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) MARVIN EICHORN MSHA EVPCOO...................................................................... DIRECTOR	1.00 ................. 54.00	X		0	749,219	42,742
(2) MATHEW CUSANO MD...................................................................... PHYSICIAN &	40.50 ................. 0.50	X		409,806	0	30,983
(3) SHANE HILTON SVP MARKET OPER...................................................................... DIRECTOR	1.50 ................. 48.50	X		0	396,092	58,587
(4) MONTY MCLAURIN VPCEO NW MKT...................................................................... VICE CHAIR &	9.00 ................. 36.00	X	X	0	386,782	54,704
(5) JAMES MATT WILSON MD...................................................................... PHYSICIAN &	40.50 ................. 0.50	X		251,763	0	23,835
(6) TOM TULL MSHA VP...................................................................... DIRECTOR	1.00 ................. 44.00	X		0	211,963	25,216
(7) CHARLES WARD...................................................................... CHAIR	1.00 ................. 0.50	X	X	21,445	0	0
(8) ROBERT LEONARD...................................................................... SEC/TREASURE	1.50 ................. 1.00	X	X	11,705	0	0
(9) CHARLES SLEMP...................................................................... DIRECTOR	0.50 ................. 0.50	X		0	0	0
(10) VALERIE LAWSON...................................................................... DIRECTOR	1.00 ................. 0.50	X		0	0	0
(11) JAMES MANICURE...................................................................... DIRECTOR	1.50 ................. 1.00	X		0	0	0
(12) BUFORD STURGILL...................................................................... DIRECTOR	0.50 ................. 0.50	X		0	0	0
(13) BILL WAMPLER...................................................................... DIRECTOR	1.00 ................. 0.50	X		0	0	0
(14) ERNIE WARD...................................................................... DIRECTOR	1.50 ................. 1.00	X		0	0	0
(15) MARK LEONARD...................................................................... NCH/DCH CEO	23.00 ................. 22.00		X	0	308,337	49,252
(16) STEPHEN SAWYER AVP CFO NW MKT...................................................................... AVP/CFO NW M	17.00 ................. 28.00		X	0	203,148	31,777
(17) ROBERT MITCH KENNEDY CNO...................................................................... NCH CNO	45.00 ................. 0.00		X	151,219	0	22,889

(A) Name and business address	(B) Description of services	(C) Compensation
VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON,VA24212	ANESTHESIA SERV	850,934
WESTERN VIRGINIA REGIONAL P O BOX 82368 LAFAYETTE,LA705982368	ER PHYSICIANS	812,944
HANCOCK DANIEL & JOHNSON PC P O BOX 72050 RICHMOND,VA232552050	LEGAL SERV	324,768
ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY,UT84127	LABORATORY SERV	224,249
WEATHERBY LOCUMS INC PO BOX 972633 DALLAS,TX753972633	PHYSICIAN SERV	201,526
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 10

- 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

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

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.") ..
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
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.

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..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

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)) .........

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

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

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

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

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 NORTON COMMUNITY HOSPITAL 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 NORTON COMMUNITY HOSPITAL INC		Employer identification number 54-0566029

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 NORTON COMMUNITY HOSPITAL INC			Employer identification number 54-0566029
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 C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

3,298

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

3,298

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1	NCH HAD LOBBYING EXPENSES OF 3,298 WHICH REPRESENTS THE PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION ATTRIBUTABLE TO DIRECT LOBBYING.

Schedule C (Form 990 or 990EZ) 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

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

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 .....	2,111,034		2,111,034
b	Buildings ....	51,065,770	22,711,046	28,354,724
c	Leasehold improvements	282,116	215,858	66,258
d	Equipment ....	47,757,695	35,965,452	11,792,243
e	Other .....	1,292,715	518,477	774,238
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				43,098,497

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
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	10,793,199
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

LINE 2: NORTON COMMUNITY HOSPITAL IS INCLUDED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF BALLAD HEALTH. THE FOOTNOTE EXPLANATION RELATIVE TO INCOME TAXES READS: "BALLAD IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR BALLAD AND ITS TAX- EXEMPT SUBSIDIARIES. BALLAD'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. BALLAD HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2018. AT JUNE 30, 2018, TAX RETURNS FOR MSHA AND WHS FOR 2015 THROUGH 2017 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE."

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 225.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 450.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	346,126		346,126	0.550 %
b	Medicaid (from Worksheet 3, column a) . . . . .	13,136,823	8,338,148	4,798,675	7.610 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	13,482,949	8,338,148	5,144,801	8.160 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	156,735		156,735	0.250 %
f	Health professions education (from Worksheet 5) . . .	3,220,747	1,610,139	1,610,608	2.560 %
g	Subsidized health services (from Worksheet 6) . . . .	2,136,117	915,311	1,220,806	1.940 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	14,253		14,253	0.020 %
j	Total. Other Benefits . .	5,527,852	2,525,450	3,002,402	4.760 %
k	Total. Add lines 7d and 7j .	19,010,801	10,863,598	8,147,203	12.930 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

8,076,044

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

3,068,897

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

17,819,016

Enter Medicare allowable costs of care relating to payments on line 5.....

15,426,360

Subtract line 6 from line 5. This is the surplus (or shortfall)........

2,392,656

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON,VA24273 BALLADHEALTH.ORG/LOCATIONSHOSPITALS H 1879	X	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	NORTON COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): BALLADHEALTH.ORG/LOCATIONSHOSPITALS

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	NORTON COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 225.000000000000%
and FPG family income limit for eligibility for discounted care of 450.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

BALLADHEALTH.ORG

The FAP application form was widely available on a website (list url):

