF OTHER HEALTH SERVICES. DURING FY18 SCCH HOSTED A CHAMBER OF COMMERCE BREAKFAST. THE SPEAKER, A CARDIOLOGIST FROM SCCH, PROVIDED EDUCATION ON CARDIOVASCULAR HEALTH. SCCH ALSO OFFERS CPR AND FIRST AID CLASSES FREE OF CHARGE TO AREA ORGANIZATIONS, SUCH AS THE FOREST SERVICE. SCCH CONTINUES TO ENCOURAGE PHYSICAL ACTIVITY BY SPONSORING EVENTS SUCH AS EMORY & HENRY COLLEGE'S WASPER 5K RUN. THE EVENT IS OPEN TO THE PUBLIC AND ENCOURAGES THE COMMUNITY TO RUN IN THE UNIQUE COURSE THAT IS A BLEND OF ROAD AND CROSS COUNTRY. THEY ALSO SUPPORT THE MARION LITTLE LEAGUE TO PROMOTE PHYSICAL ACTIVITY IN CHILDREN. FREE MEDICATIONS WERE PROVIDED TO SOME LOW-INCOME PATIENTS AT THE TIME OF THEIR DISCHARGE. THE HOSPITAL CONTINUED ITS PRACTICE OF PROVIDING MEDICATIONS AND SUPPLIES TO AREA RESCUE SQUADS THIS YEAR.
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 13H	BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY.

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	FRANCIS MARION MANOR HEALTH &	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	REHABILITATION	AddressLine1Txt
Address Line2	100 FRANCIS MARION LANE	AddressLine2Txt
City	MARION	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24354	ZIPCd

Field	Value	IRS element (for citing)
Facility	NURSING HOME	FacilityTxt

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE	FINANCIAL ASSISTANCE APPROVAL CAN APPLY TO AN ASSORTMENT OF PATIENTS SUCH AS THOSE WHO HAVE EXHAUSTED THEIR MEDICAID/TENNCARE BENEFITS, THOSE WHO QUALIFIED FOR MEDICAID/TENNCARE AFTER THE DATE OF SERVICE, DECEASED PATIENTS WITH NO ESTATE OR ASSETS, UNINSURED PATIENTS, AND UNDERINSURED PATIENTS. WHILE BALLAD HEALTH'S QUALIFICATIONS FOR FINANCIAL ASSISTANCE IS BASED ON FEDERAL POVERTY GUIDELINES, ASSET VALUES MAY ALSO BE USED TO DETERMINE ELIGIBILITY. UNIQUE CIRCUMSTANCES MAY BE ASSESSED ON A CASE-BY- CASE BASIS. CHARITY APPROVAL COVERS ALL DATES OF SERVICE FOR THE PATIENT WHEN THEY ARE APPROVED AND THERE IS NO LIMITATION OR CAP ON THE AMOUNT OF CHARITY THAT A PATIENT MAY RECEIVE. BALLAD HEALTH HOSPITALS DO NOT STOP APPROVING FINANCIAL ASSISTANCE FOR PATIENT ACCOUNTS IF A HOSPITAL'S CHARITY WRITE-OFFS EXCEED THE HOSPITAL'S CHARITY BUDGET. ALL BALLAD HEALTH HOSPITALS PROVIDE AN UNINSURED DISCOUNT; THE CURRENT UNINSURED DISCOUNT IS 80%. IN ADDITION TO THE UNINSURED DISCOUNT, MANY PATIENTS WILL FURTHER QUALIFY FOR ADDITIONAL FINANCIAL ASSISTANCE. ALL PATIENTS SEEKING FINANCIAL ASSISTANCE MUST SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE AND SUBMIT DOCUMENTS IN SUPPORT OF THE INFORMATION ON THE APPLICATION, UNLESS SPECIFICALLY EXCLUDED ACCORDING TO OUR POLICY GUIDELINES. MEDICAID ELIGIBLE PATIENTS WILL QUALIFY FOR 100% FINANCIAL ASSISTANCE AND NOT BE REQUIRED TO COMPLETE THE REQUIRED DOCUMENTATION WHEN: A) MEDICAID ELIGIBILITY REQUIREMENTS ARE MET AFTER THE SERVICE IS PROVIDED, B) NON-COVERED CHARGES OCCUR ON A MEDICAID ELIGIBLE ENCOUNTER, OR C) BENEFITS HAVE BEEN EXHAUSTED. DECEASED PATIENTS WITH NO ESTATE ALSO QUALIFY FOR 100% FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE DETERMINATIONS MAY BE RETROACTIVE FOR ALL OUTSTANDING BALANCES. IN ADDITION, WE HAVE A NUMBER OF PROGRAMS WITH SPECIAL DISCOUNTS SUCH AS LACTATION CONSULTATION SERVICES; ONCOLOGY TREATMENT REGIMENS; ENROLLMENT IN VARIOUS COMMUNITY PROGRAMS, AND PRESCRIPTION DRUGS FILLED POST-DISCHARGE.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION	THE COST TO CHARGE RATIO (WORKSHEET 2 "RATIO OF PATIENT CARE COST TO CHARGES") WAS USED TO CALCULATE LINE 7A FINANCIAL ASSISTANCE AT COST. OUR COST ACCOUNTING SYSTEM WAS USED TO DETERMINE LOSSES FROM MEDICAID AND TENNCARE REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH AND SMYTH COUNTY PHYSICIANS, BOTH DIVISIONS OF SCCH. WE USED THE COST TO CHARGE RATIO FOR THEIR DATA BECAUSE THESE ARE SMALLER DIVISIONS NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS OR EXPENSES SPECIFIC TO A COMMUNITY HEALTH EVENT, WITH NO ADDITIONAL OVERHEAD INCLUDED IN THE COST. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF INTERNSHIPS (PRIMARILY NURSING, PHARMACY, AND THERAPY STUDENTS) WITH LOCAL SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING. ANOTHER SOURCE OF HEALTH PROFESSIONS EDUCATION REPORTED ON LINE 7F IS OUR MEDICARE-APPROVED CNA, "CERTIFIED NURSING ASSISTANT", PROGRAM (IN ITS THIRD YEAR). THE CNA PROGRAM COST AND REIMBURSEMENT INFORMATION COMES FROM OUR FILED MEDICARE COST REPORT, ADHERING TO IRS 990 INSTRUCTIONS. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USE OUR COST ACCOUNTING SYSTEM BECAUSE WE HAVE ESTABLISHED, STANDARD COSTING REPORTS FOR THESE SERVICES. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY OR MEDICAID/TENNCARE ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITAL THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE, ROUTINE SERVICES OR ANCILLARY SERVICES. WE INCLUDED A HOSPITAL OWNED AND OPERATED PHYSICIAN CLINIC, KNOWN AS RURAL RETREAT. THE CLINIC IS LOCATED IN A RURAL, MEDICALLY UNDERSERVED AREA. WE INCLUDED THE HOSPITAL'S 77,863 SUBSIDY IN LINE 7G. LINE 7I CASH AND IN-KIND CONTRIBUTIONS INCLUDE CASH DISBURSEMENTS AND THE IN-KIND DONATIONS OF MEDICATIONS TO LOCAL NONPROFIT RESCUE SQUADS AND FIRE DEPARTMENTS. IN-KIND DONATIONS OF MEDICATIONS ARE BASED ON OUR ACTUAL COST FOR THESE ITEMS.
