TY 2018 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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Alan Levine BH President CEO...................................................................... President	1.00 ................. 59.00	X	X				0	2,032,246	193,444
(2) Marvin Eichorn BH EVPCAO...................................................................... Director	1.00 ................. 59.00	X					0	1,011,865	36,694
(3) Tim BelisleBH EVPGen Counsel...................................................................... Sec./Treas.	1.00 ................. 59.00	X	X				0	577,064	79,532
(4) Eric Deaton BH EVPCOO...................................................................... Director	1.00 ................. 59.00	X					0	570,270	42,955
(5) Tammy Albright...................................................................... CEO-GCH	30.00 ................. 15.00		X				227,202	0	30,915
(6) Judith Clark end 81818...................................................................... CFO-GCH	40.00 ................. 0.00		X				90,212	0	26,160
(7) Lindsay Haun start 81918...................................................................... CFO-GCH	0.00 ................. 40.00		X				0	81,017	19,020
(8) Chris Miller start 20319...................................................................... COO-GCH	40.00 ................. 0.00			X			0	147,026	24,149
(9) Joseph Kretschmar MD...................................................................... Physician	40.00 ................. 0.00				X		587,259	0	42,422
(10) William Bridges MD...................................................................... Physician	40.00 ................. 0.00				X		528,297	0	40,697
(11) Jami Goodwin MD...................................................................... Physician	40.00 ................. 0.00				X		408,728	0	35,702
(12) Beth Bulawa MD...................................................................... Physician	40.00 ................. 0.00				X		405,633	0	41,688
(13) Howard Herrell MD...................................................................... Physician	40.00 ................. 0.00				X		397,589	0	38,151
(14) Barton Hove...................................................................... Former Officer-Retired	0.00 ................. 0.00					X	0	1,296,774	17,936
(15) Todd Dougan...................................................................... Former Officer-Retired	0.00 ................. 10.00					X	0	488,595	18,367
(16) Gary Miller...................................................................... Former Officer	0.00 ................. 50.00					X	0	347,667	30,404

- 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 the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

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) 2018

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) 2018

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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, 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 2018. 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 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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

2018

Name of the organization

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization Takoma Regional Hospital Inc dba Greeneville Community Hospital

Part I	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
RESTRICTED	,	$ RESTRICTED	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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization Takoma Regional Hospital Inc dba Greeneville Community Hospital		Employer identification number 51-0603966

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization Takoma Regional Hospital Inc dba Greeneville Community Hospital			Employer identification number 51-0603966
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) (2018)

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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

2018

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

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

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) 2018

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) 2015	(b) 2016	(c) 2017	(d) 2018	(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) 2018

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

(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

1,023

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

1,023

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
Part II-B, Line 1i - Other Activities Description	Takoma Regional Hospital, Inc. had lobbying expenses of $1,023 which represents the portion of dues paid to Tennessee Hospital Association attributable to direct lobbying.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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 the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

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 SFAS 116 (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 SFAS 116 (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 SFAS 116 (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) 2018

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

Temporarily restricted 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 .....	5,686,171		5,686,171
b	Buildings ....	29,059,850	2,254,594	26,805,256
c	Leasehold improvements
d	Equipment ....	11,845,416	6,124,470	5,720,946
e	Other .....	1,909,520	758,803	1,150,717
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				39,363,090

Schedule D (Form 990) 2018

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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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
(1) AWUIL				542,871
(2) Due from Affiliates				87,184,632
(3) LT Comp Investments				1,104,799
(4) Other Current Receivables				54,693
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				88,886,995

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
Due to Third Party Payors	3,816,898
Pharmacy, Medical, Worker's Comp	1,359,985
Reserve for Professional Liab.	211,748
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	5,388,631
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) 2018

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

Part X : FIN48 Footnote

Takoma Regional Hospital, Inc. is included in the audited consolidated financial statements of Ballad Health. The footnote explanation relative to income taxes reads: "Ballad is classified as an organization exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. As such, no provision for federal income taxes is included in the accompanying consolidated financial statements. Taxable subsidiaries are discussed in Note K. No significant uncertain tax positions exist at June 30, 2019. Tax returns for 2016 through 2018 are subject to examination by the Internal Revenue Service."

Schedule D (Form 990) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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

2018

Open to Public Inspection

Name of the organization

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

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 22500.0000000 %

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 45000.0000000 %

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) . . .	1,313,435		1,313,435	1.780 %
b	Medicaid (from Worksheet 3, column a) . . . . .	8,431,523	4,040,253	4,391,270	5.970 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	9,744,958	4,040,253	5,704,705	7.750 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	186,208	13,301	172,907	0.230 %
f	Health professions education (from Worksheet 5) . . .	137,380		137,380	0.190 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	3,236	2,208	1,027
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	7,500		7,500	0.010 %
j	Total. Other Benefits . .	334,324	15,509	318,814	0.430 %
k	Total. Add lines 7d and 7j .	10,079,282	4,055,762	6,023,519	8.180 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	18,697	18,697	0.030 %
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	18,697	18,697	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare 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. ......

1,222,508

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. ......

452,328

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).....

11,854,106

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

15,874,146

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

-4,020,040

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 %	(e) Physicians' profit % or stock ownership %
1Greeneville Phy Svcs LLC	Medical Services	75.000 %	25.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

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?2Name, 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)					Facility reporting group
1	Greeneville Comm Hosp-East 1420 Tusculum Boulevard Greeneville,TN37745 balladhealth.org/locations 0000000054	X	X	X	A
2	Greeneville Comm Hosp-West 401 Takoma Boulevard Greeneville,TN37743 balladhealth.org/locations 0000000054	X	X	X	A

Schedule H (Form 990) 2018

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)

	A
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 19

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/locations#hospitals

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 16

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
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 225.0000% and FPG family income limit for eligibility for discounted care of 450.0000%

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) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
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

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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) 2018

Page 7

Part VFacility Information (continued)

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

	A
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) 2018

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, 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: A - Part V, Section B, Line 3j	Facility/Group A includes the following hospital campuses:Greeneville Community Hospital-East and Greeneville Community Hospital-WestDuring FY19, Takoma Regional Hospital, Inc. d/b/a Greeneville Community Hospital operated under the FY16 CHNA approved by its board of directors at the end of FY15. Priorities established for our CHNA were determined by the most significant health needs of the community. GCH conducted their FY19 CHNA this tax reporting period with board approval and publication occurring during late FY19. For the FY18 CHNA, Ballad Health and its hospitals and entities agreed to focus on an index of 25 active population health index measures (plus an additional 31 measures for monitoring). The population health index itself is based on the focus areas outlined in the previous FY15 CHNA and align with national health improvement efforts, such as Healthy People 2020. Wellmont Health System and its hospitals, Mountain States Health Alliance and its hospitals, focused on the same population health index measures determined by Ballad Health, our health system's parent, when completing their individual FY19 CHNA's.To understand each communitys 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 CHNA community members for each facility evaluated measures that make up Ballad Healths population health index and a few additional measures related to access to health screenings. The groups 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, representatives identified four top focus areas:-Smoking-Physical activity/obesity -Substance abuse/mental health-Maternal/infant health
Facility: A - Part V, Section B, Line 5	Information for the CHNA assessment was gathered from a variety of sources, including:- Physician needs assessment- Community health facility assessment- Mental health needs assessment- Publicly available population and demographic information- Publicly available population health information, including America's Health Rankings and the County Health Rankings- State and regional health department data- The Southwest Virginia Health Authority's Blueprint for Health Enabled Prosperity- The ETSU, Wellmont, Mountain States Community Work Group Project- Other studiesSignificant information was gleaned from a process conducted by the ETSU College of Public Health and supported by both Wellmont Health System and Mountain States Health Alliance. Community workgroups were formed, involving a cross section of subject matter experts to assess regional health needs, including those of underserved people, families, children and those suffering from mental health and substance abuse challenges. Regional meetings were also held which included representatives of the community at large, patients and minorities or agencies serving them.Findings from this work were taken into account in both the assessment and implementation plan. The information was then collated and assessed to determine the greatest unmet health needs facing our region. Strategies to address these needs were then developed, utilizing internal resources and partnerships with other health care organizations and physicians.
Facility: A - Part V, Section B, Line 6a	The community health needs assessment conducted by Greeneville Community Hospital (GCH) was based upon the hospital's involvement and enrichment of those who live within Greene County, Tennessee. The primary service area is shared by GCH-East (Laughlin Memorial Hospital) and GCH-West (Takoma Regional Hospital, Inc.) and thus the community health needs assessment was completed in cooperation with both hospitals.
Facility: A - Part V, Section B, Line 11	Key findings noted during the FY16 CHNA were the low rankings of the counties we serve in several categories related to health and wellness, including prevalence of chronic disease management, tobacco use, diet and exercise, as well as a need for expanded and enhanced mental health services. They also emphasized the vulnerability of our underinsured and uninsured populations, and that if our communities are to thrive, we must focus on encouraging healthy children and families.Greeneville Community Hospital operates a diabetes treatment center. The center offers diabetes services and free educational programs. Dietitians, nurses and certified diabetes educators teach about topics such as preparing nutritious meals, tracking blood sugar, reducing diabetes' long-term effects, and other diabetes related topics.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.To help meet these needs, Greeneville Community Hospital will continue to strengthen our partnerships and continuum of care opportunities with area health departments, Federally Qualified Health Centers, and Frontier Health, the region's leading provider of behavioral health services.
Facility: A - Part V, Section B, Line 13h	The Ballad Health 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) 2018

