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 Pres & CEO	1.00 ................. 59.00	X	X			0	2,032,246	193,444
(2) Marvin Eichorn...................................................................... BH EVP & CAO	1.00 ................. 59.00	X				0	1,011,865	36,694
(3) Tim Belisle...................................................................... EVP&Gen Counsel	1.00 ................. 59.00	X	X			0	577,064	79,532
(4) Eric Deaton...................................................................... BH EVP & COO	1.00 ................. 59.00	X				570,270	0	42,955
(5) Lynn Krutak...................................................................... BH EVP/CFO	0.10 ................. 59.90		X			0	854,023	90,292
(6) Monty McLaurin...................................................................... Pres/CEO NW Mkt (end 1/13/19)	1.00 ................. 44.00			X		0	558,099	42,029
(7) Timothy Attebery...................................................................... Pres/CEO NW Mkt (end 8/31/18)	44.80 ................. 0.20			X		0	422,275	42,806
(8) Greg Neal...................................................................... Pres/CEO NE Mkt	44.80 ................. 0.20			X		0	388,527	40,559
(9) Lisa Smithgall...................................................................... SVP/Chief Nursing Executive	1.00 ................. 49.00			X		0	327,205	29,575
(10) Dale Poe...................................................................... CFO NW Mkt(end 4/12/19)	44.80 ................. 0.20			X		0	317,756	30,193
(11) Stephen Sawyer...................................................................... CFO NW Region	26.00 ................. 19.00			X		0	244,949	32,397
(12) Robert Bender...................................................................... CFO NE Mkt	36.00 ................. 9.00			X		0	236,215	32,068
(13) Rebecca Beck...................................................................... VP/COO HVMC	45.00 ................. 0.00			X		0	219,930	28,226
(14) Christopher Hobson...................................................................... VP/COO BRMC	45.00 ................. 0.00			X		0	192,237	31,820
(15) Tim Anderson...................................................................... VP Pt Care Svcs (end 9/01/18)	45.00 ................. 0.00			X		0	186,595	28,750
(16) Bobbie Murphy...................................................................... VP Pt Care Svcs (Start 9/01/18	45.00 ................. 0.00			X		0	160,422	22,613
(17) David Pryputniewicz MD...................................................................... Staff Physician	40.00 ................. 0.00				X	1,222,702	0	41,395

(A) Name and business address	(B) Description of services	(C) Compensation
Solstas Lab Partners 4380 Federal Drive Greensboro,NC27410	Lab Services	3,544,468
Highlands Pathology Consultants PC 10368 Wallace Alley 18 Kingsport,TN37663	Lab Services	3,133,517
American Physician Partners LLC 415 Broad Street Kingsport,TN37660	ED Phy Coverage	1,334,333
Soliant Health PO Box 1024640 Atlanta,GA30368	Staffing Services	954,797

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 4

- 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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

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 Wellmont Health System dba Bristol Regional Medical Center

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 Wellmont Health System dba Bristol Regional Medical Center		Employer identification number 62-1636465

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 Wellmont Health System dba Bristol Regional Medical Center			Employer identification number 62-1636465
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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

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

6,790

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

6,790

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	Wellmont Health System had lobbying expenses of $6,790 which represents the portion of dues paid to Tennessee Hospital Association attribue 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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

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 .....	107,181	13,800,703		13,907,884
b	Buildings ....		505,768,627	307,892,758	197,875,869
c	Leasehold improvements		8,172,587	3,232,441	4,940,146
d	Equipment ....		355,004,397	293,924,406	61,079,991
e	Other .....		19,057,681	11,009,830	8,047,851
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					285,851,741

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

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Due to Affiliates	233,762,765
Due to Third Party Payors	3,682,512
Professional Liabilities & Other	5,855
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	237,451,132
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

Wellmont Health System 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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

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) . . .	22,311,971		22,311,971	3.440 %
b	Medicaid (from Worksheet 3, column a) . . . . .	66,245,044	52,981,506	13,263,538	2.040 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	88,557,015	52,981,506	35,575,509	5.480 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	3,033,651	182,135	2,851,516	0.440 %
f	Health professions education (from Worksheet 5) . . .	13,102,435	5,159,114	7,943,321	1.220 %
g	Subsidized health services (from Worksheet 6) . . . .	88,844	3,426	85,418	0.010 %
h	Research (from Worksheet 7) .	135,011	92,150	42,861	0.010 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	411,092		411,092	0.060 %
j	Total. Other Benefits . .	16,771,033	5,436,825	11,334,208	1.740 %
k	Total. Add lines 7d and 7j .	105,328,048	58,418,331	46,909,717	7.220 %

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
1	Physical improvements and housing
2	Economic development
3	Community support	2,500	2,500
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	2,500	2,500

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. ......

41,720,044

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

15,436,416

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).....

175,754,948

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

164,855,254

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

10,899,694

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 %
1Holston Valley Amb Surg Ctr	Surgical Services	52.000 %	48.000 %
2Sapling Grove Amb Surg Ctr	Surgical Services	65.000 %	35.000 %
3Greeneville Phy Svcs LLC	Medical Services	75.000 %	25.000 %
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?5Name, 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	Bristol Regional Medical Ctr 1 Medical Park Boulevard Bristol,TN37620 balladhealth.org/locations 0000000131	X	X	X		X	A
2	Holston Valley Medical Center 130 Ravine Road Kingsport,TN37660 balladhealth.org/locations 0000000133	X	X	X		X	A
3	Hancock County Hospital 1519 Main Street Sneedville,TN37869 balladhealth.org/locations 0000000165	X			X	X	A
4	Lonesome Pine Hospital 1990 Holton Avenue Big Stone Gap,VA24219 balladhealth.org/locations H 1915	X	X	X		X	A
5	Mountain View Regional Hosp 310 3rd Street NE Norton,VA24273 balladhealth.org/locations H 1930	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):

