TY 2024 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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Alan Levine BH PresCEO...................................................................... Director, Chair	1.00 ................. 64.00	X	X				0	3,848,876	286,146
(2) Eric Deaton BH EVPCOO...................................................................... Director	1.00 ................. 64.00	X	X				0	1,747,698	137,400
(3) Marvin Eichorn BH EVPCAO...................................................................... Director	1.00 ................. 64.00	X	X				0	1,445,711	53,543
(4) Julie Bennett CLOGovnc Offcr...................................................................... Director, Secretary	1.00 ................. 64.00	X	X				0	976,689	102,286
(5) Shane Hilton...................................................................... BH EVP/CFO	1.00 ................. 64.00		X				0	988,163	113,059
(6) Kenneth Shafer...................................................................... CEO - JCMC	45.00 ................. 0.00			X			497,939	0	53,570
(7) Lemmie Taylor...................................................................... CEO - SSH	45.00 ................. 0.00			X			349,273	0	44,707
(8) Lisa Carter...................................................................... Regional President	45.00 ................. 0.00			X			885,760	0	100,719
(9) Melanie Stanton...................................................................... CEO - FWCH	45.00 ................. 0.00			X			437,785	0	51,372
(10) Morgan May...................................................................... VP System Nursing Operations	45.00 ................. 0.00			X			356,300	0	36,875
(11) Frank Canova...................................................................... Regional CFO	44.00 ................. 1.00			X			417,021	0	45,128
(12) David Wild MD...................................................................... Regional CMO	45.00 ................. 0.00				X		521,746	0	51,629
(13) Dwight Owens...................................................................... VP Oncology Services	45.00 ................. 0.00				X		344,489	0	45,069
(14) Christopher Jett...................................................................... CEO - NsCH	45.00 ................. 0.00				X		439,800	0	48,899
(15) Alison Johnson...................................................................... CNO - JCMC	40.00 ................. 0.00				X		253,496	0	35,858
(16) Preethi Manappetty...................................................................... RN	40.00 ................. 0.00				X		271,301	0	0
(17) Eric Carroll CEO Greene Co...................................................................... Former Highest Compensated	0.00 ................. 45.00					X	362,699	0	44,574

- TIN:

SCHEDULE A
(Form 990)

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

2024

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2024

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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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 2024 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2023 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2024. 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—2023. 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—2024. 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—2023. 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) 2024

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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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 on 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 2024 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2023 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2024 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2023 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2024. 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—2023. 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) 2024

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) .

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

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 on 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 on 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) 2024

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

11a

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

11b

A 35% controlled entity of a person described on 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 on 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) 2024

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) 2024

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 2024 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-2024	(iii) Distributable Amount for 2024
1 Distributable amount for 2024 from Section C, line 6
2 Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2024:
a From 2019.......
b From 2020.......
c From 2021.......
d From 2022.......
e From 2023.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2024 distributable amount
i Carryover from 2019 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2024 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2024 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2020.....
b Excess from 2021.....
c Excess from 2022.....
d Excess from 2023.....
e Excess from 2024.....

Schedule A (Form 990) (2024)

Schedule A (Form 990) 2024

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) 2024

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)
(Rev. January 2025)

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

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 ......... Right Arrow

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) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025) Page 2

Name of organization Mountain States Health Alliance

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025)

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) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025)

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) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

right arrow

Complete if the organization is described below. 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

2024

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 .................................................................... right arrow

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 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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 ..... right arrow

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

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

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.

Cat. No. 50084S

Schedule C (Form 990) 2024

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 right arrow

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 right arrow

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) 2021	(b) 2022	(c) 2023	(d) 2024	(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) 2024

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

Yes

187,260

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

187,260

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 1:	Mountain States Health Alliance had lobbying expenses of $187,260 which represents the portion of dues paid to various organizations attributable to direct lobbying, including Tennessee Hospital Association, Virginia Hospital and Healthcare Association and National Association of Children's Hospitals.

Schedule C (Form 990) 2024

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

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

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) (Rev. 1-2025)

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 right arrow

Permanent endowment right arrow

Term endowment right arrow

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 .....	22,458,385		22,458,385
b	Buildings ....	535,912,210	291,048,683	244,863,527
c	Leasehold improvements	4,812,144	4,333,723	478,421
d	Equipment ....	360,786,344	291,021,565	69,764,779
e	Other .....	54,482,943	6,012,607	48,470,336
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				386,035,448

Schedule D (Form 990) (Rev. 1-2025)

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Due to 3rd Party Payors	7,027,671
Operating Lease Obligation ST	985,271
Operating Lease Obligation LT	2,377,358
Professional Liabilities Reserve	9,006,402
Due to Payor Stimulus Reserve	2,270,500
Deferred Income	12,558,451
Medicare Advanced Payments ST	-35,626


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	34,190,027
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) (Rev. 1-2025)

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, Line 2:

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, 2025 and 2024. Tax returns for 2022 through 2024 are subject to examination by the Internal Revenue Service."

Schedule D (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2024

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 22500.0000000000 %

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

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

Yes

200% 250% 300% 350% 400% Other 45000.0000000000 %

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

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

Yes

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

Yes

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

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) . . .	36,086,907		36,086,907	2.970 %
b	Medicaid (from Worksheet 3, column a) . . . . .	238,307,689	320,648,406	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	274,394,596	320,648,406	36,086,907	2.970 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	7,269,838	1,069,934	6,199,904	0.510 %
f	Health professions education (from Worksheet 5) . . .	21,729,796	4,350,924	17,378,872	1.430 %
g	Subsidized health services (from Worksheet 6) . . . .	87,836,016	29,519,565	58,316,451	4.800 %
h	Research (from Worksheet 7) .	2,748,010	115,676	2,632,334	0.220 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1,154,805		1,154,805	0.090 %
j	Total. Other Benefits . .	120,738,465	35,056,099	85,682,366	7.050 %
k	Total. Add lines 7d and 7j .	395,133,061	355,704,505	121,769,273	10.020 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2024

Schedule H (Form 990) 2024

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support			9,818		9,818	0 %
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			9,818		9,818	0 %

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. ......

78,076,568

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

3,903,828

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).....

152,170,754

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

144,420,679

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

7,750,075

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2024

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?8Name, 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 Community 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 Community Hospital 1901 S Shady Street Mountain City,TN37683 balladhealth.org 00000039	X	X			X		X		A
7	Unicoi County Hospital 2030 Temple Hill Road Erwin,TN37650 balladhealth.org 00000119	X	X					X		A
8	Lee County Community Hospital 127 Health Care Drive Pennington Gap,VA24277 balladhealth.org H 1940	X	X			X		X		A

Schedule H (Form 990) 2024

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)

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 24

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

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 25

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) 2024

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Facility Reporting Group - 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 225.000000000000%
and FPG family income limit for eligibility for discounted care of 450.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

balladhealth.org

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

balladhealth.org

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

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2024

Page 6

Part VFacility Information (continued)

Billing and Collections

	Facility Reporting Group - 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) 2024

Page 7

Part VFacility Information (continued)

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

	Facility Reporting Group - 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) 2024