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	Ballad Health Medical Associates FKA Takoma Med Assoc 438 E Vann Road Greeneville,TN37743	Physician services
2	Laughlin Healthcare Center 801 E McKee Street Greeneville,TN37743	Nursing home
3	BHMA OBGYN & Womens Health-Greeneville 1021 Coolidge Street Suite 2 Greeneville,TN37743	Outpatient clinic
4	Greeneville Occupational Medicine 1021 Coolidge Street Suite 4 Greeneville,TN37743	Outpatient clinic
5	BHMA Pediatrics-Greeneville FKA KidsFirst Pediatrics 5000 Monarch Pointe Greeneville,TN37745	Outpatient clinic
6	Takoma Center for Sleep Disorders 1024 Coolidge Street Greeneville,TN37743	Outpatient clinic
7	Takoma Outpatient Rehabilitation 108 W Summers Street Greeneville,TN37743	Rehabilitation services
8	Takoma Outpatient Rehabilitation 1321 Tusculum Boulevard Greeneville,TN37743	Rehabilitation services
9	BHMA Behavioral Health-Greeneville 303 Takoma Avenue Greeneville,TN37743	Behavioral health services
10	BHMA General Surgery-Greeneville West 1404 Tusculum Boulevard MOB 3 Suite Greeneville,TN37745	Surgical services
11	Greeneville Community Hospital Outpatient Therapy Svcs 1404 Tusculum Boulevard MOB 3 Suite Greeneville,TN37745	Outpatient clinic
12	Wound Care Center Greeneville Community Hospital 1406 Tusculum Boulevard MOB 2 Suite Geeneville,TN37745	Outpatient clinic
13	BHMA Family and Internal Medicine 1021 Coolidge Street Suite 3 Greeneville,TN37743	Outpatient clinic