12345

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 1,2,3,4,5 - Part V, Section B, Line 3j	Facility/Group A includes the following facilities:Bristol Regional Medical Center, Holston Valley Medical Center, Hancock County Hospital, Lonesome Pine Hospital and Mountain View Regional HospitalDuring FY19, WHS hospitals were operating under the 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. WHS hospitals conducted their third CHNA this tax reporting period with board approval and publication occurring during 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 affiliates, 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 the Ballad Health 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 1,2,3,4,5 - 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 ETSUCollege 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 thecommunity at large 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 1,2,3,4,5 - Part V, Section B, Line 6a	Each hospital within Wellmont Health System completed a CHNA. - Bristol Regional Medical Center- Holston Valley Medical Center- Hawkins County Memorial Hospital- Hancock County Hospital- Takoma Regional Hospital, Inc.- Lonesome Pine Hospital- Mountain View Regional Hospital
Facility: A 1,2,3,4,5 - 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.Wellmont engaged the community in a myriad of activities developed toaddress the most prevalent health needs in our service area. Some of ourprograms this year include:- Diabetes education. Numerous presentations were provided (free of charge)to discuss preventative measures. We also participated in a cardiovasular program. Diabetes field trips for local teachers took place and many radio spots discussed diabetes awareness and prevention, including weight loss topics. Our team members are involved with a local Diabetes Association support group and HVMC provides free meeting space for the Kingsport Diabetes Association's monthly meetings.- Our trauma team remained very active throughout FY19. They offered emergency preparedness, injury prevention and other topics related to trauma events.- We offered a support group for people who have undergone bariatric weight-loss surgery and those considering the procedure.To address the high obesity rate in our community, which often results in diabetes, Holston Valley Medical Center (HVMC) operates a Comprehensive Weight Management Center. The center offers weight loss solutions by a highly trained staff, weight-loss resources and tips to help patients succeed long-term. The center also offers a support group for people who have had bariatric surgery.Holston Valley Medical Center 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.Wellmont Health System includes the hospitals reported in this Form 990. Most of the charitable donations made during the year are reported in the hospitals. More detail of Wellmont Health System's charitable donations during the year is reported in the Form 990, Part III narrative included in Schedule O.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.
Facility: A 1,2,3,4,5 - 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 the Ballad Health 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
2
3
4
5
6
7
8
9
10

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	A cost to charge ratio was used to compute the cost related to financial assistance (charity) write-offs (line 7a) and the hospitals' loss related to TennCare/Medicaid services (line 7b). Costs reported in the other community benefit categories were not included when computing the cost to charge ratio in order to avoid duplication of cost. Community health improvement (line 7e) and research (line 7h) report actual costs associated with programs and activities. Generally, these costs are well defined in a specific cost center (hospital department). Line 7f health professionseducation is comprised of internships (primarily internal medicine residents, nursing, pharmacy, and therapy students) with schools and universities, allowing their health profession students to get hands-on training in a hospital setting. Our Medicare-approved programs include medical residents and pharmacy. For these programs, Medicare-approved costs and Medicare reimbursement comes from filed Medicare cost reports. Our Organizational Development Department (OD) maintains records for the non-Medicare programs. OD keeps records of the number of students receiving training at our hospitals and the amount of hours the students spend at our hospitals. Hours may differ based on the school and the type of program (RN, radiology, lab, etc.). The number of team members that provide training to students will also vary based on where the student is training. For example, an RN trainer on a medical floor may have 3 or 4 students under her/his direction, while an RN trainer in a specialty area such as ICU or the ER may be training one-on-one with a single student. We only include labor costs for our hospital team members that provide training (i.e. no overhead is applied) and we only attribute a percentage of our team members' time to actual training. Contributions (line 7i)represent cash donations, medical supplies made to other nonprofit organizations that support community wellness and the donation of a Wellness Center building/land.
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, TennCare, 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, WHS 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 WHSs 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 39% of completed financial assistance applications processed during FY19 received a full discount (complete write-off). An additional 11% received a partial discount, resulting in an overall approval rate of 50% for completed applications. Therefore, 51% 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 TennCare (TN) or Medicaid (VA). 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	The Ballad Health audited financial statements include a footnote on page 13 that describes bad debt. WHS 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 gain is reported using WHS'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 provided 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, The goal of Ballad Health 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, WHS 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	Wellmont Health System's service area is defined by management at the county level based on patient activity and locations of our campuses. The primary service area ("PSA") includes the Tennessee counties of Sullivan, Hawkins, and Hancock, and the Virginia counties of Washington, Wise, Lee, and Scott. The secondary service area ("SSA") is defined as Washington, Greene, Carter, Johnson, and Unicoi counties of Tennessee, and Russell, Buchanan, Smyth, Tazewell, Dickenson, and Wythe counties of Virginia.PSA- Population 358,813; Median Household Income $39,357SSA- Population 452,529; Median Household income $39,436Approximately 16.90% of our patients are Medicaid recipients, and 8.87% are uninsured and all of the PSA counties are designated as medically underserved areas (Tennessee and Virginia).
Part VI, Line 4 - Community Building Activities	Ballad Health 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 Ballad Health 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.Community building reported on this return includes a charitable contribution to a nonprofit organization for continued revitalization efforts.
Part VI, Line 5 - Promotion of Community Health	WHS is dedicated to operating efficiently so that waste is minimized. WHSs 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.WHS has several hospitals with Medicare-approved health profession education programs. In addition, our hospitals 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 WHS 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 WHS.
Part VI, Line 6 - Affilated Health Care System	Wellmont Health System is a Tennessee non-profit corporation and a premier provider of healthcare services in Northeast Tennessee and Southwest Virginia. Wellmont includes seven hospitals (five included in this return), an integrated physician network, and several ambulatory sites. Wellmont hospitals offer a broad scope of services ranging from community based acute care to highly specialized tertiary services including a trauma center, comprehensive heart care, and cancer care.Wellmont owns and operates an integrated health care delivery system providing inpatient, outpatient, and other health care services at multiple locations in Northeast Tennessee and Southwest Virginia. Currently, Wellmont owns and operates six acute care hospital facilities and one critical access hospital with a total of 1,155 licensed beds. The acute care facilities owned by Wellmont include Holston Valley Medical Center in Kingsport, Tennessee, Bristol Regional Medical Center in Bristol, Tennessee, Mountain View Regional Hospital in Norton, Virginia, Lonesome Pine Hospital in Big Stone Gap, Virginia, Hawkins County Memorial Hospital in Rogersville, Tennessee, Takoma Regional Hospital, Inc. D/B/A Greeneville Community Hospital in Greeneville, Tennessee, and the critical access hospital, Hancock County Hospital in Sneedville, Tennessee.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 WHSs hospitals, 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.- Consolidation of Level III NICU and other services to enhance quality of care and patient outcomes- 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 Mountain States Health Alliance and Wellmont Health System 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
Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number
62-1636465

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) Barter Theatre PO Box 867 Abingdon,VA24212	54-6000120	501c3	24,000	0			Sponsorship
(2) Boys & Girls Club of the Mt PO Box 1074 Bristol,VA24203	54-0653489	501c3	0	370,452	NBV	Leased space	Wellness Center building/land
(3) Kingsport Chamber Foundation 400 Clinchfield St Ste 100 Kingsport,TN37660	58-1453565	501c3	11,450	0			Sponsorship
(4) VA Highlands CC Edu Fnd PO Box 828 Abingdon,VA24212	52-1225133	501c3	30,000	0			Adjunct instructor

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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

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 .........