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
Part V, Section B	Facility Reporting Group A
Facility Reporting Group A consists of:	- Facility 1: Johnson City Medical Center, - Facility 2: Indian Path Community Hospital, - Facility 3: Franklin Woods Community Hospital, - Facility 4: Sycamore Shoals Hospital, - Facility 5: Russell County Hospital, - Facility 6: Johnson County Community Hospital, - Facility 7: Unicoi County Hospital, - Facility 8: Lee County Community Hospital
Facility Reporting Group - A Part V, Section B, line 3j:	The Community Health Needs Assessment report also included information related to other findings from the data collection process. Special topics such as Adverse Childhood Experiences, Access, Child Health, and others were also detailed. The report also included extensive data appendices further describing the community and health and social related outcomes.
Facility Reporting Group - A Part V, Section B, line 5:	To assess the health of those living in our service area, Ballad Health utilized the Mobilizing for Action through Planning and Partnerships (MAPP 2.0) framework. This comprehensive assessment was conducted from summer 2023 through spring 2024 and included all Ballad Health hospitals. We gathered primary data through surveys with community partners and members, as well as stakeholder meetings. There was broad representation from multi-sector community partners such as, but not exclusively, health departments, academic institutions, community-based organizations, faith-based organizations, justice systems, behavioral health organizations, clinical providers, governmental agencies, emergency personnel, and social services. There was also special focus on including vulnerable and marginalized populations input. Additionally, we compiled secondary data from national, state, regional and county sources. This thorough approach helps us understand and address the unique health needs of our communities. Throughout the community health needs assessment process, we focused on identifying health priorities and disparities within each community. Community members ranked the top three health issues in their area, providing valuable local insights. Combining these perspectives with county, state and national data gives us a comprehensive view of the region's health. This foundation helps us develop effective solutions to improve health outcomes for all.
Facility Reporting Group - A Part V, Section B, line 6a:	The comprehensive assessment was conducted from summer 2023 through spring 2024 and included all Ballad Health hospitals (Bristol Regional Medical Center, Dickenson Community Hospital, Franklin Woods Community Hospital, Greeneville Community Hospital, Hancock County Hospital, Hawkins County Memorial Hospital, Holston Valley Medical Center, Indian Path Community Hospital, Johnson City Medical Center, Johnson County Community Hospital, Johnston Memorial Hospital, Lee County Community Hospital, Lonesome Pine Hospital, Niswonger Children's Hospital, Norton Community Hospital, Russell County Hospital, Smyth County Community Hospital, Sycamore Shoals Hospital, Unicoi County Hospital, and Woodridge Hospital).
Facility Reporting Group - A Part V, Section B, line 11:	Phase 3 of the MAPP 2.0 framework focuses on the continuous improvement of the community. As part of this phase, presentations on Ballad Health's Community Health Needs Assessment (CHNA) process were provided to each of the hospital boards to promote engagement and secure buy-in ahead of the development of Community Health Improvement Plans (CHIPs). These presentations aimed to ensure that hospital leadership fully understood the CHNA process and were committed to the subsequent steps. The CHIPs were developed by each facility based on the CHNA findings and involve collaboration between hospital leadership and community partners in their design and implementation. Each CHIP outlines specific, actionable strategies tailored to address the priority health issues identified in the CHNA. These strategies include measurable objectives, timelines, and assigned responsibilities to ensure accountability and progress tracking.Recognizing the complexity of the identified health issues, Ballad Health emphasizes the importance of collaboration, ensuring that all partners have a seat at the table. This inclusive approach is essential for addressing the multifaceted health challenges that no single entity can manage alone. By fostering strong partnerships and collective action, Ballad Health aims to create effective and sustainable health improvement strategies for the community. Furthermore, the CHIPs will include regular progress reviews and updates to adapt to emerging needs and challenges. This dynamic process ensures that the plans remain relevant and effective over time, continually improving health outcomes in the community. Through these comprehensive and collaborative efforts, Ballad Health is committed to making meaningful and lasting improvements in community health.
Facility Reporting Group - A 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) 2024

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?6
Name and address		Type of Facility (describe)
1	1 - MSHA dba BH Homecare-Johnson City 509 Med Tech Parkway Ste 200 Johnson City,TN37604	Licensed Home Health Agency
2	2 - MSHA dba BH Homecare-Abingdon 611 Campus Dr Ste 300 Abingdon,VA24210	Licensed Home Health Agency
3	3 - MSHA dba BH Homecare-Greeneville 1410 Tusculum Blvd Ste 1600 Greeneville,TN37745	Licensed Home Health Agency
4	4 - MSHA dba BH Homecare-Norton 96 15th St NW Ste 104A Norton,VA24273	Licensed Home Health Agency
5	5 - MSHA dba BH Hospice-Bristol 280 Steeles Road Bristol,TN37620	Licensed Hospice Agency
6	6 - MSHA dba BH Hospice-Abingdon 611 Campus Dr Ste 500 Abingdon,VA24210	Licensed Hospice Agency
7
8
9
10

Schedule H (Form 990) 2024

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:	Financial assistance approval can apply to an assortment of patients such as those who have exhausted their Medicaid/TennCare benefits, those who qualified for Medicaid/TennCare after the date of service, deceased patients with no estate or assets, uninsured patients, and underinsured patients. While Ballad Health's qualifications for financial assistance is based on federal poverty guidelines, asset values may also be used to determine financial assistance eligibility. Unique circumstances may be assessed on a case-by-case basis. Charity approval covers current or active patient balances when they are approved and there is no limitation or cap on the amount of charity that a patient may receive. Ballad Health hospitals do not stop approving financial assistance for patient accounts if a hospital's charity write-offs exceed the hospital's charity budget.All Ballad Health hospitals provide an uninsured discount; the current uninsured discount is 85% for all acute facilities and 77% for all critical access facilities. 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:	The cost to charge ratio (worksheet 2 "ratio of patient care cost to charges") was used to calculate line 7a financial assistance at cost, which includes charity and uninsured discounts. MSHA's cost accounting system was used to report Tenncare and Medicaid 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 MSHA's 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. MSHA's 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. Ballad Health 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 services, MSHA's 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 small clinic inside Johnson County Community Hospital (JCCH), a federally designated critical access hospital, is subsidized by JCCH and the clinic's departmental operating report is used to compute the clinic's community benefit. The second exception is a palliative care program. For this program, the department's operating report is used. Although there are other service lines within MSHA hospitals that incur losses, MSHA does not report services that hospitals are required by state licensure to provide, routine services or ancillary services. Line 7g also includes $50,380,028 of actual cost MSHA incurred that is attributable to physician clinics. Services are being subsidized at these clinics in order to maintain access and service in rural areas that would otherwise be unavailable to the community or below the community's need if not provided. MSHA is careful to ensure no double counting of costs. 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 II, Community Building Activities:	MSHA 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, offers assistance with coordination, advocacy, or contributes 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.During FY25, MSHA provided funds to the Lee County Board of Supervisors to support funding of a local basketball court, Jonesborough's Farm to Table Program, the Johnson City Chamber Foundation to support the National Civics Program for middle schools, and to the Boys and Girls Club of Elizabethton in support of their Great Futures Program, along with other contributions for community building projects.
Part III, Line 2:	Self-pay balances include accounts after payments and contractual adjustments (discounts) have been applied from all third-party payors 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 Health's system-wide self-pay policy, any patient who has no insurance and is ineligible for any government assistance program received an 85% discount, with the exception of critical access hospitals, where it is 77%. 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:	Ballad Health estimates that approximately 5% of MSHA's bad debt would have qualified for financial assistance if patients had provided a financial assistance application and required documentation. Pursuant to the merger, 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 individual's 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 MSHA believes 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 our program. Without a completed application, these are recorded as bad debt instead of charity care.
Part III, Line 4:	Ballad Health's audited financial statements include a footnote on page 15 that describes bad debt. MSHA is included in the June 30, 2025 audited financial statements of Ballad Health (attached).
Part III, Line 8:	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.
Part III, Line 9b:	Requests for financial assistance are evaluated using established guidelines, while allowing for unique financial circumstances - for example, medically indigent patients with catastrophic medical costs that would threaten the patient's household financial viability. When a patient requests financial assistance or when an application has been received, the patient's account is placed in a hold status to prevent further collection activities until financial assistance eligibility is determined. All Ballad Health hospitals comply with IRS 501(r) regulatory guidelines.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 payors and will make attempts to work with these payors 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 the Ballad Health financial assistance policy.
Part VI, Line 2:	Ballad Health and its hospitals have pledged to improve the health of our service area counties by focusing on access, quality and population health measures. These metrics enable Ballad Health to collaborate with our communities and address the region's health disparities and access challenges. Through the Community Health Needs Assessment (CHNA) process, we have gained valuable insights into the health disparities within our communities and prioritized the most pressing issues in each hospital's service area. This collaborative approach helps us educate and drive meaningful change, ensuring better health outcomes for all.The community health needs assessment identified chronic disease, behavioral and mental health, and obesity and overweight as the top three health priorities for the hospital service area. These issues emerged as the most pressing health concerns based on data from various sources, including local perspectives and community surveys. Addressing these critical areas allows us to focus efforts on improving overall health outcomes and quality of life in the region.
Part VI, Line 3:	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. MSHA is also happy to mail all documents to patients and offers a plain language summary. 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:	MSHA serves the healthcare needs of 29 Appalachian counties in Northeast Tennessee, Southwest Virginia, Southeast Kentucky, and Northwest North Carolina. All of the counties MSHA serves are federally designated as medically underserved areas. MSHA's largest hospital, Johnson City Medical Center, is a tertiary referral center and level one trauma center. 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: Johnson County Community Hospital in Tennessee and Lee County Community Hospital in Virginia.Additionally, according to County Health Rankings, counties where MSHA hospitals are located consistently rank poorly for both health outcomes and health factors.
Part VI, Line 5:	MSHA is dedicated to operating efficiently so that waste is minimized. MSHA's 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 and universities receive training and experience in MSHA hospitals. MSHA resources are devoted to health conferences for local health professionals, 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 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:	Mountain State's 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 Health's 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 MSHA's 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 Johnson County Community Hospital and Lee County Community Hospital. JCCH and LCCH receive certification through the states of Tennessee and Virginia since they are critical access hospitals. MSHA, based in Johnson City, Tennessee includes 8 wholly owned hospitals which are included in this Form 990. In addition, MSHA owns 2 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 our 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. ISHN also operates Appalachian Highlands Clinically Integrated Network, a Clinical Integration Program that supports and encourages the delivery of quality health care services. Hospitals in the Ballad Health system work closely with one another to share expertise and resources.
Part VI, Line 7, Reports Filed With States	TN,VA
Part VI, Additional Information	Ballad Health is required to report community benefit estimates on a quarterly basis with the states of Tennessee and Virginia. The reporting includes all of Ballad's hospital organizations and is reported using IRS Form 990, Schedule H instructions for reporting community benefit. Ballad operates under a Cooperative Agreement (CA) in Virginia and a Certificate of Public Advantage (COPA) in Tennessee as obligated by agreements between Ballad and the two states to allow Mountain States Health Alliance and Wellmont Health System to merge.