Schedule H (Form 990) 2018

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 - Charity Care Eligibility Criteria (FPG Is Not Used)	Financial assistance approval can apply to an assortment of patients such as those who have exhausted their Medicaid/TennCare benefits, those who qualified for Medicaid/TennCare after the date of service, deceased patients with no estate or assets, uninsured patients,and underinsured patients. While Ballad Healths qualifications for financial assistance is based on federal poverty guidelines, asset values may also be used to determine eligibility. Unique circumstances may be assessed on a case-by-case basis. Charity approval covers current or active patient balances when they are approved and there is no limitation or cap on the amount of charity that a patient may receive. Ballad Health hospitals do not stop approving financial assistance for patient accounts if a hospitals charity write-offs exceed the hospitals charity budget.All Ballad Health hospitals provide an uninsured discount; the current uninsured discount is 77%. 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 - Explanation of Costing Methodology	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 and line 7b TennCare and Medicaid losses. Line 7e community health improvement includes costs that are taken directly from departmental operating reports or expenses specific to a community health event, with no additional overhead included in the cost. Line 7f health professions education is comprised of internships (primarily nursing, pharmacy, and therapy students) with schools and universities, allowing their health profession students to get hands-on training in a hospital setting. The Ballad Health Clinical Education Department (CE) maintains records for the non-Medicare programs. CE 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 his/her 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 care services, we use our cost accounting system because we have established standard costing reports for these services. We are careful to ensure no double counting of cost. Although we have other service lines within our hospital that lose money, we do not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7h research represents GCH's expense allocation from Ballad Health for research. Line 7i cash and in-kind contributions include cash disbursements and an in-kind donation of land to local nonprofit organizations.
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense	Self-pay balances include accounts after payments and contractual adjustments (discounts) have been applied from all third-party payers such as Medicare, Medicaid, commercial insurers, and others - generally leaving the patient responsible for any remaining deductible and/or co-payment. Other self-pay accounts are from patients with no insurance or other third-party coverage. Under Ballad Healths system-wide self-pay policy, any patient who has no insurance and is ineligible for any government assistance program received a 74% discount until September 30, 2018, at which time the uninsured discount increased to 77%. 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, GCH writes the account off to bad debt. The hospital's overall self-pay accounts receivable balance is evaluated on an ongoing basis to evaluate the age of accounts receivable, historical write-offs and recoveries and any unusual instances (such as local, regional or national economic conditions) which affect the collectability of receivables.
Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit	Our primary external collection agency estimates that 37% of GCHs 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 individuals 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 individuals propensity to pay score. Just over 41% of completed financial assistance applications processed during FY19 received a full discount (complete write-off). An additional 10% received a partial discount, resulting in an overall approval rate of 51% for completed applications. Therefore, 49% 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. A letter is sent to the patient outlining missing information on incomplete applications. The letter also provides a contact phone number patients may call for assistance in completing the application. All self-pay patients receive follow up calls from a company WHS pays to process charity care applications for uninsured patients and to offer patients enrollment assistance in Medicaid (VA) or TennCare (TN). The follow up calls are as follows: every 31 days, 31-60 days up to 3 calls are made, after 60 days up to 2 additional calls are made. 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. WHS 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.
Part III, Line 4 - Bad Debt Expense	Ballad Healths audited financial statements include a footnote on page 13 that describes bad debt. GCH is included in the June 30, 2019 audited financial statements of Ballad Health (attached).
Part III, Line 8 - Explanation Of Shortfall As Community Benefit	Excluding Medicare losses reported in Part I subsidized health, the Part III Medicare loss is reported using GCH's filed Medicare cost report (C/R). The C/R uses a cost to charge ratio based on a step-down allocation methodology. 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 - Provisions On Collection Practices For Qualified Patients	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 patients 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 hospitals adhere to our billing and collection guidelines. Our 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 Medicaid or TennCare.After insurance benefit verification, our hospitals bill 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 hospitals provide 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 hospitals accept 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 agencyReasonable 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 last year. An executive steering team was established, aided by national experts with experience in large-scale population health improvement. Because our hospitals are located in a region with many chronic disease challenges, Ballad Health's goal is to target population health issues to make lasting improvements. Ballad conducted approximately 150 interviews and held 40 meetings with external groups, including the regional health departments, United Way agencies, chambers of commerce, schools and community organizations, the regional accountable care community steering committee, as well as internal groups such as our population health and social responsibility committee of the Ballad Health board of directors, the Ballad Health population health clinical committee, and our hospital community boards.
Part VI, Line 3 - Patient Education of Eligibility for Assistance	Consistent with the Ballad Health financial assistance policy, GCH communicates with and provides education to our patients through various avenues regarding governmental assistance programs and hospital financial assistance. Various educational and application documents related to obtaining financial assistance are widely available at WHS 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 departments and admitting areas. We are also happy to mail all documents to patients. We offer a plain language summary and all of our documents are available in English and Spanish. Financial assistance information is available during pre-registration, registration and/or during financial counseling. We offer governmental program eligibility representatives to assist patients in securing eligibility for Medicaid or TennCare, federal disability and other governmental assistance programs. Additionally, if a patient or community resident expresses an interest in the ACA healthcare exchange, our representatives have the qualifications and experience to assist them through the entire process. Our financial counselors offer financial assistance applications to patients who do not qualify for governmental assistance programs and are unable to pay for some or all of their healthcare.All patient billing statements have verbiage discussing financial assistance along with contact information. Our last letter to the patient displays the plain language summary. In all oral correspondences with a patient, if it is identified the patient cannot meet payment requirements on their account, financial assistance is discussed as an option. Applicants are notified of financial assistance determination in writing.
Part VI, Line 4 - Community Information	Greeneville Community Hospital campuses are located in Greeneville, Tennessee (Greene County) on the eastern border of the state. The county is primarily rural, and the population is estimated by the U.S. Census Bureau to be 68,808. The latest census bureau data estimates the median age of residents of Greene County is 44.5 which is older than the median age of 38.9 in Tennessee. 21.3% of Greene County residents are 65 or older compared to 16% for the state. The population projections for Greene 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 Greene county is projected to experience the most population change over the next five years. The aging population of the county presents opportunities for earlier identification and better management of health conditions that oftentimes affect elderly populations.The bureau estimates Greene County median household income at $40,100 ($34,296 for the town of Greeneville) compared to the State of Tennessee's median income of $51,300. 34.7% of Greene County's children live in poverty compared to 21% statewide.Greene County is almost 65.2% rural compared with the statewide rural rate of 33.6%. 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. Although 19% of people in the U.S. live in rural areas and 30% of the vehicle miles traveled occur in rural areas, almost half of crash deaths occur there. 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 1,670:1 compared to the state's average of 1,390:1. In other words, we have 20% more residents per physician than the overall state rate. Our county's ratio of population of mental health providers is 1,150:1 compared to the state's average of 700:1. This is over 64% more residents per mental health provider than the overall state rate. 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, 36% of the adults in Greene 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 34% is 26% higher than the statewide rate and resident's access to exercise opportunities is 39% less than the state. According to the 2019 County Health Rankings, Greene County is ranked 50 out of 95 in Tennessee for health outcomes and 52 in health behaviors. As for social and economic factors, Greene County ranks 47 primarily due to high rates of children in poverty and above average unemployment rates.
Part VI, Line 4 - Community Building Activities	GCH 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 GCH 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.Part II, Community Building Activities, Line 3 - Community SupportGCH promoted the health of the communities it serves through various community building activities in FY19. Some examples include:Boys & Girls Club of Greeneville & Greene County offered a safe place for kids, positive programs and provided caring adults to supervise the youth of our community. Net community building expense was $8,800. A donation of $6,250 was given to Greene Leaf, a program of the Greene County Local Educational Advancement Foundation, for a technology campaign. Their mission is to serve as an advocate for creating a premier educational environment for the students of Greene County, Tennessee. Several GCH team members support local nonprofits by attending quarterly meetings of the Healthy TN Community and Community EMS Board meetings. Net community building expense was $2,022.United Way provides transportation assistance for cancer patients who cannot afford to get to frequent treatments and might miss treatments and support with nutritional supplement they could not otherwise afford and provides financial assistance to Greene County residents who sruggle with speech and hearing disorders as they seek treatment. United Way also supports four other specific programs to promote early childhood reading and education, learning health education to support better health through education. Net community building expense was $1,500.
Part VI, Line 5 - Promotion of Community Health	GCH is dedicated to operating efficiently so that waste is minimized. GCHs 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.GCH campuses have Medicare-approved health profession education programs. In addition, GCH campuses serve as training sites for many types of health professions: nursing, pharmacy, psychology, lab, respiratory therapy, EMT, public health, etc. Students from several colleges, universities, and programs receive training and hands-on experience in our hospitals. We devote resources to health conferences for local health professionals and offer other programs focused on improving the health of our residents. While we operate in a predominantly low-income, rural area, we continue to offer services that operate at a loss to GCH because residents would otherwise need to leave their home town or county to receive needed care.Physicians that request privileges who are qualified and credentialed are extended privileges by GCH.
Part VI, Line 6 - Affilated Health Care System	Greeneville Community Hospital is a two campus hospital in Greeneville, Tennessee which includes Greeneville Community Hospital-East and Greeneville Community Hospital-West and 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 GCH'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.Wellmont Health Systems merger with Mountain States Health Alliance opened up many opportunities not previously available to two competing health systems. Collaboration started post-merger and we continue to see progress towards improving efficiencies within our health system, activities consistent with Ballad Healths population health initiative, sharing best practice quality improvements, and other benefits related to operating as one rather than operating in a competitive environment. A new clinical council was formed immediately following the merger. The council includes physician nominated from the leadership of all Ballad hospitals. A new Community Benefit and Population Health Committee of the board was established and various other infrastructures have been established since the merger.Across GCH campuses, there were many projects, programs and collaborative efforts that took place during the year. Some examples include:- A plan was approved to adopt an integrated technology platform bringing all of our hospitals and points of service together as an integrated system- Opioid prescribing reduction across all WHS hospitals- WHS hospitals shared successful achievements from value optimization team projectsSince our system is both horizontally and vertically integrated, patients can be efficiently moved along an integrated, comprehensive continuum of care as their health dictates. If needed, patients can be moved to one of Ballad Health's tertiary care facilities providing advanced treatment options.Hospitals in the Ballad Health system work closely with one another to share expertise and resources.
Part VI, Line 7 - States Filing of Community Benefit Report	TN VA
Part VI - Additional Information	Ballad Health is required to report community benefit estimates on a quarterly basis with the states of Tennessee and Virginia. The reporting includes all of Ballad's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad operates under a Cooperative Agreement (CA) in Virginia and a Certificate of Public Advantage (COPA) in Tennessee as obligated by agreements between Ballad Health and the two states to allow Wellmont Health System and Mountain States Health Alliance to merge.

Schedule H (Form 990) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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

2018

Open to Public
Inspection

Name of the organization
Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number
51-0603966

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	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Boys & Girls Club PO Box 1977 Greeneville,TN37744	62-1706248	501c3	8,800	0			Sponsorship
(2) Greene LEAF PO Box 1253 Greeneville,TN37744	45-4418460	501c3	6,250	0			Technology campaign

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) 2018

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

Grantmaker's Description of How Grants are Used

The Community Benefit and Population Health Committee for Ballad Health is comprised of members from Tennessee and Virginia. Committee members have various perspectives on community health improvement and work to develop an understanding of population health, philanthropy, community benefit obligations and the role Ballad Health plays in health access improvement. The senior leadership for Ballad Health, including the President and CEO and COO, attend the meetings. Among the responsibilities of the committee is ensuring charitable contributions comply with Ballad Health Board policies.All requests are submitted electronically with the required information to determine eligibility. After the committee has reviewed requests, various levels of approval are required, including the Ballad Health CEO or Ballad Health Board, based on the level of commitment. Applicants requesting funding for a specific event or program should include the following information:- Mission statement of organization- Year organization was founded- Tax status and federal taxpayer ID number - Website- Description of the event/program- Event/program budget- Other sources of income- Impact of the event/program on the health of residents in our region- Beneficiaries of contribution- Number of people served annually - Event/program accomplishments- Measure of accomplishments

Schedule I (Form 990) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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

2018

Open to Public Inspection

Name of the organization

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

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 in 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 in 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) 2018