Yes

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? .............

Yes

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 Pres & CEO	(i) (ii)	------------- 1,101,957	------------- 750,000	------------- 180,289	------------- 172,174	------------- 21,270	------------- 2,225,690	------------- 150,202
2Andrew Kramer MD Staff Physician	(i) (ii)	581,479 -------------	-------------	774 -------------	21,946 -------------	18,648 -------------	622,847 -------------	-------------
3Barton Hove Former Officer-Retired	(i) (ii)	246,667 -------------	161,333 -------------	888,774 -------------	9,467 -------------	8,469 -------------	1,314,710 -------------	-------------
4Bobbie Murphy VP Pt Care Svcs (Start 9/01/18	(i) (ii)	------------- 156,913	------------- 2,896	------------- 613	------------- 1,454	------------- 21,159	------------- 183,035	-------------
5Christopher Hobson VP/COO BRMC	(i) (ii)	------------- 180,763	------------- 10,033	------------- 1,441	------------- 9,509	------------- 22,311	------------- 224,057	-------------
6Dale Poe CFO NW Mkt(end 4/12/19)	(i) (ii)	------------- 271,619	------------- 44,683	------------- 1,454	------------- 11,110	------------- 19,083	------------- 347,949	-------------
7David Pryputniewicz MD Staff Physician	(i) (ii)	469,226 -------------	515,269 -------------	238,207 -------------	24,733 -------------	16,662 -------------	1,264,097 -------------	-------------
8Elizabeth Jackson MD Staff Physician	(i) (ii)	573,290 -------------	-------------	162 -------------	18,947 -------------	20,787 -------------	613,186 -------------	-------------
9Eric Deaton BH EVP & COO	(i) (ii)	497,063 -------------	40,165 -------------	33,042 -------------	26,522 -------------	16,433 -------------	613,225 -------------	-------------
10Greg Neal Pres/CEO NE Mkt	(i) (ii)	------------- 362,612	------------- 25,322	------------- 593	------------- 18,585	------------- 21,974	------------- 429,086	-------------
11John Ehrenfried MD Staff Physician	(i) (ii)	542,766 -------------	-------------	414 -------------	18,729 -------------	22,311 -------------	584,220 -------------	-------------
12Kelly Oggero MD Staff Physician	(i) (ii)	504,936 -------------	-------------	1,123 -------------	19,774 -------------	22,352 -------------	548,185 -------------	-------------
13Lisa Smithgall SVP/Chief Nursing Executive	(i) (ii)	------------- 324,565	-------------	------------- 2,640	------------- 13,673	------------- 15,902	------------- 356,780	-------------
14Lynn Krutak BH EVP/CFO	(i) (ii)	------------- 585,707	------------- 250,000	------------- 18,316	------------- 72,647	------------- 17,645	------------- 944,315	-------------
15Marvin Eichorn BH EVP & CAO	(i) (ii)	------------- 678,984	------------- 300,000	------------- 32,881	------------- 12,241	------------- 24,453	------------- 1,048,559	-------------
16Monty McLaurin Pres/CEO NW Mkt (end 1/13/19)	(i) (ii)	------------- 357,053	------------- 157,624	------------- 43,422	------------- 18,299	------------- 23,730	------------- 600,128	-------------
17Rebecca Beck VP/COO HVMC	(i) (ii)	------------- 204,764	------------- 14,670	------------- 496	------------- 11,359	------------- 16,867	------------- 248,156	-------------
18Robert Bender CFO NE Mkt	(i) (ii)	------------- 222,795	------------- 12,696	------------- 724	------------- 12,270	------------- 19,798	------------- 268,283	-------------
19Stephen Sawyer CFO NW Region	(i) (ii)	------------- 182,298	------------- 47,287	------------- 15,364	------------- 10,709	------------- 21,688	------------- 277,346	-------------
20Tim Anderson VP Pt Care Svcs (end 9/01/18)	(i) (ii)	------------- 175,561	------------- 9,601	------------- 1,433	------------- 9,608	------------- 19,142	------------- 215,345	-------------
21Tim Belisle EVP&Gen Counsel	(i) (ii)	------------- 400,672	------------- 161,656	------------- 14,736	------------- 56,640	------------- 22,892	------------- 656,596	-------------
22Timothy Attebery Pres/CEO NW Mkt (end 8/31/18)	(i) (ii)	------------- 363,268	------------- 30,785	------------- 28,222	------------- 22,809	------------- 19,997	------------- 465,081	-------------
23Todd Dougan Fomer Officer-Retired	(i) (ii)	446,194 -------------	35,385 -------------	7,016 -------------	6,061 -------------	12,306 -------------	506,962 -------------	-------------

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

Part I, Line 1a: Relevant information in regards to selections on 1a.

Health or Social Club DuesDuring the fiscal year ended June 30, 2019, Wellmont Health System provided a country club membership to Barton Hove. These amounts are included in taxable compensation.Part I, Line 2 - Discretionary SpendingWellmont Health System provided a monthly vehicle allowance to Eric Deaton for travel expenses during the fiscal year ended June 30, 2019. The amount is included in taxable compensation.

