TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) BARTON HOVE RETIRED 1312018...................................................................... BOARD MEMBER	0.10 ................. 31.90	X	X	1,219,926	49,559
(2) TED FIELDS...................................................................... CHAIRMAN	1.00 .................	X	X	0	0
(3) NORRIS SNEED...................................................................... VICE-CHAIR	1.00 .................	X	X	0	0
(4) DAVID WAGNER...................................................................... IMMEDIATE PA	1.00 .................	X	X	0	0
(5) GARY POE...................................................................... TREASURER	1.00 .................	X	X	0	0
(6) MICHAEL BERRY...................................................................... SECRETARY	1.00 .................	X	X	0	0
(7) VANN AVIRETT...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(8) TERRY BEGLEY...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(9) ROBERT BLEVINS JR...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(10) KAY BUNN...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(11) WILLIAM BURRISS III...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(12) JERRY CALDWELL...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(13) SCOTT COEN MD...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(14) MARY MARGARET DENTON...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(15) STEVE HARVILLE...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(16) LAURENCE LAGUARDIA...................................................................... BOARD MEMBER	0.50 .................	X		0	0
(17) DAVID OAKLEY JR...................................................................... BOARD MEMBER	0.50 .................	X		0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) EMILY O'QUINN........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(19) JESSICA PARROTT........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(20) KRISTEN REEDY........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(21) ED ROOP END 11282017........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(22) DARLA SCOTT........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(23) MARY SHRADER........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(24) LADONNA STREET........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(25) JON TUNNELL........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(26) HARRISON TURNER MD........................................................................ BOARD MEMB/P	0.50 .......................	X		0	0	0
(27) JOHN WILLIAMS........................................................................ BOARD MEMBER	0.50 .......................	X		0	0	0
(28) TODD DOUGAN END 4302018........................................................................ EVP/CFO-WHS	0.10 .......................44.90		X	0	488,418	36,727
(29) TODD NORRIS........................................................................ PRESIDENT	40.00 .......................10.00		X	296,547	74,137	26,897

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	3,002,320	2,079,675	5,614,415	5,775,347	2,920,331	19,392,088
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3	3,002,320	2,079,675	5,614,415	5,775,347	2,920,331	19,392,088
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.						19,392,088

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..	3,002,320	2,079,675	5,614,415	5,775,347	2,920,331	19,392,088
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	682,604	804,730	746,523	569,330	750,532	3,553,719
9	Net income from unrelated business activities, whether or not the business is regularly carried on..		2,550	4,350	2,700	5,950	15,550
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..	777	19,470		797		21,044
11	Total support. Add lines 7 through 10						22,982,401

Gross receipts from related activities, etc. (see instructions) ..................

7,714

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

84.380 %

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

62.790 %

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
PART II, LINE 10	MISCELLANEOUS OTHER INCOME 21,044

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization WELLMONT FOUNDATION INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization WELLMONT FOUNDATION INC		Employer identification number 58-1594191

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization WELLMONT FOUNDATION INC			Employer identification number 58-1594191
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	1,320,023	1,320,884	1,322,831	1,319,254	1,311,437
b	Contributions ...
c	Net investment earnings, gains, and losses	-11,586	-861	-1,947	3,577	7,817
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	1,308,437	1,320,023	1,320,884	1,322,831	1,319,254

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	4,780		4,780
b	Buildings ....
c	Leasehold improvements	1,145	955	190
d	Equipment ....	94,429	86,665	7,764
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				12,734

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,086,621
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

SCHEDULE D, PAGE 3, PART X

WELLMONT FOUNDATION, INC. 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."