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)
1Alan Levine BH President CEO President	(i) (ii)	------------- 1,101,957	------------- 750,000	------------- 180,289	------------- 172,174	------------- 21,270	------------- 2,225,690	------------- 150,202
2Barton Hove Former Officer-Retired	(i) (ii)	------------- 246,667	------------- 161,333	------------- 888,774	------------- 9,467	------------- 8,469	------------- 1,314,710	-------------
3Beth Bulawa MD Physician	(i) (ii)	310,677 -------------	57,662 -------------	37,294 -------------	18,646 -------------	23,042 -------------	447,321 -------------	-------------
4Chris Miller start 20319 COO-GCH	(i) (ii)	------------- 144,738	-------------	------------- 2,288	------------- 8,931	------------- 15,218	------------- 171,175	-------------
5Eric Deaton BH EVPCOO Director	(i) (ii)	------------- 497,063	------------- 40,165	------------- 33,042	------------- 26,522	------------- 16,433	------------- 613,225	-------------
6Gary Miller Former Officer	(i) (ii)	------------- 301,352	------------- 39,377	------------- 6,938	------------- 18,235	------------- 12,169	------------- 378,071	-------------
7Howard Herrell MD Physician	(i) (ii)	390,943 -------------	-------------	6,646 -------------	17,064 -------------	21,087 -------------	435,740 -------------	-------------
8Jami Goodwin MD Physician	(i) (ii)	369,549 -------------	19,517 -------------	19,662 -------------	16,734 -------------	18,968 -------------	444,430 -------------	-------------
9Joseph Kretschmar MD Physician	(i) (ii)	293,487 -------------	287,364 -------------	6,408 -------------	19,673 -------------	22,749 -------------	629,681 -------------	-------------
10Marvin Eichorn BH EVPCAO Director	(i) (ii)	------------- 678,984	------------- 300,000	------------- 32,881	------------- 12,241	------------- 24,453	------------- 1,048,559	-------------
11Tammy Albright CEO-GCH	(i) (ii)	212,627 -------------	13,630 -------------	945 -------------	11,201 -------------	19,714 -------------	258,117 -------------	-------------
12Tim BelisleBH EVPGen Counsel Sec./Treas.	(i) (ii)	------------- 400,672	------------- 161,656	------------- 14,736	------------- 56,640	------------- 22,892	------------- 656,596	-------------
13Todd Dougan Former Officer-Retired	(i) (ii)	------------- 446,194	------------- 35,385	------------- 7,016	------------- 6,061	------------- 12,306	------------- 506,962	-------------
14William Bridges MD Physician	(i) (ii)	308,912 -------------	182,891 -------------	36,494 -------------	18,365 -------------	22,332 -------------	568,994 -------------	-------------

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation

Schedule J (Form 990) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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

