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 members and each member is entitled to elect a specified number of directors to the SCCH Board (it's "class" of directors). The Mountain States Health Alliance (MSHA) class of directors, which has 80% of the voting power, is elected by Ballad Health's Board of Directors, MSHA's sole member, which serves as MSHA's Board of Directors. The Smyth County Community Hospital Foundation elects its class of SCCH directors, which has 20% of the voting power. Neither member can veto an appointment by the other member.”

“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 conflicted member vote on the matter that gives rise to the potential conflict.”

“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.”

“Director Compensation: SCCH's board members Eric Deaton, John Jeter, Brian Miller, D.O. and Greg Neal receive compensation for services provided to related organizations and do not receive compensation for services as a SCCH board member.”

“On an annual basis, Ballad Health's Human Resources (H/R) Department evaluatescompensation for all executives at a position level of Assistant Vice President andabove. The review includes SCCH's CEO. H/R's evaluation is based on market dataobtained from independent third-party consultants for positions with similarresponsibilities at similarly situated organizations. Based on this comparable data,Ballad Health's President & CEO evaluates the data and submits his recommendationsto Ballad Health's Board of Directors for their final review and approval. In addition, Ballad Health 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.”

“Similar to SCCH's CEO, SCCH's CFO receives compensation that complies with BalladHealth's salary policy. His pay is set at a market percentile specific to hisposition as CFO.”

“P/S Expenses - Not on Books = $17585”

“P/S Interest Inc - Not on Books = -$5257”

“P/S Ordinary Inc - Not on Books = -$150480”

“Charity Care: While reimbursement for healthcare services rendered is critical to the operation and sustainability of the organization, SCCH recognizes its obligation to provide care to individuals who cannot afford essential medical services, including emergency care. SCCH accepts all patients regardless of their ability to pay. A patient is classified as a charity patient when they meet the established policies of Ballad Health and guidelines outlined by the federal government. However, financial assistance decisions are not solely based on income. Unique financial circumstances are weighed with verified patient assets which can determine financial assistance eligibility. It is not until after verification of income and assets that a decision regarding the amount of financial assistance can be made. In Fiscal Year 2019, SCCH incurred a loss of $286,603 attributable to the provision of charity care. This amount does not include the costs associated with bad debt accounts.Medicaid/TennCare: SCCH provides care to persons covered by governmental programs, such as Medicaid and TennCare (Tennessee residents). SCCH incurred a loss of $655,197 providing care to this population of patients during the year. Uninsured Discount: Uninsured patients received an 80% discount through September 30, 2018, at which time the uninsured discount increased to 85%. Certain elective procedures are not eligible for the uninsured discount. This uninsured discount is calculated each year in accordance with Tennessee regulations and without regard to a patients income or assets. Although the uninsured discount is not required by the Commonwealth of Virginia, Ballad Health applies the same discount to our Virginia hospitals, including SCCH. The approximate cost of this discount in FY19, using a cost to charge ratio, was $1,401,241 for SCCH. SCCH partnered with the company Bolder Outreach Solutions to work with self-paying patients who have limited financial resources. Representatives were available at SCCH to determine possible governmental medical assistance (Medicaid or TennCare) eligibility, and to help with the application process and follow-up. 517 patients were approved during FY19 for coverage. Once a person is approved for Medicaid or TennCare through this program offered through SCCH, they retain coverage for future medical care. SCCH incurred expense of $39,310 during FY19 to provide this service. COMMUNITY DONATIONS:For many years, SCCH has provided assistance to local non-profit lifesaving organizations such as ambulance services, fire departments and rescue squads. SCCH donates free medications and pharmaceutical supplies to these organizations. The cost of donated medications to rescue organizations during FY19 was $6,687. SCCH contributed $1,380 to Emory & Henry College in support of their School of Health Science, $250 to a local church to help provide a service dog; and, other small donations. Consistent with prior years, we wrote off lab charges of just over $40,000 related to lab tests performed for a local free clinic that serves low-income uninsured residents. AWARDS AND ACCREDITATIONS:SCCH received a Healthgrades 2019 Special Clinical Quality award for Pulmonary Care Excellence for superior clinical outcomes in treating chronic obstructive pulmonary disease (COPD) and pneumonia. Healthgrades evaluates hospital performance using objective quality measures including clinical outcomes and patient safety, as well as patient experience. 2018 Womens Choice Award for Americas 100 Best Hospitals for best emergency care in VirginiaAmerican Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)The Joint Commission accreditationQuest 2013 Top Performing HospitalPremier 2014 Premier Quest Award for High-Value HealthcareSmyth Regional Home Care: The Joint Commission accreditationSmyth Regional Home Care: Centers for Medicare and Medicaid Services Office of Licensure and CertificationSmyth Regional Home Care: 2014 HHCAHPS HONORS Elit”