Schedule H (Form 990) 2024

Additional Data

Software ID:
Software Version:

- TIN:

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

Schedule I
(Form 990)
(Rev. January 2025)

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 instructions and the latest information.

OMB No. 1545-0047

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	(h) Purpose of grant or assistance
(1) Appalachian Service Project 4523 Bristol Highway Johnson City,TN37601	62-0989383	501c3	10,000	Substandard Housing Program
(2) Dawn of Hope Inc 500 East Unaka Avenue Johnson City,TN37601	62-0798776	501c3	10,000	Program Support
(3) East Tennessee State University PO Box 70732 Johnson City,TN37614	62-6021046	501c3	11,000	Pediatrics Conference
(4) East Tennessee State University Foundation PO Box 70721 Johnson City,TN37614	23-7092731	501c3	96,320	Program Support-Center for Nursing Excellence
(5) East Tennessee State University PO Box 70732 Johnson City,TN37614	62-6021046	501c3	470,000	Program Support-College of Pharmacy
(6) East Tennessee State University PO Box 70732 Johnson City,TN37602	62-6021046	501c3	174,753	Research Grants
(7) Johnson County Board of Education 2110 N Church Street Mountain City,TN37683	62-6000688	501c3	18,000	Program support for children in the court system
(8) Kingsport Chamber Foundation 400 Clinchfield St Ste 100 Kingsport,TN37660	58-1453565	501c3	10,000	Program Support
(9) Make-A-Wish East Tennessee 6700 Baum Drive Ste 7 Knoxville,TN37919	58-1799549	501c3	20,000	Program Support
(10) Salvation Army PO Box 1715 Johnson City,TN37605	58-0660607	501c3	30,000	Red Kettle Drive
(11) Washington County Board of Education 405 West College Street Jonesborough,TN37659	62-6000899	501c3	9,000	Program support for children in the court system
(12) Zoll Medical Corporation PO Box 27028 New York,NY10087	04-2711626		192,416	Defibrillators for Unicoi County EMS
(13) Bristol Motor Speedway 151 Speedway Boulevard Bristol,TN37620	62-1016760	501c3	50,000	Children's Charities
(14) Up & At 'EM Inc PO Box 44 Johnson City,TN37605	47-3088983	501c3	15,000	Fitness Program

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) Rev. 1-2025

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

Part I, Line 2:

The Ballad Health Community Benefit and Population Health Committee is a collective group of members from both Tennessee and Virginia. These members bring a variety of insights into community health improvement, striving to cultivate an understanding of population health, community benefit obligations, and the integral role that Ballad Health plays in enhancing health access. Senior leadership of Ballad Health, including the President and CEO and the COO, are present at these meetings. One of the committee's key duties is to ensure that charitable donations are in line with the policies set by the Ballad Health Board. All applications for assistance are completed with the necessary information to assess eligibility, and reviewed and approved by an administrative committee which includes members from the Community Benefit and Population Health Committee. In addition, community health improvement applications and recommendations are reviewed by the Community Benefit and Population Health Committee annually. Following a thorough review of all applications, approval must be obtained from various levels, including the Ballad Health CEO or the Ballad Health Board, depending on the level of commitment required. For those seeking funding for a specific event or program, the application should include the following details: -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) Rev. 1-2025

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

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 .....

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) (Rev. 1-2025)

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, 1099-MISC compensation, and/or 1099-NEC			(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 PresCEO Director, Chair	(i) (ii)	0 ------------- 1,520,581	0 ------------- 2,128,611	0 ------------- 199,684	0 ------------- 253,530	0 ------------- 32,616	0 ------------- 4,135,022	0 ------------- 0
2Eric Deaton BH EVPCOO Director	(i) (ii)	0 ------------- 894,611	0 ------------- 604,644	0 ------------- 248,443	0 ------------- 110,198	0 ------------- 27,202	0 ------------- 1,885,098	0 ------------- 0
3Clay Runnels MD - BH EVP Chief Phys Exec - Former Officer	(i) (ii)	0 ------------- 797,671	0 ------------- 541,155	0 ------------- 36,700	0 ------------- 100,731	0 ------------- 30,397	0 ------------- 1,506,654	0 ------------- 0
4Marvin Eichorn BH EVPCAO Director	(i) (ii)	0 ------------- 805,288	0 ------------- 598,349	0 ------------- 42,074	0 ------------- 20,040	0 ------------- 33,503	0 ------------- 1,499,254	0 ------------- 0
5Lynn Krutak Former Officer	(i) (ii)	0 ------------- 414,747	0 ------------- 526,405	0 ------------- 160,110	0 ------------- 53,781	0 ------------- 22,403	0 ------------- 1,177,446	0 ------------- 0
6Shane Hilton BH EVP/CFO	(i) (ii)	0 ------------- 615,030	0 ------------- 366,316	0 ------------- 6,817	0 ------------- 80,643	0 ------------- 32,416	0 ------------- 1,101,222	0 ------------- 0
7Julie Bennett CLOGovnc Offcr Director, Secretary	(i) (ii)	0 ------------- 564,044	0 ------------- 403,122	0 ------------- 9,523	0 ------------- 78,804	0 ------------- 23,482	0 ------------- 1,078,975	0 ------------- 0
8Lisa Carter Regional President	(i) (ii)	516,690 ------------- 0	327,553 ------------- 0	41,517 ------------- 0	72,481 ------------- 0	28,238 ------------- 0	986,479 ------------- 0	0 ------------- 0
9Mark Wilkinson MD CMO Dig Hlth Former Highest Compensated	(i) (ii)	0 ------------- 464,142	0 ------------- 136,319	0 ------------- 22,271	0 ------------- 68,267	0 ------------- 30,717	0 ------------- 721,716	0 ------------- 0
10Joshua McFall CFO CorpRetail Former Key Employee	(i) (ii)	0 ------------- 391,342	0 ------------- 114,510	0 ------------- 18,504	0 ------------- 60,380	0 ------------- 32,862	0 ------------- 617,598	0 ------------- 0
11Matthew Loos Chief Acad Offcr Former Highest Compensated	(i) (ii)	0 ------------- 422,435	0 ------------- 105,608	0 ------------- 20,541	0 ------------- 20,171	0 ------------- 33,955	0 ------------- 602,710	0 ------------- 0
12David Wild MD Regional CMO	(i) (ii)	409,297 ------------- 0	102,610 ------------- 0	9,839 ------------- 0	20,053 ------------- 0	31,576 ------------- 0	573,375 ------------- 0	0 ------------- 0
13Kenneth Shafer CEO - JCMC	(i) (ii)	394,990 ------------- 0	99,338 ------------- 0	3,611 ------------- 0	20,639 ------------- 0	32,931 ------------- 0	551,509 ------------- 0	0 ------------- 0
14Andrew Wampler BH SVPGen Cnsl Former Officer	(i) (ii)	0 ------------- 320,716	0 ------------- 93,811	0 ------------- 49,530	0 ------------- 52,740	0 ------------- 25,147	0 ------------- 541,944	0 ------------- 0
15Melanie Stanton CEO - FWCH	(i) (ii)	311,933 ------------- 0	79,209 ------------- 0	46,643 ------------- 0	18,454 ------------- 0	32,918 ------------- 0	489,157 ------------- 0	0 ------------- 0
16Christopher Jett CEO - NsCH	(i) (ii)	289,449 ------------- 0	148,566 ------------- 0	1,785 ------------- 0	17,976 ------------- 0	30,923 ------------- 0	488,699 ------------- 0	0 ------------- 0
17Frank Canova Regional CFO	(i) (ii)	322,518 ------------- 0	80,435 ------------- 0	14,068 ------------- 0	18,594 ------------- 0	26,534 ------------- 0	462,149 ------------- 0	0 ------------- 0
18Tim Belisle Former Officer	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 448,129	0 ------------- 0	0 ------------- 0	0 ------------- 448,129	0 ------------- 448,129
19Eric Carroll CEO Greene Co Former Highest Compensated	(i) (ii)	284,100 ------------- 0	66,847 ------------- 0	11,752 ------------- 0	18,020 ------------- 0	26,554 ------------- 0	407,273 ------------- 0	0 ------------- 0
20Lemmie Taylor CEO - SSH	(i) (ii)	263,585 ------------- 0	66,006 ------------- 0	19,682 ------------- 0	29,647 ------------- 0	15,060 ------------- 0	393,980 ------------- 0	0 ------------- 0
21Morgan May VP System Nursing Operations	(i) (ii)	274,478 ------------- 0	68,574 ------------- 0	13,248 ------------- 0	10,630 ------------- 0	26,245 ------------- 0	393,175 ------------- 0	0 ------------- 0
22Dwight Owens VP Oncology Services	(i) (ii)	264,784 ------------- 0	49,688 ------------- 0	30,017 ------------- 0	16,089 ------------- 0	28,980 ------------- 0	389,558 ------------- 0	0 ------------- 0
23Chase Wilson CFO JCMC Former Key Employee	(i) (ii)	215,985 ------------- 0	42,665 ------------- 0	11,513 ------------- 0	13,857 ------------- 0	30,327 ------------- 0	314,347 ------------- 0	0 ------------- 0
24Alison Johnson CNO - JCMC	(i) (ii)	189,590 ------------- 0	48,035 ------------- 0	15,871 ------------- 0	8,431 ------------- 0	27,427 ------------- 0	289,354 ------------- 0	0 ------------- 0
25Preethi Manappetty RN	(i) (ii)	271,268 ------------- 0	0 ------------- 0	33 ------------- 0	0 ------------- 0	0 ------------- 0	271,301 ------------- 0	0 ------------- 0