Schedule J (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 K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number
62-1636465

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Sullvn Cty Hlth EDL&HS 06	62-1256662	865293AF1	11-02-2006	207,055,314	Construction at HVMC		X		X		X
B	Sullvn Cty Hlth EDL & HSG	62-1256662	865293AH7	05-05-2011	76,165,000	Refund 2006A Bond		X		X		X
C	Sullvn Cty Hlth EDL & HSG	62-1256662		12-13-2012	42,500,000	Purchase EPIC EMR		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	19,580,000		6,495,000		34,326,900
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	207,055,314		76,165,000		42,500,000
4 Gross proceeds in reserve funds .............	18,977,995
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............			74,942,165
7 Issuance costs from proceeds ...............	2,164,568		1,298,533		31,809
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	185,912,751				42,468,191
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2011		2011		2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X	X			X
16 Has the final allocation of proceeds been made? ..........	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X
b Exception to rebate? ........		X	X		X
c No rebate due? .........	X			X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X		X			X
b Name of provider ..........	Banc of America		Banc of America
c Term of hedge .........	6000.00 %		12400.00 %
d Was the hedge superintegrated? ......		X		X
e Was the hedge terminated? ........		X		X

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?	X			X		X
b Name of provider ..........	MA Mutual Life
c Term of GIC .........	400.00 %
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........	X
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X		X

Part Ⅵ

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

Return Reference	Explanation
Part VI	Schedule K - Date Rebate Computation Performed Sullivan County TN Health EDL & HSG 06C 10/31/2016

Schedule K (Form 990) 2018

Additional Data

Software ID:	18007218
Software Version:	2018v3.1

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

Part I

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

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

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

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

Part II

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

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) Greg Neal	Key Emp	Education		X	75,000	50,000		No		No	Yes
(2) Eric Deaton	Offcr/Dir	Education		X	29,000			No		No	Yes




Total ............... $						50,000

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

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

(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	Yes	No

Part V

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

Return Reference	Explanation
Schedule L, Part V Supplemental Information	Eric Deaton has an educational loan note receivable balance at June 30, 2018 totaling $15,818. The note receivable balance was transferred to Ballad Health on July 1, 2018.

Schedule L (Form 990 or 990-EZ) 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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