2018

Open to Public
Inspection

Name of the organization

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

Return Reference	Explanation
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Wellmont Health System is Takoma Regional Hospital, Inc.'s (TRH) sole member. The board of directors of Ballad Health, Wellmont's parent organization, serves as Wellmont's board of directors and is responsible for appointing the directors of TRH's board.Takoma Regional Hospital's Board of Directors are responsible for:- Development and establishment of the organization's policies and strategic plan,- Development and approval of the organization's annual capital and operating budgets,- Regular review of the organization's financial performance,- Annual review of medical staff competency standards, and- Regular review of the organization's Corporate Compliance Plan.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	Following the merger of Takoma Regional Hospital, Inc.'s sole member, Wellmont Health System, and Mountain States Health Alliance in February 2018 to form Ballad Health, the newly appointed Ballad Health Board of Directors assumed board responsibilities for Wellmont and Mountain States. Both Wellmont and Mountain States remain separate legal entities.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	Certain decisions of the board are, pursuant to charter, subject to approval of the member. No ordinary, day-to-day decisions are subject to member approval.
Form 990, Part VI, Line 11b: Form 990 Review Process	The President of Greeneville Community Hospital reviewed the Takoma Regional Hospital, Inc.'s Form 990 with the Board of Directors prior to filing. The return was made available to each board member in an electonic format prior to the review.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	Ballad Health has a conflict of interest policy for all members of the Board of Directors, the Executive Chair/President, Executive Vice Presidents, Senior Vice Presidents, and Vice Presidents, and applies to all Ballad Health organizations, including Takoma Regional Hospital, Inc. 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 delcare 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 delcare the conflict. While each member of the board or board committees are responsible for disclosing conflicts of interest, it is also the responsibility of any board member aware of a conflict which has not been disclosed to ensure the board is made aware. The presiding officer of a board or board committee meeting may ask a conflicted member to excuse themselves from the meeting during the discussion related to the issue with which the conflict of interest applies. Under no circumstances shall a member vote on a matter that gives rise to a potential conflict.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Governing documents and conflict of interest policy are made available upon request to the appropriate parties requesting them. Financial statements are made available upon request to appropriate parties requesting them, and they are made available to those parties who own indebtedness.
Other Changes In Net Assets Or Fund Balances - Other Increases	Acquisition of Laughlin Memorial Hospital (eff. 4/1/19) = $63352051
Other Changes In Net Assets Or Fund Balances - Other Increases	Intercompany debt forgiveness = $74368823
Other Changes In Net Assets Or Fund Balances - Other Decreases	Premier Healthcare partnership income-not on books = -$126622
Other Changes In Net Assets Or Fund Balances - Other Decreases	Premier Healthcare partnership interest income-not on books = -$5009
AWARDS AND RECOGNITIONS	All the GCH campuses are accredited by The Joint Commission (TJC). TJC is an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States. TJC is the nations largest standard-setting and accrediting body in health care. Joint Commission surveyors visit accredited health care organizations a minimum of once every 39 months to evaluate standards compliance. All regular Joint Commission accreditation survey visits are unannounced. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects on an organization's commitment to meeting certain performance standards.GCH is also accredited by the Commission on Cancer, a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MSQUIP) achieving a Low Acuity Center accreditation, and American Academy of Sleep Medicine (AASM) achieving H-3 reaccreditation. The security, safety & emergency management force at both Ballad Health and GCH has been recognized by Security magazine as part of the 2018 Security 500 rankings. Security magazine remarked: We are recognizing your organization for your safety and security policies and efforts to keep patients, staff and visitors safe. Our team has been monitoring your work in this area, and we wanted to recognize you.
CHARITY AND OTHER UNREIMBURSED COSTS	While reimbursement for healthcare services rendered is critical to the operation and sustainability of the organization, GCH recognizes its obligation to provide care to individuals who cannot afford essential medical services, including emergency care. GCH accepts all patients regardless of their ability to pay. A patient is classified as a charity patient when they meet the established policies of Ballad Health and guidelines outlined by the federal government. However, financial assistance decisions are not solely based on income. Unique financial circumstances are weighed with verified patient assets which can determine financial assistance eligibility. It is not until after verification of income and assets that a decision regarding the amount of financial assistance can be made. In fiscal year 2019, GCH incurred a loss of $1,313,435 attributable to the provision of charity care. This amount does not include the costs associated with accounts classified as bad debt. TENNCARE/MEDICAID: GCH provides care to persons covered by governmental programs, such as TennCare (Tennessee residents) and Medicaid. GCH incurred a loss of $4,391,270 providing care to this population of patients during the year.UNINSURED DISCOUNT: Uninsured patients received a 74% discount through September 30, 2018, at which time the uninsured discount increased to 77%. The uninsured discount is applied to all uninsured patients at GCH. Certain elective procedures are not eligible for the uninsured discount. The uninsured discount is calculated each year in accordance with Tennessee regulations and without regard to a patient's income or assets. Although the uninsured discount is not required by the Commonwealth of Virginia, Ballad Health applies the same discount to hospitals located in Virginia. The approximate cost of this discount in FY19, using a cost to charge ratio, was $1,951,632 for the hospitals included in this Form 990 return.
COMMUNITY CONTRIBUTIONS	As the largest employer in the region, Ballad Health is one of the areas principal benefactors and has made corporate citizenship an integral part of its culture. From system-wide initiatives to GCH campuses and individual efforts of caring team members, the aim is to enrich the communities that it serves. GCHs commitment includes direct financial contributions that support community healthcare needs and those non-profit agencies that advocate the health and well-being of community members.In FY19, GCH made donations to numerous health and human service organizations, social and well-being non-profits, and others within the service area.Donations to local organizations provide health care, work to increase access to health care and/or conduct research with the aim of improving health, or promote a healthy community included: - American Cancer Society, Inc.- Greene Leaf- United Way of Greeneville- YMCA of Greene County, TNThroughout the year, GCH makes contributions to local schools and organizations that provide educational, health, and social support to youth. Many of the donations to benefit young people are restricted to services focusing on healthy eating and physical activities, after school and summer programs providing at-risk children a safe environment, and literacy programs. Studies show a correlation between literacy and medical compliance/overall health. Some of the contributions to youth programs included:- Mosheim Middle School- Tusculum Athletics, Inc.- Boys & Girls Club of Greeneville and Greene County GCH also makes financial contributions to local nonprofits that provide social, economic and well-being benefits to communities served. A strong social and economic community attracts talented health care professionals and enhances the lives of community members. Some of the donations to these organizations during the year include:- Greene County EMS - $500 in-kind land donation (net book value) located at 1024 Coolidge Street, Greeneville, TN The board of directors and senior management of Ballad Health encourage team members to devote time to local community service projects, task forces, committees, boards, volunteer programs, and other charitable organizations that benefit our communities. Team members, within reason, are allowed to serve on these outside activities as representatives of GCH. Team members serve on local chamber of commerce boards as a healthcare representative, local county economic boards, participate in school health programs, assist charitable organizations with fundraising activities, speak at local clubs/churches/groups on healthcare topics, provide assistance to local organizations at Thanksgiving and Christmas, provide health education and/or first aid at local festivals, and many other predominantly health related activities.
COMMUNITY RESOURCES	Ballad Health supports its parish nurse program, which is designed to provide holistic ministry and special promotion services within the faith community. The parish nurse program assists individuals in gaining optimal mental, physical and spiritual health by complementing the ministry provided by pastors and other lay ministers. Some of the services and programs provided include screenings for blood pressure, cholesterol, diabetes, glaucoma and overall fitness, classes for all age groups offered on health related issues (nutrition, exercise, parenting, care for elderly parents, stress management, CPR), hospital, nursing home and home visits for assessment of health care needs, referrals to appropriate community resources and the creation of health tips in congregational newsletters, bulletin boards and other forms of communication. In FY19, WHSs parish nurse program provided 649 home visits, accompanied community members to 1,772 clinic visits and visited community members while in the hospital or nursing home on 933 occasions. The program offered 243 blood pressure screening clinics, 412 glucose screenings, 80 health fairs and one blood drive, resulting in identification and referral of 296 people with abnormal results to physician services. The program offered health education to parishioners through 329 educational sessions, 233 newsletter articles, 22 church bulletin articles and 110 bulletin board displays. The cost for GCH to provide this program was $3,140.In FY19, Ballad Health made a major change regarding air ambulance services. Ballad selected Med-Trans, locally known as Wings Air Rescue, to continue to operate four full-time bases in Elizabethton, TN, Greeneville, TN, Jenkins, KY and Marion, VA plus a base at Bristol Motor Speedway, which is active during race events. Licensed in Tennessee, Ballad Health One air ambulance provides transport of critically ill and injured patients to one of the closest tertiary hospitals in the region. Ballad Health also provided staffing, physicians, and medical supplies to the Commonwealth of Virginia for the Virginia State Polices Med Flight air ambulance service. VSP Med Flight will continue to maintain its base in Abingdon, VA. The contribution from GCH for the air ambulance services, especially critical in rural areas, was $29,090.Ballad Health offers to the community Nurse Connection, a 24-hour toll-free health information line supported by registered nurses who provide nurse triage with medically approved triage guidelines, health information and education, registration for classes and screenings, and referrals to external resources such as Poison Control and crisis intervention. The direct cost of Nurse Connection was $7,721 this year for GCH.GCH, in collaboration with area health agencies and providers, helps with coordination, advocacy and publicity, provides space, or contributes to support groups for their program activities.A leadership committee representing 24 regional organizations, along with more than 150 community stakeholder groups, has created the regions first Accountable Care Community, a collaborative group whose goal is to transform the health of a region spanning 21 counties in Northeast Tennessee and Southwest Virginia. A partnership of Ballad Health, Healthy Kingsport and the United Way of Southwest Virginia serves as the backbone of the Accountable Care Community, which uses the collective impact model to align the efforts of all sectors of a community or region to accomplish shared objectives. The Accountable Care Community will focus on supportive systems, programs and environments that nurture strong children and families to help them develop the key characteristics to succeed in life. The goals of the Accountable Care Community are to see more children succeed in school, go on to college,and have productive careers, and to enable families to succeed in overcoming generational barriers. Our area is sometimes referred to as the "diabetes belt" due to the high number of residents with diabetes. Our Diabetes Treatment Centers are accredited by the American Diabetes Association. Self-management classes, offered free of charge, are taught by specially trained registered nurses, dietitians and certified diabetes educators. For those who prefer one-on-one counseling instead of classes, the center will accommodate for that.Diabetes Treatment Center staff are also involved with hospital inpatients to help control patient blood sugar levels, assist with medication management and take advantage of a person's inpatient stay to provide diabetes education. DTC staff provide health coaching at businesses in Greene County, Tennessee, present health information to community groups, and participate in health fairs. Team members also educate teachers in various school districts about care for their students with diabetes. Our Diabetes Expo draws upwards of 300 community members each year to learn about diabetes and receive free screenings, including foot, eye, kidney, and glucose. The best way to keep our communities healthy is to provide them with the latest information about their health. GCH strives to provide information about everything from disease and injury prevention to the latest treatments and technologies available to coping with disease and its symptoms. Some of our programs during FY19 include:- Nutrition presentations were provided by our dietitian on topics such as tips for healthy eating, how to read food labels, with information pamphlets provided to participants and diabetes care management- Numerous presentations were provided to senior citizens including breast cancer diagnosis, heart health and nutrition learning sessions from our dietitianGCH team members participated in health fairs, such as:- Derby Day for Foundation - Health Fair for New Mothers- Winter Wellness Fair GCH team members are engaged in a myriad of community activities. Some examples during FY2019 include:- Two team members participated in the B.E.A.R. Buddies Reading Program - Our Director of Radiology spoke to senior citizens about breast cancer diagnosis- Four team members represent the hospital on the Healthy Tennessee Community subcommittee of the Greene County Health Council for our area- Team members assisted with the March of Dimes Community Walk Hospital meeting space is open to local organizations that support community health and wellness. Some examples include community health needs assessment committee meetings and various support groups such as diabetes, stroke, breast cancer and cancer support groups. Some of the Healthy Tennessee Community committee meetings were also held at GCH.
