2019-05-10T13:16:15-05:00 2018-06-30 990 2017-07-01 540566029 NORTON COMMUNITY HOSPITAL INC NORT 4233023374 1021 W OAKLAND AVENUE STE 103 JOHNSON CITY TN 37604 STEPHEN SAWYER AVP CFO NW MKT AVP/CFO NW MARKET 2766799600 2019-05-10 151.102.241.104 2019-05-10 13:16:15 CD P 87E77A894FBEAE8A07458463D987FBB2F40DF0C9 39095CF110B0C8EE9B5E629A9826572B753F4624 2017 2019-02-21 02:37:17Z X MARK LEONARD 100 15TH STREET NW NORTON VA 24273 68259885 false X BALLADHEALTH.ORG X 1949 VA 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. 14 4 664 10 53463 38449 98297 61404 63389952 65912524 983073 1504145 497900 321283 64969222 67799356 64675 46853 0 35591617 36789287 0 0 26493911 26186816 62150203 63022956 2819019 4776400 96531232 100425685 38253781 36594451 58277451 63831234 X OUR MISSION: HONOR THOSE WE SERVE BY DELIVERING THE BEST POSSIBLE CARE. false false 53897706 46853 66016245 NORTON COMMUNITY HOSPITAL (NCH) IS LOCATED IN NORTON, VIRGINIA. OUR 129-BED ACUTE-CARE FACILITY HAS SERVED SOUTHWEST VIRGINIA AND SOUTHEASTERN KENTUCKY SINCE 1949. AS THE LARGEST HEALTHCARE FACILITY IN THE COALFIELD REGION, NCH PROVIDES A WIDE ARRAY OF SERVICES THROUGH HIGHLY TRAINED PHYSICIANS, AND SUPPORT STAFF. NCH IS THE SOLE OWNER OF DICKENSON COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN CLINTWOOD, VIRGINIA. NCH IS A SUBSIDIARY OF MOUNTAIN STATES HEALTH ALLIANCE. 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. (CONT'D ON SCHEDULE O) (CONT'D) 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. NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED JUST OVER 12,000 BLACK LUNG PROCEDURES THIS YEAR. MSHA'S GRANTS AND AWARDS DEPARTMENT WORKS THROUGHOUT THE YEAR WRITING GRANT APPLICATIONS FOR PROGRAMS TO BENEFIT COMMUNITIES THROUGHOUT MSHA'S LARGE SERVICE AREA. EXAMPLES OF THIS REPORTING PERIOD INCLUDED: A GRANT RENEWAL TO PAY THE SALARY AND BENEFITS FOR A MEDICATION ASSISTANCE CASEWORKER TO EXPAND OUR MEDICATION ASSISTANCE PROGRAM TO NORTON COMMUNITY HOSPITAL, SERVING WISE, DICKENSON, AND RUSSELL COUNTIES. HAVING THIS PROGRAM IN SOUTHWEST VIRGINIA ENABLES US AS A HEALTH SYSTEM TO COME FULL CIRCLE BY SERVING PATIENTS GOING FROM HOSPITAL DISCHARGE TO DOCTORS' OFFICES AND VICE-VERSA. THIS PROGRAM HELPS US TO BETTER SERVE OUR UNINSURED AND UNDERINSURED PATIENTS AND PLAYS A SIGNIFICANT ROLE IN IMPROVING PATIENTS' HEALTH, REDUCING HOSPITAL READMISSIONS, AND ASSISTING DOCTORS IN PROVIDING PROPER TREATMENT TO THIS PATIENT GROUP WHO TRADITIONALLY CAN BE NON-COMPLIANT WITH MEDICATIONS DUE TO PRESCRIPTIONS BEING COST-PROHIBITIVE. NCH OFFERS A FREE SUPPORT GROUP, "THE BETTER BREATHERS CLUB", FOR PEOPLE WITH COPD, ASTHMA, CHRONIC BRONCHITIS, LUNG CANCER AND OTHER PULMONARY DISEASES. THE CLUB MEETS MONTHLY WHERE MEMBERS CAN RECEIVE VALUABLE INFORMATION AND DEVELOP SKILLS TO HELP BETTER MANAGE BREATHING DIFFICULTIES AND IMPROVE THEIR QUALITY OF LIFE. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 113,737 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. IN ADDITION, MSHA CORPORATE ALLOCATES A PORTION OF ITS PHYSICIAN RECRUITMENT DEPARTMENTAL EXPENSES SINCE THAT DEPARTMENT SERVICES ALL MSHA DIVISIONS, INCLUDING NCH. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S, ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. NCH RECRUITMENT EXPENSE DURING FY18 INCLUDED PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. A PORTION OF OUR RECRUITMENT IS PHYSICIAN DEBT FORGIVEN BY THE HOSPITAL OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY AND CONTINUES PROVIDING MEDICAL SERVICES TO OUR RESIDENTS. AS WE NOTED ON NCH'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 NORTON 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, WHILE NAVIGATORS WORKED WITH 70 ADDITIONAL PATIENTS DURING THIS PILOT. MSHA'S PARENT COMPANY, BALLAD HEALTH, EMBARKED ON A CAMPAIGN NEAR THE END OF THIS FISCAL YEAR TO REDUCE HOSPITAL-ACQUIRED C. DIFF BY 30% IN 90 DAYS. THIS IS A BOLD UNDERTAKING BY BALLAD HEALTH'S NEW CLINICAL COUNCIL AND OUR INFECTION PREVENTION DEPARTMENT. C. DIFF IS A SIGNIFICANT THREAT TO HOSPITAL PATIENTS EVERYWHERE. IT'S OUR DUTY AS CAREGIVERS TO PROTECT OUR PATIENTS FROM HARM ALL OF THE TIME, SO PREVENTING C. DIFF IS VITAL. OUR PLAN INVOLVES SOME BASIC STEPS OUR CLINICAL TEAM MEMBERS SHOULD ALWAYS TAKE TO AVOID THIS INFECTION. THE PLAN REQUIRES ALL TEAM MEMBERS TO BE MINDFUL OF HOW THEY TREAT C. DIFF., WITH TEAM MEMBERS INVOLVED IN THE TREATMENT PROCESS RECEIVING SPECIFIC INFORMATION APPROPRIATE FOR THEIR ROLE. IN ADDITION, A VIDEO IS AVAILABLE ON OUR INTRANET SITE THAT ILLUSTRATES SOME OF THE KEY TAKEAWAYS. OUR ULTIMATE GOAL IS ZERO HOSPITAL-ACQUIRED C. DIFF