PART II - COMMUNITY BUILDING ACTIVITIES	SCCH LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR SCCH TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. WE DO NOT CAPTURE COSTS ASSOCIATED WITH TEAM MEMBERS THAT SERVE ON OTHER NONPROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. SCCH, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. MOST OF THESE ORGANIZATIONS WORK TO IMPROVE THE LIVES OF COMMUNITY MEMBERS THAT HAVE LIMITED, OR NO, FINANCIAL RESOURCES.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY	SELF-PAY BALANCES INCLUDE ACCOUNTS AFTER PAYMENTS AND CONTRACTUAL ADJUSTMENTS (DISCOUNTS) HAVE BEEN APPLIED FROM ALL THIRD-PARTY PAYERS SUCH AS MEDICARE, MEDICAID, COMMERCIAL INSURERS, AND OTHERS - GENERALLY LEAVING THE PATIENT RESPONSIBLE FOR ANY REMAINING DEDUCTIBLE AND/OR CO-PAYMENT. OTHER SELF-PAY ACCOUNTS ARE FROM PATIENTS WITH NO INSURANCE OR OTHER THIRD-PARTY COVERAGE. UNDER BALLAD HEALTH'S SELF-PAY POLICY, ANY PATIENT WHO HAS NO INSURANCE AND IS INELIGIBLE FOR ANY GOVERNMENT ASSISTANCE PROGRAM RECEIVED A 71% DISCOUNT UNTIL FEBRUARY 1, 2018, AT WHICH TIME THE UNINSURED DISCOUNT INCREASED TO 80%. MANY SELF-PAY PATIENTS WILL FURTHER QUALIFY FOR FINANCIAL ASSISTANCE (SOMETIMES REFERRED TO AS CHARITY CARE) IF THEY PROVIDE THE FINANCIAL INFORMATION WE NEED TO DEEM THEM ELIGIBLE. AFTER THE NORMAL COLLECTION PROCESS HAS INDICATED AN ACCOUNT IS UNCOLLECTIBLE, SCCH WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO EVALUATE THE AGE OF ACCOUNTS RECEIVABLE, HISTORICAL WRITE-OFFS AND RECOVERIES AND ANY UNUSUAL INSTANCES (SUCH AS LOCAL, REGIONAL OR NATIONAL ECONOMIC CONDITIONS) WHICH AFFECT THE COLLECTABILITY OF RECEIVABLES.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE	OUR PRIMARY EXTERNAL COLLECTION AGENCY ESTIMATES THAT 38% OF SCCH'S BAD DEBT WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE IF PATIENTS HAD PROVIDED OUR HOSPITALS WITH A FINANCIAL ASSISTANCE APPLICATION AND REQUIRED DOCUMENTATION. THE AGENCY BASED THEIR LIKELY ELIGIBLE FOR CHARITY ASSUMPTION ON INDIVIDUALS WITH A LOW SCORE. AN INDIVIDUAL'S SCORE IS BASED ON AN ALGORITHM THAT INCLUDES DATA POINTS SUCH AS FICO CREDIT SCORE, PROPERTY VALUE, YEARS AT CURRENT RESIDENCE, NUMBER OF TIMES AN INDIVIDUAL HAS MOVED AND AN INDIVIDUAL'S PROPENSITY TO PAY SCORE. JUST UNDER 83% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS PROCESSED DURING FY18 RECEIVED A FULL DISCOUNT (COMPLETE WRITE-OFF). AN ADDITIONAL 12% RECEIVED A PARTIAL DISCOUNT, RESULTING IN AN OVERALL APPROVAL RATE OF 95% FOR COMPLETED APPLICATIONS. THEREFORE, ONLY 5% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS WERE DENIED. UNFORTUNATELY, MANY PATIENTS EITHER DO NOT SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE OR DO NOT PROVIDE A COMPLETE APPLICATION. INCOMPLETE APPLICATIONS ARE RETURNED TO PATIENTS ALONG WITH A NOTICE OF MISSING INFORMATION. THE NOTICE ALSO PROVIDES A CONTACT PHONE NUMBER PATIENTS MAY CALL FOR ASSISTANCE IN COMPLETING THE APPLICATION. ALL SELF-PAY PATIENTS RECEIVE FOLLOW UP CALLS EVERY 21 DAYS FROM A COMPANY SCCH PAYS TO PROCESS CHARITY CARE APPLICATIONS FOR UNINSURED PATIENTS AND TO OFFER PATIENTS ENROLLMENT ASSISTANCE IN MEDICAID (VA) OR TENNCARE (TN). OUR FINANCIAL COUNSELORS FOLLOW UP WITH PATIENTS THAT HAVE A BALANCE AFTER INSURANCE HAS PAID. WE HAVE MANY INSTANCES OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE BELIEVE WOULD QUALIFY FOR FINANCIAL ASSISTANCE. ALTHOUGH PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE, MANY WILL NOT DO SO. SCCH WOULD PREFER FOR PATIENTS TO SUBMIT COMPLETED FINANCIAL ASSISTANCE APPLICATIONS GIVEN THAT HISTORICAL DATA CLEARLY INDICATES THAT MOST UNINSURED PATIENTS AND MANY UNDERINSURED WILL QUALIFY FOR FINANCIAL ASSISTANCE UNDER OUR PROGRAM. WITHOUT A COMPLETED APPLICATION, WE HAVE NO CHOICE OTHER THAN TO RECORD AN UNPAID ACCOUNT AS BAD DEBT INSTEAD OF CHARITY CARE.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS	BALLAD HEALTH'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PAGES 13-14 THAT DESCRIBES BAD DEBT. SCCH IS INCLUDED IN THE JUNE 30, 2018 AUDITED FINANCIAL STATEMENTS OF BALLAD HEALTH. THE AUDITED FINANCIAL STATEMENTS ARE FOR THE FIVE MONTHS ENDING AFTER THE FEBRUARY 1, 2018 MERGER OF MOUNTAIN STATES HEALTH ALLIANCE AND WELLMENT HEALTH SYSTEM (ATTACHED).
PART III, LINE 8 - MEDICARE EXPLANATION	SCHEDULE H PART III, SECTION B REPORTS A SCCH MEDICARE LOSS DURING FY18. THE LOSS REPORTED IN PART III EXCLUDES MEDICARE LOSSES OF 812,491 REPORTED IN PART I, LINE 7G SUBSIDIZED HEALTH SERVICES RELATED TO PROGRAMS SUCH AS INPATIENT AND OUTPATIENT REHABILITATION CARE AND OUTPATIENT ENDOSCOPY. MEDICARE ALLOWABLE COSTS ARE REPORTED USING SCCH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS TRANSPORTATION OF A PATIENT AND COMFORT ITEMS THAT INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED AND TO FEDERALLY RECOGNIZED MEDICALLY UNDERSERVED AREAS. A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE, LEAVING THE HOSPITAL TO ABSORB THE LOSS. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS SUCH AS THOSE NOTED ABOVE, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. WHILE WE AGREE THAT COSTS SUCH AS MARKETING TO ATTRACT PATIENTS AND LOBBYING ARE REASONABLE TO EXCLUDE, IT DOES NOT SEEM REASONABLE TO EXCLUDE RECRUITMENT OF PHYSICIANS AND BASIC ITEMS SUCH AS A TELEVISION AND PHONE IN PATIENT ROOMS. WE BELIEVE MEDICARE LOSSES SHOULD BE ALLOWED AS A REPORTABLE COMMUNITY BENEFIT, SIMILAR TO GOVERNMENTAL PROGRAMS SUCH AS MEDICAID. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, HOSPITALS ARE REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR THE MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW COST. THEREFORE, IT IS ONLY LOGICAL TO ALLOW HOSPITALS TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT. BY MAKING THIS CHANGE, NONPROFIT PROVIDERS WILL BE ENCOURAGED TO CONTINUE IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT MAY BE ECONOMICALLY INJURIOUS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GUIDELINES, WHILE ALLOWING FOR UNIQUE FINANCIAL CIRCUMSTANCES - FOR EXAMPLE, MEDICALLY INDIGENT PATIENTS WITH CATASTROPHIC MEDICAL COSTS THAT WOULD THREATEN THE PATIENT'S HOUSEHOLD FINANCIAL VIABILITY. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT'S ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED. ALL BALLAD HEALTH HOSPITALS COMPLY WITH IRS 501(R) REGULATORY GUIDELINES. OUR COLLECTION POLICY CLEARLY STATES THAT ALL PATIENTS ARE TREATED EQUALLY - WITH DIGNITY AND RESPECT. WE ENSURE THAT OUTSIDE COLLECTION AGENCIES USED BY OUR HOSPITAL ADHERE TO OUR BILLING AND COLLECTION GUIDELINES. OUR HOSPITAL'S COLLECTION PROGRAM INCLUDES COMMUNICATING EXPECTED FINANCIAL RESPONSIBILITY PRIOR TO SERVICE. OUR HOSPITAL PROVIDES ASSISTANCE TO HELP UNDERINSURED AND UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND TO HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDICAID OR TENNCARE. AFTER INSURANCE BENEFIT VERIFICATION, OUR HOSPITAL BILLS INSURANCE CARRIERS. IF THE INSURANCE CARRIER DENIES PAYMENT OF THE SERVICE/PROCEDURE AS NON-COVERED OR THE PATIENT HAS EXCEEDED THEIR MAXIMUM BENEFITS, THE SERVICE/PROCEDURE WILL QUALIFY FOR THE UNINSURED DISCOUNT. FINANCIAL COUNSELORS ARE AVAILABLE TO DISCUSS FINANCIAL ASSISTANCE WITH PATIENTS AND THEIR FAMILIES. OUR HOSPITAL PROVIDES A NUMBER OF PAYMENT OPTIONS: - A PRE-SERVICE DISCOUNT MAY BE OFFERED - A DISCOUNT IN EXCESS OF ESTABLISHED DISCOUNTING RATES MAY BE GRANTED FOR CATASTROPHIC HIGH DOLLAR ACCOUNTS - OUR HOSPITAL ACCEPTS ALL NON-CONTRACTED AND OUT-OF-NETWORK PAYERS AND WILL MAKE ATTEMPTS TO WORK WITH THESE PAYERS REGARDING APPROPRIATE REIMBURSEMENT AND BILLING TO THEIR MEMBERS - PAYMENT ARRANGEMENTS ARE AVAILABLE SO LONG AS THE ACCOUNT IS NOT WITH A COLLECTION AGENCY REASONABLE EFFORTS ARE MADE TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE - SEE SCHEDULE H, PART VI, LINE 3 FOR INFORMATION ON HOW PATIENTS ARE INFORMED ABOUT OUR FINANCIAL ASSISTANCE POLICY.