BALLADHEALTH.ORG

A plain language summary of the FAP was widely available on a website (list url):
BALLADHEALTH.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	NORTON COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	NORTON COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 3E	DURING FY18, NCH WAS OPERATING UNDER THE CHNA APPROVED BY ITS BOARD OF DIRECTORS AT THE END OF FY15. PRIORITIES ESTABLISHED FOR THEIR CHNA WERE DETERMINED BY THE MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. MSHA HOSPITALS, INCLUDING NCH, CONDUCTED THEIR THIRD CHNA THIS TAX PERIOD WITH BOARD APPROVAL AND PUBLICATION OCCURRING AT THE END OF FY18. FOR THE NEW FY18 CHNAS, BALLAD HEALTH AND ITS HOSPITALS AND ENTITIES AGREED TO FOCUS ON AN INDEX OF 25 ACTIVE POPULATION HEALTH INDEX MEASURES (PLUS AN ADDITIONAL 31 MEASURES FOR MONITORING). THE POPULATION HEALTH INDEX ITSELF IS BASED ON THE FOCUS AREAS OUTLINED IN THE PREVIOUS FY15 CHNAS AND ALIGN WITH NATIONAL HEALTH IMPROVEMENT EFFORTS, SUCH AS HEALTHY PEOPLE 2020. TO UNDERSTAND EACH COMMUNITY'S INDIVIDUAL NEEDS, BALLAD HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR EACH BALLAD HOSPITAL TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN ITS SERVICE AREA. THROUGHOUT THE CHNA PROCESS, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH DISPARITIES AND AVAILABLE RESOURCES WITHIN EACH COMMUNITY. COMMUNITY MEMBERS FROM EACH COUNTY MET WITH BALLAD REPRESENTATIVES TO DISCUSS CURRENT HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. THE WISE COUNTY'S CHNA COMMUNITY MEMBERS EVALUATED MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX AND A FEW ADDITIONAL MEASURES RELATED TO ACCESS TO SCREENINGS. THE NORTON COUNTY GROUP'S MEMBERS COMPLETED A SURVEY RELATIVE TO WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR SPECIFIC COMMUNITY OVER THE NEXT THREE YEARS. AFTER ALL THE DETAILS AND DATA COLLECTION WAS COMPLETE AND INTERVIEWS WITH VARIOUS FOCUS GROUPS WERE COMPLETE THE NORTON COUNTY REPRESENTATIVES IDENTIFIED THE TOP FOCUS AREAS. FOUR KEY PRIORITIES WERE IDENTIFIED: -SMOKING -SUBSTANCE ABUSE -MENTAL HEALTH -OBESITY
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 5	AS PART OF THE FY18 BALLAD HEALTH CHNA PROCESS, BALLAD CONDUCTED LOCALIZED COMMUNITY FOCUS GROUPS WITH ORGANIZATION REPRESENTATIVES SUCH AS THOSE FROM LOCAL HEALTH DEPARTMENTS, SCHOOL SYSTEMS, HEALTH CLINICS, EMERGENCY SERVICES, BUSINESSES, AND PHILANTHROPIC BOARDS. THE INDIVIDUALS IN NCH'S COMMUNITY WERE SELECTED FOR PARTICIPATION BY THE HOSPITAL'S CEO. THE NCH FOCUS GROUP MEMBERS WERE REPRESENTED BY NORTON COMMUNITY INTERNAL MEDICINE RESIDENCY PROGRAM, MOUNTAIN EMPIRE OLDER CITIZENS, HEALTHY APPALACHIA INSTITUTE, CITY OF NORTON, NORTON COMMUNITY PHYSICIANS, NORTON HOSPITAL FOUNDATION BOARD AND NORTON COMMUNITY BOARD OF DIRECTORS. MEDICALLY UNDERSERVED POPULATIONS WERE REPRESENTED BY HEALTH APPALACHIA INSTITUTE. ALSO, BETWEEN THE FOUNDATION BOARD AND THE COMMUNITY BOARD, THERE ARE A NUMBER OF INDIVIDUALS THAT SIT ON THESE BOARDS THAT REPRESENT LOW INCOME, MINORITY POPULATIONS, AND MEDICALLY UNDERSERVED. ACTIVITIES ASSOCIATED WITH THE JUNE 2018 ASSESSMENT TOOK PLACE FROM FALL OF 2017 THROUGH THE SPRING OF 2018. COMMUNITY MEMBERS FROM WISE COUNTY MET WITH BALLAD HEALTH REPRESENTATIVES TO DISCUSS HEALTH PRIORITIES AND IDENTIFY POTENTIAL SOLUTIONS. COMMUNITY MEMBERS WERE MADE AWARE OF THE 25 MEASURES THAT MAKE UP BALLAD HEALTH'S POPULATION HEALTH INDEX PLUS 3 ADDITIONAL MEASURES RELATED TO ACCESS TO HEALTH SCREENING. PARTICIPANTS THEN COMPLETED A SURVEY TO INDICATE THEIR OPINION ON WHAT HEALTH PRIORITIES SHOULD BE A FOCUS FOR THEIR COMMUNITY.
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 6A	EACH HOSPITAL WITHIN MOUNTAIN STATES HEALTH ALLIANCE COMPLETED A CHNA. NCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, JOHNSON COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, SYCAMORE SHOALS HOSPITAL AND UNICOI COUNTY MEMORIAL HOSPITAL.
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 11	DURING THE YEAR, NCH CONTINUED TO FOCUS ON ITS CHNA PRIORITIES AS IDENTIFIED IN ITS FY15 REPORT. NCH'S PRIMARY AREAS OF FOCUS INCLUDED: OBESITY, DIABETES, CANCER, AND SUBSTANCE ABUSE. MANY ADDITIONAL COMMUNITY NEEDS EXIST IN OUR REGION. IT IS FISCALLY IMPOSSIBLE FOR A HOSPITAL TO ADDRESS EVERY HEALTH NEED IN A COMMUNITY, WHICH IS WHY THE CHNA PROCESS IS USED TO IDENTIFY AND PRIORITIZE AREAS OF FOCUS. A THOUGHTFUL CHNA EVALUATES OVERALL COMMUNITY HEALTH NEEDS TO DETERMINE WHICH ONES THE HOSPITAL CAN BEST INFLUENCE IN A POSITIVE WAY. CONSIDERATION IS GIVEN TO OTHER ORGANIZATIONS IN THE HOSPITAL'S GEOGRAPHIC AREA THAT ALREADY OFFER SERVICES ADDRESSING SPECIFIC HEALTH NEEDS. IN SOME CASES, IT IS BEST TO SIMPLY SUPPORT AN IDENTIFIED HEALTH NEED THROUGH A FINANCIAL DONATION TO ANOTHER NONPROFIT ORGANIZATION SKILLED IN CERTAIN AREAS: TEEN PREGNANCY, DENTAL HEALTH, FIGHTING HOMELESSNESS, ETC. HOSPITALS ALSO LEND SUPPORT TO OTHER NONPROFIT ORGANIZATIONS BY SERVING ON THEIR BOARDS, COMMITTEES, AND ASSISTING WITH FUNDRAISING EFFORTS. SOME OF NCH'S ACTIVITIES DURING FY18: OBESITY/PHYSICAL ACTIVITY: AN OUTSTANDING KID'S FITNESS PROGRAM IN OUR REGION FOR THE PAST THREE YEARS IS THE MORNING MILE PROGRAM. THE MORNING MILE IS A BEFORE SCHOOL WALK/RUN THAT STARTED IN 2015 WITH FEWER THAN 5 SCHOOLS PARTICIPATING. CURRENTLY THERE ARE OVER 15 SCHOOLS PARTICIPATING IN THE MORNING MILE PROGRAM IN OUR SWVA REGION. THE RESULTS ARE VERY POSITIVE, NOT ONLY FROM A PHYSICAL FITNESS STANDPOINT, BUT ALSO IN AN IMPROVED STUDENT ATTENTION SPAN IN THE CLASSROOM. DIABETES: THE HOSPITAL SCHEDULED ROTATING CLASSES FOCUSING ON PRE-DIABETES AND/OR OBESITY, IDENTIFYING AND REDUCING RISK OF DIABETES. WE OFFER MONTHLY CLASSES AND A SUPPORT GROUP FOR DIABETIC PATIENTS AND THEIR FAMILIES. WE PREPARED "SURVIVAL KITS" WHICH PROVIDE BASIC EDUCATIONAL MATERIALS FOR PEOPLE NEWLY DIAGNOSED WITH DIABETES TO BE DISTRIBUTED TO CLINICS AND PHYSICIAN OFFICES. FOUR SEPARATE SURVIVAL KITS WERE DISTRIBUTED TO PHYSICIAN OFFICES, SPECIFIC TO PRE-DIABETES, AT-RISK PATIENTS, TYPE 1 DIABETES OR TYPE 2 DIABETES. THIS ALLOWED PHYSICIANS TO HAVE APPROPRIATE EDUCATIONAL INFORMATION ON-HAND TO SHARE WITH THEIR PATIENTS. NCH CURRENTLY OFFERS NUTRITIONAL ANALYSIS FOR OFFERINGS IN OUR CAFETERIA TO AID DINERS IN MAKING HEALTHIER EATING CHOICES. THE HOSPITAL COMPILED A LIST OF MEDICAID INSURANCE PLANS AS WELL AS COMMERCIAL INSURANCE PLANS THAT COVER DIABETES SELF-MANAGEMENT EDUCATION CLASSES, WHICH WE DISTRIBUTED TO LOCAL PHYSICIAN OFFICES. THIS INFORMATION ASSISTS PHYSICIANS SO THEY KNOW WHICH THIRD-PARTY INSURERS PROVIDE COVERAGE AS THEY DISCUSS DIABETES CLASSES WITH THEIR PATIENTS. THE HOSPITAL ALSO REVIEWS THE INSURANCE COVERAGE ON AN INDIVIDUAL PATIENT BASIS TO SEE IF A PATIENT'S INSURANCE COVERS DIABETES EDUCATION SO THAT WE ARE ABLE TO COMMUNICATE COVERAGE TO PATIENTS, WHICH MAY ENCOURAGE MORE PATIENTS TO ATTEND EDUCATIONAL CLASSES BENEFICIAL TO THEIR HEALTH. CANCER: THE HOSPITAL INTRODUCED LOW-DOSE LUNG SCREENINGS THIS YEAR TO ENABLE EARLIER DETECTION OF LUNG CANCER. WE PROVIDED THE LOW-DOSE CT SCANS FREE OF CHARGE TO ALMOST 100 COMMUNITY MEMBERS. WE PARTICIPATED IN THE "EVERY WOMAN'S LIFE" PROGRAM THAT HELPS UNINSURED LOW-INCOME WOMEN GAIN ACCESS TO BREAST CANCER SCREENING SERVICES. 71 EXAMS WERE PROVIDED THROUGH THE PROGRAM THIS YEAR. WE ALSO PARTICIPATED IN THE SEE, TEST & TREAT PROGRAM. THIS PROGRAM ORGANIZES EVENTS TO SCREEN FOR CANCER AND OFFERS PARTICIPANTS HEALTH EDUCATION. THE EVENTS ARE FOR MEDICALLY UNDERSERVED COMMUNITIES; SCREENING INCLUDES MAMMOGRAMS, PELVIC AND CLINICAL BREAST EXAMS WITH SAME-DAY RESULTS ALONG WITH A CONNECTION FOR FOLLOW UP CARE. SUBSTANCE ABUSE: A DRUG TAKE BACK DAY WAS HELD ON APRIL 26,2018 ACROSS SOUTHWEST VA, WHERE RESIDENTS COULD GO TO ONE OF 9 LOCATIONS IN WISE, LEE AND SCOTT COUNTIES AND THE CITY OF NORTON FROM 9AM-1PM TO DISPOSE OF POTENTIALLY DANGEROUS, EXPIRED, UNUSED OR UNWANTED MEDICATIONS. THIS EVENT HELPS COMBAT THE ISSUES OF ABUSE, DIVERSION, AND MISUSE OF MEDICATIONS REMAINING IN HOME MEDICINE CABINETS. THERE WERE MANY LOCAL SPONSORS OF THIS HUGE EVENT. NCH MADE SURE OUR PATIENTS AND LOCAL PHYSICIAN OFFICES WERE NOTIFIED ABOUT THE EVENT. THE HOSPITAL BEGAN A NEW PROCESS THIS YEAR TO MAKE SURE PATIENTS ARE REFERRED TO HEALTHY FAMILIES OF SOUTHWEST VIRGINIA, A PROGRAM THROUGH MOUNTAIN EMPIRE OLDER CITIZENS, INC.'S SOUTHWEST VIRGINIA CHILDREN'S ADVOCACY CENTER. HEALTHY FAMILIES RECEIVE REFERRALS FROM HOSPITALS, COUNSELORS, OB/GYN PRACTICES OR SELF-REFERRAL. OUR HOSPITAL REFERS NEW MOTHERS, MANY OF WHOM HAVE RISK FACTORS SUCH AS SUBSTANCE ABUSE, BUT OTHER FACTORS AS WELL. THE NEW MOMS RECEIVE VISITS WHILE IN THE HOSPITAL FROM TRAINED VOLUNTEERS. HEALTHY FAMILIES' VISITORS PROVIDE DEVELOPMENT AND HEALTH INFORMATION, SUPPORT AND CONNECT PARENTS WITH LOCAL RESOURCES, AS NEEDED. AFTER LEAVING THE HOSPITAL, WEEKLY HOME VISITS ARE MADE TO PROVIDE TRANSPORTATION ASSISTANCE, DEVELOPMENTAL SCREENINGS FOR INFANTS, CHILDHOOD LITERACY PROGRAMS, AMONG MANY OTHER SERVICES. FAMILIES ARE FOLLOWED UNTIL THE BABY REACHES 2 YEARS OF AGE. RECENTLY, NCH BEGAN WORKING WITH A LOCAL OB/GYN PRACTICE TO ASSIST THESE FAMILIES WITH REFERRALS, TRANSPORTATION TO PHYSICIAN VISITS AND OTHER NEEDS FAMILIES MAY HAVE. NCH TEAM MEMBERS ARE NOW PARTICIPATING IN NEONATAL ABSTINENCE SYNDROME (NAS) AND MATERNAL DRUG USE COLLABORATIVES AND SUMMITS HELD IN WEST VIRGINIA AND VIRGINIA, INCLUDING A QUARTERLY NAS TASK FORCE MEETING. INFORMATION OBTAINED FROM THESE MEETINGS IS SHARED WITH HOSPITAL STAFF, OB DOCTORS AND PEDIATRICIANS. WE ARE NOW SEEING MORE COLLABORATION WITH ALL OF THE LOCAL RESOURCES AS A RESULT OF OUR INVOLVEMENT IN THE MEETINGS AND WE BELIEVE AT LEAST SOME OF THE IMPROVEMENTS IN THE CARE WE PROVIDE TO THESE MOMS AND BABIES CAN BE ATTRIBUTED TO OUR INVOLVEMENT WITH THE OUTSIDE MEETINGS AND INVOLVEMENT WITH OTHER ORGANIZATIONS THAT SHARE OUR DESIRE TO IMPROVE THE LIVES OF THESE MOMS AND THEIR BABIES. WISE COUNTY HEALTH DEPARTMENT RECEIVED A GRANT FOR A NEW NAS OUTREACH PROGRAM THAT WORKS MUCH LIKE HEALTHY FAMILIES (DESCRIBED EARLIER), BUT THIS PROGRAM IS LIMITED TO NAS PATIENTS. EVERY PATIENT WITH A HISTORY OF DRUG ABUSE RECEIVES A "PLAN OF SAFE CARE" COMPLETED ACCORDING TO VIRGINIA DEPARTMENT OF HEALTH REGULATIONS. OUR PATIENTS WHO HAVE A HISTORY OF DRUG ABUSE DURING PREGNANCY ARE REFERRED TO THE PROGRAM. CASE WORKERS MAKE A PERSONAL VISIT TO THE HOSPITAL TO COMPLETE THE PLAN OF SAFE CARE AND CASE WORKERS FOLLOW UP WITH THE FAMILIES AT HOME TO PROVIDE AN ASSORTMENT OF SERVICES UNTIL THE BABY IS 2 YEARS OLD. NCH ALSO WORKS WITH LOCAL COMMUNITY SERVICE BOARDS ON A PROJECT LINK PROGRAM TO MEET THE NEEDS OF SUBSTANCE ABUSE MOMS IN OUR COMMUNITY. ALL MOTHERS WITH A POSITIVE DRUG SCREEN OR ARE PRESCRIBED SUBUTEX/SUBOXONE ARE REFERRED TO PROJECT LINK. WE MAKE SEVERAL REFERRALS EVERY MONTH TO PROJECT LINK AS WELL AS TO THE LOCAL DEPARTMENT OF SOCIAL SERVICES (CHILD PROTECTIVE SERVICES) AND TO THE NAS OUTREACH PROGRAM THROUGH THE LOCAL HEALTH DEPARTMENTS. NCH, ALONG WITH MSHA'S OTHER HOSPITALS, HAS BEEN DILIGENT IN ITS GOAL TO ENSURE APPROPRIATE PRESCRIBING OF OPIOIDS AND A REDUCTION IN OPIOIDS IN OUR REGION. THE RESULT IS A SIGNIFICANT REDUCTION IN PRESCRIBING RATES. OPIOID DOSES ADMINISTERED AT MSHA'S HOSPITALS WERE REDUCED BY MORE THAN 40 PERCENT. THE HOSPITAL CONTINUED ITS PRACTICE OF PROVIDING MEDICATIONS AND SUPPLIES TO AREA RESCUE SQUADS THIS YEAR.
FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 13H	BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY ALLOWS FOR SOME EXCEPTIONS TO STRICTLY ADHERING TO FEDERAL POVERTY GUIDELINES WHEN AWARDING FINANCIAL ASSISTANCE. UNIQUE CIRCUMSTANCES MAY BE WEIGHED AND ASSESSED FOR FINANCIAL ASSISTANCE CONSIDERATION ON A CASE-BY-CASE BASIS. ALSO, THERE ARE SOME SERVICES WHERE FINANCIAL ASSISTANCE MAY BE PROVIDED OUTSIDE OF FEDERAL POVERTY GUIDELINES. THESE ARE NOTED IN BALLAD HEALTH'S FINANCIAL ASSISTANCE POLICY.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE	FINANCIAL ASSISTANCE APPROVAL CAN APPLY TO AN ASSORTMENT OF PATIENTS SUCH AS THOSE WHO HAVE EXHAUSTED THEIR MEDICAID BENEFITS, THOSE WHO QUALIFIED FOR MEDICAID AFTER THE DATE OF SERVICE, DECEASED PATIENTS WITH NO ESTATE OR ASSETS, UNINSURED PATIENTS, AND UNDERINSURED PATIENTS. WHILE BALLAD HEALTH'S QUALIFICATIONS FOR FINANCIAL ASSISTANCE IS BASED ON FEDERAL POVERTY GUIDELINES, ASSET VALUES MAY ALSO BE USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. UNIQUE CIRCUMSTANCES MAY BE ASSESSED ON A CASE-BY-CASE BASIS. CHARITY APPROVAL COVERS ALL DATES OF SERVICE FOR THE PATIENT WHEN THEY ARE APPROVED AND THERE IS NO LIMITATION OR CAP ON THE AMOUNT OF CHARITY THAT THEY CAN RECEIVE. BALLAD HEALTH HOSPITALS DO NOT STOP APPROVING FINANCIAL ASSISTANCE FOR PATIENT ACCOUNTS IF A HOSPITAL'S CHARITY WRITE-OFFS EXCEED THE HOSPITAL'S CHARITY BUDGET. ALL BALLAD HEALTH HOSPITALS PROVIDE AN UNINSURED DISCOUNT; THE CURRENT UNINSURED DISCOUNT IS 80%. IN ADDITION TO THE UNINSURED DISCOUNT, MANY PATIENTS WILL FURTHER QUALIFY FOR ADDITIONAL FINANCIAL ASSISTANCE. ALL PATIENTS SEEKING FINANCIAL ASSISTANCE MUST SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE AND SUBMIT DOCUMENTS IN SUPPORT OF THE INFORMATION ON THE APPLICATION, UNLESS SPECIFICALLY EXCLUDED ACCORDING TO OUR POLICY GUIDELINES. MEDICAID ELIGIBLE PATIENTS WILL QUALIFY FOR 100% FINANCIAL ASSISTANCE AND NOT BE REQUIRED TO COMPLETE THE REQUIRED DOCUMENTATION WHEN: A) MEDICAID ELIGIBILITY REQUIREMENTS ARE MET AFTER THE SERVICE IS PROVIDED, B) NON-COVERED CHARGES OCCUR ON A MEDICAID ELIGIBLE ENCOUNTER, OR C) BENEFITS HAVE BEEN EXHAUSTED. DECEASED PATIENTS WITH NO ESTATE ALSO QUALIFY FOR 100% FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE DETERMINATIONS MAY BE RETROACTIVE FOR ALL OUTSTANDING BALANCES. IN ADDITION, WE HAVE A NUMBER OF PROGRAMS WITH SPECIAL DISCOUNTS SUCH AS LACTATION CONSULTATION SERVICES; ONCOLOGY TREATMENT REGIMENS; ENROLLMENT IN VARIOUS COMMUNITY PROGRAMS, AND PRESCRIPTION DRUGS FILLED POST-DISCHARGE.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION	THE COST TO CHARGE RATIO (WORKSHEET 2 "RATIO OF PATIENT CARE COST TO CHARGES") WAS USED TO CALCULATE LINE 7A FINANCIAL ASSISTANCE (CHARITY CARE) COST. OUR COST ACCOUNTING SYSTEM WAS USED TO DETERMINE LOSSES FROM MEDICAID/TENNCARE REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH AND OUR PHYSICIAN CLINIC. WE USED COST TO CHARGE RATIOS FOR THEM BECAUSE THEIR DATA IS NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS OR EXPENSES SPECIFIC TO A COMMUNITY HEALTH EVENT, WITH NO ADDITIONAL OVERHEAD INCLUDED IN THE COST. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF STUDENT INTERNSHIPS (PRIMARILY MEDICAL RESIDENTS, NURSING, PHARMACY, EMT, RESPIRATORY THERAPY, PHYSICAL/OCCUPATIONAL THERAPY, AND STUDENTS FROM OTHER ALLIED HEALTH PROGRAMS) WITH LOCAL SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO RECEIVE HANDS-ON TRAINING IN A HOSPITAL SETTING. NCH'S FILED MEDICARE COST REPORT IS THE SOURCE FOR COST AND REIMBURSEMENT REPORTED ON LINE 7F FOR OUR MEDICARE-APPROVED MEDICAL RESIDENT PROGRAM. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT (OD) MAINTAINS RECORDS FOR THE NON- MEDICARE PROGRAMS. OD KEEPS RECORDS OF THE NUMBER OF STUDENTS RECEIVING TRAINING AT OUR HOSPITALS AND THE AMOUNT OF HOURS THE STUDENTS SPEND AT OUR HOSPITALS. HOURS MAY DIFFER BASED ON THE SCHOOL AND THE TYPE OF PROGRAM (RN, RADIOLOGY, LAB, ETC.). THE NUMBER OF TEAM MEMBERS THAT PROVIDE TRAINING TO STUDENTS WILL ALSO VARY BASED ON WHERE THE STUDENT IS TRAINING. FOR EXAMPLE, AN RN TRAINER ON A MEDICAL FLOOR MAY HAVE 3 OR 4 STUDENTS UNDER HER/HIS DIRECTION, WHILE AN RN TRAINER IN A SPECIALTY AREA SUCH AS ICU OR THE ER MAY BE TRAINING ONE-ON-ONE WITH A SINGLE STUDENT. WE ONLY INCLUDE LABOR COSTS FOR OUR HOSPITAL TEAM MEMBERS THAT PROVIDE TRAINING (I.E. NO OVERHEAD IS APPLIED) AND WE ONLY ATTRIBUTE A PERCENTAGE OF OUR TEAM MEMBERS' TIME TO ACTUAL TRAINING. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USED OUR COST ACCOUNTING SYSTEM TO DETERMINE COMMUNITY BENEFIT EXPENSE. THERE IS ONE EXCEPTION WHERE WE DO NOT USE OUR COST ACCOUNTING SYSTEM. WE HAVE A PHYSICIAN CLINIC IN A RURAL, LOW INCOME AREA THAT IS SUBSIDIZED BY THE HOSPITAL. NCH OWNS AND OPERATES THE CLINIC AND SUBSIDIZES THE CLINIC'S LOSSES (436,844). WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND MEDICAID/TENNCARE ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITAL THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE OR SERVICES THAT ARE READILY AVAILABLE FROM OTHER FOR-PROFIT PROVIDERS IN OUR SERVICE AREA.
PART II - COMMUNITY BUILDING ACTIVITIES	NCH LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. WE DO NOT CAPTURE COSTS ASSOCIATED WITH TEAM MEMBERS THAT SERVE ON OTHER NONPROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. NCH, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. MOST OF THESE ORGANIZATIONS WORK TO IMPROVE THE LIVES OF COMMUNITY MEMBERS THAT HAVE LIMITED, OR NO, FINANCIAL RESOURCES.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY	SELF-PAY BALANCES INCLUDE ACCOUNTS AFTER PAYMENTS AND CONTRACTUAL ADJUSTMENTS (DISCOUNTS) HAVE BEEN POSTED FROM ALL THIRD-PARTY PAYERS SUCH AS MEDICARE, MEDICAID, COMMERCIAL INSURERS, AND OTHERS - GENERALLY LEAVING THE PATIENT RESPONSIBLE FOR ANY REMAINING DEDUCTIBLE AND/OR CO-PAYMENT. OTHER SELF-PAY ACCOUNTS ARE FROM PATIENTS WITH NO INSURANCE OR OTHER THIRD-PARTY COVERAGE. UNDER BALLAD HEALTH'S SELF-PAY POLICY, ANY PATIENT WHO HAS NO INSURANCE AND IS INELIGIBLE FOR ANY GOVERNMENT ASSISTANCE PROGRAM RECEIVED A 71% DISCOUNT UNTIL FEBRUARY 1, 2018, AT WHICH TIME THE UNINSURED DISCOUNT INCREASED TO 80%. MANY SELF-PAY PATIENTS WILL FURTHER QUALIFY FOR FINANCIAL ASSISTANCE (SOMETIMES REFERRED TO AS CHARITY CARE) IF THEY PROVIDE THE FINANCIAL INFORMATION WE NEED TO DEEM THEM ELIGIBLE. AFTER THE NORMAL COLLECTION PROCESS HAS INDICATED AN ACCOUNT IS UNCOLLECTIBLE, NCH WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO EVALUATE THE AGE OF ACCOUNTS RECEIVABLE, HISTORICAL WRITE-OFFS AND RECOVERIES AND ANY UNUSUAL CIRCUMSTANCES (SUCH AS LOCAL, REGIONAL OR NATIONAL ECONOMIC CONDITIONS) WHICH AFFECT THE COLLECTABILITY OF RECEIVABLES.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE	OUR PRIMARY EXTERNAL COLLECTION AGENCY ESTIMATES THAT 38% OF MSHA'S BAD DEBT WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE IF PATIENTS HAD PROVIDED OUR HOSPITALS WITH A FINANCIAL ASSISTANCE APPLICATION AND REQUIRED DOCUMENTATION. THE AGENCY BASED THEIR LIKELY ELIGIBLE FOR CHARITY ASSUMPTION ON INDIVIDUALS WITH A LOW SCORE. AN INDIVIDUAL'S SCORE IS BASED ON AN ALGORITHM THAT INCLUDES DATA POINTS SUCH AS FICO CREDIT SCORE, PROPERTY VALUE, YEARS AT CURRENT RESIDENCE, NUMBER OF TIMES AN INDIVIDUAL HAS MOVED AND AN INDIVIDUAL'S PROPENSITY TO PAY SCORE. JUST UNDER 83% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS PROCESSED DURING FY18 RECEIVED A FULL DISCOUNT (COMPLETE WRITE-OFF). AN ADDITIONAL 12% RECEIVED A PARTIAL DISCOUNT, RESULTING IN AN OVERALL APPROVAL RATE OF 95% FOR COMPLETED APPLICATIONS. THEREFORE, ONLY 5% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS WERE DENIED. UNFORTUNATELY, MANY PATIENTS EITHER DO NOT SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE OR DO NOT PROVIDE A COMPLETE APPLICATION. INCOMPLETE APPLICATIONS ARE RETURNED TO PATIENTS ALONG WITH A NOTICE OF MISSING INFORMATION. THE NOTICE ALSO PROVIDES A CONTACT PHONE NUMBER PATIENTS MAY CALL FOR ASSISTANCE IN COMPLETING THE APPLICATION. ALL SELF-PAY PATIENTS RECEIVE FOLLOW UP CALLS EVERY 21 DAYS FROM A COMPANY MSHA PAYS TO PROCESS CHARITY CARE APPLICATIONS FOR UNINSURED PATIENTS AND TO OFFER PATIENTS ENROLLMENT ASSISTANCE IN MEDICAID (VA) OR TENNCARE (TN). OUR FINANCIAL COUNSELORS FOLLOW UP WITH PATIENTS THAT HAVE A BALANCE AFTER INSURANCE HAS PAID. WE HAVE MANY INSTANCES OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE BELIEVE WOULD QUALIFY FOR FINANCIAL ASSISTANCE. ALTHOUGH PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE, MANY WILL NOT DO SO. NCH WOULD PREFER FOR PATIENTS TO SUBMIT COMPLETED FINANCIAL ASSISTANCE APPLICATIONS GIVEN THAT HISTORICAL DATA CLEARLY INDICATES THAT MOST UNINSURED PATIENTS AND MANY UNDERINSURED WILL QUALIFY FOR FINANCIAL ASSISTANCE UNDER OUR PROGRAM. WITHOUT A COMPLETED APPLICATION, WE HAVE NO CHOICE OTHER THAN TO RECORD AN UNPAID ACCOUNT AS BAD DEBT INSTEAD OF CHARITY CARE.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS	BALLAD HEALTH'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PAGES 13-14 THAT DESCRIBES BAD DEBT. NCH IS INCLUDED IN THE JUNE 30, 2018 AUDITED FINANCIAL STATEMENTS OF BALLAD HEALTH. THE AUDITED FINANCIAL STATEMENTS ARE FOR THE FIVE MONTHS ENDING AFTER THE FEBRUARY 1, 2018 MERGER OF MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM (ATTACHED).
PART III, LINE 8 - MEDICARE EXPLANATION	MEDICARE ALLOWABLE COSTS ARE REPORTED USING NCH'S FILED MEDICARE COST REPORTS (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS TRANSPORTATION OF A PATIENT AND COMFORT ITEMS THAT INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED AND TO FEDERALLY RECOGNIZED MEDICALLY UNDERSERVED AREAS. A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE, LEAVING THE HOSPITAL TO ABSORB THE LOSS. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS SUCH AS THOSE NOTED ABOVE, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. WHILE WE AGREE THAT COSTS SUCH AS MARKETING TO ATTRACT PATIENTS AND LOBBYING ARE REASONABLE TO EXCLUDE, IT DOES NOT SEEM REASONABLE TO EXCLUDE RECRUITMENT OF PHYSICIANS AND BASIC ITEMS SUCH AS A TELEVISION AND PHONE IN PATIENT ROOMS. ALTHOUGH NCH DID NOT SUSTAIN A MEDICARE LOSS THIS YEAR, WE BELIEVE MEDICARE LOSSES SHOULD BE ALLOWED AS A REPORTABLE COMMUNITY BENEFIT, SIMILAR TO GOVERNMENTAL PROGRAMS SUCH AS MEDICAID. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, HOSPITALS ARE REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR THE MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW COST. THEREFORE, IT IS ONLY LOGICAL TO ALLOW HOSPITALS TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT. BY MAKING THIS CHANGE, NONPROFIT PROVIDERS WILL BE ENCOURAGED TO CONTINUE IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT MAY BE ECONOMICALLY INJURIOUS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION: REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GUIDELINES, WHILE ALLOWING FOR UNIQUE FINANCIAL CIRCUMSTANCES - FOR EXAMPLE, MEDICALLY INDIGENT PATIENTS WITH CATASTROPHIC MEDICAL COSTS THAT WOULD THREATEN THE PATIENT'S HOUSEHOLD FINANCIAL VIABILITY. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT'S ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED. ALL BALLAD HEALTH HOSPITALS COMPLY WITH IRS 501(R) REGULATORY GUIDELINES. OUR COLLECTION POLICY CLEARLY STATES THAT ALL PATIENTS ARE TREATED EQUALLY - WITH DIGNITY AND RESPECT. WE ENSURE THAT OUTSIDE COLLECTION AGENCIES USED BY OUR HOSPITAL ADHERE TO OUR BILLING AND COLLECTION GUIDELINES. OUR HOSPITAL'S COLLECTION PROGRAM INCLUDES COMMUNICATING EXPECTED FINANCIAL RESPONSIBILITY PRIOR TO SERVICE. OUR HOSPITALS PROVIDE ASSISTANCE TO HELP UNDERINSURED AND UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND TO HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDIAID OR TENNCARE. AFTER INSURANCE BENEFIT VERIFICATION, THE HOSPITAL BILLS INSURANCE CARRIERS. IF THE INSURANCE CARRIER DENIES PAYMENT OF THE SERVICE/PROCEDURE AS NON-COVERED OR THE PATIENT HAS EXCEEDED THEIR MAXIMUM BENEFITS, THE SERVICE/PROCEDURE WILL QUALIFY FOR THE UNINSURED DISCOUNT. FINANCIAL COUNSELORS ARE AVAILABLE TO DISCUSS FINANCIAL ASSISTANCE WITH PATIENTS AND THEIR FAMILIES. OUR HOSPITAL PROVIDES A NUMBER OF PAYMENT OPTIONS: - A PRE-SERVICE DISCOUNT MAY BE OFFERED - A DISCOUNT IN EXCESS OF ESTABLISHED DISCOUNTING RATES MAY BE GRANTED FOR CATASTROPHIC HIGH DOLLAR ACCOUNTS - OUR HOSPITAL ACCEPTS ALL NON-CONTRACTED AND OUT-OF-NETWORK PAYERS AND WILL MAKE ATTEMPTS TO WORK WITH THESE PAYERS REGARDING APPROPRIATE REIMBURSEMENT AND BILLING TO THEIR MEMBERS - PAYMENT ARRANGEMENTS ARE AVAILABLE SO LONG AS THE ACCOUNT IS NOT WITH A COLLECTION AGENCY REASONABLE EFFORTS ARE MADE TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE - SEE SCHEDULE H, PART VI, LINE 3 FOR INFORMATION ON HOW PATIENTS ARE INFORMED ABOUT OUR FINANCIAL ASSISTANCE POLICY.