Return Reference	Explanation
Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents	Wellmont Health System and Mountain States Health Alliance merged on February 1, 2018 to form Ballad Health (BH), a tax-exempt healthcare delivery system. At time of merger, the BH Board of Directors became the directors of Wellmont Health System and Mountain States Health Alliance. BH is the sole member of Wellmont Health System and Mountain States Health Alliance. In FY19, BH appointed four BH officers to serve as the board of directors for Wellmont Health System and Mountain States Health Alliance.
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Wellmont Health System is a Tennessee non-stock, nonprofit organization with Ballad Health as its sole member.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	Ballad Health has the authority to appoint Wellmont Health System board members. The President and CEO of Ballad Health serves as the President and CEO for Wellmont Health System.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	Decisions of the Wellmont Health System Board of Directors are subject to approval by the Ballad Health Board of Directors.
Form 990, Part VI, Line 11b: Form 990 Review Process	Ballad Healths EVP/CFO reviewed the Form 990 with the board of directors prior to the return being filed with the IRS. The return was made available to each board member in an electronic 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. All persons covered by this policy are required to complete a conflict of interest disclosure form on an annual basis. Should a conflict arise, it is the responsibility of the conflicted individual to update his or her disclosure immediately. All meetings of the board or board committees have a standing agenda item first on the agenda titled Conflicts of Interest. If a member of the board or board committee has a conflict of interest involving any issue on the board agenda, he or she must declare the conflict of interest during the period allotted for disclosure. If any issue arises during a meeting in which the board member has a conflict of interest, he or she must immediately declare the conflict. While each member of the board or board committee is responsible for disclosing conflicts of interest, it is also the responsibility of any board member aware of a conflict which has not been disclosed to ensure the board is made aware. The presiding officer of a board or board committee meeting may ask a conflicted member to excuse themselves from the meeting during the discussion related to the issue with which the conflict of interest applies. Under no circumstances shall a member vote on a matter that gives rise to a potential conflict.
Form 990, 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 of the company on a quarterly basis.
Other Changes In Net Assets Or Fund Balances - Other Decreases	Alternative Investment Income - Not on Books = -$7302
Other Changes In Net Assets Or Fund Balances - Other Decreases	Capital Infusion to Parent Organization = -$XXX-XX-XXXX
Other Changes In Net Assets Or Fund Balances - Other Increases	Joint Venture Distributions = $406391
Other Changes In Net Assets Or Fund Balances - Other Decreases	Partnership Ordinary Income - Not on Books = -$129877
Other Changes In Net Assets Or Fund Balances - Other Increases	Partnership Share - Deductions = $4996
Other Changes In Net Assets Or Fund Balances - Other Increases	Temporarily Restricted Grants = $14000
AWARDS AND RECOGNITIONS	All the WHS hospitals are accredited by the Joint Commission (TJC) with many of the hospitals designated with advanced gold seal certifications for various programs. 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 organizations commitment to meeting certain performance standards. The security, safety & emergency management force at both Ballad Health and WHS 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.Consistent with prior years, Wellmont Health System hospitals received excellent 2019 hospital quality ratings from CareChex. CareChex scores, rates, ranks, and compares inpatient quality performance across general, acute, and non-federal hospitals. Hospital ratings incorporate a detailed composite evaluation of clinical outcomes including patient safety indicators, inpatient quality indicators, risk-adjusted mortality, complications, and readmissions. In addition, scores based on patient experiences (patient satisfaction scores) are used. An analysis by clinical category, MS-DRG, principal diagnosis and procedure, discharge status, and trends over time are also utilized. Bristol Regional Medical Center- Recognized as a High-Performing Hospital for 2019 by U.S. News & World Report, ranking Number 7 in Tennessee and earning High Performing ratings for chronic obstructive pulmonary disease, colon cancer surgery, heart failure and knee replacement. - Received the American College of Cardiology Chest Pain-MI Registry 2019 Platinum Performance Achievement Award recognizing success in implementing a higher standard of care for heart attack patients by meeting aggressive performance measures.- Earned the Tennessee Department of Healths BEST for Babies award for efforts to reduce infant mortality. Holston Valley Medical Center- Recognized as a High-Performing Hospital for 2019 by U.S. News & World Report, ranking Number 7 in Tennessee and earning High Performing ratings for chronic obstructive pulmonary disease, colon cancer surgery, heart failure and knee replacement. - Received the American College of Cardiology Chest Pain-MI Registry 2019 Platinum Performance Achievement Award recognizing success in implementing a higher standard of care for heart attack patients by meeting aggressive performance measures.- Leader in cardiovascular research and training, with annual visits from Harvard fellows to study techniques used by prominent cardiologists at Holston Valley Medical Center.Hancock County Hospital- Recognized in 2019 by Beckers Hospital Review as 67 "Critical Access Hospitals to Know".
CHARITY AND OTHER UNREIMBURSED COSTS	While reimbursement for healthcare services rendered is critical to the operation and sustainability of the organization, WHS recognizes its obligation to provide care to individuals who cannot afford essential medical services, including emergency care. WHS 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, WHS incurred a loss of $22,311,971 attributable to the provision of charity care. This amount does not include the costs associated with accounts classified as bad debt. TENNCARE/MEDICAID: WHS provides care to persons covered by governmental programs, such as TennCare (Tennessee residents) and Medicaid. WHS incurred a loss of $13,263,538 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 WHS hospitals. 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 $9,723,199 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 WHS hospitals and individual efforts of caring team members, the aim is to enrich the communities that are served. WHSs 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, WHS 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: - $5,000 to Crossroads Medical Mission - primary medical services to uninsured, underinsured, residents with poor access to medical care and others not currently receiving medical care- Medical supplies were donated to local emergency responder organizationsThroughout the year, WHS 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:- $370,452 to Boys & Girls Club of the Mountain Empire, Inc. noncash donation (net book value)of WHS Wellness Center building/land located on State Street, Bristol, TNWHS 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:- Chambers of Commerce throughout our service areas- Towns and cities to improve downtown areas and support community events- Bristol Lions Club- Levis Legacy Foundation Water Guardian tags for family members to promote drowning awareness and provide swimming lessons to families in needWHS also contributes to the arts, festivals, churches/ministries and other organizations in the local communities. Donations to these organizations during the year include:- $5,000 to Bristol Rhythm and Roots, an award-winning music festival 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 WHS. 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 WHS to provide this program was $42,991.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 WHS for the air ambulance services, especially critical in rural areas, was $398,322.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 $105,728 this year.WHS, in collaboration with area health agencies and providers, helps with coordination, advocacy and publicity, provides space, or contributes supplies to support groups for their program activities.The Health Resources Center (HRC) is a community outreach service provided in two locations. The Johnson City HRC is located inside the Wellness Center. The Kingsport HRC is in the Fort Henry Mall. The centers are staffed by a registered nurse and other health professionals, including a registered dietitian. The HRC offers free classes, screenings, blood pressure checks, support groups, nutritional education, informational materials and resources and other services to meet community members health and health education needs.Classes offered to the public include: diabetes education and management, nutrition and healthy cooking, CPR training, exercise, weight loss, lung health, green cleaning using simple cleaning recipes, avoiding seasonal allergies, glaucoma, colorectal cancer, stress in seniors, elder concerns, sleep health, drug addiction, cancer education, heart health, foot care, safe babysitting, breastfeeding, techniques for managing chronic pain, Medicare information sessions for seniors turning 65, relaxation training, sleep apnea screening, vaccines, balance and falls prevention, child illnesses and special needs programs and classes, suicide prevention, and, many other disease-specific classes and screenings, including stroke risk. Almost all of these courses are offered free of charge except for a small fee that may be imposed for lab charges or guidebooks.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. Camp Caterpillar, funded by WHS, features the hallmarks of a traditional day camp - kids, crafts, and other activities. But beyond the fun and games, grieving hearts find hope and healing. Through the WHS hospice program, Camp Caterpillar is designed for children, teenagers and families who have experienced the death of a loved one. The free, one-day camp utilizes social workers, counselors and nurses to help participants address their grief, learn coping strategies and share memories. The camp day kicks off with a special shared activity for all attendees, followed by age-divided breakout rotations to help children express their feelings through colors and music, discover coping strategies, share stories and create memory boxes and other crafts. Through each activity, campers are accompanied by volunteers who serve as camp buddies. The volunteers spend the day with the children and provide emotional support. The volunteers also spend individual time with any child who needs to take a few minutes away from the crowd to decompress. Dogs, certified by Therapy Dogs International, and their owners provide comfort to the children. Meanwhile, adults meet as a group to focus on understanding child stages of grief, responding to a child's unique needs, and coping with their adult feelings. Adults and children also receive materials to help facilitate discussion and healing at home. Camp Caterpillar receives referrals for campers from schools and other community organizations. In partnership with Bristol Motor Speedway, the Level II trauma center at Bristol Regional Medical Center sponsors the nationally acclaimed Accident Avoidance Workshops for teenage drivers. These intensive two day clinics,offered multiple times each year,teach hands-on,in-car accident avoidance and defensive driving skills. WHS serves as the exclusive medical care provider for Bristol Motor Speedway. In addition to staffing the infield care center for drivers and crew, the Ballad Health organization also operates multiple care centers around the track for the race fans.Bristol Regional Medical Center offers a Safe Sitters course to teach safety skills for babysitters. Topics covered in the course include rescue skills, first aid and nurturing, safe childcare.The WHS service area is sometimes referred to as the "diabetes belt" due to the high number of residents with diabetes. The Diabetes Treatment Centers, available at Bristol Regional and Holston Valley Medical Centers, are accredited by the American Diabetes Association. Self-management classes are taught by specially trained registered nurses, dietitians and certified diabetes educators and offered free of charge. For those preferring one-on-one counseling instead of group classes, the centers will also provide individual counseling at no cost. The Diabetes Treatment Center (DTC) staff also serve hospital inpatients to assist in control of blood sugar levels, medication management and educate on diabetes management. On average, 27 to 33 percent of the patients at Holston Valley Medical Center have diabetes. DTC staff provide health coaching at local businesses, present health information to community groups, and participate in health fairs. DTC staff also educate teachers in various school districts about caring for students with diabetes. The DTC also holds an annual Diabetes Expo with over 300 community members in attendance receiving free screenings, including foot, eye, kidney, and glucose education. In addition to diabetes classes held at our Diabetes Treatment Centers, staff provided diabetes education outreach presentations as well.Studies show people who understand their healt