PART VI, LINE 2 - NEEDS ASSESSMENT	FOCUSING ON 25 ACTIVE POPULATION HEALTH INDEX MEASURES ALLOWS BALLAD HEALTH TO FURTHER ENGAGE THE EFFORTS OF ITS HOSPITALS IN PARTNERSHIP WITH COMMUNITIES IN OUR SERVICE AREAS. IT HAS HELPED BALLAD TO BETTER IDENTIFY HEALTH DISPARITIES THAT APPEAR ACROSS THE INDIVIDUAL COMMUNITIES AND HAS HELPED BALLAD TO PRIORITIZE ISSUES THAT ARE MOST IMPORTANT IN EACH HOSPITAL'S COMMUNITY. ENGAGING LOCAL COMMUNITY ORGANIZATIONS WILL EXPAND PARTNERSHIPS SO THAT ORGANIZATIONS WORK TOGETHER MORE TO ADDRESS COMMUNITY HEALTH NEEDS. BALLAD HEALTH DEVELOPED A COMPREHENSIVE PROCESS TO GATHER INPUT FOR AND DRAFT A POPULATION HEALTH PLAN DURING FY18. AN EXECUTIVE STEERING TEAM WAS ESTABLISHED, AIDED BY NATIONAL EXPERTS WITH EXPERIENCE IN LARGE-SCALE POPULATION HEALTH IMPROVEMENT. BECAUSE OUR HOSPITALS ARE LOCATED IN A REGION WITH MANY CHRONIC DISEASE CHALLENGES, BALLAD HEALTH'S GOAL IS TO TARGET POPULATION HEALTH ISSUES TO MAKE LASTING IMPROVEMENTS. BALLAD CONDUCTED APPROXIMATELY 150 INTERVIEWS AND HELD 40 MEETINGS WITH EXTERNAL GROUPS, INCLUDING THE REGIONAL HEALTH DEPARTMENTS, UNITED WAY AGENCIES, CHAMBERS OF COMMERCE, SCHOOLS AND COMMUNITY ORGANIZATIONS, THE REGIONAL ACCOUNTABLE CARE COMMUNITY STEERING COMMITTEE, AS WELL AS INTERNAL GROUPS SUCH AS OUR POPULATION HEALTH AND SOCIAL RESPONSIBILITY COMMITTEE OF THE BALLAD HEALTH BOARD OF DIRECTORS, THE BALLAD HEALTH POPULATION HEALTH CLINICAL COMMITTEE, AND OUR HOSPITAL COMMUNITY BOARDS.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	CONSISTENT WITH THE BALLAD HEALTH FINANCIAL ASSISTANCE POLICY, SCCH COMMUNICATES WITH AND PROVIDES EDUCATION TO OUR PATIENTS THROUGH VARIOUS AVENUES REGARDING GOVERNMENTAL ASSISTANCE PROGRAMS AND HOSPITAL FINANCIAL ASSISTANCE. VARIOUS EDUCATIONAL AND APPLICATION DOCUMENTS RELATED TO OBTAINING FINANCIAL ASSISTANCE ARE WIDELY AVAILABLE AT SCCH AND ALL DOCUMENTS ARE AVAILABLE ON THE BALLAD HEALTH WEBSITE. PRINTED FINANCIAL ASSISTANCE EDUCATIONAL MATERIALS ARE PART OF EACH REGISTRATION PACKET AND POSTERS ARE DISPLAYED IN HIGHLY VISIBLE AREAS OF THE HOSPITAL. OUR FINANCIAL ASSISTANCE POLICY AND DOCUMENTS ARE AVAILABLE IN OUR EMERGENCY DEPARTMENT AND ADMITTING AREAS. WE ARE ALSO HAPPY TO MAIL ALL DOCUMENTS TO PATIENTS. WE OFFER A PLAIN LANGUAGE SUMMARY AND ALL OF OUR DOCUMENTS ARE AVAILABLE IN ENGLISH AND SPANISH. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING PRE-REGISTRATION, REGISTRATION AND/OR DURING FINANCIAL COUNSELING. WE OFFER GOVERNMENTAL PROGRAM ELIGIBILITY REPRESENTATIVES TO ASSIST PATIENTS IN SECURING ELIGIBILITY FOR MEDICAID OR TENNCARE, FEDERAL DISABILITY AND OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. ADDITIONALLY, IF A PATIENT OR COMMUNITY RESIDENT EXPRESSES AN INTEREST IN THE ACA-HEALTHCARE EXCHANGE, OUR REPRESENTATIVES HAVE THE QUALIFICATIONS AND EXPERIENCE TO ASSIST THEM THROUGH THE ENTIRE PROCESS. OUR FINANCIAL COUNSELORS OFFER FINANCIAL ASSISTANCE APPLICATIONS TO PATIENTS WHO DO NOT QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND ARE UNABLE TO PAY FOR SOME OR ALL OF THEIR HEALTHCARE. ALL PATIENT BILLING STATEMENTS HAVE VERBIAGE DISCUSSING FINANCIAL ASSISTANCE ALONG WITH CONTACT INFORMATION. OUR LAST LETTER TO THE PATIENT DISPLAYS THE PLAIN LANGUAGE SUMMARY. IN ALL ORAL CORRESPONDENCES WITH A PATIENT, IF IT IS IDENTIFIED THE PATIENT CANNOT MEET PAYMENT REQUIREMENTS ON THEIR ACCOUNT, FINANCIAL ASSISTANCE IS DISCUSSED AS AN OPTION. APPLICANTS ARE NOTIFIED OF FINANCIAL ASSISTANCE DETERMINATION IN WRITING.