Schedule J (Form 990) (Rev. 1-2025)

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 4b

The following executives listed in Schedule J, Part II participated in a 457(f) retirement plan provided by Ballad Health (BH). The 457(f) plan is a nonqualified tax-deferred compensation plan available to a select group of key executives for the intent of supporting retention and to offer a competitive total retirement program. Account balances have a "substantial risk of forfeiture". In addition to creditor risk, substantial risk of forfeiture is created through default risk if the participant's employment with Ballad Health is terminated prior to age 65. However, the 457(f) plan contains a non-compete provision that provides the account balance to be paid in a lump sum after the executive satisfies the two-year non-compete period. This provision applies to employer contributions if the executive has provided eligible service for six or more years. The executive will receive the entire account balance if he/she becomes disabled, dies or if the executive terminates for "good reason or is involuntarily terminated without "good cause" within a 24-month period after a change-of-control occurs. Distributions from this plan are subject to federal, state, and local taxes on the entire account balance upon distribution. Alan Levine $233,490 Eric Deaton $ 90,158 Clay Runnels $ 80,691 Shane Hilton $ 60,603 Julie Bennett $ 56,613 Lisa Carter $ 52,441 Mark Wilkinson $ 47,433 Joshua McFall $ 40,625 Lynn Krutak $ 38,666 Andrew Wampler $ 32,739 Lemmie Taylor $ 13,511 Upon meeting the Substantial Risk of Forfeiture provisions of the Ballad Health 457(f) Plan mentioned above, the following former executive received his deferred compensation plan balance during the year. Timothy Belisle $448,129

Schedule J (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)
(Rev. January 2025)

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.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

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. ........................... $

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

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) (Rev. 1-2025)

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	10,436	See Part V		No

Part V

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

Return Reference	Explanation
Part IV, Supplemental Information	Alan Levine, President and CEO of the Ballad Health/Mountain States Health Alliance Board of Directors, is a family member of Laura Levine, an employee of Mountain States Health Alliance.

Schedule L (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)
(Rev. January 2025)
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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public
Inspection