Form 990, Part III, Line 4a - Program Service Accomplishments	Greeneville Community Hospital is an acute care hospital in Greeneville, Tennessee and one of the hospitals within the Ballad Health system. Ballad Health is an integrated healthcare system serving 29 counties of Northeast Tennessee, Southwest Virginia, Northwest North Carolina and Southeast Kentucky. Ballad Health was created upon the merger of two large regional health systems, Wellmont Health System and Mountain States Health Alliance, on February 1, 2018. Through rigorous state oversight, these two competitors have been granted the ability to merge into an integrated healthcare delivery system with a simple and concise mission: to improve the health of the people we serve. On April 1, 2019, Takoma Regional Hospital, Inc. acquired neighboring Laughlin Memorial Hospital (LMH) and both facilities began doing business as Greeneville Community Hospital (GCH) with East (formerly Laughlin Memorial Hospital) and West (formerly Takoma Regional Hospital, Inc.) campuses. GCH is one hospital with two distinct campuses and part of the Ballad Health system. Greeneville Community Hospital East in Greeneville, Tennessee, is committed to providing the highest quality medical services and diagnostic medical equipment for their patients. Greeneville Community Hospital West in Greeneville, Tennessee, is providing award-winning care that is recognized nationally for quality and patient safety.By working in collaboration with each other under the umbrella of Ballad Health, the hospital campuses had a significant opportunity to better organize their services to the community by allowing each campus to specialize in specific types of services. Concentrating patient volume for certain services in one unit or facility can improve the quality of care offered and also reduces the cost of care. Significant duplication of inpatient services existed prior to the combination, creating unnecessary and duplicative cost. Through the merger that created Ballad Health, we pledged to the community and our regional employers to reduce unnecessary costs by organizing our resources in a way that makes the most sense for the community. Consolidation of services in Greene County, TN was discussed publicly prior to the merger and was pre-approved by state officials in our COPA agreement.Specific to the hospitals included in this Form 990, services were provided to: 2,172 inpatients 266,496 outpatient visits 100,430 patient encounters 20,131 emergency room visits 414 deliveries 2,002 surgical casesGREENEVILLE, TN: GREENEVILLE COMMUNITY HOSPITAL EAST (GCHE) 140-bed acute care hospital Formerly known as Laughlin Memorial Hospital Operates a 90-bed skilled nursing facility known as Laughlin Healthcare Center Services include acute inpatient services, including inpatient surgery, same-day surgery, endoscopy, ICU/PCU and obstetrics, including labor and deliveryGREENEVILLE, TN: GREENEVILLE COMMUNITY HOSPITAL WEST (GCHW) 100-bed acute care hospital through April 2019, decreasing to 27 licensed beds Formerly known as Takoma Regional Hospital, Inc. Services include inpatient rehabilitation care, psychiatric care, diagnostic imaging, outpatient laboratory services and sleep lab
Form 990, Part VI, Line 15a Compensation Process for Top Officials	The compensation plan for GCH's Board President and Ballad Health's President and CEO, Alan Levine, was reviewed and approved by the executive committee. An outside and independent compensation consultant was used to determine his compensation and benefits. Studies and surveys were used to ensure his pay is comparable to like positions at similarly situated organizations. 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 GCH'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. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics set in advance of the pay year. Established metrics include: communication with patients, patient evidence-based care scores and patient safety, value based purchasing, etc.
Form 990, Part VI, Line 15b - Compensation Process for Officers	Similar to GCH's CEO, other GCH officers receive compensation that complies with Ballad Health's salary policy. Their pay is set at a market percentile specific to their positions.
IMPROVING HEALTHCARE QUALITY	QUALITY METRICS - Ballad Healths Board of Directors has adopted a zero-harm culture for the organization, and processes have commenced to institutionalize this objective. This focused effort on quality improvement significantly benefited patients. Specific examples include: zero infections for abdominal hysterectomy cases across the system; 47 percent reduction in pressure injury rate; 42 percent reduction in clostridium difficile infections; 39 percent reduction in iatrogenic pneumothorax rate; and 13 percent reduction in central line bloodstream infections.During FY19, there has been a 10 percent reduction in the hospital readmission rate over the prior year, and a 25 percent reduction among legacy hospitals since 2015 as evidence that physician and administrative partnership is resulting in lower cost and lower risk to patients. Ballad Health achieved the lowest readmission rate in either legacy health systems histories. ONGOING QUALITY IMPROVEMENT PROGRAMS RECEIVE PRAISE FROM NATIONAL EXPERTS - Ballad Health has instituted a comprehensive quality improvement program system-wide based on the FOCUS PDCA modela model designed to empower team members to identify opportunities for improvement and measurably implement those opportunities. These efforts are organic and driven by staff at all levels. The Ballad Health approach to quality improvement was recently praised by national experts who facilitate and assess organizational commitment to quality. For instance, in the past year, a total of 130 quality improvement projects across the system qualified at various levels of improvement for recognition, with 42 national judges evaluating the projects and awarding recognition for the results. Examples of improvement projects include: a 50 percent reduction in hospital-acquired Clostridium difficile (C.diff) across all hospitals within three months.
IMPROVING THE COMMUNITY'S HEALTH STATUS	Greeneville Community Hospital (GCH) is one of only 29 organizations in the country participating in the Centers for Medicare & Medicaid Services (CMS) new initiative, Accountable Health Communities Model (referred to as AHC Program), aimed at improving the health of eligible Medicare and Medicaid beneficiaries. The AHC 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. GCH serves as the Bridge Organization for the AHC Program locally, leading a collaborative of multiple organizations and clinical delivery sites to bring needed services to beneficiaries residing in Southwest Virginia. Full implementation of the AHC Program was achieved during FY19. Nine full-time team members, (six Navigators, one Lead Navigator, one Screening and Referral Specialist, and one Program Manager) salaries are reimbursed by federal funding. Two part-time Navigator positions remain open. Fifty-two locations in Southwest Virginia and Northeast Tennessee serve as clinical delivery sites and the capability to identify health-related social needs. Patients screening positive for health-related social needs receive a Community Referral Summary. The Community Referral Summary contains contact and program information for relevant resources to assist with the needs identified by the screening. Since formal go-live of the AHC Program on November 17, 2018 and through June 30, 2019, 61,705 screenings have been offered, 35,544 screenings answered, 9,050 needs identified, 5,030 Community Referral Summaries given, and 2,142 patients navigated to care. The above stats are inclusive of the Ballad Health hospitals in Virginia plus three hospitals in Northeast Tennessee located close to Southwest Virginia. Greeneville Community Hospital also created a data system for the screening, referral, and navigation services in lieu of the CMS AHC Data System. The internal data system improved operational efficiency by at least five-fold. Patient Navigators have been re-deployed from five Virginia Community Services Boards to hospital emergency departments and primary care offices in the Ballad Health service area. This redeployment allows the Navigators to establish initial contact with a patient and complete a personal interview and action plan related to the health-related social needs identified by the patient. Laptops and cell phones were purchased for the Navigators to provide the ability to work at the clinical delivery sites and from other locations, as needed.
INVESTMENTS	COMMON ELECTRONIC HEALTH RECORD - Ballad Health made progress in FY19 toward establishing a common clinical platform and electronic health record (EHR). An implementation plan was developed to include infrastructure enhancements to support the expansion. A common EHR across the new health system will allow patient information to be shared immediately at the point of service regardless of where a patient enters the Ballad system, providing clinical staff with information to better manage patients in the emergency room, clinics, acute and post-acute settings.
MEDICAL EDUCATION	GCH participates in Ballad Healths Nurse Intern II program, overseen by Ballad Healths Clinical Education team. The program pairs each nurse intern with a registered nurse (RN) preceptor on a designated hospital unit. The interns work with their preceptor to gain valuable clinical skills to assist in the transition from nursing student to licensed nurse. The interns are under no obligation to work for Ballad Health although many of them choose to do so. Interns who complete the program become a Nurse Intern III and advance to a Nurse Intern IV upon graduation and move to RN status upon passing of the NCLEX (National Council Licensure Examination). GCH continues to offer free Certified Nursing Assistant (CNA) classes open to the public. The program includes classroom sessions followed by clinical experience. There is no requirement for participants to work for Greeneville Community Hospital upon completion of the program. The training opportunity often leads to job opportunities for graduates of the program. In FY19, over 93 percent of the graduates were hired by GCH. GCH facilities serve as clinical training areas for health professional education students. Dedicated staff work with regional colleges and universities, as part of the educational curriculum, to coordinate the placement of healthcare professional students. Health care students training in GCH facilities are required to complete orientation and computer training.Included in the number receiving clinical training at GCH, 23 nursing students from various colleges, universities and programs received training. This nursing clinical experience required extensive involvement by GCH nursing staff. The cost of the clinical setting and hands-on instruction to GCH was $33,003.GCH provided a clinical training setting for another 79 students in health-related programs, such as biomedical engineering, radiology, pharmacy, respiratory therapy, physician assistant, nurse practitioner, laboratory, occupational therapy, social work, public health, EMT/paramedic, and other allied-health disciplines. The cost of clinical training for these additional students was $83,493.
OTHER ACCOMPLISHMENTS	Ballad Healths grants and awards department works throughout the year writing grant applications to benefit communities throughout the large service area. Some examples of this reporting period include: Awarded a grant for Car Seats and Teen Driver Safety to provide car seats to people in the community and to educate teen drivers on safe driving habits (such as don't text and drive). Received a grant that provides funding (in addition to our Ballad Health Cancer Patient Assistance Fund) for 75 additional patients to overcome barriers to breast cancer treatment through meeting their basic needs and/or improving their quality of life (i.e. rent/mortgage, groceries, utilities, transportation vouchers, gas cards, etc.). The Cancer Navigation program provides a single point of contact to help patients coordinate their care and understand their treatment plan. The Navigators often determine obstacles, such as the need for financial assistance, that keep patients from receiving treatment. The Komen/Virginia Blue Ridge Mobile Mammography grant was utilized to provide mammograms to women who may otherwise not receive them due to cost or access issues, along with helping to arrange financial assistance for additional diagnostic studies and further treatment, where applicable. Patients needing additional studies and treatment were assisted by our Cancer Navigators if they did not have a primary care provider.GCH continues the Value Optimization System (VOS). The goal of the system is to accelerate achievement of patient-centered care to meet patients expectations of high quality, high satisfaction, and efficient care. Each VOS team meets over an intense four-day period to identify waste/inefficiencies, develop an improved work plan, and then implement the plan immediately. The results are referred to as value streams.
PROGRAMS FOR SPECIAL POPULATIONS	GCH partnered with Bolder Outreach Solutions to assist patients without insurance. Representatives were available for these patients at all GCH campuses in order to determine sources of possible governmental medical assistance (TennCare or Medicaid) and to assist in the application process and follow-up. 338 patients were approved for coverage during FY19. GCH incurred expense of $24,487 during FY19 to provide this service. Ballad Health and a group of the nations leading health systems are joining forces to identify ways to better care for some of the nations most vulnerable populations. The Medicaid Transformation Project is a national effort to transform healthcare and address social determinants of health for the nearly 75 million Americans who rely on Medicaid. The work will focus on five key areas of opportunity, four of which have been identified: behavioral health, child and maternal health, substance use disorder and avoidable emergency department visits. WHS hospitals will be able to improve care for all vulnerable populations based on solutions/best practices provided by this project.
PROGRAMS TO IMPROVE CHILDHOOD LITERACY	Since 2014, Ballad Healths Niswonger Childrens Hospital has reached outside the hospital walls and into the community to improve child literacy through the B.E.A.R. Buddies reading program, which pairs volunteer mentors with elementary school students who need a boost in their reading skills. When five new schools recently requested to join the program, Ballad Health Chairman and CEO Alan Levine issued a call to Ballad Health team members to help fill the gap. To date, 100 volunteers for the 2020 school year have signed up.Ballad Health is committed to promoting strong starts for kids and reading achievement is an essential element that every child needs in order to be positioned for future health and success. Ballad Health partnered with seven United Way organizations from Southwest Virginia and Northeast Tennessee to pilot an initiative to increase grade-level reading and improve reading proficiency for children in the region. The partnership will have a huge impact on the community as the United Way organizations work together with local schools to improve childhood literacy across the region. Ballad Health is participating in a new initiative called STRONG Kids, which stands for Striving Toward Resiliency and Opportunities for the Next Generation, that brings together and assists regional organizations that support children. The program will enable Ballad Health, Niswonger Childrens Hospital and the Bristol chapter of Speedway Childrens Charities to share ideas and best practices that will help children in the region reach their potential through expanded opportunities in health, education and economic vitality. The partnership is designed to bring a new level of support to these organizations that are on the front lines serving children.
RESEARCH	The Ballad Health clinical research department serves as the central office for multi-specialty research oversight to Ballad Health. In addition to providing full spectrum support for studies generated and managed by the research department, the department provides oversight for studies generated by external groups. The research department has participated in several large-scale, multi-center trials with a high subject retention rate and a great sponsor/monitoring rating. Oversight services include administrative, regulatory support, and internal service arrangement. In addition, since teaching and continuing education play a large role within the organization, research staff participated in conferences/webinars. The department maintains reportable metrics and financial reports on a quarterly basis. The focus for principal investigators is mostly in therapeutic areas such as oncology, neuro/trauma/ortho, pharmacology, endocrinology, pediatrics, and cardiology. A variety of studies include different designs that may include, but are not limited to, pharmaceutical/investigational trials, retrospective medical chart reviews and registry studies. The research department is dedicated to:- providing consistent oversight and management of clinical research performed at all WHS facilities,- ensuring regulatory compliance and fiscal responsibility, and- creating a research culture across the health system.During FY19, the unreimbursed expenses of the research department were $1,027.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- 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