PART VI, LINE 4 - COMMUNITY INFORMATION	SCCH IS LOCATED IN THE TOWN OF MARION, VIRGINIA, WHICH IS IN SOUTHWEST VIRGINIA. SOUTHWEST VIRGINIA (SWVA) IS LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION AND HAS A HIGH RATE OF UNINSURED ADULTS. ACCORDING TO U.S. CENSUS BUREAU ESTIMATES, THE TOWN OF MARION HAS A POPULATION OF 5,814, WHILE SMYTH COUNTY'S POPULATION IS 31,298. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF SMYTH COUNTY IS 44.6 WHICH IS OLDER THAN THE MEDIAN AGE OF 38.0 IN VIRGINIA. 21% OF SMYTH COUNTY'S RESIDENTS ARE 65 OR OLDER COMPARED TO 14.2% FOR THE STATE. THE POPULATION PROJECTIONS FOR SMYTH COUNTY OVER THE NEXT FIVE YEARS SHOW THAT THE COUNTY WILL LIKELY EXPERIENCE LITTLE TO NO POPULATION GROWTH OVERALL. HOWEVER, THE AGE 65+ POPULATION FOR SMYTH COUNTY IS PROJECTED TO EXPERIENCE THE MOST POPULATION CHANGE OVER THE NEXT FIVE YEARS, AS IT MOVES FROM 21% OF THE TOTAL POPULATION IN 2018 TO 24.3% OF THE POPULATION IN 2023. THE AGING POPULATION OF THE COUNTY PRESENTS OPPORTUNITIES FOR EARLIER IDENTIFICATION AND BETTER MANAGEMENT OF HEALTH CONDITIONS THAT OFTENTIMES AFFECT ELDERLY POPULATIONS IN RURAL AREAS. THE BUREAU ESTIMATES SMYTH COUNTY'S MEDIAN HOUSEHOLD INCOME AT 40,544 COMPARED TO THE STATE OF VIRGINIA'S MEDIAN INCOME OF 68,766. THE TOWN OF MARION'S MEDIAN INCOME IS 31,933, 115% BELOW THE STATE MEDIAN. 24% OF SMYTH COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 14% STATEWIDE. SMYTH COUNTY IS 75.3% RURAL COMPARED WITH THE STATEWIDE RURAL RATE OF 24.5%. THIS FACTOR IS A SIGNIFICANT CONTRIBUTING FACTOR IN INFLUENCING HEALTH OUTCOMES IN A POPULATION. MANY RURAL RESIDENTS MUST TRAVEL A GREATER DISTANCE TO ACCESS DIFFERENT POINTS OF THE HEALTH CARE DELIVERY SYSTEM; HOWEVER, DUE TO GEOGRAPHIC DISTANCE, SOMETIMES EXTREME WEATHER CONDITIONS, LACK OF PUBLIC TRANSPORTATION AND CHALLENGING ROADS, RURAL RESIDENTS MAY BE LIMITED, AND IN SOME INSTANCES, EVEN PROHIBITED FROM ACCESSING HEALTH CARE SERVICES. MORE THAN 50% OF VEHICLE CRASH-RELATED FATALITIES OCCUR IN RURAL AREAS, EVEN THOUGH LESS THAN ONE-THIRD OF MILES TRAVELED IN A VEHICLE OCCUR THERE. AND THERE IS AN ADDITIONAL 22% RISK OF INJURY-RELATED DEATHS IN RURAL COMMUNITIES. WITHIN OUR OWN COUNTY, INJURY DEATHS ARE 29.4% HIGHER THAN THE STATEWIDE RATE. AND, WHILE OUR AREA HAS GENERALLY UNFAVORABLE HEALTH STATISTICS, THE NUMBER OF RESIDENTS PER PRIMARY CARE PHYSICIAN IN OUR COUNTY IS 32.6% HIGHER THAN THE OVERALL STATE RATE AND 70% HIGHER THAN TOP PERFORMING U.S. COUNTIES. RECRUITING PHYSICIANS TO RURAL AREAS IS OFTEN CHALLENGING DUE TO A MYRIAD OF FACTORS, SUCH AS GEOGRAPHY, ECONOMICS, CULTURE AND EDUCATION. GEOGRAPHICALLY, RURAL COMMUNITIES ARE OFTEN FAR REMOVED FROM SUBURBAN AND URBAN CENTERS THAT PROVIDE ACCESS TO EDUCATION, CULTURAL AND ECONOMIC OPPORTUNITIES. THESE LIMITATIONS INFLUENCE THE RELOCATION DECISION OF THE PHYSICIAN CANDIDATE AND HIS/HER SPOUSE/CHILDREN TO LOCATE TO A RURAL AREA. A NUMBER OF FACTORS CONTRIBUTE TO A UNIQUE AND CHALLENGING ENVIRONMENT THAT INFLUENCE OVERALL HEALTH STANDING IN OUR COUNTY. ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS, 30% OF THE ADULTS IN SCCH'S HOME COUNTY ARE OBESE. OBESITY INCREASES THE RISK FOR MANY HEALTH CONDITIONS SUCH AS CORONARY HEART DISEASE, TYPE 2 DIABETES, HYPERTENSION, STROKE, CANCER, SLEEP APNEA AND RESPIRATORY PROBLEMS, AND OSTEOARTHRITIS. EVIDENCE INDICATES PHYSICAL ACTIVITY, INDEPENDENT OF ITS EFFECT ON WEIGHT, HAS SUBSTANTIAL BENEFITS FOR HEALTH. OUR COUNTY'S INACTIVITY RATE OF 28% IS 33% HIGHER THAN THE STATEWIDE RATE. OTHER DEMOGRAPHIC FACTORS INFLUENCING HEALTH STATUS IN THE COUNTY ALSO INCLUDE EDUCATION LEVELS. A LARGE PORTION OF SMYTH COUNTY RESIDENTS DO NOT HAVE AN EDUCATION PAST HIGH SCHOOL (56%), COMPARED TO ONLY 30% IN THE STATE OF VIRGINIA. ADDITIONALLY, A LARGE PORTION OF SMYTH COUNTY RESIDENTS (17%) DO NOT HAVE HEALTH INSURANCE, WHICH IS HIGHER THAN THE VIRGINIA STATE AVERAGE OF 15%. ACCORDING TO THE 2018 COUNTY HEALTH RANKINGS, SMYTH COUNTY IS RANKED 102ND OUT OF 133 IN VIRGINIA FOR HEALTH OUTCOMES AND 106TH IN HEALTH BEHAVIORS. WHEN COMPARED TO OTHER VIRGINIA COUNTIES, SMYTH COUNTY HAS HIGH RATES OF ADULT OBESITY AND PHYSICAL INACTIVITY, AS WELL AS HIGH RATES OF ALCOHOL- IMPAIRED DRIVING DEATHS. AS FOR SOCIAL AND ECONOMIC FACTORS, SMYTH COUNTY RANKS 95TH DUE TO HIGH RATES OF CHILDREN IN POVERTY AND HIGHER UNEMPLOYMENT RATES.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	SCCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. SCCH'S LEADERSHIP REMAINS MINDFUL OF MANAGING LIMITED RESOURCES SO THAT ADEQUATE FACILITIES AND EQUIPMENT ARE AVAILABLE FOR THE CARE OF OUR PATIENTS. SURPLUS FUNDS ARE INVESTED INTO IMPROVING TREATMENT OPTIONS FOR OUR PATIENTS THROUGH NEW TECHNOLOGIES, RECRUITING PHYSICIANS AND TRAINED STAFF IN SHORTAGE AREAS, AND IMPROVING OUR FACILITIES. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. SCCH SERVES AS A TRAINING SITE FOR MANY TYPES OF HEALTH PROFESSIONS: NURSING, PHARMACY, PSYCHOLOGY, LAB, RESPIRATORY THERAPY, EMT, PUBLIC HEALTH, ETC. STUDENTS FROM SEVERAL COLLEGES RECEIVE TRAINING AND EXPERIENCE IN OUR HOSPITALS. WE DEVOTE RESOURCES TO HEALTH CONFERENCES FOR LOCAL HEALTH PROFESSIONALS AND OFFER OTHER PROGRAMS FOCUSED ON IMPROVING THE HEALTH OF OUR RESIDENTS. WHILE WE OPERATE IN A PREDOMINANTLY LOW-INCOME, RURAL AREA, WE CONTINUE TO OFFER SERVICES THAT OPERATE AT A LOSS BECAUSE SCCH RESIDENTS WOULD OTHERWISE NEED TO LEAVE THEIR HOME TOWN OR COUNTY TO RECEIVE NEEDED CARE. THE MAJORITY OF SCCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY SCCH.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	SCCH IS A 44-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 13-MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. SCCH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE. IT IS ONE OF THE HOSPITALS WITHIN THE BALLAD HEALTH SYSTEM. BALLAD HEALTH OPERATES A FAMILY OF 21 HOSPITALS, INCLUDING THREE TERTIARY CARE FACILITIES, 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. PATIENTS BENEFIT FROM SCCH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. IF NEEDED, PATIENTS CAN BE MOVED TO ONE OF BALLAD HEALTH'S TERTIARY CARE FACILITIES PROVIDING ADVANCED TREATMENT OPTIONS. HOSPITALS IN THE BALLAD HEALTH SYSTEM WORK CLOSELY WITH ONE ANOTHER TO SHARE EXPERTISE AND RESOURCES.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	VIRGINIA, TENNESSEE