SCHEDULE D, PAGE 4, PART XIII

THE ENDOWMENT FUNDS HELD BY WELLMONT FOUNDATION, INC. HAVE BEEN RESTRICTED BY THE DONORS. BASED ON THE CURRENT RESTRICTIONS, THE FUNDS ARE TO BE USED FOR "ANY PROJECT IN THE FIGHT AGAINST CANCER", HOSPICE AND VARIOUS WELLMONT MADISON HOUSE PROGRAMS.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)		(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
			Yes	No
	CHILDRENS MIRACLE NETWORK 205 WEST 700 SOUTH SALT LAKE CITY, UT84101	EVENT		No	64,784	-64,784
	WINE WOMEN & SHOES 440 CRYSTAL SPRINGS ROAD SAINT HELENA, CA945749666	EVENT		No	21,500	-21,500








Total . . . . . . . . . . . . . . . . . . . .					86,284	-86,284

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

TN, VA

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 CHILDRENS MIRAC (event type)	(b) Event #2 WINE WOMEN & SH (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	587,668	150,185	86,080	823,933
2	Less: Contributions . . . .	537,337	137,871	78,366	753,574
3	Gross income (line 1 minus line 2) . . . . . .	50,331	12,314	7,714	70,359

4	Cash prizes . . . . .
5	Noncash prizes . . . .	22,362	9,439	660	32,461
6	Rent/facility costs . . . .	23,182	3,385	1,798	28,365
7	Food and beverages . . .	35,588	9,080	1,345	46,013
8	Entertainment . . . .		2,442	1,514	3,956
9	Other direct expenses . . .	41,711	4,566	150	46,427
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				157,222
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				-86,863

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation
SCHEDULE G, PAGE 1, PART I, LINE 2B, COLUMN (V)	CHILDRENS MIRACLE NETWORK MEMBERSHIP AGREEMENT WINE, WOMEN & SHOES EVENT CONSULTING FEES 21,500

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
WELLMONT FOUNDATION INC

Employer identification number
58-1594191

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) WELLMONT HEALTH SYSTEM 1905 AMERICAN WAY KINGSPORT,TN37660	62-1636465	501C3	23,290	EDUCATION
(2) WELLMONT HEALTH SYSTEM 1905 AMERICAN WAY KINGSPORT,TN37660	62-1636465	501C3	1,118,846	EQUIPMENT
(3) WELLMONT HEALTH SYSTEM 1905 AMERICAN WAY KINGSPORT,TN37660	62-1636465	501C3	2,264,488	GENERAL SUPPORT
(4) PROJECT FIT AMERICA PO BOX 308 BOYS HOT SPRINGS,CA95416	36-3730823	501C3	15,390	FITNESS EQUIPMENT
(5) WELLMONT HAWKINS CO MEM HOSPITAL 1905 AMERICAN WAY KINGSPORT,TN37660	62-1816368	501C3	31,048	GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) PATIENT FINANCIAL ASSIST	4392	184,831
(2) MAMMOGRAM SCREENINGS	331	51,007
(3) HEALTHCARE SCHOLARSHIPS	24	22,816
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

SCHEDULE I, PAGE 1, PART I, LINE 2

WELLMONT FOUNDATION (FOUNDATION) WAS ORGANIZED FOR THE BENEFIT OF WELLMONT HEALTH SYSTEM (WHS). WHS REQUESTS FUNDING THROUGHOUT THE YEAR FROM THE FOUNDATION FOR VARIOUS PROGRAMS AND COMMUNITY BENEFIT ACTIVITIES. SOME OF THE ACTIVITIES FUNDED BY THE FOUNDATION DURING FY18 INCLUDE: - EQUIPMENT AND GENERAL SUPPORT TO WHS - GENERAL SUPPORT TO A RELATED HOSPITAL - SCHOLARSHIPS FOR LOCAL STUDENTS ENROLLED IN HEALTHCARE PROFESSIONS - FREE MAMMOGRAM SCREENINGS FOR SOME LOW-INCOME PATIENTS - FINANCIAL ASSISTANCE TO LOW-INCOME PATIENTS

Schedule I (Form 990) 2019

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1BARTON HOVE RETIRED 1312018 BOARD MEMBER/WHS CEO	(i) (ii)	------------- 817,290	------------- 391,085	------------- 11,551	------------- 27,695	------------- 21,864	------------- 1,269,485	-------------
2TODD DOUGAN END 4302018 EVP/CFO-WHS	(i) (ii)	------------- 344,429	------------- 143,894	------------- 95	------------- 15,519	------------- 21,208	------------- 525,145	-------------
3TODD NORRIS PRESIDENT	(i) (ii)	202,654 ------------- 50,664	93,486 ------------- 23,371	407 ------------- 102	9,442 ------------- 2,360	12,076 ------------- 3,019	318,065 ------------- 79,516	-------------