2018

Open to Public Inspection

Name of the organization

Takoma Regional Hospital Inc
dba Greeneville Community Hospital

Employer identification number

51-0603966

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Wellmont Health System 1905 American Way Kingsport,TN37660 62-1636465	Hospital System	TN	501c3	3	BALLAD		No
(2)Wellmont Hawkins Co Memorial Hosp 851 Locust Street Rogersville,TN37857 62-1816368	Hospital	TN	501c3	3	WHS		No
(3)Wellmont Cardiology Services 1905 American Way Kingsport,TN37660 26-3557623	Medical Services	TN	501c3	10	WHS		No
(4)Wellmont Medical Associates 1905 American Way Kingsport,TN37660 27-0898372	Medical Services	TN	501c3	7	WHS		No
(5)Wellmont Sleep Services 1905 American Way Kingsport,TN37660 27-3777167	Medical Services	TN	501c3	3	WHS		No
(6)Ballad Health Foundation Inc 1019 West Oakland Ave Suite 2 Johnson City,TN37604 58-1594191	Fundraiser	TN	501c3	7	BALLAD		No
(7)Wellmont Madison House 2000 Greenway Street Kingsport,TN37660 62-1308216	Assisted Living	TN	501c3	10	WHS		No
(8)Wellmont Wexford House 2421 N John B Dennis Hwy Kingsport,TN37660 58-1859039	Nursing Home	TN	501c3	10	WHS		No
(9)Wellmont Imaging Services Inc 1905 American Way Kingsport,TN37660 86-1103148	Healthcare	TN	501c3	12a	WHS		No
(10)Mountain States Health Alliance 303 Med Tech Parkway Suite 220 Johnson City,TN37604 62-0476282	Hospital System	TN	501c3	3	BALLAD		No
(11)MSHA Auxiliary 400 N State of Franklin Road Johnson City,TN37604 58-1418345	Supporting Organization	TN	501c3	12a	MSHA		No
(12)Smyth County Community Hospital 245 Medical Park Drive Marion,VA24354 54-0794913	Hospital	VA	501c3	3	MSHA		No
(13)Norton Community Hospital 100 15th Street NW Norton,VA24273 54-0566029	Hospital	VA	501c3	3	NA		No
(14)Dickenson Community Hospital 312 Hospital Drive Clintwood,VA24228 77-0599553	Hospital	VA	501c3	3	NCH		No
(15)Johnston Memorial Hospital 16000 Johnston Memorial Drive Abingdon,VA24211 54-0544705	Hospital	VA	501c3	3	NA		No
(16)Abingdon Physician Partners 16000 Johnston Memorial Drive Abingdon,VA24211 20-5485346	Medical Services	VA	501c3	12a	JMH		No
(17)Ballad Health 303 Med Tech Parkway Suite 220 Johnson City,TN37604 61-1771290	Supporting Organization	TN	501c3	12b	NA		No
(18)East TN Healthcare Holdings Inc 203 Gray Commons Circle Gray,TN37615 81-5475903	Opioid Treatment	TN	501c3	3	MSHA		No
(19)Laughlin Memorial Hospital Inc 1420 Tusculum Boulevard Greeneville,TN37745 62-0701119	Hospital	TN	501c3	3	MSHA		No
(20)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) 2018