COMMUNITY RESOURCES (cont'd)	- Trauma team provided many courses during the year to emergency responders, schools, and others. Special training was provided for trauma in rural areas due to Ballad Health service areas being predominantly rural. Rural communities have a 22 percent higher risk of injury-related deaths than urban areas. Only 30 percent of vehicle miles traveled occur in rural areas, however, almost half of crash deaths occur there. And, rural trauma is more likely to be from accidents related to farming, hiking, horseback riding, use of four-wheelers, etc.- Specific health issues, mostly related to diabetes and injury prevention, and first aid were covered by outreach in a popular radio format.- Through a partnership with the Sullivan County Regional Health Department, caregivers from Bristol Regional's Deborah H. Quillen Birthing Center educate the community on the dangers of smoking for pregnant women using "Smoky Sue", a doll that shows the harmful effects of tar and nicotine on a fetus.- In addition to the health education classes, support group meetings are held at our hospitals for various health conditions such as diabetes, bariatric weight loss, and cancer.
d/b/a - Additional Names	Holston Valley Medical Center;Hancock County Hospital;Lonesome Pine Hospital;Mountain View Regional Hospital
Form 990, Part VI, Line 15a - Compensation Process for Top Official	The executive committee serves as the compensation committee of Ballad Health's Board of Directors. The compensation plan for Alan Levine, Ballad Health's President and CEO, 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.
Form 990, Part VI, Line 15b - Compensation Process for Officers	The executive committee reviewed and approved compensation for all Ballad Health executives at the vice-president level and above during FY19 using the same methodology used to determine the CEO's compensation.
HANCOCK COUNTY, TN: HANCOCK COUNTY (HCH)	10-bed facility designated by Tennessee as a critical-access hospital Hospital built through a partnership between Wellmont Health System and the Hancock County Commission Services include inpatient/outpatient acute care, emergency care, radiology, laboratory, respiratory therapy and physical therapy services
Holston Valley Medical Center	All Kingsport-based invasive and advanced cardiology services from Indian Path Community Hospital were integrated to Holston Valley Medical Center during FY19. With the two hospitals operating three miles apart, the opportunity to collaborate and customize services was the best choice for patients.
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 benefitted 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	Wellmont Health System (Wellmont)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. Wellmont 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. Wellmont 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	WHS 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). Wellmont 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 Wellmont upon completion of the program. The training opportunity often leads to job opportunities for graduates of the program. In FY19, over 65 percent of the graduates were hired by WHS. WHS serves as an educational environment for the training of medical residents of the James H. Quillen College of Medicine at East Tennessee State University (ETSU) and the DeBusk College of Osteopathic Medicine at Lincoln Memorial University. Residents receive supervised, hands-on training in a particular area of expertise, such as primary care or surgery. Clinical rotations are conducted at Bristol Regional Medical Center, Holston Valley Medical Center and Mountain View Regional Hospital. Hospitals incur significant costs beyond those customarily associated with providing patient care to train residents. In addition to medical residents, WHS also provides training for other Medicare-approved programs including allied health programs for pharmacy. WHS incurred $4,645,384 in unreimbursed costs for these programs in FY19. WHS 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 WHS facilities are required to complete orientation and computer training.Included in the number receiving clinical training at WHS, 1,582 nursing students from various colleges, universities and programs received training. This nursing clinical experience required extensive involvement by WHS hospital nursing staff, particularly at the two largest WHS facilities, Bristol Regional Medical Center and Holston Valley Medical Center. The cost of the clinical setting and hands-on instruction to WHS was $2,268,901.WHS provided a clinical training setting for another 813 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 $1,028,426.In addition to the hands-on training of medical residents, described above, Wellmont donated $30,000 to the Virginia Highlands Community College Educational Foundation to provide a part-time instructor for the Appalachian Tri-College nursing program. The instructor is to be located at Southwest Virginia Community College and Virginia Highlands Community College. Wellmont Health Systems medical libraries, located at Holston Valley Medical Center and Bristol Regional Medical Center, are medical libraries that provide access to medical databases, various print publications and facilitate inter-library journal and book loans. WHS medical libraries maintain book collections including medical, nursing, leadership, and cultural diversity books available for lending. The library subscribes to an online medical database. The medical libraries are utilized by various medical staff. In addition, the medical libraries provide medical information to team members and others by way of books, articles and searches of the medical literature. The libraries supplied approximately 91 articles to numerous patrons during FY19.
Mountain View Regional Hospital	As Ballad Health continues its work to bring together hospitals, medical practices and other services to form a community health improvement organization, one small but important step is rolling out the new Ballad Health brand. This included discussions between hospital leadership within the system and local leaders, community boards and other key stakeholders to outline the naming convention for facilities under the Ballad Health name. After evaluating options, Mountain View Regional Medical Center selected a new name to reflect their important role within the health system and their deep ties to the communities they serve. In November 2018, Mountain View Regional Medical Center changed its name to Mountain View Regional Hospital.
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: Grant renewal to pay the salary and benefits for a medication assistance caseworker to expand a medication assistance program serving Wise County. The program in Southwest Virginia enables the health system to serve uninsured and underinsured patients; thus, playing a significant role in improving patients health, reducing hospital readmissions, and assisting doctors in providing proper treatment to patients who otherwise could be non-compliant with medications due to cost-prohibitive prescriptions. 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 dont 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.WHS 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.
Part III, Line 4a Program Service Accomplishments	Ballad Health (Ballad) is a tax-exempt entity and the parent corporation of both Wellmont Health System (WHS) and Mountain States Health Alliance (MSHA). The two healthcare systems came together on February 1, 2018 as a result of a merger approved by both Tennessee and Virginia Departments of Health. Ballad operates under a Certificate of Public Advantage (COPA) in Tennessee and a Cooperative Agreement (CA) in Virginia. Pursuant to the COPA and CA, WHS and MSHA are required to fulfill the obligations, commitments and covenants set forth in the COPA. Such obligations include that Ballad Health shall meet, over the ten-year period beginning July 1, 2018, established minimum spending criteria on initiatives for expanded access to healthcare services, health research and graduate medical education, population health improvement, and a region-wide health information exchange. The full text of the COPA can be found on the Tennessee Department of Health's website, while the CA can be found on the Virginia Department of Health's website.Ballad Health is a healthcare delivery system serving 1.2 million residents from 29 counties in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeastern Kentucky. Ballad operates 3,162 licensed beds in 21 hospitals, including 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. Form 990 for WHS includes five wholly-owned hospitals while two wholly-owned hospitals, Takoma Regional Hospital d/b/a Greeneville Community Hospital in Greeneville, Tennessee and Hawkins County Memorial Hospital in Rogersville, Tennessee file separate returns.In addition to the acute care hospitals, WHS wholly owns or has ownership interest in a nursing home, an assisted living facility, physician practice organizations, ambulatory surgery centers and other health care businesses. Specific to the hospitals included in this Form 990, services were provided to: 38,209 inpatients 854,588 outpatient visits 139,419 emergency visits 2,006 deliveries 22,364 surgeries
PROGRAMS FOR SPECIAL POPULATIONS	WHS assisted some patients not able to pay for prescriptions at discharge. The unreimbursed cost for these prescriptions was $12,598.WHS partnered with Bolder Outreach Solutions to assist patients without insurance. Representatives were available for these patients at all WHS facilities in order to determine sources of possible governmental medical assistance (TennCare or Medicaid) and to assist in the application process and follow-up. 3,942 patients were approved for coverage during FY19. WHS incurred expense of $476,897 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, 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 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 participate 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 $14,065.
SULLIVAN COUNTY, TN: BRISTOL REGIONAL MEDICAL CENTER (BRMC)	348-bed tertiary hospital Centers of Excellence include Wellmont CVA Heart Institute, J.D. and Lorraine Nicewonder Cancer Center, Primary Stroke Center, cardiac care, diabetes treatment center, emergency department, inpatient/outpatient hospice care, neuroscience services, occupational health, outpatient services, psychiatric care, rehabilitation services and womens health Level II trauma center Level II neonatal intensive care unit First hospital in the Southeast to offer CyberKnife radiosurgery for the treatment of cancer and other tumors Augmented its robotics program with the Da Vinci Robotic Surgery System
SULLIVAN COUNTY, TN: HOLSTON VALLEY MEDICAL CENTER (HVMC)	505-bed tertiary hospital Centers of Excellence include Wellmont CVA Heart Institute, Christine LaGuardia Phillips Cancer Center, diabetes treatment center, neuroscience services, outpatient services, rehabilitation services and womens health Level I trauma center Holston Valley Regional Childrens Hospital to include a Level III neonatal intensive care unit and pediatric intensive care unit
WISE COUNTY, VA: LONESOME PINE HOSPITAL (LPH)	60-bed community hospital Services include emergency care, intensive care, medical, surgical, pediatric and obstetrics Southwest Virginia Cancer Center in Norton,Virginia and Wellmont Cancer Institute in Bristol,Virginia serve medical/radiation oncology patients as part of hospital operations
WISE COUNTY, VA: MOUNTAIN VIEW REGIONAL HOSPITAL (MVRH)	118-bed community hospital Provides medical/surgical services with the support of an emergency room and diagnostic imaging services 64-slice computed tomography CT scan