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2019

Additional Data

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Software Version:

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...	X	5	865,166	FMV
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PAGE 1, PART I, LINE 32B	WELLMONT FOUNDATION, INC. UTILIZES CHARLES SCHWAB TO ASSIST WITH THE SALE OF DONATED STOCK.
SCHEDULE M, PAGE 2, PART II	PROFESSIONAL PARK CONDOMINIUMS, A CONDOMINIUM REGIME ESTABLISHED BY PROFESSIONAL PARK ASSOCIATES, LLC, IS MADE UP OF SEVERAL MEMBERS, ALL OF WHOM OWN A PERCENTAGE OF UNIT 108. FIVE (5) MEMBERS' SHARES WERE DONATED TO WELLMONT FOUNDATION, INC. ON DECEMBER 13, 2017. THE PROPERTY VALUE WAS DETERMINED BY A LICENSED AND CERTIFIED REAL ESTATE APPRAISER.

Schedule M (Form 990) (2019)

Additional Data

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Return Reference	Explanation
FORM 990, PAGE 1, PART I, LINE 6	WELLMONT FOUNDATION, INC.'S 120 VOLUNTEERS WORKED APPROXIMATELY 804 HOURS FOR THE YEAR ENDED JUNE 30, 2018.
FORM 990, PAGE 2, PART III, LINE 4A	THE FISCAL YEAR ENDED WITH 6.3 MILLION IN CONTRIBUTIONS FROM 3,632 COMMUNITY PARTNERS AND FOUNDATION ASSOCIATES. WE GAVE BACK 3.4 MILLION TO OUR HOSPITALS THROUGH FACILITY IMPROVEMENTS, EDUCATIONAL EFFORTS AND GRASSROOTS CAUSES. THROUGH OUR WORK WITH CHILDREN'S MIRACLE NETWORK HOSPITALS, 718,152 WAS RAISED TO PROVIDE FACILITIES IMPROVEMENTS, EQUIPMENT AND PROGRAM ENHANCEMENTS TO OUR CENTERS FOR INFANTS AND CHILDREN, NEONATAL AND PEDIATRIC INTENSIVE CARE UNITS AND EMERGENCY CARE. OUR MEDICAL FACILITY IMPROVEMENTS INCLUDE COMPLETION OF THE NICU RELOCATION/RENOVATION/EXPANSION AND RENOVATION OF THE BARBARA HUMPHREYS BIRTHING CENTER AT HOLSTON VALLEY MEDICAL CENTER, PURCHASE OF A LARGE BORE CT SCANNER, COMPLETION OF BILL GATTON CENTER FOR ADVANCE CARDIAC REHABILITATION, RENOVATION OF THE NURSERY AT TAKOMA REGIONAL HOSPITAL, INC., COMPLETION OF AN ORTHOPAEDIC SIMULATOR LAB AND VARIOUS PURCHASES FOR CANCER, CHILDREN, DIABETES AND OTHER SERVICES. GRANT FUNDING FROM CENTERS FOR MEDICARE & MEDICAID SERVICES SUPPORTED PROFESSIONALS TO ENROLL QUALIFIED CHILDREN INTO THE CHILDREN'S HEALTH INSURANCE PROGRAM AND COMPLETE A PROJECT UTILIZING CERTIFIED HEALTH INSURANCE NAVIGATORS TO HELP INDIVIDUALS AND BUSINESSES OBTAIN INSURANCE COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACE.
FORM 990, PAGE 6, PART VI, LINE 6	THE BUSINESS AND AFFAIRS OF WELLMONT FOUNDATION, INC. ARE GOVERNED EXCLUSIVELY BY THE BOARD OF GOVERNORS. THE FOUNDATION'S BOARD OF GOVERNORS IS DESIGNATED BY WELLMONT HEALTH SYSTEM, THE SOLE MEMBER OF THE CORPORATION. IN ADDITION TO SUCH RIGHTS OF APPROVAL AND CONSENT AS MAY BE RESERVED TO THE SOLE MEMBER THE FOUNDATION PURSUANT TO APPLICABLE LAW, TRANSACTIONS OF THE FOLLOWING MATTERS BY THE FOUNDATION SHALL REQUIRE THE PRIOR APPROVAL OF WELLMONT HEALTH SYSTEM: (A) IMPLEMENTATION OF FOUNDATION'S ANNUAL BUDGET, (B) INCURRING ANY LOAN OR OTHER INDEBTEDNESS FOR BORROWED MONEY, (C) ACQUISITION OF ANY EQUIPMENT OR PERSONAL PROPERTY FOR A PURCHASE PRICE IN EXCESS OF 50,000 OR THE ACQUISITION OF ANY REAL ESTATE, REGARDLESS OF PURCHASE PRICE, (D) THE UNDERTAKING OF CERTAIN CONTRACTUAL COMMITMENTS, (E) ENTERING INTO ANY PLAN OF MERGER OR CONSOLIDATION, (F) ACQUISITION OF SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER LEGAL ENTITY, AND (G) INSTITUTION OF ANY LITIGATION BY OR ON BEHALF OF THE FOUNDATION.