ADDITIONAL INFORMATION	BALLAD HEALTH IS REQUIRED TO REPORT COMMUNITY BENEFIT ESTIMATES ON A QUARTERLY BASIS WITH THE STATES OF TENNESSEE AND VIRGINIA. THE REPORTING INCLUDES ALL OF BALLAD'S HOSPITAL ORGANIZATIONS AND IS REPORTED USING IRS FORM 990, SCHEDULE H INSTRUCTIONS FOR REPORTING COMMUNITY BENEFIT. BALLAD OPERATES UNDER A COOPERATIVE AGREEMENT (CA) IN VIRGINIA AND A CERTIFICATE OF PUBLIC ADVANTAGE (COPA) IN TENNESSEE AS OBLIGATED BY AGREEMENTS BETWEEN BALLAD AND THE TWO STATES TO ALLOW MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM TO MERGE.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LINCOLN THEATRE	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	117 E MAIN STREET PO BOX 664	AddressLine1Txt
City	MARION	CityNm
State Abbreviation	VA	StateAbbreviationCd
ZIP	24354	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	541477479	RecipientEIN
IRC Section	501C3	IRCSectionDesc
Cash Grant	$5,050	CashGrantAmt
Purpose Of Grant	SPONSORSHIP	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE I, PAGE 4, PART IV	FormAndLineReferenceDesc
Explanation	PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS DONATION REQUESTS THAT WILL BE EXPENSED AT THE CORPORATE DIVISION REQUIRE TWO LEVELS OF APPROVAL, WITH FINAL REVIEW BY EITHER THE VP OF MARKETING OR PRESIDENT & CEO OF BALLAD HEALTH. DONATIONS THAT WILL BE EXPENSED BY ONE OF OUR HOSPITALS REQUIRES FINAL APPROVAL BY THE INDIVIDUAL HOSPITAL'S CEO. ALL REQUESTS ARE NOW REQUIRED TO USE THE ONLINE APPLICATION FORM. THE ONLINE FORM PROVIDES CONSISTENCY AMONG APPLICANTS AND GIVES US THE INFORMATION WE NEED IN ORDER TO MAKE A VETTED FUNDING DECISION. SOME OF THE INFORMATION WE REQUIRE FROM APPLICANTS INCLUDES: -IF THE APPLICANT IS REQUESTING FUNDING FOR A SPECIFIC EVENT OR PROGRAM, THE DATE, LOCATION, TIME ARE REQUIRED -DESCRIPTION OF THE EVENT/PROGRAM -APPLICANT'S OTHER SOURCES OF INCOME -EVENT/PROGRAM BUDGET -HOW THE EVENT/PROGRAM SUPPORTS BALLAD HEALTH'S MISSION -WHO WILL BENEFIT FROM OUR CONTRIBUTION -WHAT WILL THE EVENT/PROGRAM ACCOMPLISH -HOW WILL THE EVENT/PROGRAM MEASURE ITS ACCOMPLISHMENT -APPLICANT ORGANIZATION'S MISSION STATEMENT -YEAR THE APPLICANT ORGANIZATION WAS FOUNDED -NUMBER OF PEOPLE SERVED ANNUALLY BY THE APPLICANT -APPLICANT'S WEBSITE -TAX STATUS OF THE APPLICANT AND FEDERAL TAXPAYER ID NUMBER WITH FEW EXCEPTIONS, DONATIONS TO NATIONAL ORGANIZATIONS ARE HANDLED AT THE CORPORATE LEVEL, WHICH PREVENTS MULTIPLE CONTRIBUTIONS BEING MADE TO THE SAME NATIONAL ORGANIZATION AND ALLOWS ADDITIONAL CONTRIBUTION DOLLARS TO BE USED FOR REGION-SPECIFIC REQUESTS. DONATIONS FROM OUR HOSPITALS ARE ALMOST ENTIRELY DIRECTED TO LOCAL NONPROFIT ORGANIZATIONS. BALLAD HEALTH'S SOCIAL RESPONSIBILITY COMMITTEE IS COMPRISED OF COMMUNITY, VOLUNTEER AND BUSINESS LEADERS AS WELL AS THE PRESIDENT & CEO, CHIEF OPERATING OFFICER AND OTHER LEADERS FROM ACROSS THE SYSTEM. COMMITTEE MEMBERS WERE SELECTED SO THAT MEMBERSHIP EXPERTISE INCLUDES PUBLIC HEALTH, HEALTH PROFESSIONS EDUCATION, KNOWLEDGE OF OTHER RESOURCES AVAILABLE TO CHARITABLE ORGANIZATIONS, AND INDIVIDUALS WITH HANDS-ON COMMUNITY VOLUNTEER EXPERIENCE. SOME OF THE ROUTINE ACTIVITIES OF THE COMMITTEE DURING QUARTERLY MEETINGS INCLUDE: -QUARTERLY REVIEW OF THE SOCIAL RESPONSIBILITY SCORECARD; A MEASUREMENT OF ACTUAL ACCOMPLISHMENTS IN THE YEAR COMPARED TO TARGETS SET AT THE BEGINNING OF THE YEAR -REVIEW OF CHARITABLE CONTRIBUTION GIVING FOR THE PREVIOUS QUARTER -OPPORTUNITY FOR LOCAL TAX-EXEMPT ORGANIZATIONS TO PRESENT TO THE COMMITTEE PROGRAMS THEY OFFER, ACHIEVEMENTS, AND FUNDING NEEDS -THE COMMITTEE MAY OR MAY NOT RECOMMEND BALLAD HEALTH FUNDING OF PROGRAMS -SOMETIMES, BALLAD HEALTH DEPARTMENTS WILL BRING PROPOSALS FOR NEW PROGRAMS TO BENEFIT A SPECIFIC POPULATION, SUCH AS CHILDREN	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
TONY KECK
MSHA EVP, CPHO	$370,812	$81,021	$6,777	$49,071	$16,513	$524,194
BRIAN MILLER DO
DIRECTOR	$320,941	$63,190	$22,241	$8,778	$17,645	$432,795
STAN HICKSON
VP, PRES. SW MKT.	$314,961	$66,794	$1,519		$20,856	$404,130
ERIC SACKNOFF MD
DIRECTOR	$291,005		$6,195	$7,523	$21,222	$325,945
JOHN JETER
TREAS./CFO	$180,862	$30,559	$404	$10,107	$19,092	$241,024
JAMES TYLER
SCCH CEO	$189,839	$66,850	$10,003	$7,890	$16,653	$291,235
BELDON FLEMING
PHARMACY MGR	$140,784	$7,308	$15	$8,847	$23,051	$180,005
LORI MARTIN
ADMINISTRATOR - FMM	$121,718	$2,944	$15	$5,197	$20,523	$150,397
LINDA WHITE
FORMER SCCH CEO	$264,066	$72,552	$3,699	$25,335	$18,580	$384,232
CATHY MAINE
FORMER SCCH KEY EMPL	$99,692	$16,205	$13,603	$4,151	$7,414	$141,065

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

SCHEDULE J, PAGE 1, PART I, LINE 4

TONY KECK 0 38,493 0 LINDA WHITE 0 7,074 0

SCHEDULE J, PART III

PART I, LINE 4B TONY KECK AND LINDA WHITE PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE 457(F) PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON- OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24-MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4A	(CONTINUED) OUR MEMBERSHIP CONSISTS OF MOUNTAIN STATES HEALTH ALLIANCE (MAJORITY OWNER) AND SMYTH COUNTY COMMUNITY FOUNDATION. IN FEBRUARY 2018, MOUNTAIN STATES HEALTH ALLIANCE (MSHA) AND WELLMONT HEALTH SYSTEM (WHS) MERGED TO FORM BALLAD HEALTH, A TAX-EXEMPT ENTITY AND PARENT COMPANY OF MSHA AND WHS. BALLAD OPERATES 3,293 LICENSED BEDS IN 21 HOSPITALS, AN OUTPATIENT ADDICTION TREATMENT FACILITY, LONG-TERM CARE FACILITIES, HOME CARE AND HOSPICE SERVICES, RETAIL PHARMACIES, OUTPATIENT SERVICES AND A COMPREHENSIVE MEDICAL MANAGEMENT CORPORATION. FOR THE YEAR ENDING JUNE 30, 2018, SCCH RECORDED 1,372 INPATIENT HOSPITAL ADMISSIONS AND 284 NURSING HOME ADMISSIONS. THERE WERE 74,951 OUTPATIENT VISITS, 16,459 EMERGENCY VISITS AND 10,891 HOME HEALTH VISITS. SCCH SUBSIDIZED A PHYSICIAN CLINIC LOCATED IN A RURAL, MEDICALLY UNDERSERVED AREA. THE CLINIC