PART VI, LINE 2 - NEEDS ASSESSMENT	FOCUSING ON 25 ACTIVE POPULATION HEALTH INDEX MEASURES ALLOWS BALLAD HEALTH TO FURTHER ENGAGE THE EFFORTS OF ITS HOSPITALS IN PARTNERSHIP WITH COMMUNITIES IN OUR SERVICE AREAS. IT HAS HELPED BALLAD TO BETTER IDENTIFY HEALTH DISPARITIES THAT APPEAR ACROSS THE INDIVIDUAL COMMUNITIES AND HAS HELPED BALLAD TO PRIORITIZE ISSUES THAT ARE MOST IMPORTANT IN EACH HOSPITAL'S COMMUNITY. ENGAGING LOCAL COMMUNITY ORGANIZATIONS WILL EXPAND PARTNERSHIPS SO THAT ORGANIZATIONS WORK TOGETHER MORE TO ADDRESS COMMUNITY HEALTH NEEDS. BALLAD HEALTH DEVELOPED A COMPREHENSIVE PROCESS TO GATHER INPUT FOR AND DRAFT A POPULATION HEALTH PLAN DURING FY18. AN EXECUTIVE STEERING TEAM WAS ESTABLISHED, AIDED BY NATIONAL EXPERTS WITH EXPERIENCE IN LARGE-SCALE POPULATION HEALTH IMPROVEMENT. BECAUSE OUR HOSPITALS ARE LOCATED IN A REGION WITH MANY CHRONIC DISEASE CHALLENGES, BALLAD HEALTH'S GOAL IS TO TARGET POPULATION HEALTH ISSUES TO MAKE LASTING IMPROVEMENTS. BALLAD CONDUCTED APPROXIMATELY 150 INTERVIEWS AND HELD 40 MEETINGS WITH EXTERNAL GROUPS, INCLUDING THE REGIONAL HEALTH DEPARTMENTS, UNITED WAY AGENCIES, CHAMBERS OF COMMERCE, SCHOOLS AND COMMUNITY ORGANIZATIONS, THE REGIONAL ACCOUNTABLE CARE COMMUNITY STEERING COMMITTEE, AS WELL AS INTERNAL GROUPS SUCH AS OUR POPULATION HEALTH AND SOCIAL RESPONSIBILITY COMMITTEE OF THE BALLAD HEALTH BOARD OF DIRECTORS, THE BALLAD HEALTH POPULATION HEALTH CLINICAL COMMITTEE, AND OUR HOSPITAL COMMUNITY BOARDS.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	CONSISTENT WITH BALLAD HEALTH FINANCIAL ASSISTANCE POLICY, NCH COMMUNICATES WITH AND PROVIDES EDUCATION TO OUR PATIENTS THROUGH VARIOUS AVENUES REGARDING GOVERNMENTAL ASSISTANCE PROGRAMS AND HOSPITAL FINANCIAL ASSISTANCE. VARIOUS EDUCATIONAL AND APPLICATION DOCUMENTS RELATED TO OBTAINING FINANCIAL ASSISTANCE ARE WIDELY AVAILABLE AND ALL DOCUMENTS ARE AVAILABLE ON THE BALLAD HEALTH WEBSITE. PRINTED FINANCIAL ASSISTANCE EDUCATIONAL MATERIALS ARE PART OF EACH REGISTRATION PACKET AND POSTERS ARE DISPLAYED IN HIGHLY VISIBLE AREAS OF THE HOSPITAL. OUR FINANCIAL ASSISTANCE POLICY AND DOCUMENTS ARE AVAILABLE IN OUR EMERGENCY DEPARTMENT AND ADMITTING AREAS. WE ARE ALSO HAPPY TO MAIL ALL DOCUMENTS TO PATIENTS. WE OFFER A PLAIN LANGUAGE SUMMARY AND ALL OF OUR DOCUMENTS ARE AVAILABLE IN ENGLISH AND SPANISH. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING PRE-REGISTRATION, REGISTRATION AND/OR DURING FINANCIAL COUNSELING. WE OFFER GOVERNMENTAL PROGRAM ELIGIBILITY REPRESENTATIVES TO ASSIST PATIENTS IN SECURING ELIGIBILITY FOR MEDIAID OR TENNCARE, FEDERAL DISABILITY AND OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. ADDITIONALLY, IF A PATIENT OR COMMUNITY RESIDENT EXPRESSES AN INTEREST IN THE ACA-HEALTHCARE EXCHANGE, OUR REPRESENTATIVES HAVE THE QUALIFICATIONS AND EXPERIENCE TO ASSIST THEM THROUGH THE ENTIRE PROCESS. OUR FINANCIAL COUNSELORS OFFER FINANCIAL ASSISTANCE APPLICATIONS TO PATIENTS WHO DO NOT QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND ARE UNABLE TO PAY FOR SOME OR ALL OF THEIR HEALTHCARE. ALL PATIENT STATEMENTS HAVE VERBIAGE DISCUSSING FINANCIAL ASSISTANCE ALONG WITH CONTACT INFORMATION. OUR LAST LETTER TO THE PATIENT DISPLAYS THE PLAIN LANGUAGE SUMMARY. IN ALL ORAL CORRESPONDENCES WITH THE PATIENT, IF IT IS IDENTIFIED THEY CANNOT MEET PAYMENT REQUIREMENTS ON THEIR ACCOUNT, FINANCIAL ASSISTANCE IS DISCUSSED AS AN OPTION. APPLICANTS ARE NOTIFIED OF FINANCIAL ASSISTANCE DETERMINATION IN WRITING.
PART VI, LINE 4 - COMMUNITY INFORMATION	NCH IS LOCATED IN NORTON, WISE COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. SOUTHWEST VIRGINIA (SWVA) IS LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION AND HAS A HIGH RATE OF UNINSURED ADULTS. ACCORDING TO U.S. CENSUS BUREAU ESTIMATES, NORTON HAS A POPULATION OF APPROXIMATELY 4,043, WHILE WISE COUNTY'S POPULATION IS 39,539. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF WISE COUNTY IS 40.3 WHICH IS OLDER THAN THE MEDIAN AGE OF 38.0 IN VIRGINIA. 17.5% OF WISE COUNTY'S RESIDENTS ARE 65 OR OLDER COMPARED TO 14.6% FOR THE STATE. THE POPULATION PROJECTIONS FOR WISE COUNTY OVER THE NEXT FIVE YEARS INDICATE THAT THE COUNTY WILL LIKELY EXPERIENCE LITTLE TO NO POPULATION GROWTH OVERALL. HOWEVER, THE AGE 65+ POPULATION FOR WISE COUNTY IS PROJECTED TO EXPERIENCE THE MOST POPULATION CHANGE OVER THE NEXT FIVE YEARS, AS IT MOVES FROM 17.5% OF THE TOTAL POPULATION IN 2018 TO 19.9% OF THE POPULATION IN 2023. THE AGING POPULATION OF THE COUNTY PRESENTS OPPORTUNITIES FOR EARLIER IDENTIFICATION AND BETTER MANAGEMENT OF HEALTH CONDITIONS THAT OFTENTIMES AFFECT ELDERLY POPULATIONS IN RURAL AREAS. THE BUREAU ESTIMATES WISE COUNTY MEDIAN HOUSEHOLD INCOME AT 38,255 COMPARED TO THE STATE OF VIRGINIA'S MEDIAN INCOME OF 68,766. NORTON CITY'S MEDIAN INCOME IS 26,971, 155% BELOW THE STATE MEDIAN. 29% OF WISE COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 14% STATEWIDE. WISE COUNTY IS ALMOST 57% RURAL COMPARED WITH THE STATEWIDE RURAL RATE OF 24.5%. THIS IS A SIGNIFICANT CONTRIBUTING FACTOR IN INFLUENCING HEALTH OUTCOMES IN A POPULATION. MANY RURAL RESIDENTS MUST TRAVEL A GREATER DISTANCE TO ACCESS DIFFERENT POINTS OF THE HEALTH CARE DELIVERY SYSTEM; HOWEVER, DUE TO GEOGRAPHIC DISTANCE, SOMETIMES EXTREME WEATHER CONDITIONS, LACK OF PUBLIC TRANSPORTATION AND CHALLENGING ROADS, RURAL RESIDENTS MAY BE LIMITED, AND IN SOME INSTANCES, EVEN PROHIBITED FROM ACCESSING HEALTH CARE SERVICES. MORE THAN 50% OF VEHICLE CRASH-RELATED FATALITIES OCCUR IN RURAL AREAS, EVEN THOUGH LESS THAN ONE-THIRD OF MILES TRAVELED IN A VEHICLE OCCUR THERE. AND THERE IS AN ADDITIONAL 22% RISK OF INJURY-RELATED DEATHS IN RURAL COMMUNITIES. WITHIN OUR OWN COUNTY, INJURY DEATHS ARE 40% HIGHER THAN THE STATEWIDE RATE. WISE COUNTY'S PREMATURE (AGE ADJUSTED) MORTALITY IS 87.5% HIGHER THAN THE STATE RATE. AND, WHILE OUR AREA HAS GENERALLY UNFAVORABLE HEALTH STATISTICS, THERE ARE FAR FEWER PRIMARY CARE PHYSICIANS PER RESIDENT IN OUR COUNTY THAN THE STATE'S AVERAGE. OUR COUNTY'S RATIO OF POPULATION TO PRIMARY CARE PHYSICIANS IS 1,990:1 COMPARED TO THE STATE'S AVERAGE OF 1,320:1. IN OTHER WORDS, WE HAVE 51% MORE RESIDENTS PER PHYSICIAN THAN THE OVERALL STATE RATE AND 93% HIGHER THAN TOP PERFORMING U.S. COUNTIES. RECRUITING PHYSICIANS TO RURAL AREAS IS OFTEN CHALLENGING DUE TO A MYRIAD OF FACTORS, SUCH AS GEOGRAPHY, ECONOMICS, CULTURE AND EDUCATION. GEOGRAPHICALLY, RURAL COMMUNITIES ARE OFTEN FAR REMOVED FROM SUBURBAN AND URBAN CENTERS THAT PROVIDE ACCESS TO EDUCATION, CULTURAL AND ECONOMIC OPPORTUNITIES. THESE LIMITATIONS INFLUENCE THE RELOCATION DECISION OF THE PHYSICIAN CANDIDATE AND HIS/HER SPOUSE/CHILDREN TO LOCATE TO A RURAL AREA. A NUMBER OF FACTORS CONTRIBUTE TO A UNIQUE AND CHALLENGING ENVIRONMENT THAT INFLUENCE OVERALL HEALTH STANDING IN OUR COUNTY. ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS, 31% OF THE ADULTS IN NCH'S HOME COUNTY ARE OBESE. OBESITY INCREASES THE RISK FOR MANY HEALTH CONDITIONS SUCH AS CORONARY HEART DISEASE, TYPE 2 DIABETES, HYPERTENSION, STROKE, CANCER, SLEEP APNEA AND RESPIRATORY PROBLEMS, AND OSTEOARTHRITIS. EVIDENCE INDICATES PHYSICAL ACTIVITY, INDEPENDENT OF ITS EFFECT ON WEIGHT, HAS SUBSTANTIAL BENEFITS FOR HEALTH. OUR COUNTY'S INACTIVITY RATE OF 31% IS ALMOST 41% HIGHER THAN THE STATEWIDE RATE. WISE COUNTY'S ADULT SMOKING RATE IS 40% HIGHER THAN THAT OF VIRGINIA'S AVERAGE. OTHER DEMOGRAPHIC FACTORS INFLUENCING HEALTH STATUS IN THE COUNTY ALSO INCLUDE EDUCATION LEVELS. THE MAJORITY OF WISE COUNTY RESIDENTS HOLD A HIGH SCHOOL DIPLOMA, AT 31.7%. HIGHER EDUCATION DROPS SIGNIFICANTLY WITH ONLY 13.5% HOLDING A BACHELOR'S DEGREE OR HIGHER. ACCORDING TO THE 2018 COUNTY HEALTH RANKINGS, WISE COUNTY IS RANKED 124TH OUT OF 133 COUNTIES IN VIRGINIA FOR HEALTH OUTCOMES AND 114TH IN HEALTH BEHAVIORS. WHEN COMPARED TO OTHER VIRGINIA COUNTIES, WISE COUNTY HAS HIGH RATES OF ADULT OBESITY AND PHYSICAL INACTIVITY AS WELL AS HIGH RATES OF ALCOHOL- IMPAIRED DRIVING DEATHS. AS FOR SOCIAL AND ECONOMIC FACTORS, WISE COUNTY RANKS 126TH DUE TO LOWER RATES OF HIGH SCHOOL EDUCATION, HIGH RATES OF CHILDREN IN POVERTY AND HIGHER UNEMPLOYMENT RATES.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	NCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. NCH'S LEADERSHIP REMAINS MINDFUL OF MANAGING LIMITED RESOURCES SO THAT ADEQUATE FACILITIES AND EQUIPMENT ARE AVAILABLE FOR THE CARE OF OUR PATIENTS. SURPLUS FUNDS ARE INVESTED INTO IMPROVING TREATMENT OPTIONS FOR OUR PATIENTS THROUGH NEW TECHNOLOGIES, RECRUITING PHYSICIANS AND TRAINED STAFF IN SHORTAGE AREAS, AND IMPROVING OUR FACILITIES. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. NCH HAS A MEDICARE-APPROVED INTERNAL MEDICINE RESIDENCY EDUCATION PROGRAM. IN ADDITION, OUR HOSPITAL SERVES AS A TRAINING SITE FOR MANY OTHER TYPES OF HEALTH PROFESSIONS SUCH AS NURSING, PHARMACY, RESPIRATORY THERAPY, AND OTHER ALLIED HEALTH PROGRAMS. WE PROVIDE FOR MEDIA COVERAGE TO EDUCATE OUR COMMUNITY ON HEALTH ISSUES, PROVIDE FREE CLINICAL CARE TO LOW INCOME INDIVIDUALS IN COLLABORATION WITH OTHER NONPROFIT ORGANIZATIONS, AND PROVIDE FREE DRUGS AND SUPPLIES TO LOCAL NONPROFIT EMERGENCY RESPONSE ORGANIZATIONS. NCH OWNS DICKENSON COUNTY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN THE APPALACHIAN MOUNTAINS. DICKENSON IS 100% RURAL ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S 2018 COUNTY HEALTH RANKINGS REPORT. DICKENSON COUNTY'S MEDIAN HOUSEHOLD INCOME IS JUST UNDER 51% OF THE MEDIAN STATEWIDE INCOME AND THE COUNTY'S HEALTH OUTCOMES RANK 125 OUT OF 133 IN THE STATE. DCH OPERATES AT A SUBSTANTIAL FINANCIAL LOSS AND RELIES ON NCH TO SUBSIDIZE ITS OPERATIONS. NCH'S CAPITAL CONTRIBUTION TO DCH WAS ALMOST 833,000. THE MAJORITY OF NCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREAS. SOME OF OUR BOARD MEMBERS ARE NOT CONSIDERED INDEPENDENT, PER IRS FORM 990 INSTRUCTIONS. FOUR WERE EMPLOYED BY NCH'S MAJORITY OWNER, MOUNTAIN STATES HEALTH ALLIANCE. TWO MEMBERS LACK INDEPENDENCE BECAUSE THEY RECEIVED 1099 REPORTABLE COMPENSATION EXCEEDING 10,000 FOR HEALTH INSURANCE PAID BY NCH. TWO MEMBERS ARE NOT CONSIDERED INDEPENDENT BECAUSE THEY HAD A FAMILY MEMBER EMPLOYED BY NCH DURING THE YEAR (IN A NON-MANAGERIAL POSITION). ONE BOARD MEMBER IS NOT INDEPENDENT BECAUSE HE WAS EMPLOYED BY NCH AS A PHYSICIAN. ANOTHER BOARD MEMBER WAS NOT INDEPENDENT BECAUSE HE WAS EMPLOYED BY NCH AS A PHYSICIAN AND ALSO HAD A FAMILY MEMBER EMPLOYED BY NCH (IN A NON-MANAGERIAL POSITION). PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY NCH
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	NCH IS A 129-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 14-MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. NCH IS ONE OF THE HOSPITALS WITHIN THE BALLAD HEALTH SYSTEM. BALLAD HEALTH OPERATES A FAMILY OF 21 HOSPITALS, INCLUDING THREE TERTIARY CARE FACILITIES, A DEDICATED CHILDREN'S HOSPITAL, COMMUNITY HOSPITALS, THREE CRITICAL ACCESS HOSPITALS, A BEHAVIORAL HEALTH HOSPITAL, AN ADDICTION TREATMENT FACILITY, LONG-TERM CARE FACILITIES, HOME CARE AND HOSPICE SERVICES, RETAIL PHARMACIES, OUTPATIENT SERVICES AND A COMPREHENSIVE MEDICAL MANAGEMENT CORPORATION. PATIENTS BENEFIT FROM NCH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. IF NEEDED, PATIENTS CAN BE MOVED TO ONE OF BALLAD HEALTH'S TERTIARY CARE FACILITIES PROVIDING ADVANCED TREATMENT OPTIONS.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	VIRGINIA, TENNESSEE
ADDITIONAL INFORMATION	BALLAD HEALTH IS REQUIRED TO REPORT COMMUNITY BENEFIT ESTIMATES ON A QUARTERLY BASIS WITH THE STATES OF VIRGINIA AND TENNESSEE. THE REPORTING INCLUDES ALL OF BALLAD'S HOSPITAL ORGANIZATIONS AND IS REPORTED USING IRS FORM 990, SCHEDULE H INSTRUCTIONS FOR REPORTING COMMUNITY BENEFIT. BALLAD OPERATES UNDER A COOPERATIVE AGREEMENT (CA) IN VIRGINIA AND A CERTIFICATE OF PUBLIC ADVANTAGE (COPA) IN TENNESSEE AS OBLIGATED BY AGREEMENTS BETWEEN BALLAD AND THE TWO STATES TO ALLOW MOUNTAIN STATES HEALTH ALLIANCE AND WELLMONT HEALTH SYSTEM TO MERGE.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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
NORTON COMMUNITY HOSPITAL INC