FORM 990, PAGE 6, PART VI, LINE 7A	WELLMONT HEALTH SYSTEM (WHS) IS WELLMONT FOUNDATION'S SOLE MEMBER. THE BOARD OF DIRECTORS OF BALLAD HEALTH, WHS'S PARENT ORGANIZATION, SERVES AS WHS'S BOARD OF DIRECTORS AND IS RESPONSIBLE FOR APPOINTING THE DIRECTORS OF THE FOUNDATION'S BOARD.
FORM 990, PAGE 6, PART VI, LINE 7B	SEE FORM 990, PART VI, SECTION A, LINE 6 FOR EXPLANATION.
FORM 990, PAGE 6, PART VI, LINE 9	BARTON HOVE (RETIRED 1/31/2018)
FORM 990, PAGE 6, PART VI, LINE 11B	THE BALLAD HEALTH FOUNDATION PRESIDENT REVIEWED THE WELLMONT FOUNDATION, INC. FORM 990 WITH ITS BOARD OF GOVERNORS PRIOR TO FILING. 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	THE FOUNDATION IS PART OF THE NEWLY FORMED BALLAD HEALTH HEALTHCARE SYSTEM FORMED WHEN WELLMONT HEALTH SYSTEM AND MOUNTAIN STATES HEALTH ALLIANCE MERGED IN FEBRUARY 2018. BALLAD HEALTH HAS A CONFLICT OF INTEREST POLICY FOR ALL MEMBERS OF THE BOARD OF DIRECTORS, THE EXECUTIVE CHAIR/PRESIDENT, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND VICE PRESIDENTS, AND APPLIES TO ALL BALLAD HEALTH ORGANIZATIONS. ALL PERSONS COVERED BY THIS POLICY ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS. SHOULD A CONFLICT ARISE, IT IS THE RESPONSIBILITY OF THE CONFLICTED INDIVIDUAL TO UPDATE HIS OR HER DISCLOSURE IMMEDIATELY. ALL MEETINGS OF THE BOARD OR BOARD COMMITTEES HAVE A STANDING AGENDA ITEM FIRST ON THE AGENDA TITLED "CONFLICTS OF INTEREST". IF A MEMBER OF THE BOARD OR BOARD COMMITTEE HAS A CONFLICT OF INTEREST INVOLVING ANY ISSUE ON THE BOARD AGENDA, HE OR SHE MUST DECLARE THE CONFLICT OF INTEREST DURING THE PERIOD ALLOTTED FOR DISCLOSURE. IF ANY ISSUE ARISES DURING A MEETING IN WHICH THE BOARD MEMBER HAS A CONFLICT OF INTEREST, HE OR SHE MUST IMMEDIATELY DECLARE THE CONFLICT. WHILE EACH MEMBER OF THE BOARD OR BOARD COMMITTEES ARE 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	COMPENSATION FOR BARTON HOVE (FOUNDATION PRESIDENT UNTIL 1/31/18), AND TODD NORRIS (ASSUMED FOUNDATION PRESIDENT ROLE 2/1/18) WAS REVIEWED AND APPROVED DURING THE TAX YEAR BY THE HUMAN RESOURCES COMMITTEE OF THE FOUNDATION'S SOLE MEMBER, WELLMONT HEALTH SYSTEM, AND SUBSEQUENTLY APPROVED BY THE BOARD OF WELLMONT'S PARENT ORGANIZATION, BALLAD HEALTH. WELLMONT MERGED WITH MOUNTAIN STATES HEALTH ALLIANCE DURING FY18 TO FORM BALLAD HEALTH. AT MERGER, BALLAD'S BOARD OF DIRECTORS ASSUMED BOARD RESPONSIBILITIES FOR BOTH WELLMONT AND MOUNTAIN STATES. DATA OF COMPARABLE POSITIONS IN SIMILARY SITUATED ORGANIZATIONS FROM AN INDEPENDENT COMPENSATION CONSULTANT WAS USED WHEN DETERMINING COMPENSATION.
FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO THE APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM.
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. FORM 990 - ADDITIONAL INFORMATION FY18 FORM 990 HAS NUMEROUS REPORTING CHANGES FROM PRIOR YEAR RETURNS. WE BELIEVE THESE CHANGES ARE NECESSARY TO BETTER REFLECT THE ORGANIZATION'S ACTIVITY.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WELLMONT FOUNDATION INC