Name of the organization

Mountain States Health Alliance

Employer identification number

62-0476282

Return Reference	Explanation
Part III, Program Service Accomplishments	Ballad Health (Ballad) is an integrated healthcare delivery system consisting of 20 hospitals in Northeast Tennessee and Southwest Virginia, including a Level 1 Trauma Center, dedicated children's hospital, several community hospitals, four critical access hospitals, a behavioral health hospital, an addiction treatment facility, long-term care facilities, home care and hospice services, retail pharmacies, outpatient services and a comprehensive medical management corporation. Ballad works closely with an active independent medical community and community stakeholders to improve the health and well-being of over one million people in 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky. Ballad is a Tennessee non-profit corporation and is the main provider of healthcare services in Northeast Tennessee and Southwest Virginia. Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). On February 1, 2018, Ballad was formed through a merger of two legacy systems, Mountain States Health Alliance and Wellmont Health System. Ballad was formed under state-action immunity in compliance with federal antitrust law, to create a healthier region and keep healthcare local. The action approving the merger was officially taken through the agreements made between Ballad and the State of Tennessee in the Certificate of Public Advantage (the "COPA") and the Letter Authorizing the Cooperative Agreement (the "CA") in Virginia. Pursuant to the COPA and CA, Ballad must fulfill certain obligations, commitments, and covenants. Tennessee and Virginia, through their respective health departments, supervise specific aspects of Ballad's operations under certain conditions of the COPA and the CA. The COPA and amendments are publicly available on the website of the Tennessee Department of Health, at https://www.tn.gov/health/copa.html. The Cooperative Agreement is available on the website of the Virginia Department of Health, at https://www.vdh.virginia.gov/licensure-and- certification/cooperative-agreement/. Form 990 for Mountain States Health Alliance (MSHA) includes eight wholly owned hospitals including a tertiary hospital, a children's hospital and a behavioral health hospital; two others, wholly 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: 42,447 inpatients 617,000 outpatient visits 174,227 emergency visits 3,627 deliveries 27,291 surgeries 98,447 home health visits
WASHINGTON COUNTY, TN: JOHNSON CITY MEDICAL CENTER (JCMC)	- Located in Johnson City, Tennessee and serving the community since 1911. The 585-bed regional tertiary referral center has 416 beds dedicated to acute care, 85 beds for children and 84 beds for behavioral. - Provides a wide array of acute care services, including a complete range of cardiovascular, neurology, oncology, surgical and rehabilitation services. JCMC is a comprehensive, acute-care teaching hospital affiliated with James H. & Cecile C. Quillen College of Medicine at East Tennessee State University (ETSU). - Region's only Level I trauma center, one of only five in Tennessee, with 24/7 orthopedic traumatologist specialist coverage. - Region's only safety net hospital. - Regional Cancer Center at JCMC has relationships with Harvard, Duke, and Vanderbilt universities. - Niswonger Children's Hospital (NsCH) is a hospital within a hospital located on the campus of JCMC. NsCH is the only children's hospital in northeast Tennessee and serves more than 200,000 children in the four state, 29-county region. NsCH has more than 20 pediatric subspecialties providing specialty care through a pediatric emergency room and 85 inpatient beds, including a 16-bed neonatal abstinence syndrome unit. The Level III designated neonatal intensive care unit is only one of five state-designated tertiary centers for high-risk maternal fetal care in Tennessee and is the regional referral center for neonatal patients. A Ronald McDonald House is located on the campus and provides services to pediatric patients and family members. In October 1999, a clinical affiliation was entered with St. Jude's Children's Research Hospital to provide pediatric cancer and other catastrophic disease treatment services. The affiliation with St. Jude's is one of only eight in the country. The First Regional Hemophilia Program, a state sponsored program for congenital bleeding disorders, is housed in the St. Jude affiliate clinic and provides programs for both children and adults with hemophilia. - Woodridge Hospital, a free-standing 84-bed behavioral health hospital located across the street from JCMC, provides mental health and chemical dependency services for adults, adolescents, and children in Northeast Tennessee and Southwest Virginia. Woodridge is the only dedicated inpatient behavioral health hospital in the region and provides a 24/7 intervention helpline. In 2023, Woodridge opened a new access point for behavioral healthcare with a 24/7 walk-in behavioral crisis clinic for patients experiencing behavioral health emergencies, such as suicidal or homicidal ideation, acute psychosis, auditory and/or visual hallucinations and other extreme mental or emotional crises.
WASHINGTON COUNTY, TN: FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH)	- 80-bed acute care hospital located in Johnson City, Tennessee and providing services since 2010. - Provides specialty and subspecialty care, including general acute medical, maternity, comprehensive diagnostic imaging, emergency services and advanced surgical services, including minimally invasive robotic surgery. - FWCH was the first "Leadership Energy and Environmental Design" (LEED) certified hospital in Tennessee.
SULLIVAN COUNTY, TN: INDIAN PATH COMMUNITY HOSPITAL (IPCH)	- 239-bed acute care hospital located in Kingsport, Tennessee serving the community since 1984. - Provides general medical and surgical services, including the Center for Women and Babies, various outpatient services, including advanced services such as the lung nodule clinic, a regional cancer center, and a sleep center. - IPCH opened the third Niswonger Children's Network Pediatric Emergency department in 2023, strengthening the system of care for children by joining Niswonger Children's Hospital in Johnson City and the J.D. Nicewonder Family Pediatric Emergency Department at Bristol Regional Medical Center.
CARTER COUNTY, TN: SYCAMORE SHOALS HOSPITAL (SSH)	- 121-bed acute care facility located in Elizabethton, Tennessee providing services to the community since 1955. - Provides inpatient, geropsychiatric, and outpatient care for medical and surgical patients.
JOHNSON COUNTY, TN: JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH)	- Federally designated critical access hospital located in Mountain City, Tennessee serving residents of upper Northeast Tennessee, parts of western North Carolina and Southwest Virginia since 1998. - Provides inpatient, emergency and outpatient care along with cardiac rehabilitation, diagnostic, and physical therapy services.
RUSSELL COUNTY, VA: RUSSELL COUNTY HOSPITAL (RCH)	- 78-bed Medicare dependent hospital located in Lebanon, Virginia. - Included in the 78-bed complement, is a 20-bed inpatient psychiatric unit. RCH offers a full array of primary care services and some specialty services, including a cancer center.
UNICOI COUNTY, TN: UNICOI COUNTY HOSPITAL (UCH)	- 10-bed acute care hospital, located in Erwin, Tennessee and providing services since 2018. - Provided general acute inpatient, emergency, cardiology, diagnostic imaging, sleep lab, and rehabilitation services. - Hurricane Helene and flooding impacts associated with the storm permanently destroyed the location on September 27, 2024. Ballad Health continues to work on the long-term rebuilding of this facility to offer sustainable care to the community.
LEE COUNTY, VA: LEE COUNTY COMMUNITY HOSPITAL (LCCH)	- 10-bed critical access hospital located in Pennington Gap, Virginia providing services since 2021 to residents of Southwest Virginia and Southeast Kentucky. - LCCH was specially designed to meet the needs of its community, with acute and emergency services, diagnostic radiology and lab services, outpatient cardiology and additional rotating clinics for specialty care and telehealth access. Ballad Health is in its seventh full year of operation under active supervision by the State of Tennessee and the Commonwealth of Virginia. Fiscal Year 2025 was marked by resilience, innovation, and a deepened commitment to improving health outcomes across Northeast Tennessee and Southwest Virginia. Throughout the period, Ballad Health continued to maintain and expand access to essential care and services, delivering high quality care, and reducing the cost of care for the people we are entrusted to serve. Over the past seven years, Ballad Health has made significant strides in regional healthcare. The organization successfully reopened a previously closed hospital in Southwest Virginia, invested capital in critical infrastructure, expanded services where needed, and consolidated others where appropriate. We met the challenges of a global pandemic that claimed thousands of lives in our region and severely disrupted hospital operations. We coordinated care in the wake of Hurricane Helene and its devastating aftermath and worked closely with both the Tennessee Department of Health and Virginia Department of Health to respond to the evolving needs of the region. Notable examples include investments in mental health services, the opening of high-quality childcare centers, the creation of the Quillen Center for Urological Services, and the launch of a new dental clinic that has served thousands of uninsured Virginians. Ballad Health has achieved these milestones while navigating national challenges, often responding faster and more effectively than other well-regarded hospitals and health systems. Similarly, our emergency department performance outpaces other peer hospitals on publicly reported metrics. Furthermore, a recent independent evaluation of physician access revealed that, while the rest of the nation has experienced a decline in physician supply, Ballad Health's rural region has either maintained or improved access in many specialties. In FY25, Ballad Health continued to demonstrate its commitment to improving the health of the Appalachian Highlands region through investments in its people, COPA Plan spending commitments, and capital. These investments included: - Partnering with the Tennessee Center for Nursing Advancement, the ETSU Research Corporation, East Tennessee State University (ETSU) College of Nursing, and StoryCollab on the Nursing Narrative Initiative. This project highlights the voices and experiences of nurses across the region, aiming to inspire future professionals and support current staff through storytelling and reflection. Additionally, investing in Ballad Health team members by launching B Excellent to strengthen our culture through continuous learning, skill-building, and team member engagement. - More than $65 million in new investments for rural health, behavioral health, children's health, population health, health research and graduate medical education, and health information exchange. - Capital spend of over $128 million, the highest level in our history. This included investments in new diagnostic and treatment technology, equipment upgrades, facility improvements, information technology, and the continued expansion of Niswonger Children's Hospital.
Hurricane Helene	Hurricane Helene tragically struck on September 27, 2024, causing catastrophic flooding throughout the Appalachian Highlands. Floodwater from Hurricane Helene permanently destroyed Unicoi County Hospital and caused significant disruption to several other facilities. At Greeneville Community Hospital, Sycamore Shoals Hospital, Johnson County Hospital and Laughlin Healthcare services had to be suspended and patients relocated due to flood-related damage and safety concerns. Thanks to Ballad Health's integrated system, coordinated emergency response, and the dedication of our team members, all patients were safely evacuated to other facilities. In response, Ballad Health quickly established a 24/7 advanced urgent care clinic in Erwin, Tennessee, to ensure continued access to critical healthcare services for the community.
Strengthening Rural Access Through Strategic Workforce Planning	Ballad Health is taking a proactive approach to protecting care in rural Appalachia. To guide this effort, Ballad Health engaged a nationally recognized healthcare consulting firm to conduct a detailed provider needs assessment. This process closely examines the supply and demand for physicians and advanced practice providers in the region and helps guide recruitment where shortages are most severe, and ensures we meet federal requirements. Nationally, the projected shortage of primary care physicians by 2030 ranges from 27,300 to 40,300, according to the Association of American Medical Colleges (AAMC) and other workforce studies. This makes Ballad Health's forward-looking strategy especially critical for rural regions. Since 2018, Ballad Health has recruited more than 800 providers to help close important gaps across the region. Between 2022 and 2025, general primary care adequacy improved from 62% to 72%, and 8 of 12 specialties also showed measurable progress. Ballad Health's access and quality metrics now outperform many national peers. Only 1% of emergency room patients leave before being seen, compared to 6 to 8% at other emergency rooms. Discharge times are up to 100 minutes faster than leading academic medical centers and sepsis care compliance ranks among the best in the country.
Quality of Care - Recognition from Independent Organizations:	Ballad Health hospitals achieved national recognition for quality and safety from several respected national organizations, including U.S. News & World Report, the American Medical Association, and the American Heart Association. The Blue Cross and Blue Shield Association designated multiple Ballad Health hospitals as "Blue Distinction Centers" in service areas such as cardiology, hip and knee replacement, and maternity care. In addition, they highlight only five hospitals in Tennessee as "Blue Distinction Centers in Quality and Value" for cardiology services, with two of the five hospitals being Ballad Health facilities.