Employer identification number
54-0566029

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	(e) Amount of non-cash assistance	(h) Purpose of grant or assistance
(1) UNIV OF VA AT WISE ALUMNI ASSOC 1 COLLEGE AVENUE WISE,VA24293	23-7039917	501C3	6,000		SPONSOR ALUMNI ASSOC
(2) UNIV OF VA AT WISE FOUNDATION 1 COLLEGE AVENUE WISE,VA24293	54-1638774	501C3	25,000		ATHLETIC PROGRAMS
(3) NORTON RESCUE SQUAD INC 1710 MAIN AVENUE SW NORTON,VA24273	52-1358372	501C3	5,000	1,276	EMS SUPPLIES

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)
(2)
(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

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

Schedule I (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

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? .........

Yes

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)
1MARVIN EICHORN MSHA EVPCOO DIRECTOR	(i) (ii)	------------- 576,652	------------- 128,590	------------- 43,977	------------- 18,900	------------- 23,842	------------- 791,961	-------------
2MATHEW CUSANO MD PHYSICIAN & DIRECTOR	(i) (ii)	282,721 -------------	93,223 -------------	33,862 -------------	8,891 -------------	22,092 -------------	440,789 -------------	-------------
3SHANE HILTON SVP MARKET OPER DIRECTOR	(i) (ii)	------------- 328,389	------------- 63,529	------------- 4,174	------------- 35,389	------------- 23,198	------------- 454,679	-------------
4MONTY MCLAURIN VPCEO NW MKT VICE CHAIR & VP	(i) (ii)	------------- 301,780	------------- 36,465	------------- 48,537	------------- 31,532	------------- 23,172	------------- 441,486	------------- 15,920
5JAMES MATT WILSON MD PHYSICIAN & DIRECTOR	(i) (ii)	222,254 -------------	28,637 -------------	872 -------------	6,374 -------------	17,461 -------------	275,598 -------------	-------------
6TOM TULL MSHA VP DIRECTOR	(i) (ii)	------------- 169,186	------------- 31,777	------------- 11,000	------------- 13,998	------------- 11,218	------------- 237,179	-------------
7MARK LEONARD NCH/DCH CEO	(i) (ii)	------------- 256,905	------------- 37,607	------------- 13,825	------------- 28,138	------------- 21,114	------------- 357,589	-------------
8STEPHEN SAWYER AVP CFO NW MKT AVP/CFO NW MARKET	(i) (ii)	------------- 177,000	------------- 17,273	------------- 8,875	------------- 9,343	------------- 22,434	------------- 234,925	-------------
9ROBERT MITCH KENNEDY CNO NCH CNO	(i) (ii)	134,514 -------------	11,039 -------------	5,666 -------------	4,202 -------------	18,687 -------------	174,108 -------------	-------------
10VISHAL RAJ MD PHYSICIAN	(i) (ii)	508,272 -------------	20,000 -------------	18,193 -------------	15,122 -------------	15,459 -------------	577,046 -------------	-------------
11ELLIE TONY NADER MD PHYSICIAN	(i) (ii)	420,257 -------------	20,000 -------------	799 -------------	-------------	9,598 -------------	450,654 -------------	-------------
12DARYL PIERCE MD PHYSICIAN	(i) (ii)	409,967 -------------	-------------	5,082 -------------	12,546 -------------	21,546 -------------	449,141 -------------	-------------
13MICHAEL GREEN MD PHYSICIAN	(i) (ii)	388,521 -------------	-------------	7,170 -------------	8,057 -------------	1,218 -------------	404,966 -------------	-------------
14RUBYE WASHINGTON-MOORE MD PHYSICIAN	(i) (ii)	301,421 -------------	7,500 -------------	21,668 -------------	8,337 -------------	22,866 -------------	361,792 -------------	-------------

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, PAGE 1, PART I, LINE 4

SHANE HILTON, SVP MARKET OPER. 0 17,507 0 MONTY MCLAURIN, VP/CEO NW MKT. 0 16,160 0 MARK LEONARD 0 13,619 0

SCHEDULE J, PART III

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

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
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

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JAMIE FLEMING	FAMILY MEMBER	33,557	SEE PART V		No
(2) DEBBIE WARD	FAMILY MEMBER	70,353	SEE PART V		No
(3) JESSICA WILSON	FAMILY MEMBER	11,864	SEE PART V		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
SCHEDULE L, PART V	(D1) JAMES MANICURE, NORTON COMMUNITY HOSPITAL (NCH) BOARD MEMBER, IS A FAMILY MEMBER OF JAMIE FLEMING, AN EMPLOYEE OF NCH. (D2) ERNIE WARD, NORTON COMMUNITY HOSPITAL (NCH) BOARD MEMBER, IS A FAMILY MEMBER OF DEBBIE WARD, AN EMPLOYEE OF NCH. (D3) JAMES WILSON, NORTON COMMUNITY HOSPITAL (NCH) BOARD MEMBER, IS A FAMILY MEMBER OF JESSICA WILSON, AN EMPLOYEE OF NCH.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