Employer identification number

58-1594191

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)WELLMONT HEALTH SYSTEM 1905 AMERICAN WAY KINGSPORT,TN37660 62-1636465	HOSP. SYS.	TN	501C3	3	BALLAD		No
(2)WELLMONT HAWKINS CO MEMORIAL HOSP 851 LOCUST STREET ROGERSVILLE,TN37857 62-1816368	HOSPITAL	TN	501C3	3	WHS		No
(3)TAKOMA REGIONAL HOSPITAL INC 401 TAKOMA AVENUE GREENEVILLE,TN37743 51-0603966	HOSPITAL	TN	501C3	3	WHS		No
(4)TAKOMA REGIONAL HOSPITAL FDN INC 1905 AMERICAN WAY KINGSPORT,TN37660 47-1334302	FUNDRAISER	TN	501C3	7	WHS		No
(5)WELLMONT CARDIOLOGY SERVICES 1905 AMERICAN WAY KINGSPORT,TN37660 26-3557623	MED. SERV.	TN	501C3	10	WHS		No
(6)WELLMONT MEDICAL ASSOCIATES INC 1905 AMERICAN WAY KINGSPORT,TN37660 27-0898372	MED. SERV.	TN	501C3	7	WHS		No
(7)WELLMONT SLEEP SERVICES 1905 AMERICAN WAY KINGSPORT,TN37660 27-3777167	MED. SERV.	TN	501C3	3	WHS		No
(8)WELLMONT MADISON HOUSE 1905 AMERICN WAY KINGSPORT,TN37660 62-1308216	ASST. LIV.	TN	501C3	10	WHS		No
(9)WELLMONT WEXFORD HOUSE 1905 AMERICAN WAY KINGSPORT,TN37660 58-1859039	NSG. HOME	TN	501C3	10	WHS		No
(10)WELLMONT IMAGING SERVICES INC 1905 AMERICAN WAY KINGSPORT,TN37660 86-1103148	HEALTHCARE	TN	501C3	12A	WHS		No
(11)MOUNTAIN STATES HEALTH ALLIANCE 303 MED TECH PARKWAY SUITE 220 JOHNSON CITY,TN37604 62-0476282	HOSP. SYS.	TN	501C3	3	BALLAD		No
(12)MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD SUITE 101 JOHNSON CITY,TN37604 58-1418862	FUNDRAISER	TN	501C3	12A	MSHA		No
(13)MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604 58-1418345	SUPP. ORG.	TN	501C3	12A	MSHA		No
(14)SMYTH COUNTY COMMUNITY HOSPITAL 245 MEDICAL PARK DRIVE MARION,VA24354 54-0794913	HOSPITAL	VA	501C3	3	MSHA		No
(15)NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON,VA24273 54-0566029	HOSPITAL	VA	501C3	3	NA		No
(16)DICKENSON COMMUNITY HOSPITAL 312 HOSPITAL DRIVE CLINTWOOD,VA24228 77-0599553	HOSPITAL	VA	501C3	3	NCH		No
(17)JOHNSTON MEMORIAL HOSPITAL 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 54-0544705	HOSPITAL	VA	501C3	3	NA		No
(18)ABINGDON PHYSICIAN PARTNERS 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 20-5485346	MED. SERV.	VA	501C3	12A	JMH		No
(19)BALLAD HEALTH 303 MED TECH PARKWAY SUITE 220 JOHNSON CITY,TN37604 61-1771290	SUPP. ORG.	TN	501C3	12B	NA		No
(20)EAST TN HEALTHCARE HOLDINGS INC 203 GRAY COMMONS CIRCLE GRAY,TN37615 81-5475903	OPIOID TRT	TN	501C3	3	MSHA		No
(21)LAUGHLIN MEMORIAL HOSPITAL INC 1420 TUSCULUM BOULEVARD GREENEVILLE,TN37745 62-0701119	HOSPITAL	TN	501C3	3	MSHA		No
(22)LAUGHLIN HEALTHCARE FOUNDATION 1420 TUSCULUM BOULEVARD GREENEVILLE,TN37745 58-2105493	FUNDRAISER	TN	501C3	12A	MSHA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SAPLING GROVE AMB SURGERY CENTER 220 MEDICAL PARK BOULEVARD BRISTOL,TN37620 20-4450153	MED. SERV.	TN	N/A				No			No