INFECTIONS. FOLLOWING MSHA AND WHS'S MERGER THIS YEAR, TEAM MEMBERS TRANSITIONED TO STANDARD SCRUB COLORS, WHICH MEANT TEAM MEMBERS' SCRUBS THROUGHOUT OUR MANY HOSPITALS AND CLINICS, INCLUDING NCH, HAD TO BE REPLACED. A TEAM MEMBER FROM FRANKLIN WOODS COMMUNITY HOSPITAL RECOGNIZED AN OPPORTUNITY TO HELP OTHERS BY ORGANIZING A "SAVE OUR SCR 53897706 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false true false false false false false true true true true false false true 123 0 true 664 true true true false false false false false false false false false X 14 4 false false false false true true true true true false false true true true true true true false false false VA TN X LYNN KRUTAK 4233023374 303 MED TECH PARKWAY SUITE 300 JOHNSON CITY TN 37604 MARVIN EICHORN MSHA EVPCOO DIRECTOR 1.00 54.00 X 0 749219 42742 MATHEW CUSANO MD PHYSICIAN & 40.50 0.50 X 409806 0 30983 SHANE HILTON SVP MARKET OPER DIRECTOR 1.50 48.50 X 0 396092 58587 MONTY MCLAURIN VPCEO NW MKT VICE CHAIR & 9.00 36.00 X X 0 386782 54704 JAMES MATT WILSON MD PHYSICIAN & 40.50 0.50 X 251763 0 23835 TOM TULL MSHA VP DIRECTOR 1.00 44.00 X 0 211963 25216 CHARLES WARD CHAIR 1.00 0.50 X X 21445 0 0 ROBERT LEONARD SEC/TREASURE 1.50 1.00 X X 11705 0 0 CHARLES SLEMP DIRECTOR 0.50 0.50 X 0 0 0 VALERIE LAWSON DIRECTOR 1.00 0.50 X 0 0 0 JAMES MANICURE DIRECTOR 1.50 1.00 X 0 0 0 BUFORD STURGILL DIRECTOR 0.50 0.50 X 0 0 0 BILL WAMPLER DIRECTOR 1.00 0.50 X 0 0 0 ERNIE WARD DIRECTOR 1.50 1.00 X 0 0 0 MARK LEONARD NCH/DCH CEO 23.00 22.00 X 0 308337 49252 STEPHEN SAWYER AVP CFO NW MKT AVP/CFO NW M 17.00 28.00 X 0 203148 31777 ROBERT MITCH KENNEDY CNO NCH CNO 45.00 0.00 X 151219 0 22889 JUSTIN IVORY CFO, NCH/DCH 23.00 22.00 X 0 88532 14065 VISHAL RAJ MD PHYSICIAN 40.00 0.00 X 546465 0 30581 ELLIE TONY NADER MD PHYSICIAN 40.00 0.00 X 441056 0 9598 DARYL PIERCE MD PHYSICIAN 40.00 0.00 X 415049 0 34092 MICHAEL GREEN MD PHYSICIAN 40.00 0.00 X 395691 0 9275 RUBYE WASHINGTON-MOORE MD PHYSICIAN 40.00 0.00 X 330589 0 31203 2974788 2344073 468799 32 false true false VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON VA 24212 ANESTHESIA SERV 850934 WESTERN VIRGINIA REGIONAL P O BOX 82368 LAFAYETTE LA 705982368 ER PHYSICIANS 812944 HANCOCK DANIEL & JOHNSON PC P O BOX 72050 RICHMOND VA 232552050 LEGAL SERV 324768 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY SERV 224249 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERV 201526 10 26709 24288 10407 61404 PATIENT REVENUE 622110 64671633 64671633 WELLNESS PROGRAMS 622110 1372212 1372212 LAB OUTREACH INCOME 621500 12681 12681 LTD RETIREMENT 900099 -144002 -144002 65912524 808290 808290 180678 58733 121945 121945 22240 99705 647387 450264 401796 647387 48468 695855 48468 647387 REVENUE FROM PARENT 900099 55253 55253 EMPLOYER PROVIDED PARKING 900099 18542 18542 MISC REV-VENDING 900099 4868 4868 120675 120675 199338 67799356 66003564 53463 1680925 X 46853 46853 1583240 684227 899013 27293363 25490238 1803125 1141553 1069695 71858 5009906 4340012 669894 1761225 1729406 31819 266927 250631 16296 347579 1968 345611 93818 93818 98498 98498 6394365 5286547 1107818 175290 9155 166135 716203 586131 130072 1425913 1407780 18133 1074075 950112 123963 376608 363156 13452 432716 432716 4409312 2673524 1735788 51599 122564 -70965 MEDICAL SUPPLIES & DRUGS 6402198 6402198 MANAGEMENT FEES TO PARENT 1917593 796506 1121087 REPAIRS AND MAINTENANCE 1274550 1217812 56738 DUES & SUBSCRIPTIONS 436734 282727 154007 292838 186464 106374 63022956 53897706 9125250 0 X 2714701 2743843 9843893 10613039 294918 1317625 1395340 253685 362613 102509330 59410833 47123055 43098497 35086412 41338335 191861 579100 96531232 100425685 6101019 5276338 20708048 20524914 11444714 10793199 38253781 36594451 X 58203041 63802843 74410 28391 58277451 63831234 96531232 100425685 X 4776400 913591 -136208 X X false true X true false X false false false false false true 3298 false false false 3298 false SCHEDULE C, PART II-B, LINE 1 NCH HAD LOBBYING EXPENSES OF 3,298 WHICH REPRESENTS THE PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION ATTRIBUTABLE TO DIRECT LOBBYING. 