Return Reference	Explanation
FORM 990, PAGE 2, PART III, LINE 4A	(CONT'D) BALLAD OPERATES 3,293 LICENSED BEDS IN 21 HOSPITALS, AN OUTPATIENT ADDICTION TREATMENT FACILITY, LONG-TERM CARE FACILITIES, HOME CARE AND HOSPICE SERVICES, RETAIL PHARMACIES, OUTPATIENT SERVICES AND A COMPREHENSIVE MEDICAL MANAGEMENT CORPORATION. NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED JUST OVER 12,000 BLACK LUNG PROCEDURES THIS YEAR. MSHA'S GRANTS AND AWARDS DEPARTMENT WORKS THROUGHOUT THE YEAR WRITING GRANT APPLICATIONS FOR PROGRAMS TO BENEFIT COMMUNITIES THROUGHOUT MSHA'S LARGE SERVICE AREA. EXAMPLES OF THIS REPORTING PERIOD INCLUDED: A GRANT RENEWAL TO PAY THE SALARY AND BENEFITS FOR A MEDICATION ASSISTANCE CASEWORKER TO EXPAND OUR MEDICATION ASSISTANCE PROGRAM TO NORTON COMMUNITY HOSPITAL, SERVING WISE, DICKENSON, AND RUSSELL COUNTIES. HAVING THIS PROGRAM IN SOUTHWEST VIRGINIA ENABLES US AS A HEALTH SYSTEM TO COME FULL CIRCLE BY SERVING PATIENTS GOING FROM HOSPITAL DISCHARGE TO DOCTORS' OFFICES AND VICE-VERSA. THIS PROGRAM HELPS US TO BETTER SERVE OUR UNINSURED AND UNDERINSURED PATIENTS AND PLAYS A SIGNIFICANT ROLE IN IMPROVING PATIENTS' HEALTH, REDUCING HOSPITAL READMISSIONS, AND ASSISTING DOCTORS IN PROVIDING PROPER TREATMENT TO THIS PATIENT GROUP WHO TRADITIONALLY CAN BE NON-COMPLIANT WITH MEDICATIONS DUE TO PRESCRIPTIONS BEING COST-PROHIBITIVE. NCH OFFERS A FREE SUPPORT GROUP, "THE BETTER BREATHERS CLUB", FOR PEOPLE WITH COPD, ASTHMA, CHRONIC BRONCHITIS, LUNG CANCER AND OTHER PULMONARY DISEASES. THE CLUB MEETS MONTHLY WHERE MEMBERS CAN RECEIVE VALUABLE INFORMATION AND DEVELOP SKILLS TO HELP BETTER MANAGE BREATHING DIFFICULTIES AND IMPROVE THEIR QUALITY OF LIFE. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 113,737 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. IN ADDITION, MSHA CORPORATE ALLOCATES A PORTION OF ITS PHYSICIAN RECRUITMENT DEPARTMENTAL EXPENSES SINCE THAT DEPARTMENT SERVICES ALL MSHA DIVISIONS, INCLUDING NCH. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S, ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. NCH RECRUITMENT EXPENSE DURING FY18 INCLUDED PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. A PORTION OF OUR RECRUITMENT IS PHYSICIAN DEBT FORGIVEN BY THE HOSPITAL OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY AND CONTINUES PROVIDING MEDICAL SERVICES TO OUR RESIDENTS. AS WE NOTED ON NCH'S FY17 FORM 990, MSHA IS ONE OF ONLY 32 ORGANIZATIONS IN THE COUNTRY SELECTED TO BE PART OF THE U.S. CENTERS FOR MEDICARE & MEDICAID SERVICES' (CMS) NEW INITIATIVE, ACCOUNTABLE HEALTH COMMUNITIES (AHC), AIMED AT IMPROVING THE HEALTH OF MEDICARE AND MEDICAID BENEFICIARIES. THE NEW CMS PROGRAM IS DESIGNED TO INTEGRATE CARE FOR HEALTH-RELATED SOCIAL NEEDS INTO USUAL CARE BY IMPLEMENTING SYSTEMATIC SCREENING, REFERRAL, AND PATIENT NAVIGATION SERVICES FOR NEEDS SUCH AS FOOD INSECURITY, HOUSING INSTABILITY, SAFETY, TRANSPORTATION NEEDS, AND UTILITY ASSISTANCE. MOUNTAIN STATES SERVES AS THE BRIDGE ORGANIZATION FOR THE PROJECT LOCALLY, LEADING A COLLABORATIVE OF MULTIPLE ORGANIZATIONS AND CLINICAL DELIVERY SITES TO BRING NEEDED SERVICES TO BENEFICIARIES RESIDING IN SOUTHWEST VIRGINIA. THE FIRST STEPS IN IMPLEMENTING THE AHC COOPERATIVE AGREEMENT WERE COMPLETED DURING FY18. SIX FULL-TIME TEAM MEMBERS WERE HIRED, WHOSE POSITIONS ARE FINANCED BY THE FEDERAL FUNDS, (3 NAVIGATORS, 1 LEAD NAVIGATOR, 1 SCREENING AND REFERRAL SPECIALIST, AND 1 PROGRAM MANAGER), WHILE THREE FULL-TIME AND ONE PART-TIME NAVIGATOR POSITIONS REMAINED OPEN AS OF 6/30/18. IN ADDITION, MSHA ADMINISTRATIVE TEAM MEMBERS PROVIDED MORE THAN 700 HOURS OF THEIR TIME TO THIS INITIATIVE. WHEN FULLY IMPLEMENTED, OVER 50 UNITS AT CLINICAL DELIVERY SITES IN SOUTHWEST VIRGINIA, INCLUDING NORTON COMMUNITY HOSPITAL, AND NORTHEAST TENNESSEE WILL HAVE A SCREENING PROCESS IN PLACE TO IDENTIFY HEALTH-RELATED SOCIAL NEEDS. PATIENTS THAT SCREEN POSITIVE FOR HEALTH- RELATED SOCIAL NEEDS ARE GIVEN A "COMMUNITY REFERRAL SUMMARY", WHICH CONTAINS CONTACT AND PROGRAM INFORMATION FOR RELEVANT RESOURCES THAT ASSIST WITH THE NEEDS IDENTIFIED BY THE SCREENING. DURING FY18, EDUCATION AND PILOT TESTING FOR SCREENING PROCESSES OCCURRED AT 17 PRIMARY CARE PHYSICIAN OFFICES, TEN EMERGENCY DEPARTMENTS, THREE INPATIENT LABOR AND DELIVERY UNITS, THREE INPATIENT PSYCHIATRY UNITS, AND ONE INTENSIVE OUTPATIENT PSYCHIATRY UNIT. DURING THE FALL OF 2017 AND WINTER OF 2018, A PROCESS WAS TESTED USING A DATA SYSTEM DEVELOPED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN TOTAL, 2,547 HEALTH-RELATED SOCIAL NEEDS SCREENINGS OF VIRGINIA MEDICARE AND MEDICAID BENEFICIARIES WERE COMPLETED USING THE SYSTEM. DURING THIS PILOT TESTING, A NUMBER OF OPERATIONAL OBSTACLES WERE IDENTIFIED, INCLUDING DUPLICATIVE DATA ENTRY TASKS, LENGTHY LOG-IN STEPS, AND MANUAL CREATION OF THE COMMUNITY REFERRAL SUMMARIES. DATA ENTRY TIME TOOK TOO LONG, SO MOUNTAIN STATES TRANSITIONED FROM THE CMS DATA SYSTEM TO AN INTERNALLY-PRODUCED SYSTEM. THIS TRANSITION IMPROVED OPERATIONAL EFFICIENCY BY AT LEAST FIVE-FOLD. PATIENT NAVIGATORS WERE TRAINED IN DISCIPLINES SUCH AS MENTAL HEALTH FIRST AID, INTERPERSONAL COMMUNICATION, AND MANY OTHER RELATED TOPICS. THE NAVIGATORS WERE DEPLOYED TO WORK FROM FIVE VIRGINIA COMMUNITY SERVICES BOARDS IN OUR SERVICE AREA. NAVIGATORS WORK FROM COMMUNITY SERVICES BOARDS TO IMPROVE THE REFERRAL PROCESS, AS WE EXPECT A LARGE NUMBER OF BEHAVIORAL HEALTH-RELATIVE NEEDS TO BE IDENTIFIED DURING NAVIGATION SERVICES. LAPTOPS AND CELL PHONES WERE PURCHASED FOR THE NAVIGATORS TO HAVE THE ABILITY TO WORK FROM THE COMMUNITY SERVICES BOARDS, CLINICAL DELIVERY SITES, AND POTENTIALLY OTHER LOCATIONS TO MEET PATIENTS. NAVIGATION SERVICES WERE PILOTED WITH PATIENTS, LEADING TO CHANGES IN THE QUESTION SETS, WHICH IMPROVED EFFICIENCY BY REDUCING THE AMOUNT OF TIME REQUIRED FOR EACH PATIENT AND THE NUMBER OF QUESTIONS PATIENTS MUST ANSWER. BETWEEN MARCH 1 AND JUNE 30, NAVIGATION SERVICES PROVIDED AS PART OF OUR PILOT RESOLVED THE HEALTH-RELATED SOCIAL NEEDS OF 47 PATIENTS, WHILE NAVIGATORS WORKED WITH 70 ADDITIONAL PATIENTS DURING THIS PILOT. MSHA'S PARENT COMPANY, BALLAD HEALTH, EMBARKED ON A CAMPAIGN NEAR THE END OF THIS FISCAL YEAR TO REDUCE HOSPITAL-ACQUIRED C. DIFF BY 30% IN 90 DAYS. THIS IS A BOLD UNDERTAKING BY BALLAD HEALTH'S NEW CLINICAL COUNCIL AND OUR INFECTION PREVENTION DEPARTMENT. C. DIFF IS A SIGNIFICANT THREAT TO HOSPITAL PATIENTS EVERYWHERE. IT'S OUR DUTY AS CAREGIVERS TO PROTECT OUR PATIENTS FROM HARM ALL OF THE TIME, SO PREVENTING C. DIFF IS VITAL. OUR PLAN INVOLVES SOME BASIC STEPS OUR CLINICAL TEAM MEMBERS SHOULD ALWAYS TAKE TO AVOID THIS INFECTION. THE PLAN REQUIRES ALL TEAM MEMBERS TO BE MINDFUL OF HOW THEY TREAT C. DIFF., WITH TEAM MEMBERS INVOLVED IN THE TREATMENT PROCESS RECEIVING SPECIFIC INFORMATION APPROPRIATE FOR THEIR ROLE. IN ADDITION, A VIDEO IS AVAILABLE ON OUR INTRANET SITE THAT ILLUSTRATES SOME OF THE KEY TAKEAWAYS. OUR ULTIMATE GOAL IS ZERO HOSPITAL-ACQUIRED C. DIFF INFECTIONS. FOLLOWING MSHA AND WHS'S MERGER THIS YEAR, TEAM MEMBERS TRANSITIONED TO STANDARD SCRUB COLORS, WHICH MEANT TEAM MEMBERS' SCRUBS THROUGHOUT OUR MANY HOSPITALS AND CLINICS, INCLUDING NCH, HAD TO BE REPLACED. A TEAM MEMBER FROM FRANKLIN WOODS COMMUNITY HOSPITAL RECOGNIZED AN OPPORTUNITY TO HELP OTHERS BY ORGANIZING A "SAVE OUR SCRUBS" PROGRAM TO COLLECT USED SCRUBS FOR DONATION TO A GLOBAL CHARITY. THE CHARITY IS A MEDICAL RELIEF ORGANIZATION THAT COLLECTS USED SCRUBS AND DONATES THEM TO HEALTHCARE WORKERS IN RESOURCE-POOR AREAS, INCLUDING COUNTRIES SUCH AS NICARAGUA, GUATEMALA, HAITI AND GUYANA, WHERE HOSPITALS OFTEN HAVE A SHORTAGE OF UNIFORMS. PROVIDING SCRUBS TO THESE HOSPITALS ALLOWS OTHER CRITICAL MEDICAL NEEDS, SUCH AS MEDICINES AND SURGICAL SUPPLIES, TO BE MORE EASILY FUNDED. IN ADDITION TO GENTLY USED SCRUBS, OUR TEAM MEMBERS DONATED JACKETS, LAB COATS, HEALTHCARE SHOES, AND OTHER MEDICAL APPAREL. THE PROGRAM WAS A GREAT SUCCESS ACROSS OUR BALLAD HEALTH SYSTEM: OUR TEAM MEMBERS DONATED MORE TH
FORM 990, PAGE 6, PART VI, LINE 6	NORTON COMMUNITY HOSPITAL, INC. IS ORGANIZED AS A VIRGINIA NON-STOCK, NONPROFIT CORPORATION. MOUNTAIN STATES HEALTH ALLIANCE IS THE 50.1% MEMBER OF NCH, WHILE COMMUNITY HEALTHCARE FOUNDATION, INC. IS THE 49.9% MEMBER.
FORM 990, PAGE 6, PART VI, LINE 7A	THERE ARE TWO CLASSES OF MEMBERS, AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE NORTON COMMUNITY HOSPITAL CLASS IS ELECTED BY THE COMMUNITY HEALTHCARE FOUNDATION BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT.
FORM 990, PAGE 6, PART VI, LINE 7B	CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS, ETC. NO ORDINARY DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL.
FORM 990, PAGE 6, PART VI, LINE 11B	THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS. THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW.
FORM 990, PAGE 6, PART VI, LINE 12C	BALLAD HEALTH HAS A CONFLICT OF INTEREST POLICY FOR ALL MEMBERS OF THE BOARD OF DIRECTORS, THE EXECUTIVE CHAIR/PRESIDENT, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND VICE PRESIDENTS, AND APPLIES TO ALL BALLAD HEALTH ORGANIZATIONS, INCLUDING NORTON COMMUNITY HOSPITAL. ALL PERSONS COVERED BY THIS POLICY ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS. SHOULD A CONFLICT ARISE, IT IS THE RESPONSIBILITY OF THE CONFLICTED INDIVIDUAL TO UPDATE HIS OR HER DISCLOSURE IMMEDIATELY. ALL MEETINGS OF THE BOARD OR BOARD COMMITTEES HAVE A STANDING AGENDA ITEM FIRST ON THE AGENDA TITLED "CONFLICTS OF INTEREST". IF A MEMBER OF THE BOARD OR BOARD COMMITTEE HAS A CONFLICT OF INTEREST INVOLVING ANY ISSUE ON THE BOARD AGENDA, HE OR SHE MUST DECLARE THE CONFLICT OF INTEREST DURING THE PERIOD ALLOTTED FOR DISCLOSURE. IF ANY ISSUE ARISES DURING A MEETING IN WHICH THE BOARD MEMBER HAS A CONFLICT OF INTEREST, HE OR SHE MUST IMMEDIATELY DECLARE THE CONFLICT. WHILE EACH MEMBER OF THE BOARD OR BOARD COMMITTEE IS RESPONSIBLE FOR DISCLOSING CONFLICTS OF INTEREST, IT IS ALSO THE RESPONSIBILITY OF ANY BOARD MEMBER AWARE OF A CONFLICT WHICH HAS NOT BEEN DISCLOSED TO ENSURE THE BOARD IS MADE AWARE. THE PRESIDING OFFICER OF A BOARD OR BOARD COMMITTEE MEETING MAY ASK A CONFLICTED MEMBER TO EXCUSE THEMSELVES FROM THE MEETING DURING THE DISCUSSION RELATED TO THE ISSUE WITH WHICH THE CONFLICT OF INTEREST APPLIES. UNDER NO CIRCUMSTANCES SHALL A MEMBER VOTE ON A MATTER THAT GIVES RISE TO A POTENTIAL CONFLICT.
FORM 990, PAGE 6, PART VI, LINE 15A	ON AN ANNUAL BASIS, BALLAD HEALTH'S HUMAN RESOURCES (H/R) DEPARTMENT EVALUATES COMPENSATION FOR ALL EXECUTIVES AT A POSITION LEVEL OF ASSISTANT VICE PRESIDENT AND ABOVE. THE REVIEW INCLUDES NCH/DCH'S CEO. H/R'S EVALUATION IS BASED ON MARKET DATA OBTAINED FROM INDEPENDENT THIRD- PARTY CONSULTANTS FOR POSITIONS WITH SIMILAR RESPONSIBILITIES AT SIMILARLY SITUATED ORGANIZATIONS. BASED ON THIS COMPARABLE DATA, BALLAD HEALTH'S PRESIDENT & CEO EVALUATES THE DATA AND SUBMITS HIS RECOMMENDATIONS TO BALLAD HEALTH'S BOARD OF DIRECTORS FOR THEIR FINAL REVIEW AND APPROVAL.
FORM 990, PAGE 6, PART VI, LINE 15B	SIMILAR TO NCH/DCH'S CEO, NCH'S CFO RECEIVES COMPENSATION THAT COMPLIES WITH BALLAD HEALTH'S SALARY POLICY AND UNDERGOES THE SAME REVIEW AND APPROVAL PROCESS BY BALLAD HEALTH'S BOARD OF DIRECTORS AS THE CEO, AS DESCRIBED IN 15A. TWO PHYSICIANS SERVE ON NCH'S BOARD. THEIR COMPENSATION RELATES TO MEDICAL SERVICES PROVIDED TO NCH.
FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY. FORM 990, PART VII- RELATED ORGANIZATIONS DIRECTOR COMPENSATION: NORTON COMMUNITY HOSPITAL'S BOARD OF DIRECTORS, MARVIN EICHORN, SHANE HILTON, MONTY MCLAURIN, AND TOM TULL RECEIVE COMPENSATION FOR SERVICES PROVIDED TO RELATED ORGANIZATIONS AND DO NOT RECEIVE COMPENSATION FOR SERVICES AS A NCH BOARD MEMBER. FORM 990, PART X - ADDITIONAL INFORMATION PART IV, LINE 24A AND PART X, LINE 20 - TAX EXEMPT BOND LIABILITY THE TAX EXEMPT BOND LIABILITY REFLECTS THE PORTION OF BONDS ISSUED BY MOUNTAIN STATES HEALTH ALLIANCE, NCH'S MAJORITY OWNER, ON BEHALF OF NCH FOR CAPITAL NEEDS. NCH PAYS ALL COSTS RELATED TO THIS PORTION OF THE BOND ISSUE.
FORM 990, PART IX, LINE 11G	HOSPITAL SUPPORTED CLINICS 1,013,202 0 0 HOSPITAL BASED PROVIDERS 1,303,849 0 0 PHYSICIAN FEES 2,410,880 0 0 CONTRACT LABOR 70,515 29,142 0 COLLECTION FEES 0 423,662 0 LAUNDRY & HOUSEKEEPING SVCS. 359,840 0 0 CONSULTING FEES 0 214,825 0 FACILITIES & CONSTRUCTION MGM 0 99,018 0 TRANSCRIPTION SVCS. 0 59,426 0 VARIOUS FEES 128,261 281,745 0 TOTAL 5,286,547 1,107,818 0
FORM 990, PART XI, LINE 9	PENSION PLAN ADJUSTMENT 760,822 CHANGE IN TEMP. RESTRICTED ASSETS -46,019 ELIMINATION OF INTERCOMPANY REC/PAY -832,469 EMPLOYER PROVIDED PARKING-NOT ON BOOKS -18,542 TOTAL -136,208
FORM 990, PAGE 12, PART XII, LINE 2C	BALLAD HEALTH (BALLAD) IS A TAX-EXEMPT ENTITY AND THE PARENT CORPORATION OF BOTH MOUNTAIN STATES HEALTH ALLIANCE (MSHA) AND WELLMONT HEALTH SYSTEM (WHS). THE TWO HEALTHCARE SYSTEMS CAME TOGETHER ON FEBRUARY 1, 2018 AS A RESULT OF A MERGER APPROVED BY BOTH VIRGINIA AND TENNESSEE DEPARTMENTS OF HEALTH. THE INDIVIDUALS SERVING AS THE BOARD OF DIRECTORS OF BALLAD ALSO SERVE AS THE BOARD OF DIRECTORS OF MSHA AND WHS. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF BALLAD INCLUDE MSHA, WHS AND THEIR SUBSIDIARIES AND AFFILIATES WHICH WERE PREVIOUSLY INCLUDED IN EITHER MSHA OR WHS AUDITED CONSOLIDATED FINANCIAL STATEMENTS. BALLAD HAS AN AUDIT COMMITTEE WHICH ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.