(2) HOLSTON VALLEY AMB SURGERY CENTER 103 WEST STONE DRIVE KINGSPORT,TN37660 62-1816864	MED. SERV.	TN	N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) WELLMONT INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1320035	MED. SERV.	TN	N/A					No
(2) MCOT INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1325938	BUS. SERV.	TN	N/A					No
(3) MEDICAL MALL PHARMACY INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1565006	MED. SERV.	TN	N/A					No
(4) WELLMONT PHYSICIAN SERVICES INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1567353	MED. SERV.	TN	N/A					No
(5) WPS PROVIDERS 1905 AMERICAN WAY KINGSPORT,TN37660 20-5564642	MED. SERV.	TN	N/A					No
(6) WELLMONT HEALTH SERVICES INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1254373	MED. SERV.	TN	N/A					No
(7) WELLMONT INSURANCE CO SPC LTD 1905 AMERICAN WAY KINGSPORT,TN37660 98-1195624	INSURANCE		N/A					No
(8) BLUE RIDGE MEDICAL MANAGEMENT CORP 1905 AMERICAN WAY KINGSPORT,TN37660 62-1490616	MED. SERV.	TN	N/A					No
(9) MEDISERVE MEDICAL EQUIPMENT 1905 AMERICAN WAY KINGSPORT,TN37660 62-1212286	DME	TN	N/A					No
(10) MOUNTAIN STATES PROPERTIES 1905 AMERICAN WAY KINGSPORT,TN37660 62-1845895	PROP. MGMT	TN	N/A					No
(11) MOUNTAIN STATES PHYSICIAN GROUP 1905 AMERICAN WAY KINGSPORT,TN37660 62-1700412	MED. SERV.	TN	N/A					No
(12) COMMUNITY HOME CARE INC 1490 PARK AVENUE NW SUITE B NORTON,VA24273 54-1453810	DME	VA	N/A					No
(13) WILSON PHARMACY INC PO BOX 5289 JOHNSON CITY,TN37604 62-0329587	PHARMACY	TN	N/A					No
(14) CRESTPOINT HEALTH INSURANCE COMPANY 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-0381170	INSURANCE	TN	N/A					No
(15) INTEGRATED SOLUTIONS HEALTH NETWORK 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1711997	HLTH NTWK	TN	N/A					No
(16) NOLICHUCKEY MANAGEMENT SVCS INC 1420 TUSCULUM BOULEVARD GREENEVILLE,TN37745 62-1776681	MED. SERV.	TN	N/A					No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,775,347	2,920,331
9	Program service revenue (Part VIII, line 2g) .........		0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,431,828	969,324
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-99,474	-80,913
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	8,107,701	3,808,742
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,991,407	3,721,356
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	719,473	790,736
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	89,164	86,784
b	Total fundraising expenses (Part IX, column (D), line 25) 825,855
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	407,998	389,857
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	4,208,042	4,988,733
19	Revenue less expenses. Subtract line 18 from line 12.......	3,899,659	-1,179,991
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	31,410,145	31,333,903
21	Total liabilities (Part X, line 26).............	2,144,058	2,768,476
22	Net assets or fund balances. Subtract line 21 from line 20.....	29,266,087	28,565,427