Leading Innovation in Physician Well-Being	Ballad Health Medical Associates has earned bronze-level national recognition from the American Medical Association as a Joy in Medicine Health System organization for taking meaningful steps to address physician burnout and promote well-being across the Appalachian Highlands. Ballad Health Medical Associates is the only organization in Tennessee to receive Joy in Medicine recognition for the 2025-2026 cycle, with only four organizations in Virginia achieving this distinction.
Cardiovascular Excellence Continues to Set National Standards	Holston Valley Medical Center continues to lead the nation in cardiovascular care, cementing Ballad Health's reputation as a destination for exceptional cardiac treatment. For 2025, Healthgrades named Holston Valley one of America's 50 Best Hospitals for Vascular Surgery for the sixth consecutive year and ranked it No. 1 in Tennessee for vascular surgery. Holston Valley also earned the Vascular Surgery Excellence Award and received five-star ratings for several critical procedures, including abdominal aorta repair, carotid surgery (achieving this distinction for the 16th year in a row), and peripheral vascular bypass. Holston Valley and Bristol Regional Medical Center earned the Platinum Performance Achievement Award from the American College of Cardiology (ACC) for excellence in heart attack care through the chest pain - MI Registry. Johnston Memorial Hospital received the Silver Performance Achievement Award, recognizing its commitment to evidence-based care and improved outcomes for patients experiencing acute myocardial infarction. These honors reflect the dedication of Ballad Health's clinical teams to consistently deliver high-quality, guideline-driven care that improves survival rates and long-term outcomes for heart patients across the Appalachian Highlands. This recognition reflects Ballad Health's commitment to creating a supportive and efficient work environment for physicians and advanced practice providers, an essential strategy for improving care quality and access in rural communities. These results show Ballad Health's commitment to listening to our communities, recruiting where it matters most, and building the strong healthcare workforce the Appalachian Highlands relies on.
Recognition Spanning Our Entire Health System	U.S. News & World Report 2025-2026 National and Regional Distinctions: - Holston Valley Medical Center was named a "Best Regional Hospital and ranked No. 9 in Tennessee, earning "high performing distinctions in 10 different clinical areas. - Bristol Regional Medical Center, Indian Path Community Hospital, and Johnson City Medical Center were recognized for excellence in cardiac, pulmonary, and surgical care. - Specific clinical honors include high-performance ratings in hip fracture and hip replacement care, gynecological cancer treatment, aortic valve surgery, abdominal aortic aneurysm repair, pacemaker implantation, pneumonia care, spinal fusion, colon cancer surgery, transcatheter aortic valve replacement, and diabetes care.
Charity Care Update	Ballad Health maintained increased patient eligibility for charity care at 225% of the federal poverty guidelines (up from 200% before the merger in 2018). In FY25, Ballad Health provided over $65 million for charity care, the highest since its formation. Notably, the weighted average median household income in the region is approximately $51,000 with some communities falling below that level. Ballad Health's threshold for free charity care for a family of 2.5 people is approximately $54,000 based on 225% of the Federal Poverty Level. This positions Ballad Health as having one of the most generous charity care policies in the nation. Ballad Health continued its efforts to reduce the number of preventable hospitalizations and emergency department visits. Ballad Health also remained committed to advancing value-based initiatives, such as the Appalachian Highlands Care Network (AHCN). The AHCN connects uninsured patients and their families with free or low-cost clinics, dental services, financial counseling, and preventative care services. The AHCN is recognized as a national model for partnership programs between a health system and local organizations, outpatient clinics and providers working together to deliver a more supportive system of care for the uninsured population. These efforts to provide cost efficient care benefit the taxpayers, patients, and hospitals. By the end of the period, the AHCN had enrolled over 11,100 uninsured individuals, demonstrating its growing impact across the Appalachian Highlands. Progress in Target Areas Ballad Health achieved improvements in the target areas of expanding access to care, improving quality of care, and lowering the cost of care. I. Access to Care & Population Health Access to Care Metrics: Ballad Health achieved improvements in 20 of 25 access measures over the pre-merger baseline. Notable areas of improvement since FY24 include appropriate emergency department wait times, asthma emergency department visits, diabetes screening, and rate of SBIRT administration during emergency department visits. The virtual urgent care platform is available 24/7 and accessible via smartphone or internet, and Ballad Health is the only regional provider offering this service. II. Improving Quality of Care, Patient Experience & Staff Experience a. Quality of Care Metrics: Ballad Health publishes its quality data on its website. The currently reported baselines are pre-COVID. Notable highlights include the following: i. Ballad Health improved in 10 of the 17 target measures for FY25 using the pre-COVID baselines. ii. Emergency Department throughput metrics have shown improvement. Notably, OP22 Left Without Being Seen decreased by 33.8% compared to FY24. The median time from ED arrival to transport for admitted patients and the ED2b ED Decision to Transport (ED1) also improved. iii. Ballad Health implemented a standardized mortality case review process, supported by predictive analytic tools to help caregivers identify and act on early signs of deterioration. These efforts contributed to measurable reductions in mortality from FY23 to FY25, across various conditions, including Heart Failure (25%), Pneumonia (18%), and Sepsis (14%). iv. Among the hospital infection indicators, Ballad Health is performing as expected or meeting the measure in all but one measure when using the Centers for Disease Control and Prevention's recommended adjustment methodology accounting for differences in patient population. b. Clinical Council: The Clinical Council (the Council) is aligned with the Ballad Health Board of Directors and the Board's Quality, Service and Safety Committee (QSSC). During FY25, the Council was comprised of 27 physicians from many backgrounds and specialties. Of those physicians, nearly half were independent. The Council continued to assist in establishing key quality and patient safety priorities with consideration to risk, volume, propensity for problems (including incidence, prevalence, and severity), impact on health outcomes, patient safety and quality across all areas of care. Key accomplishments in FY25 included: i. enhancements in electronic health record workflows, ii. standardization of a variety of high-value care initiatives, iii. implementation of projects for provider wellbeing and workforce support, iv. updates to medication use processes, and v. improvements to children's and women's care standards. c. Patient Experience: In the aggregate, 90% of patients surveyed by Press-Ganey, the nation's most credible firm for tracking patient and employee experience, would recommend Ballad Health's hospitals. In some Ballad Health hospitals, that number reaches as high as 97%. While emergency department wait times remain a concern, it should be noted that the metrics for Ballad Health outperform national averages, and some of America's, Tennessee's, and Virginia's most well-respected health systems in areas such as patients who leave without being seen, time from presentation to discharge, and sepsis care. III. Lowering Cost of Care Ballad Health and community physicians continue to reduce the cost of care to patients, employers, and government payors through value-based care. a. Price Transparency: Ballad Health continued to meet the Centers for Medicare & Medicaid Services hospital price transparency requirements under section 2718(e) of the Public Health Service Act. As such, Ballad Health's gross charges, discounted cash prices, payer-specific negotiated rates, and de-identified minimum and maximum negotiated rates for all hospital items and services as well as a consumer-friendly estimator tool and other pricing information are publicly available on its website. b. Cost-Efficiency Measures: According to countyhealthrankings.org, Ballad Health and community physicians have reduced preventable hospitalizations in our region by 50% since 2017. This has resulted in over $200 million of annual recurring savings to taxpayers, employers, and patients. Our region's preventable hospitalization rate is as low, or lower than, communities like Nashville - a stunning result given the magnitude of resources available in those communities. In FY25, Ballad Health saw more than $45 million (for projects greater than $200,000) in savings due to cost-efficiency measures taken across the areas of contract labor, supplies, and pharmacy efficiency. Through the work of the AHCN, Ballad Health has helped reduce preventable hospitalizations for the uninsured population, reducing the cost to taxpayers of charity care, and improving patient safety by avoidance of hospitalization.
Part IV, Line 24a and Part X, Line 20 - Tax Exempt Bonds	The tax exempt bond liability reflects the portion of bonds issued by Ballad Health, MSHA's parent organization, on behalf of MSHA for capital needs. MSHA pays all costs related to this portion of the bond issue.
Form 990, Part V, line 1a	Ballad Health (BH), MSHA's parent organization, files Form 1096 on a consolidated basis for all subsidiaries that are required to file Forms 1099-MISC/NEC. MSHA reimburses BH for all expenses related to vendor payments and the expenses are recorded on MSHA's books.
Form 990, Part VI, Section A, line 6	Line 6 explanation - Mountain States Health Alliance is a Tennessee non-stock, nonprofit organization with Ballad Health as its sole member.
Form 990, Part VI, Section A, line 7a	Line 7a explanation - 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, Section A, line 7b	Line 7b explanation - 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, Section B, line 11b	Line 11b Explanation - 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 organization's 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, Section B, line 12c	Ballad Health policy requires Board of Directors and Board Committee members, the Executive Chair/President, and Executive Vice Presidents to complete a conflict of interest disclosure statement on an annual basis. Ballad Health policy also requires team members to complete an annual acknowledgement that they have read and understand the conflict of interest policy and they will complete a conflict of interest disclosure statement if they have a conflict of interest. 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. This applies to all Ballad Health organizations.
Form 990, Part VI, Section B, line 15	Line 15a - Compensation Process for Top Official The executive compensation committee serves as the compensation oversight committee of Ballad Health's 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 Health's 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. Line 15b - Compensation Process for Officers On an annual basis, Ballad Health's Human Resources (H/R) Department evaluates compensation for all executives at a position level of Assistant Vice President and above. H/R's evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on this comparable data, Ballad Health's 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.
Form 990, Part VI, Section C, line 19	Governing documents and conflict of interest policy are made available upon request to the appropriate parties requesting them. Financial statements are made available upon request to appropriate parties requesting them, and they are made available to those parties who own indebtedness of the company on a quarterly basis.
Form 990, Part VII, Section A, Line 2	Line 2 does not include W-2's processed by our parent organization, Ballad Health, on behalf of MSHA. Team members' reportable compensation, if included in Part VII, Section A, is reported as compensation from related organizations.
Form 990, Part IX, line 11g	Collection Services: Program service expenses 0. Management and general expenses 43,717,526. Fundraising expenses 0. Total expenses 43,717,526. Consulting Fees: Program service expenses 0. Management and general expenses 10,080,593. Fundraising expenses 0. Total expenses 10,080,593. Contract Labor: Program service expenses 32,680,407. Management and general expenses 2,866,076. Fundraising expenses 0. Total expenses 35,546,483. Dietary Services: Program service expenses 10,883,940. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,883,940. Environmental Services: Program service expenses 13,616,962. Management and general expenses 0. Fundraising expenses 0. Total expenses 13,616,962. Hospital Supported Clinics: Program service expenses 93,010,832. Management and general expenses 0. Fundraising expenses 0. Total expenses 93,010,832. Laboratory Services: Program service expenses 5,512,366. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,512,366. Laundry Services: Program service expenses 3,593,828. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,593,828. Other: Program service expenses 17,156,740. Management and general expenses 2,492,161. Fundraising expenses 0. Total expenses 19,648,901. Physician Fees: Program service expenses 56,584,800. Management and general expenses 0. Fundraising expenses 0. Total expenses 56,584,800.
Form 990, Part XI, line 9:	Temporarily Restricted Grants 922,869. Intercompany Transfers 14,359,724.