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

Wellmont Health System
dba Bristol Regional Medical Center

Employer identification number

62-1636465

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)	(f) Direct controlling entity
(1) Wellmont Health Management Services 1905 American Way Kingsport,TN37660 62-1825259	Healthcare	TN	WHS

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 Hawkins Co Memorial Hosp 851 Locust Street Rogersville,TN37857 62-1816368	Hospital	TN	501c3	3	WHS	Yes
(2)Takoma Regional Hosp Inc DBA Greene 1420 Tusculum Boulevard Greeneville,TN37745 51-0603966	Hospital	TN	501c3	3	WHS	Yes
(3)Wellmont Cardiology Services 1905 American Way Kingsport,TN37660 26-3557623	Medical Services	TN	501c3	10	WHS	Yes
(4)Wellmont Medical Associates 1905 American Way Kingsport,TN37660 27-0898372	Medical Services	TN	501c3	7	WHS	Yes
(5)Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City,TN37604 58-1594191	Fundraiser	TN	501c3	7	Ballad Health	Yes
(6)Wellmont Madison House 2000 Greenway Street Kingsport,TN37660 62-1308216	Assisted Living	TN	501c3	10	WHS	Yes
(7)Wellmont Wexford House 2421 North John B Dennis Highway Kingsport,TN37660 58-1859039	Nursing Home	TN	501c3	10	WHS	Yes
(8)Wellmont Imaging Services Inc 1905 American Way Kingsport,TN37660 86-1103148	Healthcare	TN	501c3	12a	WHS	Yes
(9)Wellmont Sleep Services 1905 American Way Kingsport,TN37660 27-3777167	Medical Services	TN	501c3	3	WHS	Yes
(10)Mountain States Health Alliance 303 Med Tech Parkway Suite 220 Johnson City,TN37604 62-0476282	Hospital System	TN	501c3	3	Ballad Health		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	Related	-832,713	511,389		No	-77,602		No	65.000 %
(2) Holston Valley Ambulatory Surgery Center 103 West Stone Drive Kingsport,TN37660 62-1816864	Medical Services	TN	WHS	Related	962,590	1,442,480		No	2,683,632		No	48.000 %
(3) Greeneville Physician Services LLC 1905 American Way Kingsport,TN37660 45-5070419	Medical Services	TN	WHS	Related	-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	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) Wellmont Inc 1905 American Way Kingsport,TN37660 62-1320035	Medical Services	TN	WHS	C		-90,140,490	100.000 %	Yes
(2) Wellmont Collections Inc 2004 American Way Suite 101 Kingsport,TN37660 62-1325938	Business Services	TN	WHS	C	3,148,783	2,824,212	100.000 %		No
(3) Medical Mall Pharmacy Inc 1905 American Way Kingsport,TN37660 62-1565006	Medical Services	TN	WHS	C		-102,161	100.000 %		No
(4) Wellmont Physician Services 1905 American Way Kingsport,TN37660 62-1567353	Medical Services	TN	WHS	C			100.000 %		No
(5) WPS Providers Inc 1905 American Way Kingsport,TN37660 20-5564642	Medical Services	TN	WHS	C			100.000 %		No
(6) Wellmont Health Services Inc 1905 American Way Kingsport,TN37660 62-1254373	Medical Services	TN	WHS	C	1,331,046	4,726,831	100.000 %		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) Nolichuckey Management Svcs Inc 1420 Tusculum Boulevard Greeneville,TN37745 62-1776681	Medical Services	TN	LMH	C					No
(15) Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman KY1-1203 CJ 98-1195624	Insurance	CJ	WHS	C	50,045	20,667,353	100.000 %	Yes

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

Yes

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

Yes

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

Yes

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

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

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

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

Yes

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

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Wellmont Cardiology Services	j	205,402	FMV
(2) Wellmont Medical Associates	j	904,899	FMV
(3) Wellmont Medical Associates	l	75,584	Supprt Svc/Invo
(4) Holston Valley Ambulatory Surgery Center	j	1,082,095	FMV
(5) Holston Valley Ambulatory Surgery Center	s	406,391	Cash distrib.