ALLOWS RESIDENTS TO RECEIVE QUALITY CARE WITHOUT HAVING TO TRAVEL OUTSIDE OF THEIR HOME AREA. THIS IS ESPECIALLY IMPORTANT FOR ELDERLY RESIDENTS AND OTHERS THAT REQUIRE FAMILY OR FRIENDS TO PROVIDE TRANSPORTATION TO PHYSICIAN APPOINTMENTS. OUR COST DURING THE YEAR TO SUBSIDIZE THE CLINIC WAS 77,863. THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC) ISSUED A PRESS RELEASE DATED APRIL 11, 2018 STATING THAT THE UNITED STATES COULD SEE A SHORTAGE OF UP TO 120,000 PHYSICIANS BY 2030. THE U.S. POPULATION IS ESTIMATED TO GROW BY NEARLY 11%, WITH THOSE OVER AGE 65 INCREASING 50% BY 2030. MUCH OF THE INCREASED DEMAND COMES FROM A GROWING, AGING POPULATION. THE AGING POPULATION WILL ALSO AFFECT PHYSICIAN SUPPLY SINCE ONE-THIRD OF ALL CURRENTLY ACTIVE DOCTORS WILL BE OLDER THAN 65 IN THE NEXT DECADE AND LIKELY TO RETIRE. THE AAMC POINTS OUT THAT DATA CONDUCTED IN 2017 INDICATED THAT AN ADDITIONAL 31,600 PHYSICIANS WOULD HAVE BEEN NEEDED IF UNDERSERVED POPULATIONS UTILIZED THE SAME HEALTH CARE SERVICES AS INSURED INDIVIDUALS. THE DATA LOOKED AT PEOPLE IN NON-METROPOLITAN AREAS AND PEOPLE WITHOUT INSURANCE COMPARED TO PEOPLE LIVING IN METROPOLITAN AREAS. FURTHERMORE, THE STUDY INDICATED NEARLY HALF OF THE SHORTAGE WAS IN THE SOUTH. SCCH SPENT 329,279 DURING FY18 TO RECRUIT AND RETAIN PHYSICIANS. SCCH RECRUITMENT EFFORTS ARE BASED ON DOCUMENTED COMMUNITY NEED. SCCH IS LOCATED IN A MUA (MEDICALLY UNDERSERVED AREA), AS DESIGNATED BY THE U.S. HEALTH RESOURCES & SERVICES ADMINISTRATION (HRSA). MUA DESIGNATION INDICATES AN AREA AS: HAVING TOO FEW PRIMARY CARE PROVIDERS, HAVING A HIGH INFANT MORTALITY, A HIGH POVERTY RATE OR A HIGH ELDERLY POPULATION. SCCH, ALONG WITH THE SMYTH COUNTY HOSPITAL HEALTHTRUST AND THE SMYTH COUNTY HEALTH DEPARTMENT, HOSTED THEIR SECOND ANNUAL FREE HEALTH FAIR FOR LOCAL LAW ENFORCEMENT AGENTS IN THE COUNTY. THE ALL-DAY EVENT PROVIDED OFFICERS A VARIETY OF SCREENINGS FREE OF CHARGE, INCLUDING LAB WORK, VISION, SLEEP, VARIOUS VACCINATIONS INCLUDING FLU SHOTS, BLOOD PRESSURE AND BMI CHECKS, AND MORE. GUESTS WERE ABLE TO SPEND TIME WITH HEALTH CARE PROVIDERS AND ASK QUESTIONS ABOUT THEIR RESULTS OR OTHER HEALTH CONCERNS. HEALTH EDUCATION CLASSES WERE PROVIDED THROUGHOUT THE YEAR. FOR EXAMPLE, WE OFFER CPR CLASSES FOR LOCAL BUSINESSES AND AGENCIES AND A JOINT CLASS IS OFFERED FOR PEOPLE WITH HIP AND KNEE PAIN. DURING THE YEAR SCCH HOSTED TWO CHAMBER OF COMMERCE BREAKFASTS. AT THE FIRST BREAKFAST A SURGEON PROVIDED EDUCATION ON BREAST CANCER/BREAST CANCER AWARENESS AND AT THE SECOND BREAKFAST A CARDIOLOGIST PROVIDED EDUCATION ON CARDIOVASCULAR HEALTH. IN AUGUST 2018, SCCH HOSTED THE FIRST MEETING OF THE SOUTHWESTERN CHAPTER OF THE VIRGINIA NURSES ASSOCIATION (VNA). NURSES FROM ACROSS SOUTHWEST VIRGINIA ATTENDED. THE EVENT WAS OPEN TO MEMBERS AS WELL AS NONMEMBERS, BOTH RNS AND LPNS. GUESTS INCLUDED REPRESENTATIVES FROM THE VNA, A DELEGATE FOR THE 5TH DISTRICT OF VIRGINIA, AND A NURSE EDUCATOR AND CO-LEAD OF THE NURSING TASK FORCE AND COALITION FOR NURSES ON BOARDS FOR THE STATE OF VIRGINIA. ATTENDEES WERE PROVIDED UPDATES ON NURSING ACTIVITIES ACROSS THE STATE, UPCOMING CONFERENCES AND SCHOLARSHIP OPPORTUNITIES, UPDATES ON LEGISLATION AND BILLS RELATED TO HEALTH CARE AND NURSING, AND AN INTERACTIVE PROGRAM FOCUSED ON HARNESSING NURSING PERSPECTIVES AND THE VALUE OF NURSES ON BOARDS. SEVERAL SCCH TEAM MEMBERS WERE SELECTED LAST YEAR TO SERVE AS OFFICERS FOR THE SOUTHWESTERN CHAPTER OF THE VNA. IN OCTOBER 2018, SCCH HOSTED A LEGISLATIVE RECEPTION SPONSORED BY THE SOUTHWEST CHAPTER OF THE VNA AND THE VIRGINIA COUNCIL OF NURSE PRACTITIONERS (VCNP). THE EVENT BROUGHT TOGETHER SEVERAL LEGISLATORS AND THEIR REPRESENTATIVES TO TALK ABOUT HEALTHCARE REFORM, FOCAL POINTS FOR THE UPCOMING SESSION AND THEIR POSITION ON VIRGINIA NURSING'S PUBLIC POLICY PLATFORM. MUCH OF THE FOCUS OF THE EVENING WAS TARGETED AT POPULATION HEALTH, PRACTICE AUTHORITY IN THE STATE OF VIRGINIA, EDUCATION RESOURCES TO SUPPORT LOCAL COLLEGES, ESPECIALLY THOSE WITH NURSING PROGRAMS, CURRENT LEGISLATION AROUND THE CARE OF PSYCHIATRIC PATIENTS AND ITS IMPACT ON THE ACUTE CARE SETTING, AND THE OPIOID CRISIS. ATTENDEES CAME FROM ACROSS SOUTHWEST VIRGINIA AND REPRESENTED A VASTLY DIVERSE NURSING POPULATION FROM COLLEGE DEANS TO NURSING STUDENTS TO NURSES WITH THE STATE HOSPITAL AND CORRECTIONAL FACILITIES, AS WELL AS CHIEF NURSING OFFICERS FROM THE REGION, LONG-TERM CARE PROVIDERS, AND ACUTE-CARE NURSES FROM HOME HEALTH AND HOSPITALS. AS WE NOTED ON SCCH'S FY17 FORM 990, MSHA IS ONE OF ONLY 32 ORGANIZATIONS IN THE COUNTRY SELECTED TO BE PART OF THE U.S. CENTERS FOR MEDICARE & MEDICAID SERVICES' (CMS) NEW INITIATIVE, ACCOUNTABLE HEALTH COMMUNITIES (AHC), AIMED AT IMPROVING THE HEALTH OF MEDICARE AND MEDICAID BENEFICIARIES. THE NEW CMS PROGRAM IS DESIGNED TO INTEGRATE CARE FOR HEALTH-RELATED SOCIAL NEEDS INTO USUAL CARE BY IMPLEMENTING SYSTEMATIC SCREENING, REFERRAL, AND PATIENT NAVIGATION SERVICES FOR NEEDS SUCH AS FOOD INSECURITY, HOUSING INSTABILITY, SAFETY, TRANSPORTATION NEEDS, AND UTILITY ASSISTANCE. MOUNTAIN STATES SERVES AS THE BRIDGE ORGANIZATION FOR THE PROJECT LOCALLY, LEADING A COLLABORATIVE OF MULTIPLE ORGANIZATIONS AND CLINICAL DELIVERY SITES TO BRING NEEDED SERVICES TO BENEFICIARIES RESIDING IN SOUTHWEST VIRGINIA. THE FIRST STEPS IN IMPLEMENTING THE AHC COOPERATIVE AGREEMENT WERE COMPLETED DURING FY18. SIX FULL-TIME TEAM MEMBERS WERE HIRED, WHOSE POSITIONS ARE FINANCED BY THE FEDERAL FUNDS, (3 NAVIGATORS, 1 LEAD NAVIGATOR, 1 SCREENING AND REFERRAL SPECIALIST, AND 1 PROGRAM MANAGER), WHILE THREE FULL-TIME AND ONE PART-TIME NAVIGATOR POSITIONS REMAINED OPEN AS OF 6/30/18. IN ADDITION, MSHA ADMINISTRATIVE TEAM MEMBERS PROVIDED MORE THAN 700 HOURS OF THEIR TIME TO THIS INITIATIVE. WHEN FULLY IMPLEMENTED, OVER 50 UNITS AT CLINICAL DELIVERY SITES IN SOUTHWEST VIRGINIA, INCLUDING SMYTH COUNTY COMMUNITY HOSPITAL, AND NORTHEAST TENNESSEE WILL HAVE A SCREENING PROCESS IN PLACE TO IDENTIFY HEALTH-RELATED SOCIAL NEEDS. PATIENTS THAT SCREEN POSITIVE FOR HEALTH- RELATED SOCIAL NEEDS ARE GIVEN A "COMMUNITY REFERRAL SUMMARY", WHICH