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(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?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Sapling Grove Ambulatory Surgery Center 220 Medical Park Boulevard Bristol,TN37620 20-4450153	Medical Services	TN	WHS					No			No
(2) Holston Valley Ambulatory Surgery Center 103 West Stone Drive Kingsport,TN37660 62-1816864	Medical Services	TN	WHS					No			No
(3) Greeneville Physician Services LLC 1905 American Way Kingsport,TN37660 45-5070419	Medical Services	TN	WHS	Excluded	-40	239,784		No			No	75.000 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Wellmont Inc 1905 American Way Kingsport,TN37660 62-1320035	Medical Services	TN	WHS	C				No
(2) Wellmont Collections Inc 2004 American Way Suite 101 Kingsport,TN37660 62-1325938	Business Services	TN	NA	C				No
(3) Medical Mall Pharmacy Inc 1905 American Way Kingsport,TN37660 62-1565006	Medical Services	TN	NA	C				No
(4) Wellmont Physician Services 1905 American Way Kingsport,TN37660 62-1567353	Medical Services	TN	NA	C				No
(5) WPS Providers Inc 1905 American Way Kingsport,TN37660 20-5564642	Medical Services	TN	NA	C				No
(6) Wellmont Health Services Inc 1905 American Way Kingsport,TN37660 62-1254373	Medical Services	TN	NA	C				No
(7) Blue Ridge Medical Management Corp 1905 American Way Kingsport,TN37660 62-1490616	Medical Services	TN	MSHA	C				No
(8) Mediserve Medical Equipment 1905 American Way Kingsport,TN37660 62-1212286	Durable Medical Equipment	TN	BRMMC	C				No
(9) Mountain States Properties 1905 American Way Kingsport,TN37660 62-1845895	Property Management	TN	BRMMC	C				No
(10) Mountain States Physician Grp 1905 American Way Kingsport,TN37660 62-1700412	Medical Services	TN	BRMMC	C				No
(11) Community Home Care Inc 1490 Park Avenue NW Suite B Norton,VA24273 54-1453810	Durable Medical Equipment	VA	NCH	C				No
(12) Wilson Pharmacy Inc PO Box 5289 Johnson City,TN37604 62-0329587	Pharmacy	TN	BRMMC	C				No
(13) Crestpoint Health Insurance Company 509 Med Tech Parkway Suite 100 Johnson City,TN37604 62-0381170	Insurance	TN	ISHN	C				No
(14) Integrated Solutions Health Network 509 Med Tech Parkway Suite 100 Johnson City,TN37604 62-1711997	Health Network	TN	MSHA	C				No
(15) Nolichuckey Management Svcs Inc 1420 Tusculum Boulevard Greeneville,TN37745 62-1776681	Medical Services	TN	LMH	C				No
(16) Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman KY1-1203 CJ 98-1195624	Insurance	CJ	NA	C				No

Schedule R (Form 990) 2018

Page 3

Part V

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

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

Yes

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

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

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

Schedule R (Form 990) 2018

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) 2018

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) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

1	Briefly describe the organization’s mission or most significant activities: Mission: Honor those we serve by delivering the best possible care. Vision: To build a legacy of superior health by listening to and caring for those we serve.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	4
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	0
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	597
6	Total number of volunteers (estimate if necessary) .............	6	92
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	9,466
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	7,619

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	346,073	41,233
9	Program service revenue (Part VIII, line 2g) .........	57,036,021	57,380,162
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	46,440	186,196
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,310,992	597,438
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	60,739,526	58,205,029
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,100	21,175
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)	34,912,746	40,133,525
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)....	29,807,269	33,457,199
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	64,722,115	73,611,899
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,982,589	-15,406,870
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	32,494,699	169,822,344
21	Total liabilities (Part X, line 26).............	3,656,439	18,801,170
22	Net assets or fund balances. Subtract line 21 from line 20.....	28,838,260	151,021,174

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 61,182,416 including grants of $ 21,175 ) (Revenue $ 57,502,506 )
	See Schedule O

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 expenses61,182,416

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,644,920	6,552,524	718,236

(A) Name and business address	(B) Description of services	(C) Compensation
Solstas Lab Partners PO Box 751337 Charlotte,NC28275	Lab Services	383,199




2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 1

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	41,233
e	Government grants (contributions)		1e

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

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		41,233

		Business Code
2a	340B Program	900099	5,738,180	5,738,180
b	Hospital Patient Revenue	900099	50,973,686	50,973,686
c	P/S Business Income	541900	117,156	117,156
d	Rent to T/E Affiliates	900099	25,802	25,802
e	Wellness Programs	900099	525,338	525,338
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		57,380,162

3 Investment income (including dividends, interest, and othersimilar amounts) ......			73,318			73,318
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		301,241
b	Less: rental expenses		74,736
c	Rental income or (loss)		226,505
d	Net rental income or (loss)......			226,505			226,505
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	121,853
b	Less: cost or other basis and sales expenses	8,975
c	Gain or (loss)	112,878
d	Net gain or (loss).....			112,878	112,878
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Cafeteria & Vending		722514	202,406			202,406
b	Gift Shop/Hair Salon		900099	19,243			19,243
c	Revenue From Parent		900099	132,606			132,606
d	All other revenue ....			16,678		9,466	7,212
e	Total. Add lines 11a–11d ......			370,933
12	Total revenue. See Instructions......			58,205,029	57,493,040	9,466	661,290

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	21,175	21,175
2	Grants and other assistance to domestic individuals. See Part IV, line 22	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	487,331		487,331
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	31,790,199	29,386,759	2,403,440
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	958,040	827,857	130,183
9	Other employee benefits .......	4,982,755	3,662,260	1,320,495
10	Payroll taxes ...........	1,915,200	1,882,466	32,734
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	15,366	2,132	13,234
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	3,413	2,796	617
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	13,251,460	9,988,106	3,263,354
12	Advertising and promotion ....	99,194	1,718	97,476
13	Office expenses .......	1,089,685	999,579	90,106
14	Information technology ......	901,813	324,067	577,746
15	Royalties ..	0
16	Occupancy ...........	3,208,989	3,086,420	122,569
17	Travel ............	118,529	103,679	14,850
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	25,260		25,260
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	1,800,523	1,713,697	86,826
23	Insurance ...	-345,087	-354,856	9,769
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	7,263,413	7,263,413
b	Management Fees	3,455,431		3,455,431
c	Maintenance	1,329,842	1,321,998	7,844
d	Taxes - UBIT	14,146	11,589	2,557
e	All other expenses	1,225,222	937,561	287,661
25	Total functional expenses. Add lines 1 through 24e	73,611,899	61,182,416	12,429,483	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 ........			3,662,160	1	8,512,545
2	Savings and temporary cash investments .........				2	0
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			10,166,678	4	25,540,292
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
					6	0
7	Notes and loans receivable, net ....			799,101	7	35,899
8	Inventories for sale or use ........			1,269,767	8	3,426,715
9	Prepaid expenses and deferred charges ......			124,468	9	632,599
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	48,500,957
b	Less: accumulated depreciation	10b	9,137,867	13,964,561	10c	39,363,090
11	Investments—publicly traded securities .				11	0
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	916,245
14	Intangible assets ...............			2,507,964	14	2,507,964
15	Other assets. See Part IV, line 11 ...........				15	88,886,995
16	Total assets. Add lines 1 through 15 (must equal line 34)...			32,494,699	16	169,822,344

17	Accounts payable and accrued expenses .....	3,043,192	17	12,855,880
18	Grants payable ...		18
19	Deferred revenue .........		19	297,513
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23	259,146
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	613,247	25	5,388,631
26	Total liabilities. Add lines 17 through 25..	3,656,439	26	18,801,170

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	28,838,260	27	151,021,174
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	28,838,260	33	151,021,174
34	Total liabilities and net assets/fund balances ........	32,494,699	34	169,822,344