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 3,462,702 including grants of $ 3,462,702 ) (Revenue $ 2,911,096 )
	THE MISSION OF THE WELLMONT FOUNDATION, INC. IS TO SUPPORT THE MISSION, VISION AND VALUES OF WELLMONT HEALTH SYSTEM THROUGH THE USE OF COMMUNITY INVOLVEMENT AND PHILANTHROPIC SUPPORT. FOR THE FISCAL YEAR ENDED JUNE 30, 2018, WELLMONT FOUNDATION, INC. CONTINUED ITS CORE FUNDRAISING MISSION TO FOCUS ON FUNDS THAT SUPPORT RESEARCH, EDUCATION AND INNOVATION FOR HEART CARE, CANCER CARE, CHILDREN'S HEALTH AND HOSPITAL ADVANCEMENT. THIS STRATEGIC FOCUS ALLOWS US TO WORK REGIONALLY TO COMBAT THE LEADING CAUSES OF SUFFERING AND DEATH AND SUPPORT WELLMONT HEALTH SYSTEM'S WORK TO CONTINUALLY IMPROVE THE PATIENT AND FAMILY EXPERIENCE. (CONTINUED ON SCHEDULE O) THE FISCAL YEAR ENDED WITH 6.3 MILLION IN CONTRIBUTIONS FROM 3,632 COMMUNITY PARTNERS AND FOUNDATION ASSOCIATES. WE GAVE BACK 3.4 MILLION TO OUR HOSPITALS THROUGH FACILITY IMPROVEMENTS, EDUCATIONAL EFFORTS AND GRASSROOTS CAUSES. THROUGH OUR WORK WITH CHILDREN'S MIRACLE NETWORK HOSPITALS, 718,152 WAS RAISED TO PROVIDE FACILITIES IMPROVEMENTS, EQUIPMENT AND PROGRAM ENHANCEMENTS TO OUR CENTERS FOR INFANTS AND CHILDREN, NEONATAL AND PEDIATRIC INTENSIVE CARE UNITS AND EMERGENCY CARE. OUR MEDICAL FACILITY IMPROVEMENTS INCLUDE COMPLETION OF THE NICU RELOCATION/RENOVATION/EXPANSION AND RENOVATION OF THE BARBARA HUMPHREYS BIRTHING CENTER AT HOLSTON VALLEY MEDICAL CENTER, PURCHASE OF A LARGE BORE CT SCANNER, COMPLETION OF BILL GATTON CENTER FOR ADVANCE CARDIAC REHABILITATION, RENOVATION OF THE NURSERY AT TAKOMA REGIONAL HOSPITAL, INC., COMPLETION OF AN ORTHOPAEDIC SIMULATOR LAB AND VARIOUS PURCHASES FOR CANCER, CHILDREN, DIABETES AND OTHER SERVICES. GRANT FUNDING FROM CENTERS FOR MEDICARE & MEDICAID SERVICES SUPPORTED PROFESSIONALS TO ENROLL QUALIFIED CHILDREN INTO THE CHILDREN'S HEALTH INSURANCE PROGRAM AND COMPLETE A PROJECT UTILIZING CERTIFIED HEALTH INSURANCE NAVIGATORS TO HELP INDIVIDUALS AND BUSINESSES OBTAIN INSURANCE COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACE.