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:

- TIN:

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

NORTON COMMUNITY HOSPITAL INC

Employer identification number

54-0566029

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
(1) NORTON COMMUNITY PHYSICIAN SVCS LLC 96 15TH STREET NW NORTON,VA24273 26-0868690	MED. SERV.	VA	8,347,325	2,837,574	NCH

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)MOUNTAIN STATES HEALTH ALLIANCE 303 MED TECH PARKWAY SUITE 220 JOHNSON CITY,TN37604 62-0476282	HOSP. SYS.	TN	501C3	3	BALLAD		No
(2)MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD SUITE 101 JOHNSON CITY,TN37604 58-1418862	FUNDRAISER	TN	501C3	12A	MSHA		No
(3)MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604 58-1418345	SUPP. ORG.	TN	501C3	12A	MSHA		No
(4)SMYTH COUNTY COMMUNITY HOSPITAL 245 MEDICAL PARK DRIVE MARION,VA24354 54-0794913	HOSPITAL	VA	501C3	3	MSHA		No
(5)COMMUNITY HEALTHCARE FOUNDATION 100 15TH STREET NW NORTON,VA24273 54-2002314	SUPP. ORG.	VA	501C3	12A	NA		No
(6)DICKENSON COMMUNITY HOSPITAL 312 HOSPITAL DRIVE CLINTWOOD,VA24228 77-0599553	HOSPITAL	VA	501C3	3	NCH		No
(7)JOHNSTON MEMORIAL HOSPITAL 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 54-0544705	HOSPITAL	VA	501C3	3	NA		No
(8)ABINGDON PHYSICIAN PARTNERS 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 20-5485346	MED. SERV.	VA	501C3	3	JMH		No
(9)BALLAD HEALTH 303 MED TECH PARKWAY SUITE 220 JOHNSON CITY,TN37604 61-1771290	SUPP. ORG.	TN	501C3	12B	NA		No
(10)EAST TN HEALTHCARE HOLDINGS INC 203 GRAY COMMONS CIRCLE GRAY,TN37615 81-5475903	OPIOID TRT	TN	501C3	3	MSHA		No
(11)WELLMONT HEALTH SYSTEM 1905 AMERICAN WAY KINGSPORT,TN37660 62-1636465	HOSP. SYS.	TN	501C3	3	BALLAD		No
(12)WELLMONT HAWKINS CO MEMORIAL HOSP 851 LOCUST STREET ROGERSVILLE,TN37857 62-1816368	HOSPITAL	TN	501C3	3	WHS		No
(13)TAKOMA REGIONAL HOSPITAL INC 401 TAKOMA AVENUE GREENEVILLE,TN37743 51-0603966	HOSPITAL	TN	501C3	3	WHS		No
(14)TAKOMA REGIONAL HOSPITAL FDN INC 1905 AMERICAN WAY KINGSPORT,TN37660 47-1334302	FUNDRAISER	TN	501C3	7	WHS		No
(15)WELLMONT CARDIOLOGY SERVICES 1905 AMERICAN WAY KINGSPORT,TN37660 26-3557623	MED. SERV.	TN	501C3	10	WHS		No
(16)WELLMONT MEDICAL ASSOCIATES 1905 AMERICAN WAY KINGSPORT,TN37660 27-0898372	MED. SERV.	TN	501C3	7	WHS		No
(17)WELLMONT FOUNDATION 1905 AMERICAN WAY KINGSPORT,TN37660 58-1594191	FUNDRAISER	TN	501C3	7	WHS		No
(18)WELLMONT MADISON HOUSE 1905 AMERICAN WAY KINGSPORT,TN37660 62-1308216	ASST. LIV.	TN	501C3	10	WHS		No
(19)WELLMONT WEXFORD HOUSE 1905 AMERICAN WAY KINGSPORT,TN37660 58-1859039	NSG. HOME	TN	501C3	10	WHS		No
(20)WELLMONT IMAGING SERVICES INC 1905 AMERICAN WAY KINGSPORT,TN37660 86-1103148	HEALTHCARE	TN	501C3	12A	WHS		No
(21)WELLMONT SLEEP SERVICES 1905 AMERICAN WAY KINGSPORT,TN37660 27-3777167	MED. SERV.	TN	501C3	3	WHS		No
(22)LAUGHLIN MEMORIAL HOSPITAL INC 1420 TUSCULUM BOULEVARD GREENEVILLE,TN37745 62-0701119	HOSPITAL	TN	501C3	3	MSHA		No
(23)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) EMMAUS COMMUNITY HEALTHCARE PLLC 6070 HWY 11E PINEY FLATS,TN37686 20-0577483	MED. SERV.	TN	NA				No			No
(2) MEDICAL SPECIALISTS OF JC LLC 2528 WESLEY STREET SUITE 2 JOHNSON CITY,TN37601 27-2199037	MED. SERV.	TN	NA				No			No
(3) EAST TN AMBULATORY SURGERY CNTR 701 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1787537	MED. SERV.	TN	NA				No			No
(4) GREENEVILLE PHYSICIAN SERVICES LLC 1905 AMERICAN WAY KINGSPORT,TN37645 45-5070419	MED. SERV.	TN	NA				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	(h) Percentage ownership	(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) BLUE RIDGE MEDICAL MANAGEMENT CORP 1905 AMERICAN WAY KINGSPORT,TN37660 62-1490616	MED. SERV.	TN	NA	C CORP					No
(2) MEDISERVE MEDICAL EQUIPMENT 1905 AMERICAN WAY KINGSPORT,TN37660 62-1212286	DME	TN	NA	C CORP					No
(3) MOUNTAIN STATES PROPERTIES 1905 AMERICAN WAY KINGSPORT,TN37660 62-1845895	PROP. MGMT	TN	NA	C CORP					No
(4) MOUNTAIN STATES PHYSICIAN GROUP 1905 AMERICAN WAY KINGSPORT,TN37660 62-1700412	MED. SERV.	TN	NA	C CORP					No
(5) COMMUNITY HOME CARE INC 1490 PARK AVENUE NW SUITE B NORTON,VA24273 54-1453810	DME	VA	NCH	C CORP	408,605	896,810	100.000 %	Yes
(6) WILSON PHARMACY INC PO BOX 5289 JOHNSON CITY,TN37604 62-0329587	PHARMACY	TN	NA	C CORP					No
(7) INTEGRATED SOLUTIONS HEALTH NETWORK 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1711997	HLTH NETWK	TN	NA	C CORP					No
(8) CRESTPOINT HEALTH INSURANCE COMPANY 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-0381170	INSURANCE	TN	NA	C CORP					No
(9) WELLMONT INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1320035	MED. SERV.	TN	NA	C CORP					No
(10) MCOT INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1325938	BUS. SERV.	TN	NA	C CORP					No
(11) MEDICAL MALL PHARMACY INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1565006	MED. SERV.	TN	NA	C CORP					No
(12) WELLMONT PHYSICIAN SERVICES 1905 AMERICAN WAY KINGSPORT,TN37660 62-1567353	MED. SERV.	TN	NA	C CORP					No
(13) WPS PROVIDERS INC 1905 AMERICAN WAY KINGSPORT,TN37660 20-5564642	MED. SERV.	TN	NA	C CORP					No
(14) WELLMONT HEALTH SERVICES INC 1905 AMERICAN WAY KINGSPORT,TN37660 62-1254373	MED. SERV.	TN	NA	C CORP					No
(15) WELLMONT INSURANCE CO SPC LTD 1905 AMERICAN WAY KINGSPORT,TN37660 98-1195624	INSURANCE		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 .....................

Yes

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

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) ...................

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 ............................

Yes

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

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

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
(1) COMMUNITY HOME CARE INC	A	27,266	FMV
(2) COMMUNITY HOME CARE INC	L	1,893	FMV
(3) COMMUNITY HOME CARE INC	M	1,275	FMV
(4) COMMUNITY HOME CARE INC	O	7,217	FMV
(5) COMMUNITY HOME CARE INC	Q	139,659	FMV
(6) DICKENSON COMMUNITY HOSPITAL	O	1,142,723	COST
(7) DICKENSON COMMUNITY HOSPITAL	Q	788,778	COST

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:

1	Briefly describe the organization’s mission or most significant activities: OUR MISSION: HONOR THOSE WE SERVE BY DELIVERING THE BEST POSSIBLE CARE. OUR VISION: TO BUILD A LEGACY OF SUPERIOR HEALTH BY LISTENING TO AND CARING FOR THOSE WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	664
6	Total number of volunteers (estimate if necessary) .............	6	10
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	53,463
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	38,449

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	98,297	61,404
9	Program service revenue (Part VIII, line 2g) .........	63,389,952	65,912,524
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	983,073	1,504,145
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	497,900	321,283
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	64,969,222	67,799,356
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	64,675	46,853
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)	35,591,617	36,789,287
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	26,493,911	26,186,816
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	62,150,203	63,022,956
19	Revenue less expenses. Subtract line 18 from line 12.......	2,819,019	4,776,400
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	96,531,232	100,425,685
21	Total liabilities (Part X, line 26).............	38,253,781	36,594,451
22	Net assets or fund balances. Subtract line 21 from line 20.....	58,277,451	63,831,234