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	6,237
6	Total number of volunteers (estimate if necessary) .............	6	571
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	7,302
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,048,673	2,009,248
9	Program service revenue (Part VIII, line 2g) .........	672,218,873	703,475,445
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	19,377,788	344,059
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	20,131,783	7,734,266
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	714,777,117	713,563,018
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	158,533	470,318
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)	306,603,651	250,949,496
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)....	404,665,369	397,768,370
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	711,427,553	649,188,184
19	Revenue less expenses. Subtract line 18 from line 12.......	3,349,564	64,374,834
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,026,995,312	434,840,245
21	Total liabilities (Part X, line 26).............	484,905,481	374,448,325
22	Net assets or fund balances. Subtract line 21 from line 20.....	542,089,831	60,391,920

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 555,552,056 including grants of $ 470,318 ) (Revenue $ 704,116,588 )
	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 expenses555,552,056

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Andrew Kramer MD........................................................................ Staff Physician	40.00 .......................0.00	X		582,253	0	40,594
(19) Elizabeth Jackson MD........................................................................ Staff Physician	40.00 .......................0.00	X		573,452	0	39,734
(20) John Ehrenfried MD........................................................................ Staff Physician	40.00 .......................0.00	X		543,180	0	41,040
(21) Kelly Oggero MD........................................................................ Staff Physician	40.00 .......................0.00	X		506,059	0	42,126
(22) Barton Hove........................................................................ Former Officer-Retired	0.00 .......................0.00		X	1,296,774	0	17,936
(23) Todd Dougan........................................................................ Fomer Officer-Retired	10.00 .......................0.00		X	488,595	0	18,367

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,783,285	7,729,408	1,045,145

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,009,248
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.......		2,009,248

		Business Code
2a	340B Drug Program	900099	3,998,550	3,998,550
b	Hospital Patient Revenue	900099	698,247,419	698,247,419
c	Hospital Wellness Program	900099	480,938	480,938
d	P/S Ordinary Income	541900	129,877	129,877
e	Rent to Exempt Affiliates	900099	618,661	618,661
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		703,475,445

3 Investment income (including dividends, interest, and othersimilar amounts) ......			86,454			86,454
4 Income from investment of tax-exempt bond proceeds			37,173			37,173
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		2,535,485
b	Less: rental expenses		993,287
c	Rental income or (loss)		1,542,198
d	Net rental income or (loss)......			1,542,198			1,542,198
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	451,205	7,302
b	Less: cost or other basis and sales expenses	238,075
c	Gain or (loss)	213,130	7,302
d	Net gain or (loss).....			220,432	213,130	7,302
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	Billing Services		561000	584,023			584,023
b	Cafeteria & Vending		722514	2,937,278			2,937,278
c	Revenue from Parent		900099	1,403,469			1,403,469
d	All other revenue ....			1,267,298	428,013		839,285
e	Total. Add lines 11a–11d ......			6,192,068
12	Total revenue. See Instructions......			713,563,018	704,116,588	7,302	7,429,880

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	470,318	470,318
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 ....	2,622,569	416,826	2,205,743
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	197,069,342	173,077,622	23,991,720
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	8,007,778	6,565,178	1,442,600
9	Other employee benefits .......	30,255,745	19,105,212	11,150,533
10	Payroll taxes ...........	12,994,062	12,499,172	494,890
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	9,300		9,300
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	133,508,998	122,629,132	10,879,866
12	Advertising and promotion ....	52,170	1,480	50,690
13	Office expenses .......	9,504,690	9,002,812	501,878
14	Information technology ......	14,232,739	5,114,362	9,118,377
15	Royalties ..	0
16	Occupancy ...........	9,569,244	9,122,060	447,184
17	Travel ............	394,737	323,480	71,257
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	9,691,960	8,729,019	962,941
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	28,215,323	24,756,070	3,459,253
23	Insurance ...	859,347	54,992	804,355
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	148,200,390	148,200,390
b	Management Fees	26,309,756		26,309,756
c	Maintenance	7,889,596	7,598,481	291,115
d	Dues & Subscriptions	710,324	271,263	439,061
e	All other expenses	8,619,796	7,614,187	1,005,609
25	Total functional expenses. Add lines 1 through 24e	649,188,184	555,552,056	93,636,128	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 ........			12,780	1	62,255
2	Savings and temporary cash investments .........			34,371,800	2	0
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			86,068,997	4	86,438,286
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				49,389	5	50,000
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 ....			4,363,227	7	5,788,989
8	Inventories for sale or use ........			15,000,936	8	13,954,530
9	Prepaid expenses and deferred charges ......			10,026,166	9	1,585,422
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	901,911,176
b	Less: accumulated depreciation	10b	616,059,435	392,268,344	10c	285,851,741
11	Investments—publicly traded securities .			413,789,540	11	0
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 ..			6,919,097	13	0
14	Intangible assets ...............			37,626,739	14	37,626,739
15	Other assets. See Part IV, line 11 ...........			26,498,297	15	3,482,283
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,026,995,312	16	434,840,245

17	Accounts payable and accrued expenses .....	74,666,271	17	62,989,686
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	268,039,990	20	69,034,179
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 ..	15,346,632	23	4,973,328
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	126,852,588	25	237,451,132
26	Total liabilities. Add lines 17 through 25..	484,905,481	26	374,448,325

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	542,089,831	27	60,377,920
28	Temporarily restricted net assets ...........		28	14,000
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 ...........	542,089,831	33	60,391,920
34	Total liabilities and net assets/fund balances ........	1,026,995,312	34	434,840,245