“Smyth County Community Hospital (SCCH) has a 55-plus year history of providing healthcare services within the community of Marion, Virginia. SCCH is a 44-bed community-based hospital that offers both acute care and inpatient rehabilitation care. The hospital provides comprehensive outpatient services and a variety of outreach programs such as homecare. Additionally, SCCH has a 109-bed nursing care facility, Francis Marion Manor Health and Rehabilitation (FMM). FMM provides both skilled-level and nursing facility-level health care services. 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 3,162 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, 2019, SCCH recorded 1,392 inpatient hospital admissions and 250 nursing home admissions. There were 75,109 outpatient visits, 16,768 emergency visits and 9,118 home health visits. PROMOTE COMMUNITY HEALTH:SCCH subsidizes two physician practices located in rural, medically underserved areas. These clinics allow 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 two clinics was $224,165.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 $314,091 during FY19 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 hosted their third annual Law Enforcement Health Fair providing valuable medical services to local law enforcement officers and their spouses. The hospital provided free lab work and multiple screenings including blood pressure, height and weight, body mass index, grip test, bone density, vision, hearing and vascular, as well as a one-on-one review of lab work results with a nurse practitioner. Vaccinations were also provided, including flu, shingles and tetanus. As an extra measure, free lung function tests and chest x-rays were offered to all of the meth lab officers at the Smyth County Sheriffs Office. In addition, the hospital recognized a special need due to the increase in responses to drug-related calls for law enforcement. After learning that this was not something they regularly had access to, the hospital is now providing sharps containers for every police officers vehicle throughout the”

“Part V, Line 2aBallad Health (BH), SCCH's parent organization, processes payroll for SCCH. SCCH reimburses BH for all salary and benefits related to our teams 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 mid-level provider (nurse practitioner, physician assistant, etc.) must be a W-2 employee of the clinic. Therefore, SCCH pays two mid-level providers directly (rather than BH paying these team members' salary with SCCH reimbursing Ballad Health). The number of SCCH team members that received reportable compensation in excess of $100,000 was 7.Part VI, Line 1aThe bylaws of SCCH were amended to create an Executive Committee consisting of officers of SCCH. The Executive Committee is authorized to exercise the full authority of the Board of Directors, subject to limitations set by law, the board, the MSHA board, or the bylaws themselves.”

“Part IV, Line 24A and Part X, Line 20 - Tax Exempt Bond LiabilityThe 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.”

