Smyth County Community Hospital

“Mountain states health alliance is the 80% member of smyth county community hospital. Smyth county community hospital foundation is the 20% member of smyth county community hospital.”

“There are two classes of members, and each class is entitled to elect a specified number of directors to the board. The mountain states health alliance (msha) class is elected by the msha board of directors and the smyth county community hospital class is elected by the smyth county community hospital foundation board of directors. Neither side can veto an appointment.”

“Certain decisions of the board are, pursuant to charter and virginia statute, subject to approval of the members. These decisions include: dissolution of the corporation; merger of the corporation; non-ordinary course of business sale of assets; etc. No ordinary, day-to-day decisions are subject to member approval.”

“The cfo reviewed the form 990 with the board of directors prior to filing with the irs and the return was made available to each board member in an electronic format prior to the review.”

“Annually, the corporate audit and compliance department of msha forwards the conflict of interest policy and disclosure form to all msha management team members and board members including those at scch. Employees and board members must note any conflicts or attest they have "none", and return the form to the audit and compliance department. Any noted disclosures are forwarded to the appropriate management or board personnel to evaluate and utilize when a transaction involving a conflicted person arises. Additionally, personnel who have a conflict arise between the annual distribution of the policy and forms are required to disclose the conflict and would be disciplined in any instance where they have not disclosed and engaged in a conflicted transaction.”

“On an annual basis, mountain state health alliance's human resource (h/r) department evaluates compensation for all executives at a position level of assistant vice president and above. The review includes scch's ceo. H/r's evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on this comparable data, mountain state's president & ceo evaluates the data and submits his recommendations to mountain state's board of directors for their final review and approval. In addition, mountain states offers an incentive plan to executives based on targeted achievement metrics set in advance of the pay year. Established metrics include: communication with patients, patient evidence-based care scores and patient safety, value-based purchasing, etc. These same metrics are used for all employees throughout msha, with only a small number of exceptions for our companies that do not provide direct patient care.”

“Similar to scch's ceo, scch's cfo receives compensation that complies with mountain state's salary policy and undergoes the same review and approval process by mountain state's board of directors as the ceo, as described in 15a. His pay is set at a market percentile specific to his positon as cfo of scch. One physician serves on scch's board. His compensation relates to medical services he provides to a related organization. Board member, tony keck, receives compensation from a related organization for his position with the related organization; he does not receive compensation for his scch board service.”

“Governing documents and our conflict of interest policy are made available upon request to appropriate parties requesting them. Financial statements are made available to those parties who own indebtedness of the company on a quarterly basis. Form 990, part vii - related organizations director compensation: hospital board of directors members john jeter and stan hickson have form 990 reportable compensation derived from services they provide to related organizations and to scch. Tony keck has form 990 reportable compensation for services provided to msha, a related organization. Eric sacknoff, m.d., has form 990 reportable compensation for services provided to msmg, a related organization. None of their compensation is related to their board service.”

“Part i, line i - organization's mission: smyth county community hospital (scch) is committed to bringing loving care to health care. We exist to identify and respond to the health care needs of individuals and communities in our region and to assist them in attaining their highest possible level of health.”

“(continued) for the year ending june 30, 2017, scch recorded 1,426 inpatient hospital admissions and 318 nursing home admissions. There were 77,566 outpatient visits, 17,535 emergency visits and 11,141 home health visits. To help fight the opioid abuse epidemic in southwest virginia, scch partnered with community providers and pharmacists to create a pharmacy task force. The task force approached the smyth county hospital healthtrust with the idea to install drug take-back boxes at local law enforcement agencies. Over 5,000 was donated to purchase three boxes that were placed inside two local police departments and the local sheriff's office. Scch was recognized by us senator mark warner for our efforts in providing training to physicians and pharmacists, creating prescription drug take- back boxes, calling for the establishment of a drug consortium, and making a positive impact in combating the opioid epidemic. Our triumph cancer navigator program celebrated its 1-yr anniversary and has expanded its scope to cover all types of cancer. The program is designed to support cancer patients and their families, advocate for the patient, and to help coordinate the patient's care throughout the continuum of treatment - from diagnosis to survivorship. There is no charge for these services regardless of whether a patient chooses to receive their treatment at scch or an unrelated facility. We have three navigators serving scch's service area to include breast, neck/head & other cancers; lung, gi and other; and, a navigator that provides community-wide services (attends local civic, women's groups, schools, etc. To provide education relative to cancer and available resources). Those that join the program receive one- on-one assistance from specially trained oncology professionals. Our cancer navigators communicate with the patient's doctor, will coordinate transportation, set up appointment reminders and provide emotional support for both the patient and the patient's family. Our navigators will also coordinate support services such as treatment planning, prosthesis selection, nutrition counseling, and identification of resources for spiritual care, financial assistance and other needs. Our navigators participate in community events such as health fairs, cancer education events, and cancer support groups. They visit physician offices, seniors' groups, attend meetings with local business organizations, and they work with many other organizations to explain the navigation program and provide cancer awareness/education through the community. The program has made an impact, with the triumph program receiving a patient satisfaction score of 93. With financial assistance from a usda rural development grant, mountain states health alliance (msha) established a telemedicine network connecting icu doctors at johnson city medical center (msha's flagship hospital) with the system's six rural hospitals, including scch. Specialists at jcmc are able to conduct real-time consultations with patients and caregivers in the icu at our rural hospitals. Many patients in rural towns do not have cars or disposable income to spend on gas, meals or lodging to come to jcmc for care, so telemedicine brings the care to them. This new service is projected to serve about 5,000 patients per year. The usda grant is one of the usda's distance learning and telemedicine projects. The hospital subsidized a physician clinic located in a rural, medically underserved area. The clinic allows residents to receive quality care without having to travel outside of their home area. This is especially important for elderly residents and others that require family or friends to provide transportation to physician appointments. Our cost during the year to subsidize the clinic was 126,950. Mountain states health alliance is one of only 32 organizations in the country that were chosen recently to be part of the u.s. Centers for medicare & medicaid services' (cms) new program aimed at imp”

“Part v, line 2a msha, scch's majority owner, processes payroll for scch. Scch reimburses msha for all salary and benefits related to our team members and the expense is recorded on scch's books. Scch operates a rural health clinic. Under current centers for medicare and medicaid services (cms) regulations governing staffing at a rural health clinic, at least one midlevel provider (nurse practitioner, physician assistant, etc.) must be a w-2 employee of the clinic. Therefore, scch pays one midlevel provider directly (rather than msha paying this team member's salary with scch reimbursing msha).”

“Hospital supported clinics 3,319,151 0 0 physician fees 1,811,519 0 0 dietary fees 1,724,707 0 0 laundry services 863,177 0 0 rehabilitation services 510,843 0 0 laboratory services 119,338 0 0 other 409,426 159,680 0 lithotripsy services 105,000 0 0 transcription services 113,836 0 0 collection services 0 334,728 0 consulting fees 0 179,471 0 facilities & construct. Mgmt. 0 129,873 0 total 8,976,997 803,752 0”

“Part iv, line 24a and part x, line 20 - tax exempt bond liability the tax exempt bond liability reflects the portion of bonds issued by mountain states health alliance, scch's majority owner, on behalf of scch for capital needs. Scch pays all costs related to this portion of the bond issue.”

“Temporarily restricted grants -6,500”