2111034 2111034 51065770 22711046 28354724 282116 215858 66258 47757695 35965452 11792243 1292715 518477 774238 43098497 PENSION & POST-RETIREMENT BENEFITS 8786183 DUE TO AFFILIATES 1264196 PROFESSIONAL LIABILITIES RESERVE 713478 DUE TO THIRD PARTY PAYERS 29342 10793199 X SCHEDULE D, PAGE 3, PART X LINE 2: NORTON COMMUNITY HOSPITAL IS INCLUDED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF BALLAD HEALTH. THE FOOTNOTE EXPLANATION RELATIVE TO INCOME TAXES READS: "BALLAD IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR FEDERAL INCOME TAXES 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." true true X true X 2.250000000000 true X 4.500000000000 true true false false 346126 346126 0.00550 13136823 8338148 4798675 0.07610 13482949 8338148 5144801 0.08160 156735 156735 0.00250 3220747 1610139 1610608 0.02560 2136117 915311 1220806 0.01940 14253 14253 0.00020 5527852 2525450 3002402 0.04760 19010801 10863598 8147203 0.12930 true 8076044 3068897 17819016 15426360 2392656 X true true 1 1 NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON VA 24273 BALLADHEALTH.ORG/LOCATIONSHOSPITALS H 1879 X X X X NORTON COMMUNITY HOSPITAL 1 false false true X X X X X X X X X X 18 true true false true X BALLADHEALTH.ORG/LOCATIONSHOSPITALS X true 19 false true false true X 225.000000000000 450.000000000000 X X X true true X X X X true X BALLADHEALTH.ORG X BALLADHEALTH.ORG X BALLADHEALTH.ORG X X X X X X true X false X X X true X false false FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 3E DURING FY18, NCH WAS OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES ESTABLISHED FOR THEIR CHNA WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS, INCLUDING NCH, CONDUCTED THEIR THIRD CHNA THIS TAX PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, 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 CHNAS 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 WISE COUNTY'S CHNA COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO SCREENINGS. THE NORTON 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 NORTON COUNTY REPRESENTATIVES IDENTIFIED THE TOP FOCUS AREAS. FOUR KEY PRIORITIES WERE IDENTIFIED: -SMOKING -SUBSTANCE ABUSE -MENTAL HEALTH -OBESITY FACILITY 1, NORTON 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 NCH'S COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. THE NCH FOCUS GROUP MEMBERS WERE REPRESENTED BY NORTON COMMUNITY INTERNAL MEDICINE RESIDENCY PROGRAM, MOUNTAIN EMPIRE OLDER CITIZENS, HEALTHY APPALACHIA INSTITUTE, CITY OF NORTON, NORTON COMMUNITY PHYSICIANS, NORTON HOSPITAL FOUNDATION BOARD AND NORTON COMMUNITY BOARD OF DIRECTORS. MEDICALLY UNDERSERVED POPULATIONS WERE REPRESENTED BY HEALTH APPALACHIA INSTITUTE. 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 WISE 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, NORTON COMMUNITY HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. NCH'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, NORTON COMMUNITY HOSPITAL - PART V, LINE 11 DURING THE YEAR, NCH CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. NCH'S PRIMARY AREAS OF FOCUS INCLUDED: OBESITY, DIABETES, CANCER, AND SUBSTANCE ABUSE. 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. SOME OF NCH'S ACTIVITIES DURING FY18: OBESITY/PHYSICAL ACTIVITY: AN OUTSTANDING KID'S FITNESS PROGRAM IN OUR REGION FOR THE PAST THREE YEARS IS THE MORNING MILE PROGRAM. THE MORNING MILE IS A BEFORE SCHOOL WALK/RUN THAT STARTED IN 2015 WITH FEWER THAN 5 SCHOOLS PARTICIPATING. CURRENTLY THERE ARE OVER 15 SCHOOLS PARTICIPATING IN THE MORNING MILE PROGRAM IN OUR SWVA REGION. THE RESULTS ARE VERY POSITIVE, NOT ONLY FROM A PHYSICAL FITNESS STANDPOINT, BUT ALSO IN AN IMPROVED STUDENT ATTENTION SPAN IN THE CLASSROOM. DIABETES: THE HOSPITAL SCHEDULED ROTATING CLASSES FOCUSING ON PRE-DIABETES AND/OR OBESITY, IDENTIFYING AND REDUCING RISK OF DIABETES. WE OFFER MONTHLY CLASSES AND A SUPPORT GROUP FOR DIABETIC PATIENTS AND THEIR FAMILIES. WE PREPARED "SURVIVAL KITS" WHICH PROVIDE BASIC EDUCATIONAL MATERIALS FOR PEOPLE NEWLY DIAGNOSED WITH DIABETES TO BE DISTRIBUTED TO CLINICS AND PHYSICIAN OFFICES. FOUR SEPARATE SURVIVAL KITS WERE DISTRIBUTED TO PHYSICIAN OFFICES, SPECIFIC TO PRE-DIABETES, AT-RISK PATIENTS, TYPE 1 DIABETES OR TYPE 2 DIABETES. THIS ALLOWED PHYSICIANS TO HAVE APPROPRIATE EDUCATIONAL INFORMATION ON-HAND TO SHARE WITH THEIR PATIENTS. NCH CURRENTLY OFFERS NUTRITIONAL ANALYSIS FOR OFFERINGS IN OUR CAFETERIA TO AID DINERS IN MAKING HEALTHIER EATING CHOICES. THE HOSPITAL COMPILED A LIST OF MEDICAID INSURANCE PLANS AS WELL AS COMMERCIAL INSURANCE PLANS THAT COVER DIABETES SELF-MANAGEMENT EDUCATION CLASSES, WHICH WE DISTRIBUTED TO LOCAL PHYSICIAN OFFICES. THIS INFORMATION ASSISTS PHYSICIANS SO THEY KNOW WHICH THIRD-PARTY INSURERS PROVIDE COVERAGE AS THEY DISCUSS DIABETES CLASSES WITH THEIR PATIENTS. THE HOSPITAL ALSO REVIEWS THE INSURANCE COVERAGE ON AN INDIVIDUAL PATIENT BASIS TO SEE IF A PATIENT'S INSURANCE COVERS DIABETES EDUCATION SO THAT WE ARE ABLE TO COMMUNICATE COVERAGE TO PATIENTS, WHICH MAY ENCOURAGE MORE PATIENTS TO ATTEND EDUCATIONAL CLASSES BENEFICIAL TO THEIR HEALTH. CANCER: THE HOSPITAL INTRODUCED LOW-DOSE LUNG SCREENINGS THIS YEAR TO ENABLE EARLIER DETECTION OF LUNG CANCER. WE PROVIDED THE LOW-DOSE CT SCANS FREE OF CHARGE TO ALMOST 100 COMMUNITY MEMBERS. WE PARTICIPATED IN THE "EVERY WOMAN'S LIFE" PROGRAM THAT HELPS UNINSURED LOW-INCOME WOMEN GAIN ACCESS TO BREAST CANCER SCREENING SERVICES. 