“SCCH serves as a clinical training facility for health professional education students. We have dedicated staff to work with regional colleges and universities to coordinate the placement of healthcare professional students as part of their educational curriculum. In addition to clinical training, the health care students entering our system are required to have orientation and computer training. Included in the number of participants receiving clinical experience at SCCH were 82 nursing students from various colleges, universities and programs. This nursing clinical experience required extensive SCCH nursing staff involvement. The clinical setting and hands-on instruction cost SCCH $118,063.SCCH provided a clinical setting for another 112 students training in health-related programs such as pharmacy, social work, OT/PT, laboratory, EMT/paramedic and other allied-health disciplines. The hospitals costs related to this training was $329,670.SCCHs nursing care facility, Francis Marion Manor, continues to offer a successful program to train Certified Nurse Assistants. Our Certified Nurse Assistant (CNA) program is approved by Medicare as an allied health education program. To qualify as a Medicare-approved program, a provider must incur the costs associated with both the clinical and the classroom instruction portions of the program, must control the program curriculum and administrative duties, must employ the faculty, and must control the classroom instruction and clinical training. In addition, the program must be recognized by a national approving body or state licensing organization. We offer the CNA program free of charge and participants are under no obligation to work for SCCH or another Ballad Health facility upon completion of the program. 30 students attended our CNA program during FY19.”

“Mountain States Health Alliance (Mountain States) is one of only 29 organizations in the country participating in the Centers for Medicare & Medicaid Services (CMS) new initiative, Accountable Health Communities Model (referred to as AHC Program), aimed at improving the health of eligible Medicare and Medicaid beneficiaries. The AHC Program is designed to integrate care for health-related social needs into usual care by implementing systematic screening, referral, and patient navigation services for needs such as food insecurity, housing instability, safety, transportation needs, and utility assistance. Mountain States serves as the Bridge Organization for the AHC Program locally, leading a collaborative of multiple organizations and clinical delivery sites to bring needed services to beneficiaries residing in southwest Virginia. Full implementation of the AHC Program was achieved during FY19. There are nine full-time team members for the program, whose positions are financed by federal funds, (six Navigators, one Lead Navigator, one Screening and Referral Specialist, and one Program Manager), while two part-time Navigator positions remain open. Fifty-two locations serve as clinical delivery sites in southwest Virginia and northeast Tennessee and have processes in place to identify health-related social needs. Patients that screen positive for health-related social needs are given a Community Referral Summary, which contains contact and program information for relevant resources that assist with the needs identified by the screening. Since formal go-live of the AHC Program on November 17, 2018 through June 30, 2019 there have been 61,705 offered screenings, 35,544 answered screenings, 9,050 needs identified, 5,030 Community Referral Summaries given to patients, and 2,142 navigated patients. The stats provided are inclusive of the Ballad Health Virginia hospitals plus three Tennessee hospitals located close to Southwest Virginia. Mountain States also created an internally-produced data system for the screening, referral, and navigation services in lieu of using the CMS AHC Data System. This data system improved operational efficiency by at least five-fold over the CMS Data System. Patient Navigators have been re-deployed from five Virginia Community Services Boards in our service area to hospital emergency departments and primary care offices. This allows the Navigators to establish initial contact with a patient and complete a personal interview and action plan related to the health-related social needs identified by the patient. Laptops and cell phones were purchased for the Navigators to have the ability to work at the clinical delivery sites and from other locations, as needed.Ballad Health embarked on a campaign near the end of fiscal year 2018 to reduce hospital-acquired C. diff by 30% in 90 days. This was a bold undertaking by Ballad Healths new Clinical Council and our Infection Prevention Department. C. diff is a significant threat to hospital patients everywhere. It is our duty as caregivers to protect our patients from harm all of the time, so preventing C. diff is vital. Our plan involves some basic steps our clinical team members should always take to avoid this infection. The plan requires all team members to be mindful of how they treat C. diff., with team members involved in the treatment process receiving specific information appropriate for their role. In addition, a video is available on our intranet site that illustrates some of the key takeaways. Our ultimate goal is zero hospital-acquired C. diff infections. It should be noted that the 30/90 initiative to reduce hospital-acquired C. diff infections was a huge success, as the team, led by Ballad Healths Clinical Council Chair and System Chair of Ballads Hospitalist Division, Dr. Vashist, easily exceeded their goal, reducing C. diff infections system-wide by 44% in FY19. A cost analysis estimates the cost of C. diff at Ballad Health is between $15,642 to $20”