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

Cat. No. 51056K

Schedule O (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)
(Rev. January 2025)

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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

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 LLC 509 Med Tech Parkway Suite 100 Johnson City,TN37604 62-1711997	Health Network	TN	3,794,360	328,296	MSHA
(2) AnewCare Collaborative LLC 509 Med Tech Parkway Suite 100 Johnson City,TN37604 45-3232366	Accountable Care Organization	TN	7	0	ISHN
(3) Appalachian Highlands Clinically Integrated Network LLC 400 N State of Franklin Rd Johnson City,TN37604 99-2004473	Accountable Care Organization	TN	91,128	91,128	ISHN

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)Abingdon Physician Partners 16000 Johnston Memorial Drive Abingdon,VA24211 20-5485346	Medical Services	VA	501C3	12a	JMH		No
(2)Ballad Health 303 Med Tech Parkway Suite 300 Johnson City,TN37604 61-1771290	Supporting Organization	TN	501C3	12b	N/A		No
(3)Ballad Health Center for Early Learning 400 N State of Franklin Road Johnson City,TN37604 92-3891827	Child Day Care Services	TN	501C3	Line_10_Organization	BALLAD HEALTH		No
(4)Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City,TN37604 58-1594191	Fundraiser	TN	501C3	Line_7_Organization_	BALLAD HEALTH		No
(5)Dickenson Community Hospital 312 Hospital Drive Clintwood,VA24228 77-0599553	Hospital	VA	501C3	Line_3_Hospital_Coop	WHS		No
(6)East TN Healthcare Holdings Inc 203 Gray Commons Circle Suite 110 Gray,TN37615 81-5475903	Opioid Treatment	TN	501C3	Line_10_Organization	N/A		No
(7)Johnston Memorial Hospital Inc 16000 Johnston Memorial Drive Abingdon,VA24211 54-0544705	Hospital	VA	501C3	Line_3_Hospital_Coop	MSHA	Yes
(8)Ballad Health Auxiliary 400 N State of Franklin Road Johnson City,TN37604 58-1418345	Supporting Organization	TN	501C3	12a	BALLAD HEALTH		No
(9)Smyth County Community Hospital 245 Medical Park Drive Marion,VA24354 54-0794913	Hospital	VA	501C3	Line_3_Hospital_Coop	MSHA	Yes
(10)Takoma Regional Hospital Inc DBA GCH 1420 Tusculum Boulevard Greeneville,TN37745 51-0603966	Hospital	TN	501C3	Line_3_Hospital_Coop	WHS		No
(11)Wellmont Cardiology Services 303 Med Tech Parkway Ste 220B Johnson City,TN37604 26-3557623	Medical Services	TN	501C3	Line_10_Organization	WHS		No
(12)Wellmont Hawkins Co Memorial Hosp Inc 851 Locust Street Rogersville,TN37857 62-1816368	Hospital	TN	501C3	Line_3_Hospital_Coop	WHS		No
(13)Wellmont Health System 303 Med Tech Parkway Suite 300 Johnson City,TN37604 62-1636465	Hospital System	TN	501C3	Line_3_Hospital_Coop	BALLAD HEALTH		No
(14)Wellmont Madison House 2000 Greenway Street Kingsport,TN37660 62-1308216	Assisted Living	TN	501C3	Line_10_Organization	WHS		No
(15)Wellmont Medical Associates Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 27-0898372	Medical Services	TN	501C3	Line_10_Organization	WHS		No
(16)Wellmont Wexford House 2421 N John B Dennis Hwy Kingsport,TN37660 58-1859039	Nursing Home	TN	501C3	Line_10_Organization	WHS		No

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

Cat. No. 50135Y

Schedule R (Form 990) (Rev. 1-2025)

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(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	N/A				No			No
(2) Medical Specialists of JC LLC 2528 Wesley St Ste 2 Johnson City,TN37601 27-2199037	Medical Services	TN	N/A				No			No
(3) East Tennessee Ambulatory Surgery Center 701 Med Tech Parkway Suite 100 Johnson City,TN37604 62-1787537	Medical Services	TN	N/A				No			No
(4) Quality Improvement Ptrs LLC 2528 Wesley Street Suite 2 Johnson City,TN37601 86-1932106	Healthcare	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) Ballad Health Development Corporation 400 N State of Franklin Rd Johnson City,TN37604 88-3118592	Investments	TN	N/A	C					No
(2) Ballad Ventures LLC 400 N State of Franklin Rd Johnson City,TN37604 84-4214681	Investments	TN	N/A	C					No
(3) Blue Ridge Medical Management Corp 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-1490616	Medical Services	TN	MSHA	C	141,551,420	262,519,590	100.000 %	Yes
(4) Community Home Care Inc 1490 Park Avenue NW Suite B Norton,VA24273 54-1453810	Durable Medical Equipment	VA	N/A	C					No
(5) Mediserve Medical Equipment of Kingsport Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-1212286	Durable Medical Equipment	TN	BRMMC	C	4,251,697		100.000 %		No
(6) Mountain States Physician Group Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-1700412	Medical Services	TN	BRMMC	C	18,698,907	12,990	100.000 %		No
(7) Mountain States Properties Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-1845895	Property Management	TN	BRMMC	C	15,414,366	138,150,136	100.000 %		No
(8) Nolichuckey Mgmt Svcs Inc 1420 Tusculum Blvd Greeneville,TN37745 62-1776681	Medical Services	TN	N/A	C					No
(9) Wellmont Health Services Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-1254373	Medical Services	TN	N/A	C					No
(10) Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman KY1-1203 CJ 98-1195624	Insurance	CJ	N/A	C					No
(11) Wellmont Physician Services Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-1567353	Medical Services	TN	N/A	C					No
(12) Wellmont Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-1320035	Medical Services	TN	N/A	C					No
(13) Wilson Pharmacy Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 62-0329587	Pharmacy	TN	BRMMC	C	9,254,703	11,360,806	100.000 %		No
(14) WPS Providers Inc 303 Med Tech Parkway Ste 220B Johnson City,TN37604 20-5564642	Medical Services	TN	N/A	C					No

Schedule R (Form 990) (Rev. 1-2025)

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

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) Blue Ridge Medical Management Corp	A	433,215	FMV
(2) Blue Ridge Medical Management Corp	L	305,900	Cost
(3) Blue Ridge Medical Management Corp	M	81,422	Cost
(4) Mountain States Properties	K	1,161,398	FMV
(5) Abingdon Physician Partners	P	2,296,041	Cost
(6) Blue Ridge Medical Management Corp	P	42,428,481	Cost
(7) Johnston Memorial Hospital	K	359,322	FMV
(8) Johnston Memorial Hospital	S	305,053	Cost
(9) Mountain States Properties	S	2,138,817	Cost
(10) Wilson Pharmacy Inc	A	48,121	FMV

Schedule R (Form 990) (Rev. 1-2025)

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) (Rev. 1-2025)

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) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Honor those we serve by delivering the best possible care.
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 2024 (Part V, line 2a) ......	5	7,188
6	Total number of volunteers (estimate if necessary) .............	6	298
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	107,815
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	96,133

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,205,724	22,353,381
9	Program service revenue (Part VIII, line 2g) .........	1,057,080,021	1,257,371,962
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	42,268	8,027,547
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	8,779,370	20,086,805
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,070,107,383	1,307,839,695
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,815,725	1,172,377
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	391,150,125	443,237,789
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	636,713,159	771,277,977
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,029,679,009	1,215,688,143
19	Revenue less expenses. Subtract line 18 from line 12.......	40,428,374	92,151,552
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	603,516,492	787,963,231
21	Total liabilities (Part X, line 26).............	133,820,220	210,832,814
22	Net assets or fund balances. Subtract line 21 from line 20.....	469,696,272	577,130,417

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 1,029,421,465 including grants of $ 1,172,377 ) (Revenue $ 1,243,442,225 )
	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 expenses1,029,421,465

(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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Andrew Wampler BH SVPGen Cnsl........................................................................ Former Officer	1.00 .......................54.00	X	0	464,057	77,887
(19) Lynn Krutak........................................................................ Former Officer	1.00 .......................64.00	X	0	1,101,262	76,184
(20) Tim Belisle........................................................................ Former Officer	0.00 .......................0.00	X	0	448,129	0
(21) Chase Wilson CFO JCMC........................................................................ Former Key Employee	45.00 .......................0.00	X	270,163	0	44,184
(22) Joshua McFall CFO CorpRetail........................................................................ Former Key Employee	0.00 .......................45.00	X	0	524,356	93,242
(23) Clay Runnels MD - BH EVP........................................................................ Chief Phys Exec - Former Officer	0.00 .......................65.00	X	0	1,375,526	131,128
(24) Mark Wilkinson MD CMO Dig Hlth........................................................................ Former Highest Compensated	0.00 .......................55.00	X	0	622,732	98,984
(25) Matthew Loos Chief Acad Offcr........................................................................ Former Highest Compensated	0.00 .......................45.00	X	0	548,584	54,126

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	5,407,772	14,091,783	1,826,569

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





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	3,943,532
e	Government grants (contributions)		1e	16,994,170

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,415,679

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

h Total. Add lines 1a-1f.......		22,353,381

		Business Code
2a	Patient Revenue	622110	1,256,514,753	1,256,514,753
b	Diabetes Program Revenue	900099	686,304	686,304
c	Lab Outreach Revenue	621500	106,543		106,543
d	O/P Rehabilitation Revenue	900099	58,238	58,238
e	Wellness Classes Revenue	900099	6,124	6,124
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		1,257,371,962

3 Investment income (including dividends, interest, and othersimilar amounts) ......			171,095			171,095
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	784,250
b	Less: rental expenses	6b	398,342
c	Rental income or (loss)	6c	385,908
d	Net rental income or (loss).......			385,908			385,908
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a		23,312,552
b	Less: cost or other basis and sales expenses	7b		15,456,100
c	Gain or (loss)	7c		7,856,452
d	Net gain or (loss).........			7,856,452	-15,428,548		23,285,000
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..

Business Code
11a	Business Interruption Insurance		900099	10,000,000			10,000,000
b	Cafeteria/Vending		722514	3,303,278			3,303,278
c	Network Management Services		900099	1,859,964			1,859,964
d	All other revenue ....			4,537,655	1,605,354	1,272	2,931,029
e	Total. Add lines 11a–11d ......			19,700,897
12	Total revenue. See instructions.....			1,307,839,695	1,243,442,225	107,815	41,936,274

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,172,377	1,172,377
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	3,359,370	410,239	2,949,131
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	355,214,826	280,551,994	74,662,832
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,085,456	7,226,800	1,858,656
9	Other employee benefits .......	53,942,044	30,407,408	23,534,636
10	Payroll taxes ...........	21,636,093	20,540,931	1,095,162
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	422,922		422,922
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	292,196,231	233,039,875	59,156,356
12	Advertising and promotion ....	468,004	32,061	435,943
13	Office expenses .......	7,825,809	7,412,587	413,222
14	Information technology ......	15,417,119	13,798,374	1,618,745
15	Royalties ..
16	Occupancy ...........	14,094,384	14,030,763	63,621
17	Travel ............	1,688,280	1,580,381	107,899
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	25,095,329	25,017,838	77,491
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	28,718,675	28,394,051	324,624
23	Insurance ...	2,685,922	2,592,447	93,475
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	263,073,778	263,073,778
b	Hosp Provider Assessmnt	59,898,837	59,898,837
c	Maintenance	23,535,658	18,191,062	5,344,596
d	Support Services	19,748,490	8,944,380	10,804,110
e	All other expenses	16,408,539	13,105,282	3,303,257
25	Total functional expenses. Add lines 1 through 24e	1,215,688,143	1,029,421,465	186,266,678	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 ........			15,000	1	15,100
2	Savings and temporary cash investments .........			41,165	2	188,189
3	Pledges and grants receivable, net ......			1,090,896	3	10,679,039
4	Accounts receivable, net .............			134,323,789	4	325,909,636
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
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			16,489,591	7	1,308,019
8	Inventories for sale or use ............			21,672,885	8	22,662,363
9	Prepaid expenses and deferred charges ......			8,044,969	9	6,054,239
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	978,452,026
b	Less: accumulated depreciation	10b	592,416,578	359,080,211	10c	386,035,448
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			13,141,003	14	13,141,003
15	Other assets. See Part IV, line 11 ...........			49,616,983	15	21,970,195
16	Total assets. Add lines 1 through 15 (must equal line 33)...			603,516,492	16	787,963,231

17	Accounts payable and accrued expenses .....	92,742,498	17	169,539,426
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	7,086,527	20	7,086,527
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 ..	33,343	23	16,834
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	33,957,852	25	34,190,027
26	Total liabilities. Add lines 17 through 25..	133,820,220	26	210,832,814

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	467,978,037	27	574,489,314
28	Net assets with donor restrictions ...........	1,718,235	28	2,641,103
	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 ...........	469,696,272	32	577,130,417
33	Total liabilities and net assets/fund balances ........	603,516,492	33	787,963,231