CONTAINS CONTACT AND PROGRAM INFORMATION FOR RELEVANT RESOURCES THAT ASSIST WITH THE NEEDS IDENTIFIED BY THE SCREENING. DURING FY18, EDUCATION AND PILOT TESTING FOR SCREENING PROCESSES OCCURRED AT 17 PRIMARY CARE PHYSICIAN OFFICES, TEN EMERGENCY DEPARTMENTS, THREE INPATIENT LABOR AND DELIVERY UNITS, THREE INPATIENT PSYCHIATRY UNITS, AND ONE INTENSIVE OUTPATIENT PSYCHIATRY UNIT. DURING THE FALL OF 2017 AND WINTER OF 2018, A PROCESS WAS TESTED USING A DATA SYSTEM DEVELOPED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN TOTAL, 2,547 HEALTH-RELATED SOCIAL NEEDS SCREENINGS OF VIRGINIA MEDICARE AND MEDICAID BENEFICIARIES WERE COMPLETED USING THE SYSTEM. DURING THIS PILOT TESTING, A NUMBER OF OPERATIONAL OBSTACLES WERE IDENTIFIED, INCLUDING DUPLICATIVE DATA ENTRY TASKS, LENGTHY LOG-IN STEPS, AND MANUAL CREATION OF THE COMMUNITY REFERRAL SUMMARIES. DATA ENTRY TIME TOOK TOO LONG, SO MOUNTAIN STATES TRANSITIONED FROM THE CMS DATA SYSTEM TO AN INTERNALLY-PRODUCED SYSTEM. THIS TRANSITION IMPROVED OPERATIONAL EFFICIENCY BY AT LEAST FIVE-FOLD. PATIENT NAVIGATORS WERE TRAINED IN DISCIPLINES SUCH AS MENTAL HEALTH FIRST AID, INTERPERSONAL COMMUNICATION, AND MANY OTHER RELATED TOPICS. THE NAVIGATORS WERE DEPLOYED TO WORK FROM FIVE VIRGINIA COMMUNITY SERVICES BOARDS IN OUR SERVICE AREA. NAVIGATORS WORK FROM COMMUNITY SERVICES BOARDS TO IMPROVE THE REFERRAL PROCESS, AS WE EXPECT A LARGE NUMBER OF BEHAVIORAL HEALTH-RELATIVE NEEDS TO BE IDENTIFIED DURING NAVIGATION SERVICES. LAPTOPS AND CELL PHONES WERE PURCHASED FOR THE NAVIGATORS TO HAVE THE ABILITY TO WORK FROM THE COMMUNITY SERVICES BOARDS, CLINICAL DELIVERY SITES, AND POTENTIALLY OTHER LOCATIONS TO MEET PATIENTS. NAVIGATION SERVICES WERE PILOTED WITH PATIENTS, LEADING TO CHANGES IN THE QUESTION SETS, WHICH IMPROVED EFFICIENCY BY REDUCING THE AMOUNT OF TIME REQUIRED FOR EACH PATIENT AND THE NUMBER OF QUESTIONS PATIENTS MUST ANSWER. BETWEEN MARCH 1 AND JUNE 30, NAVIGATION SERVICES PROVIDED AS PART OF OUR PILOT RESOLVED THE HEALTH-RELATED SOCIAL NEEDS OF 47 PATIENTS,
FORM 990, PART V	PART V, LINE 2A MSHA, SCCH'S MAJORITY OWNER, PROCESSES PAYROLL FOR SCCH. SCCH REIMBURSES MSHA FOR ALL SALARY AND BENEFITS RELATED TO OUR TEAM MEMBERS AND THE EXPENSE IS RECORDED ON SCCH'S BOOKS. SCCH OPERATES A RURAL HEALTH CLINIC. UNDER CURRENT CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) REGULATIONS GOVERNING STAFFING AT A RURAL HEALTH CLINIC, AT LEAST ONE MIDLEVEL PROVIDER (NURSE PRACTITIONER, PHYSICIAN ASSISTANT, ETC.) MUST BE A W-2 EMPLOYEE OF THE CLINIC. THEREFORE, SCCH PAYS TWO MIDLEVEL PROVIDERS DIRECTLY (RATHER THAN MSHA PAYING THESE TEAM MEMBERS' SALARY WITH SCCH REIMBURSING MSHA). THE NUMBER OF SCCH TEAM MEMBERS THAT RECEIVED REPORTABLE COMPENSATION IN EXCESS OF 100,000 WAS 6.
FORM 990, PAGE 6, PART VI, LINE 6	MOUNTAIN STATES HEALTH ALLIANCE IS THE 80% MEMBER OF SMYTH COUNTY COMMUNITY HOSPITAL. SMYTH COUNTY COMMUNITY FOUNDATION IS THE 20% MEMBER OF SMYTH COUNTY COMMUNITY HOSPITAL.
FORM 990, PAGE 6, PART VI, LINE 7A	THERE ARE TWO CLASSES OF MEMBERS, AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) CLASS IS ELECTED BY BALLAD HEALTH'S BOARD OF DIRECTORS, MSHA'S SOLE MEMBER, WHICH SERVES AS MSHA'S BOARD OF DIRECTORS, AND THE SMYTH COUNTY COMMUNITY HOSPITAL CLASS IS ELECTED BY THE SMYTH COUNTY COMMUNITY FOUNDATION BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT.
FORM 990, PAGE 6, PART VI, LINE 7B	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, PAGE 6, PART VI, LINE 11B	THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS AND THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW.
FORM 990, PAGE 6, PART VI, 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 SMYTH COUNTY COMMUNITY HOSPITAL. 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 COMMITTEES 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, PAGE 6, PART VI, LINE 15A	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. THE REVIEW INCLUDES SCCH'S CEO. 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.
FORM 990, PAGE 6, PART VI, LINE 15B	SIMILAR TO SCCH'S CEO, SCCH'S CFO RECEIVES COMPENSATION THAT COMPLIES WITH BALLAD HEALTH'S SALARY POLICY. HIS PAY IS SET AT A MARKET PERCENTILE SPECIFIC TO HIS POSITION AS CFO OF SCCH.
FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY. FORM 990, PART VII - RELATED ORGANIZATIONS DIRECTOR COMPENSATION: SCCH'S BOARD MEMBERS STAN HICKSON, JOHN JETER, TONY KECK, BRIAN MILLER, D.O. AND ERIC SACKNOFF, M.D. RECEIVE COMPENSATION FOR SERVICES PROVIDED TO RELATED ORGANIZATIONS AND DO NOT RECEIVE COMPENSATION FOR SERVICES AS A SCCH BOARD MEMBER.
FORM 990, PART IX, LINE 11G	HOSPITAL SUPPORTED CLINICS 2,725,478 0 0 PHYSICIAN FEES 1,983,996 0 0 DIETARY SERVICES 1,787,729 0 0 COLLECTION FEES 0 358,790 0 LAUNDRY/HSKPG. SERVICES 644,758 0 0 REHABILITATION SERVICES 1,017,587 0 0 CONSULTING FEES 0 76,807 0 LITHOTRIPSY SERVICES 86,800 0 0 FACILITIES & CONSTRUCT. MGT. 0 147,914 0 LABORATORY 154,392 0 0 TRANSCRIPTION SERVICES 176,337 0 0 OTHER 809,306 169,995 0 TOTAL 9,386,383 753,506 0
FORM 990, PART X	PART IV, LINE 24A AND PART X, LINE 20 - TAX EXEMPT BOND LIABILITY THE TAX EXEMPT BOND LIABILITY REFLECTS THE PORTION OF BONDS ISSUED BY MOUNTAIN STATES HEALTH ALLIANCE, SCCH'S MAJORITY OWNER, ON BEHALF OF SCCH FOR CAPITAL NEEDS. SCCH PAYS ALL COSTS RELATED TO THIS PORTION OF THE BOND ISSUE.
FORM 990, PART XI, LINE 9	TEMPORARILY RESTRICTED GRANTS -2,410 P/S EXPENSES-NOT ON BOOKS 17,585 P/S ORDINARY INC-NOT ON BOOKS -116,898 P/S INTEREST INC-NOT ON BOOKS -2,260 EMPLOYER PROVIDED PARKING-NOT ON BOOKS -6,787 TOTAL -110,770
FORM 990, PAGE 12, PART XII, LINE 2C	BALLAD HEALTH (BALLAD) 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. THE INDIVIDUALS SERVING AS THE BOARD OF DIRECTORS OF BALLAD ALSO SERVE AS THE BOARD OF DIRECTORS OF MSHA AND WHS. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF BALLAD INCLUDE MSHA, WHS AND THEIR SUBSIDIARIES AND AFFILIATES WHICH WERE PREVIOUSLY INCLUDED IN EITHER MSHA OR WHS AUDITED CONSOLIDATED FINANCIAL STATEMENTS. BALLAD HAS AN AUDIT COMMITTEE WHICH ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.

