Smyth County Community Hospital

“Mountain states health alliance is the 80% member of smyth county community hospital. Smyth county community 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 ballad health's board of directors, msha's sole member, which serves as msha's board of directors, and the smyth county community hospital class is elected by the smyth county community 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.”

“Ballad health has a conflict of interest policy for all members of the board of directors, the executive chair/president, executive vice presidents, senior vice presidents, and vice presidents, and applies to all ballad health organizations, including smyth county community hospital. All persons covered by this policy are required to complete a conflict of interest disclosure form on an annual basis. Should a conflict arise, it is the responsibility of the conflicted individual to update his or her disclosure immediately. All meetings of the board or board committees have a standing agenda item first on the agenda titled "conflicts of interest". If a member of the board or board committee has a conflict of interest involving any issue on the board agenda, he or she must declare the conflict of interest during the period allotted for disclosure. If any issue arises during a meeting in which the board member has a conflict of interest, he or she must immediately declare the conflict. While each member of the board or board committees 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.”

“On an annual basis, ballad health's human resources (h/r) department evaluates compensation for all executives at a position level of assistant vice president and above. The review includes 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, ballad health's president & ceo evaluates the data and submits his recommendations to ballad health's board of directors for their final review and approval.”

“Similar to scch's ceo, scch's cfo receives compensation that complies with ballad health's salary policy. His pay is set at a market percentile specific to his position as cfo of scch.”

“Governing documents and conflict of interest policy are made available upon request to 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. Form 990, part vii - related organizations director compensation: scch's board members stan hickson, john jeter, tony keck, brian miller, d.o. And eric sacknoff, m.d. Receive compensation for services provided to related organizations and do not receive compensation for services as a scch board member.”

“(continued) our membership consists of mountain states health alliance (majority owner) and smyth county community foundation. In february 2018, mountain states health alliance (msha) and wellmont health system (whs) merged to form ballad health, a tax-exempt entity and parent company of msha and whs. Ballad operates 3,293 licensed beds in 21 hospitals, an outpatient addiction treatment facility, long-term care facilities, home care and hospice services, retail pharmacies, outpatient services and a comprehensive medical management corporation. For the year ending june 30, 2018, scch recorded 1,372 inpatient hospital admissions and 284 nursing home admissions. There were 74,951 outpatient visits, 16,459 emergency visits and 10,891 home health visits. Scch 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 77,863. The association of american medical colleges (aamc) issued a press release dated april 11, 2018 stating that the united states could see a shortage of up to 120,000 physicians by 2030. The u.s. Population is estimated to grow by nearly 11%, with those over age 65 increasing 50% by 2030. Much of the increased demand comes from a growing, aging population. The aging population will also affect physician supply since one-third of all currently active doctors will be older than 65 in the next decade and likely to retire. The aamc points out that data conducted in 2017 indicated that an additional 31,600 physicians would have been needed if underserved populations utilized the same health care services as insured individuals. The data looked at people in non-metropolitan areas and people without insurance compared to people living in metropolitan areas. Furthermore, the study indicated nearly half of the shortage was in the south. Scch spent 329,279 during fy18 to recruit and retain physicians. Scch recruitment efforts are based on documented community need. Scch is located in a mua (medically underserved area), as designated by the u.s. Health resources & services administration (hrsa). Mua designation indicates an area as: having too few primary care providers, having a high infant mortality, a high poverty rate or a high elderly population. Scch, along with the smyth county hospital healthtrust and the smyth county health department, hosted their second annual free health fair for local law enforcement agents in the county. The all-day event provided officers a variety of screenings free of charge, including lab work, vision, sleep, various vaccinations including flu shots, blood pressure and bmi checks, and more. Guests were able to spend time with health care providers and ask questions about their results or other health concerns. Health education classes were provided throughout the year. For example, we offer cpr classes for local businesses and agencies and a joint class is offered for people with hip and knee pain. During the year scch hosted two chamber of commerce breakfasts. At the first breakfast a surgeon provided education on breast cancer/breast cancer awareness and at the second breakfast a cardiologist provided education on cardiovascular health. In august 2018, scch hosted the first meeting of the southwestern chapter of the virginia nurses association (vna). Nurses from across southwest virginia attended. The event was open to members as well as nonmembers, both rns and lpns. Guests included representatives from the vna, a delegate for the 5th district of virginia, and a nurse educator and co-lead of the nursing task force and coalition for nurses on boards for the state of virginia. Attendees were provided updates on nursing activities across the state, upcoming conferences and”

“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 two midlevel providers directly (rather than msha paying these team members' salary with scch reimbursing msha). The number of scch team members that received reportable compensation in excess of 100,000 was 6.”

“Hospital supported clinics 2,725,478 0 0 physician fees 1,983,996 0 0 dietary services 1,787,729 0 0 collection fees 0 358,790 0 laundry/hskpg. Services 644,758 0 0 rehabilitation services 1,017,587 0 0 consulting fees 0 76,807 0 lithotripsy services 86,800 0 0 facilities & construct. Mgt. 0 147,914 0 laboratory 154,392 0 0 transcription services 176,337 0 0 other 809,306 169,995 0 total 9,386,383 753,506 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 -2,410 p/s expenses-not on books 17,585 p/s ordinary inc-not on books -116,898 p/s interest inc-not on books -2,260 employer provided parking-not on books -6,787 total -110,770”

“Ballad health (ballad) is a tax-exempt entity and the parent corporation of both mountain states health alliance (msha) and wellmont health system (whs). The two healthcare systems came together on february 1, 2018 as a result of a merger approved by both tennessee and virginia departments of health. The individuals serving as the board of directors of ballad also serve as the board of directors of msha and whs. The audited consolidated financial statements of ballad include msha, whs and their subsidiaries and affiliates which were previously included in either msha or whs audited consolidated financial statements. Ballad has an audit committee which assumes responsibility for oversight of the audit of its financial statements and the selection of an independent auditor.”