4b	(Code: ) (Expenses $ 258,654 including grants of $ 258,654 ) (Revenue $ )
	WE PROVIDED SCHOLARSHIPS FOR NURSING STUDENTS AND HELPED NUMEROUS CO- WORKERS CONTINUE THEIR EDUCATION THROUGH VARIOUS CONFERENCES HELD TO SOLIDIFY THEIR UNDERSTANDING OF THE MOST UP-TO-DATE ADVANCES IN THEIR CHOSEN FIELDS. GRANT FUNDING SUPPORTED OUR PARTNERSHIP WITH SUSAN G. KOMEN FOR THE CURE BREAST CANCER SCREENING PROGRAMS, WHICH PROVIDED MAMMOGRAMS TO 331 WOMEN DURING FISCAL 2018. WELLMONT FOUNDATION, INC., ALSO PROVIDED FINANCIAL SUPPORT TO MORE THAN 4,486 PATIENTS AND EMPLOYEES OF WELLMONT THROUGH DONATIONS TO THE EMPLOYEE EMERGENCY FUNDS AND SEVERAL PATIENT ASSISTANCE FUNDS.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses3,721,356

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	296,547	1,782,481	113,183

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization

1	Briefly describe the organization’s mission or most significant activities: MISSION: HONOR THOSE WE SERVE BY DELIVERING THE BEST POSSIBLE CARE. VISION: TO BUILD A LEGACY OF SUPERIOR HEALTH BY LISTENING TO AND CARING FOR THOSE WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	25
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	25
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	6
6	Total number of volunteers (estimate if necessary) .............	6	120
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	5,950
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	4,355

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	753,574
d	Related organizations		1d	151,205
e	Government grants (contributions)		1e	516,218

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,499,334

g	Noncash contributions included in lines 1a - 1f:$		1g	865,166

h Total. Add lines 1a-1f.......		2,920,331

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....

3 Investment income (including dividends, interest, and othersimilar amounts) ......			750,532			750,532
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		9,218,460	7a
b	Less: cost or other basis and sales expenses	9,235	8,990,433	7b
c	Gain or (loss)	-9,235	228,027	7c
d	Net gain or (loss).........			218,792	-9,235		228,027
8a	Gross income from fundraising events (not including $ 753,574of contributions reported on line 1c). See Part IV, line 18 ....
			8a	70,359
b	Less: direct expenses ...		8b	157,222
c	Net income or (loss) from fundraising events..			-86,863			-89,110
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	GAMING ACTIVITES < 15K SCH G		900099	5,950		5,950
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			5,950
12	Total revenue. See instructions.....			3,808,742	-9,235	5,950	889,449

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	3,462,702	3,462,702
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	258,654	258,654
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	570,703		234,056	336,647
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	155,141		49,659	105,482
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,097		1,963	4,134
9	Other employee benefits .......	46,019		20,369	25,650
10	Payroll taxes ...........	12,776		3,969	8,807
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17	86,784			86,784
f	Investment management fees ......	32,079		32,079
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	52,727		46,794	5,933
12	Advertising and promotion ....
13	Office expenses .......	45,086		20,245	24,841
14	Information technology ......	800		800
15	Royalties ..
16	Occupancy ...........
17	Travel ............	14,151		12,487	1,664
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,941		989	952
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,957		2,957
23	Insurance ...	11,078		11,078
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	FUNDRAISING EVENTS	148,980			148,980
b	APPREC. ITEMS TO DONORS	78,415		3,176	75,239
c	DUES AND MEMBERSHIPS	1,067		325	742
d	REBATES	576		576
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	4,988,733	3,721,356	441,522	825,855
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,094,579	1	1,561,638
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......			2,643,667	3	1,062,965
4	Accounts receivable, net .............			99,087	4	5,000
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			22,500	9	46,305
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	100,354
b	Less: accumulated depreciation	10b	87,620	24,926	10c	12,734
11	Investments—publicly traded securities .			26,525,840	11	28,174,450
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			-454	15	470,811
16	Total assets. Add lines 1 through 15 (must equal line 33)...			31,410,145	16	31,333,903

17	Accounts payable and accrued expenses .....	79,649	17	681,855
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	2,064,409	25	2,086,621
26	Total liabilities. Add lines 17 through 25..	2,144,058	26	2,768,476

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	29,266,087	32	28,565,427
33	Total liabilities and net assets/fund balances ........	31,410,145	33	31,333,903