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 53,897,706 including grants of $ 46,853 ) (Revenue $ 66,016,245 )
	NORTON COMMUNITY HOSPITAL (NCH) IS LOCATED IN NORTON, VIRGINIA. OUR 129-BED ACUTE-CARE FACILITY HAS SERVED SOUTHWEST VIRGINIA AND SOUTHEASTERN KENTUCKY SINCE 1949. AS THE LARGEST HEALTHCARE FACILITY IN THE COALFIELD REGION, NCH PROVIDES A WIDE ARRAY OF SERVICES THROUGH HIGHLY TRAINED PHYSICIANS, AND SUPPORT STAFF. NCH IS THE SOLE OWNER OF DICKENSON COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN CLINTWOOD, VIRGINIA. NCH IS A SUBSIDIARY OF MOUNTAIN STATES HEALTH ALLIANCE. IN FEBRUARY 2018, MOUNTAIN STATES HEALTH ALLIANCE (MSHA) AND WELLMONT HEALTH SYSTEM (WHS) MERGED TO FORM BALLAD HEALTH, A TAX-EXEMPT ENTITY AND PARENT COMPANY OF MSHA AND WHS. (CONT'D ON SCHEDULE O) (CONT'D) BALLAD OPERATES 3,293 LICENSED BEDS IN 21 HOSPITALS, AN OUTPATIENT ADDICTION TREATMENT FACILITY, LONG-TERM CARE FACILITIES, HOME CARE AND HOSPICE SERVICES, RETAIL PHARMACIES, OUTPATIENT SERVICES AND A COMPREHENSIVE MEDICAL MANAGEMENT CORPORATION. NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED JUST OVER 12,000 BLACK LUNG PROCEDURES THIS YEAR. MSHA'S GRANTS AND AWARDS DEPARTMENT WORKS THROUGHOUT THE YEAR WRITING GRANT APPLICATIONS FOR PROGRAMS TO BENEFIT COMMUNITIES THROUGHOUT MSHA'S LARGE SERVICE AREA. EXAMPLES OF THIS REPORTING PERIOD INCLUDED: A GRANT RENEWAL TO PAY THE SALARY AND BENEFITS FOR A MEDICATION ASSISTANCE CASEWORKER TO EXPAND OUR MEDICATION ASSISTANCE PROGRAM TO NORTON COMMUNITY HOSPITAL, SERVING WISE, DICKENSON, AND RUSSELL COUNTIES. HAVING THIS PROGRAM IN SOUTHWEST VIRGINIA ENABLES US AS A HEALTH SYSTEM TO COME FULL CIRCLE BY SERVING PATIENTS GOING FROM HOSPITAL DISCHARGE TO DOCTORS' OFFICES AND VICE-VERSA. THIS PROGRAM HELPS US TO BETTER SERVE OUR UNINSURED AND UNDERINSURED PATIENTS AND PLAYS A SIGNIFICANT ROLE IN IMPROVING PATIENTS' HEALTH, REDUCING HOSPITAL READMISSIONS, AND ASSISTING DOCTORS IN PROVIDING PROPER TREATMENT TO THIS PATIENT GROUP WHO TRADITIONALLY CAN BE NON-COMPLIANT WITH MEDICATIONS DUE TO PRESCRIPTIONS BEING COST-PROHIBITIVE. NCH OFFERS A FREE SUPPORT GROUP, "THE BETTER BREATHERS CLUB", FOR PEOPLE WITH COPD, ASTHMA, CHRONIC BRONCHITIS, LUNG CANCER AND OTHER PULMONARY DISEASES. THE CLUB MEETS MONTHLY WHERE MEMBERS CAN RECEIVE VALUABLE INFORMATION AND DEVELOP SKILLS TO HELP BETTER MANAGE BREATHING DIFFICULTIES AND IMPROVE THEIR QUALITY OF LIFE. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 113,737 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. IN ADDITION, MSHA CORPORATE ALLOCATES A PORTION OF ITS PHYSICIAN RECRUITMENT DEPARTMENTAL EXPENSES SINCE THAT DEPARTMENT SERVICES ALL MSHA DIVISIONS, INCLUDING NCH. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S, ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. NCH RECRUITMENT EXPENSE DURING FY18 INCLUDED PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. A PORTION OF OUR RECRUITMENT IS PHYSICIAN DEBT FORGIVEN BY THE HOSPITAL OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY AND CONTINUES PROVIDING MEDICAL SERVICES TO OUR RESIDENTS. AS WE NOTED ON NCH'S FY17 FORM 990, MSHA IS ONE OF ONLY 32 ORGANIZATIONS IN THE COUNTRY SELECTED TO BE PART OF THE U.S. CENTERS FOR MEDICARE & MEDICAID SERVICES' (CMS) NEW INITIATIVE, ACCOUNTABLE HEALTH COMMUNITIES (AHC), AIMED AT IMPROVING THE HEALTH OF MEDICARE AND MEDICAID BENEFICIARIES. THE NEW CMS PROGRAM IS DESIGNED TO INTEGRATE CARE FOR HEALTH-RELATED SOCIAL NEEDS INTO USUAL CARE BY IMPLEMENTING SYSTEMATIC SCREENING, REFERRAL, AND PATIENT NAVIGATION SERVICES FOR NEEDS SUCH AS FOOD INSECURITY, HOUSING INSTABILITY, SAFETY, TRANSPORTATION NEEDS, AND UTILITY ASSISTANCE. MOUNTAIN STATES SERVES AS THE BRIDGE ORGANIZATION FOR THE PROJECT LOCALLY, LEADING A COLLABORATIVE OF MULTIPLE ORGANIZATIONS AND CLINICAL DELIVERY SITES TO BRING NEEDED SERVICES TO BENEFICIARIES RESIDING IN SOUTHWEST VIRGINIA. THE FIRST STEPS IN IMPLEMENTING THE AHC COOPERATIVE AGREEMENT WERE COMPLETED DURING FY18. SIX FULL-TIME TEAM MEMBERS WERE HIRED, WHOSE POSITIONS ARE FINANCED BY THE FEDERAL FUNDS, (3 NAVIGATORS, 1 LEAD NAVIGATOR, 1 SCREENING AND REFERRAL SPECIALIST, AND 1 PROGRAM MANAGER), WHILE THREE FULL-TIME AND ONE PART-TIME NAVIGATOR POSITIONS REMAINED OPEN AS OF 6/30/18. IN ADDITION, MSHA ADMINISTRATIVE TEAM MEMBERS PROVIDED MORE THAN 700 HOURS OF THEIR TIME TO THIS INITIATIVE. WHEN FULLY IMPLEMENTED, OVER 50 UNITS AT CLINICAL DELIVERY SITES IN SOUTHWEST VIRGINIA, INCLUDING NORTON COMMUNITY HOSPITAL, AND NORTHEAST TENNESSEE WILL HAVE A SCREENING PROCESS IN PLACE TO IDENTIFY HEALTH-RELATED SOCIAL NEEDS. PATIENTS THAT SCREEN POSITIVE FOR HEALTH- RELATED SOCIAL NEEDS ARE GIVEN A "COMMUNITY REFERRAL SUMMARY", WHICH CONTAINS CONTACT AND PROGRAM INFORMATION FOR RELEVANT RESOURCES THAT ASSIST WITH THE NEEDS IDENTIFIED BY THE SCREENING. DURING FY18, EDUCATION AND PILOT TESTING FOR SCREENING PROCESSES OCCURRED AT 17 PRIMARY CARE PHYSICIAN OFFICES, TEN EMERGENCY DEPARTMENTS, THREE INPATIENT LABOR AND DELIVERY UNITS, THREE INPATIENT PSYCHIATRY UNITS, AND ONE INTENSIVE OUTPATIENT PSYCHIATRY UNIT. DURING THE FALL OF 2017 AND WINTER OF 2018, A PROCESS WAS TESTED USING A DATA SYSTEM DEVELOPED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN TOTAL, 2,547 HEALTH-RELATED SOCIAL NEEDS SCREENINGS OF VIRGINIA MEDICARE AND MEDICAID BENEFICIARIES WERE COMPLETED USING THE SYSTEM. DURING THIS PILOT TESTING, A NUMBER OF OPERATIONAL OBSTACLES WERE IDENTIFIED, INCLUDING DUPLICATIVE DATA ENTRY TASKS, LENGTHY LOG-IN STEPS, AND MANUAL CREATION OF THE COMMUNITY REFERRAL SUMMARIES. DATA ENTRY TIME TOOK TOO LONG, SO MOUNTAIN STATES TRANSITIONED FROM THE CMS DATA SYSTEM TO AN INTERNALLY-PRODUCED SYSTEM. THIS TRANSITION IMPROVED OPERATIONAL EFFICIENCY BY AT LEAST FIVE-FOLD. PATIENT NAVIGATORS WERE TRAINED IN DISCIPLINES SUCH AS MENTAL HEALTH FIRST AID, INTERPERSONAL COMMUNICATION, AND MANY OTHER RELATED TOPICS. THE NAVIGATORS WERE DEPLOYED TO WORK FROM FIVE VIRGINIA COMMUNITY SERVICES BOARDS IN OUR SERVICE AREA. NAVIGATORS WORK FROM COMMUNITY SERVICES BOARDS TO IMPROVE THE REFERRAL PROCESS, AS WE EXPECT A LARGE NUMBER OF BEHAVIORAL HEALTH-RELATIVE NEEDS TO BE IDENTIFIED DURING NAVIGATION SERVICES. LAPTOPS AND CELL PHONES WERE PURCHASED FOR THE NAVIGATORS TO HAVE THE ABILITY TO WORK FROM THE COMMUNITY SERVICES BOARDS, CLINICAL DELIVERY SITES, AND POTENTIALLY OTHER LOCATIONS TO MEET PATIENTS. NAVIGATION SERVICES WERE PILOTED WITH PATIENTS, LEADING TO CHANGES IN THE QUESTION SETS, WHICH IMPROVED EFFICIENCY BY REDUCING THE AMOUNT OF TIME REQUIRED FOR EACH PATIENT AND THE NUMBER OF QUESTIONS PATIENTS MUST ANSWER. BETWEEN MARCH 1 AND JUNE 30, NAVIGATION SERVICES PROVIDED AS PART OF OUR PILOT RESOLVED THE HEALTH-RELATED SOCIAL NEEDS OF 47 PATIENTS, WHILE NAVIGATORS WORKED WITH 70 ADDITIONAL PATIENTS DURING THIS PILOT. MSHA'S PARENT COMPANY, BALLAD HEALTH, EMBARKED ON A CAMPAIGN NEAR THE END OF THIS FISCAL YEAR TO REDUCE HOSPITAL-ACQUIRED C. DIFF BY 30% IN 90 DAYS. THIS IS A BOLD UNDERTAKING BY BALLAD HEALTH'S NEW CLINICAL COUNCIL AND OUR INFECTION PREVENTION DEPARTMENT. C. DIFF IS A SIGNIFICANT THREAT TO HOSPITAL PATIENTS EVERYWHERE. IT'S OUR DUTY AS CAREGIVERS TO PROTECT OUR PATIENTS FROM HARM ALL OF THE TIME, SO PREVENTING C. DIFF IS VITAL. OUR PLAN INVOLVES SOME BASIC STEPS OUR CLINICAL TEAM MEMBERS SHOULD ALWAYS TAKE TO AVOID THIS INFECTION. THE PLAN REQUIRES ALL TEAM MEMBERS TO BE MINDFUL OF HOW THEY TREAT C. DIFF., WITH TEAM MEMBERS INVOLVED IN THE TREATMENT PROCESS RECEIVING SPECIFIC INFORMATION APPROPRIATE FOR THEIR ROLE. IN ADDITION, A VIDEO IS AVAILABLE ON OUR INTRANET SITE THAT ILLUSTRATES SOME OF THE KEY TAKEAWAYS. OUR ULTIMATE GOAL IS ZERO HOSPITAL-ACQUIRED C. DIFF INFECTIONS. FOLLOWING MSHA AND WHS'S MERGER THIS YEAR, TEAM MEMBERS TRANSITIONED TO STANDARD SCRUB COLORS, WHICH MEANT TEAM MEMBERS' SCRUBS THROUGHOUT OUR MANY HOSPITALS AND CLINICS, INCLUDING NCH, HAD TO BE REPLACED. A TEAM MEMBER FROM FRANKLIN WOODS COMMUNITY HOSPITAL RECOGNIZED AN OPPORTUNITY TO HELP OTHERS BY ORGANIZING A "SAVE OUR SCR

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses53,897,706

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) JUSTIN IVORY........................................................................ CFO, NCH/DCH	23.00 .......................22.00	X		0	88,532	14,065
(19) VISHAL RAJ MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	546,465	0	30,581
(20) ELLIE TONY NADER MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	441,056	0	9,598
(21) DARYL PIERCE MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	415,049	0	34,092
(22) MICHAEL GREEN MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	395,691	0	9,275
(23) RUBYE WASHINGTON-MOORE MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	330,589	0	31,203

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,974,788	2,344,073	468,799

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	26,709
e	Government grants (contributions)		1e	24,288

f	All other contributions, gifts, grants, and similar amounts not included above		1f	10,407

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

h Total. Add lines 1a-1f.......		61,404

		Business Code
2a	PATIENT REVENUE	622110	64,671,633	64,671,633
b	WELLNESS PROGRAMS	622110	1,372,212	1,372,212
c	LAB OUTREACH INCOME	621500	12,681		12,681
d	LTD RETIREMENT	900099	-144,002	-144,002
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		65,912,524

3 Investment income (including dividends, interest, and othersimilar amounts) ......			808,290			808,290
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		180,678	6a
b	Less: rental expenses		58,733	6b
c	Rental income or (loss)		121,945	6c
d	Net rental income or (loss).......			121,945		22,240	99,705
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	450,264	647,387	7a
b	Less: cost or other basis and sales expenses	401,796		7b
c	Gain or (loss)	48,468	647,387	7c
d	Net gain or (loss).........			695,855	48,468		647,387
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
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	REVENUE FROM PARENT		900099	55,253	55,253
b	EMPLOYER PROVIDED PARKING		900099	18,542		18,542
c	MISC REV-VENDING		900099	4,868			4,868
d	All other revenue ....			120,675			120,675
e	Total. Add lines 11a–11d ......			199,338
12	Total revenue. See instructions.....			67,799,356	66,003,564	53,463	1,680,925

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	46,853	46,853
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
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 ...........	1,583,240	684,227	899,013
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........	27,293,363	25,490,238	1,803,125
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,141,553	1,069,695	71,858
9	Other employee benefits .......	5,009,906	4,340,012	669,894
10	Payroll taxes ...........	1,761,225	1,729,406	31,819
11	Fees for services (non-employees):
a	Management ......	266,927	250,631	16,296
b	Legal .........	347,579	1,968	345,611
c	Accounting ...........	93,818		93,818
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	98,498		98,498
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	6,394,365	5,286,547	1,107,818
12	Advertising and promotion ....	175,290	9,155	166,135
13	Office expenses .......	716,203	586,131	130,072
14	Information technology ......	1,425,913	1,407,780	18,133
15	Royalties ..
16	Occupancy ...........	1,074,075	950,112	123,963
17	Travel ............	376,608	363,156	13,452
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	432,716		432,716
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,409,312	2,673,524	1,735,788
23	Insurance ...	51,599	122,564	-70,965
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	MEDICAL SUPPLIES & DRUGS	6,402,198	6,402,198
b	MANAGEMENT FEES TO PARENT	1,917,593	796,506	1,121,087
c	REPAIRS AND MAINTENANCE	1,274,550	1,217,812	56,738
d	DUES & SUBSCRIPTIONS	436,734	282,727	154,007
e	All other expenses	292,838	186,464	106,374
25	Total functional expenses. Add lines 1 through 24e	63,022,956	53,897,706	9,125,250	0
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 ........			2,714,701	1	2,743,843
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			9,843,893	4	10,613,039
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	294,918
8	Inventories for sale or use ............			1,317,625	8	1,395,340
9	Prepaid expenses and deferred charges ......			253,685	9	362,613
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	102,509,330
b	Less: accumulated depreciation	10b	59,410,833	47,123,055	10c	43,098,497
11	Investments—publicly traded securities .			35,086,412	11	41,338,335
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 ...........			191,861	15	579,100
16	Total assets. Add lines 1 through 15 (must equal line 33)...			96,531,232	16	100,425,685

17	Accounts payable and accrued expenses .....	6,101,019	17	5,276,338
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	20,708,048	20	20,524,914
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	11,444,714	25	10,793,199
26	Total liabilities. Add lines 17 through 25..	38,253,781	26	36,594,451

	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 ...........	58,277,451	32	63,831,234
33	Total liabilities and net assets/fund balances ........	96,531,232	33	100,425,685