71 EXAMS WERE PROVIDED THROUGH THE PROGRAM THIS YEAR. WE ALSO PARTICIPATED IN THE SEE, TEST & TREAT PROGRAM. THIS PROGRAM ORGANIZES EVENTS TO SCREEN FOR CANCER AND OFFERS PARTICIPANTS HEALTH EDUCATION. THE EVENTS ARE FOR MEDICALLY UNDERSERVED COMMUNITIES; SCREENING INCLUDES MAMMOGRAMS, PELVIC AND CLINICAL BREAST EXAMS WITH SAME-DAY RESULTS ALONG WITH A CONNECTION FOR FOLLOW UP CARE. SUBSTANCE ABUSE: A DRUG TAKE BACK DAY WAS HELD ON APRIL 26,2018 ACROSS SOUTHWEST VA, WHERE RESIDENTS COULD GO TO ONE OF 9 LOCATIONS IN WISE, LEE AND SCOTT COUNTIES AND THE CITY OF NORTON FROM 9AM-1PM TO DISPOSE OF POTENTIALLY DANGEROUS, EXPIRED, UNUSED OR UNWANTED MEDICATIONS. THIS EVENT HELPS COMBAT THE ISSUES OF ABUSE, DIVERSION, AND MISUSE OF MEDICATIONS REMAINING IN HOME MEDICINE CABINETS. THERE WERE MANY LOCAL SPONSORS OF THIS HUGE EVENT. NCH MADE SURE OUR PATIENTS AND LOCAL PHYSICIAN OFFICES WERE NOTIFIED ABOUT THE EVENT. THE HOSPITAL BEGAN A NEW PROCESS THIS YEAR TO MAKE SURE PATIENTS ARE REFERRED TO HEALTHY FAMILIES OF SOUTHWEST VIRGINIA, A PROGRAM THROUGH MOUNTAIN EMPIRE OLDER CITIZENS, INC.'S SOUTHWEST VIRGINIA CHILDREN'S ADVOCACY CENTER. HEALTHY FAMILIES RECEIVE REFERRALS FROM HOSPITALS, COUNSELORS, OB/GYN PRACTICES OR SELF-REFERRAL. OUR HOSPITAL REFERS NEW MOTHERS, MANY OF WHOM HAVE RISK FACTORS SUCH AS SUBSTANCE ABUSE, BUT OTHER FACTORS AS WELL. THE NEW MOMS RECEIVE VISITS WHILE IN THE HOSPITAL FROM TRAINED VOLUNTEERS. HEALTHY FAMILIES' VISITORS PROVIDE DEVELOPMENT AND HEALTH INFORMATION, SUPPORT AND CONNECT PARENTS WITH LOCAL RESOURCES, AS NEEDED. AFTER LEAVING THE HOSPITAL, WEEKLY HOME VISITS ARE MADE TO PROVIDE TRANSPORTATION ASSISTANCE, DEVELOPMENTAL SCREENINGS FOR INFANTS, CHILDHOOD LITERACY PROGRAMS, AMONG MANY OTHER SERVICES. FAMILIES ARE FOLLOWED UNTIL THE BABY REACHES 2 YEARS OF AGE. RECENTLY, NCH BEGAN WORKING WITH A LOCAL OB/GYN PRACTICE TO ASSIST THESE FAMILIES WITH REFERRALS, TRANSPORTATION TO PHYSICIAN VISITS AND OTHER NEEDS FAMILIES MAY HAVE. NCH TEAM MEMBERS ARE NOW PARTICIPATING IN NEONATAL ABSTINENCE SYNDROME (NAS) AND MATERNAL DRUG USE COLLABORATIVES AND SUMMITS HELD IN WEST VIRGINIA AND VIRGINIA, INCLUDING A QUARTERLY NAS TASK FORCE MEETING. INFORMATION OBTAINED FROM THESE MEETINGS IS SHARED WITH HOSPITAL STAFF, OB DOCTORS AND PEDIATRICIANS. WE ARE NOW SEEING MORE COLLABORATION WITH ALL OF THE LOCAL RESOURCES AS A RESULT OF OUR INVOLVEMENT IN THE MEETINGS AND WE BELIEVE AT LEAST SOME OF THE IMPROVEMENTS IN THE CARE WE PROVIDE TO THESE MOMS AND BABIES CAN BE ATTRIBUTED TO OUR INVOLVEMENT WITH THE OUTSIDE MEETINGS AND INVOLVEMENT WITH OTHER ORGANIZATIONS THAT SHARE OUR DESIRE TO IMPROVE THE LIVES OF THESE MOMS AND THEIR BABIES. WISE COUNTY HEALTH DEPARTMENT RECEIVED A GRANT FOR A NEW NAS OUTREACH PROGRAM THAT WORKS MUCH LIKE HEALTHY FAMILIES (DESCRIBED EARLIER), BUT THIS PROGRAM IS LIMITED TO NAS PATIENTS. EVERY PATIENT WITH A HISTORY OF DRUG ABUSE RECEIVES A "PLAN OF SAFE CARE" COMPLETED ACCORDING TO VIRGINIA DEPARTMENT OF HEALTH REGULATIONS. OUR PATIENTS WHO HAVE A HISTORY OF DRUG ABUSE DURING PREGNANCY ARE REFERRED TO THE PROGRAM. CASE WORKERS MAKE A PERSONAL VISIT TO THE HOSPITAL TO COMPLETE THE PLAN OF SAFE CARE AND CASE WORKERS FOLLOW UP WITH THE FAMILIES AT HOME TO PROVIDE AN ASSORTMENT OF SERVICES UNTIL THE BABY IS 2 YEARS OLD. NCH ALSO WORKS WITH LOCAL COMMUNITY SERVICE BOARDS ON A PROJECT LINK PROGRAM TO MEET THE NEEDS OF SUBSTANCE ABUSE MOMS IN OUR COMMUNITY. ALL MOTHERS WITH A POSITIVE DRUG SCREEN OR ARE PRESCRIBED SUBUTEX/SUBOXONE ARE REFERRED TO PROJECT LINK. WE MAKE SEVERAL REFERRALS EVERY MONTH TO PROJECT LINK AS WELL AS TO THE LOCAL DEPARTMENT OF SOCIAL SERVICES (CHILD PROTECTIVE SERVICES) AND TO THE NAS OUTREACH PROGRAM THROUGH THE LOCAL HEALTH DEPARTMENTS. NCH, 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. THE HOSPITAL CONTINUED ITS PRACTICE OF PROVIDING MEDICATIONS AND SUPPLIES TO AREA RESCUE SQUADS THIS YEAR. FACILITY 1, NORTON 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. 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 BENEFITS, THOSE WHO QUALIFIED FOR MEDICAID 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 FINANCIAL ASSISTANCE 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 THEY CAN 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 (CHARITY CARE) COST. OUR COST ACCOUNTING SYSTEM WAS USED TO DETERMINE LOSSES FROM MEDICAID/TENNCARE REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH AND OUR PHYSICIAN CLINIC. WE USED COST TO CHARGE RATIOS FOR THEM BECAUSE THEIR DATA IS 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 STUDENT INTERNSHIPS (PRIMARILY MEDICAL RESIDENTS, NURSING, PHARMACY, EMT, RESPIRATORY THERAPY, PHYSICAL/OCCUPATIONAL THERAPY, AND STUDENTS FROM OTHER ALLIED HEALTH PROGRAMS) WITH LOCAL SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO RECEIVE HANDS-ON TRAINING IN A HOSPITAL SETTING. NCH'S FILED MEDICARE COST REPORT IS THE SOURCE FOR COST AND REIMBURSEMENT REPORTED ON LINE 7F FOR OUR MEDICARE-APPROVED MEDICAL RESIDENT PROGRAM. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT (OD) MAINTAINS RECORDS FOR THE NON- MEDICARE PROGRAMS. OD KEEPS RECORDS OF THE NUMBER OF STUDENTS RECEIVING TRAINING AT OUR HOSPITALS AND THE AMOUNT OF HOURS THE STUDENTS SPEND AT OUR HOSPITALS. HOURS MAY DIFFER BASED ON THE SCHOOL AND THE TYPE OF PROGRAM (RN, RADIOLOGY, LAB, ETC.). THE NUMBER OF TEAM MEMBERS THAT PROVIDE TRAINING TO STUDENTS WILL ALSO VARY BASED ON WHERE THE STUDENT IS TRAINING. FOR EXAMPLE, AN RN TRAINER ON A MEDICAL FLOOR MAY HAVE 3 OR 4 STUDENTS UNDER HER/HIS DIRECTION, WHILE AN RN TRAINER IN A SPECIALTY AREA SUCH AS ICU OR THE ER MAY BE TRAINING ONE-ON-ONE WITH A SINGLE STUDENT. WE ONLY INCLUDE LABOR COSTS FOR OUR HOSPITAL TEAM MEMBERS THAT PROVIDE TRAINING (I.E. NO OVERHEAD IS APPLIED) AND WE ONLY ATTRIBUTE A PERCENTAGE OF OUR TEAM MEMBERS' TIME TO ACTUAL TRAINING. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USED OUR COST ACCOUNTING SYSTEM TO DETERMINE COMMUNITY BENEFIT EXPENSE. THERE IS ONE EXCEPTION WHERE WE DO NOT USE OUR COST ACCOUNTING SYSTEM. WE HAVE A PHYSICIAN CLINIC IN A RURAL, LOW INCOME AREA THAT IS SUBSIDIZED BY THE HOSPITAL. NCH OWNS AND OPERATES THE CLINIC AND SUBSIDIZES THE CLINIC'S LOSSES (436,844). WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND 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 OR SERVICES THAT ARE READILY AVAILABLE FROM OTHER FOR-PROFIT PROVIDERS IN OUR SERVICE AREA. PART II - COMMUNITY BUILDING ACTIVITIES NCH 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 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. NCH, 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 POSTED 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, NCH 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 CIRCUMSTANCES (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 MSHA'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 MSHA 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. NCH 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. NCH 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 WELLMONT HEALTH SYSTEM (ATTACHED). PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE REPORTED USING NCH'S FILED MEDICARE COST REPORTS (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. ALTHOUGH NCH DID NOT SUSTAIN A MEDICARE LOSS THIS YEAR, 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 HOSPITALS PROVIDE ASSISTANCE TO HELP UNDERINSURED AND UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND TO HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDIAID OR TENNCARE. AFTER INSURANCE BENEFIT VERIFICATION, THE 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 BALLAD HEALTH FINANCIAL ASSISTANCE POLICY, NCH 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 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 MEDIAID 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 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 THE PATIENT, IF IT IS IDENTIFIED THEY 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 NCH IS LOCATED IN NORTON, WISE COUNTY, WHICH IS IN RURAL 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, NORTON HAS A POPULATION OF APPROXIMATELY 4,043, WHILE WISE COUNTY'S POPULATION IS 39,539. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF WISE COUNTY IS 40.3 WHICH IS OLDER THAN THE MEDIAN AGE OF 38.0 IN VIRGINIA. 17.5% OF WISE COUNTY'S RESIDENTS ARE 65 OR OLDER COMPARED TO 14.6% FOR THE STATE. THE POPULATION PROJECTIONS FOR WISE COUNTY OVER THE NEXT FIVE YEARS INDICATE THAT THE COUNTY WILL LIKELY EXPERIENCE LITTLE TO NO POPULATION GROWTH OVERALL. HOWEVER, THE AGE 65+ POPULATION FOR WISE COUNTY IS PROJECTED TO EXPERIENCE THE MOST POPULATION CHANGE OVER THE NEXT FIVE YEARS, AS IT MOVES FROM 17.5% OF THE TOTAL POPULATION IN 2018 TO 19.9% 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 WISE COUNTY MEDIAN HOUSEHOLD INCOME AT 38,255 COMPARED TO THE STATE OF VIRGINIA'S MEDIAN INCOME OF 68,766. NORTON CITY'S MEDIAN INCOME IS 26,971, 155% BELOW THE STATE MEDIAN. 29% OF WISE COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 14% STATEWIDE. WISE COUNTY IS ALMOST 57% RURAL COMPARED WITH THE STATEWIDE RURAL RATE OF 24.5%. THIS 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 40% HIGHER THAN THE STATEWIDE RATE. WISE COUNTY'S PREMATURE (AGE ADJUSTED) MORTALITY IS 87.5% HIGHER THAN THE STATE RATE. AND, WHILE OUR AREA HAS GENERALLY UNFAVORABLE HEALTH STATISTICS, THERE ARE FAR FEWER PRIMARY CARE PHYSICIANS PER RESIDENT IN OUR COUNTY THAN THE STATE'S AVERAGE. OUR COUNTY'S RATIO OF POPULATION TO PRIMARY CARE PHYSICIANS IS 1,990:1 COMPARED TO THE STATE'S AVERAGE OF 1,320:1. IN OTHER WORDS, WE HAVE 51% MORE RESIDENTS PER PHYSICIAN THAN THE OVERALL STATE RATE AND 93% 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, 31% OF THE ADULTS IN NCH'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 31% IS ALMOST 41% HIGHER THAN THE STATEWIDE RATE. WISE COUNTY'S ADULT SMOKING RATE IS 40% HIGHER THAN THAT OF VIRGINIA'S AVERAGE. OTHER DEMOGRAPHIC FACTORS INFLUENCING HEALTH STATUS IN THE COUNTY ALSO INCLUDE EDUCATION LEVELS. THE MAJORITY OF WISE COUNTY RESIDENTS HOLD A HIGH SCHOOL DIPLOMA, AT 31.7%. HIGHER EDUCATION DROPS SIGNIFICANTLY WITH ONLY 13.5% HOLDING A BACHELOR'S DEGREE OR HIGHER. ACCORDING TO THE 2018 COUNTY HEALTH RANKINGS, WISE COUNTY IS RANKED 124TH OUT OF 133 COUNTIES IN VIRGINIA FOR HEALTH OUTCOMES AND 114TH IN HEALTH BEHAVIORS. WHEN COMPARED TO OTHER VIRGINIA COUNTIES, WISE 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, WISE COUNTY RANKS 126TH DUE TO LOWER RATES OF HIGH SCHOOL EDUCATION, HIGH RATES OF CHILDREN IN POVERTY AND HIGHER UNEMPLOYMENT RATES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH NCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. NCH'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. NCH HAS A MEDICARE-APPROVED INTERNAL MEDICINE RESIDENCY EDUCATION PROGRAM. IN ADDITION, OUR HOSPITAL SERVES AS A TRAINING SITE FOR MANY OTHER TYPES OF HEALTH PROFESSIONS SUCH AS NURSING, PHARMACY, RESPIRATORY THERAPY, AND OTHER ALLIED HEALTH PROGRAMS. WE PROVIDE FOR MEDIA COVERAGE TO EDUCATE OUR COMMUNITY ON HEALTH ISSUES, PROVIDE FREE CLINICAL CARE TO LOW INCOME INDIVIDUALS IN COLLABORATION WITH OTHER NONPROFIT ORGANIZATIONS, AND PROVIDE FREE DRUGS AND SUPPLIES TO LOCAL NONPROFIT EMERGENCY RESPONSE ORGANIZATIONS. NCH OWNS DICKENSON COUNTY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN THE APPALACHIAN MOUNTAINS. DICKENSON IS 100% RURAL ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S 2018 COUNTY HEALTH RANKINGS REPORT. DICKENSON COUNTY'S MEDIAN HOUSEHOLD INCOME IS JUST UNDER 51% OF THE MEDIAN STATEWIDE INCOME AND THE COUNTY'S HEALTH OUTCOMES RANK 125 OUT OF 133 IN THE STATE. DCH OPERATES AT A SUBSTANTIAL FINANCIAL LOSS AND RELIES ON NCH TO SUBSIDIZE ITS OPERATIONS. NCH'S CAPITAL CONTRIBUTION TO DCH WAS ALMOST 833,000. THE MAJORITY OF NCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREAS. SOME OF OUR BOARD MEMBERS ARE NOT CONSIDERED INDEPENDENT, PER IRS FORM 990 INSTRUCTIONS. FOUR WERE EMPLOYED BY NCH'S MAJORITY OWNER, MOUNTAIN STATES HEALTH ALLIANCE. TWO MEMBERS LACK INDEPENDENCE BECAUSE THEY RECEIVED 1099 REPORTABLE COMPENSATION EXCEEDING 10,000 FOR HEALTH INSURANCE PAID BY NCH. TWO MEMBERS ARE NOT CONSIDERED INDEPENDENT BECAUSE THEY HAD A FAMILY MEMBER EMPLOYED BY NCH DURING THE YEAR (IN A NON-MANAGERIAL POSITION). ONE BOARD MEMBER IS NOT INDEPENDENT BECAUSE HE WAS EMPLOYED BY NCH AS A PHYSICIAN. ANOTHER BOARD MEMBER WAS NOT INDEPENDENT BECAUSE HE WAS EMPLOYED BY NCH AS A PHYSICIAN AND ALSO HAD A FAMILY MEMBER EMPLOYED BY NCH (IN A NON-MANAGERIAL POSITION). PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY NCH PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM NCH IS A 129-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 14-MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. NCH 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 NCH'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. 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 VIRGINIA AND TENNESSEE. 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. true UNIV OF VA AT WISE ALUMNI ASSOC 1 COLLEGE AVENUE WISE VA 24293 237039917 501C3 6000 SPONSOR ALUMNI ASSOC UNIV OF VA AT WISE FOUNDATION 1 COLLEGE AVENUE WISE VA 24293 541638774 501C3 25000 ATHLETIC PROGRAMS NORTON RESCUE SQUAD INC 1710 MAIN AVENUE SW NORTON VA 24273 521358372 501C3 5000 1276 EMS SUPPLIES 3 SCHEDULE I, PAGE 1, PART I, LINE 2 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 BALLAD'S HOSPITALS REQUIRE 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 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 AND 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 ACCOMPLISHMENTS -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 false true false false false false false false false MARVIN EICHORN MSHA EVPCOO DIRECTOR 576652 128590 43977 18900 23842 791961 MATHEW CUSANO MD PHYSICIAN & DIRECTOR 282721 93223 33862 8891 22092 440789 SHANE HILTON SVP MARKET OPER DIRECTOR 328389 63529 4174 35389 23198 454679 MONTY MCLAURIN VPCEO NW MKT VICE CHAIR & VP 301780 36465 48537 31532 23172 441486 15920 JAMES MATT WILSON MD PHYSICIAN & DIRECTOR 222254 28637 872 6374 17461 275598 TOM TULL MSHA VP DIRECTOR 169186 31777 11000 13998 11218 237179 MARK LEONARD NCH/DCH CEO 256905 37607 13825 28138 21114 357589 STEPHEN SAWYER AVP CFO NW MKT AVP/CFO NW MARKET 177000 17273 8875 9343 22434 234925 ROBERT MITCH KENNEDY CNO NCH CNO 134514 11039 5666 4202 18687 174108 VISHAL RAJ MD PHYSICIAN 508272 20000 18193 15122 15459 577046 ELLIE TONY NADER MD PHYSICIAN 420257 20000 799 9598 450654 DARYL PIERCE MD PHYSICIAN 409967 5082 12546 21546 449141 MICHAEL GREEN MD PHYSICIAN 388521 7170 8057 1218 404966 RUBYE WASHINGTON-MOORE MD PHYSICIAN 301421 7500 21668 8337 22866 361792 SCHEDULE J, PAGE 1, PART I, LINE 4 SHANE HILTON, SVP MARKET OPER. 0 17,507 0 MONTY MCLAURIN, VP/CEO NW MKT. 0 16,160 0 MARK LEONARD 0 13,619 0 SCHEDULE J, PART III PART I, LINE 4B MONTY MCLAURIN, SHANE HILTON, AND MARK LEONARD 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. JAMIE FLEMING FAMILY MEMBER 33557 SEE PART V false DEBBIE WARD FAMILY MEMBER 70353 SEE PART V false JESSICA WILSON FAMILY MEMBER 11864 SEE PART V false SCHEDULE L, PART V (D1) JAMES MANICURE, NORTON COMMUNITY HOSPITAL (NCH) BOARD MEMBER, IS A FAMILY MEMBER OF JAMIE FLEMING, AN EMPLOYEE OF NCH. (D2) ERNIE WARD, NORTON COMMUNITY HOSPITAL (NCH) BOARD MEMBER, IS A FAMILY MEMBER OF DEBBIE WARD, AN EMPLOYEE OF NCH. (D3) JAMES WILSON, NORTON COMMUNITY HOSPITAL (NCH) BOARD MEMBER, IS A FAMILY MEMBER OF JESSICA WILSON, AN EMPLOYEE OF NCH. FORM 990, PAGE 2, PART III, LINE 4A (CONT'D) 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. NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED JUST OVER 12,000 BLACK LUNG PROCEDURES THIS YEAR. MSHA'S GRANTS AND AWARDS DEPARTMENT WORKS THROUGHOUT THE YEAR WRITING GRANT APPLICATIONS FOR PROGRAMS TO BENEFIT COMMUNITIES THROUGHOUT MSHA'S LARGE SERVICE AREA. EXAMPLES OF THIS REPORTING PERIOD INCLUDED: A GRANT RENEWAL TO PAY THE SALARY AND BENEFITS FOR A MEDICATION ASSISTANCE CASEWORKER TO EXPAND OUR MEDICATION ASSISTANCE PROGRAM TO NORTON COMMUNITY HOSPITAL, SERVING WISE, DICKENSON, AND RUSSELL COUNTIES. HAVING THIS PROGRAM IN SOUTHWEST VIRGINIA ENABLES US AS A HEALTH SYSTEM TO COME FULL CIRCLE BY SERVING PATIENTS GOING FROM HOSPITAL DISCHARGE TO DOCTORS' OFFICES AND VICE-VERSA. THIS PROGRAM HELPS US TO BETTER SERVE OUR UNINSURED AND UNDERINSURED PATIENTS AND PLAYS A SIGNIFICANT ROLE IN IMPROVING PATIENTS' HEALTH, REDUCING HOSPITAL READMISSIONS, AND ASSISTING DOCTORS IN PROVIDING PROPER TREATMENT TO THIS PATIENT GROUP WHO TRADITIONALLY CAN BE NON-COMPLIANT WITH MEDICATIONS DUE TO PRESCRIPTIONS BEING COST-PROHIBITIVE. NCH OFFERS A FREE SUPPORT GROUP, "THE BETTER BREATHERS CLUB", FOR PEOPLE WITH COPD, ASTHMA, CHRONIC BRONCHITIS, LUNG CANCER AND OTHER PULMONARY DISEASES. THE CLUB MEETS MONTHLY WHERE MEMBERS CAN RECEIVE VALUABLE INFORMATION AND DEVELOP SKILLS TO HELP BETTER MANAGE BREATHING DIFFICULTIES AND IMPROVE THEIR QUALITY OF LIFE. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 113,737 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. IN ADDITION, MSHA CORPORATE ALLOCATES A PORTION OF ITS PHYSICIAN RECRUITMENT DEPARTMENTAL EXPENSES SINCE THAT DEPARTMENT SERVICES ALL MSHA DIVISIONS, INCLUDING NCH. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S, ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. NCH RECRUITMENT EXPENSE DURING FY18 INCLUDED PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. A PORTION OF OUR RECRUITMENT IS PHYSICIAN DEBT FORGIVEN BY THE HOSPITAL OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY AND CONTINUES PROVIDING MEDICAL SERVICES TO OUR RESIDENTS. AS WE NOTED ON NCH'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 NORTON 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, WHILE NAVIGATORS WORKED WITH 70 ADDITIONAL PATIENTS DURING THIS PILOT. MSHA'S PARENT COMPANY, BALLAD HEALTH, EMBARKED ON A CAMPAIGN NEAR THE END OF THIS FISCAL YEAR TO REDUCE HOSPITAL-ACQUIRED C. DIFF BY 30% IN 90 DAYS. THIS IS A BOLD UNDERTAKING BY BALLAD HEALTH'S NEW CLINICAL COUNCIL AND OUR INFECTION PREVENTION DEPARTMENT. C. DIFF IS A SIGNIFICANT THREAT TO HOSPITAL PATIENTS EVERYWHERE. IT'S OUR DUTY AS CAREGIVERS TO PROTECT OUR PATIENTS FROM HARM ALL OF THE TIME, SO PREVENTING C. DIFF IS VITAL. OUR PLAN INVOLVES SOME BASIC STEPS OUR CLINICAL TEAM MEMBERS SHOULD ALWAYS TAKE TO AVOID THIS INFECTION. THE PLAN REQUIRES ALL TEAM MEMBERS TO BE MINDFUL OF HOW THEY TREAT C. DIFF., WITH TEAM MEMBERS INVOLVED IN THE TREATMENT PROCESS RECEIVING SPECIFIC INFORMATION APPROPRIATE FOR THEIR ROLE. IN ADDITION, A VIDEO IS AVAILABLE ON OUR INTRANET SITE THAT ILLUSTRATES SOME OF THE KEY TAKEAWAYS. OUR ULTIMATE GOAL IS ZERO HOSPITAL-ACQUIRED C. DIFF INFECTIONS. FOLLOWING MSHA AND WHS'S MERGER THIS YEAR, TEAM MEMBERS TRANSITIONED TO STANDARD SCRUB COLORS, WHICH MEANT TEAM MEMBERS' SCRUBS THROUGHOUT OUR MANY HOSPITALS AND CLINICS, INCLUDING NCH, HAD TO BE REPLACED. A TEAM MEMBER FROM FRANKLIN WOODS COMMUNITY HOSPITAL RECOGNIZED AN OPPORTUNITY TO HELP OTHERS BY ORGANIZING A "SAVE OUR SCRUBS" PROGRAM TO COLLECT USED SCRUBS FOR DONATION TO A GLOBAL CHARITY. THE CHARITY IS A MEDICAL RELIEF ORGANIZATION THAT COLLECTS USED SCRUBS AND DONATES THEM TO HEALTHCARE WORKERS IN RESOURCE-POOR AREAS, INCLUDING COUNTRIES SUCH AS NICARAGUA, GUATEMALA, HAITI AND GUYANA, WHERE HOSPITALS OFTEN HAVE A SHORTAGE OF UNIFORMS. PROVIDING SCRUBS TO THESE HOSPITALS ALLOWS OTHER CRITICAL MEDICAL NEEDS, SUCH AS MEDICINES AND SURGICAL SUPPLIES, TO BE MORE EASILY FUNDED. IN ADDITION TO GENTLY USED SCRUBS, OUR TEAM MEMBERS DONATED JACKETS, LAB COATS, HEALTHCARE SHOES, AND OTHER MEDICAL APPAREL. THE PROGRAM WAS A GREAT SUCCESS ACROSS OUR BALLAD HEALTH SYSTEM: OUR TEAM MEMBERS DONATED MORE TH FORM 990, PAGE 6, PART VI, LINE 6 NORTON COMMUNITY HOSPITAL, INC. IS ORGANIZED AS A VIRGINIA NON-STOCK, NONPROFIT CORPORATION. MOUNTAIN STATES HEALTH ALLIANCE IS THE 50.1% MEMBER OF NCH, WHILE COMMUNITY HEALTHCARE FOUNDATION, INC. IS THE 49.9% MEMBER. 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 CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE NORTON COMMUNITY HOSPITAL CLASS IS ELECTED BY THE COMMUNITY HEALTHCARE 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 THE RETURN WITH THE IRS. 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 NORTON 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 COMMITTEE IS RESPONSIBLE FOR DISCLOSING CONFLICTS OF INTEREST, IT IS ALSO THE RESPONSIBILITY OF ANY BOARD MEMBER AWARE OF A CONFLICT WHICH HAS NOT BEEN DISCLOSED TO ENSURE THE BOARD IS MADE AWARE. THE PRESIDING OFFICER OF A BOARD OR BOARD COMMITTEE MEETING MAY ASK A CONFLICTED MEMBER TO EXCUSE THEMSELVES FROM THE MEETING DURING THE DISCUSSION RELATED TO THE ISSUE WITH WHICH THE CONFLICT OF INTEREST APPLIES. UNDER NO CIRCUMSTANCES SHALL A MEMBER VOTE ON A MATTER THAT GIVES RISE TO A POTENTIAL CONFLICT. FORM 990, 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 NCH/DCH'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 NCH/DCH'S CEO, NCH'S CFO RECEIVES COMPENSATION THAT COMPLIES WITH BALLAD HEALTH'S SALARY POLICY AND UNDERGOES THE SAME REVIEW AND APPROVAL PROCESS BY BALLAD HEALTH'S BOARD OF DIRECTORS AS THE CEO, AS DESCRIBED IN 15A. TWO PHYSICIANS SERVE ON NCH'S BOARD. THEIR COMPENSATION RELATES TO MEDICAL SERVICES PROVIDED TO NCH. 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, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY. FORM 990, PART VII- RELATED ORGANIZATIONS DIRECTOR COMPENSATION: NORTON COMMUNITY HOSPITAL'S BOARD OF DIRECTORS, MARVIN EICHORN, SHANE HILTON, MONTY MCLAURIN, AND TOM TULL RECEIVE COMPENSATION FOR SERVICES PROVIDED TO RELATED ORGANIZATIONS AND DO NOT RECEIVE COMPENSATION FOR SERVICES AS A NCH BOARD MEMBER. FORM 990, PART X - ADDITIONAL INFORMATION 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, NCH'S MAJORITY OWNER, ON BEHALF OF NCH FOR CAPITAL NEEDS. NCH PAYS ALL COSTS RELATED TO THIS PORTION OF THE BOND ISSUE. FORM 990, PART IX, LINE 11G HOSPITAL SUPPORTED CLINICS 1,013,202 0 0 HOSPITAL BASED PROVIDERS 1,303,849 0 0 PHYSICIAN FEES 2,410,880 0 0 CONTRACT LABOR 70,515 29,142 0 COLLECTION FEES 0 423,662 0 LAUNDRY & HOUSEKEEPING SVCS. 359,840 0 0 CONSULTING FEES 0 214,825 0 FACILITIES & CONSTRUCTION MGM 0 99,018 0 TRANSCRIPTION SVCS. 0 59,426 0 VARIOUS FEES 128,261 281,745 0 TOTAL 5,286,547 1,107,818 0 FORM 990, PART XI, LINE 9 PENSION PLAN ADJUSTMENT 760,822 CHANGE IN TEMP. RESTRICTED ASSETS -46,019 ELIMINATION OF INTERCOMPANY REC/PAY -832,469 EMPLOYER PROVIDED PARKING-NOT ON BOOKS -18,542 TOTAL -136,208 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 VIRGINIA AND TENNESSEE 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. 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