Schedule R IRS990ScheduleR

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Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
MOUNTAIN STATES HEALTH ALLIANCE
303 MED TECH PARKWAY SUITE 220	JOHNSON CITY	TN	37604	620476282	HOSP. SYS.	TN	501C3	3	BALLAD	false
MOUNTAIN STATES FOUNDATION
2335 KNOB CREEK ROAD SUITE 101	JOHNSON CITY	TN	37604	581418862	FUNDRAISER	TN	501C3	12A	MSHA	false
MSHA AUXILIARY
400 N STATE OF FRANKLIN ROAD	JOHNSON CITY	TN	37604	581418345	SUPP. ORG.	TN	501C3	12A	MSHA	false
NORTON COMMUNITY HOSPITAL
100 15TH STREET NW	NORTON	VA	24273	540566029	HOSPITAL	VA	501C3	3	NA	false
DICKENSON COMMUNITY HOSPITAL
312 HOSPITAL DRIVE	CLINTWOOD	VA	24228	770599553	HOSPITAL	VA	501C3	3	NCH	false
JOHNSTON MEMORIAL HOSPITAL
16000 JOHNSTON MEMORIAL DRIVE	ABINGDON	VA	24211	540544705	HOSPITAL	VA	501C3	3	NA	false
ABINGDON PHYSICIAN PARTNERS
16000 JOHNSTON MEMORIAL DRIVE	ABINGDON	VA	24211	205485346	MED. SERV.	VA	501C3	12A	JMH	false
SMYTH COUNTY COMMUNITY FOUNDATION
1 HEALTH WAY	MARION	VA	24354	311650055	SUPP. ORG.	VA	501C3	12A	NA	false
BALLAD HEALTH
303 MED TECH PARKWAY SUITE 220	JOHNSON CITY	TN	37604	611771290	SUPP. ORG.	TN	501C3	12B	NA	false
EAST TN HEALTHCARE HOLDING INC
203 GRAY COMMONS CIRCLE	GRAY	TN	37615	815475903	OPIOD TRT	TN	501C3	3	MSHA	false
WELLMONT HEALTH SYSTEM
1905 AMERICAN WAY	KINGSPORT	TN	37660	621636465	HOSP. SYS.	TN	501C3	3	BALLAD	false
WELLMONT HAWKINS CO MEMORIAL HOSP
851 LOCUST STREET	ROGERSVILLE	TN	37857	621816368	HOSPITAL	TN	501C3	3	WHS	false
TAKOMA REGIONAL HOSPITAL INC
401 TAKOMA AVENUE	GREENEVILLE	TN	37743	510603966	HOSPITAL	TN	501C3	3	WHS	false
TAKOMA REGIONAL HOSPITAL FDN INC
1905 AMERICAN WAY	KINGSPORT	TN	37660	471334302	FUNDRAISER	TN	501C3	7	WHS	false
WELLMONT CARDIOLOGY SERVICES
1905 AMERICAN WAY	KINGSPORT	TN	37660	263557623	MED. SERV.	TN	501C3	10	WHS	false
WELLMONT MEDICAL ASSOCIATES
1905 AMERICAN WAY	KINGSPORT	TN	37660	270898372	MED. SERV.	TN	501C3	7	WHS	false
WELLMONT FOUNDATION
1905 AMERICAN WAY	KINGSPORT	TN	37660	581594191	FUNDRAISER	TN	501C3	7	WHS	false
WELLMONT MADISON HOUSE
1905 AMERICAN WAY	KINGSPORT	TN	37660	621308216	ASST. LIV.	TN	501C3	10	WHS	false
WELLMONT WEXFORD HOUSE
1905 AMERICAN WAY	KINGSPORT	TN	37660	581859039	NSG. HOME	TN	501C3	10	WHS	false
WELLMONT IMAGING SERVICES INC
1905 AMERICAN WAY	KINGSPORT	TN	37660	861103148	HEALTHCARE	TN	501C3	12A	WHS	false
WELLMONT SLEEP SERVICES
1905 AMERICAN WAY	KINGSPORT	TN	37660	273777167	MED. SERV.	TN	501C3	3	WHS	false
LAUGHLIN MEMORIAL HOSPITAL INC
1420 TUSCULUM BOULEVARD	GREENEVILLE	TN	37745	620701119	HOSPITAL	TN	501C3	3	MSHA	false
LAUGHLIN HEALTHCARE FOUNDATION
1420 TUSCULUM BOULEVARD	GREENEVILLE	TN	37745	582105493	FUNDRAISER	TN	501C3	12A	MSHA	false

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd
EMMAUS COMMUNITY HEALTHCARE PLLC
6070 HWY 11E	PINEY FLATS	TN	37686	200577483	MED. SERV.	TN	NA	false	false
MEDICAL SPECIALISTS OF JC LLC
2528 WESLEY STREET SUITE 2	JOHNSON CITY	TN	37601	272199037	MED. SERV.	TN	NA	false	false
EAST TN AMBULATORY SURGERY CNTR
701 MED TECH PARKWAY SUITE 100	JOHNSON CITY	TN	37604	621787537	MED. SERV.	TN	NA	false	false
GREENEVILLE PHYSICIAN SERVICES LLC
1905 AMERICAN WAY	KINGSPORT	TN	37660	455070419	MED. SERV.	TN	NA	false	false

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (16 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
BLUE RIDGE MEDICAL MANAGEMENT CORP
1905 AMERICAN WAY	KINGSPORT	TN	37660	621490616	MED. SERV.	TN	NA	C CORP	false
MEDISERVE MEDICAL EQUIPMENT
1905 AMERICAN WAY	KINGSPORT	TN	37660	621212286	DME	TN	NA	C CORP	false
MOUNTAIN STATES PROPERTIES
1905 AMERICAN WAY	KINGSPORT	TN	37660	621845895	PROP. MGMT	TN	NA	C CORP	false
MOUNTAIN STATES PHYSICIAN GROUP
1905 AMERICAN WAY	KINGSPORT	TN	37660	621700412	MED. SERV.	TN	NA	C CORP	false
COMMUNITY HOME CARE INC
1490 PARK AVENUE NW SUITE B	NORTON	VA	24273	541453810	DME	VA	NA	C CORP	false
WILSON PHARMACY INC
P O BOX 5289	JOHNSON CITY	TN	37604	620329587	PHARMACY	TN	NA	C CORP	false
CRESTPOINT HEALTH INSURANCE COMPANY
509 MED TECH PARKWAY SUITE 100	JOHNSON CITY	TN	37604	620381170	INSURANCE	TN	NA	C CORP	false
INTEGRATED SOLUTIONS HEALTH NETWORK
509 MED TECH PARKWAY SUITE 100	JOHNSON CITY	TN	37604	621711997	HLTH NETWK	TN	NA	C CORP	false
WELLMONT INC
1905 AMERICAN WAY	KINGSPORT	TN	37660	621320035	MED. SERV.	TN	NA	C CORP	false
MCOT INC
1905 AMERICAN WAY	KINGSPORT	TN	37660	621325938	BUS. SERV.	TN	NA	C CORP	false
MEDICAL MALL PHARMACY INC
1905 AMERICAN WAY	KINGSPORT	TN	37660	621565006	MED. SERV.	TN	NA	C CORP	false
WELLMONT PHYSICIAN SERVICES
1905 AMERICAN WAY	KINGSPORT	TN	37660	621567353	MED. SERV.	TN	NA	C CORP	false
WPS PROVIDERS INC
1905 AMERICAN WAY	KINGSPORT	TN	37660	205564642	MED. SERV.	TN	NA	C CORP	false
WELLMONT HEALTH SERVICES INC
1905 AMERICAN WAY	KINGSPORT	TN	37660	621254373	MED. SERV.	TN	NA	C CORP	false
WELLMONT INSURANCE CO SPC LTD
1905 AMERICAN WAY	KINGSPORT	TN	37660	981195624	INSURANCE				false	N/A
NOLICHUCKEY MANAGEMENT SVCS INC
1420 TUSCULUM BOULEVARD	GREENEVILLE	TN	37745	621776681	MED. SERV.	TN	NA	C CORP	false

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (true)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	false	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	false	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd