TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) Alan Levine...................................................................... BH Pres/CEO	1.00 ................. 64.00	X	X	0	2,837,324	224,600
(2) Marvin Eichorn...................................................................... BH EVP/CAO	1.00 ................. 64.00	X	X	0	1,313,705	44,243
(3) Lynn Krutak...................................................................... BH EVP/CFO	1.00 ................. 64.00		X	0	1,107,634	99,395
(4) Eric Deaton...................................................................... BH EVP/COO	1.00 ................. 64.00	X	X	0	1,039,919	94,315
(5) Tim Belisle...................................................................... BH EVP/Gen Cncl	1.00 ................. 64.00	X	X	0	779,407	86,025
(6) Edward Hickson...................................................................... VP, Pres SW Mkt	45.00 ................. 0.00			716,431	0	42,884
(7) Linda White...................................................................... VP/Pres NW Mkt, Frmr CEO FWCH	0.00 ................. 45.00			0	591,267	56,460
(8) Andrew Wampler...................................................................... VP Oper Excl, Frmr CFO NW Mkt	0.00 ................. 45.00			0	403,405	63,378
(9) Brian Dawson MD...................................................................... VP, CMO So. Mkt	45.00 ................. 0.00			395,800	0	40,714
(10) Lisa Carter...................................................................... VP Pediatric Svcs	45.00 ................. 0.00			394,475	0	40,058
(11) Lemmie Taylor...................................................................... VP, CEO SSH	45.00 ................. 0.00			380,803	0	50,930
(12) Melanie Stanton...................................................................... VP, CEO FWCH	45.00 ................. 0.00			351,810	0	38,280
(13) Joshua McFall...................................................................... VP, CFO Southern Mkt	44.50 ................. 0.50			342,101	0	34,972
(14) Kenneth Shafer...................................................................... VP, COO JCMC	45.00 ................. 0.00			290,846	0	23,258
(15) Morgan May...................................................................... VP, CNO JCMC	45.00 ................. 0.00			246,692	0	20,053
(16) David Sensibaugh...................................................................... Pres/CEO ISHN	40.00 ................. 0.00			244,564	0	19,306
(17) Patricia Baise...................................................................... Former VP, CEO Behavioral Hlth	0.00 ................. 45.00			0	236,265	17,610

(A) Name and business address	(B) Description of services	(C) Compensation
East Tennessee State University PO Box 70732 Johnson City,TN37614	Med Supp/Gen Acad Svcs	5,250,193
Medical Educ Assistance Corp PO Box 699 Mountain Home,TN37684	Medical Education Svcs	3,431,856
Assocd ReglUniv Pathologists PO Box 27964 Salt Lake City,UT84127	Pathology Services	3,133,015
AYA Healthcare Inc PO Box 123519 Dallas,TX75312	Healthcare Staffing Svcs	2,449,369
Anesthesia & Pain Consultants 1009 Lark St 2 Johnson City,TN37604	Anesthesiology Services	1,484,021
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 67

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

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

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

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) 2020

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. 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—2019. 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—2020. 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—2019. 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) 2020

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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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—2019. 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) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) 2020

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 lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2020

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 0.015 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 0.035	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) 2020

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

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) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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

2020

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization Mountain States Health Alliance

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization Mountain States Health Alliance		Employer identification number 62-0476282

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization Mountain States Health Alliance			Employer identification number 62-0476282
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) (2020)

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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

2020

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

Mountain States Health Alliance

Employer identification number

62-0476282

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) 2020

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) 2017	(b) 2018	(c) 2019	(d) 2020	(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) 2020

Page 3

Part II-B

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

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

(a)

Yes|No

(b)

Amount

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

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

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

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

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

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

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

Yes

42,913

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

42,913

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	Mountain States Health Alliance had lobbying expenses of $42,913 which represents the portion of dues paid to various organizations, including Tennessee Hospital Association, Children's Hospital Alliance of Tennessee and Virginia Hospital and Healthcare Association, attributable to direct lobbying.

Schedule C (Form 990 or 990EZ) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2020

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

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

1a	Land .....	22,219,663		22,219,663
b	Buildings ....	517,084,306	248,534,470	268,549,836
c	Leasehold improvements	4,709,344	3,112,865	1,596,479
d	Equipment ....	485,850,202	418,225,230	67,624,972
e	Other .....	15,063,075	5,341,312	9,721,763
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				369,712,713

Schedule D (Form 990) 2020

Page 3

Part VII

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

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

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value
(1)Due From 3rd Party Payors				-8,369,711
(2)Due From Affiliates				36,668,853
(3)Long Term Compensation Investment				5,000
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				28,304,142

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
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	79,401,545
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) 2020

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

Mountain States Health Alliance 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, 2021 and 2020. Tax returns for 2018 through 2020 are subject to examination by the Internal Revenue Service."

Schedule D (Form 990) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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

2020

Open to Public Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

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? . . . . . .

Yes

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? . . . . . . . . .

Yes

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

Yes

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) . . .	19,502,636		19,502,636	2.390 %
b	Medicaid (from Worksheet 3, column a) . . . . .	124,693,925	107,698,487	16,995,438	2.080 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	144,196,561	107,698,487	36,498,074	4.470 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	4,525,279	625,731	3,899,548	0.480 %
f	Health professions education (from Worksheet 5) . . .	17,262,297	3,244,207	14,018,090	1.720 %
g	Subsidized health services (from Worksheet 6) . . . .	8,676,923	6,992,707	1,684,216	0.210 %
h	Research (from Worksheet 7) .	725,572	37,748	687,824	0.080 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	12,291,442		12,291,442	1.500 %
j	Total. Other Benefits . .	43,481,513	10,900,393	32,581,120	3.990 %
k	Total. Add lines 7d and 7j .	187,678,074	118,598,880	69,079,194	8.460 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

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	5,000	5,000
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	5,000	5,000

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

88,569,670

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. ......

32,770,778

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).....

154,216,755

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

141,995,526

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

12,221,229

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 %
1Medl Spec of JC LLC	Medical Services	51.000 %	49.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

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?7Name, 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)									Other (describe)	Facility reporting group
1	Johnson City Medical Center 400 N State of Franklin Rd Johnson City,TN37604 balladhealth.org 00000121	X	X	X	X		X	X	Mental Health	A
2	Indian Path Community Hospital 2000 Brookside Drive Kingsport,TN37660 balladhealth.org 00000134	X	X		X			X		A
3	Franklin Woods Comm Hospital 300 Med Tech Parkway Johnson City,TN37604 balladhealth.org 00000123	X	X					X		A
4	Sycamore Shoals Hospital 1501 W Elk Avenue Elizabethton,TN37643 balladhealth.org 00000012	X	X					X	Mental Health	A
5	Russell County Hospital 58 Carroll Street Lebanon,VA24266 balladhealth.org H 1892	X	X					X	Mental Health	A
6	Johnson County Comm Hospital 16901 S Shady Street Mountain City,TN37683 balladhealth.org 00000039	X				X		X		A
7	Unicoi County Hospital 100 Greenway Circle Erwin,TN37650 balladhealth.org 00000119	X	X					X		A

Schedule H (Form 990) 2020

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):

123456

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 21

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 22

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) 2020

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) 2020

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 (if not, describe in Section C)

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2020

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) 2020

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Facility: A 1,2,3,4,5,6,7 - Part V, Section B, Line 3j	Facility/Group A includes the following facilities:Johnson City Medical Center, Indian Path Community Hospital, Franklin Woods Community Hospital, Sycamore Shoals Hospital, Russell County Hospital, Johnson County Community Hospital and Unicoi County Hospital. 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. During FY21, MSHA hospitals were operating under the three-year community health needs assessments (CHNAs) plans approved by the board of directors at the end of FY18. Priorities established for the CHNAs were determined by the most significant health needs of each community. Ballad Health hospitals, including MSHA hospitals, conducted their fifth CHNA this tax period with board approval and publication occurring at the end of FY21. For FY21 CHNAs, Ballad Health utilized a mixed-methods approach for primary and secondary data collection to gather regional information to inform the 2021 community health needs assessments. The secondary data collection entailed the compilation of secondary data pertaining to agreed-upon metrics and indicators from an array of verified sources. The primary data collection component involved both a key stakeholder survey and key stakeholder focus groups. Findings from both research methods were used to prioritize the needs of the community served by each Ballad Health facility and determine priority focus areas for future improvement efforts. Analysis of secondary data for Washington County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Washington County. For Johnson City Medical Center, Franklin Woods Community Hospital, Niswonger Childrens Hospital, and Woodridge Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Washington County are substance abuse, mental health, and Adverse Childhood Experiences (ACEs). Analysis of secondary data for Sullivan County, findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Sullivan County. For Indian Path Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Sullivan County, TN are substance abuse, mental health, and transportation. Analysis of secondary data for Carter County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Carter County. For Sycamore Shoals Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Carter County, TN are substance abuse, mental health, Adverse Childhood Experiences (ACEs), and transportation.Analysis of secondary data for Unicoi County, findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Unicoi County. For Unicoi County Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Unicoi County, TN are education, mental health, and Adverse Childhood Experiences (ACEs). Analysis of secondary data for Russell County, VA findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Russell County. For Russell County Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Russell County, VA are substance abuse, mental health, and poverty.Analysis of secondary data for Johnson County, TN findings from the key stakeholder survey, and the perspectives of diverse key stakeholders led to the prioritization of community issues for Johnson County. For Johnson County Community Hospital, the three priority areas for future improvement efforts that were selected by key stakeholders in Johnson County, TN are substance abuse, mental health, and Adverse Childhood Experiences (ACEs).
Facility: A 1,2,3,4,5,6,7 - Part V, Section B, Line 5	The community health needs assessment process was guided by the Mobilizing for Action Through Planning and Partnerships (MAPP) model, with an understanding that aspects of the model may have to be adapted due to the purpose of the assessment for Ballad Health and constraints related to the COVID-19 pandemic. In coordination with the MAPP model, concepts from both Community-Based Participatory Research (CBPR) and the Arkansas Center for Health Improvement (ACHI) Community Health Assessment Community Health Assessment Toolkit were also utilized for the assessments. Following guidance from the MAPP model, a Key Stakeholder Survey was designed with the primary aim of identifying the most-pressing community issues. In aligning with principles of CBPR, the key stakeholder survey was designed to allow key stakeholders to frame community issues in their own words through the use of open-ended questions. In addition to the identification of community issues, the key stakeholder survey was also designed to discern why survey respondents believed the community issues they selected had the greatest effect on the overall health and wellbeing of their community. Questions related to ideas and suggestions for improvement efforts, gauging the success of efforts after the previous community health needs assessments, and community struggles related to the COVID-19 pandemic were also included in the survey. Independent focus groups were conducted for each Ballad Health facility in order to provide specific and unique information for each community being served. The MAPP model and questions from the key stakeholder survey were used to guide the development and construction of the focus groups. Because the key stakeholder survey primarily dealt with the identification of community issues, the focus groups were primarily designed to prioritize community issues identified through the key stakeholder survey and discuss actionable items around how to best address these community issues. Questions related to root causes of community issues, the current state of resources to address community issues, needed resources to initiate improvement efforts and be successful, and community struggles related to the COVID-19 pandemic were also included in the focus group facilitation guide. The key stakeholder focus groups were conducted virtually via WebEx and were one hour and thirty minutes in length.For Johnson City Medical Center, Niswonger Childrens Hospital, Franklin Woods Community Hospital, and Woodridge Hospital there were thirty-five focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Washington County, TN which included: the school system, businesses, government, the health care system, health departments, faith based organizations, and a diverse group of community based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders. For Indian Path Community Hospital there were eighteen focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Sullivan County, TN which included: the school system, businesses, government, the health care system, health departments, faith based organizations, and a diverse group of community based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Sycamore Shoals Community Hospital there were ten focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Carter County, TN which included: the school system, businesses, government, the health care system, health departments, faith based organizations, and a diverse group of community based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Unicoi County Hospital there were six focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Unicoi County, TN which included: the school system, businesses, government, the health care system, health departments, faith based organizations, and a diverse group of community based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Russell County Hospital there were nine focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Russell County, VA which included: the school system, businesses, government, the health care system, health departments, faith based organizations, and a diverse group of community based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders.For Johnson County Community Hospital, there were seven focus group participants. Similar to the key stakeholder survey representation, focus group participants represented an array of different sectors in Johnson County, TN which included: the school system, businesses, government, the health care system, health departments, faith based organizations, and a diverse group of community based organizations. For stakeholders who were not able to attend the focus group in real-time, blank facilitation guide templates with questions concerning the three priority areas identified by the focus group participants were sent to them immediately after the conclusion of the focus group. This allowed key stakeholders who were not able to attend the focus group in real-time to still provide input and the hospital to ensure the involvement of diverse stakeholders. Activities associated with the June 2021 assessments took place from summer of 2020 through the spring of 2021. The assessment activity including focus groups & surveys were used to develop the hospital implementation plans that were completed fall 2021.
Facility: A 1,2,3,4,5,6,7 - Part V, Section B, Line 6a	Each hospital within Ballad Health completed a CHNA. Mountain States Health Alliance's (MSHA) CHNAs were conducted with all Ballad Health hospitals to include: Bristol Regional Medical Center, Hancock County Hospital, Hawkins County Memorial Hospital, Greeneville Community Hospital, Holston Valley Medical Center, Johnson City Medical Center (includes Niswonger Children's Hospital and Woodridge Hospital), Franklin Woods Community Hospital, Indian Path Community Hospital, Lonesome Pine Hospital (including Mountain View campus), Johnson County Community Hospital, Johnston Memorial Hospital, Norton Community Hospital, Dickenson Community Hospital, Russell County Hospital, Smyth County Community Hospital, Sycamore Shoals Hospital, and Unicoi County Hospital.
Facility: A 1,2,3,4,5,6,7 - Part V, Section B, Line 11	During the year, MSHA will focus on its CHNA priorities as identified in its FY21 CHNA report. MSHAs primary areas of focus included: substance abuse, mental health, and Adverse Childhood Experiences (ACEs). 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 hospitals 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. Ballad Health made financial contributions to other nonprofit organizations providing community services that support MSHA hospitals CHNAs. For example, Ballad Health contributed to: A Step Ahead Tri-Cities, Coalition for Kids, Bristols Promise, ETSU Pediatrics, Fahe housing collaborative, Frontier Health, Mom Power Families Free, Niswonger Foundation, Second Harvest Food Bank, Strongwell, Upper East Tennessee Human Development Agency, and YWCA.
Facility: A 1,2,3,4,5,6,7 - Part V, Section B, Line 13h	Ballad Health's financial assistance policy allows for some exceptions to strictly adhering to federal poverty guidelines when awarding financial assistance. Unique circumstances may be weighed and assessed for financial assistance consideration on a case-by-case basis. Also, there are some services where financial assistance may be provided outside of federal poverty guidelines. These are noted in Ballad Health's financial assistance policy.

Schedule H (Form 990) 2020

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	MSHA dba Ballad Health Homecare-Johnson City 509 Med Tech Parkway Suite 200 Johnson City,TN37604	Licensed Home Health Agency
2	MSHA dba Ballad Health Homecare-Clintwood 312 Hospital Drive Suite A Clintwood,VA24228	Licensed Home Health Agency
3	MSHA dba Ballad Health Homecare-Abingdon 611 Campus Drive Suite 300 Abingdon,VA24210	Licensed Home Health Agency
4	MSHA dba Ballad Health Hospice-Abingdon 611 Campus Drive Suite 500 Abingdon,VA24210	Licensed Hospice Agency
5	MSHA dba Ballad Health Homecare-Lebanon 116 Flannagan Avenue Lebanon,VA24266	Licensed Home Health Agency
6	MSHA dba Ballad Health Hospice-Bristol 280 Steeles Road Bristol,TN37620	Licensed Hospice Agency
7	MSHA dba Ballad Health Homecare-Greeneville 1410 Tusculum Blvd Suite 1600 Greeneville,TN37745	Licensed Home Health Agency
8	MSHA dba Ballad Health Homecare-Norton 96 15th Street NW Suite 104A Norton,VA24273	Licensed Home Health Agency
9
10

Schedule H (Form 990) 2020

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 TennCare/Medicaid benefits, those who qualified for TennCare/Medicaid 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 all dates of service for the patient when they are approved and there is no limitation or cap on the amount of charity that they can receive. Ballad Health hospitals do not stop approving financial assistance for patient accounts if a hospitals charity write-offs exceed the hospitals charity budget.All Ballad Health hospitals provide an uninsured discount; the current uninsured discount is 85% with the exception of critical access hospitals. The uninsured discount for Johnson County Community Hospital, a designated Critical Access Hospital, is 73%. 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 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, Ballad Health offers a number of programs with special discounts such as lactation consultation services; oncology treatment regimens; enrollment in various community programs, and prescription drugs filled post-discharge.
Part I, Line 7 - Explanation of Costing Methodology	The cost to charge ratio (worksheet 2 "ratio of patient care cost to charges") was used to calculate line 7a financial assistance (charity care) cost. MSHAs cost accounting system was used to determine losses from Tenncare and Medicaid reported on line 7b, with the exception of home health and a small physician clinic a cost to charge ratio was used for their data because these are smaller divisions not available in MSHAs cost accounting software. Line 7e community health improvement includes costs that are taken directly from departmental operating reports or expenses specific to a community health event, with no additional overhead included in the cost. Line 7f health professions education is comprised of internships (primarily internal medicine residents, nursing, pharmacy, and therapy students) with schools and universities, allowing their health profession students to receive hands-on training in a hospital setting. MSHAs Medicare-approved programs include medical residents, pharmacy and pastoral care. For these programs, Medicare-approved costs and Medicare reimbursement comes from filed Medicare cost reports. The Ballad Health Organizational Development Department (OD) maintains records for the non-Medicare programs. Only labor costs are included for MSHA team members that provide training (no overhead is applied) and only a percentage of team members time is attributed to actual training. For line 7g subsidized health care services, MSHAs cost accounting system is used because MSHA has established, standard costing reports for these services. There are exceptions where MSHA does not use the cost accounting system. A a small clinic inside JCCH, a federally designated critical access hospital, is subsidized by JCCH and the clinics departmental operating report is used to compute the clinics community benefit. The second exception is a palliative care program. For this program, the departments operating report is used. The third exception relates to low-dose CT scans for lung cancer. Patient charges for this screening were written-off as an administrative adjustment (not as charity). The cost to charge ratio was used to determine the cost of the free scans. MSHA is careful to ensure no double counting of cost. Although there are other service lines within MSHA hospitals that lose money, MSHA does not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7h research represents MSHA's expense allocation from Ballad Health for research. Line 7i cash and in-kind contributions includes cash disbursements and in-kind donations of medications to local nonprofit rescue squads and fire departments. In-kind donations of medications are based on actual cost for these items.
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/Medicaid, commercial insurers, and others - generally leaving the patient responsible for any remaining deductible and/or co-payment. Other self-pay accounts are from patients with no insurance or other third-party coverage. Under Ballad Healths system-wide self-pay policy, any patient who has no insurance and is ineligible for any government assistance program received an 85% discount. Many self-pay patients will further qualify for financial assistance (sometimes referred to as charity care) if they provide the financial information needed to deem them eligible or upon determination of presumptive charity eligibility.After the normal collection process has indicated an account is uncollectible, MSHA writes the account off to bad debt. The 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	MSHAs primary external collection agency historically estimated that approximately 37% of MSHAs bad debt would have qualified for financial assistance if patients had provided a financial assistance application and required documentation. MSHA has begun to score accounts using a presumptive eligibility tool. This tool utilizes various data points for a proprietary algorithm operated by an outside vendor to provide an individuals score which is then relied upon to assign presumptive charity eligibility. There are 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. MSHA would prefer for patients to submit completed financial assistance applications given that historical data clearly indicates that most uninsured patients and many underinsured patients will qualify for financial assistance under MSHA's program. Without a completed application or approval through the presumptive charity eligibility review, these are recorded as bad debt instead of charity care.
Part III, Line 4 - Bad Debt Expense	Ballad Healths audited financial statements include a footnote on page 17 that describes bad debt. MSHA is included in the June 30, 2021 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 allowable costs are reported using MSHA's filed Medicare cost report (C/R). The C/R uses a cost to charge ratio based on a step-down allocation methodology. MSHA believes 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.Ballad Health's collection policy clearly states that all patients are treated equally - with dignity and respect. Ballad Health ensures that outside collection agencies adhere to Ballad Health billing and collection guidelines. The collection program includes communicating expected financial responsibility prior to service. MSHA 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 TennCare or Medicaid.After insurance benefit verification, MSHA 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. MSHA hospitals provide a number of payment options:- a pre-service discount may be offered- a discount in excess of established discounting rates may be granted for catastrophic high dollar accounts- MSHA 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- as part of Ballad Health's commitments to the State of Tennessee and Commonwealth of Virginia to form Ballad Health, not-in-network discounts are applied per policies in place for MSHA hospitals- payment arrangements are available as 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 Ballad Health's financial assistance policy.
Part VI, Line 2 - Needs Assessment	Focusing on population health improvement and associated priority metrics 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 hospitals community. Engaging local community organizations expands partnerships so that organizations work together more to address community health needs. Ballad Health uses a comprehensive process to gather input for and continues to evolve its population health plan. Because our hospitals are located in a region with many chronic disease challenges and high levels of health-related social risks, Ballad Healths goal is to target population health issues to make lasting improvements. Ballad conducts ongoing interviews, focus groups and meetings with external groups, including the regional health departments, United Way agencies, chambers of commerce, schools and community organizations, the regional accountable care community leadership council, as well as internal groups such as our population health and community benefit committee of the Ballad Health board of directors, the Ballad Health population health clinical committee, social needs council, grant advisory committees and our hospital community boards in the creation and on-going implementation of its population health plan.
Part VI, Line 3 - Patient Education of Eligibility for Assistance	Consistent with the Ballad Health financial assistance policy, MSHA communicates with and provides education to 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 MSHA 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 hospitals. Our financial assistance policy and documents are available in emergency departments and admitting areas. We are also happy to mail all documents to patients. We offer a plain language summary, and all documents are available in English and Spanish. Financial assistance information is available during pre-registration, registration and/or during financial counseling. MSHA offers governmental program eligibility representatives to assist patients in securing eligibility for TennCare or Medicaid, federal disability and other governmental assistance programs. Additionally, if a patient or community resident expresses an interest in the ACA-healthcare exchange, MSHA representatives have the qualifications and experience to assist them through the entire process. 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. The 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	MSHA serves the healthcare needs of 29 Appalachian counties in Tennessee, Southwest Virginia, Kentucky, and North Carolina. All of the counties MSHA serves are federally designated as medically underserved areas. MSHAs largest hospital, Johnson City Medical Center, is a tertiary referral center and level one trauma center. All of MSHAs wholly owned hospitals are located in federally designated medically underserved areas. Medically underserved areas are designated by the U.S. Department of Health and Human Services. Shortage areas are identified through analysis of physician to population ratios depending on whether an area is considered to have a high need. Criteria used to determine high need are poverty rates, the percent of the population over age 65, infant mortality rates and fertility rates. MSHA operates 2 critical access hospitals: wholly-owned Johnson County Community Hospital in Tennessee and majority-owned Dickenson County Community Hospital in Virginia.Many rural residents must travel a greater distance to access different points of the health care delivery system. Due to geographic distance, sometimes extreme weather conditions, lack of public transportation and challenging roads, rural residents may be limited, and in some instances, even prohibited from accessing health care services. Within the counties in MSHAs service area, unintentional injury deaths are much higher than the statewide rates. For example, in Tennessee Unicoi Countys rate is 26% higher than the state rate and in Virginia, Russell Countys rate is 23% higher than the statewide rate. While the MSHA service area has generally unfavorable health statistics, there are far fewer primary care physicians per resident in some of the counties served than the states average. For example, in Carter County, the ratio of population to primary care physicians is 82% higher than the states average and Unicois ratio is 111% higher. Both of these counties are more than double the ratio of U.S. top performers according to the University of Wisconsin Population Health Institute County Health Rankings. Recruiting physicians to rural areas is often challenging due to a myriad of factors, such as geography, economics, culture and education. Geographically, rural communities are often far removed from suburban and urban centers that provide access to educational, cultural and economic opportunities. These limitations influence the relocation decision of the physician candidate and his/her spouse/children to locate to a rural area. The health status of the population in MSHA'S service area is generally poor. A number of factors contribute to a unique and challenging environment that influence the overall health standing for counties included in the MSHA service area. Obesity increases the risk for many health conditions such as coronary heart disease, type 2 diabetes, hypertension, stroke, cancer, sleep apnea and respiratory problems, and osteoarthritis. Evidence indicates physical activity, independent of its effect on weight, has substantial benefits for health. Relative to obesity and physical activity levels, many of the counties served by MSHA have high levels of obesity combined with high levels of physical inactivity as shown below. The percentages of adult obesity: Johnson County 30%, Unicoi County 27%, Carter County 38%, Sullivan County 33% and Russell County 33%. The adult obesity rate for U.S. top performers is 26% according to the University of Wisconsin Population Health Institute County Health Rankings.The percentages of physical inactivity: Carter County 30%, Sullivan County 31%, Unicoi County 22%, Johnson County 26%, and Russell County 38%. The physical inactivity rate for U.S. top performers is 19% according to the University of Wisconsin Population Health Institute County Health Rankings. MSHAs service area extends to some of the poorest rural counties in the region with a poverty rate of almost 30% in some areas. The County Health Rankings estimates county median household incomes are: Johnson County - $35,800; Russell County - $39,000; Carter County - $39,200 and Unicoi County - $47,700, all below the state of Tennessee median household income of $52,400. Some of the most well-off counties in MSHA'S service area still have a median household income lower than state and national averages. For instance, Washington Countys median household income is $49,200 and Sullivan Countys is 46,000. The rate of children in poverty in some areas is considerably higher than the state of Tennessee rate of 19% and the state of Virginia rate of 13%. For example, the percentage of children living in poverty in Johnson County is 36%, Carter County is 28%, Unicoi County is 22% and Russell County is 23%. The latest census bureau data estimates the median age of residents of Unicoi County is 46.5, Johnson County is 46.0, and Carter County is 45.4, all significantly older than the median age of 38.7 in Tennessee. All of MSHAs communities have a large elderly population, far exceeding that of the country. Persons 65 years and older in the counties MSHAs hospitals are located in range from 17.9% to 23.3% compared to 16.5% for the U.S.
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 MSHA 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. MSHA does not capture costs associated with team members that serve on other nonprofit boards or provide services to other nonprofits.MSHA, in collaboration with area health agencies and providers, may offer assistance with coordination, advocacy, or contribute supplies to support groups for their program activities that serve to assist special populations within the area. Most of these organizations work to improve the lives of community members that have limited, or no, financial resources.
Part VI, Line 5 - Promotion of Community Health	MSHA is dedicated to operating efficiently so that waste is minimized. MSHAs leadership remains mindful of managing limited resources so that adequate facilities and equipment are available for the care of patients. Surplus funds are invested into improving treatment options for patients through new technologies, recruiting physicians and trained staff in shortage areas, and improving MSHA facilities. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary.MSHA has several hospitals with Medicare-approved health profession education programs. In addition, MSHA hospitals serve as training sites for many types of health professions: nursing, pharmacy, psychology, lab, respiratory therapy, EMT, public health, etc. Students from numerous colleges, universities, and programs receive training and experience in MSHA hospitals. MSHA resources are devoted to health conferences for local health professionals, two health resources centers conveniently located in a shopping mall and a wellness center; provide for media coverage to educate residents on health issues; offer events to the public that combine fun activities with health education; and many other programs focused on improving the health of area residents. While MSHA operates hospitals in predominantly low-income, rural and isolated areas, MSHA continues to offer services that operate at a loss because residents would otherwise need to leave their hometown or county to receive needed care. Mountain States Health Alliance merged with Wellmont Health System in February 2018 to form Ballad Health healthcare system. Mountain States and Wellmont still exist as legal entities and continue to operate multiple hospitals. MSHA's governing body is comprised of persons who reside in the organization's primary service areas. Physicians that request privileges who are qualified and credentialed are extended privileges by MSHA.
Part VI, Line 6 - Affilated Health Care System	Mountain States merger with Wellmont opened up many opportunities not previously available to two competing health systems. Collaboration started post-merger and Ballad Health continues 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 clinical council was formed immediately following the merger. The council includes physicians nominated from the leadership of all Ballad hospitals. A Community Benefit and Population Health Committee of the board was established, and various other infrastructures have been established since the merger. Across MSHAs hospitals, there were many projects, programs, and collaborative efforts that took place during the year. MSHA provides care to people in 29 counties in Tennessee, Virginia, Kentucky and North Carolina. Each hospital is fully accredited by The Joint Commission, with the exception of JCCH. JCCH receives certification through the State of Tennessee since it is a critical access hospital. MSHA, based in Johnson City, Tennessee includes 7 wholly-owned hospitals. In addition to its wholly-owned hospitals, MSHA has majority ownership in 4 hospitals located in Southwest Virginia, each of which file separate returns. In addition to acute care hospitals, the system includes such services as:Primary/specialty physician practices, emergency departments, occupational medicine, rehabilitation, outreach laboratory, mental health, neonatal intensive care, a NACHARI-affiliated children's hospital, renal dialysis, St. Jude's Oncology, inpatient/outpatient surgery, skilled nursing, long-term care, home health, and more. With these additional facilities and services, MSHA extends a highly effective health care delivery system. Since the system is both horizontally and vertically integrated, patients can be efficiently moved along an integrated, comprehensive continuum of care as their health status dictates. MSHA's flagship facility, Johnson City Medical Center is at the core of the system offering full-service tertiary care. In addition to MSHA hospitals, MSHA is the sole member of Blue Ridge Medical Management Corporation (BRMMC). MSHA extends an integrated healthcare delivery system through BRMMC to include multiple primary and specialty care patient access centers and numerous outpatient care sites, including urgent care centers, occupational medicine services, a same day surgery center and rehabilitation.MSHA partners with East Tennessee State University to operate Overmountain Recovery, an opioid addiction recovery facility located in Gray, Tennessee.MSHA is the sole member of Integrated Solutions Health Network, LLC. (ISHN). ISHN operates Anewcare Collaborative, the region's first accountable care organization, bringing together community health care providers to provide better outcomes and improved patient satisfaction at a lower cost.MSHA county-specific operations are governed by a community board of directors. County boards report to a system level board of directors. All boards are primarily composed of local community residents.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 Health's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad Health operates under a Certificate of Public Advantage (COPA) in Tennessee and a Cooperative Agreement (CA) in Virginia 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) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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

2020

Open to Public
Inspection

Name of the organization
Mountain States Health Alliance

Employer identification number
62-0476282

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) Appalachian School of Law 1169 Edgewater Drive Grundy,VA24614	54-1743079	501c3	130,000	0			Improve Access to Healthcare
(2) Boys & Girls Club of JC 2210 Market Street Johnson City,TN37601	62-0810733	501c3	25,000	0			Program Support
(3) Castlewood Fire and Rescue 103 Donnie Dean Drive Castlewood,VA24224	54-1866613	501c3	0	5,322	Cost	Med'l supplies from inventory	EMS Supplies
(4) Dante Rescue Squad POB 668 Lower Bearwallow Rd Dante,VA24237	54-1837346	501c3	0	7,796	Cost	Med'l supplies from inventory	EMS Supplies
(5) East Tn State Univ PO Box 70732 Johnson City,TN37614	62-6021046	501c3	5,065,733	0			Center Nursing Excellence
(6) East Tn State Univ Fndtn PO Box 70721 Johnson City,TN37614	23-7092731	501c3	6,865,850	0			Rural Health Research
(7) Kingsport Chamber Foundation 400 Clinchfield St Ste 100 Kingsport,TN37660	58-1453565	501c3	14,000	0			Funfest, Kid's Central Health Booth
(8) Milligan College PO Box 189 Millgn College,TN37682	62-0535866	501C3	13,410	0			Physician Assistant Program
(9) Milligan College PO Box 189 Mllgn College,TN37682	62-0535755	501c3	150,000	0			Addictions Counseling Program
(10) Music For All 39 W Jackson Place Suite 150 Indianapolis,IN46225	36-3413042	501c3	18,000	0			Sponsorship
(11) Second Harvest Food Bank 127 Dillon Court Gray,TN37615	62-1303822	501c3	24,000	0			Food Pantries
(12) Town of Pennington Gap POB 305 526 Industrial Dr Pennington Gap,VA24277	54-6015001	501c3	15,000	0			Program Sponsorship
(13) United Way of Southwest VA 1096 Ole Berry Dr Abingdon,VA24210	54-0718860	501c3	25,000	0			Trauma Informed Community
(14) VA Polytechnic Institute 201 Southgate Center Blacksburg,VA24061	54-6001805	501c3	120,000	0			Improve Access to Healthcare

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) 2020

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) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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
Graphic Arrow

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

Attach to Form 990.
Graphic Arrow

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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 on Line 1a? ....

Yes

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) 2020

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)	------------- 1,105,435	------------- 1,577,573	------------- 154,316	------------- 203,351	------------- 21,249	------------- 3,061,924	------------- 122,199
2Andrew Wampler VP Oper Excl, Frmr CFO NW Mkt	(i) (ii)	------------- 294,460	------------- 86,532	------------- 22,413	------------- 38,776	------------- 24,602	------------- 466,783	-------------
3Brian Dawson MD VP, CMO So. Mkt	(i) (ii)	334,184 -------------	50,371 -------------	11,245 -------------	19,408 -------------	21,306 -------------	436,514 -------------	-------------
4Chase Wilson VP, COO BHMA (Prev CFO SE Mkt)	(i) (ii)	135,247 -------------	32,356 -------------	240 -------------	8,999 -------------	22,137 -------------	198,979 -------------	-------------
5David Sensibaugh Pres/CEO ISHN	(i) (ii)	58,716 -------------	61,634 -------------	124,214 -------------	3,507 -------------	15,799 -------------	263,870 -------------	-------------
6Edward Hickson VP, Pres SW Mkt	(i) (ii)	453,239 -------------	261,467 -------------	1,725 -------------	16,845 -------------	26,039 -------------	759,315 -------------	-------------
7Eric Carroll CEO Greene Co Prev. CEO UCH	(i) (ii)	171,643 -------------	43,011 -------------	1,155 -------------	11,026 -------------	19,121 -------------	245,956 -------------	-------------
8Eric Deaton BH EVP/COO	(i) (ii)	------------- 577,023	------------- 447,591	------------- 15,305	------------- 73,799	------------- 20,516	------------- 1,134,234	-------------
9Joshua McFall VP, CFO Southern Mkt	(i) (ii)	270,304 -------------	70,756 -------------	1,041 -------------	16,378 -------------	18,594 -------------	377,073 -------------	-------------
10Kenneth Shafer VP, COO JCMC	(i) (ii)	223,854 -------------	65,467 -------------	1,525 -------------	3,470 -------------	19,788 -------------	314,104 -------------	-------------
11Lemmie Taylor VP, CEO SSH	(i) (ii)	230,550 -------------	145,686 -------------	4,567 -------------	27,159 -------------	23,771 -------------	431,733 -------------	-------------
12Linda White VP/Pres NW Mkt, Frmr CEO FWCH	(i) (ii)	------------- 386,764	------------- 202,398	------------- 2,105	------------- 33,388	------------- 23,072	------------- 647,727	-------------
13Lisa Carter VP Pediatric Svcs	(i) (ii)	241,653 -------------	144,851 -------------	7,971 -------------	17,314 -------------	22,744 -------------	434,533 -------------	-------------
14Lynn Krutak BH EVP/CFO	(i) (ii)	------------- 606,603	------------- 494,254	------------- 6,777	------------- 79,271	------------- 20,124	------------- 1,207,029	-------------
15Marvin Eichorn BH EVP/CAO	(i) (ii)	------------- 701,564	------------- 576,630	------------- 35,511	------------- 17,300	------------- 26,943	------------- 1,357,948	-------------
16Melanie Stanton VP, CEO FWCH	(i) (ii)	262,144 -------------	81,536 -------------	8,130 -------------	16,585 -------------	21,695 -------------	390,090 -------------	-------------
17Morgan May VP, CNO JCMC	(i) (ii)	193,605 -------------	51,921 -------------	1,166 -------------	-------------	20,053 -------------	266,745 -------------	-------------
18Patricia Baise Former VP, CEO Behavioral Hlth	(i) (ii)	------------- 215,470	-------------	------------- 20,795	------------- 1,347	------------- 16,263	------------- 253,875	-------------
19Tim Belisle BH EVP/Gen Cncl	(i) (ii)	------------- 418,179	------------- 345,978	------------- 15,250	------------- 60,679	------------- 25,346	------------- 865,432	-------------

Schedule J (Form 990) 2020

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.

Unless expressly approved by the Ballad Health Executive Chair/President, first-class transportation is generally not permitted. The Executive Chair/President may utilize first class travel for flights of a long duration. The Vice Chair/Lead Independent Director of the Board of Directors reviews and determines approval for expense reimbursement requests made by the Executive Chair/President. Charter flights must be approved in advance by the Executive Chair/President and are limited to business trips that can be justified based on financial savings, essential time savings and meeting logistics. On an annual basis, the Internal Audit Department of Ballad Health validates all charter travel was for valid business purposes and in compliance with the Ballad Health senior executive travel and business reimbursement policy.

Schedule J (Form 990) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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 instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
Mountain States Health Alliance

Employer identification number
62-0476282

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	Hlth & Edu Facil Bd 2012	62-1464028	478271JV2	09-18-2012	94,745,050	Construction & Equip		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	37,880,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	95,337,514
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,889,665
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	93,447,849
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2016
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2019, a current refunding issue)? ........		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2019, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

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

Cat. No. 50193E

Schedule K (Form 990) 2020

Page 2

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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	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?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		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
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
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

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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	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? .....

Schedule K (Form 990) 2020

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

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 Hlth & Edu. Facil. Bd. 2012A&B&C 11/28/17Schedule K - Additional Information Hlth & Edu. Facil. Bd. 2012A&B&C Construct and equip surgery center at Johnson City Medical Center;Construct and equip hospital facilities, including refinancing of taxble indebtedness relating thereto1. Comment on Part I, Line A.In 2012, when the bonds referenced in Schedule K were issued, Mountain States Health Alliance owned and/or operated hospitals in a number of different locations both in Tennessee and in Virginia. As a result, Mountain States Health Alliance utilized conduit governmental bond issuers in multiple jurisdictions in order to finance improvements to its hospital facilities. In 2012, Mountain States Health Alliance was the conduit borrower of tax-exempt bonds issued by multiple issuers in Tennessee and Virginia. For federal tax purposes, even though different government issuers were involved, these multiple issues in each year were required to be treated, and were treated, as a single "issue" because they met the single "issue" test under the applicable federal tax regulations. Therefore, multiple issuers are listed under Line A because the bonds that were issued were part of a single "issue" for federal tax purposes.Additional Issuer EIN: 54-1276910Additional CUSIP#s: 478271JWO; 977220AA02. Comment on Part II, Line 3. Line 3 for the listed bond issues does not match the applicable issue price for such bond issue because of interest earnings earned on the proceeds of such bonds.

Schedule K (Form 990) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2020

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Laura Levine	Family Member	33,592	See Part V		No

Part V

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

Return Reference	Explanation
Schedule L, Part V Supplemental Information	(1) Alan Levine, CEO of the MSHA/BH Board of Directors, is a family member of Laura Levine, an employee of MSHA.

Schedule L (Form 990 or 990-EZ) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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

2020

Open to Public
Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

Return Reference	Explanation
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Mountain States Health Alliance 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 Mountain States Health Alliance board members. The President and CEO of Ballad Health serves as the President and CEO for Mountain States Health Alliance.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	Decisions of the Mountain States Health Alliance Board of Directors are subject to approval by the Ballad Health Board of Directors.
Form 990, Part VI, Line 11b: Form 990 Review Process	The Ballad Health Tax Department prepares and reviews the Form 990. During preparation other functional areas within the organization provide information and support to complete an accurate return. The return is reviewed by the organizations EVP/CFO and is provided in electronic form to all members of the Board of Directors prior to being filed with the IRS.
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 Increases	Intercompany Transfers = $10676517
Other Changes In Net Assets Or Fund Balances - Other Increases	Other Acquisition = $197148
Other Changes In Net Assets Or Fund Balances - Other Increases	Temporarily Restricted Grants = $25923
2019 NOVEL CORONAVIRUS (COVID-19) PUBLIC HEALTH EMERGENCY	The United States Secretary of Health and Human Services declared a Public Health Emergency (PHE) on January 31, 2020 due to confirmed cases of the 2019 Novel Coronavirus (COVID-19). On March 10, 2020 Ballad Health executed its disaster plan in response to the COVID-19 pandemic. This included the activation of its Corporate Emergency Operations Command (CEOC) to coordinate efforts across the system and around the region to rapidly plan for, and execute, ongoing response to the issues resulting from the COVID-19 pandemic. The policy establishing the CEOC is established and authorized by the Board of Directors, and follows guidelines established by the Federal Emergency Management Agency (FEMA) and the CDC. CEOC is led by an incident commander appointed by the Chief Executive Officer in this instance the Chief Operating Officer. The CEOC is composed of key leaders overseeing essential functions of the health system, including logistics, supply chain, communications, operations, finance, government relations and clinical services. The CEOC acts as the clearinghouse for all organizational planning and decision-making related to the event, and continues its responsibilities under the oversight of, and until discontinued by, the Chief Executive Officer. The Chief Executive Officer, who also serves as Chair of the Board of Directors, keeps the Board of Directors apprised of issues on an ongoing basis and ensures compliance with the Boards delegations of authority pursuant to Ballad Healths policies.During fiscal year 2021, CEOC continued to manage activities related to the PHE which included frequent communications to internal parties, news media, and the public. These communications included providing data related to the prevalence of the virus in the community, hospital capacity and constraints, and other timely information related to the progression of the pandemic. Upon release of vaccines, communications and efforts progressed to include the distribution of vaccination to eligible individuals. This was through newly established Ballad Health vaccination centers, outpatient clinics, supporting community partners, and other mobile outreach efforts. Ballad Health administered almost 88,000 vaccine doses through these efforts during the fiscal year starting with the delivery of the first dose in the service region on December 15, 2020. The system also discharged over 6,500 patients diagnosed with COVID-19 and referred an additional 1,600 patients from Emergency Departments into the Safe at Home program. Through the Safe at Home program and other measures, the healthcare system focused on delivery of care to patients in the most convenient and appropriate environment for their condition. These measures reduced hospital stays for patients in need of monitoring while conserving hospital beds for patients in need. Ballad Health also focused on supporting patients recovering from COVID-19 through the Center for Post-COVID Care and other COVID-19 support groups. This innovative approach creates an access point to comprehensive clinical care for those struggling with post-COVID symptoms. Through the Center for Post-COVID Care, Ballad Health provides a full spectrum of services, including care navigation and care management. The health system also fosters research and learning opportunities and collaborates with other leading institutions to understand post-COVID care and increase awareness to healthcare providers, patients and community members of this Long COVID condition.
CARTER COUNTY, TN: SYCAMORE SHOALS HOSPITAL (SSH)	121-bed acute care facility Offers complete inpatient and outpatient surgical services including general surgery, surgical oncology, orthopedics (including hand and extremities), plastic surgery and gynecological surgeryCertified chest pain and heart failure program by the Joint CommissionA certified acute stroke-ready program by the Joint CommissionNew Leaf Senior Care offers inpatient psychiatric treatment to adults 55 and older Campus includes a regional cancer center clinic, an outpatient rehabilitation clinic, and comprehensive primary care and specialist care
IMPROVING ACCESS TO HEALTHCARE SERVICES	RE-IMAGINE RURAL HEALTHCARE - Since 2010, more than 136 rural hospitals have closed in the United States, according to the North Carolina Rural Health Research Program. Compared to other states, Tennessee ranks worst in the nation, with 16 rural hospital closures since 2005. In the region served by Ballad Health, however, it is a different story. Every community in the region with a hospital prior to the merger creating Ballad Health continues to be served by a hospital. In fact, in the middle of the pandemic, Ballad Health opened the countrys newest rural hospital. In July 2021, Ballad Health followed through on its promise to the residents of Lee County, Virginia, and reopened Lee County Community Hospital in Pennington Gap. REOPENING HOSPITAL IN LEE COUNTY, VA - Ballad Health took significant strides towards reopening Lee County Community Hospital as a Critical Access Hospital despite impacts of the COVID-19 pandemic. During renovations of the hospital, Ballad Health staffed a new urgent care center to provide residents in the area with immediate access to care. All preparation work and renovations were completed during fiscal year 2021 in order to meet the July 1, 2021 grand reopening date. This 10-bed modern medical facility will serve the community in rural Southwest Virginia and Southeast Kentucky. GREENE COUNTY, TN CONSOLIDATION AND NEW SERVICES- During the 2018 fiscal year, the two hospitals in Greene County, Laughlin Memorial and Takoma Regional, saw combined operating losses of $11 million, with cumulative two-year losses totaling nearly $25 million. As competing hospitals in the community, both hospitals were failing financially. With Ballad Healths creation, both hospitals were consolidated into one, with the Laughlin Memorial campus being renamed Greeneville Community Hospital.Ballad Health continues to identify ways to reduce unnecessary administrative and overhead cost, improve quality, eliminate unnecessary duplication of high-cost services, and seek better supply pricing all of which further reduced the overall cost of care for patients in the Appalachian Highlands. Ballad Health has utilized the savings it has created and invested them into a population health infrastructure, Epic electronic medical record platform, provider recruitment, academics and training. STRONG Futures - In early 2021, Ballad Health announced a major investment into serving the specialized needs of pregnant women, babies and families who suffer from the pain of addiction. Ballad Health STRONG Futures is housed in the former Takoma Regional Hospital in Greeneville and provides residential and other care for pregnant women and mothers who suffer from addiction or need other behavioral health services. The program provides a range of residential and intensive outpatient behavioral health services that help ensure the strongest-possible new beginnings for women and their children. The program is unique in that children may live with the mother during treatment. Programs for financial stability, educational classes and fathers are also offered.STRONG Futures serves community members in Carter, Cocke, Greene, Hamblen, Hancock, Hawkins, Johnson, Sullivan, Unicoi and Washington counties. The STRONG Futures program has served 147 families, impacting over 800 individuals.EXPANDED ACCESS TO RURAL COMMUNITIES In addition to opening new hospitals in rural communities, Ballad Health has focused on expansion of access to other healthcare services. Ballad Health opened a new urgent care center in Banner Elk, North Carolina. This center provides convenient access to residents who previously were required to travel excessive distances for care. This clinic also serves as a convenient resource for students, faculty, and staff of a nearby college. CREATED SINGLE COORDINATED REGIONAL TRAUMA SYSTEM - One of the most significant ways Ballad Health has been able to comply with the provisions of the Certificate of Public Advantage and Cooperative Agreement, which required avoidance of duplication of services where appropriate, was the consolidation of the two Level I trauma centers operating in the region and the subsequent creation of a coordinated regional trauma system. In approving this move in advance, the State of Tennessee relied upon the evidence published in multiple respected studies which found higher volume trauma centers lead to improved outcomes. The move toward a single coordinated trauma system followed the guidance of the American College of Surgeons (ACS), which verifies trauma centers. The Tennessee Department of Health, after conducting a rigorous review of the trauma program at Johnson City Medical Center, issued its Level I Trauma Center Reverification Site Visit Report. The report found the hospital has demonstrated an outstanding commitment to care for the injured patient. Further, the survey resulted in zero deficiencies, a first for trauma care in the region. CONSOLIDATED REGIONAL PERINATAL CENTER - Tennessee law requires a regionalized system of care for high-risk newborns. The result of this law is a policy in Tennessee that recognizes five regional perinatal centers. Niswonger Childrens Hospital at Johnson City Medical Center is the designated center for regional perinatal care for the Appalachian Highlands. Prior to the merger, perinatal care in the Appalachian Highlands did not meet the goals of the state, with two NICUs that were not coordinated and shared volumes. Ballad Health immediately took steps to correct this after the merger, leading to a more sustainable and coordinated system of care for neonates, while also reducing the costs associated with maintaining two lower-volume units. After this consolidation, Ballad Health partnered with ETSUs Quillen College of Medicine, which provides ongoing expert neonatology coverage for the hospital, ensuring Ballad Health has neonatology provider coverage 24 hours per day. With more than 25 pediatric specialists to provide support for the Perinatal Center, this is the first time every newborn in the region has access to such highly specialized care.EXPANDED ACCESS TO PEDIATRIC SPECIALTIES - With financial support from Ballad Health and the State of Tennessee, the ETSU Quillen College of Medicine was able to successfully recruit pediatric surgeons to support the Niswonger Childrens Hospital. Our partners at ETSUs Quillen College of Medicine also provide 24/7 neonatology coverage for the NICU. Ballad Health now proudly meets the highest standards for regional perinatal care, something that was not thought possible prior to the merger creating Ballad Health.PARTNERSHIP WITH ETSU TO CREATE FELLOWSHIP PROGRAM IN ADDICTION MEDICINE - Ballad Health and East Tennessee State University formed a partnership to create a new fellowship program in addiction medicine. As part of its commitment to expand education and training in the region, Ballad Health will fund any unreimbursed costs of the fellowship program which, over a 10-year period, could cost more than $2.5 million. ESTABLISHMENT OF CENTER FOR RURAL HEALTH RESEARCH Tennessee Governor Bill Lee announced the creation of a new Center for Rural Health Research that will be housed at the College of Public Health at East Tennessee State University. In addition to state funding, Ballad Health has committed to contributing more than $15 million during the next 10 years to the Center. The goal of the Center will be to work with Ballad Health, local healthcare delivery partners, national experts and the leadership of ETSU Health to identify new mechanisms to improve health in rural and nonurban communities. Specific emphasis will be placed on strategies that disrupt inter-generational cycles of behaviors that contribute to poor health outcomes, which ultimately can affect college and career-readiness.RECRUITMENT OF NEW PHYSICIANS TO RURAL SOUTHWEST VIRGINIA - Ballad Health provided the necessary resources to recruit new specialists to serve our region, many of whom were recruited to private practices not owned by Ballad Health. The addition of specialists is helping to improve access to care in rural communities. For instance, Wise County, in Virginia now benefits from an orthopedist, a cardiologist and several other physicians and providers. Wythe County, in Virginia, a community not served by a Ballad Health hospital, benefits from a cardiologist recruited by Ballad Health. Throughout the region, new physicians and advanced practitioners, recruited and funded by Ballad Health, are serving the region from trauma care to pediatrics, from Wythe County, Virginia to Hancock County, Tennessee. CREATION OF APPALACHIAN HIGHLANDS CARE NETWORK Unveiled a major, coordinated effort to increase healthcare access for low-income uninsured people, aiming to reduce health disparity and inequity. The new Appalachian Highlands Care Network is designed to bridge gaps, improve health and reduce avoidable healthcare cost and utilization. The program includes all Balla
IMPROVING ACCESS TO HEALTHCARE SERVICES (Cont'd)	LAUNCH NISWONGER CHILDRENS NETWORK Unveiled philanthropic investment into comprehensive, regional system of care that represents a nearly $60 million commitment to children, families and the future of the Appalachian Highlands. This is a regional system of healthcare and community services marking a new phase in high standards of care and well-being for children, regardless of where they live, across Northeast Tennessee and Southwest Virginia.
IMPROVING HEALTHCARE QUALITY	QUALITY METRICS - Ballad Health continues to make headway in its aim of being a zero-harm, top-decile health system by improving the quality of care delivered to patients by reducing hospital-acquired infection rates and improving other key indicators related to quality care. The State of Tennessee established a scoring system in the COPA to measure key indicators related to quality care and compares those scores to a baseline figure established prior to the merger.In 2021, seven of our quality measures performed among the top decile in the country, the most in the health systems history. Those metrics included in-hospital fall with hip fracture rate, post-operative sepsis rate and perioperative hemorrhage or hematoma rate, among others.These quality metrics were achieved during a time when COVID-19 had a terrible impact on hospital operations, while associated infections and complications have deteriorated nationally.FOCUS ON QUALITY - Ballad Health launched a series of initiatives, including the work of the Clinical Council, implementation of systemwide tiered safety huddles and bold and ambitious initiatives like 30 in 90 reducing infections by 30% over 90 days that target hospital-acquired infections like Clostridioides difficile (C. diff), Catheter-associated Urinary Tract Infections (CAUTI), surgical site infections and others. Not only did Ballad Health achieve its goal of reducing the number of C. diff cases by 30% within 90 days, the reduction in C. diff cases has continued as Ballad Health has now reduced C. diff cases by 70% since the programs inception.As part of Ballad Healths systemwide initiative to improve safety and reduce harm, Ballad Health has continued its tiered-safety huddle program throughout the pandemic, which continues to grow in popularity among frontline caregivers. Any issues identified during those huddles are elevated to hospital leadership. If hospital leadership cannot resolve the issue, the issue is further elevated to the market level and then to the corporate level. Using this approach, Ballad Health can improve outcomes and enhance safety by rapidly deploying resources to support and solve safety issues as they arise.PARTICIPATION IN THE MEDICAID TRANSFORMATION PROJECT - Ballad Health and a group of the nations leading health systems joined forces to identify ways to better care for some of the nations most vulnerable populations. The 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 focused on four keys areas of opportunity: behavioral health, child and maternal health, substance use disorder and avoidable emergency department visits. PARTICIPATION IN THE HIGH-VALUE CARE COLLABORATIVE - Ballad Health was chosen for a national initiative, The High-Value Care Collaborative, a partnership of the American Hospital Association, the American Board of Internal Medicine Foundations Choosing Wisely campaign, and the Costs of Care organization. The High-Value Care Collaborative brings together participants to improve efficiency, decrease cost and improve quality in healthcare. During the past year, Ballad Health and other participants in the program adopted strategies to reduce unnecessary cost and deliver evidence-based care that has been demonstrated to reduce the burden on patients.
IMPROVING THE COMMUNITY'S HEALTH STATUS	ACCOUNTABLE CARE COMMUNITY ACHIEVEMENTS - To help address the broader needs of the community at large, Ballad Health has convened the nations largest accountable care community (ACC), spanning two states with more than 300 participating organizations in 21 counties throughout the Appalachian Highlands.Through five months of regional focus groups and stakeholder meetings, the ACC selected four priority areas to influence through its work: substance abuse, tobacco use, overweight and obesity, childhood trauma and resiliency.The ACC leadership council has agreed that the most impactful way to address the four priority areas is by focusing on interventions that benefit children and families. To reflect this commitment toward youth, the group chose the name STRONG (Striving Toward Resilience and Opportunity for the Next Generation) Accountable Care Community and is organizing activities into four categories: STRONG Starts (conception through kindergarten), STRONG Youth (kindergarten through 12 years old), STRONG Teens (13 to 18 years old) and STRONG Families (adults and caregivers).In May, Ballad Health announced it would invest $2 million in 21 regional, community-based organizations to support strategies aimed at improving childrens health outcomes in the region, including providing social support services and navigation for women suffering from addiction, preventing food insecurity, parenting and resiliency training and keeping youth from dropping out of school. The work these community organizations are doing will help ensure that children and families reach their full potential.Ballad Health and the regions STRONG Accountable Care Community unveiled a new partnership and coordinated care network with Unite Us that will enhance community members health and well-being. The partnership, announced in June, will join Ballad Health with the Unite Tennessee and Unite Virginia networks. These networks connect people with unmet health and social service needs, such as housing, food, transportation and employment. Within Ballad Health, specially trained staff now conduct health related social needs screenings for gaps in care, such as food andhousing insecurity, transportation challenges or other obstacles.The Unite Us technology helps staff connect families with community organizations committed to resolving those issues. The network, however, is not dependent on Ballad Health. Participating organizations also now use the system to refer clients to each other even if the people theyre referring arent Ballad Health patients.CREATION OF NEW BALLAD HEALTH BEHAVIORAL SERVICES DIVISION - To achieve success in a value-based healthcare environment and to achieve the goals for improved access to behavioral services for the region, Ballad Health created the Behavioral Health Services Division. CREATION OF THE BALLAD HEALTH INNOVATION CENTER - Ballad Health created The Innovation Center to serve as a hub for development of partnerships and collaborations that can bring to market life-saving initiatives and other technologies and services that can improve the human condition. COMMUNITY RESOURCES - Ballad Health parish nurses work with individual congregations to help people in religious communities improve their health, prevent illness and injury and ease suffering associated with any health crisis. The parish nurse acts as counselor, educator and healthcare provider by identifying needs of the congregation, coordinating health screenings, providing educational programs, supplying health literature and referring congregants to supportive health services where appropriate. Also, the parish nurse maintains an active visitation program to parishioners who are homebound, hospitalized or in nursing homes. Currently, there are dozens of churches in Northeast Tennessee and Southwest Virginia that are serviced by the Ballad Health parish nurse program. Ballad Healths Nurse Connect is a toll-free line that connects community members with experienced nurses around the clock. The nurses provide expert medical advice anytime, day or night, make referrals to a primary care provider with a location and hours convenient to the community member and referrals to a physician specialist when they need advanced local medical care. They also provide health information and resources, including health screenings and immunizations, and make referrals to urgent care clinics to see a doctor near the community member the same day. Ballad Healths Marsh Regional Blood Center supplies the blood needs of 25 medical facilities, all regional cancer centers, and local rescue aircraft across the Appalachian Highlands. This is accomplished through our collection facilities in Kingsport, Johnson City, Bristol, and mobile blood drives.CHARITABLE CONTRIBUTIONS- From its inception in February of 2018, Ballad Health made significant contributions to the community it serves totaling over $27 million to date in direct contributions and other community health improvement initiatives. A few examples from fiscal year 2021 include: contribution towards Center for Rural Health and Research Fund, contribution towards Strong BRAIN Institute, support for Milligan Universitys Addiction Counseling Program, support towards a Medical / Legal Partnership to improve access to health care and patient health.
INVESTMENTS	COMMON ELECTRONIC HEALTH RECORD - Ballad Health continued building on prior progress around a common electronic medical record. An implementation plan was developed to include infrastructure enhancements to support the expansion. This investment of over $200 million will allow patient information to be shared immediately at the point of service regardless of where a patient enters the Ballad Health system, providing clinical staff with information to better manage patients in the emergency room, clinics, acute and post-acute settings. In the midst of, and despite the global health pandemic, on October 1, Ballad Health successfully completed the acute care phase of the transition. This new common platform will provide patients and their doctors with new options for access, care and security of patient records unprecedented in Ballad Healths service area. This concluded a multi-year effort to transition to a single patient record platform. With this accomplishment, Ballad Health expects to optimize its connectivity to consumers, improving the patient experience dramatically. Ballad Healths conversion to a single technology platform, is just the first of many steps the system is taking as part of its digital transformation journey. Last year, Ballad Health launched an app for patients, giving them direct access to new services, including real-time scheduling, digital access to health information, price transparency and better coordination between providers, regardless of their location. More than 150,000 Ballad Health patients use the Ballad Health app, with thousands joining each month.CHARITY CARE CONTRIBUTIONS - For 2021, Ballad Health provided more than $80 million in free care, cost that is not reimbursed by any payer nor recovered from the patient who qualifies for charity assistance. Following the merger, Ballad Health increased the threshold for patients to qualify for charity care from 200% of the federal poverty level to 225% of the federal poverty level and provides significant discounts for people up to 450% of the federal poverty level. ACCOUNTABLE CARE ORGANIZATION SAVINGS - Ballad Health was among the first health systems to implement and successfully demonstrate that value-based care led to reduced costs through its Accountable Care Organization (ACO), AnewCare Collaborative. Value-based care means payments for healthcare are based on the quality of care provided and in the reduction of the total cost of care. Since the United States Centers for Medicare and Medicaid Services established the shared savings program six years ago, AnewCare has been one of only 18 ACOs in the nation to generate savings for taxpayers each year saving taxpayers more than $60 million since inception.MEDICAL EDUCATION - Ballad Health continues to offer free Certified Nursing Assistant (CNA) classes, which are open to the public. The CNA courses are approved and regulated by either the Tennessee State Board of Nursing or the Virginia Board of Nursing. The training opportunity can lead to career opportunities for those who complete the program. Ballad Health offers the course free of charge and participants who successfully complete the course meet criteria to sit for the state certification examination. The program includes classroom sessions followed by clinical experience. Clinical hours are conducted at various Ballad Health facilities. RESEARCH the Ballad Health research department serves as the central source of oversight for multi-specialty research. In addition to providing full spectrum support for research studies at Ballad Health, the department also provides oversight for studies generated externally. Teaching and continuing education play a large role at Ballad Health and research staff participate in conferences/webinars and conduct a monthly research orientation sessions. The research department has participated in several large-scale, multi-center trials with a high subject retention rate and sponsor/monitoring rating. Oversight services include administrative, legal, regulatory support, internal service arrangement and financial management. 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 Ballad facilities,ensuring regulatory compliance and fiscal responsibility, andcreating a research culture across Ballad facilities
JOHNSON COUNTY, TN: JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH)	Federally designated Critical Access Hospital serving residents of the upper northeast tip of Tennessee, parts of North Carolina and Southwest VirginiaLocated in one of Tennessees poorest counties providing care to the rural and medically underservedOffers 24/7 emergency care, inpatient and outpatient care, cardiac rehabilitation, various diagnostic services, physical therapy, a primary care clinic, and Senior Life Solutions, a behavioral health program for seniors
OTHER NOTABLE EVENTS AND AWARDS	Recognized by Forbes Magazine as one of the 29 best workplaces in America for diversityEarned the College of Healthcare Information Management Executives (CHIME) Digital Health Most Wired recognitionSmyth County Community Hospital earned CMS 5 Star rating for patient experience.Ballad Health provided support to build the Miracle League Field at Brickyard Park in Kingsport, TN that provides opportunities for children and adults with both mental and physical disabilities to play baseball on a safe, smooth, cushioned field. It is the only field of its kind in Northeast Tennessee.Received its Accreditation/Department of Distinction from the International Association for Healthcare Security & Safety (IAHSS)Partnered with East Tennessee State University (ETSU) to launch Strong BRAIN Institute to study adverse childhood experiences. The Strong BRAIN (Building Resilience through Adverse Childhood Events -Informed Networking) Institute facilitates the development and dissemination of evidence-based practices that prevent, reduce or mitigate the negative effects of Adverse Childhood Events (ACEs) on health and health disparities. The Institute will also work to inform the citizenry and workforce in the Appalachian Highlands on the importance of being trauma informed. Established through a five-year gift from Ballad Health to ETSU, the Strong BRAIN Institute will be guided by an advisory board comprised of ETSU experts, Ballad Health experts and community members.Recognized by Harvard University and UnitedHealthcare as one of four healthcare organizations leading the way towards a 3D model for value-based care.Partnered with Mayo Clinic, in response to the COVID-19 Pandemic to conduct research into convalescent plasma as an experimental treatment.
Part III, Program Service Accomplishments	Ballad Health (BH) is an integrated community health improvement organization serving 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina and Southeast Kentucky. Our system of 21 hospitals, including a dedicated childrens hospital, post-acute care and behavioral health services, and a large multi-specialty group physician practice works closely with an active independent medical community and community stakeholders to improve the health and well-being of more than 1 million people. By leading in the adoption of value-based payments, addressing health-related social needs, funding clinical and health systems research and committing to long-term investments in strong children and families in our region, Ballad Health is striving to become a national model for rural health and healthcare. Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). The two healthcare systems came together on February 1, 2018 as a result of a merger approved by both Tennessee and Virginia Departments of Health. Ballad Health operates under a Certificate of Public Advantage (COPA) in Tennessee and a Cooperative Agreement (CA) in Virginia. Pursuant to the COPA and CA, MSHA and WHS 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.Form 990 for Mountain States Health Alliance (MSHA) includes seven wholly-owned hospitals including a childrens hospital and a behavioral health hospital; four others, majority owned by MSHA, each file a separate return. MSHA is sole shareholder of Blue Ridge Medical Management Corporation (BRMMC), a for-profit entity that owns and manages physician practices and real estate and provides other health care services to patients in Tennessee and Virginia. MSHA is the sole member of Integrated Solutions Health Network, LLC (ISHN). ISHN, also included in this Form 990, is a regional health solutions company headquartered in Johnson City, Tennessee. ISHN is an expansive network of providers serving residents of Northeast Tennessee and Southwest Virginia and consists of provider groups, primary care physicians, specialists, and allied health providers. Specific to the hospitals included in this Form 990, services were provided to: 40,407 inpatients555,806 outpatient visits 131,046 emergency visits 3,853 deliveries 21,537 surgeries138,569 home health visits
Part VI, Line 15a Compensation Process for Top Official	The executive compensation committee serves as the compensation oversight committee of Ballad Healths Board of Directors. The executive compensation committee is comprised of members who are determined to be independent and whom are not reliant upon any business relationship with Ballad Health for income or compensation. The compensation plan for Alan Levine, Ballad Healths Chairman, President and CEO, was reviewed and approved by the executive compensation committee and then by the Ballad Health Board of Directors in accordance with the Board's compensation policy and practice. The Board of Directors relies upon the advice of an independent and experienced compensation consultant with knowledge about pay practices for comparable positions within the industry, and who has access to broad data, studies and surveys in order to ensure the compensation falls within competitive and appropriate ranges for the position.
Part VI, Line 15b - Compensation Process for Officers	On an annual basis, Ballad Healths Human Resources (H/R) Department evaluates compensation for all executives at a position level of Assistant Vice President and above. H/Rs evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on this comparable data, Ballad Healths CEO evaluates the data and, if appropriate, makes necessary adjustments. Any adjustments to Senior Vice Presidents or above are reviewed by the Board of Directors Executive Compensation Committee. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics categorized by; Quality, Service and Safety; Access to Care; Financial Stewardship, and any other metrics approved from time to time by the Board of Directors.
RUSSELL COUNTY, VA: RUSSELL COUNTY HOSPITAL (RCH)	78-bed acute care hospital located in Southwest Virginia Offers a full array of primary care services and some specialty services such as Clearview Psychiatric Center, hospice care, center for sleep disorders, direct lab testing, and a cancer center
SULLIVAN COUNTY, TN: INDIAN PATH COMMUNITY HOSPITAL (IPCH)	239-bed acute care hospitalProvides advanced services including lung nodule clinic, an accredited joint replacement program and a dedicated spine centerCenter for Women and Babies a more than $8 million commitment to provide women and children services to the region. This consolidation of women and childrens services to one location will allow Ballad Health to centralize strong teams of caregivers and specialists to give patients better access to the care they needCampus offers a regional cancer center, a sleep center for both adults and children, a full range of surgical services, a family birth center and many other service lines
UNICOI COUNTY, TN: UNICOI COUNTY HOSPITAL (UCH)	10-bed acute care hospital opened in October 2018 Services include 24/7 emergency care, cardiology services, radiology and diagnostic imaging, laboratory, respiratory, sleep lab, and rehabilitation
WASHINGTON COUNTY, TN: FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH)	80-bed acute care hospital First Leadership in Energy and Environmental Design (LEED) certified hospital in Tennessee, setting the precedent for environmentally friendly designs, and named one of Soliant Healths 2016 Most Beautiful HospitalsFirst hospital in Tennessee to earn Perinatal Care Certification from the Joint Commission Certified with The Joint Commission Seal of Approval for minimally invasive colorectal surgery, the only hospital in Tennessee and one of just five in the nation to have earned this disease-specific certificationEarned the Tennessee Department of Healths BEST for Babies award for efforts to reduce infant mortality
WASHINGTON COUNTY, TN: JOHNSON CITY MEDICAL CENTER (JCMC)	585-bed regional tertiary referral center 432 acute care beds, a 69-bed dedicated childrens hospital and an 84-bed behavioral health hospitalTeaching hospital affiliated with James H. & Cecile C. Quillen College of Medicine at East Tennessee State University (ETSU)Second hospital built in TennesseeLevel I trauma center one of only five in Tennessee Regional Cancer CenterRanked by U.S. News and World Report as a top-performing hospital in Heart Attack and Stroke Recognized by BlueCross BlueShield Association as a Blue Distinction Center+ for maternity careNiswonger Childrens Hospital (NsCH) is a 69-bed childrens hospital within a hospital located on the campus of Johnson City Medical Center serving more than 200,000 children in the four-state, 29-county region. Regions only dedicated hospital for children providing comprehensive services with access to more than 20 pediatric subspecialties Clinics affiliated with St. Jude Childrens Research Hospital located on the campus. Staffed by pediatric hematology-oncology physicians and other clinic support team members, the Tri-Cities affiliate is a partnership among the St. Jude Childrens Research Hospital, East Tennessee State University and NsCH. The outpatient clinic, established in 1999, is part of the St. Jude mission to extend the protocol-structured treatment and research at St. Jude through clinical, research and academic partnerships with pediatric programs. More than 300 children with malignancies are followed each year and more than 3,000 outpatient visits occur annually, including treatment of many children with congenital bleeding disorders and a variety of other hematological problems. The First Regional Hemophilia Program, a state sponsored program for congenital bleeding disorders, is housed in the St. Jude Tri-Cities Affiliate and provides programs for both children and adults with hemophilia. Neonatal intensive care unit, with Level III designation, is one of only five state-designated perinatal centers in Tennessee and is the regional referral center for neonatal patients Pediatric emergency department serving patients from birth to 18 years of age 24 hours a day from specially trained personnel Partners with med flight provider to provide a specialty crew for neonates requiring transports The Northeast Tennessee Regional Perinatal Center located at JCMC is one of five state-designated tertiary centers for high-risk maternal fetal care. State designation is based on guidelines for the service provisions and designations of levels of care governed and reviewed by a state appointed committee through Tennessee Department of HealthWoodridge Hospital, a service of JCMC, is an 84-bed inpatient behavioral health hospital serving a wide region in Northeast Tennessee and Southwest Virginia. Woodridge is the only dedicated inpatient behavioral health hospital in the region providing mental health and chemical dependency services for adults, adolescents, and children ages 6 and older. The hospital provides a 24/7 intervention helpline

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

- 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

2020

Open to Public Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) Integrated Solutions Health Network 509 Med Tech Parkway Suite 100 Johnson City,TN37604 62-1711997	Health Network	TN	2,774,895	927,295	MSHA

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)MSHA Auxiliary 400 N State of Franklin Road Johnson City,TN37604 58-1418345	Supporting Organization	TN	501C3	12a	MSHA	Yes
(2)Smyth County Community Hospital 245 Medical Park Drive Marion,VA24354 54-0794913	Hospital	VA	501C3	3	MSHA	Yes
(3)Norton Community Hospital 100 15th Street NW Norton,VA24273 54-0566029	Hospital	VA	501C3	3	WHS		No
(4)Dickenson Community Hospital 312 Hospital Drive Clintwood,VA24228 77-0599553	Hospital	VA	501C3	3	WHS		No
(5)Johnston Memorial Hospital 16000 Johnston Memorial Drive Abingdon,VA24211 54-0544705	Hospital	VA	501C3	3	NA		No
(6)Abingdon Physician Partners 16000 Johnston Memorial Drive Abingdon,VA24211 20-5485346	Medical Services	VA	501C3	12a	JMH		No
(7)Ballad Health 303 Med Tech Parkway Suite 220 Johnson City,TN37604 61-1771290	Supporting Organization	TN	501C3	12b	NA		No
(8)East TN Healthcare Holdings Inc 203 Gray Commons Circle Gray,TN37615 81-5475903	Opioid Treatment	TN	501C3	3	MSHA	Yes
(9)Wellmont Health System 1905 American Way Kingsport,TN37660 62-1636465	Hospital System	TN	501C3	3	BALLAD HEALTH		No
(10)Wellmont Hawkins Co Memorial Hosp 851 Locust Street Rogersville,TN37857 62-1816368	Hospital	TN	501C3	3	WHS		No
(11)Takoma Regional Hospital Inc DBA GCH 1420 Tusculum Boulevard Greeneville,TN37745 51-0603966	Hospital	TN	501C3	3	WHS		No
(12)Wellmont Cardiology Services 1905 American Way Kingsport,TN37660 26-3557623	Medical Services	TN	501C3	10	WHS		No
(13)Wellmont Medical Associates 1905 American Way Kingsport,TN37660 27-0898372	Medical Services	TN	501C3	7	WHS		No
(14)Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City,TN37604 58-1594191	Fundraiser	TN	501C3	7	BALLAD HEALTH		No
(15)Wellmont Madison House 2000 Greenway Street Kingsport,TN37660 62-1308216	Assisted Living	TN	501C3	10	WHS		No
(16)Wellmont Wexford House 2421 N John B Dennis Hwy Kingsport,TN37660 58-1859039	Nursing Home	TN	501C3	10	WHS		No
(17)Wellmont Imaging Services Inc 400 N State of Franklin Road Johnson City,TN37604 86-1103148	Healthcare	TN	501C3	12a	WHS		No
(18)Wellmont Sleep Services 1905 American Way Kingsport,TN37660 27-3777167	Medical Services	TN	501C3	3	WHS		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2020

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	(k) Percentage ownership
(1) Emmaus Community Healthcare PLLC 6419 Bristol Hwy Piney Flats,TN37686 20-0577483	Medical Services	TN	NA					No			No
(2) Medical Specialists of Johnson City LLC 2528 Wesley Street Suite 2 Johnson City,TN37601 27-2199037	Medical Services	TN	MSHA	Excluded	87,260	267,237		No			No	51.000 %
(3) East Tennessee Ambulatory Surgery Center 701 Med Tech Parkway Suite 100 Johnson City,TN37604 62-1787537	Medical Services	TN	NA					No			No
(4) Greeneville Physician Services LLC 1905 American Way Kingsport,TN37660 45-5070419	Medical Services	TN	NA	Related				No			No	25.000 %
(5) Rehabilitation Hospital of Bristol LLC 103 North Street Bristol,VA24201 20-5612001	Medical Services	TN	N/A					No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(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	(h) Percentage ownership	Yes	No
(1) Blue Ridge Medical Management Corp 1905 American Way Kingsport,TN37660 62-1490616	Medical Services	TN	MSHA	C	120,768,290	242,706,371	100.000 %		No
(2) Mediserve Medical Equipment 1905 American Way Kingsport,TN37660 62-1212286	DME	TN	BRMMC	C	2,843,702	8,810,148	100.000 %		No
(3) Mountain States Properties 1905 American Way Kingsport,TN37660 62-1845895	Property Management	TN	BRMMC	C	12,116,543	155,392,847	100.000 %		No
(4) Mountain States Physician Grp 1905 American Way Kingsport,TN37660 62-1700412	Medical Services	TN	BRMMC	C	56,639,573	12,995,642	100.000 %		No
(5) Community Home Care Inc 1490 Park Avenue NW Suite B Norton,VA24273 54-1453810	Durable Medical Equipment	VA	NA	C					No
(6) Wilson Pharmacy Inc PO Box 5289 Johnson City,TN37604 62-0329587	Pharmacy	TN	BRMMC	C	6,219,901	6,457,289	100.000 %		No
(7) Crestpoint Health Insurance Company 509 Med Tech Parkway Suite 10 Johnson City,TN37604 62-0381170	Insurance	TN	ISHN	C			100.000 %		No
(8) Wellmont Inc 1905 American Way Kingsport,TN37660 62-1320035	Medical Services	TN	NA	C					No
(9) Wellmont Collections Inc 2004 American Way Suite 101 Kingsport,TN37660 62-1325938	Business Services	TN	NA	C					No
(10) Medical Mall Pharmacy Inc 1905 American Way Kingsport,TN37660 62-1565006	Medical Services	TN	NA	C					No
(11) Wellmont Physician Services 1905 American Way Kingsport,TN37660 62-1567353	Medical Services	TN	NA	C					No
(12) WPS Providers Inc 1905 American Way Kingsport,TN37660 20-5564642	Medical Services	TN	NA	C					No
(13) Wellmont Health Services Inc 1905 American Way Kingsport,TN37660 62-1254373	Medical Services	TN	NA	C					No
(14) Nolichuckey Mgmt Svcs Inc 1420 Tusculum Blvd Greeneville,TN37745 62-1776681	Medical Services	TN	LMH	C			100.000 %		No
(15) Ballad Ventures LLC 400 N State of Franklin Rd Johnson City,TN37604 84-4214681	Investment	TN	NA	C					No
(16) Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman KY1-1203 CJ 98-1195624	Insurance	CJ	N/A	C					No

Schedule R (Form 990) 2020

Page 3

Part V

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

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

Yes

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

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

Yes

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

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

Yes

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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) Smyth County Community Hospital	l	116,019	FMV
(2) Smyth County Community Hospital	q	260,241	Cost
(3) Smyth County Community Hospital	r	103,056	Cash
(4) Norton Community Hospital	o	131,684	Cost
(5) Norton Community Hospital	s	269,899	Cash
(6) Johnston Memorial Hospital	p	417,746	Cost
(7) Abingdon Physician Partners	m	445,646	FMV
(8) Abingdon Physician Partners	o	129,280	Cost
(9) Abingdon Physician Partners	q	50,653	Cost
(10) Blue Ridge Medical Management Corp	a	499,421	FMV
(11) Blue Ridge Medical Management Corp	k	58,796	FMV
(12) Blue Ridge Medical Management Corp	m	40,188,366	FMV
(13) Blue Ridge Medical Management Corp	q	557,001	Cost
(14) Mediserve Medical Equipment	k	58,796	FMV
(15) Mountain States Properties	k	488,589	FMV
(16) Mountain States Properties	p	568,843	FMV
(17) Wilson Pharmacy Inc	a	66,967	FMV
(18) Wilson Pharmacy Inc	o	66,612	Cost

Schedule R (Form 990) 2020

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2020

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) 2020

Additional Data

Software ID:	20011551
Software Version:	2020v4.0

1	Briefly describe the organization’s mission or most significant activities: Our mission: Honor those we serve by delivering the best possible care.Our vision: To build a legacy of superior health by listening to and caring for those we serve.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	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 2020 (Part V, line 2a) ......	5	7,233
6	Total number of volunteers (estimate if necessary) .............	6	205
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	2,051,018
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	732,751

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,903,981	9,827,762
9	Program service revenue (Part VIII, line 2g) .........	792,669,397	767,814,082
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-215,711	154,614
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	9,843,932	11,799,342
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	805,201,599	789,595,800
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,985,282	12,370,549
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)	294,218,115	293,270,688
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)....	467,044,022	511,355,179
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	763,247,419	816,996,416
19	Revenue less expenses. Subtract line 18 from line 12.......	41,954,180	-27,400,616
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	556,120,495	541,476,325
21	Total liabilities (Part X, line 26).............	169,963,725	171,820,583
22	Net assets or fund balances. Subtract line 21 from line 20.....	386,156,770	369,655,742

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 685,753,487 including grants of $ 12,370,549 ) (Revenue $ 767,814,082 )
	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 expenses685,753,487

(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) Eric Carroll CEO Greene Co........................................................................ Prev. CEO UCH	45.00 .......................0.00	215,809	0	30,147
(19) Chase Wilson........................................................................ VP, COO BHMA (Prev CFO SE Mkt)	45.00 .......................0.00	167,843	0	31,136

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,747,174	8,308,926	1,057,764

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	276,850
e	Government grants (contributions)		1e	9,059,231

f	All other contributions, gifts, grants, and similar amounts not included above		1f	491,681

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

h Total. Add lines 1a-1f.......		9,827,762

		Business Code
2a	CARES Act Revenue	900099	6,468,181	6,468,181
b	Diabetes Program Revenue	900099	667,692	667,692
c	Lab Outreach Revenue	621500	1,946,512		1,946,512
d	Patient Revenue	622110	756,852,514	756,852,514
e	Wellness Programs Revenue	900099	1,879,183	1,879,183
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		767,814,082

3 Investment income (including dividends, interest, and othersimilar amounts) ......			92,685			92,685
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		866,889	6a
b	Less: rental expenses		354,046	6b
c	Rental income or (loss)		512,843	6c
d	Net rental income or (loss).......			512,843		104,506	408,337
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	282,638		7a
b	Less: cost or other basis and sales expenses	220,709		7b
c	Gain or (loss)	61,929		7c
d	Net gain or (loss).........			61,929	61,929
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Cafeteria/Vending		722514	1,965,132			1,965,132
b	Network Mgt Services		900099	894,515			894,515
c	Support Services		900099	6,836,845	6,836,845
d	All other revenue ....			1,590,007			1,590,007
e	Total. Add lines 11a–11d ......			11,286,499
12	Total revenue. See instructions.....			789,595,800	772,766,344	2,051,018	4,950,676

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	12,370,549	12,370,549
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, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	2,698,147	284,781	2,413,366
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........	235,814,145	186,291,716	49,522,429
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,893,781	5,452,417	1,441,364
9	Other employee benefits .......	32,941,351	18,759,949	14,181,402
10	Payroll taxes ...........	14,923,264	13,705,193	1,218,071
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	152,830	2,444	150,386
c	Accounting ...........	5,292		5,292
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)	190,027,585	150,507,248	39,520,337
12	Advertising and promotion ....	713,613		713,613
13	Office expenses .......	4,737,143	4,194,856	542,287
14	Information technology ......	12,462,593	11,154,127	1,308,466
15	Royalties ..	0
16	Occupancy ...........	10,394,699	10,252,936	141,763
17	Travel ............	1,085,513	1,029,205	56,308
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	22,087,080	21,815,528	271,552
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	33,186,552	31,302,224	1,884,328
23	Insurance ...	2,303,380	2,209,700	93,680
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	192,560,669	192,560,669
b	Maintenance	19,817,684	19,263,442	554,242
c	Support Services	16,896,762	1,092,432	15,804,330
d	Dues & Subscriptions	1,970,572	795,681	1,174,891
e	All other expenses	2,953,212	2,708,390	244,822
25	Total functional expenses. Add lines 1 through 24e	816,996,416	685,753,487	131,242,929	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 ........			81,098	1	27,382
2	Savings and temporary cash investments .........			749,516	2	533,456
3	Pledges and grants receivable, net ......			1,335,101	3	131,622
4	Accounts receivable, net .............			92,012,798	4	92,535,896
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6	0
7	Notes and loans receivable, net ...........			8,596,085	7	13,512,169
8	Inventories for sale or use ............			17,748,851	8	18,530,781
9	Prepaid expenses and deferred charges ......			7,436,490	9	5,047,161
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,044,926,590
b	Less: accumulated depreciation	10b	675,213,877	386,001,515	10c	369,712,713
11	Investments—publicly traded securities .				11	0
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets ...............			13,141,003	14	13,141,003
15	Other assets. See Part IV, line 11 ...........			29,018,038	15	28,304,142
16	Total assets. Add lines 1 through 15 (must equal line 33)...			556,120,495	16	541,476,325

17	Accounts payable and accrued expenses .....	71,714,129	17	80,414,766
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	12,389,332	20	12,004,272
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	85,860,264	25	79,401,545
26	Total liabilities. Add lines 17 through 25..	169,963,725	26	171,820,583

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	386,114,364	27	369,587,413
28	Net assets with donor restrictions ...........	42,406	28	68,329
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	386,156,770	32	369,655,742
33	Total liabilities and net assets/fund balances ........	556,120,495	33	541,476,325